Introduction: Elderly malnutrition is an iceberg phenomenon and remains undiagnosed most of the time. The elderly people are at risk of malnutrition due to physical, psychological, social, dietary and environmental risk factors. When malnutrition gets compounded with various co-morbidities, it turns into a vicious cycle. Aim: To focus on the assessment of nutritional status of elderly population in rural areas: a community based cross sectional study above 60 years of age in a rural area of Hapur, Uttar Pradesh, India.  Materials and Methods: This was a community-based cross-sectional study done for a period of four months in the rural field practice area of Rama Medical College, Hospital & Research Centre, Hapur, Uttar Pradesh, India. Following ethical clearance, study subjects were selected by using single stage area wise cluster sampling technique. Data was collected from 240 elderly individuals by face-to-face interview using semi structured questionnaire. Details regarding socio-demographic variables like age, gender, educational status, occupational status, economic dependency and place of residence were taken. Nestle’s Short Form Mini Nutritional Assessment (SF-MNA) screening tool was used to assess the nutritional status of the study participants. The association was assessed by Chi-square test. Significance level was considered at p-value of ≤0.05. Results: Prevalence of malnutrition was seen among 33 (13.75%) individuals. A 105 (43.75%) were at the risk of malnutrition and 102 (42.5%) had satisfactory nutritional status. The comparison between well nourished, at risk of malnutrition and malnourished groups showed significant differences with respect to age (p-value=0.016), economic dependency (p-value=0.002), place of residence (p-value=0.004), Body Mass Index (BMI) (p-value=0.024), calf circumference (p-value=0.016) and presence of co-morbid illness (p-value=0.015). Conclusion: The findings of the present study clearly indicate that malnutrition is a multifactorial condition associated with socio-demographic, somatic and functional status. A multidimensional approach is required to deal with these issues. Nutritional assessment and screening of elderly people should be done by opportunistic screening for early detection of malnutrition and to implement an appropriate nutritional intervention.

Background: Global health is facing numerous health problems but Hepatitis B Virus is regarded as a major health concern because it has manifested among 7% of the world's population. The majority of people who are infected with this virus are reported from developing countries and they have little to no access to medical facilities; their options of getting a proper treatment are minimal. Hepatitis B Virus is a blood-borne disease; it is transmitted from person-to-person through contact and practices that involve the exchange of body fluids such as unsafe sex or blood transfusions of an infected person. Vertical transmission can also aid in the spreading of the Hepatitis B Virus, contaminated needles used in the injection of drugs or infected needles used for tattoos can also be fundamental tools for spreading this virus. This study was done to assess and find the risk factors of Hepatitis B among rural population in a tertiary care teaching hospital. Methods: A case-control study was done among the patients visiting Rama Medical College, Hospital & Research Centre, Hapur for regular checkups. The sample included 80 cases and 80 controls. The non-probability convenient method was used as a sampling technique. Data was collected using a structured questionnaire. Data were analyzed using SPSS Statistics 23 and frequencies, mean, standard deviation, p values, and odds ratios were calculated. Results: A total of 80 cases and 80 controls were taken (Male to female ratio was 1:4). The mean age of patients was 38.74 ± 13.597. The frequency of age ranging from age 18 to 30 was maximum. Odds ratios and p values were calculated for different risk factors. The odds ratio for the history of blood transfusion was 1.581. Patients who had family members with hepatitis B had a p-value of 0.002. Those who share toothbrushes had an odds ratio of 1.116. Individuals who used illicit injectable drugs had an odds ratio of 2.206. Patients with a history of dental procedures had an odds ratio of 1.581. People with tattoos, ear, and nose piercings had an odds ratio of 1.527. Patients with a history of surgical procedures had an odds ratio of 1.165. Conclusion: This study showed that those patients who received a blood transfusion are at more risk of getting hepatitis B infection. Similarly, patients who live with hepatitis B patients or those who have infected family members are at risk. Sharing tooth brushes, and using illicit injectable drugs are at risk. Patients with a history of dental or surgical procedures are also at risk of developing hepatitis B.

Background: Falls are a leading cause of morbidity and mortality among the elderly, particularly in urban environments with increasing aging populations. This study aimed to assess the incidence, associated risk factors, and outcomes of falls among elderly individuals in an urban setting. Methods: A retrospective observational study was conducted by reviewing the medical records of 250 elderly patients (≥60 years) admitted for fall-related complaints in a tertiary urban hospital. Data were analyzed using descriptive statistics and chi-square tests. Results: The majority of patients were aged 70–79 years, with females accounting for 56.4% of cases. Hypertension (62%), diabetes (48.8%), impaired vision (48.4%), and polypharmacy (45.2%) were common risk factors. Most falls occurred indoors (62.4%), primarily due to environmental hazards like slippery flooring and poor lighting. About 31.2% of patients suffered fractures, and 12.4% sustained head injuries. Hospital stays exceeded 5 days in 26.8% of cases, but only 22% received rehabilitation. Conclusion: Falls among the urban elderly are frequent and preventable. Early identification of risk factors, environmental safety measures, and structured post-fall care can significantly reduce complications and improve geriatric health outcomes.

Introduction Fistula in ano is a challenging anorectal condition with a high recurrence rate, necessitating precise preoperative assessment for optimal surgical outcomes. Various imaging modalities aid in diagnosis, with CT fistulogram emerging as a valuable tool. This study evaluates the accuracy of CT fistulogram in identifying fistula characteristics and its correlation with intraoperative findings. Methods: A prospective study was conducted on 60 patients diagnosed with fistula in ano. Each patient underwent a thorough clinical evaluation, including digital rectal examination and proctoscopy. CT fistulogram was performed to assess fistula anatomy, including number, type, length, internal opening, and presence of abscesses. These findings were compared with intraoperative observations to determine the accuracy of CT imaging. Results: CT fistulogram demonstrated high accuracy in detecting fistula characteristics, with a 96.7% success rate in identifying the number of fistulae. It showed perfect agreement with intraoperative findings in localizing fistula type, distinguishing between intersphincteric (27.1%) and transsphincteric (72.9%) variants. Internal opening measurements on CT closely matched surgical findings (p=0.779). Additionally, CT had high sensitivity in detecting abscesses, with an 88.9% true positive rate and no false negatives. Conclusion: CT fistulogram proves to be a highly accurate, non-invasive imaging modality for preoperative evaluation of fistula in ano. Its ability to provide detailed three-dimensional visualization enhances surgical planning, minimizes intraoperative surprises, and improves patient outcomes. Given its superior diagnostic capability, CT fistulogram should be considered an integral part of fistula in ano assessment, particularly in complex cases.

