Introduction; - Epilepsy is increasingly recognized as a disorder involving widespread neural networks, including the central autonomic network (CAN) and cerebrovascular regulatory circuits. Impairment in dynamic cerebral autoregulation and altered cerebrovascular reactivity may contribute to peri-ictal instability, cognitive decline, and elevated risk of Sudden Unexpected Death in Epilepsy (SUDEP). However, studies examining integrated autonomic and cerebrovascular physiology in epilepsy are limited. Aim: To evaluate cerebral hemodynamic indices—mean cerebral artery velocity (MCAv), breath-holding index (BHI), autoregulatory slope index (ASI), and cerebrovascular resistance (CVR)—in adults with epilepsy and to examine their relationship with autonomic dysfunction using the modified Composite Autonomic Scoring Scale (mCASS). Methods: In this prospective case–control analysis, 180 adults with epilepsy and 180 matched healthy controls underwent standardized autonomic testing and transcranial Doppler (TCD) assessment. TCD parameters included baseline MCAv, BHI (rebreathing CO₂ response), ASI (Valsalva Phase II autoregulation), and CVR (MAP/MCAv during tilt). Autonomic function was scored using mCASS. Statistical analysis employed Mann–Whitney U, Kruskal–Wallis, and Spearman correlation tests. Results: Epilepsy patients demonstrated significantly impaired cerebral hemodynamics compared with controls: lower MCAv (48.2 ± 9.3 vs 55.7 ± 8.6 cm/s, p < 0.001), reduced BHI (0.82 ± 0.21 vs 1.14 ± 0.29, p < 0.001), more negative ASI (–18.3 ± 9.1 vs –9.8 ± 6.7, p < 0.001), and higher CVR (2.12 ± 0.31 vs 1.78 ± 0.22, p < 0.001). Among epilepsy subtypes, temporal lobe epilepsy (TLE) showed the greatest impairment, followed by idiopathic generalized epilepsy (IGE), and then controls (p < 0.001 for all comparisons). Significant correlations were observed between autonomic dysfunction and cerebral hemodynamics. Higher mCASS scores correlated with lower BHI (r = –0.52), more negative ASI (r = 0.49), and elevated CVR (r = 0.54) (all p < 0.001). Conclusion: Epilepsy is associated with substantial disruption of cerebral hemodynamics, particularly reduced cerebrovascular reactivity and impaired autoregulation. These disturbances strongly correlate with the severity of autonomic dysfunction, suggesting shared neuropath physiological mechanisms within CAN–vascular circuits. TCD-based hemodynamic evaluation may provide critical insights into SUDEP risk, epilepsy severity, and neurovascular health in epilepsy patients.

Dental plaque is the primary etiological factor for oral diseases such as gingivitis and periodontitis. Chlorhexidine, a widely used allopathic mouthwash, is considered the gold standard for plaque control, but its long-term use is associated with side effects. Ayurvedic mouthwashes, such as HiOra, have been proposed as an alternative with fewer adverse effects. This randomized crossover clinical trial aimed to compare the antiplaque and anti-gingivitis efficacy of allopathic (0.2% Chlorhexidine gluconate) and Ayurvedic (HiOra) mouthwashes. Materials and Methods the study included 70 participants aged 18-25 years, randomly allocated into two groups: Group A (Chlorhexidine) and Group B (HiOra). Each participant used the assigned mouthwash for 3 weeks, followed by a 4-week washout period, after which they switched to the other mouthwash for another 3 weeks. Plaque accumulation and gingival health were assessed using Turesky et al. modification of the Quigley-Hein Plaque Index and Loe and Silness Gingival Index. Microbiological evaluation was performed by assessing colony-forming units (CFU) and zone of inhibition. Statistical analysis was conducted using paired and independent t-tests. Results The mean plaque index score reduced significantly in both groups after 3 weeks (Chlorhexidine: 3.26±0.37 to 2.18±0.30; HiOra: 3.30±0.31 to 2.18±0.23, p=0.001). Gingival index scores also showed significant improvement in both groups (Chlorhexidine: 1.92±0.25 to 1.07±0.22; HiOra: 1.94±0.26 to 1.08±0.29, p=0.001). The reduction in CFU was statistically significant for both mouthwashes (Chlorhexidine: 18.93±4.24 to 2.70±1.03; HiOra: 19.78±4.16 to 2.68±0.87, p=0.001). No significant difference was observed between the two groups in terms of plaque index, gingival index, and CFU reduction (p>0.05). However, after the washout period, CFU levels increased significantly in both groups, with a greater increment in the HiOra group. Conclusion Both Ayurvedic (HiOra) and allopathic (Chlorhexidine) mouthwashes demonstrated comparable efficacy in reducing plaque and gingival inflammation. Given its minimal side effects, HiOra may serve as a natural alternative to Chlorhexidine for long-term plaque control. Further clinical studies are recommended to validate its long-term effectiveness and safety.

