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Background: Overactive bladder (OAB) is identified by urinary urgency, with or without urgency urinary incontinence, typically accompanied by increased daytime urinary frequency and nocturia, in the absence of proven infection or other evident pathology. Methods: A cross-sectional, observational, questionnaire-based knowledge, attitude, and practice (KAP) survey was conducted across India from January 2022 to July 2023 to understand OAB therapy through 14 multiple朿hoice questions containing questionnaire shared with 1, 029 healthcare professionals (HCPs), including urologists, surgeons, nephrologists, and consulting physicians. Results: The HCPs see 10-20% of patients daily in clinical practice, wherein 5-10% are females. Patients usually consult general practitioners first and then other specialists. Although anticholinergics are commonly used in the management of OAB, HCPs reported that side effects (57%) and the high cost of therapy (43%) were mainly responsible for discontinuing anticholinergics. Mirabegron was preferred by 67% of HCPs in the treatment of these patients. Mirabegron is also preferred as a first-line treatment by all HCPs in this survey. It is prescribed for 6-12 months, has a response rate of >75% in clinical practice, and offers a more favourable side-effect profile compared to anticholinergics. In cases where patients do not respond to anticholinergics or experience treatment failure, a combination therapy of mirabegron and solifenacin is preferred. Conclusions: The survey highlights the use of mirabegron as a first-line treatment for OAB, its better side-effect profile, and its role in combination therapy with solifenacin for patients unresponsive to anticholinergics, ultimately improving the quality of life of patients.
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Takayasu抯 arteritis (TA) a.k.a pulseless disease is a chronic inflammatory occlusive thrombo-aortopathy. It is a rare inflammatory disease affecting large arteries, often leading to significant diagnostic challenges, especially when presenting with atypical symptoms. This case report explores a patient, whose primary complaints were chest pain and no neurological or constitutional symptoms, diverging from the common presentations of diminished pulses or limb claudication. Advanced imaging, including CT Aortogram and interventions like cardiac angiography, played a crucial role in detecting vascular inflammation and stenosis, facilitating accurate diagnosis and management. The case underscores the importance of considering Takayasu arteritis in differential diagnoses, even with non-classical presentations. This present case demonstrates rare and unique presentation of TA where patient presents with myocardial infarction and cardiogenic shock and also explains the diagnostic dilemma of TA with such unusual presentation.
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Background: Type 2 diabetes mellitus (T2DM) is known to be associated with cognitive impairment, but the Impact of the timing of diagnosis on cognitive function remains unclear. This pilot project aims to assess the cognitive function of people diagnosed with T2DM at an early vs. late stage. The study will examine several cognitive domains, such as attention, memory, executive function, visuospatial skills, and sensorimotor abilities. Methods: We recruited 80 adults diagnosed with T2DM, evenly split into 2 groups-one with early diagnosis (?5 years) (n=40) and other with late diagnosis (?6 years) (n=40) depending on when their disease was identified. Both groups underwent evaluation for demographic and clinical factors. Cognitive function was assessed using mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and Addenbrooke's cognitive examination (ACE-III). Specific domain of cognition wasmeasured as span of attention (Tachitoscope), memory (PGI Battery scale), executive function (Stroop test), visuospatial function (Corsi block test), sensorimotor abilities (auditory /visual reaction time), and intelligence (Koh抯 Block design test). Results: Preliminary findings suggest that the early diagnosis group showed significantly average cognitive performance compared to the late diagnosis group. They also showed improved metabolic control and increased levels of physical activity. Individuals in the early diagnosis group had higher educational levels and socioeconomic status, potentially leading to improved disease detection and more effective health management. Conclusions: These findings indicate that identifying T2DM at an early stage, help in preserving cognitive function as compared to a diagnosis made at a later stage.
