Background: The objective of the current study was to assess the patient satisfaction ratings for ultrasound-guided 4-in-1 nerve blocks using bupivacaine and dexmedetomidine in combination with two doses for knee and below-knee orthopaedic operations. Materials and Methods: A comparative study was carried out among patients planned to undergo knee and below knee surgeries under SAB. A total of 100 patients were randomly divided into 2 groups. Group A was given 29 mL of 0.125% bupivacaine with 0.5µg/kg dose of dexmedetomidine (1 mL) making it to a total 30 mL solution, in USG guided 4 in 1 block while Group B was given 29 mL of 0.125% bupivacaine with 1µg/kg dose of dexmedetomidine (1 mL) making it to a total 30 ml solution, in USG guided 4 in 1 block. Results: In this study, mean age of the participant was 40.64±11.44 years in Group A and 40.12±12.55 years in Group B ranging from 18 years to 60 years. Maximum participant in Group A (n = 18) aged between 41 and 50 years and in Group B (n = 17) were aged between 30 and 40 years. Only 10 participants aged below 30 in both the groups. The study population comprised of 36 males in Group A and 31 males in Group B and 14 females in Group A and 19 females in Group B. There was no significant difference of gender between both groups (p = 0.287). In this study, 18% of the patients were very satisfied in group B while only 4% were very satisfied in group A. Similarly, 68% of the patients were satisfied in group B while 66% were very satisfied in group A. In this study, only 14% of the patients were not satisfied in group B while 30% were not satisfied in group A. We found that the patients’ satisfaction was significantly better in group B in comparison to group A (p = 0.024). Conclusion: The study concluded that the patients’ satisfaction was significantly better in group B in comparison to group A.

Background: The goal of the current study was to examine the hemodyanamic variables both intraoperatively and postoperatively in ultrasound guided 4-in-1 nerve blocks using bupivacaine and dexmedetomidine in combination across two doses for knee and below knee orthopaedic operations.Material & Methods: A comparative study was carried out among patients planned to undergo knee and below knee surgeries under SAB. A total of 100 patients were randomly divided into 2 groups. Group A was given 29 ml of 0.125% bupivacaine with 0.5µg/kg dose of dexmedetomidine (1ml) making it to a total 30 ml solution, in USG guided 4 in 1 block while Group B was given 29 ml of 0.125% bupivacaine with 1µg/kg dose of dexmedetomidine (1ml) making it to a total 30 ml solution, in USG guided 4 in 1 block.Results: In this study, mean intraoperative heart rate from baseline to 120 min was comparable between both groups and statistically non-significant(P>0.05), mean intraoperative systolic BP from baseline to 120 min was comparable between both groups and statistically non-significant (P>0.05), mean intraoperative diastolic BP from baseline to 120 min was comparable between both groups and statistically non-significant(P>0.05) and mean intraoperative SPO₂ from baseline to 120 min was comparable between both groups which was statistically non-significant(P>0.05). Similary ,In the present study, oxygen saturation from 0-hour to 24-hour post administration of 4- in -1 block was comparable between both groups (P>0.05) and was statistically non-significant, mean heart rate from 0-hour to 24-hour post administration of 4- in -1 block was comparable between both the groups and was statistically non-significant(P>0.05) and mean systolic BP from 0-hour to 24-hour post administration of 4- in -1 block was comparable between both the groups and statistically non-significant(P>0.05).Conclusion: The study concluded that both groups were comparable in terms of intraoperative and post-block hemodynamic variables such as heart rate, systolic and diastolic BP, and oxygen saturation.

The term "Sciatica" refers to leg nerve discomfort brought on by irritation and/or compression of the sciatic nerve. Sciatica starts in the lower back and extends down the leg, deep into the buttock. A herniated or slipped disc that puts pressure on the nerve root is the most frequent cause of this condition. Typically, sciatica only affects one leg at a time. However, depending on where the nerve is being pinched, sciatica may manifest in both legs. The weakness of knee flexion (bending), the weakness of foot movements, the inability to bend the foot inward (inversion), or the inability to bend the foot down may all be signs of partial nerve injury (plantar flexion). Excessive pressure caused on by bad posture or other causes is one risk factor. In addition to sensible medication therapy, physical therapy can aid in easing sciatica pain. It is important to stay as far away from activities that could cause sciatica as you can.

