Mitral valve prolapse (MVP) is the most common valvular abnormality, affecting approximately 2-3% of the population in the United States. MVP usually has a benign course, but it occasionally leads to serious complications, including clinically significant mitral regurgitation (MR), infective endocarditis, sudden cardiac death, and cerebrovascular ischemic events. 100 diagnosed case of mitral valve prolapse (by echocardiography) were studied retrospectively. Most common age group was 15-39 years. 2) Most common symptom was palpitation with chest pain. 3) Most common sign was systolic click. 4) Most common ECG finding was early repolarization. MVP is benign entity which most commonly affects young age group. Most of patients present with chest pain and palpitation but some may be symptom free. Most common ECG finding was early repolarisation but to consider this as diagnostic test we need more broader study.

Lower extremity amputation is performed to remove ischemic, infected, necrotic tissue or locally unresectable tumor, and at times, is a life-saving procedure. Peripheral artery disease, alone or in combination with diabetes mellitus, contributes more than half of all amputations; trauma is the second leading cause. Lower extremity amputations are common debilitating complications in patients with diabetes mellitus. Our aim was to analyse the various causes for lower extremity amputations, assess the complications and amputation rates in patients with diabetes mellitus and to identify risk groups for lower extremity amputations that can be focussed for preventive treatment at Vydehi Institute of Medical Sciences and research centre, Bangalore. This retrospective audit was conducted jointly in the Dept of General Surgery & Dept of Medicine, VIMS&RC, a super speciality teaching hospital in south India, between Jan 2011 and Dec 2014. Case files of patients who underwent lower extremity amputations were retrieved from the institution medical records section and data analysed for demography, clinical presentation of diabetics, other causes for amputation such as vascular disorders, kidney disorders, malignancy and diabetic ulcer/ infections of the foot, and post-operative morbidity and mortality. 137 patients were amputated, of which 120(87.59%) males and 17(12.40%) females (table-1, fig-1). 82(59.85%) patients were diabetic and 55(40.14%) non diabetic patients which included twenty three peripheral vascular disease (16.78%), osteosarcoma 16(11.67%), crush injuries 9(6.56%) and elephantiasis 3(2.18%) (fig-3). Of the 82 diabetics males were 65(79.26%) and females 17(20.73%) (Table-2). Foot infections and chronic renal disease preceded amputation in patients with diabetes. Diabetic women were older than the men when amputated, diabetic men underwent multiple amputations both minor and major, had severe foot infections compared to the women. 90 % of all diabetes-related amputations were preceded by foot ulcers leading to ischaemic gangrene. Various interventions the patient underwent ranged from wound debridement to revision amputation ( table-3,fig-4)The number of diabetics attending the diabetic foot clinic increased over the years showing the impact of awareness programmers and counselling about the disease (fig-2).The complications of diabetic foot infections ranged from cellulitis to gangrene (table-4,fig-5) There was 50% reduction in the rate of amputations performed above the ankle in patients with diabetes during the year 2014( table-6)) as most of them were referred to the multidisciplinary foot team in our diabetic clinic prior to the decision of amputation. There was no mortality in the study. The gradual decrease in rate of major amputations is due to an active implementation of the consensus guidelines of foot care in the diabetic clinic and awareness of the patients to get themselves examined and treated for foot problems early. Diabetic foot complications and diabetic nephropathy when identified early in diabetics can prevent major lower extremity amputations.

