Background: The present study was aimed to compare the success rate of three different techniques of I-Gel insertion i.e. standard, rotational, triple airway manoeuvre in anaesthetised paralysed adults. Materials and Methods: A total of 150 patients were included in this Prospective Randomised Trial at Department of Anaesthesia, Dr. R.P.G.M.C. Kangra at Tanda during the study period. The patients were divided into 3 groups with 50 patients each. The patients in group A included standard technique, group B with rotational technique and group C included triple airway manoeuvre. The primary endpoint of this investigation was the first attempt insertion success rate. The secondary endpoints were insertion time, number of attempts. Results: In our study, in standard group first attempt success rate was 86 % and second attempt success rate was 14%. In rotational group, first attempt success rate was 96% and 4% in second attempt and lastly triple airway manoeuvre group first attempt success rate was 94% and 6% in second attempt. Though success rate was higher in rotational and triple airway group than standard group, there was no significant difference of success rate distribution between three groups (p = 0.149). Hence all the three groups were comparable for first attempt success rate. Number of insertion attempts were significantly higher in standard group in comparison to rotational group (1.3±0.46 vs. 1.04±0.19; p<0.0001) and triple airway manoeuvre group (1.3±0.46 vs. 1.06±0.24; p = 0.001). In our study, insertion time in standard group was 11.76±4.92 sec, in rotational group was 10.42±2.89 sec and 8.50±2.44 sec in triple airway manoeuvre group. On comparison, insertion time was significantly shorter in triple airway manoeuvre group in comparison to standard group (8.50±2.44 sec vs 11.76±4.92 sec; p<0.0001) and significantly shorter in comparison with rotational group (8.50±2.44 sec vs 10.42±2.89 sec; p = 0.027). Conclusion: The triple airway maneuver technique shows higher overall success rate in first attempt of insertion, shorter insertion time, lesser insertion attempts in comparison to rotational and standard techniques of I-Gel insertion.

Background: The purpose of the current study was to examine the simplicity of inserting an I-Gel and stomach tube using three different insertion methods standard, rotational, and triple airway manoeuvre in anaesthetized paralysed adults. Materials & Methods: A total of 150 patients were included in this Prospective Randomised Trial at Department of Anaesthesia, Dr. R.P.G.M.C. Kangra at Tanda during the study period. The patients were divided into 3 groups with 50 patients each. The patients in group A included standard technique, group B with rotational technique, and group C included triple airway manoeuvre. Results: Our study showed that in standard group I-Gel insertion was easy in 84% of the patients, moderate in 14% and difficult in 2% of patients, in rotational group I-Gel insertion was easy in 94% of the patients and moderate in remaining 6% of patients, in triple airway manoeuvre group I-Gel insertion was easy in 92% of the patients and moderate in 8%of patients. Ease of I-Gel insertion was statistically not significant and were comparable between all the three groups (P = 0.384). In standard group gastric tube insertion was easy in 88% of the patients and moderate in 12%, in rotational group gastric tube insertion was easy in 96% of the patients and moderate in 4% and in triple airway manoeuvre group gastric tube insertion was easy in 100% of the patients. This might be due to better positioning and sealing in the triple airway manoeuvre technique with respect to both techniques (P = 0.025). Conclusion: Present study concluded that gastric tube insertion was significantly better in triple airway manoeuvre than standard and rotational techniques while Ease of I-Gel insertion was comparable between all the three groups.

Aim of the Study: Comparison between ultrasound guided femoral block versus intravenous fentanyl for their analgesic effectiveness in ease of patient positioning for subarachnoid block. Materials and Methods: This double-blind study was planned with fifty patients of ASA 1 and ASA 2, aged between 20 to 80 years scheduled to undergo surgery for fracture neck of femur. It is a randomized prospective study where patients were allocated to two groups. Group A (N = 25) patients were given 10ml of Inj. Bupivacaine 0.5% for femoral nerve block with the help of ultrasound guidance. Group B (N = 25) patients received titrated doses. of Inj. Fentanyl 0.5mcg/kg I.V. This dosage was repeated to 3 doses with a total of 1.5 mcg with 5 minutes interval between the doses. Visual analogue scale was used 15 minutes after the block/I.V. Fentanyl i.e., during positioning to assess the analgesia provided. Sub arachnoid block was performed using appropriate dose of Inj. Bupivacaine (hyperbaric, dextrose 80mg/mL). was recorded by another anaesthesiologist blinded to the mode of analgesia with scores of 0-3. Results: Statistically significant difference was noted in VAS score among Group A (Mean = 1.44, SD = 1.583) and Group B (Mean = 2.96, SD = 2.010) with a p value of 0.044 (Chi Square test). Conclusion: From this study it can be concluded that in comparison to I.V Fentanyl, femoral nerve Block is more efficacious for ease of positioning during spinal anaesthesia in fracture neck of femur surgeries. Femoral nerve Block provides superior analgesia and better quality of patient positioning. This further aids in reducing the time taken to perform spinal anaesthesia in sitting position when compared to intravenous Fentanyl in fracture neck of femur surgery.

