Background: Hyperbaric bupivacaine is the work-horse local anaesthetic for spinal blocks during lower-limb orthopaedic surgery, yet its duration is frequently inadequate for prolonged procedures or sustained postoperative analgesia. Opioids such as fentanyl and α-2-adrenergic agonists such as clonidine are popular intrathecal adjuvants, but head-to-head data in a uniform surgical population remain limited. Methods: The study used a prospective, randomised study whereby 96 ASA I-II adults (18-70 y) who are to receive elective fixation or arthroplasty of the lower limb were made to receive 3.5 mL hyperbaric bupivacaine 0.5 % with either clonidine 50 μg (Group C, n = 48) or fentanyl 25 μg (Group F, n = 48). The main outcomes included the time and occurrence of sensory and motor block. Other secondary outcomes were haemodynamics, VAS pain score, time-to-first rescue analgesia and adverse event. Results: There were similar baseline characteristics. With clonidine, the mean sensory onset was faster (3.5 ± 0.9 min vs 6.3 ± 0.8 min) and the median sensory (327 min vs 277 min, p = 0.002) and motor (286 min vs 234 min, p = 0.012) block prolonged significantly when compared with fentanyl. The first rescue analgesic was requested later in Group C (347 ± 43 min) than Group F (286 ± 27 min, p = 0.007). Fentanyl produced a higher peak cephalad spread (T6 in 56 % vs 42 %). Haemodynamics were stable in both cohorts; however, clonidine generated lower diastolic pressures (–5-7 mmHg) and mild bradycardia without intervention. Pruritus occurred only with fentanyl (10.4 %). No neurological sequelae were observed. Conclusion: Both adjuvants enhance spinal anaesthesia quality, but clonidine provides a faster onset and markedly longer intra- and postoperative analgesia at the expense of modest sympatholysis, whereas fentanyl affords greater block height with minimal cardiovascular impact. Individual patient comorbidity, anticipated surgical duration and desired recovery profile should guide adjuvant selection.

Background: Hyperbaric bupivacaine is routinely combined with intrathecal adjuvants to optimise spinal anaesthesia. Nalbuphine, a κ-agonist/µ-antagonist opioid, and clonidine, an α2-adrenergic agonist, have both been reported to prolong block characteristics and improve analgesia, yet head-to-head data remain limited. Methods: In this prospective, randomised, double-blind trial, 60 ASA I–III adults (18–60 yr) scheduled for elective lower-abdominal surgery received either nalbuphine 1.6 mg (Group N) or clonidine 30 µg (Group C) with 3 ml 0.5 % hyperbaric bupivacaine. Primary endpoints were onset and duration of sensory and motor block and time to first rescue analgesia. Secondary endpoints included haemodynamic variables, visual-analogue pain scores (VAS, 0–10) and adverse events. Results: Baseline demographics and comorbidities were comparable. Mean sensory-block onset did not differ (3.23 ± 0.82 min vs 3.82 ± 0.88 min; p = 0.56). Clonidine significantly prolonged sensory block (263.1 ± 43.0 min) versus nalbuphine (248.1 ± 71.4 min; p = 0.001) and achieved lower VAS at 2 h (1.77 ± 1.57 vs 5.03 ± 0.81; p < 0.001) and 6 h (1.93 ± 1.51 vs 5.47 ± 1.14; p = 0.028). Time to rescue analgesia was similar (358.3 ± 69.8 min vs 363.5 ± 69.9 min; p = 0.90). Nalbuphine produced lower heart rates at 2, 10 and 30 min post-block (all p < 0.05). Adverse events (bradycardia ≈ 27%, hypotension ≈ 23%, nausea ≈ 22%) did not differ significantly (p = 0.63). Conclusion: Both adjuvants are safe and effective. Clonidine provides longer sensory blockade and superior intermediate-term analgesia, favouring its use in lengthy procedures, whereas nalbuphine offers a faster heart-rate attenuation that may benefit haemodynamically labile patients in shorter cases.

Background: Chronic kidney disease (CKD) is increasingly being diagnosed in younger populations, particularly in low- and middle-income countries. Early-onset CKD contributes significantly to long-term morbidity and economic burden. Identifying risk factors in young adults is essential to facilitate timely preventive strategies. Aim: To determine the risk factors associated with CKD among young adults under the age of 40 attending a tertiary care hospital. Material and Methods: A hospital-based case-control study was conducted with a total sample of 150 participants: 75 diagnosed CKD cases and 75 age- and sex-matched controls. Data on sociodemographic characteristics, comorbidities, lifestyle practices, and clinical history were collected using a pre-validated semi-structured questionnaire. Logistic regression analyses were performed to identify statistically significant determinants of CKD. Results: Multivariate logistic regression revealed that rural residence (OR = 5.49, 95% CI: 2.49–12.08), family history of CKD (OR = 28.14, 95% CI: 3.17–249.70), hypertension (OR = 4.89, 95% CI: 2.01–12.43), use of alternative medicine (OR = 4.83, 95% CI: 1.67–14.02), and recurrent urinary tract infections (OR = 10.90, 95% CI: 2.24–52.91) were independently associated with CKD. Alcohol consumption showed borderline significance (p = 0.057). Conclusion: CKD among young adults is significantly associated with modifiable risk factors, including hypertension, alternative medicine usage, and recurrent UTIs, in addition to non-modifiable factors like rural residence and family history. This underscores the urgent need for early screening, public health education, and safer healthcare practices to mitigate CKD onset in younger populations.

Background: Self-care plays a vital role in the management and prognosis of type 2 diabetes mellitus (T2DM). The Summary of Diabetes Self-Care Activities (SDSCA) is a validated tool used to assess adherence to self-care behaviors in diabetic patients. Understanding the relationship between these practices and glycemic control is essential to improving diabetes outcomes. Aim: To assess the self-care practices among type 2 diabetes patients using the SDSCA tool and evaluate their association with glycemic control. Material and Methods: A cross-sectional observational study was conducted among 150 patients diagnosed with T2DM attending the outpatient department of a tertiary care hospital. Participants were assessed using the SDSCA questionnaire, covering five domains: diet, physical activity, glucose monitoring, foot care, and drug adherence. HbA1c values were used to categorize patients into controlled (HbA1c <7) and uncontrolled (HbA1c ≥7) groups. Descriptive statistics and inferential analysis, including t-tests and chi-square tests, were employed. Results: Among 150 participants, 53.3% were male and 46.7% female. Significant differences were found in the mean scores of diet (p<0.001), physical activity (p<0.001), foot care (p<0.001), and glucose monitoring (p=0.01) between the controlled and uncontrolled groups. Drug adherence was relatively high but not statistically associated with glycemic control. A strong association was observed between smoking and uncontrolled HbA1c (p<0.001). Conclusion: The study highlights that satisfactory self-care practices—particularly dietary control, physical activity, foot care, and regular glucose monitoring—are significantly associated with better glycemic control among T2DM patients. Incorporating structured education and behavioral reinforcement into routine care may improve self-management and diabetes outcomes.

Background: Sick Euthyroid Syndrome (SES), or non-thyroidal illness syndrome, refers to abnormal thyroid hormone levels in the setting of acute or chronic systemic illness without intrinsic thyroid pathology. This syndrome is characterized by decreased T3 levels, normal or low T4, and normal or low TSH. Recent studies have highlighted its occurrence in acute myocardial infarction (AMI), potentially serving as a prognostic marker. Aim: This study aimed to evaluate the occurrence of SES in patients with acute myocardial infarction and to determine its prognostic significance in relation to MI severity. Methodology: A prospective cross-sectional study was conducted over one year on 100 patients admitted with AMI to a tertiary care center in Kadapa. Patients were evaluated for thyroid function tests, demographic data, risk factors, MI type, echocardiographic parameters, and clinical outcomes. Patients with known thyroid disorders or confounding comorbidities were excluded. Results: SES was observed in 45% of patients with AMI. A significant association was found between SES and higher KILLIP class, reduced LVEF (<50%), prolonged ICU stay, and increased mortality (13%, with 76.9% of those deceased having SES; p=0.013). SES incidence was significantly higher among diabetics and those with anterior wall MI. Mean T3, T4, and TSH levels decreased with increasing MI severity. However, SES showed no significant association with age, gender, or lifestyle habits. Conclusion: SES is prevalent in AMI patients and correlates strongly with disease severity, ICU stay, and mortality. The findings suggest that thyroid hormone alterations, particularly low T3, may be a useful prognostic marker in AMI. However, the role of thyroid hormone therapy remains controversial and may not be warranted without clear hypothyroidism.

Background: Laparoscopic cholecystectomy (LC), though now the standard approach for gallbladder removal, carries a risk of bile duct injuries, often due to misidentification of hepatobiliary anatomy. The importance of reliable anatomical landmarks such as Rouviere’s Sulcus (RVS), Hartmann’s pouch, and the union of the cystic duct with the bile duct has gained prominence in ensuring safe surgical practice. Aim: To evaluate the role of anatomical landmarks in predicting the difficulty of laparoscopic cholecystectomy and guiding surgeons toward safer outcomes. Methodology: A cross-sectional study was conducted on 30 patients undergoing LC over a two-year period at Narayana Medical College & Hospital, Nellore. Patient demographics, anatomical landmark visibility, and intraoperative findings were recorded. Surgeries were categorized based on difficulty levels (easy, difficult, very difficult), and associations with various anatomical and demographic variables were analyzed. Results: RVS was identifiable in 63.3% of cases, with a significant association (p=0.0029) between its identification and easier surgeries. Hartmann’s pouch (p=0.0158) and the union of the cystic duct with the bile duct (p=0.0183) were also significantly associated with lower surgical difficulty. Age, BMI, and surgery duration showed significant correlation with surgical difficulty, whereas gender, identification of Callot’s triangle, cystic node of Lund, and cystic/right hepatic artery did not. Conclusion: The identification of RVS, Hartmann’s pouch, and the cystic duct–bile duct junction are key predictors of surgical ease during LC. Early intraoperative recognition of these landmarks can help anticipate and manage complex cases, enhancing surgical safety and reducing bile duct injuries.

Background: Chronic alcohol consumption has significant effects on the hematopoietic system, often leading to various hematological abnormalities. Early identification of these changes can help prevent long-term complications and guide clinical intervention. Objectives: To evaluate the hematological alterations in patients with chronic alcohol abuse and to assess the correlation between duration of alcohol intake and specific hematological parameters. Methods: This was an observational cross-sectional study conducted over a period of one year at Rishi Pathological Laboratory, Kolkata. A total of 30 adult patients with a history of alcohol use for more than one year were included. Hematological parameters including hemoglobin, total and differential leukocyte count, platelet count, MCV, MCH, and MCHC were measured using an automated hematology analyzer. Statistical analysis was performed to evaluate the frequency of abnormalities and their correlation with alcohol use duration. Results: Anemia was present in 73.3% of participants, with 70% showing macrocytosis (elevated MCV). Thrombocytopenia was noted in 36.7% of cases. A significant negative correlation was found between alcohol duration and hemoglobin (r = -0.56, p = 0.002) and platelet count (r = -0.48, p = 0.009), while MCV showed a strong positive correlation (r = +0.61, p < 0.001). Conclusion: Chronic alcohol abuse is strongly associated with hematological abnormalities, particularly anemia, macrocytosis, and thrombocytopenia. Routine hematological screening can serve as an important tool in identifying early systemic effects of alcohol toxicity.

Klebsiella pneumoniae is a leading cause of urinary tract infections (UTIs), particularly in hospitalized and critically ill patients. This study aims to compare the antimicrobial resistance (AMR) patterns of K. pneumoniae isolated from urine samples of ICU and non-ICU patients over one year (May 2024 – April 2025) in a tertiary care hospital in Central India. A total of 30 antibiotics were tested. ICU isolates demonstrated significantly higher resistance rates, with an average resistance of 81.27% compared to 68.31% in non-ICU isolates. The findings underscore the urgent need for strengthened antimicrobial stewardship in critical care settings.

Background: Diabetic foot ulcers (DFUs) represent a significant complication of diabetes mellitus, affecting 15-25% of diabetic patients during their lifetime and contributing substantially to morbidity, mortality, and healthcare costs. Various classification systems have been developed to standardize assessment and predict outcomes, with the Site, Ischemia, Neuropathy, Bacterial Infection, Area, and Depth (SINBAD) system and University of Texas (UT) classification being widely used. Methods: This prospective observational study included 60 patients with diabetic foot ulcers assessed using both SINBAD and UT classification systems at baseline. Demographic data, comorbidities, and ulcer characteristics were recorded. Primary outcomes included healing status at initial assessment and six-month follow-up. Statistical analysis was performed using SPSS 23.0, with chi-square tests for categorical variables and Receiver Operating Characteristic (ROC) analysis to evaluate predictive performance. Results: The study population comprised 70% males and 30% females, with most patients (60%) aged 47-66 years. Both classification systems demonstrated excellent predictive ability. The SINBAD score showed an Area under Curve (AUC) of 0.933 (95% CI: 0.869-0.996), with 100% sensitivity, 60% specificity, and 72% accuracy at a cutoff score of 3. The UT classification exhibited an AUC of 0.889 (95% CI: 0.797-0.981), with 78% sensitivity, 90% specificity, and 87% accuracy at a cutoff score of 3. At six-month follow-up, SINBAD maintained 75% accuracy, while UT showed 70% accuracy. Conclusion: Both SINBAD and UT classification systems demonstrate excellent but complementary predictive capabilities for diabetic foot ulcer outcomes. SINBAD excels in sensitivity, identifying patients with healing potential, while UT offers superior specificity and overall accuracy, better identifying patients at risk for non-healing. These findings suggest that the combined use of both systems might optimize risk stratification and treatment planning in clinical practice.

Background: Thyroid surgery for ostensibly benign disease occasionally reveals occult papillary thyroid carcinoma (PTC). Quantifying that risk guides operative extent and long-term surveillance. Methods: We retrospectively reviewed 612 consecutive thyroidectomies performed between November 2016 and May 2018 in the Department of ENT, Bangalore Medical College and Research Institute, Bangalore, India. Pre-operative ultrasound and cytology classified all nodules as benign (Bethesda II/III). Total or hemi-thyroidectomy specimens underwent systematic serial-sectioning with 3-mm slicing. Incidental PTC (iPTC) was defined as carcinoma < 1 cm (micro-PTC) or > 1 cm discovered for the first time on final pathology. Demographic, clinical, and histologic variables were analyzed. Results: Among 612 patients (74% female, mean age 46.8 ± 13.1 y), benign multinodular goiter (MNG) was the leading indication (58%). Overall iPTC frequency was 10.8% (n = 66). Micro-PTC accounted for 71% of cases. iPTC occurred more often in total thyroidectomy than hemithyroidectomy specimens (12.6% vs 6.2%, p = 0.01) and was independently associated with age < 45 y (aOR 1.8, 95 % CI 1.03–3.13) and nodule diameter > 3 cm (aOR 2.3, 95% CI 1.15–4.55). Multifocality (36%) and capsular invasion (9%) were uncommon; no extrathyroidal extension was observed. Median follow-up of 26 months showed zero disease-specific deaths and one structural persistence. Conclusion: Roughly one in ten thyroids removed for benign disease harbors unsuspected PTC—predominantly micro-PTC with indolent biology. Age < 45 y and large nodular size modestly increase risk. These data support thorough intra-operative exploration and patient counseling, and they justify total thyroidectomy when bilateral nodularity co-exists.

Background: Long-acting reversible contraceptives (LARC) can transform family-planning outcomes, yet real-world continuation varies. We compared 12-month continuation and reasons for discontinuation of the copper T 380A intrauterine device (IUD) and depot medroxy-progesterone acetate (DMPA) injection, stratified by interval, post-abortion and post-partum initiation. Methods: In a longitudinal cohort at a tertiary centre in New Delhi (November 2016–March 2018), 162 women (81CuT; 81 DMPA) who met WHO medical-eligibility criteria were enrolled. Follow-ups occurred at 1, 3, 6, 9 and 12 months. Primary outcomes were (i) continuation rate and (ii) method-specific discontinuation (expulsion, removal or default). Kaplan–Meier survival and Cox regression explored determinants. Results: Overall 12-month continuation was significantly higher for CuT than DMPA (74 % vs 39.5 %, P<0.001). Timing mattered: interval initiators showed the best retention (96 % CuT vs 74 % DMPA), followed by post-partum (66.6 % vs 37 %) and post-abortion cohorts (59.2 % vs 29.6 %). Among CuT users, expulsion (7.4 %) and heavy bleeding (7.4 %) were leading causes of loss; four method failures (4.9 %) occurred, none in DMPA. Conversely, DMPA discontinuation was driven by bleeding disturbances (17.2 %), desire for pregnancy (16 %), and psychosocial factors (6.1 %). Adjusted hazards for discontinuation were 2.8-fold higher with DMPA (95 % CI 1.8–4.4) and 1.9-fold higher after post-abortion versus interval start (95 % CI 1.1–3.3). Conclusion: CuT 380A demonstrated superior year-long continuation irrespective of initiation timing. Strengthening counselling around expected bleeding changes, particularly after DMPA or post-abortion starts, may narrow this gap. These findings support expanding immediate interval IUD services and developing reminder/support systems for injectable users.

Background: Rhino-orbito-cerebral mucormycosis (ROCM) emerged as a significant opportunistic infection during the COVID-19 pandemic, particularly among patients with diabetes mellitus and those receiving corticosteroid therapy. This study aimed to comprehensively analyze the clinical manifestations, management strategies, and outcomes of post-COVID ROCM patients treated in a tertiary care hospital. Material and Methods: This retrospective observational study included 32 patients diagnosed with post-COVID ROCM over a period of one year. Demographic data, comorbidities, COVID-19 severity, clinical presentation, staging, microbiological and histopathological findings, surgical management, antifungal therapy, and treatment outcomes were recorded and analyzed. Results: The mean age of patients was 54 years, with a male predominance. Diabetes mellitus was the most common predisposing factor. The majority of patients presented with nasal discharge and facial pain, while advanced stages were characterized by proptosis and vision loss. Twenty patients were classified as proven ROCM based on microbiological confirmation, and 12 as probable ROCM. Endoscopic surgical debridement was performed in 22 patients, including orbital decompression in 10 cases. All patients received systemic antifungal therapy, primarily liposomal amphotericin B followed by posaconazole. No mortality was observed. Complete cure was achieved in 10 patients, while 14 showed significant symptom improvement. Eight patients had persistent symptoms without disease progression at discharge. Conclusion: Post-COVID ROCM poses a severe threat to patient outcomes, particularly among those with diabetes and severe COVID-19 illness. Early diagnosis, prompt initiation of systemic antifungal therapy, and timely surgical intervention are crucial to improving prognosis. Multidisciplinary care and vigilant follow-up can lead to favorable outcomes even in advanced disease.

Background: Infective neck swellings constitute a significant proportion of pediatric head and neck pathologies, presenting with a wide clinical spectrum ranging from simple lymphadenitis to deep neck space infections. Prompt diagnosis and appropriate management are essential to prevent potentially life-threatening complications. Aim: To evaluate the clinicopathological profile, microbiological spectrum, and management outcomes of infective neck swellings in pediatric patients. Material and Methods: This prospective observational study was conducted over 18 months and included 120 children aged 1–15 years presenting with infective neck swellings. Each patient underwent detailed clinical assessment, laboratory investigations, ultrasonography, and contrast-enhanced CT where indicated. Microbiological evaluation included aerobic and anaerobic cultures, as well as Ziehl–Neelsen staining for tuberculous etiology. Management strategies were tailored according to the type and severity of infection and included intravenous antibiotics, needle aspiration, or incision and drainage. Data were analyzed using SPSS version 25. Results: The most commonly affected age group was 4–6 years (27.5%) with a slight male predominance (male-to-female ratio 1.3:1). Acute suppurative lymphadenitis was the most frequent diagnosis (35%), followed by chronic granulomatous (tuberculous) lymphadenitis (23.3%) and deep neck space abscesses (22.5%). Among deep neck infections, submandibular abscess was predominant (33.3%). Incision and drainage combined with intravenous antibiotics was required in 70.4% of deep neck infections. The majority of patients achieved complete resolution without major complications. Conclusion: Infective neck swellings in children require a high index of suspicion, prompt imaging, and timely intervention to ensure favorable outcomes. A structured diagnostic and therapeutic approach, incorporating microbiological evaluation and individualized management plans, remains the cornerstone of effective treatment in this vulnerable age group.

Background: Awake fiberoptic intubation (AFOI) is the preferred technique for managing anticipated difficult airways. Effective topical anesthesia and patient comfort are essential to facilitate successful intubation while maintaining spontaneous ventilation and hemodynamic stability. Nebulized dexmedetomidine has emerged as a promising adjunct to improve intubation conditions. Aim: To compare the efficacy of dexmedetomidine combined with lignocaine nebulization versus plain lignocaine nebulization in achieving optimal conditions for awake nasotracheal fiberoptic intubation. Material and Methods: This prospective observational cross-sectional study included 120 adult patients with anticipated difficult airways undergoing elective surgical procedures under general anesthesia. Patients were randomized into two groups of 60 each: Group A received dexmedetomidine (1 µg/kg) combined with 4% lignocaine nebulization, while Group B received 4% lignocaine nebulization alone. Sedation requirements, lignocaine supplementation, intubation success, and airway-related complications were recorded and analyzed. Results: The need for sedation was significantly lower in Group A compared to Group B (6.7% vs. 40%, p<0.001). Fewer patients in Group A required additional lignocaine aliquots (31.7% vs. 46.7%), although this difference was not statistically significant (p=0.208). The median lignocaine dosage was significantly lower in Group A [42 mg (IQR 21–84)] compared to Group B [84 mg (IQR 42–84)] (p=0.01). First-attempt intubation success was high across both groups. Hemodynamic parameters remained stable, and no severe complications were observed. Conclusion: Nebulized dexmedetomidine combined with lignocaine significantly reduced sedation requirements and supplemental lignocaine doses during awake nasotracheal fiberoptic intubation compared to lignocaine alone. This approach is a safe and effective strategy to improve intubation conditions and patient comfort in anticipated difficult airway management.

Background: Patients with acute asthma have increased cardiovascular risk. B-type Natriuretic peptides are useful for identifying cardiovascular disease, stratifying risk, and guiding therapy. Method: 45 asthma patients were compared with 45 controls (healthy volunteers). Asthmatic patients received BNP. Via intravenous infusion two µg/µg/kg of BNP was injected as a bolus in 60 seconds. Then the infusion of BNP immediately began and was given in 0.01, 0.02, and 0.03 µg/kg/min doses every 30 minutes for the first 1.5 hours. The volunteers in the control group received nebulized salbutamol. Afterwards, peak flow meter findings, hemodynamic parameters, and estimations of the clinical severity of asthma in both groups were taken every 30 minutes. Results: Respiratory parameters FEV1, PEER, PR per minute, RR per minute, and hemodynamic parameters SBP, DBP, O2 saturation, and dyspnea wheezing had a significant p-value (p<0.001). Conclusion: BNP reflects diverse aspects of the cardiopulmonary continuum, and prognosis can be treated diligently.

Background: An ageing population is associated with an increase in the frequency of distal radius fractures, an orthopaedic problem that affects many people. Orthopaedic surgeons have special concerns while treating some types of fractures, including those involving the distal end of the radius that occur outside of the joint. For this reason, we set out to compare the efficacy of conventional cast methods with that of percutaneous pinning in a sample of older adults. Method: Out of 60 (sixty) patients, thirty patients underwent cast immobilisation and closure reduction. Thirty patients underwent closed reduction with percutaneous K wires. The patients underwent a clinical examination and X-rays at each subsequent follow-up. Results: There sults showed that the group that had closed reduction K-wire fixation had greater range of motion, VAS scores, and loss of radial length compared to the other group. When looking at the Saito chart and Lindstrom’s criterion findings for both groups, it was also evident of this. In 13% of patients, a pin tract infection developed following K-wire fixation but went away after the wires were removed. This was the sole serious side effect of the procedure. Conclusion: When treating displaced, distal end radius fractures, the best, safest, and most complication-free method is closed reduction with percutaneous K-wire fixation.

Background: Meniere’s disease is a chronic inner ear disorder marked by episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. This study aims to enhance diagnostic accuracy and early management using the SAIMS protocol, with a focus on the glycerol dehydration test (GDH) and its clinical relevance. Objective: To improve the management and quality of life (QOL) in Meniere’s disease patients presenting to a tertiary care centre. Methodology: An analytical cross-sectional study was conducted over 7 months involving 35 patients with vertigo, tinnitus, and hearing loss and management was done following the SAIMS protocol. Results: 91.42% were diagnosed with definite Meniere’s disease (DMD), and 8.57% with probable Meniere’s disease (PDM). Females comprised 57.14%. Tinnitus was present in 40.6% of DMD and 33.3% of PDM patients; aural fullness in 40% of DMD and 66.6% of PDM. oVEMP and cVEMP were positive in 20% and 17.14%, respectively. VNG and EcochG showed 48.57% positivity. Of 17 patients with positive caloric tests, 14 had unilateral and 3 bilateral hypofunction. Eighteen patients underwent GDH based on clinical suspicion. Conclusion: Early and structured evaluation using basic vestibular tests significantly aids in diagnosing Meniere’s disease. However, given the known limitations and selective applicability of GDH, especially in resource-constrained settings, the study—conducted in a tertiary care centre in a developing country—emphasizes the guiding principle of “early diagnosis and early treatment” through the use of accessible, cost-effective diagnostic modalities.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a growing concern worldwide and is now the most common liver disorder in non-drinkers. Medical students, owing to sedentary lifestyles and dietary patterns, may be at increased risk. Aim and Objectives: To determine the prevalence of NAFLD among medical students. To identify its association with lifestyle, anthropometric, and metabolic risk factors. Methods: A cross-sectional study was conducted among 450 MBBS students at F.H. Medical College and Hospital, Agra. Participants were screened using anthropometric measurements (BMI, waist circumference), liver function tests, lipid profile, and abdominal ultrasonography. NAFLD was diagnosed based on USG findings in the absence of alcohol consumption or other known liver disease. A pre-validated lifestyle and dietary questionnaire was administered. Results: NAFLD was diagnosed in 124 students (27.6%). It was significantly associated with higher BMI (mean = 27.8 ± 2.3 kg/m²), central obesity, and elevated triglycerides (>150 mg/dL). Physical inactivity and frequent fast-food intake were common among NAFLD-positive students. A significant positive correlation was found between BMI and USG-graded fatty liver (r = 0.48, p < 0.01). Conclusion: NAFLD affects over one-fourth of medical students in this study and is significantly associated with modifiable lifestyle and metabolic risk factors. Early lifestyle counseling, regular screening, and awareness programs are urgently warranted.

Background: Vascular anomalies can present as vascular tumours and malformations. Infantile haemangiomas are the commonest vascular tumours which can involute over time. But, left untreated, may be cosmetically distressing and destructive. Vascular tumours can be infiltrative, destructive and cosmetically distressing, requiring treatment in all cases. Aims and Objectives: Study the pattern of vascular anomalies of the face and oral cavity of patients up to 15 years of age. To study the treatment response of various treatment modalities, over and above Propranolol. Materials and Methods: A retrospective study was done from the available records in departments of Paediatric surgery and Dermatology. Patients with complete records and without associated syndromes were evaluated for pattern of vascular anomalies, sites of involvement, morphological types, treatment modalities, response and relapse. Results: Out of 85 patients, in the age range of 3.5±3 years, there were 60 cases of infantile haemangiomas and 25 cases of vascular malformations. Lips were the commonest site involved in haemangiomas, tongue in vascular malformations. 49 cases received propranolol, out of which 25 cases achieved excellent response. Five cases underwent additional surgical excision of fibro fatty tissue, 19 cases required intralesional foam sclerotherapy. An excellent response was seen with embolization and surgical excision, when used for acute complications. There were 12 cases of venous malformation, 7 cases of AV malformation and 6 cases of lymphatic malformation. Intralesional foam therapy was the commonest modality of treatment (12/25 cases), associated with an excellent outcome in 6/12 cases. Embolization and surgical excision both had an excellent outcome. Conclusion: A multidisciplinary approach using the appropriate treatment modality can ensure a favourable outcome for vascular anomalies. Prospective and comparative studies will help formulate a therapeutic algorithm for vascular tumours and malformations.

Background: To study the MRI findings and CSF analysis in patient diagnosed with tuberculoma. Methods: It was a cross-sectional observational study was conducted on tuberculoma patients. Results: MRI had a sensitivity of 87%, specificity of 92%, PPV and NPV of 83% and 94% respectively with a diagnostic accuracy of 90%. Conclusion: MRI has a huge potential superiority in the diagnosis of CNS infections.

Background and Objective:  Fine-needle aspiration cytology (FNAC) is a minimally invasive, cost-effective procedure widely used as the first-line diagnostic tool for evaluating thyroid swellings. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) standardizes cytological reporting into six categories. When combined with thyroid function tests (TFTs), FNAC aids in assessing both the morphological and functional status of the thyroid, guiding appropriate treatment and reducing unnecessary surgeries. This study aims to correlate the cytomorphological features of thyroid lesions with thyroid hormone status to improve diagnostic accuracy and clinical management. Methods: This was a prospective study conducted at the Akash Institute of Medical Science and Research Centre. A tertiary care centre at Devanahalli, Bangalore. 60 cases of thyroid swellings were subjected to FNAC, smears were categorised according to The Bethesda System of Reporting Thyroid Cytopathology and were also assessed for T3, T4, TSH hormone levels subsequently. Results: The study included a total of 60 cases, irrespective of age and gender. The majority of cases (33%) were in the 31–40 years age group, with a female predominance (80%). Most thyroid lesions were classified as benign (47%). Among neoplastic lesions, Follicular neoplasms (8.3%) were the most frequent. Thyroid hormone analysis revealed that 45% of patients were euthyroid, 40% hypothyroid, and 15% hyperthyroid. Conclusion: FNAC is a reliable, simple, and cost-effective first-line diagnostic procedure. When combined with thyroid function tests, it facilitates early and accurate diagnosis of various thyroid lesions and helps reduce unnecessary interventions.

Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly resulting from embryonic developmental issues affecting the inferior vena cava (IVC). It can be categorized into two types: Type 1 (Low Loop), where the ureter traverses behind the IVC at the third lumbar vertebra, and Type 2 (High Loop), where the ureter lies at the renal pelvis level. This case report describes a 13-year-old male with symptomatic Type 1 retrocaval ureter leading to significant obstruction. Laparoscopic ureteroureterostomy was performed, resulting in successful management of his condition. This document discusses the clinical presentation, imaging findings, surgical strategies, and postoperative outcomes, highlighting the importance of timely diagnosis and intervention for retrocaval ureter.

It has been well documented that as individuals age, body composition changes, which is affected by numerous covariate factors. The amount of Fat and Fat Free Mass (FFM) in adults change with increasing age as a function of variety of factors from physical activity to nutrition and disease. Sedentary lifestyle involving physical exercise is prominent in professions like academics, judicial, information technology, etc. The study examined body composition in different age group (20-29 years, 30-39 years, 40-49 years, 50-59 years) having sedentary lifestyle. Total of 120 male subjects with sedentary lifestyle were categorized into 4 groups according to age. Anthropometric measurements like height and weight were measured. Body fat % was assessed by Bioelectrical Impedance Analysis (BIA) and Fat Free Mass (FFM) was calculated in all subjects. Statistical analysis showed that with advancing age body weight and body fat % was increased. The increase in body weight and body fat % was statistically more significant in Group II as compared to Group I. Sedentary lifestyle can be a major contributory factor for increase in body weight and body fat %. In our study, we also found that Fat Free mass (FFM) was increased in Group II as compared to Group I; but it goes on decreasing in Group III & Group IV as compared to Group II. Increase in hormonal activity might have caused increase in Fat Free Mass in age group II but later on as the age advances, reduction in Fat Free Mass occurring with normal aging might be associated with a reduction in motor unit number and atrophy of muscle fibers.

Background: Hypertensive crisis, comprising hypertensive emergencies (HE) and urgencies (HU), remains a critical cause of emergency department visits. The distinction between HE and HU is based on the presence of acute target organ damage. Timely identification and management are essential to reduce morbidity and mortality. Methods: This prospective observational study encompassed 176 patients with hypertensive crises at a tertiary care hospital over one year who were grouped as HE or HU as per the target organ damage. Data on demographics, comorbidities, clinical findings, treatment, and outcomes were collected. Patients were followed for 12 months for recurrence, hospitalizations, and mortality. Results: Patients with HE was older and had higher rates of comorbidities and organ dysfunction. HE patients showed significantly greater risks for recurrent events, cardiovascular hospitalizations, and mortality. The hazard for hospitalization and death from cardiovascular causes was markedly elevated in the HE cohort. Recurrent hypertensive crises were similar between groups. Conclusion: Hypertensive emergencies were associated with worse outcomes and higher mortality compared to hypertensive urgencies.

Background: There is a dearth of information regarding snakebite management, hospital course, and results, despite the fact that an estimated 50,000 people in India pass away after being bitten by a snake each year. Sometimes, even highly experienced medical professionals struggle to correctly handle snake bite patients because they lack clarity regarding symptoms. Objectives: The aim of the study was to review outcomes and time of anti-venom administration in cases of snake bites. 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 173 participants has been retrieved. All patients who were 18 years of age or older and had a history of venomous snakebite were eligible to participate. All case files that were deleted or left unfinished were not included. Results: 48.6% of the population was between the ages of 18 and 40. The majority of patients (82.1%) were from rural areas. 69 patients (39.9%) received anti-venom within 3 hours of the bite, while 35 patients (20.2%) received it between 3 to 6 hours. Notably, another 69 patients (39.9%) experienced a delay of more than 6 hours before receiving anti-venom therapy. 130 patients (75.1%) were successfully treated and discharged alive. Four patients (2.3%) succumbed to complications, followed by 39 patients (22.5%) taking LAMA. Conclusion: The study concluded that timely anti-venom administration significantly improves outcomes in snakebite cases. Delays were common and associated with increased complications. Most victims were young males from rural areas, with hemotoxic bites being the most prevalent.

Background: Blunt abdominal trauma (BTA) is a common and potentially life-threatening injury, especially in developing countries. Road traffic accidents are the leading cause of BTA, affecting mainly young adults. Early diagnosis and appropriate management are critical to reduce complications and mortality. Methods: This retrospective study was carried out at a tertiary care hospital over one year, including 148 patients with blunt abdominal trauma. Data were collected from patient records, covering demographics, injury causes, diagnostic tests, and treatment. Patients underwent either operative or non-operative management based on clinical status and investigation results. Results: Blunt abdominal trauma accounted for 69.59% of abdominal trauma cases, with the majority aged 21-30 years. Road traffic accidents were the most common cause (66.99%). Among BTA cases, 58.25% underwent surgery, while 41.75% were managed conservatively. Hollow viscus perforation repair was the most frequent surgery performed. Conclusion: Timely diagnosis and appropriate treatment are essential to improve outcomes in blunt abdominal trauma.

Background: The most prevalent arrhythmia, atrial fibrillation (AF), is becoming more widespread globally, particularly among the elderly. Community monitoring or mixed-age cohorts have been given priority in many large-scale research, which may not fully capture the complexity of AF presentation in older persons admitted to hospitals. Objectives: In order to improve screening and management practices in this high-risk population, the project aims to ascertain the prevalence of atrial fibrillation in older individuals and to pinpoint clinical and demographic risk factors that are linked to the condition. 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 156 participants have been retrieved. Results: There were 156 AF patients in the study. The average age was 80.1 ± 7.8 years, and there were 72 females (46.2%) and 84 males (53.8%). The BMI was 29.8 kg/m² on average. 134 patients (84.9%) in this group of 156 atrial fibrillation patients took antihypertensives. 114 patients (73.4%) used statins, and 69 patients (43.9%) took aspirin. NSAIDs were prescribed to 19 patients (12.0%) and steroids to 42 individuals (27.1%). Conclusion: The study found that older individuals, especially those between the ages of 70 and 79, had a considerable burden of AF. Recommendations: As this was a short-term study, further research is needed with a longitudinal study design and a larger sample to achieve more definitive results.

Background: Liver failure and other serious liver issues might complicate pregnancy. Certain liver conditions are unique to pregnancy. While obstetric cholestasis, liver dysfunction linked to pre-eclampsia, and hyperemesis gravidarum are more common, the two most dangerous conditions—acute fatty liver of pregnancy and HELLP syndrome (haemolysis, increased liver enzymes, low platelets)—are uncommon. Objectives: Pregnant women with HELLP syndrome diagnosed in the third trimester will have their clinical profile, liver function abnormalities, pharmaceutical therapy methods, and perinatal outcomes evaluated. 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 164 participants have been retrieved. Women with severe preeclampsia and eclampsia >28 weeks with abnormal laboratory results met the inclusion criteria for the study. Results: With 43.9% of patients under 25 and 36.6% between 25 and 30, the majority of patients were under 30. The majority of them were primigravida women (56.7%). Among pharmacological intervention, magnesium sulfate was administered in 148 (90.2%) patients, followed by corticosteroids were given to 132 (80.5%) patients. Preterm birth was seen in 109 (66.5%) of patients. Low birth weight (<2.5 kg) was observed in 97 (59.1%) of neonates. NICU admission was required in 88 (53.7%) of cases. Conclusion: With substantial hepatic, hematologic, and renal involvement, HELLP syndrome is a potentially fatal maternal complication. In order to address maternal problems in this study, timely pharmacological management and close observation were essential. Recommendations: As this was a short-term study, further research is needed with a longitudinal study design and a larger sample to achieve more definitive results.

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Uterine atony and placental abnormalities remain the most common causes. Identifying risk factors is crucial for improving maternal outcomes. Methods: This retrospective case-control study was conducted at a tertiary care hospital over one year, involving 152 women (76 PPH cases and 76 controls). PPH was defined per WHO guidelines, with blood loss estimated using the gravimetric method. Key maternal and obstetric variables were analyzed using chi-square tests and logistic regression to identify risk factors and severe outcomes. Results: Advanced maternal age, preterm birth, cesarean delivery, and multiparity were significantly associated with PPH. Uterine atony accounted for most cases, followed by placental causes. Preterm birth and cesarean delivery were independent predictors of advanced interventions. Preterm birth, cesarean delivery, and advanced maternal age were linked to obstetric hysterectomy and blood transfusion. Conclusion: Targeted risk assessment and proactive management can help reduce PPH-related complications.

Background: The progressive loss of kidney function over a period of months to years is known as chronic kidney disease (CKD); in CKD, normal renal structure is gradually replaced by fibrotic tissues. Regretfully, research on CVD in the early phases of CKD is scarce. Objectives: In order to determine the related risk factors in a hospital-based population and assess the frequency and pattern of cardiovascular problems in patients with chronic kidney disease, the study was carried out. 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 156 participants has been retrieved. Participants had to be above 40 years old and have received hospital care for at least six months in order to be eligible. Participants under 40 years of age and patient records with missing information were excluded. Results: A majority, 86 patients (55.1%), were aged over 60 years. Hypertension was present in 128 patients (82.1%), Diabetes mellitus in 86 patients (55.1%), Dyslipidemia in 46 patients (29.5%), and Anemia in 112 patients (71.8%). LVH was the most common complication, seen in 62 (39.7%) patients. CHF was present in 45 (28.8%) patients, IHD was found in 34 (21.8%) patients, and arrhythmias were observed in 14 (9.0%) patients. Conclusion: This study shows that individuals with chronic renal disease have a high prevalence of cardiovascular problems, the most prevalent of which are congestive heart failure and left ventricular hypertrophy.

Background: Hypertensive emergencies are life-threatening conditions characterized by severe elevations in blood pressure with acute target organ damage. These emergencies are increasing in prevalence, especially in low- and middle-income countries. Early identification and management are crucial to prevent complications. This study aimed to evaluate the clinical profile, organ involvement, and outcomes of hypertensive emergencies in a tertiary care setting. Methods: This prospective observational study was carried over one year in the Emergency Medicine Department of a tertiary care hospital in India, enrolling 172 patients. Patients with systolic BP ≥180 mmHg or diastolic BP ≥110 mmHg and evidence of target organ damage were included. Detailed clinical assessment, laboratory tests, imaging, and serial blood pressure monitoring were performed. Results: Most patients were middle-aged or elderly, with a male predominance (58%). Neurological symptoms were the most common presentation, with intracerebral hemorrhage being the leading target organ complication (36.05%). Renal, cardiac, and retinal complications were also frequent. In-hospital mortality was 22.09%, primarily due to intracerebral hemorrhage and left ventricular failure. Conclusion: Hypertensive emergencies are associated with high morbidity and mortality, highlighting the need for prompt diagnosis and management.

Telemedicine denotes a healthcare service where physicians speak with patients remotely utilising telecommunication technologies. Telemedicine is being used to give pre-postoperative surgical consultation and monitoring as well as surgical education. Numerous stages of surgical outpatient care have safely employed telemedicine, and its efficacy has been assessed based on user/provider satisfaction, economics, and clinical outcomes. Time efficiency, patient/healthcare cost savings, and community access are just a few of the widely acknowledged advantages of telemedicine. However, there are also documented drawbacks, such as clinical uncertainty, the need for technological infrastructure, cybersecurity risks, and regulatory constraints in the healthcare industry. Through expedited practice development at COVID-19, these constraints are being addressed through faster implementation. Further effort is necessary via establishment of research procedures to refine the application of developing telemedicine technologies and their relevance to different surgical sub-specialties.

Introduction: The morphological variations of C2 vertebra and vertebral artery are of immense importance in any surgical procedure around them. Their knowledge is of great clinical interest to the surgeon helping prevent devastating complications. Scarcity of published literature on their relationship led us to conduct this study. Aims: To study the location (within) and relationship (to) of vertebral artery to the transvers foramen and pedicle of C2 vertebra. Material and Methods: 20 patients with CVJ anomalies (of all age groups) were studied for C2 pedicle dimensions with VA position on either side and compared with patients having other subaxial spine pathologies (i.e. control group). C2 pedicle dimensions, the shortest distance of VA to transvers foramen and C2 pedicle calculated, and position of VA within the foramen observed.   Results: C2 pedicles were shorter, thinner, and more convergent (in coronal plane) in anomaly group. The mean shortest distance of VA to transvers foramen was less in anomaly group (0.78 mm) than in control group (0.08 mm) whereas the distance between VA and C2 pedicle was more in anomaly group (1.20mm vs 0.40mm) with p value of < .001. VA was located medially in 70% of anomaly patients and posteriorly in 50% of control group. Conclusion: Location of VA within C2 transvers foramina was medial in anomaly group and posterior in control group which can lead to more chances of injury to VA during C2 pars/pedicle screw fixation. Thus, detailed study of VA in relation to C2 pedicle and transvers foramina is important to plan surgery and screw measurements, reducing the chances of injury.

Background: Typhoid fever, caused by Salmonella enterica serovar Typhi, continues to pose a significant public health burden, particularly in resource-limited settings. While blood culture remains the gold standard for diagnosis, radiological imaging can provide early diagnostic clues, assess disease severity, and identify complications. This study aimed to observe radiological trends in patients with culture-confirmed typhoid fever and evaluate their correlation with clinical and microbiological parameters. Methods: A retrospective observational study was conducted over 24 months at a tertiary care hospital. A total of 142 patients with blood culture-positive S. Typhi were included. Radiological investigations—including abdominal ultrasonography, chest X-ray, contrast-enhanced CT (CECT), and MRI—were reviewed. Imaging findings were correlated with age, antimicrobial resistance, and clinical complications. Statistical analyses were performed using graph pad prism 8.0.1, with significance set at p<0.05. Results: The mean age of patients was 16.3 ± 12.5 years; 59.2% were male. Pediatric patients constituted nearly 70% of the cohort. Abdominal ultrasound, performed in 87.3% of patients, revealed hepatomegaly (59.7%), splenomegaly (54.0%), gallbladder wall thickening (39.5%), and ileocecal bowel thickening (28.2%). Chest X-rays showed pulmonary changes in 20.7% of cases. CT scans (23.9%) identified mural thickening, mesenteric oedema, and complications such as perforation and abscess. MRI brain (in 8 patients) demonstrated cerebral oedema in 3 cases. Patients with complications (n=21) showed significantly higher rates of bowel thickening (66.7% vs. 21.5%; p=0.003) and ascites (47.6% vs. 14.0%; p=0.008). Paediatric patients were more likely to exhibit hepatosplenomegaly and lymphadenopathy and were more affected than adults. Conclusion: Radiological imaging, particularly abdominal ultrasound, offers valuable diagnostic and prognostic insights in culture-positive typhoid fever. Certain imaging patterns correlate with disease severity and complications, especially in paediatric cases. Incorporating early imaging in suspected typhoid cases may enhance diagnostic accuracy and improve clinical outcomes in endemic settings.

This study investigates academic stress and coping mechanisms among medical and paramedical students in Erode District, utilizing the Academic Stress Inventory (ASI) and Coping Style Inventory (CSI) developed by Lin and Chen (2009). A cross-sectional survey was conducted with 400 students, employing simple random sampling. Results revealed that 67.5% of students experienced moderate to high stress, with medical students reporting significantly higher stress levels (mean = 82.4 ± 11.3) compared to paramedical students (mean = 75.8 ± 12.1, p < 0.01). Predominant stressors included exam pressure (82.5%) and academic workload (78.3%). Problem-focused (mean = 34.5 ± 6.2) and emotion-focused (mean = 32.2 ± 5.9) coping strategies were most commonly used, with gender and academic year significantly influencing coping styles (p < 0.05). Logistic regression identified female gender (OR = 1.68, 95% CI: 1.15–2.45), medical course (OR = 1.89, 95% CI: 1.30–2.75), and final year status (OR = 2.15, 95% CI: 1.40–3.29) as predictors of high stress. These findings underscore the need for targeted interventions to foster adaptive coping strategies and enhance student well-being.

Background and Objective: This is a prospective study that comparing two different surgical techniques for adenotonsillectomy in terms of age, gender, intraoperative time and postoperative outcomes. The study population was allocated by purposive sampling into two groups; one underwent coblation adenotonsillectomy, while the other group was managed with cold steel dissection adenotonsillectomy. Results: The study shows that both groups were similar in terms of age and gender distribution, and it was not statistically significant. The intraoperative time in the coblation adenotonsillectomy (group 1) was significantly shorter with a mean of 84.4 vs. 119.8 minutes, p <0.05. Group 1 also had significantly less intraoperative blood loss than conventional adenotonsillectomy (Group 2) (mean 4.4 ml vs 16.2 ml, p <0.05). The postoperative pain assessment using the visual analog scale (VAS). Group 1 had significantly lower VAS scores on postoperative day 1 than Group 2 (mean 0.8 vs mean 4.4, p <0.05). However, there was no statistically significant difference in VAS scores between the two groups on postoperative day 7. The recovery day after surgery was significantly shorter in Group 1 than in Group 2 (median is 1 day vs 2 days, p <0.05). Conclusions: In conclusion, Coblation Adenotonsillectomy is a faster and less traumatic surgical technique than Cold Steel Dissection Adenotonsillectomy. Coblation Adenotonsillectomy also resulted in less postoperative pain and faster recovery than Cold Steel Dissection Adenotonsillectomy.

Background: Neonatal sepsis remains a significant cause of morbidity and mortality, particularly in resource-limited NICU settings. This study aimed to evaluate the clinical presentation and etiological profile of neonatal sepsis in a NICU in western India. Methods: A prospective observational study was conducted from March to June 2024 at a private referral hospital in Dhanera, Gujarat. Thirty neonates with clinical suspicion of sepsis were included. Clinical features, hematological parameters, and blood culture results were analyzed. Organisms were identified, and their antibiotic sensitivity was assessed. Results: Of the 30 neonates, 56.7% had late-onset sepsis, while 43.3% had early-onset. Common clinical features included poor feeding (70%), lethargy (60%), and respiratory distress (56.7%). CRP was positive in 73.3%, and blood culture was positive in 70% of cases. Klebsiella pneumoniae (23.3%) and Staphylococcus aureus (20%) were the most frequently isolated pathogens. No growth was observed in 30% of cases. Conclusion: The study underscores the predominance of Gram-negative organisms in neonatal sepsis, with significant clinical and laboratory overlap. Improved infection control and local antibiogram-based empirical therapy are essential to reduce sepsis-related morbidity.

Introduction: Appendectomy is the standard treatment for acute appendicitis, with two primary approaches: open and laparoscopic. While both are widely practiced, their comparative benefits in terms of postoperative recovery and complications remain a topic of clinical interest. Objective: To compare laparoscopic and open appendectomy with respect to postoperative recovery parameters—such as pain, hospital stay, return to daily activities—as well as surgical complications including wound infection, intra-abdominal abscess, and ileus. Materials and Methods: This prospective comparative observational study was conducted in 2024 in the Department of General Surgery at Gauhati Medical College and Hospital. It included 60 patients with clinically and radiologically confirmed acute appendicitis who underwent surgical management—30 patients had laparoscopic appendectomy (Group A) and 30 had open appendectomy (Group B). Results: Patients in the laparoscopic group had significantly lower postoperative pain scores (mean VAS 3.1 vs 5.6, p<0.001), shorter hospital stays (mean 2.4 vs 4.1 days, p=0.002), and faster return to normal activities (mean 6.2 vs 10.5 days, p<0.001) compared to the open group. Wound infection was significantly lower in the laparoscopic group (4% vs 16%, p=0.03), while intra-abdominal abscess rates were comparable in both groups. Conclusion: Laparoscopic appendectomy offers superior postoperative recovery and fewer wound-related complications compared to open appendectomy. It may be considered the preferred approach in most cases of uncomplicated appendicitis, subject to surgeon expertise and patient condition.

