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Sanjay Gupta, Ajay Kumar, Adiveeth Deb

Background: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotic therapy for FG. Materials and Methods: Data from patients who underwent surgery for FG was retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. Outcome was also assessed in terms of mortality. Results: Fifty patients with a median age of 58.5 (40-83) years were included. The perianal region and scrotum (88%) were the most commonly affected. Diabetes mellitus (DM) was the most common comorbidity (92%). The median time to onset of symptoms was 7 (2-15) days, and the median duration of hospital stay was 22 (4-65) days. Ventilator requirement was required in 15 (30%) patients. The median UFGSI score was 9.5 (3-15). The overall mortality rate was 26%. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (68%). Acinetobacter baumannii and Klebsiella pneumonia were signicantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of > 9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. Conclusion: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modied. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.
Vijayalakshmi Naik

Since Independence, UEE has been solitary imperative goal of educational progress in India. To achieve UEE, Government of India has initiated numerous programmes but it is sad that dropout rate is not declined. A foremost percentage of the dropouts comprises of socially underprivileged children. Most of the children have to effort very hard to earn their livelihood, and reside in slums. Recent approaches in the education technology like applications of multimedia by computer technology prove to cater to the various requirements of students in the educational system. Multimedia is a sole medium with structures of quality, audio-visual recording, and sound effects. Using Multimedia Approach, in teaching-learning process, is a perceptual knowledge, and as outcome students acquires the concepts and skills effectively. The present study was carried out with the objective to study the effect of the multi-media approach in relation to traditional approach in fostering selected Mathematics Competencies among Slum Students. The sample of the study was 40 slum students of standard six. The pre-posttest experimental design was followed for the present research study. The treatment for the Experimental group was given by the investigator for 40 sessions specically to foster Mathematics Competencies using a specially designed instructional material. Analysis of the results revealed, that Multi-Media Approach was signicantly more effective than of the traditional approach in fostering selected Mathematics Competencies among Slum students. Educational implications of the study were discussed in the study
Satyaki Basu, Dipankar Kundu, Santu Mondal, Sourish Ghosh

Background: Polycystic ovarian syndrome has been one of a major public health problem. It causes multifactorial in etiology such as menstrual dysfunction, hyperandrogenism, hirsutism, insulin resistance, dyslipidemia and obesity which increased risk of diabetes mellitus and cardiovascular disease. Prolactin has been reported as a potent lipogenic and diabetogenic factor, that affecting energy balance and fuel metabolism. The present study was designed to assess serum prolactin and insulin resistance in PCOS women and to compare them with healthy women as controls. Material And Methods: A comparative study including 50 women newly diagnosed as PCOS and 50 healthy women as controls was conducted. The age group for the study was 18-35 years. Fasting blood samples were drawn to assess serum prolactin, serum insulin and fasting blood sugar. Insulin resistance was calculated by homeostasis model assessment. Results: A signicant increase in fasting serum insulin (p<0.001) and HOMA – IR (p<0.001) were found in patients with PCOS in comparison with controls. Prolactin and FPG were found elevated in the PCOS women and were statistically signicant. Conclusions: The current study provides further evidence that signicantly higher fasting insulin and HOMA in PCOS group indicates presence of IR. IR in PCOS group may have a potential role in the prediction of dysglycemic disease in women with PCOS. This study found signicant correlation between serum prolactin and serum insulin
Aniket Paul, Dipankar Kundu, Satyaki Basu

Introduction: The three commonest types of Meningitis are Bacterial, Viral and Tubercular; they differ in their pathophysiology and management. That is why early differentiation between them is important. Bacterial meningitis have heavy fatality rates whereas Tubercular meningitis inicts severe neurological sequalae. Aims & Objectives: To determine whether ADA and CRP can be used successfully to predict the type of Meningitis affection Methodology: This is a Hospital based cross-sectional observation study which was undertaken in Biochemistry dept. Medical College, Kolkata. Eighty cases of meningitis were taken. ADA and CRP was measured along with Protein, Sugar and Differential staining cell counting. The cases were divided into three groups (Bacterial, Viral, and Tubercular) on the basis of microscopic and Biochemical Examination. Results & Analysis: ANNOVA test was done along with Bon Ferronis Test which revealed that there was signicant difference in mean of ADA & CRP in the three different groups.ROC curve for CRP between Reactive and Non-reactive meningitis revealed that if CRP values are more than 11.0, 95% of the cases were reactive whereas ROC curve for ADA between Tubercular and Non Tubercular forms showed when the concentration was more then 9.0, 95% of the cases were of Tubercular origin. Conclusion: When taken together ADA and CRP successfully predict the type of Meningitis. It is also helpful in diagnosing those cases when the Cell count and type was equivocal.
Paramasivam Preethi, R.R. Mahendra Raj, Thalaimalai Saravanan, K.R. Shakila

Corticosteroid remains mainstay of treatment for immune mediated mucocutaneous disorders. The very usefulness of the drug, which has become a double-edged sword, when used for long time. The administration of immunomodulators decrease the dose of steroids, reduces the steroid side effects and improves rejuvenation time. In addition to immunomodulatory drugs there are some drugs that are used to spare corticosteroids in the treatment of immune mediated mucocutaneous diseases. This review attempts to elicit the use of steroid sparing drugs in immune mediated diseases.
OmPrakash Shyoran, Mahadev Choudhary, Jai Prakash Yogi, Bushra Fiza, Maheep Sinha, Vihan Chawdhary

AIM: The study was planned to evaluate the association of C - reactive protein with Serum Uric Acid and Bicarbonate Level in COPD. MATERIAL AND METHODS: In the present study total 100 (n=100) patients diagnosed for COPD, were enrolled for the study. Patients with neoplastic pathologies, pneumonia and Liver or renal diseases, pregnant and lactating females were excluded from the study. RESULT: The mean level of Serum Bicarbonate, C-reactive protein and uric acid were signicantly higher in COPD patients. A signicant association was observed (p ≤ 0.0001). CONCLUSION: In the present study higher bicarbonate levels that could be the individual biomarker which can assess the respiratory acidosis and CRP and Uric Acid levels judges the severity the disease.
Santhi K S, Elizabeth Joseph, Rachana C Nair

BACKGROUND: Combined spinal epidural anaesthesia is the most popular anaesthetic technique for major gynaecological surgeries. Epidural adjuvants enhance the quality and duration of surgical anaesthesia. Adjuvants like opioids or alpha 2 agonists provide a dose sparing effects on local anaesthetics and accelerate the onset of sensory blockade of epidural anaesthesia. Our study was aimed to compare the hemodynamic, sedative and analgesia potentiating effects of Dexmedetomidine and Fentanyl when added to epidural Bupivacaine for gynaecological surgeries. METHODOLOGY: Patients of ASA Grade I and II, aged between 30 and 65 years who were scheduled for major gynaecological surgeries were included in the study. Patients were randomly divided into two groups, Group D (N = 51) and Group F (N = 51). Group D received epidural injection of 0.5 mcg/kg of Dexmedetomidine diluted to 5ml with Normal Saline (NS) and Group F received 0.5mcg/ kg of Fentanyl diluted to 5 ml with NS, in addition to a spinal dose of 3ml of 0.5 % Bupivacaine. When two segment regression of sensory level was noted, epidural block was supplemented with 0.5 mcg /kg of the study drug in combination with 1.5 ml/segment of 0.5% Bupivacaine. Duration of sensory block, motor block, and incidence of bradycardia, hypotension, nausea and pruritus were assessed. RESULTS: The duration of analgesia and motor block were signicantly longer in the Dexmedetomidine group. The incidence of bradycardia was more in the Dexmedetomidine group, but the incidence of hypotension was nearly the same. CONCLUSION: Dexmedetomidine seems to be a better alternative to Fentanyl as an epidural adjuvant due to early onset of sensory anaesthesia and prolonged postoperative analgesia.
Meghna Sharma, Bushra Fiza, Pragati Upadhyay, Arun Kumar, Maheep Sinha