Introduction: Lichen planus (LP) is a chronic inflammatory condition primarily affecting the skin and mucous membranes, but its musculoskeletal manifestations remain understudied. This study explores the association between LP and musculoskeletal symptoms using an interdisciplinary approach. While LP is primarily considered a dermatological condition, emerging evidence suggests systemic involvement, including musculoskeletal manifestations. Materials and methods: This study employed a cross-sectional observational design to investigate the musculoskeletal manifestations of lichen planus (LP). The study was conducted at a tertiary care dermatology clinic over a period of six months (January 2024 to June 2024). The interdisciplinary approach involved collaboration between dermatologists, rheumatologists, and immunologists to ensure a comprehensive evaluation of both cutaneous and musculoskeletal manifestations. The study population consisted of 300 patients diagnosed with LP. A control group of 150 age- and sex-matched individuals without LP or any known rheumatic conditions was also included for comparison. Results: The mean age of LP patients was 45.2 years, and the majority were female (60.0%). Joint pain was the most common symptom (50.0%), followed by myalgia (40.0%), joint swelling (30.0%), and stiffness (25.0%). Musculoskeletal symptoms in LP patients were characterized by moderate severity and a chronic course, with a mean duration of 6–7 months. The mean Visual Analog Scale (VAS) pain score of 6.5 indicates moderate to severe pain, which likely impacts patients' quality of life. Patients with severe LP had a significantly higher prevalence of joint pain (90.0%), joint swelling (60.0%), myalgia (70.0%), and stiffness (50.0%) compared to those with mild or moderate disease. Conclusion: The findings underscore the systemic nature of LP and highlight the need for an interdisciplinary approach to its management. Early recognition and treatment of musculoskeletal symptoms may improve patient outcomes and quality of life.

Aim: A pre-experimental study was carried to “Assess the effectiveness of structured teaching programme among mothers of under five children regarding Upper Respiratory Tract Infection in Ayaan Institute of Medical Science Hospital & Research Centre, Kankamidi Village, Moinabad Mandal, Ranga Reddy District, Telangana State., in order to educate mothers about upper respiratory tract and to prevent unnecessary use of medicines. Material And Method: The Study was done by colleting data from (30) mothers of under-five children with the help of structured interview by using a questionnaire. The score interpretation is used to classify the mothers with the help of descriptive and influential statistics after collecting the data the analysis and interpretation is done, mainly to know the effectiveness of structured teaching programme. Results: Among 30 mothers of under five children majority 27 (90%) of the mothers had moderate knowledge and 3 (10%) of mother had inadequate knowledge pre-test and majority 27 (90%) of the mothers had adequate knowledge and 3 (10%) of mothers had moderate knowledge post-test. Conclusion: Based on the study following conclusion were drawn. The existing knowledge regarding upper respiratory tract infections among mothers of under-five age group children was moderately adequate.

duction

Traumatic cataract is a significant cause of visual impairment and blindness, particularly in young, active individuals. It results from direct or indirect ocular trauma that damages the crystalline lens, leading to opacification and impaired vision. The management of traumatic cataract poses unique challenges, including associated ocular injuries, increased risk of complications, and complex surgical techniques. This evaluation aims to outline the clinical approach and management strategies for patients presenting with traumatic cataract. Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery. Materials and methods: This is a prospective study was conducted in the Department of Ophthalmology, Mahavir Institute of Medical Sciences and Research Centre in patients who was presented with unilateral traumatic cataract, underwent surgical intervention and completed at least 6 months. Patients of both genders and all age groups with unilateral traumatic cataract were included in the study. Patient's data including demographic details, causative agents, initial visual acuity, intraocular pressure, slit lamp examination findings, B-scan findings, treatment / surgery, early and late complications and final outcome were obtained from patient's chart in the hospital record. Removal of cataract was performed as a second and separate procedure in patients of perforating ocular injury, intraocular lens (IOL) implantation was performed only in patients with adequate capsular support. Patients without any capsular support were kept aphakic. Anterior vitrectomy was performed in patients with posterior capsular tear and vitreous prolapse. Result: Majority of the cases were seen in age group 5-14 years with male preponderance. 55% were penetrating trauma and 45% were blunt trauma. Corneal and iris tissue injuries were the most common associated injuries. Final visual acuity was 6/6-6/18 in 43% of patients, 6/24-3/60 in 31% of patients and less than 3/60 in 26% of patients. The most common late complication was PCO. On comparing final visual outcome among adult and paediatric age group, there was no significant difference. The time interval between injury and intervention had no significant effect on final visual outcome. Conclusion: This study demonstrates the critical importance of timely management and tailored surgical approaches in traumatic cataract cases. While the majority of patients achieved favorable visual outcomes, associated ocular injuries and complications significantly influenced the prognosis. Continued advancements in surgical techniques and post-operative care are essential to improving outcomes in such cases.

Introduction Encephalopathy is a term that means brain disease, damage, or malfunction. Encephalopathy can present a very broad spectrum of symptoms that range from mild, such as some memory loss or subtle personality changes, to severe, such as dementia, seizures, coma or death. In general, encephalopathy is manifested by an altered mental state that is sometimes accompanied by physical manifestations (for example, poor coordination of limb movements). The diagnosis of encephalopathy is usually made with clinical tests done during the physical examination (mental status tests, memory tests, and coordination tests) that document an altered mental state. In most cases, findings on clinical tests either diagnose or presumptively diagnose encephalopathy. Usually, the diagnosis is achieved when the altered mental state accompanies another primary diagnosis such as chronic liver disease, kidney failure, anoxia, or many other diagnoses.  Materials & Methods This is a Prospective observational study conducted in the Inpatient Department of Paediatric, Tertiary Care Teaching Hospital. MRI/CT brain will be performed according to the clinical requirement and patient condition at initial admission. If there is clear diagnostic information on initial imaging no further neuroimaging will be performed on these children unless a prognostic imaging is deemed necessary by treating neurologist.  Delayed imaging will be done when the initial neuroimaging is normal/nondiagnostic and child continues to have neurological symptoms and signs without obvious diagnoses from clinical, blood, CSF investigations.  Also, when there are new onset neurological symptoms/ progressive worsening of neurological status after initial neuroimaging. Result In 21.95% of cases, second scan was done on 4^th day of illness followed by 12.19% of cases on 3^rd day. Second scan was done from 4th-10th day of illness in 56.09% followed by 1st-3rd day and 11^th -20^th day in 19.51% and 17.07% respectively. Second scan was diagnostic in 80.48% of cases and nonspecific findings in 4.87% of cases and was  normal in only 4.87% of cases. Reason for second neuroimaging was Clinical Worsening in 41.46% and No Clinical Improvement in 31.7% of cases. Second neuroimaging was Diagnostic in 9.75% of cases.   Delayed neuroimaging and Both Neuroimagings were equally helpful in majority of cases (78.04%) and no neuroimaging was helpful in 17.07% of cases. First neuroimaging was diagnostic in 46.34% of cases and not diagnostic in 56.68%of cases. Second neuroimaging was diagnostic in 60.97% of cases and nondiagnostic in 34.14% of cases. Conclusions The present study demonstrates that there is a subjective component to scan interpretation, which can have important implications for the clinical management of acute encephalopathy cases. The agreement between raters was good for CT but only moderate for MRI. Agreement varied with diagnosis; for blinded reading radiologists were good at diagnosing acute encephalopathy; however, agreement was worse for ADEM and other alternative aetiologies. The study showed that imaging data are affected by imaging timing and technique, and there was poor agreement on some regional abnormalities.

