Background: Pneumoperitoneum using carbon dioxide (CO₂) is essential for laparoscopic cholecystectomy, but the pressure level used can significantly influence intraoperative dynamics and postoperative recovery. Lower pressures may minimize complications without compromising surgical efficacy. Aim: To evaluate the benefits of low intraperitoneal CO₂ pressure (8–10 mm Hg) compared to standard pressure (12–14 mm Hg) during laparoscopic cholecystectomy in terms of operative time, postoperative pain, analgesic requirement, and day of discharge. Materials and Methods: This observational study included 80 patients undergoing elective laparoscopic cholecystectomy, divided equally into Group A (low-pressure) and Group B (standard-pressure). Intraoperative time, postoperative pain at multiple intervals, duration of analgesic requirement, and postoperative day of discharge were recorded and analyzed. Data were compared using appropriate statistical tests, with p < 0.05 considered significant. Results: Patients in the low-pressure group experienced significantly less postoperative pain at all observed intervals. They required fewer days of injectable analgesics and were discharged earlier than those in the standard-pressure group. Intraoperative time did not significantly differ between the two groups, indicating that reduced pressure did not compromise surgical efficiency. Conclusion: Low intraperitoneal CO₂ pressure during laparoscopic cholecystectomy is associated with reduced postoperative discomfort and faster recovery without affecting operative time. It may serve as a safer, more comfortable option for selected patients undergoing laparoscopic procedures.

Background: Safety perceptions and menstrual side-effects heavily influence contraceptive satisfaction. We compared adverse events and cycle-pattern changes over 12 months in users of copper T 380A intrauterine device (CuT) and depot medroxy-progesterone acetate (DMPA). Methods: The same longitudinal cohort (n = 162) was analysed for safety endpoints: bleeding pattern, pelvic pain, pelvic inflammatory disease (PID), weight change, and migraine/headache and bone pain. Bleeding was categorised as normal, amenorrhoea, oligomenorrhoea, heavy or irregular. Event rates were compared using χ² and expressed per 100 woman-years (WY). Results: By 12 months, amenorrhoea occurred in 29.6% of DMPA versus 1.2% of CuT users (RR 24.3, 95% CI 3.4–175). Heavy bleeding affected 17.2% (CuT) and 4.9% (DMPA) (RR 0.28, 95% CI 0.1–0.8). Irregular/spotting episodes were common in early DMPA months (24.6 % at 1 month) but declined to 4.9 % by 12 months; CuT users reported negligible irregularity after month 6 (Figure 2A). Pelvic pain/backache was more frequent with CuT (22.2% vs 3.7%; P<0.01) yet seldom prompted removal. PID incidence was low: 3.7/100 WY with CuT and 1.2/100 WY with DMPA. No uterine perforation or injection-site infection occurred. Weight gain >2 kg registered in 8.6% of DMPA versus 2.4% of CuT users (P<0.05). Headache/migraine (8.6% vs 1.2%) and bone pain (4.9% vs 2.4%) also clustered in the DMPA arm. Conclusion: Distinct safety profiles emerged: CuT users experienced heavier menses and pelvic discomfort, whereas DMPA users faced amenorrhoea, early irregular bleeding, weight gain and neurologic/musculoskeletal complaints. Both methods showed low serious-adverse-event rates. Anticipatory counselling should tailor messages to these profiles and emphasise the benign nature of amenorrhoea and transient spotting with DMPA, and the treatability of CuT-associated menorrhagia.

Background: Dengue is a major vector-borne viral illness affecting children in endemic regions. Timely recognition of its clinical and laboratory profile is essential for reducing morbidity and mortality. Objectives: To assess the clinical, epidemiological, biochemical profile, and outcomes of dengue and dengue-like illness in children. Methods: A prospective observational study was conducted among 73 children diagnosed with dengue or dengue-like illness. Data on demographics, seasonal distribution, clinical features, complications, and laboratory investigations were analyzed. Disease severity and outcomes were documented. Results: The majority of patients were aged 6–10 years (34.2%) and 11–15 years (32.9%), with a slight female predominance (53.4%). Most cases occurred in urban areas (58.9%), and seasonal distribution was almost equal across pre-monsoon, monsoon, and post-monsoon periods. Common clinical features included hepatomegaly (60.3%), rash (56.2%), and warning signs (57.5%). Leukopenia (58.9%), haemoconcentration (54.8%), and thrombocytopenia (52.1%) were frequent lab findings. While 58.9% had mild disease, 41.1% had moderate to severe dengue, with complications like shock (50.7%) and ascites (49.3%). The mean fever duration was 5.01 ± 2.40 days. Importantly, all patients recovered fully with no mortality.

Conclusion: Dengue in children commonly presents with significant systemic involvement and complications. Early diagnosis and prompt supportive care ensure excellent outcomes, even in severe cases. Ongoing vigilance and public health measures are crucial to control disease impact.

Background: Incisional hernia is a common postoperative complication associated with considerable morbidity. Effective management strategies and their outcomes need ongoing evaluation to optimize patient care. Objectives: This prospective clinical study aimed to assess the demographic profile, clinical presentation, management strategies, and postoperative outcomes of patients with incisional hernia. Methods: A total of 80 patients diagnosed with incisional hernia were studied prospectively over one year. Clinical presentations, defect sizes, surgical methods, complications, and length of hospital stay were analyzed using descriptive statistics, chi-square, and independent t-tests. Results: Most patients were between 41–50 years (27.5%) with a mean age of 47.2 years. Swelling alone (45%) was the predominant symptom. Moderate-sized defects (5–10 cm) were most frequent (42.5%). Open mesh repair was performed in 65% of cases, while laparoscopic repair accounted for 35%. Common complications included wound infection (12.5%), seroma (10%), and mesh-related pain (7.5%), with a low recurrence rate (2.5%). Mean hospital stay was significantly shorter in laparoscopic repair (4.2±1.3 days) compared to open repair (6.8±2.1 days, p<0.001). No significant association between type of repair and complication rates was found (p=0.902). Conclusion: Incisional hernia commonly affects middle-aged patients, primarily presenting as painless swelling. Although open mesh repair remains prevalent, laparoscopic repair significantly reduces hospital stays without altering complication rates. Thus, laparoscopic repair is recommended when feasible to enhance recovery and patient outcomes.

Non-communicable diseases (NCDs), including diabetes, cardiovascular diseases, chronic respiratory diseases, cancers, and mental health disorders, are now the leading cause of death globally, particularly in low- and middle-income countries. India, with its diverse population and dual burden of communicable and non-communicable diseases, faces an urgent need to adopt holistic, sustainable, and patient-centric models of care. Homeopathy, recognized by the Ministry of AYUSH [1], Government of India, is one of the most widely used complementary systems of medicine. This review explores the emerging role of homeopathy in managing NCDs through an integrative lens—evaluating the clinical evidence, mechanisms, limitations, and future potential. With appropriate research, regulation, and collaboration, homeopathy could meaningfully contribute to integrated care frameworks addressing India’s NCD crisis.

Background: Ophthalmology is a technologically advanced microsurgical specialty with evolving scope and job opportunities. However, undergraduate preference for this specialty remains moderate, particularly in the Indian context. This study assessed MBBS students’ perception of Ophthalmology as a career and factors influencing or discouraging their choice. Aim and Objectives: To assess the level of preference for Ophthalmology as a career among MBBS students and identify the motivating and dissuading factors influencing their choice. Materials and Methods: This cross-sectional analytical study was conducted over six months among 1000 MBBS students from five medical colleges in Bhopal, Central India. A structured questionnaire comprising demographic details, career preference, motivational/deterrent factors, and clinical exposure was administered in hard copy. Descriptive statistics were used to summarize data, while Chi-square and logistic regression analyses assessed associations. A p-value of <0.05 was considered statistically significant. Results: Only 8.7% of students marked Ophthalmology as their first preference, whereas 22% chose it as their second. Notably, 16.3% reported they would never choose the specialty, and 23.6% would consider it only as a last resort. The top motivating factors included fewer emergency duties (mean: 6.81), better work-life balance (6.50), and the daycare nature of surgeries (6.49). Key deterrents were the long learning curve (5.72), high setup cost (5.75), and limited rural opportunities (5.51). Clinical postings positively influenced perceptions in over 70% of participants. Departmental participation further increased interest in 61.8% of involved students. Conclusion: Despite the low initial preference for Ophthalmology, positive clinical exposure and departmental engagement significantly improved its acceptance as a career choice. Enhancing undergraduate exposure and addressing deterrent perceptions may improve the uptake of this crucial specialty in India.

Background: Treatment-resistant schizophrenia (TRS) poses significant therapeutic challenges, often necessitating the use of antipsychotic polypharmacy (APP) when monotherapy proves ineffective. Despite widespread clinical adoption, the long-term outcomes and safety profile of APP remain controversial due to concerns regarding adverse effects, medication adherence, and overall functional prognosis. Materials and Methods: A prospective observational study was conducted over a 36-month period involving 120 TRS patients diagnosed according to DSM-5 criteria. Participants were divided into two groups: Group A received antipsychotic monotherapy (n=60), and Group B received APP (n=60). Primary outcome measures included changes in the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), and Clinical Global Impressions (CGI) scores, along with monitoring of metabolic and cardiovascular side effects. Data were analyzed using repeated-measures ANOVA and Kaplan-Meier survival analysis. Results: Group B showed a statistically significant greater reduction in PANSS total scores (mean decrease of 35.2±5.3) compared to Group A (mean decrease of 27.1±6.0, p<0.001). Improvements in GAF scores were also more prominent in Group B (increase of 18.5±4.1 vs. 13.2±3.9; p=0.003). However, Group B exhibited higher incidence of metabolic syndrome (31.7% vs. 16.7%; p=0.02) and required more frequent dosage adjustments. Medication adherence did not differ significantly between the groups. Conclusion: Antipsychotic polypharmacy may offer superior symptomatic relief and functional improvement in patients with treatment-resistant schizophrenia over the long term. However, the benefits must be weighed against the elevated risk of metabolic complications. Careful patient selection and ongoing monitoring are crucial when implementing APP strategies.

Background: Pregnancy anemia is a significant public health issue in India, especially in rural India, because of nutritional deficiencies, infections, and socio-economic status. Odisha state, with its tribal and rural population, is still at risk of high maternal anemia prevalence. Objective: Among antenatal mothers residing in Deogaon block of Balangir district, Odisha, estimate anemia frequency and find related elements. Methods: A cross-sectional study was undertaken from June 2024 up to February 2025, involving 400 pregnant women who visited subcentres of Deogaon block for antenatalcheckups, and data were collected on socio-demographic information, obstetric history, dietary pattern, and hemoglobin levels through pre-tested semi-structured questionnaire. Hemoglobin levels were measured using Sahli’s method. Results: The prevalence of anemia among the study participants was found to be 62.44%. Socio-economic status, birth spacing, parity, and iron supplementation adherence were significantly associated with anemia. Conclusion: The high prevalence of anemia among antenatal mothers calls for strengthening of health education, regular screening, and nutritional interventions in rural settings.

Introduction: Adenoid hypertrophy (AH) is a common pediatric condition characterized by the abnormal enlargement of the adenoids, leading to nasal obstruction, sleep disturbances, and recurrent infections. This study aims to compare the efficacy of topical azelastine (137 mcg) and topical fluticasone furoate (27.5 mcg) in managing AH in children aged 6–15 years. Methods: A prospective, hospital-based study was conducted at the Department of ENT & HNS, Muzaffarnagar Medical College & Hospital, involving 80 patients, randomly divided into two groups: Group A (Azelastine) and Group B (Fluticasone). Patients were treated for three months, and their progress was monitored at Day 7, Day 14, 1 month, and 3 months using symptom assessment, endoscopic evaluation, and radiological grading. Results: The study found that both nasal sprays significantly improved nasal congestion, snoring, and sleep disturbances, with fluticasone furoate showing a more rapid onset of symptom relief, particularly in the first 14 days. At 3 months, both groups exhibited comparable symptom resolution rates (95%). Endoscopic and radiological findings revealed a greater reduction in adenoid size in the fluticasone group, making it the preferred option for rapid and sustained improvement. Adverse effects were minimal in both groups, with mild nasal irritation being the most common complaint. Conclusion: fluticasone furoate demonstrates superior short-term efficacy in symptom relief, while both treatments are equally effective in long-term management of AH. This study suggests that intranasal corticosteroids may be a more favorable first-line therapy for pediatric AH, potentially reducing the need for surgical intervention. Further research is recommended to explore long-term outcomes and combination therapies.

Background/Justification: Competency-Based Medical Education (CBME) is transforming medical training by emphasizing competencies over time-based curricula. As CBME adoption increases, assessing its effectiveness through student feedback is critical. Aims/Objectives: This study investigates student perspectives on the CBME curriculum, focusing on teaching hours, the balance of theoretical and practical assessments, the introduction of skill labs, and perceived learning gaps. Study Design: Cross-sectional, descriptive analytical study. Material and Methods: 150 MBBS students across all years from a tertiary care teaching medical college were surveyed using a structured questionnaire to gather insights into their experiences with CBME. Results: 65% of students were somewhat familiar with CBME. While 67% found teaching methods effective, 58.2% of students were neutral about the assessment methods. Most students rated their overall satisfaction at 7-8 on a scale of 1-10. Suggestions for improvement included allocating more class time. Conclusion: The CBME curriculum is generally well-received, with strong outcomes in medical knowledge and communication skills. However, systems-based medicine and practice-based learning need more attention, and improvements in assessment methods and class time are recommended.

Introduction: Dengue fever can rapidly progress to severe disease in children. This study aims to assess the utility of abdominal ultrasonography in early diagnosis and severity prediction by identifying key sonographic findings—such as gallbladder wall thickening and ascites—and correlating them with clinical parameters in pediatric dengue patients. Methods: This prospective study at Prathima Institute (Dec 2018–2020) included children aged 2 months to 18 years with dengue (NS1/IgM positive). Clinical, laboratory, and ultrasound findings—gallbladder thickness, ascites, hepatosplenomegaly—were recorded and correlated with disease severity using WHO 2009 criteria. Ethical clearance and informed consent were obtained. Results: In 80 children with dengue, mean age was 6.8 years and male-to-female ratio was 1.6. Gallbladder wall thickening (100%), ascites (45%), hepatomegaly (20%), and splenomegaly (10%) were observed. Gallbladder thickness >5 mm significantly correlated with severe dengue and mortality (P < 0.001, ANOVA). Conclusion: Gallbladder wall thickening strongly correlates with dengue severity and poor outcomes in children. Early ultrasound evaluation, including assessment of gallbladder thickness and other abdominal findings, can serve as an essential non-invasive tool for predicting complications and guiding timely management, especially in resource-limited settings where early intervention is critical.

This case report presents a typical clinical and neuroimaging findings of cobblestone lissencephaly, a rare neuronal migration disorder characterized by abnormal cerebral convolutions giving rise to cobblestone appearance. The subject, a 6-year-old female, exhibited refractory seizures, loss of vision in right eye, mild cognition impairment and hypotonia.  Radiological imaging showed a distinct focal loss of gyrations with cortical thickening of bilateral frontal lobes (cobblestone-like brain surface) and, inferior vermian hypoplasia, and shrunken right eye globe (phthisis bulbi). She was referred by her pediatrician for evaluation.

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder among reproductive-aged women, often associated with insulin resistance, hyperandrogenism, and metabolic disturbances. Vitamin D deficiency is frequently observed in women with PCOS and has been implicated in its pathophysiology. Aim and Objectives: This study aimed to evaluate the effect of vitamin D supplementation in vitamin D-deficient females with PCOS. Methods: A prospective interventional study was conducted among 60 women aged 18–35 years diagnosed with PCOS based on Rotterdam criteria and serum 25(OH)D levels <20 ng/mL. Participants received oral cholecalciferol (60,000 IU/week) for 8 weeks. Clinical assessments (BMI, acne, hirsutism, menstrual irregularity) and biochemical parameters (fasting glucose, insulin, serum 25(OH)D, testosterone, HOMA-IR, lipid profile) were measured pre- and post-intervention. Results: Post-supplementation, serum 25(OH)D levels significantly increased from 12.5 ± 3.4 to 32.8 ± 5.9 ng/mL (p<0.001). Significant improvements were observed in fasting blood glucose (p=0.049), insulin levels (p<0.001), HOMA-IR (p<0.001), and serum testosterone (p<0.001). HDL increased (p<0.001), and LDL decreased (p=0.007), while total cholesterol and triglycerides showed non-significant changes. Clinical symptoms such as hirsutism and menstrual irregularities also showed improvement. Conclusion: Vitamin D supplementation significantly improves insulin sensitivity, reduces androgen levels, and favourably modulates lipid profiles in vitamin D-deficient women with PCOS. These findings support the inclusion of vitamin D status assessment and correction as part of PCOS management strategies.

Pregnancy complicated by ovarian tumors either benign or malignant is not uncommon. Diagnostic accuracy becomes essential to differentiate patients needing surgical management versus those which can be managed conservatively. Ultrasound and magnetic resonance imaging (MRI) are safe diagnostic tools during pregnancy. The overall incidence of ovarian tumours in pregnancy is 2.4-5.7%. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester.  If surgery is required factors like tumor size, gestational age and associated complications dictate the choice between open or laparoscopic route. A multidisciplinary approach is necessary in case of high suspicion of malignancy. This study evaluates the clinical features, course in pregnancy, management, and pregnancy outcome in patients with ovarian masses diagnosed during pregnancy. This was a retrospective analysis of medical records of 4 patients diagnosed with ovarian mass during pregnancy in the department of Obstetrics and Gynaecology at Patna Medical College and hospital from Jan 2024 to Feb 2025.

Introduction: The Intensive Care Unit (ICU) is a setting characterized by polypharmacy, where a large number of drugs are administered to patients, contributing to high treatment and hospitalization costs. The primary objective of this study was to evaluate the current usage pattern of antimicrobial agents in the Pulmonary Medicine Intensive Care Unit (PMICU) of a teaching hospital in central India. Aims and Objectives: The aim of the study was to describe and analyze the utilization of antibiotics in the PMICU of a tertiary care center, in accordance with the WHO/INRUD prescribing core indicators. Materials and Methods: A prospective observational study was conducted to assess the prescription patterns of antibiotics in the PMICU. Case records of patients receiving antibiotic therapy were reviewed and evaluated using descriptive statistical methods. A total of 87 prescriptions were analyzed. Results: Among the 87 patients included, the most common age group admitted to the ICU was 61–75 years, with a higher proportion of male patients. The most frequent reasons for ICU admission were pneumonia (33.34%), type 2 respiratory failure (20.46%), and type 1 respiratory failure (9.94%). The most commonly prescribed antibiotics were Levofloxacin (10.19%), Azithromycin 500 mg IV (9.06%), Piperacillin + Tazobactam and Ceftriaxone + Sulbactam (8.49%), and Meropenem 1 g (7.93%). The average number of drugs prescribed per encounter was 20.16. Of these, 20.12% (approximately 4.96 drugs per prescription) were antibiotics. All prescriptions (100%) included injectable antibiotics, and 45.38% of the drugs were prescribed by their generic names. Conclusion: This study provides an overview of antibiotic usage patterns in the PMICU of a teaching institution. The findings highlight the need for judicious use of antibiotics in ICU settings to promote rational prescribing practices and combat antimicrobial resistance.

Introduction: Medico-legal cases (MLCs) form an integral component of emergency healthcare services in tertiary hospitals and often involve clinical scenarios with legal implications, such as road traffic accidents, assaults, poisoning, and suicidal attempts. The frequency and nature of such cases vary across regions due to differences in socioeconomic, cultural, and infrastructural factors. This study was conducted to evaluate the pattern and distribution of MLCs in the Emergency Department of Lakhimpur Medical College and Hospital, Assam. Materials and Methods: A retrospective, descriptive study was carried out in the Emergency Department of a tertiary care hospital in Assam. All medico-legal cases registered over the study period were included. Data were collected from medico-legal registers and emergency department records, focusing on age, gender, nature of the incident, clinical findings, and patient outcomes. Descriptive statistics were used to analyze the data using SPSS version 21. Results: A total of 384 MLCs were recorded. The majority of patients (80.98%) were aged 18–37 years, with a mean age of 31.49 ± 14.15 years. Males constituted 57.55% of cases. Assault was the most common cause (56.77%), followed by injuries (22.40%) and road traffic accidents (10.16%). Simple injuries were predominant (92.70%), and most cases (98.95%) were managed on an outpatient basis. Alcohol involvement was documented in only 0.26% of cases. Conclusion: The study highlights a distinct regional pattern, with assault being the leading cause of MLCs, unlike other areas where RTAs dominate. These findings emphasize the need for region-specific data to guide hospital preparedness and public health interventions.

Introduction: Low birth weight (LBW), defined by the World Health Organization as a birth weight of less than 2500 grams, remains a significant public health challenge due to its strong association with neonatal morbidity, mortality, and long-term developmental issues. India contributes nearly 40% of the global LBW burden. Various maternal and obstetric risk factors such as teenage pregnancy, parity, inter-pregnancy interval, anemia, and hypertensive disorders are implicated. The northeastern region, particularly Upper Assam, lacks comprehensive data on LBW determinants. Materials and Methods: A retrospective cross-sectional study was conducted at the Maternal and Child Health (MCH) block of Lakhimpur Medical College and Hospital, Assam, over one year (October 2022–September 2023). Data were extracted from delivery registers and obstetric records for 300 live births. Variables analyzed included maternal age, gravida, parity, blood pressure, hemoglobin levels, gestational age, and neonatal outcomes. Statistical analysis was performed using SPSS version 21. Chi-square and Fisher’s exact tests were used, with p<0.05 considered significant. Results: The incidence of LBW was 33.33%. Most LBW neonates (31.33%) weighed between 1.5–2.5 kg. Higher LBW proportions were seen among adolescent mothers (18.9%), primigravida (12.6%), and grand multipara (25%). Pregnancy-induced hypertension showed a significant association with LBW (55.3% vs. 36.4% in normotensive mothers, p<0.05). No significant association was observed between LBW and gestational diabetes. Conclusion: The study highlights a substantial burden of LBW in Upper Assam. Targeted antenatal interventions focusing on adolescent pregnancy, parity extremes, and hypertensive disorders are essential to reduce LBW incidence and improve neonatal outcomes.

Background: Non-traumatic acute abdominal pain is a common surgical emergency with diverse etiologies requiring prompt diagnosis and intervention. Understanding its clinical spectrum and outcomes is essential to improve perioperative management, especially in resource-limited settings. Methods: This prospective observational study was conducted over two years at a tertiary care hospital. A total of 368 adult patients presenting with non-traumatic acute abdomen who underwent emergency surgery were included. Data on demographics, clinical diagnosis, laboratory and imaging findings, operative procedures, complications, and outcomes were recorded and analyzed. Statistical associations between clinical variables and postoperative complications were assessed using chi-square or Fisher’s exact test. Results: The most common diagnoses were acute appendicitis (29.9%), intestinal obstruction (20.1%), and duodenal/gastric perforation (17.9%). Open surgical approaches predominated, with laparoscopic procedures used selectively. Postoperative complications occurred in 27.7% of patients, with surgical site infections being most frequent (22%). Significant predictors of complications included age >60 years (p=0.001), presence of comorbidities (p=0.009), shock at admission (p=0.011), diagnosis of perforation or bowel gangrene (p=0.001), leukocytosis (p=0.019), hypoalbuminemia (p=0.012), and delayed surgery >48 hours (p=0.002). The in-hospital mortality rate was 6%, primarily due to septic shock and respiratory failure. Conclusion: Non-traumatic acute abdominal pain in adults commonly results from appendicitis, obstruction, and perforation. Early identification of high-risk patients based on age, comorbidities, sepsis, and biochemical markers is critical to reduce postoperative morbidity and mortality. Timely surgical intervention and improved perioperative care can enhance outcomes in emergency general surgery.

Background: Keloid and hypertrophic scar are the result of abnormal growth of fibrous tissue following healing of a cutaneous injury in predisposed individuals. Some treatment options are pressure garments, radiation therapy, excision, intralesional injections, cryotherapy, and silicone gel dressing and lasers though no single modality is completely effective. Aim: To study the comparative efficacy, outcome and the adverse effects of 4 different modalities of treatment of keloids namely, Intralesional triamcinolone acetonide (TAC), Intralesional triamcinolone acetonide and 5-fluoro uracil (TAC+5-FU), Intralesional triamcinolone acetonide and silicone gel sheet (TAC+SGS) and Intralesional Radiofrequency (RF). Materials and Methods: A randomized open label study was conducted in the department of surgery, Dr KNS MIMS, Gadia, Barabanki, UP from April 2024 to February 2025. 100 patients were allocated to 4 groups, Group 1(TAC), Group 2(TAC + 5FU), Group 3(TAC + SGS) and Group 4(RF). Group 1 received Intralesional injections of Triamcinolone acetonide (alone), Group 2 received Intralesional injections of Triamcinolone acetonide and 5- fluorouracil, Group 3 was given Intralesional injections of Triamcinolone acetonide and topical silicone gel sheet and Group 4 was treated with intralesional radiofrequency. Results: A total of 100 patients of age group 18-50 years were enrolled and was divided into 4 groups consisting of 25 patients each. Improvement of pliability, vascularity, pigmentation and height of keloid was maximum in TAC + 5FU group and least was in TAC + SGS group. At the end of 4 weeks, excellent improvement was found highest in 36% of TAC+5FU group, 28% in TAC alone, 24% RF group and 20% in TAC+SGS group. At the end of 8 weeks, excellent improvement was found highest in 31.6% of TAC+5FU group, 23.1% in TAC alone, 17.8% in RF group and 12.3% in TAC+SGS group. At the end of 8 weeks, excellent improvement was found highest in 51.8% of TAC+5FU group, 44.4% in TAC alone, 40.7% RF group and 25.9% in TAC+SGS group and subsequently good improvement was also found highest in 29.6% of TAC+5FU group, 25.9% in TAC alone, 22.2% RF group and 18.6% in TAC+SGS group. A gradual decrease was also observed in all the scores, and at 8 weeks, the scores were noted as pigmentation [1.08±0.13*], pliability [1.91±0.23*], height [0.11±0.01*], vascularity [0.63±0.01*] and itching [0.41±0.02*]. The difference was statistically significant. Skin atrophy, telangiectasia, hypopigmentation and recurrence were observed more with TAC group therapies whereas, ulceration and infection were more frequent with RF treatment, however few cases were also seen in TAC+5FU group. Conclusion: In this study in terms of pliability and overall improvement maximum response was seen in group TAC + 5 FU and TAC + SGS was least effective.

Background and Aim: Chronic otitis media (COM) is a common middle ear disorder characterized by persistent tympanic membrane (TM) perforation, which often leads to conductive hearing loss (CHL). The severity of hearing impairment may be influenced by both the site and size of the perforation. This study aims to evaluate the correlation between the anatomical features of the perforation and the degree of CHL, providing insights into prognosis and management. Material and Methods: A hospital-based cross-sectional study was conducted on 150 patients aged 10–60 years, diagnosed with inactive mucosal COM and dry TM perforation. Otoscopic and microscopic examinations were performed to assess the size and site of perforations, and patients underwent pure tone audiometry to quantify hearing loss. Perforation size was classified into four groups (0–10%, 11–20%, 21–40%, and >40%), and site was categorized as anterior, posterior, or combined. Data were analyzed using SPSS, with Pearson correlation and Chi-square tests applied where appropriate. Results: The study revealed a significant correlation between the size and site of TM perforation with the degree of CHL. Patients with combined perforations had the highest average hearing loss (41.6 ± 5.8 dB), while anterior perforations had the least (31.9 ± 5.6 dB). Hearing loss increased with the size of perforation, from an average of 27.74 ± 1.9 dB in Group I (0–10%) to 47.05 ± 6.6 dB in Group IV (>40%). Additionally, disease duration over 5 years was associated with significantly greater hearing loss compared to shorter durations (p < 0.0001). Conclusion: Both the size and anatomical site of tympanic membrane perforation are key determinants of conductive hearing loss in chronic otitis media. Larger and posterior or combined perforations result in greater auditory deficits. These findings emphasize the importance of early diagnosis and surgical intervention to prevent long-term hearing impairment.

Background: Carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy increases Heart Rate (HR), Mean Arterial Pressure (MAP), Rate Pressure Product (RPP). In this randomized, comparative interventional clinical study, we compared the efficacy of Clonidine and Esmolol to provide perioperative hemodynamic stability in patients undergoing laparoscopic cholecystectomy. Methods: Ninety patients of either sex, ASA physical status 1, undergoing elective laparoscopic cholecystectomy, were randomly allocated into three groups containing thirty patients each. Group C received intravenous infusion Clonidine, 2 mcg/kg, diluted in 20 ml of normal saline, slowly over 10 minutes before induction. Group E received given intravenous Esmolol, 1.5 mg/kg, as a loading dose, over a period of 5 minutes before induction. Group P received 20 ml of intravenous Normal Saline. Results: Heart rate, mean arterial pressure and Rate pressure product in Group C and E were significantly less throughout the period of pneumoperitoneum in comparison to Group P. At a few time points, specifically at pneumoperitoneum and afterwards, it was seen that mean arterial blood pressure and rate pressure product remained significantly low in Group C while compared Group E. Conclusion: Clonidine attenuates the haemodynamic response by limiting the extent of rises in heart rate and blood pressure more effectively compared to Esmolol. Both the study drugs attenuate the haemodynamic responses more effectively than Placebo.

Introduction: Postoperative sore throat (POST) is a common complication of general anaesthesia (GA), particularly after tracheal intubation, with an incidence of 21–65%. This study compares the efficacy of nebulized ketamine, dexmedetomidine and normal saline given 15 minutes before general anaesthesia in reducing the incidence and severity of postoperative sore throat (POST). Materials and Methods: In this prospective interventional study 90 patients aged 18 to 65 years with American Society of Anaesthesiologist (ASA) grade I and II, scheduled for elective general anaesthesia, were randomly assigned to three groups. Group D (dexmedetomidine),Group K(ketamine), and Group S(saline).Primary aim was to evaluate the incidence and severity of POST based on patient assessments conducted at 2, 6, 12, and 24 hours postoperatively. Results: Group D demonstrated a noticeably lower incidence (28.7%) and severity of POST (11 cases mild;1 case moderate) compared to Group K (53.2% [20 cases mild; 3 cases moderate]) and Group S (55.6% [18 cases mild ; 6 cases moderate]) at 2 hours postoperatively. This pattern persisted at 6 hours postoperatively, with Group D showing an incidence of 21.9% (8 cases mild; 1 case moderate),Group K at 39.8% (16 cases mild; 1 case moderate), and Group S at 48.9% (16 cases mild; 5 cases moderate). The heart rate and mean arterial pressure (MAP) between the Dexmedetomidine, Ketamine, and Normal Saline groups did not show significant differences, with both groups having a P-value greater than 0.05 (P > 0.05). No statistically significant differences in postoperative sedation, nausea, or vomiting. Conclusion: Dexmedetomidine nebulization administered preoperatively effectively reduces the incidence and severity of early POST.

Introduction: Spinal anesthesia with hyperbaric bupivacaine is commonly used for lower limb surgeries. Adjuvants like clonidine and dexmedetomidine, both α2-adrenergic agonists, enhance the quality and duration of spinal block. This study aimed to compare the effects of intrathecal dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine in patients undergoing surgical fixation of femur and tibia fractures. Materials and Methods: In this prospective, randomized clinical trial, 52 patients aged 18–60 years with ASA I–II status were divided into two groups: Group A received 2.5 ml 0.5% hyperbaric bupivacaine plus 50 mcg clonidine, and Group B received 2.5 ml 0.5% hyperbaric bupivacaine plus 5 mcg dexmedetomidine intrathecally. Sensory and motor block characteristics, intraoperative hemodynamics, duration of analgesia, and side effects were recorded. Results: Both groups were comparable in demographic and surgical parameters. Group B showed significantly faster onset of sensory (168 ± 29 s vs. 211 ± 37 s) and motor blockade (346 ± 31 s vs. 384 ± 29 s) (p < 0.001). Duration of sensory (319 ± 15 min vs. 277 ± 10 min) and motor blockade, as well as postoperative analgesia, was significantly prolonged in Group B (p < 0.001). Hemodynamic parameters and oxygen saturation remained stable and comparable. Sedation scores were higher with dexmedetomidine but without significant respiratory depression. Conclusion: Intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine provides faster onset and longer duration of spinal anesthesia with better postoperative analgesia compared to clonidine, making it a superior adjuvant for femur and tibia fracture surgeries.

Background: Ultra sound guided supraclavicular block is commonly used to provide primary anaesthesia for upper limb surgeries along with postoperative pain care. This randomized study compared the efficacy of dexmedetomidine and clonidine as adjuvants to ropivacaine 0.75% in ultrasound-guided peripheral nerve blocks for upper limb surgeries. Methods: This was a prospective, randomized, and double-blinded comparative research that included 60 ASA I and II patients who were scheduled for the upper limb surgery. The patients were randomized into two groups, namely, Group RD and Group RC, with 30 patients each. The patients in Group RD were given USG-guided supraclavicular brachial plexus block with 21 ml of 0.75% ropivacaine and dexmedetomidine 1 µg/kg and patients in Group RC received 21 ml of 0.75% ropivacaine and clonidine 1 µg/kg. The primary outcome was the onset and duration of sensory blockade, the onset and duration of motor blockade, time to first analgesic request. Secondary outcomes included hemodynamic parameters and adverse effects. Results: Group RD significantly prolonged the duration of both sensory and motor blockade compared to Group RC. Group RD provided longer duration of analgesia when compared to Group RC (p value <0.05). Conclusion: This study suggested that dexmedetomidine is a more effective adjuvant than clonidine for prolonging the duration of ropivacaine-based peripheral nerve blocks in upper limb surgeries.

Background: Laparoscopic surgeries, though minimally invasive, are often associated with significant postoperative pain. Ultrasound-guided subcostal transversus abdominis plane (TAP) block is increasingly used for analgesia. This study aimed to compare the efficacy of dexamethasone and clonidine as adjuvants to ropivacaine in subcostal TAP block. Materials and Methods: In this prospective, randomized, double-blind study, 60 ASA I–II patients undergoing elective laparoscopic abdominal surgeries were allocated into two groups. Group D received 20 mL of 0.375% ropivacaine plus 8 mg dexamethasone per side, while Group C received the same volume of ropivacaine plus 1.5 mcg/kg clonidine per side. The TAP block was administered bilaterally under ultrasound guidance postoperatively. Duration of analgesia, visual analog scale (VAS) pain scores, rescue analgesia requirements, and adverse effects were evaluated over 12 hours. Results: Group C (clonidine) had a significantly longer duration of analgesia (655.00 ± 81.33 minutes) than Group D (503.37 ± 74.53 minutes; p = 0.0001). VAS scores were significantly lower in Group C at most time intervals beyond 60 minutes. Fewer patients in Group C required rescue analgesia (16.7% vs. 40%; p = 0.03). Adverse effects were mild and comparable between groups, with no block failures reported. Conclusion: Clonidine is more effective than dexamethasone in prolonging analgesia and reducing pain scores when used as an adjuvant to ropivacaine in subcostal TAP block for laparoscopic surgeries, without increasing adverse effects.

Introduction: Adenotonsillectomy is a common paediatric surgical procedure often complicated by challenges in anaesthesia management, including postoperative pain, sedation, and emergence agitation. Dexmedetomidine and fentanyl are widely used adjuncts for sedation and analgesia in paediatric anaesthesia, but their comparative effects on hemodynamics and postoperative outcomes in adenotonsillectomy require further evaluation. Objective: To compare the effects of dexmedetomidine and fentanyl on intraoperative hemodynamics, postoperative sedation, analgesia, and emergence agitation in paediatric patients undergoing adenotonsillectomy. Materials and Methods: In this randomized, double-blind study, 60 paediatric patients aged 4–8 years undergoing adenotonsillectomy were allocated into two groups. Group D received dexmedetomidine (0.5 µg/kg) and Group F received fentanyl (2.5 µg/kg) after induction of anaesthesia. Hemodynamic parameters (heart rate and mean arterial pressure), postoperative sedation (Ramsay Sedation Score), analgesic requirements, and adverse events including emergence agitation were recorded and analyzed. Results: Both groups were comparable demographically. Group D showed significantly better hemodynamic stability with lower heart rate and mean arterial pressure intraoperatively and postoperatively (p < 0.05). Postoperative sedation scores were higher in Group D up to 40 minutes (p < 0.001). Rescue analgesic requirements were significantly lower in Group D (p = 0.003). Emergence agitation occurred only in Group F (16.7%) and was absent in Group D (p = 0.02). Incidences of nausea, vomiting, bradycardia, and hypotension were comparable between groups. Conclusion: Dexmedetomidine provides superior hemodynamic stability, enhanced sedation, reduced analgesic needs, and lower emergence agitation compared to fentanyl in paediatric adenotonsillectomy, making it a preferable agent for perioperative management.

Background: Corneal ulcer is a potentially sight threatening ocular condition and the leading cause of monocular blindness. It is the second most common cause of monocular blindness, after unoperated cataract in developing countries. Purpose: To determine epidemiological, clinical and microbiological characteristics of bacterial and fungal keratitis. Materials and Methods: It was a hospital based, prospective, non-randomised case study of 100 patients over duration of 1 year. Results: Corneal ulcers were common in 40 – 60 age group (38%) with Male to Female ratio of 2.7: 1. Majority of patients were agricultural labourers. Ocular trauma was the major predisposing factor in majority of cases (76%). Out of 100 cases, 75 were culture positive, 64 were bacterial isolates and 36 were fungal isolates. Conclusion:  This study has revealed that suppurative corneal ulcers are caused by both bacterial and fungal agents with bacterial preponderance. A proper understanding of clinical, microbiological characteristics of various etiological agents will enable to initiate appropriate therapy, thereby minimizing the amount of visual loss.

