Introduction: Orbital complications are among the most important potentially vision-threatening complications of rhinosinusitis. Infection from the paranasal sinuses, particularly the ethmoid sinus, may spread to the orbit through the thin lamina papyracea or through valveless venous channels. Clinical manifestations range from preseptal cellulitis to orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Early diagnosis and coordinated management by otorhinolaryngologists, ophthalmologists, and radiologists are essential for preventing permanent visual morbidity. Objectives: To evaluate the clinical profile, radiological characteristics, management strategies, and outcomes of patients presenting with orbital complications secondary to acute and chronic rhinosinusitis. Materials and Methods: This prospective observational study was designed to include 60 patients with clinical and radiological evidence of orbital complications associated with acute or chronic rhinosinusitis. Demographic characteristics, presenting symptoms, ophthalmological findings, sinus involvement, Chandler stage, imaging findings, treatment modality, duration of hospitalization, and final outcomes were recorded. Patients were managed with intravenous antimicrobial therapy, supportive treatment, and surgical drainage/endoscopic sinus surgery where indicated. Results: Illustrative dataset: Of 60 patients, 38 (63.3%) were male and 22 (36.7%) females. Acute rhinosinusitis accounted for 42 (70.0%) cases and chronic rhinosinusitis for 18 (30.0%). Ethmoid sinus involvement was most frequent (81.7%), followed by maxillary (65.0%) and frontal (38.3%) involvement. Preseptal cellulitis was observed in 23 (38.3%), orbital cellulitis in 17 (28.3%), subperiosteal abscess in 13 (21.7%), orbital abscess in 5 (8.3%), and cavernous sinus thrombosis in 2 (3.3%) patients. Thirty-four patients (56.7%) responded to medical therapy alone, whereas 26 (43.3%) required surgical intervention. Complete recovery without significant visual deficit occurred in 55 (91.7%) patients. Conclusion: Orbital complications of rhinosinusitis require rapid recognition and multidisciplinary management. Ethmoid sinus disease predominates, and more advanced postseptal complications are associated with a greater likelihood of surgical intervention. Timely imaging, intravenous antibiotics, repeated ophthalmological assessment, and appropriately selected surgical drainage can result in favorable visual and clinical outcomes.

Background: Pneumonia complicated by acute respiratory failure requiring mechanical ventilation remains a leading cause of intensive care unit (ICU) admissions in tertiary care hospitals across India. The anesthesiologist's dual role in airway management and critical care support makes their perspective central to understanding treatment outcomes in this high-risk population. Objective: To evaluate the clinical characteristics, ventilatory management strategies, and treatment outcomes of pneumonia patients requiring mechanical ventilator support in a tertiary care ICU setting in Hyderabad, India. Methods: A prospective observational study was conducted over eight months (July 2022 to February 2023) at a tertiary care hospital in Hyderabad. Thirty adult patients with confirmed pneumonia requiring invasive mechanical ventilation were enrolled. Clinical data including demographics, comorbidities, ventilator parameters, arterial blood gas values, microbiology, duration of ventilation, ICU stay, complications, and final outcomes were systematically recorded and analyzed. Results: Of 30 patients (mean age 52.4 ± 14.8 years; 63.3% male), the overall ICU survival rate was 66.7% (n=20), with an in-hospital mortality of 33.3% (n=10). Mean duration of mechanical ventilation was 9.3 ± 4.1 days, and mean ICU length of stay was 12.4 ± 5.2 days. The most prevalent comorbidities were diabetes mellitus (46.7%) and hypertension (40.0%). Klebsiella pneumoniae was the most frequently isolated pathogen (27%). Key complications included ventilator-associated pneumonia (30%), acute kidney injury (26.7%), and septic shock (23.3%). Significant improvements in PaO₂/FiO₂ ratio (148.6 to 238.4 mmHg, p<0.001) and SpO₂ (88.4% to 95.1%, p<0.001) were observed over the first seven days. Conclusion: Pneumonia patients on mechanical ventilation carry a substantial mortality burden in Indian tertiary ICUs. A lung-protective ventilation strategy, aggressive treatment of sepsis, early prone positioning in severe ARDS, and meticulous VAP prevention bundles are pivotal to improving outcomes. Systematic anesthesiology-led critical care protocols significantly influence patient prognosis.

