Background: Diabetic nephropathy (DN) is one of the most serious microvascular complications of diabetes mellitus and a leading cause of end-stage renal disease. Microalbuminuria is recognized as an early marker of renal involvement, while glycated hemoglobin (HbA1c) reflects long-term glycemic control. This study aims to assess the correlation between microalbuminuria and HbA1c levels and their role in predicting the progression of diabetic nephropathy. Materials and Methods: A cross-sectional study was conducted on 150 patients with type 2 diabetes mellitus attending the outpatient department of a tertiary care hospital. Patients were stratified based on the presence and severity of microalbuminuria. HbA1c levels were measured using high-performance liquid chromatography (HPLC), and urinary albumin excretion was assessed using immunoturbidimetry. Statistical analysis included Pearson correlation and linear regression to determine the relationship between HbA1c and microalbuminuria. Results: The mean age of the participants was 56.3 ± 10.5 years, with a male-to-female ratio of 1.2:1. The average HbA1c was 8.4 ± 1.3%, and the mean urinary albumin excretion was 74.6 ± 25.8 mg/day. A significant positive correlation was observed between HbA1c and microalbuminuria (r = 0.68, p < 0.001), indicating that poor glycemic control is associated with increased albuminuria. Patients with HbA1c >9% had a markedly higher prevalence of moderate to severe microalbuminuria compared to those with HbA1c <7%. Conclusion: Microalbuminuria is strongly correlated with HbA1c levels in patients with type 2 diabetes, suggesting that tight glycemic control may reduce the risk of progression to overt nephropathy. Monitoring both parameters can provide valuable insight into renal prognosis and help guide early therapeutic interventions.

Introduction: Most cases of sub hepatic caecum and appendix are asymptomatic and hence remain unnoticed. Inflammation in sub hepatic located appendix may mimic hepatobiliary or gastric pathology clinically. This may lead to delayed diagnosis and results in many surgical complications.  It is a rare congenital anomaly and results due to anomalies of midgut rotation. Materials and Methods: Present cross-sectional cadaver-based investigation was conducted on a total of thirty (30) adult human cadavers of both sexes, representative of the North Indian population. The cadavers were obtained from the Department of Anatomy, ESIC Medical College and Hospital, Faridabad, Haryana. The study was carried out over a comprehensive period of three years, beginning in February 2022 and culminating in April 2025. During cadaveric dissection, detailed observations were made regarding the anatomical position. Result: In this present cadaveric study of 30 cadavers, the caecum was predominantly located in the right iliac fossa in 93.3% of cases, while a sub-hepatic position was observed in 6.6%. Regarding shape, the normal adult type was most common, seen in 83.3% of specimens, followed by the exaggerated type in 10%, and the infantile (conical) type in 6.6% of cases. Conclusion: This type of developmental error along with appendicitis can pose a significant challenge in its diagnosis and surgical management. Knowledge of such embryological variations are of paramount importance to surgeons and radiologists to prevent surgical complications.

Introduction: The Prevalence of ESBL producing Escherichia coli (E.coli) has increased throughout the world and is a major cause of treatment failure in Intensive Care Units (ICUs). The Antibiotic resistance is increasing at alarming levels and has emerged as a major public health concern of the 21^st century. The resistance to beta lactam antibiotics is a grave concern in treating infections in hospital settings especially in ICUs. The β-lactams are among the commonly used classes of antibiotics for treating infections however the production of beta lactamases by the bugs has made these antibiotics ineffective leading to drug resistance. This study has been done to determine the magnitude of extended spectrum beta lactamase (ESBL) producing E. coli isolates among the patients in ICUs of Government general hospital, Kakinada. Aims: To determine the prevalence of ESBLs among Escherichia coli isolates in ICUs of this region. Materials & Methods: This was a prospective study conducted for 3 months in the department of microbiology, Government general hospital Kakinada. The Escherichia coli isolates recovered from various samples of patient admitted to different ICUs, were subjected to ESBL production screening test by Kirby Bauer’s disc diffusion method as per CLSI guidelines. Results: A total of 138 samples were collected in this study out of which 64 were culture positives and 74 were culture negatives. Out of total 64 samples 21 (33%) were Escherichia coli isolates, Out of 21 Escherichia coli 8 were (38%) ESBL producers. The highest prevalence of ESBL producers was seen in Paediatric ICU 3 (37%) and Gynaecology ICU 3 (37%). In this study highest prevalence of ESBL producing Escherichia coli was observed in urine samples (62.5%) followed by pus samples (25%) and sputum 1 (12.5%). The most susceptible antibiotics to the ESBL producers of E .coli were piperacillin – tazobactam (100 % sensitive), followed by imipenem (62.5%), and cefoperazone- sulbactam (37.5%). Conclusion: This study highlights the prevalence of ESBL producing Escherichia coli in the ICUs of our hospital, and an in-depth analysis of their antibiogram will be helpful in formulating the antibiotic policy and prevent spread of ESBL strains. It is recommended that ESBL screening for all isolates, (Enterobacteriaceae family) for detecting antibiotic resistance and early institution of an appropriate antibiotic.

Background: Acute kidney injury (AKI) is becoming a major global health issue, especially in intensive care units (ICUs). This rise is largely due to factors like sepsis, heart failure, exposure to nephrotoxins, and hemodynamic instability. Having accurate data on how often AKI occurs is essential for effective management and policy-making. Method: In our study, we conducted a prospective observational analysis over 18 months, from June 2021 to November 2022, in a medical ICU. We included 700 adults aged between 18 and 75 years who had normal baseline creatinine levels, making sure to exclude anyone who had previously undergone renal replacement therapy (RRT) or had received a transplant. We defined and staged AKI using the RIFLE criteria. We analyzed data on demographics, comorbidities, risk factors (like vasopressor use and nephrotoxins), APACHE-II scores, and outcomes such as RRT, mortality, and length of stay using SPSS v21.0. Result: The occurrence of Acute Kidney Injury (AKI) was found to be 38% (n = 266 out of 700), broken down into stages as follows: Stage 1 (21.3%, n = 149), Stage 2 (8.6%, n = 60), and Stage 3 (8.1%, n = 57). Interestingly, the incidence of AKI was notably higher in females (43.9%) compared to males (33.8%, p = 0.02), particularly among patients aged 51 to 70 years. The leading causes of AKI were heart failure (42.5%) and sepsis (39.8%). Additionally, the use of vasopressors (24.6% of the cohort) was a strong predictor of severe AKI, with Stage 2/3 cases reaching 54.6% (p < 0.001). Renal Replacement Therapy (RRT) was necessary for 12.8% (n = 34) of AKI patients, mainly due to fluid overload (61.8%) and metabolic acidosis (38.2%). Mortality rates increased with the severity of AKI: Stage 1 had a mortality rate of 2.0%, Stage 2 was at 8.3%, and Stage 3 soared to 66.7% (p < 0.001). Patients with Stage 3 AKI also experienced longer ICU stays, exceeding 7 days in 70.2% of cases (p < 0.001). Conclusion: In conclusion, AKI impacts more than one-third of patients in medical ICUs, with heart failure and sepsis being the main culprits. The advanced stages of AKI are linked to vasopressor use, higher mortality rates, extended hospital stays, and the need for RRT, highlighting the critical importance of early detection and preventive measures.

Background: Infected non-union of the tibia is a complex orthopedic challenge, often resulting from high-energy trauma or failed internal fixation. The Ilizarov ring fixator offers the dual benefit of infection control and bone regeneration through distraction ontogenesis. Objective: To assess the functional and radiological outcomes of infected non-union of the tibia treated using the Ilizarov fixator. Methods: A prospective study was conducted on 40 patients (ages 20–60) with infected tibia non-unions between August 2022 and January 2024. All were treated with Ilizarov external fixation after debridement, with or without corticotomy. Outcomes were evaluated using ASAMI scoring and external fixation index (EFI). Results: Union was achieved in all patients. Functional outcomes were excellent in 18 (45%), good in 20 (50%), and fair in 2 (5%) cases. Bone results were excellent in 25 (63%), good in 13 (32%), and poor in 2 (5%). Complications included pin site infections (12.5%), joint stiffness (15%), and deep infection (7.5%). EFI was higher in smokers (2.6 months/cm) than in non-smokers (2.1 months/cm). Conclusion: Ilizarov fixation is effective in achieving union and functional restoration in infected tibia non-unions, especially when managed with proper debridement, fixation, and rehabilitation.

Background: A fertilized egg implants outside the uterus, specifically on the liver, in an uncommon and potentially fatal condition known as a hepatic ectopic pregnancy. These pregnancies are linked to a greater risk of bleeding during diagnosis or therapy because of the liver’s abundant blood supply. Case Report: A 30 years old multiparous female was referred to a private diagnostic centre for MRI whole abdomen with symptoms of recurrent right hypochondrial pain and vomiting for last 3 months. MRI was performed and reveal complete 12 week fetus attached to inferior surface of segment VI of right lobe of liver. The post-operative stay was uneventful and the patient was discharged on the 5^th post-operative day. Conclusion: MRI is a valuable tool for diagnosing ectopic pregnancies, including rare hepatic ectopic pregnancies, by visualizing the implantation site and assessing for complications like rupture.

Background: Ectopic pregnancy (EP), defined as implantation of a fertilized ovum outside the endometrial cavity, remains a significant cause of early pregnancy-related morbidity and mortality. Despite diagnostic and therapeutic advancements, its incidence is on the rise, particularly due to increased post-sterilization failures and the use of assisted reproductive techniques (ART). Aim of the study: Study of ectopic pregnancy regarding etiology, clinical features and operative findings and histopathology with special reference to the prevalence in post sterilization and assisted reproductive techniques. Methodology: A prospective observational study was conducted at S.V. Medical College’s Government Maternity Hospital, Tirupati, over one year, involving 69 patients diagnosed with EP. Detailed history, clinical examination, ultrasonography, and intraoperative findings were documented. Data were analyzed using SPSS v23.0. Results: Most patients were aged 26–30 years (65%), with 74% being multigravida. The commonest presenting symptoms were vaginal bleeding (83%) and abdominal pain (77%). Risk factors identified included post-tubectomy (24%), IUCD use (6%), and infertility (4%). The most frequent EP site was the fallopian tube (83%), predominantly ampullary (31%). Right-sided ectopic pregnancies were more common (64%). Ruptured EP was found in 88% of cases. Laparotomy was required in 74%, while methotrexate therapy had a 69.2% success rate in selected unruptured cases. Postoperative complications included anemia (84%) and need for blood transfusion (73%). One maternal death was reported. Conclusion: EP is a critical gynecological emergency requiring early diagnosis and prompt intervention to reduce morbidity and mortality. Increased awareness, timely ultrasound, and risk factor identification—especially post-sterilization and ART—are vital. Methotrexate is effective in early, stable cases, while surgery remains essential in most ruptured cases.

Background: Chronic urticaria (CU) is a persistent skin disorder characterized by recurrent wheals and/or angioedema lasting more than six weeks. The exact cause remains unclear, but immune dysregulation, infections, and stress are key contributors. CU affects approximately 1% of the population and can significantly impact quality of life. Methods: A cross-sectional observational study was conducted on 152 CU patients at the Department of Dermatology, Venereology, and Leprosy at a tertiary care centre in Assam. Data on demographics, triggers, comorbidities, and laboratory findings were analysed. Statistical analysis was performed using SPSS software. Results: 70% of patients were females, with the 30-50 years age group being most affected. Common triggers included stress (36%), food allergens (34%), and infections (31%). 13% of patients had autoimmune thyroid disease, and 19% had diabetes. 80% of cases responded well to antihistamines, while 15% required immunosuppressants. Conclusion: Chronic urticaria is multifactorial, requiring a systematic diagnostic and management approach. Identifying triggers, associated comorbidities, and optimizing antihistamine therapy are key to effective treatment.

Background: Chronic anal fissure is a common and distressing anorectal condition characterized by severe pain and bleeding during defecation. Lateral internal sphincterotomy (LIS) is widely regarded as the definitive surgical treatment, particularly in patient’s refractory to medical therapy. This study evaluates the outcomes and safety profile of LIS in a cohort of chronic anal fissure patients. Material and Methods: A prospective observational study was conducted on 72 patients diagnosed with chronic anal fissure at a tertiary care center. All patients underwent lateral internal sphincterotomy under appropriate anesthesia. Postoperative pain, wound healing, and complications were assessed at 1, 2, 4, and 8 weeks post-surgery. Patient satisfaction and recurrence were also recorded. Results: Among the 72 patients included in the study, the majority were male (63.9%) and between 31–45 years of age. Pain on defecation was reported by all participants, with bleeding per rectum (80.6%) and constipation (56.9%) being common associated symptoms. The most frequent fissure location was the posterior midline (87.5%). Closed technique of lateral internal sphincterotomy was performed in 90.3% of cases. A significant reduction in postoperative pain was observed, with mean VAS scores decreasing from 8.2 preoperatively to 3.5 at 1 week and 1.2 at 1 month (p < 0.001). By 4 weeks, 90.3% of patients achieved complete healing. Minor complications included wound infection (8.3%) and transient gas incontinence (5.6%), while the recurrence rate at 3 months was 2.8%. Conclusion: LIS is a safe, effective, and well-tolerated procedure for the management of chronic anal fissure, offering high healing rates and rapid symptom relief. With a low rate of recurrence and minimal complications, it continues to be the gold standard in surgical management for patients unresponsive to conservative therapy.

Background: Timely and accurate diagnosis of SARS-CoV-2 infection is essential for controlling the spread of COVID-19. While RT-PCR remains the gold standard, its limited availability and longer turnaround time in resource-limited settings have led to the use of alternative diagnostic methods such as Rapid Antigen Tests (RAT) and TRUENAT. This study aimed to evaluate and compare the diagnostic performance of RAT and TRUENAT against RT-PCR. Methods: A cross-sectional diagnostic evaluation study was conducted at Sub District Hospital, Khedbrahma, Gujarat, from 9 January 2020 to 2 February 2021. A total of 300 patients underwent testing using all three modalities: RT-PCR, RAT, and TRUENAT. Clinical and demographic data were collected. RT-PCR served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RAT and TRUENAT were calculated. Agreement with RT-PCR was assessed using Cohen’s Kappa, and ROC analysis was performed. Results: Among 300 patients, 40% were RT-PCR positive. RAT showed a sensitivity of 64%, specificity of 93%, PPV of 87%, and NPV of 77%. TRUENAT demonstrated superior performance with sensitivity of 84%, specificity of 98%, PPV of 97%, and NPV of 89%. The overall agreement with RT-PCR was moderate for RAT (κ = 0.61) and substantial for TRUENAT (κ = 0.82). The ROC analysis confirmed higher diagnostic accuracy for TRUENAT (AUC = 0.91) compared to RAT (AUC = 0.79). Conclusion: TRUENAT offers diagnostic performance comparable to RT-PCR and is a suitable alternative in secondary care and rural settings, especially where molecular infrastructure is limited. RAT may be useful for rapid screening, but confirmatory testing is necessary due to its lower sensitivity. Strategic deployment of TRUENAT can enhance early detection and strengthen COVID-19 diagnostic capacity in decentralized healthcare systems.

Background: The human brain undergoes many gross and microscopical changes with regression of brain tissue leading to enlargement of the ventricle as age advances; hence, sexual diamorphism of the ventricle is of paramount importance to understanding gender differences in normal individuals. Method: 45 male and 45 female adult volunteers were selected. The computed tomography (CT) was used to study the morphometric study of ventricles of the brain. Results: Comparison of metrical parameters like height of 4^th ventricle, width of 4th ventricle, length of right frontal horn of lateral ventricle and length of left frontal horn of lat ventricle and these parameters had a highly significant p-value (p<0.001). These values are confirmed by discriminate analysis of coefficient. Conclusion: The present study of gender differences in ventricles of the brain is useful for anatomists, medico-legal experts and anthropologists, above all neurophysicians, or neurosurgeon to distinguish normal physiological or anatomical ventricles from pathological ventricles.

Background: Chronic pain has become a common problem within healthcare system and can negatively impact patients’ lives. This study was done to assess clinical characteristics and presentations and explore the impact of chronic pain on patients’ quality of life (QoL) using quantitative data among chronic patients attending dedicated pain clinics in Eastern India. Methodology: A total of 143 patients suffering from chronic pain attending two dedicated pain clinics – one public (ESI Institute of Pain Management, ESI Hospital Sealdah, Kolkata) and one private Pain Clinic, Ultadanga, Kolkata; and one public routine health care facility (Department of Orthopedics & Physical Medicine & Rehabilitation, Medical College & Hospital, Kolkata), were initially recruited in the study after they fulfilled the study selection criteria and gave written informed consent. To assess the impact of chronic pain on QoL, the interviewer read out a list of activities [Brief Pain Inventory Short Form (BPI-SF) and the American Chronic Pain Association Quality of Life Scale] and asked the participants or respondents to rate their ability to do the activities on a 11 point scale (0- does not interfere and 10- completely interferes). This questionnaire was exercised on participants on Day 0 and at 3^rd follow-up visit. Out of these, 124 patients completed the prospective observational study after taking IEC approval. Quantitative data are presented as mean ± standard deviation, while qualitative data are demonstrated as frequency and percent. Results: The male and female gender distribution was almost equivalent in group 2 and group 3 but different in group 1 (80% male and 20% female). Most of participants mentioned that low back pain [group 1 (50%), group 2 (42.5%) and group 3 (55%)], arthritis [group 1 (7.5%), group 2 (15%) and group 3 (5%)] and neuropathy [group 1 (10%), group 2 (2.5%) and group 3 (12.5%)] were the main causes of chronic pain among all categories. Disc problems were the most common reason for chronic pain, almost identical in all three groups. Pain affected the daily general activities (4.25±1.13); walking ability (2.92±1.47); and enjoyment of life (6.37±1.11) of the respondents at baseline more in case of group 3 patients. Pain affected the mood (5.85±1.35) and Normal work (3.72±1.26) more in group 2; in comparison to relation with other people (3.6± 1.13) and Sleep (4.05± 1.51) in group 1. There was significant increase (p< 0.0001) in QoL scale score 3^rd follow-up visit in all three groups, which was much more appreciable on group 3 patients (7.72 ± 0.16). Conclusion: This study provides insight into the association between pain and the quality of life among adults aged (18-75 yrs), calling for greater attention to the effectiveness of pain management via dedicated pain clinics. This study shows that chronic pain patients in India had experienced pain and it is negatively associated with quality of life.

Introduction: Vulvovaginal candidiasis (VVC) is a common fungal infection seen in women of reproductive age group. The rise of non-albicans Candida (NAC) species and antifungal resistance necessitates species-level diagnosis and targeted therapy. Objectives: To determine the prevalence, species distribution, risk factors, and antifungal susceptibility patterns of VVC among women in Bareilly, Uttar Pradesh. Methods: A cross-sectional study was conducted from January 2023 to December 2024 on 218 symptomatic women. High vaginal swabs were collected and cultured on Sabouraud Dextrose Agar and CHROMagar. Candida species were identified and tested for antifungal susceptibility. Results: Of the 218 women, 112 (51.4%) were culture-positive. Candida albicans was the most common isolate 96 (85.7%), followed by C. glabrata 8 (7.1%) and other NAC species. Major risk factors included rural habitation 86 (76.8%), recent antibiotic use 50 (44.6%), and oral contraceptive use 36 (32.1%). Fluconazole resistance was noted in 8.3% of C. albicans and 50% of C. glabrata isolates, while voriconazole showed high efficacy across all species. Conclusion: The high prevalence of VVC and increasing NAC resistance highlight the need for routine species identification and antifungal testing to improve treatment outcomes and reduce the incidence of antifungal resistance.

Introduction: Distal third femur shaft fractures are associated with significant morbidity and can lead to long-term functional impairment if not managed properly. The choice of surgical fixation is crucial for achieving optimal outcomes. Antegrade intramedullary nailing (AIN) and locked plating (LP) are two commonly employed methods, each with distinct advantages and challenges. While AIN is known for its minimally invasive approach and intramedullary support, LP offers enhanced stability for fractures with complex patterns. This study aims to compare the functional outcomes of AIN versus LP in treating distal third femur shaft fractures to determine which technique yields better results in terms of recovery and complications. Methodology: The study was conducted in patients treated for distal third femur shaft fracture (type A – AO classification) at Adhichunchangiri Institute of Medical Science, BG Nagar from the month of MAY 2023 to MAY 2025. About Thirty such cases were allocated alternatively into two groups i.e., Antegrade intramedullary nailing (AIN) and locked plating (LP). The functional outcome of the management of fracture was assessed based on Neer’s criteria where the Patient’s age ranged from 18 to 80 years with a mean of 48.27. Results: Majority of the study participants were males, and the mean age was around 39.86 years and 49.6 years in AIN and DF-LCP group respectively. The causes of fractures were motor vehicle accident in 19 patients, fall from height in 06 patients and 5(16.66) had slip and fall from standing height. There were no sports or industrial accidents. 15 fractures involved the right side and 15 involved the left .Duration of hospital stay was 9.8 and 13.26 days in AIN and DF-LCP group respectively. Mean time for union was 20 weeks The Mean hospital stay for managing distal third fractures of the femoral shaft was 9.8 days for the AIN group, which is shorter when compared to 17.80 days for the DFLCP group .The mean duration for clinical union of fractures in the intramedullary nailing (AIN) group was 19.93 weeks, significantly shorter than the 25 weeks observed in the distal femoral locking compression plate (DFLCP) group Overall, nailing demonstrated better outcomes in terms of avoiding persistent pain, shortening, stiffness, and superficial infections when compared to DFLCP for the treatment of distal femur fractures while the AIN group showed only 3 superficial infections. Patients were followed up over a duration of 1 to 24 months. According to Neer’s Criteria, the outcome was excellent in majority in the AIN group ie 80 % of EXCELLENT OUTCOME while GROUP DFLCP showed mixed results with only 40% of EXCELLENT OUTCOME followed by GOOD OUTCOME of 26.66%, fair OUTCOME of 26.66% and poor outcome of 6.66%, only in the group DFLCP implying a better overall functional outcome in the AIN group. Conclusion: The AIN group outperformed the DF-LCP group in this study by achieving clinical union of the fractured bone in a shorter time frame and reducing the length of hospital stay. Furthermore, the AIN group achieved excellent outcomes in a higher proportion compared to the DF-LCP group. Also complications were minimal for group AIN, thus AIN group demonstrated a greater safety profile than DF-LCP.

Background: Biapenem is a parenteral, broad-spectrum carbapenem antibiotic effective against a wide range of Gram-positive, Gram-negative, and anaerobic bacteria. Structurally related to imipenem and meropenem, biapenem offers distinct advantages in terms of β-lactamase stability and reduced neurotoxicity. Methods: All isolates of Acinetobacter baumanni, Pseudomonasspp., Escherichia coli,Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas putida, Pseudomonas aeruginosa, and Acinetobacter spp. ,isolated from the Blood, Body fluids, Endotracheal secretions , Pus, Sputum , and urine were included in the study. Only one isolate per patient was included in the study for the different antibiotics. Results: A total of 95 isolates were collected, with Escherichia coli (n = 42, 44.2%) being the most frequently isolated organism. Samples were obtained predominantly from blood (n = 32), indicating a focus on systemic and nosocomial infections. The majority of samples were received from the Emergency Department (EMG, n = 8), suggesting that critical care and emergency services are primary sites of infection with resistant organisms. Biapenem showed a high sensitivity rate compared to other beta-lactams among 95 isolates tested. Conclusion: Biapenem remains a valuable option in the treatment of serious bacterial infections, particularly in regions with high rates of resistance to other β-lactams.