Introduction: Inguinal hernia repair is among the most frequently performed general surgical procedures worldwide. The evolution from traditional tissue-based (non-mesh) techniques to mesh-based (tension-free) repairs has significantly influenced recurrence rates and postoperative recovery. Despite this, non-mesh repairs continue to be practiced in selected patients and specific clinical contexts, necessitating a comparative evaluation of outcomes. Methods: This prospective comparative study included 60 patients aged 18–70 years with uncomplicated primary inguinal hernia, who consented to participate. Patients with recurrent or complicated hernias, or those unfit for surgery due to significant comorbidities, were excluded. Participants were randomly allocated into two equal groups of 30 each: Group A underwent mesh repair using the Lichtenstein tension-free hernioplasty technique, while Group B underwent non-mesh repair using either the modified Bassini or Shouldice technique. Results: In this study of 60 patients equally divided into mesh and non-mesh inguinal hernia repair groups, baseline characteristics such as age, sex distribution, BMI, laterality of hernia, and comorbidities were comparable between the groups, with no significant differences. The mean duration of surgery was significantly longer in the mesh group (65.2 ± 8.5 minutes vs. 55.7 ± 9.1 minutes; p<0.001), though intraoperative blood loss and conversion rates were similar. Postoperative pain scores (VAS) were significantly lower in the mesh group at 6 and 24 hours, but comparable by the seventh day. Both groups had low and similar rates of complications, including wound infection, seroma, chronic pain, and recurrence, though recurrence was observed only in the non-mesh group (10%, p=0.075). Importantly, the mesh group had a shorter hospital stay (2.6 ± 0.7 vs. 3.4 ± 1.1 days; p<0.001) and returned to daily activities sooner (12.8 ± 3.2 vs. 16.3 ± 4.5 days; p<0.001), suggesting better short-term recovery outcomes. Conclusion: Mesh repair provides better short-term and long-term outcomes, with reduced postoperative pain, quicker recovery, and lower recurrence compared to non-mesh repair. These findings reaffirm mesh-based repair as the preferred technique in inguinal hernia surgery while acknowledging that non-mesh repairs remain relevant in selected patient populations.

Background: Long-acting reversible contraceptives such as the copper-bearing intra-uterine device (CuT 380A) and depot-medroxyprogesterone acetate (DMPA) injection are programme priorities in India, yet concerns about safety and menstrual side-effects limit uptake and continuation. Methods: We conducted a single-centre, open-label prospective cohort study in a tertiary care hospital, recruiting healthy parous women aged 18–40 years who chose CuT 380A (n = 100) or DMPA 150 mg IM q12 weeks (n = 100). Participants were followed at months 1, 3, 6, 9 and 12. Primary outcomes were cumulative adverse events (AEs) and evolution of World Health Organization (WHO) bleeding patterns. Secondary outcomes included discontinuation, weight change and haemoglobin. Data were analysed with χ², t-tests and Kaplan-Meier survival; p < 0.05 was significant. Results: Baseline characteristics were similar (mean age 25.8 ± 4.2 y; mean parity 1.9 ± 0.7). At 12 months the cumulative AE rate was 18.0 % for CuT vs 30.0 % for DMPA (RR 0.60, 95 % CI 0.36–0.98). Heavy/prolonged bleeding was the commonest AE with CuT (12 %), whereas amenorrhoea (27 %) and ≥ 2 kg weight-gain (24 %) predominated with DMPA. Mean haemoglobin fell by 0.4 g/dL in CuT users but rose by 0.2 g/dL in DMPA users (p = 0.03). Continuation at 12 months was 88.0 % for CuT versus 74.0 % for DMPA (log-rank p = 0.01). Conclusion: Both methods were broadly safe, but CuT 380A was associated with fewer systemic AEs and higher 12-month continuation, while DMPA produced predictable amenorrhoea in one-quarter of users. Tailored counselling on bleeding expectations and weight management could enhance satisfaction and reduce early discontinuation.

Background: Post-spinal hypotension (PSH) in older adults is common and may precipitate myocardial or cerebral hypoperfusion. Multiple prophylactic strategies exist; however, direct head-to-head comparisons between sympathomimetic, 5-HT₃–antagonist and glucocorticoid regimens remain scant. Methods: In this prospective, parallel-group randomised study, 180 ASA I–III patients ≥ 65 y scheduled for infra umbilical surgery under single-shot spinal anaesthesia were allocated (computer sequence, sealed envelopes) to receive either intramuscular (IM) ephedrine 25 mg (Group E), intravenous (IV) ondansetron 8 mg (Group O) or IV dexamethasone 8 mg (Group D) immediately before neuraxial block. The primary outcome was incidence of PSH—defined as systolic blood pressure (SBP) <90 mmHg or >20% fall from baseline within 30 min. Secondary outcomes included serial mean arterial pressure (MAP), vasopressor rescue, adverse events and length of stay. Results: Baseline characteristics were comparable. PSH occurred in 8/40 (20%) patients in Group E, 13/40 (32.5%) in Group O and 18/40 (45%) in Group D (p = 0.03). Group E maintained significantly higher MAP throughout the initial 15 min (Figure 1). Total rescue ephedrine requirement was lowest in Group E (median 0 mg) versus Groups O (5 mg) and D (25 mg; p < 0.001). Nausea was reduced in Groups O and D compared with E, whereas tremor was noted only with ephedrine (Table 4). No patient developed serious arrhythmia or postoperative cognitive dysfunction. Conclusion: Prophylactic IM ephedrine provides superior haemodynamic stability compared with IV ondansetron or dexamethasone in geriatric patients undergoing spinal anaesthesia, at the expense of mild adrenergic-related tremor. Ondansetron offers intermediate protection and additional antiemetic benefit. Dexamethasone alone is least effective for PSH prevention.

Background: Monochorionic (MC) twin pregnancies account for only ≈0.3 % of all births but contribute disproportionately to perinatal morbidity and mortality because the twins share a single placenta with inter-twin vascular anastomoses. Evidence-based protocols for intensive surveillance and timely fetal therapy have evolved, yet real-world outcome data from low- and middle-income tertiary settings remain sparse. Methods: We performed a retrospective cohort study of all MC twin pregnancies delivered at a tertiary care teaching hospital. A dedicated multidisciplinary database captured maternal demographics, antenatal surveillance, fetal interventions, delivery details, and neonatal outcomes through discharge. Primary outcomes were (i) “at least one neonatal survivor” and (ii) composite severe neonatal morbidity. Multivariable logistic regression identified independent predictors. Results: Among 120 MC twin gestations, mean maternal age was 29.4 ± 4.8 years; 15% were conceived by assisted reproduction (Table 1). Intensive fortnightly ultrasound with Doppler commenced at a median 13 weeks. Major antenatal complications comprised selective fetal growth restriction (sFGR) in 18%, twin-twin transfusion syndrome (TTTS) in 12%, and twin anaemia-polycythaemia sequence (TAPS) in 5% (Table 2, Figure 2). Fetoscopic laser photocoagulation was undertaken in 12 cases and associated with 83% dual-twin survival. Mean gestational age at delivery was 34.2 ± 2.5 weeks (Figure 1); 72% received antenatal corticosteroids. Overall, 88% were liveborn twin pairs and 93% had at least one survivor (Table 3). Composite severe morbidity occurred in 22% and was independently predicted by delivery < 32 weeks (aOR 4.96, p < 0.001) and sFGR (aOR 2.35, p = 0.028), whereas antenatal steroids were protective (Table 4). Conclusion: Structured surveillance combined with in-utero therapy in a resource-constrained tertiary hospital yielded neonatal survival comparable to high-income benchmarks. Preventing extreme prematurity and optimising management of sFGR remain the key modifiable targets.

Background: When it comes to cervical lymph node metastases from an unknown primary (CUP) in the head and neck, we face a unique set of challenges in both diagnosis and treatment. Even with the strides we’ve made in imaging and treatment options, figuring out the best way to manage these cases is still a hot topic of discussion. This review pulls together the latest evidence on how we diagnose and treat CUP. Methods: To gather information, we conducted a thorough literature search following PRISMA guidelines, which led us to 52 studies involving 4,253 patients with confirmed cervical metastases from an unknown primary source. We extracted and analyzed data on diagnostic effectiveness, treatment methods, and patient outcomes. We also looked into how survival rates and side effects varied across different treatment options. Result: Our findings showed that FDG-PET/CT had a primary tumor detection rate of 52%, which jumped to 65% when paired with directed panendoscopy. Patients who underwent surgical management followed by adjuvant chemoradiotherapy had the best 5-year overall survival rate at 68% and locoregional control at 74%, though this came with a higher incidence of grade ≥2 late toxicity at 35%. On the other hand, radiotherapy alone resulted in lower survival rates at 52% but had less toxicity. When we compared these results to historical data, we saw notable improvements in both diagnostic yield and survival. Conclusion: Recent advancements in imaging and combined therapies have significantly enhanced the diagnostic precision and clinical outcomes for patients with cervical CUP. While the combination of treatments offers the best chance for controlling the disease, it also brings a greater risk of side effects. Tailoring management strategies based on imaging results and risk assessment is crucial. Moving forward, more prospective studies are needed to fine-tune treatment choices and incorporate new biomarkers.

Purpose:  To Study of sociodemographic profile, pattern & present trends in drowning in the Dibrugarh region. Methods: Present study was done in a retrospective manner the at the department of Forensic medicine, Assam medical College & hospital, Dibrugarh, Assam for a period of two years from January 2023 to December 2024. A total of 3623 numbers of post-mortem examinations was done during these periods out of which 390 cases were found to be drowning death. Results: A total of 390 (10.7%) drowning deaths were reported, with 265 (67.94%) being male and 125 (32.05%) being female. The age range of 20–30 years had the highest number of casualties, with 88 (22.56%) cases. Minor injuries are found in 88 cases and major 56 cases. Most common place of occurrence in drowning are river followed by ponds and lakes because of fishing and other marketing purpose. Most of the drowning bodies are decomposed 88 cases found after 7 days of death. Conclusion: Accidental drowning is identified as the primary cause of these incidents, reinforcing the need for preventive measures and safety initiatives in high-risk locations like near rivers and lakes for fishing.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern requiring long-term pharmacological management. Polypharmacy is common in COPD treatment but may increase the risk of adverse drug reactions (ADRs), especially in elderly and comorbid patients. Objective: To evaluate the association between polypharmacy and the incidence of ADRs in COPD patients attending a tertiary care teaching hospital in Western India. Methods: This was a prospective, observational study conducted over 12 months in the outpatient department of a tertiary care hospital. A total of 260 clinically diagnosed COPD patients were included. Polypharmacy was defined as the concurrent use of five or more medications. ADRs were recorded, assessed using the WHO-UMC causality scale, and analyzed in relation to the number of drugs prescribed. Results: Polypharmacy was observed in 71.15% of patients. ADRs occurred in 25% of patients, with a significantly higher incidence in the polypharmacy group (29.19%) compared to the non-polypharmacy group (14.67%). A clear increasing trend of ADR incidence was noted with the number of medications prescribed. The most common ADRs were dry mouth, tremors, and nausea. Most reactions were classified as probable or possible. Conclusion: Polypharmacy is strongly associated with an increased risk of ADRs in COPD patients. Rational prescribing, regular medication review, and adherence to treatment guidelines are essential to reduce drug-related harm and improve patient outcomes.

Background: Caesarean scar pregnancy (CSP) is a rare and potentially life-threatening form of ectopic pregnancy, where the gestational sac implants within the myometrial tissue of a previous cesarean section scar. With rising cesarean delivery rates and improved imaging techniques, the detection of CSP has increased. Prompt diagnosis and appropriate intervention are critical to avoid complications such as uterine rupture, hemorrhage, and potential loss of fertility. Case Presentation: We report a case of a 38-year-old woman with a history of one cesarean delivery and one abortion, who presented with 3 months of amenorrhea, abdominal pain, and intermittent vaginal bleeding. Transvaginal ultrasound revealed a heterogeneous lesion at the lower uterine segment in anterior aspect near the cesarean scar, with severe anterior myometrial thinning. Colour Doppler study showed increased peripheral vascularity. MRI further confirmed a solid-cystic lesion infiltrating the anterior uterine wall and extending toward the bladder, raising suspicion of failed cesarean scar ectopic pregnancy. Surgical management involved suction and evacuation followed by exploratory laparotomy, wedge resection, and scar repair. Histopathology confirmed retained products of conception. Postoperative recovery was uneventful, with restoration of normal myometrial thickness at follow-up. Conclusion: This case highlights the importance of early diagnosis of CSP through advanced imaging modalities such as transvaginal ultrasound and MRI. Accurate characterization and multidisciplinary management are essential for optimal outcomes, preserving fertility and minimizing maternal morbidity.

Background: Cervical cancer remains a leading cause of mortality in low- and middle-income nations despite global screening efforts. While cytology and HPV testing can triage women, definitive diagnosis of epithelial lesions still relies on colposcopy-directed biopsy. Data on the diagnostic yield of colposcopy in women with a clinically “unhealthy” cervix are heterogeneous, with reported sensitivity ranging 56 – 93%. Methods: In this single-centre prospective study, 300 sexually active women aged ≥ 21 years presenting to the gynaecology outpatient clinic with clinically unhealthy cervix (persistent discharge, erosion, growth, or bleeding on touch) underwent standardised colposcopic examination using Reid Colposcopic Index (RCI). Directed biopsies were obtained from abnormal areas; random four-quadrant punch biopsies were added when impressions were normal. Histopathology was the reference standard for cervical intra-epithelial neoplasia grade 2 or worse (CIN2+). Diagnostic performance indices with 95% confidence intervals (CI) were calculated. Results: Mean age was 38 ± 9 years. Colposcopy was normal in 120 (40%), inflammatory in 60 (20%), low-grade (LSIL) in 55 (18.3%), high-grade (HSIL) in 50 (16.7%) and suggestive of invasive cancer in 15 (5%). CIN2+ was confirmed histologically in 90 (30%) cases. Colposcopy showed sensitivity 88.9% (80/90; 95% CI 80.3-94.4), specificity 90.5% (190/210; 95% CI 85.4-94.2) and area-under-curve (AUC) 0.91 (Figure 2). Agreement between colposcopic impression and histology was substantial (κ = 0.79). Conclusion: Colposcopy, when performed systematically with RCI, demonstrates high accuracy for detecting CIN2+ in women with unhealthy cervix and can safely guide biopsy in resource-constrained settings.

Aim and Objective: Assessment of comparison of different surgical procedures adopted as a surgical care of chronic pancreatitis. Materials and Methods: 60 (sixty) patients for total 18 months duration from 15/12/22 to 15/6/24 had been taken for the present study. One year post-operative follow up has been considered so far. Patients admitted in Gauhati Medical College & Hospital Surgery Dept. with clinical, bio-chemical, pathological and radiological features of chronic pancreatitis. Inclusion Criteria: Patients with clinical, bio-chemical, pathological and radiological evidence of chronic pancreatitis were included. Exclusion Criteria: Patient with definite evidence of malignancy and patient who had refused to give consent. A detailed and thorough history of all patients in this present study were taken. Diagnosis of CP were justified by relevant investigations which had included laboratory, radiological and endoscopy. In this study different surgical procedures were undertaken. Results: 93% had history of alcohol intake. 53% had weight loss, 93% had lost of quality of life.28% patient showed head mass. LPJ procedure was found to be the procedure of choice if no head mass. But Frey’s is said to be acceptable in CP with head mass. Head mass which are in doubt of malignancy may be undertaken Whipple procedure. Pain relief is more than 90% all though out with dramatic improvement of QOL was achieved after surgical procedure. Conclusions: CP was considered a benign, irreversible and progressive disease. Surgery is said to be standard of care. Every surgical procedure has found to have merits and demerits. No surgery can able to cure CP completely. Puestow procedure (LPJ) is the excellent procedure in controlling pain in non-bulky head. Resection and drainage (hybrid) procedure (Frey’s) gives much benefit when there is head mass. Quality of life found to be improved.

Introduction: Rapid advancement in medical science has revolutionized the treatment protocol for HIV/AIDS in the very recent past. Identifying those with adherence-related challenges and implementing appropriate strategies to enhance adherence are essential. Objectives: In this study the objective was to find out the effects of behavioral factors in ART adherence amongst the patients attending the ART Centre of Assam Medical College and Hospital. Materials and Methods: A Hospital based prospective study was conducted at the Anti-Retroviral Therapy (ART) Centre of Assam Medical College on 150 People Living with HIV (PLHIV) on ART. Results: Among the study participants majority (82.67%) took their medications regularly in the course of 6 months of follow up in the study whereas 17.33% reported missing pills sometime in their follow up period. Out of the study participants who had alcohol history 24.6% did not take pills regularly while 22.6% of participants with smoking history were not regular in their pill intake. The study participants who were very happy with the support of their family, 90% took pills regularly. Conclusion: Societal factors play a major role in adherence as majority of those who disclosed their HIV status and happy with the support they received from them had better adherence. Training of partners and/or families on supporting adherence will greatly contribute in boosting the morale of the diseased counterpart.

Background: Oral Submucous Fibrosis (OSMF) is a chronic, progressive precancerous oral mucosal disorder, most of which is linked with the habit of chewing areca nut, tobacco, and similar substances. It is marked by stiffness of the mucosa and limitation of mouth opening and has a great potential for malignant transformation into oral cancer. Objective: The current study investigates an integrative treatment method that fuses Ayurvedic therapies, Dental Science, and contemporary medical practices for the successful treatment of OSMF and oral cancer prevention. Methods: The intervention protocol consisted of contemporary modalities like OLI therapy (intralesional injections and diode laser) and guided physiotherapeutic exercises for mouth opening, along with dietary supplements. It was supplemented with Ayurvedic intervention in the form of Gandusha (oil pulling), Kavala (Herbal Gargle), Pratisarana (herbal local application), Mukh Yoga, Mukha Abhyang, Dhoompan, Dantadhavana and herbal preparations directed towards decreasing fibrosis and inflammation. Patient outcomes were measured in terms of improvement in mouth opening, relief in symptoms, and quality of life. Results: Considerable improvement was noted in mouth opening and symptom alleviation following the integrative treatment. Comparative analysis showed superior efficacy over individual modalities. Ayurvedic therapies were seen to offer synergistic effects when combined with conventional interventions, leading to decreased fibrosis, improved mucosal flexibility, and enhanced patient compliance. Conclusion: An integrated treatment procedure integrating Ayurvedic and conventional therapies shows better results in controlling OSMF and inhibiting its progression to oral cancer. Early detection, lifestyle changes, and long-term home-based therapy also add further strength to the effectiveness of this holistic treatment plan.

Background: Isthmocele, also known as cesarean scar defect, is a myometrial discontinuity at the site of a previous cesarean section, with potential implications for gynecologic and obstetric morbidity. With increasing cesarean rates globally and in India, the prevalence of isthmocele is expected to rise, yet its risk factors remain under-investigated in the Indian population. Aim: To evaluate the prevalence and associated risk factors of isthmocele formation following cesarean section. Materials and Methods: This was a hospital-based prospective cohort study conducted in the Department of Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad. A total of 69 women undergoing cesarean delivery were included after informed consent and followed up at 6 weeks and 6 months postoperatively using transvaginal ultrasound (TVUS) to detect isthmocele. Variables such as uterine position, suture technique, and duration of labor, cervical dilatation, and obstetric history were evaluated for associations. Results: At 6 weeks, 13% of women had detectable isthmocele, which decreased to 7.7% at 6 months. Retroverted uterus, single-layer uterine closure, and lower socioeconomic status showed a higher incidence, though most risk factors did not reach statistical significance. TVUS proved useful in identifying isthmocele in the early postpartum period. Conclusion: The study highlights a notable prevalence of isthmocele in early post-cesarean follow-up. Though most associations were not statistically significant, trends suggest that surgical technique and uterine orientation may influence isthmocele development. Greater attention to closure techniques and uterine positioning could help reduce isthmocele formation.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality, with both pulmonary and systemic components. The BODE index, a multidimensional tool incorporating BMI, airflow obstruction, dyspnea, and exercise capacity, and serum fibrinogen, a marker of systemic inflammation, have been proposed as comprehensive indicators of disease severity. Objective: To assess the BODE index and serum fibrinogen levels in stable COPD patients and analyze their correlation with spirometric parameters. Methods: A cross-sectional observational study was conducted at Santosh Medical College & Hospital, including 101 stable COPD patients diagnosed per GOLD criteria. BMI, mMRC dyspnea scale, spirometry (FEV1, FVC), 6-minute walk distance (6MWD), and serum fibrinogen were recorded. BODE index scores were calculated, and data analyzed for correlation. Results: The study population had a mean age of 55.25 ± 7.74 years, predominantly male (62%). Distribution by GOLD stage: Grade 1 (38.61%), Grade 2 (39.60%), and Grade 3 (21.78%). BODE index quartiles: 0–2 (22.77%), 3–4 (31.68%), 5–6 (34.65%), 7–10 (10.89%). Fibrinogen levels showed a non-significant trend across BODE grades (p=0.282), and FEV1 decreased with increasing BODE score. mMRC and GOLD staging were significantly associated with BODE quartiles (p<0.005). Conclusion: The BODE index correlates well with spirometric staging and dyspnea scores, reinforcing its prognostic utility. While serum fibrinogen trends upward with increasing disease severity, the relationship was not statistically significant, suggesting the need for larger cohort studies.

Background: Basifrontal contusions, often resulting from high-velocity trauma, present a unique challenge due to their proximity to critical neurovascular structures and their tendency for silent progression. The absence of overt clinical signs can lead to delayed recognition and deterioration. In settings where intracranial pressure (ICP) monitoring is unavailable, structured imaging-based protocols are essential. This study evaluates the outcomes of patients managed using the CREVICE protocol. Objective: To analyze the management strategies and clinical outcomes in 125 patients with isolated basifrontal contusions, stratified according to the CREVICE protocol, and compare surgical versus conservative approaches. Methods: A retrospective observational study was conducted at MGMGH, KAPV Govt Medical College, Trichy, from January 2023 to January 2024. 125 patients with CT-confirmed isolated basifrontal contusions were included. Patients were stratified based on CREVICE protocol into major and minor criteria groups for initiating intervention. Outcome measures included mortality, functional status (GOS), hospital stay duration, and need for surgical escalation. Results: Of the 125 patients, 72 (57.6%) had bilateral contusions and 53 (42.4%) had unilateral lesions. Early surgery was performed in 31 patients (24.8%) meeting major CREVICE criteria, and delayed surgery in 38 (30.4%) due to neuro worsening or radiological progression. Conservative management succeeded in 56 patients (44.8%) with minor criteria. The mortality rate was 16%, predominantly in bilateral lesions. Good functional outcomes (GOS 4–5) were seen in 64.8% of cases. Patients with contusions of 20–35 cm³ and borderline GCS (9–13) had improved outcomes when managed proactively. Conclusion: Basifrontal contusions, due to their silent course and deep anatomical location, require vigilant monitoring and structured decision-making. The CREVICE protocol enables timely identification of high-risk patients and facilitates intervention even in resource-limited settings without ICP monitoring. Early surgical intervention based on protocol criteria significantly improves outcomes in moderate-volume lesions.

Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection which results in gas within the renal parenchyma, collecting system, or perinephric tissue. A majority of cases occur in patients with diabetes mellitus (DM). In EPN, early aggressive medical treatment may avoid nephrectomy. Aims: The aim of this study was to analyze the characteristics of patients with EPN with respect to patient clinical presentation, diagnostic investigations, microbiological findings, treatment modality and outcome, and the influence of prognostic factors on the outcome. Materials and Methods: We reviewed the hospital records of 20 patients with EPN for clinical, laboratory, radiological, and microbiological findings, treatments given, and outcome. The severity of EPN was graded as per the Huang classification. We applied the reported prognostic factors to our patients to find out whether these factors correlated with failure of conservative treatment. Results: Most of the study subjects had DM and all but five of them were females. Escherichia coli was the most common causative organism involved in 30% of our cases. Twelve (60%) of our patients responded to conservative treatment, eight required stenting, and none expired on conservative treatment. Conclusions: In this series of patients with EPN, nearly all had DM, nearly all were women, and E.coli was the most frequently isolated pathogen. Nearly a third of our patients had bilateral disease. In a majority of our patients, conservative treatment afforded a striking success rate of 60%. We recommend early aggressive medical treatment and suggest that nephrectomy should be considered only if patients deteriorate or do not improve on conservative treatment.

Divergent usage of smart phone devices for uninterrupted connectivity has numerous advantages and unprecedented challenges, leading to the physiological foundation of emotional health diseases. Early researches have delved into multi-varied prospects of techno-gadget affinity, however limited research has been incorporated to compare the dependency of techno-addiction to the emotional health, identified by physical symptoms. Comprehended attention needs to be given to artifacts including anxiety, depression, stress, self-esteem, metabolism on its influences by screen time in various age groups. Our previous research paradigm has further motivated us to probe into the relatedness and impact of features. This research study was conducted on the medical diagnostic survey of OPD patients to evaluate the co-morbidities when inhibited by Techno-addiction as a resultant of excessive usage of social media and gaming across age and gender groups and the consequent effect leading to a predictive risk-based model through empirical evidence. A thorough history-collection method was improvised for medical diagnostics by recordings captured through pulse-oximetry, electroencephalogram (EEG), electrocardiogram (ECG) and audiometer. Informative and engrossing results were obtained by clinical examinations of 640 OPD patients which was analyzed statistically to portray a vivid comprehension of the interplay between resulting mental problems brought on by excessive technology usage and tech-timing- such as headaches, palpitations, social anxiety, insomnia, phobia, depressive symptoms, and hearing-vision quandary. This study also predicatively analyses the risk aggravations in already existing ailments amongst the control group with likeliness of associated with Techno-addiction (TA). Physiological factors have been correlated with dimensions of emotional health in our research, which empirically suggests that extreme addiction to Tech-devices severely affects the arousal-valence-dominance model towards negative mental health symptoms. Thus, this work enables the various segments of respondents to become critical of excessive screen timing and has the potential for future longitudinal studies keeping into consideration various geographical and economic social world and treatment targets. The findings of our work exhibit that digital dementia is a forerunner of numerous mental health issues with critical impact in incremental insomnia, headache, palpitation, social phobia and depression. The authors have also analytically modelled that amongst patients affected by similar ailments, the cognitive risk factors accustomed to long screen time would intensify with adverse effects. Furthermore, this work confirms the significance of influence of over usage of digital gadgets as central modulator of cerebral-vascular regulation and emotional wellness dynamics over various age limits and with gender classification.

Background: Chronic myeloid leukemia in chronic phase (CML-CP) is characterized by the BCR-ABL1 fusion oncogene, which results from the t (9;22) (q34; q11.2) translocation. Tyrosine kinase inhibitors (TKIs) have revolutionized the management of CML-CP, but resistance often due to BCR-ABL1 kinase domain (KD) mutations remains a major therapeutic challenge. Objectives: This study aimed to assess the prevalence and mutation spectrum of BCR-ABL1 KD mutations in patients with TKI-resistant or suboptimal response CML-CP at a tertiary care centre in Northeast India, and to evaluate mutation-directed treatment strategies. Methods: CML-CP patients exhibiting treatment failure or suboptimal response to first-line or second-line TKIs were included. BCR-ABL1 KD mutation analysis was conducted using Sanger sequencing and Next Generation Sequencing (NGS), depending on clinical indication. Clinical correlation with treatment history and mutation pattern was analyzed. Results: BCR-ABL1 KD mutations were detected in a substantial proportion of patients with TKI resistance. The T315I mutation was the most commonly observed, conferring resistance to imatinib, nilotinib, and dasatinib. The spectrum of mutations varied with prior TKI exposure. NGS allowed for early detection of low-level mutations in patients with evolving resistance. Therapeutic interventions included switching to second- or third-generation TKIs or considering allogeneic stem cell transplantation in cases of multi-drug resistance. Conclusion: BCR-ABL1 kinase domain mutations play a critical role in TKI resistance among CML-CP patients. Timely mutation analysis, particularly via sensitive techniques such as NGS, is essential for guiding individualized treatment. Mutation-adapted therapy improves clinical outcomes and should be incorporated into routine management protocols for TKI-resistant CML.

Background: Necrotizing fasciitis (NF) is a rapidly progressing and life-threatening soft tissue infection requiring early diagnosis and prompt surgical intervention. Clinical diagnosis in early stages is challenging due to its nonspecific presentation, often mimicking other soft tissue infections (STIs). The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed to assist in early identification, but its limitations have led to the proposal of modified versions incorporating additional parameters such as serum lactate. Aim: To evaluate the diagnostic and prognostic effectiveness of the original and modified LRINEC scoring systems, including serum lactate, in distinguishing NF from other STIs. Methodology: A prospective observational study was conducted on 100 patients presenting with NF or other STIs at SVRRGGH, Tirupati, between March 2021 and November 2023. Laboratory parameters, LRINEC scores, comorbidities, clinical outcomes, and serum lactate levels were analyzed. Results: The study included 40 NF and 60 STI patients. NF patients had significantly higher CRP levels (>150 mg/L in 90% vs. 5%), elevated lactate (>18 mg/dL in 85% vs. 5%), and higher LRINEC scores (>8 in 57.5% vs. 1.6%). Comorbidities such as diabetes (35% vs. 18.3%) and peripheral vascular disease (25% vs. 6.6%) were more common in NF patients. ICU and hospital stays were significantly longer in NF patients. Serum lactate emerged as a strong predictor of NF and correlated with in-hospital mortality. Conclusion: The modified LRINEC score, incorporating serum lactate, offers superior diagnostic and prognostic accuracy for NF. Early application may enhance clinical decision-making, allowing timely surgical intervention and reducing mortality.

Background: The clinical estimate of the incidence of a solitary thyroid nodule is slightly higher than the actual incidence. Clinically indiscernible nodules are often found when the same gland is examined by ultrasonography, CT, or MRI, or when it is exposed after surgery. Fine-needle aspiration (FNa) biopsy is currently the most accurate diagnostic for determining the presence of cancer in thyroid nodules. Better outcomes are obtained with Fine Needle aspiration when done under ultrasonography supervision. Radionuclide scanning has been the gold standard for assessing solitary nodule thyroid since 1939, when Hamilton and Soley demonstrated that the malignant thyroid tissue contained less radioactive iodine than the normal thyroid tissue. Aim: To study the incidence of malignancy in solitary thyroid nodule and multinodular goitre. Methodology: A prospective quantitative study done in 100 patients with nodular goitre admitted in Department of General Surgery, GGH, Guntur for 21 months from October 2022 to June 2024 by Convenience sampling technique. Results and Conclusion: The mean age for STN thyroid disorders is 34.5 and for MNG is 44.5 years. Though thyroid disorders are common in females most male thyroid disorders are associated with malignancy. Family history is a major risk factor in development of thyroid disorders. Incidence of malignancy in STN 16% and in MNG is 2% with their comparison study showing highly significant p-value of 0.0183.

Background: Cystoid macular oedema (CME) is a common subclinical complication following cataract surgery, even when performed without intraoperative complications. The emergence of optical coherence tomography (OCT) has enabled objective measurement of macular thickness changes postoperatively.
Objective: To compare macular thickness changes using spectral-domain OCT in patients undergoing uncomplicated manual small incision cataract surgery (SICS) versus phacoemulsification. Methods: This prospective observational study enrolled 130 patients aged 45–65 years undergoing cataract surgery at a tertiary care hospital. Patients were divided into two groups: Group A (n=65) underwent manual SICS, and Group B (n=65) underwent phacoemulsification. Macular thickness was measured using OCT preoperatively, and postoperatively at the 1st, 3rd, and 5th week. Visual acuity was assessed at each interval. Results: Both groups showed a statistically significant increase in macular thickness postoperatively. Mean macular thickness in Group A increased from 224.28 ± 10.10 µm preoperatively to 232.27 ± 16.78 µm at 5 weeks (p<0.01). In Group B, it increased from 224.60 ± 12.05 µm to 228.11 ± 11.94 µm (p<0.01). However, between-group differences were not statistically significant (p>0.05). Visual recovery was satisfactory in both groups, with slightly better outcomes observed in the phacoemulsification group. Conclusion: Both manual SICS and phacoemulsification cause a transient increase in macular thickness postoperatively, with a slightly higher trend in SICS. These subclinical changes were not associated with visual deterioration. OCT proves to be an essential tool for postoperative retinal monitoring.

Background: Chronic subjective tinnitus is a prevalent auditory symptom, often debilitating due to its subjective nature and the absence of a universal cure. The study aimed to evaluate the clinical, audiological and psychological profiles of patients with chronic subjective tinnitus with the objective of exploring correlations between tinnitus severity, audiological findings and psychological distress at a tertiary care hospital. Methodology: A prospective observational study was conducted for a period of 18 months. A total of 100 patients with chronic subjective tinnitus participated. Following a thorough clinical history, audiometry and psychological assessments (Tinnitus Handicap Inventory, Pittsburgh Sleep Quality Index) were done. Data was analyzed using descriptive statistics, Chi-square tests and paired t-tests. Results: The majority of participants (61%) had tinnitus for less than a year. Sensorineural hearing loss was the most common audiological finding affecting over 60% of participants. Tinnitus severity correlated with psychological distress, with 32% reporting a moderate handicap. Sleep disturbances were common with 97% experiencing sleep difficulties and the most common etiologies were sensorineural hearing loss (22%) and presbycusis (18%). Conclusion: Chronic subjective tinnitus is multifactorial with significant audiological and psychological impacts. Early detection and a holistic approach, combining audiological and psychological interventions are crucial for improving patient outcomes.

Background: Substance abuse among the adolescents is a global health concern and is increasing at an alarming pace in both developed and developing countries. Tea is one of the largest agricultural industries in India. There are reports of increased tobacco and alcohol related deaths in the people residing in tea garden areas of India. Due to poor parental supervision and increased prevalence of substance abuse among the adults, the adolescents residing in the tea garden areas are at increased risk of substance abuse. The objectives of the study were to study the prevalence, pattern and the factors associated with substance abuse among the adolescents residing in the tea garden areas of Cachar, Assam. Materials and Methods: A cross-sectional study was carried out among 360 adolescents residing in the tea garden areas of Cachar, Assam. There are about 56 tea gardens in Cachar district, out of which 4 tea gardens were selected at random and the sample size was proportionately allocated among them. A pre-designed, pre-tested proforma was used to interview the study participants. Results: In the present study, the prevalence of substance abuse among the adolescents was 28.9%. Most of study participants (46.4%) belonged to lower middle class and only 1.6% were from upper class. Among those who were substance abusers, most (21.1%) were using smokeless form of tobacco. Among the substance abusers most (35.6%) were using it once a month and only 4.8% were using it more than once a day. A statistically significant association was observed between sex of the study participants and prevalence of substance abuse. Similar association was observed between age of the study participants and substance abuse. Peer pressure (30.8%) was the most common reason for starting substance abuse. Conclusion: The prevalence of substance abuse among the adolescents was quite high in the given study. Awareness programs targeting the adolescents along with the parents, teachers and peer groups about the harmful effects of substance abuse should be initiated. Health education on substance abuse imparted through school curriculum can prove to be helpful in prevention.

Background: Delay in diagnosis and treatment of tuberculosis can enhance the transmission of infection, worsen the disease, increase economic burden, and increase mortality. Objectives: To explore the extent of delay in diagnosis of tuberculosis and to estimate the out-of-pocket expenditure incurred by tuberculosis patients during the intensive phase of treatment. To find out the factors associated with diagnostic delays and out-of-pocket expenditure. Methodology: A community-based cross-sectional study was conducted among tuberculosis patients in nine Tuberculosis Units of Central Chennai from Jan to Sep 2021. About 190 tuberculosis patients who had completed the intensive phase of treatment were selected by multistage random sampling and interviewed using a semi-structured questionnaire. Chi-square test was used to study the association between sociodemographic factors, diagnostic delay, and out-of-pocket expenditure. Results: Nearly 85% of participants had cough as predominant symptom and 62% initially consulted a private health facility. About two-third (68%) were diagnosed during the third visit and 69% had diagnostic delay of more than 15 days. Total cost spent for diagnosis and treatment during the intensive phase was Rs. 7,450, with 24% experiencing catastrophic costs. Those who initially consulted private health facility were significantly associated with diagnostic delay and out-of-pocket expenditure. Conclusion: Though diagnostic delay reported in this study was comparatively lower, both patients and health providers had a role in diagnostic delays. Interventions to increase awareness about tuberculosis and to increase the suspicion of the disease in patients with chest symptoms by private health providers may reduce diagnostic delay and out-of-pocket expenditure.

Background: Music is composed of frequencies, tone, rhythm, beats and lyrics. It is a complex signal that stimulates the human body at various tiers, such signals may cause emotional changes which result in an increase or decrease in sympathetic or parasympathetic activity of the cardiac autonomic nervous system. Aims: To study the effect Music on Blood Pressure and Heart Rate. Material & Method: Medical students aged 17 to 20 years are randomly divided into music intervention group and control group according to the inclusion criteria. Intervention group are subjected to classical western music for 10 minutes respectively.  The Blood pressure and Heart rate of subject is measured at rest, immediately after exposure, 5 minutes after exposure, 15 minutes after exposure and 30 minutes after exposure. Result: The parasympathetic dominance is seen in various parameters with exposure to respective intervention. In our study the Blood pressure and Heart rate decreased after Music therapy [Classical western music].

Sterile fluid for culture and antibiotic sensitivity are of utmost important since they do not harbour any microorganisms. The detection of even a single microorganism indicates life-threatening infections which in turn, may lead to longer stay in the hospital paving way for the development of multidrug resistant pathogen. Aim: The present study aims in the identification of bacterial pathogens from aseptic body fluids and estimation of their antimicrobial susceptibility. Material & Methods: The samples for this study were collected between January 2022 and August 2023. Our sample size was 440 specimens. The aseptic fluids were collected from the patients by convenient sampling technique and were sent to the Microbiology lab for culture & sensitivity. Conventional diagnostic methods were used for the bacterial identification. Antibiotic susceptibility pattern of the isolates was determined by Kirby Bauer disk diffusion method and was interpreted based on the Clinical and Laboratory Standard Institute guidelines (CLSI) 2022. Results: A total of 440 samples were received, out of which 110 showed positive culture reports. The majority of the isolates were gram negative bacteria (74.5%) and gram positive organisms accounted for 25.5%.In our study the predominant organisms isolated from sterile fluids were Escherichia coli 22.7%(25/110), Klebsiella pneumoniae 22.7% (25/110), Acinetobacter species 11.81% (13/110),  Staphylococcus aureus 13.63% (15/110),Pseudomonas aeruginosa 17.27% (19/110).All gram negative were sensitive to carbapenem except for Pseudomonas which showed 94% sensitivity.35% were MRSA but all were sensitive to Vancomycin and Linezolid. Hence, the antibiotic policy can be formulated from the prevalence and antibiotic sensitivity pattern for the rational use of antibiotics.

Objectives:  The present study was to compare the open versus laparoscopic rives stoppa mesh placement in uncomplicated ventral hernias and to find out the recurrence and post operative complications. Methods: All patients who admitted in surgery wards were categorized into 2 groups depending on the type of surgery they were received. Group A – Open Rives Stoppa repair, Group B – Laparoscopic or endoscopic Totally Extra Peritoneal Rives Stoppa. Then the postoperative data on pain, seroma formation, drain or no drain, wound infection and recurrence were analyzed. Patients were followed up on 7^th  day, 1 month and 3 months and 6 months. Results:  The mean age was similar—47.80 ± 9.81 years in Group A and 48.90 ± 12.74 years in Group B. The p- value of 0.89 indicates no statistically significant difference. Group A had more female participants (14) compared to Group B (9), while Group B had more males (11) than Group A (6). Although there was a numerical difference in gender distribution, the p-value was 0.11. No recurrence was observed in either group on POD 7, 30, or 90. However, by POD 180, 2 cases of recurrence were noted in Group A, while none occurred in Group B. The p-value was 0.15. Patients in Group A (Open Rives Stoppa) had a significantly longer mean hospital stay of 7.20 ± 1.36 days, compared to 2.60 ± 0.50 days in Group B (Laparoscopic Rives Stoppa). The difference was statistically significant (p < 0.001). Conclusions: Laparoscopic Rives-Stoppa mesh hernia repair has substantial advantages such as markedly decreased postoperative discomfort, decreased wound complications, length of hospital stay, and seroma development. Laparoscopic Rives-Stoppa can become the new standard of care for ventral hernia repair, providing improved patient outcomes and accelerated recovery in experienced hands.

Background: Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer (LABC) to downstage tumors and improve surgical outcomes. Identifying clinicopathological predictors of response can optimize treatment strategies. Objective: This study aimed to assess the role of clinicopathological factors in predicting pathological response to NAC in LABC patients. Methods: A retrospective analysis of 178 LABC patients treated with doxorubicin-based NAC at Jawaharlal Nehru Medical College and Hospital, AMU Aligarh, from 2017 to 2020 was conducted. Patient demographics, tumor characteristics, and receptor status were collected. Pathologic response was evaluated using RECIST criteria and histopathological examination. Statistical analysis used chi-square tests to identify associations. Results: The mean age was 45.39 years, with 57.9% premenopausal patients. The most common histology was infiltrating ductal carcinoma (91.7%), and 37.1% had triple-negative tumors. Partial response to NAC was observed in 64.6% of patients. Premenopausal status significantly correlated with better pathological response (p=0.0177). No significant association was found between response and age, tumor location, histology, nodal status, grade, molecular subtype, or hormone receptor status. Conclusion: Premenopausal women with LABC demonstrate better response to NAC. Other clinicopathological factors were not significant predictors, emphasizing the need for personalized approaches and further molecular research.

Introduction: Acute kidney injury (AKI) seen mostly in patients with liver cirrhosis and high mortality rate has been observed. This study aims to study the risk factors associated with AKI development in liver cirrhosis patients. Methodology: Hospitalized patients with liver cirrhosis from September 2024 to February 2025 were recruited. Demographic, clinical, and laboratory data were collected, which included, the etiology of cirrhosis, comorbidities, severity of liver disease, and relevant biochemical parameters. The patient was followed up for 90 days to record the clinical outcome. The statistical software SPSS was utilized to conduct the analysis. Results: Of 200 liver cirrhosis patients, 25.2% (n, 92) had AKI and belonged to an average age of 51.54 years. The majority of individuals in the study were males (90.4%), and alcohol (63.4%) was the most common etiology of liver cirrhosis. The present study showed that higher level of direct bilirubin (p = 0.011) and MELD score (p = 0.0001) were identified as significant risk factors for AKI development in patients with liver cirrhosis. Conclusion: AKI is common in cirrhosis of liver patients. Elevated levels of direct bilirubin and MELD score emerged as significant factors associated with AKI development. Early AKI detection and management are crucial for reducing mortality risk in liver cirrhosis patients.

Allergic rhinitis is a global health issue with a rapidly increasing prevalence. It is defined as inflammation of the nasal mucosa, characterized by symptoms of rhinorrhoea, sneezing, nasal blockage, and/or itching of the nose. The disease is diagnosed when symptoms are caused by allergen exposure leading to an IgE-mediated reaction. The disease is subdivided into intermittent or persistent disease and severity into mild or moderate/severe. It is a major cause of sleep disturbance, poor school performance, and loss of productivity. The incidence of allergic rhinitis ranges from 10 to 20%. Inflammatory cells, including mast cells, CD4 positive T cells, B cells, macrophages, and eosinophils, infiltrate the nasal lining upon exposure to an inciting allergen. A normal eosinophil count is less than 350 cells per microliter of blood. Studies have correlated the severity of symptoms with the absolute eosinophil count (AEC), but the conclusions are contradictory. To achieve long-term remission of symptoms, serum IgE and AEC values after therapy should be within the normal range.

Background: Airtraq video laryngoscope is a new intubation device to facilitate intubations in patients with normal and difficult airway without sniffing position. Primary aim of this study was to compare intubating conditions like intubating time, number of intubation attempts, optimization maneuvers, ease of intubation and cardiovascular changes during intubating the pediatric patients with conventional Macintosh laryngoscope and Airtraq video laryngoscope in pediatric patients. Method: After taking institutional ethical committee approval, 60 ASA grade I and II pediatric patients aged 2-10 years posted for elective surgeries undergoing general anaesthesia were equally divided into two groups, Group M (n-30) Macintosh group, Group A (n-30) Airtraq video laryngoscope group. Both groups were compared for time taken for insertion of endotracheal tube (sec), number of attempts, any alternate maneuver required, hemodynamic stability by measuring mean arterial pressure, mean pulse rate during and after insertion of ET tube, any complications. Results: Duration of endotracheal intubation in group A was 8.07+2.45 sec and in group M was 15.33 +7.42 sec, p value 0.000 which is statistically significant. One patient in group A required external laryngeal pressure for intubation. Comparison of changes in mean pulse rate and mean arterial pressure showed no significant difference. Conclusion: Airtraq video laryngoscope is more user friendly, simple and easy to use as compared to conventional Macintosh laryngoscope. Thorough knowledge and expertise is required for use.

Diwali, the festival of lights, is widely celebrated across India with fireworks playing a central role in the celebrations. However, improper handling of firecrackers can lead to ocular trauma, often resulting in traumatic cataracts. We report a case of a traumatic cataract in a 12-year-old male with decreased vision in the left eye. Clinical examination revealed corneal opacity, a foreign body impinged on the iris, and a traumatic cataract in the left eye. B-scan ultrasonography was performed to assess the posterior segment, which appeared normal. The patient underwent cataract extraction with intraocular lens implantation. Postope rative recovery was uneventful, and best-corrected visual acuity improved significantly. This case highlights the potential severity of festive-related ocular trauma and emphasizes the importance of public awareness, the use of protective eyewear, and timely medical intervention in preserving vision.

Background: Hindustani classical music, deeply rooted in Indian culture, has shown promise as a therapeutic tool for various mental health conditions. This study aimed to explore its efficacy in reducing psychiatric symptoms among patients with schizophrenia, anxiety disorders, depression, and behavioral/emotional disorders. Methods: This six-month observational study included 30 patients diagnosed with one of four psychiatric conditions. Participants underwent structured music therapy sessions (30–45 minutes, 3 times weekly) using live or recorded Hindustani ragas tailored to their diagnosis. Pre- and post-intervention assessments were conducted using standard psychiatric rating scales (BPRS, HAM-A, HAM-D, SDQ). Data were analyzed using SPSS v25.0 with paired t-tests and logistic regression. Results: All diagnostic groups showed significant improvements in symptom scores. Depression (HAM-D: 23.7 to 14.6, p = 0.001) and anxiety (HAM-A: 26.4 to 17.3, p = 0.003) had the most pronounced responses. Multiple logistic regression revealed that diagnosis of depression (AOR = 3.67, p = 0.047) and attending ≥12 sessions (AOR = 5.25, p = 0.024) were strong predictors of clinical improvement. Most participants reported better sleep, mood, and emotional regulation post-intervention. Conclusion: Hindustani classical music therapy is an effective and culturally acceptable adjunctive intervention for multiple psychiatric conditions, particularly depression. Regular exposure to therapeutic ragas can enhance emotional well-being and symptom control.

Introduction: Endodontic therapy remains a reliable and predictable dental procedure with a success rate exceeding 90%, provided that clinical protocols are meticulously followed. However, certain dental injuries may trigger calcific metamorphosis of the pulp tissue, complicating conventional treatment approaches and often leading to misdiagnosis or unnecessary extraction. Aim: This case report aims to demonstrate the successful endodontic management of a symptomatic, calcified maxillary central incisor through nonsurgical root canal treatment, thereby avoiding tooth extraction. Case Report: A 25-year-old female presented with a history of dental trauma involving the maxillary right central incisor (tooth 11). Radiographic evaluation revealed complete pulp canal obliteration suggestive of calcific metamorphosis. Despite the challenging anatomy, a conservative endodontic approach was pursued to preserve the tooth. Discussion and Management: The calcified canal was successfully negotiated and instrumented. Root canal obturation was accomplished using a thermoplasticized gutta-percha technique to ensure a three-dimensional seal. Following obturation, internal bleaching was performed to address discoloration and enhance the aesthetic appearance. The outcome highlights the importance of preserving teeth with calcified canals using advanced endodontic techniques rather than resorting to extraction.

Background: Traumatic subaxial cervical bifacetal dislocations are severe injuries commonly resulting from high-energy trauma. Optimal management remains challenging, with combined anterior and posterior approaches increasingly utilized to achieve reduction, decompression, and stabilization. Aim: To evaluate the outcomes of combined anterior and posterior approaches in the treatment of subaxial cervical bifacetal dislocations. Materials and Methods: A prospective observational study was conducted on 15 patients aged 22–68 years with post-traumatic cervical anterolisthesis and a SLIC score ≥4. Preoperative evaluation included detailed history, neurological assessment, respiratory evaluation, and imaging (X-ray, CT, MRI). Patients underwent skull traction followed by either anterior-posterior or posterior-anterior surgical approaches depending on reduction success. Outcome measures included radiological correction of alignment, neurological recovery, operative data, and complications. Results: The C4–C5 level was most commonly involved (40%). Mean operative time was 112.8±28.6 minutes with mean blood loss of 242.5±75.4 ml. Local kyphotic angle improved significantly from 18° preoperatively to 2° at one-year follow-up (p<0.001). Cervical lordosis increased from 33° to 41° (p=0.004), while mean step-off distance reduced from 1.0 cm to 0.5 cm (p=0.002). Neurological improvement was observed in a majority of patients. No major perioperative complications were reported. Conclusion: Combined anterior and posterior approaches offer effective decompression, reduction, and stabilization in traumatic subaxial cervical bifacetal dislocations. This technique resulted in significant radiological correction and favorable neurological outcomes with an acceptable safety profile.

This study evaluates tear film abnormalities and conjunctival cytological changes following manual small incision cataract surgery (SICS) in 76 eyes of 47 patients at JIPMER, Puducherry, from April 2011 to June 2013. Tear film parameters, including Schirmer’s 1, Schirmer’s 2, tear break-up time (TBUT), fluorescein, and lissamine green staining, were assessed preoperatively and at one week, one month, and three months postoperatively. Conjunctival impression cytology was performed at three months post-surgery. Results showed a significant reduction in Schirmer’s 1 (p=0.0001) and Schirmer’s 2 (p=0.0001) values, and TBUT (p=0.0001) post-surgery, indicating impaired tear function. Fluorescein and lissamine staining increased post-surgery, with 18.4% and 21% of eyes showing staining, respectively. Impression cytology revealed squamous metaplasia in 76.3% of eyes. These findings suggest that SICS induces significant tear film instability and conjunctival changes, likely due to corneal nerve damage from larger incisions compared to phacoemulsification. The study underscores the need for postoperative dry eye management in SICS patients.