Introduction: Thyroid surgery is among the most frequently conducted endocrine operations. Traditional hemostasis methods, including clamp-and-tie and electrocautery, are linked to prolonged surgical duration and heightened risk of complications. The harmonic scalpel, an ultrasonic surgical instrument, is widely utilized in thyroid surgery for its capacity to concurrently incise and coagulate tissues while minimizing thermal injury. This study sought to evaluate the benefits of the harmonic scalpel in thyroid surgery for operative duration, intraoperative hemorrhage, and postoperative results. Methods: This prospective comparison study involved 50 patients undergoing thyroid surgery at a tertiary referral center. Patients were categorized into two groups: Group A (n = 25) received thyroidectomy utilizing the harmonic scalpel, whereas Group B (n = 25) underwent surgery employing conventional techniques. Parameters including operation duration, intraoperative hemorrhage, postoperative discomfort, drainage volume, length of hospital stay, and complications were documented and assessed. Statistical analysis was conducted utilizing suitable methods, with p < 0.05 being significant. Results: A considerably shorter average operating time (75 ± 10 minutes) was recorded in the harmonic scalpel group as compared to the conventional group (105 ± 15 minutes, p < 0.001). Comparing Group A (50 ± 15 mL) to Group B (90 ± 20 mL), we find that there was a significant decrease in intraoperative blood loss (p < 0.001). The harmonic group had a smaller volume of postoperative drainage (40 ± 10 mL) compared to the conventional group (70 ± 15 mL), with a p-value less than 0.01. The conventional group stayed in the hospital for 5 ± 1.2 days, while the harmonic scalpel group stayed for 3.5 ± 1 days, resulting in decreased postoperative pain (p < 0.01). There was no statistically significant difference in the occurrence of complications such as hypocalcemia and recurrent laryngeal nerve damage between the two groups. Conclusion: Reduced operating time, less blood loss, less postoperative pain, and shorter hospital stay are some of the notable benefits of using a harmonic scalpel in thyroid surgery. It improves surgical efficiency without raising complication rates, and it's safer than traditional methods.

Background: Pre-analytical errors are a major source of inaccuracies in laboratory medicine and are particularly critical in microbiology, where specimen quality directly influences diagnostic accuracy. Errors occurring during specimen collection, labeling, transport, and storage can lead to false or misleading results, delayed diagnosis, and inappropriate antimicrobial therapy. Objectives: To determine the frequency and types of pre-analytical errors in microbiology samples received at a tertiary care hospital laboratory. Materials and Methods: This observational study was conducted in the Department of Microbiology over a period of seven months from 1 September 2022 to 31 March 2023. All microbiology samples received during the study period were assessed for pre-analytical errors using predefined criteria. Errors were categorized based on the type of error and type of sample. Data were analyzed using descriptive statistics and expressed as percentages. Results A total of 1,240 microbiology samples were evaluated, of which 186 samples (15.0%) demonstrated one or more pre-analytical errors. The most common errors were improper sample collection (34.9%), insufficient sample quantity (21.5%), and delayed transport to the laboratory (18.3%). Blood samples accounted for the highest proportion of errors (32.8%), followed by urine (29.6%) and sputum samples (18.3%). Multiple pre-analytical errors were observed in 18.3% of affected samples. Conclusion Pre-analytical errors are common in microbiology laboratories and are largely preventable. Strengthening sample collection practices, ensuring timely transport, and providing regular training to healthcare personnel can significantly reduce these errors and improve the quality of microbiological diagnosis.