Background: Women with iron deficiency anemia are at an increased risk of maternal morbidity and poor perinatal outcome. The present study was done with the objective to evaluate the efficacy and safety of ferric carboxymaltose in the treatment of iron deficiency anemia in pregnancy. Material & 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 1^st June 2019 to 31^st May 2020. Forty three antenatal women with iron deficiency anemia were included in the study.  The subjects were given intravenous ferric carboxymaltose and Response of treatment in terms of hemoglobin, packed cell volume, serum iron, serum ferritin and total iron binding capacity was assessed at 2 and 4 weeks on follow up. Results: The mean age in subjects was 25.3 years and Maximum subjects were in age group 21 – 25 years and belong to lower middle class according to modified Kuppuswamy scale.All the subjects developed reticulocytosis following treatment with FCM. At 2 weeks post infusion the mean hemoglobin was 10.48 g/dL while At 4 weeks post infusion the mean hemoglobin was 11.42 g/dL. The mean value in packed cell volume at 2 weeks of follow up was 33.64 % while At 4 weeks post infusion the mean packed cell volume was 37.11%. Mean serum iron at 2 weeks of follow up was 114.67 ug/dl while At 4 weeks of follow up mean serum iron was 137.95 ug/dL. At 2 weeks follow up, the levels of mean serum ferritin was 135.3 ng/mL while at 4 weeks, the levels of mean serum ferritin 107 ng/mL. At 4 weeks of follow up there was a significant fall in total iron binding capacity (155.97 ug/dL).Out of 43 subjects, 4.7% developed local adverse reactions and none of the subjects developed systemic reactions.  Conclusion: The present study concluded that intravenous ferric carboxymaltose is efficacious in replenishment of iron stores and improvement of hemoglobin levels and has better safety profile.

Background: The smart phone is regarded as a crucial communication tool and is now an essential component of modern human society. Numerous health issues have been linked to excessive usage of smartphones. This study was done to evaluate the pattern of Smart Phone usage among adult population of Himachal Pradesh. Methods:A descriptive cross sectional survey was conducted amongst the 400 participants in the age group of 18 to 60 years, using Google forms. The questionnaire was circulated among residents of Himachal Pradesh for responses. Results: Among the total 400 participants, 391 (97.75%) were using personal smart phone. 180 (45%) participants were using smart phone for 3-4 hours per day. 394 (98.5%) were using social networking sites, 123 (30.75%) were using gaming apps, 301 (75.25%) were using music & video apps, 205 (51.25%) were using app related to the academic work and 164 (41%) were using news app. 205 (51.25%) participants were suffering from eye strain/watering/itching for eyes, 108(27.0%) were having difficulty in sleep, 114 (28.5%) were having headache, 87 (21.75%) were having cervical problem, 54 (13.5%) were having mental health problems and 48 (12%) were having musculoskeletal problem due to usage of smart phone. 33 (8.25%) suffered from any injury or met with an accidents due to use of smart phone, 108 (27%) were using  smart phone while driving, 167 (41.75%) were  using smart phone while in conference and workshop, 296 (74%) were using smart phone while they were sitting in group of family members, 315 (78.75%) were using smart phone before going to bed in night, 176 (44%) were using smart phone if ever wake up in night, 249 (62.25%) were using smart phone soon after wake up in morning, 166 (41.5%)  were using smart phone in toilet and 237 (59.25%) were felt that they were addicted to smart phone. Conclusion: While smartphones play a useful part in our everyday lives, excessive use of them can have a negative impact on our health, sleep, daily performance, and even lead to dependence and addiction.

Aim: The purpose of the current study is to show how acute regional contractility impairment, as determined by 3D echocardiography, can be used to predict LV remodelling in individuals who have experienced an Acute Myocardial Infarction (AMI). Methods: We enrolled 48 AMI patients in the trial who underwent primary PCI and afterwards received the best available medical care. Regional contractility in the immediate post-infarction period, as measured by 3D echo parameters at baseline: Regional Index of Contraction Amplitude (RICA) and the index of contraction amplitude, were correlated with the amplitude of ventricular remodelling at 6 months post-infarction in all of these cases (ICA). A rise in LV end-diastolic global volume of more than >15% from baseline was considered Positive Remodelling (PR). Results: Patients with Positive Remodeling (PR) presented at baseline a significantly lower ejection fraction (44.75% versus 49.95%, p = 0.009), associated with a higher end-systolic volume (80.34 ml vs. 70.63 mL, p = 0.02) and lower values for index of contraction amplitude-ICA (3.05 vs. 3.53, p = 0.01) and for regional index of contraction amplitude-RICA (1.38 vs. 2.78, p<0.0001), in comparison with the patients who did not experience ventricular re-modeling. RICA achieved the best statistical significance for predicting the development of LV remodeling during the evolution of the disease. For RICA, the ROC curve using logistic analysis showed an Area Under the Curve (AUC) of 0.88, highly significant (p = 0.0001). Conclusion: Impairment of regional contractility is associated with development of LV re-modeling to a more significant extent than the global impairment of ventricular contractility.

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.

