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.

Introduction: Spinal tuberculosis (Pott’s spine) is a common form of extrapulmonary tuberculosis in developing countries and is associated with significant morbidity due to pain, deformity, and neurological deficits. Although the Directly Observed Treatment Short Course (DOTS) regimen is widely implemented under national tuberculosis control programs, limited data are available regarding its effectiveness in the management of spinal tuberculosis. Objectives: To evaluate the effectiveness of the DOTS regimen in spinal tuberculosis with respect to clinical improvement, neurological recovery, laboratory and radiological healing, and the occurrence of adverse drug reactions. Methods: A prospective observational study is conducted on 34 consecutive patients diagnosed with spinal tuberculosis and treated with Category I DOTS regimen in the Department of Orthopaedics, V.M.M.C. and Safdarjung Hospital, New Delhi, from October 2010 to February 2012. Four patients are lost to follow-up, and 30 patients are included in the final analysis. Diagnosis is based on clinical features, laboratory parameters, and radiological findings on X-ray and MRI. Patients are followed up periodically to assess symptom relief, neurological status, ESR levels, radiological resolution, and drug-related adverse effects. Results: The majority of patients are in the 21–40 years age group (47%), with female predominance (60%). Thoracic spine involvement is the most common. All patients present with back pain, and 90% have constitutional symptoms. Motor weakness is observed in 70% of cases. Paradiscal type is the commonest form of spinal tuberculosis (90%). At 6 months of DOTS therapy, 90% of patients show complete resolution of back pain, with gradual normalization of ESR by the fifth month. MRI reveals complete or significant resolution of bone edema and abscesses in most patients. Neurological recovery is better in early stages of paraplegia, while advanced stages show partial recovery. Adverse drug reactions are mild and manageable, and no patient demonstrates drug resistance. A small proportion of patients require extension of DOTS therapy and surgical intervention. Conclusion: DOTS regimen is an effective and safe treatment modality for spinal tuberculosis, resulting in favorable clinical, laboratory, radiological, and neurological outcomes in the majority of patients. Early diagnosis and strict compliance with therapy are crucial for optimal recovery, while advanced disease may require prolonged treatment and surgical management.

Background: Tuberculosis (TB) remains a major public health challenge in low- and middle-income countries, with India alone accounting for nearly 27% of the global burden. Although chest radiography is a frontline screening tool, many resource-limited areas lack trained radiologists. While AI-based diagnostic tools show promise, their adoption is limited by cost, infrastructure, and technical barriers. Objective: This study evaluated the diagnostic accuracy and feasibility of a no-code AI model built using Google Teachable Machine (GTM) to classify chest X-rays (CXRs) as TB-positive or normal in resource-limited settings. Methods: A balanced open-source dataset of 1,400 CXRs (700 TB-positive, 700 normal) was used. GTM, leveraging transfer learning (MobileNet), enabled model training without coding or specialized hardware. The dataset was split 85:15 for training and testing. Evaluation metrics included accuracy, sensitivity, specificity, precision, F1 score, and training curve analysis. Results: The GTM model achieved an accuracy of 98.57% (95% CI 95.9–99.5), sensitivity of 99.05% (95% CI 94.8–99.8), and specificity of 98.10% (95% CI 93.3–99.5) Only three misclassifications occurred in the 210 test images. The model was trained in under 10 minutes on a consumer laptop using browser-based Google Teachable Machine. Conclusion: The no-code GTM model while being accessible, fast, and deployable in rural or low-resource settings, demonstrated diagnostic performance within the range of previously reported performance for deep learning and commercial CAD systems; external validation is needed to confirm these findings. Its offline capability and ease of use make it a promising first-line screening tool for TB control in India and other high-burden regions. Further research should explore external validation, integration with explainability tools, and real-world implementation via PHCs and mobile units.

Background: Shock is a pathophysiologic state characterized by significant systemic reduction in tissue perfusion resulting in decreased oxygen delivery. Accurate estimation of volume status in patients with shock is important to estimate volume repletion and monitor adverse consequences of volume overload. Aims and Objectives: For the objective measurement of intravascular volume status in children, obtaining and evaluating the data on IVC diameter by ultrasonography. Materials and Methods: Hospital based prospective, observational study. Patients between 1 month to 18 years admitted to pediatric emergency, PICU and emergency department of Nalanda Medical College and Hospital with shock and age matched euvolemic controls admitted in paediatric ward. Maximum sagittal IVC diameter was measured in the two groups and compared. Results: Total of 60 pairs of cases and controls were enrolled. Mean sagittal IVC diameter in shock group was 0.99±0.447cms as compared to controls which was 1.46±0.523cms (p-value<0.001). Conclusion: The maximum sagittal IVC diameter measured by bedside ultrasound is lower in children with shock as compared to euvolemic controls.

Background: Early and reliable prediction of severe dengue in children remains a major challenge, particularly in endemic regions. Although WHO 2009 warning signs include certain laboratory and radiological features, their predictive value varies widely across populations. This study evaluates hematological, biochemical, coagulation, and ultrasonographic biomarkers as early predictors of severe dengue among pediatric patients. Methods: This retrospective observational study analyzed 100 serologically confirmed pediatric dengue cases admitted within four days of fever onset to a tertiary pediatriccenter in Karnataka. Laboratory tests—including hematocrit (PCV), WBC counts, platelet counts, liver enzymes (AST, ALT), serum albumin, coagulation profile (PT, APTT, INR)—were performed at admission. Ultrasound examination assessed gallbladder wall edema, ascites, hepatomegaly, and pleural effusion. Receiver operating characteristic (ROC) curves, optimal cut-off points, sensitivity, specificity, and AUCs were computed to identify biomarker performance. Results: Twenty-three children (23%) progressed to severe dengue. The strongest predictors were raised PCV (AUC 0.710, p = 0.001), INR elevation (AUC 0.719, p = 0.001), prolonged APTT (AUC 0.629, p = 0.045), and gallbladder wall edema on ultrasound (AUC 0.508, p = 0.025). Platelet counts (p = 0.074) and SGOT/SGPT values were not statistically significant predictors in this early-presenting cohort. Gallbladder wall edema was present in 16% and showed significant association with severe dengue. Conclusion: Key early biomarkers—including elevated PCV, deranged coagulation parameters, and gallbladder wall thickening—are strong predictors of severe dengue in children. These findings support biomarker-based risk stratification to guide monitoring intensity and early intervention.

Introduction: Partograph is a graphic composite representation of the events of labour. It allows critical delineation and appreciation of normal and abnormal parturitional state and pinpoints the patients who could benefit from intervention. It is appropriate for all labor. Aims: To evaluate role of partograph in monitoring of labour. Materials and Method: The present study was conducted from March 2022 to August 2023 for a period of 18 months in the department of Obstetrics and Gynecology at Chittaranjan seva sadan hospital. Total 3000 patients were included in this study. Result: Chi-square test showed that there was significant association between maternal complications and the patients of the two groups (p<0.0001). Maternal complications were higher among the patients with abnormal partograph (11.7%) as compared to normal partograph (4.6%) but it was not significant (Z=1.07; p=0.07). Chi-square test showed that there was no significant association between period of gestation and the patients of the two groups (p<0.001). Postdated delivery thus the patients of the two groups were matched for their period of gestation. Post-dated deliveries were significantly higher among the patients with abnormal partograph (61.2%) as compared to normal partograph (16.3%) (Z=6.53; p<0.0001). Conclusion: The partograph is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary. It is effective in preventing prolonged labour, obstructed labour, reducing operative intervention and improving maternal outcome (PPH/need for BT/Trauma/puerperal sepsis) & neonatal outcome (APGAR score and NICU admission). In this study, mean duration of active phase of labour increased as the partographic curve fell to the right of alert line (abnormal partograph). Women with abnormal partograph required more augmentation of labor due to prolonged duration of active phase and of labor & abnormal labor like protracted dilatation, arrest of dilatation and arrest of descent.

Introduction: Adequate postoperative analgesia in children is essential for ensuring their comfort, reducing anxiety and promoting optimal recovery as unmanaged pain has long term consequences on their physical and emotional well-being, regional anaesthesia with adjuvants have been tried for the same. Aim: This study aimed to compare the effect of caudal versus intravenous Dexmedetomidine as adjuvants to Ropivacaine caudal epidural block for postoperative analgesia in pediatric infraumbilical surgery under general anaesthesia. Material and Methods: After taking permission from institutional ethic committee and research review board this Randomized, Double blind interventional study was conducted on 60 pediatric patients of either sex, belonging to ASA grade I and II, aged 1 to 6 years, weighing 10 kg to 18 kg posted for infraumbilical surgeries under general anaesthesia. Patients were randomly divided in two groups of 30 each. Group A-Patients received caudal inj.0.2% ropivacaine 1ml/kg+inj. Dexmedetomidine 1mcg/kg in one ml saline and IV normal saline 10ml infusion over 10 minutes. Group B-Patients received caudal 0.2%ropivacaine 1ml/kg+1 ml saline and IV inj. Dexmedetomidine 1mcg/kg in 10 ml saline infusion over 10 minutes. Time to first rescue analgesia, total analgesic consumption in the first 24 hrs. and postoperative sedation scores were recorded. Haemodynamic parameters (HR, SBP, DBP, MBP) and Spo2 and side effects noted. Results: The mean time to first rescue analgesia in group A was 887.39+/-228.74 minutes in group A (caudal dexmedetomidine) as compared to 617.61+/-96.54 minutes in Group B (I.V. Dexmedetomidine) The difference in duration of postoperative analgesia was statistically significant (p<0.001) with 95% CI [179.0438, 360.5162]. The median of total frequency of rescue analgesia was one in group A as compared to two in group B  with p=0.002 and 95% CI [0.3052, 0.8348]. Sedation scores were comparable in both the groups (p value> 0.05). Conclusion: Caudal dexmedetomidine as an adjuvant to caudal ropivacaine provides longer postoperative analgesia and reduces rescue analgesic requirements compared to intravenous dexmedetomidine in pediatric patients.

Background: Indoor air pollution represents a significant environmental health concern, particularly for children with asthma who spend considerable time in enclosed environments. Understanding the relationship between indoor pollutant exposure and asthma outcomes is essential for developing effective prevention strategies. Methods: A prospective observational study was conducted among 248 children aged 6-14 years with physician-diagnosed asthma. Indoor air quality measurements including particulate matter (PM2.5), nitrogen dioxide (NO2), and volatile organic compounds (VOCs) were obtained from participants’ homes using standardized monitoring equipment. Asthma control was assessed using the Childhood Asthma Control Test (C-ACT), and exacerbation frequency was documented over a 12-month follow-up period. Spirometry was performed to evaluate pulmonary function. Results: Children exposed to high indoor PM2.5 levels (>35 μg/m³) demonstrated significantly poorer asthma control (C-ACT score: 16.2 ± 4.1 vs. 21.8 ± 3.6, p<0.001) compared to those with low exposure. The mean annual exacerbation frequency was 3.8 ± 1.9 in the high-exposure group versus 1.4 ± 1.2 in the low-exposure group (p<0.001). Elevated NO2 concentrations were associated with reduced FEV1/FVC ratio (78.3 ± 8.2% vs. 85.7 ± 6.4%, p<0.001). Multiple regression analysis revealed that PM2.5 exposure independently predicted exacerbation risk (OR: 2.84, 95% CI: 1.92-4.21, p<0.001). Conclusion: Indoor air pollution exposure significantly compromises asthma control and increases exacerbation frequency in school-aged children, emphasizing the critical need for environmental interventions in residential settings.

Background: Neonatal infections remain a significant cause of morbidity and mortality in newborns worldwide. Understanding the spectrum of causative pathogens and their antimicrobial sensitivity patterns is essential for guiding empirical antibiotic therapy and improving clinical outcomes. Methods: A prospective observational study was conducted among 412 neonates with clinically suspected infections admitted to the neonatal intensive care unit over an 18-month period. Blood, cerebrospinal fluid, urine, and surface swab cultures were obtained, and antimicrobial sensitivity testing was performed using standardized disc diffusion methods. Clinical outcomes were documented and analyzed. Results: Culture-positive infections were confirmed in 168 neonates (40.8%). Early-onset sepsis accounted for 38.7% of cases, while late-onset sepsis comprised 61.3%. Gram-negative organisms predominated (58.9%), with Klebsiella pneumoniae (24.4%) and Escherichia coli (18.5%) being most prevalent. Gram-positive organisms accounted for 35.1%, predominantly Staphylococcus aureus (15.5%) and Coagulans-negative staphylococci (12.5%). High antimicrobial resistance was observed, with 67.4% of Gram-negative isolates demonstrating extended-spectrum beta-lactamase production. Sensitivity to meropenem (92.3%), amikacin (78.6%), and piperacillin-tazobactam (71.2%) remained high among Gram-negative organisms. Mortality rate was 14.3% among culture-positive neonates, significantly higher than culture-negative cases (5.7%, p<0.001). Conclusion: Gram-negative organisms, particularly Klebsiella pneumoniae, dominate the neonatal infection spectrum with concerning resistance patterns. These findings necessitate regular surveillance and antimicrobial stewardship programs to optimize empirical therapy and combat emerging resistance.

Background: Renal tumors with spindle cell morphology pose significant diagnostic challenges due to overlapping histopathological features among diverse entities. Primary Renal Synovial Sarcoma (RSS) is an exceptionally rare malignancy, whereas Renal Cell Carcinoma with Sarcomatoid Differentiation (sRCC) represents an aggressive dedifferentiated phenotype of RCC with grave prognosis. Accurate distinction between these entities is critical, as their management and outcomes differ markedly. Methods: We report a case series of two diagnostically challenging renal tumors encountered at a tertiary care centre in Rajasthan. Detailed clinicoradiological correlation, histomorphological examination, and an extensive immunohistochemical (IHC) panel were employed to arrive at the final diagnoses. Results: The first case involved a 24-year-old female with a radiologically benign-appearing renal cyst, which on histopathology revealed a malignant spindle cell neoplasm. Lack of renal epithelial and myogenic markers, along with strong nuclear positivity for TLE, supported a diagnosis of Primary Renal Synovial Sarcoma. The second case was a 65-year-old female with a renal mass showing biphasic morphology comprising clear cell carcinoma and high-grade sarcomatoid areas. IHC positivity for PAX8 and Vimentin confirmed Renal Cell Carcinoma with Sarcomatoid Differentiation. Both cases underscored the limitations of morphology alone and the indispensable role of ancillary testing. Conclusion: Rare renal tumors with spindle cell morphology are important diagnostic “surprises” in renal pathology. Differentiation between primary renal sarcomas and sarcomatoid dedifferentiation in RCC cannot be reliably achieved on routine H&E sections alone. A systematic approach incorporating adequate sampling and judicious use of immunohistochemical markers such as TLE and PAX8 is essential for accurate diagnosis, prognostication, and appropriate therapeutic decision-making.

Background: Acanthosis nigricans (AN) is a cutaneous marker frequently associated with insulin resistance (IR). The homeostasis model assessment of insulin resistance (HOMA-IR) is widely used to assess IR. Its association with treatment outcomes in AN is underexplored. Objectives: To evaluate the relationship between baseline HOMA-IR and treatment response in AN, and to compare the efficacy of oral myo-inositol plus topical lactic acid (MYO+LA) with oral alpha-lipoic acid plus topical lactic acid (ALA+LA). Methods: A hospital-based comparative study was conducted at a tertiary dermatology outpatient department between July 2022 and December 2023. Seventy-two patients with AN were alternately allocated to MYO+LA (n=36) or ALA+LA (n=36). Patients were followed for six months. Primary outcome was change in AN grade; secondary measures included HOMA-IR and correlation with clinical improvement. Statistical analysis was performed with ANOVA and correlation tests. Results: Mean age was 31.47 years (range 20–55). Males constituted 70.83% and urban residents 80.55%. Neck was the commonest site (68.05%). Mean baseline HOMA-IR was 1.68. At six months, one-grade reduction was the most frequent response (42/72). Patients with lower baseline HOMA-IR had significantly greater improvement. The ALA+LA group showed a numerically higher mean grade reduction (+0.472 vs MYO+LA), but the difference was not statistically significant (p=0.53). Conclusions: Lower baseline HOMA-IR values predict better clinical outcomes. Both regimens are effective, with no significant difference in efficacy. Early metabolic screening and individualized treatment improve outcomes.

Background: Acanthosis nigricans (AN) is a dermatological condition frequently associated with insulin resistance, obesity, endocrinopathies, and occasionally malignancies. While several studies have explored its pathogenesis, there is limited data on demographic and clinical profiles of AN patients in North India. Objectives: To describe the demographic and clinical characteristics of AN in patients attending a tertiary care hospital in North India. Methods: A hospital-based observational study was conducted between July 2022 and December 2023 at a tertiary dermatology OPD in Jaipur. A total of 72 patients clinically diagnosed with AN were enrolled. Demographic data (age, sex, urban/rural residence, occupation), clinical features (site distribution, grading, family/past medical history), and metabolic parameters including HOMA-IR were recorded. Statistical analysis was performed using descriptive statistics and correlations. Results: The mean age was 31.47 years (20–55). Males predominated (70.83%). Most patients were urban residents (80.55%). The neck was the most frequently affected site (68.05%), followed by axillae and groin. Family history of diabetes was present in 19.44%. Mean HOMA-IR was 1.68. A positive correlation was observed between age and HOMA-IR (r=0.31). Students (22.2%) and corporate employees were most frequently affected. Higher age groups and higher HOMA-IR values were associated with more severe AN. Conclusions: AN in North Indian patients predominantly affects young adult males, with neck being the most common site. Urban lifestyle and positive family history of diabetes contribute to its prevalence. Early recognition of demographic and clinical trends can help guide screening for insulin resistance and associated comorbidities.

Introduction: Total laparoscopic hysterectomy (TLH) is increasingly preferred over abdominal hysterectomy (AH) as a minimally invasive surgical option. This study compares operative outcomes, blood loss, recovery, and complication rates between TLH and AH. Materials and Methods: A retrospective analysis of 200 women undergoing hysterectomy at a tertiary care center in Gujarat from January 2025 to November 2025 was conducted. Patients were divided into TLH (n=106) and AH (n=94) groups. Operative duration, blood loss, hospital stay, and post-operative complications were compared. Mann-Whitney U test and Fisher’s exact test were applied, and p<0.05 was considered statistically significant. Results: Mean operative time was significantly shorter in TLH (90 ± 20 min) compared to AH (100 ± 20 min, p<0.001). Average blood loss was markedly lower in TLH (75 ± 25 ml) than in AH (350 ± 50 ml, p<0.0001). Hospital stay was significantly shorter in TLH (3 ± 1 days) versus AH (5 ± 1.5 days, p<0.0001). Complications occurred in 5 TLH cases (4.7%) and 3 AH cases (3.2%), with no significant difference (p=0.52). Conclusion: TLH offers substantial advantages over AH in terms of operative time, blood loss, and hospital stay, with comparable safety and complication profile. TLH is a safe and effective alternative to open hysterectomy for benign gynecological conditions.

Objectives: To analyse the main prenatal anatomical spectrum of hypoplastic left heart syndrome, its characterstics and associated other system anomalies. Method: we retrogradely analysed our study done for screening of CHD by fetal echocardiography in 6634 consecutive obstretic patients out of which 29 cases were identified with CHD out of which 3 cases were hypoplastic left heart syndrome and its spectral disease. The study done during the period of November 2018 to December 2019.

Introduction: Obesity is a chronic, multifactorial disease associated with increased risk of metabolic and cardiovascular disorders. Although lifestyle modification remains the cornerstone of obesity management, long-term adherence and sustained weight loss are often difficult to achieve. Metformin, an insulin-sensitizing agent widely used in type 2 diabetes mellitus, has demonstrated modest weight-reducing and metabolic benefits in obese individuals. However, real-world evidence regarding its effectiveness in obese Indian patients remains limited. The study aimed to evaluate the effectiveness, metabolic outcomes, safety, and treatment adherence of metformin therapy in adults with obesity. Materials and Methods: This prospective observational study was conducted at Dr Ulhas Patil Medical College, Jalgaon, from January 2024 to June 2025. A total of 100 adults with obesity (BMI ≥30 kg/m²) were enrolled. All participants received oral metformin, initiated at 500 mg/day and titrated up to 1500–2000 mg/day as tolerated, along with standardized lifestyle modification advice. Anthropometric measurements, glycaemic parameters, lipid profile, adverse events, and adherence were assessed at baseline and at 3, 6, and 12 months. Statistical analysis was performed using appropriate tests, with p < 0.05 considered statistically significant. Results: The mean age of participants was 42.6 ± 9.8 years, with females constituting 62% of the cohort. Mean body weight decreased significantly from 98.4 ± 11.6 kg at baseline to 90.8 ± 10.7 kg at 12 months, corresponding to a mean weight loss of 7.7% (p < 0.001). Mean BMI declined from 35.8 ± 3.9 to 33.0 ± 3.6 kg/m². At 12 months, 64% of patients achieved ≥5% weight loss, while 22% achieved ≥10% weight loss. Significant improvements were observed in glycaemic and lipid parameters, particularly among patients with type 2 diabetes mellitus. Gastrointestinal adverse events were mild and transient, with an overall treatment adherence rate of 86%. Conclusion: Metformin is a safe, well-tolerated, and cost-effective adjunct to lifestyle modification and helps in obesity management, providing modest but sustained weight loss and significant metabolic benefits in real-world clinical practice.

Introduction: Neonatal sepsis is a bacterial bloodstream infection with positive blood culture in first four weeks of life. Early diagnosis of neonatal sepsis helps clinician to treat in time and thereby reduces complications and mortality. Early diagnosis in neonatal sepsis is difficult merely on clinical suspicion. Blood culture is the gold standard for diagnosis but it takes 48-72 hrs. Therefore, haematological and biochemical parameters play an important part in early diagnosis and management strategies in neonatal sepsis. Material & Methods: This study included 80 neonates with sepsis confirmed by blood culture positivity over a period of 12 months (Oct 2024-Sept 2025). In this study we evaluate various haematological parameters-Total leukocyte count (TLC), Absolute neutrophil count (ANC), Immature to total neutrophil ratio (I/T ratio), Immature to mature neutrophil ratio, Platelet count, Red cell distribution width (RDW) and biochemical parameters-CRP from blood samples which were collected prior to initiation of treatment. Result: Out of 80 neonatal sepsis cases (confirmed by blood culture) 36(45%) shows leukocytosis 16(20%) shows leukopenia; 22(27%) shows neutrophilia; 33(41%) shows neutropenia; 32(40%) shows high Immature to total neutrophil ratio (I/T ratio); 26(32%) shows high Immature to mature neutrophil ratio; 42(52%) shows low Platelet count; 74(92%) shows high Red cell distribution width (RDW) and 77(96%) shows raised CRP levels. Conclusion: The haematological and biochemical parameters studied in this study are cost effective, less time consuming and easy to perform. Understanding these dynamics can enhance diagnosis and treatment, highlighting the need for personalized approaches in neonatal sepsis management.

Background: The bilateral superficial cervical plexus block technique is widely used for managing pain after surgery, but the ideal dosage of anesthetic agents has to be administered to control the severity of post-thyroid surgical pain. Method: 120 (one hundred twenty) patients were selected for BSCPB and divided into three groups and each group consists of 40 patients. Patients in group P received normal saline, group R received Ropivacaine 0.5%; group RC received Ropivacaine 0.5% and clonidine 0.5 mcg/kg. Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in patients with a bispectral index between 40 and 60. All patients received 2 gm of acetaminophen during the first 24 hours after surgery. The pain score was checked every 4 hours, and Inj Ketorolac 30 mg (IV) was given to reduce pain scores >4 on a numeric pain scale. Results: The comparison of the mean values of demographic characteristics, age, height, and duration of surgery (minutes) remains insignificant (p>0.001) indicates all groups have similar parameters. In the comparison of SBP at the end of resection, incision, and extubation, there was a significant difference among the groups (p<0.001). Regarding rescue analgesic (sufentanil) usage intraoperatively and pain score in PACU – significantly lower values were observed in group RC (p<0.001) which indicates better intra and post-operative analgesia. Conclusion: It is proved that group RC (ropivacaine + clonidine) was significantly effective in achieving pain reduction and ideal as anesthetic agents to maintain hemodynamic status.

Calcaneus fractures account for approximately 60% of all tarsal injuries. Functional outcomes largely depend on the integrity and restoration of the subtalar joint, which is a key weight-bearing joint of the foot. In this study, we took 50 cases with calcaneum fracture to evaluate intraarticular fracture pattern and to evaluate outcome of various surgical methods of fixation of intraarticular fractures. Joint destruction and severe intraarticular comminution with soft tissue compromise leads to fair to poor outcomes. Good anatomical articular reduction with suitable surgical intervention along with strict post-operative rehabilitation protocol, we can achieve good to excellent outcomes. In the study, it was found that Essex lopresti classification and CT based Sanders classification are useful in better preoperative planning and management.

Background: Medical methods of abortion (MMA) using mifepristone and misoprostol have revolutionized pregnancy termination globally. However, incomplete abortion remains a significant complication, particularly when medications are procured without medical supervision. Objective: To evaluate the incidence, risk factors, clinical presentation, management strategies, and outcomes of incomplete abortion following medical abortion in first-trimester pregnancies. Methods: A prospective analytical observational study was conducted at Government Mohan Kumaramangalam Medical College Hospital, Salem, over one year. One hundred women presenting with first-trimester incomplete abortion after MMA were enrolled. Data collection included demographic information, medication history, clinical examination, ultrasonographic evaluation, and management outcomes. Statistical analysis was performed using t-tests and descriptive statistics. Results: The mean age was 27.34±5.22 years, with 52% from rural areas. Only 38% used the recommended mifepristone-misoprostol combination, while 45% procured medications from pharmacies without supervision. Retained products of conception were identified in 28% on ultrasound. Medical management was employed in 70%, surgical evacuation in 10%, and expectant management in 20%. Blood transfusion was required in 10%. Post-intervention, 81% reported abdominal pain and 28% experienced prolonged bleeding after two weeks. Complete resolution occurred in 82%, with 13% readmissions and 5% requiring repeat evacuation. Conclusion: Incomplete abortion following MMA is significantly associated with unsupervised medication use, improper drug regimens, and lack of counseling. Enhancing public awareness, regulating drug dispensing, and ensuring proper follow-up are critical to reducing complications and improving maternal outcomes.

Background: Proteinuria represents a critical marker of renal dysfunction and cardiovascular risk in patients with chronic kidney disease (CKD) and hypertension. While angiotensin receptor blockers (ARBs) are established as first-line agents for proteinuria reduction, the addition of cilnidipine, an L/N-type calcium channel blocker, may provide superior renoprotective benefits through complementary mechanisms of action. Methods: This prospective randomized controlled study enrolled 126 hypertensive patients with CKD and significant proteinuria. Participants were randomly allocated to receive either combination therapy with cilnidipine plus ARB (n=63) or ARB monotherapy (n=63). The primary endpoint was reduction in urinary protein-to-creatinine ratio (UPCR) at 12 months. Secondary endpoints included blood pressure control, estimated glomerular filtration rate (eGFR) changes, and adverse effects. Statistical analysis employed paired and unpaired t-tests with significance set at p<0.05. Results: At 12 months, the combination therapy group demonstrated significantly greater reduction in UPCR compared to ARB monotherapy (mean reduction 0.89±0.34 g/g vs 0.42±0.28 g/g, p<0.001). Both groups achieved comparable blood pressure control (134.2±8.4/82.3±5.6 mmHg vs 135.8±9.1/83.7±6.2 mmHg, p>0.05). The combination group showed superior preservation of eGFR (mean change -2.3±4.1 mL/min/1.73m² vs -5.8±4.9 mL/min/1.73m², p=0.002). Heart rate reduction was significantly greater in the combination group (p<0.001). Adverse events were comparable between groups. Conclusion: Combination therapy with cilnidipine plus ARB demonstrated superior antiproteinuric efficacy compared to ARB monotherapy in hypertensive patients with CKD, independent of blood pressure reduction. This strategy represents a promising approach for enhanced renoprotection in this high-risk population.

Background: Snakebite envenomation remains a major yet under-recognised cause of preventable morbidity and mortality in rural India, where delayed access to anti-snake venom and limited critical-care resources adversely influence patient outcomes. Objectives: To assess the clinical profile and toxicity of snake envenomation; determine its prognosis with reference to bite to needle time; and to document the adverse effects of anti-snake venom therapy. Methods: This was a single-centre, hospital-based descriptive study conducted in the Department of Emergency Medicine and Intensive Care Unit of Rajah Muthiah Medical College and Hospital, Chidambaram, Tamil Nadu, over one year (April 2018–April 2019). Consecutive patients aged ≥12 years with confirmed snake envenomation were enrolled. Results: Among 43 snake envenomation cases, most were middle-aged (37.2% aged 41–50 years; 23.2% aged 31–40 years), predominantly female (58.1%) and entirely from rural areas. Bites mainly involved the lower limbs (right 55.8%, left 30.2%), occurred mostly in daytime (77.0%), and were frequently due to unidentified species (48.8%); Russell’s viper accounted for 27.9%. Hemotoxic envenomation predominated (79.1%). Cellulitis was very common (86.0%), with acute kidney injury in 14.0% and neuroparalysis in 16.3%; 18.6% required mechanical ventilation. Over half received >8 vials of ASV (55.8%). ASV reactions were frequent, chiefly urticaria (30.2%) and anaphylactic shock (9.3%). Overall outcome was favourable: 86.0% were discharged, 9.3% referred and 4.7% died. Early ASV (<5 h) was associated with no deaths and no DIC, whereas both deaths and all DIC occurred when ASV was delayed >5 h (p=0.042, p=0.037). Conclusion: Early hospital presentation and timely administration of anti-snake venom significantly improved outcomes in this rural cohort of snake envenomation patients, underscoring the need to strengthen community awareness, referral pathways, and emergency care capacity to reduce snakebite-related morbidity and mortality.

Background: Day-care anaesthesia requires airway techniques that provide optimal laryngeal mask airway insertion conditions with stable hemodynamics and rapid recovery. Objective: To compare the ease of laryngeal mask airway insertion between dexmedetomidine with propofol and fentanyl with propofol in short day-care procedures lasting 30–60 minutes. Methods: This single-centre, prospective, parallel-group randomized controlled trial enrolled ASA I–II adults aged 18–70 years undergoing short day-care procedures and allocated them by block randomization to receive either fentanyl–propofol (Group A) or dexmedetomidine–propofol (Group B) for laryngeal mask airway insertion. Results: Both groups were demographically comparable, with similar mean age (35.76 vs 35.63 years) and weight (60.24 vs 61.39 kg), and a predominance of males (78.0% vs 73.2%). LMA insertion conditions were excellent in both arms: fully relaxed jaw (Grade 1) was seen in 87.8% (Group A) and 95.1% (Group B), with no Grade 3/4 cases; 97.6% in each group had no coughing, and only one patient per group exhibited bucking, with no stridor, breath holding or lacrimation. Intraoperatively, heart rate was similar at baseline but became marginally lower with dexmedetomidine at several time points, while diastolic and mean arterial pressures showed small but statistically significant reductions from 5–15 minutes. Postoperatively, heart rate was slightly higher in Group B at 1–2 hours, whereas SBP, DBP and MAP remained consistently lower (e.g. at 0 hours SBP 104.1 vs 115.0 mmHg; MAP 76.2 vs 83.2 mmHg), with both regimens maintaining overall hemodynamic stability. Conclusion: Dexmedetomidine–propofol provided LMA insertion conditions comparable to fentanyl–propofol while offering smoother, clinically acceptable haemodynamic stability during short day-care procedures.