Aim: The purpose of this study to evaluate the level of serum Albumin, Calcium and Albumin corrected calcium with severity of acute pancreatitis. Material and methods:The study was conducted in Department of Biochemistry in association with Department of Gastroenterology, Mahatma Gandhi Medical College & Hospital. In present study out of 133 patients diagnosed for Acute Pancreatitis; total 115 patients (n=115) of either gender of 18 to 65years age groups were enrolled for the study. Patients with history of any acute or chronic illness like: - Hyperparathyroidism, Diabetes Mellitus, Impaired renal function, Malnourished, Pregnant and lactating women and patients on calcium supplements were excluded. Result: Mean level of calcium decreased with progression in disease severity (p≤0.001).The mean Albumin Corrected Calcium was also signicantly lower in the patients presenting with severe and moderate acute pancreatitis compared with the mild acute pancreatitis patients (p≤0.0001). Conclusion: The study recommends hypocalcaemia and hypoalbuminemia as independent risk factors of progression towards severe pancreatitis. Similarly, albumin corrected calcium is suggested as a reliable marker for severity of pancreatitis.
Sagarika Ray, Amit Kumar Pal

BACKGROUND: The COVID 19 pandemic has wreaked havoc in the lives of people all over the world. Due to the sudden change in the way of life mental health problems have been rising across the globe. Medical students have been no exception to this. AIMS AND OBJECTIVES: This study aims to assess whether the pandemic has adversely affected the mental health of undergraduate medical students of West Bengal, India. MATERIALS AND METHODS: An online survey was conducted using standardized questionnaires, namely Perceived Stress Scale and Beck Depression Inventory, to assess the levels of stress and depression among the students. Specic stressors affecting the students were also studied. RESULTS: Moderate or severe levels of stress and/or depression were reported by 83.87% out of the 465 students who participated in the study. However only 21.08% of them have sought professional help. The most stressful factor for rst year students was the online mode of education, while that for the second and third year students was uncertainty about future, and that for nal year students was the impact on internship rotations and clinical experience. CONCLUSIONS: COVID 19 pandemic has signicantly affected the mental health of medical undergraduate students in India. The treatment gap has to be reduced to ensure a better quality of life for the individual, and thus benet the entire society at large.
Joshi Pranav B, Shah Shalin D, Sikariya Kusum K, Chaudhary Jay, Patel Mayank A

Motor Neuron Disease (MND) is a heterogenous group of disorders with degeneration of upper and/or lower motor neurons. Limited data is available for clinical characteristics of MND from western India. Methods: We retrospectively observed all cases of MND, evaluated at our centre. Those with conrmed diagnosis, exclusion of secondary causes and with one year of minimal follow up were included, for the anaysis. RESULTS: Out of 51 patients of MND, 36 were diagnosed as Amyotropic Lateral Sclerosis (ALS) and 15 patients were having pure Lower Motor Neuron(LMN) type of MND. Male: female ration was 2.8:1 in ALS group , with mean age of 50 years. Out of 10 bulbar onset MND patients, 5 died in the follow-up period. In the LMN subgroup, younger onset monomelic amyotrophy, of upper limb onset (Hirayama) was commonest subtype. No patients with isolated Upper motor Neuron type of MND was found. SUMMARY: ALS subgroups of patients had younger age of onset in western Indian population, with signicant male rd preponderance. Hirayama disease was commonest LMN type of MND, with onset in 3 decade and more commonly seen in males
Nimta Kishore, A. Varshneya, A. Nagrath

BACKGROUND- Caesarean delivery, one of the most commonly performed surgical procedure. The choice of anaesthesia is spinal blockade for elective caeserean-section,unless general anaesthesia is specically indicated. Aspiration pneumonitis remains an important cause of morbidity and mortality in anaesthesia practise,particularly in obstetric patients,prophylaxis against it is paramount importance in pre-anaesthetic management. AIMS AND OBJECTIVES- The aim of this study was to compare pH and volume of gastric contents after administration of combination of metoclopramide and pantoprazole versus ondansetron and pantoprazole during elective caesarean section under spinal anaesthesia for prophylaxis against aspiration pneumonitis. METHODS: It is a prospective study where 100 parturient women, ASA 1 and 2 scheduled for elective caesarean section. They were divided into 2 groups: ondansetron(4mg) and pantoprazole(40mg),and metoclopramide(10mg), pantoprazole(40mg) administered intravenously 2hours before surgery. Gastric aspirate was taken in various positions before giving spinal anaesthesia and at the end of operation. Patients at risk were according to criteria of gastric volume more than 0.4ml/kg with pH <2.5. RESULTS:Patients at risk were 7(14%) in metoclopramide group and 1(2%) in ondansetron group before giving spinal anaesthesia(p=0.027) and 6(12%) in metoclopramide group and 0(0%) in ondansetron group at end of operation(p=0.012) . Since p-value was less than 0.05 there was signicant difference between two groups. CONCLUSION: As there was signicant difference between ondansetron and metoclopramide , it is recommended to use ondansetron and pantoprazole for prophylaxis against aspiration pneumonitis.
Arulkumaran. P

AIM: Aim of the study is to nd the causes of hemoptysis in inpatients in a tertiary care hospital in south India. METHODS AND MATERIAL: Retrospective study. case sheets of Inpatients either admitted to the thoracic medicine department for hemoptysis and inpatients who later developed hemoptysis were included in the study irrespective of the amount of hemoptysis. RESULTS: pulmonary tuberculosis constitutes 78.26% with sequelae patients constituting 52.17% and active case 25%. Other causes such as bronchiectasis, COPD-chronic bronchitis, pneumonia, carcinoma lung and ILD constitute 10.86%, 5.43%, 2.17%, 2.17% and 1.08% respectively. CONCLUSION: The most common cause of hemoptysis is pulmonary tuberculosis(active and sequelae). Among the pulmonary tuberculosis patients post tuberculous sequelae is the common cause. This followed by bronchiectasis, COPD-chronic bronchitis, pneumonia, carcinoma lung and interstitial lung disease.
K. Swaroopa, G. Savaraiah

Agriculture plays a vital role in India's economy 54.6. percent of the total work force in the country is engaged in agricultural 1 and allied sector activities . Agriculture in India denes familial tradition, social relations and gender roles. Female in the agricultural sector, whether through traditional means or industrial, for subsistence or as an agricultural labourer, represents a momentous demographic group. Agricultural sector employs 80 percent of all economically active women comprising 33 percent of the agricultures in the country. Agriculture, the single largest production endeavour in India 2 is contributing substantially to the GDP . As per the provisional estimates of national income released by CSO on th 29 May 2020, the share of agriculture and allied sectors in Gross Value Added (GVA) of the country at current prices is 17.8 percent for the year 2019-20. The share of agriculture and allied sectors in GVA of the country has declined from 18.2 percent in 2014-15 to 17.8 percent in 2019-20, an inevitable outcome of a development process in which the relative performance of non-agricultural sectors becomes mole 3 dominant . Within the agriculture sector, the share of crops has fallen from 11.2 percent in 2014-15 to 9.4 percent in 2018-19. The decline in the share of crops has been made up by an 4 increase in the share of livestock and sheries sectors . Given the importance of the agricultural sector, the Government of India has taken several steps for its development in a sustained manner.
Saroj Mandal, Sidnath Singh, Kaushik Banerjee, Aditya Verma, Vignesh R.

