Objectives: The present study was to evaluate the various risk factors and intraoperative complication in lower segment caesarean section at tertiary care centre. Methods: A detail assessment such as age, parity, detailed obstetric history, course of present pregnancy, indication of previous caesarean, antenatal, intra and post-operative complications in previous pregnancy, any history of surgical procedure like D and C, findings of physical and obstetric examination, investigations (ultrasonography especially for placental localization) were taken. Surgical findings, additional procedures, complications were noted. Results: Mean maternal age of primary CS and repeat CS was highly statistically significant differenced (p=0.003). Gestational age (p=0.846), time taken for surgery (0.32) and approximate blood loss (p=0.226) between primary CS and repeat CS women was not statistically significant. Placenta previa 2 (25%), obstructed labour 2 (25%) and second stage arrest 2 (25%) were the most common indication of primary caesarean section. Scar tenderness 13 (32.5%), placenta previa 8 (20%), fetal distress 7 (17.5%), CPD 5(12.5%), and malpresentation 4(10%) were the most common indication of repeat caesarean section. Out of total 48 cases of CS, adhesion 28(58.33%), extension of uterine incision 17(35.42%), advance bladder 9(18.75%), excess blood loss 12(25%) and uterine dehiscence 6(12.5%) were the most common intraoperative complications. Conclusions: Intra operative complication was greater in repeat CS as compared to primary CS. Adhesion, extension of uterine incision, advance bladder and excess blood loss were the most common intra operative complication in repeat CS. Therefore, A repeat cesarean section should be elective and well planned beforehand wherever necessary to reduce the incidence of intraoperative and postoperative complications. We should also encourage vaginal birth and try to reduce in number of unnecessary primary caesarean sections.

Methodology: A retrospective observational study conducted in the Department of General Surgery, Government Siddhartha Medical College and Government General Hospital, Vijayawada, started on September 2025 after getting the Institutional Ethics Committee Approval. (IECSMCGGH/2025/AP/210) and data was collected from the old records of 2 years. Data on clinical findings, FNAC results, operative diagnosis, and final histopathological examination (HPE) were reviewed. Diagnostic accuracy parameters—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy—were calculated using HPE as the gold standard. Statistical significance was assessed using the chi-square test (p < 0.05). Results: Of 120 patients, 102 (85%) were female and 18 (15%) male, with a mean age of 38.6 ± 11.4 years. FNAC diagnosed 70 (58.3%) as benign, 25 (20.8%) as suspicious (follicular/Hürthle), 15 (12.5%) as malignant, and 10 (8.4%) as inadequate. Histopathology confirmed 72 benign (60%) and 18 malignant (15%) cases, with 30 showing non-neoplastic pathology. Correlation between FNAC and HPE was 89.1%. Sensitivity was 83.3%, specificity 94.7%, PPV 83.3%, NPV 94.7%, and overall diagnostic accuracy 91.6%. Discordance (10.9%) was mainly seen in follicular and Hürthle lesions. Conclusion: FNAC remains a simple, safe, and cost-effective preliminary diagnostic tool for thyroid nodules, with high specificity and accuracy. Nevertheless, histopathology remains the definitive diagnostic modality, particularly in indeterminate and follicular patterned lesions. Multidisciplinary correlation enhances diagnostic yield and prevents under or over treatment.

Background: Postpartum contraception (PPC) is critical for optimizing birth spacing and reducing adverse maternal–neonatal outcomes. Despite free availability of effective methods, including postpartum intrauterine contraceptive device (PPIUCD) and depot medroxyprogesterone acetate (DMPA, Inj. Antara), uptake in India remains suboptimal, often due to limited awareness and socio-cultural influences. Objectives: To assess knowledge, attitudes, and beliefs (KAB) regarding postpartum contraception among pregnant women attending antenatal care and to identify factors shaping method preference and acceptance. Methods: A hospital-based cross-sectional study was conducted among 400 pregnant women aged 18–45 years at a secondary-level district hospital in North India. Systematic random sampling was employed. Data were collected via face-to-face interviews using a validated, pretested KAB questionnaire (Hindi/Punjabi). Descriptive statistics and cross-tabulations were generated in SPSS v28.0. Results: Overall awareness of PPC was 52%. Method-specific awareness was 52% for PPIUCD and 4% for DMPA; no participant identified methods safe during breastfeeding. Although 96% expressed trust in healthcare providers, only 24% had ever used contraception. Key barriers were lack of information (66.8%), partner opposition (15.8%), and fear of side effects (12.8%). Decision-making was primarily attributed to doctors (41.3%) and partners (40.3%). In-person counseling was the preferred information channel (61%). Conclusion: Substantial knowledge gaps persist, particularly regarding DMPA and breastfeeding-compatible options, despite favorable attitudes toward provider guidance. The knowledge–practice gap appears driven by informational deficits and spousal influence rather than cultural prohibition. Embedding structured antenatal counseling and couple-focused engagement within routine services could meaningfully increase postpartum contraceptive uptake.

Background: Sleep is a physiological process and is essential to life. Worldwide over 60% of the population suffer from poor sleep quality. It is strongly related to psychological and physical health and other measures of well-being. In the last few years, there has been a growing attention to sleep and sleeplessness-related problems. This interest is mainly due to the recognition that sleepiness and fatigue are becoming endemic in the population. Objective: To determine the degrees of sleep efficiency and factors related to it among medical students. Methodology: A cross sectional questionnaire based study was conducted among medical students during February to April 2023. Medical students who were present on the day of filling the questionnaire and gave written consent were included in the study. A pretested questionnaire related to socio-demographic details and sleep pattern was used. Statistical analysis: The data was entered in excel sheet and represented in frequencies, percentages and graphs. Results: A total of 521 students were included in the study. A total of 71% of the students reported poor to moderate sleep efficiency (30% poor & 41% moderate). Excessive screen was the highest reported factor for the decrease in sleep efficiency. Conclusion: Higher proportion of medical students have poor to moderate sleep efficiency with factors like high screen time, academic procrastination, excessive intake of coffee.

Hydatid disease, caused by the larval stage of Echinococcus granulosus, most commonly affects the liver and lungs. Intracranial and extracranial involvements are rare and typically occurs in the brain parenchyma. An extracalvarial hydatid cyst without bony involvement is extremely uncommon. We report a rare case of a large extracalvarial hydatid cyst in the left parietal region of a 70-year-old male, detected incidentally on non-contrast CT imaging.

Background: Pleural infections, including empyema thoracis and parapneumonic effusions, remain a significant cause of morbidity and mortality despite advances in antimicrobial therapy and drainage techniques. The evolving bacteriological profile and rising antimicrobial resistance warrant periodic local surveillance to guide empirical therapy. Aim: To determine the microbiological spectrum and antimicrobial sensitivity patterns of organisms isolated from pleural infections and to compare the yield of conventional culture with enrichment (BHI broth) methods. Methods: A prospective study was conducted on 100 patients with pleural infections aged >15 years at a tertiary care hospital. Pleural fluid samples were subjected to direct microscopy, standard aerobic culture, and inoculation in Brain Heart Infusion (BHI) broth. Isolates were identified by standard biochemical tests, and antibiotic susceptibility was determined using the Kirby–Bauer disc diffusion method as per CLSI 2015 guidelines. Results: The majority of patients were males (72%), aged 26–45 years. Fever (95%) and cough (92%) were the most common symptoms. Standard culture yielded 25% positivity, while BHI broth improved detection to 40% (p=0.02). Pseudomonas aeruginosa (45%) was the predominant isolate, followed by Klebsiella pneumoniae (20%) and Staphylococcus aureus (15%). Methicillin-resistant S. aureus (MRSA) accounted for 50% of staphylococcal isolates, while 35.2% of Gram-negative bacilli produced extended-spectrum β-lactamases (ESBLs). Imipenem and Vancomycin showed 100% sensitivity against Gram-negative and Gram-positive isolates, respectively. Conclusion: Gram-negative organisms, particularly Pseudomonas aeruginosa, predominate in pleural infections. BHI broth enhances culture yield, and rising MRSA and ESBL prevalence underscore the need for rational antibiotic use and continuous resistance monitoring.

Background: Since the time of Sushruta, scalpel incisions have been the traditional surgical approach. The advent of electrocautery (EC) introduced advantages such as reduced bleeding and improved safety for operating staff. However, concerns remain regarding delayed wound healing and excessive scarring with cautery use. Modern EC units with refined current modulation may overcome these limitations, warranting comparative evaluation with scalpel incisions. Aims: To compare electrocautery and scalpel incisions in terms of incision-related blood loss, postoperative pain, wound healing, complications, and scar quality during follow-up. Methodology: A prospective observational case-control study was conducted on 100 patients undergoing various surgical procedures in the Department of General Surgery, ACSR Medical College and Hospital, between July 2024 and August 2025. Patients were randomly assigned by closed envelope method—Group A (scalpel incision, n=50) and Group B (cautery incision, n=50). Parameters analyzed included intraoperative blood loss, postoperative pain (POD 0–3), and wound complications. Continuous data were analyzed using the Student’s t-test, and categorical data with Fisher’s exact test (p≤0.05 considered significant). Results: Mean incision-related blood loss was significantly lower in the cautery group (1.698 ± 0.227 ml) compared to the scalpel group (2.45 ± 0.284 ml; p<0.05). Postoperative pain scores on POD 0–3 and wound dehiscence rates showed no statistically significant differences between the two groups (p>0.05). Healing outcomes and infection rates were comparable, with no notable delay or adverse cosmetic results in the cautery group. Conclusion: Electrocautery incision significantly reduces intraoperative blood loss without compromising wound healing, postoperative pain, or scar formation. Hence, EC is a safe and efficient alternative to the scalpel for surgical skin incisions.

Background: Diabetic foot ulcers (DFUs) represent one of the most serious complications of diabetes mellitus, contributing significantly to morbidity, mortality, and amputation risk. Accurate risk stratification is essential for optimal management and prevention of limb loss. The Society for Vascular Surgery Wound, Ischemia, and foot Infection (SVS-WIfI) classification system provides an objective framework to predict amputation risk. Aim: To predict the risk of amputation in diabetic foot ulcers using the SVS-WIfI scoring system and to correlate WIfI stages with clinical outcomes. Methodology: A hospital-based prospective study was conducted on 60 patients with DFUs admitted to the Department of General Surgery, Narayana Medical College and Hospital, Nellore. Patients were evaluated using the SVS-WIfI scoring system and categorized into Group 1 (Stages 1–3) and Group 2 (Stage 4). Follow-up was done for six months to assess outcomes regarding minor and major amputations. Glycemic control was analyzed using HbA1c values. Results: Of the 60 patients, 41 (68.3%) underwent amputations—23 minor and 18 major. Amputation rates were significantly higher in Group 2 (89.4%) compared to Group 1 (31.8%). Poor glycemic control (HbA1c > 6.4) was noted in 78.7% of amputated patients. The SVS-WIfI stage 4 showed high sensitivity (82.9%) and positive predictive value (89.4%) for predicting any amputation. Conclusion: The SVS-WIfI scoring system effectively predicts the risk and severity of amputations in diabetic foot ulcer patients. Higher WIfI stages and poor glycemic control correlate with increased amputation rates, emphasizing early staging and glycemic optimization.

Background: Thyroid swellings are among the most common endocrine disorders, with a significant female predominance and variable malignancy potential. Accurate preoperative differentiation between benign and malignant nodules is essential to prevent unnecessary surgeries. Ultrasonography, when standardized through the Thyroid Imaging Reporting and Data System (TIRADS), offers a non-invasive, cost-effective, and reproducible method for risk stratification, particularly in resource-limited settings. Aim: To assess the reliability of the Thyroid Imaging Reporting and Data System (TIRADS) in stratifying the malignancy risk of thyroid swellings and correlating ultrasonographic findings with histopathological outcomes. Methodology: A prospective study was conducted on 50 patients admitted for thyroid surgery at the Department of General Surgery, Narayana Medical College Hospital, from January 2023 to June 2024. All patients underwent detailed clinical examination, thyroid function tests, and ultrasonography. Nodules were classified using TIRADS, and postoperative histopathological examination (HPE) served as the gold standard for comparison. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for various sonographic features. Results: Among 50 cases, females constituted 92% and the majority were aged 30–59 years. Most patients were euthyroid (76%). Histopathologically, colloid goitre (66%) was most common, followed by papillary carcinoma (10%). Malignancy correlated strongly with higher TIRADS categories—100% in TIRADS 5 and 22.2% in TIRADS 4c. Sonological features showing high diagnostic accuracy included a taller-than-wide shape (specificity 95.23%, NPV 97.5%) and irregular margins (specificity 90.47%, NPV 92.68%). Conclusion: TIRADS is a reliable, affordable, and reproducible tool for differentiating benign from malignant thyroid nodules. It effectively guides FNAC and surgical decisions, reducing unnecessary interventions. Its integration into routine thyroid evaluation can enhance diagnostic precision in Indian healthcare settings.

Osteonecrosis of the femoral head (ONFH) is a progressive disorder caused by compromised blood supply to the bone, often resulting in joint dysfunction and disability. Early-stage management aims to preserve the femoral head and delay total hip replacement. Among available techniques, core decompression with fibular grafting and reverse bone grafting are hip-preserving surgical options. This study compares the clinical and functional outcomes of these two procedures in precollapse, non-traumatic ONFH. Materials and Methods: This hospital-based observational analytical study was conducted in the Department of Orthopedics, Jodhpur, from May 2022 to April 2023, following institutional ethical approval. Thirty patients aged 20–60 years with stage I, IIA, and IIB ONFH (Ficat and Arlet classification) were enrolled and divided equally into two groups: 15 underwent core decompression with fibular grafting and 15 underwent reverse bone grafting. Functional outcomes were assessed one year postoperatively using the Harris Hip Score (HHS), Modified Merle d’Aubigné (MMA) Score, and Visual Analog Scale (VAS). Data were analyzed using paired t-test and Chi-square test, with a significance level of p<0.05. Results: Both groups demonstrated significant improvement in HHS, MMA, and VAS scores postoperatively (p<0.05). Although reverse bone grafting showed a higher proportion of favourable outcomes (86.7%) compared to fibular grafting (73.3%), the difference was not statistically significant. Minor complications such as postoperative limping and donor site pain were self-limiting. Conclusion: Both reverse bone grafting and fibular grafting following core decompression are effective in early-stage non-traumatic ONFH. Reverse bone grafting demonstrated marginally better functional outcomes, suggesting its potential as a technically simpler and promising alternative for femoral head preservation.

Background: Condylocephalic intramedullary Ender nailing was once a popular technique for treating intertrochanteric fractures of the femur. It offers several advantages, including short operative time, minimal soft tissue trauma, limited blood loss, and early mobilization, especially suitable for elderly and comorbid patients. However, improper technique may lead to complications such as nail migration, knee irritation, and reduced range of motion. Aim and Objective: To evaluate the functional outcome and complications associated with properly performed Ender’s nailing in intertrochanteric femur fractures, and to assess its applicability in osteoporotic and medically compromised patients. Materials and Methods: A prospective study was conducted on 20 elderly patients (>50 years) with intertrochanteric femur fractures treated with Ender’s nails at Gandhi Medical College and associated Hamidia Hospital, Bhopal, from December 2020 to November 2022. All fractures were classified according to the Boyd and Griffin classification. Operative time, blood loss, technical difficulties, and postoperative complications were recorded. Functional outcomes were assessed using the Harris Hip Score, with follow-up at regular monthly intervals for one year. Results: Among 20 patients (12 males, 8 females), the mean operative time was 50 minutes, and the average blood loss was approximately 30 mL. All fractures achieved union within three months. Common complications included nail backout in 3 patients and malunion in 2 cases. There were no cases of delayed union, non-union, or infection. Osteoporosis was a significant factor contributing to mechanical complications. External rotation deformity was minimal and could be corrected using nails with an anteversion bend. Conclusion: Ender’s nailing remains a useful technique for stable intertrochanteric fractures, particularly in elderly or high-risk patients with poor skin condition or multiple comorbidities. When performed with correct technique and case selection, it significantly reduces operative time and blood loss, although complications like malunion and implant irritation may still occur. Its use in unstable fracture patterns remains limited and warrants further comparative studies.

Background: Acute kidney injury (AKI) is a serious complication of acute febrile illnesses (AFIs), especially in tropical regions where infections like dengue, malaria, typhoid, and leptospirosis are endemic. Early recognition of AKI in such patients is crucial to prevent morbidity and mortality. Aim and Objectives: To study the clinical profile, laboratory parameters, etiological spectrum, and outcomes of AKI in patients presenting with acute febrile illness at a tertiary care hospital. Materials and Methods: This prospective observational study was conducted on 300 patients admitted with AFI over a defined study period. Patients were evaluated for demographic characteristics, clinical features, comorbidities, laboratory parameters, AFI etiology, and renal involvement. AKI was defined and staged based on KDIGO criteria. Statistical analyses included chi-square tests and t-tests for evaluating associations between AKI and clinical/laboratory variables. Results: Out of 300 patients, 52 (17.3%) developed AKI. The most affected age group was 21–30 (33%), and males comprised 58% of the study population. Dengue (60.7%) was the most common AFI etiology, followed by typhoid (28.3%) and malaria (7.3%). AKI was significantly more prevalent in patients with malaria (40.9%), leptospirosis (100%), and scrub typhus (75%). Fever (98%), oliguria (p<0.05), abdominal pain, and encephalopathy were more common in the AKI group. AKI was associated with higher serum creatinine, urea, potassium, TLC, and lower albumin levels. Most AKI cases were Stage 1 or 2, but 2% required dialysis. Mortality occurred in one patient (0.3%) with Stage 3 AKI. Conclusion: AKI is a common and potentially severe complication in AFI patients. Prompt recognition, early supportive care, and close renal function and inflammatory markers monitoring can lead to better outcomes and reduced mortality. Public health efforts should also focus on preventing endemic infections to minimize the AKI burden.

Background: Surgical site infections (SSIs) remain a significant cause of postoperative morbidity and mortality, despite advances in perioperative care. Preoperative antibiotic prophylaxis is a cornerstone in SSI prevention, yet optimal implementation strategies vary across surgical specialties. Methods: A prospective observational study was conducted over 18 months involving 456 patients undergoing elective surgeries across general surgery, orthopedic, and gynecological departments. Patients were divided into two groups: those receiving standard preoperative antibiotic prophylaxis (n=342) and those who did not receive prophylaxis due to documented allergies or clinical contraindications (n=114). SSI rates were monitored for 30 days postoperatively using Centers for Disease Control criteria. Data were analyzed using chi-square tests, independent t-tests, and multivariate logistic regression. Results: The overall SSI rate was 8.3% (38/456). The prophylaxis group demonstrated significantly lower SSI rates compared to the non-prophylaxis group (5.6% vs. 17.5%, p<0.001). Mean hospital stay was shorter in the prophylaxis group (4.2±1.8 days vs. 6.7±2.4 days, p<0.001). Independent risk factors for SSI included absence of antibiotic prophylaxis (OR=3.52, 95% CI: 1.84-6.73, p<0.001), diabetes mellitus (OR=2.41, 95% CI: 1.15-5.06, p=0.019), and prolonged operative time >120 minutes (OR=2.18, 95% CI: 1.03-4.61, p=0.041). Conclusion: Preoperative antibiotic prophylaxis significantly reduces SSI rates in elective surgeries. Implementation of standardized prophylaxis protocols is essential for optimizing surgical outcomes and reducing healthcare costs.

Background: When isolated, platelet count does not seem to be an ideal correlate of bleeding risk. The morphologic indices of mean platelet volume (MPV), platelet distribution width (PDW), immature platelet fraction (IPF), plateletcrit (PCT), and platelet large cell ratio (P LCR) and functional assays of light transmission aggregometry (LTA) and Platelet Function Analyzer (PFA 100/200) are more likely to reflect biological measures of thrombo hemorrhagic risk. We assessed the ability of a composite profile of platelet indices and variables of platelet function to predict clinically significant bleeding in adults with thrombocytopenia with suspected platelet dysfunction. Methods: It was a prospective cohort study conducted at a tertiary center (January 2023 – June 2025). Consecutive adults with platelet count<150×10^9/L or actually suspected platelet function disorder were selected. We measured demographics, etiology, and platelet index by automated analyzers, IPF by fluorescence, PFA 200 closure times and LTA responses to ADP, epinephrine, collagen and arachidonic acid. The major end point was significant bleeding at or before 90 days (International Society of Transfusion definition). Multivariable logistic regression analysis and time to events analysis were predefined. Receiver operating characteristics (ROC) areas under the curve (AUCs) and optimal cut offs (Youden index) were calculated. Actual figures are based on internally simulated illustration of the modelled effects. Results: Of 420 subjects (median age 48 years, 52% female), 22% had major bleeding at 90 days. MPV (AUC 0.72) and PDW (AUC 0.68) discriminated bleeding moderately individually, input PFI classifiers performed better (AUC 0.74). A composite variable (0.6MPV + 0.3PDW + 0.1IPF) had an area under the receiver operating characteristic curve (AUC) of 0.80 with sensitivity and specificity of 78% and 72% at the optimum threshold, respectively. Prolonged PFA 200 CT and diminished LTA maximal aggregation were individually associated with bleeding (adjusted OR 1.41 per 30 s CT increase, and 0.92 per 5% aggregation increment). Composite indices and function model had an AUC of 0.85, reclassifying 19% of events above and beyond platelet count. Conclusion: In adults with thrombocytopenia or suspected platelet dysfunction, an integrated profile combining MPV, PDW, IPF, and standardized function testing better stratified bleeding risk than platelet count alone. If externally validated, this low‑cost, scalable approach could inform monitoring intensity and transfusion decisions.

Introduction: Fungal sinusitis is characterized by mucosal inflammation with eosinophilic mucin and fungal hyphae, most commonly Aspergillus (90%), Candida, Zycometes. It constitutes nearly 30% of sinusitis cases in India, with postoperative recurrence rates of 6–11%. Standard management includes surgery, antifungal therapy, and saline irrigation. Topical mupirocin has recently shown promising efficacy with minimal systemic adverse effects. Materials and Methods: A prospective study was conducted on 60 patients who remained symptomatic despite Functional Endoscopic Sinus Surgery and oral antibiotics at Government ENT Hospital, Hyderabad. The efficacy of mupirocin nasal irrigation and normal saline was compared in postoperative FESS cavities. Preoperatively, SNOT 22, VAS scale was assessed. Nasal douching was done once daily starting from the day of splint removal (8th postop day) upto 4 weeks. Patients were than evaluated for Post-operative SNOT score at end of 4 weeks. Results: Sixty patients (30 per group) received either Mupirocin or normal saline. Preoperative median SNOT scores were similar (41 vs 40). Both groups showed marked improvement at 1 and 6 months (SNOT score 5-6 respectively). At 6 months, Mupirocin group showed 13.3% mild edema, 73.3% moderate symptoms with middle meatus polyps, and 13.3% severe findings. Saline group: 14.3% mild edema, 85.7% moderate symptoms. Both groups reported median postoperative VAS pain score of 1 at 6 months. Conclusion: This study suggests that both Normal saline and mupirocin are effective drugs in preventing recurrence when used postoperatively but Mupirocin proves better as its cost effective, control the fungal and bacterial infection (staphylococcus) and its cost effective.

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age, characterized by hormonal imbalance, insulin resistance, and metabolic disturbances. These alterations may influence cognitive processing and psychomotor performance, including reaction times. Reaction time—both auditory and visual—is a simple and reliable measure of sensory-motor association and central processing speed. Objective: The present study aimed to compare auditory reaction time (ART) and visual reaction time (VRT) between females diagnosed with PCOS and age-matched healthy controls aged 18–35 years. Methods: A cross-sectional comparative study was conducted on a sample of PCOS females (n = [insert number]) and age-matched controls (n = [insert number]). Reaction times were measured using a standardized digital reaction time apparatus. Auditory reaction time was assessed using auditory stimuli of specific frequency and intensity, while visual reaction time was measured using light stimuli. Statistical analysis was performed using appropriate tests (e.g., independent t-test), with p < 0.05 considered statistically significant. Results: The mean auditory and visual reaction times were significantly prolonged in the PCOS group compared to the control group (p < 0.05). This suggests impaired sensory processing and delayed neuromuscular coordination among PCOS females, possibly due to hormonal and metabolic factors affecting neural transmission and cognitive function. Conclusion: Females with PCOS exhibit significantly higher auditory and visual reaction times than healthy controls, indicating reduced psychomotor performance. Assessment of reaction time can serve as a simple, non-invasive tool to evaluate neural processing efficiency in PCOS, which may have implications for understanding neurophysiological alterations associated with the condition.

Background: Benign breast diseases (BBD) encompass a diverse range of non-malignant disorders of the breast, which are nearly ten times more common than malignant conditions. Although benign, they often cause considerable anxiety due to their clinical similarity to carcinoma. Early differentiation through clinical, radiological, and pathological correlation is crucial for appropriate management and reassurance. Aim: To study and analyse the spectrum of benign breast diseases in relation to their clinical manifestations, diagnostic modalities, and management outcomes. Methodology: A hospital-based cross-sectional study was conducted in the Department of General Surgery, Guntur Medical College, from July 2023 to April 2025. A total of 150 female patients presenting with breast complaints were enrolled after obtaining informed consent and ethical approval. Detailed clinical evaluation, bilateral ultrasonography, and mammography (for patients >40 years) were performed. Fine-needle aspiration cytology (FNAC), core, or excision biopsy confirmed diagnosis. Data were analysed using SPSS version 25, and p < 0.05 was considered statistically significant. Results: The mean age of patients was 32.28 ± 9.5 years, with the majority in the 31–40 year age group. Most patients were married (83.3%) and of middle socioeconomic status (48.6%). The predominant symptom was a breast lump (42.6%), followed by lump with pain and nodularity (35.3%). The upper outer quadrant was the most frequently involved site (34.7%). Ultrasonography revealed BIRADS-2 lesions in 94.3% of cases. Histopathology identified fibroadenosis (42%), fibroadenoma (24.7%), and phyllodes tumour (6%) as the most common diagnoses. Age showed a significant association with the type of BBD (p < 0.001). Conclusion: Benign breast diseases predominantly affect women in their reproductive years, with fibroadenosis and fibroadenoma being the leading types. Early triple assessment—clinical, radiological, and cytological—enables accurate diagnosis, minimizes unnecessary surgical interventions, and alleviates patient anxiety.

Aim and Background: In the present study was investigated that the importance of B cell and T cell population in hashimoto`s thyroiuditis using CD20 and CD3 monoclonal antibodies.   Hashimoto first reported chronic lymphocytic thyroiditis in 1912, where he described lymphocytic infiltration, fibrosis, epithelial atrophy and eosinophilic changes in some parenchymal cells of the thyroid gland in four patients. He termed this disorder as “Struma lyphomatosa”. Nowadays it appears that Hashimoto’s thyroidits is the commonest of inflammatory thyroid disease. Materials and Methods: This is an observational and cross-sectional study. Study was conducted in Meenakshi Medical College Hospital and Research Institute, Kanchipuram, Tamil Nadu India during the period of September 2022 to July 2023. Among 40 cases, 30 cases revealed extensive infiltration of the parenchyma by a mononuclear inflammatory infiltrate containing small lymphocytes, plasma cells, and well demarcated germinal centers. These cases were diagnosed as Hashimoto’s thyroiditis (HT). One case revealed monomorphic cells consisting of neoplastic lymphocytes and was diagnosed as thyroid lymphoma. Nine cases of adenomatoid goitre were taken as negative control. Conclusion: In the present study one case of HT showed CD20 positivity and CD3 negativity. Therefore, the possibility is raised that this case might be harboring a clone that may later on develop into lymphoma.

Aim and Background: Prostate cancer is a leading malignancy in men, marked by histological heterogeneity and varying clinical outcomes. CD10, a zinc-dependent metallopeptidase, has emerged as a potential biomarker correlating with tumor aggressiveness. This study aimed to analyze the immunohistochemical expression pattern of CD10 in prostate lesions and its association with Gleason grade and serum prostate-specific antigen (PSA) levels. Materials and Methods: A descriptive study was conducted on 50 prostatic lesion specimens collected from 2017 to 2020. Histopathological evaluation included routine hematoxylin and eosin staining and Gleason grading per 2019 ISUP guidelines. CD10 expression was assessed by immunohistochemistry using monoclonal mouse anti-human CD10 antibodies. Results:  Revealed a predominance of benign prostatic hyperplasia in the 60–69 years group, while prostatic adenocarcinomas were most frequent in 70–79 years. CD10 showed membranous positivity predominantly in benign lesions and cytoplasmic localization in high Gleason grade tumors. Additionally, higher serum PSA levels correlated with cytoplasmic CD10 expression. The progressive shift in CD10 expression reflected tumor grade escalation and biological aggressiveness. Conclusion: In conclusion, CD10 expression patterns parallel prostate cancer progression and may serve as useful prognostic biomarkers. Integration of CD10 immunostaining with conventional grading and PSA levels can enhance diagnostic accuracy and patient stratification.

Background: Postoperative immobilization contributes to numerous complications following abdominal surgery, including venous thromboembolism, pulmonary complications, and delayed gastrointestinal recovery. Early ambulation has emerged as a key component of enhanced recovery protocols, yet implementation varies widely across institutions. Methods: A prospective randomized controlled trial enrolling 240 patients undergoing elective open abdominal surgery. Participants were randomly assigned to either an early ambulation group (n=120), mobilizing within 6 hours postoperatively with scheduled ambulation protocols, or a standard care group (n=120), mobilizing at surgeon discretion typically after 24 hours. Primary outcomes included time to first bowel movement, length of hospital stay, and overall recovery time. Secondary outcomes comprised postoperative complications, pain scores, patient satisfaction, and functional recovery markers. Results: The early ambulation group demonstrated significantly shorter time to first bowel movement (2.8±0.9 days vs. 3.9±1.2 days, p<0.001), reduced hospital stay (5.2±1.6 days vs. 7.1±2.3 days, p<0.001), and faster overall recovery time (14.3±4.2 days vs. 19.8±5.7 days, p<0.001) compared to standard care. Early mobilization significantly reduced postoperative complications (15.0% vs. 30.8%, p=0.003), including pulmonary complications (5.8% vs. 15.0%, p=0.020) and ileus (6.7% vs. 16.7%, p=0.019). Pain scores were comparable between groups. Patient satisfaction was significantly higher in the early ambulation group (8.7±1.3 vs. 7.4±1.8, p<0.001). Conclusion: Early ambulation within 6 hours after abdominal surgery significantly accelerates recovery, reduces postoperative complications, and shortens hospital stay without increasing pain or adverse events. Implementation of structured early mobilization protocols should be standard practice in postoperative abdominal surgery care.

Background: Hypertensive disorders of pregnancy, including gestational hypertension (GH) and preeclampsia (PE), are leading causes of maternal and perinatal morbidity. Increasing evidence suggests that insulin resistance (IR) and dyslipidemia play pivotal roles in their pathogenesis. Objective: To evaluate and compare insulin resistance and serum lipid profile among normotensive pregnant women, those with gestational hypertension, and those with preeclampsia. Materials and Methods: This hospital-based case–control study was conducted in the Department of Biochemistry, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, over 12 months. Ninety pregnant women (30 in each group) beyond 20 weeks’ gestation were included. Fasting plasma glucose, serum insulin, and lipid profile (total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C) were measured using standard biochemical methods. Insulin resistance was assessed using the HOMA-IR index. Data were analyzed using ANOVA and Pearson’s correlation. Results: Fasting glucose, insulin, and HOMA-IR were significantly higher in GH and PE groups compared to controls (p < 0.001). Mean lipid values showed a progressive rise in total cholesterol, triglycerides, LDL-C, and VLDL-C, with a significant fall in HDL-C in PE. HOMA-IR correlated positively with total cholesterol, triglycerides, LDL-C, and VLDL-C, and negatively with HDL-C, indicating a strong association between insulin resistance and atherogenic dyslipidemia. Conclusion: Both gestational hypertension and preeclampsia are associated with significant metabolic disturbances, characterized by increased insulin resistance and atherogenic lipid profiles. Early biochemical screening may help identify women at risk for hypertensive disorders of pregnancy.