Background: Non-responding pneumonia (NRP) presents a significant challenge in clinical practice, often requiring advanced diagnostic techniques to identify underlying causes. In this context, fiberoptic bronchoscopy (FOB) emerges as a promising tool, offering potential diagnostic and therapeutic benefits in the management of NRP. Aim and Objective: To evaluate the utility of fiberoptic bronchoscopy in diagnosing and managing non-responding pneumonia, focusing on diagnostic yield, impact on clinical management, safety profile, and patient outcomes. Materials and Methods: This study included 100 patients with non-responding pneumonia who underwent FOB. The diagnostic yield was assessed, and changes in clinical management following FOB results were recorded. Complications and patient outcomes were also evaluated, including hospital length of stay and mortality rate. Results: FOB was successful in all patients, with a high overall diagnostic yield of 65%. Diagnoses included bacterial pneumonia (25%), tuberculosis (15%), fungal infections (10%), viral infections (5%), malignancy (10%), and other conditions (15%). These results underscore the effectiveness of FOB in diagnosing a wide range of conditions. Changes in clinical management occurred in 60% of cases, including adjustments in antibiotic therapy and initiation of anti-tuberculosis or antifungal treatments. Minor bleeding and transient hypoxemia were observed in 5% and 8% of patients, respectively. The average hospital stay was 10.2 ± 3.5 days, with patients having a definitive diagnosis through FOB showing a significantly shorter stay than those without a definitive diagnosis (8.5 vs. 13.5 days, p < 0.05). The mortality rate was 10%. Conclusion: Fiberoptic bronchoscopy is a valuable and safe diagnostic tool for non-responding pneumonia. It offers a high diagnostic yield and positively impacts clinical management. The procedure’s safety profile, with minimal complications, provides confidence in its use and its potential to significantly influence patient outcomes.

Introduction: Hypothyroidism, characterized by insufficient thyroid hormone production, affects a significant segment of the population, particularly in India. Recent studies suggest a link between nitrate levels and thyroid dysfunction, potentially contributing to oxidative stress and thyroid damage. This study aims to investigate the relationship between nitrite and thyroid hormone levels, which may reveal potential therapeutic targets for managing thyroid disorders. The findings could have implications for understanding the impact of dietary nitrates after getting converted to nitrites, on thyroid health and developing novel treatments for hypothyroidism and related conditions. Objectives: This study aims to investigate the relationship between serum nitrite levels with serum TSH and FT4 in hypothyroid patients attending KPC Medical College and Hospital. Materials and Methods: This is a cross-sectional study where serum TSH, FT4 and nitrite level was measured and compared in 65 newly diagnosed hypothyroid patients (case) and 65 healthy euthyroid controls at KPC Medical College and Hospital. Results: The positive correlation between serum nitrites and TSH (showing mean nitrite 0.25 ± 0.12 μM/L in cases with mean TSH as 7.76 ± 2.55 mIU/L, compared to 0.13 ± 0.05 μM/L in healthy controls with a mean TSH value of 2.22 ± 1.24mIU/L) and the weak negative correlation with fT4(1.18 ± 0.43 ng/dL in cases compared to 1.42 ± 0.73 ng/dL in controls) seen.

Sex-related crimes against women are a global issue that violate morals, human dignity, and the equality of the genders. Psychiatric disorders, venereal illnesses, attempted suicides, unplanned pregnancies, desire murder, and interpersonal violence are all long-term repercussions of Sexual offenses include sexual assault and violence. Despite strict legislation, notably the POCSO, sexual harassment of women Workplace (Prevention, Prohibition, and Redressal) Act and Criminal Law Amendment Act, sexual offenses, rape, and child abuse are on the rise. Materials and Methods: The study was conducted on 110 female victims of alleged sexual offenses who had consented for medical evaluation and study, while being transported to the Department of Forensic Medicine of a tertiary centre in Assam, India. The study analysed 110 female victims of alleged sexual offenses, during the period of 1st March, 2023 to 29th February 2024. Results: In this study, it was found the highest frequency of cases occurred in the 16- 20 age group. Most victims belonged to lower socio-economic backgrounds (SES Class V). 79.09% of the victims were unmarried, A high number of perpetrators were boyfriends (66.36%). 83.63% of cases reported no substance abuse. Conclusion: The study addressing sexual offenses requires strict law enforcement, societal change, education, and collaboration between legal, medical, and community sectors to ensure victim support, justice, and prevention of sexual violence.

Introduction: Hypothyroidism, characterized by insufficient thyroid hormone production, affects a significant segment of the population, particularly in India. Recent studies suggest a link between nitrate levels and thyroid dysfunction, potentially contributing to oxidative stress and thyroid damage. This study aims to investigate the relationship between nitrite and thyroid hormone levels, which may reveal potential therapeutic targets for managing thyroid disorders. The findings could have implications for understanding the impact of dietary nitrates after getting converted to nitrites, on thyroid health and developing novel treatments for hypothyroidism and related conditions. Objectives: This study aims to investigate the relationship between serum nitrite levels with serum TSH and FT4 in hypothyroid patients attending KPC Medical College and Hospital. Materials and Methods: This is a cross-sectional study where serum TSH, FT4 and nitrite level was measured and compared in 65 newly diagnosed hypothyroid patients (case) and 65 healthy euthyroid controls at KPC Medical College and Hospital. Results: The positive correlation between serum nitrites and TSH (showing mean nitrite 0.25 ± 0.12 μM/L in cases with mean TSH as 7.76 ± 2.55 mIU/L, compared to 0.13 ± 0.05 μM/L in healthy controls with a mean TSH value of 2.22 ± 1.24mIU/L) and the weak negative correlation with fT4(1.18 ± 0.43 ng/dL in cases compared to 1.42 ± 0.73 ng/dL in controls) seen. Conclusion: Our study demonstrates a significant association between serum nitrite levels and thyroid function in hypothyroid patients.

Becker’s nevus is a cutaneous hamartoma, often characterized by unilateral hyperpigmentation and hypertrichosis. It typically appears during adolescence, more commonly in males, and is most often located on the upper torso or shoulder. Though benign, its pathogenesis remains only partially understood. Accumulating evidence suggests a significant role for androgens in its development and clinical expression. While it has well-documented associations in the context of Becker’s nevus syndrome, recent case reports and observations suggest a broader spectrum of dermatological and systemic conditions may occur alongside Becker’s nevus. This case series presents patients with Becker’s nevus who exhibit atypical or rarely reported associations, offering insight into potential androgenic involvement.

Introduction: The growing significance of segmental thoracic spinal anesthesia in daily anesthetic practice has compelled us to conduct a study on healthy patients to rigorously evaluate its feasibility, safety, advantages, and disadvantages. Primary Objectives: To assess the hemodynamic stability of laparoscopic cholecystectomy surgeries under thoracic spinal anaesthesia at baseline, 3min, 6min, 12min,15min, 20min, 30min, 1hr, 2hr, 3hr respectively. Secondary Objectives: To assess the adequacy of the procedure and side-effects associated with the same in all cases. Material and Methods: 40 patients belonging to ASA grade I & II, admitted to Shridevi Institute of Medical Sciences & Research Hospital, Tumkur from January 2024 to December 2024 undergoing elective Laparoscopic Cholecystectomy were taken and Thoracic Segmental Spinal Anaesthesia was administered. The primary objective was to evaluate the effectiveness of thoracic segmental spinal anesthesia in laparoscopic cholecystectomy surgeries by monitoring hemodynamic stability (pulse rate, SpO2, and blood pressure) at various intraoperative intervals, as well as to determine the need for additional intraoperative sedation and analgesia. Result: The thoracic segmental spinal procedure was successfully performed on all 40 patients involved in the study. During the operation, intraoperative hypotension was noted in 11 individuals, while 12 experienced episodes of bradycardia, with one patient requiring a transition to general anesthesia due to the severity of the situation. Additionally, 10 patients reported experiencing shoulder pain during the procedure, with half of these individuals needing supplemental analgesia to manage their discomfort. Remarkably, there were no reports of abdominal pain or nausea among the patients. Following the surgery, the mean Visual Analog Scale (VAS) scores were meticulously collected to assess postoperative pain levels. Conclusion: Thoracic Segmental Spinal Anaesthesia appears to be a Safer alternative to General anesthesia and there is minimal to no requirement for supplementary intraoperative sedation and analgesia.

Background:  Endometrial stromal sarcoma (ESS) is a rare and aggressive malignancy that primarily affects postmenopausal women, with significant impact on quality of life. Its rarity, aggressive behaviour, and limited standard treatments present challenges in classification and management. This case study discusses the complexities of diagnosing, treating, and understanding ESS. Results: Low- grade endometrial stromal sarcoma (LGESS) is a rare and indolent uterine malignancy, often misguiding as benign pathology, thereby posing a diagnostic conundrum, particularly in perimenopausal women. We present the intriguing case of a 40- year- old perimenopausal woman who initially manifested with nonspecific symptoms of abnormal uterine bleeding and abdominal mass. Radiological evaluation revealed a suspicious malignancy in right adnexa, prompting surgical intervention. Histopathological examination, complemented by immunohistochemical profiling, confirmed the diagnosis of LGESS. This case underscores the imperative of maintaining a high index of suspicion for uterine sarcomas in atypical presentations and highlights the nuances in the diagnostic and therapeutic approach to this uncommon neoplasm. Through this report, we aim to enrich the existing clinical discourse and advocate for heightened vigilance in the evaluation of perimenopausal uterine pathology. Conclusion: Endometrial stromal sarcoma’s scarcity and aggressiveness underscore the need for tailored approaches to diagnosis and management. Surgical intervention and adjuvant therapies, while considered, offer limited efficacy. Molecular analysis holds promise for personalized treatment strategies. Despite advances, the prognosis remains unfavourable, necessitating continued research and innovation to address the intricacies of ESS comprehensively.

Introduction: The most prevalent pancreatic condition seen in emergency rooms is acute pancreatitis (AP).  According to a prospective study, 9.1% of people die from AP.  Acute kidney injury (AKI), respiratory failure, and heart failure are only a few of the local and systemic consequences that can quickly result from AP and can be fatal. Aims: This study aims to evaluate the role of serum lactate dehydrogenase (LDH) levels in predicting the severity of acute pancreatitis. It also seeks to assess the association between LDH levels and clinical outcomes in patients admitted to a tertiary care hospital. Materials & Methods: Study design was Retrospective study. This Study was conducted from One year January 2024 – December 2024 at department of General Medicine, Murshidabad Medical College & Hospital, Station Road, Berhampore, Murshidabad, West Bengal, Pin-742101 and total sample size were 130 patients. Result: Patients with elevated LDH had a significantly higher WBC count (14.5 ± 4.8 ×10⁹/L) compared to those with normal LDH (11.2 ± 3.5 ×10/L, p < 0.01). Although serum amylase and lipase levels were also higher in the elevated LDH group (390 ± 150 U/L and 480 ± 200 U/L, respectively), the differences were not statistically significant (p = 0.12 and p = 0.08, respectively). Conclusion: We concluded that serum levels of lactate dehydrogenase (LDH) can be a useful biomarker for estimating the severity and clinical trajectory of acute pancreatitis.  While patients with normal LDH were more likely to experience additional serious consequences including pancreatic necrosis and myocardial infarction, elevated LDH levels were linked to more respiratory difficulties such the requirement for tracheal intubation.

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the axial skeleton, particularly the sacroiliac joints and spine. It typically presents in young adults aged 20-40, with a male predominance and strong association with HLA-B27. Early symptoms are often vague, leading to diagnostic delays of 5-10 years. Magnetic resonance imaging (MRI) has revolutionized early diagnosis by detecting both active inflammation and chronic structural changes before they become visible. MRI offers higher sensitivity than X-rays, and chronic MRI findings aid in staging and monitoring. Other imaging modalities have limited roles, such as CT, ultrasound, and PET. Imaging is crucial for monitoring treatment response and detecting sacroiliac joint involvement in AS cases. Aims: To highlight the critical role of imaging in detecting sacroiliac (SI) joint involvement, which is present in the majority of ankylosing spondylitis (AS) cases, for early diagnosis and effective disease management. Materials and Methods: The present study was an Observational, retrospective or prospective study. This Study was conducted from One year January 2024- December 2024 at department of General Medicine, Murshidabad Medical College & Hospital, Station Road, Berhampore, Murshidabad, West Bengal, Pin-742101. Study population 50. Result: A total of 50 patients (mean age: 32.4 ± 8.1 years; 76% male) were studied, with 84% showing HLA-B27 positivity and a mean BASDAI score of 5.2 ± 1.3. Radiographically, 66% had definite sacroiliitis (Grade ≥2), with Grade 3 being most common (36%). MRI revealed BME in 78%, sclerosis in 68%, erosions in 64%, and ankylosis in 18%, all correlating with significantly higher BASDAI scores (p < 0.05). Bilateral symmetrical SI joint involvement was most frequent (52%), followed by bilateral asymmetrical (28%), right unilateral (12%), and left unilateral (8%). Conclusion: The study reveals that most patients with suspected ankylosing spondylitis (AS) show sacroiliac joint involvement, with 66% showing definite sacroiliitis and 78% showing bone marrow edema. High HLA-B27 positivity and elevated inflammatory markers support active AS diagnosis, emphasizing MRI’s critical role in early diagnosis.

Background: Hidradenitis suppurativa is a chronic, inflammatory, disfiguring dermatological disorder, recalcitrant to treatment and hampers the mental condition of the patients. This study attempted to access the common psychiatric comorbidities in patients of Hidradenitis suppurativa. Methods: 60 patients of Hidradenitis suppurativa were recruited through purposive sampling. Hidradenitis suppurativa was staged according to Hurley Staging. Self-report data was gathered using standardized questionnaires for psychological distress, depression and anxiety. Statistical analysis was conducted to examine correlations between these psychosocial variables and the degree of marital discord. Results: Half of our patients had significant psychological distress as evidenced by GHQ-12 scores. 46.7% of our patients scored above cut off for both anxiety and depression subscale of HADS. There was significant association between Hurley stage of illness and the presence of psychological distress, including anxiety and depression. Conclusion: The strong association between disease severity and the prevalence of psychological distress, anxiety and depression calls for a comprehensive and multidisciplinary approach to patient care. By recognizing the significant mental health challenges faced by HS patients, healthcare providers can develop targeted interventions that address both the physical and emotional aspects of the disease.

Background: Critically ill patients need diagnostic imaging tools that are available, non-invasive and accurate for better diagnosis and outcome. With the recent increased use of portable ultrasound machines, which is easily available, bedside technique, safe and relatively cheap, sonography can be used to diagnose chest pathologies in critically ill patients. Aims and Objectives: To study the role of chest sonography in critically ill patients to diagnose various lung pathologies and to confirm the findings with CT correlation. Materials and Methods: This is a cross sectional single institutional observational study of 85 cases of chest ultrasound for the period of about one and half year in our institution .Of 85 cases included in the study, 43 are male and 42 are female. 10 cases belong to 10-19 years age group, 7 cases belong to 20-29 years, 11 cases belong to 30-39 years, 18 cases belong to 40-49 years, 32 cases belong to 50-59 years and 7 cases are above 60 years. Results: Our study shows that the sensitivity and specificity of the bedside chest ultrasonogram is good in most pathologies, better than chest X ray and as good as a computed tomography of the chest. It required only an average of 10 minutes to do the entire scan. It is also more affordable than a CT of the chest. Conclusion: We found that the chest ultrasound was better than chest radiograph and in most cases as good as a CT. Steps should also be taken that a low cost ultrasound machine be available in medical wards so that clinical diagnosis can be aided with this useful tool. It would be a useful step to include training in the basics of bedside chest ultrasonography for all residents as it has proved to be a useful tool in diagnosis, procedures and initiation of appropriate therapy.

Tranexamic acid is a commonly used antifibrinolytic agent for controlling postoperative and traumatic bleedings. Seizures are a rare but serious side effect of its use especially in patients with chronic kidney disease. We report two cases of chronic kidney disease who underwent surgery for closure of A-V fistula and uterine prolapse respectively, developed seizure and neuropsychiatric symptoms after receiving Tranexamic acid.

Background: Severe pre-eclampsia remains a major contributor to maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries. Rapid control of hypertension is critical in reducing complications. Labetalol and Nifedipine are both widely used antihypertensives, but their comparative efficacy and safety in severe pre-eclampsia remain subjects of ongoing clinical interest. Materials and Methods: This randomized clinical study was conducted at a tertiary care hospital and included 64 pregnant women with severe pre-eclampsia, randomly allocated into two groups (n=32 each). Group A received intravenous Labetalol, and Group B received oral Nifedipine. Time to achieve target systolic blood pressure (<150 mmHg), total antihypertensive dose required, maternal side effects, and fetal outcomes were assessed. Statistical analysis was performed using SPSS version 23.0, with significance set at p<0.05. Results: Labetalol demonstrated a significantly faster reduction in systolic blood pressure, with a greater proportion of patients achieving target BP within 30 minutes (p=0.012). Additionally, fewer doses were required to achieve blood pressure control in the Labetalol group compared to Nifedipine (p=0.038). However, both groups showed no significant differences in maternal ICU admissions, need for intubation, or mode of delivery. Neonatal outcomes, including NICU admission rates and birth status, were also comparable. Side effects such as dizziness and headache were more frequently reported in the Nifedipine group but did not differ significantly. Conclusion: Both intravenous Labetalol and oral Nifedipine are effective and safe in managing severe pre-eclampsia. Labetalol offers a quicker response with lower dosage requirements, while Nifedipine remains a suitable alternative, especially where IV access is limited.

Background: Dyslipidemia is a major modifiable risk factor for cardiovascular disease. While rosuvastatin effectively lowers LDL-C, combination therapy with fenofibrate may offer added benefits in improving triglyceride and HDL-C levels. This study aimed to evaluate and compare the short-term effects of rosuvastatin alone versus its combination with fenofibrate on lipid profile and biochemical parameters in patients with mixed dyslipidemia. Materials and Methods: A prospective, randomized, open-label study was conducted at a tertiary care center involving 262 patients with mixed dyslipidemia. Participants were randomized equally into two groups: one receiving rosuvastatin 10 mg daily and the other receiving a fixed-dose combination of rosuvastatin 10 mg with fenofibrate 160 mg. Hematological, renal, hepatic, glycemic, and lipid parameters were assessed at baseline and after 30 days of treatment. Statistical comparisons were made using unpaired t-tests, with p < 0.05 considered significant. Results: Both regimens led to significant improvements in lipid profiles over 30 days. Rosuvastatin monotherapy achieved a greater reduction in LDL-C, while the combination group showed superior improvements in HDL-C and triglyceride levels. Mild elevations in hepatic transaminases and HbA1c were more pronounced in the combination group. Renal markers, including serum creatinine and BUN, were elevated in the rosuvastatin group, whereas uric acid levels were higher with combination therapy. Adverse events differed between groups, with musculoskeletal symptoms more frequent in the monotherapy group and gastrointestinal complaints more common in the combination group. Conclusion: Rosuvastatin–fenofibrate combination therapy offers enhanced control of HDL-C and triglycerides, whereas rosuvastatin monotherapy remains more effective for LDL-C reduction with fewer hepatic side effects. Treatment selection should consider individual lipid targets and tolerability.

Human metapneumovirus (hMPV) is an emerging and underrecognized respiratory pathogen that plays a significant role in the global burden of acute lower respiratory infections (ALRI), particularly among infants, older adults, and immunocompromised individuals. Since its discovery in 2001, hMPV has been identified as a widespread cause of both sporadic and seasonal respiratory illnesses across all age groups. This review provides a comprehensive overview of the current understanding of hMPV, including its epidemiological patterns, virological characteristics, clinical manifestations, and public health implications. The virus displays marked seasonality, with infection rates peaking in late winter and early spring in temperate climates, while circulation patterns in tropical regions remain variable. hMPV belongs to the family Paramyxoviridae, genus Metapneumovirus, and possesses a negative-sense, single-stranded RNA genome encoding key structural proteins such as the conserved fusion (F) protein and the highly variable attachment (G) protein. Genetic diversity, particularly in the G protein, contributes to immune evasion and poses challenges for vaccine development. Clinically, hMPV infection ranges from mild upper respiratory symptoms to severe lower respiratory tract diseases such as bronchiolitis and pneumonia, with heightened severity observed in high-risk populations. Co-infection with other respiratory viruses, including RSV and influenza, can further increase morbidity. Despite its global prevalence and clinical relevance, hMPV remains underdiagnosed due to limited routine testing and overlapping symptomatology with other respiratory viruses. Ongoing research into hMPV pathogenesis, host immune responses, and vaccine development is essential for reducing its disease burden and improving patient outcomes.

Introduction: Budd-chiari syndrome is a rare disease characterized by hepatic venous outflow. Diagnosis is based on demonstration of hepatic venous outflow obstruction. Venography is mainstay for definitive diagnosis and for the characterisation of anatomy of obstructed veins and collaterals. This enables us to decide regarding surgical correction or endovascular therapy. Aim: To evaluate the role of colour doppler imaging in evaluation of hepatic veins, IVC and portal vein in budd chiari syndrome and to compare with cross sectional imaging and trans catheter venography and to assess the usefulness of venous pressure measurement in budd chiari syndrome. Materials and Methods: The study group includes 30 pat ients clinically diagnosed budd chiari syndrome referred to intervention radiology of Government Stanley medical college for transcatheter venography. Their Doppler findings are compared with transcatheter venography. Results: The right, middle, left hepatic veins and IVC Doppler findings correlated with transcatheter venography study in the cases of BCS. The colour Doppler findings helps in identifying the direction of the flow. Whether the flow is towards the IVC and to the right atrium or away from the IVC. The common pitfall encountered is that the dilated collaterals sometimes mimic normal hepatic vein. But with proper evaluation, complete tracing of the vessel and direction of the flow differentiated the collaterals from the hepatic vein. Conclusion: The present study has showed that results with Doppler are comparable to that of Tran’s catheter venography. There is no risk of radiation and infection with Doppler study and can be done immediately on receiving the patient in the healthcare facility. So Doppler can be preferred for diagnosis and for the follow up of budd chiari syndrome over Tran’s venous catheterization.

Background: Spinal anesthesia is commonly employed for lower limb procedures owing to its rapid onset and efficient sensory and motor blocking. However, it poses a danger of hemodynamic instability, especially hypotension, due to sympathetic blocking. The purpose of this study was to assess the efficacy of the Inferior Vena Cava Collapsibility Index (IVC-CI) as a prognostic indicator of hypotension at varying degrees of dermatomal blocking subsequent to spinal anesthesia. Methods: A prospective observational research was performed on 30 adult patients undergoing elective lower limb procedures with spinal anesthesia with 0.5% hyperbaric bupivacaine. Ultrasound was used to measure the IVC-CI before and after the spinal anesthesia. We measured the baseline and lowest post-spinal mean arterial pressure (MAP) to figure out how much MAP had gone down. The level of sensory block in the dermatomes was recorded, and the occurrence of hypotension was examined in relation to IVC-CI and block height. Results: There was a statistically significant rise in post-spinal IVC-CI (p = 4.98 × 10⁻¹⁷) and a significant decrease in MAP (p = 1.74 × 10⁻²³) after spinal anesthesia. There was a strong link between post-spinal IVC-CI and the number of people who had hypotension. Even though higher dermatomal blocks (T6–T8) had a higher rate of hypotension, there was no statistically significant link between block level and MAP drop. Conclusion: Pre-spinal IVC-CI is a dependable, non-invasive forecaster of hypotension subsequent to spinal anesthesia. Adding IVC-CI to the pre-anesthetic exam may help find patients who are at risk of spinal-induced hypotension and help with better fluid management.

Background: Anesthesiology is a critical and diverse medical specialty, yet public awareness of anesthesiologists’ comprehensive role, especially beyond the operating room, remains limited. Understanding patient knowledge and perceptions is vital for enhancing trust, improving patient-provider interaction, and ultimately elevating peri-operative safety and care quality. Aim: This study aimed to assess the knowledge and perceptions of patients undergoing elective surgery regarding anesthesia services, anesthesiologists’ roles, and preoperative concerns, comparing individuals with no prior surgical experience to those with previous surgeries. Methods: A cross-sectional study was conducted over six months at a tertiary care teaching hospital, involving 200 adult patients (18-65 years, ASA I-II) scheduled for elective surgery. Participants were stratified into first-time (n=100) and previously operated (n=100) groups. Data were collected using a 24-item questionnaire, designed to assess knowledge about anesthesia, anesthesiologists, and potential complications. The questionnaire underwent expert review for content validity and informal patient assessment for face validity, and was available in Kannada and English (with forward and backward translation). Statistical analysis primarily utilized descriptive statistics and chi-square tests of independence. Results: The cohort consisted of 200 rural patients (56.5% female, 78% educated, mode age 31-50 years). A strong association was found between higher educational attainment and greater knowledge about anesthesia (χ2=22.68, p<0.001), anesthesiologists (χ2=21.66, p<0.001), and general postoperative complications (χ2=16.96, p<0.001). However, knowledge of postoperative behavioral complications was not significantly linked to education (χ2=1.58, p=0.454). Prior surgical experience significantly influenced perceptions and fears: previously operated patients reported less overall fear (χ2=8.58, p=0.003) and notably less fear of not waking up (χ2=6.620, p=0.010) compared to first-time patients. They were also significantly more likely to identify anesthesiologists as responsible for perioperative pain relief (70% vs. 21%; χ2=48.412, p<0.001) and acknowledge their comprehensive managing role in the OR (18% vs. 7%; χ2=4.571, p=0.033). Despite this, awareness of anesthesiologists’ roles outside the OR remained severely limited (e.g., pain clinic 4%, labor room 2%, 0% for ICU/MRI/CT), and a significant disparity existed in recalling anesthesiologist names (20%) versus surgeon names (79%). Conclusion: Significant gaps persist in patient knowledge regarding anesthesiologists’ roles, particularly outside the operating room. While prior surgical experience mitigates some fears and improves understanding of anesthesiologists’ intraoperative and pain management responsibilities, foundational knowledge is strongly linked to education. These findings underscore the urgent need for targeted patient education strategies to enhance awareness, foster trust, and improve the patient-anesthesiologist relationship for better peri-operative outcomes.

Background: Mental health disorders, including schizophrenia and bipolar affective disorder (BPAD), impose significant burdens on patients and their caregivers. Schizophrenia is characterized by chronic cognitive and behavioral impairments, while BPAD involves episodic mood fluctuations. Caregivers face emotional, financial, and social challenges, yet differences in burden between these disorders remain understudied. Materials & Methods: A cross-sectional study was conducted over 16 months (January 2024–April 2025) involving 120 patients (60 schizophrenia, 60 BPAD) and their primary caregivers. Caregiver burden was assessed using the Family Burden Interview Schedule (FBIS), while symptom severity was measured with PANSS (schizophrenia), YMRS, and HAM-D (BPAD). Statistical analysis included descriptive and inferential tests (t-tests, chi-square, correlation) using SPSS 23.0. Results: Sociodemographic profiles of patients and caregivers were comparable, except for illness duration (shorter in schizophrenia, p=0.002). BPAD caregivers reported higher objective burden (mean=22.35 vs. 17.53, p=0.001), particularly in physical health impact (p=0.03). Schizophrenia caregivers experienced more severe global burden (p=0.035). PANSS total scores correlated significantly with burden in schizophrenia (r=0.454, p=0.001), but no such association was found for mood symptoms in BPAD with HAM-D and YMRS total scores. Conclusion: This study reveals distinct caregiver burden patterns in schizophrenia and bipolar affective disorder (BPAD). BPAD caregivers experienced higher objective burden, driven by the disorder’s episodic unpredictability, while schizophrenia caregivers faced greater global burden due to chronic symptom severity. Symptom severity in schizophrenia (PANSS) correlated significantly with burden, whereas BPAD burden was independent of mood symptoms severity (HAMD/YMRS), suggesting psychosocial influences. Demographic factors had minimal impact, emphasizing the role of clinical and contextual factors. Tailored interventions are needed—addressing chronicity in schizophrenia and episodic strain in BPAD. Future research should explore psychosocial and cultural mediators to optimize caregiver support strategies.

Introduction: Hepatitis B virus (HBV) poses a significant occupational hazard for medical students. Although the recombinant Hepatitis B vaccine is widely administered and considered safe, adverse drug reactions (ADRs) remain underreported in this population. Objective: To evaluate the incidence, type, severity, and timing of ADRs following Hepatitis B vaccination among medical students. Method: A prospective observational study was conducted on 150 medical students at Zydus Medical College, Dahod. Participants received three doses of the Hepatitis B vaccine (rDNA, BEVAC) and were monitored for ADRs at 1 hour, 24 hours, and 72 hours post-vaccination using structured questionnaires. Causality assessment was performed using WHO-UMC criteria. Result: ADRs were reported in 21.33%, 16%, and 11.33% of students after the first, second, and third doses respectively. The majority of reactions occurred within 24 hours and included fever, injection site pain, fatigue, and headache. All reactions were mild to moderate and self-limiting. No serious adverse events were observed. Conclusion: The Hepatitis B vaccine demonstrated a favourable safety profile in medical students. Routine monitoring and reporting of ADRs should be emphasized to strengthen pharmacovigilance, especially among future healthcare providers.

Background: Acute abdomen is the common cause of emergency admissions.  USG plays an important role in the diagnosis of disease. Material and Methods: This study was done on patient presented with acute abdomen. Scout X-ray done in 250 patients. Scout X –Ray film gives lots of information and very helpful in diagnosing perforation and intesinal obstruction. Results: X-Ray was 100% diagnostic in cases of perforation peritonitis. Intestinal obstruction was diagnosed in 95.55% cases. Conclusion: This study shows that simple X-Ray plays an important role in definite diagnosis of acute abdomen.

Background: To determine the accuracy of diffusion-weighted imaging (DWI) for the diagnosis of cervical lymph node metastasis from oral cancer. Methods: Hospital Based Descriptive type of Observational Study was conducted on biopsy proven patients (in patients or out patients) of oral cancer with enlarged neck nodes at or below clinical stage T4a referred to the department of Radio-diagnosis for MRI examination. Results: Clinical and MRI T stage when compared histopathologically results in 35.40% and 80.50% accuracy rate respectively. Kappa value for clinical data was 0.05and for MRI data was 0.72. MRI showed better T staging of primary tumor than clinical assessment when compared histopathologically. Conclusion: MRI assessment of tumour staging augments clinical findings to plan appropriate therapy.

To study the MRI findings and CSF analysis in patient diagnosed with tuberculoma. It was a cross-sectional observational study was conducted on tuberculoma patients. MRI had a sensitivity of 90.00%, specificity of 94.00% with a diagnostic accuracy of 92.00%. Three false negative cases were diagnosed as neurocysticercosis on MRI. One case of astrocytoma was falsely picked as tuberculoma on MRI. This patient had peripherally enhanced lesion on T1 contrast, hypointense lesion on T2, infratentorial lesion with perilesional edema. MRI has a huge potential superiority in the diagnosis of CNS infections.

Background: The widespread use of the internet among youth has led to increased concerns regarding internet addiction and its impact on mental health, particularly among medical students who are already under significant academic pressure. This study aimed to assess the prevalence of internet addiction and its association with psychological distress among undergraduate medical students. Methods: A cross-sectional study was conducted over three months at Bhaskar Medical College, Hyderabad, involving 400 undergraduate medical students. Data were collected using a socio-demographic questionnaire, Young’s Internet Addiction Test (YIAT), and Kessler Psychological Distress Scale (K10). Statistical analysis included descriptive statistics, chi-square tests, and correlation analysis. Results: The majority of participants (49.5%) were aged 21–24 years, with 51.75% being male. Internet addiction was prevalent in 85% of students, with 42% exhibiting mild and 41.75% moderate levels. Psychological distress was present in over half the participants, with 26.5% experiencing severe distress. A significant association was observed between duration of internet use and levels of internet addiction (χ² = 42.47, p < 0.001). A strong positive correlation was also found between internet addiction and psychological distress (r = 0.67, p < 0.001), indicating that higher addiction levels were associated with increased distress. Conclusion: Internet addiction and psychological distress are significantly prevalent and interrelated among medical students. These findings underscore the need for targeted mental health support, regular screening, and digital well-being interventions in medical education settings.

Background: When there is over storage of deposits of bilirubin in the body causes neonatal hyperbilirubinemia (NH), commonly referred to as jaundice in the neonatal, which is mainly seen as coloring of skin as yellow. Objectives- Serum bilirubin levels and associated risk factors for newborn jaundice were determined by the study. Materials and Methods: The study was retrospective in nature. The study was carried out at GMERS Medical College, Junagadh, Gujarat, India. The study was done for one year. In all, 150 patients were enrolled. Neonates ≥37 weeks who were otherwise healthy met the inclusion requirements. Results: Out of all participants, 68 (45.5%) were discovered to be female, while 82 (54.5%) were found to be male. Just two (1.5%) of the babies were post-term (>42 weeks), while 37 (24.5%) were born between 40.1 and 42 weeks. Only 8 babies (5.5%) had TSB values < 3 mg/dL, whereas the majority of the newborns (62, 41%) had TSB in the 4.0–4.9 mg/dL range, followed by TSB >6 mg/dL in 21 newborns (14%). Conclusion: The relationship between total serum bilirubin (TSB) levels and gestational age is inverse. Most babies have elevated serum bilirubin levels between 37 and 40 weeks of gestation. To avoid difficulties in the baby, hyperbilirubinemia must be detected early and treated appropriately.

Background: It is impossible to overestimate the significance of early cardiovascular disease (CVD) detection and monitoring, and biomarkers play a key role in this process. A specific state or disease, or normal or aberrant processes, might be indicated by biochemical biomarkers, that basically are molecules which are biological and can be there in blood, fluids of the body and the tissues. Objectives: In this study, we used biomarkers like CK-MB/Trop-I to determine early cardiovascular disease diagnosis. Materials and Methods: The study was prospective in nature. The study was carried out at GMERS Medical College, Junagadh, Gujarat, India. The study was done for one year. In all, 150 patients were enrolled. Participants had to be at least eighteen years old and report of acute chest pain in order to be eligible. Results: 67 people with AMI had normal hs-Troponin I levels, whereas 83 participants with higher hs-Troponin I levels experienced AMI. Participants with unstable angina, LRTI, COPD, or GERD did not exhibit high or normal hs-Troponin I levels. Nine individuals with AMI had normal CK-MB levels, whereas 74 people with high CK-MB levels were found to have AMI. While 26 subjects had normal CK-MB values, 08 persons had increased CK-MB associated with unstable angina. Conclusion: AMI necessitates prompt identification and treatment, according to the current study. AMI can be distinguished from other disorders with the help of cardiac markers in early diagnosis. Troponin I is the most sensitive and specific cardiac marker among those examined for the diagnosis of acute myocardial infarction.

Background: 1.9% of all fractures are fractures in the tibial shaft, making them the most frequent fractures in the long-bone. Early weight bearing (EBW) prior to bone union raises concerns since it may result in implant failure and reduced stability. Objectives: In tibial shaft fractures treated by IM nailing, the study aims to evaluate the results of delayed versus EWB. Materials and Methods: The study was retrospective in nature. The study was carried out at GMERS Medical College, Junagadh, Gujarat, India. The study was conducted for one year. In all, 150 patients were enrolled. Participants had to be at least 18 years old and under 65 years old, and they had to have fractures in the segmental tibia of open and closed both till grading of IIIA Gustilo Anderson. Results: The mean age was 46 years, with the range between 29-61 years of age. Among all, 107 (71.3%) of participants were male, while 43 (28.7%) of participants were female. Smoking history was seen in 45 (35.5%) of participants. With an average healing period of 15.3 weeks as opposed to 18.5 weeks in the delayed group, patients in the EWB group had noticeably faster radiographic union with a p-value less than 0.001.

Conclusion: With no higher risk of complications like infection, non-union, or malunion, this retrospective analysis shows that EWB after IMN for fractures in the tibial shaft is linked to significantly faster radiological union, better functional outcomes, and an earlier return to work than delayed weight-bearing.

Background: Increase in spread of both necrosis and inflammation of tissues of subcutaneous, skins, and fascia that is superficial are hallmarks of necrotizing soft tissue infection (NSTI), which is an infection of bacterial. This includes cellulitis, myositis, and fasciitis that necrotizes. Objectives: Achieving appropriate and healing of wound early in individuals with wounds are open caused by necrotizing fasciitis (NF) is the goal of our investigation. Materials and Methods: The study was retrospective in nature. The study was carried out at GMERS Medical College, Junagadh, Gujarat, India. The study was conducted for one year. In all, 150 patients were enrolled. Everyone from 12 to 75 years old who is having surgery in emergency for NF of the lower or upper limbs were assessed. Pregnant patients, patients with bleeding problems, patients with pre-existing life-threatening comorbidities, patients with GCS less than 10, and patients with gangrene of Fournier’s were all excluded from the study. Results: The majority of participants, 18 (24%) in Group A and 21 (28%) in Group B, were between the ages of 41 and 50. Fifteen (20%) and eighteen (24%), respectively, of the participants in Group A and Group B were under thirty years of age. Group A experienced a significantly higher mean frequency of re-debridement 2.05 ± 0.05 than Group B 1.95 ± 0.05. Conclusion: This retrospective analysis shows that VAC therapy is a better way to treat open wounds after NSTIs than traditional dressings. Particularly in the first several weeks following surgery, patients treated with VAC dressing needed fewer dressing changes, felt less discomfort, and needed re-debridement less frequently.

Background: Primary bone tumors are uncommon but clinically significant entities due to their potential for malignancy and morbidity. Accurate diagnosis relies on a multidisciplinary approach, primarily involving radiological and histopathological correlation. Understanding the concordance between these modalities is essential for improving diagnostic accuracy and treatment outcomes. Aim: To evaluate the histopathological spectrum of primary bone tumors over a three-year period and to assess the correlation between radiological and histopathological findings in a tertiary care setting. Methods: This retrospective observational study was conducted at Rajarajeswari Medical College and Hospital, Bengaluru, over a three-year period. A total of 120 cases of primary bone tumors were included. Data were collected from institutional pathology and radiology records. Inclusion criteria encompassed cases with complete clinical, radiological, and histopathological information. Statistical analysis was performed using SPSS version 23.0, and the degree of agreement between radiological and histopathological diagnoses was assessed using the kappa coefficient. Results: Among the 120 cases, 68 (56.7%) were male and 52 (43.3%) were female, with a mean age of 29.4 ± 12.6 years. Benign tumors (60%) were more common than malignant tumors (40%). The most frequent benign tumor was osteochondroma (18.3%), while osteosarcoma (21.7%) was the most common malignant tumor. The femur was the most frequently affected site (30%). Radiological and histopathological diagnoses were concordant in 104 cases (86.7%). The kappa value was 0.78, indicating substantial agreement (p < 0.001). Sensitivity and specificity of radiological assessment for malignancy were 91.7% and 87.5%, respectively. Conclusion: There is a high degree of correlation between radiological and histopathological diagnoses in primary bone tumors. However, histopathological confirmation remains essential, especially in ambiguous or borderline cases, to avoid diagnostic errors and guide appropriate management. Recommendations: A multidisciplinary approach involving both radiologists and pathologists is recommended for accurate diagnosis. Continued emphasis on training in musculoskeletal tumor radiology and pathology, along with the use of standardized classification criteria, can further improve diagnostic consistency and patient outcomes.