Background: Femoral shaft fractures are among the most common major injuries in the pediatric population. Treatment modalities vary based on age, fracture pattern, and available resources. This study aims to evaluate and compare the outcomes of conservative and surgical approaches in managing pediatric femoral shaft fractures. Materials & Methods: This prospective comparative study was carried out in the Department of Orthopaedics at the College of Medicine and JNM Hospital over a period from January 2024 to January 2025, following approval from the Institutional Ethics Committee. A total of 100 pediatric patients, aged between 2 and 14 years, presenting with unilateral, closed femoral shaft fractures were enrolled in the study. Results: This study included 100 pediatric patients with femoral shaft fractures, equally divided into conservative (Group A) and surgical (Group B) treatment groups. The surgical group had a significantly higher mean age and was more commonly injured in road traffic accidents, whereas falls from height were more frequent in the conservative group. Transverse fractures were more prevalent in the conservative group, while oblique/spiral fractures were significantly more common in the surgical group. The mean fracture union time was significantly shorter in the surgical group. Limb length discrepancy and malunion were significantly more frequent in the conservative group, whereas postoperative complications like infection and reoperation occurred only in the surgical group but were not statistically significant. Functional outcomes favored the surgical group, with significantly more patients achieving excellent results per Flynn’s Criteria. Conclusion: This study found that surgical management of pediatric femoral shaft fractures led to faster healing, fewer complications, and better functional outcomes compared to conservative treatment, especially in older children and severe injury cases. While conservative treatment remains suitable in selected situations, surgical intervention generally offers improved recovery, emphasizing the need for individualized treatment based on age, fracture type, and injury mechanism.

Background: Urinary stone disease is not very common in pregnancy but when it occurs, it can cause significant complications for both mother and fetus. Diagnosing and treating stones during pregnancy is challenging because of limited imaging options and concern for fetal safety. This study was aimed to assess the prevalence of urinary stones in pregnant women presenting with flank pain or urinary symptoms and to evaluate the associated maternal and fetal complications. Material and Methods: This prospective observational study was conducted in the Urology department of a tertiary care hospital over a period of 18 months. A total of 500 pregnant women were included who presented with symptoms suggestive of urinary tract involvement. Patients were evaluated using urine examination, renal function tests, and ultrasonography. Confirmed cases of urinary calculi were followed throughout pregnancy to monitor complications. Results: Out of 500 women, 38 were diagnosed with urinary stones, giving a prevalence of 7.6%. Most common age group affected was 25–30 years. Flank pain and dysuria were the most frequent complaints. Stones were mostly located in ureter, followed by renal pelvis. Right side was more commonly involved. Common complications included urinary tract infection (UTI), preterm labor, hydronephrosis, and in some cases, hospital admission for pain management. Conclusion: This study highlights that though urinary stones are not frequent in pregnancy, they should be considered in differential diagnosis of abdominal pain. Timely diagnosis using safe modalities like ultrasound and conservative management are key to reduce maternal and fetal complications.

Background: Inguinal hernia is a very common surgical problem worldwide. It affects males more than females and mostly seen in elderly age group, although younger people also get affected. The purpose of this study was to study the clinical profile of patients presenting with inguinal hernia in a tertiary care hospital and to know about common symptoms, risk factors, and types of hernia. This was a prospective observational study conducted over one year duration at the Department of General Surgery, involving 100 patients who presented with inguinal swelling. Material and Methods: Majority of patients were males and belong to age group of 40-60 years. Most common symptom was painless swelling in groin region. Some patients had history of heavyness, pain during walking or lifting heavy weights. Right-sided hernia was more common than left-sided. Direct hernia were common in elderly patients and indirect hernia were seen more in younger males. Few patients had bilateral hernia. Risk factors identified included chronic cough, constipation, heavy lifting, smoking, and family history of hernia. Results: Surgical repair was done for most of the patients with Lichtenstein mesh hernioplasty being the most common technique. Most patients had uneventful recovery. Few cases had minor complications like seroma and superficial wound infection. Conclusion: This study concludes that inguinal hernia is common surgical issue and most patients can be diagnosed clinically. Awareness of risk factors and early diagnosis can help in reducing complication and improve outcomes. Education of patients and timely surgical intervention is important to prevent complications like strangulation or obstruction.

Introduction: Chronic obstructive pulmonary disease (COPD) is a common and gradually worsening lung condition that demands prompt diagnosis and proper treatment. Identifying and addressing the disease in its early stages is essential to avoid complications, ultimately lowering both illness and death rates. Aim and Objective: To evaluate the effectiveness of PUMA (Prevalence Study and Regular Practise, Diagnosis, and Treatment among General Practitioners in Populations at Risk of COPD in Latin America) and Capture (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk) questionnaires as screening tools in COPD diagnosis. Materials and Methods: A cross sectional study was carried out in 150 patients with age>/=40 years and at risk of COPD (Current or former smokers and/or history of biomass exposure) from May 2025 to July 2025 in a tertiary care centre, Kurnool. To collect the responses to PUMA and CAPTURE questionnaires, face to face interviews were conducted, followed by a spirometry test. COPD was defined as post bronchodilator FeV1/FVC<0.70.Statistical analysis was done and the results were reviewed. Results: Out of 150 subjects, majority were males (84%) and smokers for 20-30 years (48%) with heavy intensity (46%).Spirometry tests revealed obstructive pattern in 105 subjects (70%) with 38 subjects classified as severe obstruction. At a cut off score of >=6,PUMA questionnaire yielded Sensitivity 71.4%,Specificity 75.6%,PPV 87.2% and NPV 53.1%.CAPTURE questionnaire with a cut off score >=4 yielded Sensitivity 64.8%,Specificity 73.3%,PPV 85.0% and NPV 47.1%.AUC was higher for PUMA (0.73) than for CAPTURE (0.69). Conclusion: These results imply that PUMA questionnaire may be a more effective tool for COPD screening compared to CAPTURE questionnaire, but needs confirmation of diagnosis with spirometry.

Background and Objectives: Platelet-Rich Fibrin (PRF), a second-generation platelet concentrate, has demonstrated regenerative potential in various surgical specialties. This study aimed to evaluate the efficacy of PRF in Type I tympanoplasty among patients with inactive mucosal chronic otitis media (COM), specifically in terms of graft uptake and hearing improvement. Materials and Methods: This was a prospective, randomized, comparative study conducted on 60 patients aged 15–60 years with inactive mucosal COM and central pars tensa perforation. Patients were randomly assigned to two groups: Group 1 underwent tympanoplasty with PRF application (n = 30), while Group 2 underwent tympanoplasty without PRF (n = 30). PRF was prepared intraoperatively by centrifuging autologous blood and applied over the temporalis fascia graft. Preoperative and postoperative assessments included pure tone audiometry and otoscopic evaluation at 1, 2, and 3 months. Results: Graft uptake was significantly higher in the PRF group (96.6%) compared to the control group (73.3%) (p = 0.026). Hearing improvement was also greater in the PRF group, with a mean AB gap improvement of 22.77 ± 6.14 dB versus 17.17 ± 10.07 dB in the control group (p = 0.012). No adverse effects were observed. The type of perforation, patient age, and gender did not significantly affect outcomes. Conclusion: PRF significantly enhances tympanic membrane healing and hearing outcomes in Type I tympanoplasty. It is a safe, cost-effective, autologous biomaterial that offers superior graft uptake without complications, making it a promising adjunct in otologic surgery.

Salivary gland tumours comprise less than 5 % of head and neck tumours. Mucoepidermoid carcinomas are the most common malignant tumour of salivary gland primarily seen in parotids in 45 percent of cases.
It is generally found in fifth or sixth decade of life, is rare in young adults and even rarer in paediatric age group. Here we report the rarest of rare case of mucoepidermoid carcinoma in a 5-year –old child who presented with an asymptomatic mass on the right cheek. Patient underwent Right sided parotidectomy followed by local radiotherapy by 2-D technique to a dose of 50GY/25#/5weeks. Patient is asymptomatic and doing well after two years of post-operative radiotherapy.

Background: To study the clinico-pathological of patients with breast cancer attending the Tertiary Heath care Institute in South India (GSL Medical College at Rajamahendravaram), according to the AJCC 8^th edition. Methods: A hospital based retrospective study amongst patients with breast cancer treated at a Medical Oncology Department of GSL Medical college and Hospital, Rajahmundry, Andhra Pradesh from 1^st April 2021 to 30^th June 2022. Results: The mean age of the patients was 51.2±11.7 (25-76) years and the mean duration of illness was 16.2±33.8 months. The median follow-up was 49 months (range, 13–68 months). If we look at menopausal status, 110 (33.3%) patients were premenopausal, 75 perimenopausal (22.7%) and 112(33.9%) were postmenopausal. Among the postmenopausal patients,33 (10.1%) patients have got surgical menopause. Mean LVEF 59.3±7.6 (45%-68.6%) among participating study group patients. HBsAg positivity rate was 0.9% (3 patients). HCV positivity rate was 1.5% (5 patients) HIV positivity was seen 1.2% (4 patients). Conclusion: The most common age group was 51-60 years age group female and are postmenopausal. Most present in advance stages due to lack of screening activites and social taboos of reporting late. Most Have hoemone positive disease approx. 80%., least number are triple negative which is highely aggressive.

Background: (PXF) is a systemic, age-related condition marked by aberrant extracellular fibrillar accumulation in ocular tissues. It is correlated with heightened risk during cataract surgery and secondary glaucoma. (DM) may influence PXF development through microvascular and extracellular matrix alterations. Aim: To determine the Incidence of pseudoexfoliation syndrome among diabetic patients with senile cataract and assess its correlation with demographic and diabetic variables. Methods: A cross-sectional observational study was conducted at Mata Gujri Memorial Medical College and L.S.K. Hospital, Kishanganj, Bihar, over 12 months. Two hundred consecutive type 2 diabetic patients aged ≥50 years with senile cataract were enrolled. Slit-lamp biomicroscopy and Goldmann applanation tonometry were performed to detect PXF. Patient age, sex, duration of diabetes, and ocular findings were recorded. Data were analyzed using SPSS v23.0. Descriptive statistics summarized patient characteristics and PXF Incidence. Chi-square tests evaluated correlations, with p < 0.05 denoting significance. Results: Of 200 patients (mean age 66.4 ± 7.8 years; 59% male), PXF was detected in 34 (17%). Incidence increased significantly with age (p = 0.001), rising from 6.5% in ages 50–60 to 83.3% in those >80 years. No significant gender difference was observed (18.6% males vs. 14.6% females; p = 0.42). PXF was more frequent in patients with longer diabetes duration: 8.8% (<5 years), 16.3% (5–10 years), and 30.4% (>10 years) (p = 0.007). Conclusion: PXF is common (17%) in diabetic patients with senile cataract, with Incidence significantly influenced by advancing age and longer duration of diabetes. Gender did not affect Incidence. Recommendations: Preoperative slit-lamp screening for PXF in elderly diabetic cataract patients, particularly those with diabetes duration >10 years, is vital. Awareness among ophthalmologists on the risk factors and intraoperative strategies for managing PXF can reduce surgical complications.

Background: The relationship between high myopia and progressive anatomical alterations in the retina and optic nerve head, which frequently result in irreversible visual impairment, is becoming more well acknowledged. High-resolution imaging of the retinal layers is made possible by optical coherence tomography (OCT), which makes it possible to identify these alterations early. It can be difficult to interpret OCT values in high myopia eyes, nevertheless, because of structural abnormalities that frequently resemble glaucomatous patterns. Aim: To evaluate the established OCT parameters—retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and ganglion cell complex (GCC)—in high myopic individuals and to correlate these values with the severity of myopia. Methods: Over the course of a year, Mata Gujri Memorial Medical College and L.S.K. Hospital in Kishanganj, Bihar, hosted this prospective observational study. A total of 160 patients between the ages of 18 and 60 who had high myopia (spherical equivalent ≥ −6.00 D) were included. To measure RNFL, GCIPL, and GCC thickness, each subject had a thorough ocular examination and spectral-domain OCT. SPSS version 23.0 was used for statistical analysis, and Pearson’s correlation test was used to evaluate correlation with refractive error. Results: The mean RNFL thickness was 81.3 ± 7.4 µm, GCIPL was 66.7 ± 5.2 µm, and GCC was 85.9 ± 6.8 µm—all significantly lower than normal reference values. A moderate negative correlation was found between the degree of myopia and OCT parameters (RNFL: r = -0.472; GCIPL: r = -0.396; GCC: r = -0.438; p < 0.001). Participants with higher myopia (≥ -8.00 D) had significantly thinner retinal layers than those with moderate high myopia (-6.00 to -7.99 D). Conclusion: High myopia is associated with significant thinning of RNFL, GCIPL, and GCC, with a strong correlation to increasing refractive error. These changes may mimic early glaucomatous damage and should be interpreted cautiously. Recommendations: Routine OCT evaluation of inner retinal layers should be incorporated into the assessment of high myopic patients. Establishing myopia-specific normative databases is essential to improve diagnostic accuracy and avoid misdiagnosis, particularly in differentiating high myopia from early glaucoma.

Pure primary ovarian squamous cell carcinoma (oSCC) is very rare, with about 42 cases have been reported in the literature. De novo occurrence of the pure SCC in absence of a prior lesion is the rarest type, and it arises from the metaplasia of the surface epithelium of the ovary. Because of its rarity, a definitive treatment protocol for treatment is not yet available. We report a case of Squamous Cell Ovarian Carcinoma which was managed at our institute (Dr Rajendra Prasad Govt. Medical College) with Surgery and Chemotherapy.

Background: Seizures are a common pediatric neurological emergency, particularly in children aged 3 months to 5 years. Timely diagnosis and identification of underlying causes are essential for appropriate management and prognosis. Objectives: To assess the clinical, demographic, and etiological profile of seizures in preschool-aged children admitted to a tertiary care hospital. Methodology: This hospital-based prospective observational study was conducted at the Department of Pediatrics, Pacific Institute of Medical Sciences (PIMS), Umarda, Udaipur, over 12 months. A total of 116 children aged 3–60 months presenting with seizures were included after informed consent. Data collected included demographic variables, nutritional status, clinical presentation, type of seizure, laboratory findings (hematology, electrolytes, glucose), cerebrospinal fluid (CSF) analysis, electroencephalogram (EEG), and neuroimaging (CT/MRI). Data were analyzed using SPSS 2022. Results: Of the 116 children, 68 (58.6%) were males. Most participants were in the 13–36 months’ age group (50%). Febrile seizures were the predominant etiology (53.4%), followed by epilepsy, CNS infections, and metabolic causes. Generalized tonic-clonic seizures were the most frequent type (64.7%). Fever was present in 72.4% of children. Upper respiratory tract infection (URTI) was the most common febrile illness. Developmental delay was seen in 15.5% of cases. Anemia was noted in over 50% of patients, and electrolyte disturbances in 5.2%. Abnormal EEG findings were present in a significant subset, while neuroimaging revealed abnormalities in children with complex, focal, or refractory seizures. Conclusion: Febrile seizures remain the leading cause of seizures in preschool children, particularly in the 13–36 months age group. A multidisciplinary approach, including thorough clinical examination and judicious use of laboratory and imaging modalities, enhances diagnostic accuracy. Public health measures targeting improved nutrition, early detection of infections, and parental education may reduce seizure burden and associated morbidity in this vulnerable population.

Background: Chronic alcohol consumption has been associated with multiple hematological alterations due to its direct toxic effects on bone marrow, nutritional deficiencies, and altered iron metabolism. These changes may serve as important indicators for early detection of alcohol-related systemic damage. This study aimed to evaluate variations in hematological indices among individuals with a history of chronic alcohol intake. Materials and Methods: A hospital-based observational study was conducted on 120 participants, comprising 80 chronic alcoholic individuals (≥5 years of regular alcohol consumption) and 40 age- and sex-matched healthy controls. Complete blood counts were performed using an automated hematology analyzer. Parameters assessed included hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), total leukocyte count (TLC), and platelet count. Statistical analysis was performed using Student’s t-test, with p<0.05 considered significant. Results: Chronic alcoholic individuals showed significantly lower mean Hb levels (12.1 ± 1.8 g/dL) compared to controls (14.2 ± 1.4 g/dL, p<0.001). MCV was notably elevated in alcoholics (98.5 ± 6.2 fL) versus controls (88.4 ± 5.7 fL, p<0.001). Platelet counts were reduced in the alcoholic group (165 ± 45 × 10³/µL) compared to controls (232 ± 51 × 10³/µL, p<0.001). No significant difference was observed in TLC between groups (p=0.08). Macrocytosis was present in 46.3% of alcoholics, whereas only 5% of controls exhibited similar findings. Conclusion: Chronic alcohol consumption is associated with significant alterations in hematological parameters, particularly anemia, macrocytosis, and thrombocytopenia. Routine hematological evaluation can aid in early diagnosis and management of alcohol-related systemic effects.

Introduction: Laparoscopic procedures often induce significant physiological changes due to carbon dioxide (CO₂) pneumoperitoneum and patient positioning, impacting cardiovascular stability. Dexmedetomidine, a selective alpha (α) 2 agonist, offers sedation and analgesia with minimal respiratory depression, presenting a potential advantage for managing such procedures. This study was conducted to assess the haemodynamic effects of dexmedetomidine in patients undergoing laparoscopic hysterectomy. Objectives included evaluating changes in key haemodynamic parameters, including heart rate and blood pressure, analyzing factors such as sedation levels and postoperative pain management and assessing postoperative outcomes including complications, analgesic requirements, and overall patient recovery. Materials and Methods: This observational study was conducted at Apollo Hospitals, Guwahati, from September 2019 to August 2020. A total of 56 patients aged 35-60 years, classified as ASA 1 and 2, were divided into two groups: Group A (dexmedetomidine) and Group B (normal saline). Group A was administered dexmedetomidine at a dose of 0.5 mcg/kg over 15 minutes, followed by a continuous infusion of 0.3 mcg/kg/h, while Group B received normal saline as a control. Standard general anaesthesia was administered, and intraoperative haemodynamic variables were monitored at defined intervals. Results: Group A demonstrated significantly better regulation of heart rate and blood pressure (p < 0.05). Additionally, the incidence of postoperative nausea and vomiting was lower in patients who received dexmedetomidine. Group A exhibited higher sedation scores, consistent with previous research highlighting dexmedetomidine’s sedative efficacy without significantly prolonging recovery. Additionally, the need for fentanyl rescue doses was notably lower in Group A than in Group B, suggesting superior analgesic effectiveness. Conclusion: Dexmedetomidine administration provides superior haemodynamic stability and reduces postoperative analgesic needs, making it a valuable adjunct for laparoscopic procedures.

Background: Dengue is one of the most common vector born cause of acute viral illness with considerable morbidity & mortality. Recently, there is a rise of dengue in India. This study was undertaken to evaluate the clinical profile and laboratory findings during the evolution of dengue fever. Methods: A total of 61 patients of dengue fever who were NS1 antigen or IgM dengue positive, admitted to medicine wards of Agartala Government Medical College & GBP Hospital, included in the study. Thorough clinical examination and relevant laboratory investigations performed in all patients. Results: Males were commonly affected (68.3%). Fever was the most common presentation (100%), followed by myalgia (98.4%), headache (96.7%), melena (8.2%), and epistaxis (4.9%) diarrhea (8.2%). Malena was the most common hemorrhagic manifestation followed by epistaxis. Laboratory findings include varying degree of thrombocytopenia in most of the patients (68.2%), leukocytopenia (78.2%), and increased hematocrit (82%) and deranged liver function test- AST (78.7%) and ALT (90.2%). Conclusions: Early community level awareness and vector control measures need to be strengthened during the peri-monsoon period to reduce the burden of dengue cases. Young adults, particularly males, are most affected by dengue. Accurate and timely serological testing and regular monitoring of laboratory parameters are crucial for early diagnosis and effective management. So, community based studies for early diagnosis, treatment and to predict the pace of dengue spread based on clinical presentation and laboratory findings during endemics is necessary and these findings guide better management strategies and public health interventions in dengue-endemic regions.

Introduction: The Pediatric Intensive Care Unit (PICU) plays a pivotal role in reducing childhood mortality by providing critical care to severely ill children. Despite global efforts to reduce under-five mortality, regional disparities in PICU outcomes persist, especially in resource-limited settings. This study aimed to assess the clinical spectrum, risk factors, and outcomes among children admitted to a newly established PICU in a government medical college in India. Methods: A cross-sectional study was conducted over two months in the PICU of Siddhartha Medical College, Vijayawada. Children aged 1 to 12 years admitted during the study period were included, excluding those with congenital anomalies, malignancies, early discharge (<24 hours), or LAMA. Data on demographics, clinical features, investigations, treatment, and outcomes were collected using a structured questionnaire. Statistical analysis was performed using SPSS. Results: Of the 280 admissions, 258 (92.1%) children survived, and 22 (7.9%) died. CNS infections (36.4%), seizures (90.9%), altered sensorium (90.9%), status epilepticus (86.4%), and raised intracranial pressure (95.5%) were significantly associated with mortality (p < 0.0001). Complications like ARDS (50%), MODS (31.8%), and AKI (9.1%) were more common among non-survivors. Mortality was significantly associated with mechanical ventilation (90.9%) and inotrope use (86.4%) (p < 0.0001). No significant associations were found between mortality and age, gender, or length of hospital stay. Conclusion: The study highlights that while common symptoms like fever and respiratory distress were frequent, severe neurological manifestations and systemic complications were strongly linked to poor outcomes. Early recognition and aggressive management of high-risk clinical features such as CNS involvement, multi-organ dysfunction, and the need for intensive support (e.g., ventilation) are crucial in improving survival in PICU settings.

Introduction: The Sequential Organ Failure Assessment score is extensively used in intensive care units to measure organ disfunction and predict patient consequences. Initial documentation of organ failure is critical in supervisory treatment methods and refining existence charges. This study aims to assess the efficacy of the SOFA score in determining organ disfunction and its association with patient prediction in ICU surroundings. Methods: A prospective observational study was shown on patients admitted to the ICU. SOFA scores were planned at admission and checked during the ICU stay. Clinical and laboratory parameters were recorded, and patient consequences, including death and distance of ICU stay, were analysed. Statistical analysis was completed to measure the correlation between SOFA scores and patient prediction. Results: A significant association was found between higher SOFA scores and increased ICU mortality. Patients with determinedly raised SOFA scores had worse consequences, whereas those with deteriorating scores showed better regaining rates. The study approves that the SOFA score is a dependable predictor of organ disfunction and patient prognosis in ICU surroundings. Conclusion: The SOFA score is an operative tool for measuring organ disfunction and predicting patient consequences. Regular monitoring of SOFA scores can assistance in clinical decision-making and resource distribution in ICU organisation.

Objective: Antimicrobial resistance is rising at an alarming speed. Data regarding cost variation among alternate antibiotic regimens for an infection are lacking. We aimed at studying cost variation among common acute outpatient infections seen in Indian settings. Material and methods: A cross-sectional study was undertaken using data from secondary sources. Four common acute uncomplicated infections such as acute otitis media, enteric fever, and community acquired pneumonia and urinary tract infection were chosen. Standard treatment regimens were drawn from the “ICMR treatment guidelines for antimicrobial use” and/or other similar evidence-based texts. Unit prices of antimicrobial agents were drawn from widely trusted commercial drug directory i.e. CIMS. Median costs per treatment course were calculated using all alternate antibiotic regimens for the studied infections. Cost variation was calculated and presented as both the absolute differences as well as percentage cost variation. Results: Our analysis revealed substantial cost variations. Percent cost variation ranged from as low as 12% in community acquired pneumonia to as high as 23051% variation in case of urinary tract infections. Conclusion: The study generates data regarding the cost implications of alternate treatment regimens for commonest infections seen in outpatient departments in India. Results indicate urgent need to incorporate economic evaluations of alternate regimens in the standard treatment guidelines.