Background: Childhood immunization is a proven, cost-effective intervention, yet persistent socioeconomic and access-related disparities in India contribute to missed and delayed doses. Objectives: To determine the vaccination status of children 1 to 5 years of age; and the factors associated with childhood immunization defaulters. Methods: This was a single-centre, hospital-based analytical cross-sectional study conducted in the Department of Paediatrics, Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research, Tamil Nadu, India, from January–December 2023; systematic random sampling of every 5^th eligible child targeted a sample of 850. Results: Among 850 children (54.1% male; 60.0% urban), age was evenly distributed across one-year bands (12–23 mo 24.7%, 24–35 mo 24.1%, 36–47 mo 25.3%, 48–59 mo 25.9%). Most families were Hindu (80.0%); lower-middle (37.6%) and upper-lower (30.6%) SES predominated. Mothers commonly had secondary education (35.3%) and were homemakers (63.5%); 72.9% had ≥4 ANC visits. Institutional delivery was high (public 50.6%, private 43.5%). Cards were available for 72.9% and BCG scars in 89.4%. Overall, 72.0% were fully immunized; defaulters constituted 28.0%. Compared with non-defaulters (n=612), defaulters (n=238) were younger (12–23 mo 30.3% vs 22.5%; p=0.025), more rural (60.1% vs 32.2%; p<0.001), from lower SES (upper-lower 39.9% vs 27.0%; p<0.001), with lower maternal education (no schooling 21.0% vs 11.4%; p<0.001), higher birth order (≥3: 28.2% vs 16.8%; p<0.001), and fewer ANC visits (<4: 43.3% vs 20.8%; p<0.001). Defaulting correlated with no card (56.3% vs 15.7%) or absent BCG scar (28.6% vs 3.6%) and greater distance (>5 km 39.5% vs 23.9%; all p<0.001). Conclusion: Targeted strengthening of reminder–recall, card retention, reliable session calendars, and rural outreach—prioritizing low-SES, high-parity families—can meaningfully reduce defaulting and improve equitable completion of age-appropriate vaccination among 1–5-year-olds.

Background: Magnesium modulates airway smooth-muscle tone and inflammation, yet the relationship between routine serum magnesium levels and pediatric asthma severity and control remains insufficiently defined. Objectives: To determine the levels of serum magnesium among asthmatic children; and to correlate levels of serum magnesium with severity of asthma. Methods: This single-centre, hospital-based analytical cross-sectional study was conducted in the Department of Paediatrics, Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research (September 2023–March 2024) among children aged 5–18 years with GINA-defined asthma after informed consent/assent. Data were analysed using SPSS v27. Results: In 200 asthmatic children (mean age 10.8 ± 3.6 y; 58% male; 62% urban), control was suboptimal (ACT/C-ACT 19.2 ± 4.6; 46% uncontrolled) with mean FEV₁ 82.2 ± 14.6% (36% <80%). By GINA, 48% were mild, 37% moderate, 15% severe. Mean serum magnesium was 1.86 ± 0.24 mg/dL (median 1.85; IQR 1.72–1.99); 21.5% had hypomagnesemia. Magnesium fell with increasing severity (mild 1.92; moderate 1.83; severe 1.74 mg/dL), with significant pairwise differences (p=0.021; p<0.001; p=0.038) and rising hypomagnesemia (10.4%→25.7%→46.7%). Magnesium correlated with FEV₁ % predicted (r=0.32) and ACT/C-ACT (r=0.28), both p<0.001. Adjusted analyses showed lower odds of moderate–severe asthma per 0.1 mg/dL higher magnesium (OR 0.85; 95% CI 0.76–0.95) and fewer frequent exacerbations (OR 0.88; 95% CI 0.79–0.98). ROC performance for moderate–severe disease was fair (AUC 0.71; cutoff ≤1.80 mg/dL; sensitivity 68%, specificity 66%). Conclusion: Lower serum magnesium was independently associated with poorer asthma status – lower FEV₁, worse control, and higher odds of moderate–severe disease – supporting its value as a simple, supportive biomarker alongside guideline-based assessment.

Purpose: The primary objectives of this study was to study the morphological and functional status of corneal endothelial cells in pre & post-operative cataract surgery patients, to assess the relationship between nucleus grading and postoperative endothelial cell count and to determine endothelial cell status as strong predictive marker for visual outcome in cataract surgery (SICS). Secondary objective of study was to study effect of various surgical techniques in SICS on endothelial cell count and visual outcome. Methods: This was an observational, prospective study. A total of 428 eyes from patients aged between 20 and 50 years who were treated by small incision cataract surgery (SICS) technique in a tertiary care centre in Bhopal region for a period of 18 months were included in this study. The study population was stratified into two assessment groups: preoperative baseline and postoperative evaluation intervals (postoperative day 1, week 1, and month 1). Baseline endothelial parameters, including preoperative endothelial cell density (ECD), Coefficient of variation (CV) of cell size, and central corneal thickness (CCT), were systematically evaluated and analyzed with respect to their interrelationships and comparative changes across both the preoperative and postoperative assessment time points using Rexxam SPM-700 AS non-contact specular microscope with integrated pachymeter. Results: Out of 428 eyes, average mean age of patient is 34.6 year. This study demonstrated a progressive decline in ECD throughout the postoperative period, with mean reductions of 5.03% on postoperative day 1, 5.57% at postoperative week 1, and 5.95% at postoperative month 1 (p<0.001). CCT demonstrated maximal corneal edema on postoperative day 1 (increase of 3.11%), with gradual resolution approaching baseline values by postoperative month 1 (increase of 0.21%). CV exhibited a significant progressive increase, rising by 7.7% on postoperative day 1, further increasing to 11.3% at postoperative week 1, and reaching 13.6% at postoperative month 1. All observed changes in these endothelial parameters achieved statistical significance (p<0.001). Conclusion: Protection of corneal endothelium is very much necessary for achieving good visual outcome after a cataract surgery. This study concluded that there was some endothelial cell loss and a transient increase in corneal thickness following SICS with subsequent progressive decrease in central corneal thickness as postoperative days progressed till 1 month follow up and returned closest to its preoperative value.

Background & Methods: The aim of the study is to study Changing trends in clinical and demographic profile presentation for screening of ROP over 7 years. All included infants were screened and evaluated for ROP by a trained ophthalmologist from the Gandhi Medical College and Hamidia Hospital, with the assistance of a trained nursing staff. Study Design: Ambispective Cohort Study. Results: A total of 2,870 patients were included in the study over the 7-year period. Males consistently outnumbered females across all years, representing 56. 5% (1,622) of the total patients, while females accounted for 43. 5% (1,248). The largest proportion of patients (40. 1% or 1,152 patients) fell in the 1-1. 5 kg birth weight category. Mean gestational age -33 weeks the largest proportion of patients (38. 8% or 1,113 patients) fell in the 28-32 weeks gestational age category. Out of total patients over the 7 years, 74. 8% (2,148) were referred from urban areas, while 25. 2% (722) were from rural areas. Of the total 2,870 patients, 51. 6% (1,481) were inborn and 48. 4% (1,389) were outborn. The total number of cases over the seven-year period was 400. Conclusion: Retinopathy of prematurity is one of the most common cause of preventable childhood blindness. This disease has presented with ever evolving epidemiology which has affected the diagnosis and treatment. Analyzing screening trends is important as it gives an overall impression of what all population is able to receive the ROP services at a place and to modify the screening programme as per the need of the area. In our study the largest proportion of patients (40. 1% or 1,152 patients) fell in the 1-1. 5 kg birth weight category, the largest proportion of patients (40. 1% or 1,152 patients) fell in the 1-1. 5 kg birth weight category which are the traditional high risk group. An increase in referral to tertiary centre (14% to 25.2%) denotes awareness regarding the ROP screening but lack of management services and hence to divert resources for management facility as well.

Introduction: Femicide is the intentional killing of women and girls because of their gender. It is an extreme manifestation of violence against women and girls rooted in misogyny and harmful beliefs and norms. Aims: To analyze the epidemiological profile and pattern of injuries in femicide cases in South Kerala over a 15-year period using autopsy records, in order to identify demographic trends, common causes, and characteristic injury patterns. Materials & Methods: This is a retrospective study conducted at the Department of Forensic Medicine, Government Medical College, Thiruvananthapuram, analyzing femicide cases over a 15-year period from January 1, 2002, to December 31, 2016, with a total sample size of 238 cases. Result: Period of survival for majority of victims is less than 1 day only. 2 of them alone survived for a period of greater than a month before dying. In a similar study it is noted that of the 181 cases, 21% (46 cases) were brought dead to the hospital, victims of hanging and jumping typically survived less than a day, assault victims survived for an average of 3 days (range: 0–16 days), poison victims survived 5 days (range: 0–43 days), and burn victims survived 6 days (range: 0–102 days). Conclusion: We concluded that the lack of proper data on femicides in India is a major issue, as most of the gender-based violence against women in the family go unreported or underreported with no standardised method in place to accurately identify it.

Background: Accurate assessment of neonatal hyperbilirubinemia is crucial to prevent bilirubin-induced neurological dysfunction. Total serum bilirubin (TSB) estimation remains the diagnostic gold standard, while transcutaneous bilirubin (TCB) measurement provides a rapid, non-invasive alternative. This study aimed to evaluate the correlation between TCB and TSB values measured prior to initiation of phototherapy in term neonates. Methods: This cross-sectional analysis included 100 term neonates enrolled in a randomized controlled trial conducted at a tertiary care hospital in Rajasthan. Prior to initiation of phototherapy, TCB was measured using a transcutaneous bilirubinometer, followed immediately by venous sampling for TSB estimation using an automated analyzer (Erba Mannheim XL-640/EM 360). Descriptive statistics and Pearson correlation coefficient were used to assess the relationship between TCB and TSB values. Results: The mean TCB level was 18.85 ± 1.90 mg/dL, while the mean TSB level was 18.87 ± 1.95 mg/dL, showing a negligible mean difference of 0.02 mg/dL. However, the Pearson correlation coefficient between TCB and TSB was r = 0.35, indicating a moderate positive correlation. Increasing variability between TCB and TSB measurements was observed at higher bilirubin levels (>18 mg/dL). Conclusion: Although mean TCB values closely approximated mean TSB levels, the moderate correlation suggests that TCB alone is insufficient for precise individual-level clinical decision-making. TCB is a useful screening tool to identify neonates requiring further evaluation; however, confirmatory TSB estimation remains essential before initiating treatment, particularly at higher bilirubin levels.

Epidermoid cysts are common benign cutaneous lesions; however, their occurrence in the vulvar region is uncommon and often poses diagnostic confusion due to similarity with other vulvar masses. We report a case of a vulvar epidermoid cyst in a reproductive-aged woman presenting with a slowly enlarging, painless vulvar swelling. Clinical examination and imaging suggested a benign cystic lesion. Complete surgical excision was performed, and histopathological examination confirmed the diagnosis of an epidermoid cyst. This case highlights the importance of considering epidermoid cysts in the differential diagnosis of vulvar swellings and emphasizes surgical excision as definitive management.

Background: The morphometric determination of position of the lingula is essential while performing osteotomy of mandible. Also, mandibular foramen is used as an anatomical landmark in various surgeries and other invasive procedures. The present study provides the data on morphology and morphometry of lingula & mandibular foramen which will be helpful for the surgeons during different procedures on and around the mandible. Materials and Methods: The present study was performed in the Department of Anatomy of a tertiary care hospital, Mumbai, India. Morphology and morphometry of lingula & mandibular foramen of 100 dry adult human mandibles were recorded. Serial number was given to each mandible from 1 to 100. Gloves, thread & scale were used for the measurement of various parameters. Result: In the present study, shape of the lingula was found triangular in 56%, truncated in 27.5%, assimilated in 10% and nodular in 6.5% of the mandibles considering both sides. Single mandibular foramen was observed in all the mandibles. The mandibular foramen was present in all the mandibles. Out of 3 mandible, 1 bilateral and 2 right unilateral accessory mandibular foramen (4%) were noted. Also, the measurement of distance of mandibular foramen from different points on the mandible were recorded in this study. Conclusion: The knowledge of the morphology and morphometry of lingula & mandibular foramen will help dentists, anaesthetists and surgeons in various clinical procedures and to prevent complications during these interventions.

Background: Poor sleep quality may influence blood pressure variability, an emerging marker of cardiovascular risk. Young adults often experience sleep disturbances, yet data on their relationship with BPV remain limited. The aim of this study was to assess the association between the 24-hour blood pressure of young people who visited a tertiary care hospital in Rajasthan. Methods: From March to September 2025, a cross-sectional analytical study was carried out at Shri Ramkaran Joshi Government Hospital, which is affiliated with Government Medical College, Dausa. There were 120 recruits, ages 18 to 35. The Pittsburgh Sleep Quality Index was used to measure sleep quality; scores higher than five indicated poor sleep. To collect BPV parameters, such as average actual variability, coefficient of variation, and standard deviation of 24-hour systolic blood pressure, all subjects performed 24-hour ambulatory blood pressure monitoring. The statistical research included group comparisons, correlation analysis, and multivariable linear regression. Results: Of the 120 participants, 55 (45.8%) were categorized as good sleepers and 65 (54.2%) as poor sleepers. The mean 24-hour SD of systolic BP was significantly higher in poor sleepers compared with good sleepers (15.26 ± 1.68 vs. 13.93 ± 1.57 mmHg; p < 0.001The PSQI score and SD-SBP had a moderately favorable connection (r = 0.44; p < 0.001). After controlling for age, sex, BMI, and mean 24-hour blood pressure, a one-point increase in PSQI was independently linked to a 0.29 mmHg increase in SD-SBP (95% CI: 0.18–0.40; p < 0.001) in multivariable analysis. Conclusion: In this hypothetical dataset in young people, in young people, poor sleep quality was substantially linked to higher blood pressure variability. Independent of mean BP and other covariates. These findings highlight the potential importance of assessing and improving sleep quality as part of cardiovascular risk prevention strategies in younger populations.

Background: The gold standard for treating symptomatic gallstone disease is laparoscopic cholecystectomy (LC), which offers advantages like less pain, shorter hospital stays, and improved esthetic results. Nevertheless, certain pathophysiological alterations are introduced when pneumoperitoneum is created using carbon dioxide (CO₂) to see the surgical field. These include potentially fatal hemodynamic instability and benign shoulder tip pain following surgery. Objective: This study’s main goal was to assess the frequency and range of complications that were specifically linked to the use of carbon dioxide pneumoperitoneum in patients having elective laparoscopic cholecystectomy at a tertiary care facility. These complications included hemodynamic changes, respiratory changes, and postoperative shoulder pain. Methods: Over the course of six months, Teerthanker Mahaveer Medical College (TMMC) undertook this retrospective observational study. An analysis was conducted on 204 patients receiving elective laparoscopic cholecystectomy. We gathered and examined information on patient demographics, intraoperative vitals (heart rate, mean arterial pressure, EtCO₂), and postoperative problems that were especially related to pneumoperitoneum. Results: The study population (N=204) was predominately female (68.6%) and had an average age of 42.5 years. Shoulder tip discomfort was the most common consequence noted (34.3%). In 18.6% of instances, there was intraoperative hypercarbia (EtCO₂  45 mmHg). In 2.9% of patients, subcutaneous emphysema was observed. During insufflation, hemodynamic parameters increased in a statistically significant but clinically acceptable way. Pneumoperitoneum problems did not result in any recorded deaths or conversions to open surgery. Conclusion: Although CO₂ pneumoperitoneum is generally safe, it is linked to a particular set of consequences, including temporary hypercarbia and referred shoulder pain. To reduce these hazards, intra-abdominal pressure must be closely monitored.

Aim: To evaluate the effectiveness of preoperative nebulization of magnesium sulfate (MgSO₄) in reducing postoperative complications, attenuating hemodynamic stress response to intubation, and improving oxygenation parameters in patients undergoing general anesthesia. Materials and Methods: A prospective, randomized, double-blind controlled trial was conducted on 100 adult patients (age 18-65 years) scheduled for elective surgical procedures requiring general anesthesia with endotracheal intubation. Patients were randomly divided into two groups: Group A (n=50) received 3 ml of normal saline nebulization, and Group B (n=50) received 3 ml of 250 mg isotonic magnesium sulfate nebulization for 15 minutes, 5 minutes before induction of anesthesia. Primary outcomes included incidence of postoperative sore throat (POST), hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure), and oxygenation parameters (SpO₂, PaO₂/FiO₂ ratio). Secondary outcomes included severity of POST at 6 hours and 24 hours postoperatively, incidence of hoarseness, cough, and postoperative complications. Result: Preoperative nebulization with MgSO₄ significantly reduced the incidence of POST (56% vs 84%, p<0.001), severity of sore throat pain on swallowing (4±1.2 vs 7±1.8, p<0.001), and attenuated the stress response to endotracheal intubation with reduced heart rate elevation at 3 and 6 minutes post-intubation (p<0.001). Oxygenation parameters showed significant improvement in the MgSO₄ group with PaO₂/FiO₂ ratio maintained at 380±25 mmHg compared to 320±35 mmHg in control group at 90 minutes intraoperatively (p<0.001). Dynamic lung compliance was significantly better preserved in the MgSO₄ group. The number needed to treat (NNT) to prevent one case of POST was 3.6. No significant adverse effects were observed in either group. Conclusion: Preoperative nebulization of magnesium sulfate is a safe, simple, and effective non-invasive method to reduce the incidence and severity of postoperative sore throat, attenuate hemodynamic stress response during intubation, and preserve pulmonary oxygenation parameters in patients undergoing general anesthesia with endotracheal intubation. Its ease of application, minimal systemic absorption, favorable safety profile, and cost-effectiveness make it an attractive option for routine preoperative airway management protocols.

Background: The evolution of human beings from quadrupedalism to bipedalism has adjusted the balance of the upper limb at the shoulder joint. The different angles of scapula provide the point of attachment to various muscles and control movements of those muscles at shoulder joint and shoulder girdle. The present study provide the data on morphomtery of scapular angles and these findings could be of great value in the further exploration of this subject. Material and Methods: The study was conducted on superior, inferior, lateral and spinovertebral angles of one hundred unpaired dry adult human scapulae. All dry adult human scapulae were of undetermined age and gender. Each scapula was given a serial number and they were labelled from 1 to 100. Goniometer was used for measurement of different angles of the scapula. Result: The different angles of total one hundred scapulae were studied out of which fifty one were of the left side and forty nine were of the right side. Statistical analysis of the data was carried out to find out the mean and standard deviation (SD). The total mean of the superior angle of scapula was 87.12⁰ ± 2.92, of which the mean of left side was 87.66⁰ ± 2.74 and the mean of right side was 86.55⁰ ± 2.99. The total mean of the inferior angle of scapula was 43.52⁰ ± 2.40, of which the mean of left side was 43⁰ ± 2.42 and the mean of right side was 44.06⁰ ± 2.25. The total mean of the lateral angle of scapula was 80.46⁰ ± 3.35, of which the mean of left side was 81.09⁰ ± 3.45 and the mean of right side was 79.79⁰ ± 3.11. The total mean of the spinovertebral angle of scapula was 144.92⁰ ± 3.80, of which the mean of left side was 141.19⁰ ± 3.88 and the mean of right side was 144.67⁰ ± 3.56. Conclusion: Knowledge of the morphometry of different angles of scapula will be helpful in anthropology and kinematics of the shoulder joint.

Background: Intraoperative shivering is a common complication during spinal anaesthesia, leading to patient discomfort and potential hemodynamic alterations. Fentanyl, administered via different routes, has been used to prevent shivering, but comparative efficacy of intrathecal versus intravenous administration remains unclear. This study aimed to evaluate and compare the effectiveness of intrathecal and intravenous fentanyl for intraoperative shivering. Material and Methods: A prospective randomized controlled study was conducted at BJMC and Civil Hospital, Ahmedabad, from August 2024 to March 2025. A total of 120 patients, aged 18–60 years, ASA I–II, scheduled for elective surgeries under spinal anaesthesia, were randomly assigned to two groups: Group A received intrathecal fentanyl 25 µg (n=60) and Group B received intravenous fentanyl 1 µg/kg (n=60). Shivering scores and sedation levels (Ramsay Sedation Scale) were recorded at 5-minute intervals intraoperatively. Baseline demographic and clinical characteristics, including age, gender, height, weight, BMI, and ASA status, were comparable between groups. Statistical analysis was performed using Student’s t-test and Chi-square test, with p < 0.05 considered significant. Results: Baseline characteristics were similar between groups (p > 0.05). Shivering scores were significantly lower in Group A compared to Group B from 5 minutes onwards (e.g., 5 min: 0.72 ± 0.52 vs 1.02 ± 0.75, p = 0.012), with differences remaining significant throughout the surgery. Sedation scores increased gradually in both groups; Group B exhibited slightly higher scores at most time points, with statistically significant differences at several intervals (e.g., 20 min: 2.02 ± 0.29 vs 2.20 ± 0.48, p = 0.013). No adverse hemodynamic effects were observed. Conclusion: Intrathecal fentanyl is more effective than intravenous fentanyl in preventing intraoperative shivering while providing adequate sedation without compromising hemodynamic stability. Intrathecal administration can be considered a safe and superior approach for shivering management during spinal anaesthesia.

Background: Peri-extubation cough is a common and undesirable event during emergence from general anesthesia, which may lead to hemodynamic instability and airway-related complications. Dexmedetomidine, an α₂-adrenergic agonist, has been shown to suppress airway reflexes. This study evaluated the efficacy of low-dose intratracheal dexmedetomidine in attenuating peri-extubation cough. Material and Methods: This prospective, randomized, comparative clinical trial was conducted on 90 adult patients (ASA I–II), aged 18–65 years, undergoing elective surgeries under general anesthesia with endotracheal intubation. Patients were randomly allocated into three equal groups (n = 30 each): Group DEX 0.3 received intratracheal dexmedetomidine 0.3 µg/kg, Group DEX 0.5 received 0.5 µg/kg, and Group NS received normal saline. The study drug was instilled intratracheally 30 minutes before the end of surgery. Peri-extubation cough was assessed using a four-point cough severity scale. Extubation time and baseline demographic variables were recorded. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p < 0.05 considered statistically significant. Results: Baseline demographic characteristics, including age, body mass index, gender distribution, and ASA physical status, were comparable across all three groups (p > 0.05). Post-hoc Dunn analysis revealed a significant reduction in cough severity in the DEX 0.3 group compared to placebo (adjusted p = 0.000142), while no significant difference was observed between DEX 0.5 and placebo after Bonferroni correction. The incidence of no cough was highest in the DEX 0.3 group (63.3%), compared to DEX 0.5 (23.3%) and placebo (3.3%), with a statistically significant difference versus placebo (adjusted p = 0.00014). Extubation time was significantly prolonged in the DEX 0.5 group compared to both DEX 0.3 and placebo (adjusted p = 3.1 × 10⁻¹⁰), whereas no significant difference was noted between DEX 0.3 and placebo. Conclusion: Intratracheal dexmedetomidine at a dose of 0.3 µg/kg effectively attenuates peri-extubation cough without delaying extubation, making it a preferable dose compared to 0.5 µg/kg in adult patients undergoing elective surgery under general anesthesia.

Introduction: Homicide, one of the leading causes of unnatural deaths, has always been a matter of concern. Its rate has been increasing worldwide alongside the growing population. We have made an attempt through this study, to analyse and understand the demographics behind this heinous crime in the Dhubri district of Assam, India; which will help to identify some potential risk factors, susceptible victims, the weapons frequently used, methods of inflicting fatal injuries and respective cause(s) of death. One of the prime objectives of medicolegal autopsy is also to find out the manner of death as far as possible. A cross-sectional study involving a total of 32 cases of homicide has been conducted across a span of 2 years, to draw a conclusion regarding the pattern and magnitude of homicidal deaths in Dhubri district of Assam and hence help legislators frame better governance policies and laws to prevent this crime and loss of innocent lives. Aims and Objectives: Aim: To determine the pattern and magnitude of homicides in the cases registered under the jurisdiction of Dhubri district of Assam.
Objectives:

• To determine the methods of homicide.
• To determine the common age groups affected.
• To determine the sex more vulnerable to homicides.
• To determine whether rural or urban population is more affected.
• To determine the commonest cause of death, type of weapon used, organ or organs involved.
• To determine the relation of accused with the victim if known.

Materials and Methods: This is a cross-sectional study for a duration of 2 years starting from 01/03/2023 to 28/02/2025 consisting of cases brought for autopsy to Dhubri Medical College and Hospital, Assam. The history and sociological aspects and demographic details of deceased were obtained from accompanying persons / relatives and police as per the predesigned proforma. Each case was examined and evaluated at autopsy, both externally and internally. Emphasis was given to the presence of any injury causing the death, signs of struggle or defence wounds. Simultaneously, Dead body challan, Inquest report, Bed head tickets from hospital (when available) were also studied. Inclusion Criteria: Cases where a distinctive opinion regarding manner of death was given as ‘homicide’ on the basis of the injuries present were included in the study. Exclusion Criteria: (1). Cases where findings are obscured due to advanced stage of decomposition. (2). Unidentified dead bodies. (3). Cases with findings suggestive of suicide, accidental or natural death. Results: The study revealed that 2.5% of the total cases were homicides and a majority of the victims were in their 3rd or 4th decades of life with female victims’ preponderance over male victims’. The rural population were the prime targets and majority succumbed to the injuries at the site of incidence of the crime. A surge in the number of cases was observed in the months of March and August and a large number of cases belonged to the Muslim community. Heavy sharp cutting weapons were the most commonly encountered weapons of offence. Head injury emerged as the commonest cause of death and majority of the medicolegal autopsies were conducted within 12 to 24 hours following death. Conclusion: The current study reflected the trend of homicidal deaths in Dhubri district of Assam. Females of Muslim community residing in rural areas were the most common victims. Dhubri is predominantly a rural district and majority of the rural population in Dhubri belongs to the Muslim community; which may be one of the reasons. Illiteracy, domestic violence, marital disputes, infidelity, sexual violence are the prevailing social evils in most of Indian society and Dhubri is no exception. Availability of sharp cutting weapons in rural households is obvious but the matter of concern is that people resort to its hostile use when any dispute arises. Injury, mostly over the head followed by death at the scene of crime without any medical attention suggests the severity, or rather, lethality of the injuries sustained and also highlights the lack of prompt medical services in the vicinity.

Abnormal uterine bleeding (AUB) in adolescents is a common gynecological problem, most frequently occurring in the early post-menarchal years. It is defined as bleeding that is excessive in volume, duration, or frequency and interferes with physical, social, or emotional well-being. The most common cause of AUB in adolescents is ovulatory dysfunction due to immaturity of the hypothalamic–pituitary–ovarian axis. However, other etiologies such as pregnancy, coagulation disorders, endocrine abnormalities, infections, and structural lesions must be considered. Diagnosis is primarily clinical and begins with a thorough history focusing on menstrual patterns, severity of bleeding, sexual activity, systemic illness, medications, and family history of bleeding disorders. Physical examination emphasizes hemodynamic stability, signs of anemia, endocrine abnormalities, and systemic disease. Initial laboratory evaluation typically includes a pregnancy test, complete blood count, and, when indicated, coagulation profile and thyroid function tests. Imaging is not routinely required and is reserved for cases with suspected structural pathology or failure of medical therapy. Management depends on the severity of bleeding, hemoglobin level, and underlying cause. Mild cases may be managed with reassurance, iron supplementation, and nonsteroidal anti-inflammatory drugs. Moderate to severe bleeding often requires hormonal therapy, including combined oral contraceptives or progestins. Acute severe AUB with hemodynamic instability requires hospitalization, high-dose hormonal therapy, and supportive care. Investigation beyond basic evaluation is warranted in adolescents with severe anemia, recurrent or persistent AUB, poor response to treatment, or features suggestive of bleeding disorders or endocrine disease. Early recognition and appropriate management are essential to prevent complications and improve quality of life in affected adolescents.

Background: Liver diseases unique to pregnancy constitute an important group of disorders that can significantly affect maternal and fetal outcomes. Among these, HELLP syndrome—defined by hemolysis, elevated liver enzymes, and low platelet count—is a severe pregnancy-specific condition, commonly regarded as a variant of preeclampsia. It usually develops in the third trimester or early postpartum period and is associated with widespread endothelial dysfunction and microangiopathy, leading to hepatic injury and systemic complications. Clinical manifestations are often nonspecific, including right upper quadrant or epigastric pain, nausea, vomiting, headache, and malaise, which may delay diagnosis. Laboratory findings are central to diagnosis and reveal evidence of hemolysis, hepatic dysfunction, and thrombocytopenia. HELLP syndrome may result in serious complications such as acute liver failure, hepatic hematoma or rupture, disseminated intravascular coagulation, placental abruption, and fetal growth restriction. Prompt diagnosis, close maternal–fetal monitoring, and timely delivery remain the cornerstone of management, supported by intensive care and correction of coagulopathies when required. This abstract emphasizes the importance of early recognition and appropriate management of HELLP syndrome to reduce maternal and perinatal morbidity and mortality associated with pregnancy-related liver diseases.

Abnormal uterine bleeding (AUB) is a common gynecologic complaint that significantly affects women’s health and quality of life across the reproductive lifespan. To standardize diagnosis and guide management, the International Federation of Gynecology and Obstetrics (FIGO) introduced the PALM–COEIN classification system, which categorizes AUB causes into structural (PALM: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia) and non-structural entities (COEIN: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified). Modern management of AUB requires an algorithmic approach that integrates this classification with clinical evaluation, patient characteristics, and reproductive goals. Initial assessment focuses on hemodynamic stability, exclusion of pregnancy, and identification of risk factors for malignancy. Targeted investigations—including laboratory tests, ultrasonography, hysteroscopy, and endometrial sampling—are selected based on suspected PALM–COEIN categories. Management strategies are individualized and range from medical to surgical options. Medical therapies, such as nonsteroidal anti-inflammatory drugs, antifibrinolytics, hormonal contraceptives, progestins, and levonorgestrel-releasing intrauterine systems, are first-line for many COEIN causes and selected PALM conditions. Surgical interventions, including hysteroscopic polypectomy, myomectomy, endometrial ablation, or hysterectomy, are reserved for refractory cases, significant structural pathology, or malignancy. An algorithmic approach grounded in the PALM–COEIN framework promotes accurate diagnosis, rational use of investigations, and evidence-based treatment selection. This structured strategy improves clinical outcomes, optimizes resource utilization, and supports patient-centered care in the modern management of abnormal uterine bleeding.

Background: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by elevated maternal serum bile acid concentrations and associated with an increased risk of adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, fetal distress and stillbirth. Serum total bile acid (TBA) concentration has been studied as a potential biochemical predictor of these outcomes. Objective: To evaluate maternal serum bile acid levels as a predictor of adverse fetal outcomes in pregnancies complicated by ICP. Methods: A retrospective analysis of ICP cases assessed the relationship between maternal fasting serum total bile acid (TBA) concentrations and adverse perinatal outcomes. Adverse outcomes typically included spontaneous preterm labor, meconium-stained amniotic fluid, low Apgar scores, and stillbirth. Receiver operating characteristic (ROC) curves and multivariate logistic regression analyses were used to determine optimal TBA cut-off values predictive of increased risk.  Results: Maternal serum TBA demonstrated predictive value for adverse outcomes in ICP. A critical TBA threshold of approximately ≥40 µmol/L was associated with a significantly increased risk of adverse perinatal events (OR ~3.8; 95% CI 1.23–11.73; P = 0.021) compared to lower levels. ROC analysis supported the utility of TBA as a predictor (area under the curve ~0.66). Meta-analytic data further showed that severe ICP (TBA ≥ 40 µmol/L) was significantly associated with increased risks of overall adverse outcomes (RR ~1.96), preterm birth, meconium-stained amniotic fluid and neonatal asphyxia/respiratory distress syndrome. Conclusions: Elevated maternal serum bile acid concentrations—especially when ≥40 µmol/L—are associated with an increased risk of adverse fetal outcomes in intrahepatic cholestasis of pregnancy and may serve as a useful biochemical predictor for risk stratification. Clinical monitoring of bile acid levels in ICP can aid in identifying high-risk pregnancies and guiding management to improve perinatal outcomes.