Background: Keratosis pilaris could be a common and generous hereditary skin clutter that comes about in patches of unpleasant bumps on the skin, with changing degrees of blushing and irritation. These bumps within the skin are caused by the dead skin cells that plug the hair follicles. Keratosis pilaris frequently shows in little, difficult bumps on the legs and arms. A common treatment strategy for numerous skin break out conditions, counting keratosis pilaris, is corrosive, which has appeared guarantee in later a long time. Aim: This audit analyzes the utilize and victory of different sorts steroids in clinical and non-clinical settings to treat and get it keratosis pilaris. A few sorts of steroids have anti-inflammatory properties that have demonstrated valuable in minimizing the appearance of skin break out. The known effect of steroids on keratosis pilaris is thought little of and ought to be given more consideration by healthcare industry pioneers. Method: A writing look of articles distributed between 1955 and 2021 utilizing PubMed was performed utilizing the watchwords “keratosis pilaris,” and “steroid.” Articles that included newborn children, the elderly, sensitivities related to steroids, existing history of skin surgeries, and skin injury were avoided. This audit included case ponders and bunch thinks about. The articles were analyzed for the sort of treatment utilized for keratosis pilaris, the measurement or concentration of the treatment strategy, and the in general comes about on keratosis pilaris. Result: The subjective examination included portrayals of visual components of keratosis pilaris, such as the examination of the appearance of the keratotic papules. A add up to of 49 articles were distinguished, of which 6 were at long last surveyed. Conclusion: Steroids have appeared empowering comes about when treating skin break out.

In this era of degenerative diseases and complex pathological phenomena, many physicians are trying to get some knowledge about Organopathy for successful case management. Organopathy is a fruit of analytical mind of Paracelsus after that, Rademacher and Burnett kept this method alive with their hard-works and honest efforts. The organopathic remedies are selected by knowledge of their pharmacological activity on the local expression and their linkage to an organ and its pathology. Underlying this, according to Burnett, was the idea of a pathological perspective of homeopathy, where the simillimum selected is that of the disease and not just that of the symptoms. He believed that behind the holistic symptom expression is a more distinctive, a more precise symptomatology that identifies the “true pathologic simile”. In Homeopathy, the most appropriate treatment protocol is based on the similia principle; however, this may not happen in cases with inadequate symptom to select the similimum, or where the true picture might be masked or the case may be at an incurable stage warranting only palliation. Therefore, the course of treatment should not always be fixed. Experienced physicians switch from one method to another based on the case, availability of the symptoms also based on his experience with the basic objective of finding closest similimum to the patient’s totality of symptom perceived by the physician, through his skill, knowledge and observations. Organopathy has given a new approach to remedies and their prescribing.

This study is to assess the structural lining of the stomach when naturally and artificially ripened fruit [pawpaw] is consumed since the stomach is an organ of storage and digestion. Mature unripe Pawpaw’s were plucked off from the parent plant and were dividing into two groups. Group 1, was kept to rip at normal room temperature while group two was induced with Calcium Carbide to rip. 10gram of Calcium carbide was placed in a bowl containing 5ml of water for dissolution in a closed metal bucket containing 1kg of the fruit [pawpaw] rapped with black nylon and was allowed for two days. After ripening, sampled fruits were washed and juiced. 600g of both the naturally ripened and calcium carbide ripened pawpaw were peeled separately and blended in an electric blender with deionized water. The juice was filtered and poured into clean bottles labeled [CaC2 induced ripened juice and naturally ripened pawpaw juice] for administration. A total of 21 adult Wister rats weighing between 126.9-214.3g were used. LD50 was carried out using Lorke, 1983 method. Three groups were considered; Group 1: Normal control group of 4 rats [2 males and 2 females] receive normal water and feeds only as placebo. Group 2: Treatment Group [1] of 4 rats [2 males and 2 females] received naturally ripened pawpaw juice. Group 3: Treatment Group [2] of 4 Wistar rats [2 males and 2 females] received Calcium Carbide ripened pawpaw for 4 weeks. About 5mL/kg for both the natural fruit and the CaC2 ripened fruits were administered against each body weight of the adult Wistar rats. The Wistar rats were weighed and one Wistar rat was sacrificed weekly in each group. Blood sample and organs [stomach] were collected from the three groups for histopathological analysis. The results showed hyperplasia, ulceration, atrophy of the stomach walls of the two treatment groups.

Factor VII deficiency is an uncommon autosomal recessive disorder. For the extrinsic coagulation pathway to start, it is a necessary component. Because of the disease's rarity and coagulation abnormality, the anaesthetic management of these individuals carries a higher risk. Here we report a case of factor VII deficiency in a 40-year-old guy who underwent complete hip replacement surgery under general anaesthesia. The patient was scheduled for the elective surgery following a comprehensive evaluation. The patient's hemodynamic state was stable and extubation was uneventful.