Introduction: Lower abdominal procedures (e.g., inguinal herniotomy, orchiopexy, pyloromyotomy) are common in early infancy, a period with heightened vulnerability to postoperative apnoea and hemodynamic instability. Spinal anaesthesia (SA) has re-emerged as an attractive alternative to general anaesthesia (GA) to minimize airway manipulation, opioid exposure, and early apnoea risk, while maintaining surgical conditions. The evidence base includes randomized trials and large observational cohorts. Materials and Methods: A prospective, randomized controlled trial was conducted on 60 full-term infants (ASA status I-II) scheduled for elective lower abdominal surgeries (e.g., inguinal hernia repair, orchidopexy). Infants were randomly allocated to either the SA group (n=30) or the GA group (n=30). The primary outcome was the incidence of perioperative respiratory events (apnoea, desaturation). Secondary outcomes included haemodynamic stability, postoperative pain scores (FLACC scale), time to full recovery, parental satisfaction, and complications. Result: The incidence of perioperative respiratory events was significantly lower in the SA group (3.3% vs. 30%, p<0.01). Haemodynamic parameters were more stable in the SA group. Postoperative pain scores were comparable at initial assessment but were significantly lower in the SA group at 2 and 4 hours postoperatively. Time to first oral intake and discharge readiness was shorter in the SA group. Conversion to GA was required in 2 patients (6.6%) in the SA group. Conclusion: Spinal anaesthesia is a safe and effective technique for lower abdominal surgeries in infants. It is associated with a significantly lower risk of respiratory complications, greater haemodynamic stability, and a faster recovery profile compared to general anaesthesia. It should be considered a primary anaesthetic option in this vulnerable population. 

Background: : As per the previous studies, the line that connects the highest portion of iliac crests crosses at L4–L5 intervertebral disc space level in midline posteriorly. This line on palpation and imaging have different relationships, especially in the L4–L5 interspace. Purpose: The purpose of this study is to determine whether the level at the highest iliac crest on palpation and in the c-arm is are same or not.  Materials And Methods: Admitted patients with lower back pain who are all accepted for injection steroid epidural route at our hospital, between July 2022 to November 2022. The authors drew the iliac crest line posteriorly on palpation and later in the C-arm, the level identified and was compared. Results: Thirty-four patients were included in our study with basic anthropometric variables (mean) are age 20-65 years (42 year), sex 12 males and 22 females, weight 50-95 kg (73.6 kg), height 145-185 cm (165.6 cm), body mass index 19-38 kg/m² (26.8 kg/m²). On palpation, the intercrestal line crosses the midline 8.8% at L3 spinous process, 55.9% at L3-L4 interspinous space, 29.4% at L4 spinous process, 5.9% at L4-L5, and in no case at L5 spinous process. The C-arm imaged line crossed at L4 in 70.5% and L4-5 in 29.5% of patients with normal spinal anatomy. Conclusion: Our research found that using the iliac crest line to locate spinal levels is more accurate with imaging than palpation. On palpation, the line at the highest level of the iliac crest is at L3–4 and L4 spinal levels rather than the L4 or L4–5 levels.

Introduction Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy, according to WHO guidelines. Gestational Diabetes Mellitus is “any degree of glucose intolerance that either starts during pregnancy or is newly diagnosed in pregnancy” as per ACOG (American College of. Obsterics and Gynecology). It includes women, whose glucose tolerance, is normal after pregnancy and those with type 2 diabetes with persistent glucose in intolerance developed later Materials and methods This case-control study was conducted at Department of Biochemistry, Mamata Medical College over a period of 1 year. A total of 360 pregnant women were enrolled in the study, including 180 women with gestational diabetes mellitus (GDM) and 180 healthy, age-matched pregnant women. The participants were recruited serially at 24–28 weeks of gestation. A three-hour oral glucose tolerance test was performed for women with plasma glucose concentrations exceeding 130 mg/dL on a glucose challenge test. The fasting plasma glucose concentration of the diagnosing oral glucose tolerance test was used as the mid-pregnancy fasting plasma glucose in this study. Results  In the present study, 360 gravid women, whose serum ferritin level was estimated at 24 to 28 weeks, were followed up with repeat screening for GDM in the third trimester. Among them, 71 (19.7%) were diagnosed with GDM during the follow-up period The present study assessed baseline demographic characteristics between the GDM (n = 77) and non-GDM (n = 311) groups. The mean age of participants in the GDM group was 28.0 ± 5.2 years, while in the non-GDM group, it was 27.0 ± 4.4 years, with a p-value of 0.087, indicating no significant difference between the groups. Conclusion: We can infer that serum ferritin is associated with development of GDM. Based on the findings of the current study, serum ferritin level can be used a predictive marker for the development of GDM.

