Background and Objectives: Antibiotic resistance is a growing concern worldwide. Laparoscopic cholecystectomy is a common surgical procedure where antibiotic prophylaxis is often used. Traditionally antibiotics have been advised pre and post operatively in surgery for gall bladder. The knowledge about usage of a single dose prophylactic preoperative antibiotic in comparison to conventional usage of perioperative antibiotics in laparoscopic Cholecystectomy is limited. Hence, this study focuses on comparing the efficacy of a single dose prophylactic antibiotic versus the usage of pre and postoperative antibiotics in laparoscopic Cholecystectomy. To assess the incidence of surgical site infections (SSIs) and antibiotic-resistant bacteria. To identify risk factors for SSIs and antibiotic resistance. Method: This is a prospective study conducted in the Department of General Surgery, at JNKTMCH, Madhepura. Study duration is Two years. Over 192 consecutive patients subjected for laparoscopic Cholecystectomy were included in study. They were divided in two groups (A&B) after applying exclusion. 74 patients in group A were given single dose of preoperative prophylactic antibiotic. No further post-operative antibiotics were given. 78 patients in group B were given both pre and postoperative antibiotics. Infective complications and cost constraints were compared between both the groups. Statistical analysis was done using chi-square test wherever necessary. Conclusion: Usage of single dose prophylactic preoperative antibiotics with no further post operative antibiotics would be sufficient to prevent surgical site infection in uncomplicated laparoscopic Cholecystectomy.

DOI: 10.5281/zenodo.

Background and Objectives: Secondary peritonitis is a severe and potentially life-threatening condition. Early prediction of mortality is crucial for optimizing treatment strategies. (1) To compare the predictive value of lactate clearance and base deficit for mortality in secondary peritonitis. (2) To evaluate the relationship between lactate clearance, base deficit, and severity of peritonitis. (3) To identify the optimal cutoff values for lactate clearance and base deficit for predicting mortality. Methods: Prospective cohort study. Lactate levels are normally maintained at less than 1.5 mmol/L using a delicate balance between production and clearance (by liver and kidneys). Hyperlactemia has shown correlation with higher mortality. In our study on 30 indoor patients of perforation peritonitis in JNKTMCH, Madhepura Bihar. we found that higher lactate level (> 4) is associated with higher ventilator need (80%) and hence higher mortality (60%).

DOI: 10.5281/zenodo.

Introduction: Pregnancy-Induced Hypertension (PIH) is a significant global health concern, contributing to maternal and fetal morbidity and mortality. Among hypertensive disorders of pregnancy, preeclampsia is particularly severe, characterized by elevated blood pressure and multi-organ dysfunction, leading to complications such as placental abruption, intrauterine growth restriction, and preterm birth. Its complex etiology involves genetic predisposition, immune dysfunction, and vascular abnormalities. Early prediction of PIH is critical for timely intervention and improved outcomes. The HDP Gestosis Score, incorporating clinical and biochemical factors, offers a promising approach for stratifying risk and identifying high-risk patients in the first trimester. Material and Methods: This prospective observational study was conducted over one year in the Obstetrics and Gynecology Department of a tertiary care center to evaluate the HDP Gestosis Score’s predictive ability for PIH. A total of 100 first-trimester antenatal patients meeting inclusion criteria were enrolled. Baseline demographic and clinical data, including maternal age, BMI, family history, and obstetric history, were collected. The HDP Gestosis Score was calculated, and patients were categorized into risk groups. Regular follow-ups included blood pressure monitoring and clinical assessments to track PIH development. Statistical analysis, including sensitivity, specificity, and predictive values, was performed using SPSS 21.1, with significance set at p < 0.05. Results: Among the 100 participants, 52% were categorized as high risk (score ≥3), 33% as moderate risk (score 2), and 15% as low risk (score 1). The score exhibited a high sensitivity of 98.11% and a strong negative predictive value (95.24%), effectively ruling out low-risk patients, while the specificity was moderate at 42.55%. PIH development was significantly higher in patients with a score ≥3, with 96.3% confirmed cases by the final visit, compared to lower scores. Key risk factors associated with higher scores included elevated MAP (>85 mmHg, 26%), obesity (20%), and primigravida status (57%). These findings underline the HDP Gestosis Score’s strength as an early risk assessment tool, although its moderate specificity suggests the need for integration with additional diagnostic methods for enhanced predictive accuracy. Conclusion: The HDP Gestosis Score demonstrated high sensitivity and reliability in predicting Pregnancy-Induced Hypertension (PIH) among first-trimester antenatal patients, enabling early identification of high-risk cases. While its moderate specificity indicates room for improvement, integrating the score with additional diagnostic tools can enhance its accuracy.

DOI: 10.5281/zenodo.

