Introduction: Neonatal intestinal obstruction is an occlusive syndrome marked by a delay or absence of intestinal transit most often due to an obstacle downstream of the pylorus. It is the consequence of a functional and/or mechanical anomaly. This is a frequent medical and surgical emergency in neonatology. The difficulty of its management as well as the lack of data on the issue in our country led us to study the different therapeutic methods and their results. Objective: To study the therapeutic methods and the results of the management of neonatal intestinal occlusions in the surgery department of the Mother-Child Foundation Jeanne Ebori University Hospital. Patients and Methods: This is a descriptive and retrospective study from January 1, 2019 to December 31, 2021. It focused on all newborns from 0 to 28 days old presenting with an occlusive syndrome or having presented it during hospitalization, during our study period. Results: Over this period, 69 newborns presented neonatal intestinal obstruction, i.e. a frequency of 25.2% of surgical emergencies operated on during that period. Ulcerative-necrotizing enterocolitis and ano-rectal malformations were the most seen. Treatment was based on etiology. The mortality rate was 32%. Conclusion: ONN are frequent and burdened with high mortality in our country. they are dominated by anorectal malformations and ulcerative-necrotizing enterocolitis. The improvement of diagnostic and therapeutic delays, the optimization of antenatal diagnosis and the awareness of midwives, gynecologists and pediatricians on these different conditions would improve their prognosis.

Three uremic patient groups were studied 50 on regular hemodialysis, 25 patients on Intermittent peritoneal dialysis and 25 patients on conservative management were evaluated for the presence of autonomic nervous system function impairment The uremic group were compared with a control group comprising 50 healthy individuals to four standardized cardiovascular autonomic reflex tests. The cardiovascular autonomic reflex tests consist of two types of tests. Those determine sympathetic functions by measuring changes in blood pressure in response to standing and sustained isometric exercise. Those determined parasympathetic functions by assessing variations in heart rate response during deep breathing and Valsalvamaneuver. It was found the frequency of both sympathetic and parasympathetic dysfunctions were significantly higher in the three uremic group than in the control group (34% versus 4%). (p-Value<0.005). The prevalence of sympathetic dysfunction according to the standardized sympathetic cardiovascular autonomic reflex test was 11% in the hemodialysis treated group, 30% in patients on intermittent peritoneal dialysis group and 40% in the non-replacement therapy group whereas the parasympathetic cardiovascular autonomic reflex test revealed parasympathetic dysfunctions in 21%, 56%, 60% of patients on hemodialysis, patients on intermittent peritoneal dialysis and patients on non-replacement therapy, respectively. Objective cardiovascular autonomic impairments are widely spread among patients with chronic renal failure in Mosul provenance with parasympathetic function impairment being more common than sympathetic function (p-value<0.005).

Introduction: Primary stability is a key factor in implant success. This study used computed axial tomography to determine the bone depth in implant candidate sites and its correlation with radio frequency findings. Materials and Methods: This study was included a total of 85 dental implants in 24 patients; 11 males and 13 females. Surgical guides were made from stereolithography 3D designing. Electronic surgery was performed on patient-selected implant sites based on computed axial tomography data entered into surgical guide software. Bone depth value determined bone depth. After osteotomy, the manufacturer-recommended implant was placed. Primary implant stability was determined by installing relevant stability. P. value was significant (<0.05). Results: In this particular research, the mean value of the scale was found to be 433.3 with a standard deviation of 198.4, and the implant stability was measured at 55.7 with a standard deviation of 5.6. The Pearson correlation test was used to evaluate the correlation between the dental stability and bone depth density. Respectively the results indicated that there is a significant relation between the dental stability and bone depth density. Conclusion: Both the dental stability followed by a density, and they were significantly correlated. In other words, the bone depth density is determined by the tomography methods of dental implants.

