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Yadgir district is identified as most backward ditrict by NITI ayoga on account of their “lowest composite indicators in terms of health and nutrition, education, agriculture, water resources, financial inclusion, skill development and basic infrastructure. Traditional community tanks (TCT’s) are classic examples of common pool resources that have been traditionally managed by local communities for irrigating their crops since age old and they are a living example that illustrates the capability of a man-made tank ecosystem evolved in harmony with nature to withstand natural disasters like drought, floods, and cyclones. These tanks not only protect and conserve the environment, but also contribute to livelihood security to rural farmers. These tanks have contributed significantly in agricultural production through supplementary irrigation and are declined recent decades in Yadgir district which is susceptible to drought compared to other district in the states. Such 13 TCT’s were rejuvenated for enhancing water storage capacity in the district under “Jal Samvardhane -District-wide Water Conservation Project” by Bharatiya Jain Sangh (BJS) In colloboration with Dept. of Agriculture, Yadgir. The study proved that, the average water storage capacity was raised by 24.80 percent in selected rejunuvented TCT’s. The average GWL increased for all selected tanks from 1.62 m to 3.81 m during the post-monsoon seasons of 2019 and 2020, respectively, compared to 1.31 metres before tank disiltation in Rabi 2018. Pigeonpea yield was increased by 4.13 percent (6.56 q/ha) to 20.57 percent (7.62 q/ha) with an average of 11.80 percent across all TCTs. Similarly, cotton prices increased by 4.85 percent (7.13 q/ha) to 21.53 percent (7.45 q/ha) throughout the growing season, with an average of 13.44 percent across all TCTs. Tank irrigation development activities have a substantial impact on groundwater recharge, access to groundwater, and in turn on the extension of irrigated water area. Tank irrigation development efforts have been shown to alter crop patterns, increase crop yields, and diversify crops, resulting in increased employment and farm income of small & marginal farmers of the Yadgir district.

BACKGROUND: Stroke is responsible for the largest proportion of neurological disorders causing a significant morbidity. Gamma-glutamyl transferase (GGT) enzyme has an active involvement in atherosclerosis through its role in oxidative and inflammatory mechanisms. Recent evidence suggests that serum GGT is related to the risk and prognosis of cerebrovascular diseases. METHODS: A total of 200 patients (100 with acute ischemic stroke and 100 without stroke) were recruited from various medical wards and medical intensive care unit. Categorical variables were compared between two groups using Chi-squared test and odds ratio (OR). Independent sample t-test was used to see to compare mean GGT level of stroke patients with control. RESULTS: There was no statistical difference with respect to distribution of age groups (χ2 = 1.25, P = 0.741) and gender (χ2 = 2.678, P = 0.1018) between cases and controls. Mean age of stroke patients (mean [M] = 61.7, standard deviation [SD] = 13.8) did not differ from controls (M = 62.2, SD = 13.6), P = 0.80. The odds of suffering from diabetes were significantly higher in stroke patients than cases (OR = 2.25, P = 0.005). Independent sample t-test found a significant difference in serum GGT level between cases (M = 57.47, SD = 11.8) and control (M = 41.72, SD = 7.5), P ≤ 0.0001. CONCLUSIONS: Serum GGT was significantly higher in stroke patients than age-sex-matched nonstroke patients. Association remained significant in stroke patients irrespective of age, gender, and other risk factors. Stroke patients with diabetes, hypertension, dyslipidemia, obesity, and smoking had higher level serum GGT level than those without these risk factors. Prospective cohort studies can further explore the potential of GGT as a predictor of acute ischemic stroke.

Abstract Objective: To determine the association between the preoperative level of hemoglobin A1c (HbA1c) and in-hospital mortality in patients who underwent valvular heart surgery in our center in a retrospective cohort. Methods: In this retrospective consecutive cohort study, patients with type 2 diabetes mellitus who were referred to our center for elective valvular surgery were enrolled and followed up. The endpoint of this study was in-hospital mortality. Based on the level of HbA1c, patients were dichotomized around a level of 7% into two groups: exposed patients with HbA1c ≥ 7% and unexposed patients with HbA1c < 7%. Then, the study variables were compared between the two groups. Results: Two hundred twenty-four diabetic patients who were candidates for valvular surgery were enrolled; 106 patients (47.3%) had HbA1c < 7%, and 118 patients (52.6%) had HbA1c ≥ 7%. The duration of diabetes was higher in patients with HbA1c ≥ 7% (P=0.007). Thirteen (5.8%) patients died during hospital admission, of which nine patients were in the high HbA1c group. There was no significant difference between the groups regarding in-hospital mortality (P=0.899). Both the unadjusted and adjusted logistic regression models showed that HbA1c was not a predictor for in-hospital mortality (P=0.227 and P=0.388, respectively) Conclusion: This study showed no association between preoperative HbA1c levels and in-hospital mortality in candidates for valvular heart surgery.

