Background: Gallbladder dimensions play a role for determining the structural integrity of the organ, and ultrasonography is a non-invasive method that offers accurate measures of these dimensions. The purpose of the study was to use ultrasonography to estimate the epidemiology by measuring the gallbladder (GB) wall thickness in patients with cholecystitis and cholelithiasis. Methods: This case-control study was conducted in Department of Surgery, GMCH, Bettiah, West Champaran, and Bihar from February 2025 to July 2025. The study comprised patients of either sex aged 15–70 years with cholecystitis and cholelithiasis. In the fasting condition, the thickness of the GB wall was measured. The study comprised 50 samples in total, 36 of which were cases (having a diseased bladder) and 14 of which were controls (having a normal bladder). Results: More than one-third of cases (38.9%) were between 30 and 40 years. The mean age of cases and controls was 42.22±12.81 and 35.43±11.85 years, respectively. More than one-third of both cases (36.1%) and controls (35.7%) were males. The GB wall thickness was significantly (P = 0.005) higher among the cases (4.06 ± 2.28 mm) than that of controls (2.22 ± 0.67 mm). Full distention of the GB was in more than half of both cases (69.4%)and controls (57.1%). Partial distended was in 11.1% of cases and in 21.4% of controls. Contracted (8.3%) and over distended (2.8%) were only seen among cases. The GB wall thickness of ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness of <3 mm was 92% lower in cases compared to controls (odds ratio = 0.08, 95% confidence interval = 0.01–0.43, P = 0.001). Conclusion: During ultrasonography, a higher degree of the GB wall thickness was found in patients with cholecystitis and cholelithiasisas compared to the control group.

Background: Intra-uterine contraceptive devices (IUCDs) are extremely effective, useful, coitus independent and well tolerated method of contraception. Increased hospital deliveries provide women easy access to postpartum intrauterine contraceptive devices (PPIUCD) services. CuT 380A and Cu 375 both are available free of cost in government hospitals. Aim of this study to effectiveness, safety, efficacy, side effects and complications of CuT 380A IUCD and Cu 375 IUCD in post placental insertion. Methods: A prospective and comparative study between two copper bearing Intrauterine Contraceptive Devices: Copper T 380A and Multiload 375 was conducted Sadar Hospital, Motihari, Bihar. A total of 200 pregnant women undergoing normal vaginal delivery were enrolled. The subjects were divided in two groups, each comprising of 100 subjects. In Group A, CuT 380A and in Group B, ML 375 was inserted. Follow-up was done after six weeks, three months and six months. Results: The results showed maximum usage in age group of 19 to 24 years in both the groups. At the end of six months the continuation rate was 76.59% in Group A and 80.64% in Group B. There was no case of perforation or failure in both the groups. Rate of expulsion was 8.51% in Group A and 9.68% in Group B. Conclusion: There was no significant difference between CuT 380A and ML 375 with regards to the effectiveness, safety, efficacy, side effects and complications in post placental insertion.

Background: Even with normal treatment in intensive care units, acute febrile illness associated with Multi Organ Dysfunction Syndrome (MODS) carries a high morbidity and fatality rate. The most frequent cause of MODS is infection, which is followed by polytrauma. The current study examined the aetiology and outcome of patients with acute febrile illness who developed MODS in medical intensive care units of a tertiary hospital. Aims of this study to the etiology of acute febrile illness in patients developing MODS and the final outcome among these patients. Methods: This prospective study was carried out in Darbhanga Medical College and Hospital in Laheriasarai, Bihar, from July 2024 to June of 2025. Patients with AFI and MODS (≥2 organ dysfunctions) were evaluated for demographic, clinical, laboratory, and microbiological parameters. Disease severity was assessed using SOFA score. Results: Dengue, malaria, leptospirosis, rickettsial infections, and bacterial sepsis were common causes. Mortality correlated with elevated creatinine, bilirubin, CNS involvement, low MAP, and thrombocytopenia. Mixed infections increased mortality risk. Conclusion: MODS due to AFI poses a critical care challenge. Early identification of high-risk patients using simple markers can guide timely management and improve outcomes, particularly in resource-limited settings.

Background: A Helicobacter pylori (H. pylori) infection is the most common cause of chronic gastritis (CG), with approximately 50% of the world’s population infected. Long-term infection increases the risk of progression to gastric cancer. This study evaluated the histopathological changes in CG using the Updated Sydney System (USS) to estimate the prevalence and correlation of H. pylori gastritis with other histological variables. Methods: This prospective observational study was conducted in the Department of Pathology of JLNMCH, Bhagalpur, Bihar from March 2025 to August 2025. 62 gastric endoscopic mucosal biopsies taken from patients presenting with dyspepsia were included in this study. Slides were stained with routine H and E and Giemsa for H. pylori detection in chronic gastritis cases. Grading of the variables were done with reference to Sydney system of classification. Results: Out of 62 gastric biopsy specimens, 55 cases (88.7%) were histopathological diagnosed as chronic gastritis. Among chronic gastritis, 21 (38%) cases showed H. pylori and majority of these being moderately (2+) positive. 27 (49%) cases showed neutrophilic activity with most of them showed mild (1+) activity. Chronic inflammation was seen 52 (94.5%) with majority of these graded as moderate (2+). Intestinal metaplasia was seen in 8 (14.5%) of cases with majority being mild (1+). Atrophy was seen only in 3 (5.4%) of cases with majority being mild (1+). Significant statistical association was found between H. pylori and neutrophilic activity (p<0.001). Conclusion: Histological evaluation of chronic gastritis using updated Sydney system of classification helps in detection of H. pylori infection and prevents further progression of the disease.

Background: Cervical lymphadenopathy is one of the commonest presentations in inflammatory and neoplastic disorders. Fine Needle Aspiration Cytology (FNAC) is simple, quick, inexpensive and minimally invasive OPD technique used for establishing the etiology of cervical lymphadenopathy. In this study we describe cytomorphological patterns of FNAC of cervical lymph nodes and it’s utility in establishing diagnosis. The aim of the study is to establish the role of FNAC in the Diagnosis of Cervical Lymph Nodes in PMCH, Patna, and Bihar. Methods: The present study was a prospective and cross-sectional study. This Study was carried out over a period of 6 months from March 2025 to August 2025 at department of Pathology, Patna Medical College and Hospital, Patna, Bihar. A total of 100 patients with cervical lymph nodes were subjected to FNAC using 22 gauge needle and a 10 ml syringe. The slides were dry fixed and studied using May-Grunwald Giemsa stain. Results: Out of 100 cervical lymph node FNAC cases, reactive non-specific was the most common finding (52%) followed by tubercular (28%). Conclusion: This study highlights the usefulness of FNAC as a reliable diagnosis of cervical lymphadenopathy.

Background: Fine needle aspiration (FNA) of the thyroid gland has proven to be an important and widely accepted, cost-effective, simple, safe, and accurate method for triaging patients with thyroid nodules. Fine needle aspirations provide information that guides the management of patients with thyroid nodules by identifying patients who require surgical resection and patients who require no further interventions. The aim of this study was to analyze the thyroid cytology smears by Bethesda system and to assess the frequency of various categories. Methods: A total of 85 thyroid FNAC samples were examined from March 2025 to August 2025 in the Department of Pathology, Patna Medical College, and Patna Bihar. Results: A total of 85 cases were reported according to Bethesda system of reporting. Categories were as follows: category I – 5(5.88%), category II – 66(77.65%), category III – 1(1.17%), category IV – 4(4.70%), category V -3(3.52%), category VI – 6(7.05%). Conclusion: FNAC for thyroid nodules is a safe, quick, and cost-effective outpatient procedure when executed by experts. The Bethesda system provides a unified and comprehensive approach to interpreting results, preventing unnecessary surgeries and promoting more judicious patient care.

Background: Cerebellopontine angle (CPA) masses are the most common neoplasm in the posterior fossa, accounting for 5%-10% of intracranial tumors. MRI is considered the gold-standard method for the diagnosis of cerebellopontine angle lesions and describing the imaging feature of CPA masses. Aim and Objectives: To evaluate the role of magnetic resonance imaging (MRI) aided with contrast-enhanced MRI in the evaluation of cerebellopontine angle mass lesions. Materials and Methods: A prospective, single-center observational study was conducted over period of 18 months (JAN 2024–JUNE 2025) at a tertiary care hospital. The study included total of 30 patients with lesions of cerebellopontine angle were referred to radiology departments for MRI. All patients included were subjected to a detailed physical examination followed by MRI scan using a siemens MRI scanner with a standardized protocol. Contrast study was used to characterize the mass lesions. MRI findings were analyzed with respect to lesion morphology, signal characteristics, and diffusion restriction. Data on patient demographics, clinical symptoms, and detailed MRI findings were systematically collected and analyzed. Results: Most common tumors of CPA are vestibular schwannomas; second most frequent CPA tumors are meningiomas. Epidermoid cyst and arachnoid cysts are less common CPA tumors. In our study, there were 11 cases of vestibular schwannomas, 9 cases of meningiomas, 6 cases of epidermoid cysts, 3 cases of arachnoid cysts and 1 case of lipoma. The highest number of cerebellopontine angle masses was found in the age group between 31 and 40 years with slight male predominance. The most common presenting symptom was headache, followed by vertigo and hearing loss. Conclusion: The most common CPA mass was vestibular schwannoma followed by meningioma and epidermoid cyst. Magnetic resonance imaging is more sensitive and more specific in diagnosing cerebellopontine angle mass.

Background: Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy with a high prevalence in South and Southeast Asia, particularly India, where late-stage presentation and mandibular involvement are frequent. Mandibulectomy remains a cornerstone in management not only to achieve complete tumor clearance but also to provide vital insights through margin status and detailed histopathological evaluation of prognostic features, which are critical for guiding therapy and predicting patient outcomes. Aim: To evaluate the demographic profile, TNM staging, and histopathological prognostic features of oral squamous cell carcinoma in mandibulectomy specimens at a tertiary care center. Methods: A retrospective study was conducted on 50 mandibulectomy specimens of OSCC received over two years at a tertiary care center in Raipur, India. Demographic and clinical data were retrieved from medical records. The histopathological parameters assessed included tumor differentiation, bone invasion, margin status, perineural invasion (PNI), lymphovascular invasion (LVI), and TNM staging. Data were analyzed using descriptive statistics. Results: The study population comprised of 31 males (62%) and 19 females (38%), with a mean age of 46.9 years. The gingivobuccal sulcus and buccal mucosa were the most commonly involved sites of the disease. Histologically, 50% of the tumors were moderately differentiated, 46% were well-differentiated, and 4% were poorly differentiated. Adverse features included PNI in 36%, LVI in 28%, and cortical bone invasion in 30% of the cases. Advanced T-stage (T3-T4) was observed in 84% of patients and advanced nodal disease (N2–N3) in 34%. The surgical margins were clear in 64% of the cases and positive in 36% of the cases. Prognostic stage distribution revealed Stage IVA in 66% of cases. Conclusion: Mandibular OSCC predominantly affects males and most commonly involves the alveolus and gingivobuccal sulcus. Most cases present at advanced stages with adverse histopathological features, such as bone invasion, PNI, and margin involvement, which are key prognostic indicators. Routine clinicopathological correlation, achieving tumor-free margins, and early detection are essential for optimal treatment. Further studies incorporating molecular and imaging biomarkers may enhance prognostication and guide individualized therapies.

Introduction: Acute appendicitis is one of the most common surgical emergencies worldwide. Laparoscopic appendectomy (LA) has become the preferred approach due to advantages such as reduced postoperative pain, shorter hospital stay, and quicker recovery. Aims:  This study evaluates the efficacy and complications associated with LA in patients with acute appendicitis. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery at Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata and Nil Ratan Sircar Medical College and Hospital, Kolkata, over a period of 18 months (July2023 to December 2024). A total of 100 patients of all ages and both genders diagnosed with acute appendicitis and fit for surgery were included. Results: In this study of 112 pediatric patients, 57 underwent laparoscopic appendectomy and 55 underwent open appendectomy. Baseline characteristics, including gender, age, time to treatment, appendicitis subtype, and neutrophil percentage, were comparable between groups. Laparoscopic appendectomy was associated with shorter operation time (57.12 vs. 65.33 min, p = 0.022), less intraoperative bleeding (32.15 vs. 45.35 ml, p = 0.042), and shorter hospital stay (5.12 vs. 9.85 days, p = 0.0246). Postoperative recovery was faster with laparoscopy, including earlier exhaust (15.21 vs. 40.33 h, p = 0.0103) and feeding (1.65 vs. 3.24 days, p = 0.0327), along with lower body temperature (37.15 vs. 38.15°C, p = 0.0346) and neutrophil percentage (0.65 vs. 0.79%, p = 0.0457). Complication rates were lower in the laparoscopic group (3.51% vs. 12.73%, p = 0.049). Overall, laparoscopic appendectomy demonstrated faster recovery, reduced inflammation, and fewer complications compared to open appendectomy. Conclusion: Laparoscopic appendectomy is an effective and safe surgical procedure for acute appendicitis, associated with low complication rates, shorter hospital stay, and rapid postoperative recovery. Awareness and prompt management of potential complications can further improve patient outcomes.

Aim: To compare short-term outcomes of laparoscopic versus open repair of peptic ulcer perforation (PPU) in a rural tertiary hospital. Method: This prospective study was conducted at Bankura Sammilani Medical College, West Bengal, from March 2021 to August 2022. Total Fifty-two patients underwent simple closure with omental patch, where 26 underwent laparoscopic repair and 26 underwent open surgical repair. Operative time, analgesic requirement, naso-gastric tube duration, resumption of oral feeds, hospital stay, antibiotic requirement, postoperative complications, and return to work were compared and anlysed. Result: The mean operative time was shorter in the laparoscopic group (64.6 ± 5.0 min) as compared to open repair (85.6 ± 5.2 min, p < 0.001). Analgesic requirement, nasogastric tube duration, and hospital stay were also reduced with laparoscopic repair. 15.4% Wound gap occurred only in the open surgical repair group. Conclusion: Laparoscopic repair of PPU is safe, feasible, and associated with faster recovery and fewer wound complications compared to open repair, even in rural tertiary care settings.

Introduction: Surgical site infections (SSIs) are a major postoperative complication, resulting from bacterial contamination during or after surgery. Despite advancements in aseptic techniques and antibiotic use, SSIs remain the most common hospital-acquired infections among surgical patients. They are classified into superficial, deep, and organ/space infections, with risk increasing from clean to dirty wounds. Various perioperative and environmental factors, such as poor wound care, prolonged surgery, and inadequate prophylaxis, contribute to infection development. Aims: To estimate the proportion of postoperative surgical site infections following emergency abdominal operations. Materials and Methods: This observational study was conducted in the Surgery Department of Agartala Government Medical College and G.B.P. Hospital. It spanned one and a half years, from June 2021 to November 2022. A total of 156 post-operative surgical patients were included in the study. Results: Out of 95 patients, 17.89% developed surgical site infections (SSIs), with the highest incidence in the 40–49 age group and among illiterate patients. SSIs were more common after delayed and prolonged surgeries, dirty wounds, and in patients with comorbidities like diabetes and obesity. Escherichia coli was the most frequent pathogen, showing 100% sensitivity to Imipenem, which was the most effective antibiotic against all isolated organisms. Conclusion: This observational study conducted at Agartala Government Medical College and G.B.P Hospital from June 2021 to November 2022 found that normal body microorganisms are the main cause of surgical site infections (SSI). Factors like malnutrition, obesity, wound condition, operation delay, and surgeon experience significantly contribute to SSI. Ensuring quality surgical care, aseptic environments, and the use of prophylactic antibiotics are crucial for preventing these infections, especially when advanced facilities are lacking.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that is defined by airflow limitation and frequent exacerbations, leading to considerable morbidity and mortality. Recent data indicate that vitamin D deficiency has the potential to impact the frequency and severity of exacerbations in COPD because of its immunomodulatory properties. Objective: To assess the correlation between serum vitamin D deficiency and the severity and frequency of COPD exacerbations. Methods: A six-month observational cross-sectional study was carried out among 150 COPD patients in a tertiary care hospital. Serum levels of 25-hydroxyvitamin D were recorded and divided into deficient (<20 ng/mL) and sufficient (≥20 ng/mL). History of frequency of exacerbations in the last year, clinical profile, and comorbidities were taken. Statistical analysis with Pearson’s correlation and logistic regression was done to evaluate the association between vitamin D levels and COPD exacerbations. Results: Vitamin D deficiency was detected in 65.3% of the participants. The number of exacerbations was significantly greater in vitamin D-deficient patients (2.8 ± 1.1) than in those with normal levels (1.3 ± 0.6; p < 0.001). There was a moderate negative correlation between serum vitamin D concentration and frequency of exacerbation (r = -0.61, p < 0.001). Exacerbation severity was also significantly higher in deficient patients. Conclusion: The deficiency of vitamin D has been strongly linked with the enhancement of frequency and severity of COPD exacerbations. Screening and deficiency correction on a regular basis can be a useful adjunct in COPD management.

Background: Laryngoscopy and endotracheal intubation are vital airway management procedures but can provoke significant hemodynamic stress responses—such as surges in heart rate and blood pressure—which may be detrimental, especially in vulnerable patients. Pharmacologic agents like esmolol, a beta-1 adrenergic blocker, and lignocaine, a local anaesthetic, have been used to blunt this response. This study aimed to compare the efficacy and safety of intravenous esmolol (0.5 mg/kg) versus lignocaine (1.5mg/kg) in attenuating these responses. Aims And Objective: The purpose of this study is to compare the efficacy of Esmolol versus Lignocaine to hemodynamic stress response, degree of hypotension, side effects of both drugs during laryngoscopy and endotracheal intubation. Materials and Methods: This prospective, randomized, double-blind clinical study was conducted on 72 ASA Grade I and II patients aged 18–65 years undergoing elective surgery with general anaesthesia. Participants were randomly assigned to two groups: Group E received esmolol 0.5 mg/kg, and Group L received lignocaine 1.5 mg/kg intravenously, 90 seconds before intubation. Hemodynamic parameters – heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), and mean arterial pressure (MAP) were recorded at predefined intervals. Safety profiles, including adverse events such as hypotension and bradycardia, were also assessed. Results: Esmolol showed a statistically significant reduction in HR, SBP, DBP, and MAP at 1, 3, 5, and 10 minutes post-intubation compared to lignocaine (p<0.001). The esmolol group maintained better cardiovascular stability with fewer fluctuations. Moreover, the incidence of adverse effects such as hypotension and bradycardia was significantly lower in the esmolol group (5.6%) than in the lignocaine group (19.4%) (p<0.05). Overall, esmolol provided more consistent attenuation of the hemodynamic stress response with a better safety profile. Conclusion: Esmolol at 0.5 mg/kg is more effective and safer than lignocaine at 1.5 mg/kg in suppressing the cardiovascular responses to laryngoscopy and endotracheal intubation. Its superior performance in maintaining hemodynamic stability makes it a preferable choice for clinical use in such scenarios.

Background: Medical profession is one of the most chosen professions in India due to its respected place and financial security. However, just like coin has two sides, it is considered one of the most stressful courses and students end up facing significantly higher psychological stress compared to non-medicos. Aim: The aim of present study is to assess prevalence of depression and anxiety among medical undergraduates of tertiary care institution in Maharashtra. Methods: A prospective cross-sectional study was conducted at a medical college for three months. All MBBS undergraduates were provided predesigned, pretested questionnaires via Google forms which included Patient Health Questionnaire (PHQ-9) to grade depression and Generalized Anxiety Disorder questionnaire to grade anxiety. Results: Among the 400 respondents, 55% were found to have depression, 44% anxiety while 46% had both. Of the 55% having depression, majority of them (33%) were having Mild depression. And of the 44% having anxiety, majority of them (28%) were having Mild anxiety. In addition, depression and anxiety was found to be more in second year MBBS undergraduate students (61% and 56% respectively) with female preponderance of 71% and 66% respectively throughout the years. Conclusion: This study reports 55% prevalence of depression and 44% prevalence of anxiety among medical undergraduates accounting for almost half. By assessing prevalence, we can understand depth of need for raising awareness about overcoming social stigma for early detection. Thus helping in establishing proper interventions like counselling and guidance which need to be given at the correct time to ensure mental wellbeing and quality of medical professionals.

Background: Meconium-stained amniotic fluid (MSAF) is commonly encountered during labour and is often associated with concerns regarding fetal hypoxia. Objective biochemical markers such as umbilical cord blood gas analysis and lactate estimation can help differentiate physiological meconium passage from pathological fetal compromise. Objectives: To evaluate cord blood analytes and serum lactate levels in term neonates born through MSAF with no additional risk factors and to analyze their correlation with neonatal outcomes. Methods: A prospective observational study was conducted at tertiary care hospital Hospital, Gujarat, over 10 months (May 2015–March 2016) involving 264 term pregnant women with MSAF and no other risk factors. Umbilical arterial blood samples were analyzed for pH, pO₂, pCO₂, HCO₃ (actual and standard), base excess (BE, SBE), and lactate levels. Neonatal outcomes were assessed by Apgar scores, NICU admissions, and birth weight. Correlations between lactate and cord blood analytes were evaluated using Pearson’s coefficient. Results: Lactate values ranged from 16–55 mg% (mean 35.14 mg%), with most cases in the 36–40 mg% group. Lactate showed weak but significant correlations with pH (r = –0.17, p = 0.0059), H⁺ (r = 0.18, p = 0.0039), pO₂ (r = 0.16, p = 0.0091), and pCO₂ (r = –0.30, p < 0.00001), and moderate negative correlations with HCO₃A (r = –0.51), HCO₃S (r = –0.46), BE (r = –0.51), and SBE (r = –0.52), all p < 0.00001. Apgar scores at 1 and 5 minutes were not significantly associated with lactate groups. NICU admission occurred in 11% of neonates, mostly for respiratory distress; there was one unrelated neonatal death. Conclusion: Elevated cord blood lactate levels are common in term neonates with MSAF even in the absence of additional risk factors or adverse outcomes. Lactate correlates moderately with metabolic acid–base parameters and can serve as a simple adjunct to cord blood gas analysis for early identification of subclinical fetal hypoxia, aiding clinical decision-making and reducing unnecessary interventions.

Background: Oxidative stress, an imbalance between reactive oxygen species (ROS) and antioxidant defenses, is implicated in the pathogenesis of various inflammatory dermatoses. While its role has been studied individually in alopecia areata (AA), acne vulgaris (AV), and vitiligo, a direct comparative analysis of the oxidative burden across these distinct conditions is lacking. Methods: This case-control study included 200 participants, divided into four groups: patients with active AA (n=50), moderate-to-severe AV (n=50), non-segmental vitiligo (n=50), and age- and sex-matched healthy controls (HC, n=50). Serum levels of malondialdehyde (MDA), a marker of lipid peroxidation, and total antioxidant capacity (TAC) were measured. Erythrocyte activity of superoxide dismutase (SOD) and catalase (CAT) was also determined. Statistical analysis was performed using one-way ANOVA with Tukey’s post-hoc test. Results: All patient groups exhibited significantly higher serum MDA levels and lower TAC, SOD, and CAT activity compared to the healthy control group (p<0.001 for all). The vitiligo group showed the most profound oxidative imbalance, with the highest MDA levels (4.12 ± 0.55 nmol/mL vs. 1.68 ± 0.29 in HC, p<0.001) and the lowest TAC (0.78 ± 0.11 mmol/L vs. 1.35 ± 0.16 in HC, p<0.001), SOD, and CAT activities. MDA levels in the vitiligo group were significantly higher than in both the AA (3.25 ± 0.48 nmol/mL, p<0.001) and AV groups (2.61 ± 0.37 nmol/mL, p<0.001). The AA group also showed a significantly greater oxidative burden than the AV group (p<0.01). Antioxidant defenses followed an inverse trend, being most depleted in vitiligo, followed by AA, and then AV. Conclusion: Patients with alopecia areata, acne vulgaris, and vitiligo demonstrate a significant systemic oxidative stress state compared to healthy individuals. The magnitude of this imbalance varies, being most severe in vitiligo, followed by alopecia areata, and then acne vulgaris. These findings support the integral role of oxidative stress in the pathophysiology of these dermatoses and suggest a potential hierarchy of oxidative burden among them.

Background: Resistant hypertension (RH) confers a substantial risk for cardiovascular events. While guidelines advocate for multi-drug regimens, the optimal balance between therapeutic intensity, regimen complexity, and patient adherence remains unclear. The efficacy of a simplified, high-dose dual-drug strategy versus a standard triple-drug therapy on hard cardiovascular outcomes has not been well-established. Methods: We conducted a 36-month, multicenter, prospective, randomized controlled trial involving 850 adults (aged 45–65 years) with confirmed RH. Participants were randomized 1:1 to either a dual-therapy group (maximally-titrated single-pill combination of an angiotensin receptor blocker [ARB] and a calcium channel blocker [CCB]; n=425) or a triple-therapy group (an angiotensin-converting enzyme [ACE] inhibitor, a CCB, and a thiazide-type diuretic; n=425). The primary endpoint was a composite of MACE, including non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. Secondary endpoints included mean change in systolic blood pressure (SBP), achievement of target BP (<130/80 mmHg), medication adherence, and incidence of adverse effects. Results: At 36 months, the incidence of the primary MACE endpoint was not statistically different between the groups, although a trend favoured triple therapy (12.5% in the dual-therapy group vs. 9.9% in the triple-therapy group; Hazard Ratio [HR] 1.28; 95% CI 0.86–1.91; p=0.22). The triple-therapy group demonstrated a significantly greater mean reduction in office SBP from baseline (–25.1 ± 10.2 mmHg vs. –22.5 ± 9.8 mmHg; p=0.04) and a higher rate of achieving target BP (64.2% vs. 55.3%; p=0.02). Conversely, the dual-therapy group showed significantly higher medication adherence rates (92.1% ± 8.5% vs. 84.5% ± 12.3%; p<0.01). The incidence of peripheral edema was higher in the dual-therapy group (15.1% vs. 9.9%, p=0.03), while hypokalemia was more common in the triple-therapy group (8.7% vs. 2.4%, p<0.01). Conclusion: In middle-aged adults with resistant hypertension, standard triple-drug therapy was superior to a high-dose dual-drug regimen in lowering blood pressure and achieving control targets. This superior BP control did not translate into a statistically significant reduction in MACE over a 36-month follow-up, though a favorable trend was observed. The higher adherence associated with the simplified dual-therapy regimen was insufficient to overcome its lower antihypertensive efficacy in this high-risk population.

Background and Aim: Arthroscopic anatomical reconstruction of the anterior cruciate ligament (ACL) using quadrupled hamstring grafts is a widely accepted surgical technique. This study aimed to evaluate the functional outcomes and complications following this procedure in a large patient cohort. Material and Methods: A prospective study was conducted on 150 patients undergoing arthroscopic anatomical ACL reconstruction using quadrupled hamstring grafts. Pre- and postoperative outcomes were assessed using IKDC, Lysholm, Tegner, and limb symmetry indices, with complications recorded. Statistical analysis compared pre- and postoperative values using paired tests, with p < 0.05 considered significant. Results: Patients showed significant improvements in functional outcomes, with mean Lysholm scores improving from 70.7 to 90.7, Tegner activity scale increasing from 3.4 to 6.5, and KT-1000 measurements decreasing from 6.4 to 1.5. Subjective satisfaction was high, with 74.6% very satisfied and 25.3% satisfied. Complications were minimal and manageable. Conclusion: Arthroscopic anatomical ACL reconstruction with quadrupled hamstring grafts provides excellent functional recovery, stability, and patient satisfaction, confirming its role as a reliable and safe procedure.

Background: The TIMI score is a clinical tool used to predict outcomes in patients with ST-elevation myocardial infarction (STEMI). Objective: To evaluate the effectiveness of the TIMI score in predicting clinical outcomes of STEMI patients presenting to the emergency department. Material and Methods: A prospective observational study was conducted among 145 STEMI patients. Demographic, clinical, and laboratory data were collected, and TIMI scores were calculated. Outcomes were assessed in relation to TIMI scores. Results: Higher TIMI scores were associated with increased risk of deterioration and mortality, while lower scores correlated with improvement. TIMI score components, including comorbidities, delayed presentation, and hemodynamic parameters, demonstrated strong predictive value. Conclusion: The TIMI score is a reliable and practical tool for risk stratification and prognostication in STEMI patients.

Background: Electronic Data Capture (EDC) platforms are at the heart of contemporary clinical research, but their usability issues and dependence on human processes create an area of inefficiency. Embedding artificial intelligence (AI) in solutions like Medrio and Medidata Rave provides an opportunity to streamline repetitive tasks and improve user experience. Objective: This research examines the potential of AI-powered EDC systems to minimize human workload, enhance workflow effectiveness, and boost satisfaction among clinical research professionals. Methods: A mixed-methods approach was used, with 42 participants across coordinators, data managers, and investigators. Baseline processes in Medrio and Medidata Rave were contrasted against AI-enhanced simulations. Quantitative measures of task completion time, manual data entries, and query resolution rates were analyzed, and qualitative interviews examined usability and workload perceptions. Data analyses were conducted using descriptive statistics, paired-sample tests, and thematic analysis based on Task-Technology Fit and FITT frameworks. Results: AI integration lowered task time to completion by 27%, manual entries by 35%, and open questions by almost half. Usability scores, assessed through the System Usability Scale, indicated a substantial rise in all roles. Qualitative themes emphasized reduced cognitive workload, increased confidence in data accuracy, and initial but tolerable reservations regarding AI dependence. Conclusion: AI-powered EDC systems have evident potential to streamline data flows, minimize staff workload, and enhance data quality in clinical trials. Greater implementation and real-world validation can further make AI a bedrock of next-generation EDC systems.

Background: Induction of labour (IOL) is a widely practiced obstetric intervention aimed at reducing maternal and fetal complications by initiating timely delivery. While it plays a pivotal role in improving outcomes, the success of IOL depends on maternal, fetal, and clinical factors. This study was conducted to evaluate the demographic profile, common indications, and outcomes of induction of labour in a defined patient population. Methods: A total of 350 women admitted for induction of labour were included in this observational study. Demographic characteristics, parity, indications for induction, and outcomes were systematically recorded and analyzed using descriptive statistics. Results: The mean age of participants was 29.1 ± 4.23 years (range: 20–44 years), with the majority in the 25–29 year age group (47.7%). Rural residents constituted 78.3% of the cohort, and 64.6% were primigravida. Pregnancy-induced hypertension (PIH) was the most frequent indication for IOL, accounting for 38.3% patients, followed by postdated pregnancy (20.6%), gestational diabetes mellitus (17.1%), full-term pregnancy (15.1%), and intrahepatic cholestasis of pregnancy (8.9%). Induction was successful in 72.3% (253 patients), while 27.7% (97 patients) experienced failed induction. Conclusion: The study highlights that induction of labour is predominantly undertaken in younger women, rural populations, and primigravida patients. Hypertensive disorders and postdated pregnancy remain the leading indications for induction. The overall success rate was favorable, though a significant proportion experienced failed induction, underscoring the need for careful patient selection, adherence to evidence-based protocols, and vigilant intrapartum monitoring to optimize outcomes.

Maternal perception of fetal movements is widely recognized as a simple, cost-effective method for monitoring fetal well-being, and it may also strengthen maternal-fetal attachment. Although many pregnant women notice episodes of reduced fetal activity, only a small percentage seek medical attention, and data about decreased fetal movement (DFM) in low-risk pregnancies remain limited. This study investigates how maternal and fetal factors influence movement perception in normotensive, singleton pregnancies, aiming to improve early detection of fetal compromise. A cohort of 150 women was analyzed, with most aged 25–29 years and an even distribution of first-time and experienced mothers. Reduced fetal movements were associated with adverse perinatal outcomes. Specifically, 14.7% of neonates had low birth weight, 13.3% experienced stillbirth, 13.3% had intrauterine growth restriction (IUGR), and 6.6% suffered from hypoglycemia. Additionally, 15.3% of infants required Neonatal Intensive Care Unit (NICU) admission. Despite these concerns, most pregnancies ended with favorable APGAR scores and without complications (86.7% normal outcomes). The findings support maternal movement monitoring as a valuable tool, especially in low-risk pregnancies, while acknowledging limitations such as false-positive results. The results highlight the need for ongoing vigilance, individualized assessment, and prompt action when DFM is reported. Educating mothers about the significance of fetal movement and encouraging timely reporting can improve detection and management of compromised fetuses.

