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.