Adenosine Triphosphate Binding Cassette Transporters are among largest families of protein. ABC transporters move both inorganic and organic molecules across membrane. 49 types of ABC Transporters are located in kidney, liver and brain etc. Transmembrane and nucleotide binding domains form ABC transporters. Moreover, various monogenic as well as multi-genic disorders have associated with ABC Transporters. But still the data available is not sufficient that reveal the potential of ABC transporters. Hence this review has been designed with a view to locate more receptors and their therapeutic potential so that the disorders associated with them can be managed efficiently

Abbreviations:

ATP = Adenosine Triphosphate

ABC = ATP Binding Cassette

CFTR = Cystic Fibrosis Transmembrane Conductance Regulator

TMD = Transmembrane Domain

NBD = Nucleotide-Binding Domain

AD = Alzheimer’s disease

HDL = High Density Lipoprotein

Introduction: Hydronephrosis is usually a common finding in pregnancy. Ultrasound (USG) is the best modality for diagnosis and follow-up for both prenatal and post-natal hydronephrosis. Aim: To assess prevalence of hydronephrosis and feto maternal outcome in pregnant women with hydronephrosis. Methods: This is prospective observational study conducted at the Departments of Obstetrics and Gynaecology of tertiary hospital of Rajasthan state which is in the North-Western part of India, over a 1-year period, from july 2023 to june 2024. Results: One hundred three pregnant women were taken. The prevalence of hydronephrosis was found to be 24.27%. The right kidney was affected in 68% cases, left kidney was affected in 24% cases and 8% had bilateral hydronephrosis. 96% cases of hydronephrosis were managed conservatively and 4% cases were managed surgically by DJ stenting. Conclusions: Hydronephrosis in pregnancy is mostly physiological which can be treated conservatively with minimal maternal and fetal morbidity.

The present study compared the psychiatric morbidity, personality traits, and stressful life events between patients with deliberate self-harm (DSH) and non-DSH patients. One hundred and fifteen consecutive cases of deliberate self-harm presented to a referral hospital were evaluated after being referred to psychiatric evaluation with the help of semi structured proforma. There were only 14 (12.2%) patients out of 115 who had attempted suicide during their illness with a male preponderance. There were 15(27.8%) males and 4(6.6%) females who had history of psychiatric hospitalization present. Stressed relations were the most common associated problems with males having stress with their siblings and females with their in-laws. DSH group patients had significantly high levels of (indicated by scores) neuroticism and psychoticism scores, and significantly low level of extraversion scores as compared to their respective control.

Introduction: Ileostomy is very common in surgical practice. The temporary ileostomy was introduced to decrease the clinical consequences of an anastomotic leak and shown to reduce the risk of anastomotic leakage as such. Aim: To study ileostomy closure complications rate. Methods:  Hospital based study on 100 patients undergoing ileostomy closure following bowel surgery, for one year at Dept. of Surgery, S.P. M. C , Bikaner. Patients were subjected to stoma closure after valid written informed consent. Results:  Male to female ratio was 2.33:1 with mean age of 45.35±16.25.  Mean BMI was 20.96±1.5 kg/m2. Mean time operative time for stoma closure was 73.35 ± 6.60. Maximum 12 patients had electrolyte imbalance followed by 7 had wound infection, 8 patients had intra abdominal collection followed by 5 obstructions. Conclusion: The rate of complications associated with the stoma was non-negligible, so strict criteria should be applied when deciding whether to use a stoma and with its closure time.

Introduction: The constant pressure of dealing with life-and-death situations imposes significant stress on doctors, adversely impacting their mental health and increasing their risk of various health issues. AIM: To study mental and physical health and prevalence of comorbidities in doctors. Methodology: In a cross-sectional observational study conducted over 18 months from September 2022 to March 2024, the research aimed to investigate a specified phenomenon within the population of Mahatma Gandhi Medical College & Hospital. The study included all consultants and post-graduate residents across both clinical and paraclinical branches of the institution. Result: Doctors, especially residents and those in clinical subjects, experience higher rates of co-morbidities, depression, and anxiety, influenced by long duty hours, high work pressure, and poor lifestyle. Conclusion: The study reveals the adverse effects of demanding work environments on doctors' physical and mental health, highlighting the need for reduced duty hours, improved mental health support, and better workplace conditions.

Objective: To evaluate the efficacy of foraminal steroid injection in relieving chronic lumbosacral radicular pain and determine the clinical outcome of the treatment. Methodology: A cross-sectional study was conducted at the Orthopedic & Spine Unit of Hayatabad Medical Complex, Peshawar from February, 2023 to January, 2024. A total of forty-four participants who had lumbar radicular pain radiating to the leg(s) were included in the study. Patients with known contraindications, current infection, history of lumbar steroid injection or spinal surgery, neurological deficits were excluded from the study. Clinical outcomes were determined with the help of patient satisfaction scale, a visual numeric pain scale and a Roland-Morris low back pain questionnaire finger-to floor distance. Results: At the end of the study period of 12 months, the patient satisfaction score had increased from 0.7 ± 0.5 to 3.1 ± 0.7, the mean Roland-Morris score was increased from 7.8 ± 1.4 to 24.3 ± 1.6, the visual numeric pain decreased from 9.7 ± 1.5 to 2.3 ± 0.8, and the finger-to-floor distance reduced from 65.6 ± 1.7 cm to 18.6 ± 1.3 cm. Overall, 88.6% of the patients in our study had a successful clinical outcome, obtaining a greatest improvement within 6-8 weeks of treatment. Conclusion: We reported a very promising clinical outcome among patients being treated with foraminal epidural steroid injection in alleviating the chronic lumbosacral radicular pain

This study compared the various factors that might have contributed to deliberate self-harm attempts in patients admitted to a referral medical center from June 2009 to July 2010 and was compared with questionnaire filled from humans who have never attempted DSH (Control). It was concluded that social stress of family, society or environment and psychiatric disorders are the commonest cause of deliberate self-harm attempts in individuals and an easy access to organophosphates or other poisons facilitates the same.

Infantile colic is a common condition characterized by excessive and inconsolable crying in otherwise healthy infants. Despite its prevalence, effective treatments remain limited. This study investigates the efficacy of probiotics in reducing symptoms of colic in infants. A randomized, double-blind, placebo-controlled trial was conducted with 100 infants diagnosed with colic. Participants were divided into two groups, with one receiving a daily probiotic supplement and the other a placebo. The primary outcome measured was the reduction in daily crying duration over a four-week period. Secondary outcomes included changes in gut microbiota composition and parental stress levels. Results indicated a significant reduction in crying duration in the probiotic group compared to the placebo group. Additionally, beneficial changes in gut microbiota and decreased parental stress were observed. These findings suggest that probiotics may be an effective intervention for managing colic symptoms in infants.

Background: The suprascapular notch, located on the superior border of the scapula, plays a key role in the passage of the suprascapular nerve and vessels. Variations in its presence or absence can significantly impact clinical outcomes, particularly in cases of suprascapular nerve entrapment. Despite its importance, the anatomical variation of a completely absent suprascapular notch has not been extensively studied. This research aims to explore the incidence of a completely absent suprascapular notch in dry scapulae and to examine its potential clinical implications. Understanding these variations is essential for improving surgical techniques and preventing nerve injuries during shoulder procedures. This study aimed to document and compare the incidence of complete absence of suprascapular notch and to know its clinical significance. Materials and Methods: Sixty adult scapulae of unknown age and gender were analyzed in this cross-sectional study in the anatomy department of the Bhagwan Mahaveer Institute of Medical Sciences in Pawapuri, Nalanda, Bihar (India). Among that, thirty scapulae belong to the right side and thirty to the left. Each scapula was observed for the absence of the suprascapular notch. Results: We found that the majority of the scapulae, 55 out of 60 (91.67%), had a suprascapular notch. Specifically, 27 right scapulae (45%) and 28 left scapulae (46.67%) had the notch. On the other hand, only 5 scapulae (8.33%) were missing the notch 3 from the right side (5%) and 2 from the left side (3.33%). The incidence was more prevalent on the right-side scapula as compared to the left side. However, the statistical analysis showed no significant difference between the right and left scapulae regarding the presence or absence of the notch. Conclusion: This study reveals that a completely absent suprascapular notch varies among populations and may increase the risk of suprascapular nerve entrapment neuropathy. Recognizing this anatomical variation is vital for surgeons to avoid inadvertent nerve injury during shoulder surgeries.

Hepatocellular Carcinoma is a fatal disease and the third biggest cause of mortality from cancer. Because chemotherapy treatment may have a variety of adverse effects, the use of alternative cancer therapies has been a prominent focus of study. When compared to other drug discovery sources, traditional medicine has given several unique therapeutic molecules for preventative and curative therapy. This study examined the hepatoprotective potential of an ethanol-based extract of Zanthoxylum rhetsa fruits against Swiss albino mice's Diethylnitrosamine (DEN)-induced liver cancer. The animals were given oral dosages of 100 and 250 mg/kg body weight of the ethanolic extract, whereas DEN was delivered intraperitoneally once a week for 21 days. At the end of the treatment period, the animals were sacrificed, and liver tissue as well as blood were obtained to determine marker enzymes and oxidative stress indicators. On estimate, the treated group showed an improvement in the marker and antioxidant activity. These findings showed that the increased enzyme levels revealed a protective mechanism for Z rhetsa fruit extract in DEN-induced HCC in mice. The biochemical parameters were corroborated by histological examination of the animals' livers. As a result, ethanol extracts of Z rhetsa fruits have substantial anticancer effects.

Background: Cesarean section (C-section) is a common surgical procedure, with postoperative care playing a crucial role in recovery. Traditionally, oral feeding is delayed post-C-section, but recent evidence suggests that early oral feeding may improve recovery outcomes. This study aimed to compare early versus late oral feeding after C-section in a tertiary care hospital in Rajasthan, India. This study was aimed to compare the return of bowel movements in women undergoing cesarean sections under regional anesthesia who are given early oral feeding versus late oral feeding. Methods: This prospective clinical study, conducted over 12 months, included 250 women undergoing elective cesarean delivery at Sardar Patel Medical College, Bikaner, Rajasthan. Participants were randomized into two groups: 125 received early oral feeding (Group A ;>6 hours) and 125 received late oral feeding (Group B ; >12 hours). Data on postoperative outcomes, including the return of bowel sounds, passage of flatus, ambulation, need for injectable analgesics, maternal satisfaction, and hospital stay, were collected and analyzed. Results: The EOF group showed significantly faster recovery, with a higher return of bowel sounds at 12 hours (77.60% vs. 56.00%, p = 0.0001) and earlier passage of flatus (69.60% vs. 52.00%, p = 0.007). Patients in the EOF group also had better ambulation at 24 hours (94.40% vs. 73.60%, p = 0.0001), required fewer injectable analgesics (9.60% vs. 44.80%, p = 0.022), and experienced shorter hospital stays (mean 4.16 days vs. 7.09 days, p = 0.0001). Maternal satisfaction was significantly higher in the EOF group. Conclusion: Early oral feeding after cesarean section significantly improves postoperative recovery, leading to faster return of bowel function, reduced need for analgesics, shorter hospital stays, and higher patient satisfaction. These findings support the implementation of early oral feeding protocols in post-cesarean care.

Objective: To investigate the correlation between histopathological features and hormonal profiles in patients with Type II diabetes. Methods: A cross-sectional study was conducted with 185 patients diagnosed with Type II diabetes. Histopathological analysis was performed on biopsies from the pancreas, liver, and kidneys, assessing beta-cell depletion, fibrosis, and other tissue changes. Hormonal profiles, including insulin, glucagon, adiponectin, leptin, and cortisol levels, were measured using ELISA.  Results: Significant beta-cell depletion (75%) and liver fibrosis (58%) were observed, with a strong negative correlation between beta-cell depletion and fasting insulin levels (r = -0.68, p < 0.001). Elevated glucagon levels were positively correlated with kidney basement membrane thickening (r = 0.63, p < 0.001). Lower adiponectin levels were associated with increased liver fibrosis (r = -0.52, p < 0.01), and higher cortisol levels correlated with the accumulation of advanced glycation end products (r = 0.58, p < 0.01). Conclusion: The study concludes that significant correlations exist between histopathological features and hormonal profiles in Type II diabetes, emphasizing the need for comprehensive treatment approaches that address both cellular and hormonal aspects to improve patient outcomes.

Background: Short stature in children can result from various causes, including familial short stature (FSS). FSS is characterized by a hereditary pattern where the height of the child is below the normal range for their age and sex but is consistent with the heights of one or both parents. Objective: This study aims to determine the frequency of familial short stature in children presenting with short stature. Methods: Data were collected on demographic information, clinical history, and growth patterns. Parental heights were obtained, and mid-parental height was calculated to determine the target height range for each child. Familial short stature was diagnosed and biochemical tests were conducted to rule out other potential causes of short stature. These tests included thyroid function tests (T3, T4, TSH), growth hormone levels, insulin-like growth factor 1 (IGF-1), complete blood count (CBC), and metabolic panel including liver and kidney function tests.  Results: The study included 500 children presenting with short stature, comprising 260 boys (52%) and 240 girls (48%). The age of the participants ranged from 2 to 18 years, with a mean age of 10.5 ± 4.3 years. The distribution of the participants across different age groups was as follows: 2-6 years (20%), 7-12 years (40%), and 13-18 years (40%). The mean height was 145.3 ± 7.2 cm, with boys taller (150.2 ± 7.5 cm) than girls (140.3 ± 6.8 cm). The study revealed a higher prevalence of familial short stature (FSS) in boys (55.8%) compared to girls (43.8%). This difference was statistically significant, with a p-value of 0.002, indicating a notable gender disparity in the occurrence of FSS among children with short stature. Conclusion: Familial short stature is a common cause of short stature in children, accounting for 42% of the cases in this study. Awareness and recognition of FSS are important for appropriate diagnosis and management, avoiding unnecessary investigations and interventions. 

Background: Kidney transplantation is the preferred treatment for end-stage renal disease. Early surgical complications can have profound effects on post-transplant outcomes. Methods: In this prospective observational study, 85 kidney transplant recipients were followed. Early surgical complications within 30 days post-transplant were categorized as vascular, urological, or wound-related. Patient demographics, type of complication, and subsequent clinical outcomes were recorded and analyzed. Results: Among the 85 patients, 22 (25.9%) experienced early surgical complications. Vascular complications were the most frequent (n=12, 54.5%), followed by urological (n=7, 31.8%) and wound-related complications (n=3, 13.6%). Patients with complications had a significantly higher incidence of delayed graft function compared to those without complications (45.5% vs. 12.5%, p=0.002). The median length of hospital stay was significantly longer in the complication group (15 days vs. 7 days, p=0.001). One-year graft survival was slightly lower in the complication group but did not reach statistical significance (80% vs. 88%, p=0.153). However, patients with complications had higher rates of acute rejection episodes within the first-year post-transplant (31.8% vs. 12.5%, p=0.041). Conclusion: It is concluded that early surgical complications significantly affect the outcomes of kidney transplant recipients, leading to increased graft dysfunction, longer hospital stays, and higher readmission rates.