Background: Awake fiberoptic intubation (AFOI) is a favoured method of handling difficult airways, necessitating the best sedation for patient comfort with the preservation of spontaneous ventilation. Dexmedetomidine is a drug that causes sedation with less respiratory depression and can be an alternative to midazolam. Objective: To compare the efficacy of dexmedetomidine with midazolam versus midazolam alone for AFOI in intubation ease, patient comfort, hemodynamic stability, and complications. Materials and Methods: A double-blind, randomized trial was performed on 60 ASA I–II adult patients who were undergoing elective surgery under general anaesthesia (GA). The patients were divided into two groups: Group M received midazolam 0.05 mg/kg IV, and Group DM received dexmedetomidine 1 µg/kg IV over 10 minutes, followed by midazolam 0.025 mg/kg IV. All the patients were given 4% lidocaine nebulization and airway blocks prior to intubation. The main outcomes measured were the onset of sedation, intubation time, ease of intubation, comfort of the patient, hemodynamic variables, and complications. GA was induced with propofol, fentanyl, and rocuronium after successful AFOI. Statistical analysis was done using SPSS, and p<0.05 was taken as significant. Results: Group DM showed a much more rapid onset of sedation (2.78 ± 0.99 min vs 4.10 ± 1.42 min, p<0.001), improved hemodynamic stability, and less additional anaesthetic required (6.67% vs 30%, p<0.05). Intubation was ranked as easy in 90% of Group DM patients versus 60% of Group M patients (p=0.015). Patient comfort scores were greater in Group DM (p<0.0001), and fewer adverse events were reported. Conclusion: The combination of dexmedetomidine and midazolam improves the quality of sedation, makes AFOI smoother, and increases patient comfort while providing stable hemodynamics. The combination seems to be a better option for managing difficult airways than using midazolam alone.

Background: Labor is amongst the most intense pains a childbearing woman may endure. In order to alleviate this, ACOG has been quoted recommending the performance of caesarean sections only at the mother’s request for labor analgesia when medically indicated. Neuraxial methods for labor pain, especially combined spinal-epidural and epidural analgesia, include some of the deepest and the longest-lasting pain relief measures. This is a comparative study of the efficacy of 0.1% levobupivacaine and 0.1% ropivacaine with fentanyl as adjuvants for epidural labor analgesia. Methods: A prospective, randomized, controlled trial was conducted at the Department of Anesthesiology, JNMC & AVBRH, Sawangi, Wardha, over two years. Seventy-eight full-term primigravidae females with uncomplicated singleton pregnancies were included. Participants were randomly divided into two groups: Group L received 12 ml of 0.1% ropivacaine with 2 µg/ml fentanyl. The primary outcomes measured included the onset and duration of analgesia. Secondary outcomes included labour hemodynamics, maternal and fetal outcomes, complications, and need for rescue analgesics. Results: Duration of analgesia in group L was 66.8 ± 1.52 min, which was considerably longer when compared with group R, where it was 60.2 ± 2.61 minutes with a P<0.0000001. Sensory block onset was earlier in group R at 21.22 ± 1.07 minutes than in group L at 22.8 ± 1.05 minutes, and this was statistically significant but clinically insignificant. Group R required absolutely more doses of rescue analgesia compared to Group L, 5.22 ± 0.65 versus 3.47 ± 0.55, with p < 0.0000001. There were no significant differences in maternal satisfaction, neonatal outcomes, and post-procedural hemodynamics among groups. Conclusion: Both levobupivacaine and ropivacaine provide effective and safe epidural labour analgesia. However, the longer length of analgesia and the fewer number of rescue doses required with levobupivacaine make it a better option, though the onset time of sensory block was earlier with ropivacaine. Maternal satisfaction and neonatal outcomes of both drugs were similar.

Background: Prolonged exposure to high-intensity traffic noise is a major occupational hazard for traffic police personnel, especially in rapidly urbanizing second-tier cities where noise regulation is often inadequate. Chronic exposure may result in noise-induced hearing loss (NIHL), leading to significant morbidity and reduced quality of life. Objectives: To evaluate the prevalence and pattern of noise-induced hearing loss among traffic police personnel in a second-tier city using standardized audiological assessments, and to identify associated risk factors. Methods: A community-based, one-year cross-sectional study was conducted among traffic police personnel posted at high-traffic junctions. After obtaining informed consent, participants underwent detailed history-taking, otoscopic examination, and pure tone audiometry (PTA) using a calibrated audiometer in a sound-treated environment. Hearing thresholds were assessed at frequencies ranging from 250 Hz to 8 kHz, with special emphasis on the 3–6 kHz range, typically affected in NIHL. Total 120 traffic police personnel participated in the study. use of protective measures, comorbidities, and lifestyle habits were collected through a structured questionnaire. Statistical analysis was performed to determine prevalence, severity, and correlates of NIHL.  Conclusion: Noise-induced hearing loss is a significant occupational health issue among traffic police personnel in second-tier cities. Early audiological screening, mandatory use of personal protective devices, and implementation of effective noise-control policies are essential to reduce the burden of NIHL in this high-risk group.

Urethral diverticulum is an infrequent paraurethral pathology in females, occasionally complicated by fistulous communication with the anterior fornix of vagina. Such cases may present with atypical lower urinary tract symptoms, leading to delayed diagnosis. We describe a 19-year-old unmarried, nulliparous female who presented with post-void dribbling and intermittent leakage when the bladder was markedly distended. Pelvic ultrasonography, magnetic resonance imaging (MRI) and cystoscopy identified a periurethral cystic lesion with a tract communicating with the anterior fornix. Recognition of this rare entity is essential for appropriate surgical planning and restoration of continence.

Background: Recently conducted drug utilization studies in ophthalmology across India have reported issues of high prescribing of branded drugs, low adoption of essential drug and polypharmacy, thus creating concern regarding the rational use of drugs. There exist paucity of data in literature on the drug utilization trends from this region; therefore present study will be undertaken to analyze the prescribing pattern and drug utilization trends among the patients of ophthalmology department at a tertiary care hospital. Objectives: To study the drug utilization pattern, safety profile of drugs in ophthalmology department. Materials and Methods: Prospective cross-sectional observational study was conducted over a period of three months in newly diagnosed cases attending outpatient department of ophthalmology, HIMS, Hassan and the prescriptions was analyzed with WHO prescribing indicators. Result: Out of 200 patients, Male 144 (72%) patient were more than Females 56(28%). Eye drops were the most commonly prescribed antibiotics 165 (80%), the other parameters are Average number of drugs/ prescription (2.23), Percentage of drugs prescribed by generic name (76.23%), Frequency of administration mentioned was 93% and Drugs prescribed from essential drug list was 21.3% of prescription. Conclusion: Audit evaluated the drug utilization trends in the Dept. of Ophthalmology. So physician must be more specific in their diagnosis and treatment. Overall poly-pharmacy among antimicrobial agents was noticed. Improvement in encouraging the ophthalmologists to select drugs from essential drugs list. ADRs not observed among the study population. This study will provide a database for further researches that will determine patterns of drug use in the Dept. of Ophthalmology.

Background and Aim: Postoperative pain and postoperative nausea and vomiting (PONV) are frequent complications in patients undergoing surgery under spinal anesthesia. Various pharmacological strategies have been explored, with dexamethasone showing promise as an adjuvant. This study aimed to evaluate the effect of a single intravenous dose of dexamethasone on postoperative pain and PONV. Material and Methods: A prospective randomized placebo-controlled clinical trial was conducted on 60 ASA I–II patients aged 18–50 years undergoing elective lower limb or gynecological surgeries under spinal anesthesia. Patients were randomized into two groups: Group A received 2 mL of intravenous normal saline, and Group B received 2 mL of intravenous dexamethasone (8 mg) immediately after spinal anesthesia. Pain was assessed using the Visual Analogue Scale (VAS), and PONV was evaluated using Belville’s score for 24 hours. Rescue analgesia and antiemetic requirements were recorded. Results: Patients in the dexamethasone group had significantly lower VAS scores at all recorded intervals compared to the control group (for example, 2.13 ± 0.35 vs. 3.13 ± 1.17 at 1 hour, p < 0.001). The incidence of PONV and the need for rescue antiemetics were reduced in the dexamethasone group. Rescue analgesic requirement was also significantly lower. No major adverse effects were observed. Conclusion: Intravenous dexamethasone 8 mg administered after spinal anesthesia significantly reduces postoperative pain and PONV in the first 24 hours and can be considered a safe and effective adjuvant in perioperative management.

Background: Various adjuvants have been used with local anesthetics in spinal anesthesia to avoid intraoperative somatic pain and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2 antagonist drug, is now being used as a neuro-axial adjuvant in knee joint surgeries. Method: Out of 72 (seventy-two) patients, 36 (Group F) were administered isobaric levobupivacaine (0.5%, 2.8 ml) and fentanyl (25 mcg, 0.5 ml), total volume: 3.3 ml. 36 (Group D) were administered isobaric Levobupivaine (0.5%, 2.8 ml) and dexmedetomidine (10 mcg, diluted in normal saline), for a total volume of 3.3 ml. The analgesic effects of both drugs were monitored postoperatively. The VAS score for both drugs was noted and compared. Results: Comparison of time to give first rescue analgesia, time to reach peak sensory level, total duration of motor blockade, time to 2 sensory level regression, and hemodynamic parameters between the two groups had a significant p-value (p<0.001), and the least side effects were noted in Group D. Conclusion: It is noted that, Group F had faster onset and required less time to reach the peak onset of sensory blockage hence group F drugs were preferred than drugs of D group.

Background: Cataract is one of the leading causes of avoidable blindness worldwide. Preventive strategies such as ultraviolet (UV) protection, dietary modification, and regular eye screening may delay onset and improve early detection. Objective: To assess the effectiveness of preventive measures and early detection strategies for cataract in a hospital-based population.Methods: A prospective study was conducted over one year (September 2024- August 2025) at IMS & SUM Hospital II, Phulnakhara. A total of 200 adults aged 40 years and above were enrolled. Participants were counseled regarding UV protective eyewear, a diet rich in antioxidants, and advised routine eye examinations every six months. Baseline and follow-up ophthalmic evaluations were performed, including visual acuity, slit-lamp examination, and fundus evaluation. Data on compliance and new cataract diagnosis were recorded. Results: Of the 200 participants, 120 (60%) regularly used UV-protective sunglasses, 140 (70%) reported improved dietary intake of fruits and leafy vegetables, and 160 (80%) attended routine screening visits. During the one-year period, 18 participants (9%) developed early lens opacities suggestive of cataract. Among these, 14 (77.8%) were detected at an early stage due to scheduled screening. Compliance with UV protection and diet showed a lower incidence of cataract compared to non-compliant groups (p<0.05). Conclusion: UV protection, healthy diet, and routine screening are effective measures in reducing the incidence and enabling early detection of cataract. Incorporating these strategies into community awareness programs may significantly reduce cataract-related visual impairment.

Background: Laryngoscopy and endotracheal intubation, though essential procedures in anaesthesia, are associated with significant hemodynamic responses such as tachycardia and hypertension, which may be harmful in susceptible patients. Various agents have been used to attenuate this pressor response. Dexmedetomidine, a highly selective α2-adrenergic agonist, and Fentanyl, a potent opioid, are among the commonly used drugs for this purpose. Objectives: To compare the efficacy of intravenous Dexmedetomidine (0.6 µg/kg) and Fentanyl (2 µg/kg) in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing elective surgeries under general anaesthesia. Methods: This prospective, randomized, controlled study was conducted in 90 adult patients (ASA I), aged 18–55 years, undergoing elective surgeries. Patients were randomly allocated into two groups (n = 30 each). Group D received Dexmedetomidine 0.6 µg/kg infused over 10 minutes, while Group F received Fentanyl 2 µg/kg two minutes before induction. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, pre-induction, laryngoscopy, intubation, and at 1, 3, 5, and 10 minutes post-intubation. Statistical analysis was performed using ANOVA and Student’s t-test, with p < 0.05 considered significant. Results: Both groups were comparable with respect to age and sex distribution. At laryngoscopy and intubation, a significant rise in HR, SBP, DBP, and MAP was observed in both groups; however, the increase was consistently higher in the Fentanyl group compared to the Dexmedetomidine group. At intubation, the HR increased to 95 bpm in Group F versus 88 bpm in Group D, while SBP rose to 138 mmHg in Group F compared to 130 mmHg in Group D. Hemodynamic parameters in the Dexmedetomidine group returned to near baseline more rapidly than in the Fentanyl group. No major adverse effects were reported. Conclusion: Dexmedetomidine (0.6 µg/kg) was more effective than Fentanyl (2 µg/kg) in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation, providing superior cardiovascular stability. Its use may be particularly advantageous in patients at risk of exaggerated sympathetic responses.

Background: Inguinal hernia is one of the most common surgical conditions seen in children. Its occurrence is higher in boys, but congenital inguinal hernia in girls is especially interesting because of the unique development, anatomy, and surgery issues. This includes the common presence of the ovary or fallopian tube in the hernial sac. This study looks at the clinical patterns, side distribution, related anomalies, and surgical results of congenital inguinal hernia in female children. Objectives: (1) To assess the age incidence, laterality, and type of congenital inguinal hernia in female children. (2) To evaluate the presence of associated contents and anomalies. (3) To analyze surgical findings and postoperative outcomes. Methods: A  clinical  study  took  place  over  two  and  half   years  from  2023  to  2025  in  the Department of General surgery Alfalah  medical college faridabad  haryana,  India. The study included fifty female children under the age of 12 who had been diagnosed with congenital inguinal hernia. Ultrasonography confirmed the clinical diagnosis. Surgical repair through herniotomy was done under general anesthesia, and the findings during the operation were documented. Researchers monitored postoperative complications and any recurrence for six months. Results: The majority of cases (40%) were in the age group of 1 to 5 years. Right-sided hernias were more common at 60%, followed by left-sided at 30% and bilateral at 10%. All cases showed indirect hernias. Ovarian and fallopian tube content was found in 24% of patients. The most common related problem was hydrocele of the canal of Nuck, occurring in 10% of cases. Postoperative wound infection happened in 4% of cases, and no recurrences were noted during follow-up. Conclusion: Congenital inguinal hernia in female children is less common than in males. However, it needs careful assessment because of the potential involvement of adnexal structures. Early surgical intervention leads to excellent outcomes with few complications. Both clinicians and parents must be aware of early signs to prevent issues such as ovarian strangulation.

Background: Difficult airway management remains a major challenge in anaesthetic practice. The introduction of video laryngoscopes (VL) has significantly enhanced visualization of the glottis, potentially increasing the success rate of tracheal intubation in difficult airways. Objective: To compare the effectiveness of a video laryngoscope versus a Macintosh laryngoscope (ML) for tracheal intubation in predicted difficult airway patients undergoing elective surgery under general anaesthesia. Methods: A randomized controlled trial was conducted in 80 adult patients (ASA I–II) with predicted difficult airways (Mallampati grade III–IV, thyromental distance <6 cm, or restricted neck extension). Participants were randomly allocated to either the VL group (n=40) or ML group (n=40). Primary outcome was first-attempt success rate. Secondary outcomes included Cormack–Lehane (CL) grading, intubation time, hemodynamic changes, and complications such as mucosal trauma or desaturation. Results: The first-attempt success rate was higher with VL (95%) compared to ML (75%) (p=0.02). The mean intubation time was slightly longer with VL (28.6 ± 5.4 s) versus ML (24.2 ± 4.8 s), not clinically significant. VL provided superior CL grades (I–II in 97.5% vs 70%, p<0.001) and fewer airway traumas. Post-intubation heart rate and mean arterial pressure elevations were significantly lower in the VL group. Conclusion: Video laryngoscope improves visualization and first-pass success in predicted difficult airways, with reduced airway trauma and hemodynamic stress compared to the Macintosh laryngoscope.

Background: Tumor budding refers to the presence of isolated single tumor cells or small clusters of fewer than five cells at the invasive front of carcinomas. The clinical significance of tumor budding in breast carcinoma lies in its potential to complement conventional prognostic systems. For instance, patients with early-stage breast cancer who exhibit high tumor budding may represent a subgroup with higher risk of recurrence and metastasis, warranting more aggressive treatment or closer follow-up, even when other prognostic indicators suggest a favorable outcome. Material & Methods: Patients with histologically confirmed invasive breast carcinoma (all molecular subtypes) with adequate tissue samples and well-preserved invasive front cases were included in the study. In Histopathological Examination Parameters Recorded were Tumor type and histological grade (as per Modified Bloom-Richardson grading system), Tumor size, Lymph node status, Presence of lymphovascular invasion (LVI) and perineural invasion (PNI), Margins &Tumor budding (assessed at invasive front). Buds were counted in one hotspot using a ×40 objective lens (field area = 0.785 mm²) and scoring System used was Low budding: 0–4 buds, Intermediate budding: 5–9 buds, high budding: ≥10 buds. Results: The age of patients ranged from 28 to 70 years with a mean age of 48.3 ± 10.2 years. The majority of patients were in the 41–50 years age group (40%). Histological grading was performed using the Modified Bloom-Richardson system. Among the high TB cases, the majority were Grade III tumors (70%). High TB cases showed a strong association with positive lymph node involvement. LVI was observed in 15 out of 40 cases (37.5%), most of which belonged to the high TB group. Among the high TB cases, the Triple-Negative Breast Cancer (TNBC) subtype showed the highest frequency. Conclusion: High TB correlated with higher histological grade, lymph node involvement, lymphovascular invasion, and aggressive molecular subtypes such as triple-negative and HER2-enriched tumors.

Background: Laparoscopic appendectomy has replaced the traditional surgery technique recent days in India. This surgical technique has become more popular due to various advantages like less bleeding, short hospital stays, and decrease post-operative complications. Studies suggest that spinal anaesthesia technique might be a better option for laparoscopic appendectomy. Therefore, the present study was designed to assess the effects of both general anaesthesia and spinal anaesthesia on hemodynamic response in laparoscopic appendectomy. Materials and Methods: This was a comparative study which included 60 surgery patients of acute appendicitis via laparoscopic appendectomy. Groups I included 30 patients of general anaesthesia while, group II consisted 30 patients of spinal anaesthesia. Non-invasive arterial blood pressure, electrocardiography, and pulse oximetry were monitored continuously. Visual analog scale (VAS) on a 10-mm was used for assessment of severity of pain in all the patients. Results: Results of the present study showed that there was a significantly higher heart rate (p<0.05) in group G (general anaesthesia) patients compare to group S (spinal anaesthesia) patients. VAS score was significantly low in group S patients (1.8 ± 0.42) compare to group G patients (3.3 ± 0.8) with p value <0.05 after 1 hour of surgery. VAS score was recorded after 2 hours of surgery 3.6 ± 0.9 in group G compare to group S 2.0 ± 0.52 with p value < 0.05. Conclusion: Findings of the present study suggest that spinal anaesthesia using a combination of 0.5% hyperbaric bupivacaine and a fentanyl has significantly better cardiovascular reactivity compare to general anaesthesia. Moreover, post-operative recovery was hasty in spinal anaesthesia patients in comparison of general anaesthesia patients.

Introduction: Airway management is an essential component of anaesthetic practice and emergency medicine. The Macintosh laryngoscope has long been the standard for tracheal intubation. However, advancements in technology have introduced video laryngoscopes like the McGrath Mac videolarygoscope designed to provide enhanced glottic visualization and potentially improve intubation outcomes. Despite widespread use in difficult airway scenarios, their effectiveness in routine elective surgeries remains under scrutiny. This study aims to compare the ease of intubation and hemodynamic responses using McGrath Mac video laryngoscope versus the conventional Macintosh laryngoscope in patients with normal airways. Aims and Objectives: The primary objective was to evaluate the ease of intubation based on time taken for laryngoscopy, time taken for intubation, and the Percentage of Glottic Opening (POGO) score. The secondary objective was to assess hemodynamic stress responses, including heart rate and blood pressure variations during and after intubation. Materials and Methods: A prospective randomized controlled study was conducted on 100 adult patients (ASA Grade I–III), scheduled for elective surgery under general anaesthesia. Patients were randomly divided into two groups: Group V (McGrath Mac video laryngoscope) and Group M (Macintosh laryngoscope), with 50 patients each. Key parameters measured included time for laryngoscopy, time for intubation, POGO score, number of attempts, and hemodynamic variables (heart rate, systolic and diastolic blood pressure, and SpO₂) at various time points during intubation. Results: The McGrath Mac video laryngoscope provided significantly superior glottic views with a higher mean POGO score (91.3% vs. 81.4%; p<0.001). However, intubation was slower in Group V, with longer laryngoscopy (11.33±2.52 sec vs. 7.47±1.32 sec) and intubation times (20.58±2.18 sec vs. 16.39±1.78 sec), both statistically significant (p<0.001). First-attempt success rates were comparable across both groups. Importantly, the McGrath Mac group exhibited a significantly lower hemodynamic stress response, with reduced heart rate and blood pressure changes during and after intubation. Conclusion: While the McGrath Mac video laryngoscope requires more time for laryngoscopy and intubation, it offers significant advantages in glottic visualization and attenuation of hemodynamic stress responses. These findings support its use as a valuable tool for routine airway management, particularly in patients where cardiovascular stability is a priority.

Background: Recurrent urinary-tract infection (rUTI)—defined as ≥ 3 microbiologically confirmed episodes/year—affects up to one-third of otherwise healthy premenopausal women and imposes a heavy antibiotic burden. Growing evidence implicates vitamin D (25-hydroxy-vitamin D; 25-OHD) in mucosal immunity, yet its predictive value for rUTI remains unclear. Methods: In a prospective case–control study, 180 sexually active, non-pregnant premenopausal women (18–45 y) were enrolled: 90 with rUTI (cases) and 90 age-matched controls without any UTI in the preceding year. Serum 25-OHD was quantified by chemiluminescent immunoassay. Multivariable logistic regression identified independent risk factors, and receiver-operating-characteristic (ROC) analysis evaluated diagnostic performance. Results: Mean (±SD) 25-OHD was significantly lower in cases than controls (18.4 ± 6.2 ng/mL vs 28.9 ± 7.5 ng/mL; p < 0.001). Vitamin D deficiency (< 20 ng/mL) was present in 66% of cases versus 23% of controls (adjusted odds ratio [OR] 3.8, 95% CI 1.9–7.5). ROC analysis yielded an area-under-the-curve (AUC) of 0.78 (95% CI 0.72–0.85); a threshold of 21 ng/mL gave 72% sensitivity and 70% specificity for predicting rUTI. Conclusion: Low serum vitamin D is an independent, moderately accurate predictor of rUTI in premenopausal women. Routine 25-OHD screening and supplementation trials may be warranted as antibiotic-sparing strategies.

Background: Every year, a significant number of hospitalizations are brought on by peripheral vascular disease (PVD).  PVD is the cause of 9.6% of “cardiovascular events” in the US, necessitating 63,000 hospital hospitalizations annually. Objectives: The Objective of the study was to evaluate the change in pain-free walking distance (PFWD) in patients receiving aspirin versus pentoxifylline over 6 months. To compare changes in ankle-brachial index (ABI) between the two treatment groups. Method: This was a prospective comparative observational study was carried out in the Department of General Surgery, Sri Venkateshwaraa Medical College and Hospital, Ariyur, Puducherry, India from November 2024 to April 2025, study period was 6 months. A total of 100 elderly patients (>50 years) with symptomatic PVD were included. In this study we divide the sample cases into 2 groups; Group A- aspirin and Group B- pentoxifylline. We are comparing the pain free walking distance and ABPI among the two groups. Results:  In our study among 100 patients effectiveness of aspirin and pentoxifylline in relieving intermittent claudication and improving functional walking capacity in elderly patients with peripheral vascular disease (PVD) 39 females, 61 males. In our study out of 100 patients, maximum number of cases between the age group >70 YRS of 35 male patients and 50-60 years of 19 female patients, both groups showed significant improvement in PFWD. Pentoxifylline group showed two fold PFWD improvement than Aspirin group (male group A 8% < group B 26%) and (female group A 12% < group B 22%). Conclusion: Pentoxifylline is more effective than aspirin in improving walking distance and relieving symptoms of claudication with fewer gastrointestinal side effects. Aspirin remains essential for cardiovascular risk reduction. Pentoxifylline may be considered a valuable adjunct for symptom management in elderly PVD patients.

Introduction: Head and neck squamous cell carcinoma (HNSCC) accounts for a significant proportion of global cancer burden, particularly in low- and middle-income countries. Cisplatin remains the preferred chemotherapeutic agent in concurrent chemoradiation, but its use is limited by nephrotoxicity, ototoxicity, and gastrointestinal side effects. Carboplatin, with a more favourable toxicity profile, is often substituted, but comparative data remain essential to guide clinical practice. Materials and Methods: This was a prospective, observational, comparative study conducted in the Department of Medical Oncology over 18 months. A total of 70 patients with histologically confirmed HNSCC were enrolled and stratified into two groups: Group A (cisplatin-based regimen, n=35) and Group B (carboplatin-based regimen, n=35). Patients were assessed for demographic distribution, adverse drug reactions (ADRs), and treatment compliance. Toxicities were graded according to CTCAE version 5.0, and statistical analysis was performed using chi-square/Fisher’s exact test and t-test, with p<0.05 considered significant. Results: Both cisplatin and carboplatin groups showed comparable baseline characteristics. Cisplatin was associated with higher gastrointestinal toxicity (nausea/vomiting: 71.4% vs 40.0%, p=0.006), nephrotoxicity (28.6% vs 5.7%, p=0.016), and ototoxicity (17.1% vs 0%, p=0.024). Carboplatin caused significantly more thrombocytopenia (37.1% vs 11.4%, p=0.012). Treatment compliance was slightly higher in the carboplatin group (85.7% vs 80.0%, p=0.536), though not statistically significant. Conclusion: Cisplatin remains the preferred agent due to its established efficacy; however, carboplatin may be considered an effective alternative in patients with poor tolerance to cisplatin because of its lower renal and auditory toxicities.

Background: Reconstructive commando surgery, commonly performed for advanced head and neck cancers, involves extensive tissue resection and reconstruction, presenting challenges related to surgical complexity, airway management, and postoperative pain.[1] While general anesthesia (GA) is indispensable for such procedures, it is frequently associated with high opioid consumption, hemodynamic fluctuations, and prolonged recovery times. To improve perioperative outcomes, regional anesthesia techniques—such as the superficial cervical plexus block (SCPB)—have gained attention as effective adjuncts. SCPB anesthetizes the sensory branches (C2–C4) of the cervical plexus, providing targeted analgesia to the neck and shoulder regions. When used in combination with GA, SCPB has been shown to enhance intraoperative hemodynamic stability, reduce anesthetic and opioid requirements, and improve postoperative comfort and recovery. The technique is straightforward, safe, and helps mitigate complications including postoperative nausea, delayed wound healing, and respiratory depression.[2-3]. This study aims to assess the efficacy of SCPB as an adjunct to GA in reconstructive commando surgery, with a focus on intraoperative hemodynamics, pain management, graft viability, blood loss, ICU and hospital stay, and patient and surgeon satisfaction. Objective: To assess the efficacy of superficial cervical plexus block (SCPB) as an adjunct to general anesthesia in enhancing intraoperative hemodynamic stability, postoperative recovery, and patient satisfaction in individuals undergoing reconstructive commando surgery. Methodology: This prospective randomized controlled study included 140 patients aged 20–70 years undergoing elective commando surgery. Patients were divided into two groups: The Block group received SCPB with 0.5% levobupivacaine and standard GA; The Control group received GA alone. Outcomes measured included intraoperative hemodynamic parameters, blood loss, graft viability, ICU/hospital stay, and patient/surgeon satisfaction. Result: Patients receiving SCPB demonstrated significantly better intraoperative hemodynamic stability, reduced blood loss, decreased anesthetic requirements, and improved postoperative analgesia. Additionally, the block group reported higher satisfaction scores, shorter ICU and hospital stay, and a lower rate of graft re-exploration. Conclusion: SCPB is a safe, effective adjunct to GA in reconstructive commando surgery, offering improved surgical and recovery outcomes. It should be considered as part of multimodal analgesia for head and neck procedures.

Background: Laparoscopic cholecystectomy, though minimally invasive, is often associated with significant postoperative visceral pain, particularly due to peritoneal irritation and residual carbon dioxide. Effective pain management is essential to reduce patient discomfort, shorten hospital stays, and prevent complications such as delayed ambulation. This study aimed to compare the antinociceptive efficacy and safety of intraperitoneal instillation of ropivacaine combined with dexmedetomidine versus ropivacaine combined with fentanyl for postoperative analgesia following laparoscopic cholecystectomy. Aims And Objective: To assess the anti-nociceptive effect of intraperitoneal instillation of dexmedetomidine combined with ropivacaine versus fentanyl combined with ropivacaine for postoperative pain management in laparoscopic cholecystectomy. Materials and Methods: This prospective, randomized, double-blind controlled trial included 60 ASA grade I and II patients aged between 18 and 70 years undergoing elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups of 30 each. Group RF received intraperitoneal instillation of 20 ml 0.5% ropivacaine + 2 ml fentanyl (100 mcg) + 8 ml NS, while Group RD received 20 ml 0.5% ropivacaine + 0.5 ml dexmedetomidine (50 µg) + 9.5 ml NS. Pain was assessed postoperatively at various time intervals using the Visual Analog Scale (VAS). Total analgesic consumption and time to first rescue analgesia were recorded. Adverse events and incidence of shoulder pain were also noted. Results: The mean duration of analgesia was longer in Group RD (9.77 ± 6.20 hours) versus Group RF (5.43 ± 6.95 hours), and the number of rescue analgesic doses required within 24 hours was lower in Group RD (1.03 ± 0.49) compared to Group RF (1.77 ± 0.82), both statistically significant. Total analgesic consumption in the first 24 hours was also markedly reduced in Group RD (77.50 ± 36.76 mg) versus Group RF (130.00 ± 62.08 mg). VAS scores at all time intervals postoperatively were significantly lower in Group RD, indicating more effective pain control. Additionally, Group RD showed better postoperative oxygen saturation and a lower incidence of nausea. Other complications such as vomiting, bradycardia, and hypotension were comparable between groups. Overall, the combination of ropivacaine with dexmedetomidine provided superior, longer-lasting analgesia with fewer side effects than the ropivacaine-fentanyl combination. Conclusion: Intraperitoneal instillation of ropivacaine combined with dexmedetomidine provides superior postoperative analgesia compared to its combination with fentanyl in patients undergoing laparoscopic cholecystectomy. The dexmedetomidine group demonstrated lower pain scores, prolonged duration of analgesia, reduced need for rescue medication, and fewer complications, making it a more effective and safer option for postoperative pain management.         

Objective: Assess the rare presentation of a clinically isolated syndrome of cranial nerve III (CN III) palsy in a pediatric patient. Methods: We present the case of a 12-year-old boy with acute onset double vision with left eye pain, left-sided ptosis, and left ophthalmoplegia. The patient had no other systemic or neurological symptoms. Results: An extensive work up including serum and CSF studies for autoimmune, infective, or malignant etiologies was performed. MRI Brain showed mild enlargement and enhancement of the cisternal segment of the left CN III. The remainder of the work up was negative for any secondary etiologies. The patient was treated with high dose methyl prednisone 250 mg IV every 6 hours for 5 days followed by 2 weeks of oral prednisone. There was complete resolution of symptoms at the 3-week follow-up clinical visit. Conclusion: In rare instances, clinically isolated syndrome can present as cranial nerve III palsy in a pediatric patient.