The worldwide epidemic of diabetes mellitus and hyperglycemia in pregnancy (HIP) presents many challenges, some of which are country-specific. To address these specific problems, parochial resolutions are essential. In India, the government, by working in tandem with (a) national groups such as the Diabetes in Pregnancy Study Group of India, and (b) global organizations such as the International Diabetes Federation, has empowered the medical and paramedical staff throughout the country to manage HIP. Additionally, despite their academic university backgrounds, Indian health planners have provided practical guidelines for caregivers at the ground level, who look up to these experts for guidance. This multipronged process has helped to negotiate some of the multiple problems that are indigenous and exclusive to India. This review traces the Indian journey to manage and prevent HIP with simple, constructive, and pragmatic solutions.

Since its initial description in 1964, various ophthalmic indications of neodymium: Yttrium-aluminum-garnet (Nd: YAG) laser have evolved. The common indications include capsulotomy of posterior capsule for opacification following cataract surgery and peripheral iridotomy in angle closure glaucoma. We present the case of successful use of Nd: YAG laser in treatment of occlusio pupillae and iridolenticular ring synechiae in a 37-year-old male presenting with bilateral 360° posterior synechiae secondary to chronic anterior uveitis.

Background: Gestational diabetes mellitus (GDM) is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. Materials and Methods: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2nd year (2013–2014) after blood sugar levels were controlled. Results: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P < 0.0001, relative risk >1 in every case). Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001). Conclusion: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study.

Introduction: Percutaneous Nephrolithotomy (PCNL) is the treatment modality used for the extraction of large renal stones, or multiple calculi or stones resistant to shock wave lithotripsy. The General Anaesthesia (GA) is the standard modality for PCNL. However, few studies conclude that Spinal Anaesthesia (SA) can be an alternative method of anaesthesia with similar incidence of complications. Aim: In our study we evaluated the feasibility of spinal anaesthesia in terms of intraoperative and postoperative results in patients undergoing PCNL. Materials and Methods: The total 1298 PCNL operations were done for kidney stone from January 2013 to December 2016, out of which 1160 patients underwent PCNL under SA while remaining 138 operations were carried out under GA in the prone position. We retrospectively collected data from the patient’s documents. The intraoperative haemodynamic stability was primary objective, and average fall of haemoglobin, postoperative anaesthetic outcome like total tramadol used in first 24 hours, surgical outcome like total clearance of stone burden, patient satisfaction, surgeon satisfaction, need of blood transfusion, conversion to general anaesthesia and pleural puncture were the secondary objectives. Results: The mean age of the patients was 38.0±17.1 years, and the mean operative time was 80.0±25.9 minutes. The mean calculus size was 30.2±11.8 mm. Return of sensory and motor activity took 150.0±29.2 minutes and 111.0±18.8 minutes, respectively. In first 10 minutes of anaesthesia, 148 (12.75%) patients developed hypotension, which was managed by ephedrine 6 mg intravenously (IV). Total seventy two patients (6.2%) needed blood transfusion and 32 (2.75%) complained of headache, dizziness and low back pain for two to four days after the operation, which improved with analgesics and bed rest. Ninety percent of the patients had complete clearance of calculus or there were no significant residual calculi larger than 5 mm on follow up ultrasonography. Conclusion: It can be concluded from our study that spinal anaesthesia is the safe and effective method of anaesthesia for PCNL in adult patients.

ISO certification was a great hope for many stakeholders in India for making the country strong in terms of quality practices. It was a blessing in disguise when in early nineties; buyers were imposing conditions that you should be ISO compliant to do business with them. ISO was a great system to bring in improvements in the way an organization functions. But unfortunately some have adopted a short cut approach in getting the certification done. It is only just before the audit team comes for re-inspection that firms start removing dust from the quality manual files so that they can pretend that that they follow those systems. But a real commitment to adhering to these systems is missing. The paper describes such scenario existing in some quarters in India and warns against such practices for the overall good of the system.

