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.12777654

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.12777759

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.12777883

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.12777993

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.12778249

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.12778508

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.12778536

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.12778634

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.12778687

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.12778720

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.12777460

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.12778742

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.12778772

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.12778787

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.12778831

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.12778854

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.12778874

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.12778895

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.12779039

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.12779082

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.12779120

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.12779271

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.12779466

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.12779626

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.12779900

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.12780034

Background: Subarachnoid blockade amongst regional anesthesia has been most commonly used for performing abdominal and umbilical surgeries. There is persistent search for finding an adjuvant to local anesthetics to prolong its action along with hemodynamic stability. In this study we have used Buprenorphine as an adjuvant to local anaesthetic agent and have assessed its ability to prolong motor and sensory blockade and hemodynamic stability along with adequate postoperative analgesia. Materials and Methods: This observational study was conducted on 50 patients of ASA grade I/II, undergoing Laparoscopic appendicectomy surgery. Inj. Levobupivacaine isobaric (0.5%) 2ml along with inj. Buprenorphine 60mcg (0.2ml) as an adjuvant was given intrathecally inT8- T9/T9- T10. We have studied following parameters: onset and duration of sensory and motor blockade, hemodynamic changes, duration of analgesia and complications in patients. Result: Onset of sensory block at T4 level was 2.0±1.0 min and total time of regression of sensory blockade was 180±8.0 min. onset of motor blockade 4.50±0.5 min and total duration of motor blockade 90.0±1.0 min. There were minimal changes in hemodynamic parameters with postoperative analgesia lasting 210±8 minutes. Conclusion: This study shows that the addition of Buprenorphine to Intrathecal isobaric levobupivacaine is safe as it maintains hemodynamic stability without producing excessive side effects. Buprenorphine as adjuvant prolongs the duration of postoperative analgesia and the request for first rescue analgesics.

DOI: 10.5281/zenodo.12780099

Background & Objectives: Lumbar spine instability has been surgically managed by posterior lumbar interbody fusion devices using pedicle screw and rod fixation. Many surgeons advocate the use of an interbody fusion device (Cage) to assist in fusion and increase the stability of the construct. The aim of the study is to assess and compare the functional and radiological outcome of patients undergoing surgical fixation with or without interbody cage. Methods: 20 Patients were studied in Department of Orthopaedics in teaching hospitals Department of Orthopaedics, Shri Atal Bihari Vajpayee Medical College and Research institute, Bengaluru, who are diagnosed with instability of lumbar spine and willing for surgery. Clinical follow-up at 6wks, 3months, 6months, 12months intervals regarding pain, fusion and the functional outcome will be evaluated by visual analogue scale (VAS) pain rating, and Oswestry Disability Index (ODI) and AP, Lateral and Flexion – Extension radiographs. Results: In our study, 10 patients were included in each of two groups treated with PLIF with Cage or Bone graft alone. Average age was 46.3 yrs in BG group and 47.4 yrs in cage group. Both groups showed improvement in pain and disability scores as measured by VAS, ODI, SF-36. Fusion rates at 3, 6 months and 1 year in BG group fusion rates were 0,30% and 90% as compared to Cage group were 0, 50% and 100% respectively. 30% had sensory disturbance in BG group and 10% in Cage group. Complications were screw loosening 20%, non-union 10%, Urinary disturbance 10% in BG group and Deep infection 10% in Cage group. Both groups had intra-op CSF leak of 10% each. All patients returned to Pre-injury status except 1(10%) in BG group. Conclusion: Addition of an interbody fusion device (Cage) helps in greater stability, lower implant failure, higher fusion rate and better functional outcome in patient treated with PLIF for lumbar spine instability. We conclude solid fusion would correlate with good functional outcomes in patients with unstable lumbar segments. PLIF with Cage is associate with lesser complication rate and better patients satisfaction in terms of pain relief.

