Teenage girls experience physical and psychological changes during puberty. The primary change experienced is menstruation. Menstruation experienced sometimes accompanied by complaints of dysmenorrhea. Dysmenorrhea experienced causes discomfort, and it reduces learning achievement. Education about treating primary dysmenorrhea in Teenagers could be done pharmacological and non-pharmacological. One non-pharmacological way to handle dysmenorrhea is by administering videos of warm compresses and effleurage massage at Senior High School 2 Amlapura. The design used was a pre-experiment with a pretest-posttest design. Implementation in March-April 2022 with a purposive sampling technique, 42 respondents who experienced dysmenorrhea was recruited as the sample. The research instruments were administrated in pre-test and post-test. Data normality test using Kolmogorov Smirnov that was not normally distributed. Data analysis used the Wilcoxon test with a p-value (<0.05) significance level. The mean result before counseling was 79, and after counseling increased to 95. The Wilcoxon test results indicated a significant benefit in the provision of video with a p-value of 0.000 (<0.05) comparison of pre-test and post-test for 42 respondents who obtained post-test scores more significant than the pre-test with 79 of the pre-test results to 95 of the post-test results. Suggestions for Teenagers to actively seek information about menstruation and how to deal with dysmenorrhea in a non-pharmacological way.

Continuity of care in midwifery is a series of continuous service activities during pregnancy, childbirth, postpartum, newborn, and family planning. About 40% of pregnant women had health problems, and 15% of pregnant women suffered from long-term, life-threatening complications that could lead to death. Back pain often complained by mothers occurs in around 60% to 80% of pregnant women in Indonesia. This study aimed to identify the implementation of midwifery care in the pregnant woman from age 18 weeks 2 days, giving birth, postpartum and newborn baby. This study employed a case report method, and data collection was done by interview, examination, observation, and documentation. The pregnancy was done in physiology and according to the standard. The giving birth process of Mrs. “WN” was at 38 weeks 4 days. During postpartum, it was not found any problems on mothers. The involution of the uterus, the expulsion of the lochea, and the lactation process until 42 days were normal. The development of the baby from newborn to 42 days was done physiologically. It was expected that the midwives provide midwifery care according to the standard; hence, it could prevent problems and complications during pregnancy, labor, postpartum and newborn.

Background: The procedure of endoscopic retrograde cholangiopancreatography (ERCP) is a challenging one with rare postoperative complications. Although biliary plastic stent-related duodenal perforations are uncommon, they can be fatal. Treatment options for perforations of this type are varied and controversial. Case presentation: A male patient, 48 years old, with severe pain in the abdomen was referred to Dr. Moewardi Hospital. For one day after endoscopic retrograd cholangiopancreatography (ERCP) five days ago. To hepatopancreatobiliary surgery department of Moewardi Hospital for malignant biliary obstruction due to advanced pancreatic cancer. Due to obstructed jaundice due to biliary stenosis, the patient underwent dilatation and stent placement of the bile duct. After perforation of duodenal due in to biliary peritonitis and biliary, the patients underwent duodenography, laparotomy, peritoneal lavage, and a biliodigest procedure. Conclusion: Despite the low risk of interference with complications, biliary obstruction such as pancreatitis, bleeding and fatigue may happen. Early detection or a high index of suspection lead to effective intervention. Stent migration can lead to duodenal perforation, which can lead to morbidity and mortality if treatment is delayed.‎

50 Patients with presumably primary knee osteoarthritis were evaluated for involvement of other joints. The osteoarthritic group was compared with 50 age matched control group, suffering from low back pain. It was found that 56% of osteoarthritis cases have other joint involvement, compared to 6% of control group if the shoulder joint involvement is excluded (p-value < 0.05). The frequency of joint involvement (articular and or periarticular) in the osteoarthritic group was shoulders (50%), elbows (40%), Wrist (55%), metacarpophalangeal joints (34%), ankles (56%) and metatarsophalangeal joints (34%). On the other side the frequency of joint involvement in the control group (articular and or periarticular) was shoulders (40%), elbows (2%), wrists (6%), metacapophalangeal joints (6%), ankles (16%) and metatarsophalangeal joints (1%). The frequency of symptoms and signs outside the Knee in the Osteoarthritis group can be explained by either an underlying low grade inflammatory joint disease or by a degenerative process which is “Multifocal”. These possibilities will be explained later in the discussion. We conclude that careful clinical and laboratory evaluation, as well as long term follow up is necessary before a firm diagnosis of primary osteoarthritis is to be made. Further studies are needed to uncover the spectrum of what is considered a primary Knee Osteoarthritis and whether many of the causes could be not primary.