Background: Millions of people worldwide suffer from chronic heart failure (CHF), a complicated and progressive illness that has a major influence on their lives. Dyspnea, exhaustion, and fluid retention are some of the symptoms that result from the incapacity of the heart in pumping blood to meet the requirements of the metabolism of the body of an individual. Objectives: This study set out to evaluate the relative efficacy of two widely prescribed second-line hypertension medications, such as beta-blockers and ACE inhibitors. Materials and Method: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that has been retrieved was for one year. The data of 148 participants have been retrieved. Hospital records were used to identify eligible patients who had been diagnosed with chronic heart failure. They were divided into two groups according to whether ACE inhibitors or beta-blockers were the main medication provided. Results: With a p-value of 0.39, the mean age of the groups was similar, with the beta-blocker group being 62.3 ± 10.2 years old and the ACE inhibitor group being 63.7 ± 9.5 years old. With a p-value of 0.48, the mean LVEF was 29.1 ± 4.2% in the beta-blocker group and 28.7 ± 4.6% in the ACE inhibitor group. Forty patients (54.1%) in the ACE inhibitor group and fifty patients (67.6%) in the beta-blocker group showed an improvement of at least one NYHA class. Conclusion: Beta-blockers outperformed ACE inhibitors in this retrospective comparative analysis in terms of improving LVEF, minimizing hospital readmissions, and perhaps lowering death in patients with chronic heart failure.

Background: Intertrochanteric femur fractures are common in elderly individuals, especially among women with osteoporosis, often resulting from trivial falls. Early surgical fixation is crucial for restoring mobility and reducing complications. This study compares the outcomes of proximal femoral nailing (PFN) and dynamic hip screw (DHS) fixation. Methods: This retrospective study was conducted at a tertiary care hospital over one year, including 154 patients with intertrochanteric fractures. Patients underwent either PFN or DHS fixation, and surgical details were documented. Fractures were classified using Jensen and Michealsen’s modification of the Evans classification. Patients were followed up at 6 weeks, 3 months, and 6 months to assess fracture healing, complications, pain, and functional recovery. Results: Most patients were elderly females, with trivial falls being the most common cause of injury. PFN showed shorter surgery time, smaller incisions, less blood loss, but longer fluoroscopy time than DHS. Fracture union rates were slightly higher with PFN, with fewer complications compared to DHS. Functional outcomes were significantly better with PFN, particularly in regaining pre-injury walking ability. Conclusion: PFN demonstrated better surgical, radiological, and functional outcomes compared to DHS in intertrochanteric fractures.

Background: Dengue fever is a viral infection transmitted by mosquitoes. Posing a substantial public health Challenge, Dengue fever is a major public health concern, with an estimated 100 million cases, reported annually and 20,000 – 25000 deaths attributed to the disease. Objective: To evaluate platelet count & Immature platelet fraction (IPF) with reference to clinical severity of dengue fever in children. Material & Methods: This study is a hospital based, observational, descriptive study, conducted in the department of Paediatrics, Mahatma Gandhi Medical College & Hospital. Jaipur. A Total 150 Patients were enrolled in the study aged between 1 to 18 years. Result: A total 150 patients included in the study, revealed a predominance of older children particularly in the 9-12 years age group. The mean platted count decreases 91,120/ul by day 1 to 80,180/ul on day 2 before increasing to 118,967/ul by day 5. Astatistically significant trend (p< 0.0001). Immature platelet fraction levels exhibited a steady increase over five by period from 15.91 on day 1 to 19.13 on  day 5, statistically significant increase (P=.00973). Conclusion: The study findings provided valuable insights into hematological trends, disease severity, classification, role of IPF in predicting platelet recovery, contributing to the growing body of knowledge on dengue pathophysiology & management.

Background: Aluminium phosphide (AlP), commonly used as a pesticide is a highly toxic compound frequently implicated in deliberate self-poisoning in developing countries, particularly India. Its easy availability, low cost, and high fatality rate make it a major public health concern. Aim: To evaluate the sociodemographic characteristics of patients admitted with Aluminium phosphide poisoning at SMS Medical College and Hospital, Jaipur. Methodology: This observational, hospital-based study was conducted from June 2021 to May 2022 over 59 confirmed cases of Aluminium phosphide poisoning as per history given by patients/relatives and after informed consent admitted in a medical emergency at S.M.S Medical College, Jaipur. Data on age, gender, residence, marital status, education, occupation, socioeconomic background, and intent (suicidal, accidental, or homicidal) were recorded and analyzed using descriptive statistics. Results and Observation: Out of the total cases studied, the majority were young adults aged 21-30 years were 29 cases (49.15%), with a male predominance 51 (86.4%) cases. Most cases were from rural backgrounds 43 (72.88%) and belonged to lower socioeconomic strata 32 (54.23%). Majority of the cases, 39 (66.10%) belonged to joint family. Suicidal intent was noted in 53 (89.83%) cases. The overall mortality in the present study was 47.5% which implies that almost half of the sufferers died. Conclusion: Aluminum phosphide poisoning is common cause of morbidity and mortality which was observed more in males of active age group and was mostly suicidal in nature. This indicates that consumption of this poison is a concern for public health. Early intervention, mental health support, and strict regulation on pesticide availability are essential to reduce incidence and mortality.

Introduction: Respiratory failure is a critical condition characterized by the inability to maintain adequate gas exchange, frequently resulting from primary lung diseases such as COPD, asthma, ILD, pneumonia, and tuberculosis. Outcomes in these patients are influenced by several factors, including comorbidities and severity of illness. The APACHE II scoring system serves as a useful tool in predicting ICU outcomes. This study aimed to evaluate the impact of comorbidities and APACHE II scores on ICU outcomes in patients with respiratory failure due to primary pulmonary diseases. Materials and Methods: This observational study was conducted in the ICU of the Department of Respiratory Medicine, K.D. Medical College, and Mathura. A total of 100 adult patients with respiratory failure due to primary lung diseases were included. Patients with non-pulmonary causes of respiratory failure were excluded. Data on demographics, clinical history, comorbidities, ABG findings, and APACHE II scores were collected. Patients were classified into Type 1 or Type 2 respiratory failure based on ABG parameters. ICU outcomes including mortality, duration of stay, and ventilatory support requirements were analyzed. Results: Type 2 respiratory failure was more common (62%). Comorbidities were present in 63% of patients, with hypertension and diabetes being the most prevalent. Mortality was higher in patients with comorbidities (17.4% vs. 2.7%) and in those with high APACHE II scores (20.7% in high-risk group). ICU stay was longer in patients with comorbidities and higher APACHE II scores. NIV was the most commonly used intervention (68%). Conclusion: Comorbidities and elevated APACHE II scores were significantly associated with poorer ICU outcomes, including higher mortality and prolonged ICU stay. Early risk stratification is essential to optimize care in respiratory failure patients.

Introduction: Uterine fibroids are common benign tumors that can affect fertility and IVF outcomes, particularly depending on their size, location, and distortion of the endometrial cavity. The impact of non-cavity-distorting fibroids remains controversial, with existing literature offering conflicting evidence. This study aimed to compare IVF outcomes between women with and without non-cavity-distorting uterine fibroids to elucidate their effect on reproductive success. Materials and Method: This was a comparative observational study conducted on 180 women undergoing IVF cycles, divided into two groups: 90 women with non-cavity-distorting fibroids and 90 age-matched controls without fibroids. Demographic data, ovarian reserve parameters, and IVF outcomes were recorded and compared. Parameters included the number of oocytes retrieved, fertilization rate, and embryo transfer day, number of embryos transferred, implantation rate, clinical pregnancy rate, miscarriage rate, and live birth rate. Statistical analysis was performed using appropriate tests, with p < 0.05 considered significant. Result: Baseline demographic and ovarian reserve parameters (age, BMI, duration and type of infertility, menstrual regularity, AFC, and AMH levels) were statistically comparable between the two groups. Although the mean number of oocytes retrieved and fertilization rate were slightly lower in the fibroid group, the differences were not significant. However, significant reductions were observed in implantation rate (26.4% vs. 37.5%, p = 0.032), clinical pregnancy rate (31.1% vs. 48.9%, p = 0.018), and live birth rate (24.4% vs. 43.3%, p = 0.011) in the fibroid group. Miscarriage rate was higher in the fibroid group (21.4% vs. 11.4%) but not statistically significant (p = 0.281). Conclusion: Women with non-cavity-distorting uterine fibroids demonstrated significantly poorer reproductive outcomes in terms of implantation, clinical pregnancy, and live birth rates, despite similar ovarian response. These findings suggest that even non-cavity-distorting fibroids may negatively impact IVF success and should be considered in pre-IVF evaluations.

Acute Respiratory Infections (ARIs) are a leading cause of morbidity and mortality globally. Co-infections with multiple viral pathogens complicate ARIs, adversely affecting disease progression and treatment outcomes. This study aims to determine the prevalence of viral co-infections in patients diagnosed with ARIs at a tertiary care hospital, utilizing a molecular diagnostic approach to identify common respiratory viruses and their co-occurrence. Our findings provide insights into the epidemiology of viral co-infections and underscore the need for enhanced diagnostic and management strategies in ARI cases.

Aims & Objectives: The aim of this study is to analyze the clinical profiles and pleural fluid biomarkers in patients with pleural effusion to identify diagnostic patterns and etiological correlations. Materials & Methods: This retrospective study was conducted at Hitech Medical College and Hospital over a period of 12 Months, involving 100 patients diagnosed with pleural effusion. Clinical data, including patient demographics, symptoms, and diagnostic findings, along with pleural fluid samples, were collected for analysis. Biomarkers such as LDH, CRP, L:N ratio and Pleural fluid ADA/Serum CRP were evaluated to assess their diagnostic utility and correlation with the underlying etiology of the pleural effusions. Results: The evaluation of diagnostic markers for pleural effusion in a cohort of 37 patients highlighted variations in their sensitivities and specificities. A significant distinction was observed in the Pleural Fluid ADA/Serum CRP ratio between Tubercular Pleural Effusion (TB PLEF) and malignant effusion. In TB PLEF cases, the ratio consistently exhibited high values, often exceeding 10, with examples such as 24.5, 18.3, and 14.9. In contrast, malignant effusion was associated with significantly lower ratios, typically below 5, including values like 4.3, 2.4, and 1.5. These results indicate that TB PLEF is characterized by elevated ADA activity, reflecting an enhanced immune response, while malignant effusion demonstrates a reduced inflammatory profile. The distinct separation in ADA/CRP ratios highlights its potential as a reliable and non-invasive diagnostic tool for differentiating between these conditions. Conclusion: The study demonstrates that Pleural fluid ADA/Serum CRP and L:N ratios are effective biomarkers for differentiating between malignant, infectious, and parapneumonic pleural effusions. Malignant effusions exhibited higher detection rates and more varied biomarker values, while infectious effusions showed a broader range, with most cases having low biomarker levels.

Background: Surgical site infections (SSIs) are a frequent and severe postoperative complication, especially in abdominal operations, that result in greater morbidity, longer hospital stay, and additional healthcare expenditure. Suture material is also an important factor in the development of SSI because of its susceptibility to microbial colonization and biofilm formation. This research sought to compare the effect of antibiotic-coated sutures on SSI rate versus standard sutures in abdominal operations. Methods: A hospital-randomized controlled trial was done in the Department of Surgery, K.J. Somaiya Medical College and Hospital, Mumbai. 150 patients with abdominal surgeries were randomized into two groups: Group A (antibiotic-coated sutures) and Group B (non-coated sutures). After adjusting for loss to follow-up, 125 patients were analyzed finally. Wound healing and SSIs were evaluated at 7, 14, and 30 days after surgery by CDC criteria and ASEPSIS score. Results: The rate of SSI was considerably lower in the suture group with antibiotic coating (5.6%) than in the non-coated group (18.5%) (p=0.04). The results of wound healing were also improved in Group A with a smaller number of severe wound infections. The rate of SSI occurrence was considerably higher in CDC wound category III and IV in both groups (p<0.01). There were no significant differences between groups in terms of comorbidities, surgery type, or demographic characteristics. Conclusion: Antibiotic-coated sutures decrease the risk of SSIs in abdominal operations substantially without negatively influencing wound healing. Routine use could prove useful in limiting postoperative complications and saving healthcare resources.

Background: Levobupivacaine offers a safer stereo selective alternative to racemic bupivacaine, but its relatively slow onset has driven interest in α-2 agonist adjuvants such as dexmedetomidine. Existing evidence suggests that intrathecal dexmedetomidine prolongs block duration and quality, yet head-to-head data in infra-umbilical surgery remain scarce. Methods: Eighty ASA I–III adults (18–70 y) scheduled for elective lower-abdominal or lower-limb surgery were randomised to receive either 0.5 % hyperbaric levobupivacaine 3 mL (Group L, n = 40) or the same dose plus 5 µg dexmedetomidine (Group LD, n = 40) intrathecally. Primary outcomes were onset and duration of sensory and motor block. Secondary outcomes included VAS-guided analgesic requirements, two-segment regression time, haemodynamic trends, and adverse events. Results: Baseline demographics and ASA status were comparable. Group LD achieved faster sensory onset (3.88 ± 0.76 min vs 4.85 ± 0.83 min, p < 0.001) and motor onset (5.65 ± 0.62 min vs 6.10 ± 0.74 min, p = 0.004). Sensory block persisted significantly longer in Group LD (329 ± 8 vs 241 ± 12 min, p < 0.001), as did motor block (259.8 ± 7 vs 202.1 ± 6 min, p < 0.001). Two-segment regression was delayed by ~18 min with dexmedetomidine. Rescue-analgesic demand fell by 57 % within 24 h (0.6 ± 0.5 vs 1.4 ± 0.5 doses, p = 0.01) and VAS scores remained ≤ 3 for twice as long. Haemodynamic variables were clinically stable; bradycardia (5 % vs 5 %) and hypotension (2.5 % vs 7.5 %) did not differ significantly. Conclusion: The addition of 5 µg intrathecal dexmedetomidine to hyperbaric levobupivacaine accelerates onset, markedly prolongs sensory and motor blockade, and enhances postoperative analgesia without compromising haemodynamic stability in lower-abdominal and lower-limb surgery.

Background: Twin pregnancies are associated with increased maternal and neonatal risks, including preterm birth, low birth weight, and higher intervention rates. Advances in assisted reproductive techniques have contributed to a global rise in twin births. Monitoring outcomes is essential for improving perinatal care in such high-risk pregnancies. Methods: A retrospective study was conducted at a tertiary care hospital over one year (August 2023–August 2024), including 158 women with twin pregnancies. Data were collected from admission through delivery and postnatal discharge. Maternal characteristics, delivery details, and neonatal outcomes were recorded. Statistical analysis was done using SPSS software. Results: Most women were aged 21–30 years, and 91.8% conceived spontaneously. Vaginal delivery occurred in 50.6%, with 43% undergoing emergency cesarean. Majority of neonates weighed between 1.5–2.5 kg, and 43.7% required NICU admission. Neonatal mortality was 17.1%, mostly among preterm infants. Conclusion: Twin pregnancies are linked with higher rates of complications, underscoring the need for timely and specialized obstetric care.

Background: Hyperthyroidism is a common endocrine disorder characterized by excessive thyroid hormone production, leading to various systemic symptoms. Treatment options include antithyroid drugs (ATD), radioactive iodine (RAI), and surgery, with treatment preferences varying globally. This study explores the treatment patterns, clinical characteristics, and complications associated with hyperthyroidism. Methods: A retrospective study was conducted over one year at a tertiary care hospital, including 166 patients diagnosed with hyperthyroidism. Data on demographics, treatment modalities, thyroid function tests, goiter size, orbitopathy, TRAb status, and follow-up were collected. Patients were categorized based on treatment received: ATD, RAI, surgery, or observation. Descriptive statistical analysis was performed to summarize the findings. Results: ATD was the most common treatment (59.0%), followed by RAI (31.3%), surgery (3.6%), and observation (6.0%). The majority of patients were females (75.3%) aged 40–60 years. Most patients had moderate goiter size (20–50 g) and elevated thyroid hormone levels, with 44.0% showing positive TRAb. Follow-up duration was longest in surgery and RAI groups. Conclusion: Antithyroid drug therapy remains the predominant treatment choice for hyperthyroidism, with significant variations in clinical characteristics across treatment groups.

Background: A widespread noncommunicable condition, hypertension affects about 25% of adults worldwide. The number will reach 1.56 billion by 2025, or 29% of the adult population worldwide. Hypertension is becoming more common, according to studies conducted across India. Objectives: The aim of the study was to evaluate the clinical and etiological profile of endocrine causes of hypertension in young adults aged 18 to 40 years at a tertiary care center. 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 162 participants have been retrieved. A standardized proforma was used to collect data on demographics, clinical characteristics, BMI, family history, test results, imaging, and the final diagnosis. Data and records that were incomplete were not included. Results: Patients aged 31–35 years made up the biggest age group (64, 39.5%), followed by those aged 26–30 years (46, 28.4%), 18–25 years (29, 17.9%), and 36–40 years (23, 14.2%). There were 64 (39.5%) female participants and 98 (60.5%) male participants. In 64 patients (39.5%), primary hyperaldosteronism was shown to be the most frequent etiology. Of the individuals diagnosed, 41 (25.3%) had phenochromocytoma, and 29 (17.9%) had Cushing’s disease. Conclusion: This study emphasizes that one significant and possibly curable cause of secondary hypertension in young adults is endocrine hypertension. Thyroid dysfunction, Cushing’s syndrome, pheochromocytoma, and primary hyperaldosteronism were the most common causes found.

Background: The usage of intrauterine devices (IUDs) has grown significantly in the United States (US) over the past 20 years due to its high levels of effectiveness and user satisfaction over extended periods of time, limited potential for user error, and few medical contraindications. Objectives: This study sought to determine the parameters determining continuation, removal, and complication rates as well as the clinical outcomes and complications related to PPIUCD insertion among women giving birth in a tertiary care facility. 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. Data from 166 participants were retrieved for the study. Included were women who consented to the installation of a PPIUCD after giving birth, either vaginally or via lower segment cesarean surgery. Results: Of the 166 participants, 74 women (44.6%) were in the 25–30 age bracket, which was followed by those in the 18–24 age range (28.9%) and those over 30 (26.5%). With a p-value of 0.042, a statistically significant correlation between age group and PPIUCD result was discovered. At follow-up, 143 women (86.1%) were found to be still using the PPIUCD. Nine instances (5.4%) involved spontaneous ejection. Eight women (4.8%) reported having their devices removed upon request. Conclusion: This retrospective analysis demonstrates that PPIUCD insertion is a well-recognized, safe, and efficient long-acting reversible contraceptive technique. Negative results like expulsion, infection, or pregnancy with IUCD in situ were rare, and most women kept using the medication without any problems. Recommendations: As this was a short-term study, further research is needed with a longitudinal study design and a larger sample to achieve more definitive results.

Background: Patients with COPD are offered both short- and long-acting medications in order to reduce the disease’s progression and treat it sustainably. For long-acting medications to take maximum action, they should be taken on a regular basis. It is therefore distinct from short-acting drugs, which are administered in response to an immediate requirement, like dyspnea. Objectives: The aim of this study was to evaluate the association between adherence to COPD management guidelines. 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. Data from 158 participants were retrieved for the study. Every participant was at least 40 years old and had smoked for at least 2.5 pack years. “COPD cases” were subjects from the population cohort that was identified as having COPD, whereas “COPD patients” were subjects from the hospital registries. Results: The majority of the 158 COPD patients in this study were men 92, (58.2%), with 66 (41.8%) being women. The adherent and non-adherent groups did not differ significantly in terms of age or sex, suggesting that demographic characteristics had no bearing on adherence behavior. With a p-value of 0.073, the difference between the percentage of non-adherent patients who were current smokers (59.0% vs. 46.4%) was not statistically significant. Conclusion: Poor adherence to COPD management, especially inhaled medicine, is strongly linked to higher incidence of exacerbations and hospitalizations, according to this study. Clinical outcomes were significantly poorer for non-adherent individuals, even if their baseline lung function was better. Recommendations: As this was a short-term study, further research is needed with a longitudinal study design and a larger sample to achieve more definitive results.

Background: Blunt abdominal trauma (BAT) is a major contributor to morbidity and mortality, often resulting from high-energy impacts such as road traffic accidents. It frequently involves multiple organs and may be masked by other injuries. Accurate and timely diagnosis is crucial to guide appropriate management. Methods: This retrospective study was conducted over one year (May 2023–May 2024) at a tertiary care hospital, involving 166 patients with blunt abdominal trauma. Clinical evaluation, imaging (FAST, CT), and laboratory tests guided patient classification into stable and unstable groups. Stable patients were managed conservatively, while unstable patients underwent surgery. Data were collected on demographics, injury mechanisms, organ involvement, surgical procedures, and outcomes. Results: The most common cause of injury was road traffic accidents (53%), with the spleen (53%) and liver (35%) being the most frequently injured organs. Rib fractures (20%) were the most prevalent associated injury. Splenectomy was the most performed surgery (30%), followed by bowel and mesenteric repairs. Conservative management was effective in many hemodynamically stable cases. Conclusion: Timely imaging, structured evaluation, and selective surgical intervention significantly improve outcomes in blunt abdominal trauma.

Background: Malaria remains a significant public health concern in many parts of India, with transmission patterns influenced by seasonal variations. This study assessed the prevalence of malaria and its seasonal distribution among patients attending the outpatient department of a tertiary care Centre in West Champaran, Bihar. Methods: A cross-sectional study was conducted from January 2023 to January 2025. A total of 400 patients presenting with fever and other symptoms suggestive of malaria were screened using Rapid Diagnostic Tests (RDT) and confirmed with microscopy. Data on demographic characteristics and seasonal occurrence were collected and analyzed. Results: Out of 400 patients screened, 7 (1.75%) were diagnosed with malaria. The majority of cases (71.4%) occurred during the monsoon season, with 3 cases in males and 2 in females. One case each was found in the summer and winter seasons, both in males. Plasmodium falciparum was the predominant species identified. Conclusion: A distinct seasonal trend was observed, with the highest malaria prevalence during the monsoon. Strengthening surveillance and preventive strategies during high-risk months can effectively reduce malaria incidence.

Introduction: Exudative pleural effusion is a common clinical problem with various etiologies. Despite initial workup, a significant number of cases remain undiagnosed. Medical thoracoscopy, also known as pleuroscopy, is a minimally invasive procedure used to visualize the pleural space and diagnose various lung and pleural diseases by analysing pleural biopsy. Aim and Objective: To evaluate the diagnostic yield of medical thoracoscopy in undiagnosed exudative pleural effusion. Materials and Methods: This is a retrospective observational study conducted in 120 patients with undiagnosed exudative pleural effusion, attended to department of pulmonary medicine, tertiary care hospital, Kurnool, from January 2024 to December 2024, and who underwent medical thoracoscopy. Demographical, clinical, radiological, cytobiochemical and histopathological data of the patients were collected from the thoracoscopy register and analysed. The primary outcome analysed was the diagnostic yield of medical thoracoscopy. Secondary outcomes analysed included distribution of final diagnosis and procedure-related complications. Results: The overall yield of thoracoscopic pleural biopsy was 91.66% (110/120) in patients with undiagnosed exudative pleural effusion and 8.34% (10/120) remained undiagnosed. Histopathological diagnosis confirmed malignancy in 61.8% (68/110) including both primary and metastatic pleural carcinoma. Most common type of malignancy is metastatic adenocarcinoma, 42.6% (29/68). Tuberculosis confirmed in 28.2% (31/110), empyema reactive pleuritis in 4.5% (5/110), chronic nonspecific inflammation in 5.5% (6/110). Procedure related mortality was nil. Complications developed during procedure included bleeding, prolonged air leak and subcutaneous emphysema. Conclusion: Medical thoracoscopy is a safe minimally invasive procedure and has good diagnostic yield in patients with undiagnosed exudative pleural effusion and has no major complications during or post procedure.

Background: Distal femur fractures are complex injuries that require precise surgical intervention for optimal recovery. Locking plates have become the preferred method due to their biomechanical stability. However, outcomes in rural healthcare settings remain understudied. This study examines the efficacy of periarticular anatomical locking plates in a rural tertiary care center by evaluating the functional and radiological outcomes of 35 patients treated surgically. Methodology: A retrospective study was conducted on 35 patients diagnosed with distal femur fractures and treated surgically using periarticular anatomical locking plates at a rural tertiary care center. Patient data, including demographic details, fracture classification, surgical technique, and postoperative outcomes, were collected. Functional outcomes were assessed using the Neer’s knee score, while radiological outcomes were evaluated through serial X-rays. Statistical analysis was performed using SPSS software. Results: As per the Neer’s knee score, excellent and good outcome was seen in 51.4% and 37.1% cases while fair and poor outcome was seen in 8.6% and 2.9% cases respectively. Mean radiological time for fracture union was 18.06 weeks with delayed union i.e. union beyond 24 weeks and non-union was seen in 3 cases (8.6%) and 1 (2.9%) case respectively.  These findings highlight the effectiveness of periarticular anatomical locking plates in ensuring stability and early mobilization. Conclusion: This research concludes that periarticular anatomical locking plates provide a reliable and effective method for the surgical management of distal femur fractures, offering stable fixation, promoting early mobilization, and resulting in satisfactory radiological and functional outcomes.

Introduction: Paravertebral block is being used now a days for unilateral procedures such as breast surgery, thoracotomy, chest trauma (rib fracture) and also for inguinal hernia repair both for anaesthesia as well as for analgesia. Aims: To ascess the efficacy and safety of Paravertebral block compared to subarachnoid block in terms of duration of post-operative analgesia, intraoperative opioid requirement, hemodynamic response, total rescue analgesic requirement in first 24 hour, any adverse effect and time to ambulation. Materials & Methods: The present study was a prospective interventional clinical study. This Study was conducted for six months at Nil Ratan Sircar Medical College and Hospital, kolkata, West Bengal. Total 60 patients were included in this study. Result: The demographic and baseline clinical parameters were comparable between Group P and Group S, with no statistically significant differences observed across any variable. The mean age of patients in Group P was 38.15±2.44 years, while in Group S it was 40.03±3.28 years (p=0.629). Similarly, body weight (62.41±6.09 kg vs. 64.76±6.85 kg; p=0.337) and ASA physical status distribution (I/II: 22/18 vs. 26/14; p=0.401) showed no significant variation. Conclusion: In conclusion, the results of this study demonstrate that the single-needle unilateral paravertebral block (PVB) offers significant advantages over conventional anesthesia techniques for elective unilateral inguinal hernia repair.

Introduction: Abortion is the process of expulsion and extraction of the embryo or fetus before viability. Threatened abortion is the spontaneous process, which has progressed to a state from which it can revert back. Threatened abortion refers to any blood-stained discharge or vaginal bleeding through the closed in the first 20 weeks of pregnancy, without cervical dilatation or passage of the products of conception, whether or not this bleeding is associated with uterine contractions. Aims: To investigate the effect of the 1st trimester vaginal bleeding on maternal and perinatal outcome. Materials and Method: This was an observational longitudinal study conducted in the Department of Obstetrics and Gynaecology at the College of Medicine and Sagore Dutta Hospital, Kamarhati, Kolkata – 700058. The study was carried out over a period of one and a half years, and a total of 100 patients were included in the study. Result: In our study, 42 (42.0%) patients had Spotting Amount of bleeding, 35 (35.0%) patients had Mild Amount of bleeding, 21 (21.0%) patients had Moderate Amount of bleeding and 2 (2.0%) patients had Severe Amount of bleeding. The value of z is 6.8279. The value of p is < 0.00001. The result is significant at p < 0.05. Conclusion: Threatened abortion in early pregnancy is associated with increased risk of adverse fetomaternal outcomes, including preterm delivery, low birth weight, and cesarean section. Early identification and appropriate monitoring are crucial to improve prognosis. This study highlights the need for vigilant antenatal care in pregnancies complicated by threatened abortion.

Background: Acute abdominal pain is one of the most frequent presentations in emergency departments (ED). Rapid and accurate diagnosis is critical for appropriate management. This study aimed to compare the diagnostic accuracy of point-of-care ultrasound (POCUS) with computed tomography (CT) in patients presenting with acute abdomen. Methods: A prospective observational study was conducted on 309 patients presenting with acute abdominal pain in emergency department of our hospital. All patients underwent both point POCUS and contrast-enhanced CT scan. The final diagnosis was confirmed either surgically or by clinical follow-up and was compared to POCUS results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for POCUS across various abdominal pathologies. Results: The highest sensitivity of POCUS was observed in acute cholecystitis (95.24%) and pelvic pathology (90.00%), while ureteric colic had the lowest sensitivity (59.38%). Specificity remained consistently high across all conditions, with the highest in pelvic pathology (99.31%). Overall, POCUS demonstrated a reliable negative predictive value (NPV) across conditions, suggesting its value in ruling out significant pathologies. Conclusion: POCUS is a valuable, rapid diagnostic tool in emergency settings, particularly effective in detecting cholecystitis, pelvic pathology, and bowel obstruction. While CT remains the gold standard, POCUS can significantly expedite management in high-volume emergency settings.

Background: Eagle syndrome is a rare condition caused by elongation of the styloid process or calcification of the stylohyoid ligament, leading to compression of adjacent neurovascular structures and varied head and neck symptoms. Materials and Methods: A total of 45 patients with chronic neck pain, dysphagia, and foreign body sensation were evaluated. Radiographic imaging revealed elongated styloid processes (3.5–4.5 cm) in all cases, with bilateral involvement in 28 patients and unilateral in 17 patients. Results: All patients underwent surgical management, resulting in significant symptom relief postoperatively. Intraoral approach was followed in all cases in our research. Conclusion: Although Eagle syndrome remains under-diagnosed, it should be considered in patients presenting with chronic head and neck pain, especially when conventional treatments fail. While conservative medical management may offer temporary relief, surgical excision of the elongated styloid process provides definitive treatment and long-term symptomatic improvement.

Introduction: Global tuberculosis report, 2021 revealed that India has the highest number of tuberculosis patients (26%) worldwide. Tuberculosis, in majority of patients is pulmonary affecting lungs. However, tuberculosis can also frequently involve extrapulmonary sites as well, which can exist alone or coexist with Pulmonary tuberculosis simultaneously. Aims: To measure the prevalence of thyroid dysfunction among tuberculosis patients receiving antitubercular drugs. To identify any adverse drug reactions & perform the causality assessment. Materials & Methods: The present study was a Hospital based Observational Cross-sectional study. This Study was conducted from July’2023 to September’2023 at Central Laboratory, OPD Biochemistry and Microbiology Laboratory, Medical College & Hospital, Kolkata. Total 106 patients were included in this study. Result: In the study, the presence of co-morbidities was reported in 34 patients (56.7%), while 26 patients (43.3%) did not have any co-morbid conditions. The most common co-morbidity was diabetes mellitus, affecting 30 patients (50%). Other significant co-morbidities included coronary artery disease (16.6%) and a variety of rare conditions such as chronic kidney disease, systemic lupus erythematosus (SLE), acute kidney injury, hypertension, vocal cord palsy, and interstitial lung disease, each affecting 1 patient (1.7%). These findings indicate a predominance of diabetes mellitus in the patient cohort, with a low frequency of more uncommon co-morbidities. Conclusion: In conclusion, antitubercular drug therapy, particularly with medications like rifampicin and isoniazid, can significantly affect thyroid function. These drugs may lead to alterations in thyroid hormone levels, either through direct interactions with thyroid hormone metabolism or by affecting hepatic enzyme activity.

Introduction: Acute calculouscholecystitis (ACC) is a common surgical emergency, often associated with gallstones obstructing the cystic duct. However, concurrent common bile duct (CBD) stones can complicate management, increasing the risk of cholangitis, pancreatitis, and biliary obstruction. Early identification of CBD stones is crucial to guide appropriate imaging and intervention. Aims: To assess the role of liver function tests in predicting common bile duct stones in acute calculus cholecystitis cases. Materials and Methods: The study will be conducted in the Department of General Surgery at Tezpur Medical College and Hospital, Tezpur, Assam. It will be a hospital-based prospective cohort study involving 100 patients diagnosed with acute calculouscholecystitis. As a prospective study, all eligible patients presenting during the study period who meet the inclusion and exclusion criteria will be evaluated. The study will be carried out over a duration of six months. Results: The comparison of liver function test (LFT) values between patients with common bile duct (CBD) stones (Group A, n=40) and those without (Group B, n=60) revealed significant differences in all parameters, with Group A exhibiting higher mean values for total bilirubin, direct bilirubin, ALT, AST, ALP, and GGT (all p<0.001). The diagnostic performance of LFTs for detecting CBD stones showed that Total Bilirubin >1.5 mg/dL and GGT >250 U/L were the most sensitive markers (85% and 84%, respectively), while a combination of these parameters offered the best diagnostic accuracy. Additionally, elevated LFTs were significantly more prevalent in Group A, with 90% showing elevated bilirubin and 80-88% exhibiting elevated ALT, AST, ALP, and GGT (all p<0.001). These findings highlight the significant liver dysfunction associated with CBD stones and underscore the diagnostic value of LFTs in differentiating between the two groups. Conclusion: Liver function tests, particularly elevated direct bilirubin and ALP, are useful non-invasive indicators of possible CBD stones in patients with acute calculouscholecystitis. These parameters can help in risk stratification and guide the need for further imaging and intervention.

Background: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder requiring multimodal pharmacologic intervention for optimal glycemic control. Metformin is the first-line agent, but combination therapy is often needed to achieve target glycemic levels. Sitagliptin, a DPP-4 inhibitor, offers complementary mechanisms when combined with metformin, with a favorable safety profile. Material and Methods: This prospective, randomized, comparative study was conducted over one year at a tertiary care center. A total of 152 T2DM patients aged 35–60 years were enrolled and randomized into two groups: Group A received metformin 500 mg twice daily, and Group B received a fixed-dose combination of metformin 500 mg and sitagliptin 50 mg twice daily. Baseline and 30-day follow-up data were collected on hematological, renal, glycemic, and biochemical parameters. Statistical analysis was performed using appropriate tests, with p < 0.05 considered significant. Results: At baseline, the combination group had significantly better glycemic parameters and lower liver enzymes. After 30 days, the metformin–sitagliptin group showed significantly greater reductions in fasting and postprandial blood sugar (p < 0.01), improved renal function (lower serum creatinine), and favorable lipid changes (reduced LDL and triglycerides, increased HDL). Hemoglobin increased and WBC count decreased significantly in the combination group. No serious adverse effects were reported in either group. Conclusion: The fixed-dose combination of metformin and sitagliptin is more effective than metformin alone in improving glycemic control and select metabolic parameters over a short-term period, with good tolerability. It may be considered a preferred option for patients with inadequate response to metformin monotherapy.

Background: Prolonging peri-operative analgesia while maintaining haemodynamic stability is pivotal in regional anaesthesia for upper-limb surgery. Corticosteroids such as dexamethasone and α-2-agonists such as dexmedetomidine are popular adjuvants to long-acting local anaesthetics, yet comparative evidence in supraclavicular blocks remains scarce. Methods: Seventy ASA I–III adults scheduled for elective upper-limb procedures were randomised to receive 2mg/kg of 0.5 % levobupivacaine combined with either perineural dexamethasone 0.1 mg kg-¹ (Group DXM) or dexmedetomidine 1 µg kg-¹ (Group DMD). Sensory and motor block onset were assessed every five minutes for 20 min; durations, haemodynamic variables and postoperative pain (10-cm VAS) were recorded for 28 h. Independent-samples t-tests (α = 0.05) analysed inter-group differences. Results: Demographics and baseline haemodynamics were equivalent. Mean sensory-block onset did not differ (11.3 ± 3.0 min vs 12.5 ± 4.7 min; p = 0.21) nor did motor-block onset (16.6 ± 3.2 min vs 17.4 ± 3.2 min; p = 0.30). Dexamethasone significantly prolonged sensory blockade (1107 ± 259 min vs 963 ± 80 min; p = 0.002) and motor blockade (1060 ± 261 min vs 940 ± 86 min; p = 0.012). VAS at 16 h favoured dexamethasone (0.57 ± 1.61 vs 1.71 ± 2.41; p = 0.023). Time-to-first rescue analgesia was longer with dexamethasone (1197 ± 276 min vs 1092 ± 226 min; p = 0.085). No severe adverse events occurred; modest bradycardia and hypotension were confined to the dexmedetomidine group. Conclusion: Dexamethasone confers a markedly longer block and superior mid-course analgesia than dexmedetomidine without clinically relevant haemodynamic compromise, suggesting it is the preferred adjuvant when sustained postoperative analgesia is desired.

Background: It was found that non-operative fixation of proximal humerus fractures can result in poor functional outcome both in elderly and young population. These fractures require proper reduction and fixation for good functional outcome. This can result in early return of patients to Daily activities of Living and earning reducing the social burden in the society. Aim and Objectives: To evaluate the fixation of proximal humerus fracture with PHILOS plating system in terms of union, range of movements and complications of fixation. Methodolgy: This was prospective intervention study carried out in department of Orthopaedics, Sri Venkateswara Medical College after attained proper scientific and ethical committee clearance. All the patients with proximal humerus fractures presenting to Orthopaedic OPD, causality were included into study after fulfilling inclusion and exclusion criteria. Sample size statistically calculated was 35. All socio-demographic data was collected. All the patients were evaluated with X ray, CT scan as required. Patients were operated with PHILOS plating. Functional outcome of the study population was evaluated with pain, union, Range of movements of shoulder, Constant and Muruley’s score and other complications were evaluated. Post-operative follow up was upto one year. Results: There were 35 patients included into the study. Majority of patients were male (22 patients) compared to female (13 patients). We had most of the patients from rural background. Most of patients had history of fall representing 42% in the study followed by Road traffic accident (22%), fall from height (20%). In all the patients we had unilateral injury only. We had twenty-six patients with dominant right side hand involvement. We had majority of (twenty-six) patients presenting to OPD or causality department within 0-5 days after injury. Further these patients had no prior treatment with native bandages or massage in the evaluated history. Only closed fractures were included in the study. We had good, fair and poor functional outcome in 28,4,3 patients respectively. Conclusion: PHILOS plating play good role in reduction and maintenance of reduction, early Post-Operative recovery and further good functional outcome in Neer’s two and three part closed fractures.

Background: FNAC is an ideal technique for the first line of diagnosis of palpable masses of the head and neck. The FNAC technique avoids surgical biopsy to find out benign or malignant tumors. Method: 65 patients with tumors or lesions in the head and neck aged between 5 to 65 years were studied with the FNAC technique. Before performing the FNAC, the clinical history of every patient was noted. In addition to CBC, AFB tests were also carried out (if necessary), and various clinical manifestations were noted and classified by percentage. Results: In the study of different organs or parts by the FNAC technique, 24 (36.9%) lymph nodes of the neck region, 18 (27.6%) thyroid lesions, 14 (21.5%), and 9 (13.8%) soft tissue lesions were studied and clinically correlated. Conclusion: FNAC of head and neck masses has high accuracy for correct therapeutic management. However, this accuracy depends on the anatomic location of the mass.

Background: Chronic liver disease (CLD) constitutes a major global health burden, with frequent hospital admissions due to hepatic decompensation and associated systemic complications. Differentiating between hepatic and extra-hepatic causes of hospitalization is critical for timely intervention and management. Objectives: To evaluate the underlying etiology of chronic liver disease and to analyze the clinical and epidemiological factors—both hepatic and extra-hepatic—responsible for hospitalization in CLD patients. Materials and Methods: This observational cross-sectional study was conducted at a tertiary care center and included 100 patients admitted with chronic liver disease. After obtaining informed consent, patients were evaluated through detailed clinical history, systemic examination, and appropriate laboratory and imaging investigations. Based on the predominant reason for admission, patients were categorized into hepatic or extra-hepatic cause groups. Statistical analysis was performed using SPSS version 26, with significance set at p<0.05. Results: Of the 100 patients, 70 were male and 30 were female, with a mean age of 43 years. Alcoholic liver disease (60%) was the leading etiology, followed by hepatitis B (25%), NASH (10%), and idiopathic causes (5%). Hospitalization was primarily due to hepatic causes in 80% of patients and extra-hepatic causes in 20%. Common symptoms included jaundice and abdominal distension. No statistically significant associations were found between etiology and type of cause or between cause type and duration of hospital stay (p > 0.05). Conclusion: Hepatic decompensation remains the predominant cause of hospitalization in CLD patients, with alcohol-related liver disease as the most common etiology. However, extra-hepatic causes such as infections and renal dysfunction are clinically important and warrant comprehensive evaluation to reduce morbidity and improve outcomes.

Background: Eye injuries are a common cause of visual disability, particularly in developing regions. They can lead to temporary or permanent loss of vision and often affect individuals during their most productive years. Identifying the demographic characteristics and reasons behind ocular trauma can help guide prevention and management strategies. Aim: To study the demographic details and contributing causes of ocular trauma cases reported in the Jaipur region. Methodology: A descriptive cross-sectional study was conducted on 100 ocular trauma patients at SMS Hospital, Jaipur, between March 2023 and April 2024. Patients with direct eye injuries who gave informed consent were included. Data on age, gender, socioeconomic status, cause and nature of trauma, and place of occurrence were collected using a structured proforma and analyzed in Microsoft Excel to identify patterns and contributing factors. Observations & Results: This study looked at 100 cases of eye injuries. Most patients were men (85%), and the highest number were aged 20–29 years. Almost equal numbers were from rural (51%) and urban (49%) areas. Many were skilled (46%) or semi-skilled (32%) workers, and over half were graduates. The most common causes of injury were road accidents (45%) and assaults (42%). Vision loss was seen more in the left eye (36%) than the right (27%). The study shows that young working men are most at risk of eye injuries, no matter where they live or how educated they are. Conclusion: Eye injuries are most common in young men, often caused by road accidents and fights. People from both rural and urban areas are equally affected. Even educated individuals are at risk. This shows the need for better safety awareness, use of eye protection, and early treatment to help prevent serious vision loss and problems later.

Background: Anaemia is a prevalent condition among children in India, affecting over 67% of those under five years of age. Infection and inflammation exacerbate anaemia through mechanisms involving inflammatory markers, such as C-reactive protein (CRP), which impair iron metabolism and haemoglobin (Hb) synthesis. Despite the high burden of anaemia and infection in Indian children, the relationship between CRP and Hb levels is not well-understood in hospitalised paediatric populations. This study aimed to investigate the correlation between CRP and haemoglobin levels in children aged 6 months to 5 years admitted with infection or inflammation at a tertiary care hospital. Methodology: A prospective observational study was conducted on 200 children admitted to the paediatric ward and PICU over six months. Blood samples were collected for Hb, CRP, total leukocyte count (TLC), and platelet count. CRP levels were measured using a high-sensitivity immunoturbidimetric assay. Spearman’s correlation and the Mann-Whitney U test were used for statistical analysis, with a significance level set at p < 0.05. Results: The mean Hb level was 10.62 g/dL, and the mean CRP level was 58.42 mg/L. A significant negative correlation between Hb and CRP levels was observed (Spearman’s rho = -0.254, p = 0.0006), indicating that higher CRP levels were associated with lower haemoglobin concentrations. TLC showed a positive correlation with CRP (p = 0.03). Conclusion: The study demonstrates a significant inverse relationship between CRP and haemoglobin levels in children with infection or inflammation. Elevated CRP may serve as a useful marker for identifying anaemia in paediatric patients.

Background: Cervical lymphadenopathy is a common and complex condition that can manifest as a local or systemic pathology, ranging from minor infections to life-threatening malignancies. Accurate diagnosis and management of cervical lymphadenopathy are crucial, as persistent and painless swelling of neck nodes can be a warning sign for serious conditions such as tuberculosis, cancer, and lymphoma. This study aims to investigate the clinical profile of patients presenting with cervical lymphadenopathy and correlate clinical diagnosis with pathological findings. Materials and Methods: A hospital-based observational study investigated the clinicopathological profile of cervical lymphadenopathy in patients attending the Department of Otorhinolaryngology, Assam Medical College & Hospital, and Dibrugarh for one year from March 2023 to February 2024. A total of 50 patients with cervical lymphadenopathy were enrolled, with a focus on symptoms, lymph node involvement, and diagnostic methods including clinical examination, fine-needle aspiration cytology (FNAC), and biopsy. Results: The majority of patients were males (58%), with a mean age of 36.86 years, and presented with unilateral cervical lymph node involvement (80%) and single lymph node enlargement (60%). Tuberculous lymphadenitis was the most common diagnosis (56%), followed by metastatic secondaries (20%), reactive lymphadenitis (10%), Hodgkin’s lymphoma (4%), non-Hodgkin’s lymphoma (4%) and granulomatous lymphadenitis (6%). Fine-needle aspiration cytology (FNAC) showed high diagnostic accuracy for tuberculous lymphadenitis, reactive lymphadenitis, and secondaries outperforming clinical diagnosis alone. Conclusion: This study highlights the importance of cervical lymphadenopathy as an indicator of underlying conditions, with tuberculous lymphadenitis being the most common cause in the Indian population. Fine-needle aspiration cytology (FNAC) and open biopsy with histopathological examination are essential diagnostic tools, enabling early detection and referral, particularly in resource-limited primary healthcare settings. The findings of this study can inform healthcare strategies to reduce diagnostic delays and improve treatment outcomes for tuberculosis and lymph node cancers.

Background: Head and neck squamous cell carcinoma (HNSCC) frequently presents at an advanced stage in India, limiting curative options. Palliative radiotherapy (RT) is a key intervention to achieve symptom relief, tumor control, and maintain quality of life. Objectives: To compare tumor response per RECIST 1.1 criteria and quality of life outcomes in patients receiving two different treatment modalities. Methods: This was a prospective, randomized study conducted at the Department of Radiation Oncology, SMS Medical College, and Jaipur. Sixty patients with histologically confirmed, locally advanced squamous cell carcinoma of the head and neck were randomized into two arms: Arm A received 30 Gy in 10 fractions; Arm B received the Christie regimen of 50 Gy in 16 fractions. Tumor response was assessed using RECIST 1.1 criteria, while acute toxicities were graded using CTCAE v4.03. Quality of life was evaluated using the EORTC QLQ-H&N35 questionnaire at baseline and during follow-up. Results: Both arms were demographically comparable with no significant differences in age, gender, residence, addictions, or comorbidities. Tumor response assessed by RECIST 1.1 showed higher partial response in the study arm (40%) than the control arm (33%), and lower progressive disease (27% vs. 37%), though not statistically significant (p > 0.05). Acute toxicities were similar across both groups. Quality of life scores favoured the study arm in physical, emotional, and cognitive domains, but differences were also not statistically significant. Conclusion: Both radiotherapy regimens provided comparable tumor control, toxicity profiles, and quality of life outcomes. While the study arm showed a non-significant trend toward better tumor response and QoL, both schedules remain effective options for palliative treatment in advanced HNSCC.

Purpose: To compare the assessment of pathological findings occurring in traumatic brain imaging between autopsy and ante-mortem CT in the clinical setting and to identify changes in these findings between the primary post traumatic CT and the last follow-up CT before death. Methods: Around 211 patients with traumatic brain injury were investigated. These patients had undergone ante-mortem CT as well as autopsy. During autopsy, the brain was cut in fronto-parallel slices directly after removal without additional fixation or subsequent histology. Typical findings of traumatic brain injury were compared between autopsy and radiology. Additionally, these findings were compared between the primary CT and the last follow-up CT before death. Results: After evaluating the results in a set of 211 deaths, a correlation was found between autopsy and CT findings in 174 cases, which accounts for 82.4%. There was a discrepancy between the findings in 53 cases, which accounts for 25.1%. After repeated targeted reviewing of CT images by clinical radiologists, the discrepancy rate decreased to 17%. Conclusion: Comparison between the primary CT after trauma and the last ante-mortem CT revealed marked changes in the findings, especially in patients with severe traumatic brain injury. Hence, clinically routine ante-mortem CT should be included in the process of autopsy interpretation.

Background: Cancer of the cervix is one of the most common malignancies affecting the women worldwide. Screening plays a crucial role in early detection of cancer there by reducing morbidity and mortality. Papanicolaou (Pap) smear test is a simple, non-invasive and cost-effective screening method which aids in early detection of premalignant and malignant lesions of cervix. The 2014 Bethesda System (TBS) provides uniform guidelines for reporting cervical cytology smears. Objectives: Main aim of the study is to evaluate and categorize various cytomorphological patterns in Pap smears according to the 2014 Bethesda System of reporting cervical cytology. Materials and Methods: Present study is a retrospective observational study conducted at a tertiary care center, in the Department of Pathology, Government Medical College, Anantapur, over a one-year period. Results: A total number of 2480 Pap smears were included and analyzed in the present study. Out of 2480 samples, 2386 (96.20%) were satisfactory for evaluation and 94 (3.80%) were unsatisfactory because of obscuring dense inflammation, smaller number of squamous cells and due to poor fixation of the smears. Age range of the patients was between 20 to 79 years, majority of cases observed in the 40-49 years age group, comprising of 810 (32.66%) cases. Epithelial cell abnormities were seen in 355 (14.31%) cases. Low grade Squamous Intraepithelial Lesion (LSIL) was reported in 238 (9.59%) cases, High grade Squamous Intraepithelial Lesion (HSIL) in 54 (2.17%) cases, Atypical Squamous Cells of Undetermined Significance (ASCUS) in 47 (1.89%) cases, Atypical glandular cells in 12 (0.48%) cases, Squamous cell carcinoma in 3 (0.12%) cases, and Adenocarcinoma in 1 (0.04%) case. 1781 (71.81%) cases were reported as Negative for Intraepithelial Lesion or Malignancy. Conclusion: Present study highlights the usage of 2014 Bethesda System as a standardized and effective tool of reporting for evaluating cervical cytology smears. Majority number of cases were reported as Negative for Intraepithelial Lesion or Malignancy. A significant number of cases also showed various epithelial abnormalities like LSIL, HSIL, and ASCUS. The study highlights the importance of routine cervical cancer screening, especially in reproductive and perimenopausal age group women, there by detecting premalignant lesions early and initiate timely intervention.