DOI: 10.5281/zenodo.12784074

Background & Objectives: Lumbar spine instability has been surgically managed by posterior lumbar interbody fusion devices using pedicle screw and rod fixation. Many surgeons advocate the use of an interbody fusion device (Cage) to assist in fusion and increase the stability of the construct. The aim of the study is to assess and compare the functional and radiological outcome of patients undergoing surgical fixation with or without interbody cage. Methods: 20 Patients were studied in Department of Orthopaedics in teaching hospitals Department of Orthopaedics, Shri Atal Bihari Vajpayee Medical College and Research institute, Bengaluru, who are diagnosed with instability of lumbar spine and willing for surgery. Clinical follow-up at 6wks, 3months, 6months, 12months intervals regarding pain, fusion and the functional outcome will be evaluated by visual analogue scale (VAS) pain rating, and Oswestry Disability Index (ODI) and AP , Lateral and Flexion – Extension radiographs. Results: In our study, 10 patients were included in each of two groups treated with PLIF with Cage or Bone graft alone. Average age was 46.3 yrs in BG group and 47.4 yrs in cage group. Both groups showed improvement in pain and disability scores as measured by VAS, ODI, SF-36. Fusion rates at 3, 6 months and 1 year in BG group fusion rates were 0,30% and 90% as compared to Cage group were 0, 50% and 100% respectively. 30% had sensory disturbance in BG group and 10% in Cage group. Complications were screw loosening 20%, non-union 10%, Urinary disturbance 10% in BG group and Deep infection 10% in Cage group. Both groups had intra-op CSF leak of 10% each. All patients returned to Pre-injury status except 1(10%) in BG group. Conclusion Addition of an interbody fusion device (Cage) helps in greater stability, lower implant failure, higher fusion rate and better functional outcome in patient treated with PLIF for lumbar spine instability. We conclude solid fusion would correlate with good functional outcomes in patients with unstable lumbar segments. PLIF with Cage is associate with lesser complication rate and better patients satisfaction in terms of pain relief.

DOI: 10.5281/zenodo.12784112

Intertrochanteric fractures are most frequently observed fractures of proximal femur. It involves upper end of femur, area between two trochanters with or without extending into the upper femoral shaft. With increased life expectancy, incidence of proximal femoral fractures is rapidly increasing. In geriatric population, inter-trochanteric fractures are caused by moderate to minimal fall while in younger population, it is caused by high velocity trauma. In 1990 26% of total hip fractures of world occurred in Asia. This is expected to rise upto 37% in 2025 and 45% in 2050. Femur being the chief weight bearing bone of the body is related to mobility. A hip fracture represents probably the most devastating consequence of osteoporosis and a mild trauma in terms of mortality, morbidity, disability, quality of life and hospital care and cost. Femoral fractures mandate end of patient’s functional freedom, hence results in chronic bedridden state.

DOI: 10.5281/zenodo.12784749

Background: More than 85% of women experience some form of perineal trauma during vaginal birth, with approximately 60% requiring sutures. This study was conducted to compare risk factors and outcomes of third and fourth degree tear with first and second degree tear in Indian population. Materials and Methods: This observational study included all women with first, second, third, and fourth degree perineal tears. Women with third or fourth degree tears constituted the OASI group, while those with first or second degree tears constituted the Control group. Maternal and fetal risk factors were noted in all patients and OASI and Control groups were compared. All the women were were assessed for symptoms like perineal pain, fecal urgency, fecal incontinence to faeces, liquid and gas, and painful defecation at 6 weeks, 3 and 6 months follow-up periods after primary sphincter repair. Results: There was a significant association of parity, and type of tear, and the odds of having OASI was 4.8 times more in primipara. There was significant association between birth weight above 4kg, shoulder dystocia, prolonged second stage of labour, episiotomy and neonatal head circumference ≥35cm and increased risk of OASI. Perineal pain, need of analgesia, constipation and painful defecation were common complaints in both OASI and Control groups, whereas incontinence to faeces, flatus, liquid and sphincter defect were observed only in OASI group. Conclusion: Primiparity, instrumental delivery, prolonged second stage of labour, episiotomy, shoulder dystocia, birth weight ≥ 4000 g, and neonatal head circumference ≥35cm are risk factors for OASI in this subset of Indian women.

