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Etomidate’s haemodynamic stability is due to its unique lack of effect on the sympathetic nervous system and on baroreceptor function. Even in cardiac patients an induction dose of etomidate results in very stable haemodynamics. Etomidate also has minimal effects on respiratory system as compared to other induction agents. Since it causes minimal histamine release, this gives an advantage in patients with reactive airway disease, making it less likely that they will have bronchospasm. However, pain on injection and myoclonus are two most common side effects of this drug. Pain on injection has disappeared after the new fat emulsion of etomidate, but the new solvent has not reduced the incidence of myoclonus.1): To compare the effects of pretreatment with two doses of Dexmedetomidine on the incidence of Etomidate induced myoclonus using numerical based grading; 2): To compare the effects of pretreatment with two doses of Dexmedetomidine on attenuation of stress response at laryngoscopy and intubation after induction with Etomidate.Study area: The proposed study was carried out in the Department of Anesthesiology and Intensive care at a tertiary care teaching hospital, after seeking clearance from the college ethical committee and obtaining written informed consent from patient. Study design: Prospective Interventional Randomized Comparative Study Study period: 1 year It was a prospective and interventional randomized comparative study where 180 patients with age group 18-65 years, of either sex,ASA grade I & II, BMI, undergoing elective surgical procedures under general anaesthesia with endotracheal intubation were included in the study. They were divided into three groups where patients were randomly allocated into one of the three groups using Block Randomization with sealed envelope system. In Group 2 and 3, 78.3% and 76.6% patients did not have myoclonus during induction with etomidate. Stress response to intubation was suppressed by dexmedetomidine. Based on the observations of our study, we conclude that pretreatment with 0.5µg/kg and1µg/kg Dexmedetomidine significantly reduce etomidate induced myoclonus and stress response at intubation. However, dexmedetomidine in dose of 0.5µg/kg is associated with fewer side effects of bradycardia and hypotension.

Background COVID-19 pandemic compelled medical schools to opt for online mode in medical education. The competency-based curriculum started in India last year onwards allotted more hours to practical teaching than lectures. As the lockdown extended, there was a need to shift laboratory teaching to online mode. We describe our experience of developing and implementing a framework to rapidly shift practical lab teaching of preclinical subjects to online mode. Methods A mixed method study was conducted during the COVID-19 lockdown period in a public funded medical institute of India. A framework utilizing the principles of small group teaching using the available resources was developed and implemented. Online feedback was obtained from students, while in-depth telephonic interview was conducted for teachers. Results A Demonstrate-Engage-Assess framework for online Practical teaching of Preclinical subjects (DEAPP) was developed and implemented. Feedback was obtained from 103 first year students and six teachers from preclinical subjects. Around 62%–80% students were satisfied with online practical teaching or agreed with benefits of various online tools used in the teaching sessions. Teachers found the framework more planned, and resource efficient, while students found it to be more engaging, enjoyable, and motivated for learning. No face-to-face interaction, non-experiential learning, and adaptation to newer technology were the main barriers perceived in online practical laboratory teaching. Conclusion DEAPP framework was found to be feasible for rapid online transition of practical lab teaching and reported by the students and teachers as engaging, enjoyable and motivated learning.

Introduction: Scarcity of blood and blood products is frequently encountered in health care institutions. Medical students can serve as an important pool of potential blood donors for the attached teaching hospitals. Aim: To determine the knowledge, attitude and practices (KAP) of medical students about voluntary blood donation. Settings and Design: It was a cross- sectional study conducted among medical students of Dr RPGMC Tanda in Himachal Pradesh, in the months of August to December, 2015. Material and Methods: All the students present on the day of the survey who expressed their consent for participation were enrolled in the study. A pre- tested, structured questionnaire was used as a study tool. After the collection of the baseline information, a brief interactive awareness session, addressing voluntary blood donation was organized for the participants and their willingness to donate blood was again noted at the conclusion of the session. The data was analyzed by using SPSS software. Results: 235 students participated in the study, 102 (43.4%) males and 133 (56.5%) females. The mean age was 20.42 ±1.38 years. Knowledge of Voluntary Blood Donation: The mean knowledge score of participants was 74.4%. Overall 225 (95.7%) participants were aware of their blood groups. Attitude related to blood donation: 91% study participants felt that people should donate blood and were themselves willing to donate blood. Practice Relating to Blood Donation: Out of the 235 study participants, only 54(22.9%) had donated blood so far. Willingness to donate blood after interactive awareness session increased from 91% to 97.5%. Conclusion: The study population has relatively good knowledge and a favourable attitude about voluntary blood donation. However the prevalence of blood donation among the students is still low, especially among the girls.

