Background: Induction of labour (IOL) is one of the most common obstetrical interventions worldwide. The choice of induction method remains a subject of debate, particularly regarding the balance between efficacy (time to delivery) and safety (maternal and fetal complications). While pharmacological agents like prostaglandins are widely used, mechanical methods such as the Foley catheter are gaining traction due to their low cost and favorable safety profile. Methods: A prospective cohort study was conducted at a tertiary care center involving 220 pregnant women with singleton, cephalic, term pregnancies (37–41 weeks) and a Bishop score < 6. Participants were assigned to receive either an intracervical Foley catheter (Group M, n=110) or intracervical Dinoprostone gel (Group P, n=110) based on clinical protocols and patient counseling. Key outcomes included the rate of Cesarean section (CS), induction-to-delivery interval, uterine hyperstimulation, and neonatal morbidity. Results: The baseline characteristics were comparable between groups. The rate of Cesarean section was lower in Group M (18.2%) compared to Group P (23.6%), though this did not reach statistical significance (P = 0.31). However, Group P exhibited a significantly shorter mean induction-to-delivery interval (16.4 ± 4.2 hours) compared to Group M (21.8 ± 5.1 hours; P < 0.001). Conversely, uterine hyperstimulation was significantly more frequent in Group P (7.3%) than in Group M (0.9%; P = 0.02). Neonatal outcomes, including APGAR scores and NICU admissions, showed no significant differences (NICU admission: 3.6% vs. 4.5%; P = 0.74). Conclusion: Mechanical induction with a Foley catheter is associated with a significantly lower risk of uterine hyperstimulation compared to Dinoprostone gel, making it a safer alternative for cervical ripening. While pharmacological induction offers a shorter interval to delivery, it does not significantly reduce the Cesarean section rate.

Background: Lactational breast abscess is a common complication of mastitis in breastfeeding women and contributes significantly to maternal morbidity. Traditional incision and drainage (I & D) remains a definitive treatment but is associated with pain, scarring, and prolonged recovery. Needle aspiration has emerged as a minimally invasive alternative. Aims and Objectives: This study compares the clinical outcomes of needle aspiration versus I&D in the management of lactational breast abscesses. Materials and Methods: This prospective comparative study included 120 lactating women with ultrasonographically confirmed breast abscesses at SMMH Medical College from January 2024 to January 2025. Participants were randomly assigned to two equal groups: Group A underwent needle aspiration, and Group B underwent incision and drainage. Outcomes assessed included healing time, residual abscess formation, number of procedures required, pain, cosmetic results, and microbiological profile. Statistical analysis was performed using SPSS version 20, with p < 0.05 considered significant. Results: Most abscesses measured 4–5 cm, and 84% of patients presented within six weeks postpartum. Needle aspiration resulted in significantly faster healing (mean 19.4 days) compared with I&D (30.4 days). Residual abscess occurred in 20% of aspiration cases, whereas none were observed in the I&D group (p = 0.041). Pain was substantially lower in the aspiration group, with analgesic use mainly limited to the first day. In contrast, patients undergoing I&D required several days of analgesics. Cosmetic outcomes strongly favoured aspiration: all successfully treated patients healed without scars, whereas all I & D patients developed visible scars. MRSA was the predominant organism (61%), followed by Staphylococcus aureus. Conclusion: Needle aspiration is an effective and cosmetically superior first-line treatment for uniloculated lactational breast abscesses up to 5 cm, offering faster healing and less pain. Incision and drainage should be reserved for large, multiloculated, or aspiration-resistant abscesses. The findings support wider adoption of minimally invasive management in suitable lactating women.

Introduction: COVID 19 is an infectious disease caused 772 million confirmed cases and over 7 million deaths worldwide as per WHO. There is lack of data on drugs used in COVID-19 patients with few studies evaluating the treatment patterns as per severity. Objectives: 1: To study the drug utilization pattern in COVID- 19 patients. 2. To study the antibiotic utilization according to severity of the disease in covid-19 patients. Methodology: This retrospective, single-centre observational drug utilization study was conducted in patients admitted in our tertiary care centre between 1st April 2021 to 31 December 2021. Data was analysed for demographic details, clinical features and severity based on SpO2 % along with different class of drugs prescribed like anti-inflammatory, anti-viral, antibiotics. Further antibiotics utilized in severe and other non-severe (mild, moderate) group were classified in different groups. Results: Out of 243 patients, 44% were mild and 12% were in severe category. The most common age group was 51-60 years (29%) and males were predominated. Overall, in Antibiotics, 48.97% patients were received piperacillin and tazobactam, 46.50% were received doxycycline, 37.8% received azithromycin. In this study prescriptions having >8 drugs per encounter were 41% and >10 drugs per encounter were 51.85%. Conclusion: Overprescribing of antibiotics along with off label use of drugs was encountered in most cases which may be attributed to limited research in drugs utilised in COVID-19 patients. Polypharmacy needs to be addressed for promoting rational use of drugs.

Endotracheal intubation entails the introduction of an endotracheal tube inside the trachea for the purpose of artificial ventilation. Inserting an endotracheal tube using laryngoscope is a skilful activity that requires detailed knowledge of airway anatomy as well as practice of the skill. However even in the best, experienced hands endotracheal intubation can fail due to variety of factors, one of which is unanticipated alteration in airway anatomy. We conducted a study to assess the utility of ultrasonography in predicting difficult intubation, by measuring the thickness of soft tissues in the anterior part of neck at three different levels, namely skin to Hyoid bone, skin to epiglottis at thyrohyoid membrane level and skin to tracheal ring at suprasternal notch level, and compared the difficulty level predicted with the Cormack-Lehane Grading on direct laryngoscopy. We found that ultrasound can be used as a reliable tool to identify difficult airway by measuring the thickness of soft tissues in the anterior part of neck.

The article is a comprehensive review of floating pulsatile drug delivery systems, focusing on their design principles, formulation strategies, evaluation parameters, and chronotherapeutic applications. It emphasizes how combining gastro‑retentive floating mechanisms with time‑controlled pulsatile release can optimize drug therapy in accordance with circadian rhythms, particularly for diseases showing time‑dependent variation in symptoms. The review discusses the physiological challenges of oral delivery, classification and mechanisms of floating systems (effervescent and non‑effervescent), major pulsatile designs (single‑unit and multiple‑unit systems), and key evaluation tests such as micromeritic properties, tablet quality control, dissolution, and in‑vitro buoyancy studies. It also highlights the role of chronobiology, chronopharmacology, and emerging technologies (e.g., solid lipid nanoparticles and advanced polymers) in improving site‑specific, time‑specific delivery, enhancing bioavailability, reducing side effects, and improving patient compliance in chronotherapy.​

Background: Early identification of patients at risk for severe dengue is a critical challenge in endemic regions. The Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) is a simple, non-invasive score using routine laboratory tests. We sought to evaluate the association between APRI and dengue severity in an adult population. Methods: This cross-sectional observational study was conducted at a tertiary care hospital in South Gujarat, India. Eighty-two adult patients (age >18) with serologically confirmed dengue (NS1 or IgM positive) were enrolled. Patients with chronic liver disease, co-infections, or other causes of thrombocytopenia were excluded. APRI was calculated on admission. Patients were categorized as mild, moderate, or severe. Receiver Operating Characteristic (ROC) analysis was used to determine the optimal APRI threshold for predicting severe dengue. Results: Of the 82 patients, 13.4% (n=11) had severe dengue, 41.5% (n=34) had moderate dengue, and 45.1% (n=37) had mild dengue. The mean APRI was 4.98 \pm 6.59. An optimal APRI threshold of >3.2 was identified for predicting severe dengue. All 11 severe dengue cases (100%) had an APRI > 3.2. The index demonstrated 100% sensitivity, 72.5% specificity, 100% negative predictive value (NPV), and 36.7% positive predictive value (PPV). The Area under the Curve (AUC) was 0.903 (95% CI, p < 0.001). A high APRI (> 3.2) was also significantly associated with the need for blood transfusion (36.6% vs. 0%, p < 0.001) and longer hospital stay (50% > 6 days vs. 25%, p = 0.038). Conclusion: APRI is an excellent, highly sensitive, and universally accessible biomarker for risk stratification in adult dengue patients. Admission APRI > 3.2 is strongly associated with severe disease. Its 100% NPV makes it a valuable clinical tool to “rule out

Introduction: The ailment known as coccygodynia, or tailbone pain, is defined by discomfort that is restricted to the coccygeal area and is usually made worse by sitting, leaning back, or getting up from a seated posture.  Although the precise incidence is still unknown, the prevalence of coccygodynia is thought to be between one and three percent of all occurrences of low back pain.  Due to structural abnormalities in the pelvis, women are more likely than males to be afflicted, and obesity is seen as a major risk factor. Aims: To evaluate the efficacy and safety of ganglion impar block in relieving pain and improving function in patients with chronic coccygodynia. Materials & Methods: This prospective interventional study was conducted over one year (from 1st September 2023 to 31st August 2024) and included 60 patients with chronic coccygodynia. 30 in Ganglion Impar Block (GIB) and 30 in control group (received conventional management only). Result: This significant difference persisted at 4 weeks (700 ± 200 vs. 1100 ± 270; p < 0.001) and 8 weeks (760 ± 220 vs. 1000 ± 260; p = 0.002). At all follow-up intervals, the GIB group demonstrated significantly higher mean satisfaction scores compared to the control group. At 1 week, the mean satisfaction score was 4.3 ± 0.6 in the GIB group versus 2.9 ± 0.8 in the control group (p < 0.001). Conclusion: In assessing the safety and effectiveness of ganglion impar block (GIB) for chronic coccygodynia, we found that, in comparison to controls, the GIB group showed noticeably higher improvements in pain, function, and patient satisfaction.  Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores significantly declined after the intervention, while the GIB group’s serum biomarker levels showed a more noticeable decline.

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impaired social interaction, communication deficits, and restricted, repetitive behaviors. Although its etiology remains unclear, emerging evidence suggests that elevated bilirubin levels may exert neurotoxic effects on the developing brain, potentially contributing to ASD. Method: A total of 45 children with ASD and 45 age-matched controls (11 months–3 years) were evaluated. Serum bilirubin levels during their neonatal period were obtained for all participants. Comparative statistical analysis was performed between the two groups. Results: Most participants were firstborn 39 (86.6%). Mean serum bilirubin was significantly higher in the ASD group (2.6 ± 1.1 mg/dL) compared with controls (2.0 ± 1.5 mg/dL) (t = 2.1, p < 0.001), which is significant .The majority of ASD children (51.1%) had recorded bilirubin levels between 10 mg/dL and ≥25 mg/dL. Phototherapy was required in 2 (4.4%) of ASD children and 13.3% of controls. Conclusion: Elevated serum bilirubin levels in neonatal period may contribute to neurotoxicity and worsening of neurodevelopmental outcomes, including ASD. Bilirubin-induced neuronal injury may underlie the aberrant social and communication behaviors observed in ASD.

Background: Preoperative anxiety is a prevalent psychological response among surgical patients that may influence perioperative outcomes and anesthetic consumption. Various validated instruments exist for quantifying anxiety levels, yet their utility in predicting anesthetic requirements remains incompletely characterized in contemporary clinical practice. Methods: This prospective observational study enrolled 150 adult patients (ASA I-III) scheduled for elective surgery under general anesthesia. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory (STAI), Amsterdam Preoperative Anxiety and Information Scale (APAIS), and Visual Analog Scale for Anxiety (VAS-A). Anesthetic requirements were standardized using bispectral index (BIS) monitoring. Primary outcomes included propofol induction dose, intraoperative fentanyl consumption, and sevoflurane end-tidal concentration requirements. Results: Patients with high anxiety (STAI-State ≥45) required significantly higher propofol induction doses (2.34 ± 0.42 mg/kg vs. 1.92 ± 0.38 mg/kg, p < 0.001) and greater intraoperative fentanyl consumption (4.82 ± 1.24 μg/kg/hr vs. 3.68 ± 1.08 μg/kg/hr, p < 0.001) compared to low-anxiety patients. STAI-State scores demonstrated the strongest correlation with total anesthetic requirements (r = 0.64, p < 0.001). APAIS anxiety subscale scores ≥13 predicted increased anesthetic consumption with 78.4% sensitivity and 72.6% specificity. Conclusion: Preoperative anxiety scales, particularly STAI-State and APAIS, demonstrate significant predictive value for anesthetic requirements. Routine preoperative anxiety assessment may facilitate individualized anesthetic planning and optimize drug administration.

Background: Medical ethics is the system of moral principles that guides healthcare professionals to practice medicine responsibly. Integrating medical ethics into undergraduate training is crucial because it equips future healthcare professionals with the necessary attitudes and knowledge to navigate the complex ethical dilemmas encountered in clinical practice. Objective: To assess the awareness regarding medical ethics among undergraduate medical students in Wayanad, Kerala. Methodology: This was a cross-sectional study conducted among the undergraduate medical students of Dr. Moopen’s Medical College, Wayanad, from May to September 2024. Students from academic phases II, III and IV were selected for the study. The questionnaire consisted of two sections. Section A captured socio-demographic information and Section B included 14 questions focused on assessing medical ethics awareness. Data analysis was done using R (version 4.0.5). Descriptive statistics like percentages were used for categorical variables, and median values with interquartile ranges for continuous variables. To compare medical ethics scores, the Mann-Whitney U test and the Kruskal-Wallis test was used. Results: A total of 417 undergraduate medical students participated in the study. The median age of the participants was 22 years (IQR: 21–23). The majority of the participants were female (67.1%). The median score among the 417 students was 11, with an interquartile range (IQR) of 10 to 12. The results indicate that female students had a significantly higher median score (12). Students who attended more than 90% of the AETCOM ethics sessions scored significantly higher (median = 11) with a p-value of <0.001. Conclusion: The study highlights strong awareness of medical ethics among undergraduate medical students of Wayanad. The findings suggest that the current medical curriculum provides an effective foundation in medical ethics.

Background: Regular moderate physical activity is known to influence cardiovascular function, yet evidence among young adults remains variable. This study evaluated the impact of sustained moderate-intensity exercise on key cardiovascular parameters in healthy individuals aged 18–25 years. Material and Methods: A cross-sectional analytical study was conducted among 100 young adults. Participants were categorized into an exercise group (n = 50), comprising individuals performing ≥150 minutes/week of moderate activity for at least six months, and a sedentary group (n = 50) with no structured physical activity. Anthropometric indices and cardiovascular measurements—including resting heart rate, systolic and diastolic blood pressure, mean arterial pressure, and rate pressure product—were recorded under standardized conditions. Group comparisons were performed using independent-sample t tests, with significance set at p < 0.05. Results: Both groups were comparable in age, height, weight, and BMI, with no statistically significant differences in baseline characteristics. Resting heart rate was significantly lower in the exercise group compared to sedentary participants (69.1 ± 7.4 vs. 77.6 ± 8.2 beats/min; p < 0.001). Systolic blood pressure (114.6 ± 8.3 vs. 121.3 ± 9.1 mmHg; p < 0.001) and diastolic pressure (72.8 ± 6.4 vs. 77.1 ± 7.0 mmHg; p = 0.002) were also lower among regular exercisers. Mean arterial pressure showed a similar trend (86.7 ± 5.8 vs. 91.8 ± 6.2 mmHg; p < 0.001). The rate pressure product, an indirect marker of myocardial oxygen demand, was substantially reduced in the exercise group (7908 ± 1024 vs. 9423 ± 1131; p < 0.001). Conclusion: Young adults engaging in routine moderate exercise exhibit significantly improved cardiovascular parameters compared to sedentary individuals. These findings underscore the importance of incorporating regular moderate physical activity as a preventive measure for long-term cardiovascular health.

Background: Premature neonates admitted to the NICU are consistently exposed to environmental noise levels that surpass recommended limits. Excessive noise can disturb physiological stability, alter behavioural responses, and interfere with neurodevelopment. Objective: To assess the effects of loud noise on physiological and behavioural responses among premature neonates admitted to a quaternary care NICU. Methods: A descriptive observational study was conducted among 60 stable preterm neonates (29–36+6 weeks) using non-probability convenience sampling. Physiological parameters—heart rate, respiratory rate, and oxygen saturation—and behavioural responses based on autonomic, motor, state, attention/interaction, and self-regulation cues were recorded using validated tools. Noise levels were measured with a decibel meter during morning (08:30–09:30) and night (01:30–02:30) shifts. Data were analysed using descriptive statistics and paired t-tests. Results: Morning noise levels were significantly higher (54.0 dB) than night levels (43.1 dB) (p < 0.001). Higher morning noise was associated with increased heart rate (150.9 vs 141.1 bpm), higher respiratory rate (54.0 vs 50.5/min), and lower SpO₂ (95.9% vs 98.1%) (all p < 0.001). Behavioural stress signs increased by a mean of 4.67 points during periods of loud noise (p < 0.05). Conclusion: Loud noise in the NICU exerts a significant adverse impact on both physiological stability and behavioural organization of premature neonates. Implementation of noise-reduction policies and staff sensitization is essential to promote a developmentally supportive NICU environment.

Background: Women with cardiac disease face significant haemodynamic stress during labour, and the choice of analgesia may influence maternal and neonatal outcomes. Evidence from low-resource tertiary centres is limited. Objective: To describe labour analgesia practices in women with cardiac disease and to compare associated maternal and neonatal outcomes. Methods: This retrospective observational study included consecutive pregnant women with documented cardiac disease who delivered at SCBMCH, Cuttack, Odisha, between April 2023 and March 2024. Data on demographics, cardiac diagnosis, labour analgesia technique (neuraxial, systemic opioid, or none), haemodynamic events and immediate maternal and neonatal outcomes were collected from anaesthesia and obstetric records. The primary outcome was a composite of adverse maternal events (ICU admission, inotropic support, or maternal death). Secondary outcomes included hypotension, arrhythmia, mode of delivery and neonatal status at birth. Results: A total of 110 women were included; 65 (59.1%) received neuraxial analgesia, 30 (27.3%) systemic opioids and 15 (13.6%) no analgesia. Hypotension occurred in 12/65 (18.5%) neuraxial, 3/30 (10.0%) systemic and 1/15 (6.7%) no-analgesia cases (p = 0.36). Composite adverse maternal events occurred in 3/110 (2.7%), all in the neuraxial group (p = 0.27). Emergency cesarean rates (p = 0.57) and neonatal outcomes, including Apgar <7 at 5 minutes (4.5% overall), did not differ significantly across groups. Conclusion: In this hypothetical cohort, neuraxial labour analgesia was the most commonly used approach and was associated with a higher incidence of early hypotension, though severe maternal adverse events were rare. Analgesia choice did not significantly influence neonatal outcomes. Larger prospective studies are required to clarify safety in high-risk cardiac subgroups.

Cardiac arrhythmias are common in the post operative period following cardiac surgery. The aim of the study is to assess the incidence, etiology, best possible management and effects on outcome like morbidity and mortality in patients having arrhythmia Post CABG in the early post-operative period and in a follow up over one year at a tertiary level hospital in eastern India.

Background: The selection of an appropriate induction agent is crucial in maintaining hemodynamic stability during general anesthesia. Propofol and etomidate are commonly used intravenous anesthetics with distinct cardiovascular profiles. Understanding their comparative hemodynamic effects is essential for optimizing patient outcomes, particularly in vulnerable populations. Methods: This prospective, randomized, double-blind controlled trial enrolled 120 adult patients (ASA I-II) scheduled for elective surgery. Patients were randomly allocated to receive either etomidate (0.3 mg/kg) or propofol (2 mg/kg) for induction. Hemodynamic parameters including mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded at baseline, immediately post-induction, and at 1, 3, 5, and 10 minutes post-induction. Results: The propofol group demonstrated a significantly greater reduction in MAP compared to the etomidate group at 1 minute post-induction (68.4 ± 8.2 mmHg vs. 82.6 ± 7.8 mmHg, p < 0.001). The incidence of hypotension was significantly higher in the propofol group (31.7% vs. 8.3%, p = 0.002). Heart rate changes were comparable between groups. Etomidate maintained hemodynamic stability throughout the induction period with minimal fluctuations from baseline values. Conclusion: Etomidate provides superior hemodynamic stability compared to propofol during anesthesia induction. These findings support the preferential use of etomidate in patients where cardiovascular stability is paramount.

Background: Probiotic-fluoride dentifrices have emerged as promising agents for modulating the oral microbiome and reducing cariogenic bacteria, but clinical evidence regarding their efficacy remains limited. Aim: To evaluate the anticariogenic activity and improvement in oral health status of participants using a probiotic-fluoride dentifrice over a 60-day period. Material and Methods: Sixty participants were allocated into test and control groups. Clinical parameters including Plaque Index (PI), Oral Hygiene Index (OHI-S), and Streptococcus mutans CFU levels were assessed at baseline and at 15-day intervals up to 45 days. Microbiologic and clinical outcomes were compared within and between groups. Results: The test group demonstrated significant improvements in PI and OHI-S between 30 and 45 days, along with a significant reduction in S. mutans CFU levels at 45 days. The control group showed no meaningful improvements. Conclusion: Probiotic-fluoride dentifrice demonstrated superior plaque reduction, oral hygiene improvement, and anticariogenic effect compared to conventional toothpaste.

Background: Primary amenorrhea is a complex clinical condition arising from diverse genetic, anatomical, and endocrine causes. Cytogenetic evaluation plays a pivotal role in establishing diagnosis and guiding long-term management. Material and Methods: A cross-sectional study of 120 patients with primary amenorrhea was conducted, assessing clinical features, hormonal patterns, pelvic imaging, and cytogenetic findings using standard G-banded karyotyping. Results: Chromosomal abnormalities were identified in 48 cases, including 45,X, mosaic patterns, structural X-chromosome alterations, and 46,XY gonadal dysgenesis. Clinical and hormonal findings correlated strongly with cytogenetic patterns. Normal karyotype individuals showed etiologies including Müllerian agenesis and hypothalamic–pituitary dysfunction. Conclusion: Cytogenetic assessment remains essential in the evaluation of primary amenorrhea, enabling accurate etiological classification and guiding fertility planning, hormonal therapy, and long-term follow-up.

Background: The infraorbital foramen is a key anatomical landmark with significant clinical implications for anesthesia, surgery, and forensic identification. Population-specific morphometric data are essential due to variability in IOF dimensions and laterality. Material and Methods: A cross-sectional analysis of 120 adult dry skulls (60 male, 60 female) was performed. Measurements of the infraorbital foramen and its distances from key craniofacial landmarks were taken bilaterally using digital calipers. Sexual dimorphism and laterality were assessed statistically. Results: Male skulls demonstrated consistently higher morphometric values compared to female skulls. Laterality differences were present but mostly subtle. Significant variation was noted in IOF–Nasion, IOF–ZMS, and IOR–OC distances. Conclusion: The study reveals marked sexual dimorphism and clinically relevant variation in IOF position. These findings underscore the importance of preoperative anatomical assessment and population-specific reference data.

Background: Total abdominal hysterectomy remains a common gynecological procedure associated with substantial postoperative pain. Transversus abdominis plane (TAP) blocks have gained recognition as effective regional analgesic techniques, yet the comparative efficacy between lateral and posterior approaches remains inadequately characterized. Methods: This prospective randomized comparative study enrolled 90 female patients (ASA I-II, aged 40-75 years) scheduled for elective total abdominal hysterectomy under spinal anesthesia. Participants were randomly assigned to receive either bilateral lateral TAP block (Group L, n=45) or bilateral posterior TAP block (Group P, n=45), each using 15 mL of 0.5% levobupivacaine per side. Primary outcomes included pain intensity measured by Numerical Rating Scale (NRS) at predetermined intervals over 24 hours, analgesia duration, and rescue analgesic requirements. Patient satisfaction was assessed using a five-point Likert scale. Results: Pain scores demonstrated comparable values between groups during the initial two postoperative hours. Subsequently, Group P exhibited significantly lower NRS scores at 4 hours (2.96 ± 0.37 vs. 3.33 ± 0.64, p<0.01), 6 hours (3.31 ± 0.93 vs. 3.73 ± 1.23, p<0.01), and 12 hours (2.38 ± 1.03 vs. 2.91 ± 1.04, p=0.016). The posterior approach demonstrated prolonged analgesia duration (9.44 ± 0.50 vs. 8.06 ± 1.57 hours, p<0.01) and reduced rescue analgesic consumption (1.04 ± 0.74 vs. 2.13 ± 0.59 doses, p<0.01). Patient satisfaction rates were notably higher in Group P (93.3% vs. 82.2% satisfied/very satisfied). Hemodynamic stability and adverse event profiles remained comparable between groups. Conclusion: The posterior TAP block approach demonstrates superior analgesic efficacy, extended pain relief duration, decreased opioid requirements, and enhanced patient satisfaction compared to the lateral technique following abdominal hysterectomy.

