Objectives: The present study was to evaluate the ultrasound reporting of fatty liver in asymptomatic patients during routine health checkup. Methods: The patients who had been investigated by ultrasonography, those with fatty liver were defined as cases and those without fatty liver were defined as controls. The lipid profile [i.e., total cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL)] was obtained for all patients. The serum GOT [aspartate transaminase (AST)], serum GPT [alanine transaminase (ALT)], and HbA1c levels were available in various proportions of patients. Results: A total of 200 patients with age group 15 to >65 years were enrolled. All the patients were investigated by ultrasonography. Of these patients, 120 were diagnosed with fatty liver, and the remaining 80 patients with a normal hepatic echopattern served as controls. The mean age of the cases and controls was 47.76 and 42.78 years respectively. Male and female patients comprised 42% and 58% of the cases respectively. Triglyceride level between patients of case and control was significant differences (p=0.017). Total cholesterol and HDL cholesterol between case and control group was not significant differences (p>0.05). And LDL cholesterol, GOT (AST), GPT (ALT) between case and control was statistically significant differences (p<0.05). While, HbA1c level between cases and control group was statistically highly significant differences (p<0.000). Conclusions: Fatty liver was more common in female than male. The triglyceride level, LDL cholesterol, GOT (AST), GPT (ALT) and HbA1c were significantly increased in fatty liver asymptomatic patients. Hence, Ultrasonography is one of the best investigative tools for the diagnosis of fatty liver in asymptomatic patients.

Introduction: Mycobacterium tuberculosis causes TB, significantly impacting developing economies. Despite its limitations, WHO and RNTCP endorse sputum smear microscopy (SSM) as a primary diagnostic tool in low-resource settings like India. This study assesses the effectiveness of Kinyoun’s technique (KT), a modification of Ziehl-Neelsen staining (ZN), in diagnosing pulmonary TB. Methods: It was prospective study. Both gender, suspected TB were included. Those cannot produce sputum were excluded.  Sputum sample was collected, and smears were prepared, stained and observed under microscope as per the guidelines. Chi square test was used for statistical analysis. P < 0.05 was considered to be statistically significant. Results: The study detected 151 smear-positive lung TB cases, predominantly male (55%). ZN outperformed KT, with a detection rate of 94.7% versus 83.4%. Statistical analysis confirmed ZN’s greater sensitivity with a significant P value of 0.0017. Conclusion: This study highlights the importance of effective TB diagnostics, especially in LMICs. ZN superior sensitivity, demonstrated by higher detection rates and statistical analysis, suggests that integrating ZN with advanced molecular techniques could greatly enhance TB control and reduce its global impact.

Introduction: Spinal anesthesia (SA) is essential for abdominal surgeries, using adjuvants like Buprenorphine and Dexmedetomidine to enhance Bupivacaine’s effects. This study aims to compare their efficacy and side effects to optimize patient outcomes, examining how each adjuvant affects anesthesia duration and postoperative stability. Methods: This study employs a randomized controlled trial design, in government Medical College, Rajamahendrawaram among those undergoing abdominal surgery. Participants are assigned to receive spinal anesthesia with either Buprenorphine or Dexmedetomidine as adjuvants to Bupivacaine. Outcomes measured include duration of sensory and motor blocks, time to first analgesic requirement, and patient satisfaction. Results: In this study, 50 patients were equally divided into two groups, receiving SA with Buprenorphine or Dexmedetomidine. No significant differences were observed in the duration of sensory block or patient satisfaction scores. However, the time to first analgesic requirement was significantly longer in Group A (P = 0.0023). Conclusion: The study concluded that while both Buprenorphine and Dexmedetomidine effectively prolong spinal anesthesia, Buprenorphine extends the time to first analgesic requirement more significantly than Dexmedetomidine. Both adjuvants showed similar patient satisfaction and sensory block duration, underscoring their utility in clinical settings for abdominal surgeries.

Introduction: Psoriasis, affecting 2.3% of dermatology outpatients in India, often involves the palms and soles as palmoplantar psoriasis (PP), leading to significant discomfort. Treatment is challenging due to poor drug penetration. This study aims to compare the efficacy of iontophoresis-delivered topical methotrexate with topical calcipotriol in Palmoplantar psoriasis (PP) management. Methods: It was a prospective study conducted in the department of Dermatology, Konaseema institute of Medical Sciences and Research foundation. Both gender with PP not on treatment for the last 1 year were included in the research. The medications were applied as per the study protocol. The efficacy of both treatments was evaluated using the percentage reduction in the ESIF score at the 4th and 8th weeks. Results: Fifty patients were studied, with a mean age of 44.5 years and male predominance. The sole was most frequently involved (58%). At 4 weeks, both drugs showed similar improvement (~17%). By 8 weeks, methotrexate achieved a 38.8% reduction, significantly better than calcipotriol’s 22.7%, indicating superior long-term efficacy. Conclusion: Methotrexate delivered through iontophoresis showed greater long-term efficacy than topical calcipotriol in treating palmoplantar psoriasis. Both therapies were similarly effective at four weeks, but methotrexate provided significantly better results by eight weeks, suggesting it as a promising alternative for localized, treatment-resistant cases with minimal systemic side effects.

Introduction: Lung cancer (LC) is the most prevalent cancer globally, with 2.2 million new cases in 2020, significantly affecting older individuals, especially smokers. This study examines the demographic factors influencing LC, focusing on age, sex, socioeconomic status, and exposure risks to develop targeted prevention and early detection strategies. Methods: It was a prospective cross-sectional study conducted in GSL Medical College. Necessary approvals were obtained. Both genders, > 18 years with histologically diagnosed LC were included in the study. Participants were briefed about the study and given a physical and clinical examination. Data including demographic details, smoking history, and family history were recorded. BMI was calculated and income categorization was done. Results: This study of 87 NSCLC cases showed a mean age of 61.3 years, predominantly affecting males (59) with a high incidence in the 61-70 age group. Adenocarcinoma was most common, especially among non-smokers. Most patients were overweight and from middle-income backgrounds. Lung cancer subtypes varied by smoking status and income. Conclusion: This study affirmed that NSCLC mainly impacts older males, especially in the 61-70 age range, reflecting global trends. The prevalence of adenocarcinoma in non-smokers and links to socioeconomic status and BMI highlight the disease’s complex causes, necessitating personalized management and prevention strategies.

Introduction & Objectives: Human Immunodeficiency Virus (HIV) infection remains a significant public health concern, particularly in developing countries. While the advent of Highly Active Antiretroviral Therapy (HAART) has improved survival and quality of life in people living with HIV (PLHIV), its long-term use has been associated with metabolic complications, including dyslipidaemia. This study was conducted to evaluate longitudinal changes in lipid profile and its association with CD4 counts in HIV-positive patients after initiation of HAART. Materials & Methods: This prospective longitudinal cohort study was conducted at a tertiary care hospital in central India between May 2021 and October 2022. Ninety HAART-naïve, HIV-positive adults aged 18–65 years were enrolled after applying strict inclusion and exclusion criteria. Fasting blood samples were collected at baseline (prior to HAART initiation), and at 3- and 6-months post-HAART initiation for lipid profile (total cholesterol, triglycerides, HDL) and CD4 count estimation. Biochemical analyses were done using a fully automated biochemistry analyzer and CD4 counts by flow cytometry. ANOVA and Bonferroni post-hoc tests were used for group comparisons, and Pearson’s correlation coefficient was applied to assess relationship between CD4 count and lipid parameters. Results: The mean age of the study population was 38 years, with males constituting 64.4% of participants. At baseline, 44.4% of patients had severe immunosuppression (CD4 < 200 cells/µl). CD4 counts significantly increased from 277.5 ± 198.1 cells/µl at baseline to 486.6 ± 180.0 cells/µl after 6 months of HAART (p<0.001). Serum triglycerides and total cholesterol levels significantly increased at 3 and 6 months (p<0.05), while HDL levels showed a decreasing trend but were not statistically significant. A 30% prevalence of dyslipidaemia, predominantly hypertriglyceridemia and hypercholesterolemia, was observed. CD4 counts were positively correlated with triglycerides (r=0.259, p=0.014) and total cholesterol (r=0.326, p=0.002), but not significantly correlated with HDL. Discussion: HAART significantly improves immune function as indicated by rising CD4 counts but is associated with adverse changes in lipid metabolism. The observed dyslipidaemia may increase the risk of cardiovascular complications if left unchecked. The significant correlation between CD4 counts and lipid parameters suggests that lipid profile monitoring could provide insights into immunological status, especially in resource-constrained settings where CD4 testing is not always accessible.

Background: Symptoms of the functional gastrointestinal illness known as Irritable Bowel Syndrome (IBS) include changes in bowel habits, persistent gas, and abdominal pain. Recent studies have shown that the gut microbiota plays an important role in the pathophysiology of irritable bowel syndrome (IBS), and probiotics have emerged as a potential treatment option to enhance gut health by restoring microbial balance. Objective: Aiming to assess the effect of probiotic supplementation on gastrointestinal health in Palamu, Jharkhand-based individuals suffering from irritable bowel syndrome. Methods: Over the course of three months, 108 adults diagnosed with irritable bowel syndrome (IBS) using Rome IV criteria participated in this prospective interventional trial. A probiotic supplement was given to the participants every day for eight weeks. Evaluations were conducted at baseline, 4 weeks, and 8 weeks using assessment measures such as the IBS Symptom Severity Score (IBS-SSS), Bristol Stool Form Scale (BSFS), and the IBS Quality of Life Questionnaire (IBS-QoL). Paired t-tests and analysis of variance were used to analyse the data in SPSS v25. Results: The mean IBS-SSS score significantly decreased from 296.2 ± 52.1 at baseline to 178.4 ± 45.7 at week 8 (p < 0.001). Normal stool consistency (BSFS types 3–4) improved from 28.7% at baseline to 67.6% by week 8. The mean IBS-QoL score improved from 54.3 ± 11.8 to 72.9 ± 10.4 (p < 0.001). No serious adverse events were reported, and compliance was high. Conclusion: Probiotics proved effective in alleviating IBS symptoms and improving gut health and quality of life in a rural patient population. These findings support the incorporation of probiotics as a safe and accessible adjunct therapy in IBS management, particularly in resource-limited settings like Palamu.

Background: Acute Myocardial Infarction (AMI) is a leading cause of mortality globally. Timely intervention is crucial, with international guidelines recommending symptom-to-door time under 120 minutes and door-to-balloon (D2B) time under 90 minutes to improve outcomes. This study aimed to identify factors contributing to delays in symptom-to-door and door-to-balloon times among AMI patients in Rajasthan and to compare clinical outcomes between those receiving timely intervention (<90 minutes) and those experiencing delays. Materials and Methods: A hospital-based observational study was conducted at the Emergency Department of Narayana Super Specialty Hospital, Jaipur, from July 2023 to December 2024. A total of 400 patients diagnosed with STEMI, NSTEMI, or new-onset LBBB were included. Data on sociodemographic characteristics, clinical symptoms, comorbidities, mode of transport, and time intervals related to AMI management were collected using structured questionnaires. Key metrics such as symptom-to-door time and Door to Balloon time were statistically analyzed using t-tests and ANOVA (significance at p<0.05). Results: The mean age of participants was 58.7 ± 11.2 years. The average symptom-to-door and Door to Balloon times were 133±48 and 95±15 minutes, respectively. Delays were significantly associated with rural residence, low education, lower socioeconomic status, and use of public transport. Conversely, EMS use and ambulance transport led to shorter times. Patients with diabetes and atypical symptoms had greater delays, while those with chest pain or previous MI presented earlier. Conclusion: Multiple sociodemographic and clinical factors contribute to delays in AMI management. Enhancing EMS access, raising public awareness, and addressing healthcare disparities are essential to improve timely reperfusion and reduce AMI-related morbidity and mortality in Rajasthan.

Background: Orbital lesions, presenting with proptosis, lid swelling, and visual disturbances, pose significant diagnostic challenges due to their anatomical complexity and potential for vision-threatening complications. Early differentiation between inflammatory, neoplastic, and vascular pathologies is critical to guide timely intervention. Objective: This study aimed to evaluate the diagnostic accuracy of ultrasound B-scan in detecting orbital pathologies and correlate its findings with CT imaging, with histopathological confirmation where available. Methods: A prospective observational study was conducted at a tertiary care center involving 70 patients with orbital complaints. All subjects underwent standardized ophthalmic examination, B-scan ultrasonography (7.5–10 MHz probe), and CT imaging (axial/coronal ± contrast). Lesion parameters (intraconal/extraconal location, size, echogenicity, vascularity) were analyzed. Results: The cohort comprised 40 males and 30 females, with the highest incidence in the 31–40 age group (22.85%) and pediatric patients (0–10 years: 20%). Inflammatory lesions (37.14%) dominated, followed by vascular pathologies (21.42%) and thyroid orbitopathy (14.28%). B-scan and CT demonstrated 87.1% concordance in lesion localization. Intraconal lesions were predominantly solid, whereas extraconal lesions exhibited mixed composition (62.3% solid, 27.3% mixed, 10.4% cystic). CT detected bony involvement and sinus extension in 10% of cases. Conclusion: Ultrasound B-scan is a reliable first-line modality for evaluating soft-tissue orbital lesions. Its high concordance with CT underscores its utility in lesion localization. CT remains indispensable for assessing bony involvement. A combined imaging approach optimizes diagnostic precision and guides targeted management.

Background: Severe anemia is associated with significant cardiovascular adaptations that manifest as abnormalities on electrocardiography (ECG) and two-dimensional echocardiography (2D Echo). These cardiac changes contribute substantially to morbidity and mortality. However, the reversibility of these abnormalities following treatment remains inadequately documented, particularly in resource-limited settings. Objectives: This study aimed to evaluate the impact of treatment on ECG and 2D Echo parameters in patients with severe anemia admitted to Government General Hospital, Vizianagaram, and to assess the correlation between hemoglobin improvement and cardiac parameter normalization. Methods: A hospital-based cross-sectional study was conducted from October 2023 to September 2024, including 120 adult patients with severe anemia (hemoglobin <7 g/dL). Comprehensive ECG and 2D Echo evaluations were performed at admission and after treatment (hemoglobin ≥10 g/dL). Parameters assessed included heart rate, QRS duration, QTc interval, chamber dimensions, ejection fraction, and E/A ratio. Statistical analysis evaluated changes in cardiac parameters and their correlation with hemoglobin improvement. Results: Pre-treatment ECG abnormalities included sinus tachycardia (78.3%, n=94), ST-segment depression (45%, n=54), T-wave flattening (52.5%, n=63), and prolonged QTc interval (38.3%, n=46). Echocardiographic findings revealed increased left ventricular end-diastolic diameter (73.3%, n=88), enhanced cardiac output (81.7%, n=98), and hyperdynamic left ventricular function (68.3%, n=82). Post-treatment assessment demonstrated significant normalization of cardiac parameters, with resolution of tachycardia in 85.1% (n=80) of affected patients, normalization of ST-segment changes in 77.8% (n=42), and restoration of normal chamber dimensions in 79.5% (n=70). Conclusion: Treatment of severe anemia results in significant reversibility of cardiac abnormalities detected on ECG and 2D Echo. Early identification and correction of severe anemia may prevent long-term cardiac complications. This study emphasizes the importance of routine cardiac evaluation and follow-up in patients with severe anemia, particularly in resource-constrained settings.

Background: Preeclampsia is the major cause of perinatal death, IUGR, pre term death, maternal mortality and morbidity in developing country. The aim of this study was to compare and quantify serum calcium, uric acid, glucose, and magnesium levels in pre-eclampsia and normal pregnant women, as well as determine whether there was any association between them. Methods: 100 women ranging in age from 18 years to 35 years were recruited. They were divided in two groups. 50 were pre-eclamptic women with gestational age of ≥20 weeks (Case group) and rest 50 were normal pregnant women of same gestational age (Control group). The levels of magnesium, calcium, glucose, and uric acid in the blood were measured. Result: Serum calcium and magnesium levels were significantly lower (p<0.001) in the pre-eclamptic group, whereas serum uric acid levels were significantly higher (p0<001) in preeclamptic group. The level of serum glucose was raised in preeclampsia. Conclusion: serum levels of calcium, magnesium, uric acid and glucose are altered in pre-eclampsia, implying that these factors may play a role in the aetiology and severity of pre-eclampsia.so assessing the serum level of this parameters will aid in the early detection of pre-eclampsia.

Introduction: Sickle cell (SC) disease, encompassing variants like SC anemia and HbSβ-thalassemia, results from genetic mutations in the β-globin gene. This study aimed to explore the clinical and hematological profile of SCβ-thalassemia patients and assess the effectiveness of hydroxyurea (HU) treatment in Indian patients with SCβ-thalassemia. Methods: This prospective, open-label, observational study was conducted at <details of the study site were removed for blinded peer review> between October 2013 and 2015. Patients diagnosed with SCβ-thalassemia were included in this study. Results: A total of 56 SCβ -thalassemia patients (28 children, 28 adults) were included. The most common clinical feature for HU therapy was vaso-occlusive crisis (VOC), observed in 48.2% of patients. The mean VOC frequency before treatment significantly decreased from 6.6 to 1.0 after treatment, indicating an 85.5% reduction (P<0.0001), followed by the reductions in mean blood transfusion (83.9%) and hospitalization (90.8%). There was a significant improvement in Hb levels from baseline to 24 months (8.3 g/dL to 9.7 g/dL; P<0.001). Myelotoxicity was observed in seven patients. The mean serum creatinine, total bilirubin, indirect bilirubin, direct bilirubin, and lactate dehydrogenase were decreased by 16.2%, 32.0%, 32.5%, 33.7%, and 35.2%, respectively, after treatment with HU. Conclusion: This comprehensive analysis reveals the positive impact of HU therapy on hematological and biochemical profiles in patients with SCβ-thalassemia. These findings underscore the potential of HU therapy as an effective and well-tolerated treatment option.

Background and Aim: Extended totally extraperitoneal repair (eTEP) is a new technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias. The principle is to create a larger space than what is done in TEP specially to tackle large groin hernias. However, there is still a paucity of well conducted, peer reviewed comparative studies regarding the advantages, if any, of eTEP. This study is to compare the efficacy of extended total extra peritoneal (e-TEP) and total extra peritoneal (TEP) repair in the treatment of inguinal hernia. Methods: This is a prospective randomised study of total 40 patients having bilateral inguinal hernia in which 20 patients underwent eTEP repair (group A) while 20 patients underwent TEP repair (group B) who presented to Surgery Department Civil Hospital Ahmedabad between March 2023 to June 2024. Permission of ethics committee was taken. Results: On comparing both groups mean operating time for eTEP was significantly less than that of TEP group. Conversion rates to open surgery were higher in TEP group. Post-operative seroma formation was higher in eTEP group as compared to TEP group. There was less incidence of pneumoperitoneum in eTEP group due to peritoneal breach. We had one recurrence in TEP group. Surgeon satisfaction score was better for eTEP group. Conclusion: We don’t conclude that eTEP is better than TEP however eTEP has the slight advantage of a large working space and hence proper placement of mesh and better surgeon satisfaction for ease of doing surgery.

Background: Deliberate self-harm (DSH) is a pervasive public health challenge, particularly in developing regions like India. DSH encompasses a variety of behaviors—from self-injury via cutting or burning to deliberate poisoning—that, while not always intended to result in death, cause significant physical harm and psychological distress. Social determinants, including family dynamics, socioeconomic status, and adverse life experiences, have been identified as critical contributors to the risk of DSH. Objective: The primary objective of this study is to explore the array of social factors associated with DSH among individuals admitted to a tertiary care government hospital. Secondary objectives include examining the psychiatric comorbidities present in these patients and delineating a detailed socio-demographic profile to better understand the underlying risk factors. Methods: A cross-sectional observational study was conducted using a meticulously designed questionnaire available in English, Hindi, and Marathi. A total of 104 patients aged between 12 and 65 years who had attempted DSH were enrolled along with their accompanying carers. Data collection focused on socio-demographic parameters, clinical history, modes of self- injury, and associated psychiatric and social factors. The study was conducted following IEC approval and with informed consent from all participants. Results: Our findings indicate that the majority of patients were young adults (65.38% aged 12–29 years) and predominantly male (69.23%). Most patients originated from rural areas (63.46%), and poisoning emerged as the most common method of self-harm (84.62%). Interpersonal family problems were identified as the most significant social stressor (36.54%). Although a large portion of patients (68.27%) did not have a diagnosable psychiatric disorder, a notable subset was affected by anxiety and panic disorders (18.27%). Conclusion: DSH is a complex behavior resulting from the interplay of social, psychological, and environmental factors. The study underscores the critical need for community-based interventions, improved mental health services, and targeted preventive strategies aimed at addressing the social determinants of self-harm.