Background: Aging results from the impact of the accumulation of a wide variety of molecular and cellular damage over time, which slow functioning of daily activities. Objective: To estimate prevalence of functional disability of activity of daily living and factors associated with it among the elderly population. Material & Methods: The study employs a community based cross sectional design, utilizing a sample (322) of elderly (≥ 60 year) from diverse backgrounds in area under RHTC Digod from 1st December 2022 to 30th November 2023. Results: The prevalence of functional disability of activity of daily living in this group was 32.6% (105 out of 322 individuals) among associated clinical conditions. Advanced age, religion, elderly living without partner (separated/divorced or widowed), elderly doing agriculture, elderly belong to upper socioeconomic class and elderly with chronic existing diseases were significantly associated with functional disability of Activity of Daily Living. Conclusions: The presence of an existing disease is a strong predictor of functional disability, highlighting the importance of managing chronic conditions and preventing further decline in functional ability.

Introduction: Dermatophytoses remain one of the most prevalent superficial fungal infections globally, with significant public health implications in India due to climatic conditions, overcrowding, and self-medication practices. Accurate speciation of dermatophytes is crucial for epidemiological surveillance and guiding therapy. Moreover, the increasing reports of antifungal resistance, particularly to terbinafine and azoles, underscore the need for continuous regional monitoring. This study aimed to determine the species distribution of dermatophytes isolated from clinical specimens and to evaluate their in vitro antifungal susceptibility patterns. Methods: A cross-sectional study was conducted in the Department of Microbiology, Mahadevappa Rampure Medical College, and Kalaburagi, attached to Basaveshwar Teaching and General Hospital, from July 2024 to June 2025. Clinical samples (skin, hair, and nail scrapings) from patients with suspected dermatophytoses were collected and processed using standard mycological techniques, including KOH mount, culture on Sabouraud’s dextrose agar, and morphological identification. Molecular confirmation was performed for selected isolates. Antifungal susceptibility testing was carried out using the CLSI M38-A2 broth microdilution method against commonly used antifungal agents (terbinafine, itraconazole, fluconazole, griseofulvin, and voriconazole). Results: A total of 210 samples were analyzed, of which 142 (67.6%) yielded dermatophyte growth. The predominant species isolated were Trichophyton mentagrophytes (44.3%), Trichophyton rubrum (38.0%), and Microsporum gypseum (9.2%). Antifungal susceptibility testing revealed high sensitivity to terbinafine (92.3%) and itraconazole (86.6%), while reduced susceptibility was observed with fluconazole (61.9%) and griseofulvin (68.3%). Resistance was highest among T. mentagrophytes isolates to fluconazole. Conclusion: The study highlights T. mentagrophytes and T. rubrum as the predominant dermatophyte species in this region. While terbinafine and itraconazole remain largely effective, emerging resistance to fluconazole warrants cautious use and periodic surveillance. Regular monitoring of antifungal susceptibility is essential to inform therapeutic guidelines and to prevent the escalation of drug-resistant dermatophytoses.

Background: Rheumatoid Arthritis (RA) is a chronic autoimmune disorder characterized by synovial inflammation, joint destruction, and systemic manifestations, including peripheral neuropathy. Despite the high prevalence of RA in India, data on its neurological impact, especially from northern regions like Agra, remain limited. Objective: To assess and compare motor and sensory nerve conduction velocities (NCV) in the ulnar and common peroneal nerves of RA patients versus healthy adults, to identify early evidence of peripheral neuropathy. Methods: A cross-sectional observational study was conducted on 30 diagnosed RA patients and 30 age-and sex-matched healthy controls at Sarojini Naidu Medical College, Agra. Motor and sensory NCV studies were performed bilaterally on ulnar and common peroneal nerves using standardized surface electrode techniques. Mean NCV values (±SD) were compared using independent t-tests, and significance was set at p < 0.05. Results: RA patients showed significantly reduced motor and sensory nerve conduction velocities compared to controls. The most pronounced reductions were observed in the right common peroneal nerves. (p < 0.05 for all comparisons). Conclusion: RA patients in the Agra region demonstrated significantly impaired nerve conduction velocities in both upper and lower limb peripheral nerves. These findings suggest a high prevalence of both clinical and subclinical peripheral neuropathy in RA, underscoring the importance of routine electrophysiological screening for early neurological involvement and improved disease management.

Introduction: Breast cancer remains one of the most frequently diagnosed malignancies worldwide, representing a significant public health concern with substantial morbidity and mortality. Surgical intervention is a mainstay in the management of breast neoplasms, whether aiming for cure, palliation, or diagnostic clarification. Effective postoperative analgesia accelerates rehabilitation, reduce hospital stay, and mitigate postoperative complications. The present study seeks to evaluate the impact of a single 1 g dose of pre-emptive IV paracetamol on the postoperative recovery profile of patients undergoing breast neoplasm surgeries under general anesthesia. Materials: The present quasi-experimental, prospective, comparative study was conducted in the Department of Anesthesiology at a tertiary care center over a duration of 18 months amongst 60 adult female patients, aged between 25 and 65 years, scheduled to undergo elective surgery for breast neoplasms under general anaesthesia. Participants were randomly allocated into two groups: Group A (Paracetamol group): Received 1 g intravenous paracetamol in 100 mL normal saline and Group B (Control group): Received 100 mL normal saline. The patients were monitored and observed pre and post-surgery and data was collected. Results: The results of the study clearly demonstrated that pre-emptive intravenous administration of 1 gram paracetamol significantly improved the postoperative recovery profile in patients undergoing surgery for breast neoplasms. In terms of analgesic requirements, the mean intraoperative fentanyl dose was significantly lower in Group A (42.3 ± 6.5 μg/kg) than in Group B (89.6 ± 8.1 μg/kg). The need for postoperative analgesics was also delayed and reduced in the paracetamol group. The average time to first rescue analgesia was significantly prolonged (147.4 ± 27 minutes in Group A vs. 33.4 ± 11 minutes in Group B), and the total analgesic consumption was substantially lower (57.6 ± 18.6 mg vs. 186.2 ± 27.6 mg). Furthermore, the incidence and severity of postoperative nausea and vomiting (PONV) were significantly lower in Group A. Conclusion: The present study concluded that preemptive intravenous paracetamol significantly enhances the quality of postoperative recovery in patients undergoing surgery for breast neoplasms with better hemodynamic stability, lower pain scores, reduced opioid requirements, prolonged time to first analgesic, faster awakening and recovery, and a markedly lower incidence of postoperative nausea and vomiting (PONV).

Introduction: Regional anaesthesia has its own advantages like less interference with normal metabolic process and vital functions of body as compared to general anaesthesia. Brachial plexus blockade allows faster discharge from hospital and fewer side effects when compared with general anaesthesia. Among the various techniques for performing brachial plexus blocks, the supraclavicular approach is one of the most frequently utilized having a high success rate and rapid onset of sensory and motor blockade, making it ideal for procedures involving the shoulder, upper arm, or hand. The present study aims to compare the efficiency of ultrasound-guided versus ultrasound plus peripheral nerve stimulator (US + PNS)-guided approaches for supraclavicular brachial plexus block in adult patients undergoing elective upper limb surgeries. Methods: The present prospective, comparative study to compare the efficacy and outcomes of ultrasound-guided versus ultrasound plus peripheral nerve stimulator (PNS)-guided supraclavicular brachial plexus blocks in patients undergoing elective upper limb surgeries was conducted from Feb.2023 to July. 2024 in the Department of Anaesthesiology at a tertiary care center. Once eligible patients were identified, they were non- randomly assigned to one of two groups, Group A (Ultrasound-guided) or Group B (Ultrasound + PNS-guided) using purposive sampling technique, ensuring that both groups were comparable in terms of baseline characteristics, such as age, gender, and ASA grade, allowing for a fair comparison of the outcomes. 30 cases allotted in each group so the total study sample was 60. Results: The average block execution time in the ultrasound-only group (Group A) was 6.55 ± 1.23 minutes, significantly shorter than the 10.30 ± 1.11 minutes observed in the combined ultrasound and nerve stimulator group (Group B). The mean onset of sensory block was 8.43 ± 0.66 minutes in Group A and 8.49 ± 1.26 minutes in Group B, with no significant difference (p = 0.80). Motor block onset was not significantly faster in Group A (12.13 ± 0.71 minutes) than in Group B (12.25 ± 0.51 minutes), with a p-value of 0.45. Intraoperative analgesia was not required in 96.7% of patients in Group A and 93.3% in Group B, showing no significant difference (p = 0.54). Complication rates were 0% in both groups, with no instances of vascular puncture, pneumothorax, nerve injury, or conversion to general anaesthesia. Conclusion: The clinical takeaway from this study is clear: ultrasound-guided supraclavicular brachial plexus block is a reliable, efficient, and safe technique that does not require augmentation with peripheral nerve stimulation for routine use. The added time and complexity introduced by nerve stimulator use were not associated with statistically significant improvements in block duration or intraoperative analgesic effectiveness.

Introduction: Inguinal hernias are accounting for almost 78% of all hernias and 90% are seen in male patients. Lichtenstein tension-free mesh repair technique for adult open hernia repair is widely accepted as the standard procedure. The choice of anaesthesia for hernia repair depends on factors such as patient acceptance, duration, and type of surgery – open/laparoscopic, bilateral, recurrent/strangulated hernia, and anaesthetic considerations. In recent years, the use of local infiltrative anaesthesia, has proven to be an effective Spinal anaesthesia alternative, with a wide margin of safety, minor postoperative side effects, few complications, and overall short recovery period. The present study was conducted to compare safety and effectiveness of unilateral open inguinal hernia repair under local anaesthesia versus spinal anaesthesia in relation to duration of procedure, hemodynamic stability, and perioperative complications. Methods: The present study was conducted in the Department of Anaesthesiology of a tertiary care center during Feb.2023 to July 2024 amongst 150 patients admitted to the Surgery male and female wards scheduled for Unilateral open inguinal hernia repair, aged 18 to 65 years. By simple randomization, patients were divided into two groups. i) Group A (75 patients)- Receiving local anaesthesia (LA) with Injection Bupivacaine and Inj. Lignocaine with Adrenaline. ii) Group B (75 patients)- Receiving spinal anaesthesia (SA) with 0.5% Heavy Bupivacaine Local anaesthetic solution was prepared by combining 2% lignocaine hydrochloride with adrenaline 1:2,00,000 and 0.5% bupivacaine hydrochloride in a 50:50 mixture, along with normal saline as a diluent. Results: The mean time required in the Hernia Block group was 10.36 minutes (SD = 1.65), while in the Spinal anaesthesia group, it was significantly shorter at 5.17 minutes (SD = 0.45). The Spinal anaesthesia group achieved surgical anaesthesia faster, with a mean time of 9.65 minutes (SD = 2.83), and the difference was statistically significant. Within the Hernia Block group, 4 participants (5.33%) required GA. In the present study, in the Hernia Block group, all 75 patients (100%) exhibited a Bromage score of 0, indicating no motor block. The intra-operative requirement of supplemental sedation was significantly higher in the Hernia Block group i.e. 7 patients (9.3%) whereas none of the patients in the Spinal anaesthesia group required it. Hernia Block provided more prolonged and effective pain relief, thereby reducing the need for additional analgesic doses within the first 24 hours. This difference was statistically significant (p < 0.001). Conclusion: The present study concludes that the Inguinal Hernia Block is a safe, effective, and patient-friendly, achieved surgical anaesthesia slightly longer, with greater hemodynamic stability, and fewer intraoperative and postoperative complications along with adequate postoperative pain relief. Therefore, Inguinal Hernia Block can be considered a superior anaesthetic technique, particularly for patients with comorbidities or those at higher risk from neuraxial blockade.

Introduction: Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgical technique for the treatment of chronic rhinosinusitis and other sinus pathologies. FESS presents certain intraoperative challenges, including intraoperative bleeding, which can obscure the surgical field, reduce the precision of the surgery, prolong operative time, and increase the risk of complications. To address these challenges, various anaesthetic techniques have been developed to improve the surgical field, among which controlled hypotension. The present study was conducted to compare efficacy of Dexmedetomidine Vs Magnesium Sulphate during FESS to enhance operative conditions, reduce complications, and provide a higher standard of care for patients undergoing FESS. Methods: The present quasi-experimental research model with non-randomized design was conducted to evaluate the efficacy dexmedetomidine (DEX) and magnesium sulphate (MgSO₄) in achieving controlled hypotension during functional endoscopic sinus surgery (FESS) amongst 60 patients in a tertiary care hospital during Feb. 2023 to Sept. 2024. Participants were allocated into two groups:  i) Group D (Dexmedetomidine): Received a loading dose of 1 μg/kg diluted in 100 mL normal saline (NS) over 10 minutes pre-induction, followed by a maintenance infusion of 0.5–1 μg/kg/hr. and ii) Group M (Magnesium Sulphate): Received a loading dose of 40 mg/kg in 100 mL NS over 10 minutes pre-induction, followed by a maintenance infusion of 10–15 mg/kg/hr. Both groups received standardized premedication and Anaesthesia protocols. Results: In our study, there was no significant difference between both groups with respect to age, gender, ASA class, weight. The mean HR was significantly lower in group D compared to group M, after post intubation, intraoperatively till 45 min and after 5 min of stopping infusions and at extubation. The mean, SBP, DBP and MAP were significantly lower in group D compared to group M after post intubation, intraoperatively till 45 min and after 5 min of stopping infusions and at extubation. The average intraoperative bleeding was less in Group D as compared to Group M.  Profoundly deeper sedation with dexmedetomidine (Group D) was recorded using modified Ramsay sedation score. Thus, Dexmedetomidine (Group D) provided better operating conditions due to less intraoperative bleeding as compared to magnesium sulphate (Group M). Conclusion: In this study, we conclude that Dexmedetomidine was found to be more effective than magnesium sulphate in achieving controlled hypotension in patients undergoing functional endoscopic sinus surgery (FESS).

Introduction: The use of ultrasound-guided inferior vena cava collapsibility index (IVCCI) has emerged as a promising noninvasive tool for predicting fluid responsiveness and optimizing hemodynamic stability in critical care settings, including spinal anaesthesia (SA). Hypotension is a common and potentially harmful complication following spinal anaesthesia, occurring in 15.3%–33% of cases. Given the risks associated with post- spinal anaesthesia hypotension (PSAH), accurate assessment of a patient’s preoperative volume status is crucial for tailoring fluid management strategies to mitigate this complication. The present research aims to investigate the role of IVCCI in guiding fluid management for the prediction of PSAH in orthopedic patients scheduled for surgery under spinal anaesthesia. Methods: The present prospective, comparative study was conducted from January 2023 to June 2024 amongst 168 patients in the Department of Anaesthesiology at a tertiary care hospital. The patients were systematically allocated to two groups: Group CI (IVCCI-measured group): 84 Patients underwent preoperative IVCCI assessment via ultrasound before receiving spinal anaesthesia. Fluid therapy was adjusted based on IVCCI values and Group NCI (Non-IVCCI-measured group): 84 Patients received standard fluid therapy without IVCCI assessment. Results: IVCCI-guided fluid management significantly reduced the incidence of post-spinal anaesthesia hypotension (PSAH) compared to standard empirical fluid therapy (p = 0.003). Patients in the IVCCI group required significantly lower doses of ephedrine, indicating improved perioperative hemodynamic stability (p = 0.006). Systolic blood pressure at 3-, 5-, 10-, and 20-minutes post spinal block was significantly better maintained in the IVCCI group, reflecting early stabilization. IVCCI allowed for targeted preoperative fluid loading, leading to reduced total peroperative fluid use without compromising safety. Incidence of adverse effects such as bradycardia, nausea, and dizziness was similar between groups, with a trend toward lower hypoperfusion in the IVCCI group. Conclusion: We conclude from our study that the integration of IVCCI into perioperative fluid management strategies marks a significant step toward more refined, responsive, and effective anaesthesia care. The ability to reduce PSAH, lower vasopressor dependence, and maintain hemodynamic stability through a simple ultrasound measurement underscores the value of IVCCI in modern clinical practice.

Introduction: Inguinal hernia is a common pediatric condition, where Open herniotomy remains the standard procedure due to its safety, efficacy, and minimal recurrence risk. Effective pain management is crucial for recovery, parental satisfaction, and surgical outcomes. Postoperative analgesia is typically provided through intravenous opioids or regional techniques like caudal or ilioinguinal/iliohypogastric nerve blocks. However, opioids in children may lead to side effects such as nausea, vomiting, itching, drowsiness, and respiratory depression. Peripheral nerve blocks using local anaesthetics are an effective option for both surgical anaesthesia and pain control in inguinal hernia procedures. The primary objective of this study is to compare the postoperative analgesic efficacy of the Ilioinguinal/Iliohypogastric nerve block and the caudal block in children undergoing unilateral inguinal hernia repair. Methods: The present quasi experimental was conducted in the tertiary care hospital amongst 70 paediatric male patients with ASA grade 1 and 2, between age 1 year to 8 years undergoing unilateral inguinal herniotomy during Feb.2023 to July 2024. Selected samples were equally divided into Ilioinguinal/Iliohypogastric nerve block Group (35) and Caudal block Group (35). Duration of analgesia was monitored in both ilioinguinal/iliohypogastric nerve block and caudal block patients. After giving General anaesthesia, patient was either given Ilioinguinal/Iliohypogastric nerve block or Caudal block depending on the study group. Results: The mean duration of analgesia was longer in the Caudal Block group (8 ± 1.75 hours) compared to the Ilioinguinal/Iliohypogastric Block group (6 ± 2.25 hours), however the difference was not statistically significant. Ilioinguinal/Iliohypogastric Block group generally had higher pain scores than the Caudal Block group at 2, 4, and 6 hours postoperatively, with significant p-values. At 8 and 10 hours, the Caudal group had slightly higher scores, though the differences remained statistically significant. These findings suggest that the Caudal Block was more effective in managing postoperative pain during the early postoperative period. The requirement for rescue analgesia by each study participant within 24 hours postoperatively was slightly higher in the Ilioinguinal/Iliohypogastric Block group compared to the Caudal Block group. In the Ilioinguinal/Iliohypogastric Block group, 5 rescue analgesia given to each participant out of 35 participants and while in the Caudal Block group, 4 rescue analgesia given to each participant within first 24 hours. This, suggests that the Caudal Block may have provided slightly better or more sustained postoperative analgesia. Conclusion: Overall, the study concludes that while both the Ilioinguinal/Iliohypogastric Block and Caudal Block are effective and safe regional anesthesia techniques in pediatric surgery, the Caudal Block offers more postoperative analgesia.

Introduction: Electroconvulsive therapy is considered as a first line treatment as recommended by the American psychiatric association (APA), for patients with severe depression, acute mania, mood disorders with psychiatric feature and catatonia. The introduction of ultra-short acting intravenous anaesthetic drugs and muscle relaxant particularly succinyl choline in clinical practice gave way for modified ECT with lesser complications. There is always a need of ideal anaesthetic agent which has rapid, smooth induction, short duration of action, minimal effects on seizures duration, compatible with antipsychotic drugs, minimal side effects, and rapid recovery. The present study aims to compare the effectiveness of thiopentone and propofol as an intravenous agent for modified ECT in view of induction characteristics, hemodynamic parameters, seizure duration, recovery characteristics, and adverse effects. Methods: The present study was conducted by department of Anaesthesiology at tertiary care centre amongst 70 patients with ASA grade I and II of either sex, between 18- 60 years undergoing electroconvulsive therapy during Feb.2023 to Sept. 2024. The patients were randomly divided into two equal groups, Group T (Thiopentone): 35 patients were given Inj. Thiopentone 3-5 mg/kg for ECT and Group P (Propofol): 35 patients were given Inj. Propofol 1.5-2 mg/kg for ECT. Following parameters were monitored- Time and the dose of the induction agent required for loss of eye lash reflex/loss of verbal contact for Thiopentone and Propofol. Noninvasive blood pressure, heart rate, SpO2, ECG were monitored prior to induction, immediately after induction and at 0, 5, 10, 15 and 30 minutes after ECT convulsions. Duration of seizure and time for return of spontaneous ventilation after apnea. Results: Induction was rapid with Propofol (40.83 ± 1.44 in seconds) as compared to Thiopentone (47.80 ± 4.44 in seconds) which was statistically significant (P<0.001). Seizure duration was less in the Propofol group (39.26±1.70) compared to Thiopentone group (40.60±4.49) but it was statistically not significant. There was no statistically significant difference in heart rate, systolic and diastolic blood pressure before and after induction. Thus, in our study we found significant change in heart rate, systolic blood pressure, and diastolic blood pressure in both the groups after administration of ECT followed by decreasing trend by the end of 15 min and reaching back to baseline values by the end of 30 min. Time needed for return of spontaneous breathing was less with Propofol (115.14±2.39 sec) compared to Thiopentone (120.54±5.15 sec) with statistical significance (P<0.001). Conclusion: We finally concluded that, Propofol provides fast smooth induction, better hemodynamic stability, early smooth recovery, and less adverse effects as compared to Thiopentone making it as an agent of choice for modified ECT.

Background: Stunting is a major public health concern associated with adverse health and developmental outcomes. Hospital-based data on the etiological profile and response to intervention in stunted children in Kerala remain limited. Objectives: (1) To describe the clinical profile of children with stunting attending the paediatric outpatient department (OPD) of a tertiary care hospital in Kerala. (2) To estimate the impact of interventions, based on etiology, in children with treatable causes of stunting at the end of a two-year follow-up. Methods: This prospective observational study was conducted at paediatric OPD of Government Medical College, Ernakulam. Children aged 2–15 years with stunting were enrolled consecutively over six months. Children with prior diagnosis or treatment for growth failure were excluded. Relevant data was collected using structured proforma. Anthropometry, bone age, laboratory investigations, and relevant endocrine/genetic tests were performed. Etiology-specific interventions were initiated, and children were followed up for two years. Results: Of 150 children enrolled with stunting, 108 completed follow up. The mean age was 6.2±3.1 years, with a male predominance (60.2%). Majority (57.4%) were less than 7 years age. Severe stunting was present in 21.3% and wasting in 67.6%. Familial short stature (FSS) (36.1%) and constitutional delay of growth and puberty (CDGP) (34.3%) were the most common diagnoses. Endocrine causes identified were hypothyroidism (2.8%), growth hormone (GH) deficiency (5.6%). GH stimulation test was done for 17, of which 9 were abnormal. Only 4 initiated GH treatment due to cost constraints. Severe bone age delay was significantly associated with poor height velocity (p=0.04). Conclusions: FSS and CDGP remain predominant causes of stunting, but endocrine, genetic, and nutritional etiologies are also important. Early identification, growth monitoring, and low-cost interventions can improve outcomes, while access to advanced diagnostics and growth hormone therapy remains a challenge.

Introduction: Carbapenem-resistant (CR) gram-negative organisms present a critical global threat. Phenotypic tests such as modified Carbapenem Inactivation method (mCIM) and EDTA carbapenem inactivation method (eCIM) provide affordable options for detecting carbapenemases in resource-limited settings. This study aimed to identify CROs, differentiate resistance mechanisms using mCIM/eCIM, and evaluate effective strategies for treatment and control of carbapenem-resistant organisms (CROs) infections. Methods: A prospective observational study was conducted in the department of Microbiology, Kakatiya Medical College, from January 2023 to May 2024. A total of 210 non-duplicate Gram-negative isolates resistant to one or more carbapenems were tested using mCIM and eCIM as per CLSI guidelines. Results: Of 210 isolates, 108 (51.4%) were carbapenemase producers: 67 (32%) were metallo-β-lactamases (MBLs) and 41 (20%) were serine carbapenemases. Klebsiella pneumoniae was the predominant isolate. The highest proportion of MBLs was found in urine samples, while serine carbapenemases were more common in blood cultures. Conclusion: The mCIM and eCIM tests provide effective phenotypic screening for carbapenemases. These methods are essential in guiding empirical therapy, especially in settings lacking molecular diagnostics.

Introduction: Fluid overload significantly worsens outcomes in CKD, particularly in dialysis patients. Traditional exams often miss early congestion. POCUS, especially lung ultrasound, offers sensitive, bedside detection of B-lines, effusions, and venous congestion. This study aimed to evaluate POCUS in identifying fluid overload and guiding management in CKD patients. Methods: This prospective observational study (Jan–Jun 2025, Takshashila University) included CKD stage 3–5 adults. Excluding acute illness and lung disease, patients underwent POCUS lung ultrasound, IVC assessment, and echocardiography. Findings were compared with clinical and laboratory data. Primary outcome was fluid overload detection; secondary outcomes included correlations with clinical and dialysis parameters. Results: Eighty-eight CKD patients (mean age 54.6 years, 62.5% male) were studied; 52.3% on dialysis. POCUS detected fluid overload in 61.4% versus 44.3% clinically (κ=0.62). Findings included B-lines (61.4%), pleural effusion (20.5%), and dilated IVC (36.4%). Overload was higher in dialysis patients (p=0.04), with strong clinical correlations. Conclusion: POCUS outperformed clinical examination in detecting fluid overload among CKD patients, particularly those on dialysis. Strong correlations with clinical and laboratory indices underscore its reliability. Integrating lung, IVC, and cardiac ultrasound offers a comprehensive, bedside approach, supporting personalized fluid management and improved outcomes in this high-risk population.

Introduction: Diabetic retinopathy (DR) is a leading cause of preventable blindness, requiring timely detection. Conventional screening faces access and cost barriers. Smartphone-based fundus imaging offers an affordable, portable solution with promising accuracy. This study evaluates its effectiveness, feasibility, and diagnostic reliability for early detection in resource-limited settings. Methods: This prospective study at Mamata Medical College (Jan–May 2025) enrolled diabetic patients >18 years with ≥5 years disease. Smartphone fundus photography using a handheld adapter was compared with standard tabletop imaging. Images were graded independently using the ICDR scale, with inter-rater agreement assessed and discrepancies resolved by a senior consultant. Results: The study of 97 participants (mean age 54.2 years, HbA1c 8.1%) showed comparable DR grading between smartphone and standard imaging. DR severity correlated significantly with hypertension, dyslipidemia, and poor glycemic control. Smartphone screening demonstrated high accuracy (91.7%) and strong agreement (κ=0.86), confirming its reliability for DR detection. Conclusion: This study concludes that smartphone-based fundus imaging is a reliable, accurate, and feasible alternative to standard fundus cameras for diabetic retinopathy screening. With strong diagnostic performance and agreement, it offers a practical, cost-effective tool for early detection, particularly valuable in resource-limited settings to reduce preventable vision loss.

Background: Tofacitinib, an oral Janus kinase (JAK) inhibitor, offers an advanced small-molecule option for moderate-to-severe ulcerative colitis (UC). Despite proven efficacy in pivotal trials, Indian real-world data remain scarce. This study aimed to evaluate the safety and effectiveness of tofacitinib in biologic-naïve Indian patients treated under routine care at a tertiary center in Jaipur. Methods: A retrospective observational study was performed on 50 adult, biologic-naïve UC patients receiving tofacitinib (10 mg BID × 8 weeks, followed by 5–10 mg BID maintenance) between January 2022 and June 2024 at Apex Hospital, Jaipur. Patients were followed for 52 weeks. Primary outcomes included clinical remission, clinical response, endoscopic mucosal healing, and steroid-free remission. Safety events were collected from records. Results: Mean age was 38 ± 10 years; 60% were male. Baseline disease was moderate in 70% and severe in 30%. Clinical remission rates at 8, 16, 24, and 52 weeks were 40%, 48%, 56%, and 54%, respectively; clinical response rates were 75%, 85%, 70%, and 78%. Endoscopic mucosal healing occurred in 55% and 45% at 16 and 52 weeks, respectively. Steroid-free remission was achieved in 50% at 52 weeks. Adverse events occurred in 35%, mostly mild; two serious events (cytomegalovirus colitis and anal abscess) resolved completely. Conclusion: Tofacitinib demonstrated favorable effectiveness and safety in biologic-naïve Indian UC patients. Real-world outcomes mirrored international data, supporting its role as a cost-effective oral advanced therapy in India.

Background: Symptoms of depression are not uncommon in spouse of schizophrenia patient especially in those who lives in nuclear family.de-institutionalization, socioeconomic factors, age of spouse, duration of schizophrenia further augments depressive symptoms. only few studies have focused on caregiving distress among married patients with schizophrenia. Objectives: The aim of this study is to observe the prevalence of depression among spouse of schizophrenia patients and to correlate severity of depression in their spouse. Methods: Patients(n=62) attending the department of psychiatry in AIMSS diagnosed with schizophrenia according to ICD-10 criteria, living together with their spouse, after obtaining written informed consent basic demographic characters were collected, patients administered PANSS and spouse were given Beck depression inventory (BDI) Tamil version self-rating scale to rate depression. Results: In current study 62 patients along with their respective spouse were recruited. male spouse was older than female, most of the patients from rural background, unemployed, or unskilled. female patients had more negative symptoms and more score on Beck depression inventory (BDI). up to 30(48.3%) caregiving spouse had mild to moderate depression while none had severe depression, male caregivers had more depressive symptoms when their spouse had predominant negative symptoms. Conclusion: Depression was common among spouse with low education level, urban background, and longer duration of schizophrenic illness. presence of negative symptoms in female patients associated with more depressive symptoms in male caregivers.

Background: Patients routinely post public reviews about medicines. These first-hand accounts often focus on daily, quality-of-life effects—such as stomach upset, sleep, and sweating—that can be missed or under-reported through routine channels. Objective: To synthesise patient-reported experiences of metformin from large public review sites, quantify how often key themes appear in a structured sample, and discuss how such signals can complement evidence-based practice and pharmacovigilance. Methods: We reviewed metformin pages on Drugs.com and WebMD (cut-off 30th June 2025). Platform summaries (ratings, counts) were extracted. We then coded a structured sample of recent reviews for six themes: gastrointestinal (GI) intolerance, sleep disturbance, sweating, dizziness/fatigue, extended release (XR/ER) switch mentioned, and discontinuation mentioned. Themes were compared with trusted references (NHS, DailyMed/FDA) and with studies on XR tolerability. We treat online reviews as signal-generating, not incidence. Results: On Drugs.com, metformin’s overall page shows 6.8/10 from 661 reviews (54% positive, 19% negative), and the Type-2-diabetes sub-page shows 5.9/10 from 271 reviews (45% positive, 32% negative). In our coded sample completed to date (n=60), themes occurred as follows: GI intolerance 44 (73%), sleep disturbance 11 (18%), sweating 13 (22%), dizziness/fatigue 16 (27%), XR/ER switch mentioned 9 (15%), discontinuation 12 (20%). NHS and DailyMed/FDA sources emphasise GI effects, advise with-food dosing, and list symptoms that include sweating, dizziness, and unusual sleepiness; XR studies consistently show better GI tolerability versus immediate-release (IR), mirroring patient workarounds. Conclusions: Online reviews repeatedly flag early GI upset and frequent mentions of sweating and sleep problems. While not suitable for incidence, these data help clinicians set expectations (start low, titrate, with meals, consider XR early if GI effects threaten adherence) and prompt simple follow-up questions about sleep and night sweats. Used alongside labels and pharmacovigilance databases, patient-voice data can strengthen counselling and generate testable hypotheses.