Aims: Comparison of onset of action of sensory and motor block and the duration of action of buprenorphine with levobupivacaine and buprenorphine with ropivacaine and to compare hemodynamic effects of drugs. Setting and Design: A One-Year Randomised Clinical Trial. Materials and Methods: Total of 70 adult patients of either sex, ASA grade I – II, scheduled for lower abdominal surgery were enrolled in the study and randomized into two groups. Group LB received 14.5ml of 0.5% Levobupivacaine + Inj Buprenorphine 150mcg (0.5ml) making volume 15ml. Group RB received 14.5ml of 0.75% plain Ropivacaine + Buprenorphine 150 mics (0.5ml) making volume 15ml. The onset and duration of sensory-motor block, hemodynamic variables (HR, SBP, DPB, MAP, RR), and duration of analgesia were recorded. Result: Sensory and motor blockade onset was earlier in group RB than in group LB. The duration of sensory and motor blockade was earlier in group LB than in group RB. The mean hemodynamic parameters were comparable in both groups. Conclusion: In adults undergoing lower limb surgery, the LB group produced a longer duration of action with late onset of sensory and motor block than the RB group. Hemodynamic effects were comparable.

Background: Breast lesions, both benign and malignant, pose significant diagnostic challenges in clinical practice. Early and accurate diagnosis is critical for appropriate treatment and management. Fine Needle Aspiration Cytology (FNAC), cell block preparation, and histopathology are widely used diagnostic techniques. FNAC is commonly utilized for its convenience and speed; however, it sometimes lacks sufficient tissue for definitive diagnosis. Cell block preparation, which involves creating tissue blocks from FNAC aspirates, has been suggested to improve diagnostic accuracy by preserving tissue architecture. Histopathology remains the gold standard for diagnosing breast lesions, offering detailed insights into lesion morphology. Aim: The aim of this study was to prospectively compare the diagnostic accuracy and correlation of FNAC, cell block, and histopathology in the diagnosis of breast lesions and to assess the added value of the cell block technique. Methods: A total of 53 female patients, aged 18–70 years, who presented with breast lumps at SRM Medical College and Hospital, Bhawanipatna, Kalahandi, were enrolled in this prospective study. All participants underwent FNAC, followed by cell block preparation and histopathological examination. Diagnostic accuracy was evaluated by comparing FNAC and cell block results with histopathology as the reference standard. Sensitivity, specificity, and diagnostic accuracy were calculated, and Cohen’s kappa statistic was used to assess inter-method agreement. Results: Out of 53 cases, histopathology confirmed 27 benign and 26 malignant lesions. FNAC identified 31 benign, 19 malignant, and 3 suspicious cases. Cell block detected 29 benign and 21 malignant lesions. The sensitivity, specificity, and diagnostic accuracy were higher for cell block (sensitivity 92.3%, specificity 96.3%, accuracy 94.3%) compared to FNAC (sensitivity 84.6%, specificity 92.6%, accuracy 88.7%). Cohen’s kappa values indicated substantial agreement between FNAC and histopathology (κ = 0.77) and almost perfect agreement between cell block and histopathology (κ = 0.88). Conclusion: The study demonstrated that cell block preparation enhances the diagnostic performance of FNAC in breast lesions, providing higher sensitivity and specificity, with nearly perfect agreement with histopathology. FNAC, though valuable, has limitations in certain cases that can be overcome with cell block preparation. Recommendations: It is recommended that cell block preparation be incorporated as an adjunct to FNAC in clinical practice for more accurate and reliable diagnosis of breast lesions. Further studies with larger sample sizes and multicentric data could help establish standardized protocols for the use of cell block in breast pathology.

Penoscrotal elephantiasis is a rare condition characterized by chronic lymphedema of the external genitalia, often resulting in gross disfigurement and significant psychological and functional morbidity. We present the case of a 38-year-old male with massive, painless penoscrotal swelling persisting for five years. Examination and diagnostics confirmed that diagnosis as penoscrotal elephantiasis. The patient was subsequently managed surgically. The surgical protocol involved a 2-phase approach, with reconstruction of penis in phase 1, followed by scrotal reconstruction, 2 weeks later. The surgery was effective and without complications. The final result was seen 4 weeks post operatively with no significant cosmetic or functional deficits.

Background: Melasma is a common acquired hyperpigmentation disorder that predominantly affects sun-exposed areas of the face, often leading to significant cosmetic disfigurement and psychological distress. Its chronic course and recurrence can substantially impair patients’ quality of life (QoL). This study aims to assess the impact of melasma severity on QoL in patients attending a tertiary care center in Central India. Aims and Objectives: To evaluate the quality of life in melasma patients using the Melasma Quality of Life Scale (MELASQOL) and correlate it with disease severity measured by the Melasma Area and Severity Index (MASI). Materials and Methods: This was a cross-sectional study involving 250 clinically diagnosed melasma patients aged 18 years and above. The severity of melasma was assessed using the MASI score, and quality of life was evaluated using the MELASQOL questionnaire. Data were analyzed using descriptive statistics, Pearson correlation, t-tests, and ANOVA. A p-value <0.05 was considered statistically significant. Results: Out of 250 patients, 86% were females and 14% were males, with a mean age of 34.8 ± 7.9 years. Moderate melasma (MASI 8–16) was observed in 56.4% of cases. The mean MELASQOL score was 10.92 ± 4.5, indicating a moderate to severe impact on QoL. A significant positive correlation was found between MASI and MELASQOL scores (r = 0.71, p < 0.001). Females, patients over 35, and those with longer disease duration (>3 years) showed significantly higher MELASQOL scores. Conclusion: Melasma considerably impacts the quality of life, which increases with disease severity. The findings underscore the importance of incorporating QoL assessments in routine dermatological practice and addressing psychosocial components in comprehensive melasma management.

Background: Recent guidelines from the National Medical Commission have given formative assessment increased emphasis. Continuous monitoring of student progress, along with structured learning and timely feedback, is vital. Effective formative assessment not only enhances their understanding but also contributes to better outcomes in summative evaluations and future professional success. Objectives: The present study aims to explore multiple facets of formative assessment within the context of pharmacology education. It seeks to evaluate how students perceive the effectiveness of formative assessments in deepening their understanding of pharmacological concepts. Additionally, the study focuses on assessing student satisfaction with the quality and usefulness of feedback received during these assessments. Another objective is to identify the perceived strengths and limitations of formative assessment as experienced by students in this discipline. Furthermore, the research intends to gather constructive suggestions from students to improve the design and implementation of formative assessments in pharmacology theory, with the ultimate goal of enhancing their academic engagement and learning outcomes. Material and Methods: This cross-sectional study was done among all 180 second professional year undergraduate medical students from Dr. LNP Government Medical College, Ratlam, Madhya Pradesh, from August 2024 to September 2024. After a brief introductory session about formative assessment, a questionnaire was given to all students following informed consent. The participants had 30 minutes to fill out the questionnaire. The questionnaire contained 20 questions, including different aspects of formative assessment. Changes in response concerning awareness of formative assessment were calculated. Results: The findings revealed that a significant proportion of students—110 (69.6%)—expressed satisfaction with the integration of formative assessments within each module. Additionally, 120 students (75.9%) acknowledged that these assessments were conducted on a regular basis. However, 22% of the respondents expressed disagreement with the overall assessment plan. A majority of students, 104 (65.8%), agreed that formative assessments contributed positively to their learning process and served as a motivational tool to enhance their engagement with the subject matter. In contrast, only 32 students (20.2%) did not perceive these assessments as beneficial for learning. The aspect of feedback and remedial support appeared to be comparatively less effective; only 50 students (31.6%) felt that the feedback provided was both useful and timely. While many students were dissatisfied with the quality of feedback, they reported a general sense of satisfaction with the remedial support offered by individual departments. Conclusion: From the students’ perspective, formative assessments serve as a valuable tool for enhancing learning among undergraduate medical students. They contribute to better understanding and engagement with the subject matter. However, despite their educational benefits, challenges related to time constraints and the availability of teaching faculty remain significant barriers to the effective and consistent implementation of formative assessments.

Background: Acne vulgaris is a highly prevalent inflammatory skin disorder with multifactorial etiology and a broad spectrum of clinical presentations. Despite its high incidence, variations in clinical patterns based on age, gender, and site distribution necessitate localized epidemiological insights to improve management. Aim: To delineate the clinical and epidemiological profile of acne vulgaris among patients attending a tertiary care center. Material and Methods: This hospital-based observational study was conducted over six months, including 120 patients clinically diagnosed with acne vulgaris. Detailed history, physical examination, lesion distribution, grading (based on Global Acne Grading System), and scarring patterns were documented. Data were analyzed using SPSS version 26, and p-values less than 0.05 were considered statistically significant. Results: The study population comprised 38 males and 82 females, with the highest prevalence in the 21–25 years age group (38.3%). Cheeks (83.3%) and forehead (75%) were the most commonly affected sites. Grade 3 acne was the most frequent (46.7%), followed by grade 2 (26.7%). Atrophic scars, particularly ice pick (22 cases) and distensible retraction scars (14 cases), were the most common sequelae observed. Conclusion: Acne vulgaris is most prevalent in young adult females, predominantly affecting the face, with a high burden of moderate-to-severe lesions and associated scarring. Early intervention is critical to minimize physical and psychological morbidity.

Background: Common warts, caused by the human papillomavirus (HPV), are a frequent dermatological concern with a tendency for recurrence and resistance to conventional therapies. Immunotherapeutic approaches, such as intralesional vitamin D3, have shown promise in enhancing wart resolution by stimulating the host immune response. Aim: To evaluate the resolution of common warts following intralesional vitamin D3 injections and to compare its efficacy with a placebo group receiving normal saline. Material and Methods: This prospective interventional study included 35 patients with clinically diagnosed common warts, who were randomly assigned into two groups. Group A received intralesional vitamin D3 injections, while Group B received normal saline. Injections were administered every two weeks for three sessions. Patients were followed up for a total of 12 weeks to assess clinical improvement and adverse events. Data were analyzed using SPSS version 26, with p<0.05 considered statistically significant. Results: A significantly higher rate of complete wart resolution was observed in the vitamin D3 group compared to the placebo group. Most cases responded within 2–3 sessions without major adverse effects. Upper extremities were the most commonly affected sites, and the majority of patients were aged 21–30 years. Conclusion: Intralesional vitamin D3 is an effective, safe, and well-tolerated treatment for common warts, offering superior outcomes compared to placebo. It holds potential as a preferred immunotherapeutic modality in clinical dermatology.

Background: Though copper plays a key role in the innate immune system, if it is elevated in the liver cause’s cirrhosis and leads to fatal. Hence the factors that cause elevation of copper content have to be ruled out. Method: Out of fifty (50) children with liver disease aged 5 to 20 years, 11 (eleven) children had elevated copper content in their livers. Estimation of liver copper by atomic spectrometry and liver biopsy ATP7B mutation analysis were carried out to confirm the excess of copper storage in the liver. Results: ATP7B had a negative finding, 24-hour urine copper and dry weight liver copper had elevated contents of copper levels, and rhodanine staining on liver biopsy had a significant presence of copper contents. Conclusion: The present positive availability of copper in elevated content differs from Wilson disease or Indian childhood cirrhosis, and treatment with penicillamine or zinc or both brings the normalcyin copper content. The etiology of this disease is unknown.

Introduction: Anterior shoulder dislocation is a common emergency presentation. Traditional methods of reduction often require procedural sedation, which carries risks and resource demands. The interscalene nerve block (ISNB) offers a regional anesthesia, an alternative that may improve safety and efficiency. This prospective study evaluated the effectiveness, safety, and feasibility of using ISNB for shoulder reduction in the emergency department (ED) setting. Material and Method: This was a prospective observational study conducted in the ED of a tertiary care hospital over 6 months. Thirty adult patients with anterior shoulder dislocation underwent reduction using ultrasound-guided ISNB. Results: This study demonstrated a high success rate, significant pain reduction, no complications, lesser need of procedural sedation and sedation related complications. Conclusion: ISNB is an effective, safe, and time-efficient alternative to sedation for shoulder reduction in the ED. It can reduce pain significantly and minimize the need for monitoring associated with sedation.

COVID-19, a severe form of acute respiratory syndrome, is caused by coronavirus-2 (SARS-COV-2). It was initially observed in Wuhan, China in 2019. It rapidly spread worldwide and revamped into a severe form of a pandemic that has caused substantial mortality and morbidity. To combat this severe infection, combined efforts were initiated globally in the field of medical research that led to the development of various types of vaccines. They were approved for emergency use of licenses for the treatment of COVID-19 disease. Although vaccines have proven effective in controlling pandemics, some of the possible side effects of vaccines have remained elusive due to fast-track vaccine development. The mass COVID-19 vaccination that covered millions of populations revealed rare ADRs including anaphylaxis, myocardial infarction, venous thrombosis, stroke and Guillain-Baree Syndrome. We report 2 patients who developed stroke and acute exanthematous reactions following COVID-19 vaccination.

Background: Menstrual hygiene is a critical aspect of adolescent health, yet it remains neglected, especially in tribal and rural settings where taboos, lack of education, and limited access to sanitary facilities prevail. This study aimed to assess the knowledge, attitude, and practices (KAP) related to menstrual hygiene among adolescent girls in tribal areas of Rajasthan. Objectives: To evaluate the level of knowledge, prevailing attitudes, and menstrual hygiene practices among adolescent girls in tribal regions and identify associated sociodemographic factors. Methods: A community-based cross-sectional study was conducted among 422 adolescent girls aged 10–19 years in selected tribal villages of Udaipur district, Rajasthan. A pretested, semi-structured questionnaire was used to collect data on sociodemographic variables, knowledge, attitude, and practices regarding menstruation. Descriptive statistics and chi-square tests were used to analyze the data using SPSS version 25.0. Results: Only 38.6% of the participants had knowledge of menstruation before menarche. Mothers were the primary source of information (52.7%). While 29.4% understood that menstruation is a normal physiological process, 64.2% considered it impure and 71.3% reported facing social or religious restrictions. Regarding hygiene, 47.9% used cloth alone, and only 17.3% used sanitary pads exclusively. Genital hygiene and safe disposal practices were poor. A statistically significant association (p < 0.001) was found between the mother’s education level and the adoption of hygienic menstrual practices. Conclusion: Menstrual hygiene among tribal adolescent girls in Rajasthan is suboptimal, with prevailing misconceptions, negative attitudes, and unhygienic practices. Targeted health education, improved access to menstrual products, and WASH infrastructure, along with culturally sensitive community engagement, are urgently required to improve menstrual health outcomes in these underserved populations.

Background: Hypothyroidism is a common late complication in patients undergoing radiotherapy (RT) for head and neck cancers (HNC), primarily due to incidental radiation exposure to the thyroid gland. As survivorship improves, the long-term management of treatment-related toxicities, including endocrine dysfunction, has become increasingly important. This study aims to see the dose going to thyroid gland in head and neck cancer patients undergoing radiotherapy. Material and Methods: A total of 20 Head and neck patients were included in our retrospective study. Dosimetric data of all recruited patients were analyzed, retrospectively. Dosimetric analysis of PTV was done and the following parameters Dmax, Dmean, D2, D98, D50, V95, Homogenity index (HI), Conformity Index (CI) was assessed. Dosimetry of OARS- PRV Brainstem (Dmax), Bilateral Optic Nerve (Dmax), Optic Chiasma(Dmax), Right and Left lens(Dmax), Eyes(Dmax), Mandible(Dmax), Parotids (Dmean), Lips (Dmean), Cochlea (Dmean), PRV spine (Dmax) was done. The mean doses to both the thyroid glands was assesed. Results: Dosimetric analysis revealed that the mean dose delivered to the Planning Target Volume (PTV) was 69.8 Gy, with good conformity (mean CI: 1.125) and homogeneity (mean HI: 0.081). Organs at risk (OARs), including the brainstem, spinal cord, optic structures, and parotid glands, generally received doses within acceptable limits. However, the thyroid gland received a high mean dose of 65.82 Gy, placing patients at significant risk for radiation-induced hypothyroidism. These findings highlight the need for routine thyroid function monitoring and consideration of thyroid-sparing strategies during radiotherapy planning. Conclusion: This study demonstrates that while radiotherapy for head and neck cancer achieves adequate target coverage with acceptable dosimetric parameters for most organs at risk, the thyroid gland is often exposed to high radiation doses, with a mean dose of 65.82 Gy. Such exposure significantly increases the risk of developing hypothyroidism, a common yet frequently underdiagnosed late effect. Therefore, routine post-treatment thyroid function monitoring is essential for early detection and management. Furthermore, implementing thyroid-sparing techniques during radiotherapy planning should be considered to reduce long-term endocrine complications and improve overall survivorship care.

Aims and Objectives: (1) To evaluate and study/compared about various organs injured in patients presenting with blunt abdominal trauma/etiology to King George Hospital, Visakhapatnam and their outcomes. (2) To find out various etiologies leading to blunt abdominal trauma and most common of them. (3) Effects of time interval between injuries and intervention on outcome. (4) To find out different modes of presentation of blunt abdominal trauma. (5) Various organs injured and most common injured organ. (6) Compare solid organ injuries to others and their outcomes. (7) Compare between conservative and interventional approach. Methods: This is a observational study performed at Department of General Surgery in Andhra medical college, Vizag. All patients included are presenting with blunt abdominal trauma cases, aged 14 years and over between Jan 2024 to Jan 2025. Results: From the study it was found that solid organs like spleen, liver, kidney were more commonly injured in blunt abdominal injury. Of that, Splenic and liver injuries formed the majority of cases. Most of the Splenic injuries were managed by splenectomy while most of the liver injuries were managed conservatively. Conclusion: In our analysis, hepatosplenic injuries were more prevalent and accounted for approximately 60% of all blunt abdominal injuries. To determine the extent of the organ trauma, prompt resuscitation along with straightforward tests like chest X-rays, abdominal X-rays, and peritoneal aspiration or lavage are important. If abdominal injuries are not identified and treated immediately, there is a very high rate of death and morbidity.

Background: The WHO Trauma Care Checklist is suitable for any emergency care environment and it has been linked to better patient outcomes across various healthcare environments. We can evaluate any guideline or checklist only by comparing before and after implementing effects. Hence the present study aimed to compare the efficiency of the WHO Trauma Care Checklist in patients attending casualty due to trauma incidents. Methodology: The present cross-sectional study was done on patients attending casualties with life-threatening trauma incidents. A total of 60 patients meeting inclusion criteria were randomly divided into 2 groups. Group 1: Patients who received trauma care without using the WHO checklist, and only by the standard of care. Group 2: Patients who received trauma care according to the WHO’s checklist. Demographic details, the level of pain, Injury Severity Score (ISS), the care provided, death rate, and complications following trauma were examined. Data analysis was conducted using SPSS software. Results: Level of pain, Glasgow coma scale score, Injury severity score (ISS), and patient satisfaction were improved in patients belonging to the WHO checklist group than in the No checklist group with a statistically significant p-value <0.005. Examination of pulse, temperature, physical examination of the spinal cord, sensory test, motor skills test, scalp test, and abdominal test were improved in the WHO checklist implemented group with a statistical significance of p=0.001. CT scan of the abdomen, chest imaging, and history of tetanus received, and missed injuries were improved in the WHO checklist group than the No checklist group. Conclusion: The use of checklists in the evaluation of trauma patients has been a critical component of improving the care process reducing medical errors and increasing patients’ quality of life.

Background: Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of diabetes mellitus, particularly in the elderly, leading to significant morbidity, including sensory loss, pain, and increased risk of foot ulcers and amputations. Despite its high prevalence, DPN often remains undiagnosed, especially in asymptomatic individuals. Nerve conduction studies (NCS) offer a reliable means to detect both clinical and subclinical neuropathy. Aim: To compare peripheral nerve conduction parameters in elderly patients with type 2 diabetes mellitus and age-matched non-diabetic controls and to evaluate the association of nerve conduction abnormalities with glycemic control. Methods: A retrospective, cross-sectional study was conducted at Rajarajeswari Medical College and Hospital, Bengaluru. Data from 100 elderly participants (≥60 years), including 50 diabetics and 50 non-diabetic controls, were analyzed. Demographic data, HbA1c levels, and NCS results were collected. NCS parameters for motor (median, tibial) and sensory (sural) nerves were compared between groups. Statistical analysis was performed using SPSS version 23.0, with a significance level set at p < 0.05. Results: The diabetic group had significantly higher HbA1c levels (8.4 ± 1.2%) compared to controls (5.2 ± 0.4%, p < 0.001). Symptomatic neuropathy was present in 66% of diabetics and 12% of controls. Subclinical neuropathy was detected in 18% of diabetics and 4% of controls (p = 0.04). Diabetics showed significant impairments in all nerve conduction parameters, including reduced amplitudes, delayed latencies, and slower conduction velocities (p < 0.001). A strong negative correlation was observed between HbA1c and conduction velocity of the tibial (r = -0.62) and sural (r = -0.58) nerves. Conclusion: Peripheral nerve conduction is significantly impaired in elderly diabetics compared to non-diabetic controls, with a high prevalence of both clinical and subclinical neuropathy. Poor glycemic control is strongly associated with nerve dysfunction. Recommendations: Routine nerve conduction studies should be considered for elderly diabetic patients, including those without symptoms. Emphasis should be placed on maintaining optimal glycemic control to prevent or delay the onset of neuropathy.

Background: There are several consequences linked to mother smoking during pregnancy, including a higher risk of perinatal morbidity and death. Gaining knowledge on how smoking affects pregnancy and, consequently, pregnancy outcomes could be crucial in identifying a preventable factor contributing to unfavorable pregnancy outcomes. Objectives: The study was done to retrospectively evaluate the correlation between maternal smoking and the incidence of IUGR in a defined population. Materials and Methods: The study was retrospective in nature. The study was carried out at a tertiary care hospital. The study was conducted for one year. In all, 150 patients were enrolled. The existence of a risk factor for intrauterine growth restriction or an indication of a pregnancy problem was a prerequisite for research admission. Results: The total gestational duration was 278 ± 10.4 days for the light smokers and 277 ± 9.5 days for the heavy smokers, with a p-value of 0.544. A p-value of 0.002 indicated that there was a statistically significant difference in birth weight between the mild and heavy smoking groups. Conclusion: While postnatal growth was enhanced, maternal smoking throughout pregnancy limited prenatal weight and length growth. Maternal smoking appeared to reduce linear growth more than associated factors of risk and to happen after second trimester.

Background: The risks caused by terrestrial animals can be reduced with the help of effective rabies vaccines, which have been available for a while, as well as public health infrastructure, stray animal control efforts, and sound clinical evaluation of exposure. Objectives: The study was done to determine the rabies and its burden along with the epidemiology of rabies cases admitted to our hospital. Materials and Methods: The study was retrospective in nature. The study was carried out at a tertiary care hospital. The study was conducted for one year. In all, 150 patients were enrolled. To gather data on the different factors of risk for the development of rabies disease in the research area, a questionnaire survey was carried out. Results: 45 (30%) of participants were children, while 35 (23.3%) of participants were adolescents. 58 (38.7%) were female participants, while 92 (61.3%) of participants were male. 45 (30%) of participants were in the group of not taking the anti-rabies vaccine and immunoglobin and complete vaccination without immunoglobin. Conclusion- Given that the disease is incurable, policy and planning should be prioritized in order to lower the frequency of animal bite exposure and to raise awareness and encourage behavior that can help avoid the sickness.

Background: Iatrogenic nerve injuries following head & neck surgeries can be prevented by intraoperative neural monitoring (IONM). During IONM, neuromuscular blocking agents can interfere with electromyography signals. Methods: An observational study was conducted at our institute after ethical committee clearance on neuromuscular management in IONM cases. After PAC, informed consent, general anaesthesia was induced and tracheal intubation was performed with an initial dose of muscle relaxant, maintained with inhalational agents and analgesic (propofol/dexmedetomidine/fentanyl/ketamine infusions) without using a maintenance dose of NMBA as per the anaesthetist’s choice, level of neuromuscular blockade assessed via TOF monitoring. IONM facilitated via Medtronic nim-neuro®3.0 nerve monitoring systems. After adequate reversal, the patient was extubated and observed for residual paralysis, depth of sedation (Ramsay sedation score), postoperative pain (Vas score), incidence of PONV, surgeon satisfaction score, and other adverse effects. Result: 40 patients with a mean age of 33.51 years were analysed. Maximum incidence of hypotension seen with propofol + dexmedetomedine infusion (17/25 cases that had intraoperative hypotension) but better preferred. Least with dexmedetomidine + fentanyl infusion. 40% had vas score >/=4 at 30 minutes. 55% had Ramsay sedation score > 2 at 30 minutes. Post extubation bronchospasm seen in 1 case. No incidence of post-operative nausea and vomiting, or residual muscle paralysis. The average surgeon satisfaction score is 4.25/5. Conclusion: Propofol/dexmedetomidine infusion after the initial NMBA dose with TOF monitor was a better choice among the options available in our institute. Depth of anaesthesia monitoring is beneficial in optimal dosing of maintenance anaesthetic agents.

Background: Urinary tract infections (UTI) are a frequent cause of bacterial illness in children, presenting with diverse clinical features across different pediatric age groups. UTI may remain unrecognised, especially in young infants, which can later progress to renal scaring and end stage renal disease. Our study was aimed to assess the clinical, microbiological, and radiological profile of UTI and thus emphasising the importance of history taking, clinical examination and proper evaluation including radiological investigations in children with urinary tract infections. Methods: This is a retrospective, observational, record-based study done in children between the ages of 1 month and 12 years who were admitted with UTI in the pediatric ward of Government Medical College Ernakulam between 1st January 2021 to 31st December 2024. Results: Of the total 385 children with UTI, majority of 167 (43.4%) were below 1 year of age where males predominated. 41.3% children had recurrent UTI, of which 8 children had a second UTI following MCU study. 234 (60.8%) children had complicated UTI and was more in girls. 39.2% children presented with low grade fever. Phimosis seen in 50 boys (25.5%) and vulvovaginitis was found in 6 girls. E. coli was the commonest bacterial isolate in urine culture & sensitivity followed by Klebsiella. Abnormalities in ultrasonogram of abdomen (USG) was detected in 105 children. 44.5% of 326 children in whom MCU was done showed abnormalities. 51 children with abnormal MCU had normal USG abdomen. 4 children had renal scarring by DMSA scan. Conclusion: All children with urinary tract infections should be timely diagnosed and managed according to standard guidelines. Early diagnosis, appropriate antimicrobial treatment and long-term follow-up are essential to prevent complications and ensure optimal outcomes. MCU should be considered along with USG abdomen for screening VUR in children with UTI.

Background: Conditions such as chronic rhinosinusitis, nasal polyposis, and various sinonasal disorders are frequently managed using endoscopic sinus surgery (ESS). Despite the effectiveness of this surgical approach, a subset of patients may encounter post-operative pain or discomfort. In recent years, nalbuphine and dexmedetomidine have garnered attention as potential agents for use in preemptive analgesia in ESS. The present randomized study was conducted to assess the efficacy of nalbuphine and dexmedetomidine in minimizing post-operative pain intensity and the need for opioids among individuals undergoing ESS. Materials and Methods: A total of 126 patients were randomly allocated to receive either nalbuphine, dexmedetomidine, or a placebo prior to the initiation of general anesthesia. Pain levels, opioid consumption, and adverse reactions were systematically assessed during the post-operative recovery phase.  Results: Both nalbuphine and dexmedetomidine groups demonstrated a statistically significant reduction in pain scores and opioid requirements compared to the control group. Among the two agents, dexmedetomidine showed a more pronounced analgesic effect. Furthermore, patients administered dexmedetomidine reported a lower incidence of post-operative nausea and vomiting during the initial days following surgery. No notable differences in the incidence of sedation or respiratory depression were observed across the three study arms. Conclusion: The findings suggest that nalbuphine and dexmedetomidine are effective as preemptive analgesics in ESS, contributing to reduced post-operative pain and opioid use. Dexmedetomidine appears to offer superior analgesic benefits along with a more favorable profile in terms of nausea and vomiting. These outcomes may support the incorporation of dexmedetomidine into pain management protocols to enhance post-operative recovery and patient satisfaction following ESS.

Background: Preterm neonates have increased nutritional demands that are often unmet by human milk alone. Human milk fortifiers (HMFs) are recommended to meet protein and caloric needs essential for postnatal growth. Objective: To evaluate the impact of multinutrient human milk fortification on early postnatal growth in preterm neonates during NICU hospitalization. Methods: This open-label randomized controlled trial included 72 preterm infants (<37 weeks gestation, <2kg birth weight) assigned to either Fortified Group (FG) or Unfortified Group (UFG). Anthropometric measurements (weight, length, and head circumference) were recorded regularly until discharge. Growth velocity was compared using appropriate statistical methods. Results: Infants in the FG showed significantly higher gains in weight (18.5±2.1 g/kg/day vs. 14.2±1.8 g/kg/day), length (1.1±0.2 cm/week vs. 0.8±0.2 cm/week), and head circumference (0.9±0.1 cm/week vs. 0.6±0.1 cm/week) than UFG (p<0.05 for all). Conclusion: Human milk fortification significantly improves early postnatal growth parameters in preterm neonates. Routine use of HMF should be considered in NICUs for eligible preterm infants.

Background: Mood-related disorders such as postpartum blues and postnatal depression frequently affect women following childbirth, particularly in rural settings. These disorders, if left unrecognized, can adversely impact maternal wellbeing and infant care. Objectives: (1) To assess the incidence of postpartum blues and postnatal depression. (2) To determine the association between postpartum blues and postnatal depression. (3) To evaluate the predictive value of obstetric and psychosocial factors in postnatal depression. Methods: This prospective observational study included 53 postpartum women attending a rural tertiary care center. Participants were evaluated using Stein’s Maternity Blues Scale within the first week postpartum and the Edinburgh Postnatal Depression Scale (EPDS) at one and two months. Statistical analysis was conducted using SPSS. Results: Postnatal depression (EPDS ≥10) was found in 26.4% of participants. Although postpartum blues was prevalent (60.3%), its association with depression was not statistically significant. Similarly, no single obstetric or psychosocial factor emerged as a strong predictor, although previous abortion and gestational age showed weak trends. Conclusion: A notable proportion of rural women experience depressive symptoms after childbirth. These findings support the routine screening for postpartum depression, independent of risk factors.

Background: Adverse drug reactions (ADRs) are a primary cause of recurrent hospitalization and negatively impact quality of life. An adverse drug reaction has been defined as any noxious, unintended and undesired effect of a drug, which occurs at a dose used in humans for prophylaxis, diagnosis, therapy or modification of physiological function. This study aimed to evaluate the clinical spectrum, outcomes, seriousness, causality, and severity of adverse drug reactions (ADRs) in geriatric and paediatric patients. Methods: This was a retrospective analysis of spontaneously reported adverse drug reactions (ADRs) collected from both indoor and outdoor geriatric (≥ 65 years) and paediatric (≤ 12 years) patients between April 2023 and September 2023 at the ADR Monitoring Centre, Department of Pharmacology, and VIMSAR Burla. Then an analysis was conducted for clinical presentation, causation (according to the WHO-UMC scale), and severity (according to the Hatwig and Seigel scale). Results: Among 116 ADRs, 42 occurred in geriatric patients (36.2%), whereas 15 occurred in paediatric patients (12.9%). Gastrointestinal illnesses (33.13%) and neurological disorders (23.8%) were the most frequently affected bodily systems in geriatric patients. While in paediatric patients, gastrointestinal issues account for 40% cases, followed by skin and appendage conditions at 33.3%. The most prevalent causative drug in geriatric patients is cardiovascular medications (40.4%) while in paediatric patients, it is antimicrobials (66.6%). The causality assessment of the majority of ADRs was feasible. Conclusion: ADRs frequently occur in geriatric and paediatric patients, typically within four weeks of initiating oral medication. It is advisable to implement active surveillance for drug safety monitoring in these at-risk populations.

ASPECTS stands for “alberta stroke program early CT score’’. Stroke is one of the leading causes of mortality globally and a main cause of disability. The ASPECT score is a crucial tool to assess the presence or absence of early ischemic changes in specific brain regions that help to determine the extent of infarction and predict the potential for tissue salvage and outcome after treatment. The score was originally designed to help identify patients who were likely to demonstrate the most clinical benefit from intravenous thrombolysis. The ASPECT score specifically evaluates the presence of early ischemic changes on non-contrast CT imaging. The ASPECTS score is a quantitative score. The territory of the middle cerebral artery is divided into 10 regions, and points are subtracted for areas with early ischemic signs, such as focal swelling or parenchymal hypoattenuation. Each region can earn a score from 0 to 10, with higher scores indicating less brain tissue affected by ischemia. Patients with extensive early ischemic changes at presentation are unlikely to benefit from thrombolysis or thrombectomy procedures. This study investigated the role of the Alberta Stroke Program Early CT Score (ASPECTS) in predicting mortality among thrombolysed acute ischemic stroke (AIS) patients. Among 120 patients of acute ischemic stroke mean age of patients in this study is 60.2 ±13.4 years, Mean age of patients of acute ischemic stroke is 64.0 ± 11.5 years. Glasgow Coma Scale (GCS) scores were significantly associated with patient’s outcomes in this study (p = 0.003), with lower GCS correlating with higher mortality. In this study those patients who had a higher NIHSS score had higher chances of mortality found (p=0.00009).Although ASPECTS has been widely endorsed for its predictive validity in early ischemic changes, our findings showed a statistically significant association between ASPECTS scores and patient mortality (p = 0.0357). Earlier evidence suggesting that lower ASPECTS (<6) is strongly predictive of poor outcomes and increased mortality.

Depression is the most common mental illness which is linked with a deficit in monoamine neurotransmitters like serotonin, norepinephrine, and dopamine. Standard antidepressants increase the release of these neurotransmitters, but 5-HT3 receptor antagonists like ondansetron and granisetron used in our experiment augments their action by preventing reuptake. Our study and references suggest that 5-HT3 receptor blocking improves neuroplasticity and mood. This present study examines the antidepressant activity of 5-HT3 antagonists with reference to the standard antidepressant drug fluoxetine (20mg/kg) in Swiss albino mice. This study was conducted at Aarupadai Veedu Medical College, Pondicherry, with animal ethics clearance and following CCSEA guidelines. Twenty-four Swiss albino mice of 30–35 grams were randomly divided into four groups which were: Control, Fluoxetine (20 mg/kg), Ondansetron (0.5 mg/kg), and Granisetron (1000 µg/kg). Animals were acclimatized under standard conditions and treatment was given orally. Fluoxetine significantly decreased immobility time (86.6 sec) and swimming time (273.3 sec) in the Forced Swimming Test, indicating very strong antidepressant effects (P<0.05). The test drugs ondansetron and granisetron have demonstrated moderate improvement, reducing immobility to 149.3 sec and 136.1 seconds, respectively. This is reflecting a mild but significant antidepressant-like activity. In our Tail Suspension Test, fluoxetine reduced immobility time significantly to 86 seconds (P<0.05), reflecting a strong antidepressant activity, while ondansetron (149 sec) and granisetron (136 sec) again reflected moderate but significant effects. These results clearly indicate that 5-HT3 antagonists may possess antidepressant activity which are less potent than the standard drug and these also can be dose-dependent. Our study has evaluated the antidepressant activity of 5-HT3 antagonists, ondansetron and granisetron, versus fluoxetine in Swiss albino mice in the Forced Swim Test and Tail Suspension Test. Both test drugs reflected moderate but significant immobility reductions (P<0.05), demonstrating mild antidepressant-like activity. Granisetron proved to be superior to ondansetron, justifying their use as adjunct therapies. Our study gives evidence justifying the antidepressant-like efficacy of 5-HT3 receptor antagonists such as granisetron and ondansetron. These drugs present a promising line of investigation for future or adjunctive antidepressant therapies, and further preclinical and clinical studies are indicated. Further clinical trials are needed with varying doses of the test drugs to make 5-HT3 receptor antagonists antiemetics a priority in short-term clinical depression patients as well as alleviating pre-operative and post-operative stress.

Background: The purpose of this study was to assess soft tissue tumour of the extremities with diffusion-weighted echo-planar MR imaging at 3.0 T. Methods: Hospital based cross-sectional and quantitative study conducted on patient selected after applying inclusion and exclusion criteria. Prior to examination, written and informed consent was taken from the patient/guardian. Prior to MRI and biopsy of soft tissue tumours, proper precautions was taken and patient was excluded from study if MRI is contraindicated due to any reason. All data were analyze by EPI-info software. Results: According to the final pathology results, the best cutoff for the mean ADC value was calculated as 950mm²/s with a sensitivity of 100.00%, a specificity of 100%. Conclusion: We concluded that addition of DWI to standard MRI improves the diagnostic accuracy for differentiation of malignant from benign soft tissue tumours at 3.0 T.

Background: In this study we compared ultrasound with CT in detecting causes of Common stomach and bowel pathologies such as appendicitis, diverticulitis, volvulus in patients presenting at the department with acute abdominal pain in the majority of cases. Methods: A cross-sectional study was conducted on all clinically suspected lesions involving stomach and bowel patients included. All those who fulfilled the inclusion criteria were explained the purpose of the study. After clinical assessment, all consenting patients underwent ultrasound and computed tomography (CT) within a few hours of presentation. Results: A total of 100 patients with stomach and bowel disorders were studied using ultrasound and multidetector CT scan. 25 patients were diagnosed with appendicular pathologies, 25 cases with primary neoplasms, 18 were abdominal Koch’s, 17 were Crohn’s disease, 6 were ulcerative colitis, 4 were volvulus, 3 were diverticulitis, 2 were intussusception. Acute appendicitis was the most frequent finding seen in 23 patients. Ultrasound was diagnostic in all except one case. Conclusion: We concluded that the ultrasound was used as an initial modality of choice for the evaluation of the patients. This study showed high sensitivity in cases like acute appendicitis, intussusception, and appendicular mucocele. CT scan is a diagnostic modality of choice in bowel and intestinal disorders. In our study in only two cases, there was a discrepancy among the findings obtained in the final diagnosis. A case of abdominal tuberculosis was diagnosed as Crohn’s disease and a case of bacterial colitis was diagnosed as ulcerative colitis. Incidental findings like Meckel’s diverticulum and intussusceptions were picked up efficiently on CT scans.

Background: To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). Methods: 100 Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included. We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Results: The mean densities of the dural sinuses ranged from 26.00 to 58.75 HU (mean= 48.13 HU). There was a strong correlation between mean density and Hgb level (r=0.52) and between mean density and Hct level (r=0.84). Conclusion: Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.