Background: Conjunctivitis of the newborn is defined as hyperemia and eye discharge in the neonates and is a common infection occurring in the neonates in the first month of life. In the United States, the incidence of neonatal conjunctivitis ranges from 1-2%, in India, the prevalence is 0.5-33% and varies in the world from 0.9-21% depending on the socioeconomic status. Aim: To study the organisms causing conjunctivitis of the newborn and to correlate the etiology with the mode of delivery. Design: Single center, prospective, observational study. Materials and Methods: A total of 300 mothers and their newborns, born over a period of one year, were included in the study. Of these 200 newborns were delivered through vaginal route (Group A) and 100 (Group B) delivered by lower segment caesarean section (LSCS). At the time of labour, high vaginal swabs were taken from the mothers. Two conjunctival swabs each from both eyes of the newborn were collected at birth and transported to Microbiology department in a candle jar immediately. Results: Eight babies in Group A, developed conjunctivitis at birth. None of the babies in Group B developed conjunctivitis, this difference was statistically highly significant (P

Juvenile primary hypothyroidism causing cystic ovaries and pseudoprecocious puberty (Van-Wyk Grumbach syndrome (VWGS)) is well documented in literature. There are only a few reports of primary hypothyroidism presenting as ovarian cysts in adults. Here we present a case of huge bilateral ovarian cysts in adulthood as the presenting feature of VWGS due to chronic uncontrolled juvenile hypothyroidism. Large uniloculor right ovarian cyst (119 × 81 × 90 mm) and a multicystic left ovary (55 × 45 × 49 mm) were detected in a 24 year lady with secondary amenorrhea, galactorrhea, and palpable abdominal mass with history of neonatal jaundice, delayed milestones, short stature, and precocious menarche at age of 7.5 years age. She had elevated levels of cancer antigen (CA)-125 which normalized post levothyroxine supplementation. Elevated CA-125 may lead to misdiagnosis of ovarian carcinoma and inadvertent treatment. Bilateral ovarian cysts in adults are a rare presentation of juvenile hypothyroidism. It is necessary to screen for primary hypothyroidism in patients presenting with bilateral ovarian cysts to prevent unnecessary evaluation and treatment.

Rathke′s cleft cysts (RCC) are cystic sellar and suprasellar lesions derived from remnants of Rathke′s pouch, lined by cuboidal or columnar epithelium. RCC are usually asymptomatic but can present with headache, visual impairment, panhypopituitarism and hypothalamic dysfunction. Diabetes Insipidus as a presenting symptom of RCC is reported, but rare. We present a case of a 48-year-old male presenting with polyuria and on investigations found to have central diabetes insipidus due to a sellar RCC. Patient underwent transsphenoidal surgery with complete excision with resolution of his symptoms. His polyuria resolved post-surgery without vasopressin replacement, which has never been reported.

Acute pancreatitis due to hypercalcemia associated with hyperparathyroidism (HPT) is not very common. We herein report a case of a 21-year-old woman, who presented with acute pancreatitis. She had a past history of recurrent nephrolithiasis. Subsequent evaluation revealed hypercalcemia (serum calcium: 12.6 mg/dL); low phosphate (2.9 mg/dL) with elevated parathyroid hormone (PTH, 156.7 pg/mL) and HbA1c (6.9%). Diagnosis of primary HPT (PHPT) was made. Recurrent pancreatitis due to hypercalcemia may have resulted in diabetes mellitus.

A 72-year-old man presented with palpitation, dyspnea, and chest discomfort. Initial investigations revealed atrial fibrillation (AF) and pericardial effusion, further investigations unraveled primary hypothyroidism (thyroid stimulating hormone) of 34.7 μIU/ml and total thyroxine (T4) of 5.57 μg/dl). Treatment with levothyroxine led to resolution of symptoms, AF, and pericardial effusion.

Objectives: To cure long and multiple ureteric strictures by a simple procedure without the long term complications of bowel interposition or surgery of high magnitude like auto-transplantation. Methods: Ureteric strictures in 5 patients were treated with buccal mucosa onlay grafts with an omental wrap. The underlying etiology was tuberculosis in 4 patients and amyloidosis in I patient. Mean age was 45 years. Three patients had strictures in upper ureter, 1 patient in mid-ureter and 1 patient had panureteric stricture. In all pa-tients length of stricture was greater than 5 cm. Results: Ureteric patency was established in all patients. Four patients have persistent improvement in renal func-tion. In I patient, renal function improved initially (at 6 months follow-up) but subsequently (at 1-year follow-up) the unit was non functioning. Follow-up was in the range of 1.5 year to 3.5 years. Conclusions: In selected patients with complicated be-nign ureteric strictures, buccal mucosal dorsal onlay graft was proved capable of maintaining patency and good uri-nary drainage. The procedure is technically simple and devoid of complications.

