Background: Thyroid nodules are commonly encountered in clinical practice and require accurate diagnostic evaluation to differentiate benign lesions from malignancies. Ultrasonography using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), along with fine-needle aspiration cytology (FNAC) interpreted by the Bethesda system, plays an important role in preoperative risk stratification. Aim: This study aimed to evaluate the association between radiological findings and cytopathological diagnosis of thyroid nodules in patients attending a tertiary care center in Uttar Pradesh. Materials and Methods: A retrospective and prospective cross-sectional study was conducted in the Departments of Pathology and Radiology at VIMS, Gajraula, from January 2023 to September 2024. Patients presenting with palpable or incidental thyroid nodules underwent high-resolution ultrasonography followed by ultrasound-guided FNAC. Thyroid nodules were categorized according to ACR TI-RADS, and cytological findings were reported using the Bethesda system. The diagnostic accuracy, specificity, and positive predictive value of FNAC and TI-RADS were assessed and compared with histopathological findings wherever available. Results: A total of 127 patients were included, with a mean age of 43.2 ± 11.4 years and female predominance. The mean thyroid nodule size was 2.14 ± 1.2 cm. FNAC findings showed that 80.0% of lesions were non-cancerous, while 20.0% were cancerous. Papillary carcinoma was reported in 13.0% of cases, follicular neoplasm in 7.4%, AUS/FLUS in 5.6%, and suspicious follicular neoplasm in 3.7%. Most nodules belonged to benign or probably benign TI-RADS categories, while suspicious and moderately suspicious lesions constituted a smaller proportion. FNAC demonstrated an accuracy of 90.74% and a positive predictive value of 81.82%. Specificity for benign lesions was 95.24% for FNAC and 93.33% for TI-RADS, whereas specificity for malignant lesions was 93.02% and 95.45%, respectively. Conclusion: The combined use of ultrasonographic TI-RADS scoring and FNAC improves diagnostic precision in the evaluation of thyroid nodules. This dual-modality approach is useful for identifying malignant lesions, reducing unnecessary surgical interventions, and improving preoperative management in tertiary care settings. Further studies with larger cohorts and long-term follow-up are recommended to validate these findings.

Background: Acute respiratory infections are one of the most frequent causes of pediatric outpatient visits, and are a significant contributor to antibiotic consumption. There are many infections that are viral and self-limiting, and inappropriate antibiotic prescribing is a preventable contributor to antimicrobial resistance. Antibiotics are the most commonly used drugs in children with ARI, and their use is guided by evidence-based clinical guidelines. Objective: To evaluate antibiotic prescribing practices and adherence to clinical guidelines in pediatric outpatients with ARI. Methods: The study was a cross-sectional, observational study of 420 prescriptions for children aged 1 month to 12 years who were seen in a pediatric outpatient department. A structured proforma was used to record diagnosis, clinical features, investigations, antibiotic use, drug class, dose, duration and appropriateness. Results: In 238/420 encounters (56.7%) an antibiotic was prescribed. The most frequent diagnoses were acute upper respiratory tract infection/common cold (33.8%), acute pharyngitis/tonsillitis (21.4%), acute otitis media (13.6%), bronchitis/bronchiolitis (12.6%), pneumonia (10.7%) and acute sinusitis (7.9%). In total, 152 of the antibiotic prescriptions (63.9%) were guideline-concordant and 86 (36.1%) were inappropriate. The most common inappropriate prescriptions were for common cold/viral upper respiratory infection (72.7%) and bronchitis/bronchiolitis (66.7%). Amoxicillin-clavulanate was the most commonly used antibiotic (39.1%), followed by azithromycin (24.4%) and amoxicillin (18.5%). Documentation of diagnosis, fever, respiratory rate and danger signs was complete in 61.2% of encounters, and was associated with lower inappropriate prescribing (27.4% vs 49.2%, p=0.001). Conclusions: The use of antibiotics for pediatric acute respiratory infections was widespread and over one-third of the prescriptions were inappropriate. Diagnosis-based stewardship, documentation and following pediatric outpatient guidelines are required.

Background: Iron deficiency anemia is the most prevalent nutritional anemia in children and can affect growth, immunity, cognition and development. Where iron studies are not available, hematological indices may be useful in determining the severity and for early diagnosis. Methods: This cross sectional study involved 210 children aged 6 months to 12 years who were diagnosed with IDA by hemoglobin, red cell indices, peripheral smear, serum ferritin and transferrin saturation. Children who had hemoglobinopathies, chronic kidney disease, acute infection, recent transfusion, or hematinic therapy were excluded. The hematological parameters were compared between the mild, moderate and severe anemia groups. Results: Mean age was 4.8 +/- 3.1 years; 116 children (55.2%) were male. The most common anemia was moderate (46.7%), followed by mild (31.9%) and severe (21.4%). Mean hemoglobin was 10.4 +/- 0.5 g/dL in mild, 8.3 +/- 0.8 g/dL in moderate, and 6.4 +/- 0.7 g/dL in severe anemia (p<0.001). As the severity increased, MCV, MCH, ferritin and transferrin saturation decreased, whereas RDW and platelet count increased. Hemoglobin correlated positively with ferritin (r=0.52, p<0.001) and MCV (r=0.61, p<0.001), and negatively with RDW (r=-0.58, p<0.001). Conclusion: Routine haematological parameters are significantly related to the severity of paediatric IDA and can be used as an aid to early grading and treatment decisions.

Background: Exclusive breastfeeding is recommended for optimal growth, but information on longitudinal anthropometric changes throughout the first year of life is limited in the local context. Objective: To evaluate the relationship between exclusive breastfeeding for 6 months and growth parameters in the first year of life. Methods: 180 term singleton infants were recruited and followed from birth to 3, 6, 9 and 12 months. Infants who were only breastfed for six months were compared with infants who were mixed or formula fed prior to six months. Weight, length, head circumference and WHO z-scores were measured. Results: 180 infants, 112 (62.2%) were exclusively breastfed for six months and 68 (37.8%) were non-exclusively breastfed. Baseline birth weight was comparable between groups (2.94 ± 0.36 kg vs 2.91 ± 0.34 kg, p=0.59). At 12 months, mean weight was slightly lower in the exclusive breastfeeding group (9.28 ± 0.86 kg vs 9.61 ± 0.91 kg, p=0.018), while length (74.9 ± 2.7 cm vs 74.3 ± 2.8 cm, p=0.15) and head circumference (45.9 ± 1.3 cm vs 45.6 ± 1.4 cm, p=0.12) were similar. There was no increased risk of undernutrition, but at 12 months, weight-for-length z-score was lower among exclusively breastfed infants (0.18 ± 0.79 vs 0.49 ± 0.84, p=0.014). Fewer episodes of respiratory illness (0.72 ± 0.84 vs 1.18 ± 1.02, p=0.002) were associated with exclusive breastfeeding. Conclusion: Adequate linear and head growth was observed during exclusive breastfeeding, and the weight gain was relatively leaner with relatively lower morbidity.

Background: Nocturnal enuresis is a common paediatric condition that may persist beyond early childhood and affect emotional wellbeing, sleep, family functioning, and school participation. Rural school data are important for estimating community burden and identifying modifiable associated factors. Methods: A school-based cross-sectional study was conducted among 416 children aged 6–12 years attending five rural primary schools in Mathura district from March 2024 to September 2025. Data were collected using a pre-tested structured parent questionnaire. Nocturnal enuresis was defined as bedwetting during sleep occurring at least twice per week for at least three months. Variables included demographic characteristics, wet-night frequency, daytime urinary symptoms, bedtime, and evening fluid intake, ease of arousal, snoring, family history, and recent stress. Data were analysed using frequency distributions, percentages, mean ± standard deviation, median with interquartile range, and appropriate statistical tests. Results: The overall prevalence of nocturnal enuresis was 18.8% (78/416). Wet-night frequency among enuretic children ranged from 2 to 7 nights/week, with a mean of 3.56 ± 1.46 and median of 3.0 (IQR: 2–4). Primary enuresis was present in 64 children (82.1%), while secondary enuresis was present in 14 children (17.9%). Monosymptomatic nocturnal enuresis accounted for 48 cases (61.5%), and non-monosymptomatic nocturnal enuresis accounted for 30 cases (38.5%). Nocturnal enuresis was significantly associated with maternal education, daytime urgency, daytime frequency, daytime wetting, later bedtime, evening fluid intake after 6 pm, type of evening drink, and difficulty in arousal from sleep. Parental night waking was common among affected children and reflected a family management practice. Age group, sex, number of siblings, birth order, snoring, family history of bedwetting, and recent stress were not statistically significant. Conclusion: Nocturnal enuresis affected nearly one-fifth of rural school children aged 6–12 years. The condition was mainly primary and monosymptomatic, although a substantial subgroup had daytime urinary symptoms. Later bedtime, evening fluid intake, difficulty in arousal, and daytime urinary symptoms were important associated factors, supporting the need for early identification and structured, non-stigmatizing counselling.

Background: Laparoscopic cholecystectomy is now a procedure of choice for cholelithiasis and chronic cholecystitis. Laparoscopic procedures are being done under general anaesthesia with muscle relaxants and controlled ventilation. Postoperative nausea and vomiting (PONV) is a common and a distressing complication after surgery. PONV may be mild or transient, but its impact on patients can be much more severe, it can cause inability to mobilize after surgery, restricted oral intake, complications of protracted vomiting and delayed recovery and discharge after surgery. Methods: Sixty patients, of either sex, ASA physical status I or II, undergoing elective laparoscopic cholecystectomy, were randomly allocated into two groups containing thirty patients each. Group A received intravenous inj. Amisulpride 5 mg i.v. over 1-2 minutes before induction of anaesthesia. Group O received intravenous inj. Ondansetron 4 mg i.v. over 1-2 minutes before induction of anaesthesia. Results: In Group A, total 4 patients had nausea and/or vomiting, while other 26 patients were asymptomatic, while in Group O, total 13 patients had nausea and/or vomiting, while 17 other patients were asymptomatic. Conclusion: Amisulpride can be considered as a safe and a promising alternate option for PONV in place of Ondansetron.