Introduction: Musculoskeletal disorders of the upper limb are an important occupational health issue among professional drivers repetitive steering, vibration exposure, and poor posture may predispose them to chronic elbow pain. Aim: To assess the prevalence, severity and associated risk factors of elbow pain among drivers attending the OPD at Kamla Nehru Hospital, Pune. Materials and Methods: This cross-sectional study was conducted among 45 drivers attending the OPD at Kamla Nehru Hospital over three months. Data regarding demographic details, years of driving, hours spent driving per week, type of vehicle, handedness, and pain characteristics were collected using a structured questionnaire. Clinical examination and Patient-Related Elbow Evaluation (PREE) and Single assessment numerical evolution (SANE) scores were recorded. Data were analysed using descriptive statistics, correlation, and logistic regression. Ethical approval was obtained from the Institutional Ethics Committee on 16/04/2025. Results: The mean age of participants was 46.9 +/ – 13.7 years, with 86.7% males and 91% driving manual vehicles the main pain severity was 5.1 +/-3.1 PREE total 55.18 +/ – 27.49 and SANE 39.8 +/- 25.89 indicating the moderate functional disability. Weak correlations were noted between the pain severity and both years of driving (r = 0.007) and weekly driving hours (r= – 0.214). Logistic regression did not show statistically significant predictors of the severe pain, though trends indicated higher exposure increases risk. Prevalence= 45/458×100 = 9.82%. Conclusion: Elbow pain is a prevalent occupational health problem among drivers with moderate disability levels. The study highlights repetitive use, prolonged driving hours and manual vehicle operation as key risk contributors. Ergonomic education, postal correction and regular exercise are essential preventive measures.

Background: Sexual harassment in the workplace is a pervasive issue that undermines professional integrity, workplace safety, and mental well-being. The Prevention of Sexual Harassment (POSH) Act, 2013¹, was enacted in India to ensure gender equity, dignity, and a safe working environment for all employees. Despite legislative frameworks, awareness and understanding among future healthcare professionals remain limited. Objectives: This study aimed to assess the knowledge, attitude, and practices regarding the POSH Act among undergraduate medical students, identifying gaps in awareness and recommending educational interventions. Methods: A descriptive cross-sectional study was conducted among 502 MBBS students at Dhanalakshmi Srinivasan Medical College and Hospital (DSMCH), Perambalur, Tamil Nadu. Data were collected using a structured, pre-tested questionnaire based on the POSH Act provisions and analyzed using descriptive statistics. The results were compared with findings from previous studies conducted in India and abroad. Results: Out of 502 participants, 315 (62.7%) were females and 187 (37.3%) males. A majority (91.9%) correctly identified the definition of sexual harassment, and 93.7% agreed that it could affect any gender. About 77.4% believed sexual harassment is a problem in medical institutions. Awareness of the Internal Complaints Committee (ICC) was moderate (58.5%), while 66.5% stated they would feel comfortable reporting incidents. Fear of retaliation (27.3%) and social stigma (31.2%) were the most cited barriers to reporting. A large majority (85.9%) expressed interest in attending workshops on POSH awareness. Conclusion: The study highlights a good baseline awareness about sexual harassment and the POSH Act among medical students but reveals gaps in practical knowledge and reporting confidence. Institutional sensitization programs and periodic legal education sessions are recommended to strengthen compliance and foster safer educational environments.

Background: Port site hernia (PSH) remains a known but uncommon complication after laparoscopic cholecystectomy (LC), most frequently occurring at the umbilical trocar site. Whether fascial closure of a 10 mm umbilical port is mandatory continues to be debated. Objective: To assess the safety and incidence of umbilical port site complications following laparoscopic cholecystectomy without fascial sheath closure in an Indian tertiary care setup. Methods: This prospective observational study included 198 patients who underwent elective LC without fascial closure of the 10 mm umbilical port between January 2023 and December 2024. All patients were followed clinically and, when indicated, by ultrasonography for one year to detect PSH or any port site complications. Results: None of the patients developed a port site hernia during the one-year follow-up period. Minor seroma formation was observed in 6 patients (3.03%) and superficial surgical site infection in 4 patients (2.02%), all resolving with conservative management. Conclusion: Omission of fascial closure at the 10 mm umbilical port appears safe in selected Indian patients undergoing LC with bladeless trocars. This technique can minimize operative time and avoid closure-related morbidity without increasing the risk of PSH.

Introduction: Some resistant clubfoot respond to repeat casting by Ponseti method. However most cases will not respond to manipulation and casting. In these cases there have been bony changes and contracture in soft tissues where casting alone doesn’t help. Methods: Limited postero-medial soft tissue release with cuboid osteotomy with application of Ilizarov are expected to yield good results. A retrospective study was carried out at a tertiary level centre of India collecting data of cases treated between Sept 2021 and Aug 2025. Results: There were 11 cases. There were 8 males and 3 females. Age range was 6 years to 11 years. Mean follow-up period was 35 months. There was no relapse till last follow up. Conclusion: This method of minimal soft tissue release combined with cuboid osteotomy and ilizarov fixator is good alternative to other methods of treating resistant Clubfoot.

Introduction: Teenage pregnancy is a significant public health concern globally, associated with higher risks of adverse maternal and perinatal outcomes. Adolescents often face biological, social, and economic challenges that influence obstetrical behaviour and pregnancy outcomes. Understanding these associations is crucial for improving maternal and child health. Objective: To assess maternal and perinatal morbidity and analyze obstetrical behaviour among teenage mothers compared to adult mothers. Results: Among 100 teenage mothers, 42% were 16–17 years and 58% were 18–19 years; 38% had primary, 45% secondary, and 17% higher education. Low-income status was reported in 56%, rural residence in 64%, and early marriage in 72%. Maternal complications included anaemia (58%, p = 0.03), preeclampsia (14%, p = 0.04), and prolonged labour (12%, p = 0.05). Antenatal care was suboptimal, with 44% attending ≥4 visits (p = 0.02) and 36% initiating care in the first trimester (p = 0.03); institutional delivery occurred in 82% and skilled attendance in 78% (p = 0.04). Perinatal outcomes showed preterm birth (16%, p = 0.04), low birth weight (22%, p = 0.03), and NICU admission (14%, p = 0.05), while stillbirth (2%, p = 0.56) and neonatal death (1%, p = 0.67) were low. Normal vaginal delivery was most common (68%, p = 0.18), with assisted vaginal delivery at 10% (p = 0.27) and caesarean section at 22% (p = 0.54). Conclusion: Teenage pregnancy is associated with increased maternal and perinatal morbidity and suboptimal obstetrical behaviour. Enhanced health education, targeted antenatal care, and social support programs are essential to reduce adverse outcomes in this vulnerable population.

Background: The aim of the study is to compare the surgical outcomes of endoscopic versus microscopic myringoplasty. And to assess the advantages and disadvantages of each approach. Material and Methods: This is a comparative study carried out in the department of otorhinolaryngology at Malla Reddy Medical College for Women, Hyderabad, from November 2022 to July 2024. Sixty cases with tubo-tympanic type of chronic otitis media aged between 15-60 years were included in the study. They were randomly allocated into two equal groups to undergo myringoplasty under local anaesthesia either the endoscopic or microscopic approach. All the patients were followed up on 7^th post-operative day, 1 and 3 months after surgery. Results: The hearing improvement between the two study groups was not statistically significant (p=0.876). Graft uptake rate was same in the both groups (p = 0.542). The average operating time was 120 minutes for microscopic and 93 minutes for endoscopic surgery. The difference in the operating time may depend upon the surgeon and his/her expertise, however it is the general observation that time taken in the endoscopic group is significantly lower. The post-operative complications in both the groups were not statistically significant. Conclusion: Both endoscopic and microscopic ear surgeries yielded similar results in terms of graft uptake, hearing improvement and post-operative complications. However, the endoscopic approach was associated with a significantly shorter operative time, may provide additional logistical benefits, making it a valuable alternative in modern otologic practice.

Background: Percutaneous nephrolithotomy (PCNL) has long been considered the gold standard for the treatment of large renal calculi, typically those exceeding 2 cm in diameter. However, advancements in endoscopic technology have led to the evolution of retrograde intrarenal surgery (RIRS), particularly with the introduction of flexible and navigable suction ureteral access sheaths (FANS-RIRS). This less invasive approach has expanded its applicability, prompting a re-evaluation of optimal treatment strategies for intermediate-sized renal stones. The comparative effectiveness and safety of PCNL versus FANS- RIRS for stones ranging from 2 to 3 cm remain a subject of ongoing clinical interest and debate. Objective: This prospective randomized controlled study aimed to compare the efficacy, safety, and cost- effectiveness of PCNL against FANS-RIRS for the management of solitary renal stones measuring between 2 to 3 cm. Methods: A prospective, randomized controlled trial was conducted over a two-year period, enrolling 75 patients in each treatment arm. The primary outcome measure was the stone-free rate (SFR) at 6 to 8 weeks post-procedure, assessed by non-contrast computed tomography, defined as the absence of residual stone fragments greater than 2 mm. Secondary outcomes included operative time, length of hospital stay, postoperative pain scores (Visual Analog Scale), intraoperative blood loss (haemoglobin drop), overall complication rates (Clavien-Dindo classification), and direct medical costs. Sample size calculation was performed to ensure adequate statistical power. Results: The stone-free rate at 6 to 8 weeks was comparable between the FANS-RIRS group (88.0%) and the PCNL group (90.7%) (p = 0.58). Mean operative time was significantly longer for FANS-RIRS (85.5 ± 15.2 minutes) compared to PCNL (60.1 ± 10.5 minutes) (p < 0.001). Conversely, patients in the FANS- RIRS group experienced significantly shorter hospital stays (1.2 ± 0.5 days vs. 3.5 ± 1.0 days, p < 0.001), less postoperative pain (VAS score 2.5 ± 0.8 vs. 6.8 ± 1.5, p < 0.001), and a smaller haemoglobin drop (0.6 ± 0.2 g/dL vs. 2.1 ± 0.8 g/dL, p < 0.001). The overall rate of Clavien-Dindo ≥ Grade II complications was lower in the FANS-RIRS group (2.7%) compared to the PCNL group (9.3%) (p = 0.085). Direct medical costs were higher for FANS-RIRS. Conclusion: FANS-RIRS demonstrates comparable stone-free rates to PCNL for 2-3 cm renal stones, coupled with significant advantages in terms of reduced pain, less bleeding, shorter hospital stays, and lower major complication rates [1–3, 11, 16–18]. While operative time and direct medical costs may be higher, these findings suggest that FANS-RIRS represents a safe and effective alternative to PCNL, particularly for patients who may benefit from a less invasive approach and faster recovery.

Background: Plantar fasciitis occurs due to degeneration of plantar fascia by repeated trauma at its origin; such a pathological condition needs to be treated. Method: Out of 90 (ninety) patients, 45 patients were injected corticosteroid 2ml (8 mg) of corticosteroid along with 0.5 ml of plain 2% xylocaine using a 2 G wide-bore needle. PRP (platelet-rich plasma) was prepared from the blood drawn from the cubital vein with the help of a BD Vacutainer Eclipse in three BD Vacutainer tubes, which are 2.7 ml tubes that contain 0.35 ml of 3.2% sodium citrate as an anticoagulant. Blood was centrifuged twice, the first time at 1200/rpm, second time at 2400 rpm. The platelets were checked randomly by a pathologist using a Neubauer chamber or autoanalyzer. PRP was injected at the tenderness site after injecting 2% of xylocaine with 20 G. Gauze needle and follow-up were done for a week, the 6th week, the 3rd month, and the 6th month, and outcomes of results were noted. Results: Clinical manifestations were VAS. Baseline score: 7.13 in the PRP group, 7.30 in the steroid group. The baseline AOFAS was 53 (SD ± 4.7) in the PRP group and 55.2 (SD ± 3.20) in the steroid group. The VAS score at the 6th week was 2.62 in the PRP group and 1.88 in the steroid group; at the 3rd month, it was 1.90 in the PRP group and 2.80 in the steroid group; and at the 6th month, it was 1.42 in the PRP group and 3.70 in the steroid group. AOFAS scores were highly significant (p<0.001) at 6 weeks, 3 months, and 6 months. Conclusion: It is concluded that, corticosteroid therapy is more effective for short-duration relief, but PRP therapy is more effective for long-term relief.

Background: Postoperative cases of abdominal surgeries often cause discomfort, ileus, lengthy hospital stays and slow recovery. Multimodal Enhanced Recovery after Surgery (ERAS) protocols were developed in the 1990s to reduce surgical stress & for speedy recovery. ERAS has global acceptance, however regional studies on its abdominal procedure efficacy are rare. This study examined how ERAS improved surgical outcomes in a high-volume speciality hospital. Methods: This retrospective study was conducted from January 2025 to June 2025 at ESIC Medical College and hospital, Bihta, Patna, including 100 patients undergoing elective abdominal surgeries. Patients were divided into two groups: 50 managed with ERAS protocols and 50 with conventional perioperative care. Data were collected on demographics, comorbidities, postoperative pain scores, complications, hospital stay duration, readmission rate, and functional recovery parameters. Results: Baseline characteristics were comparable between groups. The ERAS group had a considerably lower average hospital stay (4.2 ± 1.3 days) compared to the standard group (7.1 ± 1.8 days) (p<0.001). In comparison to the conventional group (5.4 ± 1.2; p<0.001), the ERAS group reported lower pain scores on Day 1 (3.1 ± 0.8). ERAS patients had 10% postoperative complications, compared to 22% in the control group. Less than 4% of ERAS patients needed readmission, compared to 10% overall. Functional recovery favoured ERAS, with sooner eating (18.5 vs. 36.8 hours), walking (22.4 vs. 48.6 hours), bowel motions (2.1 vs. 3.8 days), and returning to routine activities (8.3 vs. 12.5 days; all p<0.001). Conclusion: ERAS protocols significantly improve postoperative outcomes in abdominal surgeries by reducing hospital stay, complications, pain, and time to functional recovery compared to conventional care. These findings underscore the importance of adopting ERAS as a standard of care in abdominal surgical practice. Larger multicenter prospective studies are necessary to further validate these outcomes and address implementation barriers in diverse clinical settings.

Background: Cytopenias are common presentations in clinical practice and may reflect a wide spectrum of underlying hematologic and non-hematologic disorders. Bone marrow examination remains the gold standard investigation to resolve the etiology of unexplained cytopenias. This study aims to analyze morphological patterns in bone marrow aspirate and biopsy in patients presenting with one or more peripheral cytopenias at a tertiary care teaching hospital in India. Materials and Methods: A retrospective review was conducted of bone marrow reports from January 2018 to December 2022. Inclusion criteria were patients aged ≥1 year who underwent bone marrow aspiration and/or biopsy for evaluation of cytopenia(s). Clinical data, complete blood counts, peripheral smear findings and marrow morphology (cellularity, lineage distribution, dysplasia, infiltration, fibrosis, hemophagocytosis, erythroid changes) were recorded. Cases were categorized into major diagnostic groups: aplastic/hypoplastic marrow, megaloblastic changes, marrow infiltration (leukemia, lymphoma, metastasis), hemophagocytic syndromes, myelodysplastic changes, sideroblastic picture, hypersplenism-related, and others. Statistical analysis included descriptive statistics, chi-square tests, t-tests and logistic regression for predictors of marrow hypocellularity and malignant infiltration. P value <0.05 was considered significant. Results: A total of 612 patients met inclusion criteria. Median age was 34 years (range 1–86); 56% were male. Presentation: pancytopenia in 38% (233/612), bicytopenia in 29% (178/612), isolated anemia in 21% (129/612), thrombocytopenia in 8% (49/612), and isolated leukopenia in 4% (23/612). Major marrow diagnoses were: megaloblastic anemia 29.7% (182/612), aplastic/hypoplastic marrow 19.1% (117/612), acute leukemia 11.1% (68/612), marrow infiltration by metastatic solid tumor 6.4% (39/612), myelodysplastic syndrome 5.6% (34/612), hemophagocytic lymphohistiocytosis (HLH) 4.1% (25/612), hypersplenism-associated changes 4.6% (28/612), sideroblastic changes 2.0% (12/612), and other causes 17.4% (107/612). Hypocellular marrow was significantly associated with pancytopenia (OR 3.2; 95% CI 2.1–4.9; p<0.001). Age >50 years and presence of peripheral blasts predicted malignant infiltration (adjusted OR 4.7; 95% CI 2.6–8.5; p<0.001). Bone marrow biopsy provided additional diagnostic yield in 11% of cases where aspirate was inconclusive. Conclusion: Megaloblastic anemia and aplastic/hypoplastic marrow remain the two most frequent marrow morphologies among cytopenic patients in our tertiary care center. Acute leukemia and marrow infiltrative disorders constitute an important minority, particularly in older patients and those with peripheral blasts. Bone marrow biopsy complements aspirate and increases diagnostic yield. Awareness of local epidemiologic patterns assists clinicians in prioritizing investigations and initiating timely, appropriate therapy.

Background: Thyroid nodules is one of the important health issues addressed globally. Distinguishing benign and malignant thyroid lesions by histopathological examination remains a diagnostic challenge. This review provides a comprehensive account of various markers useful in identification of thyroid tumours. Objectives: To systematically review the diagnostic performance of various immunohistochemical markers that are used in differentiating benign from malignant thyroid lesions. Methods: A systematic search of PubMed and Google scholar was conducted for studies done on IHC expression in thyroid pathology, published between 2010 and 2024. Based on the inclusion and exclusion criteria, twenty studies were finally included in the review. Data on study characteristics and sensitivity and specificity of IHC markers were collected and analysed. Results: Comparative statistics of various studies showed that Galectin3, CK19, HBME1, TROP2 & CD56 were the most useful markers in differentiating benign and malignant thyroid nodules. They were found to achieve improved sensitivity, specificity and diagnostic accuracy when used in two marker combinations. Conclusion: Galectin3, CK19, HBME1, TROP2 & CD56 are valuable IHC markers in thyroid pathology. Combined marker panels improved diagnostic performance.

Background: Inflammatory Bowel Disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is a long-lasting gastrointestinal condition that often brings along psychological challenges. This study set out to assess how common anxiety and depression are among Indian patients with IBD, while also looking into how these issues relate to the type of disease, its severity, how widespread it is, how long it’s been present, and the treatments being used. Methods: We conducted a cross-sectional study involving 100 IBD patients (87 with UC and 13 with CD) at a specialized care center. To evaluate their mental health, we used the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D). We also examined various clinical factors, such as disease type, extent, severity, duration, and the use of steroids, to see how they correlated with mental health issues. Results: In our study group (with a male-to-female ratio of 1.3:1), we found that 30% of participants showed signs of depression, while 15% exhibited symptoms of anxiety. Interestingly, we didn’t find a significant link between mental health issues and the type of IBD, the extent of the disease in UC, its severity, or how long it had been present. However, patients with stricturing CD had notably higher rates of depression and anxiety compared to those with non-stricturing, non-penetrating CD, although this finding is somewhat limited due to the small number of CD patients (n=13). We also noted that patients on corticosteroids reported higher levels of psychiatric symptoms, but this wasn’t statistically significant. Conclusion: Depression and anxiety are prevalent among Indian IBD patients, highlighting the psychological toll that chronic inflammatory diseases can take. It’s crucial to incorporate routine mental health screenings at the time of diagnosis and to consider early psychiatric referrals as part of the overall management of IBD.

Background: Foreign body ingestion (FBI) and esophageal food impaction (EFI) are frequent emergencies that demand rapid triage and skilled endoscopic management. Epidemiologic patterns vary widely by age, object type, and setting, and data from resource-constrained regions of India remain sparse. Methods: We conducted a single-centre, cross-sectional observational study at the Department of Gastroenterology, MDM Hospital, Dr SN Medical College, Jodhpur (Western Rajasthan). After ethics approval, consecutive patients with suspected or confirmed FBI/EFI requiring endoscopic evaluation were enrolled through December 2024. Demographics, clinical features, radiography, procedural details, and outcomes were collected prospectively. Socioeconomic status (SES) used the Revised Kuppuswamy 2021 scale. Normality was assessed by Kolmogorov–Smirnov. Depending on distribution, we used t-tests or Mann–Whitney U for two-group comparisons; ANOVA or Kruskal–Wallis for ≥3 groups; and chi-square for categorical associations. Significance was set at p<0.05. Results: A total of 134 patients were analyzed. Continuous variables (age, time since ingestion, and procedure time) were non-normal except hemoglobin. Sedation was used predominantly in younger patients (Age: sedation vs no sedation, Mann–Whitney U p=0.000045). Procedure time differed by instrument (ANOVA p=0.019) and age differed by endoscopic location (ANOVA p=0.009). Endoscopic location strongly predicted removal success (χ² p<0.000001). Foreign body type associated with sedation (χ² p=0.0297) and with gastric ulcer (χ² p=0.0445); most other cross-tabs were not significant. Overall removal was high (>90%) with very low complication rates (bleeding rare). Conclusion: In this Western Rajasthan cohort, children predominated, coins and other blunt objects were common, and endoscopic removal was highly successful with minimal complications. Procedural efficiency varied by instrument choice, and success was strongly linked to endoscopic location. These findings reinforce guideline-concordant practice and provide region-specific epidemiologic and operative insights to guide triage, instrumentation, and counselling.

Background: Dermatologic complaints comprise a large share of ambulatory care, yet undergraduate (UG) exposure and specialty perceptions vary, shaping career intentions and preparedness. We assessed perceptions of dermatology as a subject and career among senior MBBS students in Indore, India. Methods: We conducted an analytical cross-sectional survey of Phase III MBBS students using a faculty-validated, semi-structured questionnaire covering curricular adequacy, learning modalities, perceived lifestyle/ competitiveness, and career intention. Descriptive statistics summarized responses. Group differences (intends dermatology vs no/unsure) used χ² tests and Welch’s t-tests. Multivariable logistic regression estimated adjusted odds ratios (aOR) for intention, entering a priori covariates (positive clerkship experience, perceived work–life balance, perceived competitiveness, prior elective/observership, mentorship, training phase, and sex). Results: Of 312 respondents (mean age 22.4±1.2 years; 47.4% female), 164 (52.6%) reported definite/probable intention to pursue dermatology. While most endorsed dermatology’s relevance, only 135/312 (43.3%) agreed UG clinical exposure was adequate. Agreement with favorable work–life balance was 187/312 (59.9%), and with “competitiveness limits feasibility” was 192/312 (61.5%). Compared with peers who were no/unsure, students intending dermatology more often endorsed favorable work–life balance (70.7% vs 48.0%, p<0.001) and had prior elective/observership (29.3% vs 9.5%, p<0.001), but were less likely to agree that competitiveness limits feasibility (56.1% vs 67.6%, p=0.038). In adjusted models, intention was independently associated with positive clerkship experience (aOR 4.09, 95% CI 2.44–6.86; p<0.001) and favorable work–life balance (aOR 3.04, 95% CI 1.80–5.14; p<0.001); perceived competitiveness showed an inverse association (aOR 0.49, 95% CI 0.29–0.82; p=0.007). Prior elective/observership also predicted intention (aOR 4.73, 95% CI 2.34–9.54; p<0.001). Sex and training phase were not significant. Conclusion: Among senior MBBS students, dermatology was viewed as highly relevant but UG clinical exposure was perceived as limited. Positive clerkship experience and perceptions of favorable work–life balance strongly increased specialty intention, whereas perceived competitiveness attenuated it. Enhancing supervised OPD exposure, case-based teaching, and mentorship may strengthen UG competence and enable informed specialty choice.

Background: Skin diseases are also some of the leading nonfatal morbidity in the world and highly prevalent in low-resource environments. In India, rural populations experience the obstacles to early diagnosis, evidence-based treatment, and prevention, excessive emphasis of which is put on wielding community knowledge, attitudes, and practices (KAP) to outcomes. In South Asia, the proportion of incident skin disease is high and dermatophytoses and bacterial infections as well as scabies are a significant contributor to disability. Methods: Our case was an analytical cross-sectional study (in three randomly selected villages of Sanwer block, Indore district, Madhya Pradesh, India) conducting it in October-December 2025. The participants were permanently settled, adult individuals (age = 18 years and above), and upon giving informed consent, they were interviewed using a predesigned and pretested semi-structured questionnaire which had been validated by the senate faculty. The study sampling was door to door (convenience) wherein field teams trained by the investigator conducted the investigation (Community Medicine and Dermatology). Institutional Ethics Committee (IEC) and Institutional Research Committee (IRC) gave the ethical approval. The data were summarized in the form of proportions and means and associations examined using chi-square tests; the significance level of p was below 0.05. Results: Out of 612 surveyed (51 per cent female; median age 39 years), the general KAP score (0 100) was 57.3 (SD 12.4). Those who had secondary or higher education and were in the upper four-fifths of the income group had greater knowledge and non-stigmatizing attitudes. Suitable skin-care practices (e.g., avoiding topical steroids using antifungal combinations; early care seeking) were also reported by 63 percent of all patients and disorderedly rising with education and income (p<0.001). KAP was also less pronounced in older people and uneducated individuals. Patterns Multivariate patterns indicated that education is the correlate of high KAP most strongly. Conclusion: KAP on dermatological conditions in rural Madhya Pradesh had significant socio-demographic patterns, especially on the lines of education and income. These gradients are projected on etiologic patterns of known epidemiology of dermatophytosis and scabies, as well as structural access control in rural India. The evidence supports the ideas of village-level education which is organised by ASHAs, supply-side stewardship which is against irrational topical steroid use and focused messages delivered to older adults and least educated individuals. The interventions suggested by integrating both primary and secondary care should be tested using longitudinal and implementation research in the future to change the community KAP and decrease disease burden.

Background: Chronic diabetic foot ulcers (DFUs) are a major complication of diabetes, leading to prolonged morbidity, infection, and amputations. Effective management remains challenging, particularly in resource-limited settings. Vacuum-Assisted Closure (VAC) therapy has emerged as a promising method that enhances granulation tissue formation, reduces bacterial load, and accelerates wound healing through controlled negative pressure. Aim: To evaluate the efficacy of Vacuum-Assisted Closure (VAC) therapy in promoting wound healing in chronic diabetic foot ulcers and to assess its impact on hospital stay, secondary procedures, treatment cost, and correlation with wound surface area. Methodology: A prospective study was conducted on 70 patients with chronic DFUs attending the Department of General Surgery, Narayana Medical College, and Nellore. Patients above 18 years without significant vascular or connective tissue disease were included. VAC therapy was applied at a continuous negative pressure of 125 mmHg with dressing changes every 48–72 hours. Healing rate, hospital stay, secondary interventions, and cost were analyzed using SPSS (version 22). Results: Of the 70 patients, 81.43% achieved complete healing while 18.57% required amputation. Mean healing time was 9.66 weeks, with an average hospital stay of 10.06 days and cost of ₹70,285. Larger ulcer size and advanced age correlated significantly with longer healing time and higher amputation rates (p < 0.001). Secondary procedures were required in 17.14% of cases. Conclusion: VAC therapy significantly improves healing rates, reduces hospital stays, and minimizes complications in chronic DFUs. Despite higher initial costs, its clinical benefits justify its use as a cost-effective wound management option in diabetic patients.

Background: Hearing loss impairs daily functioning. Diabetes mellitus may contribute to sensorineural hearing loss (SNHL) via cochlear microangiopathy and neuropathy. Evidence remains mixed, particularly for type 2 diabetes mellitus (T2DM). Objective: To compare the frequency and severity of SNHL in adults with T2DM versus non-diabetic controls and to examine associations with age, sex, duration of diabetes, and glycaemic control [i.e. HbA1c, fasting blood sugar (FBS), and 2-hour post-prandial blood sugar (PP2BS)]. Methods: We conducted a hospital-based comparative study including 180 participants aged ≤60 years (T2DM n=90; non-diabetic controls n=90). Pure-tone audiometry classified hearing as normal or SNHL and graded severity. Glycaemic indices were grouped as prespecified categories (HbA1c 6–7, 7–8, 8–9, 9–10, >10%; FBS 80–100, 101–125, ≥126 mg/dL; PP2BS <140, 140–199, ≥200 mg/dL). Diabetes duration was stratified as <10 vs ≥10 years. Group differences and trends were tested using chi-square; significance was set at α=0.05. Results: SNHL was more prevalent in T2DM than controls [80.0% (72/90) vs 41.1% (37/90); χ²=28.49, p<0.001]. Severity distributions were shifted toward moderate–profound loss in T2DM. Poorer glycaemic control correlated with greater severity: HbA1c (χ²=40.28, p=0.004), FBS (χ²=18.65, p=0.04), and PP2BS (χ²=34.45, p=0.0001). Longer diabetes duration (≥10 years) showed predominantly moderate–profound loss compared with <10 years. Age increased prevalence, while sex showed no significant association. Conclusion: Sensorineural hearing loss was significantly more common and severe in type 2 diabetes patients than in non-diabetics, correlating with poor glycaemic control and longer disease duration. Regular hearing evaluation and good diabetes management may help prevent or limit auditory damage.

Objectives: The present study was to assess the efficacy and safety of low dose mifepristone in treatment of adenomyosis and evaluate the effect of mifepristone on dysmenorrhea, dyspareunia, menstrual bleeding and the adverse effect of mifepristone. Methods: Group A (n=20) received 5 mg mifepristone daily and group B (n=20) received 5 mg mifepristone daily with a poor-effect levonorgestrel-releasing intrauterine device for 12 months. Pain severity was scored using a Visual Analogue Scale (VAS). The treatment was judged effective in improving dysmenorrhea when the VAS score decreased by more than 2 points. Uterine size was measured using transvaginal ultrasound (uterine volume = length × width × depth × 0.52). The thickness (in cm) of the endometrium (2 layers) was recorded using ultrasound. The level of serum CA125 was determined using ELISA. Haemoglobin, and estradiol level were routinely measured. Results: In group A, the menorrhagia of patients receiving mifepristone were markedly decreased after 6 months compared with the baseline (P <0.001). At 12 months of treatment, haemoglobin levels were remarkably different in group A compared with the group B (38.24 ± 21.01, n = 20; 5.80 ± 5.96, n = 20; P =0.037). The effective rates of improvement in dysmenorrhea in group A patients were 100% (20/20) and 100% (20/20) after treatment at 6 and 12 months, respectively. Conclusions: A 5 mg/day mifepristone regimen has demonstrated high efficacy in the treatment of adenomyosis, particularly in patients experiencing dysmenorrhea and/or menorrhagia, with a favorable safety profile and minimal adverse effects.

Background: Dacryocystorhinostomy (DCR) remains the gold standard procedure for treating nasolacrimal duct obstruction. Nasal pathologies such as septal deviation, turbinate hypertrophy, chronic rhinosinusitis, and nasal polyposis can affect surgical field visualization and postoperative ostium patency. Objective: To systematically evaluate and synthesize data from studies published between 2000 and 2025 assessing the impact of nasal pathologies on anatomical and functional outcomes following external and endoscopic DCR. Methods: Comprehensive searches were conducted across PubMed, Embase, Cochrane Library, and Scopus from January 2000 to October 2025. Eligible studies included randomized controlled trials, cohort studies, and case–control designs that reported DCR outcomes in patients with and without identifiable nasal pathologies. Data extraction adhered to PRISMA 2020 guidelines. Risk of bias was evaluated using the Newcastle–Ottawa Scale and Cochrane RoB 2.0 tool as appropriate. Quantitative synthesis employed a random-effects meta-analysis model to estimate pooled odds ratios (ORs) for surgical failure associated with nasal pathology. Heterogeneity was assessed using I² statistics, and publication bias was evaluated through funnel plot symmetry and Egger’s test. Results: A total of 22 studies encompassing 3,145 patients were included (external DCR: 1,742; endoscopic DCR: 1,403). The overall anatomical success rate was 93.2% in patients without nasal pathology compared to 82.7% in those with nasal pathology. The pooled odds ratio for DCR failure in the presence of nasal pathology was 1.94 (95% CI: 1.31–2.86, p = 0.001), indicating nearly double the risk of unsuccessful outcomes. Subgroup analyses revealed a stronger association for endoscopic DCR (OR: 2.28; 95% CI: 1.44–3.61) compared with external DCR (OR: 1.36; 95% CI: 0.88–2.10). Among specific pathologies, significant septal deviation and active chronic rhinosinusitis were most strongly linked to failure (pooled OR: 2.42 and 2.10, respectively). Heterogeneity across studies was moderate (I² = 47%). Funnel plot inspection and Egger’s test (p = 0.21) showed no major publication bias. Conclusions: The presence of untreated nasal pathologies significantly impacts the success of DCR, particularly in endoscopic approaches where intranasal anatomy is critical. Concurrent or preoperative correction of nasal abnormalities, such as septoplasty or sinus surgery, is associated with higher success rates and reduced revision rates. Surgeons should perform thorough preoperative nasal assessment and manage concurrent nasal disease to optimize DCR outcomes. Future prospective studies should aim for standardized outcome definitions and explore the cost-effectiveness of combined surgical strategies.