Background: Jaundice during pregnancy is an important medical condition associated with significant maternal and fetal morbidity and mortality, especially in developing countries. The incidence and etiology of jaundice vary with geographic region and healthcare access. Early identification of the underlying cause is crucial for optimal maternal and perinatal outcomes. Objectives: To determine the incidence, clinical profile, and etiological factors of jaundice among pregnant women attending a tertiary care antenatal center. Methods: This prospective observational study was conducted at a tertiary care antenatal center over a defined study period. All pregnant women presenting with clinical and/or biochemical evidence of jaundice were included. Detailed history, clinical examination, laboratory investigations, and imaging studies were performed to establish the etiology. Maternal and fetal outcomes were recorded and analyzed. Results: The incidence of jaundice in pregnancy was found to be low but clinically significant. The most common etiologies included viral hepatitis, intrahepatic cholestasis of pregnancy, hemolytic disorders, and hypertensive disorders of pregnancy such as HELLP syndrome. Viral hepatitis, particularly hepatitis E, constituted the leading cause of jaundice. Adverse maternal outcomes included hepatic failure, coagulopathy, and postpartum hemorrhage, while fetal complications included preterm birth, low birth weight, and increased perinatal mortality. Conclusion: Jaundice in pregnancy, though uncommon, poses serious risks to both mother and fetus. Viral hepatitis remains the predominant cause in the studied population. Early diagnosis, multidisciplinary management, and timely referral to tertiary care centers are essential to improve maternal and perinatal outcomes.

Background: Abnormal uterine bleeding (AUB) in premenopausal women is a common gynecological complaint. Identifying the prevalence of endometrial hyperplasia and malignancy among these patients helps guide diagnostic strategies and management, particularly the use of endometrial sampling. Objective: To determine the prevalence of endometrial hyperplasia (with and without atypia) and endometrial carcinoma in premenopausal women presenting with AUB, and to describe associated clinical risk factors. Methods: Cross-sectional study of premenopausal women (age 18–50 years) presenting with AUB at a tertiary care gynecology clinic over a defined study period. Patients with pregnancy, known coagulopathy, recent intrauterine instrumentation, or hormone therapy within 3 months were excluded. All enrolled participants underwent transvaginal ultrasound followed by endometrial sampling (pipelle or dilation & curettage) with histopathological examination. Data collected included age, parity, body mass index (BMI), menstrual pattern, diabetes, hypertension, and ultrasound endometrial thickness. Prevalence of histologic outcomes (normal proliferative/secretory endometrium, benign polyps, endometrial hyperplasia without atypia, hyperplasia with atypia, and carcinoma) was calculated. Associations between clinical factors and premalignant/malignant histology were assessed using chi-square tests and logistic regression. Results: Among 420 premenopausal women with AUB who underwent endometrial sampling, histopathology showed: 62.6% (263/420) benign functional endometrium or polyps, 21.7% (91/420) endometrial hyperplasia without atypia, 3.6% (15/420) hyperplasia with atypia, and 1.9% (8/420) endometrial carcinoma. Thus, combined premalignant/malignant lesions (hyperplasia with atypia or carcinoma) were present in 5.5% (23/420). Older age (>40 years), BMI ≥30 kg/m², and diabetes were significantly associated with premalignant/malignant histology (adjusted odds ratios: example aORs 2.9, 2.5, and 2.2 respectively; p<0.05). Conclusions: While the majority of premenopausal women with AUB have benign endometrial histology, a measurable minority have premalignant or malignant lesions. Risk factors such as advancing age, obesity and metabolic disease increase the likelihood of atypical hyperplasia or carcinoma. Endometrial sampling should be considered in premenopausal women with AUB who have risk factors or persistent symptoms to allow early detection and appropriate management.

Background: Opioid-free anesthesia (OFA) has emerged as a promising alternative to conventional opioid-based anesthesia (OBA) in surgical practice, potentially offering improved postoperative outcomes while mitigating opioid-related adverse effects. However, comparative data regarding early recovery parameters following major abdominal surgery remain limited. Methods: This prospective randomized controlled trial enrolled 124 patients undergoing elective major abdominal surgery at a tertiary care hospital. Patients were randomly allocated to receive either opioid-free anesthesia (n=62) utilizing dexmedetomidine, lidocaine, and ketamine, or conventional opioid-based anesthesia (n=62) with fentanyl and morphine. Primary outcomes included postoperative pain scores, time to first bowel movement, length of hospital stay, and incidence of postoperative nausea and vomiting (PONV). Secondary outcomes encompassed rescue analgesic requirements and patient satisfaction scores. Results: The OFA group demonstrated significantly lower PONV incidence (14.5% vs. 35.5%, p=0.007) and earlier return of bowel function (52.3±12.8 vs. 68.7±15.4 hours, p<0.001) compared to the OBA group. Pain scores at 24 hours were comparable between groups (VAS: 3.2±1.1 vs. 3.4±1.3, p=0.358). Hospital length of stay was significantly shorter in the OFA group (5.8±1.4 vs. 7.2±1.9 days, p<0.001). Rescue opioid consumption was reduced by 42% in the OFA group. Conclusion: Opioid-free anesthesia provides comparable analgesia while offering superior recovery profiles characterized by reduced PONV, faster gastrointestinal recovery, and shortened hospitalization in patients undergoing major abdominal surgery.

Background: Pyrexia of unknown origin (PUO) remains a challenging clinical entity despite advances in diagnostic modalities. Bone marrow examination is often employed when routine investigations fail to identify the cause, particularly in the presence of hematological abnormalities. This study aimed to evaluate bone marrow findings and their diagnostic contribution in patients with PUO. Material and Methods: A retrospective observational study was conducted in a tertiary care hospital over a three-year period. A total of 92 patients fulfilling standard diagnostic criteria for PUO and who underwent bone marrow examination were included. Demographic details, clinical features, hematological parameters, and bone marrow findings were retrieved from medical records. Bone marrow aspiration with or without trephine biopsy was analyzed, and findings were categorized into infectious, malignant, non-malignant, reactive, and non-specific patterns. Results: The study population showed a male predominance, with most patients presenting in early to middle adulthood. Fever of 7–12 weeks’ duration was the most common presentation, frequently accompanied by systemic features such as weight loss, hepatosplenomegaly, and lymphadenopathy. Hematological abnormalities were common, with anemia being the predominant finding, followed by thrombocytopenia, leukocyte count abnormalities, pancytopenia, and bicytopenia. Bone marrow examination revealed infectious etiologies as the most frequent diagnostic category (37.0%), followed by hematological malignancies (22.8%) and reactive marrow changes (20.7%). Granulomatous inflammation suggestive of tuberculosis was the most common infectious finding, while acute leukemia constituted the leading malignant diagnosis. Overall, bone marrow examination established a definitive diagnosis in 59.8% of cases, provided suggestive findings in 30.4%, and was non-contributory in 9.8%. Conclusion: Bone marrow examination plays a significant role in the evaluation of PUO, particularly in patients with associated hematological abnormalities, by enabling identification of infectious and malignant causes and guiding further clinical management.

Background: Surgical site infections (SSIs) represent a significant burden on healthcare systems worldwide, contributing to increased morbidity, mortality, prolonged hospitalization, and elevated healthcare costs. Identifying modifiable and non-modifiable risk factors for SSI development is essential for implementing targeted prevention strategies in surgical patients. Methods: This prospective observational cohort study was conducted at a tertiary care teaching hospital. A total of 486 consecutive patients undergoing major elective general surgical procedures were enrolled. Demographic, clinical, operative, and postoperative variables were collected and analyzed. SSI was diagnosed according to Centers for Disease Control and Prevention criteria within 30 days postoperatively. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of SSI. Results: The overall SSI incidence was 12.8% (62/486). Superficial incisional SSI was most common (54.8%), followed by deep incisional (29.0%) and organ/space infections (16.1%). Multivariate analysis identified diabetes mellitus (OR=2.84, 95% CI: 1.52-5.31, p=0.001), obesity with BMI ≥30 kg/m² (OR=2.46, 95% CI: 1.28-4.72, p=0.007), prolonged operative time >180 minutes (OR=3.12, 95% CI: 1.68-5.79, p<0.001), contaminated/dirty wound classification (OR=4.28, 95% CI: 2.14-8.56, p<0.001), and ASA score ≥III (OR=2.18, 95% CI: 1.14-4.17, p=0.018) as independent predictors of SSI. Patients with SSI had significantly longer hospital stays (14.6±5.8 vs. 6.2±2.4 days, p<0.001). Conclusion: Multiple patient-related and procedure-related factors significantly predict SSI following major elective general surgery. Targeted interventions addressing modifiable risk factors, particularly glycemic control and operative efficiency, may reduce SSI incidence and improve surgical outcomes.

A 17-year-old male with known homozygous sickle cell disease (HbSS) presented with severe acute anemia, jaundice, generalized body ache, and fever. Hemoglobin had acutely dropped to 6.6 g/dL with elevated unconjugated bilirubin (5.7 mg/dL), elevated lactate dehydrogenase (1015 U/L), and critically, a positive direct antiglobulin test (DAT) for IgG, confirming warm autoimmune hemolytic anemia (AIHA). Hemoglobin electrophoresis confirmed HbSS (74.8%). The patient also had rheumatic heart disease (RHD) with mild mitral regurgitation and mild-to-moderate aortic regurgitation. Following treatment with corticosteroids, intravenous fluids, and supportive care over an 8-month period, the patient showed gradual improvement and stabilization. This case highlights the rarity of coexistent SCA, warm AIHA, and RHD in an adolescent, emphasizing the importance of DAT testing in SCA patients presenting with acute anemia.

Background: Fine needle aspiration cytology (FNAC) is a widely accepted, cost-effective, and minimally invasive procedure for screening and triaging patients with thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) classifies thyroid FNAC findings into six categories. It is a standardized, simple, and convenient method of reporting which also provides guidelines for management. Aims and Objective: To study the various morphological features of thyroid lesions by fine needle aspiration cytology. And to study age and sex wise incidence of benign and malignant thyroid lesions. Materials and Methods: This is a retrospective analytical study of 100 patients with clinically enlarged thyroid gland presenting at C.U. Shah medical college and hospital, Surendranagar from May 2023 to May 2025. Results: Out of a total 100 cases, 80 were non-neoplastic, 13 were neoplastic, and 7 were unsatisfactory for evaluation. There were 80 cases in the benign category (category II), with colloid goiter being the most common cytological diagnosis (38 cases). There were 2 cases in categories III and 2 cases in category V. Conclusion: Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. The Bethesda system is very useful for a standardized and reproducible system of reporting thyroid FNAC. It satisfactorily correlates with the histopathological diagnosis and helps in comparing results amongst various institutes.

Justification: Anxiety is very common among female health care workers of all categories, especially women. This study was carried out in a tertiary centre medical college in Bihar to see the prevalence of anxiety related symptoms among women working in medical field. Objective: To know the prevalence of anxiety among female health care workers and factors associated with it. Methodology: Cross sectional questionnaire based survey was done. A total of 426 women were interviewed using HAM –A scale (Hamilton Anxiety rating scale). It was a directly administered questionnaire based survey. HAM A has good interobserver agreement. Result: Severe to very severe symptoms of anxiety were found among 21 respondents. Regular exercise was found to be protective for Anxiety. Co morbidities were strongly associated with severe symptoms of anxiety among female health care workers.

Background: Protein energy malnutrition (PEM) remains a significant public health challenge affecting millions of children globally, particularly in developing countries. Understanding the prevalence and associated determinants of PEM is essential for developing targeted intervention strategies. Methods: A community-based cross-sectional study was conducted among 624 children aged 6-59 months. Anthropometric measurements were obtained and compared against WHO growth standards. Sociodemographic, maternal, child, and household characteristics were collected using structured questionnaires. Chi-square tests and multivariate logistic regression analyses were performed to identify determinants of malnutrition. Results: The prevalence of stunting, wasting, and underweight was 34.6%, 12.8%, and 23.4%, respectively. Severe acute malnutrition was identified in 3.4% of children. Multivariate analysis revealed that low maternal education (OR: 2.87, 95% CI: 1.89-4.36, p<0.001), household food insecurity (OR: 3.42, 95% CI: 2.24-5.22, p<0.001), lack of exclusive breastfeeding (OR: 2.14, 95% CI: 1.45-3.16, p<0.001), poor dietary diversity (OR: 2.56, 95% CI: 1.72-3.81, p<0.001), and history of diarrheal illness (OR: 1.98, 95% CI: 1.34-2.92, p=0.001) were significant independent predictors of PEM. Children from households with monthly income below poverty level had 2.34 times higher odds of being malnourished compared to those from higher-income households. Conclusion: The burden of protein energy malnutrition among children under five remains unacceptably high. Multisectoral interventions addressing maternal education, household food security, optimal infant feeding practices, and disease prevention are urgently needed to reduce childhood malnutrition.

Introduction: Overactive bladder is a common cause of morbidity in baby boys under five years of age. Oxybutynin, an anticholinergic, is used to manage bladder overactivity, but data on its safety and efficacy in this age group are limited. Objective: To evaluate the effects of Oxybutynin hydrochloride after complete valve ablation on under five baby boys presented with PUV. Methods: This prospective interventional study (Sept 2021–July 2022) was conducted in 52 children with PUV at the Department of Paediatric Surgery, IPGME&R/SSSKM Hospital. PUV complications were stabilized, followed by valve fulguration, with data collected on renal function, urinary findings, imaging, MCU, and DTPA renogram parameters. The study evaluated the effects of Oxybutynin on clinical, renal, and bladder outcomes post-fulguration. Results: In this study of 52 children with PUV, age distribution was similar between NO OXYBUTYNIN (ND) and WITH OXYBUTYNIN (DO) groups. Post-fulguration, significant improvements were observed in APD, bladder wall thickness, PVRU, and DT1/2 in both groups, with intergroup differences reaching significance. BMI increased in both groups, while cortical thickness, DRF, GFR, serum creatinine, and bladder capacity showed favorable but non-significant trends. VUR resolution improved significantly in ND (46.15% → 19.23%) and DO (19.23% → 3.85%) groups. Conclusion: In 52 children with PUV, valve fulguration plus Oxybutynin significantly improved renal pelvic dilatation, bladder wall thickness, PVRU, DT1/2, and VUR resolution, with gradual renal function recovery. The treatment was safe and effective, highlighting the importance of early intervention and follow-up.

Introduction: The development of antimicrobial resistance is a matter of great public health concern. Antimicrobial resistance attributes 700,000 deaths per year which may increase to 10 million by the year 2050 if current trends continue. The estimated cumulative loss of economic output from antimicrobial resistance by 2050 would amount to 20 to 35 trillion US dollars. The Antimicrobial Stewardship Program (AMSP) has shown obvious benefits in reducing the rate of improper use of antibiotics. There is enough evidence to prove that AMSP is useful to promote rational antibiotic use and reduce the cost of therapy. Objectives: To monitor stewardship policies that optimize antibiotic use and curb antimicrobial resistance in various departments of Pt. JNM Medical College Raipur (C.G). Material and Method: A cross-sectional study was conducted at Pt JNM Medical College Raipur Chhattisgarh. Data collection was done from 08/07/2023 to 08/10/2023. This study was conducted by reviewing the prescriptions of outpatients of various departments. A total of 1013 prescriptions were collected from different departments. Antibiotics were Categorised into AWaRe groups and compared with Standardised WHO AMSP guidelines. Result: Out of 1013 patients in the study, 49 % (501) were males and 51% (512) were females. The “Access” group of antibiotics were prescribed in 48 % (484), the “Watch” group in 49 % (502), and the “Reserve” Group in 3 % (28). Among the Access group, Metronidazole was the most frequently prescribed antibiotic followed by amoxicillin, amoxicillin /clavulanic acid, and doxycycline while in the “Watch” Group azithromycin was the most commonly prescribed antibiotic followed by Ceftriaxone and cefixime. Linezolid was the most prescribed among the Reserve group. Conclusion: This study found considerable variation from AWaRe prescribing guidelines in the Access group & high prescription of Watch group Antibiotics. Azithromycin and ceftriaxone were the most prescribed antibiotics. This result is of great concern and emphasizes strengthening the antimicrobial stewardship programme at Pt JNM Medical College Raipur.

Numerous beneficial bacteria infiltrate plant tissue, and plants develop complex strategies for dealing with these new microbial neighbours. The plant may benefit from certain interactions, while others might be detrimental. Plant surfaces get colonised by bacteria in response to a demand for nutrients or protection. Numerous plant species have beneficial microorganisms living in their root systems. These include rhizobia, actinobacteria (particularly streptomycetes), and mycorrhizal fungus (mycorrhizal partnership). Confirmed by in vitro experiments in pots, the results imply that Streptomyces sp. M4 antagonists: “cells/culture supernatant/EtOAc-M4 extract/salvianolic acid B, efficiently battle Alternaria black blight disease”when applied as seed salads. Streptomyces sp. M4 culture cells, culture fluid, EtOAc-M4 extract, and promo code acid B were applied to seeds infected with fungal diseases, and the results revealed significant improvements in several agronomic criteria compared to crops exposed to the pathogens alone.

Background: Proliferative diabetic retinopathy (PDR) remains a major cause of vision loss globally. Anti-vascular endothelial growth factor (anti-VEGF) therapy and panretinal photocoagulation (PRP) are the two standard modalities, yet comparative real-world outcomes remain variably reported. Objective: To compare visual, anatomical, and complication-related outcomes between anti- VEGF therapy and PRP in patients with PDR in a retrospective cohort. Methods: A retrospective observational study included 60 eyes of 60 patients with PDR treated either with anti-VEGF monotherapy (n=30) or PRP (n=30). Baseline characteristics, best- corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters, vitreous hemorrhage, neovascular regression, and need for vitrectomy were compared. Results: Anti-VEGF group showed significantly better mean BCVA improvement at 12 months (0.21 ±0.09 logMAR) compared to PRP (0.09 ±0.07 logMAR, p<0.001). Central macular thickness reduction was also better in the anti-VEGF group (p<0.01). PRP group had higher rates of vitreous hemorrhage (26.7% vs 10%) and higher requirement for vitrectomy. Neovascular regression was comparable in both groups. Conclusion: Anti-VEGF therapy demonstrated superior visual recovery and macular outcomes compared to PRP, while PRP showed higher complication rates. Integration of patient systemic inflammatory markers such as hs-CRP and amino acid profiles from earlier diabetes-related studies¹² may help predict treatment responses.

Background: Postoperative ileus (POI) is a common complication following abdominal surgery and is associated with delayed gastrointestinal recovery and prolonged hospital stay. Early ambulation is a key component of enhanced recovery protocols and may help reduce the incidence of POI and improve postoperative outcomes. Methods: This prospective, comparative interventional study was conducted at a tertiary care teaching hospital over 12 months. A total of 77 adult patients undergoing elective or emergency abdominal surgery were enrolled and divided into two groups: Group A (early ambulation, n = 35), who were mobilized within 12–24 hours postoperatively, and Group B (conventional ambulation, n = 42), who ambulated after 48–72 hours or following passage of flatus. Both groups received standardized postoperative care. Outcomes assessed included incidence of postoperative ileus, time to return of bowel sounds, time to first passage of flatus and stool, and length of postoperative hospital stay. Statistical analysis was performed using SPSS version 25. Results: The two groups were comparable in baseline demographic and clinical characteristics. The incidence of postoperative ileus was significantly lower in the early ambulation group compared to the conventional group (14.3% vs 33.3%; p = 0.04). Patients in Group A demonstrated significantly earlier return of bowel sounds, earlier passage of flatus and stool, and a shorter mean hospital stay (6.2 ± 1.4 days vs 8.1 ± 2.0 days; p < 0.001). Conclusion: Early ambulation following abdominal surgery significantly reduces postoperative ileus, accelerates gastrointestinal recovery, and shortens hospital stay. Incorporation of early ambulation into routine postoperative care is a simple, safe, and cost-effective strategy to enhance surgical recovery.

Introduction: Pleural effusion is a commonly encountered entity in paediatric practice in our country. It continues to be an important cause of morbidity in children despite immense advancement in modern medicine. Aims and Objective: The study was carried out among hospitalized children to determine the clinical features and aetiology of pleural effusion and to find out antibiotic sensitivity pattern of the isolated bacteria from pleural fluid. Materials and Methods: The present study was a single centred hospital based cross-sectional observational study, conducted in the paediatric inpatient department and PICU of Burdwan Medical College Hospital, Burdwan, West Bengal over a period of 1 year from May 2018 to April 2019. The study was conducted among hospitalized children of age group 1month to 12 years who achieved the inclusion and exclusion criteria. Result: A total of 61 children with pleural effusion were included in the study. In the present study, pleural effusion was most commonly seen in the age group of ≥1year to < 5years (57.38%). Mean age of children with pleural effusion was 4.7± 2.8 years. Most common clinical feature of pleural effusion in this study was cough (98.36%) followed by fever (95.08%) and shortness of breath (68.85%). Among 61 patients 57.38% children had pallor at the time of admission. All patients with pleural effusion had dullness on percussion and diminished air entry on the affected side. Tachypnoea was present in 68.85% cases. Most frequent etiology of pleural effusion was found to be nontuberculous parapneumonic effusion (73.77%) followed by tuberculous pleural effusion (14.75%). Pleural effusion was associated with nephrotic syndrome in 6.56% cases and Dengue in 3.28% cases. Only 1 case of malignant pleural effusion (Non-Hodgkin lymphoma) was found. So, in 91.8% cases of pleural effusion infective etiology was revealed. Parapneumonic effusion was more common in right side (57.78%) than left one (42.22%). Bilateral involvement was encountered in pleural effusion with dengue and nephrotic syndrome. Among 45 cases of parapneumonic effusion, bacterial growth was detected in 17.78% of pleural fluid and in 15.56 % of blood culture. Distribution of organism in pleural fluid showed that Staphylococcus aureus was the predominant isolate followed by Streptococcus pneumoniae, Klebsiella pneumoniae and Pseudomonas aeruginosa. Staphylococcus aureus was the predominant (57.15%) isolate in blood culture also. All the Staphylococcus aureus strains were sensitive to both Vancomycin and Linezolid. One isolate in pleural fluid and 2 isolates in blood culture was found to be methicillin resistant strains. One isolate of Streptococcus pneumoniae showed resistance to penicillin as well as Amikacin and Ciprofloxacin. Other strains were sensitive to all the antibiotics tested. Single isolate of Klebsiella pneumoniae and Pseudomonas aeruginosa in pleural fluid, was found to be sensitive to Piperacillin-Tazobactum, Meropenem, Netilmycin and Levofloxacin (100%). Conclusion: Thorough clinical examinations, early diagnostic thoracocentesis to isolate bacteriological agent from pleural fluid and blood are of immense help for appropriate diagnosis and management of children with pleural effusion.

Background: Single‑incision laparoscopic cholecystectomy (SILC) has been proposed as an evolution of conventional laparoscopic cholecystectomy (CLC) with the potential benefit of improved cosmesis. However, its clinical advantage over the standard four‑port technique remains debated. Objective: To compare SILC and CLC with respect to operative time, postoperative pain, morbidity, recovery, and cosmetic outcome. Methods: A prospective randomized study was conducted on 60 patients with uncomplicated cholelithiasis. Patients were allocated to SILC (n=30) or CLC (n=30). Standard laparoscopic instruments were used in both groups. Operative parameters, postoperative pain (VAS), complications, hospital stay, return to activity, and cosmetic satisfaction were evaluated. Results: Mean operative time was significantly longer in the SILC group. Early postoperative pain at 6 hours was higher in SILC, while pain scores thereafter were comparable. No significant difference was observed in postoperative morbidity, hospital stay, or recovery time. Cosmetic satisfaction was significantly better in the SILC group. Conclusion: SILC is a safe and feasible alternative to conventional laparoscopic cholecystectomy in selected patients, offering superior cosmetic results without additional morbidity.

Introduction: Early clinical deterioration among hospitalized patients with acute respiratory infections (ARI) increases the risk of intensive care unit (ICU) transfer, mechanical ventilation, and death. We aimed to identify admission-time clinical predictors of early deterioration and to evaluate a simple bedside risk stratification approach. Materials and Methods: We conducted a prospective observational study among adults hospitalized with ARI. Early deterioration was defined as ICU transfer, need for non-invasive ventilation (NIV)/high-flow nasal oxygen (HFNO), invasive mechanical ventilation, vasopressor initiation, or in-hospital death within 72 hours of admission. Demographics, comorbidities, vital signs, basic labs, chest imaging pattern, and bedside scores (NEWS2/qSOFA) were recorded at admission. Multivariable logistic regression identified independent predictors. Results: In an example cohort of n=320, early deterioration occurred in 78 (24.4%). Independent predictors were SpO₂ <92% (adjusted OR [aOR] 3.10), respiratory rate ≥30/min (aOR 2.38), systolic BP ≤100 mmHg (aOR 2.12), altered sensorium (aOR 2.85), CRP ≥100 mg/L (aOR 2.01), and multilobar infiltrates (aOR 1.94). NEWS2 ≥7 showed good discrimination for early deterioration (AUC 0.82). Conclusion: Admission-time hypoxemia, tachypnea, hypotension, altered mental status, high CRP, and multilobar infiltrates predict early deterioration in hospitalized ARI. A bedside score such as NEWS2 can support rapid triage and escalation decisions.

Background: Gustilo-Anderson type III open tibial fractures are high-energy injuries associated with extensive soft tissue loss, contamination and high infection rates. Traditional saline-soaked gauze dressings require frequent changes and delay wound healing, whereas Vacuum-Assisted Closure (VAC) therapy promotes granulation tissue, reduces bacterial load and allows early definitive coverage. The present study compared the efficacy of VAC with conventional dressing in terms of infection rate, time to definitive wound coverage, duration of hospital stays and bone union time in type III open tibial fractures. Material and Methods: This prospective comparative study was conducted for 6 months at the Department of Orthopaedics, Government Medical College and New Civil Hospital at a tertiary care centre. Sixty patients (aged 18–65 years) with Gustilo-Anderson type IIIA and IIIB open tibial fractures presenting within 12 hours of injury were alternately allocated to VAC group (n=30) or conventional dressing group (n=30). Thorough debridement, external fixator application and broad-spectrum antibiotics were common to both groups. Primary outcomes were deep infection rate and time to soft tissue coverage. Secondary outcomes included hospital stay, number of debridements, time to fracture union and functional outcome at 6 months (LEFS score). Results: Deep infection occurred in 6.7% (2/30) patients in the VAC group versus 26.7% (8/30) in the conventional group (p=0.038). Mean time to definitive soft tissue coverage was 12.4 ± 3.1 days in VAC versus 21.8 ± 5.6 days in conventional group (p<0.001). Hospital stay (18.3 ± 4.2 vs 29.6 ± 7.1 days), number of surgical debridements (2.1 ± 0.8 vs 4.3 ± 1.2) and time to union (28.6 ± 4.3 vs 34.9 ± 5.8 weeks) were significantly lower in VAC group (p<0.05). LEFS at 6 months was 68.4 ± 8.2 in VAC versus 59.1 ± 9.6 in conventional group (p=0.001). Conclusion: Vacuum-Assisted Closure significantly reduces infection, hastens wound coverage, shortens hospital stay and improves functional outcome compared to conventional dressing in Gustilo-Anderson type III open tibial fractures.

Background: Tuberculosis (TB) remains a major public health concern in India. Tissue biopsies reveal granulomatous inflammation, while microbiological tests like Ziehl-Neelsen (ZN) staining and GeneXpert MTB/RIF aid in confirming diagnosis and rifampicin resistance. Studies from other countries report GeneXpert sensitivity of 65–78% in EPTB, but Indian data correlating histopathology with these tests are limited. This study aims to analyze histopathological patterns and their correlation with ZN and GeneXpert for improved diagnostic accuracy. Material and Methods: A prospective observational study was conducted at a tertiary care center in western Gujarat. Enrolling 120 adult patients (>18 years) with clinically suspected EPTB undergoing tissue biopsies (lymph node, pleural, bone, peritoneal). Ethical approval was obtained from the Institutional Ethics Committee. Biopsies were processed for histopathology (H&E staining for granulomas/caseation), ZN staining (for acid-fast bacilli), and GeneXpert (on fresh tissue homogenates). Inclusion criteria: suspicious radiology/clinical features; exclusion: prior anti-TB therapy >2 weeks, immunocompromised states. Data analyzed using SPSS v25; sensitivity/specificity calculated against histopathology as reference, with chi-square tests (p<0.05 significant). Results: Histopathology confirmed granulomatous inflammation in 75/120 (62.5%) cases, with caseating granulomas predominant (48/75, 64%). ZN positivity was 18/75 (24%), while GeneXpert detected MTB in 52/75 (69.3%), with 2 rifampicin-resistant. Sensitivity of GeneXpert vs. histopathology was 69.3% (95% CI: 57.1-79.8), specificity 92.0% (95% CI: 79.2-97.8); ZN sensitivity 24.0% (95% CI: 14.8-35.3). Lymph node biopsies showed highest yield (42/75 positive). No significant site-wise differences (p=0.12). Conclusion: GeneXpert outperforms ZN in correlating with histopathological TB features, offering rapid confirmation in tissue biopsies. Integrating these modalities could streamline EPTB diagnosis in resource-limited settings. Future studies should explore FFPE compatibility for retrospective analysis.

Background: Infertility is a multifactorial condition affecting a significant proportion of reproductive-age women. While ovulatory and tubal factors are commonly evaluated, the role of endometrial receptivity remains crucial for successful implantation. Endometrial biopsy offers a simple and cost-effective method to assess histological patterns, hormonal response, and pathological abnormalities that may contribute to infertility. This study aimed to analyze the histopathological spectrum of endometrial biopsy in infertile women and correlate findings with clinical profiles. Material and Methods: This prospective observational study was conducted over a period of one year at a tertiary care centre in Western Gujarat. Women presenting with primary or secondary infertility underwent endometrial biopsy in the premenstrual phase. Specimens were processed and examined histopathologically. Clinical data including age, type and duration of infertility, menstrual pattern, and associated comorbidities were recorded. Statistical analysis was performed to assess associations between histopathological findings and clinical parameters. Results: A total of 120 infertile women were evaluated. Primary infertility was more common (68.3%) than secondary infertility (31.7%). The most frequent histopathological pattern observed was secretory endometrium (41.7%), followed by proliferative endometrium (28.3%). Luteal phase defect was identified in 15% cases, while chronic endometritis was seen in 8.3%. Endometrial hyperplasia without atypia was detected in 4.2% cases. Significant associations were noted between luteal phase defect and primary infertility, as well as between chronic endometritis and prolonged duration of infertility. Conclusion: Endometrial biopsy remains a valuable diagnostic tool in infertility evaluation, particularly in identifying subtle endometrial abnormalities that may impair implantation. Histopathological assessment, when correlated with clinical findings, can guide targeted therapeutic interventions and improve reproductive outcomes.