Introduction: Although the illicit use of opiates and prescription opioids, with an estimated 33 million illicit users, is not as widespread as the illicit use of cannabis worldwide, the opioids are the major drugs of potential harm and health consequences. Although the prevalence of people injecting illicit drugs in India is low relative to West with an estimate between 0.18 and 1.1 million and a slowly declining trend of illicit use of opium and heroin worldwide, the injecting route of heroin and synthetic opioid analgesics in India has shown a rapid growth in the past two decades. This rapid growth in the population of injection drug users poses new challenges in the management and care of these patients. Methods: This was a cross‑sectional descriptive study conducted among the opioid use disorder patients≥10 years of age, diagnosed as per the Diagnostic and statistical manual of mental disorders‑5 (DSM‑5), who visited the drug de‑addiction center for the treatment. A semi‑structured proforma was used to record socio demographic profile. The semi‑structured pro forma for sociodemographic variables covered details regarding the age group, sex, residence, family type, education, occupation, socioeconomic status, and path of referral. Results: It has been found that opioid use disorders have higher prevalence in young adulthood, age group (18-35). Most of our patients were self-employed (45%), fully employed (30%) or part time (10%). The education status of patients were illiterate (20%), 5th class (5%),8th class (45%), 10th class (20%) and fully educated (10). The most used drugs were cannabis (70%), heroin (85%), pentazocine (90%), and hypnotic (15%). The patients were also habituated with smoking (45%) and alcoholism. The cause of addiction were shame and guilt (60%), free will (25%) and peer pressure (10%). The marital status of the patients were unmarried (85%), married (15%). Conclusion: Opioid use disorders have shown a significant rising trend as compared to the previous study from the same center in the form of more patients representing the rural population as compared to the urban population, involvement of students in opioid dependence as compared to more employed people, increase in use of heroin as compared to pharmaceutical agents, and increase in use of intravenous route as compared to oral.

Background: Optimal postoperative analgesia after total abdominal hysterectomy (TAH) remains challenging. Ultrasound-guided transversus abdominis plane (TAP) block with long-acting local anaesthetic such as levobupivacaine is widely used, yet its duration is limited. The α-2 agonists—dexmedetomidine and clonidine—prolong peripheral nerve blockade, but head-to-head data as TAP adjuvants are sparse. Methods: In this prospective randomised study, 108 ASA I–III women aged 35–70 y scheduled for elective TAH under spinal anaesthesia were allocated to three groups (n = 36 each): L (received 18 mL 0.25 % levobupivacaine + 2 mL saline per side), LC (18 mL levobupivacaine + 1 µg kg⁻¹ clonidine) and LD (18 mL levobupivacaine + 1 µg kg⁻¹ dexmedetomidine). Bilateral ultrasound-guided TAP block was performed after skin closure. Pain (VAS 0–10), haemodynamics and adverse events were recorded for 24 h; duration of analgesia (first VAS ≥ 4) and time-to-rescue diclofenac were primary outcomes. Results: Groups were demographically comparable. LD produced the longest analgesia (13.7 ± 4.0 h) versus LC (6.2 ± 1.3 h) and L (3.2 ± 0.7 h) (p < 0.001). Mean VAS scores were significantly lower in LD from 4 h to 12 h post-block (p < 0.01). Time-to-rescue mirrored analgesic duration (LD 15.7 ± 3.9 h > LC 6.8 ± 1.3 h > L 3.7 ± 0.7 h; r = 0.99, p < 0.001). Haemodynamics and SpO₂ remained stable without inter-group differences. Incidence of nausea/vomiting (≈ 70 %) was similar across cohorts. Conclusion: Dexmedetomidine 1 µg kg⁻¹ markedly prolongs and deepens TAP analgesia compared with clonidine or plain levobupivacaine, without compromising haemodynamic stability or increasing complications. Routine incorporation of dexmedetomidine may enhance multimodal ERAS pathways after TAH.

Background: Cervical cancer remains a major public-health problem despite global progress in prevention and early detection. In India it is the second-leading cancer among women, with rural and tribal communities disproportionately affected. The Rewa Division of central India is home to several distinct ethnic groups with limited screening access, yet contemporary epidemiological data are sparse. Methods: We conducted a retrospective, record-based study using all histopathologically confirmed cervical-cancer cases reported to the regional cancer registry and major pathology laboratories from January 2015 to December 2024 at department of Radiation Oncology, SSMC and Sanjay Gandhi Memorial Hospital, Rewa, MP, India. Demographic variables (age, residence, self-reported ethnicity), district of residence (nine districts), and year of diagnosis were extracted. Mean annual case-loads were compared across districts and age groups with one-way ANOVA; rural-urban differentials were examined with a paired t-test. Secular trend was assessed by simple linear regression of annual totals (α = 0.05). Results: A total of 861 cases were analysed. Mean yearly burden varied significantly by district (F = 13.03, p < 0.0001), peaking in Rewa (20.8 ± 15.6) and Sidhi (8.8 ± 4.8) (Table 1). Age-group differences approached but did not achieve statistical significance (F = 2.64, p = 0.064) (Table 2). Rural women bore a four-fold higher mean incidence than their urban counterparts (38.5 ± 28.1 vs 9.8 ± 4.4; t = 3.72, p = 0.0047) (Table 3, Figure 2). Annual cases rose at ~7 cases/year (R² = 0.53, p = 0.017) (Table 4). Conclusion: Cervical-cancer burden in the Rewa Division is unequally distributed, with rural districts and communities of Rewa and Sidhi contributing the majority of cases and an overall upward trend during the last decade. Culturally tailored HPV-vaccination drives, district-level screening outreach, and strengthened cancer-registry coverage are urgently required.

Background: Proximal humerus fractures are common in the elderly, particularly among osteoporotic individuals. Open reduction and internal fixation (ORIF) with the PHILOS (Proximal Humerus Internal Locking System) plate offers angular stability and early mobilization, though outcomes may vary based on fracture pattern and surgical approach. Objectives: To evaluate functional outcomes of proximal humerus fractures treated with PHILOS plating and assess the influence of fracture type and surgical approach on recovery. Materials and Methods: This prospective, descriptive study was conducted over one year on 30 skeletally mature patients with displaced proximal humerus fractures managed at a tertiary care center. Patients underwent ORIF using PHILOS plating via either the deltopectoral or deltoid-splitting approach. Functional outcomes were assessed using the Constant and Murley Score (CMS) over regular follow-ups. Data were analyzed using SPSS v26, with p<0.05 considered statistically significant. Results: Most patients were females (60%) and aged 51–60 years. The mean CMS was 79.5 ± 14.2. Two-part fractures had the highest CMS (81.2 ± 17.7), with significantly lower scores in complex fractures (p=0.005). The deltopectoral approach yielded better outcomes than the deltoid split (80.6 vs. 75.0, p=0.009). Joint stiffness occurred more frequently in 3-part fractures (p=0.016). Conclusion: PHILOS plating yields satisfactory functional outcomes in proximal humerus fractures, with better results in simpler fractures and with the deltopectoral approach. Fracture complexity significantly impacts recovery, underlining the need for individualized surgical planning.

Background: Intertrochanteric femur fractures are increasingly prevalent in the elderly population, often resulting from trivial trauma due to osteoporosis. Surgical fixation remains the cornerstone for early mobilization and functional recovery. Among the various operative techniques, the Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) are widely employed. Our study aimed to compare these two fixation methods in terms of functional outcomes, complication rates, and intraoperative parameters. Methods: Our prospective study was conducted at Krishna Mohan Medical College & Hospital, Mathura, Uttar Pradesh, India from January 2024 to December 2024, including 60 patients with intertrochanteric femur fractures. Patients were randomly assigned to DHS (n=30) and PFN (n=30) groups. Intraoperative details, postoperative complications, radiological union, and functional outcomes were analyzed using Harris Hip Score over a follow-up period of 12 months. Results: The mean operative time was significantly lower in the PFN group (62.5 ± 7.8 minutes) compared to the DHS group (78.3 ± 9.2 minutes, p<0.001). Blood loss was lesser with PFN (mean 140 ± 25 ml) than DHS (mean 370 ± 40 ml). The average time to fracture union was 11.3 weeks in the PFN group versus 12.6 weeks in the DHS group. Complications such as malunion and screw cut-out were more common in the DHS group. Functional outcomes at 12 months showed excellent to good results in 86.6% of PFN patients compared to 66.6% in the DHS group (p=0.038). Conclusion: Both DHS and PFN are effective in managing intertrochanteric femur fractures. However, PFN showed superiority in terms of operative efficiency, lower complication rates, and better functional outcomes, particularly in unstable fractures.

Background: Early postnatal growth of preterm has many effects on later health. However, the studies on growth pattern among them are fewer. This study aims to assess the postnatal growth pattern of preterm babies up to 6 months of corrected gestational age (CGA) and the risk factors for postnatal growth failure (PGF). Methods: A hospital based prospective study involving preterm neonates was conducted. Eligible Preterms were recruited and information like feeding pattern, gestational age, parity etc. were noted. They were followed up at 1 month and 6 months of corrected gestational age, and their weight, length and head circumference were measured at these follow up visits. Each of these parameters were plotted on Fenton’s and WHO growth chart and postnatal growth failure (PGF) and growth pattern were assessed. Along with this factors affecting PGF were also studied. Results: The SGA preterm infants exhibited relatively poor growth. While factors like duration of stay in the hospital, multiple gestation, day of starting 1^st enteral feed and reaching full enteral feeds although had an significant effect in determining PGF at 1month CGA, but later at 6 months CGA, these factors did not have any significant effect in determining PGF. Conclusion: Further studies with larger samples are needed to see the growth pattern of preterm babies and the factors determining their outcomes as well as the influence of early catch-up growth in adulthood.

Background: As the third most common malignancy and the second most deadly cancer, colorectal cancer induces estimated 1.9 million cases and 0.9 million deaths worldwide. According to the ICMR registry in New Delhi, India, the annual incidence rates are 4.4/100000 in men and 3.9/100000 in women. Biomarkers like p53 and Ki67 help in differentiating benign from malignant colorectal disease and the IHC of these biomarkers levels have an inverse relationship with patient survival thus helping in targeted therapeutic interventions. Aims and Objective: To do the histopathological study of the Precancerous and Cancerous lesions of Colorectum and to evaluate the expression of p53 and Ki-67 in them to correlate the observed levels with clinical and pathological findings. Materials and Methods: This hospital based prospective study is conducted over a period of one year in the Department of Pathology at Silchar Medical College and Hospital, Silchar, Cachar, Assam, India. The study included a total of thirty patients of various ages and genders, who were suspected of having either 1) precancerous lesions such as adenomas and polyps (18 cases) or 2) adenocarcinoma based on colonoscopic biopsy or surgical specimens (12 cases). The expression of p53, and Ki-67 as primary objectives, were recorded, tabulated and compared to assess their predictive value in colorectal neoplastic lesions. All the cases were processed as per standard protocol for routine hematoxyline and eosin staining. Extra sections were cut for doing immunohistochemistry and the expression of p53 and Ki-67 was studied. Results: Most cases of Colorectal Carcinoma (CRC) occurred in individuals over the age of 55years, with a male-to-female ratio of 5:3. In the CRC group (group 2), p53 was detected in 75% (9/12) cases, and a high Ki-67 index was observed in 91.67% (11/12) cases. In the precancerous colorectal lesions (group1), p53 was detected in 16.67% (5/18) cases and a high Ki-67 expression was noted in highly dysplastic cases. Comparative statistics from the pilot study indicated that the immunoexpression of p53, and Ki-67 was significantly higher in the CRC group compared to group 1 (polyps). Conclusions: The expression of p53, and Ki-67 may serve as key tissue biomarkers that differentiate between benign and malignant colorectal conditions, and they also hold potential prognostic and predictive value in colorectal cancer.

Aims and Objectives: Dermatophytes affects more than 30% of the population, usually as superficial mycosis but also present as deeper subcutaneous tissue infection in rare occasions. Because of ambiguous clinical presentations of dermatophytosis need to diagnose accurately to avoid mismanagement. The present study was selected to compare Sabouraud Dextrose Agar (SDA) with Dermatophytes Test Medium (DTM) in isolation of dermatophytes. Study design: Observational (prospective) study. Place and Duration of Study: Department of Microbiology and Department of Dermatology, Gandhi Medical College and Hamidia Hospital Bhopal, Madhya Pradesh, India, between January2020 to October 2021 Methodology: This study was conducted in Department of Microbiology, Gandhi Medical College, Hamidia and Associated hospitals, Bhopal (M.P.) from January 2020 to October 2021. A total of 180 samples were collected from patients suspected of superficial mycoses which were then subjected to direct KOH examination and culture on plain SDA, on SDA with antibiotics slants (cycloheximide and chloramphenicol), on Dermatophyte Test Medium. The growths were examined macroscopically as well as microscopically. Results: In our study, majority of patients, belonged to the age group of 21-30 years (25%) with a male to female ratio of 2:1. Tinea corporis (27.2%) was the most common clinical types. KOH mount was found positive in 74 (41.1%) and culture was positive in 76 (42.2%) samples. Trichophyton mentagrophytes (32.89%) was the predominant fungal pathogen isolated followed by Trichophytonrubrum. Out of 29 dermatophyte positive culture isolates, isolation of dermatophytes was observed in 24 (82.75%) patients in both Sabouraud Dextrose Agar and Dermatophyte test medium. 5 (17.25%) dermatophyte isolates were observed only in Dermatophyte test medium. Conclusion: Both SDA and DTM gives good isolation results, whereas DTM is superior to SDA in isolation and aid in easy interpretation.

Introduction: Distal tibia fractures are relatively rare and constitute less than 7% of all tibia fractures. Management of these fractures is a challenging task for a surgeon to achieve bony union and restore a near-full range of motion of ankle joint by means of stable anatomical fixation and early mobilization because of its anatomical location and less blood supply without muscular coverage. Various treatment options are available for distal tibia fracture ranging from conservative management to intramedullary interlocking (IMIL) nailing or open reduction and internal fixation (ORIF) with plating or closed reduction and percutaneous plating or external fixators. Material and Methodology: Retrospective analysis of 55 cases fulfilling inclusion criteria of distal tibia fracture treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) using distal tibia anatomical locking plate at G.K. General hospital, Bhuj, Gujarat from August 2022- November 2023 was done. Clinical, radiological and functional outcome were evaluated at 1, 2,3, and 6th months postoperatively by using the AOFAS score. Results: There were 35 male and 20 female with mean age of 45.27 years with mean follow up of 9.18 months in our study. Average hospital stay was 6.21 days. Average time of fracture union was 17.27 weeks. Total 25 patients (45.45%) had excellent results, 20 patients (36.36%) had good results, 4 patients (7.27%) had fair results, and 6 patients (10.90%) had poor results according to AOFAS score. Conclusion: Locking compression plate using MIPPO technique for distal tibia fracture preserve periosteal blood supply causes minimal soft tissue damage while insertion preserving fracture hematoma leads to rapid fracture consolidation, better union time and fewer complications as compared to conventional open reduction methods. MIPPO is an effective technique for distal tibia fracture providing excellent functional and radiological outcome.

Background: Acetabular fractures, though uncommon, present significant surgical challenges due to their complex anatomy and potential for long-term disability. While open reduction and internal fixation (ORIF) remains the gold standard for displaced fractures, outcomes vary based on surgical timing, approach selection, and reduction quality. This study evaluates the functional outcomes and prognostic factors of surgically managed acetabular fractures at a tertiary care center. Methods: A prospective clinical study was conducted on 20 male patients with displaced acetabular fractures (>2 mm displacement) treated surgically at Adichunchanagiri Institute of Medical Sciences (August 2023–February 2025). Fractures were classified using the Letournel-Judet system. Surgical approaches (Kocher-Langenbeck for posterior fractures, ilioinguinal for anterior fractures) were tailored to fracture morphology. Functional outcomes were assessed using the Merle D’Aubigné-Postel score, complications and reduction quality were analyzed. Results: The cohort (mean age: 33.35 ± 9.44 years) comprised exclusively males, with road traffic accidents as the primary etiology (100%). Elementary fracture patterns (65%) predominated, most commonly posterior wall (35%). Anatomic reduction (<2 mm displacement) was achieved in 90% of cases. Functional outcomes were excellent in 45% (n=9), good in 30% (n=6), fair in 15% (n=3), and poor in 10% (n=2) of patients. Delayed surgery (>7 days) correlated with poorer outcomes (p < 0.05). Complications included surgical site infection (10%) and heterotopic ossification (5%). Conclusion: Early surgical intervention (<7 days) and anatomic reduction are critical for optimal outcomes in acetabular fractures. The Kocher-Langenbeck and ilioinguinal approaches provide reliable exposure for posterior and anterior fractures, respectively. Prophylactic measures (e.g., indomethacin) may reduce heterotopic ossification. These findings reinforce the importance of specialized care and protocol-driven management for these complex injuries.

Introduction: Complex tibial plateau fractures involving multiple columns often result from high-energy trauma and require precise surgical planning to restore joint congruity and alignment. Luo’s three-column classification, based on CT imaging, enables tailored fixation strategies. This study aims to evaluate the functional and radiological outcomes of column-specific fixation in complex tibial plateau fractures using this approach. Methods: A prospective observational study was conducted at the Adichunchanagiri Institute of Medical Sciences between September 2023 and March 2025. Twenty patients aged 18–60 years with closed, bicondylar or tricolumnar tibial plateau fractures (Schatzker types V/VI or AO type C), confirmed by CT and classified using the three-column system, underwent individualized fixation using standard surgical approaches. Patients were followed at 3, 6, and 12 months postoperatively. Functional outcomes were assessed using the Modified Rasmussen Functional Score, and radiological outcomes using the Modified Rasmussen Radiological Criteria. Results: Of the 20 patients, 80% were male with a mean age of 39.8 ± 8.4 years. Road traffic accidents caused 85% of injuries. Two-column fractures (70%) predominated over three-column (30%). At 12 months, 65% achieved excellent functional outcomes (Rasmussen score: 27–30), 25% good (20–26), and 10% fair (10–19). Radiologically, 70% were excellent and 25% good. One patient (5%) developed a superficial infection; no implant failures or nonunions occurred. Mean knee flexion improved to 124° (range: 110–135°). Conclusion: Column-specific fixation based on CT-guided three-column classification offers favorable outcomes in complex tibial plateau fractures. This approach ensures anatomical reduction, enhanced stability, and reproducible functional recovery. Continued follow-up and multicentric studies with larger cohorts are recommended to validate long-term benefits.

Background: Renal artery stenosis (RAS) is a common secondary cause of hypertension, predominantly resulting from atherosclerosis and fibromuscular dysplasia. Early detection is crucial to prevent complications such as resistant hypertension, renal dysfunction, and cardiovascular events. Objectives: This study was aimed to evaluate the prevalence of RAS in hypertensive patients and assess its association with clinical and demographic factors. Methods: A cross-sectional study was conducted over 18 months in the Department of General Medicine at MGM Medical College and Hospital, Navi Mumbai. Sixty hypertensive patients aged ≥30 years underwent clinical evaluation, laboratory investigations, and bilateral renal artery Doppler ultrasonography. Data was analyzed using descriptive statistics, chi-square tests, and t-tests. A p-value <0.05 was considered statistically significant. Results: Among 60 patients, 53.3% were male, and the most common age group was 61–70 years. Bilateral RAS was found in 61.7% of patients. Significant associations were observed between RAS and male gender (p=0.023), hypertension grade (p=0.024), and NSTEMI/STEMI (p<0.001). Though not statistically significant, smoking (p=0.060) and CVA (p=0.058) showed trends toward association. Patients with RAS had significantly smaller kidney size (p<0.01) and higher creatinine levels (p<0.001), indicating compromised renal function. Conclusion: RAS is prevalent among hypertensive patients, particularly older males and those with severe hypertension or ischemic heart disease. Doppler imaging is a useful non-invasive tool for early detection. Early diagnosis and tailored management strategies are essential to improve clinical outcomes.

Background: Shivering following general anesthesia is a frequently encountered postoperative complication. This prospective, randomized, double-blind, placebo-controlled study aimed to evaluate and compare the prophylactic effectiveness of dexmedetomidine and tramadol in attenuating post-anesthetic shivering. Materials and Methods: A total of 234 patients scheduled for surgical procedures under general anesthesia were randomly allocated into three groups to receive either dexmedetomidine at a dose of 1 µg/kg, tramadol at 2 mg/kg, or a placebo. Postoperative assessments included the frequency and intensity of shivering, cardiovascular parameters, and incidence of side effects. Results: The group administered dexmedetomidine exhibited a significantly reduced rate of shivering in contrast to those who received tramadol and placebo (p<0.001). The mean shivering intensity scores were also notably lower in the dexmedetomidine group, compared to tramadol and placebo. Dexmedetomidine contributed to greater hemodynamic stability, reflected in reduced heart rate and improved blood pressure control relative to the other groups. Although sedation was more frequent with dexmedetomidine, its use was associated with lower occurrences of nausea and vomiting compared to the tramadol group. Conclusion: Dexmedetomidine proved more effective than tramadol in preventing shivering after general anesthesia and exhibited a more favorable safety profile. The findings support the use of dexmedetomidine as an optimal choice for shivering prevention in the postoperative setting.

Background: Urinary tract infection (UTI) is a frequent yet often silent complication of pregnancy that can precipitate pyelonephritis, pre-term delivery and low-birth-weight infants if untreated. Local data on pathogen spectrum and resistance patterns are essential to guide empiric therapy, especially amid rising antimicrobial resistance in India. Objectives: To determine the prevalence of bacteriuria and to study the bacteriological profile and antibiotic-susceptibility patterns of uropathogens among pregnant women attending a tertiary-care hospital in Palanpur, Gujarat. Methods: In this hospital-based cross-sectional study (October 2024 – March 2025) we screened 220 consecutive antenatal women using mid-stream or catheter urine cultures. Significant bacteriuria was defined as ≥10⁵ CFU mL⁻¹ in asymptomatic and ≥10³ CFU mL⁻¹ in symptomatic women. The isolates were identified by standard biochemical tests. Antibiotic susceptibility testing was done using CLSI M100-S34 break-points. Results: Thirty-five specimens yielded significant growth, giving an overall UTI prevalence of 15.9% (95% CI 11.3–21.4). Most infections occurred in women aged 25–29 years (51.4%) and 20–24 years (34.3%). Asymptomatic bacteriuria (17.6 %) was almost twice as common as symptomatic UTI (10.0%). Gram-negative bacilli predominated (94%); Escherichia coli (32.4%), Acinetobacter spp. (27.0%) and Klebsiella pneumoniae (18.9%) comprised nearly four-fifths of isolates. Among Gram-negative bacilli, resistance exceeded 80% for Ampicillin, Amoxicillin-clavulanate and Cefazolin; 64% resistance seen with Cotrimoxazole and 49% with Cefotaxime. In contrast, resistance to Amikacin and Imipenem remained low (12% and 18%, respectively), and Nitrofurantoin retained good activity against E. coli (83% susceptible) but not Acinetobacter. Both Enterococcus isolates were susceptible to all agents except Tetracycline (50% resistant). Conclusions: One in six pregnant women harboured largely asymptomatic bacteriuria dominated by multidrug-resistant Gram-negative bacilli. Empiric regimens in this setting should favour Nitrofurantoin or single-dose Fosfomycin for uncomplicated infections and reserve aminoglycosides or carbapenems for suspected multidrug-resistant cases. Continuous antenatal screening and locality-specific antibiogram monitoring are imperative to optimise maternal and fetal outcomes.

Introduction and Aim: Intestine perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. Despite various measures such as safe drinking water supply and safe disposal of waste, intestinal perforation from salmonellosis remains the most common emergency surgery performed. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in surgical technique. More disturbing is that we now see increasing number of ileal perforations and colonic involvement. Typhoid fever is a systemic and severe febrile illness caused primarily by the gram negative bacillus Salmonella enteritidis serovar Typhi. Hence it is an infective disorder with fatal outcome if the disease is not treated properly. The most lethal complication of it are bleeding and ileal perforation, both arising from necrosis of Peyer’s patches in the terminal ileum. Complications are to be controlled as and when infection is cured. The aim of this study to know the best treatment protocol for this emergency disease after a thorough genesis. Also to show whether simple repair of perforation is the justified surgical procedure in terms of morbidity, mortality and cost effectiveness. Materials and Methods: The present study was conducted in 195 adult patients of Typhoid perforation admitted during 2018 to 2022 and treated surgically at Gauhati Medical College. Double layer simple closure of perforation done in majority. In this study enteric perforation was more common in males than in females with a ratio of 6.8:1.Their ages ranges from 14 to 65 years. Duration of perforation, number of perforation and development of faecal fistula are the factors which significantly affect mortality. Primary proximal temporary ileostomy and ileo transverse anastomosis were performed in some patients with multiple perforations and/or with perforation situated near/on the ileocaecal junction having greater risk of “repair leak”. Resection and anastomosis is considered in some cases of multiple perforations and unhealthy gut with or without defunctioning ileostomy. Results: Common post-operative complications include wound infection (21%), bleeding (1.02%-2 cases out of 195), faecal fistula (1.9%)-4 cases out of 195 and skin excoriation around ileostomy (9.4%).Primary closure (two layer) of perforation satisfactory result in terms of complications and resection is preferred in selected patients. Conclusions: Ileal perforation following typhoid fever is not unusual. Resuscitation followed by emergency surgery is the appropriate to manage. Quinolone is the drug of choice. Usually two layer primary closure is the procedure of choice though resection and anastomosis is reserved for special situation. Prognosis is much better if appropriately managed.

Hyponatremia is a critical electrolyte imbalance often observed in patients with diabetes mellitus and chronic kidney disease. This case report describes a 50-year-old female with a 10-year history of type 2 diabetes mellitus (T2DM) who presented with a one-month-old right foot ulcer, intermittent fever, serous discharge, and lower limb swelling for ten days. Laboratory investigations revealed dimorphic anemia, neutrophilic leukocytosis, renal function impairment, and electrolyte imbalances, including hyponatremia (serum sodium 129 mmol/L). Despite prior treatment, the ulcer failed to heal, raising concerns about diabetic foot complications. Empirical intravenous antibiotic therapy with piperacillin-tazobactam and clindamycin was initiated to control infection. The patient’s glycemic control was suboptimal (random blood glucose 326 mg/dL, HbA1c 10.7%), necessitating insulin therapy. She later underwent a right leg amputation due to the severity of the infection and poor wound healing. Postoperatively, worsening hyperglycemia, elevated serum creatinine (2.2 mg/dL), and further sodium depletion (128 mmol/L) were noted, suggesting hyperglycemia-induced osmotic imbalances and declining renal function. To mitigate nephrotoxicity, antibiotic therapy was adjusted, and renal protective agents such as taurine, acetylcysteine, sodium bicarbonate, and calcium supplementation were introduced. Blood transfusion was planned to correct anemia. Continuous monitoring and tailored interventions were prioritized to manage hyponatremia, optimize glycemic control, and prevent further complications. This case underscores the importance of comprehensive management in diabetic patients with electrolyte imbalances, emphasizing the need for timely intervention to prevent severe complications associated with T2DM, infection, and renal dysfunction.

Background: Hemodynamic perturbations during induction and laryngoscopy contribute to peri-operative morbidity. Propofol is popular for its rapid onset but is frequently implicated in hypotension, whereas etomidate is reputed for cardiovascular stability. Evidence comparing both agents in a uniform surgical population remains heterogeneous. Methods: After institutional ethical committee approval, 68 ASA I–II adults undergoing elective surgery were randomized to receive propofol 2 mg kg⁻¹ (Group P, n = 34) or etomidate 0.3 mg kg⁻¹ (Group E, n = 34). Standard monitoring captured heart-rate (HR) and non-invasive blood-pressure at baseline (T0), induction (T1), 1 min post-induction (T2), and 1, 3, 5 min post-intubation (T3–T5). Primary outcome was magnitude of hemodynamic change; secondary outcome was requirement for rescue vaso-active drugs. Results: Demographics were comparable (p > 0.05). Propofol produced a 15.8% fall in mean systolic pressure by T5 versus 3.3% with etomidate (p < 0.001). HR rose transiently at T3 in both groups (+3.7% vs +3.0%) but returned to baseline by T5. Rescue ephedrine was required in 26% of Group P vs 6% of Group E (p = 0.02). Conclusion: Etomidate preserved systolic and mean arterial pressures more consistently than propofol, with fewer vaso-active interventions. In ASA I–II patients where cardiovascular stability is desirable, etomidate may be preferred for induction.

Background: Despite the theoretical advantages of video laryngoscopy and fiberoptic bronchoscopy, literature comparing their stress responses directly with direct laryngoscopy remains heterogeneous. Some studies report significant attenuation of hemodynamic responses with VL and FOB compared to DL, while others suggest that the duration of intubation or patient-specific factors may offset these benefits. Methodology: Participants were randomly assigned into three equal groups (n = 30 each) using a computer-generated random number table: Group D: Intubation using Direct Laryngoscope, Group V: Intubation using Video Laryngoscope & Group F: Intubation using Fiberoptic Bronchoscope. Anesthesia was induced with the following intravenous agents: Midazolam at 0.03 mg/kg, Fentanyl at 2 µg/kg, Propofol at 2 mg/kg & Vecuronium bromide at 0.1 mg/kg to facilitate neuromuscular blockade. Hemodynamic variables including systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation (SpO₂) were recorded at pre-determined time intervals: Baseline (pre-induction), Immediately after intubation & at 1, 3, and 5 minutes post-intubation Additionally, saliva and venous blood samples were collected at two time points: Baseline: prior to the administration of anesthesia & Post-intubation: 5 minutes following successful tracheal intubation. Results: Direct laryngoscopy induced the highest stress response, both hemodynamically and biochemically. Video laryngoscopy showed a moderate increase in heart rate and blood pressure, significantly less than DL but more than fiberoptic. Fiberoptic bronchoscopy caused the least physiological disturbance, indicating its superiority in minimizing intubation-related stress. All changes were statistically significant (p < 0.05) when comparing Group D with Groups V and F. Conclusion: Direct laryngoscopy induces the greatest hemodynamic and biochemical changes while fiberoptic intubation results in the least. Video laryngoscopy stands in between, offering a safer alternative to DL with better visualization and reduced sympathetic activation.

Background: The coronary arteries are the primary vascular channels responsible for delivering oxygenated blood to the myocardium. Understanding the normal anatomy of the coronary arteries, along with their variations, is essential to ensure favorable clinical outcomes during therapeutic interventions such as angioplasty and coronary artery bypass grafting. The present study is conducted to elucidate the anatomical variations in branching pattern of right and left coronary arteries in the cadaveric hearts obtained from Department of Anatomy. This study also examines the predominance of right or left coronary arterial dominance. Materials and Methods: 32 hearts were obtained from embalmed cadavers from Department of Anatomy, KGMU UP, and Lucknow. Hearts were fixed and stored in 10 percent formalin. Result: Present study shows highest percentage of right dominance (93.74%) in comparison to incidence of left dominance (3.13%) and co-dominance (3.13%). Third coronary artery, anomalous origin of left circumflex artery from left marginal artery and trifurcation of left coronary artery were observed in 1 heart, 1 heart and 2 hearts respectively out of 32 hearts. Conclusion: A comprehensive understanding of coronary artery anatomy and its variations is essential for achieving optimal clinical outcomes in the management of coronary artery diseases. Such knowledge enables healthcare professionals to effectively treat cardiac conditions, minimizing the risk of complications during interventions like angioplasty or coronary artery bypass grafting.

Introduction: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Early identification of disease severity is critical for optimizing outcomes. Biomarkers such as RDW, which reflects systemic inflammation and oxidative stress, offer promising insights into CAP prognosis. This study focuses on evaluating RDW in relation to CURB-65 and its association with serum biomarkers like procalcitonin and CRP. Methodology: Conducted at SMS Medical College, Jaipur, the study included 70 CAP patients. RDW, serum procalcitonin, and C-reactive protein (CRP) levels were measured at admission, during hospitalization, and at discharge. Sample size of 70 adult CAP patients meeting inclusion criteria (e.g., pulmonary infiltrate on radiograph) and excluding recent hospitalizations or immunocompromised conditions. Descriptive and inferential statistics (ANOVA, chi-square test) to assess biomarker correlations with CAP severity. Results: Mean age 57.07 years with 54.3% female. RDW increased significantly with CURB-65 scores (p = 0.000). Patients with a score of 4 exhibited the highest RDW levels. Both biomarkers showed a progressive increase with CAP severity, correlating with CURB-65 scores. Mortality rate was 26%, and RDW levels were predictive of ICU admission and prolonged hospital stays. Conclusion: RDW is a reliable, cost-effective biomarker for assessing CAP severity. Its integration into clinical protocols, alongside CURB-65, offers improved patient stratification and outcome prediction.

Background: The correlation between high cholesterol and diabetic retinopathy (DR) is a little studied topic. Diabetic individuals with and without retinopathy will have their hemoglobin A1c (HbA1C), total cholesterol (TC), fasting blood sugar (FBS) and superoxide dismutase levels compared and assessed to see whether they may be used as markers of the development and progression of the disease. It may be conceivable to prevent visual complications in diabetics through better risk assessment that includes more specialists and starts medication earlier if we have a clearer grasp of these metabolic markers and their connection to DR. Materials & Methods: Once the institutional ethics committee gave its approval, the research authors would begin their individual studies.  Participants gave their consent before the inquiry began after being fully informed.  The study included 100 participants with diabetic retinopathy and 100 healthy controls.  The outpatient departments assessed each group. This prospective observational study conducted in Biochemistry Department at Maharani Laxmibai Medical College, Jhansi.  This examination also includes fundus fluorescein angiography and ophthalmoscopy.  The ETDRS Grading System was then used to provide a grade to each patient, indicating the degree of reduction in retinopathy. Results: The average FBS level in diabetics without retinopathy was 127.6 in the research. Meanwhile, the average levels of diabetics with proliferative diabetic retinopathy (PDR) were 152.1 and those with non-proliferative diabetic retinopathy (NPDR) were 195.2. A correlation between diabetic retinopathy and fasting blood sugar levels is likely due to the fact that the p-value is less than 0.05. A p-value less than 0.05 indicates a correlation between HbA1c levels and the severity of diabetic retinopathy. The relationship appears to be strong based on this. Furthermore, total cholesterol levels were less than 0.05, suggesting a correlation. Twenty DR patients had blood total cholesterol levels that were too high, whereas thirty-four patients had normal cholesterol levels. Conclusion: The main factors that lead to the development of retinal degeneration in diabetics are high lipid levels and an inadequate management of blood sugar levels. Monitoring and regulating levels of fasting blood sugar, hemoglobin A1c, and total cholesterol is crucial for improving diabetes care. The cholesterol levels of twenty out of fifty-six diabetics were found to be high.

Background: PACG (Primary Angle Closure Glaucoma) is a significant cause of blindness in India, progressing more rapidly than primary open-angle glaucoma. Anatomical factors like shallow ACD (Anterior Chamber Depth) and LT (Lens Thickness) contribute to its pathogenesis. Understanding these parameters is crucial for early diagnosis and prevention. Methods: A case-control study was conducted with 50 PAC spectrum cases (PACS, PAC, PACG) and 50 age- and gender-matched normal controls. Detailed ocular evaluation, including best corrected visual acuity, intraocular pressure, slit-lamp examination, gonioscopy, fundus exam, optical biometry, AS-OCT (Anterior Segment OCT), and visual field analysis (if indicated), was performed. ACD and LT were measured using optical biometry; angle width (AOD at 500 µm) was assessed using AS-OCT. Results: The mean age of cases was 54.26 years, with a male:female ratio of 1:3.1. Among cases, 74% were PACS, 12% were PAC, and 14% were PACG. Mean ACD was significantly lower in cases (2.33 ± 0.21 mm) compared to controls (3.32 ± 0.18 mm). Mean LT was higher in cases (4.53 ± 0.60 mm) versus controls (4.16 ± 0.36 mm). Mean AOD was also lower in cases (221.02 ± 55.06 µm) than in controls (598.52 ± 125.08 µm). A 0.01 mm decrease in ACD correlated with a 0.784 µm decrease in AOD and a 0.0198 mm increase in LT. Conclusion: PACG cases showed significantly shallower ACD, narrower angles, and thicker lenses, especially in females. These biometric parameters are valuable for early detection and timely intervention in angle closure disease.

Background: Acute pancreatitis affects approximately 34 cases per 100,000 people annually worldwide, with traditional management advocating nil per oral (NPO) status to achieve “pancreatic rest.” However, emerging evidence suggests early enteral feeding may offer superior outcomes by maintaining gut barrier integrity and preventing bacterial translocation. Methods: This prospective randomized controlled trial included 50 patients with mild to moderate acute pancreatitis, equally randomized into Group A (early enteral feeding within 48 hours) and Group B (NPO for 72 hours). Primary outcomes included complication rates, hospital stay duration, and APACHE II score changes. Secondary outcomes assessed serum pancreatic enzymes and NPO duration. Results: Baseline characteristics were comparable between groups. Group A experienced significantly fewer complications (32% vs 68%, p=0.017), with notable reductions in abdominal distension (4% vs 28%) and sepsis (0% vs 16%). All Group A patients were discharged within 5 days (mean 3.28±0.54 days) compared to only 24% of Group B patients, with Group B requiring longer hospitalization (mean 6.76±1.8 days, p<0.001). APACHE II scores improved in Group A (1.92±0.68) but deteriorated in Group B (3.73±0.778) after 72 hours (p<0.001). No significant differences were observed in serum amylase or lipase levels between groups. Conclusion: Early enteral feeding in mild to moderate acute pancreatitis significantly reduces complications, shortens hospital stays, and improves clinical outcomes compared to traditional NPO management. These findings challenge the conventional pancreatic rest paradigm and support early nutritional intervention as the preferred approach for most acute pancreatitis patients.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a novel and effective treatment for type 2 diabetes mellitus (T2DM), providing glycaemic control and cardiovascular protection. However, patient-level data on awareness, usage, and satisfaction with GLP-1 RAs in Eastern India are sparse. Objectives: To assess awareness, usage, and satisfaction among T2DM patients regarding GLP-1 RAs in five Eastern Indian states. Methods: A cross-sectional survey of 500 adult patients with T2DM was conducted using a structured questionnaire across urban and rural centers in West Bengal, Bihar, Odisha, and Jharkhand. Data were analyzed using SPSS version 26.0. Results: Awareness of GLP-1 RAs was observed in 132 (26.4%) patients. Among them, 88 (17.6%) had used GLP-1 RAs. Among users, 63 (71.6%) reported good glycaemic control and 54 (61.3%) reported satisfaction. The most common barriers to usage were cost (72.7%), injectable route (60.2%), and lack of physician recommendation (51.1%). Conclusion: Awareness and usage of GLP-1 RAs are limited among T2DM patients in Eastern India despite favorable clinical outcomes among users. Educational interventions and affordability measures may help optimize utilization.