Introduction: Pterygium takes its name from Greek word pterygos meaning 'wing'. AIM: To compare duration of surgery, post-operative complication, patient discomfort and graft stability between uses of suture less glue free versus suture for fixating conjunctival graft after primary pterygium excision and also compare the recurrence rate between two methods of primary pterygium excision after 6 months. Methods This study includes 100 patients to comparative study to evaluate the outcome of suture versus suture less glue free conjunctival Autograft for primary pterygium excision was conducted in department of ophthalmology at MBS Hospital, Kota from October 2021 to October 2023 after obtaining ethical committee clearance, all the patient underwent primary pterygium  excision by single experienced surgeon using the same standard technique the patient per examined on post operative Day-1,  one week, 1 month,3 months and 6 months, The technique used in our study is simple randomization technique. This technique maintains complete randomization of patient assignment to a particular groupSTATISTICAL ANALYSIS P value < 0. 05 was taken as significant data entry was done in Microsoft Excel for statistical purpose Results This perspective comparative study conducted on 100 in which 50 patients underwent primary pterygium excision with suture less technique and 50 patients with conjunctivalautografting with 10-0 nylon suture. A major proportion of patient were in the age group 41 - 50 years ( 30 patients 30%) , majority of patients were female numbering 68 patients ( 68%) while males were 32 number (32%), majority of patient had Grade-2 pterygium being 62 in number( 62%) while 28 patient (28%) had Grade -1 and 10 patients (10% ) had great 3 pterygium  The socialist glue free group had significantly laser post operative discomfort compared to Suture group. At post operative day one, week 1(p=0.000 at both day-1 and week -1). The difference was not significant. At first month postoperatively (P=0.077). And none of the patient in either group had any discomfort at 3 and 6 month The suture lessGlue free group had significantly lesser post-operative inflammation compared to Suture group at post-operative day 1 and week 1(p=0.001 at both day-1 and week 1). One patient in Suture group was had Suture Granuloma at third month postoperative follow up which was excised. Conjunctival graft secured with auto logos blood were at stable is those secured with such a day-1 and weak -1 1st, 3rd, and 6th month postoperatively.  In 4 patients recurrence were noted in each of groups Conclusion: Glue free limbal conjunctival Autograft is safe effective economical and its surgical outcomes following primary pterygium surgery are comparable to conventional suture limbal conjunctival Autograft with lower post-operative suture related complications, less patient discomfort and greater patient satisfaction

Background: Adherence to antiretroviral therapy (ART) is crucial for the treatment of HIV infection, and poor adherence can lead to drug-resistant strains and disease progression. In Nigeria, mobile SMS support has not been employed in the setting of UNTH Ituku Ozalla, Enugu. Methods: This study aimed to determine the effect of Mobile SMS support on ART adherence among adult HIV patients aged 18 years and above, confirmed HIV-positive status patients who had received antiretroviral drugs for at least one month prior to the study, and HIV positive patients attending ART clinic at UNTH who are owners of mobile phones with SMS capability. The study involved 227 participants, with the majority aged 31-40 years. Results: The intervention group had a higher proportion of good baseline adherence than the control group. The mean baseline adherence score was 89.67 in the intervention group and 90.75 in the control group. The proportion of participants with good adherence significantly increased after SMS intervention. The highest proportion of participants with good adherence was among females. Participants in the intervention group who had no basic education were less likely to be adherent than others. Non-use of alcohol and smoking were strong predictors of adherence. Conclusion: To control non-adherence, strategies to control reasons for forgetfulness should be adopted, and policy makers should consider funding programs proposing weekly mobile phone text-messaging as a means for promoting adherence to antiretroviral therapy.

Objective: To compare the outcome of intralesional injection of Hyaluronic acid with Triamcinolone and Triamcinolone alone in the management of Oral Lichen Planus. Methodology: This randomized controlled trial, conducted in the Oral & Maxillofacial Surgery department at Punjab Dental Hospital(PDH), Lahore, included 30 patients aged 20-70 years with histopathologically confirmed Oral Lichen planus (0.5-4 cm), using a Split mouth technique. One side of the lesion received intralesional Triamcinolone (40 mg/ml), while the other side received a combination of Hyaluronic acid and Triamcinolone. Pain and lesion size were assessed using a Visual Analogue Scale and measured at 2 and 12 weeks. Data was analyzed in SPSS version 20.0, with significance at P < 0.05, comparing mean pain scores and lesion disappearance between groups using t-tests and Chi-square tests. Results: Total 30 patients were included. The mean age of the patients was 48.76±14.67 year. Oral health assessment revealed that 9(30%) patients had good oral hygiene, and 15(50%) average hygiene.  At baseline and 2nd week mean pain score in Intervention group was 5.7±1.08, 1.60 ±0.62   and in control patients was 5.6±1.03 and 2.10±0.99. Disappearance of lesion showed no significant difference between groups. Although in intervention group rate of disappearance of lesion was higher. i.e. Intervention: 73.3% vs. Control: 50%, p-value=0.063 Conclusion: The conclusion of the study is that intralesional injection of Hyaluronic acid plus Triamcinolone is more effective than Triamcinolone alone for treating Oral Lichen Planus in terms of pain reduction and lesion disappearance.

Diabetic macular edema (DME) is a prevalent and debilitating complication of diabetic retinopathy, significantly contributing to vision loss in diabetic patients. Objective: The main objective of the study is to assess the efficacy of different dosages of suprachoroidal triamcinolone acetonide in treating refractory diabetic macular edema (DME). Methodology of the study: This randomized control trial was conducted at Gulf Nursing College DG Khan during 2022 to 2023. A total of 48 patients with refractory DME were enrolled in the study. Suprachoroidal TA injections were administered using a microinjector specifically designed for suprachoroidal delivery. The injections were performed under aseptic conditions by a trained ophthalmologist. Results: Data were collected from 48 patients. Each group consisted of 16 patients, with mean ages of 59.82±2.35 years for the 4 mg TA group, 61.11±1.98 years for the 8 mg TA group, and 55.78±4.56 years for the 12 mg TA group. The mean duration of diabetic macular edema (DME) varied slightly among groups, being 5.2±1.23 years for the 4 mg TA group, 4.9±2.98 years for the 8 mg TA group, and 6.1±1.76 years for the 12 mg TA group. All groups had a mean baseline central retinal thickness (CRT) of 500 micrometers and a mean baseline best-corrected visual acuity (BCVA) of 60 letters. The 12 mg TA group exhibited the most substantial changes, with a 55% increase in the percentage of patients achieving a ≥15-letter improvement in BCVA. Conclusion: It is concluded that suprachoroidal triamcinolone acetonide (TA) is effective in reducing central retinal thickness and improving best-corrected visual acuity in patients with refractory diabetic macular edema, with higher doses yielding more significant results.

Objective: To determine the efficacy of Mitomycin C in reducing Recurrence of Anterior Ureteral Stricture. Material and methods: This descriptive case series study was conducted at of Department of Urology, Shaikh Zayed Hospital, Lahore. 60 patients meeting the inclusion and exclusion criteria was included in the study through wards of Department of Urology, Shaikh Zayed Hospital, Lahore. Informed consent was taken. Basic demographics like name, age, gender was noted. A complete history, examination, and relevant investigations was completed in all patients. Later on, 0.1% mitomycin C was injected after IOU at the site in the 1, 5, 7, and 11 o'clock positions with a TLA needle using a straight working channel pediatric cystoscope. SCIC was not offered. Patients was regularly followed up after 1st and 3rd month. The follow-up consisted of history, examination, and uroflowmetry. Efficacy of the mitomycin was noted as per operational definition. Results: The mean age of the study patients was 43.53±9.5 years. The maximum flow rate was 28.56 with standard deviation of 12.33. The efficacy of the procedure was noted in the 46(76.7%) cases and absent tin the 14(23.3%). Conclusion: A high efficacy was observed after use of mitomycin c in the management of urethral stricture

Background: Non–alcoholic fatty liver disease is defined as accumulation of fat in the hepatocytes in the absence of significant alcohol consumption. It is chronic health problem with a clinical spectrum ranging from asymptomatic increase in the liver enzymes, which is a precursor of cirrhosis and hepatocellular carcinoma. Material and Methods: This study was conducted among 150 patients of hypothyroidism and 150 controls selected on basis of inclusion and exclusion criteria. Laboratory investigations including fasting lipid profile, fasting blood sugar, liver function tests and thyroid profile were performed in all participants of both study groups.  Results: Fatty liver was found in 57.33% of cases of hypothyroidism compared to only 22.67% of controls. Statistical analysis showed that the overall difference in incidence of fatty liver between both groups was highly significant (P<0.01). In subsets of patients with BMI<23 kg/m2 and with BMI in the range of 23–24.9 kg/m2, the presence of fatty liver on ultrasound was significantly more frequent in hypothyroidism cases compared to controls (P<0.01). Conclusion: Recognition of the risk factors for NAFLD and their early and effective management is an important aspect of good management strategy.

Background: Alzheimer's disease is a progressive neurodegenerative disorder characterized by cognitive decline and memory loss. Traditional histopathological methods, while effective, are limited by subjective interpretation and variability among pathologists. AI, with its capability to process and analyze large datasets, offers a promising complementary approach. Methods: The study involved 145 patients diagnosed with Alzheimer's disease. Various AI methodologies, including machine learning and deep learning, were applied to histopathological images of brain tissues.  Results: AI-driven analysis demonstrated superior performance in detecting hallmark features of AD, such as amyloid plaques and neurofibrillary tangles. The AI model achieved an accuracy of 92%, sensitivity of 90%, and specificity of 94% in identifying AD related pathological markers. This performance was significantly better than traditional histopathological methods, which had an accuracy of 80%, sensitivity of 78%, and specificity of 82%. The integration of AI significantly reduced diagnostic variability, with inter-pathologist agreement increasing from 70% to 90%. Conclusion: The synergy between AI and histopathology represents a significant advancement in Alzheimer's disease diagnosis. By leveraging AI's analytical power, the medical field can achieve more accurate and timely diagnoses, ultimately improving patient outcomes and advancing our understanding of AD pathology.

Background: Acute poisoning is a significant public health issue that results in considerable morbidity and mortality around the world. Autopsy examinations are essential in providing valuable insights into the pathological and toxicological aspects of poisoning cases, which helps in understanding the nature and extent of fatal exposures. This study aims to analyze autopsy findings from acute poisoning cases presented at a tertiary care center. By identifying trends, common toxic agents, and associated pathological changes, the study seeks to enhance both clinical and forensic approaches to poisoning. The findings can also inform preventive strategies and improve public health outcomes. Materials and Methods: This prospective cross-sectional study was conducted over one year in the Department of Forensic Medicine and Toxicology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. It included cases of acute poisoning referred for postmortem, focusing on clinical history, circumstantial evidence, and toxicological findings. A structured proforma documented external findings like froth, stains, or cyanosis and internal examination of organs. Cases of chronic poisoning, non-toxic bites, or unconfirmed poisoning were excluded. Data were collected from medico-legal registers, case papers, inquest reports, and chemical analyses, with informed consent from relatives. Results: A total of 1,410 autopsies were performed during the study period, with acute poisoning cases accounting for 7.8% (n=110). The majority of cases involved males (60.9%), reflecting a higher incidence in this group. External autopsy findings revealed frothy secretions at the mouth and nostrils as the most common feature (60.91%), followed by characteristic oral cavity odors (45.45%) and perioral staining (35.45%). Cyanosis was noted in 31.82% of cases, indicating systemic hypoxia, while less frequent findings included vomitus-stained clothing (21.82%) and bite or sting marks (10.91%). Internal examinations demonstrated significant gastrointestinal involvement, with inflammation and congestion affecting the stomach (97.27%), esophagus (92.73%), and small intestine (70%). Petechial hemorrhages were most commonly observed in the gastric mucosa (42.73%), while rare findings such as mucosal perforation (1.82%) reflected severe toxic exposures. Organ congestion was widespread, with the brain (98.18%), spleen (97.27%), and kidneys (97.27%) showing the highest prevalence, underscoring the systemic impact of poisoning. Pulmonary congestion (63.64%) and edema in the brain (98.18%) and lungs (75.45%) highlighted the critical involvement of the central nervous and respiratory systems. Odor analysis indicated a garlicky smell in the majority of stomach contents (81.64%), linked to phosphide poisoning, while kerosene- and acetone-like odors were less frequent. Rat poison emerged as the leading toxic agent (37.27%), followed by organophosphates (13.64%), drugs (8.18%), and snake bites (10.91%). Conclusion: External autopsy findings in acute poisoning cases commonly included froth at the mouth and nostrils, characteristic odors, cyanosis, and bite or sting marks. Internal findings revealed inflammation, mucosal congestion, petechial hemorrhages, and damage to the gastrointestinal tract, with organ congestion and cerebral or pulmonary edema. Rat poison was the leading cause, followed by organophosphates, drugs, corrosives, pesticides, and snake bites, with many cases involving unidentified agents. 

The emergence of multidrug-resistant (MDR) bacteria constitutes a significant worldwide health crisis, necessitating the development of novel antimicrobial drugs. This work involved the synthesis of silver nanoparticles (AgNPs) utilizing biologically generated isolates of Escherichia hermannii (SHE), Citrobacter sedlakii (S11P), and Pseudomonas putida (S5), followed by characterization of their physicochemical characteristics and antibacterial effectiveness. Advanced characterization techniques, such as ultraviolet-visible spectroscopy (UV-Vis), zeta potential analysis, and transmission electron microscopy (TEM), demonstrated that SHE-derived AgNPs exhibited enhanced properties, including reduced particle size (4–12 nm) and increased stability (zeta potential: −22 mV). These AgNPs demonstrated exceptional antimicrobial efficacy against multidrug-resistant pathogens, including Pseudomonas aeruginosa, Staphylococcus aureus, and methicillin-resistant S. aureus (MRSA), significantly surpassing traditional antibiotics like gentamicin and vancomycin at ultralow concentrations (0.0002 mg/µL). The stability and antibacterial efficacy of the AgNPs were preserved for up to 90 days following synthesis, highlighting their durability. This study emphasizes the promise of biologically produced AgNPs as a novel antibacterial platform, providing a highly effective and sustainable solution to address the worldwide challenge of antibiotic resistance.