Background: Abnormal uterine bleeding (AUB) is common and often multifactorial. Thyroid dysfunction, even the mild, “subclinical” type, can disturb menstrual cycles. Vitamin D deficiency is also common and may interact with thyroid function. We tested whether correcting vitamin D deficiency in women with AUB and subclinical hypothyroidism (SCH) could improve thyroid tests and menstrual symptoms. Methods: This was a prospective, single-centre interventional study of reproductive-age women (15–50 years) presenting with AUB and biochemical SCH plus vitamin D deficiency/insufficiency. Eligible participants received oral cholecalciferol 60,000 IU weekly for 8 weeks. The primary outcome was change in serum TSH at 8 weeks; secondary outcomes included change in 25-OH vitamin D and patient-reported change in bleeding pattern. Paired comparisons and group analyses were used; p<0.05 considered statistically significant. Results: Of 110 women screened, 97 completed the 8-week follow-up and were included in the analysis. Their average vitamin D level rose from 17.6 ± 5.2 to 41.1 ± 12.6 ng/mL after treatment (p<0.001). The average TSH level fell from 6.6 ± 1.5 to 5.4 ± 1.5 μIU/mL (p=0.01), while FT3 and FT4 stayed within the normal range and did not change much. Overall, 64 of 97 women (66%) reported that their menstrual bleeding became better, and these women had a larger fall in TSH than those who did not improve (1.7 ± 0.7 vs 0.4 ± 0.7 μIU/mL, p=0.004). Conclusions: An 8-week therapeutic course of weekly cholecalciferol corrected vitamin D deficiency and produced a modest but statistically significant fall in TSH in women with AUB and SCH; two-thirds experienced menstrual improvement. These findings support checking and treating vitamin D deficiency in this population and justify randomized trials to confirm causality.

Introduction: Anaemia is one of the most frequently encountered clinical conditions in haematology, with diverse aetiologies requiring accurate morphological diagnosis. While peripheral smear (PS) examination remains the cornerstone for classification, advancements in automated haematology analysers have introduced red blood cell (RBC) histograms and indices as valuable supplementary tools. RBC indices provide quantitative data that complement PS findings in anaemia evaluation. Mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) help classify anaemia as microcytic, macrocytic, or normocytic, aiding in the identification of causes such as iron or vitamin B12 deficiency and chronic diseases. These parameters, along with red cell distribution width (RDW) and histogram patterns, assist in the early detection and differentiation of anaemia subtypes. This study aims to evaluate the correlation between PS morphology, RBC indices, and histogram patterns in patients with anaemia. Aim: To study the correlation between red blood cell histogram morphology, RBC indices and peripheral smear findings in the diagnosis of anaemia. Materials and Methods: This cross-sectional study was conducted over a period of three months, from March to May 2025, involving a total of 215 patients at Central Laboratory, Akash Institute of Medical Sciences and Research Centre. EDTA-anticoagulated blood samples were analysed using the Beckman Coulter Unicel DxH 800, an automated 7-part haematology analyser, to obtain RBC histograms and indices. Peripheral blood smears were prepared, stained with Leishman stain, and the microscopic findings were correlated with histogram patterns and RBC indices. Results: A total of 215 patients with anaemia were included, comprising 61.86% females and 38.14% males. The highest prevalence of anaemia was observed in the 29–38 age group (47.45%), followed by the 18–28 age group (23.25%). Morphologically, microcytic hypochromic anaemia was the most common type (76.74%), followed by normocytic normochromic (17.67%), dimorphic (4.19%), and macrocytic anaemia (1.40%). Histogram patterns included broad base (37.2%), left shift (33.5%), normal curve (18.6%), bimodal (7.4%), and right shift (3.3%). Microcytic anaemia predominantly showed left shift and broad base curves; normocytic anaemia showed normal and broad base curves; macrocytic anaemia showed right shift; and dimorphic anaemia exhibited varied patterns. A significant correlation (p < 0.05) was observed between histogram patterns and peripheral smear morphology. When combined with red cell indices (MCV, RDW, MCH, MCHC) and histogram analysis, enhanced the accuracy of morphological classification. Conclusion: Integrating RBC indices and histogram analysis with traditional peripheral smear examination enhances diagnostic accuracy in anaemia evaluation. Automated haematology analysers provide objective, reproducible data that complement morphological findings, allowing for earlier and more precise identification of anaemia subtypes. Given the significant global health burden of anaemia, particularly in resource-limited settings, adopting such combined diagnostic approaches can facilitate timely management and improve patient outcomes.

Background: High-energy proximal tibial fractures challenge surgeons due to articular disruption and soft tissue injury. Because of soft tissue injury the treatment is usually challenging, and this study promises to assess the outcome with ilizarov external fixator which promises to be a good solution. Objective: To assess the clinical and functional outcome of proximal tibial fractures treated with ilizarov external fixator. Methods: This prospective study evaluated 30 patients (mean age 40.3 years) treated with Ilizarov circular fixators from 2015-2017. All of them were treated with wound debridement followed by ilizarov ring fixator application along with bone grafting or preliminary knee spanning fixator if the soft tissue damage demands. Outcomes were assessed using Ramussen clinical and functional criteria. Result: Most were Schatzker V-VI (57%) from road traffic accidents (70%). Mean union time was 16.2 weeks, knee flexion averaged 120°, and alignment stayed within 10° varus/valgus in 83%. Modified Rasmussen scores showed excellent/good results in 87% (26/30). Pin-site infections occurred in 37%, compartment syndrome in 7%. Conclusion: Ilizarov fixation delivers reliable outcomes with early weightbearing, suitable for complex fractures with soft tissue compromise.

Background: Periodontal disease remains a significant global health concern and a leading cause of tooth loss in adults. While scaling and root planing (SRP) constitutes the gold standard for nonsurgical periodontal therapy, the search for effective adjunctive therapies continues. Natural products, particularly berries with their rich polyphenolic content and anti-inflammatory properties, have shown potential in modulating periodontal inflammation and bacterial growth. Methods: A randomized controlled trial was conducted in the Department of Dentistry,  Anugrah Narayan Magadh Medical College and Hospital, Gaya, over a period of three months from March 2025 to May 2025, involving 68 patients with chronic periodontitis. Participants were randomly assigned to either Group A (SRP + placebo, n=34) or Group B (SRP + elderberry supplement 500 mg twice daily, n=34). Periodontal parameters including probing pocket depth (PPD) and clinical attachment level (CAL) were measured at baseline and day 28 using Williams Graduated Periodontal Probe. Results: Both groups demonstrated significant improvements in periodontal parameters after intervention. However, Group B showed significantly greater reduction in mean PPD (2.18 ± 0.62 mm) compared to Group A (1.42 ± 0.54 mm) (p<0.001). Similarly, CAL gain was significantly higher in Group B (1.86 ± 0.58 mm) versus Group A (1.14 ± 0.48 mm) (p<0.001). The percentage of sites with PPD ≥4 mm decreased from 100% to 23.5% in Group B compared to 44.1% in Group A (p=0.012). Conclusion: Elderberry supplementation as an adjunct to conventional SRP demonstrates superior clinical outcomes in chronic periodontitis treatment, suggesting that berry supplements may serve as a valuable complementary approach to nonsurgical periodontal therapy.

Introduction: One of the most vital public health concern is Oral and maxillofacial trauma (OMFT) due to its significant impact on facial aesthetics and function. Our study aims to assess the frequency, pattern, and etiology of Oral and maxillofacial fractures in Chhindwara district of Madhya Pradesh. Materials and Methods: A retrospective, cross-sectional study was conducted at the Chhindwara Institute of Medical Sciences, analyzing records of 162 patients from January 2020 to December 2022. Data were categorized by age, gender, and etiology and fracture pattern. Chi-square test was utilised for statistical analysis with a significance level of p < 0.05. Results: The highest prevalence of Oral and maxillofacial fractures was observed in patients aged 31–40 years (30.2%), followed by the 21–30 age group (28.4%). Males comprised 77.2% of cases, indicating a higher susceptibility due to occupational hazards and risk-prone behaviors. Road traffic accidents (RTAs) were the prime cause of trauma (76.8% in males, 43.2% in females), followed by falls and assaults. Mandibular fractures were the most common, accounting for 45% of cases, followed by Le Fort I fractures, dentoalveolar fractures and zygomatic fractures. Conclusion: Oral and maxillofacial trauma is primarily caused by RTAs, particularly affecting males aged 21–40 years. Targeted prevention strategies including public awareness programs regarding traffic sense and traffic regulation enforcement are essential to decline the incidence of such injuries.

Trial Design: A prospective, randomized, single-blind, comparative trial was conducted with 100 patients scheduled for elective open cholecystectomy. Patients were randomly allocated to two groups: Group A received a landmark-guided subcostal TAP (Transversus Abdominis Plane) block, and Group B received a landmark-guided ESP (Erector Spinae Plane) block, both using 20 ml of 0.25% ropivacaine prior to induction of anaesthesia. Methods: Randomization was performed using a computer-generated sequence and sealed envelope technique. The primary outcomes were duration to first request for rescue analgesia, total postoperative rescue analgesic consumption, mean VAS (Visual Analogue Scale) pain scores at multiple time points, perioperative hemodynamic changes, and patient and surgeon satisfaction (5-point Likert scale). Blinded data collection ensured outcome assessment objectivity. Adverse event rates were also recorded. Results: Both groups were similar in demographic and surgical parameters. The ESP block group demonstrated significantly lower mean postoperative VAS scores at all recorded intervals, longer duration to first rescue analgesic, and reduced total consumption of rescue analgesic compared to the TAP group (mean paracetamol consumption 1.5 ± 0.57 g for ESP vs. 2.04 ± 0.82 g for TAP; p = 0.0003). Mean patient satisfaction scores favored ESP (4.52 ± 0.50 vs. 4.32 ± 0.46). Hemodynamic variables were largely comparable except for lower systolic and mean arterial pressures at select postoperative intervals in ESP group. The incidence of adverse events (e.g., nausea, vomiting, headache) did not significantly differ between groups. Conclusions: In open cholecystectomy, landmark-guided ESP block with ropivacaine 0.25% offers superior and prolonged postoperative analgesia, reduces rescue analgesic use, and provides better patient satisfaction compared with subcostal TAP block, with minimal differences in adverse events. ESP block is thus a practical and effective alternative in settings lacking ultrasound facilities.

Aim: The aim of this study is to compare the diagnostic efficacy of perfusion magnetic resonance imaging (perfusion MRI), magnetic resonance spectroscopy (MRS), and positron emission tomography-computed tomography (PET-CT) in detecting glioma recurrence in post-radiotherapy treated patients and to establish the most reliable imaging modality for clinical practice. Materials and Methods: A comparative analysis of 120 post-radiotherapy glioma patients (45 with recurrent gliomas, 75 with pseudo progression/radiation necrosis) was conducted. All patients underwent perfusion MRI (dynamic susceptibility contrast), MRS (proton spectroscopy), and ¹⁸F-FDG PET-CT or ¹¹C-MET PET-CT imaging. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each modality. Results: Perfusion MRI demonstrated sensitivity of 89.5%, specificity of 84.4%, PPV of 81.3%, and NPV of 91.1%. MRS achieved sensitivity of 91.2%, specificity of 79.5%, PPV of 77.8%, and NPV of 92.5%. PET-CT (¹⁸F-FDG) showed sensitivity of 78.9%, specificity of 93.3%, PPV of 89.2%, and NPV of 86.4%. Combined multimodal imaging improved overall diagnostic accuracy to 93.7%. Conclusion: While perfusion MRI and MRS demonstrate superior sensitivity for detecting glioma recurrence, PET-CT provides excellent specificity with superior ability to differentiate recurrence from treatment-related changes. Multimodal imaging approach combining all three modalities offers optimal diagnostic accuracy in post-radiotherapy glioma surveillance.

Background: Acute pancreatitis is a common gastrointestinal emergency with a wide clinical spectrum, ranging from mild, self-limiting inflammation to severe disease associated with significant morbidity and mortality. Understanding its clinical characteristics and outcomes is essential for improving management strategies. Material and Methods: This hospital-based observational study included 234 patients diagnosed with acute pancreatitis based on clinical presentation, biochemical markers, and imaging findings. Demographic details, etiological factors, laboratory parameters, severity scores, complications, and outcomes were recorded prospectively. Severity was classified using the Revised Atlanta criteria, and risk stratification was performed using the BISAP scoring system. All patients were followed until discharge for assessment of complications, need for intensive care, interventions, length of stay, and mortality. Results: The mean age was 42.8 ± 13.6 years, and 62.4% were male. Alcohol-induced disease (47.9%) and gallstones (36.8%) were the leading etiologies. Vomiting occurred in 77.4%, while fever was noted in 26.9%. Mean serum amylase and lipase levels were 726 ± 305 U/L and 1,148 ± 492 U/L, respectively. Based on BISAP scoring, 63.7% had scores 0–1, 24.8% had a score of 2, and 11.5% scored ≥3. According to the Revised Atlanta Classification, 60.7% had mild, 24.8% moderately severe, and 14.5% severe pancreatitis. Acute necrotic collections developed in 12.4%, pseudocysts in 7.7%, and pancreatic necrosis in 9.0%. Systemic complications included acute kidney injury (7.3%), respiratory failure (6.0%), and shock (4.7%). ICU admission was required in 16.7%, and 11.1% underwent interventional procedures. The mean hospital stay was 8.4 ± 3.6 days, and the in-hospital mortality rate was 3.8%. Conclusion: Most patients presented with mild disease; however, a notable proportion developed significant complications. Early risk assessment and prompt supportive care remain key to improving outcomes.

Diabetic nephropathy (DN) is one of the major health issues associated with type 2 diabetes mellitus (T2DM). T2DM is a major risk factor for end-stage renal disease (ESRD) and chronic kidney disease. Blood urea, urine albumin, creatinine, and serum cystatin C are common markers for the diagnosis and progression of DN. Our aim was to com- pare the levels of serum Cystatin C and other renal parameters in patients with diabetes mellitus (DM) and DN which included 120 participants were recruited based on the inclusion and exclusion criteria; of these, 60 were suffering from type-2DM and the remaining 60 were from DN. After taking the case history, the blood and urine samples were collected and sent to the laboratory for estimation of FBS and PPBS, blood urea, serum creatinine, serum cystatin C, and urine albumin creatinine ratio. Every participant in this study had higher blood glucose levels than usual. When both groups were compared, patients with DN showed higher levels of blood urea, serum creatinine, serum cystatin C, and urine albumin creatinine ratio than those with DM.
Conclusion is that levels of blood urea, creatinine, serum cystatin C, and urine albumin creatinine ratio were found to be higher in patients with diabetic nephropathy as compared to DM patients. Similarly, a positive correlation was found between the urine albumin creatinine ratio and serum cystatin C levels, so it can be considered an early diagnostic marker for diabetic nephropathy.

Background: Resistant hypertension (RH) represents a challenging clinical entity associated with increased cardiovascular morbidity and mortality. Understanding the prevalence and determinants of RH in diverse populations is essential for developing targeted management strategies. Methods: This prospective observational study enrolled 724 consecutive hypertensive patients attending the outpatient clinics of a tertiary care hospital. RH was defined as blood pressure ≥140/90 mmHg despite optimal doses of three antihypertensive medications including a diuretic, or blood pressure controlled on four or more agents. Comprehensive clinical, biochemical, and ambulatory blood pressure monitoring (ABPM) assessments were performed. Results: The prevalence of RH was 14.8% (107/724). Patients with RH were significantly older (62.4 ± 9.8 vs 54.6 ± 11.2 years, p<0.001), had higher body mass index (32.6 ± 5.4 vs 27.8 ± 4.2 kg/m², p<0.001), and longer hypertension duration (14.2 ± 6.8 vs 8.6 ± 5.4 years, p<0.001). Diabetes mellitus (58.9% vs 32.4%, p<0.001), chronic kidney disease (42.1% vs 18.6%, p<0.001), and obstructive sleep apnea (34.6% vs 12.8%, p<0.001) were more prevalent in RH patients. Multivariate logistic regression identified obesity (OR=2.84, 95% CI: 1.72-4.68, p<0.001), diabetes mellitus (OR=2.36, 95% CI: 1.48-3.76, p<0.001), chronic kidney disease (OR=2.18, 95% CI: 1.34-3.54, p=0.002), and obstructive sleep apnea (OR=2.12, 95% CI: 1.26-3.56, p=0.005) as independent determinants of RH. White-coat effect was identified in 23.4% of apparent RH cases through ABPM. Conclusion: Resistant hypertension affects approximately one in seven treated hypertensive patients in tertiary care settings. Obesity, diabetes, chronic kidney disease, and obstructive sleep apnea represent major modifiable and non-modifiable determinants requiring comprehensive evaluation and management.

Background: Non-alcoholic fatty liver disease is a spectrum of disorders defined by excess accumulation of triglyceride within hepatocytes, which may cause multiple abnormalities like visceral obesity, dyslipidemia, diabetes, hypertension, and cardiovascular diseases. Method: 60 (sixty) NAFLD Patients were studied for USG lipid profile, HbA1C, routine blood examination, blood pressure recorded by sphygmomanometer, and ECG recorded (if necessary) to rule out cardiac co-morbidities. Results: 12 (20%) were grade I, 28 (46.6%) had grade II, 20 (33.3%) had grade III NAFLD, and BMI was 22.8 to 23.2 in 38 (63.3%) and 23.3 to 24.2 in 22 (36.6%). 22 (36.6%) were pre-diabetic, 38 (63.3%) were diabetic, 16 (26.6%) were normotensive, 44 (73.3%) had HTN, 17 (28.3%) had IHD, and 3 (5%) had MI and elevated biochemical profiles. Conclusion: It is observed that 3rd grade NAFLD among type II DM and hyperlipidemia have a high risk of morbidity and mortality. Such patients must be treated efficiently.

Background: Although bupivacaine is a well-established long-acting regional anesthetic like other amides, ropivacaine is used due to its non-cardiotoxicity, having similar efficacy; hence, it is used alone and compared by mixing with dexamethasone. Method: Out of 90 (ninety), 45 patients were given dexamethasone and ropivacaine, and 45 patients were given ropivacaine alone. Results: The onset of motor block and sensory block and the duration of motor block were longer in patients treated with dexamethasone and ropivacaine with a significant p-value (p < 0.001) as compared to ropivacaine alone. Conclusion: It is confirmed and concluded that dexamethasone added to ropivacaine in a supraclavicular block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor blocks without causing any sedation or toxicity.

Background: The causes of functional constipation are physical and psychological morbidity and poor quality of life. Due to lack of awareness, children suffer with functional constipation. Method: 90 (ninety) children who visited the OPD with constipation were studied. Children who fulfilled the ROME-III criteria for constipation were evaluated for demographic profile, socio-economic status, and psychological and dietary habits affecting bowel pattern were noted. Results: The highest age group was 2 to 4 years (66.6%), and the least was 11 to 12 years (4.4%). 67 (74.3%) were rural residents, 23 (25.5%) were urban, and the highest type of family was nuclear (68.8%); 42 (46.6%) had abnormal posture, 30 (33.3%) had fecal soiling, 8 (8.8%) had recurrent abdominal pain, 6 (6.6%) had blood-streaked stool, 2 (2%) had urinary symptoms, and 2 (2.2%) had GERD. Frequency of stool was once <3 per week in 67 (74.4%) children > 3 per week in 23 (25.5%) children. The highest stool type was type III was (70%) and the least was type IV (3.3%). The highest diet was junk food (74.4%), and 6.6% skipped breakfast. The highest psychological precipitation was 35% temper tantrums, followed by sibling rivalry at 28.8%. Conclusion: Functional constipation is common in children, aggravated by skipping breakfast, low intake of vegetables and fruits, marital disharmony, sibling rivalry, school phobia, and aversion to using the toilet, causing a great impact on functional constipation.

Background: Short surgical procedures require sedative agents that ensure rapid onset, adequate depth of sedation, haemodynamic stability, and quick recovery. Propofol is widely used but is often associated with dose-dependent hypotension and lack of analgesia. Combining ketamine with propofol (ketofol) may counterbalance these limitations. This study compares ketofol and propofol alone for sedation during short surgical procedures. Methods: A prospective comparative study was conducted on 120 ASA I–II adult patients undergoing short surgical procedures. Participants were randomized into two groups: Group P received propofol alone, and Group K received ketofol (ketamine 0.5 mg/kg + propofol 0.5 mg/kg). Sedation time, total drug requirement, haemodynamic changes, recovery time, adverse events, and patient and surgeon satisfaction were evaluated. Data analysis was performed using SPSS version 20.0, with p < 0.05 considered statistically significant. Results: Baseline characteristics were comparable. Group K showed significantly faster achievement of adequate sedation (1.9 ± 0.7 min vs. 2.8 ± 0.9 min), lower propofol-equivalent dose requirement (82 ± 20 mg vs. 118 ± 26 mg), and fewer top-up doses. Ketofol demonstrated superior haemodynamic stability, with fewer episodes of hypotension (SBP drop >20%: 8.3% vs. 23.3%; p = 0.03). Recovery was faster in the ketofol group (12.1 ± 3.5 min vs. 16.4 ± 4.1 min; p < 0.001). Patient and surgeon satisfaction scores were also higher with ketofol. Although adverse events were lower in Group K (10% vs. 21.7%), the difference was not statistically significant. Conclusion: Ketofol offers faster onset, better haemodynamic stability, reduced drug requirement, and quicker recovery compared to propofol alone, making it a safe and effective sedative option for short surgical procedures.

Background: Lumbar spine surgeries involving instrumentation cause substantial postoperative pain due to extensive muscular dissection and bony manipulation. Effective analgesia is essential for enhancing recovery and patient comfort. Ultrasound-guided erector spinae plane block (ESPB) has emerged as a promising regional technique, but its comparative efficacy against local anesthetic wound infiltration remains under-evaluated. Aim and Objective:  This study was to compare the analgesic effectiveness of ultrasound-guided ESPB with local anesthetic wound infiltration in lumbar spine instrumentation surgeries, focusing on postoperative pain scores, time to first rescue analgesia, and total 24-hour analgesic consumption, while also assessing intraoperative hemodynamic stability and the need for additional intraoperative analgesia. Methods: This prospective randomized controlled study included 40 patients aged 18–60 years, classified as ASA I–II, and scheduled for elective lumbar spine instrumentation surgery. Patients were randomized into two groups: Group B received bilateral ESPB with 20 mL of 0.375% bupivacaine on each side, while Group L received wound infiltration with 10 mL of 0.5% bupivacaine plus 10 mL of 2% lignocaine. Postoperative pain was assessed using the Numeric Rating Scale (NRS) at predefined intervals up to 24 hours. Time to first rescue analgesia, total postoperative analgesic consumption, hemodynamic parameters, and adverse events were recorded. Results: All 40 patients completed the study. Baseline demographic characteristics were comparable between groups. Group B demonstrated significantly lower NRS scores at 30 minutes, 1 hour, 2 hours, and 4 hours compared with Group L. The median time to first rescue analgesia was markedly longer in Group B (12 hours) than in Group L (30 minutes). Total 24-hour analgesic consumption was lower in Group B (tramadol 100 mg; paracetamol 1 g) than in Group L (tramadol 150 mg; paracetamol 2 g). Hemodynamic stability was maintained in all patients, and no block-related complications were observed. Conclusion: Ultrasound-guided ESPB provides superior postoperative analgesia compared with local anesthetic wound infiltration in lumbar spine instrumentation surgeries. It significantly lowers pain scores, prolongs the pain-free interval, and reduces postoperative analgesic requirements without compromising safety. ESPB should be considered an effective component of multimodal analgesia strategies in spine surgery.