Introduction: Subarachnoid block, although being highly efficient with lesser drug doses, often has limitation such as hypotension, continues to be a matter of concern to the anesthetist. The present study was aimed to compare the use of phenylephrine, ephedrine, and mephentermine bolus for maintenance of blood pressure during spinal anesthesia in lower abdominal surgeries. Materials and Methods: This is Randomized, single blind, prospective & comparative study. The study has been undertaken at the Department of Anesthesiology, Shadan Institute of Medical Sciences Teaching Hospital & Research Centre. Study population ASA 1 or 2 women with term, uncomplicated, singleton pregnancy scheduled to undergo elective caesarean section. We have optimized a sample size of 50 (25 in each group) using a sealed envelope technique to determine the drug that were used for prevention of hypotension. Patients in the ‘phenylephrine group’(P) had received an infusion of phenylephrine hydrochloride, whereas patients in the ‘mephentermine group’ (M) had received an infusion of mephentermine sulphate. Results A total of 50 patients were analyzed. Within 5 minutes of Spinal anaesthesia there was no significant difference between Group-P and Group-M on drop of average Systolic blood pressure, Diastolic blood pressure and average Heart rates at different minutes. But after administering the drug for hypotention correction Group P shows very high average SBP and DBP correction compared to Group M which is statistically significant (p<0.0001) and Group P shows a fall in the heart rate compared to Group M which is statistically significant nit (PACU) Conclusion: Mephentermine and ephedrine were similar in performance, offered a better hypotensive control, and had lower recurring events as compared to phenylephrine.

Introduction: Psoriasis is a common chronic inflammatory condition of the skin, which also has nails and systemic involvement. Psoriatic involvement of the nail bed or nail matrix results in nail psoriasis. Nail involvement is a visible indicator to predict future joint inflammatory damages and disease activity. Nail psoriasis can manifest clinically as a wide variety of nail changes, like nail discoloration, subungual hyperkeratosis, pitting and onycholysis, depending upon the part of the nail units affected. Patients with psoriatic nails have impaired quality of life due to the appearance of nails, and significant morbidity and functional impairments may arise in large cases. Its management is challenging because it is long term, and often not satisfying the patients leads to depression, which further deteriorates the condition. Patient education with explaining the prognosis and outcomes of the treatment is the most important aspect.  Material and Methods: All the psoriasis patients attending the outpatient department of dermatology and venereology at a tertiary referral center in Hyderabad for a period of 1 year were included in this cross-sectional study. Patients receiving/have received systemic antipsoriatic medications or topical nail medications in the past 3 months and patients with concomitant onychomycosis proven by microscopy and/or culture were excluded from the study. A detailed history was taken in each patient with particular reference to cutaneous complaints including duration, progression, and treatment modalities. Based on the age of onset of disease, patients were classified into early-onset group (age of disease onset <40 years) and late-onset group (age of disease onset at or after 40 years).  Results: A total of 90 patients with psoriatic nail involvement were included in the study. The mean age of the patients was 44.1± 11.2 years (range 14-74 years). Fifty-five percent of patients had the disease for more than 5 years, and the duration of treatment ranged from 0.2 to 11 years (4.9 ± 2.6 years). The mean body mass index (BMI) of the study population was 26.3 ± 3.2 kg/m2. Hypertension was the commonest comorbidity. Conclusions: Our study documents nail changes in psoriasis and severity of involvement in the Indian context. We found discordance between the extent of nail involvement (as scored by nail psoriasis severity index) and the impact on quality of life (as evaluated by nail psoriasis quality of life 10). This lack of congruent impact suggests that probably the scoring systems need appropriate adaptation suited to the Indian population. Furthermore, a high proportion of patients had raised levels of immune and serological markers. Such reports in arthropathies other than rheumatoid arthritis raise a word of caution in their interpretation for diagnostic purposes. It can be seen that a close monitoring and follow-up of psoriatic patients with nail disease is of utmost importance. Further controlled studies with a larger population-based sample size are warranted before definite conclusions can be reached.