Antibiotic resistance in tuberculosis (TB) presents a huge problem to world health, profoundly affecting treatment results. This study examines the effects of drug resistance on tuberculosis patients, concentrating on multi-drug-resistant (MDR), pre-extensively drug-resistant (pre-XDR), and extensively drug-resistant (XDR) tuberculosis. We analyzed data from 18 studies including 10,222 tuberculosis patients, indicating that 12.1% exhibited drug-resistant tuberculosis, predominantly among those aged 30 to 45 years. Resistance patterns exhibited variability, with multidrug-resistant tuberculosis (MDR TB) occurring in 15% to 40% of cases, pre-extensively drug-resistant (pre-XDR) in 8% to 25%, and extensively drug-resistant (XDR) in 5% to 18%. Co-morbidities, including HIV (18% to 70%) and diabetes mellitus (12% to 22%), exacerbated treatment results. Treatment success rates varied between 55% and 75%, however, death rates were notably high at 10% to 25%, accompanied by considerable loss-to-follow-up rates (5% to 10%) and treatment failure rates (3% to 7%). Patients with drug-resistant tuberculosis consistently had inferior results compared to those with drug-susceptible tuberculosis. The increasing frequency of MDR, pre-XDR, and XDR TB underscores the critical necessity for innovative therapeutic methods and comprehensive treatment regimens to address resistance. This study highlights the necessity of tackling antibiotic resistance to enhance tuberculosis treatment results and mitigate the worldwide proliferation of drug-resistant variants.

Red blood cells (RBCs) are specialized blood cells responsible for transporting oxygen from the lungs to body tissues and returning carbon dioxide to the lungs. They are characterized by their biconcave disc shape and high flexibility, which facilitate their passage through small blood vessels and efficient gas exchange. Red blood cells typically have a diameter of 6-8 micrometers and are present in concentrations of approximately 4.2 to 6.1 million cells per microliter of blood. The research aims were as follows: to measure the count of RBCs and to determine the dimensions of RBCs. The research plan is divided into three groups: the Duhok Governorate group, the Salah Al-Din Governorate group, and the Al-Najaf Governorate group. The results indicated that the mean dimensions of RBCs were as follows: A. Duhok group: Mean (μ) ≈ 6.299 B. Sala Al-Din group: Mean (μ) ≈ 6.0464 C. Al-Najaf group: Mean (μ) ≈ 5.8682, The results for the RBC counts were as follows: A. Duhok group: Mean = 4.5513 B. Salah Al-Din group: Mean = 4.462 C. Najaf group: Mean = 4.271. Comparing the results among the three groups, Duhok showed the highest mean RBC dimensions (6.299 μ) and count (4.5513), followed by Salah Al-Din (6.0464 μ and 4.462, respectively), with Najaf displaying the smallest dimensions (5.8682 μ) and count (4.271). These variations suggest potential regional differences in RBC characteristics that could relate to genetic or environmental factors. In conclusion, the study highlights significant differences in both the dimensions and counts of RBCs among the Duhok, Salah Al-Din, and Najaf groups. These findings underscore the importance of regional variations in hematological parameters, potentially influenced by genetic, environmental, or dietary factors in these populations. Further research could explore these factors to better understand their impact on RBC characteristics and overall health outcomes.

Objectives: This study compared the efficacy of metallic endo-clips and extracorporeal knotting techniques for closing the appendiceal stump in laparoscopic appendectomy. The primary goals were to assess the impact on surgery duration, hospital stay, and postoperative complications and identify the potential benefits of using metallic endo-clips. Methods: This retrospective comparative study was conducted at Nishtar Medical University, Multan, Pakistan. Patients were divided into two groups: Group A received metallic endo-clips, while Group B underwent extracorporeal knotting. Data were collected from surgical notes and discharge forms, and statistical analysis was performed using SPSS version 25. Results: Among the 70 patients, 62.9% were male, and 37.1% were female. The male-to-female ratio was 2:1. Most patients (81.4%) were aged up to 35 years, with 68.6% from urban areas. Using metallic endo-clips, Group A had a significantly shorter mean surgery duration (28.89 minutes) than Group B (34.23 minutes). Hospital stay duration showed no significant difference between the two groups. Only 4.3% of patients experienced complications, with a higher incidence in Group B (66.7%). Conclusions: The study suggests that using metallic endo-clips for laparoscopic appendiceal stump closure offers potential benefits, including shorter surgery duration and lower rates of complications. This technique may enhance surgical efficiency and reduce the risk of prolonged anaesthesia and surgery. Although this study had some limitations, it highlights the promise of metallic endo-clips as a viable alternative for appendiceal stump closure in laparoscopic appendectomy.

Introduction: Breast cancer is a leading cause of death and disability among women, especially young women, in low- and middle-income countries. AIM: To study the molecular subtypes and hormone receptor status in breast cancer patients and their association with histopathological findings and TNM staging. Methodology: This hospital-based prospective observational study was conducted over a period of 18 months, from January 2023 to June 2023, at the Department of Surgery, S.P. Medical College and P.B.M. Hospital, Bikaner. The study focused on all breast cancer patients admitted to the surgical wards of the hospital during this time. Result: In our study, the most affected age group was 46-55 years (47%) with a mean age of 48.55 ± 10.80 years. Right breast lumps were more common (58%), and 73% had retracted nipples. TNM stages IIB and IIIA were most frequent in Luminal A and B groups, while TNBC and HER2-positive cases were more advanced. Conclusion: Our study shows that triple negative and her 2 neu positive were seen with advance stage of malignancy and group A and B with early and locally advanced malignancy.

Introduction:Silicosis is a chronic lung disease caused by inhaling large amounts of crystalline silica dust, usually over many years.AIM:To study clinical and radiological features in patients  of occupational pulmonary disease, silicosis.Methodology:The study is a cross-sectional descriptive investigation conducted over one year, from June 2022 to June 2023, at the Department of Respiratory Medicine, Jaipur National University, Jaipur, Rajasthan.Result:The study reveals that most patients with silicosis are middle-aged (mean age 44.39 years) with significant chronic exposure to silica dust (mean 16.68 years), and a high prevalence of respiratory symptoms and smoking. Radiological and spirometric findings confirm severe pulmonary impairment, with progressive declines in lung function correlating with disease severity and prolonged exposure. Conclusion: In a study of 80 male stone mine workers with a mean age of 44.39 years, prolonged stone dust exposure and smoking were linked to severe silicosis, characterized by significant declines in lung function, prominent radiological abnormalities, and prevalent respiratory symptoms.

Introduction: Peritonitis is one of the common cause of ‘acute abdomen’.It may be localized or generalized, and may result from infection  or from a non-infectious process. AIM: To determine the efficacy of Mannheim peritonitis index. in predicting the morbidity and mortality in patients with secondary peritonitis. Methodology: The study is designed as a hospital-based, prospective observational study, set to span 12 months from January 2023 to December 2023, and will be conducted at the Department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner. The study aims to include all patients presenting with clinical suspicion of peritonitis. Result: In our study, the mean age of patients with peritonitis was 43.33 years, with the majority presenting with abdominal pain, distension, and vomiting. The MPI score correlated strongly with outcomes: severe peritonitis had the highest mortality rate at 60%, compared to 5.6% in the moderate group. Conclusion: Mannheim Peritonitis index (MPI) is a simple and objective scoring system to predict the morbidity and mortality in patients with peritonitis.

Background: The stem bark extract of Cassia sieberiana which are widely used in folkloric medicine in Africa was evaluated for antibacterial activity and its toxicological profile. Antibacterial activities of the stem bark against clinical isolates such as E. coli, K. pneumonia, P. aeruginosa, Proteus mirabilis, S. pyogenes and S aureus were compared with cefoxitin. Toxicological profiles were determined following the administration of 75, 150 and 300 mg/kg of the Stem bark extract and distilled water, as control, to male albino rats for 28 days. Biochemical and haematological indices, and body weights were evaluated. The vital organs were also examined. The ethanol Stem bark extract of Cassia sieberiana   demonstrated antibacterial activity against the pathogenic bacteria assayed. Toxicological investigation of the extract showed no significant alterations in haematological and biochemical indices, and the vital organs as well. The acute toxicity test was greater than 5000 mg/kg in rats. Findings suggest that the ethanol stem bark extract of   Cassia sieberiana   possess potent antimicrobial activity which supports the traditional use of this plant across Sub-Saharan Africa. The plant is also considered safe after oral exposure for 28 days.

Background Idiopathic unilateral anhidrosis which is also known as Harlequin syndrome was first reported by lance et al. in 1988.It is a rare disorder common in females than males. Usual presentation is unilateral facial anhidrosis with flushing and hyperhidrosis in the opposite side. Anhidrosis can also be involved in arms, neck and trunk

Background: Patients with cryptogenic stroke and left atrial cardiomyopathy are at high risk of stroke recurrence. The study compares the efficacy of rivaroxaban and aspirin in preventing recurrent strokes in this population. Objective: To evaluate the effectiveness of rivaroxaban versus aspirin in reducing stroke recurrence in patients with a history of cryptogenic stroke and left atrial cardiomyopathy. Methods: A randomized, controlled, open-label trial was conducted with 220 patients. Participants were randomly assigned to receive rivaroxaban (15 mg once daily) or aspirin (100 mg once daily) for 12 months. The primary endpoint was stroke recurrence. Secondary endpoints included major adverse cardiovascular events (MACE), major bleeding events, functional outcomes (modified Rankin Scale), and quality of life (Stroke Impact Scale). Results: Stroke recurrence was significantly lower in the rivaroxaban group (6.4%) compared to the aspirin group (14.5%) (p = 0.03). Ischemic strokes were reduced in the rivaroxaban group (5.5% vs. 12.7%, p = 0.04). Major bleeding events occurred slightly more in the rivaroxaban group (5.5%) than the aspirin group (2.7%), though not statistically significant (p = 0.31). Functional outcomes and quality of life were slightly better in the rivaroxaban group. Conclusion: Rivaroxaban significantly reduces stroke recurrence compared to aspirin in patients with cryptogenic stroke and left atrial cardiomyopathy, with a manageable increase in bleeding risk. Rivaroxaban may be a more effective preventive therapy for this population.

This study investigates the histopathological and morphometric variations in liver tissue due to chronic alcohol consumption in a cohort of 25 patients. Liver samples were analyzed for signs of damage, including inflammation, fibrosis, and cellular necrosis. Histopathological evaluation revealed that 76% of patients exhibited moderate to severe fibrosis, while 60% showed significant hepatocyte ballooning. Inflammatory infiltrates were present in 68% of the samples, with 32% demonstrating mild necrosis. Morphometric analysis quantified a 30% increase in hepatocyte size and a 25% reduction in sinusoidal space compared to non-alcoholic controls. Additionally, 44% of patients had a fibrosis area exceeding 20% of the total liver section. These results highlight the extensive damage caused by chronic alcohol consumption, demonstrating the progression of liver disease in this population. The findings underscore the importance of early intervention and inform potential therapeutic strategies for managing alcohol-induced liver damage.

Background: With the fast-track development of vaccines worldwide, the severity and hospitalisations due to covid 19 has come down and vaccinated people are getting the disease in a milder form than unvaccinated people. Here in our study, we are focussing on the breakthrough infections in high-risk population who are vaccinated twice with any of the covid vaccines as per present national protocols. Though all the current vaccines available in the world do not confer 100 percent protection against the disease, they do prevent the development of very severe disease and decreases mortality compared to unvaccinated people. This study is to find out the clinical severity based on clinical, biochemical and other inflammatory markers and radiological features in the above-mentioned population. This study provided information about the difference in outcome of covid 19 in different comorbid conditions. Objective: To assess the severity of Covid 19 affected in high-risk groups who are vaccinated with two doses of any vaccine against Covid 19 based on the clinical, laboratory and radiological parameters. Methods: Observational cohort study, Data required for the study is procured from the covid 19 patients admitted in isolation wards and intensive care units in District Hospital Palakkad. The medical records of those patients were also used as the sources of information required for the study during 2021. Results In our study 76.5% of patients were above 60years old and only 3.9% are below 40 years. Regarding gender66.7% were males. Diabetes mellitus is the most common comorbidity ie 58.82% followed by Chronic obstructive pulmonary disease 21.57% and Coronary artery disease 17.65%.Out of 51 participants,43 had taken covishield which comes to 84.31%.Clinically 19.6% had tachycardia ,21.57% had elevated systolic blood pressure of over 140mmHg whereas 13.8% had diastolic BP above 90mmHg.Respiratory rate of above 20 per minute was found in 51% ,13.7% had SPO2 >94% in room air.41.17% required nasal oxygen via prongs or facemask ,19.6% required Non invasive ventilation. Of the biochemical and hematopathological parameters studied 70.6% had D Dimer more than 500,58.8% had absolute neutrophil count less than 8000 and.88.2% had NLR over 3. Imaging studies showed 68.63% with an abnormal chest X ray.31 people had their HRCT thorax done out of which 45.16% had moderate lung involvement and 35.46% had severe lung involvement. Regarding the outcome 80.39% were discharged in a clinically stable condition and only 10 patients succumbed to their illness. Interpretation and conclusions Break through covid19 infection in high-risk population is associated with a mortality rate of 20% which is significantly higher than those without comorbidity. The risk of developing severe disease is also more in those groups compared to general population. Diabetes mellitus is the most important and common risk factor associated with poor outcome. ARDS is the most common cause of mortality in covid 19 which is aggravated by the coexistence of comorbidities.

Introduction: Hemorrhoids are one of the most common benign anorectal problems worldwide with high prevalence, estimated worldwide prevalence ranges from 2.9% to 27.9%, of which more than 4% are symptomatic. AIM: To study the operative efficacy of harmonic scalpel method of hemorrhoidectomy over conventional hemorrhoidectomy. Methodology: The study is a hospital-based comparative investigation conducted over a period of 18 months, from April 2023 to September 2024, at the Department of Surgery, S.P. Medical College and P.B.M. Hospital, Bikaner. The study population comprises all patients who undergo hemorrhoidectomy surgery within the specified timeframe. Result: The Harmonic Scalpel (HS) method of hemorrhoidectomy demonstrated significantly lower postoperative pain scores, reduced hospital stays, and fewer complaints of constipation compared to the conventional (C) method. However, recurrence rates were lower in the HS group (8%) compared to the C group (14%), indicating a potential benefit in long-term outcomes with the HS technique. Conclusion: The Harmonic Scalpel hemorrhoidectomy offers superior efficiency, reduced pain, and quicker recovery compared to conventional methods, making it a more effective option despite its higher cost and learning curve.

