World Health Organization classified corona virus disease 2019 (COVID-19) as a pandemic, at the time of writing affecting nearly every country and territory across the globe. During this time global healthcare systems struggling with shortages of personal protective equipments, ventilators and supportive medical equipments. Patients with COVID-19 are at risk for acute respiratory distress syndrome (ARDS) and other complications especially in patients with co-morbidity like diabetes, chronic kidney disease, patient on cancer chemotherapy and a fraction will require high-level respiratory support to survive. Additionally, significant strain has been placed on protective equipment like face mask, face shields, Personal protective kit, uninterrupted supplies of which, required to protect the healthcare workers helping to treat critically ill patients during this pandemic. During this time of exigency 3D printing health care manufacturing technology is pivotal, as this is not only robust, economical and accurate but also versatile and useful for various applications. 3D printing is a revolutionary healthcare manufacturing technique which can transform three dimensional designs into real objects. 3D printing technology has innumerable applications in the field of healthcare and education where it has introduced customization, prototyping, manufacturing and personalization. Although innovative yet, 3D printed and bioprinted products still face many challenges including a proper legal status, quality assurance, intellectual property rights as well as safety of end users. There is an urgent need to establish in-depth guidelines so that such an innovative and miraculous technique can support mankind and strained health care systems.

Background: Pyogenic infections are characterized by severe local inflammation, usually with pus formation which is increasingly being caused by MDR isolates leading to difficulty in treatment and unfavourable outcomes. Objectives: To study bacteriological profile and antimicrobial susceptibility pattern of isolates from pus samples Material and methods: This prospective study was undertaken in the Department of Microbiology, Geetanjali Medical College and Hospital, Udaipur. Processing of samples and identification of isolates were done according to the standard bacteriological protocols. Antimicrobial susceptibility testing, screening and confirmation of phenotypic resistance traits were performed and interpreted based on CLSI guidelines. Results: Total of 143 isolates were obtained from 140 culture positive samples. Male preponderance was seen and most cases were between 21-40 years of age. Maximum resistance in GPC isolates was seen for beta-lactams and beta-lactam combination drugs while in GNB isolates, third and fourth generation cephalosporins were also resistant along with beta lactam drugs. MRSA, ESBL and ICR production were detected in approximately 50-60% isolates. No MBL producing strain was isolated. Conclusions: It is important for microbiology laboratory to record phenotypic traits like MRSA, ICR, ESBL, AmpC and MBL production, as these traits result in multidrug resistant isolates making treatment a challenge. A hospital should take proactive steps in setting up antibiotic policy and AMSP guidelines and constitute a hospital infection committee to monitor the emergence of drug resistance and should implement standard work precautions among health care personnel along with orientation programmes.

Background: Presently various subjective as well as objective assessment methods are available like long question, short question, multiple choice question, problem based learning, OSCE/OSPE, spotting, viva –voce, etc. It is a matter of research that whether these assessment methods as well as innovations are as successful as they promise to be, and whether students perception is similar to teachers perception or not. Objectives: To gain more insight into students as well as teachers actual preference and perception towards available methods of assessment which will be helpful in designing reliable, valid, more structured assessment system acceptable for both students and teachers. Materials & Methods: A cross sectional questionnaire based, observational study was conducted in tertiary care teaching institute of Rajasthan, India. Student and teacher perception analyzed by descriptive and thematic analysis. Institutional Ethical permission and informed consent was taken prior to the study. Results: Out of 500 students studying in different years of MBBS and 100 medical teachers from different departments; only 300 students and 84 teachers responded to the pre-defined and validated questionnaire. Most of teachers (71%) and students (40%) considered MCQ is more scoring as well as better performing assessment method. Both teachers (79%) and students (67%) considered viva voce is more stress full. Regarding intermittent formative assessment methods 50% teachers and 40% students considered intermittent formative assessment very much helpful; most of students (60%) and teachers (50%) favored twice a year assessment and display of results within a weeks in form of marks (students 47% and teachers 50%). Strictness of teacher was most important factor which affects student's performance during viva-voce according to both students and teachers. Conclusions: Though perception of students and teachers are similar regarding most of assessment methods, yet disparity exists which will helpful in further improvement and planning of assessment during development of curriculum