Introduction: CSOM is a very common disease in lower socioeconomic people of our country. Two varieties of CSOM are mucosal type and Squamosal type. The squamosal type is associated with either cholesteatoma or granulation tissue. Aims: Among patients undergoing mastoid exploration, histopathological examination confirmed cholesteatoma in a higher proportion of ears compared to granulation tissue, and cholesteatoma cases were associated with more complications—such as ossicular erosion, labyrinthine fistula, and facial nerve involvement—than those with granulations in CSOM. Materials & Methods: This is an observational cross-sectional study conducted over 12 months in the Department of Otorhinolaryngology and Head & Neck Surgery at IPGMER-SSKM, Kolkata. A total of 150 symptomatic CSOM patients were enrolled as the study sample. Result: In our study the 150 patients, 40 (47.1%) in the cholesteatoma group and 10 (15.4%) in the granulation group experienced complications, while 45 (52.9%) and 55 (84.6%), respectively, had no complications. Overall, complications occurred in 50 patients (33.3%) and were significantly more frequent in the cholesteatoma group compared to the granulation group (p < 0.001). Conclusion: We concluded that in this study of 150 CSOM patients, histological investigation revealed a higher prevalence of cholesteatoma compared to granulation tissue. Patients with cholesteatoma were considerably older, suggesting a link with advancing age, though gender distribution did not differ significantly.

Introduction: Nasal polyps are hypertrophied, oedematous mucosa of the nasal cavity and paranasal sinuses, commonly classified as bilateral nasal polyposis (B/L polyposis) or antrochoanal polyps (ACP). Inflammatory cells such as eosinophils and mast cells play a key role in their pathogenesis. Aims: To evaluate eosinophil and mast cell infiltration in nasal polyps, compare infiltration between B/L polyposis and ACP, and correlate tissue eosinophilia with systemic eosinophil levels. Materials and Methods: This cross-sectional observational study was conducted in the Department of Pathology at Nil Ratan Sarkar Medical College and Hospital, Kolkata and Department of ENT at IPGMER & SSKM Hospital, between January 2024 and June 2025. The study included 50 cases of nasal polyps—both bilateral nasal polyposis and antrochoanal polyps—encompassing patients of all ages and both sexes. Participants were enrolled after obtaining written informed consent and Institutional Ethics Committee approval, resulting in a final sample size of 50 cases. Results: Of 50 cases, 36 (72%) had B/L polyposis and 14 (28%) had ACP. Median eosinophil count/HPF was 40 in B/L polyposis versus 11 in ACP (p<0.05). Mast cells in epithelium: median 2.5/10 HPF in B/L polyposis, 0 in ACP; in stroma: 23 versus 7.5 (both p<0.05). Tissue eosinophilia (>5/HPF) was present in all cases, while only 5 patients had blood eosinophilia. Tissue and blood eosinophil counts showed no significant correlation (r=0.224, p>0.05). Conclusion: Local eosinophil and mast cell infiltration is significantly higher in B/L polyposis compared to ACP, suggesting their key role in pathogenesis. Anti-inflammatory therapy should be considered the mainstay in managing bilateral nasal polyposis.

Objective: To evaluate the diagnostic reliability of ultrasound strain elastography in differentiating benign from malignant thyroid nodules, using Fine Needle Aspiration Cytology (FNAC) as the reference standard. Methods: This prospective observational study included 100 patients presenting with thyroid nodules at a tertiary care hospital between June 2024 and June 2025. All patients underwent conventional ultrasonography followed by strain elastography using the Rago scoring system and strain ratio measurement. Ultrasound-guided FNAC was performed for cytological evaluation and categorized according to the Bethesda System. Bethesda II–IV were grouped as benign and V–VI as malignant. Diagnostic indices of elastography—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy—were calculated, with p < 0.05 considered statistically significant. Results: Of the 100 nodules, 76% were benign and 24% malignant on FNAC. Softer elastography scores (1–2) were predominantly benign, while harder scores (4–5) showed strong association with malignancy (p < 0.001). Malignant nodules demonstrated significantly higher strain ratios (4.38 ± 1.12) compared with benign nodules (1.92 ± 0.64) (p < 0.001). Ultrasound elastography achieved a sensitivity of 83.3%, specificity of 84.2%, PPV of 60.6%, NPV of 94.6%, and an overall diagnostic accuracy of 84%. Conclusion: Ultrasound strain elastography significantly enhances the differentiation of benign and malignant thyroid nodules, showing high specificity and excellent negative predictive value when correlated with FNAC. Its ability to reliably identify soft, benign nodules supports its use as a valuable non-invasive adjunct to conventional ultrasonography, potentially reducing unnecessary FNAC procedures and improving clinical decision-making.

Objective: To evaluate the diagnostic utility of magnetic resonance imaging (MRI) in pediatric epilepsy, correlate neuroimaging findings with clinical features and assess the overall diagnostic yield in a tertiary care setting in Bhopal. Materials and Methods: A cross-sectional observational study was conducted from June 2024 to June 2025 at a tertiary care hospital in Bhopal, Madhya Pradesh. One hundred pediatric patients aged 0–15 years diagnosed with epilepsy were enrolled. Exclusion criteria included progressive neurological disorders, prior neurosurgical interventions, or contraindications to MRI. Clinical evaluation included demographic data, perinatal history, birth complications, developmental milestones, and seizure classification according to the ILAE 2017 criteria. Brain MRI was performed using a 1.5 Tesla scanner with standard sequences, and findings were interpreted independently by two pediatric radiologists. Data were analyzed descriptively, and correlations between MRI findings and clinical features were assessed. Results: Among 100 patients, 58% were male and 42% female. The most common seizure types were generalized tonic–clonic (40%) and focal seizures (32%). MRI was normal in 40% and abnormal in 60% of patients. The most frequent abnormalities included mesial temporal sclerosis (15%), cortical dysplasia (12%), hypoxic–ischemic injury (10%), and neurocysticercosis (8%). MRI demonstrated a diagnostic yield of 60%, highlighting its role in detecting underlying structural etiologies, especially in patients with developmental delays or perinatal complications. Conclusion: MRI is a valuable diagnostic tool in pediatric epilepsy, aiding in the identification of structural brain lesions and guiding clinical management, including medical therapy and surgical planning. Routine MRI evaluation is recommended in children with red flag features such as focal seizures, abnormal neurological examination, or developmental delay.

Background: Regional analgesia is popular technique to achieve post operative pain relief. Both Fascia iliaca compartment block (FICB) and ‘3 in 1’ nerve block are two regional anaesthetic technique for intraoperative and post-operative pain relief in neck femur surgeries. Use of a single injection in ‘3in 1’ block necessitates special skill and nerve sparing. FICB is placed more laterally thereby improving safety and has emerged as a viable alternative. Here we used USG guided method. This study intends to compare the analgesic effects of these two blocks in patients undergoing lower limb surgeries. Methods: In this study, 78 patients with ASA I and II were randomly allocated to 2 groups, GROUP F and GROUP B. GROUP F patients received Fascia illiaca compartment block and GROUP B received ‘3in1’ block. Patient observed in the post-operative period to determine the duration of effective analgesia from the end of surgery. Results: On comparison, it was found that duration of analgesia was significantly higher in FICB compared to ‘3in1’ block. Although comparison of the total dose of rescue analgesic required in the first 24 hour post-operative period showed no significant difference among two groups. Conclusion: From this study we would like to suggest Fascia iliaca block as a safer and more effective alternative to ‘3in1’ block for post-operative analgesia in neck femur surgeries.

Background: Primary dysmenorrhea is a major cause of recurrent pelvic pain and activity limitation in young women. NSAIDs provide symptomatic relief, whereas hormonal therapy may offer broader cycle-regulatory benefits. However, real-world comparative evidence is limited, and this study evaluated the relative effectiveness and tolerability of NSAIDs versus hormonal therapy. Methods: A comparative observational study was conducted in a tertiary care center involving 216 women aged 15–35 years diagnosed with primary dysmenorrhea. Participants received either NSAIDs or hormonal therapy for ≥3 cycles, and outcomes were assessed using VAS, NRS, functional scores, and pain-diary variables. Side effects, adherence, and rescue analgesia were documented. Statistical comparisons used chi-square and t-tests with significance set at p < 0.05. Results: Both treatments significantly reduced menstrual pain, but hormonal therapy demonstrated greater improvements across all outcome measures. Mean VAS reduction was higher with hormonal therapy (4.5 vs 3.5), accompanied by fewer days of pain (1.2 vs 1.8) and better functional recovery (78.8% vs 60.7%). The need for rescue analgesia was notably lower in the hormonal group (18.2% vs 36.6%). Side-effect patterns differed, with more gastric discomfort in NSAID users and more breast tenderness or mild weight change in hormonal users. Conclusion: Hormonal therapy demonstrates superior and more sustained clinical benefit compared with NSAIDs in managing primary dysmenorrhea.

Background: Electrolyte disturbances are common in hypercapnic acute exacerbations of COPD (AECOPD) and may influence clinical outcomes, particularly the response to noninvasive ventilation (NIV). Identifying early predictors of NIV failure is crucial to guide timely escalation of care. This study evaluated the association between serum electrolytes (Na⁺, K⁺, Cl⁻) and NIV outcomes in hypercapnic AECOPD. Methods: This retrospective study included 178 patients with hypercapnic AECOPD admitted over one year in a tertiary care hospital. Clinical parameters, ABG profiles, and serum electrolytes at admission were recorded. Patients were categorized into acid–base subgroups, and NIV was initiated based on persistent respiratory acidosis and clinical distress. Electrolytes were compared between NIV success and NIV failure groups using the Student’s t-test (p < 0.05). Results: NIV failure was associated with significantly lower pH, higher PaCO₂, reduced PaO₂/FiO₂ ratio, and elevated lactate levels. Electrolyte abnormalities were notable, with higher serum potassium and lower chloride in the NIV failure group, while sodium levels were similar. Patients with respiratory plus metabolic acidosis had the highest NIV failure rate (95%), whereas respiratory acidosis with metabolic alkalosis showed the best outcomes. Diuretic use was common and may have contributed to metabolic patterns across groups. Conclusion: Serum potassium and chloride disturbances are important early predictors of NIV failure in hypercapnic AECOPD and should be closely monitored.

Background: Sleep quality and duration have been proposed as modifiable factors influencing the risk of gestational diabetes mellitus (GDM), but existing evidence remains inconsistent. Understanding these associations is particularly important in early pregnancy when preventive strategies are most effective. This study examined whether sleep quality or duration is associated with the development of GDM in pregnant women. Methods: A prospective longitudinal study was conducted among 194 pregnant women recruited before 14 weeks of gestation from a tertiary care hospital. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and physical activity using the Baecke questionnaire. GDM was diagnosed at 24–28 weeks using the 75-g OGTT based on standard criteria. Logistic regression models were used to evaluate associations between sleep parameters and GDM. Results: Baseline characteristics were comparable between groups except for higher age, BMI, and prior GDM history in women who developed GDM. Sleep quality components and total PSQI scores did not differ significantly between GDM and non-GDM groups. Short night sleep (<7 h) was more common among women with GDM and showed a twofold increased risk in univariate analysis. However, no sleep parameter, including short or long sleep duration, remained significantly associated with GDM after adjustment. Conclusion: Sleep quality and duration were not independently associated with GDM, although short sleep showed a modest unadjusted risk.

Background: Accessory spleens are congenital nodules of splenic tissue that arise from incomplete fusion of splenic mesenchymal buds during embryogenesis. Although often clinically silent, their presence is important for surgeons and radiologists because they may mimic abdominal masses or lead to persistent symptoms after splenectomy. Evidence from cadaveric studies in Odisha remains limited. Objective: To determine the prevalence, number, anatomical distribution, and morphological characteristics of accessory spleens identified during routine cadaveric dissections at SRM Medical College and Hospital, Bhawanipatna medical college in Western Odisha. Methods: A retrospective analysis was conducted on adult cadavers dissected over six months in the Department of Anatomy, SRM Medical College and Hospital, Bhawanipatna. Documentation from routine abdominal dissections was reviewed. For each cadaver, observations regarding the presence of accessory spleens, their number, precise location, size, and gross morphology were collected from departmental records. Data were analyzed using descriptive statistics. Results: Among 60 adult cadavers (40 males and 20 females) examined, accessory spleens were observed in 6 cases, representing a prevalence of 10%. A total of eight accessory spleens were recorded. The splenic hilum was the most frequent location (62.5%), followed by the tail of the pancreas (25%) and the gastrosplenic ligament (12.5%). All accessory spleens were rounded to ovoid, well-encapsulated, and similar in appearance to the main spleen. Their size ranged from 0.7 to 2.1 cm, with an average diameter of 1.3 ± 0.4 cm. Conclusion: The study demonstrates that accessory spleens were present in 10% of cadavers examined, with the splenic hilum being the predominant site. Awareness of such variants is essential in abdominal surgery, trauma care, and radiological interpretation, as failure to identify accessory splenic tissue may lead to diagnostic errors or incomplete splenectomy.

Background: Vestibular symptoms are commonly reported following viral infections, but the clinical course and objective neurophysiologic correlates that distinguish persistent post-viral vestibular dysfunction from transient vestibular complaints remain incompletely characterized. Objective: To define clinical trajectories of vestibular symptoms after viral illness and to identify neurophysiologic markers that predict persistence versus recovery. Methods: In a prospective longitudinal cohort study, adults presenting within 3 months of a documented viral illness with new vestibular symptoms (vertigo, imbalance, oscillopsia; n = 72) were enrolled and followed for 12 months. Baseline assessment included standardized symptom scales (Dizziness Handicap Inventory, Vertigo Symptom Scale), bedside neuro-otologic exam, video head-impulse testing (vHIT), caloric testing, cervical and ocular vestibular-evoked myogenic potentials (cVEMP/oVEMP), computerized dynamic posturography, and videonystagmography (VNG). A matched control group without vestibular complaints after viral illness (n = 30) underwent the same baseline testing. Participants were reassessed at 3, 6 and 12 months. Trajectories were defined by symptom resolution, intermittent symptoms, or persistent disabling dysfunction. Multivariable models examined baseline neurophysiologic predictors of persistent dysfunction. Conclusions: Post-viral vestibular complaints follow heterogeneous clinical trajectories. A subset of patients develops persistent, objectively demonstrable vestibular dysfunction, with specific neurophysiologic abnormalities (reduced vHIT gain, abnormal VEMPs, caloric asymmetry) at presentation that predict poor recovery. Early multimodal vestibular testing can identify high-risk patients who may benefit from targeted vestibular rehabilitation and closer follow-up.

Background: Vocal fold scarring disrupts the layered microstructure and viscoelastic properties of the lamina propria, resulting in impaired vibratory function and chronic dysphonia. Despite advances in regenerative approaches, predicting therapeutic outcomes remains limited by an incomplete understanding of how altered tissue biomechanics influence phonation. This study employs advanced biomechanical modelling to characterize the mechanical consequences of vocal fold scarring and to evaluate the potential efficacy of emerging regenerative interventions. Using a multilayer, continuum‐based finite element model incorporating nonlinear, anisotropic tissue properties, we simulated scar-induced alterations in stiffness, viscosity, extracellular matrix composition, and mucosal wave propagation. Model outputs were validated against available high-speed imaging and phonatory data. Results demonstrate that even moderate increases in lamina propria stiffness and loss of shear compliance produce significant reductions in vibratory amplitude, phase symmetry, and glottal closure efficiency. Simulated regenerative strategies—such as reducing collagen density, restoring elastin architecture, and augmenting hyaluronic acid content—improved vibratory metrics in a dose-dependent manner, with optimal therapeutic benefit achieved through balanced restoration of both elastic and viscous components. This biomechanical framework provides a predictive platform for assessing regenerative therapies and highlights critical microstructural targets for restoring optimal vocal fold kinematics. The findings support the integration of computational modelling into the design and personalization of future treatments for vocal fold scarring.

Background: Successful otologic and neurotologic surgery relies heavily on a precise understanding of temporal bone microanatomy. Anatomical variations across populations can influence surgical approaches, complication rates, and preoperative planning. Despite India’s diverse genetic and morphological landscape, comprehensive population-specific imaging atlases remain limited. Objective: This study aims to characterize microanatomical variability of the temporal bone within the Indian population using high-resolution computed tomography (HRCT) and to develop a detailed, surgeon-oriented atlas to support optimized clinical and surgical decision-making. Methods: HRCT scans of adult Indian patients without temporal bone pathology were retrospectively analyzed. Key anatomical structures—such as the facial nerve canal, cochlea, semicircular canals, jugular bulb, sigmoid sinus, mastoid pneumatization patterns, and carotid canal—were measured and mapped. Variations were quantified, stratified by demographic factors, and integrated into a standardized imaging atlas. Representative 3D reconstructions and multiplanar reference images were incorporated for surgical relevance. Results: Significant variability was observed in mastoid pneumatization, jugular bulb position, and facial nerve canal morphology. Distinct patterns in cochlear dimensions and semicircular canal orientation were noted compared with reported Western and East Asian datasets. These findings were systematically compiled into a high-resolution CT atlas highlighting morphometric ranges, high-risk anatomical variants, and surgical landmarks critical for mastoidectomy, cochlear implantation, transmastoid facial recess approaches, and lateral skull base procedures. Conclusion: The developed HRCT-based atlas provides the first comprehensive reference of temporal bone microanatomical variability specific to the Indian population. By enhancing anatomical predictability and supporting individualized surgical planning, this atlas has the potential to improve surgical safety, reduce complication rates, and serve as a valuable educational tool for trainees and practicing surgeons.

Background: Accurate knowledge of normal subglottic diameter (SGD) in children is essential for safe endotracheal tube sizing, surgical planning, and diagnosis of subglottic stenosis. Existing reference data are limited by small samples, narrow age ranges, or regional variability. This study aimed to establish nationally representative normative values for endoscopically measured subglottic diameter across pediatric age groups and to produce age-specific reference charts. Methods: We performed a multicentre, cross-sectional observational study at five tertiary pediatric otolaryngology centers Study period Two years, at DMCH Darbhanga. Consecutive children (neonates to 16 years) undergoing diagnostic airway endoscopy for non-obstructive indications were enrolled after informed consent. Exclusion criteria included prior airway surgery, congenital airway anomalies, active airway infection, or clinically suspected stenosis. Subglottic diameter was measured under standardized technique during rigid or flexible endoscopy at the level of the cricoid using calibrated endoscopic rulers and still-frame image analysis. Demographic data (age in months, sex, weight, height) were recorded. Data were analyzed by age strata (neonate: 0–1 mo; infant: 1–12 mo; toddler: 1–3 y; preschool: 3–6 y; school: 6–12 y; adolescent: 12–16 y). Percentile curves (5th, 50th, 95th) were generated using LMS modelling. Linear and non-linear regressions examined relationships between SGD and age, weight, and sex. Conclusions: This large, multicentre endoscopic study provides robust national reference values for pediatric subglottic diameter across the full pediatric age range. The provided percentile charts and nomogram can improve airway device selection and aid in diagnosis of subglottic pathology. Further validation in other populations and prospective assessment of clinical impact are recommended.

Background: Metabolic syndrome (MetS) – a combination of obesity, hypertension, dyslipidemia, and hyperglycemia – raises the risk of cardiovascular disease and type 2 diabetes. Serum uric acid (SUA) is increasingly linked to MetS through oxidative stress, inflammation, and insulin resistance. Hyperuricemia correlates with several MetS components, but data from Western Gujarat are limited. This study evaluates the association between SUA and MetS in a tertiary care setting, highlighting the regional need for routine SUA screening. Material and Methods: This cross-sectional study was conducted over one year at a tertiary care centre in Western Gujarat, India. A total of 300 participants aged 30-65 years were enrolled, comprising 150 with MetS diagnosed using the harmonized International Diabetes Federation (IDF) criteria and 150 age- and sex-matched controls without MetS. Ethical approval was obtained from the institutional ethics committee, and informed consent was secured from all participants. Anthropometric measurements (body mass index, waist circumference), blood pressure, and fasting blood samples for glucose, lipid profile, and SUA were collected. Exclusion criteria included chronic kidney disease, gout, malignancy, or use of uric acid-altering medications. Data analysis involved descriptive statistics, independent t-tests for comparisons, Pearson correlation for associations, and logistic regression for odds ratios, using SPSS version 25.0. Significance was set at p < 0.05. Results: The mean age of participants was 48.2 ± 9.5 years, with 55% males. Mean SUA levels were significantly higher in the MetS group (6.8 ± 1.4 mg/dL) compared to controls (4.5 ± 1.1 mg/dL; p < 0.001). Hyperuricemia (>7.0 mg/dL in men, >6.0 mg/dL in women) was prevalent in 62% of MetS cases versus 18% in controls. Positive correlations were found between SUA and waist circumference (r = 0.42, p < 0.01), triglycerides (r = 0.38, p < 0.01), systolic blood pressure (r = 0.35, p < 0.01), and fasting glucose (r = 0.31, p < 0.05), with an inverse correlation for HDL-cholesterol (r = -0.29, p < 0.05). Logistic regression revealed that elevated SUA increased the odds of MetS by 2.8-fold (95% CI: 1.9-4.1, p < 0.001), independent of age and sex. Conclusion: Elevated SUA is strongly associated with MetS and its components in this Western Gujarat cohort, underscoring its potential as a biomarker for cardiometabolic risk. Routine SUA assessment could aid in early MetS detection and management.

Subtrochanteric femur fractures have historically posed a significant challenge in orthopedic trauma due to the unique biomechanical stresses and anatomical complexity of the region. A comprehensive review of existing literature reveals the evolution of treatment modalities, outcomes associated with different fixation techniques, and ongoing debates regarding the optimal surgical approach. According to Fielding (1954), subtrochanteric fractures are defined as those occurring within 5 cm distal to the lesser trochanter. These injuries are especially prevalent in elderly patients with osteoporotic bones and in younger patients as a result of high-energy trauma. The biomechanical difficulty arises due to strong deforming muscle forces acting on the proximal and distal fragments, including the iliopsoas, gluteus medius and minimus, and the adductors. Studies by Sims and Lawrence (2002) emphasize the high stress concentration in the subtrochanteric region, which consists of dense cortical bone prone to delayed healing and nonunion. Historically, conservative treatments involving prolonged traction and casting yielded poor outcomes. The DCS was introduced to provide angular stability in complex proximal femoral fractures. However, literature points out its limitations, particularly in osteoporotic bone. Intramedullary nailing, pioneered by Kuntscher (1970), offers biomechanical advantages and allows early mobilization. Biomechanical comparisons such as Ricci et al. (2004) show LPFN devices reduce bending moments and maintain alignment better in unstable fractures. Clinical studies including Bong et al. (2007) report faster recovery. Subramanyam et al. (2015) found LPFN superior for operative time and blood loss, while Zhang et al. (2017) suggested DCS may offer better rotational stability in select cases. Complications such as infection, implant failure, varus collapse, or screw cut-out are noted. Functional recovery assessed via Harris Hip Score generally favors LPFN.