Cardiology has been greatly affected by the rapid advancements in artificial intelligence (AI) technologies, which have led to innovation and changed clinical practices. This paper provides an in-depth analysis of these AI-driven developments and their potential to improve cardiovascular healthcare. By systematically reviewing scholarly articles and peer-reviewed literature, this study gives a comprehensive overview of AI applications in cardiology. The search was performed systematically using databases such as PubMed/MEDLINE, ScienceDirect, IEEE Xplore, and Web of Science with predefined selection criteria. The selected articles synthesis shows that AI has many applications in cardiology including diagnostic innovations, precision medicine, remote monitoring technologies, drug discovery, and clinical decision support systems. The results indicate that AI is central to the transformation of cardiovascular medicine through diagnostics, treatment strategies, and patient care. Although the research highlights the transformative potential of AI in cardiology it also recognizes ongoing challenges such as algorithm accuracy, interoperability, and integration of AI into clinical workflows. Nevertheless, further development and strategic implementation of AI in cardiology are expected to provide more personalized efficient and effective cardiovascular care leading to improved patient outcomes thus shaping the future practice of cardiology. This paper adds to the existing body of knowledge by providing new insights into how AI is changing the role played by cardiologists today.

This study examines the influence of anatomical knowledge on radiological interpretation accuracy and efficiency. We hypothesize that enhanced anatomical understanding improves diagnostic performance and reduces error rates. Using a sample of radiologists with varying levels of anatomical knowledge, we assessed diagnostic accuracy, time taken for interpretation, error rates, and cognitive test scores. The results indicate a positive correlation between anatomical expertise and radiological performance, underscoring the importance of anatomical training in radiology.

Background: Toxoplasma gondii is an opportunistic protozoan parasite that causes a life-threatening disease toxoplasmosis – in immunocompromised individuals, including patients with cancer, and hematological malignancy (HM) is challenged by the impaired antibody response; meanwhile, molecular testing is necessary to demonstrate reactivation.  Objective: Study of detection rates and risk factors for toxoplasmosis in cancer & HM patients using serological and molecular methods. Results The results of the present study represent serodiagnosis of  IgG and IgM Toxoplasma gondii  using (ELISA) in four groups, hematological malignant under immunosuppressive treatment, liver disease under steroid treatment, colon cancer and control groups in two hospitals in Erbil governorat The present results revealed higher percentages of positivity for   T. gondii  IgG antibodies in patients than control, hematological malignant (57.1% ), liver disease (51.5%), colon cancer (25.9%), and control (18.0) respectively with a statistically significant difference         P value  (<0.05) between hematological and control groups and also between liver diseases and control while P value (> 0.05) between colon cancer and control groups  Table (3.2) While, table (3.3) show, seropositive of  T.gondii IgM antibodies among the same groups, hematologicalmalignant(12.9%), liver diseases (0%), colon cancer (3.7%), and control (2%)  respectively with a statistically significant difference   P value 0.024 (<0.05) between hematological and control groups while P value (>0.05)between liver disease and control and also between colon cancer and control groups. The present results revealed higher percentages of seropositivity for T. gondii    in cancer patients (58.76%) compared with the controls (20%) with a statistically significant difference P value 0.00 Table (3.4).also, the percentages of PCR for      T. gondii  in cancer patients (52.57%) compared with the controls (10 %) was statistically significant P value 0.00, while table 3.6 showed the was no statistically significant difference between ELISA method and PCR method  for detection seropositive of T. gondii and P value 0.311

Introduction: CKD is a degenerative illness that affects more than 10% of the global population, or more than 800 million people. AIM: To study the relationship between socio demographic and clinical variables with psychiatric morbidity. Methodology: In this cross-sectional observational hospital-based study, conducted in the Department of General Medicine and the Department of Nephrology at Mahatma Gandhi Medical College & Hospital in Jaipur, the objective was to evaluate the quality of life and psychiatric morbidity among patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis. Result: GHQ, HAM-D, and HAM-A scales reveal significant psychiatric symptoms, with the majority experiencing varying degrees of depression and anxiety. Statistical analyses show all correlations between co-morbidities and quality of life indicators, including WHO QOL scores, GHQ, HAM-D, and HAM-A, are highly significant (p ≤ 0.000). The study also finds a negative correlation between WHO QOL scores and GHQ, HAM-D, and HAM-A scores, indicating that poorer quality of life is strongly associated with worse mental health outcomes. Conclusion: This study underscores the significant impact of chronic kidney disease (CKD) on both the physical and mental health of patients undergoing hemodialysis.

Introduction:  Pre-operative nutritional assessment of the patients requiring emergency laparotomy is crucial as malnutrition is present in most of patients undergoing emergency laparotomy. Serum albumin is the most important laboratory test for the diagnosis of undernutrition. Aim: This is a clinical study to correlate Pre-operative Serum Albumin level at the time of admission with post-operative recovery, complications and hospital stay in patients undergoing emergency laparotomy. Methods: This study was performed between January 2021 and January 2022. We measured preoperative Serum albumin in 52 patients who underwent Emergency Laparotomy and these patients were observed for postoperative complications. Results: Out of the 52 patients (44 Males and 8 females) 27 had postoperative complications. A serum albumin level less than or equal to 3g/dl was significantly associated with higher morbidity and mortality in patients undergoing Emergency Laparotomy. Conclusion: Although there are multiple variables affecting postoperative outcome, our study shows that S. albumin is a good indicator of postoperative complications in patients undergoing emergency laparotomy and the patients with low level of S. albumin had a higher complication rate as compared to the patients with normal S. Albumin level.

Background: This paper aims are to show the relation between Pharmacoeconomics and health policy decision-making strategy. It is set to focus on the evaluation of cost-effectiveness of pharmaceutical interventions and its influence on policymaking. Some different techniques for analyzing costs used in economic assessments have been reviewed here, such as cost-utility analysis, cost-effectiveness analysis, and cost-benefit analysis. Apart from the correlation with healthcare policy decision-making in health policy, pricing and reimbursement guidelines, formulary design, pharmaceutical benefits management, resource allocation; priority setting- patient access and affordability among other things are affected by those evaluations from an economic standpoint. The paper also enlists certain challenges associated with evaluating pharmacoeconomics such as methodological difficulties, data limitations/availability, uncertainty etcetera when keeping in mind patient preferences/values in doing so. This paper also encounters problems associated with using study findings to inform policy decisions about their evaluation-interpretation/application. Complexities involved in interpreting and applying study results in different settings or levels where policies are made but more so those which can affect them most directly i.e. national level compared to regional/provincial ones etc. It further discusses various stakeholders' roles including policymakers themselves, healthcare providers, pharmaceutical companies’ payers, patients themselves among others who have a say on what will become part of the healthcare system based on available evidence from this field that plays a very significant role in shaping policies at all levels ranging from global down to national up to local community levels too if need be. In essence, the review underlines the importance of integrating pharmacoeconomics into health policy development to assure cost-effective resource allocation and, hence, improved access of patients to quality health services.

Background: The foramen spinosum is a significant opening found in the base of the skull on the greater wing of the sphenoid bone. The foramen spinosum allows the middle meningeal artery, parietal trunk of the middle meningeal artery, and posterior trunk of the middle meningeal vein to pass through into the middle cranial fossa. This study aimed to determine the morphological features, examine the specific structural characteristics, and measure the dimensions of the Foramen Spinosum in the base of preserved human skulls that belonged to the North Indian population. Materials and Methods: This cross-sectional study was conducted on fifty dry adult skulls of unidentified gender that belonged to the North Indian population. We observed the shape of the foramen spinosum and the diameters of it. Measurements were done with the help of a digital vernier caliper. The collected data was analyzed using the Statistical Package for Social Sciences (SPSS, version 24.0) software. Results: The study investigated the morphological characteristics of the foramen spinosum, focusing on both shape and diameter measurements, in a sample of 100 cases. Regarding shape, the most common configuration was round, observed in 26% of cases on the right side and 23% on the left side, making up 49% of the total cases. Oval-shaped foramina were noted in 15% on the right side and 17% on the left side, accounting for 32% overall. Pinhole shapes were found in 5% of the right side and 6% of the left side, summing up to 11% of the cases. Irregular shapes were present in 4% of cases on both sides, making up 8% of the total sample. A Chi-Square analysis indicated no significant difference in the distribution of foramen spinosum shapes between the right and left sides (X² = 0.399, p = 0.94). In terms of diameters, the study found that the mean anteroposterior diameter (length) was 3.91±1.54 mm on the right side and 3.30±1.39 mm on the left side, with a statistically significant difference between the two sides (p = 0.042). The mean transverse diameter (width) was 3.18±1.20 mm on the right side and 2.91±1.41 mm on the left side, with no significant difference observed between the sides (p = 0.312). Conclusion: These variations are clinically significant, particularly in cases of skull base fractures and in diagnosing aneurysms or vascular lesions within the cranial cavity. Understanding these differences is valuable for neurosurgeons, helping them to identify and protect neurovascular structures when operating in the middle cranial fossa.

Background: The Bicipital Groove (BG) is a concave area located between the lesser and larger tubercles of the proximal region of the humerus. The structure includes the biceps tendon, its synovial sheath, and the ascending branch of the anterior circumflex humeral artery. Understanding the morphometry of the shoulder area is crucial for comprehending its functional aspects. The study aimed to analyze the morphometric characteristics of the bicipital groove of the humerus in the population of North India.

Materials and Methods: This cross-sectional study was conducted on 100 mature adult humeri (50 right and 50 left) of unidentified gender.  The dimensions of the medial wall, lateral wall, width, and depth were measured using a vernier caliper. The parameters were precisely measured and the data were evaluated. Measurements were done with vernier caliper. The collected data was analyzed using the Statistical Package for Social Sciences (SPSS, version 24.0) software.

Results: The average length of the bicipital groove was 85.81 ± 5.79 mm on the right side and 87.96 ± 6.72 mm on the left side, with no significant differences between the two sides. The average width was 6.89 ± 1.07 mm on the right side and 7.91 ± 1.64 mm on the left side. The average depth was 4.27 ± 0.51 mm on the right side and 5.02 ± 0.91 mm on the left side. Both the width and depth showed significant differences between the right and left sides. For the medial and lateral walls of the bicipital groove, the average lengths on the right side were 24.16 ± 1.03 mm and 31.60 ± 2.16 mm, respectively, while on the left side, they were 23.56 ± 2.12 mm and 31.06 ± 0.22 mm. There were no significant differences in the lengths of the medial and lateral walls between the right and left sides.

Conclusion: This study evaluates the morphometry of the bicipital groove in the humeri of individuals from the north Indian population to enhance understanding of this anatomical feature. The data gathered will aid in planning orthopedic surgeries involving the upper arm bone, diagnosing tendon and structural issues related to the groove, and providing a reference for replacing the humeral head in upper-end fractures. This information is crucial for determining the appropriate prosthetic design, size, and placement, and will be valuable to anthropologists, radiologists, orthopedic surgeons, and clinical anatomists.

Background: Hypertensive disorders of pregnancy are the most extensively studied ailments throughout pregnancy. In the past, methyldopa was frequently prescribed, but it has since been mostly substituted by T. labetalol and T. nifedipine because methyldopa takes longer to start working. Chronic hypertension is linked to a higher occurrence of negative outcomes for both the mother and the baby during pregnancy and childbirth. Therefore, it is crucial to identify the most effective treatment for lowering high blood pressure. This study aimed to examine the side effects of drugs, obstetric difficulties, and mode of delivery between Group A (given T. labetalol) and Group B (administered T. nifedipine).

Materials and Methods: A prospective study was conducted in the Department of Obstetrics and Gynaecology at Darbhanga Medical College and Hospital in Darbhanga, Bihar, India. The study involved 200 pregnant women with hypertension or blood pressure readings of 140 mmHg or higher for systolic blood pressure (SBP) or 90 mmHg or higher for diastolic blood pressure (DBP) after 20 weeks of gestation. The participants were assigned to two groups using a random process: Group A (n=100) received T. labetalol, whereas Group B (n=100) received T. nifedipine. The two groups were compared based on criteria such as age, side effects of the respective medicines, complications during pregnancy, and outcomes, including the method of birth (vaginal or cesarean). The Chi-square and t-test were employed to assess the differences in variables between the two groups.

Results: In our study, we found that preeclampsia was most common in women aged 21 to 25, with 53% of cases occurring in this age group. The average age was 25.32±3.56 years in Group A and 25.89±3.78 years in Group B. In Group A, which took Labetalol, 35% of the women needed a 200 mg dose, 25% needed 300 mg, and 23% required 400 mg. In Group B, which took Nifedipine, 49% needed a 30 mg dose, 27% needed 20 mg, and 24% required 40 mg. Interestingly, no one in the Labetalol group reported any side effects, while in the Nifedipine group, 1% experienced dizziness, 1.5% had palpitations, and 2% suffered from headaches. This suggests that Labetalol was better tolerated than Nifedipine. In terms of complications, 1.5% of the Labetalol group had intrauterine growth restriction (IUGR), 2.5% experienced oligohydramnios, and 1.5% resulted in intrauterine death (IUD), with 44.5% having no complications. For the Nifedipine group, 3.5% had IUGR, 3% experienced oligohydramnios, and 0.5% resulted in IUD, while 43% had no complications. When it came to delivery outcomes, 39% of the women in the Labetalol group had vaginal deliveries, 6.5% had emergency caesarean sections, and 4.5% had elective caesarean sections. In the Nifedipine group, 36% had vaginal deliveries, 8% had emergency caesarean sections, and 6% had elective caesarean sections. There was no significant difference between the groups in terms of delivery methods. Among those who had vaginal deliveries, normal labor was seen in 6% of the Labetalol group and 8% of the Nifedipine group. Normal labor with episiotomy occurred in 38% of the Labetalol group and 30% of the Nifedipine group. Outlet forceps delivery was used in 6% of the Labetalol group and 4% of the Nifedipine group, while vacuum delivery was used in 2% of the Labetalol group and 6% of the Nifedipine group. Finally, the post-intervention blood pressures were similar between the two groups, with no significant differences in systolic or diastolic blood pressure.

Conclusion: Both tablet labetalol and tablet nifedipine demonstrated equivalent efficacy. Regarding pharmacological side effects and tolerability, the tablet labetalol was significantly superior to tablet nifedipine.