Background: Ovarian lesions manifest with a wide spectrum of clinical and morphological features. Neoplastic lesions of Ovary present as diverse histo-morphological entities as they arise from different cells of origin.The present study was conducted to identify the different histo-pathological lesions of ovary in a tertiary care hospital. Methods: This was a retrospective record based 1 year study conducted in Department of Pathology, Sardar Patel Medical College, Bikaner and included a total of 175 Ovarian specimens which were diagnosed by histo-pathological examination. Results: Total of 175 ovarian lesions were studied. 95 lesions were non neoplastic whereas 80 lesions were identified to be of neoplastic etiology. Most common non – neoplastic lesion was Follicular cyst with 19 cases (10.85%) followed by Cystic follicle with 14 (8%) cases. Most common neoplastic benign lesion was Serous Cystadenoma with 23 cases (13.14%) and most common Neoplastic Malignant lesion was Serous Cystadenocarcinoma with 4 cases (2.28%). Conclusion: Due to differing histologic subtypes of various ovarian lesions and similar presenting features in both neoplastic and non-neoplastic cases, histopahological study is an essential step in making an accurate diagnosis of lesions of Ovary.

DOI: 10.5281/zenodo.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a severe respiratory condition causing significant morbidity and mortality worldwide, primarily due to long-term exposure to harmful particles or gases, particularly cigarette smoke. Aim: This study aims to evaluate zinc levels, ALP activity, and RBS measurements in patients with COPD, with the goal of understanding their roles as potential biomarkers for systemic effects and disease management. Results: The study found that COPD patients and healthy controls had similar average ages, RBS levels, ALP levels, and zinc concentrations. However, when comparing the two groups using indicators like RBS, ALP, and serum zinc levels, a statistically significant difference was found. In the COPD patient group, there was a positive correlation between ALP and zinc, while in the control group, there was a positive association between ALP and zinc. Conclusion: Monitoring COPD patients’ zinc, alkaline phosphatase, and random blood sugar levels can reveal systemic impact, comorbidities, inflammation, and immune response impairment. Monitoring these indicators helps develop effective treatment strategies and reduce systemic consequences, enhancing patient care and overall outcomes.

DOI: 10.5281/zenodo.

The concept of “Food as Medicine” has gained significant traction as a preventive and therapeutic tool in managing chronic diseases. Non-communicable diseases (NCDs) such as cardiovascular disease, type 2 diabetes, obesity, and cancer account for the majority of global mortality and morbidity, emphasizing the need for preventive measures beyond pharmaceutical interventions. Dietary interventions, including plant-based diets, Mediterranean diets, anti-inflammatory diets, and personalized nutrition plans, have emerged as powerful strategies for reducing disease risk and improving overall health outcomes. This systematic review evaluates the efficacy of dietary interventions in preventing and managing chronic diseases, synthesizing evidence from 32 peer-reviewed studies using a PRISMA-based framework.
The results underscore that diet improvements can lower chronic disease risk factors by enhancing metabolic health, reducing chronic inflammation, and promoting a healthy body weight. Research from various studies shows that plant-based diets, high in fruits, vegetables, legumes, and whole grains, protect against reduced risk of heart disease, diabetes, and obesity. In particular, Mediterranean and anti-inflammatory dietary patterns can reduce cardiovascular risk factors, enhance insulin sensitivity, and improve mental health outcomes. Berries, nuts, and other anti-oxidant-rich foods minimize oxidative stress, a key driver of chronic disease progression. Neuroprotective foods with omega-3 fatty acids and polyphenols have also been demonstrated to improve brain function in people and diminish the chance of neurodegenerative diseases. Moreover, diet types preserving muscle and bone are fundamental to avoiding such age-related diseases as osteoporosis and sarcopenia. Nevertheless, long-term compliance, social-economic obstacles, and cultural traditions are significant challenges. The review emphasizes the need for personalized, culturally sensitive dietary approaches to improve health outcomes and encourage long-term behaviour change. Data were also collected to assess potential modifications for this. Future studies should focus on the multimodal approach of food-based interventions within healthcare delivery systems, to ease the burden of chronic diseases worldwide.

DOI: 10.5281/zenodo.