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Background: Hysterectomy is the most frequently performed major surgical procedure in gynaecology. It is an efficacious treatment option for numerous gynaecological conditions. This study aimed to investigate the different routes of hysterectomies, such as abdominal, vaginal, and laparoscopic, and their outcomes in benign gynaecological diseases in a tertiary care centre in Tamil Nadu.Methods: This retrospective observational study included 200 patients who were admitted to the department of obstetrics and gynaecology at Chettinad Hospital and Research Institute, Tamil Nadu, India underwent hysterectomy between January 2021 and January 2023, and were collected from the MRD. Patient history included age, parity, indication for surgery, duration of surgery, route of hysterectomy, intraoperative or postoperative complications, duration of hospital stay were collected.Results: This study analysed 200 patients who underwent hysterectomy, with the majority aged between 40-50 years (60%) and multiparous women (85%). The most common indications were abnormal uterine bleeding (80%), uterine prolapse (12%), benign ovarian cyst (5%) and post-menopausal bleeding (3%). Total abdominal hysterectomy (49%) was the most common approach, followed by vaginal/non-descent hysterectomy (19.5%), total laparoscopic hysterectomy (16.5%), and laparoscopic-assisted vaginal hysterectomy (15%). Complications included wound infections (3.5%), excessive bleeding (3%), bladder injuries (1%) and ureter injury (0.5%). The procedure duration and hospital stay were shorter for vaginal and laparoscopic approaches than for open abdominal hysterectomy. The laparoscopic approach had the lowest rates of complications such as bladder injuries and excessive bleeding.Conclusions: Vaginal hysterectomy is preferred for uterine prolapse, whereas laparoscopic techniques offer benefits such as reduced blood loss and lesser hospital stay and morbidities. Although rare, complications emphasize the need for careful postoperative monitoring to optimize patient care.
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Women often report musculoskeletal ailments during perinatal period resulting in less sleep hours and decline in physical activity. It has been speculated that physical activity can lower the frequency of muscular pain and enhance good quality sleep among women. Hence, the review aimed to investigate the association of breastfeeding related musculoskeletal pain, sleep quality and physical activity thus refining quality of life among women. Literature search was performed using search strategy on PubMed, Scopus and Pedro databases during 2019-2023. A total 54,037 articles were found via database searching out of which only 16 studies were relevant meeting the inclusion criteria. All the studies found that breastfeeding related musculoskeletal pain, sleep quality and physical activity are associated with each other. To lower the incidence of muscular pain and improve sleep quality, physical activity can be incorporated thus preventing occurrence of future complications. Hence, it has been suggested that physical activity is key solution of emerging musculoskeletal pain and broken sleep quality. Evidence from this literature supports that prenatal education emphasizing necessity of physical activity should be routinely integrated into maternal care in an effort to reduce chances of future complications.
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A retained placenta is suspected when there is failure of expulsion of the placenta even after 30 minutes of delivery of the fetus. Retained placenta is a common cause of PPH and, hence, a significant cause of maternal mortality and morbidity in developing countries. Thus, early intervention is necessary to prevent this post-delivery of the baby. We present a case of retained placenta in a young primigravida with oligohydramnios with fetal horse horseshoe-shaped kidney and a foetal echogenic bowel loop. Her clinical findings and investigations were not significant at the time of admission. She was induced with dinoprostone gel intra-cervically and delivered via vaginal route. There was failure of expulsion of the placenta even after 30 minutes of delivery of the baby. Inj. syntocin 5 units were given via the umbilical cord. In the event of this failure, the patient was shifted inside the OT, and manual removal of the placenta was done under general anaesthesia f/b evacuation retained bits of placental membranes with ovum forceps under USG guidance. Retained placenta can lead to severe PPH and its consequences in the postpartum period. Thus, it requires timely intervention to prevent PPH and reduce maternal mortality and morbidity. Cases of retained placenta can occur even in the absence of any known identified risk factors and should be managed in a tertiary care centre with OT facilities.
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ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.