Background: Postpartum hemorrhage is a major cause of maternal morbidity and mortality worldwide, highlighting the need for effective prophylactic interventions. Carbetocin, a long-acting oxytocin analog, may offer advantages over traditional Oxytocin in reducing blood loss and improving maternal outcomes. Due to its short half-life and duration of activity, oxytocin is presently the recommended treatment for preventing postpartum hemorrhage. However, in many small countries where cold chain transportation and storage are not possible, the effectiveness of the product cannot be guaranteed because it is sensitive to heat. In contrast, carbetocin remains stable under high temperatures. However, the available data is inadequate to establish the comparative efficacy and tolerability of carbetocin and oxytocin in avoiding postpartum hemorrhage after vaginal birth. The objective of this study is to assess and compare the safety and efficacy of oxytocin and carbetocin in minimizing postpartum hemorrhage in women who are undergoing normal vaginal delivery. Materials and Methods: By utilizing randomly generated numbers obtained from the internet, a total of 100 women were divided into two groups, namely Group C and Group O, with each group consisting of 50 women. Women in group O were administered an intramuscular injection of oxytocin at a dose of 10 IU, whereas women in group C were given a single injection of heat-stable carbetocin at a dosage of 100 μg. Medication administration commenced immediately after the baby's birth. The primary outcome measure was the average blood loss after vaginal delivery. The secondary outcome variables included the proportion of women who experienced blood loss over 500 milliliters, the requirement for extra uterotonic or surgical therapies, and the incidence of adverse events.  Results: Women who were administered carbetocin had a significantly reduced average blood loss compared to those who received oxytocin, and this difference was statistically significant (p < 0.05). Conversely, there was no noticeable fluctuation in the Proportion of women experiencing PPH (excessive blood loss over 500 milliliters). While a smaller number of women in the carbetocin group required blood transfusions or additional uterotonic medicines, this difference did not reach statistical significance (p >0.05). There was no statistically significant difference (p>0.05) between the two groups in terms of the occurrence of adverse events. Conclusion: Carbetocin has shown greater efficacy than oxytocin in preventing postpartum hemorrhage in women who have had a vaginal delivery of a single baby. The government must ensure that carbetocin is both inexpensive and easily accessible.

Background: Proper CT scan evaluation of structures related to the sphenoid sinus is very important before any skull base surgery through the endoscopic transsphenoidal approach. Internal carotid artery (ICA) is one such structure in the vicinity of the sphenoid sinus which if injured due to improper radiological assessment, can cause life-threatening complications of the sinus surgery. This study aimed to know the prevalence of dehiscence in the wall of the internal carotid artery and the resultant protrusion in the sphenoid sinus. Materials and Methods: This was a retrospective study conducted on 150 patients who presented with sinus disease. Their CT scans were studied for the presence of any dehiscence in the wall of the internal carotid artery and also protrusion of the internal carotid artery into the sphenoid sinus. The result was analyzed as a percentage and the ‘p’ value was calculated using Fischer’s exact test. Results: The presence of a dehiscent carotid artery wall was found in fifteen cases, eight of them were males and seven were females. On applying Fisher’s Exact test, the ‘p’ value was calculated as 0.786. Protrusion of the internal carotid artery into the sphenoid sinus was found in forty cases, eighteen of them were males and twenty-two were females. The ‘p’ value was calculated as 0.2731. Conclusion: This normally looking anatomical variation is very dangerous if ignored before embarking upon surgery. The study will be helpful to surgeons who work on the skull base region and perform endoscopic sinus surgeries, to avoid inadvertent injury to the internal carotid artery.

Background and Objectives- OSMF is a premalignant disorder that primarily affects people in the Indian subcontinent. It causes the oral soft tissues to become increasingly juxtaepithelial fibrosis-prone, which eventually makes it impossible to open the mouth. The objectives of the study was to assess the efficacy of TRA in treatment of OSMF, its side effects and quality of life in patients. Methods- It was a monocentric single blind study conducted in Department of OtoRhinoLaryngology  in Tertiary care centre for a period of 1 year. In order to assess the effectiveness of trans RA in the treatment of OSMF, a premalignant condition in the oral cavity, we have undertaken a study to determine the quality of life in patients with Grade I and Grade II OSMF and to determine the efficacy of tretinoin (a vitamin A supplement) in the form of soft gel capsules containing trans RA. In total, 40 patients with OSMF who were classified as Grade I and II by Khanna and Andrade in 19957 were included in the study. Two groups of twenty patients each, 1 and 2, were randomly selected from among these patients. Results-  It was seen the burning sensation in test groups shows a decreasing trends as the efficacy of TRA increases as the time of follow up progresses and it was statistically significant (p<0.05). The result of this study showed an improvement in the mouth opening of the patients of test Group with a significant decrease in the burning sensation as compared to the control group. the major side effects seen during the follow up period for test group was headache seen in 64% of patients and it was significant (p<0.05), followed by nausea and vomiting in 50%, dizziness and rashes were also seen in patients who were continuously taking the medication for 6 months.; The quality of life significantly improved due to better mouth opening and decrease in burning sensation. None of the patients showed relapse after the discontinuation of the drug. Conclusion- This baseline study provides opportunities for additional research on the systemic use of all RA forms available for treating OSMF as well as on the use of medication in a formulation that can be injected locally into fibrous bands to validate the above findings.

Background: Anxiety is a prevalent mental health concern among university students, particularly within rigorous academic environments such as medical schools. The demanding curriculum, high expectations, and the pressure to succeed can significantly impact students' mental well-being, leading to heightened levels of anxiety. Understanding the factors that contribute to anxiety in medical students is crucial for developing effective interventions and support systems. This study aims to examine the relationship between BMI, gender, and anxiety levels in medical students. Materials and Methods: This cross-sectional study was conducted on 100 healthy enough male and female MBBS students at the Indira Gandhi Institute of Medical Sciences in Patna, Bihar, India. Hamilton Anxiety scale was used to assess the anxiety levels. These anxiety scores were correlated with their BMI values. The data was compiled and structured into a table using Microsoft Excel 2019. Afterward, the data was imported to GraphPad version 8.4.3 for additional statistical analysis. Results: Our study found significant differences in BMI and anxiety scores between male and female participants. Men had an average BMI of 22.61 with a standard deviation of 3.14, while women had a lower average BMI of 20.02 with a standard deviation of 2.96, which was statistically significant (P-value < 0.0001). In terms of anxiety, men had an average score of 11.65±4.16, whereas women had a higher average score of 15.83±7.26. This difference was also statistically significant (P-value = 0.0002). The study investigated the correlation between BMI and anxiety scores. For male participants, the correlation coefficient (r) was -0.148 with a P-value of 0.309, indicating no significant relationship. Similarly, for female participants, the correlation coefficient was -0.107 with a P-value of 0.456, also showing no significant relationship. However, when considering the overall sample of 100 participants, the correlation coefficient was -0.233 with a P-value of 0.019. This result indicates a statistically significant negative correlation between BMI and anxiety scores across the entire sample. Conclusion: MBBS students exhibit a range of anxiety levels, ranging from low to severe. To alleviate this worry, it is advisable to implement various measures such as counseling and stress management approaches right from the beginning of the curriculum.

Background: The greater palatine foramen (GPF) plays a crucial role in dental and maxillofacial surgeries, serving as a key landmark for regional anesthesia. This study focuses on the anatomical variations and clinical significance of the GPF in North Indian adult skulls. By examining these variations, we aim to provide insights that enhance the accuracy and safety of surgical procedures. Our findings are intended to assist clinicians in better understanding the anatomical differences that may impact patient outcomes. This research contributes to the broader knowledge base necessary for improving surgical techniques and patient care in the region. This study aimed to determine the morphological characteristics, precise position, and exact location of the greater palatine foramen, as well as the orientation of this foramen in adult human skulls. Materials and Methods: This cross-sectional study was conducted on fifty dry adult skulls of unidentified gender. We measured the location of the greater palatine foramen in relation to the 3rd molar along with the shape and direction of the opening on the palate observed in the adult human dry skulls of the North Indian population and the perpendicular distance of GPF from the mid-maxillary suture and posterior border of the hard palate was also measured on both sides. Measurements were done with vernier caliper. The collected data was analyzed using the Statistical Package for Social Sciences (SPSS, version 24.0) software. Results: The greater palatine foramen (GPF) was oval in 72% of cases, round in 21%, and irregular in 7%, with irregular cases showing a lingula-like projection. The GPF was positioned opposite the second maxillary molar in 16% of cases, between the second and third molars in 10%, and opposite the third molar in 74%, consistently on both sides. The GPF opening is directed anteromedially in 70% of cases, anteriorly in 19%, and anterolateral in 11%. The lesser palatine foramen was absent in three skulls on the left side, with single, double, and triple foramina present in 43%, 38%, and 16% of cases, respectively. The mean distances of the GPF to the midline maxillary suture and the posterior border of the hard palate showed no significant differences between the right and left sides. Conclusion: The study concluded that the third molar can serve as a dependable reference point for identifying the greater palatine foramen. In cases where the third molar has not erupted, the palatine suture and the posterior border of the hard palate can be employed as valid reference points for this purpose.

Abstract: Background: Gestational diabetes is a prevalent illness that affects several pregnant women and can have detrimental effects on both the mother and the baby. To effectively handle this illness, monitoring blood glucose levels and lipid profiles is imperative. This study aims to analyze and contrast the alterations in glycosylated haemoglobin (HbA1c) and lipid profile parameters between women with gestational diabetes and those without, to improve diagnostic and therapeutic approaches for this illness. The study revealed that HbA1c serves as a distinct indicator of dyslipidemia in women with gestational diabetes, emphasizing the correlation between these factors in pregnant women in Bihar. Materials and Methods:  We conducted a comparative study involving a sample of fifty pregnant women who were diagnosed with gestational diabetes in their third trimester, and another fifty pregnant women who did not have gestational diabetes or any pregnancy complications during their third trimester. We randomly selected the participants from the age range of 20 to 45 years. In patients diagnosed with gestational diabetes, we measured serum lipid profile parameters, blood glucose levels during an oral glucose tolerance test, and levels of glycosylated hemoglobin. We then compared these measurements with those of pregnant women who were in good health. Results:The study found that the mean age of 50 pregnant women diagnosed with GDM was 32.5 years, while the mean age of 50 healthy pregnant women in the control group was 28.4 years. The GDM group exhibited serum triglyceride levels of 190.8±8.22 mg/dL, whereas the control group displayed levels of 148.3±6.39 mg/dL. The GDM group had a mean serum total cholesterol of 212.3±14.46 mg/dL, while the control group had a mean serum total cholesterol of 171.9±17.32 mg/dL. The levels in the GDM group were markedly increased compared to the control group. The GDM group had a mean serum HDL cholesterol level of 58.64±3.88 mg/dL, while the control group had a mean level of 54.53±7.11 mg/dL. There was no statistically significant difference between the two groups. The blood LDL cholesterol levels were 92.2±14.83 mg/dL in the GDM group and 81.76±8.54 mg/dL in the control group. The difference between the two groups was statistically significant. The disparities in fasting blood glucose, as well as blood glucose levels at 1 hour and 2 hours, between the patients and controls were shown to be statistically significant. The average HbA1c levels for the cases and control groups were 8.58±1.09 mg/dL and 5.92±0.93 mg/dL, respectively. The statistical significance of the difference between healthy pregnant women and women with GDM was observed. Conclusion: The study results prove beyond a doubt that the amounts of triglycerides, HDL, glycated haemoglobin, and glucose in the blood play a major role in how dyslipidemia worsens in women with gestational diabetes mellitus (GDM). While it is widely known that lipid markers generally increase during a normal pregnancy, the specific pattern of increase in GDM (gestational diabetes mellitus) differs..

Background: The palatine bone's horizontal plates, along with the pre-maxilla and the palatine processes of the maxilla, unite to create the hard palate, a crucial component of the skull. The structure has an arched shape with varying depth and breadth. It is widest in the molar area and serves as a barrier between the oral and nasal cavities. This essential anatomical structure serves a pivotal function in several forensic investigations. This study provides useful information for forensic scientists and anthropologists, highlighting its significance in the field of forensics. Through careful examination, this work attempts to improve understanding of craniofacial anatomy and its significance in the forensic sciences. The information acquired from this study can serve as a vital point of reference for further research in the fields of anatomy, forensic sciences, dentistry, and anthropometrics. This study aimed to measure the hard palate's morphometric characteristics in dried human cranium bones from the North Indian population. Materials and Methods: This cross-sectional study was conducted on fifty dry adult skulls of unidentified gender. These human-dried skull bones were obtained from the Department of Anatomy of Nalanda Medical College, Patna Bihar, and also from different medical colleges in the Bihar state of India. We measured the hard palate's height, breadth, and length using a digital vernier caliper. We also evaluated the palatine index (PI) and palatine height index (PHI). The collected data was analyzed using the Statistical Package for Social Sciences (SPSS, version 24.0) software. Results: In the current study, the average palatine length, width, and height were 45.95 ± 4.05 mm, 32.51 ± 2.83 mm, and 10.93 ± 2.32 mm, respectively. The mean values for the palatine index and the palatine height index were 70.78 ± 7.66 mm and 33.88 ± 7.68 mm, respectively. According to the palatine index, the most common type of hard palate was leptostaphyline (88%), followed by mesostaphyline (8%), with brachystaphyline (4%) being the least frequent. In terms of the palatine height index, orthostaphyline (54%) was the most frequent, followed by chemostaphyline (26%), with hypsistaphyline (20%) being the least common. Conclusion: The findings of this study will be helpful for anthropometry, dental care, and medical science. Knowing about the hard palate's anatomy is important for making full dentures for people without teeth, studying anthropology, performing certain palate surgeries, and classifying head shapes by race and ethnicity. Understanding the palatal index helps surgeons when they fix cleft lips or palates.

Background: The posterior condylar canal is a large emissary foramen present in the base of the skull. It gives passage to the posterior condylar vein. Its variations are generally associated with posterior condylar vein variations and sometimes may cause misinterpretation of being pathological. We conducted the present study to ascertain the prevalence of this canal and its variations in occurrence. Materials and Methods: We conducted an observational study on fifty dry skulls of unknown age and sex. The skulls were examined for the prevalence of the posterior condylar canal, and its presence on one or both sides and absence were noted. Results: The examination revealed the presence of the posterior condylar canal in forty skulls, with twenty being right-sided and twelve being left-sided. There was a bilateral presence of the canal in eight of the skulls examined. Ten skulls did not show the presence of a posterior condylar canal on any side. Conclusion: Many clinical conditions require knowledge of common anatomical variations of the base of the skull. The prevalence of the posterior condylar canal is one such variation that may become important when there is a fistula involving the dural venous sinuses. Thus, the present study will be useful for surgeons operating over the base of the skull near the occipital condyle.