Background: In the current study, degree of osteoporosis and fracture classification were evaluated in senior patients who had bipolar hip arthroplasty at Indira Gandhi Medical College in Shimla. Materials and Methods: At Indira Gandhi Medical College in Shimla's orthopaedic surgery department, the current study was carried out. It comprised instances that were both prospective and retrospective and who underwent modular bipolar hip arthroplasty following hip surgery using the posterolateral method for an unstable femur neck fracture. 35 patients were enrolled in a prospective case starting in May 2016 and 25 traceable operated patients were included in a retrospective study over the previous five years. Results: The mean average age of the patients was 78.5±6.87 years with female predominance of 67% and involving left side in 57% of patients. All the patients who underwent replacement were unstable and Garden Type III and IV. Majority of fractures (78.3%) were while 21.7% patients had Pauwel Type II. Majority of fractures were Subcapital and Transcervical type in 86.7%. All patients except one had osteoporosis as revealed by DEXA scan. About 78% of patients had Type 4 and Type 5 osteoporosis pattern as documented by Singh’s index. Conclusion: Present study concluded that among majority of the elderly cases of fracture neck of femur who undergone bipolar hip arthroplasty were classified as Garden Type III and IV, Pauwel Type III and were Subcapital and Transcervical type. All these cases had osteoporosis on DEXA scan and had Type 4 and Type 5 osteoporosis pattern in Singh’s index.

Background: The current study was conducted at Indira Gandhi Medical College in Shimla to assess the post-operative problems, limb length discrepancy and weight bearing among fracture neck femur patients over the age of 70 who underwent modular bipolar hip arthroplasty. Materials and Methods: The present study was conducted in Department of Orthopaedic Surgery Indira Gandhi Medical College, Shimla. It included both prospective and retrospective cases who were operated by posterolateral approach of hip joint for unstable fracture neck of femur and treated with modular bipolar hip arthroplasty. A prospective cases included 35 patients from May 2016 onwards and retrospective cases included 25 traceable operated patients in last 5 years. Results: The mean average age of the patients was 78.5±6.87 years with female predominance of 67% and involving left side in 57% of patients. Results could be assessed in 56 patients only as 4 patients died in postoperative period while at hospital secondary to multiple systemic co-morbidities, 78% patients had uneventful post-operative period secondary to early mobilization whereas only 6 patients who declined to be mobilized from bed developed Grade 1 bed sores following surgery. It was found that from our 54 patients most patients (87%) had limb length discrepancy of less than 1 cm. On X-ray examinations of 54 patients were available, stem was found to be in valgus placement (37%) or central (46.3%) in majority. Small number had stem in varus. None of patients had heterotrophic ossification or calcification or dislocation. Most patients (52) were mobilized by 2^nd week with weight bearing to tolerance (96.2%) i.e. 15 patients in 1^st week and 37 patients in 2^nd week. Only 2 prospective patients failed to mobilize after 2 week hospital stay, among which one patient had Alzheimer's disease while another had renal dysfunction. Most of the patients started almost full weight bearing with walker at the time of 1^st mobilization but were very comfortable in doing full weight bearing after 3 weeks. Conclusion: Present study concluded that only minor complications were observed in our series. Grade 1 bedsore, DVT, superficial infection, UTI and Pneumonia were the common complications among elderly cases of fracture neck of femur who undergone bipolar hip arthroplasty. All the complications were managed satisfactorily. Since the morbidity was minimal, weight bearing was started early in all patients.

Background: The present study was done for the Analysis of Receiver Operating Characteristic (ROC) curve based on Standardised Uptake value Maximum (SUV_max) and biopsy results in 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 biopsy. Any focal tracer uptake on ⁶⁸Ga-PSMA PET/CT was regarded as pathological. Histopathology was taken as gold standard. SUV_maxof the lesions were measured for quantization. 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. The median SUV_max for cases with confirmed malignancy (n = 16) was found out to be 17.6 (IQR 18.9). Median SUV_max for cases with no evidence of malignancy was 6.3 (IQR 2.80). The difference between the two groups was found to be statistically significant (Mann Whitney U test, p = 0.002). On evaluation of Receiver Operating Characteristics (ROC) curve, area under the curve was 0.818. It was found that at cut off value of 10.4 for SUV_max, the sensitivity of ⁶⁸Ga PSMA PET/CT was 75% and specificity was 94.1%. It was observed that median of the SUV_max was same across categories of biopsy. Conclusion: The present study concluded that SUV_max cut-off of 10.4 on ⁶⁸Ga PSMA PET/CT can detect PCa with a sensitivity of 75% and specificity of 94.1%.