Background: Osteoarthritis (OA) of the knee is a prevalent and debilitating chronic joint disease characterized by cartilage degradation and pain, significantly impacting quality of life. Its treatment encompasses various approaches, such as surgery, medication, prescribed exercise, physical modalities, and patient education. While knee arthroplasty offers an effective solution for advanced OA knee, its high cost and potential complications make it less suitable for younger individuals or those not in the final stages of the disease. Pharmacological treatments for KOA, including analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections, are available but carry a risk of notable side effects. Intra-articular injections, including hyaluronic acid (HA) and platelet-rich plasma (PRP), are increasingly explored as non-surgical therapeutic options for knee OA. While both aim to alleviate symptoms and potentially modify disease progression, their comparative clinical and functional efficacy remains a subject of ongoing debate. This study aims to compare the clinical and functional outcomes of intra-articular PRP versus HA injections in patients with knee OA. Methods: This was a prospective, randomized, controlled, single-blinded clinical trial involving 60 patients (30 PRP, 30 HA), aged 40-60 years, diagnosed with Kellgren-Lawrence Grade I or II knee OA. Participants received a series of three intra-articular injections at weekly intervals under ultrasound guidance. Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and secondary outcomes included the Visual Analogue Scale (VAS) for pain. Outcomes were assessed at baseline, 6,12and 24 weeks’ post-injection series. Longitudinal changes were analyzed using repeated measures ANOVA or linear mixed models, with a p-value < 0.05 considered statistically significant. Results: Baseline demographic characteristics and initial WOMAC and VAS scores were comparable between both groups. Both PRP and HA injections led to significant improvements in knee pain and functional status from baseline over 24 weeks. However, the PRP group consistently demonstrated statistically significantly greater and more sustained reductions in both WOMAC and VAS scores compared to the HA group at all post-intervention follow-up intervals (6, 12, and 24 weeks). The improvements in the PRP group were notably more profound, leading to significantly lower pain levels and better functional outcomes than in the HA group. Conclusion: Intra-articular PRP injections are significantly more effective than HA injections in reducing pain and improving functional outcomes in patients with early knee osteoarthritis over a 24-week period. These findings advocate for PRP as a superior non-surgical therapeutic option for the management of this prevalent joint disease.

Introduction: Acromioclavicular joint dislocations are prevalent among young adults due to trauma, especially in contact sports or road traffic accidents. While nonoperative management is standard for Type I and II injuries, surgical intervention is often recommended for Type IV-VI and selected Type III dislocations. This study evaluates the clinical and functional outcomes of double-button fixation in acute AC dislocations at a tertiary care center. Methods: This prospective study included 20 patients (Rockwood Type III–V) undergoing surgical repair using the double-button technique at Adichunchanagiri Institute of Medical Sciences between January 2023 and July 2024. Preoperative and postoperative Constant-Murley and VAS scores were recorded over an 18-month follow-up. Radiographic assessment of joint reduction and complications was also performed. Results: The mean age was 33.8 years, with 85% male participants. The mean preoperative CMS improved from 30.9 ± 5.2 to 89.4 ± 6.1 at 6 months (p < 0.001), and VAS scores reduced from 6.4 ± 1.1 to 0.9 ± 0.7 (p < 0.001). Anatomical reduction was maintained in 90% of patients. Only one patient had a superficial infection, with no cases of hardware failure or revision surgery. Conclusion: Double-endobutton fixation is a safe and effective technique for managing acute Rockwood Type III–V AC joint dislocations. It provides excellent clinical and functional outcomes with minimal complications, making it a dependable choice, especially in active young adults.

Background: A Clinical audit is an essential device to improve quality of care. The contributions of audit-trained students lead to meaningful improvements in patient care and healthcare services. Aim: To appraise and understand Experience, Knowledge, Attitude and Practice of students in a teaching hospital in Southern part of India about clinical audits and its applicability. Methods: A total of 25 Pharm D (Doctor of Pharmacy) students posted in Teaching Hospital were given training in audit procedures by trained professionals. They were formed into 5 groups and then encouraged to complete an audit from each group. Students were provided with feedback forms specifically exploring their experiences, knowledge, attitudes and practices after they completed an audit. Results: Out of 25 students, 24 fully responded. In the experience domain, 91% rated 4 or 5, and two rated 3. All agreed or strongly agreed that the training improved their knowledge of clinical audit processes. In attitude, 58% agreed, 38% strongly agreed, and 4% strongly disagreed that audits are essential for patient care. In practice, 75% felt confident, 21% very confident, and 4% somewhat confident in independently applying audit methods. Conclusion: There is a need for orienting and training students in Audits. Students need to be encouraged to take up more diverse tasks in Audits (e.g., data analysis, presenting findings). Undertaking audits help students not only to deepen their understanding of quality improvement and develop practical skills but also build their professional confidence, shape positive attitudes, and prepare for independent practice.

Introduction: Tuberculosis (TB) remains a major global health burden, with multidrug-resistant TB (MDR-TB) posing a significant challenge due to its low cure rate and high mortality. Early detection of drug-resistant TB (DR-TB) is essential for controlling its spread, and high-resolution computed tomography (HRCT) plays a crucial role in assessing disease extent and identifying surgical candidates. Materials & Methods: This observational cross-sectional study included 115 microbiologically confirmed DR-TB patients at our medical college. HRCT thorax imaging was performed, and findings were analyzed using SPSS and MS Excel. Results: The majority of cases (63.4%) were in the 21–50 age group, with a male predominance (78.2%). Acquired resistance (88.7%) was more common than primary resistance. Bilateral lung involvement (79.1%) and multiple thick-walled cavities (80.8%) were significant indicators of drug resistance. The most common HRCT features included tree-in-bud appearance (91.3%), consolidation, ground-glass opacity, and mediastinal lymphadenopathy. Rifampicin resistance was highest (69.5%). Conclusion: HRCT is a valuable tool for early detection of DR-TB, aiding in treatment decisions and surgical planning. Identifying key imaging features can improve patient outcomes and contribute to global TB control efforts.

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, especially in rural areas with limited access to emergency obstetric care. This study aims to evaluate the clinical profile, etiologies, interventions, and maternal outcomes of PPH in a rural population. Methods: A hospital-based observational study was conducted on 73 postpartum women diagnosed with PPH at the Department of Obstetrics and Gynecology in a Prathima Institute of medical sciences located in Karimnagar, Telangana, India.  Data on demographic details, obstetric factors, etiology of PPH, interventions used, and outcomes were collected and analyzed. Results: Most participants were aged between 21–40 years, with 58.9% being primiparous. Cesarean delivery was more common (57.5%) than vaginal delivery. Manual removal of the placenta was required in 49.3% of cases. Immediate onset of PPH occurred in 58.9%, and signs of shock were seen in 46.6%. The mean estimated blood loss was 1356.71 mL. Uterine atony (Tone) was the most common cause (39.7%), followed by retained tissue (26%), trauma (24.7%), and thrombin disorders (9.6%). Uterotonics were used in 46.6% of cases, and 52.1% required blood transfusion. Surgical interventions included hysterectomy (35.6%) and uterine artery ligation (34.2%). While 54.8% of patients recovered, complications occurred in 39.7%, and the mortality rate was 5.5%. Conclusion: PPH continues to pose a significant threat to maternal health in rural areas. Early identification, prompt management, and improved access to emergency obstetric services are critical to reducing adverse outcomes.

Background: The incidence of acute small bowel obstruction presenting itself as an emergency is high, owing to its rapid onset and brisk progress. It is one of the most common abdominal emergencies. The need to understand the pathophysiological changes that occur during the disease process is of utmost importance to decrease the morbidity and mortality post small bowel obstruction. Aim and Objectives: In this study, we aim to define the incidence and the management of acute small bowel obstruction due to both medical and surgical causes. Materials and Methods: We conducted a prospective cohort study of 200 patients presenting with obstipation, between January 2022 and January 2025. All patients were subjected to a battery of biochemical tests and a set of radiological investigations for a complete clinical diagnosis. Results: Out of the 200 patients presenting with obstipation, 132 patients had dynamic obstruction, with pathology either in the wall, in the lumen, or outside the wall; while the rest (24 patients) had obstruction due to medical causes. The gold standard investigation was a contrast enhanced CT of the abdomen. The most common cause of dynamic obstruction encountered in our practice was adhesion, followed by inflammatory and infective pathologies. Conclusion: An early diagnosis followed by prompt management is of paramount importance whilst dealing with a case of small bowel obstruction. This consequently leads to a faster decision of surgery vs. conservative management, while avoiding complications such as perforation and peritonitis, thereby decreasing the mortality and morbidity due to sepsis and MODS.

Background: Hemodynamic stability and electrocardiographic (ECG) changes during spinal anaesthesia can vary significantly between hypertensive and normotensive patients, influencing postoperative outcomes. Objectives: To compare the intraoperative hemodynamic behavior, ECG changes, and postoperative outcomes between hypertensive and normotensive patients undergoing surgery under spinal anaesthesia. Methods: This prospective observational study included 132 patients, evenly divided into hypertensive and normotensive groups. Demographic profiles, block characteristics, heart rate, blood pressure parameters (SBP, DBP, MAP), ECG changes, and postoperative outcomes including pain scores, ICU admission, PONV, hospital stay, and 30-day cardiovascular events were recorded and analyzed. Results: The hypertensive group demonstrated a significantly higher baseline heart rate and blood pressure (SBP, DBP, MAP) compared to normotensives. Although heart rate and blood pressure declined following spinal anaesthesia in both groups, normotensive patients exhibited greater hemodynamic stability. Two-segment regression of spinal block was significantly faster in hypertensives (p = 0.04). At 2 hours postoperatively, pain scores were significantly higher in hypertensives (p = 0.0004). ECG changes, including ST depression and T-wave inversion, were more frequent in hypertensives, though not statistically significant (p = 0.156). Postoperative complications such as PONV, ICU admission, and 30-day cardiovascular events were more prevalent among hypertensives, but differences were not statistically significant. Conclusion: Hypertensive patients under spinal anaesthesia tend to experience greater hemodynamic fluctuations, delayed pain control, and a higher—but not statistically significant—rate of ECG changes and postoperative complications compared to normotensives.

Introduction: Ultrasonography (US) is the most common and most useful way to image the thyroid gland and its pathology, as recognized in guidelines for managing thyroid disorders published by the American Thyroid Association and other authoritative bodies. Aims: The aim of this study is to evaluate the profiles of thyroid swellings using ultrasonography and conventional cytology, and to assess the concordance between these two diagnostic methods in the accurate classification and management of thyroid lesions. Materials & Methods: The present study was an observational cross-sectional study. This study was conducted from one year (January 2023-December 2023) at College of Medicine and Sagore Dutta Hospital. Total 126 patients were included in this study. Result: In TIRADS 1, the majority of cases were classified as Bethesda II (78.6%), followed by Bethesda I (14.3%) and Bethesda III (7.1%). For TIRADS 2, Bethesda II remained predominant (84.6%), with smaller proportions falling into Bethesda I (5.1%), Bethesda III (2.6%), and Bethesda V (7.7%). In TIRADS 3, cases were more evenly distributed: Bethesda II (37.0%), Bethesda III (33.3%), Bethesda IV (18.5%), and Bethesda V (11.1%). Among TIRADS 4 cases, Bethesda II accounted for 35.5%, followed by Bethesda III (29.0%), Bethesda IV (16.1%), Bethesda V (9.7%), and Bethesda VI (9.7%). Conclusion: In conclusion, this study highlights the valuable role of both ultrasonography and conventional cytology in the assessment of thyroid swellings. The findings suggest that ultrasonography, particularly through the TIRADS system, is effective in stratifying thyroid nodules based on their risk, while cytology provides essential diagnostic confirmation.

Introduction: Antimicrobial resistance (AMR) poses a major global health threat, primarily due to irrational antibiotic use. This study assesses the knowledge, attitude, and practices (KAP) regarding antimicrobial stewardship (AMS) among interns and junior residents in a tertiary care setting. Materials and Methods:  A cross-sectional, questionnaire-based study was conducted at GMERS Medical College, Morbi, from September to November 2024. A total of 105 interns and residents were surveyed using a pre-validated tool to evaluate their KAP on AMS. Results: Out of 105 participants (mean age 24.8 ± 2.3 years), 71.4% had good AMS knowledge, with residents scoring significantly higher than interns (p = 0.003). While 78.1% showed a positive attitude, only 58.1% reported good practices. Residents outperformed interns in AMS practice adherence (p = 0.041). Knowledge-practice correlation was moderate (r = 0.41, p < 0.001), but attitude and practice showed only weak correlation. Logistic regression revealed that being a junior resident (AOR = 1.88, p = 0.035) and having good knowledge (AOR = 2.26, p = 0.018) were significantly associated with better practice. Conclusion: Despite moderate knowledge and positive attitude, gaps in AMS practices persist, especially among interns. Structured, hands-on AMS training is essential to bridge this knowledge-practice divide.

Background: Since seizures are a medical emergency, prompt treatment is necessary to reduce morbidity and death. The rate at which a drug enters the bloodstream frequently determines how well a treatment works to lower these outcomes. When it comes to treating seizures in children, benzodiazepines like lorazepam, midazolam, and clonazepam are usually the preferred options. An improved method of treating seizures in children when there isn’t instant access to an intravenous line, parents and paramedics can learn the safe, economical, and easy-to-use technique of intranasal midazolam, which administers antiepileptic medication directly to the bloodstream and cerebral fluid through the nasal mucosa. In an emergency, it provides better seizure control. Intranasal midazolam, when used as an anesthetic, has proven to be safe and effective for children undergoing various diagnostic studies and minor procedures. Objectives: To determine and compare the efficacy of intranasal midazolam with that of intravenous lorazepam in the control of acute onset seizures in children aged 6 months to 15 years. Methodology: This randomized, open-label trial (August 2023–March 2024) at AIMS, Bellur, Mandya, compared intranasal midazolam (Group A) and intravenous lorazepam (Group B) for pediatric seizure management. Children (6 months–15 years) were stratified by age and randomized into two groups. Group A received 0.2 mg/kg intranasal midazolam.And Group B received 0.1 mg/kg intravenous lorazepam. Seizure cessation time was the primary outcome, with success defined as cessation within 5 minutes, delayed control as 5-10 minutes, and failure as no cessation within 10 minutes. Children were monitored for 60 minutes post-seizure with vital signs recorded every 30 minutes. Results: Mean survival time for Intranasal Midazolam was 4.3 min and for intravenous lorazepam was 6.467 min and Median survival time for Intranasal Midazolam was 3 min and for intravenous lorazepam was 7 mins. This was statistically significant at p value <0.017. Conclusion: The overall time to cessation of seizure after arrival at hospital was faster with intranasal midazolam than intravenous lorazepam.

Introduction: Venipuncture, a common yet painful invasive procedure, often evokes considerable fear and anxiety. Effective pain management is crucial to prevent long-term behavioral issues and adverse clinical consequences. Pain relief by topical anesthetic preparations such as the EMLA cream (eutectic mixture of local anesthetics) is composed of 2.5% lignocaine and 2.5% prilocaine, is one among the pharmacologic techniques. Although use of topical anaesthesia prior to minor procedures in children is becoming a standard of care in few of the hospitals across India, we intend to do this study to seek the benefit of using EMLA in reducing the pain during IV cannulation. Objective: To compare pain responses in children during IV cannulation with and without the application of EMLA cream. Materials and Methods: A prospective study was conducted in the Department of Paediatrics at Adichunchanagiri Hospital and Research centre, from May to July 2024. The study population consisted of 102 children aged 12 months to 18 years, recruited through convenient sampling. Pain was assessed during initial cannulation without anesthesia and reassessed during secondary cannulation, which was performed 60 minutes after applying EMLA cream. Pain assessment was done using FLACC (<5 years) and Wong-Baker (>5 years) scales. Data was entered in MS Excel and analyzed with SPSS-22 software, with quantitative data presented as mean ± SD and qualitative data as frequency and percentage, visualized through graphs and tables. McNemar test was used as test of significance (p < 0.05), comparing routine cannulation to cannulation after topical anesthesia. Results: This study included 102 participants with an average age of 6.82 ± 4.5 years. The sample was evenly distributed between children under 5 years (n=51) and those 5 years or older (n=51), with a slight female predominance (51%). The mean pain scores during routine cannulation and with EMLA application were 7.5 ± 1.646 and 6.52 ± 2.1, respectively. The use of EMLA cream significantly reduced pain during IV cannulation, with a statistically significant association observed at p value of < 0.001. Conclusion: The study confirms that EMLA cream when used as a topical anesthetic, significantly reduces pain during intravenous cannulation in paediatric patients. Given these benefits, it is recommended that EMLA cream or similar topical anesthetics be considered as a standard practice for paediatric IV cannulation.

Background: Peritonitis due to gastrointestinal hollow viscus perforation is a critical surgical emergency associated with significant morbidity and mortality. Accurate prognostic tools are essential for early identification and effective management of high-risk patients. The Mannheim Peritonitis Index (MPI), developed by Wacha and Linder, offers a validated, straightforward scoring system to predict outcomes in such cases. Aims & Objective: This study aimed to evaluate the effectiveness of the MPI scoring system in predicting mortality and morbidity among patients with peritonitis resulting from hollow viscus perforation in an Indian population. Methods: A prospective cohort study was conducted over one year at SVRRGGH, Tirupati, involving 100 patients diagnosed intraoperatively with peritonitis due to hollow viscus perforation. Patients were assessed using the MPI and stratified into risk categories. Data were analyzed using SPSS v24.0, applying chi-square and t-tests to assess statistical significance (p<0.05). Results: The mean age was 32.3±13.7 years, with a male predominance (74%). Duodenal perforation (74%) was the most common cause. Organ failure was observed in 21% of patients. The MPI distribution showed 83% with scores <21, 10% with 21–29, and 7% with >29. Mortality was significantly higher in patients with MPI >29 (57.1%) and 21–29 (42.9%), while those with scores <21 had no mortality. A statistically significant association was found between higher MPI scores and increased mortality (p<0.01). Conclusion: The MPI scoring system is a reliable and effective tool for predicting morbidity and mortality in patients with peritonitis due to hollow viscus perforation. Early risk stratification using MPI can guide clinical decision-making, allowing timely interventions and potentially improving patient outcomes.

Background: Heart failure is a clinical syndrome characterized by constellation of symptoms such as dyspnea, orthopnea and lower limb swelling and signs such as elevated jugular venous pressure, pulmonary congestion often caused by a structural or functional cardiac abnormality resulting in reduced cardiac output or elevated intracardiac pressures. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome. Left ventricular diastolic or systolic dysfunction results in increased preload and after load, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centered on decongestive drugs, at best tailored according to the initial hemodynamic status with little regard to the underlying pathophysiological particularities. As a consequence, AHF is still associated with high mortality and hospital readmission rates. The main aim of this study is to give an insight to the local causes of heart failure and understanding clinical and epidemiological variables. Materials and Methods: The study was a comparative cross-sectional study. The study was conducted with a sample size of 100 patients who presented to the Emergency Medicine department with features suggestive of acute heart failure for a period of one year. Results and Conclusion: Among 100 patients study population, majority of the belonged to age group of 40-49 years, the mean age was 59.94 years. Three fourths were males and approx. one fourth were females. 76% of them were literates. Three fourths were employed and one fourth were unemployed (24%). 81% of them belonged to urban region. 89% of them had hypertension, followed by smoking (64%), alcoholism (57%), diabetes (39%). 38% of the study population were tobacco chewers. 34% had dyslipidemia and 31% had obesity. 18% of them had previous history of AHF. 28% of them had family history of AHF. 86% reported dyspnea, followed by chest pain (74%), edema (38%), orthopnea (12%). 5% of the study population reported PND. 48% belonged to Class II, followed by Class III (42%). 8% belonged to Class I and 2% belonged to class IV NYHA classification. 62% had Ischemic pathology, 28% had hypertension, 6% had valvular pathology, 4% were idiopathic in nature. 91% were discharged successfully.

Background: Organophosphorus (OP) compounds, commonly used as pesticides in agricultural settings, are a major cause of acute poisoning and mortality in India due to their easy availability and low cost. Aim of the study is to evaluate the prognostic role of hypokalemia in patients with acute OP poisoning. Methodology: It was an Observational study done in 50 patients who were prospectively enrolled from the CCU and General Medicine Department at Government General Hospital, Kadapa between a periods from December 2022 to November 2023. Patients were stratified based on serum potassium levels into hypokalemic and normokalemic groups to assess the impact on morbidity and mortality. Results: Hypokalemia was observed in 38% of patients and was significantly associated with adverse clinical outcomes, including seizures (p=0.041), respiratory depression (p=0.005), abnormal pupil size (p=0.018), fasciculations (p=0.014), and ECG changes (p=0.03). Notably, all four reported deaths occurred in the hypokalemic group (p=0.0077), and the need for mechanical ventilation was also significantly higher among these patients (p=0.00085). Additionally, the hypokalemic group experienced a significantly longer hospital stay (mean 4.05 days vs. 2.32 days; p<0.001). Sensitivity and specificity of hypokalemia as a predictive marker for poor outcomes were 75% and 97.83%, respectively. Conclusion: The findings support the use of serum potassium as an accessible and economical prognostic marker in acute OP poisoning. The results align with previous studies linking hypokalemia to increased morbidity, need for respiratory support, and mortality. Given the clinical and economic burden of OP poisoning in India, prompt recognition and correction of hypokalemia may improve outcomes. This study emphasizes the importance of early electrolyte assessment as part of standard management in OP poisoning cases.

Background: he concept of laparoscopic cholecystectomy largely replaced open cholecystectomy as the gold standard treatment of gall stone disease because of less scarring, shortened hospital stays, earlier returns to usual activities, lesser morbidity. The conversion rate of 3.6 to 13.9% is reported in the literature. The most common causes for conversion are obscure biliary anatomy, presence of dense pericholecystic adhesions, intraoperative bleeding, and failure of the progression. Factors predisposing to conversion can be classified as patient related (diabetes mellitus and other co-morbidities), disease related (acute/chronic, size of the stone, duration of illness) and surgeon related (experience). Aim: To study the number of Cholecystectomies done laparoscopically, and to know the Conversions to Open Cholecystectomy, and to study the Complicating factors leading to Conversion. Methodology: This was a prospective observational study done in 100 patients admitted with symptomatic gall stone disease without choledocholithiasis between October 2022 to March 2024 in Guntur Medical College Hospital. Results: A prospective study was carried out in the Department of General Surgery in 100 patients undergoing laparoscopic cholecystectomy. We had 4% conversion rate with 96% cases completed laparoscopically. Conclusion: Conversion rate of laparoscopic cholecystectomy to open cholecystectomy was found to be 4% at our institute during the study period. Pre-operative findings of BMI >30, history of previous abdominal surgeries can help in prediction of lap to open conversion in cholecystectomy. Other factors like age, gender, history of cholecystitis, history of pancreatitis, WBC count, GB wall thickness, pericholecystic collection were not helpful in predicting the conversion rate.

Background: Total knee replacement (TKR) is commonly associated with substantial blood loss, often necessitating transfusion. The use of a pneumatic tourniquet is thought to reduce intraoperative bleeding; however, its overall benefit remains controversial due to possible postoperative complications and mixed effects on total blood loss. Aim: To compare blood loss and the need for transfusion in patients undergoing primary total knee replacement with or without the use of a tourniquet. Materials and Methods: This prospective comparative study included 160 patients undergoing primary TKR. Group A (n = 80) underwent surgery with a tourniquet, while Group B (n = 80) had the procedure without one. Intraoperative blood loss, postoperative drain output, calculated total blood loss, and transfusion requirements were measured. Statistical analysis was performed using SPSS version 25, with p < 0.05 considered significant. Results: The tourniquet group had significantly lower intraoperative blood loss (145.6 ± 52.4 mL vs. 285.4 ± 64.5 mL, p < 0.001) and total blood loss (512.8 ± 89.3 mL vs. 637.8 ± 92.5 mL, p < 0.001). However, postoperative drain output was higher in the tourniquet group (266.3 ± 70.5 mL vs. 196.9 ± 68.9 mL, p = 0.002). There was no statistically significant difference in the proportion of patients requiring transfusion (15% vs. 23.75%, p = 0.20), but the no-tourniquet group received a higher volume of transfused blood (0.56 ± 0.7 units vs. 0.30 ± 0.5 units, p = 0.04). Conclusion: Tourniquet use during primary TKR is associated with reduced intraoperative and total blood loss but results in greater postoperative drain output. Although transfusion rates were similar between groups, the total volume transfused was higher in the no-tourniquet group. These findings support selective tourniquet use based on patient-specific considerations.

Introduction: Distal radius fractures are common orthopedic injuries requiring effective fixation to restore wrist function. Surgical options include conventional dynamic compression plates (DCP) and volar locking plates (VLP). This study aims to compare the functional and radiological outcomes of locking versus conventional plating methods. Materials and Methods: A prospective comparative study was conducted at a tertiary care center in Karnataka, India, from January 2024 to January 2025. Fifty adult patients with closed, displaced distal radius fractures were randomized into two groups (n=25 each): Group A underwent fixation with volar locking plates, and Group B received conventional DCP. Patients were followed for 12 weeks. Functional outcomes were assessed using Modified Mayo Wrist Score and DASH score. Radiological parameters included radial length, inclination, volar tilt, and articular step-off. Range of motion and complication rates were also evaluated. Statistical analysis was done using SPSS v26.0. Results: Group A demonstrated significantly better restoration of radial length (11.2±1.8 mm vs 9.4±2.1 mm, p=0.003), radial inclination (p=0.001), and volar tilt (p=0.002). Modified Mayo Wrist Scores and DASH scores also favoured the locking plate group (p=0.01 and p=0.001, respectively). Wrist flexion and extension were significantly higher in Group A. Complication rates were lower in the locking plate group (12% vs 28%), though not statistically significant. Conclusion: Volar locking plates offer superior early radiological and functional outcomes compared to conventional plates in distal radius fractures, with a trend toward fewer complications. Locking plates should be preferred, especially for unstable or intra-articular fractures requiring early mobilization.

Introduction: Spinal anaesthesia is the preferred method for caesarean section due to its rapid onset and maternal safety. However, maternal hypotension is a common complication, potentially compromising fetal outcomes. Ephedrine and phenylephrine are commonly used vasopressors, but concerns remain about their differential effects on neonatal acid–base status. The study aims to compare the fetal effects of phenylephrine and ephedrine administered for spinal anaesthesia-induced hypotension during caesarean section, using APGAR scores and umbilical cord blood gas parameters. Materials and Methods: This was a prospective, randomized, double-blind study conducted on 80 ASA I parturient undergoing elective caesarean section under spinal anaesthesia. Participants were allocated into two groups (n=40 each): Group E received IV ephedrine, and Group P received IV phenylephrine. Neonatal outcomes assessed included APGAR scores at 1 and 5 minutes, birth weight, resuscitation requirement, and umbilical arterial and venous blood gas analysis. Results: Both groups were demographically comparable. Group P had significantly higher APGAR scores at 1 minute (p=0.034), lower need for neonatal resuscitation (2.5% vs. 12.5%, p=0.042), higher umbilical arterial pH (p=0.019), and less negative base excess (p=0.007). The incidence of fetal acidosis (pH < 7.20) was significantly higher in Group E (22.5% vs. 5%, p=0.017). Conclusion: Phenylephrine demonstrated better neonatal acid–base outcomes compared to ephedrine, with fewer neonates requiring resuscitation. These findings support the use of phenylephrine as the preferred vasopressor for managing spinal anaesthesia-induced hypotension in obstetric practice.

Introduction: Spinal anaesthesia is the preferred method for caesarean section due to its rapid onset and maternal safety. However, maternal hypotension is a common complication, potentially compromising fetal outcomes. Ephedrine and phenylephrine are commonly used vasopressors, but concerns remain about their differential effects on neonatal acid–base status. The study aims to compare the fetal effects of phenylephrine and ephedrine administered for spinal anaesthesia-induced hypotension during caesarean section, using APGAR scores and umbilical cord blood gas parameters. Materials and Methods: This was a prospective, randomized, double-blind study conducted on 80 ASA I parturient undergoing elective caesarean section under spinal anaesthesia. Participants were allocated into two groups (n=40 each): Group E received IV ephedrine, and Group P received IV phenylephrine. Neonatal outcomes assessed included APGAR scores at 1 and 5 minutes, birth weight, resuscitation requirement, and umbilical arterial and venous blood gas analysis. Results: Both groups were demographically comparable. Group P had significantly higher APGAR scores at 1 minute (p=0.034), lower need for neonatal resuscitation (2.5% vs. 12.5%, p=0.042), higher umbilical arterial pH (p=0.019), and less negative base excess (p=0.007). The incidence of fetal acidosis (pH < 7.20) was significantly higher in Group E (22.5% vs. 5%, p=0.017). Conclusion: Phenylephrine demonstrated better neonatal acid–base outcomes compared to ephedrine, with fewer neonates requiring resuscitation. These findings support the use of phenylephrine as the preferred vasopressor for managing spinal anaesthesia-induced hypotension in obstetric practice.

Background: Diabetes has now become a global pandemic. Scientists are searching every nook and corner to find a solution to this. The use of herbal drugs is one of them. Aspalathus Linearis (Rooibos) is a herb commonly used as a tea in Africa. This has shown many promises of being useful in various human ailments including Diabetes Mellitus. Our study is a venture to do a systematic evaluation of this in human diabetic adults. Methodology: This was a quantitative cross-sectional institution-based study passed by the Institutional Ethics Committee. Newly diagnosed diabetics not yet put on any medicine were selected for the study from both sexes in the age group of 18 to 60 years. Pregnant and lactating women and people suffering from other ailments were excluded. They were divided into two groups: control and test groups. 5 parameters were tested at the beginning of the study for both the groups – fasting blood sugar 1-hour PPBS, 2-hour PPBS, GTA (area under glucose tolerance curve), and HbA1C. The control group was advised lifestyle modification (LSM) measures which include diet and exercise. The test group was advised to follow LSM plus they were asked to take two cups of Rooibos tea every day in the morning and evening. At the end of three months, both groups were retested for all five parameters. Data were statistically analyzed and a conclusion was drawn. Result and Discussion: Results show that the parameter glycated hemoglobin was reduced significantly in both populations. But other parameters particularly GTA were reduced significantly only in the test group and not in the control group. From these findings, it was calculated that GTA was a more sensitive parameter than glycated hemoglobin in evaluating diabetes. It was also proved that diabetes is improved with regular consumption of Rooibos tea. This effect is statistically significant. Conclusion: It can be concluded from this study that diabetes is improved by regular consumption of Rooibos tea. Although this has quite a few limitations yet this opens the scope for better and broader future studies.

Background: Hip fractures are a major burden to both individuals and society, leading to disability or even mortality for elderly patients if not treated properly with the latest devices. Method: Out of 90 (ninety) patients, 45 were inserted with proximal femoral nail (PFN) and 45 with internal proximal nail anti-rotation (PFNA). The helical blade whole PFN has two screws, one large, which stabilizes the fractured part of the femur, and another one is anti-rotation, while PFNA has a helical blade, which provides stability and anti-rotation mobility. Both surgeries are similar, but instrumentation and techniques differ. Results: In the comparison of personal details, duration of surgery (in minutes), and blood loss (ml). Fluoroscopy images had significant p-values (p < 0.001). Postsurgical complications with cut-out z-effect were 5 (11.1%) in the PFN group and 1 (2.2%) in the PFNA group. Reoperations were more in the PFN group 5 (11.1%) and least in the PFNA group 1 (2.2%). Shortening >1 cm in 8 (17.7%) PFN and 5 (11.1%) in PFNA groups. Misalignment was more 5 (11.1%) in PFN and 1 (2%) in PFNA group. Harris’s score after one year post-operatively had a significant p-value (p < 0.001). Conclusion: PFNA technique reduces the duration of time, loss of blood, fluoroscopy imaging, and mortality rates as compared to the PFN technique. Hence, PFNA is a better option for elderly (osteoporotic) patients.

Background: Ultrasound-guided transversus abdominis plane (TAP) block is increasingly used to minimise opioid exposure after paediatric lower-abdominal surgery. Although long-acting bupivacaine affords several hours of analgesia, early breakthrough pain is common. Corticosteroids such as dexamethasone potentiate local-anaesthetic effects, but high-quality paediatric evidence remains sparse. Methods: In this prospective comparative study, 64 children (1–10 y; ASA I–II) scheduled for elective unilateral herniotomy or hydrocoele repair received ultrasound TAP blocks with 0.25 % bupivacaine (0.5 mL kg-1). Group A (n = 32) received dexamethasone 0.1 mg kg-1 (max 4 mg) perineurally; Group B (n = 32) received normal saline. Primary outcome was time to first rescue analgesia. Secondary outcomes were haemodynamics, FLACC pain scores, 24-h acetaminophen/diclofenac consumption and adverse events. Results: Time to first rescue analgesia was almost doubled with dexamethasone (13.8 ± 1.6 h vs 7.2 ± 0.9 h; p < 0.001). Group A showed significantly lower FLACC scores at 4 h (1.6 ± 0.5 vs 2.1 ± 0.9; p < 0.001) and 6 h (2.1 ± 0.8 vs 2.9 ± 0.8; p = 0.832). Mean 24-h acetaminophen (264 ± 91 mg vs 392 ± 115 mg) and diclofenac (16.0 ± 5.7 mg vs 24.3 ± 7.5 mg) requirements were reduced 32 % and 34 %, respectively. Dexamethasone blunted tachycardic responses 2–12 h post-operatively without clinically relevant hypotension. No neurotoxicity, wound complications or vomiting occurred. Conclusion: Low-dose dexamethasone safely extends TAP-block analgesia by ≈6 h, improves early pain scores and confers meaningful opioid-sparing advantages in children. Routine incorporation of dexamethasone (0.1 mg kg-1) into paediatric unilateral TAP blocks is supported.

Background: The rationale for this study lies in the need to improve the diagnostic approach to acute appendicitis through the comparison of two important scoring systems. By directly evaluating the diagnostic accuracy performance across diverse populations and the role of inflammatory markers this study has the potential to refine clinical practices and enhance patient outcomes. Ultimately it will provide essential evidence that can guide the choice of scoring systems used in real-world clinical settings improving efficiency in diagnosis reducing unnecessary interventions and optimizing healthcare resource utilization. Aim: The study aimed to compare the performance of recently developed appendicitis inflammatory response (AIR) score, the Alvarado score (AS) & ultrasound abdomen in reducing negative appendicectomies with histopathological correlation. Objectives: The primary objective is to compare the diagnostic accuracy of the Appendicitis Inflammatory Response Score with the Alvarado Score and ultrasound abdomen in patients presenting with suspected acute appendicitis with biopsy as gold standard. Method: Study Setting: Patients presenting with right iliac fossa and lower abdominal pain to general surgery OPD and emergency causality of GGH, SRIKAKULAM. Study Duration: 18 months. Study Design: cross-sectional observational study. Study Population: 100. Inclusion Criteria: 1.Patients presenting with clinical signs and symptoms suggestive of acute appendicitis. 2. Age more than 13 years. Exclusion Criteria: 1. Age less than 13 years 2. Patients with chronic pain abdomen 3.Patients with generalised peritonitis, sepsis, and pregnant patients were excluded. Results: This is a cross sectional observational study in which a total of 100 consecutive young and adult patients with a presumptive diagnosis of acute appendicitis were enrolled for the period between November 2023 and April 2025- 18 months. Most common age group is 25-44years (41%) next common age group is 13-24 years (37%) with mean age of 38.2 (Table2a). In this study males (52%) are more than the females (48%) – Table 2b. Clinical presentation of the patients regarding duration 80% of the patients presented after 24 hours. Most common presentation migration of pain present in (80%) with Anorexia, nausea present in (92%), next most common presentation is localized tenderness (72%) showing in Table 2c. The overall prevalence of acute appendicitis proved by histopathology as a gold standard was 92% (92 patients) with a negative appendectomy rate of 8%. For clinical scores a cutoff point of at least 7 for AS and at least 8 for AIR was considered diagnostic for acute appendicitis. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate of the AS were 88.3%, 78.5%, 87.4%, 76%, and 82.6% and those for the AIR score were 93.3%, 84.1%, 88.4%, 78.8%, and 88.6%, respectively. The data reported in this study has shown that the sensitivity, specificity, and accuracy rate of the AIR score were significantly higher than the AS; P=0.05. The sensitivity, specificity, PPV, NPV, and accuracy rate of ultrasound in this study were 72%, 65%, 82.6%, 44.8%, and 72.2%, respectively (Table 6). Conclusion: AIR score is relatively more accurate than Alvarado’s score especially in selecting a safe candidate for discharge from an emergency. In addition AIR score is found to decrease the need for radiological images and NA rate more than Alvarado.

Background: Telemedicine has emerged as a vital component of modern healthcare, yet its adoption among medical professionals remains inconsistent. Objectives: This study aims to evaluate the knowledge, attitudes, and practices of medical professionals regarding telemedicine, while identifying the barriers and facilitators that influence its adoption and integration into medical practice. Methods: A cross-sectional survey was conducted from June 7 to October 10, 2024, involving 128 medical professionals, including interns, residents, and faculty across various specialties at Government Medical College and Rajindra Hospital, Patiala. (India). A 22-item structured questionnaire assessed demographics, knowledge, attitudes, practices, and perceptions. Quantitative data were analyzed using descriptive statistics with Python (pandas), while qualitative responses underwent thematic analysis. Visualizations were created using matplotlib and seaborn. Results: Respondents demonstrated moderate knowledge (mean score 2.98/5), with 94.5% proficient in video calls but only 26.6% aware of National Medical Commission (NMC) guidelines. Attitudes were largely positive, with 89.1% believing telemedicine enhances patient care, citing increased access (95.3%) and convenience (85.2%) as key advantages. However, 60.2% never used telemedicine, attributing this to limited physical examination capabilities (85.9%), technical issues (67.2%), and a significant training gap (92.2% untrained). Follow-up consultations (35.2%) and chronic disease management (20.3%) were deemed most suitable, with optimism for AI-driven enhancements (68.8% for personalized recommendations) and a call for manpower and equipment improvements (90.6%). Conclusion: Despite recognizing telemedicine’s potential, medical professionals face substantial barriers including inadequate training, technical limitations, and low guideline awareness. Strategic investments in education, infrastructure, and regulatory support are essential to enhance adoption and optimize healthcare delivery in India.