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Background: Neonatal sepsis is a critical condition posing a significant threat to newborns globally, particularly in developing countries. The non-specific symptoms and time-consuming traditional diagnostic methods highlight the need for rapid and reliable biomarkers. Recent studies suggest platelet count and indices such as mean platelet volume (MPV) and platelet distribution width (PDW) as potential indicators for early diagnosis of neonatal sepsis. This study aimed to assess the correlation between platelet count and its indices and neonatal sepsis.Methods: A hospital-based cross- sectional study was conducted at NICU of tertiary care hospital involving 80 neonates with suspected sepsis. Platelet count, PDW, and MPV were measured and correlated with neonatal sepsis. Statistical analyses were performed using SPSS software, with a significance set at p<0.05.Results: Of the 80 neonates studied, 22.5% exhibited thrombocytopenia. There was a noteworthy inverse relationship discovered between platelet count and sepsis, while MPV and PDW were higher. Gram-negative organisms were the most common cause of sepsis, out of which E. Coli (63.64%) was the most common.Conclusions: The study confirmed a significant association between platelet count and indices with neonatal sepsis. Platelet count, MPV, and PDW can serve as effective, rapid diagnostic markers, potentially improving early detection and outcomes in neonatal sepsis.
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Background: The objective of the study was to evaluate serum ferritin levels to define it as a diagnostic and prognostic biomarker for severity of sepsis.Methods: In this hospital-based descriptive type of observational study, conducted at the Department of Pediatrics, NIMS Medical College; 80 children of age group 6 months to 18 years with diagnosis of pediatric sepsis were included. Children were divided into grades of sepsis (sepsis, severe sepsis, septic shock, MODS). Progress of sepsis, severe sepsis, septic shock, and sepsis with MODS was followed with serum ferritin levels on day 1, day 3, day 7, or more than 7 days and one week post recovery.Results: Pneumonia was identified as the most common source of infection. The blood culture positivity rate was 32.5%. E. coli was the most common organism grown on blood culture. Median serum ferritin levels increased as sepsis severity worsened. A significant association was discovered between sepsis severity and CRP levels at the time of admission.Conclusions: There is a consistent pattern of Serum ferritin levels with increasing severity of pediatric sepsis. Routine use of serum ferritin levels in diagnosis and prognostication is both feasible and simple. CRP level correlate well with serum ferritin level for diagnosis of sepsis.
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Background: This study was conducted to gather expert opinion regarding the clinical use of a high dose of amoxicillin 600 mg + clavulanic acid 42.9 mg in pediatric practice in Indian settings.Methods: This cross-sectional study comprised 19 questions and gathered perspectives from pediatricians across India regarding the prescription practices of amoxicillin (600 mg) and clavulanic acid (42.9 mg) for various bacterial infections in pediatric patients. Data were analyzed using descriptive statistics.Results: Majority (85.65%) of clinicians opined that the high dose of amoxicillin (600 mg) and clavulanic acid (42.9 mg) was very effective in treating bacterial infections in pediatric patients. About 54% of the respondents reported prescribing 600 mg amoxicillin + 42.9 mg clavulanic acid as the high dose for pediatric patients, while 41% of them prescribed 400 mg amoxicillin + 57 mg clavulanic acid as the high dose for pediatric patients. According to 51% of clinicians, the benefits of prescribing the higher-strength formulation of amoxicillin (600 mg) + clavulanic acid (42.9 mg) compared to the standard-strength formulation of amoxicillin (500 mg) + clavulanic acid (125 mg) include increased effectiveness against resistant bacteria, reduced risk of adverse effects, and reduced frequency of dosing.Conclusions: This study highlighted the clinicians' preference for the high dose of amoxicillin (600 mg) and clavulanic acid (42.9 mg) as an effective treatment for bacterial infections in pediatric patients. The respondents preferred the high dose over other doses of amoxicillin and clavulanic acid due to the lower percentage of adverse effects.