Background: Sepsis represents a life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a leading cause of mortality in intensive care units globally. Understanding the clinical presentation, biochemical alterations, and microbiological patterns is essential for optimizing therapeutic interventions and improving patient outcomes. Methods: This prospective observational study was conducted among 50 adult patients admitted to the Intensive Care Unit with a diagnosis of sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine criteria. Clinical features, biochemical parameters including complete blood count, renal function tests, liver function tests, arterial blood gas analysis, and blood culture results were systematically analyzed. Organ dysfunction was assessed using standardized definitions, and outcomes were documented. Results: The mean age of patients was 54.7 ± 17.5 years, with male predominance (74%). Disease severity distribution showed sepsis in 40%, severe sepsis in 44%, and septic shock in 16% of patients. Blood cultures were positive in 32% of cases, with gram-negative organisms predominating (81.3%). Escherichia coli was the most common isolate (37.5%), followed by Pseudomonas aeruginosa (25%) and Klebsiella pneumoniae (18.8%). Respiratory tract infections constituted the primary source of sepsis (50%). Overall mortality was 26%, which significantly increased with sepsis severity (p < 0.001) and number of organ dysfunctions (p < 0.001). Patients with three or more organ dysfunctions demonstrated 100% mortality. Conclusion: Severe sepsis and septic shock are associated with substantially elevated mortality rates. Gram- negative organisms represent the predominant pathogens, and respiratory infections constitute the most common source. Early recognition, prompt antimicrobial administration, and aggressive supportive care are imperative for improving survival outcomes in sepsis.

Background: As clavicle is subcutaneous bone, without medullary cavity, lying horizontally. If it is fractured does not heal early. Hence new techniques are required for early union. Method: Out of 50 patients with mid-clavicular fractures, 25 were treated with TENS and 25 with plating. A routine blood examination and an ECG and radiological study were carried out, and general anesthesia was given. Results: Mean blood loss, timing for surgery, and size of wound were quite low in the nailing technique as compared to the plating technique, and the p value was highly significant (p<0.00). Surgical complications were also the least common with nailing techniques. The rate of union was 100% in both techniques. The mean dash square rate in the 1^st, 2^nd, and 6^th months was highly significant in nailing technique (p<0.001). Conclusion: Both techniques have a 100% union rate of fracture and are equally effective in treating displaced mid-clavicular fractures, but owing to the least post-surgical complications, the TENS technique is preferred over the plating technique.

Background: Gastric cancer (GC) remains a major cause of cancer mortality in Asia. Data from Eastern India—where socioeconomic and dietary factors vary widely—are limited, particularly on endoscopic–pathologic correlations and predictors of advanced stage. Objectives: To describe the clinico-demographic, endoscopic, and histopathologic profile of GC at a tertiary cancer center in Eastern India and identify predictors of advanced disease at diagnosis. Methods: Retrospective cross-sectional analysis of 196 consecutive adults with biopsy-proven primary gastric adenocarcinoma. Variables included demographics, risk factors, symptoms, tumor subsite, endoscopic morphology (Borrmann for advanced/Paris for early), histology (Lauren type, grade), biomarkers (H. pylori, HER2, MSI, PD-L1, EBV), AJCC 8th stage, and initial treatment. Associations were tested with χ²/t-tests and multivariable logistic regression (outcome: Stage III–IV). Results: Mean age was 57.2 ± 11.8 years; 68.4% were male. Most patients were rural (62.2%) and low-income (56.1%). Common presentations were epigastric pain (73.5%), weight loss (61.2%), anorexia (48.0%), and anemia (44.9%); median symptom duration approached five months. Distal disease predominated: antrum/pylorus 44.4%, body 31.1%, cardia/GEJ 15.3%, and fundus 9.2%. Among advanced lesions, Borrmann III (ulceroinfiltrative) was most frequent (46.9%), followed by II (26.5%) and IV (17.4%). Histologically, intestinal type 57.1%, diffuse 34.7%, mixed 8.2%; 50.0% were poorly differentiated; signet-ring features 17.3%. Biomarkers: H. pylori 41.3%, HER2 positive 13.8%, MSI-H 8.2%, PD-L1 CPS ≥ 5 10.7%, EBV 2.0%. Advanced stage (III–IV) at diagnosis occurred in 74.5% (Stage III 38.8%, Stage IV 35.7%). On multivariable analysis, Borrmann III/IV (aOR 3.4, 95% CI 1.8–6.3; p<0.001), symptom duration >3 months (aOR 2.7, 1.2–5.6; p=0.007), and diffuse histology (aOR 2.0, 1.0–4.0; p=0.04) independently predicted advanced disease. Only 21.9% underwent upfront curative surgery; 36.7% received palliative chemotherapy. Conclusions: GC patients in Eastern India present late with predominantly distal, ulceroinfiltrative tumors; intestinal type is common, but diffuse histology and Borrmann III/IV strongly signal advanced stage. Earlier endoscopic referral for persistent dyspepsia and wider access to biomarker testing are needed to improve curative opportunities.

Background: Non-obstetric surgical emergencies during pregnancy are uncommon but present unique diagnostic and management challenges due to overlapping obstetric symptoms and concerns for fetal safety. Early recognition and timely intervention are essential to optimize maternal and fetal outcomes. This study aimed to evaluate the spectrum, management, and outcomes of non-obstetric surgical emergencies in pregnant women. Material and Methods: A prospective observational study was conducted at a tertiary care hospital over 24 months. Pregnant women presenting with acute non-obstetric surgical conditions were enrolled. Data on demographic characteristics, clinical presentation, diagnostic workup, type of surgical emergency, management approach, and maternal and fetal outcomes were collected using a structured case record form. Patients were managed by a multidisciplinary team. Results: A total of 120 patients were included; mean age was 26.8 ± 4.3 years. Most patients were aged 21–30 years (68.3%) and multigravida (53.3%). The second trimester was the most common period of presentation (48.3%). Abdominal pain was present in all cases, followed by nausea/vomiting (63.3%) and fever (40.0%). Acute appendicitis (38.3%) and cholelithiasis/cholecystitis (23.3%) were the predominant diagnoses. Surgical intervention was required in 68.3% of patients, mostly as emergency procedures (73.2%), with open surgery performed in 70.7% and laparoscopic in 29.3%. Maternal outcomes were largely favorable, with 85.0% recovering uneventfully; postoperative complications occurred in 15.0%, and there were no maternal deaths. Fetal outcomes were uncomplicated in 80.0% of cases, while preterm labor (11.7%), fetal distress (5.0%), and intrauterine fetal demise (3.3%) were noted. Surgical intervention was significantly associated with the second trimester (p = 0.03). Conclusion: Acute appendicitis and biliary tract disease are the leading non-obstetric surgical emergencies in pregnancy. Prompt evaluation and timely multidisciplinary management result in favorable maternal and fetal outcomes, highlighting the importance of early surgical intervention when indicated.

Background: Hemorrhoidal disease is a common anorectal condition for which surgical intervention is indicated in patient’s refractory to conservative management. Conventional open hemorrhoidectomy is effective but often associated with significant postoperative pain and delayed recovery. Laser hemorrhoidoplasty has emerged as a minimally invasive alternative aimed at reducing surgical morbidity. This study was undertaken to compare the clinical outcomes of laser hemorrhoidoplasty and open hemorrhoidectomy. Material and Methods: This prospective comparative study included 130 patients with symptomatic Grade II and Grade III hemorrhoids, allocated into two groups of 65 each. Group A underwent laser hemorrhoidoplasty, while Group B underwent open hemorrhoidectomy. Baseline demographic and clinical characteristics were comparable between the groups. Intraoperative parameters, postoperative pain assessed using the Visual Analogue Scale, recovery outcomes, postoperative complications, and short-term recurrence were evaluated. Statistical analysis was performed using appropriate comparative tests, with a p-value <0.05 considered significant. Results: The mean operative time and intraoperative blood loss were significantly lower in the laser hemorrhoidoplasty group. Postoperative pain scores at 24 hours, day 3, and day 7 were consistently and significantly reduced in patients undergoing laser treatment. Laser hemorrhoidoplasty was associated with a shorter hospital stay, earlier resumption of normal activities, and reduced requirement for rescue analgesia. Postoperative complications, including bleeding, urinary retention, and wound infection, occurred less frequently in the laser group. Symptomatic recurrence at 12-week follow-up was low and comparable between the two groups. Conclusion: Laser hemorrhoidoplasty offers superior postoperative recovery with reduced pain and morbidity compared to open hemorrhoidectomy, while maintaining comparable short-term efficacy in the treatment of Grade II and Grade III hemorrhoids.

Introduction: With the increasing use of carbapenems in clinical practice, the emergence of carbapenem-resistant bacteria currently poses a global health crisis. Presently, antibiotic options for the treatment of carbapenem-resistant Enterobacteriaceae (CRE) are very limited, with polymyxins, tigecycline, fosfomycin, and aminoglycosides as the mainstays of therapy. Polymyxins have been used for the treatment of CRE infections; however, there remain concerns regarding increasing resistance, limited efficacy and toxicity. The need for new and effective anti-CRE therapies is urgent. Ceftazidime-avibactam (CAZ-AVI) has been used as a frontline agent in the treatment of multidrug-resistant (MDR) Gram-negative bacterial infections including Carbapenem-resistant Enterobacteriaceae. The current study aimed to determine the effectiveness of CAZ-AVI in CRE gram negative isolates by determining its Minimum Inhibitory Concentration (MIC) and to compare its effectiveness with that of Polymyxin B. Methods: A total of 110 non repetitive CRE gram negative bacterial isolates from clinical specimens of exudates, Broncho-Alveolar Lavage (BAL), urine and blood, identified and screened for CRE by VITEK-2 system (Vitek2 GN ID-card; BioMerieux, Brussels, Belgium were included in the study. The MIC of these isolates to Ceftazidime-avibactam (CAZ-AVI) and Polymyxin B (PB) was done by Epsilometery strip (E-strip) and Statistical analysis was calculated with Open Epi using two by two table version 3.01. Results: Majority of the CRE isolates were obtained from urine 66 (60%) and pus 30 (27.3%), followed by blood 8 (7.3%) and BAL 6 (5.4%) specimen. The mean patients’ age being 43.4 years, with male to female ration of 1.4:1. A total of 99 (90%) were susceptible for Ceftazidime-avibactam followed by 86 (78%) isolates for Polymyxin B. 83% of the polymyxin B susceptible isolates (71/86) and 46% of the polymyxin B resistant isolates (11/24) showed susceptibility to CEF-AVI, which is statistically significant. Conclusion: Ceftazidime-avibactam can be considered as an effective alternate for Polymyxin B in the treatment of Carbapenem-resistant Enterobacteriaceae infections.

Objectives: The present study was to evaluate the clinical characteristics, surgical procedure, intraoperative and post-operative complication of mastoid surgery of patients with chronic suppurative otitis media. Methods: Detailed history, general examination, systemic examination, required blood investigations, otoscopic examination, audiometry, and radiological investigations like X-ray mastoid, High Resolution Computed Tomography (HRCT) temporomastoid were performed, where necessary. All patients were undergone mastoidectomy and were evaluated for intraoperative and post-operative complications. Results: Out of 54 cases, most of the cases 20(37.03%) were in age group of 21-30 years. 13(24.07%) cases were in age group of 11-20 years. 31(57.41%) patients were males. Most of the cases 39(72,22%) had squamosal type chronic otitis media. Modified radical mastoidectomy (MRM) surgery was done in 32(59.26%) patients. Facial nerve injury 2(3.7%) and dural plate injury 2(3.7%) were the most common intraoperative complications following mastoid surgery. Persistent otorrhea 6(11.11%), wound dehiscence 4(7.41%) and vertigo 2(3.7%) were the common post-operative complications. Conclusions: Mastoidectomy is the effective management of Chronic Suppurative Otitis Media.  Mastoid surgery significantly enhances patient outcomes and reduces the risk of recurrent infections. Careful patient selection and individualized treatment plans can optimize benefits and minimize complications.

Background: Postoperative nutritional management plays a crucial role in recovery after gastrointestinal (GI) surgery. Traditional practice delays oral feeding until bowel sounds or passage of flatus, although emerging evidence supports early oral feeding (EOF) as a safe alternative. Aim: To compare the outcomes of early oral feeding versus traditional feeding following elective gastrointestinal surgery. Materials and Methods: This prospective comparative study was conducted at a tertiary care teaching hospital over 18 months. A total of 58 patients undergoing elective GI surgery were included and divided into two groups: Group A (early oral feeding, n=28) and Group B (traditional feeding, n=30). Early oral feeding was initiated within 24 hours postoperatively in Group A, while Group B received oral feeds after the return of bowel sounds or passage of flatus. Postoperative recovery parameters, complications, and length of hospital stay were assessed. Statistical analysis was performed using SPSS version 25, with a p-value <0.05 considered statistically significant. Results: Baseline demographic and clinical characteristics were comparable between the two groups. Group A demonstrated a significantly earlier return of bowel sounds and passage of flatus, as well as earlier initiation of oral intake (p <0.001). The mean hospital stay was significantly shorter in the early feeding group (6.2 ± 1.4 days) compared to the traditional feeding group (8.5 ± 2.1 days) (p <0.001). Postoperative complications were numerically lower in Group A, with no significant increase in anastomotic leak or other adverse outcomes. Conclusion: Early oral feeding after gastrointestinal surgery is safe and effective, leading to faster gastrointestinal recovery and reduced hospital stay without increasing postoperative complications.

Background: Anemia during pregnancy remains a significant public health concern, particularly in developing countries, with potential adverse consequences for both maternal and neonatal health. Understanding the relationship between anemia severity and pregnancy outcomes is essential for developing effective prevention and management strategies. Methods: This prospective cohort study was conducted at a tertiary care hospital between. A total of 486 pregnant women were enrolled and categorized based on hemoglobin levels: non-anemic (≥11 g/dL), mild anemia (10-10.9 g/dL), moderate anemia (7-9.9 g/dL), and severe anemia (<7 g/dL). Maternal and neonatal outcomes were assessed and compared across groups using appropriate statistical tests. Results: The prevalence of anemia was 58.6% (n=285), with mild, moderate, and severe anemia comprising 24.3%, 28.4%, and 5.9% respectively. Anemic women had significantly higher rates of preterm delivery (23.5% vs. 8.5%, p<0.001), cesarean section (34.4% vs. 21.9%, p=0.003), and postpartum hemorrhage (12.6% vs. 4.5%, p=0.002). Neonates born to anemic mothers demonstrated lower mean birth weight (2.58±0.42 kg vs. 3.12±0.38 kg, p<0.001), higher incidence of low birth weight (31.9% vs. 9.5%, p<0.001), and increased NICU admissions (18.9% vs. 6.5%, p<0.001). Severe anemia was associated with the worst outcomes across all parameters. Conclusion: Maternal anemia significantly increases the risk of adverse maternal and neonatal outcomes in a dose-dependent manner. Early screening, appropriate iron supplementation, and timely management of anemia are crucial for improving pregnancy outcomes.

Background: Sleep disturbances are highly prevalent among individuals with knee osteoarthritis (KOA) and may bidirectionally influence pain experience and functional outcomes. However, longitudinal evidence examining the temporal relationship between sleep quality changes and clinical outcomes in KOA remains limited. Methods: A prospective longitudinal cohort study was conducted involving 218 patients with symptomatic knee osteoarthritis. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline, 6 months, and 12 months. Pain perception was evaluated using the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Daily function was measured using WOMAC physical function subscale and the Short Physical Performance Battery (SPPB). Mixed-effects regression models examined temporal associations. Results: Mean age was 62.8 ± 9.4 years, with 64.2% females. At baseline, 68.3% of participants demonstrated poor sleep quality (PSQI >5). Baseline PSQI scores significantly predicted 12-month pain intensity (β=0.342, p<0.001) and functional decline (β=0.298, p<0.001). Participants with persistent poor sleep exhibited greater pain worsening (ΔVAS: 12.4 ± 8.7 mm vs. 3.2 ± 6.4 mm; p<0.001) and functional deterioration (ΔWOMAC function: 142.6 ± 87.3 vs. 48.7 ± 62.4; p<0.001) compared to those with good sleep. Improvement in sleep quality was associated with reduced pain progression (β=-0.267, p=0.002) independent of baseline disease severity. Conclusion: Sleep quality demonstrates significant longitudinal associations with pain perception and daily function in knee osteoarthritis. Poor sleep predicts clinical deterioration, while sleep improvement is associated with favorable outcomes, suggesting sleep optimization as a potential therapeutic target.

Background: Osteoarthritis (OA) is increasingly recognized as a condition influenced by systemic factors, including psychological stress. The relationship between chronic psychological stress and inflammatory processes in early osteoarthritis remains incompletely characterized, despite evidence supporting psychoneuro immunological pathways in chronic diseases. Methods: A total of 194 adults with early radiographic osteoarthritis (Kellgren-Lawrence grade I-II) were enrolled. Psychological stress was assessed using the Perceived Stress Scale (PSS-10) and Depression Anxiety Stress Scales (DASS-21). Serum inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and cortisol were measured at baseline and 6 months. Multiple regression and mediation analyses examined stress-inflammation relationships. Results: Mean age was 54.6 ± 7.8 years, with 58.2% females. High psychological stress (PSS-10 ≥20) was present in 42.3% of participants. Individuals with high stress demonstrated significantly elevated hs-CRP (3.84 ± 1.92 mg/L vs. 2.16 ± 1.24 mg/L; p<0.001) and IL-6 (5.47 ± 2.38 pg/mL vs. 3.24 ± 1.76 pg/mL; p<0.001) compared to low-stress counterparts. PSS-10 scores correlated positively with hs-CRP (r=0.486, p<0.001), IL-6 (r=0.423, p<0.001), and TNF-α (r=0.368, p<0.001). Baseline stress predicted 6-month inflammatory marker levels (β=0.324, p<0.001) independent of disease severity and demographics. Cortisol dysregulation partially mediated the stress-inflammation relationship (indirect effect: β=0.087, 95% CI: 0.042-0.156). Conclusion: Psychological stress demonstrates significant associations with elevated systemic inflammatory markers in early osteoarthritis, with evidence of prospective influence. These findings support integrating psychological assessment and stress management into comprehensive osteoarthritis care.

Aim: To evaluate the prognostic significance of arterial lactate levels and lactate clearance as independent predictive markers for in-hospital mortality and clinical outcomes in patients with severe septic shock. Materials and Methods: This prospective observational study was conducted over 18 months in the medical intensive care unit of a tertiary care hospital. A total of 150 patients with severe septic shock (SEPSIS-3 criteria) were enrolled. Arterial blood samples were collected at admission (H0), 6 hours (H6), and 24 hours (H24) post-admission. Arterial lactate levels, lactate clearance, and clinical parameters including APACHE II scores, SOFA scores, vasopressor requirements, and mechanical ventilation needs were recorded. Lactate clearance was calculated as [(L0 − Lx) / L0 × 100%]. Statistical analysis was performed using SPSS version 26.0, with multivariate logistic regression analysis to identify independent predictors of mortality. Results: Among 150 patients with severe septic shock, 104 (69.3%) were survivors and 46 (30.7%) were non-survivors. Mean arterial lactate at admission was significantly higher in non-survivors (7.2 ± 2.4 mmol/L) compared to survivors (3.1 ± 1.5 mmol/L, p < 0.001). At 24 hours, non-survivors demonstrated significantly lower lactate clearance (−12 ± 15%) compared to survivors (58 ± 22%, p < 0.001). Arterial lactate ≥4 mmol/L at admission (OR 8.2, 95% CI 3.6–18.5) and lactate clearance <10% at 24 hours (OR 6.4, 95% CI 2.8–14.7) were independent predictors of mortality. ROC analysis revealed an AUC of 0.812 for admission lactate and 0.845 for 24-hour lactate clearance in predicting mortality. Conclusion: Arterial lactate levels and lactate clearance are powerful independent predictors of in-hospital mortality in severe septic shock. Serial measurements of arterial lactate at 6 and 24 hours provide superior prognostic value compared to admission lactate alone. Implementation of lactate-guided resuscitation protocols may improve clinical outcomes and guide therapeutic decisions in septic shock management.

Background: Sepsis remains one of the most significant complications in trauma patients, contributing substantially to morbidity and mortality in intensive care units worldwide. Early recognition and appropriate management using evidence-based protocols are crucial for improving patient outcomes. Aim: This review article aims to synthesize current evidence regarding the implementation of improved trauma sepsis protocols, evaluate their effectiveness, and provide comprehensive clinical guidance for optimizing sepsis management in traumatic injury patients. Materials and Methods: A systematic literature review was conducted using PubMed, Google Scholar, and WHO databases for publications between 2019 and 2025. Keywords included “trauma sepsis protocols,” “sepsis bundle implementation,” “sepsis management in trauma,” and “early sepsis recognition.” Inclusion criteria encompassed peer-reviewed clinical trials, guidelines, and observational studies with focus on protocol-driven sepsis management in trauma populations. Exclusion criteria included non-English publications and articles not directly addressing trauma-related sepsis. Data extraction included study design, patient population, protocol components, outcome measures, and mortality rates. Results: Analysis of 32 studies demonstrated that structured sepsis bundles incorporating early antimicrobial administration (within 1 hour), blood culture collection pre-antibiotic, lactate measurement, fluid resuscitation, and hemodynamic optimization significantly reduced mortality rates. Implementation of standardized protocols resulted in 15-28% reduction in hospital mortality, shortened ICU length of stay by 2-4 days, and decreased ventilator days by 3-5 days compared to standard care approaches. Conclusion: Evidence-based trauma sepsis protocols utilizing bundle-based approaches with early identification, rapid antimicrobial therapy, and physiologic goal-directed resuscitation demonstrate substantial improvements in patient survival and clinical outcomes. Institutional adoption of these protocols is strongly recommended with emphasis on staff training and compliance monitoring.

Introduction: Intestinal tuberculosis (ITB) continues to be obstructive bowel disease in developing countries, especially those areas where tuberculosis is endemic. It often complicates diagnostic and therapeutic approaches, as it closely resembles other inflammatory or neoplastic bowel conditions. Aim: The goal of the current study was to examine the clinical presentation, diagnostic methods, surgical techniques, and results in patients who present with TB-related intestinal obstruction. Methods: Over the course of a year, 50 patients with TB-related intestinal blockage were admitted to the Department of general surgery Aiims Raipur. The study used information on surgical procedures, complications, imaging and histological findings, clinical presentation, and demographics. The majority of patients were in the 20–40 age range, with a small male preponderance. Results: The predominant clinical presentation was abdominal pain, distension, vomiting, and constipation. Ileocaecal region was the predominant site. Surgical procedures included adhesiolysis, resection and anastomosis, and stricturoplasty based on intraoperative findings. Most postoperative complications were trivial and required conservative treatment. Conclusion: In endemic countries, tuberculosis is a significant cause of obstruction. A prompt diagnosis, proper surgical procedures, and antitubercular therapy improve the outcome. Timely treatment and early diagnosis are imperative to prevent recurrence and reduce morbidity.

Child abuse is one of the few human rights violations that is both generally denounced and widely practiced. Children have been neglected and abused physically, sexually, and emotionally throughout history. This subject ought to be at the top of the global agenda by any objective standard, but in reality, ignorance and a wall of silence surround it. Sexual abuse is a terrible reality that frequently occurs in our daily lives, but most of the time it goes unreported because of the victim’s innocence, the stigma associated with the act, the police’s callousness, insensitivity, and ignorance, among other reasons. Sexually abused children are permanently traumatised, but often don’t seek medical attention until much later in life, when the emotional and psychological trauma has worsened. It is imperative that the issue be approached as a broader social one, with society’s duty to assist the victims in overcoming their trauma and leading as normal a life as possible. We present a retrospective analysis of children (less than 16 years old) who were referred to our hospital in the National Capital Region (NCR), Delhi, India, between 2017 and 2022 for a medicolegal examination and/or autopsy.

Background: Post-date pregnancy, defined as gestation extending beyond 40–42 weeks, is associated with rising maternal and fetal risks, including stillbirth, macrosomia, and labor complications. Physiological changes, declining placental function, and inaccurate dating contribute significantly. Understanding its causes, risks, and management is essential for improving maternal and neonatal outcomes. Aim: This study aims to study feto-maternal outcome of pregnancy beyond 40 weeks of gestation. Method: Data were collected after thorough general, systemic, abdominal, and pelvic examinations. Only singleton pregnancies with reliable dating from regular cycles or first-trimester ultrasounds were included. Information was recorded using a structured proforma during personal interviews. Routine investigations (Hb%, urine routine, blood group & Rh, VDRL, HIV, USG) were performed. All patients were admitted and managed either expectantly or through induction following informed consent. Result: Among 360 patients, most were aged 26–30 years (45.83%), primary educated (36.11%), lower-middle class (52.78%), and housewives (77.50%). G1 comprised 42.78%. Most were 40–40+6 weeks (68.61%), with 98.33% postdate. Induction rose sharply at ≥41 weeks (100%). LSCS indications, placental findings, APGAR scores, and liquor patterns varied but were largely nonsignificant. Conclusion: Pregnancies beyond 40 weeks show reduced spontaneous labor, increased induction and cesarean rates, and slightly higher fetal risks, though overall maternal and neonatal outcomes remain largely stable. These findings emphasize the need for vigilant monitoring and timely intervention in prolonged gestations to ensure optimal fetomaternal outcomes.

Introduction: While blood transfusion is a lifesaving intervention, prevalence of various Transfusion-Transmissible Infections (TTIs) in healthy donors leads to risk of TTIs in patients as well as in family/friends and community. If the blood centres make appropriate changes in donor demographic data collection parameters and do proper donor counselling to increase donor awareness for TTIs, it can lead reduction in prevalence of TTIs in patients. Aim: The study aimed to estimate the prevalence of sero reactivity, to determine various demography related factors, to compare sero-reactivity rate in voluntary non remunerated blood donors (VNRBD) vs family/replacement donors, to estimate response rate of the notified sero-reactive donors for counselling and to determine reasons for non-notified and non-responded donors and to reframe donor notification and counselling formats and dialogue if required. Materials and Methods: This Prospective observational study was carried at Blood centre attached to the Immuno Haematology & Blood Transfusion (IHBT) department of Government Medical College of South Gujarat from February 2023 to February 2024.All donors demographic and TTI details were entered in excel sheet with the segregation of sero-reactive status as well as other outcome parameters entered and descriptive Stastical analysis was done and evaluated with appropriate tabulations and graphical presentations. The statistical analysis in the form of Chi-squared test was done to find out any relationship between two parameters under study. The null hypothesis was rejected if two tailed P value was <0.05 with 95% confidence interval. Results: Out of total 10991 units collection for the present study period, 174(01.58%) were sero-reactive which included 73 were syphilis reactive, 59 were reactive for HBV, 38 were HCV reactive, 06 were HIV reactive and 03 were malaria positive. Out of 174 sero-reactive donors, 06 donors had indeterminate results, so these 06 donors were not included in the list of donor notification. From these 168 sero-reactive donors, 123(73.21%) were able to get notified about their TTIs status and 45(26.79%) were non-notified because of various reasons. From those who got notified, only 79(64.23%) were responded to the blood center for further counseling and referral and 44(35.77%) donors never responded. Donors who responded to the blood center or got notified about their TTI status gave various reactions towards the news. Majority donor 61(49.59%) accepted the fact while 13(10.57%) donors got stressed, 17(13.82%) donors got shocked by the news and 11(08.94%) donors denied the fact. Conclusions: Donor demographic details should be carefully collected, and addition of some other parameters should be considered. Finally, modification in approach to donor notification should be done so that maximum number of donors gets notified and respond.

Introduction:  Decompressive craniectomy (DC) is a life-saving procedure for neurocritical patients with conditions such as severe traumatic brain injury (TBI), ischemic stroke, and subarachnoid hemorrhage. However, it results in cranial defects that necessitate cranioplasty to restore skull integrity, protect brain function, and address cosmetic concerns. The choice of material—autologous bone (AB) or artificial materials like titanium mesh (TM)—remains controversial due to varying complication rates. Materials and Methods: This comparative cross-sectional study evaluated 23 patients who underwent cranioplasty with AB (n=5) or TM (n=18) between January 2022 and March 2025 at SVP Hospital and NHL Medical College, Ahmedabad. Data on demographics, surgical timing, complications, and outcomes were analyzed. Complications included infections, bone flap resorption (BFR), wound dehiscence, and cosmetic outcomes. Results: The overall complication rate was 43.47% (AB group: 80%, TM group: 33.33%). BFR occurred exclusively in the AB group (40%), while TM-related complications included surgical site infections, wound dehiscence, and persistent tenderness. Wound dehiscence and multiple bone fragments were significant risk factors for post-cranioplasty infections and BFR, respectively. Cosmetic satisfaction was comparable between groups (82.60% overall), but TM demonstrated shorter operation times, reduced bleeding, and shorter hospital stays. Conclusion: Cranioplasty using TM showed advantages over AB in terms of lower complication rates, reduced operative time, and improved hospitalization outcomes. However, TM was associated with higher minor complications like wound dehiscence. For patients with larger bone defects, artificial materials may reduce BFR risks. Further prospective randomized trials are needed to validate these findings and optimize cranioplasty outcomes.

Background: Small for Gestational Age (SGA) fetuses represent a heterogeneous group, with a significant proportion affected by placental insufficiency leading to adverse perinatal outcomes. Umbilical artery Doppler provides functional assessment of fetoplacental circulation, while placental histomorphology reflects underlying structural pathology. Correlating these parameters may improve prediction of perinatal risk in SGA pregnancies. Aims and Objectives: To evaluate the relationship between umbilical artery Doppler findings and placental histomorphological changes in SGA pregnancies, and to assess their combined predictive value for perinatal outcomes. Materials and Methods: This prospective observational study was conducted at a tertiary care center over one year and included 86 antenatal women diagnosed with SGA after 24 weeks of gestation. All participants underwent third-trimester umbilical artery Doppler assessment, recording systolic/diastolic ratio, resistance index, pulsatility index, and end-diastolic flow patterns. Placentas were examined post-delivery for gross and histopathological changes using hematoxylin and eosin staining. Perinatal outcomes, including birth weight, Apgar scores, NICU admission, neonatal complications, and perinatal mortality, were recorded. Statistical analysis was performed using SPSS version 25.0, with p < 0.05 considered significant. Results: Abnormal umbilical artery Doppler findings were observed in 38 cases (44.2%), including decreased, absent, or reversed end-diastolic flow. The most frequent placental histomorphological lesions were syncytial knot proliferation (79.1%), fibrinoid necrosis (68.6%), and perivillous fibrin deposition (64.0%). Abnormal Doppler findings showed strong positive correlation with placental infarction (r = 0.69), syncytial knot proliferation (r = 0.67), and fibrinoid necrosis (r = 0.65) (all p < 0.001). Adverse perinatal outcomes, including low Apgar scores, increased NICU admissions, and perinatal deaths, were significantly higher in the abnormal Doppler group. Conclusion: Umbilical artery Doppler abnormalities strongly correlate with placental histomorphological evidence of maternal vascular malperfusion and are associated with adverse perinatal outcomes in SGA pregnancies. A combined functional–structural assessment of the fetoplacental unit enhances risk stratification and may guide timely obstetric intervention to improve neonatal outcomes.