Aim: The main aim of the study is to estimate the prevalence of hyponatremia in patients on antihypertensive therapy and to assess the prevalence of hyponatremia on different classes and combination of anti-hypertensive drugs. Methods: A cross sectional study among 172 subjects with hypertension for more than 6 months was done. A detailed history including the class of anti-hypertensive, Serum sodium levels are obtained and patients were classified as mild, moderate and severe hyponatremia. Results: The mean Age (years) among the subjects was 60.94 (± 12.68). Among the subjects, 65 had Beta blockers, 84 had Calcium channel blockers, 73 had ACE inhibitors / ARBs, 29 had Diuretics, 6 had Alpha blockers and 4 had centrally acting drugs. 100 subjects had 1 drug followed by 58 had 2 drugs, 10 had 3 drugs and 4 had 4 drugs. Mean Serum sodium among subjects was 132.33 (± 6.17) mEq/L. 106 had Hyponatremia. 63 had Mild, 34 had Moderate and 9 had severe hyponatremia. Use of increased number of antihypertensives [4 drugs-100%, 3 drugs-80% and 1drug-57%] were showing statistical significance with occurrence of hyponatremia. The study showed nil difference in prevalence of hyponatremia among subjects using different classes of antihypertensives. Conclusion: Among subjects, 106 had Hyponatremia. Use of increased number of antihypertensives were showing statistical significance with hyponatremia. The study showed nil difference in prevalence of hyponatremia among subjects using different classes of antihypertensives.

Objective: To compare Total Abdominal Hysterectomy (TAH) and Non-Descent Vaginal Hysterectomy (NDVH) in patients undergoing hysterectomy for the benign gynecological conditions. Methods: A prospective observational study was carried on over one year in the Department of Obstetrics and Gynecology at Assam medical college, Dibrugarh. Sixty patients undergoing hysterectomy were recruited and equally divided into 2 groups: Group-TAH and Group-NDVH. Comparative analysis included demographic, clinical, intraoperative, and postoperative parameters. Results: No significant differences were found in age, education, or socioeconomic status between groups. Mean BMI was higher in the NDVH group (p < 0.001). The indication for surgery differed significantly: AUB-L was predominant in TAH (66.6%) and AUB-A in NDVH (66.6%) (p < 0.001). NDVH had considerably lower mean intraoperative blood loss (245 mL vs. 545 mL, p < 0.001), fewer analgesic requirements, shorter catheterization time, faster return of bowel function, and earlier ambulation. Postoperative pain scores and hospital stay were also significantly reduced in NDVH patients (p < 0.05). Conclusion: NDVH offers several clinical and postoperative advantages over TAH, including reduced morbidity, faster recovery, and cost-effectiveness. Where feasible, NDVH should be the preferred approach for benign uterine conditions.

Introduction: Magnesium influences uterine contractility and pain by acting as a calcium antagonist and N-methyl-D-aspartate (NMDA) receptor blocker. Low serum magnesium is linked to poor uterine tone and increased postoperative pain (POP). This study aims to evaluate the effect of serum magnesium levels on uterine contractility and postoperative pain (POP) in cesarean sections (CSs) under spinal anesthesia (SA). Methods: This 4-month prospective observational study included women aged 18–40 undergoing elective CS under SA. Participants were grouped by serum magnesium levels. Uterine tone and POP were assessed, with standardized analgesia. Outcomes included intraoperative uterine contractility and 24-hour pain scores and analgesia requirements. Results: Among 61 participants, Group A (low magnesium) showed significantly lower serum magnesium levels and poorer uterine tone at all intervals. Postoperative pain scores and analgesia needs were higher in Group A. A moderate negative correlation (r = -0.62, p < 0.001) linked higher magnesium levels to reduced postoperative pain. Conclusion: Higher serum magnesium levels were significantly associated with better uterine tone and reduced POP scores. Patients with lower magnesium levels required more rescue analgesia. These findings suggest that serum magnesium plays a crucial role in modulating uterine contractility and enhancing postoperative analgesia following CS.

Introduction: Vitamin D influences insulin secretion and sensitivity, with deficiency commonly observed in type 2 diabetes mellitus (T2DM). It may worsen glycemic control by impairing β-cell function and increasing inflammation. The aim of the study is to evaluate the association between serum vitamin D levels and glycemic parameters in individuals with T2DM. Methods: This hospital-based cross-sectional study was conducted over three months in a tertiary care center among T2DM patients aged 30–70 years. After informed consent, clinical data and fasting blood samples were collected. Serum vitamin D, HbA1c, and FPG were analyzed to assess the association between vitamin D status and glycemic control. Results: Among 61 participants (mean age 54.3 years), 45.9% were vitamin D deficient and 70.5% had poor glycemic control. HbA1c was highest in the deficient group, showing a significant inverse association (p = 0.012). Vitamin D levels negatively correlated with FPG (r = -0.41) and HbA1c (r = -0.48), both statistically significant. Conclusion: This study concludes that lower serum vitamin D levels are significantly associated with poor glycemic control in T2DM. Monitoring and correcting vitamin D deficiency may serve as a supportive strategy in diabetes management to improve glycemic outcomes and reduce the risk of complications.

Introduction: Labour causes intense pain affecting maternal and fetal outcomes. This study aims to compare 0.1% ropivacaine with fentanyl and 0.125% bupivacaine with fentanyl for continuous epidural labour analgesia, focusing on analgesic quality, motor block, maternal satisfaction, and neonatal outcomes to guide optimal, safe, and effective drug selection. Methods: This prospective randomized controlled trial at Katuri Medical College included 70 parturients aged 18–35 years in active labour. Participants received either ropivacaine or bupivacaine with fentanyl via continuous epidural infusion. Pain relief, motor block, maternal vitals, labour duration, delivery mode, and neonatal outcomes were monitored using standardized protocols. Results: Among 70 participants, both groups showed similar demographics and epidural placement levels. Ropivacaine group had lower pain scores, more spontaneous deliveries, and no motor block or numbness. Labour duration and neonatal outcomes were comparable. Bolus needs were minimal, and no pruritus was noted, indicating effective and well-tolerated analgesia. Conclusion: Both ropivacaine and bupivacaine with fentanyl offered effective labour analgesia. Ropivacaine demonstrated slightly better maternal outcomes with less motor block and more spontaneous deliveries, though not statistically significant. Given its safety and comfort profile, ropivacaine may be the preferable choice for continuous epidural analgesia in labour.

Background: Lipoprotein(a) [Lp(a)] is a well-established causal risk factor for atherosclerotic cardiovascular disease, yet its fluctuations during acute coronary events and their prognostic implications remain poorly understood. This study aims to assess if these early Lp(a) alterations may serve as a novel biomarker for future cardiovascular risk. Methods: The study was conducted at GMERS Medical College, Ahmedadbad, over a period of 1 year (Jan 2024–Jan 2025). A total of 152 adults with acute coronary syndrome undergoing percutaneous coronary intervention were enrolled. Peripheral blood samples were collected at predefined intervals and biochemical parameters were measured by turbidometric assays and standard methods. Results: The majority were men (76.3%) with an average age of 65.2 yrs and frequently presented with diabetes (34.2%) and hypertension (63.8%). Serum Lp(a) dipped briefly and rebounded, while hs-CRP, CK, and CK-MB peaked at 3–6 hours and fell by 48 hours (p < 0.001). The most frequently observed major adverse event during follow-up was target lesion revascularization (87 cases), with a small number of severe events such as cardiac death (10 cases). Conclusion: Fluctuations in biochemical markers reflect procedural myocardial stress and acute inflammation. Nevertheless, the overall complications were predominantly related to procedural events with a small number of severe outcomes.

Background: In the absence of underlying disorders of connective tissue like rheumatoid arthritis, systemic lupus erythematosus (SLE), sclerosis that is systemic, and others, antiphospholipid antibodies (aPL) are linked to primary antiphospholipid antibody syndrome (APS), an immune-mediated condition that increases the risk of arterial and venous thrombotic events as well as pregnancy loss. Objectives: The purpose of the study was to evaluate the results of immunosuppressive treatment for patients with primary anti-phospholipid syndrome symptoms that did not meet the criteria. Materials and Methods: The study was prospective in nature. The study was carried out at GMERS Medical College, Junagadh, Gujarat, India. The study ran for a full year. In all, 154 patients were enrolled. Results: Among the cohort, thrombocytopenia was the most prevalent non-criteria symptom, occurring in 84 patients (54.5%). The most common condition, skin ulcers, occurred in 14 patients (9.1%), followed by liver reticularis in 77 patients (50.0%) and cardiac valve disease in 28 patients (18.2%). Conclusion: The study came to the conclusion that immunosuppressive treatment may be necessary for non-criteria symptoms, which are frequent in primary APS. Comparing immunosuppressants, especially Rituximab, to Mycophenolate or Azathioprine, the former had a greater incidence of full clinical response and lower rates of relapse and side effects.

Background: Acinetobacter is notorious enough to cause a variety of human infections including Ventilator associated pneumonia, bacteremia, prosthetic valve endocarditis, meningitis, skin and wound infections, peritonitis (in patients receiving peritoneal dialysis) and urinary tract infections, particularly in ICU patients. Materials & Methods: A prospective observational study was done (January 2023-December 2023) in the Department of Microbiology.100 samples were received from adult patients admitted in various ICUs. Isolation, speciation and antimicrobial sensitivity testing was done as per standard CLSI (M100ED32) guidelines. Results: Among 100 samples, 83 were culture positive, out of which 31 isolates of Acinetobacter were identified. Among 31 Acinetobacter isolates, 68% were A. baumannii, 29% were A. lowffii & 3.22% were A.haemolyticus. . All three Acinetobacter species showed highest sensitivity to Colistin (95% A.baumannii, 100% A. lwoffii & A.haemolyticus) followed by Tetracyclines & Aminoglycosides. Most of the isolates were resistant to Cefepime (95%) and Cefotaxime (84%) followed by Carbapenem (45%). Conclusion: Majority of the Acinetobacter isolates were showing multi-drug resistance. Colistin and Tetracycline were found to be effective in treating MDR isolates of Acinetobacter baumanii, whereas Gentamicin, Tetracycline, Piperacillin-tazobactam, Doxycycline and Carbapenems along with Colistin were looking promising in treating Acinetobacter lwofii infections. Antimicrobial resistance patterns shown by various Acinetobacter species in the present study would be beneficial in forming local antibiogram for the hospital, particularly for ICU patients.

Background: Invasive fungal infections (IFIs) pose a significant threat to immunocompromised individuals, particularly those with hematological malignancies or undergoing immunosuppressive treatments. The rising incidence and shifting epidemiology of IFIs warrant detailed evaluation. This study aimed to compare IFI patterns and outcomes in hematological vs. non-hematological immunosuppressed patients. Methods: A retrospective observational study was conducted at a tertiary care hospital from January 2023 to January 2024, involving 132 adult patients diagnosed with IFIs. Data were collected from medical records and categorized per EORTC/MSG criteria into proven, probable, and possible IFIs. Clinical characteristics, microbiological results, radiological findings, risk factors, and outcomes were analyzed. Statistical analysis was performed using SPSS, with significance set at p<0.05. Results: Among 132 patients, 84 had IFIs—mostly invasive candidiasis (63.1%), followed by pulmonary aspergillosis (34.5%). Hematological patients had higher prior immunosuppressive therapy (100% vs. 65.8%, p=0.012). Six-month mortality was 35.7%, with no significant survival difference between groups. Pneumonia was the most common preceding bacterial infection (41.7%). Conclusion: IFI burden is high among both hematological and non-hematological immunosuppressed patients, with similar outcomes despite differing risk profiles.

Background: Complications that are microvascular problems are observed to be associated with an increased risk of macrovascular disease in individuals with diabetes, and there is growing evidence that they typically occur before the development of macrovascular disease. Objectives: The goal of this study is to assess whether elevated HbA1c levels are significantly linked with the development of diabetic retinopathy, nephropathy, and neuropathy in patients with T2DM. Materials and Methods: It was a retrospective study. The study was carried out at a tertiary care centre. The study was conducted for one year. In all, 157 participants were enrolled. Those participants who were diagnosed with T2DM for at least five years, were between the ages of forty and seventy-five, and had access to full medical data, including HbA1c values and records of microvascular problems, were eligible to enroll. Results: Participants were 59 ± 7 years old on average. There were 86 (55%) males and 71 (45%) females, representing a small majority. The most frequent consequence, affecting 66 individuals (42%), was diabetic neuropathy. 53 (33.8%) of the group had diabetic retinopathy, while 46 (29.3%) had nephropathy. Conclusion: The study came to a conclusion that the substantial correlation between microvascular problems among T2DM participants and higher HbA1c levels. Glycemic control must be effective in order to lower the risk of neuropathy, nephropathy, and retinopathy.

Objectives: The present study was to assess the Serum Vitamin D levels in children aged 0- 14 years at tertiary care centre, Pawapuri, Nalanda, Bihar. Methods: A total of 600 children with age group 0-14 years were enrolled. 25(OH)D level determination had been made by tandem mass spectrometry (LC-MS/MS) from blood samples where 25(OH)D levels were determined in units of “ng/mL. Vitamin D levels were classified into three groups as follows; <12 ng/mL indicating deficiency, 12-20 ng/mL indicating insufficiency, and >20 ng/mL indicating normal.  Results: Out of 600 children, 42.33% were male and 57.67% were females. Among male children, most of the children (62.20%) had sufficient vitamin D level. 11.42% children had deficiency of vitamin D. Among 57.67% female children, 44.51% children had sufficient vitamin D level.   24.57% female children had deficiency of vitamin D level. Out of 600 children, 52% had sufficient vitamin D level. 29% had insufficient vitamin D and 19% children had deficiency of vitamin D level. Among infant, most of the infant (79.22%) had sufficient vitamin D level. 6.49% infant had insufficient vitamin D level. Among preschool children, 55.76% had sufficient vitamin D level. 11.54% had insufficient vitamin D level. Among school aged children 98(16.33%), 48.98% had sufficient vitamin D level. 18.36% had insufficient vitamin D level. Similarly, among adolescents, 35.24% had insufficient vitamin D level. While, 30.33% had insufficient vitamin D level. Conclusions: Vitamin D deficiency and insufficiency is increased as with advancing of age. Rate of prevalence of vitamin D deficiency is greater in female children as compared to male children.  Hence, we should organise health checkup camp in a urban as well as rural area for awareness of vitamin D deficiency and screening of serum 25(OH)D concentration in children.

This prospective, observational, single-centre study was conducted on patients with clinical suspicion of infection based on SIRS criteria (≥2), admitted to the 64-bedded ICU of the Department of Anaesthesia and Critical Care, Gauhati Medical College and Hospital. Sepsis was defined as SIRS with a proven or suspected source of infection. A total of 91 patients were enrolled. IG# and IG% were measured at the time of development of SIRS (on days 0), day 1 and day 3. Blood cultures were performed on day 0, and procalcitonin levels were measured on days 3 and 5. SOFA scores were calculated on days 0, 1, and 3. IG count showed the earliest significant rise within 48 hours of SIRS onset, with a sensitivity of 91.51%% and specificity of 85.1% (p < 0.001). Cutoff values for IG count were >0.05 on Day 0, >0.08 on Day 1, and >0.1 on Day 3.Similarly IG% also showed significant rise within 48 hours of SIRS onset, with a sensitivity of 90.51%% and specificity of 88.49% (p < 0.001) A positive correlation between IG and Procalcitonin score were observed, with Pearson correlations of 0.46 on Day 0 and 0.78 on Day 1 for IG# and 0.28 on Day 1 and 0.77 on Day 2 for IG%. IG is a highly sensitive and early biomarker for sepsis, demonstrating significant discriminating value within the first 48 hours.

Background: COPD and asthma patients often experience respiratory infections that worsen their condition. Identifying causative organisms and their antibiotic sensitivity is vital for proper treatment. Objective: To determine common pathogens in sputum cultures of COPD and asthma patients and assess their antimicrobial sensitivity patterns. Methods: A cross-sectional study was conducted on 100 patients (79 COPD, 21 asthma). Sputum samples were cultured, and antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method following CLSI guidelines. Results: Positive sputum cultures were observed in 41.77% of COPD and 28.57% of asthma patients. Candida albicans, Klebsiella spp., and Pseudomonas aeruginosa were common isolates. Klebsiella showed highest sensitivity to imipenem; Pseudomonas to fluoroquinolones; Candida albicans to voriconazole. Staphylococci showed widespread antibiotic resistance. Conclusion: The study highlights distinct microbial profiles and antibiotic sensitivity in COPD and asthma patients, emphasizing the need for regular microbial surveillance to guide effective therapy.

Background: Despite national progress in child health, rural areas like Varanasi continue to face challenges in reducing risks among under-five children. Identifying at-risk children and the associated factors is crucial to inform targeted interventions. Objectives: To estimate the prevalence of at-risk under-five children in rural Varanasi and identify associated socio-demographic and environmental risk factors. Methods: A community-based cross-sectional study was conducted from April 2023 to March 2025 among 374 under-five children in rural Varanasi. Data were collected using a house-to-house survey. Risk factors assessed included maternal illiteracy, birth order, low birth weight, preterm birth, birth spacing, feeding practices, and environmental conditions. Statistical analysis was performed using SPSS v25, and Chi-square tests were used to assess associations. Results: The prevalence of at-risk under-five children was 67.4%. Non-exclusive breastfeeding (49.2%) and low birth weight (28.5%) were the most common risk factors. Significant associations were observed between at-risk status and maternal education, housing type, overcrowding, ventilation, birth order, and exclusive breastfeeding (p < 0.05). No significant associations were found with age, gender, religion, caste, family size, or socioeconomic status. Conclusions: A high proportion of under-five children in rural Varanasi are at risk due to preventable factors. Improving maternal education, promoting exclusive breastfeeding, and addressing environmental conditions like housing and overcrowding are essential to improve child health outcomes in this setting.

Background & Aim: Mental health has intrinsic and instrumental value and is integral to our well-being. It is very crucial to personal, community and socio-economic development. The COVID-19 pandemic declared by WHO on 11^th March 2020, (the  pandemic) had caused physical and mental health problems among individuals around the world. Medical students are also at risk of developing mental health issues during the pandemic. Hence, the study had been initiated to study the mental health status of the first year medical students in a Medical college of Assam. Materials & Methods: The cross-sectional study was conducted among first year medical undergraduate students in a Medical of Assam from April 2022 to June 2022. The data was collected by self-administered structured questionnaire method. The mental health states of the study participants was assessed by GAD-7, PHQ-9, PSS-10 for anxiety, depression and stress. Data obtained were analysed by SPSS-16 and tests applied for analysis as percentages, frequency, chi square, Pearson Chi square, Fishers exact test. Results: The findings of the study revealed that the mean age of participants was 20.41 yrs, 36 (38.3%) minimal, 36 (38.3%) mild, 17 (18.1%) moderate, and 5 (5.3%) moderately severe depression; the level of anxiety 46 ( 48,9%) minimal, 33 (35.1%) mild, 11 (11.7%); 9 (9.6%) high, 75 (79.8%) moderate and 10 (10.6%) had observed stress among the study participants. The association between gender with stress & depression found to be significant. p value for gender & stress was 0.039 and p value for gender & depression was 0.02567 by Fishers exact test. Conclusion: The study concluded that the study participants had different levels of depression, anxiety and stress. Among the students, 79.8% moderately stressed while females are highly stressed (16.7%) compared to male students (3.8%).The counselling and promotion of effective & creative implementation of mental health awareness programme should be initiated periodically & regularly among students.

Background: Acute abdomen is a common emergency condition requiring timely diagnosis and management. Objective: To evaluate the diagnostic accuracy and efficacy of contrast-enhanced computed tomography (CECT) in identifying and differentiating various causes of acute abdomen. Methods: This prospective observational study was conducted at the Department of Radiodiagnosis, Shree Giriraj Multi-Speciality Hospital, Rajkot. A total of 30 patients presenting with acute abdominal pain underwent CECT evaluation using a 16-slice Siemens Emotion Multidetector CT. Findings were correlated with surgical and clinical diagnoses. Diagnostic parameters such as sensitivity, specificity, and accuracy were calculated. Results: The most frequent CT diagnoses were appendicitis (26.7%), intestinal obstruction (20%), and pancreatitis (16.7%). CT findings matched final clinical or surgical diagnoses in 26 out of 30 cases. The calculated sensitivity was 92.9%, specificity was 83.3%, and diagnostic accuracy was 86.7%, affirming CT’s reliability in acute abdomen evaluation. Conclusion: Contrast-enhanced CT plays a critical role in diagnosing acute abdominal conditions. Its high diagnostic performance underscores its value as a frontline imaging modality in emergency radiology, aiding in prompt and appropriate clinical decision- making.

Background: Millets, often termed “nutri-cereals,” are rich in nutrients, environmentally sustainable, and suitable for cultivation in low-input agricultural systems. Despite their benefits, millet consumption has declined in urban India. Women, as key decision-makers in household diets, play a crucial role in influencing food choices. Objectives: To evaluate the level of awareness, types of millets consumed, frequency and methods of consumption, and socio-demographic factors influencing millet awareness among women in Udaipur. Methods: A community-based cross-sectional study was conducted over six months (Nov 2023–April 2024) among 120 women aged ≥18 years residing in the Urban Health Training Center (UHTC) field practice area, Dhanmandi, Udaipur. A semi-structured questionnaire was used for data collection. Sampling involved simple random selection of streets followed by systematic selection of households. Data were analyzed using SPSS; chi-square test was used for categorical data, with p<0.05 considered statistically significant. Results: The mean age of participants was 39.3±13.62 years. Most were Hindu (80.8%), homemakers (83.3%), and belonged to the lower-middle socio-economic class (56.6%). Awareness of millets was reported by 63.3% of participants. Religion (p=0.00001), socio-economic status (p=0.0008), dietary habits (p=0.000012), and lifestyle (p=0.035) were significantly associated with millet awareness. Among those aware, barnyard millet (93.4%) and foxtail millet (82.9%) were most commonly consumed. Khichdi (97.4%) and rab (72.3%) were the most frequently prepared millet dishes. Boiling (94.7%) was the predominant method of preparation. Only 2.3% consumed millets daily; most (41.9%) consumed them weekly. Conclusion: Although awareness of millets was moderate, regular consumption remains low. Socio-cultural and dietary factors significantly influence awareness and consumption patterns. Targeted nutrition education and improved availability of millet-based products could enhance their integration into urban diets, supporting both public health and sustainable agriculture.

Background: The internet has become an indispensable tool for education, communication, and entertainment. However, excessive use may lead to internet addiction, particularly among youth and students in demanding academic environments like medical colleges. This study aimed to assess the prevalence and pattern of internet addiction among medical students in Udaipur, Rajasthan. Objectives: To determine the prevalence of internet addiction among medical students using Young’s Internet Addiction Test (IAT), and to assess its association with sociodemographic and behavioural factors. Methods: A cross-sectional study was conducted among 392 undergraduate medical students from a government medical college in Udaipur. Participants were selected using stratified random sampling. Data were collected using a semi-structured questionnaire and Young’s Internet Addiction Test (IAT). Statistical analysis was performed using SPSS version 25. Chi-square tests were used to determine associations between addiction levels and selected variables. A p-value of <0.05 was considered statistically significant. Results: Out of 392 participants, 23.5% had normal internet use, 44.1% had mild addiction, 28.3% had moderate addiction, and 4.1% were found to have severe addiction. Male students, hostel residents, and those using the internet for more than 4 hours daily were significantly more likely to show moderate to severe levels of addiction (p < 0.05). Non-academic usage was also associated with higher IAT scores. No significant association was found between year of study and internet addiction levels. Conclusion: Internet addiction is highly prevalent among medical students, with nearly one-third showing moderate to severe addiction. Risk factors include male gender, excessive usage time, and hostel residence. Institutions should implement targeted awareness, digital hygiene programs, and provide psychological support to prevent the adverse effects of excessive internet use.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory illness marked by acute exacerbations that increase morbidity and mortality. Identifying reliable biomarkers like NT-proBNP and serum magnesium may help predict outcomes and guide early intervention during acute exacerbations. Material and Methods: This prospective observational study was conducted on 115 hospitalized AECOPD patients. Clinical, radiological, and biochemical data—including NT-proBNP and serum magnesium levels—were collected and correlated with outcomes such as mortality, ICU stay, ventilation need, and weaning success. Results: Most patients were elderly males with high smoking prevalence and common symptoms like breathlessness and cough. Abnormal chest X-rays were found in 88.7%, and most sputum cultures were sterile. Non-survivors had significantly lower serum magnesium and higher NT-proBNP levels. Mortality was associated with pulmonary hypertension, prolonged ICU/NIV duration, need for invasive ventilation, and failed weaning, confirming the prognostic value of these biomarkers. Conclusion: NT-proBNP and serum magnesium levels are valuable prognostic indicators in AECOPD. Early assessment and targeted interventions may reduce complications and improve outcomes.

Background: Seroma formation is a common postoperative complication following mastectomy, with reported incidences ranging from 15% to 90%. It can result in delayed recovery, increased outpatient visits, and higher healthcare costs. Quilting sutures have emerged as a technique to minimize dead space, potentially reducing seroma incidence. Aim: To compare the effectiveness of quilting technique versus conventional plain suturing in reducing post-mastectomy seroma formation. Methodology: A prospective randomized controlled trial was conducted at Sri Venkateswara Medical College, Tirupathi, involving 78 patients undergoing mastectomy with or without axillary lymph node dissection between December 2022 and December 2023. Patients were randomized into two groups: Group A (quilting sutures) and Group B (conventional suturing). Data on postoperative fluid accumulation, seroma formation, wound discharge, pain scores, drain duration, and hospital stay were recorded. Results: Patients in the quilting group (Group A) demonstrated significantly lower daily seroma volumes (Day 5 mean: 15.39 ml vs. 30.33 ml, p < 0.001), earlier drain removal, and shorter hospital stay (7.49 vs. 11.13 days, p = 0.01). Visual Analog Scale (VAS) scores indicated significantly less pain in Group A from Day 2 onwards. Additionally, wound site discharge and complications such as flap necrosis were reduced in the quilting group. Conclusion: Quilting sutures significantly reduce the formation and severity of post-mastectomy seroma, shorten hospital stay, and enhance patient recovery. Despite slightly longer operative times, the technique is cost-effective and improves physical and mental outcomes. Wider adoption of quilting may streamline post-mastectomy care and reduce healthcare resource utilization.

Background: Diabetic foot ulcers represent a significant clinical challenge due to delayed wound healing associated with impaired cellular and molecular processes. Aim of the study is to evaluate the efficacy and safety of topical insulin in promoting wound healing in patients with chronic diabetic ulcers. Methodology: A randomized controlled trial was conducted over one year at the Department of General Surgery, SVRRGGH, Tirupati, involving 104 patients with non-healing diabetic foot ulcers. Participants were randomized into two groups: Group A received topical insulin dressings, while Group B received conventional saline dressings. Wound healing progress was assessed biweekly over six weeks, evaluating ulcer size, granulation tissue development, pus culture results, and overall patient satisfaction. Statistical analyses included unpaired t-tests and chi-square tests, with significance set at p<0.05. Results: Baseline characteristics were comparable between the groups. By day 7, the insulin group showed a significant reduction in ulcer size (p=0.01), which persisted through weeks 4 and 6. Healthy granulation tissue was more prevalent in the insulin group (86.3% at week 4) compared to the saline group (2%). Pus cultures turned negative faster in the insulin group (70.6% at day 14 vs. 49% in saline, p=0.01), and hospital stay was significantly shorter (16.6±3.3 vs. 34.9±4.7 days, p=0.01). All insulin-treated patients reported good satisfaction, compared to 13.7% in the saline group. Conclusion: Topical insulin significantly accelerates wound healing in diabetic ulcers, enhances granulation tissue formation, reduces infection rates, shortens hospital stay, and improves patient satisfaction. It is a promising adjunct therapy for chronic diabetic foot ulcer management.

Background: Total knee arthroplasty (TKA) is a definitive surgical intervention for relieving pain and restoring function in patients with advanced degenerative joint disease, most notably osteoarthritis. Objective: To compare perioperative blood loss, postoperative pain, functional outcomes, and complications in patients undergoing total knee arthroplasty (TKA) with and without the use of a tourniquet. Methods: This prospective comparative study included 100 patients undergoing unilateral primary TKA at a tertiary care center from August 2023 to January 2025. Patients were divided equally into two groups: Group A (tourniquet use) and Group B (no tourniquet). Intraoperative blood loss, postoperative drain output, hemoglobin drop, analgesic requirements, pain scores (VAS), KOOS scores, range of motion (ROM), and complications were recorded. Results: Intraoperative blood loss was significantly lower in Group A (135.8 ± 40.5 mL) than in Group B (258.2 ± 55.3 mL; p < 0.001). However, Group A had higher postoperative drain output (312.6 ± 65.4 mL vs. 238.9 ± 51.2 mL; p < 0.001) and similar total hemoglobin drop. VAS scores at two weeks were higher in the tourniquet group (4.3 ± 1.0 vs. 2.6 ± 0.9; p < 0.001), with correspondingly greater analgesic use. Conclusion: Although tourniquet use reduces intraoperative bleeding in TKA, it leads to increased postoperative pain, delayed functional recovery, and does not significantly reduce overall blood loss. Avoidance of tourniquet may enhance early rehabilitation and patient comfort, suggesting a shift in clinical preference may be warranted.

Background: Acute pancreatitis affects approximately 34 cases per 100,000 people annually worldwide, with traditional management advocating nil per oral (NPO) status to achieve “pancreatic rest.” However, emerging evidence suggests early enteral feeding may offer superior outcomes by maintaining gut barrier integrity and preventing bacterial translocation. Methods: This prospective randomized controlled trial included 50 patients with mild to moderate acute pancreatitis, equally randomized into Group A (early enteral feeding within 48 hours) and Group B (NPO for 72 hours). Primary outcomes included complication rates, hospital stay duration, and APACHE II score changes. Secondary outcomes assessed serum pancreatic enzymes and NPO duration. Results: Baseline characteristics were comparable between groups. Group A experienced significantly fewer complications (32% vs 68%, p=0.017), with notable reductions in abdominal distension (4% vs 28%) and sepsis (0% vs 16%). All Group A patients were discharged within 5 days (mean 3.28±0.54 days) compared to only 24% of Group B patients, with Group B requiring longer hospitalization (mean 6.76±1.8 days, p<0.001). APACHE II scores improved in Group A (1.92±0.68) but deteriorated in Group B (3.73±0.778) after 72 hours (p<0.001). No significant differences were observed in serum amylase or lipase levels between groups. Conclusion: Early enteral feeding in mild to moderate acute pancreatitis significantly reduces complications, shortens hospital stays, and improves clinical outcomes compared to traditional NPO management. These findings challenge the conventional pancreatic rest paradigm and support early nutritional intervention as the preferred approach for most acute pancreatitis patients.

Background and Objectives: Gemcitabine plus platinum-based chemotherapy remains the standard first-line treatment for unresectable or metastatic biliary tract cancer (BTC), supported by multiple previous studies and landmark trials. This prospective study evaluates the demographic profile, treatment outcomes, and prognostic factors in patients with advanced BTC treated with Gemcitabine + Platinum (Cisplatin/Carboplatin) at Artemis Hospital, Gurugram, India. Methodology: This institutional ethics committee-approved prospective observational study included 45 patients with histologically confirmed BTC treated between July 2018 and July 2019, followed for 12 months. Patients received Gemcitabine + Cisplatin/Carboplatin as first-line therapy until disease progression or unacceptable toxicity. Response evaluation was done after completion of every 3 cycles till 12 months. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses identified factors influencing outcomes.  Results: The median age was 58 years (range: 34–80), with 55.5% females. Most patients (55.6%) were from Haryana, followed by Uttar Pradesh (17.8%). Gallbladder cancer (73.3%) was the most common primary site, with liver metastases (80%) being predominant. Baseline CA19-9 was elevated (>500 U/mL) in 42.2%. Grade I–II toxicities occurred in 24.4%, while 15.5% had Grade III–IV toxicities. Response rates at sequential evaluations were 48.9%, 13.3%, 6.6%, and 2.2%, with disease control rates of 55.6%, 22.2%, 15.5%, and 6.6%, respectively. Median OS was 5.38 months (95% CI: 0.98–6.59), and PFS was 5.17 months (95% CI: 4.15–6.20). The 12-month survival rate was 15.5%. Factors significantly improving OS included age <65 years, ECOG PS 0–1, stage ≤IVA, and liver/lung metastases. Multivariate analysis confirmed age, ECOG PS, disease stage, and bilirubin levels as independent predictors of OS, while female sex, disease stage, and bilirubin <1.5×ULN influenced PFS.  Conclusions: Gemcitabine-platinum chemotherapy remains an effective first-line regimen for advanced BTC in real-world settings, though survival outcomes were inferior to the ABC-02 trial, likely due to a higher proportion of metastatic disease (95%), gallbladder primaries (73.3%), and inclusion of PS 2 patients (11%). Disease stage, ECOG PS, and bilirubin levels were key prognostic factors.

Background: Labour pain is one of the most severe forms of physiological pain experienced by women. Effective labour analgesia improves maternal satisfaction and may positively influence the course and outcome of labour. Epidural analgesia remains the gold standard for labour pain relief. Ropivacaine and levobupivacaine, newer local anesthetics, are increasingly being used due to their better safety profiles and reduced motor blockade. Aim: To compare maternal and fetal outcomes using 0.125% ropivacaine versus 0.125% levobupivacaine for epidural labour analgesia in a tertiary care hospital setting. Methods: This retrospective randomized comparative study was conducted at King George Hospital and Government Victoria Hospital, Andhra Medical College, Visakhapatnam, over 18 months (November 2022 – April 2024). Sixty parturients were divided into two equal groups: Group R (n=30) received 10 ml of 0.125% ropivacaine, and Group L (n=30) received 10 ml of 0.125% levobupivacaine via epidural. Parameters compared included onset and duration of analgesia, pain relief using Visual Analog Scale (VAS), mode of delivery, maternal side effects, and fetal outcomes such as APGAR scores and birth weight. Data were analyzed using SPSS v24, with p<0.05 considered statistically significant. Results: The onset of analgesia was significantly faster in the ropivacaine group (8.4 ± 1.6 min) than the levobupivacaine group (10.3 ± 1.9 min, p=0.001), whereas the duration of analgesia was longer in Group L (86.7 ± 12.3 min vs 79.2 ± 11.4 min, p=0.014). VAS scores were significantly lower in Group R at 30 and 60 minutes post-administration (p<0.05). Mode of delivery, maternal side effects, and neonatal outcomes including APGAR scores and NICU admissions were comparable and not statistically different between groups. Conclusion: Both ropivacaine and levobupivacaine at 0.125% concentration were effective and safe for epidural labour analgesia. Ropivacaine had a quicker onset and better early pain relief, while levobupivacaine offered a longer duration of analgesia. Maternal and fetal safety profiles were similar for both agents. Recommendations: Ropivacaine may be preferred when rapid onset is prioritized, whereas levobupivacaine may be chosen for sustained analgesia. Further prospective, multicentric studies with larger sample sizes are recommended for more definitive conclusions.

Background: Nasal Continuous Positive Airway Pressure (nCPAP) is a well-established modality of non-invasive respiratory support in preterm neonates. However, the optimal strategy for weaning from nCPAP remains inconclusive. Heated Humidified High Flow Nasal Cannula (HHHFNC) has been increasingly utilized as an alternative weaning method due to its potential advantages in comfort, ease of use, and reduced nasal trauma. Methods: A prospective randomized interventional study was conducted on 80 preterm neonates (<34 weeks gestational age) admitted to the NICUs at Basaveshwar and Sangameshwar Teaching and General Hospitals, affiliated with Mahadevappa Rampure Medical College, Kalaburagi. Eligible neonates, stabilized on nCPAP (6 cm H₂O) for a minimum of 48 hours, were randomized into two groups: direct weaning from nCPAP and weaning via HHHFNC. Both groups were monitored for clinical stability, respiratory distress (SAS score), duration of respiratory support, complications, and treatment failure. Results: Both groups were comparable in terms of baseline demographics. The mean SAS score was significantly lower in the HHHFNC group (4.75 ± 1.48) compared to the nCPAP group (5.67 ± 1.59), indicating a statistically significant reduction in respiratory distress (p = 0.009). There was no significant difference in the mean duration of respiratory support between the groups (177.2 ± 72.13 hours in HHHFNC vs. 177.0 ± 69.04 hours in nCPAP, p = 0.990). Treatment failure and mortality rates were comparable, though nasal trauma was reported only in the nCPAP group. Conclusions: HHHFNC is a safe and effective alternative to nCPAP for weaning in preterm neonates with stable respiratory status. It offers comparable clinical outcomes with the added benefits of reduced nasal trauma and improved respiratory comfort. HHHFNC may be considered a viable weaning strategy in neonatal intensive care settings.

Background: Anterior shoulder instability due to Bankart lesions is a common problem, particularly among young, active individuals. Arthroscopic Bankart repair has emerged as the standard treatment to restore glenohumeral stability. This study aimed to evaluate the functional outcomes of arthroscopic Bankart repair among patients presenting with anterior shoulder instability. Objectives: To assess the functional outcome following arthroscopic Bankart repair in patients diagnosed with Bankart lesions using standardized scoring systems. Methods: This descriptive observational study was conducted over one year at the Department of Orthopaedics, Silchar Medical College and Hospital. A total of 20 patients with confirmed Bankart lesions and <20% glenoid bone loss underwent arthroscopic Bankart repair using suture anchors. Functional outcome was measured using the Oxford Shoulder Instability Score (OSIS) and Rowe Score at baseline and at 6 weeks, 12 weeks, and 6 months postoperatively. Standardized postoperative rehabilitation protocols were followed. Results: The mean OSIS improved significantly from 50.4 ± 3.9 preoperatively to 16.8 ± 4.2 at 6 months (p<0.001). The Rowe Score increased from 44.5 ± 3.9 to 92 ± 5.4 over the same period (p<0.001), indicating marked improvement in stability and function. Range of motion parameters such as forward elevation, abduction, and internal/external rotation also showed statistically significant gains. Patient satisfaction was high, with 85% reporting being “highly satisfied” at the final follow-up. Conclusion: Arthroscopic Bankart repair yields excellent functional outcomes and high patient satisfaction in appropriately selected cases of anterior shoulder instability. Structured rehabilitation further enhances recovery and return to activity.