Background: Clinical research plays a pivotal role in advancing evidence-based medical practice, yet knowledge, attitude, and practice (KAP) toward it among medical professionals remain variable. Assessing these domains is essential to identify gaps that may hinder effective participation in research activities. Objectives: To assess the knowledge, attitude, and practices regarding clinical research among medical teachers, postgraduate students, and interns in a tertiary care teaching hospital in Thiruvananthapuram, Kerala. Methods: A cross-sectional analytical study was conducted among 116 medical professionals from clinical and non-clinical departments at the SUT Academy of Medical Sciences over three months. Participants included medical teachers, postgraduates, and interns who provided informed consent. Data were collected using a pretested semi-structured questionnaire assessing sociodemographic variables and KAP regarding clinical research. The data were analyzed using SPSS version 20, and results were expressed as frequencies, percentages, and means with standard deviations. Associations were tested using Chi-square and Fisher’s exact tests, with p < 0.05 considered significant. Results: Most participants (63.8%) were aged 20–30 years, with a near-equal gender distribution. Knowledge regarding the necessity of clinical research was high (90.5%), while only half correctly identified regulatory authorities and consent requirements. Attitudes were largely positive, with 91.4% believing clinical research benefits mankind and 88.8% supporting inclusion of ICH-GCP training in postgraduate curricula. In practice, 60.3% had participated in clinical research, though only 36.2% had attended GCP workshops and 25.9% had registered studies under CTRI. The most frequently cited barriers were lack of funds (62.1%) and time (60.3%). Conclusion: The study reveals a generally favorable attitude toward clinical research but highlights moderate knowledge and suboptimal practice levels among participants. Strengthening institutional training, mentorship, and support systems could enhance active research engagement and improve the quality of academic research output.

Background: Individual barriers to change in lifestyle include lack of proper knowledge particularly about nutrition and physical activity, lack of acceptance to change behaviour, lack of self‑motivation and lastly physical and socioeconomic limitations. With this background, the present study was sought to assess the well-being knowledge using well-being assessment tool among the employees of our tertiary care teaching hospital. Materials & Methods: It was a observational, cross-sectional, and descriptive epidemiological study done at JIS School of Medical Science and Research (JISMSR), located in Santragachi, West Bengal, India. Study population was office staff & paramedics works at JISMSR (52 in total). Study duration was 22 days, from 11 December 2024 to 3 January 2025. The questionnaire contained the following sections: socio-demographic status: information on age, gender, socio-economic background, etc; physical activity: assessed using the IPAC (International Physical Activity Questionnaire) with 7 questions; and nutrition: based on the Nutritional Baseline Survey, consisting of 5 questions. Other parameters like sleep: measured using the Pittsburgh Sleep Quality Index (PSQI) with 7 questions; mental health status: assessed with the DASS 10 (Depression, Anxiety, and Stress Scale), containing 10 questions; social support: evaluated using 6 questions regarding social relationships and support systems; risk factors/co-morbidities: questions regarding known co-morbidities and lifestyle risk factors. Results: Overall, participants have higher levels of vigorous and moderate activity. A significant number of participants report prolonged sitting hours. Although majority of the participants has good sleep score (56%), 44% of total participants has bad sleep score. Out of 52 participants, 30 are found to be consumed of various kind substances for addiction. Conclusion: The overall well-being in healthcare staff is good at our tertiary care hospital. Majority of the staff showing risks with regards to their physical well-being due to poor exercise practices and abnormal food intake behaviour. Joint family system was found to be a factor for better mental health well-being among healthcare staff. Practicing exercise, meditation, yoga and controlling abnormal food intake leads to further well-being improvement among the healthcare staff.

Objective: The main aim of the study is to analyze epidemiological profile and the predominant system involved and its postmortem findings in sudden death cases subjected for postmortem. Methods: We retrospectively reviewed data based on the history given by Investigating Officer, inquest reports, Postmortem findings in Postmortem Certificates, histopathological reports and chemical analysis reports between March 2022 to August 2022. Results: In this study maximum number of cases died due to sudden death presented with complaints of chest pain (33.3%) followed by sudden unconsciousness (30%) as presenting complaints. In this study majority of the cases who died of sudden death was confined to the Cardio Vascular system (80%) and male predominance. Conclusion: Sudden natural deaths due to coronary artery heart disease were most common cause with male preponderance in this region. In the study, majority of sudden death cases were observed in the age group of 51-60 years and laborer being predominant occupation among them which may be due to lack of awareness, not seeking timely health care services and poverty.

Background and Objective: Tonsillectomy is one of the most commonly performed surgical procedures in the practice of Otorhinolaryngology. Many methods have been described in the history of medical literature which can be traced back to the time of Celsus (40AD). In modern time it is performed by various methods out of which cold dissection technique (CDT) and bipolar electrocautery are the most commonly taught and practiced methods. Bipolar electrocautery is a method known to be associated with shorter duration of surgery and decreased risk of intra and post-operative hemorrhage. However there is need to study its effect on post-operative pain as it is likely to cause thermal injury to surrounding tissue. Many studies suggest that post tonsillectomy pain following bipolar electrocautery technique (BPE) is more severe and prolonged due to injury to surrounding mucosa and pharyngeal muscle . Therefore this study was designed to compare the post-operative pain between two most commonly performed procedures in our institution i.e. cold dissection technique (mentioned CDT hereafter) and bipolar electrocautery (mentioned BPE hereafter), to assess whether there exist some statistically significant difference between post-operative pain following these two techniques. Methods: This was a prospective randomized study conducted in the department of ENT, Tinsukia Medical College and Hospital. Study duration was from 1st June 2024 to 31st May 2025. Fifty four patients above the age of 12 years planned for tonsillectomy were included in the study. Inclusion criteria was patient with history of recurrent tonsillitis, sleep disordered breathing, and chronic tonsillitis. Those patients with acute upper respiratory tract infection, bleeding disorders and with unwillingness to participate in the study were excluded. All patients were divided into two groups randomly- CDT and BPE group. All patients were operated by same surgeon using similar anesthetic and analgesic technique. The post-operative pain intensity was estimated using visual analogue scale (VAS) rating from 0 to 10. Pain scoring was done at 6 and 12 hour post operatively then on daily basis till discharge. It was again recorded at 1st follow up on 7th day after discharge. Results: Out of 54 patients, 27 patients were operated by cold dissection technique (CDT) and 27 patients were operated by bipolar electrocautery assisted dissection (BPE). Mean age in CDT group was 24.29 years whereas it was 20.33 years in BPE group. At 6th hour following surgery, 22 patients (81.4%) in CDT group experienced moderate pain and 5 (18.5%) patients in the same group experienced severe pain. At 12th hour it was 11 (40.7%) and 16 (59.2%) respectively. On the other hand, in the BPE group, 24 patients (88.8%) had moderate pain and 3 patients (11.1%) had severe pain at 6th hour following surgery. At 12th hour, 9 patients (33.3%) experienced moderate pain and 18 patients (66.6%) experienced severe pain in this group. On day 1, 21(77.78%) patients had moderate pain and 6 (22.22%) patients had severe pain in CDT group. The same was 22 (81.4%) and 5 (18.5%) respectively for BPE group. From day 2 onwards patients in both the group had mild pain only. On 1st follow up all patients from both the groups were pain free. The mean pain score for CDT group was 6±1.33 at 6th hour, 7.29±1.84 at 12th hour and 5.74±1.03 at day 1. The same was 5.59±0.95 at 6th hour, 6.74±1.66 at 12th hour and 5.81±1.21 at day 1 for BPE group. There was no statistically significant difference. Conclusion: Based on observation of the present study, it is concluded that there is no significant difference of post-operative pain between CDT and BPE method. Both CDT and BPE are safe approaches but BPE has added advantage of less surgical time and significant reduction in intra operative bleeding as per results of our study.

Introduction: Extrapulmonary tuberculosis (EPTB) contributes significantly to the global TB burden, particularly among children, posing diagnostic challenges due to its varied clinical presentations. Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) has emerged as a rapid and reliable diagnostic tool. This study aimed to evaluate factors associated with EPTB and assess the temporal association of CBNAAT positivity with symptom duration at presentation. Material and Methods: A hospital-based prospective observational study was conducted in the Pediatric Department of Gauhati Medical College & Hospital from July 2023 to July 2024. Seventy-five children aged 1–12 years diagnosed with EPTB were included. Detailed demographic, clinical, and socioeconomic data were collected. Relevant samples from affected sites were subjected to CBNAAT testing. Associations of CBNAAT positivity with history of TB contact, nutritional status, Mantoux test, and time of presentation were statistically analyzed. Results: The mean age of the study population was 5.2 years, with maximum cases (37.3%) in the 4–8 years age group. Slight female predominance was noted (52%). Lymph node TB and CNS TB were the most common presentations (41.3% each). CBNAAT was positive in 27 cases (36%). Significant associations were found with history of TB contact (p=0.0001), malnutrition (p=0.0001), and Mantoux positivity (p=0.0001). CBNAAT positivity showed no statistically significant relation with time of presentation (p=0.061), though higher detection rates were observed beyond two weeks of symptom onset. Conclusion: EPTB in children predominantly involves lymph nodes and CNS. CBNAAT proves valuable in diagnosis, especially in malnourished children, those with TB contact, and Mantoux positivity. Temporal presentation did not significantly influence CBNAAT detection, underscoring the need for timely testing across all presentations.

Introduction: Ovarian cancer is a leading cause of gynecological cancer mortality, often diagnosed at advanced stages due to nonspecific symptoms. Tumor markers such as CA125, CA19.9, CEA, LDH, AFP, and βhCG are widely used as adjuncts in diagnosis and monitoring, though their utility varies across histological subtypes. Aim: To evaluate the diagnostic role of tumor markers in ovarian tumors and correlate their elevation patterns with histopathological subtypes and tumor aggressiveness. Methods: A prospective observational study was conducted on 60 patients with ovarian masses at BKL Walawalkar Rural Medical College, Ratnagiri. Histopathological examination was performed using hematoxylin and eosin staining, and preoperative serum levels of CA125, CA19.9, CEA, LDH, AFP, and βhCG were measured using immunoassay techniques. Data were analyzed for age distribution, histopathological spectrum, and marker elevation. Results: The majority of patients were aged 45–70 years (63.5%). High‑grade serous adenocarcinoma was the most common subtype (30%), followed by serous cystadenoma (17%) and mucinous cystadenocarcinoma (12%). CA125 was the most frequently elevated marker (13.3%), predominantly in high‑grade serous adenocarcinoma (33.3%). CA19.9 and CEA were elevated in mucinous carcinomas (14.3% each). LDH showed minor elevation (5.6%), while AFP and βhCG were not elevated in germ cell tumors. Overall marker positivity was lower compared to tertiary‑center studies, possibly due to early-stage detection, smaller tumor volumes, and rural referral bias. Conclusion: CA125 remains the most reliable marker for serous carcinomas, while CA19.9 and CEA are useful in mucinous tumors. Germ cell tumors require AFP and βhCG evaluation, though marker negativity may occur in early disease. Integration of histopathology with biomarker profiling enhances diagnostic accuracy and prognostic assessment in ovarian cancer.

Background: Unanticipated difficult tracheal intubation remains a leading cause of anesthesia-related morbidity and mortality. Despite numerous preoperative screening tests, their individual predictive accuracies remain modest, necessitating evaluation of combined assessment strategies. Methods: This prospective observational study enrolled 450 adult patients undergoing elective general anesthesia with endotracheal intubation. Preoperative airway assessments included Mallampati classification, thyromental distance (TMD), interincisor distance (IID), neck circumference (NC), Wilson risk score, and upper lip bite test (ULBT). Difficult intubation was defined as Cormack-Lehane grade 3–4, >2 intubation attempts, or requirement for advanced airway adjuncts. Diagnostic performance metrics and multivariate logistic regression were analyzed. Results: Difficult intubation occurred in 37 patients (8.2%). The ULBT demonstrated superior diagnostic accuracy with sensitivity 72.3%, specificity 88.1%, positive predictive value (PPV) 37.5%, and negative predictive value (NPV) 96.8%. Mallampati III/IV yielded sensitivity 64.9% and specificity 77.8% (PPV 21.4%, NPV 95.9%). TMD <6.5 cm showed specificity 84.7% but low sensitivity (51.4%). Combined assessment using ULBT + Mallampati + TMD improved sensitivity to 84.6% while maintaining specificity of 69.3%. Multivariate analysis identified ULBT class III (OR=4.8, 95% CI: 2.3–9.8, p<0.001), Mallampati III/IV (OR=3.2, 95% CI: 1.5–6.7, p=0.002), and NC >42 cm (OR=2.6, 95% CI: 1.2–5.5, p=0.014) as independent predictors. Interobserver reliability was substantial for ULBT (κ=0.81) and moderate for Mallampati (κ=0.64). Conclusion: The ULBT emerges as the single most accurate predictor of difficult intubation. A combined screening approach significantly enhances sensitivity, supporting routine multimodal airway assessment. However, no test provides absolute predictive certainty, underscoring the necessity for comprehensive difficult airway preparedness.

Background: Ultrasound-guided fascial plane blocks are increasingly used in multimodal analgesia for abdominal surgery. ESPB and QLB represent two promising techniques, but their comparative analgesic efficacy remains under investigation. Material and Methods: Eighty patients undergoing abdominal surgery with midline incisions were randomized into ESPB or QLB groups. Postoperative pain scores, opioid consumption, time to first analgesic request, and PCA usage were evaluated at fixed intervals over 24 hours. Results: QLB provided superior early postoperative analgesia, significantly lower static and dynamic NRS scores at 0 and 4 hours, reduced opioid consumption, and fewer PCA attempts. ESPB provided comparable pain relief beyond 8 hours but was less effective during the initial postoperative period. Conclusion: Both blocks are effective for postoperative analgesia; however, QLB offers superior early pain control and greater opioid-sparing benefits, making it a favorable choice for abdominal surgeries requiring deep visceral analgesia.

Background: The present study is undertaken to evaluate Platelet count and platelet indices in diagnosis of neonatal sepsis. Methods: This prospective observational study was conducted on 100 consecutive neonates (both inborn and out born), with clinical signs and symptoms of sepsis along with either positive culture (confirmed neonatal sepsis) or other laboratory findings suggestive of bacterial and fungal infection in absence of positive cultures (probable sepsis), were included after written informed consent from parents. Results: 71 (71.00%) out of 100 cases had increased values of Platelet Distribution Width. In Proven sepsis group 31(86.11%) cases had increased values of PDW, in Probable sepsis 31(63.27%) and in No sepsis group 9(60.00%) cases were having increased values of PDW. This difference was statistically not significant (P value is 0.08). Conclusion: Platelet count and platelet indices, which are easily available hematological parameters in remote & resource poor areas of our country, should be taken into consideration for suspected cases of neonatal sepsis so that prompt treatment can be given, and morbidity and mortality can be reduced.

Background: Early‑onset sepsis is considered to be acquired from the maternal genital tract whereas late‑onset sepsis (LOS) is considered to originate from health‑care setting or from the community. There is a lack of etiological data on neonatal sepsis acquired in the community, due to insufficient laboratory facilities in rural areas and potentially low levels of care seeking, resulting in much‑unreported morbidity and mortality. Methods: This prospective study was conducted on newborns admitted to the Neonatal Intensive Care Unit of our tertiary care hospital. Details of newborns with the final diagnosis of sepsis were reviewed. Neonates with positive blood culture were included in the study. Results: The multivariate analysis using conditional logistic regression identified that Prenatal use of steroids was associated with a 1.81-fold increased risk of BSIs, although this had no statistical significance. Administration of Parenteral nutrition was statistically significantly associated with risk of neonatal sepsis. Conclusion: In conclusion, we demonstrated that after controlling for gender, birth weight and Apgar scores, the administration of parenteral nutrition, and possibly the prenatal use of steroids remained significant predictors of neonatal BSIs.

Background: Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. To study the complication of dengue like illness in children. Methods: The hospital-based study was conducted on patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria. Results: According to complications, in dengue positive cases, bleeding was the most common complication seen in 51.00% cases while shock, myocarditis, and convulsion were present in 34.00%, 3.00% and 1.00% of cases respectively. Conclusion: It concluded that dengue hemorrhagic shock was most common complication.

Background: Febrile seizure (FS) is a highly common neurological problem at childhood. Approximately, 2%-5% of children are estimated to undergo at least one seizure during a febrile illness before they get 5 yrs old, accounting for 30% of all seizures among children. Methods: Hospital based Prospective, Analytical, Case – Control study conducted on children aged between 6 months to 5 years with simple/complex febrile seizures (seizure occurring in developmentally normal child in association with a febrile illness in the absence of CNS infection or any other defined cause of seizures). Results: In study group, 13(26%) patients had abnormal (<4.4 mg/dl) range of ionized calcium level while in control group no patient had abnormal ionized calcium level.Mean ionized calcium level was 4.32±0.23 mg/dl and 4.74±0.24 mg/dl in study and control groups respectively and this difference was found statistically highly significant (p<0.001). Conclusion: The findings suggest that a considerable percentage of children having febrile seizures suffer from calcium deficiency.

Background: To determine the prevalence of Red Blood Cells (RBC) alloantibodies in multi-transfused chronic kidney disease (CKD) patients. Methods: Present study was conducted in the Department of Immuno-Haematology and Transfusion Medicine, S.P. Medical College and P.B.M. Associated Group of Hospitals, Bikaner. Results: The distribution of alloantibodies across ABO blood groups revealed that the anti-C antibody was found in a patient with blood group A, while the anti-E antibody was detected in a patient with blood group O. No alloantibodies were observed in patients with blood groups B or AB, suggesting that the occurrence of alloimmunization was not confined to a specific blood group. Furthermore, the strength of the Indirect Antiglobulin Test (IAT) reactions indicated moderate (2+) reactivity for anti-C and stronger (3+) reactivity for anti-E, reflecting variable yet clinically significant immune responses. Conclusion: The study highlights a middle-aged, male-dominated cohort of multi-transfused CKD patients, predominantly Rh-positive and with blood groups O and B being most common. Despite repeated transfusions, 2 cases of alloimmunization were observed, as evidenced ICT positive and all (100%) cases of DCT had negative results.

Background: This study compared the two methods in order of their sensitivity, specificity, cost effectiveness, time efficacy, enhancing workflow along with their limitations and challenges. Methods: In this Blood Centre based observational cross-sectional study we performed irregular antibody screening in blood donor samples by standard pool cell and 3 cell panel at our Blood Centre’s in-house laboratory. Results: Both panels have extremely high specificity (over 99.98%) and identical overall accuracy at 99.9808%, indicating strong performance in correctly identifying true negatives and maintaining general accuracy. However, the Pool Cell Panel demonstrates higher sensitivity (87.5% vs. 77.78%), meaning it’s better at detecting true positives, which is critical in minimizing false negatives. Conversely, the 3-Cell Panel has a higher positive predictive value (87.5% vs. 77.78%), suggesting greater reliability when a positive result is reported. The negative predictive values are nearly perfect for both, essentially swapped due to the inverse relationship with PPV and sensitivity. Overall, the Pool Cell Panel may be more suitable in contexts where missing a true positive is costlier, while the 3-Cell Panel offers greater confidence in reported positives. Conclusion: The study concludes that while pooled cell panels offer a slightly higher sensitivity in antibody detection among donors, the standard 3-cell panel remains a more reliable tool for positive result interpretation due to its higher positive predictive value.

Background: As a surgical procedure, caesarean delivery may be accompanied by a number of complications, surgical site infection (SSI) being one of them. The rate of SSI ranges from 0.5% to 15% worldwide. Methods: An observational study included 250 patients undergoing lower segment caesarean section was conducted at Jhalawar Medical College, Jhalawar during the period of February 2022 to December 2022. Women underwent lower segment caesarean section including both elective and emergency caesarean section were evaluated for entry in to the study. A written consent was taken. Various risk factors like BMI, anaemia, hypertension, DM, PROM, socioeconomic status were taken into consideration. Results: The incidence of wound infection in my study was 8.8%. This present study depicted that Anemia, PROM, DM, HTN, increased surgical time, increase BMI, low socioeconomic status, increased no. of PV examinations are predominant risk factors leading to wound infection. Conclusion: Correcting malnutrition, anemia, stabilizing diabetes and eradicating all infection such as urinary tract infection, proper preparation   of skin, proper surgeons scrubbing, and using proper surgical technique can decrease the risk of post operative abdominal wound infection. Strategies for prevention of this morbidity must aim to correct anemia , to avoid prolonged hospital stay prior to delivery, to   correct maternal co-morbidities prior to surgery and Strict adoption of asepsis. SSI   surveillance must be done as a part of HAI audit which aims at improving Quality control measures and infection control practices.

Background: Our hypothesis is that NLR could be a useful important inflammatory marker that detects the inflammatory status during acute exacerbations of COPD (AECOPD) and could identify early acute exacerbations for early management. Methods: The cross-sectional study include patients with Chronic Obstructive Pulmonary Disease irrespective of the severity and duration of disease. Study cases are personally interviewed to get relevant details after getting informed signed consent. Based upon inclusion and exclusion criteria a minimum of 100 cases is selected. An exacerbation of COPD is defined as an onset or worsening of more than two respiratory symptoms (ie, dyspnea, cough or wheeze, sputum amount or purulence) for two or more consecutive days. Results: 46.00% patients’ duration of disease was more than 10 year and NLR was 4.45±1.28. The severity wise difference in NLR was statistically significant. Conclusion: NLR can be used as a new inflammatory marker for assessment of inflammation in COPD patients. It is a good predictor for exacerbation of COPD. It is a quick, cheap, easily measurable with no need for a special request.

Background: Unusual presentations lead to diagnostic dilemma and may delay the diagnosis of typhoid fever. The present study describes the clinical presentation of enteric fever at a tertiary care centre. Methods: The study was a hospital based prospective observational study. The parents of the children were informed about the research and its objectives, and written informed consent was obtained from them. Children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. The demographic and clinical features of the patients were described. Results: All the children presented with fever as the main complaint (100%). Loss of appetite and headache were the next common complaints reported by 61.00% cases. Commonest sign noticed was toxic look (83%) followed by coated tongue (76%) and splenomegaly (61%). Hepatomegaly was also noted in 34% of cases. Conclusion: This study was undertaken to observe the clinical profile of typhoid fever in children admitted in a tertiary care hospital. Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission.

Background: Asthma is a globally significant non-communicable disease with a high morbidity and mortality in both children and adults. Approximately 300 million people have asthma worldwide and by 2025 a further 100 million may be affected. Methods: Present study entitled “Serum hs –CRP in Asthma and its ability in predicting asthma control” with the objectives to evaluate hs-CRP level in serum of asthmatic children and the relation of hs-CRP with pulmonary function test (spirometry). Results: 98.1% cases with poorly control asthma had abnormal hs-CRP while only 47.1% cases in well controlled asthma had abnormal hs-CRP. This was found to highly significant (p<0.001). When abnormal hs-CRP is used as a test of poor control of asthma it has a sensitivity of 98%, Specificity of 52%, Positive Predictive Value of 92.6% and Negative Predictive Value of 81%. Conclusion: Serum hs-CRP was evaluated in cases of childhood asthma. Majority of cases with frequent acute exacerbations and poor control had significantly elevated levels of hs-CRP. The mean hs-CRP was significantly greater in these cases. hs-CRP can be used as an affordable, easily available, bedside test for assessing asthma control.

Background: To study the clinical profile of tuberculosis in vaccinated and unvaccinated children. Methods: A total of 100 consecutive children below 12 years of age suffering from various forms of tuberculosis attending pediatric outpatient department/ receiving inpatient care at a tertiary care service hospital. Results: BCG vaccinated group prominent symptoms were fever (96.6%), Cough (53.3%), Convulsion (40%), Altered sensorium (53.3%), vomiting (50%), followed by constipation (30%), respiratory distress (26.6%), pain abdomen (20%).In BCG unvaccinated group fever was present in 98.6%, convulsion (67.1%), altered sensorium (65.7%), vomiting (57.14%), respiratory distress (27.1%), constipation (27.1%), abnormal movements were present in 10% cases in unvaccinated group. Conclusion: Higher incidence of pulmonary tuberculosis in BCG vaccinated group was not statistically significant. However, high incidence of neuro-tuberculosis in BCG unvaccinated group was statistically significant. The underlying risk factors were poor socio-economic status, malnutrition and poor immunization coverage and should be taken into consideration in order to prevent morbidity and mortality due to tuberculosis in children.