High-resolution computed tomography (HRCT) of the lung is a key component of the multidisciplinary approach to diagnosis in diffuse lung disease (DLD). HRCT also plays an important role in the follow-up of patients with established DLD.        AIMS & OBJECTIVE: To evaluate the importance of high resolution computed tomography in the diagnosis of diffuse lung diseases and to detect diffuse lung diseases in patients who had normal or questionable radiographic abnormalities with symptoms or pulmonary function tests suggestive of diffuse lung disease and to study the various patterns of diffuse lung diseases on HRCT. MATERIALS and METHODS: The study was carried out in the Department of radiology, Madhubani Medical College, Madhubani, Bihar in a time span of one year (12 months) from April 2023 to March 2024(12 months) after obtaining the institutional ethical committee clearance and consent from the patients from selected patients. The relevant data such as age, parity were analyzed. RESULTS:    In the current study the most common cases are of tuberculosis. Next common condition observed was idiopathic pulmonary fibrosis,12 (24%) cases out of 60 cases and most of them were having changes of end stage lung disease and had short lived history during the course of this study, followed by bronchiectasis, pulmonary edema and emphysema. Diffuse lung diseases are slightly more common in males than in females. Out of 60 cases 33 (64%) were males and 17(36%) are females. CONCLUSION: HRCT is 16% more sensitive in detection of diffuse lung disease abnormalities than chest radiograph in our study

Background:   Diabetic foot ulcers (DFUs) pose a therapeutic challenge to surgeons, especially in developing countries where health care resources are limited and the vast majority of patients present to health facilities late with advanced foot ulcers. Our experience in the surgical management of DFUs in our local environment and compare with what is known in the literature. Materials and methods: All patients who presented to the surgical wards or surgical outpatient clinic with diabetic foot ulcers were consented for the study and those who met the inclusion criteria were consecutively enrolled into the study. Patients with healed foot ulceration were excluded from the study. Identification of patients with the foot at risk for ulceration was done in the medical wards or diabetic clinics and diabetic patients who were found to have active foot ulceration were referred to the surgical wards or surgical outpatient clinics for proper surgical management.  Result: 90 were recruited, with a mean age of 51.32±11.45 years. Majority of patients (73%) had a lower socioeconomic status. All patients had type 2 diabetes, with male predominance (78%). Mean diabetes mellitus duration was 9.68±5.03 years. Ulcer (92.31%) and discharge (72.31%) were the commonest complaints. During correlation analysis, a strong statistically significant (p<0.001) correlation was observed between amputation and HBA1c level (0.749) and SINBAD score (0.875), while correlation with RBS level was weak (0.535). Commonest presenting site was forefoot, followed by hindfoot. Conclusion: The surgical management of the diabetic foot requires a multifaceted approach that integrates timely diagnosis, comprehensive patient education, and individualized treatment strategies to address the complex interplay of neuropathy, ischemia, and infection inherent in diabetic foot pathology. However, the paramount importance of preventive care, rigorous glycemic control, and patient education cannot be overstated, as these measures can significantly reduce the incidence and severity of diabetic foot complications.