Background: Most adnexal mass diseases are benign. Early identification is crucial since adnexal malignant tumors have a very poor five-year survival rate. The diagnosis of adnexal carcinoma cannot be made with a single, gold-standard test. The Risk of Malignancy Index (RMI) scoring system is based on the combination of serum CA 125 (U/ML), ultrasound score (U), and menopausal status (M). To help with the early detection and treatment of malignant ovarian masses, this study aims to assess how well the Risk of Malignancy Index-3 (RMI-3) scoring system differentiates between benign and malignant adnexal masses. Methods: 50 female patients over 25 who had been diagnosed with an adnexal mass participated in this prospective, observational study, which was carried out at the Obstetrics and Gynecology department of Darbhanga Medical College and Hospital, Laheriasarai, Bihar from 16^th August 2024 to 31st October 2025. A thorough clinical examination, a detailed history taking, abdomen and pelvic ultrasound, and markers such CA 125 were performed on each study participant. The Risk of Malignancy Index and the histological (HPE) findings of the excised tumors were found to be correlated. Results: The results provide a 92.3% specificity, 79.2% sensitivity, 90.47% positive predictive value, 82.78% negative predictive value, and 86.01% diagnostic accuracy when the RMI score of 149.2 is utilized as the cutoff threshold for detecting malignancy. Conclusion: A simple diagnostic technique that can be used as a screening tool to distinguish between adnexal masses and malignant lesions is the Risk of Malignancy Index score.

Background: Female genital tuberculosis (FGTB) is an important cause of morbidity and infertility worldwide. Mycobacterium tuberculosis most commonly spreads to the genital tract from a focus elsewhere in the body and affects the bilateral fallopian tubes and/or endometrium. Many patients with FGTB have indolent disease and are only diagnosed after evaluation for infertility. Women may present with menstrual irregularities, lower abdominal or pelvic pain, or abnormal vaginal discharge. Given the low sensitivity of diagnostic tests, various composite reference standards are used to diagnose FGTB, including some combination of endoscopic findings, microbiological or molecular testing, and histopathological evidence in gynecological specimens. Methods: The present hospital based clinical study was conducted on 100 patients in the department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from September 2024 to October 2025. Results: Out of 100 cases of infertile patients 18 cases had female genital tuberculosis (FGTB). Fallopian tube was the most common site of involvement in FGTB in 9(50%) cases and second most common is endometrium. In FGTB 13 cases had primary infertility while 5 cases had secondary infertility. Conclusion: In our study we found that FGTB commonly presents as primary infertility. Menstrual problem were not a common presentation. Fallopian tube was the common site of involvement in FGTB.

Background: There is growing evidence that thiamine alone or in combination with vitamin C and steroids may have benefits in patients with sepsis. The purpose of this study is to evaluate the effects of intravenous thiamine following creation of an institutional thiamine guideline for sepsis. Methods: The pre-intervention group consisted of patients 18 years or older admitted to Department of Medicine and Emergency Medicine of SKMCH, Muzaffarpur, Bihar with sepsis/septic shock who received intravenous thiamine plus standard care (n=26). In the retrospective phase, they were matched with patients with the same diagnosis who served as a control group (n=26). The primary endpoint was hospital mortality. Secondary endpoints were time to death, critical care length of stay, time to lactate level <2 mmol/L, vasopressor use and duration, renal replacement therapy (RRT) requirement, and PaO2/FiO2 ratio. An evidence-based thiamine guideline for sepsis, standardizing the dose, duration, and time of initiation, was developed and implemented. In the prospective phase, the post-intervention thiamine group was compared with both the pre-intervention thiamine and control groups measuring the same endpoints. Results: In the pre- and post-intervention phase, there was no difference in hospital mortality. However, more patients in the control group required RRT as compared to pre-intervention thiamine group (65.4% vs. 42.3%, P=0.013). The post-intervention thiamine group also showed decreased RRT requirement compared to the control group (36.8% vs. 65.4%, P=0.02). Conclusion: Thiamine did not show hospital mortality benefit. However, it may be considered for use in patients with renal dysfunction. Future studies should further explore renally-protective effects of thiamine.

Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Early recognition of ST-elevation MI (STEMI) and prompt activation of pre-hospital percutaneous coronary intervention (PCI) are critical for improving patient outcomes. The World Health Organization defines MI based on the presence of chest discomfort, elevated troponin levels, and ECG changes. This study aimed to assess the impact of early STEMI recognition and pre-hospital PCI activation on mortality rates. Methods: A retrospective cohort study was conducted involving patients diagnosed with STEMI by emergency medical services (EMS), Emergency medicine unit of SKMCH, Muzaffarpur, and Bihar from April 2024 to September 2024. Data were collected from hospital records, electronic patient care reports, and patient contact. Key variables included demographic data, medical history, pre-hospital interventions, time intervals (call-to-balloon [C2B], first medical contact-to-balloon [FMC2B], the time from when treatment by a healthcare provider begins to balloon time, and door-to-balloon [D2B]), and patient outcomes. Statistical analysis was performed using SPPS statistical software version 24. Results: A total of 76 patients were analyzed, predominantly male (88%), with a mean age of 57 years. Early STEMI recognition and pre-hospital PCI activation resulted in a mean C2B time of 90 minutes, FMC2B time of 68 minutes, and D2B time of 33 minutes. Most patients (93%) underwent PCI upon arrival. Outcomes showed that 76% of patients recovered without complications, 16% recovered with complications, 4% worsened, and 4% died. Conclusion: Early recognition of STEMI and pre-hospital PCI activation significantly improved patient outcomes, in adherence to international time benchmarks. These findings highlight the need for continued efforts to optimize emergency medical services (EMS) protocols and public awareness to further reduce mortality rates.

Background: An incisional hernia of the abdominal wall is one of the most common problems following abdominal surgery. In this study, patients undergoing bilateral lateral incision surgery for abdominal wall hernia were followed up to examine postoperative consequences. Methods: Patients with abdominal wall hernias greater than 5 cm were the subject of this descriptive cross-sectional study, which was carried out from January to September 2025 in the surgery department of the Govt. Medical College and Hospital in Bettiah, West Champaran, and Bihar. After a six-month follow-up, 66 patients who had bilateral lateral incision repair for abdominal wall hernias had their clinical and demographic information documented in this study. SPSS version 22 was used for all data analysis. Results: About 65.2% of participants were females, and the mean age of the patients was 59.89±10.12 years. About 36.4% and 42.4% of patients had a history of diabetes and hypertension, respectively, and 81.8% and 63.6% had a history of abdominal surgery and hernia repair, respectively. The prevalence of seroma, wound infection, and hematoma was 6.1%, 3.0%, and 1.5%, respectively. After follow-up, hernia recurrence was observed in 1.5% of patients. Diastasis, lateral hernia, and death after surgery were not observed in any of the patients. Conclusion: The results of this study indicated that bilateral lateral incision repair for abdominal wall hernias was associated with a low rate of postoperative complications. Additionally, the recurrence rate of hernia was minimal, which suggested that this surgical approach was a safe and effective option for managing abdominal wall hernias.

Background: Parotid abscesses are uncommon infections of the major salivary glands, most often caused by bacterial pathogens such as Staphylococcus aureus and mixed anaerobes. Fungal parotid abscesses are exceedingly rare, with only a few reported cases in the literature. Immunocompromised states, including diabetes mellitus, predispose individuals to opportunistic fungal infections, often caused by Candida species. Early recognition of this entity is critical to avoid delayed treatment and potential life-threatening complications. Case Presentation: The case report of a 70-year-old woman with long-standing diabetes mellitus who presented with a painful swelling of the left parotid region. Clinical examination revealed a tender, erythematous swelling without discharge and intact facial nerve function. Laboratory investigations demonstrated leukocytosis and raised C-reactive protein. Ultrasound showed a hypoechoic lesion suggestive of an abscess, and contrast-enhanced CT of the face and neck confirmed a peripherally enhancing lesion involving both superficial and deep lobes of the parotid. Surgical incision and drainage yielded approximately 15–20 ml of pus. Initial empirical antibiotic therapy failed to improve the condition. Gram stain revealed budding yeast cells, and culture grew Candida non-albicans, resistant to fluconazole and voriconazole but sensitive to Nystatin and Amphotericin. The patient was subsequently treated with intravenous Caspofungin and oral Nystatin, with marked improvement in inflammatory markers, wound healing, and full recovery at two weeks. Histopathology confirmed fungal elements. Conclusion: This case underscores the importance of considering fungal etiology in parotid abscesses, particularly in elderly diabetic or immunocompromised patients unresponsive to antibiotics. Prompt imaging, microbiological diagnosis, and tailored antifungal therapy are essential to achieving favorable outcomes.

Lymphoepithelial carcinoma (LEC) of the larynx is an exceptionally rare malignancy, accounting for approximately 0.2% of all laryngeal cancers, with fewer than 50 cases reported worldwide. First described by the World Health Organization (WHO) in 1978 as a distinct clinicopathological entity, LEC is characterized by poorly differentiated squamous epithelial cells set against a dense lymphoid stroma. While most cases are described in the nasopharynx, laryngeal involvement is uncommon, and diagnostic confusion with squamous cell carcinoma (SCC), lymphoma, or melanoma remains a frequent challenge. We report the case of an 80-year-old female chronic smoker from Pune, who presented with severe dyspnea requiring emergency tracheostomy and progressive dysphagia of one year duration. Endoscopic evaluation revealed an endophytic growth on the left aryepiglottic fold, while computed tomography demonstrated a supraglottic mass without cartilage erosion. Histopathological examination revealed non-keratinizing squamous epithelium with pleomorphic nuclei and chronic inflammatory infiltrate, consistent with lymphoepithelial carcinoma. Immunohistochemistry was essential in distinguishing this entity from lymphoma and melanoma. Given the advanced age and frailty of the patient, a palliative management approach was undertaken. This case underscores the diagnostic and therapeutic dilemmas posed by laryngeal LEC, particularly in elderly individuals, and highlights the importance of histopathology and immunohistochemistry in reaching an accurate diagnosis. Furthermore, it adds to the limited global literature, emphasizing the need for awareness among clinicians to suspect LEC in elderly smokers presenting with unexplained dysphagia, dyspnea, and supraglottic masses.

Background: Preeclampsia is a pregnancy-related hypertensive condition associated with significant maternal and fetal morbidity and mortality. It arises due to impaired placental vascular remodeling leading to persistently elevated uteroplacental resistance, which can be assessed non-invasively using uterine artery Doppler ultrasound. The present study examines the role of second trimester uterine artery Doppler in identifying pregnancies unlikely to develop preeclampsia, with particular emphasis on the negative predictive value (NPV) of resistance index (RI), pulsatility index (PI) and protodiastolic notch. Methods: A prospective observational study was conducted in 100 pregnant women undergoing routine anomaly scanning between 18 and 21 weeks of gestation. Bilateral uterine artery Doppler interrogation was performed. Abnormal Doppler was defined as RI and PI > 95^th percentile for gestational age. Pregnancy outcomes were recorded, and diagnostic accuracy parameters were calculated. Results: Preeclampsia occurred in 15% of the cohort. Right uterine artery RI showed strong statistical association with disease development and demonstrated high sensitivity (86.7%) with excellent NPV (96.8%). Across all Doppler parameters, NPV exceeded 90%, indicating strong exclusionary performance. Conclusion: Normal second-trimester uterine artery RI reliably excludes preeclampsia and supports the role of Doppler ultrasound as a screening adjunct.

Introduction: Femoral fractures are common among children and adolescents. Its management has several methods which have improved with time recently. Most of these fractures are effectively managed conservatively with hip spica in very young children and only unstable and displaced fractures need surgical intervention. Children and adolescents in the age group of 4-19 years are treated with various methods of treatment. We have studied the short term results of femur fracture in children and adolescents prospectively which were managed by using Titanium Elastic Nailing System. Materials and Methods: This study included Twenty-three patients, aged 5 to 15 years, with diaphyseal femur fractures treated using TENS (Titanium Elastic Nailing System). Results: Most patients (52.17%) were 9-12, with a higher prevalence of males (73.91%). The most common fracture type was transverse (69.57%), predominantly on the right side (69.57%). Union rates were 21.74% at 8 weeks, 56.52% at 10, and 21.74% at 12 weeks. Complications included limb lengthening (21.74%) and malalignment (13.04%). Functional outcomes at 12 weeks post-operation were mostly excellent (60.87%) or satisfactory (30.43%), with one poor result (8.70%). Conclusions: Titanium elastic nailing system (TENS) is effective for pediatric femoral shaft fractures, achieving high bone union rates and minimal complications. Most fractures healed within 10 weeks, and patients had excellent or satisfactory functional outcomes, supporting TENS as a beneficial treatment for children aged 5 to 15.

Introduction: Increased incidence of road traffic accidents, natural disasters, and industrial accidents claim most of human mortality and morbidity. These injuries commonly involve long bones, especially the tibia due to its subcutaneous location. Tibial diaphyseal fractures are the most common, followed by proximal tibial fractures. The treatment of proximal tibial fractures changed dramatically in 1969 following the study by Reudi and Ailgower (1) where 75% patients after internal fixation of tibia fractures were pain free and had good functional outcome at 4 years follow up. The following widespread use of internal fixation led to an increase in major complications like malunions (42%), superficial infections (20%), nonunion (18%), and osteomyelitis (17%). This led to a search for newer techniques which led to lesser soft tissue damage and yielded better results. Amongst these techniques was biological minimally invasive percutaneous plate osteosynthesis (MIPPO). In the 1990’s Krettek et al popularized the Minimally Invasive Percuntaneous Plate Osteosynthesis (MIPPO) technique in which conventional plates were placed through a small incision and slid through a subcutaneous tunnel. Biologically friendly plating and minimally invasive plating continues to remain popular today. This study compares MIPPO in proximal tibia fractures, in terms of functional outcome, union rate and time and the various complications associated with each group. Method & Material: The present study was conducted in the Department of Orthopaedics. This study included 32 patients with the fracture proximal tibia of the patients and age of patient ranging from 20 to 75 years. All the patients with proximal tibia fractures were included in the study. Result: A total of 32 patients of proximal tibial fractures were treated with minimally invasive percutaneous plate osteosynthesis technique. There were 29 male and female patient, with maximum patients in the age group of 31 to 40 years. Road traffic accident evolved as most common mode of injury. Fractures were classified according to AO classification. C1 type of fracture seen in 8 (25 %) patients and A2 type in 7 (21.9%) patients. Rasmussen’s clinical and radiological scoring system was used for final evaluation of the results. Conclusion: Minimally invasive percutaneous plate Osteosynthesis is better technique, and should be considered as primary option for the surgical treatment of the proximal tibia fractures. Clinical outcome of MIPPO technique are favourable and comparable to world literature in terms of fracture union, early mobilization and functional outcome. MIPPO technique preserve the soft tissues around the fracture site hence healing of the fracture is early. For the same reason MIPPO can be a treatment option for the grade I compound fractures. MIPPO technique can be successfully used for the simple or grade I compound fracture of proximal tibia.

Background: Knee osteoarthritis is prevalent globally among the aged adults with an ageing and increasingly obese population. It is also the second leading cause of disability and a heavy economic and social burden. The aim of this study is to analyse the efficacy of intra articular PRP injections in knee osteoarthritis. Materials and Methods: In this study, participants kejagah patients with osteoarthritis knee the participants who suffered from knee osteoarthritis (Grades II/III), were randomly divided into two groups: intra articular injection of PRP and CS. Knee injury and osteoarthritis outcome score (KOOS), the 20-Meter-Walk Test (20MW), active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 2-months, and 6-months after interventions. Results: It is evaluated based on active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 1,3 and 6-months after interventions. Conclusions: Our study demonstrated that one shot of PRP injection, decreased joint pain more and longer-term, alleviated the symptoms, and enhanced the activity of daily living and quality of life in short-term duration in comparison with CS.

Background: Polycystic ovary syndrome (PCOS) is frequently accompanied by metabolic disturbances, particularly insulin resistance, which may influence ovarian morphology. Ultra-sonographic markers such as ovarian and stromal volumes have been proposed as potential indicators of metabolic dysfunction. Objectives: This study aimed to evaluate the associations between ovarian and stromal volumes and fasting insulin, fasting blood glucose (FBG), and post-prandial blood glucose (PPBG) levels in women aged 18–40 years diagnosed with PCOS. Methods: A cross-sectional analysis was conducted involving 120 women meeting the Rotterdam criteria for PCOS. Ovarian and stromal volumes were measured using transvaginal or transabdominal ultrasonography. Fasting insulin, FBG, and PPBG were assessed through standard laboratory tests. Correlations between morphological and metabolic variables were examined using Pearson’s correlation coefficients. Results: The average ovarian volume was 12.4 ± 3.8 mL, and the mean stromal volume was 7.9 ± 2.5 mL. Stromal volume showed strong positive correlations with fasting insulin (r = 0.62, p < 0.001), FBG (r = 0.41, p < 0.01), and PPBG (r = 0.45, p < 0.01). Ovarian volume demonstrated weaker correlations with fasting insulin (r = 0.33, p = 0.02) and PPBG (r = 0.29, p = 0.04), and no significant association with FBG (r = 0.18, p = 0.11). Conclusion: Stromal volume appears to be more closely linked to metabolic abnormalities than total ovarian volume, indicating its potential value in evaluating metabolic risk in PCOS. Further longitudinal research is recommended.

Background: Pre-eclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Anesthetic management during cesarean delivery in pre-eclamptic patients poses unique challenges due to altered cardiovascular physiology and the risk of hemodynamic instability. Neuraxial anaesthesia is widely preferred, but real-world data from Indian tertiary care settings are limited. Objectives: To evaluate maternal and perioperative outcomes associated with neuraxial anaesthesia in pre-eclamptic patients undergoing cesarean delivery. Methods: This retrospective observational study was conducted at Shree Krishna Medical College and Hospital (SKMCH), Muzaffarpur. Medical records of 100 women with pre-eclampsia who underwent cesarean delivery under neuraxial anaesthesia over a 10-month period were reviewed. Outcomes included intraoperative hemodynamic stability, anesthetic complications, and maternal outcomes. Results: Neuraxial anaesthesia was associated with stable intraoperative hemodynamics, minimal anesthetic complications, and favorable maternal outcomes. The incidence of severe hypotension and conversion to general anaesthesia was low. Conclusions: Neuraxial anaesthesia appears to be a safe and effective anesthetic technique for cesarean delivery in patients with pre-eclampsia in a real-world tertiary care setting.

Background: The biggest nerve in the human body, the sciatic nerve (SN) is essential for lower limb motor and sensory function. Although the nerve leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle in the conventional description, there are often physical differences in the nerve’s connection to the piriformis and degree of bifurcation. Particularly during hip replacements, deep gluteal intramuscular injections, and regional anesthetic blocks, these variances present serious clinical hazards. Methods: A comprehensive search was carried out for cadaveric, surgical, and imaging research published up to 2024 in PubMed, Scopus, Google Scholar, and Web of Science. Over the course of two months, the study was organized at GMERS Medical College and Hospital with multi-institutional academic collaboration. We gathered information on the degree of bifurcation (pelvic vs. extra-pelvic) and the frequency of sciatic nerve alterations according to the Beaton and Anson categorization. To determine the pooled prevalence of these variants and evaluate their clinical implications, a meta-analysis was conducted. Results: A total of 4,250 lower limbs from 28 studies that satisfied the inclusion criteria were examined. 83.4% of people had normal anatomy (Beaton and Anson Type A). With a prevalence of 12.1%, the most frequent variation was the common peroneal nerve piercing the piriformis while the tibial nerve ran beneath it (Type B). In 14.2% of the specimens, there was a high division of the sciatic nerve within the pelvis. Different geographic trends in variation frequency were found by subgroup analysis. Conclusion: Clinicians need to be aware of the very common occurrence of sciatic nerve anatomical abnormalities. In addition to raising the possibility of iatrogenic nerve damage during gluteal injections, the high frequency of the nerve penetrating the piriformis muscle points to a possible structural basis for piriformis syndrome. Additionally, in order to guarantee anesthetic effectiveness during popliteal blocks, ultrasonography guidance is required because to the variety in bifurcation levels.

Background: Dermatophytosis is a common superficial fungal infection with increasing prevalence in rural populations, particularly in tropical and subtropical regions. Recent years have witnessed a rise in chronic, recurrent, and treatment-resistant cases. Objective: To evaluate the clinical profile of dermatophytosis and identify associated risk factors among patients from rural communities. Materials and Methods: A prospective cross-sectional multicentric study was conducted from March 2025 to September 2025. One hundred patients with clinically diagnosed dermatophytosis were enrolled. Demographic details, clinical patterns, and predisposing factors were recorded. Diagnosis was confirmed clinically and supported by potassium hydroxide (KOH) microscopy where indicated. Results: Tinea corporis and tinea cruris were the most prevalent clinical types. Male predominance was observed. Excessive sweating, occlusive clothing, misuse of topical corticosteroids, poor hygiene, and overcrowding were the most common associated risk factors. Conclusion: Dermatophytosis represents a growing public health concern in rural areas. Addressing modifiable risk factors and promoting rational antifungal use are essential to reduce disease burden.

Background: The benefits of breastfeeding have been established in infancy and beyond. Lactogenesis II which is defined as onset of copious milk production after birth typically occurs within 72 hours postpartum and is a critical factor in initiating and establishment of successful breastfeeding. If this stage occurs beyond 72 hours after childbirth it is termed as delayed onset of lactation (DOL). DOL is found to be associated with reduced milk supply, shortened breastfeeding duration, problematic weight loss in newborns, early cessation of breastfeeding and thereby negatively influencing the rate of exclusive breastfeeding. A thorough understanding of prevalence of DOL in the mother and the factors influencing it helps in anticipating difficulties in advance and to provide enhanced support to breastfeeding mothers in this critical period. Objectives: (1) To study the prevalence of delayed onset of lactogenesis II. (2) To study the factors influencing the onset of lactogenesis II and the risk factors for delayed onset of lactation. Methods: A cross-sectional study involving 107 mother-infant dyads was conducted to assess onset of Lactogenesis II in relation to maternal age, education, BMI, parity, mode of delivery, and breastfeeding practices, among other factors. Statistical significance was evaluated using p-values (significance set at p<0.05). Results: The overall prevalence of delayed onset of Lactogenesis II was 26.2%. No statistically significant associations were found between Lactogenesis II and maternal age, education, socioeconomic status, infant gender, comorbidities, gestational age, birth weight, or most breastfeeding practices. However, significant associations were observed for maternal BMI (p=0.001), parity (p=0.045), and mode of delivery (p=0.021). Vaginal delivery and multiparity were positively correlated with the early onset of Lactogenesis II, whereas higher BMI had increased incidence of DOL. Lesser number of feeds in the first 2 days of postpartum was associated with significant delay in onset of lactogenesis II (p=0.014 on day 1 and p=0.008 on day 2) Newborns of mothers with DOL had significant weight loss on day 4 of life (p=0.001). Conclusion: Our findings demonstrated that, while most demographic and clinical variables showed no significant effect, maternal BMI, parity, and mode of delivery were significant predictors of Lactogenesis II. These findings highlight the importance of considering maternal physiology and obstetric history in postnatal lactation support strategies.

Introduction: Patients with low left ventricular ejection fraction (LVEF) undergoing off‑pump coronary artery bypass graft (OPCAB) surgery are at increased risk of perioperative hemodynamic instability. Although both Ivabradine and Carvedilol have been individually used to optimize perioperative heart rate and hemodynamics, evidence is scarce regarding the comparative effectiveness of Ivabradine, Carvedilol, and their combination in this high-risk population. Aims: To compare the effectiveness of Ivabradine alone, Carvedilol alone, and a combination of Ivabradine + Carvedilol in maintaining post‑operative hemodynamic stability in OPCAB patients with pre‑existing low LVEF. Materials and Methods: This prospective, randomized, controlled study included 63 adults (≥18 years) with LVEF ≤40% undergoing elective off-pump CABG at the Department of Cardiac Anesthesia, Medical College Hospital, Kolkata. Patients received either carvedilol or ivabradine perioperatively. Demographics were recorded, and heart rate and blood pressure were monitored. Data were analyzed using SPSS; p < 0.05 was considered significant. Results: Baseline demographics, including age, gender, weight, height, and BMI, were comparable across the Ivabradine, Carvedilol, and combination groups, with no statistically significant differences (all p > 0.05). Mean blood pressure was similar at baseline (p = 0.429) and gradually declined over time in all groups without significant inter-group differences. Baseline heart rate was also comparable (p = 0.633); however, heart rate reduction during follow-up was significantly greater in the combination group from 6 to 48 hours (p ≤ 0.002), while differences at 3 hours remained non-significant (p = 0.126). Conclusion: In OPCAB patients with low LVEF, combined therapy with Ivabradine and Carvedilol appears more effective than either agent alone in achieving post‑operative hemodynamic stability, reducing heart rate, decreasing incidence of arrhythmia, and minimizing inotrope and ventilatory support. This combination may represent an optimal perioperative rate‑control strategy in high‑risk cardiac surgery patients.

Background: Abdominal wall closure after laparotomy is a crucial determinant of surgical outcomes. Inadequate closure may result in wound dehiscence, surgical site infection (SSI), suture sinus, and incisional hernia, leading to increased morbidity and healthcare costs. The choice of suture material remains debated, with non-absorbable polypropylene offering long-term strength but associated with foreign body reaction, and absorbable polydioxanone providing prolonged tensile support with potentially fewer chronic complications. Methods: This prospective comparative study was conducted at F.M. Medical College and Hospital, Balasore, Odisha between October 2023 and October 2025, including 100 patients undergoing elective or emergency midline laparotomy. Patients were randomized into two groups: Group A underwent abdominal wall closure with No. 1 loop polypropylene (Prolene®) and Group B with No. 1 loop polydioxanone (PDS®). Patients were assessed for early complications (SSI, wound dehiscence, suture sinus) and late complications (incisional hernia) during a six-month follow-up. Data were analyzed using chi-square or Fisher’s exact test, with p<0.05 considered statistically significant. Results: Baseline characteristics, including age, sex, comorbidities, and diagnosis, were comparable between groups. Surgical site infection occurred in 18 patients (36%) in the polypropylene group versus 14 (28%) in the polydioxanone group. Wound dehiscence was noted in 6% of polypropylene and 4% of polydioxanone patients. Suture sinus occurred in 6% of polypropylene cases but in none with polydioxanone. At six months, incisional hernia rates were identical in both groups (4%). Conclusion: Both polypropylene and polydioxanone are effective for abdominal wall closure following laparotomy. However, polydioxanone showed a trend toward fewer wound complications, particularly SSI and suture sinus, while long-term outcomes such as incisional hernia were similar. Polydioxanone may therefore represent a safer alternative in reducing early wound morbidity.

Objectives: To analyze the incidence and underlying causes of “post-operative pulmonary complications (PPCs)”. Methods: A total of 100 patients undergoing emergency S.C.B. Medical College and Hospital, Cuttack, Odisha were enrolled in this prospective observational study. Post op pulmonary complications were identified based on routine clinical examination, fall in oxygen saturation (<94%), increased in respiratory rate (>20), any abnormality in chest x ray and any added sounds heard on auscultation. Results: Emergency laparotomy was undertaken for multiple clinical conditions, the most frequent being perforation peritonitis, abdominal trauma, intestinal blockage, and appendicular perforation. Of the 100 participants, 27 experienced post-operative pulmonary complications. These complications were more prevalent among patients of advanced age, those with a history of smoking, and those who underwent prolonged surgical procedures. Conclusion: Postoperative pulmonary complications are a major contributor to increased morbidity and prolonged hospital stays after emergency laparotomy. This research underlines the critical role of timely detection of contributing factors, including advanced age, underlying pulmonary disorders, and longer operative times.

Our study included 100 patients who underwent surgery for various indications and stoma construction. The aims and objectives of the study are to study the various complications occurred after the construction of ileostomy and to study the ways in which these complications can be minimized and managed in a better way. Stoma education before the procedure will help to prevent complications due to stoma. A preoperative visit with the stoma therapist is essential. A good operative technique and proper site selection avoid complications to the best extent. The complications were better managed with proper preoperative planning with effective stoma care in postoperative period.

Background: Shoulder pain and functional limitation resulting from partial-thickness rotator cuff tendon tears present a significant clinical challenge, particularly in the aging population. Conventional treatment modalities—including conservative management and surgical intervention—often yield variable outcomes and may be associated with complications. Autologous platelet-rich plasma (PRP), rich in growth factors, has emerged as a promising biological therapy aimed at enhancing tendon healing. This study aimed to evaluate the effectiveness of PRP infiltration in reducing pain and improving shoulder function in patients with partial rotator cuff tendon tears. Materials and Methods: This prospective cohort study was conducted in the Outdoor Orthopaedics Department of S.K. Hospital, Sikar, from June 2023 to December 2023. A total of 38 patients aged ≥20 years with MRI-confirmed partial-thickness rotator cuff tears were included. All patients received a single ultrasound-guided subacromial PRP injection. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, the Shoulder Pain and Disability Index (SPADI) for functional evaluation, and the presence of painful arc syndrome at baseline, 2 weeks, 6 weeks, and 12 weeks post-injection. Statistical analysis was performed using SPSS version 21.0, with p <0.05 considered statistically significant. Results: The mean age of participants was 47.32 ± 11.85 years, with a male predominance (55.3%) and right shoulder involvement in 63.2% of cases. Painful arc was present in all patients at baseline and showed complete resolution by 12 weeks (p = 0.0001). Mean SPADI scores significantly decreased from 70.89 at baseline to 38.24 at 12 weeks (p = 0.0001). Similarly, mean VAS scores declined from 7.84 to 2.79 over the study period (p = 0.0001). A significant shift in pain severity was observed, with most patients transitioning from severe pain at baseline to mild pain at final follow-up (p = 0.0001). Conclusion: PRP infiltration demonstrated significant efficacy in reducing pain and improving shoulder function in patients with partial-thickness rotator cuff tendon tears. As a safe, minimally invasive, autologous biological therapy, PRP may serve as an effective alternative to delay or avoid surgical intervention.

Background: Surgical management of clavicle fractures conventionally requires general anesthesia, which carries inherent risks and potential complications. The clavipectoral fascial plane block (CPB) has emerged as an alternative regional anesthetic technique for clavicle fracture osteosynthesis. This study evaluates the efficacy and safety of CPB in providing adequate anesthesia for clavicle fracture surgery. Aim: To assess the therapeutic efficacy and safety of CPB in delivering surgical anesthesia for clavicle fracture osteosynthesis procedures. Materials and Methods: This prospective cohort study was conducted at DR S.N.Medical College and attached Hospitals, enrolling 40 patients undergoing clavicle fracture osteosynthesis. Sociodemographic data, fracture classification, surgical procedure details, intraoperative parameters, fentanyl requirements, need for conversion to general anesthesia, rescue analgesia demands, clinical outcomes (NRS, Quick DASH, Constant Murley scores), radiological outcomes, complications, and patient satisfaction were evaluated. Results: The mean age of participants was 38.25 years, with male predominance (80%). Fracture types included Allman type I (32.5%) and type II (67.5%). Most patients (57.5%) underwent open reduction and internal fixation with plating. Intraoperatively, 90% maintained stable vital signs without significant blood pressure or pulse rate changes. Similarly, 90% did not require fentanyl or conversion to general anesthesia. Postoperatively, 70% did not require rescue analgesia. Clinical outcomes improved significantly over 12 weeks: NRS pain scores decreased, Quick DASH functional scores improved, and Constant Murley shoulder scores increased. Radiological assessment confirmed callus formation and fracture union in all patients by 12 weeks. Most participants (72.5%) experienced no complications, with high levels of patient satisfaction reported. Conclusion: CPB is an effective and safe alternative to general anesthesia for clavicle fracture osteosynthesis. It provides stable intraoperative conditions, effective postoperative analgesia, facilitates fracture healing, improves functional outcomes, and results in high patient satisfaction. Incorporating CPB into clinical practice may optimize perioperative management and enhance patient outcomes.