Ocular diseases, including glaucoma, macular degeneration, diabetic retinopathy, and dry eye syndrome, remain significant causes of vision impairment and blindness worldwide. Traditional drug delivery methods, such as eye drops and ointments, often face limitations in achieving optimal therapeutic outcomes due to poor bioavailability, rapid tear clearance, and low patient compliance. Advanced drug delivery systems, such as nanocarriers, microneedles, in situ gels, and sustained-release implant devices, hold promise in surmounting these challenges to enhance bioavailability, targeting efficiency, and drug retention time in ocular tissues. Through this systematic review, we hope to provide insights into the recent developments, hurdles, and further potentials in advanced drug delivery for ocular diseases. Through an assessment of peer-reviewed studies, we uncover novel approaches to maximize drug effectiveness and patient outcomes while reducing unwanted side effects. Advanced drug delivery systems have developed as novel approaches to overcome the limitations of conventional ocular therapies. By enhancing drug targeting and bioavailability and enabling prolonged release, these systems hold potential for improved therapeutic efficacy. To illustrate, nanocarriers and microneedles have demonstrated their ability to alleviate the frequency of dosing and potentially enhance patient compliance considerably. In addition, these recent advancements in drug delivery technology provide new opportunities for personalized medicine approaches, wherein treatment protocols are adapted to meet the needs of the individual patient and their unique ocular disease. However, there are still multiple barriers to solve concerning the economic, regulatory, and long-term safety where evidence is still lacking. In this review, we discuss current progress in ocular drug delivery systems and suggest future directions in this important area of research and development.

DOI: 10.5281/zenodo.

Background and Aim: While many skin lesions seen during the neonatal period are typically physiological and temporary, there are significant dermatological conditions that require appropriate management. This study aims to examine the clinical characteristics of skin lesions observed during the neonatal period. Material and Methods: An observational study examining cutaneous manifestations in neonates was carried out in the Department of Dermatology, in partnership with the Department of Paediatrics, at a Tertiary Care Teaching Institute in Gujarat, India, over the course of one year. A total of 150 neonates participated in the study. An in-depth evaluation of the patient’s history, clinical examination, and investigations was conducted and analysed. Results In a study involving 150 neonates, the gender distribution revealed that 80 (53.3%) were male, while 70 (46.6%) were female. In a recent analysis of various cutaneous manifestations, physiological cutaneous lesions emerged as the most prevalent, observed in 100 cases, accounting for 66.6%. This was followed by birthmarks or congenital lesions in 61 cases, representing 40.6%. Transient noninfective lesions were noted in 40 cases, making up 26.6%, while eczematous eruptions were identified in 11 cases, or 7.3%. Lastly, infectious lesions were the least common, appearing in just 2 cases, which is 1.3% of the total. Conclusion: The findings of the current study indicate that newborn cutaneous manifestations present in a variety of forms. In our observations, physiological skin manifestations occurred with notable frequency, in addition to birthmarks and congenital skin conditions. Grasping these manifestations is crucial for effective management and determining the suitable approach. The current research did not identify a significant prevalence of infectious or malignant skin conditions.

DOI: 10.5281/zenodo.

Menopause is a phase of woman’s natural aging process and is marked by the cessation of ovarian function. Menopause is a normal life transition in a woman’s life when reproductive capacity is lost due to loss of ovarian function resulting in a decrease in circulating oestrogen levels Menopause is an oestrogen deficient state. The increased incidence of cardiovascular risk in the post-menopausal women may partly be due to hormonal changes leading to derangement of lipid metabolism. The present study is aimed to evaluate the variation in  lipid profile in pre- and post-menopausal women. 40 Premenopausal & 40 Postmenopausal women were enrolled in the study after obtaining consent from each patient. Lipid profile was done & compared between both the groups. It was found in study that there is  increase in serum Total Cholesterol (TC), Triglycerides (TG), LDL-cholesterol and VLDL-cholesterol level in post-menopausal women as compared to those in pre-menopausal women (p<0.001). HDL-cholesterol level was significantly decreased in post-menopausal women as compared to that in pre-menopausal women (p<0.001). Predicting the factors affecting the lipid profile in post-menopausal women, adopting strategies to control these mechanisms by modifying the relative risk factors during menopausal transition may improve the cardiovascular risk profile in these women.

DOI: 10.5281/zenodo.

Aim: To assess the pattern of injuries in fatal road traffic accidents. Material & Methods: The present cross-sectional study was conducted at the Department of Forensic Medicine & Toxicology after due approval from the ethical committee for a period of 1 year. 80 deceased dying due to fatal RTA autopsied at the mortuary of were recruited in the study. Data was collected from medico-legal case register, inquest reports, hospital bed tickets, history from eyewitnesses, relatives, friends of deceased & investigating police officer, photographs of the site of incident were obtained from the investigating officer & photographs also obtained during post mortem examination. Results: There was male dominance with maximum subjects were from age group of 21-30 years. Most common profile among the study subjects was rider of 2 wheeler. Most common pattern of external injury among the study subjects was abrasion (87.5%) followed by laceration (81.25%) & contusion (37.5%). Fracture was found in 13.35% of the subjects while crush injury in 11.34%. The body region most commonly affected was extremities (95%), followed by head & neck including face (88.75%) & chest (28.75%). Most common cause of death was head injury (51.25%) followed by shock & haemorrhage (36.25%). Conclusion: For a developing nation like India, traffic accidents are a regrettable financial burden. Male residents of HMV between the ages of 21 & 30 were the most frequent RTA victims. The most frequent injuries were contusions, abrasions, & lacerations. Most often, injuries occurred to the extremities. One known serious health issue that kills & disables people in this nation is head injuries from RTAs. It is imperative that the relevant authorities act quickly & appropriately to protect this vulnerable population by lowering the number of brain injuries linked to RTAs.