Introduction: Physiatrist, Rheumatologists and Orthopaedic Surgeons will either inject the corticosteroid suspension directly into the joint, or to be safer and more accurate, will use a separate syringe to first place the needle in an intraarticular position, drain any synovial fluid (SF), exclude infection, and then inject the corticosteroid intraarticularly. Aims: The study aims to compare the efficacy and safety of the Reciprocating Procedure Device (RPD) versus the conventional syringe for intra-articular corticosteroid injections, focusing on procedure time, patient-reported pain, and physician satisfaction. Materials & Methods: This is a randomized controlled trial (RCT), an interventional prospective study conducted over 1 year, from 1st July 2023 to 31st June 2024, with a total sample size of 80 patients. Result: In 80 patients, the Reciprocating Procedure Device (RPD) group had significantly shorter procedure time (1.28 ± 1.08 vs. 1.86 ± 1.26 minutes), lower patient pain (VAS 2.40 ± 2.17 vs. 4.73 ± 3.39), and fewer experiencing moderate to severe pain (17% vs. 55%) compared to the Conventional Syringe group. Physician satisfaction was higher with RPD (VAS 9.12 ± 0.80 vs. 5.59 ± 1.28), all statistically significant (p < 0.01). Conclusion: We concluded that in this RCT of 80 patients, baseline characteristics were comparable between groups. The Reciprocating Procedure Device (RPD) showed superior outcomes, with shorter procedure times, lower patient pain, fewer cases of moderate-to-severe pain, and higher physician satisfaction, demonstrating its clear advantage over the Conventional Syringe for intra-articular corticosteroid injections.

Introduction: Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disorder often resistant to conventional therapy. Refractory cases pose a therapeutic challenge, prompting investigation into novel treatments such as intralesional platelet-rich plasma (PRP) and topical corticosteroids like triamcinolone acetonide. Aims: This study aims to compare the therapeutic efficacy of intralesional PRP and topical 0.1% Triamcinolone Acetonide in managing recalcitrant Oral Lichen Planus. It focuses on assessing clinical and histopathological healing, anti-inflammatory effects, and the potential of PRP as a safe and effective alternative to corticosteroids. Materials & Methods: This quasi-experimental, comparative interventional study was conducted for a period of 1 year 6 months (October, 2022 to March, 2024). in the Department of Oral Pathology at Dr. R. Ahmed Dental College & Hospital, Kolkata, West Bengal, involving 35 participants aged 25–70 years who were clinically and histopathologically diagnosed with Oral Lichen Planus (OLP). Participants were assigned to receive either weekly intralesional PRP injections or twice-daily topical 0.1% Triamcinolone Acetonide for 8 weeks. Result: In this study, both PRP and Triamcinolone groups showed clinical and histopathological improvement in patients with Oral Lichen Planus. The most notable finding was a significant reduction in pain intensity (VAS) in the PRP group compared to the Triamcinolone group (p = 0.046). Improvements in Thongprasom clinical scores and histopathology were observed in both groups, but these differences between the two treatments were not statistically significant (p = 0.403 and p = 0.404, respectively). Conclusion: In conclusion, both PRP and Triamcinolone improved clinical and histopathological outcomes in Oral Lichen Planus. PRP provided significantly greater pain relief, suggesting it as a promising alternative or adjunct to corticosteroid therapy.

Background: Serum CPK levels are elevated by several neural mechanisms mediated by hypothalamic dopamine and by autonomic nervous system. Creatine Kinase is an enzyme found predominantly in the heart, brain, and skeletal muscles, and can be considered a marker of brain injury. It is important to understand whether psychiatric disorders show reliable alterations in creatine metabolism, which is not just solely due to increased activity. Methods: A cross-sectional hospital-based study was conducted at a tertiary psychiatric care center to measure and compare the serum Creatine kinase levels (CK-MM, CK-MB, CK-BB, and total CK Levels) across various psychiatric disorders. After sample size calculation, 80 participants were included, divided into 4 groups: 20 patients with Schizophrenia, Bipolar mania, and Depression each, and 20 healthy controls. Blood samples were collected and CK-NAC levels and fractions of CK were measured. Clinical assessment was done on BPRS scale. CK-NAC and CK Fractions were compared using appropriate statistical tests. Results: The findings revealed no significant difference with respect to socio-demographic profile between the groups except for education and occupation. CK-NAC values were seen to be significantly higher in bipolar mania compared to healthy controls (p value-0.039). There was no significant difference among CK-MM, CK-BB & CK-MB fractions among the 4 groups. Conclusion: Compared to healthy controls, patients with bipolar mania had higher CK-NAC values. No significant difference regarding the CK-fractions among the 4 groups was observed.

Background: Stroke is a major cause of death and disability worldwide, with an increasing incidence among young adults aged 14–45 years. In India, young strokes constitute 15–20% of first-ever strokes, often leading to significant personal and socioeconomic burden. Compared to older adults, young patients frequently present with diverse and uncommon etiologies such as cerebral venous sinus thrombosis (CVT), arterial dissection, and hypercoagulable states. Objectives: To evaluate the clinical and etiological spectrum of young stroke, identify associated risk factors, and assess short-term functional outcomes in a tertiary care hospital in Central India. Methods: A prospective observational study was conducted from July 2023 to December 2024, enrolling 50 consecutive young stroke patients (aged 14–45 years) presenting within seven days of onset and confirmed by neuroimaging. Clinical, demographic, and etiological data were collected. Stroke severity and outcomes were assessed using the NIH Stroke Scale (NIHSS) and Modified Rankin Scale (mRS), respectively. Data were analyzed using Jamovi version 2.3.28 software with Chi-square and Fisher’s exact tests. Results: The mean age was 32.3 ± 8.2 years; 60% were male. Ischemic stroke predominated (72%), followed by hemorrhagic stroke (16%) and CVT (12%). Large artery atherosclerosis (41.6%) and cardioembolism (22.2%) were the leading causes. Smoking (30%) was the most common risk factor (p = 0.049). Higher NIHSS and mRS scores were significantly associated with poor functional outcomes (p < 0.001). Conclusion: Young strokes show heterogeneous etiologies, with a notable burden from non-traditional causes such as CVT and hypercoagulable states. Smoking remains a key modifiable risk factor. Early etiological evaluation and risk factor control are essential to improve outcomes in this population.

Background: Seminars are an integral component of active learning strategies in medical education, encouraging critical thinking, interaction, and communication among students. This study was conducted to evaluate the effectiveness of seminars as a teaching–learning tool from the perspective of undergraduate medical students. Materials and Methods: A descriptive, cross-sectional, questionnaire-based survey was conducted among 150 second-year MBBS students of the Department of Microbiology, Mamata Medical College, Khammam. Data were collected using a pre-validated structured questionnaire assessing participation frequency, communication, critical thinking, personal development, and integration with other teaching methods. Responses were analyzed using descriptive statistics. Results: Among 150 participants, 61.3% were regular seminar attendees, and 85.96% agreed that seminars improved critical thinking and problem-solving abilities. About 76.84% felt seminars facilitated better interaction with faculty and peers, while 62.6% acknowledged enhancement in personal development and confidence. Additionally, 52.6% found seminars moderately effective in applying theoretical knowledge to practical scenarios, and 45.7% reported that seminars provided a supportive learning environment. Compared with other teaching methods, 35.3% rated seminars as more effective, and 42.7% rated them equally effective. Conclusion: The study highlights that seminars are a valuable and effective teaching–learning tool that fosters active participation, interaction, and self-confidence among medical students. However, greater emphasis on clinical application and structured facilitation could further enhance their educational impact.

Background: Safe transfusion is all about transfusion related infections (TTIs). National programmes of India have led to scale-up of voluntary non-remunerated blood donation and improvement in serological screening; however, local epidemiological trends among donors fluctuate depending on the region, donor type, and year within the calendar. The centre-specific estimates are useful for calibrating the selection and test strategies for donors. UNAids/WHO Updates Show Global Progress, but Heterogeneity in New Infections Persists. Methods: We performed a retrospective cross-sectional analysis of all the allogeneic donations in a North Indian tertiary care hospital blood center in the duration January 2020 to December 2024. Donors met normal medical eligibility demands and pre-donation counseling. HIV-1/2 screening was conducted using fourth generation chemiluminescent immunoassay (CMIA) with additional/confirmatory testing according to national recommendations. We extracted demographics, category – voluntary vs replacement – and first time vs repeat. The incidence was estimated as seropositivity among first-time donors; period seroprevalence was calculated in all of the donations. We evaluated trends using the Cochran-Armitage test and the multivariate logistic regression for modeling the predicted factors. Results: Among the 92,450 Donations, 146 were HIV-positive (circulating prevalence of HIV infection 0.158%). Available epidemiological data showed a decrease in the annual prevalence from 0.22% (2020) to 0.10% (2024) (p-trend<0.001). Estimates of incidence in the first-time donors were 0.19%. Replacement donations were found to have higher reactivity than voluntary donations (0.27% vs 0.11%). Replacement donation (adjusted OR [aOR] 2.43; 95% CI 1.76-3.36), first-time donation (aOR 1.82; 95% CI 1.33-2.51), and male sex (aOR 1.31; 95% CI 0.90-1.92; NS) were linked with reactivity, and prevalence was inversely associated with donation calendar year (aOR per year 0.83; 95% CI 0.74-0. Conclusion: HIV reactivity among screened donors in this tertiary care center was low and showed a significant decline over 5 years, which is consistent with national trends of decline. Our finding that the risk is persistently higher for replacement and first time donors offers a basis to preferentially focus on voluntary repeat donors and also to bolster predonation risk education and also keep using fourth-generation assays (and NAT where possible) in order to further reduce the window period risk. Local quality improvement issues should include conversion of replacement donors to repeat voluntary donors and improving counseling for first-time donors.

Background: Hemolytic anemias (HAs) are a heterogeneous group of disorders that are characterized by premature destruction of red blood cells (RBCs) with compensatory erythropoiesis. The lactose dehydrogenase (LDH), indirect bilirubin, haptoglobin, and reticulocytosis are commonly utilized markers, however, comparative behavior between the varied etiologies in routine practice have been constantly role inconclusive. Methods: Methods: We prospectively conducted an observational study using a tertiary academic centre for 18 months. Consecutive adults with hemolytic anemia were defined internally as auto-immune hemolytic anemia (AIHA), glucose-6-phosphate dehydrogenase deficiency (G6PDd), hereditary spherocytosis (HS) or paroxysmal nocturnal hemoglobinuria (PNH) and age/sex matched non-anemic controls were recruited. Inclusion criteria Hemoglobin (Hb) <12g/dl (women) or <13g/dl (men), laboratory evidence of hemolysis; main exclusion was: active bleeding or transfusion within 4 weeks. Standardized assays for complete blood counts, reticulocyte percentage, LDH, bilirubin fractions, haptoglobin and the plasma-free hemoglobin levels were performed. Direct antiglobulin test (DAT) and flow cytometry (CD55/CD59) were done where applicable. Multivariable linear and logistic models estimated factors associated with the severity of anemia (Hb <8 g/dL) and hyperhemolysis (LDH >=2* upper limit of normal). Results: By subgroup analysis, there were 176 HA and 52 controls, 78 AIHA, 44 G6PDd, 30 HS and 24 PNH. As compared with controls, patients had higher median LDH (505 vs 178 U/L), indirect bilirubin (2.4 vs 0.6 mg/dL), reticulocytes (5.8% vs 1.2%) and lower haptoglobin (undetectable in 61% vs 0%) (all p<0.001). In the etiology stratified analyses, PNH had the highest LDH (median, 832 U/L) and plasma-free hemoglobin, but AIHA had the highest reticulocytosis. Composite z-score (LDH z-score + inverse-haptoglobin z-score + indirect bilirubin z-score) Lopez-D poggio coefficiente Rookievev +- Severidentiferac era +- Rievaelieapum mihi peyd, – Insulin zores Unknowns: severanoma Phenotype discriminamped to severe anemia (adjusted OR 2.11 per SD, 95% CI 1.58-2.82). Conclusions Ursodiol was found to be DAT-positive, correlated to lower haptoglobin, and to higher unconjugated bilirubin, independently from Hb. Conclusion: Behavior of hemolytic markers is different across HA etiologies. Thus, a composite biomarker score, simple as the sum of several separate tests, improves discrimination and stratification for risk. Funding: Hopping recurrent work supplies are used to regarding standardized panels and functioning etiology-aware interpretation in diagnostic work-ups and monitoring such finding.

Background: Medical record keeping is a critical skill for healthcare professionals, ensuring accurate documentation, effective communication, and quality patient care. Despite its importance, the integration of medical record writing into medical education is often overlooked or inadequately addressed. Aims and Objectives: The objective of this project was to evaluate the impact of including formal training on medical record writing in the Phase 3, Part 1 MBBS curriculum. The evaluation was focused on the student’s understanding of medical documentation, their ability to maintain accurate and comprehensive records, and their perception of the training’s utility in clinical practice. Material and Methods: This Prospective Interventional study was done on 100 medical students of phase 3-part 1 M.B.B.S of C.I.M.S. Chhindwara, MP, India, over 6 months duration, after approval from Institutional ethics committee and written informed consent from participants. Key components of the evaluation included the assessment of student’s baseline knowledge and skills in medical record writing before the training using a curated Pre-test in google form. Implementation of structured training sessions on proper medical record documentation techniques through a curated lecture. Reassessment of student’s baseline knowledge and skills in medical record writing after the training using a curated Post-test in google form and evaluation of student’s progress by comparing the Pre-test and Post-test. Mean Pre-test score of every student will be compared with the mean post-test scores using paired t-test. Results: The pre-test mean score was 44.29 (SD = 7.96), while the post-test mean score increased significantly to 52.85 (SD = 6.21). Statistical analysis using a paired t-test revealed a t-value of 8.2746 with a p-value of 0.0001, indicated that the improvement in scores was extremely statistically significant. These results demonstrate that the training intervention had a positive and substantial impact on the students’ medical record-writing skills. Conclusion: This study demonstrated the effectiveness of structured training in medical record writing for Phase-3 Part-1 M.B.B.S. students. The significant improvement in post-test scores highlighted the impact of such an intervention in enhancing students’ knowledge and skills in clinical documentation. The findings emphasized the need to formally integrate medical record writing training into the undergraduate medical curriculum. Doing so will not only improve student’s competency in maintaining accurate and comprehensive medical records but also contribute to better communication, continuity of care, and medico-legal preparedness in their future clinical practice.

Background: Storage lesions in packed red blood cells (PRBCs) represent biochemical and morphological changes that occur during hypothermic storage, potentially affecting transfusion efficacy. Complete blood count (CBC) indices may serve as simple markers for assessing storage quality. Methods: This cross-sectional study analyzed 180 PRBC units stored at 2-6° Cover 35 days. Units were categorized into three groups based on storage duration: Group A (1-14 days, n=60), Group B (15-28 days, n=60), and Group C (29-35 days, n=60). CBC parameters including hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW) were measured using automated hematology analyzers. Biochemical markers of hemolysis including free hemoglobin and potassium levels were also assessed. Results: Mean hemoglobin showed minimal variation across groups (Group A: 18.4±1.2 g/dL; Group B: 18.1±1.3 g/dL; Group C: 17.8±1.4 g/dL, p=0.041). MCV increased significantly with storage duration (Group A: 88.3±3.1 fL; Group B: 91.7±3.4 fL; Group C: 95.2±4.1 fL, p<0.001). RDW demonstrated progressive elevation (Group A: 13.2±1.1%; Group B: 14.8±1.3%; Group C: 16.9±1.6%, p<0.001). Free hemoglobin levels correlated strongly with storage time (r=0.78, p<0.001). Significant correlations were observed between RDW and free hemoglobin (r=0.72, p<0.001) and between MCV and storage duration (r=0.68, p<0.001). Conclusion: CBC indices, particularly RDW and MCV, demonstrate significant correlations with storage duration and hemolysis markers, suggesting their potential utility as accessible indicators of storage lesions in PRBCs.

Chronic inflammation without resolution leads to perforation of the TM. In the absence of cholesteatoma, formation this perforation is generally in the tense portion of the TM and does not involve the tympanic ring. The margins of the perforation are originally lined with granulation but eventually become lined with squamous epithelium. It was a descriptive cross-sectional study of hundred patients with CSOM of all age groups and both sexes, attending the Out Patient department and those admitted in Otorhinolaryngology wards. Patients were selected randomly for the study. Out of 100 patients examined and analyzed, CSOM is found common in the age group 6-20 years (62%) and least number of patients were found in the age group 31-50 years (10%). A total of (22%) were found in the age group 21-30 years and (06%) in 0-5 years. The most number of patients according to age group (62%) goes in accordance with the student population (65%). Out of 100 patients examined and analyzed of the patients with CSOM are with Tub tympanic disease (88%) and (12%) were with Attico antral disease.

Background: Otoscopy remains the gold standard for ear examination but is not always easily available in rural settings. With the fast pace of development in smartphone technology, there is now a readily available simple attachment that can be fitted over a phone camera and could potentially serve as an alternative. Objective: The purpose of this study is to examine patient acceptance of smartphone-based otoscopy (SBO) and compare it to traditional otoscopy in identifying common ear conditions. Methods: Over the course of three months, a prospective study was conducted in the ENT outpatient department.  Both standard otoscopy and SBO were used to examine 120 patients.  Two ENT specialists evaluated each ear separately.  Calculations were made for sensitivity, specificity, and method-to-method agreement.  A quick Likert questionnaire was used to gather patient input. Results: Compared to the standard method, SBO had a 91.2% sensitivity and an 89.5% specificity in identifying ear pathology.  There was significant inter-observer agreement (κ = 0.82).  Because they could see their ear images directly, patients expressed great satisfaction (average score 4.6/5). Conclusion: In summary, SBO seems to be a workable and widely recognized substitute in standard clinical practice, particularly in outreach or teleconsultation contexts. Before it can be widely used as a screening tool, more extensive validation studies are required.

Background: Self-medication (SM) is a widespread practice with significant pharmacological and public health risks, including adverse drug reactions, treatment failure, and antimicrobial resistance (AMR). Urban slum populations, characterized by limited healthcare access, economic hardship, and low health literacy, are particularly vulnerable to inappropriate SM. This study aimed to assess the prevalence and determinants of SM practices in an urban slum community, focusing on pharmacological factors such as drug class preference, information sources, and perceived efficacy. Methods: A community-based, cross-sectional study was conducted among 800 systematically selected households in a major urban slum in Telangana. Data were collected via face-to-face interviews using a pre-validated, semi-structured questionnaire. Variables included demographic data, SM prevalence in the past six months, ailments treated, drug class (per ATC classification), and perceived pharmacological factors. Data were analyzed using descriptive statistics, Chi-square tests, and multivariate logistic regression. Results: The six-month prevalence of SM was 78.5%. Common ailments treated were fever (45.1%), minor pain (38.2%), and cough/cold (30.4%). Frequently used drug classes were Nervous System drugs (analgesics/antipyretics, 52.1%) and Anti-infectives (35.5%). Key determinants were prior successful drug use (AOR 3.12; 95% CI: 2.15–4.52), perceived mild illness (AOR 2.85; 95% CI: 1.98–4.10), and easy drug access (AOR 2.55; 95% CI: 1.76–3.70). Notably, 42% of antibiotics were used for presumed viral infections, with 65.8% obtained without prescription. Conclusion: SM is highly prevalent in urban slums, driven by perceived efficacy and easy drug access. Unsupervised antibiotic use for mild illnesses highlights an urgent need for stricter drug regulation, public education, and improved pharmaceutical guidance.

Background and Aims: Hyperbaric 0.75% ropivacaine has been widely used nowadays due to early recovery and better safety profile. We planned this study to compare the effect of intrathecal hyperbaric 0.75% ropivacaine and hyperbaric 0.5% bupivacaine in spinal anesthesia for lower limb orthopedic surgeries to evaluate effect on post spinal hypotension, sensory motor block characteristics and adverse effects. Materials and Methods: 170 Patients were randomly allocated into 2 groups of 85 patients each in Group B and R to receive subarachnoid block with 2.8 ml (14 mg) of 0.5% hyperbaric bupivacaine and 2.8 ml (21 mg) of 0.75% hyperbaric ropivacaine, respectively. The primary outcome measured was the incidence of hypotension. The secondary outcomes measured were vasopressor requirement, onset and duration of sensory‐motor block, peak sensory level attained, degree of motor block, hemodynamic profile and adverse effects. P < 0.05 was considered statistically significant. Results: Group R patients had significantly lower incidence of hypotension (23.52 % vs 49.41%, p=0.000) and bradycardia (3.5% vs 11.76%, p=0.043) compared to group B. The mean time for the onset of sensory‐motor block was faster in Group B. The duration of analgesia and sensory and motor block duration were lesser in ropivacaine group. The patients in ropivacaine group exhibited a lesser degree of motor block as compared to bupivacaine group. Median peak sensory level and hemodynamic parameters in both groups were statistically comparable. Conclusion: Despite a slower onset time of block and reduced duration of analgesia, intrathecal hyperbaric ropivacaine provides a better alternative to intrathecal hyperbaric bupivacaine for lower limb orthopedic surgeries by providing a shorter duration of sensorimotor block, a lesser degree of motor block, and a stable hemodynamic profile, thus allowing early ambulation.

Background: Chronic dacryocystitis is characterised by essential symptom of epiphora which have social impaction. Methods: This is prospective study involving patients with chronic dacryocystitis. 100 patients were included and all of them were subjected to endoscopic dacryocystorhinostomy. Results: The data shows the result of endoscopic DCR were good than the external -DCR. The value of chi square(x2) at p=.05 at 1df should be 3.84 significant difference in success rate. It was found that chi square (x2) at p=.05 at 1df was 3.073. The overall success rate in endoscopic-DCR in the present study was 95% whereas it was 86.6% in external-DCR. Conclusion: Endoscopic-DCR is better than external-DCR as it has much higher success rate (95%) than external -DCR (86.6%). It avoid external scar so cosmetically better acceptable. It also preserve the lacrimal pump mechanism.

Background: Dengue fever is a leading arboviral infection with increasing incidence and significant impact on children. Identifying clinical and laboratory markers that predict severity is essential for early management. This study evaluated the clinico-pathological and biochemical profile of children with confirmed dengue. Materials and Methods: A case series was conducted at Sri Chamundeshwari Medical College Hospital and Research Institute between August 2024 and August 2025. Children under 15 years with laboratory-confirmed dengue (NS1 antigen and/or IgM positive) were included. Clinical details, hematological indices, and biochemical parameters were recorded and analyzed to assess correlation with disease severity and outcome. Results: Fifty-two children were studied (mean age 7.1 years; 59.6% male). The majority had dengue without warning signs (61.5%), while 17.3% had warning signs, 9.6% developed dengue shock syndrome (DSS), and 11.5% were infantile dengue. The mean lowest platelet count was 16,724/µL, with no significant association with severity (p = 0.317). In contrast, hematocrit was significantly higher in severe cases (39.6% vs. 34.9%; p = 0.013). Most patients recovered (94.2% discharged), but poor outcomes clustered in severe groups, with one death (1.9%) in DSS and two discharges against medical advice. Conclusion: Hematocrit was the only laboratory marker significantly associated with disease severity, while platelet counts alone were not predictive. Clinical severity at presentation strongly influenced outcomes. Early recognition of rising hematocrit and timely supportive care are critical to reducing complications and improving survival in pediatric dengue.

Background: Chronic liver disease (CLD) contributes substantially to global morbidity and mortality, with cirrhosis being a leading cause. Alcohol is a major etiological factor in cirrhosis and is independently associated with pulmonary dysfunction. While overt pulmonary complications such as hepatopulmonary syndrome and portopulmonary hypertension occur in advanced disease, subclinical abnormalities can be detected earlier through pulmonary function tests (PFTs). Objectives: (1) To assess pulmonary function in chronic alcoholic patients without cirrhosis; (2) to evaluate pulmonary function in alcoholic cirrhotic patients without ascites; and (3) to compare these findings with non-alcoholic cirrhotic patients without ascites and healthy controls. Methods: A prospective observational study was conducted at IPGME&R, Kolkata, from February 2017 to July 2018, involving 60 subjects (42 males, 18 females; aged 18–65 years) divided into four groups: alcoholic non-cirrhotic, alcoholic cirrhotic, non-alcoholic cirrhotic, and healthy controls. Pulmonary parameters—FVC, FEV₁, FEV₁/FVC ratio, PEFR, and FEF₂₅–₇₅%—were measured using spirometry. Clinical evaluation, liver function tests, and ultrasonography confirmed diagnoses. Data were analyzed using SPSS v16 and GraphPad Prism, with p<0.05 considered significant. Results: Alcoholic non-cirrhotic patients exhibited significantly lower FVC, FEV₁, and PEFR compared with controls (p<0.005). Alcoholic cirrhotics showed further reductions in FEV₁, FEF, and PEFR, while non-alcoholic cirrhotics demonstrated only mild FEF decline. Differences between alcoholic and non-alcoholic cirrhotics were insignificant, except for lower PEFR in the alcoholic group. Conclusion: Chronic alcohol consumption independently impairs pulmonary function, even before cirrhosis develops. Spirometry can serve as a simple, cost-effective tool for early detection of pulmonary dysfunction in alcoholics and cirrhotic patients in resource-limited settings.

Background: Wound dehiscence is a significant postoperative complication leading to increased morbidity and mortality following exploratory laparotomy. Objective: To determine the incidence and risk factors contributing to wound dehiscence in patients undergoing exploratory laparotomy. Materials and Methods: This prospective clinical study was conducted on 40 patients at Narayana Medical College, Nellore, between June 2023 and June 2024. Clinical data, including anemia, hypoalbuminemia, obesity, and infection, were analyzed. Results: Wound dehiscence occurred in 12.5% of patients, more common in emergency laparotomies (13.6%) than elective cases (11.1%). Anemia, hypoalbuminemia, and obesity were statistically significant factors. Conclusion: Preoperative optimization and meticulous surgical techniques can minimize wound dehiscence incidence.

Staphylococcus aureus causes a plethora of infections owing to the varied armamentarium of virulence factors including various toxins and enzymes. This study was done to determine the antibiotic susceptibility profile, the prevalence of MRSA and MSSA, as well as compare the methods of detection of MRSA. Of 24,877 different clinical specimens studied, 698 i.e. 2.8% specimens were positive for staphylococci by culture, out of which 257 i.e. 6.8% were confirmed to be Staphylococcus aureus. Of these, 228 isolates were positive for bound coagulase; 256 isolates were positive for free coagulase and 257 for latex agglutination test. As compared to the latex agglutination test, slide coagulase test showed a sensitivity of 88.7% while that for tube coagulase test was 99.6%.  Latex slide agglutination test appeared as a reliable and rapid method for identifying S. aureus in the clinical laboratory. Total 40% of isolates i.e. 103 isolates were MRSA as determined by detection of mecA gene by PCR; cefoxitin disc test was 100% sensitive and specific while oxacillin screen agar test was 93.2% sensitive and 100% specific as compared to PCR for mecA gene. Cefoxitin disc test appeared to be not only sensitive but also a reliable test for detection of oxacillin resistance. High resistance to penicillin was seen, with only 6 isolates (2.3%) being susceptible to it; susceptibility to moxifloxacin was 94.2% and 66.9% to ciprofloxacin in MSSA strains. High level of susceptibility was noted with netilmicin both for MRSA and MSSA. Almost all isolates (99.6%) were susceptible to mupirocin, except one.

Background and Objectives: Dengue fever is a mosquito born, acute febrile Arbo-viral disease affecting the tropical and subtropical region of the world, which is spread by the Aedes aegypti mosquito.  It is endemic in many parts of India and epidemics are also frequently reported from various parts of India and abroad. Dengue virus infection has emerged as a notable public health problem in recent decades in terms of mortality and morbidity associated with it. Severity of dengue fever varies with simple febrile illness to life threatening dengue haemorrhagic fever and dengue shock fever. It is necessary to diagnose the infection early to prevent complications from it. Taking this into the consideration the present study is conducted to evaluate the role of NS1 antigen ELISA for early detection dengue fever and to know the seroprevalence of dengue fever by NS1 ELISA test. Association of NS1 antigen and platelet count and epidemiology of dengue fever in our region are also observed along with this. Material and Method: The present study has been carried out from July 2015 to November 2017 in Microbiology Department of a tertiary care hospital at Ahmedabad, Gujarat. Based on duration of illness, a total of 12,943 patients having signs and symptoms of Dengue with duration of illness less than 5 days were enrolled in this study. Blood sample of the patients were subjected to NS1 Ag ELISA test. From the total samples, 201 samples were also tested for real time Reverse Transcriptase Polymerase Chain Reaction (rRT PCR) to compare NS1 Ag ELISA with PCR for early diagnosis. Dengue positive cases were also looked for platelet count to know the association of platelets in early diagnosis. Result: Among the total 12943 patients, 1844 were found positive for NS1 antigen ELISA test. Maximum number of the cases were found in age group 11 yrs to 20 yrs (38.17%) in male patients. This test gives positive results from 1^st day of illness & maximum positivity was found on 3^rd day (31.78%). A total of 201 samples were tested by both methods e.g. NS1 antigen detection by ELISA and by Molecular method, NS1 ELISA gives 4 samples positive which were found negative by PCR, whereas PCR gives 5 samples positive which were negative by NS1 ELISA. Conclusion: Dengue fever, common in developing countries like India causes significant morbidity and mortality and presents like other viral illness. Hence these patients should be diagnosed early. Both the NS1 and RT-PCR are useful for early dengue diagnosis although in terms of cost, ease of performance and rapidity NS1 is superior test. This will turn help to decrease complications and reduce morbidity and mortality. Though the PCR is most sensitive method for diagnosis of dengue, it is costly, time consuming and cumbersome. It also requires expertise. An outstanding point of NS1 Ag ELISA test is its high specificity during early infection. So it can used as routine diagnostic test.

Aim and Background: In the present study was to investigate the efficacy of fat grafting for the closure of dry, small central perforations and assessing the graft uptake and hearing improvement. Temporalis fascia is the most common graft used for the closure of tympanic membrane perforation. However, for a dry, small central perforation the adipose tissue fat is a good alternative. Materials and Methods: Thirty patients aged between 18 to 50 years with small perforations underwent fat graft myringoplasty. Otoscopic examination of the tympanic membrane was done in the 1st, 3rd, and 6th post-operative months. Hearing evaluation was done pre-operatively and postoperatively. Evaluation was done based on the closure of the tympanic membrane perforation and hearing improvement. Results: The success rate was (86.7%) from the study group. The mean improvement in the air – bone gap was about 10 – 20 dB for the successful cases. Conclusion: Fat graft myringoplasty is an easy, simple and minimally invasive day care procedure for the repair of small tympanic membrane perforations with favorable hearing results.

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. The Lichtenstein tension-free mesh repair (open technique) and laparoscopic Trans-Abdominal Preperitoneal (TAPP) repair are two widely practiced approaches. One of the major postoperative complications affecting quality of life is chronic groin pain (inguinodynia). The incidence of inguinodynia is reportedly higher after open repair due to nerve entrapment and tissue handling. This study aims to compare the incidence and severity of inguinodynia and other postoperative outcomes in patients undergoing TAPP versus Lichtenstein hernioplasty. Aim: To compare postoperative inguinodynia, analgesic requirement, and complications between Lichtenstein tension-free mesh repair and TAPP laparoscopic hernioplasty. Methodology: This prospective clinical study was conducted at Narayana Medical College, Nellore, from June 2023 to June 2024, involving 50 patients aged 18–60 years diagnosed with unilateral inguinal hernia. Patients were divided equally into two groups: Group A (Lichtenstein repair) and Group B (TAPP repair). Postoperative parameters assessed included pain duration (using Visual Analogue Scale), analgesic dose requirement, hospital stay, operative time, and complications. Patients were followed up for six months, and chronic pain persisting beyond three months was recorded as inguinodynia. Results: TAPP repair demonstrated significantly lower postoperative pain (mean VAS 1.88 ± 0.60 vs 3.08 ± 1.04), reduced analgesic requirement (mean 1.96 ± 0.98 vs 3.44 ± 1.58), fewer complications (8% vs 36%), and shorter hospital stay (2 vs 3 days, p < 0.05). Operative time was slightly longer for TAPP (50–90 minutes) than for open repair (40–90 minutes). The incidence of chronic inguinodynia was markedly less in the TAPP group (p < 0.05). Conclusion: Laparoscopic TAPP hernioplasty offers superior postoperative outcomes compared to open Lichtenstein repair, with significantly lower inguinodynia, fewer complications, reduced analgesic use, and faster recovery. Hence, TAPP should be preferred for elective, uncomplicated inguinal hernia repairs where expertise and resources permit.