Background: Neostigmine, the conventional agent for neuromuscular blockade reversal, acts indirectly by inhibiting acetylcholinesterase and is associated with unpredictable recovery times and muscarinic side effects. Sugammadex, a modified γ-cyclodextrin, reverses steroidal neuromuscular blocking agents by direct encapsulation, offering the potential for rapid and predictable reversal. While prior studies demonstrated its efficacy in deep blockade, evidence comparing both agents in moderate blockade under inhalational anaesthesia was limited.  Methods: One hundred twenty patients, of either sex, ASA physical status I or II, undergoing elective Laparoscopic cholecystectomy under general anaesthesia, were randomly allocated into two groups containing sixty patients each. Group A received Sugammadex for Reversal of muscle relaxant and Group B received Neostigmine/Glycopyrrolate for Reversal of Muscle Relaxant. Results: Sugammadex achieved TOF ≥ 0.9 significantly faster than Neostigmine (89 second versus 399 second, P < 0.0001). 98% of patients receiving Sugammadex recovered within 2 minutes showing greater predictability, while with neostigmine some patients required more than 7 minutes to recover. Conclusion: Sugammadex provides markedly faster, more predictable, and reliable reversal of moderate rocuronium-induced neuromuscular blockade compared with neostigmine during sevoflurane anaesthesia, with a comparable safety profile.

Background and Aims: Emergency laparotomy carries a significantly higher risk of morbidity and mortality compared to elective gastrointestinal surgery. Preoperative risk stratification is essential for identifying high-risk patients and guiding perioperative management. This study aimed to determine and compare the accuracy of the Portsmouth-POSSUM (P-POSSUM) score and the National Emergency Laparotomy Audit (NELA) score in predicting 30-day and 60-day postoperative mortality in patients undergoing emergency laparotomy at a tertiary care centre in Eastern India. Methods: This retrospective cohort study included 116 consecutive patients who underwent emergency laparotomy at KPC Medical College and Hospital, Kolkata, from January 2021 to March 2023. Demographic variables, laboratory parameters, and operative details were retrieved from medical records. P-POSSUM and NELA scores were calculated using electronic risk calculators. Mortality at postoperative day 30 and 60 was the primary outcome. Statistical analysis was performed using SPSS version 19.0; an independent samples t-test was used for group comparison. Discriminatory accuracy was assessed using receiver operating characteristic (ROC) curve analysis and comparison of area under the curve (AUC) values. Results: Among 116 patients, the 30-day mortality rate was 8.6% (n = 10) and the 60-day mortality rate was 13.8% (n = 16). ROC curve analysis revealed that the AUC for the NELA score was significantly superior to that of the P-POSSUM score for both 30-day mortality [AUC 0.873 (95% CI 0.799–0.948) vs. 0.533 (95% CI 0.361–0.726), p < 0.001] and 60-day mortality. Conclusion: The P-POSSUM score demonstrated significantly greater discriminatory accuracy in predicting both early and late postoperative mortality following emergency laparotomy compared to the NELA score in this Eastern Indian cohort. The authors recommend adoption of the P-POSSUM score as the preferred risk stratification tool for patients undergoing emergency laparotomy.

Background: Tuberculosis is a preventable and curable disease. In 2022, TB was the world’s second leading cause of death from a single infectious agent. Isoniazid is the first line medicine for the treatment of active tuberculosis and latent TB infection, with high bactericidal activity. Resistance to isoniazid reduces the effectiveness of TB treatment and increases the risk of acquiring resistance to other first line drugs. This leads to increase risk of multidrug resistant TB. Aim and objectives: The objective is to study clinical profile and treatment outcome in isoniazid mono resistant pulmonary TB under programmatic conditions. Materials and Methods: This study is a prospective, observational and longitudinal single center study performed at the tertiary health care center in South Gujarat (DRTB NODAL Center). Diagnosed isoniazid (mono- H) resistant pulmonary tuberculosis patients during study period were enrolled and followed up during study to record demographic data, clinical characteristics and treatment outcomes. Results: In our study, 30 patients of isoniazid mono resistance pulmonary TB were enrolled. The mean age of patients was 36.7 years. Two-third of the patients were male (70%). 63.3% of patients were underweight (BMI < 18.5 kg/m²). All patients presented with symptoms of cough, fever and anorexia. Primary H mono resistant was detected in 83.3% patients. Most common INH mutation detected on FL-LPA was in the Kat G gene in 60% patients followed by InhA gene in 36.7% patients and one patient had both gene mutation. The most common ADRs observed were gastritis and GIT symptoms (43.3%). In our study favorable outcomes with treatment regimen as per national program guidelines was observed in 28 (93.34%) patients. Unfavorable outcome was observed in form of treatment failure in 1 patient and death in 1 patient. Conclusion: Most of isoniazid mono resistant TB patients present with primary resistance to isoniazid. Patients who have microbiologically confirmed TB with rifampicin sensitive need to be checked for FL-LPA for isoniazid sensitivity. The availability of rapid diagnostic test and treatment regimen under national program is effective for diagnosis and management of H mono resistant TB.

Background: Pertrochanteric fractures in elderly patients are associated with significant morbidity, mortality, and functional impairment. Bipolar hemiarthroplasty has emerged as an effective treatment option for unstable fractures in osteoporotic patients. However, evidence comparing metaphyseal and diaphyseal fit stems remains limited. Aim: To compare the functional outcomes of metaphyseal and diaphyseal fit bipolar hemiarthroplasty in elderly patients with pertrochanteric fractures. Methods: This prospective observational cohort study included 54 elderly patients with unstable pertrochanteric fractures treated with bipolar hemiarthroplasty. Patients were divided equally into diaphyseal stem and metaphyseal stem groups. Functional outcomes were assessed using Harris Hip Score (HHS) and Visual Analogue Scale (VAS) at multiple postoperative intervals. Operative time, blood loss, mobilization, and full weight-bearing status were also evaluated. Results: The mean age of participants was 72.91 ± 9.35 years, with females constituting 61.1% of cases. Diaphyseal stem fixation demonstrated significantly higher HHS at 2 weeks, 6 weeks, 3 months, and 6 months compared to metaphyseal stems (p<0.001). Mean operative time and blood loss were significantly higher in the diaphyseal group (162.00 ± 51.59 minutes and 663.70 ± 280.40 mL respectively) compared to the metaphyseal group (114.67 ± 18.79 minutes and 411.48 ± 132.74 mL respectively). However, patients in the diaphyseal group achieved earlier full weight bearing. Conclusion: Diaphyseal fit bipolar hemiarthroplasty demonstrated superior functional outcomes and earlier mobilization compared to metaphyseal fit stems despite increased operative time and blood loss. Diaphyseal fixation may therefore be preferred in elderly patients with unstable pertrochanteric fractures.

Aim: The aim of this paper is to describe how nociceptive pathways in the peripheral nervous system, thalamus, and cortical areas respond to NSAIDs and opioids, with emphasis on the biological basis of analgesia and the clinical implications of central and peripheral modulation of pain transmission. Materials and Methods: This paper was prepared as a narrative review of published literature on nociception, pain transmission, thalamic relay function, cortical pain processing, and the pharmacology of NSAIDs and opioids. Sources describing peripheral transduction, ascending spinothalamic signaling, thalamocortical integration, and descending inhibitory pathways were synthesized to build a structured account of drug effects across the pain axis. Result: The literature shows that NSAIDs reduce pain mainly by blocking cyclooxygenase-mediated prostaglandin synthesis in inflamed tissue and also by lowering central prostaglandin signaling, thereby reducing peripheral sensitization and central amplification of nociceptive input. Opioids act through μ, δ, and κ receptors to inhibit neurotransmitter release, hyperpolarize nociceptive neurons, and strengthen descending inhibitory control at spinal and supraspinal levels, including thalamic and cortical circuits. Conclusion: Nociception is not a single linear pathway but a distributed network involving peripheral receptors, spinal relays, thalamic integration, and cortical perception, all of which can be modified by analgesic drugs. NSAIDs are most effective where inflammation drives prostaglandin-dependent sensitization, whereas opioids exert broader central inhibition but carry greater risks of tolerance, dependence, and adverse effects.

Aim: Dexmedetomidine and clonidine are alpha-2 adrenergic agonists frequently used as adjuvants to local anaesthetics in brachial plexus block because they may shorten onset time, improve block quality, and prolong postoperative analgesia. The clinical question addressed in this review is whether dexmedetomidine provides superior efficacy to clonidine when used in axillary brachial plexus block, while maintaining acceptable haemodynamic and safety outcomes. Materials and Methods: A structured clinical evidence synthesis was undertaken using indexed comparative literature on dexmedetomidine versus clonidine as perineural adjuvants in brachial plexus block. Core evidence was drawn from a 2022 meta-analysis of 24 randomized controlled trials 2017 systematic review and meta-analysis of 14 randomized controlled trials. Both reviews compared dexmedetomidine and clonidine as adjuvants to local anaesthetics for upper-limb surgery and analyzed sensory block duration, motor block duration, analgesia duration, onset characteristics, and adverse events. Result: Across comparative brachial plexus block evidence, dexmedetomidine consistently outperformed clonidine on efficacy endpoints. In the 2022 meta-analysis, dexmedetomidine significantly prolonged sensory block duration by a mean difference of 173.31 minutes, motor block duration by 158.35 minutes, and duration of analgesia by 203.92 minutes compared with clonidine. Dexmedetomidine also hastened onset of sensory block by 1.58 minutes and motor block by 1.46 minutes, and improved the likelihood of higher-grade block quality. The 2017 meta-analysis similarly found that dexmedetomidine increased sensory, motor, and analgesic duration by an estimated ratio of means of about 1.2 each, while also accelerating onset. The 2017 review signaled increased transient bradycardia and postoperative sedation with dexmedetomidine, whereas the 2022 review found no statistically significant difference in hypotension. Conclusion: The best available evidence suggests that dexmedetomidine is clinically more effective than clonidine as a perineural adjunct in brachial plexus block, with longer sensory and motor blockade, longer postoperative analgesia, and somewhat faster onset.

Aims: To compare the fetomaternal outcomes in gestational thrombocytopenia with thrombocytopenia due to hypertensive disorders of pregnancy. Objectives: The objectives of the study were to evaluate fetomaternal outcomes in gestational thrombocytopenia, to assess fetomaternal outcomes in thrombocytopenia associated with hypertensive disorders of pregnancy, and to compare the fetomaternal outcomes between gestational thrombocytopenia and thrombocytopenia secondary to hypertensive disorders of pregnancy. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, over a period of 18 months. A total of 304 antenatal women beyond 20 weeks of gestation with persistent thrombocytopenia (<1.5 lakh/mm³) were enrolled. Patients were divided into Group A comprising 152 women with thrombocytopenia associated with hypertensive disorders of pregnancy and Group B comprising 152 women with gestational thrombocytopenia. Detailed history, clinical examination, complete blood count, coagulation profile, liver and renal function tests, and obstetric ultrasonography were performed. Maternal and fetal outcomes were assessed until discharge. Statistical analysis was performed using SPSS version 17.0, and p value <0.05 was considered statistically significant. Results: Majority of patients in both groups belonged to the 21–30 years age group and presented at term gestation. Moderate thrombocytopenia was the most common presentation in both groups. Deranged liver enzymes, elevated bilirubin, renal dysfunction, coagulation abnormalities, postpartum hemorrhage, and platelet transfusion requirements were significantly more common in Group A compared to Group B. Vaginal delivery was the most common mode of delivery in both groups, although cesarean section rates were higher in hypertensive thrombocytopenia. Neonatal complications including NICU admission, neonatal demise, and neonatal thrombocytopenia were also more frequent in Group A. Conclusion: Gestational thrombocytopenia is generally a benign condition with favorable maternal and fetal outcomes and spontaneous postpartum recovery. In contrast, thrombocytopenia associated with hypertensive disorders of pregnancy is associated with increased maternal complications such as postpartum hemorrhage, coagulation abnormalities, liver and renal dysfunction, along with poorer neonatal outcomes. Early diagnosis, close monitoring, and multidisciplinary management are essential to improve fetomaternal outcomes in thrombocytopenic pregnancies.