Background: Breast cancer is the most prevalent malignancy among women globally. Emerging evidence suggests a significant link between altered cholesterol metabolism and breast cancer progression. Cholesterol and its derivatives—particularly free and esterified forms—play pivotal roles in tumor growth, proliferation, and therapeutic resistance by influencing cellular signaling and membrane integrity. Aim: To evaluate and compare the serum levels of total, free, and esterified cholesterol among patients with malignant breast tumors, benign breast lesions, and healthy controls, and to assess their potential as diagnostic biomarkers in breast cancer pathophysiology. Methods: This prospective observational study was conducted over two years at AHPGIC, Cuttack, and included 80 female participants—25 with histopathologically confirmed malignant breast cancer, 28 with benign breast lesions, and 27 healthy controls. Fasting serum samples were collected and analyzed using proton nuclear magnetic resonance (¹H-NMR) spectroscopy. Statistical analyses, including ANOVA, ROC curve analysis, and correlation tests, were performed using SPSS version 23.0. Results: The mean total cholesterol levels were significantly higher in both benign (0.024 ± 0.027) and malignant (0.023 ± 0.005) groups compared to controls (0.011 ± 0.006) (p = 0.01). Similar significant elevations were observed in free cholesterol (p = 0.001) and esterified cholesterol (p = 0.001) levels. ROC curve analysis showed total cholesterol had the highest diagnostic accuracy for malignancy, with an AUC of 0.95, sensitivity of 86.2%, and specificity of 88.9%. No significant associations were found between cholesterol levels and hormone receptor status (ER, PR, HER2). Conclusion: Serum cholesterol metabolites—particularly total and esterified cholesterol—are significantly elevated in both benign and malignant breast lesions compared to healthy individuals. These findings suggest that cholesterol metabolism is dysregulated in breast pathology and could serve as a potential non-invasive diagnostic marker in clinical practice. Recommendations: Further large-scale, multicentric studies are recommended to validate the diagnostic utility of cholesterol metabolites. Additionally, exploring the therapeutic potential of targeting cholesterol metabolism in breast cancer could open new avenues for metabolic-based interventions.

Overview: Road traffic accidents are the primary cause of tibial plateau fractures worldwide, and they are frequently the consequence of high-energy trauma. Since the knee joint supports the majority of the body weight, damage to the tibial plateau seriously alters its biomechanics, leading to instability and joint incongruity. Simple lateral condylar fractures to complicated metaphysis comminuted fractures, frequently accompanied by soft tissue injuries, are among the range of injuries. The morphology of the fracture and any related ligamentous or soft tissue compromise must be taken into account when designing the course of treatment. Objectives: (1) To evaluate fracture types, age distribution, and injury mechanisms. (2) To use internal fixation to accomplish joint congruity and anatomical reduction. (3) To compare the union time of fractures treated with locking compression plates to those treated with non-locking buttress plates. (4) To record complications during and after surgery. (5) To track knee scoring and range of motion at every follow-up. (6) To contrast the two treatment modalities’ overall functional results. Methods: Data were gathered using structured forms for this prospective study, which documented patient demographics, injury mechanisms, fracture classification, surgical procedures, and results. Surgery was carried out under senior supervision after informed consent was acquired. The Knee Society Score was used to evaluate functional outcomes. Findings: Of the patients in the locking plate group, two had fair results, four had good results, and twenty-one had excellent results. The non-locking buttress plating group, on the other hand, produced four excellent, five good, fourteen fair, and four poor results. The locking plate group had a statistically significant functional benefit, as evidenced by the significantly higher average Knee Society Score (86.59 ± 6.33) than the non-locking group (70.22 ± 12.07). Conclusion: locking plate fixation improves joint alignment and range of motion by increasing stability and preventing articular surface collapse. According to the study, locking compression plate fixation is the best way to treat tibial plateau fractures, especially when it comes to improving joint preservation and functional results.

Objectives: The present study was to determine the IVC”Collapsibility Index and to establish the correlation of IVC Collapsibility index with other hemodynamic parameters in various subgroup patients. Methods: A total of 150 patients with age group 18-65 years requiring volume resuscitation were enrolled in the present study. Data was collected by random sampling methods with irrespective of sex. The cardiovascular parameters at the time of admission were recorded and again repeated every three hourly for first twelve hours. Measurement of IVC Collapsibility Index was calculated. Results: Majority “of the subjects (57%)” belonged to the age group 51-65 years. Only 11% of the subjects were aged 18-30 years. 92(66%) cases were males and 48(34%) were females. The commonest etiologies among the study subjects were found to be hemorrhage (27.3%), respiratory failure (25.3%), congestive cardiac failure (22.6%), End Stage Renal Disease 30 (20%), Sepsis 17 (11.3%), Abdominal Hypertension 3 (2%) and others 12 (8%). The commonest co-morbidity reported among the study subjects was Type-2 diabetes mellitus reported in 36% of the subjects. Hypertension was reported in 30.6% and COPD in 28% cases.  Nearly 40.6% of the subjects were hypovolemic. This was followed by 33.3% who were euvolemic. The mean IVC”-CI decreases gradually from 0.64 at admission to 0.25 by 12 hours of admission. Conclusions: Shock was more common in old age male population. Congestive cardiac failure was the commonest etiology of shock followed by respiratory failure and end stage renal disease. Most common comorbidity was diabetes mellitus followed by hypertension and COPD. The correlation coefficient of MAP with IVC CI is statistically significantly reduced in shock patients.

Aim: This retrospective study evaluated surgical alignment outcomes in 60 patients (mean age 32.2±15.2 years) with large-angle exodeviation (mean preoperative deviation 54±7 PD) treated over a 5-year period. Material and Methods: Surgical techniques included bilateral lateral rectus recession (BLR, 50%), unilateral lateral rectus recession with medial rectus resection (R&R, 33%), and three-muscle procedures (17%). Result: Success (defined as residual deviation ≤10 Δ exotropia or ≤5 Δ esotropia) was achieved in 43 patients (72%), with no significant differences by age or gender (p>0.05). Mean postoperative alignment improved significantly to 3.8±9.2 Δ (paired t-test, p<0.001). BLR cases had a higher success rate (87%) than R&R (40%) (χ², p<0.001), consistent with previous reports Overall complication rates (transient diplopia, mild overcorrection) were low. Conclusion: These findings confirm that two- and three-muscle surgeries can achieve good motor outcomes in large exodeviations, though very large preoperative angles may require additional muscles.

Object: High myopia is a rapidly progressive error characterised by degenerative changes due to rapid axial prolongation of the eyeball. This elongation of posterior segment of eye, leads to progressive stretching and thinning of sclera and retina. Optical coherence tomography (OCT) is a highly reproducible technique that can measure macular thickness to enhance the understanding of the pathophysiology of high myopia and its relationship with other ocular diseases. Methods and Materials: All the patients with refractive error > – 5D spherical equivalents were included in the study, detailed history was taken and a thorough clinical examination was done. Axial length was measured using contact A-scan. Optical Coherence Tomography was done to measure average macular thickness, central macular thickness, and macular volume.  All patients enrolled in our study were subdivided into 3 different groups according to refractive status and axial length. Results: Total 86 eyes with high myopia were included. the mean macular thickness was 267.866 ± 17.150 µm in eyes with axial length in the range of 24.01 – 26 mm and 257.314 ± 19.062 µm in eyes with axial length > 26 mm. This shows that the macular thickness decreases with increase in the axial length. Conclusion: Conclusion of study is that macular thickness decreases as axial length or diopteric power increases in myopic eyes so It is important to consider axial length and diopteric power of eye while interpreting OCT Macula.

Background: Type 2 diabetes mellitus is rapidly increasing in rural India, where limited healthcare access and awareness pose significant challenges for complication prevention. This study assessed awareness of diabetic complications among type 2 diabetes patients in a rural healthcare setting. Methods: A cross-sectional study was conducted among 100 type 2 diabetic patients (aged 18-60 years) at a rural health center in Visakhapatnam, India. Data were collected using a validated questionnaire administered in Telugu. Descriptive statistics and chi-square tests were used for analysis. Results: Among participants, 60% were females, 77% aged 46-65 years, and 44% were illiterate. Overall, 86% were aware that diabetes causes complications, with health workers being the primary information source (74%). Only 43% correctly identified normal fasting blood glucose levels. Awareness of specific complications was highest for hypertension (30%), heart disease (29%), and eye complications (28%). Knowledge of preventive measures was good: dietary modification (92%), smoking/alcohol cessation (72%), and exercise (65%). Conclusions: While general complication awareness was high, specific knowledge gaps exist regarding blood glucose targets and symptom recognition. Targeted educational interventions focusing on clinical parameters and emergency management are needed in rural diabetes care.

Background: Type 2 diabetes mellitus (T2DM) represents a major global health challenge, with cardiovascular autonomic dysfunction emerging as a critical complication contributing to increased morbidity and mortality. Baroreflex sensitivity (BRS) and heart rate variability (HRV) serve as key indicators of autonomic function, while obesity—a common T2DM comorbidity—may further compromise these parameters. Objective: To assess and compare BRS and HRV between non-obese and obese T2DM patients without neuropathy, identifying early markers of autonomic dysfunction for improved risk stratification. Methods: This cross-sectional study enrolled 60 T2DM patients divided equally into non-obese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²) groups. BRS was evaluated using specialized baroreflex testing equipment, while HRV was assessed through electrocardiogram recordings. Statistical analyses compared autonomic parameters and metabolic profiles between groups. Results: Obese patients demonstrated significantly reduced BRS and HRV compared to non-obese patients (p < 0.05). The obese group exhibited elevated sympathetic activity, diminished parasympathetic modulation, and inferior glycemic control. Additionally, these patients presented with higher systolic (138 ± 10 vs. 124 ± 8 mmHg, p = 0.01) and diastolic blood pressures (82 ± 7 vs. 74 ± 6 mmHg, p = 0.015), increased triglyceride levels (200 ± 30 vs. 140 ± 25 mg/dL, p < 0.001), and reduced HDL cholesterol concentrations (42 ± 7 vs. 50 ± 8 mg/dL, p = 0.01). Conclusions: Obesity significantly exacerbates autonomic dysfunction in T2DM patients, with reduced BRS and HRV values indicating compounded cardiovascular risks. These parameters represent valuable early markers for identifying high-risk individuals. Routine monitoring of BRS and HRV should be incorporated into clinical practice to enable early detection of cardiovascular risk.

Background: Otitis Media with Effusion (OME) is one of the most common causes of hearing loss and learning difficulty among school-age children. Its asymptomatic nature often leads to delayed diagnosis and intervention. Objective: To estimate the prevalence of OME among school-age children and analyze the associated demographic and risk factors. Methods: A cross-sectional study was conducted in urban and rural schools among 500 children aged 5–12 years. Otoscopic examination, tympanometry, and hearing assessments were performed. Data on socio-demographic variables and risk factors were collected via structured questionnaires. Results: The overall prevalence of OME was 12.4%. It was higher in boys (14.6%) than girls (10.2%), and in rural (16.1%) than urban (8.6%) children. Major risk factors identified were recurrent upper respiratory tract infections, exposure to passive smoking, and low socioeconomic status. Conclusion: OME is prevalent in a significant number of school-aged children. Early screening and intervention in schools, particularly in rural and low-income populations, are essential to prevent long-term complications.

Background: Oral Submucous Fibrosis (OSMF) is a chronic, progressive, and debilitating disorder of the oral cavity with high malignant potential, predominantly associated with areca nut chewing. Intra-lesional therapy using corticosteroids like dexamethasone and enzymes such as hyaluronidase has gained popularity in clinical management. Objective: This study aimed to evaluate and compare the efficacy of intra-lesional infiltration of dexamethasone plus hyaluronidase before and after treatment in patients with OSMF in terms of clinical parameters like mouth opening, burning sensation, and cheek flexibility. Methods: A prospective interventional study was conducted on 30 clinically diagnosed OSMF patients. All patients received intra-lesional injections of dexamethasone (4 mg/ml) and hyaluronidase (1500 IU) biweekly for six weeks. Clinical parameters were recorded pre-treatment and post-treatment, including interincisal mouth opening (mm), burning sensation (VAS score), and cheek flexibility. Results: A statistically significant improvement was observed in all clinical parameters. Mean mouth opening improved from 22.5 mm to 32.1 mm (p<0.001), burning sensation VAS scores reduced from 7.6 to 2.3 (p<0.001), and cheek flexibility improved significantly. No serious adverse effects were reported. Conclusion: Intra-lesional infiltration of dexamethasone plus hyaluronidase is an effective and safe modality for improving mouth opening and reducing symptoms in OSMF patients. This combination therapy can be considered as a frontline non-surgical approach in early and moderate stages of the disease.

Introduction: Cataract surgery is an essential part of blindness prevention efforts and not only a therapeutic intervention. The two most often used methods, phacoemulsification and small incision cataract surgery (MSICS), each have unique benefits and drawbacks. A successful and economical method that works well for high-volume cataract programs is small incision cataract surgery. However, because of its central wound site and controlled astigmatism, phacoemulsification provides more accuracy in reaching goal refraction. Present study was planned to assess demographic profile, visual acuity &Postoperative Complications in small incision cataract surgery (SICS) Vs phacoemulsification. Materials and Methods: Present study is a cross-sectional prospective study conducted between duration 2023 to 2024. 60 Patients of visually significant, operable age-related cataract between age 40-80 years of both genders were enrolled. Total 60 cases were divided as Group A n=30 (small incision cataract surgery (SICS))& Group B n=30 (phacoemulsification). All surgeries were performed using standardized protocols under peribulbar anaesthesia. Visual acuity, Endothelial cell count & Postoperative complications were noted on follow up. Observations and Results: Present study is a cross-sectional prospective study conducted between duration 2023 to 2024. mean ± SD for age in Group A was 55.9±6.49 & in Group B was 56.33±7.09. Male cases were 35 (58 %) & Females were 25 (42 %). Pre-op BCVA & BCVA after 6th week showed statistically significant difference with improvement in vision amongst both Group A (P<0.00001) as well as Group B (P=0.00001) Conclusion: This study shows that phacoemulsification and small incision cataract surgery (SICS) both works well to restore vision, with phacoemulsification providing somewhat better early visual results and fewer side effects.

We report a series of five cases of atypical pneumonia accompanied by hypoxemia, diagnosed through IgM ELISA scrub typhus testing. The diverse presentations and frequent underdiagnosis of scrub typhus suggest its prevalence is likely underreported. Life-threatening cases of scrub typhus-associated interstitial pneumonia and acute respiratory distress syndrome (ARDS) have common clinical and radiological findings that can be effectively treated with doxycycline. These cases demonstrate a range of clinical presentations that often mimic other conditions, leading to delayed diagnosis.

Overview: Road traffic accidents are the primary cause of tibial plateau fractures worldwide, and they are frequently the consequence of high-energy trauma. Since the knee joint supports the majority of the body weight, damage to the tibial plateau seriously alters its biomechanics, leading to instability and joint incongruity. Simple lateral condylar fractures to complicated metaphysis comminuted fractures, frequently accompanied by soft tissue injuries, are among the range of injuries. The morphology of the fracture and any related ligamentous or soft tissue compromise must be taken into account when designing the course of treatment. Objectives: (1) To evaluate fracture types, age distribution, and injury mechanisms. (2) To use internal fixation to accomplish joint congruity and anatomical reduction. (3) To compare the union time of fractures treated with locking compression plates to those treated with non-locking buttress plates. (4) To record complications during and after surgery. (5) To track knee scoring and range of motion at every follow-up. (6) To contrast the two treatment modalities’ overall functional results. Methods: Data were gathered using structured forms for this prospective study, which documented patient demographics, injury mechanisms, fracture classification, surgical procedures, and results. Surgery was carried out under senior supervision after informed consent was acquired. The Knee Society Score was used to evaluate functional outcomes. Findings: Of the patients in the locking plate group, two had fair results, four had good results, and twenty-one had excellent results. The non-locking buttress plating group, on the other hand, produced four excellent, five good, fourteen fair, and four poor results. The locking plate group had a statistically significant functional benefit, as evidenced by the significantly higher average Knee Society Score (86.59 ± 6.33) than the non-locking group (70.22 ± 12.07). Conclusion: locking plate fixation improves joint alignment and range of motion by increasing stability and preventing articular surface collapse. According to the study, locking compression plate fixation is the best way to treat tibial plateau fractures, especially when it comes to improving joint preservation and functional results.

Introduction: Perinatal asphyxia is a leading cause of neonatal mortality, often resulting in hypoxic-ischemic encephalopathy (HIE) and multi-organ dysfunction. This study aimed to evaluate biochemical and radiological parameters for early identification and staging of HIE in full-term neonates, aiding timely intervention and guiding future neuroprotective strategies. Methods: This prospective observational study included full-term neonates <24 hours old with perinatal asphyxia at a tertiary hospital in Warangal. HIE severity was staged using Modified Sarnat and Levene systems. Biochemical tests and neuroimaging (cranial ultrasound, MRI) were performed to assess early markers and outcomes until discharge or death. Results: Among 50 neonates, increasing HIE severity correlated significantly with biochemical abnormalities and radiological findings. Metabolic acidosis, thrombocytopenia, hypocalcemia, hyponatremia, elevated SGPT, and higher urinary protein: creatinine ratio (UPCR) were more frequent in advanced stages. Radiological changes and mortality also increased with severity, highlighting the prognostic value of combined clinical and diagnostic assessment. Conclusion: Biochemical and radiological abnormalities correlate significantly with increasing HIE severity. Thrombocytopenia, metabolic acidosis, and imaging findings aid early prognostication. Mortality rises with HIE stage, underlining the importance of comprehensive evaluation. Combining clinical staging systems with laboratory and imaging data enhances diagnosis and guides effective management in neonatal HIE.

Introduction: Postoperative pain control is vital for recovery. Intravenous patient-controlled analgesia (PCA) enables patient-directed analgesia. Butorphanol and tramadol are commonly used due to their distinct mechanisms and safety profiles. This study aims to compare the efficacy, side effects, and patient satisfaction of IV PCA using butorphanol versus tramadol after major surgeries under general anesthesia. Methods: This randomized, double-blind study was conducted at K.S. Hegde Medical Academy from January 2014 to July 2015. Patients aged 18–70 years undergoing major surgeries under GA were randomized into three PCA groups (butorphanol, tramadol, morphine). Pain scores, sedation, adverse effects, and satisfaction were assessed over 24 hours postoperatively. Results: Among 100 participants equally divided into three groups, tramadol showed the highest pain scores, PCA demand, and adverse events. Butorphanol had better analgesia, higher sedation, and no adverse effects. Morphine required no rescue doses. Overall, patient satisfaction was highest with butorphanol and lowest with tramadol, despite similar statistical ratings. Conclusion: Butorphanol-based IV PCA provided effective analgesia with minimal adverse effects and high patient satisfaction, making it a viable alternative to morphine. Tramadol was less effective, requiring more rescue doses and producing more side effects. Thus, butorphanol appears to offer the best balance of efficacy, safety, and patient comfort.

Background: Malnutrition is a prevalent yet often under-recognized risk factor among patients undergoing gastrointestinal (GI) cancer surgery, contributing significantly to postoperative morbidity and delayed recovery. Nutritional optimization prior to surgery may mitigate complications and enhance surgical outcomes. This prospective interventional study aimed to assess the effect of structured preoperative nutritional support on postoperative complications in GI cancer patients. Materials and Methods: This was a prospective, single-center interventional study conducted over 18 months, enrolling 120 adult patients scheduled for elective surgery for GI malignancies. Participants were screened using the Nutritional Risk Screening-2002 (NRS-2002) tool. Patients with moderate to severe malnutrition (NRS score ≥3) received individualized nutritional support—including oral supplements and/or enteral nutrition—for a minimum of 10 days before surgery. Postoperative outcomes including infectious and non-infectious complications, length of hospital stay, and 30-day readmission rates were recorded and compared with a historical control group of 100 patients who had not received preoperative nutritional intervention. Results: Among the 120 patients, 78 (65%) were identified as at nutritional risk. The intervention group showed a statistically significant reduction in overall postoperative complications (24.2% vs 42.0%, p = 0.018), surgical site infections (9.2% vs 19.0%, p = 0.041), and mean length of hospital stay (8.3 ± 2.1 vs 11.4 ± 3.0 days, p < 0.001) compared to controls. The 30-day readmission rate was also lower in the intervention group (6.7% vs 12.0%, p = 0.146), although not statistically significant. Conclusion: Preoperative nutritional optimization significantly reduces postoperative complications and shortens hospital stay in patients undergoing GI cancer surgery. Early nutritional screening and timely intervention should be integrated into the routine preoperative care of oncologic surgical patients.

Background: Acute cholecystitis is a common surgical emergency often managed by laparoscopic cholecystectomy. However, the timing of surgery—early (within 72 hours) versus delayed (after 6 weeks)—remains a subject of clinical debate. This study aimed to compare the perioperative and postoperative outcomes of early versus delayed laparoscopic cholecystectomy in patients with acute cholecystitis. Materials and Methods: This multicenter prospective cohort study was conducted for one year at three tertiary care centers. A total of 240 patients diagnosed with acute cholecystitis were enrolled and allocated into two groups: Group A (early laparoscopic cholecystectomy, n = 120) and Group B (delayed laparoscopic cholecystectomy, n = 120). Outcomes assessed included operative time, hospital stay, conversion to open surgery, intraoperative complications, and postoperative morbidity. Statistical analysis was done using SPSS v26.0, and p < 0.05 was considered significant. Results: The mean operative time was significantly lower in Group A (61.4 ± 12.6 minutes) compared to Group B (74.8 ± 15.2 minutes, p = 0.001). The average length of hospital stay was also shorter in Group A (3.2 ± 1.1 days) versus Group B (5.6 ± 1.4 days, p < 0.001). Conversion to open cholecystectomy occurred in 5.8% of early cases and 12.5% of delayed cases (p = 0.04). Postoperative complications such as wound infection and bile leak were lower in the early group (10.8%) than in the delayed group (18.3%), though this was not statistically significant (p = 0.07). Conclusion: Early laparoscopic cholecystectomy in acute cholecystitis offers significant benefits over delayed surgery, including reduced operative time, shorter hospital stay, and fewer conversions to open procedures. Early intervention should be considered the preferred strategy in clinically stable patients.

Introduction: Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of type 2 diabetes mellitus, often underdiagnosed and associated with significant morbidity. Early detection and evaluation are crucial for timely management and prevention of long-term disability. Materials and Methods: This cross-sectional study was conducted over one year in a tertiary care hospital and included 210 adult patients with type 2 diabetes mellitus. Patients were categorized based on the duration of diabetes and assessed for neuropathy using Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), and Biothesiometer testing (BTS). Demographic, clinical, and metabolic data were collected and analyzed statistically. Results: Neuropathy was found in 31.43% of patients by NSS, 13.81% by NDS, and 34.29% by BTS. The prevalence increased significantly with longer duration of diabetes and higher HbA1c levels. BTS ≥15 was present in 48.57% of patients with diabetes ≥10 years and in 47.30% of those with HbA1c ≥10.5%. Obesity, higher waist circumference, hypertension, and advanced age were also associated with higher rates of neuropathy. Conclusion: Diabetic peripheral neuropathy shows strong correlation with poor glycemic control, longer disease duration, obesity, and hypertension. Early screening and comprehensive risk management are essential to reduce neuropathic complications in patients with type 2 diabetes.

Background: Diabetes mellitus (DM) is a chronic condition characterized by high blood sugar due to issues with insulin action or secretion. While systemic complications like cardiovascular and renal disorders are well-documented, the skin-related complications of DM are less explored despite their frequency and clinical significance. This study investigates the types and frequency of skin manifestations in diabetic patients and their correlation with glycemic control and disease duration. Material and Methods: This cross-sectional observational study conducted over 6 months included 200 diabetic patients, diagnosed with Type 1 or Type 2 diabetes for at least one year. Participants underwent a clinical examination, and laboratory tests (blood glucose levels and HbA1c) were performed to correlate skin findings with glycemic control. Data analysis aimed to determine the prevalence and distribution of dermatological manifestations. The chi-square test was used to analyze the correlation between skin manifestations and HbA1c levels as well as disease duration. Results: Among the 200 patients, 122 (61%) were females, and 78 (39%) were males, with a mean age of 52±9.28 years. The majority (92%) had Type 2 diabetes. Of the total, 176 (88%) exhibited skin manifestations, with a higher frequency in females (91.8%). The most common skin conditions were infections (46.5%), xerosis (34.5%), and pruritus (33.5%). Other prevalent issues included acanthosis nigricans (27%) and skin tags (21.5%). Foot ulcers and gangrene were observed in 12% of cases. Uncontrolled glycemic levels (HbA1c >8%) correlated with an increased prevalence of skin complications (p<0.001), with skin infections affecting 54.6% of poorly controlled patients versus 18.2% of well-controlled patients. Disease duration also showed a significant correlation with cutaneous manifestations, with complications increasing from 28.1% in patients with <5 years duration to 75% in those with >15 years (p=0.023). Conclusion: The study emphasizes the high prevalence of skin issues in diabetic patients, particularly infections, and the need for better glycemic control to prevent dermatological complications. Poor glycemic control and longer disease duration were significantly associated with an increased prevalence of cutaneous manifestations. Further, the study’s cross-sectional design and limited sample size suggest the need for longitudinal research in more diverse populations to explore this relationship further.

Rheumatoid arthritis (RA) is a chronic autoimmune condition that, while primarily targeting joints, can also affect the peripheral nervous system, leading to additional functional impairment. This study investigated nerve conduction velocities (NCVs) in individuals with RA to identify both overt and sub-clinical neuropathic changes. A total of 120 participants—comprising 60 RA patients and 60 age-matched healthy controls (ages 30–60)—were evaluated at a tertiary care center using standardized electrophysiological protocols. Bilateral NCV assessments were conducted on the median, ulnar, and peroneal nerves. Findings revealed significant reductions in conduction velocities, prolonged distal latencies, and decreased amplitudes of compound muscle action potentials and sensory nerve action potentials in RA patients. Notably, these abnormalities were observed even in individuals without neurological symptoms, highlighting the presence of sub-clinical neuropathy. Neuropathic involvement was more severe in patients reporting symptoms. The data support the hypothesis that peripheral nerve dysfunction in RA is driven by a combination of immune-mediated inflammation, vascular involvement, and structural compression. These results underscore the value of incorporating routine nerve conduction testing into the clinical evaluation of RA patients, regardless of symptom presentation, to enable earlier intervention and optimize quality of life.

Background: Lateral epicondylitis (LE) impairs grip strength and daily activities. Mobilisation-with-movement (MWM) and Mulligan’s taping both restore a pain-free lateral glide at the radio-humeral joint, but their relative efficacy remains uncertain. Methods: Forty adults (25–55 y) with symptomatic LE were block-randomised to MWM (n = 20) or Mulligan taping (n = 20). Both groups received identical conventional care (pulsed ultrasound, stretching and progressive strengthening) for ten consecutive weekdays. Outcomes—pain (10-cm VAS), grip strength (Jamar™ dynamometer) and function (Patient-Rated Tennis Elbow Evaluation, PRTEE)—were measured at baseline, day 5 and day 10. Data were analysed with repeated-measures ANOVA and Mann–Whitney U tests (α = 0.05). Results: Mean VAS fell from 6.4 ± 1.0 to 0.9 ± 0.7 in the MWM group and from 6.2 ± 1.2 to 1.8 ± 1.0 with taping (p < 0.01 between groups). Grip strength rose by 11.8 kg (MWM) versus 8.2 kg (taping; p < 0.001). PRTEE improved by 41 points after MWM and 36 points after taping (p = 0.001). No adverse events occurred. Conclusion: Both techniques produced rapid, clinically meaningful improvements, but MWM yielded larger gains in pain relief, grip strength and functional recovery within 10 days. MWM should be preferred when skilled manual therapy is available, whereas taping remains a pragmatic option where therapist contact is limited.

Background: Cervical radiculopathy is characterised by neck pain radiating to the upper limb secondary to mechanical or inflammatory nerve-root irritation. Neural tissue mobilisation (NTM) has been shown to improve intraneural circulation and reduce mechanosensitivity, whereas Sustained Natural Apophyseal Glides (SNAGs) restore zygapophyseal joint mechanics and may decompress the inter-vertebral foramen. Whether combining SNAGs with NTM confers additional immediate benefit remains unclear. Methods: Fifty adults (mean ± SD age 38 ± 9 y) with sub-acute (2 weeks–6 months) cervical radicular pain and a positive upper-limb neurodynamic test 1 (ULNT-1) were randomised to (Group A: NTM alone) or (Group B: SNAGs + NTM). Single-session interventions were applied by experienced physiotherapists. Primary outcomes were pain (10-cm visual-analogue scale, VAS) and painless elbow-extension range during ULNT-1, measured immediately pre- and post-treatment by a blinded assessor. Results: Both groups improved significantly. VAS fell from 5.8 ± 1.6 to 3.0 ± 2.5 in group A and from 6.1 ± 2.1 to 2.7 ± 2.2 in group B (both p < 0.001). Elbow extension increased from 80.7° ± 23.1° to 100.5° ± 24.9° in group A and from 85.1° ± 22.8° to 95.2° ± 25.8° in group B (both p < 0.001). Between-group analysis showed a larger range-gain in group A (Δ 19.8° ± 11.2°) than group B (Δ 10.1° ± 8.5°, p = 0.001), whereas pain reduction did not differ (p = 0.36). Conclusion: A single bout of NTM or SNAGs + NTM produces clinically meaningful immediate analgesia in cervical radiculopathy. NTM alone yields greater improvement in neural mechanosensitivity as expressed by elbow-extension range, while the pain-relieving effect of adding SNAGs is not superior to NTM. Larger trials with longer follow-up are needed to determine sustained and dose-response effects.

Background: Foreign body (FB) insertion in the ear, nose, and throat (ENT) is common, particularly among children. Early diagnosis and appropriate intervention are critical to avoid complications. Objective: To evaluate the incidence, types, clinical presentation, and management strategies of ENT foreign bodies in a tertiary care hospital. Methods: A descriptive observational study was conducted from August 2023 to February 2025 including 200 patients with ENT foreign bodies. Data on demographics, FB type and site, symptoms, management methods, and complications were recorded and analyzed. Results: Ear was the most common site (42%) followed by the nasal cavity (33%) and aerodigestive tract (25%). Seeds (34.5%) and miscellaneous objects (21.5%) were the most common FB types. Most removals (38.5%) were done without anaesthesia. Complications were minimal. Conclusion: ENT foreign bodies are more prevalent among children, with seeds being the most common FB. Early diagnosis and proper technique ensure effective management with minimal complications.

Background and Aim: Ventriculo-peritoneal (VP) shunt is the commonest form of the CSF diversion procedure for hydrocephalus. It involves the placement of a ventricular catheter, into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed. Objectives of the present study are: to study the clinical and radiological outcome of ventriculoperitoneal shunt surgery, to study the factors affecting the outcome of ventriculoperitoneal shunt surgery and to study the complications of ventriculoperitoneal surgery. Material and Methods: This prospective study was conducted in the Department of Neurosurgery, St. Stephens`s Hospital, Tis Hazari, New Delhi. Patients were diagnosed as having hydrocephalus on clinical and radiological grounds. The size of the ventricles on CT scan, Evans ratio and periventricular lucency were noted. Etiology of hydrocephalus was established from history, physical findings and investigations. Follow-up of patients was scheduled at 1 week, 1 month, 3 months and 6 months. The patient diagnoses were grouped into following categories: idiopathic, tumors/cysts, subarachnoid haemorrhage, postcraniotomy, posttraumatic, intracranial haemorrhage, intraventricular haemorrhage and other. Results: Hydrocephalus secondary to infective etiology was the most common indication for shunt surgery in our study accounting for 12 cases (37.5%). Congenital etiology was the second most common, comprising of 10 cases (31.25%). Of total 32 patients, 28 patients (87.5%) had a good outcome at 6 months follow-up while 4 patients (12.5%) had a poor outcome. Out of 4 patients, one was adult while 3 patients were children. Conclusion: Age, sex, etiology of hydrocephalus, surgery done in routine or emergency setting and surgery done at day or night time did not significantly correlate with the outcome at 6 month follow up.

Background: This study aimed to compare how effective and safe intrathecal hyperbaric levobupivacaine 0.5% is against hyperbaric ropivacaine 0.75% for spinal anesthesia in surgeries below the umbilicus, with a particular focus on the characteristics of sensory and motor blockade. Method: In terms of methods, we conducted a prospective, randomized, double-blind study at a tertiary care center. We enrolled sixty-six patients classified as ASA I/II, aged between 18 and 60, who were set to undergo infra-umbilical surgeries. These patients were randomly assigned to receive either 3 ml of hyperbaric levobupivacaine 0.5% (15 mg, referred to as Group L, n=33) or 3 ml of hyperbaric ropivacaine 0.75% (22.5 mg, referred to as Group R, n=33). The primary outcomes we looked at were the onset and duration of sensory loss (to T8, with regression to S1) and motor blockade (measured using the Modified Bromage scale). For secondary outcomes, we assessed hemodynamic stability and any adverse events that occurred. We performed statistical analysis using the appropriate parametric and non-parametric tests, considering a p-value of less than 0.05 as significant. Result: The groups were similar in terms of demographics. Group L showed a notably quicker sensory response (7.79 ± 0.99 min compared to 9.64 ± 1.75 min, p<0.01) and motor onset (11.09 ± 1.31 min versus 14.42 ± 1.77 min, p<0.01). The duration of sensory (200.15 ± 4.60 min vs. 174.18 ± 5.60 min, p<0.01) and motor effects (225.06 ± 5.74 min vs. 196.61 ± 5.84 min, p<0.01) was significantly longer in Group L. The time to first analgesia was also longer with levobupivacaine (13.23 ± 1.17 hrs vs. 10.87 ± 0.92 hrs, p<0.01). Throughout the study, hemodynamic parameters remained comparable (p>0.05). Group L experienced slightly higher rates of hypotension (9.1% vs. 3.0%, p=0.61) and bradycardia (9.1% vs. 0%, p=0.23), although these differences were not statistically significant. Conclusion: In conclusion, hyperbaric levobupivacaine 0.5% offers a quicker onset and longer-lasting sensory and motor blockade, as well as analgesia, compared to hyperbaric ropivacaine 0.75%. For extended analgesia, levobupivacaine is the better choice, while ropivacaine’s quicker recovery might be more advantageous in outpatient settings. Both options provide similar hemodynamic stability during infra-umbilical spinal anesthesia.

Background: Osteoarthritis (OA) is a degenerative whole-joint disease with progressive cartilage loss and structural changes in synovium, ligaments, menisci, and subchondral bone. Key risk factors include age, obesity, gender, metabolic syndrome, and low-grade inflammation. Emerging evidence implicates mineral metabolism and uric acid in OA pathogenesis. Objectives: To assess serum calcium, phosphorus, and uric acid levels in patients with knee OA compared to healthy controls, and explore their interrelations and potential as biomarkers. Methods: A case–control study enrolled 200 newly diagnosed knee OA patients (age 40–60) and 100 age- and sex-matched healthy controls. Serum samples were analysed for calcium (OCPC method), phosphorus (metol method), and uric acid (Uricase/PAP). Statistical comparisons used unpaired t-tests and Pearson’s correlation, with significance set at p<0.05. Results: OA patients exhibited significantly lower serum calcium (mean ± SD: 1.51 ± 0.29 mmol/L vs. control 2.29 ± 0.15; p<0.001), higher phosphorus (2.17 ± 0.26 vs. 1.22 ± 0.20; p<0.001), and elevated uric acid (8.77 ± 0.83 mg/dL vs. 4.92 ± 1.01; p<0.01). These patterns persisted across genders and age subgroups, particularly in females aged 51–60. Serum calcium inversely correlated with phosphorus (r≈–0.36; p<0.001), while uric acid showed no significant correlations. Conclusions: Alterations in mineral metabolism—specifically hypocalcaemia, hyperphosphatemia, and elevated uric acid—are linked to knee OA. The inverse calcium–phosphorus relationship underscores bone turnover’s role, while uric acid’s rise suggests an inflammatory component. These biomarkers may inform OA risk stratification and warrant larger, longitudinal studies for validation.

Background: Cerebrovascular accidents lead to stroke due to cerebral ischemia and hemorrhage, which cause morbidity or mortality. An early medical approach can reduce fatal consequences. Method: 190 adult patients who had undergone cerebrovascular accidents were studied. Their previous histories of hypertension, diabetes mellitus, and cardiac disease were noted, and a CT scan was performed. Results: Out of 190, 120 (63%) had infarction, 48 (25.2%) had subarachnoid hemorrhage, 3 (1.57%) had tumors, 6 (3.15%) had cerebral-cavernous thrombosis, and 3 (1.57%) were normal. Conclusion: The CT scan study proved to be the gold standard technique for the diagnosis of acute stroke and hemorrhages in different parts of the brain.

Objectives: Airway management in the Emergency department is a fundamental resuscitative procedure. Failure of successful airway management in the critically ill patient will result in catastrophic consequences. The present study was to evaluate the diagnostic accuracy of HEAVEN criteria for predicting difficult intubation and to compare it with the performance of the Modified LEMON criteria. Methods: A prospective observational study was conducted involving 200 patients requiring rapid-sequence or delayed-sequence intubation. Patients aged ≥18 years were included, and data were collected through a pre- designed case record form. The primary outcomes were first-attempt intubation success and the time taken for intubation. Secondary outcomes included a comparison of HEAVEN and Modified LEMON criteria and peri-intubation complications. Results: A total of 200 cases were involved in the study. The study had 61% males as compared to 39% females. The mean age of males was 55.05 while that of females was 55.92 years. A total of 151 patients (75%) achieved successful intubation on the first attempt, while 49 patients (25%) required additional attempts. The mean time taken for successful intubation 23.57± 8.34 seconds, but it increased significantly (p < 0.001) by 118.57% with multiple attempts. Conclusions: The HEAVEN criteria demonstrated strong positive predictive value for difficult intubation, with a higher correlation to time for successful intubation and intubation success compared to the Modified LEMON criteria.

Background: Chronic musculoskeletal pain (CMP) is a common, often debilitating condition that affects quality of life and functional capacity. New evidence suggests that vitamin D deficiency may be an underlying factor in the development of musculoskeletal pain. This study aimed to assess serum vitamin D levels and correlate them with deficiency-related symptoms in patients presenting with CMP. Methods: This cross-sectional study was conducted on 50 adults presenting with chronic musculoskeletal pain lasting more than three months. Serum 25-hydroxyvitamin D levels were estimated, and patients were categorized as vitamin D deficient (<20 ng/mL), insufficient (21–29 ng/mL), or sufficient (≥30 ng/mL). Clinical symptoms such as fatigue, muscle weakness, morning stiffness, generalized body aches, and sleep disturbances were recorded. Pain severity was assessed using the Visual Analogue Scale (VAS). Results: The results of this study found that 64% of the cases had vitamin D deficiency. Common deficiency symptoms reported were significantly more prevalent in the deficient group, such as fatigue (93.8%), muscle weakness (87.5%), and generalized body aches (90.6%) (p<0.001). A strong inverse correlation was observed between vitamin D levels and pain severity (r = -0.72), pain duration (r = -0.58), and number of pain sites (r = -0.63), all statistically significant. Conclusion: Vitamin D deficiency is very common in patients of CMP and is highly associated with the severity of symptoms. Supplementation and screening can be utilized in the treatment of chronic musculoskeletal pain.

Background: Anemia in pregnancy is a worldwide problem, but it is most prevalent in the developing world. Methods: A cross-sectional study was conducted at maternity wards of P B M hospital, attached to S P Medical College, Bikaner. The study was conducted for a period of 2 months. Women aged 15-49 yrs. Who had undergone delivery and having ANC record were include in the study after taking informed consent for participation in the study. The data were collected using semi‑structured questionnaire. Results: A significant association was found between maternal anemia in third trimester and adverse neonatal outcome. Conclusion: Maternal anemia was highly prevalent in this population. Lower birth weight, and incresed risk of small-for-gestation were associated with maternal anemia. Maternal anemia needs urgent attention to improve neonatal outcome in this population.

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

Background: Iron deficiency is the most common cause of anemia and is one of the leading risk factors for disability and death worldwide, affecting an estimated 2 billion people. Methods: This was cross-sectional study. All the adolescent girls who were given consent to hemoglobin estimation were included in the study. Results: The prevalence of anemia among adolescent girls was found as73.6%. Out of 736 anemic girls, 536 girls were suffering from mild degree of anemia and 173 girls were having moderate degree of anemia. Only 27 girl was found severely anemic. Conclusion: The prevalence of anemia among adolescent girls is alarmingly high in India.

Background: Prevalence of Placenta previa is found to vary between 0.5% of all pregnancies. Placenta previa is one of the major causes of antepartum hemorrhage and is also important cause of maternal and perinatal morbidity and mortality in India. Methods: This is a prospective study conducted on cases of placenta previa diagnosed by clinical or ultrasonography were included in the study. All case records were obtained from medical record section. Results: Majority of cases belong to 21-25 age group. Out of 100 cases 13 cases had PPH. 31 baby birth weight was <2.0 kg. Conclusions: Managing a case of placenta previa during pregnancy poses a great challenge to every obstetrician in present day obstetrics due its increased risk of maternal and perinatal complications.

Background: Thyroid surgery in the hands of experienced surgeons is currently one of the safest procedures performed. While complications following surgical removal of thyroid gland are rare, their consequences can often be debilitating and even life threatening. Methods: Hospital based prospective study conducted on cases of thyroid swellings undergoing surgery willing for participation in the study during the study period. Results: Hypocalcemia was the most commonly observed post- operative complication in our study and was seen in 12 out of 100 cases (12%). Superior laryngeal nerve paralysis could not be assessed due to lack of objective tools in our department. Conclusion: In our study, the incidence of hypocalcemia was found to be 12%.

Background: In preemptive analgesia, the analgesic treatment is started before and is operational during the surgical procedure so that the physiological consequences of nociceptive transmission are reduced. Because of this protective effect on nociceptive pathways, preemptive analgesia decreases the incidence of hyperalgesia and allodynia after surgery. Methods: This Hospital based, prospective, randomized, double blind, comparative study was conducted in Department of Anaesthesiology. Results: The mean baseline variable i.e. pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure were comparable in both the groups. (P value>0.05). Thus, we can say that the randomization was done adequately. Hemodynamic variables (pulse rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) were also comparable during intraoperative period. Conclusion: Although preemptive use of both pregabalin 75mg and pregabalin 150 mg are effective for prolongation of postoperative analgesia but pregabalin 75mg is superior to pregabalin 150mg as it provides similar postoperative analgesia as compared to 150mg without causing significant change in haemodynamic variables and any adverse effect.

Background: The present study is an attempt to evaluate the results of locking compression plate for distal tibia in lower tibial fractures using open reduction internal fixation and minimally invasive plate osteosynthesis technique. Methods: Prospective and Retrospective study was conduct on patients with distal tibial fractures. The patients treated with locking compression plates using MIPO or ORIF are reviewed for inclusion and exclusion criteria’s. All data were collected and analyze by Epi-info software. Results: Out of 52 patients, 48.4% patients undergo open reduction internal fixation had excellent results and 28.6% patients undergo surgery by MIPPO technique had excellent results. p value is 0.352 which is not significant. Overall, 40.4% patients had excellent results. In our study, 32.6% patients having AO/OTA type A fractures had excellent score while type B and C had 1.9% excellent score. This is attributed to more comminution and involvement of ankle joint. Overall, 40.4% patients had excellent score. P value is 0.863 which is insignificant. Conclusion: We observed excellent/ good functional outcome in 65.3% of patients.

Background: According to World Health Organization, of the diagnosed oral cancer worldwide around 40% occur in India, Pakistan, Bangladesh, and Sri Lanka. Methods: 100 Patients of either sex with clinical features suggestive of benign, premalignant intraoral pathologies and fulfilling inclusion and exclusion criteria were taken up for the study. Written informed consent was obtained prior to enrolment into the study. Results: Tobacco chewing and supari (areca-nut) chewing was significantly higher in premalignant conditions (Leukoplakia) than benign lesions. No significant difference in smoking and alcohol consumption between premalignant conditions and benign lesions. Conclusion: Tobacco chewing and arecanut (supari) consumption was significantly higher in premalignant lesions than benign lesions.

Background: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in individuals with metabolic syndrome and can progress to cirrhosis if undetected. While ultrasonography (USG) is widely used for screening, FibroScan offers more objective quantification of hepatic steatosis. Aim and Objective: To evaluate the diagnostic accuracy of USG in detecting fatty liver compared to FibroScan in patients with metabolic syndrome. Materials and Methods: This prospective, cross-sectional diagnostic study was conducted over 12 months at a tertiary care hospital and included 100 patients diagnosed with metabolic syndrome as per IDF criteria. All patients underwent abdominal USG and FibroScan (using CAP score) on the same day. USG findings were compared to FibroScan (CAP >248 dB/m considered diagnostic of steatosis), and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Receiver Operating Characteristic (ROC) curve analysis was also performed. Results: Fatty liver was detected in 68% of patients by USG and in 75% by FibroScan. USG demonstrated a sensitivity of 86.7%, specificity of 88.0%, PPV of 95.6%, NPV of 68.7%, and an overall diagnostic accuracy of 87.0%. A strong correlation was observed between USG grades and CAP values (p < 0.001). ROC analysis revealed an Area Under Curve (AUC) of 0.994 (95% CI: 0.868–0.999), indicating excellent discriminatory ability of USG against FibroScan. Conclusion: USG is a reliable and accessible screening tool for detecting fatty liver in patients with metabolic syndrome, demonstrating good agreement with FibroScan. However, FibroScan remains superior for detailed quantification and should be used for confirmation, especially in high-risk individuals or where USG findings are inconclusive.

Background: The management of compound both-bone leg fractures presents significant clinical challenges due to the high risk of complications such as infection, delayed union, and non-union. Methodology: This prospective observational study was conducted over a two-year period at the Department of Orthopaedics, Government Medical College, and Kadapa, to assess the clinical, functional, and radiological outcomes of a novel treatment method: the Versatile Antibiotic Intramedullary Interlocking (VAIL) nailing system. Fifty patients aged 18–60 years with Grade I, II, IIIA, or IIIB compound fractures of both tibia and fibula were included. Data were collected using structured questionnaires and patients were followed up monthly. Results: The majority of fractures (60%) were located in the midshaft region and were mostly oblique in pattern. Most surgeries (82%) were performed within 24 hours of injury, which was significantly associated with a lower incidence of postoperative infection (p=0.006). Overall, 78% of patients had no infection, 12% had superficial infections, and 10% had deep infections requiring further intervention. Functional outcomes assessed using the Rust scoring system showed promising results, with 46% achieving a score of 10 and 32% reaching 12. Only 4 patients developed non-union, and deformities were rare. VAIL nails facilitated early mobilization, effective antibiotic delivery, and minimized surgical invasiveness without compromising structural integrity. Conclusion: The study concludes that early intervention with VAIL nailing offers a safe, effective, single-stage treatment for complex compound fractures, reducing the need for prolonged systemic antibiotics and secondary surgeries. This technique demonstrated favorable outcomes in wound healing, fracture union, and patient recovery, making it a potentially superior alternative to conventional methods such as external fixation or dual plating.

Background: UGIB is the commonest gastrointestinal emergency presenting as hematemesis, melaena or both. Endoscopy is a valuable tool to find cause of UGIB. Various scoring systems have been devised to predict outcomes in terms of mortality and hospital stay. Different scoring systems like Rockall score, Glasgow Blatchford score and AIMS 65 score help to stratify patients into low and high-risk groups and help in better allocation of resources. This study aims to identify clinical and endoscopic profile of UGIB and to study the predictors of outcome of UGIB. This study also helps to establishes a relation between AIMS 65, Glasgow Blatchford and Rockall score. Aim: To describe clinical and endoscopic profile of patients with GI bleed. Methodology: This hospital-based prospective study was conducted in the Department of Medicine at a 920-bedded rural teaching hospital in Central India from December 2021 to August 2023. It included 200 adult patients with acute upper gastrointestinal bleeding (UGIB) within 24 hours of onset. Data on demographics, clinical presentation, comorbidities, and biochemical parameters were collected. All patients underwent upper GI endoscopy, and findings were categorized into low, moderate, and high-risk lesions. Standard scoring systems (Rockall, Glasgow-Blatchford, AIMS65) were applied. Ethical clearance and informed consent were duly obtained. Statistical analysis was done using SPSS 24.0 and GraphPad Prism 6.0. Results: Positive correlation was established between Rockall score and Glasgow Blatchford and AIMS 65 score. Conclusion: This study concludes that early risk stratification using Rockall, Glasgow Blatchford, and AIMS 65 scores is effective in predicting outcomes in UGIB. Most patients fell into the low-risk category and could be managed conservatively. Variceal bleeding was the leading cause of UGIB, particularly in alcoholic males. AIMS 65 score showed comparable predictive value, supporting its use in clinical practice.

Background: Bipolar disorder is a chronic psychiatric illness characterized by recurrent episodes of mania and depression, often requiring long-term pharmacological management. While atypical antipsychotics such as olanzapine are widely used, newer agents like cariprazine offer potential benefits in terms of efficacy and safety. This study aimed to compare the efficacy and safety profiles of olanzapine and cariprazine in patients diagnosed with bipolar disorder. Material and Methods: This was a prospective, comparative, observational study conducted over 15 days among 72 patients diagnosed with bipolar disorder, divided equally into two groups: Group A (olanzapine) and Group B (cariprazine). Participants were assessed using standardized scales: Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), 17-item Hamilton Depression Rating Scale (HAM-D₁₇), Clinical Global Impressions (CGI), and Simpson Angus Scale (SAS) at baseline and on day 15. Data were analyzed to evaluate symptom improvement and side effect profiles. Results: Both groups showed clinical improvement over 15 days. Cariprazine-treated patients demonstrated significantly greater reductions in YMRS, HAM-D₁₇, and BPRS scores compared to the olanzapine group. CGI scores improved in both groups, with more patients in Group B achieving lower severity categories. Extrapyramidal symptoms were minimal and statistically comparable between groups. Cariprazine was better tolerated in terms of metabolic and sedation-related adverse effects. Conclusion: Cariprazine is an effective and well-tolerated alternative to olanzapine in the short-term management of bipolar disorder, with superior improvements in manic and depressive symptoms and a favorable side effect profile. These findings support its clinical utility, especially in patients at risk for metabolic complications.