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

Background: The cervical vertebrae are smallest of all the vertebrae present in the vertebral column. It is characterized by a foramen in each transverse process. The foramen transversarium (FT) of 6 th to 1 st cervical vertebrae transmits vertebral vessels and sympathetic nerves. Presence of another foramen apart from FT in the transverse process of cervical vertebrae is called accessory FT. Anatomical knowledge of these variations are helpful for conducting cervical spinal surgeries by the surgeons in order to prevent injury to vertebral vessels and sympathetic nerves. Methods: The present study was conducted in the department of anatomy, UCMS and GTB Hospital, Delhi, India. A total number of 241 dried cervical vertebrae were collected from the bone bank of the Department of Anatomy. Presence of any variation from the normal anatomy of the cervical vertebrae were noted and photographed. Results: Out of 241 cervical vertebrae (typical and atypical), the accessory FT was noted in typical cervical vertebrae only. Accessory FT was seen in 37 (27.6%) vertebrae, out of 134 typical cervical vertebrae. These accessory FT were either bilateral complete in 4 (2.9%) or incomplete 9 (6.7%) or unilateral complete 6 (4.5%) and unilateral incomplete 12 (8.9%) were observed. Six (4.5%) typical cervical vertebrae showed presence of complete accessory FT on one side and incomplete accessory FT on the other side in the same vertebra. Conclusions: Knowledge of variations of the presence of accessory FT in the typical cervical vertebrae is not only important to anatomist but also to radiologist in identifying the presence of duplicate vertebral artery and hence helping the neuro surgeons in preventing accidental bleeding from the vertebral artery while performing surgery on the cervical spine.

Background : Determination apex of sacral hiatus (SH) is of paramount importance to Anaesthetists, Orthopaedicians, Obstetricians and Gynaecologists for caudal epidural block (CEB). Dorsal sacral dimensions were therefore taken to facilitate them for easy location of SH. Methods: Following parameters of each of the sixty human sacra were measured using vernier calipers at the level of spinous process of second sacral vertebra (S2). a) Distance between the two supero-lateral crests b) Distance between the right supero-lateral crest level to the apex of sacral hiatus (SH) c) Distance between the left supero-lateral crest to the apex of SH d) Distance from the spinous process of S2 to the apex of SH e) Distance from the spinous process of S2 to the base of SH The data obtained was analysed statistically. Results : Mean of the distance between the two supero-lateral crests was 51 ± 6.37 mm and 52.7 ± 5.30 mm in males and females respectively, mean of the distance between the right supero-lateral crest and the left supero-lateral crest to the apex of SH was 45.91 ± 6.94 mm in males 42.50 ± 11.23 mm in females and 44.74 ± 6.77 mm in males and 42.50 ± 10.97 mm in females respectively , vertical distance from spinous process of S2 to the apex of SH in males and females was 38.83 ± 9.33 mm and 32.4 ± 1.64 mm respectively. Vertical distance from spinous process of S2 to the base of sacral hiatus was 59.20 mm ± 10.81 mm in males and 52.80 ± 9.18 mm in females. Conclusion: From the data obtained it was concluded that an isosceles triangle was formed between the two supero-lateral crests at the level of spinous process of S2 and the apex of SH.

An Electrocardiogram (ECG) is a tool that records the electrical activity of the human heart which is useful for diagnosing cardiac diseases. But, during recording signal is corrupted by different types of noises, for getting proper information from the signal it is necessary to perform denoising. This paper presents the elimination of different types of noises from the corrupted ECG signal. In this paper, a new threshold estimation rule for ECG signal denoising is also presented. The performance of three thresholding estimation rules, i.e. Heursure, Rigrsure & Minimaxi and denoising methods, i.e. discrete wavelet transform (DWT) and its three expansive forms such as double-density discrete WT (DDDWT), Dual-tree discrete WT (DTDWT) and Dual-tree double density discrete WT (dDDTDWT) are compared. The Pure ECG signal record no. 100 downloaded from MIT-BIH arrhythmia database for the analysis the final results shows that Heursure thresholding estimation rule with denoising method DDDTDWT gives better performance than others with better Signal to Noise Ratio (SNR) and Root Mean Square Error (RMSE). The proposed algorithm for threshold estimation rule is computationally faster and mathematically simple as compared to all existing threshold calculation rules.

