50 of breast cancer patients have collected Information on breast cancer prognosis was obtained as we obtained socioeconomic data at the individual level to address covariates potentially associated with reproduction and time-varying breast cancer. The paper contains information on the diagnosis and treatment of breast cancer in pregnant women. The features of therapeutic measures (surgical method, chemotherapy, hormone, and radiation therapy) depending on the duration of pregnancy are described. Attention is paid to the question of the possibility of pregnancy after treatment for breast cancer. It was emphasized that the treatment plan is determined individually, taking into account the stage of the disease, the duration of pregnancy, prognosis factors, the patient's desire to maintain this pregnancy.

The incidence of intertrochanteric fractures is rising because of increasing number of senior citizens with osteoporosis. By 2040 the incidence is estimated to be doubled. In India the figures may be much more. These fractures occur both in the elderly and the young, but they are more common in the elderly population with osteoporosis due to a low energy mechanism. The female to male ratio is between 2:1 and 8:1. These patients are also typically older than patients who suffer femoral neck fractures. Hence, in this article, we discuss the comparison of patients’ self assessment with the physician’s assessment of the outcome of hip fractures using Harris Hip scoring system.

The development of food preferences begins early, even before birth. The likes and dislikes of taste and food items changes as we grow into adults. Taste preferences have strong innate component about the role of desires and aversions and thus acts as guiding symptoms for a case and in prescription. So, these can help us in individualization, miasmatic analysis of the patient in hand and further in Homoeopathic prescriptions. A case report of acne also has been given, showing how considering the desire and aversion of food in the totality of symptoms helps us in achieving the desired result easily.

Background:….. Objective: research aimed to know and improve the results of Surgical Treatment of Incisional Abdominal Hernia; the average age ranged between 45 and 60 years. Material and Method: One hundred patients were collected from Al-Yarmouk Teaching Hospital, Baghdad, AL-Ramadi Teaching Hospital, Al-Anbar, and Baquba Teaching Hospital, Diyala, Iraq, and they were the type of hernia in patients of small and medium type B 10 cm defects in the anterior abdominal wall (W1-W2), who underwent surgical treatment of abdominal hernia using mesh substitutes. Three methods have been relied upon in the treatment of abdominal hernias, which are onlay, sub lay, and extrasublay; the analysis of demographic data, whether by finding the mean value and the slandered division for the ages of patients or finding a deal for P-value, was based on the statistical analysis program SPSS SOFT 22 and results show the average age to the comparison group was 52.32 ± 3.77, as for the CCG group 1 = 52.73 ± 2.94 and the group 3rd CCG2 = 51.96 ± 3.52. A decrease in the general complications rate was observed for patients when using the sub-lay method. The percentage reached 4.4%, which confirms the success of our current study and the improvement of treatment for these complications.

Background:  Most of the Patients with chronic spontaneous urticaria report systemic complaints. Therefore present study was done to evaluate the frequency and characteristics of associated systemic symptoms amongpatients with Chronic Spontaneous Urticaria. Methods: All 100 consecutive patients of chronic urticaria aged 18 years and above attending the outpatient Dermatology, Venereology & Leprosy clinic of Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh between April 2016 and March 2017. Information on age, gender, symptom duration, previous medical history etc. was collected. Results: The study comprised 100 consecutive patients with chronic Spontaneous urticaria and had 25 males and 75 females (M:F=1:3) aged between 18 and 69 (mean±SD = 36.12±10.88) years. Among the total patients, maximum 32 patients had feeling of hot or cold, 23 patients experienced general symptoms like Headache, Loss of concentration, Malaise, Lassitude, Feverish feel. Similarly, flushing was experienced by 20 patients .Gastrointestinal symptoms like Nausea, Vomiting, Diarrhea, indigestion & pain abdomen as well as  joint symptoms such as joint pains and swelling was seen in 18 patients each. On the other hand, cardio-respiratory symptoms like Syncope, Palpitations Breathlessness /wheeze was seen in 11 patients. Among the total patients , 34 patients experienced 1 associated systemic symptoms,25 patients  experienced 2 associated systemic symptoms,  17 patients experienced 3 associated systemic symptoms, 6 patients experienced 4 associated systemic symptoms , 1 patient experienced 5 associated systemic symptoms while 17 patients experienced no associated systemic symptoms. Conclusions: The present study concluded that most of the patients of Chronic Spontaneous Urticaria experienced one or more associated systemic symptoms and Feeling of hot or cold, Headache, Loss of concentration, Malaise, Lassitude & Feverish feel were the most common experienced associated systemic symptoms. 