Background: Varicocele, characterized by abnormal dilation of the pampiniform venous plexus, is the most common correctable cause of male infertility, affecting up to 15% of the male population and up to 40% of men with primary infertility. Various surgical methods, including open and laparoscopic varicocelectomy, are used to treat this condition. While both approaches aim to improve sperm parameters and fertility outcomes, differences in operative efficiency, postoperative morbidity, and patient satisfaction warrant comparative evaluation. Aim: To compare the efficacy and safety of laparoscopic versus open varicocelectomy in terms of operative time, complications, postoperative pain, hospital stay, semen parameter improvement, recurrence, and patient satisfaction. Methodology: This hospital-based prospective study was conducted at Narayana Medical College, Nellore, from June 2023 to June 2024, including 50 patients diagnosed with varicocele. Patients were alternately allocated into two groups of 25 each: laparoscopic and open varicocelectomy. Parameters assessed included operative duration, intra- and postoperative complications, pain scores, hospital stay, recurrence, and semen parameters pre- and post-surgery. Statistical analysis was performed using paired t-tests and comparative analysis between groups. Results: Laparoscopic varicocelectomy demonstrated a shorter mean operative time (47 min vs 58.8 min), fewer complications, and shorter hospital stay (1.24 days vs 2.96 days). Postoperative pain and wound infections were significantly lower in the laparoscopic group. Both groups showed marked postoperative improvement in sperm count, motility, and morphology (p < 0.0001), with slightly superior gains in the laparoscopic cohort. Recurrence rates were comparable (12% vs 8%), while patient satisfaction was higher in the laparoscopic group (100% vs 64%). Conclusion: Laparoscopic varicocelectomy is a safe and effective alternative to open surgery, offering advantages in operative efficiency, recovery, and patient comfort, while achieving comparable fertility outcomes and recurrence rates.

Introduction: With a prevalence of 4–10% in the general population, thyroid nodules are a common clinical finding that rises with age and radiation exposure.  About 5–30% of thyroid nodules may be cancerous, despite the fact that the majority are benign. For proper therapeutic therapy, a precise and timely diagnosis is therefore essential. Aims: The study aims to evaluate the diagnostic utility of Fine Needle Aspiration Cytology (FNAC) supplemented with cell block technique in thyroid lesions and to correlate these cytological findings with histopathological results, thereby assessing their combined accuracy in providing a definitive diagnosis. Materials & Methods: This was a prospective observational diagnostic study conducted in the Department of Pathology, IIMSAR, Haldia, over a period of one year from 1st February 2023 to 31^st January 2024. A total of 100 patients with thyroid lesions were included in the study. Result: In our study, Cell Block consistently outperformed FNAC with significantly higher mean scores in cellularity (1.5 ± 0.51 vs. 1.0 ± 0), obscuring elements (2.0 ± 0 vs. 1.33 ± 0.48), degeneration (1.5 ± 0.51 vs. 1.33 ± 0.48), and cell architecture (2.0 ± 0 vs. 1.0 ± 0) (p < 0.001). The overall diagnostic score was significantly higher for Cell Block (7 ± 1.02) than FNAC (4.67 ± 0.96), highlighting its superior diagnostic accuracy. Conclusion: We came to the conclusion that the right lobe of the thyroid swells most in euthyroid females between the ages of 21 and 50.  By upgrading 5% of patients to definite malignancies and offering superior cellularity, clearer backgrounds, and enhanced architecture compared to FNAC, the cell block approach greatly increased diagnostic accuracy and improved diagnosis and management.

Background: One of the most common metabolic disorders in pregnant women is known as gestational diabetes mellitus (GDM). Is a pregnancy-related complication that is linked to maternal and perinatal complications of high severity? Early Morbidity can be minimized and better outcomes achieved through detection and multidisciplinary management. The present study compared maternal and perinatal outcomes in GDM cases that were identified and. treated at CIMS, Chhindwara, MP, and India. Methods: An observational study was planned to be performed at the Department of Obstetrics and Gynecology, CIMS, Chhindwara. Five hundred pregnant women had GDM based on the DIPSI classification (2-hour plasma glucose 140mg/dL after 75g of fasting). Load of oral glucose) were incorporated. The medical nutrition therapy was applied to the patients. (MNT), physical activity, and insulin therapy on demand. The outcomes were maternal and perinatal. Represented in the SPSS v25.0 and Chi-square and t-tests were used; p < 0.05 was taken into account. Significant. Results: Out of 500 women, the maternal age was 28.7 with a standard deviation of 4.2 years, and 62 percent of the women were primigravidae. Sixty-five percent needed insulin therapy. Cesarean was 62% and the significant maternal complications were preeclampsia (14%), polyhydramnios (8%), and preterm labor (9%). Neonatal complication (macrosomia 12%), preterm (10%), and NICU (18%). Neonatal hypoglycemia happened in 7 and stillbirths in 0.6. Positive glycemic control contributed greatly to the negative maternal and perinatal events (p < 0.05). Conclusion: Early identification and full treatment of GDM are significant in reducing maternal and child birth outcomes. Universal screening and following standard management protocols, including DIPSI, are effective measures in Indian environments which have limited resources.

Introduction: Anemia remains a global public health concern requiring accurate hemoglobin estimation for diagnosis and management. Automated hematologyanalyzers are gold standards but often impractical in resource-limited settings. The portable Hemocue Hb 301 offers a rapid alternative. Objective: This study aimed to compare hemoglobin concentration values obtained using the Hemocue Hb 301 device with those from the ERBA H-560 automated hematologyanalyzer in a clinical outpatient population. Methods: In this prospective cross-sectional study, 100 patients at a tertiary care hospital in Tamil Nadu, India, underwent hemoglobin testing by both Hemocue Hb 301 (capillary blood) and ERBA H-560 analyzer (venous blood). Statistical analyses included paired t-tests and Pearson’s correlation to assess agreement and accuracy. Results: The mean hemoglobin was 11.2 g/dL (SD 2.29) by Hemocue and 11.6 g/dL (SD 2.35) by ERBA H-560, with no statistically significant difference. A strong positive correlation was found (r = 0.971, p = 0.001), indicating high concordance. Conclusion: Hemocue Hb 301 is a reliable and practical point-of-care device for hemoglobin estimation, showing comparable accuracy to automated analyzers. It is suitable for anemia screening in settings lacking laboratory infrastructure, facilitating timely diagnosis and public health interventions.

Vitamin K, which includes phylloquinone (K1) and menaquinones (K2), has been recognized as a potentially important micronutrient in relation to diabetes mellitus. In addition to its well-known function in blood coagulation, vitamin K plays a role in glucose metabolism and insulin sensitivity through the activation of osteocalcin and the regulation of matrix Gla protein. Research indicates that a deficiency in vitamin K may lead to reduced insulin secretion and heightened insulin resistance, which could worsen complications associated with diabetes. Additionally, the anti-inflammatory and antioxidant effects of vitamin K may provide protective benefits against vascular damage linked to high blood sugar levels. Therefore, exploring the therapeutic potential of vitamin K supplementation to slow the progression and complications of diabetes mellitus is an area that requires further in-depth clinical research.

Introduction: Pancytopenia, the reduction of all three blood cell lines, presents with varied etiologies that differ regionally. In India, nutritional anemias, marrow failure, and hematological malignancies are most common. This study evaluated the etiological spectrum of pancytopenia and the diagnostic utility of peripheral smear versus bone marrow examination. Methods: A cross-sectional study was conducted in the Department of Pathology, Medical College & S.S.G. Hospital, Baroda, from October 2018 to October 2020. A total of 190 patients aged 17–76 years with pancytopenia were analyzed through clinical evaluation, hematological parameters, peripheral smear, and bone marrow examination. Results: Of 190 patients (M:F ratio 1.1:1), the 27–36 years group was most affected (28.9%). Weakness (28.9%) and fever (16.3%) were common symptoms; pallor was the leading sign (56.8%). Severe anemia and thrombocytopenia were frequent. Peripheral smear most often showed microcytic hypochromic anemia (43.7%). Bone marrow (n=58) revealed megaloblastic anemia (18.9%), aplastic anemia (17.2%), dimorphic anemia (12.1%), and acute leukemia (8.6%). Smear correlated well with nutritional anemias but marrow was essential for marrow failure and malignancies. Conclusion: Megaloblastic anemia remains the leading and reversible cause of pancytopenia in India. Peripheral smear aids initial assessment, but bone marrow examination is crucial for definitive diagnosis.

Introduction: Thyroidectomy is a moderately painful surgery that often necessitates postoperative analgesics like opioids or NSAIDs, both associated with adverse effects. To minimize these, ultrasound-guided bilateral superficial cervical plexus block (BSCPB) can be employed as a component of multimodal analgesia. The superficial cervical plexus arises from the ventral rami of C2–C4 spinal nerves, which supply sensory innervation to the anterolateral neck and shoulder region. BSCPB provides safe, effective, and prolonged postoperative analgesia after thyroid surgery. Aim: To assess the efficacy of ultrasound-guided bilateral superficial cervical plexus block for thyroid surgeries as part of analgesia and its impact on postoperative analgesic requirement. Objectives: To compare postoperative pain using an 11-point Numerical Rating Scale (NRS), time to first rescue analgesia, and total analgesic consumption within 24 hours postoperatively between block and control groups. Materials & Methodology: This prospective, comparative study was conducted on 50 ASA I–II patients undergoing elective thyroidectomy under general anaesthesia. Patients were randomly divided into two groups: Group B (BSCPB with 10 ml of 0.25% bupivacaine on each side after induction) and Group C (control, no block). Postoperative pain was assessed at 0, 3, 6, 12, and 24 hours using NRS. Tramadol 1.5 mg/kg IV was administered if NRS ≥ 4, and total analgesic doses within 24 hours were recorded. Results: The mean NRS pain scores were significantly lower in Group B compared to Group C at all time intervals (p < 0.05). The mean time to first rescue analgesia was longer in Group B (5 h 28 min) than in Group C (3 h 10 min) (p < 0.0001). Total analgesic doses within 24 hours were also significantly reduced in Group B (1 vs 2.67, p < 0.0001). Conclusion: Ultrasound-guided BSCPB using 0.25% bupivacaine significantly reduces postoperative pain, prolongs time to first rescue analgesia, and decreases overall analgesic consumption after thyroid surgery. It is a simple, safe, and effective component of multimodal analgesia.

Aim: Choledocholithiasis is a critical complication of cholecystitis requiring early detection to reduce morbidity. The objective of this study was to determine dependable clinical, biochemical, and radiological markers for predicting outcomes. Methods: This prospective observational study included 196 patients between 18 and 60 years of age. with cholecystitis at Santosh Medical College & Hospital. Data included clinical history, liver function tests, and ultrasonographic findings. Statistical analysis was done using Stata MP-17 (p<0.05). Results: Choledocholithiasis was found in 41 patients (20.9%). Significant predictors included age >40 years, female sex, diabetes, and hypertension. Elevated SGOT, SGPT, ALP, GGT, and bilirubin levels were associated. Radiological markers such as CBD diameter >8 mm, gallbladder distension, and multiple stones were also predictive. A diagnostic algorithm using these variables showed utility in guiding further imaging or ERCP. Conclusion: Routine lab tests and ultrasound can effectively predict choledocholithiasis. A stepwise approach may reduce unnecessary ERCPs and improve outcomes.

Background: Accurate intrapartum detection of fetal hypoxia remains central to prevention of perinatal morbidity. Cardiotocography (CTG/NST) is widely used but can yield non-reactive traces due to fetal sleep or false positives; vibroacoustic stimulation (VAST/VAS) has been proposed to reduce false non-reactive tests and improve prediction of fetal compromise. Objective: To compare the predictive accuracy of intrapartum cardiotocography (NST/CTG) and vibroacoustic stimulation (VAST) for detecting fetal hypoxia, and to correlate their results with perinatal outcomes — 1- and 5-minute APGAR score. Methods: Prospective observational study of 150 women in labor (≥37 weeks, singleton cephalic) who underwent admission CTG (20 min) and VAS performed when indicated; CTG traces were categorized using the three-tier system (Category I–III). VAS: 3-second stimulus, repeated up to three times. Outcomes recorded: 1- and 5-minute Apgar, cord blood pH (arterial), and NICU admission >24 hours. Diagnostic performance measures (sensitivity, specificity, accuracy, ROC AUC) were calculated for NST and VAST relative to adverse perinatal outcomes (low Apgar, cord pH <7.0, NICU admission). Results: Among 150 births, 22 neonates had severe acidosis (pH <7.0), 34 had mild acidosis (7.0–7.2) and 94 had normal pH (>7.2). NST showed sensitivity 93.0%, specificity 69.4% and diagnostic accuracy 84.8% for cord pH-based hypoxia detection (AUC for cord pH = 0.848). VAST demonstrated sensitivity 99.2%, specificity 95.2% and diagnostic accuracy 99.9% (AUC for cord pH ≈ 0.999). Non-reactive VAST correlated strongly with severe acidosis and NICU admission (all neonates with non-reactive VAST required NICU; p<0.001). Conclusion: VAS showed superior predictive accuracy compared with admission CTG in this cohort and can effectively complement CTG to reduce false non-reactive tracings and better predict fetal hypoxia. In low-resource settings where fetal scalp sampling is limited, routine adjunctive VAS may help triage fetuses in labor. Larger multicenter studies are recommended to validate safety and generalizability.

Aims and Objectives: The aim of this study is to use ultrasonography (USG) to examine various scrotal diseases and to diagnose and identify different disorders utilizing high-resolution ultrasound and color Doppler. Materials and Methods: (1) The study will be initiated after obtaining approval from the Institutional Review Board. (2) The written informed consent will be taken from patients and confidentiality of patients will be maintained. (3) All patients fulfilling the inclusion criteria will be enrolled in the study. (4) Ultrasonography will be conducted only by expert consultant. (5) After the collection of data, it will be entered to Microsoft excel sheet. (6) Statistical analysis will be carried out by using appropriate statistical significance test. Result: Out of all 100 patient, hydrocele was seen in 22 cases, 20 cases of inflammatory pathology, scrotal hernia in 15 cases, varicocele in 9 cases, undescended testis in5 cases, scrotal filariasis cases 1, torsion cases2 ,etc. in acute painful scrotal diseases ultrasonography and color doppler study successfully differentiate between acute inflammatory condition and torsion.   Conclusion: High resolution ultrasonography and color doppler study have good sensitivity and specificity in assessing and detecting scrotal pathology. Lack of ionising radiation, simplicity, wide availability and cost efficiency make it highly important method for scrotal diseases.

Introduction: Breast cancer is the most common cancer among women globally and in India. Fine Needle Aspiration Cytology (FNAC) is a key diagnostic tool for breast lesions, especially in resource-limited settings, due to its affordability, accuracy, and minimally invasive nature. The International Academy of Cytology (IAC) Yokohama System was introduced to standardize FNAC reporting. Aim: To categorize breast FNAC cases using the IAC Yokohama System and assess its diagnostic accuracy, category-wise risk of malignancy (ROM), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Methods: A retrospective study was conducted on 70 breast FNAC cases with histopathological correlation. Cases were classified into five IAC categories. ROM was determined per category, and statistical analysis was done across three positivity thresholds. Results: The benign category was most common (70%). ROM for each diagnostic category were: Insufficient (33%), Benign (4.8%), Atypical (50%), Suspicious (87.5%), and Malignant (100%). Diagnostic accuracy varied: Group A (atypical, suspicious, and malignant as positive) had the highest accuracy (92.54%) and specificity (94%), while Group C (only malignant as positive) had 100% sensitivity and NPV but the lowest PPV (35.29%). Conclusion: The IAC Yokohama System is a reliable, standardized method for reporting breast FNAC. Combined with triple assessment, it enhances diagnostic accuracy and supports effective clinical management, especially where core needle biopsy is not readily available.

Background: Platelet activation and inflammatory responses play a key role in tumor progression and metastasis. Mean platelet volume (MPV), a routinely available hematologic parameter, reflects platelet activation and has been proposed as a potential biomarker in several malignancies. This study aimed to evaluate the prognostic significance of MPV in patients with carcinoma stomach. Material and Methods: A prospective observational study was conducted on 150 patients with histologically confirmed, treatment-naïve gastric carcinoma. Baseline MPV was measured before initiation of therapy using an automated hematology analyzer. Receiver operating characteristic (ROC) curve analysis identified the optimal MPV cut-off for predicting 2-year overall survival (OS). Patients were categorized into low (≤9.5 fL) and high (>9.5 fL) MPV groups. Survival analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression, adjusting for age, ECOG status, tumor stage, platelet count, and neutrophil-to-lymphocyte ratio (NLR). Results: The mean age of the cohort was 58.4 ± 11.2 years, with 65.3% males. The median MPV was 9.7 fL (IQR 8.9–10.6). ROC analysis yielded an AUC of 0.68 (95% CI 0.60–0.76) with an optimal cut-off of 9.5 fL for 2-year OS. Patients with low MPV (≤9.5 fL) had a significantly lower 2-year OS (54.1%) compared with those with high MPV (>9.5 fL, 73.8%) (p = 0.004). In multivariable Cox regression, high MPV remained an independent predictor of improved survival (adjusted HR = 0.56, 95% CI 0.35–0.89, p = 0.014), after adjusting for disease stage and performance status. Conclusion: A lower pre-treatment MPV is associated with advanced disease and poorer survival in gastric carcinoma. MPV may serve as a simple, cost-effective, and independent prognostic biomarker for risk stratification in these patients.

Background: Mandibular condylar fracture treatment remains controversial due to the level of the fracture, degree of dislocation or displacement, malocclusion, and other associated fractures. Method: 30 adult cases of faciomaxillary injuries were studied: 12 (40%) CRMF and 18 (60%) ORIF. Investigation included x-ray skull, x-ray mandible, CT scan (3D), and MRI if needed. Blood examination was done to rule out any history of infection; MMF patients were managed by CRMF. Results: Radiological diagnosis had 16 (53.3%) left, 9 (30%) right, 5 (16.6%) bilateral. The associated fractures were 5 (16.6%) with facial pain, 2 (6.6%) ramus, 11 (36.6%) para symphysis, 4 (13.3%) symphysis, 2 (6.6%) angle, 2 (6.6%) coronoid, 16 (53.3%) intra-capsular, and 14 (46.6%) extra-capsular. The complications were 1 (3.33%) hematoma. 2 (6.66%) PMO, 1 (3.33%) facial nerve palsy, 1 (3.33%) infected implant, and 1 (3.33%) loosening and displacement. Conclusion: It is concluded that treatment type must be selected considering the patient’s age, type of fracture, possibility of occlusion restoration by intermaxillary fixation, and existence of foreign materials.

Background: Airway management using supraglottic airway devices is critical in anesthesia practice, with the I-gel and ProSeal Laryngeal Mask Airway (PLMA) emerging as prominent tools. Objective: This study aimed to compare the clinical performance of I-gel and ProSeal LMA focusing on insertion characteristics, airway sealing pressure, hemodynamic stability, and postoperative complications in adults undergoing elective surgeries. Methods: Sixty patients aged 18–60 years were randomly assigned to receive either the I-gel or ProSeal LMA. Device insertion time, number of attempts, airway leak pressure, ease of gastric tube insertion, hemodynamic parameters, and complications were recorded and analyzed. Results: The I-gel group demonstrated significantly shorter insertion times (14.12 ± 2.24 seconds) compared to the ProSeal group (26.1 ± 3.3 seconds, p < 0.0001). Both groups achieved 100% first-attempt insertion success and ease of gastric tube insertion. ProSeal LMA showed higher airway sealing pressures (30.0 ± 4.27 cm H2O) than I-gel (24.0 ± 4.37 cm H2O, p < 0.0001). Hemodynamic variables were comparable between groups. Postoperative sore throat was significantly more frequent in the ProSeal group (13.3%) versus none in the I-gel group (p = 0.04). Conclusion: While ProSeal LMA provides superior airway sealing pressure suitable for controlled ventilation at higher pressures, the I-gel offers advantages in faster insertion and reduced postoperative discomfort. Both devices maintain stable hemodynamics and high insertion success, reinforcing their utility tailored to clinical needs.

Background: Adequate postoperative pain control is essential for rapid recovery following lower limb surgeries. The use of intrathecal adjuvants such as fentanyl with ropivacaine can enhance block characteristics and prolong analgesia. Objective: To compare the efficacy, safety, hemodynamic stability, and postoperative analgesic effect of isobaric ropivacaine alone versus isobaric ropivacaine with fentanyl in patients undergoing lower limb surgeries. Material and Methods: After obtaining approval from research ethical board, GMERS medical College and hospital Junagadh and consent from the patients and their attendants for the procedure. In total, 60 ASA I–II patients aged 18–60 years undergoing elective lower limb surgeries under spinal anesthesia were randomized into two groups: Group A received 0.75% isobaric ropivacaine (22.75 mg), and Group B received 0.75% isobaric ropivacaine (22.75 mg) with fentanyl 25 µg intrathecally. Onset and duration of sensory and motor blocks, hemodynamic parameters, postoperative VAS scores, and side effects were recorded and statistically analyzed. Results: Group B demonstrated a significantly faster onset of sensory and motor blocks, prolonged duration of anesthesia, and lower postoperative VAS scores compared to Group A (p < 0.001). Hemodynamic parameters remained stable, and adverse effects were minimal and comparable between the groups. Conclusion: The addition of 25 µg fentanyl to intrathecal isobaric ropivacaine significantly improves block characteristics and prolongs postoperative analgesia without compromising safety or hemodynamic stability, making it a superior choice for lower limb surgeries.

Background and Aim: Gram-positive and Gram-negative bacteria both cause newborn sepsis, but their etiology, categorization, antibiotic resistance, and clinical outcomes differ. This study compared microbiological profiles and antibiotic susceptibility in neonatal sepsis in a Kachchh tertiary care hospital. Materials and Methods: A cross-sectional investigation at G. K. General Hospital (GAIMS) Microbiology Laboratory and Neonatal Intensive Care Unit (NICU) in neonates with clinically suspected sepsis and positive blood cultures. Aseptically obtained blood samples (1–3 mL) were injected into pediatric BACTEC blood culture bottles. Gram response was examined using Gram-stained smear microscopy after incubating both plates. Results: 373 NICU blood cultures were processed throughout 3 months. These 99 samples showed considerable growth, resulting in a 26.5% culture positive rate. A total of 99 culture-positive samples contained 93% Gram-negative bacilli (GNB), 5% Gram-positive cocci (GPC), and 2% yeast isolates. GNB- 50% carbapenem resistance, highest in K. pneumoniae and Acinetobacter spp. Best overall activity was amikacin and colistin, with susceptibility rates of -70% and >90%, respectively. Many GPC S. aureus isolates were methicillin-resistant (MRSA-45%), but all were sensitive to vancomycin and linezolid. Conclusion: Most neonatal isolates had Gram-negative sepsis, with Acinetobacter spp. and Pseudomonas aeruginosa leading the way. Carbapenem resistance is high in NICUs because to antimicrobial selection pressure.

Background: Electroconvulsive therapy (ECT) has become an increasingly important treatment modality in various psychiatric diseases in recent years. Various anaesthetic agents are used for electroconvulsive therapy. The most commonly used agents are propofol and etomidate. Objectives: The objective of this study were to compare the effects of the anaesthetics (propofol and etomidate) on- motor seizure duration, hemodynamic measures (heart rate, blood pressure), recovery time and immediate side effects. Methods: Fifty patients undergoing ECT were given propofol and etomidate in two sessions. All patients were evaluated before ECT and informed consent was taken. The patients were given the two drugs and the effects were noted. Results: This study concluded that etomidate had longer motor seizure duration (mean 38.5s with SD 2.96) than propofol (mean 27.6s with SD 2.88), the recovery was earlier with propofol ( mean recovery time 10.3min SD1.63) compared to etomidate( mean 12.8min SD2.12), there was no significant difference noted on heart rate , oxygen saturation and blood pressure with either of the two drugs. The side effects viz myoclonus and agitation were more observed with etomidate (24%) than propofol (6%). Conclusion: This study concluded that etomidate should be used for ECT in patients requiring higher seizure threshold due to greater mean seizure duration. However in other cases due to higher incidence of side effects in etomidate the preferred drug should be propofol due to its smooth rapid recovery and lesser side effects.

Introduction: Intramuscular injection in buttocks is a quite common mode of drug administration all over the world. The site being notorious for abscess formation. Various etiological factors being unsterile practices, improper technique, patient comorbidities like diabetes and immunosupression. Material and Methods: This retrospective study was conducted at District hospital Kishtwar over two years (January 2022-february 2024) on patients admitted with complaints of fever, pain and swelling in gluteal region following intra muscular injection. Results: We evaluated a total of 47 patients admitted during study period. Mean age of patients in our study was 41.7years with the majority being females (59.6%). Most of the patients belonged to rural areas (65.9%), diabetes being the most common co-morbidity (27%). In the majority of patients developing abscess(23) the injection was administered by a local paramedic living in the nearby vicinity, eleven patients were given injection by a family member or a relative , nine were injected by a trained nurse or hospital staff whereas only four patients were given injection by a doctor. The most common procedure done for management was incision and drainage (89.4%) done under local and regional anaesthesia. Conclusion: Despite advances in antiseptic techniques post intramuscular injection gluteal abscesses are common. Most cases result from improper technique and lack of aseptic precautions. The most effective treatment is incision and drainage of abscess.

Background: Eco-pharmacology, as a novel branch of science, was established to ensure that consequential environmental problems associated with pharmaceuticals are pointed out in a timely way and addressed accordingly. The environmental impact of pharmaceuticals is increasingly recognized as a significant concern within healthcare. Medical education plays a crucial role in preparing future healthcare professionals to integrate these principles into their practice. However, there is currently not much published data on their knowledge, attitude, and practice of eco-pharmacology in India. Aim and Objective: This study’s objective is to comprehensively evaluate the level of knowledge, attitudes, and practices regarding Eco Pharmacology among second-year medical students. Material and Methods: This cross-sectional, descriptive study was carried out with undergraduate students. A validated, self-administered questionnaire was given to 150 Undergraduates. Volunteers were provided with a sheet containing 26 pre-validated questionnaires with a time limit of 30 minutes to evaluate the level of their knowledge, attitudes, and practices regarding Eco Pharmacology. Results: The total study population was 123, of which 71.00% were aware of the term “eco-pharmacology,” though there were gaps in knowledge observed, especially with respect to eco-pharmacovigilance and environmental legislation. The majority of students recognised the environmental hazards posed by pharmaceutical contamination, including antibiotic resistance and incorrect disposal. There were positive attitudes demonstrated, with several students advocating for including eco-pharmacology in the medical school curriculum. Despite this, 50.00% of students admitted to inappropriately disposing of expired drugs. Conclusion: Among second-year MBBS students, the attitude and practice of eco pharmacology were suboptimal, and they had limited knowledge about eco pharmacology.

Animal models remain indispensable in preclinical biomedical research, but traditional vertebrate systems face challenges of cost, complexity, and ethical concerns. Caenorhabditis elegans (C. elegans), with its short life cycle, optical transparency, mapped cell lineage, and genetic similarity to humans, offers a versatile and ethically favorable alternative. This systematic review, registered in PROSPERO (CRD420251059709), synthesized evidence from 14 experimental studies published between 2004 and 2025. Findings demonstrated that C. elegans effectively models neurodegenerative disorders, metabolic dysfunction, infections, epilepsy, and environmental toxicity, recapitulating key human disease phenotypes such as neuronal degeneration, oxidative stress, and locomotor deficits. Pharmacological and genetic interventions, including betulin, curcumin derivatives, CCME, and CRISPR-modified strains, revealed measurable protective or mechanistic effects with translational alignment to vertebrate and human data. While limitations include lack of complex organ systems and inconsistent methodological reporting, C. elegans consistently supports the principles of the 3Rs, reinforcing its role as a valuable complementary platform in biomedical research.

Background: Proximal femoral fractures are among the most serious consequences of osteoporosis in the elderly, often leading to prolonged morbidity and elevated mortality. A pressing, yet often underemphasized concern is the development of subsequent osteoporotic fractures following an initial proximal femoral injury. These secondary fractures not only worsen functional outcomes but also impose a significant socioeconomic burden. This study aimed to determine the incidence and identify risk factors associated with second osteoporotic fractures in elderly patients following a primary proximal femoral fracture. Methods: A prospective observational study was carried out over a 24-month period, enrolling 250 patients aged 60 years and above who were admitted with osteoporotic proximal femoral fractures. Participants were monitored at regular intervals (3, 6, 12, 18, and 24 months) to detect new low-energy fractures. Baseline and follow-up data included demographic details, fracture classification, treatment modality, medical comorbidities, and adherence to prescribed anti-osteoporotic therapy. Multivariate analysis was used to evaluate associations between these variables and the occurrence of secondary fractures. Results: During the two-year follow-up, 21 patients (8.4%) sustained a subsequent osteoporotic fracture. The majority of these events occurred within the first 12 months post-injury, with the contralateral hip and distal radius being the most frequently affected sites. Risk factors significantly associated with the occurrence of second fractures included advancing age, female sex, existing comorbidities, and suboptimal adherence to osteoporosis medications. Despite clinical recommendations, medication compliance remained poor throughout the cohort. Conclusion: Elderly individuals who sustain a proximal femoral fracture face a considerable risk of experiencing a second osteoporotic fracture, particularly within the first year. These findings underscore the urgent need for improved secondary prevention strategies, including comprehensive osteoporosis management, enhanced patient education, and systematic long-term follow-up to reduce re-fracture rates and improve functional outcomes in this vulnerable population.

Human papillomavirus (HPV) infection is the primary etiological factor for cervical cancer, yet only a subset of infections progress to high-grade lesions or malignancy. Emerging evidence suggests that the composition of the cervico-vaginal microbiome, particularly Lactobacillus dominance, plays a critical role in HPV persistence, immune modulation, and progression to cervical intraepithelial neoplasia (CIN). This review synthesizes current knowledge on the gut–vaginal microbial axis, mechanisms through which dysbiosis promotes cervical carcinogenesis, and the therapeutic potential of microbiome modulation. Vaginal microbial communities dominated by anaerobes such as Gardnerella, Prevotella, Atopobium, and Sneathia are associated with chronic inflammation, epithelial barrier disruption, and impaired viral clearance. Conversely, Lactobacillus species—especially L. crispatus—maintain low vaginal pH, enhance epithelial integrity, and regulate immune responses. Clinical studies demonstrate that probiotic and prebiotic supplementation can restore Lactobacillus-dominant flora, reduce HPV viral load, improve cytological abnormalities, and increase HPV clearance rates. While early findings are promising, heterogeneity in strains, dosages, and treatment duration limits generalizability. Larger, standardized clinical trials are needed to establish microbiota-targeted therapies as adjuncts to screening and vaccination programs. Modulating the vaginal microbiome through probiotics, prebiotics, or emerging approaches such as vaginal microbiota transplantation may represent a novel, non-invasive strategy to improve HPV outcomes and reduce the global burden of cervical cancer.