Background: Spinal anesthesia is often administered in sectio caesarea. It is an easier and faster anesthetic technique to block the nervous system. Bupivacaine is the most common drug for spinal anesthesia in patients undergoing sectio caesarea. Levobupivacaine is an enantiomer of bupivacaine. In several studies, this agent is reported to have less cardiotoxic and neurotoxic effects and a shorter duration of the motor block than bupivacaine. This study aims to compare the effectiveness of intrathecal bupivacaine-fentanyl and levobupivacaine-fentanyl in patients undergoing sectio caesarea. Materials and Methods: This research involved 18-40-year-old patients who underwent elective sectio caesarea and cito with a gestational age of more than 37 weeks and the condition of the American Society of Anesthesiologists (ASA) class I and II. Thirty-two patients were divided into two groups (the group receiving bupivacaine 12.5 mg (2.5 mL) with fentanyl 25 mcg (0.5 mL) (Group BF) and the group receiving levobupivacaine 12.5 mg (2.5 mL) with fentanyl 25 mcg (0.5 mL) (LF Group)). The analgesic duration was recorded. Vital signs including blood pressure and pulse, neonatal side effects and patient side effects were recorded. Result: There was no statistically significant difference in analgesic duration between the two groups. The mean MAP was found to be lower in the BF group compared to the LF group. Hypotension and bradycardia were more common side effects in the BF group. There were no significant differences in neonatal effects. Conclusion: The combination of levobupivacaine 12.5 mg and fentanyl 25 mcg intrathecally can be a good alternative to the combination of bupivacaine 12.5 mg and fentanyl 25 mcg in sectio caesarea. Both are combinations for spinal anesthesia in sectio caesarea which are effective and have no side effects on neonates.

Background: Around the world, osteoporosis is a serious public health issue that is linked to significant morbidity and mortality. Osteoporosis-related knowledge and practice are generally lacking among people. This study sought to assess the knowledge, attitudes and behaviours regarding osteoporosis prevention among people living in tribal area of Himachal Pradesh. Material and Methods: A descriptive cross-sectional survey was conducted amongst the 400 Ortho OPD patients at the Regional Hospital, Keylong in District Lahaul and Spiti of Himachal Pradesh who were chosen using a convenience sampling technique. Using a self-administered, pre-tested, semi-structured questionnaire, data on their socio-demographic characteristics as well as knowledge, beliefs and practices of osteoporosis preventive measures were gathered. Epi info v7 software was used to evaluate the data using the necessary statistical tests. Results: Of the 400 participants in the current study, 26.25 percent (105) were under the age of 40, while 73.75 percent (295) were over that age. Male patients (226) made up 56.5% of the total, while female patients made up 43.5%. (174). Participants knew surprisingly little about different osteoporosis risk factors and protective methods. They generally also had modestly favorable thoughts about osteoporosis and a small level of self-efficacy in putting the suggested practices for the disease into effect. Conclusion: The current study found that participants had poor understanding of osteoporosis and were not properly applied to prophylactic measures. This was primarily caused by a lack of understanding of how deadly osteoporosis is. Therefore, public health initiatives should be implemented to modify people's lifestyles and improve awareness of osteoporosis prevention.

Anaesthesia and preanaesthesia checkup are an integral part of any surgery. It affects the outcome of patient; long term hospital stays and helps in optimizing medical condition. Unfortunately, anaesthesia and Pac is still not well understood among people mostly in rural areas. People don’t have the concept behind pac. This study was conducted in a secondary health institute civil hospital Palampur on patients coming for various elective surgeries. A modified Singla and Mangla questionnaire was asked to fill by these patients. It was found that most of the people don’t know who is going to perform Pac and they think it is just needed to get date of surgery. we found in our study that during Pac we should explain the patients about need to do Pac, why the surgery is being cancelled and need of optimizing medical conditions before going to surgery. This would help in making people understand importance of Pac and anaesthesia during surgery.