Background: The neck-shaft angle (NSA) is the angle formed between the axis of the femoral neck and the axis of the femoral shaft. This angle is crucial for the biomechanical function of the hip joint, affecting stability, range of motion, and weight-bearing capacity. It plays a significant role in orthopaedic diagnoses and treatments, particularly concerning hip fractures and the design of prosthetic implants. Our research focuses on providing valuable data for better surgical planning and implant design. This study aims to evaluate the NSA in the North Indian population using dry bones.

Materials and Methods: This present cross-sectional study was conducted on fifty dry adult femurs of unknown gender. Among that, twenty-four femur bones belong to the right side and twenty-six to the left. The neck shaft angle is measured by a goniometer. Graph Pad Prism version 9 was used to statistically analyze the results.

Results: We recorded that the neck shaft angle (NSA) was 129.52±3.82 degrees on the right side and 129.96±3.65 degrees on the left. The overall mean value of neck shaft angle (NSA) observed in the study was 129.75±3.70 degrees. The current investigation yielded no statistically significant distinctions between the left and right side characteristics.

Conclusion: The neck shaft angle acquired from this study should be taken into account when performing surgical stabilization of femoral neck fractures or osteotomies in the adult population of North India. It is important to mention that this applies to the design and manufacture of orthopaedic implants and hip prostheses using bioengineering techniques.

Background: Extensor Digitorum (ED) and Extensor Digiti Minimi (EDM) muscles arise from the common extensor origin from the lateral epicondyle of the humerus. On the dorsum of the hand, the tendons of ED divide into 4 parts for the medial 4 fingers; the tendon to the little finger commonly joins with the EDM tendon from the radial side as a band near the 5th metacarpophalangeal joint. There could be several variations in the attachments of these tendons over the dorsum of the hand. Aims and Objectives: This study aimed to find out the variations in the attachments of the tendons of the Extensor Digitorum and Extensor Digiti Minimi muscles over the dorsum of the hand. Materials and Methods: The study was performed on 25 cadavers in the Department of Anatomy, Netaji Subhas Medical College & Hospital, Bihta, Patna, Bihar (India). Cadaveric dissection of the dorsum of the hand was performed exposing the tendons of ED and EDM up to their distal attachments.  Results: On dissection, it was observed that there was no separate tendon of ED to the little finger among 4 cadavers (i.e. 16%). On the contrary, apart from the usual two slips for the little finger, there was an extra slip arising from the EDM tendon and getting attached to the tendon of ED to the ring finger. Conclusion: The knowledge of such variations in the attachments of extensor tendons will be helpful for surgeons performing tendon transfer procedures. This will guide the surgeons in better diagnosis and reconstructive treatment in cases of trauma or tenosynovitis.

Animals having an allogeneic bone marrow transplant had significantly reduced amounts of butyrate in intestinal tissue when it came to graft vs host illness, demonstrating the effectiveness of butyrate in treating inflammatory conditions. Globally, colitis is becoming more and more common regarding healthcare issues. The investigation aimed to evaluate butyric acid's protective role as an antioxidant on the colon's function and inflammatory response in colitis caused by DSS. Four separate sets of rats were equally dispersed. The macroscopic score and body weight were recorded during the experiment. Upon completion of the study, blood samples were obtained to test the levels of MDA and GSH in the serum. Additionally, colon tissue was obtained for colon length and histology. Furthermore, the PPAR-gamma gene of the spleen has been identified. Data analysis post the sodium butyrate treatment showed a significant improvement in body weight. However, the macroscopic score and colon length are statistically positively impacted by sodium butyrate treatment. Serum MDA levels were sharply reduced and GSH content was raised by sodium butyrate. Additionally, the colon D group's section displayed a significant mucosa thickening, which was linked to a notable proliferation of submucosal solitary lymphatic follicles that expanded into tubular glands. In conclusion, oral sodium butyrate can be used to decreasing the severity of colitis, and upregulated PPAR-gamma gene expression. These findings suggest that sodium butyrate may mitigate the colitis triggered by DSS in rats by boosting the redox system's homeostasis.

The present study was aimed to determine the follicular size and concentration of estrogen and progesterone in pre and post puberty in buffalo. This study was conducted in Sharqat city (Salah Alden Province) during the period from April 2022 to January 2023. This experiment included 18 Iraqi river heifers buffalos divided to three groups (G1: 6 heifers 12 months age, G2:6 buffalos aged 18 months and G3: 6 buffalos aged 22 months). Estrus detection was done through visual observation in the early morning and evening. Ovarian follicular diameters using Linear – array intra-rectal transducer of real time B mode with 7.5 MHz. Ultrasound examinations of the ovaries was done biweekly from the beginning of the present study and continuously to the first estrus, pubertal age. Estrogen and progesterone were analyzed by ELISA technique using special kit for each hormone monthly till puberty. the largest diameter of the follicle was in the third and second group (12.41 ± 0.17 mm and 11.37 ± 0.30 mm, respectively), with a significant difference P<0.05 compared to the first group (1.37 ± 0.38 mm). The level of progesterone was significantly high P>0.05 in the second and third groups (1.02 ± 033 and 1.43 ± 0.16 ng/ml, respectively) compared to the first group (0.33 ± 0.05 ng/ml). The level of estrogen reached its highest level in the second group at the age of puberty (30.133 ± 0.87 pg/ml) compared to the first group, before the age of puberty (22.107 ± 1.52 pg/ml) and the third group, post puberty (18.469 ± 1.08 pg/ml). In conclusion: The measuring of estrogen and progesterone levels are the sufficient method for the predict age of puberty in buffalo. The hormones and ultrasonography is fast, safe and reliable for detect puberty in buffalo.

This present study was aimed to determining the relationship between age of puberty in Iraqi buffalo with body weight and some biochemical parameters. This study was conducted in Sharqat city (Salah Alden Province) during the period from April 2022 to January 2023. This experiment included 18 Iraqi river heifers buffalos divided to three groups (G1: 6 buffalo’s heifers 12-17 months age, G2: 6 buffalos aged 18-21 months and G3: 6 buffalos aged 22-23 months). Estrus detection was done through visual observation in the early morning and evening. The blood concentration of Glucose, cholesterol, Total Protein and Triglyceride were estimated by spectrophotometer using special kit. Body weight and body condition score (BCS) were scale monthly till puberty. The results of the current study appeared that the age of puberty in Iraqi buffaloes ranges between 18-22 months. There was no substantial change in the values or levels of total protein and cholesterol in different groups. Triglycerides level was significantly higher P< 0.05 in both the first and third groups compared with the second group. The highest level of glucose was reached in the 3ed group compared with first and second group. The highest weight of the experimental animals was in the third group compared to the second and first group and the weight of the animals in the second group was considerably higher (P > 0.05) compared to the first group. Body condition scour compactness reached its highest level in the third and second groups (3.5, 3.5) compared with the first group (2.5). In conclusion: The age of puberty in Iraqi buffalo are about 18-20 months in Salah-Aldin province. The body weight and body condition score have high correlation with age of puberty in buffalo. The age of puberty have significant effect on the levels of glucose and Triglyceride especially.

Background: Subtrochanteric fractures occur within 5 cm of the lesser trochanter in the proximal femur, posing significant surgical challenges due to complex anatomy and high mechanical stresses. These fractures account for 25% of all hip fractures and result from high-energy trauma in younger patients or low-energy falls in the elderly. Two main surgical techniques are used: intramedullary (IM) fixation, involving a rod in the femur's marrow canal, and extramedullary (EM) fixation, using plates and screws on the bone's outer surface. This paper compares the clinical outcomes, complications, and biomechanical effectiveness of IM and EM fixation methods to determine the best approach for subtrochanteric femur fractures. Materials and Methods: A total of 85 patients underwent a retrospective evaluation at the Department of Orthopaedics, Darbhanga Medical College and Hospital, located in Darbhanga, Bihar, India. Patients who had intramedullary (IM) implants such as IM femoral nail or proximal femoral nail were classified as Group A. Patients with extramedullary (EM) implants, specifically 95° condylar plate or locked anatomical proximal femoral plate, were classified as Group B. The study analyzed many factors like the age, gender, side of a fractured hip, cause of the fracture, kind of anesthesia used, waiting time before surgery, duration of follow-up, type of fracture, Harris hip score (HHS), and any mechanical issues. Statistical analysis was conducted by GraphPad version 8.4.3. Results: From our observation of 85 patients (Group A: 62, Group B: 23), with a mean age of 42.9 years (range 16-65), comprising 60 (70.59%) males and 25 (29.41%) females, we noted an average follow-up period of 13.42 months. The primary cause of subtrochanteric fractures was falling from a height. Various fixation methods were utilized, including IM femoral nails (41.18%), PFN (29.42%), 95° condylar plates (14.11%), and proximal femoral anatomical plates (15.29%). Group A showed higher rates of malalignment (17.74%) and implant failure (6 cases), compared to Group B, which had fewer instances of malalignment and implant failure. Delayed union and non-union cases were more prevalent in Group A but did not reach statistical significance. Overall, the Harris Hip Score averaged 86.5 across the study population, showing no significant difference between the groups. Conclusion: Intramedullary and extramedullary fixation procedures each have benefits and drawbacks for treating subtrochanteric fractures. Intramedullary techniques cause minimal soft tissue injury, support the medial cortex, and have good load-bearing capacity, but may not achieve precise anatomical reduction. Extramedullary techniques can achieve anatomical alignment but may increase soft tissue damage, infection risk, and bleeding. Our study found both methods produced comparable and satisfactory outcomes. The choice of fixation method remains controversial, and further research is needed. Both IM and EM fixation can be effective for treating subtrochanteric fractures. 

Introduction: Peritonitis continues to be one of the major infectious problems confronting the surgeons. Its accurate diagnosis and management are a challenge to every surgeon. Aim: To compare POSSUM, MPI SCORE and Sepsis Score of STONER and ELEBUTE in predicting outcome in terms of mortality and morbidity in patients undergoing exploratory laparotomy for perforation peritonitis due to hollow viscous perforation. Methods: Prospective observational study of total 150 cases of perforation peritonitis admitted in General surgical wardswere included in the study after applying inclusion and exclusion criteria and getting informed written consent and approved by the institute of ethical committee, at tertiary care hospital from May 2019-May 2020 to assess the utility of MPI, POSSUM and SEPSIS SCORE OF STONER AND ELEBUTE in case of perforation peritonitis. Results: Out of total 150 cases, 78(52%) were <50 years, 108(72%) were male, 53(35.33%) patients had multi system organ failure and 76.66% presented after 24 hours of peritonitis. Total 24 patients died and 126 survived.In our study cut off value of 27 MPI point, the sensitivity is 91.70% and specificity is 88.90 %.best cut off of POSSUM came out to be 47 which gave the sensitivity and specificity for POSSUM to be 91.70% and 90.50% respectively.ROC analysis for best cut off of Sepsis Score of Stoner and Elebute came out to be 24.50 which gave the sensitivity and specificity for sepsis score of Stoner and Elebute to be 100% and 100%.On comparing the three scores MPI, POSSUM and Sepsis Score of Stoner and Elebute have similar and high sensitivity and very good specificity for predicting mortality.Conclusion: MPI, POSSUM score and SEPSIS SCORE OF STONER AND ELEBUTE are good prognostic scoring systems and should be used routinely to identify the patients with high mortality.

Introduction: Trauma is a major health problem in our country. Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Aim: To assess the Incidence of injury, mode of injury, clinical presentation, management and outcomes of solid organ injury in Blunt trauma abdomen. Methods: A prospective observational study consists of an analysis of randomly selected 100 cases with blunt abdominal trauma admitted during the period of May 2019 to May 2020. All patients were managed in trauma center as per ATLS guidelines. The patients were followed up for a varying period of 15 days to 3 months.  Results: Around 9:1 was the male to female ratio, automobile accidents accounted for 78% of cases, 60 (60%) patients had other associated injuries. Most of the patients (81 %) were presented to hospital within 4 hours after injury. Spleen was the commonest organ injured (55%), followed by liver (42%), most common presenting symptoms was abdominal pain (99%) followed by vomiting and altered sensorium in 15% each and most common sign was abdominal tenderness (85%) followed by tachycardia (59%) and abdominal guarding in 40%. 19 (19%) patients in this study underwent a laparotomy. 3 mortalities were noted in this study. All these 3 were operated and had grade 4 injuries.  Conclusion: Road traffic accident was the most common mode of injury in the young and reproductive group males.

Introduction: Multiple myeloma (MM) is normally not seen as central nervous system (CNS) manifestations but extramedullary disease can occur in up to 5 % cases through hematogenous spread or via bone cortex to the contiguous tissue. Infiltration of the CNS or meninges is rare in MM as compared to the other malignancies and carries a very poor prognosis. The disease can also spread to lung, pleura, lymph nodes, digestive tract etc. Case description: A 75-year-old gentleman, a diagnosed case of MM for the past 15 years, on treatment, presented with altered sensorium and fever since 5 days. Lumbar puncture was done and CSF was sent for examination. CSF cytology revealed infiltration by many plasma cells which on flow cytomety where positive for CD38. CSF culture did not show any growth. Ziehl-Neelson staining did not show presence of acid-fast bacilli. No fungus was identified on India ink preparation. MRI and CT scan brain did not show any large bleed. Bone marrow examination and peripheral blood smear did not show increase in plasma cells. Conclusion: This case study highlights the rare occurrence of CNS involvement in a case of multiple myeloma.

Background: Pain is a distressing sensation often triggered by intense or damaging stimuli, playing a crucial role in medical diagnosis and treatment. Effective postoperative pain management is essential to prevent prolonged central and peripheral hyperexcitability in nociceptive pathways, which can lead to adverse physiological and psychological effects. This study aimed to compare the efficacy and safety of transdermal buprenorphine and fentanyl patches for postoperative analgesia in major abdominal surgeries. Materials and Methods: This prospective, double-blinded, randomized study was conducted over one year in the Department of Anaesthesia and Intensive Care at Acharya Shri Chander College of Medical Sciences and Hospital, Jammu. Sixty ASA I-II patients undergoing major abdominal surgeries were enrolled and randomly assigned to two groups of 30 each. Group I received a buprenorphine patch (10 μg/h) and Group II received a fentanyl patch (25 μg/h), both applied 8 hours before surgery. Postoperative pain levels, hemodynamic parameters, sedation scores, and side effects were evaluated at multiple intervals up to 24 hours postoperatively. Results: Baseline characteristics, including age, weight, and gender distribution, were comparable between the groups. Both transdermal patches provided effective postoperative pain relief, with VAS scores peaking at 2 hours and decreasing thereafter. At 24 hours, VAS scores were 0.53 for Group I and 0.60 for Group II, with no significant differences. The mean time to first rescue analgesic was slightly shorter in Group I (172 minutes) compared to Group II (184 minutes), but not significantly different. Sedation scores were initially higher in the fentanyl group but normalized by 24 hours. Hemodynamic stability was maintained in both groups, with no significant differences in heart rate or blood pressure. Fentanyl was associated with a higher incidence of side effects, particularly headache and blurring of vision. Conclusion: Both buprenorphine and fentanyl transdermal delivery systems (TDS) are effective for postoperative analgesia in major abdominal surgeries, with a lesser requirement for rescue analgesics. Buprenorphine TDS is more cost-effective and offers a longer duration of action, while fentanyl TDS provides superior initial analgesia with less sedation. Both transdermal systems are beneficial for postoperative pain management, ensuring stable hemodynamic parameters and effective analgesia.