Background: Breast milk gives all the nutrients to the infants they need in the right amounts and contributes to their overall health. It guards against diseases including diabetes, cancer, and many others as well as allergies, illness, and obesity. Present study was carried out to evaluate the knowledge towards breast feeding among reproductive age group females in Himachal Pradesh Methodology: This cross-sectional survey was conducted from July 2022 to September 2022 using Google forms among the reproductive age group females residing in the state of Himachal Pradesh. The google form was circulated among reproductive age group female residents of the state for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected.  Information regarding their socio-demographic characteristics and knowledge regarding breast feeding were obtained. Data was analyzed using Epi info v7 software using appropriate statistical tests. Results:A total of 400 females were participated in this survey. Among them, maximum 205 (52.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 153(38.25%), Hindu 373(93.25%) and housewife 332(83%). In the present study 13% (52) females had very good knowledge (16-20 marks) towards breast feeding, 66.75% (267) having good knowledge (12-15 marks), 17.25% (69) having fair knowledge (8-11 marks) and 3% (12) having poor knowledge (<8 marks). Conclusion: During the antenatal time, every female of reproductive age should get counseling and adequate information regarding breastfeeding, and all myths about breast feeding should be appropriately addressed.

Aims: This study aimed to compare left ventricular (LV) function and clinical/biologic features between septal and apical pacing over a six-month follow-up period in patients with high-grade atrioventricular block. Methods: This non-randomized prospective single-center study includes patients allocated to receive an apical or midseptal ventricular lead. Computed tomography was used to confirm the intended lead tip position. Pacemaker parameters, QRS duration, LV volumes and ejection fraction, European Quality of Life Score, Functional Class, Six-minute Walk test, and NT-proBNP‎ were assessed at baseline and six months later. Results: A pacemaker was implanted in 58 patients (27 in the midseptal group and 31 in the apical group). No significant differences between the two groups were observed at baseline. Paced QRS duration was significantly lower in the midseptal than apical pacing group (‎p = 0.002‎)‎. After six months follow-up period, pacing parameters remained comparable between the two groups while patients assigned to the midseptal pacing group have a higher ejection fraction (‎p = ‎0.016‎). Higher LV end-diastolic and end-systolic volumes ‎were observed in the apical than midseptal pacing group at 6 months (‎p = 0.008 and p = 0.003, respectively‎). At 6 months, the midseptal group has lower serum NT-proBNP (‎p = 0.003) and higher six-minute walk test distance (p‎ = 0.030). Nevertheless, EuroQol index and NYHA>1 show no statistical difference. Conclusions: Compared ‎with right ventricular (RV) apical pacing, midseptal pacing was associated with better LV ejection fraction and six-minute ‎walk test, and lower LV volumes and NT-proBNP levels. RV midseptal pacing might be a ‎better option than regular RV apical pacing to lessen its negative effects.

Background: The present study was done to evaluate the histo-pathological finding and tumor burden among prostate cancer patients. Material 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 mpMRI, deranged renal function tests or coagulogram and refused consent were excluded. Forty-four patients underwent ⁶⁸Ga-PSMA PET/CT and 33 patients underwent mpMRI and biopsy. Results: Mean age of patients was 66.61±9.3 years and median PSA level was 13.4 ng/ml (IQR 13.9). Malignancy was detected in 16/33 (48.5%) patients who underwent biopsy. Tumors were low grade PCa in 9 cases and high grade PCa in 7 cases. Prostatitis was detected in 4 cases. [Granulomatous prostatitis (n=1), Acute/chronic prostatitis (n=3)]. In all 16 patients diagnosed of having malignancy on biopsy, adenocarcinoma was detected in all on histopathology. Prostatic intra-epithelial neoplasia (PIN) was not detected in any case. The range of tumour burden in patients was from <5 to 70%. One patient with tumour burden of less than 5% was found to be negative on ⁶⁸Ga PSMA PET/CT. Conclusions: The present study concluded that all the cases of Prostate Cancer were having adenocarcinoma and had high tumor burden. Histopathological examination of prostatic specimens has important role in the diagnosis and management of various prostatic lesions.

Over the past decade, infant and young child feeding (IYCF) practices in India have improved, though they remain sub-optimal and linked to persistent child undernutrition. Analysis of eight key breastfeeding indicators shows significant increases in early initiation and exclusive breastfeeding from 2006 to 2017 across genders, urban-rural areas, educational levels, and wealth quintiles. Despite these gains, disparities persist, highlighting the need for targeted interventions to further improve IYCF practices nationwide.

