Pavan Kumar Yanamadala

Introduction: Abnormal Uterine Bleeding (AUB) has a profound impact on the reproductive health and overall quality of life of women. Although many causes have been identified, the role of regional, sociodemographic, and clinical factors is still not thoroughly examined in India. Aim: To assess the aetiological classification of AUB by employing the FIGO PALM-COEIN system. Materials and Methods: The present retrospective observational study investigated 384 cases of AUB at the Department of Obstetrics and Gynaecology, Government General Hospital, Guntur, Andhra Pradesh, from September 2024 to February 2025. The analysis involved data extracted from electronic and physical medical records, encompassing demographic, clinical, and diagnostic information. The causes were classified according to the FIGO PALM-COEIN criteria. Descriptive statistics were employed to encapsulate the demographic and clinical attributes of the study cohort. Categorical variables were represented as frequencies and percentages. Results: Among 384 women with AUB, the mean age was 38.9±7.6 years, with most patients aged 36-45 years (198, 51.6%). Overweight or obesity was observed in 245 subjects (63.8% of participants). The most frequent co-morbidities were hypothyroidism in 103 subjects (26.8%) and Polycystic Ovary Syndrome (PCOS) in 66 subjects (17.2%). AUB-L (Leiomyoma) in 119 subjects (31.0%), AUB-O in 97 subjects (Ovulatory dysfunction) (25.3%), and AUB-A (Adenomyosis) in 55 subjects (14.3%) were the predominant aetiologies. Significant associations were noted between AUB subtypes and age, early marriage, endocrine disorders, and nulliparity (p<0.05). Conclusion: According to the findings of the present study AUB in Indian women arises from multiple factors shaped by both structural and hormonal influences.

Lichen Planus (LP) is a chronic inflammatory skin condition affecting 0.1-1 % of people globally, with a lower incidence in India. It typically appears as itchy, purplish papules or plaques on the skin, mucous membranes, and nails. Factors contributing to LP include genetic predisposition, immune system issues, psychological stress, and triggers like medications, infections, or environmental factors. Drug-induced exacerbations, though rare, can occur due to hypersensitivity or toxic effects. A 35-year-old woman sought medical help for itchy skin lesions present for 20 days. Examination revealed hyperpigmented violaceous plaques and papules on her limbs and back. Initial treatment included systemic corticosteroids, antihistamines, and topical therapies. However, five days later, she returned with worsened lesions, a burning sensation, and oral mucosa involvement, suggesting a drug-induced reaction. Further tests showed elevated serum potassium and transaminases, leading to her admission for inpatient care. This case highlights the risk of treatment-related exacerbations in lichen planus, emphasising the need for personalised therapeutic strategies. Medication- induced exacerbations can result from direct toxicity or immunological hypersensitivity, with corticosteroids, NSAIDs, and antimalarials being key contributors. Effective management should include stopping suspected medications, providing supportive care, and adjusting treatment based on symptom severity. International guidelines recommend immunosuppressive agents like cyclosporine or methotrexate for resistant cases, along with careful monitoring of treatment protocols. In summary, managing lichen planus involves weighing treatment effectiveness against medication risks. This case underscores the importance of ongoing monitoring and tailoring treatment strategies to align with evidence-based international guidelines for optimal patient outcomes.

A BSTRACT: Introduction: The issue of antimicrobial resistance presents a significant obstacle to global health, largely driven by the inappropriate use of antibiotics, especially in tertiary care settings. In response, the World Health Organization (WHO) has introduced the AWaRe framework to promote the rational use of antibiotics; however, further investigation is required to effectively implement this framework within Indian hospital settings. Aim: This research intends to assess the patterns of antibiotic prescriptions within a south-Indian tertiary care hospital, employing the WHO’s AWaRe framework combined with a range of prescribing indicators. Materials and Methods: This observational, prospective study was carried out at a Tertiary Care Hospital in Kakinada from September 2024 to February 2025. Data were collected and analyzed from 136 patient records receiving systemic antibiotics through electronic health record, and clinical outcomes were analyzed using descriptive statistics and the Chi-square test. Results: Our study showed a significant prevalence of Watch group antibiotics, accounting for 63.9% of prescriptions, in contrast to the mere 13.2% for Access group antibiotics. More common empirical prescribing raises concerns regarding the potential escalation of antibiotic resistance. It is crucial to recognize that the patterns of antibiotic prescribing have a significant influence on patient outcomes. Conclusion: The antibiotic prescribing practices in this study suggest a significant need for improvement, particularly in the use of Watch group antibiotics. This offers an opportunity to align better with WHO AWaRe guidelines. Targeted antimicrobial stewardship initiatives are crucial for promoting responsible antibiotic use and enhancing patient outcomes. Future research should evaluate the effectiveness of these interventions and their long-term impact.