Background: The treatment of LMCAD has shifted from coronary artery bypass grafting (CABG) to Percutaneous coronary intervention (PCI). However, data on long-term outcomes of PCI for LMCA disease, especially in patients with acute coronary syndrome (ACS) remains limited and conicting. This study aims to nd the association of the immediate and 4-year mortality in ACS patients with LMCA disease treated by PCI based on ejection fractions at admission. Methods: A retrospective analytical study was conducted. Patients were divided at admission into those with reduced left ventricular ejection fraction and those with preserved ejection fraction. Results: Forty (58.8%) of the patients presented with preserved EF. The mean age of the patients was 71.6±7.1 years. The mean LVEF of the preserved group was 61.6±4.3% and signicantly higher than that of the reduced group. Age and cardiovascular risk factor prole was similar between the two groups. Patients with reduced ejection fraction had signicantly higher levels of serum creatinine and signicantly lower levels of Hb and HDL. Mean hospital stay was signicantly longer for patients with preserved EF. In-hospital deaths were also similar between the two groups. The reduced EF group had a signicantly higher allcause mortality in the 4-year follow-up period. The mean years of follow-up for all participants was 4.2±1.3 years. Conclusion: It was seen that in patients presenting with ACS and undergoing PCI due to LMCAD, LVEF at admission, singly and in in multivariate regression is an important predictor of in hospital and 4-year mortality
V. Janardhanam, P. Vinayaga Murthy

An attempt was made in the present investigation to study the behaviour pattern of problems among youth. Sample for the present study consists of 300 parents, both fathers and mothers and their children with problem behavior in Chittoor of Andhra Pradesh State. The Achenbach System of Empirically Based Assessment-Adult SelfReport (ASEBA-ASR) by Achenbach and Rescorla, (2003) was designed to empirically assess the behavior problems among youth and their age ranges from 18-24 years and ‘t’ tests were used to analyse the data. Findings of the study revealed that gender, nature of course and age have any signicant differences in behaviour pattern of problems among youth.
Brilla Balsam J, Lancelet T.S

Most diseases involve many genes in complex interactions, in addition to physical and cultural environmental factors. If a disease is caused by genetic and environmental factors, its etiological origin can be referred to as having a multifactorial pattern. The common multifactorial diseases encompass environmental inuences on the causal processes. Thyroid is a multifactorial type of origin of disease. The epidemiological studies show that if thyroid disease is caused by the interaction of both genetic and environmental factors, then mostly it is autoimmune thyroid disease. When the antibodies attack the thyroid gland, it is called Auto Immune Thyroid Disease (AITD). The present study attempts to examine whether the occurrence of thyroid disease in a micro area is due to autoimmune conditions. To prove the fact clinically, blood of thyroid patients were collected and tested in a laboratory. The result shows that most of the patients have autoimmune thyroid disease. Moreover, some environmental and genetic factors were also examined since thyroid disease is a multifactorial origin of disease.
Uma Jain, Jayshree Chimrani, Kajal Krishna

INTRODUCTION- Polycystic ovarian syndrome (PCOS) is a common, heterogeneous disorder affecting 5-15% of women of reproducing age group and characterized by hyperandrogenic skin symptoms, (acne, Hirsutism and female pattern alopecia,) irregular menstrual bleeding, obesity, dysmenorrhea infertility, and increased risk of metabolic syndrome and endometrial cancer. MATERIAL AND METHOD-The present study was conducted in a private gynecological Clinic Shivpuri, (M.P.). After taking Consent women suffering from PCOS (Fullled the clinical and USG criteria of PCOS(Rotterdam criteria )) along with androgenic symptoms like acne, hirsutism and androgenetic alopecia with or without other symptoms like menstrual irregularities and dysmenorrhea were included in the study.. All patients then received a combination of ethenyl Estradiol (0.035mg) + Cyproterone acetate (2mg). The Patients were followed in the third month, Sixth month, and at about 1 year for improvement in various complaints RESULT- According to presenting symptoms the most common presenting symptom was acne 72.72%, followed by menstrual irregularities 68.18%, hirsutism 50%, alopecia 27.27%, and dysmenorrhea in 27.27%. In acne patients, 37.5% of patients showed improvement after 3 cycles of CPA/EE, 75% showed at 6 months and in 93.75%, improvement was seen at 12 months. In the case of alopecia (83.33%) patient showed improvement after >6 cycles. Patients with hirsutism showed no improvement after 3 months of therapy but 54.54% of the patients showed a change in texture after 6 months of therapy and 72.72% after 9-12 months of therapy. Patients with dysmenorrhea reported a decrease in pain after therapy. The acceptance of the treatment was very good. In 86.36% of patients, good tolerance of drug was seen and in only 3 patients adverse effects (headache and nausea) of the drug were there. All the patients were having good to moderate satisfaction with the therapy. CONCLUSION- Since androgen excess is the prime defect in polycystic ovarian disease, its reduction is the main therapeutic target for most women. Our study found that combined hormonal contraceptives containing ethenyl Estradiol (0.035mg) + Cyproterone acetate (2mg) in a 21/7 regimen had a positive effect in the treatment of acne, hirsutism, menstrual irregularity, and dysmenorrhea in PCOS patients.
G M Naveen, Shreedhar K.R, Santhosh M.C

A Light weight ferrocement is a composite material consisting of cement-sand mortar (matrix) along with light weight ne aggregate ( In this research blast furnace slag is employed as light weight ne aggregate ) as a replacement of sand in some quantity and reinforced with layers of small diameter wire meshes . These studies mainly attempt to determine the rst crack strength, ultimate strength and the inuence of mesh wires on some of these properties. This work has been proposed to investigate on the Load-Deection and Moment-Curvature characteristics of lightweight ferrocement in monotonic and repeated loading. These results are expected to be useful in a better understanding of the exural behaviour of lightweight ferrocement and in the design of such members subjected to monotonic and repeated loading.
Preeti Gupta, Uma Jain, Deepali Jain

INTRODUCTION- Maternal mortality is still a signicant public health problem now severe acute maternal morbidity (SAMM) has emerged as an important indicator in maternal health care to review the . cause of maternal deaths Severe morbidity data is very important for policy planner to evaluate the quality of health care system, to know the requirement of emergency obstetrics care (EMOC) and to improve the health care system. MATERIAL AND METHOD- This is a retrospective study done in a private maternity hospital in Gwalior (M.P.). The study was done during a period from 01/01/2017 to 01/01/2021. In our study 4808 live birth were there during this period 59 cases were diagnosed as severe maternal morbid cases. RESULTS- In present study the incidence of SAMM was 12.27 per one thousand live birth. In this study – most (54.23%) of women were in the age group of 21-25, were unbooked (57.62%) , primipara (38.98%), full term (47.45) and of low-income group (64.40%) In this study we found the most common morbidity was (30.50%) hypertensive disorder of pregnancy, the second one was (23.72%) of severe hemorrhage. In our study, severe anemia was the most frequent medical disorder present in morbid Patients. During the study period four patients died. The most common cause of maternal death was pregnancy-induced hypertension and its associated disorders. CONCLUSION- This study summarized that lack of awareness, lack of education, rst delay in reaching to the health care system, lack of antenatal visits, preexisting chronic medical disease, inadequate use of magnesium sulphate before transferring patient of severe PIH/eclampsia, and improper use of antibiotics and delay in diagnosis and referral to higher center are the main factor contributing to severe maternal morbid cases. Identication of SAMM cases is very useful in monitoring the quality and effectiveness of obstetrics care, it helps in improving the health care system.
S. Srinivasan, P. Divya, A. Rohini, R. Jayapreethi