DOI: 10.5281/zenodo.12784767

Aim of the study: The study based on the positive linear relationship existing between nasal dimension and stature is used to estimate stature in living as well as dead people in forensic anthropology. The dimension of the nose used as a plausible alternative to estimate stature when long bones are missing, fragmented or damaged. Material and Methods: This meta-analysis aims to quantify evidence on the correlation between the nasal dimension and stature. 100 male cases and 100 female cases were randomly selected from patients attending the SDM trust’s Ayurvedic medical college, Danigod post-graduate center & Padma Ayurvedic hospital & research center, Terdal, Karnataka. Age groups selected for the study are between 21 to 50 years. Results: In Males, individually Nasal Height (r=0.284) show strong correlation between with stature while Nasal Breadth is showing the correlations (r=0.207) with stature in males individually. In Females Nasal Height (r=0.199) and Nasal breadth (r=0.122) showing correlation with stature. In total cases correlation of nasal height is strongest (r=673) with stature while with nasal breadth correlation (r=532) with stature also stronger. Discussion: Estimation of stature from nasal height, nasal breadth and nasal index in our study shows significant result in our population. Our results and other author’s results show little difference in formula to calculate stature due to selection of different population group. Conclusion: Nasal dimensions are showing positive linear correlation as well as Significant gender difference (p value <0.001)) with stature. So, nasal dimensions are useful for determination of stature. Region wise there is minor to moderate difference in all the measurements, so state and population wise different regression formula and multiplication factor are required to estimate accurate stature.

DOI: 10.5281/zenodo.12784836

Background: Abdominal pain is one of the most common complaints of patients visiting in an emergency department. Diagnosis and management of abdominal pain are challenging due to the varied clinical spectrum of presentation. Material and Methods: This prospective observational study was done in the department of surgery, at NMCH Jamuhar Sasaram, Study duration of Two years. 64 cases of acute appendicitis were included in this study. Cases were analyzed as per age, sex, symptoms, signs, ultrasound findings, complication, duration of the hospital stay and outcome. Complete blood count and other routine blood tests were done. Ultrasonography was the imaging modality used for diagnosis. Results: In the present study, the maximum number of cases (71.87%) was male and 28.13% were female. The maximum number of cases [n=30] belonged to the age group of 20-29 years. Symptom such as pain in the abdomen was present in all cases; this was followed by nausea and vomiting, which was seen in 90% of cases. Tenderness over MC Burney’s point was present in all cases. The next common sign was rebound tenderness which was seen in 93.75% of the cases, which is suggestive of the presence of an inflamed appendix in the pelvis. The complete blood count parameters were normal except for the leucocyte count, which was raised in 92% of the cases. In our study, thickening of the wall of the appendix was the commonest finding, seen in all thirty cases. Complications were seen in 4 cases. In most of the cases, 95.31% [n=61] were treated with surgical appendectomy. Three cases [4.69%] had appendicular mass, which was managed conservatively on the basis of the ochsner Sherren regimen. Conclusion: Acute appendicitis is one of the leading causes of surgical acute abdomen worldwide. Emergency appendectomy is considered as the treatment of choice, but conservative management also has a role.

DOI: 10.5281/zenodo.12784858

Background: Giant peptic ulcer perforation is a life-threatening surgical emergency with high mortality rate. This study compares two different surgical techniques omentopexy and omental plugging for the treatment of giant peptic perforation. Methods: This study was a prospective study comparing the efficacy of omental plugging and omentopexy. The study was done at Emergency Department of General Surgery in Nalanda Medical College and Hospital, Patna over one-year period from October 2017 to September 2018. Patients were randomly allocated to two groups: one for omental plugging (cases) and other for omentopexy (controls). Results: A prospective non-randomized study of 12 patients with giant peptic perforation (≥2 cm in diameter) was carried out over a period of 24 months. The highest incidence was seen in males over 50 years of age. Biliary leak rates were 33% in the omentopexy group compared to no leak in the omental plugging group. This rate when calculated on standard error of proportion was significant at 5% level (p<0.05). Mortality rate was higher in omentopexy group compared to omental plugging group. Conclusions: Omental plugging seems to be associated with low rates of biliary leak compared to omentopexy and hence should be the procedure of choice in giant peptic ulcer perforation compared to omentopexy.