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Background: This study was done to report on adequate antenatal care services owing to the impact of IEC intervention among deprived Baiga tribal women. Methods: Intervention study of 367 tribal women having a reproductive age of 15 to 49 year of 24 villages from district-Dindori. Pre-tested, administered intervention tools were implemented in intervention groups (12 villages) to enhance women's knowledge for the use of ANC services (phase-I) and in phase-II impact evaluation survey of mother’s antenatal care utilization and related details were collected from mothers of both intervention and control group. Based on baseline indicators, a carry forward IEC-intervention study was taken considering the case-control design. Logistic regression analysis was used to identify the associated factors. Results: Use of ANC services 82.3% was found to have increased by 10.3% from baseline (72%); it was found significantly higher (88%) in the intervention group while lower (76.1%) in the control group. As regards 60% women received more than 3 ANC check-ups remarkably higher by 13% in the intervention group. Health institution child births 44.8% were found meaningfully improved by 36.8% from baseline (8%); also, it was revealed higher (49.7%) in the intervention group than lower (40%) in the control group. Women’s education and exposure of previous pregnancy has found strong association with adequate antenatal care in intervention groups. Conclusions: A comparatively high proportion of the use of ANC services and institutional child birth were found in the intervention group. Improving the access to more quality health services in other tribal communities may necessitate the intervention research.
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Background: B-cell prolymphocytic leukemia (B-PLL) is a rare disease, consisting <1% of mature B-cell malignancies. B-PLL is often refractory to chemotherapy, with a median survival of 3 years. Due to its rarity, no large cohort studies exist elucidating outcomes. Methods: All B-PLL patients >15 years were identified in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database between 2000-2020. Statistical analysis explored demographic variables like age; categorized as adolescent or young adult (AYA) and adults. In adults, differences in survival due to factors such as sex, race/ethnicity, household income, rurality, and age categorized in 10-15 year buckets was analyzed. Results: B-PLL patients were predominantly white (78%), over 40 years (96%) and mostly residing in metropolitan areas (90%). Interestingly, the AYA cohort were mostly female (70%). 35% of the AYA patients were Hispanic, while being only 9% in adults. Among adults, the rate of Asian/Pacific-Islander patients that were alive at the time of the data query was 53% compared to 34% in Hispanic, 31% in black, and 24% in white patients (p=0.025). Younger age was also associated with greater chances of survival (p<0.001). Conclusions: In line with known poor prognosis of the disease, 23% patients were alive at the time of data query. Female and Hispanic patients were overrepresented in the AYA age group. In the adult group Asian/Pacific-Islander patients had better survival outcomes, as did younger patients. Further research is necessary to explore why B-PLL incidence in AYA patients is higher among Hispanic and females.
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Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a very rare congenital cardiac disorder with an incidence of about 1 in 300000 live births. The majority of patients are symptomatic in early infancy with symptoms of intractable heart failure. Only very few patients survive to adulthood with minimal symptoms. A young female was referred to us in view of breathlessness, clinical examination didn抰 show any signs except a grade 2 systolic murmur in the pulmonary area. The patient underwent 2D echocardiography evaluation which revealed suspicion of ALCAPA and was confirmed using coronary angiography. The patient underwent surgical closure of ALCAPA along with left internal mammary artery (LIMA) to left anterior descending (LAD) anastomosis, postoperative period was uneventful, on routine follow-up the patient is doing well with resolution of dyspnea. ALCAPA is a very rare disorder and most of it is diagnosed in infancy and not many surviving beyond infancy, high degree of suspicion of ALCAPA is needed for young patients presenting with symptoms of angina, heart failure.