BackgroundGeneration Z students frequently encounter difficulties such as academic demands, prolonged exposure to screens, and psychological stressors, all of which adversely affect their sleep quality. This study investigates the behavioural and psychological elements that shape sleep patterns among individuals aged 18 to 24 in Andhra Pradesh, with particular emphasis on the timing of sleep onset, overall sleep duration, and the presence of sleep disturbances.Materials and MethodsA cross-sectional online survey was conducted using Google Forms, with a total of 932 participants involved. The primary objective of this survey was to collect data on a range of sleep-related parameters, which encompassed sleep latency, duration, disturbances, and various potential influencing factors, including academic pressures, screen time, and psychological stressors.ResultsWhile a majority of the students fell asleep within 30 min, a notable proportion experienced delays in falling asleep. The quantity of sleep reported by students varied widely, with many expressing that they failed to attain sufficient rest. Key factors that negatively impact sleep quality include heightened anxiety, academic stressors, and excessive engagement with electronic devices.ConclusionGeneration Z students in Andhra Pradesh face a decline in sleep quality due to a range of behavioural and psychological stressors, including academic demands, overuse of technology, and increased anxiety. By introducing targeted awareness programs and interventions that address these challenges, it is possible to improve sleep health and foster a more positive overall well-being for this group.

Introduction: Haemodialysis patients frequently experience a diminished Quality of Life (QoL) due to dietary restrictions and associated health challenges. Malnutrition, a common issue among these patients, significantly impacts their overall health and well-being. Thus, the study was conducted to evaluate the potential benefits of individualised nutritional counselling in addressing malnutrition and improving the QoL for patients undergoing haemodialysis. Aim: The study aimed to assess the effectiveness of nutritional counselling in improving the QoL for patients undergoing routine haemodialysis treatment. Materials and Methods: This observational study was conducted at Trust Multispeciality Hospitals in Kakinada, Andhra Pradesh, India, between October 2023 and April 2024. A total of 73 haemodialysis patients were included in the study. The QoL scores were assessed both before and after the nutritional counselling sessions. The Microsoft Excel Analysis ToolPak was used to perform statistical analysis. The Mann-Whitney U test and Z-test for two sample means were applied, with statistical significance set at p<0.05. Results: Out of the total 73 patients enrolled in the study, 44 (60%) were males and 29 (40%) were females. The study revealed significant improvements in the QoL scores after nutritional counselling. There was a statistically significant difference in QoL scores before and after the intervention (U=1691, n1=73, n2=73, p=0.0000453). Conclusion: Nutritional counselling has a substantial positive impact on the QoL of haemodialysis patients. The intervention resulted in marked improvements in their overall well-being, highlighting the critical role of dietary management in patient care.

Bell's palsy is an acute, idiopathic paralysis of the peripheral facial nerve, resulting in sudden unilateral facial weakness. It is often associated with viral infections, particularly herpes simplex, and is more common in adults than children. This case is notable as it involves a 13-year-old male with no prior illness or risk factors. A previously healthy 13-year-old male suddenly developed left-sided facial weakness, including an inability to fully close his left eye and a drooping mouth, without any history of trauma or illness. Neurological examination revealed left-sided facial nerve palsy, lagophthalmos, and Bell's phenomenon, with other cranial nerves unaffected. CT imaging ruled out intracranial abnormalities but showed bilateral maxillary and ethmoid sinusitis. A diagnosis of Bell's palsy was made based on clinical presentation and the exclusion of other conditions. The patient received a treatment regimen of 20 mg oral Prednisolone, 1000 mg Valacyclovir, and methylcobalamin. Supportive care included lubricating eye drops, protective eye taping during sleep, and physiotherapy for facial exercises. The patient was advised to return for reassessment in five days. Pediatric Bell's palsy usually has a positive prognosis, with most cases resolving within weeks to months. Early corticosteroid and antiviral treatment may enhance recovery. This case highlights the urgent need for prompt diagnosis and intervention in pediatric Bell's palsy to prevent complications and ensure optimal recovery. A thorough neurological assessment and appropriate imaging are essential to rule out other causes of facial paralysis.