Background: Nipple discharge is an important complaint that frequently results patients’ anxiety and physician concern. It accounts 5% of all breast related symptoms. The evaluation and management of patients with nipple discharge aims to identify malignant cases from those associated with benign disease. Objectives: Studies on the nipple discharge are scare among women; therefore, the study was carried. Patients and Methods: Between July 2021 and December 2021, 100 patients with nipple discharge were included in the study. All patients were interviewed and clinical assessment based on a careful history, physical examination, imaging studies and cytological examination. Results: The age of all patients with nipple discharge was 39.9 years, ranging from 16 to72 years. BI-RADS >2 was noticed among 6(13%) of those with inflammatory lesion, 4(8.7%) of those with benign lesion and 11(23.9%) of those with malignant lesions. BI-RADS >2 was significant prominent in malignancy (p = 0.01). It was non-significantly present among inflammation and benign (p = 0.3 and 0.1, respectively). Color of discharge was bloody 5(26.3%) and serous 5(26.3%) in malignant lesions, respectively. It was bloody 5(13.9%) and serous 2(5.3%) of the benign lesions. In inflammatory lesion, the discharge was blood 2(10.5%), serous 4(10.5%) and purulent 3(15.8%). Bloody discharge was significantly prominent in benign and malignant lesions (p = 0.02 and 0.03, respectively). Conclusions: High BI-RADS are related to malignancy, bloody and serious nipple discharge related to malignancy.

Background: Hemoglobin (Hb), Vitamin B-12 and Vitamin D tests are designed to screen & measure the levels of these specific vital components in the body and suggest corrective action & treatment plans. The present study aimed to analyze the results of Hemoglobin (Hb), Serum Vitamin B-12 and Vitamin D tests done at a Private Laboratory in New Delhi. Methods: Retrospective review of records of a private laboratory named Labcorp Diagnostics Pvt Ltd covering the period 1^st to 31^st January 2022 was done. Laboratory data of study participants who were undergone Hemoglobin (Hb), Vitamin B-12 and Vitamin D tests during the study period was retrieved and analyzed using Epi Info V7 Software. Results: In the present retrospective review, laboratory data of 169 study participants who had undergone Hemoglobin (Hb), Vitamin B-12 and Vitamin D tests was analyzed. Mean Haemoglobin (Hb) level was 12.53±2.082g/dL. 109(64.5%) had their Hb level in normal range, 56(33.1%) had Hb level below the normal range while only 4(2.4%) study participants had their Hb level above the normal range. Mean Serum B12 Level was 370.02±357.223ng/mL. 96(56.8%) had their Serum B12 Level in normal range, 61(36.1%) had Serum B12 Level below the normal range while only 12(7.1%) study participants had their Serum B12 Level above the normal range. Mean Serum Vit D3 Level was 24.28±24.268ng/mL. 41(24.3%) had their Serum Vit D3 Level in normal range, 127(75.1%) had Serum Vit D3 Level below the normal range while only 1(0.6%) study participants had their Serum Vit D3 Level above the normal range. Conclusion: Present study concluded that almost one third of the study participants had their Hemoglobin (Hb) and serum Vitamin B-12 level below the normal range while almost three fourth of the study participants had their Serum Vit D3 Level below the normal range.

Background: Tests for Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) Levels are intended to screen and measure the levels of these particular important substances in the body and to recommend treatments and corrective measures. The present study aimed to evaluate the results of Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests done at a Private Laboratory in New Delhi. Methods: A retrospective review of records of a private laboratory named Labcorp Diagnostics Pvt Ltd covering the period 1^st to 31^st January 2022 was done. Laboratory data of study participants who were undergone Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) during the study period were retrieved and analyzed using Epi Info V7 Software. Results: In the present retrospective review, laboratory data of 169 study participants who were undergone Hemoglobin A1c(HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests were analyzed. The mean Hemoglobin A1c(HbA1c) level was 6.07±1.294%. 61(36.1%) had their HbA1c level in the normal range, 77(45.6%) had HbA1c level below the normal range while only 31(18.3%) study participants had their HbA1c level above the normal range. The mean Serum cholesterol Level was 191±47.547 mg/dL. 75(44.4%) had their Serum cholesterol Level in the normal range, 94(55.6%) had Serum cholesterol Levels above the normal range and none of the study participants had their Serum cholesterol Level below the normal range. The mean Serum TSH Level was 2.950±2.156 mIU/L. 149(88.2%) had their Serum TSH Level in the normal range, 16(9.5%) had Serum TSH levels above the normal range while only 4(2.4%) of the study participants had their Serum TSH Level below the normal range. Conclusion: Present study concluded that almost one-fifth of the study participants had their Hemoglobin A1c (HbA1c) level above the normal range, more than half of the study participants had their Serum cholesterol Level above the normal range while almost one-tenth of study participants had their Serum TSH Level above the normal range.