Regional approaches for blocks of the lower limb have advanced principally in response to the requirement to provide good analgesia postoperatively and thereafter. When central neuraxial blockade is used to deliver anaesthesia and analgesia for a surgical procedure, these treatments are routinely performed either before or after the block. Modern practise increasingly requires a shorter hospital stay, enhanced patient expectations and prompt mobilisation. This page explains the current procedures and rationale for performing specific blocks to the lower limb, as well as the postoperative treatment of these blocks.

Hanging is a common method of suicide/homicide in the Indian scenario. Hanging is increasingly described in India as a method chosen by adults to attempt suicide. We report a case study of 14 year old female child presented to emergency department with attempted suicidal hanging.

Background: Daily activities like driving a car, combing your hair, or reaching for something on a high shelf might become challenging if you have shoulder pain, stiffness, or weakness. The purpose of this study was to evaluate the knowledge of shoulder pain risk factors and treatments among Ortho OPD patients at the Regional Hospital in Bilaspur, Himachal Pradesh. Material and Methods: This cross sectional study was conducted between July- September 2022 among Ortho OPD patients at the Regional Hospital in Bilaspur, Himachal Pradesh selected by convenience Sampling Technique.Information regarding their socio-demographic characteristics and knowledge, regarding prevention and practices in case of shoulder pain were obtained using a self-administered, pre-tested, semi-structured questionnaire. Data was analyzed using Epi info v7 software using appropriate statistical tests. Results: In the present study 32.5% (130) of the Patients fall were below 40 years of age while 67.5% (270) were above 40 years.  52.75% (211) of patients were male and 47.25% (189) were female. 36 (9 %%) of the total study participants were unaware of any risk factors for shoulder pain. Bad posture while standing, sitting, and sleeping is cited by 254 respondents (63.5%) as the main risk factor for shoulder pain, followed by inactivity in 196 respondents (49%). Shoulder injury/dislocation 170 (42.5%), and overuse of the shoulder joint 180 (45%). Of the total survey participants, 296 (74%) said they took painkillers for shoulder pain, followed by 291 (72.75%) for pain relief gels, 280 (70%) for cold treatments or ice, 275 (68.75%) for regular exercise, and 273 (68.25%) for calcium and vitamin D supplements. Conclusion: Regular exercise and yoga sessions, correct posture while standing, sitting, and sleeping, proper back support, and avoiding heavy lifting on the head can all help to prevent shoulder pain. Painkillers and pain relief creams Application of cold and heat, as well as relaxing the shoulder, relieves shoulder pain.

Background: A frequent presenting complaint in primary care is elbow pain. Any part of the joint, such as the tendons, bursae, bones, or nerves, might develop pathology. The purpose of this study was to evaluate the knowledge of elbow pain prevention strategies and practices among Ortho OPD patients at the Regional Hospital in Bilaspur, Himachal Pradesh. Material and Methods: This cross sectional study was conducted between Aug- December 2020 among Ortho OPD patients at the Regional Hospital in Bilaspur, Himachal Pradesh selected by convenience Sampling Technique.Information regarding their socio-demographic characteristics, knowledge regarding prevention and practices during elbow pain were obtained using a self-administered, pre-tested, semi-structured questionnaire. Data was analyzed using Epi info v7 software using appropriate statistical tests. Results: In the present study 37.5% (150) of the Patients fall were below 40 years of age while 62.5% (250) were above 40 years. 55% (220) of patients were male and 45% (180) were female. The majority of patients, 296 (74%), agreed that frequent breaks from monotonous work help prevent elbow pain or injury. These responses were followed by those of 395 (73.75%), 287 (71.75%), 286 (71.5%), and 284 (71%), who advised patients to avoid lifting heavy objects and refrain from performing the same hand and arm motions repeatedly. Maximum 318 patients (79.5%) said they applied pain-relieving gels to their elbows when they were in pain, followed by 298 patients (74.5%), 297 patients (74.25%), 289 patients (72.25%), 297 patients (74.25%) who immobilised their elbows, and 286 patients (71.5%) who said they avoided lifting heavy objects. Conclusion: The most effective treatments for elbow discomfort are rest, stretching, ice, and physical therapy. Stretching and doing out may help with rehabilitation and pain management.