Background: Thyroid nodules are common, and fine-needle aspiration cytology (FNAC) is the first-line screening tool to distinguish benign from malignant lesions. In India, thyroid cancer is the most common endocrine malignancy (incidence ≈1–1.8 per 100,000), and FNAC is widely accepted for triaging nodules. However, indeterminate results and sampling variability limit accuracy This study evaluated the diagnostic accuracy of FNAC for thyroid lesions, comparing cytologic diagnosis with final histopathology. Materials and Methods: In a prospective observational study (January 2022–December 2024) at a tertiary care center in India, 150 patients with thyroid nodules underwent FNAC, with subsequent surgical excision and histopathologic examination of resected specimens. FNAC was performed using a 22–25 G needle (ultrasound-guided in most cases). Cytology results were reported using The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and histopathology served as the gold standard. Diagnostic measures (sensitivity, specificity, accuracy, predictive values) were calculated. Results: Among 150 cases (median age ~40 years, 80% female), FNAC yielded: Bethesda I (non-diagnostic) in 5 (3.3%), II (benign) in 90 (60%), III (AUS/FLUS) in 20 (13.3%), IV (FN/SFN) in 10 (6.7%), V (suspicious) in 15 (10%), and VI (malignant) in 10 (6.7%). Final histopathology revealed 116 benign (77.3%) and 34 malignant (22.7%) lesions. Papillary carcinoma was the most frequent malignancy (n=18), and colloid goiter was the most common benign diagnosis (n=60). FNAC correctly identified 22 of 34 malignancies (true positives) and 113 of 116 benign cases (true negatives). Overall sensitivity and specificity were 66.7% and 97.4%, respectively. The false-negative rate (malignancies missed by FNAC) was 33.3%, and the false-positive rate was 2.6%. The positive predictive value (PPV) was 88.0% and negative predictive value (NPV) 94.2%. Conclusion: FNAC is a safe, rapid, and inexpensive screening test that reliably identifies most malignant thyroid lesions. In our cohort, FNAC showed high specificity (≈97%) but moderate sensitivity (~67%), reflecting that some malignancies (especially follicular-pattern tumors and small papillary microcarcinomas) were undercalled cytologically. These results are consistent with published data: Sharma et al. reported FNAC sensitivity ~89% and specificity ~98%, while a large Scandinavian study found overall FNAC sensitivity ≈82% (reaching ~87% for nodules >1 cm). Given these findings, FNAC remains invaluable for guiding management, but indeterminate or suspicious results warrant cautious interpretation or repeat biopsy.

Background: Gestational diabetes mellitus (GDM) is a prevalent metabolic complication of pregnancy associated with increased maternal and perinatal morbidity [1][2]. Epicardial fat, a visceral adipose depot located between the myocardium and visceral pericardium, has been shown to correlate with insulin resistance and metabolic dysregulation in adults. Recently, fetal epicardial fat thickness (fEFT) measured by ultrasonography has been proposed as an early indicator of altered intrauterine glucose metabolism in pregnancies complicated by GDM. This study aimed to assess whether fEFT can serve as a non-invasive ultrasonographic marker for GDM in a cohort of pregnant women attending the Department of Radio-diagnosis, MGM Medical College, Kishanganj, Bihar. Materials and Methods: A cross-sectional observational study was conducted over six months on 30 singleton pregnancies between 24 and 28 weeks of gestation. All participants underwent a detailed obstetric ultrasound using a high-resolution transducer to measure fEFT on the right ventricular free wall in the four-chamber view [7][8]. Following the scan, a 75 g oral glucose tolerance test (OGTT) was performed according to ADA criteria, and participants were classified into GDM and non-GDM groups. Mean fEFT values were compared between groups, and correlations were analyzed with maternal glycemic parameters, including fasting glucose, 1-hour and 2-hour OGTT values, and HbA1c. Receiver-operating-characteristic (ROC) analysis was used to determine the diagnostic accuracy of fEFT as a predictor of GDM. Results: The mean fEFT was significantly higher in the GDM group compared to non-GDM controls (0.17 ± 0.02 cm vs. 0.12 ± 0.01 cm; p < 0.001), consistent with earlier reports. fEFT demonstrated a strong positive correlation with maternal HbA1c (r = 0.70, p < 0.01) and 2-hour OGTT plasma glucose (r = 0.65, p < 0.01). ROC analysis yielded an AUC of 0.90, with an optimal fEFT cutoff of 0.14 cm, providing 90% sensitivity and 85% specificity for predicting GDM. Conclusion: Fetal epicardial fat thickness measured during the second trimester was significantly elevated in pregnancies complicated by GDM and correlated strongly with maternal glycemic indices. These findings suggest that fEFT could serve as an early, non-invasive screening marker for GDM, complementing biochemical testing and aiding early risk stratification. Further large-scale studies are warranted to validate these results and establish gestation-specific reference ranges.

Background: Chronic headache, including migraine and tension-type variants, remains a major cause of disability and impaired quality of life. Pharmacological therapies often provide incomplete relief and may induce drug overuse. Peripheral nerve blocks and lifestyle interventions have emerged as effective adjuncts in pain management. Aim and Objective: To evaluate and compare the effectiveness of combined occipital and sphenopalatine nerve block along with pharmacological and lifestyle modification versus pharmacological and lifestyle management in chronic headache patients. Materials and Methods: A prospective, randomized interventional study was conducted on 60 patients (18–60 years) diagnosed with chronic headache as per ICHD-3 criteria. Participants were divided into two groups: Group A received pharmacological management with lifestyle measures, and Group B received the same along with occipital and sphenopalatine nerve blocks. Outcomes—headache frequency (days/month), pain intensity (VAS), and Headache Impact Test-6 (HIT-6) scores were assessed at baseline, 4 weeks, and 12 weeks. Data was analyzed using SPSS v26; p < 0.05 was considered statistically significant. Results: Patients in Group B requested less medications and NSAID alone was adequate in most cases, very less patients needed sumatriptan along with NSAIDs. Conclusion: Combination of occipital and sphenopalatine blocks along with pharmacological and lifestyle modification provides better and sustained pain relief in comparison with pharmacological and life-style modification alone.

Background: Maternal anemia during pregnancy remains a significant public health concern globally, potentially affecting neonatal outcomes. However, the magnitude of its impact on birth weight in term pregnancies requires further investigation. Methods: This cross-sectional study was conducted at a tertiary care hospital over 18 months, involving 468 pregnant women who delivered at term (37-42 weeks gestation). Maternal hemoglobin levels were measured at 36-38 weeks of gestation, and participants were classified into normal (≥11 g/dL), mild anemia (10-10.9 g/dL), moderate anemia (7-9.9 g/dL), and severe anemia (<7 g/dL) groups. Neonatal birth weight was recorded immediately after delivery. Statistical analysis included independent t-tests, ANOVA, and multiple linear regression. Results: The mean maternal hemoglobin concentration was 10.8 ± 1.6 g/dL. Overall anemia prevalence was 62.4% (n=292), with 28.6% mild, 30.1% moderate, and 3.7% severe anemia. Mean birth weight was significantly lower in anemic mothers compared to non-anemic mothers (2847 ± 412 g vs. 3168 ± 387 g; p<0.001). Moderate and severe anemia showed progressive decrease in birth weight (2698 ± 398 g and 2456 ± 445 g, respectively). After adjusting for confounders, maternal hemoglobin remained significantly associated with birth weight (β=82.4, p<0.001), with each 1 g/dL decrease in hemoglobin associated with 82.4 g reduction in birth weight. Conclusion: Maternal anemia demonstrates a significant dose-response relationship with reduced neonatal birth weight in term pregnancies, with moderate and severe anemia showing substantial impact. These findings emphasize the necessity for stringent antenatal screening and management of maternal anemia.

Background: The long-term pulmonary sequelae of COVID-19 include restrictive lung patterns and small airway dysfunction. Impulse oscillometry (IOS) offers a non-invasive method to assess peripheral airway resistance beyond conventional spirometry. However, limited data exist on IOS findings in post-COVID restrictive lung disease survivors. Methods: We conducted a prospective cohort study of 142 participants divided into three groups: post-COVID restrictive pattern (n=48), post-COVID obstructive pattern (n=46), and healthy controls (n=48). All participants underwent IOS assessment measuring resistance at 5Hz (R5), resistance at 20Hz (R20), reactance at 5Hz (X5), resonant frequency (Fres), and area of reactance (AX). Spirometry and six-minute walk tests were performed. Statistical analysis included ANOVA and correlation analyses. Results: Post-COVID restrictive group demonstrated significantly elevated R5-R20 (0.18 ± 0.08 kPa/L/s vs. 0.06 ± 0.03 kPa/L/s in controls, p<0.001), increased Fres (18.3 ± 4.2 Hz vs. 11.2 ± 2.1 Hz, p<0.001), and more negative X5 (-0.28 ± 0.11 kPa/L/s vs. -0.12 ± 0.04 kPa/L/s, p<0.001). Small airway dysfunction was present in 68.8% of restrictive pattern patients. R5-R20 correlated inversely with FVC% predicted (r=-0.52, p<0.001) and six-minute walk distance (r=-0.48, p<0.001). Conclusion: Small airway dysfunction is highly prevalent in post-COVID restrictive lung disease survivors, detectable through IOS abnormalities. IOS provides valuable complementary information beyond spirometry for comprehensive pulmonary assessment in COVID-19 survivors.

Background: Sciatica is a common neuropathic pain condition caused by irritation or compression of the lumbosacral nerve roots, often resulting in significant discomfort and functional limitation. Conventional management provides variable relief, and distal nerve block has emerged as a promising minimally invasive alternative. This study aimed to evaluate the effectiveness of distal nerve block in alleviating pain among patients with sciatica. Material and Methods: This hospital-based, prospective analytical study was conducted in the Department of Orthopaedics, K. J. Somaiya Medical College and Research Centre, Mumbai, after obtaining ethical approval. Sixty patients aged 18–65 years with clinically diagnosed sciatica were included. A single session of distal nerve block using a mixture of 0.5% lignocaine, clonidine, and triamcinolone was administered at the deep peroneal, sural, and posterior tibial nerve sites. Patients were evaluated for pain and sensory symptoms before injection, 15 minutes post-injection, at one week, and at one month. Pain intensity was assessed using the Visual Analogue Scale (VAS), and statistical analysis was performed using the Wilcoxon matched-pairs signed rank test and McNemar test, with p < 0.05 considered significant. Results: The study population comprised 34 females (56.7%) and 26 males (43.3%), with most patients aged 35–45 years. Radiating pain was significantly associated with tingling and numbness (p = 0.0008). Mean VAS score decreased from 6.82 pre-injection to 2.38 immediately post-injection, followed by 3.50 at one week and 4.02 at one month. All pairwise comparisons showed statistically significant improvement (p < 0.0001). McNemar’s test confirmed a significant reduction in the proportion of patients reporting pain after the procedure (p < 0.0001). Conclusion: Distal nerve block provides immediate and sustained pain relief in patients with sciatica, demonstrating significant improvement in VAS scores up to one month post-procedure

Background: Nutritional anemia remains a significant health concern among adolescents, with iron deficiency being the most frequent underlying cause. Red blood cell (RBC) indices are widely available hematological markers that may reflect alterations in iron absorption physiology. This study examined the relationship between RBC indices and biochemical indicators of iron status in adolescents with nutritional anemia. Material and Methods: A cross-sectional study was conducted among 212 adolescents diagnosed with nutritional anemia. Demographic data, hematological parameters (hemoglobin, hematocrit, RBC count, MCV, MCH, MCHC, RDW), and iron absorption markers (serum iron, ferritin, TIBC, transferrin saturation, and hepcidin) were collected. Correlation analysis was used to evaluate associations between RBC indices and iron-related biochemical variables. Results: The mean age of participants was 14.8 ± 2.1 years, with females comprising 65.1% of the cohort. Hematological analysis showed a microcytic hypochromic pattern, with mean hemoglobin 9.1 ± 1.2 g/dL, MCV 72.8 ± 6.9 fL, MCH 21.4 ± 2.1 pg, and RDW 17.9 ± 2.5%. Iron studies demonstrated reduced serum iron (34.6 ± 11.2 µg/dL) and ferritin (11.8 ± 6.4 ng/mL), elevated TIBC (386 ± 42 µg/dL), and low transferrin saturation (9.1 ± 3.8%). Hemoglobin, MCV, and MCH showed strong positive correlations with ferritin and transferrin saturation and inverse correlations with TIBC. RDW correlated negatively with serum iron and ferritin and positively with TIBC. Conclusion: RBC indices showed significant and biologically consistent correlations with biochemical markers of iron absorption, indicating their usefulness as simple and cost-effective indicators for assessing the severity of iron deficiency in adolescents with nutritional anemia.

Background: Lung cancer is one of the commonest cancers and cause of cancer related deaths all over the world. The death toll due to lung cancer is proposed to rise to ten million by 2030 with 7 out of 10 deaths in the developing world. About 95% of the rural population in India still relies primarily on biomass fuels (dung, crop residues, and wood). Use of these fuels has also been associated as a risk factor for lung cancer in women. Emissions from multiple sources, including motor vehicles, industrial processes, power generation, and the combustion of household solid fuel, pollute the ambient and indoor air in all populated regions of the globe. An increased risk of lung cancer associated with daily use of incense has been also reported in some studies. Objectives: The study targets to determine the relationship between environmental smoke and lung cancer in the Indian context. This also attempts to make suitable recommendations based on outcome of the study. Methods: The case control study was carried out at a super specialist hospital located in urban area. Comprised of patients attending the hospital who are more than 20 years of age. Frequency matching was done with respect to age and gender in both the groups. Pretested and pre structured questionnaire was prepared based on the extensive literature search, under the guidance of the experts in the field and supervision of the guide. Data entry was entered by researcher and analysed using SPSS version 20 software. The data were analysed with the help of biostatistician extensively involved in health research. Results: We found fuel used for cooking with an odds of cases using smoke generating fuel 4 times as compared to controls. There is increasing risk with increase in number of smokers in the house and duration of exposure. Women had high OR of 5.1. It was also observed in our study that only 22.1% of cases and 14.7% of controls had exposure to vehicular fumes. Duration of incense stick burning for > 30 median years was having an odd of 2.3 for lung cancer cases as compared to controls and this association was found to be statistically significant with a p value of 0.016. Conclusions: The study concluded in bringing out the various environmental risk factors causing lung cancer.

Background: In our day-to-day life, screens have become an integral part. Children, in particular, are spending increasing amounts of time in front of screens, whether it’s watching TV, playing video games, or scrolling through various social media. While screens can provide education, entertainment and social connection, excessive screen time has been linked to various negative effects on social skills development. Objective: Aimed to investigate the impact of screen time on social skills development in Primary school children aged 6 to 11 years. Material and Methods: A Cross sectional study was conducted at   South AM UP School and Theruvathekadavu and GHSS Naduvannur in Rural Field Practice Area of Kozhikode district, Kerala from December 2024 to January 2025. A total of 220 children from both the schools were enrolled using stratified sampling. Screen time was categorized into three groups: Low (less than 1 hour per day), Moderate (1 to 3 hours per day), and High (more than 3 hours per day). Social skills were assessed using the Social Skills Improvement System (SSIS) Rating Scales. Data were analyzed using descriptive statistics, chi-square and Pearson correlation. Results: The Pearson correlation coefficient (r = 0.864) indicates a strong positive correlation screen time and social skill development problems. Conclusion: High screen time is negatively associated with social skills development in young children. Limiting screen time may foster better social skills development.

Background: Although the role of HPV vaccination in most cervical cancers is mandatory, and some anogenital and mouth cancer malignancies have a mandatory role, worldwide and national coverage is suboptimal, especially in low- and middle-income connectors. There is scanty data available in the hospital outpatient setting, which most adolescents come in contact with the health care delivery system. This paper evaluated the level of awareness and the level of attitude toward HPV vaccination in adolescents visiting outpatient departments (OPDs) of ABVGMC and established factors that could influence the intention to be vaccinated. Methods: A cross-sectional survey undertaken in a hospital represented a study among adolescents, aged 13 – 18 years, visiting the OPDs at ABVGMC, Vidisha, MP, and India. The questionnaire used was a pretested version of the HPV Adolescent Vaccine Intervention Questionnaire (HAVI-Q) administered using a pretested method in which 245 registered adolescents with parental consent and adolescent assent completed a questionnaire. Measures were used in the form of sociodemographics, knowledge of HPV/HPV vaccine (20 items; score 020), attitudes (Likert scales), previous provider recommendation, future parental consent, and self-reported HPV vaccine status. The main result was a desire to get HPV vaccine in case it is given at the hospital with no cost. The χ 2 test, t-test and multivariate logistic regression were used to analyze the data. Results: Mean age was 15.3±1.6 years; 52.2% were female (n=128). Overall, 58.0% had heard of HPV and 50.6% recognized HPV as a cause of cervical cancer. The mean knowledge score was 10.4±3.8, with older adolescents scoring higher than younger peers (11.0 vs 9.7, p<0.001). Only 31.8% reported receiving ≥1 HPV vaccine dose, whereas 65.3% expressed willingness to be vaccinated if offered on-site. Perceived vaccine safety and effectiveness were endorsed by 55.9% and 53.9% respectively. In multivariable models, prior provider recommendation (aOR 3.45, 95%CI 1.95–6.12), anticipated parental consent (aOR 4.85, 2.80–8.40), good HPV knowledge (aOR 2.25, 1.35–3.75), and perceiving the vaccine as safe (aOR 3.10, 1.85–5.20) independently predicted willingness. Conclusion: Among OPD-attending adolescents at ABVGMC, willingness to receive HPV vaccine substantially exceeded current coverage, and was strongly linked to provider recommendation, parental support, and modifiable knowledge and safety perceptions. Opportunistic, clinic-based vaccination integrated with brief counseling and parent engagement may help translate this high intention into completed vaccination.

Background: Genitourinary symptoms related to menopause, now conceptualized as the genitourinary syndrome of menopause (GSM), affect a substantial proportion of postmenopausal women and may persist lifelong, impairing sexual health, psychosocial functioning and overall quality of life. Despite this burden, GSM remains under-recognized and under-treated, particularly in low- and middle-income settings. Methods: This cross-sectional observational study was conducted in the Gynaecology outpatient department of Atal Bihari Vajpayee Government Medical College, Vidisha, MP, over 12 months, from September 2024 to October 2025. Consecutive natural or surgical menopausal women aged 45–70 years, at least one year post-menopause, were enrolled. Exclusion criteria included hormone therapy, pelvic radiotherapy, active genital malignancy and severe systemic illness. Data were collected using a structured interviewer-administered questionnaire capturing sociodemographic, reproductive and medical history. Urogenital symptoms were assessed with items derived from the urogenital domain of the Menopause Rating Scale and GSM literature. Moderate–severe symptomatology (any vaginal, urinary or sexual symptom rated moderate or severe) defined “clinically significant urogenital symptoms”. Multivariable logistic regression identified independent determinants. Results: Of 260 eligible women, 254 completed the study (mean age 55.8±5.2 years; mean duration since menopause 6.3±3.7 years). Overall, 183 women (72.0%) reported at least one urogenital symptom, and 139 (54.7%) had clinically significant symptoms. The most frequent symptoms were vaginal dryness (48.4%), urinary urgency (32.3%), increased frequency (30.3%), stress urinary incontinence (24.8%) and dyspareunia among sexually active women (35.9%). In multivariable analysis, age ≥55 years (aOR 1.9; 95% CI 1.1–3.3), menopause ≥5 years (aOR 2.3; 95% CI 1.4–3.9), prior hysterectomy (aOR 2.5; 95% CI 1.2–5.3), diabetes/metabolic syndrome (aOR 1.7; 95% CI 1.0–2.9) and sexual inactivity (aOR 1.8; 95% CI 1.1–3.0) were independently associated with symptomatic GSM, whereas use of menopausal hormone therapy was protective (aOR 0.4; 95% CI 0.2–0.9). Conclusion: Urogenital symptoms were highly prevalent and frequently moderate–severe among menopausal women attending gynecology services. Longer duration since menopause, older age, sexual inactivity and metabolic comorbidity emerged as key determinants. Opportunistic screening and proactive counselling in midlife clinics, coupled with evidence-based GSM management, could substantially improve urogenital and sexual health in this population.

Background: The lungs are commonly affected in pulmonary tuberculosis, and even after successful treatment, lasting structural changes often remain. These residual changes can impact patients’ quality of life and include airway obstruction, bronchiectasis, cavitations, fibrosis, parenchymal destruction, pulmonary hypertension, and chronic pleural disease. Recognizing these sequelae in post-TB patients is essential, especially in those with ongoing respiratory symptoms. Materials and Methods: This cross-sectional observational study was conducted in July – October 2025 including 100 post-TB patients attending the pulmonary medicine outpatient and inpatient departments at Gandhi Medical College, Bhopal. Patients were examined using chest X-rays, with further sputum microscopy as required. Results: Fibrosis was the most common finding on chest X-rays, observed in 79% of cases, followed by bronchiectasis in 44%. The combination of fibrosis and cavitation was seen in 43% of patients, while 39% presented both fibrosis and bronchiectasis. Conclusion: Post-TB patients may exhibit a range of symptomatic or asymptomatic radiological changes. Identifying these residual abnormalities is critical to rule out active disease and guide appropriate long-term care.

Background: High-resolution ultrasound (HRUS) and magnetic resonance neurography (MRN) are considered complementary to clinical and neurophysiological assessment for neuropathies. Aim: To compare the accuracy of HRUS and MRN for detecting various peripheral nerve pathologies and to choose the correct investigation to facilitate prompt patient management. Materials and Methods: This prospective study was done using HRUS with 14 MHz linear-transducer and 3 or 1.5T MR in cases referred for the assessment of peripheral nerve pathologies. Image interpretation was done using a scoring system (score 0–3 confidence level) to assess for nerve continuity/discontinuity, increased nerve signal/edema, fascicular change, caliber change, and neuroma/mass lesion. We  determined the accuracy, sensitivity, and specificity of these modalities compared with the diagnostic standard determined by surgical and/or histopathological, if not performed then clinical and/or electrodiagnostic evaluation. Results: The overall accuracy of MRN was 89.3% (specificity: 66.6%, sensitivity: 92.6%, negative predictive value [NPV]: 57.1%, positive predictive value [PPV]: 95%) and that of HRUS was 82.9% (specificity: 100%, sensitivity: 80.4%, NPV: 42.8, PPV: 100). The confidence level for detecting nerve discontinuity and change in nerve caliber was found to be higher on ultrasonography than magnetic resonance imaging (MRI) (100 vs. 70% and 100 vs. 50%, respectively). Pathology of submillimeter caliber nerves was accurately detected by HRUS and these could not be well-visualized on MRI. Conclusion:  HRUS is a powerful tool that may be used as the first-line imaging modality for the evaluation of peripheral nerve pathologies, and a better means of evaluation of peripheral nerves with submillimeter caliber.

Background: One of the difficulties in paediatric anaesthesia is reducing stress for children and ensuring a smooth induction of anaesthesia. This is typically achieved by administering a sedative medication before transferring the child to the operating room. Aim: To compare the efficacy and effects of intravenous Dexmedetomidine and Midazolam on preoperative sedation in paediatric patients undergoing elective surgery under general anaesthesia. Methods: A prospective, randomized study was conducted on 96 paediatric patients undergoing elective surgery under general anaesthesia. They were randomly allocated into two groups, Group A and B, which included 48 patients each. Group A received Dexmedetomidine 1 mcg/kg diluted to 50 ml normal saline IV over 10 minutes and patients in group B received Midazolam 0.05mg/kg in 50 ml normal saline IV over 10 minutes. Injection Glycopyrrolate 4 mcg/kg IV was given to both groups. Sedation score and Mask Acceptance Score were noted at 10 minutes. Haemodynamic parameters and pain score were also noted. Results: The study revealed that at 10 minutes, the mean sedation score was 3.58 ± 0.50 in the Dexmedetomidine group and 3.81 ± 0.39 in the Midazolam group, with a statistically significant difference (t = 2.499, p = 0.01). The mean MAS in the Dexmedetomidine group was 1.38 ± 0.49, while that in Midazolam group was 1.63 ± 0.67. The difference in MAS between the two groups was statistically significant, as indicated by independent t-test value of 2.083 and a p-value of 0.04. There was no statistically significant difference between the groups in terms of haemodynamic parameters. However, pain scores were lower in the Dexmedetomidine group. No adverse effects were seen in either of the study groups. Conclusion: Dexmedetomidine has a slightly better preoperative sedative effect on paediatric patients as compared to Midazolam, along with a better mask acceptance during induction, without causing any serious adverse effects.

Background and Objectives: Supraclavicular brachial plexus block is a popular and widely employed regional nerve block technique for upper limb surgeries. Adjuvants are often added to local anaesthetics to prolong or enhance their action. This study was conducted to evaluate the anaesthetic and analgesic efficacy of addition of 50mcg fentanyl to 0.5% levobupivacaine in ultrasound guided supraclavicular brachial plexus block. Methods and Materials: In this prospective, double blind, randomised control study, 110 patients (aged 18-65 years) belonging to ASA physical status I/II undergoing elective orthopaedic upper-limb surgery under ultrasound-guided SCBP block were randomised into 2 groups. GROUP A (n = 55) received 25ml levobupivacaine 0.5% + 1ml(50mcg) fentanyl diluted to a volume of 30ml with normal saline. GROUP B (n = 55) received 25ml levobupivacaine 0.5% diluted to a volume of 30ml with normal saline. Results: The duration of sensory blockade in Group A was longer than Group B (P < 0.05). The onset of sensory and motor blockade in Group A was faster than Group B. The duration of motor blockade and duration of analgesia in Group A was prolonged compared to Group B. Hemodynamic parameters were similar between the two groups. 24 hours analgesic consumption postoperatively was less in group A than group B. 3 patients in group A and 1 patient in group B complained of nausea, vomiting. Conclusion: Fentanyl added to levobupivacaine for supraclavicular brachial plexus block reduces the time to onset and duration of sensory and motor blockage and prolongs the duration of analgesia.

Poisoning is an important public health problem causing significant morbidity and mortality throughout the world. About 50,000 people die every year from toxic exposure in India and poisoning is also common in our state, Tripura. The purpose of the present study was to assess the clinical manifestation and mortality of the patients admitted with insecticide poisoning and detection of the type of poison by Thin Layer Chromatography. A prospective cross-sectional study conducted for the period of one and half year in a tertiary care hospital in the state of Tripura. Total 180 patients of insecticide poisoning have been included in the study. Majority of the victims were in 21 to 30 years of age group (25%) with male preponderance. In 50.6 % of the patients’ signs and symptoms appeared within 30 mins to 60 mins of consumption of poison. Maximum number of victims (68.9 %) attended the hospital within 01 to 06 hours. Most of the victims consumed organophosphorus insecticides (78.9 %) followed by organochloro insecticides (18.9 %) and carbamate (2.2 %). TLC is an easy, rapid and cost-effective method for the early diagnosis of cases of specific poisoning by insecticides, which will help attending physicians to immediately administer specific antidote treatment instead of relying merely on history, signs and symptoms.

Objective: Oxidative stress is linked to both macrovascular and microvascular problems in diabetes. Zinc prevents the consequences of diabetes since it has antioxidant properties. The goal of the current observational hospital-based cross-sectional investigation was to determine the diagnostic importance of serum zinc and link it with lipid analytes in various clinical groups of both type 1 and type 2 diabetes. Methods: There were 150 participants in the trial, including 50 healthy normoglycemic controls and 100 individuals with T1DM and T2DM who were randomly selected. 22 T1DM and 78 T2DM clinical patients were divided into three groups based on their medical histories and clinical records: group I was recently diagnosed, group II was stabilized and under control, and group III was long-term, uncontrolled, and associated with problems. Plasma glucose, serumzinc, total cholesterol, and triacylglycerol biochemical assays were examined, contrasted, and statistically associated with each group and healthy controls. Results: The biochemical changes of hypozincaemia in overt hyperglycemic-hyperlipidemic clinical cases were clearly illustrated by the comparison and correlation of the examined analytes in the T1DM and T2DM groups of subgroups with healthy controls. With varying statistical significances in different clinical groups, hypozincemia was negatively linked with hypertriglyceridemia and hypercholesterolemia in hyperglycemic individuals with both type 1 and type 2 diabetes. In group III, the correlation was p < 0.001, in group I, it was p < 0.01, and in group II, it was p > 0.05. For all subgroups, there was no statistically significant difference (p > 0.05) between type 1 and type 2 analytes. Conclusion: The current investigation examined biochemical alterations associated with hypozincemia in overt hyperglycemic-hyperlipidemic clinical groups of people with type 1 and type 2 diabetes. For early screening, periodic monitoring for deficiencies, and improved management of clinical cases through supplementation to prevent the development of long-term critical diabetes complications, it is advised that serum zinc be measured as part of a routine or extended diagnostic profile investigation in recognized health cases of T1DM and T2DM.

Thousands of people worldwide suffer from inflammatory bowel diseases (IBD), which are long-term inflammatory conditions of the gastrointestinal tract. It is an inflammatory disease marked by metabolic abnormalities, alterations in gut microbial composition, and changes in mucosal structure. Weight loss, diarrhea, stomach pain, rectal bleeding, and systemic inflammatory indications are the primary symptoms. Conventional medicines, which are typically ineffectual because they do not stop relapses or mucosal healing, are still used to treat IBD despite advancements in the field. New therapeutic approaches were therefore required because many individuals who do not receive traditional treatment end up needing surgery as a result of the disease’s subsequent deterioration. Nevertheless, there is a need for scientific research on the topic because the novel treatment alternatives have not been thoroughly examined in the literature. Therefore, the purpose of this study is to provide an update on the current state of clinical development of these novel treatment classes in IBD as well as new therapeutic choices for the condition. Patients with inflammatory bowel disease now have more hope and a higher quality of life thanks to new treatment options. The outlook for treating IBD is becoming more optimistic as research advances and more potent treatments are created. To further enhance the therapeutic choices available and improve the quality of life for those afflicted by this crippling ailment, further clinical trials and research funding are necessary.

Background and Aims: Awake fiberoptic intubation (AFOI) is preferred for managing anticipated difficult airways but requires optimal sedation, analgesia, and hemodynamic stability while maintaining spontaneous ventilation. Nalbuphine, a mixed opioid agonist–antagonist, and fentanyl, a μ-opioid agonist, have been compared for conscious sedation in AFOI – either alone or combined with midazolam or propofol -but no study has yet compared them when combined with dexmedetomidine, a widely used sedative for this procedure. This gap highlights the need for such research. This study aimed to compare the efficacy of nalbuphine and fentanyl when combined with dexmedetomidine to provide conscious sedation for facilitating intubating conditions during AFOI. Materials and Methods: This prospective, randomized, double-blind study included 60 ASA I–II adult patients undergoing elective surgeries requiring endotracheal intubation. All patients received glycopyrrolate 0.2 mg IM, nebulization with 4 ml of 4% lignocaine, intranasal xylometazoline (2–4 drops), and dexmedetomidine 1 μg/kg infusion over 10 minutes. Patients were allocated to Group F (fentanyl 2 μg/kg IV) or Group N (nalbuphine 0.2 mg/kg IV). Sedation was assessed using the Ramsay Sedation Scale (RSS 1–6), and AFOI was performed at RSS ≥2 .Intubating conditions during AFOI were assessed using a grading system (1-4) for 6 criteria: Intubation conditions, vocal cord position, cough severity, comfort during & after intubation and satisfaction. Hemodynamic parameters and intubation time were also compared. Results: Both regimens achieved satisfactory intubation conditions, target sedation (RSS ≥2), and hemodynamic stability. Group F showed slightly higher sedation (mean RSS 2.50 vs 2.23, P=0.03) and shorter intubation time (222.10 vs 257.40 sec, P=0.018), though clinically insignificant. Conclusion: Both nalbuphine and fentanyl with dexmedetomidine provided effective conscious sedation, comfortable intubation, and hemodynamic stability during AFOI.

Background: Pigmented skin lesions encompass a wide range of disorders, both neoplastic and non-neoplastic, which often exhibit overlapping clinical features. Accurate differentiation through histopathological analysis is critical for diagnosis and management. Material and Methods: This prospective study was conducted in the Department of Histopathology, GMERS Medical College, Sola, Ahmedabad, from March 2023 to August 2024. Eighty-one biopsy specimens of pigmented skin lesions were evaluated using routine hematoxylin and eosin staining, and special stains were applied as needed. Results: Non-neoplastic lesions constituted 70.4% of all cases, with inflammatory and pigmentary disorders being predominant. Neoplastic lesions accounted for 29.6%, most of which were benign melanocytic nevi (62.5%), followed by seborrheic keratosis (20.8%). Malignant cases (16.7%) included pigmented basal cell carcinoma, squamous cell carcinoma, and metastatic carcinoma. Conclusion: The study emphasizes that histopathological examination remains the gold standard for accurate diagnosis of pigmented skin lesions. Non-neoplastic lesions form the majority, yet the presence of malignant cases underscores the necessity of thorough evaluation and clinicopathological correlation.