This commentary evaluates the report by Oumerzouk et al. describing three cases of COVID-19–associated acute disseminated encephalomyelitis (ADEM). Although the cases are clinically interesting, significant concerns arise regarding the diagnostic certainty of ADEM due to limited and incomplete neuroimaging. MRI sequences essential for confirming ADEM, including T1, T2, ADC, PWI, and SWI, were not presented, and spinal imaging—crucial for identifying myelitis—was omitted. Several image descriptions were inconsistent or unconvincing, and hemorrhagic lesions in patient-2 more strongly suggest acute hemorrhagic necrotizing encephalitis (AHNE) rather than ADEM. Overall, inadequate imaging and application of diagnostic criteria limit the validity of the authors’ conclusions.

Background: Fast food consumption has evolved to become more than just a food to be consumed in line with modernity in the world, especially among students in urban regions (small and large cities). Fast food is defined as food that is quickly prepared, such as chips, sandwiches, hamburgers, fried chicken, French fries, chicken nuggets, fish, pizza, or ice cream. It is also known as an alternative to home-cooked food because of its reasonable prices, quick service, availability, convenience, and appropriate environment provided by fast food outlets. Objectives: Determining the relationship between eating fast food with student demographic characteristics Methods: This descriptive prevalence survey, was carried out at the Baquba Technical Institute from the (1st January –2022 ending on 28thFebruary - 2022). The 200 students who made up the entire sample for this study — 100 men and 100 women — ranged in age from 21 to 3.32 years. Before beginning, permission was acquired to conduct this investigation. Due to the informed nature of the sample, non-responding was not taken into account while determining the sample size for the research that benefits the community. Statistical analysis was performed using SPSS software version 24. Results: In the current study, 200 college students total were included, with a mean age of 21 3.32 years, 50% males and 50% females, with 42% of them living in rural areas and the rest in urban ones. The highest percentage of fast-food consumption occurs in the age group of 20 to 24 years (71, 61.47%), and males consume it more frequently than females (58, 50.43%) statistically speaking. Fast food consumption was found to be statistically not significantly associated with demographic variables (age, gender, and residency). Those who eat fast food represent 69% of urban dwellers. Conclusion: The majority of studied sample consume 44% of meals per day, fast-food eaten habits found more among male than female. Hamburger, Falafel, Potatoes, sag and cake consumed mostly by male. Female students prefer Coffee & Nescafe and soft drinks more than other beverage types. Recommendation: The role of family & government is vital in educating on health, especially to the younger generation regarding fast-food. Universities and colleges should take a step forward as well as make plans to limit the sale of fast food on campus, also replace it with healthy meals.

Seasonal variation in admissions and mortality due to acute myocardial infarction has been observed in different countries, this study carries out to determine the existence of seasonal rhythms and some epidemiological variable in hospital admissions for acute myocardial infarction. This is a Retrospective study of (588) patients record with acute Myocardial infarction admitted to the coronary care unit in Baqubah Teaching Hospital, for the period from 1st January 2014 to 31st December 2015. Data are collected from the case records according to special designed questionnaire form (Appendix) and inter in computer, the data of patients are analyzed through gathering the data of climate temperature, resting electrocardiogram and prior history of cardiac disease and coronary risk factors. The total Number of cases are (588) of acute myocardial infarction, most of admission occur in Jan 74 (12.5 %), most common affected gender is male 434 (73.80 %), most commonly affected aged group was between (51 - 60) years 187 (31.8%), retired was the frequent occupation among the patients with AMI 183 (31.21%), smoking is most probably affected risk factor (46.25%) and mortality was 121 (20.5%) mostly in March and February. It is concluded there is a seasonal distribution in admissions for acute myocardial infarction, with an increase in winter and a decrease in summer, and patients aged (50 - 60) years are more affected age group.