Background: Spinal anaesthesia is most common technique for patients undergoing abdominal hysterectomy owing to its attributes: rapid onset, adequate motor blockade, easier to administer and cost effectiveness. Dexmedetomidine have been evaluated as neuraxial adjuvant, sedative and also for postoperative pain adjunct. Objectives: To evaluate effect of intravenous dexmedetomidine (0.25mcg/kg) bolus dose for prolonging duration of spinal anaesthesia in patients undergoing elective abdominal hysterectomy. Materials & Methods: This prospective, double-blind, randomized study was conducted in adult patients scheduled to undergo abdominal hysterectomy. After 15 minutes of subarachnoid block, they were divided into two equal groups and given either 0.25mcg/kg of intravenous dexmedetomidine (group D) or intravenous normal saline (group C). Sensory block and motor block characteristics along with time for first rescue analgesia requirement postoperatively were recorded. Duration of postoperative analgesia was noted from the time of subarachnoid block to the first demand of rescue analgesia. Results: There was no significant difference in onset of sensory block in both groups (p>0.05) but there was statistically significant difference for time for reach maximum highest sensory block (T6) between both the groups (p<0.05). Time to get grade 0 from grade 3 blocks was statistically significant in both groups (p<0.01). Time from sensory onset time to first dose of rescue analgesic were significantly prolonged in group D as compared to group C (p<0.01). Conclusions: This study concluded that intravenous dexmedetomidine 0.25μg/kg was significantly better in terms of sensory, motor block characteristics and postoperative analgesic requirement as compared to placebo.

Background: Diabetes mellitus can lead to multiple cardiovascular complications, including coronary artery disease (CAD), cardiac hypertrophy, and heart failure. Diabetes is also associated with alteration in the amount of several classes of lipoprotein, apolipoproteins and minerals. Objectives: To find out the correlation of Apolipoproteins Apo A1 and Apo B, IL6, Cu and Zn trace elements in diabetic patient with cardiac complications. Materials and Methods: This study was performed on 50 patients with diabetic cardiac complications and 50 diabetic patients. Blood sample was collected by vein puncture using an aseptic technique. Serum was separated from the sample and was analyzed for biochemical parameters. Results: Mean serum levels of Cu, Apo B and IL6 were significantly increased in blood samples of diabetic cardiac patients compared to diabetic control (P<0.0001). Mean serum levels of Zn, Apo A1 were significantly decreased in blood samples of diabetic cardiac patients compared to diabetic control (P<0.0001). Conclusion: This study concluded that there is increased level of serum copper, Apo B, IL 6, HbA1c in diabetic cardiac complication patient as compared to diabetes patients and there is decreased level of serum zinc, Apo A1 in diabetes cardiac complication patients as compared to diabetic patients.

Background: Free radical and oxidative stress is considered to be a conjoining tie between diabetes mellitus (DM) and its complications including nephropathy. Objectives: To assess levels of antioxidant vitamins E, vitamin C and lipid peroxidation status in Indian patients of type 2 DM with nephropathy. Materials and Methods: This cross sectional study was conducted at tertiary care teaching hospital. All the diabetic patients with or without nephropathy during the study period were enrolled in the study. Nondiabetic healthy hospital staffs were selected as controls for the study. Serum levels of malondialdehyde (MDA), Vitamin E, Vitamin C levels were estimated in controls, patients of type 2 DM without complication and with nephropathy. Results: Plasma levels of HbA1c, serum LDL, HDL, MDA, vitamin E and C were found significantly different in all three groups viz; controls, uncomplicated diabetic and diabetic nephropathy patients. Vitamin E and vitamin C levels showed negative correlation with plasma HbA1c levels in control and DN (diabetic nephropathy) patients. Both the vitamins negatively correlated with serum MDA levels in diabetic uncomplicated and diabetic nephropathy patients. Conclusions: The present study concluded that free radical injury (oxidative stress) is increased and antioxidants defence (Vitamin E and C) were compromised in type 2 DM. These derangements are of a higher magnitude in patients of type 2 DM with nephropathy.