DOI: 10.5281/zenodo.

Amitraz is one of the formamidines, which were developed in early 1960’s and used widely as a contact insecticide and acaricide in agriculture and veterinary medicine. Its mechanism of action is postulated to be mediated through the noradrenergic nervous systems. The signs and symptoms are somewhat similar to cholinesterase inhibitor poisoning and have sometimes been misdiagnosed as poisoning due to organophosphates (OP). As a result, many patients receive a wrong treatment on the line of OP compound poisoning. Amitraz induced bradycardia, mydriasis, sedation, intestinal stasis, hyperglycaemia, and even lethality and their actions can be blocked using antagonists of alpha2-adrenoreceptors. Yet their use in humans has not been evaluated. Here we present a series of cases of amitraz compound poisoning between years Jan 2020 to Dec 2021.

DOI: 10.5281/zenodo.

Background and Aim: The literature presents conflicting findings regarding the comparative effectiveness and safety of morphine and nalbuphine. The current study aimed to evaluate and compare the pain scores, motor blockade, and side effects associated with the use of intrathecal morphine versus nalbuphine in conjunction with bupivacaine during laparoscopic gynaecological procedures. Material and Methods: A study was conducted involving 100 patients classified as American Society of Anaesthesiology (ASA) Class I/II, all of whom were scheduled for elective laparoscopic gynaecological procedures. In this study, participants were randomly assigned to one of two groups, each consisting of 50 individuals. The allocation was conducted using a sealed envelope method. Group A received a combination of 100 µg morphine and 2 ml bupivacaine, while Group B was administered 400 µg Nalbuphine along with 2 ml bupivacaine. The main goal of our research was to assess pain intensity using the visual analogue scale (VAS). Post-operative side effects such as hypotension, bradycardia, respiratory depression, nausea, vomiting, and pruritus were documented and categorised as secondary objectives of the study. Results: The findings indicate that following extubation, the mean motor blockade scores were recorded at 4.20±0.54 for group A and 4.22±0.42 for group B. The mean motor blockade score recorded after 12 hours was 5.94±0.48 for group A and 5.92±0.34 for group B. The analysis revealed no notable difference in motor blockade scores between groups A and B. The mean Visual Analogue Scale (VAS) scores recorded after extubation and at the 3-hour mark were similar across both groups. However, at the 6, 12, and 24-hour intervals, group B exhibited higher scores compared to group A, although these differences were not statistically significant (p>0.05). Conclusion: Nalbuphine demonstrates analgesic efficacy that is on par with morphine; however, it offers a superior safety profile, particularly concerning the incidence of pruritus.

DOI: 10.5281/zenodo.

Background: The relationship between diabetes and cardiovascular disease (CVD) is intricate and multifactorial. Dyslipidemia, characterized by abnormal lipid profiles, significantly increases cardiovascular risk in diabetic individuals. Understanding how factors such as gender, lifestyle, and tribal status affect lipid profiles is crucial for targeted health interventions. This study aims to compare lipid profiles and cardiovascular risk among diabetic tribal and non-tribal populations in southeast Rajasthan, focusing on gender differences. Methodology: This cross-sectional study included diabetic subjects from tribal and non-tribal communities in southeast Rajasthan, categorized into four groups: tribal women, tribal men, non-tribal women, and non-tribal men. Lipid profiles—total cholesterol, triglycerides, HDL, and LDL—were measured for each group. Additionally, cardiovascular risk was assessed using atherogenic indices, including the atherogenic index, atherogenic coefficient, atherogenic lipid profile, cardiac heart disease ratio, and cardiac risk ratio. The results were compared across the four groups to evaluate variations in cardiovascular risk. Results: Non-tribal men showed the highest cardiovascular risk, followed by non-tribal women, tribal men, and tribal women. Elevated lipid values and atherogenic indices in non-tribal men indicated a greater predisposition to CVD. Non-tribal women exhibited higher cardiovascular risk than tribal women, despite both groups engaging in domestic work. This was attributed to less physical activity and more sedentary lifestyles among non-tribal women. Tribal women, who performed both domestic tasks and rigorous job work, had the lowest cardiovascular risk. Across all groups, men demonstrated a higher risk of CVD compared to women, likely due to more sedentary work patterns. Conclusion: The study reveals significant differences in cardiovascular risk among diabetic tribal and non-tribal populations, with non-tribal men being most at risk. Tribal women had the lowest risk, likely due to their active lifestyle. The findings underscore the importance of physical activity in reducing cardiovascular risk, particularly for non-tribal men and women who lead more sedentary lives. Lifestyle modifications, including increased physical activity, could mitigate cardiovascular risk in these populations.