Introduction: Blunt trauma abdomen is a common entity encountered by surgeons in OPD and emergency, caused mainly due to road traffic accidents, accidental falls, assaults and accounts for a large number of trauma related injuries and deaths. It is one of the leading preventable causes of unnatural deaths in developed and developing countries. It occurs when the abdomen is injured by a force without the skin being pierced, but can damage internal organs, leading to internal bleeding, contusions, and even organ rupture. Because of the spleen’s location and its fragility, it is the commonest solid organ injured in cases of blunt trauma abdomen. Our Institute being a tertiary referral centre receives cases of blunt trauma abdomen with splenic injuries for its management, the present study tries to address some aspects in the evaluation and management of patients with splenic injury following blunt trauma. In response to any physiological challenges following Splenic injuries the treatment approaches vary and range from non-operative management for stable patients to surgical intervention, including splenectomy, for those who are unstable. The response to any physiological challenge takes precedence; always the optimal treatment strategy however should consider the hemodynamic status, the anatomic derangement and associated injuries. The management of splenic trauma aims to restore the hemostasis and the normal patho-physiology especially considering the available modern tools in managing bleeding. Methods: A prospective study on patients with blunt trauma abdomen associated with splenic injuries was conducted in the Post Graduate Department of General Surgery, MKCG Medical College, Berhampur, spanning from May 2023 to Feb 2025, with an aim to evaluate and compare the various management strategies of splenic trauma. Observations: Splenic trauma was responsible for 26.67% of all abdominal trauma cases with the majority [88.89%] of cases associated with blunt trauma abdomen, road traffic accidents attributed to more than 50% of the cases. Majority of cases presented in 3rd decade of life, with a male preponderance. [Ratio of 1.6:1]. Fall in heamatocrit value was observed in 80% of cases. Associated injuries [35 cases out of 40 cases] were seen in majority of cases, showing that splenic injuries in isolation is seldom seen. Most of the cases belong to Grade III (15 cases) and Grade II (11 cases) severity. None of the cases were of Grade V severity. For Grade 1 injuries and some of Grade II injuries a non-operative approach was adopted while all Grade III and Grade IV injuries were managed by splenectomy. CT scan has the 100% accuracy rate in diagnosing the cases of splenic injury. Wound infection, atelectasis, pneumonia and systemic sepsis were the morbidities associated with post-operative complications. Conclusion: Non-operative treatment can be effective for patients with isolated splenic injuries caused by blunt abdominal trauma, especially when they are hemodynamically stable. This approach is feasible in centers with adequate monitoring capabilities and access to emergency surgical intervention if necessary. Non-operative management is most suitable when the patient’s condition is stable, there are minimal associated injuries, and the spleen’s injury grade is low. In cases where splenic preservation is possible, techniques such as splenorrhaphy, partial splenectomy, or even splenic transplantation can be considered, all of which help maintain spleen function. In comparing splenorrhaphy and splenectomy, splenorrhaphy in young adults with hemodynamic stability and grade II injuries yielded excellent results, with lesser blood transfusions and shorter hospital stays, and the need for re-exploration and rebleeding was minimal. Post-operative complications and mortality rates were also low, and these patients had better immunity than in patients who underwent splenectomy. Splenectomy remains helpful for patients who are hemodynamically unstable, have multiple traumatic injuries, suffer from severe peritoneal contamination due to bowel and associated organ injuries and experienced higher post-operative morbidity and mortality. There was an increased risk of respiratory infections, as well as a long-term risk of sepsis. Auto transplantation in two cases showed a potential reduction in sepsis risk but did not eliminate it entirely.

Background: Interventional cytopathology procedures, such as fine-needle aspiration cytology (FNAC), are important diagnostic tools in current modern pathology. While their clinical accuracy is well established, limited data exist on patient-reported satisfaction and experience in cytopathologist-led clinics. Understanding patient perspectives can inform targeted improvements in care delivery. Objectives: To evaluate patient-informed experiences in an interventional cytopathology clinic and identify key factors contributing to satisfaction, with the goal of developing strategies to enhance procedural quality and patient-centered care. Material and Methods: A prospective, cross-sectional, observational study was conducted over a 6-month period at a tertiary care interventional cytopathology unit. Patients undergoing FNAC or image-guided aspirations were invited to complete a structured, bilingual (Gujarati and English) 30-item questionnaire assessing domains such as pre-procedure communication, procedural comfort, staff interaction, wait time, and post-procedure follow-up. Responses were collected anonymously and analysed using descriptive statistics and thematic analysis. Results: Of the 200 patients surveyed (mean age 48.2 ± 13.6 years; 58% female), 93.3% reported high overall satisfaction. Domains with the highest positive responses included communication clarity (94.8%), procedural explanation (91.2%), and respectful staff behaviour (96.1%). The most common concern was prolonged waiting time, reported by 7% of respondents. Thematic analysis revealed that reduced anxiety, confidence in the provider, and a calm clinic environment were central to a positive experience. Conclusion: Patient-centered strategies such as clear communication, empathetic engagement, and timely care significantly enhance satisfaction in interventional cytopathology. On site feedback systems, improved pre-procedure counseling, and staff training in soft skills are recommended to further optimize care quality.

Background: Acute Respiratory Infections (ARIs) are a leading cause of morbidity and mortality in children under five, particularly in low- and middle-income countries. In India, ARIs contribute significantly to pediatric outpatient visits and hospital admissions. Children below five years are more vulnerable due to factors like malnutrition, incomplete immunization, and inadequate breastfeeding. Despite the burden, region-specific data on ARI patterns and associated risk factors remain limited. This study was conducted to analyze the clinical pattern, seasonal distribution, risk factors, and outcomes of ARIs among hospitalized under-five children in a tertiary care setting. Material and Methods: This was a prospective observational study conducted over six months in the Pediatrics Department of a tertiary care teaching hospital in India. A total of 250 under-five children presenting with ARI were included. Children with respiratory symptoms due to non-infectious causes were excluded. Data on demographics, presenting symptoms, diagnosis, nutritional status, breastfeeding practices, immunization, and outcomes were recorded. Morbidity was assessed by PICU admission, mechanical ventilation, and prolonged hospital stay (>7 days). Data analysis was done using SPSS v25 with p<0.05 considered statistically significant. Results: Most ARI cases occurred in children aged 13–24 months (28%) and 7–12 months (24%), with a male predominance (58%). Common symptoms were fever (80.8%) and cough (76%). Upper respiratory tract infections (28%), bronchiolitis (24%), and pneumonia (22%) were the leading diagnoses. Seasonal peaks were observed in March (20%) and April (22%). Significant risk factors associated with ARI severity included malnutrition (p=0.01), exclusive breastfeeding <6 months (p=0.02), delayed presentation (p=0.02), and incomplete immunization (p=0.04). Most children (92%) were discharged, while 14% required PICU care, 8% needed ventilation, and 18% had prolonged stays. Conclusion: The study highlights that ARIs predominantly affect children in their first two years of life, with fever and cough as major presenting complaints. Upper and lower respiratory infections show a seasonal trend with peaks in cooler months. Modifiable risk factors like nutrition and immunization significantly influence ARI severity.

Background: Preterm birth, defined as delivery prior to completing 37 weeks of gestation, remains a critical global health issue and a leading cause of neonatal mortality and morbidity. Identifying robust predictive methods for spontaneous preterm birth is a top priority. Complete blood count indices like Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) have been shown as potential indicators of systemic inflammation, which is implicated in preterm labor pathogenesis. Objective: To compare various parameters like Age, Gravida, Parity, Gestational Weeks, Hemoglobin, Neutrophils, Lymphocytes and Platelet among groups. Methods: cross-sectional study conducted in S.P. Medical College, Bikaner among 170 pregnant women admitted to the obstetric department with threatened preterm labor during May 2024 to April 2025 time period. NLR (absolute neutrophil count / absolute lymphocyte count) and PLR (absolute platelet count / absolute lymphocyte count) values were obtained during the first day of admission. Results:  A significant association was found between elevated NLR and SPTB (Spontaneous Preterm Birth): 46.1% of those with NLR >4 experienced preterm labor, compared to 13.3% with NLR <4 (p<0.001). Similarly, PLR >118 was significantly associated with SPTB: 33.33% of those with PLR >118 experienced preterm labor, compared to 10% with PLR <118 (p<0.001). Conclusion:  study shows that both NLR and PLR are reliable markers for predicting the risk of spontaneous preterm labor.

Background: Primary open angle glaucoma (POAG), multifactorial condition, and progressive in nature, leading to visual field defect due to raised intraocular pressure. Prevalence of POAG is very high. Globally it contributes to severe visual impairment and blindness. Pharmacotherapy is the primary therapeutic approach to lower raised intraocular pressure for primary open angle glaucoma cases. Very few head to head studies were present regarding use of these two drugs in POAG– timolol & brinzolamide. Aims and Objectives: To compare and evaluate the clinical efficacy and ocular safety of timolol 0.5% versus 1% brinzolamide. Materials and Methods: This prospective, observational and comparative study with longitudinal design was conducted in the Department of Ophthalmology OPD in a tertiary care hospital of West Bengal for 12 months. One twenty cases of primary open angle glaucoma were selected satisfying the inclusion and exclusion criteria and divided equally into two groups based on simple random sampling. Patients in A group received0.5% timolol and patients in B group received1% brinzolamide were evaluated for efficacy and safety. Results: Based on observation atday 0, 4^th week & 12^thweek IOP reducing capacity was seen more in Group A patients receving 0.5% timolol compared to group B receiving 1% brinzolamide. Whereas regarding safety issue both A and B group showed similar safety profile.

Introduction: Rotator cuff injuries are a leading cause of shoulder pain and dysfunction, especially in middle-aged and elderly individuals, with prevalence increasing with age and activity. The rotator cuff consists of four muscles—supraspinatus, infraspinatus, subscapular is, and teres minor—that stabilize the shoulder and enable movement. Injuries can result from trauma, degeneration, repetitive overhead activity, or impingement, leading to pain, weakness, and restricted motion. Aims: To analyse the demographic variations in the incidence of rotator cuff injuries with the help of magnetic resonance and ultrasound imaging in rural population and to assess the diagnostic effectiveness of Ultrasonography (USG) in comparison to magnetic resonance imaging (MRI) for evaluating shoulder pain and detecting rotator cuff injuries. Methods: The study was an analytical cross-sectional study conducted in the Department of Radio diagnosis at B K L.Walawalkar Rural Medical College and associated hospital, Chiplun, Ratnagiri. Maharashtra, India. It included 40 symptomatic patients presenting for diagnosis or treatment of suspected rotator cuff injuries, all of whom underwent both MRI and Ultrasonography (USG)evaluations. Result: The study included 40 participants with a mean age of 40.28 ± 7.89 years. Males had a slightly higher mean age (41.25 ± 8.42 years) compared to females (38.81 ± 6.77 years). Handedness distribution was nearly equal, with no significant difference. However, occupation showed a significant variation, with most participants being workers (37.5%), followed by education staff and housewives (22.5% each), owners (15%), and chemists (2.5%). Conclusion: The analysis showed no significant association with age or handedness, but occupation was significantly linked to the condition, with physically active jobs being more common, indicating a possible occupational influence.

Background: Trigeminal neuralgia (TN) is a chronic pain condition characterized by severe, unilateral facial pain. In cases resistant to pharmacological treatment, interventional pain procedures offer an effective alternative. Injection of local anesthetic and steroid via ultrasonography at the pterygopalatine fossa (PPF) and posterior to the lateral pterygoid plate targets the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve and has shown promise. Aim: To assess the immediate and long-term efficacy of ultrasound-guided injection of local anesthetic and steroids into the pterygopalatine fossa and posterior to the lateral pterygoid plate for patients suffering from refractory trigeminal neuralgia. Methods: This prospective case series was conducted in the Pain Clinic of SMHS Hospital, GMC Srinagar. Twenty-one patients with refractory trigeminal neuralgia underwent ultrasound-guided trigeminal nerve block using a combination of 0.2% Ropivacaine and 40 mg Triamcinolone. Pain scores (VAS), duration of pain relief, complications, and quality of life were assessed at intervals up to 6 months post-intervention. Results: A significant reduction in pain scores was observed immediately post-procedure and sustained in most patients over a 6-month period. The average pre-procedure VAS score was 8.2±0.7 and reduced to 2.1±0.9 within 24 hours. At 6 months, 71.4% of patients reported sustained pain relief with improved quality of life. Minimal adverse events were recorded. Conclusion: Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa and posterior to lateral pterygoid plate is a safe and effective technique for patients with resistant trigeminal neuralgia, providing both immediate and long-term analgesia with minimal complications.

Background: Skill is an ability that is acquired through deliberate, systemic, and sustained effort; hence, the four steps of Peyton’s model of training make every student confident and successful. Method: Out of 100 MBBS phase II students, 50 students were given a kit for suturing with a used inner bicycle tube cut open, and small square-shaped pieces were prepared to fit in an embroidery frame to practice suturing. The remaining students were taken to the operation theater for observation of suturing by surgeons, which is the traditional method. Results: In the checklist or feedback study, bad performers ranged from 0 to 3, and in response to the Likert scale, the number of students who strongly disagreed varied from 0 to 6. It indicates positivity and significant results in teaching suturing. Conclusion: Peyton’s model is more effective in teaching complex procedure skills. The procedure is cost-effective, and the trainer becomes confident for his future as a surgeon.

Introduction: Urinary tract tumors (UTTs) vary by site, histology, and risk factors such as smoking, hypertension, and occupational exposure. Males are more commonly affected. Bladder tumors are mainly urothelial, while kidney tumors are often RCC. This study aims to evaluate clinical, pathological, and demographic patterns in UTT cases. Methods: This 18-month prospective observational study at KIMS, Amalapuram included all histopathologically confirmed UTTs. Clinical, demographic, and risk factor data were collected. Specimens underwent gross and microscopic analysis, WHO classification, and TNM staging. Urothelial tumors were graded and subtyped. Ethical clearance and informed consent were obtained. Results: Among 68 UTT cases, bladder tumors (61.7%) were most common, followed by kidney (30.8%). Smoking (47%) and hematuria (64.7%) were key findings. RCC was the predominant renal tumor; most urothelial tumors were high/low-grade with male predominance. Site-specific histology showed consistent but varied distribution patterns. Conclusion: UTTs show varied site-specific and histopathological profiles. Bladder tumors were most prevalent, RCC was the dominant renal tumor, and urothelial tumors displayed male predominance. Smoking was the leading risk factor. Understanding these patterns aids in early detection, individualized management, and better clinical outcomes in UTT patients.

Introduction: Esophageal varices, a serious complication of cirrhosis, can cause life-threatening bleeding. Given the limitations of endoscopy, this study aims to assess non-invasive predictors like platelet count, spleen size, and Child-Pugh class to identify high-risk patients, improving screening accuracy and reducing unnecessary endoscopies in cirrhotic individuals. Methods: This one-year observational study at Andhra Medical College included newly diagnosed cirrhotic patients. After ethical approval and informed consent, clinical, biochemical, and ultrasound data were collected. Non-invasive parameters were assessed and correlated with variceal grading by endoscopy using modified Paquet’s classification to predict esophageal varices in cirrhosis. Results: Among 100 cirrhotic patients, 44% had large varices, more prevalent in advanced Child-Pugh classes and severe ascites (p < 0.001). Large varices correlated with lower platelet count, albumin, and platelet/spleen ratio, and higher bilirubin, prothrombin time, portal vein diameter, and spleen size, indicating significant association with disease severity. Conclusion: The study demonstrates that non-invasive parameters, including platelet count, spleen size, liver function tests, and Child-Pugh score, can reliably predict large esophageal varices. Incorporating these markers into routine evaluation may reduce dependence on endoscopy, enabling targeted surveillance and timely intervention in high-risk cirrhotic patients, especially in low-resource settings.

Introduction: Dacryocystitis, an inflammation of the lacrimal sac due to nasolacrimal duct obstruction, commonly affects older females and lower socioeconomic groups in tropical regions like India. This study aims to identify the causative organisms and evaluate their antibiotic susceptibility patterns. Methods: This prospective study at Rangaraya Medical College included acute and chronic dacryocystitis cases. Samples from lacrimal sac discharge were collected and analyzed microbiologically. Antibiotic susceptibility was tested using the Kirby-Bauer disc diffusion method. A conjunctival swab from the opposite eye served as control. Ethical approval and informed consent were obtained. Results: Among 100 patients (mean age 41.3 years), most were rural and from lower socioeconomic backgrounds. Epiphora was universal. In the test group, 83 isolates were identified CoNS (33.73%) and S. aureus (25.30%) predominated. These showed highest sensitivity to Linezolid. Gram-negative isolates responded best to Gentamicin and Piperacillin-Tazobactam. Conclusion: The study underscores Staphylococcus species as major pathogens in dacryocystitis, with emerging Gram-negative involvement. Linezolid and Gentamicin were most effective antibiotics. Rising resistance patterns warrant careful antibiotic selection. Regular culture and sensitivity testing should be emphasized for effective treatment and prevention of recurrent or resistant lacrimal sac infections.

Objective: To study various clinical characteristics, determinants & various management protocol of polycystic ovarian syndrome (PCOS). Methods: Hospital based prospective cross-sectional study, conducted in the department of obstetrics & gynecology. Detailed demographic history, menstrual history, family history, obstetric history was taken, anthropometric measurement of height, weight, waist circumference & Hip circumference was taken for Body Mass Index (BMI) & Waist Hip ratio respectively. Thorough clinical examination for presence of acne, acanthosis nigricans excess body hair distribution was noted. Relevant investigations like fasting blood sugar, thyroid profile, pelvic ultrasonography were done. PCOS was diagnosed as per Rotterdams criteria. Patients were followed and different management protocol were noted. Results: The most common age group among PCOS patients was 21–25 years. Most participants resided in rural areas and belonged to the low socioeconomic group. The predominant education level was secondary education (61.5%). The most observed BMI category was 21–25 (43.3%). The most common waist-hip ratio was 0.86–0.96, observed in 64 patients (61.5%), indicating central obesity. A sedentary lifestyle was reported by 53 patients (51.0%). Menstrual irregularity was the most frequently reported symptom/ Infertility was noted in 40 cases (38.5Thyroid disorder was the most frequent. Most women had an LH/FSH ratio >3. A HOMA-IR value >2.5 was seen in 38.5% of patients, the most frequent category indicating significant insulin resistance.  Conclusion: The findings of this study underscore the complex interplay between endocrine, metabolic, and lifestyle factors in the manifestation and progression of PCOS. They emphasize the importance of comprehensive evaluation and personalized management strategies that address not only the reproductive and cosmetic concerns but also the underlying metabolic disturbances to improve both immediate and long-term health outcomes. Early diagnosis, patient education, and integration of multidisciplinary care are critical to mitigating the burden of PCOS.

Background: Pneumoperitoneum for laparoscopic surgeries induces a cardiovascular response characterized by abrupt elevations of arterial pressure and systemic vascular resistance. Adequate preloading, along with the use of drugs: Alpha adrenergic agonists like Clonidine, Dexmeditomidine, and beta blocking agents like Esmolol, high doses of Opioids like Fentanyl, Remifentanyl, or Vasodilators etc are often used to avoid circulatory responses to pneumo-peritonium. Hence, this study was conducted with an objective to compare IV Dexmedetomidine and IV Clonidine in the evaluation of the recovery characteristics by Ramsay Sedation Scale (RSS) in patients undergoing laparoscopic surgeries under isoflurane anaesthesia. Materials and Methods: A randomized, double-blinded, prospective study was conducted among 90 patients divided into three groups with 30 patients in each group. Group C received Inj. Clonidine 2 μg/kg I.V. in 100cc normal saline slowly over 20 min in the preoperative holding area before shifting patient to OT. Group D received Inj. Dexmedetomidine 1μg/kg I.V. in 100cc normal saline slowly over 20min and Group K received Inj. Normal saline 20cc slowly over 20min. Results: Post operatively, recovery profile of the patients which was assessed using Ramsay sedation scale among the respective three groups was statistically not significant. Conclusion: The study drugs at this dosage, could not be used for day care surgery. However larger studies are required to draw final conclusions regarding use of these drugs in day care surgery.

Background and Objective: Oral sub mucous fibrosis is a pre malignant condition associated with habit of chewing betel nut mixed with lime, tobacco, gutka and pan masala. This condition is pre dominantly seen in Indian sub-continent and south east Asia. It is pathologically characterized by fibro elastic change of oral mucosa leading to trismus. Management include life style modification, intralesional steroid, antioxidant and physiotherapy aiming to improve the trismus. Numerous studies have been conducted using intralesional Triamcinolone alone or in combination with other agents to assess their efficacy in improving trismus, however studies on efficacy of intralesional Dexamethasone is limited. This study was undertaken to evaluate the efficacy of intralesional Dexamethasone, which is an affordable and easily available agent, in improving the trismus resulting from oral sub mucous fibrosis. Methods:  This is a randomized prospective comparative clinical study enrolling 52 patients in age group of 20 to 70 years. Inclusion criteria was grade three trismus associated with oral sub mucous fibrosis and with written informed consent. Patients previously treated for the same condition, those with temporomandibular joint pathology, those with oral cancer, those with contraindication to steroid and not willing to participate were excluded. All participants were categorized into two groups, A and B.  Group A patients received weekly injection of intralesional Dexamethasone in a dose of 4 mg (1ml) for 8 weeks. Group B patients were treated with weekly injection of 1ml of water for injection as placebo. Interincisal distance was measured prior to treatment and during follow up visit at 4 weeks and 8 weeks from the start of treatment. Results: At the end of 8 weeks, improvement in mouth opening was 8.80±2.32 mm for group A and the same was 1.91±0.77 mm for group B. It was evident that improvement in mouth opening was significantly better in patients treated with intralesional Dexamethasone as compared to the patients treated with placebo with p value less than 0.0001. Conclusion: Intralesional Dexamethasone can be considered a reliable agent to treat trismus associated with oral sub mucous fibrosis. Outcome will be far better if it is combined with oral lycopene, vitamin B complex and regular mouth opening exercise.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder posing a significant global health challenge, particularly in developing countries. Among its complications, diabetic retinopathy (DR) and diabetic nephropathy (DN) are major microvascular conditions that contribute to long-term morbidity, visual impairment, and renal failure. These complications often share common risk factors, such as age, gender, duration of diabetes, glycemic control, and hypertension. Objective: This study aimed to assess the prevalence of DR and DN in patients with type 2 diabetes mellitus (T2DM) and to explore their associations with demographic and clinical variables including age, sex, duration and age of onset of diabetes, metabolic control, and hypertension. The study also examined the interrelationship between retinopathy, nephropathy, and maculopathy. Methods: A hospital-based cross-sectional study was conducted on 50 patients with T2DM attending the ophthalmology and medicine departments of a tertiary care hospital. Retinopathy was assessed through detailed fundus examination, and nephropathy was evaluated using dipstick testing and 24-hour urinary protein estimation. Statistical analysis was performed to determine the associations between clinical variables and microvascular complications. Results: Diabetic retinopathy was present in 64% of patients, while 50% had macroalbuminuria. Retinopathy prevalence increased with age, though the association was not statistically significant. Males were significantly more affected by DR (p=0.002). Duration of diabetes (p=0.043) and hypertension (p=0.035) were significantly linked to DR. Macroalbuminuria was significantly associated with longer diabetes duration (p=0.031) and poor glycemic control (p=0.044). Severity of retinopathy and presence of maculopathy showed strong associations with macroalbuminuria (p=0.033 and p=0.0024, respectively). Conclusion: This study underscores a significant correlation between retinopathy and nephropathy in T2DM, especially in patients with prolonged disease, male gender, hypertension, and poor glycemic control. Integrated screening and multidisciplinary management are essential to prevent vision and kidney-related complications.