Over 700,000 Americans suffer from Vertebral Compression Fractures (VCFs), the most prevalent osteoporosis consequence. Four in 10 white women over 50 will break a hip, spine, or vertebrae. VCFs can cause persistent pain, deformity, height loss, poor daily functioning, pressure sores, pneumonia and psychological suffering. Patients with acute VCF may experience back pain when coughing, sneezing, or lifting. Kyphosis and midline spine discomfort are common physical exam findings. Asymptomatic patients are detected accidentally on plain radiography in over two-thirds. Acetaminophen, NSAIDs, opioids and calcitonin can treat acute VCFs. Physicians must consider drug side effects in older patients. Other conservative treatments include a limited amount of bed rest, a brace, physical therapy, nerve root blocks and epidural injections. Percutaneous vertebral augmentation, which includes vertebroplasty and kyphoplasty, is controversial, but it may be an option for people who can't get rid of their pain without surgery or whose quality of life is significantly affected. Family physicians can prevent vertebral fractures by managing risk factors and treating osteoporosis.

The management of postoperative pain in patients having Total Knee Arthroplasty (TKA) continues to improve as surgical procedures and pharmacology advance. The current standard of care is multimodal pain management, which includes opioids, nonsteroidal anti-inflammatory medications, gabapentinoids, peripheral nerve blocks and periarticular injections. Newer techniques include local anesthetics with delayed release and cryneurolysis. To summarize the current evidence-based treatment modalities and predict changes in the management of TKA patients, we reviewed available data on:

• Oral Analgesics

• Periarticular Injections

• Peripheral Nerve Blocks

• Multimodal Regimens

• Newer modalities for post-TKA pain management

Multimodal analgesic regimens that target many pain pathways may offer the most effective pain treatment, rehabilitation, patient satisfaction and reduction of opioid use and associated adverse effects. Periarticular injections of local anaesthetics with delayed release may further improve pain control.

Objectives: Refractory Hypokalemia associated Hypomagnesemia is an electrolyte imbalance commonly found in debilitated hospitalized patients. Possible consequences of this dual electrolyte hypos disturbances, including but not excluded to, neuromuscular, neurologic, heart dysfunctions. The simplest and commonly used test to diagnose the accompanied hypomagnesemia in refractory hypokalemic patients, is a serum magnesium level (Mg⁺²). When replacing Mg⁺²via the IV route, approximately half of the dose is retained by the body while the remainder is excreted in the urine. The low retention rate is due to the slow uptake of large concentration of Mg⁺². The primary purpose of this study is to determine whether an extended infusion of 2 grams MgSO₄ over 12 hours twice daily for 5 days (Strategy I) compared to a standard infusion of 5 grams MgSO₄ over 4 hours once daily for 5 days (Strategy II) results in a greater sustaining in Mg⁺² level ≥2 mg/dl after at least 3 days from MgSO4 infusion off. Materials and Methods: We retrospectively reviewed refractory hypokalemic associated hypomagnesemia patients who received IV magnesium sulfate at our institution between 2018 and 2020 at standard infusion rate of 5 grams MgSO₄ over 4 hours once daily for 5 days (Strategy II) or at extended infusion rate of 2 grams MgSO₄over 12 hours twice daily for 5 days (Strategy I). All refractory hypokalemic associated hypomagnesemia patients whose chemistry data could be retrospectively retrieved via our institutional electronic health record (Hakeem), will be included in this study. Patients whose magnesium level exceeded 4 mg/dl during MgSO₄ infusion days will be excluded. A chi square test will be conducted to evaluate the proportion of studied patients in both tested infusion strategies who had late magnesium level ≥2 mg/dL. An independent T-test will be conducted to compare the Mean±SD of %∆ Mg⁺² between Strategy I and Strategy II. Results: There was no difference between the two strategies regarding Mg⁺² levels above 2 mg/dL 4 hrs. after the end of the infusion, on the other hand, there was a significant difference in the percentage of patients maintaining Mg⁺² levels above 2 mg/dL at least 72hrs after the end of infusion. Conclusion: The extended infusion of MgSO₄ is significantly increases the percentage of patient retaining normal Mg⁺² levels 72 hrs. after the end of the infusion, decreases the length of ICU and overall hospital stay, in addition to lowering 28-days ICU overall mortality rates.