Background: Anatomy is a foundational element of medical education, traditionally taught through cadaveric dissection. However, this method poses challenges such as limited cadaver availability, ethical concerns, and high maintenance costs. This study evaluates the effectiveness of virtual dissection tools in enhancing anatomical knowledge compared to traditional cadaveric dissection among first-year medical students at Government Medical College and Hospital Sundargarh, Odisha. Materials and Methods: A quasi-experimental study was conducted over one year, involving 150 first-year MBBS students divided into an experimental group (n=75) using virtual dissection tools and a control group (n=75) utilizing traditional cadaveric dissection. Knowledge gains were assessed through pre- and post-tests comprising 50 multiple-choice questions covering key anatomical concepts. Data analysis was performed using SPSS version 26.0, with paired and independent t-tests employed to compare knowledge gains within and between groups. Results: The study found that students using virtual dissection tools demonstrated significantly greater knowledge gains compared to those in the traditional dissection group. The experimental group showed an average improvement of 36.0 points in total test scores, compared to 23.0 points in the control group (p<0.001). Furthermore, student feedback revealed higher satisfaction, ease of understanding, and interest in anatomy among those using virtual tools, with significant differences in all measured aspects of the learning experience (p<0.001). Conclusion: The study provides strong evidence that virtual dissection tools can enhance anatomical education by improving knowledge retention and student satisfaction. These tools offer a valuable supplement to traditional cadaveric dissection, particularly in settings where resources are limited. The integration of virtual dissection into medical curricula could provide a more comprehensive, effective, and engaging learning experience for students.

Background: The sciatic nerve is the largest nerve in the human body, as well as in many other animals. There are two reasons for this; one being that there are numerous neural fibres that gather to produce this nerve, and secondly, due to the extensive size of the gluteal region and lower limb, in other words, the regions innervated by this nerve. The sciatic nerve develops from the lumbo-sacral plexus, from the fourth lumbar to the third sacral (L4-L5 and S1-S3) spinal nerves. The nerve often has a maximum width of two centimetres (cm) or more, and can reach a diameter of over 0.5 cm, as it passes posterior and inferior to piriformis. The sciatic nerve is described as the nerve with the largest diameter in the body.  Materials and Methods: This is a Prospective, observational study and Conventional Routine dissection method. 800 Embalmed human adult cadavers lower limb specimens. Adult lower limb specimens were obtained from the embalmed cadavers allotted for routine dissection to the first year MBBS students at the Department of Anatomy, Index Medical college. Both right and left lower limbs were used from all 800 cadavers. Therefore, every right lower limb has a corresponding left lower limb. Specimens where damage to piriformis or the sciatic nerve observed was excluded. Results : In our study the SN exited inferior to the PM in 736 lower limbs (92%); between the fascicles of the PM and inferior to the PM in two lower limbs (6%); and in one thigh, between the fascicles of the PM and superior to the PM (2%). The anatomical variations that are always unilateral occurred more frequently in the left side (11%) compared to the right side (6%). Conclusion: The goal of this project was to identify the anatomical variations of the sciatic nerve divisions in relation to the piriformis muscle and provide awareness of additional sciatic nerve entrapments that are possible within the subgluteal space. While piriformis syndrome was once the “catch-all” diagnosis for posterior hip and buttock pain, there are many potential causes that need to be explored, including sciatic nerve entrapment within the subgluteal space. 