DOI: 10.5281/zenodo.12784870

Background: Present study was undertaken to evaluate the effectiveness and safety of intrapartum modified biophysical profile along with vibroacoustic stimulation test in the assessment of fetal well-being compared with modified biophysical profile for women with a singleton pregnancy. Methods: This prospective study was carried out on a group of pregnant women of gestational age more than 35 weeks attending the labour room of obstetrics and gynecological department of Patna medical college and hospital, from October 2013 to October 2015. A total 220 pregnant women were selected and randomly divided into two groups, 110 women were given modified biophysical profile and 110 were underwent modified biophysical profile with VAST. Results: Among 110 women, who underwent modified biophysical profile, 80(72.7%) showed reactive response and 30(27.3%) showed non-reactive response. A total 110 women, in whom modified biophysical profile was combined with VAST, 100(91%) showed reactive response and 10 (9%) showed non-reactive response. Statistical comparison for predicting perinatal mortality was done. Modified biophysical profile with VAST had a high sensitivity (100% vs. 80%), specificity (92.5% vs. 75.2%), negative predictive value (100% vs. 98.7%) and positive predictive value (20% vs. 13.3%) as compared to modified biophysical profile. Test accuracy for predicting perinatal mortality was more than mBPP (92.7% vs.75.4%). Conclusions: Addition of VAST in place of NST in modified biophysical profile has high specificity & positive predictive value, shortens the testing time.

DOI: 10.5281/zenodo.12784883

Background: Obstetric cholestasis (OC), also known as intrahepatic cholestasis of pregnancy (ICP), is a hepatic disease unique to pregnancy which presents with intense generalized pruritus without any skin rash. The aim is to study the outcome of pregnancy both maternal and fetal complicated by OC. Methods: This retrospective case control study was conducted at the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna. The medical records of all women with OC who delivered between Jan 2015 and Jan 2016 were reviewed. Results: The incidence of OC was 8.2%. The most common symptom was generalized pruritus which appeared after 28 weeks in 73.3% cases. The cesarean section rate was 93.3%. A higher incidence of meconium staining in amniotic fluid at delivery (17.1% vs 1.1%, p<0.005) and preterm premature rupture of membranes (8.9% vs 1.1%, p<0.01) was noted without an increase in preterm delivery rate (24.4% vs 15.6%). There was no statistically significant difference in the following parameter – pathological cardiotocography, 1-5 minuteApgar score <7, intrauterine growth restriction, neonatal intensive care admission or perinatal mortality. There was no case of postpartum hemorrhage. Conclusions: The incidence of OC is high in the Indian population. Perinatal outcome is good in actively managed women, although at the cost of a high intervention rate.

DOI: 10.5281/zenodo.12784901

Background: Although initially recognized over 150 years ago, the patho-physiologic implications of elevated intra- abdominal pressure (IAP) have essentially been rediscovered only within the past two decades. The aim of the study was to evaluate the incidence, morbidity and mortality of intra-abdominal hypertension and abdominal compartment syndrome in emergency laparotomy patients in tertiary care rural hospital. Method: IAP measurement was done in all patients undergoing emergency laparotomy with manometry technique (U tube technique) using per- urethral foley’s catheterization. Results: Our study population was a group of patients who underwent laparotomy for various indications which included traumatic as well as non-traumatic causes. In total, 104 patients, with 30 females and 74 males were included in the study population who fulfilled the study criteria. The mean ± SD age in our study were 40.2±13 years with 20-30yrs being the most common age group. Most of the studies on IAH and ACS analyse either trauma or ICU patients. Little has been reported on ACS in general surgical population. Our study population was a group of patients who underwent laparotomy for various indications which included traumatic as well as non-traumatic causes, hence a predominance of general surgical patients. Conclusions: Findings suggest that the incidence of ACS in our study is 3.84 % and found to be more common in trauma patients. There is significant association between increased Intra-abdominal pressure at 6 and 24 hours after laparotomy and organ dysfunction. The total mortality rate in ACS group was 75%. There is significant association between increased Intra-abdominal pressure and mortality.