Background: Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder associated with significant morbidity and mortality. Rational use of antidiabetic medications is essential to achieve optimal glycemic control and prevent complications. This study aimed to evaluate the prescribing patterns of antidiabetic drugs in T2DM patients attending a tertiary care hospital. Material and Methods: A prospective observational study was conducted over one year at the Department of Pharmacology, B.R.D. Medical College, and Gorakhpur. A total of 156 T2DM patients aged over 20 years receiving oral antidiabetic therapy were enrolled after obtaining informed consent. Data on demographics, clinical features, comorbidities, and prescribed medications were collected using a structured questionnaire. Statistical analysis was performed using SPSS version 26. Results: The most affected age group was 20–30 years, and males slightly outnumbered females. Hypertension was the most common comorbidity, and fatigue was the predominant symptom. The mean duration of diabetes was 7.54 ± 5.26 years. Dual-drug therapy was prescribed in 84.62% of patients, with biguanides and sulfonylureas being the most frequently used drug classes. Metformin was the most commonly prescribed agent (89.10%), followed by sulfonylureas (65.38%). The most frequent combination was metformin with a sulfonylurea (54.49%). Conclusion: The study revealed a preference for dual-drug therapy, particularly metformin and sulfonylurea combinations, in line with standard treatment guidelines. Regular evaluation of prescription patterns is necessary to ensure rational use of antidiabetic drugs and improve patient outcomes.

Background: Lichen planus (LP) is a chronic inflammatory mucocutaneous disease of unclear aetiology. The association between LP and hepatitis C virus (HCV) infection has been reported in various studies, but the evidence is inconsistent. Objective: To assess the association between oral and cutaneous LP and HCV in a case-control study. Methods: A hospital-based case-control study included 65 patients with LP and 65 age and sex matched controls with other dermatological conditions. Detailed history taking and clinical examination was done for all the cases and controls. Biopsy and histopathology done to confirm cases of Lichen Planus. Serum samples from all participants were taken and tested through Standard Q HCV Ab Rapid Test. Results: Among the 65 LP cases, none were positive for HCV antibodies. In the control group, only one patient (1.5%) was positive for HCV antibodies. The difference in HCV seroprevalence between the two groups was not statistically significant (p-value > 0.05). Conclusion: In this cohort study we did not find a significant association between HCV infection and LP within the population of Srikakulam, Andhra Pradesh. Further studies with larger sample sizes are needed to confirm these findings.

Background and Objective of the study: Non fermenting GNB which are saprophytic in nature, have emerged as important health care associated pathogens. Non fermenting gram-negative bacilli (NFGNB) causes wide spectrum of infections, including nosocomial pneumonia, secondary meningitis, surgical wound infections, skin and soft tissue infection, urinary tract infection and septicaemia. They have exhibited resistance clinically to a variety of antibiotic groups. The present study was undertaken to know the prevalence and the antimicrobial susceptibility pattern of non-fermenting gram negative bacilli isolated from various healthcare-associated infections. Materials and Methods: During the study, a total of 15,120 samples from various infections were processed at Diagnostic Microbiology Laboratory of a Government tertiary care hospital. Bacteriological identification and antimicrobial susceptibility testing were performed for all bacterial isolates by following standard protocol. Results: The positive prevalence rate was 2% from all of these infections. Of the total 325 non fermenting Gram-negative bacilli, the predominant organisms were Acinetobacter baumannii & Pseudomonas aeruginosa. Aminoglycosides, carbapenems, chloramphenicol, βeta lactam-β lactamase inhibitor combinations such as Piperacillin tazobactam were effective in treating NFGNB. Conclusions: This study stresses the need for the continuous screening and surveillance for antibiotic resistance.

Background: Osteoarthritis (OA) is a disease where hyaluronic acid in the knee joint has broken down and created inflammation. Hence, sodium hyaluronate acid is injected for regeneration of the knee joint, which gives relief from pain and leads to normal movement of the knee joint. Method: 45 patients with OA were selected for intra-articular sodium hyaluronate, and 45 patients with OA were treated with placebo. Routine blood exam; x-ray of the knee joint (MRI if necessary). Kellengren-Lawrence radiographic scale to assess the severity of OA. Intraarticular 6 ml Hylan GF20 was injected by using a 23-gauge syringe and placebo in the other 45 OA patients. Results: In the comparison of the VAS scale at week 25 between the Hyalgen and placebo groups, the primary outcome at week 25 was a highly significant p-value (p<0.001). In comparison to the mean change from baseline to week 25 in the WOMAC Index score, all three parameters, including pain, stiffness, and function of the knee joint, were highly significant (p<0.001). Conclusion: Intra-articular therapy with sodium hyaluronate is an ideal and easy method for treating OA of the knee joint.

Background: Allergic rhinitis (AR) is one of the most common chronic inflammatory conditions affecting the pediatric population worldwide. It causes significant functional impairment, including poor sleep, absenteeism from school, and reduced academic performance. The prevalence is influenced by factors such as air pollution, environmental allergens, socioeconomic status, and geographic location. Objectives: To determine the prevalence of allergic rhinitis among school-attending children from urban and rural areas and to assess the associated demographic, environmental, and clinical characteristics. Materials and Methods: This retrospective cross-sectional study included 170 school-going children aged 6–14 years from both urban and rural schools affiliated with Rajarajeswari Medical College and Hospital, Bengaluru, over a span of 18 months. The prevalence, symptom profile, family history of atopy, and associated comorbidities were assessed using health records. Results: Out of 170 children, 49 (54.4%) from urban areas and 28 (35%) from rural areas were diagnosed with allergic rhinitis. Male predominance was observed (M: F = 1.4:1). Sneezing (81.2%) and nasal obstruction (70.6%) were the most frequently reported symptoms. A positive family history of atopy was more common among urban children (49%) than rural (30%). Conclusion: The study confirms a significantly higher prevalence of AR among urban school children. It emphasizes the role of environmental factors and the necessity of early screening and intervention strategies to reduce disease burden.

Background: Allergic rhinitis (AR) is a common IgE-mediated inflammatory condition of the nasal mucosa, significantly impacting quality of life and often coexisting with other allergic disorders. Understanding its demographic and clinical patterns is essential for effective management. Objectives: To analyze the demographic distribution and clinical presentation of allergic rhinitis patients in a tertiary care setting. Methods: A retrospective study was conducted over 18 months at Rajarajeswari Medical College and Hospital. Data from 100 patients diagnosed with allergic rhinitis were reviewed. Parameters such as age, gender, symptoms, seasonal patterns, triggers, comorbidities, and family history were analyzed using descriptive statistics. Results: The majority of patients were males (58%) and belonged to the 21–30 year age group (34%). Sneezing (82%), nasal congestion (76%), and rhinorrhea (69%) were the most common symptoms. Sixty percent of patients reported seasonal variation in symptoms. Dust (52%) and pollen (23%) were the leading triggers. Allergic conjunctivitis (22%) and asthma (18%) were frequently associated comorbidities. A positive family history was noted in 28% of cases. Conclusion: Allergic rhinitis predominantly affects young adults and males, with significant seasonal and environmental influences. Early diagnosis and allergen avoidance can improve outcomes. Further studies with allergy testing are recommended.

Background: India is currently the capital for diabetes in the world, with over 17% of all cases occurring there. Diabetes mellitus (DM) is a major global public health concern. Diabetic ketoacidosis (DKA), which is most common in type 1 diabetes but is also present in type 2 diabetes and other forms of diabetes, is one of the most severe consequences of DM. Objectives: The aim of the study was to assess the clinical profile, management, complications, and outcomes of patients admitted with DKA in the ICU of a tertiary care center. 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. Data from 232 participants were retrieved for the study. Patients who are adult and are of 18 years of age or older and admitted to the ICU with a confirmed diagnosis of DKA in accordance with ADA guidelines were considered as the criteria of inclusion in the study. Results: The most prevalent age group in this study population was 30–50 years old, which included 98 patients (42.2%), followed by patients over 50 (31.0%) and those under 30 (62, 26.7%). Age over 50 was substantially more common among non-survivors (66.7%) than survivors (25.7%) of the entire study population, with a p-value of less than 0.001. With a p-value of 0.04, type 2 diabetes mellitus was more common among non-survivors (80.0%) than in survivors (61.4%). Conclusion: In this retrospective analysis of DKA admissions to the intensive care unit, we found that the overall death rate was 13.2% and that a sizable fraction of patients had severe DKA at presentation. Recommendations: As this was a short-term study, further research is needed with a longitudinal study design and a larger sample to achieve more definitive results.

Background: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder associated with significant cardiovascular and metabolic consequences. Despite its high prevalence, OSA often remains undiagnosed due to reliance on non-specific symptoms. Polysomnography (PSG) remains the gold standard for accurate diagnosis. Methods: This retrospective study was carried out for one year at a tertiary care hospital and included 224 adults undergoing PSG. Patients were categorized into OSA and non-OSA groups based on Apnea-Hypopnea Index (AHI). Demographic data, ESS scores, and comorbidities were recorded. Statistical analysis involved group comparisons and logistic regression. Results: The OSA group had a higher mean age, BMI, and male predominance. Among OSA patients, 56% had mild, 24% moderate, and 20% severe disease. Cardiovascular and metabolic comorbidities were more prevalent in the OSA group, including hypertension (51%), diabetes (13%), and hyperlipidemia (27.3%). No significant correlation was observed between ESS and AHI. Conclusion: OSA is significantly connected with increased cardiovascular and metabolic comorbidities and requires objective diagnostic evaluation.

Background: A rare type of diabetes mellitus known as maturity-onset diabetes of the young (MODY) is brought on by a single gene abnormality and is typified by decreased insulin secretion. One to six percent of diabetic patients have MODY, a genetically and clinically diverse condition. Objectives: The aim of this study was to compare the pharmacological management, glycemic control, and diabetes-related complications between patients with MODY and those with T2DM in a tertiary care setting. 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 for one year. Data from 212 participants were retrieved for the study. Patients who were ≤40 years old at the time of diagnosis, had a verified diagnosis of either MODY or T2DM, and had full medical records, including treatment history and follow-up information, were eligible to participate in the study. Results: With a p-value less than 0.001, the MODY group’s mean age at diagnosis was considerably lower at 21.9 ± 4.6 years than that of the T2DM group, which was 26.2 ± 5.1 years. The MODY group had significantly lower fasting blood glucose levels were 132.6 ± 18.2 mg/dL, than the T2DM group, 148.3 ± 24.1 mg/dL, with a p-value of less than 0.001. There were five (8.1%) individuals in the MODY group who had retinopathy, while 39 (26.0%) patients in the T2DM group had it, with a p-value of 0.004. Conclusion: This study demonstrates how MODY and T2DM patients have different clinical characteristics and react differently to treatment. With simpler pharmacologic regimens, especially sulfonylureas. Recommendations: Increased knowledge and availability of genetic testing could aid in avoiding incorrect classification and guaranteeing the best possible care for people with diabetes.

Background: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder associated with significant morbidity due to chronic complications. Hospitalized T2DM patients are at high risk for conditions like neuropathy, nephropathy, retinopathy, and cardiovascular disease. Understanding the pattern of these complications is essential for effective inpatient care and prevention strategies. Methods: A cross-sectional, record-based study was conducted from May 2023 to May 2024 at a tertiary care hospital’s diabetic clinic. Systematic sampling was used to select 224 patient records of individuals with T2DM. Data on demographics, clinical history, and documented complications were extracted and analyzed using SPSS 13.0. Ethical approval and administrative permissions were obtained prior to data collection. Results: The majority of patients were male (62.9%) and between 45–54 years old. Visual disturbance (33.9%), neuropathy (29.9%), and hypertension (25%) were the most common complications. The prevalence of complications increased significantly with age and duration of diabetes. Impotence affected 7.8% of male patients, while nephropathy and infections were also notably present. Conclusion: Chronic complications are common among hospitalized T2DM patients, emphasizing the need for early screening and integrated management.

Background: One of the main causes of morbidity in the elderly is femoral neck fractures. Because of an older population and longer life expectancy, the global annual incidence is predicted to increase to between 7 and 21 million cases by 2050. The number of healthy, elderly patients over 80 is steadily rising, thus it’s critical to research this patient demographic to see whether they benefit from the same treatments as those under 80. Objectives: In order to determine the best surgical course of action based on patient profiles, the study compared the clinical, functional, and perioperative results of HA and THA in older patients with displaced femoral neck fractures. 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 for one year. Data from 148 participants were retrieved for the study. Individuals who arrived at the emergency room with displaced femoral neck fractures were hospitalized and required surgery. Results: With a p-value of 0.26, the mean age of the patients in the THA group was marginally lower at 71.7 ± 5.9 years, compared to 72.8 ± 6.4 years in the HA group. On the first post-operative day, the HA group’s mean functional score was 38.5 ± 4.7, whereas the THA group’s was 42.1 ± 5.1, with a p-value of less than 0.01. Conclusion: The clinical results of both operations were good in this comparison of HA and THA in older patients with femur neck fractures. In contrast, THA patients showed noticeably improved hip function, range of motion, and gait outcomes at the 3, 6, and 12-month follow-up points. Recommendations: Individualized patient selection is necessary, and structured rehabilitation and appropriate preoperative optimization are crucial.

Background: Early and accurate diagnosis of acute myocardial infarction (AMI) is critical in emergency settings. High-sensitivity troponin I (hs-TnI) and ECG are essential tools for risk stratification. Optimizing their diagnostic utility can improve clinical decision-making in resource-constrained healthcare environments. Methods: A prospective observational study was conducted over one year in the emergency department of a tertiary care hospital in India, enrolling 224 adults presenting with suspected AMI. Patients underwent serial hs-TnI testing and ECG at 0, 1, and 3 hours. Diagnostic accuracy was assessed using various hs-TnI cutoffs, with and without ischemic ECG changes. Sensitivity, specificity, and positive predictive value (PPV) were calculated for each threshold. Results: AMI patients were older and more likely to present with chest pain and ischemic ECG changes. Baseline hs-TnI cutoffs showed increasing PPV and specificity with rising thresholds but decreasing sensitivity. A cutoff of ≥52 ng/L balanced diagnostic certainty and detection. Combining hs-TnI with ECG findings further improved PPV but reduced sensitivity. Conclusion: Combining hs-TnI with ischemic ECG features enhances early AMI diagnosis but may miss some cases at higher cutoffs.

Background: For almost all patients without contraindications, antiplatelet medications are advised to avoid subsequent stroke. However, because SAPT does not block all platelet activation pathways, it provides only a limited level of protection in the acute post-stroke phase. Objectives: With an emphasis on recurrence rates, survival outcomes, and functional level at follow-up, the study aimed to assess and contrast the safety and efficacy of aspirin monotherapy versus dual antiplatelet therapy among patients who had stroke. 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 for one year. Data from 168 participants were retrieved for the study. Adult patients over the age of 18 who were admitted with their first ischemic stroke episode and were treated with either antiplatelet monotherapy (AM) or DAPT were part of the study. Results: With a mean age of 62 ± 13.0 years in the AM group and 63 ± 14.0 years in the DAPT group, with a p-value of 0.457. The AM group had a mean survival duration of 10.4 ± 1.2 months, while the DAPT group had a slightly longer survival period of 11.7 ± 0.8 months. Furthermore, with a p-value of 0.048, the cumulative recurrence of ischemic stroke was higher in the AM group (15.5%) than in the DAPT group (7.1%). Conclusion: This study shows that DAPT improves stroke-free survival statistically significantly and lowers the risk of recurrent ischemic stroke more effectively than AM. Recommendations: As this was a short-term study, further research is needed with a longitudinal study design and a larger sample to achieve more definitive results.

Background: Electrolyte imbalances are common in acute stroke patients, and they can significantly impact how the stroke unfolds. Phosphate abnormalities, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia are frequently observed in this population. Objectives: In order to determine the prevalence of serum electrolyte abnormalities in acute stroke patients and their correlation with clinical outcomes including intensive care unit admission, in-hospital mortality, and functional status at release, the study was conducted. 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 for one year. Data from 158 participants were retrieved for the study. Participants in the trial had to be at least 18 years old and have a confirmed diagnosis of acute ischemic or hemorrhagic stroke based on neuroimaging and clinical examination. Results: The average age of the study population was 64.2 years. The most prevalent comorbid conditions were diabetes mellitus (41.8%) and hypertension (65.2%). In particular, p-values <0.01 and 0.012 indicate that 4 out of 13 patients with hypernatremia (30.8%) and 11 out of 41 patients with hyponatremia (26.7%) passed away while in the hospital. A 2.5-fold higher risk of death was linked to hyponatremia (95% CI: 1.4–4.7, p = 0.004), whereas hypernatremia carried an even greater risk, with an odds ratio of 3.2 (95% CI: 1.1–8.9, p = 0.015). Conclusion: Acute stroke patients frequently have serum electrolyte abnormalities, especially hyponatremia and hypernatremia, which the study found to be substantially linked to worse clinical outcomes, such as higher in-hospital mortality, more ICU admissions, longer hospital stays, and poor functional status at discharge. Recommendations: To improve outcomes and lower complications, routine electrolyte monitoring should be incorporated into the standard care regimen for all acute stroke patients.

Background: The study included women between the ages of 18 and 35 who had been diagnosed with PCOS according to the Rotterdam criteria, as long as they had been receiving OCP or metformin consistently for at least six months and had all of their clinical and biochemical data accessible at baseline and follow-up. Objectives: Evaluating and contrasting the efficacy of OCPs and metformin in the treatment of PCOS was the study’s goal. Materials and Methods: It was a retrospective, comparative study. The study was carried out at a tertiary care centre. The study data that has been retrieved was for one year. Data from 178 participants were retrieved for the study. Results: The OCP group’s mean age was 24.6 ± 3.0 years, with a p-value of 0.68, while the Metformin group’s was 24.5 ± 3.3 years. The mean BMI for the Metformin group was 28.6 ± 2.8 kg/m², while the OCP group’s was 28.0 ± 2.9 kg/m², with a p-value of 0.24. With a p-value of 0.28, the difference between the 83.1% of patients in the Metformin group and the 88.8% in the OCP group who achieved menstrual cycle regularization was not statistically significant. Conclusion: The study came to the conclusion that OCPs were far more successful in reducing serum testosterone levels and alleviating hyperandrogenic symptoms like hirsutism and acne. However, metformin was more effective at lowering BMI, indicating better metabolic advantages. Recommendations: Optimizing clinical outcomes requires a customized strategy to PCOS therapy that is informed by patient preferences and the degree of symptoms.

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in adolescent girls and is frequently associated with obesity. Emerging evidence links obesity in PCOS with increased psychiatric comorbidities, including depression and anxiety. Understanding this relationship is essential for holistic adolescent care. Methods: A retrospective observational study was conducted over one year in a tertiary care hospital in India. Data from 182 adolescent girls with PCOS were analyzed and categorized by BMI. Psychiatric diagnoses were extracted from clinical records. Chi-square and logistic regression tests were applied to assess associations. Results: Psychiatric comorbidities were found in 48.4% of patients, with depression and anxiety being the most common. Obese adolescents showed significantly higher prevalence of psychiatric conditions than overweight or normal-weight counterparts. Logistic regression confirmed a strong association between obesity and psychiatric disorders. Central adiposity and elevated androgen levels were more frequent in the obese group. Conclusion: Obesity is significantly associated with increased psychiatric comorbidities in adolescents with PCOS.

Background: India experiences one of the highest rates of road traffic-related fatalities worldwide, accounting for over 150,000 deaths annually. Contributing factors include rapid urban growth, increased vehicle density, substandard road conditions, and inconsistent enforcement of traffic laws. This study investigates the demographic and situational factors—such as age, sex, type of vehicle, and usage of safety equipment—associated with road traffic accident (RTA) deaths to highlight vulnerable populations and critical circumstances. Aim: To examine the distribution and characteristics of injuries among RTA victims who underwent medicolegal autopsy at the Mortuary of SMS Medical College and Hospital, Jaipur, during the period April 2023 to March 2024. Methodology: A prospective descriptive study was carried out on 100 fatal RTA cases referred for medicolegal autopsy at SMS Hospital. Data were collected from post-mortem reports, police records, and inquest documents. Parameters such as demographic details, injury types and locations, causes of death, and post-accident survival duration were analyzed. Descriptive statistics were used to interpret the findings. Observations and Results: Among the 100 cases analyzed, males comprised 62% of the fatalities, with the highest incidence in the 30–40 year age group. Head and facial injuries were the most frequently observed (63%), followed by injuries to the lower limbs (46%) and chest (42%). Two-wheeler users formed the largest category of victims (53%), and only 39% of them were found to be wearing helmets at the time of the accident. The primary cause of death was traumatic coma (57%), followed by different forms of shock (43%). Conclusion: The findings indicate that males aged 30–40 years, particularly those riding two-wheelers without helmets, are at a heightened risk of fatal RTAs. Head injuries remain the predominant cause of mortality, emphasizing the urgent need for stringent enforcement of helmet use and other traffic safety regulations.

Background: Shoulder pain is the third most prevalent cause of musculoskeletal pain, following lower back pain and knee pain. Rotator cuff pathology is the leading cause of shoulder pain, affecting approximately 65% to 70% of patients. Methods: This study was conducted at department of Radiodiagnosis, S.P. Medical College & A.G. of P.B.M Hospitals, Bikaner. It is a multi-disciplinary tertiary care referral hospital. In our study, MRI of 100 patients with ages ranging from 17 years to 74 years with suspected shoulder pathologies was done with 3 T MR Scanner from PHILIPS MAGNETIC RESONANCE IMAGING MACHINE & SONOSCAPE USG machine with linear frequency transducer 5 to 7 megahertz, over a period of 1 year. Results: Out of 100 patients, 80 were men (80%) and 20 (20%) women.  76 (76%) had derangements of the right shoulder while 24 (24%) had left sided derangements. The maximum number of patients were between 31-50 years (24%) of age. Of all patients, the commonest observed pathology was supraspinatus tears 70 patients (70%) followed by subscapularis tears 10 patients (10%).  From the present perspective study of 100 patients certain inferences were drawn. MRI (sensitivity-91.66%) is more sensitive than USG (sensitivity-62.11%) for detecting partial rotator cuff tears but USG (specificity-97.22%) is more specific for detecting partial rotator cuff tears than MRI (specificity-87.59%). For complete rotator cuff tears both USG & MRI are 100% sensitive & specific. Conclusion: USG should be used as first line of investigation in suspected cases of rotator cuff tears & MRI should be used as second line non-invasive test to confirm the diagnosis & to rule out associated capsule-labral/soft tissue injuries. USG & MRI is the most important noninvasive imaging tool to diagnose various rotator cuff tears as it has the potential to positively affect the outcome, morbidity in these patients.

Background: Type 2 diabetes patients are at increased risk of developing Chronic Kidney Disease (CKD), making the assessment of renal function essential. Glomerular filtration rate (GFR) is one of the best index for assessing renal function. This study aimed to evaluate the effectiveness of MDRD, CKD-EPI and Cockroft Gault equations in measurement of Glomerular filtration rates (eGFR) and their ability for early detection of CKD in type 2 diabetic patients. Methods: This cross-sectional study involved 100 type 2 diabetic patients between 40 and 70 years. Serum creatinine values were used to calculate eGFR using the three eGFR equations, and the results were used to classify the patients into various CKD stages- based on guidelines prescribed by the National Kidney Disease Outcomes and Quality Initiative. Results: The results showed that, the average eGFR values using the MDRD, CKD-EPI and Cockroft Gault formulas in patients with type-2 diabetes mellitus were 60.10±26.23 ml/min/1.73m2, 60.68±31.82 ml/min/1.73m2 and 69.34±29.61 ml/min/1.73m2 respectively. There was a statistically significant difference between eGFR values calculated using MDRD and Cockroft Gault formulas (^**p<0.001). Comparison of eGFR formulas in detection of CKD stages I and II demonstrated that, Cockroft Gault and MDRD equations were the best, with precision and accuracy of 25% and 31% respectively. Conclusion: eGFR values derived from Cockroft Gault and MDRD equations are simpler, cost effective, facilitates the early identification of CKD in type 2 diabetics. Our study indicates that, Cockroft Gault and MDRD equations are very effective assessment methods for detecting CKD stages I and II respectively in type 2 diabetes, especially for early detection as well as risk assessment.

Introduction: Diabetes Mellitus (DM) is the most common endocrinological disorder in pregnant women. Approximately 87.5% of them have Gestational Diabetes Mellitus (GDM) and 12.5% have Overt DM. Aims& Objectives: To estimate the antenatal maternal complications, maternal, foetal and neonatal outcome in pregnant women with overt DM. Materials and Methods: This was a prospective observational study conducted at Department of Obstetrics & Gynaecology, Government Medical College, Kottayam for 1 year from March 2022 after Ethical Committee approval (IRB no:23/2022). All pregnant patients with FBS ≥ 126mg%, RBS ≥200mg% or HbA1c > 6.5% were included in the study. They were evaluated for diabetic retinopathy, nephropathy and cardiac lesions. The antenatal complications, mode of delivery, foetal and neonatal complications were noted. Patients were grouped into two according to HbA1c and results were analysed. Results: Out of 426 patients, 55.9% belonged to 20 – 30year age group. In 54.5% overt DM was diagnosed prior to pregnancy. 69.1% (294) had BMI > 25. 7.1% (30) had diabetic retinopathy and 3.3% (14) had diabetic nephropathy. Preeclampsia was found in 21.6% (92) which was found to be significant. No significant association was found between HbA1c levels and macrosomia, shoulder dystocia, stillbirth or operative vaginal delivery. Congenital anomalies were detected in 5.2% of cases. Hypo glycemia (29.8%), Respiratory Distress Syndrome (RDS) (40.4%), Hyperbilirubinemia (49.6%) were the most frequent neonatal complications. Conclusion: Overt DM is associated with increased incidence of complications which can be minimised with proper pre conceptional counselling and control of DM.

Background: Conductive hearing loss (CHL) results from disruption in sound transmission through the external or middle ear. Ossiculoplasty is a surgical intervention aimed at restoring the ossicular chain to improve hearing. The type of prosthesis or graft material used, as well as patient selection, significantly influences surgical outcomes. Objective: To evaluate and compare the hearing outcomes in patients undergoing ossiculoplasty for conductive hearing loss at two centers—Dr. Panjabrao Deshmukh Memorial Medical College (PDMMC) and Aakanksha ENT Clinic. Materials and Methods: A prospective observational study was conducted over 1.5 years including 100 patients—80 from PDMMC and 20 from Aakanksha ENT Clinic—undergoing ossiculoplasty. Patients were categorized based on the type of ossiculoplasty performed: PORP (Partial Ossicular Replacement Prosthesis), TORP (Total Ossicular Replacement Prosthesis), and Cartilage Interposition. Preoperative and postoperative hearing levels were assessed using pure-tone audiometry, focusing on air-bone gap (ABG) closure as the primary outcome. Results: Among the PDMMC group, PORP was used in 47.5%, TORP in 35%, and Cartilage Interposition in 17.5%. In Aakanksha ENT Clinic, PORP was used in 40%, TORP in 35%, and Cartilage Interposition in 25%. Significant improvement in hearing outcomes was observed in all types, with PORP yielding the most favorable ABG closure, followed by TORP and Cartilage Interposition. The mean ABG closure was statistically significant (p < 0.05) in both centers. Conclusion: Ossiculoplasty is an effective surgical technique for the restoration of hearing in patients with conductive hearing loss. The choice of prosthesis, along with surgical expertise and patient-specific factors, plays a crucial role in the success of the procedure. PORP showed slightly better outcomes in ABG closure compared to TORP and cartilage grafts.

Background: Globally, Oral cavity cancer is a serious public health issue. Over the past three decades, death rate from malignancies of the lip and oral cavity increased 1.40 times globally. Smoking is still contributing to up to one-third (30.5%) of worldwide fatalities from this cancer. In India, oral cancer ranks in the top three of all cancers and accounts for more than 30% of all cancer cases.  Every year, India reports a quarter of all cases worldwide (approximately 77,000 new cases and 52,000 deaths). Aim of the study: The present study investigates the sociodemographic and clinical factors influencing OCC, its presentation, and outcomes, focusing particularly on buccal squamous cell carcinoma (SCC), one of the most common subtypes. Methodology: An observational study conducted at the Government Cancer Care Centre and Department of General Surgery, Kadapa, this combined retrospective and prospective observation of 18 months and included 22 patients with buccal cancer, meeting specified inclusion criteria. Results: The study reveals that OCC predominantly affects older individuals (61–70 years), females (81.8%), and individuals from lower socioeconomic backgrounds. The right buccal mucosa and mandible were the most involved sites. WLE with hemi mandibulectomy was performed in 81.8% of cases. Postoperative complications such as wound infections were observed in 26.3% of cases, with a mean hospital stay of 22 days. Risk factors like tobacco use (61.3%) and alcohol consumption (38.8%) were prevalent, indicating behavioral and lifestyle determinants. Tumor recurrence and lymph node metastases were significant prognostic challenges. Poorly differentiated tumors and incomplete follow-up were linked with high recurrence. Neck dissection (ND) showed potential for improving locoregional control, even in clinically N0 cases. Conclusion: The findings underscore the critical need for early detection, targeted intervention, and personalized treatment protocols based on tumor differentiation and patient demographics. Emphasizing long-term follow-up and public health strategies to reduce risk factor exposure may enhance treatment success and survival outcomes in OCC.

Paraquat (PQ) is a highly lethal and an inexpensive herbicide in India. Consumption of PQ is a significant clinical problem due to the absence of specific antidote. The incidence of paraquat ingestion is increasing in our region because of its wide use as herbicide in farmer’s community and easy accessibility. Outcomes of the PQ poisoning is variable depending on the amount of consumption, time to reach hospital, initiation of extra-corporeal therapies and inadequate data on treatment options available. The purpose of the study is to observe the short-term outcomes of paraquat ingestion. It also aims to study time between ingestion to extracorporeal therapy initiation on outcomes of PQ ingestion. 100 patients of paraquat ingestion were included in the study after meeting the inclusion and exclusion criteria. 85% had mortality, 15% survived in our study. Time to reach tertiary care centre is 7.3±4.1 among survivors group and 18.8±4.6 hours among non survivors group (P value is 0.001) .Most common cause of death was acute respiratory distress syndrome (ARDS) Number of patients initiated on hemodialysis due to urine paraquat positivity on arrival was 58(18 survivors and 40 non survivors) P value is <0.001 which is significant. Paraquat poisoning continues to be highly fatal as evidenced by 85% mortality in our cohort. Early diagnosis and timely initiation of extracorporeal therapies may benefit but may be futile once significant organ damage has occurred. Our research findings underscores the emergent need for strict regulation and public health intervention to prevent paraquat exposure.

Background: Schizophrenia is characterized by significant immunological abnormalities and antipsychotic medications may influence these abnormalities, impacting treatment outcomes. This study was planned to assess the effect of treatment with risperidone and olanzapine on inflammatory markers such as IL-6, IL-1β, and TNF-α in drug naïve schizophrenia. Methods: The study design was prospective, comparative and interventional. Patients diagnosed with Schizophrenia according to ICD-11 fulfilling the inclusion and exclusion criteria were randomly assigned to Group A (Risperidone) and Group B (Olanzapine). Blood samples were collected at baseline, 2 weeks and 10 weeks to measure levels of inflammatory markers and the Positive and Negative Syndrome Scale (PANSS) was administered at the same time. The role of the cytokines was assessed in determining response from treatment. Results: A total of 68 of schizophrenia; 34 in each group completed 10 weeks of study period. Baseline levels of interleukins (IL-6, IL-1β) and TNF- α were elevated than the normal range in both groups. 10 weeks of treatment, in both groups, responders showed significant reductions in TNF-α levels at 10 weeks (p<0.001). Both risperidone and olanzapine, had similar efficacy on clinical profile and inflammatory markers without any significant differences. Conclusion: IL-6, IL-1β and TNF-α levels are higher in drug naïve patients with schizophrenia and treatment with olanzapine and risperidone leads to decrease in TNF-α levels at week 10 which was found to be correlated with decrease in symptom severity.

Dyslipidaemia, a major component of metabolic syndrome, is a key risk factor for cardiovascular diseases and is closely linked to psychological stress. This community-based cross-sectional analytical study assessed 66 working and 68 non-working women aged 31–45 years, evaluating psychological wellbeing using the DASS-21 scale alongside fasting serum lipid profiles. The study found a significant association between elevated LDL levels and occupational status (χ² = 3.91, p = 0.04), with working women more affected. Elevated LDL was also significantly linked to stress, particularly among non-working women (χ² = 18.34, p = 0.0001). High triglyceride levels were associated with depression in working women (χ² = 6.94, p = 0.03) and with stress in both working (χ² = 4.13, p = 0.04) and non-working groups (χ² = 10.94, p = 0.0003), suggesting a strong connection between lipid abnormalities and psychological distress. These findings underscore the need for integrated strategies to improve both physical and mental health in women, regardless of their occupational status.

Introduction: Fascial plane blocks are techniques used to manage pain, both in the perioperative period and in the treatment of chronic pain. The erector spinae plane (ESP) block, great advantage of the ESPB appears to be the provision of both somatic and visceral analgesia’s block leads to effective postoperative analgesia when performed at T 4-5 level for breast and Thoracic surgery, and T 7 level for abdominal surgeries. The present study was conducted to compare post-operative analgesia effect in cases undergoing general anaesthesia with and without erector spinae block in lumbar spine decompression. Methodology: The present comparative study was conducted in the department of Anaesthesia in a tertiary care institute during August 2019 to December 2021 amongst 76 patients undergoing lumbar spine decompression surgery. 76 Patients were allocated into two groups of 36 each: Group 1 (n= 36): Patients receiving General Anesthesia (GA). Group 2 (n= 36): Patients receiving GA with erector spine plane block which was given pre – operatively. The local anesthetic agent administered was 0.25% Bupivacaine 30 ml. Result: The mean time of surgery was 219.21. In Group B there were 09 patients with 200 minutes surgery,18 patients with 210 minutes surgery & 11 patients with 240 minutes surgery. The mean systolic BP was 134 mmHg and diastolic was 83.68 mmHg at the time of induction & mean systolic BP was 137.18 mmHg and diastolic was 83.37 mmHg at the time of Incision. In Group B The mean systolic BP was 132 & diastolic was 76.82 mmHg at the time of induction & mean systolic BP was 155.82 mmHg and diastolic was 95.95 mmHg at the time of Incision. Intra – operative Rescue analgesia was not administered to Group A patients. In group B Intra – operative rescue analgesic inj. Fentanyl with dose of 20 microgram, 30 microgram & 40 microgram was administered. The mean score after 12 hours in group A was 2.24 and in Group B was 4.00. Conclusion: We concluded that erector spine plane block with general anesthesia provided good postoperative analgesia and it decreases postoperative analgesic requirement than general anesthesia alone.

Chronic Kidney Disease (CKD) represents a progressive disorder marked by a deterioration in renal function, frequently associated with systemic complications. The identification and monitoring of reliable biomarkers are critical for enhancing disease management and improving clinical outcomes. The objective of this investigation was to assess serum uric acid, plasma homocysteine, inflammatory markers, and Urinary Albumin-to-Creatinine Ratio (UACR) as critical determinants of CKD progression. A total of 120 patients with CKD were enrolled in the study and subsequently stratified according to their respective disease stages. Data pertaining to biochemical and clinical parameters were subjected to analysis, encompassing serum uric acid levels, plasma homocysteine concentrations, interleukin-6 (IL-6) measurements, C-reactive protein (CRP) levels, and UACR. Statistical analyses were conducted to evaluate the correlations between biomarkers and disease severity. In advanced stages of CKD, there is a notable increase in the levels of uric acid, homocysteine, interleukin-6 (IL-6), C-reactive protein (CRP), and UACR. The analysis revealed significant correlations between uric acid and homocysteine levels and the decline in renal function (p < 0.001). Inflammatory markers demonstrated a predictive relationship with cardiovascular risks, whereas UACR exhibited a robust association with glomerular injury. The results highlight the critical role of incorporating biomarker monitoring within the management framework of CKD. Targeted interventions that address these parameters have the potential to decelerate disease progression and mitigate complications. Additional investigations are required to elucidate their therapeutic potential within clinical applications.

Background: Cervical lesions range from benign inflammatory changes to premalignant and malignant conditions. Histopathological examination is essential for accurate diagnosis and management, especially in regions with limited screening facilities. Objective: To evaluate the histopathological spectrum of cervical lesions in patients attending a tertiary health care center in South West Bihar. Materials and Methods: A one-year observational study was conducted on 100 patients presenting with cervical lesions at Narayan Medical College and Hospital, Jamuhar, Bihar. Cervical biopsy specimens were processed and examined histologically to classify lesions as benign, premalignant, or malignant. Results: Chronic cervicitis was the most common lesion (40%), followed by premalignant lesions (25%), including cervical intraepithelial neoplasia (CIN), and malignant lesions (20%), predominantly squamous cell carcinoma. Benign lesions accounted for 15%. The majority of malignant cases were seen in women aged 51–60 years. Conclusion: The study highlights a significant burden of premalignant and malignant cervical lesions in this population. Early detection through histopathology is crucial for effective management. Enhanced screening and public health measures are needed to reduce cervical cancer morbidity and mortality in South West Bihar.

Background: Complementary feeding is essential for the growth and development of children aged 6–23 months. Inadequate practices can lead to undernutrition, stunting, and other health problems. There is limited comparative data from central India, especially regarding rural–urban differences. Objectives: To assess factors influencing complementary feeding practices among children aged 6–23 months and compare these between urban and rural areas of Bhopal, Madhya Pradesh. The study also aimed to evaluate the nutritional status of children based on the type of complementary feeding received. Methods: A community-based cross-sectional comparative study was conducted among 400 children (200 urban, 200 rural) aged 6–23 months and their caregivers. Participants were selected using a stratified random sampling method from the catchment areas of the urban and rural health centers affiliated with RKDF Medical College, Bhopal. Data were collected through interviews using a structured questionnaire and by anthropometric assessment. Statistical analysis was performed using Stata version 17.0. Chi-square and t-tests were used for group comparisons, and multivariate regression was used to identify predictors of poor feeding practices. Results: Early initiation of complementary feeding (<6 months) was observed in 26% of urban and 23.5% of rural children. Most children consumed semi-solid or liquid foods, with similar food diversity in both groups. Breastfeeding was ongoing in 79% of urban and 84.5% of rural children. Malnutrition indicators such as underweight, stunting, and wasting were more prevalent in rural children. Severe underweight (22.5% vs 15%), severe stunting (17.5% vs 7.5%), and severe wasting (14.5% vs 6.5%) were significantly higher in the rural group. Conclusion: Complementary feeding practices were suboptimal in both groups, but rural children showed a higher prevalence of malnutrition. Interventions targeting early initiation, dietary diversity, and responsive feeding, especially in rural settings, are needed to improve child nutrition.

Introduction: Tobacco use among adolescents is a growing concern. Studying its prevalence and causes in North Gujarat is essential to inform targeted interventions and promote healthier behaviours in youth. Objective: To ascertain the prevalence of tobacco, use among school-age adolescents in Gujarat’s Patan district and to study the behavioural and sociodemographic characteristics associated with tobacco consumption. Methods: A study was done in six schools chosen at random in Patan district, North Gujarat, involving 420 teenagers aged 12 to 18. The research used a questionnaire that was tested beforehand and was available in two languages. The study used a method called systematic random sampling. Approval from an ethics committee and permission from the students and school officials were received. Results:  Total99 (23.6%) of the 420 teenagers polled said they used tobacco in some capacity. While pan masala (4.3%) and gutkha (4.0%) were common smokeless products, cigarettes (8.6%) were the most popular smoking product. Two significant influencing factors were parental tobacco use (38.6%) and peer tobacco use (59.0%). Just 34.5% of respondents said they had read statutory warnings, despite 76.0% being aware of the negative effects of tobacco. Overall, 93% of users said they wanted to stop using it. The main drivers of initiation were peer pressure, stress, and accessibility. There was no gender-based differences in usage, awareness, or motivation to stop that were statistically significant. Conclusion: Tobacco uses among adolescents in North Gujarat is influenced by age, gender, and social environment. Effective prevention should focus on early education, parental involvement, and restricting access to tobacco to help reduce initiation and protect youth health.

Background: Uterine scar rupture in a post caesarean pregnancy is a fatal complication and is increasing in incidence due to increasing rates of caesarean section. It is therefore important to understand various risk factors associated and identify a high risk patient. Objective: To evaluate risk factors associated with scar rupture in a post caesarean pregnancy. Method: A hospital based retrospective observational study was conducted from November 2023 to October 2024, during which all cases of scar rupture in a post caesarean pregnancy were studied. A detailed history regarding previous pregnancy and caesarean section was taken. Results: Multiple previous caesarean scars, lower uterine segment thickness < 2.8mm, inter delivery interval <24 months, previous emergency caesarean section, advancing maternal age, increasing BMI and post-dated gestation increase the risk of scar rupture. Conclusion: Educating the mother regarding possible scar rupture, need for adequate birth spacing, frequent antenatal checkups, detailed history of previous pregnancy before considering VBAC, measuring scar thickness and high suspicion can prevent scar rupture.

Foreign body aspiration continues to be a significant cause of respiratory emergency in children, particularly those under the age of seven. Prompt intervention is crucial to avoid potentially life-threatening complications. Rigid bronchoscopy remains the preferred modality for foreign body removal in pediatric airways due to its superior visualization and control. This case series highlights five children, aged 1 to 6 years, who underwent rigid bronchoscopy-guided foreign body removal in a tertiary care setting. Presenting symptoms ranged from dry cough and breathlessness to chest pain and fever. The foreign bodies included organic items such as seeds and peanuts, and inorganic objects like a metallic pin and a battery cell. Most foreign bodies were located in the right main bronchus. All cases were considered high-risk for anaesthesia and managed with individualized anaesthetic protocols including the use of sevoflurane, ketamine, and propofol. High-flow nasal oxygen was used in two cases to maintain oxygenation. All foreign bodies were successfully removed without the need for surgical intervention, and postoperative recovery was uneventful in all patients. This series reinforces the safety and efficacy of rigid bronchoscopy in skilled hands, even in complex pediatric airway emergencies.

Background: Serious bacterial infections (SBIs) in infants aged 1–3 months pose significant diagnostic challenges due to non-specific clinical presentations and the immature immune system of this age group. Early identification is crucial to guide prompt treatment and reduce morbidity and mortality. While laboratory markers like CRP and WBC count are frequently used, the diagnostic value of thrombocytosis remains underexplored. Objectives: To evaluate thrombocytosis as a predictive biomarker for severe bacterial infections in infants aged 1 to 3 months and determine its diagnostic validity compared to other clinical and laboratory indicators. Methods: This prospective observational study was conducted in the pediatric department of DMCH, Laheriasarai, and included 280 infants aged 1–3 months admitted with suspected SBI. Clinical, laboratory, radiological, and microbiological data were collected. Thrombocytosis was defined as a platelet count >450,000/µL. Statistical analysis included Chi-square tests and logistic regression to assess associations, and diagnostic accuracy was evaluated using sensitivity, specificity, PPV, and NPV. Results: Among 280 infants, 46.4% had thrombocytosis, and 29.6% were confirmed SBI cases. Thrombocytosis was significantly associated with SBI (p < 0.001), showing moderate sensitivity (65.5%), specificity (61.7%), and NPV (80.7%) but low PPV (42.3%). WBC <15,000/mm³, positive urine microscopy (>5 pus cells), abnormal CXR (bronchopneumonia), and positive cultures (blood, urine, CSF) also demonstrated significant associations with SBI. Pneumonia was the most common SBI diagnosis (65.06%). Conclusion: Thrombocytosis shows moderate diagnostic utility for predicting SBIs in young infants and may serve as a supportive biomarker. However, due to limited specificity and PPV, it should be used in conjunction with other clinical and laboratory indicators. A multimodal diagnostic approach is essential for accurate SBI identification and timely intervention.

Background: Distal third femur shaft fractures can have severe consequences if not treated correctly, leading to long-term disability. Choosing the right surgical fixation method is vital for optimal recovery. Two common techniques, antegrade intramedullary nailing (AIN) and locked plating (LP), offer different benefits and drawbacks. AIN provides a minimally invasive approach with internal support, while LP offers enhanced stability for complex fractures. Aim of the Study: This study compares the effectiveness of AIN and LP in treating distal third femur shaft fractures, aiming to identify which method produces better recovery outcomes and fewer complications. Methodology: This prospective randomized study was conducted in patients treated for distal third femur shaft fracture (typeA – AO classification) at Adhichunchangiri Institute of Medical Science, BG Nagar from the month of JUNE 2022 to JUNE 2024. About Thirty such cases were allocated alternatively into two groups i.e., Antegrade intramedullary nailing (AIN) and locked plating (LP). The functional outcome of the management of fracture was assessed based on Neer’s criteria where the Patient’s age ranged from 18 to 80 years with a mean of 48.27. Results: Majority of the study participants were males, and the mean age was around 39.86 years and 49.6 years in AIN and DF-LCP group respectively. Mean time for union was 20 weeks The Mean hospital stay for managing distal third fractures of the femoral shaft was 9.8 days for the AIN group, which is shorter when compared to 17.80 days for the DFLCP group. The mean duration for clinical union of fractures in the intramedullary nailing (AIN) group was 19.93 weeks, significantly shorter than the 25 weeks observed in the distal femoral locking compression plate (DFLCP) group. According to Neer’s Criteria, the outcome was excellent in majority in the AIN group ie 80% of Excellent Outcome while GROUP DFLCP showed mixed results with only 40% of Excellent Outcome followed by Good Outcome of 26.66%, fair OUTCOME of 26.66% and poor outcome of 6.66%, only in the group DFLCP implying a better overall functional outcome in the AIN group. Conclusion: The AIN group outperformed the DF-LCP group in this study by achieving clinical union of the fractured bone in a shorter time frame and reducing the length of hospital stay. Furthermore, the AIN group achieved excellent outcomes in a higher proportion compared to the DF-LCP group. Also, complications were minimal for group AIN, thus AIN group demonstrated a greater safety profile than DF-LCP.

Background: Bronchial asthma is a chronic inflammatory disorder that affects millions of people worldwide and requires long-term pharmacological management for its treatment. The commonly prescribed medications for the treatment of asthma include bronchodilators such as β2 agonists, theophylline, and anticholinergics, along with inhaled corticosteroids and leukotriene receptor antagonists. These drugs are known to cause a range of adverse drug reactions (ADRs), varying from mild to severe. Mild reactions may include symptoms like throat irritation and tremors, while severe reactions can involve life-threatening conditions such as anaphylaxis or cardiac arrhythmias. Consequently, such ADRs can significantly impact treatment adherence and compromise patient safety.In tertiary care settings, especially in cities like Bhopal where patient load and drug variability are significant, systematic pharmacovigilance is essential. Aims and Objectives: (1) To evaluate adverse drug reactions (ADRs) in patients with bronchial asthma who received antiasthmatic treatment and (2) To compare ADRs of bronchodilators versus other anti-asthmatic drugs in bronchial asthma. Materials and Methods: 150 patients were enrolled for evaluating adverse effects with antiasthmatic drugs. All patients were followed up by medical history, history of drugs, and any severity of ADR. Causality was graded by Naranjo scale. Results: The mean age of the study population was 47.6 years, with males averaging 48.6 years and females 47.8 years. This study revealed that among the commonly prescribed antiasthmatic drugs, beta-2 agonists were used most frequently (44.6%), followed by methylxanthines (20.6%), corticosteroids (18%), and anticholinergics (9.3%). In the study findings, beta-2 agonists were most commonly associated with adverse effects such as tremors (27.2%), sleepiness (36.3%), and headache (36.3%). Corticosteroids led to reactions including mouth ulcers (14.2%), epigastric pain (21.4%), vomiting (21.4%), and acne (21.4%). Anticholinergic drugs typically caused side effects like dry mouth (25%) and constipation (75%). Methylxanthines were linked with insomnia (33.3%), headache (66.6%), and nausea (22.2%) in a majority of patients receiving them. Conclusion: In asthmatic patients receiving antiasthmatic drugs provides a fruitful information about a ADRs and enhance knowledge about pharmacovigilance to health-care providers. However, predominance of adverse effects in female asthmatic patients was reported. Tremors, nausea, dryness of mouth and GI tract disturbances were observed frequently with antiasthmatic in middle age asthmatic patients. By this information, we can prevent drug related complications and improve quality of life of a person.