Background: Anatomical Variations of Renal Arteries and Their Surgical Significance in Laparoscopic Procedures deals with a clinically relevant diagnostic and anatomical problem in the routine practice of tertiary care. The objective of this study was to document renal artery variations and explain their significance for laparoscopic donor nephrectomy, pyeloplasty and renal hilar surgery. Method: The study design was a cross sectional observational study using CT angiographic and cadaveric approach in the Department of Anatomy, Radiology and Surgery of a tertiary care centre. A total of 150 renal units of 75 adults were included in the study, which was performed using multidetector CT angiography and additional cadaveric observations. The participants/specimens were divided into single renal artery, accessory renal artery and early branching patterns. Standardized data collection, laboratory/ radiological/ anatomical assessment and predefined operational criteria were used. Results: A single renal artery was found in 72.0% of renal units, accessory renal arteries in 21.3% and early branching in 18.7%. The left side had more accessory arteries (25.3%) than the right side (17.3%), but this difference was not significant (p=0.228). Inferior polar arteries were found in 9.3% and were deemed to be surgically significant in the lower pole. Conclusion: Variations in the renal arteries were frequent and significant. Vascular mapping is crucial prior to laparoscopic renal surgery to minimize vascular injury and ischemic complications.

Background: End-stage kidney disease is increasing worldwide, primarily in the developing countries. It is affecting mainly the productive age group. We therefore sought to describe the clinical and epidemiological characteristics of hemodialysis patients. Aims and Objective: To identify the socio-demographic characteristics, comorbidities and clinical profile of patients treated with hemodialysis. Material and Methods: This was a descriptive, cross-sectional study conducted among 40CKD patients undergoing hemodialysis at I.Q City medical college and Hospital, Durgapur, West Bengal. The study was based on the patients’ attending Hemodialysis Unit in between April 2025 to March 2026. The ethical clearance for the research was taken. 40 patients were retrieved and data was collected according to Performa. Socio demographic profiles including age, sex and clinical data including etiology, duration of CKD, duration of hemodialysis and laboratory parameters including hemogram and renal function test were recorded. Patients more than 20 years and above and receiving hemodialysis more than six months included in the study. Results: Among all 40 patients, range age is 24 to 66 years with mean (SD) 45.46(±12.32) years. Almost half of the patients 20(50%) belongs to the middle age group (36-56) years followed by 10(25%) comprises as senior citizens (60 and above) years. Twenty-six (65%) are male and 14(35%) patients are female. Similarly, 27(67.5%) are married and majority 32(80%) belongs to Hindu community. 33(82.5%) were as nuclear family. Regarding education level, eighteen (45%) were illiterate and only 3(7.5%) had University level education and 36(90%) were dependent on their family after starting the treatment. Conclusion: Hypertension and diabetes were the leading cause of End stage renal disease in most of the patients. Early diagnosis, treatment and proper follow up of the risk factors will be the key to prevent progression of chronic kidney disease into the end stage requiring hemodialysis or Renal Transplant.

Background: Parotidectomy remains the standard treatment for a variety of benign and malignant parotid gland lesions. However, the extent of gland excision may influence postoperative morbidity, particularly facial nerve dysfunction. This study compared the surgical outcomes and complications associated with total and near-total parotidectomy. Material and Methods: A retrospective comparative study was conducted on 94 patients who underwent parotidectomy between January 2018 and December 2024. Patients were divided into a total parotidectomy group (n=46) and a near-total parotidectomy group (n=48). Demographic characteristics, operative parameters, postoperative complications, facial nerve function, and oncological outcomes were analyzed and compared. Results: The baseline demographic and clinical characteristics were comparable between the groups. Near-total parotidectomy was associated with significantly shorter operative time (136.2±23.4 vs. 154.8±26.5 minutes; p=0.001), reduced hospital stay (4.3±1.2 vs. 5.2±1.4 days; p=0.002), and shorter drain duration (2.8±0.8 vs. 3.4±0.9 days; p=0.001). Temporary facial nerve weakness occurred significantly less frequently following near-total parotidectomy than total parotidectomy (10.4% vs. 28.3%; p=0.028). Overall postoperative complications were also significantly lower in the near-total parotidectomy group (20.8% vs. 43.5%; p=0.019). Permanent facial nerve weakness, Frey’s syndrome, salivary fistula, seroma, hematoma, and surgical site infection were less common after near-total parotidectomy, although these differences were not statistically significant. Negative surgical margins (90.9% vs. 91.7%) and local recurrence rates (9.1% vs. 8.3%) were comparable between the groups. Conclusion: Near-total parotidectomy was associated with reduced postoperative morbidity and improved perioperative outcomes while maintaining oncological effectiveness comparable to total parotidectomy. It may therefore be considered a safe and effective surgical alternative in appropriately selected patients.

Aim: Breast implant surgery has traditionally been judged through technical outcomes and aesthetic assessment, yet modern evaluation increasingly prioritizes patient-reported outcomes, longitudinal quality of life, and safety transparency. This critical review aims to synthesize current evidence on quality-of-life outcomes after breast implant surgery, evaluate the strengths and limitations of patient-reported outcome measures, and examine the growing significance of systemic concerns in shared decision-making. Materials and Methods: A narrative critical review approach was undertaken using contemporary peer-reviewed evidence and registry-based analyses focused on patient-reported outcome measures after breast implant surgery. Core source material included a 2024 systematic review and meta-analysis of Breast-Q augmentation outcomes involving 39 studies, 53 cohorts, and 18,322 patients, together with a 2022 registry-based qualitative analysis from the Australian Breast Device Registry examining 268 open-ended patient responses after augmentation. The review prioritized domains relevant to health-related quality of life: satisfaction with breasts, psychosocial well-being, sexual well-being, physical well-being, complications, revision burden, and patient perceptions of systemic illness. Results: Breast implant surgery often produces substantial improvements in patient-reported psychosocial well-being, sexual well-being, and satisfaction with breast appearance. In the 2024 meta-analysis, psychosocial well-being improved by a mean difference of 38.10 points, sexual well-being by 40.20 points, and satisfaction with breasts by 47.88 points, whereas physical well-being improved only slightly and inconsistently. Registry-based qualitative data deepen this picture by showing that satisfaction frequently depends not only on appearance but also on surgeon communication, aftercare, and the natural feel of implants. At the same time, dissatisfaction arose from asymmetry, rippling, pain, altered sensation, tightness, rupture, revision surgery, and perceptions of inadequate counseling. Emerging systemic concerns included self-reported fatigue, joint pain, cognitive complaints, hair loss, and other symptoms interpreted by some patients as breast implant illness. Conclusion: The strongest lesson from current evidence is that aesthetic success alone is an insufficient endpoint. High-quality breast implant care requires long-term surveillance, standardized patient-reported outcome measures, transparent disclosure of device-specific risks, and a consent process that addresses both proven complications and uncertain systemic concerns without dismissing patient experience. The future of implant evaluation therefore lies in integrating surgical outcomes, registry surveillance, symptom monitoring, and person-centered counseling rather than relying on appearance-based judgments alone.

Aim: Cyanide is one of the most labile toxicants encountered in forensic practice, and interpretation of postmortem cyanide concentrations is often complicated by storage-related instability. The aim of this review-style paper is to examine how different storage conditions influence cyanide levels in postmortem tissues and how these changes affect forensic interpretation. Cyanide’s instability in cadavers and stored specimens is well recognized, and the magnitude and direction of concentration changes may depend on the specimen type, initial cyanide burden, temperature, elapsed storage time, and preservative use. Materials and Methods: A focused literature-based synthesis was prepared using published studies on cyanide stability in blood, solid organs, and gastric contents, with particular attention to studies comparing refrigerated, frozen, and room-temperature storage. Evidence from cadaveric studies, animal models, and authentic casework was reviewed to identify common stability patterns and practical laboratory implications. Key variables extracted from the literature included temperature, duration of storage, tissue matrix, preservation with sodium fluoride, and analytical technique. Result: Across the literature, cyanide demonstrated variable stability in postmortem tissues, with blood often showing apparent concentration increases during storage, likely from postmortem redistribution, diffusion, or matrix effects, whereas liver, kidney, and brain exhibited inconsistent rises and falls. Refrigeration at 4°C and freezing at -20°C generally improved preservation, but neither condition completely prevented change, especially over longer storage intervals. In a cadaveric review, cyanide transformation was shown to depend strongly on time in the body, time in storage, concentration at death, and sample preservation. More recent work also suggests that chromatographic methods may show more stable long-term patterns than older spectrophotometric techniques. Conclusion: Postmortem cyanide interpretation must always account for storage conditions, because cyanide levels may change significantly after collection. Frozen storage is usually preferable for delayed analysis, refrigerated storage is acceptable for short intervals, and immediate preservation is ideal. Forensic conclusions should be based on the full case context rather than a single cyanide value alone, especially when specimens have been stored under nonstandard conditions.