DOI: 10.5281/zenodo.12784976

Interest in the formation and clinical management of gallstone disease dates back to ancient times as archaeological evidence suggests that members of the royal Egyptian family were afflicted with this disorder. Gallstone disease continues to be a major health problem in this country and throughout the world, with estimates indicating that it is on the rise. The development and worldwide application of laparoscopic cholecystectomy has once again focussed our attention on gallstone disease. Materials and Methods: This retroprospective study was carried out in the Department of Pathology, ESIC Medical College and Hospital Kalaburagi, Karnataka. Observation: Most of the patients belong to the category of chronic cholecystitis (52%). In this group chronic cholestasis with gallstones only was the most common presentation (32%). As expected, the female cases are more in all types of cases especially in chronic calculus cloleystitis. Conclusion: Most of the organisms were isolated as single isolate. Poly isolate cases were associated with complicated cases. It is better documented in cases like empyema, which showed positive culture reports having klebsiella, E. coli as well as bactericides which is as an anaerobe.

DOI: 10.5281/zenodo.12785025

Aim: The aim of the present study was to evaluate whether iron deficiency anemia is associated with acute bronchiolitis. Material & Methods: This Cross-Sectional Analytical study was carried out in the Department of Paediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for the period of 24 months  after obtaining ethical approval to explore the association between iron deficiency anemia and bronchiolitis. For this purpose, a total number of 200 patients were enrolled in the study and among them, 100 children with bronchiolitis were considered as cases, and 100 healthy children without bronchiolitis were considered as control, who were matched with age. Results: Majority of the patients were in the age group between 13-18 months. The mean age was found 13.087±5.735 months in cases and 15.125±7.963 months in controls. The mean age difference was not significant between the two groups (p>0.05). Male participants (65%) were the predominant group in the study and female participants (35%). Exclusive breastfeeding was found in 39 cases and 64 controls respectively. The differences were statistically significant (p<0.05) between the two groups in the chi-square test. Overcrowding was found in 76 cases and 60 controls respectively. There was a significant difference in Hb (gm/dl) between cases and controls followed by MCV (fl) between cases and controls. The MCH (pg) level was statistically and significantly lower in cases compared to controls; followed by MCHC (g/dl) which was statistically and significantly   lower   in   cases compared to controls. S. Iron (µg/dl) was statistically and significantly lower in cases compared to controls. Transferrin Saturation (%) was statistically and significantly lower in cases compared to controls. RDW-CV (%) was statistically and significantly higher in cases compared to controls. Among the 200 study subjects 80 cases had anemia, followed by 60 controls had anemia. Their difference was statistically significant between the two groups (p<0.05). Conclusion: Iron deficiency anemia has a significant association with bronchiolitis. A larger and more extensive study was recommended.

DOI: 10.5281/zenodo.12785143

Introduction: Duodenal perforation (DP) is a critical gastrointestinal emergency requiring prompt diagnosis and treatment to reduce significant morbidity and mortality. This study aimed to identify common age groups, risk factors, seasonal trends, prognostic determinants, and outcomes of operative and non-operative treatments, emphasizing early intervention to improve patient outcomes. Methods: This hospital-based observational study excluded iatrogenic, gastric antral, and traumatic DPs. Data collection included patient history, NSAID/corticosteroid use, and H. pylori presence. Diagnostic imaging confirmed perforation severity. Prognostic factors, treatment modalities, and outcomes were analyzed for morbidity and mortality. Follow-ups assessed recovery and complications, with statistical analysis correlating risk factors and outcomes. Results: Among 50 patients (92% male, mean age 43.54 years), 76% were of lower socio-economic status, 64% had peptic ulcers, and 56% used NSAIDs. All had abdominal pain and distension; 94% had air under the diaphragm. Treatment included mostly live omental patch closure. Postoperative complications occurred in 36%, with 64% having no complications. Conclusions: This study highlights the critical importance of timely surgical intervention and effective postoperative care in managing DPs. With an average hospital stay of 8.69 days and a notable incidence of complications, early detection and treatment remain key to improving patient outcomes and minimizing morbidity and mortality.