Sickle cell hemoglobinopathies, including the sickle cell trait (HbAS), can impact various physiological systems during pregnancy, increasing the risk of maternal and fetal complications such as miscarriage, anemia, preeclampsia, vaso-occlusive crises, and acute chest syndromes. Pregnant women with sickle cell trait, although generally less affected than those with sickle cell disease (HbSS), still face potential risks that require careful monitoring and management.
This case series aims to: (1) Examine the clinical features of sickle cell trait in pregnancy. (2) Identify maternal and perinatal complications associated with sickle cell trait. (3) Investigate the role of blood transfusions in managing sickle cell trait during pregnancy.
A retrospective analysis was conducted on five cases of pregnant women diagnosed with sickle cell trait (HbAS) over six months. The study explored clinical outcomes, including the presence of sickling crises, vaso-occlusive episodes, infections, and the need for medical interventions such as blood transfusions. The cases revealed that, while no significant sickling crises or severe vaso-occlusive episodes were observed in the majority of patients, complications did arise in one case (Case E), where the patient experienced a sickling crisis due to pneumonia. Despite this, the majority of pregnancies progressed with favorable outcomes, including term deliveries, normal fetal birth weights (ranging from 2.3 kg to 3.0 kg), and vaginal births. However, one case (Case E) required a cesarean section due to complications. Blood transfusions and oxygen therapy were administered in specific cases to address anemia, oxygen deprivation, and vaso-occlusive symptoms. The findings suggest that pregnancies in women with sickle cell trait (HbAS) generally proceed uneventfully, with minimal complications. However, complications such as infections, sickling crises, and vaso-occlusive pain episodes may occur, requiring timely medical intervention. Close monitoring, adequate hydration, blood transfusions, and oxygen therapy are essential in managing these pregnancies. This case series underscores the importance of individualized prenatal care for pregnant women with sickle cell trait. Although these women generally experience uncomplicated pregnancies, there is still a risk of complications that may require interventions like blood transfusions or cesarean sections. Healthcare providers must remain vigilant and prepared for potential crises or exacerbations, especially in the presence of additional risk factors such as infections. Further research is needed to refine management protocols and improve clinical outcomes for these patients. The study highlights the need for enhanced clinical awareness regarding the management of sickle cell trait in pregnancy. While the trait is generally less severe than sickle cell disease, careful monitoring for complications such as anemia, infections, and sickling crises is essential to ensuring maternal and fetal well-being.

Introduction: The Circumcision is a painful intervention frequently performed in paediatric surgery. We aim to compare the efficacy of caudal block versus penile block under general anesthesia for children undergoing circumcision. Caudal block and penile block both diminishes pain that helps to preserve physiological stress response and opioids or NSAID consumption are reduced. Aims and Objective: (1) The main objective of our study is to evaluate the effectiveness of caudal block and penile block for the relief of postoperative analgesia. (2) The secondary objective of our study is to evaluate the postoperative additional analgesia requirement and any other side effect of these block. Study Design: Prospective Observational study at Department of Anesthesia. Study Site: Department of Anesthesia, SKIMS (Sher-e-Kashmir Institute of Medical Sciences, Srinagar). Study Population: A total of 70 children aged between 4 months to 5 years were taken who underwent circumcision surgery were assigned to two groups. Study duration: 1^st March 2024 to 28^th February 2025. Sample Size: 70 Patients and Randomly Collection. Result: In this study A total of 70 children aged between 4 months to 5 years were taken who underwent circumcision surgery were assigned to two groups. The overall results demonstrate that caudal anaesthesia provides superior outcomes compared to the penile block in paediatric patients. Conclusion: Although both blocks provide analgesia but our study findings suggest that caudal anaesthesia is a more effective and safer option for managing pain and minimizing side effects in paediatric patients undergoing surgery. One more finding was noted that penile block patients experiences pain at injection site which was not noted in caudal block.

Background: Subchorionic hematoma (SCH) is a common complication in pregnancy associated with adverse maternal and fetal outcomes. Understanding the demographic characteristics, clinical presentations, and pregnancy outcomes of women with SCH is essential for effective clinical management. Objective: This study aimed to investigate the demographic characteristics, clinical presentations, and pregnancy outcomes of women with SCH, as well as to assess the association between SCH size and clinical parameters. Methods: A retrospective analysis was conducted on data from [insert time frame] of pregnant women diagnosed with SCH. Demographic characteristics, clinical presentations, and pregnancy outcomes were analyzed descriptively. Associations between SCH size and clinical parameters were assessed using appropriate statistical tests. Results: The study included [insert number] pregnant women with SCH. The majority of participants were in their mid-twenties to early thirties, with a balanced representation of primiparous and multiparous women. Vaginal bleeding was present in 38.3% of participants, and a significant proportion had a history of previous abortions. Maternal complications included gestational diabetes mellitus, gestational hypertension, and premature rupture of membranes. Cesarean section delivery was more common than vaginal delivery. Fetal outcomes varied, with a notable percentage of babies having low birth weights. The comparison based on SCH size revealed significant associations with vaginal bleeding and previous abortion history. Conclusion: This study provides valuable insights into the demographic characteristics, clinical presentations, and pregnancy outcomes of women with SCH. Understanding these factors is crucial for optimizing clinical management and counseling for pregnant women with SCH. Further research is warranted to elucidate the underlying mechanisms linking SCH to adverse pregnancy outcomes and to develop targeted interventions to mitigate associated risks.

Introduction: Strabismus is a condition where the eyes fail to align properly when focusing on an object. The sensitive period for developing binocularity starts at 10-16 weeks of age and peaks between 1-3 years. Disruption in ocular fusion and binocularity during this time can result in ocular misalignment and strabismus. This condition, primarily affecting children, can persist into adulthood. Strabismus surgery aims to improve ocular alignment, restore binocular vision, and enhance the cosmetic appearance of patients. Purpose: (1) To evaluate the outcomes of strabismus surgery in terms of motor alignment. (2) To assess the functional improvements following horizontal strabismus surgery in a tertiary eye care hospital in central India. Place and Duration of Study: This study was conducted in the Ophthalmology Department of a tertiary eye care hospital in central India, from February 2024 to March 2025. Methods: A prospective study of 16 patients aged 6 to 45 years undergoing horizontal strabismus surgery was conducted. Data collected included demographic details (age, gender), associated refractive errors, type of strabismus (acquired or congenital), preoperative angle of deviation in prism diopters (PD), type of surgery performed, and anesthesia used. Postoperative outcomes were assessed based on motor alignment and functional vision improvements. Satisfactory motor alignment was defined as ≤10 PD, and functional vision was evaluated using binocular vision restoration and stereopsis tests. Results: The study cohort had a mean age of 22.8 ± 10.4 years, with 62.5% males and 37.5% females. Refractive errors were noted in 56.25% of patients, with myopia being the most common (25%). Congenital strabismus was observed in 56.25% of cases. Preoperative deviations ranged from 15 to 50 PD (mean: 32.5 ± 10.75 PD). Surgical techniques included recession-resection surgery (68.75%) and single muscle surgery (31.25%), performed predominantly under general anesthesia (87.5%). Postoperatively, 81.25% of patients achieved satisfactory motor alignment within 10 PD of orthotropia. Binocular vision was restored in 62.5% of patients, and stereopsis improved in 37.5%. Conclusion: Horizontal strabismus surgery demonstrated excellent outcomes in motor alignment and functional vision restoration. The study emphasizes the importance of early and effective surgical intervention in managing strabismus, with further research recommended to validate findings in larger populations.

Background: Facilitating clear communication between healthcare providers (HCPs) and women in labour stands as a crucial element in delivering dignified and consented maternity care. The intention of this quality improvement (QI) study is to enhance the communication proficiency of HCPs in the labour ward, with the ultimate goal of ensuring dignified and consented care during the maternity process. Methods: The research, undertaken in the labour room of a tertiary care centre and spanning a period of 12 weeks from June to August, 2022 initiated by appraising instances of care lacking in dignity and consent. This involved gathering foundational data from women who had experienced normal vaginal deliveries. Pre-formulated questionnaires were utilized, alongside interviews with HCPs, to identify the reasons behind such instances. Subsequently, a series of Plan-Do-Study-Act cycles were implemented to test changes introduced by sensitizing resident doctors and nursing staff in the labour room. Results: The findings indicated a noteworthy enhancement in communication, as healthcare providers consistently engaged in addressing women by their names (100%), securing consent prior to each clinical examination (93%), and furnishing information regarding the progress of labour following each examination (54%). Confidentiality maintenance increased to 70%, while positive responses to patient needs, preferences, and questions rose to 74%. Conclusions: The conclusions drawn from this research highlight the feasibility and effectiveness of a QI approach as a behaviour change intervention among HCPs to provide dignified and consented care.

Background: Hypertension and type 2 diabetes mellitus (T2DM) are commonly occurring chronic diseases that frequently appear together in patients, leading to a compounded risk for cardiovascular and renal complications. Together, these conditions hasten the onset of damage to vital organs, although their interrelationship and co-occurrence patterns are not well defined in certain groups. Objective: To evaluate the prevalence and strength of association amongst hypertension and type 2 diabetes mellitus and to identify demographic, clinical, and biochemical correlates contributing to this comorbidity among patients attending a tertiary care center. Methods: A research was directed over a 1-year period (January 2023–December 2023) at AIIMS Patna. 300 patients diagnosed with T2DM were enrolled and assessed for the presence of hypertension based on JNC-8 criteria. Data on demographic variables, duration of diabetes, body mass index (BMI), glycemic control (HbA1c), lipid profile, renal parameters, and lifestyle factors were collected. Statistical examination involved chi-square tests and Pearson’s correlation for categorical variables and continuous variables respectively. Results: Among 300 T2DM patients, 198 (66%) had coexisting hypertension. The occurrence of hypertension was significantly higher in patients aged ≥55 years (p < 0.01) and those with longer duration of diabetes (>5 years) (p = 0.002). Hypertensive diabetics had considerably higher BMI, serum triglycerides, and HbA1c levels compared to normotensive diabetics (p < 0.05). A positive association was observed between systolic blood pressure and HbA1c (r = 0.38), as well as BMI (r = 0.44), indicating poor glycemic control and obesity as contributing factors. Conclusion: A high prevalence of hypertension is observed in individuals with T2DM, especially among the elderly and those with obesity and poor blood sugar regulation. Early screening and integrated management of both conditions are crucial to prevent long-term complications. Targeted lifestyle interventions and pharmacologic strategies must address the intertwined pathophysiology of these comorbid diseases in tertiary care settings.

Background: A main microvascular consequence of type 2 diabetes mellitus (T2DM), diabetic nephropathy (DN) is a main cause of end-stage renal failure. Although various metabolic and inflammatory mechanisms have been linked to its pathophysiology, new studies point to thyroid hormones—especially free triiodothyronine (fT3)—may affect renal function and course of diabetic kidney disease. Objective: The aim is to assess in individuals with type 2 diabetes the correlation between circulating free triiodothyroid (fT3) levels and the degree of diabetic nephropathy. Method: Over one year, AIIMS Patna undertook a hospital-based cross-sectional observational study. Urinary albumin-to– creatinine ratio (UACR) guided patients with proven T2DM into three groups: macroalbuminuria, microalbuminuria, and normoalbuminuria. Together with renal function measures including serum creatinine, estimated glomerular filtration rate (eGFR), and UACR, blood levels of fT3, thyroid-stimulating hormone (TSH), and free thyroxine (fT4) were examined. FT3 levels and indicators of nephropathy severity were investigated for relationships. Results: Enrolled overall were 200 T2DM patients. Patients with macroalbuminuria had much lower fT3 levels than those with normoalbuminuria (p < 0.001.). Whereas eGFR (r = 0.41) showed a positive association, fT3 and UACR (r = –0.47) and serum creatinine (r = –0.38) showed a negative correlation. After controlling age, diabetes management, and thyroid status, these correlations stayed somewhat strong. Conclusion: Low circulating fT3 levels are thus strongly linked to the development of diabetic nephropathy in type 2 diabetic individuals. For diabetic patients, fT3 could be a target for metabolic monitoring and a possible early sign of renal damage.

Background: Many times, requiring complicated medication, Acute Coronary Syndrome (ACS) patients run a higher risk of adverse drug reactions (ADRs). Maximizing patient safety and treatment results in this population depends on an awareness of the pattern and distribution of ADRs. Objective: To examine during a one-year period the pattern, etiology, severity, predictability, and preventability of ADRs in ACS patients admitted to a tertiary care hospital. Methods: In the Cardiology Department of a tertiary care hospital, a 12-month prospective observational study was undertaken. Included were all ACS patients who experienced ADRs throughout hospital stay. Demographic, clinical, and ADR specific data were gathered. Using the WHO-UMC and Naranjo scales, causality was evaluated; severity by the modified Hartwig and Siegel scale; predictability by the Rawlins and Thompson criterion; and preventability by the Schumock and Thornton scale. Results: Of 350 ACS patients admitted during the course of the research, 70 (20%) reported at least one ADR. 85 ADRs in all were recorded. Bleeding (25%), hypotension (20%), and gastrointestinal problems (15%), were the most often occurring ADRs. The most often linked pharmacological class was antiplatelet drugs and anticoagulants. According to causality analysis, 30% of ADRs were “possible” and 60% were “probable.” Severity ratings showed that 10% were severe, 20% mild, and 70% moderate. Eighty percent of ADRs were predictable based on the Rawlins and Thompson criterion. Of ADRs, 25% were found by the Schumock and Thornton scale to be preventable.

Background: Type IIIB open proximal tibia fractures are severe injuries characterized by extensive soft tissue damage, bone exposure, and high risk of infection and non-union. Timely and coordinated orthopedic and plastic surgical management is essential to optimize outcomes. Early bone fixation combined with prompt soft tissue coverage has emerged as a critical strategy in reducing complications, preserving limb function, and improving healing rates. This approach aligns with modern limb salvage protocols, emphasizing early intervention and multidisciplinary care for complex extremity trauma. Methods: A total of 20 cases of Gustilo-Anderson Type IIIB open proximal tibial fractures were included in the study. They were managed by initial debridement, stabilization, and soft tissue coverage. After thorough wound irrigation and necrotic tissue removal, fracture fixation is performed using locking compression plates, intramedullary nails, or external fixators, depending on fracture pattern and soft tissue condition. Soft tissue defects are addressed within 72 hours using local rotational flaps, free flaps, or vacuum-assisted closure. Results: This study of 20 patients with Type IIIB open proximal tibial fractures, which were managed with early bone fixation and soft tissue coverage, yielded favorable outcomes. The mean time to surgery was 18.2 hours, and soft tissue coverage was achieved within 54.6 hours on average. Radiological union occurred at a mean of 18.4 weeks. Superficial and deep infection rates were 20% and 10%, respectively. Flap survival was 90%, with few complications. Functional outcomes at one year were satisfactory (mean LEFS score: 62.5). Delayed coverage and higher ASA grade were significant risk factors for infection and non-union. Conclusion: We conclude that early fixation and timely soft tissue reconstruction can significantly enhance outcomes in Type IIIB open tibial fractures. While LCPs may offer advantages in fracture stability and functional recovery, the most critical factors remain physiological status and timing of soft tissue intervention. These findings support early, integrated orthopedic and reconstructive strategies in limb restoration protocols.

Pheochromocytomas are rare catecholamine-secreting tumours arising from chromaffin cells of the adrenal medulla. Large pheochromocytomas (>6 cm) are uncommon and present significant surgical and anaesthetic challenges. This report details a case of a 1.16 kg, 15 × 12 × 7.5 cm³ adrenal pheochromocytoma managed successfully via surgical excision. The case is compared with both Indian and global literature to highlight variations in clinical presentation, diagnostic approaches, and treatment outcomes.

Background: Pediatric urinary tract infections (UTIs) are a common cause of morbidity in young children, with rising concerns regarding antibiotic resistance. This study aimed to investigate the trends in antibiotic resistance among common pathogens responsible for UTIs in children aged 0 to 5 years, over a one-year period from October 2023 to October 2024. Methods: This prospective observational study included 300 pediatric patients diagnosed with UTIs at a tertiary care center. Urine samples were collected and subjected to culture and sensitivity testing to identify the causative pathogens and their resistance patterns to commonly used antibiotics. Results: The most common pathogens isolated were Escherichia coli (58%), Klebsiella pneumoniae (18%), and Enterococcus faecalis (12%). Resistance rates were highest against ampicillin (68%), followed by trimethoprim-sulfamethoxazole (58%) and ciprofloxacin (25%). Notably, multidrug resistance was observed in 30% of E. coli isolates. Conclusion: The study highlights significant antibiotic resistance trends among common pathogens causing pediatric UTIs, particularly in relation to first-line antibiotics. These findings emphasize the need for judicious use of antibiotics, regular surveillance, and the development of targeted treatment guidelines to manage UTIs effectively in children.

Background: Intensive‑care units (ICUs) are major consumers of broad‑spectrum antimicrobials, accelerating antimicrobial‑resistance (AMR). Objectives: (i) Characterise the prescription pattern of antimicrobial agents (AMAs) in an adult medical ICU, and (ii) appraise prescribing quality with World Health Organization (WHO) core indicators and defined‑daily‑dose (DDD) metrics. Methods: Between 1 January 2023 and 30 June 2024, 270 consecutive adults (≥ 18 y) hospitalised ≥ 24 h in the ICU of the National Institute of Medical Sciences & Research (NIMS), Jaipur, were prospectively enrolled. Demographic, clinical and full medication data were extracted. WHO indicators (drugs / encounter, generic prescribing, encounters with an AMA, an injection and Essential‑List drugs) were calculated. AMA consumption was expressed as DDD/100 bed‑days (ATC/DDD 2024). Results: Median age was 54 y (IQR 41–69); 54.4 % were female and 45.6 % were male. Median ICU stay was eight days. In total, 2903 drug orders (median 11 per encounter, IQR 6–14) were written; 93.4 % used generic names. AMAs featured in 79.3 % of encounters (median 3 courses) and injections in 68.9 %. Piperacillin–tazobactam (25.8 %), cefuroxime (23.0 %) and amikacin (12.6 %) were most common. Overall AMA load was 162 DDD/100 bed‑days; piperacillin–tazobactam alone contributed 42 DDD/100 bed‑days. Only 39 % of AMA items were listed in the 2022 WHO Essential Medicines List. Fixed‑dose combinations (FDCs)—chiefly cefuroxime/axetil and amikacin/sulbactam—represented 26 % of AMA prescriptions. Conclusions: Pronounced polypharmacy, intense empiric broad‑spectrum use and poor Essential‑List adherence were observed. Embedding a robust antimicrobial‑stewardship bundle—culture‑guided de‑escalation, restriction of high‑end agents, pharmacist‑led reviews and rapid diagnostics—could rationalise therapy and curb local AMR.

Background: The incidence of cancer in India is increasing with the variation of rise in different locations based on their epidemic reasons. So, this study was carried out to analyse the incidence of different deep-seated lesions among patients visiting the hospital outpatient ward in Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur where there were majority of people have a history of smoking and chewing tobacco. Methodology: A prospective diagnostic test study was carried out among patients with lesions and were referred to image guided Fine needle aspiration cytology (FNAC) for evaluation. The necessary medical history, test results, and other pertinent information were retrieved from the patient’s hospital record. In order to examine the data, descriptive statistics were used. Results: Over the course of two years, 130 cases were considered. With a mean age of 58.3 years and a male preponderance of roughly 97 cases (73.84%), the majority of the 33 incidents were in the age bracket of 51-60 years. For imaging the deep seated lesions, 113 cases (86.92%) underwent USG guided FNAC and 17 (13.07%) underwent CT guided FNAC. About 90 cases (69.23%) arose from lung, followed by 9 (6.92%) from abdomen, 8 (6.15%) from the liver and 3 (2.30%) from kidney. Notably, 11 cases (8.46%) have non-neoplastic lesions, and 107 cases (82.30%) were of neoplastic origin, in that, squamous cell carcinoma of lung was the most prevalent and was noted in 40 cases. Conclusion: The squamous cell carcinoma of lungs was the most common malignancy noted after analyzing the deep-seated lesions and was more prevalent among men who are smokers and tobacco chewers. Thus, this study provided an insight into screening and diagnose the lesion among the regional population with a history of tobacco consumption.