Thousands of chemicals are being used recently in our new high tech foods like ready to eat Japanese, Chinese, packaged and tinned foods. Most food additives act as either preservatives or flavor enhancers like monosodium glutamate (MSG), a sodium salt of glutamic acid. The present study investigated the effect of intraperitoneally administered MSG on cortex of the kidneys of adult albino Wistar rats and compared with control group. The histomorphometry done by calibrating with ocular micrometer on kidney tissue of control and experimental group revealed a significant difference in glomeruli with increase in length, size of bowman's capsule with an increase in bowman's space. The size of renal tubules could not be compared as the cells of these tubules in experimental group were disintegrated and distorted. In the experimental group (rats treated with 4 mg MSG/g body weight), the cortex of the kidneys developed variable pathological changes, which were patchy in distribution with intervening normal areas. There was distortion of renal cytoarchitecture. Many glomeruli (66.4%) showed hypercellularity, i.e., cellular proliferation of mesangial or endothelial cells and infiltration of inflammatory cells. The capillary membrane showed thickening as was evident on PAS stain. Since MSG, as a food additive, was found to be toxic on various organs of the body by various researchers, it should perhaps be stopped from being used as a food additive. This may be a suggestion which needs validation in human studies.

Micellar behavior of cationic surfactants, dodecyldimethylethylammonium bromide (DDAB) and dodecyltrimethylammonium chloride (DTAC) in aqueous media has been investigated over the temperature range 288.15–308.15 K. The critical micelle concentration (cmc) and degree of ionization (β) of the micelles were determined from the conductivity measurements at different temperatures. The cmc behavior of DDAB and DTAC was analyzed in comparison with the results of DTAB in terms of effect of counter ion and increase in alkyl chain. Thermodynamic parameters ( Δ G m ° , Δ H m ° and Δ S m ° ) for the micelle system were estimated by applying the charged pseudo-phase separation model. At lower temperatures, the micellization in case of DDAB was found to be entropy-driven while at higher temperatures it was enthalpy-driven. In case of DTAC only entropic effect dominates over the entire temperature range.

The laminae of fifth and sometimes fourth sacral vertebrae fail to fuse posteriorly in the sagittal plane leading to formation of a deficiency in the posterior wall of the sacral canal commonly known as sacral hiatus. During osteology demonstration class of MBBS students of the Department of Anatomy, U.C.M.S and G.T.B Hospital, Delhi, we noticed a sacrum in which sacral hiatus was extending to a level just inferior to the spinous process of second sacral vertebra. Review of literature suggested that the extent of sacral hiatus could be variable. To our knowledge, extension of sacral hiatus just inferior to spinous process of second sacral vertebra has not been described in the past. Familiarity with such kind of variation may help in administration of caudal epidural anaesthesia.

Sometimes one foramen is seen lying near or along the fronto-sphenoidal suture, superolateral to the lateral end of superior orbital fissure. This inconsistent foramen, known as meningo-orbital foramen (MOF), transmits a branch of anterior meningeal artery, providing additional blood supply to the orbit. The frequency of occurrence of MOF, its distance from supraorbital notch/foramen and frontozygomatic suture has not been seen in North Indian population therefore a study was conducted on 100 orbits of fifty North Indian skulls. MOF was found to be present in 32 orbits (Right =18, Left=14). The mean distance from MOF to the supra-orbital notch/foramen was 36.2 mm on the right and 36.6 on the left side. The mean distance from MOF to frontozygomatic suture was 21.0 mm on the right and 20.5 mm on the left side. As in some surgical interventions, MOF may lie near the operating field, surgeons need to be familiar about its presence and location. Meningo-orbital Foramen in the Lateral Orbital Wall – Topographical Anatomy and Clinical Relevance

This paper is basically extension of our work in detection of diseases using data mining techniques. Here it shows that heart disease can be diagnose by using various data mining techniques and algorithms such as decision tree, split validation and apply model. Some Attributes like age, root canal treatment, smoking and diabetes predicts the probability of patients getting a heart disease. The proposed system that is the union of computer-based patient records with clinical decision support can lower down medical mistakes, unwanted practice variation and helps in improving patient safety and outcome.