Introduction: Cancer-associated thrombosis is a well-recognized contributor to morbidity and mortality in patients with malignancies. Although venous thromboembolism is common, arterial thrombosis is rare and often overlooked, particularly when it precedes typical cancer-related symptoms. Gastric adenocarcinoma initially presenting with arterial thrombosis is exceedingly uncommon. This report describes an unusual presentation in which upper-limb arterial thrombosis served as the first clinical indication to an underlying gastric malignancy. Case Report: A 50-year-old woman with well-controlled hypertension presented with headache and dizziness and was noted to have absent peripheral pulses in the right upper limb. She had no history of diabetes, dyslipidemia, smoking, autoimmune disease, or thrombotic events. Vascular imaging revealed thrombosis of the distal right brachial artery extending to the bifurcation, with collateral formation. Brain imaging revealed acute and chronic lacunar infarcts, suggesting recurrent silent ischemic events. However, as the conventional cardiovascular risk factors or an identifiable embolic source were not present, the etiology initially remained unclear.
Further evaluation of secondary causes of thrombosis revealed an acquired hypercoagulable state, with reduced levels of protein C, protein S, and antithrombin III, along with elevated homocysteine levels. Autoimmune and antiphospholipid antibody test results were negative. During hospitalization, the patient developed upper gastrointestinal bleeding, prompting endoscopic evaluation. Upper gastrointestinal endoscopy revealed ulceroproliferative growth involving the gastric antrum and pylorus, and histopathology confirmed poorly differentiated gastric adenocarcinoma with signet ring cell features. Computed Tomography showed diffuse gastric wall thickening with regional and para-aortic lymphadenopathy, consistent with advanced disease, without evidence of additional arterial thrombosis. Discussion and Conclusion: This case highlights the diagnostic challenges posed by malignancy-associated arterial thrombosis, particularly when it precedes overt oncological symptoms. The combination of arterial ischemic events and acquired deficiencies in natural anticoagulants supports a paraneoplastic hypercoagulable state. Clinicians should maintain a high index of suspicion for occult malignancy in patients presenting with unexplained arterial thrombosis, as early recognition may facilitate timely diagnosis and appropriate management.

Background: Acute kidney injury (AKI) is a serious complication of tropical acute febrile illness (TAFI) and contributes significantly to morbidity, mortality, and healthcare burden in endemic regions. Early recognition of AKI and associated systemic complications is essential for improving clinical outcomes. Methods: A hospital-based observational study was conducted among 100 patients with AKI complicating TAFI. Demographic characteristics, clinical presentation, laboratory parameters, etiological profile, AKI severity according to the RIFLE classification, complications, dialysis requirement, intensive care unit (ICU) admission, and clinical outcomes were evaluated. Statistical analysis was performed to assess associations between selected variables and AKI severity. Results: The mean age of participants was 40.14 ± 15.04 years, with male predominance (62%). Fever was present in all patients, while myalgia (51%), vomiting (50%), rash (50%), and decreased urine output (49%) were common presenting symptoms. Pedal edema (57%), tachycardia (53%), conjunctival congestion (48%), and icterus (47%) were the predominant clinical signs. Dengue (32%) was the leading etiology, followed by malaria (21%), leptospirosis (17%), scrub typhus (14%), enteric fever (8%), and undifferentiated fever (8%). RIFLE classification showed Risk in 38%, Injury in 34%, and Failure in 28% of patients. Major complications included sepsis (53%), ARDS (52%), shock (51%), and MODS (51%). Dialysis was required in 26% and ICU admission in 34% of patients. Complete recovery occurred in 64%, partial recovery in 22%, and mortality was 14%. A significant association was observed between age category and AKI severity (p=0.026). Conclusion: TAFI-associated AKI is a multisystem disorder with substantial morbidity, dialysis requirement, and mortality. Early recognition, strict renal monitoring, and prompt management of sepsis, shock, and respiratory failure are crucial to improve renal recovery and reduce adverse outcomes.

Aims and Objectives: To estimate serum vitamin B12 and ferritin levels in infants with iron deficiency anaemia and vitamin B12 deficiency anaemia, and to assess their correlation with maternal serum vitamin B12 and ferritin levels. Methods: This descriptive cross-sectional study included 280 infants aged 29 days to 1 year admitted to the Department of Pediatrics, J.K. Lon Hospital, Kota, between March 2023 and March 2024. Infants with anaemia admitted for common medical conditions were enrolled. Complete blood count, serum ferritin, and serum vitamin B12 levels were measured in infants and their mothers. Data were analysed using SPSS software. Results: Iron deficiency anaemia was the most common cause of anaemia (69.3%). Dimorphic anaemia predominated (41.8%), followed by vitamin B12 deficiency anaemia (32.9%) and isolated iron deficiency anaemia (12.9%). Isolated vitamin B12 deficiency accounted for 32.9% of severe anaemia cases. The mean serum vitamin B12 level in infants was 107.12 pg/mL. A strong correlation was observed between maternal and infant serum vitamin B12 and ferritin levels, with infants of deficient mothers more likely to have similar deficiencies. Conclusion: Vitamin B12 deficiency is a significant and under-recognized cause of anaemia in infants and is strongly associated with maternal nutritional status. Maternal iron and vitamin B12 deficiencies increase the risk of corresponding deficiencies in infants. Routine evaluation of serum vitamin B12, along with iron studies and peripheral smear examination, should be included in the workup of anaemic infants. Maternal vitamin B12 supplementation during pregnancy and lactation is essential to prevent infant anaemia.

Background: Diabetes mellitus (DM) is one of the most common metabolic disorders. Type-2 diabetic patients have increased risk of cardiovascular disease including atherosclerosis and dyslipidaemia. Materials and Methods: A total of N=50 control who were between 35-50 years both sexes matched, healthy non-smokers, non-alcoholics were included and N=50 diabetic patients who were on anti-diabetic treatment were enrolled. Aim is to assess the lipid profile of diabetic patients and to compare them with that of the controls. Results: Triglyceride (TG), very low-density lipoprotein (VLDL), total cholesterol (TC) and low-density lipoprotein (LDL) values were significantly increase whereas high density lipoprotein (HDL) values were decrease in diabetics than controls. Conclusion: Diabetes mellitus has an impact on lipid metabolism. Dyslipidaemia was reported in the diabetic group. Diabetic patients are prone to cardiovascular and coronary artery diseases. Hence, regular lipid profile monitoring will help to prevent above diseases.

Background and Aims: Laryngoscopy and tracheal intubation provoke transient but potentially hazardous sympathetic responses. Adequate neuromuscular blockade and depth of anaesthesia at the moment of intubation may attenuate this response. We compared haemodynamic changes and intubating conditions when the appropriate moment for tracheal intubation was determined by combined train-of-four (TOF) and bispectral index (BIS) monitoring versus conventional clinical assessment. Methods: In this prospective, randomised, single-centre study, 68 adult patients of either sex, ASA physical status I–II, scheduled for elective laparoscopic cholecystectomy under general anaesthesia, were allocated by lottery to two groups of 34 each. In Group M (monitor-guided), the trachea was intubated when TOF count at the adductor pollicis was zero and BIS was ≤ 40. In Group C (clinical assessment), the trachea was intubated after clinical judgement of jaw-muscle relaxation and loss of the eyelash reflex. Heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP, MAP), peripheral oxygen saturation (SpO₂) and intubating conditions (Copenhagen score) were recorded at baseline (T0), after induction (T1), pre-intubation (T2), and 1 (T3), 3 (T4) and 5 (T5) minutes after intubation. Data were analysed with Student’s t-test and the chi-square or Fisher’s exact test, as appropriate. Results: HR, SAP, DAP and MAP were significantly higher in Group C than in Group M at all post-intubation time points (P < 0.05). The peak HR after intubation was 107.5 ± 12.7 bpm in Group C versus 97.0 ± 3.0 bpm in Group M (P < 0.0001), and peak MAP was 112.0 ± 2.0 mmHg versus 100.0 ± 4.1 mmHg, respectively (P < 0.0001). Excellent intubating conditions (score 5) were achieved in all 34 patients in Group M, whereas all Group C patients had only moderate conditions (score 3–4; P < 0.0001). Conclusion: Combined TOF and BIS monitoring to time tracheal intubation produces significantly better intubating conditions and attenuates the haemodynamic stress response compared with conventional clinical assessment.

Introduction: Type 2 diabetes mellitus (T2DM) increases cardiovascular risk due to chronic hyperglycemia and dyslipidemia. Poor glycemic control and abnormal lipid profiles, particularly elevated LDL-C and low HDL-C, contribute to adverse cardiovascular events. This study examines their association with cardiovascular outcomes in T2DM to guide risk assessment and preventive care. Methods: A five-month prospective observational study was conducted at Government Medical College, Machilipatnam, including T2DM patients aged 35–75 years. Demographic, clinical, and laboratory data were collected. Patients were followed for cardiovascular events, confirmed through clinical, biochemical, and imaging evaluations. Exclusion criteria included prior CVD, T1DM, CKD, infections, or malignancy. Results: In this study of 120 T2DM patients, 25% experienced cardiovascular events over five months. Higher HbA1c, LDL-C ≥ 130 mg/dL, and hypertension significantly predicted events. HbA1c ≥ 9% had the strongest association (OR 3.25, p=0.031), highlighting poor glycemic control as a key cardiovascular risk factor. Conclusion: Poor glycemic control, elevated LDL-C, and hypertension significantly increased cardiovascular event risk in T2DM patients. HbA1c ≥ 9% was the strongest predictor. The study underscores the need for comprehensive management of metabolic parameters to prevent cardiovascular complications and improve outcomes in individuals with T2DM.

Background: Intrathecal opioids are commonly used as adjuvants to local anaesthetics during spinal anaesthesia to prolong postoperative analgesia and improve block quality. Nalbuphine and buprenorphine have different receptor profiles and may produce different analgesic effects. Aim: To compare intrathecal nalbuphine and intrathecal buprenorphine as adjuvants to hyperbaric bupivacaine for postoperative analgesia in patients undergoing lower limb surgeries under spinal anaesthesia. Methods: This comparative study included patients undergoing lower limb surgeries under spinal anaesthesia. Patients were divided into two groups: group BN received intrathecal bupivacaine with nalbuphine, while group BB received intrathecal bupivacaine with buprenorphine. Onset and duration of sensory and motor block, duration of analgesia, time to rescue analgesia, haemodynamic parameters, sedation score, and adverse effects were compared. Results: Nalbuphine produced significantly earlier onset of sensory and motor blockade. Buprenorphine produced significantly prolonged sensory and motor block, longer duration of analgesia, and delayed rescue analgesic requirement. Haemodynamic parameters remained stable in both groups, and adverse effects were minimal. Conclusion: Intrathecal buprenorphine was superior for prolonged postoperative analgesia, while nalbuphine provided faster onset of blockade with good safety.

Background: Hepatitis B virus (HBV) infection remains an important public health problem because of its potential to cause chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hospital-based screening helps in identifying the burden of infection and guiding preventive strategies. Aim: To determine the prevalence of HBV infection among patients attending a tertiary care hospital. Methods: This retrospective observational study was conducted in the department of Microbiology, Government Medical College, Rajamahendravaram, from April 2023 to March 2024. Laboratory records of patients screened for HBV were reviewed. A total of 6,712 individuals were included, comprising 2,613 male, 1,708 non-antenatal female, and 2,391 antenatal female. Known hepatitis B-positive cases were excluded. Data were analyzed using frequencies, percentages, and chi-square test. Results: Overall, 211 of 6,712 screened individuals were positive, giving an HBV prevalence of 3.14%. Among males, positivity was 4.36%; among non-antenatal females, 4.57%; and among antenatal females, 0.79%. Age-wise variation was significant among males and the non-antenatal population, whereas it was not significant among antenatal women. HBV positivity was significantly lower in antenatal women compared with the non-antenatal population. Conclusion: Although HBV prevalence was relatively low, continued screening, vaccination, and health education are essential, particularly in antenatal women, to reduce transmission and disease burden.