Objective: Allergic rhinitis (AR) is a common inflammatory nasal condition affecting over 400 million people globally and significantly impacting the quality of life. Topical nasal steroids (TNS) are the first-line treatment. This study aims to compare the efficacy and safety of mometasone furoate and fluticasone propionate nasal sprays, both of which are glucocorticoids that reduce nasal inflammation, in the management of allergic rhinitis. Methods: A prospective, comparative, open-label study was conducted on 120 patients with allergic rhinitis at the Government E.N.T. Hospital, Koti, and Hyderabad. Patients were randomized into two groups, Group A received mometasone furoate nasal spray, and Group B received fluticasone propionate nasal spray for 28 days. Total Nasal Symptom Score (TNSS) and Absolute Eosinophil Count (AEC) were measured at baseline and on day 28. Clinical response was assessed at follow-up, and data were analyzed using SPSS version 26.0. Results: No significant differences were observed between the two groups in overall TNSS improvement (p = 0.7400). However, the mometasone group showed a statistically significant improvement in nasal congestion (p < 0.05). Mean AEC at baseline and the end of 28 days in the mometasone group was 721.0±179.66 cells/µL and 318.63 ± 138.63 cells/µL and in group 2 was 662.57 ± 166.12 cells/µL and 344.53 ± 172.71 cells/µL respectively. There was a significant variation in average AEC at the end of 28 days of treatment (p<0.05). Only mild adverse effects were reported in both groups. Conclusion: Both mometasone furoate and fluticasone propionate nasal sprays effectively managed allergic rhinitis. Mometasone demonstrated a greater reduction in AEC and better control of nasal congestion. Only mild adverse effects were observed across both the groups.

Introduction: Urinary tract infections (UTIs), predominantly caused by Escherichia coli and multidrug-resistant Klebsiella pneumoniae (KP), pose significant global health concerns. This study aims to detect carbapenem resistance genes in MDR KP using PCR, facilitating early identification and guiding effective treatment and infection control strategies. Methods: This prospective study was conducted at GSL Medical College from January 2024 to February 2025. Mid-stream urine samples from adult UTI suspects were analyzed for pathogens and antibiotic susceptibility. Carbapenem-resistant Klebsiella pneumoniae strains underwent PCR to detect blaVIM-1, blaNDM-1, and blaIMP genes using specific primers and thermal cycling. Results: Total 211 pathogens were isolated; Esch.coli (62; 29%) was the leading followed by KP (55; 26%). CR was detected in 36 (100%) KP strains.  OXA 48 gene was detected in maximum (19; 53%) followed by VIM-1 (5; 14%), blaNDM-1 (4; 11%), blaIMP (3; 8%) and unknown (10; 28). Conclusion: This study highlights a high prevalence of carbapenem-resistant KP in UTIs, with blaOXA-48 being the most common gene. The findings emphasize the urgent need for enhanced molecular diagnostics, antibiotic stewardship, and surveillance to control the spread of resistance and guide targeted therapeutic interventions.

Introduction: Postoperative pain management is crucial for recovery after inguinal hernia repair. TAP and epidural blocks are effective regional anesthesia techniques, with TAP offering fewer complications. While epidurals provide extensive analgesia, they pose risks like hypotension and urinary retention. This study compares their analgesic efficacy, side effects, and postoperative recovery impact. Methods: This was a prospective research conducted in government Medical College, Rajahmundry. Study included individuals aged 20–60 years requiring inguinal hernia repair. Patients were randomized into Groups E (epidural) and T (TAP block). Pain scores, hemodynamic parameters, and adverse events were assessed postoperatively. Rescue analgesics were given for VAS ≥4, and patient satisfaction was evaluated using a 7-point Likert scale. Results: Fifty patients were included, 25 in each group. Mean age and BMI were comparable. Pain scores were lower in Group T, with significant differences at 24 hours (P=0.05). Rescue analgesia was required more in Group E (P=0.02). Group E had higher adverse events, including bradycardia, hypertension, and desaturation (P=0.01). Conclusion: This study concludes that ultrasound-guided TAP blocks provide effective postoperative analgesia for unilateral inguinal hernia surgery with fewer adverse events and reduced rescue analgesic requirements compared to single-shot epidural blocks. While epidural blocks offer comprehensive pain relief, TAP blocks present a safer, minimally invasive alternative with a lower risk of complications.

Introduction: Wound healing is often delayed in diabetics due to hyperglycemia, vascular impairment, and inflammation. Non-diabetics typically heal faster with fewer complications. Advanced glycation end-products further hinder diabetic wound repair. This study aimed to compare healing outcomes between diabetic and non-diabetic patients undergoing skin surgery to guide better postoperative management. Methods: It was a prospective research conducted in Konaseema Institute of Medical Sciences and Research Foundation. Individuals with diabetes and non-diabetes who attended for skin surgery’s were included. Uniformity was maintained for surgical procedure as well as decontamination and followup. Outcomes included healing time, SSI, dehiscence, secondary interventions; assessed by epithelialization and discharge absence with regular postoperative follow-ups. Results: Diabetic patients had higher BMI, hypertension, and HbA1c levels. Postoperative healing was delayed with more infections and wound dehiscence compared to non-diabetics. Healing was significantly slower in diabetics, especially with poor glycemic control. Higher HbA1c levels were strongly associated with longer healing times and prolonged follow-up beyond 28 days. Conclusion: Diabetes adversely affects wound healing following skin surgery. Delayed healing, higher infection rates, and prolonged recovery were more common in diabetic patients. Poor glycemic control, as reflected by elevated HbA1c, significantly contributed to these outcomes, underscoring the need for tight metabolic control and individualized wound management strategies in diabetics.

Background: The subtype of influenza A virus (H1N1 influenza) emerged from the recombination of various prior swine, avian and human flu strains, causes upper respiratory tract and lower respiratory tract infections in humans causing a global pandemic affecting millions of people. Material & Methods: The retrospective study evaluates the specimens from suspected cases of influenza A (H1N1) infection which were processed for Real Time Polymerase Chain Reaction for swine influenza A (Inf-A), (SW Inf-A), (SW-H1), (Rnase-P) from 2017 to 2019. Results: The positivity rate across the three years before the COVID era, with an insignificantly slight decrease from 2017 to 2019 (i.e. 32.7% to 32.1%). Overall test positivity was significantly less in year 2018 in comparison to 2017 and there was again significant rise in 2019. The age group 45-65 had the highest positivity across all scenarios (Total: 35.8%, Males: 36.0%, Females: 35.5%). There was no significant difference in test positivity among different genders in 2017 (p=0.89), 2018 (0.58). But in 2019, test positivity was significantly high among females in comparison to males (p=0.03). Conclusion: The variability in positivity rates in different years among different genders and age confirms the reassortment of strains emphasizing the need for regular surveillance of all the strains. The effectiveness of the vaccination drive for older adults, persons with comorbidities, and children is also vital for controlling the morbidity and mortality.

Introduction: Infraclavicular approach for brachial plexus block is under used but effective technique. The introduction of ultrasonography had rekindled the interest in infraclavicular brachial plexus block. Dexamethasone or Ketamine when added as adjuvant to local anaesthetic like ropivacaine will increase the duration of analgesia. Objectives: To compare postoperative analgesic effect, between Dexamethasone and Ketamine added as adjuvant to 0.2% Ropivacaine in ultrasound guided Infraclavicular Brachial Plexus Block. The primary objective of the study was the duration of post op analgesia or time taken for first rescue analgesia in hours. The secondary objectives were to find postoperative pain score and total rescue analgesic consumption in 24 hours. Methods: This was a prospective comparative observational study after institutional and ethics committee approval and patient consent. 100 patients aged 18-60 years with BMI <30 kg/m² belonging to American Society of Anaesthesiologist (ASA) physical status 1&2 undergoing elective forearm surgery were divided into two groups of 50 each. Group D received USG guided infraclavicular brachial plexus block with 0.2% Ropivacaine 28ml + inj Dexamethasone 8 mg and Group K received 0.2% Ropivacaine 28 ml + inj Ketamine 25 after giving general anaesthesia. Each patient received Inj Paracetamol 1 gm IV intraoperatively and Q8th hourly in post-operative period. Duration of analgesia, post-operative pain score and analgesic requirements were studied in both groups.  Also patient satisfaction score at 24 hour and occurrence of any complications were noted.  Statistical analysis was done with SPSS software version 16.  Qualitative data were compared using Chi square test and Quantitative data compared using independent t test. A P value of less than 0.05 was taken as significant. Results: The mean time required for first rescue analgesic was significantly more in Group D compared to Group K, 19.94+/-2.92 vs 10.76+/-1.69 respectively (P <0.05). The mean total rescue analgesic required in 24 hours significantly low in GroupD compared to Group K, 1.02+/-0.552 vs 1.96+/-0.532 (P <0.05).  There was a low NRS score in Group D compared to Group K. Conclusion: Addition of Dexamethasone is superior to Ketamine as adjuvant to 0.2% ropivacaine for post operative analgesia in patient receiving infraclavicular brachial plexus block.

Aim & Background: The ICU often prioritizes aggressive life-sustaining treatments, potentially overlooking patients’ complex needs. Early palliative care (PC) integration may improve patient outcomes and family satisfaction. This study evaluates the impact of early PC on symptom management, ICU length of stay, healthcare utilization, and family satisfaction. Methods: An observational cohort study of 150 critically ill patients in a tertiary care center was conducted. Patients were divided into two groups: those receiving early PC within 48 hours of admission (PC Group) and those receiving standard ICU care (Non-PC Group). Primary outcomes included symptom burden (pain and agitation scores), ICU length of stay, and healthcare utilization. Secondary outcomes assessed family satisfaction. Results: The PC Group had significantly lower pain (82% vs. 64%, p<0.01) and agitation scores (75% vs. 53%, p<0.01) after 48 hours. Median ICU stay was shorter (8 vs. 11 days, p<0.05), with reduced healthcare utilization, including fewer days on mechanical ventilation (4 vs. 5, p<0.05) and lower vasopressor use (36% vs. 64%, p<0.01). Family satisfaction was higher in the PC Group (8.5 vs. 6.5, p<0.01). Conclusions: Early PC integration in the ICU improves symptom management, reduces ICU stay, lowers resource utilization, and enhances family satisfaction. This study supports early PC as a standard practice to provide holistic, patient-centered care aligned with patients’ values and goals.

Background: Proximal humerus fractures constitute a significant portion of osteoporotic fractures, especially in individuals over the age of 50. While most are minimally displaced and managed non-operatively, displaced and unstable fractures often require surgical intervention. Among the various fixation options, the Proximal Humerus Internal Locking System (PHILOS) and Joshi’s External Stabilizing System (JESS) are widely used, yet their comparative efficacy remains debated. Objective: This study aimed to compare the clinical, functional, and radiological outcomes of JESS and PHILOS in the management of Neer type 2-, 3-, and 4-part proximal humerus fractures. Methods: A prospective, cross-sectional study was conducted on 64 patients at K.M. Medical College and Hospital, Mathura, from May 2022 to November 2024. Patients were randomly allocated into two equal groups: Group 1 (JESS) and Group 2 (PHILOS). Outcomes were evaluated using intraoperative parameters, Constant-Murley scores at discharge, shoulder range of motion, complication rates, and patient satisfaction. Statistical analysis was performed using SPSS, with p < 0.05 considered significant. Results: Both groups were comparable in baseline characteristics. The JESS group demonstrated significantly shorter operative time (45.9 vs. 81.3 minutes), lower intraoperative blood loss (143.8 vs. 296.2 ml), and shorter hospital stay (5.9 vs. 6.8 days, p = 0.095). Immediate postoperative Constant-Murley scores were significantly higher in the JESS group (p = 0.002). Early range of motion outcomes and functional parameters also favoured JESS. Complication rates were low and comparable between groups. Conclusion: Both JESS and PHILOS are effective for the surgical management of proximal humerus fractures. However, JESS offers advantages in terms of surgical simplicity, minimal invasiveness, and better early postoperative function, making it particularly suitable for elderly or osteoporotic patients and in resource-limited settings.

Background & Objectives: Maxillofacial trauma, commonly caused by road traffic accidents (RTAs), assaults, and falls, requires precise evaluation for effective management. Multidetector computed tomography (MDCT) is the gold standard for imaging these injuries, with 3D reconstructions enhancing diagnostic capabilities. This study aims to classify fractures using MDCT and compare the diagnostic accuracy of 3D reconstructions versus axial images. Methods: A retrospective observational study was conducted on 100 patients in the Department of Radiology, East Point College of Medical Sciences & Research Institute, Bengaluru, Karnataka. Fractures were classified based on anatomical involvement, and 3D reconstructions were compared with axial images for diagnostic accuracy. Statistical analysis assessed inter-observer agreement and modality efficacy. Results: Among the patients, 84% were male, with RTAs being the most common cause (79%). The orbit (57%) and zygomatic bone (42%) were the most frequently affected regions. Le Fort fractures were seen in 18% of cases. 3D reconstructions enhanced visualization of complex fractures, particularly in the mandible (64.2%) and zygomaticomaxillary complex (52.4%), while 2D images were superior for nasal (54.3%) and orbital (69.8%) fractures. MDCT showed high inter-observer agreement (κ = 0.89). Conclusion: MDCT, with both 2D and 3D imaging, is essential for diagnosing maxillofacial fractures. While 3D reconstructions aid in surgical planning, axial images remain critical for detecting subtle fractures. A combined imaging approach ensures comprehensive assessment and better patient outcomes.

Objective: National Medical Commission (NMC) has introduced several guidelines to ensure quality medical education. To implement the guidelines the faculties should be aware of the same and should take active part in rollout of these guidelines. The current study was undertaken to evaluate the knowledge of medical faculties in India about the guidelines by NMC. Material and Methods: This cross sectional study was conducted among faculties and Senior Residents (SR’s) of various medical colleges in India, using a predesigned pretested self-administered structured questionnaire (Google form) as a data collection tool for data collection. Results: A total of 120 responses were obtained from Professors (36.66%) followed by Associate Professors (33.34%), Assistant Professors (24.16%) and Senior Residents (5.84%) in our study. Maximum faculty were from Government medical colleges (50.84%) followed by Autonomous (28.33%) and Private (20.8%). Nearly half of faculty (50.84%) showed excellent knowledge regarding NMC guidelines but (12.5%) faculty showed poor knowledge. Conclusion: There is need to conduct periodic faculty awareness program to uplift the medical education.

Background: An organ or tissue that protrudes abnormally through a gap in its surrounding wall is called a hernia. A hernia that pushes through the anterior abdominal wall fascia is known as a ventral hernia. Umbilical, paraumbilical, epigastric, and midline incisional hernias are examples of midline ventral hernias. Insufficient healing of an earlier incision can lead to incisional hernias. Objective: The objective of our study was to the incidence of complications like seroma, mesh buldging and recurrences among patients undergoing IPOM and IPOM plus. To observe any swelling, pain, discharges in the umbilicus among the patients who underwent IPOM and IPOM plus on follow up for 6 months after procedure. Method: We carried out a prospective observation study in the General Surgery department of Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Pondicherry, India, between January 2024 to December 2024, for a period of 12 months and follow up period 6 months. We calculated a sample size of total 30 patients of both genders, aged between 18 and 70 years, presenting with reducible umbilical hernia were included in the study by simple random sampling. We created two groups; Group 1 (IPOM) – 15 patients and group 2 (IPOM PLUS) – 15 patients. Result: in this study included 30 patients with a male-to-female ratio of 2:1. The mean age of participants was 56.26 years (±8.46), and the mean BMI was 25.5 (±3.09), suggesting that most patients were in the overweight category. The mean defect size was 2.36 cm (±0.67), with variations observed between groups. A significant difference was found between the two groups, with seroma formation occurring in 100% of cases in the IPOM group, whereas no cases were reported in the IPOM Plus group (p = 0.0317). Recurrence was observed in 16.67% of cases, occurring exclusively in the IPOM group, while no recurrences were noted in the IPOM Plus group (p = 0.0476). Conclusion: This study concludes that the frequency of postoperative seroma formation and recurrence is lower after laparoscopic (IPOM-Plus) in umblical hernia repair compared to laparoscopic IPOM.

Background: Subclinical hypothyroidism (SCH), characterized by elevated thyroid-stimulating hormone (TSH) levels alongside normal free thyroxine levels, is linked to various metabolic disorders. Metabolic syndrome (MetS), which includes central obesity, dyslipidemia, hypertension, and hyperglycemia, significantly increases the risk of cardiovascular and metabolic diseases. The relationship between SCH and MetS is not fully explored. Aim: This research aimed to assess the prevalence and features of subclinical hypothyroidism among individuals with and without metabolic syndrome and to pinpoint potential predictors of SCH within the MetS group. Methods: This cross-sectional comparative study spanned eight months and involved 300 participants split into two groups: those with MetS and those without. Each participant underwent assessment for demographic, clinical, and biochemical markers, such as TSH levels, lipid profiles, fasting glucose, and blood pressure. Statistical analysis was conducted using SPSS version 23.0, applying Chi-square, t-tests, and multivariate regression. Results: The incidence of SCH was notably higher in the MetS group (68%) compared to the non-MetS group (52%). TSH levels were also higher in the MetS group (7.46 ± 1.50 mIU/L) compared to the non-MetS group (7.27 ± 1.51 mIU/L, p = 0.02). Parameters like triglycerides, fasting glucose, and waist circumference were significantly elevated in the MetS group, whereas HDL cholesterol was lower (all p < 0.001). Multivariate regression indicated that high triglycerides (OR 1.34, p < 0.001), increased waist circumference (OR 1.12, p < 0.001), and elevated TSH levels (OR 1.25, p = 0.02) were significant predictors of SCH in individuals with MetS. Conclusion: There is a robust link between SCH and MetS, with metabolic abnormalities significantly elevating the risk of developing SCH. Thyroid dysfunction could potentially worsen metabolic disturbances, underscoring the importance of integrated care approaches. Recommendations: Routine thyroid function tests are recommended for individuals with metabolic syndrome. Further longitudinal studies are necessary to clarify the causal relationships and the effect of managing metabolic factors on thyroid function.

Background: Pregnancy is a physiological condition that can bring changes in Anthropometric pattern and cardiovascular events. It was also found that both changes during pregnancy can produce severe complications. It is very important to analyze the cardiovascular changes & anthropometrics during pregnancy to manage the complications. Methodology: Total 200 study subjects were enrolled in the study. 100 were non-pregnant and 100 were pregnant women. Subjects were evaluated for pulse rate, blood pressure, height, weight and BMI. All the readings were recorded. Results: This was observed that pulse rate, mean systolic blood pressure was significantly raised in pregnant women when compared with non-pregnant (p<0.05). In anthropometric findings weight and BMI was significantly more in pregnant women than non- pregnant women (p<0.05). Conclusion: This can be concluded that in pregnancy both cardiovascular changes as well as changes in anthropometric pattern can be recorded that can help to manage the complications during pregnancy.

Introduction: Medicines play an essential role in treating diseases of the ear, nose, and throat (ENT). This study aimed to analyze the prescription patterns and ADR profiles of drugs, with a specific focus on corticosteroids, in the ENT department of a tertiary care teaching hospital. Materials: A prospective observational study was conducted over 12 months at G.S.V.M. Medical College, Kanpur, involving 361 patients aged 18 years and above attending OPD/IPD services. The WHO prescribing indicators were used to evaluate the rationality of prescriptions. ADRs were assessed using the Naranjo causality assessment scale. Results: The most commonly affected organ was the ear (46.8%). A total of 2922 drugs were prescribed, with an average of 8.09 drugs per prescription. Corticosteroids accounted for 3.9% of prescriptions (average 0.31 per prescription). Commonly prescribed corticosteroids included dexamethasone (30.1%), triamcinolone acetonide + lidocaine (26.5%), and betamethasone-based combinations (24.8%). Most corticosteroids were administered topically (64.6%), followed by injectable (30.1%) and oral (5.3%) routes. Antibiotics were prescribed in 73.1% of cases, predominantly β-lactam antibiotics (58.7%), followed by aminoglycosides (17%) and fluoroquinolones (11.4%). ADRs were observed in 10.53% of patients, commonly presenting as gastric upset, nausea, and dizziness. Among these, 52.6% were deemed “probable” and 47.4% “possible” as per Naranjo’s scale. Conclusions: The study highlights the widespread use of corticosteroids and antibiotics in ENT conditions, with a need to optimize drug utilization practices to minimize ADRs. It underscores the importance of regular prescription audits and adherence to essential drug lists and generic prescribing to enhance patient safety and cost-effectiveness in ENT care.