Background: Nutrient foramen of long bones defines the extent of bone vascularisation. Information regarding nutrient foramen is necessary to conserve circulation during orthopaedic and surgical procedures. The present study was conducted to examine the position, number and calibre of nutrient foramina in 100 dry femora belonging to North Indian population.Methods: The total length (TL) of each femur was measured by taking the measurement between the most proximal aspect of the head of the femur and the most distal aspect of the medial condyle. Number of nutrient foramina was determined by using a magnifying lens. Distance of nutrient foramen from upper end was measured. Direction and obliquity of nutrient foramina were noted. Position of nutrient foramina was determined in relation to length of femur and linea aspera. Caliber of nutrient foramen was measured using 18, 20, 22 and 24-gauge needles.Results: Length of femur on right side was 435.2 mm (Range 393-523 mm). Length of femur on left side was 437 mm (range 369-524). 78 (78%) femora had single nutrient foramen, 11 (11%) had double nutrient foramen and 11 (11%) had no nutrient foramen. All foramina were directed upwards. Maximum foramina were located in middle third of femur (84%) followed by upper third of femur (8%). Most common location was on the intermediate area between two lips of linea aspera (42%) followed closely by medial lip of linea aspera (36%).Conclusions: This study has provided additional data on the subject which will help in resection, surgical procedures and transplantation techniques by orthopedician in North Indian population.

Variations in the morphology of pancreas are not very common. We observed a rare variant of the uncinate process of the pancreas that extended in the mesentery of the small intestine. After its origin from the lower part of the head of the pancreas, the mesenteric process (MP) passed over the third part of the duodenum to enter the mesentery of the jejunum and ileum and extended up to the level of the pelvic brim. The branches of the superior mesenteric vessels were embedded in the extended MP of the pancreas. This aberrant extension of the pancreas was drained by a narrow duct, which joined the main pancreatic duct inside the head. We did not observe a separate uncinate process arising from the head. On histology normal acini and endocrine cells were observed in the extension. This variant is important as symptoms of pancreatic disease from such extensions may be confused with other commonly encountered acute or chronic abdominal conditions.

Background: The deficiency in the antero-inferior wall of the bony part of external auditory canal (EAC) closes by 5 years of age but if it persists beyond that age it is called foramen of Huschke. Depending on the population studied, persistence of this foramen has been seen in 0-67% of adult crania. Review of literature revealed that no data was available in North Indian population; therefore the present study is being undertaken. Methods: Sixty North Indian adult human crania were examined and the presence of foramen of Huschke was noted. The side to which it belonged to, its shape and size were observed. Size of the foramen was measured using vernier caliper. Results: Out of sixty North Indian adult human crania seen, foramen of Huschke was present in 14 crania. It was observed unilaterally in 10 crania and bilaterally in 4. Although different shapes of the foramen like pin point, pin head, circular, irregular and U shape were observed but in majority of cases it was U shaped. Its size varied from pin point- 10 mm transversely and pin point to 9 mm longitudinally. Conclusion: This study revealed that about 23% of North Indian adult human crania have foramen of Huschke. Persistent foramen of Huschke in the adult life may be involved in different abnormalities of the EAC and may lead to otological complications. Therefore, ENT surgeons should be aware of persistent foramen of Huschke and keep it as one of the possible diagnoses while dealing with patients presenting with otological complications. Also the surgeons should be careful while performing endoscopy of Temporomandibular Joint (TMJ) so that accidental damage of TMJ can be prevented.

Background of the study: People who have undergone extensive meditation have shown improvement on cognitive performance .It does this by training and bringing mental processes under greater voluntary control and direction them in beneficial ways. This study was designed with the purpose to observe the effectiveness of mindful meditation on attention, short term memory and visual reaction time on normal individual. We examined whether brief mindfulness training affects on cognition. Our findings suggest that two weeks of meditation training can enhance the ability to sustain attention, short term memory and visual reaction time on normal individual. Purpose of the study: To examine whether brief mindful training affects on attention.short term memory and visual reaction time on normal indivisual. Procedure: A total no. of 230 subjects age group(15-25) were taken for the study. Pre evaluation has been done by using Trail making test, Digit span test and Human Benchmark test. Trail making test for attention, Digit span test for short term memory and Human Benchmark test for visual reaction time. These test were carried out to the subjects for pre and post Evaluation. Mindful meditation was provided to subjects for 15 minutes once a day for two weeks. Subject were made to sit comfortably on a mat and asked them to take a deep breath before meditation. Each subject is given a mantra (OM) and is instructed to concentrate through this mantra(OM). Results: The data was statically analyzed by using SPSS software. There is overall increased attention, increase short term memory and decrease reaction time were shown. The P- Value of TMTA1-TMTA2- .000 , TMTB1-TMTB2- .000 , RT1-RT2 - .007 , DTI-DT2 -.000 . The value is < .05 as seen in table-3 so this study accepts the alternate hypothesis. Conclusion: Our findings suggests that two weeks of meditation training can enhance the ability to sustain Attention ,Short term Memory and visual reaction time on normal individual.