BACKGROUND: Mucormycosis is a rapidly progressing, life threatening, opportunistic fungal infection caused by angioinvasive mucorales species of the phylum zygomycetes.The major risk factors of the disease are uncontrolled diabetes mellitus, COVID-19 infection,prolonged usage of high dose of systemic corticosteroids,immunocompromised status and neutropenia. These create a nidus for fungal infection through nasal mucosa which spreads up through paranasal sinuses into orbit manifesting as rhino-orbital mucormycosis. AIM 1. To study the epidemiology and various clinical patterns of presentation of rhino-orbital mucormycosis in post covid patients. 2. To analyse the risk factors associated with progression of rhino-orbital mucormycosis in post covid patients. METHODS: A retrospective study of 25 patients diagnosed as rhino-orbital mucormycosis in post covid patients at Government Kilpauk Medical College Hospital between April and July 2021 was done. RESULTS: In our study,males (64%) are more commonly affected with age preponderance of 51-60 years(28%). The mean age of presentation was 52.1+/-4.49years.The most common symptom of the disease is nasal discharge with sinus and orbital pain(52%).The most common form of presentation is orbital apex syndrome in seven patients(28%).Five patients had loss of vision, of which four were due to central retinal artery occlusion(16%) and one due to cavernous sinus thrombosis.MRI imaging of these patients showed sinus involvement(100%) in all cases ,orbital(48%) and cerebral involvement(8%).The major risk factors responsible for progression of disease in our study are uncontrolled diabetes, prolonged usage of high dose steroid therapy, medial wall involvement, optic nerve head involvement and artery thrombosis. CONCLUSION: Post covid patients presenting with nasal discharge with sinus and orbital pain symptoms need to be diagnosed and managed properly to avoid spread of infection and fatal complications. Aggressive surgical debridement of infected tissues helps in increasing the survival rate of the patients. Patients with risk factors need to be closely monitored to prevent vision loss and cosmetic disfigurement surgeries.
Lokesh Kumar Singh, Alka Gupta, Jigyasa Srivastava

AIM: Effect of statin use on status of diabetic retinopathy /diabetic macular edema in patients of type 2 diabetes mellitus Check the lipid profile and detail fundus examination of all patients included in study. Effect of lipid lowering agents (statin) on Diabetic retinopathy. Asses the changes in fundus of DME patients after giving statin. MATERIALS AND METHODS:- A prospective study was conducted in the OPD of upgraded department of ophthalmology at LLRM Medical College, Meerut over the duration of from July 2019 to June 2020. The proposed study was in association of status use and hyper triglyceridemia with diabetes macular edema in patients with type-2 diabetes and diabetic retinopathy. Clearance from institution ethics committee was obtained before the study was started. An informed consent was obtained from all the patients before including them in to the study. A total of 86 patients were divided in to two equal groups randomly RESULTS:- A prospective study was conducted in the OPD of upgraded department of ophthalmology at LLRM Medical College, Meerut over the duration of from July 2019 to June 2020 and sample size of patients taken was 86 About 70.9% of the patients in this study were males and 29.1% were females. About 26.7% of the study subjects in this study had diabetes mellitus since 16 – 20 years,25.6% since more than 20 years and 20.9% since 11 – 15 years. During the baseline the CSME in left eye was present in 24.4% of the cases and during follow up,the CSME was present in 10.5% of the cases . At the time of baseline,about 64% of the patients had no CSME in right eye and 36% had CSME.At the time of follow up 87.2% of the cases had no CSME and 12.8% had CSME. In mild NPDR during follow up,44.2% had mild NPDR,24.4% had moderate NPDR and 8.1% had severe NPDR at baseline. About17.4%ofthepatientswhohadmoderateNPDRatbaselinealsohadmoderateNPDRduringfollowupvisits inlefteye. Among all the patients with mild NPDR during follow up, 54.7% had mild NPDR, 22.1% had moderate NPDR and 10.5% had severe NPDR during baseline. About 12.8% who had moderate NPDR during baseline also had moderate NPDR during follow up in right eye Mean cholesterol level during baseline was 154.13 mg/dl and during follow up was 138.12 mg/dl which was statistically significant (p=0.000). The mean triglyceride level during the baseline was 178.37 mg/dl and during follow up was 156 mg/dl which was statistically significant between the two groups (p=0.000). Mean LDL cholesterol level during the baseline was 94.99 mg/dl and during follow up was 61.24 mg/dl which was statistically significant between baseline and follow up (p=0.000). This study had shown improvement of visual acuity,decrease in macular edema and progression of diabetic retinopathy. The study also revealed that ,the statins are effective in decreasing the total cholesterol, LDL cholesterol, and triglycerides. CONCLUSION:- This study had shown improvement of visual acuity,decrease in macular edema and progression of diabetic retinopathy in patients whom statins was given The study also revealed that,the statins are effective in decreasing the total cholesterol(mean value during baseline was 154.13 mg/dl which reduces to 138.12 mg/dl during follow up),LDL cholesterol (mean value reduces from 94.99 mg/dl during baseline to 61.24 mg/dl during follow up)and triglycerides (mean value during baseline 178.37 mg/dl to 156 mg/dl during follow up).as given.
Chetan S. Bhangale, Teli Sheikh Emaran Sheikh Esmail, JaiPrakash Ramanand, Harshal M. Mahajan

INTRODUCTION: Threat of COVID-19 pandemic is still not over and another threat of Post-COVID mucormycosis has started looming over the horizon. Early recognition, diagnosis, and prompt administration of appropriate antifungal treatment are important for improving outcomes for patients with mucormycosis.The present study was done to evaluate the prescribing pattern of antifungal drugs and clinical outcome in Post-covid suspected cases of Mucormycosis at Dedicated COVID hospital.MATERIALS AND METHODS: The present observational study was done after obtaining the Ethics committee approval from Institutional Ethics Committee (IEC), Government Medical College, Jalgaon.We collected the data of previous treatment records, demographics, comorbidities, laboratory investigations and clinical outcome from the case files of patients admitted with diagnosis of clinically suspected mucormycosis with history of COVID19 infection. RESULTS: Out of the total 112 patient records, majority belonged to age group 51-60 years comprising of 37 patients (33%).In the present study,Amphotericin B was most commonly prescribed antifungal drug followed by posaconazole, fluconazole and itraconazole.Amongst Amphotericin B, lipid emulsion was most commonly prescribed in 82 patients (73.2%), followed by liposomal formulation in 58 patients (51.8%). CONCLUSION: The present study aims to provide data on prescribing trends of antifungal drugs in post-COVID clinically suspected cases of mucormycosis,which is lacking in published Indian literature
B Deekshitha, Shree Varsha, Sakilam Varsha, Y V Reddy

Vitamin D Deficiency (VDD) is one of the most significant global health problem and there is a strong demand for the prediction of its severity. The independent parameters like age, sex, weight, height, body mass index (BMI), waist circumference,body fat,bone mass,exercise,sunlight exposure,and milk consumption were used for prediction of VDD. Factors such as lack of sunlight exposure,low physical activity,poor dietary habits,lack of sleep and stress increase the risk of the impacts due to Vitamin D Deficiency.There are certain bad habits that increase the risk of VDD .This project aims at predicting the occurrence of VDD using Gaussian Naive Bayes classifier and Random Forest Prediction classifier.
Sivakumar Sivasubramaniam, Ambujam Govindasamy, Kode Leela Sravanthi, Brindha Pandiyan