DOI: 10.5281/zenodo.

Objective: To study the effect of preoperative infusion of ringer’s lactate and haemaccel solution for the prevention of spinal hypotension. Methods: The 100 cases studied were divided randomly into two groups of 50 each depending upon the fluid given as preload to each patient. Group-A received Ringer’s lactate solution as preload and Group-B received Haemaccel as preload. Careful screening of all patients in the pre-operative state was done, a meticulous attention was paid in excluding all patients with a known history of heart or lung disease or any other patient having contraindications for spinal anaesthesia. Both the groups were comparable with respect to age, sex, weight incidence and duration of pre-operative fasting. Equal number of types of surgeries were performed in both the groups. Results: Hypotension was found in 58% of cases in Ringer’s lactate group and 22% of cases in Haemaccel group. The total number of patients in whom mephentermine was used as vasopressor was higher in Ringer’s lactate group 18, as compared to 6 in Haemaccel group. Incidence of hypo-tension observed in this study was highly significant statistically. There appears a definite difference in the incidence of hypo- tension between the older and younger age levels. The higher incidence of hypotension in the elderly patients may be related to the diminished residual vascular tone in elderly patients following sympathetic denervation. The usefulness of fluids in preventing hypotension after spinal anaesthesia was also observed in elderly patients. Further preloading with Haemaccel was found to be more effective as compared to Ringer’s lactate solution. Conclusion: Administration of IV fluids either crystalloids or colloids before spinal anaesthesia does reduce the incidence of spinal hypotension significantly. In the prevention of spinal hypotension administration of Haemaccel as preload appears to be the most physiological technique and requires less ionotropic mephentermine support.

DOI: 10.5281/zenodo.

Polypharmacy, defined as the simultaneous use of multiple medications, is increasingly prevalent among elderly populations due to rising life expectancies and the growing burden of chronic illnesses. While necessary in managing complex conditions, polypharmacy presents significant risks, including adverse drug reactions (ADRs), medication non-adherence, and increased healthcare utilization. This systematic review evaluates evidence-based strategies for managing polypharmacy, focusing on comprehensive medication reviews, deprescribing practices, interdisciplinary care models, and digital health tools. Comprehensive medication reviews guided by frameworks such as the Beers Criteria and STOPP/START guidelines have significantly reduced ADRs and enhanced adherence. Additionally, deprescribing, interdisciplinary approaches, and the integration of digital health technologies such as clinical decision support systems (CDSS) and medication adherence apps have revolutionized polypharmacy management. However, barriers such as healthcare disparities, regulatory complexities, and professional training gaps remain. Addressing these challenges requires a patient-centered, holistic approach emphasizing collaboration, education, and technological innovation. By synthesizing current evidence, this review aims to outline the opportunities and challenges in polypharmacy management, providing actionable strategies to optimize medication use among elderly populations.

DOI: 10.5281/zenodo.

Polycystic Ovarian Disease (PCOD) is a multifaceted endocrine disorder that affects a significant proportion of women globally, with a prevalence ranging from 6% to 20%. The condition is characterized by diverse symptoms, including hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology, accompanied by metabolic disturbances such as insulin resistance, obesity, and dyslipidemia. This systematic review examines the multifactorial etiology of PCOD, encompassing genetic predisposition, hormonal imbalances, insulin resistance, chronic inflammation, environmental toxins, gut dysbiosis, and lifestyle factors. Emerging evidence underscores the role of epigenetic modifications, endocrine-disrupting chemicals, and dietary patterns in exacerbating the condition. Additionally, the review highlights the significant psychological burden associated with PCOD, including anxiety and depression. Current research emphasizes the importance of integrative approaches to understanding the interplay between genetic, metabolic, and environmental factors. The findings underline the urgent need for longitudinal studies to identify causal relationships and develop personalized therapeutic strategies. By addressing the systemic and individual factors contributing to PCOD, this review aims to guide future research and improve diagnostic and management approaches for this complex condition.

DOI: 10.5281/zenodo.