Background: Traumatic dorsolumbar burst fractures result in anterior and middle column disruption, frequently leading to spinal instability, kyphotic deformity, and neurological deficits. Posterior pedicle screw fixation alone may fail to provide adequate anterior column support, resulting in correction loss and implant failure. Transpedicular bone grafting enables anterior column reconstruction through a posterior approach, potentially improving biomechanical stability and clinical outcomes. Objective: To assess the clinical, radiological, and neurological outcomes of transpedicular bone grafting combined with posterior pedicle screw fixation in patients with traumatic dorsolumbar burst fractures. Methods: A prospective observational study was conducted in the Department of Orthopaedics, DR S.N.Medical College and attached Hospitals from July 2023 to April 2024 on 30 patients with unstable traumatic dorsolumbar burst fractures (T10–L2). All patients underwent posterior pedicle screw fixation with transpedicular cancellous bone grafting. Neurological outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes included kyphotic angle and vertebral body height restoration. Functional outcomes were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Patients were followed for a minimum of 12 months. Results: The mean kyphotic angle improved significantly from 22.4° ± 4.6 preoperatively to 8.6° ± 2.9 postoperatively (p < 0.001), with minimal loss of correction at final follow-up. Vertebral body height was restored from a mean of 58% preoperatively to 83% at final follow-up. Neurological improvement of at least one ASIA grade was observed in 70% of patients. Mean VAS and ODI scores showed statistically significant improvement. No implant failure or graft-related complications were encountered. Conclusion: Transpedicular bone grafting combined with posterior pedicle screw fixation is a safe and effective technique for treating traumatic dorsolumbar burst fractures. It provides reliable anterior column support, maintains sagittal alignment, and results in favorable neurological and functional outcomes.

Background: India has 104 million tribal people, with Madhya Pradesh having the highest tribal population. Tribal communities remain marginalized with poor health indicators. Objectives: To assess the socio-demographic profile and disease pattern among individuals attending community-based medical camps in a tribal district. Methodology: A community-based cross-sectional study conducted in Jhabua district. All camp attendees were assessed for demographic and clinical details. Results: 78.9% women (15–49 years) had anemia. 26.6% attendees had diagnosed sickle cell anemia. 13.2% adults were hypertensive. 30% women had leucorrhoea. 20% children had worm infestation. Conclusion: High burden of anemia, reproductive infections, sickle cell disease, hypertension, and parasitic infections was observed.

Background: Cannabis use disorder (CUD) is an increasing social health issue with significant psychiatric morbidity and poorly understood personality-mediated processes. This paper has analyzed CUD prevalence rate and some of the related psychiatric conditions and how they relate to personality trait patterns assessed using the 16 Personality Factors (16PF) questionnaire. Methods: This is a cross-sectional analytical study involved 387 cannabis users (265 CUD, 122 non-dependent) at Department of Psychiatry in RD Gardi Medical College, Ujjain, MP. The participants were being diagnosed with ICD-10 (F12.0 cannabis abuse, F12.1 dependence), structured clinical interview, 16PF personality assessment, and validated depression (PHQ-9), anxiety (GAD-7), and psychotic symptoms (PANSS) measures. Bivariate and multivariate analyses identified the levels of relationships between the CUD severity levels, psychiatric comorbidities, and personality dimensions. Findings: The prevalence rate of cannabis use disorder was 68.5% (n=265). Seventy one point three percent of CUD cases had comorbid psychiatric disorders: major depressive disorder 52.1, anxiety disorders 41.9, psychotic symptoms 28.3 and personality disorders 34.0. The profile of cannabis-dependent individuals showed high levels of emotional instability (Cohen d=1.38), less self-control (d= -1.31), very vigilant (d=1.12) and open to change (d=1.89) per the 16PF profiles. The Personality dimensions which had the closest correlations with CUD were lower in rule-consciousness, perfectionism and emotional-stability; and higher in tension, openness-change-ability and sensitivity. In dose-response, it was the personality factors that independently predicted the psychiatric comorbidity severity. Conclusion: Cannabis use disorder has shown significant psychiatric burden that is mediated partially by the personality weaknesses in emotional control and behavioral control. Stratification of treatment based on personality is worth a look in CUD intervention.

Background: Adequate intraoperative mydriasis is essential for safe cataract surgery. Intracameral adrenaline is widely used, but the optimal concentration remains uncertain. Aim: To compare the efficacy of initial and sustained intraoperative mydriasis between intracameral adrenaline concentrations of 1:3,00,000 IU and 1:10,00,000 IU. Materials and Methods: A prospective comparative study was conducted on 60 patients undergoing cataract surgery at Mata Gujri Memorial Medical College and L.S.K. Hospital, Bihar. Patients were divided into two groups after randomization, receiving intracameral adrenaline at either 1:3,00,000 IU or 1:10,00,000 IU concentrations. Initial mydriasis and maintenance of mydriasis during various intraoperative stages were assessed and compared. Results: Group A (1:3,00,000 IU) showed significantly greater initial mydriasis (7.82 ± 0.54 mm) compared to Group B (7.05 ± 0.51 mm) (p = 0.004). Sustained dilation at at various intraoperative was also superior in Group A as compared to Group B (p < 0.05). No adverse effects were reported. Conclusion: Intracameral adrenaline at 1:3,00,000 IU achieves faster and more sustained mydriasis than 1:10,00,000 IU, enhancing surgical conditions without added risk.

Background: Rapid pupillary dilation is essential for efficient ophthalmic examinations and interventions. Tropicamide is widely used for mydriasis, but the optimal method to achieve the fastest dilation remains unclear. Objective: To determine the fastest way of achieving tropicamide-induced mydriasis using different instillation protocols and adjuvents. Methods: A prospective study was conducted on 200 eyes at Mata Gujri Memorial Medical College and L.S.K. Hospital, Kishanganj, Bihar, over 18 months. Patients were divided into 5 groups:

• Control Group (Group E): Single drop of tropicamide 0.8% instilled.
• Group A: Single drop of paracaine 0.5% instilled 5 minutes prior to a single drop of tropicamide 0.8%.
• Group B: Two drops of tropicamide 0.8% instilled 5 minutes apart.
• Group C: Single drop of tropicamide 0.8% instilled, followed by eyelid closure for 5 minutes.
• Group D: Single drop of tropicamide 0.8% instilled, followed by lacrimal sac occlusion for 5 minutes.

Time to achieve adequate mydriasis (≥6 mm pupil diameter) was recorded.
Results: Rate of Mydriasis: Group D > Group C > Group B > Group A > Control. Conclusion: Group D (lacrimal sac occlusion) achieved the fastest and maximum mydriasis due to prolonged ocular surface contact and reduced nasolacrimal drainage.

Background: A glucose homeostasis condition known as insulin resistance (IR) is characterized by a decreased sensitivity of adipose tissue, muscle fiber, liver, and other bodily tissues to insulin, even in the presence of normal or elevated blood concentrations of the hormone. Nevertheless, it is uncommon to evaluate the comorbidity of insulin resistance and thyroid discrepancies, particularly the order in which these indicators appear. Methods: The present study conducted on patients presenting with complaints (for the first time) related to the abnormal thyroid profile to the IPD / OPD of the Department of Medicine. Result: Out of 50 abnormal thyroid patients 17 were insulin resistant which is almost 34% of present study population. Out of which 13 were insulin resistant hypothyroid patients who constitute 26% and 4 were insulin resistant hyper thyroid patients who constitute 8%, which shows significant insulin resistance in thyroid patients. Conclusion: Present study shows that insulin resistance is present in significant number of thyroid patients. Insulin resistance in thyroid abnormalities is affected by number of factors like age, gender and BMI. Insulin resistance is present in both hypothyroidism as well as hyperthyroidism. Similarly fasting insulin levels are raised in both hypothyroidism as well as in hyperthyroidism.

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Methods:  From the patients admitted 100 representative cases of Type 2 DM are taken as subjects for the study. The diagnosis of diabetes is based on revised criteria according to consensus panel of experts from the national diabetes data group and WHO. Results: 82.00% cases of Type 2 DM were normal thyroid function and 6.00% cases were hypothyroidism, 12.00% cases were sub hypothyroidism. Hypothyroidism and subclinical hypothyroidism is more evident in the elderly age groups (55–65 years). Among those diabetic patients with thyroid dysfunction (subclinical hypothyroidism and hypothyroidism), 15 (83.33%) out of 18 were females. Conclusion: Thyroid dysfunction was more in female than male. Maximum number of T2DM patients had subclinical hypothyroidism.

Background: The aim of this study was to explore the study of thyroid function in patients with metabolic syndrome. Methods: This cross-sectional study was conducted on 200 patients with metabolic syndrome (MetS) (National Cholesterol Education Program’s-Adult Treatment Panel III Criteria) in the study group and 100 subjects without metabolic syndrome in the control group. Anthropometric variables and blood pressure were taken using standardized technique and body mass index was calculated. TSH, T4 and T3 were measured using electrochemiluminescence immuno assay. Results: The overall prevalence of thyroid dysfunction in patients with MetS was 44.00% with high prevalence of sub clinical hypothyroidism (28%). Conclusion: Hypothyroidism brawny associated with components of metabolic syndrome.

Background: A considerable evidence suggests that maternal inflammation dysregulation may play as a risk factor for both maternal and neonatal outcomes. The study’s objectives were designed to predictive role of C – reactive protein in early pregnancy among women. Methods: Hospital based comparative analysis was conducted on women with early pregnancy upto 14 weeks with either abdominal pain or vaginal bleeding or suspected extrauterine pregnancy. C-reactive protein (CRP) quantitative estimation is done by turbi-diametric method. Results: The mean C – reactive protein level in cases was 2.09±0.71 mg/dl and in control was 9.25±5.13 mg/dl. Hence mean C – reactive protein levels were higher among controls showing that a higher C – reactive protein level was seen among pregnant women in early gestation with normal intrauterine pregnancy when compared to abnormal presentations in first trimester of pregnancy. Conclusion: Our results of significantly increased CRP levels in normal pregnancy and a clear association between CRP and normal pregnancy, support the clinical application of this diagnostic tool in early pregnancy, especially as a predictor of abnormal first trimester pregnancies.

Background: Cervical cancer is the second most common cancer among women worldwide. There are no data on the knowledge, attitude and practices of Rajasthan women about this cancer. So this study was conducted regarding Knowledge, Attitude and Practices related to cervical cancer. Methods: It was a questionnaire based cross-sectional hospital study carried out on 500 women visiting the outpatient with non-random sampling i.e. sequential inclusion of women who met the study criteria. Data were collected via face-to-face interviews by one trained interviewer using a structured questionnaire. Results: A total of 500 women are approached for interview, in which 420(84.00%) had not heard about cervical cancer, only 16.00% women had knowledge about cervical cancer. About 80.00% women had positive attitude about cervical cancer screening & it’s vaccine. Conclusions: Women need more information about cervical cancer risk factors, symptoms and screening program.

Background: Lung pathology plays a vital role in the forensic investigation of deaths, providing critical information that aids in determining the cause and manner of death. The lungs are often affected by a diverse array of conditions, making a thorough examination essential for accurate medicolegal analysis. Methods: This study involved a detailed examination of lung pathology in 100 medicolegal autopsies. All cases received for medico-legal autopsies throughout the research period were included in this analysis. This research did not include dead bodies in various stages of decomposition. Each autopsy case was systematically analysed to document both gross and histopathological lung findings. Results: The cohort comprised 66 males and 34 females, with ages ranging from 1 month to 78 years. The mean age of cohort was 49.36±9.36 years. A total of 100 lungs of adult autopsies were performed. All cases showed one or other histopathological lesions in lung. The various pulmonary lesions were classified as pulmonary infection 23 cases, COPD 13 cases and pulmonary vascular diseases 64 cases. Conclusion: Autopsy provides normal as well as diseased human tissue for morphologic studies and it may reveal the diagnosis which may not be suspected clinically or may, in some way, discredit. In present study, pulmonary haemorrhage and congestion was the most frequently encountered lesion in medicolegal autopsies.

Background: Despite growing evidence, there remains a need for studies that systematically assess the perceived stress and its association with various sociodemographic factors in individuals suffering from FGIDs, particularly in the Indian context where cultural perceptions and coping styles may influence symptom reporting and psychological response. Methods: A cross-sectional study was carried out in the Department of Psychiatry in association with department of Gastroenterology at RNT Medical College & M.B.G.H, Udaipur. The study involved a total of 400 cases of Functional Gastrointestinal disorders, diagnosed according to Rome IV Criteria by gastroenterologist. Results: The results show a clear relationship between the type of functional gastrointestinal disorder (FGID) and the level of perceived stress (Chisquare = 21.903, df = 4, p = 0.000).Among the 228 individuals with Irritable Bowel Syndrome (IBS), the majority had moderate (184; 55.4%) or severe stress (32; 88.9%), while only a few reported low stress (12; 37.5%). In contrast, among the 164 individuals with Functional Dyspepsia (FD), most had low (20; 62.5%) or moderate stress (140; 42.2%), and only 4 participants (11.1%) reported severe stress. All 8 individuals with Functional Constipation had moderate stress only. Conclusion: This cross- sectional descriptive study, examined perceived stress and its association with various sociodemographic factors among 400 Indian patients with Functional Gastrointestinal Disorders (FGIDs), including Irritable Bowel Syndrome (IBS), Functional Dyspepsia (FD), and Functional Constipation. Stress levels varied significantly by age, gender, residence, education, occupation, and socioeconomic status. Severe stress was highest among older adults and urban residents, with low stress more common in rural areas and among the self-employed. FGID was significantly associated with perceived stress. IBS patients had higher levels of moderate and severe stress, while FD patients reported lower stress levels. Functional Constipation was associated only with moderate stress. The findings emphasize the need for integrative FGID management strategies in India, including mental health evaluation and stress management, alongside traditional treatments.

The tympanic membrane (TM) undergoes a number of pathological changes in middle ear disease which can be detected by a video otoendoscope. Middle ear disease is also accompanied by changes in middle ear pressure which can be assessed by tympanometry. The objectives of this study were to find the correlation between video otoendoscopy and tympanometry in cases of fluid in the middle ear and to deduce which of the two is more efficient and reliable for early diagnosis. 191 patients with OME were included over 10 months. Detailed history and clinical examination with otoendoscope and tympanometry and otoscope were done. The results were collected and correlation between otoendoscopy and tympanometry was determined and their individual sensitivity, specificity and diagnostic accuracy was calculated. Our study found that there is good correlation between tympanometry and video-otoendoscopy. Tympanometry remains superior to Otoendoscopy in detecting AOM with respect of sensitivity and specificity. On the other hand, tympanometry is more precise in detecting the presence or absence of OME. It also shows that tympanometry plus otoendoscopy together greatly increase the chances of detecting AOM and OME. Using both these modalities together:

1. Reduces overdiagnosis and unnecessary treatment. Increases the probability of correct diagnosis of other conditions with symptoms that otherwise could be attributed to AOM.
2. Improve diagnostic accuracy
3. Reduces financial costs associated with misdiagnosis
4. Promote consistency in diagnosis
5. Helps in monitoring and documentation of the progression of the disease process for patients being considered for surgical treatment. Thus, we can conclude that instead of using only otoscopy for diagnosing AOM or OME, we should utilize both otoendoscopy as well as tympanometry at the first visit itself for early diagnosis of AOM and early detection of OME before development of any sequalae which can be missed if these modalities are not used.

Background: Hypertension-related kidney damage represents a key cause of long-standing renal dysfunction and is linked with multiple metabolic and cardiovascular complications. Recent findings indicate that deficiencies of certain micronutrients, especially cobalamin, may play a role in the progression of renal impairment and influence overall clinical outcomes in affected individuals. Objectives: This investigation was designed to determine circulating cobalamin concentrations among individuals with hypertension-related kidney involvement and to examine their relationship with selected clinical and laboratory parameters over a one-year observation period. Materials and Methods: A facility-based observational investigation was carried out at Naraina Hospital and Research Center over twelve months and included 200 individuals diagnosed with hypertension-related kidney involvement. Circulating cobalamin concentrations were quantified using validated immunoassay methods. Participants were classified into deficient, borderline, or adequate categories based on established laboratory thresholds. Clinical characteristics, renal function indices, and hematological variables were evaluated to explore associations with cobalamin status. Results: Reduced cobalamin concentrations were identified in a considerable proportion of participants, with an additional subset demonstrating values near the lower reference limit. Lower concentrations were more frequently observed among individuals with longer-standing hypertension and more advanced renal impairment. Reduced cobalamin status showed a frequent association with anemia and a higher occurrence of protein loss in urine. These observations indicate a link between altered cobalamin levels and greater disease severity in hypertension-related kidney involvement. Conclusion: Vitamin B12 deficiency is a common and clinically relevant finding in patients with hypertensive nephropathy. Routine assessment of vitamin B12 levels may aid in comprehensive evaluation and management of this high-risk population by identifying a potentially correctable metabolic abnormality.

Aim: This review examines the evolution of antidiabetic fixed-dose combinations (FDCs) from first-generation agents focused on glycemic control to next-generation formulations providing cardiovascular and renal organ protection in type 2 diabetes mellitus (T2DM) patients. Materials and Methods: A comprehensive literature review was conducted through PubMed, Google Scholar, and clinical trial databases for publications between 2018-2025. Search terms included “antidiabetic FDCs,” “GLP-1 SGLT-2 combinations,” “organ protection,” and “cardiorenal outcomes.” Studies comparing combination antidiabetic therapies, cardiovascular outcome trials, and renal protection studies were included. Clinical trials (DAPA-HF, EMPA-REG, LEADER, DAPA-CKD) and observational cohort studies were analyzed for efficacy and safety data. Results: Next-generation FDCs combining GLP-1 receptor agonists with SGLT-2 inhibitors demonstrate superior cardiorenal protection compared to monotherapy or early-generation metformin-based combinations. GLP-1/SGLT-2 combinations reduce major adverse cardiovascular events by 26-34% and serious renal events by 35-48%. Fixed-dose formulations improve medication adherence from 46.5% to 68.6%, with 47% of heart failure risk reduction mediated through improved adherence. DPP-4 inhibitor combinations show metabolic benefits but limited organ protection compared to GLP-1/SGLT-2 regimens. Conclusion: The paradigm shift from glycemic-centric to organ-protective therapy represents a fundamental advancement in diabetes management. Next-generation FDCs incorporating SGLT-2 inhibitors and GLP-1 receptor agonists should be prioritized in patients with established cardiovascular disease, heart failure, or chronic kidney disease. Future research must address optimal sequencing and dosing of triple FDCs (metformin/DPP-4i/SGLT-2i) for enhanced outcomes.

Aim: To determine the incidence and prevalence of left ventricular dysfunction in normotensive Type 2 diabetic patients and establish the correlation between glycemic control, metabolic parameters, and cardiac function abnormalities. Materials and Methods: A cross-sectional observational study was conducted on 300 normotensive Type 2 diabetic patients (150 males, 150 females) aged 35-70 years and 150 age-matched, gender-matched normotensive healthy controls. Comprehensive echocardiography with Doppler imaging was performed to assess left ventricular systolic and diastolic function. Blood pressure monitoring confirmed normotensive status (<140/90 mmHg). Glycemic parameters (HbA1c, fasting glucose), lipid profile, high-sensitivity C-reactive protein (hs-CRP), and anthropometric measurements were recorded. Exclusion criteria included history of hypertension, smoking, significant alcohol intake, valvular heart disease, renal insufficiency, and thyroid disorders. Results: Left ventricular dysfunction was detected in 180 (60%) diabetic patients compared to 18 (12%) controls (p <0.001). Diastolic dysfunction was present in 156 (52%) diabetics versus 12 (8%) controls. Systolic dysfunction (LVEF <50%) was identified in 54 (18%) diabetics and 6 (4%) controls. Mean LVEF was 61.8% ± 8.9% in diabetics versus 68.4% ± 7.2% in controls (p <0.001). Left ventricular mass index was significantly elevated in diabetics (98.5 ± 26.3 g/m²) compared to controls (84.2 ± 19.1 g/m²) (p = 0.002). HbA1c showed inverse correlation with LVEF (r = -0.456, p <0.001) and positive correlation with left ventricular mass index (r = 0.512, p <0.001). hs-CRP levels positively correlated with diastolic dysfunction severity (r = 0.478, p <0.001). Conclusion: Normotensive Type 2 diabetic patients demonstrate significantly high incidence of subclinical left ventricular dysfunction despite the absence of hypertension and cardiac symptoms. Early detection through echocardiography and optimal glycemic control are essential for preventing progression to overt heart failure.

Aim: This study was undertaken to determine the role of Contrast Enhanced Multiphasic Multi Detector Computed Tomography (CE-MDCT) in the evaluation of focal liver lesions and its potential role in differentiating benign from malignant lesions, with emphasis on morphological and enhancement characteristics for accurate diagnosis and appropriate patient management. Materials and Methods: A prospective cross-sectional study was conducted on 100 patients presenting with focal liver lesions. All patients underwent contrast-enhanced multidetector computed tomography imaging using a standardized protocol with imaging in unenhanced, arterial, portal venous, and delayed phases of enhancement. Morphological features including size, location, density, multiplicity, and enhancement patterns were systematically evaluated. Enhancement characteristics were classified based on lesion behavior in each phase. Statistical analysis was performed using descriptive statistics and accuracy calculations with 95% confidence intervals. Results: The study population predominantly comprised patients from the fourth to fifth decades of life (mean age: 52.3 years), with male predominance (68%). Abdominal pain was the most common clinical presentation (72%), followed by hepatomegaly (56%). Right lobe involvement was more frequent (78%), with 62% of patients having multiple lesions. Among cystic lesions (n=37), simple cysts (51.4%) were most common, followed by liver abscess (32.4%) and hydatid cysts (16.2%). CE-MDCT demonstrated 97.3% accuracy for benign cystic lesion detection. Overall diagnostic accuracy was 98% for benign lesions and 91.5% for malignant lesions. Conclusion: Contrast-enhanced multiphasic multi-detector CT is a highly accurate, non-invasive imaging modality for detection, characterization, and differentiation of focal liver lesions. The high sensitivity and specificity of CE-MDCT for both benign and malignant lesion detection make it an essential tool in the diagnostic algorithm for patients with focal liver pathology, potentially reducing need for further investigations and guiding appropriate clinical management.

Background: Chronic anal fissure is a prevalent benign anorectal disorder marked by intense discomfort during defecation and rectal haemorrhage. When other treatments don’t work, lateral internal sphincterotomy (LIS) is thought to be the best surgical option. Objective: To assess the efficacy and safety of lateral internal sphincterotomy in individuals with anal fissure. Materials and Methods: This prospective study was executed at PMCH, Patna, Bihar, spanning a duration of 9 months (March 2025–November 2025). Fifty individuals with anal fissure were subjected to lateral internal sphincterotomy. During follow-up, we looked at postoperative outcomes such pain alleviation, healing of the fissure, complications, and recurrence. Results: Most patients saw a big improvement in their pain and fissures within six weeks. There were little complications, and no severe incontinence was noted. Conclusion: Lateral internal sphincterotomy is a secure and efficacious technique for the treatment of anal fissure, demonstrating superior healing rates and negligible complications.

Background: Diabetic foot disease is a major complication of diabetes mellitus and a leading cause of non-traumatic lower-limb amputations. Objective: To evaluate diabetic foot ulcers using Wagner’s classification and correlate ulcer grade with management outcomes. Methods: A prospective study was conducted at PMCH, Patna (February–October 2025) involving 75 patients graded using Wagner’s classification. Results: Wagner grade II and III ulcers were most common. Higher grades required surgical intervention. Conclusion: Wagner’s classification is a simple and effective tool for evaluation and management of diabetic foot ulcers.

Background: Bleeding from the gastrointestinal tract remains a frequent and serious complication among hospitalized patients, especially those admitted to tertiary care centers or categorized as high risk. Pharmacological suppression of gastric acid is a cornerstone of preventive strategies, most commonly achieved using proton pump inhibitors or histamine-2 receptor antagonists. Despite widespread use of both drug classes, uncertainty remains regarding their relative effectiveness in preventing gastrointestinal bleeding. Objectives: To evaluate and compare the effectiveness of proton pump inhibitors and H2-receptor antagonists in lowering the incidence of gastrointestinal bleeding among hospitalized patients through a systematic synthesis of available evidence. Methods: A comprehensive systematic review with meta-analysis was conducted, including randomized controlled trials and comparative observational studies that directly compared proton pump inhibitors with H2-receptor antagonists in hospital or tertiary care settings. Relevant studies were identified through electronic database searches, screened for eligibility, and assessed for inclusion. The primary endpoint was the occurrence of gastrointestinal bleeding. Secondary outcomes included rebleeding events, requirement for blood transfusion, mortality, and adverse effects. Quantitative pooling was performed using standard meta-analytic techniques, with assessment of between-study heterogeneity. Results: Pooled analysis demonstrated that proton pump inhibitors were associated with a significantly lower risk of gastrointestinal bleeding compared with H2-receptor antagonists. This benefit was most evident in critically ill and high-risk patient populations. Proton pump inhibitors also showed a favorable effect in reducing rebleeding rates and transfusion requirements. No consistent difference in mortality was observed between the two treatment groups. Although moderate heterogeneity was present, the overall direction of effect consistently favoured proton pump inhibitors. Conclusion: The findings of this meta-analysis indicate that proton pump inhibitors provide superior protection against gastrointestinal bleeding compared with H2-receptor antagonists, particularly in patients at moderate to high risk. These results support preferential use of proton pump inhibitors in high-risk clinical settings, with careful consideration of patient selection and treatment duration to optimize safety and effectiveness.

Background: In general surgery practice, ventral hernias—which include incisional, umbilical, and para-umbilical defects—represent a significant burden. Laparoscopic Ventral Hernia Repair (LVHR) has becoming more popular due to its less invasive nature; however open mesh repair has traditionally been the norm. There is still a dearth of information comparing these methods in semi-urban Indian contexts, nevertheless. Objective: This study’s main goal was to assess and contrast the short-term results of laparoscopic and open ventral hernia repair (OVHR). The study specifically sought to evaluate the length of hospital stay, intraoperative blood loss, postoperative pain intensity, operative time, and the frequency of early postoperative problems such seroma and surgical site infection (SSI). Methods: Over the course of 11 months, the Department of Surgery at Jawahar Lal Nehru Medical College and Hospital (JLNMCH), Bhagalpur, carried out a prospective comparative study. A total of 75 patients with simple ventral hernias were recruited and divided into two groups: Group A received LVHR (n = 35) and Group B received OVHR (n = 40). Results: The LVHR group’s mean operating time ( ) was substantially longer than the OVHR group’s ( ) ( ). On the other hand, Group A had a shorter mean hospital stay ( ) and considerably lower postoperative pain scores at 24 hours (VAS: vs. ). Compared to 2.8% in the laparoscopic group, 12.5% of the open group experienced surgical site infections. Conclusion: An efficient and safe substitute for open treatment is laparoscopic ventral hernia repair. It is a feasible alternative even in settings with limited resources since, despite the longer operating time, it gives clear benefits in terms of decreased postoperative discomfort, lower wound morbidity, and faster hospital discharge.

Background: The gastrointenstinal tract (GIT) is a hollow muscular Tube extending from the oral cavity to the anus. Acid peptic disease is among common disorders affecting this region globally, caused by an imbalance between acid secretion and gastric mucosal defences. Gastric cancer is a significant health burden in India. Accurate diagnosis and classification and gastric lesions are essential for effective treatment. Endoscopy has enhanced the accuracy and early histoscopy diagnosis of mucosal lesions. This cross sectional study examines 60 gastric biopsies over a two year period. Method: the study categorized histopathological findings from gastro duodenal biopsies collected via endoscopy and analyzed their correlation with endoscopic results. Results: Most of the cases were above 50 years of age with male preponderance. The common site for gastric biopsy was gastric antrum and the common endoscopic finding was ulcero-proliferative growth. Intestinal adenocarcinoma followed by diffuse infiltrating adenocarcinoma were the most common histological types. Conclusion: Endoscopic gastric biopsies are instrumental in diagnosing both benign and malignant lesions across various age groups and sites. The combination of endoscopy and histopathological analysis provides a powerful diagnosis tool for better patient management.

Background: Cervical cancer is the second most common cancer in women following breast carcinoma. It is the cause of second most common cancer related mortality in women. As per Globocan 2020, 604100 new cases of cervical cancer were detected globally in 2020 and 341,831 deaths were attributed to the malignancy. In India, cervical cancer accounted for 9.4% of all cancers and 18.3% (123, 907) of new cases. The most commonly used and the most cost-effective screening test is cervical cytology and DNA testing for Human Papilloma virus in cervical cell samples. The clinical trials showed that these tests significantly decreased the morbidity and mortality in cervical cancer.  Pap smear is the most cost-effective method for the prevention and detection of cervical cancer and has reduced the cervical cancer mortality by 70%.  The imperfect sensitivity and variable smear quality of conventional Pap collection led to a search for a better alternative. In 1996, Liquid based cytology method was developed hoping to overcome the disadvantages of the previous method by improving sensitivity, sample adequacy and faster sample preparation. The present study was carried out to determine comparative effectiveness of conventional Pap smear and Liquid based cytology for evaluating cervical cytology over a period of two years from Nov 2020 – Oct 2022 in the Department of Pathology, M.K.C.G. Medical College and Hospital, Berhampur, Odisha. Methods: The present study design is a prospective randomized evaluation of diagnostic tests. A total number of 220 subjects were studied over a period of 2 years (November 2020 to October 2022) at Department of Pathology, M.K.C.G. Medical College, Berhampur. Conventional Pap smears& Liquid based cytology were prepared from each sample collected (Split Sample Technique) and analyzed according to new BETHESDA System of reporting (2014). Results: In the present study, comparison of morphological details and results of cervical cytology smears by both methods showed that, liquid-based cytology method provides less endocervical cells but higher clarity of background with reduced obscuring material (blood, mucus and inflammatory cells). The samples with liquid-based cytology were more representative, which allowed for better morphological evaluation. Also, more cases of epithelial lesions were detected by LBC and both sensitivity & specificity of epithelial abnormality detection was higher with LBC compared to conventional method. Conclusion: Liquid based cytology requires more infrastructures and trained personnel, but is a better alternative to conventional smears for detection of premalignant and malignant conditions of cervix. Wherever economically feasible, LBC should be the first choice for cervical cytology collection.

Background and Objective: One of the main causes of antepartum haemorrhage and a major contributor to the morbidity and mortality of mothers and newborns is placenta previa (PP). The risk and severity of complications vary with the location of placental implantation. This study aimed to evaluate the association between maternal and perinatal outcomes and the location of PP in a tertiary care center. Methods: This retrospective observational study was done in the Department of Obstetrics and Gynaecology at JLNMCH, Bhagalpur, Bihar during a period of  October 2024 to September 2025. All pregnant women with ultrasonographically confirmed PP and gestational age ≥28 weeks who delivered at the institution were included. A total of 75 cases were analyzed. Patients were categorized into low-lying/marginal PP and major PP based on ultrasonographic and intraoperative findings. Maternal outcomes assessed included blood transfusion, postpartum haemorrhage, ICU admission, obstetric hysterectomy, and maternal mortality. Prematurity, NICU hospitalization, stillbirth, and early neonatal death were among the fetal outcomes. After the data were analyzed using the appropriate statistical tests, a p-value of less than 0.05 was considered statistically significant. Results: Out of 75 cases of PP, obstetric hysterectomy was performed in 8 patients (10.7%). Maternal mortality occurred in 3 cases (4%) and was primarily associated with massive postpartum haemorrhage and hemodynamic instability. A total of 18 fetal deaths (24%) were recorded, mainly due to extreme prematurity and severe fetal compromise. A Compared to low-lying or marginal PP, major PP was associate to substantially greater incidence of postpartum haemorrhage, blood transfusion need, preterm delivery, obstetric hysterectomy, and perinatal mortality. Conclusion: A significant risk of serious maternal and neonatal problems is linked to PP, especially in major group early diagnosis, appropriate antenatal surveillance, planned delivery in equipped tertiary care centres, and readiness for massive transfusion and surgical intervention are crucial to reducing maternal and perinatal mortality.