Background: The present study is taken to screen the incidence of obesity & hypertension in adolescent population and its association with lipid profile, glucose profile & anthropometric indices. Early detection of childhood obesity is important as it provides an opportunity to take corrective measures and prevent complications. Methods: This is a cross-sectional study of the adolescent. 400 adolescents is selected out the patients admitted in pediatric ward for treatment of specific ailments. They are divided into 4 groups based on the Blood pressure and BMI measurements. Results: The association between BMI and systolic blood pressure was found statistically significant (p value 0.002). The association between BMI and diastolic blood pressure was found also statistically significant (p value 0.004). Mean FBS in over weight patients was 113.40±3.94 mg/dl. The association between BMI and FBS was found statistically significant (p value 0.003). Mean Hb1Ac in over weight patients was 5.60±0.64%. The association between BMI and Hb1Ac was also found statistically significant (p value 0.005). Mean Cholesterol in over weight patients was 211.88±23.84 mg/dl. The association between BMI and total cholesterol was found statistically significant (p value 0.001). Mean HDL in over weight patients was 34.01±1.43 mg/dl. The association between BMI and HDL was found statistically significant (p value 0.004). Mean LDL in over weight patients was 136.95±12.35 mg/dl. The association which was significantly higher in overweight children. (p value 0.002s). Similarly, the mean Triglyceride in over weight patients was 170.95±34.99 mg/dl. The association between BMI and triglyceride was found statistically significant (p value 0.003). Conclusion: Obesity and overweight have become worldwide epidemic. The prevalence of overweight and obesity among children has increased markedly in the last two decades. Our study support that obesity/overweight is prevalent in rural area also for which dietary habits & physical inactivity are the major contributors. Hypertension, lipid derangement & hyperglycemia can lead to significant morbidity presently as well as in future.

Background: Smoking is a major etiological factor for COPD and may interact with metabolic syndrome (MetS), potentially affecting lung function. Aim: To assess the smoking burden and pulmonary function (FEV₁/FVC ratio) in COPD patients with and without MetS. Methods: Using the same dataset of 110 COPD patients, smoking history (pack-years) and lung function (FEV₁/FVC%) were compared between MetS-positive and MetS-negative groups. Results: Smoking prevalence was significantly higher in MetS patients (43.63% vs 36.36%, p=0.04). Mean pack-years were markedly higher among MetS patients (35.82 vs 24.6, p<0.01). MetS patients demonstrated significantly lower mean FEV₁/FVC ratios (56.64 vs 60.81, p<0.05). Conclusion: COPD patients with metabolic syndrome had higher smoking exposure and worse lung function. This reinforces the need for targeted smoking cessation interventions, especially for COPD patients with metabolic risk clustering.

Background: The COVID-19 pandemic has proven how immunisation can avert illnesses, hospitalisations, and fatalities, affecting health systems worldwide. Medical staff are more likely to get infections due to their close contact with patients. Tracking antibody levels following immunisation, especially in people who have had infections, can help determine immune protection length and strength. Methods: Researchers observed the Pathology Department of Patna Medical College and Hospital (PMCH). The study comprised 100 healthcare workers, 50 of whom were affected. Electrochemiluminescence Immunoassay (ECLIA) was used to measure serum antibody titers twice: 28 days after the first immunisation and 6 months or 1 year after the second. Results: Previously infected participants demonstrated significantly higher antibody titers (109.77 ± 69.64 AU/mL) compared to non-infected individuals (13.31 ± 42.48 AU/mL) at 28 days. Although antibody levels declined over time in both groups, infected individuals maintained higher titers at 6 months. Conclusion: A past COVID-19 infection boosts the immune response following vaccination, supporting hybrid immunity. Healthcare providers must offer booster doses and monitor serological levels to ensure long-term protection as antibody levels drop across all groups.

Introduction: Granulomatous lymphadenitis is a chronic inflammatory condition that can be associated with lymphoproliferative disorders, infectious diseases and autoimmune conditions. Among infectious diseases, tuberculosis is the most common disease caused by Mycobacterium tuberculosis. In developing countries like India, where the disease burden is highest FNAC serves as a minimally invasive, cost-effective primary diagnostic tool for evaluating lymphadenopathy. However, due to its limitation’s ancillary techniques like ZN staining and CBNAAT can be employed to confirm tubercular etiology. It is also necessary to rule out other causes of granulomatous lymphadenitis. ZN staining is a simple, rapid and economical method for detecting acid-fast bacilli (AFB). CBNAAT is based on real time polymerase chain reaction (RT PCR) which has significantly higher sensitivity and specificity compared to ZN staining. Aims: To study various cytomorphological patterns of granulomatous lymphadenitis and correlate with ZN stain and CBNAAT findings. Materials and Method: This cross-sectional study was carried out for a period of 6 months from November 2024 to April 2025 at Akash Institute of Medical Sciences and Research Centre. 105 cases diagnosed as granulomatous lymphadenitis on FNAC were included in this study. Clinical details, site of aspiration, type of aspirate were noted. Smears prepared from material obtained on fine-needle aspiration were fixed in ethanol and stained with hematoxylin and eosin. Further, ZN stain was performed on air-dried smears. Samples for CBNAAT was collected simultaneously in a falcon tube with normal saline. Results: A total of 105 cases diagnosed as granulomatous lymphadenitis on FNAC were evaluated and correlated using ZN stain and CBNAAT. Higher incidence was observed in females, accounting for 60%. Majority of patients (33.33%) belonged to 16-30 years age group. Cervical region (71.43%) was the most common site of lymphadenopathy. On FNAC, most common aspirate was blood-mixed aspirates seen in 52.38% of cases. Among the cytomorphological patterns, caseating granulomatous lymphadenitis was the most common observed in 57.14% of cases. Mycobacterium tuberculosis was detected in 84.76% of cases using CBNAAT and 70.48% of cases using ZN staining. Conclusion: A single time sample collection with FNAC for routine cytology, ZN staining for AFB and CBNAAT for detection of Mycobacterium offers comprehensive and effective approach in rapid diagnosis of tuberculous lymphadenitis. In resource limited settings where advance techniques are not available and in cases of blood-mixed aspirate where CBNAAT sensitivity is lower, FNAC still remains cost-effective initial diagnostic tool in evaluating lymphadenopathy. Diagnostic yield and accuracy of FNAC are significantly enhanced when used in conjunction with ancillary techniques to confirm tubercular lymphadenitis. This study revealed that FNAC findings of granulomatous lymphadenitis cases showed a stronger correlation with CBNAAT compared to conventional ZN stain.

Background: Antepartum hemorrhage is one of the most dangerous and devastating group of disorders in obstetrics. Placenta previa contributes to 1/3^rd of the cases of antepartum hemorrhage. Advanced maternal age, high parity and previous LSCS are common risk factors Aim and Objective: The aim of present study is to study the fetomaternal outcome in cases of placenta previa. Methods: A Prospective observational study is conducted in department of OBG, Vijaynagar institute of medical sciences, Ballari for a period of 18months (jan2018- june2019.) Out of 12,071 deliveries during this period, 100 cases were included in study, data collected and results analyzed. Results: Majority belonged to age group 20 -29 yr (83%). 55% presented with vaginal bleeding as chief complaint. Major risk factor is previous caesarean delivery (38%).2 cases were complicated with placenta accrete. 17% cases had PPH. Peripartum hysterectomy was performed in 4%. Perinatal mortality is 15.4% and 18.23% newborns required NICU admission. Conclusion: Placenta previa contributes significantly to maternal and perinatal morbidity and mortality. Maternal complications are because of massive hemorrhage and fetal complications are due to prematurity. Appropriate antenatal care and timely referral to tertiary care center with 24hr blood bank facility, multidisciplinary approach and neonatal back up can reduce the morbidity and mortality associated with this condition.

Background: Dermoscopy enhances the diagnostic accuracy of pigmented skin lesions (PSLs), yet the histopathological correlates of specific dermoscopic features remain incompletely characterized. This study aimed to evaluate the correlation between dermoscopic patterns and histopathological findings and determine the diagnostic accuracy of individual dermoscopic criteria for melanoma detection. Methods: A prospective diagnostic accuracy study was conducted on 180 consecutive PSLs from 165 patients undergoing excisional biopsy at a tertiary center. Dermoscopic images were evaluated by two blinded dermatologists using standardized criteria. Histopathological examination served as the reference standard. Diagnostic performance metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Statistical significance was set at p<0.05. Results: The mean participant age was 58.3 ± 12.7 years. Histopathology confirmed 40 melanomas (22.2%), 56 dysplastic nevi (31.1%), 52 common nevi (28.9%), 22 seborrheic keratoses (12.2%), and 10 solar lentigines (5.6%). Blue-white veil showed the highest specificity (94.2%) and PPV (78.3%) for melanoma, with an accuracy of 89.4% (p<0.001). Irregular pigment network demonstrated sensitivity of 82.5% and specificity of 76.4% (p<0.001). Multivariate analysis identified blue-white veil (OR=8.3, 95% CI: 3.7–18.6, p<0.001) and atypical vascular pattern (OR=5.9, 95% CI: 2.4–14.5, p=0.001) as independent predictors of melanoma. Interobserver agreement was substantial (κ=0.74, p<0.001). Conclusion: Specific dermoscopic features demonstrate strong histopathological correlates and robust diagnostic accuracy for melanoma. Blue-white veil and atypical vascular patterns are highly predictive of melanocytic atypia and should prompt immediate histopathological evaluation. These findings validate dermoscopy as a reliable non-invasive tool for preoperative risk stratification of PSLs.

Background: The goal of this study is to assess the results of Standardized Urinary Incontinence Training (SUIT) for children with FUI based on the guidelines of the German Consensus Group on Continence Training (KgKS) and to identify potential influencing factors that may hinder successful urotherapy. Materials and Methods: Retrospective enrolment was done for all children aged 5–16 years who had received SUIT because of FUI between 2015 and 2024. MEN-only patients and those with organic or neurogenic causes of incontinence were excluded. The participants were divided into three groups based on their diagnosis and symptoms: dysfunctional voiding (DV) without incontinence, non-monosymptomatic enuresis nocturna (Non-MEN), and daytime urine incontinence (DUI). The International Children’s Continence Society (ICCS) criteria were used to assess the results at early and late follow-ups, and statistical analyses were conducted to find important success factors. Results: A total of 114 patients were recruited. Of the 42 children, in whom long-term response was assessed, 29 were in the non-Men group; among these, with a follow-up of more than 24 months, complete response was achieved in 9 children, and 20.6% had relapse in this group. In the DUI group, 5 children had a complete response, and 1 had a relapse. None of the children had relapse in DV w/IC group. Conclusion: Results show that SUIT is a successful first-line therapy for pediatric FUI. The results emphasize the value of customized treatments and the possible advantages of multicenter, interdisciplinary research focusing on behavioral aspects of treatment regimens.

Background: Uterine cavity abnormalities are a significant contributing factor to female infertility. While Transvaginal Sonography (TVS) and Hysterosalpingography (HSG) are the standard first-line diagnostic tools, their sensitivity in detecting subtle intrauterine pathologies—such as small endometrial polyps, mild intrauterine adhesions, or uterine septa—remains debated compared to the gold standard of hysteroscopy. Methods: This prospective, randomized, parallel-group study included 320 women with unexplained or mild male-factor infertility. Participants were randomized into two groups: Group A (n=160) underwent standard evaluation (TVS and HSG) and received treatment only if pathology was identified via these modalities. Group B (n=160) underwent TVS, HSG, and routine diagnostic office hysteroscopy with a “see-and-treat” protocol. Primary outcomes were the prevalence of missed pathology in Group B and cumulative conception rates in both groups at 12 months. Results: Baseline characteristics were comparable between groups. In Group B, hysteroscopy identified intrauterine pathology in 28.1% of patients who had normal findings on TVS/HSG. The sensitivity of the combined TVS/HSG approach was found to be 64.2%, while specificity was 88.5%. The cumulative clinical pregnancy rate at 12 months was significantly higher in Group B (44.3%) compared to Group A (30.6%) (RR 1.45; 95% CI 1.12–1.87; p = 0.012). The miscarriage rate was lower in Group B (9.8% vs. 18.4%), though this did not reach statistical significance (p = 0.14). Conclusion: Routine office hysteroscopy detects a significant volume of intrauterine pathology missed by conventional imaging. The diagnosis and concurrent treatment of these abnormalities significantly improve conception rates, suggesting that hysteroscopy should be considered an integral part of the infertility workup rather than a secondary procedure.

Background: Gallstone disease is a common biliary disorder, with choledocholithiasis occurring in a significant proportion of patients. Missed common bile duct (CBD) stones can lead to serious postoperative complications. Accurate preoperative detection of CBD stones is therefore essential. Ultrasonography (USG) is widely used as the initial imaging modality, while magnetic resonance cholangiopancreatography (MRCP) has emerged as a reliable non-invasive alternative. Objectives: To compare the diagnostic accuracy of ultrasonography and MRCP in detecting gallbladder and CBD stones, using intraoperative findings as the gold standard. Materials and Methods: This prospective observational study was conducted at a tertiary care centre from July 2019 to June 2021. Thirty-two patients with clinically suspected gallstone disease underwent abdominal ultrasonography followed by MRCP. Imaging findings were compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: The mean age of patients was 42.5 years, with a female predominance (75%). For detection of CBD stones, USG showed a sensitivity of 52.17% and specificity of 88.89%, whereas MRCP demonstrated a sensitivity of 95.65% and specificity of 88.89%. Both modalities showed high sensitivity (92%) and specificity (85.71%) for gallbladder stones. MRCP findings showed a stronger correlation with intraoperative findings compared to ultrasonography. Conclusion: Ultrasonography remains a useful first-line investigation for gallstone disease; however, its sensitivity for detecting CBD stones is limited. MRCP provides significantly higher diagnostic accuracy and correlates well with intraoperative findings. Selective preoperative MRCP is recommended to detect occult CBD stones and reduce postoperative complications.

Background: Pharmacovigilance plays a crucial role in ensuring drug safety through systematic monitoring and reporting of adverse drug reactions (ADRs). Despite the establishment of the Pharmacovigilance Programme of India (PvPI), underreporting of ADRs continues to impede effective signal detection and patient safety. Limited data exist on the behavioral determinants influencing ADR reporting among healthcare professionals in Central India. Objective: This study aimed to assess the knowledge, attitude, and practice (KAP) toward pharmacovigilance among doctors, nurses, and pharmacists at a tertiary-care teaching hospital in Indore, Madhya Pradesh, and to evaluate the influence of professional experience and PvPI training on KAP performance. Methods: A cross-sectional study was conducted from January to June 2024 at the Index Medical College Hospital and Research Centre (IMCHRC), Indore. A pre-validated KAP questionnaire consisting of 25 items (knowledge = 10, attitude = 8, practice = 7) was administered to 420 healthcare professionals selected via stratified random sampling. Descriptive and inferential statistics, including ANOVA, Pearson’s correlation, Spearman’s rho, and point-biserial correlation, were applied using SPSS version 26.0. A p-value < 0.05 was considered statistically significant. Results: Among 420 participants, doctors (42.4%) demonstrated higher overall KAP scores compared to nurses and pharmacists (p < 0.05). Mean knowledge, attitude, and practice scores were 9.65 ± 2.8, 12.95 ± 3.1, and 9.60 ± 2.9, respectively. Strong positive correlations were found between knowledge and attitude (r = 0.638, p < 0.01), knowledge and practice (r = 0.594, p < 0.01), and attitude and practice (r = 0.562, p < 0.01). PvPI-trained professionals exhibited significantly higher total KAP scores (r_pb = 0.406, p < 0.001). Years of experience were moderately associated with improved KAP performance (ρ = 0.238–0.284, p < 0.01). Conclusion: While healthcare professionals displayed adequate awareness and positive attitudes toward pharmacovigilance, underreporting persists due to behavioral and systemic barriers. Structured PvPI-based training, interdisciplinary sensitization, and integration of ADR reporting within hospital information systems are pivotal for strengthening India’s pharmacovigilance framework. This study highlights the urgent need for behavioral reinforcement strategies to transform pharmacovigilance from passive compliance to proactive clinical culture.

Background: The foramina in the floor of the middle cranial fossa are of considerable anatomical and clinical importance, as they serve as essential conduits for major cranial nerves and blood vessels connecting the cranial cavity with extracranial regions. Materials and Methods: Present study was conducted in the Departments of Anatomy at TSM Medical College, Lucknow, and Umanath Singh Autonomous Medical College, Jaunpur, using 30 dry adult Indian human skulls (60 sides) of unknown sex and origin. The foramen ovale was examined morphologically and classified as oval, almond-shaped, round, or irregular. Its dimensions anteroposterior (length) and transverse (width)- were measured bilaterally using digital vernier calipers. Results: The present study found that the oval shape of the foramen ovale was most common (60%), slightly more on the right side, followed by almond-shaped (26.7%), round (8.3%), and irregular (5%) forms. Shape distribution was largely similar between the right and left sides. While breadth and area showed no significant side differences, the mean length was slightly greater on the right, a difference that was statistically significant (p = 0.002). Conclusion: The present study provides baseline data on the morphology and morphometry of the foramen ovale (FO), highlighting its clinical relevance for neurosurgical and radiological procedures. Notable right–left differences in the anteroposterior diameter and other variations emphasize the importance of detailed FO anatomy for safe interventions. These findings offer essential anatomical insights for future research and clinical practice.

Background: The autopsy diagnosis of death by drowning is the most difficult problem in forensic pathology due to the delayed approach to medico-legal experts because of delays in transport and rituals of society. Method: 80 dead bodies aged between 10-75 years death due to drowning (50 male and 30 female) were studied by autopsy. The places of drowning and external and internal post-mortem findings were recorded in both sexes. Results: 45 (56.2%) drowning in lakes/rivers, 10 (12.5%) in wells, 21 (26.2%) in house tanks, and 4 (5%) in swimming pools. In external post-mortem findings, the highest was injury 40 (50%) followed by 31 (38.7%) froth around the mouth/nostril, and the least finding was 2 (2.5%) mud/sand in nails. In internal post-mortem findings, the highest was 73 (91.2%) voluminous lungs, followed by 58.7% mud/sand/salt in the larynx; 8 (10%) had the least internal injury. Conclusion: The present study of autopsy will certainly help the medico-legal expert to differentiate homicide and suicide in drowning deaths.

Background: Chronic abdominal pain is one of the most common problems dealt in day-to-day practice by paediatricians. In most of these children, no cause can be identified. Although it is common but its definition, pathophysiological mechanisms and predisposing factors are not completely understood & there is need for large well performed clinical trials for evidence-based treatment. Methods: Hospital based prospective case control study conducted on children aged 5 to 15 years in routine OPD and indoor patient fulfilling the inclusion criteria. Results: Out of 150 cases, 100 (66%) children were among 5-10 yrs age group, while 50 (33%) children were among 11-15 years. 106 (70.7%) children belong to lower middle class, followed by 35 (23.3%) children in upper middle class while 9 (6%) children belong to upper lower class. Cases were classified according to ROME III criteria. According to clinical symptoms and investigations, 79 (52.6%) children had symptoms suggestive of IBS, 39 (26%) children had Dyspepsia, 15 (10%) children had Functional pain abdomen, 5 (3.3%) children had FAPS, 2 (1.3%) children had Giardiasis, 2 (1.3%) children had right ovarian cyst, 3 (2%) children had coeliac disease, 3 (2%) children had cystitis and 2(1.33%) children had gastritis. Conclusion: This study reports higher prevalence of FGIDs in children with RAP and also identifies the variables associated with increased risk of this disorder in children with RAP. FGIDs were present in 93% children with RAP. Female gender, school going children, psychological stress, traumatic life event and lower socioeconomic status increase the prevalence.

Background: Dengue is the most important arthropod-borne viral infection of humans. Each year there are about 50 million dengue infections and about 500,000 individuals are hospitalized with DHF, mainly in Southeast Asia. Methods: The study was commenced after obtaining clearance from the institutional ethical committee. Written consent was taken from the parents and those who were not willing excluded from the study. Patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria were enrolled for the study. Results: Mean age was 10.22± 3.04 year in dengue negative cases and 10.15±3.21 year in dengue positive cases. Male patients outnumber than the female with a male to female ratio of 1.65:1. Fever was present in 100% of cases while documented fever was present in 92.2 % of dengue positive group, followed by vomiting (76.5%), pain abdomen (58.8%), headache (43.1%), eye pain bodyache (41.2% each), rash (11.8%) and joint pain (3.9%). Petechiae and melaena were present in 21.6% of dengue positive cases while nasal bleeding was present in 2(3.9%) cases. Conclusion: It concluded that low platelet counts and rising hematocrit has good association to differentiate dengue from other dengue like illness in a resource limited setting. Cases with prolonged fever rarely turns out to be severe dengue. Significant number of dengue like illness cases etiology was undiagnosed. This is an area of research. Other virus of virulence might be the explanation.

Background: Sickle cell disease (SCD) is characterized by chronic hemolysis and compensatory bone marrow erythroid hyperplasia. Understanding the relationship between bone marrow morphological changes and peripheral hemolytic markers may provide valuable insights into disease severity assessment and therapeutic monitoring. This study aimed to evaluate the correlation between bone marrow histomorphological features and peripheral hemolytic markers in SCD patients. Methods: This cross-sectional analytical study was conducted on 72 confirmed SCD patients aged 12-45 years. Bone marrow aspiration and trephine biopsy were performed, and histomorphological parameters including cellularity, myeloid-to-erythroid (M:E) ratio, erythroid hyperplasia grade, iron stores, and dysplastic changes were assessed. Peripheral hemolytic markers including lactate dehydrogenase (LDH), indirect bilirubin, reticulocyte count, and haptoglobin were measured simultaneously. Correlation analysis was performed using Pearson’s and Spearman’s coefficients. Results: Mean bone marrow cellularity was 78.4 ± 12.6%, with 87.5% of patients demonstrating erythroid hyperplasia. The mean M:E ratio was 0.8 ± 0.3. Significant positive correlations were observed between erythroid hyperplasia grade and LDH levels (r=0.68, p<0.001), reticulocyte count (r=0.72, p<0.001), and indirect bilirubin (r=0.54, p<0.001). Bone marrow cellularity showed moderate positive correlation with reticulocyte count (r=0.61, p<0.001). Haptoglobin levels demonstrated significant negative correlation with erythroid hyperplasia grade (r=-0.58, p<0.001). Patients with severe erythroid hyperplasia exhibited significantly higher LDH (892.4 ± 186.3 vs. 542.7 ± 124.8 U/L, p<0.001) compared to those with mild hyperplasia. Conclusion: Bone marrow histomorphological changes significantly correlate with peripheral hemolytic markers in SCD patients, suggesting that peripheral markers may serve as reliable non-invasive surrogates for assessing bone marrow compensatory response.

Background: Hepatic encephalopathy (HE) is a major neuropsychiatric complication of liver cirrhosis, often accompanied by respiratory alkalosis and reduced arterial pCO₂ levels. Hypocapnia contributes to cerebral vasoconstriction and diminished cerebral perfusion, potentially worsening neurological outcomes. This study aimed to evaluate the correlation between arterial pCO₂ levels and the severity of HE in cirrhotic patients. Aim: To assess the correlation between arterial pCO₂ and hepatic encephalopathy severity in liver cirrhosis. Materials and Methods: This hospital-based cross-sectional study included 140 patients with liver cirrhosis and HE admitted between August 2025 and October 2025. HE severity was graded using the West Haven criteria. Arterial blood gas (ABG) analysis provided pCO₂ levels, and relevant clinical and laboratory data were recorded. Statistical analyses included t-tests, ANOVA, proportion tests, and Spearman correlation. A p-value <0.05 was considered significant. Results: The mean age was 48.2 ± 8.3 years. Most patients (86.4%) had at least Grade 1 HE. The mean arterial pCO₂ level was markedly reduced at 29.8 ± 6.0 mmHg. A strong inverse correlation was noted between pCO₂ and HE grade (Spearman’s ρ = -0.91, p < 0.001). Mean pCO₂ levels decreased progressively from Grade 0 (36.7 mmHg) to Grade 4 (18.2 mmHg). Severe hypocapnia (<25 mmHg) was a strong predictor of overt/worsening HE, with a risk ratio of 3.61 and an odds ratio of 84.45 (p < 0.001). Conclusion: Arterial pCO₂ levels show a strong, graded inverse correlation with HE severity and serve as a robust predictor of overt or worsening encephalopathy. Routine pCO₂ assessment via ABG analysis may support early diagnosis, risk stratification, and timely intervention in cirrhotic patients presenting with altered mental status.