Background: For upper limb surgeries, currently ultrasound guided supraclavicular brachial plexus block is more preferred. The procedure may need multiple injections to deliver the drug in-order to block the limb and yet occasionally fail. Peripheral nerve stimulation requires the stimulation of inferior trunk alone to deliver the local anaesthetic but necessitates multiple blind attempts. Will combining the two techniques increase success rates and even better be less morbid to the patient? Methods: 100 patients admitted for upper limb surgery selected consecutively, were given brachial plexus blocks by either of the two guidance techniques considered for the current study. These procedures were performed by the medical faculty following standard practices. From all the study participants, the following were observed and recorded: (1) Socio-demographic details and clinical details. (2) Primary outcomes – quality of sensory block, success rates. (3) Secondary outcomes – quality of motor block, block execution time, time of onset of sensory and motor block. (4) Intraoperative requirement of iv opioids and block related complications. (5) Patient satisfaction on a four-point scale. (6)Paraesthesia persisting for more than 48 hours. Quality of sensory block was evaluated and graded as a 3-point scale. Quality of motor block was evaluated using modified Bromage scale. Block was considered failed once complaint of pain was raised by the patient and was given general anaesthesia by the discretion of the duty anaesthesiologist. Patients of both groups were followed up for paraesthesia persisting after 48 hours’ post-block. Result: Both groups were comparable in terms of demographic profile. The success rate was significantly high for the combined approach (90%), as compared to 82% in ultrasound only. Quality of sensory block was higher with the combined approach (1.9±0.27 v/s 1.8±0.38) which is insignificant statistically. Block execution time was quicker with ultrasound only (12.6±2.33 min v/s15.36±2.28 min) and is significant. Sensory blockade was achieved earlier (5.6±3.6 min) in ultrasound only than with the combined approach (6.26±3.77 min) and is statistically insignificant. Ultrasound group needed more rescue analgesia (18%) and had the most paraesthesia persisting after 48hrs (12%) both of which are statistically insignificant. Patient satisfaction between the two groups is not statistically significant. Conclusion: Dual guidance technique increases chances for successful block when compared to using ultrasound alone, though it requires longer block execution time while all other block characteristics remain equally comparable. The combined method was less distressful.

Background: Globally, currency whether in the form of paper notes or coins is probably the most widely handled article by people every day. Thus, currencies could be one of the most potential vehicles to transmit infectious diseases amongst the people. Antibiotic resistance is a growing concern for public health world-wide, resulting in antibiotic drugs ineffective in treating bacterial infections associated with increased morbidity and mortality. Some of the previous studies have focused for identifying the presence of microorganisms on circulating currency, not included study on ESBL detection, multidrug-resistant (MDR) microorganisms and multiple antibiotic resistance index (MARI) analysis. Therefore, the aim of this study was to characterize ESBL producer, different multidrug-resistant strains and understand their multiple antibiotic resistance indices from the circulating Indian currency samples. Methods: This is a prospective study based on laboratory investigations on Indian currency which were collected randomly from various sources of our hospital. Each currency note was collected from the participant in a sterile plastic bag and then transferred to the laboratory immediately and then the swab samples are subjected to laboratory analysis. Results: A total 130 currency notes were processed for contamination, 86 (66%) bacteria were isolated from contaminated currency notes. Among the 86 positive isolates 9 (10%) were pathogenic Gram-negative and 77 (90%) were non-pathogenic Gram-positive environmental organisms. Conclusion: The study reports significant percentages of methicillin and multidrug resistance among CoNS isolates with a wide range of MAR indices. Our study also revealed the prevalence of Gram-negative bacteria in currency notes with ESBL producing isolates and multidrug resistant organisms with a wide range of MAR indices. The outcome of this study reflects that paper currency material may be a source for bacterial transmission causing infectious diseases, foodborne illness, nosocomial infections and thus could be public health problem.

Background: Non-alcoholic steatohepatitis (NASH), the progressive inflammatory form of non-alcoholic fatty liver disease (NAFLD), is increasingly implicated in cardiovascular morbidity and mortality. Despite its growing prevalence, subclinical cardiac dysfunction in NASH often remains undetected, especially in the Indian population. Objective: To assess the clinical profile, metabolic risk factors, biochemical markers, and echocardiographic evidence of cardiovascular dysfunction in patients with NASH at a tertiary care centre. Materials and Methods: This cross-sectional observational study was conducted in the Department of General Medicine at NIMS University, Jaipur, from January to December 2024. Sixty-five adult patients (aged 25–64 years) with NASH were enrolled. Data were collected on demographics, risk factors, biochemical profile, ECG, and echocardiographic findings. Statistical analysis was done using SPSS v23. Results: The mean age was 45.0 ± 10.0 years, with 60% males. Obesity (38%), diabetes (31%), hypertension (35%), and dyslipidaemia (51%) were the predominant risk factors. Biochemical analysis showed elevated ALT (62 ± 30 IU/L) and AST (58 ± 25 IU/L) with a mean AST/ALT ratio of 0.94. ECG was abnormal in 45% (LV hypertrophy 15%, ST-T changes 12%). On echocardiography, LV ejection fraction was preserved in 92%, but 31% had Grade I and 8% Grade II diastolic dysfunction. LV hypertrophy was present in 28%, and left atrial enlargement in 23%. Conclusion: NASH is associated with significant subclinical cardiac dysfunction and a high prevalence of metabolic risk factors. Early cardiovascular screening and aggressive risk modification are warranted to reduce morbidity in this population.

This study investigates the interplay between Body Mass Index (BMI), body fat percentage (BF %), handgrip strength (HGS), and handgrip endurance (HGE) among underweight, normal weight, and overweight adolescents, addressing critical gaps in understanding how adiposity and musculoskeletal fitness interact during a pivotal developmental stage. Adolescence, marked by rapid physiological changes, is a formative period for long-term health outcomes; yet limited research explores how BMI classifications and body composition relate to functional strength and endurance in this population. A cross-sectional design was employed, recruiting 450 adolescents (12–20 years) stratified into underweight (n=150), normal weight (n=150), and overweight (n=150) groups based on WHO BMI-for-age percentiles. BF% was measured via bioelectrical impedance analysis (BIA), while HGS (peak force, kg) and HGE (time to 50% strength decline during sustained contraction) were assessed using a calibrated dynamometer. Covariates included age, sex, and physical activity levels. Statistical analyses encompassed ANOVA, Pearson’s correlations, and multivariate regression.
Results revealed significant disparities across BMI categories. Overweight adolescents exhibited the highest HGS (28.5 ± 5.2 kg) but the lowest HGE (42.3 ± 10.1 seconds), whereas underweight participants demonstrated the lowest HGS (20.1 ± 4.8 kg) and moderate HGE (55.6 ± 12.4 seconds). Normal weight individuals balanced moderate HGS (25.3 ± 4.9 kg) with the highest HGE (62.8 ± 11.3 seconds). BF% correlated positively with HGS (r=0.34, p<0.01) but inversely with HGE (r=−0.41, p<0.01), suggesting that adiposity may enhance absolute strength at the expense of endurance. Regression models indicated BF% as a stronger predictor of HGE (β=−0.38, p<0.001) than BMI (β=−0.22, p=0.003), while both BMI and BF% independently predicted HGS (β=0.29 and 0.26, respectively; p<0.01). Sex-specific analyses highlighted males’ superior HGS, whereas females outperformed in HGE, emphasizing hormonal and biomechanical influences.
These findings underscore the dual role of adiposity in adolescent musculoskeletal fitness: while higher BF% may confer strength advantages, it imposes endurance limitations. Clinically, interventions for overweight youth should prioritize endurance training to mitigate metabolic and functional risks, whereas underweight adolescents may benefit from resistance training to augment strength. The study advocates for integrating BF% assessments with BMI in school health screenings to tailor fitness programs and address nuanced health needs. Future longitudinal research should explore causal pathways and the impact of targeted exercise regimens.

Type 2 diabetes mellitus (T2DM) is associated with complications driven by oxidative stress and metabolic dysregulation. This cross-sectional study compared oxidative stress markers, lipid profiles, and glycemic control in controlled vs. uncontrolled T2DM patients to elucidate the clinical implications of sustained hyperglycemia. A cohort of 200 participants (100 controlled [HbA1c <7%] and 100 uncontrolled [HbA1c ≥7%]) was evaluated for fasting blood glucose (FBG), HbA1c, lipid parameters (total cholesterol, LDL-C, HDL-C, triglycerides), and oxidative stress biomarkers, including malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), catalase (CAT), and total antioxidant capacity (TAC). Statistical analyses employed independent t-tests, Mann-Whitney U tests, and correlation coefficients (Pearson/Spearman).
Results revealed significantly elevated oxidative stress in uncontrolled T2DM, with higher MDA levels (5.2 ± 1.3 vs. 3.1 ± 0.8 nmol/mL, p<0.001) and reduced antioxidant activity (SOD: 12.4 ± 2.1 vs. 18.6 ± 3.0 U/mL; GSH: 6.5 ± 1.2 vs. 9.8 ± 1.5 µmol/L, p<0.001). Uncontrolled patients exhibited worsened lipid profiles, including elevated LDL-C (145 ± 28 vs. 112 ± 24 mg/dL), triglycerides (210 ± 45 vs. 150 ± 32 mg/dL), and lower HDL-C (38 ± 6 vs. 45 ± 7 mg/dL, all p<0.001). Strong positive correlations emerged between HbA1c and MDA (r=0.72), LDL-C (r=0.65), and triglycerides (r=0.68), while inverse correlations linked HbA1c to HDL-C (r=-0.59), SOD (r=-0.71), and GSH (r=-0.63) (all p<0.001).
The findings underscore that uncontrolled T2DM is characterized by exacerbated oxidative stress and dyslipidemia, driven by persistent hyperglycemia. These metabolic disturbances likely contribute to accelerated vascular and end-organ damage. The study highlights the critical need for stringent glycemic control and integrated management strategies targeting oxidative stress and lipid abnormalities to mitigate diabetes-related complications. Further longitudinal research is warranted to explore causal mechanisms and therapeutic interventions.

Background: The hemodynamic changes during laparoscopy are due to reflex sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimulation. Many pharmacological methods have been devised to reduce the extent of hemodynamic events including high dose of opioid, local anaesthetics like lignocaine, alpha and beta adrenergic blockers and vasodilation drugs like nitroglycerine. Hence, this study was conducted to compare the effects of IV dexmedetomidine v/s IV clonidine as a premedication in attenuating hemodynamic responses to pneumoperitoneum. Materials and Methods:  A randomized, double-blinded, prospective study was conducted among 90 patients divided into three groups with 30 patients in each group. Group Clonidine receiving a loading dose of 2 μg/kg of clonidine in 100 ml of normal saline over 20 minutes, followed by infusion of plain normal saline started 5 minutes after anesthesia induction. Group D receiving Dexmedetomidine a loading dose of 1μg/kg of dexmedetomidine in 100 ml of normal saline over 20 minutes, followed by infusion of dexmedetomidine @ 0.5μg/kg/hr, started 5 minutes after anaesthesia induction. Group K patients receiving 100 ml of normal saline over 20 minutes followed by infusion of plain saline started 5 min after anaesthesia induction. Results: Both IV Dexmedetomidine 1μg/kg followed by maintenance dose of 0.5mcg/kg/hr and IV Clonidine 2 μg/kg given prior to the induction of anaesthesia in laparoscopic surgery effectively attenuated the haemodynamic response to pneumoperitoneum.

Aim: To determine the predictive value of Gestosis score (GS) for predicting the occurrence of PE. To assess accuracy of Gestosis score in identifying adverse obstetric and neonatal outcome. Methods: This longitudinal study was conducted in the department of Obstetrics and Gynecology in KIMS hospital, Bengaluru after obtaining Institutional Ethical Clearance over a period of 18 months, among 100 pregnant women. All antenatal cases of any gestational age at the time of booking were included in the study and followed up till delivery. Data was collected and Gestosis score employed and analysed for obtaining the predictive performance. The maternal and neonatal outcome and association with GS was measured. Results: The incidence of preeclampsia in this study was 8%. Most of the women were aged between 26-30 years. 56 women had GS>/=3 and 44 women had score<3. The sensitivity, specificity, PPV, NPV and predictive accuracy in this study was noted to be 100%, 29.27%, 21.62%, 100% and 40.82% respectively. Majority of the women in cases group underwent caesarean delivery – 74%, and had postpartum complications – 36%. Women with higher Gestosis score had increased NICU admission for their neonate – 48%. Conclusion: Though the sensitivity was 100%, the specificity was low. The sensitivity being high, can help enable early detection and appropriate intervention to prevent the associated feto-maternal complications. GS – a simple scoring system, allows for easy assessment of at risk women and thereby feto-maternal surveillance can help improve feto-maternal outcomes.

Introduction: Laparoscopic cholecystectomy has now become the gold standard method for almost all gallbladder diseases except a few. Atypical mycobacterial infections at port site has become a frequent problem encountered in patients undergoing laparoscopic cholecystectomy. These microorganisms show limited response to first line antitubercular agents. Thus standard treatment consist of combinations of second line agents like macrolides such as Clarithromycin, Aminoglycosides like Amikacin, and Fluouoquinolones like Ciprofloxacin. In our study we started a simple regimen of injectable Amikacin and oral Clarithromycin for 28 days for the screened and documented patients having atypical mycobacterial infection at port sites after laparoscopic cholecystectomy. Primary Objective: To assess the response of treatment. Secondary Objective: To assess the adverse effects of combined antibiotic the. Type of study and study design: The study was an analytical observational study. Study population: The patients attending the OPD of Department of Surgery with confirmed atypical mycobacterial infection at port sites after laparoscopic cholecystectomy who fulfill the inclusion criteria of the study. Sample size: Sample size of our study was 17. Data collection procedures & instruments used: The data were collected by interviewing and clinical examination of patients attending outpatient department (OPD) of department of Surgery Patients with history of laparoscopic cholecystectomy within last 4 weeks and developed pain, erythema, induration, swelling at the port sites and confirmed as case of atypical mycobacterial infection at port sites by laboratory examinations (AFB positive & CBNAAT negative). Quality Control and confidentiality: The analysis of all data were done at the Department of Pharmacology using SPSS Software V:20 (IBM Inc). Ethical considerations: The Study commenced only after obtaining ethical approval of the same by Institutional Ethics Committee (IEC). Result: There was significant reduction of mean swelling, induration, erythema and pain between Day 0 and Day 28. In our study only 2 of the 17 subjects developed any adverse reactions. They developed nausea and vomiting to this antibiotic regimen during study period. Conclusion: The results suggest that this combined antibiotic therapy for 28 days has significantly reduced pain, swelling, induration and erythema at the port sites. Additionally no significant treatment emergent adverse effects were encountered in the study period.

Background and purpose: Myopia, also known as near sightedness, has become a major global health concern due to its raising prevalence and significant impact on vision. With the raising burden of myopia, there has also been a sharp increase in the number of refractive surgeries aimed at correcting the condition. Central corneal thickness (CCT) plays a crucial role in determining the suitability of these surgeries. The purpose of this study was to investigate the relationship between myopia and central corneal thickness. The present study aim is to investigate the relationship between central corneal thickness (CCT) and degree of myopia in patients visiting the Ophthalmology OPD in Gitam Institute of Medical sciences and Research, Visakhapatnam. Material and methods: This is a hospital based analytical observational study. One hundred and sixteen myopic individuals between 11 and 40 years of age with spherical equivalent (SE) ranging from -0.5 to -6 diopters after cycloplegic refraction were enrolled in the study. CCT was measured in both eyes of each patient using noncontact anterior segment OCT. The relation between CCT and myopia was analyzed using statistical tests like ANOVA, Pearson’s correlation coefficient. P value less than 0.05 is considered statistically significant. Results: a Total of 232 eyes were analyzed. The mean value for right eye CCT is 523.83 in low myopia, 514.33 in moderate myopia and 519.71 in high myopia. The mean value for left eye CCT is 523.40 in low myopia, 511.67 in moderate myopia and 517.63 in high myopia. The p value for right eye is 0.331 and left eye is 0.185. Age verses central corneal thickness, the p value in right eye is 0.437 and left eye is 0.546 which shows the test is not statistically significant. Sex verses central corneal thickness, the p value in right eye is 0.128 and left eye is 0.179 which shows the test is not statistically significant. No correlation was observed between mean CCT and SE (r value 0.019 and p value 0.841.) Conclusion: The associations between CCT and myopia is not significant. We cannot presume the corneal thickness by the degree of myopia, which doesn’t make any difference while providing treatment for myopia.

Background: Acinetobacter species have emerged as significant opportunistic pathogens in healthcare settings. This study aimed to investigate the epidemiology and antibiotic resistance patterns of Acinetobacter infections in a tertiary care hospital in Northeast India. Methods: A retrospective cross-sectional study was conducted from January 2021 to June 2023. All Acinetobacter isolates from clinical specimens were included. Identification and antimicrobial susceptibility testing were performed using conventional methods and automated systems. Demographic and clinical data were collected from medical records. Results: Out of 8,894 bacterial isolates, 625 (7.0%) were identified as Acinetobacter spp. The majority (89.0%) were from inpatients. A. baumannii was the predominant species (86%). Pus/wound exudates (32.6%), urine (20.2%), and endotracheal aspirates (19.4%) were the most common specimen types. Inpatient isolates showed high resistance to multiple antibiotic classes, with 67.6% classified as multidrug-resistant and 51.4% as extensively drug-resistant. Colistin remained highly effective (99.5% susceptibility). Diabetes, post-surgical states, and chronic kidney disease were common underlying conditions. Conclusion: This study revealed a high prevalence of multidrug-resistant Acinetobacter infections, particularly among inpatients. The findings underscore the need for enhanced antimicrobial stewardship and infection control measures to address this growing public health challenge.

Background: Diabetic retinopathy (DR) is a major microvascular complication of type 2 diabetes mellitus (T2DM) and a leading cause of vision loss worldwide. Understanding its epidemiology and associated risk factors is crucial for early detection and prevention. Materials and Methods: A cross-sectional study was conducted among 246 patients with T2DM attending a tertiary care hospital over 12 months. Detailed demographic, clinical, and laboratory data were collected. All participants underwent comprehensive ophthalmic examination, including fundus evaluation, with DR graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Statistical analysis included univariate and multivariate logistic regression to identify independent predictors of DR. Results: The mean age of participants was 57.8 ± 10.4 years, with 53.7% males. Most patients were urban residents (68.3%), and the mean duration of diabetes was 10.2 ± 6.5 years. The overall prevalence of DR was 38.2%, with mild non-proliferative DR in 15.4%, moderate NPDR in 11.4%, severe NPDR in 4.9%, and proliferative DR in 4.1% of patients. Diabetic macular edema was present in 7.3%. Compared to patients without DR, those with DR were significantly older, had longer diabetes duration, higher prevalence of hypertension and dyslipidemia, and higher mean HbA1c levels. On multivariate analysis, longer duration of diabetes (AOR 1.12; p < 0.001), older age (AOR 1.04; p = 0.021), hypertension (AOR 1.86; p = 0.025), and higher HbA1c (AOR 1.29; p = 0.008) were identified as independent risk factors for DR. Conclusion: DR was present in more than one-third of patients with T2DM in this study. Longer diabetes duration, advanced age, hypertension, and poor glycemic control were significant independent predictors. Regular screening and aggressive control of modifiable risk factors are essential to reduce the burden of DR.

Background: Subarachnoid block (SAB) is commonly used for lower limb surgeries, and the addition of adjuvants to local anesthetics can improve the quality and duration of analgesia. Nalbuphine and fentanyl are two widely used intrathecal adjuvants, but their comparative efficacy and safety profiles remain an area of ongoing clinical interest. Aim and Objectives: To compare the onset, duration of sensory and motor block, and hemodynamic effects of intrathecal nalbuphine versus fentanyl when used as adjuvants to 0.5% levobupivacaine in patients undergoing lower limb surgeries under SAB. Materials and Methods: In this prospective, randomized study, 70 ASA I–II patients aged 18–65 years scheduled for elective lower limb surgeries under SAB were randomly allocated into two groups (n=35 each). Group N received 1 mg nalbuphine with 0.5% levobupivacaine, and Group F received 25 mcg fentanyl with 0.5% levobupivacaine. The onset and duration of sensory and motor blockade were assessed, along with intraoperative and postoperative hemodynamic parameters. Pain was evaluated using the Visual Analog Scale (VAS), and motor block using the Bromage score at predetermined intervals. Results: Fentanyl group showed a faster onset of sensory (10 ± 3 min) and motor block (15 ± 4 min) compared to nalbuphine (15 ± 5 min and 20 ± 7 min, respectively). However, the nalbuphine group had a significantly longer duration of sensory (8.5 ± 1.5 hours) and motor block (6.0 ± 1.2 hours) compared to fentanyl (7.0 ± 1.0 hours and 5.5 ± 0.8 hours, respectively). Hemodynamic parameters were more stable in the nalbuphine group, with lower intraoperative and postoperative blood pressure and heart rate fluctuations. Conclusion: Both nalbuphine and fentanyl are effective intrathecal adjuvants to levobupivacaine in SAB. Fentanyl offers a faster onset, whereas nalbuphine provides prolonged analgesia with superior hemodynamic stability. The choice of adjuvant should be guided by clinical context and individual patient requirements.

Background: Difficult airway management is a critical concern in anaesthetic practice. Failure to anticipate a challenging intubation scenario can result in significant perioperative morbidity and mortality. Bedside tests like the Modified Mallampati Test (MMT) and the Upper Lip Bite Test (ULBT) are frequently used for preoperative airway evaluation, though their diagnostic accuracy varies. Objective: To evaluate and compare the diagnostic efficacy of the Upper Lip Bite Test (ULBT) and the Modified Mallampati Test (MMT) in predicting difficult endotracheal intubation among adult patients undergoing elective surgery, using the Cormack-Lehane (CL) grading as the gold standard. Methods: This prospective observational study included 250 adult patients undergoing elective surgeries under general anaesthesia at a tertiary care teaching hospital. Each patient underwent a preoperative airway assessment using MMT and ULBT. During direct laryngoscopy, Cormack-Lehane grades were recorded by a blinded anaesthesiologist. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curves, and Cohen’s kappa statistics were used to evaluate the predictive accuracy of the tests. Results: Difficult intubation (CL Grades III/IV) was identified in 29.2% of cases. ULBT Grade III patients showed a strong association with difficult laryngoscopy. ULBT demonstrated a sensitivity of 76.0%, specificity of 94.0%, PPV of 88.0%, NPV of 86.0%, and overall accuracy of 86.5%. In comparison, MMT had a lower sensitivity of 35.0%, specificity of 84.0%, PPV of 65.0%, NPV of 62.0%, and accuracy of 66.0%. ROC analysis revealed an area under the curve (AUC) of 0.89 for ULBT and 0.66 for MMT, indicating superior diagnostic performance for ULBT. Conclusion: The Upper Lip Bite Test (ULBT) is significantly more accurate and reliable than the Modified Mallampati Test (MMT) in predicting difficult intubation. Its incorporation into routine airway assessment can enhance patient safety and preparedness for airway challenges.

Background: Consciousness during spinal anaesthesia often magnifies pre-operative anxiety, activating the hypothalamic–pituitary–adrenal axis and elevating serum cortisol. Pharmacological anxiolysis carries adverse-effect risks; music is a simple non-drug alternative. Objective: To determine whether continuous peri-operative music reduces serum cortisol and stabilizes haemodynamics in adults undergoing elective lower-limb surgery under spinal anaesthesia. Methods: In this double-blind, randomized controlled trial, 100 adults (18–60 y; ASA I–II) scheduled for lower-limb surgery at a tertiary center were allocated to a music group (n = 50) or control group (n = 50). From induction of spinal anaesthesia to skin closure, the music group received patient-selected music via noise-cancelling headphones; controls wore silent headphones. Primary outcome was serum cortisol (µg dl⁻¹) pre-operatively and 60 min post-operatively. Secondary outcomes were haemodynamic variables (SBP, DBP, MAP, HR, SpO₂) recorded pre-operatively and every 15 min intra-operatively. Data were analysed with unpaired/paired t-tests and Χ² tests (α = 0.05). Results: Baseline demographics were comparable between groups. Mean postoperative cortisol was significantly lower in the music group (24.95 ± 6.46) versus controls (31.99 ± 6.45; p < 0.001), while pre-operative levels did not differ (p = 0.11). Intra-operative haemodynamics and SpO₂ remained within clinically acceptable ranges for both groups with no significant between-group differences. Conclusions: Peri-operative music is an effective, low-cost intervention that attenuates the cortisol response and anxiety without compromising haemodynamic stability during spinal anaesthesia. Routine incorporation of music therapy may enhance patient experience and mitigate stress-related sequelae.