Background: Bardet–Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy characterized by progressive vision loss, polydactyly, obesity, intellectual disability, metabolic disturbances, and renal abnormalities. Despite its significant impact on morbidity and mortality, BBS often remains underdiagnosed, particularly in resource-limited settings where genetic testing is inaccessible. Case Presentation: We present a case series of three pediatric patients with Bardet–Biedl syndrome (BBS) from Central India, comprising two 9-year-old female patients and one 10-year-old male patient. All three patients exhibited hallmark features of the syndrome, including progressive visual impairment due to retinitis pigmentosa, post-axial polydactyly, central obesity, and metabolic abnormalities. Case 1 demonstrated hypoplastic ovaries with associated hormonal imbalances, while Case 2 exhibited moderate intellectual disability, hepatosplenomegaly, and insulin resistance. Case 3 presented with learning difficulties, hypogonadism, insulin resistance, dyslipidemia, and early renal parenchymal involvement, along with mild cardiac changes. Diagnosis in all cases was established based on characteristic clinical features supported by biochemical and radiological findings, as genetic testing was not readily available. Genetic counseling was recommended for all families. A multidisciplinary management approach, including ophthalmologic surveillance, metabolic control, dietary and lifestyle interventions, endocrinological evaluation, renal monitoring, and neurodevelopmental support, was initiated to improve quality of life and delay disease progression. Conclusion: Early recognition of BBS is critical for timely intervention and reducing complications, particularly renal failure, which is the leading cause of morbidity and mortality in affected individuals. Given the limited availability of genetic testing, clinical diagnosis based on characteristic features remains essential in low-resource settings. Increased awareness among healthcare professionals can facilitate prompt identification, allowing for comprehensive, multidisciplinary management to optimize patient outcomes.

Background: Epidural analgesia is among the most effective methods for intrapartum pain relief. Patient-controlled epidural analgesia (PCEA) has become increasingly popular technique for this, especially after advent of ropivacaine, with ongoing debate regarding the role of background or mandatory bolus infusions in optimizing analgesia and maternal satisfaction. Methods: A prospective randomized double-blinded intervention study was conducted on ninety parturients in active labour which were randomized into 2 groups to receive either PCEA alone or PCEA with an hourly mandatory bolus using 0.125% ropivacaine with fentanyl (2 µg/mL). The primary outcomes were analgesia quality (measured by VAS) and total drug consumption. Secondary outcomes included maternal satisfaction, mode of delivery, neonatal Apgar scores, and incidence of motor block. Data were analysed using Student’s t-test and chi-square test, with p < 0.05 considered significant. Results: Both groups achieved effective labour analgesia. The mean number of demand boluses was significantly lower in Group PCEA+MB (0.33 ± 0.47) compared to Group PCEA (3.08 ± 0.73; p < 0.001). Mean total epidural drug consumed in group PCEA+MB was 26.91± 4.23 ml and in group PCEA was 25.62± 2.71 ml which was not significantly different (p = 0.089). Maternal satisfaction was significantly higher in Group PCEA+MB. Obstetric and neonatal outcomes, including Apgar scores and motor block incidence, were similar. Conclusion: Addition of mandatory bolus to PCEA with ropivacaine and fentanyl resulted in more efficient pain relief with less demand of rescue top ups and increased maternal satisfaction without any significant side effects among parturients.

Background: Competency-Based Medical Education (CBME) emphasizes outcome-oriented training and requires assessment methods that evaluate applied clinical competence rather than factual recall alone. Traditional assessment modalities in undergraduate pharmacology often fail to assess prescribing skills, clinical reasoning, and professional attitudes essential for safe medical practice. The Objective Structured Clinical Examination (OSCE) has emerged as a promising tool to address these limitations. Objectives: To evaluate the effectiveness, reliability, and acceptability of OSCE in assessing undergraduate pharmacology competencies under the CBME framework and to compare OSCE performance with traditional assessment methods. Materials and Methods: A prospective, cross-sectional analytical study was conducted among second-year MBBS students (n = 83) in the Department of Pharmacology at a tertiary care teaching institution. Ten competency-based OSCE stations were developed through blueprinting and standardization. OSCE scores were compared with theory examination and viva voce scores. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC), and student perceptions were collected through a structured questionnaire. Results: The mean OSCE score was 67.2 ± 8.7. OSCE scores were significantly higher than theory examination scores (p < 0.001) and viva voce scores (p = 0.03). A moderate positive correlation was observed between OSCE and theory scores (r = 0.59, p < 0.001). Inter-rater reliability was excellent (ICC = 0.80). Most students perceived OSCE as fair, clinically relevant, and superior to traditional assessment methods. Conclusion: OSCE is a reliable, valid, and CBME-aligned assessment tool for undergraduate pharmacology. Its routine integration into assessment programs is recommended to enhance evaluation of applied competence, rational prescribing, and patient safety.

Background: The frontal recess is a critical anatomical region implicated in chronic rhinosinusitis (CRS), a condition with significant implications for patient quality of life. Complications during surgery can arise due to the intricate nature of the frontal recess and its proximity to vital structures such as the orbit and anterior cranial fossa. Materials and Methods: This study was a cross-sectional study, here 100 consecutive patients (200 sides) who were complaining of at least two of the following symptoms (nasal block, nasal/postnasal discharge, facial pain/pressure, or reduction/loss of smell) for at least 12 weeks during the study period, and the study was conducted at Osmania Medical College, Hyderabad. Results: In the prevalence and infection rates of frontal recess cells in patients with chronic rhinosinusitis, categorized into anterior, posterior, and medial cell groups. The anterior group, was statistically significant. In the chi-square tests for specific frontal recess cells versus the overall infection rate indicate varying levels of significance. The Supra Agar Cell (SAC) shows a chi-square value of 5.35 and a p-value of 0.021, marking it as significant (S). Conclusion: The study contributes to the existing literature by providing new insights into the complex anatomy of the frontal recess and its role in chronic rhinosinusitis. These findings underscore the importance of detailed preoperative assessment and complete surgical excision of frontal recess cells to improve outcomes and prevent complications in patients with chronic rhinosinusitis.

Background: Dengue fever represents a significant public health burden in tropical and subtropical regions, with children being particularly vulnerable to severe manifestations. Early identification of patients at risk for progression to severe dengue is crucial for appropriate clinical management and resource allocation. This study aimed to evaluate clinical features and laboratory parameters as predictors of disease severity in pediatric dengue patients. Methods: This prospective observational study was conducted over 18 months and included 248 children aged 1-14 years with confirmed dengue infection. Patients were classified according to WHO 2009 criteria into dengue without warning signs, dengue with warning signs, and severe dengue. Clinical and laboratory parameters were compared across severity groups, and multivariate logistic regression analysis was performed to identify independent predictors of severe disease. Results: Among 248 patients, 98 (39.5%) had dengue without warning signs, 112 (45.2%) had dengue with warning signs, and 38 (15.3%) had severe dengue. The mean age was 7.8 ± 3.4 years, with male predominance (58.1%). Thrombocytopenia (<100,000/μL) was observed in 72.6% of patients with severe dengue compared to 28.6% in non-severe cases (p < 0.001). Elevated hematocrit (>20% rise), elevated AST (>3× normal), and low platelet count were independent predictors of severe dengue. The platelet-to-hematocrit ratio ≤3.5 demonstrated 84.2% sensitivity and 78.6% specificity for predicting severe dengue (AUC = 0.87, p < 0.001). Mortality rate was 2.6% among severe dengue cases. Conclusion: Laboratory parameters, particularly thrombocytopenia, hemoconcentration, and hepatic transaminases, serve as valuable predictors of severe dengue in children. The platelet-to-hematocrit ratio represents a simple, accessible marker for early identification of patients requiring intensive monitoring.

Background: Recurrent inguinal hernia remains a significant surgical challenge, with conventional open repairs associated with increased morbidity and technical difficulties due to scarring and anatomical distortion. Laparoscopic transabdominal preperitoneal (TAPP) mesh repair has emerged as a promising approach for managing recurrent hernias, offering potential advantages in visualization and mesh placement in virgin tissue planes. Methods: This prospective observational study was conducted over 24 months and included 86 patients with recurrent inguinal hernia who underwent laparoscopic TAPP meshplasty. Patients were evaluated for operative parameters, postoperative outcomes, complications, and recurrence rates during a minimum follow-up period of 12 months. Data were analyzed using descriptive statistics, and outcomes were compared based on previous repair type. Results: The mean age of participants was 52.4 ± 11.8 years, with 91.9% being male. Mean operative time was 68.3 ± 15.2 minutes, and mean hospital stay was 1.8 ± 0.6 days. The visual analog scale pain score at 24 hours was 3.2 ± 1.1. Early complications occurred in 9.3% of patients, including seroma (4.7%), hematoma (2.3%), and wound infection (2.3%). Chronic pain at 6 months was observed in 3.5% of patients. The recurrence rate at 12-month follow-up was 2.3%. Patients with previous laparoscopic repair had significantly longer operative times compared to those with prior open repair (p = 0.021). Conclusion: Laparoscopic TAPP meshplasty is a safe and effective approach for recurrent inguinal hernia repair, demonstrating low complication rates, minimal postoperative pain, acceptable recurrence rates, and early return to normal activities.

Background: Laparoscopic appendectomy has become the preferred surgical approach for acute appendicitis due to its minimally invasive nature and rapid recovery profile. However, post-operative intra-abdominal complications, particularly pelvic abscess formation, remain a significant concern affecting patient outcomes and healthcare resource utilization. Methods: A prospective observational study was conducted at a tertiary care hospital over 18 months, enrolling 324 patients who underwent laparoscopic appendectomy for acute appendicitis. Patients were followed for 30 days post-operatively. Diagnosis of pelvic abscess was confirmed through clinical assessment and computed tomography imaging. Demographic, operative, and pathological variables were analyzed to identify risk factors. Results: The overall incidence of post-operative pelvic abscess was 4.01% (n=13). Mean age of affected patients was 34.8 ± 12.4 years. Complicated appendicitis (gangrenous/perforated) was significantly associated with abscess formation (p=0.002). Prolonged operative duration (>60 minutes) demonstrated significant correlation (p=0.018). Intra-operative peritoneal contamination was present in 84.6% of abscess cases. Mean time to abscess diagnosis was 7.2 ± 2.8 days post-operatively. Conservative management with antibiotics and percutaneous drainage was successful in 76.9% of cases, while 23.1% required surgical intervention. Conclusion: Post-operative pelvic abscess following laparoscopic appendectomy occurs in approximately 4% of cases, with complicated appendicitis and prolonged operative time being significant risk factors. Early recognition and appropriate management strategies are essential for optimal patient outcomes.

Background: The Pediatric Risk of Mortality (PRISM) score is a widely used severity-of-illness scoring system designed to predict mortality risk in critically ill children. While extensively validated in developed countries, the performance of PRISM may vary across different healthcare settings and patient populations. Validation of this scoring system in diverse clinical environments is essential to ensure its reliability and applicability for clinical decision-making and quality benchmarking. Methods: This prospective observational study was conducted in a tertiary care pediatric intensive care unit (PICU) over 18 months, enrolling 342 critically ill children aged 1 month to 14 years. PRISM III scores were calculated within the first 24 hours of admission using the most abnormal physiological values. The primary outcome was PICU mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Results: The overall PICU mortality rate was 14.6% (50/342). Non-survivors had significantly higher mean PRISM III scores compared to survivors (24.8 ± 8.6 vs. 8.4 ± 6.2, p < 0.001). The PRISM III score demonstrated excellent discrimination with an AUC of 0.91 (95% CI: 0.87-0.95). Calibration analysis showed good agreement between predicted and observed mortality (Hosmer-Lemeshow χ² = 8.42, p = 0.394). The standardized mortality ratio was 0.94 (95% CI: 0.72-1.22), indicating appropriate prediction accuracy. A PRISM III score ≥15 predicted mortality with 86.0% sensitivity and 82.2% specificity. Conclusion: The PRISM III score demonstrates excellent discriminatory ability and good calibration for mortality prediction in our pediatric intensive care population. This scoring system is a reliable tool for risk stratification, resource allocation, and quality assessment in the PICU setting.

Background: Hypothyroidism and hyperthyroidism are the main symptoms of thyroid dysfunction, which is a major endocrine burden worldwide. Micronutrients have a crucial role in the production and metabolism of thyroid hormones. The functions of vital trace elements like zinc (Zn) and copper (Cu) are still being researched, despite the fact that iodine is well known. Iodothyronine deiodinase requires zinc as a cofactor, and thyroxine production and antioxidant defense depend on copper. Objective: The purpose of this study was to assess the relationship between thyroid profile parameters (T₃, T₄, and TSH) and serum copper and zinc levels in patients with hypothyroidism and hyperthyroidism in comparison to healthy controls. Methods: From April 2021 to March 2022, an analytical observational study was carried out at the National Institute of Medical Sciences & Research in Jaipur. Three groups of 81 participants each clinically diagnosed hypothyroidism, hyperthyroidism, and age-and sex-matched healthy controls were created from the study population (N=243). Thyroid profile (T₃, T₄, TSH) and serum copper/zinc levels were measured using photometric techniques and chemiluminescence in fasting venous blood samples. Results: According to the study, thyroid issues are more common among women. Both hypothyroidism (74.38 ± 16.18 μg/dl) and hyperthyroidism (62.75 ±14.40 μg/dl) had significantly lower serum zinc levels than controls (89.97 ±12.85 μg/dl; p<0.001). On the other hand, hyperthyroidism patients had significantly higher serum copper levels (179.57 ± 33.77 μg/dl) than controls (164.1 ±54.31 μg/dl; p<0.05), but hypothyroid patients had a non-significant increase. Conclusion: The study shows that thyroid dysfunction is associated with significant changes in trace element homeostasis. While copper increase seems to be exclusive to the hyperthyroid condition, the ubiquitous fall in zinc indicates a possible role for zinc supplementation in controlling thyroid diseases.

Background: Ropivacaine is an amino-amide local anesthetic (LA) agent which is a newer local anesthetic. Ropivacaine is similar to bupivacaine in chemical structure but is 30-40% less potent than bupivacaine. Because of this, ropivacaine is well studied for spinal anesthesia (SA). Ropivacaine is safe and has a shorter duration of action than bupivacaine, which is a positive. Ropivacaine also has a lower incidence of transient neurological symptoms (TNS) in comparison to intrathecal lignocaine. Objectives: The objective of this study was to analyze and compare the clinical effectiveness of 0.75% Ropivacaine (3 ml) and 0.5% Bupivacaine (3 ml) in infra-umbilical surgeries. Materials and Methods: A study sample of 100 patients was selected for the study. The patients were randomly divided into two groups, 50 patients in each group. Group R (Ropivacaine): 3 ml (22.5 mg) of 0.75% Ropivacine was given intrathecally. Group B (Bupivacaine): 3 ml (15 mg) of 0.5% Bupivacaine was given intrathecally. Conclusion: 0.75% Hyperbaric-Ropivacaine may be preferred over 0.5% Hyperbaric-Bupivacaine for subarchnoid-block, in short duration surgical procedures to provide benefit of early postoperative recovery.

Background: Foetal haemoglobin (HbF) is essential in influencing disease severity in hemoglobinopathies, including sickle cell disease and β-thalassemia. Comprehending the mechanisms that govern HbF expression is crucial for therapeutic progress. Objective: To perform a comparative analysis of foetal haemoglobin regulation among various patient cohorts and evaluate the factors influencing HbF expression. Materials and Methods: This prospective observational study was carried out at Srirama Chandra Bhanja (SCB) Medical College, Cuttack. Patients with hemoglobinopathies were recruited based on study criteria. We looked at haematological markers, HbF levels, genetic modifiers, and treatment status. Results: The concentrations of HbF varied significantly among the study groups. Elevated HbF levels were associated with a less severe illness phenotype and improved haematological parameters. Conclusion: The regulation of HbF is influenced by a multitude of factors, including genetic, epigenetic, and therapeutic elements. Strategies designed to enhance HbF expression can markedly enhance clinical outcomes.

Abstract: Iron is an essential micronutrient that is critical for oxygen transport, DNA synthesis, and cellular metabolism. Disruption of iron homeostasis contributes to the onset and advancement of numerous chronic and acute diseases. Objective: To evaluate patterns of iron metabolism dysregulation and investigate its impact on disease progression and clinical outcomes. Materials and Methods: This prospective observational study assessed iron parameters, including serum ferritin, transferrin saturation, and serum iron levels, in patients with chronic inflammatory and metabolic diseases. Researchers looked at how iron dysregulation and how bad a disease is are related. Results: Iron metabolism changed a lot, and having too much or too little iron made the condition worse. Conclusion: Dysregulated iron metabolism is a significant factor in the progression of illness. Early detection and accurate modulation of iron homeostasis may improve clinical outcomes.

Background: Oral submucous fibrosis (OSMF) is a chronic, progressive, and potentially malignant disorder of the oral cavity with increasing evidence of systemic involvement. Aim: To estimate and compare serum urea, uric acid, and creatinine levels in patients with oral submucous fibrosis and healthy controls. Materials and Methods: A cross-sectional comparative study was conducted on 80 subjects divided into two groups. Biochemical parameters were estimated using standard methods and analyzed using the independent samples t-test. Results: Mean serum urea, uric acid, and creatinine levels were conservatively but significantly higher in OSMF patients compared to controls. Conclusion: The findings suggest subtle systemic metabolic alterations in OSMF.

Background: Immunohistochemistry (IHC) is essential in the histological diagnosis of breast diseases, especially in differentiating benign proliferations from malignant neoplasms. p63, a marker for myoepithelial cells, is frequently employed to ascertain the presence or absence of myoepithelial cells in breast core needle biopsies. But unusual expression patterns and mistakes in interpretation might make it hard to diagnose, especially when there isn’t much biopsy evidence. Objectives: To examine the diagnostic challenges linked to p63 immunostaining in breast core biopsies and to underscore patterns of atypical expression that may resemble malignancy or benignity. Materials and Methods: This retrospective case series was performed at CIMS Bilaspur, a tertiary care hospital in Chhattisgarh, during the span of one year. Ten breast core biopsy patients were included in which p63 immunostaining presented diagnostic difficulties. We looked at histomorphology, p63 staining patterns, how they related to other myoepithelial markers, and the final diagnoses. Results: In 40% of the 10 cases, there was disagreement in the diagnosis because of how p63 was interpreted. Aberrant p63 positivity was observed in certain malignant lesions, whereas localized or discontinuous staining was identified in benign tumors. The most prevalent error was the misperception of focused p63 positivity as indicative of benignity. Linking morphology with other markers like SMA and calponin made it easier to make accurate diagnoses. Conclusion: p63 is a useful myoepithelial marker, however it is not perfect. To avoid misdiagnosis, it is important to know about its diagnostic problems, especially in core biopsies. It is highly advised to use a panel-based technique along with meticulous morphological examination.

273. Scar Endometriosis: A Rare Cause of Painful Abdominal Wall Mass – A Retrospective Case Series from a Tertiary Care Hospital
B. P. Singh, Shahnaz Bano, Prashant Thakur
Background: Scar endometriosis is an infrequent presentation of extra-pelvic endometriosis, defined by the implantation of functional endometrial tissue within surgical scars, typically subsequent to obstetric or gynecologic interventions. It usually shows up as a painful mass on the abdomen wall that gets worse and worse with each menstrual cycle. Because it is rare and doesn't show any clear signs, it is sometimes misinterpreted as a hernia, suture granuloma, lipoma, or abscess. Objectives: To assess the clinical profile, diagnostic difficulties, imaging features, surgical intervention, and histological results of scar endometriosis in patients referred to a tertiary care facility. Methods: A retrospective study of 10 histopathologically validated instances of scar endometriosis treated at CIMS Bilaspur over the course of one year was performed. We looked at the patient's age, the type of surgery they had before, the time between the surgery and the start of their symptoms, the clinical presentation, the imaging results, the surgical technique, and the outcomes. The average age of the patients was 31.8 ± 4.6 years. All patients had a history of previous obstetric or gynecologic surgery, with lower-segment cesarean section being the most prevalent (80%). The most common symptom was a painful lump at the site of the surgery (100%), with pain that came and went in 70% of cases. Ultrasonography indicated a diagnosis in 80% of cases, although MRI confirmed it in certain instances. All patients had extensive local excision with clean margins. Histopathology verified the presence of endometrial glands and stroma in every instance. No recurrence was noted during the follow-up period. Conclusion: Scar endometriosis, while uncommon, must be examined in reproductive-age women exhibiting painful masses at scar sites, especially with cyclical symptoms. A high level of clinical suspicion, the right imaging, and full surgical removal are all important for diagnosis and treatment.

Background: To investigate the risk factors associated with intraoperative complications in patients with pseudoexfoliation undergoing cataract surgery. To assess both intraoperative and postoperative complications in patients with pseudoexfoliation syndrome undergoing cataract surgery. Material and Methods: The study included patients with pseudoexfoliation syndrome and cataract who visited the Ophthalmology OPD from August 2023 to May 2024. A detailed clinical examination including visual acuity testing, refraction, external ocular examination and a thorough slit lamp biomicroscopy was done. Result: The mean age of presentation in the study was 68.28 years, with the majority, 44 (88%) out of 50 patients, being above 60 years of age. The male-to-female ratio was approximately 3:2, indicating a male predominance. 27 (54%) patients had bilateral occurrence, while 23 (46%) had unilateral pseudoexfoliation. It was found that 4 (8%) patients with pseudoexfoliation had associated diabetes mellitus, 14 (28%) had associated hypertension, and 3 (6%) had associated ischemic heart disease. The range of intraocular pressure (IOP) in this study was between 11-21 mmHg, with a mean IOP of 16.40 mmHg. Specifically, 44 (88%) had pseudoexfoliation material along the pupillary margin, 20 (40%) had it over the surface of the iris, 7 (14%) showed iris atrophy, 1 (2%) exhibited iridodonesis, and 16 (32%) had posterior synechiae. 10 (20%) of patients with pseudoexfoliation had very poor mydriasis (< 4mm), 25 (50%) had fair mydriasis (5-6mm), and approximately 15 (30%) had good mydriasis (more than 6mm).The most common type of cataract encountered was advanced cataract(including nuclear sclerosis grade III and IV, mature, and hypermature cataract). Poor pupillary dilatation, phacodonesis, subluxation/dislocation of the cataractous lens, and zonular dialysis are considered to be the most important risk factors because they can lead to increased intraoperative complications. On comparing the size of the pupillary diameter with intraoperative complications, a significant correlation (P = 0.021) was obtained. Additionally, there was a significant correlation between the size of the pupillary diameter and postoperative complications (P = 0.01). Majority of the patients attained a visual acuity of 6/6 to 6/18. Conclusion: The present study showed that poor mydriasis, preoperative zonular dialysis, iridodonesis, Phacodonesis, and the type of cataract were the most common risk factors affecting the surgical outcome. Patients with pseudoexfoliation syndrome and cataract undergoing small incision cataract surgery must be carefully evaluated for zonular weakness, insufficient mydriasis, Phacodonesis, and subluxation/dislocation of the cataractous lens. These preoperative risk factors can significantly impact the surgical outcome.

Background: Lower segment caesarean section (LSCS) is a commonly performed obstetric procedure; however, rare postoperative complications such as uterine scar dehiscence with pyoperitoneum can result in significant maternal morbidity. Due to its nonspecific clinical presentation, diagnosis is often delayed, necessitating prompt recognition and timely surgical intervention. Methods: This descriptive case series was conducted over an eleven-month period from 1 January 2025 to 31 November 2025. Six patients who developed uterine scar dehiscence complicated by pyoperitoneum following LSCS were included. All patients were referred from Umaid Hospital and managed surgically at Mahatma Gandhi Hospital, Jodhpur. Clinical presentation, laboratory findings, radiological evaluation, intraoperative findings, surgical management, and postoperative outcomes were analyzed. Results: The patients ranged in age from 22 to 34 years, with both primigravida and multigravida women affected. The time of presentation varied from postoperative day 5 to day 20. Common presenting symptoms included fever, abdominal pain, abdominal distension, and wound discharge. All patients had elevated leukocyte counts. Contrast-enhanced computed tomography was diagnostic in most cases, revealing uterine scar dehiscence with pelvic abscess or pyoperitoneum. All patients underwent emergency surgical exploration, which revealed purulent intraperitoneal collections and dehisced uterine scars. Surgical management included drainage of pus, peritoneal lavage, adhesiolysis when required, and primary repair of the uterine scar. The postoperative course was uneventful in all patients, with no mortality and successful uterine preservation in all cases. Conclusion: Uterine scar dehiscence with pyoperitoneum following LSCS is a rare but serious complication. High clinical suspicion, early radiological evaluation, and timely surgical intervention are essential for favorable maternal outcomes and uterine preservation.

Background: Anemia constitutes a pervasive public health challenge in India, acting as both a direct cause of morbidity and a significant comorbidity in various systemic disorders. The state of Bihar faces a unique set of challenges characterized by socio-economic constraints, recurrent flooding, and nutritional deficits, which exacerbate the hematological burden. Despite the implementation of national control programs, the prevalence of anemia remains disproportionately high in the Gangetic plains. Objective: This study aimed to estimate the prevalence of anemia and characterize its morphological patterns among patients attending the Outpatient Department (OPD) of Darbhanga Medical College and Hospital (DMCH). Methods: A hospital-based cross-sectional observational study was conducted over a duration of 11 months. A total of 100 clinically suspected or randomly screened patients from the general OPD were enrolled. Hemoglobin estimation was performed using an automated cell counter, followed by peripheral blood smear examination to determine morphological types. Anemia was defined according to World Health Organization (WHO) criteria. Results: Out of 100 subjects, the overall prevalence of anemia was found to be 68%. The prevalence was significantly higher in females (76.6%) compared to males (55%). The majority of the anemic population fell into the moderate category (45.6%). Morphological analysis revealed that Microcytic Hypochromic anemia was the predominant type (58.8%), indicative of iron deficiency, followed by Normocytic Normochromic anemia (29.4%). Significant associations were observed regarding rural residence and lower socio-economic status. Conclusion: The study highlights a substantial burden of anemia among the OPD attendees at DMCH, Laheriasarai. The predominance of microcytic hypochromic anemia suggests nutritional iron deficiency as the primary driver. These findings reinforce the need for targeted nutritional interventions, deworming protocols, and routine screening in tertiary care settings to mitigate morbidity.

Pawapuri, Nalanda, involving 50 newly diagnosed hypothyroidism cases aged 20 to 60 years, of both sexes, and 50 controls of the same age and sex. There was a substantial increase in blood uric acid and serum creatinine levels among the hypothyroid individuals (p<0.001, respectively). The use of Pearson’s correlation coefficient demonstrated a strong link between TSH and uric acid, while indicating a non-significant correlation with serum creatinine. The study underscores the clinical importance of routinely conducting thyroid function tests in individuals with impaired renal function and vice versa.

Background: Polycystic Ovary Syndrome (PCOS) is a complex disorder that affects multiple systems in the body, with significant long-term effects on the risk of non-communicable diseases. Hyperandrogenism and dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis have been linked to metabolic decline, but local data from Uttarakhand is limited. Objective: To evaluate the incidence of non-communicable disease risk factors in PCOS patients in Uttarakhand and relate these findings to androgen levels and serum cortisol. Methods: A cross-sectional study involved 150 women of reproductive age (18–40 years) diagnosed with PCOS based on the Rotterdam criteria at a tertiary hospital in Uttarakhand. We analyzed anthropometric measurements, blood pressure, fasting glucose, lipid profiles, HOMA-IR, hs-CRP, and hormonal levels (total testosterone, free testosterone, DHEA-S, morning cortisol). Results: Obesity was found in 64.7% of participants, central obesity in 71.3%, hypertension in 32.7%, dyslipidemia in 68.0%, insulin resistance in 59.3%, and elevated hs-CRP in 47.3%. Serum testosterone (r = 0.52, p < 0.001) and cortisol (r = 0.49, p < 0.001) were positively associated with BMI, HOMA-IR, triglycerides, and systolic blood pressure. Conclusion: Women with PCOS in Uttarakhand showed a high prevalence of risk factors for metabolic non-communicable diseases. Higher levels of androgens and cortisol are strongly linked to metabolic decline, highlighting the importance of early screening and lifestyle and medical interventions.

Introduction: A quality management system (QMS) should be implemented to ensure accurate and reliable results from diagnostic laboratories. However, in developing countries like India, where resources are limited, many laboratories that were not previously performing molecular tests and lack accreditation to international standards may only implement a few parameters of quality control. Introducing a molecular test like real-time reverse transcription polymerase chain reaction (RT-PCR) during the COVID-19 pandemic, where accurate and timely results are essential for outbreak control, carries a high risk of errors. Without robust quality assurance (QA), inaccurate test results can lead to inappropriate treatment decisions, mismanagement of patients, and gaps in disease surveillance. Aim: To identify key performance quality indicators (KPQIs) in an RT-PCR testing laboratory for COVID-19. Method: Key Performance Quality Indicators were identified, and a retrospective analysis was conducted on all nasopharyngeal swabs received for SARS-CoV-2 RT-PCR testing over seven months (November 2020 to May 2021). Results and Conclusion: Collection and analysis of data at each step of the testing cascade serve as quality indicators for the overall performance of the testing process. It is crucial to analyze and report these indicators regularly to minimize laboratory errors and generate accurate results. In our study, laboratory errors occurred in less than 5% of samples, demonstrating effective QA measures.

Background: Guillain-Barré Syndrome (GBS) is an acute, inflammatory, demyelinating disorder of the peripheral nervous system, often following a viral or bacterial infection. Although GBS is relatively rare in children, it is a serious condition that demands prompt recognition and treatment. The outcome of pediatric GBS can vary, and identifying clinical characteristics and prognostic factors is crucial for improving patient management and recovery. This study aims to evaluate the clinical profile and outcomes of children diagnosed with GBS at Osmania General Hospital, Hyderabad. Objective: To analyze the clinical features, treatment, and outcomes of children diagnosed with Guillain-Barré Syndrome at Osmania General Hospital, and to identify prognostic factors influencing recovery. Methods: A retrospective analysis was conducted on pediatric patients diagnosed with GBS between December 2022 to November 2024 at Osmania General Hospital. Clinical data, including age, gender, presenting symptoms, diagnostic tests, treatment protocols, and outcomes, were collected and analyzed. The primary outcomes measured were recovery time, functional status at discharge, and long-term prognosis. Results: A total No. of [157] pediatric patients were included in the study. The most common presenting symptoms included [100]. Prognostic factors identified in the study included which were associated with better or poorer outcomes. Conclusion: Pediatric GBS at Osmania General Hospital presents with a diverse clinical profile, and the outcomes are influenced by various factors such as [18%]. Early diagnosis, timely intervention, and appropriate treatment are critical to improving recovery. Further studies are recommended to explore the long-term follow-up of pediatric GBS patients and refine prognostic models.