Background: The shoulder joint is the most unstable. The most common complication of traumatic shoulder dislocation is recurrent dislocation. The Latarjet procedure, introduced in 1954, was described as a coracoid bone block technique to prevent anterior dislocation. Latarjet procedure has become the treatment of choice for recurrent anterior glenohumeral instability. This study aimed to evaluate the effectiveness of the Laterjet procedure in preventing recurrent shoulder dislocation. Materials and Methods: This was a prospective observational study. Patients were reviewed on week 2 after the operation for stitch removal, then week 6, month 3, month 6, month 12, and month 24. The mean follow-up period was 18 months. Results: A total of thirteen patients were included in the study. No patients have recurrent dislocation after this procedure. Only one patient has recurrent traumatic subluxation. The restriction of external rotation was about 0 to 5 degrees. According to Rowe score/Walch-Duplay score, the overall excellent and good satisfaction rate was about 84%. Conclusions: Latarjet procedure continues to be a viable treatment option in selected patients with posttraumatic anterior shoulder instability as this procedure has less chance of recurrence rate and complications.

The COVID-19 pandemic that hit globally has left devastating effects economically, bodily and psychosociological. The results of post viral complications and its remedy protocols have been substantially studied, published in various journals but sequalae of long duration steroidal treatment effects & coping efforts, has been restrained mainly in the third world countries like India. The micronutrients in bodily frame play a pivotal function in fighting the contamination by distinctive mechanisms. Of them zinc, ascorbic acid and vitamin D have crucial function in controlling the entry of virus into host cells and modifying the anti-inflammatory markers in reaction to body immunology. As the covid infection results in multiorgan involvement with raised CRP, (C reactive protein) and D dimer in reaction to infection, therefore the steroids dexamethasone, methylprednisolone, performed a crucial function in preventing the dangerous outcomes of anti-inflammatory cascade, but the excessive doses that has necessitated to manipulate the storm of inflammation, resulted in shorterm and long-term effects in patients like Avascular necrosis of femoral head, mainly in post-menopausal females, elderly males or even younger people, who have been admitted and discharged from Govt Hospital and Medical college, Kurnool, Andhra Pradesh.

Introduction: Breast cancer is a leading cause of death among women internationally. In India, it accounts for the second most common cancer after cancer of the cervix in women. Although BSE (Breast Self-Examination) is a simple, quick, and cost-free procedure for screening of breast cancer, review of literature shows that the practice of BSE is low and often unknown in India, ranging from 0% to 52%. The present study was designed to determine the knowledge, attitude, and practice regarding BSE among women in two slums in Kolkata.  Method: A community-based cross-sectional study was conducted among women of reproductive age group (i.e. 15-49yrs) in two slums in Chetla. The minimum sample size calculated was 300. Two slums were selected by simple random sampling and all the women of the reproductive age group were listed out of which 300 women were selected by simple random sampling. Data were collected through an interview method with the help of a pre-tested, semi-structured schedule in the local language. For knowledge items, categorical responses were applied, for attitude items, a 5-point Likert scale was used, and for practice, similar scale items were applied.  A p-value of <0.05 was considered statistically significant. Data was analysed using SPSS (version 20). Results: Total mean knowledge score,mean attitude score and mean practice score were 18.54 ± 4.274 (poor),24.29 ± 2.046(good) and 3.98 ± 1.146(poor), respectively. KAP score was highest in age group of 30-39 years, in women with higher education, and in the higher socio-economic class. Conclusion: All steps must be taken to increase the public awareness regarding regular breast self-examination as a breast cancer screening method.

Background: Burn injuries are associated with high acute morbidity and mortality, yet long-term survival outcomes among burn survivors remain under-reported. Persistent physiological, psychological, and systemic complications may contribute to increased delayed mortality. Objectives: To evaluate the rate of long-term mortality among burn survivors and identify clinical factors associated with mortality following discharge. Materials and Methods: This retrospective study was conducted at Zoram Medical College from 2022 to 2025. Medical records of 100 burn survivors were reviewed. Data collected included demographics, burn characteristics, comorbidities, hospital course, and follow-up survival status. Long-term mortality and factors influencing it were analyzed. Results: Among the 100 burn survivors, 21% experienced long-term mortality during the follow-up period. Higher total body surface area (TBSA) involvement, presence of inhalational injury, comorbidities, and prolonged hospital stay were significantly associated with increased mortality. Flame burns were the most common etiology, and adults aged 18–40 years comprised the largest proportion of survivors. Conclusion: Burn survivors exhibit a substantial risk of long-term mortality even after successful acute management. Severe burns, inhalational injury, and comorbid conditions are key predictors of delayed death. These findings emphasize the need for structured long-term follow-up, early identification of high-risk patients, and comprehensive post-discharge care to improve survival outcomes.

Background/Objectives: Effective postoperative analgesia is essential for early mobilization after total knee arthroplasty (TKA). Continuous adductor canal block (cACB) may provide prolonged sensory blockade with minimal motor weakness compared with single-shot ACB (sACB). This study aimed to evaluate the effectiveness of cACB on postoperative pain control and recovery outcomes in patients undergoing TKA. Methods: A hypothetical multicentre retrospective cohort study was conducted over one year, including 40 adult patients who underwent primary unilateral TKA (cACB: n = 20; sACB: n = 20). Data were extracted from anesthesia and postoperative records. The Numerical Rating Scale (NRS) pain score at rest after 24 hours was the main result. Pain at other timepoints, 48-hour opioid use (oral morphine equivalents), time to initial ambulation, LOS, quadriceps weakness, PONV, and catheter-related problems were among the secondary outcomes. Between-group comparisons were performed using appropriate statistical tests, and longitudinal pain trends were analyzed using a mixed-effects model. Results: The two groups were comparable at baseline. Mean NRS pain at 24 hours was significantly lower in the cACB group compared with sACB (2.8 ± 1.2 vs 4.1 ± 1.5; mean difference −1.3; p < 0.001). Total opioid consumption over 48 hours was reduced in the cACB group (12 ± 8 mg vs 30 ± 15 mg; p < 0.001). Patients receiving cACB ambulated earlier (12 ± 6 h vs 20 ± 8 h; p = 0.002). LOS showed a nonsignificant trend toward reduction. Quadriceps weakness and PONV rates were low in both groups. Mixed-effects analysis demonstrated significant group and group–time interaction effects favoring cACB (p < 0.05). Conclusion: In this hypothetical multicentre analysis, continuous adductor canal block was associated with superior postoperative analgesia, reduced opioid requirements, and earlier mobilization after TKA compared with single-shot ACB. The results encourage more prospective assessment of cACB in improved recovery pathways, notwithstanding the limitations imposed by the small sample size and retrospective design.

Background: Glycemic variability has emerged as a potential independent risk factor for diabetic complications beyond traditional measures of glycemic control such as glycated hemoglobin. The relationship between glucose fluctuations and early renal microvascular changes in type 2 diabetes mellitus remains incompletely understood and warrants prospective investigation. Methods: A total of 174 patients with type 2 diabetes mellitus without established diabetic kidney disease were enrolled and followed for 24 months. Glycemic variability was assessed using continuous glucose monitoring, with calculation of coefficient of variation (CV), mean amplitude of glycemic excursions (MAGE), and time in range (TIR). Renal outcomes included changes in estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), and novel tubular biomarkers. Results: Participants were stratified into high glycemic variability (CV ≥36%, n=82) and low glycemic variability (CV <36%, n=92) groups. After 24 months, the high variability group demonstrated significantly greater decline in eGFR (-8.4 ± 4.2 vs. -3.6 ± 2.8 mL/min/1.73m², p<0.001) and higher incidence of new-onset albuminuria (28.0% vs. 10.9%, p=0.003). MAGE was independently associated with eGFR decline (β=-0.42, p<0.001) after adjusting for HbA1c and traditional risk factors. Time in range showed inverse correlation with UACR progression (r=-0.58, p<0.001). Conclusion: Glycemic variability is independently associated with accelerated early renal microvascular changes in type 2 diabetes mellitus, suggesting that glucose fluctuations contribute to nephropathy progression beyond mean glycemic exposure. Targeting glycemic variability may represent a novel therapeutic strategy for renal protection in diabetes.

Background: Glycemic variability has emerged as a potential independent risk factor for diabetic complications beyond traditional measures of glycemic control such as glycated hemoglobin. The relationship between glucose fluctuations and early renal microvascular changes in type 2 diabetes mellitus remains incompletely understood and warrants prospective investigation. Methods: A total of 174 patients with type 2 diabetes mellitus without established diabetic kidney disease were enrolled and followed for 24 months. Glycemic variability was assessed using continuous glucose monitoring, with calculation of coefficient of variation (CV), mean amplitude of glycemic excursions (MAGE), and time in range (TIR). Renal outcomes included changes in estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), and novel tubular biomarkers. Results: Participants were stratified into high glycemic variability (CV ≥36%, n=82) and low glycemic variability (CV <36%, n=92) groups. After 24 months, the high variability group demonstrated significantly greater decline in eGFR (-8.4 ± 4.2 vs. -3.6 ± 2.8 mL/min/1.73m², p<0.001) and higher incidence of new-onset albuminuria (28.0% vs. 10.9%, p=0.003). MAGE was independently associated with eGFR decline (β=-0.42, p<0.001) after adjusting for HbA1c and traditional risk factors. Time in range showed inverse correlation with UACR progression (r=-0.58, p<0.001). Conclusion: Glycemic variability is independently associated with accelerated early renal microvascular changes in type 2 diabetes mellitus, suggesting that glucose fluctuations contribute to nephropathy progression beyond mean glycemic exposure. Targeting glycemic variability may represent a novel therapeutic strategy for renal protection in diabetes.

Background: Though ropivacaine is less cardiotoxic and less neurotoxic and safer local anaesthetic as compared to bupivacaine, the duration of motor and sensory blockage is limited; hence, adjuvant to ropivacaine will be appreciated because it increases the duration of sensory and motor blockage. Method: Out of sixty (60) adult patients undergoing upper limb surgical operation, 30 received 30 ml of 0.5% ropivacaine with 1 ml of normal saline, while another 30 (group N) received the same amount of ropivacaine with 1 ml of (equivalent to 10 mg) nalbuphine ( adjuvant ) for supraclavicular brachial plexus block. Results: There was a significant p-value (p<0.001) in the comparison of both groups; duration of sensory and motor blockade and duration of analgesia were significantly prolonged in the ropivacaine adjuvant group as compared to ropivacaine alone group. Conclusion: It is observed that ropivacaine and nalbuphine together are more efficient at prolonging sensory and motor blockade and postoperative analgesia as compared to ropivacaine alone without any extra side effects.

Background: Vitamin D is essential to the metabolism of the bones and the healing of the fractures by regulating calcium homeostasis and osteoblast differentiation. Vitamin D deficiency in the preoperative period is known to be common among the fracture patients but it has not been properly studied as a modifiable predictor of the outcome of fracture healing. Methods: The study was a prospective observational cohort study at a tertiary care trauma center and included a total of 156 adults aged between 18-75 years with surgically dealt long bone fracture (either the femoral shaft, tibial shaft, or humeral shaft). There was a preoperative measurement of baseline serum 25-hydroxyvitamin D [25(OH)D]. The patients were categorized on three levels: deficiency (<20 ng/mL; n=58), insufficiency (20 29 ng/mL; n=52), and sufficiency (30 or more; n=46). The main outcomes were time to radiological union (measured by Radiographic Union Scale for Tibia [RUST] score), occurrence of delayed union and nonunion and functional recovery at the 6 and 12 months measured by the Harris Hip Score and Lower Extremity Functional Scale. During the process, secondary outcomes were pain scores (Visual Analog Scale), complications after the operation, and the postoperative stay. Statistical tests were done using one-way ANOVA, Pearson correlation, and multi variate logistic regression with a significance level of p< 0.05. Results: Mean age was 43.2 ± 15.3 years; 68.6% were male. Mean 25(OH)D pre-operative was 22.4 + 8.9ng/mL. The adequate group (11.3 ± 2.1 weeks) had time to union that was much lower than insufficient (13.8 ± 2.7 weeks; p=0.003) and deficient groups (15.2 ± 3.4 weeks; p<0.001). The incidence of delayed union was 7.0% in the sufficient, 16.7% in the insufficient and 29.3% in the deficient groups (p<0.01). The scores of Harris Hip at 12 months were also much higher in sufficient group (87.3 +/- 6.2) compared to insufficient (74.6 +/- 8.4), and deficient groups (61.4 +/- 10.1) (both p<0.001). Preoperative use of 25(OH)D as an independent predictor of faster union ( 25(OH)D 0.52; p=0.004) and better functioning ( 25(OH)D 0.48; p=0.008) was determined by multivariate analysis. Hospitalization was less in patients with adequate amounts of vitamin D (5.2 +1.8 vs. 8.3 +3.1; p<0.001). Conclusion: Preoperative vitamin D deficiency is a preventable risk factor which is independent of delayed union, prolonged functional recovery and increased length of stay following fixation of long bone fractures. Universal screening of preoperative patients with vitamin D and strategic administration of supplementation could be the optimal method to start contingent on winning fractures and functional improvement, especially in high-risk populations. More randomized trials are justified to make evidence-based supplementation.

Aim: To compare the incidence of delayed healing and fracture union failure in patients with femoral neck fractures receiving systemic steroid therapy versus those without steroid exposure in a prospective cohort design. Materials and Methods: A prospective observational study was conducted over 24 months involving 200 patients (100 with steroid therapy, 100 without) presenting with femoral neck fractures. Patients were followed at 6 weeks, 12 weeks, 24 weeks, and 52 weeks post-operative. Radiographic assessment was performed using anteroposterior and lateral hip radiographs. Statistical analysis included Chi-square test, Mann-Whitney U test, and logistic regression analysis. P-value <0.05 was considered statistically significant. Results: The incidence of delayed union was significantly higher in steroid-treated patients (34%) compared to non-steroid group (12%, p=0.002). Fracture nonunion rates were 16% in steroid group versus 4% in control group (p=0.008). Mean time to union was 18.2±4.6 weeks in steroid group versus 12.4±3.2 weeks in control group (p<0.001). Harris Hip Score at 12 months was significantly lower in steroid group (68.4±12.3 vs 82.1±8.9, p<0.001). Complications including AVN were more frequent in steroid-treated patients (18% vs 6%, p=0.012). Conclusion: Systemic steroid therapy is an independent risk factor for delayed fracture healing and nonunion in femoral neck fractures. Patients on chronic steroid therapy require early surgical intervention, close radiographic monitoring, and potentially augmentative strategies to promote bone healing. These findings underscore the importance of identifying steroid-exposed patients at risk and implementing preventive measures.

Background: Focal seizures, arising from a specific cortical region, exhibit diverse clinical presentations depending on the lobe involved. Accurate classification and neuroimaging correlation are essential for diagnosis, localization, and management. This study aimed to evaluate the clinico-radiological profile of patients presenting with focal seizures in a tertiary care setting in Central India. Aims and Objectives: This study was to evaluate the clinical profile and neuroimaging characteristics of patients presenting with focal seizures in a tertiary care centre. The specific objectives were to describe the demographic and clinical features of these patients, classify seizure types according to the ILAE 2017 criteria, identify and categorize CT/MRI abnormalities, and assess the correlation between seizure semiology and radiological findings. Methods: This cross-sectional observational study included 100 patients with clinically diagnosed focal seizures. A detailed clinical evaluation and classification according to the ILAE 2017 guidelines were performed. All patients underwent brain CT and/or MRI. Seizure semiology was correlated with radiological findings, and statistical analysis was conducted using Fisher’s exact test. Results: The majority of patients were in the 19–30 years age group (30%), with a female predominance (56%). Focal impaired awareness seizures were the most common (41%), followed by focal motor (27%) and focal to bilateral tonic-clonic seizures (25%). Temporal and frontal lobes were the most frequently involved regions. Neuroimaging revealed abnormalities in 95% of patients, with infarcts (25%), tuberculomas (14%), and gliosis/encephalomalacia (12%) being the most common. A statistically significant association was found between seizure semiology and radiological findings (p = 0.0045). Conclusion: This study underscores the importance of integrating seizure semiology with neuroimaging findings to localize epileptogenic foci accurately. The high prevalence of structural lesions, such as infarcts and infections, in this population underscores the need for tailored diagnostic approaches, especially in resource-limited, high-burden regions. Early and accurate diagnosis can guide targeted therapy and improve patient outcomes.

Background: Intestinal obstruction is a common surgical emergency associated with significant morbidity and mortality, particularly when diagnosis and intervention are delayed. Understanding the local clinical profile and outcomes is essential for improving management strategies. Objectives: To study the clinical presentation, etiology, management modalities, and outcomes of patients presenting with intestinal obstruction at a tertiary care teaching hospital. Materials and Methods: This hospital-based prospective observational study was conducted in the Department of General Surgery at Government Medical College, Karimnagar, over a period of 12 months. A total of 57 adult patients diagnosed with acute intestinal obstruction were included. Data regarding demographics, clinical features, etiology, investigations, management, intraoperative findings, postoperative complications, and outcomes were collected using a pre-designed proforma. Data were analyzed using SPSS version 25, with results expressed as mean ± SD, frequencies, and percentages. Results: The mean age of patients was 51.6 ± 14.2 years, with a male predominance (66.7%). Abdominal pain (96.5%) was the most common presenting symptom. Postoperative adhesions (36.8%) were the leading cause of obstruction, followed by obstructed hernias (24.6%). Small bowel obstruction was more common (68.4%) than large bowel obstruction. Surgical intervention was required in 59.6% of patients. Postoperative complications occurred in 19.3%, with surgical site infection being the most frequent. The overall mortality rate was 7%, and the mean hospital stay was 8.6 ± 3.1 days. Conclusion: Intestinal obstruction predominantly affects middle-aged males, with adhesions being the most common etiology. Early diagnosis and timely management are crucial to reduce complications and mortality.

Background: Laparoscopic cholecystectomy induces significant hemodynamic alterations due to pneumoperitoneum, CO₂ retention, and patient positioning. Dexmedetomidine, a highly selective α₂-adrenergic agonist, offers sedation, analgesia, and sympatholysis with reduced anaesthetic requirements. However, optimal dosing for maximum stability with minimal adverse effects remains unclear. This study compares two infusion doses following a standard loading dose to evaluate hemodynamic attenuation, anaesthetic requirements, and recovery characteristics. Methods: A prospective, single-blinded, randomized comparative study was conducted on 60 ASA I–II patients aged 18–60 years undergoing elective laparoscopic cholecystectomy at SCB Medical College, Cuttack (2020–2022). Patients were allocated into two groups (n=30 each):
Group A: Dexmedetomidine 1 µg/kg bolus + 0.2 µg/kg/hr infusion.
Group B: Dexmedetomidine 1 µg/kg bolus + 0.6 µg/kg/hr infusion.
Standardized general anaesthesia protocol was followed. Hemodynamic variables (HR, SBP, DBP, MAP, SpO₂, EtCO₂) were recorded at induction, intubation, peritoneal insufflation, every 5 min for 30 min, then every 10 min. Secondary outcomes included propofol supplementation, fluid boluses, sedation score, and recovery time. Statistical analysis was performed using SPSS v26, with p<0.05 considered significant. Results: Both groups were demographically comparable. Group B demonstrated significantly better attenuation of tachycardic response during intubation and 1-minute post-intubation (p<0.05). MAP and SBP fluctuations were lower in Group B, indicating superior hemodynamic stability. Propofol supplementation for hypertensive/tachycardic episodes was lower in Group B. However, Group B showed slightly prolonged recovery time and higher sedation scores, though within an acceptable clinical range. No severe bradycardia, hypoxia, or adverse events occurred in either group. Conclusion: Dexmedetomidine at 0.6 µg/kg/hr infusion following 1 µg/kg bolus provides better hemodynamic stability and reduces anaesthetic requirements compared to 0.2 µg/kg/hr, without major adverse effects. Mildly delayed recovery remains the trade-off but is clinically acceptable. Thus, the higher infusion dose is preferable for laparoscopic cholecystectomy requiring stable hemodynamics.

Objectives: The present study was to evaluate the microbial profile of neonatal septicemia and its antibiogram prevalent and sensitivity pattern in a tertiary care hospital of Bihar. Methods: A total of 154 neonates with clinical sign of sepsis were admitted in Neonatal Intensive Care Unit during study period. All the clinical assessment and investigation including specimen collection, culture, identification of isolates and antibiotic sensitivity testing were performed. Results: Out of 154 new born with clinical sepsis, blood culture were positive in 100(64.94%) cases. 82(74%) had EOS and 18(18%) had LOS.  Majorities of newborn were males 67(67%). 59(59%) had low birth weight <2500 gram. 58(58%) had gestational age <37 weeks. Out of 64 pathogenic bacteria, klebsiella pneumoniae 23(35.93%), Staphylococcus aureus 19(29.69%) and Escherichia coli 11(17.19%) were the most common isolates. Out of 36 pathogenic candida, Candida tropicalis 13(36.11%) and Candida kruzei 8(22.22%) were the most common.  In the gram-negative isolates, the highest sensitivity was reported for Amikacin 42(100%), Colistin 42(100%), Imipenem 41(97.62%), followed by Gentamicin 36(85.71%). Highest resistance was seen in ampicillin (100%). In gram-positive isolates, the highest sensitivity was reported for Vancomycin 24(100%), Teicoplanin 24(100%), Linezolid 23(95.83%) followed by gentamicin 22(91.67%), and Amoxicillin/clavulanic acid 17(70.83%). Conclusion: Regular monitoring of antibiotic resistance is necessary and depending on the antibiotic sensitivity pattern of the isolates, antibiotic should be used. Blood culture is a Gold Standard for diagnosis of neonatal sepsis and should be done in all the suspected cases of neonatal sepsis.

The global rise in temperatures due to climate change has led to record-breaking heat events, with 2024 identified as the hottest year globally by the World Meteorological Organization. For the first time, the global average temperature surpassed 1.5°C above pre-industrial levels. Extreme temperature events are associated with a rise in mortality, particularly from cardiovascular and respiratory conditions, although heat-related deaths are often underreported due to challenges in establishing direct causality. Vulnerable groups including infants, the elderly, and individuals with chronic illnesses are disproportionately affected. This narrative review compiles current epidemiological findings and health impact assessments to provide a comprehensive understanding of how heat affects public health and to inform strategies for effective intervention and risk reduction.

Aim and Background: In our Neuromuscular Clinic, Dystrophinopathies form the commonest of muscle disorders; they constituted about 45% of the primary muscle’s diseases. Materials and Methods: Patients attending the neuromuscular clinic of our hospital were screened for inclusion into the study. Patients with Dystrophinopathy (n=69; 68 boys and 1 girl), (confirmed by absence or reduced levels of dystrophin on immunostaining of muscle biopsy), who were seen in the Neuromuscular clinic of Meenakshi Medical College Hospital and Research Institute, Kanchipuram during the period January 2022 – December 2024 were included in the study. Patients with the spectrum of Dystrophinopathies were broadly subdivided in group I – Duchenne Muscular Dystrophy (DMD) and group II (Outlier’s / DMD). Results: There is progressive decline in the muscle power and also functional ability. Without therapy patients become wheel chair bound by age of 8 to 9 years. Steroid therapy helps to maintain/ slow the decline and prolong duration of ambulation by another 2 to 3 years. Result: Most of our patients had facial weakness and significant axial weakness even in the initial stages, which worsened with disease progression. This progression of axial and facial weakness may indicate late stage of disease with impeding loss of ambulation. Facial weakness and axial weakness have not been hitherto been reported in Dystrophinopathies. Conclusion: Multidisciplinary approach, through a specialized clinic with members from all concerned specialities, involving early diagnosis, medical and physical therapy, genetic counselling, with supportive care in the late stages improve quality of life in Duchenne Muscular dystrophy patients.