Hydatid disease, caused by Echinococcus granulosus, remains a significant zoonosis in endemic, agriculture-based regions. This case series highlights five pediatric patients from semi-rural settings with hydatid cysts involving the lungs, liver, and mesentery. Clinical evaluation and imaging (ultrasonography, chest-X-Ray, CT) facilitated diagnosis. Surgical management included thoracotomy with decortication, Pericystectomy, or exploratory laparotomy, based on cyst location. All patients received postoperative albendazole (10 mg/kg/day) for six months. Each case was confirmed by Histopathology. No recurrences or major complications occurred during follow-up. This series underscores the importance of suspecting hydatid disease in pediatric cystic lesions in endemic areas and supports combined surgical-medical therapy for favourable outcomes.

Introduction: Rotator cuff injuries are a frequent cause of shoulder pain and functional impairment, and accurate diagnosis is essential for guiding management. Magnetic resonance imaging (MRI) is considered the reference standard for evaluating soft tissue structures of the shoulder, while ultrasonography (USG) is a cost-effective, readily available, and dynamic imaging modality. Correlating the diagnostic performance of USG with MRI can help determine its reliability in clinical practice. Aims: This analytical cross-sectional study was conducted to compare the diagnostic efficacy of ultrasonography (USG) and magnetic resonance imaging (MRI) in detecting partial- and full-thickness rotator cuff tears in symptomatic patients. The study aimed to evaluate the accuracy, reliability, and diagnostic value of USG in comparison to MRI, with the objective of determining whether USG can serve as a primary diagnostic and screening tool for rotator cuff injuries, while reserving MRI as a secondary confirmatory investigation when necessary. Materials and Methods: This analytical cross-sectional study was conducted in the Department of Radiodiagnosis, B.K.L. Walawalkar Rural Medical College and Associated Hospitals, Chiplun, Ratnagiri, Maharashtra. A total of 40 symptomatic patients with suspected rotator cuff pathology were included. All patients underwent both MRI and USG of the affected shoulder. MRI served as the reference standard, and USG findings were compared for detection of rotator cuff tears, tendinopathy, and associated pathologies. Statistical measures, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy, were calculated. Result: In this study, USG showed excellent diagnostic performance for detecting glenohumeral joint fluid in one analysis (sensitivity 92.3%, specificity 100%, PPV 100%, NPV 96.4%, accuracy 97.5%), with no false positives and only one false negative compared to MRI. However, an alternative analysis revealed much lower sensitivity (51.0%) and specificity (60.0%), with a high number of false negatives (24) and false positives (8). On MRI, hypertension showed a statistically significant association with biceps tendinopathy (p = 0.04), while gender had borderline significance (p = 0.05); other factors such as handedness, smoking, trauma, and diabetes were not significant. Fluid along the biceps tendon on MRI showed no significant association with any demographic or clinical variables. Conclusion: Ultrasonography demonstrates high reliability for detecting glenohumeral joint fluid under optimal conditions, achieving excellent sensitivity, specificity, and overall diagnostic accuracy when compared with MRI. However, its performance declines substantially in detecting smaller or equivocal fluid collections, underscoring the continued value of MRI as the gold standard for subtle pathology. USG demonstrated a comparatively elevated accuracy in identifying tendinopathic alterations in the rotator cuff tendon. USG was more specific and had a moderate degree of sensitivity for diagnosing tendinopathic changes. Hypertension may be a potential risk factor for biceps tendinopathy, while other demographic and clinical variables showed no significant associations. USG remains a valuable, cost-effective, and accessible first-line imaging tool, but standardized protocols and operator expertise are essential to maximize its diagnostic utility.

Introduction: Carcinoma prostate has become a most relevant cause of death in world. The diagnosis of CaP is conventionally obtained by saturation prostate biopsy and morphological examination of tissue sections. This method is reliable but requires careful training. Therefore, new molecular approaches for early screening and diagnosis are urgently needed. Gene expression analysis was recently used to increase our knowledge about the biology of CaP and also to determine prognosis and progression of disease. Aim: An Approach to Identify the Potential Association of ATRNL1 with Disease Progression and Prognosis in Prostate Cancer. Methods: Expression of the ATRNL1 gene was analyzed between normal and tumor samples in the GDC TCGA PRAD (Genomic Data Common: The Cancer Genome Atlas Prostate Adenocarcinoma Collection) dataset. Disease progression-related clinicopathological parameters such as serum PSA level (ng/ml) and Gleason score were associated with the expression of ATRNL1 using the same GDC TCGA PRAD dataset. To validate these findings, the expression of ATRNL1 gene was checked in our sample set of 25PCa (prostate cancer) and 15control patients. Results: In the GDC TCGA PRAD dataset, the expression of the ATRNL1 was significantly downregulated in prostate cancer tissue samples (n = 497) compared to adjacent normal (n = 52) (p<0.0001), whereas there was a significant negative correlation between the expression of the ATRNL1 and the serum PSA level (r=-0.097, p=0.042). However, no significant association was found between the lncRNA BOLA3-DT expression and the Gleason score (p > 0.05). In this study, it was found that BOLA3-DT was downregulated in PCa tissue samples compared to BPH samples (p<0.193). In the GDC TCGA PRAD dataset, it was revealed that BOLA3-DT could serve as an excellent diagnostic marker with a sensitivity of 74.6% and a specificity of 73.1% (AUC-0.808). Conclusion: ATRNL1, a novel gene, was found to be downregulated in prostate cancer. The expression of the ATRNL1 gene can serve as a diagnostic marker in prostate cancer.

Background: Due to the multiple usages of organophosphorus (OP) compounds as fertilizer, medicine for humans, and veterinary, lubricating agents, many people consume OP compounds with the intention of suicide, which severely acts on the central and peripheral nervous systems and proves fatal. Method: 180 (one hundred eighty) adult patients who consumed OP are treated with stomach wash and antidotes and I.V fluids. Before treatment their blood is collected from the median cubital vein, and a random blood sugar estimation is noted. Results: Their clinical manifestations were studied and classified with percentages. 26 (14.4%) dyspnea was the highest manifestation, followed by 20 (11.1%) hypotension, 19 (10.5%) drowsiness, 17 (9.44%) coma, 16 (8.8%) giddiness, and ataxia and the least were 8 (4.4%) ataxia. 102 (56.6%) patients had 60-200 mg% random blood sugar, and 78 (43.3%) had >200 mg% random blood sugar. The mortality was 16 (8.8%). Conclusion: The random blood sugar level does not alter the mortality of OP poisoning cases, and pseudo cholinesterase level estimation may be measured at the time of admission to classify the grades of severity in OP poisoning cases.

Background: Aluminum phosphide poisoning is a pesticide, but it is such a poison that it does not have an effective antidote; hence, it has a higher rate of mortality in suicide cases. Method: 54 (fifty-four) medical autopsies were carried out. Detailed external and internal examinations of each cadaver were studied. Staining of G.I.T. organs and slides was prepared by H and E staining and studied under a microscope. Results: The stomach was mainly impacted by ALP poison; lung, heart, and trachea congestion was more in the trachea; 48 (88.8%) edema was observed in the stomach, liver, kidney, spleen, and lungs too. Mucosal hemorrhage was noted in the stomach and lungs. Conclusion: As it is a fatal poison, availability must be controlled and kept away from children. More research is required to find out an effective antidote to reduce the mortality.

Background and Aim: Burning mouth syndrome (BMS) has been considered an enigmatic condition because the intensity of pain rarely corresponds to the clinical signs of the disease. The present study aims to explore the causes, clinical features, and therapeutic approaches. Material and Methods: This study was conducted to explore diagnostic profiles, symptom severity, and therapeutic responses in individuals diagnosed with Burning Mouth Syndrome (BMS). Material and Methods: This study was conducted to explore diagnostic profiles, symptom severity, and therapeutic responses in individuals diagnosed with Burning Mouth Syndrome (BMS). Total 150 patients were enrolled in the study. A comprehensive history was recorded, including pain characteristics, duration, onset, aggravating/relieving factors, and associated symptoms like taste alterations or dry mouth. Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) were used to assess pain severity. The Hamilton Anxiety and Depression Rating Scales were administered to identify psychological comorbidities. Results: All patients reported a burning sensation, which is the defining symptom of the syndrome. Other frequent complaints included xerostomia (63.3%) and dysgeusia (57.3%), while tingling sensations (21.3%) and sleep disturbances (34.7%) were also notable. Anxiety (42.7%) and depression (31.3%) were significant findings, affirming the psychological overlap seen in BMS. Deficiencies in vitamin B12 (24%) and iron (19.3%) suggest that metabolic or nutritional imbalances may contribute to symptom development. Conclusion: This study reaffirms BMS as a chronic neuropathic disorder with significant psychosocial and systemic overlap.

Background: Objective Structured Clinical Examination (OSCE) is a well-established method for evaluating clinical competencies in a structured and standardized manner. Traditionally, faculty members serve as assessors, and trained standardized patients simulate clinical scenarios. However, resource constraints and evolving pedagogies have led to exploration of innovative assessment models. Objectives: This study aimed to 1) Design 25 OSCE stations; 2) Conduct OSCE using 25 students as assessors and 25 students as performers, followed by role reversal; 3) Evaluate student feedback on this peer-led evaluation model. Material and Methods: A cross-sectional observational study was conducted in a medical college over two days. Twenty-five OSCE stations covering various clinical domains (history-taking, examination, counselling, and procedures) were prepared by faculty. On Day 1, 25 students acted as assessors and 25 as performers. On Day 2, the roles were switched. Subjects were trained to simulate patients. Students assessed their peers using structured checklists and global rating scales. Post-examination, participants completed a pre-validated feedback questionnaire assessing perceptions on learning, objectivity and confidence. Quantitative data were analysed using descriptive statistics and correlation tests. Result and Analysis: A majority of students (88%) correctly identified OSCE as a structured assessment tool. 84% agreed that OSCE improved their clinical skills. About 76% reported increased confidence post-assessment. Interestingly, 63% preferred student evaluators over faculty due to reduced anxiety. However, concerns about inter-rater variability and leniency were noted. Feedback indicated a need for better training of peer assessors. Graphs demonstrated trends in confidence levels, skill improvement, and evaluation preferences. Conclusion: Student-led OSCE is a feasible and effective model, especially in resource-limited settings. It enhances clinical learning and reduces anxiety but requires rigorous training of assessors to maintain objectivity.

Background: The paranasal sinuses are group of air-filled spaces surrounding the nasal cavity. These sinuses are arranged in pairs. Anatomical variations of the paranasal sinuses are common especially the ethmoidal air sinuses. Variations in the pneumatization of the sinuses may disturb sinus ventilation thus predisposing to infections from the neighboring structures. This study aims at the anatomical variations of the paranasal air sinuses, which can reduce the surgical complications during FESS, thus helps to reduce the recurrence of the disease and allows the ENT surgeon to change their operative technique. Methods: The studies were performed in CT images taken from Toshiba Aquillon 16 slice CT scanner or 64 slice multidetector Ct. Siemens healthcare scanner machines.
The following parameters are studied:
(1) Distibution of the anatomical variations of PNS among males and females. (2) Age wise distribution of anatomical variations of PNS. (3) Presence of single or multiple anatomical variations of PNS. (4) Presence of unilateral or bilateral anatomical variations of PNS. (5) Nasal Septal Deviation. (6) Paradoxical Middle Turbinate. (7) Medialised Uncinate Process. (8) Concha Bullosa. (9) Bulla ethmoidalis. (10) Agger Nasi Cell. (11) Haller Cells. (12) Frontal Cells. (13) Onodi Cell. Result: In our study most of the patients had more than one anatomical variation. Out of 100 patients studied, 88% (88) of patients had more than one anatomical variation, of these 62.5% (55) were males and 37.5% (33) were females. Only minor group of patients presented with one anatomical variation 12% (12). In our study all the patients had at least one anatomical variation.

Background: Over 3 million people are thought to be blind due to glaucoma, which affects over 60 million people globally. The primary cause of irreversible blindness in the globe is glaucoma. Primary open angle glaucoma affects 6.48 million of the 11.2 million people in India who are 40 years of age or older and have glaucoma total. Purpose: To assess and compare drug compliance of topically applied timolol gel forming solution versus travoprost 0.004% eye drops in the treatment of primary open angle glaucoma. Methods: This is an open labelled, randomized study carried out at K.R Hospital, Mysore during January 2013 to June 2014, with the informed consent of the patients after obtaining approval from the ethical committee. Forty one patients of POAG were treated with timolol gel forming solution once daily at night and another forty one patients of POAG were treated with travoprost 0.004% eye drops once daily at night for 3 months. Patients were given daily drug reminder chart at every visit, which was assessed by a follow up study done once in a fortnight for 3 months and drug compliance was assessed using a predetermined questionnaire. Results: Among travoprost group, 72.4% were of medium adherence with score 1 or 2 and 27.6% were of low adherence with score >2. Among timolol group, 86.0% were of medium adherence and 14.0% were of low adherence. Conclusion: Patients using timolol gel forming solution showed better compliance than those using travoprost eye drops.

Aim: The purpose of this study was to determine the frequency and intensity of anxiety and depression in patients with hypothyroidism. Objectives: (1). To determine the prevalence of depression and anxiety among patients diagnosed with hypothyroidism. (2). To assess the severity of depression and anxiety using standardized clinical assessment tools. Study Design: PHQ-9 and Hamilton’s Anxiety Rating Scale are used in this cross-sectional questionnaire-based study, which was conducted in a tertiary care hospital in Vizianagaram, to evaluate the depression and anxiety levels of hypothyroidism patients, respectively. Study Sample Size: A total of 84 completed questionnaires from outpatients who visited the general medicine and general surgery departments at our GGH were collected during the study period that is from July 2024 –December 2024. Results were reviewed and analyzed using descriptive statistics like frequency and percentage. Results: Over a six-month period, questionnaire data from 84 individuals was evaluated for this study. Most of the participants (90%) were women. Approximately 28.5% of the patients were between the ages of 36 and 40. In terms of anxiety and depression, the prevalence percentages were 70% and 95%, respectively. In accordance with the PHQ-9 and Hamilton’s Anxiety assessment scale, the majority of participants reported mild anxiety (36%) and mild depression (43%). Conclusion: The results of the study showed that anxiety and depression are common among people with hypothyroidism. In addition to psychiatric comorbidities including anxiety and depression, thyroid disruption has been connected to learning and memory deficiencies. Both an endocrinologist and a psychiatrist must treat and supervise patients who come with these symptoms in order to maximize their therapy. Mental morbidity can be reduced and overall health outcomes can eventually be improved with early diagnosis of an endocrine problem.

Proximal humeral fractures make up 4% of all fractures, predominantly affecting women over 50 due to osteoporosis. While many are stable and treated non-operatively, complex cases often require surgery. Locking compression plates (LCP) enhance fixation in osteoporotic bone by reducing screw loosening and improving stability. This prospective study assessed LCP outcomes in three- and four-part proximal humeral fractures in patients over 50 at SMCH Orthopaedics between November 2023 and October 2024. Ethical approval and informed consent were obtained. Twenty patients (13 with three-part, 7 with four-part fractures) underwent LCP (PHILOS) fixation and were followed for six months. Outcomes were evaluated using the Constant-Murley Score. Three-part fractures demonstrated better results in pain relief, mobility, and strength, with fewer complications than four-part fractures. Healing was faster in three-part cases (17.2 vs. 21.7 weeks), and Constant scores were higher (84.8 vs. 66.7). Four-part fractures showed increased complications, including infection, delayed union, and mechanical failure. Despite this, all patients showed functional improvement over time. LCP fixation proved to be a reliable treatment for complex proximal humerus fractures in elderly patients, especially for three-part fractures, supporting early mobilization, stable fixation, and satisfactory recovery outcomes.

Introduction: Hypertension and pre-hypertension is growing public health concerns, increasingly affecting young adults. Medical students, due to their stressful academic environment and lifestyle behaviours, may be particularly vulnerable. This study aimed to assess the prevalence of pre-hypertension and hypertension and identify associated risk factors among undergraduate medical students in Gujarat, India. Materials & Methods: A cross-sectional study was conducted from January to June 2025 among 915 undergraduate medical students at a medical college in Gujarat. Data were collected using a structured questionnaire covering demographics, lifestyle factors, and family history of hypertension. Anthropometric measurements and blood pressure were recorded following standard protocols, and blood pressure was classified according to JNC 7 criteria. Data were analyzed using SPSS version 25.0, applying chi-square tests and ANOVA. Results: Of 915 participants, 73.7% were normotensive, 20.5% had pre-hypertension, and 5.8% had hypertension. Pre-hypertension was most common among Phase III Part II MBBS students (25.9%), while hypertension was highest among interns (6.7%). Males (6.5%) had slightly higher hypertension prevalence than females (4.8%). Family history of hypertension was associated with higher rates of elevated blood pressure (p = 0.285, not significant). Inadequate physical activity (p < 0.001) and higher BMI (p < 0.001) showed strong associations with elevated blood pressure. Conclusion: More than one-fourth of medical students exhibited elevated blood pressure, with significant associations observed for inadequate physical activity and higher BMI. These findings underscore the importance of early screening, lifestyle modification, and targeted interventions to prevent hypertension and its long-term complications in young adults.

Introduction: Cataract surgery is a widely performed procedure, yet it carries a heightened risk of postoperative complications such as macular edema. Administering intravitreal anti-VEGF agents or corticosteroids during surgery has emerged as an effective approach to prevent or control this condition. This study aims to assess the effectiveness of combining cataract extraction with intravitreal anti-VEGF or steroid therapy in enhancing visual outcomes and managing postoperative macular edema. Methods: This prospective observational study evaluated the visual and anatomical outcomes of combining phacoemulsification with intravitreal anti-VEGF or steroid in 30 eyes with macular edema due to diabetic retinopathy, RVO, or AMD. Significant improvement in BCVA and reduction in central foveal thickness (CFT) were observed at 3 months postoperatively without significant adverse effects or IOP changes. These findings support the efficacy and safety of this combined approach. Results: Most patients were between 51 and 65 years old, with a male predominance. Both vision improvement p<0.00001 and reduction in macular edema p<0.00001 were statistically significant. Among the 21 patients with diabetic macular edema (DME) who received a single intravitreal injection during cataract surgery, improvement in BCVA from 1.26 (±0.32) to 0.63 (±0.29), and central foveal thickness (CFT) decreased from 589.3 (±119.53) to 292.3 (±80.05) three months later, with no significant change in intraocular pressure or side effects. In 5 patients with retinal venous occlusions, improvement in BCVA from 0.96 (±0.53) to 0.53 (±0.23), and CFT reduced from 767 (±123.48) to 377.5 (±146.60) by three months. The 4 patients with age-related macular degeneration (AMD) showed similar improvements in vision, from 1.07 (±0.22) to 0.45 (±0.2), and CFT decreased from 508.8 (±122.79) to 277.6 (±70.98) at three months. Conclusions: The use of intravitreal anti-VEGF or steroid injections in patients undergoing cataract surgery with macular edema, when combined with the surgery, yields better outcomes. This approach demonstrated significant improvement in both visual acuity and macular edema morphology, with the data showing a positive clinical response.

Background: Open globe injuries are among the most serious ophthalmic emergencies and often lead to significant visual impairment, especially in younger individuals. Prompt and effective surgical management is essential, particularly when the posterior segment is involved. Vitrectomy has emerged as a key intervention in such cases, but visual recovery varies widely depending on several clinical factors. This study was conducted to evaluate the prognostic indicators that influence visual outcomes following vitrectomy in patients with open globe injuries. Methods: This prospective observational study was carried out at Shri C.H. Nagri Municipal Eye Hospital, Ahmedabad, over a two-year period from June 2019 to July 2021. A total of 58 eyes of 58 patients, all of whom had sustained open globe injuries and subsequently underwent pars plana vitrectomy (PPV), were included in the analysis. Only those with posterior segment involvement following primary globe repair were selected. Preoperative assessment included documentation of injury zone, presence of intraocular foreign body (IOFB), vitreous hemorrhage, nucleus drop, and retinal detachment. Surgical interventions included PPV alone or in combination with lensectomy and IOFB removal, depending on the clinical scenario. Visual acuity outcomes were evaluated using best corrected visual acuity (BCVA) and were compared pre- and postoperatively at 1 week, 1 month, and 3 months using paired t-tests. Results: Patients with Zone I and Zone II injuries showed statistically significant improvement in BCVA following vitrectomy (p < 0.05), while those with Zone III injuries showed minimal gains. Significant improvement was also observed in cases with IOFB, vitreous hemorrhage, and nucleus drop. Conversely, the presence of retinal detachment was associated with limited visual recovery. All surgical modalities led to significant improvements in BCVA, with no notable difference in outcome between PPV alone and combined procedures. Conclusion: Visual outcomes following vitrectomy in open globe injuries are significantly influenced by the zone of injury and preoperative retinal status. Early intervention, especially in anterior segment injuries without retinal detachment, yields favorable results.

Introduction: Diabetes is a class of metabolic disorders typified by hyperglycaemia brought on by deficiencies in either the action or secretion of insulin, or both. Diabetes-related chronic hyperglycaemia is linked to long-term harm, malfunction, and failure of several organs, including the kidneys, eyes, and nerves. The most crucial indicator of the kidneys’ ability to remove different chemicals from the blood is the Glomerular Filtration Rate (GFR). The National Kidney Foundation (NKF) and Kidney Disease Outcomes Quality Initiative (KDOQI) released guidelines to utilise estimated GFR (eGFR) based on serum creatinine and further taking age, racial origin, and gender into account in an effort to get beyond the limits of serum creatinine. Cystatin C has been suggested as a substitute indicator of renal function because creatinine measurements and their application as a GFR estimate have several issues. The purpose of this study was to determine how useful this more recent molecule is for determining GFR. Materials and Methods: Present study is a cross-sectional prospective study. 60 Type II Diabetes mellitus cases diagnosed within two-year enrolment with normal serum creatinine were enrolled. Serum Cystatin C was estimated by turbudometric immunoassay & Creatinine by Modified Jaffe’s Reaction.  Hoek’s formula used for Estimation of GFR from serum Cystatin C & Cockcroft and Gault Formula used for Estimation of GFR from serum Creatinine. Observations and Results: Mean ±SD of age was 51.06 ±6.91. Male cases were 38 (63.3 %) & female cases were 22 (36.6 %). Height (cm) Mean ±SD was 155.91 ±4.70. Weight (kg) Mean ±SD was 66.93 ± 7.48. statistically Significant difference was observed in GFR calculated by different methods amongst males. However, it was statistically non-significant amongst females. statistically Significant difference was observed in GFR calculated by different methods amongst cases who had diabetes for more than 1 year. However, it was statistically non-significant amongst Newly diagnosed diabetes. Conclusion: To conclude, Cystatin C is an alternative filtration marker for estimating GFR which is more useful for detecting early renal impairment in Type II diabetic patients.

Introduction: Lateral epicondylitis, commonly known as tennis elbow, is one of the most prevalent musculoskeletal conditions affecting the upper limb. It is characterized by pain and tenderness over the lateral epicondyle of the humerus, primarily due to overuse and degeneration of the extensor carpi radialisbrevis (ECRB) tendon. Aims: This study compares the clinical effectiveness, functional outcomes, recovery duration, cure rates, and complication profiles of corticosteroid injection versus dry needling in the treatment of lateral epicondylitis. Materials & Methods: This prospective, comparative, hospital-based study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital (CNMCH), Kolkata, from 1st June 2023 to 31st December 2024. A total of 60 patients diagnosed with lateral epicondylitis were included in the study using a complete enumeration technique, with 30 patients allocated to each treatment group. Result: In this study of 60 patients, corticosteroids showed faster short-term improvement in pain and function, with significantly lower VAS and PRTEE scores at 2 weeks (VAS: 5.2 ± 0.407 vs. 5.7 ± 0.466, p = 0.0001; PRTEE: 49.7 ± 6 vs. 54.2 ± 6.3, p = 0.0063), but dry needling demonstrated superior long-term outcomes at 12 weeks (VAS: 0.7 ± 0.466 vs. 2.1 ± 0.845, p = 0.0001; PRTEE: 10.3 ± 1.67 vs. 19 ± 2.98, p = 0.0001), with fewer recurrences and sustained improvement. Conclusion: This study found corticosteroids provided quicker short-term relief in lateral epicondylitis but had higher recurrence and adverse effects, while dry needling offered slower yet more sustained improvement with fewer complications. Thus, dry needling appears to be the safer and more effective long-term treatment.