Many authors suggest that abnormal branching pattern of axillary artery is very common. This compelled us to explore the axillary region of 20 formalin fixed cadavers of either sex to note the frequency of unusual branching of axillary artery over a period of five years. Axillary artery branched normally as described in various textbooks of Anatomy in thirty nine (97.5%) out of forty axillae examined. Only in one axilla (2.5%), it was observed that the second part of axillary artery branched unusually whereas on the other side it branched normally. Knowledge of such abnormal presentation of the axillary artery in the era of reconstructive surgeries is of great help to the interventionist so as to avoid any vascular catastrophe resulting in some kind of mishap. Awareness of such unusual branching pattern of axillary artery is also of great importance to vascular surgeons and radiologists dealing with this region. Embryological origin and the clinical relevance of the abnormality encountered in the branching pattern of the axillary artery in the present study have been discussed in the paper.

Fifth lumbar vertebra is an atypical vertebra as it has widely separated inferior articular processes and thick transverse processes projecting out from the body and pedicles of the vertebra. On routine examination of osteology specimens we found a fifth lumbar vertebra in two separate parts. One part consisted of body, pedicles, transverse and superior articular processes. The other part consisted of lamina, spinous and inferior articular processes. Knowledge of this variation may be of importance to the clinicians for diagnosis of certain neurological deficits in the lower limb and to orthopaedic surgeons and neurosurgeons during the surgical intervention of that area.

Background: Work related musculoskeletal disorders are commonly encountered. Studies have been conducted to evaluate the prevalence of pain among industry workers, computer operators etc. However, the knowledge regarding prevalence of pain among non teaching and supporting staff members is scarce. Method: The survey was conducted by means of a questionnaire. A total of 101 non teaching and supporting staff members constituted the study population. Data was analyzed using descriptive statistics. Results: 79% of the individuals complained of pain at different sites of the body. 22% had no pain. The awareness of physiotherapy among this population is scarce. Only 16% resorted to Physiotherapy for pain relief. 85% of the individuals depend on medications and home remedies. Conclusion: More than half of the individuals complained of pain in the study. As pain has a profound consequence on an individual's functional and psychological existence, there is a need to evaluate it in detail and treat accordingly. There is a need to augment the awareness regarding physiotherapy in this population.

Sa crum is made up of large fused 5 sacral vertebra forming posterior wall of pelvis. On routine examination of the bones present in the bone bank of our department we noticed a sacrum in which sacral canal was incompletely formed due to imperfect formation of second sacral laminae. Knowledge of such type of variation may be of importance to the clinicians in dealing with patients presenting with bladder and or bowel disturbances or presenting with some neurological deficit of the lower limb. Orthopaedic surgeons should also be aware of this anomaly while operating in the sacral region.

Background: Since scanty literature is available on the absence of costal element forming foramen transversarium of atlas vertebra therefore this study was undertaken. Atlas vertebrae were examined to see the presence of foramen transversarium and their boundaries. Methods: Hundred foramina transversaria of 50 atlas vertebrae were examined grossly. Results: Foramen transversarium was seen to be present in all the transverse processes of the atlas vertebrae examined. Costal element was found to be missing in seven foramina tranversaria out of 100 foramina seen. It was found to be absent on the right side in three vertebrae and in two it was absent bilaterally. Conclusions: In case the costal element of the foramen transversarium is absent, the second part of vertebral artery passing through this foramen is liable to be damaged while operating at the level of atlanto-occipital joint the operating surgeon should be aware of such variations so as to avoid injury of second part of vertebral artery and subsequently preventing any kind of neurological involvement. Radiologists must also know about such variations so as to correctly interpret radiological image of the craniovertebral region.

Lateral side of each intermediate crest has four dorsal sacral foramina for the passage of posterior division of the sacral nerves. Not only they serve as an important landmark in placement of spinal instrumentation but are also of great importance in transsacral block of sacral nerves for producing analgesia and anesthesia in pelvic surgeries. Therefore a study on the variation in number of dorsal sacral foramina was conducted in 60 adult dry North Indian sacra. Three dorsal sacral foramina were seen on the lateral side of each intermediate crest in four sacra (6.6%) and five in 6 sacra (10%) amongst all the sacra examined. Either a single pair, double pair or totally absent foramina were not observed in any of the sacra seen. This study revealed that there is variation in the number of dorsal sacral foramina. Anaesthetists should be aware of this disparity to be able to perform trans-sacral nerve block successfully. Radiologists must also know about this variation to interpret the radiographs of lumbosacral region. Neurologist and orthopedist should also be cognizant of this fact to diagnose patients presenting with bizarre clinical findings.