DOI: 10.5281/zenodo.12785273

Introduction: COPD, prevalent and incurable, often coexists with cardiovascular comorbidities. Cardiac biomarkers like troponins and NT-proBNP aid in detecting cardiac dysfunction in COPD, crucial for timely intervention. Elevated biomarker levels during exacerbations signify myocardial damage and predict mortality, highlighting the need for comprehensive management strategies in COPD patients. Methods: A cross-sectional study conducted at GSL Medical College, Rajahmundry, from January 2021 to June 2022, assessed left heart function in COPD exacerbations. Patients aged over 25 admitted with acute exacerbations were evaluated using 2D echocardiography and correlated with troponin levels. Inclusion criteria followed GOLD guidelines, while cardiac biomarkers were measured using a Roche kit. Results: Out of 138 individuals, >80 age group comprised 8.7%. Male-female ratio was 3; 5% were nonsmokers. Shortness of breath was the common complaint (60%), with tachycardia in 102. Crepitations were noted in 61%. Elevated troponin T (60.8%) and BNP (32.6%) levels were prevalent. Echocardiography revealed dilated right atrium and ventricle (61.59%) and left ventricle dysfunction (31.88%). Among those with elevated troponin, 83.3% required ventilator support. Conclusion: The study underscores the significant burden of cardiovascular comorbidities in COPD patients, with elevated troponin T and BNP levels indicating cardiac involvement. Echocardiographic findings reveal prevalent right atrial and ventricular dilation, alongside left ventricular dysfunction. These results emphasize the importance of comprehensive management strategies addressing both respiratory and cardiovascular health in COPD patients.

DOI: 10.5281/zenodo.12785451

Background: Milligan Morgan haemorrhoidectomy is the most widely practiced Gold standard surgical technique for the management of 3rd and 4th degree haemorrhoids. Staplers are novel methods known for its simplicity, ease and standardization to an anastomosis. Methods: A prospective randomized control study was done including 60 consecutive patients. The patients were divided into two group’s viz. Stapler hemorrhoidectomy and Open haemorrhoidectomy group. Significant difference was estimated using Chi Square test and Student’s, t independent test. Level of significance was taken as 0.05. Results: Sixty patients in two equal groups were studied. The mean operating time for open group was significantly higher than the stapled group (P = 0.0001). The SH group returned to normal activity significantly early. There was no significant difference in pain score on day one. Pain score was significantly lower for the SH group on days 2 and 3. Conclusions: Operative time, duration of hospital stay and return to normal activity were satisfactory with stapler haemorrhoidectomy than the open method.