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Neuroendocrine tumors (NETs) have varied pathophysiological characteristics, location, clinical presentation, management & outcome. Unfortunately, most NETs are non-functional and therefore, either remain asymptomatic until incidentally detected or present very late with pressure symptoms, adding up to the associated morbidity and mortality. Here we presented a case of a 43-year gentleman, who presented to gastroenterology OPD with chief complaints of heartburn and pain in the upper abdomen for one year. He had an equivocal clinical examination and laboratory parameters. Upper GI endoscopy and computed tomography revealed multiple nodular growths in the D1 segment and pylorus of the stomach. He was successfully managed by wide local excision of D1 and distal stomach (pylorus) followed by Polya gastrojejunostomy reconstruction. Histopathology confirmed well-differentiated NETs, low Ki67, and positive for chromogranin and synaptophysin. This case draws attention to the early age of presentation of multifocal NETs with vague symptoms and equivocal clinical examination. Coexisting gastric NETs with duodenal NETs in itself is very rare, never the less non-functional status and pre-operative diagnostic dilemma. Here, we have also drawn attention to the pros and cons of various diagnostic tools and how their utility can sometimes limit the approach of clinicians, apart from a high index of suspicion.
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Anaplastic meningioma with osteosarcomatous differentiation is a very rare finding. We herewith present squash cytology, histopathology and immunohistochemistry findings of this rare case with systematic approach to diagnosis. A 38-year-old female presented with complaints of headache, vomiting, seizure with loss of consciousness and left side weakness. Radiologically, there was a heterogeneous hyperintense likely extra axial densely calcified solid lesion measuring approximately 4.2�1�5 cm along right high frontal convexity compressing the adjacent brain parenchyma. Histology sections revealed fibro collagenous tissue, devitalized bone, multiple vascular spaces lined by fibrous septa with giant cells, along with spindle cell and round proliferation at one end with vague whorl formation. High mitosis, (>20/10 hpf) along with malignant lacy osteoid closely abutting the highly pleomorphic cells were indicative of a malignant spindle cell neoplasm with osteosarcomatous differentiation. Systematic approach, immunohistochemistry with involvement of all the specialities involved led to the correct diagnosis and management of patient.
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Focal myositis is a rare disease, and to date, 250 cases have been reported in literature. It is a benign dysimmune disease of unknown etiology. It is defined as myopathy affecting a single muscle without systemic manifestation with a historically proven inflammatory myositis process. It usually presents as a mass ranging from 1 to 20 centimeters, growing insidiously over weeks to months, and may be painless or tender. Or the growth can be rapid and with a lot of pain and disability. It's common in lower limbs and rare in facial muscles. It usually regresses spontaneously and does not invade the surrounding structures. In 18% of cases, there may be a relapse. Laboratory studies may show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Creatine kinase (CK) is usually not elevated significantly. Autoantigens are often normal or may be marginally elevated. Magnetic resonance imaging (MRI) is a diagnostic tool of choice and is done with relative ease. Electromyography (EMG) occasionally shows recordable spontaneous and repetitive discharges. Nerve conduction velocity (NCV) may be helpful if nerves are involved. A muscle biopsy usually confirms the diagnosis with specific features. Tumours of muscle and Inflammatory myositis need to be differentiated. Sometimes focal myositis may be associated with immune-mediated inflammatory disease (IMID), neoplasms, radiculopathy, and trauma. Focal myositis is usually self-limiting and benign. It usually responds to NSAID and occasionally may require a short course of steroids, especially in those with elevated ESR and CRP.
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Background: This study aimed to gather the clinicians� perspective regarding the use and prescription practice of dual combination oral anti-diabetic drugs (OADs) in type 2 diabetes mellitus (T2DM) management in Indian settings. Methods: A cross-sectional study was conducted by using a 29-item structured questionnaire covering factors considered, challenges, preferred indicators of glycemic control, continuous glucose monitoring (CGM) use, and strategies. Additionally, it explored clinicians' feedback and experiences with dual combination oral anti-diabetic drugs in T2DM management. Results: Seventy percent of clinicians observed improved adherence to dual combination therapy of OAD. The combination of dipeptidyl-peptidase 4 (DPP4) inhibitors and metformin was favored for early initiation and showed better tolerability within the first year according to 42% of clinicians. Approximately 63% of clinicians prefer vildagliptin + metformin for 40� year-old diabetics. The combination yields favorable outcomes: 21% in young, 14% in elderly, and 7% in long-standing diabetes cases. After 5 years, 37% of clinicians observed 40-50% of diabetics reaching an HbA1c goal of <7.0% with this combination. Clinicians choose glimepiride + metformin for treatment intensification based on its efficacy, cardiovascular (CV) safety, and fewer adverse events. These factors were collectively recognized by 66.54% of respondents. Conclusions: This study provided valuable insights into real-world clinical practices and preferences regarding dual combination therapy for diabetes management. Clinicians identified the fixed-dose combination of DPP4 inhibitors and metformin as the preferred choice and highlighted the effectiveness of glimepiride + metformin in overcoming treatment intensification challenges.