Total knee arthroplasty (TKA) often results in significant postoperative pain, impacting recovery and patient mobility. Effective pain management, crucial for early mobilization and reducing complications, typically involves a multimodal approach. While the Femoral Nerve Block (FNB) is commonly used to manage TKA pain, it often fails to address posterior knee pain. However, FNB alone often fails to address posterior knee pain, leading to the addition of a Sciatic Nerve Block (SNB). While SNB improves posterior knee analgesia, it risks motor side effects like foot-drop due to peroneal nerve involvement. To address this, the study proposes a selective Tibial Nerve Block combined with FNB, aiming to reduce pain while preserving peroneal nerve function. The primary hypothesis is that a combined FNB and selective Tibial Nerve Block will offer better analgesia than FNB alone. Secondary outcomes include assessing pain scores, opioid usage, and motor function post-surgery. The study's objective is to measure factors like time to first analgesic request, cumulative opioid consumption, motor blockade, and any complications across both groups, using tools such as the Numeric Rating Scale for pain and Modified Bromage Score for motor function. This randomized, double-blind study aims to provide insights into optimizing pain management in TKA, potentially enhancing patient recovery and minimizing complications through targeted analgesic techniques.

Background: Electrolyte disturbances are common in patients with diabetes mellitus, particularly those with poor glycemic control. Hyperglycemia-induced renal dysfunction and osmotic diuresis can alter sodium, potassium, and chloride levels. This study aims to investigate the pattern of electrolyte imbalances in type 2 diabetes mellitus patients and their association with glycemic control. Materials and Methods: A prospective cross-sectional study was conducted with 79 type 2 diabetes mellitus patients attending the medicine outpatient department of S.V. Medical College, Tirupati. Serum sodium, potassium, and chloride levels were measured using ion-selective electrodes, and HbA1c was determined using immunoturbidimetry. Data analysis was performed using SPSS software. Results: Serum sodium levels were significantly lower in uncontrolled diabetes patients (128.7 ± 7.2) compared to controlled patients (134.5 ± 3.76, p = 0.0018). Serum chloride levels were significantly higher in uncontrolled patients (109.5 ± 5.9) than in controlled patients (106 ± 3.89, p = 0.0342). No significant difference in serum potassium levels was found between the two groups (p = 0.7882). A moderate negative correlation between HbA1c and serum sodium (r = -0.62) was observed, while a positive correlation with serum chloride (r = 0.38) was noted. Conclusion: The study confirms that poor glycemic control is associated with significant electrolyte disturbances, particularly sodium and chloride levels. These findings underscore the importance of monitoring electrolyte levels in diabetic patients to prevent potential complications. Further research is needed to explore the mechanisms behind potassium imbalances in diabetes.

Objective: This retrospective research aimed to compare the efficacy and safety of different surgical techniques in the management of “Benign Prostatic Hyperplasia (BPH)”. Methods: Medical records of subjects undergoing surgical intervention for BPH were retrospectively analyzed. Surgical techniques included “transurethral resection of the prostate (TURP)”, “holmium laser enucleation of the prostate (HoLEP)”, “photo selective vaporization of the prostate (PVP)”, “transurethral microwave thermotherapy (TUMT)”, and “prostatic urethral lift (PUL)”. Key outcome measures included improvement in urinary symptoms, perioperative complications, and long-term outcomes. Results: Significant differences were observed among the surgical techniques in baseline characteristics and perioperative outcomes. While all techniques led to improvements in urinary symptoms, laser prostatectomy techniques demonstrated potentially lower complication rates. Minimally invasive procedures showed promise in terms of reduced invasiveness and shorter recovery times. Conclusion: This comparative analysis provides valuable insights for clinicians in selecting the most appropriate surgical approach for people with BPH, considering individualized treatment goals and patient preferences.

Background: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder primarily characterized by inflammation of the joints. It affects millions of individuals globally, leading to pain, swelling, stiffness, and potential joint destruction if left untreated. The pathophysiology of RA involves the immune system attacking the synovial tissues of the joints, resulting in the release of inflammatory mediators and the activation of various immune cells.  Materials and methods: The present study was a cross sectional study was conducted on patients who fulfilled the American Rheumatologic association criteria, in Department of General Medicine. The data was collected from patients who fulfilled the criteria and have undergone the hematological tests. A total of 88 subjects were enrolled for the study, who were divided into 2 groups-cases group and control group with 44 subjects in each group based duration of rheumatoid arthritis up to 5 years. Result: Sex ratio of females to males is this study is 4:1. The risk of developing disease is greatest between 40 to 49 years. Rheumatoid factor positivity is 79% and rheumatoid factor negativity is 21%. The prevalence of anemia in rheumatoid arthritis patients is 75%. In rheumatoid factor positive patients mean Hb values is less (9.11gm %) compared to rheumatoid factor negative patients (10.23gm%). Iron deficiency anemia patients mean Hb is lower(8.6gm%) than in anemia of chronic disease is (10.9gm%). The prevalence of  rheumatoid arthritis according to DAS 28 score categories in decreasing order are  moderate 45.4% , severe 48.9% and mild 5.7%. Anemia is very well correlated with rheumatoid factor positivity, disease activity (DAS 28 score), duration of disease   and   ESR. Conclusion The hematological profile of RA patients is influenced by the underlying disease, the level of inflammation, and the treatment regimen. Anemia, leukocytosis, thrombocytosis, and coagulation abnormalities are common findings, with significant clinical implications. Understanding these changes helps clinicians assess disease activity, predict potential complications, and make informed decisions about treatment. Regular monitoring of hematological parameters is crucial to managing RA effectively, minimizing complications, and improving patient outcomes.

Objective: To determine the prevalence of anaemia among individuals with type 2 diabetes mellitus in Rohilkhand region. Methodology: From July 2023 to July 2024, this retrospective research was carried out in the Rohilkhand area. The study's primary objective was to investigate the prevalence of anemia among patients diagnosed with type 2 diabetes mellitus. For the aim of this investigation, data were gathered from a total of 20,430 people who were divided into unique categories: those who suffered from anemia and those who had glycaemic control. According to this criterion, the people were categorized, and those with diabetes who were considered to have their condition under control had an HbA1C level that was in the range of 7.5% or below. Results: Anaemia was defined as a hemoglobin level below 13 g/dL for men and 12 g/dL for women. The data showed a 30.2% overall prevalence of anemia, with a higher incidence in females (62.1%) and those with poorly controlled diabetes (33.46%). The findings indicated a significant correlation between poor glycemic control and higher rates of anemia, emphasizing the need for regular screening and integrated care. Conclusion: The study concluded that addressing anaemia in type 2 diabetes patients, particularly those with inadequate blood sugar management, is crucial to improving health outcomes and reducing complications.