Background: Postpartum mothers with HIV are at risk of transmitting the disease to their babies. The prevention of mother-to-child transmission of HIV program was needed, which can cause illness, disability, and mortality to have a negative impact on the quality of life of mothers and their babies. The purpose of this study is to describe the characteristic of postpartum mothers with HIV and their babies born at Wangaya Hospital Denpasar. Method: This research employed a descriptive observational study with the retrospective approach conducted at Wangaya Hospital Denpasar. Result: The result of the study showed that 82.8% of the postpartum mothers with HIV at Wangaya Hospital Denpasar in 2020 were in productive age 20-35 years old. Meanwhile, 100 postpartum mothers had taken the antiretroviral medication, 98.3% had done a caesarean section, and 100% of postpartum mothers did not breastfeed their children. The characteristic of babies from mothers with HIV showed that 84.9% had APGAR score in the first seven to ten minutes, 81.1% of babies had good weight, and all the babies had profilaksis zidovudine therapy according to the condition to the babies' weight. Conclusion: Most postpartum mothers with HIV have got antiretroviral medication during pregnancy, choose a caesarean section, and do not breastfeed their babies, so the incidence of adverse birth decreases. It can be seen from the data that babies born are in good condition and have got prophylaxis. It shows prevention of mother-to-child transmission of HIV program at Wangaya Hospital Denpasar has been running well.

The study aimed to assess the prevalence related to perceived stress associated during the COVID-19 pandemic in a sample of north Indian population using a designed online cross-sectional survey. Subjects answered a version of the Perceived Stress Scale (PSS-14). Method and material: This cross-sectional survey of residents of the state of Himachal Pradesh was carried out between January 2022 and March 2022 using Google forms. The questionnaire (PSS-14) was distributed among state citizens in both rural and urban areas via email and social media sites such WhatsApp groups, Facebook, Instagram, and LinkedIn and finally 400 replies were gathered. We collected data on their socio-demographic traits and the 14-item Perceived Stress Scale (PSS-14). SPSS v27 software was used to evaluate the data using the necessary statistical tests. Results: A total of 400 respondents took part in the study, including 240 (60.0%) from urban areas and 160 (40.0%) from rural areas of which 211 (52.75%) were females. The mean age of the participants was 25.70±8.39years, with men ranging from 18 to 62 and women from 15 to 59 years. Out of 400 participants, 140 (35.00%) had a college degree, 259 (64.75%) had a government or private job, 248 (62.00%) were married, and 384 (96.00%) were Hindu. The mean (SD (Standard Deviation)) PSS-14 score was 28.06±8.49. Univariate analysis identified 83.3% of cases with moderate to high stress levels. Conclusion: We found a significantly high prevalence of stress among test population during COVID era. Appropriate interventions and psychosocial support at community level may help in preventing these high stress levels in the general population.

Background: Present study was done to evaluate the sleep duration among Adult Population of Shimla city and its associated factors.Methods: It was a Cross sectional community-based study conducted in Shimla city from Nov 2021- April 2022 among Adult population having age between 18-60 years. A pre-tested self-administered, anonymous, semi-structured questionnaire was used to evaluate the sleep pattern and sleep habits. The collected Data was thoroughly screened and entered in Microsoft Excel spreadsheet 2007 and analyzed by using Epi Info v7 software. Results: In the present study a total of 408 adults age between 18-60 years selected from all 34 municipal wards of Shimla city were participated. Among the total 408 participants, 298 (73%) participants had adequate sleep duration of (6-8 hours) followed by 68 (16.7%) participants had inadequate sleep duration of >8 hours followed by 42 (10.3%) participants had inadequate sleep duration of <6 hours. In the present study, 130 (31.9%) participants went to bed for sleep on an average 10-11 pm, followed by 111 (27.2%) participants went to bed for sleep after 12 am. Similarly, 135 (33.1%) participants wake up after 8 am in the morning, followed by 105 (25.7%) participants wake up 6-7 am in the morning, 92 (22.5%) participants wake up by 7-8 am in the morning, 61 (15.0%) participants wake up 5-6 am in the morning and rest 15 (3.7%) participants wake up before 5 am in the morning. In the present study, adequate sleeping duration pattern was significantly associated with the time to sleep and wake up, habit of watching TV/Laptop before sleep, day time sleeping, time gap between eating and sleeping, intake of sleeping or other pills, exercise and snoring habits. (P<0.05). Conclusion: Our study concluded that almost one fourth of study participants slept for inadequate duration. Mostly slept after 10pm and wake up after 8 am. Sleep duration was significantly associated with different sleeping habits.

Encephalitis and meningitis are inflammatory conditions that affect the central nervous system. Encephalitis is inflammation of the brain, while meningitis is inflammation of the membranes protecting the brain and spinal cord. Encephalitis and meningitis can occur as a result of certain viral, bacterial, fungal, and parasitic infections. Both conditions have similar symptoms, and both require prompt diagnosis and treatment to help prevent complications. In this review we tried to outline the differences between encephalitis and meningitis, including their associated symptoms, causes, and risk factors. We also provide information on Diagnostic methods, treatment and preventive measures.