Concerning cardiac compromise, we should know if Takotsubo Cardiomyopathy (TTS) was ruled out as a differential of the cardiological complaints. TTS has been repeatedly reported as a complication of SARS-CoV-2 vaccinations [2]. Arguments for TTS are that the myocardium was hypokinetic, that the ECG showed ST-depression, and that troponin and CK were elevated. TTS mimics myocardial infarction clinically, chemically, electro-physiologically, and on echocardiography but coronary angiography is normal.  Rhabdomyolysis has been repeatedly reported as a complication of SARS-CoV-2 vaccinations [3]. However, symptoms started with sensory disturbances [1]. Because the patient complained about sensory disturbances at onset and because Nerve Conduction Studies (NCSs) of the lower extremities revealed reduced amplitude of the sensory Nerve Action Potential (SNAP), sensory polyneuropathy or Small Fiber Neuropathy (SFN) need to be ruled out appropriately. Both sensory polyneuropathy and SFN have been previously reported as complications of SARS-CoV-2 vaccinations [4]. 

Objective: Hospitalization associated malnutrition is a type of stress condition that characterizes by hypermetabolism. Such hypermetabolism is accompanied by increased Lean Body Mass (LBM) catabolism and increased Basal Energy Expenditure (BEE). The severity of this hyper-catabolism may be the primary determinant of severe wasting in hospitalized and critically ill patients. This hypermetabolic status can be mitigated partially through the beta-adrenergic receptors in which propranolol can mitigate this hyperdynamic and hypermetabolic status through its non-selective adrenergic antagonist. The aim of this study is to evaluate the clinical impacts of using propranolol as an anticatabolic agent in adjunctive to either enteral or parenteral nutrition provision. Materials and Methods: A retrospective analysis was conducted in our institution between April 2017 and April 2019. Discharged or dead patients were excluded if failed to complete at least 1 week after hospital admission. Our sample was stratified into two comparative groups. Group I (Malnourished hospitalized patients who were administered propranolol tab 40 mg TID as an anti-catabolic agent), Group II (Malnourished hospitalized patients who weren’t administered propranolol tab). Independent Samples, One-Sample T-test and Chi square test were used in our study. Results: The mean age of our 188 studied malnourished hospitalized patients was 58.94±10.37 years in which 131 patients (69.7%) of the eligible sample were males and 57 patients (30.3%) were females. Group I had significantly higher average albumin level (ALB_avg) than Group II (3.49±0.02 g/dL vs 3.25±0.06 g/dL) with Mean difference±SEM of +0.24±0.01 g/dL. Conclusion: Non-selective beta-blockade with propranolol improves survival in severe malnourished hospitalized patients without evidence of clinically significant hemodynamic compromise Significant higher ALB_avg accompanied with lower Blood Urea Nitrogen (BUN) may indicate for propranolol anti-catabolic effect which may have a positive major and minor clinical impacts.

Background: The present study was done to correlate between S. PSA levels and SUV max on 68Ga PSMA PET/CT in Prostate Cancer Patients. Materials and Methods: Forty-four patients with suspected PCa on clinical assessment and/or raised serum PSA levels (>4ng/ml) were prospectively recruited. Patient who underwent prostatic biopsy prior to 68Ga-PSMA PET/CT and mp MRI, deranged renal function tests or coagulogram and refused consent were excluded. Forty-four patients underwent 68Ga-PSMA PET/CT and 33 patients underwent biopsy. Any focal tracer uptake on 68Ga-PSMA PET/CT was regarded as pathological. Histopathology was taken as gold standard. Results: Mean age of patients was 66.61±9.3 years. Malignancy was detected in 16/33 (48.5%) patients who underwent biopsy. In 17/33 (51.5%), no evidence of malignancy was noted. The median and IQR (interquartile range) of S. PSA levels in this group of 33 patients was 13.4±13.9ng/ml. The median and IQR of the SUVmax was 7.5 and 12.85. On statistically evaluation, no significant correlation was observed between S. PSA and SUVmax (r = 0.316, p = 0.073). Conclusions: The present study concluded that there was no significant correlation was observed between S. PSA and SUVmax in prostate cancer patients.