ntroduction: Low birth weight (LBW) is defined by WHO as the weight of live born infants less than 2,500 g irrespective of their gestation. LBW is closely associated with fetal and perinatal mortality and morbidity. At the population level, the proportion of babies with a LBW is an indicator of a multifaceted public-health problem that includes long-term maternal malnutrition, ill health, hard work and poor health care in pregnancy. At an individual level, LBW is an important predictor of newborn health and survival and is associated with higher risk of infant and childhood mortality.  Methods: This was a prospective study conducted in the Department of Pediatrics, Tertiary Care Teaching Hospital over a period of 1 year. There was a total of 450 babies in this study, of which 150 were low birth weight babies and the rest 300 babies were weighing 2.5 kg or    more. To ascertain the maternal factors responsible for low-birth-weight babies, study of which will enable us to understand the measures involved in reducing the neonatal   mortality and morbidity. In this study, an analysis 150 mothers of LBW babies were done and compared with 300 normal weight babies. The variables were subjected to computer analysis using focus format.  Results: In mothers who had no education& Mothers belonging to lower socioeconomic class had higher chance of delivering low birth weight babies. Parity has a significant relationship with birth weight. There is significant association of PIH and oligohydramnious with birth weight.  Maternal malnutrition and anaemia have a significant association with LBW Conclusion: This study was conducted to know the maternal and bio-social factors that influence low birth weight babies. There was no significant association with maternal age and religion (community) with birth weight in our study. Parity has a significant relationship with birth weight with higher birth weight among women with higher parity. There is significant association of PIH and oligohydramnious with birth weight. Maternal malnutrition and anaemia have a significant association with LBW with higher incidence of Low birth weight among malnourished and anaemic mothers. 

Background: Lung cancer is one of the most frequent cancers and a major cause of cancer death worldwide. Lung cancer accounts for 11.6% of all new cancer cases identified each year and is quickly becoming the most prevalent fatal neoplastic disorder in the world, accounting for 18.4% of all cancer-related fatalities worldwide1. Objectives: 1. To study the clinical profile of newly diagnosed bronchogenic carcinoma patients. 2. To study the clinicopathological correlation among various histological types of bronchogenic carcinoma in the above patients. 3. To study the extrapulmonary manifestations and the prevalence of identifiable paraneoplastic syndromes (if present) in patients with bronchogenic carcinoma. Material & Methods: Study Design: Prospective hospital-based observational study. Study area:  The study was conducted in the Department of Pulmonary Medicine, Government Medical College, Kadapa.  Study Period:  June 2023 – December 2023. Sample size: The study consisted of 52 subjects. Sampling method: Simple random Sampling Technique. Inclusion criteria: Patients attending hospital, diagnosed with bronchogenic carcinoma in the specified period. Study tools and Data collection procedure: Patients included in the study were selected according to the inclusion and exclusion criteria. After obtaining informed consent, data was gathered from history, objective examination of the patients and lab investigations using a semi-structured questionnaire. The localisation of the tumors was done by chest x-ray, fibre optic bronchoscopy and/or CT scan as required. Tissue diagnosis was obtained by FNAC/ biopsy or other cytology and histopathological examination of the specimen was carried out. The type pattern of paraneoplastic syndromes was noted. Results: COPD (65.38%) and Diabetes (23%) were the common co-morbidities affecting the study population followed by HTN (19.2%). H/O old PTB was noted in 11.5% of the patients and 1 patient (1.9%) had h/o ILD. 2(3.8%) patients had past h/o malignancy. One patient had h/o squamous cell carcinoma of the right ear another patient had cervical cancer and 1 (3.8%) patient had a family history of malignancy (first-degree relative). Conclusion: Lung cancer is a rapidly progressive disease with a very high mortality rate but treatment in the early stage may give a good prognosis. High-risk patients with having smoking history should be evaluated clinicoradiologically with high suspicion so that early diagnosis can be made and the quality of life of patients can be improved. Primary lung cancer should always be suspected in a person presenting with unexplained cough for several weeks with other symptoms such as weight loss, and fever with non-resolving collapse-consolidation on chest radiograph.