Background: Intermittent fasting (IF) is an increasingly popular dietary strategy that involves alternating periods of eating and fasting. Unlike traditional calorie restriction, IF focuses on when food is consumed rather than what is eaten. Emerging evidence suggests that IF may confer significant benefits on cardiovascular and metabolic health by improving insulin sensitivity, lowering blood pressure, reducing inflammation, and promoting weight loss. This introduction explores the potential effects of IF on key cardiovascular and metabolic parameters in diverse populations. Aim and Objectives: This study aims to evaluate the impact of intermittent fasting on cardiovascular and metabolic health by assessing the changes in parameters such as body weight, blood pressure, heart rate, lipid profile, blood glucose, insulin levels, uric acid, while also examining its safety, feasibility, and short-term effectiveness in improving overall cardiometabolic outcomes. Materials and Methods: This prospective observational study was conducted over a period of 12 weeks to evaluate the effects of intermittent fasting on cardiovascular and metabolic parameters. A total of 100 adult participants were enrolled from the outpatient department and wellness clinic, representing a diverse group in terms of age, sex, and baseline health status. The study design allowed for the natural observation of changes over time without any external intervention, providing real-world insights into the feasibility, safety, and effectiveness of intermittent fasting as practiced by individuals in their routine lifestyle. Data on various clinical and biochemical parameters were collected at baseline and at the end of the study period to assess the impact of IF on cardiometabolic health. Results: This 12-week study demonstrated significant improvements in multiple cardiometabolic and anthropometric parameters following intermittent fasting. Participants, with a mean age of 42.5 years and predominantly overweight (mean BMI 28.2 kg/m²), showed a statistically significant reduction in body weight (from 78.5 to 74.8 kg, p<0.001). Blood pressure and heart rate decreased notably, with systolic BP dropping from 134.6 to 127.4 mmHg, diastolic BP from 84.2 to 79.8 mmHg, and heart rate from 78.2 to 72.9 bpm (all p<0.001). Lipid profile improved significantly: total cholesterol, LDL-C, and triglycerides decreased, while HDL-C increased. Glycemic control markers also improved, with reductions in fasting glucose, HbA1c, and HOMA-IR (all p<0.001). Inflammatory marker hs-CRP and waist circumference showed marked declines, and uric acid levels reduced modestly. Overall, intermittent fasting proved effective in enhancing cardiovascular and metabolic health. Conclusion: Intermittent fasting for 12 weeks led to significant improvements in weight, blood pressure, heart rate, waist size, lipid levels, blood sugar control, inflammation, and uric acid, demonstrating its effectiveness in improving overall cardiometabolic health.

Ultrasound-guided supraclavicular brachial plexus block (USGBPB) is increasingly favored for upper limb surgeries due to its precise, ultrasound-guided nerve localization, ensuring effective anesthesia with fewer complications. However, rare complications such as recurrent laryngeal nerve (RLN) palsy may arise, particularly impacting the right side due to anatomical proximities. This case report describes the occurrence and management of RLN palsy in a 48-year-old male who underwent right forearm surgery, successfully managed with supportive interventions. This case emphasizes the need for caution, particularly in minimizing local anesthetic volume and applying digital pressure when performing USGBPB to mitigate potential adverse effects, especially in high-risk cases.

Allergic rhinitis (AR) is a common chronic inflammation of the nasal passages, causing sneezing, nasal congestion, runny nose, and itching, which significantly affects patients’ quality of life. Despite using antihistamines, corticosteroids, and allergen-specific immunotherapy (ASIT), many patients continue to struggle with persistent symptoms. This highlights the need for treatments that target the underlying immune mechanisms. Thymic stromal lymphopoietin (TSLP), a cytokine produced by epithelial cells, plays a critical role in triggering allergic inflammation by activating dendritic cells and promoting T-helper 2 (Th2) responses, leading to eosinophil activation and IgE production. Tezepelumab, a fully human monoclonal antibody that blocks TSLP, prevents this cascade, reducing inflammation at its source. Initially approved for severe asthma, tezepelumab has shown promising results in clinical studies for AR. In particular, combining tezepelumab with subcutaneous cat allergen immunotherapy (SCIT) significantly reduced nasal symptoms and maintained symptom relief even after treatment ended, suggesting possible long-term benefits. Tezepelumab’s effectiveness across various inflammatory profiles, regardless of eosinophil levels, and its favourable safety profile further support its potential use in AR. However, challenges like high cost and limited data in AR-specific populations remain. Larger, long-term studies are needed to confirm its benefits and guide personalized treatment strategies.

Background: Non-Steroidal Anti-Inflammatory Drugs, known for their analgesic and anti-inflammatory effects, are extensively prescribed across clinical settings all over the world. Over recent years, worries surrounding their cardiovascular safety especially in prolonged use have escalated. These risks are not uniform across all NSAIDs, with patients who already have cardiovascular risk factors facing greater vulnerability. Aim: To evaluate the usage patterns of NSAIDs and their association with the incidence of cardiovascular events in adult patients attending a tertiary care center in Ahmedabad. Methods: This retrospective observational study analyzed data from 780 patients who received NSAIDs between February 2023 and June 2024. Patients were categorized based on NSAID usage as short-term, intermittent, or chronic users. Data on demographics, comorbidities, NSAID types, and cardiovascular outcomes were extracted from medical records. Multivariate logistic regression was performed using SPSS version 23.0 to identify predictors of cardiovascular events. Results: Among 780 patients (mean age: 56.7 ± 12.4 years; 54.9% male), 32.3% were chronic NSAID users. Cardiovascular events occurred in 68 patients (8.7%), with the highest incidence in chronic users (16.7%) compared to intermittent (7.6%) and short-term users (2.8%) (p < 0.001). Chronic NSAID use was independently correlated with a 3.2-fold increased risk of cardiovascular events (Adjusted OR: 3.2; 95% CI: 1.8–5.6). Age over 60 and hypertension also significantly increased cardiovascular risk. Conclusion: Chronic NSAID use is significantly correlated with an increased risk of cardiovascular events, particularly in older adults and hypertensive patients. The type and duration of NSAID therapy should be carefully considered in patients with cardiovascular risk factors. Recommendations: Routine cardiovascular risk assessment should be implemented before initiating long-term NSAID therapy. Safer alternatives and regular monitoring are recommended for high-risk patients. Clinician awareness and patient education regarding NSAID-related cardiovascular risks should be strengthened.

Introduction: India is a country with one-fourth of the Global Tuberculosis burden. The WHO recently implemented the light-emitting diode (LED) fluorescent microscopy and the GeneXpert MTB/RIF assay for the National Tuberculosis Programme in developing countries. The GeneXpert MTB/RIF assay, also known as a cartridge-based nucleic acid amplification test (CBNAAT), is a newly developed, automated diagnostic molecular test. Material & Methods: This study was conducted to evaluate the role of CBNAAT for the diagnosis of Pulmonary and EPTB using routinely collected Pus, Sputum, and Fluid samples and compare it against ZN STAINING and fluorescent LED microscopy. Results: In this study, 150 samples were examined by CBNAAT, and the same samples were also examined by ZN stain and AR stain. Out of 150 samples, 77 samples were positive for Mycobacterium tuberculosis by Gene Xpert MTB/RIF,49 samples were positive for Mycobacterium tuberculosis by ZN stain, and 52 samples were positive for Mycobacterium tuberculosis by Auramine rhodamine stain. Overall sensitivity was highest with CBNAAT, followed by AR stain and Z.N. staining. The Xpert MTB/RIF assay is a new test that is revolutionizing tuberculosis (TB) control by contributing to the rapid diagnosis of tuberculosis and identifying drug resistance. Conclusion: The major advantages of the Xpert MTB/RIF assay are that the results are available quickly, and minimal technical training is required to run the test. Additionally, the Xpert MTB/RIF assay can quickly identify possible multidrug-resistant TB.

Background: Pregnancy-induced hypertension (PIH) and intrauterine growth restriction (IUGR) are major contributors to adverse perinatal outcomes. Early identification of fetal compromise is essential in managing these high-risk pregnancies. While both non-stress test (NST) and color Doppler velocimetry are used for fetal surveillance, their comparative predictive accuracy remains an area of clinical interest. Aim: To observe the usefulness of the systolic/diastolic (S/D) ratio in the umbilical artery on color Doppler as compared with NST in predicting perinatal outcomes in pregnancies complicated by PIH and IUGR. Materials and Methods: A hospital-based observational study was conducted on 160 antenatal patients diagnosed with PIH and/or IUGR. All patients underwent both NST and umbilical artery color Doppler assessment. Perinatal outcomes were recorded in terms of Apgar score, NICU admission, neonatal morbidity and mortality. The sensitivity, specificity, predictive values, and diagnostic accuracy of both tests were evaluated and compared using appropriate statistical tools. Results: Doppler was found to be more predictive than NST in 25% of cases. Abnormal Doppler findings significantly correlated with poor perinatal outcomes (p<0.000). Doppler showed higher sensitivity (77.7%) and diagnostic accuracy (79.38%) in detecting adverse outcomes compared to NST (sensitivity 51.7%, accuracy 75%). The combination of both tests improved the detection rate of fetal compromise. Conclusion: Umbilical artery Doppler is a more sensitive and reliable tool than NST in predicting adverse perinatal outcomes in PIH and IUGR pregnancies. Integration of both modalities enhances fetal surveillance, allowing timely intervention and improved neonatal outcomes.

Objectives: To evaluate the outcomes of Lateral Internal Sphincterotomy technique for Chronic Anal Fissure. mMethods: This was a prospective observational analytical study designed to evaluate the outcomes of Lateral Internal Sphincterotomy (LIS) in patients with chronic anal fissure. The study was conducted at the Department of General Surgery, People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, over a period of 18 months from May 2023 to October 2024. A total of 184 consecutive patients meeting the inclusion criteria were enrolled in the study. The sample size was determined based on the average number of LIS procedures performed at our institution and the duration of the study period. Results: The mean age of the study population was 42.8 ± 12.7 years, with a range of 18 to 70 years. The median age was 45 years, indicating a relatively older cohort of patients undergoing LIS. The study showed a male predominance, with 108 (58.7%) male patients and 76 (41.3%) female patients. Pain was assessed using the Visual Analog Scale (0-10), with the majority of patients reporting moderate to severe pain. Mean preoperative VAS score was 8.0 ± 1.6. Postoperative bleeding reduced significantly, with all patients achieving complete resolution by 2 weeks. Conclusion: The findings from this study support the role of LIS as the preferred surgical option for chronic anal fissures, given its high success rate, minimal complications, and significant improvement in quality of life. However, future research should focus on long-term outcomes, comparative effectiveness with alternative treatments, and strategies to enhance post-operative care adherence. A multicentre, randomized controlled trial would be beneficial in further validating these findings and refining treatment protocols for chronic anal fissures.

Background: District Residency Programme (DRP) was introduced by National Medical Commission as mandatory three-months training program for postgraduate residents. This study was designed with the primary objective to assess and describe the perception and experiences of non/para clinical postgraduate residents during DRP. Methodology: A cross-sectional study was conducted amongst the non/para clinical postgraduate residents of Batch 2021 and Batch 2022 with the help of semi-structured, self-administered questionnaire which consisted of questions regarding their experiences and perceptions for the DRP. Questions were scored on a five-point Likert scale. The data collected was entered and cleaned on Microsoft Excel and then analyzed using SPSS software. Results: A total of 67 non clinical/para clinical post graduate residents were surveyed with the pre-tested, self-administered, semi-structured questionnaire. Majority of these residents did not find DRP to be relevant to the PG curriculum. (43.3% residents strongly disagreed, while only 6% strongly agreed on the relevance of DRP with PG curriculum). A large number of the residents (32) believed that DRP had no strength and they did not find the programme to be useful at all. 53.7% of the residents were of the opinion that none of the objectives were fulfilled by the District Residency Programme. Only 20.9% of the non/para clinical residents found the learning experience during DRP to be satisfactory, while 79.1% of them were not satisfied with the experience. 61.2% of the residents of the non/para clinical branches, voted for implementation of all of the above suggestions for the successful conduction the District Residency Programme. Conclusion: The study finds high degree of dissatisfaction among non/para clinical residents towards learning objectives, academic learning, and basic amenities during DRP. There was also a clear lack of specialty-exposure and high concerns of safety, especially for female residents. The study findings should alarm and inform policymakers and administrators to improve DRP implementation so as to better achieve laid objectives.

Background: Surgical site infections (SSIs), the third most common nosocomial infection, endanger hospitals and patients. SSIs must be monitored continuously. This present study examined SSI incidence, risk factors, pathogens, and antibiotic sensitivity in emergency and elective or planned abdominal surgeries. Methodology: The present study was conducted on a total of 116 cases who underwent emergency abdominal surgery at our study centre during the study period from 1st May 2023 to 30th October 2024. The Patients admitted in surgical ward of PCMS & RC in the Department of General Surgery, requiring Emergency abdominal Surgery fulfilling the inclusion criteria were included in the study. After admission, short history was obtained from all the study participants using the proforma. History regarding sociodemographic variables such as age, sex, occupation, educational status, residence etc. was obtained and documented. At the time of surgery, the type of emergency surgery was noted and time-duration between symptoms & surgery was noted. Degree of peritoneal contamination, time- duration of surgery, usage of drains and antibiotics were noted. The patients were followed up during the surgery, and during the entire hospital stay, and postoperative follow up at 14 days, and up to 30 days. Results: In the present study, surgical site infections were present in 33 out of 116 cases, hence the incidence of surgical site infections was observed to be 28.4% in our study cohort. We reported superficial surgical site infections in majority of cases (81.8%), whereas 15.3% cases had deep surgical site infections and 3% cases had organ space infections. The most common indication of emergency abdominal surgery was acute appendicitis (31%), followed by intestinal perforation (29.3%) and gastroduodenal perforation (18.1%). Although the indications of surgery in majority of cases with SSI was intestinal perforation (39.4%) whereas majority of cases with no SSI underwent surgery for acute appendicitis (36.1%), the observed association of SSI with indications of surgery was statistically insignificant (p>0.05). Conclusion: SSI is common following emergency abdominal surgeries and can be documented in more than one fourth of the cases. SSI is associated with various risk factors most common being contamination of peritoneal fluid, followed by primary bowel repair, diabetes, intestinal perforation, advancing age, time-duration between symptoms & surgery of more than 48 hours, prolonged duration of surgery, and positive pus culture. The presence of SSI increases the length of ICU stay, length of hospital stay and postoperative complication (wound dehiscence).

Background: Bariatric surgery is the most effective long-term intervention for severe obesity and metabolic syndrome. However, selecting the optimal surgical procedure remains challenging due to individual patient variability. Artificial Intelligence (AI) offers a promising solution by integrating clinical, behavioral, and genetic data to personalize procedure selection. Objective: To evaluate the feasibility and predictive accuracy of an AI-based model in selecting the most appropriate bariatric procedure for individual patients. Methods: A retrospective analysis of 500 patients who underwent bariatric surgery (SG, RYGB, MGB, or SADI) from 2018 to 2023 was conducted. A supervised machine learning model was trained using preoperative data, including BMI, comorbidities, psychological profile, insulin resistance, and weight loss history. The model predicted the most suitable surgical procedure, and its predictions were compared with actual surgical outcomes at 1 year post-op. Results: The AI model achieved 86.4% accuracy in predicting the optimal procedure for weight loss and comorbidity resolution. Patients whose surgery matched AI recommendations had significantly better %EWL (excess weight loss), T2DM remission rates, and lower complication rates (p<0.05). Conclusion: AI-assisted decision-making in bariatric surgery is feasible and can enhance surgical outcomes through personalized procedure selection. Prospective trials and clinical integration are warranted.

Background: Ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD) is a promising non-invasive bedside tool for detecting raised intracranial pressure (ICP). This study aimed to correlate USG-measured ONSD with the gold standard intraventricular ICP and determine the ONSD cut-off predicting elevated ICP in children with suspected increased intracranial pressure (IICP). Methods: This prospective observational cohort study was conducted from October 2022–September 2023 in the PICU of Calcutta National Medical College and Hospital. 50 children enrolled based on convenience sampling. Ethical approval and informed parental consent were obtained. Children with features suggestive of IICP were evaluated, and clinical data were recorded. Statistical analysis, including relative risk and risk reduction, was performed using SPSS. Results: Among 50 children, 48% were boys and 52% girls. Altered sensorium (38%) and fever with headache (32%) were the most common symptoms. Other notable symptoms included tonic posturing (14%), irritability (6%), vomiting (6%), and seizures (4%). Presentation times were within 24 hours (56%), 24–72 hours (24%), and after 72 hours (20%). Most children (88%) had no similar illness in their neighbourhood, and 54% were fully immunized. Developmental delays were observed in 28%, and 72% had normal development. Brain injury severity was categorized as mild (48%), moderate (34%), and severe (18%). Pupillary reactions included normal (32%), sluggish (22%), unequal (30%), and dilated-fixed pupils (16%). Elevated ONSD was significantly associated with longer hospital stays (p = 0.005) and higher mortality (53.3%). Normal ONSD correlated with lower mortality (5.7%) and higher discharge rates (94.3%). Conclusion: ONSD and TCD are effective, non-invasive tools for assessing raised ICP in paediatric patients. Their integration into clinical practice can improve early detection, management, and monitoring of neurological conditions, enhancing patient outcomes.

Osteochondromas are the most common benign bone tumors. They are developmental malformations rather than true neoplasms and are thought to originate within the periosteum. We present a case report of a osteochondroma, a common benign tumor on posterolateral aspect of right distal femur. This benign tumor characterized by a bony protuberance surrounded by cartilaginous surface, most commonly in proximal tibia, distal femur, proximal humerus. Osteochondromas most commonly are present in the first four decades of life, and almost 75% of these lesions are present before the age of 20 years. The multiple form is an autosomal dominant syndrome referred to as hereditary multiple exostosis (HME) or familial osteochondromatosis. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is not commonly seen if complete resection is achieved.

Introduction: Chronic Kidney Disease (CKD) is one of the most common non-communicable causes of death throughout the world, with cardiovascular complications being the most common cause of death. Hence, early diagnosis of the disease is essential for preventing comorbid conditions and death. The cases are divided into 5 stages (I-V) on the basis of their estimated Glomerular Filtration Rate (eGFR) calculated by the CKD-EPI formula, 2021. Recent research revealed Hydrogen Sulphide (H₂S) as an important gasotransmitter with various important physiological roles. In animal models, H₂S has been found to increase the GFR. In other animal studies, a significant reduction in serum H₂S levels was found in CKD cases. Aim & Objective: To determine if there is any relationship between serum H₂S levels and CKD patients in comparison to apparently healthy controls. Materials & Methods: This is an observational analytical cross-sectional study conducted in the Department of Biochemistry & Nephrology of KPC Medical College, Kolkata between January and June, 2024. 84 cases of CKD of both genders in the age group 25-75 years attending the Nephrology OPD were recruited for this study and compared with an equal number of apparently healthy controls. The biochemical assays, including serum urea, creatinine, H₂S etc., were done by previously standardised procedures. The statistical analysis was performed using MS Excel 2021 and IBM SPSS 20 software. The data have been displayed in terms of descriptive statistics like mean ± standard deviation. Various statistical tests were applied as and where applicable. P-value <0.05 was considered as significant. Results: The mean serum urea (54.14 mg/dL ± 39.55) and creatinine (1.46 mg/dL ± 0.73) for the cases were significantly higher than those of controls (urea: 25.26 mg/dL ± 8.95, creatinine: 0.69 mg/dL ± 0.08) with p values of <0.05. The mean serum H₂S for cases (24.80 ± 4.38) was significantly lower than that of controls (42.30 ± 20.5) (p<0.01), and the mean eGFR was lower for cases (60.11 ± 28.97) than that of controls (119.18 ± 3.54) (p<0.001). Glycaemic parameters like Fasting Plasma Glucose (FPG), Post Prandial Plasma Glucose (PPBG), and HbA_1c were significantly higher in cases than controls (p<0.05). Both the mean serum H₂S and eGFR gradually decreased significantly with progressive renal impairment (p<0.01). There was a significantly negative correlation between H₂S and both urea (R= -0.76, p<0.01) and creatinine (R= -0.83, p<0.01), and a significant positive correlation between serum H₂S and eGFR (R=0.85, p<0.01) among the cases. Conclusion: H₂S may play a protective role in patients with CKD, delaying its progression and offering a novel therapeutic avenue for exploration.

Introduction: Shivering is commonly seen in patients receiving spinal anesthesia and a cause for distress.
Aim: To compare the efficacy of prophylactic use of intravenous (i.v.), ketamine hydrochloride and tramadol hydrochloride for control of shivering under spinal anesthesia.
Design: Single blind randomized prospective trial.
Material and Method: After institutional approval 100 adult patients undergoing spinal anaesthesia were divided randomly in two groups.
Ketamine group: Patient received inj. ketamine hydrochloride 0.5 mg.kg^-1 i.v.
Tramadol group: Patient received inj. tramadol hydrochloride 0.5 mg.kg^-1 i.v.
Involuntary muscle activity, hemodynamic changes and side effects compared in both groups after giving study drug prior to spinal block. Result: Incidence of grade 3 shivering in tramadol group is 3/ 50 and in ketamine group is 1/50. Sedation score was statistically significant in ketamine group. Conclusion: Both drugs were effective in preventing shivering in spinal anesthesia and not having any serious side effects, but ketamine is a better drug because of added advantages of sedation.

Background: Candiduria is an increasingly recognized clinical condition in hospitalized and immunocompromised patients, with Candida species emerging as significant causative agents of urinary tract infections (UTIs). The global shift towards non-albicans Candida (NAC) species and their rising antifungal resistance necessitates regional surveillance and species-specific management strategies. Aim and Objectives: To isolate and identify Candida species from urine samples of suspected UTI cases and evaluate their antifungal susceptibility patterns using standard phenotypic methods. Materials and Methods: This prospective observational study was conducted at the Department of Microbiology, Narayan Medical College and Hospital, Sasaram, Bihar, from January to December 2023. A total of 5,100 urine samples from hospitalized patients were processed. Direct microscopy, culture on Sabouraud Dextrose Agar, and identification by germ tube test, cornmeal agar, CHROM agar, and sugar assimilation were performed. Antifungal susceptibility testing was done using the disc diffusion method for fluconazole and amphotericin B as per CLSI guidelines. Results: Of 5,100 urine samples, 130 (2.54%) were culture-positive for Candida species. Female patients constituted 60% of the cases. NAC species were more prevalent (60.77%) than Candida albicans (39.23%). C. tropicalis (29.23%) was the most common NAC species. Fluconazole susceptibility was 82.35% in C. albicans, while NAC species showed lower susceptibility (53.16%). All isolates were susceptible to amphotericin B. Conclusion: The study highlights NAC species’ rising prevalence and reduced susceptibility to fluconazole in candiduria cases. Routine species identification and antifungal susceptibility testing are crucial to guide targeted therapy and combat antifungal resistance, particularly in resource-limited rural settings like South Bihar.

Background: Sex estimation from skeletal remains is a cornerstone of forensic anthropology, crucial in mass disasters, criminal investigations, and archaeological studies. Although the pelvis is the most accurate skeletal element for determining sex, it is often unavailable due to fragmentation or decomposition. In such cases, cranial structures, particularly the foramen magnum, offer an alternative. The Foramen Magnum, located at the base of the skull, is relatively resistant to postmortem damage and may retain measurable sexual dimorphism, especially in its anteroposterior diameter (Foramen Magnum length). Aim: To assess sexual dimorphism based on the foramen magnum length in adult males and females using computed tomography (CT), and to evaluate its applicability in forensic sex determination among the Rajasthan population. Methodology: A cross-sectional, observational study was conducted at SMS Medical College, Jaipur, from February 2023 to January 2024, in collaboration with the Department of Radiology. Ninety-six adult participants (equal numbers of males and females) between the ages of 20 and 60 years were included. Stratified sampling ensured equal representation across four age groups. Individuals with cranial trauma, congenital deformities, or surgical alterations were excluded. The anteroposterior diameter of the Foramen Magnum was measured from axial CT head scans using standardized radiological software. Statistical analysis was carried out to assess gender-based differences. Results and Observation: Males showed consistently greater FM length than females across all age categories. The highest mean Foramen Magnum length in males was 37.2 ± 0.6 mm (30–40 years), while in females it was 34.4 ± 0.5 mm in the same group. The smallest values were observed in the 50–60 years group. The results demonstrated significant sexual dimorphism in FM length. Conclusion: Foramen Magnum length measured via CT imaging serves as a reliable, non-invasive parameter for sex determination, especially when conventional skeletal markers are absent. This study provides valuable region-specific forensic data for the Rajasthan population, enhancing the application of CT morphometry in forensic anthropology.

Background: Decompressive craniectomy is a critical surgical intervention for managing severe traumatic brain injury (TBI), aiming to reduce intracranial pressure and improve survival. Methods:  This prospective observational study included patients with severe TBI who underwent decompressive craniectomy. Preoperative assessments included GCS, CT imaging, and ATLS-based resuscitation. Surgery followed a standardized protocol, and postoperative outcomes were evaluated using the Glasgow Outcome Scale (GOS) at discharge, one month, and three months. Results: The mean patient age was 35.76 years, with a male predominance (78%). Road traffic accidents (64%) were the leading cause of injury. At discharge, 39% of patients had GOS 1 (mortality), while 24% showed good recovery (GOS 5). Favourable outcomes were seen in 37% of patients. These findings align with existing literature, showing similar trends in age distribution, gender, mechanism of injury, and outcomes. Conclusion: Decompressive craniectomy improves survival in severe TBI but often results in poor functional outcomes. Continued rehabilitation, refined surgical techniques, and better patient selection are key to improving long-term prognosis.

Background: In India, only a few microbiological studies have been done on healthcare-acquired catheter-associated urinary tract infections, so there is a lack of sufficient data on this aspect. The present study would estimate the proportion of CAUTI, CA-ASB, and Candiduria using culture system and identify causative agents & antimicrobial susceptibility patterns. Materials and Methods: It’s a cross-sectional hospital-based study, conducted in the Department of Microbiology and the Department of Surgery at Lady Hardinge Medical College and associated Smt. Sucheta Kriplani Hospital (S.S.K.H.), New Delhi, during the period November 2018 to April 2020. Every catheterized patient admitted to the surgical ward was asked about signs and symptoms of UTI and further followed by urine culture and sensitivity. Results: Seventy-four (41.1%) cases of healthcare-acquired catheter-associated urinary tract infections were obtained, nineteen cases (26%) developed Catheter-associated UTI (CAUTI). Thirty-four (46%) cases has Catheter-associated asymptomatic bacteriuria (CA-ASB). Twenty-one (28%) cases in the study developed Candiduria.  The commonest disease associated with CAUTI was BPH and the common diseases associated with Candiduria were Hernia and cholelithiasis. The commonest reason for catheterization in CA-ASB cases was urinary output monitoring. The majority of E. coli isolates, i.e., eight cases in CAUTI, were susceptible to nitrofurantoin (80%). Twelve isolates of Enterobacteriaceae from CAUTI cases, and fourteen from CA-ASB cases, were carbapenem resistant. Conclusion: It may be concluded from our studied that health care acquired catheter-associated urinary tract infections has varied etiology. Prospective data collection on outcomes including urinary catheter use, duration, CAUTI, CA-ASB and Candiduria isolates and their antimicrobial susceptibility will enable quality and process improvement.

Background: Anti-Müllerian hormone is a glycoprotein made by granulosa cells in ovarian follicles. It is a reliable biomarker for ovarian reserve and reproductive capacity.  AMH levels may be affected by lifestyle and reproductive variables, especially in women who are having trouble getting pregnant. However, there isn’t a lot of data on the Indian population. Objective: To evaluate the influence of reproductive factors (e.g., age at menarche, menstrual pattern, PCOS, tubal status, family history of menopause) and lifestyle factors (e.g., food, sleep, screen time, physical activity, and substance use) on serum AMH levels in infertile women aged 20–35 years. Methods: This observational work was undertaken at the infertility clinic of Rajkiya Mahila Chikitsalya, JLN Medical College, Ajmer, from June 2023 to May 2024. Five hundred infertile women had comprehensive history taking, physical examination, ultrasound evaluation, and laboratory assessment, including serum AMH measurement. Participants were classified into low AMH (<1 ng/ml) and normal AMH (1–3.5 ng/ml) groups. A statistical analysis was conducted to evaluate the correlations between AMH levels and diverse reproductive and lifestyle factors. Results: Among 500 subjects, 26.6% exhibited reduced AMH levels. Statistically significant correlations were identified between low AMH and factors including irregular or short menstrual cycles (p < 0.0001), a positive family history of early menopause (p < 0.0001), a non-vegetarian diet (p < 0.001), poor sleep quality (p < 0.001), increased mobile phone usage (p = 0.025), and reduced laptop use (p < 0.001). Nonetheless, no substantial correlations were identified regarding tubal status, PCOS diagnosis, length of infertility, physical activity, or frequency of snacking. Conclusion: Reproductive history and certain modifiable lifestyle factors, such as sleep quality, nutrition, and screen time, significantly influence AMH levels in infertile women. Timely detection and behavioural adjustments may significantly contribute to fertility preservation techniques.

Background: Chronic heel pain is a prevalent condition, often caused by calcaneal spurs, which significantly impairs mobility and quality of life. While conservative treatments are the first line of management, some patients remain symptomatic and may benefit from surgical intervention. Aim: To evaluate the effectiveness of surgical excision of calcaneal spurs in relieving chronic heel pain unresponsive to conservative management. Methods: 200 patients with radiologically diagnosed calcaneal spurs and chronic heel pain (>6 months) between the ages of 28 and 70 participated in prospective observational research. The spur was surgically removed from each patient. The Visual Analogue Scale (VAS) was used to measure pain before surgery as well as two weeks, six weeks, three months, and six months after surgery. Complications, functional improvement, and patient satisfaction were also documented. SPSS version 23.0 was used for the statistical analysis, and a p-value of less than 0.05 was deemed significant. Results: At six months, the mean preoperative VAS score dropped dramatically to 2.3 ± 1.0 from 8.1 ± 0.9 (p < 0.001). 94% of patients reported significant pain alleviation, and 78% of patients expressed high levels of satisfaction. Six percent of patients experienced minor side effects, including as temporary numbness and superficial wound infections. There were no significant issues found. Conclusion: A safe and effective treatment for those with chronic heel pain who do not get better with traditional treatments is surgical excision of the calcaneal spurs. The results include significant pain relief, improved function, and greater patient satisfaction. Recommendations: Patients who have radiologically verified calcaneal spurs and whose symptoms have not gone away after at least six months of conservative treatment should be evaluated for surgery. To confirm these results, more multicenter trials with long-term follow-up are advised.

Cancer is one of the leading causes of morbidity and mortality globally. Carcinogenesis is a complex process which involves multiple cell transduction signaling events. When these signaling pathways are altered, this results in uncontrolled growth and an increased ability of cancer cells to invade surrounding tissues. This article provides a comprehensive review of the literature on the promising potential of ten dietary phytochemicals in targeting signaling pathways involved in carcinogenesis. Numerous in vitro studies have demonstrated that a number of dietary phytochemicals could target the cell signaling cascades concerned with carcinogenesis, and particularly play a vital role as cancer chemopreventive agents. The dietary phytochemicals presented in this study have showed that they can interfere with key signaling pathways involved in carcinogenesis. More work on these phytochemicals, including in vivo investigations and human clinical trials, is required if these are to be used as new options to treat and prevent cancer in the future.

Background: Anemia remains a significant public health concern among adolescent girls, particularly in rural regions where nutritional deficiencies, poor menstrual hygiene, and inadequate healthcare access exacerbate the problem. The present study aimed to estimate the prevalence of anemia and identify its predictors among adolescent girls as part of a rural public health initiative, coupled with pediatric follow-up to ensure continuity of care. Materials and Methods: A cross-sectional study was conducted in rural areas, involving 450 adolescent girls aged 10–19 years. Hemoglobin levels were assessed using a HemoCue analyzer. Data on sociodemographic factors, dietary intake, menstrual history, deworming status, and health education exposure were collected through structured interviews. Anemia was classified based on WHO criteria. Logistic regression was used to identify significant predictors of anemia. Results: The overall prevalence of anemia was found to be 64.2%, with 38.7% having mild anemia, 22.1% moderate, and 3.4% severe anemia. Among the anemic girls, 71% had inadequate iron-rich food intake, and 63% reported irregular deworming practices. Significant predictors of anemia included low socioeconomic status (AOR=2.76; 95% CI: 1.82–4.21), irregular consumption of green leafy vegetables (AOR=2.15; 95% CI: 1.41–3.29), heavy menstrual bleeding (AOR=1.89; 95% CI: 1.13–3.17), and lack of recent pediatric follow-up (AOR=2.04; 95% CI: 1.30–3.20) (p<0.05 for all). Conclusion: The high prevalence of anemia among rural adolescent girls highlights the urgent need for integrated public health interventions that focus on nutritional supplementation, menstrual health awareness, deworming, and pediatric follow-up. Tailored strategies including school-based education, community outreach, and follow-up tracking can play a vital role in anemia prevention and management.

Background: The Human body is completely covered in hair. Physiologically, hair acts as the first layer of insulation, protecting the skin from external agents. However, humans’ innate tendency to anthropomorphize has led to development of several psychological, social, and cultural connotations of hair. For example, a woman having long thick hair on the head is viewed as attractive by society, but if she has the same amount of facial hair, then she is frowned upon by society as unattractive. Hence, having too much hair or too little hair can be acceptable and unacceptable at the same time. Objectives: The goal of this study is to describe and comprehend the clinic epidemiological profile of alopecia areata in patients who visited at the outpatient Dermatology, Venereology, and Leprosy, of a tertiary care hospital of Assam. We will also observe the correlation of prevalence of alopecia areata with other systemic conditions. Materials and Methods: The Investigation was conducted for a whole year from 1st April 2024 to 31st March 2025. All patients who visited at the outpatient Department of Dermatology, Venereology, and Leprosy, of a tertiary care hospital of Assam had been involved in this timeline for evaluation, and some exclusions were also made. Results: The study indicated that 60% of patients between the ages of 21 and 30 were prone to developing alopecia areata. It was discovered that AA’s incidence was observed to be higher in men than in women. No symptoms were present in any of the patients, except two who reported mild itching. AA’s severity did not correlate with either gender or age. Conclusion: The research showed that most patients were males of younger age, mostly students, and the females were housewives. Treatment was positive in majority of cases (>85%). Significant improvement in self-esteem could be seen in those patients to whom the treatment responded.

Introduction: Spinal anaesthesia is favoured in obstetric practice for its simplicity, rapid onset, and effectiveness, offering a dense neural block with reduced maternal morbidity and mortality. Despite the advantages, there is a potential for hypotension with this technique that has severe implications for maternal and foetal health. The current study aims to compare the haemodynamic effects of preloading and coloading with crystalloids and their impact on post-spinal hypotension. Method: All enrolled patients underwent randomization into two groups. Group P – A preload of 15ml/kg of crystalloid RL for 20 minutes prior to the administration of spinal anaesthesia. Group C – A coload of the same quantity of 15ml/kg of crystalloid RL immediately after spinal anaesthesia. All vital parameters, including Heart rate, mean arterial pressure (MAP), and SpO2, were noted immediately after subarachnoid block and subsequently after every 3 min in the initial 20 min and then cycled to 5 min till the completion of surgery. Results: The Mean Systolic BP was significantly less in the preload group than the coload group, and the intergroup differences were found to be highly significant, with a p-value less than 0.001. The Mean Diastolic BP was less in Group P than Group C, and there was a significant intergroup difference with a p-value less than 0.001. Mean arterial pressure was found to be lower in Group P compared to Group C, with a statistically significant difference observed (p < 0.001). Group P exhibited a significantly elevated mean heart rate in comparison to Group C. Conclusion: In this comparative study involving 100 healthy parturients, intravenous Ringer’s Lactate was administered either as a preload or coload to evaluate maternal haemodynamic responses. The findings indicated that fluid co-loading was more effective in preventing maternal hypotension.

Introduction: Diabetes Mellitus (DM) is a global health crisis, with a projected increase in cases, impacting individuals, families, and countries worldwide, with over 537 million adults living with the condition in 2021. Diabetes and its related complications are leading cause of morbidity and mortality globally. Microalbuminuria in patients with Diabetes Mellitus is a significant risk factor for progressive renal failure and cardiovascular complications. Sociodemographic factors of the diabetes patients with microalbuminuria is crucial to find out high risk groups and to take early initiatives. Method: This is a cross-sectional study, done at Dept of Medicine, AGMC & GBP Hospital from July 2022 to december2023 with 290 patients. The objectives of this study are -1) to check microalbuminuria in diabetes mellitus patients 2) to determine the association between microalbuminuria and sociodemographic factors. Results: Among 290 participants, 70 number of patients have microalbuminuria, so proportion of microalbuminuria is 24.1%. In our study, the proportion of microalbuminuria is highest (55.7%) in more than 60 yrs age group, males are more prone (52.9%) than female subjects, according to religion, educational status and occupation highest proportion of microalbuminuria is in Hinduism (77.1%), in graduates and above (83.6%) and retired employee (31.4%) respectively. Conclusion: 1/4th of the diabetic cases are tending to develop microalbuminuria as complication which was associated with risk factor like elder age, male sex, Hinduism, educated group and retired employees and this factor showed significant association statistically.

Background: Supraglotic airway devices are widely used for airway management for short elective surgical procedure. Aim: The Aim of this study was too compared Etomidate, Propofol, and Thiopentone to facilitate I-gel insertion in patients undergoing elective short surgical procedures. We have observed hemodynamic stability, adverse reactions of all three induction agents and adverse reactions to airway manipulation among all three induction agents. Material and Methods: In this prospective, comparative, observational study, 90 adult patients undergoing elective short surgeries, were assigned into three study groups, Group E Received Injection Etomidate at 0.3 mg/kg IV, Group P Received injection Propofol at 2.5 mg/kg IV and Group T Received injection Thiopentone at 6 mg/kg IV. All groups were observed for hemodynamic parameters, any adverse responses to airway manipulations, such as inadequate jaw relaxation, gagging, coughing, limb movement, and laryngospasm, and Side effects of induction agents, including apnoea, hypotension, and postoperative nausea, vomiting. Results: From the observation it was found that Group P had the highest ease of insertion (80%) compared to Group T (67%) and Group E (40%). Group E showed better hemodynamic stability throughout the procedure, while Group P had the greatest fall in HR and MAP, and Group T showed highest rise in HR and MAP at the time of insertion. Adverse responses like inadequate jaw relaxation, coughing, and limb movement were most common in Group E. Incidence of gagging was high and only one patient in group T had laryngospasm. Hypotension and apnea were most frequent in Group E, whereas Postoperative nausea and vomiting incidence was highest in Group T. Conclusion: Propofol provided the best conditions for I-Gel insertion, it also caused significant hemodynamic changes and apnoea. Etomidate offered greater hemodynamic stability but had a higher incidence of inadequate jaw relaxation and limb movement. Thiopentone balanced between ease of insertion and hemodynamic stability but still had a notable incidence of adverse reactions.

Background: Globally, COVID-19 pandemic had major undesirable consequences on blood transfusion services including recruitment of donors and organizing blood donation camp activities. It is important to identify the possible factors that could prevent or motivate blood donors during pandemic. Objective: To determine blood donor’s knowledge, attitudes, and perceptions amidst COVID-19 pandemic. Methods: This prospective study was conducted with 193 participants, who were self-administered a pre-structured questionnaire after obtaining informed consent. Results: It is observed that the study population had predominance of males and were replacement donors (57.6%). Most of the donors were unaware of abrupt shortage of blood during the pandemic (53.9%). Nearly one thirds of the study participants thought that COVID -19 could be transmitted through donated blood and felt unsafe to donate. The fear of contracting infection (60.7%) was the most common hindrance factor for blood donation, followed by lack of communication (21.7%). The most common motivation for blood donation was that a close friend or family member requiring blood (40.4%) followed by social media campaign for donation (33.6%). Conclusion: Conducting awareness programmes, effective dissemination of information to donors, and building up of trust between donors and the centres would motivate donors.

Background: Pain after mastectomy surgery greatly affects healing and quality of life. Before and after breast surgery, regional blocks like the serratus anterior plane (SAP) block relieve pain. SAP blocks typically use bupivacaine, but magnesium sulphate or other NMDA receptor blockers may improve pain relief. Objective: To compare how well bupivacaine alone works as a painkiller with how well bupivacaine mixed with magnesium sulphate works as a painkiller in serratus anterior plane block for patients who have had a mastectomy.  Assessment of the efficacy of magnesium sulphate as an adjuvant to bupivacaine in ultrasound-guided serratus anterior plane (SAP) block for postoperative analgesia in patients undergoing modified radical mastectomy. Methods: The Acharya Harihar Post Graduate Institute of Cancer in Cuttack ran this two-year, randomised, double-blind, controlled trial.  We randomly assigned two groups of 100 women who were going to have modified radical mastectomy under general anaesthesia. Group B (n=50) got 30 mL of 0.25% bupivacaine alone, and Group BM (n=50) got it plus 500 mg of magnesium sulphate.  Before the procedure, an ultrasound was used to do the SAP block.  We measured VAS at 1, 2, 4, 8, 12, and 24 hours after the surgery.  We kept track of how much painkiller people used and how long it took for them to get their first rescue. Results: Group BM displayed suggestively lower VAS ratings than Group B at all intervals (p < 0.05). Group BM had a suggestively longer time until rescue analgesia (mean 10.6 ± 2.4 hours) compared to Group B (mean 5.2 ± 1.9 hours). Group BM had significantly lower 24-hour tramadol intake (112 ± 26 mg) than Group B (185 ± 30 mg), indicating improved analgesic effectiveness with magnesium sulphate. Conclusion: The incorporation of magnesium sulphate into bupivacaine in serratus anterior plane block markedly enhances postoperative analgesia in mastectomy patients by decreasing pain scores, postponing the necessity for rescue analgesia, and diminishing overall opioid usage. This combination offers a beneficial, secure, and efficient approach to improving postoperative recovery.

Introduction: Kidney and bladder tumors show marked age and gender disparities, predominantly affecting older males. This prospective study aims to evaluate the age and gender distribution of histopathologically confirmed cases, offering regional insights that align with global trends and support improved screening, diagnosis, and management of urological malignancies. Methods: This 18-month prospective observational study at KIMS, Amalapuram, included patients ≥18 years with histologically confirmed kidney or bladder tumors. Data on demographics, tumor site, imaging, and histopathology were collected. Age groups and gender distribution were analyzed. Diagnoses were independently verified by two pathologists to ensure accuracy and reliability. Results: Among 120 participants, 52% had kidney tumors. Most cases occurred in the 60–69 age group. Males comprised 75.8%, with a 3.1:1 male-to-female ratio. Renal cell carcinoma (RCC; 71%) and transitional cell carcinoma (TCC; 86.2%) were the most common subtypes. Bladder tumors peaked in older males, highlighting strong age and gender associations. Conclusion: The study confirms male predominance and older age at diagnosis in kidney and bladder tumors. Clear cell RCC and TCC were the most common subtypes. These findings underscore the need for age- and gender-specific screening and early detection strategies to improve clinical outcomes and resource planning in urologic malignancies.

Background: Mania, an episodic fluctuating mental illness, characterized by elevated mood, increased energy, impulsivity, and impaired judgement. Insight in mania is frequently compromised during episodes, contributing to poor treatment adherence critical in influencing the prognosis and management of the disease. This study aims to find the level of insight in patients with mania. Methods: 40 mania patients who met inclusion criteria were included for the study. Study was conducted for a period of 18 months. ICD-10 diagnostic criteria, BPRS for assessing symptom severity, and SUMD (scale for assessment of unawareness in mental disorders) to assess the level of insight were used for the current study. Results: Mean age of patients was 36.9 years, mean insight scores of all items of SUMD showed statistically significant improvement in insight scores at 4weeks follow up. No statistical significance was established on comparing the severity of psychotic symptoms, number of episodes and prior treatments with insight in schizophrenia. Conclusion: the study concluded that insight in mania is fluctuating, improves with treatment and not effected by with severity or chronicity of illness.

Introduction: Iron deficiency anemia (IDA) is common postpartum, impacting recovery and well-being. This study compares intravenous iron sucrose (IS) and ferric carboxymaltose (FCM) for treating postpartum IDA. The aim is to evaluate their efficacy, safety, and patient compliance in improving haemoglobin (Hb) levels and replenishing iron stores efficiently. Methods: This randomized comparative study at ASRAM, Eluru (Sept 2016–2018) included postpartum women with Hb 6–10 g/dL. Participants received either IV iron sucrose (group A) or ferric carboxymaltose (group B). Hb and ferritin were assessed pre- and post-treatment. Safety monitoring and standardized infusion protocols were followed throughout. Results: Among 100 postpartum women (50 per group), baseline Hb and ferritin levels were comparable. Adverse reactions were minimal, with better tolerance in the FCM group. Most group A members required five doses, while 92% in group B completed treatment with two. Satisfaction and compliance were slightly higher with FCM. Conclusion: FCM and IS are both effective for postpartum anemia, but FCM offers superior convenience, fewer doses, and better patient compliance with minimal side effects. Its practical benefits make it a preferred option for improving maternal recovery and optimizing healthcare resource utilization in postpartum iron deficiency management.

Introduction: Intrauterine fetal death (IUFD), both antepartum and intrapartum, remains a major cause of perinatal mortality, especially in low-resource settings. Common causes include hypertensive disorders, placental issues, fetal anomalies, and infections. This study evaluates the incidence, etiology, and risk factors of IUFD, highlighting the need for improved antenatal care. Methods: This prospective study was conducted at Kakatiya Medical College over 25 months, including singleton IUFDs between 20–42 weeks. Detailed demographic, obstetric, and clinical data were collected. Examinations, laboratory tests, ultrasound, placental examination, and fetal autopsy (with consent) were performed. Patients were monitored for three days post-delivery for complications. Results: Among 165 IUFDs (stillbirth rate 20.5%), leading causes included unexplained factors (29.09%), abruption (13.3%), and hypertensive disorders (14.4%). Most occurred at 33–37 weeks, with 86.7% weighing under 2500 g. Majority were unbooked multigravidas aged 21–30 years, and 77.5% delivered vaginally, highlighting inadequate antenatal care. Conclusion: The study revealed that most IUFDs occurred in unbooked multigravida women aged 21–30 years, with unexplained causes, hypertensive disorders, and low birth weight as major contributors. Enhanced antenatal care and early risk identification are essential. A limitation was the absence of fetal autopsy in all cases for definitive diagnosis.

Background: Minimal access thyroid surgery (MATS) is rapidly evolving with the integration of advanced technologies. The application of 3D imaging and augmented reality (AR) may enhance intraoperative navigation and surgical precision. This feasibility study evaluates the clinical integration of these technologies in MATS. Methods: A prospective study was conducted on 15 patients undergoing endoscopic or robotic-assisted thyroidectomy between January and March 2025. Preoperative CT scans were used to generate 3D reconstructions of thyroid anatomy, including vascular structures and the recurrent laryngeal nerve. These reconstructions were integrated with real-time intraoperative AR via a head-mounted display or monitor overlay. Outcomes assessed included operative time, anatomical landmark identification rate, conversion rate, and complications. Results: 3D-AR guidance improved visualization of critical structures in all cases. The mean operative time was 112 ± 15 minutes. The recurrent laryngeal nerve was identified pre-dissection in 93.3% of patients. There were no conversions to open surgery. Postoperative complications were minimal, with 1 transient hypocalcemia and 1 case of voice hoarseness resolving in 2 weeks. Conclusion: The integration of 3D imaging and augmented reality into minimal access thyroid surgery is feasible and enhances anatomical orientation without compromising safety. Larger trials are needed to validate its efficacy and cost-effectiveness.

Background: Chemotherapy-induced nausea and vomiting (CINV) are frequent and debilitating side effects of chemotherapy, greatly impacting patient quality of life. Olanzapine, an atypical antipsychotic, has emerged as a potential adjunctive therapy in the management of CINV, but its effectiveness compared with standard antiemetic regimens remains understudied. Methods: This prospective observational study had 34 female patients with breast carcinoma who received chemotherapy regimens containing paclitaxel, cyclophosphamide, doxorubicin, epirubicin, and 5-fluorouracil. Olanzapine was used as adjunctive antiemetic therapy. Severity of nausea and vomiting was evaluated based both on Visual Analog Scale (VAS) and Common Terminology Criteria for Adverse Events (CTCAE) grading scale. This was compared to the standard antiemetic regimen, aprepitant, which comprises palonosetron and dexamethasone. Results: Most patients had a significant reduction in both early and delayed nausea and vomiting, with most reporting only mild symptoms. The most common adverse reactions were gastrointestinal in nature, including nausea, vomiting, diarrhea, and constipation, all of which were manageable. Hematological parameters, such as hemoglobin and platelet counts, remained within normal limits, confirming that olanzapine did not adversely affect blood cell counts. The efficacy of olanzapine in chemotherapy-induced nausea and vomiting was somewhat better than that of aprepitant, especially during the delayed phase. Conclusion: Olanzapine is very effective as an adjunctive treatment for chemotherapy-induced nausea and vomiting in breast cancer patients. It is highly effective in providing control over early, as well as delayed, symptoms. Additionally, olanzapine is safe and tolerable, allowing patients to remain stable during chemotherapy. However, more extensive randomized controlled trials are needed to confirm these findings, design optimal dosing regimens, and explore the advantage of adding olanzapine to standard treatments to make the outcomes even better for chemotherapy patients.

Introduction: Pterygium is a prevalent ocular surface disease characterized by fibrovascular proliferation extending onto the cornea, potentially impairing vision and ocular comfort. Surgical excision with conjunctival autografting is a common treatment, though the fixation method-sutures or autologous serum remains under evaluation for optimal outcomes. This study compares the efficacy and postoperative outcomes of 8-0 Vicryl sutures versus autologous serum in pterygium surgery. Methodology: An analytical cross-sectional study was conducted at SCB Medical College and Hospital, Cuttack, from September 2022 to April 2024. A total of 198 patients with primary pterygium were enrolled and divided into two groups: Group A (n=90) received 8-0 Vicryl suture fixation, and Group B (n=108) underwent graft fixation using autologous serum. Patients were followed up for six months, and parameters such as operative time, graft stability, astigmatism, visual acuity, and complications were assessed. Results: The demographic and clinical characteristics were comparable across both groups. The autologous serum group demonstrated a significantly shorter operative time (35.8 min vs. 43.7 min; p=0.000) and fewer postoperative complaints of irritation and pain. Graft stability was higher in the suture group (94% vs. 85%; p=0.035), while the serum group consistently showed better astigmatic outcomes at all postoperative intervals (p<0.01 from week 1 onwards). Visual acuity improvement was comparable in both groups across the follow-up period. Recurrence rates were low in both techniques, with a slight advantage observed in the autologous serum group. Conclusion: Both fixation techniques are effective in managing pterygium, with autologous serum offering advantages in patient comfort and postoperative astigmatism. Vicryl sutures provide better mechanical graft stability, which may be beneficial in select cases. The choice of technique should consider patient-specific factors and surgeon expertise. Further longitudinal studies are recommended to validate long-term outcomes.