Rare malignancies of the female genital tract remain diagnostically challenging and lack standardized treatment algorithms, especially in resource‑constrained settings. Over a 36‑month period, we retrospectively reviewed four consecutive cases to illustrate their clinicopathological diversity, management strategies, and short‑term outcomes: a 54‑year‑old with synchronous adult‑type ovarian granulosa cell tumor (FIGO IA) and cervical adenocarcinoma (FIGO IB2); a 68‑year‑old with primary malignant vaginal melanoma; a 30‑year‑old with ovarian clear cell carcinoma and omental metastasis; and a 20‑year‑old with FIGO IIIA2 ovarian dysgerminoma. Presentations ranged from abnormal bleeding and pelvic discomfort to abdominal distension; multimodal imaging and targeted serum markers (inhibin‑B, LDH, CA‑125) guided suspicion, while definitive diagnoses hinged on histology and immunoprofiles such as PLAP/CD117 for dysgerminoma and S100/HMB‑45 for melanoma. All patients underwent tailored cytoreductive surgery—balancing oncologic clearance with fertility considerations—followed by site‑specific adjuvant therapy: cisplatin‑based chemoradiation for cervical adenocarcinoma, wide local excision with optional immunotherapy for vaginal melanoma, platinum‑taxane chemotherapy for clear cell carcinoma, and three BEP cycles for dysgerminoma. At six‑month follow‑up, all four remained disease‑free, underscoring the value of individualized, multidisciplinary care; the findings advocate for regional tumor registries and stronger referral networks to refine evidence‑based management of these uncommon yet formidable gynecologic cancers.

Background: Neurotuberculosis, particularly tuberculous meningitis (TBM), remains a significant health concern in developing regions, often associated with high morbidity and mortality. Early diagnosis and prompt treatment are crucial for better outcomes. Objectives: This study aims to evaluate the clinical and laboratory profile of adult patients presenting with neurotuberculosis at a Government General Hospital in Sangareddy. Methods: A prospective observational study was conducted on 100 adult patients presenting with signs and symptoms of neurotuberculosis. Of these, 50 patients were diagnosed with tuberculous meningitis based on clinical criteria, cerebrospinal fluid (CSF) analysis, and neuroimaging findings. These 50 cases were studied in detail with respect to their clinical presentation, laboratory results, and radiological findings. Results: Among the 50 confirmed TBM cases, the most common presenting symptoms were fever (84%), headache (78%), vomiting (52%), and altered sensorium (46%). Neck stiffness was observed in 60% of the patients. CSF analysis typically revealed lymphocytic pleocytosis, elevated protein levels in 88% of patients, and low glucose levels in 72%. Neuroimaging findings included basal meningeal enhancement, hydrocephalus, and infarcts in various regions of the brain. Most patients responded favorably to anti-tubercular therapy with adjunct corticosteroids, although a subset developed complications such as hydrocephalus and cranial nerve palsies. Conclusion: Tuberculous meningitis presents with varied and often non-specific clinical features, making early diagnosis a challenge. A high index of suspicion, supported by CSF and radiological findings, is essential for timely intervention. Detailed evaluation of the clinical and laboratory profile aids in understanding disease progression and improving patient outcomes.

Background: Catheter-Associated Urinary Tract Infections (CAUTIs) are a significant concern in hospitalized patients, especially in intensive care units. They contribute to increased morbidity, mortality, and healthcare costs. This study evaluates the incidence, demographic patterns, microbial profiles, and risk factors associated with CAUTI in a Tertiary care hospital located in a tribal region of Maharashtra. Methods: A prospective, non-randomized study was conducted over 18 months involving 142 patients with indwelling catheters admitted to the ICU. CAUTI incidence, demographic distribution, comorbid conditions, duration of catheterization, microbial pathogens, and antibiotic sensitivity were analyzed. Results: The incidence of CAUTI was 21.83%. Higher infection rates were observed in patients aged >40 years, males (20.4), females (24.5%), diabetics (39.3%), renal failure patients (50%), and those catheterized for longer durations. E. coli (37.5%) was the predominant uropathogen, showing high sensitivity to Amikacin (73.3%) and Nitrofurantoin (66.6%). Conclusion: CAUTI remains a prevalent issue, especially in patients with comorbidities and prolonged catheter use. Regular monitoring, proper catheter care, and tailored antimicrobial therapy are essential to reduce infection rates.

Introduction: Dysmenorrhea, characterized by painful uterine cramps that occur before and during menstruation, is a prevalent menstrual disorder among adolescents. The primary cause of dysmenorrhea is linked to an excessive or imbalanced release of prostaglandins from the endometrium during menstruation. The aim of present study is to find the prevalence of dysmenorrhea and determinants of menstrual distress in adolescent girls (14-19 years) in rural field practice area of a medical college. Material and Methods: The present cross-sectional study was carried out during February 2024 to April 2024. In present study 525adolescent girls (14-19 years) of were enrolled from rural field practice area of nearby villages adopted under Family Adoption Programme of Medical College. Observation and Results: In present study out of 525adolescent girls, the prevalence of dysmenorrhea was70.67%. About 50.40% adolescent girls were having mild dysmenorrhea, 38.01% moderate dysmenorrhea and 11.59% adolescent girls were having severe dysmenorrhea. The mean age of menarche was 12.36±1.94 years. Majority of adolescent girls 56.76% were having regular monthly menstrual cycle and 43.24% were having irregular monthly menstrual cycle. Conclusion: This study confirmed that dysmenorrhoea is a very common problem among adolescent girls, and they experience a number of physical and emotional symptoms associated with dysmenorrhea and it also affects their quality of life. Prevalence of dysmenorrhoea among adolescent girls (14-19 years) was found to be 70.67%. Abdominal pain was the most common type of pain, with most adolescent girls reporting a mild level of dysmenorrhoea.

Aim: The Aim of this study was to determine the knowledge, attitude, and practices of Intern doctors with respect to ophthalmic emergencies on day-to-day basis. Material and Methods: Participants included All those who are undergoing compulsory rotatory residential internship at C.U SHAH Medical College and Hospital Surendranagar with the help of a google form questionnaire detailing ophthalmic emergency scenarios distributed through social platform, Scoring was given out of 10 with GOOD score being >=5 and POOR score <5. Linear correlation being established through scoring and emergency management skills. Results: The overall response of Intern doctors in our study was seen to be “good” in 80 participants (score more than 5) compared to 9 participants who had a score less than 5, toward ophthalmic emergency questionnaire. Whereas the attitude towards management of ocular emergencies and participation was overall positive which was the main purpose for awareness and engagement of intern doctors towards this area. Conclusion: The poor practice in fresh medical graduates could be tackled by training new medical graduates with skill programs and workshops, and thorough revision of SOPs specifically focusing on ophthalmic emergencies and continued education through tribal eye camps at disease vulnerable areas. Since medical graduates form the root level of health care; strengthening them can help in managing and mitigating ophthalmic emergencies to reduce ocular morbidity and prevent blindness to a greater extent.

Introduction: Optic disc edema (ODE) is a clinical sign associated with a range of ocular and systemic disorders, including papilledema, optic neuritis, and ischemic optic neuropathies. While Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing intracranial causes of ODE, Optical Coherence Tomography (OCT) has emerged as a non-invasive, accessible alternative for structural assessment. This study aimed to compare the diagnostic utility of OCT and MRI in patients presenting with ODE. Materials and Method: This study was conducted on 30 patients clinically diagnosed with optic disc edema. All participants underwent detailed ophthalmic examination, OCT imaging, and brain and orbital MRI. OCT findings included RNFL thickness, papillary elevation, subretinal hyporeflective spaces, and ganglion cell layer thinning. MRI findings were assessed for posterior globe flattening, optic nerve sheath dilation, tortuosity, and contrast enhancement. Diagnostic yields were compared for papilledema, optic neuritis, and NAION. Result: Increased RNFL thickness was observed in 73.3% of cases on OCT, while optic nerve sheath dilation was the most common MRI finding (66.7%). OCT detected papilledema in 13 cases and MRI in 14 cases (p = 0.71). The diagnostic concordance between OCT and MRI was high (kappa = 0.81). OCT showed a sensitivity of 85.7% and specificity of 93.8% for detecting papilledema, with a PPV of 92.3% and NPV of 88.2%. Conclusion: OCT demonstrates strong diagnostic agreement with MRI in detecting optic disc edema, particularly papilledema. It serves as a valuable, cost-effective, and non-invasive adjunct to MRI, especially in resource-limited settings.

Introduction: Intertrochanteric fractures are prevalent in the elderly, often complicated by osteoporosis, leading to increased risks of displacement, delayed healing, and implant failure. This study compared outcomes of cement-augmented versus non-augmented interlocking nail fixation for managing osteoporotic intertrochanteric fractures. Materials and Methods: This prospective randomized controlled trial was conducted at The Oxford Medical College, Hospital & Research Centre. Fifty patients with osteoporosis (BMD T-score ≤ -2.5) and intertrochanteric fractures were divided into two groups: Group A (cement-augmented TFN) and Group B (non-augmented TFN), with 25 patients in each group. Functional outcomes were assessed using the Harris Hip Score (HHS) and Visual Analog Scale (VAS) for pain at 2 weeks, 6 weeks, and 6 months. Radiological assessments of fracture healing were performed using X-rays and CT scans at similar intervals. Statistical analyses included independent t-tests and Chi-square tests. Results: The mean age of patients in Group A was 68.2 ± 8.50 years and in Group B 67.8 ± 8.30 years (p = 0.85). VAS scores and HHS showed no significant differences between the groups, though marginally better outcomes were noted in the cemented group. Callus formation and fracture union rates were comparable, with slightly higher rates in Group A (p > 0.05). Postoperative complications, including infections and bleeding, were lower in Group A, though not statistically significant. Conclusion: While both methods effectively managed intertrochanteric fractures in osteoporotic patients, cement augmentation offered a slight advantage in reducing complications and improving outcomes. However, larger multi-center studies with longer follow-ups are needed to validate these findings.

Introduction: Labour induction is a common obstetric intervention employed when the benefits of early delivery outweigh the risks of continuing the pregnancy. Misoprostol, a prostaglandin E1 analogue, is widely used for cervical ripening but is associated with side effects such as uterine hyperstimulation. Nitric oxide donors like isosorbide mononitrate (IMN) have shown promise in cervical priming with fewer adverse fetal effects. This study aimed to compare the maternal and fetal outcomes of sequential IMN followed by misoprostol versus misoprostol alone. Materials and Methods: This prospective observational study included 200 term pregnant women with a Bishop score <6 undergoing labour induction. Group 1 received 40 mg IMN vaginally followed by 25 mcg misoprostol every 4 hours (max six doses). Group 2 received misoprostol alone. Outcomes included improvement in Bishop’s score, induction-to-delivery interval, mode of delivery, need for oxytocin, adverse effects, and neonatal parameters. Statistical analysis was performed using SPSS v26.0, with significance at p<0.05. Results: Group 1 demonstrated significantly shorter induction-to-active phase (11.37 ± 8.34 vs 17.44 ± 9.85 hrs) and induction-to-delivery intervals (14.74 ± 9.65 vs 20.71 ± 10.27 hrs; p=0.001). A higher percentage in Group 1 achieved vaginal delivery (81% vs 69%), though not statistically significant. Adverse maternal effects, especially hypotension and headache, were higher in Group 1 (56% vs 8%). Neonatal outcomes, including Apgar scores, NICU admissions, and birth weights, were comparable. Conclusion: Sequential IMN and misoprostol effectively shorten labour duration and reduce misoprostol requirement but are associated with increased maternal side effects, without compromising fetal safety.

Chronic granulomatous mastitis (CGM) a rare benign inflammatory breast entity characterized by lobulocentric granulomas. The nonspecific manifestations and varied demographic features of this condition, as well as similarities in presentation with other breast conditions, pose substantial diagnostic and treatment challenges. This is a retrospective observational study of 89 patients at a tertiary health care Centre in VIMSAR, Sambalpur, Odisha. Results were noted and found to be, mostly, in consensus with other International Studies with some subtle differences specific to Indian population. CGM was observed to be present most commonly in porous women of reproductive age group. It was observed to present with a lump in present with associated signs of inflammation.

Background: Motor vehicle exhaust forms the major contributor to the air pollution in today’s world of rapid urbanization and industrialization. Traffic police personnel working in the busy urban areas or traffic points are at a high risk of exposure to traffic pollution. Objective: This study is conducted to see the effect of air pollution on the PTF of traffic police personnel in comparison to those police personnel that are not engaged in traffic duty in Guwahati city. Materials and Methods: It is a comparative cross-sectional study done on 100 traffic police personnel aged 30-50 years engaged in traffic duty for 8 hours per day in Guwahati city. The control group consist of 100 traffic police personnel matched for height, weight, BMI that were never engaged in traffic control duty. Pulmonary Function Tests were measured by Medspiror digital expirograph (Medspiror – Med System Pvt Ltd Chandigarh, India). Spirometry was carried out as per guidelines laid down by The American Thoracic Society. Parameters recorded are FVC, FEV1, FEV1/FVC%, FEF25-75, PEFR. Statistical analysis are done by applying unpaired t- test. Results: Significant decrease in FVC, FEV1, PEFR and FEF25-75 was noted in the subject group in comparison to control group. No significant difference is noted in FEV1/FVC between subject and control group Conclusion: This study showed impairment in the PFTs of the traffic police personnels in comparision to general duty police personnels. This may be attributed to the exposure of traffic police personnels to the heavy traffic pollution.

Background: Evidence suggests that mild to moderate forms of pulmonary hypertension are much more common in patients with chronic kidney disease causing signs and symptoms of right ventricular dysfunction, progressively worsening fatigue, dyspnea, and syncope. Moreover, the hemodialysis modality and access like Central Venous Catheter and Arterio-Venous fistula also adds on to the pathogenesis of pulmonary hypertension. This study has been designed to see the prevalence of pulmonary arterial hypertension in patients of chronic kidney disease and in patients on different hemodialysis access like Arterio-Venous Fistula and Central Venous Catheter. Materials and Methods: The study population has been divided in three groups, Group 1, Patients with diagnosis of chronic kidney disease (CKD) stage 5 not on Hemodialysis, here pulmonary artery systolic pressure (PASP) is evaluated at diagnosis of CKD stage 5 and again after 6 months. In between if patients are initiated on hemodialysis, they have been shifted to either group 2 or group 3 depending upon the hemodialysis access. Group 2, Patients of CKD stage 5 on Hemodialysis by Central Venous Catheter and Group 3, Patients of CKD stage 5 on Hemodialysis by Arterio-Venous fistula. In both the population pulmonary artery systolic pressure is evaluated at initiation of dialysis and again after 6 months and the values have been compared. Pulmonary Artery Systolic Pressure measured by Doppler echocardiography and a value more than or equal to 35 mmHg is taken as Pulmonary Hypertension. Results: At First visit, out of 28 patients of CKD stage 5 not on Dialysis, 3 (10.71%) had Pulmonary Hypertension and 25 (89.29%) did not and at 6 months, out of 28 patients, 5 (17.86%) has Pulmonary Hypertension and 23 (82.14%) do not. At First visit, out of 39 patients of CKD stage 5 on Dialysis by Central Venous Catheter, 4 (10.26%) had Pulmonary Hypertension and 35 (89.74%) did not and at 6 months, out of 39 patients of CKD stage 5 on Dialysis by Central Venous Catheter, 2 are lost, so out of 37, 10 (27.03%) has Pulmonary Hypertension and 27 (72.97%) do not. At First visit, out of 42 patients of CKD stage 5 on Dialysis by Arterio-Venous Fistula, 5 (11.90%) had Pulmonary Hypertension and 37 (88.10%) did not and at 6 months, out of 42 patients of CKD stage 5 on Dialysis by Arterio-Venous Fistula, 1 is lost, so out of 41, 13 (31.71%) has Pulmonary Hypertension and 28 (68.29%) do not. Conclusion: The incidence of Pulmonary Hypertension increases with the time spent on CKD, Dialysis modality and vascular access also adds on to the pathogenesis of Pulmonary Hypertension and the incidence of Pulmonary Hypertension at same 6 months of dialysis is more in Dialysis by Arterio-Venous Fistula than Dialysis by Central Venous Catheter, meaning that the hemodynamic alteration is more in Dialysis by Arterio-Venous Fistula than Dialysis by Central Venous Catheter.

Background: Xanthelasmas are localized accumulation of lipid deposits on the eyelids. Lesions are typically asymptomatic and treatment is often sought for cosmetic purposes. Radiofrequency (RF) surgery and trichloroacetic acid (TCA) application are among the treatment options for xanthelasma palpebrarum (XP), though comparative studies between the two are currently lacking. Aim: In this study we aim to compare the efficacy of Radiofrequency (RF) surgery with 50% trichloroacetic acid (TCA) versus 50% trichloroacetic acid (TCA) alone application in the treatment of XP. Materials and Methods: This interventional analytical study was conducted on 40 patients of XP from August 2024 to January 2025. Patients were divided into two groups of which one was treated with radiofrequency cautery with 50% TCA and the other group with 50% TCA application. Treatment efficacy was assessed using serial clinical photographs and grading scores till 4 weeks. Results: At the 4-week follow-up, 70% of lesions treated with RF ablation with 50% TCA showed an improvement score of 4, while 70% of lesions treated with 50% TCA application alone demonstrated an improvement score of 3. Conclusion: Compared to TCA application, RF ablation with TCA application required fewer treatment sessions to achieve more than 75% clearance of lesions.

Background: Tympanoplasty is a common procedure performed by ENT Surgeons. However there is a paradigm shift from conventional Microscopic to Endoscopic setup. The aim of the study was to evaluate intra operative merits and demerits of Trans canal Endoscopic Ear Surgery (TEES). Method: This study included a total of 120 patients of chronic otitis media (mucosal type) undergoing single-handed TEES between July 2023 and January 2025 at a tertiary care centre included and were evaluated on proforma based parameters. Result: The study found that TEES provided clear visualization of middle ear structures in the majority of cases and minimal operative time. Although most surgeons reported ease of instrumentation and minimal difficulty with hand-eye coordination, the study also highlighted some limitations, including the steep learning curve for new surgeons and challenges associated with instrumentation. Conclusion: It suggests that TEES is an effective and alternative to traditional microscopic tympanoplasty, offering promising outcomes in terms of surgical time, and good visualization of middle ear anatomy and easy to perform.

Background: Prevalence of Triple Negative Breast Cancers (TNBCs) in India ranges from 27% to 35% across studies, of which, South India has the highest prevalence of 34%. The percentage of tumor infiltrating lymphocytes(TIL) is an independent prognostic marker in TNBC. Studies on expression of PDL1 in TNBC in our demography are limited which prompted us to examine the same. Aims: (1). To evaluate the association between TIL% and PDL1 expression. (2). To study the clinical pathological characteristics of PDL1 positive cases. Materials and Methods: Between January 2017 and December 2020, we received 52 cases of TNBC at our hospital. Clinical data-age, stage at diagnosis, tumors with high tumor infiltrating lymphocytes (TIL) load were studied. Immunostaining of PDL1 was performed on these cases. After scoring of PDL1, we compared the levels of expression and its histomorphological significance. Statistical analysis was performed using V.25.0 Statistical Package for the Social Sciences (SPSS). The Fisher’s exact test and chi-square test was used to examine associations between categorical variables. The significance level was set at <0.05 in all cases. Results: Our study showed a significant association between TIL and PDL1 expression as all the PDL1 positive cases had TIL > 60%. Conclusion: Through this study, we aimed to establish the prevalence of PDL1 positivity in tumor cells of TNBC, among the population of Tamil Nadu. We also wanted to tap further into the connection between TIL and PDL1 expression.

Takayasu’s arteritis (TA) is a rare systemic inflammatory large vessel vasculitis of unknown etiology, primarily affecting the aorta and its branches. It is characterized by granulomatous inflammation, leading to massive intimal fibrosis and vascular narrowing. Neurological presentations are mostly secondary to hypertension and/or ischemia, resulting in complications such as seizure, stroke, and amaurosis. Stroke is a common complication, occurring in 10-20% of patients. Although stroke is an infrequent initial manifestation, only a few cases been reported.

Background: Hereditary Spastic Paraparesis (HSP) encompasses a group of genetically heterogeneous neurodegenerative disorders characterized by progressive spasticity and weakness of the lower limbs. With over 80 known subtypes, the disorder ranges from pure forms to complex phenotypes involving additional neurological features. Case Summary: We present a series of three genetically confirmed cases of HSP: one with SPG11, one with SPG15, and one with SPG4 mutations. All patients presented with progressive spastic paraparesis, with variable involvement of cerebellar, pyramidal, and peripheral nervous systems. Detailed clinical evaluation, neuroimaging, electrophysiological studies, and next-generation sequencing were instrumental in diagnosis. Characteristic MRI findings and supportive electrophysiological data guided genetic testing. Conclusion: The identification of distinct genetic variants in HSP helps refine diagnosis, predict prognosis, and consider familial counseling. MRI signs such as the “Ear of the Lynx” may serve as early radiological clues to SPG11 and related forms. Genetic testing should be integrated in unexplained progressive spastic paraparesis with complex features.

Background: Spinocerebellar ataxias (SCAs) are a genetically diverse group of autosomal dominant neurodegenerative disorders. They are characterized by progressive cerebellar ataxia, often with variable combinations of pyramidal, extrapyramidal, and oculomotor disturbances. With over 40 genetically distinct subtypes, accurate diagnosis is crucial for prognosis and genetic counseling. Case Summary: We present three genetically confirmed cases of SCA: Machado-Joseph disease (SCA3), SCA2, and SCA12. Each patient presented with a distinct pattern of neurological features, disease onset, and imaging findings. Genetic confirmation was achieved through CAG repeat expansion analysis. Conclusion: Clinical phenotyping supported by neuroimaging and definitive molecular diagnosis via trinucleotide repeat testing forms the cornerstone of SCA classification. Recognition of familial patterns and phenotype-genotype correlation is critical in managing these progressive disorders.

Background: Sepsis and critical illness remain significant causes of ICU admission and mortality worldwide. The identification of simple, reliable biomarkers for prognosis and resuscitation guidance is essential. Lactate clearance, reflecting changes in tissue hypoperfusion and metabolic status, has been suggested as a potential prognostic indicator. This study evaluates the role of lactate clearance and qSOFA (quick SOFA) scores in predicting mortality and outcomes in critically ill patients. Methods: A prospective cohort study was conducted from March 2023 to February 2024 in the medical ICU of MGMGH, Trichy. A total of 100 patients aged >18 years, diagnosed with sepsis, septic shock, cardiogenic shock, or respiratory failure requiring mechanical ventilation, were included. Arterial lactate levels were measured over three days, and lactate clearance was calculated. qSOFA scores were recorded on days 1 and 3. Outcomes assessed included ICU stay duration and mortality. Data were analyzed using SPSS v23 with chi-square tests, Kaplan-Meier survival analysis and multivariable logistic regression. Results: Of the 100 patients (52 female, 48 male), the mean age was 52.87 years. The average ICU stay was 9.64 days, with a mortality rate of 23%. Positive lactate clearance was observed in 49% of patients, and negative in 51%. While lactate levels remained stable over three days (mean ~3.5 mmol/L), the mean lactate clearance was -24.21%, indicating significant inter-patient variability. No statistically significant association was found between lactate clearance and mortality (p = 0.9129). qSOFA scores decreased over time in survivors, indicating its potential utility in short-term prognosis. Multivariable analysis showed no individual variable, including lactate clearance, as a strong independent predictor of mortality. Conclusion: Despite previous literature supporting lactate clearance as a prognostic marker, this study did not find a statistically significant correlation with mortality. This discrepancy may be due to sample size, population heterogeneity, or other confounding factors. However, qSOFA score trends correlated modestly with outcomes. The findings underscore the need for multi-parameter evaluation rather than reliance on a single marker in critically ill patients.

Background: Laryngopharyngeal reflux (LPR) is a condition which results from the backflow of stomach contents into the larynx and pharynx, causing symptoms that are distinct from Gastroesophageal Reflux (GERD). The key symptoms include globus sensation, hoarseness, throat clearing, chronic cough, and sore throat. Prevalence estimates vary widely worldwide from 7% to over 60%, with some studies reporting up to 50% prevalence among patients with throat complaints attending ENT clinics. Objectives: To determine the prevalence of LPR among patients presenting with throat symptoms to the ENT outpatient department of Government Medical College, Ernakulam and to describe the common symptoms and laryngoscopic findings associated with LPR. Methods: In this observational cross-sectional study, patients presenting with throat symptoms between April 2017 and March 2018 were assessed using the Reflux Symptom Index (RSI) questionnaire. Those with RSI ≥13 underwent videolaryngoscopy, and LPR diagnosis was confirmed using the Reflux Finding Score (RFS), and a score ≥7 was considered diagnostic. Two hundred patients (male and female) aged 25–55 years were included. Data were collected based on RSI and RFS and analysed to determine the prevalence and common clinical presentations. Results: Among symptomatic individuals, 59.9% were diagnosed with LPR based on RSI and RFS. The overall prevalence of LPR was 46%. Although 69.2% of patients with RFS ≥7 were females, the difference between gender was not statistically significant. The most common symptoms were globus sensation, frequent throat clearing, and excessive throat mucus. All patients with RFS ≥7 showed erythema/hyperemia and posterior commissure hypertrophy on laryngoscopy. Conclusion: This study found a high prevalence of LPR in patients with throat symptoms, highlighting the need for increased clinical awareness and thorough evaluation. While earlier estimates suggested 10% prevalence, our findings support a substantially higher burden, pointing to the need for further research into risk factors and outcomes in the Indian population.

Background: Pharyngotonsillitis is a common cause of pediatric hospital visits in India, with Streptococcus pyogenes (Group A Streptococcus; GAS) being the most frequently implicated pathogen. It can result in suppurative complications such as peritonsillar abscess, otitis media, and sinusitis, as well as non-suppurative sequelae including acute rheumatic fever and glomerulonephritis. Although multiple bacterial pathogens may be involved, their distribution varies by age, geography, and season. Despite its clinical relevance, data from Kerala on the bacterial etiology of pharyngotonsillitis remain limited. Objectives: The primary objective was to estimate the prevalence of bacterial pharyngotonsillitis among children attending the pediatric outpatient department or admitted to the wards of Government Medical College, Ernakulam. Secondary objectives included identifying the bacterial pathogens involved, determining their antibiotic sensitivity patterns, and assessing associated clinical risk factors. Methods: A total of 340 children meeting inclusion criteria and with parental consent were enrolled. Throat swabs were obtained for Gram staining and culture. Culture-positive cases received appropriate antibiotics, and all patients were followed for two weeks to monitor for complications. Data were analyzed using SPSS version 25. Proportions were used for categorical data, and mean ± standard deviation (SD) for continuous variables. The chi-square test was used to assess statistical significance. Results: Culture-positive bacterial pharyngotonsillitis was identified in 9.4% (n = 32) of cases. GAS was isolated in 30 cases, and 2 cases of diphtheria were detected, raising significant public health concern. Clinical features significantly associated with bacterial etiology included cervical lymphadenopathy, tonsillar membrane, exudate, tonsillar hypertrophy, pharyngeal erythema, and ulceration. All streptococcal isolates were sensitive to second-generation cephalosporins. No complications were reported. Diphtheria cases were managed successfully with antibiotics and antitoxin, without sequelae. Conclusion: The study highlights the need for regional surveillance of pharyngotonsillitis pathogens and suggests that specific clinical features can guide early identification and treatment of bacterial tonsillopharyngitis.

Background: NAFLD (Non-Alcoholic Fatty Liver Disease) is a spectrum of liver disorders ranging from simple steatosis to NASH (Non-Alcoholic Steatohepatitis), cirrhosis, and hepatocellular carcinoma. NAFLD is closely linked with metabolic syndrome and its components-obesity, insulin resistance, dyslipidaemia, and hypertension. It has emerged as a significant risk factor for cardiovascular disease. CIMT (Carotid Intima-Media Thickness) is a non-invasive marker of subclinical atherosclerosis and is increasingly associated with NAFLD. Despite this, there remains a lack of Indian data on the correlation between NAFLD severity and CIMT. Methods: A descriptive cross-sectional study was conducted on adult patients diagnosed with NAFLD at Bankura Sammilani Medical College and Hospital. Patients were evaluated for metabolic parameters including blood glucose, lipid profile, liver enzymes, and anthropometric data. CIMT was measured via B-mode ultrasonography and its correlation with the grade of NAFLD and other metabolic indices was assessed. Results: The study revealed a statistically significant association between NAFLD severity and increased CIMT. Patients with higher grades of hepatic steatosis showed a progressive rise in CIMT values. Additionally, metabolic derangements such as elevated fasting glucose, insulin levels, and dyslipidaemia were significantly correlated with both NAFLD and increased CIMT, indicating a strong link between hepatic and vascular pathologies. Conclusion: NAFLD is not only a hepatic manifestation of metabolic dysfunction but also an independent predictor of subclinical atherosclerosis as evidenced by increased CIMT. Monitoring CIMT in NAFLD patients can serve as a valuable tool for early cardiovascular risk stratification. Comprehensive management strategies should target both hepatic and cardiovascular risks in this population.

Background: Gestational Diabetes Mellitus (GDM) and Gestational Hypertension (GHT) are major complications in pregnancy, often influenced by maternal age, body mass index (BMI), socioeconomic status (SES), and gestational weight gain. Methods: A cross-sectional study was conducted from 2023 to 2024 at the Department of Obstetrics and Gynaecology, PIMS, Udaipur, involving 300 pregnant women. Data on age, BMI, SES (via Kuppuswamy scale), gestational weight gain (classified using IOM guidelines), and comorbidities (GDM, GHT, and anemia) were collected through structured interviews and medical records. Statistical analysis included chi-square tests with a significance threshold of p<0.05. Results: The majority of participants were aged 20–29 years (84%). Obesity and excessive gestational weight gain were more prevalent in women over 30 years and higher SES groups. Inadequate weight gain was more common among younger women and those from lower SES backgrounds. Comorbidities showed strong associations with BMI and weight gain: GDM and GHT were significantly more prevalent in overweight and obese women (GDM: 50% in obese; GHT: 43.33% in obese), and in those with excessive weight gain (GDM: 42.85%; GHT: 41.07%). Anemia was most frequent among women with inadequate weight gain (77.55%) and lower BMI categories. Conclusion: Maternal age, BMI, SES, and gestational weight gain are significant predictors of pregnancy-related comorbidities. Excess weight and obesity increase the risk of GDM and GHT, while inadequate weight gain is associated with anemia. Targeted public health interventions promoting optimal weight management and improved prenatal care are essential to mitigate these risks, particularly among younger and socioeconomically disadvantaged women.

Background: Dengue fever, a significant mosquito-borne viral disease, exhibits a broad range of clinical symptoms, from mild febrile illness to severe, life-threatening sequelae, including dengue hemorrhagic fever and dengue shock syndrome. The illness burden in endemic nations such as India is exacerbated by the co-circulation of many dengue virus (DENV) serotypes, each linked to differing levels of clinical severity and immunological response. Objective: To examine the relationship between dengue virus serotypes and clinical severity, along with their linkage with essential laboratory indicators, in patients admitted to a tertiary care hospital. Method: A prospective observational study was performed for one year at Gouri Devi Institute of Medical Sciences and Hospital. A total of 800 patients exhibiting symptoms indicative of dengue fever were included. Serological and molecular assays were conducted to validate DENV infection and ascertain serotypes. The clinical severity was assessed according to the WHO categorization. Hematological and biochemical markers were evaluated and linked with serotype distribution and illness severity. Results: Of the 800 cases, 92 (11.5%) tested positive for dengue. DENV-1 was the most common serotype, accounting for approximately 55.4% of positive cases, followed by DENV-2 at 44.6%. DENV-3 and DENV-4 were detected in 5 and 3 cases respectively, accounting for less than 10% of infections combined. Co-infections involving multiple serotypes were found in 4.3% of seropositive individuals. DENV-1 and DENV-2 were most frequently associated with severe clinical outcomes, including thrombocytopenia, elevated hematocrit, and raised hepatic enzymes. Patients with co-infections exhibited the highest severity profiles, including increased bleeding tendencies and ICU admissions. Conclusion: DENV-1 and DENV-2 infections are predominantly linked with severe clinical presentations and significant laboratory abnormalities. Identifying serotype-specific patterns in clinical severity and laboratory findings can aid in early risk stratification, efficient resource allocation, and enhance targeted public health surveillance in dengue-endemic regions.

Background: Opportunistic fungal infections are a significant cause of morbidity and mortality among HIV/AIDS patients due to progressive immune suppression. Despite advances in antiretroviral therapy, these infections remain prevalent, particularly in resource-limited settings. Aim: To determine the spectrum and prevalence of opportunistic fungal infections among HIV/AIDS patients attending a tertiary care hospital in India, and to analyze their association with immunological status. Methods: A cross-sectional observational study was conducted over one year at Gouri Devi Institute of Medical Sciences and Hospital. A total of 300 HIV/AIDS patients were enrolled. Clinical evaluation, CD4 counts, and appropriate mycological investigations (microscopy and culture) were performed to diagnose fungal infections. Data were analyzed using SPSS version 23.0. Results: Among 300 participants, 135 (45%) had opportunistic fungal infections. The most common infections were candidiasis (23.3%), cryptococcosis (10%), aspergillosis (6.7%), and histoplasmosis (5%). Patients with CD4 counts <200 cells/mm³ showed a significantly higher prevalence of fungal infections (70.6%) compared to those with higher counts (p < 0.001). Oral thrush was the predominant clinical manifestation. Conclusion: Opportunistic fungal infections remain a major health concern in HIV/AIDS patients, especially those with advanced immunosuppression. Early detection and prompt antifungal treatment, alongside regular monitoring of CD4 counts, are essential to reduce complications. Recommendations: Routine screening for fungal infections should be integrated into HIV care protocols, particularly for patients with low CD4 counts. Strengthening diagnostic facilities and antifungal stewardship programs in tertiary care settings are recommended to improve patient outcomes.

Background: Hearing loss is a common sensory disorder affecting individuals across all age groups and significantly impacting communication and quality of life. Understanding its patterns and causes in specific populations aids in effective diagnosis and management. Objective: To retrospectively analyze the patterns and types of hearing loss among patients visiting the ENT department of a tertiary care hospital. Methods: This retrospective study reviewed clinical and audiometric records of patients presenting with hearing loss over one year at Vyas Medical College, Jodhpur. Data on demographics, type, degree, and etiology of hearing loss were collected and analyzed. Results: A majority of 250 patients were male (56%). Sensorineural hearing loss was most common (50%), followed by conductive (34%), and mixed (16%). Presbycusis and chronic otitis media caused most sensory and conductive hearing loss. The majority had mild to severe hearing loss. Conclusion: Sensorineural hearing loss predominates among patients attending the tertiary care ENT department, with significant contributions from age-related degeneration and chronic ear infections. Early diagnosis and tailored interventions are essential to manage the dual burden of hearing loss effectively.

A total of 91 patients were enrolled. IG# and IG% were measured at the time of development of SIRS (on days 0), day 1 and day 3. Blood cultures were performed on day 0, and procalcitonin levels were measured on days 3 and 5. SOFA scores were calculated on days 0, 1, and 3. IG count showed the earliest significant rise within 48 hours of SIRS onset, with a sensitivity of 91.51% and specificity of 85.1% (p < 0.001). Cutoff values for IG count were >0.05 on Day 0, >0.08 on Day 1, and >0.1 on Day 3.Similarly IG% also showed significant rise within 48 hours of SIRS onset, with a sensitivity of 90.51% and specificity of 88.49% (p < 0.001) A positive correlation between IG and Procalcitonin score were observed, with Pearson correlations of 0.46 on Day 0 and 0.78 on Day 1 for IG# and 0.28 on Day 1 and 0.77 on Day 2 for IG%. IG is a highly sensitive and early biomarker for sepsis, demonstrating significant discriminating value within the first 48 hours.

Febrile convulsions (FC) are common neurological events in children, often causing significant parental anxiety due to limited awareness and misconceptions. This study aimed to evaluate the effectiveness of an educational intervention in enhancing parental knowledge and practices related to FC. A cross-sectional study was conducted among 100 parents attending a pediatric outpatient department. Using a structured questionnaire, baseline knowledge and practices were assessed, followed by a 20–30-minute educational session covering FC causes, symptoms, and appropriate first-aid responses. One week post-intervention, the same questionnaire was re-administered. The findings revealed a statistically significant improvement in both knowledge and practice scores (p < 0.001). Notably, correct identification of fever as a cause of FC increased from 45% to 77%, while proper first-aid practices, such as placing the child on their side, improved from 54% to 88%. Misconceptions—such as beliefs in evil spirits or the need for anticonvulsants in all cases—were substantially reduced, although some persisted. The results underscore the critical role of structured health education in empowering parents, correcting misinformation, and promoting effective home management of FC. Integrating such interventions into routine pediatric care and community health programs is recommended to sustain these positive outcomes.

Febrile seizures are common in children aged 6 months to 6 years and often result from a sudden rise in body temperature without underlying neurological conditions. Effective and timely fever reduction is crucial to prevent complications such as febrile status epilepticus. This randomized clinical trial was conducted at Adichunchanagiri Institute of Medical Sciences, Karnataka, India, to compare the efficacy of cold packs versus tepid sponging in reducing body temperature among 100 pediatric patients presenting with febrile seizures. Children were randomized into two groups and treated using either cold packs or tepid sponging. Baseline temperatures were statistically comparable between the groups. However, after 20 minutes of intervention, the cold pack group demonstrated a significantly greater reduction in temperature (mean 100.71°F) compared to the tepid sponging group (mean 101.06°F), with a p-value of 0.000132. Additionally, the percentage reduction in temperature was significantly higher with cold packs (0.657%) than tepid sponging (0.292%), with a p-value < 0.0001. These findings suggest that cold packs are more effective than tepid sponging in the acute management of fever in children with febrile seizures. Given their efficiency and simplicity, cold packs may be recommended as a first-line physical cooling method both in clinical settings and for home-based fever management.

Culturally diverse communities may benefit from an integration between western and alternative forms of medicine that takes a holistic approach to caring for patients. The concept has been given the term “integrative medicine,” which goes beyond simply combining different forms of medicine and allows for an individualistic approach to patient care that incorporates the mind, spirituality, and sense of community as well as the body. Integrative Medicine [IM] involves a multimodal approach, where Ayush systems are integrated alongside modern/conventional medicine to enhance patient care and improve health outcomes. With growing global interest in holistic and personalised medicine, it is observed that ethical and regulatory clarity is essential to ensure the credibility, safety, and efficacy of integrative approaches. This benefit has been shown in a variety of settings across different nations. This approach is underpinned by mechanistic compatibility—such as shared molecular pathways, immunomodulation, and metabolic regulation—and supported by growing Randomized Controlled Trial [RCT] evidence. Incorporating AI-enhanced pharmacovigilance, GRADE-rated evidence appraisal, and health economics insights, this paper supports a policy shift from parallel to synergistic healthcare systems. India’s pluralistic healthcare structure makes it uniquely suited to lead this global evolution.