Availability of Surgical facilities in an institute is an essential part. The kind of surgical facilities available in different institutes depends on type of institute, facilities available, availability of operation theatre and staff. We conducted a study in civil hospital palampur which is a secondary care institute and only one operation theatre is available. Also lack of different kind of specialists and instruments required makes to perform surgeries a challenging issue. In such resource limited setup mostly gynecological, eye, ENT and general surgery procedures are being done in this institute currently, out of which gynecological surgeries predominate. So, it is required to upgrade the facilities and number of operation theatre so that better facilities could be provided to patients.

The physiology of the growing skeleton must be understood to treat fractures in children and adolescents. Misunderstanding the particular concerns for treating fractures in this age range generally leads to treatment failures. Fracture management begins with pain relief and child abuse detection. Treatment is to repair the fracture and preserve limb function. Consider the remaining skeletal development growth. Pediatric traumatologists must predict fractured bone growth. Conservative and surgical treatments are combined during skeletal development. Fractures around the elbow, like supracondylar humeral fractures, displaced radial condyle fractures, radial neck fractures, and radial head dislocations, are called "Monteggia lesions" and require a special kind of knowledge. These issues cause the most avoidable fracture healing failures in children and adolescents. This article describes the recent advances in management of fractures in the arm.

Background: Osteoporosis is a major public health problem associated with substantial morbidity, and mortality especially among females around the globe. Poor knowledge and practice related to osteoporosis have been noted worldwide. This study aimed to evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among women in Himachal Pradesh. Material and Methods: A descriptive cross sectional survey was conducted amongst the 400 female participants in the age group of 18 to 60 years, using google forms. The questionnaire was circulated among female residents of Himachal Pradesh to gather information about their socio-demographic traits as well as knowledge, beliefs and practices of osteoporosis preventive measures. Epi info v7 software was used to evaluate the data using the necessary statistical tests. Results: In the present study 58.75% (235) of the females fall were below 40 years of age while 41.25% (165) were above 40 years. Participants had a relatively low level of knowledge regarding various risk factors and preventive measures for osteoporosis. In general, they also had modest positive beliefs towered osteoporosis with a moderate self-efficacy in practicing osteoporosis recommended practices. Conclusion: Present study concluded that females of Himachal Pradesh possessed an insufficient knowledge regarding osteoporosis and were not adequately applied in preventative practices. This was primarily due to little appreciation of the seriousness of osteoporosis. Therefore, public health strategies should be developed to increase women's knowledge of osteoporosis prevention and change lifestyle habits.

Background: The present study was done to assess the results and diagnostic role of 68Ga-PSMA PET/CT 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. Results: Mean age of patients was 66.61±9.3 years and median PSA level was 13.4 ng/ml (IQR 13.9). In this study, malignancy was detected in 16/33 (48.5%) patients on biopsy. In 17/33 (51.5%), no evidence of malignancy was noted. 68Ga-PSMA PET/CT showed that 15 patients had positive results  and among these 13 patients were  found to have adeno-carcinoma on biopsy. Two patients with positive results on 68Ga PSMA PET/CT but negative biopsy (Considered False positive) were closely followed up with serum PSA values. Three patients had negative 68Ga PSMA PET/CT (homogenous/inhomogeneous uptake) but malignancy was detected on biopsy (False negative on 68Ga PSMA PET). In this study, 15 patients had negative results both on biopsy as well as on 68Ga-PSMA PET/CT. Conclusions: 68Ga PSMA PET/CT has good accuracy in initial diagnosis of patients with suspected prostatic adenocarcinoma with significantly high PSMA uptake in malignant tumors.