Background: Airway management remains a critical responsibility of anesthesiologists, particularly in patients with anticipated or unanticipated difficult airways. The advent of new generation videolaryngoscopes has transformed airway visualization and intubation strategies. However, real-world evidence on their performance in difficult intubations from resource-limited tertiary care centers is still evolving. Objectives: To evaluate the performance of new generation videolaryngoscopes in managing difficult intubation and to assess intubation success rates, number of attempts, time to intubation, and associated complications. Materials and Methods: This retrospective observational study was conducted at Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, over a period of 10 months. Medical records of 100 adult patients with documented difficult airway who underwent tracheal intubation using new generation videolaryngoscopes were reviewed. Data regarding patient demographics, airway assessment parameters, intubation characteristics, success rates, and complications were collected and analyzed. Results: Successful intubation using videolaryngoscopes was achieved in most patients, with high first-attempt success rates and improved glottic visualization. The mean time to intubation was reduced, and airway-related complications were minimal. Patients with higher Mallampati grades and limited neck mobility particularly benefited from videolaryngoscope-guided intubation. Conclusion: New generation videolaryngoscopes demonstrated high effectiveness and safety in managing difficult airways. Their routine availability and use can significantly improve airway outcomes, especially in tertiary care settings.

Background: Delirium is a frequent and serious complication among critically ill patients admitted to intensive care units (ICUs). It is associated with prolonged mechanical ventilation, increased length of ICU stay, higher healthcare costs, and increased mortality. Dexmedetomidine, a highly selective α2-adrenergic agonist, has gained attention as a sedative agent that provides anxiolysis and analgesia without significant respiratory depression. Emerging evidence suggests that dexmedetomidine-based sedation may reduce the incidence and duration of ICU delirium when compared with conventional sedatives. Objectives: To evaluate the role of dexmedetomidine in reducing the incidence and severity of delirium among ICU patients in a tertiary care setting. Methods: This retrospective observational study was conducted at Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, over a period of 10 months. Medical records of 100 adult ICU patients who received dexmedetomidine for sedation were reviewed. Data regarding demographic characteristics, clinical profiles, duration of ICU stay, need for mechanical ventilation, and occurrence of delirium were collected. Delirium was assessed based on documented clinical evaluation using standard delirium assessment tools. Outcomes were compared with patients who received non-dexmedetomidine sedative regimens. Results: The incidence of delirium was found to be lower in patients receiving dexmedetomidine-based sedation compared to those managed with other sedative agents. Patients in the dexmedetomidine group demonstrated shorter duration of delirium, reduced requirement for additional sedatives, and a trend toward shorter ICU stay. Hemodynamic parameters remained stable in most patients, with minimal adverse effects. Conclusion: Dexmedetomidine appears to be an effective sedative agent in reducing the incidence and duration of delirium among ICU patients. Its favorable sedative profile and minimal respiratory depression make it a valuable option for ICU sedation protocols. Further prospective and randomized studies are recommended to validate these findings.

Background: Cesarean delivery is one of the most performed obstetric surgical procedures worldwide. Regional anaesthesia techniques, particularly spinal and epidural anaesthesia, are preferred for elective cesarean sections due to better maternal safety, reduced neonatal exposure to systemic drugs, and improved postoperative recovery. However, each technique has distinct advantages and limitations with respect to onset of action, haemodynamic stability, intraoperative comfort, and postoperative analgesia. Objectives: To compare spinal and epidural anaesthesia in elective cesarean deliveries with respect to maternal haemodynamic changes, intraoperative complications, postoperative analgesia, and overall maternal outcomes. Materials and Methods: This retrospective study was conducted at Sri Krishna Medical College and Hospital, Muzaffarpur, over a period of 10 months. Medical records of 100 parturients who underwent elective cesarean delivery under regional anaesthesia were reviewed. Patients were divided into two groups based on the anaesthetic technique used: spinal anaesthesia (Group S) and epidural anaesthesia (Group E). Demographic data, intraoperative haemodynamic parameters, anaesthesia-related complications, and postoperative outcomes were analysed. Results: Spinal anaesthesia demonstrated a faster onset and shorter procedure time, whereas epidural anaesthesia was associated with better haemodynamic stability and prolonged postoperative analgesia. Hypotension was more frequently observed in the spinal group, while inadequate block and longer time to achieve surgical anaesthesia were more common in the epidural group. Conclusion: Both spinal and epidural anaesthesia are safe and effective techniques for elective cesarean delivery. Spinal anaesthesia offers rapid onset and simplicity, while epidural anaesthesia provides superior haemodynamic stability and extended postoperative pain relief. The choice of technique should be individualized based on patient characteristics and institutional expertise.

Background: Chronic anal fissure is a common anorectal condition associated with severe pain and impaired quality of life. Increased internal anal sphincter tone plays a key role in its pathogenesis. While lateral internal sphincterotomy is considered the definitive treatment, concerns regarding postoperative complications have encouraged the use of pharmacological alternatives such as topical diltiazem. This study aimed to compare the efficacy and safety of topical diltiazem with lateral internal sphincterotomy in the management of chronic anal fissure. Methods: This prospective comparative study was conducted over a period of twelve months at the Department of General Surgery, Dr. S.N. Medical College, Jodhpur. A total of 100 patients with chronic anal fissure were enrolled and randomly divided into two groups of 50 patients each. Group A received topical 2% diltiazem applied twice daily for six weeks, while Group B underwent lateral internal sphincterotomy. Patients were evaluated for pain relief, fissure healing, complications, and recurrence during follow-up visits up to six months. Results: Complete pain relief was achieved in 68% of patients in the diltiazem group and 92% in the sphincterotomy group. Fissure healing at six weeks was observed in 72% of patients treated with topical diltiazem compared to 96% in the sphincterotomy group. Minor adverse effects such as headache and local irritation were noted in the diltiazem group, while transient fecal incontinence was observed in 8% of patients in the sphincterotomy group. Recurrence rates were higher in the diltiazem group (16%) compared to the sphincterotomy group (4%). Conclusion: Lateral internal sphincterotomy remains the most effective treatment for chronic anal fissure in terms of rapid pain relief, higher healing rates, and lower recurrence. However, topical diltiazem is a safe and effective non-surgical alternative, particularly suitable for patients at risk of postoperative incontinence or those unwilling to undergo surgery.

Background: The selection of surgical technique in hip surgery markedly affects postoperative recovery, functional results, and gait biomechanics. The anterior and posterolateral approaches are the most common. Each one has its own way of preserving muscles, damaging soft tissue, and setting rehabilitation timelines. To make the best surgical decisions and get the best results for patients, you need to know how they affect return-to-activity and gait kinetics. Objectives: To compare the effects of anterior and posterolateral surgical approaches on return-to-activity and gait kinetic parameters in patients undergoing hip surgery. Materials and Methods: This retrospective study was performed at Narayan Medical College and Hospital, Sasaram, over an 18-month duration. We looked at the medical records of 100 people who had hip surgery using either the anterior or posterolateral approach. We gathered and looked at data on demographic characteristics, time to return to activity, and gait kinetic parameters. The outcomes of the two surgical approaches were compared using suitable statistical techniques. Results: Patients who had surgery using the anterior approach were able to return to normal activities much sooner than those who had surgery using the posterolateral approach. The anterior approach group had a shorter average time to walk independently, and a gait kinetic analysis showed that their stride length was longer, their cadence was higher, and their gait asymmetry was lower. These differences were statistically significant, showing that the anterior approach led to better early functional and biomechanical recovery. Conclusion: The anterior surgical approach resulted in expedited functional recovery and enhanced gait kinetics relative to the posterolateral approach. These results bolster the notion that surgical approach is a critical factor influencing postoperative functional outcomes.

Obesity is a chronic, multifactorial disease characterized by excess adiposity that profoundly affects nearly every physiological system. Its global prevalence has increased rapidly over recent decades, making it one of the most significant contributors to non-communicable disease burden worldwide. This systematic review synthesizes evidence on the effects of obesity on health, focusing on cardiometabolic, respiratory, musculoskeletal, hepatic, renal, reproductive, oncological, psychological, and mortality outcomes. Across the reviewed literature, obesity was consistently associated with increased risk of type 2 diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, stroke, heart failure, and premature mortality. These effects are largely mediated through insulin resistance, chronic low-grade inflammation, endothelial dysfunction, altered adipokine secretion, and neurohormonal dysregulation. Obesity was also strongly linked with obstructive sleep apnea, impaired pulmonary mechanics, osteoarthritis, physical disability, non-alcoholic fatty liver disease, chronic kidney disease, infertility, adverse pregnancy outcomes, depression, and reduced quality of life. Importantly, health risks increased progressively with higher degrees of adiposity and were particularly pronounced with central obesity. The findings reinforce the conceptualization of obesity as a systemic disease rather than merely a lifestyle issue and highlight the urgent need for integrated prevention and management strategies to reduce its substantial health and economic burden.

Background: Calcium channel blockers (CCBs) are commonly recommended as first-line therapy for the treatment of hypertension. Although amlodipine is extensively used in clinical practice, newer agents such as cilnidipine and benidipine possess additional pharmacodynamic properties that may enhance tolerability and vascular protection. Objective: To compare the antihypertensive efficacy and safety of amlodipine, cilnidipine, and benidipine in patients with essential hypertension. Methods: A prospective comparative study was conducted among patients diagnosed with essential hypertension. Participants were allocated to receive amlodipine, cilnidipine, or benidipine. Systolic and diastolic blood pressure were recorded at baseline and during follow-up. Adverse drug reactions, particularly pedal edema, were systematically documented. Results: All three treatment regimens produced significant reductions in systolic and diastolic blood pressure. Cilnidipine and benidipine achieved blood pressure control comparable to amlodipine, with a lower incidence of pedal edema. Conclusion: Cilnidipine and benidipine demonstrate effective antihypertensive efficacy with improved tolerability and may serve as suitable alternatives to amlodipine for long-term management of essential hypertension.

Introduction: Plantar fasciitis is a common cause of heel pain, typically exacerbated during initial weight bearing after periods of rest. Corticosteroid injections are frequently used in its management; however, their therapeutic benefits are often short-lived. Recent evidence suggests that autologous platelet-rich plasma (PRP) promotes tissue healing and provides sustained pain relief. This study aimed to compare the clinical efficacy of local PRP injection with corticosteroid injection in the management of chronic plantar fasciitis. Methods: This prospective double-blind study included sixty patients with chronic plantar fasciitis who fulfilled the inclusion criteria. Patients were randomly allocated into two groups. Group I received a local corticosteroid injection, while Group II received an autologous PRP injection. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Numerical Pain Score (NPS). Assessments were performed before injection and at 6 weeks, 3 months, and 6 months post-injection. Results: The mean VAS score in Group I decreased from 7.00 pre-injection to 2.31 at 6 months, while in Group II it decreased from 7.81 to 1.12. Similarly, the mean NPS score improved from 7.05 to 1.41 in Group I and from 7.86 to 1.02 in Group II at the 6-month follow-up. Improvements in both VAS and NPS scores were statistically significant in both groups. Ultrasonographic assessment demonstrated a significant reduction in plantar fascia thickness in both groups at 6 months, decreasing from 5.88 mm to 4.03 mm in Group I and from 5.96 mm to 3.27 mm in Group II. Conclusion: Local autologous PRP injection is a safe and effective treatment option for chronic plantar fasciitis and provides superior and longer-lasting clinical and radiological outcomes compared to corticosteroid injection.

Background: Anal fistula represents a common proctological condition with significant impact on patient quality of life. While fistulotomy remains the gold standard for low anal fistula treatment, the Ligation of Intersphincteric Fistula Tract (LIFT) procedure has emerged as a sphincter-preserving alternative with promising outcomes. Methods: This prospective comparative study included 120 patients with low transsphincteric anal fistula treated. Patients were allocated to either LIFT procedure (n=60) or fistulotomy (n=60). Primary outcomes included healing rate, recurrence rate, and fecal incontinence assessed using Wexner score. Secondary outcomes included operative time, postoperative pain, wound healing time, and patient satisfaction. Results: Complete healing was achieved in 88.3% of LIFT patients and 93.3% of fistulotomy patients (p=0.348). Recurrence rates were 11.7% and 6.7%, respectively (p=0.348). Mean Wexner incontinence scores at 12 months were significantly lower in the LIFT group (0.42±0.71) compared to fistulotomy (1.85±1.92; p<0.001). Wound healing time was shorter in LIFT (21.4±5.2 days) versus fistulotomy (32.6±8.4 days; p<0.001). Patient satisfaction scores were comparable between groups. Conclusion: While fistulotomy demonstrates marginally higher healing rates, LIFT procedure offers superior sphincter preservation with significantly lower incontinence rates. LIFT represents a viable sphincter-sparing option for low anal fistula, particularly in patients concerned about continence.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) has emerged as a pervasive comorbidity in Type 2 Diabetes Mellitus (T2DM), primarily driven by insulin resistance. However, emerging evidence points toward a significant regulatory role of thyroid hormones in hepatic lipid homeostasis, often referred to as the “thyroid-liver axis.” Despite this, the relationship between thyroid function within the physiological reference range and hepatic steatosis remains under-characterized in the Indian diabetic population. Objective: The primary objective of this study was to evaluate the correlation between plasma thyroid hormone concentrations (fT3, fT4, TSH) and hepatic triglyceride content in euthyroid patients with T2DM and to determine if specific thyroid patterns serve as predictors for fatty liver. Methods: This observational cross-sectional study was conducted at Patna Medical College and Hospital (PMCH) over 18 months, involving 250 euthyroid patients with T2DM. Individuals with alcohol abuse, known thyroid disorders, or hepatotoxic drug use were strictly excluded. Hepatic triglyceride content was assessed using abdominal ultrasonography and the Fatty Liver Index (FLI). Thyroid function tests were analyzed via chemiluminescence immunoassay. Results: Radiographic evidence of fatty liver was found in 62% of participants. Patients with NAFLD exhibited significantly higher serum TSH (2.8 1.2 vs.1.6  0.8 mIU/L, p<0.01) and lower fT3 levels (2.9 0.5 vs. 3.4 0.6 pg/mL, p<0.05) compared to non-NAFLD counterparts. A significant inverse correlation was established between plasma fT3 levels and FLI scores (r = -0.32, p<0.001). Multivariate analysis confirmed that low-normal fT3 and high-normal TSH are independent predictors of high hepatic triglyceride content. Conclusion: Even within the euthyroid range, variations in TSH and fT3 are significantly associated with hepatic triglyceride accumulation in T2DM. These findings suggest that “normal” thyroid function may not be metabolically optimal for diabetic patients, highlighting the need for vigilance regarding thyroid health in managing diabetic hepatosteatosis.

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women of reproductive age and is frequently associated with a wide spectrum of cutaneous manifestations that reflect underlying hyperandrogenism and metabolic derangements. These dermatological features often serve as early clinical indicators of the syndrome and may correlate with disease severity. Material and Methods: A hospital-based cross-sectional study was conducted on 112 women aged 18–40 years diagnosed with PCOS according to the Rotterdam criteria. Detailed demographic and clinical data were collected. All participants underwent comprehensive dermatological evaluation for acne vulgaris, hirsutism, acanthosis nigricans, androgenetic alopecia, and other cutaneous features using standardized clinical scoring systems. Anthropometric measurements were recorded, and associations between cutaneous manifestations, body mass index, and menstrual irregularity were analyzed using appropriate statistical tests. Results: The mean age of participants was 25.8 ± 4.9 years, and the mean body mass index was 27.4 ± 4.1 kg/m², with 55.4% of women classified as obese. Menstrual irregularities were present in 79.5% of cases. Acne vulgaris was the most common cutaneous manifestation (69.6%), followed by hirsutism (64.3%) and acanthosis nigricans (51.8%). Androgenetic alopecia was observed in 39.3% of patients. Mild acne and mild hirsutism were the predominant severity patterns. The prevalence of acne vulgaris, hirsutism, acanthosis nigricans, and androgenetic alopecia increased significantly with higher body mass index. These cutaneous manifestations were also significantly more frequent among women with menstrual irregularities. Conclusion: Cutaneous manifestations are common and clinically significant in women with PCOS, particularly among those with higher body mass index and menstrual irregularities. Early identification of these dermatological features can aid in timely diagnosis and facilitate comprehensive, multidisciplinary management of PCOS.

Background: Routine laboratory testing constitutes a significant component of inpatient care, yet the diagnostic yield and clinical impact of many tests remain poorly characterized. Excessive or low-value testing contributes to healthcare costs, iatrogenic anemia, and potential patient harm without commensurate clinical benefit. Methods: A prospective observational study was conducted at teaching hospital. Consecutive adult patients admitted to general internal medicine wards were enrolled. All laboratory tests ordered during hospitalization were categorized as admission, daily routine, or clinically indicated. Diagnostic yield was defined as the proportion of abnormal results leading to clinical action. Clinical impact was assessed through chart review evaluating management changes attributable to test results. Results: Among 624 patients (mean age 62.8 ± 16.4 years; 51.8% male), 18,472 laboratory tests were analyzed. The mean number of tests per patient-day was 4.8 ± 2.1. Overall diagnostic yield was 23.4%, with significant variation across test categories: admission tests (41.2%), clinically indicated tests (38.7%), and daily routine tests (12.8%, p<0.001). Clinical management was influenced by only 18.6% of all tests. Daily routine complete blood counts and metabolic panels demonstrated particularly low diagnostic yields (8.4% and 11.2%, respectively). Predictors of clinically impactful results included symptom-driven ordering (OR=3.24, 95% CI: 2.48–4.23, p<0.001) and acute clinical deterioration (OR=4.18, 95% CI: 2.96–5.90, p<0.001). Conclusion: The diagnostic yield and clinical impact of routine laboratory testing in internal medicine inpatients are substantially lower than commonly perceived, particularly for daily routine orders. Symptom-guided and indication-based testing strategies should be prioritized to optimize resource utilization and minimize patient harm.

Background: Traditional bone setters continue to be a common first point of care for fractures in many low- and middle-income settings. Despite their widespread use, inappropriate fracture manipulation and immobilization are associated with significant complications that often present late to formal healthcare facilities. This study aimed to analyze the pattern of complications arising from fractures initially treated by traditional bone setters. Material and Methods: A retrospective observational study was conducted at a tertiary care center over a five-year period. Medical records of patients presenting with fracture-related complications following initial management by traditional bone setters were reviewed. Demographic variables, mechanism and site of injury, delay in presentation, type of complications, definitive treatment, and duration of hospital stay were analyzed. Statistical analysis was performed to assess associations between delay in presentation and major complications. Results: A total of 162 patients were included, with a predominance of males and individuals in the productive age group. High-energy trauma was the most common mechanism of injury, and long bones—particularly the tibia and forearm—were frequently involved. Most patients presented after a prolonged delay following injury. Malunion and non-union constituted the most common complications, followed by infection and joint-related sequelae. A significant association was observed between delayed presentation and major structural complications. The majority of patients required operative intervention, and prolonged hospital stay was common, reflecting the severity and complexity of complications encountered. Conclusion: Fractures initially managed by traditional bone setters are associated with delayed presentation and a high burden of avoidable complications, often requiring complex surgical management. Early referral and increased public awareness regarding appropriate fracture care are essential to reduce morbidity and healthcare burden.

Background: Perinatal asphyxia is a leading cause of neonatal morbidity and mortality. Umbilical cord arterial blood pH is a key marker for assessing asphyxia severity and its impact on neonatal outcomes, particularly hypoxic ischemic encephalopathy (HIE). Objectives: To investigate the correlation between umbilical cord arterial blood pH and perinatal asphyxia, focusing on its relationship with early neonatal outcomes, including HIE and the need for resuscitation. Methods: This cross-sectional study at GMC Kota included 131 neonates with suspected perinatal asphyxia. Umbilical cord pH and neonatal outcomes, including HIE, were analyzed. Statistical analysis was performed using SPSS 24.0, with p<0.05 considered significant. Results: Among 131 neonates, 67.2% were born at 37-39 weeks. Pregnancy-induced hypertension was the most common risk factor. APGAR scores improved significantly over time. The mean umbilical cord pH was 6.9, indicating acidosis, and 39.7% of neonates had grade 3 HIE. No significant correlation was found between meconium-stained liquor and perinatal asphyxia (p=0.745). Conclusion: Umbilical cord pH is a critical marker for perinatal asphyxia and its associated outcomes, including severe HIE. The lack of correlation between meconium-stained liquor and asphyxia warrants further investigation.

Introduction: Airway management in patients undergoing coronary artery bypass grafting (CABG) with anticipated difficult airways poses significant challenges. The choice of laryngoscope can impact intubation success and postoperative complications. Aims and Objectives: To compare the efficacy and safety of the conventional Macintosh laryngoscope (Group A) versus the AmbuScope video laryngoscope (Group B) in patients with anticipated difficult airways undergoing CABG surgery. Materials and Methods: A total of 108 patients were equally divided into two groups. Baseline demographic variables including age, BMI, sex distribution, ASA grade, and Mallampati score were recorded and compared. Intubation success, primary outcome measures, and postoperative complications such as edema, dental injury, and hoarseness were assessed. Results: The demographic characteristics, including age, BMI, sex, ASA grade, and Mallampati score, were comparable between Groups A and B (all p > 0.05). Intubation time was significantly shorter in Group A (Macintosh laryngoscope) compared to Group B (AmbuScope video laryngoscope) (17.19 ± 3.22 s vs. 22.96 ± 3.38 s, p < 0.001). First-attempt intubation success was high in both groups. Incidences of edema and hoarseness were similar, while dental injuries were significantly more frequent in Group B (p = 0.042). Conclusion: The AmbuScope video laryngoscope demonstrated superior performance with comparable safety except for a higher rate of dental injury, indicating its potential advantage in managing difficult airways during CABG surgery.

Introduction: In recent decades, the prevalence and incidence of type 2 diabetes mellitus (T2DM) have increased rapidly and represent a significant global public health problem. It is estimated that the global prevalence of T2DM will rise from 382 million to 592 million by 2035. Aims: This study aims to evaluate the effectiveness of community-based educational interventions in preventing type 2 diabetes by improving knowledge, lifestyle, and metabolic outcomes, and identifying factors affecting their effectiveness and sustainability globally. Materials & Methods: This systematic review and meta-analysis, conducted according to PRISMA 2020 guidelines and registered with PROSPERO, included RCTs and quasi-experimental studies assessing community-based educational interventions for preventing type 2 diabetes in adults at risk. Studies focusing on lifestyle and behavioural modification were analyzed for their impact on glycaemic control, weight, and related outcomes compared with standard or no intervention. Result: Pain intensity, measured by the VAS score, was comparable between the GIB and control groups at baseline (7.8 ± 0.8 vs. 7.7 ± 0.9; p = 0.64). However, the GIB group showed a significant reduction in pain at all subsequent time points—from 1 hour through 8 weeks—compared to the control group (p < 0.001). Conclusion: We concluded that community-based educational interventions led by community health workers show significant potential in preventing and managing type 2 diabetes, particularly through improved knowledge, lifestyle modification, and modest glycaemic control.

Background: Hysterectomy is one of the most commonly performed gynecological surgeries and provides an opportunity to identify both clinically suspected and incidental uterine and cervical pathologies. Histopathological examination remains the gold standard for definitive diagnosis. Objectives: To analyze the spectrum of histopathological lesions in the uterus and cervix of hysterectomy specimens, study their age distribution, and correlate clinical indications with histopathological findings. Materials and Methods: A prospective cross-sectional study was conducted in the Department of Pathology at Shri Sathya Sai Medical College and Research Institute during the year 2017 June to May 2018 on 85 hysterectomy specimens. Gross and microscopic examinations were performed following standard protocols. Data were analyzed using SPSS version 23, and clinico-pathological correlation was assessed. Results: The most common age group undergoing hysterectomy was 40–49 years (50.6%). Total abdominal hysterectomy with bilateral salpingo-oophorectomy was the most frequent procedure (43.5%). Fibroid uterus was the commonest clinical indication (41.2%). Histopathologically, proliferative endometrium (44.7%), leiomyoma (41.2%), and chronic non-specific cervicitis (88.2%) were the most frequent findings. Clinico-pathological correlation was 100% for fibroid uterus, carcinoma cervix, post-menopausal bleeding with endometrial carcinoma, and uterovaginal prolapse with atrophic endometrium (p < 0.001). Conclusion: Histopathological examination of hysterectomy specimens is essential for accurate diagnosis, detection of incidental lesions, and validation of clinical indications. Leiomyoma and chronic cervicitis remain the most common uterine and cervical pathologies in hysterectomy specimens.

Aim: To evaluate the efficacy and safety of various pharmacological agents, particularly mitomycin C, in conjunction with antibiotics and local analgesics, used during and after dacryocystorhinostomy (DCR) surgery to enhance surgical success rates and minimize postoperative complications. Materials and Methods: This comprehensive review examined current literature on pharmacological interventions in DCR surgery. Data were collected from clinical trials and comparative studies evaluating the use of mitomycin C application, intraoperative medications, postoperative antibiotics, and analgesic protocols in both endoscopic and external DCR procedures. Success rates, complication profiles, and patient outcomes were analyzed across different treatment groups. Results: Mitomycin C application demonstrated success rates ranging from 77.3% to 93.34%, compared to 62-85.7% in control groups without adjunctive therapy. The use of mitomycin C significantly reduced postoperative complications including granulation tissue formation, adhesions, and synechiae. Appropriate antibiotic therapy reduced infection rates, while careful analgesic selection minimized postoperative morbidity. Combined pharmacological interventions showed enhanced efficacy in preventing stoma closure and promoting long-term patency. Conclusion: Adjunctive pharmacological agents, particularly mitomycin C in conjunction with appropriate antibiotics and analgesics, significantly improve DCR surgical outcomes by reducing fibrosis and postoperative complications. These agents represent valuable additions to standard surgical technique, especially in revision cases and high-risk patients. Careful selection and timing of pharmacological intervention optimize success rates while maintaining safety profiles.

Aim: To evaluate perioperative blood pathology markers in patients undergoing surgical procedures under local and general anaesthesia and to correlate these markers with postoperative morbidity and tissue handling complications. Materials and Methods: A prospective comparative study was conducted on 90 patients (45 local anaesthesia, 45 general anaesthesia) undergoing elective surgical procedures. Blood samples were collected preoperatively, at 24 hours, and 48 hours postoperatively. Parameters analyzed included hemoglobin (Hb), hematocrit (Hct), white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL-6), coagulation profile (PT, aPTT, platelet count, fibrinogen), and tissue damage markers. Postoperative morbidity was assessed using standardized criteria including surgical site infection, bleeding complications, and delayed wound healing. Results: Preoperative hemoglobin levels were comparable. Postoperative day-1 hemoglobin showed greater decline in general anaesthesia group (10.2 ± 1.3 g/dL) compared to local anaesthesia (11.4 ± 0.8 g/dL, p = 0.001). CRP levels at 48 hours postoperatively were significantly elevated in general anaesthesia group (78.5 ± 22.3 mg/L) versus local anaesthesia (42.1 ± 18.7 mg/L, p < 0.001). IL-6 levels were also higher in general anaesthesia group (95.3 ± 34.2 pg/mL vs. 58.6 ± 28.9 pg/mL, p = 0.002). WBC count elevation was more pronounced in general anaesthesia (14.8 ± 2.9 × 10⁹/L) than local anaesthesia (11.2 ± 2.1 × 10⁹/L, p < 0.001). Coagulation parameters showed abnormalities in both groups, but general anaesthesia demonstrated greater fibrinogen consumption (postop: 198 ± 52 mg/dL vs. 246 ± 48 mg/dL, p = 0.003). Postoperative morbidity was 15.6% in local anaesthesia group and 37.8% in general anaesthesia group (p = 0.008). Tissue handling-related complications were significantly reduced in local anaesthesia procedures. Conclusion: Local anaesthesia is associated with reduced perioperative tissue trauma, minimal inflammatory response, and lower postoperative morbidity compared to general anaesthesia. Blood pathology markers, particularly CRP, IL-6, and coagulation parameters, serve as reliable indicators of tissue trauma severity and postoperative complication risk. These markers should be monitored routinely to predict and prevent adverse postoperative outcomes.

Background: Thyroid dysfunction during pregnancy is a common but frequently underdiagnosed condition, particularly in low- and middle-income settings. Physiological changes of pregnancy can mask clinical features of hypothyroidism, leading to delayed detection. Both overt and subclinical hypothyroidism are associated with adverse maternal and fetal outcomes, making early identification during antenatal care essential. Data describing the burden of these conditions among antenatal women in central India remain limited. Objectives: To assess the burden of overt and subclinical hypothyroidism among antenatal women attending a tertiary care hospital in central India and to evaluate their distribution across different trimesters of pregnancy. Methods: A hospital-based cross-sectional study was conducted at Government Bundelkhand Medical College, Sagar, Madhya Pradesh. Pregnant women attending antenatal outpatient services or admitted for obstetric care were evaluated irrespective of gestational age. Serum thyroid-stimulating hormone was measured in all participants, and total thyroxine levels were assessed when indicated. Thyroid function status was classified using gestation-specific reference ranges. Data were analyzed descriptively to determine the burden and pattern of thyroid dysfunction. Results: A considerable proportion of antenatal women demonstrated biochemical evidence of hypothyroidism. Subclinical hypothyroidism constituted the majority of cases, while overt hypothyroidism accounted for a smaller but clinically significant proportion. Thyroid dysfunction was detected across all trimesters, with a higher number of cases identified during the second and third trimesters. Conclusion: The study reveals a substantial burden of hypothyroidism among antenatal women in central India, with subclinical disease forming the predominant share. The findings highlight that many affected women may remain undiagnosed without biochemical screening. Incorporation of routine thyroid function testing into antenatal care could facilitate early detection and timely management, thereby reducing preventable maternal and fetal complications.

Background: Early and accurate diagnosis of musculoskeletal infections is necessary to avoid permanent disability. Even though regular MRI is very sensitive, it may not be very specific in some cases. Diffusion-weighted magnetic resonance imaging (DWI-MRI) offers functional tissue characterisation and has the potential to enhance diagnostic precision. Objective: To assess the diagnostic efficacy of diffusion-weighted MRI in musculoskeletal infections and determine its additional benefits compared to conventional MRI. Materials and Methods: Individuals with clinically suspected musculoskeletal infections underwent MRI, incorporating diffusion-weighted sequences. Imaging results were compared to clinical, laboratory, and microbiological results. Results: Diffusion-weighted MRI exhibited superior sensitivity, specificity, and diagnostic accuracy relative to conventional MRI alone. Conclusion: DWI-MRI greatly increases diagnostic confidence and should be a standard part of imaging protocols for musculoskeletal infections.

Background: Ligamentous injuries of the knee are a common cause of pain, instability, and long-term functional impairment. Magnetic resonance imaging (MRI) is widely used for non-invasive assessment, while arthroscopy remains the diagnostic gold standard. Objective: To find out how accurate MRI is at finding knee ligament injuries by comparing MRI results with arthroscopic results. Materials and Methods: A retrospective study was conducted on 120 patients who were thought to have knee ligament injuries and had MRIs followed by arthroscopies. The results of MRI were compared to those of arthroscopy for injuries to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Results: MRI demonstrated high sensitivity and specificity for cruciate ligament injuries, particularly ACL tears. Detailed results with tables are presented. Conclusion: MRI is a highly reliable modality for evaluating knee ligament injuries and shows excellent correlation with arthroscopy.