Leiomyoma, a rare benign tumor of the breast, primarily occurs in the subareolar area and is found in both men and women. A case involving a 38-year-old woman with a progressively enlarging right breast lump was reported, diagnosed through histopathology as leiomyoma. Histological features included spindle-shaped cells without atypia or mitotic figures, confirmed by immunohistochemical staining. Differential diagnoses include fibroadenoma and leiomyosarcoma. Treatment typically involves local excision, with low recurrence rates noted. Overall, breast leiomyoma remains an uncommon condition, often mimicking other benign tumors in clinical presentation.

Background and Rationale: Medical education is among the most stressful academic pathways, with students reporting high stress levels. This study aimed to evaluate exam-related stress, mental well-being, and associated knowledge, attitudes, and practices (KAP) among MBBS students. Objectives: To assess anxiety among using the Generalized Anxiety Disorder-7 (GAD-7) scale, evaluate and compare students’ KAP regarding exam stress management and identify effective stress-relief strategies. Materials and Methods: A cross-sectional study was conducted among MBBS students at Dr. V.M. Government Medical College, Solapur. A self-administered questionnaire collected demographics and assessed students’ KAP regarding exam stress management. The GAD-7 scale was used to define anxiety and categorize participants into low and high anxiety groups. Responses to KAP items were recorded using a 5-point Likert scale (1 = strongly agree to 5 = strongly disagree). Results: Among 202 participants (mean age: 20.65 ± 1.8 years; 61.4% males), 59 (29.2%) had anxiety; The high-anxiety group reported less sleep (median [IQR]: 4 [2] vs. 3 [2.5], p < 0.001), less exercise (4 [2] vs. 3 [2], p < 0.001), lacked structured study schedules (3 [1] vs. 3 [2], p = 0.007), lower awareness of stress strategies (3 [2] vs. 2 [1], p < 0.001), more caffeine use (59.3% vs. 43.4%, p = 0.039), and decreased interaction with friends/family (40.7% vs. 24.5%, p = 0.021); Regression analysis identified prior anxiety diagnosis (OR = 3.22, p = 0.003), lack of stress awareness (OR = 55.0, p < 0.001), insufficient sleep (OR = 6.54, p < 0.001), less exercise (OR = 7.87, p < 0.001), and caffeine use (OR = 1.91, p = 0.040) as significant independent predictors. Interaction with friends/family was protective. Conclusion: Anxiety is prevalent among medical students. Structured academic planning, healthy routines, and supportive relationships offer protective benefits and could be encouraged.

Background: Hypertriglyceridemia is linked to cardiovascular diseases, but its role in acute thrombotic stroke is unclear. This study evaluates the relationship between hypertriglyceridemia and acute thrombotic stroke. Methods: A retrospective cohort analysis of 480 patients with acute thrombotic stroke was conducted. Data included serum triglyceride levels, stroke severity (NIHSS), and various demographic and clinical characteristics. Multivariate regression models assessed the association between triglyceride levels and stroke severity. Results: Higher triglyceride levels were significantly associated with lower stroke severity scores. Patients in the highest triglyceride quartile had a mean NIHSS score of 8.2, compared to 12.5 in the lowest quartile (p < 0.05). Higher triglyceride levels were also linked to increased prevalence of diabetes, obesity, and smoking, as well as higher likelihood of major adverse cardiovascular events (MACE) and poorer functional outcomes (mRS) at 3 months post-stroke. Conclusion: Hypertriglyceridemia is associated with lower stroke severity and better outcomes in acute thrombotic stroke. Further research is needed to confirm these findings and explore underlying mechanisms.

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Background: Most women have a reproductive life plan, and knowledge of appropriate options for birth control is imperative to execute this plan, making it an integral part of obstetric care. Awareness of the basket of choices for family planning by the healthcare provider guides the woman to individualize the method best suited for her needs. Aim: To study the trend of reproductive choices of couples who underwent family planning procedures and to study the various factors affecting their choices. Methods: Data from 1935 participants aged 22 – 45 years who underwent family planning procedures in Government Medical College Hospital, Ariyalur, from January 2021 to December 2022(2 years) were analysed. Age, Educational qualification, Economic status, Presence of medical disorders, number and sex of living children, Partner’s educational status, Occupation, and Method of sterilisation procedures were studied. Result: Female sterilisation was the widely preferred procedure in 99% of couples opting for permanent methods, with concurrent sterilisation accounting for 66% of cases. The mode of delivery, i.e, caesarean section, had a major influence on the couple’s decision to choose tubectomy. Despite the taboo associated with a desire for a male child, 24% of couples with only girl children underwent permanent sterilisation. Discussion: Counselling regarding various family planning methods needs to be improved. Long-acting reversible contraceptive methods, Vasectomy, have to be widely publicised, counselled so that deserving couples can make a sensible choice.

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Background: Femoral neck fractures are a common cause of disability, especially among older adults. The Femoral Neck System (FNS) has been developed to improve fixation stability and functional recovery compared to conventional fixation methods such as cannulated screws (CS/CCS/3CS) and medial plate augmentation. This systematic review aims to explore recent surgical techniques used for femoral neck fractures in adults and elderly and investigate the comparative analysis with the current literature. Method: The systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search encompassed an extensive database including PubMed, MEDLINE, ScienceDirect, and Cochrane Library. Studies published from 2015 to 2025 were included in the analysis. The quality of the included studies was evaluated using the appropriate tools suited to the study design. The synthesis and analysis of data included a narrative summary of study characteristics, surgical techniques used, main outcome measures and key findings. Primary outcomes included operative parameters, fracture healing time, Harris Hip Score (HHS), complication rates (nonunion, malunion, osteonecrosis, hardware failure), and reoperation risk factors. Biomechanical outcomes included stress distribution, stiffness, and displacement under simulated loading. Result: FNS generally yielded shorter operative times, reduced fluoroscopy use, faster fracture healing, higher short-term HHS, and fewer complications compared to CS/CCS, especially in younger and middle-aged patients and in Pauwels type III fractures. Biomechanical studies demonstrated greater stability at lower Pauwels angles. In elderly patients with low bone mass, CCS sometimes provided comparable or better outcomes, with lower blood loss, shorter hospital stays, and reduced costs. No significant differences were noted in long-term union rates. Conclusion: FNS offers functional and biomechanical advantages in selected patients but is not universally superior. The selection of surgical procedures must be tailored to the individual, taking into account factors such as the patient’s age, the pattern of the fracture, the quality of the bone, and the implications for available resources.

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Background: Diabetic neuropathy is a common microvascular complication of Type 2 Diabetes Mellitus (T2DM), primarily attributed to chronic hyperglycemia. Poor glycemic control leads to metabolic and vascular alterations that impair peripheral nerve function. Nerve Conduction Velocity (NCV) serves as a sensitive electrophysiological marker for evaluating early diabetic neuropathy. This study aims to analyze the physiological correlation between glycemic control, as measured by HbA1c levels, and NCV in patients with T2DM. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital from November 2024 to April 2025. A total of 120 patients with diagnosed T2DM for at least 5 years were enrolled and stratified into three groups based on HbA1c levels: Group A (<7%), Group B (7–9%), and Group C (>9%). NCV studies were performed on the median, ulnar, and peroneal nerves using standard surface electrode techniques. Statistical correlation between HbA1c levels and NCV values was assessed using Pearson’s correlation coefficient and ANOVA. Results: The mean NCV values for the median nerve were 56.3±4.1 m/s in Group A, 50.9±3.8 m/s in Group B, and 45.2±4.3 m/s in Group C (p < 0.001). Similar trends were observed for the ulnar nerve (Group A: 55.1±3.7 m/s, Group B: 49.6±3.5 m/s, Group C: 43.8±4.0 m/s) and the peroneal nerve (Group A: 47.8±3.2 m/s, Group B: 41.2±3.6 m/s, Group C: 35.4±3.9 m/s). A strong inverse correlation was observed between HbA1c levels and NCV (r = -0.72, p < 0.001), indicating that higher HbA1c levels were associated with reduced NCV across all nerves tested. Conclusion: The study establishes a significant negative correlation between glycemic control and nerve conduction velocity in patients with T2DM. These findings underscore the importance of maintaining optimal glycemic levels to prevent or slow the progression of diabetic neuropathy.

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Patellar instability is the morphologic abnormality in patello femoral joint which leads to recurrent patellar dislocations. Magnetic resonance imaging (MRI) is an effective method for evaluating the anatomy and congruence of patello femoral joint. Magnetic resonance imaging is reliable in identifying the risk factors for chronic patellar instability and in assessing knee joint damage associated with patellar dislocation. Purpose: The objectives of the study were to evaluate and characterize the common risk factors associated with patellar instability using MRI and to describe the MRI findings associated with patellar injury/dislocation.  Materials and Methods: A retrospective study was undertaken in sixty-nine patients below 45 years referred to the Department of Radio Diagnosis, St. John’s Medical College Hospital, Bangalore, for MRI knee over two years who were diagnosed to have patello-femoral instability and/or injury. Patella alta, lateralisation of tibial tuberosity, trochlear dysplasia, patellar tilt were the underlying risk factors analyzed. Also, the associated findings such as torn medial patellofemoral ligament, marrow edema, thinning of patellar cartilage and anterior cruciate ligament injury were assesssed. Results: The age range of patients in this study ranged from 13 to 45 years with predominant population pertaining to 21-30 years (43.5 %). Trochlear dysplasia was in 27 patients (39 %) and the positive cases were further divided into different types based on Dejour classification out of which most common type in this study was Type C. Patella alta was seen in 46.7 % cases. 16 cases out of 69 patients showed evidence of patellar tilt (23 %). Increased T.T-T. G was seen in 5 cases. Patellar articular cartilage damage was seen in 40 % cases. The cases showing evidence of patellar cartilage defect were further divided into 4 grades with Grade 1 being the most common in this study present in 14 patients. ACL injury was seen in 52.2 % of the cases and these were noted to be significantly more common in type A trochlear dysplasia (p value – 0.018) in comparison to non-Type A trochlear dysplasia. Conclusion: MRI is a more effective method for evaluating the anatomy and congruence of patello femoral joint. MRI clearly shows the cartilage and surrounding soft tissues of the joint. Recurrent patellar dislocations occur in individuals with underlying risk factors. MRI plays a crucial role in identifying the risk factors for chronic patellar instability and in assessing knee joint damage associated with patellar dislocation.

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Introduction: Dermatoglyphics is the study of epidermal ridge patterns on the fingers, palms, and soles. The correlation of dermatoglyphic patterns with many chromosomal abnormalities and genetic diseases is evidenced by many researchers in the world. As cervical cancer has strong genetic association, the dermatoglyphic pattern study can be useful as a screening method for early diagnosis and to find out the individuals at risk. Aims: To compare the angle between line drawn from axial triradius ‘t’ at base of palm between the thenar and hypothenar eminences to triradius ‘a’ (at base of index finger) and to triradius ‘d’ (at base of little finger) inbetween cervical cancer patient and control group. Materials and Method: This hospital based cross-sectional analytical study was conducted in different Medical Colleges & Hospital. Histopathologically confirmed seventy two cases of cervical carcinoma of above 15 years of age are considered as case & their first degree relatives were selected as control who are above 15 years of age. The axial and digital triradius in palmar print was measured by using Ink method. Result: A case-control study was done among seventy-two cases of histopathologically confirmed cervical cancer patient of above 15 years of age and their first-degree relatives as control group of 72 females of above 15 years of age. The palmar prints of both palms were collected by ink method and atd angle of each print was measured. Data were analyzed by taking mean and standard deviation and tested by student’s t-test, considering p-value<0.05 as statistically significant. Discussion: Statistically highly significant values are observed in the mean atd angle of the right hand of cervical cancer patient (40.07± 3.24) compared to control (44.57±6.39) and also left hand of cervical cancer patient (41.49± 4.07) compared to control (46.88±7.83). Conclusion: Increased atd angle of both hand has strong predilection for the development of cervical cancer.

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Background: Gallbladder diseases, particularly chronic cholecystitis and cholelithiasis, represent some of the most common gastrointestinal conditions requiring surgical intervention. Cholecystectomy remains the definitive treatment for symptomatic gallstone disease and chronic inflammation. Histopathological evaluation of gallbladder specimens obtained after surgery plays a crucial role not only in confirming the preoperative diagnosis but also in detecting incidental pathologies, including premalignant and malignant lesions, which may significantly alter patient management. Objectives: This study aimed to analyze the clinicopathological spectrum of gallbladder specimens obtained from patients undergoing cholecystectomy for chronic cholecystitis and cholelithiasis, to determine demographic trends, clinical presentation, histological patterns, and the presence of any incidental findings. Materials and Methods: This observational study was conducted in the Department of Surgery at Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, over a period of 33 months, from May 2022 to January 2025. A total of 150 patients aged between 15 and 65 years, who underwent cholecystectomy for clinically and radiologically diagnosed chronic cholecystitis and cholelithiasis, were included. Relevant demographic and clinical details were recorded. Resected gallbladder specimens were subjected to gross examination followed by histopathological analysis using hematoxylin and eosin staining. The findings were documented and correlated with clinical data. Results: Among 150 patients, females predominated, with a female-to-male ratio of approximately 3:1. The majority of patients were in the 31–50-year age group. The most common presenting symptoms were right upper quadrant pain (94%), dyspepsia (68%), and nausea/vomiting (45%). Histopathological examination revealed chronic cholecystitis as the predominant finding, seen in 82% of cases, followed by chronic cholecystitis with cholesterolosis, xanthogranulomatous cholecystitis, and dysplastic changes. Incidental gallbladder carcinoma was detected in 2% of specimens, highlighting the importance of routine histological evaluation of all cholecystectomy specimens. Conclusion: Chronic cholecystitis associated with gallstones is the most common indication for cholecystectomy, especially among middle-aged females. Histopathological examination remains indispensable in detecting incidental premalignant and malignant lesions, which can have significant therapeutic and prognostic implications. Routine submission of all gallbladder specimens for microscopic evaluation is strongly recommended to avoid missing clinically silent but critical findings.

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Objective: The present study was to evaluate and compare the diagnostic utility of arterial lactate and serum procalcitonin levels in patients with MSAP and SAP, and to determine which biomarker better predicts pancreatic infection. Methods: This prospective comparative study was conducted at KIMS and PBM Hospital, Bhubaneswar, from February 2023 to January 2025. Adult patients (18-75 years) diagnosed with MSAP or SAP within 72 hours of symptom onset were included. Arterial lactate levels were measured within 2 hours of admission via ABG, and serum procalcitonin levels within 12 hours. Patients with malignancy, liver failure, sepsis from other causes, or cardiopulmonary comorbidities were excluded. Statistical analysis involved chi-square test, t-test, ANOVA, and calculation of sensitivity, specificity, PPV, and NPV. Results: Out of the study cohort (~200 patients), elevated arterial lactate (>2 mmol/L) and serum PCT (>=1 ng/dL) were significantly associated with increased pain severity, ICU admission, longer hospital stay, and worse outcomes. Arterial lactate was found to have higher sensitivity for early detection of pancreatic hypoperfusion and sepsis, while procalcitonin demonstrated better specificity for identifying bacterial infection. Combined use improved diagnostic accuracy. Conclusion: Both arterial lactate and serum procalcitonin are valuable biomarkers in predicting pancreatic infection in MSAP and SAP. Arterial lactate, due to its early rise in response to tissue hypoxia, may serve as a more sensitive early indicator, while serum procalcitonin is a more specific marker for bacterial sepsis. Incorporating both markers into clinical protocols can enhance early risk stratification and management.

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Background: Premature canities (PC), defined as the onset of hair greying before the age of 30, has multifactorial etiology involving genetic, nutritional, and environmental factors. Micronutrient deficiencies, particularly in haemoglobin, serum ferritin, and vitamin B12, have been implicated but remain insufficiently studied. Aim: To evaluate the association of haemoglobin, serum ferritin, and vitamin B12 levels with premature canities in individuals aged <30 years. Methods: A case-control study was conducted over two years in a tertiary care dermatology OPD, enrolling 25 clinically diagnosed PC patients and 25 age- and sex-matched controls. Clinical data, scalp involvement (graded by Hair Whitening Scale), and trichoscopic features were documented. Biochemical assays for haemoglobin, serum ferritin, and vitamin B12 were performed. Statistical analysis was carried out using Fisher’s exact test. Results: The mean age of onset was 16–25 years, with a male predominance (68%). Mild PC was most common (40%), with frontal and vertex scalp predominance. Tiger hair (88%) and homogeneous depigmentation (80%) were frequent trichoscopic findings. Serum ferritin <15 ng/ml was significantly associated with PC severity (p=0.028). No significant association was observed between haemoglobin (p=0.5) or vitamin B12 (p=1.0) levels and disease severity. Conclusion: Low serum ferritin levels show a significant association with the severity of premature canities, suggesting iron deficiency as a potential modifiable risk factor. While haemoglobin and vitamin B12 deficiencies were common, their role in disease severity remains unclear. Early nutritional evaluation and intervention may help in managing PC.

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Background: Acute kidney injury (AKI) is known to independently increase the risk of death for in-hospital, especially particularly in critically ill patients, yet there is limited research from general medical wards, particularly in resource-limited settings. This retrospective analysis aimed to assess the impact of AKI on hospital mortality among patients admitted to a general medical ward at a tertiary care center, as well as to identify factors associated with increased mortality among those with AKI. Method: The study reviewed demographic, clinical, and outcome data from 100 patients admitted over a six-month period. Patients were categorized according to whether or not developed AKI, diagnosed using standard criteria. Clinical variables, including AKI status, need for inotropes, mechanical ventilation, and underlying diseases, were analyzed and compared between patients who survived their hospital stay and those who did not. Among patients with AKI, possible predictors of mortality were evaluated. Variables found to be significant in the univariate analysis were subsequently assessed through multivariate regression to identify independent risk factors. Results: Nineteen of the 100 patients (19%) developed AKI. The mortality rate among patients with AKI was significantly elevated (21%) in contrast to those without AKI (1.2%), indicating a strong association between AKI and risk of death. In the AKI subgroup, independent predictors of mortality included having a hematological malignancy, needing inotropic support, and elevated serum creatinine levels upon admission. CKD and hospital-acquired AKI did not show a significant association with death. Conclusions: The findings highlight that AKI is prevalent among medical ward admissions and represents an independent predictor of in-hospital mortality. Hematological malignancy, the need for inotropes, and elevated admission serum creatinine are key factors linked to higher risk of death in AKI patients. Additional large-scale, prospective studies are necessary to gain a deep understand AKI outcomes and develop effective prevention and management strategies, particularly in settings with limited resources.

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Background: Optic canal connects orbit to middle cranial fossa. Optic nerve and ophthalmic artery pass through this canal. The aim of the present study is to make morphometric and anatomical observations of endocranial opening of optic canal. Materials and Methods: The observations were conducted on 30 dry adult human skulls. The observations were made on shape, margins, confluence, septations, dimensions, and distance of optic foramen from apex of petrous temporal bone. Result: On morphometric observation, transverse diameter (TD) was 6.00 mm and 6.15 mm on the left and the right side, respectively. The vertical diameter (VD) was 5.14 mm on the left side and 4.82 mm on the right side. The distance of optic foramen to apex of petrous temporal bone was 21.84 mm on the left side and 21.90 mm on the right side. Conclusion: In the present study we attempt to provide a comprehensive anatomical and morphometric data of optic foramen that may help ophthalmologists and neurosurgeons during surgery.

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Background: Ilioinguinal, iliohypogastric, and genitofemoral nerves are together known as “border nerves” of the lumbar plexus. Aim of this study was to find out the variations in formation and branching pattern of these nerves and correlate with their clinical relevance. Materials and Methods: For this study 30 formaldehyde preserved cadavers were used, and the nerves were studied on both the sides, thus making the sample size of 60. Results: Iliohypogastric nerve was absent in 6.6% and double in 1.6%. It was prefixed with a twig from T12 in 6.6% and had origin from both L1 and L2 in 1.6%. The ilioinguinal nerve was absent in 3.3% and double in 3.3%. The genitofemoral nerve exhibited a large number of variations. It was absent in 1.6%. Early division of the nerve prior to emergence from the psoas major muscle was noticed in 13.3%, and early division soon after emergence from the muscle was noted in 3.3%. In one cadaver, on one side, genital branch was absent, and it continued as femoral branch only. In another cadaver, the nerve continued as genital branch only. In two other cases, genital and femoral branch- es were seen to arise separately from the lumbar plexus. The nerve had its origin from L1 and L2 in 25%, L2 and L3 in 25%, L1 in 3.3%, L2 in 46.66%, and L3 in 1.6% of the cases. Conclusion: Knowledge of these variations would be of immense help during surgical approach and giving nerve block for anesthesia and postoperative analgesia in this region.

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Background: Supraclavicular brachial plexus block is widely used for upper extremity surgeries due to its dense and rapid onset of anaesthesia. Traditional methods to assess block success, such as sensory and motor evaluations are subjective and may be delayed. Perfusion index (PI) is a non-invasive, objective parameter derived from pulse oximetry, which has emerged as a promising tool for early detection of sympathetic blockade. Objective: To evaluate the effectiveness of ultrasound-guided supraclavicular block using perfusion index and traditional assessment methods. Methods: A study was conducted on 30 ASA status I and II patients posted for upper limb surgery under ultrasound-guided supraclavicular block. PI values were recorded at baseline and every 5 minutes up to 30 minutes post-block. Sensory and motor block assessments were performed using the pin-prick test and modified Bromage Scale, respectively. PI ratio was calculated as the ratio between PI at 10 minutes and baseline PI. Haemodynamic parameters and block related complications were also monitored. Results: There was a significant increase in PI values post-block, with the mean PI rising from 1.51 ± 0.97 at baseline to 9.39 ± 3.30 at 20 minutes (p < 0.001). The mean PI ratio was 5.54 ± 3.60. The mean time for sensory block onset (pin-prick positivity) was 7.80 ± 1.33 minutes, mean motor block onset time was 6.83 ± 1.68 minutes. Haemodynamic stability was maintained throughout and no complications were reported. Conclusion: The perfusion index is a reliable, rapid and objective marker for predicting the success of supraclavicular brachial plexus block. It allows early identification of block onset and may reduce reliance on subjective assessment methods, improving clinical efficiency in regional anaesthesia practice.

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Background: Nasotracheal intubation is essential for oral and maxillofacial surgeries. Video laryngoscopes enhance visualization, but advancing the endotracheal tube through the glottis remains challenging. The use of a bougie may facilitate this process, potentially improve success rates and reduce trauma. Objective: To compare the effectiveness, efficiency, and safety of nasotracheal intubation using a video laryngoscope with versus without a bougie. Methods: This randomized controlled study was conducted at the Operation Theatre of Department of Anaesthesiology, SMS Medical College, Jaipur. Sixty adult patients scheduled for elective oral and maxillofacial surgery under general anaesthesia were enrolled and randomized into two groups: (1) Group A: Video laryngoscope with bougie. (2) Group B: Video laryngoscope without bougie.
Primary outcome: time to successful intubation; Secondary outcomes: ease of intubation, number of attempts, need for additional manoeuvres, and complications.
Results: Group B (without bougie) had significantly shorter intubation time (34.87 ± 5.61 s) compared to Group A (48.63 ± 6.35 s, p < 0.001). However, Group A showed higher first-attempt success (86.7% vs. 70%), fewer required manoeuvres (p = 0.034), and lower complication rates (nasal trauma 13.3% vs. 26.7%). Conclusion: While intubation was faster without a bougie, the use of a bougie improved first-attempt success, reduced trauma, and minimized the need for additional manoeuvres. Bougie-assisted nasotracheal intubation may offer safer and more controlled outcomes, especially in anticipated difficult airways.