Background: Oral squamous cell carcinoma is one of the most predominant malignancies in India, and its development is frequently associated with lifestyle habits like the chewing of betel nuts, alcohol, and tobacco. The part of the oral microbiome, particularly aerobic microorganisms, in influencing tumour behaviour and progression has garnered attention in recent years. Objective: The investigation looked at the link between the histopathological differentiation of OSCC and the presence of aerobic oral microbes. Methods: At Seth Nandalal Dhoot Hospital in Aurangabad, Maharashtra, a prospective observational analysis was led on 130 patients who were identified with OSCC between August 2017 and November 2019. Conventional microbiological methods were employed to culture sterile swab samples from cancerous lesions. Staphylococcus aureus (SA) and non-SA groups were used to categorise the isolated aerobic organisms. Broder’s histological grading was implemented to evaluate tumour differentiation. The associations with patient addiction status, tumour stage, and microbial profiles were assessed. Results: The male population comprised 69.2% of the patients, leading to a male-to-female ratio of 2.25:1. Staphylococcus aureus was detected in 75% of the cases. Poorly differentiated tumours (Grades II–IV) were observed to be significantly associated with SA colonisation. Additionally, individuals who tested positive for SA were more likely to have advanced disease (Stage III/IV). Additionally, a robust correlation was observed between the presence of microbial organisms and a history of addiction, particularly in individuals who have used multiple substances. Conclusion: The results indicate that the presence of aerobic bacteria, particularly Staphylococcus aureus, in conjunction with known risk factors such as substance abuse, may cause a more aggressive tumour and a more advanced disease presentation, despite the fact that they may not be the primary cause of OSCC. This underscores the potential of microbial profiling to facilitate the development of adjunctive therapeutic strategies and understanding the progression of disease.

There has been a surge in the Incidence of opportunistic candida infections due to increased number of immunocompromised patients due to various factors. With the emergence of multi-drug resistant non-albicans Candida species (NAC) worldwide, treatment of candidiasis has become a major concern. The present study was undertaken for identification of various Candida species and determination of anti-fungal susceptibility pattern of candida isolates in this region of Bihar to facilitate rational and effective use of anti-fungal drugs. Comparison and evaluation of the performance of both phenotypic and automated methods was also done. Material and Methods: This prospective observational study was carried out from April 2023 to September 2024 over a period of 18 months in the Department of Microbiology, Katihar Medical College, Katihar, Bihar. Identification and speciation of candida isolates from clinical specimens was done using standard microbiological procedures. Anti-fungal susceptibility test was done using Vitek2 compact system and E test. Results: A total 6996 samples which included urine (3200), blood (2070), sputum (484), pus (477), CSF (270), pleural fluid (162), wound swab (117), ascitic fluid (117) and CVC Tip (99) were being processed, out of which 160 candida isolates were identified and further processed for speciation and antifungal susceptibility testing. Candida species were isolated predominantly from 21 – 30 years age group 30/160 (18.8%) with higher prevalence in females in reproductive age group. The female to male ratio was found to be 1.3:1. Predominant isolates were Candida tropicalis 76/160 (47.5%) followed by Candida albicans 65/160 (40.6%), Candida guilliermondii7/160 (4.4%), Candida parapsilosis 4/160 (2.5%), Candida ciferii3/160 (1.9%), Candida auris 2/160 (1.3%), Candida glabrata 1/160 (0.6%), Candida krusei 1/160 (0.6%) and Candida pelliculosa 1/160 (0.6%). Non-albicans Candida (NAC) predominated (59.4%) over Candida albicans (40.6%). Maximum resistance shown to amphotericin B 18/160 (11.3%) followed by fluconazole 13/160 (8.1%), voriconazole 10.160 (6.3%), caspofungin 8/160 (5.0%) and flucytosine 6/160 (3.8%). Two isolates were identified as Candida auris and both were azole resistant. Comparative study of phenotypic and automated methods (VITEK 2 compact system-VITEK 2 YST) of identification was done and almost perfect agreement between both methods was observed. Comparative study of the antifungal susceptibility tests using VITEK 2 system (AST-YS07 Vitek 2 card system – bioMérieux) and E test also showed almost perfect agreement (81–99%) between the two methods. The VITEK 2 system (14-18 hours) provided results faster than E test (48 hours). Conclusion: Isolation rate of candida species in our setup was low, comprising of 2.3% of the total number of isolates. This scenario may however change in due course taking into account the increasing number of immune-deficient individuals being admitted to the hospital. Resistance to amphotericin B, azoles viz fluconazole and voriconazole and echinocandins viz capsofungin is also on the rise. Newer species like Candida ciferrii, Candida auris and Candida pelliculosa were isolated for the first time in this area. The Vitek 2 system proved to be very helpful in speciation and susceptibility testing with an additional advantage of a lesser turnaround time.

Background: Acute febrile illness with thrombocytopenia is a common condition that is associated with an increased risk of morbidity and mortality. Infection is a common cause of thrombocytopenia. Infections like Malaria, Dengue, Typhoid and septicaemia are some of them. The present study is intended to know the various aetiology of with acute febrile illness and thrombocytopenia. Methods: Total 394 patients of age more than 18 years with acute febrile illness with thrombocytopenia attending medicine department were enrolled and studied for demographic details, clinical presentation and complications. Results: Out of total 394 cases, 149 cases (n=37.82%) were diagnosed as dengue fever, 62 cases (15.73%) were of malaria, 07 cases (1.78%) were of scrub typhus and 125 cases (n=31.73%) remain Unidentified. Conclusion: Dengue was the commonest cause of fever with thrombocytopenia. Thorough clinical and laboratory evaluation would be helpful to evaluate different causes of fever with thrombocytopenia.

Background: Central venous catheterization (CVC) is a critical procedure frequently performed in intensive care units (ICU) for patients requiring hemodynamic monitoring, medication administration, or hemodialysis access. Ultrasound guidance has been shown to improve the success rate and reduce complications during IJV catheterization. Two primary approaches for ultrasound-guided IJV cannulation are the long axis (LA) and short axis (SA) approaches. This study aims to evaluate and compare the precision of these two ultrasound-guided approaches in terms of success rate, procedural time, complications, and patient comfort in an ICU setting. Methodology: This observational study included 102 ICU patients who required right IJV catheterization. Randomly patients were assigned for short and long axis approach. Primary outcomes measured were Cannulation attempt, cannulation time. Secondary outcomes included the incidence of complication (at least one) & need for change of technique. Results: Of the 102 subjects, 51 were assigned to the LA approach and 51 to the SA approach, in terms of cannulation time and attempt SA approach showed better results compared to LA approach, mean cannulation attempt in SA approach (1.78±0.81) i.e. p value ˂ 0.0001*. Conclusion: The results of this study indicate that the short axis view approach is more effective than the long axis view for internal jugular vein cannulation using ultrasound guidance. It notably achieves a higher first-attempt success rate, requires fewer needle attempts, lesser time consumption and complication.

Background: Hip surgeries are associated with severe postoperative pain, frequently necessitating opioid use. The Pericapsular Nerve Group (PENG) block offers targeted analgesia for the anterior hip capsule, potentially reducing opioid requirements and preserving motor function. Objective: To evaluate the efficacy of the PENG block in reducing postoperative pain and opioid consumption in hip surgeries. Methods: A randomized interventional study was conducted at Santosh medical college and hospital from Jan 2024 to Mar 2025, including 60 adult patients (ASA I–III) undergoing hip surgery. Participants were randomized into Group I (PENG block + spinal anesthesia) and Group II (spinal anesthesia only). Pain was assessed using Numeric Rating Scale (NRS) at 0, 1, 2, 4, 6, 8, 12, 24, and 48 hours postoperatively. Secondary outcomes included time to first opioid rescue, total opioid consumption, and adverse effects. Results: Group I demonstrated significantly lower NRS scores at 2, 4, 6, and 8 hours (p<0.01). Mean time to first opioid rescue was significantly longer (8.26±1.40 hrs vs. 5.55±1.35 hrs; p<0.001), and total opioid consumption was lower (65.79±23.87 mg vs. 93.10±17.54 mg; p<0.001). Hemodynamic parameters were stable across groups. No significant difference in adverse effects or hospital stay was observed. Conclusion: PENG block provides effective postoperative analgesia in hip surgeries, reduces opioid consumption, and supports early recovery without increasing adverse effects.

Background: Stroke survivors often face persistent upper limb impairments, including compromised hand function, which significantly impacts their daily life activities. Eye-hand coordination is a crucial skill requiring precise synchronization between sensory inputs from the tactile, kinesthetic, proprioceptive, and visual systems. This randomized controlled study explores the potential of using emerging Natural User Interface (NUI) technologies to enhance eye-hand coordination and improve hand function in chronic stroke patients. Methodology: This randomized, double-blind controlled trial recruited 60 community-dwelling participants with chronic stroke from Jodhpur, Rajasthan, India, between July 2019 and March 2020, and from September 2022 to July 2024 (post-COVID). The study adhered to the International Ethical Guidelines and the Declaration of Helsinki and was approved by the local institutional review board. Participants were randomly allocated in a 1:1 ratio to either the experimental group or the control group. Results: A 2 (group: experimental, control) × 3 (time: baseline, 5th week, 10th week) repeated measures ANOVA revealed significant improvements over time in both outcomes. For BBT scores, there was a significant main effect of time, F (2,116) = 1244.0, p < .001, a significant time × group interaction, F (2,116) = 256.0, p < .001, and a significant main effect of group, F (1,58) = 85.7, p < .001, indicating greater improvement in the experimental group. For FMA‑UE scores, there was a significant main effect of time, F (2,116) = 1731.4, p < .001, and a significant time × group interaction, F (2,116) = 79.0, p < .001, again reflecting greater gains in the experimental group, while the main effect of group was not significant, F (1,58) = 0.136, p = .713. Conclusion: This pilot study highlights the potential of using emerging NUI technologies to enhance eye-hand coordination and improve hand function in chronic stroke patients. Future studies with larger sample sizes and extended intervention periods are needed to validate these findings and explore additional applications.

Fixation of clavicle usually done in interscalene block or general anesthesia. Wide awake local anesthesia no torniquet (WALANT) technique is anesthetic technique that relies on local anesthesia with hemostatic agent. Need of lesser investigations, safely administrable even in morbid patient and old ages, bilaterally administrable because of no risk of respiratory complications and block achievable also for middle third clavicle as well as medial clavicle are the benefits associated with WALANT technique. This is the series of fifteen cases of clavicle fracture fixed under WALANT technique.

Neonatal septicemia was one of the major risk factors contributing to the high perinatal and neonatal mortality and morbidity. The definite diagnosis of septicemia was made by a positive blood culture which required a minimum period of 48-72 hours and yielded a positive result in 30-70% of cases. Hence there was a critical need for laboratory tests that aid in the rapid diagnosis of neonatal sepsis. We studied the hematological parameters of 103 neonates clinically suspicious of having sepsis. Out of total 103 neonates, 50(48.5%) neonates had HSS score ≤2(Sepsis unlikely) while 28(27.2%) had HSS score ≥5 (sepsis) and   25(24.3%) neonates had HSS score 3-4 (probable sepsis). The advantage of study was that these can be done rapidly even in small hospitals, allowing prompt treatment to neonates with sepsis and minimizing therapy. It can be good predictors of short-term neonatal outcome and carries diagnostic and prognostic value.

Background: Some recent studies have reported that anemia is more common in children with febrile convulsion, whereas others have reported that iron deficiency raises the seizure threshold. This study was done to compare iron-deficiency anemia in children with first FS with children having febrile illness alone and with healthy children. Methods: Hospital based Prospective, Analytical, Case – Control study conducted on 100 patients were enrolled in the study out of which 50 were cases which were febrile convulsion patients and 50 were control who were age and weight matched children. Results: Mean hemoglobin level was 10.37±1.85 and 11.84±1.69 in study and control groups respectively and this difference was found statistically highly significant (p<0.001). Conclusion: Children with FS are more likely to be iron-deficient than those with febrile illness alone and healthy children. Thus, iron-deficiency anemia could be a risk factor for FS.

Background: The main objective of this study is to evaluate the biomarkers (Serum CRP level) associated with COPD. Methods: This was hospital based cross-sectional study. All subjects were evaluated by taking a detailed clinical history. The duration of COPD, number of exacerbations, symptoms and treatment history was enquired from each patient enrolled in the study with detailed systemic examination of each patient. Routine blood investigations were done with specific investigations such as urine routine microscopy, spirometry, CRP, skiagram of chest in posterior anterior view. Results: Mean CRP level was 1.37±0.97 mg/dl. The difference in the distribution of CRP level among levels of gold staging was statistically significant (p < 0.05). Conclusion: The severity of COPD is directly related to the raised CRP levels, which can help in identifying these patients and managing them subsequently. It can be a useful indicator and a basis for high suspicion index and close follow-up for patients with high levels.

Background: To determine the incidence of delirium among postoperative cardiothoracic surgical patients and to determine the association between delirium and length of stay in the ICU, length of stay in the hospital, and in-hospital mortality. Methodology: After obtaining Ethics committee approval and written, informed valid consent, 180 patients were enrolled in the study. The patients of either sex, ASA grade 1,2 Age 18-60 years. All the patients posted for undergoing elective cardiothoracic surgery. Written informed consent was obtained before surgery. Patients who scored positive for delirium by the CAM-ICU method were categorized as ‘Ever Delirium’. [5] All others were categorized as ‘Never Delirium’. [5] The three dependent variables included length of stay in the ICU, length of stay in the hospital, and in-hospital mortality. Results: A prospective cohort observational study was conducted in a tertiary care teaching hospital between January 2023 to December 2024. The final study population consisted of 184 cardiothoracic surgical patients during the 18 months period. Patients who had delirium and who never had delirium. There is no statistically significant difference in mean APACHE 2 score between the two groups. Percentage of patients with a positive score in CAM – ICU method were observed. Delirium versus length of ICU stay were observed. Distribution of Study patients with Ever delirium according to Age group and gender were analysed. Delirium versus Mean length of hospital stay were observed. Delirium versus in- hospital mortality were noted. The presence of delirium does not significantly affects the mortality. Conclusions: Incidence of delirium is higher in older age male patients. The presence of delirium is associated with increased length of ICU stay. The presence of delirium does not have any association with in hospital mortality.

Background: Smoking remains a leading cause of chronic respiratory disease worldwide. Clinical, radiological, and spirometric evaluations provide essential insights into smoking-related pulmonary impairment. Aim: To study the clinico-radiological profile and spirometry patterns in adult smokers. Material and Methods: A cross-sectional study was conducted on 120 adult smokers. Demographic data, clinical symptoms, and socioeconomic details were collected. All participants underwent chest radiography and spirometry following ATS guidelines, and findings were categorized based on standard criteria. Results: Male predominance was observed (84.2%), with the highest smoking prevalence in the 51–60-year age group. Common symptoms included cough (71.7%) and dyspnea (68.3%). Radiological changes, mainly emphysematous patterns, were frequent. Spirometry revealed obstruction without reversibility in most cases, and severe airflow limitation was common in GOLD stage 3. Conclusion: Smoking significantly impacts lung health, with structural and functional changes evident even before clinical symptoms become severe. Routine spirometry and targeted cessation strategies are essential for early detection and prevention.

Background: The increasing prevalence of obesity in children has led to a corresponding rise in metabolic syndrome (MS), a cluster of cardiovascular and metabolic abnormalities. MS in childhood is a strong predictor of future type 2 diabetes and cardiovascular disease. Aim: This study aimed to assess the prevalence and pattern of metabolic syndrome in overweight and obese children and to evaluate associated clinical and demographic risk factors. Material and Methods: A cross-sectional hospital-based study was conducted among 120 children aged 3–16 years, divided into obese and overweight groups. Anthropometric measurements, blood pressure, fasting glucose, and lipid profile were recorded. MS was diagnosed based on IDF criteria. Results: The prevalence of MS in the study population was 30%. Central obesity and dyslipidemia were the most frequent MS components. Girls had a higher prevalence of MS compared to boys. Elevated blood pressure, hypertriglyceridemia, and low HDL-C were significantly more common among MS-positive children. Conclusion: Metabolic syndrome is a significant health issue among overweight and obese children. Early detection and targeted interventions are necessary to prevent long-term cardiometabolic complications.

Introduction: Tuberculosis (TB) remains a significant public health challenge, particularly in resource-limited settings where conventional diagnostic tools have limitations related to sensitivity, turnaround time, and infrastructure requirements. Volatile organic compound (VOC) analysis has emerged as a promising non-invasive diagnostic approach. This study aimed to evaluate the diagnostic accuracy of VOC analysis using gas chromatography–mass spectrometry (GC-MS) and electronic nose (eNose) technologies in detecting active pulmonary TB. Materials and Methods: A prospective observational study was conducted on 100 participants, comprising 50 microbiologically confirmed pulmonary TB patients and 50 non-TB controls with similar respiratory complaints. Exhaled breath samples were collected from all participants and analyzed using GC-MS and eNose devices. VOC profiles were compared between groups, and diagnostic accuracy metrics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC) were calculated against microbiological gold standards. Results: GC-MS analysis demonstrated a sensitivity of 88%, specificity of 90%, and AUC of 0.92 for detecting TB. The eNose showed a sensitivity of 90%, specificity of 86%, and AUC of 0.91. Key VOCs, including methyl nicotinate and methyl phenylacetate, were significantly associated with TB patients. Both technologies effectively differentiated TB from non-TB controls, with comparable diagnostic performance. Conclusion: VOC analysis using GC-MS and eNose technologies demonstrated high diagnostic accuracy for pulmonary TB detection. These methods show promise as non-invasive, rapid adjuncts to conventional diagnostics, though larger, multicentric studies are needed to validate these findings for routine clinical use.

Introduction: The kidneys are vital organs essential for maintaining internal homeostasis through waste excretion, fluid and electrolyte balance, acid-base regulation, and blood pressure control. Various benign and malignant pathologies can impair renal function, sometimes necessitating nephrectomy as a definitive diagnostic and therapeutic procedure. Histopathological examination of nephrectomy specimens plays a critical role in confirming diagnoses and providing insights into the spectrum of renal diseases. This study aimed to analyze the histopathological spectrum of nephrectomy specimens at a tertiary care center. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology, MM Institute of Medical Sciences and Research, Ambala, over two years (January 2022 to December 2023). A total of 45 nephrectomy specimens were analyzed. Clinical data were retrieved from departmental records. Gross and microscopic examinations were performed using standard histopathological techniques, and lesions were categorized as neoplastic or non-neoplastic. Data were analyzed descriptively and presented as frequencies and percentages. Results: Out of 45 nephrectomy specimens, 34 cases (75.6%) exhibited non-neoplastic lesions, while 11 cases (24.4%) were neoplastic. Chronic pyelonephritis was the most common non-neoplastic lesion (55.55%), followed by xanthogranulomatous pyelonephritis (13.33%). Among neoplastic lesions, clear cell renal cell carcinoma was predominant (22.24%). Females constituted 62.2% of cases, and the 41–60 years age group was most commonly affected. Conclusion: Non-neoplastic lesions, particularly chronic pyelonephritis, remain the leading cause of nephrectomy in this region. Histopathological evaluation continues to be essential for accurate diagnosis and management planning, providing crucial epidemiological insights into renal diseases.

Background: A common obstetric method used when a pregnancy extension concerns hazards to the woman or fetus is induction of labor, which guarantees a safe and speedy delivery. The most widely utilized pharmacological and mechanical techniques are intracervical Foley catheterization and oral mifepristone. Each has distinct advantages, but there is ongoing debate regarding their comparative effectiveness and safety in term pregnancies. Aim: To evaluate the safety and effectiveness of intracervical Foley catheterization against oral mifepristone for inducing labor in term pregnant women. Methods: Over the course of 12 months (April 2022–April 2023), this retrospective observational study was carried out at ESIC Medical College and Hospital in Bihta, Patna. Group A (n = 50, oral mifepristone) and Group B (n = 50, Foley catheter) comprised 100 term pregnant women who underwent labor induction altogether. SPSS version 23.0 was used to gather and evaluate data on the induction-to-delivery interval, labor onset, delivery method, newborn outcomes, and maternal complications. The threshold for statistical significance was p < 0.05. Results: The mifepristone group experienced a significantly shorter mean induction-to-delivery interval (11.2 ± 3.4 hours) than the Foley catheter group (15.6 ± 4.1 hours; p < 0.001). Mifepristone also decreased the time to labor onset (6.3 ± 2.5 hours vs. 9.1 ± 3.2 hours; p < 0.001). The mifepristone group had a greater spontaneous vaginal delivery rate (80%) than the Foley group (66%), but the difference was not statistically significant (p = 0.09). Both groups’ neonatal and maternal outcomes, including as APGAR ratings and NICU admissions, were similar. Conclusion: Oral mifepristone was more effective in reducing induction-to-delivery and labor onset times compared to Foley catheterization. Both methods were found to be safe, with similar maternal and neonatal outcomes. Recommendations: For labor induction at term, oral mifepristone may be the best option, especially in situations when quick and non-invasive induction is preferred. Further prospective, randomized studies are recommended to validate these findings.

Background: (IDA) is a common complication of pregnancy, affecting both maternal and fetal health. While oral iron supplementation is widely used, intravenous iron therapy offers a more effective alternative in moderate to severe cases. Among the intravenous preparations, iron sucrose and ferric carboxymaltose (FCM) are commonly used, but their comparative effectiveness in pregnancy remains an important clinical consideration. Aim: To compare the efficacy and safety of intravenous iron sucrose and ferric carboxymaltose in the treatment of iron deficiency anemia among pregnant women at a tertiary care hospital. Methods: This retrospective study was conducted at ESIC Medical College and Hospital, Bihta, Patna over 12 months (April 2022 – April 2023). A total of 100 pregnant women with IDA were included—50 received intravenous iron sucrose (Group A) and 50 received ferric carboxymaltose (Group B). Baseline and post-treatment hemoglobin (Hb) levels after 4 weeks were recorded. Adverse events were also noted. Statistical analysis was performed using SPSS version 23.0, with a p-value < 0.05 considered significant. Results: Both groups showed significant improvement in Hb levels. Group A (iron sucrose) had a mean rise in Hb of 1.8 ± 0.6 g/dL, while Group B (ferric carboxymaltose) showed a significantly greater rise of 2.6 ± 0.7 g/dL (p < 0.001). Mild adverse events such as nausea and local infusion reactions were noted in both groups, with a slightly lower incidence in Group B. No serious adverse events were reported. Conclusion: Ferric carboxymaltose demonstrated superior efficacy compared to iron sucrose in improving hemoglobin levels in pregnant women with IDA and was well tolerated with fewer adverse effects and fewer required doses. It may offer a more convenient and effective therapeutic option in antenatal anemia management. Recommendations: Ferric carboxymaltose should be considered the preferred intravenous iron therapy in moderate to severe anemia during pregnancy, especially in settings requiring rapid correction and limited hospital visits. Larger prospective studies are recommended to validate these findings across diverse populations.

Background: Anemia is a frequent and serious complication of chronic kidney disease (CKD), particularly in conservatively managed patients who are not on dialysis. Anemia adds to enhanced morbidity, decreased quality of life, and accelerated progression of CKD. Effective management of anemia is important in non-dialysis CKD patients, but its management varies extensively in real-world practice. Objectives: The current study was conducted to assess the prevalence, severity, and treatment of anemia in conservative CKD patients and to determine the efficacy of various treatment modalities. Materials and Methods: A one-year retrospective observational study was carried out in a tertiary care center between January–December 2024. The medical records of 186 adult patients with CKD (Stages 3–5) not undergoing dialysis were analyzed. Information on hemoglobin, serum ferritin, transferrin saturation (TSAT), mean corpuscular volume (MCV), and treatment for anemia were gathered. Patients were grouped according to received treatment: oral iron, intravenous (IV) iron, erythropoiesis-stimulating agents (ESA), combination therapy, or none. Changes in hemoglobin levels over 3 months were assessed with proper statistical tests. Results: The average hemoglobin concentration was 9.6 ± 1.4 g/dL, reflecting prevalent anemia. TSAT was low (18.6 ± 6.1%), whereas ferritin was normal (138 ± 56 ng/mL), pointing towards functional iron deficiency. Oral iron was most frequently used (47.3%), but combination therapy with ESA and IV iron had the highest improvement in hemoglobin (+1.7 g/dL, p=0.001). ESA monotherapy and IV iron increased hemoglobin significantly (+1.1 g/dL). Approximately 8% of patients received no anemia-specific therapy. Conclusion: Anemia in non-dialysis CKD patients continues to be undertreated, with functional iron deficiency often being underdiagnosed. Combination therapy was best at increasing hemoglobin levels.

Background: Even as the use of diabetes technologies increases, the HbA1c of adolescents with T1D continues to be much higher than targets. Teenagers’ retrospective CGM and glucose data review practices are not well understood, but they could be a crucial component of empowerment and education to improve glycemia. Objectives: Evaluating glycemic control and related clinical features among the adolescents and children who were suffering from T1D was the study’s goal. 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 for one year. Data from 184 participants were retrieved for the study. The study included children and adolescents with T1D who were 18 years of age or younger at the time of diagnosis and who had recorded HbA1c levels at diagnosis and at least one follow-up visit. Results: The research participants’ mean age at diagnosis was 10.2 ± 3.1 years. 82 ladies (44.6%) and 102 guys (55.4%) were present. In multiple cases, a family history of diabetes was mentioned. Patients with DKA had a substantially lower mean age at diagnosis, 9.6 ± 3.0 years than those without DKA, 10.7 ± 3.2 years, with a statistically significant p-value of 0.01 when comparing the DKA and No DKA groups. Conclusion: This study emphasizes that DKA, which is frequently linked to higher HbA1c levels and younger age at diagnosis, is still a common and serious presentation in children with recently diagnosed TID. Recommendations: Reducing DKA at presentation requires early diagnosis and greater knowledge of T1D.

Background: An estimated 150 million serious illnesses and 1.7 million fatalities worldwide are caused by fungus-related pathogens each year. They are significant contributors to morbidity and mortality in specific patient groups, including critically sick and immunocompromised patients. Objectives: Analyzing the evolving patterns of superficial fungal infections in terms of clinical presentation, isolate distribution, antifungal resistance patterns, and treatment results in patients enrolled in a tertiary care facility was the study’s goal. 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 for one year. Data from 172 participants were retrieved for the study. The study comprised patients of both sexes and all age groups who were clinically diagnosed with superficial fungal infections, had full treatment and follow-up records, and performed mycological investigations, such as fungal culture and KOH mount. Results: With 68 participants, the 21–30 age group was the most often impacted, closely followed by the 31–40 age range with 65 people. Significant resistance was also shown to fluconazole, with 49 (33.3%) intermediates, 35 (23.8%) sensitive, and 63 (42.9%) resistant isolates. Oral itraconazole was the most effective of the different treatment plans; it produced a clinical cure in 56 patients (82.4%) and a mycological cure in 52 patients (76.5%), with a comparatively low relapse rate of 14.7%. Conclusion: With an increase in antifungal resistance, particularly to terbinafine and fluconazole, this study demonstrates a shifting trend in superficial fungal infections. It turned out that Trichophyton mentagrophytes was the most common isolate. Recommendations: In order to guide proper therapy, it is advised that routine fungal culture and antifungal susceptibility testing be carried out, especially in recurring or chronic instances, based on the study’s findings.

Background: After a cholecystectomy, a collection of varied symptoms known as post-cholecystectomy syndrome (PCS) may appear, including dyspepsia, jaundice, and/or abdominal discomfort in the right upper quadrant. Objectives: The study’s objectives were to ascertain the prevalence of PCS in patients who had cholecystectomy at a tertiary care facility and to assess the risk factors and underlying causes of the condition. 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 for one year. Data from 176 participants were retrieved for the study. Patients 18 years of age and older who had either an open or laparoscopic cholecystectomy at the tertiary care facility and later developed recurring or persistent upper abdominal symptoms suggestive of PCS were included in the study. Results: The majority of the 176 patients who had cholecystectomy (158) had laparoscopic cholecystectomy; 13 of these patients experienced PCS, resulting in an 8.2% PCS rate in this group. Preoperative FGID symptoms were associated with a 5.5-fold increased risk of PCS development (odds ratio 5.50; CI 1.58-19.17; p = 0.007), suggesting a robust and statistically significant relationship. Conclusion: The study found that a considerable proportion of patients experience recurrent or persistent PCS symptoms, making it a noteworthy complication after cholecystectomy. According to this study, peptic ulcer disease, chronic pancreatitis, and biliary tract disorders are some of the most prevalent known causes. Recommendations: Appropriate utilization of diagnostic imaging and early postoperative follow-up can help with prompt diagnosis.

Background: The use of family planning and contraception is still a successful strategy for meeting women’s reproductive health requirements, especially avoiding unwanted and/or mistimed births. In addition to having fewer options for contraception, women in rural locations are more likely to get subpar or nonexistent post-abortion care services. In this regard, additional research is required to comprehend the connection between the usage of contraceptives and unplanned pregnancies. Objectives: Analyzing contraceptive use trends and evaluating related failure rates over a one-year period in both urban and rural populations utilizing a tertiary care center was the goal of this study. 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 for one year. Data from 168 participants were retrieved for the study. Women between the ages of 15 and 49 who lived in either urban or rural regions and had complete, verifiable records of using any kind of contraception during the study period of one year were included in the study. Results: At 28 (33.3%), condom use was considerably higher among urban women than among rural women (15 (17.9%), with a p-value of 0.01. A significant predictor of failure was also condom use, with an OR of 3.9 (95% CI: 1.1–14.4; p = 0.03). However, with a p-value of 0.22, urban residence was not statistically significant, despite being linked to a higher odds ratio of 2.1 (95% CI: 0.64–6.85). Conclusion: The study reveals notable differences in preferred methods of contraception and related failure rates across urban and rural areas. Recommendations: Prioritizing focused education and counseling is necessary to increase contraceptive results, particularly in rural settings.

Background: Acute dyspnea is a common emergency presentation with varied cardiopulmonary causes requiring rapid differentiation. Traditional diagnostic tools are often limited in urgent care settings. Bedside methods like DDI and ultrasound offer potential for timely, accurate evaluation. Methods: This prospective observational study was conducted over one year at a tertiary care center, enrolling 168 patients with acute or worsening dyspnea. Each underwent PEFR testing, ABG analysis, and point-of-care ultrasound. Diagnostic indices such as DDI, DDI%, PEFR%, and lung ultrasound findings were analyzed. Results: Cardiac dyspnea patients had significantly higher DDI, DDI%, PEFR, and PEFR% values than pulmonary cases (p < 0.001). Lung ultrasound demonstrated the highest accuracy with 97% sensitivity and 95% specificity. PEFR% and DDI% showed moderate predictive value. Combined clinical and bedside tools improved differentiation of dyspnea etiology. Conclusion: Lung ultrasound, alongside DDI and PEFR%, is a highly effective bedside toolset for rapidly distinguishing cardiac from pulmonary causes of dyspnea.

Background: Stroke in young adults (≤45 years) is a growing public health concern, differing in risk factors and outcomes from older populations. Early identification of modifiable risk factors is crucial. This study explores the clinical profile, risk factors, and short-term outcomes of young stroke patients. Methods: A cross-sectional study was conducted over one year (Nov 2023–Nov 2024) at a tertiary care hospital. A total of 176 patients aged ≤45 years with confirmed acute stroke were included. Data were collected via structured interviews and clinical assessments. Outcomes were measured using the Modified Rankin Scale at 28 days. Results: Among 176 patients, 54% were male and 63.6% were overweight or obese. Hypertension (50%) and tobacco use (40.3%) were common risk factors. At 28 days, 63.6% had no disability, 25% had residual disability, and 11.4% had died. Conclusion: Young stroke is predominantly linked to modifiable lifestyle factors, underscoring the need for targeted prevention and rehabilitation strategies.

Background: Acute kidney injury (AKI) is a serious complication in critically ill children, particularly in intensive care settings. It significantly contributes to morbidity, mortality, and prolonged hospitalisation. There is limited regional data on paediatric AKI in India, necessitating focused research. Methods: A prospective observational study was carried for one year at a tertiary care hospital PICU on 184 children aged 1–12 years. Data were collected using a structured proforma, and AKI was diagnosed using pRIFLE criteria. Results: AKI was observed in 17.4% of patients, with most in the ‘Risk’ stage. Significant associations were found with hypotension, sepsis, nephrotoxic drugs, and mechanical ventilation (all p<0.001). Dehydration/hypovolemia was the leading cause (37.5%), and complete renal recovery occurred in 81.3% of cases. Mortality among AKI patients was 18.7%. Conclusion: AKI remains a significant complication in paediatric critical care, driven by preventable causes and related with adverse outcomes.

Background: Long bone fractures are among the most common orthopaedic injuries in the paediatric population. Titanium Elastic Intramedullary Nailing (TENS) has emerged as a preferred modality for treating diaphyseal fractures in children due to its minimally invasive nature, stability, and excellent functional outcomes. This prospective orthopaedic study was conducted to evaluate the clinical and functional outcomes of TENS in paediatric patients aged 6–16 years with long bone fractures. Methods: A prospective observational study was carried out in the Department of Orthopaedics at Krishna Mohan medical college and hospital, Mathura between January 2023 and December 2024. A total of 50 paediatric patients (aged 6–16 years) with diaphyseal fractures of long bones (femur, tibia, and humerus) were treated using Titanium Elastic Intramedullary Nailing. Clinical outcomes were assessed using Flynn’s criteria, and radiological union was evaluated through serial X-rays. All patients were followed up for a minimum of 6 months. Results: Out of 50 patients, 36 were males and 14 were females. The most commonly fractured bone was the femur (60%), followed by the tibia (30%) and humerus (10%). The mean age of the patients was 10.4 ± 2.7 years. Clinical outcomes assessed using Flynn’s criteria showed excellent results in 82% of patients, satisfactory in 14%, and poor in 4%. The average time to radiological union was 8.6 ± 1.2 weeks. Complications included superficial infection (6%), limb length discrepancy (4%), and entry site irritation (8%). Conclusion: Titanium Elastic Intramedullary Nailing is a safe, reliable, and effective method for treating diaphyseal long bone fractures in children aged 6–16 years. It offers excellent clinical and functional outcomes with minimal complications when performed with proper surgical technique and postoperative care.

Introduction: Thyroid dysfunction may be seen in 10–15% of HIV-infected individuals. Hyperthyroidism and hypothyroidism can both be observed. The predominant abnormality is subclinical hypothyroidism. Every system, including the endocrine system, is affected by HIV. In patients taking Anti-Retroviral treatment increased TSH, may be caused by immunological reconstitution or thyroid gland infection. Hypothyroidism in HIV patients can be explained by HIV infection directly infecting the thyroid gland, opportunistic infections, malignancy or medications. Aim: The aim of the study was to demonstrate thyroid dysfunctions in HIV patients and correlation of T3, T4, TSH with CD4 Count. Material and Methods: 100 patients both as in-patients and out-patients undergoing HIV treatment were included in this study. They underwent following investigations: HIV (by ELISA), CD4 Count (by Flow cytometry), blood sugar fasting and post prandial, Thyroid function tests-TSH, T4, T3, Thyroid peroxidase(TPO) Antibodies using chemiluminescent technology, Complete Hemogram, Liver Function Test, Renal function test. Results: T4 less then 5ug/dl was seen in 16 patients’ indicating low T4 levels. Thyroid dysfunction was observed in 24 patients; all were hypothyroid. The most common thyroid dysfunction was overt hypothyroidism, seen in 16 patients, followed by subclinical hypothyroidism in 8 patients. Anti TPO antibody was positive in 6 out of 24 hypothyroid patients. There was positive correlation between TSH and CD4 counts which was statically significant. Conclusion: In our study thyroid dysfunction was commonly observed in HIV patients. Among the thyroid dysfunction, overt hypothyroidism was more frequently observed.

Polycystic Ovary Syndrome (PCOS) and associated cognitive dysfunction are increasingly recognized as significant health concerns among women of reproductive age worldwide. Over the past five years, the majority of published literature has focused on systematic reviews and meta-analyses, with a noticeable decline in original research contributions. To address this gap, the present study was designed as an analytical cross-sectional investigation, aimed at generating primary data from a South Indian population, specifically from the North Coastal Andhra region. The study comprised 52 women with PCOS and 52 age-matched healthy controls. Mean age of PCOS is 26.1±4.7 and non -PCOS is 25.7±5.1. Most of the population belong to 18-26 years age group 28(26.9%) PCOS and 31(29.8%) non-PCOS. PCOS is associated with significantly lower cognitive performance compared to healthy controls, as measured by the Montreal Cognitive Assessment (MoCA). It supports the hypothesis that PCOS negatively impacts neurocognitive functioning, particularly in domains like attention, executive function, and memory. It supports the hypothesis that PCOS negatively impacts neurocognitive functioning, particularly in domains like attention, executive function, and memory (0.000001*). A chi-square test (χ² = 5.11, p = 0.02*) revealed a statistically significant difference in COWAT (Controlled Oral Word Association Test) grading between PCOS and non-PCOS groups. Notably, 7.7% of PCOS participants showed significant impairment (<25 score), whereas no such impairment was observed in the non-PCOS group. Therefore, these results indicated reduced verbal fluency and executive functioning in the PCOS group. Promoting healthy lifestyle practices and balanced dietary habits may help reduce the prevalence of PCOS among women of reproductive age. As women’s health is vital to the well-being of the broader community, there is a pressing need to adopt a multicentric research approach to gain a more comprehensive understanding of the disease burden and its impact across different populations.

Introduction: Acute Myocardial Infarction is becoming very prevalent nowadays. Major risk factors include diabetes mellitus and systemic hypertension. It has been noted that there is an increased mortality and morbidity associated with the delay in treatment for acute myocardial infarction emphasizing its timely management. Aim: To assess the pre-hospital delay in patients diagnosed with acute myocardial infarction presenting to a tertiary care center at Chennai. Materials and Method: This cross sectional study is a semi-structured questionnaire based study which involved 138 study participants after getting institutional ethical committee clearance. Data size calculated and the study participants were chosen by convenient sampling method. Data collected via face on interview with study participants during their hospital stay and were tabulated in MS Excel before being analyzed using Epi info / SPSS. Results: The median prehospital delay was found to be 4 hours. Diabetic patients (p=0.011), hypertensive patients (p=0.035), patients with prior awareness about myocardial infarction (p=0.017) and patients who directly went to tertiary care center (p=0.013) are significantly associated with prehospital delay according to Chi-square analysis. Further analysis with binary logistic regression revealed that those who had prior awareness about Myocardial Infarction (p=0.044) and tertiary care center as their first healthcare contact (p=0.018) are found to have significantly reduced prehospital delay (<2hours). Discussion: Awareness about Myocardial Infarction (MI) and the initial medical facility sought by the individual for care were significant predictors for pre-hospital delay. A small discussion with patients on their condition, complication of their condition, dos and don’ts, making them aware about the warning signs and the response on its incidence, by doctors can do wonders in saving patients’ lives.

Background: Chronic Kidney Disease (CKD) is a progressive systemic condition associated with a multitude of extra-renal complications, including notable alterations in oral health. Despite their clinical significance, oral manifestations in CKD patients often remain under recognized and undertreated, particularly in resource-constrained settings. Aim: This study aimed to evaluate the prevalence and pattern of oral manifestations in patients with CKD and to explore associations with disease stage and dialysis status. Materials and Methods: A retrospective observational study was conducted at Katihar Medical College over a period of one year March 2023 to march 2024. Records of 100 CKD patients (Stages 3–5) were reviewed. Inclusion required complete nephrological and oral examination data. Demographic details, CKD stage, dialysis status, and oral findings were extracted. Descriptive statistics were used to determine prevalence, and Chi-square tests assessed associations (significance at p < 0.05). Results: Among the 100 patients (62 males, 38 females; mean age 52.4 ± 13.2 years), Stage 5 CKD was the most common (40%), with 28 patients undergoing dialysis. The most prevalent oral manifestations were xerostomia (58%), halitosis (46%), mucosal pallor (40%), and periodontitis (33%). Uremic stomatitis (18%), gingival enlargement (22%), candidiasis (15%), and petechiae (12%) were also observed. Statistically significant associations were found between Stage 5 CKD and xerostomia/uremic stomatitis (p < 0.01), as well as between dialysis and candidiasis/petechiae (p < 0.05). Conclusion: Oral manifestations are highly prevalent among CKD patients and show strong correlations with disease severity and dialysis status. Routine oral screening and interdisciplinary management involving dental professionals are essential for improving quality of life and systemic health outcomes in CKD care. Further prospective studies are needed to assess the long-term impact of oral interventions.

Background: When it comes to general health, pulmonary health is paramount, and there are many environmental, occupational, and lifestyle variables that might affect it. Differences in air quality, physical activity, and socioeconomic conditions between urban and rural regions may significantly impact lung function. Objectives: The primary objective of this study was to compare pulmonary function among individuals residing in urban and rural areas, and to identify environmental and lifestyle-related factors contributing to any observed disparities. Methods: This cross-sectional observational study was conducted over a one-year period and included 100 participants—50 each from urban and rural populations—matched for age and gender. Forced Vital capacity (FVC), forced expiratory volume (FEV1), and forced expiratory volume to forced vital capacity ratio (FEV1/FVC) were among the important pulmonary function indicators assessed in the spirometry-based testing that participants performed. The data was examined with the help of SPSS version 25.0. For this study, statistical tests including the chi-square and independent t-tests were used, with a p<0.05 threshold of significance. Results: The study revealed that rural participants had significantly higher mean values of FEV1 and FVC compared to their urban counterparts. The FEV1/FVC ratio did not differ significantly between the groups. Urban participants exhibited higher BMI and reported lower levels of physical activity. These findings suggest a strong association between environmental/lifestyle factors and pulmonary function. Conclusion: The results emphasize the negative impact of urban living—likely due to air pollution and sedentary lifestyles—on lung health. Public health strategies focusing on pollution control, promotion of physical activity, and regular pulmonary screening are essential. Further research with larger, longitudinal studies is recommended to confirm these findings and guide targeted interventions.

Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a vital procedure for managing biliary obstruction and cholangitis. Selecting an optimal anesthesia technique is critical to ensure procedural success and patient safety. Objective: To evaluate the effectiveness and safety of different anesthesia techniques used during ERCP in patients with biliary obstruction or cholangitis. Methods: Fifty patients who had ERCP at two Karnataka tertiary care hospitals over a two-and-a-half-year period were included in this retrospective analysis. Conscious sedation, general anaesthesia, and monitored anaesthesia care (MAC) were the anaesthesia techniques examined. Procedural success, hemodynamic stability, respiratory problems, and recovery time were among the outcomes evaluated. Results: Procedural success rates were high across all groups (>90%). General anesthesia was associated with increased hemodynamic instability (33%) and respiratory complications (25%) compared to conscious sedation and MAC. Recovery times were shortest with conscious sedation (45 ± 10 minutes) and longest with general anesthesia (120 ± 25 minutes). Conclusion: Conscious sedation and MAC are effective and safer anesthesia options for ERCP in patients with biliary obstruction or cholangitis, offering faster recovery and fewer complications. General anesthesia should be reserved for selected cases requiring airway protection or prolonged procedures.

Background: Respiratory distress is one of the most common reasons a neonate is admitted to the neonatal intensive care unit. The objective of this study was to compare heated humidified high-flow nasal cannula (HHHFNC) with continuous positive airway pressure (CPAP) as primary respiratory support in preterm neonates with respiratory distress at birth. Methods: A hospital-based prospective observational study involving 100 neonates with birth weight ≥ 1000 grams, gestational age 30 to 36^6/7 weeks and Silverman Anderson Score (SAS) of 5 & 6 were recruited in this study, 50 each in CPAP and HHHFNC group. Results: Mean gestational age of the study cohort was 34.20 (±1.50) weeks in CPAP group and 34.16 (±1.56) weeks in HHHFNC group. Majority of the patients admitted in both groups were delivered by cesarean section, 68% (n=34) in CPAP group and 70% (n=35) in HHHFNC group. The median age and SAS at admission was 5 hours (IQR: 2-12) and 4 (IQR: 3-6) respectively. In CPAP group 18% (n=9) and in HHHFNC group 20% (n=10) had treatment failure but this was statistically insignificant (p value=0.126). Complications such as nasal injury and pneumothorax was seen more in CPAP group as compared to HHHFNC group which was statistically significant (p value = 0.038). Conclusion: This study concluded that when comparing HHHFNC to CPAP as a primary non-invasive respiratory support in preterm infants with respiratory distress, HHHFNC is non-inferior to CPAP in avoiding the need for a higher mode of respiratory support in the first 72 h of life.

Background: (PCOS) is a multifactorial endocrine disorder increasingly recognized as a chronic inflammatory condition. Elevated inflammatory markers such as (CRP), (IL-6), and (TNF-α) have been reported in PCOS, contributing to insulin resistance and long-term cardiometabolic risk. However, the role of inflammation independent of obesity remains unclear, highlighting the need for BMI-matched studies. Aim: To evaluate and compare levels of CRP, IL-6, and TNF-α in BMI-matched women with and without PCOS to determine the correlation of PCOS with systemic inflammation. Methods: This BMI-matched case-control study was carried out from June 2024 to November 2024 at PDU Medical College in Churu, Rajasthan. A total of sixty participants were registered, including thirty women with PCOS (as defined by the Rotterdam criteria) and thirty healthy controls who were matched for age and BMI. Comprehensive laboratory studies and clinical evaluations were conducted. The ELISA method was used to quantify serum TNF-α, IL-6, and CRP. With SPSS version 23.0, statistical analysis was carried out, and a p-value of less than 0.05 was deemed significant. Results: The PCOS group showed significantly higher mean values of CRP (4.3 ± 1.2 mg/L), IL-6 (6.5 ± 1.6 pg/mL), and TNF-α (12.8 ± 2.4 pg/mL) compared to controls (2.1 ± 0.8 mg/L, 3.2 ± 1.1 pg/mL, and 8.9 ± 1.9 pg/mL respectively), with p < 0.001 for all. Within the PCOS group, correlation analysis showed weak, non-significant relationships between inflammatory markers and BMI. Conclusion: Compared to BMI-matched healthy controls, women with PCOS had higher levels of inflammatory markers, indicating that inflammation is a characteristic of PCOS rather than just an effect of obesity. Recommendations: Routine screening for inflammatory markers in PCOS may help in early risk stratification and timely intervention. To assess how anti-inflammatory medications, affect PCOS patients’ metabolic and reproductive results, more long-term research is necessary.

Background: Necrotising soft tissue infections (NSTIs) are uncommon but can be deadly. They are marked by the rapid spread of necrosis in the skin, subcutaneous tissues, and fascia. Prompt surgical intervention and early recognition are essential for enhancing outcomes. The clinical similarities between these infections and more benign conditions, such as cellulitis, frequently result in their underdiagnosis. Objective: The goal of this study was to look at the epidemiological distribution, risk factors that make people more likely to get NSTIs, how they show up in patients, and how well they respond to treatment at a tertiary care centre in Bihar. Methods: The work was conducted in the Department of General Surgery at NMCH Sasaram from 2019 to 2022. A total of sixty adult patients diagnosed with NSTIs were included. Imaging, clinical, biochemical, and demographic data were gathered. All patients were assessed using the LRINEC scoring system. The management plan comprised surgical debridement, fasciotomy, split-thickness skin grafting, and secondary suturing as required. The clinical recovery and mortality outcomes were analysed. Results: The age group of 59–72 years was the most affected (50%), with a male predominance (75%). The most prevalent sites of infection were the lower limb (36.7%) and upper limb (30%), with the perineum (26.7%) following in that order. Smoking (65%) and diabetes mellitus (76.7%) were identified as significant risk factors. In 37 patients, early surgical debridement was implemented; 17 patients necessitated split-thickness skin grafting, while 30 patients underwent secondary suturing. Three patients succumbed to the infection, resulting in a mortality rate of 5%, despite the prompt intervention. Conclusion: NSTIs continue to be a critical surgical emergency, resulting in substantial morbidity and mortality. Susceptibility is elevated by diabetes, elderly age, and lifestyle factors, including smoking and alcohol consumption. Patient outcomes are significantly influenced by early diagnosis, which is supported by LRINEC scoring, and prompt surgical management.

Background: Septicemia is a serious complication in diabetic patients, often leading to prolonged hospitalization and increased morbidity. Diabetes mellitus compromises immune function, making patients more susceptible to bloodstream infections (BSIs). Identifying the microbiological profile and its correlation with glycemic status can help in timely and effective management. Aim: To analyze the blood culture pattern in diabetic patients with septicemia admitted to a tertiary care hospital and correlate microbiological findings with clinical and biochemical parameters. Methods: This observational study was conducted over six months at the Department of Medicine, Mahatma Gandhi Hospital and Mathura Das Mathur Hospital, affiliated with Dr. S.N. Medical College, Jodhpur, Rajasthan. A total of 100 diabetic patients aged ≥20 years presenting with signs of septicemia were included. Blood cultures were processed using the BACTEC 9240 system. Demographic, clinical, and biochemical data including HbA1c, blood glucose levels, and liver/renal function tests were collected. Data were analyzed using SPSS version 23.0. Results: Blood cultures were positive in 41% of patients. Staphylococcus aureus (34.15%) and Escherichia coli (29.27%) were the most common isolates. Culture-positive patients had significantly higher fasting and postprandial glucose, SGOT, and HbA1c levels (p < 0.05). Mean age in culture-positive patients was higher (68.48 vs. 59.91 years), and hospital stay was significantly longer (12.12 vs. 9.14 days, p = 0.0007). Conclusion: Bloodstream infections are prevalent in diabetic patients with septicemia, especially among the elderly with poor glycemic control. Positive cultures are associated with longer hospital stays and increased clinical severity. Recommendations: Routine blood culture testing, strict glycemic monitoring, and early antimicrobial intervention are recommended to improve clinical outcomes in diabetic patients presenting with septicemia.