Background: Distal tibial fractures often pose challenges due to soft tissue injury, malalignment, and infection. Intramedullary interlocking nailing in the semi-extended knee position offers better reduction, minimal soft tissue trauma, and fewer postoperative complications compared to the conventional flexed-knee approach. Present study was to evaluate the functional and radiological outcomes of intramedullary interlock nailing in the semi-extended knee position for extra-articular distal tibial fractures and to assess complications such as malalignment, malrotation, anterior knee pain, and infection. Methods: This prospective observational study included 58 patients (mean age 42.6 years) treated between January 2021 and September 2023 at Gandhi Medical College, Bhopal. Patients were followed up for six months. Functional outcome was assessed using Johner and Wruh’s criteria. Results: Out of 58 patients, 50 completed follow-ups. The mean union time was 17.06 weeks. Complications included two superficial infections, one non-union, and one case of osteomyelitis. According to Johner and Wruh’s criteria, 52% of cases were graded as excellent, 38% as good, and 10% as fair. Conclusion: Intramedullary interlock nailing in the semi-extended knee position is a reliable and effective technique for distal tibial fractures, offering good alignment, early mobilization, and minimal complications.

Background: Postoperative emergence agitation (EA) is a frequent and distressing complication in pediatric patients undergoing surgery under sevoflurane anesthesia. Rapid emergence, inadequate analgesia, and altered levels of consciousness contribute to its development. The use of α2-adrenergic agonists as adjuvants in caudal anesthesia has shown promise in improving postoperative analgesia and sedation, thereby reducing the incidence and severity of EA. Aims and Objectives: To compare the efficacy of caudal dexmedetomidine (0.5 µg/kg) and clonidine (1 µg/kg) as adjuvants to 0.25% bupivacaine (1 ml/kg) in preventing postoperative emergence agitation, enhancing postoperative analgesia, and maintaining hemodynamic stability in pediatric patients undergoing lower abdominal and perineal surgeries under sevoflurane anesthesia. Methods: This prospective analytical hospital-based study was conducted in the Department of Anaesthesiology at a tertiary care center from May 2023 to October 2024. A total of 106 pediatric patients aged 1–6 years, belonging to ASA physical status I–II, were randomly allocated into two equal groups. Group C received caudal clonidine (1 µg/kg) with 0.25% bupivacaine, while Group D received caudal dexmedetomidine (0.5 µg/kg) with 0.25% bupivacaine. Postoperative sedation and pain-related distress, serving as indirect indicators of emergence agitation, were assessed using the Ramsay Sedation Score (RSS) and FLACC score at predefined intervals over 24 hours. Hemodynamic parameters, oxygen saturation, duration of analgesia, and the need for rescue analgesia were also recorded. Results: Baseline demographic and surgical characteristics were comparable between the two groups. Group D demonstrated significantly higher RSS values during the early postoperative period and consistently lower FLACC scores throughout the 24-hour observation period compared to Group C (p < 0.05). Dexmedetomidine was associated with better hemodynamic stability, as reflected by lower heart rates at 4 and 24 hours postoperatively, without respiratory depression. The time to first rescue analgesic was significantly prolonged in the dexmedetomidine group, extending up to 18–24 hours postoperatively. Conclusion: Caudal dexmedetomidine at a dose of 0.5 µg/kg is superior to clonidine at 1 µg/kg as an adjuvant to bupivacaine for caudal block in pediatric patients undergoing surgery under sevoflurane anesthesia. Dexmedetomidine provides better prevention of emergence agitation, prolonged postoperative analgesia, and improved hemodynamic stability, making it a preferable adjuvant in pediatric caudal anesthesia.

Background: Effective postoperative analgesia is essential for enhanced recovery after laparoscopic abdominal surgeries. The transversus abdominis plane (TAP) block and intraperitoneal instillation of local anesthetics are commonly used modalities, but their comparative analgesic efficacy remains variable. Methods: In this prospective observational study, 60 ASA I–II patients aged 18–60 years undergoing elective laparoscopic abdominal surgery were assigned to two groups. Group A received bilateral ultrasound-guided TAP block with 20 ml of 0.25% levobupivacaine per side, while Group B received intraperitoneal instillation of 40 ml 0.25% levobupivacaine. Hemodynamic parameters, VAS scores at rest and during coughing, time to first rescue analgesia, and 24-hour tramadol requirement were recorded. Results: Baseline characteristics were comparable. Group A demonstrated significantly lower VAS scores at all postoperative intervals (p < 0.001), a prolonged time to first rescue analgesia (7.47 ± 2.87 vs. 4.77 ± 1.76 hours), and reduced tramadol consumption (80 ± 23.12 vs. 115 ± 18.10 mg). Hemodynamic parameters remained stable with no significant complications in either group. Conclusion: Ultrasound-guided TAP block provides superior and longer-lasting postoperative analgesia with lower opioid requirements compared to intraperitoneal levobupivacaine instillation. It is a safe and effective component of multimodal analgesia within ERAS frameworks.

Introduction: Intertrochanteric femur fractures represent a substantial healthcare challenge in the elderly population. While Dynamic Hip Screw (DHS) has traditionally been the standard treatment for stable fractures, Proximal Femoral Nail (PFN) is increasingly utilized. This study compares their clinical outcomes in stable intertrochanteric fractures. Materials and Methods: A retrospective comparative analysis was conducted at SVP Hospital, Ahmedabad, reviewing records of 200 patients (100 DHS, 100 PFN) treated between January 2020 and December 2024. Patients aged ≥50 years with stable intertrochanteric fractures (AO/OTA 31-A1) were included. Operative parameters, radiological union, functional outcomes using Harris Hip Score, and complications were analyzed. Results: Both groups showed comparable baseline characteristics and operative parameters. Mean operative time was similar (DHS: 71.6±10.2 min vs PFN: 69.8±9.6 min, p=0.24). However, DHS demonstrated significantly superior functional outcomes at 6 months (74.3±6.5 vs 70.2±7.1, p=0.002) and 1 year (86.8±5.4 vs 81.7±6.3, p<0.001). Complication rates were comparable (DHS: 7% vs PFN: 10%, p=0.43). Conclusion: While both implants provide satisfactory outcomes in stable intertrochanteric fractures, DHS offers superior functional recovery despite similar intraoperative metrics. Implant selection should be individualized based on fracture morphology, patient factors, and surgical expertise.

Background: Genital dermatoses frequently mimic sexually transmitted diseases (STDs), leading to diagnostic confusion, unnecessary investigations, and significant psychological distress. Dermoscopy has emerged as a valuable non-invasive tool for evaluating genital lesions, potentially improving diagnostic accuracy. This study aimed to evaluate the clinical and dermoscopic features of non-venereal genital dermatoses that clinically simulate STDs and to assess the diagnostic utility of dermoscopy in their differentiation. Methods: This prospective observational study was conducted on 156 patients presenting with genital lesions initially suspected to be STDs but subsequently diagnosed as non-venereal dermatoses. Clinical examination and dermoscopic evaluation using polarized dermoscopy (10× magnification) were performed. Dermoscopic patterns were documented, and diagnostic accuracy was compared between clinical and clinicodermoscopic assessments using histopathology as the gold standard where applicable. Results: The mean age was 34.8 ± 12.4 years, with male predominance (67.3%). The most common conditions diagnosed were pearly penile papules (18.6%), Fordyce spots (14.7%), lichen sclerosus (12.8%), and Zoon’s balanitis (10.9%). Clinical diagnosis alone achieved 62.8% accuracy, while clinicodermoscopic evaluation improved accuracy to 89.1% (p<0.001). Specific dermoscopic patterns were identified: pearly penile papules showed grape-like structures with central vessels, Fordyce spots demonstrated yellowish-white globules, and lichen sclerosus exhibited whitish structureless areas with comedo-like openings. Dermoscopy significantly reduced unnecessary STD investigations (78.2% vs. 34.6%, p<0.001). Conclusion: Dermoscopy substantially enhances diagnostic accuracy in differentiating non-venereal genital dermatoses from STDs. Integration of dermoscopy into routine genital examination can minimize misdiagnosis, reduce patient anxiety, and avoid unnecessary investigations.

Background: Carbapenem-Resistant Enterobacterales (CRE) pose a major public health challenge due to rapid dissemination, high mortality, and limited therapeutic options. Molecular detection of carbapenemase genes provides early identification and guides infection control strategies. Aim: To determine the prevalence and molecular characteristics of carbapenemase genes among CRE isolates from a tertiary care hospital in Ahmedabad, Gujarat. Methods: This cross-sectional observational study included clinical samples (urine, blood, sputum, pus, body fluids) received in the Microbiology Department of SMS Hospital. Enterobacterales were identified by culture, biochemical tests, and automated systems. Antimicrobial susceptibility testing (AST) was performed using CLSI guidelines. Phenotypic confirmation of carbapenem resistance was done using Carba NP and EDTA synergy tests. Molecular detection of carbapenemase genes (blaNDM, blaOXA-48, blaKPC, blaVIM, blaIMP) was carried out by PCR. Results:  Among 2210 Enterobacterales isolates, 520 (23.5%) were CRE among the 190 carbapenem-resistant Gram-negative isolates analyzed, 83.1% harbored a detectable carbapenemase gene. The most prevalent gene was NDM (33.7%), followed by co-production of NDM and OXA-48 (32.6%), and OXA-48 alone (14.2%). A small proportion showed co-existence of NDM, OXA-48, and VIM (2.1%), Klebsiella pneumoniae was the predominant CRE species. High resistance was noted to carbapenems, cephalosporins, and fluoroquinolones, while tigecycline/colistin showed the highest susceptibility. Conclusion: NDM and OXA-48 were the most prevalent carbapenemase genes in our region. Molecular characterization provides better understandings of the genetic mechanisms of resistance and assists in implementing targeted infection control policies.

Background: Female paediatric inguinal hernia, although less common compared to males, presents an important surgical concern, especially in peripheral hospitals where resources may be limited. Early diagnosis is crucial due to risks of incarceration and involvement of reproductive organs. Objective: This study is aimed to document the age, side (right, left, bilateral), and complication rates (recurrence, wound infection) among female paediatric inguinal hernia patients treated at a peripheral hospital in Jammu and Kashmir. Methods: A retrospective review was conducted including 22 female paediatric patients (aged >3years–14 years) who were operated for inguinal hernia from January 2018 to October 2023. Age groups, laterality, and postoperative complications were analyzed. All patients underwent open herniotomyand high ligation of sac and were followed for at least 2 years postoperatively. Results: Of 22 cases, the majority (63.6%) were aged 3–5 years 27.3% were 6–10 years, and 9% were 11–14 years. Right-sided hernias comprised 68.2% of cases, left-sided 22.7%, and bilateral 9.1%. Postoperative complications included recurrence in 4.5% and wound infection in 9%. These findings highlight a predominance of early childhood presentation and right-sided hernias, with a low but noteworthy complication rate. Conclusion: Female paediatric inguinal hernias in this study predominantly affected younger age children and were right-sided. Prompt surgical management resulted in a low incidence of complications. The findings underscore the need for early detection and referral to prevent morbidity, especially in regions with constrained healthcare resources.

Background: Paediatric intensive care units (PICUs) play a pivotal role in managing critically ill children, with mortality rates reflecting the quality of care and disease patterns. In resource-constrained regions like eastern India, sepsis, respiratory illnesses, and neurological disorders are common, yet regional data are limited. This study examines the causes of mortalities in a PICU, alongside clinical profiles and associated factors, to guide improvements in paediatric critical care to reduce mortality rates, for prevention strategies and good outcomes from intensive care set ups. Aims: To analyse the primary causes of mortality in PICU-admitted children, evaluate demographic and clinical profiles, and assess relationships with factors such as age, nutrition, ventilation, ionotropes, and breastfeeding. Materials and Methods: A prospective observational study was conducted in the PICU of Silchar Medical College and Hospital, Assam, from July 2019 to June 2020. Inclusion criteria: children aged 1 month to 12 years. Exclusions: deaths within 2 hours, stays beyond the study period, or discharge against medical advice. Data included demographics, admission source, cause of mortality, system involved, mechanical ventilation, ionotropes, nutritional status (WHO BMI-for-age), breastfeeding history, and outcomes. Analysis used SPSS v25; chi-square tests for significance (p < 0.05). Results: Among 747 admissions, Mortality was: 18.5% (138/747). Leading causes: sepsis (37.7%, n=52), pneumonia (23.9%, n=33), meningitis (8.7%, n=12), congenital heart disease (5.8%, n=8), acute encephalitis syndrome (AES) (4.3%, n=6). Infant mortality: 73.2% (p < 0.00001), mainly sepsis (51.5%) and pneumonia (29.7%). System-wise: infections/sepsis (37.7%), respiratory (25.4%), CNS (15.2%). Out of ventilation supported children the mortality was: 71.5% (p < 0.00001); ionotropic supported children mortality was : 61.1% (p < 0.00001). Malnutrition in 58.6% of admissions; 73.9% deaths malnourished (p = 0.000054). Exclusive breastfeeding reduced mortality (p < 0.00001). Socioeconomic: upper lower class highest (42.6%). Conclusion: Sepsis and pneumonia are predominant mortality causes, exacerbated in infants and malnourished children. Targeted interventions for infection prevention, nutritional optimisation, and early mechanical support could reduce PICU mortality. Emphasis on breastfeeding and public health measures including vaccinations are essential.

Aim: To evaluate the association between fundoscopic findings and maternal-fetal outcomes in preeclampsia and to determine the predictive value of ocular manifestations in assessing disease severity and perinatal complications. Materials and Methods: This prospective observational study was conducted over 18 months in the Department of Obstetrics and Gynecology. A total of 150 pregnant women diagnosed with preeclampsia (mild and severe) were enrolled. Comprehensive fundoscopic examination was performed using direct and indirect ophthalmoscopy. Maternal complications, fetal outcomes, and adverse perinatal events were documented. Statistical analysis was performed using Chi-square test and Pearson correlation. Results: Fundoscopic abnormalities were observed in 82 patients (54.67%). The most common findings were arteriolar narrowing (45.3%), followed by hemorrhages (28.7%), cotton-wool spots (21.3%), and papilledema (12%). Patients with fundoscopic changes had significantly higher rates of maternal complications (HELLP syndrome: 26.8% vs 5.1%, p<0.001), preterm delivery (58.5% vs 28.2%, p<0.001), and adverse fetal outcomes including IUGR (34.1% vs 8.9%, p<0.001) and low Apgar scores (31.7% vs 6.4%, p<0.001). Conclusion: Fundoscopic findings serve as significant predictors of maternal and fetal complications in preeclampsia. The presence of retinal changes correlates with disease severity and adverse perinatal outcomes. Routine fundoscopy should be incorporated into the clinical assessment of all preeclamptic women to identify high-risk cases requiring intensive management.

Elagolix is an orally active, nonpeptide gonadotropin-releasing hormone (GnRH) receptor antagonist developed for the management of estrogen-dependent gynecologic disorders. It represents a major advancement over traditional injectable GnRH agonists by providing rapid, reversible, and dose-dependent suppression of ovarian hormone production without an initial flare effect. Elagolix was first approved for the treatment of moderate to severe endometriosis-associated pain and later, in combination with hormonal add-back therapy, for heavy menstrual bleeding associated with uterine fibroids. This comprehensive review examines the pharmacology, mechanism of action, pharmacokinetics, clinical efficacy, safety profile, dosing strategies, and role of add-back therapy. Evidence from pivotal randomized controlled trials, systematic reviews, and regulatory evaluations is summarized. Special emphasis is placed on bone mineral density loss, hypoestrogenic symptoms, hepatic considerations, and long-term safety. Elagolix offers a flexible, oral, and reversible therapeutic option that fills an important gap in the medical management of endometriosis and uterine fibroids.

Background: Decreased vision, whether congenital or acquired can negatively affect the learning of a child. It not only leads to bad quality of life but also has detrimental effects on the person’s self-esteem. Aims: To determine the frequency of different ocular conditions leading to ocular morbidity in a multi-centric tertiary care hospital. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Study was done in multi-centric tertiary care hospitals at Udaipur, Rajasthan from February 2024 to January 2025. Methodology: A total of 556 patients presenting in the eye out-patient department were included. Patients with unaided visual acuity of 6/6 in both eye and no other ocular abnormalities were excluded from the study. Children with congenital syndromes like Down’s syndrome, etc. leading to eye diseases were also excluded. All children underwent complete ocular examination. Data was analyzed by using SPSS version 22. Frequency and percentages were computed for gender and different ocular diseases e.g., myopia, hypermetropia, strabismus, Vernal Keratoconjunctivitis, astigmatism, red eye, subconjunctival haemorrhage etc. Post-stratification chi-square test was applied with p-value ≤ 0.05. Results: Out of 556 participants of the study, there were 308 (55.4%) males and 248 (44.6%) females. Average age of the patients was 11.15 ± 3.44 years. Myopia and red eyes were the major causes of paediatric ocular morbidity i.e. 33.81% and 26.6% respectively. Comparison between two age groups showed that Myopia was higher in children with 11 to 15 years. Myopia and astigmatism were more common in females while sub-conjunctival haemorrhage was more in males. Conclusion: Refractive errors are the commonest cause of childhood visual impairment in our setup. Correcting these preventable diseases can have a positive impact on the performance of children at school.

Background: Emergency laparotomy is associated with high postoperative morbidity, and optimal timing of postoperative feeding remains controversial. Early enteral or oral feeding may enhance recovery, but concerns regarding tolerance and complications often delay its initiation, especially in emergency settings. Objectives: To compare the effects of early versus late postoperative feeding on recovery outcomes in patients undergoing emergency laparotomy. Materials and Methods: This prospective comparative observational study was conducted at Department of General Surgery, Government Medical college, Krimnagar a tertiary care teaching hospital over one year. A total of 58 adult patients undergoing emergency laparotomy were included and divided into two groups: early feeding (initiation within 24 hours postoperatively, n = 29) and late feeding (initiation after 72 hours or after return of bowel function, n = 29). Postoperative recovery parameters, complications, length of hospital stay, and mortality were assessed. Statistical analysis was performed using SPSS version 25, with a p-value <0.05 considered statistically significant. Results: Both groups were comparable in demographic profile and surgical indications. The early feeding group showed significantly faster return of bowel sounds, earlier passage of flatus, and earlier tolerance to oral diet (p <0.001). Postoperative ileus and vomiting were significantly lower in the early feeding group. Length of hospital stay was significantly shorter with early feeding, while mortality did not differ significantly between the groups. Conclusion: Early postoperative feeding after emergency laparotomy is safe and effective, leading to faster gastrointestinal recovery, fewer complications, and reduced hospital stay without increasing mortality. Early feeding should be considered an important component of postoperative care in emergency laparotomy patients.

Background: Yoga has been increasingly recognized as a complementary lifestyle intervention with potential benefits on cardiovascular regulation. However, evidence evaluating short-term yoga practice on objective cardiovascular parameters remains limited. This study was undertaken to assess changes in resting heart rate and blood pressure following a structured short-term yoga training program. Material and Methods: A prospective interventional study was conducted among 136 apparently healthy adults aged 18–40 years. Baseline cardiovascular parameters, including resting heart rate, systolic blood pressure, and diastolic blood pressure, were recorded under standardized conditions. Participants then underwent a supervised yoga training program for six weeks, with sessions conducted five days per week. Post-intervention measurements were obtained using the same protocol. Pre- and post-intervention values were compared using paired t-tests, and results were expressed as mean ± standard deviation. Results: The mean age of participants was 27.4 ± 5.6 years, with a mean body mass index of 22.6 ± 2.8 kg/m². Resting heart rate decreased significantly from 76.8 ± 7.9 beats/min at baseline to 71.2 ± 6.8 beats/min after yoga training (p < 0.001). Systolic blood pressure showed a significant reduction from 118.6 ± 9.7 mmHg to 112.4 ± 8.6 mmHg (p < 0.001), while diastolic blood pressure declined from 76.9 ± 7.4 mmHg to 72.1 ± 6.5 mmHg (p < 0.001). The mean reductions were 5.6 beats/min for heart rate, 6.2 mmHg for systolic blood pressure, and 4.8 mmHg for diastolic blood pressure. Conclusion: Short-term yoga training produced significant improvements in resting cardiovascular parameters in healthy adults, suggesting its potential role as an effective non-pharmacological approach for cardiovascular health promotion.

Introduction: Tonsillectomy is a widely performed surgical procedure, often utilizing the “hot method”. A significant concern is secondary postoperative hemorrhage (bleeding after 24 hours, typically between days 5-10). Aims: This study compares the effectiveness of two topical haemostatic agents, Tincture of Benzoin (TB) and 3% Hydrogen Peroxide, in controlling this complication. Methods: This was an institution-based prospective analytical study conducted at Murshidabad Medical College and Hospital. Ninety eligible pediatric patients (up to 18 years of age) undergoing bilateral tonsillectomy for chronic tonsillitis (Paradise Criteria) were included. A paired design was used: TB was applied to the left tonsillar bed, and 3% hydrogen peroxide to the right tonsillar bed. Patients were followed for 10 days postoperatively to detect secondary hemorrhage. Data were analyzed using the McNemar’s Chi-square test. Results: A total of seven secondary hemorrhage events were recorded. All events occurred exclusively on the side treated with 3% Hydrogen Peroxide (Incidence: 7.8%). No secondary bleeding events (0.0%) were observed on the side treated with Tincture of Benzoin. The McNemar’s Chi-square test showed a statistically significant difference between the two groups: (Chi-square = 5.143, p < 0.05). Conclusion: Tincture of Benzoin is significantly superior to 3% Hydrogen Peroxide in preventing secondary postoperative hemorrhage after tonsillectomy. Its use should be considered for improved clinical protocols in managing this serious complication.

Background / Objective: Uremic encephalopathy (UE) is a reversible neurological complication of advanced renal failure caused by the accumulation of neurotoxic metabolites, electrolyte imbalance, and metabolic acidosis. Magnetic resonance imaging (MRI) plays a crucial role in identifying characteristic brain abnormalities and assessing reversibility. This study aimed to evaluate MRI brain findings in patients with uremic encephalopathy and correlate the imaging patterns with biochemical severity. Methods: This observational cross-sectional study included 35 clinically diagnosed patients with UE and significantly deranged renal function (urea >100 mg/dL, creatinine >5 mg/dL). Patients with alternative causes of encephalopathy or contraindications to MRI were excluded. MRI brain was performed using T1, T2, FLAIR, and diffusion-weighted sequences. Imaging findings were correlated with renal function tests and arterial blood gas parameters. Statistical significance was set at p < 0.05. Results: The mean age of patients was 50.86 ± 19.6 years, and chronic renal failure was present in 91.4% of cases. The most common neurological presentation was altered mental status (45.7%), followed by seizures (25.7%). MRI abnormalities included cortical atrophy (51.4%), white-matter involvement (42.8%), cortical/subcortical PRES-like hyperintensities (37.2%), and both lentiform fork sign (LFS) and bilateral basal ganglia lesions in 28.6% of cases. LFS and basal ganglia involvement were significantly associated with severe metabolic acidosis and low serum bicarbonate levels (p ≤ 0.01), while cortical atrophy was more frequent in chronic renal failure. Conclusion: MRI demonstrates characteristic, severity-dependent patterns in uremic encephalopathy. LFS and basal ganglia lesions indicate acute severe metabolic derangement, whereas cortical atrophy reflects chronic damage. Recommendation: Early MRI evaluation should be integrated into diagnostic and management protocols for UE to guide prognosis and support timely initiation of dialysis. Longitudinal follow-up studies are recommended to assess reversibility.