Background: Self-medication is the practice of treating any ailment or symptom that a person diagnoses for themselves without first visiting a physician. Different communities display different behaviours; hence the purpose of this study is to statistically investigate the patterns and prevalence of self-medication usage. Although health literacy practices have been increasingly recommended in public health literature, there is a lack of studies that examine the relationships between health literacy and self-medication. Methodology: A quantitative, descriptive, cross-sectional, community-based research approach was used in a sample of 316 participants. Health literacy was measured by Single Item Literacy Screener. Data was analysed using SPSS 29.0 version. Results: A total of 316 participants agreed to participate (63.9% were females). The results showed that more than half, 53.4% had adequate health literacy. The prevalence of self-medication was 74%, in these 52% had used medicines by previous prescription and 8% used alternative medicine. There was a significant relationship between the overall health literacy level and practice of self-medication. Conclusion: Improving the health literacy level of the public can reduce inappropriate self-medication Therefore, the design and implementation of training programs are necessary to increase the perception on the risk of self-medication. Appropriate reading skills are important for accessing health information, using health care services, and achieving desirable health outcomes.

Background: Medication reconciliation is the process of examining the patient's entire medication regimen at the time of admission, transfer, and discharge and comparing it with the regimen being considered for the new setting of care. This helps to prevent unintentional inconsistencies across transitions in medical care. Medication reconciliation protects patients from medication side effects while ensuring that they receive standard care. It serves as the baseline from which therapeutic interventions are developed, drug treatment is continued upon admission, and self-care is continued upon release. Objectives: Determining the frequency and kinds of discrepancies discovered during medication reconciliation was the main goal of this study. Determining the effect of medication reconciliation to assess the possible seriousness of medication inconsistencies and ascertain the drug's role in medication errors was the secondary goal. Methodology: In the inpatient units of a tertiary care hospital in the West Godavari District, a prospective, observational study on medication reconciliation was conducted for six months. Results: Of the 385 patients that made up this study, 224 (58.18%) were males and 161 (41.8%) were females. In 169 (43.89%) of the patients, medication discrepancies were detected. There were inconsistencies discovered at several transition points: 50 disparities were detected at admission, 50 during the transfer phase, and 17 on the discharge. Conclusion: A multi-centric assessment including parameters like the percentage of inpatients encountering at least one major medication error would be intriguing. This may support the idea that drug reconciliation is crucial for patient safety.

Background: Pulselessness is the main sign of Takayasu's Arteritis (TAK), a granulomatous large artery vasculitis that mostly affects the aorta, major aortic branches, and pulmonary arteries. Renal artery stenosis is the source of arterial hypertension, which is common in TA. It is estimated that there are 2.6 incidences of Takayasu's arteritis per million people worldwide each year. Case Details: We report on an 18-year-old girl whose significant arterial hypertension on her left arm, identified during a routine check-up, was the primary manifestation of Takayasu's arteritis (TA). The left arm's systolic blood pressure was noticeably greater than the right's. Additionally, there was a difference in blood pressure between the legs and left arm. Auscultation revealed the presence of vascular bruits over the left subclavian regions. A CT angiography was used to establish the diagnosis of TA. The results indicated a substantial constriction at the right renal artery's origin and characteristics compatible with aortic arteritis of the thoracic and abdominal aorta with active disease given wall enhancement. Due to the disorder's rarity and the varied ways in which it manifests clinically, a delayed diagnosis and treatment are likely. Conclusion: Our study emphasizes that this illness can and does affect young people, and as such, patients presenting with suggestive symptoms and signs—especially young patients with unexplained hypertension—should be taken into consideration. Appropriate imaging and clinical suspicion are essential for the accurate diagnosis and treatment of TA patients. Several findings were found during the clinical examination, including signs of claudication, fever symptoms, involvement of major vessels including the aorta and its branches. This illustrates the condition of Takayasu's arteritis and what medical professionals should anticipate when treating it.