Introduction: Asthma is a chronic lung illness marked by reversible airway blockage caused by inflammation of the lungs’ airways and tightness of the muscles around them. The recent Global Initiative for Asthma (GINA) guidelines defined asthma as “a heterogeneous disease, usually characterized by chronic airway inflammation.” Respiratory symptoms such as wheezing, shortness of breath, chest tightness, and cough, as well as fluctuating expiratory airflow limitation, are the characterizations of asthma. The present study aims to assess the various socio-demographic and environmental factors influencing the causation of childhood asthma among patients attending the Paediatric Department.  Materials and methods: This was an observational, cross-sectional study was conducted in the Tertiary Care Teaching Hospital. Children aged between 1-17 years, of either gender and diagnosed with asthma exacerbations defined as episodes of progressive increase in shortness of breath, cough, wheezing, or chest tightness, or some combination of these symptoms were included. Result: In this study other class of drugs prescribed along with anti-asthmatic drugs showed that multi-vitamins (38.9%), mucolytic agents (16.7%), proton pump inhibitors (antacids) (14.4%), expectorant (7.8%) and NSAIDs (7.8%) were prescribed as adjuvant therapy. Mucolytic agents and expectorants were mainly given in syrup forms for symptomatic relief. SABA (salbutamol - 61.1%) was the most commonly and frequently prescribed single anti asthmatic drugs followed by methylxanthines (21.1%), corticosteroids (8.9%), anticholinergics (7.8%) and anti-histaminics (1.1%). Majority of the patients were on fixed dose combination (FDCs). Most commonly prescribed FDC of antiasthmatic drug is combination of steroid (ICS) and LABA (71.1%). Out of which, the most common combination used is budesonide and formeterol (60%). Conclusion: Based  on  the  results,  it  was  observed  that most  of  the  patients  were  prescribed  with  multiple  (two, three,  four)  drug  therapy,  out  of  which  inhalational  route was the most preferred one. Anti-asthmatic drugs given as inhalational therapy are more  beneficial  to  the  patients than  systemic  therapy.  Most  frequently  prescribed  single class  anti-asthmatic  drug  was  levosalbutamol  (SABA).

Background: Acute-on-chronic liver failure (ACLF) is characterized by acute hepatic insult manifesting as jaundice and Coagulopathies, complicated within 4 weeks by ascites and/or encephalopathy in patients with previously diagnosed or undiagnosed chronic liver disease. Aim: Our objectives are to investigate their short-term result, precipitating causes, mortality predictors, clinical profile, and the underlying chronic liver disease aetiology. Methods: A prospective study was conducted on 200 patients with an ACLF diagnosis and same number of aged matched control (non ACLF) was examined. Demographic features, clinical profile, risk factors and biochemical parameters were measures in both ACLF and non-ACLF patients Results: Majority of the patients (46%) were >50 years age group predominantly male (87%).  In ACLF, alcoholic liver disease was most common (85.7%), followed by cirrhosis associated to the Hepatitis B virus (8.2%).. Jaundice was present in all cases; followed by ascites (94.3%) patients. esophageal varices (66%), Splenomegaly (60%), Hepatic encephalopathy (46%), severe malnutrition (32%), hepatomegaly (30%) and fever (20%). Acute flare-ups of Hepatitis B infection in 60% with Hepatitis B-related cirrhosis, recent drug use (44.8%), sepsis (28.9%), spontaneous bacterial peritonitis (14.7%), urinary tract infections (14.7%), acute hepatitis A in 2% and acute hepatitis E in 1.2% patients were the precipitating causes. High mortality was found to be substantially correlated with hepatic encephalopathy, insufficient salt, and a high International Normalized Ratio (INR). Conclusions: Rapid deterioration is a hallmark of ACLF, particularly when multiorgan failure develops as a result of specific triggering circumstances in a chronic liver illness that has been previously recognized or is still undiscovered.

Background: Approximately 2–8% of pregnancies worldwide are complicated by preeclampsia (PE), a serious pregnancy complication characterized by new-onset hypertension and proteinuria. Oxidative stress, the key pathogenic factor in PE, causes endothelial dysfunction and contributes to the severity of the disease. Early PE detection and better maternal and fetal outcomes can be enhanced by identifying reliable oxidative stress biomarkers. Objective: The purpose of this study was to determine the levels of oxidative stress markers, malondialdehyde (MDA), total antioxidant capacity (TAC), and superoxide dismutase (SOD), in women with PE and normotensive pregnancies and to determine whether any of them could serve as biomarkers for PE during early pregnancy. Methods: A total of 150 pregnant women (75 women with PE and 75 normotensive controls) were studied in a cross-sectional manner. The levels of MDA, SOD activity, and TAC were measured in the blood samples. Comparisons were made using descriptive statistics and independent t-tests, and the relationship between oxidative stress markers and blood pressure in the PE group was tested using Pearson’s correlation. Results: The PE group showed significantly higher (p < 0.01) MDA levels than the control group but lower TAC and SOD levels (p < 0.01). Significantly reduced TAC and SOD and increased MDA levels correlated positively with increased blood pressure in PE, indicating increased oxidative stress and decreased antioxidant defenses. Conclusion: The elevation of MDA and reductions in TAC and SOD in patients with PE emphasize that oxidative stress is an important component of PE pathophysiology. The use of these markers as early indicators of PE risk provides the potential for the inclusion of oxidative stress biomarkers in prenatal care protocols as a way to improve diagnostic and preventive strategies

Background: Diabetic foot disease (DFD) is a serious complication of diabetes, often complicated by infection, ulceration, and amputation. The present study will outline the various clinical presentations, glycemic control, limb vascularity, and the treatment outcomes of diabetic foot diseases. Methods: We carry out a retrospective observational study in the Department of General Surgery at Bangalore Medical College and Research Institute among 200 patients who are suffering from DFD. Doppler ultrasound and radiological imaging was conducted for assessing clinical assessment, glycemic status in the form of HbA1c, and the limb vasculature. The management consisted of medical therapy along with surgical interventions and adjunctive therapies. The outcomes were assessed based on patient records for a six-month follow-up period. Results: The main presenting complaint for most patients was foot ulcers, seen in 78% of the patients, while 60% had poor glycemic control, as represented by HbA1c ≥ 7%. Poor glycemic control was significantly associated with higher Wagner grades and worse outcomes. Impaired vascularity, as represented by an ABI of < 0.5, indicating critical limb ischemia, was seen in 25% of the patients. Limb salvage was achieved in 88% of cases, with an overall mortality rate of 5%. Adjunctive therapies, such as NPWT, present positive results for enhancing wound healing. Conclusion: DFD prognosis would be based on glycemic control and vascular status. Early intervention through multidisciplinary management takes into consideration most of the complications and thus helps improve the outcome: integrated medical and surgical management for diabetic foot disease.