Background: Access to surgical information is crucial for informed healthcare decision-making, but disparities persist, particularly in underserved regions like Muzaffarpur, Bihar. This community-based study explores access to surgical information, awareness of surgical procedures, and information sources, addressing healthcare disparities. Materials and Methods: A cross-sectional study was conducted among 500 residents of Muzaffarpur, Bihar, using a structured questionnaire. Data encompassed demographic characteristics, sources of surgical information, awareness of procedures, and perceived reliability of sources. Statistical analysis assessed factors influencing surgical awareness. Results: The majority (40%) of participants were aged 31-45, with a Bachelor's Degree (40%). Digital platforms (80%) and healthcare facilities (50%) were primary information sources. Awareness rates varied: cesarean section (90%), appendectomy (80%), cataract surgery (70%), and coronary bypass surgery (40%). Healthcare professionals (70%) were trusted sources. Participants perceived healthcare professionals (4.25) as highly reliable, family and friends (3.75) moderately reliable, and internet sources (3.90) relatively reliable. Conclusion: Disparities in surgical awareness persist in Muzaffarpur, Bihar. Internet usage is prominent, emphasizing the need for credible online resources. Trust in healthcare professionals underscores their central role. Targeted health education campaigns should address knowledge gaps in specialized surgical fields, while community health workers remain vital in underserved areas.

Aim of study multiple sclerosis (MS) is an autoimmune disorder affecting the central nervous system (CNS). This study aims to examine the CCL5 values in patients with Multiple Sclerosis. Patients and methodsA retrospective study was undertaken on 70 individuals diagnosed with multiple sclerosis utilising archived material. The RNA sequence of CCL5 was analysed using the real-time polymerase chain reaction (qPCR) technique. The CCL5 level was determined using quantitative polymerase chain reaction (RT-PCR) methodology. Results in total, a collection of 70 samples was obtained. The concentration of CCL5 was identified in all seventy patients and subsequently compared with a set of 30 control samples. There is an observed increase in the levels of CCL5 in patients diagnosed with Multiple Sclerosis (M.S) compared to individuals in good condition. Conclusion these findings provide support for the elevated levels of CCL5 observed in patients with Multiple Sclerosis. Moreover, compared to control cases, it appears that CCL5 correlates with a more unfavourable outcome in patients.

Background: A common illness in infants, neonatal jaundice is caused by high bilirubin levels in the first few days of life, which results in yellowing of the skin and eyes. Aim: This study aims to explore neonatal jaundice risk factors and assess the efficacy of multidirectional intensive phototherapy management at Azadi Teaching Hospital in Kirkuk City. Patients and Methods: In this retrospective cross-sectional study spanning from April 1st, 2021, to October 1st, 2021, a total of 497 newborns were examined. Jaundiced neonates underwent intensive phototherapy utilizing the Bilisphere 360 system, which featured a chamber with 16 cylindrical, blue TL 20W/52 fluorescent tubes. The newborns were positioned on a gauze hammock suspended at the chamber's center, illuminated on all sides. Results: A study found that neonatal jaundice affects 50.70% of studied neonates, primarily in the 16-21-day age group, with males accounting for 57.95% of the sample. 94.84% of neonates experience jaundice due to ABO blood group incompatibility and 88.10% due to Rh incompatibility. Additionally, 77.78% of term deliveries are associated with jaundice. Infants with jaundice have higher Thyroid Stimulating Hormone (TSB) and Thyroid Stimulating Hormone (TSH) levels and a younger mean age compared to non-jaundiced infants. Bilisphere 360 proves significantly more effective in the critical 12 to 48 hours after admission, with a mean total bilirubin of 10.71 ± 1.01 mg/dl compared to 14.65 ± 1.71 mg/dl for Neonatal Exchange Transfusions (P-Value: 0.001). Factors like blood group incompatibility, labor duration, and birth weight influence TSB levels in jaundiced neonates. The Bilisphere 360 method is found to be more effective in managing neonatal jaundice than Neonatal Exchange Transfusions in reducing total bilirubin levels.