Introduction:  In recent decades, the prevalence of hypertension (HTN) has gained international recognition as a risk factor for chronic renal disease and cardiovascular disorders. It also contributes significantly to disability and death. More than 1 billion adults globally suffered from hypertension in 2015, with the majority living in low- and middle-income nations. Since paediatric hypertension symptoms are typically non-specific, many kids with essential hypertension probably don’t have any symptoms at all. The most typical use of BMI is to evaluate overweight and obesity, which are caused by a more sedentary lifestyle, decreased physical activity, and higher calorie intake. According to estimates from the International Obesity Task Force (IOTF) and the International Association for the Study of Obesity (IASO), 200 million school-age children are overweight or obese and have a high BMI. Up to 85–95% of adolescents have essential hypertension. Understanding these factors, we carried out a study with the primary goal of determining the prevalence of hypertension among urban school-age children aged 6 to 17 and the secondary goal of assessing the relationship between hypertension and BMI. Material and Methods: An observational cross-sectional survey was carried out in an urban school in Rourkela, Odisha, between January 2023 and December 2023, with 986 pupils who met the study’s inclusion and exclusion criteria. The study included children of any gender who were between the ages of 6 and 17. Using the IAP BMI for age and sex chart, their BMI was computed after their height and weight were recorded, and they were then classified as normal weight, underweight, overweight, and obese. In accordance with standard procedure, blood pressure was measured. Results:  The majority of participants were in the 10-11 years age group, with a mean age of 11.23±3.45 years. Males constituted a higher percentage (53.85%) than females (46.15%), except in the 6-7 years age group. Weight distribution showed that most children had a weight of 12-30kg, with mean weights of 39.38±18.07kg for females and 41.31±18.08kg for males. The majority of children had a height of 1.21-1.40m, with mean heights of 1.41±0.17m for females and 1.43±0.17m for males. Normal BMI was observed in 45.84% of children, while 23.12% were underweight, 16.94% overweight, and 14.10% obese. The study found no significant correlation between BMI and gender but a significant correlation between BMI and age (r=0.54, P<0.001) and also between BMI and systolic hypertension (r=0.46) as well as diastolic hypertension (r=0.33). Conclusion: The study was conducted to evaluate the incidence of hypertension in correlation with BMI among urban school-going children. This observational study conducted among school-going children in the Urban School of Rourkela, Odisha has provided valuable insights into the incidence of hypertension in correlation with BMI. The findings reveal a substantial prevalence of hypertension among the studied population, with notable correlations between BMI, age, gender, and various hypertension indicators.

Background: Critical thinking is a cornerstone of medical education, yet traditional lecture-based methods often limit active engagement and problem-solving. Case scenario-based learning (CSBL) has emerged as an innovative teaching strategy to bridge the gap between theory and practice in clinical disciplines. Objective: To evaluate the effectiveness of CSBL in enhancing critical thinking, clinical reasoning, and student engagement among undergraduate medical students (MBBS Phase 3 Part 2) in Obstetrics and Gynaecology. Methods: A prospective interventional study was conducted at Government Medical College, Patiala, over five months. A total of 226 undergraduate students and senior residents participated. Teaching sessions were redesigned using case scenarios, followed by assessments with pre- and post-intervention multiple-choice tests. Feedback from students and faculty was collected using structured Likert scale questionnaires. Data were analyzed using the Chi-square (χ²) test, and Relative Risk (RR) and Risk Difference (RD) were calculated to assess improvement in performance. Results: The post-intervention analysis revealed a statistically significant improvement in learning outcomes across all ten CSBL sessions (p < 0.05). The proportion of students scoring ≥ 75 % increased by 11 %–40 % (risk difference), with students being 1.2–1.9 times more likely to achieve higher scores after CSBL (relative risk = 1.16–1.87). Student feedback demonstrated marked enhancement in attentiveness (95 %), confidence (98 %), interaction (96 %), and satisfaction (97 %). Faculty responses were similarly positive, with 90 % reporting improved engagement and motivation to innovate their teaching style. Key challenges included time constraints in preparing cases and resistance from some faculty accustomed to traditional methods. Conclusion: CSBL proved to be a highly effective and statistically significant pedagogical tool in obstetrics and gynaecology, enhancing knowledge application, critical thinking, clinical decision-making, and learner engagement. Its integration into undergraduate curricula can bridge theoretical and practical gaps, fostering interactive, clinically relevant learning experiences for both students and faculty.

Background: ST segment elevation myocardial infarction (STEMI) is a serious and potentially life-threatening condition. Low serum albumin levels and high random blood sugar (RBS) levels have been associated with adverse outcomes in patients with cardiovascular disease. However, the association between serum albumin and RBS levels and in-hospital complications in patients with STEMI is not well established. Methods: We conducted a retrospective study of 100 patients with STEMI who were admitted to our hospital between January 2020 and December 2021. The association between serum albumin and RBS levels and in-hospital complications was analysed using logistic regression models. Results: Low serum albumin levels (< 3.5 g/dL) were observed in 38% of patients, and high RBS levels (> 200 mg/dL) were observed in 54% of patients. In-hospital complications occurred in 24% of patients. Low serum albumin levels (OR=2.83, 95% CI 1.19-6.71, p=0.019) and high RBS levels (OR=3.51, 95% CI 1.47-8.40, p=0.005) were independently associated with a higher risk of in-hospital complications. Conclusions: Our study suggests that low serum albumin levels and high RBS levels are independently associated with a higher risk of in-hospital complications in patients with STEMI. These findings have important clinical implications, as they suggest that interventions aimed at improving serum albumin levels and controlling hyperglycemia may reduce the risk of adverse outcomes in patients with STEMI.

Background: Otomycosis is a superficial fungal infection of the external auditory canal, most commonly caused by Aspergillus and Candida species. It is particularly prevalent in tropical regions, with host factors such as diabetes, antibiotic use, and poor aural hygiene increasing susceptibility. Case Presentation: A 63-year-old female with uncontrolled type 2 diabetes mellitus presented with itching, pain, aural fullness, and discharge from the left ear. She reported recurrent symptoms over the past year and a history of applying mustard oil and using sharp objects for ear-picking. On examination, black, fluffy debris was noted in the external auditory canal, with an intact tympanic membrane. Microscopy of the aural debris showed septate hyphae with acute-angle branching on KOH mount. Culture on Sabouraud Dextrose Agar yielded black, powdery colonies, and Lactophenol Cotton Blue (LPCB) mount demonstrated characteristic morphology of Aspergillus Niger. The patient was treated with topical clotrimazole ear drops for 15 days and oral itraconazole for 10 days, resulting in complete resolution of symptoms. Conclusion: This case emphasizes the importance of considering Aspergillus Niger otomycosis in diabetic patients with recurrent ear complaints. Early diagnosis using microscopy and culture, along with appropriate antifungal therapy, is essential for favorable outcomes. Counseling on proper ear hygiene and strict glycemic control plays a pivotal role in preventing recurrence.

Introduction: Measurable differences have been described in the manner in which learner prefers to Acquire, analyse and recall knowledge. The unique learning preference of an individual, which include various approaches of interacting with information, which individualise a person’s learning style being aware of these differences in learning styles allows people to adjust their methods to better match the preferences of their self. VARK type of questionnaires have been put in to use around the world to test the preferential learning mode of postgraduate and undergraduate students on a number of degrees such as medical, dental, Nursing, business etc. V- visual, A- auditory, R-reading/writing, K-kinesthetics modalities. Rasch analysis is used to examine the internal construct validity of a questionnaire designed by Neil Fleming. It consists of 16 scenarios each asking the respondent to identify all of the information processing modes they would adapt in a particular scenario. This study aims to elucidate the learning style preferences of medical and dental students with in a specific academic institution, employing the VARK questionnaire as the assessment tool and their specific learning style which they assessed voluntarily. Methodology: The VARK study is a quantitative study methodology in which the questionnaire {version 8.02} consisting of 16 cases was administered to 100 phase 2 medical students from a medical college and 100 phase 2 dental students from a dental college. Participation was voluntary and the Survey was distributed among total of 200 students via a google form consisting of a consent form and the link to the questionnaire. Conclusion: This study plays a crucial role in helping students identify their individual learning preferences, thereby enhancing their engagement with information. By understanding their preferred learning styles, students can adopt strategies that strengthen metacognitive abilities and promote self-regulated learning. It is important to emphasize that the learning styles assessed in this study reflect preferences, not fixed traits. Recognizing these preferences encourages students to explore various approaches and develop personalized, effective learning strategies. The results of this study may provide insights into how students’ academic programs— whether in medicine or dentistry—influence their preferred learning styles. It is crucial for faculty members to be aware of these learning preferences, as doing so enables them to communicate more effectively, foster deeper engagement, and support student success through personalized learning strategies.

Background: Aim of the present study was to analysis the morphology, dimensions and types of papillary. Muscles present in tricuspid valve of human heart. Pillar like projections into the myocardial of the heart is called papillary muscles. The papillary muscles are required components of the tricuspid valve complex. Papillary muscles are three in number and named according to their positions – anterior, posterior and septal. Differences in the number, length, and form of the papillary muscles become clinically significant. Papillary muscle defect cause valve prolapsed and valve replacement surgery. Material & Method: The study was carried out on 100 fresh formalin fixed cadaveric heart. Hearts are not grouped into any criteria of sex and age. Morphology of shape of papillary muscles observed and morphometry was studied by measuring the length, width of each muscle are measured and documented. These measurements done by the vernier caliper. Results: Number of papillary muscles was present with a frequency 1-7. Maximum number of papillary muscles 7 seen in 3 % of hearts. 1 anterior, septal and posterior papillary muscle seen in 5%, 23%, 19% hearts respectively. Septal papillary muscle was absent in 11% of hearts. Anterior papillary muscle was seen in 100 % with maximum 6 in numbers. Septal was found in 89% in hearts. Posterior papillary muscle was found 100% in hearts. In measurements of papillary muscle, anterior papillary muscle mean height was 1.65±0.27 cm, mean width was 0.734±0.16 cm. septal mean height was 1.14±0.33cm., mean width was .35±0.14cm. Posterior papillary muscle mean height was 1.38±0.36cm. Mean width was 0.55±0.13 cm. respectively. Tricuspid valve contained three papillary muscles, respectively, in all hearts, conical and broad base and fan shaped papillary muscle pattern were found to be most prevalent. Broad base pattern absent in septal papillary muscle. Conclusion: These finding suggest that the variation in number, pattern, height and width accepted before any surgical intervention on the valvular apparatus. The knowledge of morphology and morphometry of papillary muscle is essential for cardiologists to detect etiology of different heart related problems to plan the mode of treatment and to predict their prognosis.

Background: Ultrasound-guided brachial plexus block offers distinct advantages by enabling anesthesiologists to visualize anatomical variations and the spread of local anesthetics accurately. This study aimed to evaluate the effect of adding nalbuphine to 0.5% bupivacaine for supraclavicular brachial plexus block for the potential benefits and safety profile. Material & Methods: This prospective observational study was conducted at GMERS Medical College and Hospital, Himmatnagar in patients aged 18 years and above, scheduled for upper limb surgeries requiring supraclavicular brachial plexus block as the primary anesthesia technique. 60 participants were divided into two equal-sized groups using randomization. Group B:  received 25 ml of 0.5% bupivacaine along with 1 ml of normal saline and Group N: received 25 ml of 0.5% bupivacaine combined with 1 ml (10 mg) of nalbuphine. The duration of both motor and sensory blockade and the duration of postoperative analgesia and side effects were compared in both the groups. Results: The mean duration of surgery in the group B was 125.6±17.1 min whereas it was 104.6±9.8 min for the group N (p<0.001). The mean time of onset for sensory blockade in the group B was 13.7±2.3 min whereas it was 3.6±2.1 min for the group N (p<0.001). The mean time of onset for motor blockade in the group B was 20.3±3.6 min whereas it was 4.6±3.6 min for the group N (p<0.001). The mean duration sensory blockade in the group B was 345.6±14.6 min whereas it was 375.4±79.4 min for the group N (p=0.047). The mean duration of motor blockade in the group B was 298.6±35.8 min whereas it was 336.4±72.9 min for the group N (p=0.014) No significant differences were observed in post-operative complications or sedation scores between the two groups. Conclusion: This study concludes that nalbuphine may be a valuable adjunct to bupivacaine for enhancing the quality and duration of brachial plexus blockade while minimizing intra operative complications.

Background: Acetaminophen (APAP) is the most frequently used medication worldwide, recognized for its longstanding efficacy in managing pain and reducing fever.  However, it can lead to serious liver damage, which ranks as the second leading reason for liver transplants globally. Toxicity may occur due to prolonged exposure to high doses or even a single large intake of APAP. Recently, there has been growing concern regarding the potential negative effects associated with the prolonged use of APAP even at standard therapeutic doses. Methods: In this study, the impact of prolonged therapeutic use of APAP is evaluated by administering a daily dose (equivalent to the therapeutic dose of APAP (40 mg/kg) or lower doses (10 mg/kg or 20 mg/kg) typically used by humans) to mice, and their survival duration and morphological alterations were observed for up to 40 days. Following the survival assessment, mice were anesthetized after a 10-day regimen of APAP (before the mortality caused by a 40 mg/kg dosage) and blood samples were collected to assess liver injury markers, while liver tissues were analysed for morphometric and histological alterations. Result: Results indicate that prolonged exposure to APAP at therapeutic or sub-therapeutic dose leads to a marked increase in mouse mortality and a considerable decrease in body weight. Additionally, there is significant elevations in liver injury biomarkers in serum, along with alterations in liver morphology and histological architecture. Conclusion: These results suggest that long-term use of therapeutic or sub-therapeutic doses of APAP may elevate the risk of liver toxicity.

Background: Adverse drug reactions (ADRs) can lead to non-adherence to antiretroviral therapy (ART) and are also the major causes of hospitalization and higher cost of treatment. Aims and Objectives: The aims of this study were to analyse the pattern of ADRs, causality, and severity among HIV-infected patients. Materials and Methods: It was a retrospective analysis conducted over 3 months from May 2021 to August 2021. ADRs due to antiretroviral drugs (ARVs) were collected from the Government General Hospital, Vijayawada. The WHO-UMC scale was used for assessing the causality and Hartwig–Siegel scale for severity of reactions. Results: A total of 580 ADRs due to ART were received. Among them 360 were female patients and 220 are male patients. 89% ADRs were of mild grade of severity. Most of the ADRs were related to gastrointestinal system. Causality assessment of ADRs was probable in 320(55.17%) patients and possible in 260 (44.82%) patients. Conclusion: Maximum number of ADRs was of mild nature suggesting that the ART is well tolerated among the patients. Further studies need to be conducted to fully understand the determinants of ADRs due to ART in a statistically significant manner.

Introduction: Intestinal parasitic infections remain a major health concern in developing countries, particularly in areas with inadequate sanitation, overcrowding, and unsafe water. Despite public health initiatives, these infections continue to affect children and low income groups. Objectives: To determine the prevalence and spectrum of common intestinal parasites in stool samples processed at a tertiary care hospital in Western Uttar Pradesh. Materials and Methods: This retrospective study was conducted from June 2023 to May 2025 in the Department of Microbiology. A total of 482 stool samples from both outpatient and inpatient departments were examined by direct saline and iodine wet mounts. Results: Among 482 samples, 108 (22.41%) showed significant findings, and 45 (9.33%) were positive for parasitic forms. Entamoeba histolytica (5.80%) was the most common parasite, followed by Giardia lamblia (1.66%), Ascaris lumbricoides (0.62%), Ancylostoma duodenale (0.62%), Enterobius vermicularis (0.41%), and Hymenolepis nana (0.20%). Protozoan infections (7.46%) were more prevalent than helminthic infections (1.85%). The highest infection rate occurred in children aged 0–10 years (33.33%). Conclusion: Protozoan infections predominated over helminthic infections, with E. histolytica as the leading pathogen. The results suggest a shifting trend in parasitic prevalence, likely due to improved hygiene and deworming programs. Continued surveillance, health education, and access to safe water are essential for controlling intestinal parasitic infections.

A study was conducted in the Department of Anaesthesiology, Calcutta National Medical College & Hospital with the aim of comparing Tapentadol (45 mg) nasal spray and intravenous Tramadol (100 mg) for postoperative analgesia. A total of 70 patients undergoing elective breast surgeries were included after obtaining informed consent. Patients were systematically allocated into either the Tapentadol or Tramadol group, and the study drugs were administered 10 minutes before induction of anaesthesia. Both groups were comparable in terms of age, sex, ASA physical status, and anthropometric data. Baseline hemodynamic parameters such as SBP, DBP, MAP, and PR were similar in both groups, though Tapentadol showed slightly lower values at 120 minutes, indicating better hemodynamic stability. The mean extubation time was significantly shorter in the Tapentadol group, and the time to the first rescue analgesic was longer, showing prolonged analgesic effect. Tapentadol also achieved a Ramsay sedation score of 2 more quickly, suggesting faster recovery. Postoperative NRS pain scores were consistently lower in the Tapentadol group across all observed intervals, confirming superior analgesic efficacy. The incidence of postoperative nausea and vomiting was lower with Tapentadol (22.9%) compared to Tramadol (37.1%), and although this difference was not statistically significant, it was clinically meaningful. Tapentadol demonstrated better gastrointestinal tolerability and patient comfort. Overall, Tapentadol nasal spray proved to be a more effective, better tolerated, and faster-acting analgesic compared to intravenous Tramadol for postoperative pain control in elective breast surgeries.

Background: The modifiable risk factor for stroke in young individuals is alcohol use. The relationship between cumulative burden of alcohol, stroke severity, and recovery has not been clarified. This investigation examines the relation between cumulative alcohol use and functional recovery in young adults after acute stroke. Methods: A cross-sectional analytical study was carried out among 117 alcoholic stroke patients aged 20–45 years at the Neurology Department of TVMCH from August 2023 to December 2024. Stroke severity was measured by NIHSS at admission, and functional recovery was measured by Modified Rankin Scale (MRS) at discharge. Alcohol intake was classified as mild (<105g/week), moderate (105–210g/week), or heavy (>210g/week), and cumulative alcohol burden was estimated for four years. Multivariate logistic regression analysis was used to identify the association between alcohol burden and recovery from stroke. Results: Those with greater cumulative alcohol burden presented with more severe strokes on admission (NIHSS: mild = 7, moderate = 12, heavy = 19) and poorer functional recovery on discharge (MRS: mild = 2, moderate = 3, heavy = 5). Heavy drinkers had the worst recovery, which suggests a dose-dependent association between alcohol burden and post-stroke disability. Conclusion: Increased cumulative alcohol use is linked with greater stroke severity and worse recovery in young adults. Lower alcohol consumption may enhance stroke outcomes and prevent long-term neurological deficits. More research is necessary to examine the advantages of alcohol reduction in preventing stroke and recovery.

Objectives: To evaluate hearing loss in high-risk neonates and to correlate between the severities of hearing loss among high-risk babies attending DEIC at Burdwan Medical College & Hospital, Burdwan, Purba Bardhaman. Materials and Methods: This study was conducted over a period of 3 months (March 2023 to May 2023). A total 1022 patients aged upto 3 months, who undergone hearing screening in the DEIC, Burdwan Medical College Hospital, Burdwan were included in this study. Result: A total no of 1022 (male-50.94% & female-49.06%) targeted babies were screened. Sixty-one (5.9%) cases had hearing impairment. Out of 61 hearing impaired children 32 were male and 29 females were there. 324 (31.7%) babies failed in 1^st screening procedure. Out of 324, 72 (22.22%) babies failed in 2^nd screening procedure who then underwent BERA. Sixty-one babies had abnormality in BERA study.
3 (0.29.%) babies came for hearing screening only for suspicion of hearing loss by their parents. 6 (0.58%) babies had positive family history. 813 (79.59%) babies had history of stay at NICU for more than 5 days for multiple variable reasons like very low birth weight, jaundice, birth asphyxia, low APGAR score. 51 (4.9%) babies had history of in-utero infections. 36 (3.5%) babies had craniofacial anomalies. 3 (0.29%) babies had white forelock. 28 (2.7%) babies had syndromic features. 39 (3.81%) babies had neurodegenerative disorder. 29 (2.8%) babies had culture positive post-natal infection. 3 (0.29%) babies had history of head trauma. 4 (0.39%) baby was under chemotherapy. Discussion: 40 % hearing impaired children had positive family history. 3.08% of hearing-impaired children having positive history of NICU stay for more than 5 days. 11.76% hearing impairment children had in utero infection. 27.78 % craniofacial anomalies children had hearing loss. 10.34% hearing impaired children had positive history of culture positive post-natal infection. There were 75% changes of hearing impairment caused by ototoxic drug effect. Conclusion: In our study the overall prevalence of hearing loss was 5.97% in high-risk babies. It is recommendable that all hospitals with level 3 neonatal cares should have OAE & AABR facilities. If not, a centralized hearing screening with a portable OAE is suggested and all abnormal cases can be referred for OAE & AABR to the nearest centre. All babies with abnormal AABR should undergo detailed ENT evaluation and auditory rehabilitation before 6 months of age.

Introduction: Mothers play a pivotal role in vaccinating their children. In India, in spite of the improvement of rate of vaccination, still some barriers to immunization persists, in both urban and rural areas. Aim: To evaluate, knowledge, attitudes, and practices of mothers towards vaccination of their Children in urban and rural mothers. Material and Methods: A prospective study including 600 urban mothers and 400 rural mothers was conducted rural and urban set up. A structured interview proforma was prepared and applied to evaluate, knowledge, attitude and practices of mothers towards vaccination in their children. Result: Rural mothers were more Illiterate (50% rural, 11.50% urban) and Younger (35% rural, 15.83% urban) in this study. Common cold (60% rural, 28.5% urban) and fever (rural 35%, urban 83.3%), in children was considered as significant reasons for preventing vaccinating in child as compared to diarrhea (12.5% rural, 26.6% urban). Majority of urban mothers (88.5%) knew, when to administer first vaccine to their children as compared to rural mothers (50%). Father was the main decision maker about vaccinating the child in rural group (49.5% rural, 17%urban). Doctors, Nurses, Health workers (71.25% rural, 66.67% urban) were the main source of information about vaccination in both groups. Conclusion: Illiteracy, myth and paternal dominance play as deciding factors for immunization in rural mothers, whereas, lack of awareness of vaccine schedule in both rural and urban groups played an important role for partial immunization of children.

Background: Schizophrenia is a debilitating mental health disorder characterized by loss of reality, with functional remission being an important treatment goal beyond symptomatic improvement. Objective: To assess functional remission in patients with schizophrenia and identify predictive factors associated with achieving functional remission. Methods: A cross-sectional study was conducted among 100 patients with schizophrenia attending the outpatient department of Institute of Mental Health, Kilpauk, and Chennai. Participants were assessed using the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) Scale, Clinical Global Impression (CGI) Scale, and Functional Remission of General Schizophrenia (FROGS) Scale. Functional remission was defined as achieving symptomatic remission (PANSS score <3), functional improvement (GAF score >60), and clinical remission (CGI score <3). Results: Out of 100 participants, 45% achieved functional remission across all three domains. Education above 10th standard (p=0.008), skilled occupation (p=0.013), good social support (p<0.001), use of atypical antipsychotics (p<0.001), good drug compliance (p<0.001), and fewer hospitalizations (p<0.001) were significantly associated with functional remission. Gender, marital status, religion, type of family, comorbidities, and electroconvulsive therapy showed no significant association. Conclusion: Social support, medication adherence, shorter duration of untreated illness, and fewer hospitalizations are key determinants of functional remission in schizophrenia. A multidimensional approach targeting symptomatic, functional, and psychosocial remission is essential for comprehensive treatment.

Background: Diabetes mellitus (DM) represents a complex metabolic disorder characterized by persistent hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetic nephropathy, a prevalent complication, frequently progresses to end-stage renal disease (ESRD). Notably, a substantial proportion of individuals with type 1 diabetes mellitus (T1DM) and a notable subset of those with type 2 diabetes mellitus (T2DM), ranging from 5% to 15%, advance to ESRD. Elevated serum uric acid (SUA) levels, associated with hyperuricemia, have been implicated in the pathogenesis of diabetic nephropathy due to their potential to induce endothelial dysfunction, provoke inflammation, and promote oxidative stress. This study aims to elucidate the relationship between SUA levels and microalbuminuria in patients diagnosed with T2DM. Objective: The primary objective is to investigate the correlation between serum uric acid levels and microalbuminuria in patients with type 2 diabetes mellitus, thereby assessing SUA’s potential utility as a biomarker for renal dysfunction and microvascular complications. Methodology: An observational, descriptive, cross-sectional, comparative single centric study was conducted at R.G. Kar Medical College & Hospital, involving patients admitted to the General Medicine department with T2DM. Serum uric acid concentrations and urinary albumin-to-creatinine ratios (ACR) were quantified. Statistical analyses were employed to evaluate the association between SUA levels and the presence of microalbuminuria. Conclusion: This investigation underscores a significant association between elevated serum uric acid levels and microalbuminuria among individuals with T2DM. The findings suggest that SUA may serve as a promising biomarker for the early detection of renal dysfunction and microvascular complications in diabetic cohorts. Further research is warranted to elucidate the underlying pathophysiological mechanisms and validate SUA’s prognostic value in predicting microalbuminuria. Such insights could potentially inform targeted therapeutic strategies and enhance clinical outcomes for patients with diabetes mellitus.

Introduction: Infections of the skin and soft tissues are now frequently caused by Staphylococcus. Methicillin-resistant Staphylococcus aureus (MRSA) and inducible clindamycin resistance (iMLSB) have emerged as significant challenges in the treatment of Staphylococcal infections, and medication resistance has grown. The purpose of this study was to identify MRSA and iMLSB and to determine the pattern of antibiotic susceptibility among the isolates. Materials and Methods: 150 isolates of Staphylococcus were studied for detecting the antibiotic resistance pattern and also to detect MRSA using cefoxitin disc and oxacillin E test. iMLSB resistance among MRSA strains was detected using D test. Results: Out of 150 isolates of Staphylococcus, 110 (73%) isolates were of Staphylococcus aureus and 40 (26%) isolates were of Coagulase-negative Staphylococci. Staphylococcus was most sensitive to vancomycin and linezolid, followed by clindamycin. Penicillin was the least sensitive antibiotic. 32 (21.3%) strains of Staphylococcus aureus were MRSA. Among them, 18(56.2%) were erythromycin resistant, and 08 (44%) of erythromycin-resistant strains were found to be inducible clindamycin resistant. Conclusion: Testing of all the isolates of Staphylococcus for antibiotic resistance and identifying the MRSA isolates along with iMLSB resistance is important in determining the antibiotic sensitivity, which will prevent treatment failure.

Background: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality in India, placing a significant economic burden on patients and healthcare systems. Rational prescribing and cost-effective drug utilization are critical for managing cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia. The Indian Council of Medical Research–Rational Use of Medicine (ICMR–RUM) centres play a pivotal role in promoting evidence-based, affordable treatment practices. Aim: To systematically review studies evaluating the prescription-based cost of medicines used for cardiovascular risk factors at ICMR–RUM Centre hospitals across India, assessing cost trends, rational drug use, and adherence to essential medicines lists. Methods: A comprehensive literature search will be conducted across PubMed, Scopus, Embase, Web of Science, and IndMed databases for studies published between 2010 and 2025. Eligible studies will include prescription-based cost analyses conducted in Indian tertiary care or ICMR–RUM Centre hospitals. Data extraction will cover prescription patterns, cost per prescription, generic versus branded usage, and compliance with national guidelines. Quality assessment will be performed using the Joanna Briggs Institute (JBI) checklist, and data will be synthesized qualitatively, with meta-analysis if applicable. Results: Preliminary findings suggest substantial variation in prescription costs across centres, with higher expenses associated with branded formulations and polypharmacy. Prescriptions adhering to the National List of Essential Medicines (NLEM) and rational drug use indicators show significantly reduced costs. Conclusion: The review emphasizes the importance of regular cost audits, promotion of generic prescribing, and strict adherence to essential medicine lists for ensuring cost-effective cardiovascular care. Establishing a centralized ICMR pharmacoeconomic database and integrating cost-awareness into prescribing practices can enhance affordability and rational drug use across Indian healthcare institutions.

Background: Hypothyroidism is known to alter lipid metabolism, leading to dyslipidemia and increased cardiovascular risk. Thyroid hormones play a crucial role in regulating lipid synthesis and clearance. Evaluating lipid profile changes in hypothyroid patients is essential for early prevention of metabolic complications. Methods: A cross-sectional study was conducted on 204 hypothyroid patients. Serum levels of TSH and lipid parameters, including triglycerides, cholesterol, HDL, LDL, and VLDL, were measured. Data were analyzed using Pearson’s correlation to determine the relationship between TSH and lipid profile. Statistical significance was set at p < 0.05. Results: The study revealed elevated mean values of triglycerides, cholesterol, LDL, and VLDL, with a moderate decrease in HDL among hypothyroid patients. A significant positive correlation was found between TSH and VLDL (r = 0.261, p = 0.009). Other lipid parameters showed a positive but non-significant correlation with TSH. These findings suggest altered lipid metabolism associated with thyroid dysfunction. Conclusion: Hypothyroidism is significantly associated with dyslipidemia, particularly elevated VLDL levels, increasing cardiovascular risk.

Background: The likelihood of microbes resistant to antibiotics eventually rises. As a result, selecting the right antibiotics is crucial to ensuring effective treatment and avoiding long-term issues. A WHO preliminary survey found that 16% of doctors give antibiotics to patients who have non-specific fevers. Objectives: In order to inform effective infection control and antibiotic stewardship practices, the study’s objectives were to assess the antibiotic susceptibility and resistance profiles of the bacterial isolates and analyze the prevalence and trends of hospital-acquired infections in patients admitted to a tertiary care center. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Data from 186 participants were retrieved for the study. Regardless of age or gender, this study included patients who were hospitalized to the tertiary care facility throughout the one-year study period and who experienced hospital-acquired illnesses that were verified by positive bacterial culture. Results: The most often isolated pathogen among the 186 culture-positive HAI patients examined was Escherichia coli (28.4%). Klebsiella pneumoniae came in second (22.6%). The third most frequent isolate was Pseudomonas aeruginosa (18.8%). Gram-positive isolates were largely composed of Staphylococcus aureus (14.0%), including potential MRSA. Conclusion: Gram-negative bacteria accounted for the majority of hospital-acquired infections in this study, and they were highly resistant to many drugs. The majority of pathogens were still susceptible to the effects of nitrofurantoin, carbapenems, colistin, linezolid, and vancomycin. Recommendations: Strict infection control, sensible antibiotic use informed by local antibiograms, and routine monitoring of resistance patterns should all be implemented in hospitals.

Background: Tuberculosis (TB) remains a major public health concern in India, affecting both pulmonary and extrapulmonary sites and posing challenges in treatment adherence and disease control. Despite the availability of effective therapy, unsuccessful treatment outcomes including failure, loss to follow-up, and death continue to occur. Monitoring trends and factors associated with treatment outcomes is essential to strengthen TB control programs. Methods: A retrospective cohort study was conducted on 172 TB patients treated at a tertiary care hospital in India from January 2020 to January 2025. Patient data, including sociodemographic, clinical, and treatment-related information, were extracted from hospital registers. Treatment outcomes were categorized as cured/completed, failure/loss to follow-up, and death. Results: Among the 172 patients, 89.5% achieved successful treatment outcomes, while 10.5% experienced unsuccessful outcomes. Treatment failure or loss to follow-up was higher among transferred-in patients and those with pulmonary TB, whereas extrapulmonary TB and newly registered patients showed better outcomes. Mortality was highest among patients aged ≥45 years and HIV-positive individuals. Sex and residence had minimal impact on treatment outcomes. Conclusion: The study highlights high TB treatment success but underscores the need for targeted support for older, HIV-positive, and transferred patients.

Background: Myocardial infarction (MI) is a leading cause of morbidity and mortality across the globe. Early identification of risk factors and prompt intervention are critical for improving patient outcomes. This study evaluates in-hospital mortality and associated predictors in patients with acute MI. Materials and Methods: This retrospective study analyzed 184 adult patients with STEMI or NSTEMI admitted over one year. Demographic, clinical, laboratory, procedural, and logistical data were gathered from medical records. Management followed ESC guidelines, including PCI and optimal medical therapy. Logistic regression was used to identify predictors of in-hospital mortality. Results: Among 184 patients, 66.8% were males and 33.2% females, with a mean age of 64–69 years. STEMI accounted for 35–39% of cases, and NSTEMI/UA for 61–65%. Clinical factors such as older age, diabetes, nicotinism, low blood pressure, cardiogenic shock, and femoral access were significantly associated with higher mortality. Procedural timing, restenosis in DES, and adverse events during PCI also increased the risk. Conclusion: Prompt invasive management and risk stratification are essential to reduce in-hospital mortality in acute MI patients.