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by  hyperglycemia. Ocular manifestations are among the most common and debilitating complications of T2DM. Objective: The objective of this study is to find out different ocular manifestations in patients with Type 2 Diabetes Mellitus of a duration of 0 – 5 years and its relation with the duration and severity of the disease. Methods: A prospective observational study of ocular manifestations in patients with Type 2 Diabetes Mellitus (T2DM) of duration 0-5 years attending tertiary care center, Bhubaneswar for 12 months. Detailed history, complete ocular examination, and relevant investigations were done on 560 eyes of 280 patients. Results: Out of 280 patients evaluated 130 (46.42%) were male and 150 (53.57%) were female. The most common ocular manifestation was cataract 121 (21.6%), followed by Diabetic retinopathy 48(8.57%), POAG 6(1.07%), Diabetic papillopathy 4(0.7%), BRVO 2(0.3%), 3rd Nerve palsy(0.3%). The most common type of cataract found was posterior subcapsular cataract 12(44.4%) among patients of T2DM of duration less than one year, nuclear type 64% among patients of T2DM of duration 1 to 5 years. Conclusion: These ocular findings suggest that an annual eye examination should initiated at the time of diabetes diagnosis, as it will help reduce visual morbidity.

DOI: 10.5281/zenodo.

Ovarian torsion or Adnexal torsion is an emergency condition where an ovary twist on its attachments to other structure such leads to decreased blood flow. It has diverse clinical presentation making its diagnosis challenging. This study aims to describe Ovarian Torsion cases presenting to LRE of our Tertiary care centre, PMCH Patna and it includes clinical presentation, physical examination, investigation and emergency management along with intraoperative findings. Four cases screened within last  six months of 2024,  who were diagnosed by ultrasonography with color doppler prior to surgery. All showed severely decreased blood flow with congestion of ovarian tissue and fallopian tube. All of these cases managed by surgical removal of ovary and fallopian tube.

DOI: 10.5281/zenodo.

Introduction: Dermatological conditions include scabies, pyoderma, dermatitis, urticaria, fungal skin infection, acne, alopecia and etc. Various combination of drugs generally used in the treatment of skin diseases like proactive antimicrobials, steroids etc. Drug utilization study is important to realize that inappropriate use of drugs represent a potential hazard and an unnecessary expense to the patients, and a tool to be a useful for improvements in therapeutic practices. Aim and Objectives: To establish the pattern of drug usage in patient of dermatology outpatient department of tertiary care teaching hospital. 1. To observe the prescription pattern of dermatology outpatient department. 2. To analyze the drug prescription pattern as per WHO core indicators. Methods: A prospective, observational study was carried out between January 2021 to December 2021 after written approval from Institutional Ethics Committee, total 126 patients who met the inclusion and exclusion criteria were included. Data analyzed using WHO core indicators. Statistical analysis done using MS EXCEL 2019 by using descriptive statistics. Results: Total 126 prescription analyzed and 460 total drugs prescribed. Average number of drugs per prescription were 3.68. Antimicrobials prescribed in 39.69% prescriptions. Only 2% drugs were prescribed by their generic name. 15.43% drugs were prescribed from WHO essential drug list. Conclusion: The present study shows that average number of drugs prescribed were comparable with WHO standard guideline. Antimicrobials prescribed in higher numbers so for the rational prescribing is necessary to formulate guideline. Prescription from essential medicine list should be encouraged.

DOI: 10.5281/zenodo.

Background: Among patients with advanced cancer, pain is one of the most common and persistent symptom of the disease and its treatment.  Approximately 70% to 80% of these patients experience pain, which still remains poorly controlled in 40% of patients. Pain is a distressing symptom in such patients, significantly affecting their quality of life as well. Effective pain management is therefore essential in palliative care to ensure patient comfort and dignity.  This study focuses on assessing pain levels and the use of analgesic drugs among these patients, aiming to provide insights into current practices and suggest improvements where necessary. Aim & Objective: To assess the intensity of pain and its management with the usage of analgesic drugs among patients admitted in oncology ward of a tertiary care teaching hospital in North India. Methods and Materials: A cross-sectional, observational, study was conducted after taking IEC approval, over period of six months among patients with advanced cancer receiving palliative care, of a tertiary care teaching hospital in North India. A total of 200 patients diagnosed with advanced cancer that were receiving inpatient palliative care, in oncology ward of government medical college were enrolled for this study. The data obtained from the study was tabulated in number and percentage. Results: Out of total patients analyzed, majority patients were males (63%), mostly belonging to age group of 51-60 years. The most prevalent cancer type was genitourinary followed by ca breast.  A good pain control was seen in 70% of patients after round-the-clock dosing and using adjuvant treatments along with analgesics. Morphine was the most commonly used opioid for severe pain followed by tramadol for moderate to severe pain & few Adjuvant Analgesics were also used to manage neuropathic pain. Conclusion: After analyzing the efficacy of pain management protocols, though pain management strategies were adequate for majority of patients, but still inadequate pain management among 30% of patients was observed in our study. While opioid analgesics are widely used, there is a need for more personalized and timely interventions to achieve optimal pain relief. Regular pain assessments and dose adjustments based on patient feedback can enhance the effectiveness of pain management protocols.

DOI: 10.5281/zenodo.