Introduction Hypertension-related complications, such as intravascular coagulation and histopathologic lesions (mostly massive perivillous fibrin deposition), may also affect blood flow to the fetus and therefore affect normal growth. Since, β-hCG have a different role in pregnancy, thus one study suggested low levels of serum β-hCG as a predictor of poor pregnancy outcome in early pregnancy and the common complications related to altered β-hCG are ectopic pregnancies as well as spontaneous miscarriage.  Material and Methods This is prospective, Non-Randomized and observational study was conducted in the Department of Biochemistry, Index Medical College from 2022 to 2023. First time pregnant women, who was aged 18- 40 years with singleton pregnancy, was included in the study. Detailed information was given about the study and informed consent obtained for participation in the study. Each subject was randomly and consecutively selected, representing a cross- sectional study of the Indore population. Women at POG >22 weeks with Singleton pregnancy were included a one hundred thirty Hypertensive women as case group and control group include another one hundred thirty normotensive women after matching the parity and gestation age.  Results In this study, Normotensive Group: All normotensive individuals have systolic BP <140 mmHg. By definition, systolic BP <140 mmHg is classified as normal, so this result aligns with expectations. PIH Group: None of the individuals with PIH have systolic BP <140 mmHg, as hypertension is characterized by systolic BP ≥140 mmHg. A majority of PIH cases (52.3%) have systolic BP in the 140–150 mmHg range, indicative of mild hypertension. A significant proportion (37.6%) have systolic BP in the 150–160 mmHg range, while a smaller subset (10%) have readings >160 mmHg, suggesting severe hypertension. This indicates a statistically significant difference in systolic BP distribution between the PIH and normotensive groups. The absence of overlap between the groups highlights the distinction in BP levels. Conclusion This study showed that estimation of serum Beta HCG levels in early second trimester of pregnancy is a useful indicator to identify women who are likely to develop gestational hypertension in the same pregnancy. The level of beta HCG is strongly associated with development of GHT.

Diabetic neuropathy (DN) is a common complication of type 2 diabetes (T2DM) and is characterized by persistent inflammation. Hematological parameters have emerged as a novel marker for detecting chronic inflammatory conditions, including diabetes. DN has been a significant concern and a complication of diabetes mellitus (DM). The number of people with DM has doubled during the past 20 years. By 2045, it is projected that 628 million individuals worldwide will be affected by this disease, while the currently estimated cases of DN stand at approximately 425 million.1 According to statistics, 179 million people can have DM but remain undiagnosed for various reasons. Due to ageing demographics, low levels of physical exercise, and urbanization, the number of people with T2DM has been expanding. Materials and methods: The cross-sectional analytical study was carried out at the Department of Pathology, UNS ASMC, Jaunpur and informed consent, patients were selected by consecutive sampling technique. In the study out of which 30 were non diabetic healthy subjects which were taken as group1 and 60 were known diabetic patients which were divided into two groups with HbA1c <7(30 subjects) as group 2 and HbA1c >7(30 subjects) as group 3.  All the patients were assessed because of their clinical history and laboratory evidence. The patients' clinical details, type of anaemia, laboratory investigations and complications related to diabetes were recorded on a specially designed proforma. Result: Mean RBC count of diabetics with HbA1c<7 was less when compared to non-diabetic individuals.  Significant decrease was noted in the mean RBC count, Hb, HCT and MCV of diabetics with HbA1c>7 when compared to non-diabetic individuals. There was significant decrease in mean Hb, HCT, MCV, MCH of diabetics with HbA1c >7 when compared to diabetics with HbA1c <7. Conclusion: Monitoring changes in hematological parameters can be a useful tool in better management of diabetic patients. To conclude periodic monitoring and careful assessment of haematological parameters can prove to be of utmost help in foreseeing, preventing and delaying many diabetes associated complications.

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia with derangement of carbohydrate, fat, and protein metabolism due to absolute or relative deficiency of insulin secretion and action, or both. DM, especially type-2 DM, is a serious general medical issue which has arrived at scourge extents because of the quickly expanding paces of this ailment around the world. Target organ confusions, auxiliary to diabetes, are one of the most significant restorative worries of right now. The main findings of our research were no significant differences in baseline characteristics like age and height of both groups. Weight, BMI and waist hip ratio was significantly high in cases. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and rate pressure product were significantly high in Cases individuals; however, no significant difference was noticed in pulse pressure (PP). Significantly higher body fat and visceral fat %, lower levels of cardio respiratory fitness assess by cooper 12min run test and significantly higher levels of fasting blood sugar (FBS) was observed in cases. The oxidative stress assessed by total antioxidant status (TAOS) was significantly less and malondialdehyde (MDA) was significantly high in cases when compared to age gender matched controls. Inflammatory markers TNF alpha, IL6 and hsCRP were significantly high in cases in comparison to controls.