Background: The rise in high-speed road traffic accidents has led to more extra-articular proximal tibia fractures, which can be treated conservatively, with plate osteosynthesis, or using a hybrid external fixator. Bridge plating involves extensive soft tissue dissection, increasing risks like bleeding, infection, and impaired blood supply, while hybrid external fixators pose risks of malunion, non-union, pin-tract infections, and patient compliance issues. This study aims to compare the clinical and functional outcomes of these two treatment methods for proximal tibia metaphyseal fractures. Materials and Methods: This prospective randomized study was conducted on 46 adult patients diagnosed with proximal tibia metaphyseal fracture at the Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar (India). An odd number of patients were treated with a bridge plate and even with a hybrid external fixator. Statistical analysis was conducted by GraphPad version 8.4.3. Results: The study included 46 patients with proximal tibia metaphyseal fractures, divided equally into two groups of 23. Patients in the hybrid external fixation group had a Knee Society Score (KSS) of 68.56 ± 7.11 at the final follow-up. In contrast, the bridge plating group achieved a higher KSS of 75.45 ± 7.82, indicating better outcomes. Conclusion: Our study found that bridge plating is a superior treatment modality compared to the hybrid external fixator, as it resulted in better postoperative knee range of motion, improved functional outcomes, and fewer complications. However, the clinical outcome is also influenced by factors such as the type of fracture, degree of comminution, nature of the injury (open or closed), and bone quality.

Background: Clavicle fractures, especially those occurring in the midshaft region, are frequent and present significant treatment challenges. Displaced midshaft clavicle fractures can lead to non-union and poor functional outcomes if managed non-surgically. The purpose of the present study is to evaluate functional outcomes and complications associated with open reduction and internal fixation (ORIF) with plates for displaced midshaft clavicle fractures. By examining patient satisfaction, fracture healing rates, and the incidence of complications such as symptomatic hardware requiring reoperation, this study seeks to provide valuable insights to enhance clinical decision-making and optimize patient care in cases of displaced midshaft clavicle fractures. Materials and Methods: This retrospective study was carried out on 30 patients who had undergone surgery open reduction and internal fixation with a plate for displaced mid-shaft clavicle fracture at the Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar (India). This study was conducted using the hospital database to study patients who underwent open reduction and internal fixation (ORIF) with a plate for a displaced mid-shaft clavicle fracture. The main objective of the study was to determine the rate of successful union of the affected area. The secondary outcome variables included functional outcome as assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, patient satisfaction with treatment and cosmetic appearance, pain levels, complications, and reoperations. All chosen patients were instructed to visit the outpatient department (OPD) for evaluation of patient-centered functional outcome measures. Statistical analysis was conducted by GraphPad version 8.4.3. Results: In this cohort of thirty patients with midshaft clavicle fractures treated with open reduction and internal fixation, 75% were male and 25% were female, with an average age of 35.65 years. High-energy trauma was the most common cause of injury, accounting for 73.33% of cases. According to the Robinson classification, 40% of fractures were type 2B1, and 60% were type 2B2. The 3.5 mm pre-contoured locking plate was the most frequently used implant (46.67%). All patients achieved fracture union, with an average union time of 8.1 weeks. Mechanical failure of the implant occurred in 6.66% of patients, leading to reoperations and successful subsequent union between 18-20 weeks. Twenty percent of patients experienced hardware-related symptoms, necessitating implant removal between 12 to 18 months post-surgery. The overall reoperation rate was 26.67%, and there was one case (3.33%) of superficial infection treated successfully with antibiotics. Patient satisfaction was high, with 84% fully satisfied with their treatment. The average satisfaction score for cosmetic appearance was 8.13 out of 10, and the functional outcome was favorable, with a mean DASH score of 14.15. At the final follow-up, patients reported minimal pain, with an average pain score of 0.8 on the VAS scale. Overall, the surgeries were uneventful, with no intraoperative complications reported. Conclusion: Open reduction and internal fixation for displaced midshaft clavicle fractures result in high rates of fracture union, patient satisfaction, and improved functional outcomes. However, symptomatic hardware removal is the most common cause of reoperation. Patients who experienced complications reported significantly worse functional outcome scores compared to those without complications.

The present study has been designed to Determining the prevalence and risk factors of Toxoplasma gondii in patients with rheumatoid arthritis. All samples of the experiment were taken from cephalic vein in non-heparinized tubes, at the conclusion of each treated and control period, all samples collection from Al-Dewaniyah Hospital, and from clinical private from July-2022 to Feb. 2023. The experiment was designed and divided into two groups, a group of healthy people and a group of people infected with rheumatoid arthritis with infection with Toxoplasma gondii. 1. Healthy group: 100 samples from peoples without any disease or treatment. 2. Patients group: 100 samples from peoples' patients treated and untreated with rheumatoid arthritis with infection of Toxoplasma gondii. The results of the current study present the Odd Ratio (OR) value, it was found that there is a relationship between the incidence of five types of arthritis and the presence of the Toxoplasma gondii infection. Also the results of the current study showed that there is a significant increase at (P≤0.05) in Rheumatoid factor (60.63±6.69) in a Patients Arthritis Compared with the healthy group (22.72±4.17), whereas the results of the current study also showed that there is an increase in Rheumatoid factor in the patients that was infected with arthritis and those infected with T. gondii together (97.88 ± 7.01), compared to the group that was with arthritis (60.63±6.69), and a group of healthy people (23.18 ± 3.24).

Background: Postoperative atrial fibrillation (POAF) is a commonly observed complication after coronary artery bypass grafting (CABG) surgery. This study aims to evaluate the use of vitamin C in preventing POAF, comparing the efficacy of different doses of oral vitamin C in the prevention of POAF in elderly Egyptian CABG patients. Additionally, we aim to observe the effects of vitamin C supplementation on Intensive Care Unit (ICU) stay and ventilation time in the same patient population. Methods: A prospective randomized controlled study was conducted, including CABG patients. Patients were randomized into three groups (n=60 per group): the High-dose group (Gp HD), where patients received 500mg of vitamin C every 6 hours; the Low-dose group (Gp LD), where patients received 500mg of vitamin C every 12 hours; and the Placebo group (Gp P). Patients were monitored for the occurrence of POAF, ventilation time, and the duration of their ICU stay. Results: The incidence of POAF in the ICU was lower in both Gp HD and Gp LD patients compared to Gp P patients. No significant difference was found between Gp HD and Gp LD in POAF incidence. However, both Gp HD and Gp P showed longer ventilation times compared to Gp LD patients. Additionally, it was observed that ICU stay was shorter in Gp LD patients compared to both Gp HD and Gp P patients (p < 0.001, p = 0.017, respectively). Conclusions: The administration of vitamin C supplementation, in combination with beta-blockers and statins, was effective in reducing POAF incidence in elderly Egyptian CABG patients. The impact of vitamin C supplementation on ICU stay was limited, evidently influenced by other factors such as ventilation time

In this case control study, venous blood samples were taken from 115 women aged 18-47 years, who were suffering from repeated abortion and from 30 apparently healthy women as a control group. The demographic information of patients was recorded in a questionnaire form prepared in advance including age residency. A written consent was taken from all participants in this study. The study was carried out in Karbala Maternity and Pediatric Hospital and other private laboratories in Kerbala city, Iraq during November 2022 to May 2023. The blood samples were centrifuged and the levels of serum IgM, IgG, interleukine-4 (IL-4) and interleukine-8 (IL-8) were estimated by the enzyme-linked immunosorbent assay (ELISA) method. The results showed that 53 women were aborted due to toxoplasmosis. The highest infection rate (56.6%) with toxoplasmosis was among the age group 18-26 years. The highest infection rate was among the residents of urban areas (60.3%). The results of serum immunoglobulin levels showed that 98.1% of patients showed positive IgG results, while 1.9% was positive for IgM, whereas all the healthy women from the control group showed negative IgM and IgG results. The results demonstrated that the serum IL-4 levels among the infected women with toxoplasmosis was 90.51 pg/ml compared to the control group 21.31 pg/ml, while IL-8 levels among the infected women with toxoplasmosis was 913.30 pg/ml compared to the control group 226.06 pg/ml, with highly significant differences for both interleukins. It can be concluded from the current study that the levels of IgG, IL-4 and IL-8 were increased in women with repeated abortion who were infected with T. gondii.

Background: Sodium hypochlorite is often considered an optimal solution for root canal irrigation, but its adverse effects prevent its administration to children at the necessary concentrations. Therefore, it is crucial to find an optimal root canal irrigant to prevent these adverse effects, which we aim to do through this study. We compared the antibacterial effectiveness of aqueous ozone, green tea, and normal saline as irrigants in pulpectomy treatments for primary teeth. Materials and Methods: Sixty patients aged 4 to 8 years, each with a single-rooted deciduous tooth requiring pulpectomy, were included in the study. The infected teeth were randomly assigned to one of three treatment groups based on the irrigating agents used: normal saline, green tea extract, or ozonated water. Specimens for anaerobic culture were collected from the teeth at three different times: before irrigation, after the initial irrigation, and on the third day following the final irrigation. Statistical analysis was conducted by GraphPad version 8.4.3. Results: The average colony-forming unit (CFU) count following both initial and final irrigation using ozonated water was notably lower compared to that with green tea and normal saline. Additionally, the CFU count with green tea was significantly lower than that with normal saline on the third day after final irrigation. These findings suggest that both ozonated water and green tea could serve as effective alternatives to traditional root canal irrigants for primary teeth. Conclusion: Ozonated water is a favorable choice for irrigation due to its neutral taste and strong antimicrobial effectiveness, particularly against anaerobic bacteria. Scientific research suggests it is well-received among pediatric patients. Green tea also showed considerable antimicrobial activity, though not as potent as ozonated water. Its affordability, accessibility, and longer shelf-life make it a practical option for irrigation in various cases. Our study findings suggest that both ozonated water and green tea could serve as promising alternatives to commonly used irrigants.

Background: The transcondylar approach in craniospinal surgery requires careful attention to the detailed morphology and morphometry of the occipital condyle and its surrounding structures. Although research exists on the morphometrics of the occipital condyle, there is a lack of literature on its relationship with various foramina and canals. For neurosurgeons, understanding the relationship between the hypoglossal canal and the occipital condyle is crucial. There is very limited information available on the shape of the occipital condyle, its length, and its relationship to the hypoglossal canal in the North Indian population. Aims and objective: This study aimed to analyze the shape of the occipital condyle, its length, and the proportion of the hypoglossal canal to the occipital condyle in the North Indian population. Materials and Method: The length of 100 condyles of 50 adult human skulls was measured as the largest anteroposterior distance between the anterior and posterior tip of the occipital condyles. This length was measured with the help of a digital vernier caliper. The distance of the posterior end of the occipital condyle from the external and internal opening of the hypoglossal canal was also measured. The shape of occipital condyles and the location of the hypoglossal canal in relation to occipital condyle were assessed.  An unpaired t-test was done to compare the morphometric data. The P-value of less than 0.05 was taken as a measure of significance. Results: We observed that there was no significant difference between the right and left occipital condyles, although the right condyle was slightly longer on average. The lengths of the occipital condyles ranged from 14 to 25 mm, with an average length of 20.81 mm on the right side and 20.12 mm on the left side. The external and internal apertures of the hypoglossal canal were located closer to the right occipital condyle. Most of the occipital condyles were of moderate length, making up 63% of the total, indicating this is the most common anatomical variant. Short condyles were relatively rare, representing 13% of the total, while long condyles accounted for 24%. The distribution between the right and left sides was fairly symmetrical, although the left condyles tended to be slightly longer than the right. Regarding the shape of the occipital condyles, the most common shape was quadrilateral, found in 20% of the right and 10% of the left condyles, totaling 30%. S-like shapes were observed in 4% of right and 9% of left condyles, making up 13%. Two-portioned shapes appeared in 7% of right and 8% of left condyles, totaling 15%. Oval shapes were found in 7% of both right and left condyles, totaling 14%. Similarly, 8-shaped condyles were present in 6% of right and 8% of left condyles, also totaling 14%. Kidney-shaped condyles were identified in 5% of right and 6% of left condyles, making up 11%. Triangular shapes were rare, with 1% found on both sides, totaling 2%. The rarest were ring-like shapes, found in 1% of left condyles only, making up 1% of the total. Conclusion: The occipital condyle and its related structures may show morphometric and morphological variations. Therefore, preoperative evaluation, including radiological examination and CT imaging, is crucial for every patient undergoing a transcondylar approach to craniovertebral surgeries.