Multidrug resistant Pseudomonas aeruginosa is an alarming and emerging public health problem globally across the developing countries. Pseudomonas aeruginosa is still a major cause for nosocomial infection and approximately 10-20% of these patients are admitted to the ICU’s. Bacterial isolates those are biofilm producers are more drug resistant than biofilm non-producers. The aim of the present study was to evaluate the production of biofilm and β-lactamases (ESBL, Amp C’s & MBL) in multi drug resistant Pseudomonas aeruginosa isolated from ICU & ward patients. The present cross-sectional prospective study was carried out in the Department of Microbiology, Rangaraya Medical College & Government general Hospital, Kakinada, Andhra – Pradesh, India. A total of 100 isolates of P. aeruginosa were isolated from various clinical samples. After confirmation of MDR status of P. aeruginosa further processing for biofilm and beta lactamases was performed accordingly. Biofilm production was done by Congo red agar method along with phenotypic profiling of ESBL, MBL was performed by combined disc method; Ceftazidime, Ceftazidime Clavulanic acid, IMP, IMP-EDTA combined disc test respectively. Among 100 isolates of P. aeruginosa 60 (60%) were MDR phenotypes, out of 60 MDR isolates 54 (90%) were ESBL producers, 28 (46.6%) were MBL producers & Amp C were 10 (16.6%). Out of 60 MDR P. aeruginosa isolates, Biofilm producers were 50 (83.3%) and 10 (16.6%) were biofilm non-producers. Strict antibiotic policies with early detection of beta lactamases and detection of biofilm production should be performed regularly for all clinical isolates of Pseudomonas aeruginosa so as to guide antibiotic selection along with better management of severe infection in ICU & wards patients.

Background: Neonatal sepsis is a major cause of morbidity and mortality worldwide. Understanding the bacterial profiles and antibiotic susceptibility patterns causing neonatal sepsis is crucial for guiding appropriate treatment, improving patient outcomes, and combating the emergence of antibiotic resistance. Aim of this study to evaluate the Bacteriological Profile and Antimicrobial Sensitivity Pattern of Neonatal Sepsis. Methods: This prospective observational study was under taken in the department of pediatrics, Katihar Medical College Hospital, Katihar, Bihar from January 2024 to December 2024. Blood samples from 90 clinically suspected neonatal sepsis were collected and processed in the microbiological protocol and their antimicrobial sensitivity pattern was determined. Results: Of 90 cases, 61(67.78%) showed positive blood culture. Gram positive isolates were 48(78.79%) and Gram negative isolates were 23(37.71%). Staphylococcus aureus was the most common organism 75.51% followed by E. Coli 27.87%, Klebsiellapneumoniae 9.84% and Streptococcus pneumonia 3.28% among the isolates. All the three common isolates showed 100% resistance to Ampicillin. Gram positive isolates were sensitive to Amikacin and Amoxicillin &Clavulanic acid whereas Gram negative isolates were sensitive to Gentamicin and Meropenum. Conclusion: Neonatal septicemia was found to be 67.78% during this study supported blood culture because the gold standard investigation for diagnosis. This result also showed that there was an increasing rate of antibiotic resistance to the commonly used antibiotics. These two change in microbial spectrum and antimicrobial susceptibility pattern as noticed during this study will definitely help in treating such cases with appropriate antibiotic and thereby help to decrease neonatal morbidity and mortality.

Background: Sepsis is a leading cause of morbidity and mortality in hospitalized patients, particularly when not identified early in general wards. Conventional methods of sepsis detection often lack sensitivity and are prone to delays. This study evaluates the effectiveness of machine learning-based risk scoring systems in the early detection of sepsis among patients admitted to general wards across multiple centers. Materials and Methods: A multicenter observational study was conducted across five tertiary care hospitals over 12 months. Adult inpatients (>18 years) in general wards were monitored using a machine learning-based sepsis prediction model integrated into the electronic health record systems. The model utilized real-time clinical parameters including heart rate, respiratory rate, blood pressure, temperature, white blood cell count, and serum lactate. Patients were retrospectively classified into sepsis and non-sepsis groups based on Sepsis-3 criteria. The predictive accuracy of the model was compared with the Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS) using receiver operating characteristic (ROC) curve analysis. Results: Out of 8,520 patients monitored, 654 (7.7%) developed sepsis during hospitalization. The machine learning-based model identified 542 of these cases within 6 hours of symptom onset, achieving a sensitivity of 82.9% and specificity of 88.1%. In comparison, MEWS and NEWS showed sensitivities of 67.4% and 73.2%, and specificities of 80.3% and 83.5% respectively. The area under the ROC curve (AUC) for the machine learning model was 0.91, outperforming MEWS (0.76) and NEWS (0.81) (p<0.001). Time to antibiotic initiation was reduced by an average of 3.5 hours (p<0.01) in patients flagged early by the model. Conclusion: Machine learning-based risk scores demonstrated superior predictive accuracy for early sepsis identification in general wards compared to traditional scoring systems. Incorporating such models into clinical practice may significantly enhance early intervention and improve patient outcomes.

Background: The COVID-19 pandemic led to a global shift from conventional classroom learning to digital education. In medical education, this posed unique challenges, especially in clinical training. With limited prior exposure to online platforms, medical students had to quickly adapt to E-learning systems, making it essential to assess their perceptions and acceptance of this abrupt transition. Aim: To evaluate medical students’ acceptance, accessibility, and attitudes toward E-learning during the COVID-19 lockdown, and to compare their preferences between online and face-to-face learning, particularly for clinical education. Methods: A cross-sectional, web-based study was conducted among 730 medical students from Mumbai-based medical colleges during the 2020–2021 lockdown period. Data were collected using a standardized, self-administered Google Form incorporating the E-Learning Acceptance Measure (ELAM) with three key constructs: Teaching Quality (TQ), Usefulness, and Facilitating Conditions. Descriptive and inferential statistics were analyzed using SPSS version 23.0. Results: The mean ELAM score was 104.8 ± 22.4, indicating moderate acceptance of E-learning. Face-to-face learning remained the most preferred mode (49.3%), followed by Cisco WebEx (26.7%). A significant number of students (72.6%) rated online learning lower than classroom teaching. Clinical skill training (81.4%) and technical issues (68.3%) were major challenges. High academic performers had significantly better ELAM scores (p < 0.001), showing greater adaptability to E-learning platforms. Conclusion: Medical students moderately accepted E-learning during the COVID-19 lockdown. However, challenges such as poor internet connectivity, reduced interaction, and lack of clinical exposure limited its effectiveness. Students still preferred traditional classroom methods, especially for clinical learning. Recommendations: To enhance the impact of E-learning, medical colleges should invest in improving digital infrastructure, provide training for faculty and students, and adopt blended learning models that combine the flexibility of online education with the practical value of in-person training.

Background: Occult or incidental papillary thyroid carcinoma (iPTC) discovered after surgery for benign thyroid conditions remains a frequent surprise. Its true burden—and the clinicopathologic variables that modulate risk—vary widely among geographic regions and health-care settings. Methods: A retrospective analysis was conducted in the Department of ENT, Bangalore Medical College and Research Institute, Bangalore, India. All consecutive thyroidectomies performed between November 2016 and May 2018 for benign indications (Bethesda II/III cytology or thyrotoxicosis) were reviewed. Standardised 2- to 3-mm serial-section protocols and uniform histopathologic reporting were used. Incidental PTC, including micro-PTC (<1 cm), was recorded. Demographic, biochemical, sonographic, operative, and molecular data (BRAF V600E, TERT-p) were analysed. Multilevel mixed-effects logistic regression accounted for centre-level clustering. Results: Among 1428 thyroidectomies (71% female; mean age 47.4 ± 12.9 y), the pooled iPTC frequency was 9.6% (n = 137), ranging from 8.4% to 11.1% across centres (I² = 17 %). Micro-PTC predominated (75%). Independent risk factors included age < 45 y (aOR 1.63, 95% CI 1.18–2.24), dominant nodule > 3 cm (aOR 2.15, 1.48–3.11), and bilateral multinodularity (aOR 1.71, 1.10–2.64). BRAF V600E was detected in 38% and TERT-p mutations in 4% of tumours. Central lymph-node metastases occurred in 6/41 (14.6%) patients who underwent dissection for intra-operative suspicion. At median 30-month follow-up, the disease-specific survival was 100%; two patients exhibited structurally persistent disease. Conclusion: Across South-Asian high-volume centres, roughly one in ten benign thyroidectomies conceals iPTC, most often micro-PTC with indolent behaviour. Younger patients and those with large or bilateral nodules carry higher risk. Routine total thyroidectomy is therefore a defensible strategy when bilateral disease exists, yet aggressive adjuvant therapy should be tailored to the minority harbouring high-risk molecular or pathologic features.

Background: Patients with rheumatological diseases receiving immunosuppressive therapies are at increased risk of infections. Identifying infection patterns and associated risk factors is essential for better management. Limited data is available from resource-limited settings on this topic. Methods: A retrospective study was conducted at a tertiary care rheumatology clinic over one year, including 162 patients with rheumatological conditions on immunosuppressants. Patient data were retrieved from an electronic registry. Infections were confirmed using clinical evaluation and diagnostic tests including CBC, CRP, ESR, cultures, imaging, and RT-PCR. Statistical analysis was performed using t-tests, with p-values <0.05 considered significant. Results: Among 162 patients, 86 (53.1%) had infections. Infected patients were more often female, underweight, and had lupus nephritis or spondyloarthropathy. Higher infection rates were associated with use of prednisolone, tofacitinib, mycophenolate, and adalimumab. Laboratory findings showed significantly higher inflammatory markers, lower hemoglobin, lymphocytes, vitamin D, and albumin in infected individuals. Conclusion: Infections are common in immunosuppressed rheumatology patients, with identifiable clinical and laboratory predictors.

Background: Postoperative cognitive dysfunction (POCD) is a common complication in patients undergoing surgery under general anesthesia, especially those with head injuries. The type of anesthetic agent used may influence cognitive recovery. This study explores the impact of anesthetic drug patterns on POCD in moderate-to-severe head injury patients. Methods: A retrospective study was performed over one year at a tertiary care hospital, including 176 patients aged 18–75 with moderate-to-severe head injury. Patients were split into three cohorts on the basis of anesthetic protocol: propofol (Group C), sevoflurane (Group S), and sevoflurane with methylprednisolone (Group S+MP). Data on demographics, anesthesia type, and cognitive outcomes (MMSE, MoCA) were analyzed using SPSS v19.0. Results: Baseline characteristics and anesthesia recovery profiles were comparable across groups. Group S showed significantly greater cognitive decline postoperatively compared to Groups C and S+MP. MMSE and MoCA scores on days 1, 3, and 7 were lowest in the sevoflurane-only group, indicating a higher incidence of POCD. Methylprednisolone use appeared to reduce cognitive impairment in the sevoflurane group. Conclusion: Anesthetic choice and the use of methylprednisolone significantly influence POCD outcomes in head injury patients.

Background: The COVID-19 pandemic significantly interrupted routine diabetes care, potentially affecting glycemic and lipid control in diabetic patients. Limited healthcare access, lifestyle changes, and altered medication patterns during lockdown periods posed additional challenges. This study assessed these effects in an Indian hospital setting. Methods: A retrospective cohort study was carried out over one year at a tertiary care hospital, including 158 diabetic patients. Data on HbA1c, total cholesterol (TC), triglycerides (TG), and prescribed medications were collected quarterly. Patients were grouped as having type 1 or type 2 diabetes, and pre-COVID and during-COVID comparisons were made. Results: There was a statistically significant increase in HbA1c levels during the pandemic, especially among patients with type 2 diabetes (P = 0.017). TC and TG levels showed slight increases but were not statistically significant. Prescription patterns shifted, with a decline in sulphonylurea and DPP-4 inhibitor use and an increase in SGLT2 inhibitors and GLP-1 receptor agonists. Insulin and metformin use remained largely unchanged. Conclusion: The pandemic negatively impacted glycemic control and influenced prescription trends in patients with type 2 diabetes.

Background: Palliative sedation is used to relieve excruciating pain in patients who have severe symptoms that are not responsive to comprehensive palliative treatment before death. The characteristics of an ideal sedative, such as a large therapeutic window, a desirable safety profile, and a predictable dose-dependent sedation with a rapid onset and short duration of action, are not entirely met by any of the currently available drugs. Objectives: In a palliative care context, the study compared the safety, efficacy, and symptom control of deep vs proportionate sedation regimes utilizing continuous midazolam infusion in adult cancer patients with refractory symptoms. Materials and Methods: It was a retrospective study. The study was carried out at a tertiary care centre. The study data that has been retrieved was of one year. The data of 142 participants has been retrieved. Adult patients who were diagnosed with locally advanced or metastatic cancer and hospitalized to PCU and who were at least 18 years old met the study’s inclusion criteria. Results: Of the 142 participants in the study, 70 underwent heavy sedation and 72 underwent proportionate sedation. With a p-value of 0.04, the proportional sedation group’s mean age was substantially greater at 65.8±11.6 years than that of the deep sedation group, which was 62.6±12.5. With a p-value of 0.48, men made up 52.9% of the deep sedation group and 55.6% of the proportional sedation group. Conclusion: Although the clinical results of proportionate and deep sedation regimes differ greatly, this study shows that both are useful in treating refractory symptoms in patients with terminal cancer.

Aim of the Study: To compare immediate post placental (IPP) and early postpartum (EP) intrauterine device (IUD) insertions with interval (INT) IUD insertions with respect to efficacy and complications. Material & Methods: A total no. of 200 cases were taken for study was carried out in Niloufer Hospital, Hyderabad from October 2021 to September 2023 and followed till 6 weeks after insertion. Results: Cu-T 380A was inserted in 200 cases. The acceptance rate is high in the age group of 20-29 years which is also the peak period of fertility. The high percentage of acceptors was Hindus. Religious restrictions, Superstitions and Myths may be the reason for low acceptance by many people. It was accepted at a higher rate by women of higher education because of official job or self-employment and because of knowledge of Cu-T and they were highly motivated to control their family size. Ultrasonography is an important tool to evaluate the position of IUCD within the uterus in the follow up visits. Conclusion:  Cu-T was accepted at higher rate by Hindus. Women belonging to other religions did not accept Cu-T as much as Hindus due to their religious beliefs. It was accepted at a higher rate by women of higher education because of official job or self-employment and because of knowledge of Cu-T and they were highly motivated to control their family size.

Background: When abdominal trauma occurs, Focused Assessment with Sonography for Trauma (FAST) is initially found to be a diagnostic technique for detecting intra-abdominal fluid. The effectiveness of FAST in the supine position versus FAST in the Trendelenburg position for assessing free fluid in patients with blunt abdominopelvic injuries was investigated in this study. Methods: This descriptive cross-sectional study was conducted prospectively on all patients with blunt abdominal trauma in Department of General Surgery, ICARE Institute of Medical Sciences and Research & Dr. B. C. Roy Hospital, Haldia, Purba Medinipur, West Bengal from January 2022 to July 2024. We completed FAST, on the abdominal and pelvic trauma patients, in the supine position. The patients were placed in the Trendelenburg position for 3 minutes and FAST was performed again. Demographic information and the results obtained from both FAST ultrasounds of the patients were recorded. The sensitivity and Specificity of the supine test, Positive predictive value (PPV), and negative predictive value of the supine (NPV) test were assessed. Results: In this study, in the FAST performed in the supine position free fluid was seen in 13.4%(n=16) of the patients while in the Trendelenburg position, 29.4% (n=35) of the patients clearly showed free fluid in the abdomen and pelvis. The overall Sensitivity, Specificity, PPV, and NPV of the supine test were 30.55%, 93.97%, 68.75%, and 75.72% respectively. Conclusion: Using the Trendelenburg position, for the detection of free fluid in patients with blunt abdominal traumaand stable hemodynamics with or without abdominal pain, which first-time FAST exam is not reliable or is suspected of free fluid presence, is recommended.

Background: Septic shock, a severe manifestation of sepsis, remains a significant contributor to mortality in critical care settings. The hypothalamic-pituitary-adrenal (HPA) axis plays a pivotal role in the physiological response to stress, with serum cortisol acting as a key biomarker. The prognostic utility of cortisol in septic shock, particularly in the Indian population, remains inadequately explored. Objectives: This study aimed to evaluate the association between serum cortisol levels and mortality in patients with septic shock and to examine its correlation with disease severity measured by Sequential Organ Failure Assessment (SOFA) scores. Method: A prospective observational study was conducted at Gauhati medical college and hospital over one year, enrolling 119 adult ICU patients with septic shock.250 micrograms of ACTH injection was given intravenously and cortisol increment level was measured after 30 minutes. Additional clinical parameters, including SOFA scores, procalcitonin levels, vasopressor use, and ventilation requirements, were assessed. Results: Participants with good outcome had a mean serum basal cortisol level of 11.6+/-3.45 micrograms per dL compared to 42.92+/-14.87microgram per dL for those of poor outcome, the difference was  statistically significant. Similarly, the mean serum cortisol level after 30 minutes was 18.61+/-8.97 microgram per dL for participants with a good outcome and 48.78+/-16.21 microgram per dL for those with a poor outcome. Conclusion: Serum cortisol levels, particularly when combined with dynamic testing and clinical scores, serve as valuable predictors of mortality and illness severity in septic shock. These findings underscore the potential role of cortisol assessment in guiding early interventions and resource allocation in ICU settings, especially in resource-limited environments.

Background: Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis. Methods: All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients. Results: Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity. Conclusions: Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.

Background: The humeral nutrient foramen plays a crucial role in maintaining the blood supply to the bone, especially during growth and fracture healing. Its anatomical characteristics—such as number, location, direction, and morphometric indices—are essential considerations in orthopedic surgeries. However, regional variations in these parameters are not well documented, particularly in the Hadoti region of Rajasthan. Aim: To conduct a morphometric and morphological study of the nutrient foramina in dry human humeri from the Hadoti region, with emphasis on their number, location, direction, shape, and surgical significance. Methods: This retrospective observational study was conducted over a one-year period at Jhalawar Medical College, Rajasthan and Government Medical College, Kota, Rajasthan. A total of 100 dry adult human humeri (48 right and 52 left) were included. The number, site, direction, and shape of nutrient foramina were noted, and morphometric measurements such as total bone length, distance of foramen from the proximal end, and foramen index were recorded. Data were analyzed using SPSS version 23.0. Descriptive and inferential statistics were applied, with significance set at p < 0.05. Results: Out of 100 humeri, 92% had a single foramen, 6% had two, and 2% had none. Most foramina were located on the anteromedial surface (68%), followed by the posterior (22%) and anterolateral (10%) surfaces. All foramina were directed downward. The mean bone length was 30.5 ± 2.1 cm, mean distance of foramen from the proximal end was 18.3 ± 1.8 cm, and the mean foramen index was 59.8 ± 4.3. No statistically significant differences were found between right and left humeri. Oval-shaped foramina were predominant (71%). Conclusion: The majority of nutrient foramina were single, located on the anteromedial surface, and directed downward, mostly within the middle third of the shaft. These consistent anatomical features have direct implications for orthopedic procedures involving the humerus. Recommendations: Awareness of the typical location and morphometry of the nutrient foramen can help avoid iatrogenic vascular injury during surgical interventions. Further multi-regional and radiological studies are recommended to supplement anatomical findings and improve preoperative planning.

Background: Cervical cancer remains a major health concern in India, with low screening rates contributing to high morbidity and mortality. Understanding screening practices and associated factors is crucial to improving early detection. Objective: To evaluate cervical cancer screening practices and identify socio-demographic factors influencing screening uptake among women attending Rajasthan Medical College, Ajmer. Methods: A retrospective study was conducted over one year, reviewing records of fewer than 500 women aged 21–65 years who underwent cervical cancer screening. Data on demographic characteristics, screening methods, and uptake were analyzed. Results: Out of 450 women reviewed, 30% had undergone cervical cancer screening, predominantly by Pap smear (70%). Screening uptake was significantly higher among women with secondary or higher education (42%) and urban residents (38%) compared to those with lower education (18%) and rural residents (18%) (p < 0.001). The most common barriers among unscreened women included lack of awareness (55%) and fear (20%). Conclusion: Cervical cancer screening uptake is low, with disparities influenced by education and residence. Enhancing awareness and healthcare provider engagement are key to improving screening rates and reducing cervical cancer burden.

Background: Awake fiberoptic-guided nasotracheal intubation is the preferred technique for managing anticipated difficult airways, as it maintains spontaneous ventilation and allows real-time airway visualization. Successful intubation in such scenarios requires optimal airway anesthesia to suppress reflexes and ensure patient comfort. Lignocaine is commonly used, either via nebulization or targeted nerve blocks. While nebulization is non-invasive, its efficacy is often inconsistent compared to the precision of airway nerve blocks. Aim: To compare the effectiveness of lignocaine nebulization versus airway nerve block in terms of intubation conditions, patient comfort, hemodynamic stability, and post-intubation complications during awake fiberoptic bronchoscopy-guided nasotracheal intubation. Methods: This retrospective, single-blinded, randomized study was conducted in the Department of Anesthesiology, Andhra Medical College, Visakhapatnam, over 12 months. Sixty patients scheduled for oral surgeries with difficult airway predictions were randomly divided into two groups (n=30 each). Group A received airway nerve blocks (glossopharyngeal, superior laryngeal, transtracheal) with 2% lignocaine; Group N received 10 ml of 4% lignocaine via nebulization. Parameters assessed included intubation time, vocal cord visibility, intubating conditions, patient comfort, reflex responses, hemodynamic changes (MAP, HR, SpO₂), and postoperative complications. Results: Group A showed significantly shorter intubation times (68.3 ± 9.8 sec vs. 85.5 ± 12.2 sec; p < 0.001), better vocal cord visibility, and improved intubating conditions compared to Group N. Patient comfort was superior in Group A with fewer cough and gag reflexes (p < 0.01). Hemodynamic responses were more stable in Group A, with lower MAP and HR at 1, 3, and 5 minutes post-intubation (p < 0.01). Postoperative sore throat and discomfort were less frequent in the nerve block group. Conclusion: Airway nerve block provided better intubation conditions, improved patient tolerance, greater hemodynamic stability, and fewer adverse events than lignocaine nebulization. It is a more effective method of airway anesthesia for awake fiberoptic intubation. Recommendations: Airway nerve blocks should be preferred over nebulization in patients undergoing awake fiberoptic-guided nasotracheal intubation, especially in predicted difficult airway cases. Training in block techniques should be incorporated into anesthesia practice to improve safety and patient outcomes.

Background: First-trimester tubal ectopic pregnancy (EP) complicates 1 – 2% of all conceptions and remains a leading cause of maternal morbidity and early pregnancy-related mortality. When the patient is haemodynamically stable, single-dose methotrexate (MTX) is the recommended first-line therapy, provided specific sonographic and biochemical thresholds are met. Although endometrial thickness (EMT) is routinely documented during trans-vaginal ultrasound (TVS) in women with suspected EP, its relationship to MTX eligibility has not been clearly established. Methods: In this prospective observational study we enrolled 120 consecutively diagnosed tubal EPs at a tertiary care teaching hospital. EMT was measured in the sagittal uterine plane at the double-layer interface. MTX eligibility was defined a-priori according to FIGO/ACOG criteria: stable vitals, no sonographic evidence of rupture, gestational mass ≤ 35 mm, absent fetal cardiac activity and serum β-hCG < 5,000 IU L-1. Primary outcome was correlation of EMT with MTX eligibility; secondary outcomes were (i) predictive accuracy of EMT for MTX success and (ii) the interaction between EMT and baseline β-hCG. Statistics employed Pearson’s correlation, logistic regression, and ROC analysis (α = 0.05). Results: Mean EMT was 12.1 ± 5.1 mm; 47% of women fulfilled MTX criteria and 71% of these achieved resolution with a single MTX dose. EMT correlated inversely with baseline β-hCG (r = -0.86, p < 0.001) and positively with treatment success (r = 0.65, p < 0.001). EMT > 12 mm predicted MTX success with 84% sensitivity and 78% specificity; area under the ROC curve (AUC) = 0.88 (95 % CI 0.81 – 0.94). Multivariate modelling confirmed EMT (OR 1.50 per mm, 95 % CI 1.20–1.89) as an independent predictor, whereas β-hCG lost significance. Conclusion: Greater EMT is strongly associated with meeting guideline-based MTX criteria and with subsequent therapeutic success. Incorporating EMT into existing selection algorithms may refine risk stratification, reduce unnecessary surgery and optimise counselling. Prospective validation in larger multicentre cohorts is warranted.

Background: Urethral stricture illness affects up to 300 males out of 100,000. By definition, urethral stricture is a scar-induced constriction of the urethra. Numerous factors can result in the development of stricture disease, which can be harmful to the patient’s health and quality of life. This study compares the effects of substitutional urethroplasty (SU) against anastomotic (AU) urethroplasty (SU) for bulbar urethral stricture in terms of erectile function (EF). Methods: From July 2024 to December 2024, 34 male patients with urethral stricture participated in this prospective comparative non-randomised clinical trial at the Ruban Memorial Hospital, New Patliputra Colony, Patna, and Bihar. Prior to surgery, each patient determined their baseline sexual function by completing the International Index of Erectile Function (IIEF)-15 (EF Domain). Thirteen patients had SU surgery, while twenty-one had AU. Following surgery, the IIEF-15 (EF Domain) was given once more at three and six months, and the results were compared to those obtained before surgery. Results: Thirteen patients in the SU group and twenty-one in the AU group with strictures longer than three centimeters each made up the total of 34 patients included in the study. Prior to surgery, every patient was an active sexual partner. Seven patients in the AU group experienced erectile dysfunction (ED) three months after surgery; four of them improved in the next three months, while three still experienced ED six months later. Two patients in the SU group experienced ED three months after surgery, but they recovered in the following three months. The mean IIEF-15 (EF Domain) score for the AU group was 27.6 prior to surgery, and it dropped to 25.6 six months later. Despite this, the difference was not statistically significant (P = 0.10). In contrast, the mean IIEF-15 (EF Domain) score in the SU group was 27.2 (P = 1.0) both before and six months after SU. Conclusion: There was no statistically significant difference in erectile performance at 6 months following urethroplasty for bulbar urethral stricture.

Background: Patients’ quality of life (QoL) is greatly impacted by urethral stricture illness, frequently as a result of crippling lower urinary tract symptoms (LUTS) and/or urinary tract infections. The study aims to examine the effects of transecting bulbar urethroplasty procedures used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction. Methods: This prospective study was carried out at Ruban Memorial Hospital, New Patliputra Colony, Patna, and Bihar from July 2024 to December 2024. All subjects provided their informed consent. Either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty was performed on thirty patients during transecting urethroplasty. Evaluation of sexual function both postoperatively and using the Sexual Health Inventory for Men (SHIM) questionnaire. An experienced urological surgeon conducted the micturating cystourethrogram (MCUG) and retrograde urethrogram (RGU). Results: The patients under study had a mean age of 41±13.87 years, ranging from 15 to 72 years. The stricture length varied between 2 and 3 cm, with a mean of 2.57±0.38. Thirteen patients (43.3%) had non-obliterative strictures, four (13.3%) had obliterative strictures, and thirteen (43.3%) had near-obliterative strictures. Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). Ninety percent of the attempts were successful. Regarding erectile dysfunction, five patients (16.7%) reported having it. Conclusions: Although anastomotic urethroplasty remains a highly effective and durable treatment for short segment bulbar strictures, it can cause de novo sexual dysfunction in certain patients.

Background: Preeclampsia complicates 2–8% of pregnancies and remains a leading cause of maternal–fetal morbidity and mortality. Disturbances in mineral metabolism—particularly vitamin D, calcium, and phosphorus—have been implicated in its pathophysiology, yet data from low- and middle-income settings are inconsistent. Methods: In this tertiary care hospital-based case-control study, 150 singleton pregnancies in the third trimester were enrolled: 75 normotensive controls and 75 women with de-novo preeclampsia (American College of Obstetricians and Gynecologists criteria). Fasting venous blood was analyzed for serum 25-hydroxy-vitamin D by chemiluminescent immunoassay and calcium/phosphorus by automated colorimetry. Between-group differences were assessed with Student’s t-test (two-tailed); associations were explored using Pearson correlation and multivariable logistic regression. Results: Mean (± SD) serum 25-OH-D was 28.4 ± 8.7 ng mL⁻¹ in controls versus 18.1 ± 7.3 ng mL⁻¹ in preeclampsia (p < 0.001). Hypovitaminosis D (< 20 ng mL⁻¹) was five-fold more prevalent in cases (68 % vs 14 %). Calcium levels were significantly lower (9.2 ± 0.6 vs 8.3 ± 0.7 mg dL⁻¹, p < 0.001), whereas phosphorus was slightly higher in cases (3.9 ± 0.5 vs 3.7 ± 0.4 mg dL⁻¹, p = 0.04). Vitamin D correlated inversely with mean arterial pressure (r = –0.46, p < 0.001) and proteinuria (r = –0.41, p < 0.001). In multivariate models, low vitamin D and hypocalcaemia independently predicted preeclampsia after adjusting for BMI, parity, and socioeconomic status. Conclusion: Preeclampsia is associated with marked hypovitaminosis D and hypocalcaemia, supporting a potential contributory role of disordered mineral metabolism. Early antenatal screening and targeted supplementation merit further evaluation in randomized trials.

Background: Metabolic syndrome (MetS), a constellation of cardiovascular risk factors including central obesity, dyslipidemia, hypertension, and insulin resistance, is increasingly prevalent in India and is strongly associated with acute myocardial infarction (AMI). Early identification of MetS components is essential for timely intervention and prevention of adverse cardiac events. Aim: To evaluate the correlation between individual components of metabolic syndrome and the occurrence of acute myocardial infarction in patients admitted to a tertiary care hospital. Methods: This cross-sectional study was conducted over one year at Government Bundelkhand Medical College, Sagar, Madhya Pradesh, involving 297 patients (aged 20–75 years) diagnosed with AMI or coronary artery disease. Patients were grouped based on the presence of MetS as per NCEP ATP III revised criteria. Clinical, anthropometric, and biochemical data were collected. Statistical analysis was done using SPSS version 23.0, with p-value < 0.05 considered significant. Results: Out of 297 participants, 101 (34.0%) met the criteria for MetS. Hypertension (65%), low HDL (59.3%), and hypertriglyceridemia (55.2%) were the most prevalent components. The incidence of ST-elevation myocardial infarction (STEMI) was significantly higher in patients with MetS (72.3%) compared to those without (46.9%) (p = 0.001). Mean triglyceride levels and fasting glucose were significantly elevated in the MetS group, while HDL levels were lower. MetS was associated with a 2.7-fold increased risk of AMI (OR = 2.7; 95% CI: 1.6–4.5). Conclusion: There is a significant correlation between metabolic syndrome and the occurrence and severity of acute myocardial infarction. MetS, particularly its components like hypertension and dyslipidemia, plays a pivotal role in cardiovascular risk stratification. Recommendations: Routine screening for MetS components in at-risk populations should be prioritized. Early lifestyle and pharmacological interventions targeting these modifiable factors can reduce the incidence of AMI. Regional data from underserved areas like Bundelkhand should inform public health strategies for cardiovascular prevention.

Background: Tendinopathies are common degenerative disorders of the tendon that significantly affect function and quality of life. Conventional treatments often yield limited long-term benefits, prompting interest in biological therapies such as (PRP). PRP, rich in growth factors, promotes tissue regeneration and healing, and is emerging as a promising modality for chronic tendinopathies. Aim: To evaluate the efficacy and safety of PRP injections in the management of chronic tendinopathies in a tertiary care setting. Methods: This prospective observational study was conducted at Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, over a 7-year period (December 2015 to December 2022). A total of 127 patients with chronic tendinopathies were included. PRP was prepared using a double-spin technique and injected under ultrasound guidance into the affected tendon. Pain (measured by VAS) and function (assessed using PRTEE, VISA-A, and VISA-P scores) were evaluated at baseline, 1 month, 3 months, and 6 months. Data were analyzed using SPSS version 23.0. Results: The mean age of patients was 42.7 ± 9.3 years, with lateral epicondylitis being the most common tendinopathy (37.8%). There was a significant reduction in mean VAS score from 7.8 at baseline to 1.9 at 6 months (p < 0.001). Functional scores showed corresponding improvement across all tendinopathy types (PRTEE improved from 68.5 to 24.8; VISA-A from 52.4 to 84.7; VISA-P from 56.3 to 82.9, all p < 0.001). No major complications were reported. Patient satisfaction at 6 months was high (89.7%). Conclusion: PRP injections are effective in reducing pain and improving functional outcomes in patients with chronic tendinopathies, with minimal adverse effects. The therapy demonstrated sustained benefits over a 6-month period. Recommendations: PRP should be considered as a safe and effective non-surgical option for patients with chronic tendinopathies unresponsive to conventional therapies. Further randomized controlled trials are recommended to establish standardized protocols and long-term outcomes.

Background: Renal arteries commonly exhibit anatomical variations such as accessory or aberrant branches, which have critical implications in renal transplantation, vascular surgeries, and interventional radiology. A thorough understanding of these variations is essential for reducing intraoperative risks and improving surgical outcomes. Cadaveric studies offer a direct and reliable method to document such variations. Aim: To evaluate the anatomical variations of the renal artery in cadavers and to analyze their frequency, laterality, and clinical significance in the population of the Kosi region. Methods: This retrospective observational study was conducted in the Department of Anatomy, Katihar Medical College, Katihar, over a duration of 18 months. A total of 50 cadavers were studied through dissection-based documentation. The renal arteries were traced from their origin to the hilum, and variations such as accessory arteries, their number, and site of entry were recorded. Data were analyzed using SPSS version 23.0, and statistical associations were tested using the Chi-square test. Results: Out of 100 kidneys studied, 76% had a single renal artery, while 24% had accessory renal arteries. Accessory arteries were more frequent on the right side (14%) than the left (10%). Lower polar arteries (41.7%) were the most common type of accessory vessel. Male cadavers showed a higher prevalence of variations (37.5%) compared to females (11.1%), and this was statistically significant (p = 0.042). Laterality difference was not statistically significant. Conclusion: Anatomical variations of renal arteries are common, particularly accessory arteries, which were more frequently found in males and on the right side. Recognition of these variations is crucial during renal surgeries to prevent vascular injuries and ensure successful outcomes. Recommendations: Preoperative imaging such as CT angiography should be routinely performed to detect renal vascular anomalies. Further large-scale, multicentric studies combining radiological and cadaveric data are recommended to strengthen anatomical databases and improve clinical protocols.

Background: Proton pump inhibitors (PPIs) are widely prescribed for acid-related gastrointestinal conditions, yet intravenous (IV) use is often inappropriate, especially in non-critical care settings. Overprescription contributes to increased healthcare costs and potential patient harm. Prior studies from various countries have highlighted high rates of inappropriate IV PPI usage. Methods: A prospective observational study was conducted at a tertiary care hospital in India from April 2023 to April 2024. A total of 164 in patients who received IV pantoprazole were included. Clinical notes and prescription records were reviewed to assess appropriateness based on indication, dosage, and duration. Patients were categorized into UGIB and non-UGIB groups, and factors associated with inappropriate use were analyzed. Results: Only 24.6% of prescriptions met criteria for appropriate IV PPI use. The most frequent indication was presumed UGIB (30.5%), but it had a low appropriateness rate (14%). Inappropriate use was highest in cases of abdominal pain, NBM status without valid indication, and undocumented reasons. Most errors were due to incorrect indication rather than dosing. Conclusion: Inappropriate IV PPI prescribing remains prevalent and calls for better clinical governance and education.

Background: One of the biggest global health issues is stroke. After cancer and ischemic heart disease, it is the third leading cause of death in developed nations. Permanent impairments affect about half of stroke survivors. There are currently no published guidelines for the selection of anticonvulsants for the treatment of post-stroke seizures, despite the significant prevalence of post-stroke epilepsy and shifting demographics. Objectives: With an emphasis on seizure control, adverse drug responses, and treatment outcomes during a 12-month follow-up period, the study sought to assess the safety and effectiveness of several antiseizure drugs in patients with stroke-related seizures. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that has been retrieved was of one year. The data of 172 participants have been retrieved. Patients with ischemic or hemorrhagic stroke diagnoses who later experienced seizures and were at least 18 years old were included in the study. Results: Participants were 68.3 ± 9.7 years old on average. 76 (44.2%) of the 172 participants were female, and 96 (55.7%) were male. At the 12-month follow-up, lacosamide showed the highest seizure freedom rate, with 57 out of 61 patients (93.4%), followed by eslicarbazepine acetate, with 42 out of 47 patients (89.4%). Use of lacosamide was significantly associated with higher odds of seizure freedom at 12 months (OR = 3.25, p = 0.03), compared to carbamazepine. Conclusion: In comparison to conventional treatments, this study shows that newer-generation antiseizure drugs, including lacosamide and eslicarbazepine acetate, exhibit greater tolerance and superior efficacy in the treatment of stroke-related seizures.

Background: Leiomyomas, or fibroids, are benign smooth muscle tumors that most commonly occur in the uterus. Although usually localized to their origin, unusual instances of “wandering” or ectopic leiomyomas with uncharacteristic imaging presentations complicate traditional diagnostic strategies and clinical assumptions. Objective: By discussing diagnostic problems, clinical presentation, and surgical results, this research seeks to retrospectively examine cases of wandering leiomyoma with atypical imaging features. Methods: At Bhima Bhoi Medical College and Hospital in Balangir, Odisha, from 1st June 2024 to 28th February 2025, a retrospective review was done. There were included 30 patients with histopathologically verified leiomyomas showing normal uterine location or unusual radiographical features outside. From hospital records including imaging results (MRI, CT, USG), intraoperative observations, and histopathology data were gathered. Results: Among the 30 examples, most showed faint abdominal or pelvic symptoms that were frequently first misdiagnosed as adnexal masses or other non-cancerous tumors on early imaging. Radiological results showed strange signal intensities on MRI and unusual sites including broad ligament, retroperitoneal space, and even the abdominal wall. Surgical resection and following histopathologic analysis positively let every diagnosis. The research stresses the range of imaging features and sites of ectopic leiomyomas, highlighting the need of keeping a high index of suspicion. Conclusion: In wandering leiomyomas with uncharacteristic imaging results present an uncommon but relevant diagnostic challenge. Accurate diagnosis and treatment depend on a multidiscipline approach including surgical exploration and radiological evaluation. Greater awareness helps to stop incorrect therapies and wrong diagnosis.