Documentation of firearm projectile is always a challenging task for forensic experts. The complexities increase manifold when it is in the cranial cavity in the living where any attempt to extract the projectile poses a serious threat to life. Here presenting a very interesting case of a shotgun firearm in a survived victim. The pellet entered the cranium through the right supraorbital fissure without fracturing any wall of the orbit/skull. The 3D reconstruction of the CT images was done with the help of software Osirix MD to visualize the tract. This case report brings out the importance of 3D reconstruction of images in the documentation of injury and ease of reproducibility of such documentation.

Bartter syndrome is a rare inherited salt-losing renal tubular disorder characterized by secondary hyperaldosteronism with hypokalemic and hypochloremic metabolic alkalosis and low to normal blood pressure. The primary pathogenic mechanism is defective salt reabsorption predominantly in the thick ascending limb of the loop of Henle. A 10-year-old male child came to Geetanjali Hospital with complaints of excessive urination (polyuria) and not gaining height and weight [weight and hight both less than 3rd centile]. On investigation metabolic alkalosis, hypochloraemia, hypokalaemia with normal magnesium level, hypotonic urine, high urinary calcium/creatinine ratio, and hypercalciuria were found. Early recognition and treatment are crucial for these children. Bartter syndrome patients need huge amount of potassium supplementation along with potassium sparing agent to maintain electrolyte imbalance.

Takayasu Arteritis (TA) also known as “Pulseless disease,” is an idiopathic, chronic, large vessel arteritis involving the aorta and its primary branches. The incidence of TA in children is approximately 30% pediatric patients in their study and reported an incidence in all ages of 2.6/1,000,000. We report a case of a 14 year old female child admitted in PICU of Geetanjali Medical College and Hospital, Udaipur, Rajasthan with chief complaints of involuntary movements, headache, vomiting, and fever since one day. Patient blood pressure was persistently raised above 140/100 mm of Hg. Color Doppler suggestive of right renal artery narrow caliber. Right renal artery shows parvus et tardus type spectral pattern. Ultrasonography (USG) of abdomen was also done which suggested smaller right kidney. Computed tomography angiography suggested Takayasu arteritis. Correlation of clinical history, physical examination, investigation reports were helpful to reach the final diagnosis.

Background: Quality indicators are one of the methodologies to improve the quality of hospital services. The patients admitted in hospital to which catheters are applied as a part of treatment are more likely to suffer with urinary tract infections (UTI). Objectives: To determine the effectiveness of application of quality indicator in reduction of cases of UTI and preventing CAUTI and bacteriuria of catheterized patients. Material and Methods: This study was conducted on patients requiring catheterization as a part of treatment. The intervention included pre-test, lecture and demonstration, training of proper insertion, maintenance and removal of catheter and post-test. The results of pre and post intervention were compared. Results: The present study included 1645 patients with catheterization from different sections of the hospital. The required data collected including 878 patients before intervention and 767 patients after intervention deemed second part of the study. Clinically suspected patients of UTI among catheterized patients were 80 with 8 culture confirmation of infection and 2 of them with multidrug resistant isolates. In second part of study, there were 28 patients suspected with infection with 4 culture positives. Conclusion: A significant improvement was observed after the application of QI. It is recommended to apply such indicators not only of urinary tract infections but different types of services in hospital to benefit both hospital and patient. Application of QI in different medical services is beneficial to improve various health services.