Each of these pathotypes represents a group of clones that share similar virulence characteristics. It should be mentioned, too, that because of the genome's flexibility, many E. coli isolates have been challenging to categorise as a pathotype. This is due to the fact that some isolates, which may be more virulent hybrid pathogenic strains, combine the most pathogenic features of many pathotypes. Further epidemiological studies are necessary to officially designate DAEC as a unique DEC pathotype, despite the fact that they are classified as a group apart from the other pathotypes. These studies have been impeded by the challenges associated with identifying and classifying DAEC. Material and Methods This is a prospective, observational, Random and cross-sectional study conducted in the Department of Microbiology at Index Medical College, located in Indore, Madhya Pradesh.  Submission of a stool sample that reveals an excess of five white blood cells per high-power field (HPF). A total of 180 fecal samples was collected by using disposable container. Each container was inverted and sealed immediately after collection. Results A total of 111 (61.7%) isolates were found to be ESBL producers in Table 1, whereas 68 (37.8%) isolates were shown to be MBL producers using both approaches (combined disk diffusion test and Modified Hodge test). By using both the zone indentation and the boronic acid disk test technique, AmpC was found in 48 (26.7%) diarrheagenic E. Coli isolates, while the disk approximation test yielded positive results in 44 (24.4%) isolates. The production of ESBL, MBL, and AmpC in the healthy group was comparable to those of the other study groups. It was shown that the boronic acid disk test method for AmpC detection was more user-friendly and reproducible. Conclusion:  In this investigation, the isolates' primary resistance patterns that were assessed were AmpC, ESBL, and MBL. The widespread usage of third-generation cephalosporins was the cause of the high frequency of ESBL and plasmid-mediated AmpC. The aim of phenotypic approaches for beta-lactamase detection was to determine the drug resistance profile of E. coli gut flora prior to medication delivery.

Background: Many Studies and Research Articles in our medical field focuses on Conflict Management in the clinical set up, but this study only focusses Conflict Management   on Pre-Clinical & Paraclinical settings. The objective of this study on Patterns & Parameters of Conflict Management among the Doctors of Pre-Clinical and Para Clinical Departments of GVMCH – Salem. Methods:  This Cross-Sectional Study was conducted among 45 Doctors across 7 Pre & Para Clinicals Departments of Government Medical College Salem in Tamil Nadu. Mean, Median, Mode and Standard Deviation were used for quantitative Data and Pearson Chi Square Test and Logistic regression was used for qualitative Data using Epi Info 7. Results:  The mean Score was 8.2 ± 1.4 with Mean scoring percentile of 26.8 ± 6 . There was Pearsons Chi Square significance for Variables like External Resources related to Conflict Management, Books related to Conflict Management, UG and PG pursued at, Exposure to Workshops or CME s related to Conflict Management, and age Group < 35. But on running Logistic Regression we got statistical significance for External resources related to Conflict Management and Age Group > 35 years. Conclusions:  Variables like External resources related to Conflict Management   , Age Group > 35 years  Showed  Statistical significance and better inferences compared to other dependent and independent variables  in this pre & Para Clinical Department set ups.  

Background: Thyroid dysfunction has a great impact on lipids as well as a number of other cardiovascular risk factors. Evidently, deviations in thyroid function may impart modifications upon circulating lipid levels.  Objectives The principal objective of this research was to elucidate the nuances of lipid level perturbations associated with thyroid dysfunction in a tertiary care hospital. Material and Methods: This study adopted a cross-sectional observational design. We have included a total 120 thyroid disorder patients, 40 individuals afflicted with hypothyroidism, an equal number beset by hyperthyroidism, alongside 40 euthyroid counterparts. Socio-demographic profile of all individual was recorded. Levels of total cholesterol, triglycerides, high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and the LDL/HDL ratio were meticulously scrutinized. Results: Mean serum levels of TC, TG, VLDL, LDL cholesterol and LDL/HDL ratio were significantly lower among hyperthyroid and significantly higher among hypothyroid group as compared to euthyroid group (p<0.05), whereas mean HDL level were significantly higher in hyperthyroid group and lower in hypothyroid as compared to euthyroid group (p<0.05). Conclusion: Aberrations in thyroid function wield the potential to exert profound modifications upon the lipid profile. In light of this, the systematic evaluation of thyroid dysfunction should be taken into account when evaluating and treating dyslipidemia patients.

About 60% of cancers occur in people aged >65 years. Because of limitations in application of screening, early diagnosis and access to treatment, further increases in the incidence of cancer have been foreseen. This research was planned to study the clinical profile, prognosis and outcomes of malignancies in elderly patients (age> 65 years). Methodology: The present study was conducted on 80 elderly patients of age ≥65 year, histologically proven of malignancy and taking standard treatment a tertiary care centre. History of presenting complaints, addictions, comorbid conditions and past history. The history of planned treatments viz chemotherapy, radiotherapy, hormonal therapy supportive palliative care and 15 surgeries undertaken was noted. Occurrence of adverse events during treatment and follow up period was noted. Follow up was done till 6 months and major events like death or major adverse events were noted. Charlson Comorbidity Index calculation was performed.  Results: There was male preponderance with total 58.75 % males, 56.25% of patients were 65 to 70 years old, 32.5% were in the age group 71-75 years. The average age of the patients was 70.55±3.52. Major 37.5% of patients had hypertension, 22.5% had diabetic, and the remaining patients had various comorbid diseases. Maximum 47.5% of cancer patients admitted to the hospital were admitted for less than a week. The average CCI in survivors was 4.19±0.58 whereas in mortality group average CCI was 6.27±2.61. 42.5% were receiving chemotherapy, 31.25% were receiving radiotherapy, 27.5% were receiving greatest supportive care, 16.25% were receiving hormone therapy and the remaining 15% patients underwent surgery. The majority of cancer patients (23.75%) had breast cancer, 12.5% had prostate cancer, 11.25 % had colorectal and cervical cancer, 8.75% had bladder and stomach cancer each. Alcohol, smoking, and tobacco chewing were the most common addictions among patients, each accounting for 28.75%, 26.25%, and 18.75% of the total. The majority of the patients (40%) complained of weight loss, followed by 23.75% who reported loss of appetite. After the follow up for nearly 6 months, 13.75% of cancer patients died and 61.25 % cases were continuing with follow up visits for treatments whereas 25% cases were lost to follow up. About 25% patients lost weight in the range of 3.1-5 kg during treatment whereas 15% cases lost weight >5kg.  Overall, 49 cases (61.25%) lost weight during the treatment. Conclusion: The findings of this study have highlighted the need for early detection, timely treatment, and appropriate management of malignancies in this age group. The Charlson comorbidity Index was found useful in understanding the prognosis of these cases. Treatments in elderly patients was well tolerated with the same regimen used for younger patients.