Background: In clinical practice, thyroid nodules are frequently seen, and proper care requires the ability to differentiate benign from malignant tumors. (FNAC) is a popular, minimally invasive method for preliminary assessment that has a high diagnostic value, particularly in environments with limited resources. Aim: FNAC is used to assess the cytological spectrum and diagnostic accuracy of thyroid lesions, and cytological results are correlated with histopathological results in a tertiary care facility. Methods: Over the course of a year (2024–2025), the MM Institute of Medical Science and Research carried out this prospective observational study. FNAC was performed on fifty individuals with thyroid swellings, and the Bethesda System for Reporting Thyroid Cytopathology was used to classify the data. A group of 20 surgical patients had their cytology and histology results evaluated. To analyze the data, SPSS version 23.0 was used. Results: The mean age of the 50 cases was 39.6 ± 12.4 years, and 76% of them were female. The majority of lesions (56%), classified as Bethesda Category II (benign), were followed by Category VI (malignant) at 16%. Papillary carcinoma was the most common malignancy, but colloid goiter was the most common benign condition. 90% concordance was shown by histopathological correlation. The overall diagnostic accuracy of FNAC was 90%, with sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 80%. Histopathology and cytology showed a statistically significant connection (p = 0.01). Conclusion: With excellent specificity and diagnostic accuracy, FNAC is a very useful first-line diagnostic method for assessing thyroid nodules. For a conclusive diagnosis, however, inconclusive results call for further histopathological investigation. Recommendations: Regular use of FNAC is recommended for the first evaluation of thyroid nodules. In Bethesda III–V categories and in cases where there is a high level of clinical or radiological suspicion, surgical follow-up is advised. Training and standardization of reporting should be emphasized to enhance diagnostic precision.

Background: Dermatological disorders, though primarily physical, often have significant psychological impacts due to their visible nature and chronic course. Depression is a common but under-recognized comorbidity in patients with skin diseases, influenced by both the type of condition and sociodemographic factors. Aim: To assess the incidence of depression among patients with dermatological diseases attending the outpatient department and examine its correlation with demographic characteristics. Methods: This cross-sectional observational study was conducted on 100 patients attending the dermatology outpatient department of a tertiary care hospital over twelve months. Data were collected using a structured demographic proforma and the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Statistical analysis was performed using SPSS version 23.0. Correlations between depression severity and demographic variables were tested using the Chi-square test, with p < 0.05 considered significant. Results: Out of 100 participants, 39% showed moderate to severe depression (PHQ-9 ≥ 10), 28% had mild depression, and 33% had minimal or no depression. A significant correlation was found between moderate to severe depression and female gender (p = 0.024) as well as low socioeconomic status (p = 0.017). No significant correlation was found with age or residence. Conclusion: Depression is highly prevalent among dermatology outpatients, particularly among women and those from lower socioeconomic backgrounds. These findings highlight the need for routine psychological screening in dermatological care settings. Recommendations: It is recommended that dermatology clinics implement regular mental health assessments, especially using validated tools like PHQ-9, and establish referral pathways for psychiatric consultation. Further studies with larger sample sizes are encouraged to explore disease-specific psychological impacts.

Objectives: Dexmedetomidine and clonidine have been used to prevent and treat shivering after spinal anaesthesia. A Study was conducted to compare the efficacy and safety of low dose intravenous dexmedetomidine and clonidine in controlling post-spinal anaesthesia shivering during caesarean section. Methods: 260 pregnant women of American Society of Anesthesiologists physical status I and II, aged between 18 – 40 years posted for caesarean section who developed grade 3 or 4 shivering after spinal anaesthesia were randomly divided into two groups, Group D (n = 130) received intravenous dexmedetomidine 0.5 μg/kg and Group C (n = 130) received clonidine 0.5 μg/kg. Time required to control shivering, response rate, recurrence rate, and adverse effects were observed. Results: The time taken to cease the shivering was short (2.20 ± 0.35 min) with no recurrence in dexmedetomidine in comparison with clonidine group (5.51 ± 0.48 min). There was 27.69% recurrence with clonidine. Response rate was 100% in dexmedetomidine against 82.3% of clonidine group. The sedation level was adequate with dexmedetomidine without respiratory depression. The haemodynamic parameters and other side effects were comparable and no adverse neonatal outcome was observed in both the groups. Conclusion: Intravenous dexmedetomidine 0.5 μg/kg has early onset of effect, higher response rate without recurrence with added advantage of good sedation and stable cardiorespiratory function and neonatal outcome than clonidine 0.5 μg/kg in controlling post- spinal anaesthesia shivering during caesarean section.

Overview: With a global surge in patients of diabetes mellitus and hypertension the incidence of chronic kidney disease is increasing exponentially. Irrespective of aetiology of chronic kidney disease the management of end stage renal disease is some or the other kind of replacement therapy that may include renal transplantation of haemodialysis. Various metabolic derangement take place in patients of chronic kidney disease that include hypocalcaemia and hyperparathyroidism which consequently is responsible for osteoporosis in these patients. Early diagnosis of osteoporosis and appropriate intervention is essential in these patients for proper management. Objectives: (1). To study the pattern of various mineral abnormalities and biochemical markers in patients having chronic kidney disease undergoing haemodialysis. (2) To elucidate the relationship between biochemical markers and correlate DEXA findings with biochemical markers. Methodology: This was a cross-sectional study conducted in the department of General Medicine and Radiodiagnosis at ACPM Medical College, Dhule, Maharshtra. The study was conducted over a period of 2 years (Jan 2023 to Jan 2025). In this study 50 patients having chronic renal dialysis and who were being treated by haemodialysis were included on the basis of a predefined inclusion and exclusion criteria. plasma samples were analysed for 25OH-vit D and iPTH and serum for all other biochemical parameters. Bone mineral density was assessed at femoral neck, distal radius and lumbar spine. Presence of osteoporosis or osteopenia was noted. P value less than 0.05 was taken as significant for statistical purposes. Results: Out of 50 patients having chronic kidney diseases there were 35 males and 15 females with a M:F ratio of 1:0.42. The mean age of affected male and female patients was found to be 49.4 +/- 7.79 and 47.8 +/- 7.74 years respectively. Diabetic Nephropathy was the most common cause of chronic kidney disease which was seen in 27 (54%) patients. Amongst 50 studied cases 15 (30%) patients were normocalcemic whereas hypocalcaemia and hypercalcemia were seen in 33 (66%) and 2 (4%) patients respectively. Conclusion: Patients with chronic kidney disease on hemodialysis are predisposed for development of osteoporosis and its consequences such as pathological fractures. Assessment of Bone mineral density and its proper management by anti-resorptive therapy is essential part of optimum management of these patients.

Objectives: The present study was to evaluate the various determinants of visual outcomes in open globe injuries at tertiary care center in Madhubani district of Bihar. Methods: The primary dependent variable was the visual outcome, measured as best-corrected visual acuity (BCVA) at three months post-surgery. Independent variables included demographic factors such as gender, age, occupation. Injury characteristics included the type of injury (penetrating, perforating, foreign body, or rupture), injury location (Zone I, Zone II, or Zone III), time since injury before presentation, and injury size (≤ 5 mm, 5–10 mm, 10–15 mm, >15 mm). Ocular examination findings considered factors such as anterior chamber status (cells and flares, fibrin, hyphema, or hypopyon) and lens status (aphakia, phakia, pseudophakia, or dislocation). Surgical treatment variables included the type of primary operation performed, such as cornea repair, scleral cornea repair, VHCO, PPV, or RDS. Results: most of the cases were penetrating open globe injuries (62%), while globe ruptures were rare (3%). Most eyes were classified as zone I (61%), followed by zone II (26%), with zone III injuries being the least common (13%). The good visual acuity post-operative BCVA was 32% (32/100). Factors significantly associated with poor postoperative visual acuity included delayed surgery (>2 days), presence of hypopyon, larger wound size (>10 mm), and undergoing secondary surgery (PPV and RDS). Conclusions: Open globe injuries (OGI) may lead to vision impairment. Early diagnosis and prompt treatment are required for the management of open globe injuries. We should organize ophthalmology camp time to time in rural as well as urban for awareness of OGI and its severity.

Background: Unstable intertrochanteric fractures of the femur are common in elderly populations and are associated with high morbidity and mortality. Proximal femoral nailing (PFN) offers biomechanical advantages over traditional fixation methods, particularly in unstable fracture patterns. This study aimed to evaluate the functional outcomes and complications of PFN fixation in adults with unstable intertrochanteric fractures. Methods: A prospective observational study was conducted on 20 adult patients (aged 30–80 years) with AO/OTA type 31A2 and 31A3 unstable intertrochanteric fractures at GSL Medical College, Rajahmundry, between October 2019 and March 2021. All patients underwent PFN fixation. Functional outcomes were assessed using the Harris Hip Score (HHS) at 3 and 6 months postoperatively. Data on demographic profile, fracture type, operative parameters, time to full weight bearing, and complications were recorded. Statistical analysis was performed using SPSS v20.0, with p ≤ 0.05 considered significant. Results: The mean age was 54.3 years, with a female predominance (60%). Accidental domestic falls were the most common injury mechanism (80%). Type 31A2.2 fractures were most frequent (45%). Short PFN was used in 80% of cases. The mean operative time was 68 minutes. At 3 months, 60% of patients achieved excellent/good HHS outcomes, increasing to 85% at 6 months (p = 0.001). Earlier surgery (within 5 days) and younger age correlated with better outcomes. Common complications included limb shortening (20%), lateral screw migration (15%), and varus collapse (10%), with no cases of non-union. Conclusion: PFN fixation in unstable intertrochanteric fractures provides stable fixation, allows early mobilization, and yields favorable functional outcomes with acceptable complication rates. It should be considered the preferred treatment option for such fractures.

Background: The accumulation of triglyceride fat in the liver is referred to as fatty liver disease broadly. Higher concentrations of certain circulating inflammatory markers have been associated with fatty liver disease. Alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD) patients’ inflammatory indicators were compared in the current study. Methods: From May 2024 to April 2025, 120 patients with fatty liver disease (60 with NAFLD and 60 with AFLD) at DMCH, Laheriasarai, Bihar, participated in this descriptive study. In order to measure inflammatory markers (CRP, IL6, and TNF α), venous blood samples were obtained from patients who were fasting. Statistical analysis was performed using the Student’s t test, with p-values <0.05 considered significant. Results: The mean values of Inflammatory markers (CRP, IL6 and TNF-α) in the NAFLD group were 01.86±0.57, 27.65±13.58, 34.86±12.34 and in the AFLD group were 01.97±0.74, 29.37±12.19 and 36.12±16.12. There were no significant changes in CRP, IL6, or TNF-α levels between AFLD patients and those with NAFLD. Conclusion: Inflammatory markers are raised in fatty liver disease. In patients with fatty liver disease, measuring inflammatory markers should be a top priority throughout treatment because elevated inflammatory markers in this condition indicate liver damage.

Background: Accurate gestational age estimation is vital for proper prenatal care and delivery planning. Traditional methods like the last menstrual period can be unreliable, especially with irregular cycles. Ultrasound offers a more precise alternative, with Transverse Cerebellar Diameter (TCD) and Femur Length (FL) serving as consistent and reliable indicators. These measurements are particularly helpful in high-risk or uncertain pregnancies. Aims & Objective: The objective of this study is to assess the effectiveness of Transverse Cerebellar Diameter (TCD) and Femur Length (FL) in estimating gestational age in normal pregnancies between 14 to 40 weeks at MGM Hospital, Jamshedpur, in the East Singhbhum region of Jharkhand. Materials and Methods: This cross-sectional study was conducted in the Anatomy and collaborated with Radio diagnosis and Obstetrics and Gynecology Department of MGM Hospital, East Singhbhum, Jharkhand, on 204 pregnant women between 14 to 40 weeks of gestation. Only normal singleton pregnancies with known last menstrual periods were included, and informed consent was taken. Women with complications, uncertain LMP, or discrepancies of more than one week between LMP and ultrasound were excluded. Ultrasound scans were done transabdominally using a 4.5 MHz probe. The study focused on comparing the accuracy of Transverse Cerebellar Diameter (TCD) and Femur Length (FL) for estimating gestational age. Results: In this study involving 204 pregnant women, the majority were over 33 years of age, with an average maternal age of 29.45 years. Most participants (79.41%) were aware of their last menstrual period, while 20.59% were uncertain. Femur Length (FL) measurements increased steadily with gestational age, ranging from 14.35 mm at 14 weeks to 40.28 mm at 40 weeks. Similarly, Transverse Cerebellar Diameter (TCD) showed a consistent rise from 14.13 mm to 40.07 mm across the same gestational period. Both FL and TCD demonstrated strong statistical significance and were found to be dependable indicators for accurately estimating fetal age. Conclusion: This study concludes that femur length and transverse cerebellar diameter are reliable and accurate ultrasound markers for estimating gestational age. Their consistent growth patterns make them especially useful when the last menstrual period is unknown.

Background: Human body external physical dimensions are greatly affected by ecological, biological, geographical, racial, sex and age factors. Cephalic index is a crucial anthropometric tool used to differentiate the human of different race, region, age and sex. It is a numerical value derived from ratio of the maximum width of the head to its maximum length. Objective: To evaluate and compare the cephalic indices and associated cranial types among adult males and females in the East Singhbhum region of Jharkhand. Methods: This study was conducted at MGM Medical College, Jamshedpur, involving 210 subjects (105 males and 105 females). The head length and head breadth were measured in cm using a spreading caliper and with these measurements cephalic index (CI) was calculated using Hrdlicka’s method. Results: In this study the mean cephalic index of total population was 74.09±7.83, while for males it was 72.97 ± 8.72 and for females it was 75.21 ± 6.64. Dolichocephalic head type was most common in males (59.05%) and mesocephalic head type was most common in females (41.90%). Conclusion: There was an obvious difference between Cephalic index and head shapes of males and females. Thus, we can conclude that of females of East Singhbhum region have slightly broader head than males.

Background: Pulmonary hypertension (PH) is a progressive condition characterized by elevated pulmonary artery pressure and is increasingly recognized in individuals with obesity. Adiponectin, a vasodilatory and anti-inflammatory adipokine, may play a contributory role in the pathophysiology of obesity-associated PH, but its clinical relevance remains underexplored. Primary: To evaluate the correlation between serum adiponectin levels and mean pulmonary artery pressure (mPAP) in obese Indian adults. Secondary: To determine the prevalence of PH and assess the correlation between serum adiponectin and obesity parameters. Methods: This cross-sectional observational study was conducted at a tertiary care center in New Delhi from November 2019 to March 2021. A total of 78 obese participants (BMI ≥ 25 kg/m²) underwent serum adiponectin measurement using ELISA and mPAP estimation via transthoracic echocardiography. Obstructive sleep apnea (OSA) risk was evaluated using the Berlin Questionnaire. Results: The prevalence of PH (defined as mPAP > 20 mmHg) was 60.3%, highest among participants with BMI > 35 kg/m² (76%). Serum adiponectin levels were significantly and inversely correlated with mPAP (r = –0.52, p <0.01) and BMI (p = 0.004). Participants with PH had lower adiponectin levels compared to those without PH (p = 0.02). High OSA risk was associated with both higher mPAP (p = 0.01) and lower adiponectin levels (p = 0.03). Conclusion: In this cohort of obese Indian adults, lower serum adiponectin levels were significantly associated with elevated pulmonary artery pressure and greater obesity. These findings suggest a potential pathophysiological role for adiponectin in obesity-associated PH and support its consideration as a biomarker or therapeutic target in future research.

Background: Pulmonary hypertension (PH) is a progressive condition characterized by elevated pulmonary artery pressure and is increasingly recognized in individuals with obesity. Adiponectin, a vasodilatory and anti-inflammatory adipokine, may play a contributory role in the pathophysiology of obesity-associated PH, but its clinical relevance remains underexplored. Primary: To evaluate the correlation between serum adiponectin levels and mean pulmonary artery pressure (mPAP) in obese Indian adults. Secondary: To determine the prevalence of PH and assess the correlation between serum adiponectin and obesity parameters. Methods: This cross-sectional observational study was conducted at a tertiary care center in New Delhi from November 2019 to March 2021. A total of 78 obese participants (BMI ≥ 25 kg/m²) underwent serum adiponectin measurement using ELISA and mPAP estimation via transthoracic echocardiography. Obstructive sleep apnea (OSA) risk was evaluated using the Berlin Questionnaire. Results: The prevalence of PH (defined as mPAP > 20 mmHg) was 60.3%, highest among participants with BMI > 35 kg/m² (76%). Serum adiponectin levels were significantly and inversely correlated with mPAP (r = –0.52, p <0.01) and BMI (p = 0.004). Participants with PH had lower adiponectin levels compared to those without PH (p = 0.02). High OSA risk was associated with both higher mPAP (p = 0.01) and lower adiponectin levels (p = 0.03). Conclusion: In this cohort of obese Indian adults, lower serum adiponectin levels were significantly associated with elevated pulmonary artery pressure and greater obesity. These findings suggest a potential pathophysiological role for adiponectin in obesity-associated PH and support its consideration as a biomarker or therapeutic target in future research.

Background: Fistula-in-ano is a common anorectal condition resulting from cryptoglandular infections, often presenting with persistent discharge and pain. Effective management requires accurate classification and appropriate surgical intervention to minimize recurrence and preserve continence. Objectives: To study the clinical profile, classification, and surgical outcomes of fistula-in-ano in patients treated at a tertiary care hospital in Central India. Materials and Methods: This prospective observational study was conducted over a 1-year period at the Department of General Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar. Patients diagnosed with fistula-in-ano were evaluated clinically and radiologically, classified as per Parks’ classification, and treated using appropriate surgical techniques. Results: A total of 86 patients were studied, with a male predominance (M: F = 3.8:1) and a mean age of 36.8 years. Transsphincteric (46.5%) and intersphincteric (39.5%) fistulas were most common. Fistulotomy (51.2%) was the most frequently performed procedure. Complete healing was seen in 88.4% of cases, with low recurrence (3.5%) and minimal postoperative complications. Conclusion: Proper classification and individualized surgical management of fistula-in-ano result in favorable outcomes with high healing rates and minimal recurrence.

Background: Necrotising soft tissue infections (NSTIs) are uncommon but can be deadly. They are marked by the rapid spread of necrosis in the skin, subcutaneous tissues, and fascia. Prompt surgical intervention and early recognition are essential for enhancing outcomes. The clinical similarities between these infections and more benign conditions, such as cellulitis, frequently result in their underdiagnosis. Objective: The goal of this study was to look at the epidemiological distribution, risk factors that make people more likely to get NSTIs, how they show up in patients, and how well they respond to treatment at a tertiary care centre in Bihar. Methods: The work was conducted in the Department of General Surgery at NMCH Sasaram from 2019 to 2022. A total of sixty adult patients diagnosed with NSTIs were included. Imaging, clinical, biochemical, and demographic data were gathered. All patients were assessed using the LRINEC scoring system. The management plan comprised surgical debridement, fasciotomy, split-thickness skin grafting, and secondary suturing as required. The clinical recovery and mortality outcomes were analysed. Results: The age group of 59–72 years was the most affected (50%), with a male predominance (75%). The most prevalent sites of infection were the lower limb (36.7%) and upper limb (30%), with the perineum (26.7%) following in that order. Smoking (65%) and diabetes mellitus (76.7%) were identified as significant risk factors. In 37 patients, early surgical debridement was implemented; 17 patients necessitated split-thickness skin grafting, while 30 patients underwent secondary suturing. Three patients succumbed to the infection, resulting in a mortality rate of 5%, despite the prompt intervention. Conclusion: NSTIs continue to be a critical surgical emergency, resulting in substantial morbidity and mortality. Susceptibility is elevated by diabetes, elderly age, and lifestyle factors, including smoking and alcohol consumption. Patient outcomes are significantly influenced by early diagnosis, which is supported by LRINEC scoring, and prompt surgical management.

Background: Eclampsia remains a major contributor to maternal and perinatal morbidity and mortality, particularly in developing countries like India. Despite advancements in obstetric care, the burden of eclampsia continues to be high due to late diagnosis, inadequate antenatal monitoring, and limited access to tertiary healthcare, especially in rural areas. Aim: To evaluate the maternal and perinatal outcomes among women diagnosed with eclampsia at a tertiary care center in Central India. Methods: This was a hospital-based prospective observational study conducted at Darbhanga Medical College & Hospital from September 2023 to August 2024. A total of 90 women with eclampsia were included. Data were collected on demographic details, clinical profile, mode of delivery, maternal complications, and perinatal outcomes. Statistical analysis was performed using SPSS version 23.0, with a p-value <0.05 considered statistically significant. Results: Most participants were young (mean age 23.6 ± 3.8 years), primigravida (63.3%), and from rural backgrounds (76.7%). Antepartum eclampsia was the most common type (54.4%). Cesarean section was performed in 53.3% of cases. Maternal complications included acute renal failure (17.8%), pulmonary edema (13.3%), and DIC (5.6%), with a maternal mortality rate of 7.8%. Perinatal outcomes included stillbirths (7.8%), early neonatal deaths (4.4%), NICU admissions (36.7%), and low birth weight in 45.6% of neonates. Antepartum eclampsia was significantly associated with higher maternal complication rates (p=0.032). Conclusion: Eclampsia significantly impacts maternal and perinatal health, particularly in underserved populations. Antepartum onset is associated with worse outcomes. Early identification, regular antenatal care, and timely referral to tertiary care centers are key to improving prognosis. Recommendations: Strengthening antenatal screening, increasing awareness in rural areas, ensuring magnesium sulfate availability, and improving referral systems are essential to reducing the burden of eclampsia-related complications.

Background: COPD is a progressive inflammatory lung disorder with irreversible airflow limitation. ADA, an enzyme involved in purine metabolism and immune regulation, has been proposed as a potential biomarker for inflammation in COPD. Evaluating ADA in relation to disease severity may offer insights into its diagnostic and prognostic utility. Aim: To assess the association between serum ADA levels and the severity of COPD as classified by the GOLD grading system. Methods: A hospital-based cross-sectional study was conducted on 76 clinically diagnosed COPD patients. Demographic data, smoking history, exposure to biomass fuel, and GOLD grading were recorded. Serum ADA levels were measured and statistically analyzed using ANOVA, Pearson correlation, and post-hoc tests to evaluate differences across GOLD stages and between exposure groups. Results: The majority of participants were males (65.8%) and aged between 50–69 years. Smoke exposure—either through smoking (63.2%) or chulha—was nearly universal. Mean serum ADA levels showed a significant inverse relationship with COPD severity: GOLD 1: 14.43 U/L, GOLD 2: 13.05 U/L, GOLD 3: 10.79 U/L, GOLD 4: 9.88 U/L (ANOVA p < 0.01; r = –0.695). No statistically significant differences in ADA levels were found based on smoking or gender alone, suggesting that total smoke burden, regardless of source, may influence ADA activity. Conclusion: Serum ADA levels decline significantly with increasing COPD severity, supporting its potential role as a biomarker for disease monitoring. Smoke exposure, whether from tobacco or biomass fuels, is a crucial contributing factor. Recommendations: Further longitudinal studies are recommended to validate serum ADA as a biomarker for monitoring disease progression and therapeutic response in COPD patients.

Background: A primary cause of irreversible blindness in the world, POAG is influenced by a number of modifiable risk factors, including elevated intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thinning, which indicates structural damage to the optic nerve. Determining the relationship between IOP and RNFL thickness may help with early detection and tracking the progression of glaucoma. Aim: To evaluate the correlation between intraocular pressure and retinal nerve fiber layer thickness in patients with primary open-angle glaucoma. Methods: From July 2024 to June 2025, the Department of Ophthalmology at GMCH, Purnea, hosted this hospital-based, cross-sectional study. A total of 120 POAG patients between the ages of 40 and 80 were enrolled. Goldmann applanation tonometry was used to evaluate intraocular pressure, and spectral-domain optical coherence tomography (SD-OCT) was used to measure RNFL thickness. SPSS version 23.0 was used for statistical analysis, and Pearson correlation was used to evaluate the correlations between the variables. Results: The average RNFL thickness was 78.2 ± 12.6 µm, and the average IOP was 23.6 ± 4.8 mmHg. IOP and RNFL thickness showed a statistically significant adverse relationship (r = -0.61, p < 0.001) with stronger correlations in the inferior (r = -0.65) and superior (r = -0.58) quadrants. RNFL thickness declined progressively across groups with increasing IOP levels, from 91.4 µm in the <20 mmHg group to 68.2 µm in the >25 mmHg group (p < 0.001). Conclusion: In POAG patients, this study shows a significant inverse relationship between intraocular pressure and RNFL thickness. Greater RNFL thinning, particularly in the superior and inferior quadrants, is associated with higher IOP and indicates more severe optic nerve injury. Recommendations: Routine monitoring of both IOP and RNFL thickness using SD-OCT should be integrated into glaucoma care protocols. Early detection of RNFL thinning, even in patients with borderline IOP, can facilitate timely intervention and slow disease progression.

Background: Osteoarthritis (OA) is a disease where hyaluronic acid in the knee joint has broken down and created inflammation. Hence, sodium hyaluronate acid is injected for regeneration of the knee joint, which gives relief from pain and leads to normal movement of the knee joint. Method: 45 patients with OA were selected for intra-articular sodium hyaluronate, and 45 patients with OA were treated with placebo. Routine blood exam; x-ray of the knee joint (MRI if necessary). Kellengren-Lawrence radiographic scale to assess the severity of OA. Intraarticular 6 ml Hylan GF20 was injected by using a 23-gauge syringe and placebo in the other 45 OA patients. Results: In the comparison of the VAS scale at week 25 between the Hyalgen and placebo groups, the primary outcome at week 25 was a highly significant p-value (p<0.001). In comparison to the mean change from baseline to week 25 in the WOMAC Index score, all three parameters, including pain, stiffness, and function of the knee joint, were highly significant (p<0.001). Conclusion: Intra-articular therapy with sodium hyaluronate is an ideal and easy method for treating OA of the knee joint.

Background: For lower limb surgeries, neuroaxial blockage is the preferred mode of anesthesia. Spinal block is still the first choice because of rapid onset, prolonged blockade, less failure rates, and cost-effectiveness. Method: Out of 60 patients undergoing femur surgeries, 30 were given 3 ml of bupivacaine + 5 mcg of Dexmedetomine, and 30 were given 3 ml of bupivacaine + 25 mcg (0.5 ml) of fentanyl. All hemodynamic parameters were monitored; sensory and motor blockades, VAS, and side effects are noted. Results: Duration of sensory blockage, motor blockage, and duration of spinal anesthesia had significant p-values (p<0.001) and side effects. Bradycardia was observed only in 2 patients of each group and 2 pruritis patients in group F. VAS analysis also had a significant p-value (p<0.001). Conclusion: Intrathecal Dexmedetomine 5 mcg proved a good alternative to Fentanyl 0.5 ml used in unilateral spinal anesthesia for lower limb orthopedic surgeries because of early onset and prolonged blockage with minimum side effects.

Background: There are many criteria to identify sex in the appendicular and axial skeleton, but the least data is available in literature to differentiate sex in the humerus. Method: 25 male and 25 female, right-side non-pathological macerated humerus were studied. Each bone was put in anatomical position, and metrical parameters were carried out by vernier caliper and the weight of the bones by digital weighing machine. Results: Various parameters like transverse diameter of surgical neck of humerus, transverse diameter of superior articular surface, length of humerus, and weight of humerus in both sexes were measured and compared, and all values were highly significant (p<0.001). Conclusion: The metrical study of the humerus of both sexes will be quite helpful to medico-legal experts, anthropologists, and anatomists, because the morphometric values of mesodermal derivatives is uncertain, as the bone is the most plastic tissue next to blood.

Background: Drug Package inserts serve as an important source of information for the patients and healthcare providers regarding the safe and effective use of medicine. Accurate and authentic drug information enhances patient compliance and reduces medication errors. This study was conducted to examine the extent to which drug package inserts adhere to the guidelines of the Drugs and Cosmetics Rules, 1945. Methodology: This observational cross-sectional study was conducted over two months in the Department of Pharmacology at Gandhi Medical College, Bhopal. A total of 150 package inserts from various classes, dosage forms, and pharmaceutical companies were collected from local pharmacies and the hospital drug store. After excluding 14 duplicates, 136 inserts were analysed according to Sections 6.2 and 6.3 of Schedule D (II) of the Drugs and Cosmetics Act and Rules, 1945. Results: Out of 136 drug package inserts, the majority were for antimicrobials at 18% followed by anti-diabetics at 15% and antihypertensive drugs at 13%. Furthermore, 59% inserts were for oral preparations, while intravenous injections represented 18%. According to Section 6.2 of Schedule D (II) of the Drug and Cosmetic Rules, our findings indicate that indications, posology and method of administration were included in all 100% of the inserts. Special precautions and warnings were present in 96.5%, side effects were detailed in 88%, and contraindications were listed in 83% of the inserts. With respect to Section 6.3, excipients were mentioned in 62% of the inserts, incompatibility information was provided in 34%, the shelf life was indicated in 48%, and the storage precautions were mentioned in 85%. Conclusion: This study highlights that although there have been advancements, many package inserts fail to meet the comprehensive requirements of Sections 6.2 and 6.3 of the Drug and Cosmetic Rules (1945). Regulatory authorities need to rigorously assess package inserts to improve patient adherence, medication effectiveness, and overall healthcare quality.

Background: Respiratory distress is one of the most common reasons a neonate is admitted to the neonatal intensive care unit. The objective of this study was to compare heated humidified high-flow nasal cannula (HHHFNC) with continuous positive airway pressure (CPAP) as primary respiratory support in preterm neonates with respiratory distress at birth. Methods: A hospital-based prospective observational study involving 100 neonates with birth weight ≥ 1000 grams, gestational age 30 to 36^6/7 weeks and Silverman Anderson Score (SAS) of 5 & 6 were recruited in this study, 50 each in CPAP and HHHFNC group. Results: Mean gestational age of the study cohort was 34.20 (±1.50) weeks in CPAP group and 34.16 (±1.56) weeks in HHHFNC group. Majority of the patients admitted in both groups were delivered by cesarean section, 68% (n=34) in CPAP group and 70% (n=35) in HHHFNC group. The median age and SAS at admission was 5 hours (IQR: 2-12) and 4 (IQR: 3-6) respectively. In CPAP group 18% (n=9) and in HHHFNC group 20% (n=10) had treatment failure but this was statistically insignificant (p value=0.126). Complications such as nasal injury and pneumothorax was seen more in CPAP group as compared to HHHFNC group which was statistically significant (p value = 0.038). Conclusion: This study concluded that when comparing HHHFNC to CPAP as a primary non-invasive respiratory support in preterm infants with respiratory distress, HHHFNC is non-inferior to CPAP in avoiding the need for a higher mode of respiratory support in the first 72 h of life.

Background: Bronchoalveolar lavage (BAL), an integral part of bronchoscopy, offers diagnostic insight into infections, malignancies, and inflammatory lung diseases. Bioprofiling of BAL helps assess microbial spectrum and antimicrobial resistance patterns. Objective: To evaluate the microbiological profile and antimicrobial susceptibility pattern of BAL fluid, and to compare findings between inpatient (IPD) and outpatient (OPD) settings. Methods: This was a hospital-based observational study conducted over 12 months in Santosh Hospital, Ghaziabad. A total of 120 patients undergoing bronchoscopy with BAL were enrolled. BAL samples were subjected to microbiological cultures, cytological analysis, and antimicrobial susceptibility testing. Results: The mean age of participants was 45.4 ± 10.2 years; 57.5% were male. The most common indication for BAL was suspected infection (38%). Pseudomonas aeruginosa (21%) and Staphylococcus aureus (16%) were the most common isolates. No growth was seen in 35% of samples. IPD cases had a higher prevalence of Pseudomonas aeruginosa (25.7%) vs. OPD (14%). BAL cytology detected infection in 19%, malignancy in 8%, and had no conclusive findings in 42%. High susceptibility to Piperacillin-Tazobactam, Amikacin, and Colistin was observed in bacterial isolates. Conclusion: BAL fluid analysis remains a cornerstone in diagnosing pulmonary diseases. Pseudomonas and Staphylococcus were the predominant pathogens, with notable antimicrobial susceptibility trends that support targeted therapy.

Background: Prompt and complete reversal of neuromuscular blockade (NMB) is critical for patient recovery after general anaesthesia. Neostigmine with glycopyrrolate has long been the standard reversal agent, whereas sugammadex offers a novel mechanism with potential advantages. Objective: To compare the efficacy and safety of sugammadex versus neostigmine with glycopyrrolate in reversing vecuronium-induced NMB under general anaesthesia. Methods: Ninety-two adult patients (ASA I & II) undergoing elective surgery were divided into two groups: Group A (n=46) received neostigmine with glycopyrrolate, and Group B (n=46) received sugammadex. Primary endpoints included time to recovery, extubation, and OR exit. Secondary outcomes assessed respiratory parameters, hemodynamics, and adverse effects. Results: The sugammadex group demonstrated significantly faster recovery from NMB (4.46 ± 0.81 min vs. 8.69 ± 1.45 min, p<0.001), extubation (1.25 ± 0.21 min vs. 3.81 ± 0.56 min, p<0.001), and OR exit time (3.91 ± 0.72 min vs. 8.11 ± 0.92 min, p<0.001). Respiratory and hemodynamic parameters were comparable across groups. Adverse effects such as PONV were slightly higher in the sugammadex group but not statistically significant. Conclusion: Sugammadex offers faster and more efficient reversal of NMB than neostigmine with glycopyrrolate, with comparable safety profiles. Its use may enhance perioperative efficiency and patient throughput.

Background: Assessing intravascular volume is vital in managing patients with shock. While inferior vena cava (IVC) ultrasound indices are commonly used, technical limitations necessitate exploring alternatives such as the internal jugular vein (IJV). Aim: To determine the correlation between ultrasound-guided IJV collapsibility/distensibility indices and IVC indices in shock patients. Methods: A cross-sectional observational study was conducted at a tertiary ICU with 217 fluid-responsive shock patients. IJV and IVC collapsibility and distensibility indices were measured before and after fluid resuscitation using standardized ultrasound techniques. Pearson correlation and regression analyses were used to assess associations. Results: Pre-resuscitation IVC CI and IJV CI averaged 54.9% and 54.0% respectively; post-resuscitation values decreased to 14.8% and 10.8%. IVC DI and IJV DI dropped from 33.9% and 25.1% to 12.8% and 11.6% respectively. Strong correlations were found between IVC and IJV indices (pre-resuscitation r = 0.894 for CI, 0.992 for DI; post-resuscitation r = 0.908 for CI, 0.794 for DI; p < 0.0001). Linear regression showed significant predictive value of IJV for IVC indices. Conclusion: IJV ultrasound indices correlate strongly with IVC indices and can serve as reliable surrogates for volume assessment in shock, particularly when IVC imaging is difficult.

Background: Early detection of hearing impairment in neonates is crucial for optimal speech, language, and cognitive development. High-risk neonates are particularly vulnerable to hearing loss due to various prenatal, perinatal, and postnatal factors. Otoacoustic Emissions (OAE) provide a non-invasive and efficient method for initial hearing screening. Objective: To assess the incidence of hearing impairment using OAE in high-risk neonates admitted to a tertiary care centre and to analyze the association of various risk factors with hearing loss. Methods: This prospective observational study was conducted over 18 months at the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital. A total of 271 high-risk neonates who fulfilled inclusion criteria were enrolled. Hearing screening was performed using OAE testing before discharge. Neonates who failed the initial screening were subjected to repeat OAE and, if required, Brainstem Evoked Response Audiometry (BERA) for confirmation. Results: Out of 271 high-risk neonates screened, 54 (19.9%) failed the first OAE test. On repeat OAE after 2 weeks, 32 (11.8%) continued to show a “refer” result and were subjected to BERA, where 18 (6.6%) were confirmed to have sensorineural hearing loss. Risk factors significantly associated with hearing loss included birth asphyxia, low birth weight, neonatal hyperbilirubinemia requiring exchange transfusion, and NICU stay >7 days. Conclusion: The study highlights the utility of OAE as an effective screening tool for early detection of hearing impairment in high-risk neonates. The most significant associated risk factors were birth asphyxia, hyperbilirubinemia requiring exchange transfusion, and NICU stay >7 days.

Background: Non-alcoholic fatty liver disease (NAFLD) is a growing public health concern closely associated with components of metabolic syndrome, particularly dyslipidaemia. Objective: To assess the prevalence and association of dyslipidaemia with NAFLD severity and other metabolic parameters. Methods: This cross-sectional study included 300 NAFLD patients aged 18–60 years at a tertiary hospital. Participants were evaluated through clinical examination, laboratory investigations including lipid profiles, liver enzymes, HbA1c, and BMI. Dyslipidaemia was defined based on NCEP-ATP III criteria. Results: Dyslipidaemia was observed in 93.3% of NAFLD patients. Grade II NAFLD patients had significantly higher BMI, HbA1c, total cholesterol, LDL, triglycerides, and VLDL levels (p<0.001) compared to Grade I. HDL levels were not significantly different. Liver enzymes were not strongly associated with NAFLD grade except for a slight rise in direct bilirubin. Conclusion: Dyslipidaemia is highly prevalent in NAFLD and worsens with disease severity. Routine lipid screening and aggressive lifestyle and pharmacological management are essential in NAFLD patients to prevent progression and cardiovascular complications.

Background: Diabetes mellitus type 2 (T2DM) is a prevalent metabolic disorder with multiple systemic complications, including microvascular and neuropathic damage. Hearing loss has increasingly been recognized as one of its lesser-known complications. Objective: To evaluate the prevalence and severity of hearing loss in patients with T2DM using pure tone audiometry (PTA) and compare the findings with those of age-matched non-diabetic controls. Methods: This cross-sectional comparative study was conducted in [Your Institution], involving [number] patients diagnosed with T2DM and [number] age- and sex-matched healthy subjects. All participants underwent detailed clinical evaluation, otoscopic examination, and pure tone audiometry across frequencies from 250 Hz to 8000 Hz. Statistical analysis was done to compare hearing thresholds between the two groups. Results: The mean age of diabetic participants was [mean age ± SD] years. The prevalence of sensorineural hearing loss (SNHL) was significantly higher in the diabetic group ([%] vs [%], p < 0.05). The average pure tone thresholds at high frequencies (4000–8000 Hz) were significantly elevated in the diabetic group compared to controls. Duration of diabetes and poor glycemic control (HbA1c) showed a positive correlation with the degree of hearing impairment. Conclusion: Hearing loss, particularly high-frequency SNHL, is more prevalent in patients with T2DM compared to age-matched healthy individuals. Routine audiometric screening should be considered in diabetic patients for early detection and rehabilitation.

Posterior ethmoid and sphenoid sinuses are grouped as the posterior paranasal sinus. The lateral wall of the sphenoid sinuses will show various prominences, one of them being the optic canal. The most common position of the optic nerve canal (ONC) with the sphenoid sinus is the superolateral position. These sinuses can show varying degree of pneumatization and depending on the degree of pneumatization, varied protrusion of ONC into the sinuses may occur. The sphenoethmoid cells or Onodi cells is of great surgical importance when the optic nerve is along its lateral wall.

Introduction: Neonatal sepsis is one of the major causes of morbidity and mortality in the newborn, more so in the developing countries. The incidence of neonatal sepsis has been reported to be 30/1000 live births according to National Neonatal Perinatal Database. Certain neonatal characteristics are predictive of Early Onset Neonatal Sepsis (EOS). Aim: The aim of this study was to study haematological profile for early diagnosis of neonatal sepsis and to study the most common organisms responsible for neonatal sepsis. Materials and Methods: Total 200 neonates who were admitted with clinical suspicion of sepsis were included in the present study. The neonatal sepsis screening included Total Leukocyte Count (TLC), Total Neutrophil Count (TNC), ESR, CRP, I/T Ratio >0.2, IM ratio remained significant markers for early diagnosis of culture positive EOS(P<0.05). Results: Out of 200 newborns presenting with EOS, 128 (64%) had positive blood culture. EOS was seen predominantly in male’s neonates. Among the various neonatal haematological parameters, raised ESR, I/T Ratio >0.2 are significant markers for early diagnosis of culture positive EOS (p<0.05). Conclusion: It is critical to diagnose sepsis early on and to rule out sepsis to avoid unnecessary antibiotic use. In predicting early onset newborn sepsis, a high index of suspicion combined with simple, cost-effective haematological screening measures is a sensitive and satisfactory approach.

Background: Type-1, type-2, Lucio phenomenon, and type-3 reactions are the three categories into which leprosy reactions fall. Erythema, edema of the skin lesions, and the development of elevated borders or plaques from macules are the hallmarks of a type-1 reaction. Objectives: The study aimed to compare and retrospectively analyze the clinical features, treatment approaches, and patient outcomes of Type 1 and Type 2 lepra responses. 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 for one year. Data from 184 participants were retrieved for the study. The requirements for inclusion were Histopathologically confirmed cases of leprosy; patients who presented with responses for the first time. Patients without a prior histological report, those who do not consent to a biopsy, and pregnant women were excluded. Results: The age distribution of research participants is displayed in Figure 1. Younger people were more likely to experience type 1 reactions; the age group of 31–40 years old had the most cases (26 participants), closely followed by the age group of 21–30 years old (24 participants). Thalidomide was used exclusively in the Type 2 reaction group, with 44 patients (43.1%) receiving it, while none of the Type 1 patients were treated with thalidomide, indicating a highly significant difference (p < 0.001). Conclusion: In terms of clinical characteristics, management, and results, the study showed definite distinctions between Type 1 and Type 2 lepra responses. While Type 2 reactions frequently manifested as systemic symptoms and nodular lesions, Type 1 reactions were more frequently linked to neuritis and skin plaques. Recommendations: Early recognition and appropriate management are crucial to minimize complications and nerve damage.

Background: Despite the great prevalence of pulmonary tuberculosis and the availability of more recent diagnostic technologies, cutaneous tuberculosis is still considered a rare condition. It is more widespread in areas of the world with high rates of diseases like HIV or in populations with compromised immune systems. Objectives: Comparing the clinical trends, diagnostic characteristics, and treatment outcomes of cutaneous tuberculosis in immunocompetent and immunocompromised persons was the study’s main goal. 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 for one year. Data from 172 participants were retrieved for the study. Individuals having a confirmed diagnosis of cutaneous tuberculosis during the study period based on clinical characteristics and at least one diagnostic test, such as culture, CBNAAT, or histology, were included. Results: The majority of participants were in the age group of 21–30 years, accounting for approximately 39.1% of the total. Lupus vulgaris was observed in 52 (47.7%) of participants in the immunocompetent group compared to 12 (19.0%) in the immunocompromised group, which was significant at p-value less than 0.001. 102 (93.6%) immunocompetent people and 51 (81.0%) immunocompromised people showed complete lesion clearance; the difference was statistically significant (p-value = 0.009). Conclusion: The clinical symptoms of cutaneous TB vary greatly between immunocompetent and immunocompromised patients. The majority of immunocompetent patients had lupus vulgaris, and they responded better to treatment, with faster healing times and greater lesion clearance rates. Recommendations: Particularly for immunocompromised individuals, prompt diagnosis with instruments like CBNAAT, customized treatment, and careful monitoring are crucial.

Background: Liver enzyme ratios, in this case the SGOT/SGPT (AST/ALT) ratio, play an important role in distinguishing between alcoholic and non-alcoholic liver disease. Alcoholic liver damage characteristically shows inordinately high SGOT levels secondary to mitochondrial injury, and thus, the SGOT/SGPT ratio is a possible diagnostic marker. Objectives: The objective of this study was to compare alcoholic and non-alcoholic patients’ SGOT/SGPT ratios and assess the correlation of this ratio with alcohol drinking patterns and liver function scores to determine its diagnostic as well as its prognostic value. Materials and Methods: A cross-sectional observational study was carried out on 110 subjects, divided into alcoholic (n=55) and non-alcoholic (n=55) groups. Blood samples were obtained under standardized conditions to measure the levels of SGOT and SGPT by using standard enzymatic assays. The ratio of SGOT/SGPT was calculated for each individual. Independent t-tests and Pearson correlation were conducted using SPSS to compare group differences and associations of the ratio with alcohol consumption and liver function scores. Results: Alcohol patients had much greater SGOT (120.5 ± 35.4 U/L) and SGPT (65.2 ± 20.1 U/L) values than non-alcoholics (42.7 ± 12.3 and 38.5 ± 10.8 U/L, respectively), with a significantly higher SGOT/SGPT ratio (1.85 ± 0.42 vs. 1.12 ± 0.21; p < 0.001). The ratio correlated highly and statistically significantly with weekly alcohol use (r = +0.62) and with liver function scores (r = +0.58). Conclusion: The SGOT/SGPT ratio is significantly increased in alcoholic patients and has a positive correlation with alcohol consumption and liver damage severity. These results confirm the suitability of the ratio as an easy, inexpensive biomarker for differentiation of alcoholic versus non-alcoholic liver disease and measurement of disease progression in clinical settings.

Introduction: Due to its decreased morbidity, shorter hospital stays and post-operative discomfort, improved cosmetic results, and quicker return to normal activities, laparoscopic cholecystectomy (LC) is currently the gold standard for treating symptomatic gallstone disease. Aims: The aim of this study was to determine preoperative indicators that can be useful for predicting conversion from laparoscopic to open cholecystectomy (OC). Materials & Methods: This is a Retrospective study conducted at Tezpur Medical College and Hospital and Study. Duration of the study was 1 year and total sample size were 100 patients in this study. Result: In our study the 100 patients who underwent conversion from laparoscopic to open cholecystectomy, the most frequent cause was a frozen or inflamed Calot’s triangle, observed in 56 patients (56%), which was statistically significant (p < 0.00001). Other causes included extensive intra-abdominal adhesions in 17 patients (17%), post-ERCP status in 11 patients (11%), cholecystoduodenal or cholecystocolic fistula in 10 patients (10%), and bile duct injury in 2 patients (2%). Conclusion: We came to the conclusion that certain preoperative characteristics significantly indicate the need for conversion from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC).   These include gallbladder wall thickness larger than 5 mm, age greater than 60, a history of acute cholecystitis, inflammatory or frozen Calot’s triangle, severe intra-abdominal adhesions, and previous abdominal surgery.

Introduction: Hepatitis A virus (HAV) is a common cause of acute viral hepatitis in children, particularly in developing countries where sanitation is suboptimal. While often self-limiting, the clinical spectrum in pediatric patients can range from asymptomatic infection to severe hepatitis with cholestasis or prolonged jaundice. Objective: To evaluate the clinical presentation, biochemical parameters, ultrasonographic findings, and outcomes in pediatric patients diagnosed with Hepatitis A. Methods: This hospital-based observational study was conducted at Mathadi Hospital Trust Navi Mumbai, Maharashtra 400709 from January 2024 to January 2025. A total of 40 children diagnosed with hepatitis A were included in the study. These patients were selected based on clinical presentation and confirmed serological evidence of hepatitis A infection. Results: In this study of 40 participants (mean age 14.5 ± 7.30 years), most were aged 11–20 years (77.5%) and predominantly male (57.5%), though sex distribution was not statistically significant. Ultrasonographic findings in 37 patients revealed hepatomegaly as the most common abnormality (29.7%, p = 0.00164), with variations including altered echogenicity, ascites, and gallbladder changes. Biochemically, patients showed elevated liver enzymes and bilirubin levels on admission (mean S. Billi 5.14 mg/dL, SGOT 1532 IU/L, SGPT 1534.53 IU/L), indicating acute hepatocellular injury. Repeat testing showed significant improvement, with reduced bilirubin (S. Billi 3.84 mg/dL) and transaminases, although values remained above normal. ALP and protein levels were relatively stable. A mild rise in PT/INR (1.35) suggested minimal coagulation disturbance. Conclusion: Hepatitis A in children typically presents with classic symptoms of acute viral hepatitis and shows favorable outcomes with conservative management. Early recognition and appropriate supportive treatment lead to full recovery. Public health measures including vaccination and improved hygiene remain key in reducing disease burden.

Introduction: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,” is how the International Association for the Study of Pain defines pain.  In addition to being a significant clinical, social, and economic issue, pain is a huge global public health concern, which significantly affects quality of life. Post-operative pain, if managed poorly, can cause central neuronal sensitization, which in turn causes chronic pain. Aims: Aim of the study is to compare the efficacy of intravenous Paracetamol and intranasal Tapentadol. Materials & Methods: An open label parallel group randomized clinical trial. The study was conducted in the Department of Surgery and in the Department of Pharmacology, AGMC and GBP Hospital. Study population included 150 open cholecystectomy patients. Study duration was one and half year. Result: The mean VAS scores (POD-0 at 4 pm) for the groups taking paracetamol and tapentadol was 3.5867 ± 0.3974 and 3.34 ± 0.3304, respectively.  There was a statistically significant difference (p <0.0001). The mean VAS score (POD-0 at 11 pm) for the groups taking paracetamol and tapentadol was 2.8133 ± 0.6461 and 2.4933 ± 0.4613, respectively.  There was a statistically significant difference (p =0.0006). The mean VAS score (POD-1 at 8 am) for the groups taking paracetamol and tapentadol was 1.85 ± 0.59 and 1.51 ± 0.51, respectively.  There was a statistically significant difference (p = 0.0002).The average VAS score (POD-1 at 4 pm) was 1.16 ± 0.37 for the paracetamol group and 1.03 ± 0.22 for the tapentadol group.  There was a statistically significant difference between the two groups (p = 0.0077). Conclusion: In this non-inferiority clinical trial, we found that Tapentadol showed significantly lower VAS scores (p < 0.05) and improved pain control at all-time points when compared to intravenous Paracetamol for postoperative analgesia in patients who had open cholecystectomy.  Although none of the Tapentadol group needed rescue analgesia and 2.7% of the Paracetamol group did, the difference was not statistically significant.