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.

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.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 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 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.

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.

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.

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: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.