Background & Aim: Improvement in Surgical and Anaesthetic techniques allows even complex surgeries to be performed as day care cases. The objective of the study is to compare the recovery parameters of patients undergoing anaesthesia for ambulatory surgeries under General or Spinal Anaesthesia. Materials and Methods: After approval by IEC, this study was performed in 60 patients undergoing elective ureteroscopic procedures. Patients were Randomized to receive either General anaesthesia (Group GA: n=30) or Spinal Anaesthesia (Group GA: n=30). GA was induced using standard protocols with airway maintained spontaneously using LMA. In group SA patients received 1.5 ml 0.75% Isobaric Ropivacaine for providing anaesthesia. Vitals were recorded in both the groups throughout the procedure. In addition to intra operative haemodynamics, the onset of duration and percentage of patients achieving complete sensory & motor block was also recorded in SA group. Patients were kept in phase I recovery till score of Aldrete 9 was reached. In phase II recovery (PACU) the percentage of patients sitting at 180 min, standing at 300 min and walking at 360 min were recorded. The psychomotor skills of patients were assessed using digit symbol substitution test (DSST) before discharging from phase II recovery. The main criteria for discharging patients from phase II recovery was Post Anaesthesia Discharge scoring (PADSS). Patients were discharged from phase II recovery on reaching PADSS <10. Results: Seventy three patients were enrolled and 60 patients completed the study. The onset of sensory and motor block in Group SA was 6.61±0.83 min and the onset of motor block was 9.48±0.91 min. Percentage of patients achieving complete sensory & motor block was 71%. The duration of sensory block was 208± 17.95 min and the duration of motor block was 182.07±15.98. Patients in group GA took 221.07± 4.97 and Group SA took 110.72± 7.04 min to reach Aldrete score of 10 (p value <0.05). At 180 min only 22.33% patients in group GA were able to sit, while in Group SA it was 70 (p value <0.05). The comfort score assessed by surgeon was excellent in group GA (4/4) and was only satisfactory (2/4) in Group SA. There was no difference in pain perception or PADSS at 360 min or psychomotor skills tested by Digital symbol substitution test (DSST). Conclusion: The technique of Anaesthesia doesn't interfere with readiness of patients to discharge home in terms of maintain stable vitals, pain or side effects. Isobaric Ropivacaine was found to be a poor choice for providing spinal anaesthesia due to slow onset of sensory block, inability to achieve complete motor block thus providing difficulty to operating surgeon.

Any acute complaints with pain especially in infants and children make the whole family especially the parents of the child very depressed and anxious. Such one condition is the management of acute suppurative otitis media in children which has become an essential need because the acute pain that the child suffers at most of the times is intolerable. From the most ancient days in medical field, for any acute complaints people run to various treatment of medicines which give instant relief. So, as the myth says Homoeopathic system of medicine is slow acting and not suitable for emergency conditions but here is the true side of Homoeopathy, the real fact to prove the importance of Homoeopathy in treating an acute emergency pain and give an instant relief with cure. This study can give the evidence in use of external application like ear drops is very beneficial acute aid and approach to the disease can give a immediate satisfaction and rapid relief in patients. So, the effectiveness of Homoeopathy acts well in even acute emergency conditions especially when given both internally and externally. The study concludes with the significant effect in administration of same homoeopathic medicine both as internal medicine and external application together gives better improvement.

Pilonidal sinus is an epithelium lined tract, containing hairs and unhealthy diseased granulation tissue. It is a very common disease encountered in clinical practice. It is often challenging owing to its higher chances of recurrence. Due to its similarity in features, the disease is being compared to Nadivrana according to the classics of Ayurveda. Despite the vast advancements in the field of medicine and surgery, the management of this disease remains agnostic. Though there are around 17 different techniques enumerated for the treatment of this condition, no gold standard method has been evolved in treating it. The classic of Ayurveda explains a set of treatment methodologies that not only provides a cure to the disease but also prevents the recurrence of the same which is the most notable complication of the disease. This article is aimed at throwing light into the disease and its various treatments adopted, both from modern and ayurvedic perspectives.