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Background: Spinal anaesthesia is a cornerstone of regional anaesthetic techniques, especially for infraumbilical surgeries due to its rapid onset, technical simplicity, and cost-effectiveness. However, the relatively limited duration of local anaesthetics poses a challenge in procedures of longer duration. To address this limitation, the addition of adjuvants to prolong anaesthetic action without compromising safety has become a growing area of research. Dexmedetomidine, a highly selective α2-adrenergic agonist, has been proposed as a potential intrathecal adjuvant owing to its analgesic, sedative, and sympatholytic properties. Objective: The primary aim of this study was to evaluate the clinical effectiveness and safety of adding 3 mcg dexmedetomidine to 15 mg of 0.5% isobaric levobupivacaine in patients undergoing elective infraumbilical surgeries under spinal anaesthesia. Specific objectives included comparing onset time, duration, and extent of sensory and motor block, as well as haemodynamic changes and side effects. Methods: This prospective, double-blind, randomised controlled trial included 60 adult ASA I/II patients scheduled for elective infraumbilical surgeries. Patients were divided into two equal groups. Group A received 3 ml of 0.5% isobaric levobupivacaine with 3 mcg dexmedetomidine, while Group B received the same volume of levobupivacaine with 0.3 ml normal saline. Block characteristics, vital parameters, and adverse events were recorded and analysed using appropriate statistical tools. Results: Patients in Group A experienced significantly faster onset and longer duration of both sensory and motor blocks compared to Group B (p<0.001). Group A also demonstrated prolonged postoperative analgesia without significant increase in haemodynamic instability or side effects. The incidence of hypotension, bradycardia, nausea, and urinary retention remained low and comparable between the groups. Conclusion: The addition of a low dose (3 mcg) of intrathecal dexmedetomidine to isobaric levobupivacaine significantly improves the quality and duration of spinal anaesthesia while maintaining a favourable safety profile. It offers an effective strategy to enhance intraoperative anaesthesia and postoperative analgesia in infraumbilical surgeries.

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Background: Neonatal hypoglycemia is a common metabolic disturbance in newborns, often transient but potentially harmful if severe or prolonged. It is increasingly recognized as a significant risk factor for neurodevelopmental impairment, especially when diagnosis or treatment is delayed. Aim: To evaluate the neurodevelopmental outcomes of neonates diagnosed with hypoglycemia and to assess the relationship between the severity and duration of hypoglycemia with developmental delays. Methods: A prospective observational study was conducted at Nalanda Medical College and Hospital, Patna, from July. 2023 to June 2025. A total of 100 neonates diagnosed with hypoglycemia were enrolled. Neurodevelopmental assessments were carried out at 6months 12 months,18 months using standardized tools. Data were analyzed using SPSS version 23.0. Statistical tests including Chi-square and t-tests were applied to assess associations, with a p-value < 0.05 considered significant. Results: Of the 100 enrolled neonates, 91 completed the 18-month follow-up. Among them, 68 (74.7%) had normal development, 15 (16.5%) had mild delay, and 8 (8.8%) had moderate to severe delay. A significant association was found between the severity of hypoglycemia and developmental outcomes (p < 0.001). Motor delays were the most common (78.3%), followed by language (60.9%) and cognitive delays (43.5%). Low birth weight and prolonged hypoglycemia (>6 hours) were significant risk factors for developmental delay (p = 0.001 and p < 0.001, respectively). Conclusion: Neonatal hypoglycemia, particularly when severe or prolonged, is significantly associated with adverse neurodevelopmental outcomes. Early detection and timely intervention are essential to prevent long-term impairments. Recommendations: Routine glucose monitoring in at-risk neonates, aggressive management of low glucose levels, and structured neurodevelopmental follow-up should be standard components of neonatal care. Further multicentric studies are recommended to validate findings and refine clinical guidelines.

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Background: Nutritional rickets is a preventable pediatric disorder of bone mineralization that persists in developing countries despite abundant sunlight. Its prevalence remains high in urban slum populations due to poor maternal nutrition, sociocultural practices, and inadequate child feeding. Objectives: This study aimed to identify the risk factors and clinical characteristics of nutritional rickets among children aged 1 to 4 years residing in urban slums. Methods: A community-based cross-sectional study was conducted among 566 systematically selected children in Dharavi, Mumbai. Data were collected using a pretested questionnaire, clinical examination, biochemical investigations (serum calcium, phosphate, alkaline phosphatase, 25(OH)D), and radiological assessment. Statistical analysis included descriptive measures and chi-square tests, with p<0.05 considered significant. Results: The prevalence of nutritional rickets was 9.54%. Biochemically, 70.37% of affected children had hypocalcemia, 72.22% hypophosphatemia, and 81.48% elevated alkaline phosphatase. Radiological findings included cupping (88.88%), splaying (53.7%), and fraying (48.14%). Maternal determinants included lack of calcium supplementation (83.33% of cases), veil use (51.85%), low milk intake, and infrequent non-vegetarian diet, all significantly associated with rickets. Among child-related factors, higher birth order, inadequate sunlight exposure, and poor milk intake were strongly associated, while type of weaning food showed no significant association. Conclusion: Nutritional rickets in urban slum children is strongly linked to maternal dietary practices, sociocultural habits restricting sun exposure, and inadequate child nutrition. Targeted maternal supplementation, health education, and promotion of safe sun exposure are essential preventive strategies.

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Background: Umbilical and para-umbilical hernias are common anterior abdominal wall defects in adults, often associated with risk factors such as obesity, multiparity, and chronic intra-abdominal pressure. Surgical repair is the only definitive treatment, with mesh reinforcement being the preferred approach for reducing recurrence. Objectives: To evaluate the clinical profile, surgical management, and postoperative outcomes of adult patients with umbilical and para-umbilical hernia. Materials and Methods: This prospective clinical study was conducted at Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, over one year. A total of 50 adult patients with umbilical (n=30) and para-umbilical hernia (n=20) were enrolled. Data on demographics, risk factors, clinical presentation, type of surgical repair, and postoperative outcomes were collected and analyzed. Results: Umbilical hernia was more common (60%) than para-umbilical hernia (40%). The majority of patients were in the 41–50 year age group, with a female predominance (64%). Obesity and multiparity were the most frequent risk factors. Swelling at the umbilical region was the universal presentation, while incarceration and strangulation were observed in 20% and 10% of cases respectively. Most defects measured 2–4 cm, and mesh repair was the predominant method (76%). Postoperatively, 78% had uneventful recovery. Complications included surgical site infection (10%), seroma (6%), and hematoma (4%). At 6 months, recurrence occurred in one para-umbilical hernia case (2%). Conclusion: Umbilical hernia was more prevalent than para-umbilical hernia, particularly among middle-aged, obese, multiparous women. Mesh repair provided favorable outcomes with minimal recurrence, reinforcing its role as the standard of care for adult umbilical and para-umbilical hernia management.

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Background: Nutritional rickets, primarily caused by vitamin D and calcium deficiency, remains a prevalent yet preventable condition among children in low-resource settings. Urban slums, characterized by poor nutrition, inadequate sun exposure, and low maternal literacy, pose a high risk for childhood rickets. Objective: To assess the prevalence and clinical profile of nutritional rickets among children aged 1 to 4 years in selected urban slum areas. Methods: A community-based cross-sectional study was conducted among 566 children aged 12 to 59 months residing in urban slums. Data were collected through structured interviews, clinical examination, and radiological assessment where indicated. The prevalence of rickets and its association with demographic variables, birth weight, and birth order were analyzed. Results: Nutritional rickets was observed in 9.54% of the study population. A higher prevalence was noted among children of fourth birth order (38.89%) and those with low birth weight (<2.5 kg) (6.7%). Symptoms such as leg weakness (64.81%), pain during walking (59.25%), and excessive falling (57.4%) were common. Clinical signs included enlarged wrists (77.77%), rib beading (75.92%), and bow legs (51.85%). Nearly half of the mothers were illiterate, and most children belonged to upper-lower and lower-middle socioeconomic classes. Conclusion: Nutritional rickets continues to be a public health concern in urban slums. Low birth weight, high birth order, and maternal illiteracy were significantly associated with increased risk. Community-level interventions, maternal education, and nutritional supplementation are essential to reduce disease burden.

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Background: Acute appendicitis is a common surgical emergency, with open and laparoscopic appendicectomy being the standard surgical approaches. While open appendicectomy is widely practiced due to its simplicity and low cost, laparoscopic appendicectomy offers potential benefits of reduced pain, faster recovery, and better cosmetic outcomes. Aim: To prospectively compare open versus laparoscopic appendicectomy with respect to operative parameters, postoperative pain, complications, hospital stay, and recovery. Materials and Methods: This prospective comparative study was conducted in the Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, over 18 months. A total of 40 patients diagnosed with acute appendicitis were included, with 18 undergoing open appendicectomy and 22 undergoing laparoscopic appendicectomy. Demographic details, operative time, intraoperative and postoperative complications, pain scores (VAS at 6, 12, and 24 hours), duration of hospital stay, and time to return to normal activities were recorded and statistically analyzed. Results: The mean operative time was significantly higher in the laparoscopic group (62.5 ± 12.1 min) compared to the open group (48.2 ± 10.6 min, p<0.01). Postoperative pain scores were consistently lower in the laparoscopic group at 6, 12, and 24 hours (p<0.01). Wound infection was more frequent in open appendicectomy (16.7% vs. 4.5%, p=0.04). Mean hospital stay was shorter for laparoscopic patients (3.4 ± 1.1 days vs. 5.2 ± 1.3 days, p<0.001), and return to normal activities was earlier (7.8 ± 2.0 days vs. 11.6 ± 2.5 days, p<0.001). Conclusion: Laparoscopic appendicectomy, though associated with longer operative time, offers superior postoperative outcomes including reduced pain, fewer wound infections, shorter hospitalization, and faster recovery. It should be preferred where expertise and resources are available.

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Background: Soft tissue mass lesions with morphologic heterogeneity occur in the non-epithelial extra skeletal tissue. Soft tissue tumours and tumour like lesions posed diagnostic difficulties as they exhibit similar clinical and radiological features. The clinical presentation is myriad with benign lesions masquerading as malignant tumours such as sarcomas, lymphomas and metastatic carcinoma. This study was undertaken to evaluate soft tissue tumours and tumour like lesions and characterise their distribution in a tertiary care centre of South India. Methods: The present study was a prospective cross-sectional study conducted in tertiary care centre of South India from December 2019 to May 2023.Data was obtained from clinical records of patients diagnosed as soft tissue mass lesions. Corresponding surgical specimens were processed to paraffin block and sectioned. The slides were stained with routine Haematoxylin and eosin stain. Appropriate special and immune- histochemical stains were performed to confirm histopathological diagnosis. The soft tissue tumours were categorized according to the WHO 2020 classification and graded by FNLCC grading system. The proportion of subjects was distributed according to epidemiological and histopathological features and statistically evaluated. The data was represented in terms of frequency distribution tables. The categorical and counting variables were presented by frequencies and percentages. Results: Among 284 soft tissue lesions,241 (15.43%) were soft tissue tumours and 43 (2.75%) were tumour like lesions. Benign soft tissue tumours 220(91.29%) were more common than malignant 19 (7.88%) and intermediate soft tissue tumours 2(0.82%). The most common benign soft tissue tumours were from adipocytic group and the mean age was 40.27 years with a male to female ratio of 132:88(1.50). The common site was upper limb. The most common malignant tumour was Liposarcoma. Among the tumour like lesion ganglion cyst was more common followed by synovial cyst. Conclusions: Adipocytic tumours were the most common soft tissue tumours both benign and malignant. Histopathological examination is necessary for unmasking the true biological nature of tumours as they masquerade clinically as benign or malignant entities.

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Background: The Tei index, also known as the myocardial performance index (MPI), is an echocardiographic measure that combines systolic and diastolic myocardial function. It has been progressively acknowledged as a potential prognostic indicator in diverse cardiac diseases, including acute coronary syndromes (ACS). Non-ST segment elevation myocardial infarction (NSTEMI) constitutes a significant percentage of acute coronary syndrome (ACS) cases and exhibits a broad range of outcomes. Early identification of high-risk patients continues to be a clinical focus to enhance prognosis. Objective: To assess the correlation between the Tei index and short-term prognosis in patients with NSTEMI. Methods: This prospective observational study involved 120 adult patients with a confirmed diagnosis of NSTEMI admitted to the cardiology department of a tertiary care centre during a 12-month period. All patients had thorough transthoracic echocardiography within 48 hours of admission. We used pulsed-wave Doppler measurements of isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) to figure out the Tei index. Patients were monitored for 30 days to document adverse outcomes, encompassing recurrent ischaemia, new or exacerbated heart failure, arrhythmias, and all-cause mortality. We utilised multivariate logistic regression to see how well the Tei index predicted outcomes, taking into account other clinical and echocardiographic factors. Results: The average age of the patients was 59.3 ± 9.8 years, and 72% of them were men. The average Tei index was 0.56 ± 0.08. Patients with a Tei index ≥0.55 encountered markedly elevated rates of adverse events in contrast to those with a Tei index <0.55 (38.3% vs. 12.5%, p < 0.001). In a multivariate analysis, a Tei index ≥0.55 was identified as an independent predictor of unfavourable short-term prognosis (adjusted OR = 3.21, 95% CI: 1.48–6.92, p = 0.003), even after controlling for left ventricular ejection fraction and GRACE risk score. Conclusion: An increased Tei index in NSTEMI patients is significantly correlated with unfavourable short-term clinical outcomes. Because it is easy to measure and repeat, the Tei index can be a useful tool for early risk assessment and planning for management.

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Background: Acute Coronary Syndrome (ACS) is a substantial contributor to global morbidity and death, with diabetes mellitus (DM) markedly elevating its risk and complicating its prognosis. The Indian population has a unique epidemiological profile, with diabetes becoming more common and cardiovascular disease starting earlier than in Western countries. It is important to know how common ACS is among diabetics in India and what risk factors are linked to it so that prevention and treatment can be more effective. Objectives: This study seeks to ascertain the prevalence of ACS among Indian persons with diabetes and to identify significant demographic, clinical, and lifestyle-related risk factors linked to its occurrence. Methods: A cross-sectional observational study was performed in tertiary care centres and community health facilities throughout India. Adults (≥18 years) having a confirmed diagnosis of type 1 or type 2 diabetes underwent evaluation of clinical history, lifestyle patterns, laboratory data, and cardiovascular assessment. Standard electrocardiographic, biochemical, and imaging criteria were used to diagnosis ACS. Multivariate logistic regression was employed to ascertain independent predictors of ACS. Results: Within the study cohort, the prevalence of ACS in diabetic patients was significantly elevated compared to the general population, exhibiting a male predominance and a peak incidence in the 50–65-year age range. Key risk variables significantly correlated with ACS encompassed inadequate glycaemic control (HbA1c ≥8%), hypertension, dyslipidaemia, central obesity, smoking, a sedentary lifestyle, and a history of microvascular problems. Duration of diabetes >10 years appeared as a major independent predictor. Conclusion: The work highlights the significant prevalence of ACS among Indian adults with diabetes, attributable to a combination of modifiable risk factors. To lower the number of ACS cases in this high-risk group, it is important to aggressively change risk factors, test for cardiovascular problems early, and use a full range of diabetes treatment options. Public health programs ought to emphasise lifestyle adjustment and regular cardiovascular evaluation in diabetic individuals to alleviate this escalating burden.

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Background: Lower-limb amputation results in significant functional limitations, affecting mobility, independence, and quality of life. Assistive devices such as prostheses and orthoses play a critical role in restoring functional ability. Understanding user satisfaction and associated socio-demographic factors is essential for improving rehabilitation outcomes. Objectives: To assess satisfaction with assistive devices among persons with lower-limb amputation in Udaipur district, Rajasthan, and to identify socio-demographic factors influencing these parameters. Methods: A cross-sectional study was conducted among 106 individuals with lower-limb amputation in Udaipur between January and June 2024. Participants were selected using systematic random sampling. Data were analyzed using SPSS v25. Satisfaction was assessed with the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0), defining satisfaction as a mean score ≥4. Device (8 items) and service (4 items) subscales were analyzed separately, and multivariate logistic regression was performed with satisfaction as the dependent variable; p < 0.05 was considered significant. Results: Among the 106 participants, 73.6% were male, and the majority were aged 45-59 years (35.8%). Most participants (60.4%) resided in rural areas, and 26.4% were unemployed. Prosthetic limb usage was reported by 67.9%, while 9.4% used orthotic devices. The overall QUEST mean score was 3.82 ± 0.85, with 79.0% of participants satisfied (score ≥4). Satisfaction with the device subscale was moderate (mean 3.73 ± 0.87; 76.8% satisfied), with highest ratings for safety and ease of use, and lower ratings for comfort and weight. The service subscale showed higher satisfaction (mean 4.0 ± 0.8; 82.1% satisfied), particularly for service delivery and follow-up. Major barriers included high maintenance costs (42.5%) and limited access to advanced devices (36.8%). On multivariate analysis, higher education (AOR 2.15, 95% CI 1.05–4.40) and employment (AOR 1.92, 95% CI 1.01–3.65) were independently associated with greater satisfaction, whereas age, gender, and residence showed no significant association. Conclusion: Most lower-limb amputees in Udaipur benefited from assistive devices, though challenges in comfort, affordability, and accessibility remain. Limitations include selection bias (only device users), cross-sectional design, and self-reported data. Policy efforts should focus on improving device quality, reducing costs, and expanding community-based rehabilitation services to optimize functional outcomes and user satisfaction.

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Introduction: Cesarean sections are increasingly common in India, including rural areas like Dausa, Rajasthan. Spinal and epidural anaesthesia are preferred regional techniques, each with distinct benefits and limitations. This study compares their clinical effectiveness, safety, and maternal-neonatal outcomes in a resource-limited setting, aiming to guide obstetric anaesthesia choices in semi-rural healthcare environments. Material and Method: The present study was a prospective, observational study comparing spinal and epidural anaesthesia in elective cesarean sections. Clinical efficacy, haemodynamics, adverse effects, postoperative pain, maternal satisfaction, and neonatal Apgar scores were evaluated. Data were analyzed using SPSS v25 with appropriate statistical tests. Result: In present study of 160 women undergoing elective cesarean section, spinal anaesthesia showed faster onset and adequate intraoperative conditions, epidural anaesthesia offered superior postoperative analgesia, better hemodynamic stability, fewer adverse effects, and higher maternal satisfaction. Epidural patients had significantly lower VAS pain scores and fewer analgesic requirements. Neonatal outcomes were comparable across groups. Epidural anaesthesia provided better overall comfort and was preferred by more patients for future procedures. Conclusion: The study suggests that where resources and expertise are available, epidural anaesthesia may be a preferable option for improving maternal experience and postoperative outcomes.  These findings are particularly relevant in resource-constrained settings like Dausa, Rajasthan, where anaesthetic choice should balance speed, safety, and patient comfort.

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Introduction: Spinal anaesthesia (SA) and general anaesthesia (GA) are commonly used for lower abdominal surgeries, each with distinct benefits and limitations. This study compares their effects on intraoperative stability, postoperative recovery, and complications. In resource-limited tertiary care centres, such evidence is vital for guiding anaesthetic choices, improving outcomes, and optimizing resource utilization in elective lower abdominal procedures. Material and Method: The present study was a hospital-based, prospective comparative study conducted on 168 patients undergoing elective lower abdominal surgeries. Patients were randomized into spinal (Group A) and general anaesthesia (Group B) groups. Intraoperative hemodynamic changes, duration of anaesthesia and surgery, postoperative pain (VAS score), complications, ambulation time, discharge readiness, and patient satisfaction (Likert scale) were evaluated. Data were analyzed using SPSS v26, with p < 0.05 as statistically significant. Result: Among 168 patients undergoing elective lower abdominal surgeries, spinal anaesthesia showed advantages over general anaesthesia. SA patients had significantly greater hemodynamic changes, shorter anaesthesia duration, fewer postoperative complications, faster recovery, lower postoperative pain scores, and reduced analgesic requirements. Patient satisfaction was also significantly higher in SA cases. Demographic variables, surgical types, and operative durations were comparable. Conclusion: Spinal anaesthesia showed superior outcomes over general anaesthesia in lower abdominal surgeries, offering faster recovery, better pain relief, fewer complications, and higher patient satisfaction. Though minor side effects occurred, spinal anaesthesia remains preferable approach when feasible and not contraindicated.

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Introduction: Scleroderma is a chronic autoimmune connective tissue disorder characterized by skin thickening, vascular abnormalities, and multiorgan involvement. Cutaneous manifestations often provide early diagnostic clues, and nail fold capillaroscopy is an important non-invasive tool to assess microvascular changes and disease activity. Methods: This cross-sectional observational study was conducted over a period of one year at the Calcutta School of Tropical Medicine. A total of 80 patients diagnosed with systemic sclerosis (SSc) were enrolled. Data were collected on demographic variables including age and gender, disease-related factors such as disease duration and SSc subtype, as well as clinical characteristics including cutaneous features. Detailed dermoscopy and nailfold examinations were performed, and capillaroscopy patterns were documented. All variables were systematically recorded to assess their association with disease manifestations and nailfold capillaroscopic findings. Results: In this study of 80 systemic sclerosis patients (mean age 42.6 ± 11.3 years; 65% female), 62.5% had limited cutaneous SSc and 37.5% had diffuse cutaneous SSc. All patients exhibited skin thickening, with Raynaud’s phenomenon (87.5%) and telangiectasia (60%) as common manifestations, while digital ulcers were the least frequent (27.5%). Nailfold capillaroscopy patterns differed by subtype: limited SSc predominantly showed active patterns (40%), whereas diffuse SSc frequently exhibited late patterns (40%), with a statistically significant difference in the late pattern between subtypes (p = 0.002). Capillary density <7/mm correlated negatively with disease duration (r = -0.42, p = 0.001), and giant capillaries correlated positively (r = 0.36, p = 0.005). Microhemorrhages showed no significant correlation with disease duration. The presence of digital ulcers was strongly associated with capillaroscopic patterns, particularly the late pattern (p < 0.001). Conclusion: Cutaneous manifestations in scleroderma are diverse and provide important diagnostic and prognostic information. Nail fold dermoscopy is a valuable, non-invasive tool for detecting microvascular changes and assessing disease severity, particularly in differentiating diffuse from limited scleroderma and monitoring disease progression. Early recognition of dermoscopic abnormalities can aid in timely management and potentially improve outcomes.

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Introduction: Road traffic accidents are preventable public health issues and are becoming more common. These accidents can be linked to a number of factors, including an increase in the number of vehicles on the roads, changes in daily life, a nasty habit of breaking traffic laws, anarchic traffic systems, and risky driving practices. Thoraco-abdominal injury in different forms is one of the major causes of mortality in the victims of fatal road traffic accidents. The aim of this study was to know the pattern of thoraco-abdominal injuries in victims of fatal road traffic accident cases. Materials & Methods: The present cross sectional study was conducted at the tertiary healthcare hospital. During this period, total of 173 victims of thoracic- abdominal injuries, which included 118 cases admitted at S.N. Medical College, Agra for treatment and 55 victims who were dead because of thoraco-abdominal injuries and brought to the mortuary for postmortem examination. The basic information about the deceased like age, gender, mode of travel of the victim was obtained from investigating officer narration and inquest papers. During autopsy, detailed examination of injuries was carried out and the autopsy findings were recorded and analyzed. Results: It was observed that out of 75 cases male outnumbered females in ratio 5.25:1. Majority of the victims belonged to the age group 21-30 years. The commonest injury of the thoracic region was rib fracture (41.3%). It was also observed that 17.3% of victims had pelvic fracture. Conclusion: thoraco-abdominal injuries constitutes potential factor in increasing the amount of morbidity and mortality as these injuries may occur without any external injuries in this region. So any victim with history of trauma without any visible external injuries should be promptly and thoroughly examined to find out any serious damage to internal organs. Timely diagnosis and surgical intervention would be of great help in diminishing the morbidity and mortality rates in these cases.