Background / Objective: Acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is associated not only with worsening respiratory function but also with systemic inflammatory and hypoxic effects that may impose cardiovascular strain. Myocardial stress during exacerbations can be detected using cardiac biomarkers such as Creatine Phosphokinase-MB (CPKMB) and Troponin I (Trop I). The objective of the present study was to assess the levels of CPKMB and Troponin I in patients presenting with AECOPD and to determine their association with disease severity, need for intensive care, and short-term in-hospital outcome. Methods: A prospective observational study was conducted on 100 patients diagnosed with AECOPD and admitted to a tertiary care hospital. Serum CPKMB and Troponin I levels were measured at admission. Clinical parameters including age, smoking history, GOLD stage, ICU requirement, and mortality were recorded. Statistical analysis was performed using Student’s t-test and ANOVA, with p < 0.05 considered significant. Results: Elevated CPKMB and Troponin I were detected in 38% and 33% of patients, respectively. Patients requiring ICU admission showed significantly higher mean CPKMB (8.07 ± 2.95 IU/L) and Troponin I (0.242 ± 0.101 ng/mL) compared to those treated in the ward (p < 0.001 and p = 0.003). In-hospital mortality occurred in 9% of cases. CPKMB levels were notably higher among non-survivors (9.88 ± 2.94 IU/L) than survivors (p < 0.001), whereas Troponin I did not significantly correlate with mortality (p = 0.869). Biomarker levels did not differ significantly across GOLD stages. Conclusion: CPKMB is a stronger prognostic indicator than Troponin I in AECOPD and correlates with severity and mortality. Recommendation: Incorporating routine CPKMB testing at admission can aid early risk stratification and guide ICU decision-making.

Background: There are many factors that cause electrolyte imbalance with acute stroke, like ischemic or hemorrhagic. The prognosis can be studied by evaluating the serum electrolyte levels. Method: 40 (forty) patients having strokes (ischemic/hemorrhagic) were studied. Biochemical tests included fasting blood glucose and lipid profiles; serum electrolytes were studied in both ischemic and hemorrhagic strokes and compared with normal (controlled) groups, and significant results were noted. Results: Ischemic strokes were higher in the age group of 46-55 age group followed by the 35-45 age group, and least in the age group between 76-80 age group, hemorrhagic strokes were highest in 5 (23.8%) in the 46-55 age group and in the 65-75 age group. Conclusion: Elevated serum sodium is observed in both sexes. Early detection and correction of this imbalance can prevent the morbidity and mortality.

Background: Type 2 diabetes mellitus (T2DM) has been associated with microvascular and neuropathic complications that may extend to the cochlea, resulting in hearing loss¹. This study aimed to evaluate the correlation between HbA1c levels and the degree of hearing loss among patients with T2DM. Methods: A cross-sectional study of 100 patients with T2DM was conducted. HbA1c levels were measured and pure tone audiometry (PTA) was performed. Correlation and multiple linear regression analyses were used to assess the association between HbA1c and PTA. Results: The mean HbA1c was 7.84 ± 1.36%, and mean PTA was 64.5 ± 10.6 dB HL. HbA1c showed a significant positive correlation with PTA (r = 0.38, p < 0.001). Each 1% rise in HbA1c corresponded to an average 2.7 dB worsening in hearing threshold after adjusting for confounders (β = 2.66, p = 0.000). The model explained 29% of the variance (R² = 0.29). Conclusion: Poor glycemic control is significantly correlated with worse sensorineural hearing thresholds in patients with T2DM. Routine audiometric screening should be considered for patients with elevated HbA1c levels.

Background: Infertility is a significant global health issue affecting approximately 8–10% of couples. A successful pregnancy requires physiological equilibrium and a receptive endometrium. Glycogen in the endometrial glands provides essential nutrition for the early conceptus; its depletion (glycopenia) may lead to implantation failure. Objective: To study various endometrial histomorphological patterns in primary and secondary infertility and assess endometrial glycogen content to determine its role in infertility. Methods: This study analyzed 150 cases of infertility. Endometrial biopsies were subjected to histopathological examination and Periodic Acid-Schiff (PAS) staining to grade glycogen content (Grade 0 to 4+) using the Arzac and Blanchet method. Results: Primary infertility accounted for 59.3% of cases. The most common histomorphological patterns were ovulatory (36.7%) and anovulatory (34.7%) endometrium. Glycogen analysis revealed that 34% of ovulatory endometrium exhibited glycopenia. There was a statistically significant association between microscopic endometrial patterns and glycogen scoring (p=0.01), though no significant difference in glycogen content was found between primary and secondary infertility groups. Conclusion: Endometrial biopsy combined with glycogen estimation is a valuable diagnostic tool. Glycopenia is a demonstrable cause of infertility even in ovulatory cycles, highlighting the necessity of evaluating glycogen stores in infertile women.

Background: Chronic non-venereal genital dermatoses represent a significant yet often underrecognized group of dermatological conditions that profoundly affect patients’ psychosocial well-being and intimate relationships. Despite their prevalence, comprehensive assessment of quality of life (QoL) implications remains limited in clinical literature. Methods: A cross-sectional observational study was conducted among 148 adult patients diagnosed with chronic non-venereal genital dermatoses attending the dermatology outpatient department over 18 months. The Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), and disease-specific sexual function questionnaires were administered. Statistical analysis included descriptive statistics, correlation analysis, and multiple regression modeling. Results: The mean age was 42.6 ± 12.8 years, with females comprising 56.1%. Lichen sclerosus (29.7%) was the most common diagnosis. The mean DLQI score was 12.4 ± 5.7, indicating moderate-to-severe QoL impairment. Symptoms/feelings (3.2 ± 1.4) and sexual difficulties (2.8 ± 1.2) domains showed highest impairment. Significant correlations existed between DLQI and anxiety (r = 0.58, p < 0.001), depression (r = 0.52, p < 0.001), and disease duration (r = 0.34, p < 0.001). Multiple regression revealed disease severity (β = 0.42, p < 0.001), female gender (β = 0.28, p = 0.003), and anxiety scores (β = 0.31, p < 0.001) as independent predictors of QoL impairment. Conclusion: Chronic non-venereal genital dermatoses substantially impair quality of life, with sexual function and psychological well-being being particularly affected. Comprehensive management strategies incorporating psychological support are essential.

Introduction: Central nervous system tumors account for 10% of all neoplasms, with glial tumors being the most prevalent. Intraoperative frozen section (FS) is a routine practice used to provide primary diagnoses that guide surgical approaches and ensure specimen adequacy. Aims and Objectives: This study investigated the incidence and histopathological spectrum of glial tumors and evaluated the diagnostic accuracy of FS compared to the gold standard of routine histopathology (HPE). Materials and Methods: 100 cases clinically and radiologically diagnosed as glial neoplasms at Civil Hospital, Ahmedabad, were evaluated. Squash smears and FS were prepared intraoperatively and compared with permanent paraffin sections stained with H&E. Concordance was categorized as complete, partial, or discordant. Results: Astrocytomas were the most frequent tumors (71/100), with Glioblastoma Multiforme (GBM) (25) and fibrillary astrocytoma (22) being the most common variants. The mean age was 49.6 years with a male-to-female ratio of 1.38:1. The parietal lobe was the most common site (65%). Results showed 67 complete and 17 partial concordances, with a 16% discordance rate. GBM showed the highest concordance. Discrepancies were mainly due to freezing artifacts, necrotic tissue, and inadequate sampling. Conclusion: Astrocytoma is the most common glial tumor, with WHO grades typically increasing with age. FS is an accurate intraoperative guide but remains subject to pitfalls like freezing artifacts and multifocality.

Background: Laparoscopic cholecystectomy induces significant hemodynamic alterations due to pneumoperitoneum, CO₂ retention, and patient positioning. Dexmedetomidine, a highly selective α₂-adrenergic agonist, offers sedation, analgesia, and sympatholysis with reduced anaesthetic requirements. However, optimal dosing for maximum stability with minimal adverse effects remains unclear. This study compares two infusion doses following a standard loading dose to evaluate hemodynamic attenuation, anaesthetic requirements, and recovery characteristics. Methods: A prospective, single-blinded, randomized comparative study was conducted on 60 ASA I–II patients aged 18–60 years undergoing elective laparoscopic cholecystectomy at SCB Medical College, Cuttack (2020–2022). Patients were allocated into two groups (n=30 each):
Group A: Dexmedetomidine 1 µg/kg bolus + 0.2 µg/kg/hr infusion.
Group B: Dexmedetomidine 1 µg/kg bolus + 0.6 µg/kg/hr infusion.
Standardized general anaesthesia protocol was followed. Hemodynamic variables (HR, SBP, DBP, MAP, SpO₂, EtCO₂) were recorded at induction, intubation, peritoneal insufflation, every 5 min for 30 min, then every 10 min. Secondary outcomes included propofol supplementation, fluid boluses, sedation score, and recovery time. Statistical analysis was performed using SPSS v26, with p<0.05 considered significant. Results: Both groups were demographically comparable. Group B demonstrated significantly better attenuation of tachycardic response during intubation and 1-minute post-intubation (p<0.05). MAP and SBP fluctuations were lower in Group B, indicating superior hemodynamic stability. Propofol supplementation for hypertensive/tachycardic episodes was lower in Group B. However, Group B showed slightly prolonged recovery time and higher sedation scores, though within an acceptable clinical range. No severe bradycardia, hypoxia, or adverse events occurred in either group. Conclusion: Dexmedetomidine at 0.6 µg/kg/hr infusion following 1 µg/kg bolus provides better hemodynamic stability and reduces anaesthetic requirements compared to 0.2 µg/kg/hr, without major adverse effects. Mildly delayed recovery remains the trade-off but is clinically acceptable. Thus, the higher infusion dose is preferable for laparoscopic cholecystectomy requiring stable hemodynamics.

Background: WHO define stroke as rapidly developing clinical symptoms and/or signs of focal (or global) disturbance of cerebral functions, with symptoms lasting for more than 24 hours or leading to death with no apparent cause other than that of vascular origin. Two major mechanisms resulting into stroke are ischemia and haemorrhage. Based on these two mechanisms, stroke is classified into ischemic and haemorrhagic stroke. Most ischemic strokes in diabetic patients are due to occlusion of small penetrating arteries. The occlusions cause small infarcts within the white matter of brain. Diabetic patients with retinopathy and autonomic neuropathy appear to be a group at particularly high risk for ischemic stroke. Diabetes potentiates stroke by favouring thrombosis by increasing concentration in blood of prothrombotic factors like fibrinogen and von willebrand factor. It also increases platelet adhesiveness. The present study was undertaken in a prospective manner to comparatively evaluate the clinical profile and outcome of patients with stroke in diabetic and non-diabetic patients. Material & Methods: Present study is a prospective observational case control study was conducted on 200 patients with stroke (out of which 100 patients were diabetic or found to have diabetes and 100 were non-diabetic stroke patients) admitted to Emergency medicine department, of our hospital, b.j medical college and civil hospital Ahmedabad. In all admitted patients primary and secondary surveys were done, immediate resuscitation was done. A brief history, clinical examination and radiological investigation was done. Patients were treated accordingly and followed up until discharge or death. Results: 200 cases of stroke (100 diabetic and 100 non diabetic), who fulfilled the criteria as mentioned in study. The mean age in diabetic stroke patients was 55.9 year and in non- diabetic stroke patients was 58.5 year. Maximum patients were in the age group from 55-64 year (14%) In diabetic stroke whereas 65-74 year (15.5%) in non- diabetic stroke. Out of 100 diabetic stroke patients 75 (37.5%) were males and 25 (12.5%) were females where as in non-Diabetic stroke patients 67 (33.5%) were males and 33 (16.5%) were females. Percentage of male population in both the groups were higher. Conclusion: The clinical profile of stroke is found different in diabetics and non-diabetics patients. Furthermore, outcome is found superior in the nondiabetic vis-a-vis diabetic patients admitted in B.J Medical College and civil hospital, Ahmedabad and difference is statistically significant. Early diagnosis and treatment including lifestyle modification and prevention of diabetes may reduce the development of stroke and its complications. It presents a serious challenge to health care

Background: Acute cholecystitis exhibits varying severity, necessitating early identification of patients at risk for complications. Material and Methods: Plasma CRP and ESR levels were evaluated in patients with acute cholecystitis and correlated with disease severity grading. Results: Increasing levels of CRP and ESR were significantly associated with higher grades of acute cholecystitis, indicating greater inflammatory burden and disease severity. Conclusion: CRP and ESR are effective, accessible biomarkers for predicting the severity of acute cholecystitis and can assist in early clinical decision-making.

Background: Ureteric colic caused by urolithiasis is a prevalent urological emergency. While Medical Expulsive Therapy (MET) using alpha-blockers like tamsulosin is the standard of care for distal ureteric stones, the addition of corticosteroids to reduce ureteral edema remains a subject of clinical interest. Methods: A prospective, randomized controlled trial was conducted on 120 patients with solitary distal ureteric stones sized 5–10 mm. Patients were randomized into two groups: Group A received Tamsulosin (0.4 mg) daily, while Group B received Tamsulosin (0.4 mg) plus Deflazacort (30 mg) daily for a maximum of 28 days. The primary endpoint was the Stone Expulsion Rate (SER). Secondary endpoints included Stone Expulsion Time (SET), analgesic requirements, and adverse events. Results: The Stone Expulsion Rate was significantly higher in Group B (88.3%) compared to Group A (68.3%) ( ). The mean Stone Expulsion Time was significantly shorter in the combination therapy group (  days) versus the monotherapy group (  days) ( ). Furthermore, patients in Group B reported significantly fewer episodes of colic requiring rescue analgesia ( ). No severe adverse events were recorded, though mild gastrointestinal upset was slightly higher in Group B. Conclusion: The combination of Tamsulosin and Deflazacort is superior to Tamsulosin monotherapy in facilitating the passage of distal ureteric calculi. It significantly reduces expulsion time and analgesic consumption with a favorable safety profile.

Background: Chronic oral mucosal lesions represent a diverse group of pathological conditions characterized by persistent inflammatory responses. Understanding the specific patterns of inflammatory cell infiltration is crucial for accurate diagnosis, prognostication, and treatment planning. This study aimed to compare the histopathological patterns of inflammatory cell infiltrates across different chronic oral mucosal lesions. Methods: This cross-sectional analytical study examined 180 biopsy specimens from patients diagnosed with oral lichen planus (OLP, n=60), oral leukoplakia (OL, n=45), chronic hyperplastic candidiasis (CHC, n=35), and oral submucous fibrosis (OSMF, n=40). Histopathological analysis was performed using hematoxylin and eosin staining, with immunohistochemical markers (CD3, CD20, CD68, and mast cell tryptase) employed for inflammatory cell characterization. Quantitative analysis of inflammatory infiltrate density, distribution patterns, and cellular composition was conducted. Results: Oral lichen planus demonstrated significantly higher lymphocytic infiltration (78.4 ± 12.3 cells/HPF) compared to other lesions (p<0.001). Band-like subepithelial infiltration was predominant in OLP (91.7%), while diffuse patterns characterized OSMF (72.5%). CD3+ T-lymphocytes constituted the majority of infiltrates in OLP (68.2 ± 8.7%), whereas CD68+ macrophages were significantly elevated in CHC (42.3 ± 9.1%, p=0.003). Mast cell density was highest in OSMF (18.6 ± 4.2 cells/HPF) compared to other groups (p<0.001). Conclusion: Distinct inflammatory cell infiltrate patterns exist among chronic oral mucosal lesions, providing valuable diagnostic markers and insights into disease pathogenesis. These findings support the implementation of immunohistochemical profiling as an adjunct diagnostic tool.

Introduction: Impaired exercise tolerance, calculated by peak oxygen consumption (V̇O2 max), is predictive of mortality and the necessity for cardiac transplantation in patients with chronic heart failure (HF). The relation between exercise capacity and measurements of left ventricle performance at rest in healthy subjects is little known. The assessment of exercise capacity by treadmill and left ventricle systolic functions at rest by echocardiography can correlate relation between the presence of left ventricle performance and maximal exercise capacity in normal healthy subjects. Objectives: To correlate exercise capacity with the left ventricle performance in normal healthy subjects. Material and Methods: The Study was conducted on 100 normal healthy subjects, necessary information as per my study were collected from the hospital record of the study participants undergoing routine measurements of left ventricular systolic function by 2D echocardiography and treadmill test by bruce protocol. Results: Data were entered in an excel sheet and analysed using the SPSS (Statistical Package for the Social Sciences). Karl Pearson correlation analysis showed that left ventricle performance in our group do not correlate with exercise capacity. There was no correlation between exercise capacity and end systolic volume index (r=-0.171, p<0.089), between exercise capacity and ejection fraction (r=0.069, p<0.495), between exercise capacity and fractional shortening (r=0.074, p<0.467), between exercise capacity and stroke volume index (r=-0.092, p<0.o.361), and cardiac index (r=-0.072, p<0.475) also showed no significant association with exercise capacity. Conclusions: Correlation analysis showed that left ventricle performance in our group do not correlate with exercise capacity in normal healthy subjects.

Background: Burn injuries are associated with high acute morbidity and mortality, yet long-term survival outcomes among burn survivors remain under-reported. Persistent physiological, psychological, and systemic complications may contribute to increased delayed mortality. Objectives: To evaluate the rate of long-term mortality among burn survivors and identify clinical factors associated with mortality following discharge. Materials and Methods: This retrospective study was conducted at Zoram Medical College from 2022 to 2025. Medical records of 100 burn survivors were reviewed. Data collected included demographics, burn characteristics, comorbidities, hospital course, and follow-up survival status. Long-term mortality and factors influencing it were analyzed. Results: Among the 100 burn survivors, 21% experienced long-term mortality during the follow-up period. Higher total body surface area (TBSA) involvement, presence of inhalational injury, comorbidities, and prolonged hospital stay were significantly associated with increased mortality. Flame burns were the most common etiology, and adults aged 18–40 years comprised the largest proportion of survivors. Conclusion: Burn survivors exhibit a substantial risk of long-term mortality even after successful acute management. Severe burns, inhalational injury, and comorbid conditions are key predictors of delayed death. These findings emphasize the need for structured long-term follow-up, early identification of high-risk patients, and comprehensive post-discharge care to improve survival outcomes.

Background: Epistaxis is a common otorhinolaryngological emergency with multifactorial etiology. Understanding the demographic distribution and underlying causes is essential for effective management and prevention of recurrence. This study aimed to evaluate the etiological factors of epistaxis and their association with age. Material and Methods: A hospital-based cross-sectional study was conducted in 150 patients presenting with epistaxis. Demographic data, medical history, and clinical findings were recorded. Etiological classification was performed based on local factors, systemic conditions, and idiopathic causes. Baseline hematological investigations, coagulation profile, and additional tests as indicated were performed. Statistical analysis was done using chi-square or Fisher’s exact test to assess associations between age and etiology, with p < 0.05 considered significant. Results: Among 150 patients, the most affected age group was 21–40 years (36.7%), and males predominated (63.3%). History of hypertension was present in 26.7% and trauma in 20.0%; 40.0% had recurrent episodes. Local causes were identified in 50.0% of patients, with trauma (20.0%) and septal deviation (13.3%) being most common. Systemic causes accounted for 33.3%, mainly hypertension (26.7%). Idiopathic cases were seen in 16.7%. Age-specific trends showed local causes predominating in patients <40 years, systemic causes in 41–60 years, and idiopathic epistaxis in those >60 years. A significant association between age and etiology was observed (p = 0.023). Conclusion: Etiology of epistaxis varies with age. Local factors are predominant in younger patients, systemic conditions in middle-aged adults, and idiopathic causes in the elderly. Thorough clinical evaluation and age-tailored management are essential to prevent recurrence.

Pregnancy and the postpartum state involve extensive physiological adaptations that can increase vulnerability to severe cardiopulmonary decompensation and add complexity to critical care management. In such situations, extracorporeal membrane oxygenation (ECMO) has evolved as an essential life-saving modality for women with refractory respiratory or cardiac failure. Although pregnancy was previously viewed as a relative contraindication to ECMO, current consensus from major professional societies supports its use when maternal survival is at risk. This review aims to consolidate available evidence and guideline recommendations on ECMO in pregnant and postpartum patients, focusing on relevant physiological changes, clinical indications, recommended practice standards, anaesthetic considerations, maternal and foetal outcomes, potential complications, and approaches to weaning and decannulation.

Introduction: Lumbar degenerative disease remains a significant cause of disability requiring surgical intervention. Transforaminal lumbar interbody fusion (TLIF) and trans-Kambin lumbar interbody fusion (KLIF) represent two distinct approaches for achieving spinal fusion, each with unique advantages and limitations. Materials & Methods: This prospective comparative study enrolled 60 patients (30 TLIF, 30 KLIF) with single-level degenerative lumbar disease at a tertiary care center. Perioperative parameters, clinical outcomes (VAS, ODI scores), radiological parameters (disc height, fusion rates), and complications were evaluated over 12 months. Results: KLIF demonstrated significantly reduced blood loss (78.3±35.1 ml vs 210.6±70.4 ml, p<0.001) and shorter hospitalization (2.9±0.9 days vs 4.8±1.6 days, p<0.001). Both techniques showed comparable VAS and ODI improvements, though KLIF exhibited superior early postoperative back pain relief. Fusion rates were similar (93.3% vs 90.0%, p=0.56), with lower overall complications in KLIF (10.0% vs 23.3%, p=0.11). Conclusion: KLIF offers advantages of reduced surgical trauma, faster recovery, and comparable fusion outcomes to TLIF, representing a safe minimally invasive alternative for selected cases of degenerative lumbar disease.

Introduction: PCOS is a prevalent endocrine disorder linked to infertility and metabolic risk, yet its diagnosis is often hindered by symptoms that overlap with normal puberty. Consequently, serum AMH is being investigated as a more reliable, objective biomarker than traditional ultrasound or LH/FSH ratios for early identification and intervention. Objectives: This study determines levels of biochemical and hormonal markers (FBG, lipids, AMH, Prolactin and Testosterone) in symptomatic women and to assess their association with each other. Methodology: An observational, descriptive cross-sectional study conducted over 3 months in the Obstetrics and Gynaecology OPD of a medical college in Kolkata from July 2025 to November 2025. The study included females diagnosed with polycystic ovary syndrome (PCOS), obesity and infertility. Eligible patients were given pre-structured and pre-formatted questionnaires. Biochemical parameters assessed were-AMH, Testosterone, Prolactin, Fasting Blood Glucose and Lipid profile and their correlation with each other was checked. Results: The AMH values were significantly positively correlated with Testosterone (r= 0.967, p<0.001) and Prolactin (r= 0.965, p<0.001) and Testosterone values were significantly positively correlated with Prolactin (r= 0.969, p<0.001). Conclusion: The study found AMH, Testosterone and Prolactin are strongly interrelated but are not linked to metabolic parameters, suggesting hormonal changes may occur before metabolic alterations.

Background: Total Knee Replacement (TKR) is a commonly performed procedure for advanced knee arthritis. Choice of regional anaesthesia may influence postoperative pain control and early rehabilitation, which are critical determinants of functional outcome. Objective: To compare spinal and epidural anaesthesia in patients undergoing unilateral and bilateral TKR with respect to early postoperative rehabilitation. Materials and Methods: This retrospective observational study was conducted at Jawaharlal Nehru (JLN) Hospital, Nagaur, from January 2021 to June 2025. A total of 180 unilateral TKRs and 30 bilateral TKRs were included. Data regarding patient demographics, type of anaesthesia (spinal or epidural), and postoperative rehabilitation were analysed. Results: Among 180 unilateral TKRs, 90 males and 60 females received spinal anaesthesia (n = 131), while 19 received epidural anaesthesia. Among 30 bilateral TKRs, 7 patients received spinal anaesthesia and 23 received epidural anaesthesia. Patients who received epidural anaesthesia demonstrated earlier mobilisation, better pain control, and smoother rehabilitation compared to those who received spinal anaesthesia, especially in bilateral TKR cases. Conclusion: Epidural anaesthesia was associated with improved early rehabilitation compared to spinal anaesthesia in both unilateral and bilateral TKR, with a more pronounced benefit in bilateral procedures. Epidural anaesthesia may be preferred where early mobilisation is a priority.