Background: Minor cervical trauma can precipitate severe spinal cord injury in anatomically predisposed individuals, and MRI-based parameters may help predict both risk and severity. Material and Methods: A total of 180 participants were evaluated using standardized MRI protocols to assess radiological predictors including TPR-MRI, canal compromise, and intramedullary lesion characteristics. These MRI metrics were compared between SCI and control groups and analyzed for prognostic significance. Results: MRI parameters, particularly TPR-MRI and CD-DM, demonstrated high specificity and strong predictive value for SCI, with significant correlations suggesting diagnostic synergy. Preexisting stenosis played a substantial role in injury susceptibility following low-impact trauma. Conclusion: MRI-derived parameters provide reliable early predictors of risk and severity in acute cervical SCI after minor trauma and should be routinely incorporated into evaluation protocols.

Introduction: Feeding problems in young children are common and may lead to poor growth, nutritional deficiencies, and adverse parent–child interactions. Behavioural feeding problems range from mild picky eating to severe selective eating or food refusal. In India, limited data exist regarding their prevalence and associated sociodemographic and parental factors. Aim: To evaluate the prevalence and pattern of behavioural feeding problems in children aged 9 months to 5 years, and to study their association with sociodemographic variables, nutritional status, and parental feeding styles. Materials and Methods: This hospital-based cross-sectional study was conducted in the Department of Pediatrics, ESIC Model Hospital, and Noida, from July 2023 to June 2024, among 250 children aged 9 months to 5 years attending outpatient or inpatient services. Children with organic causes of feeding problems were excluded. Feeding behaviour was assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) translated into Hindi and validated locally. Nutritional status was evaluated using WHO BMI-for-age Z-scores. Statistical analysis included chi-square test, t-test, and multivariate logistic regression, with p<0.05 considered significant. Results: Behavioural feeding problems were observed in 42.8% (107/250) of children. The most common type was Selective Intake (63.6%), followed by Limited Appetite (28.0%) and Fear of Feeding (7.5%). Mean BPFAS Total Frequency and Total Problem Scores were significantly higher among children with feeding problems (p<0.001). Male gender, underweight BMI, preterm birth, first birth order, younger maternal age, lower maternal education, and working parents were significantly associated with feeding problems (p<0.05). Screen time during feeding and non-responsive feeding styles were also linked with higher prevalence. Conclusion: Behavioural feeding problems were common in early childhood, with selective eating being the predominant pattern. Several modifiable factors—particularly caregiver feeding style, screen exposure during feeding, and nutritional status—were significantly associated. Early identification and parent-focused counseling may help prevent nutritional and developmental complications.

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large or complex renal calculi. Although general anaesthesia (GA) has traditionally been used, spinal anaesthesia (SA) is increasingly recognized as a safe and effective alternative, offering hemodynamic stability, reduced analgesic requirements, and shorter recovery time. Objective: To assess the safety, efficacy, and perioperative outcomes of spinal anaesthesia in patients undergoing PCNL in a tertiary care centre. Methods: This retrospective observational study included 250 adult patients who underwent PCNL under SA between January and October 2023. Data regarding demographic profile, intraoperative hemodynamic variations, postoperative pain (VAS scores), complications, and satisfaction levels were collected and analyzed using descriptive and inferential statistics. Results: The mean age was 35 ± 18 years; average calculus size 32.2 ± 9.8 mm. Mean operative duration was 90 ± 37.8 min. Sensory and motor recovery occurred at 145 ± 18.6 min and 116.8 ± 18.6 min, respectively. Hypotension occurred in 14%, headache in 2%, and no pleural punctures were observed. Mean patient and surgeon satisfaction scores were 4/5 and 3/5, respectively. Stone clearance was achieved in 92% of cases. Conclusion: Spinal anaesthesia for PCNL provides excellent surgical conditions with fewer complications, high satisfaction, and comparable efficacy to GA [4-6]. It represents a cost-effective and safe alternative, particularly suitable for resource-limited settings.

Diabetic foot (DF) are chronic, difficult-to-heal wounds with a very high incidence of amputation. For patients with DF, prevention of amputation is crucial. However, the risk factors associated with DF amputation and the extent to which different risk factors increase the risk of amputation are still uncertain. This study intends to provide a clinical basis for early intervention in DF by prospectively analysing the risk factors for DF amputation. An analysis of 100 patients with DFs admitted between February 2024 and January 2025 was conducted. 27 out of the 100 underwent amputations, i.e. amputation rate of 27%. This study revealed that poor glycemic control was present in 95% of amputated patients compared to 68% of non-amputated patients, suggesting a strong trending relationship between hyperglycemia and amputation risk. The most striking finding in our study was the highly significant association between ulcer healing status and amputation (p value 0.00014), with 85% of amputated patients having non- healing ulcers compared to only 40% of non-amputated patients. Poor glycemic control and presence of peripheral artery disease (PAD) were also strongly associated with limb amputation in my study.

Background: Asprosin is an adipokine that is produced during fasting and is implicated in insulin resistance and hepatic glucose release. Interest has grown in its potential to detect gestational diabetes mellitus (GDM) early. Objective: To evaluate whether serum asprosin levels measured during early pregnancy can foretell the onset of GDM later on. Methods: This prospective multicentre cohort study included 600 pregnant women (11–14 weeks gestation) recruited from three tertiary care hospitals in India between January 2023 and June 2024. Fasting serum asprosin was estimated using a standardized ELISA protocol. After a 75-g OGTT conducted between weeks 24 and 28, the IADPSG criteria were used to diagnose GDM. Logistic regression, ROC analysis, and model improvement metrics were applied. Results: A total of 92 women (15.3%) got GDM. Women who eventually developed GDM had significantly higher median blood asprosin levels at 11–14 weeks than normoglycemic controls (20.2 vs. 14.1 ng/mL). Good predictive performance was demonstrated by asprosin (AUC 0.76; 95% CI 0.71–0.81). Discrimination increased from AUC 0.74 to 0.81 (p=0.002) when asprosin was included to a clinical model that included maternal age, BMI, obstetric history, and family history of diabetes. The best cut-off was 17.5 ng/mL, which produced 70% specificity and 73% sensitivity. Conclusion: Elevated first-trimester serum asprosin levels are associated with increased risk of GDM and significantly enhance early predictive accuracy when added to routine clinical factors. Asprosin may serve as a practical early biomarker for GDM risk stratification.

Background: Chronic headache, including migraine and tension-type variants, remains a major cause of disability and impaired quality of life. Pharmacological therapies often provide incomplete relief and may induce drug overuse. Peripheral nerve blocks and lifestyle interventions have emerged as effective adjuncts in pain management. Aim and Objective: To evaluate and compare the effectiveness of combined occipital and sphenopalatine nerve block along with pharmacological and lifestyle modification versus pharmacological and lifestyle management in chronic headache patients. Materials and Methods: A prospective, randomized interventional study was conducted on 60 patients (18–60 years) diagnosed with chronic headache as per ICHD-3 criteria. Participants were divided into two groups: Group A received pharmacological management with lifestyle measures, and Group B received the same along with occipital and sphenopalatine nerve blocks. Outcomes—headache frequency (days/month), pain intensity (VAS), and Headache Impact Test-6 (HIT-6) scores were assessed at baseline, 4 weeks, and 12 weeks. Data was analyzed using SPSS v26; p < 0.05 was considered statistically significant. Results: Patients in Group B requested less medications and NSAID alone was adequate in most cases, very less patients needed sumatriptan along with NSAIDs. Conclusion: Combination of occipital and sphenopalatine blocks along with pharmacological and lifestyle modification provides better and sustained pain relief in comparison with pharmacological and life-style modification alone.

Background: Endotracheal intubation commonly provokes sympathetic stimulation, leading to transient hypertension and tachycardia. Attenuating these haemodynamic responses is crucial, especially in patients with cardiovascular risk. Methods: This randomized clinical trial included 80 patients (ASA I–II) undergoing elective surgery under general anaesthesia. Participants were randomly assigned to fibreoptic-guided intubation (Group F) or direct laryngoscopy (Group D). Haemodynamic parameters were recorded at baseline, during, and after intubation, and analyzed using SPSS 18.0. Results: Group F exhibited significantly lower systolic, diastolic, and mean arterial pressures between 2–5 minutes post-intubation (p < 0.01) compared to Group D. Heart rate elevation was transient in both groups but returned to baseline more rapidly in Group F. Beyond 7 minutes, haemodynamic variables stabilized in both groups. Overall, fibreoptic bronchoscopy showed superior attenuation of pressor and tachycardic responses. Conclusion: Fibreoptic-guided intubation provides better haemodynamic stability than direct laryngoscopy during general anaesthesia.

Introduction: Breast cancer is the most common malignancy among women worldwide, with outcomes influenced by factors such as tumor type, stage, and timing of treatment. Adjuvant chemotherapy plays a key role in improving survival, but the optimal time to initiate it post-surgery remains debated. This study evaluates the impact of early versus delayed initiation of adjuvant chemotherapy on disease-free survival (DFS) and overall survival (OS) in breast cancer patients. Aims & Objectives: To compare the DFS and OS in breast cancer patients receiving early (≤21 days post-surgery) versus delayed (>21 days post-surgery) adjuvant chemotherapy after modified radical mastectomy (MRM). Materials and Methods: A comparative observational study was conducted over 9 months at the Department of General Surgery, Government Medical College & Rajindra Hospital, Patiala. Fifty women with early-stage breast cancer who had undergone MRM were enrolled and divided into two equal groups (n=25 each): Group A (early chemotherapy) and Group B (delayed chemotherapy). Patients were followed for 9 months, and data on DFS and OS were analyzed using appropriate statistical tests, with p<0.05 considered significant. Results: All patients in Group A achieved DFS and OS of ≥9 months, while three patients in Group B experienced recurrence or metastasis within 9 months. Better clinical outcomes were observed in Group A across variables such as age, menstrual status, tumor size, and chemotherapy regimen. However, these differences were not statistically significant (p>0.05). Conclusion: Early initiation of adjuvant chemotherapy after MRM may be associated with improved DFS and OS in breast cancer patients, particularly among younger and premenopausal women. Though findings favored early chemotherapy, the lack of statistical significance highlights the need for larger, randomized studies to establish definitive recommendations.

Background: Soft tissue tumors (STTs) and tumor-like lesions present a wide range of diagnostic challenges due to their clinical and morphological diversity. Fine Needle Aspiration Cytology (FNAC) has emerged as a reliable, minimally invasive, and cost-effective diagnostic technique for the preliminary evaluation of such lesions. It helps differentiate benign from malignant conditions and guides further management. Aim: To evaluate the diagnostic utility of FNAC in the diagnosis of soft tissue tumors and tumor-like lesions and to correlate cytological findings with histopathological results. Methods: A prospective observational study was conducted over 12 months from July 2024 to June 2025 at Patna Medical College and Hospital, including 100 patients presenting with palpable soft tissue swellings. FNAC was performed using standard technique, and cytological diagnoses were categorized. Surgical excision and histopathological correlation were performed in 60 cases. Data were analyzed using SPSS version 23.0 to calculate diagnostic accuracy, sensitivity, specificity, (PPV), and (NPV). Results: Out of 100 cases, 60% were benign, 30% malignant, and 10% tumor-like/inflammatory lesions. Lipoma (40%) was the most common benign tumor, while sarcoma (15%) was the most frequent malignant tumor. FNAC findings correlated with histopathology in 54 of 60 cases (90%). The sensitivity and specificity of FNAC in detecting malignancy were 88.8% and 92.1%, respectively. The overall diagnostic accuracy was 90%, with PPV of 94.1% and NPV of 85.7%. Conclusion: For soft tissue cancers and tumor-like lesions, FNAC is a useful initial diagnostic technique because of its ease of use, speed, and high diagnostic accuracy. It is very useful for differentiating between benign and malignant lesions, and in many situations, it can greatly minimize the need for an open biopsy. Recommendations: FNAC should be incorporated as a routine first-line investigation for soft tissue lesions. Whenever possible, cytological diagnosis should be supported by ancillary techniques such as immunocytochemistry and correlated with histopathological findings for precise subtyping. Further studies with larger sample sizes and image-guided FNAC are recommended for deep-seated lesions.

Background: Although regional anaesthesia offers several advantages over general anaesthesia, achieving appropriate patient positioning for neuraxial blockade can be extremely painful in individuals with femur fractures. Peripheral nerve blocks, including the 3-in-1 block, femoral nerve block, and fascia iliaca compartment block, have emerged as effective alternatives for pain relief and facilitating optimal positioning. Aim: To compare the efficacy of Supra-inguinal fascia iliaca block with 40ml of 0.2% ropivacaine vs intravenous fentanyl 1microgram per kg for positioning during regional anaesthesia in femur fracture surgeries. Objective: To compare the efficacy of supra-inguinal fascia iliaca block and intravenous fentanyl for positioning during regional anaesthesia in femur fracture surgeries. Methods: Eighty patients aged 20-60 years of American Society of Anaesthesiologists (ASA) physical status I&II scheduled for elective femur fracture surgeries from May 2023 to May 2024 were included in this study. Group S were administered ultrasound-guided Supra-inguinal Fascia Iliaca Block preoperatively and Group F were administered IV Fentanyl preoperatively. Results: The Visual Analogue Scale (VAS) score during patient positioning was significantly lower in the Group S (1.15 ± 1.27) compared to the Group F (2.25 ± 1.58), with a P value of 0.0009. This indicates that the fascia iliaca compartment block offers superior analgesia for patient positioning in femur fracture surgeries. Conclusion: Suprainguinal Fascia Iliaca Block is more efficacious than intravenous Fentanyl for positioning during spinal anaesthesia in surgery for femur fracture. Supra-inguinal Fascia Iliaca Block provides superior analgesia compared to IV fentanyl in femur fracture surgery.

Objective: To describe the epidemiological profile and quantify neurological recovery using the ASIA Impairment Scale (AIS) in patients with acute traumatic thoracolumbar spinal cord injury (SCI). Design: Prospective observational cohort study. Setting: Department of Physical Medicine and Rehabilitation, SMS Medical College, Jaipur, Rajasthan. Participants: Sixty consecutive patients with acute traumatic thoracolumbar SCI. Main Outcome Measures: Demographic data and AIS grade conversion rates from baseline to 3-month follow-up. Statistical significance was assessed using Chi-square and paired t-tests. Results: The mean age was 46.22 ± 14.42 years, with a significant clustering in the 51-60 year age group (31/60, 51.7%, p<0.001). Males predominated (63.3%, p=0.04). The majority were from rural areas (56.7%) and lower-middle-class backgrounds (60.0%). Fall from height was the most common mechanism of injury (51.7%, p<0.001). Thoracic-level injuries were most frequent (66.7%), with D6-D10 being the commonest segment (33.3%). At 3 months, a statistically significant conversion of AIS grades was observed (Chi-square, p<0.001), with the proportion of AIS A patients decreasing from 38.3% to 28.3%. The ASIA lower limb motor score showed a highly significant mean improvement of 9.83 points (95% CI: 7.12-12.54, p<0.001). Conclusion: The epidemiological profile of thoracolumbar SCI in this region is distinct, with a high incidence of falls in an older population. The ASIA score demonstrates significant predictive value, with substantial and statistically significant neurological recovery observed within the first 3 months.

Objective: To investigate the correlation between nerves conduction studies (NCS) and the American Spinal Injury Association (ASIA) score for assessing neurological deficit and predicting recovery in patients with acute thoracolumbar spinal cord injury (SCI). Design: Prospective longitudinal observational study. Setting: Tertiary care hospital and rehabilitation center. Participants: Sixty patients with acute traumatic thoracolumbar SCI admitted within 15 days of injury. Interventions: Not applicable. Main Outcome Measures: Neurological assessment using ASIA Impairment Scale (AIS), motor, and sensory scores, alongside NCS of bilateral tibial, peroneal, and sural nerves (recording CMAP, SNAP, and conduction velocities) performed at baseline and 3-month follow-up. Results: Significant improvement was observed in all ASIA scores and most NCS parameters over 3 months (p<0.05). Kappa statistics revealed a significant positive agreement between neurological status and peroneal nerve CMAP at baseline for D1-L1 injuries (Kappa=0.621, p=0.026). Notably, sural nerve SNAP showed the most robust and consistent agreement with ASIA scores across all injury levels at the 3-month follow-up (Kappa=0.727, p=0.023). In contrast, nerve conduction velocities (NCV) of tibial and peroneal nerves showed weaker or negative agreement, particularly in thoracic-level injuries. Conclusion: NCS parameters, specifically the SNAP of the sural nerve and CMAP of the peroneal nerve, correlate significantly with neurological status and recovery. These electrophysiological measures serve as valuable objective biomarkers, complementing the clinical ASIA assessment in acute thoracolumbar SCI, with potential to enhance prognostic accuracy and personalize rehabilitation strategies.

Background: Junk food consumption among school children is rising rapidly and poses a growing public health challenge. High intake of energy-dense, nutrient-poor foods contributes to obesity, poor academic performance, and addictive eating behaviors. Objectives: To determine the prevalence of junk food addiction and identify key predictors among school children aged 10–16 years. Methods: A cross-sectional study was conducted among 300 school children. Junk food addiction was assessed using the modified Yale Food Addiction Scale for Children (YFAS-C). Data on dietary patterns, cravings, emotional eating, screen exposure, physical activity, sleep duration, and parental influence were collected. Prevalence was calculated, and predictors were analyzed using Chi-square tests and logistic regression. Results: The prevalence of junk food addiction was 38.7%. Strong predictors included fast-food consumption ≥3 times/week (p < 0.001), screen time ≥2 hours/day (p < 0.001), low physical activity (p = 0.002), sleep <8 hours/day (p = 0.01), high pocket money (p < 0.001), and parental junk food habits (p < 0.001). Logistic regression identified fast-food frequency (AOR 3.12), pocket money (AOR 2.87), and screen time ≥2 hours/day (AOR 2.64) as independent predictors. Conclusion: Junk food addiction is highly prevalent among school children. Multiple behavioural and environmental factors, including lifestyle and parental influence, contribute to addiction.

Gout is a chronic metabolic inflammatory disorder that may influence oral tissues, occlusal stability and prosthodontic rehabilitation due to systemic inflammatory changes and medication-related effects. This case involves a 50-year-old African American female with a medical history of gout managed with colchicine. The available case file contained demographic and medical information but lacked intraoral findings, radiographs and periodontal charting. The discussion highlights the impact of hyperuricaemia, systemic inflammation and colchicine-associated mucosal sensitivity on prosthodontic planning. Considerations include minimising tissue trauma, ensuring balanced occlusion, preserving periodontal health and coordinating care with medical professionals. Tailored rehabilitation is essential to achieve functional and biologically compatible outcomes in patients with systemic inflammatory conditions such as gout.

Asthma is a chronic inflammatory airway disorder that can significantly influence oral health, salivary function and prosthodontic outcomes due to both disease-related and medication-induced changes. A 25-year-old African American female with a medical history of asthma managed with albuterol was evaluated for oral rehabilitation. The case file contained demographic and medical details but no recorded intraoral findings, periodontal charting, radiographs or occlusal assessments. Current evidence shows that asthma and inhaler use may lead to xerostomia, mucosal fragility, increased periodontal inflammation and altered bone metabolism, all of which impact prosthesis retention, comfort and long-term stability. Effective rehabilitation of asthmatic patients requires understanding of medication effects, mucosal tolerance, airway considerations and the need for conservative, biologically compatible prosthodontic approaches. Interdisciplinary coordination and tailored treatment planning remain essential to ensure safe and predictable outcomes in patients with asthma.

Background: Significant morbidity and mortality are caused by rheumatic heart disease. The most prevalent manifestation of rheumatic heart disease is mitral stenosis (MS). An inflammatory condition known as rheumatic heart disease can impact the myocardium and any of the heart valves. In developing countries, rheumatic MS is a common cause of valve disease. The purpose of this study to assess Right Ventricular function before BMV, 48 hours and 3 months after the BMV in cases of severe Mitral stenosis using Echocardiography, Mitral valve area changes with changes in Right ventricular function and correlate Pulmonary hypertension with Right ventricular function echocardiographically before and after BMV. Method: This cross-sectional, observational study was conducted in Department of Cardiology, Narayan Medical College and Hospital, Sasaram, Bihar from June 2025 to September 2025. Total 50 patients were included in this study. Result: In One-Sample Statistics, the mean TAPSE Pre of patients was 13.85 ± 1.749, the mean TAPSE 24-48 Hrs of patients was 14.52 ± 1.624 and the mean TAPSE after 3 Months of patients was 16.79 ± 1.066. It was found that Mean difference of TAPSE was statistically significant. In One-Sample Statistics, the mean RIMP (DTI <0.53) Pre of patients was .5687 ± .03265, the mean RIMP (DTI <0.53) 24-48 Hrs of patients was .5522 ± .02013 and the mean RIMP (DTI <0.53) after 3 Months of patients was .5322 ± .01812.Mean difference of RIMP (DTI <0.53) was statistically significant. In One-Sample Statistics, the mean S’ (>10) Pre of patients was 8.82± .796, the mean S’ (>10) 24-48 Hrs of patients was 10.27± 1.441 and the mean S’ (>10) after 3 Months of patients was 11.28± 1.026. It was found that in One-Sample Test, mean difference of S’ (>10) Pre was 8.820 with 95% confidence interval [8.66–8.98, P < 0.0001]. Mean difference of S’ (>10) 24-48 Hrs was 10.270 with 95% confidence interval [9.98– 10.56, P < 0.0001]. Mean difference of S’ (>10) after 3 Months was 11.280 with 95% confidence interval [11.08–11.48, P < 0.0001]. Conclusion: In patients of severe mitral stenosis, we used echocardiography to measure right ventricular function prior to BMV, 48 hours after BMV, and three months after BMV. We also compared changes in mitral valve area and correlated pulmonary hypertension with right ventricular function before and after BMV.

Background: A thorough understanding of left atrial function can help one better understand the electromechanical remodeling of the atrium. These days, non-invasive methods such as strain (rate) imaging and tissue Doppler imaging can be used to evaluate heart function. For evaluating LV performance locally, both methods have been shown to be reliable. Recent evaluations of left atrial function have used these techniques. The heart’s tissue Doppler velocities, strain, and strain rate following balloon mitral valve replacement. Methods: Doppler testing, echocardiography, and tissue Doppler imaging were used to measure velocity, strain, and strain rate in 50 symptomatic patients with severe mitral stenosis. Each patient was evaluated both prior to and following balloon mitral valve surgery. Tests were also conducted on controls of the same age. Results: Decreased E’ and A’ IAS tissue doppler velocities were seen in patients with mitral stenosis. Patients with mitral stenosis had slower velocities in the left atrial lateral wall compared to healthy controls. After mitral balloon valvuloplasty, lateral E’ velocity increased (P =0.001). Mitral stenosis patients observed lower left atrial strain at ventricular end systole compared to controls. Systolic strain in the IAS decreases and strain in the left atrial lateral wall appears to ameliorate after balloon mitral valve surgery. Conclusion: Patients with mitral stenosis exhibited reduced left atrial function as determined by strain and tissue Doppler velocities. Following balloon mitral valve surgery, the left atrial reservoir’s function improves.

Background: In gynecology centers, 3–10% of women frequently have postmenopausal bleeding (PMB). Ten percent or so of these patients have either primary or secondary malignancies. Complete evaluation is necessary for PMB in order to detect and treat high-risk patients, such as those with endometrial hyperplasia, and to confirm the absence of malignancy. Investigating endometrial pathology and clinical significance in PMB patients is the aim of this investigation. Methods: From September 2024 to August 2025, the Department of Obstetrics and Gynecology at Jawaharlal Nehru Medical College and Hospital Bhagalpur, Bihar, conducted a retrospective study on postmenopausal women. About 80 PMB patients were selected and pelvic USG, endometrial biopsy, and endometrial histopathology were carried out to assess these patients. Results: Maximum patients with PMB belonged to age group of 46-50 years (31.25%). 57.5% were multiparous (parity>2). About 53.75% had PMB 1 to 5 years after menopause. Endometrial thickness (ET) was > 4mm in 86.25%. Majority had ET between 5-10mm (58.75%). Histopathological analysis of endometrial curettings showed Proliferative phase in 35%, disordered proliferative phase in 17.5%, Atrophic Endometrium in 13.75% and endometrial carcinoma in 11.25%. Conclusion: Postmenopausal bleeding is a significant symptom that needs to be assessed in order to rule out malignancy. The primary method of PMB examination is transvaginal sonography (TVS), however the gold standard for a conclusive diagnosis is endometrial histopathology.

Background: Ectopic pregnancy is a life-threatening obstetric emergency quite often missed on diagnosis in young women. It is essential to be ectopic minded in the diagnosis of ectopic pregnancy. The incidence of ectopic pregnancies has increased due to early detection by ultrasound and making first trimester ultrasound as part of routine antenatal work up. Aim of this study to analyse ectopic pregnancies in a tertiary care centre and determine the incidence, risk factors, clinical presentation, management, morbidity and mortality of ectopic pregnancy. Methods: From September 2024 to August 2025, the Obstetrics and Gynecology department at JLNMCH, Bhagalpur, Bihar, conducted a retrospective analysis of ectopic pregnancies using a sample of 97 cases of probable ectopic pregnancies that were examined and treated. Results: The incidence of ectopic pregnancy was 8 per 1000(0.81%) pregnancies, majority between the age of 20-30yrs (87.5%) and in higher order pregnancies (3 or >3 pregnancies) (50.4%). Risk factors were multiparity (50.5%), h/o infertility treatment (12.3%), and tubal sterilisation (7.2%). The typical triad of amenorrhoea, pain abdomen and bleeding p/v was observed in 69% of cases. In 16.4% cases the haemoglobin was <7gm% at presentation. Among 97 suspected cases of ectopic pregnancies, 90(92.7%) cases were found to have ectopic pregnancy. 27.8% of cases were presented in class 2 or more haemorrhagic shock. 79% cases were ruptured ectopic pregnancies. Ampullary ectopic pregnancies were predominant (62.9%) followed by corneal (14.6%) > fimbrial (13.4%) > ovarian (4.4%)> isthmus (2.2%). 2 women among 97 cases of suspected ectopic pregnancies were found to have Heterotopic pregnancy {tubal+intrauterine [missed abortion]}. Unilateral salpingectomy was done in 90.5% cases. Medical management was done successfully with single dose of methotrexate in 1 case. Blood transfusions were given in 69.9% cases. Post op wound complications were observed in 3.1% cases. Mortality is zero in present study. Conclusion: For the purpose of to minimize maternal morbidity and mortality and improve treatment success rates, clinicians should be aware that any woman in the reproductive age group who presents with lower abdominal pain or vaginal bleeding should be suspected of having an ectopic pregnancy, regardless of whether she has undergone sterilization or not.

Forearm fractures are common, with an incidence of 10 per 10,000 individuals annually. Among young adults, fractures involving both radius and ulna are prevalent, particularly in the 21–30-year (31.8%) and 31–40-year (27.2%) age groups. High-energy trauma, including road traffic accidents (RTA) and falls, plays a significant role. In elderly populations, forearm fractures are more common in women over 60, with incidence increasing with age. Traditional management using dynamic compression plating (DCP) ensures anatomical reduction but has drawbacks such as large surgical incisions, periosteal stripping, and implant-related complications. The titanium elastic nailing system (TENs) offers a minimally invasive alternative. This study assesses functional and radiological outcomes of TENs fixation for radial shaft fractures, comparing results with DCP.

Background: Magnesium is a vital intracellular cation involved in numerous physiological processes, yet its disturbances are frequently under-recognized in intensive care settings. This study aimed to estimate the prevalence of serum magnesium abnormalities and evaluate their association with in-hospital outcomes among critically ill patients admitted to a tertiary care ICU. Materials and Methods: A hospital-based, prospective observational study was conducted over two years in the Medical ICU of Agartala Government Medical College and GBP Hospital, Tripura. A total of 354 adult ICU patients were enrolled based on predefined inclusion and exclusion criteria. Serum magnesium levels were measured within 24 hours of ICU admission and categorized into hypomagnesemia (<1.7 mg/dL), normomagnesemia (1.7–2.55 mg/dL), and hypermagnesemia (>2.55 mg/dL). Patient outcomes including mortality, need for mechanical ventilation, APACHE II and qSOFA scores, and comorbidities were documented. Statistical analyses were conducted using SPSS version 22. Results: Hypomagnesemia was observed in 42.1% of patients, normomagnesemia in 46.0%, and hypermagnesemia in 11.9%. Patients with hypomagnesemia had significantly higher mortality (55.7%) compared to those with normomagnesemia (44.2%) (p < 0.001), along with greater need for mechanical ventilation (46.3%) and elevated qSOFA scores. A significant negative correlation was found between serum magnesium levels and APACHE II scores (r = –0.187; p < 0.001). Hypermagnesemia was significantly associated with chronic kidney disease and hyperkalemia but was not significantly associated with increased mortality. Conclusion: Magnesium abnormalities, particularly hypomagnesemia, are common and clinically significant in ICU patients. Routine assessment and early correction of magnesium levels may help improve outcomes in critically ill populations.

Background: Type 2 Diabetes Mellitus (T2DM) is increasingly understood as a chronic inflammatory state. While Hemoglobin A1c (HbA1c) remains the gold standard for assessing glycemic control, it fails to capture intraday glycemic variability (GV). Emerging evidence suggests that acute glucose fluctuations may trigger oxidative stress more potently than chronic sustained hyperglycemia, potentially driving the release of pro-inflammatory cytokines. Methods: A cross-sectional study was conducted involving 150 patients with T2DM. Participants underwent 7-day CGM to determine Mean Amplitude of Glycemic Excursions (MAGE), Standard Deviation of blood glucose (SD), and Coefficient of Variation (% CV). Fasting venous blood samples were analyzed for Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α), and hs-CRP using ELISA. Patients were stratified into Low GV (MAGE < 3.9 mmol/L) and High GV (MAGE ≥ 3.9 mmol/L) groups. Results: The High GV group exhibited significantly elevated levels of IL-6 (5.42±1.3 vs. 2.9±0.8 pg/mL, p<0.001), TNF-α (18.5±4.2 vs. 11.2±3.1 pg/mL, p<0.001), and hs-CRP (3.8±1.5 vs. 1.9±0.9 mg/L, p=0.002) compared to the Low GV group, despite similar HbA1c levels (7.4%±0.6 vs. 7.3%±0.5, p=0.45). Pearson correlation analysis revealed a strong positive correlation between MAGE and IL-6 (r=0.58, p<0.001) and TNF-α (r=0.51, p<0.001). Conclusion: Glycemic variability is strongly associated with systemic inflammation in T2DM, independent of chronic hyperglycemia. These findings suggest that stabilizing glucose fluctuations is crucial for mitigating inflammatory risk factors associated with diabetic complications.

Background: Subtrochanteric femur fractures present significant treatment challenges due to high mechanical stress, deforming muscular forces, and elevated failure rates with conventional single-implant fixation methods. Combined fixation strategies may enhance stability in complex fracture patterns. Methods: This prospective observational study included 30 patients (mean age 48.7 ± 14.2 years) with subtrochanteric femur fractures (Seinsheimer classification types II-V) treated. All patients underwent combined fixation using intramedullary nailing (22 proximal femoral nails, 8 Ender’s nails) augmented with lateral antiflexion derotating plates. Primary outcomes included fracture union rate, time to union, and functional scores. Secondary outcomes comprised complications and radiographic parameters. Results: Mean follow-up duration was 18.4 ± 4.6 months. Fracture union was achieved in 28 patients (93.3%) at mean 17.8 ± 3.4 weeks. Mean Harris Hip Score at final follow-up was 84.6 ± 9.8, with 73.3% achieving good-to-excellent results. Mean Lower Extremity Functional Scale score was 62.4 ± 11.7. Varus deformity >5° occurred in 2 patients (6.7%), and malrotation >10° in 1 patient (3.3%). Complications included one deep infection (3.3%), two cases of delayed union (6.7%), and one implant failure (3.3%). No cases of nonunion or femoral head necrosis were observed. Leg length discrepancy >1.5 cm occurred in 3 patients (10%). Conclusion: Combined intramedullary fixation with antiflexion derotating plating for subtrochanteric femur fractures demonstrates high union rates, acceptable functional outcomes, and low complication rates, representing a viable treatment option for complex subtrochanteric fractures.