This research aims to find out the effect of post-anesthetic Emergence of Agitation after general anesthesia on children. 133 patients were collected for this study, their ages ranged between 3 and 6 years, at Baghdad Medical Office - Al-Karkh Hospital, where it was identified and that by using the non-probability method, and a questionnaire was conducted to know the risks Caused by general anesthesia for a child, When using the Clinical Speech Fundamentals Scale, it was found that in children after exposure to anesthesia, the risk of developing speech disorders increased by 2.11 times, while the risk of developing receptive speech disorders increased by 1.87 times, and expressive speech increased by 1.72 times. Regarding cognitive impairment, he also noted a 1.69-fold increased risk of anesthesia-related defective abstract thinking. Also, there is a relationship between the effects of general anesthesia and the development of attention deficit hyperactivity disorder and movement disorders, but this relationship was not confirmed in this study.

There remains a conflict of opinion in approach to treatment of cholelithiaisis with choledocholithiasis. Available options range from open surgery, endoscopic and laparoscopic exploration. Nowadays intravenous cholangiography has been replaced by magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) and ERCP. The most direct method of dealing with choledocholithiasis preoperatively is by endoscopic retrograde cholangiopancreatography (ERCP). Generally, in well-equipped centres of the world, ERCP followed by laparoscopic cholecystectomy is recommended as a safe and cost effective procedure. However, various centres advocate laparoscopic cholecystectomy with common bile duct (CBD) exploration or a Rendezvous technique where endoscopy and laparoscopy are performed simultaneously. The present article discusses the uses, advantages and disadvantages of ERCP against CBD exploration with primary closure or T-tube drainage.

One hundred patients were collected from Al-karkh maternity hospital, Baghdad, Iraq, and Al-Hasena General Hospital, Karbala, Iraq. The study was conducted retrospectively about blood loss; the paper aims to know and Evaluate the efficacy and effects of carbetocinin on a postpartum hemorrhage. The patients were divided into two parts according to the type of cesarean section and vaginal according to carbetocin, and the index of blood loss after PPH was relied upon. All results were analyzed from August 6, 2019, to January 1, 2020; received prophylactic carbetocinin to prevent postpartum hemorrhage. Among vaginal deliveries, there was no significant difference in blood loss during delivery (p 0.065), postpartum (p 0.3), or the incidence of postpartum hemorrhage. However, there was a significant reduction in total intraoperative blood loss between cesarean deliveries with versus without.

Pseudoexfoliation (PEX) is an age-related idiopathic condition characterized by progressive production and accumulation of extracellular matrix fibrillary material in the intraocular and extraocular tissues. Ocular involvement in PEX primarily manifests with anterior segment findings. The objective of the study was to estimate the retinal nerve fibre layer (RNFL) thickness in patients of pseudoexfoliation with (PEXG) and without glaucoma (PEX) by optical coherence tomography (OCT) and determine the corneal endothelial morphometric changes by Non-contact Specular Microscope in patients of pseudoexfoliation with (PEXG) and without glaucoma (PEX). This cross-sectional analytical study was conducted in the Department of Ophthalmology, Indira Gandhi Medical College, Shimla among the selected patients of pseudoexfoliation with and without glaucoma over a period of one year. We included normal healthy controls without any glaucomatous optic disc damages and an IOP <21 mmHg in group 1, patients clinically diagnosed as pseudoexfoliation without glaucoma (PEX) in group 2, and Patients already diagnosed as pseudoexfoliative glaucoma(PEXG) in group 3. RNFL thickness was significantly decreased in PEX and PEXG patients and endothelial cell density was decreased, pleomorphism and polymegathism of cells were increased, and pseudo exfoliative materials were precipitated in endothelial cells of PEX & PEXG eyes.