Introduction: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases. Aims And Objectives: To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department. Materials And Methods: It was a prospective study in which all the patients with suspected ACD attending OPD of department of dermatology over a 3 month period were analysed. Patch testing was done using the most common antigens primarily, and other batteries were used depending on patient requirement and availability. Results: A total of 50 patients were enrolled in the contact dermatitis clinic over a period of 3 months. Hand eczema was the most common pattern seen in 23 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 32 (64%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by cobalt sulfate & potassium dichromate. Conclusion: Common allergens identified in our study were more or less similar to studies from other parts of India
A.S Shiralashetti, Mahesh Hadapad

Every nation has to move towards the constant progression of growth. The Co-Operative Banks as part of the banking system operating in Rural and Urban areas in reduced scales, caters the financial needs of Rural and Urban sector particularly agriculture and allied activities, trade and commerce and consumer finance. This paper aims to study the efficiency in sanction and disbursement made by Bijapur District Central Co-Operative Bank Ltd. Vijayapur, Karnataka during 2013-14 to 2017-18.The overall performance is efficient in sanction and disbursements of advances as the total advances shows increasing trend and the bank is disbursing loans to every talukas, all areas, and each category of loans. The Bank has managed efficiently to allocate the funds to Priority Sector as well as Non-Priority sectors; this helps the Bank to maintain high profitability by adhering the guidelines of RBI in sanction and disbursement of advances. The performance of the Bank can improve further by enhancing the loan facilities, improving the quality, introducing new products, and attracting the unreached customers.
Mohit Desai, Brajendra Kumar

Organophosphorus compounds (OPCs) are common pesticides used in agriculture in India. In this study, totally 24 patients had hypokalemia. Of 39 male patients,20 patients (51.3%) had hypokalemia. Of 11 female patients, 4 patients(36.4%)had hypokalemia. Of 50 patients totally, 14 had hyponatremia(<135 meq/dl) which constitutes 28%. Of this 6 patients had hypokalemia which accounts for 42.9%of hyponatremia.Of 24 patients with hypokalemia this 6 cases of hyponatremia accounts for 25%. Hypokalemia increases both morbidity and mortality in organophosphorus compound poisoning significantly.Hypokalemia can be used as a reliable and a cost effective marker of morbidity and mortality in organophosphorus compound poisoning
Richa Udhwani, Shiny Varghese, Maria Cecilia

Purpose: To study maternal and perinatal outcomes of COVID –positive pregnant women in a tertiary healthcare centre. Materials And Methods: This was a retrospective statistical analysis of records of COVID positive women who delivered at our institution between May 2020 to December 2020. Results: There were 44 COVID positive pregnant women during the study period of which 40 (90.9%) were term pregnancies and 4 (9.09%) preterm pregnancies. There were 17 (38.63%) women who had spontaneous onset of labour, 14 (31.8%) were induced and 13(29.5%) had elective LSCS. 14(31.8%) women had normal vaginal delivery,26(59.09%) had LSCS and 4(9.09%) had instrumental delivery. Most women 39(88.6%) were asymptomatic and 5(11.3%) presented with mild symptoms. 30 patients (68.18%) had underlying medical disorders. There were 5 (11.3%) babies with low birth weight (7 for all babies. Six (15.7%) babies required NICU admission and 2 (4.5%) were COVID positive. Conclusion: Majority of the COVID positive women were asymptomatic . Majority of the patients had an underlying comorbidity.None underwent ICU admission. Risk of preterm delivery and NICU admission was similar to COVID negative patients. Risk of vertical transmission exists. Fetal outcomes in terms of APGAR scores at 5 min, birth weight was found to be good.
Jaskaran Singh, Bhawani Shankar Modi, Kavita Pahuja, Tejendra Singh

INTRODUCTION: The common peroneal nerve is major lateral division of the sciatic nerve supplies lateral and anterior compartment of leg, when injured may leads to debilitating conditions such as foot drop and sensory loss or numbness in its supplied area. Common peroneal nerve's position subjects it to nerve injuries at two places one behind the knee joint where the nerve is superficial and other being the course of nerve through the fibular tunnel where its being tugged between musculo-aponeurotic fibers of peroneus longus muscle. Nerve injuries to common peroneal nerve has been attributed to several factors depending upon its anatomical position such as this may be due to sudden weight loss, prolonged sitting in squatting position, meniscus injuries in athletes or whether it is any surgical procedures involving the upper part of tibia and fibula. MATERIAL & METHODS: In present study we examine 70 lower limbs equally of right and left sides, the course, branching pattern and other reference point distances were measured with the help of metallic scale and dissections were photograph. RESULT: In 60% cases nerve separate from sciatic at the apex of popliteal fossa and in 80% cases it passes through the groove and then in about 70% specimen it passes through fibular tunnel, where it remains on an average 1.33 cm below the fibular head. The average distance of the nerve division was found 2.73 cm and just below that at a distance of 4.29 cm the nerve is in close contact with the bone. CONCLUSION: In present study we have observed average 7 muscular branches with variable origin from the common peroneal nerve in fibular tunnel which are likely to be damaged during surgical incision at this site.
Shruti Solanki, Palak Lakhani, Jaimin Patel, Jigna Upadhyay

Aim:To find out various cervical lesions with histopathological correlation and age. Method: This was a prospective study conducted in pathology department of a tertiary care teaching hospital over a period of two years. A total of 255 women were included in this study. All cases of gynecological lesions at Histopathology department of Gujarat adani institute of medical science,Bhuj for 2 years starting from May 2019 to May 2021 were retrieved.The demographic information such as nature of specimen which include Punch biopsy(21 cases) and total abdominal hysterectomy(234 cases) were extracted. Results: The most common finding was Nonspecific chronic cervicitis in 159 patients(62.35%) followed by normal stratified squamous epithelium was found in 42 patients(16.47%) and Papillary endocervicitis were 14 patients(5.49%).In benign tumor or tumor-like lesion,Cervical metaplasia were 12 cases(4.70%),Nabothian cyst were 6 cases(2.35%) and Endocervical polyp were 2 cases(0.78%). The premalignant cervical lesions were only 4 cases(1.56%). The malignant cervical lesions were Large cell non-keratinizing squamous cell carcinoma were 7 cases(2.74%), Large cell keratinizing squamous cell carcinoma were 4 cases(1.56%),Squamous cell carcinoma NOS were 3 cases(1.17%) ,Poorly differentiated carcinoma was only one case(0.39%),Basaloid squamous cell carcinoma was only one case(0.39%). Conclusion: Cancer cervix is an ideal malignancy for screening,can be detected early and the premalignant lesion can be treated to prevent the progress to invasive disease. Hence all women with unhealthy cervix should be subjected to punch biopsy to detect early cases of cancer & carcinoma in situ. Most common cervical lesion is Squamous Cell carcinoma and most common age group is 40-49 years.
Anshu Jamaiy, R.K. Sin, Sona Path

BACKGROUND:Cervical cancer remains one of the most common causes of death for women globally and ranks 4th of all cancers.Currently,every 2 minutes a life is lost to this disease.Endocervical adenocarcinomas are a heterogeneous group of neoplasms. Screening strategies designed for and effective in detecting squamous cell carcinoma precursors are less effective in detecting endocervical glandular precursor lesions.Because of this and possible other reasons,the real and relative incidence of endocervical adenocarcinoma has increased in recent years from 5% to up to 20-25%, particularly in patients 30yr of age or older.MATERIAL AND METHOD: It was a retrospective record based study, performed in the Department of pathology, RIMS Ranchi. Study population included all cases who were clinically suspected of any cervical pathology, with common clinical presentation of abnormal vaginal bleeding, intermenstrual heavy bleeding,postmenopausal bleeding,postcoital bleeding,whitish discharge per vagina,pain in lower abdomen, from January 2020- july 2021.RESULT:In our study incidence of SCC of cervix is 91.97% and second most common type is adenocarcinoma of cervix with incidence of 8.02%.Striking feature of adenocarcinoma of cervix is its preponderance in younger female as compared to SCC
L.B.Thamil Yazhini