Background: Decompensated chronic liver disease is frequently associated with electrolyte abnormalities, among which hyponatremia is an important marker of advanced circulatory dysfunction and poor prognosis. Aim: To study serum sodium levels in patients with decompensated chronic liver disease (CLD) and to observe their clinical significance. Methods: This prospective observational cross-sectional study was conducted at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation from July 2023 to May 2025. Sixty patients with decompensated CLD were enrolled. Clinical evaluation, liver function tests, serum electrolytes, coagulation profile, ultrasonography abdomen, portal vein Doppler, and ascitic fluid analysis were performed. Statistical analysis was done using SPSS version 23. Results: The mean age was 52 ± 10.50 years, and 95% were males. Alcohol was the commonest etiology (95%). The mean serum sodium level was 126.45 ± 5.66 mEq/L. Hyponatremia (serum sodium ≤130 mEq/L) was observed in 66.7% of patients. Significant associations were found between low serum sodium and ascites, portal hypertension, upper gastrointestinal bleed, coagulopathy, and hepatorenal syndrome. No significant association was observed with spontaneous bacterial peritonitis. Conclusion: Serum sodium is a valuable and easily measurable prognostic marker in decompensated CLD and may help identify patients at greater risk of complications.

Background: Thoracolumbar spine fractures represent a significant proportion of spinal injuries encountered in trauma centers and are frequently associated with substantial morbidity, neurological deficits, chronic pain, spinal deformity, and functional disability. Accurate assessment of fracture stability and neurological involvement is essential for determining the appropriate treatment modality. The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed as a comprehensive classification system incorporating fracture morphology, neurological status, and posterior ligamentous complex integrity to guide treatment decisions. Despite its widespread acceptance, evidence regarding its reliability and effectiveness in predicting functional outcomes remains limited in the Indian population. Aim: To assess the reliability and safety of the Thoracolumbar Injury Classification and Severity Score (TLICS) in choosing the treatment modality (surgical or conservative) for thoracolumbar spine fractures involving D5–L5 vertebral levels. Material and Methods: This prospective observational study was conducted in the Department of Orthopaedics, Government Medical College, Kozhikode, over a period of one year following Institutional Ethics Committee approval. Sixty-eight adult patients aged 18–65 years presenting with thoracolumbar fractures between D5 and L5 levels were included. Patients were evaluated clinically and radiologically using X-ray, CT scan, and MRI. TLICS scores were calculated based on fracture morphology, neurological status, and posterior ligamentous complex integrity. Patients with TLICS ≤3 received conservative treatment, while those with scores ≥5 underwent surgical management. Patients with a score of 4 were managed according to clinical judgment. Functional outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), American Spinal Injury Association (ASIA) impairment scale, and Cobb’s angle measurements during follow-up at 2 months, 4 months, 6 months, and 1 year. Results: The study evaluated the association between TLICS scores and treatment decisions while assessing pain relief, neurological recovery, functional improvement, and radiological correction. Patients managed according to TLICS recommendations demonstrated significant improvements in VAS scores, ODI scores, ASIA grades, and Cobb’s angle measurements over the follow-up period. Surgical treatment was predominantly performed in patients with higher TLICS scores and neurological deficits. Conclusion: TLICS is a reliable and practical tool for guiding treatment decisions in thoracolumbar spine fractures. The classification system facilitates appropriate selection of surgical or conservative management and is associated with favorable functional and radiological outcomes. Adoption of TLICS-based management protocols may improve treatment standardization and patient outcomes in thoracolumbar trauma.

Background: Traumatic brain injury (TBI) is a major cause of mortality and long-term disability worldwide. Secondary brain injury following TBI significantly influences prognosis, and hyperglycemia has been recognized as an important contributing factor. Elevated blood glucose levels may aggravate neuronal damage through metabolic and ischemic mechanisms. The relationship between random blood sugar (RBS) and neurological status assessed by Glasgow Coma Scale (GCS) may provide valuable prognostic information. Aim: To determine the correlation between random blood sugar levels and Glasgow Coma Scale scores in patients with traumatic brain injury. Materials and Methods: This prospective observational study was conducted on 90 patients with TBI admitted to the Department of Neurosurgery over 18 months in a Tertiary Care Hospital. Adult patients (>18 years) with mechanical brain injury and GCS scores between 3–15 were included. Patients with diabetes, metabolic disorders, malignancies, and other causes of brain injury were excluded. RBS levels and GCS scores were recorded at admission, 24 hours, 72 hours, and discharge. Statistical analysis was performed using SPSS version 26 with Pearson correlation, chi-square test, ANOVA, and logistic regression analysis. A p-value <0.05 was considered statistically significant. Results: The majority of patients were males (75.6%) with the highest incidence in the 21–40 years age group (41.1%). Road traffic accidents accounted for 67.8% of injuries. Mean admission RBS was 192.14±58.65 mg/dL and progressively decreased to 131.84±28.22 mg/dL at discharge. Severe TBI patients had higher admission glucose levels (261.33±25.03 mg/dL) compared with moderate and mild injuries. A significant inverse correlation was observed between admission RBS and GCS (r = −0.843, p<0.0001). Discussion: Hyperglycemia was associated with increased TBI severity and poorer neurological outcomes. Higher blood glucose levels corresponded with lower GCS scores and increased mortality risk. Conclusion: Early hyperglycemia showed a strong negative correlation with GCS and may serve as an important predictor of TBI severity and prognosis. Early monitoring and management of elevated glucose levels could improve clinical outcomes.

Background: This study is designed to compare the efficacy of ultrasound (USG) guided Ilioinguinal nerve block (IIN) versus USG guided Erector spinae plane block (ESP) for paediatric inguinal surgeries with respect to postoperative analgesia. Methods: Hospital based randomized prospective interventional study. 50 children of either sex aged 2 to 10 yrs of ASA grade ⅠorⅡ scheduled for elective inguinal surgery were included in study. Interventions: Patients were randomized into 2 groups with 25 patients in each group undergoing elective inguinal surgeries (n=25/group). In group A, ESP block was performed with 0.5 ml/kg of 0.2% ropivacaine and in group B IIN block was performed with 0.5ml/kg of 0.2% ropivacaine. The post-operative pain was assessed by using CHEOPS Score. The time of need to first rescue analgesic was noted. CHEOPS score was assessed every 30 minutes, 1hr, 2hr, 4hr, 6hr, 12hr, 16hr and 24hr postoperatively. Results: Significant difference was observed between the groups on post-operative CHEOPS scores at the 16^th and 24^th hour (p value < 0.05). In group A – 3 (12%) patients required rescue analgesia. While in group B 11(44%) patients required rescue analgesia. There differences were statistically significant. The total dose of rescue analgesia and mean dose of analgesia postoperatively were significantly higher in IIN group. Conclusions: The ESP group showed a better CHEOPS score and a longer duration of analgesia than the IIN group for controlling postoperative pain in pediatric inguinal surgeries.

Introduction: Breast milk Amrit for newborn is complete food and plays crucial role in immunity, growth, and neurodevelopment .Maternal apprehension and anxiety during early neonatal period can adversely affect lactation during this period. Limited studies are available on effect of music therapy and breast milk secretion. Aim: To evaluate the effect of Indian classical music, Raga Ahir bhairav on breast milk secretion in mothers of late preterm and term newborns. Material and Methods: Total 110 mothers -newborn pairs (late preterm and term) were included out of which 55 pairs were music therapy group and 55 pairs control group. Music therapy group received raga Ahir Bhairav for15 minutes four times daily (Total 12 sessions) for three consecutive days. Breast milk volume was measured daily using breast pump under standard aseptic conditions. Statistical analysis was performed using t test and chi square test. Result: Mean milk volume in music therapy group increased from 9.0 ml at session 1 to 30.7 ml at session 12 compared to 8.8 ml and 24.5 ml respectively in controlled group (p 0.001). Multiparous mothers and mothers who delivered vaginally showed greater milk production than primiparous (p 0.03) and caesarean delivered (p 0.02) respectively. Mothers of term newborns demonstrated higher milk secretion as compared to preterm. Conclusion: Music therapy had a positive effect on breast milk secretion among mothers of late preterm and term newborns with statistically significant increase in breast milk volume. It may serve as simple, cost effective and non-pharmocological adjunct to enhance lactation during early neonatal period.

Background: Anemia is the most frequently encountered hematological complication in non-hematological malignancies, adversely affecting quality of life, treatment tolerance, and prognosis. The European Cancer Anemia Survey (ECAS) documented a prevalence of 39.3% at enrollment, rising to 67% during the survey period. Objectives: To study the incidence, pattern, and severity of anemia in adult patients with solid malignancies, and to evaluate comprehensive hematological and iron study parameters. Methods: A prospective observational study was conducted (October 2023–June 2025) at the Department of Pathology, MGMCH. Sixty newly diagnosed, treatment-naïve patients (34 males, 26 females; aged 19–69 years; Hb <12 g/dL) with confirmed non-hematological malignancies underwent complete hemogram (Sysmex XP-100), peripheral blood film (Leishman stain), and iron studies (serum iron, TIBC, serum ferritin by CLIA). Results: Mean age was 54.82 ± 11.70 years with male predominance (56.7%). Mild anemia predominated (51.7%), followed by moderate (33.3%) and severe (15%). Normocytic normochromic pattern was most common on peripheral blood film (56.7%). Serum ferritin was elevated in 50%, normal serum iron in 68.3%, and normal TIBC in 73.3% of patients. Conclusion: Anemia is universal in non-hematological malignancies and increases in severity with age. Integrated early hematological assessment is essential for optimal oncological management.