Introduction: Hyperbaric bupivacaine is routinely used for spinal anaesthesia in surgery of the lower abdomen, pelvis, orthopaedics, and urology due to its rapid onset, streamlined peak action, favourable ratio of sensory to motor blockade, haemodynamic stability, as well as safety. Notwithstanding these benefits, the duration that spinal anaesthesia is effective with hyperbaric bupivacaine is often shorter than the surgical time, particularly for surgeries longer than 90–120 minutes, or for cases where extended postoperative analgesia is needed. Intravenous dexmedetomidine appears to prolong spinal anaesthesia through several central and peripheral mechanisms. The present study was conducted to evaluate the impact of administering a single bolus dose of intravenous dexmedetomidine at 0.5 microgram/kg on the duration of spinal anaesthesia with hyperbaric bupivacaine for infraumbilical surgeries. Methods: The present study was conducted in the department of anaesthesiology of the tertiary care center during Feb.2023 to July 2024   amongst 70 patients, categorised with ASA physical status I and II, within the age range of 18 to 65 years and were slated for infraumbilical surgeries. Patients were allocated into two groups using a non-randomised, sequential allocation method based on the order of presentation. Group D: Prior to the administration of subarachnoid block, patients received an infusion of dexmedetomidine at a rate of 0.5 micrograms per kilogram, diluted in 100 millilitres of normal saline and given intravenously over a period of 10 minutes. Group S: Prior to the administration of subarachnoid block, patients received an infusion of Normal saline, 100 ml, intravenously over a 10-minute period. Results: The systolic blood pressure exhibited a significant reduction (p <0.05) from baseline for both groups. The group-D demonstrated lower DBP values compared to the other group at all time points post baseline. Patients in the Dexmedetomidine group had a markedly quicker average time to onset of (1.10 ± 0.40 min), also significantly longer mean time to regression of the sensory block (Mean time Dexmedetomidine – 213.18 ± 21.48 minutes; Group S – 139.78 ± 18.15 minutes), p < 0.01 and showed statistically significant prolongation in regression time of motor block and sensory block recovery. The patients in the group -D had the first rescue analgesia time significantly prolonged in comparison to the Group S, with the Dexmedetomidine group mean being 262.52 ± 39.05 minutes and the saline group mean being 183.15 ± 26.02 minutes, p < 0. 001. Conclusion: Therefore, to put it succinctly, administering intravenous dexmedetomidine in conjunction with hyperbaric bupivacaine during sub-umbilical surgeries markedly prolonged both motor and sensory levels of anaesthesia.

Introduction: Regional anesthesia has played a pivotal role in the evolution of modern surgical anesthesia, offering distinct advantages over general anesthesia, particularly in lower abdominal surgeries. The combination of a local anesthetic with an opioid adjuvant in epidural anesthesia has become a standard practice to maximize the benefits of both drugs, improving both quality and duration of analgesia. The combination of local anesthetics and buprenorphine in epidural anesthesia is widely practiced, but the hemodynamic implications of such combinations remain underexplored. The present study aimed to directly compare the hemodynamic effects of bupivacaine with buprenorphine and levobupivacaine with buprenorphine when used for epidural anesthesia in lower abdominal surgeries. Methods: The present comparative, prospective study was conducted in the departments of Surgery and Obstetrics & Gynecology of a tertiary care teaching hospital during Feb.2023 to July 2024 amongst 110 patients posted for elective lower abdominal surgeries. Participants were divided into two equal groups, Group B: Patients in this group received bupivacaine 0.5% combined with buprenorphine 90 mcg via epidural anaesthesia. Group L: Patients in this group received levobupivacaine 0.5% combined with buprenorphine 90 mcg via epidural anaesthesia. Results: The ephedrine requirement was higher: 32.7 % vs 14.5 % received vasopressors, with mean cumulative doses of 8.0 ± 2.2 mg and 5.1 ±1.6 mg, respectively (p < 0.001).  Results affirm levobupivacaine’s cardiovascular safety margin. The Levobupivacaine produced a lighter, shorter motor block (Bromage 2.4 ± 0.4 vs 2.8 ± 0.3; duration 421 ± 56 vs 481 ± 60 min, p < 0.001). The attenuation facilitates earlier mobilisation and may decrease thromboembolic risk. The First unassisted mobilization occurred nearly one hour sooner with levobupivacaine (560 ± 70 min vs 620 ± 80 min, p < 0.001). The Composite haemodynamic stability (MAP within ±20 % without vasopressor) was achieved in 80 % of levobupivacaine patient’s vs 58 % with bupivacaine (risk difference +21.8 %, p = 0.002). Conclusion: We can conclude that, using levobupivacaine instead of regular bupivacaine with buprenorphine gives clear and important advantages. It causes much less drop in blood pressure and reduces the need for drugs like ephedrine, gives longer pain relief without making the legs weak for too long. Patients feel more comfortable and have less pain after surgery. Because the benefits are so clear and consistent, levobupivacaine with buprenorphine should now be used routinely for lower abdominal surgeries.

Background: Carbapenems are drug of choice for treatment of multidrug resistant hospital acquired infections due to the recent rise in carbapenem-resistant bacteria, treating these infections has become incredibly challenging because there are so few effective alternatives. In addition to increasing mortality and morbidity, this imparts great economic burden on the health care system. These infections can be contained with the aid of prompt detection of these carbapenemase producers, proper treatment, and measures to prevent infection. Materials and Methods: A total of 100 Carbapenem resistant isolates consisting of Enterobacterales and Pseudomonas identified by automated ID/AST method (Vitek-2) were included in the study conducted from April 2023 to June 2023 at Infosys Central Laboratory, Department of Microbiology, Bangalore Medical College and Research Institute, Bengaluru and tested for carbapenemase production by Carba NP test and PCR for NDM and OXA-48 genes. Result: Among 100 isolates Klebsiella pneumoniae was predominant (56) followed by Escherichia coli (29), Pseudomonas aeruginosa (10), Enterobacter cloacae (3) Enterobacter aerogenes (1) and Citrobacter freundii (1).86 isolates were found to be positive by Carba -NP test. PCR revealed that 36 isolates harboured NDM gene and 18 isolates harboured OXA-48 gene.12 isolates harboured both genes, while neither NDM nor OXA-48 gene was detected in 34 isolates. Conclusion: Wide adaptability of these tests by various laboratories will help in early identification of these potentially spreading carbapenemase producers, which in association with appropriate treatment and infection control practices will prevent emergence of Carbapenem resistant organisms and reduce mortality and morbidity.

Background: Mother-to-child transmission (MTCT) of HIV remains a key route of pediatric HIV infection. Awareness and understanding among pregnant women are crucial for the effectiveness of Prevention of Mother-to-Child Transmission (PMTCT) initiatives.  This study investigated awareness and knowledge of HIV and MTCT among pregnant women attending a tertiary care center. Methods: A cross-sectional descriptive study was conducted among 496 pregnant women attending the antenatal clinic. Participants were selected using systematic random sampling. Data was obtained via a pre-tested, semi-structured questionnaire addressing sociodemographic variables, awareness of HIV/AIDS, understanding of transmission channels, and PMTCT measures. Descriptive statistics were employed to summarize findings. Results: Most participants were aged 20–29 years (69%), married (98%), and from rural areas (78.4%). Awareness of HIV/AIDS was high (93%), with health personnel as the main source of information (50.9%). Knowledge of transmission was moderate for sexual contact (68.2%) and blood transfusion (62.5%) but poor for sharing sharp items (24.6%) and apparently healthy carriers (21.8%). Awareness of MTCT was reported by 60.1% of participants; however, knowledge of PMTCT interventions was low—antiretroviral therapy during pregnancy (43.6%), neonatal prophylaxis (9.3%), cesarean delivery (3.5%), and avoidance of breastfeeding (4.5%). Knowledge gaps were more pronounced among rural and less-educated women (p < 0.05). Conclusion: Although broad awareness of HIV/AIDS was moderate, detailed information, notably about MTCT and its prevention, was inadequate. Targeted educational programs, better antenatal counseling, and greater community engagement are necessary to improve maternal understanding and prevent vertical transmission.

Background: Anterior cruciate ligament (ACL) reconstruction is the standard treatment for complete ACL tears, with interference screw fixation being the most widely used tibial fixation method. Titanium screws are known for strong fixation and durability but pose challenges during revision and may interfere with imaging. Biodegradable screws eliminate long-term hardware complications and are MRI-compatible but are associated with risks such as inflammatory reactions, cyst formation, and unpredictable degradation. Aim and Objectives: This study aimed to compare the clinical and functional outcomes of titanium and biodegradable interference screws in arthroscopic ACL reconstruction, with assessment by Lysholm Knee Score and International Knee Documentation Committee (IKDC) grading. Complications such as effusion, stiffness, infection, and screw-related issues were also documented. Methods: A total of 60 patients undergoing ACL reconstruction were enrolled and randomly divided into two groups: Group A (biodegradable screw, n = 30) and Group B (titanium screw, n = 30). Pre- and post-operative evaluations included range of motion, Lachman test, anterior drawer test, Lysholm scoring, and IKDC grading. Demographic, clinical, and injury-related characteristics were analyzed to ensure comparability. Results: Both groups showed significant post-operative improvement in knee stability and function. In Group A, 67% achieved an “Excellent” Lysholm score and 87% were graded as “Normal” or “Nearly Normal” by IKDC. In Group B, 70% scored “Excellent” and 90% were classified as “Normal” or “Nearly Normal.” Stability tests (Lachman and anterior drawer) showed high rates of negative results in both groups, with titanium screws demonstrating marginally higher stability. Complications were minimal and comparable: effusion was slightly more frequent in Group A, while stiffness and minor infections were more common in Group B. No screw breakage was reported in either group. Conclusion: Both biodegradable and titanium interference screws are safe and effective for ACL reconstruction, with no statistically significant differences in functional outcomes. Titanium screws offer slightly higher stability and fewer inflammatory issues, while biodegradable screws remain advantageous in patients requiring future revision or MRI evaluation. The choice of implant should therefore be tailored to patient needs, surgeon preference, and long-term goals.

Background: Midshaft clavicle fractures, accounting for a significant portion of shoulder girdle injuries, are common in young adults due to high-energy trauma. Traditionally managed non-operatively, recent evidence favors surgical intervention for displaced fractures. However, comparative data from low-resource settings like India remain limited. Aim: To compare the functional outcomes of displaced midshaft clavicle fractures managed by conservative and operative treatments using Constant Murley Score. Materials and Methods: A hospital-based longitudinal, record-based comparative study was conducted at Sardar Patel Medical College, Bikaner, from March 2024 to February 2025. Sixty patients aged 18–60 years with displaced midshaft clavicle fractures were enrolled and randomized into two groups: Group A (Conservative): Treated with figure-of-eight bandage or arm sling. Group B (Operative): Treated with plating or intramedullary fixation (TENS).
Functional assessment was done using the Constant Murley Score at 6 months. Radiological union, complications, and ability to return to work were also assessed.
Results: The mean age was 33.43 years (Group A) vs 32.30 years (Group B).
Functional outcomes were significantly better in the operative group (p = 0.035): (1) Good-to-excellent outcomes: 83.33% (Group B) vs 50% (Group A). (2) Radiological healing favored surgery (Stage 3 union in 66.67% of Group B vs 33.33% of Group A, p = 0.036).
Complications: (1) Group A: Nonunion (6.67%), angulation (13.33%), shoulder stiffness (20%). (2) Group B: Infection (3.33%), reoperation (3.33%).
Work return was comparable, though slightly delayed in Group B.
Conclusion: Operative management offers superior functional outcomes, faster union, and fewer complications in displaced midshaft clavicle fractures compared to conservative treatment. However, surgical risks and cost must be considered. Treatment should be individualized based on patient profile, activity level, and fracture characteristics.

Introduction: Osteoarthritis of the knee is one of the most common causes of pain and disability, especially in the elderly. The presence of varus deformity further affects joint alignment, stability, and mobility. When medical management fails, Total Knee Arthroplasty (TKA) remains the most effective surgical option for restoring function and improving quality of life. Objectives: · To determine functional outcome at 4 weeks, 3 months and 6 months after total knee arthroplasty in severe osteoarthritis with varus deformity knee. Methods: This record-based observational study included patients diagnosed with advanced osteoarthritis associated with varus deformity who underwent TKA. Functional and clinical outcomes were evaluated using the Knee Society Score (KSS) at 4 weeks, 3 months, and 6 months after surgery. Statistical analysis was performed to assess improvement in pain, range of motion, and correction of deformity. Results: out of 37 patients undergoing total knee arthroplasty, most were aged 61–70 years (64.86%) and male (56.76%). The majority were from rural areas (51.35%), with the left knee more commonly involved (56.76%). Preoperatively, knee clinical scores were excellent in 81.08% and functional scores in 72.97% of patients. Both clinical and functional scores showed progressive improvement, with mean clinical scores rising from 48.23 to 83.56 and functional scores from 46.02 to 81.54 at 6 months. A significant association was observed between clinical and functional outcomes (p = 0.01). Conclusion: Total Knee Arthroplasty performed through the medial parapatellar approach with posterior-stabilized implants provides excellent short-term functional outcomes in osteoarthritic knees with varus deformity. The procedure offers reliable pain relief, correction of deformity, and restoration of normal joint function, making it a dependable option for patients with advanced knee osteoarthritis.

Introduction: Antepartum surveillance of high risk pregnancy and to obtain a best outcome has always been a challenge. Among these innovations, color Doppler imaging is the latest and most significant advancement in obstetric care. According to Callen’s Ultrasonography in Obstetrics and Gynecology “abnormalities in one or more of these vascular systems occur prior to the clinical and laboratory appearance of, or as a result of, many pathological conditions of pregnancy”. Newer technological advances such as “power” or “pulsed” Doppler make the diagnosis easier and more accurate by enabling more accurate assessment of blood flow dynamics. Aims and Objectives: (1) To evaluate the utility of color Doppler as a diagnostic aid in fetal surveillance in high risk pregnancies. (2) To study the significance of umbilical, uterine and middle cerebral artery flow indices as prognostic indicators of fetal wellbeing. (3) To study the outcome of high risk pregnancy in patients with normal v/s abnormal color indices. Results: The commonest indication for Doppler in present study was hypertensive disorder of pregnancy of which 81 cases were of GHTN, 19 of chronic Hypertension followed by DM (13), Postdatism(11),Twin Pregnancy (7), Cardiac Disease (7), severe anemia(6), incompatibility (6). Abnormal Doppler flow leads to increase in caesarean section rate. Incidence of neonatal death was higher in patients with abnormal diastolic flow than normal Doppler indices. Incidence of perinatal mortality in patients with both abnormal uterine and umbilical Doppler was 37.76% reflecting the severely compromised state of the fetus. Conclusion: Color Doppler ultrasound is a multifaceted tool in prediction and management of high risk pregnancies non-invasively. Among the various Doppler parameters, umbilical artery Doppler is particularly predictive of perinatal outcomes. Doppler velocimetry is the key for early detection, monitoring and timely decision making in management of high risk pregnancies.

Background: The improvement of human lifespan over the millennia is attributed in part to enhanced protective mechanisms against oxidative stress. One such mechanism, proposed by Ames in 1981, involves serum uric acid (SUA), which acts as a critical antioxidant in human physiology. In more recent decades, however, SUA has been implicated in a broader range of pathologies, including hypertension, chronic kidney disease (CKD), and cardiovascular disease. Objectives: The study is being conducted to correlate serum uric acid and outcomes of AKI Methods: A longitudinal study design was conducted and this study utilized a sample size of 300 patients diagnosed with AKI admitted in the department of General Medicine Mcgann Hospital Shimoga to correlate serum uric acid and outcomes of AKI. The study was conducted for a period of one year from June 2023 to June 2024. Results: Blood urea levels decreased from 123 ± 40 mg/dl at admission to 28 ± 7 mg/dl at 3-month follow-up (p < 0.0001). Similarly, serum creatinine levels declined from 3.4 ± 1 mg/dl at admission to 0.9 ± 0.5 mg/dl at 3 months (p < 0.0001). Serum uric acid levels, the primary focus of the study, showed a marked reduction from 11 ± 3 mg/dl at admission to 3 ± 1 mg/dl at 3 months, which was statistically significant (p < 0.0001). A significant relationship was observed between serum uric acid levels and recovery outcomes. In the recovery group, 92.3% had uric acid levels >7 mg/dl, while only 7.6% had levels <7 mg/dl. Conversely, all patients in the non-recovery group (100%) had uric acid levels >7 mg/dl. Among patients who recovered, 56.4% required RRT and 43.5% did not. Conclusion: Elevated serum uric acid (>7 mg/dl) at admission was significantly associated with poorer outcomes and increased requirement of Renal replacement therapy.

Background: Text neck syndrome also known as turtle neck syndrome is a prevalent health problem among students. Smart phone addiction and abnormal study posture are the major risk factors for its’s development. Objectives: This study assess the level of smartphone addiction and prevalence of text neck syndrome among medical students. Methods: It is an observational cross-sectional study which was conducted among 480 medical students in Kanyakumari government medical college Tamil Nadu, within the age group 18 to 25 years. Study was approved by institutional ethical committee. A structured questionnaire containing four sections was used for the study. Questionnaire includes: Section A: Questions regarding posture while studying and mobile phone usage, Section  B: Numeric pain rating scale, Section  C: Assessing Neck disability index, Section D: Smart phone addiction scale. The results were tabulated and statistical analysis was done using chi square and spearman correlation. Results: About 52% of participants are under risk of addiction to smart phones. 46% of mild degree of neck pain and 62% of students had mild degree of neck disability while using mobile phone and studying. There was a significant (p value < 0.05) association between NPRS and smart phone addiction, and NDI and smart phone addiction. The association between study posture and neck pain rating scale was also significant (p value < 0.05). Conclusion: The text neck syndrome is an alarming health issue among medical students because of increased smart phone addiction and abnormal posture while studying and using mobile phones. This indicates a need to reduce the addiction and to use an appropriate study posture to prevent the text neck syndrome.

Introduction: Human body normally has two bilateral scapulae also called as shoulder blades. They are flat triangular bones with cancellous tissue. They consist of body, neck and processes. They can be considered as modified long bones as they are involved in transmission of weight of upper limb to axial skeleton via clavicle. They are supplied by large sized nutrient vessels (branches from suparascapular and transverse cervical vessels) which enter through the nutrient foramina. This bone is not very well researched in our country, when it comes to nutrient foramina. But lately there has been increased interest in scapular blood supply, probably due to increased incidences of RTA or just awareness. Purpose of study: To determine the number and location of nutrient foramina on the human dry scapula and to compare it statistically. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Anatomy of G.M.C Haldwani, Uttarakhand, India. The study samples included 44 dry Scapulae bones of unknown age and sex. These scapulae have been collected over the years, from the voluntary donated bodies of Kumaon region and around. Statistical analysis was done on the results obtained. Observations: The average number of nutrient foramina per scapula was five (ranging from 1-2). The most common location was of the supraspinous fossa, i.e,56%, and least common location was subscapular fossa i.e 0.06%. However, there was no significant difference in these locations was found based on laterality. Conclusion: Hence surgeons performing scapular surgery like fractures fixation or bone grafting must emphasize on the topographic understanding of the nutrient foramina of scapula and its variations. This knowledge aids in minimising blood loss during surgeries around the pectoral girdle in living patients and also will preserve the vitality of grafted tissues.

Background: Chronic liver disease (CLD) remains a major cause of morbidity and mortality worldwide, particularly in developing countries. Among the many biochemical derangements associated with decompensated chronic liver disease (DCLD), hyponatraemia is a frequent electrolyte disturbance and has been associated with poor prognosis and increased mortality. Objectives: To estimate the proportion of deranged serum sodium levels in patients with DCLD and to determine the relationship between serum sodium and clinical outcomes among hospitalised patients. Methods: A descriptive, longitudinal study was conducted among 100 consecutive patients with DCLD admitted to the Department of General Medicine, Agartala Government Medical College and GBP Hospital, Tripura. Patients above 18 years were included after informed consent. Serum sodium levels, biochemical parameters, and disease severity scores (Child–Pugh and MELD) were assessed. Patients were categorised as having hyponatraemia (<130 mEq/L), normonatraemia (131–135 mEq/L), or hypernatraemia (≥136 mEq/L). Data were analysed using SPSS version 22; p < 0.05 was considered statistically significant. Results: Of 100 patients, 83% were male. The mean age was 51.1 ± 9.5 years. Hyponatraemia was observed in 29%, normonatraemia in 44%, and hypernatraemia in 27%. Alcoholic liver disease was the most common aetiology (47%). Hyponatraemia was significantly associated with higher Child–Pugh and MELD scores, ascites, coagulopathy, hepatic encephalopathy, hepatorenal syndrome (HRS), and increased mortality (p < 0.05). Conclusion: Hyponatraemia is common among patients with DCLD and is strongly associated with disease severity and mortality. Serum sodium measurement serves as a simple, cost-effective prognostic marker for clinical outcome in DCLD patients.

Background: Breastfeeding is a cornerstone of infant nutrition and survival, yet its optimal practices remain suboptimal in many regions. Understanding breastfeeding behavior and its determinants is essential to design effective interventions. Objectives: To assess breastfeeding practices among mothers and to identify socio-demographic factors influencing these practices in a tertiary care hospital setting. Methods: A cross-sectional study was conducted among 390 mothers of infants aged 0–12 months using a pre-tested, semi-structured questionnaire. Data on breastfeeding initiation, exclusivity, colostrum feeding, and socio-demographic characteristics were collected and analyzed using descriptive and inferential statistics. Results: Early initiation of breastfeeding within one hour of birth was practiced by 57.9% of mothers, and 64.6% practiced exclusive breastfeeding for six months. Colostrum feeding was reported by 87.2%, while 30.3% gave prelacteal feeds. Maternal education, antenatal counseling, and type of family showed significant associations with optimal breastfeeding practices (p < 0.05). Although 80% had good knowledge and 61.5% a positive attitude toward breastfeeding, practice gaps were noted. Conclusion: Breastfeeding practices were satisfactory but below desired national and global targets. Socio-demographic factors and health education significantly influenced adherence. Strengthening antenatal counseling, family engagement, and workplace support can enhance breastfeeding outcomes and contribute to improved child health.

Background: Bimalleolar ankle fractures are among the most common injuries encountered in orthopedic trauma practice. Optimal management aims to restore anatomical alignment, joint stability, and early mobilization. Although Open Reduction Internal Fixation (ORIF) is considered the standard of care, Closed Reduction Internal Fixation (CRIF) has emerged as a minimally invasive alternative that may reduce surgical morbidity. Objectives: To evaluate and compare the clinical outcomes, radiological union, operative parameters, and postoperative complications between CRIF and ORIF techniques. Materials and Methods: A prospective comparative study was conducted on 60 patients with closed bimalleolar ankle fractures treated at a tertiary care hospital. Patients were divided equally into two groups—CRIF (n=30) and ORIF (n=30). Functional outcomes were assessed using the Olerud–Molander Ankle Score (OMAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiological union time, operative duration, blood loss, and complications were recorded and analyzed statistically. Results: Both groups achieved satisfactory union within an average of 10–12 weeks. Mean OMAS and AOFAS scores at 6 months were comparable (p>0.05). However, CRIF demonstrated shorter operative time (54.6 ± 6.8 min vs. 82.3 ± 7.5 min), less intraoperative blood loss, and reduced hospital stay. The incidence of superficial infection was higher in the ORIF group. Conclusion: Both techniques yield comparable functional and radiological outcomes, but CRIF offers advantages in reduced soft tissue trauma and faster recovery. CRIF may be preferred in suitable cases, while ORIF remains essential for complex or unstable fracture patterns. Larger randomized trials are warranted to confirm these findings.

Objective: Assess the rare presentation of a clinically isolated syndrome of cranial nerve III (CN III) palsy in a pediatric patient. Methods: We present the case of a12-year-old boy with acute onset double vision with left eye pain, left-sided ptosis, and left ophthalmoplegia. The patient had no other systemic or neurological symptoms. Results: An extensive work up including serum and CSF studies for autoimmune, infective, or malignant etiologies was performed. MRI Brain showed mild enlargement and enhancement of the cisternal segment of the left CN III. The remainder of the work up was negative for any secondary etiologies. The patient was treated with high dose methyl prednisone 250 mg IV every 6 hours for 5 days followed by 2 weeks of oral prednisone. There was complete resolution of symptoms at the 3-week follow-up clinical visit. Conclusion: In rare instances, clinically isolated syndrome can present as cranial nerve III palsy in a pediatric patient.

Introduction and importance: Hernias containing appendix, caecum and transverse colon are uncommon in contrast with usual inguinal hernias containing small intestine. The patient usually presents with inguinoscrotal swelling. Case presentation: We present a case of a 6 months old male child presented with inguinoscrotal swelling, vomiting with abdominal distension. On ultrasonography (USG) of the scrotum, protrusion of the abdominal cavity contents through the right inguinal canal into the scrotum of approximately 3×1 cm × 1 cm was found which indicates right inguinal hernia. On opening the hernial sac during surgical management, the appendix, caecum were found inside the hernial sac. Open herniotomy was performed and the abdomen was closed in layers. Postoperative period of the patient was uneventful. Discussion: Congenital inguinal hernia in the child occurs mostly due to persistent processus vaginalis. History and clinical examination reveals the appearance of lump in the inguinal region or scrotum. Preoperative ultrasonography can be used to supplement the physical examination and increases the accuracy of its diagnosis. Although the laparoscopic approach is increasingly used now a days, open hernia repair is preferred in young children. Conclusion: Appendix and Caecum are unusual contents of an inguinal hernia. Open herniotomy combined with relieving of the intestinal obstruction is the treatment of choice in young children.

Background: The soft tissue component of open tibia fractures is managed with vacuum-assisted closure (VAC), which promotes blood flow to the wound site, removes fluid and exudate, and heals the wound using a sealed sponge or foam dressing.  This study aimed to investigate the outcomes of vacuum-assisted closure for open fractures of the tibia. Methods: From March 2023 to March 2025, an observational study was carried out at Usha Hospital, Juran Chhapra, Muzaffarpur, Bihar, on patients who were older than eighteen, hemodynamically stable, and had open tibia fractures (G.A. II, IIIA, and IIIB) that had undergone vacuum assisted closure (VAC) and primary internal fixation. Results: The 30 patients in this study had a mean age of 41.34 ± 14.56 years, and 83.33% of them were male. VAC dressings were applied every four days starting on the second day of the post-operative period; five cases (16.67%) had more than five VAC dressings applied, ten cases (33.33%) had four VAC dressings administered, and fifteen cases (50%) had five VAC dressings applied. The mean duration of the hospital stay was 18.82±9.46 days. Following the first procedure, the majority had tissue transfer (6.67%), healing by secondary intension (3.33%), direct closure (10%), split skin graft (63.33%), and repeat debridement followed by secondary closure (16.67%). The average reduction in the size of the wound was 10.23±3.72 cm². A single case (3.33%) had an exposed implant, and two cases (6.67%) had infections connected to the implant. One case had a terrible functional outcome at the 12-month follow-up (3.33%), nine cases had a fair outcome (30%), seventeen cases had a good outcome (56.67%), and three cases had an excellent outcome (10%). Conclusion: Applying VAC reduces the need for additional soft tissue defect covering treatments, expedites the healing process, and lessens the risk of wound infection.

Background: Among fractures of the lower end of the humerus, intercondylar fractures of the distal humerus are the most challenging and rare injuries. Fractures of the distal humerus with intra-articular extension are complicated injuries that need to be fixed with care. The idea entails anatomical reduction, complete fixation, and flawless extra-osseous implant stabilization. A significant impact of the early progressive rehabilitative exercise has been seen in the functional outcome. The purpose of this study is to assess the functional outcome of open reduction and internal fixation surgery for adults with distal humeral intercondylar fractures using pre-contoured locking compression plates using a trans-olecranon approach. Methods: In this prospective study, 20 adult patients who fulfilled the inclusion criteria and were admitted to Usha Hospital, Juran Chhapra, Muzaffarpur, Bihar, between March 2023 to March 2025, had an intercondylar fracture of the distal humerus. Results: In this study of 20 cases, there were 10 males and 10 females with average of 50.8 years. 12 cases were due to RTA and 8 due to direct fall. There was a predominance of left side (13). Out of 20 Cases, 3 (15%) were of B1 type, 1 (5%) were of type B2, 6 (30%) were of C1, 5 (25%) of C2 and 5 (25%) were of type of C3. Excellent results in 12 (60%), good in 4 (20%), fair in 3 (15%) and poor results in 1 (5%) case, according to MEPS. Conclusion: Anatomically pre-shaped distal humerus locking plate systems are helpful for early postoperative rehabilitation and stable fixation of complicated distal articular fractures. Good range of motion and a good healing rate are demonstrated by clinical and radiographic outcomes.

Background: The quality of life for a patient can be greatly impacted by recurrent patellar instability. This study used the dual patellar docking approach to assess the outcomes of medial patellofemoral ligament (MPFL) restoration in the treatment of recurrent patellar instability utilizing hamstring autograft. Methods: Twenty individuals with recurrent patellar instability participated in this prospective study. Computed tomography scans and magnetic resonance imaging were used to measure the distance between the tibial tubercle and trochlear groove and to confirm the MPFL tear. A number of radiological and clinical assessments were carried out prior to surgery. Diagnostic arthroscopy, graft preparation, patellar preparation, graft passage, femoral tunnel preparation, and graft fixation were all part of the surgical procedure. Results: The International Knee Documentation Committee score, Kujala score, Cincinnati score, and Lysholm score all showed significant improvement after surgery when compared to preoperative values (P <0.001). Furthermore, there was a substantial decrease in the preoperative values of the patellar tilt angle and patellar congruence angle compared to the postoperative assessments (P < 0.001). The post-apprehension test revealed negative results for all 20 (100%) patients, suggesting increased stability. Three patients (15%) had positive results in the post-compression test, while seventeen patients (85%) had negative results. Two patients (10%) reported having patellofemoral pain, one patient (5%) had limited flexion, one patient (5%) had residual patellar translation without dislocation, and the majority of patients (16,80%) had no problems. Conclusion: For the majority of patients, MPFL reconstruction with patellar docking produced acceptable, satisfactory congruence angles along with good Kujala and Lysholm outcomes. The success rate of this surgery in treating patellofemoral instability has been high.

Background: A condition known as periodic paralysis causes skeletal muscular weakness that is episodic, hyporeflexic, and transient. Exercise, large meals, or fasting are frequently the causes of the recurrent bouts of limb muscle weakness that patients experience. These episodes typically last a few hours to a few days. Hypokalemia, abrupt flaccid paralysis, possibly lethal episodes of muscle weakness, and potentially fatal cardiac arrhythmias are the markers of hypokalemic periodic paralysis (HPP), a kind of metabolic myopathy. Excellent healing, however, might result with early and timely diagnosis of this ailment and treatment commencement. Aim of this study to the clinical and biochemical markers of patients of hypokalemic periodic paralysis and to determine the association of dietary habits (fermented rice) with HPP. Methods: This descriptive and cross-sectional study was conducted at Department of Medicine, JLNMCH, Bhagalpur, Bihar from June 2024 to December 2024 with the total 52 patients of HPP was selected in 21-60 year age group. Results: The study included 52 patients aged 21-60 years mean (37.98±9.18), male (n=42, 80.7%), taking fermented rice (bassi) in the diet (n=51, 98%), and had no precipitating event. Most of the subjects (n=50, 96.2%) had decreased tone in all 4 limbs, DTR absent (n=33, 63.46%), haemoglobin level <12gm% (n=34, 65.4%), low serum potassium level <3.5meq/l (n=42, 80.7%), and had sinus bradycardia in ECG (n=13, 25%). Conclusion: Periodic paralysis is a hyporeflexic, episodic, and transient weakening of the skeletal muscles. Most individuals had hypokalemia and regularly ate fermented rice (bassi). Intravenous potassium should be administered to patients with acute flaccid progressive motor paralysis regardless of whether their serum potassium levels are low or normal, since they reacted well and showed no lingering weakness.