The main intension of this paper is to manifest how Anita Nair describes Indian Feminism,culture and demeanor through the women characters in her novel “Ladies Coupe”.Anita Nair is one of the most celebrated women writers in India.She often focuses on the dilemmas of women in Indian society and how they strive and tackle the predicaments to seek the independence, cachet and ipseity in the patriarchal society. Indian society is ow sequestered, conventional and importunate some particular code of deportment from women. Moreover, Indian society have not been correctly followed and show obeisance to rules and regulations,law and decree rather it’s prying well into other’s life and spread gossips but it will willingly certainly have acquainted and teemed with “class and caste”!!! Feminism is a tussle for equality of women or it’s an endeavor to make women equal to men.Feminism trusts gender bias wants to be annihilated so that egalitarianism can ambit it’s utmost perspective.The novel raises a question can a women stay single;and lead an ecstatic,contented life without men.
Dailiah Roopha P, Arumugam K, Velraj B

Seaweed is the familiar name for immeasurable species of marine algae that grow in the Ocean. Many types of seaweed contain anti-inflammatory and anti-microbial agents and also possess powerful cancer fighting agents that ultimately prove in the treatment of malignant tumours and leukaemia in people. The purpose of the present work was to determine the anti-toxicity response of seaweed Sargassum wightii against on thyroid gland of cadmium treated Rats. An extract prepared from S.wightii was treated orally every day at a dose level of 200mg/kg of body weight to the rats exposed to 50ppm cadmium for 30 days. Histopathological analysis of thyroid gland showed that an administration of S.wightii treatment reduced the histopathological inflictions and enhancing endocrine functioning in cadmium treated rats.
Niranjana Niranjana, Ren Feng

The worldwide pandemics are the common enemy of all mankind.When faced with the global pandemics, it becomes necessary for all nations to strengthen cooperation.Although India and China are close neighbors in Asia,their media coverage of each other in 2020 was extremely asymmetrical.Nonetheless,this media coverage should be strengthening communication and cooperation.Only in this way can it benefit the people of the two nations and ultimately realize a coprosperity and collaborative development.
Shashank Sharma, Ajith Kumar M S, Sudheer Sharma, Sp Agnihotri

INTRODUCTION: Extrapulmonary Tuberculosis (EPTB) accounts for 15- 25% of all TB cases. It is more difficult to diagnose than Pulmonary tuberculosis and often requires invasive procedures to obtain tissue and or fluid samples. Histology is time-consuming and establishing a diagnosis of TB with high specificity remains difficult. Tissue smear microscopy after special staining is often negative. Tissue culture often leads to considerable delays compromising patient care and outcomes. AIMS AND OBJECTIVES:1. To diagnose Extra Pulmonary Tuberculosis by Gene Xpert(Xpert MTB/Rif assay or CBNAAT) and Liquid Cultures. 2. To evaluate the Sensitivity and Specificity of Gene Xpert in Extra Pulmonary Tuberculosis in comparison with Liquid Culture MGIT960 system. MATERIALS AND METHODS: This retrospective cross-sectional study was carried out by reviewing all suspected extra pulmonary tuberculosis samples of 430 patients attending OPD at Institute of Respiratory Diseases, Jaipur from April 2020 to March 2021.The extrapulmonary samples (pleural fluid,CSF,pus,BAL,Ascitic fluid,Synovial fluid,Gastric aspirate,Liver aspirate) were subjected to GeneXpert and Liquid culture MGIT960 system. RESULTS: Of the 430 Extra Pulmonary Samples, The Sensitivity and Specificity of CBNAAT was 79.77% and 95.30% respectively in comparison with Liquid Culture. Out of the 430 Samples CBNAAT was Positive in 87 samples of which 71(81.60%) were Rifampicin sensitive and 16(18.39%) were Rifampicin Resistant.Out of the 430 Samples,Liquid cultures was Positive in 89 samples. CONCLUSION: Gene Xpert has a notable advantage of detecting tuberculosis within two hours which is acceptable to all clinicians to institute early treatment.CBNAAT is one of the rapid diagnostic tests available in the country and it should be routinely used under the public and private health sector effectively to detect early tuberculosis in Extra Pulmonary Samples.
Manju Singh, S N Gole, S L Nirala, T Narasimha Murty

Metaplastic breast cancer constitute nearly 1 % of all breast carcinoma cases. There is metaplasia of normal epithelial components of the breast into other types. They are highly aggressive with very poor prognosis. Here we present a case of 30 year old female who presented with a breast lump in her left breast associated with dull aching pain. It was 10 x 10 cm in size involving upper inner, upper outer, lower outer quadrants and retroareolar area of left breast. USG was suugestive of BIRADS VI lesion. Axillary lymph nodes were not found enlarged clinically or radiologically. Core biopsy report showed Phylloides tumor of breast. The patient underwent simple mastectomy of left breast and histopathology revealed spindle cell variant of metaplastic breast cancer. The cell blocks sent for immunohistochemistry were negative for estrogen, progesterone receptors and Her2neu receptor. The post surgical treatment of this type of breast cancer is still under study.
Narendra Kumar Singh, Vikas Kumar, Nirmala Kumari Ahirwar, Laxmi Narayan Rathore

Children and Adolescents are seen to be using cell phonesand the internet to gather information and communicate with each other across the country.This way of communication with others is the unique feature of the Digital Age which gives powerful new styles for children and adolescents to create and peregrinate their social environments. Digital Age has a simultaneous impact on Children and Adolescents along with their physical development and development of identity, morality,and sexuality.Existing Published literatureindicated that connections between children and adolescents playing violent video games can cause aggressive behavioral problems later on.Digital Age has been known to have its impact on children and adolescents in form of diminished cognitive skills and poor academic and social development in addition to poor relationshipsandperceptionsof reality.
G.V.D. N. Prasad Rao, P.V.V. Satyanarayana, D. Suryachandra Rao

The mutual fund industry in India has registered significant growth since the liberalization of Indian Economy in 1991 and has emerged as a significant financial intermediary.The growing importance of Indian mutual funds may be noted in terms of the increased mobilization of funds and the increasing number of schemes and investors in the industry.The results show that there is a significant association between educational qualification of the investors and the risk tolerance level and occupation of the investors and the risk tolerance level.The results further indicate that there is no significant association between occupation of the investors and the level of knowledge of mutual fund and monthly savings of the investors and the level of knowledge of mutual fund.Therefore, the investors have to consider the prevailing rate of risk free returns and to compare the fund returns with it. Based on this the selection of schemes and the choice of investment avenues can be decided.Due to the fund man timing skill,stock selection ability,imperfect diversification the schemes had suffered with low return. Hence to increase the fund return the concerned fund managers have to improve all these skills.
Saroj Mandal, Vignesh. R, Sidnath Singh