Background: The present study was done to evaluate the diagnostic performance of mp MRI in suspected in Prostate Cancer Patients at tertiary care Hospital. Materials and Methods: Forty-four patients with suspected PCa on clinical assessment and/or raised serum PSA levels (>4ng/ml) were prospectively recruited. Patient who underwent prostatic biopsy prior to 68Ga-PSMA PET/CT and mp MRI, deranged renal function tests or coagulogram and refused consent were excluded. Out of total 44, 33 patients also underwent mp MRI. Out of the total 44 patients, 33 underwent biopsy. Only 22 out of these 33 patients underwent mp MRI. The images were interpreted and mp MRI reporting was done according to PIRADS v.2. Histopathology was taken as gold standard. Results: Mean age of patients was 66.61±9.3 years and Malignancy was detected in 16/33 (48.5%) patients who underwent biopsy. Out of these 22 patients, 9 were interpreted as PIRADS II, 3 patients were PIRADS III and 10 were given PIRADS score of IV/V. No patient was given a PIRADS score of 1. When PIRADS III-V were considered as positive lesions on mp MRI, the sensitivity, specificity, PPV, NPV and accuracy of mp MRI was 100%, 81.82%, 84.62%, 100% and 90.91% respectively to detect the adenocarcinoma PCa. When PIRADS III was considered as negative for malignancy, the sensitivity falls to 81.82%, specificity increases to 90.91%, PPV increased to 90%, NPV decreased to 83.33% and he overall accuracy decreased from 90.91 to 86.36%. Conclusions: Present study concluded that the Majority of the patients with PIRADS IV/V had a diagnosis of malignancy and mp MRI has high sensitivity, specificity, PPV, NPV and accuracy in diagnosis of Prostate Cancer.

Introduction: LEMON (Look-Evaluate-Mallampati-Obstruction-Neck mobility) scoring system is considered as one of the popular assessment tools to predict difficult laryngoscopy and tracheal intubation. Previous studies aimed to use LEMON score to predict difficult laryngoscopy and tracheal intubation by correlating them to Cormack and Lehane grading where 3 and above was considered difficult laryngoscopy. None of these studies have identified a precise cut off LEMON score that would predict difficult laryngoscopy and intubation. The aim of this study was to identify an exact LEMON score at or above which we can predict difficult laryngoscopy and tracheal intubation. This would help to prepare equipment and personnel for expected difficult intubation based on this cut off LEMON score. Materials and Methods: 32 consenting patients of either gender between 18-65 year who were scheduled to undergo elective surgical intervention in Khoula Hospital were assessed for LEMON score and its correlation was made with Cormack Lehane grade for assessing difficulty in laryngoscopy and intubation under a uniform general anesthetic technique. The primary objective was to determine the LEMON score at or above which difficult laryngoscopy and tracheal intubation could be predicted. The secondary objectives were to study the role of age, gender and BMI in this study, as well as the sensitivity and specificity of each parameter of the LEMON score. Results: The primary outcome showed LEMON score of 2 and more can predict difficult laryngoscopy and tracheal intubation. For the secondary outcome, it showed different strengths in each component of the LEMON score in predicting difficult intubation. The best specificity (91.30%) and sensitivity (77.78%) to predict difficult tracheal intubation was noted to be hyomental distance <3. We could not show conclusive evidence that age and BMI are variables that could influence the prediction of difficult laryngoscopy and tracheal intubation, possibly because of the small sample size. Conclusion: LEMON score of 2 and more may be predictive of difficult laryngoscopy and tracheal intubation. Hyomental distance and Mallampati grade as individual predictors of the LEMON score can be more effective than others in predicting difficult laryngoscopy and tracheal intubation.

Objective: Gastrointestinal dysmotility and constipation are common problems in hospitalized patients, especially the critically ill patients. Addressing and preventing the opioid inducing constipation adverse effects is essential to patient care. In this study we aim to assess the daily Fructo-Oligosaccharides (FOSs) proactively supplementation effectiveness on opioid induced constipation and its related complications. Materials and Methods: This retrospective study was conducted on 188 Eligible patients between Jan 2018 and May 2021, which were grouped to 2 comparative cohorts; patients who were on daily FOS proactively supplementation (Cohort I) and patients who were on our institutional protocolized bowel care management (Cohort II). An Independent and One Sample T-Tests were used to analyze all non-dichotomous comparative variables and for dichotomous comparative variables, a Chi Square Test were used. Results: The mean age of the whole studied OIC affected patients was 58.94±10.37 years. The overall 28-day ICU mortality was detected in 76 patients with an overall incidence rate of 40.4% during an average of 12.76±4.95 days of ICU admission days. Group I had a significantly higher total calories input and protein density input compared to Group II (1265.53±245.95 Cal/day and 4.85±0.71 g/100 Cal vs 1155.25±228.36 Cal/day and 3.90±0.55 g/100 Cal, respectively, p<0.05). Conclusion: Our study showed that the investigated soluble fiber, in the form of FOS 1.7 gram/30 ml, may be an innovative strategy in mitigation of an opioid analgosedative related inevitable negative clinical impacts.