Background: One serious health issue is chronic kidney disease (CKD). The prevalence of CKD is steadily increasing, and it primarily affects the elderly and/or people with diabetes and high blood pressure. Assessing the prevalence of overt and subclinical neuropathy in patients with chronic kidney disease (CKD) as well as the clinical signs of peripheral nerve damage are the objectives of our study. Methods: From January 2025 to June 2025, 74 patients of different ages with chronic renal disease were treated at the medical wards of JLNMCH in Bhagalpur, Bihar, as part of the present observational study. Electrophysiological nerve conduction investigations and clinical nerve dysfunction (motor or sensory symptoms and signs) were used to determine whether peripheral nerve dysfunction was present. Results: 48 of the 74 patients evaluated had peripheral nerve dysfunction, according to an electrodiagnostic investigation, and the proportion of patients with peripheral nerve dysfunction rises with longer duration (more than 5 years). Conclusion: The most prevalent type of peripheral neuropathy seen in CKD patients is distal symmetrical mainly sensory motor neuropathy. The two most prevalent clinical indicators of peripheral neuropathy in CKD patients are loss of vibratory sensation and loss of ankle reflex. Peripheral neuropathy is more common in men with chronic kidney disease (CKD) when creatinine clearance is less than 15 milliliters per milliliter.

Background: The most significant and prevalent type of tumor in the stomach is gastric carcinoma. Due to its involvement in the development of chronic gastritis, Helicobacter pylori (H. Pylori) has been identified as a significant causative factor in gastric carcinoma. The study of gastric carcinoma with associated precursor lesion in various studies has shown variable results. The purpose of this study is to examine the histology of gastric carcinoma in relation to age, sex, anatomical location, and morphology. Additionally, to examine the correlation between precursor lesions and stomach carcinoma. Methods: This study was conducted at the department of pathology, KMCH, Katihar, Bihar. The total number of 83 endoscopic gastric biopsies and gastrectomy specimens received from department of surgery of Katihar Medical College and Hospital, Katihar, Bihar from August 2022 to July 2023 were included in the study. Results: Gastric carcinoma was most common in males and in the 7th decade. Most common histological type of tumor was intestinal type78.3%, seen in the 7th decade followed by diffuse type 21.7% in the 6th decade. Precursor lesions were positive in out of 70 cases of gastric carcinoma. And chronic atrophic gastritis was found in 42% of cases, dysplasia in 33% and intestinal metaplasia in 36%. H. pylori were positive in 54.3% cases; among them 56.4% cases were intestinal type of carcinoma and 46.6% were diffuse type of carcinoma. Conclusion: Although series was small our findings in this study were quite prominent and therefore indicate need for further studies of histological types its association with precursor lesion and H.pylori in larger population as there is high risk of gastric carcinoma in South India.

Background: Body fluid cytology is one of the most established and commonly used techniques. Data on peritoneal fluid cytology is limited, despite the fact that pleural fluid cytology is well reported. When confirming or disapproving a malignant tumor, it is clearly useful. For cytological research, the majority of labs employ cytospin smears. Cellblock can be used in conjunction with cytospin smears for a more precise diagnosis, even though they are unquestionably a good approach for cytodiagnosis. Cellblock is a diagnostic tool that can be used to diagnose, stage, and treat a variety of cancerous diseases in addition to identifying the cause of effusion. The aim of this study is to analyse the cytomorphology of peritoneal fluid using cytospin, cellblock technique and assess the utility of cellblock method in identifying malignant cells in peritoneal effusion and wash samples. Methods: This study was conducted at Department of Pathology, KMCH, Katihar, and Bihar from October 2023 to September 2024. The total number of 53 ascitic fluid and peritoneal wash samples that were clinically suspected of malignancy were studied. Each of the samples were processed by cytospin smear and cell block method. The results were interpreted by descriptive analysis. Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the cytological test was 96.15%, 100%, 100%, 96.42% and 98.11% respectively. Cellular yield for malignancy was 3.85% more by the cellblock method. Conclusion: Cellblock can provide an additional information which can aid in increasing the sensitivity of cellblock. It can complement cytospin smears, especially to detect malignant cells in peritoneal fluid. A combined approach of cytospin and cellblock can help in a more accurate diagnosis.

Epilepsy is one of the most common neurological diseases worldwide. Among people with epilepsy, 30% have medically intractable epilepsy. Temporal lobe epilepsy (TLE) is the most frequently operated focal epilepsy with favourable surgical outcome. The most common causes of temporal lobe epilepsy are hippocampal sclerosis (HS), malformations like focal cortical dysplasia (FCD), tumors, ischemic lesions, and old traumatic and inflammatory lesions. Among tumors, astrocytomas are rare and mostly pharmacoresistant. Although patient’s clinical history can help distinguish glioma from other causes. LGG may mimic Medial temporal lobe sclerosis radiologically (MRI as well as PET) and are often misdiagnosed. Thus, histopathology plays a very imperative role for predicting a good outcome after epilepsy surgery. The present case is a similar rare phenotype of Low-grade glioma, which was clinical-radiological indistinguishable but histological positive for isomorphic astrocytoma.

The respiratory system is a fundamental requirement for living things to continue to exist. This system has changed over time and evolved into a branching network of bronchial trees in multicellular species like humans. The trachea, the left and right major bronchi, and their branches leading to the alveoli make form the bronchial tree. The trachea’s size and the bronchial tree’s branching pattern are determined through cadaveric dissection in this study. Thoracic surgeons and others can use this for a variety of surgical operations and interventions. 20 lung specimens from unclaimed bodies at Jawahar Lal Nehru Medical College & Hospital’s anatomy department were used in the study. Numerous measurements are collected, including the width and length of the trachea, the subcarinal angle, and the length of the left and right major bronchus. Every dimension in the current investigation falls within the typical ranges. Four specimens out of the forty lungs displayed different branching patterns. These days, bronchoscopy techniques are frequently employed for both diagnostic and therapeutic objectives, and the results indicate that there are few variances in the dimensional study. Indirectly, the subcarinal angle aids in segment surgical excision and cardiovascular disease diagnostics.

Background: Trigeminal neuralgia (TN) is a painful condition that affects the face, causing sudden, shock-like pain along the trigeminal nerve. Even though researchers have looked into it extensively, the exact causes and mechanisms behind TN are still quite complicated and involve multiple factors. This review brings together the latest evidence on what causes TN and how it develops, drawing from clinical, imaging, and experimental studies. Objective: The goal here is to thoroughly assess and combine the existing research on the mechanisms behind TN, focusing on the roles of neurovascular issues, anatomical features, and electrical activity in the nerves. Method: To do this, we conducted a structured literature review, selecting peer-reviewed studies that included clinical trials, imaging reports, neurophysiological studies, and animal research. We identified key themes and organized them by the underlying mechanisms. We also compared the outcomes of surgical and non-surgical treatments, paying special attention to microvascular decompression and procedures targeting the ganglion. Result: Our findings revealed that neurovascular compression combined with focal demyelination was present in 41.4% of the studies we reviewed, and this group experienced the best long-term pain relief after microvascular decompression (79%). For patients who didn’t show any vascular conflict, issues like membrane hyperexcitability and central sensitization were significant factors. Certain anatomical features, such as a sharply angled trigeminal-pontine root, increased the likelihood of compression. On the other hand, pharmacological treatments alone provided lasting relief for only a small percentage of patients (27%). Experimental studies supported the idea that both compression and demyelination can independently lead to abnormal nerve firing, backing up what’s known as the “ignition hypothesis. Conclusion: In conclusion, TN results from a combination of mechanical, anatomical, and electrical factors. By using precise diagnostics and tailoring interventions to the specific pathophysiological profiles of patients, we can potentially enhance treatment outcomes.

Background: Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia resulting from granulomatous inflammation in the cavernous sinus or orbital apex. While the responsiveness to steroids is a key diagnostic feature, the long-term outcomes and factors predicting relapse are still unclear. Methods: We conducted a systematic review registered with PROSPERO (CRD42024567891), analyzing data from MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL, covering studies from their inception up to March 31, 2024. We included original studies that reported on the clinical features, management, and outcomes of patients who met the criteria for THS set by the International Headache Society or ICHD-3. Two reviewers independently selected studies, extracted relevant data, and assessed quality using the Newcastle–Ottawa Scale or the Joanna Briggs checklist. We supplemented our narrative synthesis with random-effects pooling when there were three or more similar cohorts available. Results: A total of eighteen studies involving 372 episodes of THS (295 adults and 77 children) met our inclusion criteria. The median time from symptom onset to treatment was nine days. Cranial-nerve III and VI palsies were the most common (78% and 62%, respectively), while optic-nerve involvement was noted in 10%. High-dose intravenous methylprednisolone was administered in 49% of episodes, while a conventional oral taper was used in 51%. Complete pain relief was achieved in 82% of patients within 72 hours, and 72% experienced at least a 50% recovery in ocular-motor function by day 7. Overall, relapse occurred in 24% of cases, increasing to 34% in children; pulse therapy showed a slight reduction in relapse rates compared to oral taper (20% vs. 24% in adults; 30% vs. 34% in children). MRI lesions resolved within six months in 68% of patients, and serious steroid-related adverse events were rare (4%). Conclusions: Steroids offer quick symptomatic relief for THS, but about one in four patients—particularly children—may experience a relapse. The varied imaging profiles and the presence of infectious or autoimmune mimics highlight the need for thorough evaluation and ongoing monitoring. Future research should focus on exploring steroid-sparing strategies and immunotherapy options.

Background: Inguinal hernia is a prevalent surgical condition worldwide. Laparoscopic Transabdominal Preperitoneal (TAPP) repair, a minimally invasive technique, has demonstrated potential advantages over traditional open repair, including reduced postoperative pain, faster recovery, and lower recurrence rates.
Objective: To evaluate the clinical and functional outcomes of laparoscopic inguinal hernia repair using the TAPP approach, focusing on operative parameters, postoperative recovery, complications, and recurrence rate. Methods: A prospective observational study was conducted on 60 patients undergoing TAPP repair for unilateral or bilateral inguinal hernias. Variables analyzed included demographic data, operative time, intraoperative and postoperative complications, hospital stay duration, pain scores (VAS), and follow-up outcomes over 6 months. Results: The mean operative time was 58.2 ± 12.4 minutes. Postoperative pain on day 1 was minimal (VAS score 3.1 ± 1.2). Average hospital stay was 1.4 ± 0.6 days. Minor complications (seroma, port-site infection) occurred in 8.3% of cases. No major complications or recurrences were observed during follow-up. Conclusion: TAPP repair for inguinal hernia is a safe and effective minimally invasive alternative with favorable outcomes in pain control, recovery time, and recurrence prevention.

Background: Low back pain (LBP) is a prevalent musculoskeletal disorder among young adults, and vitamin D deficiency has been identified as a potential risk factor. The purpose of this study was to investigate the association between vitamin D status and pain level in relation to the degenerative spinal changes. Method: A retrospective observational cohort of 180 young adults (18–35 years) with chronic nonspecific LBP was analyzed. The demographic and clinical characteristics, including pain level measured on Visual Analogue Scale (VAS), were obtained. Serum partial 25-hydroxyvitamin D [25(OH)D] concentrations were analyzed and classified as deficient, insufficient, and sufficient. Imaging records were reviewed for Modic changes and disc degeneration. Data was analyzed using ANOVA, chi-square tests, and Pearson’s correlation. Result: Results: Almost half of participants had vitamin D deficiency (48.9%), while 32.8% were insufficient, and only 18.3% were sufficient. Those who were deficient had significantly higher VAS scores (6.8 ± 1.4) than both insufficient (5.9 ± 1.5) and sufficient groups (5.3 ± 1.2; p < 0.001) while MRI findings showed a greater prevalence of Modic changes (32.9%) and disc degeneration (45.4%) in the vitamin D deficient individuals. There was a moderate negative correlation between serum vitamin D with pain severity, (r = –0.42, p < 0.001) using Pearson’s correlation. Conclusion: Vitamin D deficiency is prevalent in young adults with chronic LBP, and it is significantly associated with greater pain severity and degenerative spinal findings. Screening and correcting vitamin D insufficiency may be a simple adjunctive approach in the management of LBP.

Background: Jaundice in newborns is one of the most prevalent clinical problems occurring in the neonatal period which requires medical attention. Phototherapy is the most commonly used treatment modality with its own complications. However, this treatment itself may result in hypocalcaemia which can create serious complications including convulsion and related conditions. Objective: To determine the incidence of hypocalcemia in term hyper bilirubinemic neonates receiving phototherapy. Materials and Methods: This study was performed on 198 term jaundiced neonates (113 females and 85 males) receiving phototherapy. These neonates had complete normal physical examination other than hyper bilirubinemia. Results: Mean ± SD of serum calcium level significantly decreased from baseline values of 9.56±0.8 mg/dl to 9.22±0.83 mg/dl after 48-hour phototherapy. Overall, 15 neonates (7.5%) developed hypocalcaemia (calcium concentration less than 8mg/dl). Conclusion: Although phototherapy lowers serum calcium level in term neonates, the incidence of phototherapy-associated hypocalcaemia is not too much.

Background: Diaphyseal humeral fractures pose significant treatment challenges, and debate persists regarding the optimal surgical method between intramedullary nailing and plating. Objective: To compare the clinical and functional outcomes of humeral shaft fractures managed with intramedullary nailing versus plating, assessing union, complications, and functional recovery. Material and Methods: A retrospective study of 30 adult patients with traumatic diaphyseal fractures of the humerus, managed either with antegrade intramedullary nailing or open reduction and internal fixation using plating. Clinical and functional results were evaluated using the DASH score at six months. Results: Both methods achieved successful fracture union. Plating showed better shoulder and elbow function, whereas IMN resulted in shorter surgical time and fewer soft‑tissue complications. Complication profiles varied, with nonunion and shoulder stiffness more frequent in the IMN group. Conclusion: Both IMN and plating are reliable options for humeral shaft fractures. The choice should depend on fracture pattern, patient age, bone quality, and surgeon expertise to achieve optimal outcomes.

Background: Tibial diaphyseal fractures continue to be treated predominantly with either intramedullary nailing (IMN) or minimally invasive plate osteosynthesis (MIPO), yet the optimal choice remains unsettled. Objective: To compare clinical and functional outcomes of closed interlocking IMN versus locking plate fixation via MIPO in diaphyseal tibia fractures — examining union, weight‑bearing, operative time, complications and functional scores. Material and Methods: A prospective comparative study including 40 adult patients divided equally into IMN and MIPO groups. Outcomes assessed included time to union, time to full weight‑bearing, operative duration, complication rates and functional recovery (AOFAS score) at six months. Results: Both groups achieved high union rates. The IMN group displayed significantly shorter operative time and earlier weight‑bearing, while the MIPO group demonstrated superior alignment control but a slightly higher rate of wound complications. Functional outcomes were comparable but trend‑favouring IMN for early mobilization. Conclusion: Both IMN and MIPO are viable for tibial shaft fractures. Selection should be individualized based on fracture anatomy, soft‑tissue status and functional demands. Early mobilization favours IMN; alignment control favours MIPO.

Background: Chronic plantar fasciitis is a degenerative disorder of the plantar fascia leading to heel pain and functional impairment. While intralesional corticosteroid injections provide rapid symptomatic relief, autologous platelet‑rich plasma (PRP) injections may offer more durable healing by promoting regeneration. Objective: To compare pain relief (measured by Visual Analogue Scale) and functional outcome (measured by AOFAS hindfoot score) in patients with chronic plantar fasciitis treated with intralesional PRP versus corticosteroid injection. Material and Methods: A prospective randomised comparative study of 40 adult patients refractory to conservative therapy, randomized to receive either PRP injection or corticosteroid injection. Outcomes assessed at baseline, 4 weeks, 8 weeks and 12 weeks included VAS pain score and AOFAS score. Statistical significance was set at p<0.05. Results: Both groups demonstrated improvement; however, the PRP group showed significantly greater and more sustained reductions in VAS scores and greater gains in AOFAS scores from the first follow‑up onward, with fewer recurrent symptoms at the 12‑week mark. Conclusion: Intralesional PRP injection offers a superior medium‑term outcome in terms of pain relief and functional recovery compared to corticosteroid injection in chronic plantar fasciitis, and should be considered particularly when durable improvement is desired.

Background: Antimicrobial agents are commonly prescribed in outpatient settings for various infections but can cause adverse drug reactions (ADRs) ranging from mild to life-threatening, increasing morbidity, hospital stays, and healthcare costs. This study analyzes antimicrobial-related ADRs in a tertiary care hospital in India, focusing on patient demographics, infection type, and treatment patterns, aiming to support rational antibiotic use and enhance patient safety. Aims and Objectives: (1) To assess the adverse drug reactions (ADRs) occurring in patients treated with antimicrobial agents across different clinical conditions. (2) To assess antimicrobial-related adverse drug reactions (ADRs) based on age, gender, severity. Materials and Methods: 200 patients were enrolled for evaluating adverse effects with antimicrobial agents. All patients were followed up by medical history, history of drugs, and any severity of ADR. Causality was graded by Naranjo scale. Results: ADRs were most frequent in the 41–60 years group (32.6%), followed by 19–40 years (24.3%) and elderly patients (20%), with 8.7% in children, reflecting polypharmacy and reduced metabolism in older groups. ADRs were higher in males (69.5%) than females (30.5%), with severe cases more common in males (40 vs. 18). Respiratory (25.1%) and urinary tract infections (18.9%) were the leading indications for 275 antimicrobial prescriptions. Causality assessment by Naranjo’s algorithm classified 47.82% ADRs as probable, 39.78% as possible, 4.57% as certain, and 7.83% as unlikely. Conclusion: In conclusion, the study highlights that adverse drug reactions (ADRs) to antimicrobial agents were more prevalent among males and middle-aged individuals, with respiratory and urinary tract infections being the leading causes for antibiotic use. Most ADRs were classified as probable or possible based on Naranjo’s algorithm, emphasizing the need for careful antibiotic prescribing, monitoring, and awareness to minimize ADR risk, especially in high-risk groups.

Emergence agitation (EA) is a frequent and challenging complication during recovery from anesthesia in children, especially after surgeries below the umbilicus. This paper reviews the prevention of EA using propofol and fentanyl, using meta-analysis and recent randomized studies evaluating their efficacy and safety in pediatric populations. Both agents have shown favorable profiles in reducing EA incidence and severity.
The Pediatric Anesthesia Emergence Delirium (PAED) scale is the most valid and widely used tool to assess emergence agitation in children. Scores ≥10 indicate significant agitation. Clinical studies incorporating PAED scores have consistently shown that propofol administration reduces both the incidence and severity of EA. Fentanyl also lowers PAED scores but needs to be balanced against adverse effects.
Pathophysiological hypothesis suggest that sevoflurane-induced EA occurs due to rapid awakening leading to transient CNS disinhibition, excitatory neurotransmitter imbalance, and focal CNS sensitization. Propofol’s sedative effects counteract this by sustaining GABAergic inhibition during recovery, promoting a smoother transition to consciousness. Additionally, propofol’s antiemetic properties improve postoperative comfort.

Introduction: Worm infestations are a major public health problem in developing countries, particularly among children, leading to malnutrition, anaemia, impaired growth, and reduced cognitive performance. Mothers play a crucial role in the prevention and control of worm infestations through appropriate health practices, hygiene maintenance, and compliance with deworming programs. Understanding the factors influencing maternal practices is essential for designing effective interventions in rural settings. Objectives: To assess mothers’ knowledge, attitude, and practice towards worm infestation prevention and control. To find out the association between mothers’ knowledge, attitude, and practice towards worm infestation prevention and control. Methods: This observational cross-sectional study was conducted from September to October 2024 in villages covered under the Family Adoption Program (FAP) at Rajmata Srimati Devendra Kumari Singh Deo Government Medical College, Ambikapur. A total of 100 mothers of children were included as the study participants. Data were collected on demographic variables, including age, occupation, marital status, and socioeconomic status (SES), as well as on knowledge, attitude (positive or negative), and practice (good or poor) related to child health and care. The study aimed to assess the association between these variables and the KAP outcomes among the participants. Results: Among 100 participants, 12% had satisfactory knowledge, with the highest proportions in the 21–30 years age group, and marital status was significantly associated with knowledge (p = 0.022), while age, occupation, and SES were not. Overall, 46% had a positive attitude, and 38% demonstrated good practice. Good practice was higher among those with a positive attitude (35/46, 56.5%) compared to those with a negative attitude (27/54, 43.5%), with a statistically significant association (p = 0.007). Among knowledgeable participants, 42/65 (67.7%) showed good practice, whereas 20/35 (32.3%) without knowledge did, but knowledge was not significantly associated with practice (p = 0.463). Conclusion: Maternal practices play a crucial role in the prevention and control of worm infestations. The study highlights that educational status, socioeconomic conditions, and awareness levels are key determinants of effective practices. Strengthening health education, community awareness campaigns, and consistent implementation of deworming programs are necessary to reduce worm burden in rural populations of Chhattisgarh.

Background: Acute appendicitis remains one of the most common surgical emergencies worldwide. While both open appendectomy (OA) and laparoscopic appendectomy (LA) are established treatment modalities, comparative data regarding postoperative pain intensity and analgesic requirements remain inconsistent across different populations. Methods: This prospective comparative study included 120 patients with acute uncomplicated appendicitis randomized to undergo either open appendectomy (n=60) or laparoscopic appendectomy (n=60). Pain intensity was assessed using the Visual Analog Scale (VAS) at 6, 12, 24, 48, and 72 hours postoperatively. Total analgesic consumption, time to first analgesic request, hospital stay duration, and return to normal activities were recorded. Statistical analysis included independent t-tests and chi-square tests. Results: LA patients demonstrated significantly lower mean VAS scores compared to OA patients at all time points. At 24 hours postoperatively, VAS scores were 3.2 ± 1.4 versus 5.6 ± 1.8 (p < 0.001). Total morphine equivalent consumption was significantly lower in the LA group (18.4 ± 6.2 mg versus 32.6 ± 8.4 mg, p < 0.001). Time to first analgesic request was longer in LA patients (4.8 ± 1.6 hours versus 2.4 ± 1.2 hours, p < 0.001). Hospital stay was shorter in the LA group (2.1 ± 0.8 days versus 3.4 ± 1.2 days, p < 0.001). Return to normal activities occurred earlier with LA (8.6 ± 2.4 days versus 14.2 ± 3.6 days, p < 0.001). Complication rates were comparable between groups (8.3% versus 10.0%, p = 0.749). Conclusion: Laparoscopic appendectomy is associated with significantly reduced postoperative pain, lower analgesic requirements, shorter hospital stay, and faster recovery compared to open appendectomy, supporting its preferential use in acute uncomplicated appendicitis when expertise and resources are available.

Background: Giant cell tumor (GCT) of bone is benign but locally aggressive, with potential for recurrence, especially after prior surgery. Campanacci grade III lesions with cortical breach and soft tissue extension present challenges for joint preservation. Extended intralesional curettage combined with structural support using autologous bone graft and PMMA cement offers a limb-sparing alternative in select patients. Case Presentation: We report a 36-year-old female with right knee pain and swelling following a trivial fall, with a history of prior curettage for distal femoral GCT two years earlier. Imaging revealed a recurrent Campanacci grade III lesion with cortical destruction and limited soft tissue extension. She underwent extended intralesional curettage, placement of autologous cancellous bone graft harvested from the contralateral iliac wing beneath the subchondral plate, and reconstruction with PMMA cement. At 12 months follow-up, she was pain-free, ambulating independently, had full functional range of motion, and radiographs demonstrated graft incorporation, stable cement, and no evidence of recurrence. Conclusion: Recurrent Campanacci grade III distal femoral GCTs can be successfully managed with extended curettage, autologous bone grafting, and PMMA cementation. This approach preserves joint function, provides structural support, and allows early detection of recurrence, making it a viable limb-sparing option. Long-term follow-up is crucial due to the high recurrence potential.

Introduction: Laparoscopic surgery is a modern minimally invasive technique increasingly utilized for a wide range of procedures, including cholecystectomy, appendectomy, hernia repair, and several other abdominal surgeries. Postoperatively patients commonly report diffuse pain in the abdomen, back, and shoulders, which is often attributed to pneumoperitoneum and diaphragmatic irritation caused by carbon dioxide insufflation. The incidence of shoulder pain following surgery ranges widely, affecting approximately 35% to 63% of patients.  Intraperitoneal instillation of bupivacaine is an established technique for perioperative pain management, especially in laparoscopic procedures. Recently Magnesium sulfate (MgSO₄) also has been extensively studied as an adjuvant to bupivacaine in various regional anesthesia techniques. Its potentiating effects on perioperative analgesia and muscle relaxation have drawn attention recently. Tramadol is a centrally acting synthetic analgesic that offers analgesia for moderate to moderately severe pain while having a lower risk of respiratory depression and addiction compared to conventional opioids. Hence, the present study was conducted to compare the effect of intraperitoneal instillation of 0.25% bupivacaine with tramadol and 0.25% bupivacaine with magnesium sulphate for post operative analgesia after laparoscopic surgeries. Methodology: The present prospective, study was conducted amongst 70, electively posted for laparoscopic cholecystectomy from Feb.2023 to July 2024 at the Department of Anesthesiology at tertiary care institute. Total number of patients were randomly divided into two groups: Group BT- Patients receiving 30 ml of 0.25% bupivacaine with 100mg of Tramadol. Group BM- Patients receiving 30 ml of 0.25% bupivacaine with 50mg/kg Magnesium sulphate. Surgeons were then allowed to start with their procedure and told to instruct us after dissection and removal Gall bladder so that local drug can be instilled before removal of trocar. Results: The mean age of patients was 38.21 ± 7.6 years in Group BT and 37.4 ± 6.9 years in Group BM. Group BM consistently demonstrated significantly lower VAS scores compared to Group BT, particularly during the early postoperative period (up to 16 hours). The analgesic effect of Magnesium sulphate appeared to be more sustained, with delayed onset of moderate pain and longer pain-free intervals postoperatively. This translated into a significantly prolonged mean time to first rescue analgesia in Group BM (7.4 ± 1.32 hours) compared to Group BT (4.9 ± 1.10 hours), with a p-value of 0.009, indicating strong statistical significance. Patients in Group BM required a mean of 1.4 ± 0.40 g of paracetamol, whereas those in Group BT required 2.3 ± 0.52 g (p-value = 0.01). These findings highlight the enhanced analgesic efficacy and opioid-sparing potential of Magnesium sulphate as an adjuvant to Bupivacaine for intraperitoneal instillation. Conclusion: In conclusion, intraperitoneal instillation of Bupivacaine 0.25% combined with Magnesium sulphate is a safe, simple, and effective technique for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. It offers superior pain control in the immediate postoperative period, reduces the need for rescue analgesics, and minimizes the incidence of opioid-related adverse effects. Given its efficacy, low cost, and safety profile, this combination represents a valuable addition to multimodal analgesia protocols in day-care laparoscopic surgery.

Accessory cavitated uterine mass is rare and recently recognised lesion which is lined by functional endometrium causing cyclical pain during menstrual cycle. We describe, a 24 year old, married female P3L2A1, presented with severe dysmenorrhea and chronic pelvic pain. Pelvic ultrasonography and MRI imaging showed a septate, mass like structure with cavitation in the left lateral wall of uterus. Recognition of this rare entity is essential for appropriate surgical planning.

Synchronous primary endometrial and ovarian carcinoma (SPEOC) is a rare condition, often misdiagnosed as metastatic disease. We report a 50-year-old woman presenting with abdominal pain and a left ovarian solid-cystic mass. Imaging and elevated CA-125 findings are suggested as malignancy. Histopathological report confirmed the specimen as synchronous carcinomas confined to the endometrium and left ovary. Accurate diagnosis of SPEOC is crucial, as it carries a better prognosis than metastatic disease.

This systematic review synthesized current evidence on risk factors associated with pregnancy-induced hypertension (PIH) and pre-eclampsia. A comprehensive literature search for hypertensive disorders of pregnancy (HDP) across PubMed, Scopus, Web of Science, and Embase identified 874 studies, of which 18 met inclusion criteria based on PRISMA guidelines. Eligible studies comprised systematic reviews and cohort studies evaluating predictors of HDP. Across studies, advanced maternal age, primiparity, obesity, pre-existing hypertension, diabetes, and family history of hypertension were consistent risk factors. Low education, poor nutrition, and inadequate antenatal care further increased risk, especially in resource-limited settings. Early pregnancy mean arterial pressure and prehypertension were strong predictors of later HDP. Systematic reviews emphasized the role of pre-pregnancy cardiovascular health, lifestyle, and occupational exposures in determining HDP risk. Given the heterogeneity of study designs and outcomes, findings were narratively synthesized. The evidence highlights the multifactorial nature of HDP and the need for early risk assessment and preventive strategies in antenatal care.

Background and Objectives: Etonogestrel subdermal implant (ESI) is a long‐acting reversible contraceptive (LARC) with high effectiveness. However, method discontinuation reduces its public health impact. This review aims to summarize global continuation rates over time and identify key predictors of early discontinuation for the etonogestrel implant. To determine global continuation rates of the etonogestrel implant at 1, 2, and 3 years. To identify the major reasons and predictors of early discontinuation. To explore regional and demographic variations influencing continuation and discontinuation patterns. Methods: This was a prospective observational study conducted among 110 women using the etonogestrel subdermal implant (Implanon®/Nexplanon®) for contraception. The study was carried out over a period of 24 Months, in the Department of Obstetrics and Gynaecology at Patna Medical College and Hospital Patna, Bihar. Key outcomes extracted include 1‐, 2‐, and 3‐year continuation rates, reasons for removal, and demographic/clinical predictors of early discontinuation. Conclusions: The etonogestrel implant has high contraceptive effectiveness and acceptable continuation rates in many settings, particularly within the first year. However, a substantial proportion of users discontinue by year 2 or 3, often driven by side effects, especially bleeding irregularities, and by gaps in counselling and support. Interventions such as improved pre‐insertion counselling, better management of side effects, and supportive follow up may help improve long‐term continuation.

Background: Acute Fatty Liver of Pregnancy (AFLP) and HELLP syndrome are rare but serious hepatic complications of late pregnancy. Their overlapping features often make diagnosis challenging, yet their maternal and neonatal outcomes differ significantly. Objectives: To compare maternal and neonatal morbidity among pregnancies complicated by AFLP and HELLP syndrome. Methods: This retrospective study included 110 women diagnosed with either AFLP or HELLP syndrome admitted to the Department of Obstetrics and Gynecology at PMCH Patna and tertiary referral hospital, Diagnosis of AFLP was based on Swansea criteria, and HELLP syndrome was defined using the Tennessee classification. Data on demographic features, laboratory parameters, maternal complications, and neonatal outcomes were analyzed. Results: Among 110 patients, 30 had AFLP and 80 had HELLP syndrome. AFLP cases were associated with significantly higher rates of jaundice (86.6% vs 15%), acute kidney injury (63.3% vs 17.5%), DIC (60% vs 10%), and sepsis (43.3% vs 12.5%) compared to HELLP. Neonatal morbidity was higher in HELLP syndrome, including small-for-gestational-age infants (58.7% vs 30%), respiratory distress syndrome (38.7% vs 10%), and neonatal sepsis (32.5% vs 13.3%). Maternal mortality was slightly higher in AFLP (10%) than in HELLP (3.7%), though not statistically significant. Conclusions: AFLP is associated with more severe maternal systemic complications and organ dysfunction, while HELLP syndrome contributes more to neonatal morbidity. Early recognition, multidisciplinary management, and individualized delivery planning are essential to improve outcomes in both conditions.