Background: So many plants are useful for multifactorial purposes in herbal medicine among which is Hyptis suaveolens. It has an edible aromatic flavor used for food as an appetizer. The ethanolic extracts of Hyptis suaveolens is thereby evaluated to access it effect on albino rats. This is the aim of the study. Martials and Methods: The albino rats were divided into five groups, B, C,D,E of 10 rats per group while group A is the Control. Doses of 100 mg/kg, 200 mg/kg, 400 mg/kg and 800 mg/kg of ethanolic extracts of Hyptis suaveolens administered orally consecutively for 14 days to rats group B,C,D and E while rats in group A were administered water and served as Control group which was later sacrificed. Blood samples were collected for haematological analysis and also serum biochemical tests respectively. The following blood analysis were investigated from the albino rats. Packed Cell Volume (PCV) White Blood Cell (WBC) Red Blood Cell (RBC), differential leucocyte count. The red cell indices such as Mean Cell Haemoglobin Concentration (MCHC) Mean Cell Haemoglobin (MCH) and Mean Cell Volume (MCV) by calculating their absolute value. The serum biochemical parameters was carried out. Serum albumin, serum protein, alkaline phosphatase etc. using Randox, United Kingdom commercially purchased kits with Spectrophotometer for reading the absorbance. Conclusion: lntroduction of ethanolic extracts of Hyptis suaveolens into the albino rats was well tolerated from the study. lt therefore showed that the extracts is safe for administration orally and can be utilized and exploited for further novel research use.

Background: Previous studies documented that excessive screen hours and inadequate sleep duration have been found to be associated with poorer academic performance. Hence, this study was done to evaluate the Correlation of Screen hours and Sleep pattern with academic performance among school going children residing in New Delhi. Methods: A cross-sectional study was performed in January to March 2022 among 400 students chosen using a simple random sampling procedure in New Delhi. Data was collected through school teachers based on their observation and analyzed using Epi info version 7. To predict the Correlation of Screen hours and Sleep pattern with academic performance, a univariate analysis was done. At a p-value of 0.05 was taken as statistically significant. Results: Present study included 180 (45%) females and 220 (55%) male school children from New Delhi. Among them 243(60.8%) were ≤ 10 Years while 157(39.2%) were >10 years old. In the present study, 145(36.3%) students had academic performance score 5 as assessed by teacher, 150 (37.5%) had 4, 79(19.8%) had 3, 18(4.5%) had 2 and 8(2%) had academic performance score of 1. The mean academic performance score was 4.02±0.960 as assessed by teacher. In the present study, academic performance score was significantly more in students who had Duration of watching screen per day was <2 hours, Duration of watching TV on a typical day <2 hours Duration of using smartphone on a typical day <2 hours, Average duration of sleep per day on a weekday between 6-8 hours and who didn’t had Habit of watching Mobile/TV before sleeping while there was no significant difference between the students on the basis of Duration internet surfing, Duration of videogames/games on screen per day and duration of Onset of sleep after going to bed. Conclusion: The present study concluded that academic performance of the school children was significantly associated with duration of screen hours and average duration of sleep per day.

Background: Iron deficiency anemia during pregnancy is associated with an increased risk of low birth weight, preterm birth, maternal and perinatal mortality and poor Apgar score. The present study was done with the objective to evaluate the efficacy and safety ofIntravenous Iron Sucrose in the treatment of iron deficiency anemia in pregnancy. Materials 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 1^st June 2019 to 31^st May 2020. Forty three antenatal women with iron deficiency anemia were included in the study. The subjects were given intravenous Iron Sucrose and Response of treatment in terms of hemoglobin, packed cell volume, serum iron, serum ferritin and total iron binding capacity was assessed at 2 and 4 weeks on follow up. Results: In our study, it was observed that maximum subjects were in the age group of 21-25 years and belonged to class III (lower middle class) according to modified Kuppuswamy scale (69.8%).Out of 43 participants, 25.6% received dose of ISC between 801-850 mg. The mean dose of ISC was 831.26 mg. The mean value of baseline hemoglobin, reticulocyte count, packed cell volume, serum iron, serum ferritin and total iron binding capacity was found to be 8.36 g/dL, 0.74%, 25.26%, 36.17 ug/dL, 10.514 ng/dL and 493.460 ug/dL respectively. The mean value of hemoglobin, reticulocyte count, packed cell volume, serum iron, serum ferritin and total iron binding capacity at two weeks post infusion was found to be 10.03 g/dL, 2.228%, 31.021%, 92.758 ug/dL, 116.114 ng/dL and 410.61 ug/dL respectively. The mean value of haemoglobin, reticulocyte count, packed cell volume, serum iron, serum ferritin and total iron binding capacity at four weeks was found to be 11.002 g/dL, 2.507%, 34.17%, 111.03 ug/dL, 96.367 ng/dL and 380.540 ug/dL respectively. There was a very strong evidence against null hypothesis and there was significant difference in all the parametersat four weeks (p<0.001). Conclusion: The present study concluded that intravenous iron sucrose is efficacious in replenishment of iron stores in a short duration of time and improvement of hemoglobin levels and had good safety profile.