Aim of study This study examines the occurrence of EBV infection in glioma tumors that arise in individuals with a history of peripheral multiple sclerosis.the Epstein-Barr virus (EBV) has been implicated in the pathogenesis of glioma, contributing to the formation of tumors.Patients and methods we did a retrospective analysis of archival material of 30 individuals who got gliomas as a result of Multiple sclerosis. EBV DNA sequence was examined using real-time polymerase chain reaction (qPCR).   The presence of Epstein-Barr virus nuclear antigen leader protein (EBNA-LP) was identified using quantitative polymerase chain reaction (qPCR).recorded were the clinic-pathological characteristics.A statistical analysis was conducted to compare patients who tested positive for EBV with those who tested negative for EBV.Results in total, six gliomas tested positive for the Epstein-Barr virus (EBV), which accounted for 20% of the cases.   EBV DNA was detected in 6 instances.  EBNA-LP was identified in every patient who tested positive for EBV DNA.   All patients who tested positive for Epstein-Barr virus (EBV) were diagnosed with glioblastomas multiforme (GBM).  EBV-negative patients exhibited superior median overall survival and recurrence-free survival compared to EBV-positive patients. Conclusion taken together, these results lend credence to the idea that EBV infection is present in Iraqi GBM. EBV infection also appears to be linked to a poorer prognosis for patients, at least when comparing EBV-positive and negative malignancies. The results are promising, but more advanced molecular research is needed to corroborate them and offer light on the possible function of EBV in these fatal cancers.

Background: Anemia is one of the most common global health problems, particularly in India. It has been associated with significant morbidity and mortality. Laboratory investigations, including a complete blood count (CBC) and differential leukocyte count, are crucial in diagnosing anemia, platelet disorders, white cell disorder, leukemia, and other related conditions. Automated hematological analyzers have become an integral tool in providing accurate and efficient blood cell analysis. These machines not only provide essential information on RBC indices, hematocrit, and RBC distribution width (RDW), but also give a detailed RBC histogram. Materials and methods: The present study was a prospective study and comparative study was conducted in the Department of Pathology, Tertiary care Teaching Hospital over a period of one year. All patients, both male and female with anemia i.e haemoglobin levels below WHO reference values were included. Method of Collection: 3ml of EDTA venous blood sample was collected from the patient and a histogram was obtained after thorough mixing of the sample. The 5 part differential automated analyzer was used for the study. Simultaneously a peripheral smear was prepared according to standard operating procedures and stained by Leishman stain. This peripheral smear was reported by a pathologist who was not privy to histogram during the reporting of peripheral smear. Result: Females were predominantly composed of (57.5%). The age group of patients included in this study ranged from 11 years to 80 years. Majority of patients (30.83%) were within 21-30 years of age and least were 71-80 years (2.5%). Based on hemoglobin values, anemia was divided into following categories: MILD (Hb Out of the 120 subjects majority cases (60%) showed moderate anemia. In this study, Microcytic Hypochromic anemia constituted the predominant type with 79 cases (65.83%) followed by Normocytic Normochromic anemia (17.5%) and 15.83% of Dimorphic anemia. Only 1 case (0.83%) of Macrocytic anemia was encountered in the study with no cases of hemolytic anemia. The histogram pattern of all cases were analysed. Left shift was the most common pattern observed constituting 83 (69.16%) cases. Conclusion: Histogram is an important tool of diagnosis when correct interpretation of the curve is combined with findings of blood count parameters like red cell distribution width and red cell indices. By observing these curves we could give presumptive diagnosis of presence of fragments in blood, microcytic, macrocytic or dimorphic red cells. Histograms are useful tool for technologists as it could guide them that which cases need actual detailed peripheral smear examination by experts.