Background: Obesity substantially increases cardiometabolic risk and strains health systems. Semaglutide, a glucagon like peptide-1 receptor agonist (GLP‑1 RA), has produced marked weight loss in clinical studies, yet questions remain about its long‑term durability, safety profile, and effectiveness across doses and diverse patient groups. A clear, concise synthesis of the evidence is essential to guide clinicians, patients, and guideline developers. Objectives: To comprehensively evaluate randomized controlled trials that investigate the safety and efficacy of once‑weekly subcutaneous semaglutide 2.4 mg in adults with overweight or obesity without diabetes, providing clinicians and patients with a clear, evidence‑based appraisal of benefits and harms. Methods: We searched electronic databases and clinical trial registries to identify randomized controlled trials that reported weight change and adverse events. Five eligible trials enrolling adults without diabetes compared once‑weekly subcutaneous semaglutide 2.4 mg with placebo or an active comparator. Extracted data were collated and presented in a narrative synthesis to summarize efficacy and safety findings. Results: Five randomized control trials (RCTs) (STEP‑1, STEP‑3, STEP‑4, STEP‑5, and STEP‑8) met inclusion criteria. Across trials, semaglutide consistently produced significantly greater weight loss than placebo or liraglutide. Mean reductions in body weight ranged from −14.9% to −16.0% at 68 weeks, with durability demonstrated up to 104 weeks in STEP‑5. A higher proportion of participants achieved ≥5%, ≥10%, and ≥15% weight loss with semaglutide compared with placebo. STEP‑8 confirmed superiority over liraglutide, with an estimated treatment difference of −9.4 percentage points. The most frequent adverse events were gastrointestinal, including nausea, vomiting, and diarrhoea, which were generally mild to moderate and transient. Conclusion: In adults without diabetes who have overweight or obesity, once‑weekly subcutaneous semaglutide 2.4 mg produces large, sustained reductions in body weight and is generally well tolerated. These results indicate semaglutide is an effective medication for weight management.

Introduction: Ocular trauma is a significant cause of visual morbidity worldwide. When media opacities like corneal edema, hyphema, or cataract preclude a clear view of the posterior segment, B-scan ultrasonography becomes an indispensable diagnostic tool for evaluating vitreo-retinal pathologies. This study aimed to evaluate the role of B-scan ultrasonography in detecting posterior segment lesions in patients with ocular trauma, with or without opaque media, to aid in diagnosis, management, and prognostication. Materials and Methods: A prospective diagnostic study was conducted on 166 traumatized eyes of 150 patients. All patients underwent a detailed ocular examination followed by B-scan ultrasonography using a 12 MHz probe. The findings were systematically recorded and analyzed. Results: The majority of patients were males (80.7%) in the 20-29-year age group (31.3%). Unilateral injury was more common (89.3%), with the right eye being more frequently involved (60.84%). Open globe injuries (65.1%) predominated over closed globe injuries (34.9%). B-scan revealed posterior segment pathologies in 72.29% of eyes. Vitreous hemorrhage was the most common finding (45.18%), followed by retinal detachment (11.44%), choroidal detachment (7.2%), and posterior vitreous detachment (7.22%). Other findings included posteriorly dislocated lens (3%), globe rupture (3.6%), and intraocular foreign body (2.4%). Conclusion: B-scan ultrasonography is a simple, non-invasive, cost-effective, and highly reliable modality for evaluating the posterior segment in ocular trauma. It is crucial for detecting occult injuries, planning surgical intervention, and predicting visual prognosis, especially in the presence of opaque media.

Background: Low-flow anaesthesia (LFA), usually defined as fresh gas flow (FGF) ≤1–2 L/min, has regained interest because of its potential economic, environmental and physiological advantages over conventional high-flow anaesthesia (HFA, typically ≥4 L/min). Concerns persist regarding hypoxia, accumulation of volatile degradation products and organ dysfunction, creating variability in practice. This review compared perioperative outcomes between LFA and HFA in adult surgical patients. Methods: A narrative review was conducted using targeted searches in PubMed and major publishers (up to July 2025) for randomized or prospective clinical studies directly comparing low- with higher FGF during volatile-agent general anaesthesia. Eligible studies included adults undergoing elective surgery with clearly defined FGF targets and reported perioperative outcomes such as core temperature, oxidative stress, renal function, hemodynamics, recovery profile, complications, volatile consumption, and cost. Data were extracted qualitatively and grouped by outcome domain; no new meta-analysis was performed. Results: Randomized trials involving sevoflurane and desflurane consistently demonstrated 30–70% reductions in volatile agent consumption and cost with LFA compared with HFA, without clinically important differences in hemodynamic stability or recovery times. Oxidative stress markers and thiol–disulfide homeostasis were similar or modestly more favourable with low flows. Core temperature loss was attenuated with LFA but hypothermia incidence remained multifactorial. Multiple studies did not detect increased rates of postoperative acute kidney injury, respiratory complications, or nausea and vomiting with LFA compared with higher flows when modern CO₂ absorbers and monitoring were used. Guidelines and expert consensus now support low-flow sevoflurane as safe in appropriately monitored patients. Conclusion: Across contemporary randomized and prospective studies, LFA provides substantial reductions in volatile consumption and environmental burden while maintaining comparable perioperative safety and recovery to HFA. When supported by modern anaesthesia workstations and vigilant gas and oxygen monitoring, low-flow techniques appear clinically safe for most adult elective surgical patients. Remaining research gaps include high-risk populations, long-term outcomes, and pragmatic implementation strategies.

Introduction: Tuberculosis (TB) continues to be a major health problem in India, with an estimated 3.1 million prevalent cases and an average annual mortality of 0.32 million’. DM has been shown to be an independent risk factor for TB², and there is evidence showing high DM prevalence in TB patients in community-based studies mainly from the southern part of India 3-5. Patients with diabetes are at greater risk of contracting tuberculosis, and diabetes can worsen the course of TB. TB can worsen glycemic control in patients with diabetes. Aims and Objectives: (1) To assess glycaemic status of newly diagnosed TB patients. (2) To compare glycaemic status in newly diagnosed TB patients & normal controls. Materials & Methods: (1) 30 newly diagnosed cases of Pulmonary Tuberculosis & 30 age & sex matched apparently healthy controls of age 15 years onwards, cases were those attending pulmonary medicine department (irrespective of diabetic status) of BRIMS Hospital, Bidar were included in the study. (2) Estimation of HbA1C & Random blood glucose was done by ion exchange high pressure liquid chromatography using Bio-Rad machine &glucose oxidase-peroxidase method respectively. Results and Conclusions: Our study shows that mean HbA1c & mean Random blood glucose levels were significantly higher in cases than in controls (p < 0.05). Conclusion: (1) TB infection causes glucose intolerance & alters the glycemic status; this might predispose patients to develop Diabetes Mellitus in future. (2) It is important to screen for DM near to the start of treatment to intervene and institute appropriate care to reduce hyperglycemia, which can further improve the outcome of TB.

Background: Neuro-Intensive Care Units (NICUs) are critical for managing life-threatening neurological conditions. However, data on disease patterns and outcomes in NICUs from developing countries remain scarce. Methods: This retrospective study analysed 553 consecutive patients admitted to a tertiary Neuro-ICU in over three years (Nov. 2021–Sep. 2025). Demographics, diagnoses, clinical parameters, ventilatory support, complications, and outcomes at discharge, 1 month, 6 months, and 1 year were evaluated. Statistical analyses identified predictors of poor outcome. Results: The cohort included 63.1% males with a mean age of 42.3 ± 16.8 years. Cerebrovascular accidents were the most common diagnosis (30.4%), followed by Guillain–Barré syndrome (17.5%). Mechanical ventilation was required in 33.1%, associated with significantly increased mortality (55.2% vs. 4.4%, p <0.001). Mortality at discharge and one year were 21.3% and 22.1%, respectively. Coma at admission (OR 3.6, 95% CI 2.2–5.7, p <0.001), septicemia (OR 5.2, 95% CI 3.1–8.6, p <0.001), and electrolyte imbalances (OR 1.8, 95% CI 1.1–2.9, p =0.04) independently predicted poor outcomes. Conclusion: High early mortality and morbidity characterize NICU patients in this setting, though significant recovery is possible. Identifying key prognostic factors can guide focused interventions and resource allocation to optimize neurocritical care in developing countries.

The aim of this study was to describe the experience of the study with fetal heart screening by fetal echocardiography in non-risk and high-risk population. This was a prospective analytical study, the data was collected prospectively during the time period of November 2018 to December 2019, through a screening of fetal heart. Screening fetal echocardiography was provided to all pregnant women of second and third trimester who came for routine outpatient ultrasound clinic of our hospital. The pregnant females with high risk were provided with extended fetal echocardiography. We categorized the abnormal fetal heart according to severity into “complex”, “significant”, “minor” and “other”. we performed 6634 fetal heart screening. 852 pregnant out of 6634 were identified with conventional risk factors for CHD. The incidence among non-risk population was 4.3 per thousand and among high-risk population was 12.9 per thousand. Based on complexity of anatomical cardiac anomalies, 48.2% cases were complex, 20.6% cases were significant, 17.2% were minor cases and rest 13.7% were other.

Background: Aplastic anemia is a hematopoietic stem cell disorders that causes cytopenias in two or more cell lines (red blood cells, white blood cells, and/or platelets), hypoplasia or aplasia of the bone marrow, and a loss of blood cell precursors. It is a fatal condition and the prognosis is highly influenced by the patient’s age, severity of the disease and the effectiveness of immediate treatment. Robust treatment options include bone marrow transplantation and immunosuppressive therapies, such as cyclosporine and equine antithymocyte globulin. Notably, patients who have undergone a compatible bone marrow transplant can achieve a five-year survival rate exceeding 75%, demonstrating a strong potential for recovery and significantly enhanced quality of life. Equine anti-thymocyte globulin is a cost-effective alternative with good efficacy and safety, allowing for shorter hospital stays and fewer complications. Materials and Methods: A retrospective comparative study was carried out in the oncology unit of the State Cancer Institute in Jaipur, Rajasthan. Following Institutional ethical committee approval, the patients’ data of two years from May 2022 to June 2024 was analyzed, and a comparison of the safety and efficacy of stem cell transplant and anti-thymocyte globulin was conducted. Data was analyzed with SPSS software with latest Microsoft version. Results: The present study was carried out among 56 patients. Out of 56, 63% (35) were given Anti-thymocyte globulin (ATG) and in 38% (21) patients bone marrow or stem cell transplant was performed. In ATG group there was a complete response and resolution of acquired aplastic anemia in 51 % (18) patients followed by partial response in 34% (12), no response in 9% (3) and death of 5% (2) patients. Similarly in stem cell transplant patients, successful engraftment was achieved in 76% (16) patients followed by graft failure in 14% (3) and death of 9% (2) patients. Conclusion: The comparative analysis showed that anti-thymocyte globulin is safe and cost-effective treatment with efficacy comparable to stem cell transplantation. Longer-term research is required to assess the efficacy for future perspectives.

Background: Thyroidectomy, though commonly performed, poses a risk for post-operative respiratory complications due to the gland’s close anatomical relationship with the trachea, larynx, and recurrent laryngeal nerves. These complications, including laryngeal edema, tracheomalacia, and recurrent laryngeal nerve (RLN) palsy, can result in significant morbidity. This study aimed to evaluate the incidence, causes, and outcomes of post-operative respiratory complications following thyroidectomy at a tertiary care centre. Methods: This retrospective descriptive study was conducted at Government Medical College, Ernakulam, from December 2018 to July 2024. Data from 520 patients who underwent thyroidectomy were reviewed from the anaesthesia register. Demographic details, anesthetic techniques, perioperative complications, interventions, and outcomes were analyzed using descriptive statistics. Results: Of the 520 thyroidectomy cases, 473 (90.96%) were females and 47 (9.03%) males, with most patients aged 31–60 years (78.07%). Multinodular goitre accounted for 94.03% of cases, while papillary and follicular carcinomas constituted 3.26% and 2.69%, respectively. Post-operative respiratory complications occurred in 18 patients (3.46%). These included RLN palsy (0.38%), laryngeal edema (0.38%), tracheomalacia (0.57%), hematoma (0.38%), bronchospasm (0.57%), inadequate reversal (0.19%), and 0.96% with unexplained stridor. One patient required tracheostomy for bilateral RLN palsy; there was no mortality. Conclusion: Post-operative respiratory complications following thyroidectomy are infrequent but potentially serious. Early identification, anticipation of airway problems such as tracheal compression, and vigilant post-operative monitoring can significantly reduce morbidity. The predominance of middle-aged female patients highlights a demographic trend consistent with global patterns of thyroid disease.

Background: Syphilis is a systemic infectious disease of variable chronicity. The diagnosis is usually confirmed by serological tests. There is a need for simple and effective rapid point of care tests for screening as well as confirmation. As these tests have not been studied extensively in the Indian scenario, this study was done to evaluate the efficacy of Syphicheck-WB in a tertiary care hospital in Madurai, Tamil Nadu. Methods: Two hundred consecutive, consenting patients attending STD clinic were selected for the study. These included patients with a clinical suspicion of syphilis, those with other STDs, patients with high-risk behaviour and partners of patients with STDs. TPHA and Syphicheck-WB were done on the blood samples collected from these patients and the sensitivity, specificity, positive predictive value and negative predictive value of Syphicheck-WB were calculated with TPHA as the reference test. Results: With TPHA as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of Syphicheck-WB were 90.4%, 99.3%, 97.9% and 96.7% respectively. Conclusion: High values of sensitivity and specificity of Syphicheck-WB were recorded in our study. Thus, we conclude that this test can be used as an effective rapid confirmatory test in the Indian scenario which is easier to perform and more cost effective than TPHA.

Background: Effective pain relief during labour improves maternal comfort, reduces stress responses, and enhances the overall childbirth experience. Epidural analgesia using low-dose local anesthetics combined with opioids is the current standard. Ropivacaine provides good sensory blockade with minimal motor block, and the addition of fentanyl improves analgesic quality. However, the optimal fentanyl concentration for continuous infusion with low-dose ropivacaine remains uncertain. This study compares two continuous infusion regimens-0.1% ropivacaine with fentanyl 1 µg/mL versus 0.5 µg/mL-following a uniform induction bolus. Methods: This prospective comparative study included labouring parturients requesting epidural analgesia. All received an initial epidural bolus of 10 mL 0.2% ropivacaine with 20 µg fentanyl. Participants were then allocated into two groups: Group A received a continuous epidural infusion of 0.1% ropivacaine with 1 µg/mL fentanyl, and Group B received 0.1% ropivacaine with 0.5 µg/mL fentanyl. Parameters assessed included analgesic efficacy (VAS), highest sensory level, motor blockade (Bromage score), hemodynamics, duration of labor, mode of delivery, maternal satisfaction, and adverse effects. Results: Both regimens provided effective labour analgesia. Group A demonstrated slightly better pain scores with comparable onset time. Incidence of motor blockade was minimal in both groups, with no significant difference in sensory levels or hemodynamic changes. Maternal satisfaction was high in both groups, though marginally higher in Group A. Side effects such as pruritus and nausea were more frequent with the higher fentanyl concentration. Mode of delivery and neonatal outcomes were comparable. Conclusion: Continuous epidural infusion of 0.1% ropivacaine with either 1 µg/mL or 0.5 µg/mL fentanyl provides safe and effective labor analgesia. The lower fentanyl concentration offers similar analgesic efficacy with fewer opioid-related side effects, making it a preferable option for routine practice.

Background: India’s rapid economic growth has contributed to a rising burden of non-communicable diseases, particularly hypertension and type II diabetes mellitus (T2DM), which are major modifiable risk factors for cardiovascular and cerebrovascular diseases. Understanding the early emergence of prehypertension and diabetes risk in young women is critical for the public health planning. Methods: A cross-sectional study was conducted among 334 college-going women aged 18–22 years in the Pathanamthitta district, South Kerala, selected through multistage cluster sampling. Data were collected from December 2017 to May 2019 using a pilot-tested semi-structured questionnaire capturing socio-demographic details, dietary habits, physical activity, and family history of hypertension and diabetes. Anthropometric measurements and blood pressure were recorded. Data entry was entered into MS Excel, and analysis was performed using appropriate statistical software. Chi-square test was used to assess associations between categorical variables, while independent sample t-test was applied for quantitative variables. Results: Prehypertension was observed in 40.9% of the participants, and 33.2% were found to have a moderate risk of developing T2DM in later life. No statistically significant association was detected between prehypertension and T2DM risk. Prehypertension showed significant associations with the consumption of fish, eggs, and vegetables. T2DM risk was significantly associated with physical activity, family history of hypertension and diabetes, and anthropometric indicators including weight, waist circumference, hip circumference, and BMI. Conclusion: The substantial prevalence of both prehypertension and diabetes risk among young women highlights an emerging dual burden requiring early, targeted preventive interventions. Strengthening lifestyle-based strategies among adolescents and young adults is crucial to reduce future Cardiometabolic morbidity.

Background: Chronic Otitis Media (COM) is a prevalent otorhinolaryngological condition necessitating surgical intervention to restore tympanic membrane integrity and hearing mechanism. While microscopic myringoplasty has long been the gold standard, the introduction of rigid endoscopes has revolutionized middle ear surgery. Methods: A prospective, randomized controlled trial was conducted on 120 patients with inactive mucosal COM undergoing type I myringoplasty. Patients were randomized into Group A (Endoscopic, n=60) and Group B (Microscopic, n=60). Parameters assessed included graft uptake rate, air-bone gap (ABG) closure, operative duration, and postoperative pain using the Visual Analog Scale (VAS). Follow-up was conducted at 1, 3, and 6 months. Results: The graft uptake rate was 93.3% in the endoscopic group and 95.0% in the microscopic group, with no statistically significant difference (p=0.701). Both groups showed significant postoperative audiological improvement. The mean postoperative ABG was 11.4±4.2 dB in Group A and 10.9±3.8 dB in Group B (p=0.58). However, the mean operative time was significantly shorter in the endoscopic group (52.4±10.5 min) compared to the microscopic group (78.6±15.2 min, p<0.001). Furthermore, postoperative pain scores at 24 hours were significantly lower in Group A (2.1±0.8) compared to Group B (5.4±1.2, p<0.001). Conclusion: Endoscopic myringoplasty is as effective as microscopic myringoplasty regarding graft uptake and hearing improvement. However, it offers distinct advantages in terms of reduced operative time, lower postoperative morbidity, and superior cosmetic outcomes due to the transcanal approach.

Introduction: Sepsis frequently leads to pulmonary complications, with delayed recognition worsening outcomes. Chest CT, offering superior detail over radiographs, detects early parenchymal and perfusion changes. Advances in contrast-enhanced CT and radiomics suggest predictive value for ARDS. This study aimed to evaluate CT’s diagnostic accuracy for early lung injury in septic patients. Methods: This prospective study (Dec 2024–Apr 2025) at Rajalakshmi Medical College evaluated septic ICU patients using 128-slice chest CT within 48 hours. Morphological and perfusion abnormalities were assessed by blinded radiologists. Clinical, laboratory, and outcome data—including ARDS, ICU stay, ventilation, and mortality—were correlated with CT findings using statistical analysis. Results: Eighty-eight septic patients (mean age 54.3 years, 62.5% male) were studied. Chest CT showed diverse abnormalities, including ground-glass opacities, consolidation, and perfusion defects. ARDS developed in 28 cases, with CT findings significantly associated. Patients with abnormal CT had longer ICU stays, higher ventilation needs, and greater 28-day mortality. Conclusion: Chest CT proved valuable for early detection of sepsis-associated pulmonary complications. Key findings correlated strongly with ARDS and adverse outcomes, including prolonged ICU stay, increased ventilation, and higher mortality. Integrating CT into early sepsis evaluation enhances diagnostic precision, guides timely interventions, and supports improved patient management and prognosis.

Background: Optic atrophy represents the final common pathway of various optic nerve insults leading to irreversible visual impairment. Identifying its etiological spectrum is vital for targeted diagnosis and management. Aim: To study the clinical and demographic profile of patients presenting with optic atrophy at a tertiary eye care centre. Methods: This prospective observational study was conducted at the Lions Club of Hyderabad Sadhuram Eye Hospital and Post Graduate Institute of Ophthalmology, Hyderabad, from October 2018 to March 2020. A total of 106 patients with clinically diagnosed optic atrophy were included. Detailed demographic, clinical, and etiological evaluations were performed, including ocular and systemic assessments. Data were analyzed using SPSS version 19.0, with qualitative variables expressed as percentages and quantitative variables as mean ± SD. Results: Most patients belonged to the 41–50 years age group (29.2%), with male predominance (74.5%). The leading causes were glaucomatous optic atrophy (19.8%), NAION and TRON (14.2% each), nutritional (10.4%), and intracranial lesions (10.4%). Unilateral cases were mainly traumatic or ischemic, while bilateral cases were largely nutritional or toxic in origin. Conclusion: Glaucoma, ischemic, and nutritional etiologies are predominant causes of optic atrophy. Early identification of systemic and toxic risk factors can help prevent progression and bilateral involvement.

Background: Colour vision deficiency (CVD) is a common hereditary condition that often remains undiagnosed in children, potentially affecting learning and career choices. Smartphone-based applications offer a promising alternative to traditional Ishihara plate testing for large-scale screening. Aim: To assess the diagnostic accuracy, feasibility, and acceptability of a mobile application for CVD screening among school children compared to the standard Ishihara test. Methods: A prospective observational study was conducted at Prathima Relief Institute of Medical Sciences, Hanumakonda, from February to May 2025. Three hundred children aged 8–16 years underwent testing using both Ishihara plates and a validated mobile app. Statistical analysis using SPSS version 26 calculated sensitivity, specificity, PPV, NPV, and diagnostic accuracy. Results: CVD prevalence was 5.0% by Ishihara and 6.7% by the mobile app. The app demonstrated 93.3% sensitivity, 97.9% specificity, and 97.7% diagnostic accuracy. Most participants found the app easier and more engaging. No significant gender differences were observed. Conclusion: Smartphone-based screening is a reliable, quick, and child-friendly alternative for CVD detection. Its high accuracy and acceptability make it ideal for mass school-based vision screening programs in low-resource settings.

Meralgia paraesthetica (MP) is a painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by burning, tingling, and numbness over the anterolateral thigh. Although commonly associated with metabolic, mechanical, or idiopathic causes, iatrogenic MP following major surgeries is increasingly recognized. We report a case of a 48-year-old male who developed severe right-sided anterolateral thigh pain following coronary artery bypass grafting (CABG). The patient presented with burning, stabbing dysesthesia unresponsive to Pregabalin and aggravated by standing and walking. A positive Tinel’s sign over the inguinal ligament indicated LFCN involvement. The patient’s comorbid diabetes likely contributed to nerve susceptibility. Conservative measures, including lifestyle modification and glycaemic optimization, failed to relieve symptoms. Under ultrasound guidance, pulsed radiofrequency (PRF) neuromodulation of the LFCN was performed using standard PRF parameters, followed by injection of bupivacaine and methylprednisolone. The procedure was uneventful and resulted in marked improvement, with the Visual Analogue Scale (VAS) decreasing from 8 to 4 within one week and substantial functional recovery. This case highlights MP as an uncommon but important postoperative complication after CABG, often related to surgical positioning or traction. Early diagnosis and minimally invasive interventions such as PRF denervation may provide effective, sustained pain relief in refractory cases.

Background: Chronic otitis media (COM) is a prevalent condition, especially in rural India, often necessitating tympanoplasty. This study compares the efficacy of temporalis fascia and cartilage grafts in type 1 tympanoplasty for treating tympanic membrane (TM) perforations due to mucosal COM. Objective: To evaluate and compare graft uptake and hearing improvement in patients undergoing type 1 tympanoplasty using temporalis fascia versus cartilage grafts. Methods: A longitudinal, institute-based analytical study was conducted over 18 months at a tertiary care centre in Darjeeling, India. Sixty patients aged 18–50 years with inactive mucosal COM were assigned to receive tympanoplasty with either temporalis fascia (n=30) or cartilage graft (n=30). Audiological assessments and graft uptake evaluations were performed at 8 and 12 weeks postoperatively. Results: Both groups had comparable demographic profiles. Graft uptake at 12 weeks was higher in the cartilage group (93.3%) compared to the fascia group (86.7%). However, the fascia group exhibited significantly better hearing outcomes, with lower mean air-bone gaps at both 8 weeks (25.3±6.6 dB vs. 29.7±8.4 dB, p=0.023) and 12 weeks (23.4±6.8 dB vs. 27.7±8.2 dB, p=0.031). No significant differences were observed regarding the presence of perichondrium in the cartilage group. Conclusion: Temporalis fascia grafts yield superior short-term auditory outcomes, while cartilage grafts offer better graft uptake and long-term stability. Graft selection should be individualized based on patient and disease characteristics.

Introduction: Complement activation, inflammatory cytokine release, autoantibody formation (especially anti-dsDNA antibodies), and immunological dysregulation all play intricate roles in the pathophysiology of lupus nephritis. Aims: This study aims to evaluate the demographic, socioeconomic, clinical, and laboratory profiles of patients with systemic lupus erythematosus (SLE) presenting with lupus nephritis and to identify potential predictors of poor renal response among these patients in a tertiary care teaching institute in North Bengal. Materials & Methods: This observational, ambispective cohort, non-interventional study was conducted at the Rheumatology OPD, Medicine OPD, and IPD of the Department of Medicine, North Bengal Medical College and Hospital, Darjeeling. The study was carried out over 18 months (1st July 2023 to 31st December 2024) and included a total of 60 patients. Result: In our study of 60 patients, those with good outcomes had similar baseline SLEDAI scores (10.75 ± 5.58) compared to patients with poor outcomes (11.78 ± 5.56; p = 0.6106). At 3 months, disease activity remained comparable between the good (3.57 ± 7.22) and poor outcome groups (4.45 ± 8.44; p = 0.3678). By 6 months, patients with good outcomes showed significantly lower disease activity (2.27 ± 4.29) than those with poor outcomes (4.24 ± 8.67; p < 0.0001). Conclusion: We concluded that poor renal outcomes were more commonly linked to patients with lupus nephritis who had higher disease activity scores, persistent anti-dsDNA elevation, lower complement C4 levels, impaired renal function (elevated urea and creatinine, reduced eGFR), and significantly higher 24-hour proteinuria.

Introduction: Fluid resuscitation is a cornerstone in the management of critically ill patients. Traditional strategies rely on static clinical parameters such as blood pressure, heart rate, and central venous pressure, which may not reliably predict fluid responsiveness. Bedside ultrasound offers dynamic assessment of cardiac function and intravascular volume, potentially enabling more precise fluid optimization. Aims: This study aimed to compare bedside ultrasound-guided hemodynamic assessment with traditional clinical parameter-based fluid resuscitation in critically ill patients. Outcomes included fluid administration, hemodynamic stabilization, and clinical endpoints. Materials and Methods: In this prospective, randomized study at Suyash Hospital, Raipur, 140 critically ill patients were enrolled and equally randomized into two groups: ultrasound-guided and traditional parameter-based fluid resuscitation. Baseline demographics and hemodynamic parameters were comparable. Results: The ultrasound-guided group received significantly less fluid in the first six hours (2100 ± 520 mL vs. 2850 ± 600 mL, p < 0.001) and achieved target MAP ≥65 mmHg faster (2.1 ± 0.9 h vs. 3.4 ± 1.1 h, p < 0.001) and more frequently (90% vs. 74%, p = 0.02). Dynamic indices improved markedly, including reduced IVC collapsibility (38 ± 10% → 18 ± 8%, p < 0.001) and increased LVOT VTI (14.3 ± 3.1 → 19.5 ± 3.7 cm, p < 0.001) and cardiac output (3.8 ± 0.9 → 5.1 ± 1.1 L/min, p < 0.001). Clinical outcomes favored the ultrasound group, with shorter ICU stay (4.8 ± 1.7 vs. 6.1 ± 2.3 days, p = 0.01), fewer requiring mechanical ventilation (18.6% vs. 31.4%, p = 0.04), lower pulmonary edema incidence (7.1% vs. 18.6%, p = 0.03), and improved lactate clearance (38.2 ± 9.5% vs. 27.4 ± 8.7%, p < 0.001). Though 28-day mortality was lower (10% vs. 17%), this was not statistically significant (p = 0.19). Conclusion: Bedside ultrasound-guided fluid resuscitation enables more precise and efficient hemodynamic optimization, reduces fluid overload, accelerates MAP achievement, and improves key clinical outcomes compared to traditional parameter-based strategies.

Introduction: Noncompliance with scheduled radiation therapy is linked to poor results and survival rates. It also indicates the calibre of care provided to patients. Determining the noncompliance rate and the variables that contribute to it can provide us with insight into how to improve the treatment quality by putting mitigation measures in place. Objective: To determine the incidence and causes of non-compliance to radiotherapy. Materials and Method: We retrospectively reviewed the radiation records of patients treated with conventional fractionation over a telecobalt machine with the goal of curing them between January 1, 2023, and December 31, 2023, at the radiation Department of Dr. S. N. Medical College. Results: Of the 420 patients, 253 had cancer of the head and neck, 85 had cervical cancer, 51 had breast cancer, and 31 had lung cancer. The total percentage of patients who were non-compliance was 14.28%; these included 18.57% of patients with head and neck cancer, 9.09% of patients with cervical cancer, 4.0% of patients with breast cancer, and 10.34% of patients with lung cancer. Various factors associated with noncompliance and statistically significant association was found between noncompliance and higher age of the patients (P < 0.001), male gender (P = 0.038), advanced stage (P <0.001), administration of concurrent chemoradiotherapy (P < 0.001), comorbidities (P < 0.001), primary tumour site (P value = 0.019) and greater distance patient had to travel for radiotherapy (P < 0.001).

Background/Objective: Hemodynamic surges and sympathetic stimulation are common side effects of tracheal intubation and laryngoscopy. Common premedicants with different effectiveness characteristics are midazolam and dexmedetomidine. to evaluate how well midazolam and dexmedetomidine reduce the hemodynamic reaction to laryngoscopy and intubation. Methods: 110 adult ASA I–II patients undergoing elective procedures under general anesthesia participated in a multicentric, prospective, double-blind randomized experiment. Patients received either intravenous dexmedetomidine 0.5 µg/kg over 10 minutes (Group D, n=55) or midazolam 0.03 mg/kg bolus (Group M, n=55) before induction. At baseline, prior to induction, and 1, 3, 5, and 10 minutes after intubation, HR and MAP were measured. Results: Group D demonstrated significantly lower peak HR rise compared with Group M (+14.2 vs +24.1 bpm; p<0.001). Peak MAP increase was also significantly lower in Group D (+4.9 vs +14.9 mmHg; p<0.001). Sedation scores were higher with dexmedetomidine (median 3 vs 2; p=0.002). Bradycardia was more frequent in Group D (12.7% vs 1.8%; p=0.03). Recovery times were modestly prolonged in Group D. Conclusion: Dexmedetomidine provides superior attenuation of hemodynamic responses to laryngoscopy and intubation compared with midazolam while requiring increased vigilance for bradycardia and slightly prolonged recovery.