Background: Due to various problems, theneonatal period is one of the most vulnerable periods of life. Despite many advances in perinatal and neonatal care, neonatal mortality is still very high in developing countries. This study was undertaken to study the disease pattern and outcome of neonates admitted to the sick neonatal intensive care unit (SNCU) of tertiary care hospital of Shimla district of Himachal Pradesh, India. Methods: Retrospective review of medical records of alloutborn neonates admitted to the Specialized Neonatal Care Unit of pediatric ward of IGMC (Indira Gandhi medical colleges), Shimla covering the period from January 2016 to December 2020 was conducted. The most important causes of mortality and its associatedfactors were analyzed. Results: A total of 4018 outbornneonates were admitted in the SNCU of IGMC Shimla in 5 years from Jan 2016 to Dec 2020.Among them 3034 (75.51%) were discharged after recovery, 305 (7.59%) were referred to higher institution, 372(7.90%) left against medical advice and 307(7.64%) died in SNCU. Among the total of 307 neonatal deaths,maximum 110(35.83%) were due to sepsis/Pneumonia/Meningitis, followed by 60(19.54%) due to respiratory distress syndrome,50(16.29%) due to HIE/Moderate-severe Birth Asphyxia, 36(11.73%) due to other causes, 24(7.84%) due to prematurity, 13(4.23%) due to un-established causes, 12(3.91%) due to Meconium aspiration syndrome, and 2(0.65%) due to major congenital malformation. Maximum neonate 118(38.44%) had weight between 1500-2499 gm, 102(33.22%) had >2500gm, 71(23.13%) had between 1000-1499 gm while 16(5.21%) had weight <1000gm. Among the total of 307 neonatal death, 131(42.67%) were preterm while 176(57.33%) were having term birth. Conclusion: Sepsis, birth asphyxia and RDS are important preventable causes of mortality, which must be urgently addressed, if India hopes to achieve itsSustainable Development Goals.

Forty pregnant women patients were collected from Al Karama Educational Hospital, Al-Shaheed Dari Al-Fayad Hospital, Baghdad, Iraq, and Al_Hindiya general hospital, Karbala, Iraq. The results showed that most of these patients were exposed to radiation between the second and third weeks of pregnancy. Women exposed to ionizing radiation during pregnancy, where the advice from an official in charge of radiation protection was considered, in addition to the fact that the dose had several limitations, including the type of device used and the procedures used. Therefore, the calculation of the received amount was more accurate if it was calculated for each device correctly individual in some cases. For most cases of radiation exposure, the radiation dose in which the fetus is exposed is less than that to which the mother is exposed, and the stomach of the pregnant mother works in part to protect the fetus from the sources of radiation outside the body. Health problems on the fetus may be from exposure Radiation is dangerous, even at the low radiation doses that May does not cause disease to the mother. Health problems may include miscarriage and stunted growth Malformations, brain dysfunction, and cancer. The fetus is most sensitive to radiation at two weeks of age to 18 weeks of pregnancy, and the fetus is less susceptible to radiation during the stage's Subsequent pregnancy.

As the living conditions are entirely different under rural and urban setup in India, this may have impact on the occurrence of precancerous changes in the cervix. It was thought interesting to compare the cytological findings in two cohorts in relation to different risk factors of the disease. The rural women were recruited from the ongoing rural cervical cancer screening program in the western region of Lucknow for last seven years while the urban cohort was derived from the 35 years of screening of outdoor patients of the Department of Gynaecology KG Medical University, Lucknow. Cytological findings revealed high incidence of squamous intraepithelial lesions (SIL) in the rural women than in their urban counterparts with all the different risk factors of the disease like gynecological symptoms, clinical lesions of cervix, age and parity. The non-viral sexually transmitted diseases (STDs) were commonly seen in both cohorts than viral STDs. Illiteracy and poverty in the rural women make them vulnerable to the development of carcinoma cervix due to poor personal genital hygiene leading to persistent vaginal infections. There is urgent necessity of creating awareness among rural women regarding hazards and risk factors of cervical cancer and importance of cytology in the early detection of the disease. This can be achieved through educating the rural women by health workers and regular organization of camps to detect SIL, the adequate treatment of which will check the incidence of cervical cancer and associated mortality.

