Background: Hyperbaric bupivacaine is the work-horse local anaesthetic for spinal blocks during lower-limb orthopaedic surgery, yet its duration is frequently inadequate for prolonged procedures or sustained postoperative analgesia. Opioids such as fentanyl and α-2-adrenergic agonists such as clonidine are popular intrathecal adjuvants, but head-to-head data in a uniform surgical population remain limited. Methods: The study used a prospective, randomised study whereby 96 ASA I-II adults (18-70 y) who are to receive elective fixation or arthroplasty of the lower limb were made to receive 3.5 mL hyperbaric bupivacaine 0.5 % with either clonidine 50 μg (Group C, n = 48) or fentanyl 25 μg (Group F, n = 48). The main outcomes included the time and occurrence of sensory and motor block. Other secondary outcomes were haemodynamics, VAS pain score, time-to-first rescue analgesia and adverse event. Results: There were similar baseline characteristics. With clonidine, the mean sensory onset was faster (3.5 ± 0.9 min vs 6.3 ± 0.8 min) and the median sensory (327 min vs 277 min, p = 0.002) and motor (286 min vs 234 min, p = 0.012) block prolonged significantly when compared with fentanyl. The first rescue analgesic was requested later in Group C (347 ± 43 min) than Group F (286 ± 27 min, p = 0.007). Fentanyl produced a higher peak cephalad spread (T6 in 56 % vs 42 %). Haemodynamics were stable in both cohorts; however, clonidine generated lower diastolic pressures (–5-7 mmHg) and mild bradycardia without intervention. Pruritus occurred only with fentanyl (10.4 %). No neurological sequelae were observed. Conclusion: Both adjuvants enhance spinal anaesthesia quality, but clonidine provides a faster onset and markedly longer intra- and postoperative analgesia at the expense of modest sympatholysis, whereas fentanyl affords greater block height with minimal cardiovascular impact. Individual patient comorbidity, anticipated surgical duration and desired recovery profile should guide adjuvant selection.

Background: Hyperbaric bupivacaine is routinely combined with intrathecal adjuvants to optimise spinal anaesthesia. Nalbuphine, a κ-agonist/µ-antagonist opioid, and clonidine, an α2-adrenergic agonist, have both been reported to prolong block characteristics and improve analgesia, yet head-to-head data remain limited. Methods: In this prospective, randomised, double-blind trial, 60 ASA I–III adults (18–60 yr) scheduled for elective lower-abdominal surgery received either nalbuphine 1.6 mg (Group N) or clonidine 30 µg (Group C) with 3 ml 0.5 % hyperbaric bupivacaine. Primary endpoints were onset and duration of sensory and motor block and time to first rescue analgesia. Secondary endpoints included haemodynamic variables, visual-analogue pain scores (VAS, 0–10) and adverse events. Results: Baseline demographics and comorbidities were comparable. Mean sensory-block onset did not differ (3.23 ± 0.82 min vs 3.82 ± 0.88 min; p = 0.56). Clonidine significantly prolonged sensory block (263.1 ± 43.0 min) versus nalbuphine (248.1 ± 71.4 min; p = 0.001) and achieved lower VAS at 2 h (1.77 ± 1.57 vs 5.03 ± 0.81; p < 0.001) and 6 h (1.93 ± 1.51 vs 5.47 ± 1.14; p = 0.028). Time to rescue analgesia was similar (358.3 ± 69.8 min vs 363.5 ± 69.9 min; p = 0.90). Nalbuphine produced lower heart rates at 2, 10 and 30 min post-block (all p < 0.05). Adverse events (bradycardia ≈ 27%, hypotension ≈ 23%, nausea ≈ 22%) did not differ significantly (p = 0.63). Conclusion: Both adjuvants are safe and effective. Clonidine provides longer sensory blockade and superior intermediate-term analgesia, favouring its use in lengthy procedures, whereas nalbuphine offers a faster heart-rate attenuation that may benefit haemodynamically labile patients in shorter cases.

Background: Chronic kidney disease (CKD) is increasingly being diagnosed in younger populations, particularly in low- and middle-income countries. Early-onset CKD contributes significantly to long-term morbidity and economic burden. Identifying risk factors in young adults is essential to facilitate timely preventive strategies. Aim: To determine the risk factors associated with CKD among young adults under the age of 40 attending a tertiary care hospital. Material and Methods: A hospital-based case-control study was conducted with a total sample of 150 participants: 75 diagnosed CKD cases and 75 age- and sex-matched controls. Data on sociodemographic characteristics, comorbidities, lifestyle practices, and clinical history were collected using a pre-validated semi-structured questionnaire. Logistic regression analyses were performed to identify statistically significant determinants of CKD. Results: Multivariate logistic regression revealed that rural residence (OR = 5.49, 95% CI: 2.49–12.08), family history of CKD (OR = 28.14, 95% CI: 3.17–249.70), hypertension (OR = 4.89, 95% CI: 2.01–12.43), use of alternative medicine (OR = 4.83, 95% CI: 1.67–14.02), and recurrent urinary tract infections (OR = 10.90, 95% CI: 2.24–52.91) were independently associated with CKD. Alcohol consumption showed borderline significance (p = 0.057). Conclusion: CKD among young adults is significantly associated with modifiable risk factors, including hypertension, alternative medicine usage, and recurrent UTIs, in addition to non-modifiable factors like rural residence and family history. This underscores the urgent need for early screening, public health education, and safer healthcare practices to mitigate CKD onset in younger populations.

Background: Self-care plays a vital role in the management and prognosis of type 2 diabetes mellitus (T2DM). The Summary of Diabetes Self-Care Activities (SDSCA) is a validated tool used to assess adherence to self-care behaviors in diabetic patients. Understanding the relationship between these practices and glycemic control is essential to improving diabetes outcomes. Aim: To assess the self-care practices among type 2 diabetes patients using the SDSCA tool and evaluate their association with glycemic control. Material and Methods: A cross-sectional observational study was conducted among 150 patients diagnosed with T2DM attending the outpatient department of a tertiary care hospital. Participants were assessed using the SDSCA questionnaire, covering five domains: diet, physical activity, glucose monitoring, foot care, and drug adherence. HbA1c values were used to categorize patients into controlled (HbA1c <7) and uncontrolled (HbA1c ≥7) groups. Descriptive statistics and inferential analysis, including t-tests and chi-square tests, were employed. Results: Among 150 participants, 53.3% were male and 46.7% female. Significant differences were found in the mean scores of diet (p<0.001), physical activity (p<0.001), foot care (p<0.001), and glucose monitoring (p=0.01) between the controlled and uncontrolled groups. Drug adherence was relatively high but not statistically associated with glycemic control. A strong association was observed between smoking and uncontrolled HbA1c (p<0.001). Conclusion: The study highlights that satisfactory self-care practices—particularly dietary control, physical activity, foot care, and regular glucose monitoring—are significantly associated with better glycemic control among T2DM patients. Incorporating structured education and behavioral reinforcement into routine care may improve self-management and diabetes outcomes.