In this article we discussed about the Bacteriology of Water, Milk and Air. Water is the main constituent of the body and is consequently a necessary article of diet. The bacteriological examination of water constitutes an important part of the control of water, but a final judgment of the portability of water should never be given from the bacteriological examination alone; in all cases, detailed information of the topography of the drainage area should be available. It is also important to note that a single bacteriological investigation, unless quite unsatisfactory, is of very limited value. Milk is a good bacteriological medium, and it is, therefore, essential that the standard of milk for human consumption be rigorously controlled. Lactobacilli may also be present and continue the process after the initial acidification by the streptococci. It is important to examine milk for pathogens to ensure that it is safe to be consumed by man. Milk is further used for obtaining many milk products like cheese, cream, butter and ice cream. The load of microorganisms present in the air depends on whether the air is indoors or outdoors. The number of bacteria at any time is dependent on many factors, the most important of which are the number of persons present, the amount of their body movements, and the amount of disturbance of their clothing.

Thyrotoxic periodic paralysis (TPP) is a rare condition characterized by muscle weakness or paralysis in hyperthyroidism patients and it is often associated with low serum potassium levels. In rare cases, TPP occurs in hyperthyroid patients with normal serum potassium, which is referred to as normokalemic TPP. Patients with TPP are usually males of Asian descent and the incidence of males compared to females ranges from 17:1 to 70:1. This condition often appears in the third decade of life. TPP is more common in Graves' disease, but it can occur with any form of thyrotoxicosis including thyroiditis. Neurological symptoms more commonly affect the lower limbs, and weakness is usually in proximal than distal muscles. Examination of sensory, cranial nerve, respiration, bowel, and bladder function are usually unaffected. There is widespread evidence that TPP results from a combination of genetics, hyperthyroidism, and environmental factor. Management of TPP is a combination of definitive therapy for hyperthyroidism, correction, and monitoring of serum potassium levels while avoiding precipitating factors. Here we report a case of a 37-year-old Asian male who presented with sudden weakness in the bilateral lower limb with a tingling sensation. He is on regular medication for hyperthyroidism due to thyroiditis. Serum potassium levels are normal during acute attacks and before being discharged. The patient improved his clinical condition with low-dose oral potassium chloride and continued treatment of hyperthyroidism.

Background: Breast milk provides the newborn with all of the nutrients they require in the appropriate amounts and contributes to their overall health, whereas complementary feeding is required to deliver the energy and crucial nutrients for sustained growth and development. Present study was carried out to evaluate the knowledge towards breast feeding as well as complementary feeding among postnatal mothers of Himachal Pradesh. Methodology: This cross-sectional survey was conducted among the postnatal mothers residing in the state of Himachal Pradesh, using Google forms. The questionnaire was circulated among all over the state for responses using online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn till the 400 responses were collected. Data was analyzed using Epi info V7 Software. Results: Among the total 400 Post Natal Mothers, maximum 238(59.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 185(46.25%) , Hindu 382(95.5%), Housewife 298(74.5%), Multigravida 281(70.25%) and delivered in government hospitals 290(72.5%).In the present study 66(16.5%) postnatal mothers’ had very good knowledge (16-20 marks) towards breast feeding , 259(64.75%) having good knowledge  (12-15 marks), 70(17.5%) having fair knowledge  (8-11 marks) and 5(1.25%) having poor knowledge  (<8 marks) towards breast feeding. Similarly, 39(9.75%) postnatal mothers’ had very good knowledge (16-20 marks) towards complementary feeding , 288(72%) having good knowledge (12-15 marks), 54(13.5%) having fair knowledge (8-11 marks) and 19 (4.75%) having poor knowledge  (<8 marks) towards complementary feeding. Conclusion: During the antenatal period, every Postnatal Mother should receive proper breastfeeding assistance and education in addition to complementary feeding information, and all of their myths should be appropriately debunked.