200 patients were collected and a questionnaire was conducted at Al Wasty Teaching Hospital for Reconstructive Surgery, Baghdad, Iraq, Where a questionnaire was conducted to patients to measure the ability to satisfy and know the strategy that should be followed by the anesthesiologist in dealing with patients and reached several results, including communication and the modern technology used to contribute significantly to relieving stress and anxiety among patients before performing the surgery and this is a result before the surgical operations Some are in a state of fear, either natural or satisfactory, in what is known as “a phobia of surgical operations.” In both cases, the patient must try to overcome this condition quickly, so as not to affect his psychological state before surgery, and affect his recovery afterward.

Intertrochanteric fracture is one of the most common fractures of the hip, usually due to low-energy trauma like simple falls. These fractures occur both in the elderly and the young, but they are more common in the elderly population with osteoporosis due to a low energy mechanism. Nonoperative treatment is rarely indicated and should only be considered for non-ambulatory patients and patients with a high risk of perioperative mortality or those pursuing comfort care measures. The fixation method is guided by the fracture pattern; standard options include the sliding hip screw, intramedullary nail, or fixed angle plate. In this article, we describe the use of harris hip scoring system to assess the outcome of intertrochanteric fracture.

The school health program is an important driver in improving Healthcare, Education, and Economic productivity as they are interdependent. The importance of such a program has become vital in an emerging economy like India due to westernization and the increasing risk of Non-communicable diseases in the twenty-first century. We present our study to investigate the various factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming in an urban and suburban school in India. School health program in India needs a well-structured protocol for effective implementation. Health education plays a vital role in promoting good health in kids. Collaborative partnerships between healthcare and the education system are required for schools to improve outcomes.

Children are prone to urinary tract infections especially those under the age of 2 years. Urinary tract infections pose a great threat if there is any delay in diagnosis and treatment, leading on to various complications including renal scarring, hypertension, impaired renal function and even end-stage renal disease. Hence it is necessary to identify the organisms responsible and the antibiotics useful in treatment of these conditions. The study population included infants and children less than 14 years of age with symptoms of UTI and who have undergone urine culture and sensitivity. All identified isolates were tested for susceptibility against various antibiotics using Kirby Bauer disc diffusion technique on Mueller-Hinton agar. All study variables were analysed using descriptive statistical methods like frequencies and percentages for categorical variables and mean with standard deviation for continuous variables. Most of the children belonged to <=1 year age group. Majority of the cultures showed positivity for E. coli (63%), followed by Klebsiella (19%) and enterococcus species (7%). Cephalosporins showed higher resistance (61.5 – 87.2%) against E. coli. Piperacillin – Tazobactam (7.7%), Amikacin (10.3%) and Nitrofurantoin (12.8%) had least resistance to E coli. Enterococcus species showed resistance to majority of the antibiotics. The extensive use of antibiotics in urinary tract infections without the help of culture and sensitivity reports has resulted in emergence of resistance to commonly used antibiotics. One should take utmost care in prescribing antibiotics, especially in cases of UTI or else we will be forced to use injectable antibiotics for treating even uncomplicated UTI.

Introduction: An increasing  trend in infections caused by Candida species in both immunocompromised and immunocompetent individuals has been noted. Contrary to the existing knowledge that   C.albicans is the most common species, there has been rise in incidence of infections caused by Non albicans Candida species. Change in resistance pattern has also been noted. The emerging Non albicans Candida species are inherently resistant to some of the groups of antifungal agents. Injudicious use of empiric antifungal therapy results in increasing resistance among the existing susceptible strains. A need to determine local profile of Candida species and their susceptibility pattern is the need of the hour. Aims and objective: The aim of the study was to speciate and determine the anti fungal susceptibility profile of the Candida species isolated from various clinical specimens.Method: A retrospective study was carried out from January, 2018 to June 2020. All Candida isolates recovered during the study period were identified using Germ tube test, ChromAgar , API ID or VITEK2. The susceptibility testing was performed using Sensitre Yeast ONE or VITEK2 and interpreted as per CLSI standard/EUCAST. Results: A total of 273 isolates were identified as Candida species . Candida albicans(42%),  was most common followed by C.tropicalis (26%)  and C.parasilosis(7% ). 40 % of the isolates were recovered  from urine and 26% from Blood. Other less common species included C.sake, C.auris, C.kefry,C.krusei, C.famata, C..rugosa   Infections with Candida species were more common in <1 month and> 60 years of age. 19% of C.albicans were resistant to Fluconazole and 8.5% of C.tropicalis were resistant to Voriconazole.  Amongst C.sake and C.auris 91% , 100% resistance to Fluconazolewas noted respectively .All isolates remained susceptible to Eichnocandins Conclusion: Resistance to the routinely used antifungal is emerging.  Determining the antifungal susceptibility would help to reduce the emergence of drug resistance and effective patient management.