Background: Anemia is the most frequently encountered hematological complication in non-hematological malignancies, adversely affecting quality of life, treatment tolerance, and prognosis. The European Cancer Anemia Survey (ECAS) documented a prevalence of 39.3% at enrollment, rising to 67% during the survey period. Objectives: To study the incidence, pattern, and severity of anemia in adult patients with solid malignancies, and to evaluate comprehensive hematological and iron study parameters. Methods: A prospective observational study was conducted (October 2023–June 2025) at the Department of Pathology, MGMCH. Sixty newly diagnosed, treatment-naïve patients (34 males, 26 females; aged 19–69 years; Hb <12 g/dL) with confirmed non-hematological malignancies underwent complete hemogram (Sysmex XP-100), peripheral blood film (Leishman stain), and iron studies (serum iron, TIBC, serum ferritin by CLIA). Results: Mean age was 54.82 ± 11.70 years with male predominance (56.7%). Mild anemia predominated (51.7%), followed by moderate (33.3%) and severe (15%). Normocytic normochromic pattern was most common on peripheral blood film (56.7%). Serum ferritin was elevated in 50%, normal serum iron in 68.3%, and normal TIBC in 73.3% of patients. Conclusion: Anemia is universal in non-hematological malignancies and increases in severity with age. Integrated early hematological assessment is essential for optimal oncological management.

Background: Progestogen supplementation is commonly used in the management of threatened miscarriage (TM) and recurrent pregnancy loss (RPL). While both oral dydrogesterone and vaginal micronized progesterone are widely prescribed, direct comparative evidence evaluating their relative efficacy remains sparse and has not been systematically synthesized. Objective: To compare the efficacy of oral dydrogesterone versus vaginal micronized progesterone for pregnancy continuation in women diagnosed with TM or RPL. Methods: PubMed, Cochrane Library and Google Scholar were searched from inception through January 2026 following a pre-registered PROSPERO protocol (CRD420261287005). Randomised controlled trials (RCTs) comparing oral dydrogesterone to vaginal progesterone were included. Risk ratios (RR) were pooled using inverse-variance random-effects meta-analysis. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was graded using the GRADE framework. Results: Four RCTs (n = 416) met inclusion criteria for the primary analysis. Oral dydrogesterone was associated with significantly higher pregnancy continuation rates compared with vaginal progesterone (RR 1.12, 95% CI 1.02–1.23, p = 0.02; I² = 0%; NNT = 10). Sensitivity analysis excluding one high-risk study yielded borderline non-significance (RR 1.10, 95% CI 0.99–1.21, p = 0.07). Secondary analysis from one additional RCT (n = 160) showed no significant differences in late pregnancy outcomes. The overall certainty of evidence was rated LOW. Conclusions: Low-certainty evidence suggests oral dydrogesterone may improve pregnancy continuation compared with vaginal progesterone in women with TM or RPL. Late pregnancy outcomes appear comparable. Larger, adequately powered, double-blind RCTs with live birth as the primary outcome are needed to confirm these findings.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with persistent hyperglycemia and systemic complications. This study evaluated alterations in red blood cell (RBC) indices, platelet indices, and white blood cell (WBC) counts in patients with T2DM of more than 10 years’ duration compared to healthy controls. Methods: This case-control study was conducted over an 18-month period at a tertiary healthcare center in Northern India. A total of 272 patients with long-standing T2DM (>10 years post-diagnosis) and 272 age- and sex-matched healthy controls were enrolled. Complete blood counts and glycemic profiles (HbA1c and fasting plasma glucose) were analyzed. Statistical analysis was executed using SPSS version 24.0. Results: The study included 272 diabetic patients and 272 controls, mostly aged 40–60 years. Gender distribution differed significantly between groups (p = 0.002). Obesity was more common among diabetics with higher BMI (p < 0.001), along with poor glycaemic control. Significant haematological changes in diabetics included altered RBC count (p = 0.03), RDW (p = 0.04), platelet indices, PDW (p = 0.002) and MPV (p = 0.004) and abnormal WBC counts (p = 0.036). Overall, long-standing diabetes was associated with obesity, hyperglycaemia, and significant blood cell alterations. Conclusion: Long-standing T2DM is strongly associated with distinct modifications in hematological profiles. The statistical elevations in RDW, MPV, PDW, and leukocyte abnormalities highlight ongoing subtle red cell structural fragility, enhanced thrombotic platelet activation, and sustained low-grade systemic inflammation. Routine monitoring of these simple hematological markers can serve as reliable indicators to gauge cellular risk and prevent vascular complications.

Background: Relapse following a successful acute course of electroconvulsive therapy (ECT) remains a significant clinical challenge. Continuation electroconvulsive therapy (C-ECT) is used to maintain remission and prevent relapse in patients with severe psychiatric disorders, though data on its real-world effectiveness are limited. Aim: To evaluate the clinical characteristics and treatment response in patients receiving continuation electroconvulsive therapy. Materials and Methods: A total of 100 patients who received C-ECT following an acute ECT course were included. Data regarding sociodemographic profile, clinical characteristics, ECT parameters, treatment response, relapse, and adverse effects were collected from medical records. Results: The mean age of patients was 42.6 ± 13.8 years, with a male predominance (56%). Major depressive disorder was the most common diagnosis (48%), followed by bipolar disorder (32%) and schizophrenia (20%). A good treatment response was observed in 72% of patients, while 18% showed partial response and 10% had poor response. Adverse effects were mostly mild, with memory impairment being the most common (28%). Conclusion: Integration of C-ECT with pharmacotherapy and individualized treatment protocols can significantly improve long-term outcomes. Further prospective studies are warranted to validate these findings.

Background: Acute appendicitis is the most common surgical emergency in children. Early differentiation between uncomplicated and complicated appendicitis remains challenging, and inflammatory biomarkers such as C-reactive protein (CRP) may assist in assessing disease severity and guiding management. Aim: To evaluate the correlation between preoperative serum CRP levels and the severity of appendicitis in pediatric patients. Materials and Methods: This prospective observational study was conducted at a tertiary care medical college hospital in Western India from January to December 2025. A total of 106 pediatric patients diagnosed with acute appendicitis were included. Clinical evaluation, imaging findings, and laboratory parameters including CRP, total white blood cell (WBC) count, and neutrophil percentage were recorded. Ninety-nine patients underwent appendectomy, while seven were managed conservatively. Histopathological examination was used to classify cases as uncomplicated or complicated appendicitis. Statistical analysis was performed using SPSS version 19, with p<0.05 considered significant. Results: The mean age of patients was 9.85 years, with a male predominance (75.5%). Histopathology revealed uncomplicated appendicitis in 41 (41.4%) patients and complicated appendicitis in 57 (57.6%) patients. The mean WBC count (18.88 ± 14.64 vs. 12.56 ± 3.04 ×10³/mm³; p=0.033) and neutrophil percentage (84.96 ± 7.54% vs. 80.68 ± 7.41%; p=0.042) were significantly higher in complicated appendicitis. CRP demonstrated the strongest association with severity, with mean levels of 101.38 ± 68.08 mg/L in complicated cases compared to 22.74 ± 17.80 mg/L in uncomplicated cases (p<0.001). CRP values progressively increased from simple inflammation to gangrenous, necrotic, and perforated appendicitis. Conclusion: Elevated CRP levels strongly correlate with the severity of acute appendicitis in children. CRP, particularly when combined with WBC count and neutrophil percentage, serves as a valuable adjunctive marker for identifying complicated appendicitis and facilitating timely clinical decision-making.

Background: Neonatal hyperbilirubinaemia is one of the most frequent morbidities of the first week of life, occurring in approximately 60% of term and 80% of preterm infants. Phototherapy is the first-line treatment, but it is increasingly recognised to perturb mineral and vitamin D homeostasis. Hypocalcaemia and disturbances in 25-hydroxy-cholecalciferol [25(OH)D] levels are potentially preventable complications that remain under-investigated in the Indian subcontinent. Objectives: To determine the effect of phototherapy on serum total calcium and 25-hydroxy-cholecalciferol concentrations in term neonates receiving phototherapy for unconjugated hyperbilirubinaemia at a tertiary care hospital, and to identify clinical correlates of post-phototherapy mineral changes. Materials and Methods: This prospective analytical study was conducted in the Special Newborn Care Unit (SNCU), Department of Paediatrics, R. G. Kar Medical College and Hospital, Kolkata, over 18 months. A total of 150 term neonates weighing ≥2500 g and on exclusive breastfeeding who required phototherapy for unconjugated hyperbilirubinaemia were enrolled. Total serum bilirubin, total serum calcium and 25-hydroxy-cholecalciferol were measured before initiation of phototherapy and after 48 hours of continuous phototherapy. Hypocalcaemia was defined as total serum calcium <8 mg/dL and vitamin D deficiency as 25(OH)D <20 ng/dL. Data were analysed with SPSS v16.0 using paired t-test, Mann-Whitney U test, McNemar’s test and Pearson correlation; p<0.05 was considered significant. Results: The mean age of neonates was 4.17 ± 1.28 days; 60% were male; mean birth weight was 2.98 ± 0.27 kg; mean gestational age was 38.77 ± 0.76 weeks. Mean total serum bilirubin decreased significantly from 14.35 ± 2.04 mg/dL to 11.47 ± 1.74 mg/dL (mean change 2.88 ± 2.33 mg/dL; p=0.0001). Mean total serum calcium declined from 11.05 ± 1.62 mg/dL to 8.96 ± 1.05 mg/dL (mean change 2.09 ± 1.63 mg/dL; p=0.0001), and mean 25(OH)D fell from 36.64 ± 6.54 ng/dL to 14.06 ± 5.28 ng/dL (mean change 22.58 ± 6.02 ng/dL; p=0.0001). The incidence of hypocalcaemia rose from 0.7% to 8.7% (p=0.002) and that of vitamin D deficiency rose from 2.7% to 90.7% (p=0.0001). The mean fall in calcium was significantly greater in male neonates (2.35 ± 1.55 mg/dL) than in females (1.69 ± 1.68 mg/dL; p=0.01), and birth weight correlated positively with the magnitude of calcium decline (r=0.27, p=0.001). Conclusion: Phototherapy administered for 48 hours to term neonates with unconjugated hyperbilirubinaemia produces a statistically significant fall in both serum calcium and 25-hydroxy-cholecalciferol concentrations and substantially increases the incidence of biochemical hypocalcaemia and vitamin D deficiency. Routine monitoring of serum calcium and vitamin D should be considered in neonates undergoing prolonged phototherapy, with prophylactic calcium and vitamin D supplementation in those receiving phototherapy beyond 48 hours.

Introduction: The present study shares the knowledge of normal and the variant anatomy in the branching pattern of main trunk of Left coronary artery which has a vital role in clinical application to overcome the problems that encounter during various surgical procedures of heart. Materials and Methods: The study was conducted in 30 formalin fixed human cadaveric hearts of both sexes obtained from the department of Anatomy and carefully dissected to observe the main trunk of left coronary artery. Results: It was observed that Left coronary artery shows bifurcation in 80%, trifurcation in 16.6%, and quadrification in 3.33% of specimens. Conclusion: The present study helps the physician and the cardiac surgeons for interpretation of the coronary angiograms and their surgical repair.