Thrombocytopenia is a group of heterogeneous disorders of varying etiology and involving deficiency of platelets. Platelet volume parameters are significant especially in the diagnosis of causes of thrombocytopenia. The platelet volume parameters have been widely available as part of full blood count profile on automated hematology analyzers. To evaluate the relationship between platelet volume parameters and causative process in thrombocytopenia Methods: PLCR of 500 cases of thrombocytopenia (TCP) and 300 control cases having normal platelet counts were recorded. The analysis was done by Sysmex KX 21 cell counter and every case was reassessed by Peripheral Smear (P.S.) examination and if necessary also by the manual method. Only those cases that had sufficient clinico-hematological work up were included in the study. Results: Cases were grouped according to the most predominant mechanism of Group A-Accelerated platelet destruction, Group B-Impaired platelet production, and Group C-Abnormal platelet pooling. The age range was from 1 day to 90 years. The commonest age group for thrombocytopenia was between 21-30 years accounting for 88(18%) cases. 75(15%) cases belonged to both 31-40 and 41-50 age groups. The mean platelet large cell ratio P-LCR % was 22.64 ± 7.13 and in Group A it was 31.68 ± 8.36 and in Group B was 19.50 ± 5.51 and Group C was 31.48 ± 9.09. The Z test was performed between A, B and C Group with the control group of all the parameters of the platelet count. The P-LCR of accelerated destruction Group A, B, C and Vs Control were all significant values <0.05. Conclusion: Platelet Large cell ratio and the Platelet distribution width showed a direct linear relationship in all groups of Thrombocytopenia as well as the control group. Decreased production of platelets in cases of thrombocytopenia can be differentiated from other two groups of thrombocytopenia with the help of all the three parameters MPV, PDW and P-LCR as the differences are statistically significant.

The aim of this study was to determine critical predictive serum bilirubin value on first day (24 hrs) of life which can screen healthy term newborns at risk of developing significant hyperbilirubinemia. This was a prospective study conducted at "Maharaja Yashwant Rao Hospital Indore" between August 2008 and September 2009. Serum bilirubin estimation was done by Van Den Berg method to know total and direct reacting bilirubin. We believe that data from this study could be applied to babies at low risk and specially will help to screen babies who may develop neonatal hyperbilirubinemia (NNHB) inspite ruling out risk factors. This group mainly represent in which hyperbilirubinemia is due to- increased enterohepatic circulation, breast milk jaundice, hypothyroidism, drugs, galactosemia, Crigler-Najjar syndrome, Gilbert syndrome, infection etc.

Cytological examination of cavity effusions is extremely important as it highlight the cause, presence of metastatic cells, typing of unknown cases, prognosis and staging of cancer. To study and evaluate trends in cytological evaluation of cavity effusions for various pathological conditions in a tertiary health care centre. 2) To correlate their frequency in relation to diagnosis. Our Study was cross-sectional study performed in Department of Pathology, Sri Aurobindo Medical College and Post Graduate Institute from 1st January 2013 to 31st December 2014. Serous cavity effusions included in the study were pleural and peritoneal in origin. All other fluids (pericardial and synovial fluid) were excluded from the study. The history and relevant parameters were noted and correlated clinically. Cytospin and Conventional smear methods were performed on pleural and peritoneal fluids. Both air dried and wet fixed smears in methyl alcohol were used and stained with Papanicolaou (PAP) and May-Grunwald-Giemsa (MGG) stain. Out of 885 cases, 400 (45.19%) were pleural fluid, 485(54.8%) were peritoneal fluid .806 (91%) were of benign effusion and 79 (8.92%) were of malignant effusion. Total transudate cases in our study were 611 (69%) and exudates were 274 (30.9%). Male to female ratio was 1.5:1 with youngest patient 20 years old and eldest was 85years old. In younger age group benign effusions are common and malignant in older age group. Morphology and staining with May-Grunwald-Giemsa (MGG) and Papanicolaou (PAP) helped in better interpretation. Preliminary fluid analysis for cytology in resource limited settings, still remains the most convenient and cost effective method in arriving at the diagnosis, thereby reducing the need for invasive investigations and their related complications. Presence and absence of malignant cells at times can be the only clue to the presence of malignancy thereby affecting the prognosis and treatment outcome of the patient

The management of the cervical lymph nodes is an integral part of the overall treatment of the oral cavity malignancies. The indications and uses of the various types of neck dissections and pre and postoperative radiotherapy has been a subject of much debate. Based on the results of the present study and the literature available with us, we can conclude that, Dissemination of metastatic cancer to regional lymph nodes from primary sites in the upper aerodigestive tract occurs in a predictable and sequential pattern. For primary tumours in the oral cavity, the regional lymph nodes at the highest risk for early dissemination by metastatic cancer (first echelon nodes) are limited to levels 1,2 and 3, i.e., within the supraomohyoid triangle of neck. Skip metastasis to levels 4 and 5 in the absence of metastasis at levels 1,2 or 3 is very rare.