Uterine leiomyoma is the commonest benign tumor affecting women of reproductive age group, features may range from being asymptomatic to severe symptoms affecting the quality of life significantly. This study was undertaken to evaluate the possible factors which produce the various symptomatology in women having leiomyomas. This observational hospital-based study was done in a tertiary care center on 100 women of reproductive age group with leiomyoma uterus attending the Gynecology dept. The incidence of fibromyomas increased with increasing age, with AUB (HMB) being the most common complaint followed by dysmenorrhea, infertility, recurrent pregnancy losses, pressure symptoms and pain in abdomen. Most common type of leiomyoma being intramural, followed by submucous, subserous and broad ligament and cervical fibroid (including polyps).

Knowledge of medico-legal cases is of paramount importance both to the doctors and law enforcement agencies so that corresponding arrangements can be made to deal with them and preventive and corrective measures can be taken to reduce the number of such medico-legal cases. Hence, this study was conducted to know the incidence and pattern of medico-legal cases reported to the casualty / emergency department of Career Institute of Medical Sciences and Hospital (CIMSH), Lucknow for a period of 4.5 years. This is a retrospective study in which total 751 medico-legal cases were studied. In our study, there was predominance of males (79.49%) over females (20.50%) with a ratio of 3.88:1. The most frequently affected age group was 21 – 30 years (32.75%) followed by cases from age group 11 – 20 years (22.23%) and 31 – 40 years (19.70%). The road traffic accidents (RTAs) were responsible for the majority of medico-legal cases (70.03%) followed by cases of fall (12.91%).

Objective: Is to evaluate Serum Vitamin D among subfertile men at Basra maternity and children hospital and to evaluate the possible etiology. Aim: Is to explore the association of serum vitamin D levels with semen parameters and fertility status among males living at Basra city. Method: A prospective case control study was conducted on a randomly selected 120 infertile male (case group) compared with 120 fertile male that had a child within 1 year from the study time (control group). The study was conducted at Basra fertility center and outpatient department at Basra Maternity hospital during the period from (30th September 2019-30th June 2020). Both groups were investigated through detailed questionnaire and serum level of vitamin D was assessed. Among infertile men, semen samples were analyzed by the same person using the same technique on two occasions one week apart. Serum vitamin D level was measured in both groups using ELISA test. The vitamin 25(OH) D reference ranges that used in this study were as follows: sufficient > 30 ng/mL, insufficient 20-30 ng/mL and deficiency < 20 ng/dL. Result: The total number of cases was 120, and control was 120.There were a significant relation between serum vitamin D level and subfertility, as lower levels of 25OHD reported among subfertile males who had abnormal semen analysis.The current study revealed that the mean ± SD of serum 25 (OH) D level among cases group was (21.02±8.7) which was significantly lower than its level among fertile male. Most of the (48.3%) cases had deficient serum 25 (OH) D level in comparison to (26.7%) of the control group. This releation was statistically significant using  X2= 29.940, df= 1, P <0.05 S. Conclusions: There were a significant relation between serum vitamin D level and infertility, as lower levels of 25OHD reported among infertile males who had abnormal semen analysis.

The data consisted of 40 patients and 20 controls were collected, where multiple types of problems were identified to solve the problems in the anus, to the positive results that were presented during the use of fibrin glue treatment in the anus, 40 patients with Crohn's disease activity index ≤250 were collected internal fistulas. Indications have been formulated and a technique has been developed for the use of fibrin glue in patients with various types of non-distorting fistulas. For the first time, fibrin glue was used as a prolonged repair inducer for conservative closure of non-distorted intestinal fistulas.