Background: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized by glucocorticoid deficiency, high ACTH levels and normal mineralocorticoid levels. FGD is caused due to defects in adrenocorticotropic hormone (ACTH) signaling. The defect can be caused by mutations in genes encoding the ACTH receptor (melanocortin 2 receptor) or its accessory protein. Patients: Here we report three siblings with FGD. The second in order of siblings presented at an age of 15 years with history of diffuse hyperpigmentation since childhood. Their parents were non consanguineous. The patients were hyperpigmented and taller compared with their parents. None of the siblings had ambiguous genitalia or neurological abnormalities. There was no history of tuberculosis in the family. Biochemical investigations revealed low serum cortisol (1250 pg/ml). Serum electrolytes, aldosterone, and plasma renin activity was normal. Based on the above mentioned data, a provisional diagnosis of FGD was made after ruling out the common causes of glucocorticoid deficiency. Conclusion: FGD is a rare autosomal recessive disorder which causes isolated glucocorticoid deficiency. Unawareness about the condition may lead to delayed diagnosis and treatment, which are associated with high rates of morbidity and mortality. Once a diagnosis is made it is easily treatable.

Thyroid stimulating hormone (TSH) secreting adenomas are the rarest type of pituitary adenomas (1:1000000 in the population; 0.2- 2.8% of adenomas). Plurihormonal thyrotropic adenomas are even rarer usually having cosecretion of growth hormone (GH) and prolactin. We report perhaps for the first time, TSH, GH, adrenocorticotrophic hormone (ACTH) and gonadotropins secreting pituitary macroadenoma diagnosed in a 40 year lady presenting with features of thyrotoxicosis for 5 months, amenorrhea for 3 months and newly diagnosed diabetes and hypertension for 2 months along with headache, nausea, and vomiting, who had acromegaloid habitus, grade-II goitre, increased uptake on Technitium-99 pertechnate thyroid scan (4.1%; normal: 0.24-3.34%), with increased T3 (5.98 pg/ ml; 1.5-4.1), increased T4 (2.34 ng/dl; 0.9-1.8), inappropriately high TSH (2.32 μIU/ml; 0.4-4.2), insulin like growth factor-1 (711 ng/ ml; 109-264), non-suppressed post-glucose GH (15.9 ng/ml;

Hirsuitism though not uncommon (24%), is not considered to be a prominent feature of acromegaly because of its lack of specificity and occurrence. Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic ovarian syndrome (PCOS). Twenty-eight year lady with 3 year duration of hirsuitism (Modified Ferriman Gallwey score-24/36 ), features of insulin resistance (acanthosis), subtle features of acromegaloidism (woody nose and bulbous lips) was diagnosed to have acromegaly in view of elevated IGF-1 (1344 ng/ml; normal: 116-358 ng/ml), basal (45.1 ng/ml) and post glucose growth hormone (39.94 ng/ml) and MRI brain showing pituitary macroadenoma. Very high serum androstenedione (>10 ng/ml; normal 0.5-3.5 ng/ml), elevated testosterone (0.91 ng/ml, normal

A 16-year-old Indian girl presented with increased facial hair growth, weight gain, amenorrhea and generalized weakness for the last 3 months. On examination she was found to have severe hirsutism, her modified Ferriman-Gallwey score was 24/36, she had broad purple striae on abdomen, hypertension and proximal myopathy. On investigations, the patient was found to have ACTH dependent Cushing's syndrome

An eight-year, 4-month old Indian girl with low IQ and delayed milestones, presented with headache (4 years), breast development (4 months), and menstrual bleeding for 22 days. Examination revealed short stature [height: 91.5 cm; SD score: -5.59], coarse dry skin, umbilical hernia (arrow), delayed reflexes, Tanner’s stage-3 breasts, absent pubic and axillary hair

An 18-year-old Indian boy presented with increasing weight, generalised weakness, proximal myopathy and some rashes over his abdomen for the last 6 months. On examination, he was found to have broad purple striae on his abdomen, hypertension and proximal myopathy. He gave history of exogenous oral steroid use for his bronchial asthma which had been more frequent for the last year.

Fibrocalcific pancreatic diabetes (FCPD) is a rare form of ketosis-resistant diabetes in the young (15 to 40 years old) of unknown etiology. It has been observed in tropical and subtropical countries with highest incidence in south India, and is believed to have some association with tropical chronic pancreatitis, malnutrition, toxin exposure (e.g., cassava) and SPINK1 mutation. It is associated with a hundredfold increased risk of pancreatic cancer compared to the general population

A 60-year-old Indian male with a 2 year history of diabetes mellitus on insulin therapy and a past history of right sided hemiparesis due to cerebrovascular accident (CVA) presented with fracture of the neck of the left femur after a fall. X-ray showed extensive vascular calcifications, scrotal calcification and severe osteoporosis.