The use of biosafety practices and principles is to reduce the health-related risks associated with handling infectious agents, toxins and other biological hazards is important in a laboratory setting. Laboratory biosafety practices are based on the principle of containment of biological agents to prevent exposure to laboratory workers and the outside environment. Primary containment protects the laboratory workers and the immediate laboratory environment from exposure to biological agents. The application of biosafety precautions is of utmost importance to maintaining the safety of the laboratory test floor as well as protecting the employees. Biosafety levels is a set of biocontainment precautions designed to protect laboratory personnel as well as the surrounding environment and the community. Certain biosafety levels have been proposed for the laboratories depending upon the pathogenicity of the microbes being worked upon.

Dark-field microscopy (also called dark-ground microscopy) describes microscopy methods, in both light and electron microscopy, which exclude the unscattered beam from the image. As a result, the field around the specimen (i.e., where there is no specimen to scatter the beam) is generally dark. Phase-contrast microscopy is an optical microscopy technique that converts phase shifts in light passing through a transparent specimen to brightness changes in the image. Phase shifts themselves are invisible, but become visible when shown as brightness variations. A fluorescence microscope is an optical microscope that uses fluorescence instead of, or in addition to, scattering, reflection, and attenuation or absorption, to study the properties of organic or inorganic substances. "Fluorescence microscope" refers to any microscope that uses fluorescence to generate an image, whether it is a simple set up like an epifluorescence microscope or a more complicated design such as a confocal microscope, which uses optical sectioning to get better resolution of the fluorescence image. In this review, we explained the Principles, Applications, Advantages & Limitations of Dark-field microscopy, Phase-contrast microscopy fluorescence microscopy in detail.

Background: Neck discomfort is a prevalent ailment that affects people of all ages, their families, communities and healthcare systems globally. It also causes significant disability. The purpose of this study was to evaluate the knowledge of neck pain risk and prevention variables among Ortho OPD patients at Zonal Hospital Dharamshala, Himachal Pradesh. Materials and Methods: A convenience sampling technique was used to pick 400 Ortho OPD patients from Zonal Hospital Dharamshala for this cross-sectional study, which was conducted between August 2018 and October 2019. A self-administered, pre-tested, semi-structured questionnaire was used to gather information about their sociodemographic traits and knowledge about neck pain avoidance. Epi info v7 software was used to evaluate the data using the necessary statistical tests. Results: In the present study 37% (148) of the Patients fall were below 40 years of age while 63% (252) were above 40 years. 59.25% (237) of patients were male and 40.75% (163) were female. Among the total study participants, 39 (9.75%%) didn’t know about any risk factor of neck pain. 336(84%) respondents told that Bad posture while working on computer/mobile/reading is the major risk factor for neck pain followed by Hard pillow during sleep 314 (78.5%), Bad posture while sitting, walking & during sleep 223 (55.75%) and over use of computer or smart phone 221 (55.25%). Among the total, maximum 328 (82%) respondents told that the Frequent position change and stretching the neck muscles while working is the major preventive factor for neck pain followed by Maintaining good posture while sitting, walking and sleeping 321 (80.25%), Using a soft pillow during sleeping 313 (78.25%) and Adjusting the desk, chair and computer while studying/reading 232 (58%). Still 33 (8.25%) respondents didn’t know any preventive factor for shoulder pain among participants. Conclusion: According to survey findings, the participants had either insufficient or not satisfactory knowledge about the Neck pain. The present study warrants the educational program and awareness campaigns on risk factors and Preventive measures of neck pain.

Covid-19 had presented unparalleled challenges to health systems across world. The infectious disease had put the routine health care services to a halt and almost entire machinery of government health care delivery system jumped into the management of crisis like situation being brought due to covid. Like many routine care services the services related to maternal health care such as delivery and post-natal visits were severely affected due to lockdowns and restrictions posed due to the pandemic. Like many routine health care services the services related to maternal health care services were severely affected during the pandemic. The outreach services conducted post-delivery which assesses the maternal conditions for post-delivery complications were also affected. Very limited studies have been conducted to assess the impact of covid-19 on services such as delivery care and post-natal services during pandemic. The present paper tries to identify the factors which affected the delivery of services related to delivery care and post-natal services in the district. The study was conducted in Bemetara district of Chhattisgarh.