Background: Women all over the world now have to spend almost 1/3rd of their lives in menopausal years. Therefore, menopause now is a concerning matter to maintain and improve women’s health. This study was done to evaluate the knowledge regarding Menopausal Phenomenon among menopausal women in a hilly state of Northern India. Methods: This cross-sectional survey was conducted amongst the menopausal women residing in the state of Himachal Pradesh, using Google forms. The questionnaire was circulated among both rural and urban residents of the state for responses using online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn till the 400 responses were collected. Data was analyzed using Epi info V7 Software. Results: Among the total 400 participants, 150(37.5%) from urban area while 250(62.5%) were from rural area. Among the participants, majority 240(60.0%) were between 51-60 years, 165(41.25%) were Middle pass, 366 (91.5%) were employee, 380(95.0%) were married and 383 (95.75%) were Hindu. In the present study 16(4%) Menopausal women had very good knowledge (16-20 marks) towards Menopausal phenomenon, 156(39%) had good knowledge (12-15 marks), 192(48%) having fair knowledge (8-11 marks) and 36(9%) having poor knowledge (<8 marks). Conclusion: This showed that majority of menopausal women had inadequate knowledge regarding Menopausal phenomenon. The awareness towards menopause should be increased by IEC (information, education, and counseling), so as to help these women to live their postmenopausal years healthier and more active.

Background: Idiopathic Dilated Cardiomyopathy (DCM) is generally an irreversible heart muscle disease with approximate prevalence of 1:2500 and amongst the most frequent cause of heart transplantation. This study was conducted to evaluate the socio-demographic characteristics of Idiopathic Dilated Cardiomyopathy patients in a tertiary care hospital. Material and Methods: This was a cross-sectional study carried out in the Department of Cardiology at PGIMER, Chandigarh. A total of 34 patients aged between 20-60 years, diagnosed with idiopathic dilated cardiomyopathy from outpatient departments and inpatient wards scrutinized following protocoled set exclusion criteria were evaluated. Results: Among the total 34 patients 25 (73.5%) were males and 9 (26.5%) were females (M: F=2.7:1). Among them 23 (67.6%) were <40 years old while 11 (32.4%) were >40 years old. The mean age of the patients was 40.44 (S.D.± 10.42). Total patients with LVEF< 25% were 18, out of which 3 (16.7%) were female and 15 were male (83.3%). Among these 3 (16.7%) were >40 years and 15 were <40 years (83.3%).  Total patients with LVEF>25% were 16, out of which 10 males (62.5%) and 6 females (37.5%). Among these 8 (50%) were >40 years and 8 were <40 years (50%). Total patients with RVEF<35% were 11, out of which 2 (18.2%) were female and 9 were male (81.8%). Among these 3 (27.3%) were >40 years and 8 were <40 years (72.7%). Total patients with RVEF>35% were 23, out of which 16 males (69.6%) and 7 females (30.4%). Among these 8 (34.8%) were >40 years and 15 were <40 years (65.2%). Conclusion: Present study concluded that most of patients of Idiopathic Dilated Cardiomyopathy patients were males and less than 40 years old.

Background: The present study was carried out to evaluate the serum lactate, pH and procalcitonin level as a prognostic indicator for mortality among secondary peritonitis patients. Material & Methods: This cross-sectional study was conducted by Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 among patients with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria. Relevant information was collected and further analyzed by using IBM SPSS Statistics. Results: A total of 250 individuals with a diagnosis of perforation peritonitis were assessed. Of the total, 32 (12.80%) passed away while 218 (87.20%) were discharged. Mean Pre (AL1), Postoperative (AL24) lactate level and Absolute lactate clearance (AL1 - AL24) was 2.48±1.42 and 1.74±1.52 and 0.74 mmol/L respectively. There was significant difference in the AL1 and AL24. Mean AL1 in expired patients was 3.78±2.24 mmol/L while among discharged patients it was 2.29±1.15 mmol/L and its increased level was significantly associated with mortality. The mean AL24 in expired patients was 3.67±3.18 mmol/L while among discharged patients it was 1.45±0.76 mmol/L and its increased level was significantly associated with mortality. The mean AL1 - AL24 in expired patients was 0.11±2.79 mmol/L while among discharged patients it was 0.84±1.1- mmol/L and its decreased level was significantly associated with mortality. Mean Pre (pH1), Postoperative (pH24) pH level and Procalcitonin was 7.33±0.10 and 7.35±0.11 and 0.88±0.80 ng/ml respectively. Mean pH1 in expired patients was 7.16±0.09 while among discharged patients it was 7.36±0.08 and its decreased level was significantly associated with mortality. The mean pH24 in expired patients was 7.17±0.13 mmol/L while among discharged patients it was 7.38±0.07 and its decreased level was significantly associated with mortality. The mean Procalcitonin level in expired patients was 2.58 ±1.26 ng/ml while among discharged patients it was 0.63±0.18 ng/ml and its increased level was significantly associated with mortality. Conclusion: The study concluded that increased Pre (AL1), Postoperative (AL24) lactate and Procalcitonin level while decreased Absolute lactate clearance (AL1 - AL24). Pre (pH1) and Postoperative (pH24) pH level was significantly associated with mortality.