Background:-Patients with CKD are thought to be highly susceptible to emotional problems because of the chronic stress related to disease burden, dietary restrictions, functional limitations, associated chronic illness and comorbidities, adverse effects of medication, changes in self-perception, and

fear of death. Hemodialysis patients have a lower quality of life, more functional impairments, and greater occurrence of psychopathological states including suicidal ideation, lower adherence to drug treatment, and an increased likelihood of long-term term body-pain. Psychiatric Comorbidity in CKD patients can interfere with well-being and productivity, the ability to concentrate and process information, or the ability to make decisions and participate meaningfully in self-care. Therefore, the diagnosis and treatment of these conditions becomes important to improve psychological and overall well-being, and quality of life and consequently, reduce morbidity and mortality risks in this population.  Methods: -Electronic searches were conducted using title and subject headings for ‘psychiatric ‘/ ‘psychological ‘, ‘depression’, ‘mood disorders’, ‘depressive disorder’, ‘mental health’, and ‘mental illness’ in combination with ‘kidney disease’, ‘renal dialysis’, renal insufficiency’, and ‘kidney failure’. Though not briefing the clinical management guidelines, this review aims to summarize the evidence regarding psychiatric Comorbidity in CKD to aid clinical decisions. Results: - For patients treated with maintenance dialysis, the dose of most psychotropic medications does not need to be adjusted because they are metabolized in the liver. However, the metabolites are often excreted by the kidney and a minority of drugs may require a dose adjustment. The combination of pharmacotherapy and psychotherapy is likely to be successful and may be cost-effective. Conclusion: - This literature review has been conducted in an attempt to explore the main psychosocial factors in people with CKD of varying severities and those undergoing hemodialysis. Depression, anxiety, and stress are common conditions among chronic kidney disease patients and they occur more frequently among CKD and those undergoing dialysis. Lower quality-of-life scores are also associated with symptoms of psychiatric co-morbidities. The presence of comorbidities, loss of vascular access, and worse quality of life were associated with anxiety symptoms among dialysis patients. Timely and appropriate interventions lead to recovery of psychiatric problems

Which eventually improve Quality of life and life expectancy.

Background: Chronic Obstructive Pulmonary Disease is a progressive and debilitating respiratory condition; it is physiologically defined by airflow limitation. Traditionally, the severity of COPD has been and CAT score determination. In addition to that, serum Vitamin D levels would be measured. Data would be presented using SPSS software in order to evaluate the relationship of these parameters gauged using markers such as the BODE index and COPD Assessment Test score. Emerging evidence suggests that Vitamin D deficiency may exacerbate the disease, potentially impacting outcomes. Methods: The present observational prospective study was conducted for two years and included 100 diagnosed patients with COPD. Spiro metric data would be analyzed along with the BODE index with each other and the severity of the disease. Results: In the population with COPD Vitamin D levels were inversely related to the severity according to BODE (p < 0.05). Higher levels of Vitamin D were found in better spirometric results (FEV1%) and lower scores of BODE and CAT. These features were inversely related to BMI, especially in overweight and obese patients. Conclusion: The findings suggest a relationship between Vitamin D deficiency and the increased severity of COPD. The addition of Vitamin D supplementation to the management modalities may offer clinical benefits, especially in the severely symptomatic states. Longitudinal studies are further needed to confirm the therapeutic role of Vitamin D in the management of COPD.

Introduction: Obesity is usually defined according to body mass index (BMI) cut - offs. However, BMI cannot provide information on the distribution of body fat. Central obesity, as assessed by waist circumference (WC), is more strongly associated with the risk of hypertension, dyslipidaemia, type- 2 diabetes, cardiovascular disease, cancer and all - cause mortality. Aim: To identify the existence of general and central obesity by anthropometric measurements and to compare anthropometric parameters in the control and prediabetic subjects. Material and Method: The present study was conducted in the Department of Physiology, IndexMedical College, Hospital & Research center, Malwanchal University Indore, during 2022 - 2023. The Fasting Blood sugar, Lipid profile & fasting insulin Biochemical investigation was done in the department of Biochemistry of the institute. The anthropometric measurement including Weight (kg), Height (cm), Body mass index (kg/m2), Waist circumference (cm), Hip circumference (cm), Waist Hip ratio was recorded. Result: The 140 subjects aged 30 - 60, maximum numbers of Prediabetic were in the age group of 40 - 50 years. In the control group 66% women as compared to the men 32%, in prediabetic group 72% subjects were showed general obesity, central adiposity was identified in 84%. It was observed that body mass index and waist circumference were significantly higher in prediabetic subject. Conclusion: This study has important implications for identification of subjects at higher risk for future type 2 - diabetes and suggested that mass screening of prediabetic subjects and aggressive risk modification and close follow-up should be considered for prediabetic subjects with metabolic syndrome

Background: Laboratory quality can be defined as accuracy, reliability and timeliness of reported test results. The laboratory results must be as accurate as possible, all aspects of the laboratory operations must be reliable, and reporting must be timely in order to be useful in a clinical or public health setting. In India accreditation for medical laboratories is not mandatory. All laboratories only have to register themselves with the health departments in the respective states. The only accreditation agency that is authorized by the central government is the National Accreditation Board for Testing and Calibration of Laboratories (NABL). An estimate shows that there are about one lakh medical diagnostic laboratories are existing in the country. Enquiries reveal that NABL has accredited around 450 medical laboratories (0.45%), with the rest (99.5%) having only registered with the respective state health departments. Methodology: A Prospective (Cross-Sectional) study will be conducted in laboratories to evaluate current quality practices in comparison to ISO 15189:2012. The Study will be conducted in clinical Laboratories i.e. Biochemistry, Microbiology and Pathology of Nizam’s Institute of Medical Sciences which is a Tertiary care teaching Hospital. A checklist of 33 parameters based on ISO 15189:2012 standards is formulated for assessing the total processes involved in all the three laboratories (Biochemistry, Microbiology, Clinical pathology). The criteria employed to record the findings were “Yes”, “No” as the options. A total of 40 samples will be selected for each investigation considered for study in the individual laboratories (Biochemistry-16, Microbiology-13, Clinical Pathology-7). These 33 parameters were evaluated based on laboratory processes from sample collection to reporting.  Results: Laboratory has adequate space for testing but the facility is not adequate for refrigerators since room no. 106 is occupied with more refrigerators and no air conditioner is available in that room. The laboratory is Air-conditioned but room temperature is not being monitored daily as working of automated analyzers is highly temperature dependent. A fire extinguisher is not available in all rooms of the laboratory. All laboratory staff is wearing street slippers/shoes. At present there is no system of recording and reporting minor accidents/incidents (electric shock, fire accidents, needle stick injuries etc.) taking place in the laboratory. Conclusions: Based on the study it is observed that out of 33 parameters included in the study 13 parameters showed 100% compliance in accordance to ISO 15189: 2012 (E) i.e. Infrastructure, Emergency Backup, Proper waste disposal, Quality assessment of procured items, Compliance of purchase items with standard requirement, Confidentiality of patient reports, Automated equipment, Calibration of laboratory equipment, Storage condition of samples, External quality assessment scheme (EQAS), Use of appropriate vacutainer, Disposal of sharps, Disposal of infectious waste.