Chronic renal failure is increasingly health problem all around the world with a high burden of mortality and cardio vascular morbidity rate. The study is mainly directed to establish lipid profile in chronic renal failure by ascertaining the levels of serum cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol and triglycerides. In view of this extensive work has been done in the field and incessant efforts are being made to widen the horizon of lipid in chronic renal failure. The present study was aimed to find lipid abnormalities in chronic renal failure. There is significant rise in Triglycerides, VLDL, LDL in chronic renal failure. There is decrease in HDL concentration in chronic renal failure as compared to control. Increased concentration of Triglycerides and VLDL are the main causes for increased incidence of cardiovascular abnormalities in chronic renal failure.

This is a cross sectional study of 60 patients with organophosphorus poisoning admitted at MGM Medical College and Maharaja Yashwantrao hospital Indore from June 2013 to May 2014. Severity of poisoning and requirement of ventilator support were studied in these patients. The POP scale and pseudo cholinesterase levels both showed a significant association in predicting the need for ventilatory support. Lower grade of poisoning had a better outcome whereas higher severity of poisoning had a poorer outcome

The goal of our retrospective observational study is to look for the EEG changes in different location of ICH and to identify electrographic seizures. The current study brings into attention that seizures are frequent complication of intracerebral hemorrhage and may be a target for improving ultimate outcome. They occur in both lobar and deep hemorrhage and with or without associated intra ventricular extension. The study calls for need of prospective study to correlate the electrographic abnormalities with location of bleed and also the usage of prophylactic antiepileptic drugs in patients

There is some controversy about assessment of nodal stage in staging systems used for gastric cancers. The goal of the this study is to assess the influence of metastatic lymph node ratio (MLNR) and number of resected lymph nodes on survival in patients with gastric cancer who were perfomed R0 resection due to gastric adenocarcinoma. Data from 125 patients with gastric carcinoma who underwent R0 resection due to from 2009 to 2015 investigated retrospectively. Cut-off values used for MLNR were 0.1-25%, 26-50% and >50%. Sex, age, size and location of tumor , differentiation, tumor invasion, lymphovascular invasion, number of metastatic lymph nodes and MLNR were analyzed as prognostic factors. Five-year survival rate was 45.6%. Five-year survival rates among patients with pN0, pN1, pN2, pN3aand pN3b disease were 79%, 41%, 34%, 25% and 17%, respectively (p=0.0001). Five-year survival rates among patients in MLNR0, MLNR1, MLNR2 and MLNR3 categories were 79%, 42%, 28% and 5%, respectively (p=0.0001). Due to our results, tumor size, differentiation degree, depth of invasion, presence of lymphovascular invasion, number of metastatic lymph nodes, MLNR and disease stage were found to be associated with survival (p=0.0001). According to results of multivariate analysis, differentiation degree, presence of lymphovascular invasion and MLNR were found as independent risk factors, while number of metastatic lymph nodes was not an independent risk factor regarding survival. MLNR is an independent risk factor in gastric adenocarcinoma patients undergoing R0 resection regarding survival.

Breast feeding with timely started complementary feeding is the best way of infant feeding. It is necessary for infant’s overall development, better growth, fulfilling nutritional requirement and it is most vital for reducing infant mortality. Objective of our study was to assess the knowledge, attitude and practice of complementary feeding among mothers in a tertiary Care Centre of Central India. A cross sectional study was done about knowledge of mothers with children below 2 year of age with help of pretested self-designed questionnaire based interview who are attending paediatrics OPD and IPD. In our study most of mothers did not know correct time of starting complementary feeding, they also did not know what food can be given, frequency and amount of complementary feed. In our study knowledge, attitude as well as practise towards complementary feeding was lacking hence health education to mother and family members required about correct feeding in early years of life.

Breathlessness and Paroxysmal Nocturnal Dyspnoea (PND) is a common cause of emergency visit in our country. Cardiomyopathy is among most common cause of Breathlessness and Paroxysmal Nocturnal Dyspnoea (PND). The disease is often misdiagnosed and mistreated. There are very few studies on Cardiomyopathies from India. To evaluate clinical and demographic profile of patients with cardiomyopathy. We undertook this study in a tertiary care Medical College of North India. It is retrospective observational study of 80 patients. Routine echocardiography was done to diagnose cardiomyopathy. Patients with DCM were then evaluated as per protocol. We had a total of 80 patients in our study with a male: female ratio of 50:30. Most patients were aged over 40 years. The most common type of cardiomyopathy is Idiopathic CMP