Introduction: Preanesthetic medications are commonly used before administering an anesthetic agent during surgeries. The pattern of preanesthetic medication may differ based on the anesthetic agent used, the profile of the patient, the hospital setup, and the type of surgical procedure. This study is planned to assess the drug utilization pattern of preanesthetic drugs given before major surgeries under general/spinal anesthesia (G.A/S.A.) along with their adverse reactions. Methods: In this prospective observational study all patients who were planned for surgery in LLR & associated hospitals were included after taking written informed consent. Results: Average number of drugs per prescription was found 5.54 and the average number of pre-anaesthetic drugs per prescription was found 2.34. Most of the study patients were prescribed pre anaesthetic medications like anti emetics drugs (58.2%) followed by anti-anxiety drugs (38.7%). Proton pump inhibitors (PPIs/H2) blocker drugs were prescribed in 3.1% study patients. ADRs detected in the study were gastric upset in 32.31%, nausea/vomiting in 26.15%, Headache in 30 11.53%, Hypoglycemia in 3.84% patients in the post-operative ward within 24 hours after surgery. Conclusions: Our study results provide useful insights regarding the use of preanesthetic medicines in a tertiary care center. It is recommended to use preanesthetic medications like antiemetics and PPIs to all patients who will plan for surgeries especially those undergoing in general anesthesia. Always be aware of potential interactions between preanesthetic medications and other medications the patient is taking.

Introduction: Palliative care (derived from the Latin root palliare, or “to cloak”) is an interdisciplinary medical care giving approach which aims at optimizing quality of life and mitigating suffering among people with serious, complex illness. According to WHO estimate, approximately 40 million people are in need of palliative care, 78% of them people live in low- and middle-income countries. Aims: to assess awareness about knowledge, attitude, and practice of palliative care medicine in doctors. Methods and Material: It was an institutional based cross-sectional study conducted in shree Krishna hospital and pramukhswami medical college, Karamsad from September 2019 to October 2020 among 82 doctors. Awareness about knowledge, attitude and practice about palliative care among doctors was assessed by pretested tool designed by the investigator (Co-PI). Data was collected and analysed using SPSS software version 21. Results: 33% residents and 63% faculties felt that it is difficult to form a close relationship with family of terminally ill patient. More than 75% doctors expressed reluctance to discuss death related issues. Majority of residents and faculties believe that a formal training in palliative care is essential. Conclusion: Systematic training of doctors about knowledge, attitude and behavioural aspects of palliative care is recommended.

Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory condition of the peripheral cornea, characterized by corneal thinning, ulceration, and a crescent-shaped infiltrate. It is caused by various infectious and non-infectious ocular and systemic diseases. Certain morphologic and immunologic characteristics of peripheral cornea make it more vulnerable to inflammatory reactions and necrosis leads to significant ocular morbidity, including corneal perforation, scarring, and vision loss, if not managed promptly. Due to the potential for rapid progression and severe complications, early recognition and a multidisciplinary approach involving ophthalmologists and rheumatologists are essential in managing PUK to preserve vision and address systemic involvement. Our study aims to analyze the etiology and systemic association, clinical presentation, and outcome of various treatment modalities of PUK of non-infective origin. Methods: This prospective hospital-based study was conducted where 40 patients diagnosed with PUK of non-infective etiology were evaluated and treated with either medical or surgical therapy or both in a tertiary care centre and were followed up. Results: In our study, the maximum number of patients (32.5%) were 60-70 years of age group and the mean age was 57.7±18.33 years, unilateral presentation was the most common. The most common grade of presentation was grade 2 (48.21%) followed by grade 4, maximum eyes had severe involvement and meibomian gland dysfunction was the most common extraocular association. Out of 56 eyes, most of the cases were idiopathic, 16 eyes (28.57%) had meibomitis, 4 eyes (7.14%) had squamous blepharitis, 3 eyes (5.35%) had scleritis and 3 eyes (5.35%) had episcleritis. Among the known etiologies, Mooren’s ulcer 35.0 % was the most common attributable factor, followed by rheumatoid arthritis 17.5%. Visual acuity evaluation was done pre and post-treatment in our study and improvement was noted. Treatment was successful in all mild cases that received medical management alone. For perforated peripheral ulcerative keratitis, the patch graft was successful in 87.5 % of eyes. Peritomy with AMG was successful in 77.77% of eyes. Peritomy alone was successful in 100 % (3/3). On the whole surgical treatment was successful in 85 % of eyes. Conclusions: This study revealed that the maximum patients were between 60 to 70 years age group with unilateral presentation and the most common etiology was idiopathic. The second commonest are Mooren’s ulcer, rheumatoid arthritis, and systemic lupus erythematosus. Mild to moderate cases responded well to medical management. Severe cases needed immunosuppressants. Perforated cases needed surgical intervention especially patch graft which is better in achieving good anatomical integrity and enhanced visual acuity. Early diagnosis, aggressive treatment, and continuous monitoring are of paramount importance in preserving vision and preventing the severe complications associated with PUK.

Background: Type 2 Diabetes Mellitus (T2DM) has emerged as a significant risk factor for cognitive impairment in the elderly. The complex interplay of chronic hyperglycemia, insulin resistance, vascular injury, and neuroinflammation may accelerate cognitive decline in this population. Objectives: To assess the relationship between cognitive impairment and T2DM in elderly patients using standardized cognitive assessment tools and to identify contributing clinical and lifestyle factors. Materials and Methods: This cross-sectional observational study was conducted at MGM Hospital, Navi Mumbai, involving 110 participants aged ≥60 years—55 with T2DM and 55 non-diabetic controls. Cognitive performance was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Demographic, clinical, and lifestyle data were collected and analyzed using SPSS v24. Significance was set at p<0.05. Results: Diabetic participants had significantly lower cognitive scores compared to non-diabetics (MMSE: 23.4 vs. 26.1; MoCA: 22.1 vs. 25.3; p<0.001). Cognitive impairment was more prevalent among diabetics (MMSE: 54.5%, MoCA: 63.6%) than non-diabetics (18.2% and 27.3%, respectively). Longer diabetes duration (>10 years), poor glycemic control (HbA1c >7.5%), low physical activity, and insulin use were associated with worse cognitive performance. Gender-based analysis showed that both diabetic males and females had significantly lower scores than controls. Conclusion: Elderly individuals with T2DM exhibit a higher prevalence of cognitive impairment, influenced by diabetes duration, glycemic control, and lifestyle factors. Early screening and multidisciplinary interventions are essential to preserve cognitive health in this high-risk population.

Background: Sickle cell disease (SCD), a hereditary hemoglobinopathy, causes significant morbidity in India’s tribal communities. Hydroxyurea (HU), a myelosuppressive agent, reduces complications, but evidence from Indian tribal populations is limited. Objective: To assess hydroxyurea’s efficacy in reducing vaso-occlusive crises (VOCs), blood transfusion requirements, and improving hematological parameters in tribal pediatric SCD patients. Methods: A prospective observational study enrolled 100 SCD patients (82 SCD-SS, 18 SCD-β-thalassemia), aged 1–18 years, from tribal regions. Patients received HU (15–20 mg/kg/day) and were monitored over 12 months for clinical and hematological outcomes. Results: Post-HU therapy, mean hemoglobin (Hb) rose from 8.12 to 9.19 g/dL (p < 0.001). VOC frequency decreased significantly (74.39% vs. 28.05%, p < 0.001), and transfusion needs dropped (50% vs. 19.51%, p < 0.001). No major adverse effects were noted. Conclusion: Hydroxyurea effectively reduces VOCs, transfusion dependency, and improves Hb levels in tribal Indian SCD patients, supporting its broader implementation in high-prevalence areas.

Aim: This study was designed to examine the impact of treatment experiences on the psychological distress associated with infertility in male patients, while examining the influence of contributing factors such as alcohol consumption, smoking, occupational exposures, varicocele, diabetes etc. and pre-existing anxiety disorders with a focus on how different stages of diagnosis, treatment processes, and outcomes influence emotional well-being over time. Methodology: A cross-sectional study was conducted among 200 infertile male patients aged 25–50 years. Data on alcohol use, smoking, occupational exposure, varicocele, diabetes, genital trauma, and pre-existing anxiety disorders were collected through structured interviews. Psychological distress was assessed using the DASS-21 scale. Statistical analysis included chi-square tests and multivariate logistic regression. Results: Moderate to severe psychological distress was found in 58% of participants. Significant associations were observed between distress and factors such as smoking, alcohol use, occupational hazards, varicocele, diabetes, and anxiety disorders (p < 0.05). Anxiety disorders and occupational exposure were the strongest predictors in regression analysis. Conclusion: A multidisciplinary evaluation revealed that male infertility and sexual dysfunction often coexist and are frequently associated with hormonal, structural, genetic, and sperm quality abnormalities. Comprehensive assessment is essential for accurate diagnosis and effective management. Psychological distress is prevalent among infertile men, particularly those with medical and lifestyle risk factors. Integrating mental health support and risk factor screening into infertility care is essential to improve patient outcomes.

Introduction: Nocturnal enuresis is a fairly common problem in children. The world -wide prevalence is reported as 1.4% to 28% in children aged 6 to 12 years. In India the prevalence is between 7.6% to 16.3% being higher in 5 to 8 years of age and it decreases as age advances and is lower in 6 to 11 years age group [1,2]. It is a cause of lot of anxiety both in children as well as parents which partly stems from lack of understanding of the normal maturational process of bladder control. Materials and Methods: To study the clinico-epidemiological profile of children with enuresis a prospective analytical cohort study was carried out from November 2024 to March 2025. Children above 5 years of age presenting with enuresis in outpatient department were enrolled in the study. After taking informed written consent from the parents, a questionnaire regarding their symptoms was filled followed by a detailed clinical examination. The results thereafter were analysed statistically. Results: maximum age group of presentation was 5 to 7 years with prevalence decreasing with increasing age. Most of the case were non- monosymptomatic enuresis with maximum children having overactive bladder. The prevalence of overactive bladder was also higher in girls than boys with a p value of 0.01. Conclusion: enuresis is a common problem in paediatric age group and a cause of significant stress among children. Most case are non-monosymptomatic where proper identification of the cause can cure enuresis and relieve a lot of stress related to it.

Background: Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus, leading to visual impairment and blindness if not diagnosed and managed early. With India facing a growing diabetic population, it is crucial to assess the burden of DR and its systemic associations. This study aimed to estimate the proportion of DR among diabetic patients and analyze its association with systemic comorbidities like hypertension, nephropathy, neuropathy, and medication adherence. Methods: A hospital-based cross-sectional study was conducted from February 2019 to August 2020 at the District Hospital, Tumakuru. A total of 835 diabetic patients attending the NCD clinic and ophthalmology OPD were enrolled. DR was graded based on the ETDRS classification through detailed fundus examinations. Systemic comorbidities such as hypertension, nephropathy, and neuropathy were assessed using standard diagnostic criteria. Medication adherence was evaluated using the 8-item MMAS (Morisky Medication Adherence Scale-8). Data analysis was performed using SPSS 21.0, and statistical significance was assessed using chi-square and ANOVA tests. Results: The prevalence of DR (Diabetic Retinopathy) was 33.9% in the right eye and 33.8% in the left eye. Among these, NPDR (Non-Proliferative Diabetic Retinopathy) accounted for 22.6% (RE) and 22.1% (LE), while PDR (Proliferative Diabetic Retinopathy) was present in 11.3% (RE) and 11.7% (LE). DR prevalence was higher in males and increased with advancing age, longer duration of diabetes, and elevated HbA1c levels. Significant associations were observed between DR severity and systemic hypertension, nephropathy, neuropathy, and low medication adherence. No significant associations were found with serum triglycerides, cholesterol, hemoglobin levels, or intraocular pressure. Most patients with severe DR belonged to lower socio-economic classes. Conclusion: The study highlights a significant burden of diabetic retinopathy among type 2 diabetic patients, with clear associations with age, diabetes duration, poor glycemic control, systemic hypertension, nephropathy, neuropathy, and poor medication adherence. Screening for DR and addressing modifiable risk factors are essential in preventing vision-threatening complications.

Head injury and Road traffic accidents(RTA) are an unfortunate association leading to severe loss of precious human life and resource. The current study is undertaken in a tertiary medical centre in Assam, India on such cases with the study period from 1^st January 2024 to 31^st December 2024 to know about the demography of the victims and the associated cranio cerebral injuries. Males were the most involved with the age group 21-30 being the most common. 867 cases were included in the study. Pedestrians were the most common victims (32.81%). Vault fracture of the skull was commonly noted(53.75%) and the temporal bone was the most involved. Of the haemorrhages a combination of subdural and subarachnoid haemorrhage was the most commonly involved (24.67%). As craniocerebral injuries form a considerable percentage of deaths in road traffic accidents and trivial looking injuries may be the cause of death, a careful autopsy can go a long way in helping the police, public and the court of law in administering justice.

Introduction: Acute pancreatitis is a prevalent condition with a broad range of clinical manifestations and a rising incidence rate. It describes an acute pancreatic inflammatory process that is typically accompanied by elevated serum pancreatic enzymes and stomach pain. Aims: To compare the severity and related complications of acute pancreatitis with the serum levels of CRP, LDH, Amylase, and Lipase. To observe the effect of highly elevated levels of serum LDH, CRP, Amylase, lipase on disease severity and complications of acute pancreatitis. Materials & Methods: It is an institution-based observational study. Place of Study were Burdwan Medical College and Hospital. From January 2024 to January 2025. Result: In our study found that individuals with pancreatitis have significantly higher values (479.8 ± 81.01) with a p-value of <0.001. Conclusion: We concluded that conclusion that there is a strong link between the severity and consequences of acute pancreatitis and higher serum levels of lipase, amylase, LDH, and CRP. Biomarker levels were consistently greater in patients with more severe manifestations of the disease and related comorbidities, with statistically significant variations between groups.

Objective: Echocardiographic assessment of right ventricular function and to correlate it with RCA stenosis and hence identify a subset of inferior wall MI patients at higher risk of adverse clinical events. Method: Total 70 patients of IWMI were finally undergone Echocardiography and Coronary angiography. In Echocardiography RVFAC, TAPSE, MPI, Pulsed wave tissue Doppler imaging for major positive velocity (S’), RV wall motion abnormality and RV diastolic dysfunction were assessed. These findings were correlated with Coronary angiography status of Right coronary artery lesion. Result: RV WMA is seen in approx.75% of patients with proximal RCA stenosis in comparison to only 4% of patients with stenosis in mid and distal RCA. All echo parameters are showing good specificity for predicting proximal RCA stenosis but sensitivity of RV diastolic dysfunction, MPI-TDI, LVEF and MPI -PW is below 75% predicting proximal RCA stenosis. Conclusion: Echocardiographic assessment of various parameters of RV function showed significant difference between groups with or without proximal RCA lesion. Tissue Doppler systolic annular velocity, myocardial performance index and TAPSE are easy to perform and useful in predicting proximal RCA as infarct related artery.

Introduction: Acinetobacter baumannii is a Gram-negative, opportunistic pathogen that has emerged as a significant cause of ventilator-associated pneumonia (VAP) in intensive care units (ICUs), particularly within tertiary care hospitals. Its ability to acquire resistance to multiple antibiotics, especially carbapenems, poses a substantial challenge in clinical settings. The present study aimed at the antimicrobial resistance profiles of the A. baumannii isolates and clinical outcomes in VAP patients. Materials and Method: This study was conducted in Indore, Madhya Pradesh, at the Index Medical College Hospital & Research Centre, from June 2022 to December 2024. Several patients from the intensive care unit provided non-repeating samples for the study. These samples were sent to the microbiology lab for culture identification and sensitivity testing. Patients who had spent more than 48 hours in a critical care unit was included. Those not in the intensive care unit and those with less than 48 hours were not included in the study. Bacterial identification and antibiotic resistance patterns were detected in compliance with CLSI requirements 2020. Result: In the study total 200 cases with clinical disease were observed among these 75 cases were suspected for ventilator-associated pneumonia. Prolonged Ventilator Support (>10 days) had a higher incidence of VAP. Supine position, comatose patients were also found to be risk factors for VAP. Out of the 08 patients 80% patients developed the late-onset VAP due to A. baumannii. VAP due to a MDR Acinetobacter is one of the most dreaded complications that occur in the critical care setting. Discussion: The high rates of resistance observed in intensive care units necessitate stringent infection control and antibiotic stewardship protocols. The spread of MDR A. baumannii can be stopped and effective antimicrobial therapies can be tailored with the aid of routine phenotypic screening for resistance patterns. Additionally, examining other treatment modalities, such as combination antibiotic regimens, may enhance efficacy against resistant bacteria.

Background: COVID-19 has created a gap in health service needs for leprosy patients, so many patients do not have access for diagnosis, treatment, and regular follow-ups during lockdown. The data regarding the leprosy spectrum in the post COVID era is sparse. The COVID infection history and its effect on the disease will add value to the patterns of leprosy in post COVID era. Hence, this study was done to assess the clinical, bacteriological, and histological profile of leprosy in post COVID era. Aim and Objective: To assess the clinical, bacteriological, and histological profile of leprosy in post COVID era. Materials and Methods: It is a hospital-based cross-sectional study. Clinical type of leprosy and history of COVID infection in the past were noted. Slit-skin smears (SSS) were done and bacteriological index was calculated. Histopathological diagnosis of leprosy was noted. Results: A total of 40 patients (both old and new cases) confirmed by histopathology were recruited. The mean age was 40 years and the majority were males (31, 77.5%). Patients with COVID history positive were 65.0%. Based on histopathological diagnosis, the majority of the cases were borderline tuberculoid (40%). SSS were positive in 52.5% of cases. Lepra reactions were seen in 45% of cases. In COVID history positive cases, multibacillary cases (53.75%), lepra reactions (50%), and SSS positivity (69.23%) were higher than in COVID history negative cases (14.3%, 35.7%, and 21.42%, respectively). Limitation: It is a hospital-based cross-sectional study with a small sample size. Conclusion: COVID history positive Hansen’s patients showed a greater number of multibacillary cases, SSS positivity, and lepra reactions as compared to COVID history negative Hansen’s patients.

Background: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has demonstrated efficacy in improving cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). However, data on its effectiveness and safety in the Northern Indian population remain limited. Objective: To evaluate the effects of finerenone on renal and cardiovascular outcomes in patients with T2DM and CKD over a one-year period in a tertiary care hospital in Northern India. Methods: This prospective observational study included 500 patients aged ≥20 years with T2DM and CKD, treated with finerenone. Baseline data collected encompassed demographics, medical history, renal function parameters, and cardiovascular status. Follow-up assessments at 3, 6, and 12 months evaluated changes in estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), HbA1c levels, blood pressure, incidence of hyperkalemia, and cardiovascular events. Results: At 12 months, a significant reduction in UACR was observed, indicating improved renal function. The decline in eGFR was attenuated, suggesting a renoprotective effect of finerenone. Cardiovascular events were reduced, aligning with previous studies demonstrating finerenone’s cardiovascular benefits. The incidence of hyperkalemia was low, and finerenone was well-tolerated across the cohort. Conclusion: Finerenone appears to confer significant renal and cardiovascular benefits in patients with T2DM and CKD in Northern India, with a favorable safety profile. These findings support its use in this demographic, aligning with global data on its efficacy and safety.

Background: Iron deficiency anaemia is more common in groups such as pregnant women, women of childbearing age, preterm and low birth weight babies, older infants and toddlers, and teenage girls. During pregnancy, the thyroid gland and its activity are greatly affected.  The size of the thyroid gland increases by a tenth of what it was before becoming pregnant.  In populations that are iodine deficient, the size increase is more noticeable. Thyroid hormone synthesis rises by as much as 50% in tandem with the increased need for iodine. Objectives: The objective of the study was to estimate the prevalence and patterns of hypothyroidism in early pregnant women with Iron deficiency anaemia in a tertiary care hospital setting in India. Method: This was a cross-sectional study conducted between Jan 2023 to March 2025 at GS Medical College & Hospital a tertiary care Hospital. 246 pregnant women aged 18-45 years in the first trimester of pregnancy were recruited. Pregnant women with a family history of thyroid disease or any history of thyroid dysfunction or disease, either current or former. Clinical proformas were used to document the clinical examination and detailed history. We gathered information on age, place of residence, consanguinity, length of pregnancy, parity, symptoms of hypothyroidism, and food history. Blood pressure, height, weight, body mass index, and goiter were all recorded. The association of Subclinical Hypothyroidism with the above variables were statistically analysed. Data collected were entered in Microsoft Excel and analysed using SPSS version 22. Descriptive statistical measures measure like percentage; mean and standard deviation were calculated. Results: Out of 246 women included in the study, Most of them, 202 (82.11%) were in the age group 21-30 years, 182 (73.98%) belonged to the urban category, maximize 241(97.96%) were literate and 233 (94.71%) were homemakers. 206 (83.73%) had married when aged between 18-25 years age, 204 (82.92%) had a non-consanguineous marriage, 114 (46.34%) were primigravida and 132 (53.65%) were multigravida. Chi-square analysis indicated that age, residence, consanguinity, weeks of pregnancy, and gravida and diet were not significantly associated with subclinical hypothyroidism. However anti-TPO (AB) antibody was significantly associated with SCH (<0.001) observed in the study. Conclusion: our setting had a very high prevalence of hypothyroidism.  Age, place of residence, consanguinity, weeks of pregnancy, parity, eating habits, and obesity did not correlate with SCH.  Anti-TPO antibody positivity was substantially linked to SCH.

