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.