Background: Invasive fungal infections represent a major challenge in solid organ transplantation due to the risk of reactivation under immunosuppression. Aspergillus pericarditis is an uncommon manifestation associated with high mortality, and data guiding transplant decisions after such infections are limited. Case Presentation: A 48-year-old female with end-stage renal disease on hemodialysis presented with constrictive pericarditis and severe hypotension. Aspergillus fumigatus isolated by tissue culture after subtotal pericardiectomy. She was treated with voriconazole for four months with complete clinical resolution and underwent deceased donor kidney transplantation two months after treatment. The patient required temporary hemodialysis due to immediate postoperative delayed graft function and tacrolimus was started four days later. Secondary prophylaxis from transplantation onwards was with isavuconazole, due to its mild, highly predictable CYP3A4 inhibition that allowed safe titration of calcineurin inhibitors without volatile toxic spikes. Kidney transplantation was successful with no rejection or major infection. Over a 2-year follow-up, the patient had stable allograft function without fungal recurrence. Conclusion: Kidney transplantation may be feasible in selected patients with previously treated invasive aspergillosis when careful risk stratification, pre-transplant mycological eradication with the strategic deployment of newer-generation triazoles like isavuconazole to safely manage complex post—transplant pharmacokinetic interactions and tailored immunosuppression.

Objective: To present a case of staghorn renal calculus diagnosed through clinical and radiological evaluation and managed successfully with percutaneous nephrolithotomy (PCNL) at a specialized urology centre. Methods: A 58-year-old male presented with chronic right-sided flank pain, burning micturition, recurrent urinary tract infections, decreased appetite, and occasional fever. Clinical examination, laboratory investigations, and CT urography were performed for diagnostic evaluation. Results: CT urography revealed a 2.5 × 1.9 cm right renal staghorn calculus with multiple smaller calculi and upper pole calyceal dilatation. The patient was referred to the urology team, where PCNL was performed successfully with complete stone clearance. The postoperative period was uneventful except for transient fever, and the patient was discharged in stable condition. Conclusion: This case highlights the importance of early diagnosis, appropriate imaging, and timely referral in the management of staghorn renal calculi. Coordinated care with specialized teams can lead to favorable clinical outcomes.

Background: Pain and disability from knee osteoarthritis is a major problem, and excess body weight is a significant modifiable risk factor. Body mass index (BMI), clinical symptoms and radiographic severity are important for early intervention. Methods: A cross sectional study of 220 adults with symptomatic knee osteoarthritis. The clinical severity was evaluated by pain visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The Kellgren-Lawrence (KL) system was used to grade weight-bearing anteroposterior and lateral knee radiographs. BMI was classified as normal, overweight, obese class I and obese class II or higher. Results: Mean age was 58.9 +/- 8.7 years; 128 patients (58.2%) were female. Mean BMI was 28.7 +/- 4.6 kg/m2. 94 patients (42.7%) had KL grade III-IV disease. There was a significant correlation between BMI and VAS, WOMAC and KL grade (p<0.001). The mean WOMAC score was 61.8 +/- 13.4 in patients with a BMI of class II or higher, and 38.6 +/- 12.1 in normal BMI patients. BMI correlated positively with KL grade (r=0.46), VAS (r=0.41), and WOMAC (r=0.49; all p<0.001). Conclusion: Increased BMI was significantly associated with worse clinical and radiological knee osteoarthritis. Weight management should be a key part of osteoarthritis treatment.

Background: Pneumoperitoneum during laparoscopic surgery under general anesthesia is known to cause a decrease in pulmonary compliance and increase in airway pressures. Traditionally, endotracheal tubes (ETTs) have been used because they create a definitive airway, while second generation supraglottic airway devices (SGAs) have been shown to seal the airway better and to drain the stomach with less stimulation of the airway. The aim of the present study was to compare the incidence of airway complications in ETT and SGA in elective laparoscopy. Methods: This was a prospective comparative study of 120 adult ASA physical status I-II patients undergoing elective laparoscopic surgery. Patients were randomized to either ETT (n=60) or SGA (n=60; second generation device with gastric drainage channel). The following were used: standardized induction, neuromuscular blockade, controlled ventilation, pneumoperitoneum pressure, and postoperative assessment. The main outcome was the composite of airway complications within 24 hours. Secondary outcomes were device insertion characteristics, ventilatory variables, hemodynamic responses, postoperative sore throat, cough, and hoarseness, nausea-vomiting, and PACU discharge time. Results: There were no differences in baseline characteristics between groups. The mean insertion time was significantly less for SGA than ETT (15.2±3.8 vs. 22.8±5.4 seconds; p<0.001). Peak airway pressure following pneumoperitoneum was similar (23.4±3.8 vs. 24.1±4.2 cmH2O; p=0.34), and the increase in mean arterial pressure during insertion was less with SGA (8.6±5.7 vs. 15.8±7.1 mmHg; p<0.001). The composite airway complication rate was significantly greater in the ETT group (43.3%) compared to the SGA group (20.0%) (p=0.006). Sore throat (31.7% vs. 11.7%; p=0.008), emergence cough (26.7% vs. 8.3%; p=0.009), and hoarseness (18.3% vs. 5.0%; p=0.024) were more frequent after ETT. None of the patients had aspiration, regurgitation or clinically significant bronchospasm. Conclusions: In the right adult patient undergoing elective laparoscopic surgery, second-generation SGA was effective for ventilation and was found to be associated with fewer postoperative airway complications and a more stable hemodynamic response than ETT.

Background: Comparative Study of Nutrient Foramina Distribution in Long Bones among Different Age Groups, is a clinically relevant diagnostic and anatomical problem that is encountered in routine tertiary care practice. The aim of this study was to compare the number, topography, direction and foraminal index of nutrient foramina of long bones in various age groups. Method: The methods used were comparative osteological observational study in the Department of Anatomy bone museum and osteology laboratory. The study included 240 dry adult and adolescent long bones categorized into three age groups using documented skeletal collections. The participants/specimens were divided into adolescent, young adult and older adult bone groups. Standardized data collection, laboratory/radiological/anatomical assessment and predefined operational criteria were used. Results: 81.7% of the bones had a single nutrient foramen, 15.0% had two and 3.3% had none. The most frequent location was the middle third (62.1%). There was a greater percentage of accessory foramina in older adult bones compared to adolescent bones (21.3% vs 10.0%, p=0.031). In 94.6% of cases, direction was in accordance with the rule, away from the growing end. Conclusion: Age-group differences were found to be relatively small, but accessory foramina were more common in older adult bones, highlighting the need for preservation of the vascular entry zones of the diaphyses in orthopedic surgery.

Introduction: Elective surgery often leads to pain that is not amenable to simple measures. Intranasal use provides systemic access without an intravenous route; tramadol, used intravenously, shares one mechanistic feature with the dual acting agent but not the second. Aims and Objectives: Aim: To compare analgesic efficacy provided by Intranasal Tapentadol and Intravenous Tramadol in patients undergoing Elective General Surgery. Objectives: • To compare analgesic efficacy between the two study drugs. • To compare the hemodynamic stability between the two study groups • To determine incidence of post-operative nausea and vomiting between the two study drugs. Material and Method: Study Design: The study was designed as a Prospective Randomized Controlled study Study Place: The study was carried out at Kempegowda Institute of Medical Sciences, Bengaluru. Study Period: The study was conducted over the course of one year. Study Participants: After IEC approval is obtained, 72 patients satisfying the inclusion and the exclusion criteria will be included in the study. Sample Size: For 2 groups, the total sample size will be 72 subjects (36 subjects in each group). Result: A total of 72 patients were enrolled and equally randomized into two groups (n = 36 each). Baseline characteristics were comparable between the groups, ensuring the internal validity of the study. Discussion: In this study, hemodynamic parameters (SBP, DBP, MAP, and PR) were monitored across both Intranasal Tapentadol and Intravenous Tramadol groups. Baseline values for all parameters were comparable between the groups. Keywords: Analgesia, Neuropathic Pain, Nerve Blocks, Postoperative Pain, Tapentadol.

Abstract: Background: Effective post-operative analgesia is crucial for enhancing recovery and reducing opioid requirements in patients undergoing total knee arthroplasty (TKR). Levobupivacaine is a commonly used local anaesthetic in adductor canal blocks (ACB) for TKR; however, its duration of analgesia can be limited. Dexmedetomidine, an alpha-2 adrenergic agonist, is recognized for its analgesic properties and potential to extend the effects of local anaesthetics. This study evaluates the effectiveness of Levobupivacaine versus Levobupivacaine combined with Dexmedetomidine in enhancing analgesic duration and quality in patients undergoing total knee arthroplasty. Objectives: This study aimed to assess the duration of analgesia, 24-hour opioid consumption, success of early ambulation, patient satisfaction, and to look for any adverse effects or complications in patients receiving Levobupivacaine versus Levobupivacaine with Dexmedetomidine in ACB after total knee arthroplasty. Methods: A prospective, randomized clinical trial was conducted among a total of 100 patients with two patient groups undergoing TKA. Patients undergoing elective TKR surgeries, aged between 18 and 70 years of age and categorized under American Society of Anesthesiologists (ASA) class 1 to 3 were included in this study. Group A (50 patients) received Levobupivacaine alone in ACB, while Group B (50 patients) received a combination of Levobupivacaine with Dexmedetomidine. Heart rate and blood pressure were monitored at baseline, every 15 minutes for the first hour, then at 2, 5, 12, and 24 hours post-operatively. Quadriceps power was recorded preoperatively and at 6, 12, and 24 hours after the block. Patient satisfaction and any adverse events were noted at 24 hours. Rescue analgesia was provided with 75 mg diclofenac or 100 mg tramadol with 4 mg ondansetron intravenously, and total 24-hour requirements for tramadol and diclofenac were documented. The data was collected were tabulated using Microsoft excel sheet and was analyzed in SPSS trial version 23.0 using chi-square test or Fishers exact test. p<0.05 was considered to be statistically significant. Results: Group B showed a significantly delayed need of rescue analgesia of around 6 hours compared to Group A of around 3 hours. VAS pain scores were generally lower in Group B from 2 to 12 hours post-operatively, although a slight increase was noted at 24 hours, indicating extended pain relief. The mean total dose of rescue analgesia in Group A was significantly higher (301.5 mg) of tramadol compared to Group B (139.5 mg) of tramadol, indicating that the total dose of rescue analgesia requested is significantly higher in Group A than in Group B. Both groups demonstrated comparable physiological stability, with no significant differences in heart rate, blood pressure, or oxygen saturation. Differences in ASA grade and BMI were noted between the groups but did not significantly affect primary or secondary outcomes. Conclusion: Adding Dexmedetomidine to Levobupivacaine in ACB for TKR significantly enhanced the duration and quality of post-operative analgesia without compromising physiological stability. This combination reduced immediate opioid requirements and improve patient comfort, supporting its broader application in clinical settings for post-operative pain management.