Background: ITP is the most common cause of thrombocytopenia in children and is a result of immunologically mediated increased platelet destruction, which is usually acute and self-limiting but may be a recurrent or chronic disorder. Aim of study: Assessment of clinical manifestation of ITP in children. Patient and Methods: A prospective study was performed on 60 patients diagnosed as idiopathic thrombocytopenic purpura admitted to central child teaching hospital from 1st of January to 3o September 2011. Diagnosis was based on clinical and laboratory tests including bone marrow aspiration. Results: The age ranged from 6 months to 13 years and majority of cases were between 1-5 years, 68.3% were males and 31.7% were females, male to female ratio 2.1: 1. History of upper respiratory tract infection preceded the onset of illness in 71.7% of patients. Where the Duration between Preceding URTI and ITP Up to 1 week in 30.2% and >1 week in 79.8% Concerning the distribution of cases according to the season of the year: One case (1.7%) found during January, four cases (6.7%) during February, six cases (10.0%) during March, five cases (8.3%) during April, ten cases (16.7%) during May, eight cases (13.3%) during June, 14 cases (23.3%) during July , five cases (8.3%) during August and seven cases (11.7%) during September. This distribution was significant (p<0.05). The commonest presentation was cutaneous bleeding in 60%, Mucous Membrane bleeding 1.7%, both 38.3%, Splenomegaly with bleeding 6.7%, Hepatomegaly with bleeding 8.3%, Lymphadeno-pathy with bleeding 5%. In 69% of cases the initial platelet count was less than 20.000/mm³ 37.9% had anemia. Bone marrow examination done in 56 case and all were normal. In this study, one case die due to intracranial hemo– rrhage we didn’t include the management because the patients receive different types of treatments (mostly by steroid, some by IVIG and anti-D), most of patients examined by bone marrow aspiration which was normal and also we didn’t include the follow up because of most of the patients didn’t come for follow up. Conclusion: The disease is self-limited most cases at age of 1-5 years, male affected more than female, most cases preceded by upper respiratory tract infections , most cases presented by skin bleeding.

Background: Hodgkin disease is characterized by progressive enlargement of lymph nodes. It is considered unicentric in origin and has predictable pattern of spread by extension to contiguous nodes. Materials and Methods: Over a 6-year period, from January 1^st 2003 to December 31^st 2009 a retrospective study was done for 86 children with Hodgkin’s lymphoma who were admitted to the pediatric oncology unit in Children Welfare Teaching Hospital, The follow up period extended to February 10th 2011. Results: The patients were referred to from 11 governorates, 42 patients (48.8%) were from Baghdad. Highest rate of referral occurred during 2009 compared to previous years of the study. There were 63 (73.3%) males and 23(47.8%) females; male to female ratio was 2.7:1. Fifty eight patients (67.4%) presented with age group between 6-10 years, with a median age of 8 years and mean age of 7.8 years, ranged 2 years to 12.4 years. Cervical lymph node enlargement was found in 64 (74.4%) patients, followed by supraclavicular lymph node enlargement in 8 (9.3%) patients. B symptoms (weight loss, fever and night sweating), were found in 37/80 patients (43%) The mean duration of illness was 7.5 months. Stage III was seen in 42 (48.8%) patients, followed by stage II in 33 (39.5%) patients, stage I in 10 (11.6%) patients and nil for stage IV. The commonest histopathological finding was mixed cellularity in 71(82.6%) patients, then lymphocyte predominant in 12 (14%) patients, nodular sclerosis in 2 (2.3%) patients and lymphocyte depleted in 1 (1.2%) patients. Seven patients were excluded from treatment outcome (4 treated with Non-Hodgkin’s Lymphoma protocol, 1 died before treatment, 1 refused treatment by the family and 1 treated in another institute. From 79 patients who received chemotherapy; fifty six (70.9%) patients finished treatment and remained free of disease till time of last follow up, 1 (1.3%) patient died during treatment, 12 (15.2%) patients relapsed after finishing treatment, 4 (5%) patients abandoned treatment and 6 (7.6%) patients got progressive disease during treatment. At median follow up period of 36 months, ranged from 1 month – 82 months; Event free survival is 70.9%. Sevently-two (89.9%) patients were alive till time of last follow up, 2 (2.5%) died and 5 (6.3%) lost follow up. Conclusion: Males were more commonly affected than females and age group between 6-10 years was the most common. Stage III and mixed cellularity histopathological subtype were most common. Event free and overall survival is improving, yet it is below the standard reported in other countries.