A limitation of the study is that a SARS-CoV-2 infection was not ruled out as the cause of gastro-enteritis leading to the initial admission. Because the events apparently took place after the start of the SARS-CoV-2 pandemic, it cannot be ruled out that the patient deteriorated because of an undiagnosed COVID-19 infection. Arguments for a SARS-CoV-2 infection are that the patient was institutionalised and manifested with gastro-enteritis. Institutionalised patients are at an increased risk of contracting and dying from a SARS-CoV-2 infection.[2] It is also known that SARS-CoV-2 infections can manifest itself not only in the lungs but also in extra-pulmonary sites, including the gastro-intestinal tract.[3] In patients with manifestations of COVID-19 with extra-pulmonary onset, the causative agent can be difficult to confirm. We should be told whether the patient was SARS-CoV-2 vaccinated at the time of the first deterioration.

Background: Present study was done with the objective to compare the adverse effects after Intravenous Ferric Carboxymaltose and Iron Sucrose in the treatment of Iron Deficiency Anemia in Pregnancy. Material and Methods: This was a prospective study conducted in the department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College Shimla from 1st June 2019 to 31st May 2020.86 antenatal women with iron deficiency anemia were included in the study. The subjects were randomized into two equal groups and one group received intravenous ferric carboxymaltose whereas other group received intravenous iron sucrose. Results: The subjects in our study were observed for development of adverse reactions following treatment with intravenous ferric carboxymaltose and iron sucrose. Out of 43 subjects in FCM group, 4.7% developed local adverse reactions and none of the subjects developed systemic reactions. Whereas in ISC group out of 43 subjects, 7% developed local adverse effects and 4.7% developed systemic adverse reactions. The difference between the two groups was statistically significant. Conclusion: The present study concluded that ferric carboxymaltose was associated with a better safety profile compared to iron sucrose.

Background: Present study was done with the objective to compare the change in the Iron Profile after Intravenous Ferric Carboxymaltose and Iron Sucrose in the treatment of Iron Deficiency Anemia in Pregnancy. Material & Methods: This was a prospective study conducted in the department of Obstetrics and Gynaecology, IGMC, Shimla from 1st June 2019 to 31st May 2020.86 antenatal women with iron deficiency anemia were included and randomized into 2 equal groups with one group received intravenous FCM whereas another group received ISC. Results: The baseline value of hemoglobin, packed cell volume, serum iron, serum ferritin and total iron binding capacity were comparable in both the groups. All the subjects developed reticulocytosis following treatment with FCM and ISC, but the rise was significantly higher in FCM group as compared to ISC (2.9% versus 2.5% respectively at 4 weeks). At 2 weeks the mean hemoglobin was 10.48 g/dL in FCM group and 10.03 g/dL in ISC group. At 4 weeks the mean hemoglobin was 11.42 g/dL in FCM group and 11.00 g/dL in ISC group. The mean value in PCV at 2 weeks of follow up was 33.64 % in FCM group and 31.02 % in ISC group. At 4 weeks the mean PCV was 37.11% in FCM group whereas it was 34.17% in ISC group. Mean serum iron at 2 weeks was 114.67 ug/dl in FCM group and 92.75 ug/dl in ISC group. At 4 weeks mean serum iron was 137.95 ug/dL in FCM group compared to 111.03 ug/dl in ISC group. At 2 weeks, the levels of mean serum ferritin were 135.3 ng/mL in FCM group and 116.4 ng/mL in ISC group. At 4 weeks, the levels of mean serum ferritin were higher in FCM group compared to ISC group (107 ng/mL versus 96.3 ng/mL) respectively. At 4 weeks there was a significant fall in TIBC in those subjects who were treated with FCM compared to ISC (155.97 ug/dL versus 112.92 ug/dL respectively). Conclusion: There was very strong evidence against null hypothesis and there was significant difference in all the parameters in group A as compared to group B (p<0.001).

