Background: Anxiety disorders are among the most prevalent mental health conditions globally, significantly impacting the quality of life. Proper management strategies are essential for improving outcomes. Objective: This study evaluates the effectiveness of different management approaches for anxiety disorders in a tertiary care hospital in Andhra Pradesh, India. Methods: A clinical observational study was conducted from August 2018 to February 2019 among 150 patients diagnosed with anxiety disorders using DSM-5 criteria. Data were analyzed using SPSS v20.0. Results: Pharmacotherapy combined with cognitive behavioral therapy (CBT) showed better patient outcomes in comparison to pharmacotherapy alone. Benzodiazepines and SSRIs were the most commonly prescribed drugs. Conclusion: Integrative management, combining pharmacological and psychotherapeutic approaches, yields superior results in treating anxiety disorders.

Diabetes mellitus (DM) is a metabolic disease associated with chronic hyperglycemia. It is a distressing epidemic and is considered one of the leading causes of death worldwide. Globally, the prevalence of DM is estimated to be 9.3% (463 million people), increasing to 10.2% (578 million) and 10.9% (700 million) by 2030 and 2045, respectivelyThe relationship between glycated hemoglobin (HbA1c) levels and intraocular pressure (IOP) in patients with diabetes mellitus (DM) is a subject of significant clinical interest due to its implications for glaucoma risk and diabetic eye disease progression. Material and methods This is a prospective and observational study was conducted in the Department of Ophthalmology, Dr. VRK Women's Medical College, Teaching Hospital & Research Centre. Subjects with provisional diabetes were confirmed to be having diabetes by re-estimating fasting blood glucose by enzymatic assay-based glucose oxidation method. The biochemical analyses done using the Merck Micro Lab 120, semi-automated analyzer included total serum cholesterol (CHOD-POD method), high-density lipoproteins (after protein precipitation CHOD-POD method), serum triglycerides (CHOD-POD), hemoglobin (calorimetric hemoglobinometer), packed cell volume (capillary method) and the glycosylated hemoglobin fraction. Results A total of 120 patients involving 240 eyes of Type 2 diabetes mellitus patients who satisfied the inclusion criteria were included in our study. Out of 120, 76 patients were male (63.3%), and 44 patients were female (36.7%). The patients ranged between the ages of 40-89 years. The mean age was 59.62 years with a standard deviation of 9.76. The mean intraocular pressure in males was 15.6 ± 2.9 mmHg, and in females, the mean intraocular pressure was 15.5 ± 3.2 mmHg Conclusions Systemic hypertension, smoking, pulse rate and CCT were associated with elevated intraocular pressure in type 2 DM. Women with type 2 DM, especially those with CSME, were more prone to have an elevated IOP.

Introduction: Elective caesarean sections are performed when there is a medical indication for a planned delivery, such as breech presentation, placenta previa, or previous caesarean delivery. These procedures are typically associated with better maternal outcomes in terms of fewer labor complications. Emergency C-sections are required when unforeseen complications arise during labor or delivery, such as fetal distress, uterine rupture, or placental abruption. Maternal outcomes associated with caesarean sections include postoperative infections, blood loss, and extended hospital stays. Fetal outcomes depend on various factors, including the timing of the delivery, the reason for the C-section, and the neonatal care provided post-delivery. This study aims to compare the maternal and fetal outcomes in emergency versus elective caesarean sections (C-sections).  Material and Methods:  This study is a prospective, comparative analysis of 90 pregnant women who underwent either an emergency or elective caesarean section at a tertiary care hospital. The study focuses on maternal and fetal outcomes, comparing factors such as delivery complications, recovery time, infant health, and surgical complications. With a sample size of 90 women, this research analyzes both immediate and long-term outcomes related to maternal morbidity, mortality, and neonatal health.  Results Out of the 45 women in the elective C-section group, 5 (11%) experienced complications, including wound infections and mild hemorrhage. The average hospital stay was 4.5 days. In the 45 women undergoing emergency C-sections, 14 (31%) had complications such as severe blood loss, infections, and longer recovery periods. The average hospital stay was 6.3 days. The average birth weight of babies born through elective C-sections was 3.3 kg, and 5% required NICU admission due to respiratory distress. Babies born through emergency C-sections had a lower average birth weight of 3.0 kg, with 18% requiring NICU admission, mainly for respiratory support. Conclusion: By examining factors such as delivery complications, maternal recovery time, infant birth weight, and neonatal health status, the study provides insights into the risks and benefits of elective versus emergency C-sections. The findings offer significant implications for clinical practices in obstetrics and help refine decision-making regarding mode of delivery.

Introduction Occupational pulmonary diseases are more widespread and more disabling than any other group of occupational disease. The lung with its extensive surface area, high blood flow and thin alveolar epithelium is an important site of contact with substance in environment. The inhalation of dust over periods of time leads to proliferation and fibrotic changes in lungs. The workers working in industries suffer from various types of air way diseases like pneumoconiosis, farmer’s lung, chronic bronchitis, pulmonary fibrosis and asthma. So, the present study was undertaken to study the effects of wood dust on respiratory functions of exposed workers Materials and Methods This is a cross-sectional study was conducted in the Department of Physiology, Shadan Medical College diagnosed with COPD using Spirometry was recruited for the study. Details of the subjects collected at one point of time in the study period. Construction Male workers aged 40-80 years were included. Results The study found significant differences in pulmonary function between the exposed group and the control group. The PEFR, FEV1/FVC ratio, and MVV values were markedly reduced in the exposed group, with mean PEFR values of 350.5 ± 40.3 L/min compared to 420.2 ± 35.6 L/min in the control group (p < 0.001). Similarly, the FEV1/FVC ratio was lower in exposed workers (72.3 ± 6.4%) versus the control group (80.5 ± 5.8%, p < 0.001). MVV was also significantly reduced (85.6 ± 12.1 L/min vs. 102.4 ± 10.8 L/min, p < 0.001). Conclusion This study underscores the adverse effects of wood dust exposure on respiratory health. Regular health surveillance and implementation of protective measures, such as personal protective equipment and adequate ventilation, are recommended to safeguard the respiratory health of wood factory workers