Background: Menopause is associated with numerous physical and psychological symptoms, significantly impacting women's health. Hormonal therapy (HT) is widely used to alleviate these symptoms and improve quality of life. Objective: This study investigates the effects of hormonal therapy on menopausal symptoms and overall health outcomes in women, focusing on the safety and efficacy of HT in managing symptoms. Method: A prospective study was conducted at Barasat Government Medical College & Hospital, India, from January 2023 to June 2024. A sample of 108 menopausal women was recruited and assessed. Data were collected through patient interviews, clinical assessments, and follow-up visits. The efficacy of HT was evaluated based on symptom relief and health markers, with comparisons to non-HT users. Result: Of the 108 patients, 67% (n=72) reported significant improvement in vasomotor symptoms, while 55% (n=59) experienced reduced mood disturbances. HT users showed a 40% reduction in bone density loss compared to non-users. However, 12% (n=13) experienced mild side effects such as headaches and nausea. No severe adverse effects were reported. Patients initiating HT within five years of menopause onset showed the greatest benefit, particularly in terms of cardiovascular health, with a 25% reduction in risk markers. Conclusions: Hormonal therapy is effective in managing menopausal symptoms and preventing long-term health risks, though careful patient selection and monitoring are essential. Personalized treatment plans should be emphasized for optimal outcomes.

Background: Femur neck fractures are always a great challenge to orthopaedic surgeons in terms of management and outcome. In developing countries the fracture often remainsuntreated as the patients do not seek treatment due to nonavailability of treatment facility or may be treated primarily by osteopaths or operated under suboptimal theatre conditions with poor quality implants. In addition to the relative rarity of the injury, there has been a high incidence of avascular necrosis and nonunion reported in the literature. Objectives: This study was to know the outcome of neglected fracture neck of femur in elderly patients treated with cemented bipolar hemiarthroplasty. Materials and methods: This is both a retrospective and prospective study of eighteen cases as per the inclusion and exclusion criteria and were operated with cemented bipolar hemiarthroplasty. Their return to pre-injury activity level and complications were assessed for a minimum of 6 months follow up and patient satisfaction was noticed. Results: wo patients had DVT before surgery, three patients had bed sores, 10 patients had co-morbidities and all were appropriately treated. Post-operatively there were no cases of sciatic nerve palsy, infection, dislocation and no case of post-operative DVT. Two patients had limb length discrepancy, one patient had chronic hip pain and altered gait. 83% had excellent results and 15 of them returned to almost pre-injury level activities, 1 patient had chronic hip pain and altered gait, and 2 patients had limb length discrepancy. Conclusion: Cemented bipolar hemiarthroplasty in neglected fracture neck of the femur gives good results with early mobilization and returns to pre-injury activity level.

Background - To determine the prevalence of SSI after lower segment caesarean section and comprehensively investigate the etiology, risk factors, and antibiotic resistance patterns of aerobic bacteria causing surgical site infections (SSI) following lower segment caesarean section (LSCS). Methods: This is a non-interventional prospective observational study, in which a total of 226 post caesarean emergency and elective LSCS cases were enrolled for the period of Jan 2023 to June 2024. The demographic data, risk factors and clinical details for appearance of signs and symptoms of SSI were recorded in a preformatted proforma. Collection of pus swab/aspirate samples, identification of microorganisms, and antimicrobial susceptibility testing was done by standard CLSI guidelines.  Results: The prevalence rate of SSI post LSCS of 14.6% . In our study. anaemia, intra-operative blood transfusion and comorbid illness like heart disease, chronic kidney disease, diabetes mellitus (DM), and hypertension (HTN)  were found to be significantly associated with SSI. Also, certain surgical factors such as emergency procedures, longer surgeries, and higher blood loss correlate with elevated SSI incidence rates. Staphylococcus, Escherichia coli and Coagulase-Negative Staphylococcus (CONS) are most prevalent with a rate of 21.21%. Conclusions: SSIs rates observed are14.6%, which falls within the reported range of 2.5% to 41.9%.75The study identified several risk factors associated that can be targeted to effectively reduce SSI rates.

Eighty-four              Iraqi         patients    (Male       &             Female)    with         celiac       disease     with         an            age           range (3-65) were investigated. Samples were taken from the Al Karama Teaching Hospital period October 2020 - to June 2021. Data sheet was filled according to questionnaire format, which include name, age, smoking, family history & alcohol intake. The patient's diagnosis was based on some serological test (AGA, tTG) the patients were clinically subdivided into treated and untreated. Twenty- seven controls were selected randomly from apparently healthy individual (31 male & 53 female). This study aims to evaluate evaluated some genetic & immunological parameters; her were: 1-Determine whether the gene expression and the serum level of interleukins (15 and 21) have an effect on the functioning of the immune system in individuals with celiac disease. 2-Evaluated CD gene expression of treated (gluten-free diet) and naive (untreated) CD patients compared with healthy individuals. The study methodology was based on an ELISA test kit provides a quantitative in vitro assay for human autoantibodies of the IgA class against tissue transglutaminase in serum or plasma. Result shown in Table (2) indicate that the majority of patients in celiac disease were diagnosed in females more than males; in the other hand, 66,67% of the confirmed treated Patients with celiac disease were females, while 33.33% were males, 40% confirmed untreated Patients from celiac disease were males when they were females 60 %, moreover furthermore 62.96% control female group more than 37.04% male control group with a significant difference (P-value 0.03661). The collected data showed that 23 (76.67%) patients had no clinical history of celiac disease in the untreated group; on the other hand, only 7 (23.33%) had a clinical history of the patient in the same group, while 1 (3.7%) ) The group of patients treated with no clinical history more than 26 (96.30%) and the patient in the same group had a clinical history, as well as 20 (74.07%) patients, had no history of celiac disease in the control group 7 (25.93%) Patients with a family history of celiac disease in the control group, with highly significant difference * (P≤0.05), ** (P≤0.01), (P-value 0.0001). he casuistic in table (3) showed the serum of 84 patients, including 30 with celiac disease without treatment tTG-IgA (5.41 ±0.27 b), tTG-IgG (3.76 ±0.27 b),27 patients treated group tTG-IgA (10.65 ±1.84 a), tTG-IgG (7.31 ±1.46 a) and 27 healthy as controls tTG-IgA (3.62 ±0.19 b), tTG-IgG (2.72 ±0.17 b), with P-value tTG-IgA (0.0001), tTG-IgG (0.0007), within significantly high difference ** (P≤0.01). The variants represented IL-15 and IL-21 gene expressions of celiac patients untreated, treated group, compared with that in the healthy control group individuals. The results showed that of IL-21 expression in untreated patients was (27.22 ±0.23 a) tables (6) and (7), while treated group (27.37 ±0.24 a), more than control group (25.04 ±0.53 b), with high significant P-Value (P≤0.01). At the same time, the expression of the IL-15 gene in untreated patient was (29.50 ±0.40), while treated group (29.63 ±0.26a) and control group (29.04 ±0.81), with non-significant P-Value (P≤0.706).