BACKGROUND:Coronary artery disease (CAD) is one of the most common causes of mortality and morbidity in both developed and developing countries. It is a leading cause of death in India, and its contribution to mortality is rising. Considering the increasing burden of coronary artery disease and its mortality and the usefulness of identifying risk factors, studying the clinical profile and angiographic pattern will help us intervene the disease at various levels which can help control the morbidity and mortality of coronary artery diease. MATERIALS AND METHOD: The present study was conducted in the Department of Cardiology,IPGMER & SSKM Hospital,Kolkata during the period of January 2019 to December 2019.This is a hospital based observational prospective study with prospective data collection,where all patients of coronary artery disease who had undergone coronary angiography has been taken into consideration to find out the risk factors,clinical profiles and angiographic patterns in coronary artery disease patients in Kolkata. RESULTS: Maximum patients were present in the age group 51-60 years of age.Mean age is 56.7+11.6sd.Male patients were 70% and female patients were 30%.Most common symptom was chest pain,90% of patients had it during the time of presentation.The next frequent symptom was shortness of breath which was seen in 52% of patients. Most common risk factor was smoking which was seen in 58% of patients.Next frequent risk factor being hypertension seen in 43.5% of patients.Obesity was seen in 59.2% of patients.On coronary angiography,40% of patients had Single vessel CAD,27.3% had double vessel CAD,23.5% had Double vessel CAD,6.5% had Non-Significant CAD and 2.7% had Normal coronaries(recanalized epicardial coronaries).LAD was involved in 73.5% of patients,51.7 % had RCA involved,43.5 % had LCX involved and LMCA was involved in 1.7% of patients. CONCLUSION:Smoking and hypertension are the most common risk factors.Single vessel disease is the most common angiographic pattern.Risk factors should be addressed properly to decrease the morbidity and mortality of coronary artery disease
Amarjyoti Amarjyoti

This paper seeks how market research make impact on digital marketing .Digital marketing is the path for the marketers through electronic communication to channelize the goods and services towards market place.Digital marketing is the method of promoting a brand,a product,or a service through one or more forms of electronic media such as the Internet, mobile instant messaging,wireless text messaging,podcasts,online radio channels,digital television,and mobile apps. Market research is the process of gathering valuable information about the needs and preferences of consumers.It helps in determining if there is market for a product or service and is a key part in developing any business.It gives businesses an insight into the profiles and spending habits of consumers and provides companies with the data necessary for making good business decisions.
Kinjal Patel, Pragya Chaturvedi, Anu Bhandari

Femoral-facial syndrome (FFS) is an extremely rare fetal malformation. It comprises bilateral femoral hypoplasia and craniofacial dysmorphism. Maternal diabetes is associated with approximately 40% of cases of FFS. We present the case of Femoral-Facial syndrome of Newborn female child. She was delivered by vaginal route at 36th week of gestation. Mother had a history of type 2 diabetes mellitus. She was having markedly shortened bilateral lower limbs, deformed hip joint and mild talipes equino-varus deformity of left foot. There was prominent forehead, short nose with broad tip, long philthrum, thin upper lip, micrognathism and malformed low set external ears. Skeletal radiograph shows complete absence of right femur and marked hypoplasia of left femur.
P. Surendhar, R. Rani Suganya, P. Anitha

One of the most underrated aspects of surgical procedure is the very placement of skin incisions. Several factors inuence the post-operative morbidity, outcome and satisfaction of a patient. One such being the very placement of a skin incision by the surgeon. Even though the trend nowadays is to opt for laparoscopic and mini-incision surgery, the rst and basic rule in surgery is to have an incision that will be comfortable for the surgeon and provide adequate access to the area of pathology. The purpose of this study is to compare vertical and horizontal skin incisions during umbilical and paraumbilical hernia repair that makes the surgical technique and post-operative outcome much more favorable. In this study, we compare the intraoperative difculty, post operative wound healing and morbidity between these two techniques.
M.Selvi Annie Geeta, Lakshmi K.Nair

INTRODUCTION: Cataract surgery is one of the most commonly performed surgery in the elderly patients. Regional anesthesia is safe, reliable, provide adequate akinesia and analgesia of the eye, a good postoperative pain relief and a shorter hospital stay. The various regional anesthetic techniques used in ophthalmic surgeries are peribulbar block, retrobulbar block, sub tenon's block, subconjunctival block and topical corneo-conjunctival anesthesia. Due to its safer approach, the peribulbar block is most commonly. Addition of an opioid like fentanyl to the anesthetic preparation will provide a faster onset of lid and globe akinesia, faster onset of sensory blockade, increase the duration of analgesia and reduce the need for rescue analgesia postoperatively. AIM OF THE STUDY: To evaluate the effect of addition of fentanyl to the local anesthetic mixture in peribulbar block in cataract surgery. MATERIALS AND METHODS: This study was done in the Department of Anesthesiology in collaboration with the Department of Ophthalmology in Kanyakumari Government Medical College from January 2019 to December 2019. Patient posted for cataract surgery were allocated into two groups by randomization (30 each). Group S – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 0.5ml normal saline. Group F – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 25 mcg Fentanyl (0.5 ml). The Parameters related to the study such as Onset of lid akinesia, Onset of globe akinesia, Onset of sensory blockade, Duration of analgesia by VAS score, Level of sedation by Ramsay sedation score, vital parameters – SpO , pulse rate, respiratory rate, blood pressure and any 2 Complications were recorded. RESULTS: We found that the demographic parameters were comparable and statistically insignicant. The preoperative hemodynamic parameters like the systolic and diastolic blood pressure, pulse rate, SpO2, respiratory rate were statistically insignicant and comparable. The mean onset of lid akinesia was 5.8 ± 1.76 mins and 3.13 ± 1.25 mins in Group S and Group F respectively. The mean onset of globe akinesia was found to be 7.46 ± 2.22 mins and 4.2 ± 1.60 mins in Group S and Group F respectively. The mean onset of sensory blockade was 6.8 ± 1.24 mins and 4.93 ± 1.63 mins in Group S and Groups F respectively. Thus the onset of globe and lid akinesia and the onset of sensory blockade was faster in Group F compared to Group S. The mean VAS scores were statistically signicant (P0.05) in both the groups. The mean duration of analgesia was 4.56 ± 1.65 hours in Group S and 7.63 ± 2.55 hours in Group F and was found to be statistically signicant(P<0.001). CONCLUSION: Based on this study, we can conclude that there is a faster onset in the lid akinesia, globe akinesia, in the onset of sensory blockade and a substantial increase in the duration of analgesia when fentanyl is used as an additive along with the local anesthetic mixture in peribulbar block for cataract surgery
Rahul Kumar, Wasim Ahmed, Indrajeet Kumar

Purpose: To evaluate intraoperative variables and postoperative outcomes of intertrochanteric fractures with vulnerable/broken lateral walls managed with short and long cephalomedullary nails. Materials & Methodology: Twenty prospective cases of patients treated with LCMN and twenty retrospective cases treated with SCMN were included in the study. Intraoperative variables compared were duration of surgery, blood loss during surgery, and surgeon's perception of surgery. Functional outcome was evaluated by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12 at one year. Radiological assessment were done at six months/one year to look for progress of fracture union, change in neck-shaft angle, and any signs of implant failure. Results: Duration of surgery (p<0.001), blood loss during surgery (p=0.002), and surgeon's perception of surgery (p=0.002) were signicantly more in the LCMN group. The LCMN group had a better functional outcome. HHS for the LCMN group was 89.15±9.53, and for the SCMN group it was 81.53±13.21 (p=0.021). PPMS for LCMN group was 8.85± 0.67 and for the SCMN group was 7.53±1.807 (p=0.005). There were four implant failures in the LCMN group compared to none in the SCMN group (p=0.036). Conclusion: Both SCMN and LCMN are effective treatment modalities for unstable intertrochanteric fractures with vulnerable/broken lateral walls. In the absence of more extensive study and long-term follow-up, the superiority of one implant over the other cannot be recommended.
Mangesh Machindra Londhe, Tushar Vithalrao Patil, Kishor H Suryawanshi, Priyanka Sunil Gaikwad