Dr. Congenital heart disease is a major cause of increased mortality and morbidity in pediatric patients undergoing non-cardiac surgery. Therefore, safe anesthesia and recovery time should be provided. It is important to determine the patient's risk score preoperatively. However, risk assessment tools are limited in predicting increased mortality and morbidity in non-cardiac surgery. The most important point in determining the anesthesia method is to know the current anatomic and physical situation of the patient's circulation and to make a specific plan. In these patients, the goal of maintaining anesthesia is to increase arterial oxygen saturation by increasing pulmonary blood flow. Therefore, using appropriate anesthesia and monitoring techniques with multidisciplinary decision-making and planning, and identifying high-risk patients based on risk classification, could reduce mortality and morbidity in pediatric patients with congenital heart disease. Can be reduced.

Background: This study was conducted on the background of accidental injuries which have become a major issue currently in the developing world. The aims was to determine the whole extent of blunt abdominal injuries and to evaluate the whole management. Methods: This is a prospective study that was conducted in the 76 bedded trauma centre over a period of 2 years from December 2019 to December 2021. 101 patients with blunt abdominal injuries who presented to the casualty section of the hospital were selected for this study using inclusion and exclusion criteria. Results: Blunt abdominal trauma was mostly from RTA 58 (57.4%) followed by fall from heights. The remaining cases were due to other causes. The mean age of the patients was 24 years. There was 80 males and 20 female, male to female ratio 4:1. Conclusion: The establishment of a well-equipped trauma centre has contributed immensely in saving the life of patients with blunt abdominal injuries .With the modern equipment set up, monitoring of trauma patients is so well coordinated that most of the patients can survive with conservative management. Operative treatment is only relevant when necessary.

Background: The purpose of the current study was to examine the haemodynamic parameters of three different i-gel insertion strategies, including standard, rotational, and triple airway maneuver, in persons with paralysis who had undergone anaesthesia both before and after i-gel insertion. Material and Methods: A total of 150 patients were included in this Prospective Randomised Trial at Department of Anaesthesia, Dr. R.P.G.M.C. Kangra at Tanda during the study period.  The patients were divided into 3 groups with 50 patients each. The patients in group an included standard technique, group B with rotational technique, and group C included triple airway maneuver. The three groups were evaluated for Hemodynamic response before and after I-Gel insertion. Results: In the present study, in our study, there was no significant difference between age (p = 0.422), gender distribution (p = 0.466), weight (p = 0.395), height (p= 0.321) and BMI (P = 0.660) among three groups. Similarly, there was no statistically significant difference in Heart rate, Systolic blood pressure, Diastolic pressure, and Mean arterial pressure among all the three groups. Also almost all haemodynamic variables were comparable before and after i-gel insertion between all the groups (p>0.05) Conclusion: Our study concluded that haemodynamic variables like HR, SBP, DBP and MAP were comparable before and after i-gel insertion between all three groups.

Among the cyanotic heart disease, tetralogy of fallot is the most common congenital heart disease encountered in pregnant females. Based on the severity, general or neuraxial anesthesia is decided to decrease the morbidity and mortality. In severe cases general anesthesia is the technique of choice.

Introduction: Acute intestinal obstruction travels with interruption in the enteric flow. The clinical condition is composed by abdominal pain, stopping the elimination of gases and faces, abdominal distension and nausea. However, the geriatric population may have atypical clinical features, which makes diagnosis difficult and increases mortality. The most common etiologies of the acute obstructive abdomen in the elderly differ from the adult, because in those there is predominance of neoplasias and diverticular diseases complications. Objectives: Setting the profile of patients older than 60 years with acute obstructive abdomen, the main causes, outcome and treatment.  Methodology: Retrospective study where 60 medical records were analyzed with acute obstructive abdomen. Results: Regarding the main symptoms, it was observed that 86% had abdominal pain, 86% halt of stomach gas and stools, abdominal distention was observed in 51%, 60% showed vomiting, 37% presented other. Among the radiological findings, the most prevalent were: the presence of small bowel loops distension and colonic distension. Regarding the etiology, the main one was the presence of neoplasia, representing 30.2%, flanges and adhesions (23.2%), sigmoid volvo (9.3%), sigmoid diverticulum (7%). The treatment performed was surgical (86% cases). Conclusion: In the present study, neoplasia was the main etiology, followed by flanges and adhesions, differing from the literature in which there’s predominance of flanges and adhesions. The most frequent symptoms were: abdominal pain, halt of stomach gas and stools, vomiting and abdominal distension. Mortality in elderly patients with abdominal pain is high, in this survey was 32%.