Background: There are two levels of Hypertensive Disorders of Pregnancy (HDP) mild and severe. New-onset hypertension (systolic blood pressure > 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg) that develops after 20 weeks of pregnancy is known as mild HDP.  Most mild HDP cases occur after 37 weeks of pregnancy, and in these cases, the pregnancy results are similar to those of pregnancies with normal blood pressure. Objectives: The Objective of the study was conducted to estimate the prevalence of pregnancy-induced hypertension and the factors associated with pregnancy-induced hypertension. Method: This was a prospective cross sectional observational study done on 201 pregnant women with hypertensive disorders attending GS Medical College & Hospital, India. Data was entered in Microsoft excel and analysed using IBM SPSS version 23. Statistical tests were applied based on the type of variable and normality of the data. Results: A total of 201 pregnant women were included. About 61.19% (123) of the participants were up to 30 years of age. Majority (55.22%, 111) of the females belonged to the urban areas. A total of 93 females (46.26%) were primigravida. About 88.55% (178 patients) were literate and about 95.52 % of the patients were housewives. The prevalence of HDP among our study participants was 6.46% (13 patients). The prevalence of GDM was 9.45% (19 patients). Hypothyroidism was present in 18.90% (38 patients) and depression was present in 0.99% (2 patients). History of HDP in previous pregnancy was given by 2.48% (5 patients) out of 108 patients with parity >1. Conclusion: According to our research, pregnant women who were older and had a higher BMI were more likely to get HDP. Women whose spouses smoked had a greater prevalence of HDP (the relationship was near significant).

Introduction: Prevalence of overweight and obesity has been increasing around the world including India. These are major risk factors for a number of chronic diseases. Medical students are more prone to overweight–obese due to sedentary lifestyle owing to long duration of study hours, lack of physical activity and unhealthy eating habits. Aim: To determine the prevalence of overweight-obesity and its associated risk factors among medical students of Lakhimpur medical college and hospital, Assam. Material and Method: A cross-sectional study was conducted among 184 undergraduate medical students in Lakhimpur Medical College and Hospital, North Lakhimpur, Assam for a period of six months from May 2024 to October 2024. Data was collected for socio-demographic variables, behavioral risk factors and standardized anthropometric measurement were taken following WHO STEPS manual. The participants were categorized on the basis of body mass index (BMI). Data obtained was compiled, tabulated, analyzed using SPSS version 16 Software and statistically evaluated using percentage and chi square test. Results: The prevalence of overweight and obesity was found to be 23.4% and 13.6% respectively. Together they constitute 36.95% overweight-obese study subjects. The prevalence of overweight–obesity was more in male (37.1%), in students having family history of hypertension (45.2%), diabetes (41.7%) and cardiovascular diseases (44.0%). The prevalence of overweight–obesity was found to be less among the students who consumed fruits (27.8%), vegetables (35.6%) and did moderate exercise (28.1%). Overweight–obesity was significantly associated with family history of hypertension and consumption of processed food by students. Conclusion: The present study reveals a high prevalence of overweight-obesity among the medical students. There is a need to focus on BCC activities to promote healthy lifestyle behaviors and correct dietary habits among the medical students.

Introduction: Upper Gastrointestinal tract disorders are commonly encountered disorders. Endoscopic evaluation is an important diagnostic modality for visualization of such lesions. In clinically suspected cases, endoscopic biopsy can be performed to differentiate various benign and malignant lesions, to confirm the diagnosis, to determine extent of disease and assess response to therapy. Objective: To study various upper gastrointestinal tract lesions via endoscopic biopsy and to study histopathological spectrum of such upper gastrointestinal tract lesions. Materials And Methods: The present study is retrospective type of descriptive study done over a period of one year from January 2024 till December 2024 and includes hundred upper gastrointestinal endoscopic biopsies. Biopsy was taken from patients with suspected upper gastrointestinal lesions for clinical diagnosis and for histopathological correlation. Results: Out of hundred cases, 78 were non-neoplastic and 22 were neoplastic lesions. In 12 esophageal lesions, non-neoplastic were 07 and 05 neoplastic cases. In stomach, out of 80 cases, 63 cases were non-neoplastic and 17 cases were neoplastic. Most common non-neoplastic lesion was chronic non-specific gastritis and in neoplastic lesions adenocarcinoma was most common. In duodenum, all 8 cases were non-neoplastic lesions. Conclusion: Diagnostic evaluation of upper gastrointestinal lesions via fibreoptic endoscopy is a safe effective tool. It helps in direct visualization of lesions and in suspected cases endoscopic biopsy can be taken. Histopathological correlation can be done of endoscopic findings for final diagnosis and for better treatment outcome.

Background: Microtia, a congenital defect marked by the underdevelopment of the external ear, is often linked with additional systemic malformations, notably renal anomalies, and congenital heart disease (CHD). These associations are frequently underdiagnosed without proactive screening, resulting in lost opportunities for early intervention. Objective: To assess the utilization of diagnostic testing for renal anomalies and congenital heart disease in patients with microtia and to ascertain the prevalence of these associated conditions in a tertiary care environment. Methods: This was a cross-sectional observational study conducted over 11 months at GMERS Medical College and Hospital in Junagadh, Gujarat, involving approximately 100 patients diagnosed with microtia. All patients underwent a thorough examination of their medical records and were evaluated for the completion of renal ultrasound and echocardiographic screening. Renal and cardiac anomalies were recorded. Statistical analysis was conducted to ascertain correlations between the severity of microtia and its laterality. Results: Of 100 patients with microtia, 61% received renal ultrasound and 58% underwent echocardiography. Among those screened, 15% exhibited renal anomalies (e.g., unilateral renal agenesis, hydronephrosis), while 18% were diagnosed with congenital heart disease, predominantly atrial septal defect and ventricular septal defect. Bilateral microtia and more severe deformities were significantly correlated with a heightened probability of associated anomalies (p < 0.05). Conclusion: A significant percentage of patients with microtia possessed previously unrecognized renal or cardiac abnormalities. Nonetheless, the application of diagnostic screening is still inadequate. Routine screening utilizing renal ultrasonography and echocardiography should be incorporated into the clinical protocol for all children exhibiting microtia to facilitate early identification and management of significant systemic conditions.

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that imposes considerable physical, cognitive, and psychosocial burdens in its advanced stages. As the illness advances, patients frequently encounter intricate choices regarding treatment objectives, life-prolonging measures, and palliative care. Comprehending patient preferences during this phase is crucial for delivering patient-centered, dignified care. Objective: To assess treatment preferences regarding end-of-life care among patients with Parkinson’s disease, encompassing their perspectives on life-sustaining interventions, palliative care, and advance directives. Methods: An observational study utilizing a cross-sectional questionnaire was performed over 11 months at GMERS Medical College and Hospital in Junagadh, Gujarat, involving around 100 patients diagnosed with moderate to advanced Parkinson’s disease.  Participants were interviewed utilizing a structured, validated questionnaire addressing preferences for resuscitation, ventilatory assistance, artificial nutrition, hospice care, and participation in decision-making.  The data were analyzed descriptively and categorized by age, disease duration, and comorbidities. Results: Among 100 patients, 62% favored comfort-oriented care rather than aggressive life-extending treatments.  Forty-eight percent indicated a readiness to accept ventilator assistance, whereas merely thirty-six percent supported cardiopulmonary resuscitation (CPR).  Seventy-four percent preferred non-invasive symptom management, while forty-two percent had conversed about end-of-life preferences with family or healthcare professionals.  Familiarity with advance directives was minimal (21%), yet 58% indicated a desire to formulate one. Treatment preferences were markedly affected by disease stage, age, and the existence of cognitive decline. Conclusion: The study underscores an increasing preference among Parkinson’s disease patients for quality-of-life-centered end-of-life care over life-extending interventions.  There is an imperative necessity for prompt and organized dialogues regarding advance care planning in Parkinson’s disease, engaging both patients and caregivers, to synchronize medical decisions with personal values and preferences.

Background: Traumatic Brain Injury (TBI) is a significant cause of morbidity, mortality, and long-term disability worldwide. Management approaches for TBI include conservative (non-surgical) and surgical interventions, each with varying outcomes depending on the severity of the injury and available resources. Aim and Objective: To compare the outcomes of TBI patients managed conservatively versus those undergoing surgical intervention at Narayan Medical College and Hospital, Jamuhar, Bihar. Materials and Methods: A total of 50 TBI patients were included in this two-year observational study. The patients were categorized into two groups: 28 patients received conservative management, while 22 patients underwent surgical interventions. Demographic data, mode of injury, Glasgow Coma Scale (GCS) scores on admission, type of surgical intervention, complications, and outcomes at discharge and 3-month follow-up were analyzed. Outcomes were assessed using the Glasgow Outcome Scale (GOS). Results: The study population was predominantly male (78%), with the highest incidence of TBI in the 21–40-year age group (46%). Road traffic accidents (RTAs) were the most common cause of injury (62%). Severe TBI (GCS ≤8) was more frequent in the surgical group (54.5%). At the 3-month follow-up, 67.9% of conservatively managed patients achieved good recovery (GOS 5), compared to 50% in the surgical group. The surgical group had a slightly higher mortality rate (9.1%) compared to the conservative group (3.6%). The mean length of hospital stay was significantly longer in the surgical group (12.6 ± 4.7 days) compared to the conservative group (7.2 ± 3.1 days). Complications, such as raised intracranial pressure and infections, were more common in the surgical group. Conclusion: Conservative management may result in better outcomes for patients with less severe TBI, with a higher percentage of good recoveries. However, surgical intervention remains crucial for patients with severe injuries or significant intracranial pathology. The decision for surgery should be individualized based on injury severity, patient age, comorbidities, and available resources. Further large-scale studies are needed to establish definitive guidelines for TBI management in resource-limited settings.

Background: Unstable intertrochanteric femur fractures pose significant challenges in orthopedic surgery due to high complication rates and poor outcomes with conventional fixation methods. This study evaluates the efficacy of combining trochanteric buttress plating (TBP) with proximal femoral nailing (PFN) in managing these fractures. Methods: An observational study was conducted on 20 patients with unstable intertrochanteric fractures (AO/OTA types A2.1–A2.3) treated with PFN and TBP. Functional outcomes were assessed using the Harris Hip Score (HHS) at 1, 3, and 6 months postoperatively. Radiological union, intraoperative blood loss, surgical time and complications were also analyzed. Results: Mean HHS improved from 68.96 (±9.30) at 1 month to 82.67 (±5.91) at 6 months. Union was achieved in all patients with mean union time of 14.35 weeks (±1.68). Complications included abductor lurch (10%), deep infection (5%), and implant failure (5%). Varus collapse occurred in only 5% of cases. Age and fracture type did not significantly affect outcomes (P > 0.05). Conclusion: TBP augmentation with PFN provides stable fixation, promotes early mobilization, and reduces complications in unstable intertrochanteric fractures. This technique is particularly beneficial for fractures with lateral wall comminution or osteoporosis.

Background: Anastomotic leak (AL) is a serious postoperative complication following bowel resection and anastomosis, significantly increasing morbidity, mortality, and healthcare costs. Identifying modifiable risk factors is crucial to improving surgical outcomes. Aim and Objective: To assess the incidence and risk factors associated with anastomotic leak in patients undergoing bowel resection and anastomosis. Materials and Methods: A prospective observational study was conducted at Narayan Medical College and Hospital, Jamuhar, Bihar, over two years. A total of 50 patients undergoing bowel resection and primary anastomosis were included. Data on demographics, clinical variables, surgical factors, and postoperative outcomes were collected and analyzed. Statistical analysis was performed using Chi-square and t-tests, with p<0.05 considered significant. Results: The overall incidence of anastomotic leak was 20%. Significant risk factors included age ≥60 years (p=0.048), diabetes mellitus (p=0.032), hypoalbuminemia <3.5 g/dL (p=0.021), emergency surgery (p=0.017), contaminated surgical field (p=0.034), and multiple anastomoses (p=0.049). Among patients with leaks, 60% required reoperation, 30% were managed conservatively, and 10% died due to sepsis. Conclusion: Anastomotic leak is influenced by multiple patient- and surgery-related factors. Identifying high-risk patients preoperatively and implementing meticulous intraoperative techniques can help reduce leak-related complications and improve surgical outcomes.

Single domain antibodies (sdAbs), also known as nanobodies, are derived from the unique heavy-chain-only antibodies found in camelids. Additionally, similar variable domains are found in shark immunoglobulins, though these are not typically referred to as nanobodies. These biomolecules have gained immense attention due to their small size (~12-15 kDa), high solubility, remarkable stability under extreme conditions, and ability to bind cryptic and challenging epitopes with high specificity and affinity. Unlike traditional full-length antibodies, sdAbs can penetrate dense tissues and access regions that are typically inaccessible, making them versatile tools for a wide range of applications. Additionally, their straightforward genetic engineering and compatibility with microbial expression systems enable cost-effective and rapid production, which is crucial for research, industrial, and therapeutic uses. This review explores the diverse applications of sdAbs, emphasizing their transformative potential in modern biotechnology, diagnostics, and therapeutics. Their contributions to advancing precision medicine are particularly noteworthy, as they can be engineered into formats such as bispecific and multispecific constructs, antibody-drug conjugates, and chimeric antigen receptor (CAR) T-cell therapies. We also discuss their role in infectious disease detection and neutralization, oncology, autoimmune disorders, and neurological diseases. Furthermore, sdAbs are increasingly integrated into non-invasive imaging platforms, such as positron emission tomography (PET) and near-infrared fluorescence imaging, to enhance diagnostic precision. Beyond medicine, sdAbs have demonstrated utility in environmental biosensing, agricultural improvement, and industrial enzyme stabilization, highlighting their broad applicability across multiple domains. Despite their versatility and numerous advantages, several challenges remain, including potential immunogenicity in human use, scalability of production, and the need for stringent regulatory frameworks for therapeutic approval. For instance, the U.S. Food and Drug Administration (FDA) has approved Caplacizumab, a nanobody-based drug for the treatment of thrombotic thrombocytopenic purpura, demonstrating both the therapeutic potential and the rigorous regulatory pathway required for clinical implementation. Addressing these challenges will be critical for unlocking the full potential of sdAbs. With ongoing advancements in molecular engineering, synthetic biology, and structural biology, sdAbs are poised to play an increasingly pivotal role in revolutionizing science, medicine, and technology. This review provides a comprehensive overview of the structural characteristics, functional diversity, current applications, and future prospects of sdAbs, highlighting their capacity to redefine the landscape of antibody-based technologies in the coming decades.

Background: Diabetic cardiomyopathy often begins with diastolic dysfunction, which can be present even in the absence of overt cardiac symptoms. Early detection of subclinical cardiac changes in type 2 diabetes mellitus (T2DM) is essential for preventing progression to heart failure. Aim: To assess the prevalence and severity of diastolic dysfunction using echocardiography in asymptomatic T2DM patients without overt cardiac involvement in a tertiary care hospital in India. Material and Methods: A descriptive cross-sectional study was conducted involving 130 asymptomatic patients with T2DM. Detailed clinical data including age, duration of diabetes, and glycemic control were recorded. All patients underwent echocardiographic evaluation including tissue Doppler imaging to assess diastolic function. Data were analyzed using SPSS v25.0 with a p-value <0.05 considered statistically significant. Results: Diastolic dysfunction was detected in 38.5% of patients. Its prevalence increased significantly with age (p < 0.001) and longer duration of diabetes (p = 0.032). Poor glycemic control was also associated with higher rates of dysfunction (p = 0.048). Echocardiographic parameters such as E/é ratio and IVRT were significantly altered in affected individuals. Gender-wise comparison showed a higher E/é ratio in females (p = 0.031). Conclusion: A considerable proportion of asymptomatic T2DM patients harbor subclinical diastolic dysfunction. Age, duration of diabetes, and poor glycemic control are significant contributors. Routine echocardiographic screening, including tissue Doppler imaging, should be considered for early detection and timely intervention.

Background: T3 thyrotoxicosis, characterized by elevated serum triiodothyronine (T3) with normal thyroxine (T4) levels and suppressed thyroid-stimulating hormone (TSH), is a distinct but under-recognized form of hyperthyroidism. Understanding its prevalence, etiology, and optimal management is crucial for improving clinical outcomes. Aim: To determine the prevalence and causes of T3 thyrotoxicosis among newly diagnosed thyrotoxic patients and to evaluate the appropriate dose of antithyroid drugs for effective management. Material and Methods: This prospective observational study included 170 newly diagnosed thyrotoxic patients at a tertiary care center. Baseline demographic and clinical data, thyroid function tests (TSH, TT3, TT4), and etiology were recorded. Patients were divided into low-dose and high-dose antithyroid drug groups and followed for 12–14 weeks, with thyroid status monitored periodically. Results: Of the 170 patients, 75.3% had Graves’ disease and 24.7% had toxic nodular goiter. The low-dose group achieved and maintained euthyroid status in most patients (60 at 4–6 weeks, 68 at 12–14 weeks), while the high-dose group showed a progressive rise in hypothyroid cases (32 at 4–6 weeks, 40 at 12–14 weeks). No hyperthyroid cases were seen at the end of the study in either group. Conclusion: T3 thyrotoxicosis has a significant prevalence among new thyrotoxic patients, with Graves’ disease as the leading cause. Lower doses of antithyroid drugs were generally effective and minimized the risk of hypothyroidism. Individualized management and regular monitoring are essential for optimal outcomes.

Background: Comminuted intertrochanteric fractures in elderly patients pose significant challenges due to poor bone quality and instability. Optimal surgical treatment aims to allow early mobilization and reduce complications. This study evaluates the functional outcomes and complications of primary hemiarthroplasty in elderly patients with comminuted intertrochanteric fractures. Methods: A prospective study was conducted on 20 elderly patients with comminuted intertrochanteric fractures treated with primary cemented hemiarthroplasty. Patients were followed for 12 months. Functional outcomes were assessed using the Harris Hip Score (HHS), and post operative complications, including infection, dislocation, and mortality, were recorded. Results: The mean age of patients was 72.5 years. The average Harris Hip Score at 12 months was 82.4 ± 7.3, indicating good functional recovery. Early mobilization was achieved in all patients, with full weight-bearing allowed by the second postoperative day. Complications were minimal, with 2 cases of superficial infection and 1 case of dislocation successfully managed. No implant failures or reoperations were reported. Conclusion: Primary hemiarthroplasty for comminuted intertrochanteric fractures in elderly patients provides excellent early functional outcomes with low complication rates. This approach facilitates early weight-bearing and reduces the risk of fixation failure associated with internal fixation techniques, making it a reliable surgical option in this challenging patient population.

Introduction: Worldwide acne is one of the most common skin conditions which can lead to low self-esteem, social embarrassment, social withdrawal and depression Self-medication for acne is common practice among medical students due to multiple reasons. Aim: The objective of our study was to identify the prevalence and assess the knowledge, attitude and pattern of self-medication for acne among undergraduate medical students Materials and Methods: This descriptive cross-sectional study was conducted at tertiary health care centre, Ahmedabad. Data were collected by using the convenient sampling technique. Students were asked to fill a semi-structured questionnaire. Students in the first year and third year medical studying in medical college were included in the study. Data were entered and analysed using Microsoft excel 2019. Results: Out of 317 students enrolled in the study, 201 (63.4%) suffered from acne and self-medication was practiced by 71 (35.3%) students. Predominant site of lesions was on the face (89.6%). The most common source of information was reported to be friends/ seniors or family members (67.6%). More than half of the students had knowledge of the dosage of drugs (54.9%) and 52.9% students aware about adverse reactions. Most of the students read the expiration date on the drug label (95.7%). Conclusion: Acne is a highly prevalent skin condition and the practice of self-medication is also high among medical students but the knowledge regarding self-medication of acne was not adequate so proper training regarding self-medication is required.