Background: Congenital hypothyroidism (CH) caused by defects in the development of thyroid gland, which may be genetic or genetic defects in the synthesis of and secretion of thyroxine. Other causes include defect in secretion of and action of thyrotropin (TSH) and action of thyrotropin releasing hormone and the action of triodothyronine. Using umbilical cord blood to test for total thyroxin has not been a popular newborn thyroid screening methodology. Concerns have been raised regarding false-negative test results and potential effects of maternal conditions and delivery on the interpretations of the results, as these may increase fetal thyroid-stimulating hormone (TSH) levels. Congenital hypothyroidism of any cause is difficult to recognize at birth or very soon thereafter, in part because it is mitigated to some extent in utero by maternal-foetal transfer of T4.  Materials and methods: This is a Prospective, Observational and Cross-sectional study was conducted in the Department of Pediatrics, Arundathi Institute of Medical Sciences over a period of 1 year. All term neonates born to mothers and delivered during study period were included.  Mothers’ clinical details T4 regarding thyroid status, hormonal therapy, weight, BMI, and other chronic medical illnesses were recorded. At the birth – basic clinical details of the baby especially related to hypothyroidism features like birth weight, tone, cry, Anterior Fontanelle size, congenital abnormality, feeding difficulty, vomiting, not passing stool/ abdominal distension, anemia, jaundice etc. were noted and entered on patient proforma. Blood sample from umbilical cord was collected in sterile container drawn from placental side of the umbilical cord at the time of birth of the baby.  Result: In table 1, male were 51 (56.66%) and female were 39 (43.4%). Male-female ratio was 1.15:1. In our study, least were above 40 weeks and maximum were belonging in the week of 37+1 to 38. The birth weights ranged between 2.5 and 4.5 kg, with an average birth weight of 2.82 kg. Mean (standard deviation) TSH value was 7.725 (8.99) among the study group. In our study depicts the TSH values of the entire cohort. TSH values ranged between 1.2 and 100 mIU/ml.  Conclusion: The present study, similar to other studies, suggests that TSH levels in cord blood might be a feasible alternative specimen for a congenital hypothyroidism screening program in those areas where neonatal blood is not easily attainable. An elevated cord blood TSH value has been found in substantial numbers of babies. Male sex, mode of delivery and perinatal stress factors has a significant impact on CB-TSH levels. As various other factors can influence CB-TSH, its value should be interpreted with caution.

Background: Cytologic examination of body fluids obtained from the serous cavities is among the most common tasks performed in the practice of cytopathology. It is a relatively simple and non-invasive technique, which helps to conclude on the inflammatory, benign or malignant etiology of effusions. The investigation of serous effusions has an important place in cytopathology because it has diagnostic and prognostic value. The proper identification of the primary tumor with staging and grading has therapeutic and prognostic implications. In the current study, we evaluated the efficacy of two techniques for the diagnosis of malignant serous effusions. Materials and methods: This study includes 70 patients clinically and radiologically proven to have pleural effusion in our Hospital between 2022 and 2023. The fluids gathered from the patients were divided to two equal parts, while in one half conventional cytological analysis was done, in the other half the analysis was done with the cell block technique. Half of the specimens were centrifuged for 5 minutes with 2000 rpms. The sediment acquired was applied on the slide and stained with routine Giemsa and Hematoxylin Eosin stains. The other halves of the specimens were centrifuged for 5 minutes with 2000 rpms. The residual fluid over the tube was emptied. The sediment in the bottom was gathered on the blotting paper by turning the tube upside down. The material obtained was fixed with 10% formalin solution and then routine histological follow up was done. After follow up paraffin blocks were formed and paraffin blocks were cut in 4 µ sections. These sections were stained with routine Hematoxylin Eosin.  Result: Out of the total 50 cases included in this study, males were 50 and female were 20 contributing 71.4% and 28.6% respectively. Males are more than females. Age range of the study participants was from 20-70 years, with the dominant age group being 31-40 years. On physical examination 23/50 (32.9%) were hemorrhagic on appearance. On conventional smear method, benign/inflammatory condition cells are 55.7% which outnumbered malignancy that is only 15.7%, followed by suspicious for malignancy 28.6%. On cell block method, majority of the cases diagnosed were of benign/inflammation (67.1%) and then malignancy (32.9%). Conclusion: Morphological features were better identified by Cell block technique, when compared to cytological smear and additional yield of malignancy was more in cellblock method. There is adequate cellularity and delineation of nucleus and cytoplasmic details. Among the inflammatory effusions lymphocytic predominance is noted in majority of cases. Malignant pleural effusion was more common in males; the primary tumor was in the lung. In the present study, 16% were diagnosed as malignancy on cell block and only 10% were diagnosed as positive for malignancy on cytosmears. We conclude that the cell block technique method when used as an adjuvant to routine smear.