Background: The present study was conducted to evaluate the effect of programmed labour and epidural analgesia on onset and duration of stages of labour. Materials and Methods: This randomized interventional clinical trial was conducted in department of Anaesthesia at Kamla Nehru State Hospital for Mother and Child, Indira Gandhi medical College Shimla in collaboration with Department of Anaesthesia on eighty uncomplicated pregnant women that were divided into two groups of 40 patients each by block randomization. One group received programmed labour protocol (Injection Pentazocine 6 mg + Injection Diazepam 2 mg IV + Injection Tramadol 1-1.5 mg/kg I.M the rafter a single dose of injection Drotaverine 40 mg intravenously) while the other group received epidural analgesia. They were monitored for VAS score before and after intervention. Results: The two groups were comparable in terms of patient’s characteristics (age, parity, period of gestation). Both groups were comparable in terms of onset of labour Spontaneous labour seen in 65-70% of subjects. Regarding the duration of active phase of labour, in our study, in group 1 duration of active phase of 1 stage of labour was 215 min and in group 2 it was 204 minutes with standard deviation of 32 minutes in group 1 and 40.4 minutes in group 2 respectively. Using student ‘t’ test this difference was found to be significant statistically (p value <0.005). The mean duration of second stage of labour was 24.3 in group 1 and 35.8 min in group 2 with significant p value<0.005. The mean duration of third stage of labour in our study was 5.89 minutes in group 1 and 5.7 min group 2. This difference is statistically insignificant (using student ‘t’ test (>0.005). Conclusion: Our study concluded that there was significant difference in first and second stage of labour in both groups while there was no significant difference in third stage and onset of labour in both groups.

Background:Arteriovenous fistula (AVF) is the most useful vascular access for patients on regular hemodialysis (HD), and improved early outcome translates to reduced morbidity for this group of patients and the early detection of late outcomes with early management can prolong the quality of life in these patients. Aim of the study: The aim of this study is to find out the clinical outcome of patients who undergo arteriovenous fistula creation, following this procedure in regard to functionality and failure. Objective: (1) Identify the socio-cultural characteristic of patients enrolled in this study. (2) Determine the different sites for fistula and their success rate. (3) Clarify the outcome of AVF according to gender and time of follow up. (4) Determine the association between types of arterio-venous fistula and its outcome. (5) Find the association between risk factors and chronic diseases and the outcome of AVF. Method: 85 patients were enrolled in this cross-sectional study, those who underwent arteriovenous fistula creation in Hawler Teaching Hospital, ECC Erbil Cardiac Center and Rizgary Teaching Hospitals were screened clinically and radiologically in the radiology units in the respective hospitals for the study purposes, a P value of < 0.05 was regarded as statistically significant.Results: More than one quarter of cases were between 60-69 years of age, but the functionality of outcome was more in the 50-59 years age group. More than half of the cases were from Erbil city, left radio cephalic enc-side AVF creates most of the patients ( males were more), followed by left brachiocephalic end-side (females were more), near 75% of cases were functional, 15% Failure and 9% died, hypertension was the main risk factor for AVF failure followed by Diabetes mellitus, Thrombosis was the main cause of AVF failure followed by infection, bleeding was the least effective factor, no statistically significant association was found between most of the variables which may be due to small sample size. Conclusion: Hypertension had a role in assisting the fistulae to mature and later it yielded in thrombosis and failure, and diabetes had major impact in the outcome of the arteriovenous fistulae.

Background: A fractured or shattered bone is a very painful injury. Broken bones require immediate first aid, which is vital. The goal of this study was to evaluate the first aid knowledge of Ortho OPD patients at Zonal Hospital Dharamshala in Himachal Pradesh regarding fractures.Material & Methods: Between August 2018 and October 2019, a convenience sample technique was used to pick Ortho OPD patients at the Zonal Hospital Dharamshala for this cross-sectional study. Using a self-administered, pre-tested, semi-structured questionnaire, information on their sociodemographic features and knowledge of first aid knowledge related fractures was gathered. Using the software epi info v7 and the relevant statistical tests, data were evaluated. Results: In the present study 36.25% (145) of the patients fall were below 40 years of age while 63.75% (255) were above 40 years. 58% (232) of patients were male and 42% (168) were female. Among the total patients maximum 316 (79%) replied that immobilization of the injured area is the first aid measure in case of fracture followed by apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing 303 (75.75%), apply a splint to the area above and below the fracture sites 215 (53.75%), stop any bleeding              200 (50%) and give painkillers to patient 200 (50%). Still 72 (18%) didn’t know about any first aid measure in case of fracture. Conclusion: According to survey findings, the participants had eitherinsufficient or not satisfactory knowledge about the first aid treatment of fractures. Any carelessness might worsen the injury's pain and bleeding while also harming the tissues nearby. Later on, this may cause issues with the restoration and healing of the damage.