Introduction: Supraclavicular brachial plexus block is a widely used regional anesthesia technique for upper limb surgeries due to its efficacy and safety. Levobupivacaine and ropivacaine are popular local anesthetics in this context, offering prolonged sensory and motor blockade with reduced cardiotoxicity compared to bupivacaine. This study aimed to compare the clinical efficacy of 0.5% Levobupivacaine and 0.75% Ropivacaine in supraclavicular brachial plexus block using a peripheral nerve stimulator. Material and Methods: This prospective, observational comparative study was conducted over one year at a tertiary care hospital in Western Gujarat, involving 100 patients aged 18–60 years, ASA grade I or II, undergoing elective upper limb surgeries. Patients were randomly assigned to receive either 0.5% Levobupivacaine (Group L, n=50) or 0.75% Ropivacaine (Group R, n=50) in supraclavicular brachial plexus block guided by a peripheral nerve stimulator. Outcomes included onset, duration of sensory and motor block, duration of analgesia, and hemodynamic stability. Results: The study showed that Levobupivacaine had a significantly faster onset of sensory (9.42 vs. 11.58 minutes, p<0.001) and motor block (13.88 vs. 15.74 minutes, p=0.002) compared to Ropivacaine. The duration of sensory (10.24 vs. 7.72 hours, p<0.001) and motor block (9.04 vs. 7.16 hours, p<0.001) was also significantly longer with Levobupivacaine. Additionally, Levobupivacaine provided prolonged postoperative analgesia (11.82 vs. 8.58 hours, p<0.001). Conclusion: Levobupivacaine demonstrated superior block characteristics with faster onset, longer duration, and extended postoperative analgesia compared to Ropivacaine, making it a more effective option for supraclavicular brachial plexus block.

Background: Masses of the external auditory canal (EAC) pose significant diagnostic challenges due to their wide-ranging etiologies, which span from benign inflammatory lesions to malignant neoplasms. Timely and accurate diagnosis is crucial for appropriate management and optimal patient outcomes. Objective: To investigate the etiological spectrum, clinical presentation, and management approaches for EAC masses in a tertiary care clinical setting. Methods: This prospective study was conducted over a six-month period at the People’s College of Medical Sciences and Research Centre, Bhopal. It included 15 patients presenting with EAC masses, excluding those with masses primarily attributable to Chronic Suppurative Otitis Media (CSOM). All patients underwent comprehensive evaluation, including detailed history-taking, otoscopic examination, Pure Tone Audiometry (PTA), and High-Resolution Computed Tomography (HRCT). In cases with suspected malignancy, biopsy and histopathological examination were performed. Treatment strategies were individualized based on definitive diagnoses, and outcomes were assessed in terms of symptom resolution and histopathological results. Results: The mean age of patients was 18.32 years, with a female predominance (60%). The most common presenting symptoms were hearing loss (26.67%), blood-tinged otorrhea (20%), and visible mass in the EAC (20%). Clinical diagnoses included EAC polyps (40%), cholesteatoma (33.33%), and squamous cell carcinoma of the auricle (26.67%). HRCT findings revealed bony erosion in 40% and granulation tissue in the EAC and middle ear in 33.33%. Notable complications included hearing impairment (33.33%) and issues related to benign masses (26.67%). Conclusion: External auditory canal masses exhibit a broad range of etiologies, underscoring the need for thorough clinical and radiological evaluation. Although benign lesions such as polyps are frequently encountered, a significant number of cases involve aggressive or malignant pathologies. Early diagnosis and an individualized, multidisciplinary management approach are key to improving patient outcomes.

Chronomodulated drug delivery system is useful in the treatments of disease, in which drug availability is timed to match rhythms of disease, in order to optimize therapeutic effect and minimize side effects. The specific time that patients take their medication is very important as it has significant impact on success of treatment. If symptoms of a disease display circadian variation, drug release should also vary over time. Drug pharmacokinetics can also be time dependent; therefore, variations both in a disease state and in drug plasma concentration need to be taken into consideration in developing drug delivery systems intended for the treatment of disease with adequate dose at appropriate time. Various technologies such as time-controlled, pulsed, triggered and programmed drug delivery devices have been developed and extensively studied in recent years for chronopharmaceutical drug delivery.

Background: Sinonasal mucosa is highly vascular, hence poor visualization due to excessive bleeding can be dangerous. A number of techniques have been utilized to optimize surgical conditions in FESS. Aim of the study: To compare changes in heart rate (HR), mean arterial pressure (MAP), intraoperative bleeding, postoperative sedation, and postoperative pain. Methods: This was a prospective, observational study conducted in a tertiary care institute. Subjects and 60 ASA 1 and 2 patients undergoing FESS under general anesthesia were included in the study. In group D, dexmedetomidine at 0.5 mcg/kg was administered over 10 minutes followed by infusion at 0.2 – 0.8 mcg/kg/hour till 15 minutes prior to end of surgery. In group E, loading dose of esmolol 0.5 mg/kg over 10 minutes was followed by infusion of 1 – 1.5 mg/kg/hour till end of surgery. Chi-square test, Mann – Whitney u-test and Student’s t-test. Results: There was a significant decrease in mean HR at 10 min, 20 min, 40 min, 60 minutes, and 80 minutes after start of surgery in esmolol group compared to dexmedetomidine group. MAP remained comparable in both the groups. Need for vasopressors showed significant usage in group D than group E. Incidence of sedation as per Ramsay sedation scale was also higher in group D. Conclusion: Use of ESMOLOL during FESS resulted in significantly reduced heart rate with lesser incidence of intraoperative hypotension and postoperative sedation compared to dexmedetomidine.

Background And Aims: Robotic surgeries like laparoscopic surgeries require creation of capnoperitoneum. Hence, monitoring of PaCO₂ becomes more important in such surgeries. ETCO₂ is a continuous, non-invasive surrogate of PaCO₂. The aim of our study was to evaluate the correlation between ETCO₂ and PaCO₂ in patients undergoing robotic surgeries. We also evaluated the change of ETCO₂ and PaCO₂ at various time intervals compared to baseline. Method: We conducted an observational study on 60 patients undergoing robotic donor hepatectomy. ABG was taken 10 minutes after intubation (T0), 30 minutes after pneumoperitoneum (T1), 1 hour after T1(T2), 1 hour after T2 (T3) and then 2 hourly (T4, T5, etc.). The corresponding ETCO2 was also recorded. Correlation between ETCO₂ and PaCO₂ was computed using Spearman rank correlation coefficient. And p value<0.001 was considered statistically significant. Results: The mean ETCO₂-PaCO₂ gradient during T0 (baseline) was 4.47mmHg which increased to 5.58mmHg at T1 and 5.82mmHg at T2. This gradient became near baseline by T4 (4.5 hours after pneumoperitoneum). The analysis showed a positive correlation between ETCO₂ and PaCO₂ (p<0.001). The rise of PaCO₂ and ETCO₂ from baseline was maximum 30 minutes after pneumoperitoneum (10.36% and 8.23% respectively). The difference from baseline became almost negligible by 4.5 hours of pneumoperitoneum for both PaCO₂ (0.78%) and ETCO₂ (1.42%). Conclusion: Capnography monitoring in patients undergoing robotic donor hepatectomy with creation of capnoperitoneum is a good indicator of the trend of arterial carbon dioxide changes. Ventilatory parameters can be adjusted during the surgery based ETCO₂ to maintain homeostasis.

Background: Practice of yoga based relaxation techniques has been associated with various physiological changes in our body. The long term practice of these techniques has been reported to improve the pulmonary functions. However, the study on effects of short term diaphragmatic breathing on lung functions is yet lacking. Therefore, the present analytical study was conducted to find the changes in pulmonary functions after practising diaphragmatic breathing for one month among (n=40; 20 males and 20 females) 1^st year MBBS students aged between 18-20 years. Peak expiratory flow rate (PEFR) and breathe holding time (BHT) was recorded in these subjects before and after one month of practising diaphragmatic breathing. There was a significant increase in both PEFR and BHT after 1month of diaphragmatic breathing manoeuvre depicting the beneficial of diaphragmatic breathing on pulmonary functions.

Background and Objectives: Neural factors such as temperature, hormones, etc. are regulated by cardiovascular functions, in which neural factors mainly affect the autonomic-nervous system (ANS), which plays a major role in the maintenance & regulation of cardiac functions. To analyze of the effect of aerobic exercise versus yoga in young adults on parameters of heart rate variability (HRV). Methodology: This was a cross-sectional study carried out in a physiology department of a medical college over the six month span in which male & female adults with written & informed consent were involved in the study, so 70 volunteers were enrolled in the Yoga Group (Group A) & 70 volunteers in the Aerobic Exercise Group (Group B) during the six months period. Both of them have been regularly trained & adequately exercised for a span of 24 weeks by a yoga instructor & physical trainer. They noticed all the base line parameters. The study of HRV was derived from an ECG unit. The parameters were compared at baseline (by paired t-test) in both groups before & after 24 weeks in Group B & Group A by unpaired t-test & were determined with latest SPSS version software. Conclusion: From our research, it can be inferred that the Yoga group substantially raises the high frequency HRV & reduces the low frequency HRV, so that the parasympathetic activity is more determined in the Yoga group compared to the aerobic exercise group.

Background: The study was conducted in department of physiology at JNKTMCH Madhepura, Bihar. Study duration is Six Months. This was a cross-sectional study to evaluate the effect of smoking on lung function and serum lipids in asymptomatic smokers and comparable non-smokers. The mean of the various spirometric parameters were calculated of the subjects for both the groups. The mean FVC in group I and group II was 2.60 ± 0.62 L and 4.10 ± 0.64L respectively. The mean FEV₁ in group I was 1.91 ± 0.57L and 3.19 ± 0.77L in group II Group I had mean FEF 25% – 75% and PEFR of 1.98 ± 0.67L/sec and 4.50 ± 1.57L/sec respectively. Group II had mean FEF 25 – 75% of 4.22 ± 1.23L/sec and a mean PEFR of 7.22 ± 1.42L/sec. In young smokers and asymptomatic, still the spirometric values were significantly deranged as compared to controls. Even smokers with history of less pack years of smoking also had significant abnormalities of lung function. All he spirometric values in the two groups had statistically highly significant difference and were higher in non-smokers as compared to smokers. The spirometric values were reduced in smokers with history of smoking for as low as two pack years.

Introduction: Self-medication is the practice of consuming drugs without professional supervision. It is a growing global concern, particularly among medical and paramedical students. Since these students possess foundational knowledge of diseases and pharmacology, this can lead to an overreliance on self-treatment. However, this knowledge does not always translate into safe practices or appropriate attitudes. In regions with limited healthcare infrastructure, such as the eastern area of Gujarat, self-medication may become a common alternative due to factors like accessibility, affordability, and cultural practices. Understanding the interplay between knowledge, attitude, and practice (KAP) of self-medication among these students is critical for developing targeted interventions that promote rational drug use and prevent potential health risks. Aim: This study aims to assess the knowledge, attitude, and practice of self-medication among medical and paramedical students in the eastern region of Gujarat, thereby identifying gaps and informing strategies for educational and policy-level reforms. Materials and Methods: A cross-sectional study was conducted using a pre-designed, semi-structured, pre-tested questionnaire-based KAP study among undergraduate medical and paramedical students of Zydus Medical College and Hospital, Dahod, and Government Physiotherapy College, Dahod. Data were collected from 439 students, with the study excluding those who were unwilling to participate. Result: Out of 439 participants, most (87.2%) knew about self-medication, and 2^nd, 3rd, and final-year medical students knew more because of their clinical experience. Self-medication was more common among female students, which is consistent with prior research findings. Just 36.2% of respondents thought self-medication was safe, even though 64.2% were aware of over-the-counter medications and 73.8% were aware of potential negative effects. Self-medication was mostly motivated by an urgent medical necessity, and the internet served as the primary information source. The most often used medications were analgesics, and common conditions addressed included headaches, colds, and coughs. 28.7% had side effects even though 95.4% verified the drug’s expiration dates. Only 56.3% of patients finished their term of medicine, and 13.4% of respondents said self-medication had no negative effects, despite 50.3% citing pharmacological side effects as a drawback. Conclusion: The study reveals that self-medication is common among medical and paramedical students in Gujarat’s eastern area, despite their awareness of its risks and over-the-counter drug use. Many still rely on the internet or old prescriptions for self-treatment. This highlights the need for targeted educational programs, curriculum integration, and public health campaigns to promote responsible self-medication. Stronger regulations and awareness efforts by medical authorities are essential to ensure safe and ethical drug use.The study emphasizes the need for regulatory guidance to promote safe self-medication practices.

Purpose: A typical issue that causes hand incapacitation disproportionate to the condition is trigger finger. The idea behind the straightforward full release of the A1 pulley for triggering is that it has very little use and that any sacrifice will have insignificant negative effects. The function of the A1 pulley is objectively evaluated in this anatomical investigation, along with the biomechanical drawbacks of its sacrifice. Methods: To evaluate the function of the A1 flexor pulley in digit function, an anatomic research was performed on both fresh cadavers and upper limbs that had been amputated. Each digit’s tendon excursion and force necessary to achieve full finger flexion were measured while all pulleys were in place. Following conventional total A1 pulley release and partial “functional” pulley release using the “N enlargement” plasty procedure, these parameters were reevaluated. Following the completion of the conventional or “N” plasty procedures, a statistical examination of the biomechanics of an intact A1 pulley would provide insights into changes in flexor tendon gliding, pressure distribution, and potential alterations in finger function and grip strength. Results: Twenty-five digits from five upper limbs were examined one after the other. When compared to intact pulleys or partial ‘N’plasty release, the increased force and tendon excursion needed following A1 pulley release is statistically significant. Conclusion: Compared to when the pulley is intact or partly expanded, complete finger flexion following conventional release of the A1 pulley necessitates statistically significant greater force and tendon excursion. Clinical Relevance: Because of its important significance in hand biomechanics, the A1 pulley should be kept intact wherever possible. An easy and efficient method for enlarging the A1 pulley while maintaining substantial function is “N” plasty.

Background: The specificity of conventional magnetic resonance imaging is lower than its high sensitivity. Diffusion-weighted imaging, based on alterations in the microscopic motion of water molecules, promises improved specificity for breast MR imaging. The purpose of our study was to evaluate the role of DW-MRI in the diagnosis of benign and malignant breast lesions, which would help the surgeon to decide further management and outcome. Aim: To study the role of Diffusion Weighted MR Imaging of breast in differentiating benign from malignant lesions. Objective: To determine usefulness of DWI combined with ADC values in distinguishing breast lesions into benign and malignant lesions. Methods: The study included 42 female patients referred from general surgery department with palpable breast lump or a suspected breast lesion detected on Mammography / sonography or diagnosed cases of carcinoma breast with suspected recurrence.The patients underwent history taking, clinical examination, MRI evaluation using a 3 Tesla MRI machine and histopathological examination. Result: Quantitative analysis of DWI was done and their ADC values were recorded. 26 cases showed facilitated diffusion, proved to be benign. 16 cases showed restricted diffusion, 14 cases of them proved to be malignant and 2 proved to be benign on histopathological examination. Mean ADC values were significantly lower in malignant (0.895±0.041) as compared to that in benign cases (1.428±0.238). Conclusion: DWI and ADC were highly sensitive as well as specific in differentiating malignant from benign breast lesions. Both had identical diagnostic performance. They could be used together in order to obtain highly specific and accurate outcomes.

Background: COVID-19 severity is often linked to elevated Interleukin-6 (IL-6) levels, contributing to a cytokine storm. This study explores the relationship between vitamin D, vitamin B12, serum ferritin, and interleukin-6 (IL-6) in COVID-19 patients, aiming to understand their role in preventing autoimmune complications. Methods: A cross-sectional and observational research study was conducted with 100 patients suffering from COVID-19 and admitted to inpatient department at Medical College and Hospital, Kolkata. Vitamin D, B12, IL-6, and serum ferritin levels were measured using immunoassays. Correlation and multivariate regression analyses were conducted using GraphPad Prism 9.5.0 to assess the relationships between these parameters. Results: A total of 100 patients (65 male and 35 female) participated in this study. The mean age of the participants was 49.4±11.79 years. Only Ferritin versus Vitamin B12 showed statistically significant P value (P = 0.003) in correlation. When the IL-6 was taken as dependent variable and ferritin, vitamin D, and B12 as predictors, the liner model was not successful to detect the IL-6 level from the predictors (R = 0.209, P = 0.23). Conclusion: The inability to predict IL-6 levels using ferritin, vitamin D, and vitamin B12 points to the complex regulation of inflammatory markers and indicates individual contribution of the factors in COVID-19. Further research with a larger sample size and more comprehensive data on patient health status is needed to better understand the relationships between these biomarkers and their role in inflammation.

Chemical injuries to the eye represent a true ophthalmic emergency, often resulting in significant morbidity if not managed promptly and appropriately. This case series presents three patients who sustained ocular chemical injuries from various agents, including alkalis and acids, due to occupational and accidental exposures. The patients exhibited a range of clinical manifestations from mild conjunctival injection to severe corneal opacification and limbal ischemia. All cases were managed with immediate copious irrigation, followed by tailored medical therapy including topical corticosteroids, antibiotics, cycloplegics, and lubricants. With early intervention and appropriate treatment, significant improvement in visual acuity was noted in the cases. This case series underscores the need for rapid recognition, aggressive early management, and long-term follow-up in chemical eye injuries. Public education and workplace safety measures are essential to prevent such devastating ocular trauma.

Background: The use of flow cytometry in the clinical laboratory has grown substantially in the past decade. This is attributable in part to the development of smaller, user friendly instruments and a continuous increase in the number of clinical applications. Flow cytometric immunophenotyping has been used to identify neoplastic plasma cell in patient with multiple myeloma. Methods: Cross sectional study of two years, a total of 100 patients with suspected plasma cell neoplasms were enrolled. The specimen obtained will be Immuno phenotyped using an antibody panel which will include CD38, CD138, CD45, CD19, CD56, CD20, kappa, lambda. Results: In our study CD 19, CD20, CD45, CD38, CD138, CD56 was used along with anti-kappa, anti-lambda. The expression was 11%, 87%, 14%, 100%, 100%, 82% respectively for the above mentioned markers with expression of kappa chains seen in 67% and lambda in 33%. Conclusion: Flow cytometry is an efficient method to establish clonality for neoplastic plasma cells .It has become need of the hour to use it as a diagnostic tool. Also it is a quick procedure that is highly sensitive and reliable for further management in patient care.

Background: Gallstone disease is one of the most common problems affecting the digestive tract with a prevalence of 11% to 36% and is the most common cause of gall stone pancreatitis. The cholecystectomy is necessary to prevent recurrent pancreatitis in gallstone pancreatitis, but the ideal timing for cholecystectomy is controversial. Methods: This was a prospective randomized study with 60 patients conducted in the Department of general surgery, MVAS medical college, Basti from 2019 to 2024. All patient with mild gallstone pancreatitis, the following variables, duration, readmission rates, intraoperative time, intra and postoperative complications were studied. Results: A total of 60 patients in the age group of 18 to 65 years with mild gallstone pancreatitis were included in the study. Mean age of presentation was 57years. Out of 60 patients 25 underwent same admission cholecystectomy and 35 underwent interval cholecystectomy. There was a significant difference noted in terms of mean duration of hospital stay (9.28 versus 17.20 days), and readmission rate (0% versus 19.35%), but in terms of mean intraoperative time (35 min versus 42 min) there was no statistically significant difference between two group. Conclusions: Same admission cholecystectomy for mild gallstone pancreatitis can significantly reduce duration of hospital stay and readmission rates. With regard to intraoperative time, intraoperative and postoperative complication there is no statistically significant difference seen. Hence same admission cholecystectomy is safe, feasible and recommended.

Background: The prevalence of admission hyperglycemia among acute myocardial infarction patients affects their clinical results differently based on whether they have diabetes mellitus or not. Methods: In a single-center retrospective cohort (July 2012 – June 2022) we analyzed 3 330 consecutive first-time AMI patients. Plasma glucose in the first 2 h of admission was categorized as normoglycemia (<140 mg dL⁻¹), mild hyperglycemia (140–179 mg dL⁻¹) or marked hyperglycemia (≥180 mg dL⁻¹). Primary end-points were all-cause death at 30 days (short-term) and at 3 years (long-term). Multivariable Cox models and interaction terms assessed effect modification by DM status.Results: AH occurred in 43 % of the cohort (26 % mild, 17 % marked). Crude 30-day mortality rose step-wise from 4.3 % in normoglycemic to 7.8 % and 13.1 % in mild and marked hyperglycemia, respectively (p < 0.001). After adjustment, AH remained independently associated with 30-day death in non-DM patients (HR 1.35 [95 % CI 1.10–1.65] for 140–179 mg dL⁻¹; HR 1.82 [1.41–2.35] for ≥180 mg dL⁻¹) but not in DM (p-interaction = 0.02). Three-year survival mirrored these findings (Figure 1). Marked AH conferred a 1.47-fold higher adjusted hazard for long-term death in DM and a 1.82-fold increase in non-DM. Conclusion: Admission glucose ≥180 mg dL⁻¹ predicts excess early and late mortality after AMI, with a stronger relative impact in patients without diabetes. Stratification by DM status should guide risk-assessment and early glucose-targeted interventions.