Introduction: Cesarean section is one of major surgical procedure. Delivery of adequate post- operative pain management is critical. The aim of this study was to assess the efficiency of existing post-operative pain management in Khoula hospital. Materials and Methods: In this prospective observational study, 132 patients scheduled for elective and emergency cesarean section under spinal anesthesia. The primary objective was to determine patient satisfaction with their post cesarean section pain management. The secondary objectives were to determine the effect of pain control on patient’s sleep pattern, mood and daily activity over the first 24 hours. Results: Post-operative analgesia regimen was started and followed by obstetric team in 100% of cases. The most common modalities were intramuscular opioids for break through pain and co-analgesia (intravenous paracetamol and intramuscular diclofenac) alone or in combination. Patient’s opinion regarding pain management was satisfactory in 84.8%, while 15.2 % were not satisfied. Overall, 12.5 % of patients reported mild complications that responded well to management. Marginal increase in the effect of pain on social maternal behavior in regard of mood, sleep and physical activity in emergency cases compared to elective cases. Conclusion: Post-operative pain management regimen was solely started and followed by obstetrician in the hospital. It was adequate in term of patient safety. However, it was not optimal as 55.3% of patients reported moderate pain intensity as per VAS score.

Background: Although knowledge about the mechanism of pain has currently developed a lot, the provision of good and adequate anti-pain in postoperative conditions is still a challenge. In this case, opioids are drugs widely used in postoperative analgesics, but opioids are known to have many adverse side effects, such as nausea, vomiting and itching, to the risk of respiratory depression. Thus, this study aimed to compare the effects of preemptive management of ketorolac and paracetamol on postoperative pain scores, opioid consumption and postoperative patient satisfaction. Materials and Methods: Sixty patients who underwent surgery under general anesthesia were divided into three groups: the group receiving ketorolac (30 mg), the group receiving paracetamol (1,000 mg) and the control group receiving 0.9% NaCl 30 minutes before surgery. Then, the Visual Analog Scale (VAS) scores, postoperative tramadol consumption, side effects and patient satisfaction were recorded. Results: Tramadol consumption was significantly higher in the control group than in the paracetamol and ketorolac groups (p <0.001). The consumption of tramadol in the ketorolac group was higher than the paracetamol group at the 1st, 2nd and 8th-hour measurements (p = 0.048, p = 0.047, p = 0.040). However, the total tramadol consumption in the ketorolac and paracetamol groups did not differ statistically at the 12th and 24th hours. Conclusion: Preemptive management of ketorolac and paracetamol can reduce postoperative opioid consumption compared to the control group. Hence, both drugs may be a viable alternative for postoperative pain treatment to avoid the side effects of opioid drugs.

Background: The present study was carried out to evaluate the ASA Grading and Duration of stay among Secondary Peritonitis cases and its association with outcome in a tertiary care Hospital. Materials and Methods: This study was a longitudinal, prospective study in which all patients presenting to the Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021-December 2021 and with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria were recruited. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: In the present study a total of 250 patients with diagnosis of perforation peritonitis were evaluated. Among the total Males were 205 (82%) and Females were 45 (18%). Mean age of the patients was 47.28±17.34 years with range from 18 to 87 years. Among the total, 99(39.6%) patients were age < 40 years while 151(60.4%) patients were aged > 40 years. Among the total, 32(12.80%) were expired while 218(87.20%) were discharged after treatment. Among the total, 114(45.60%) patients were in grade 1 according American Society of Anesthesiologists (ASA) scoring system, 107 (42.80%) were in grade 2, 22(8.80%) were in grade 3 and 7(2.80%) were in grade 4. Among the total 32 patients who were expired, 2(6.3%) were in grade 1, 19(59.4%) were in grade 2, 9(28.1%) were in grade 3 and 2(6.3%) were in grade 4 while among the total 218 patients who were discharged, 112(51.4%) were in grade 1, 88(40.4%) were in grade 2, 13(6.0%) were in grade 3 and 5(2.3%) were in grade 4 according American Society of Anesthesiologists (ASA) scoring system. There was found significant association between ASA Grading and mortality. The mean duration of hospital stay among study participants was 8.99±6.07 days with range 1 to 40 days. The mean duration of hospital stay among 32 expired patients was 9.19±8.26 days while among 218 discharged patients was 8.96±5.70 days. There was no significant association between duration of hospital stay and mortality. Conclusion: The present study concluded that most of patients of secondary peritonitis were in grade 1 of American Society of Anesthesiologists (ASA) scoring system old and there was significant association of mortality with ASA Grading but not with duration of stay in hospital.

