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