DOI: 10.5281/zenodo.12785502

Background: Amylase was initially described in the early 1800s and is one of the pioneering enzymes to undergo scientific investigation. Although this enzyme was originally termed diastase, it was later renamed “amylase” in the early 20th century. The primary role of amylases is to break down the glycosidic bonds within starch molecules, transforming complex carbohydrates into simpler sugars. Amylase enzymes are categorized into 3 main classes—alpha-, beta-, and gamma amylases—each targeting distinct segments of the carbohydrate molecule. Alpha amylase is present in humans, animals, plants, and microbes, whereas beta amylase is primarily found in microbes and plants. Gamma amylase, on the other hand, can be located in both animals and plants. In 1908, a study by Wohlgemuth identified the presence of amylase in urine, paving the way for its application as a diagnostic laboratory test. Amylase is a frequently ordered standard diagnostic test, often combined with lipase, particularly when acute pancreatitis is suspected in patients. Amylases are among the most important industrial enzymes and also have great significance in biotechnological studies. In this study, the bacterial strain Bacillus cereus (JX125391) was identified by microscopic, biochemical characterization and screened for the amylolytic activity by starch agar plate method. The maximum enzyme activity was observed at pH 7.5 and temperature 35°C (2.78 U/ml). Partial purification of amylase enzyme was performed by Ammonium sulphate precipitation followed by dialysis. Partially purified amylase exhibited specific activity of 0.053 U/ml/mg which corresponds to 6.62 purification fold and 44.0 % Yield. Materials and Methods:  Bacillus cereus was propagated on nutrient agar medium. The pure culture was streaked on starch agar plates containing peptone 0.05%, KCl 0.01%, MgSO4. 7H2O 0.05%, (NH4)2SO4 0.01%, NaH2PO4 0.01%, starch 2% [15], agar 1.7 g and NaCl 10% and incubated for 3 days at 37°C. Discussion and Results: Amylase is a heterogeneous calcium-dependent metalloenzyme with a diverse molecular weight range, typically between 54 and 62 kDa. The compact size of amylase facilitates efficient filtration through the glomeruli. Amylase is eliminated through both the renal system and the reticuloendothelial system. This enzyme exists as 2 isoenzymes—pancreatic (P-type) and nonpancreatic (S-type)—which are products of 2 closely linked loci on chromosome 1. Additional amylase heterogeneity results from allelic variation, with 12 alleles for the S-type and 6 alleles for the P-type. Production of amylase by the Bacillus cereus was optimum (2.78 U/ml) at 35°C temperature and as the temperature increased or decreased, there was gradual decrease in the protein content and enzyme activity. At 50°C, the production of amylase and protein content was low (1.39 U/ml). Conclusion: Amylase is one of the most important enzymes known and is of great significance having approximately 25 % of enzyme market. They find potential applications in food, pharmaceutical and fine chemical industries. Earlier several studies reported the biological production of amylase from microorganisms

DOI: 10.5281/zenodo.12785559

Background: The conventional treatment regimen for inoperable stage III non-small cell lung cancer (NSCLC) involves the administration of chemotherapy and radiation therapy (60 Gy administered in 30 fractions). However, moderately hypofractionated radiation therapy (Hypo-RT) has also been explored as a potential alternative approach. Aim and Objectives: The objective of this study was to assess the effectiveness and toxicity of moderately Hypo-RT with helical TomoTherapy compared to conventionally fractionated radiation treatment (Con-RT) in patients with unresectable stage III NSCLC who are also undergoing concomitant chemotherapy. Methods and Materials: The research randomly assigned eligible patients to either the Hypo-RT group (receiving 60 Gy in 20 fractions) or the Con-RT group (receiving 60 Gy in 30 fractions) at a ratio of 1:1. Each patient had two cycles of simultaneous platinum-based chemotherapy followed by two cycles of consolidation treatment. The main objective was to assess the overall survival (OS) at the 3-year mark in the intention-to-treat population. The secondary outcomes measured in this study were progression-free survival and treatment-related adverse events. Results: There were a total of 146 patients that participated in the study. The duration of observation was 46 months, with the median value being used as a representative measure. The 3-year overall survival rates in the Hypo-RT and Con-RT groups were 58.4% and 38.4%, respectively. The difference between the two groups was statistically significant (P = 0.021). The median overall survival (OS) from randomization was 41 months in the Hypo-RT group and 30 months in the Con-RT group. The difference between the two groups was statistically significant, with a p-value of 0.021. There was no notable disparity in the frequencies of grade ≥2 treatment-related adverse events between the two groups. Conclusions: Utilizing helical TomoTherapy with a moderately Hypo-RT approach may enhance overall survival (OS) in individuals diagnosed with unresectable stage III NSCLC, while simultaneously keeping toxicity rates at a manageable level.