Ectopic pregnancy is a public health issue and a life-threatening condition in Sub-Saharan Africa due to high risk of sexually transmitted infections. While surgical option of management is often advocated for cases of ruptured ectopic gestation, unruptured cases can be managed medically especially where fertility is of a major concern. The case presented is that of a 30-year old GIP0+0 who presented at a private health facility with mild right sided lower abdominal pain and spotting per vaginal of 2days duration at a gestational age of 7weeks and 2days, she was haemodynamically stable. A pelvic Ultrasound done showed a right sided gestational sac with no cardiac activity and an empty uterus. Serum β HCG done was 913mIU/ml. She was managed as a case of unruptured ectopic gestation with intramuscular methotrexate injections and she had a complete resolution of the ectopic gestation as evidenced by the disappearance of the symptoms and biochemical assessment of the level of serum β HCG which dropped to zero.

Background- To find out Maternal Serum Alpha Fetoprotien as a marker of Placental adherence in Placenta Previa and low lying placenta.

Methods- The present study was a prospective observational hospital based study conducted in the Department of Obstetrics and Gynaecology, SMS Medical College and Attached Group of Hospitals, Jaipur from April 2021 to June 2022.

Result- The level of Maternal Serum Alpha Fetoprotien was significantly elevated i.e more than 2.3 MoM in 18 out of 24 cases of adherent placenta with a Sensitivity of 66.7% , Specificity of 90.5% , Positive predictive value of 88.9% and Negative predictive value of 70.4%. The patients with significantly raised MSAFP levels underwent major surgical intervention.

Conclusion- Maternal serum AFP was significantly and positively related with placenta adherence. Such finding suggests the potential role of maternal serum AFP in identifying pregnancies that are at high risk for placenta accreta.

Introduction: Infective endocarditis (IE) is a disease that develops because of infection located in the endocardium valves (most common), the ventricles and atria, the lining of the great blood vessels of the chest, vascular connections, or foreign bodies within the heart. Objective: This paper aims to evaluate the Kaplan-Meier survival curve and assessment results of the health of patients treating complicated aortic infective endocarditis. Patients and methods: This paper was shown as a cross-sectional study to evaluate the Kaplan-Meier survival curve and assessment results of the health of patients treating complicated aortic infective endocarditis. This data was examined by the Kaplan-Meier survival curve and assessment result health of patients treating complicated aortic infective endocarditis into 108 cases patients, which it covered all patients in different hospitals in Iraq in the range from 17^th June 2021 to 27^th August 2022. This study was analyzed all patients for both males and females, where the first group presented the males (58), and the second group was females (50), where the characteristics of demographic data were analyzed by the SPSS program. Results and Discussion: The relevance of decreasing the postoperative pacemaker rate is due to proper sizing and insertion procedure rather than the structural architecture of the bioprosthesis. Other authors have also emphasized this point. In the current research, patients with IE have been shown to have a greater requirement for a permanent pacemaker, particularly in situations of perivalvular development of the IE. In our cohort, over 55% of patients had a perivalvular expansion of the IE and significant preoperative rhythm abnormalities, which required the postoperative installation of a pacemaker. Conclusion: This paper was noticed that all men got more impacted than females, while females have more complicated than males, where the most two parameters have more complications were got high injured which are cerebrovascular stroke, and fulminant sepsis, whereas the females were complicated more than males. As well as the outcomes noticed that the results found arrhythmia based on the Kaplan- Meier survival curve.

Background: To evaluate cerebroplacental ratio in pregnancy with IUGR. Methods: This is a prospective observational study conducted at Department of Obstetrics and Gynecology, SMS Medical College & attached Hospital Jaipur from April 2021 till May 2022 on 65 women admitted in the Department of Obstetrics and Gynecology, SMS Medical College, Jaipur. After applying inclusion and exclusion criteria and taking informed consent, routine investigation and ultrasonography was done and fetal doppler was studied and cerebroplacental ratio was studied

Results: From all our cases we has studied Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy were calculated and results combined arriving to an conclusion that UA PI was 37.14% sensitivity, 86.67% specificity, 76.47% positive predictive value, 54.17% negative predictive value and accuracy of 60%. The MCA PI has 22.86% sensitivity, 100% specificity, 100% positive predictive value, and 52.63% negative predictive value and accuracy of 58.63%. The CP Ratio calculates through (MCA PI/ UA PI) has sensitivity of 37.14%, specificity 100%, positive predictive value 100%, negative predictive value 57.69% and accuracy of 66.15%.

Conclusion: Abnormal CP ratio is a better predictor of adverse perinatal outcome in IUGR. Doppler ultrasound plays a significant role in the management of growth restricted fetuses by early identification and thus helps in line of management and obstetrical surveillance.

Background: Acute respiratory distress in pregnancy is a life-threatening condition which contributes significantly directly or indirectly to maternal death. Case reported: This was that of a 20-year old G1P0+0 who presented with sudden onset of difficulty with breathing with no associated fever, neither cough nor chest tightness at a gestational age of 34weeks+4days having been referred from a private facility where she has had antibiotics and was nebulized without any success. She was not a known asthmatic and laboratory and radiological investigations carried out did not reveal any pathological cause. She was managed as a case of acute respiratory distress due to diaphragmatic compression and was subsequently delivered of a live male neonate who weighed 2.4kg and with good Apgar scores. Mother continued to improve following delivery and was discharged home on the 5th day of admission.

Conclusion: Acute respiratory distress in pregnancy can be due to hormonal changes in pregnancy coupled with diaphragmatic compression from the gravid uterus as the pregnancy advances. A high index of suspicion is required after ruling out pathological causes, this should be followed by immediate delivery to prevent maternal death.