Abstract Background: Solitary thyroid nodule (STN) is one of the most common endocrine surgical presentations encountered in clinical practice. Although the majority of thyroid nodules are benign, the possibility of malignancy necessitates detailed clinical evaluation, radiological assessment, cytological investigation, and appropriate surgical management. Fine Needle Aspiration Cytology (FNAC), ultrasonography (USG), and histopathological examination remain the cornerstones in the diagnosis and management of solitary thyroid nodules. Aim: To study the clinicopathological features, diagnostic modalities, incidence of malignancy, and management outcomes in patients presenting with solitary thyroid nodules. Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of General Surgery at RCSM Government Medical College, Kolhapur, Maharashtra, India, from September 2017 to February 2019. A total of 60 patients with clinically diagnosed solitary thyroid nodules were included using systematic random sampling. Detailed clinical history, examination findings, thyroid function tests, ultrasonography, FNAC, indirect laryngoscopy, and histopathological examination were performed. Data were analyzed using Epi Info 7.2 software. Descriptive and inferential statistical analyses were applied. Results: The majority of patients belonged to the age group of 20–39 years (48.3%), with a mean age of 38.1 ± 6.8 years. Female predominance was observed (81.7%). Right lobe involvement was more common (61.7%). Most patients were euthyroid (86.7%). FNAC revealed benign lesions in 43.3% of cases and malignancy in 18.3% of cases. Histopathological examination demonstrated follicular adenoma in 26.7%, multinodular goiter in 26.6%, and carcinoma in 21.7% of cases. Papillary carcinoma was the commonest malignant lesion (61.5%). Hemithyroidectomy was the most frequently performed surgical procedure (83.3%). Conclusion: Solitary thyroid nodules are more common in females and predominantly occur in the third and fourth decades of life. FNAC and ultrasonography are highly valuable diagnostic tools for preoperative evaluation. Papillary carcinoma remains the most common malignant lesion. Early diagnosis and timely surgical intervention significantly improve prognosis and reduce complications.

Background: Accurate estimation of skin-to-subarachnoid space depth (SSD) is essential for successful spinal anesthesia and minimizing complications. Anthropometric parameters such as body mass index (BMI) may influence spinal needle depth; however, their predictive accuracy requires validation using advanced statistical models. Methods: A prospective observational study was conducted on 100 patients undergoing elective below-umbilical surgeries under spinal anesthesia. Anthropometric variables (weight, height, BMI, arm circumference [AC], and waist circumference [WC]) were recorded. Spinal needle depth (SND) was measured intraoperatively at L3–L4 interspace. Pearson correlation, multivariate linear regression, and receiver operating characteristic (ROC) analysis were performed (Table 3, Table 4, Table 5, Table 6) Results: Mean SND was 5.20 ± 0.73 cm, while predicted depth using Bonadio’s formula was 5.62 ± 0.66 cm (Table 3). Significant correlations were observed between SND and weight (r = 0.812), BMI (r = 0.668), WC (r = 0.666), and AC (r = 0.643) (p < 0.001) .Multivariate regression identified weight (β = 0.031, p < 0.001) and BMI (β = 0.018, p = 0.002) as independent predictors. SND = 1.96 + (0.031 × weight) + (0.018 × BMI) (R² = 0.72). ROC analysis demonstrated excellent predictive ability: weight AUC = 0.91 (sensitivity 88%, specificity 82%); BMI AUC = 0.84 (sensitivity 81%, specificity 75%). Conclusion: Weight and BMI are strong independent predictors of spinal needle depth. A multivariate model enhances predictive accuracy and may improve clinical outcomes by reducing procedural attempts. Keywords: Spinal anesthesia; BMI; Needle depth; Anthropometry; ROC analysis.

Background: Type 2 diabetes mellitus (T2DM) is a major contributor to global cardiovascular morbidity and mortality. Silent myocardial ischemia (SMI), characterized by objective evidence of ischemia without anginal symptoms, is particularly prevalent in diabetic individuals due to cardiac autonomic neuropathy. Microalbuminuria (MAU), a marker of endothelial dysfunction, has emerged as a predictor of cardiovascular disease. This study aimed to evaluate the association between MAU and SMI in asymptomatic T2DM patients. Methods: A hospital-based cross-sectional study was conducted over one year (June 2024–May 2025) involving 50 asymptomatic T2DM patients aged 30–60 years with confirmed microalbuminuria (urine albumin-to-creatinine ratio >30 mg/g). Patients with known coronary artery disease (CAD), hypertension, resting ECG abnormalities, or contraindications to treadmill testing were excluded. All participants underwent detailed clinical evaluation, BMI calculation using Quetelet’s index, resting 12-lead ECG, spot urine albumin-to-creatinine ratio, and symptom-limited treadmill exercise testing (TMT) using the modified Bruce protocol. A positive TMT was defined as ≥1 mm horizontal or down-sloping ST-segment depression measured 60–80 ms after the J-point in three consecutive beats without anginal symptoms. Statistical analysis was performed using SPSS version 20.0. Continuous variables were expressed as mean ± SD; categorical variables as frequencies and percentages. Chisquare test was used for associations; p < 0.05 was considered statistically significant. Odds ratios (OR) with 95% confidence intervals (CI) were calculated where applicable. Results: The mean age of the study population was 49.8 ± 6.1 years (range 34–58 years). Males constituted 58% (n=29). Mean BMI was 25.8 ± 3.1 kg/m²; 40% (n=20) had normal BMI, 46% (n=23) were overweight, and 14% (n=7) were obese. Duration of diabetes was <5 years in 14% (n=7), 6–9 years in 60% (n=30), and >10 years in 26% (n=13). SMI was detected in 64% (32/50; 95% CI: 50.6–77.4%) by TMT. A highly significant association existed between SMI and duration of diabetes (p < 0.001), with 100% prevalence in patients with >10 years duration. BMI showed a significant association (p = 0.041; OR for overweight = 2.8, 95% CI: 1.1–7.3). No statistically significant association was observed with age (p > 0.05) or sex (p > 0.05). Conclusion: Microalbuminuria is strongly associated with silent myocardial ischemia in asymptomatic T2DM patients, with a prevalence of 64%. Duration of diabetes and higher BMI are independent predictors. Routine screening with urine albumin-to-creatinine ratio followed by TMT enables early detection and may reduce cardiovascular risk in this high-risk population.

Background: Endotracheal tube (ETT) cuff pressure (CP) monitoring is essential during general anaesthesia to prevent airway complications associated with overinflation and underinflation of the cuff. Laparoscopic surgeries, particularly those involving pneumoperitoneum and positional changes, are associated with significant physiological alterations that may influence ETT cuff pressure. Elevated cuff pressure may compromise tracheal mucosal perfusion and increase postoperative airway morbidity. Aim: To compare changes in endotracheal tube cuff pressure during laparoscopic surgeries performed in head-up and head-down positions with open abdominal surgeries. Materials and Methods: A prospective comparative study was conducted in the Department of Anaesthesiology at a tertiary care teaching hospital over a period of 21 months. A total of 150 adult patients undergoing elective abdominal surgeries under general anaesthesia were included and divided equally into three groups: Group A – open abdominal surgeries, Group B – laparoscopic surgeries in head-up position, and Group C – laparoscopic surgeries in head-down position. Endotracheal tube cuff pressure was adjusted to 25 cm H2O after intubation using an aneroid cuff manometer and serial measurements were obtained intraoperatively. Postoperative airway complications including sore throat, throat pain, hoarseness of voice, and blood-streaked expectoration were assessed. Results: Baseline demographic characteristics were comparable among the three groups. Mean cuff pressure increased progressively in all groups; however, the increase was significantly greater in laparoscopic procedures, especially in head-down position. At 60 minutes, mean cuff pressures were 25.2±0.5 cm H2O in Group A, 28.2±0.6 cm H2O in Group B, and 30.2±1.5 cm H2O in Group C (p=0.004). Postoperative sore throat and throat discomfort were more frequent in Group C compared to Groups A and B. Conclusion: Laparoscopic surgeries, especially those performed in Trendelenburg position, are associated with significant increases in endotracheal tube cuff pressure. Continuous intraoperative cuff pressure monitoring and periodic adjustment are recommended to minimize postoperative airway complications.

Background: Anal fissures are among the most painful conditions and are incredibly common. It can be extremely concerning since, in the case of an acute lesion, the degree of discomfort and handicap experienced by the patient significantly surpasses what would be anticipated from a relatively insignificant lesion. The two most popular treatments for anal fissures, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS), are compared in this study. Methods: From May 2025 to October 2025, GMCH, Bettiah, West Champaran, Bihar, was conducted a prospective study comparing MAD with LAS for the treatment of persistent anal fissures. Thirty patients who satisfied the inclusion criteria were randomly assigned to receive either MAD or LAS, and their post-operative discomfort, complications, hospital stay, recurrence rates, and compliance were examined. Results: A total of thirty patients were assigned at random to either LAS or MAD. Patients who have had LAS experience improved pain alleviation and a somewhat higher risk of infection. Compared to LAS, those who have had MAD had a lower risk of infection, recurrence rates, and sequelae. Conclusion: For the treatment of acute anal fissures, MAD and LAS are similarly safe, efficacious, and have lower recurrence rates. However, the MAD group experienced somewhat more postoperative pain.

Background: A stoma is a surgically externalization of the colon or ileum to the front of the abdominal wall. The most common causes of fecal stomas include acute abdominal trauma, carcinoma, and inflammatory bowel disease. A person with a stoma may experience both physical and psychological distress. In accumulation, complications during stoma are very common. Methods: The study, which was held August 2025 to January 2026 at the Department of General Surgery, GMCH, Bettiah, West Champaran, Bihar, involved fifty patients. All patients who had stoma closure and satisfied the inclusion criteria made up the study population. Patients of all ages who underwent stoma closure for a non-malignant condition were included in the study. Stoma closure for patients undergoing surgery for cancer, inflammatory bowel disease, or tuberculosis was not included by the study. This study group had a variety of issues, complications with different treatments, and complications with different stoma closure intervals. Results: There were less postoperative linked to early stoma closure and intraoperative application of the direct stoma closure technique. By using subcutaneous drain implantation, we can reduce the risk of wound infection and dehiscence. Conclusion: Postoperative problems can be utilizing the appropriate technique and closing the stoma at the appropriate time.