Background: Peritonitis still poses major problem for surgeons as far as morbidity and mortality is concerned. The aim of this study is to evaluate the Socio-demographic characteristics and its association with outcome in Secondary Peritonitis cases in a tertiary care Hospital. Material and Methods: This study was a longitudinal, prospective study in which all patients presenting to the Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021-December 2021 and with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria were recruited. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: In this study, a total of 250 patients with diagnosis of perforation peritonitis were evaluated. Among the total Males were 205 (82%) and Females were 45 (18%). Mean age of the patients was 47.28±17.34 years with range from 18 to 87 years. Among the total, 99(39.6%) patients were age <40 years while 151(60.4%) patients were aged >40 years. Among the total, 32(12.80%) were expired while 218(87.20%) were discharged after treatment. Among the total 205 males, 19 (9.3%) were expired and 186(90.7%) were discharged while among total 45 females 13(28.9%) were expired and 32(71.1%) were discharged. There was significant difference in mortality among males and females. Mean age of 32 expired patients was 59.16±13.32 years while mean age of 218 discharged patients was 45.49±16.96 years. There was significant difference in mortality according to age. Among the total 205 Males mean BMI was 21.93±3.00 while among the total 45 females mean BMI was 20.68±2.46. Among the total 32 expired patients mean BMI was 22.69±3.54 while among the total 218 discharged patients mean BMI was 21.76±2.80. There was no significant difference in mortality according to BMI. Conclusion: In the present study maximum patients of secondary peritonitis were males and less than 40 years old. There was significant association of mortality with gender and age group.

Background: Personal protective equipment is the most crucial weapon of health workers against COVID 19, which is confirmed by reporting increased infection and death rates in health workers because they could not reach adequate Personal protective equipment. Aims: We planned to conduct a questionnaire study aiming to evaluate the effects that may occur on the hearing and vision abilities of nurses. Design This study investigated the effectiveness of protective equipment for hearing and vision loss in intensive care nurses during the Covid-19 pandemic (N = 102) by a survey. Materials and Method: The study was applied to the Covid-19 intensive care unit nurses by obtaining their consent via the internet. Results: As a result, 13.7% of the nurses stated that they experienced communication problems due to hearing loss due to protective equipment. In addition, 56.9% of the participants stated that they had difficulty working due to the evaporation caused by the protective equipment. Finally, the rate of the nurses who noted that the protective equipment blocked them from doing their work in cases such as cardiopulmonary arrest was 28.4%. Conclusion: As a result, in our study, it was found that the equipment used in Covid-19 intensive care units caused hearing and visual communication and working difficulties on nurses. 

Background: Osteoarthritis (OA), the most common joint ailment worldwide, most usually affects the knee of the human body. This study was carried out at Regional Hospital, Keylong in district Lahaul and Spiti of Himachal Pradesh to assess the awareness of osteoarthritis knee risk and prevention factors among Ortho OPD patients. Material and Methods: About 400 Ortho OPD patients at the Regional Hospital, Keylong in the Himachal Pradesh’s district of Lahaul and Spiti were randomly selected to participate in a descriptive cross-sectional study. Data on their sociodemographic features and knowledge of risk and prevention factors for osteoarthritis knee were acquired using a self-administered, pre-tested, semi-structured questionnaire. The required statistical tests were performed on the data using the Epi info v7 programme. Results: In the present study 31.5% (126) of the Patients fall were below 40 years of age while 68.5% (274) were above 40 years. 51.25% (205) of patients were male and 48.75% (195) were female. Among the total patients, 58(14.5%) didn’t know about any risk factor of osteoarthritis Knee. 309 (77.25%) respondents told that Inadequate amounts of dietary calcium & vitamin D is the risk factor of osteoarthritis Knee ,followed by Bad posture and poor gait by 160(40%). Among the total patients, maximum 307(76.75%) told that Calcium and Vitamin D supplements helps in Prevention of osteoarthritis Knee, followed by calcium-rich foods 221(55.25%) and Good posture and gait by 171(42.75%). In our survey, 63 (15.75%) respondents didn’t know about any preventive factor of osteoarthritis Knee. Conclusion: Many responders still had little knowledge of the risk and protective factors for osteoarthritis of the knee. Exercise and yoga, Grecian capsules (glucosamine), calcium and vitamin D supplements, foods high in calcium, knee braces or knee caps, maintaining a healthy weight, avoiding knee traumas and eating a balanced, healthy diet all help to prevent osteoarthritis in the knees.