Lymphangiomas of breast are rare with only a few cases being reported so far. Among these secondary lymphangioma have been reported but cases of primary lymphangioma are even rarer. Due to its proclivity to mimic malignancy clinically, its accurate diagnosis plays a crucial role in management of these patients. This is a unique case where cytology suggested a diagnosis of vascular malformation ruling out malignancy, thus avoiding unnecessary surgical exploration along with untoward effects of chemo/radiotherapy. The histopathology revealed diagnosis of lymphangioma circumscriptum of breast
P. Paparao, A. Armuthavalli Devi

An attempt was made in the present investigation is Aim: Emotional Intelligence among intermediate students. Objectives: To study the inuence of gender, type of management and locality among intermediate students. Sample: The sample of the present investigation was selected 1200 intermediate students in Guttur, Prakasam and Nellore districts of Andhra Pradesh State of India. The subjects were in the age group from 15 to 18 years and using systematic random sampling technique. Tool: Emotional Intelligence Scale developed by Nutankumar Thingujam, and Usha Ram (1999) was used. Research Design: As there are three independent variables i.e., gender (male & female), type of management (government & private) and locality (rural & urban), each is divided in to two categories, a 2×2×2 factorial design was employed in the present study. Statistical Analysis: Means, SDs and Analysis of Variance (ANOVA) were used. Results: Results revealed signicant impact of gender, type of management and locality with regard to Emotional Intelligence. Conclusions: Females have high Emotional Intelligence than males; private college students have high Emotional Intelligence than government colleges and students of urban areas have high Emotional Intelligence than students of rural areas.
Shalini. A

WHO denes self medication as “the selection and use of medicines by individuals to treat self recognized illnesses or symptom”. Symptom based self medication has been prevalent among adult population done through OTC drugs to save cost, time & convenient without consulting a doctor. Aims: Our study aimed to assess the inuencing factors among self medication users based symptoms, drug usage pattern & other factors Methods and Material: After obtaining ethical committee clearance, 132 adults who undertook self medications were interviewed on socio demographic details & inuencing factors for self medication was asked upon where. Data analyses are expressed in frequency with percentage. Results: Based on the self medication practice age group 40-49 years & 20-29 years, females, education(Graduate & above - 50.8%), occupation (professional - 25%) were being predominant users of self medication in our study. Pharmacy/pharmacist played a major role based on the source (97%), knowledge on dose (50.8%). The major reasons for self medication practice were convenience (40.9%) & cost saving (31.1%). The most commonly used drugs were NSAIDS 42.1%, cough syrups 12.9% & antibiotics 8.6%. Based on the symptom based self medication fever, headache & pain accounted for the majority. Conclusions:In a country like India pharmacies acts as the rst point of contact between the patient and the health care system so patient awareness programs, support of pharmacists, stricter laws are required to optimize the use of OTC medicines thereby reducing self medication practice as well as drug dependence, antibiotic resistance.
Lija R Nath, Haseena T.A

Human civilization probably is passing through the most critical juncture of this millennium. Its existence is being challenged by the emergence of severe acute respiratory syndrome coronavirus (SARS-Cov-2) pandemic. The impact of COVID-19 on mental health of the masses has emerged as a matter of enormous concern. The purpose of the study was to assess the anxiety and obsessive thoughts associated with COVID-19 pandemic among general population. The study was conducted among 720 Indians living in different parts of the world. Data was collected by online survey with coronavirus anxiety scale (CAS) and Obsession with COVID-19 Scale (OCS). It was found that out of the 720 participants 86 (12%) felt extreme social isolation due to COVID 19 pandemic. Nearly one third of the participants (28%) reported moderate level of anxiety and majority of the respondents (62%) experienced disturbing thoughts about contracting COVID-19.
Rahul Kumar, Rajni Kumari, Shailesh Kumar, Santosh Kumar

Background: There is a lack of reports on spinal tuberculosis in children. We report a retrospective analysis of 124 children with TB spine treated over 30 years. Materials and Methods: One hundred twenty-four patients were included in our study. Ninety-one children were treated conservatively, while 33 children were subjected to surgery for focal debridement (n=23), posterior interspinous wiring and cementation (n=4), and posterior instrumentation with rods and segmental wiring (n=14). Thus, some of the children in the current series belonged to conservative study patients. Results: All children attained healed status and showed neural recovery (n=18). The patients attained healed status at 12 months. Spontaneous intracorporal fusion occurred only in 8.06% of 124 children. Sagittal curves during growth showed three different patterns: Unchanged, decreased, and increased curves. The residual kyphosis was unavoidable in cases with growth plate damage. Kyphosis increased in cases with wedged monovertebra and fused wedged block vertebra, though it was different at a different level. Conclusion: The posterior instrumented stabilization alone could correct or prevent the progress of the kyphosis. However, for active tuberculosis, posterior instrumented stabilization combined with anterior radical surgery should be reserved only for advanced tuberculosis with instability, the rapid progress of kyphosis, and unacceptable pre-existing kyphosis. There is a new trend of prophylactic posterior instrumentation, even for early tuberculosis.
Mishra Braja Mohan, Mishra Sandeep, Bedbak Biswajeet

Gall stone is the most common risk factor for carcinoma gall bladder. The aim of this study nds out the prevalence of malignancy in patients with Cholelithiasis. All the radiologically diagnosed cased of cholelithiasis underwent surgery were taken into consideration. All the cases of cholelithiasis operated of in General Surgery Department of VSSIMSAR, Burla were considered for study. The diagnosis conrmed by Ultrasonography /MRCP in Department of Radio diagnosis. Total numbers of patients operated are 347, out of which 279 undergone laparoscopic surgery, 58 cases undergone open surgery and 10 cases converted from laparoscopic to open surgery. Most number of patients belongs to age group 31-40, consisting of 32.85% of total number, followed by age group 41-50, and consisting of 25.07%. A female patient constitutes about 77.81 % of total number. Male: female ratio is 1: 3.5. The mean age of the patients of study group is 41 .71. Mean age of female patients is 41.09 and male is 43.88, p value 0.072 (no signicant deference between mean of female and male). The excised specimens sent for histopathological examination in Department of Pathology, VSSIMSAR, Burla. Out of 347 cases nine cases found to have carcinoma specically adenocarcinoma of gallbladder.
Jitendra Kumar, Manish Narayan, Bindey Kumar

Arterial hypertension represents a major global health concern; more than one fourth of the population is affected by high blood pressure. Albeit the underlying cause of the disease remains unclear in the vast majority of the cases, ~10% are of secondary origin. Endocrine disorders are common illnesses and some of them may lead to elevated blood pressure, among which thyroid diseases are of high prevalence and often overlooked, especially in mild cases. Overt and subclinical hyper- and hypothyroidism can both lead to (mostly mild) hypertension; however, the underlying mechanisms are only partially understood. The results of clinical studies are often controversial. During the past decades, some genetic mutations in the hypothalamus-pituitary-thyroid axis with cardiovascular consequences were revealed. Atherosclerotic changes resulting from lipid abnormalities due to thyroid dysfunction also affect the vasculature and can cause elevated blood pressure. The review gives a synopsis of our knowledge how thyroid hormone metabolism and functional thyroid diseases affect the cardiovascular system, their negative impact and causative role in the development of hypertension.
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