Background: Maternal hypotension after spinal anaesthesia is a frequent complication during lower segment caesarean section (LSCS), which may adversely affect both maternal and neonatal outcomes. Vasopressors like ephedrine and mephentermine are commonly utilized for management; however, their comparative efficacy and side effect profiles are still subjects of debate. Aim: to evaluate the efficacy and side effects of intravenous bolus administration of ephedrine versus mephentermine in the management of spinal-induced hypotension in parturients undergoing cesarean delivery. Materials and Methods:  A prospective randomized study was performed involving 100 parturients undergoing LSCS under spinal anaesthesia. Participants were equally divided into Group A, receiving an ephedrine 6 mg IV bolus, and Group B, receiving a mephentermine 6 mg IV bolus, administered when systolic blood pressure decreased by ≥20% from baseline. Patients underwent monitoring for blood pressure response, total vasopressor requirements, heart rate variations, adverse effects, and neonatal APGAR scores. Results: Both groups successfully restored blood pressure; however, Group B necessitated a significantly higher number of boluses (1.80 ± 0.75) in comparison to Group A (1.20 ± 0.50; p <0.05). Tachycardia occurred significantly more in Group B (24% vs 6%; p <0.001), as did nausea/vomiting (32% vs 24%; p <0.001). No notable differences were found in bradycardia, hypertension, or neonatal APGAR scores. Conclusion:  Both ephedrine and mephentermine are effective in managing spinal hypotension. However, ephedrine necessitates fewer boluses and is associated with fewer adverse effects, rendering it a more favorable choice for maintaining hemodynamic stability and enhancing maternal tolerance during caesarean sections performed under spinal anaesthesia.

Background: Effective pain control is crucial for patients with proximal femur fractures to enable optimal positioning for spinal anesthesia. Ultrasound-guided fascia iliaca block (FIB) and femoral nerve block (FNB) are both widely used, but their comparative efficacy remains an area of ongoing study. Aim: To compare the overall efficacy of ultrasound-guided fascia iliaca block and femoral nerve block in patients with proximal femur fractures before positioning for spinal anesthesia. Material and Methods: This prospective observational study included 80 patients with proximal femur fractures, divided into two groups: Group FIB (n = 40) received a fascia iliaca block with 30 mL of 0.25% bupivacaine, and Group FNB (n = 40) received a femoral nerve block with the same dose. Primary outcomes included pain intensity during positioning, first analgesia request time, and hemodynamic parameters. Secondary outcomes were block success rate and patient satisfaction. Results: The FIB group showed superior analgesic duration, with a mean first analgesia request time of 7.5 hours compared to 5.5 hours in the FNB group. Both groups demonstrated stable intraoperative and postoperative heart rate and mean arterial pressure. The FIB group also had better ease of positioning and patient satisfaction scores, with no significant block-related complications in either group. Conclusion: Ultrasound-guided fascia iliaca block offers superior and longer-lasting analgesia compared to femoral nerve block for patients with proximal femur fractures, facilitating easier positioning for spinal anesthesia. Both techniques are safe and effective, but FIB may be preferred for prolonged pain relief.

Background and Aim: Acute renal failure (ARF) is a frequent clinical condition in neonatal intensive care units (NICU). The leading cause of neonatal ARF is perinatal asphyxia. ARF carries poor immediate prognosis and may result in permanent renal damage in upto 40% of survivors. Early recognition of acute renal failure is particularly important in asphyxiated neonates with HIE, in whom a stable biochemical mileu is vital, because it facilitates the administration of appropriate fluid and electrolyte replacement. This study was done to determine the incidence of renal failure and its correlation with severity of asphyxia. Material and Methods: Forty-Five term neonates born with Apgar score of < 7 at 5 minutes after the birth are selected as cases and 45 term normal neonates as controls. All asphyxiated neonates (as per WHO definition) with clinical features of HIE are staged by Sarnat and Sarnat staging. The relevant blood and urine investigations done at 24, 48 and 72 hours of life and urine output was monitored. The babies were managed according to standard protocol. The renal indices were calculated were calculated after 48 and 72 hours. Results: The incidence of renal failure was significantly higher among cases (66.67%, 30 of 45 cases) while one neonate of the controls had renal failure. All cases had non-oliguric (100%) renal failure.11 (24.44%) cases had intrinsic renal failure. The renal parameters were higher among cases and correlated with the severity of asphyxia. Hyponatremia was seen in cases and its severity correlated with asphyxia severity. The serum calcium level was lower among cases and severity of hypocalcemia correlated with severity of asphyxia. FeNa was higher among cases and 11 cases had value more than 3. RFI was higher among cases and 12 cases had value more than 4. Conclusion: Perinatal asphyxia is an important cause of renal failure in the neonatal period. ARF in birth asphyxia is predominantly Pre renal failure and depends on the severity of asphyxia. Renal failure in birth asphyxia is predominantly non-oliguric, monitoring of urine output for renal failure alone does not help to identify renal failure. The renal parameters should be monitored and if possible the renal indices should be calculated to identify pre-renal and intrinsic renal failure as the treatment differs in both entities.

Background: The measurement of blood pressure (BP) is an important component of routine pediatric physical examination, because seeds of hypertension and other non- communicable diseases are sown when the baby is in utero. BP profile in children varies with age, sex, weight, height, body mass index (BMI), family history of hypertension, social economic status, and dietary habits. Aim and Objective: To determine the normal blood pressure (BP) distribution in apparently healthy high school adolescents in the age group of 13–18 years. To determine the correlation of BP values with different sex, weight, height, and body mass index (BMI). To determine the prevalence of hypertension in high school going adolescents. Materials and Methods: This was a prospective, observational study over a period of 18 months with effect from 1st of April 2021 to 30 September 2022.There were 1020 healthy high school going children (364 boys and 656 girls) in the age group of 13–18 years in this study. Results: The mean SBP of both the sexes at 13 to 18 years was 114 mm of Hg and the mean DBP of both sexes at 13 years to 18 years was 75 mm of Hg. The correlation of mean SBP with sex was insignificant and the mean DBP of both sex was significant. Correlation of SBP and DBP with respect to weight and height was insignificant and correlation of SBP and DBP with respect to BMI was significant. The prevalence of hypertension was 7.2%.

Background: Polycystic ovarian syndrome (PCOS) is one of the common endocrine disorders for women during the reproductive age. It is a heterogeneous collection of signs and symptoms that form a spectrum of disorders like clinical and biochemical affects viz., excess androgen, ovulatory dysfunction and polycystic ovaries. Objectives: We aimed to study association of serum ferritin and procalcitonin level in the polycystic ovarian syndrome. Methods: A case – control study included 65 women with PCOS and 60 healthy women. Serum ferritin and procalcitonin (PCT) were measured using chemiluminescent Immunoassay (CLIA). Results: Women with PCOS had significantly higher ferritin and procalcitonin level as compare to women without PCOS. Conclusions: Our results concluded that the women with PCOS higher ferritin and Procalcitonin level than those without PCOS. A positively association was found between serum Ferritin and Procalcitonin levels in PCOS women. Thus, PCT and serum Ferritin is a novel biomarker for low – grade chronic Inflammation in PCOS patients.

Introduction: Squamous cell carcinoma (SCC) is a prevalent malignant epithelial neoplasm arising from stratified squamous epithelium across diverse anatomical sites, including the cervix, oral cavity, larynx, esophagus, and lung. In India, SCC imposes a significant health burden due to late presentation and limited access to care. Variability in site-specific morphology, histological differentiation, and demographic patterns underscores the need for comprehensive, region-specific analysis. The objective of the study is to evaluate the demographic, clinical, cytological, and histopathological characteristics of SCC across various anatomical sites and to assess cytology-histology correlation in a tertiary care setting. Materials and Methods: This retrospective observational study analyzed 440 histopathologically confirmed SCC cases from January to December 2023. Data on age, gender, clinical presentation, anatomical site, and histological grade were collected. Cytopathological-histological correlations were performed where applicable. Descriptive statistics were used to analyze demographic and clinical trends. Results: The cervix (44.32%) and oral cavity (40%) were the most affected sites. Most patients were ≥40 years (81.82%) and female (55.68%). Histologically, 52.73% were moderately differentiated, followed by well-differentiated (28.86%) and poorly differentiated SCC (18.41%). Cytological and histopathological diagnoses were concordant in all evaluated cases (n=37), highlighting cytopathology’s diagnostic reliability. Clinical presentation varied by site, with irregular bleeding (cervix), non-healing ulcers (oral cavity), and hoarseness (larynx) being common. Conclusion: This study provides an extensive overview of SCC’s site-wise morphological and demographic patterns, emphasizing the importance of early detection and accurate histopathological grading. Cytopathology remains a reliable preliminary diagnostic tool, particularly when correlated with histology.

Introduction: Cancer incidence increases with advancing age, and elderly patients often present with unique tumor profiles and comorbidities that affect diagnosis and treatment. Despite the rising geriatric population, elderly cancer patients remain underrepresented in clinical research. This study aims to evaluate the histopathological spectrum and demographic distribution of cancers in individuals aged 60 years and above. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology at a tertiary care center over a 12-month period (January–December 2024). All histopathologically confirmed cancer cases in patients aged over 60 years were included. Relevant clinical and demographic data were retrieved from hospital records. Tumors were classified based on site, histological subtype, and grade using standard diagnostic criteria. Descriptive statistics were used for analysis. Results: Out of 985 total cancer cases, 270 (27.41%) were in patients aged >60 years, with a mean age of 69.33 years. The most common comorbidities were hypertension (60%) and diabetes (30%). Cervical (26.3%), oral cavity (19.6%), and breast (13.3%) cancers were most prevalent. Squamous cell carcinoma was the most frequent histological subtype (particularly in cervix and oral cavity), followed by adenocarcinoma. Males had a higher smoking history and greater incidence of lung and colorectal cancers. Conclusion: Geriatric cancers exhibit distinct clinicopathological patterns, notably the predominance of squamous cell carcinoma and gender-specific distributions. These insights underline the importance of age-specific diagnostic and treatment strategies in oncologic care.

Background: According to the Biomedical Waste (Management and Handling) Rules, every health facility is expected to ensure proper practice of collection, handling, and disposal of hospital wastes. Improper management is directly linked to the increased occurrence of adverse health outcomes, including sepsis. A study was conducted to assess the biomedical waste management in various government hospitals (GH) and primary health centres (PHC) of Kri*** district. Materials & Methods: About 65 study areas, which included labour wards, operation theatres, labs, collection & transport units, and storage rooms, were assessed using a checklist. The data were entered in MS Excel, exported to SPSS version 16, and statistical analysis was done. Results: At the level of segregation, all the 6 (100%) GHs and 6 (85.7%) PHCs had the sufficient number of color-coded bins. Wastes were segregated properly among 2 (33.3%) GHs and 1 (1 (14.3%) PHC. Regarding personal protective equipment, the usage was 100% in all facilities. Trolleys were available in 3 (50%) GHs and 1 (14.3%) PHC. At the level of storage and outsourcing, storage rooms were available in 4 (66.7%) GHs and 2 (28.6%) PHCs. Wastes were weighed and collected by the outsourcing agency in all 6 (100%) GHs and 4 (57%) PHCs. Conclusion: There is still a need for appropriate and periodic training of health care providers, strict implementation of biomedical waste management rules, and continuous monitoring of waste management in health care centres.

Introduction: To achieve and maintain mental health, persons with Psychiatric illness should be adherent to their medication for the recommended period. The present study is planned to know the medication adherence patterns in different Psychiatric disorders and to look into the factors associated with medication adherence. Methodology: The study was conducted in the Department of Psychiatry at Government Hospital for Mental Care (GHMC), Andhra Medical College, Visakhapatnam. It is a prospective observational follow-up study over a period of 1 year from November 2015 to November 2016.125 patients between Age group 15 – 65 years, diagnosed as having psychiatric illness, fulfilling ICD-10 diagnostic criteria, who have given written informed consent were included in the study. Patients with intellectual disability, dementia, severe co-morbid medical conditions and patients admitted under section other than 86 of MHCA 2017 were excluded. Patients were interviewed at index visit and were followed-up at 1,3,6 and 12 months. At the time of each follow-up, factors associated with adherence were recorded on semi-structured questionnaire and Medication Adherence Rating Scale (MARS) was applied. Results: Among 125 patients, 109(87.20%) were attended to Out-patient clinic and 16(12.80%) were attended to Emergency Care. Significant association was found between type of registration (outpatient vs emergency) and treatment follow-ups at 1 yr follow-up time period (p-value < 0.05). Socio-economic factors were not found to have significant association, except persons coming from tribal domiciles, the adherence were significant (<0.05). Among the patients who were diagnosed with Psychotic disorders, follow-up rate declined from 70.40% at 1 month review to 25.90% at 1 yr review. Among Manic disorder, follow-up rate declined from 88.90% at 1 month review to 33.30% at 1-year review. Among Depressive disorders, follow-up rate declined from 91.70% at the 1 month review to 16.0% at 1-year review. Among Substance abuse disorder, follow-up rate dropped from 43.20% at the 1 month review to 15.90% at 1 yr review. Patient related factors like an improvement in symptoms played a major role (60%) when compared with treatment factors (8.0%) and social factors (17.60%) effecting adherence at 1st review (1 month). During 1 year review, all factors played an almost equal role in maintaining adherence, patient related factors – 14.40%, treatment related factors – 13.60%, social factors – 12.80%. Discussion: Adherence to medication tends to decline over time and reasons are multifactorial. Non-adherence in the past is a predictor for future non-adherence hence all patients with past history of non-adherence need  to be specially intervened to improve adherence.

Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi, is endemic in many parts of India but remains underdiagnosed due to non-specific symptoms and lack of awareness. We report a case of a 22-year-old male from Ghaziabad, Uttar Pradesh, who presented with acute febrile illness and subsequently developed acute respiratory distress syndrome (ARDS). Early suspicion, serological confirmation, and timely intervention including non-invasive ventilation led to a favorable outcome. This case emphasizes the importance of recognizing scrub typhus as a differential diagnosis of febrile illness in non-endemic areas and highlights the potential for severe complications.

Introduction: The value of prophylactic laparoscopic cholecystectomy for asymptomatic gallstones remains a point of debate, particularly in high-risk populations like patients with chronic haemolytic conditions. Sickle cell disease (SCD) is frequently associated with gallstone formation, and subsequent complications can significantly increase patient morbidity. This study aimed to evaluate the effectiveness of prophylactic cholecystectomy in SCD patients presenting with asymptomatic gallbladder stones. Methods: We retrospectively analysed 50 SCD patients who underwent laparoscopic cholecystectomy at VIMSAR Burla between January 2021 and June 2024. Twenty-six patients with asymptomatic cholelithiasis were prospectively enrolled and underwent prophylactic cholecystectomy with intraoperative cholangiography. A comparison group of 24 patients who underwent cholecystectomy for symptomatic cholelithiasis was studied retrospectively. All patients received standardized perioperative care, including intravenous hydration, prophylactic antibiotics, oxygen therapy, intravenous analgesics, and subcutaneous low-molecular-weight heparin. We compared postoperative mortality, morbidity, and length of hospital stay between the two groups. Results: No postoperative deaths or bile duct injuries occurred in either group. The asymptomatic group experienced 3 postoperative complications (11.53%), while the symptomatic group experienced 7 (29.16%). Discussion: Considering SCD related complications, acute chest syndrome occurred in 1 patient (3.8%) in the asymptomatic cholelithiasis group and in 2 patients (8.33%) in the symptomatic group. Vaso-occlusive crisis was observed in 1 patient (3.8%) with asymptomatic cholelithiasis and in 2 patients (8.33%) in the symptomatic group. The mean hospital stay was 5.8 days for the prophylactic cholecystectomy group compared to 7.96 days for the symptomatic group. Conclusions: Laparoscopic prophylactic cholecystectomy in asymptomatic SCD patients was associated with a lower incidence of postoperative SCD-related complications. When combined with appropriate perioperative management, this intervention appears safe and may prevent emergency operations for acute complications such as cholecystitis, choledocholithiasis, and cholangitis. Prophylactic cholecystectomy in SCD patients also reduces the duration of hospital stays.

Introduction: Gallbladder carcinoma (GBC) is a highly aggressive malignancy often diagnosed incidentally after cholecystectomy for benign conditions. Its early detection, even when incidental, offers a potentially curative window. Aim: To evaluate six cases of incidental gallbladder carcinoma (IGBC) detected post laparoscopic cholecystectomy and analyze their clinical, operative, and histopathological profiles. Materials and Methods: A retrospective review was conducted on 1,500 laparoscopic cholecystectomy cases performed at Al Falah School of Medical Sciences between January 2023 and December 2024. Six cases were diagnosed with IGBC based on final histopathology. Results: Out of 1,500 cases, six (0.4%) were diagnosed as IGBC. Most patients presented with symptomatic cholelithiasis. Intraoperatively, dense adhesions and thickened gallbladder walls were common findings. Histologically, adenocarcinoma NOS was most frequent, with a predominance of grade 1 tumors. Conclusion: Routine histopathological evaluation of cholecystectomy specimens is essential for early detection of IGBC, especially in endemic regions like North India.

Background: As patients with liver disease continues to rise across the globe, so are the elderly patients. So this study was taken up to understand the changing pattern of demography, etiology and presentation of Chronic Liver Disease among newly diagnosed elderly patients across 2 years , one in 2012 and another in 2024. Materials and Methods: 120 patients above 60 years of age with newly diagnosed cirrhosis who visited the Dept. of Medicine and Geriatric Medicine were included in the study and were evaluated with a detailed history, clinical examination and necessary investigations. Results: The majority of the newly diagnosed chronic liver disease patients were between 60-65 years in both 2012 and 2024, however in 2024, the percentage of females increased from 18.3% to 30%. The percentage of patients diagnosed with NASH related cirrhosis increased in 2024, although Alcohol remained the major cause in both the years accounting for 53.3% and 46.7% cases in 2012 and 2024 respectively. The most common presenting symptom was fatigue and the most common complication encountered was ascites. Most of the patients had Child Pugh C cirrhosis at presentation and in both the year groups the most common cause of death was worsening hepatic encephalopathy. Conclusion: This study showed that compared to 2012, more female patients were diagnosed with cirrhosis, with increasing number of patients diagnosed from rural areas. Over the years, along with alcohol, Non-Alcoholic Steato-Hepatitis (NASH) related cirrhosis are also an important etiological factor in the causation of cirrhosis.

Background: Low-flow anesthesia (LFA), defined as fresh gas flow (FGF) <2 L/min, is increasingly advocated to minimize anesthetic agent wastage, reduce costs, and decrease environmental pollution in operating rooms. Among volatile anesthetics, sevoflurane and desflurane are widely used, but their comparative consumption and cost under LFA, especially in prolonged surgeries, remain areas of active investigation. Objectives: To compare the consumption and cost of sevoflurane versus desflurane during low-flow anesthesia for elective surgeries lasting 2–4 hours under general anesthesia at Shree Krishna Hospital, Karamsad. Methods: This observational study included 60 adult patients (ASA I–III, age 18–65 years) scheduled for elective surgeries of 2–4 hours duration. Patients were randomized into two groups (n=30 each): Group 1 received sevoflurane; Group 2 received desflurane. Anesthesia was administered using a Draeger Fabius Plus workstation with a circle absorber system. Consumption of volatile agents was calculated using a standardized formula based on mean FGF, agent concentration, and duration. Costs were derived from the amount consumed and local pricing. Statistical analysis was performed using t-tests; p<0.005 was considered significant. Results: Mean agent consumption was significantly lower for sevoflurane (20.56 ± 5.45 ml) compared to desflurane (60.78 ± 9.38 ml). Correspondingly, the mean cost for sevoflurane was Rs.538.96 ± 143.15, while for desflurane it was Rs.2165.79 ± 351.62 (p<0.005). For surgeries <150 minutes, sevoflurane consumption (18.41 ± 6.02 ml) was less than desflurane (52.27 ± 3.42) and the cost of sevoflurane (Rs.482.27 ± 157.70) was significantly lower than desflurane (Rs.1847.11 ± 145.56) p<0.005*. The higher minimum alveolar concentration (MAC) of desflurane necessitated greater usage, contributing to increased costs. Conclusions: Sevoflurane is both less consumed and less costly than desflurane for comparable durations under low-flow anesthesia. LFA significantly reduces volatile agent use and associated costs. Given its higher environmental impact and expense, desflurane should be reserved for cases where its clinical benefits outweigh these disadvantages.