Introduction: Cardiovascular disease is a public health problem globally. In India, the prevalence of Acute Myocardial Infarction (AMI) was 6.43%. Several causes lead to AMI, among which excess serum Iron and Ferritin is responsible for an increase in the generation of free radicals, thus accelerate atherogenesis through oxidation of Low-density lipoprotein – cholesterol (LDL-C). Assess serum Iron and Ferritin status and compare them with the cardic marker (CK-MB) among patients with AMI. Methods: The study was performed in a tertiary care centre in TamilNadu, India. This casecontrol study was conducted on 25 patients diagnosed with AMI and 25 age and sex-matched healthy participants as control group. Iron, Ferritin, CK-MB and lipid profile parameters were analyzed in serum samples of the participants. Result: The mean levels of serum Iron, Ferritin, CK-MB and lipid profile parameters were increased significantly among the cases when compared to the control group. CK-MB had a strong positive correlation with serum Iron and Ferritin. Serum Iron and Ferritin also had a positive correlation with total cholesterol and LDL-C, and a negative correlation with Highdensity lipoprotein – cholesterol. The odds of developing AMI in those with serum Iron >51.5µg/dl and Ferritin >137ng/dl were 36 and 61.7 times at higher risk respectively. Conclusion: Higher levels of serum Iron and Ferritin seem to be stronger risk factors for AMI, and shall be considered as early screening cardiac markers for AMI.

INTRODUCTION: Portal vein thrombosis (PVT) is an uncommon complication of chronic pancreatitis. PVT more commonly occurs as a complication of acute pancreatitis and is an indicator of severity of disease. Patients with chronic pancreatitis can develop a pre-hepatic portal hypertension (HTN) in the setting of PVT. These patients are at risk for variceal hemorrhage. Early identification and management is critical. CASE DESCRIPTION/METHODS: A 34 year old female with a history of familial hypertriglyceridemia leading to necrotizing pancreatitis complicated by PVT in the past presented with sudden onset dizziness. She was documented to have a history of liver cirrhosis. On presentation to the outside hospital (OSH), patient was hypotensive and was noted to have a 5 g drop in Hb compared to baseline. She was transferred to the ICU and required support with blood transfusions and vasopressors. EGD at OSH demonstrated grade 1 non-bleeding esophageal varices and portal hypertensive gastropathy. Patient was transferred to our institution for TIPS evaluation. On presentation to our institution, patient remained hemodynamically stable. Examination was consistent with ascites and a R sided pleural effusion, which was confirmed by imaging. She underwent a work-up for chronic liver disease, which was negative. Her ascitic fluid volume was insufficient for paracentesis. Thoracentesis was performed with removal of 1.4 L of transudate consistent with hepatic hydrothorax. Her course was complicated by worsening jaundice. She subsequently underwent liver biopsy with hepatic venogram and pressure gradients. Biopsy did not show evidence of cirrhosis and hepatic venogram was consistent with pre-hepatic portal HTN. MRCP demonstrated dilated common bile duct and main pancreatic ducts. ERCP demonstrated stenosis in the main bile duct, which was treated with plastic stent placement. Following endoscopic intervention, patient's jaundice dramatically improved. TIPS was deferred given patient's history of PVT as well as limited efficacy in the absence of cirrhosis. DISCUSSION: Among reported cases of pre-hepatic portal HTN, chronic PVT secondary to chronic pancreatitis is rare. More commonly, splenic vein thrombus is described, resulting in a sinistral portal HTN with a predominance of gastric varices. Therapeutic considerations for pre-hepatic portal HTN are mainly focused on the prevention of variceal hemorrhage. Medical and endoscopic therapy is the standard of care. TIPS is an option for refractory cases.