Ureteropelvic junction (UPJ) obstruction is the most common form of Congenital Anomaly of the Kidney and Urinary Tract UPJ and may remain asymptomatic in some cases with eventuation in end stage renal disease later in life. In this case report, we discuss the incidental finding of progressive, asymptomatic bilateral ureteropelvic junction obstruction and deranged serum creatinine in a 24 years old male who developed severe left loin pain and haematuria following a blunt force traumatic injury during a football game. It is advised that sports students should undergo renal/urogenital systems evaluation and all close-range football shots to the abdomen and blows to the abdomen or lower back should be thoroughly investigated among other recommendations.

Background: The present study was done for comparative evaluation of change in intra cuff pressure using Ambu Auragain in Trendelenburg and Reverse Trendelenburg Position in patients undergoing Laparoscopic Surgery. Material & Methods: This was a prospective cohort study conducted on 46 patients in Department of Anaesthesia to determine intra cuff-pressure in laparoscopic surgeries in Trendelenburg and Reverse Trendelenburg position with the use of Ambu AuraGain. Group A included 16 patients with Trendelenburg position and Group B included 30 patients with Reverse Trendelenburg position. Results: The mean age of patients in Group A was 44.44±11.11 years whereas the mean age of patients in Group B was 45.50±11.78 years. (p>0.05). Group A comprised of 2 (12.5%) males and 14 (87.5%) females whereas Group B comprised of 12 (40%) males and 18 (60%) females.(p>0.05). The mean BMI of patients in Group A was found to be 22.28±1.58 kg/m² and mean BMI of patients in Group B was 22.57±2.54 kg/m². (p>0.05). Group A comprised of 11 (68.8%) patients with ASA status I and 5 (31.2%) patients with ASA status II. On the other hand, Group B had 15 cases each with ASA status I and II. (p>0.05). The average duration of surgeries in Group A was 80-90 minutes whereas the average duration of surgeries in Group B was 70-80 minutes.The baseline Cuff Pressures were comparable in Group A and Group B. The comparison between mean cuff pressure of two groups was found to be statistically significant at all recorded time intervals except after SGA placement, and before CO2 insufflation (p>0.05). Cuff pressure was higher in Group A than Group B. Only 2 patients in Group A and no patient in Group B required intervention by release of air with the help of cuff manometer. This was not found to be statistically significant (p>0.05). Conclusion: We found in this study that Trendelenburg or Head down position increases intra cuff pressure peak airway pressure as compared to Reverse Trendelenburg position. So it is recommended to monitor intra cuff pressure of SGA frequently in laparoscopic surgeries.