Background: Caudal analgesia is a commonly employed technique in pediatric anesthesia for postoperative pain relief. The addition of adjuvants like clonidine and morphine to local anesthetics can enhance analgesic efficacy and duration. Objective: This study aimed to compare the effectiveness of caudal ropivacaine with clonidine versus ropivacaine with morphine for postoperative analgesia in children undergoing major abdominal surgeries. Methods: A randomized, prospective study was conducted on 40 children aged 6 months to 6 years scheduled for elective major lower abdominal surgeries. Participants were randomized into two groups: Group RC received 0.2% ropivacaine (2 mg/kg) with clonidine (2 µg/kg) and Group RM received 0.2% ropivacaine (2 mg/kg) with morphine (50 µg/kg). Total drug volume was 1 ml/kg in both groups. Postoperative pain was assessed using the FLACC scale, sedation was evaluated using a sedation score, and adverse events were monitored. The primary outcome was the duration of analgesia. Hemodynamic parameters and sedation levels were also analyzed. Results: Group RM exhibited significantly longer postoperative analgesia (19.05 ± 1.19 hours) compared to Group RC (12.25 ± 1.28 hours; p < 0.001). Sedation scores were higher in Group RC during the initial 8 postoperative hours. No significant hemodynamic instability was observed in either group. Adverse events such as vomiting and pruritus were more common in Group RM, but not statistically significant. Conclusion: The combination of ropivacaine with morphine provides superior and prolonged postoperative analgesia compared to clonidine when used caudally in pediatric abdominal surgeries, with acceptable safety and tolerability.

Atherosclerosis, a disease of large and medium-sized muscular arteries, is characterized by endothelial dysfunction, vascular inflammation, and the build up of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall. IHD is the leading cause of death worldwide. The disease is the most common reason for death of men and women over 20 years of age. Our study endeavours to study the role of emerging biomarkers IL-2, IL-6 and TNF-α  in our population, where prevalence of IHD is increasing day by day, would be helpful in diagnosing it at an early stage, thereby helping in implementing preventive measures. Aims and Objectives: To study the inflammatory biomarkers – Interleukin-2, Interleukin-6, TNF- alpha among the cases of stable Ischemic Heart Disease and the comparable controls. Materials and Methods: The study was carried out jointly in the Departments of Biochemistry and the Department of Faculty of Medicine and Health Sciences for a period of three year in Pacific Institute of Medical Sciences, Umarda, Udaipur/ World College of Medical Sciences Research and Hospital, Gurwar, Jhajjar.100 subjects were enrolled into the study in which 50 are cases and 50 are age and gender matched healthy controls. After an overnight fasting, venous blood samples were collected under sterile conditions and processed immediately for the routine biochemical investigation (lipid profile). For special investigations, the plasma samples were stored at -20ºC till subsequent analysis. All the subjects underwent the same protocol. Results: Majority (38%) of the patients were in the age group of 45-55 yrs with the mean age 54.36 ± 11.45 years and males formed the major group (64%). The controls were age and sex matched. The pattern of lipid profile observed was significantly higher TG (140.60 ± 44.62 mg/dl vs 119.62 ± 26.64 mg/dl) and lower HDL (27.88±6.43mg/dl vs 42.08 ± 4.15mg/dl) in study group compared to controls. Plasma IL-6 levels were significantly higher in study (7.76±6.03 pg/ml vs 2.29±0.85 pg/ml) as compared to controls, TNF-alpha levels were also higher in study group (122.23±46.83 pg/ml vs 105.74±30.29 pg/ml) than controls. The mean plasma IL-2 levels were not significantly different between the study group vs controls (23±6.45 pg/ml vs 22.98±4.6 pg/ml). Conclusion: However, before inflammatory markers can be recommended as a primary end point to guide the use of appropriate therapeutic strategies to reduce cardiovascular risk, it is important to have appropriate diagnostic tools which are accurate, reproducible, inexpensive and with high sensitivity and specificity.

Introduction: Coronary artery disease (CAD) and its end result, myocardial infarction (MI) continue to be a significant cause of mortality and morbidity across the world. Over the past 50 years, it has become clear that the cascade of thrombotic events following atherosclerotic plaque rupture causes occlusion of the coronary artery, interrupting blood supply and oxygen to myocardium thus resulting in infarction. Cardiac biomarkers play an important role in the diagnosis of heart disease. Cardiac troponins have been the preferred ideal marker which can predict the onset of the disease. In addition to troponins, Ischemia Modified Albumin (IMA) has emerged as a novel biomarker that provides significant value in diagnosing ischemia at an early stage. Understanding the interplay between these biomarkers and their clinical applications in IHD will provide crucial insights into how we can more effectively prevent, diagnose, and treat this debilitating disease. Material and Methods: This case-control study, conducted in collaboration with Sai Tirupati University, Udaipur, and the World College of Medical Sciences, Jhajjar, included 180 patients and 180 healthy controls. Ethical approval was granted and informed consent was obtained. After a 12-14 hour fast, blood samples were collected for Troponin I, Troponin T and IMA analysis, using commercially available kits. Results: The results of this study showed significantly elevated levels of Troponin I, Troponin T, and IMA  in patients with Ischemic Heart Disease when compared to controls. Conclusion: As ischemic heart disease remains a leading cause of morbidity and mortality globally, future research focusing on the longitudinal evaluation of these biomarkers could provide critical insights into their role in improving patient outcomes and guiding therapeutic strategies.

Background: Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide. Recent evidence suggests that oxidative stress plays a critical role in neuronal injury post-stroke, with serum ferritin serving as a potential marker for inflammation and iron-mediated oxidative damage. Elevated ferritin levels may correlate with stroke severity and poorer outcomes. This prospective study aimed to investigate the association between serum ferritin levels and the severity and short-term prognosis of AIS. Materials and Methods: A total of 100 patients diagnosed with AIS within 24 hours of symptom onset were enrolled in this prospective observational study. Serum ferritin levels were measured on admission using chemiluminescent immunoassay. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) on admission, while the functional outcome was evaluated at 30 days using the modified Rankin Scale (mRS). Patients were stratified into three groups based on serum ferritin levels: Group A (<100 ng/mL), Group B (100–200 ng/mL), and Group C (>200 ng/mL). Statistical analysis was performed to assess correlations between ferritin levels, stroke severity, and prognosis. Results: The mean serum ferritin levels were significantly higher in patients with severe stroke (NIHSS >15) compared to those with mild to moderate strokes (234.6 ± 42.3 ng/mL vs. 142.8 ± 35.7 ng/mL, p<0.01). At 30-day follow-up, poor functional outcomes (mRS ≥3) were observed in 68% of patients in Group C compared to 30% in Group B and 18% in Group A. A strong positive correlation was noted between serum ferritin levels and NIHSS scores (r = 0.68, p<0.001) and a moderate correlation with mRS scores (r = 0.55, p<0.01). Conclusion: Elevated serum ferritin levels on admission are associated with increased stroke severity and poorer short-term prognosis in AIS patients. Serum ferritin may serve as a simple and early prognostic biomarker for risk stratification and management planning in acute ischemic stroke.

This is a retrospective analytical study of clinico pathological evaluation of 140 patients presenting with cervical lymphadenopathy and evaluating the distribution of age gender and the various diagnosis based on FNAC. Cervical lymphadenopathy refers to the enlargement of lymph nodes in the neck, which may arise from a wide range of causes, including infections, inflammatory conditions, and malignancies. It is a common clinical presentation encountered across all age groups.

Background: Acinetobacter species have emerged as significant nosocomial pathogens, particularly in immunocompromised and critically ill patients. Their remarkable ability to develop multidrug resistance (MDR) poses a serious therapeutic challenge in clinical settings. Aim: To study the prevalence and antibiotic susceptibility pattern of Acinetobacter species isolated from various clinical samples in a tertiary care hospital. Materials and Methods: This prospective cross-sectional study was conducted over a period of one year in the Department of Microbiology, Government Medical College, Alwar. A total of 100 clinical samples yielding Acinetobacter isolates were included. Identification was performed using standard microbiological techniques and antibiotic susceptibility testing was carried out by Kirby-Bauer disc diffusion method according to CLSI guidelines. Results: Among the 100 Acinetobacter isolates, the predominant species was Acinetobacter baumannii (92%). The majority of isolates were obtained from respiratory tract samples (46%), followed by wound swabs (26%) and blood (15%). Antibiotic susceptibility revealed maximum sensitivity to colistin (96%), followed by tigecycline (89%) and minocycline (71%). High resistance was observed to cephalosporins (93%), ciprofloxacin (88%), and carbapenems (76%). A total of 67% isolates were multidrug-resistant (MDR), while 18% were extensively drug-resistant (XDR). Conclusion: The study highlights the alarming levels of drug resistance in Acinetobacter species, particularly A. baumannii, in hospitalized patients. Timely identification and appropriate antimicrobial stewardship are crucial to limit the spread of resistant strains and improve patient outcomes.

Background: Pre-menopausal women have traditionally been considered at lower risk for myocardial infarction (MI) due to oestrogen’s cardioprotective effects. However, emerging evidence indicates a rising trend of MI in this population, necessitating an in-depth assessment of associated risk factors and clinical patterns. Objective: To evaluate the clinical profile, risk factors, biochemical markers, and outcomes of myocardial infarction in pre-menopausal females admitted to a tertiary care hospital. Materials and Methods: A cross-sectional observational study was conducted at the National Institute of Medical Sciences & Research, Jaipur, over a 12-month period in 2024. A total of 116 pre-menopausal women (aged 18–45 years) with confirmed acute MI were evaluated. Data were collected on demographics, risk factors, laboratory values (including Troponin I/T and CPK-MB), ECG, and echocardiographic findings. Statistical analysis was performed using SPSS v26. Results: Most participants (81.9%) were in the 36–45-year age group. Abdominal obesity (51.7%), diabetes mellitus (34.5%), and hypertension (32.2%) were the predominant risk factors. Oral contraceptive use was noted in 25%, and tobacco exposure in 29.3% of cases. Troponin T was positive in 60.3%, Troponin I in 41.4%, and CPK-MB was raised in 73.3%. ST-elevation was observed in 53.8% of ECGs. Echocardiography revealed regional wall motion abnormalities in 46.2% and LV dysfunction in 15.4%. The in-hospital mortality rate was 11.2%. Conclusion: Myocardial infarction in pre-menopausal females is multifactorial, with modifiable and hormonal risk factors playing a significant role. Early identification of atypical presentations and tailored preventive strategies are essential to reduce morbidity and mortality in this vulnerable group.

Background: Soft tissue reconstruction of distal third of leg defects are major challenge to the reconstructive surgeon, due to paucity of skin, absence of muscle bed, presence of bony prominences, shape and biomechanics, around the distal third of the leg and ankle joint and foot^.[1,2] In the present era perforator propeller flaps has become an option for reconstruction of soft tissue defects over the lower third of the leg with satisfactory results. Objective: Objectives of this study is to assess the outcomes of the perforator propeller flap for soft tissue defect cover of distal third of leg. Methods: This is a prospective observational study conducted in the department of Plastic & Reconstructive Surgery, from January 2022 to February 2024 in MKCG, Medical College Brahmapur, Odisha. Observations: In this study, 40 patients with defects over the lower third of lower leg had undergone 40 perforator propeller flap methods to cover the defects with an age ranging 14 years to 60 years (mean 39.35 years), Degree of rotation 90 to 180⁰(mean 132.5⁰). Donor sites were closed primarily by short arm of the propeller and mobilization& rest of the area the donor defects were covered by split thickness skin graft (SSG), complications were, partial loss of flap in one case (2.5%), venous congestion in 3 cases (7.5%) with overall complication rate of 10%. Conclusion: It was found that perforator propeller flaps serve as simple options for reconstructions of lower third leg defects. This technique serves us with a reliable reconstruction option with acceptable aesthetic outcomes, with less donor site morbidity.

Objectives: The present study was to evaluate the clinical and microbiological profile of community acquired pneumonia at tertiary care center. Methods: A detailed history regarding presence of fever, cough, purulent sputum production and pleuritic chest pain was noted from the patients at the time of admission. Complete hemogram, renal and liver function tests, chest X-ray P/A view, ABG/electrolytes and fasting blood sugars were done in all patients. Sputum collection was done at the time of admission for gram staining and AFB staining. Sputum containing more than 25 polymorph nuclear cells and less than 10 epithelial cells per low power field was subjected to gram staining, bacterial culture and sensitivity, fungal KOH mount, fungal culture, and sensitivity. Sputum was also subjected to bacterial culture on blood agar and MacConkey agar media.  Two samples for blood culture were drawn from two different sites 30 minutes apart and were inoculated over blood agar and MacConkeys Agar media at 37ºC for 24-48 hours. Results: The mean age of the 100 samples was 58.24±21.23 years.  Most of the cases 25% and 28% were in age group of 41-60 and 61-80 years respectively. Majorities of the cases were 64(64%) males. 95(95%) had fever, 42(42%) dry cough, and 64(64%) wet coughs. Dyspnoea was affected 86(86%), hemoptysis 10(10%), and chest pain 17(17%). most common comorbidities were hypertension and diabetes mellitus (66%). Chronic kidney disease was noted in 13%. Lung diseases were present in 32% cases. Heart disease and malignancy were affected 11% and 7% cases respectively. Common isolated organism from blood culture was Pseudomonas aeruginosa 5(5%) followed by Staphylococcus aureus 3(3%) and Klebsiella 2(2%). Similarly, common organism isolates from sputum was Pseudomonas aeruginosa 13(13%) followed by Staphylococcus aureus 7(7%), Escherichia coli 6(6%). Conclusions: community acquired pneumonia is greatly seen in old age male population. Fever, cough, and dyspnoea are the most common clinical manifestation of CAP. Hypertension, diabetes mellitus and lung disease are the common comorbidities. Pseudomonas aeruginosa, Staphylococcus aureus and E. coli are the most common causative organism of community acquired pneumonia patients. Hence, early diagnosis and prompt treatment are required for the good prognosis of Community acquired pneumonia patients.

Introduction: The intercostobrachial nerve (ICBN), typically the lateral cutaneous branch of the second intercostal nerve, exhibits anatomical variations that are clinically significant, especially during axillary surgeries. Understanding these variations is essential for minimizing postoperative complications such as sensory disturbances. Materials and Methods: A descriptive observational study was conducted on 42 adult embalmed cadavers over six months (September 2024–March 2025) at the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya. Routine dissections of the pectoral, axillary, and upper arm regions were performed to evaluate the number, branching patterns, and union of ICBNs with adjacent nerves. Results: A single ICBN was observed in 71.4% of cadavers. Multiple ICBNs were found in 28.6% of cases, with two nerves in 19%, three nerves in 7.1%, and four nerves in 2.4% of cadavers. Variations included branches from the first to fourth intercostal nerves joining with the medial cutaneous nerve of the arm. Conclusion: This study emphasizes the variability of ICBN anatomy and its surgical relevance in preventing sensory complications during axillary procedures.

Background: The facial nerve (cranial nerve VII) plays a critical role in motor control of facial expression, as well as conveying taste and secretomotor innervation. Its extracranial course, especially through the parotid gland, is clinically significant due to the possibility of anatomical variations that may complicate surgical procedures. Objective: To perform a detailed anatomical study on the extracranial course and terminal branching pattern of the facial nerve using human cadaveric specimens, focusing on the frequency and nature of anatomical variations. Methods: A descriptive, observational dissection-based study was conducted on 100 facial halves from 15 fetuses and 35 adult cadavers. Trunks, divisions, terminal branches, and anastomotic patterns of the facial nerve were recorded and compared to existing literature. Results: a. 96% of facial halves presented a single trunk, b. 4% showed bifurcation (two trunks). c. 96% showed bifurcation into temporo facial and cervicofacial divisions; d. 4% exhibited trifurcation. Most common number of terminal branches was five (94%), while 6% had six, with variations mostly involving buccal and marginal mandibular branches. Davis Type 1 anastomotic pattern was predominant (96%), while Type 3 was observed in 4%. These anatomical insights correlate with previous studies and reinforce the necessity of preoperative awareness to avoid nerve damage. Conclusion: Anatomical variations in the extracranial course and branching of the facial nerve are not uncommon. Comprehensive knowledge of such variations is essential during head, neck, and parotid surgeries to avoid iatrogenic injuries.

This study examines the anesthetic management of preeclamptic patients undergoing elective and emergency surgeries. A cohort of 8 patients with varying comorbidities, including hypertension and preeclampsia, were assessed for anesthetic strategies and outcomes. The study demonstrated that with proper preoperative optimization and the use of appropriate antihypertensive medications, anesthesia could be safely administered. Regional anesthesia, particularly spinal and combined spinal-epidural blocks, were the most commonly used techniques, offering effective pain relief and maintaining stable hemodynamics. No major complications occurred during or after surgery, highlighting the importance of individualized anesthetic management. These findings support the use of tailored anesthesia in managing preeclamptic patients, ensuring successful surgical outcomes.

Background: Granulosa cell tumors (GCTs) are rare ovarian malignancies that represent a small percentage of all ovarian cancers. These tumors are typically estrogen-secreting and are more common in middle-aged and postmenopausal women. Despite a generally favorable prognosis for early-stage cases, recurrence remains a concern, especially in advanced stages. This study retrospectively analyzes clinical, pathological, and prognostic factors associated with GCTs. Methods: A retrospective analysis was conducted on 47 patients diagnosed with GCTs between 2011 and 2018 at a single institution. Data were reviewed for clinical features, treatment regimens, recurrence, and survival outcomes. The patients were staged according to the FIGO system, and treatment modalities, including surgery and chemotherapy, were assessed for their impact on prognosis. Statistical analyses were performed using SPSS. Results: The majority of patients (57.4%) presented with stage IA disease. Surgical treatment, including total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH + BSO), was performed on most patients, with adjuvant chemotherapy administered to those with high-risk features. Recurrence occurred in 25.5% of patients, with the median time to recurrence being 18.5 months. Prognostic factors such as tumor stage and size significantly influenced recurrence and survival outcomes. Conclusion: Granulosa cell tumors of the ovary generally present in early stages with a favorable prognosis. However, advanced stage, high mitotic activity, and residual disease are associated with poorer outcomes. Long-term follow-up is essential due to the potential for late recurrences.

Objective: The present study was to evaluate the etiology, complications, and long-term visual outcome of paediatric cataract surgery at tertiary care centre, Muzaffarpur district of Bihar. Methods: A thorough ophthalmological examination with slit lamp was performed using HaagStreit slit lamp system. The type, size, density, and morphology of cataract were noted using diffuse, focal and retro-illumination. Intra-ocular pressure was measured using Goldmann Applanation tonometer or I-care hand held tonometer, depending upon the age of the child. Fundus examination was done with indirect ophthalmoscope. All the children were evaluated at first, second, third, sixth week followed by every month for next three months and then every six months for 1 year. Results: Out of 100 paediatric cataract cases, most of the cases 34(34%) were in age group of 6-8 years.  Mean age of children was 6.12 ± 1.76 years.  54% were males and 46% cases were females.  144 eyes were cataract in out of 100 children. Bilateral cataract eyes were seen in 60% children and 40% had unilateral involvement. Most common etilogy (52%) were idiopathic. Others etilogy were 12% postnatal and 10% antenatal. Vitreous thrust and hyphema were seen in 7.64% and 1.39% eyes during surgical procedure. Early post operative complications were 13.89% Iridocyclitis, 13.19% glaucoma. Late post operative complications were posterior capsular opacification 22.92%. 6/12 acuity was seen in 1.39% eyes, 6/18 was seen in 6.25% eyes. 6/24 visual acuity was seen in (41.67%) most of the eyes. 14.58% eyes had 6/36. 11.81% cases had >6/60. And 9.72% children’s eyes had not recorded vision. Conclusions: Understanding of the critical period of the development of vision is extremely crucial to initiate early diagnosis and treatment within the first 3 months of life, which can even be as early as the first 6 weeks from birth. Hence, with increasing safety and efficacy of paediatric cataract surgery in the present world, screening and early treatment for visually significant cataracts is beneficial in this population.