144 urine samples were collected from persons suspected of urinary tract infections; their ages ranged from 7 to 60 years. Some pathogens of urinary tract infections were investigated, diagnosed, and antibiotic sensitivity tested. The percentage of patients with diabetes and pregnant women was also investigated, in addition to comparing patients between age and gender. The results showed the results of isolation and diagnosis of Staphylococcus aureus showed 15.27% of the number of (22) samples and were divided into age groups. The present study evaluated the ability of biofilm formation and the presence of (icaA) and (icaD) genes among strains of staphylococci isolated from patients with urinary tract infection. The presence of (icaA) and (icaD) gene was also determined by PCR technique the Biofilm development is common among Staphylococcus aureus isolated from urinary tract infections. The sensitivity of Staphylococcus aureus bacteria was tested to 10 antibiotics, and the highest sensitivity was to an antibiotic Methicillin 91%, and 86.3% towards Amoxicillin. It also gave an 81%percentage to an antibiotic Levofloxacin and Gentamicin. It is also being less sensitive to an antibiotic Ethromycin. The bacteria showed moderate sensitivity to an antibiotic Rifampicin 86.36% and to an antibiotic vancomycin 81.81% and it was less moderate sensitivity to an antibiotic Methicillin and Ethromycin 4.54%. The bacteria showed a high resistance to an antibiotic Ethromycin 90.90% and also to an antibiotic Tetracycline 81.81%, While there was no resistance to an antibiotic Rifampicin 0.0%. Through the study of the statistical analysis, it was shown that there are significant differences, that is, that there are differences in the effect of antibiotics on bacteria, and it was the best four antibiotics and had an effect on the sensitivity of bacteria it is Methicillin, Gentamicin, Levofloxacin and Ciprofloxacin.

Background: There is limited information on the post operative complications and associated co-morbidities for bowel obstruction. Present study was done to evaluate the Co-Morbidities and Post operative complications in patients of acute intestinal obstruction at IGMC Shimla. Material and Methodology: This cross-sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding Socio-demographic Characteristics, Co-Morbidities and Post operative complications was extracted and analysed using Epi Info Software v7. Results: The study showed the peak incidence of Intestinal obstruction in the age group 51-60 (11) and 61-70(10) years. Mean age in our current study was 53 years and male to female ratio was 3:1. In present study diabetes (18%) was the most common co-morbidity followed by hypertension (10%). Surgical site infection (SSI) was the most common post-operative complication (33%) followed by respiratory tract infection (17%) and septicemia (7%). This study shows that major complications occurred in patients having both hypertension and diabetes. Patients with diabetes are more liable to complications than hypertension. Conclusion: Our study concluded that diabetes and hypertension were the most common co-morbidities while Surgical site infection, respiratory tract infection and septicemia (SSI) were the most common post-operative complication among patients of Acute Intestinal Obstruction.

Background: Acute intestinal obstruction continues to be one of the commonest surgical emergencies. Present study was done to evaluate the Management and outcomes among acute intestinal obstruction patients admitted at IGMC Shimla. Material and Methodology:  This cross-sectional study was done among total of 50 patients admitted with features of acute intestinal obstruction in the general surgery department of Indira Gandhi Medical College Shimla, randomly selected during the period from 15 June 2019 to 15 June 2020. Data regarding Socio-demographic Characteristics, Management and outcomes was extracted and analysed using Epi Info Software v7. Results: The study showed the peak incidence of Intestinal obstruction in the age group 51-60 (11) and 61-70(10) years. Mean age in our current study was 53 years and male to female ratio was 3:1. In our study patients of intestinal obstruction were managed more commonly surgically 30 (60%) than conservative 20 (40%). Among the 30 patients managed surgically, Adhesiolysis was done in 8 patients, Resection & anastomosis in 7 patients, Resection anastomosis & stoma creation in 5 patients, Hemicolectomy in 6 patients, Appendicectomy in 2 patients, Transverse loop Colostomy in 1 patient and De-rotation with sigmoidopexy in 1 patient.  In the present study of 50 patients, 2 patients died. All death were due to Septicaemia and ARDS. Conclusion: Our study concluded that most of cases of Acute Intestinal Obstruction were managed surgically. Adhesiolysis, Resection & anastomosis, Resection anastomosis & stoma creation and Hemicolectomy were the common mode of surgical management. All death occurred due to Septicaemia and ARDS.