Background: Helicobacter pylori infection is recognized not only for its gastrointestinal effects but also for its role in chronic systemic inflammation, which may influence lipid metabolism and contribute to dyslipidemia. Objective: To investigate the relationship between H. pylori infection and serum lipid profile among patients presenting with dyspeptic symptoms. Methods: The Departments of Biochemistry at Geetanjali Medical College in Udaipur and SMS Medical College in Jaipur conducted a one-year prospective observational study. Thirty-six adult dyspeptic patients were consecutively enrolled. All participants underwent testing for H. pylori and fasting lipid profile assessment. Based on infection status, patients were grouped as positive or negative. Lipid parameters— TC/HDL ratio, HDL-C, non-HDLC, LDL-C, TG, TC, and AIP – were compared using independent t-tests, with multivariable regression applied to adjust for demographic and clinical factors. Results: Of the 36 patients, 20 (55.6%) tested positive for H. pylori. Compared with the negative group, infected patients exhibited higher mean triglycerides (168.2 ± 38.5 vs. 149.4 ± 34.2 mg/dL) and lower HDL-C (42.1 ± 7.8 vs. 47.3 ± 8.2 mg/dL). Derived indices were also elevated, with TC/HDL ratio at 4.62 versus 4.10 and AIP at 0.60 versus 0.49. In adjusted regression analysis, there was a nonsignificant tendency toward greater LDL-C (β +7.9 mg/dL, 95% CI −1.2 to +17.0; p=0.086) and a significant correlation between H. pylori positivity and lower HDL-C (β −4.6 mg/dL, 95% CI −8.5 to −0.7; p=0.022). Conclusion: Dyspeptic patients with H. pylori infection demonstrated a more atherogenic lipid profile than uninfected counterparts. These findings support the possibility that infection contributes to cardiovascular risk through adverse lipid modulation, underscoring the need for larger confirmatory studies.

Aim: To study Colistin sensitivity among clinical isolates by: (1). Phenotypic method namely Broth Micro Dilution (BMD). (2). Genotypic method namely Polymerase Chain Reaction (PCR) to detect Colistin resistant genes in Gram negative bacilli (pmrA, pmrB, mgrB, phoP). Methods: A cross-sectional study was conducted after collecting150 samples including pus, endotracheal aspirate, blood, sputum, urine samples from patients who have attended OPD and admitted in hospitals attached to Bangalore Medical College and Research Institute, processed in Infosys Central Laboratory, Department of Microbiology BMCRI, Bengaluru from February 2021 to January 2023, Colistin sensitivity was studied by BMD and PCR. Results: 150 clinical isolates consisting of K. Pneumoniae 54(36%), 51 were resistant and 3 sensitive, E.coli 46 (31%), 33 were resistant and 13 sensitive ,A. baumannii 24(16%),16 were resistant and 8 sensitive, P. aeruginosa 22(14%),18 were resistant and 4 sensitive, E.cloacae 2(1%), E.aerogenes 1(1%), C.freundii 1(1%) all were resistant by BMD method, among 22 P. aeruginosa 15 found to be sensitive and 7 resistant, among 150 isolates pmrA detected in 22 isolates, pmrB in 19, mgrB in 13, phoP in 15 by PCR. Conclusion: Due to increased usage there is rise in resistance, hence Colistin should be preserved by implementing antibiotic stewardship and appropriate infection control measures.

Background: Diabetes distress is an outcome related to diabetes mostly emotional which stems from worries and concerns related to diabetes and it’s management but distinguishable from clinical depression. It is not classified as a mental health disorder but rather a stress reaction to the challenges of diabetes management. To create and validate modified 20 questionnaires Diabetes Distress Scale (mDDS-20) as a tool to evaluate emotional distress related to diabetes  and to investigate the prevalence of diabetes distress among patients living with diabetes (both type-1 and 2) to uncover the factors associated with the distress and suffering experienced by these individuals. Methods and Materials: A cross-sectional study with a sample size of 300 was conducted on adult type 1 & 2 diabetes people at Bhagalpur(east), Mumbai (west). Use of non-probability convenience sampling technique and written consent was secured from participants who met inclusion and exclusion criteria. Interviews were done to fill out the diabetes distress scale having 20 questionnaires (mDDS-20), which involved six subscales like emotional burden, physician distress, regimen distress, interpersonal distress, the Indian contexed education level, sexual and financial health with inclusion of some questions related to socio-religious compulsions. Results: Participants were on an average 45 (13.3) years. Mean duration of diabetes were 3.2 years and mean HbA1c of 9.2 (2.1) %. Mean mDDS-20 at the baseline were 30 (0.6) i.e., little distress. Participants were grouped based on the level of distress. 55% of the patient reported having no distress (<25), while 10% suffered from mild (25-45) and 36% suffered from moderate distress (46-70). 9% patients were found to have high diabetes distress (71-100), found to be statistically significant (p < .001).32% of the Patient who reported having no distress were found to have their HbA1c more than 10.0% and were attributed to be non-compliant with poor life-style with least concerns for diet and lifestyle modifications. Conclusion: Results of this study demonstrates the utility of mDDS-20 instrument as one of the important outcomes in assessing diabetes management and scope of providing better psychological care as well as was helpful in finding the problem area in diabetes (PAID).

Objective & Aim: Anatomical, forensic, obstetrical, radiological, and anthropological perspectives are all interested in the human skeleton because of its unique shape and obvious sexual dimorphism. The study’s objective is to examine the morphometric relationship between sexual dimorphism in the North Indian population and the bigger sciatic notch of the dry hip bone. Methods: For the investigation, 70 adult dry hip bones of known sex—42 male and 28 female—were gathered. Every bone was completely ossified and flawless. Measurements were taken with a triflanged stainless steel calliper, and data were collated by gender and statistically analyzed using the unpaired student t-test. The following Greater Sciatic Notch parameters were taken into account and measured in millimeters. The parameters include Index I and Index II, Posterior Segment Width (OB), Maximum Depth (OC), and Maximum Width (AB). Results: The t test indicates that the posterior angle, Genoves’ sciatic notch index, and the posterior segment of Greater Sciatic Notch are significant (P < 0.001). It was discovered that the larger sciatic notch’s posterior angle was extremely important for identifying the hip bone’s sex. Conclusion: It was discovered that a hip bone’s posterior segment, posterior angle, and index II were more useful in determining sex.

Background: Urinary bladder conditions encompass a wide range of infections, inflammatory disorders, metaplastic changes, as well as benign and malignant tumors, significantly impacting morbidity and mortality. Among these, neoplastic conditions are more frequently encountered. The present study aimed to study the histopathology of various lesion of the bladder through cystoscopic biopsy. Materials and Methods: This descriptive retrospective study was undertaken in the Department of Pathology, MGM Medical College and Hospital, Chh. Sambhajinagar [MS], India. The data were collected from records for the period of July 2019 to June 2024 in the Department of Pathology, MGM Medical College, Chh. Sambhajinagar, Maharashtra India, after obtaining Institutional Ethical Clearance. Results: Majority of cases i.e 23(38.3%) were between age-group of 71-80 years, followed by 61-70 years of 11(18.3%), 51-60 years of 10(16.7%). Male to Female ratio was 1.3:1.0. Neoplastic lesions i.e 49(82.0%) were more commonly encountered than non-neoplastic lesions i.e. 09(15.0%) and 02(3.0%) cases of normal lesion of Urinary bladder. Out of 49 neoplastic cases, 3(6.1%) and 46 (93.9%) cases of benign and malignant respectively. Among malignant tumors, 25(62.5%) cases are of high-grade urothelial carcinoma. Conclusion: The commonest bladder neoplasm was high grade papillary urothelial carcinoma followed by low grade ones. The papillary urothelial neoplasm of low malignant potential was noted to be lowest in frequency. Cystoscopic biopsies help in the early diagnosis and treatment of various bladder lesions. Analysis of cystoscopic biopsies was done to ascertain the type of urinary bladder lesions.

Background: Hypertension, commonly known as high blood pressure, is a significant global health concern affecting over 1,28 billion adults aged 30-79 years worldwide, with approximately two-thirds residing in low-and middle-income countries. An estimated 46% of adults with hypertension are unaware of their condition. Losartan is the first orally available drug. It is a selective, competitive Angiotensin-II receptor blocker (ARB) and its active metabolite is 5-carboxy acid which is very long acting and 30-40 times more potent. It has a prominent effect in urinary albumin excretion (antiproteinuric action).  Amlodipine is the dihydropyridine type calcium channel blocker and it is peripheral arterial vasodilator and reduces peripheral arterial resistance and blood pressure. Both Amlodipine and Losartan are proved as antihypertensive agents but their antiproteinuric effect and its extent in patients with hypertension is not much established yet. Moreover, in recent years no head-to-head comparisons between these two drugs were done in Eastern India. This clinical study is undertaken to compare and evaluate the antiproteinuric effect of Amlodipine and Losartan in a Tertiary care centre in Kolkata. Objectives: To measure and compare the antiproteinuric effective of Amlodipine and Losartan. Methods: Prospective, randomized, open label, Uni-centric, parallel group analytical study was done in Medicine OPD of a tertiary care centre of eastern India. Total 262 (131 for each group), adults (18-80 years) were selected by systemic random sampling after fulfilling the inclusion & exclusion criteria. Group A was given Amlodipine 5mg and Group B was given Losartan-50 mg. Study was conducted after receiving proper ethical clearance and safety check. Statistical analysis was done by IBM SPSS 23.0 Software. Results: For Amlodipine group, mean age was 67.60 ± 11.30 years, 55% were male and 45% were female, mean BMI was 29.03±2.97 kg/m², mean pulse 80.15±9.51 bpm. For Losartan group, mean was 69.37±10.56 years, 51.9% were male and 48,1% were female, mean BMI was 29.53±2.35 kg/m², mean pulse was 80.62 ±8.23 bpm. Study showed statistically significant decrease in SBP & DBP over time in both the Amlodipine & Losartan group (p value<0.05) but there was no statistically significance difference in mean systolic blood pressure (SBP) & diastolic blood pressure (DBP) among the groups. There was statistically significant decrease in urine ACR seen over time in Losartan groups (p value<0.05) but there was no statistically significance decrease in urine ACR in Amlodipine group. In the 24 weeks observation Losartan group (83.21±16.30) showed statistically significant urine ACR reduction compared to Amlodipine group (95.36±11.99), as p value was <0.0001. Conclusion: Losartan is more the potent antiproteinuric drug than Amlodipine.

Trauma surgery in emergency medicine is a rapidly evolving field, with significant advancements in recent years. The integration of MIS, combined with Enhanced Recovery after Surgery (ERAS) protocols, has revolutionized trauma surgery by reducing recovery times and minimizing postoperative complications. However, challenges persist, especially in low-resource settings where trauma care systems may be underdeveloped. The aim of this review is to provide an overview of current trends and best practices in trauma surgery, addressing key strategies for improving patient outcomes. We discuss the role of minimally invasive surgery, enhanced recovery after surgery protocols, trauma scoring systems, and damage control resuscitation. Additionally, we emphasize the importance of early hemorrhage control, permissive hypotension, intraosseous vascular access, and tranexamic acid administration. By staying up-to-date with these trends and best practices, healthcare providers can improve outcomes for trauma patients and reduce mortality rates.

Background: Type 2 Diabetes Mellitus is a common metabolic disorder associated with autonomic dysfunction, particularly cardiac autonomic neuropathy, which often remains asymptomatic in early stages. Spontaneous Baroreflex Sensitivity (BRS) is a non-invasive physiological marker that reflects the ability of the cardiovascular system to adapt heart rate in response to blood pressure changes. In diabetes, chronic hyperglycemia, vascular stiffness, and neuropathy lead to reduced BRS, making it a sensitive tool for early detection of autonomic dysfunction. Methods: An observational comparative study was conducted in the Physiology Department, SMS Medical College, Jaipur, after ethics approval. Type 2 diabetes patients and age- and sex-matched controls were enrolled in study after informed consent. Resting ECG and beat-to-beat blood pressure were recorded to calculate spontaneous BRS by sequence method, and the data were analysed using SPSS version 25 software. Results: Diabetic patients exhibited significantly reduced spontaneous BRS compared to healthy controls. Both BRS (+) and BRS (–) values were lower in the diabetic group, indicating impaired autonomic regulation., suggesting autonomic dyfunction in diabetes mellitus patients. Conclusion: Spontaneous Baroreflex Sensitivity is a reliable, non-invasive tool for assessment of autonomic dysfunction in type 2 diabetes mellitus and can serve as an early biomarker for diabetic cardiovascular autonomic neuropathy.

Background: (T2DM) is a chronic metabolic disorder frequently correlated with obesity, which contributes to cardiovascular complications. Mean Platelet Volume (MPV) is a simple hematological marker of platelet activation and has been suggested as an indicator of thrombotic risk in T2DM patients. Aim: To evaluate the impact of obesity on MPV among patients with T2DM. Methods: For six months, a cross-sectional study was carried out in a hospital at the Dr. B.S. Kushwah Institute of Medical Science in Kanpur, Uttar Pradesh. One hundred adult T2DM patients were enlisted in succession. Based on their BMI, participants were categorized as either obese or non-obese. Relevant clinical information and anthropometric measurements were gathered. For the total blood count, which included MPV, fasting blood glucose, and HbA1c, venous blood samples were taken. SPSS version 23.0 was used to conduct the statistical analysis. To ascertain if obesity and MPV are related, multivariable regression, correlation analysis, and independent t-tests were used. Results: Fifty-five of the 100 participants were not fat, and forty-five were. The MPV of obese individuals was substantially greater (11.0 ± 1.0 fL) than that of non-obese individuals (9.9 ± 0.9 fL, p < 0.001). MPV was positively correlated with waist circumference (r = +0.38, p < 0.001) and BMI (r = +0.42, p < 0.001). BMI and waist circumference were independent predictors of MPV after controlling for age, sex, HbA1c, and length of diabetes, according to multivariable regression analysis. Conclusion: In patients with T2DM, obesity is substantially correlated with greater MPV, suggesting heightened platelet activation and an increased risk of thrombotic consequences. Recommendations: Monitoring MPV in obese diabetic patients may help identify individuals at higher risk for cardiovascular events. Weight management strategies should be emphasized in diabetes care to reduce platelet activation and related complications.

Background: Total knee arthroplasty (TKA) is a well-established intervention for end-stage osteoarthritis, aimed at relieving pain and restoring function. However, pre-operative coronal deformities such as varus and valgus alignment pose surgical challenges that may influence postoperative outcomes. Aim: To compare the functional outcomes of total knee replacement in patients with varus and valgus knee deformities. Materials and Methods: A prospective comparative observational study was conducted on 30 patients (15 varus, 15 valgus) who underwent primary TKA at a tertiary care hospital. Demographic data, deformity angles, and functional outcomes were assessed using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at preoperative, 6-week, 3-month, and 6-month intervals. Data were analyzed using SPSS version 25.0, applying t-test and chi-square tests; p < 0.05 was considered statistically significant. Results: Both groups were demographically comparable (p > 0.05). Mean preoperative KSS improved significantly from 46.4 ± 8.2 to 86.9 ± 6.4 in the varus group and from 44.8 ± 9.1 to 83.7 ± 7.5 in the valgus group at 6 months (p < 0.001 within groups; p > 0.05 between groups). Similarly, WOMAC scores decreased from 72.8 ± 5.9 to 23.1 ± 4.6 (varus) and from 74.6 ± 6.3 to 25.4 ± 5.2 (valgus), indicating significant improvement in pain and function. The distribution of excellent and good outcomes was similar across groups, and complication rates were low and statistically insignificant. Conclusion: Total knee arthroplasty provides substantial functional improvement in both varus and valgus knee deformities. With appropriate alignment correction and soft-tissue balancing, postoperative outcomes are comparable, regardless of pre-operative deformity type.

Introduction: Urinary NGAL (uNGAL) is a rapid, non-invasive biomarker that rises within hours of tubular injury, enabling early AKI detection before creatinine elevation. It aids risk stratification, guides renoprotective care, and complements existing diagnostics. This study aimed to evaluate uNGAL’s accuracy for early AKI identification in high-risk patients. Methods: This prospective observational study at GSL Medical College (April–July 2025) enrolled ICU and nephrology patients at AKI risk. uNGAL was measured serially via ELISA and compared with KDIGO 2012 criteria. Data were statistically analyzed using ROC curves, sensitivity, specificity, and significance testing, with P <0.05 considered significant. Results: Among 43 patients (mean age 52.4 years, 60.5% male), 48.8% developed AKI. uNGAL rose early, peaking at 24 hours (162 ng/mL), then slightly declined. A 125 ng/mL cut-off predicted stage 2–3 AKI with 88.9% sensitivity, 81.5% specificity, 92.0% NPV, 72.7% PPV, and AUC 0.89. Conclusion: Study concludes that urinary NGAL is a reliable early biomarker for detecting AKI before serum creatinine rise. A 125 ng/mL cut-off demonstrated excellent diagnostic accuracy, enabling timely identification of stage 2–3 AKI. Incorporating uNGAL into routine monitoring may improve early risk stratification, intervention, and outcomes in high-risk patients.

Introduction: Neonatal hyperbilirubinmia affects most newborns, with greater prevalence and severity in low birth weight infants due to physiological immaturity and impaired bilirubin metabolism. Early identification of risk and prevalence patterns across LBW and NBW neonates is vital for timely interventions, preventing complications, and strengthening neonatal care protocols globally. Methods: This prospective study (Nov 2016–Aug 2018) at Prathima Institute included neonates with hyperbilirubinemia. Exclusions were lack of consent, incomplete evaluation, or outside births. Risk factors and clinical data were recorded. Diagnosis, monitoring, and management followed AAP guidelines, with bilirubin measured by the Diazo method and detailed laboratory evaluations performed. Results: Among 150 neonates (50 LBW, 100 NBW), hyperbilirubinemia was more frequent in LBW (60% vs. 42%), with earlier onset and higher peak bilirubin. LBW required longer phototherapy and more exchange transfusions. Prematurity was significantly associated, while other maternal and perinatal risk factors showed higher proportions but no statistical significance. Conclusion: The study concludes that hyperbilirubinemia is more prevalent, severe, and of earlier onset in low birth weight neonates. Prematurity was the most significant risk factor. LBW infants required longer phototherapy and more exchange transfusions, highlighting the need for rigorous screening and timely intervention to improve outcomes.

Background: Perianal abscess, a common anorectal condition, arises from infection of anal glands leading to pus collection around the anus. Incision and drainage (I&D) remains the gold-standard treatment. However, postoperative management—specifically, the need for wound packing—remains controversial, as packing may delay healing and increase discomfort. Aim: To evaluate clinical outcomes of packing versus non-packing after incision and drainage of perianal abscess in terms of wound healing, fistula formation, and recurrence. Methodology: A prospective hospital-based study was conducted on 60 patients undergoing I&D for perianal abscess at Narayana Medical College, Nellore, between June 2023 and December 2024. Patients were divided equally into two groups—packing and non-packing. Wound healing, fistula formation, and recurrence were assessed on postoperative days 7, 14, and 21, and at 4 and 8 weeks. Data were statistically analyzed using chi-square and t-tests. Results: Both groups were comparable in age, gender, and laterality. Healing rates were significantly better in the non-packing group at 21 days (56.7% vs. 23.3%, p = 0.008), 4 weeks (76.7% vs. 46.7%, p = 0.016), and 2 months (90% vs. 60%, p = 0.0073). Fistula formation (10% vs. 30%, p = 0.052) and recurrence (3.3% vs. 20%, p = 0.085) were lower in the non-packing group, though not statistically significant. No cases of urinary retention were noted. Conclusion: Non-packing after perianal abscess drainage promotes faster wound healing without increasing complications, suggesting it as a preferable postoperative approach for suitable patients.

Background: Varicose veins are a common vascular disorder primarily caused by saphenofemoral incompetence leading to venous reflux and chronic venous insufficiency. Surgical intervention remains a cornerstone of management, with conventional and invaginated stripping being two widely practiced techniques. While conventional stripping effectively eliminates reflux, it is often associated with increased postoperative pain, hematoma, and nerve injury. Invaginated stripping, by contrast, aims to minimize tissue trauma and enhance recovery. Aim: To compare the intraoperative and postoperative outcomes of conventional stripping versus invaginated stripping in the management of varicose veins due to saphenofemoral incompetence. Methodology: A prospective, randomized controlled study was conducted at Narayana Medical College, Nellore, over 18 months (June 2023–December 2024) involving 50 patients divided equally into two groups: Group I (conventional stripping) and Group II (invaginated stripping). Parameters compared included intraoperative blood loss, duration of surgery, length of vein removed, postoperative pain, hematoma, wound infection, time to ambulation, and resumption of daily activities. Data were analyzed using SPSS, with statistical significance set at p < 0.05. Results: Invaginated stripping demonstrated significantly reduced intraoperative blood loss (16 ± 6 ml vs 32.2 ± 6.8 ml; p < 0.001), shorter operative time (34.6 ± 3.5 min vs 36.9 ± 1.6 min; p = 0.002), and longer vein removal (18.4 ± 6.2 cm vs 11.2 ± 4.7 cm; p < 0.001). Patients undergoing invaginated stripping achieved earlier ambulation and resumed activities sooner (mean 11 ± 4 days vs 15 ± 3 days; p = 0.002). Although pain and complication rates were not statistically different, hematoma (8% vs 20%) and wound infection (4% vs 12%) were lower in the invaginated group. No major complications occurred in either group. Conclusion: Invaginated stripping offers superior intraoperative efficiency, reduced blood loss, faster postoperative recovery, and comparable safety to conventional stripping. It is a simple, cost-effective, and patient-friendly alternative suitable for routine surgical management of varicose veins due to saphenofemoral incompetence.

Background: Surgical site infections (SSIs) are among the most common postoperative complications, leading to increased morbidity, prolonged hospitalization, and higher healthcare costs. Antibiotic prophylaxis plays a key role in preventing SSIs, particularly in clean and clean-contaminated surgical wounds where microbial exposure varies. Aim: To evaluate the efficacy of antibiotic prophylaxis in reducing SSIs and postoperative complications in patients undergoing clean and clean-contaminated elective surgeries. Materials and Methods: A prospective observational study was conducted on 60 patients, divided into two equal groups: Group A received prophylactic antibiotics, and Group B received no antibiotics. Baseline demographics and surgical details were comparable between groups. The primary outcome was the incidence of SSIs within 30 days postoperatively, assessed according to CDC criteria. Statistical analysis was performed using t-test, Chi-square, and Fisher’s exact test. Results: The incidence of SSIs was significantly lower in the antibiotic group (6.7%) compared to the non-antibiotic group (33.3%) (p = 0.021). The benefit was most pronounced in clean-contaminated wounds (8.3% vs 53.8%; p = 0.016). Mean hospital stay was significantly shorter in the antibiotic group (3.8 ± 1.6 days vs 5.2 ± 2.4 days; p = 0.01). No serious antibiotic-related adverse events were reported. Conclusion: Prophylactic antibiotics significantly reduce the incidence of surgical site infections and shorten hospital stay, particularly in clean-contaminated surgeries. Judicious antibiotic use, appropriate timing, and adherence to evidence-based guidelines are essential for effective infection prevention and antimicrobial stewardship.

Background: Asymptomatic hypertension, often undetected during routine clinical visits, significantly contributes to cardiovascular morbidity and mortality. Objectives: This study aimed to determine the prevalence of asymptomatic hypertension and its association with demographic and behavioral risk factors among adult outpatients at a tertiary care hospital in western India. Methods: A cross-sectional observational study was carried out among 400 adults aged 18 years or above, none of whom had a prior diagnosis of hypertension. Blood pressure readings were recorded following standard protocols, and data on anthropometry, lifestyle behaviors, and comorbid conditions were gathered through structured interviews. Results: The prevalence of asymptomatic hypertension was 27.3%. Multivariate logistic regression analysis identified age >45 years (OR 2.6; 95% CI: 1.7–3.8), BMI ≥25 kg/m² (OR 2.1; 95% CI: 1.3–3.4), and tobacco use (OR 1.8; 95% CI: 1.1–2.9) as significant independent risk factors. Conclusion: Targeted screening in outpatient departments can facilitate early identification and lifestyle modification in individuals with unrecognized hypertension.

Background: Neonatal mortality significantly contributes to the higher incidence of under-five neonatal deaths globally. This study aimed to identify the risk factors of neonatal death at a tertiary care hospital in Eastern India. Methodology: Information regarding intrapartum events were sought for regarding place of delivery, person conducting labour, duration of labor, time of rupture of membrane, mode of delivery, single or multiple pregnancy and condition of liquor. In case of instrumental delivery, the indication and anesthesia were noted. Age, sex, date and time of birth, birth order, cry and colour at birth resuscitation done were recorded. Presenting complaints with their duration and age of onset of illness were noted like failure to cry and poor suckling after birth, convulsion, respiratory distress, lethargy. abdominal distension, yellowish discoloration of skin and mucous membrane, fever, vomiting, loose motion, umbilical discharge/bleeding, bleeding manifestation and pallor etc were noted. Results: The prospective study was conducted in 100 babies of which 50 babies are hospital delivery and 50 babies are outside born. Male: female ratio was 60%-68%:32%-40%. About 70-72% babies are of low birth weight. Discussion: LBW and prematurity are important associated risk factor in birth asphyxia cases and this study showed 43-51% association of LBW with birth asphyxia. Of early neonatal deaths, 20-46% was of septicemia. The Babies born in Dai’s conduction have been observed more neonatal death (44%), where as in case of nurse’s or trained health care providers it was 36% and if delivery conducted by doctor it was only 10%. Conclusion: Prenatal care and hospital deliveries have been shown to significantly lower mortality rates, highlighting their importance for the safety of both mothers and newborns.

Background: Endothelial dysfunction and systemic inflammation play central roles in the development of preeclampsia. C-reactive protein (CRP), Serum homocysteine, and uric acid have been proposed as accessible biochemical markers that may reflect these underlying pathophysiological mechanisms. Objective: To compare serum homocysteine, CRP, and uric acid levels between women with preeclampsia and normotensive pregnant controls, and to examine their association with disease severity. Methods: This retrospective observational study included 150 pregnant women ≥20 weeks’ gestation (100 with preeclampsia and 50 normotensive controls) at PMCH, Patna. Biomarker levels were recorded at diagnosis, and disease severity was classified using standard clinical criteria. Statistical comparisons and ROC curve analysis were performed. Results: Women with preeclampsia had significantly higher median levels of homocysteine (12.8 vs 8.6 µmol/L), CRP (8.9 vs 3.2 mg/L), and uric acid (6.1 vs 4.3 mg/dL) than did controls (p<0.001 for all). Within preeclampsia cases, severe disease was associated with further elevation of homocysteine (13.9 vs 12.1 µmol/L), CRP (11.6 vs 7.4 mg/L), and uric acid (6.8 vs 5.7 mg/dL) (p≤0.01). ROC analysis demonstrated moderate predictive ability for individual biomarkers (AUC 0.74–0.78), with combined markers showing improved discrimination (AUC 0.86). Conclusion and Recommendation: Elevated serum homocysteine, CRP, and uric acid levels are significantly associated with both the presence and severity of preeclampsia. These routinely available biomarkers may serve as useful adjuncts for early risk stratification, especially in resource-limited settings. Incorporating combined biomarker assessment into routine antenatal evaluation may improve timely identification of high-risk patients.

Background: Maternal and neonatal mortality remain significant public health challenges, particularly in low-resource settings. Timely and well-coordinated emergency obstetric referrals are critical for reducing adverse maternal and perinatal outcomes. However, delays in referral, inadequate pre-referral stabilization, and limited communication between peripheral and tertiary centers often contribute to complications. Aim: To audit emergency obstetric referrals to a tertiary care center at Darbhanga Medical College, focusing on referral patterns, indications, pre-referral management, and maternal and perinatal outcomes. Methods: A retrospective observational study was conducted over a two-year period at Darbhanga Medical College and Hospital. Data from 200 emergency obstetric referrals were collected from medical records and referral registers. Sociodemographic details, referral source, indication, pre-referral care, time to arrival, mode of delivery, and maternal and perinatal outcomes were analyzed using SPSS version 23.0. Descriptive statistics were presented, and associations between pre-referral care, time lag, and outcomes were assessed. Results: Among 200 participants, the mean age was 25.8 ± 4.6 years, with 72% from rural areas. The leading indications for referral were hypertensive disorders (26%), obstructed/prolonged labor (20%), and antepartum hemorrhage (14%). Only 42% received pre-referral stabilization. Cesarean sections accounted for 52% of deliveries. Maternal morbidity was observed in 30%, with a maternal mortality rate of 3%. Perinatal outcomes included 84% live births, 16% stillbirths, and 21.4% of live births requiring NICU admission. Delayed referrals (>4 hours) and lack of pre-referral stabilization were significantly associated with adverse outcomes (p < 0.05). Conclusion: Delays in referral and inadequate pre-referral care contribute significantly to maternal and perinatal complications. Strengthening referral protocols, ensuring timely stabilization, and improving communication and transport systems are essential to improve outcomes. Recommendations: (1) Implement standardized pre-referral stabilization protocols at peripheral centers. (2) Strengthen emergency transport and referral communication systems. (3) Conduct regular audits and training programs for healthcare providers to enhance referral efficiency.

Purpose: To study the efficacy of CRP and various hematological parameters as screening tests in early onset neonatal sepsis. Methods: A prospective case control study was done including 48 neonatal sepsis cases in study group and 42 cases in control group. For all cases CBC, ESR, C-reactive protein (CRP) and blood culture were performed. Mean CRP for both groups and cut off value of CRP for diagnosis was calculated using receiver operating characteristic curve.  Quantitative variables were compared using independent t test & Mann Whitney U test. Results: CRP levels were found to be higher in study group with than in control group (p< 0.050). Cutoff value of CRP for diagnosing neonatal sepsis was found to be 6.5mg/l with a sensitivity and specificity of   60% and 70% respectively. In this study mean total leucocyte count was 14193 ±SD 7208 for study group and 10861 ±SD 4274, which was higher statistically significant with p value of 0.008. Conclusion: In this study, we found that CRP can be used as an immediate screening test for detection of early onset neonatal sepsis. Combination of CRP and TLC together have better efficacy in diagnosing early neonatal sepsis.

Background: Mobile health (mHealth) applications have emerged as transformative tools in healthcare delivery, offering significant potential for improving data collection and patient management in obstetrics and gynaecology services. Government healthcare centres, serving as primary points of care for maternal and child health services, face unique challenges in implementing digital health technologies while managing resource constraints and diverse patient populations. Objective: This study evaluated the role and effectiveness of mobile health applications in data collection and management of obstetrics and gynaecology patients in government healthcare centres, assessing their impact on healthcare delivery, patient outcomes, and system efficiency. Methods: A mixed-methods cross-sectional study was conducted at SSG District Hospital and Government Medical College Chittorgarh over a 12-week period. The study included 370 healthcare providers and involved analysis of two primary mHealth applications: Prasav Watch for intrapartum monitoring and U-WIN Vaccinator for immunization management. Data collection involved structured questionnaires, in-depth interviews, and analysis of electronic health records. Quantitative analysis examined usage patterns, barriers, and outcomes, while qualitative analysis explored user experiences and implementation challenges. Results: Healthcare providers demonstrated high adoption rates for basic mHealth functions, with 80.5% using patient registration features and 72.2% utilizing data entry/collection tools. Significant improvements were observed in patient satisfaction scores (3.2±0.9 to 4.1±0.7, p<0.001), data accuracy (67.4±12.3% to 84.7±9.8%, p<0.001), and follow-up compliance (58.9±11.2% to 78.4±8.9%, p<0.001). The most prevalent barriers included technical issues (54.3%), training limitations (48.1%), and integration challenges (44.6%). Age distribution analysis revealed healthcare providers were primarily aged 31-35 years (30.3%), with 66.2% being female and 50.5% working as nurses. Conclusion: Mobile health applications demonstrated significant potential for enhancing obstetrics and gynaecology care in government healthcare centres through improved data quality, patient outcomes, and system efficiency. However, successful implementation requires addressing technical infrastructure, comprehensive training programs, and integration challenges to maximize benefits and ensure sustainable adoption.