Objectives: To evaluate maternal and neonatal complications in Primigravida and Multigravida who had undergone caesarean section in the second stage of labor. Materials and Methods: Time bound prospective observational hospital study undertaken from September 2021 to August 2022 at Gauhati Medical College & Hospital. Singleton pregnancy irrespective of parity with period of gestation ≥37 weeks, which had undergone LSCS in the second stage of labor, was recruited in the study. Complete obstetrical investigations with maternal and neonatal outcome were documented. Results: During this 1 year study period, there were 15859 deliveries, a total of 7830(49.3%) were born by LSCS. Out of all LSCS cases, 123(1.57%) were performed in the second stage of labor. CPD was the most common indication which was high in primigravida (63.1%). Intra-operative maternal complications-uterine incision extension (48.3%), bladder injury (5.2%), uterine atony (41.4%) and PPH (72.4%), the need for blood transfusion (41.4%), intra-operative rupture(3.4%), the requirement of hysterectomy (1.7%), the mean duration of surgery(58.12 mins)-all were high in multigravida. Post-operative complications-wound infection(21.5%)- high in primigravida, postpartum pyrexia(5.2%), puerperal sepsis(8.6%), the mean duration of hospital stay (9.29days)- all were high in multigravida. Fetal complications- APGAR scores <5 at 5mins- (56.9%), the mean duration of NICU admission(5.6 days), the percentage of NICU admission(63.8%), fetal injuries(1.7%), need for resuscitation of babies(77.6%), fetal death((3.4%)- all were high in multigravida. Conclusion: Caesarean sections done at full cervical dilatation with impacted fetal head are difficult and associated with increased incidence of maternal and fetal complications. The prompt decision for caesarean section should be taken especially when risk factors for failure to progress are present. Second stage CS can be avoided by improvement of antenatal care, pelvic assessment in early labor, by use of partogram for monitoring of labor and timely intervention, rational use of oxytocin, proper and selective instrumental delivery, and lastly but most importantly the presence of senior and expert obstetricians in decision-making.

DOI: 10.5281/zenodo.

Background: According to GLOBOCAN 2020 Project data, breast cancer, cervical cancer, ovarian cancer, and uterine cancer are among the top 10 common cancers in females worldwide. Accurate projections of cancer incidences and mortality are required for effective and efficient policymaking as well as for adequate resource allocation. This study will forecast the incidence of various gynaecological cancers in Tamil Nadu. Methods: The incidence of various gynaecological malignancies in Tamil Nadu for the years 2012 to 2021 was obtained from the Tamil Nadu Cancer Registry Project (TNCRP). Auto regression integrated moving average (ARIMA) model was utilised to forecast the incidence of various gynaecological malignancies in Tamil Nadu up to the year 2030. Results: The incidence of new cases in 2021 was as follows (Breast cancer – 11657, ovarian cancer – 2287, Cervix cancer – 6668, other genital cancer – 2570), was taken as baseline. The projected new case incidence using ARIMA showed a 30% increase from the baseline 2021 values of Breast cancer (15155 with 95% C.I. 12795-17515), similarly the incidence of Ovarian cancer was predicted to have a 20% increase (2746 with 95% C.I – 2295-3197) and a staggering 48% increase in Other genital cancer (3811 with 95% C.I. 3079-4544) by the year 2030 when compared to the baseline values. There is a 1% decrease in cervical cancer (6737 with 95% C.I. 4542-8933) by 2030. Conclusion: This analysis using the ARIMA model shows that there will be an increasing trend in hormone-related and lifestyle-related gynaecological malignancies and a decreasing trend in infection-related malignancies. This trend analysis will help to pave a pathway towards future introduction of new policies, justify an increase in resource allocation and to create awareness and screening programs for gynaecological malignancies other than breast and cervical cancer to tackle the challenge of disease dynamics.

DOI: 10.5281/zenodo.

Introduction: Fever is one of the most common presenting complaint and cause of hospital admission among children accounting for 15-30% of all hospital visits. It is important to differentiate between the bacterial and non-bacterial causes of fever. The use of the YALE observation scale (YOS) assists in the early recognition of acute bacterial infection more than other laboratory investigations as it is a simple, quick, easy-to-apply, and cost-effective bedside scale. Objectives: To study the utility of the Yale observational scale in predicting Acute bacterial infection amongst febrile children. Methodology: This was a hospital based Descriptive observational study, among 176 children admitted with febrile illness under the Department of Paediatrics, ACSR Government Medical College & Hospital, and Nellore. Children were clinically evaluated using YOS on admission. Laboratory investigations such as total leucocyte count, neutrophil count, CRP, blood culture, and any other relevant investigations were recorded. YOS score and lab parameters mentioned were statistically correlated with the presence or absence of bacteremia, need for antibiotics, and need for oxygen therapy and duration of hospital stay in febrile children. Results: The mean YALE Observation Score among the subjects was 10.89 (± 3.17) ranging from 6 to 20. The mean YALE Observation Score was significantly higher among the children with a fever of 101.1 -103 F, Increased Duration of fever (> 6 days), > 15000/mm ³ WBC count, Positive CRP, > 10000/mm ³ Absolute Neutrophil Count, Positive culture evidence of bacteremia, increased duration of hospital stay (8 – 14 days) and need for antibiotics. The need for oxygen support was not significantly associated with the YALE Observation Score. The best cut-off of the YALE Observation Score for predicting Acute bacterial infection was 12.5 which has 65.9% sensitivity, 98.9% specificity, 98.12% positive predictive value, 76.88% negative predictive value and 83.53% diagnostic accuracy. Conclusion: YALE observation scale can be used as a simple, quick, easy-to apply, and cost-effective bedside scale. Higher YOS score was significantly associated with adverse outcomes during the illness. Hence, the YALE observation scale assists in the early recognition of acute bacterial infection before the laboratory investigations.