Background: The present observational study was carried out to evaluate the method of Management, Complications and Patient satisfaction among obstetrics and non-obstetrics patients having Post Dural Puncture Headache (PDPH) after undergoing surgeries under subarachnoid block in a Tertiary Care Hospital. Material and Methods: This was a observational Prospective study carried out at Department of Anaesthesia, Dr Rajendra Prasad Medical College, Tanda conducted on consecutive  patients ASA I and II, aged 20-60 years, obstetric/ non obstetric patients scheduled for surgery under subarachnoid block, over a period of 18 months including data collection, data organization, presentation, analysis and interpretation. After recruitment, the patients were divided into two groups comprising of obstetric and non-obstetric group. Results: The total patients included were 302, being 115 in obstetric group and 187 in non-obstetric group. In our study, out of 302 patients only 17 patients had post dural puncture headache, the total incidence being 5.6%.There were eight (7%) patients in obstetric and nine (4.8%) patients in non-obstetric group. All patients with PDPH had resolution of their symptoms by conservative management (hydration, bed rest, acetaminophen and NSAIDS), the PDPH resolved in 2(25%) of the parturients within the 1st day of its commencement, 5 (62.5%)parturients and 4 patients (44.4%) in non obstetric group had relief 2nd day after commencement of the headache. Whereas, one parturient(12.5%) and 4 patients(44.4%) in non obstetric group got relief on the 3^rd day. One patient in non obstetric group (11.1%) had relief on the fourth day. 29% of the patient responded to the fluid and bed rest, whereas 35.2% patients required acetaminophen tablet as well, however 35.2% patients required the non steroidal anti-inflammatory drugs as well. No patient in either group required epidural blood patch. In obstetrics and non-obstetrics population, incidence of nausea and vomiting was in 8.7% and 7.5% patients respectively.Other complications like backache, vertigo were 2.61% and 2.7% patients in obstetric and non-obstetric population respectively. In obstetrics and non-obstetrics population, patient satisfaction was comparable (P=0.0778). Conclusion: All patients with PDPH had resolution of their symptoms by conservative management (hydration, bed rest, acetaminophen and NSAIDS) within 3-4 days while incidence of nausea and vomiting and other complications like backache, vertigo were very less.

Background: The present observational study was carried out to evaluate the incidence and severity of PDPH in the obstetrics and non-obstetrics patients. Material and Methods: This was a observational Prospective study carried out at Department of Anaesthesia, Dr Rajendra Prasad Medical College, Tanda conducted on consecutive patients ASA I and II, aged 20-60 years, obstetric/ non obstetric patients scheduled for surgery under subarachnoid block, over a period of 18 months including data collection, data organization, presentation, analysis and interpretation. After recruitment, the patients were divided into two groups comprising of obstetric and non-obstetric group. Results: The total patients included were 302, being 115 in obstetric group and 187 in non-obstetric group. Mean age of patients in group obstetric and non-obstetric group was 30.66± 6.27 years and 52.88±12.72 years respectively (P=0.045). The patients were comparable with regards to body mass index in two groups. With regards to gender distribution in the non-obstetric group, 76 were female patients while 111 were male (P Value=0.001). In our study, out of 302 patients only 17 patients had post dural puncture headache, the total incidence being 5.6%. There were eight (7%) patients in obstetric and nine (4.8%) patients in non-obstetric group, however the difference was not statistically significant (P=0.597). Majority of the patients had mild PDPH (47.05%) followed by moderate (41.17%), and only one patient had severe (11.76%) PDPH. Conclusion: Therefore, we concluded that in the present study with the use of 26G quincke spinal needle, obstetric population had higher incidence of PDPH in comparison to non-obstetric population.

Coronavirus disease 2019 (COVID-19) outbreak is a global emergency that commonly cause respiratory symptom as well as fever in majority of patients, however, disease can progress to cause severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). GIT symptoms were also reported by some patients such as diarrhea which reported by high number of patients in compare to other symptoms as vomiting and abdominal pain. Acute GIB is medical emergency that can be either upper or lower GIB. The incidence of GIB is uncommonly reported in COVID patients, however, the GIB increase in those who use of anticoagulant for therapeutic or prophylaxis cause, co-morbidities, ulceration and erosion of GIT mucosa due to viral invasion and in severely ill patients who are in ICU or on mechanical ventilation.

Anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy are the two main kinds of ischemic optic neuropathies (IONs) (PION). AION is made up of both artery-related AION (A-AION: caused by giant cell arteritis) and artery-free AION (NA-AION: due to other causes). PION is divided into three categories: surgical PION, non-arteritic PION (NA-PION), and arteritic PION (A-PION: caused by giant cell arteritis) (a complication of several systemic surgical procedures). These five forms of ION are unique clinical entities from the perspectives of aetiology, pathogenetically, clinically, and treatment. Because A-AION is an ophthalmic emergency that necessitates urgent treatment with high-dose steroid medication to prevent any additional visual loss in one or both eyes, it is imperative that patients aged 50 and older determine whether it is arteritic or not as soon as possible. When systemic corticosteroid medication was administered to NA-AION patients within the first two weeks of start, they had considerably better visual outcomes than untreated patients. Systemic risk factors, in particular nocturnal arterial hypotension, are important contributors to the development of NA-AION; hence, controlling these factors is crucial to the disease's prevention and treatment. When given high-dose systemic steroid therapy in the very early stages of the disease, NA-PION patients' visual acuity and visual fields significantly improved when compared to untreated eyes. In order to stop any additional vision loss in one or both eyes, A-PION, like A-AION, requires prompt treatment with high-dose steroid therapy. Other than taking precautions to stop it from happening in the first place, there is no effective treatment for surgical PION.

An obstruction in the aqueous humor’s outflow between the anterior and posterior chambers of the eye causes acute angle closure, an emergency ophthalmic disorder that, if untreated, can cause secondary visual neuropathy and an abrupt increase in intraocular pressure. The most frequent primary cause in patients with pre-existing narrow angles, such as those who are long-sighted, is a pupillary block. The usage of frequently prescribed drugs is one such secondary cause of angle closure that has to be made more widely known. To rule out other potential confounding illnesses, particularly those with CNS origins, that appear similarly, a thorough questioning is necessary [1]. All patients presenting with abrupt onset of red eye along with pupillary dilatation, dull pain, and headache should have angle closure excluded. A fundamental eye exam should involve a thorough neurological examination, measurement of intraocular pressure, and evaluation of the anterior segment under a strong light. When there is a strong clinical suspicion of acute angle closure, systemic ocular hypotensive therapy must be administered as away in order to protect the optic nerve and reduce vision loss. To specify definite care, an immediate referral to an ophthalmologist is required [2].

Inherited retinal degeneration (IRD) may occur in isolation or as part of a multi-systemic condition. Ocular manifestations may be the presenting symptom of a syndromic disease and can include retinitis pigmentosa, cone-rod dystrophy, or maculopathy. Alternatively, patients affected with syndromic disease may already have other systemic manifestations at the time retinal disease is diagnosed. Some of these systemic diseases can cause significant morbidity. Here, we review several of these syndromic IRDs and their underlying genetic causes. Early recognition and referral for systemic evaluation and surveillance may lead to early intervention and an improved outcome. Obtaining a molecular diagnosis can be beneficial in securing a definitive diagnosis, especially in cases with atypical presentations. A genetic diagnosis may also be informative with regard to prognosis and potential therapies. Effective management and rehabilitation for patients with syndromic retinal dystrophy requires a comprehensive genetic-based team approach involving patients, family members, ophthalmologists, primary care physicians, and geneticists [1]. The prognosis and viable treatments may also be revealed by a genetic diagnosis. Syndromic retinal dystrophy patients need comprehensive genetic-based team management and rehabilitation, which includes patients, families, ophthalmologists, primary care doctors, and geneticists [2].

Neonatal death is the death of the newborns within first 28 days of life. In addition to neonatal causes, such as those associated with immaturity, perinatal hypoxia, infections, and congenital abnormalities, it can also be brought on by obstetric factors during pregnancy, labour, or delivery. It is vital to intervene as early as possible to predict the neonatal mortality, as a result of which Apgar score was introduced. Recent data shows that Apgar score alone should not be used to categorise preterm newborn children as asphyxiated. Therefore, the concept of combined Apgar score has been introduced. In this article, we discuss the shortcomings of Apgar score and compare it with combined-Apagar score for predicting neonatal outcome.