Background: Proximal humerus fractures predominantly occur in the elderly population. The optimal strategy for handling displaced and comminuted fracture patterns is frequently uncertain. Therefore, this study aimed to evaluate the functional result of proximal humerus fractures treated with a proximal humerus locking device and determine the prevalence of problems in these individuals. Materials and Methods: This prospective study includes 30 cases of proximal humerus fractures treated surgically at the Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India, using a proximal humerus internal locking system (PHILOS) plate. The NEER classification was utilized to categorize the fractures, whereas the NEER score was employed for functional evaluation. The study thoroughly excluded people with pathological fractures, concomitant injuries in the same limb, nerve injuries, and cases of open fracture. Statistical analysis was conducted by GraphPad version 8.4.3. Results: The study involved 30 patients with proximal humerus fractures treated with PHILOS plating. The patients included 16 males (53.33%) and 14 females (46.67%), with ages ranging from 21 to over 60 years. The average age of the study population was 46±6.1 years. Most fractures affected the left side (63.33%), and the average time from injury to surgery was 5.1 days. The average bony union time was 13.21 weeks. Fractures were categorized by the NEER classification: 6 patients (20%) had type 2 fractures, 16 patients (53.33%) had type 3 fractures, and 8 patients (26.67%) had type 4 fractures. Road traffic accidents caused 53.33% of the fractures, while falls accounted for 46.67%. Functional outcomes, assessed with NEER's score, ranged from 46 to 95, averaging 83.34. Of the patients, 36.66% had excellent results, 26.66% had satisfactory outcomes, 23.33% had unsatisfactory results, and 13.33% experienced failure. Outcomes by fracture type were as follows: for two-part fractures, 4 patients (13.33%) had excellent results and 1 (3.33%) had satisfactory outcomes. For three-part fractures, 6 patients (20%) had excellent results, 6 (20%) had satisfactory outcomes, 3 (10%) had unsatisfactory results, and 1 (3.33%) experienced failure. Among four-part fractures, 1 patient (3.33%) had excellent outcomes, 1 (3.33%) had satisfactory outcomes, 4 (13.33%) had unsatisfactory results, and 3 (10%) experienced failure. Postoperative complications were minimal, with 24 patients (80%) having no complications, 3 (10%) experiencing stiffness, 2 (6.67%) having varus malunion, and 1 (3.33%) developing a superficial infection. No cases of proximal humeral osteonecrosis or non-union were observed, and shoulder stiffness improved with physiotherapy. Conclusion: Dealing with proximal humerus fractures has always been a difficult task. Our research suggests that utilizing the PHILOS plate is a dependable choice for treating fractures of this nature. This plate offers robust fixing, promotes early mobilization, and results in outstanding functional outcomes. The findings obtained from this study can provide valuable information for clinical decision-making and assist orthopedic surgeons in choosing the most suitable treatment approach for patients with proximal humerus fractures.

Background: Neonatal sepsis is a life-threatening condition requiring prompt and accurate diagnosis. This study evaluates the effectiveness of CRP and blood culture as diagnostic tools. This study aims to compare their reliability and accuracy in detecting sepsis in newborns. Understanding the diagnostic value of these methods is crucial for improving early detection and treatment outcomes. This analysis seeks to inform and enhance clinical practices in neonatal care. Materials and Methods: In this study, we retrospectively reviewed the medical records of 330 neonates at the Department of Microbiology, Nalanda Medical College and Hospital in Patna, Bihar. The study population included neonates under 1 month of age. Neonates who met the IPSC criteria (Sepsis 2.0) and had a positive culture were classified as having proven sepsis. Those with congenital malformations or congenital infections associated with the TORCH complex were excluded from the study. Analysis was conducted using the t-test by GraphPad version 8.4.3. Results: Out of the 330 newborns that were tested for sepsis, 32 (10%) tested positive for a blood infection and 69 (21%) had an elevated level of C-reactive protein (CRP). Out of the 32 instances with a positive blood culture, CRP accurately identified 29 cases. The CRP demonstrated a sensitivity of 90.6%, specificity of 86.5%, positive predictive value of 42%, and negative predictive value of 99%. The AUC for the CRP ROC analysis was 0.83, indicating that CRP is a viable diagnostic inflammatory biomarker for newborn sepsis. The sensitivity and specificity of CRP were 90.6% and 91.6%, respectively. Neonatal sepsis was most commonly related to prematurity (53%) in neonates. Klebsiella pneumoniae 11 (34%) was the predominant pathogen identified, with a susceptibility rate of 73% to Ciprofloxacin. Conclusion: The diagnostic value of C-Reactive protein in diagnosing newborn sepsis is strong, with a sensitivity of 90.6% and a specificity of 91.6% when a cut-off point of 0.83 is employed. Thus, CRP could serve as a diagnostic biomarker for inflammation in areas with limited resources.

Background: We compared the effects of intravenous clonidine and lignocaine as premedicantin attenuation of hemodynamic response to laryngoscopy and intubation in normotensivepatients undergoing elective surgery. Methods: A total of 60 patients undergoing general anesthesia wereenrolled in the study and were randomly allocated into two groups of 30 each. Group 1 patients received intravenous clonidine 2µg/kg 10 minutes before induction and Group 2 patients received intravenous lignocaine 1.5mg/kg 3 minutes beforeintubation. Results: Both groups were matched for age, sex, BMI and ASA grade. The highest HR recorded at the time of intubation was 87.80±13.60 in group 1 and 106.2±15.6 in group 2.This difference was significant statistically(p value<0.001). Thereafter too, there was statistically significant difference in the heart rate at 1,5 and 10 minutes between the two groups and clonidine was better at controlling the heart rate.The SBP, DBP and MAP was well controlled in clonidine group compared to lignocaine group from the time of intubation till 10 minutes after intubation with a p value<0.05.Conclusion: Intravenous clonidine, 1µg/kg given 10 minutes before induction was found to be more effective in blunting hemodynamic responses to laryngoscopy and intubation compared to intravenous lignocaine(1.5mg/kg) given 3 minutes before intubation.

Background: An acute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent and medically important occurrence that results in heightened morbidity and death. The objective of the study was to evaluate the clinical and bacteriological characteristics, as well as the pattern of antibiotic resistance, in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Materials and Methods: The study included a cohort of one hundred individuals who were diagnosed with acute exacerbation of COPD. Comprehensive clinical information, such as patient characteristics, smoking habits, and concurrent medical conditions, were documented. Each patient provided sputum samples, which were then analyzed using microbiological methods. Bacterial identification was conducted utilizing conventional laboratory techniques, while antibiotic susceptibility testing was performed utilizing the Kirby-Bauer disc diffusion method. Analysed was the clinico-bacteriological profile, encompassing the prevalence of bacterial growth, dominating pathogens, and pattern of antibiotic resistance. The data was compiled and structured into a table using Microsoft Excel 2019. Afterward, the data was imported to GraphPad version 8.4.3 for additional statistical analysis. Results: This study involved 100 patients experiencing acute exacerbations of COPD, with an average age of 66 years. Among them, 80% were male, and 60% had a history of smoking. Sputum samples were collected from all patients for microbiological analysis. The analysis revealed bacterial infections in 65% of the cases. The most common pathogens identified were Haemophilus influenzae (35.39%), Streptococcus pneumoniae (26.15%), and Moraxella catarrhalis (20%). Additionally, 18.46% of the cases showed mixed infections involving multiple bacterial species, indicating polymicrobial involvement in some exacerbations. Antibiotic susceptibility testing showed varying resistance patterns among the bacteria. The highest resistance was to amoxicillin-clavulanate (45%), followed by erythromycin (35%) and ciprofloxacin (30%). A significant number of isolates were resistant to multiple antibiotics, highlighting the challenge of selecting effective antibiotics for treating COPD exacerbations. Conclusion: This study examined the bacterial composition and antibiotic resistance pattern in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). The significant occurrence of bacterial proliferation and the existence of strains resistant to several drugs emphasize the need to choose the right antibiotics. These findings emphasize the necessity for personalized treatment methods and the possible advantage of focused therapy that is determined by the vulnerability patterns of the separated pathogens.

Background: Background: Sepsis is a life-threatening illness that causes changes in blood clotting, weakened immune response, and failure of many organs. Anticipating the likelihood of septicaemia before the occurrence of organ dysfunction presents a formidable obstacle. Timely diagnosis and prioritized management are essential in deciding disease outcomes. Aim of the study: To evaluate the significance of commonly used biomarkers in promptly detecting sepsis in patients. Materials and Methods: A cross-sectional study was performed on 282 blood samples obtained from Nalanda Medical College and Hospital in Patna, Bihar, India. All samples underwent blood culture, identification, and antibiotic sensitivity testing following the guidelines set by the Clinical and Laboratory Standards Institute (CLSI- M100). The study examined common indicators of septicaemia, including Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Serum Glutamic Pyruvic Transaminase (SGPT), Serum Glutamic Oxaloacetic Transaminase (SGOT), serum urea, serum creatinine, Haemoglobin (Hb), and Total Lymphocyte Count (TLC). The patients who tested positive for the culture were compared to a control group that tested negative. Analysis was conducted using the t-test by GraphPad version 8.4.3. Results: Out of 282 samples, 68 (24.11%) were culture-positive with a mean age of 42.1±14 years. Among these, 40 (58.82%) were male and 28 (41.18%) were female, resulting in a male-to-female ratio of 1.43. Significant differences were observed between culture-positive patients (n=68) and culture-negative controls (n=214) in several markers. Culture-positive patients had a significantly lower TLC (9.66±5.43 cells/μL vs. 12.16±3.38 cells/μL, p<0.0001), higher CRP levels (11.86±9.33 mg/dL vs. 10.96±4.98 mg/dL, p<0.0001), higher SGOT (26.41±5.28 units/L vs. 22.49±5.04 units/L, p<0.0001) and SGPT levels (25.25±6.23 units/L vs. 18.82±6.11 units/L, p<0.0001), lower Hb levels (9.01±2.21 g/dL vs. 10.64±2.89 g/dL, p<0.0001), and higher serum urea levels (46.04±6.28 mg/dL vs. 35.06±5.21 mg/dL, p<0.0001). Serum creatinine levels were slightly lower in culture-positive patients (1.62±0.19 mg/dL vs. 1.73±0.42 mg/dL, p=0.038). ESR showed no significant difference (35.40±23.30 mm/hr vs. 33.36±23.92 mm/hr, p=0.539). Among the 68 culture-positive isolates, 38 (55.88%) were gram-positive and 30 (44.12%) were gram-negative. The gram-positive isolates included 16 (23.53%) MRSA, 15 (22.06%) CONS (3 methicillin-sensitive and 12 methicillin-resistant), 4 (5.88%) Enterococci, and 3 (4.41%) MSSA. The gram-negative isolates included 9 (13.24%) Acinetobacter spp., 7 (10.29%) Pseudomonas spp., 7 (10.29%) Escherichia coli, 3 (4.41%) Enterobacter spp., and 2 (2.94%) each of Klebsiella spp. and Shigella spp. Antibiotic sensitivity testing showed that over 67% of strains were sensitive to amikacin, more than 40% were sensitive to doxycycline, and over 53% were sensitive to piperacillin-tazobactam. Additionally, 75-100% of gram-negative bacteria were sensitive to colistin. No strains were resistant to vancomycin or linezolid. Out of the 282 patients suspected of sepsis, 214 (75.88%) tested negative for blood culture. Conclusion: With the rising incidence of multidrug-resistant organisms, predicting septicemia has become increasingly challenging. Our results suggest that TLC, ESR, elevated CRP, SGOT, SGPT, and serum urea may serve as early indicators of sepsis. It is crucial to develop a standardized methodology for assessing the effectiveness of both current and novel sepsis biomarkers, as this could provide valuable and clinically relevant information.

Introduction: Juvenile idiopathic arthritis explains the heterogeneous categories of chronic inflammatory rheumatoid conditions whose origin is not known and it affects children and adolescents. In literature the epidemiological data vary depending upon the geographical location, ethnicity and case definition. Epidemiology was evaluated by the categories defined by the International League of Associations for Rheumatology (ILAR). Methodology: Data from the two health claim databases i.e. Pubmed central (PMC) and National Centre of Biotechnology Information (NCBI) and between the ages 2 to 15 years old were analysed with at least one main inpatient or two secondary inpatient / verified outpatient ICD – 10 diagnoses in at least two different quarters within one calendar year. The incidence and prevalence was calculated per 100,000 patients and the entire data was extrapolated to the entire population of India, differences in gender and age groups were also considered. Data on “other” non- necessary commodities in JIA population was also collected. Results: Of the 2-3 million patients in the databases a total of 1400 patients met our Juvenile idiopathic arthritis case definition and had incidence values of 32 (28-42) and 58 (51-65), and prevalence of 131 (121 -143) and 166 (154 – 176) were noted. Both the incidence and prevalence in all the ages range were higher in females as compared to males. With increasing age the difference between males and females tend to increase. Out of the ILAR categories, oligo-arthritis was the most prevalent i.e. 69 and 91 per 100,000 and half of the juvenile idiopathic arthritis patients were in this category. It was followed by undifferentiated arthritis, with 47 and 54 cases per 100,000 and rheumatoid negative were 30 and 37 cases per 100,000. Atopic dermatitis, vasomotor and allergic rhinitis and uveitis were the comorbidities seen. Conclusion: Thus this study provide the data of the incidence and prevalence of Juvenile idiopathic arthritis in Indian population, it also contributes to knowledge on burden of disease and tools for healthcare planning.

Background: Total hip replacement (THR) is a common surgical procedure for treating neck of femur fractures, particularly in the elderly, aimed at relieving pain and restoring mobility. This study compares intraoperative blood loss across three THR techniques: cemented, uncemented, and hybrid. Cemented THR uses bone cement for fixation, providing immediate stability; uncemented relies on biological fixation for long-term stability; and hybrid combines both methods. Intraoperative blood loss is a critical factor affecting patient recovery and complication rates. This research seeks to determine if the type of THR technique significantly influences intraoperative blood loss, informing surgical decision-making and patient care. Materials and Methods: This study was carried out on 60 patients who had undergone surgery for total hip replacement for neck of femur fractures at the Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar (India). The age of the study population was ranging from 60 to 85 years. The sample consisted of 32 (53.33%) males and 28 (46.67%) females. Patients were divided into three groups based on the use of cement for implant fixation. The first group consisted of 20 patients who had both the acetabular and femoral components cemented. The second group, the hybrid group, included 20 patients who had an uncemented acetabular component and a cemented femoral component. The third group comprised 20 patients who had both the acetabular and femoral components uncemented. Statistical analysis was conducted by GraphPad version 8.4.3. Results: The study evaluated intraoperative blood loss in three groups of patients undergoing total hip replacement for neck of femur fractures. The cemented group, showed a blood loss ranging from 241.50 mL to 2543.2 mL, with a mean of 1105.57 mL and a standard deviation of 643.35 mL. The hybrid group, had a blood loss range of 246.35 mL to 2172.37 mL, with a mean of 1062.50 mL and a standard deviation of 520.11 mL. The uncemented group, exhibited a blood loss range from 50.67 mL to 1956.55 mL, with a mean of 965.30 mL and a standard deviation of 523.02 mL. Statistical analysis revealed no significant difference in blood loss among the three groups, with a P value of 0.725. These findings suggest that the type of fixation method used: cemented, hybrid, or uncemented; does not significantly impact intraoperative blood loss in total hip replacement surgeries for the neck of femur fractures. Conclusion: This study found no difference in blood loss between cemented and uncemented THR for neck of femur fractures. Ultimately, the choice between cemented, hybrid or uncemented THR should be based on a comprehensive evaluation of factors like bone quality and patient-specific risks, rather than blood loss. This study suggests that blood loss during THR for NOF should not be a deciding factor in choosing between cemented or uncemented THR for patients with NOF.