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Background: Inguinal Hernia mesh repair surgery is one of the most commonly conducted surgical procedures. Between two approaches: open and laparoscopic, which is better for the patient in terms of cost and outcome in terms of quality of life and return to economic activity. To facilitate comparability across studies, cost effectiveness analysis requires measurement of both costs and quality adjusted life years (QALY). Methods: Descriptive, observational study which entails classifying costs, identifying cost centres, tracing all costs related to the elective procedures for inguinal mesh hernioplasty by both open and laparoscopic methods followed by checking the Quality of life pre and post-surgery of these patients through the EQ-5D-3L by telephonic interview. A Cost Effective analysis was conducted by the end of the study. Based on available data, we took 35 cases of laparoscopic procedure and 45 cases of open surgery as a universal sample size. Results: Traditional costing showed a difference of approximately INR 3245.93/- in the 2 procedures with laparoscopic surgery being costlier. Significant improvements were noted in patients post laparoscopic surgeries with less people complaining of post operative pain/discomfort and early resumption of daily activities and mobility within a month after the surgery. ICER is tilted in favour of laparoscopic surgeries by a value of Rs 1,08,197.66 per QALY. Conclusions: The difference in cost is minimal but the difference in the QALY scores and ultimately the ICER determines that laparoscopic surgery has an edge over open surgery in terms of outcome and patient comfort.
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When the placenta does not expel after 30 minutes of delivery of fetus it is said to be retained. It can be a cause of post-partum haemorrhage. It may result from poor uterine contractions. The most common source of a trapped placenta is from a partial closure of the cervix and/or a contracted lower uterine segment. We present an unusual case of a retained placenta trapped in a myometrial sacculation at the left angular region of the uterus.
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Background: Perinatal asphyxia is a most common cause of neonatal death. Magnesium, the second most common intracellular cation, may play a role in neuroprotection.Methods: This observational study was undertaken in the Department of Gynecology and Pediatrics in GMC, Shahdol from January 2021 to June 2023. The term babies were included with congenital anomaly, diabetic mother, IUGR, and mother receiving magnesium therapy during labour were excluded. Data analysis was conducted using IBM SPSS statistical software (version 22.0).Results: Out of 46 newborns, mild to moderated asphyxia and severe asphyxia were presenting 32 (69.6%) and 14 (30.4%) cases respectively. HIE-I were 20 (43.5%), HIE II-16 (34.8%) and HIE III-10 (21.7%). The mean serum magnesium level in neonates with mild to moderate asphyxia was 2.1�3 and with severe asphyxia 1.5�5 respectively (p=0.001). Serum magnesium was significantly low in severe birth asphyxia as compared to mild to moderate (p=0.001) and level was significantly low in HIE stage 3. The difference in serum magnesium between HIE 1 and 3 and HIE 2 and HIE 3 was statistically significant (p=0.003 and p=0.009, respectively). A significant correlation between serum magnesium and Apgar score at 1 minute (Pearson抯 correlation coefficient, r=0.518, p=0.001) and score at 5 minutes was also statistically significant (Pearson抯 correlation coefficient, r=0.379, p=0.009).Conclusions: Neonates with severe asphyxia and HIE- grade III have significant hypomagnesemia. Asphyxia can lead to hypomagnesemia, and it is recommended to evaluate levels of magnesium in neonates with asphyxia as a routine test.