A 45- year -old man hit by a speeding vehicle presented with chest and abdominal pains, along with dyspnea and vomiting. On examination, vitals signs were pulse rate of 122 per minute, blood pressure of 100/60 mm of Hg and respiratory rate of 28 per minute. Chest examination showed tenderness on the lower ribs. The patient had ecchymotic patches and abrasions on his lower chest and abdomen. Abdominal examination showed diffuse tenderness in all quadrants. The patient also had an open fracture of right femur. Arterial blood gas analysis showed hypoxia. Liver enzymes were normal. Chest X-ray and FAST (Focused Assessment with Sonography for Trauma) did not reveal any obvious pathology. CT scan of the chest showed small contused areas of lungs on both sides. Contrast CT abdomen showed the following picture.

How do you measure tiredness? One can feel tired and have a normal haemoglobin level. In the elderly, for example, abnormal blood indices are often present despite an outwardly well appearance. The anaemia still needs to be treated. Laboratory tests are therefore used to confirm the severity of an illness and are objective, regardless of outward appearances. Treatment is given and the haemoglobin (in this example) returns to normal, without the patient even being aware in many cases. The difference between the above example and a mental health ‘condition’ is that there is no realistic cut-off point between feeling well and being unwell. Therefore, when to intervene is arbitrary. Am I tired because I’m depressed, or is it the other way round? Do two or more weeks of mild happiness mean I am ill? ‘Is there such a thing as moderate happiness?’ ‘Should we be using mood stabilizing medication or talking therapies if we are mildly or moderately happy?’ Absurd. No one speaks of another individual as being mildly or moderately happy. So why should it make sense to talk of someone as mildly or moderately depressed? What next – mildly or moderately normal? Severe conditions require treatment; mild upsets can be managed by simple alterations in lifestyle, and one does not need a medical doctor or an expert in living to tell you so. There is little point in expecting a favourable drug treatment outcome for say, hypertension, if the patient continues to smoke or is grossly overweight. Take the metabolic syndrome of dyslipidaemia, central obesity, hypertension, and insulin resistance: treatment involves removing the causative factors, not prescribing drugs to reduce weight.

E Admit or refer the person as an emergency to an ENT specialist if they have acute deafness without other typical features of Ménière’s disease (tinnitus and a sensation of fullness in the ear). Sudden onset unilateral deafness would suggest acute ischemia of the labyrinth or brainstem, but can also occur with infection or inflammation.

Management as a component of training for doctors is well recognized. However, management training is not always a planned component of training and both the access to and content of training are variable throughout the National Health Service (NHS). In this article we emphasise the importance of management and leadership skills for trainees. We discuss alternative routes to attain the relevant competencies and share our experience on the value of formal qualifications versus ‘on the job training.’ Two authors (OW and AS) are pursuing a Master’s degree in management. One author (AJS) took the route of ‘on the job training’ to attain competencies in management. Another author (DF), who has an MBA, is the Medical Director and Deputy Chief Executive of a mental health trust and organizes management training for trainee psychiatrists in collaboration with the Director of Medical Education. The article is written from the perspective of psychiatric trainees although the content is largely generic and is of relevance to all specialties

Aims: The aim was to explore the importance and inherent challenges of child abuse presenting with spurious psychiatric manifestations (‘Munchausen Syndrome by Proxy’) through a case series. Methods: Three cases of child abuse are described, each presenting with falsification of psychiatric features and symptoms by caregivers. Similarities and differences from classical ‘Munchausen Syndrome by Proxy’ are explored, and the nosological status of this entity is discussed. Results: 1. Caregiver characteristics resembled those in classical ‘Munchausen Syndrome by Proxy’. 2. Cases differed from typical medical presentations in age at presentation, in course, and in prominence of educational consequences. 3. The relationship of the mother with the child's physician was less prominent than some suggest in classical ‘MSBP’. Conclusions: The incidence of Paediatric Symptom Falsification may be higher than generally believed, and psychiatric presentations differ from classical presentations. Reporting to child protection agencies is essential, but this is difficult and tends to be avoided for various reasons. There is a need for more education of mental health and allied professionals about this condition to prevent the suffering of many children. ‘MSBP’ involves psychological problems in the mother which are very difficult to manage, and which require understanding and compassion, but which should not be a barrier to protecting the child. In so far as it describes a situation and not a disease, 'MSBP' is a disorder only by analogy. Provided this is borne in mind, its difference from other forms of child abuse argues for the retention of a specific descriptive name, so that it can be better detected and prevented.

Syncope is a common medical condition encountered in clinical practice. The pathophysiology can be complex and at times making a definitive diagnosis can be difficult. It can be associated with high rates of morbidity and mortality. Physicians’ approaches to this condition are varied and at times, due to lack of a methodical approach, potential life-threatening conditions are missed. Some patients are under investigated while other patients are over investigated. This increases the already high health care costs associated with managing this condition. This article discusses an evidence based methodical approach to diagnosis and treatment of this often-complex condition.