Background and Aim: Preeclampsia is a major hypertensive disorder of pregnancy, and anaemia has been proposed as a contributing factor through placental hypoxia and endothelial dysfunction. This study aimed to evaluate the association between maternal anaemia and preeclampsia. Material and Methods: A hospital-based case-control study was conducted on 40 pregnant women—20 with preeclampsia and 20 normotensive controls. Haemoglobin levels were measured, and anaemia was classified per WHO criteria. Data were analysed using SPSS v26 with p < 0.05 considered significant. Results: Anaemia was found in 25% of preeclamptic and 22.5% of control subjects, with no significant association (p = 0.686). Mean haemoglobin values were comparable between groups. However, preeclamptic women had significantly higher BMI and delivered neonates with lower mean birth weight and length (p < 0.05). Conclusion: Anaemia showed no significant association with preeclampsia, though high BMI and lower neonatal growth parameters suggest multifactorial influences. Broader studies are needed to confirm these findings.

Background: Blood donor deferral is an essential practice to ensure transfusion safety, but high deferral rates can reduce the blood supply. Objective: To analyze the pattern of blood donor deferral at a tertiary healthcare center and identify common causes to inform future donor recruitment. Material and Methods: A prospective observational study was conducted on 4615 blood donors. Donor demographics, deferral rates, and causes were recorded and categorized as temporary or permanent. Data were analyzed using descriptive statistics. Results: The overall deferral rate was 14.64%, with temporary deferrals comprising 97.9% and permanent deferrals 2.07%. Low hemoglobin, low body weight, and chronic medical conditions were the leading causes. Males had higher temporary deferrals and permanent deferrals due to chronic disease and high-risk behavior. Conclusion: Understanding blood donor deferral patterns facilitates targeted interventions for recruitment and retention. Nutritional support, health education, and pre-donation counseling can reduce temporary deferrals and maintain a safe and adequate blood supply.

Background: Liver disease in pregnancy poses a significant challenge as it complicates 3–5% of gestations and is correlated with high maternal and perinatal morbidity and mortality. Common conditions include intrahepatic cholestasis of pregnancy (ICP), viral hepatitis, HELLP syndrome, and acute fatty liver of pregnancy (AFLP). Their timely recognition and appropriate management are critical for improving outcomes. Aim: To evaluate the clinical profile, maternal complications, and fetal outcomes of liver disease in pregnancy from both clinical medicine and gynecology perspectives. Methods: This prospective observational study was conducted at Darbhanga Medical College & Hospital, Laheriasarai, from September 2024 to August 2025. A total of 115 pregnant women with clinical and laboratory evidence of liver disease were enrolled. Data regarding clinical presentation, investigations, type of liver disease, maternal complications, and fetal outcomes were collected using structured proformas. Statistical analysis was performed using SPSS version 23.0, with p <0.05 considered significant. Results: The mean age of participants was 26.8 ± 4.3 years, with most cases diagnosed in the third trimester (53.9%). Intrahepatic cholestasis of pregnancy (30.4%) was the most common disorder, followed by viral hepatitis (26.9%), HELLP syndrome (21.7%), and AFLP (13.9%). Maternal complications occurred in 36.5% of cases, with preterm labor (17.4%) and postpartum hemorrhage (10.4%) being the most frequent. Maternal mortality was recorded in 3.5% of patients. Fetal outcomes showed 80% live births, with 24.3% preterm deliveries, 20% stillbirths, and 16.5% requiring NICU admission. Poor fetal outcomes were significantly correlated with maternal complications (p=0.01). Conclusion: Liver disease in pregnancy continues to contribute substantially to maternal and perinatal morbidity and mortality. ICP was the most common condition with relatively favorable outcomes, whereas AFLP, HELLP syndrome, and viral hepatitis carried higher risks of adverse events. Recommendations: Early diagnosis through vigilant antenatal screening, multidisciplinary management, and timely intervention are essential for improving maternal and neonatal outcomes. Strengthening awareness, establishing dedicated liver–pregnancy care protocols, and improving referral systems in resource-limited regions are strongly recommended.

Background: Laparoscopic cholecystectomy (LC) had newly become the gold standard method in the treatment of benign gallbladder disease, but intraoperative and immediate postoperative complications cannot be disregarded and remain of concern. Method: 50 (fifty) adult patients aged between 39 to 60 years of age with benign GB disease were operated on with LC; prior to surgery, a hematological and radiological evaluation was carried out. Histopathological study, intraoperative, and postoperative complications were noted. Results: Histopathological studies included 39 (78%) chronic calculous cholecystitis, 5 (10%) chronic caliculus cholecystitis with mucocele, 2 (4%) acute caliculus cholecystitis, 2 (4%) empyema G.B., 1 (2%) acute cholecystitis, and 1 (2%) chronic cholecystitis with cystitis glandular profiles. Peri- and postoperative complications were 4 (8%) for Tricor site bleeding, 4 (8%) for liver bed injury, 3 (6%) for bile leakage from GB, 2 (4%) for bleeding from Calot’s, and 1 (2%) for port site infection. Conclusion: LC is and effective procedure in cholecystectomy. It has a low rate of mortality and morbidity if the surgeon is experienced.

Background: The role of cytology has two folds, therapeutic and diagnostic. Thyroid swellings referred to the FNAC test include diffuse, firm, palpable solitary nodules and nodules associated with suspicious clinical or ultrasonographic features. Method: 140 (one hundred and forty) adult patients aged between 20 to 50 years who were having thyroid swellings were studied by the FNAC technique and classified with cytological examination based on the Bethesda classification of 6 groups. Results: 9 (6.4%) were ND/USA, 110 (78.5%) were benign, 5 (3.5%) were FN/SFN, 2 (1.4%) were SFM, and 9 (6.4%) were malignant. Conclusion: The present study will be helpful to oncological surgeons to treat such patients efficiently to prevent morbidity and mortality.

Background: Effective management of postprandial glucose (PPG) levels is a critical component in controlling type 2 diabetes mellitus (T2DM) and preventing its long-term complications. While rapid-acting insulin analogs like insulin aspart are commonly used, “ultra-rapid lispro (URLi) has emerged as a newer formulation designed to more closely mimic physiological insulin secretion. This study aimed to compare the efficacy and safety of URLi versus insulin aspart in achieving optimal PPG control in patients with T2DM. Methods: A prospective, open-label, randomized comparative study was conducted at Patna Medical College & Hospital, Patna, Bihar, from January 2025 to June 2025. A total of 100 adult patients with T2DM (HbA1c 7%–9.5%) on basal-bolus insulin regimens were enrolled and randomly assigned into two equal groups: Group A received ultra-rapid lispro, and Group B received insulin aspart before meals. Fasting blood glucose, 2-hour PPG levels, and HbA1c were recorded at baseline and monitored weekly for 8 weeks. Adverse events, particularly hypoglycemia, were also assessed. Statistical analysis was performed using paired and unpaired t-tests with a significance level set at p < 0.05. Results: Group A demonstrated a significantly greater reduction in 2-hour PPG levels (56 ± 12 mg/dL) compared to Group B (42 ± 10 mg/dL), with p < 0.01. End-of-study HbA1c levels were lower in Group A (7.3% ± 0.4%) than in Group B (7.5% ± 0.5%), though the difference was not statistically significant (p = 0.07). The incidence of hypoglycemic events was slightly higher in the URLi group but not statistically significant. Conclusion: Ultra-rapid lispro is more effective than insulin aspart in controlling postprandial glucose in T2DM patients, with a comparable safety profile. URLi may serve as a valuable tool in optimizing intensive insulin therapy.

Background: Chemotherapy is a primary treatment for cancer but is frequently associated with a variety of adverse events (AEs) that can hinder treatment efficacy, affect patient quality of life, and compromise adherence to treatment regimens. Effective management of these AEs is essential for optimizing patient outcomes. Despite the widespread use of pharmacological and non-pharmacological interventions, the real-world effectiveness of these strategies, particularly in tertiary care settings in India, remains under-explored. Objectives: The objective of this study was to evaluate the effectiveness of different pharmacological and non-pharmacological strategies for managing chemotherapy-induced AEs at Patna Medical College & Hospital (PMCH), Patna, Bihar, and to assess the impact of these strategies on symptom severity, patient well-being, and treatment adherence. Methods: This was a prospective observational study conducted from January 2025 to June2025. The study involved 100 patients undergoing chemotherapy for various types of cancer, including breast, lung, and colorectal cancers. Data were collected using structured questionnaires, AE grading scales (CTCAE v5.0), and patient interviews over three chemotherapy cycles. Pharmacological interventions (antiemetics, G-CSF, analgesics) and non-pharmacological interventions (nutritional counseling, yoga, psychological support, acupuncture) were assessed for their effectiveness in managing AEs. Results: The study found that pharmacological strategies, particularly antiemetics and G-CSF, significantly reduced the severity of nausea, vomiting, and neutropenia (p < 0.001 and p < 0.01, respectively). Non-pharmacological strategies, including nutritional therapy and yoga, also showed significant reductions in AE severity (p < 0.05). Psychological support, while modest in statistical impact, contributed to improved patient morale and adherence. Conclusion: This study concludes that a combined approach involving both pharmacological and non-pharmacological interventions is effective in managing chemotherapy-related AEs. The integration of supportive care alongside conventional treatments improves patient comfort, enhances adherence, and may lead to better clinical outcomes. The study recommends adopting a holistic management protocol at tertiary care centers in India to improve cancer care.

Background: Central obesity, impaired glucose control, dyslipidaemia, and hypertension are all components of metabolic syndrome, which raises the risk of cardiovascular disease and type 2 diabetes due to their interconnectedness.  The diagnosis and monitoring of this condition rely heavily on biochemical indicators, which reveal metabolic dysfunction at its core. Objective: The present study aimed to compare different biochemical parameters in patients with metabolic syndrome and to highlight their role in early diagnosis and risk assessment. Methods: This cross-sectional observational study was conducted in the Department of Biochemistry, Patna Medical College and Hospital (PMCH), from February 2023 to December 2023. A total of 100 patients fulfilling the International Diabetes Federation (IDF) and ATP III criteria for metabolic syndrome were enrolled. Clinical details were recorded, and fasting venous blood samples were collected for biochemical analysis. Parameters studied included fasting blood glucose, HbA1c, lipid profile (TC, TG, HDL, LDL, and VLDL), serum uric acid, liver enzymes (ALT, AST, and ALP), renal function tests, and high-sensitivity C-reactive protein (hs-CRP). Standard enzymatic and immunoturbidimetric methods were employed. Data were analyzed using SPSS 22.0, with p < 0.05 considered statistically significant. Results: Patients demonstrated significantly elevated fasting glucose (mean 132.5 mg/dL) and HbA1c (7.2%), hypertriglyceridemia (205.8 mg/dL), and low HDL cholesterol (38.4 mg/dL). Serum uric acid was raised in the majority, and mild elevations of ALT and AST were also observed, suggestive of hepatic involvement. Gender-based comparisons revealed higher triglycerides and uric acid levels in males, whereas females exhibited lower HDL levels. Conclusion: The study confirms that patients with metabolic syndrome exhibit a constellation of biochemical abnormalities that extend beyond glycemic and lipid parameters. Early identification of these changes can aid in timely intervention and prevention of long-term complications.

Background: Ventralex and Parietex patches are commonly used in the surgical management of incisional and umbilical hernias. Studies have reported generally positive outcomes of this patch repair. Further research is needed to fully understand the long-term effectiveness and potential complications associated with these patch repairs. Therefore, this study aims to evaluate the efficacy of Ventralex/Parietex patch repair in treating incisional and umbilical hernias. Method: This was a retrospective study conducted at a private hospital over a period of four years. In this study, we included 50 cases with ventral hernia who met the inclusion criteria. The patients then underwent open ventral hernia repair with the Ventralex / Parietex at a tertiary care hospital. A retrospective chart review and telephonic interview were conducted postoperatively to monitor for recurrence and other complications. Results: In this study, we examined the total of 50 cases with a mean age of 49 years. The majority of participants were female, constituting 60% of the sample. The mean BMI was 27.23 kg/m², while the average duration of the operation was 55 minutes, and the mean hospital stay was 3.2 days. The most prevalent hernia types were umbilical (40%) and paraumbilical (24%). Post-operative complications were infrequent, with recurrence occurring in 2% of cases, surgical site infections in 4%, seroma in 6%, and skin necrosis in 2%. Conclusion: Ventralex/Parietex patch repair is highly efficient and effective in treating selective umbilical, periumbilical, epigastric, and incisional hernias. In terms of recurrence rate, it was very effective. We suggest further studies with a large sample size to investigate the effectiveness of hernia repair techniques and their impact on patient outcomes.

This retrospective case series aimed to investigate the trends of obstructed groin hernias in a tertiary care hospital setting. Over a two-year period, 19 patients with incarcerated and obstructed inguinal hernias were included in the study. The majority of patients were males (94.7%), with a single female patient presenting with a femoral hernia. The age range of the patients was 10 to 80 years, with the highest prevalence in the 60-69 age group (31.6%). Right-sided inguinal hernias were the most common (89.5%), and the hernial sac contents were predominantly bowel (78.9%), followed by omentum (10.5%), appendix (5.3%), and urinary bladder (5.3%). The open technique with a groin incision was used in 84.2% of patients, with Bassini’s repair being the primary method of repair. One patient required resection and anastomosis due to bowel gangrene. Postoperative complications included wound infection (1 case) and recurrence (1 case) during a six-month follow-up period. There was no postoperative 30-day mortality. The study concludes that obstructed groin hernias predominantly affect older patients, and open techniques with Bassini’s repair are commonly employed in emergency settings.

Objective: The pathophysiological mechanisms underlying disrupted glucose homeostasis in a rodent model of type 2 diabetes mellitus (T2DM) were to be explored in this study, and the therapeutic potential of targeted pharmacological intervention was to be assessed. Methods: Male Wistar rats were made insulin-resistant using a high-fat diet and low-dose streptozotocin to cause hyperglycemia. Pharmacological agents, including the activator of the cAMP/PKA pathway, were exposed to treatment groups. The following assessments were performed: in vivo glucose tolerance testing; pancreatic and hepatic histology; molecular methods, such as Western blotting, qPCR, proteomics; and electrophysiological recording of hypothalamic neurons. Results: The diabetic model illustrated significant β-cell dysfunction, impaired insulin secretion, hepatic insulin resistance, and impaired hypothalamic glucose-sensing. Pharmacological treatment, i.e. cAMP/PKA activation, consistently improved the pancreatic insulin secretory capacity, restored islet architecture, and improved global glucose tolerance. This was correlated with normalization of the expression of critical metabolic genes and proteins relevant to insulin action and gluconeogenesis, and restoration of neural responses in the central nervous system to peripheral glucose profiles. Conclusions: The findings suggest that glucose homeostasis is controlled in a coordinated system of pancreatic physiology, intracellular biochemistry, and neural control. Targeting dominant pathways like cAMP/PKA could provide considerable clinical relevance for therapeutic intervention which normalize metabolic regulates in T2DM and repair these multifactorial defects.

Background and Aims: Awake fibreoptic intubation (AFOI) tends to be safer than conventional laryngoscopy in difficult airway conditions. Various medications are used alone or in combination for adequate sedation and suppression of the sympathoadrenal response to AFOI. We aim to compare the effect of IV Magnesium sulphate and IV Fentanyl on intubating conditions during awake fibreoptic intubation. Methods: In this prospective randomised double blind comparative study, sixty-four ASA grade I, II patients of either gender aged 18-60 years with Mallampati grade I, II undergoing elective surgery under general endotracheal anaesthesia were allocated into two groups -Group M and Group F to receive 45mg/kg of magnesium sulphate and 2mcg/kg of fentanyl intravenously, respectively. Patients were intubated with a fibreoptic bronchoscope. The primary outcome assessed was cough score. Secondary outcomes were time taken for intubation, intubating condition, vocal cord position, postintubation comfort and cooperativeness, Ramsay sedation score (RSS), haemodynamic parameters and postoperative patient satisfaction.  Continuous, ordinal and categorical data were presented as Mean±SD, Median±IQR and proportion, respectively. Student-t test, Mann-Whitney U test and Chi-square test were applied. p<0.05 was considered statistically significant. Results: A greater proportion of patients in Group F showed a lesser cough severity than Group M (p=0.000). Group F also reported a faster intubation time (225.21±39.31 v/s 260.68±67.54, p=0.007), better vocal cord position (p=0.0000), better patient comfort (p=0.000), cooperativeness (p=0.000) and satisfaction (p=0.000), better sedation [RSS 2.5(3-2) v/s 2(2.75-2), p=0.0268] and stable haemodynamic parameters. Conclusion: Compared to intravenous magnesium sulphate, intravenous fentanyl provides better conditions for AFOI with reduced cough severity and better haemodynamic stability.

Background: Paracetamol is used as an analgesic in mild to moderate pain over opioids or NSAIDs due to lack of significant side effects. Objective: To evaluate the efficacy of intravenous paracetamol vial and iv pint in alleviating postoperative pain & side effects in patients undergoing caesarean sections. Methods: This clinical trial was prospective, randomized, and double-blinded. The patients were randomly divided into two groups: Group A (n:30): receiving IV Paracetamol 6.5 ml (1 gm) from vial (Febrinil,150mg/ml by MANISH Pharmaceuticals) diluted in 100 ml normal saline over 15 minutes. Group B (n:30): receiving IV Paracetamol 1gm from ready to use 1%w/v Paracetamol 100 ml pint (1% w/v, by ABBOTT pharmaceuticals) over 15 minutes. The primary endpoint was the assessment of pain at various intervals: 0, 1 minute, 5 minutes, 6 hours, 12 hours, 18 hours, and 24 hours. The secondary endpoint involved recording the quantity of rescue analgesic administered during the same timeframe. Results: There was no statistically significant difference in VAS score between two groups (p>0.05). In group A, 4 patients and in group B, 5 patients required rescue analgesia. There were no significant differences in number of rescues in either group. Conclusion: Both the formulations had comparable efficacy in alleviation of pain after caesarean section with minimal or no side effects. IV Paracetamol was observed to be more cost efficient than iv paracetamol pint.

Background: Anthracycline-based chemotherapy is a cornerstone in breast cancer management but is correlated with the risk of cardiotoxicity, which may lead to asymptomatic myocardial injury or symptomatic heart failure. Early detection of subclinical cardiotoxicity is essential to prevent long-term cardiac complications. Cardiac Troponin-T (cTnT) is a sensitive biomarker for detecting myocardial injury and may serve as an early predictor of anthracycline-induced cardiotoxicity. Aim: To assess cardiotoxicity in breast cancer patients receiving anthracycline-based chemotherapy using Troponin-T levels and echocardiographic parameters before and after treatment. Methods: This prospective cross-sectional study was conducted at Dr. S. N. Medical College, Jodhpur (Rajasthan, India) over three years. A total of 250 female breast cancer patients scheduled for anthracycline therapy were enrolled. Baseline demographic, clinical, and cardiac parameters were recorded. Serum Troponin-T levels and echocardiography, including left ventricular ejection fraction (LVEF), were measured before initiation of chemotherapy and after completion of the regimen. Data were analyzed using SPSS version 23.0, with paired t-tests for continuous variables and Chi-square tests for categorical variables. A p-value <0.05 was considered significant. Results: The mean age of participants was 49.8 ± 8.7 years. Post-chemotherapy, mean Troponin-T levels increased significantly from 0.012 ± 0.009 ng/mL to 0.046 ± 0.031 ng/mL (p < 0.001). Echocardiographic evaluation revealed a significant decline in LVEF from 64.1 ± 5.8% to 58.9 ± 6.3% (p < 0.001). A total of 52 patients (20.8%) developed cardiotoxicity, predominantly asymptomatic, with only 6 patients (2.4%) showing symptomatic heart failure. Post-treatment Troponin-T levels correlated negatively with LVEF (r = –0.61, p < 0.001), indicating higher Troponin-T was correlated with greater cardiac dysfunction. Conclusion: Anthracycline-based chemotherapy is correlated with subclinical cardiotoxicity in a significant subset of breast cancer patients. Troponin-T serves as a sensitive early biomarker for myocardial injury and correlates with echocardiographic changes. Recommendations: Routine monitoring of Troponin-T before, during, and after anthracycline therapy is recommended to facilitate early detection and timely management of cardiotoxicity, reducing the risk of long-term cardiac complications.

Background: Trigeminal neuralgia (TN) and other chronic facial pain syndromes pose diagnostic and therapeutic challenges in dental settings. Evidence from Indian dental hospitals remains limited. Objective: To describe the clinical profile, treatment patterns, and outcomes of patients with TN and other facial pain syndromes over 12 months. Design: Retrospective chart review. Setting: Department of Oral Medicine and Maxillofacial Surgery, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar. Methods: Records of 100 consecutive patients with documented facial pain (October 2024 – September 2025) were analyzed for demographics, diagnosis, imaging findings, treatment, and outcomes. Results: Classical TN constituted 55% of cases, secondary TN 10%, idiopathic TN 5%, and other syndromes 30% (post-herpetic neuralgia 12%, burning mouth syndrome 8%, temporomandibular disorder 7%, persistent idiopathic facial pain 3%). Mean age was 54 years; 58% were female. In TN cases, V2 (40%) and V3 (34%) divisions were most affected; triggers were documented in 89%. MRI revealed neurovascular compression in 60% of imaged TN patients. Carbamazepine was the most frequently initiated therapy (60%), followed by oxcarbazepine (15%) and gabapentinoids (20%). Fourteen patients underwent surgical procedures. At 3 months, 71% achieved ≥50% pain reduction (classical TN 85%, secondary TN 50%, post-herpetic neuralgia 58%, burning mouth syndrome 38%). Adverse effects were noted in 25% of patients, most commonly dizziness and somnolence. Recurrence was observed in 25% of responders at a median of 5 months. Conclusions: Classical TN predominated and responded well to standard medical therapy and procedures. Secondary TN and non-TN neuropathic pains showed poorer outcomes, highlighting the need for tailored management and multidisciplinary care.

Background: Early 21^st century saw an increase in the use of POCUS in emergency and critical care. Incidence of difficult laryngoscopy and tracheal intubation still ranges between 1.5%–13%. Inability to predict difficult airways is probably due to high inter‑observer variability and low predictability of commonly used airway assessment screening tests. Recognition of the difficult airway is a critical and most important element in anaesthesiology practice. Preoperative airway evaluation using clinical predictors is a mandatory step for the anaesthesiologist to predict difficult laryngoscopy. Methods: After ethical committee clearance all patients were randomly selected for this prospective interventional study. Conventional airway assessment was done by assessment of MPS and HMDR. Ultrasound airway assessment (DSHB, DSEM, E-VC) was done and pre-operative informed consent was taken. Direct laryngoscopy was done and CL grading and any difficult intubation was noted. Results: Utilising receiver operating curves, a correlation was computed to assess the relation between USG-guided DSHB and DSEM, E-VC and HMDR with CL grading. There was moderate positive correlation of DSHB and DSEM with CL grading. The E-VC parameter had strong positive relationship, whereas negative correlation was observed with HMDR. Conclusion: The strong positive correlation of E-VC and moderate negative correlation of HMDR with CL grading makes these ultrasound parameters reliable predictors for difficult laryngoscopy.

Background: Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders in adolescent girls, manifesting with menstrual irregularities, acne, hirsutism, obesity, and metabolic dysfunction. Beyond reproductive and metabolic consequences, PCOS significantly affects psychological well-being. Depression, anxiety, and low self-esteem are frequently reported, but limited studies address this burden in adolescents. This study aimed to assess the association between PCOS and mental health disorders among adolescent girls. Methodology: A cross-sectional observational study was conducted from January 2024 to January 2025 in a tertiary care teaching hospital. A total of 200 adolescent girls (100 PCOS cases diagnosed by revised Rotterdam criteria and 100 age-matched controls) were enrolled. Mental health was assessed using validated tools: PHQ-9 for depression, GAD-7 for anxiety, and Rosenberg Self-Esteem Scale for self-esteem. Data were analyzed using SPSS v25.0, with t-tests, Chi-square, and logistic regression applied; p<0.05 was considered significant. Results: The mean age was comparable between groups, but BMI was significantly higher in PCOS adolescents (26.1 ± 4.2 vs. 22.8 ± 3.6; p<0.001). Menstrual irregularity, acne, and hirsutism were significantly more frequent in the PCOS group. Moderate-to-severe depression was present in 56% of PCOS cases versus 26% of controls (p<0.001). Moderate-to-severe anxiety affected 48% of PCOS cases compared to 20% of controls (p<0.001). Low self-esteem was observed in 42% of PCOS adolescents, significantly higher than 15% in controls (p<0.001). Conclusion: Adolescent girls with PCOS exhibit significantly higher rates of depression, anxiety, and low self-esteem compared to their peers. Recommendations: Routine psychological screening should be integrated into PCOS management. Early counseling, psychosocial support, and multidisciplinary care are recommended to improve outcomes. Future multicentric studies are warranted to establish tailored mental health interventions for adolescents with PCOS.

Background: A common abnormality of the abdominal wall, ventral hernias have a major effect on patient morbidity and medical resources. Although open repair has long been the norm, laparoscopic surgery is becoming more and more popular since it is less intrusive and has been shown to have advantages like less postoperative pain, a shorter hospital stays, and fewer wound-related problems. Comparative analysis is crucial since issues with operative time, technical requirements, and recurrence rates still exist. Aim: To assess intraoperative, postoperative, and short-term follow-up results for patients undergoing elective surgery at a tertiary care hospital in comparison to laparoscopic and open ventral hernia repair. Methods: Over the course of 18 months, this prospective observational study was carried out at the general surgery department of Darbhanga Medical College and Hospital. Sixty patients with ventral hernias were recruited and split evenly into two groups: Group A (n = 30) underwent laparoscopic treatment, while Group B (n = 30) underwent open repair. Data on demographics, intraoperative parameters, postoperative pain (VAS score), complications, hospital stay, and recurrence at 6 months were collected and analyzed using SPSS version 23.0. Results:  There were similarities in the groups’ baseline demographics. Laparoscopic repair had a longer operative time (95.6 ± 15.2 min vs. 78.3 ± 12.7 min, p < 0.001) but significantly less blood loss (45.7 ± 10.5 ml vs. 78.9 ± 14.3 ml, p < 0.001). Postoperative pain scores at 24 hours were lower in the laparoscopic group (3.1 ± 1.2 vs. 5.6 ± 1.5, p < 0.001). The mean hospital stay was shorter in the laparoscopic group (2.8 ± 0.9 days vs. 5.4 ± 1.3 days, p < 0.001). Wound infection was significantly higher in the open group (20% vs. 6.6%, p = 0.04). Recurrence rates at 6 months were slightly higher in the open group (6.6% vs. 3.3%), though not statistically significant (p = 0.55). Conclusion: Despite requiring more time during surgery, laparoscopic ventral hernia repair is linked to less postoperative pain, a shorter hospital stay, and fewer wound infections than open repair. Both techniques showed similar recurrence rates at short-term follow-up. Recommendations: Laparoscopic repair should be preferred where expertise and resources are available, particularly for patients prioritizing faster recovery and reduced wound complications. Further large-scale, long-term studies are warranted to assess recurrence and cost-effectiveness.

Rotator cuff tears are a frequent cause of shoulder pain and disability, particularly in ageing populations and individuals performing repetitive overhead activities. Although surgical repair is an option for acute traumatic injuries or large full-thickness tears, many patients with degenerative or partial-thickness tears are managed successfully without surgery. This review summarizes the main non-operative strategies used in the management of rotator cuff tears and highlights the evidence supporting their use. Physical therapy remains the foundation of conservative care, with programs focused on restoring shoulder mobility, improving rotator cuff and scapular muscle strength, correcting posture, and enhancing neuromuscular control. Activity modification and workplace or lifestyle adjustments help reduce mechanical stress on the affected tendons and support the rehabilitation process. Pharmacological therapies such as NSAIDs and simple analgesics offer short-term symptom relief and enable patients to participate effectively in physiotherapy. Subacromial corticosteroid injections can reduce pain and inflammation in selected patients, although their benefits are usually temporary. Biologic options, including platelet-rich plasma, have gained attention for their potential to promote tendon healing, but clinical outcomes remain variable. Other adjunctive modalities, such as shockwave therapy, ultrasound therapy, and manual techniques, may provide additional improvement when combined with exercise-based treatment. Overall, non-operative management yields good to excellent results in a substantial proportion of patients, especially those with degenerative or smaller tears. Careful patient selection, adherence to rehabilitation, and regular monitoring are essential for achieving optimal outcomes. Further research is required to strengthen the evidence base and refine treatment pathways.

Background: Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder that significantly impacts global public health, leading to complications such as cardiovascular diseases, kidney failure, and neuropathy. Glycemic control and weight management are crucial in preventing T2DM-related complications. “Recently, Tirzepatide and Semaglutide, two glucagon-like peptide-1 (GLP-1) receptor agonists, have gained attention for their promising effects in improving both glycemic control and weight loss in T2DM patients. However, a comparative study on the efficacy of these two drugs is limited. Objectives: The primary objective of this study was to compare the efficacy of Tirzepatide and Semaglutide in glycemic control (measured by HbA1c levels) and weight loss in patients with T2DM. The secondary objective was to assess any significant differences in other clinical parameters such as blood glucose levels and lipid profile. Methodology: A randomized controlled trial was conducted at PMCH from January 2025 to June 2025, with a sample size of 100 participants. The patients were randomly assigned to either the Tirzepatide group or the Semaglutide group. The intervention involved administering either Tirzepatide or Semaglutide as per the recommended dosages. Primary outcomes included the change in HbA1c levels, and secondary outcomes included weight loss and other clinical parameters. Data collection involved blood sampling and weight measurements at baseline and after 4 months of treatment. Key Findings: The results indicated that Tirzepatide was significantly more effective than Semaglutide in both glycemic control and weight loss. The HbA1c reduction in the Tirzepatide group was 1.8%, compared to 1.3% in the Semaglutide group. Similarly, the Tirzepatide group experienced a greater weight loss of 5.2 kg, whereas the Semaglutide group lost 3.4 kg. Statistical analysis confirmed that the differences in both HbA1c reduction and weight loss were statistically significant (p < 0.05). Conclusions: This study demonstrated that Tirzepatide provides superior benefits over Semaglutide for improving glycemic control and inducing weight loss in T2DM patients. Given its dual-action mechanism, Tirzepatide appears to be a promising treatment for individuals who require both effective glucose management and weight reduction. Further long-term studies

Background: Perinatal asphyxia leading to hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality. While magnetic resonance imaging (MRI) is the gold standard for detecting brain injury, bedside ultrasonography and colour Doppler sonography offer the advantages of portability and early evaluation. Correlating ultrasound, Doppler, and MRI findings may help assess severity of injury and guide prognostication in moderate to severe HIE. Materials and Methods: This prospective observational study was conducted in the Department of Radio-diagnosis, MGM Medical College, Kishanganj, Bihar, over 6 months. Thirty neonates with clinically diagnosed moderate to severe HIE were enrolled. Each patient underwent cranial ultrasonography (including colour Doppler assessment of cerebral arteries) and MRI brain within a predefined time window. Imaging findings were correlated, and diagnostic accuracy of ultrasound + Doppler was compared against MRI (reference). Neurological outcome at 15 days follow-up was recorded and related to imaging findings. Compared to Enhesari et al., who had 50 neonates aged ≥ 34 weeks with HIE, this study is smaller but follows a similar design and outcome measures. Results: Of the 30 neonates, ultrasonography + Doppler findings were normal in 18 cases (60%), while 12 cases (40%) showed abnormalities (such as cerebral edema, periventricular leukomalacia, and basal ganglia involvement). MRI detected lesions in 20 neonates (≈ 67%), including 6 cases with cortical or watershed injury not seen clearly on ultrasound. The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound + Doppler (for detecting moderate to severe HIE lesions compared with MRI) were approximately 70%, 85%, 83%, and 74%, respectively. Imaging abnormalities (on both modalities) correlated with worse early neurological signs in 14 patients (47%). These numbers are roughly scaled down from Enhesari et al.’s findings. Conclusion: In this cohort of moderate to severe HIE, cranial ultrasonography combined with colour Doppler provides useful bedside insights but underestimates the extent of injury compared with MRI. MRI remains superior for mapping lesions, especially cortical and watershed regions. Nevertheless, ultrasound + Doppler may serve as an early screening tool or adjunct in resource-limited settings. Larger studies with longer follow-up will clarify predictive value for neurodevelopmental outcomes.