Smoking is a pernicious scourge of the world today. Smoking is well known to increase the risk of pulmonary and cardiovascular diseases by affecting the cardio–pulmonary functions. Hence, emphasis should be paid on preventive strategies of these disorders. Our study was to evaluate the effect of smoking on lung functions and lipid profile in asymptomatic smokers. A total of 100 male subjects were included which were equally divided in to two groups i.e. of smokers and non – smokers. The lung function tests and lipid profile was carried out on each subject in both the groups. No statistically significant difference was seen in the baseline characteristics of the two groups. There was no statistically significant difference between the two groups regarding mean values of blood pressure and heart rate, though; values were higher in smokers as compared to non-smokers. All the spirometric values in the two groups had statistically highly significant difference and were higher in non-smokers as compared to smokers. The spirometric values were reduced in smokers with history of smoking for as low as two pack years. No statistically significant difference was seen in the mean HDL – cholestrerol values in the two groups. Although the smokers were young and asymptomatic, still the spirometric and lipid values were significantly deranged as compared to controls. Even smokers with history of less pack years of smoking also had significant abnormalities of lung function. All spirometric and lipid parameters deteriorated significantly with increasing pack years of smoking

The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Further clonidine also reduces intraoperative requirement of opioid analgesics as compared to normal saline group. Total amount of rescue analgesia needed in 24 hour was also significantly less in clonidine group as compared to placebo group. Intraoperatively more fentanyl required in placebo group as compared to clonidine group (p<0.05).

HPV being the most important risk factor, needs to be evaluated in all the regions of the country since the prevalence of HPV and its genotypes are different in the populations from different geographical regions. Its assessment at various stages of the disease will also be helpful in understanding its role in cervical cancer pathogenesis. The present series of work entitled as “Study of cytodiagnosis of discharge per vaginum with specific reference to HPV and HSV at Index Medical College, Indore” was undertaken to detect cervical lesions of female genital tract and prevalence of HPV and HSV by means of exfoliative cytology. Out of 1542, 9 cases showed cytomorphological features of HPV and 2 cases showed cytomorphological features of HSV. All 11 cases were found to be associated with multiple risk factors. In this study, epithelial cell abnormality are more common in hindu (85.19%). In muslims, it is only (14.81%).

Enteric fevers are a common occurrence in pediatric patients especially in rural and tribal areas where the conditions of sanitation are generally poor. The common causative organisms are gram-negative bacteria Salmonella Typhi and Salmonella Paratyphi A. There is a limited data regarding the burden of the disease in Tribal Adilabad region. With this background, we in the present study tried to evaluate the prevalence of enteric fever in pediatric patients with RIMS Adilabad. Method: The data were collected from the Department of Pediatrics, Rajiv Gandhi Institute of Medical Sciences [RIMS], Adilabad from August-October 2017. All the febrile patients attending the pediatric OPD, Rajiv Gandhi Institute of Media [RIMS] presenting with clinical signs and symptoms of typhoid fever and the fever were lasting for more than 3 days. They were not on antibiotic therapy. A total of [n=66] 34 male and 32 female patients aged 0-14 years were found to have positive cultures for S.typhi. Patients were treated with ceftriaxone IV dosage based on the 100 mg/kg IV 24h for 10-14 days Results: the Most important symptom of typhoid is fever which was seen in all the 66 (100%) of cases involved in the study. The next common symptom was headache in 37 (56.06%) of cases followed by hypotension 22 (33.33%), diarrhea 21(31.81%), Abdominal pain 19 (28.79%), constipation 18 (27.27%), vomiting 14 (21.21 %) and only 7 (10.60%) and 6 (9.0 %) presented with cough and bradycardia. Maximum 45.45% patients get rid of typhoid fever after one week of medication. 22.73% of patients get rid of typhoid fever in two weeks of medication. 9.0% were cleared of infection after 3 weeks of medication. Conclusion: Typhoid fever is common in this group of the population especially in children. Fever, diarrhea and abdominal pain were the major clinical symptoms. No multi-drug resistant S.typhi was found in this population. Increase awareness regarding hygiene maintenance, sanitation and vaccinations in the population is required to reduce the burden of the disease in this area