DOI: 10.5281/zenodo.

Background: Effective premedication can attenuate hemodynamic responses during surgery, enhancing patient stability and outcomes. Clonidine, an α2-adrenergic agonist, is frequently utilized for its sympatholytic properties. This study aims to compare the hemodynamic effects of two intravenous clonidine doses as premedication in patients undergoing laparoscopic cholecystectomy. Methods: A randomized, double-blind study was conducted on 154 patients scheduled for elective laparoscopic cholecystectomy. Participants were randomly assigned to receive either 1 µg/kg (Group A) or 2 µg/kg (Group B) of intravenous clonidine diluted in 100 ml normal saline over 15 minutes, administered 30 minutes before induction. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were monitored at specified intervals. Secondary outcomes included the incidence of side effects within the first 24 hours postoperatively. Data were analyzed using Student’s t-test and Chi-square test, with significance set at p < 0.05. Results: Both clonidine doses significantly stabilized hemodynamic parameters compared to baseline. Group B exhibited a more pronounced reduction in HR, SBP, DBP, and MAP at multiple time points, including post-intubation and during pneumoperitoneum (p < 0.05). Additionally, Group B had a lower incidence of postoperative side effects such as nausea and vomiting compared to Group A, though not statistically significant. Conclusion: A higher dose of intravenous clonidine (2 µg/kg) as premedication provides superior hemodynamic stability compared to a lower dose (1 µg/kg) in patients undergoing laparoscopic cholecystectomy. This dose is well-tolerated and may enhance perioperative management.

DOI: 10.5281/zenodo.

Background: Childhood poisoning remains a significant public health concern, particularly in low- and middle-income countries, where it contributes substantially to pediatric hospital admissions and preventable morbidity. Objective: This hospital-based study aimed to analyze the patterns, clinical presentations, and outcomes of childhood poisoning cases admitted to a tertiary care hospital. Methods: A total of 89 cases were evaluated, focusing on demographic characteristics, types of poisons, mode of exposure, and associated clinical outcomes. Data were collected and analyzed to identify trends and highlight key areas for intervention. Results: The majority of poisoning incidents were accidental, with children under five years being the most affected. Household substances such as cleaning agents and medications were the leading causes, followed by agricultural chemicals. Early recognition and appropriate treatment resulted in the successful management of most cases. Conclusion: The study emphasizes the need for parental awareness, public health education, poison control measures, and improved child safety strategies to mitigate the burden of childhood poisoning.

DOI: 10.5281/zenodo.

Introduction: Hydrocele is known to occur in man since time immemorial. It was Mathew Jaboulay (1860-1913) who contributed the operation of partial excision with eversion of the sac after that so much modification has been in this field in search of an easy and less morbid procedure. However, still the surgery for hydrocele has a significant morbidity rate. Materials and Method: An observational prospective study conducted in Bankura Sammilani Medical College and hostpital within the time frame of about 1 year with 50 patients admitted for undergoing hydrocele operation. Outcome was compared with standard Jaboulay’s procedure in terms of duration of surgery, post op pain, fever, scrotal edema, hematoma, wound infection and duration of hospital stay. Result and Analysis: In our study majority belongs to the age group of 26-35yrs.Mean duration of surgery was 15.16mins. Incidence of post op pain (VAS>5) and fever was 22% and 6%. Though 6% developed scrotal edema and 4% post op infection but hematoma in only 1 case. Mean duration hospital stay was 3 days. Conclusion: As dissection of hydrocele sac is the main culprit behind the morbidity hence Sharma and Jhawer techniques which include minimal dissection has statistically significant superiority in duration of surgery, post operative pain, edema and hematoma. No statically significant difference was there with Jabouloy’s procedure in terms of post op fever and infection. Hence decreased post-operative stay compared to other surgical modalities and decreased cost incurred for patients.

DOI: 10.5281/zenodo.