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.