It can be challenging to insert nasogastric tubes (NGTs) using a traditional technique in anaesthetized, intubated patients. NGT insertion methods have been tested with various degrees of success. This review's objective was to compare the different approaches to the standard procedure in terms of success rate, insertion time, and adverse events. Several techniques of nasogastric tube (NGT) insertion have been described in the literature with different success rates. The literature suggests that the use of modified techniques of NGT insertion such as the reverse Sellick's maneuver, neck flexion with lateral neck pressure, frozen NGT, endotracheal tube-guided or video-assisted methods result in a significantly better chance of successful tube insertion at first attempt as compared to the conventional technique.

Disinfection is a process that eliminates most disease-producing microorganisms except bacterial spores. Disinfection has been divided in to High-level, Intermediate-level, and Low-level depending upon the types of microorganisms destroyed. Spaulding has devised a classification scheme to identify how medical equipment should be disinfected and sterilised based on the degree of risk of infection viz, critical, semi-critical, and non-critical items. Anaesthesia machine and equipment are potential vectors for transmission of nosocomial infection via anaesthetist's hand. Therefore, in this review article, different types of disinfection techniques have been described for disinfecting equipment used in Anaesthesia.

Lightning is a powerful natural electrostatic discharge produced during a thunderstorm. The electric current passing through the discharge channels is direct with a potential of 1000 million volts or more. Lightning can kill or injure a person by a direct strike, a side-flash, or conduction through another object. Lightning can cause a variety of injuries in the skin and the cardiovascular, neurological and ophthalmic systems.

Background: The early identification of pregnant women at risk of developing complications at birth is fundamental to antenatal care and an important strategy in preventing maternal death.  Present study was carried out to evaluate the high risk pregnancy cases admitted in labour room in Pandit Jawahar Lal Nehru Medical College & Hospital,District Chamba, Himachal Pradesh. Methodology: Retrospective review of records of labour room in Pandit Jawahar Lal Nehru Medical College & Hospital,District Chamba, Himachal Pradesh covering the period 1^st January  2022 to 30^th June 2022 was conducted. The pattern of  High Risk Pregnancies was retrieved. Data was analyzed using epi info v7 software using appropriate statistical tests. Results: In the present study we found that during the study period, a total of 159 cases of high risk pregnancy admitted in labour room in Pandit Jawahar Lal Nehru Medical College and Hospital,District Chamba, Himachal Pradesh. Among the total, there were 38 cases of pregnancy induced hypertension (3 cases of pre eclampsia and 35 cases of Gestational Hypertension), 15 cases of Anaemia (6 mild anaemia, 7 moderate anaemia and 2 severe anaemia), 52 cases of Intrahepatic cholestasis , 1 cases of Intrahepatic cholestasis  with anemia, 6 cases of gestational diabetes, 20 cases of previous caesarean section, 7 cases of twins( 1 case of twin with Polyhydramnios, 1 case pf twin with PIH and 5 cases of Twins), 3 cases of Polyhydramnios, 3 cases of oligohydramnios, 1 cases of transverse lie, 5 cases of thrombocytopenia, 4 cases of Placenta previa, 1 case of multiple disorder(pre-eclampsia with intra uterine growth retardation with oligohydramnios with thrombocytopenia), 1 case of Placenta previa with moderate anaemia and 1 case of abruption with intrauterine death. Among these 159 cases 2 were referred to DRPGMC, Tanda while 157 cases were managed at Pt.JLNMH,Chamba. Conclusion: All pregnant women require vigilance and quality obstetrics care but high-risk pregnant women require specialized care and referral.

Incidence of Caecal volvulus is 2.8-7.1 persons per million per year and it is a rare cause of intestinal obstruction which may result in delay in the diagnosis and appropriate intervention. Patients with this condition may present with highly variable clinical presentations ranging from intermittent, self-limiting abdominal pain to acute abdominal pain associated with intestinal strangulation and sepsis.