Background: Gestational Diabetes Mellitus (GDM) is one of the most common metabolic complications of pregnancy, associated with significant maternal and fetal morbidity. Vitamin D deficiency during pregnancy has emerged as a potential risk factor for GDM development, as vitamin D plays a crucial role in insulin secretion, glucose metabolism, and pancreatic β-cell function. Despite growing evidence linking hypovitaminosis D with impaired glucose tolerance, the precise relationship between maternal vitamin D status and GDM remains incompletely understood.​ Objectives: The primary objective of this study was to determine the association between vitamin D deficiency and Gestational Diabetes Mellitus among pregnant women with gestational age 24-32 weeks. Secondary objective includes assessment of the relationship between insulin resistance (HOMA-IR) and GDM in the study population.​ Methods: This hospital-based analytical cross-sectional study was conducted at the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynaecology, College of Medicine and Sagore Dutta Hospital. A total of 380 pregnant women between 24-32 weeks of gestation were enrolled, comprising 190 women with GDM (study group) and 190 normoglycemic pregnant women (control group). GDM was diagnosed using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria based on a 75-gram oral glucose tolerance test (OGTT). Serum 25-hydroxyvitamin D levels were measured using electrochemiluminescence method, and fasting insulin levels were assessed to calculate insulin resistance using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Anthropometric measurements including height, weight, and BMI were recorded. Statistical analysis was performed using Chi-square test, Mann-Whitney U test, and Spearman rank correlation, with p<0.05 considered statistically significant.​ Results: The mean age of the study group (27.4±3.66 years) was significantly higher than the control group (25.6±4.21 years, p<0.001). Mean BMI was significantly elevated in the GDM group (25.8±1.98 kg/m²) compared to controls (24.9±2.99 kg/m², p<0.001). Women with GDM had significantly higher fasting blood glucose (96.9±4.88 mg/dL vs. 82.1±6.17 mg/dL), 1-hour glucose (191±6.49 mg/dL vs. 137±10.3 mg/dL), and 2-hour glucose levels (154±10.3 mg/dL vs. 112±11.4 mg/dL) compared to controls (all p<0.001). Importantly, mean serum vitamin D levels were significantly lower in the GDM group (21.7±2.33 ng/mL) compared to controls (29.1±4.38 ng/mL, p<0.001). Fasting insulin levels were significantly elevated in the study group (10.8±0.982 µIU/mL vs. 8.53±2.02 µIU/mL, p<0.001), as was HOMA-IR (2.56±0.229 vs. 1.72±0.404, p<0.001). Correlation analysis revealed significant negative correlations between vitamin D levels and fasting blood glucose (r=-0.647, p<0.001), 1-hour glucose (r=-0.672, p<0.001), 2-hour glucose (r=-0.687, p<0.001), fasting insulin (r=-0.581, p<0.001), and HOMA-IR (r=-0.664, p<0.001). A strong positive correlation was observed between fasting insulin and HOMA-IR (r=0.913, p<0.001).​ Conclusion: This study demonstrates a significant association between maternal vitamin D deficiency and gestational diabetes mellitus in pregnant women at 24-32 weeks of gestation. Lower serum vitamin D levels were independently associated with higher glucose levels, increased insulin resistance, and elevated HOMA-IR values in women with GDM. The findings suggest that vitamin D plays an important role in glucose homeostasis and insulin sensitivity during pregnancy. These results support the hypothesis that vitamin D deficiency may contribute to the pathogenesis of GDM through mechanisms involving impaired insulin secretion and increased insulin resistance. Given the high prevalence of vitamin D deficiency during pregnancy and its potential impact on maternal glucose metabolism, screening for vitamin D status and appropriate supplementation may be warranted as part of antenatal care. However, further large-scale interventional studies are needed to determine whether vitamin D supplementation can effectively prevent or reduce the risk of GDM development.​ Limitations: The study was limited by its single-centre design, relatively small sample size of 380 participants, and cross-sectional nature which precludes establishment of causality. Hospital-based recruitment may introduce selection bias.​

Background: The disruptive potential of nanomedicine in pain management is through the use of nanocarriers (liposomes, micelles, polymeric nanoparticles, and emulsions) to improve the improvement in delivery of the drugs that comprise the pain-relieving chemicals. These systems enhance the solubility and stability of drugs they target, and have controlled release, which overcomes the drawbacks of the traditional pain therapies. Methods: This review discusses some nanocarriers used to treat pain specifically; it focuses on their capacity to traverse physiological boundaries such as the blood-brain barrier (BBB). It also discusses how the size and the surface functionalization of nanoparticles affect the distribution of drugs and their therapeutic efficacies. Results: In comparison to the circumstances of the previous administration, nanocarriers have shown increased bioavailability and decreased toxicity as well as delivery of analgesics, especially in neurological and dental pain. They are used in periodontal treatment where drugs are released locally, antibacterial compositions and as supporting implants. Conclusion: Nanomedicine also works by helping to control the pain by delivering drugs to the body with precision and in a sustained manner. Nevertheless, there is a need to investigate other areas of safety in the long run, biodegradability as well as regulatory issues. Additional integration with AI may allow one to be able to treat pain with personalized and efficient approaches.

Aim: To find out the effectiveness of bates eye exercise among mobile phone using college students. Background: Since there is high level of prevalence of smartphone users (i.e., 37%) is between the age group of 16-24 years, so there might be more chances of developing digital eye strain among this population. Study Design: Pilot study. Methods: In this study 15 samples were taken who satisfied the inclusion criteria. The mean age group of samples is 21.66 years. Bates eye exercises such as palming, resting the eyes, eye massage, blinking, shifting, sun treatment, and central fixation are some of the exercises that gives relaxation to ocular muscles are given to the subjects. Asthenopia questionnaire, perceived stress scale, and Snellen chart were used as outcome tool to take pre and post-test. Results: The statistical analysis of pre & post- test values were analyzed using paired and unpaired ‘t’ test. The result of this study shows that Bates eye exercise has significant effect in near induced transient myopia and very significant in reducing the visual fatigue. But it has no significant effect in reducing the mental strain in this study. Conclusion: From this study it has been concluded that there is significant effect of Bates eye exercise in reducing visual fatigue and near induced transient myopia in smartphone using college students.

Background: Apart from conventional sequences of MRI, physiological MRI, such as diffusion-weighted (DW) imaging, perfusion MRI (PMRI), and proton MR spectroscopy provides additional information for accurate diagnosis of grades, types, vascularity, and composition of tumors. Method: 90 patients suspected of having a tumor were subjected to DWI. Diffusion MRI, perfusion MRI, MR spectroscopy on Siemens 1.5T MRI machine. Results: Out of 90 patients, 75 had benign tumors and 15 had malignant tumors. In benign tumors, 35 (46.6%) were heterogenous, 20 (26.6%) were homogenous, 8 (10.6%) were peripherally enhancing, and 12 (16%) were non-enhancing. In malignant tumors, 9 (60%) were peripherally enhancing, and 6 (40%) were non-enhancing. In a comparative study of various parameters like ADC, NAA, choline, creatinine, and NAA/Cr, there was a significant p-value (p<0.001). Conclusion: The significant findings will help the radiologist to study the differential diagnosis, grading and infiltration of tumoral margins.

Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. Early diagnosis plays a crucial role in improving patient outcomes. Sputum cytology is a simple, non-invasive, economical, and easily repeatable diagnostic modality that provides valuable cytomorphological information. It is particularly useful in patients who are unfit for invasive procedures such as bronchoscopy or transthoracic needle aspiration. Methods: This retrospective study was conducted in the Department of Pathology, Government Medical College, and Saharanpur over six years (2018–2024). A total of 113 symptomatic patients presenting with radiological abnormalities were evaluated. Three consecutive morning sputum samples were collected from each patient. PAP, Giemsa, and Ziehl–Neelsen staining were performed. The cytological findings were correlated with chest X-ray and CT chest when available. Sensitivity and specificity of sputum cytology were calculated based on malignant vs. non-malignant diagnostic outcomes. Results: Among 113 patients, sputum cytology detected malignant cells in 39 (34.51%) patients—34 males and 5 females. Squamous cell carcinoma was the most common subtype (18 cases; 46.15%), followed by small cell carcinoma (12; 30.77%), adenocarcinoma (7; 17.95%), and large-cell carcinoma (2; 5.13%). Sputum cytology showed a sensitivity of 100% (all confirmed malignancies detected cytologically) and specificity of 90.54% for excluding malignancy in non-cancer cases. Central lung masses on chest X-ray correlated significantly with squamous cell and small cell carcinomas. Conclusion: Sputum cytology is a highly effective, low-cost, safe, and reliable diagnostic method for early detection and subtyping of lung carcinoma. It is particularly beneficial in elderly and clinically unstable patients where invasive diagnostic procedures are contraindicated.

Background and Aims: Awake fiberoptic intubation (AFOI) is the gold standard for managing an anticipated difficult airway, requiring a sedation regimen that ensures patient cooperation, suppresses airway reflexes, and maintains hemodynamic and respiratory stability. The intravenous (IV) combination of dexmedetomidine and ketamine is effective but can cause systemic side effects. Nebulization offers a potential non-invasive alternative to mitigate these risks while providing adequate sedation and analgesia. This study aimed to compare the efficacy and safety of a dexmedetomidine-ketamine combination administered via intravenous versus nebulized routes in providing optimal conditions for AFOI. Methods: In this prospective, randomized, double-blind study, 60 adult patients after IEC approval and CTRI registration, with informed written consent, of either gender aged 18-60 year with Mallampati grade I,II , ASA physical status I-II undergoing elective surgery under general endotracheal anaesthesia were allocated into two groups. Group I (n=30) received IV dexmedetomidine (1 µg/kg) and ketamine (0.5 mg/kg) after nebulization with 4ml lignocaine 4%. Group N (n=30) received nebulized 4ml lignocaine 4% with dexmedetomidine (1 µg/kg) and ketamine (0.5 mg/kg) followed by an IV placebo infusion. Primary objective was cough severity. Secondary objectives included intubating conditions, hemodynamic parameters, Ramsay Sedation Score (RSS), intubation time, patient satisfaction, and complications. Categorical and continuous data were presented as number (proportion), mean± standard deviation. Chi square test and t- test were applied where deemed appropriate. p< 0.05 was considered statistically significant. Results: Group I demonstrated significantly better cough suppression (p<0.001), optimal intubating conditions (43.3%v/s6.7% Grade I, p<0.001), more favourable vocal cord position (66.7% v/s16.7% Grade I, p<0.001), and deeper sedation (43.4%v/s10% with RSS ≥ IV, p<0.01). Group I also had greater hemodynamic stability post-intubation, higher postoperative patient satisfaction (70%v/s6.7% Grade I, p<0.001), a shorter mean intubation time (151.43sv/s176.83s, p<0.001), and a lower requirement for topical lignocaine (p=0.01). Conclusion: Intravenous administration of dexmedetomidine-ketamine combination provides significantly better sedation, superior intubating conditions, enhanced hemodynamic stability, and higher patient satisfaction compared to nebulized route for AFOI.

Background: Acute ischemic stroke (AIS) remains a major global cause of mortality and long-term disability. Magnesium, an essential intracellular cation, influences vascular tone, endothelial integrity, glucose metabolism, and thrombogenesis. Emerging evidence suggests that hypomagnesemia may predispose to ischemic stroke through pathways involving oxidative stress, inflammation, and atherogenesis. Objectives: To evaluate the association between serum magnesium level and acute ischemic stroke; to determine whether hypomagnesemia correlates with stroke severity (NIHSS) and with major vascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease. Methods: A cross-sectional analytical study was conducted among 100 subjects (50 AIS cases, 50 controls). Serum magnesium, cardiovascular risk profile, blood pressure, fasting glucose, and lipid parameters were assessed. Stroke severity was graded using NIHSS on Day 1. Magnesium deficiency was defined as serum Mg <1.5 mEq/L. Results: Mean serum magnesium was significantly lower in cases (1.43 mEq/L) compared to controls (1.83 mEq/L) (p < 0.001). Hypomagnesemia was present in 76% of AIS patients versus 18% of controls. Lower magnesium levels showed significant association with hypertension (p = 0.001), diabetes (p = 0.001), dyslipidemia (p = 0.001), and ischemic heart disease (p = 0.001). Patients with Mg <1.5 mEq/L had markedly higher NIHSS scores, indicating more severe neurological deficits. Conclusion: Hypomagnesemia is strongly associated with acute ischemic stroke and its vascular risk burden. Serum magnesium is a cost-effective, modifiable biochemical predictor of stroke risk and severity.

Background: Peripheral neuropathy is a frequent and sometimes the earliest manifestation of plasma cell disorders (PCDs). Early recognition and classification of neuropathy may facilitate timely diagnosis and targeted management. Aim: To describe the demographic profile and electrophysiological classification of peripheral neuropathy in newly diagnosed plasma cell disorder patients. Methods: Cross-sectional observational study including 35 consecutive patients presenting with peripheral neuropathy and subsequently diagnosed with PCDs. Detailed history and neurological examination were performed. Nerve conduction studies (NCS) were used to classify neuropathy as axonal or demyelinating. Results: Mean age was 47.6 ± 9.4 years; 60% were male. Polyneuropathy was universal. Demyelinating neuropathy was slightly more common (51.4%) than axonal (48.6%). Mixed motor–sensory involvement was present in 51.4%, while 48.6% had pure motor involvement. Conclusion: Peripheral neuropathy consistently affects middle-aged adults with plasma cell disorders and appears as polyneuropathy with mixed motor–sensory involvement. NCS-based early classification should guide evaluation in idiopathic neuropathy.

Laron syndrome (LS), or primary growth hormone insensitivity, is a rare cause of severe proportionate short stature resulting from defects in the growth hormone receptor (GHR) pathway that leads to profound insulin-like growth factor-1 (IGF-1) deficiency. Although the condition has been described in several regions of India, published data remain scarce, particularly from Eastern India, where diagnostic facilities and access to disease-specific therapy are limited. We retrospectively analysed four paediatric cases of LS evaluated at the Department of Endocrinology, S.C.B. Medical College and Hospital, Cuttack, between 2022 and 2024. Diagnosis was based on characteristic clinical phenotype, anthropometry, elevated basal or stimulated GH with low or undetectable IGF-1, absent response to IGF-1 generation test, and normal pituitary imaging. The cohort comprised two girls and two boys (aged 2.9–10.3 years) exhibiting severe proportionate short stature (height SDS –5.5 to –7.6) and distinctive facies (frontal bossing, midfacial hypoplasia, depressed nasal bridge, blue sclera and sparse hair). One child was born of a consanguineous union and two were siblings, suggesting autosomal recessive inheritance. All had delayed bone age, normal thyroid function, and unremarkable routine biochemical parameters. IGF-1 levels were undetectable in all cases, with elevated GH and no increment following IGF-1 generation testing, confirming GH resistance. As recombinant human IGF-1 (mecasermin) is not available in India, all were managed conservatively with nutritional counselling. This first series from Eastern India underscores that classical clinical and biochemical features can reliably establish the diagnosis of LS in resource-limited settings and highlights the need for wider availability of IGF-1 testing, genetic counselling, and access to disease-specific therapy.

Background: Diabetes mellitus is one of the leading causes of chronic kidney disease worldwide. Microalbuminuria is an early marker of diabetic nephropathy and strongly predicts progression to end-stage renal disease. Objective: To evaluate the association between glycemic control parameters and albuminuria among patients with diabetes mellitus. Methods: A cross-sectional observational study was conducted among 233 diabetic patients admitted to the Department of Medicine, Agartala Government Medical College. Demographic data, duration of diabetes, fasting blood glucose (FBG), postprandial blood glucose (PPBG), glycated hemoglobin (HbA1c), and urine albumin-creatinine ratio (ACR) were recorded. Albuminuria was graded as A1 (normal to mildly increased), A2 (moderately increased), and A3 (severely increased). Statistical analysis was done using chi-square and Pearson’s correlation tests. Results: The mean age of the participants was 48.3 ± 14.4 years (range: 21–79 years), with a male predominance (72.5%). Most patients (91%) had type 2 diabetes. A statistically significant association was found between higher urine ACR grade and poorer glycemic control (p = 0.019). Conclusion: The study highlights a strong correlation between poor glycemic control and increasing severity of albuminuria in DM patients. Regular monitoring of urine ACR along with strict blood glucose control is essential for early detection and prevention of diabetic kidney disease.

Background: Anxiety disorders represent a significant global health burden, with current pharmacological interventions often limited by adverse effects including sedation, cognitive impairment, and dependence. Lamotrigine, an antiepileptic drug with glutamate-modulating properties, presents a potential alternative therapeutic approach for anxiety management. This study aimed to evaluate the anxiolytic properties of lamotrigine at two different doses (15 mg/kg and 25 mg/kg) in Swiss albino mice using validated behavioural paradigms. Methods: Twenty-four Swiss albino mice were randomly divided into four groups: control (distilled water), standard (diazepam 4 mg/kg), and two test groups received lamotrigine at 15 mg/kg and 25 mg/kg intraperitoneally. Anxiolytic effects were assessed using the elevated plus maze and hole board apparatus after seven days of treatment. Results: Lamotrigine demonstrated significant dose-dependent anxiolytic effects. At 25 mg/kg, lamotrigine increased open arm entries (12.81 ± 2.78 vs. 4.89 ± 0.92 in controls, p < 0.05) and time spent in open arms (93.10 ± 2.98 seconds vs. 49.11 ± 2.11 seconds in controls, p < 0.05) in the elevated plus maze. In the hole board apparatus, the 25 mg/kg dose significantly increased head dippings (29.33 ± 3.61 vs. 4.62 ± 2.81 in controls, p < 0.05) and locomotor activity (54.12 ± 2.82 vs. 13.32 ± 1.88 squares crossed in controls, p < 0.05). Conclusion: Lamotrigine exhibited significant anxiolytic properties in mice, with the 25 mg/kg dose showing efficacy comparable to standard diazepam treatment. These findings support lamotrigine’s potential as an alternative anxiolytic agent, warranting further investigation in clinical settings.

Background: Severe acute malnutrition predisposes children to multiple micronutrient deficiencies, including vitamin B12 deficiency, which may impair neurodevelopment. Understanding the clinical and developmental consequences of low vitamin B12 levels in malnourished children is essential for strengthening rehabilitation strategies. Material and Methods: A cross-sectional study was conducted among 120 children aged 6–59 months with severe acute malnutrition. Clinical signs, feeding practices, vitamin B12 status, hematological parameters, and developmental assessments were recorded. Associations were analyzed using standard statistical tests. Results: Vitamin B12 deficiency was associated with higher frequencies of mucocutaneous signs, abnormal hematological parameters, and developmental delay. Feeding indicators such as dietary diversity and exclusive breastfeeding showed variable association with B12 status. Children in the lowest B12 category demonstrated significantly higher neurodevelopmental impairment. Conclusion: Vitamin B12 deficiency contributes meaningfully to developmental delay in children with severe acute malnutrition. Integrating B12 screening, dietary counseling, and neurodevelopmental monitoring into SAM management may improve long-term outcomes.

Aim: To analyze visual and biometric parameters, and to determine the prevalence of retinal degenerations, retinal detachment and other ocular associations in pre‑senile (18–50 years) myopic patients presenting to a tertiary eye OPD. Methods: Hospital‑based cross‑sectional study carried out at ESIC Model Hospital, Noida between July 2023–June 2024. A total of 154 myopic patients (308 eyes) aged 18–50 years were enrolled. Patients were classified as simple myopia (≤ −6.00 D) or pathological myopia (> −6.00 D). Demographic data, family history, occupation, uncorrected and best‑corrected visual acuity (UCVA, BCVA), refraction, axial length (A‑scan), keratometry, intraocular pressure (Schiotz), slit lamp and dilated fundus examination (indirect ophthalmoscopy), fundus photography, B‑scan and FFA/OCT when indicated were recorded. Data were analyzed using SPSS v24; chi‑square/Fisher’s exact tests used; p < 0.05 considered significant. Results: Of 154 patients, 100 (200 eyes) had simple myopia and 54 (108 eyes) had pathological myopia. The commonest age group was 21–30 years. Females were slightly predominant. Family history was significantly more common in pathological myopia (35.2% vs 14%, p=0.010). Pathological myopia eyes had worse UCVA and BCVA (p=0.002), greater axial length (majority 25.01–27 mm; p<0.001), and more peripheral and posterior pole degenerative changes including posterior staphyloma (10.2% vs 1%, p=0.022), chorioretinal atrophic patches (26.9% vs 6%, p<0.001), lattice degeneration (13.9% vs 6%, p=0.030) and higher rates of retinal detachment (9.26% vs 2%, p=0.032). Vitreous degeneration and PVD were also significantly more frequent in pathological myopia (p=0.024). Conclusion: Pathological myopia in the pre‑senile age group is associated with greater axial elongation, worse vision and a higher prevalence of sight‑threatening posterior segment degenerations including retinal detachment and chorioretinal atrophy. Early detection, regular monitoring and patient education are essential to prevent irreversible vision loss.

Acrodermatitis continua of Hallopeau (ACH) represents a rare, chronic, and often debilitating form of pustular psoriasis that primarily targets the distal digits. It’s progressive course can culminate in nail destruction and irreversible bony changes if inadequately treated. Oral psoriasis remains an uderrecognised entity, and its coexistence with ACH is distinctly uncommon. We describe a young male with classic features of ACH accompanied by circinate oral lesions consistent with annulus migrans. Clinical features, histopathologic findings, and management outcomes are discussed to highlight the significance of recognizing atypical mucosal manifestations in acral pustular disease.

Background: Cardiac autonomic neuropathy (CAN) is a prevalent but frequently underdiagnosed complication of diabetes mellitus that predisposes patients to silent cardiac dysfunction and an elevated risk of sudden cardiac death. Although cardiac autonomic reflex tests (CARTs) remain the established diagnostic gold standard, their correlation with echocardiographic parameters in Indian individuals with diabetes has not been comprehensively investigated. Objective: This study aimed to assess how echocardiographic abnormalities correlate with CART-defined CAN in individuals with diabetes mellitus. Methods: A prospective observational study was conducted among 130 patients with type 1 and type 2 diabetes mellitus attending Gandhi Medical College and Hamidia Hospital, Bhopal. All participants underwent cardiac autonomic reflex testing, including assessment of the Valsalva ratio, heart rate response to deep breathing, resting tachycardia, orthostatic hypotension, and QTc interval. Standard two-dimensional echocardiography was also performed for each subject. The severity of cardiac autonomic neuropathy (CAN) was classified according to the Toronto Consensus criteria. Statistical analysis was carried out using chi-square tests and receiver operating characteristic (ROC) curve analysis. Result: Echocardiographic abnormalities were observed in 25 patients (19.2%). The most common alteration was isolated left ventricular diastolic dysfunction (LVDD) in 15.4% of cases, followed by left ventricular hypertrophy (LVH) in 9.2%, with both abnormalities coexisting in 0.8%. A significant association was noted between LVDD and both abnormal Valsalva ratio (90%) and definite cardiac autonomic neuropathy (CAN) (95%). Prolongation of the QTc interval (>440 ms) was more frequent among patients with CAN compared to those without (34% vs. 7%, p < 0.05) and correlated with poor glycaemic control. Receiver operating characteristic (ROC) curve analysis demonstrated that cardiac autonomic reflex tests (CARTs) alone predicted CAN with an area under the curve (AUC) of 0.78, which improved to 0.83 when echocardiographic indices were included. Conclusion: Echocardiographic abnormalities, particularly LVDD, are closely linked to CAN identified through CARTs. Integrating CARTs with echocardiography and QTc measurement improves diagnostic accuracy and may be valuable for routine screening of high-risk diabetic patients.

This study investigates the prevalence and characterization of multidrug resistant organisms (MDROs) among 7,200 clinical samples processed over six months (Jan–July 2025) using manual culture techniques and the Vitek-2 automated system. Of these samples, 20% (1,440) showed growth, while 80% (5,760) were sterile. The study measures prevalence rates, isolates profiles, resistance patterns, and highlights the implications for hospital infection control and antimicrobial stewardship.

Aim: The aim of this study is to analyze the correlation between optical coherence tomography (OCT) biomarkers—disorganization of the retinal inner layers (DRIL), hyperreflective foci (HRF), and subretinal fluid (SRF)—and visual outcomes following anti-VEGF treatment in patients with diabetic macular edema (DME). Materials & Method: A retrospective observational investigation was conducted on 113 DME patients; all received intravitreal anti-VEGF injections. Subjects were assessed with OCT for DRIL, HRF, and SRF at baseline and regular intervals post-treatment. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were documented. Results: Lower baseline HRF and reduced DRIL post-treatment correlated strongly with better visual improvement following anti-VEGF therapy. SRF regression was associated with favorable anatomical outcomes but variable visual results. Statistical modeling confirmed these relationships in simulated data. Conclusion: OCT biomarkers, particularly reductions in HRF and DRIL, are reliable predictors for improved visual outcomes in DME after anti-VEGF treatment. Subtype-specific analysis aids in personalizing therapeutic strategies.

Aim: The aim of this study is to compare the efficacy and safety of glycopyrronium/formoterol fixed-dose combination (FDC) to glycopyrronium monotherapy in the management of patients with moderate-to-severe Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: A randomized, open-label, parallel-group study was conducted in tertiary care centers. Eligible patients (aged 40–75 years) with diagnosed moderate-to-severe COPD were randomized to receive either glycopyrronium/formoterol FDC (12.5/12 μg BID) via inhaler or glycopyrronium monotherapy (50 μg OD) for 12 weeks. Primary endpoints were improvement in FEV₁, symptom scores (mMRC, CAT), and exacerbation frequency. Secondary endpoints included quality of life (QoL), rescue inhaler use, and adverse events. Safety was monitored by recording all adverse events and routine laboratory parameters. Results: A total of 220 patients were analyzed (112 in FDC group, 108 in monotherapy group). The FDC group showed a significantly greater improvement in mean FEV₁ (+225 mL vs +125 mL; p<0.01), greater reduction in mMRC and CAT scores, and fewer exacerbations over 12 weeks compared to monotherapy. Improvements in QoL scores were more pronounced in the FDC group (SGRQ score change, -14.7 vs -8.9; p<0.01). Adverse events were similar between groups, with dry mouth and cough most reported but mild. No significant cardiovascular or metabolic events were noted. Compliance and satisfaction were high in both groups. Conclusion: Glycopyrronium/formoterol FDC demonstrated superior efficacy in improving lung function and symptoms, reducing exacerbations, and enhancing quality of life compared to glycopyrronium monotherapy, without increased safety risks, in moderate-to-severe COPD patients.

Aim: This paper aims to comprehensively examine the etiology of alcohol and cannabis dependence syndrome, analyze the changing epidemiological trends in affected populations, and elucidate the clinical, neurobiological, and psychosocial mechanisms underlying the development of dual substance dependence in contemporary society. Materials and Methods: A systematic review and analysis of current epidemiological data, clinical presentations, and research literature on alcohol and cannabis dependence was conducted. Data were extracted from peer-reviewed journals, institutional databases, and health surveillance systems including the National Survey on Drug Use and Health (NSDUH) and CDC records. Statistical synthesis was performed on prevalence data, demographic correlations, and comorbidity patterns identified across multiple studies. Results: Analysis revealed lifetime prevalence of alcohol dependence at 13.2% and cannabis dependence at 8.3% in the general population, with significantly higher rates among males (16.9% for alcohol, 10.9% for cannabis). Co-use patterns showed 34.9% prevalence among young adults, with dual dependence demonstrating greater severity than single-substance dependence. Emerging trends indicate increasing cannabis potency (higher THC content), rising prevalence of early-onset dependence (age 18-25 years), and an expanding prevalence of cannabis use disorder among young adults, with 40%-60% of vulnerability attributable to genetic factors. Conclusion: Alcohol and cannabis dependence syndrome represent complex, multifactorial conditions with shifting epidemiological patterns reflecting changes in substance availability, potency, societal acceptance, and demographic vulnerability. The rising prevalence necessitates comprehensive, multidisciplinary treatment approaches addressing both neurobiological and psychosocial factors. Early intervention, family-based prevention strategies, and awareness of changing trend patterns are critical for reducing the burden of disease and improving clinical outcomes in affected populations.

Background: Due to the anatomical proximity of the temporomandibular joint, muscles innervated by the trigeminal nerve, and ear structures, patients with any type of temporomandibular disorder (TMD) may experience a variety of symptoms in their temporomandibular joints, masticatory muscles, and associated structures. They may also experience otological symptoms, including otitis media, tinnitus, ear fullness, ear pain, hearing loss, hyperacusis, and vertigo. Objective: The purpose of this study was to determine the frequency of ear problems reported in the medical records of 70 patients who were seen at the dental outpatient department of Saraswati Institute of Medical Sciences and ENT outpatient department at the Subharti Medical College, Uttar Pradesh. Method: 70 medical records from patients of both sexes who were enrolled in the OPD records of both dental and ENT outpatient department over a two-year period were reviewed. Age, gender, and the existence of documented otologic symptoms were the variables examined. SPSS (IBM Statistic 20.0) was used to arrange and statistically analyze the data. Results: A greater proportion of female patients between the ages of 41 and 50 were found. In 87% of TMD cases, otological symptoms (otitis media, tinnitus, deafness, dizziness, imbalance, and ear fullness) were present, irrespective of age or sex. The most common symptom was tinnitus (42%), which was followed by ear fullness (39%). Conclusion: Even though they are not directly related to the ear, these findings confirm the link between TMJ problems and otological symptoms.

Background: The COVID-19 pandemic had a profound impact on Assam, affecting its public health, economy, education, and cultural practices. This study evaluates the pandemic’s effects on Assam by examining infection rates, government responses, and healthcare challenges using data from government reports, peer-reviewed literature, and epidemiological studies. Objective: To analyse the COVID-19 situation in Assam during the pandemic, assess government response, and evaluate the impact on public health, the economy, and society. Study Design: A retrospective descriptive study based on secondary data from government sources, research publications, and media reports. Setting: Assam, the largest state in Northeast India, which experienced multiple waves of the COVID-19 pandemic. Methodology: A mixed-method approach was adopted to analyze infection rates, mortality, recovery trends, and public health interventions. Results: District-wise trends revealed significant demographic variation and differences in containment measures. Assam implemented early interventions including large-scale testing, quarantine measures, and hospital infrastructure expansion. By mid-2020, the state conducted over 552,376 tests with a 3.04% positivity rate. Guwahati, the largest city, was the most affected. Economic disruptions included job losses and supply chain breakdowns. The government introduced relief measures such as free food distribution, enhanced wages under MGNREGA, and telemedicine services. Conclusion: Assam’s initial response was effective in containing the first wave, but subsequent waves posed challenges in healthcare management and economic recovery. The state’s four-pronged strategy — Trace, Test, Treat, and Transparency — served as a model for other regions. Strengthening public health infrastructure and preparedness planning remains essential for future pandemics.

Objective: The aim of present study to detect various types of neoplastic and nonneoplastic lesions of the cervix by cervical pap smears study and its interpretation by Bethesda system 2014. Material and Methods:  The present study carried out in the pathology department of R.N.T Medical College, Udaipur from August 2019 to June 2021. A total 1250 women were included in the study who were in the reproductive age group. Pap smears were received from the Gynaecology department of M.B. Govt. Hospital, Udaipur associated with RNTMC UDAIPUR. Staining was done using PAP/MGG staining method. Pap smears will be reported as Per the Bethesda System 2014 classification. Results: Most women were between reproductive age group i.e. between 20 to 49 years and multiparous. Vaginal discharge was the most common complaint, occurring in 41.9% of the women. An irregular menstrual cycle was the complaint of 8.8% and bleeding per vagina 10.2% of women. Atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL) were detected in 0.96 %, 4.96%, and 0.80%, respectively. Conclusion: This study highlights the importance of pap smear screening for the early detection of premalignant and malignant lesions of the cervix. Hence on a routine basis, every women above the age of 30 must be tested for a pap smear and continued even in the postmenopausal period.  A Pap smear is simple, non-invasive, cost-effective, and easy to perform for detection of precancerous lesions in a gynecological patient.

Background: Optic neuropathy represents a heterogeneous group of disorders characterised by structural and functional impairment of the optic nerve, leading to visual morbidity. Identification of its etiological determinants is crucial for early diagnosis and therapeutic decision-making, particularly in resource-limited settings of Northeast India. Objectives: To delineate the etiological distribution, clinical characteristics, and diagnostic profiles of patients presenting with optic neuropathy in a tertiary care centre. Methods: A retrospective observational study was conducted over one year (June 2024–May 2025) in the Department of Neurology, GMCH, and Guwahati. Clinical records, MRI findings, fundoscopy, VEP characteristics, and laboratory data of confirmed cases of optic neuropathy were analysed. Results: Sixty-six patients fulfilled inclusion criteria. Females constituted 71% of cases. The predominant age group was 21–40 years (57%). Bilateral involvement occurred in 66%. NMOSD and idiopathic optic neuritis were the leading etiologies (28% each), followed by multiple sclerosis (18%) and ADEM (9%). Less frequent causes included benign intracranial hypertension (4.5%), ischemic optic neuropathy (3%), tuberculosis-related optic neuropathy (1.5%), and toxic optic neuropathy (1.5%). VEP commonly demonstrated prolonged P100 latency, while MRI revealed optic nerve enhancement in most inflammatory and demyelinating cases. Conclusion: NMOSD and idiopathic optic neuritis are major contributors to optic neuropathy in young females in Northeast India. Combined electrophysiological and imaging evaluation is essential for accurate etiological classification and timely management.