DOI: 10.5281/zenodo.

Introduction: Benign Prostatic Hyperplasia (BPH) refers to the nonmalignant growth or hyperplasia of prostate tissue and it is a common cause of lower urinary tract symptoms in aged men. Overgrowth of prostatic tissue surrounding the urethra leads to constriction of the urethra and resulting to lower urinary tract symptoms. ‘BPH is often associated with lower urinary tract symptoms (LUTS), but LUTS generally cannot be used to make definitive diagnosis of BPH (5). Enlargement of median lobe of prostate be estimated by digital rectal examination which directly resulting into LUTS. Objective: To evaluate the association between severity of lower urinary tract symptoms by international prostate scoring system and size of median lobe of prostate by digital rectal examination among the patients with benign prostatic hypertrophy. Method: The study was observational prospective correlational study conducted between March 2023 to February 2024in surgery department of Bundelkhand medical college Sagar. All male patients over the age of 45 year with lower urinary tract symptoms suggestive of benign prostatic hyperplasia with fulfilled inclusion & exclusion criteria were consecutively recruited. Clinical evaluation including digital rectal examination of the prostate was done. Symptoms severity was assessed using the self-administered international prostate symptoms score (IPSS) questionnaire. Results: Subjects having Mild lower urinary tract symptoms commonly corresponded to grade 1 median lobe enlargement which was fully managed by Medical management. Subjects having Moderate lower urinary tract symptoms, most commonly correspond to median lobe grade 2 enlargement from which 72.73% subjects were managed by medical management & 27.27% subjects required surgery. Subjects having Severe lower urinary track symptoms correspond. To median lobe of grade 3 & grade 4 enlargement, from which 80% of subjects were manage by surgery & 20% of subjects were manage by medical management. Conclusion: There is association between LUTS score & size of median lobe of prostate by digital rectal examination. Patients comes with mild LUTS with grade 1 prostate in digital rectal examination can be managed medically. Most of the patients having moderate LUTS and grade 2 median lobe prostate can be early managed medically. Patients having severe LUTS and grade 3 or 4 median lobe of prostate which can be managed surgically. In rural and remote areas of low- and middle-income countries, where diagnostic imaging is insufficient and, in some instances, completely lacking. In such a situation, relying on digital rectal examination of prostate & managing according to size of median lobe of prostate is become imperative.

DOI: 10.5281/zenodo.

Background: Anxiety before surgery is a common and distressing experience that can lead to physiological changes, increased medication requirements, and a higher incidence of postoperative complications. This study investigates the efficacy of both pharmacological (midazolam) and non-pharmacological (hand-holding and conversation) interventions to alleviate preoperative anxiety in pediatric patients. Aim: To evaluate the effectiveness of preoperative interventions in reducing anxiety levels and improving postoperative outcomes among children undergoing surgery. Methodology: A prospective study was conducted over one year in the Department of Anaesthesiology at Lord Buddha Koshi Medical College and Hospital, India. Eighty pediatric patients were randomized into three groups: Group M received IV midazolam; Group HC received hand-holding and normal saline; and Group HCM received both midazolam and supportive interactions. Anxiety levels were assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), alongside monitoring hemodynamic parameters. Results: The study found comparable demographics across groups, with slight variations in sedation onset and acceptable separation rates. Group B, which received hand-holding, showed quicker sedation onset (6.0 minutes) compared to Group A (7.0 minutes). Notably, Group C (combined intervention) had a lower acceptable separation rate (81.3%), indicating potential discomfort during separation. However, similar anxiety and recovery scores were observed across groups. Conclusion: Both midazolam and supportive interventions effectively reduced preoperative anxiety in pediatric patients. While midazolam offered rapid sedation without impacting recovery times significantly, the combination with supportive strategies appeared beneficial for patient comfort. The findings emphasize the need for comprehensive approaches to managing preoperative anxiety, balancing pharmacological benefits with the potential for adverse effects.

DOI: 10.5281/zenodo.