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One of the key substitute antibiotics for treating Staphylococcus aureus infections is clindamycin. Numerous mechanisms that give resistance to macrolides, lincosamides, and Streptogramin B (MLSB) antibiotics have been implicated in clinical failure of clindamycin therapy. Treatment failure may arise from routine in vitro tests for clindamycin susceptibility failing to identify inducible clindamycin resistance caused by erm genes. The magnitude of the issue has been demonstrated by data from wealthy nations, but there is a dearth of data from emerging nations. The study’s objective was to use a straightforward double-disc diffusion test (D test) to differentiate between various resistances phenotypes in erythromycin-resistant S. aureus. Routine tests for antibiotic susceptibility, including cefoxitin disc (30μg) and oxacillin screen agar, were performed on 125 S. aureus isolates to calculate P values, SPSS was used. Methicillin resistance was found in 45 of the 125 S. aureus isolates, however, 93 were susceptible to methicillin. 23 of the 59 (40.02%) erythromycin-resistant S. aureus isolates exhibited same significance for both constitutive resistance & inducible resistance as of it is about P 0.001 and inducible phenotype 32 (20.6%). Comparing MSSA to MRSA, it was discovered that MSSA had higher levels of constitutive and inducible resistance. To inform clinicians about inducible clindamycin resistance and to stop antibiotic abuse, clinical laboratories should regularly conduct the D test.

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Background: To evaluate the role of serum albumin levels in abdominal surgical wound healing. To determine if preoperative serum albumin levels can predict postoperative wound healing complications, such as delayed wound healing or organ dysfunction. Materials and Methods: Patients admitted to the surgical wards in a tertiary care centre of India for major abdominal surgeries between January 2023 and June 2024 were included in the study. All patients underwent clinical examinations and were assessed. The following data was recorded for each patient: history, clinical examination findings, investigations performed, surgical procedures, and post-operative complications. Anthropometric measurements, specifically height and weight, were recorded. Patients were followed up until discharge from the hospital. Results: Pre-operatively, albumin levels were evenly distributed, with 50.0% of cases exhibiting low levels and 50.0% exhibiting normal levels. Post-operatively, however, there was a significant increase in the proportion of cases with low albumin levels, rising to 80.0%, while only 20.0% maintained normal levels. Cases experiencing complications demonstrated that 36.0% had low preoperative albumin levels, while 38.0% had normal levels. For hospital stays less than 7 days, 23.8% of cases had low post- operative albumin levels, while 55.0% had normal levels. Stays ranging from 7 to 14 days showed 42.5% with low albumin levels and 25.0% with normal levels. Stays exceeding 14 days exhibited 33.8% with low albumin levels and 20.0% with normal levels. Conclusion: Our findings emphasizes the crucial role of albumin in supporting immune function, collagen synthesis, and the tissue healing processes essential for postoperative recovery. Effective management and optimization of albumin levels in these patient populations may help mitigate these risks and improve surgical outcomes.

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Background: Patients from rural background in India have high demands for flexion at knee because many depend on kneeling and squatting in day to day activities post total knee replacement. We wanted to study the amount of flexion achieved in cases of Total Knee Arthroplasty using Rotating Platform High Flexion Knee. Method: The present study is a prospective analysis of grade III to grade lV osteoarthritis, and rheumatoid arthritis presenting to our hospital from July 2023 to July 2024, and treated with Total Knee Arthroplasty using Rotating Platform High Flexion Knee. The present study included 30 pts. (39 knees) operated with rotating platform high flexion knee, total knee arthroplasty and followed up for a period of 1 year. Results: As graded with the knee society score, finally, 36 of the total knees (92.31) had excellent outcome, and 2 knees had good outcome. There was one knee which required revision total knee arthroplasty as a two-stage procedure, because of the deep infection. Conclusion: Rotating Platform High Flexion Knee is intellectually interesting option in younger and active patients. Hyperflexion is easier in these patients and hence useful in Asian population for social custom.

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Timely identification and classification of shock is critical in preventing multi-organ failure and improving patient outcomes. Shock can be categorized into hypovolemic, distributive, cardiogenic, obstructive, or mixed types. However, clinical findings alone are often insufficient for accurate classification. Point-of-care ultrasonography (USG), particularly the Rapid Ultrasound in Shock (RUSH) protocol, offers a non-invasive and radiation-free diagnostic tool. In this prospective observational study, 100 ICU patients presenting with shock were evaluated using bedside USG. Diagnostic agreement between USG findings and final clinical diagnoses was analyzed using the Cohen kappa coefficient.
The RUSH protocol demonstrated an almost perfect agreement with final diagnosis in hypovolemic, obstructive, cardiogenic, and distributive shock. Substantial agreement was observed for mixed shock, and moderate agreement for undefined shock. Specifically, hypovolemic shock showed a hyperdynamic heart in 74.2%, an ‘A’ pattern in lungs and IVC collapsibility in 100% of patients. Obstructive shock was marked by RV strain in 71.4% and non-collapsible IVC in all cases. Cardiogenic shock showed hypodynamic LV in 100% and a ‘B’ pattern in 56.25%. Distributive shock had normal LV in all cases, with 38.5% showing an A-pattern and 7.7% with IVC collapsibility. Mixed and undefined shocks demonstrated variable findings.

This study highlights the utility of bedside USG in rapidly differentiating shock types and guiding early management, reinforcing its role as a valuable tool in critical care.

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Background: Blood glucose measurement is fundamental in the diagnosis and management of diabetes mellitus. Venous plasma glucose is the gold standard for laboratory testing, while capillary whole blood glucose is widely used for point-of-care monitoring. This study compares venous and capillary blood glucose levels measured by different methods. Methods: In a cross-sectional study, 500 adult participants underwent simultaneous venous and capillary blood sampling. Venous plasma glucose was measured using Beckman Coulter AU 680 a glucose oxidase-based autoanalyzer. Capillary whole blood glucose was measured using two portable glucometers (GlucoCheck™ and AccuSense™). Paired t-tests and Bland–Altman analysis was used for comparison. Results: Mean venous plasma glucose measured in the laboratory was 122.8 ± 34.9 mg/dL. Venous glucometer readings showed a slight underestimation compared to laboratory values (GlucoCheck™: 121.0 ± 34.1 mg/dL; AccuSense™: 121.5 ± 34.5 mg/dL). In contrast, capillary glucometer readings were consistently higher (GlucoCheck™: 126.5 ± 33.8 mg/dL; AccuSense™: 125.8 ± 34.4 mg/dL), representing a mean positive bias of approximately 3.0% compared to venous plasma glucose. Conclusion: Capillary glucose measurements from both devices showed excellent correlation with venous plasma glucose, with minimal clinically insignificant bias. However, device-specific differences should be considered in clinical interpretation.

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Background: Diabetes Mellitus (DM) is one of the most common endocrine disorders around the world, affecting about 366 million people in 2011, although this number is expected to rise to 552 million by the year of 2030. Serum ferritin is an acute phase reactant and is a marker of iron stores in the body. Raised iron stores induce diabetes through various pathways, including oxidative damage to pancreatic beta cells. Magnesium is a vital nutrient for the body’s health because it functions as a cofactor. The aim of the study was the evaluation of the relationship of these two parameters with some indices of diabetic control. Materials and Methods: In this prospective observational cross-sectional study, 225 cases were divided into three groups of healthy controls, newly diagnosed and on treatment (75 each), and serum ferritin, glycated hemoglobin (HbA1c), serum magnesium, fasting blood glucose were checked. Results: The mean age in new cases of diabetes mellitus was found to be (50.22 ± 6.57) years. The mean age in patients of diabetes mellitus on treatment was found to be (52.4 ± 7.0 years). Serum ferritin was significantly higher in diabetic patients when compared to controls and serum ferritin had a positive correlation with the severity of diabetes. Serum magnesium was significantly lower in diabetic patients when compared to controls and had a negative correlation with increasing severity of diabetes. Conclusion: There was a positive correlation between serum ferritin and FBS, HbA1c, and a negative corelation between serum magnesium and FBS, HbA1c. There was no significant corelation seen between these two parameters and age or sex of the patients.

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Background: Femoral neck fractures are relatively common fractures seen in orthopaedic practice which are notorious for non-union if an internal fixation is attempted. Various methods have been described to treat non-unions, of which a subtrochanteric valgus sliding osteotomy and correction with a conventional dynamic hip screw and plate system is gaining popularity. Methods: 10 patients who showed no radiological sign of union on X-ray even after 3 months of sustaining a fracture neck of Femur, underwent a subtrochanteric valgus sliding osteotomy with a dynamic hip screw and plate system. Outcomes were assessed clinically (limb length discrepancy, oxford hip score) and radiologically (radiological union, Pauwels angle, neck shaft angle). Results: All the operated patients achieved good union by an average duration of 3 months. Other radiological parameters like Pauwels angle and neck shaft angle improved. All patients were able to return to their daily activities. There weren’t any significant complications experienced by any patients following the procedure. Conclusion: Subtrochanteric valgus sliding osteotomy for fracture neck of Femur non-unions with a dynamic hip screw and plate system is a simple, efficient and cost-effective method to address a complex problem with good outcomes.

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Background: Oral mucositis (OM) is a common and debilitating toxicity in head and neck cancer patients undergoing radiotherapy (RT). Circadian rhythms influence cell cycle phases, with radiosensitivity varying across phases. Radiosensitivity is lowest in G1 and highest in G2/M, suggesting that timing of RT may influence mucosal toxicity. This study aimed to evaluate whether morning RT, coinciding with predominant G1 phase in oral mucosal cells, reduces the incidence and severity of OM compared to afternoon RT. Methods: In this prospective randomised controlled study, 200 patients with squamous cell carcinoma of the oral cavity, oropharynx, pharynx, or larynx scheduled for RT with or without chemotherapy were assigned to receive RT between 8:00–10:00 AM (Arm A) or 4:00–6:00 PM (Arm B). Total doses ranged from 66 to 70 Gy. The primary endpoint was the incidence of Grade ≥3 OM using RTOG criteria. Secondary endpoints included time to onset and duration of OM, weight loss, quality of life (QOL), treatment interruptions, and oncologic outcomes. Results: Grade ≥3 OM occurred in 53% (Arm A) vs. 62% (Arm B) of patients (p = 0.17). In patients receiving ≥66 Gy (n = 100), morning RT significantly reduced Grade ≥3 OM (45.1% vs. 68.3%, p = 0.021) and delayed onset (7.9 vs. 5.6 weeks, p = 0.034). Among smokers (n = 84), morning RT reduced Grade ≥3 OM (43% vs. 77%, p = 0.025). Weight recovery plateaued earlier in Arm A, with a significant treatment-by-time interaction (p = 0.024). Fatigue was significantly lower in Arm A post-treatment (1.5% vs. 9%, p = 0.02). No significant differences were found in QOL (except early time points), loco-regional control. Conclusions: Morning RT was associated with reduced severity and delayed onset of OM in patients receiving higher radiation doses or who smoked, along with improved weight recovery. Although no significant difference was observed in the overall cohort, these subgroup findings support further investigation of circadian-based RT timing strategies, particularly in patients at high risk for mucosal toxicity.

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Background: The surgical approach in total hip arthroplasty (THA) remains a matter of ongoing debate, particularly regarding functional recovery, complication profiles, and patient-reported outcomes. The direct anterior approach (DAA) has gained popularity as a minimally invasive option, but its advantages over posterior (PA), anterolateral (ALA), lateral, and posterolateral (PLA) approaches remain unclear. This systematic review aimed to compare the outcomes of different surgical approaches in primary THA, with particular emphasis on functional recovery, perioperative parameters, complications, and long-term results. Methods: Following PRISMA guidelines, randomized controlled trials (RCTs), prospective and retrospective studies published between 2015 and 2025 were included. Databases were searched for studies directly comparing DAA with PA, PLA, ALA, or lateral approaches. Extracted data included study design, population characteristics, surgical technique, outcome measures (functional scores, pain, complications, implant positioning, perioperative metrics), and follow-up findings. Results: Fourteen studies involving 1,639 patients were analyzed. DAA consistently demonstrated advantages in early postoperative recovery, including less pain, faster mobilization, shorter hospital stay, and improved early functional scores. Several studies reported superior component positioning and reduced leg length discrepancy with DAA. However, DAA was associated with increased operative time, higher intraoperative blood loss, and greater incidence of lateral femoral cutaneous nerve (LFCN) complications. Long-term outcomes, including functional scores, implant survival, and quality of life, were largely comparable across approaches. Conclusion: DAA offers modest early recovery and functional advantages but carries specific risks, particularly increased blood loss and nerve-related complications. Long-term outcomes are equivalent across surgical approaches. Surgical approach selection should be tailored to patient characteristics and surgeon expertise.

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Aim: The present study was conducted to compare the complication rate and outcome of interrupted versus continuous suture techniques in Snodgrass tubularized incised-plate (TIP) hypospadias repair using PDS (Polydioxanone) 6-0 suture. Materials and Methods: In our study we included 50 patients and the majority of the population in the analysed data is under the age of six year (66%), indicating a significant representation of this age group in the study. The study was carried out from September 2022 to October 2024, after obtaining consent from parents. Pediatric patients with distal penile hypospadias were enrolled and randomly assigned to receive either the interrupted or continuous suture technique for their TIP repair. Result: Chi-square test results indicate no significant differences or associations between various groups and variables studied, suggesting uniformity across the tested parameters. The distribution of hypospadias types among the patients indicates that distal penile hypospadias is the most prevalent, accounting for 86%, followed by mid penile hypospadias at 14%. In DPH group sub coronal was 64% and rest 22%. The group A is having DPH 42% and mid penile 8% whereas group B is having DPH 44% and mid penile 6%. Rate of urethra cutaneous fistula is 14% and both groups have comparable fistula rate and is not statistically significant. The occurrence of partial superficial infection is 2% in both groups, which is comparable and statistically insignificant. Meatal stenosis was notably not found in our study groups. Urethral stricture was absent in Group A whereas Group B had one patient (2%) which responded to conservative management and is statistically insignificant. Urinary stream characteristics predominantly include a uniform, single stream directed forwards in both groups and double stream was found 6% in group A and 8% in group B which is comparable and statistically insignificant.  Conclusion: The distribution of hypospadias types varies, with subcoronal types being most common, underscoring the need for tailored surgical approaches based on specific anatomical details. Parental acceptance rates are high, suggesting satisfactory cosmetic and functional results of the interventions. Management outcomes reveal a strong tendency towards the absence of complications such as meatal stenosis and urethra cutaneous fistula, indicative of effective surgical techniques and diligent postoperative care.

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Introduction: Ovarian cancer constitutes a heterogeneous group of malignancies and remains a leading cause of gynaecologic cancer-related mortality worldwide. Histopathological classification plays a critical role in diagnosis, prognosis, and therapeutic decision-making. According to the World Health Organization (WHO) 2020 classification, ovarian neoplasms are broadly categorized into epithelial tumours, germ cell tumours, and sex cord-stromal tumours, each with unique morphological, immunohistochemical, and molecular characteristics. This study presents a comprehensive analysis of the histopathological spectrum of ovarian lesions, with emphasis on recent classification updates and diagnostic challenges. Objectives: (1) To assess the frequency distribution of ovarian lesions based on age, laterality, and gross morphology. (2) To evaluate the neoplastic ovarian lesions using WHO 2020 classification. (3) To analyze pathological staging of malignant ovarian tumors. Materials & Methods: A retrospective study was conducted over a two-year period, from April 2023 to March 2025, at a tertiary care hospital in Karnataka. A total of 75 ovarian lesion cases were evaluated histologically and categorized using WHO 2020 guidelines. Results & Discussion: Non-neoplastic lesions were more frequently observed than neoplastic ones. The majority of cases occurred in the 31–50 years age group. Among neoplastic lesions, serous cystadenoma was the most common (20 cases, 26.6%). Malignant tumors included high-grade serous carcinoma (6 cases, 8%), yolk sac tumor (5 cases, 6.6%), endometrioid carcinoma (3 cases, 4%), granulosa cell tumor (3 cases, 4%), and mucinous carcinoma (2 cases, 2.6%). Conclusion: This study highlights the wide histopathological diversity of ovarian lesions, with non-neoplastic lesions being more prevalent and serous cystadenoma as the most common neoplasm. The age distribution pattern and application of the WHO 2020 classification system contribute significantly to diagnostic accuracy and effective staging. Utilizing this standardized approach enhances clinical decision-making, particularly in the management of malignant ovarian tumours.

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Background: Acute hyperglycemia in critically ill diabetic patients impacts prognosis more than chronic glucose levels. The glycemic gap—difference between admission glucose and estimated average glucose—may better predict mortality and organ dysfunction, but its utility requires further evaluation. Methods: This prospective observational study was conducted from January to December 2024 in the Emergency Medicine Intensive Care Unit of Gauhati Medical College and included adult diabetic patients (aged ≥18 years) with an HbA1c level of ≥6.5%. Upon admission, we measured random blood sugar (RBS) and HbA1c levels. We calculated estimated average glucose (eAG) = 28.7 × HbA1c – 46.7. GG = RBS – eAG. The main outcome was death within 28 days. Other outcomes were multiple organ dysfunction syndrome (MODS), shock, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and upper gastrointestinal (UGI) bleeding. We compared values between groups and used ROC curves to find the best GG cut-off points. Results: A cohort of 126 Patients were 21–90 years old (median 45 years). Median HbA1c was 9.0%. Median RBS was 264 mg/dL. Mean eAG was 211.5 mg/dL. Mean GG was 48.2 mg/dL (range –158.7 to 311.5). Death rate was 26.2%. Non-survivors had much higher GG than survivors (96.1 vs. 31.1 mg/dL; p<0.001). A GG ≥95.1 mg/dL predicted death (AUC=0.771; sensitivity 57.6%; specificity 87.1%). MODS patients also had higher GG (105.3 vs. 44.3 mg/dL; p=0.026). A cut-off ≥82.1 mg/dL predicted MODS (AUC=0.736; sensitivity 75.0%; specificity 69.5%). GG was not linked to shock, AKI, ARDS, or UGI bleed. HbA1c alone did not predict death or complications.

Conclusions: In critically ill diabetics, GG predicts death and MODS better than HbA1c. GG ≥95.1 mg/dL marks a high risk of death. GG ≥82.1 mg/dL marks a high risk of MODS. Using GG in ICU scoring systems may help identify high-risk patients early. Larger studies are needed to confirm this.

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Introduction:  Central nervous system (CNS) lesions encompass a wide range of neoplastic and non-neoplastic conditions, presenting with variable clinicoradiological features. Histopathological evaluation is required for definitive diagnosis, planning the treatment and also for prognostication purposes. Incidence of Central nervous system (CNS) tumors is very low compared to other organ neoplasms. Recent increase in the incidence may be due to advanced diagnostic modalities. Aim: To study the demography and determine the relative frequency of the various histopathological types of CNS lesions. Materials and Methods: A retrospective study was conducted in the department of pathology, Government medical college, Ananthapuram. The study included 75 cases of diagnosed CNS lesions from December 2022 to June 2024 on CNS lesions. Basic demographic data, tumor site, and histopathological profile were obtained from medical records and further analyzed and graded according to the World Health Organization (WHO) 2021 classification. Results: Total 75 cases with intracranial lesions were enrolled in this study .Among 75 cases, 41 were females (54.7%) and 34 were males (45.3%). The commonest age group was the fourth to sixth decade and most common tumor was meningioma, followed by schwannoma. Conclusion: Tumors of the CNS have the diverse clinical and histopathological profile. Rising global trends in the incidence of CNS Tumors have been observed irrespective of age. Although advance imaging modalities are available nowadays, still histopathology is considered as the gold standard in their diagnosis.

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Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with diverse clinical manifestations and fluctuating disease activity. Inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are widely used for monitoring systemic inflammation. However, their utility in reflecting actual disease activity in SLE remains under evaluation due to varying responses across disease phenotypes. Objective: This study aimed to assess the correlation between CRP and ESR levels with clinical stages of SLE as measured by the SLE Disease Activity Index (SLEDAI). Methods: A cross-sectional observational study was conducted over one year at a VIMS Gajrola, Amroha Uttar Pradesh, involving 40 patients diagnosed with SLE based on the 2012 SLICC criteria. Patients were categorized into remission, mild, moderate, and severe disease activity based on their SLEDAI scores. Statistical analysis was performed using SPSS v25, employing Spearman’s correlation, ANOVA, and chi-square tests. Results: Both CRP and ESR levels showed a progressive increase with disease severity. ESR demonstrated a strong positive correlation with SLEDAI scores (r = 0.71, p < 0.01), while CRP showed a moderate correlation (r = 0.54, p < 0.05). “ESR was more consistently elevated across disease stages, whereas CRP appeared more variable, with higher values predominantly in moderate and severe cases. Conclusion: The study confirms ESR as a reliable and accessible marker of disease activity in SLE. While CRP is less sensitive in early or non-serositis flares, it retains value in specific clinical contexts. These findings support the utility of ESR and, to a lesser extent, CRP in routine lupus monitoring, particularly in resource-limited healthcare settings.

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Background: Hypertension is a prevalent cardiovascular disorder and a leading risk factor for morbidity and mortality globally. While its multifactorial etiology includes genetic, lifestyle, and environmental factors, growing attention has been directed toward the role of micronutrients, particularly calcium and magnesium, in blood pressure regulation. Objective: This study aims to evaluate and compare serum calcium and magnesium levels in hypertensive and normotensive individuals to assess their potential role as contributing factors in hypertension. Methods: A cross-sectional, comparative study was conducted over three months in a VIMS Gajrola, Amroha, and Uttar Pradesh. Sixty participants aged 30–60 years were enrolled, divided equally into two groups: “30 hypertensive patients and 30 age- and sex-matched normotensive controls. Serum calcium and magnesium levels were measured using spectrophotometric methods, and data were statistically analyzed using the independent t-test and Pearson correlation. Results: Hypertensive individuals exhibited significantly lower mean serum calcium (8.7 ± 0.4 mg/dL) and magnesium (1.6 ± 0.2 mEq/L) levels compared to normotensive controls (calcium: 9.2 ± 0.5 mg/dL; magnesium: 2.1 ± 0.3 mEq/L), with p-values of 0.001 and <0.001 respectively. A moderate inverse correlation (r = -0.52) was found between serum magnesium and systolic blood pressure. Conclusion: The study indicates that deficiencies in serum calcium and magnesium are significantly associated with hypertension. Routine screening and correction of these mineral imbalances may offer a beneficial adjunct to conventional hypertension management.

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Background: Dry eye syndrome (DES), also referred to as dry eye disease (DED), is a multifactorial disorder of the tear film and ocular surface, leading to symptoms of discomfort, visual disturbance, and tear film instability, with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. DES is one of the most common ocular conditions globally, with prevalence estimates ranging from 5% to over 50%, depending on diagnostic criteria, study population, and geographic region. Methodology: A sample size of 120 patients (60 per group) was calculated to detect a minimum clinically significant difference of 5 points in OSDI score between groups. Participants were randomized in a 1:1 ratio into two groups using a computer-generated random sequence with block sizes of 4. Group assignments were sealed in opaque envelopes and opened sequentially after enrolment. Group A: Artificial tears – preservative-free carboxymethylcellulose 0.5%, 1 drop in each eye 4 times daily. Group B: Prescription medication – topical cyclosporine A 0.05% or lifitegrast 5% (based on availability), 1 drop in each eye twice daily. Results: Both artificial tears and prescription medications significantly improved symptoms and signs of DES over 12 weeks. Prescription medications demonstrated greater improvement in OSDI scores, TBUT, Schirmer’s test values, and corneal staining scores compared to artificial tears. Safety profiles were acceptable in both groups, with only mild, transient adverse events reported. Conclusion: This study reinforces that both artificial tears and prescription medications significantly improve DES outcomes, but prescription agents offer greater symptomatic and objective improvement due to their anti-inflammatory mechanism.

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Introduction: Paraquat, a widely used herbicide in India, is associated with high mortality due to its severe toxicity and lack of a specific antidote. Northeast India, being agriculturally intensive, frequently encounters cases of paraquat poisoning, often due to intentional ingestion. However, there is limited regional data describing the clinical profile and outcomes of such cases. Objective: To study the clinical presentation, demographic characteristics, laboratory abnormalities, complications, and outcomes of patients with paraquat poisoning admitted to a tertiary care hospital in Northeast India. Methods: This prospective observational study was conducted over 18 months from January, 2024 to June, 2025 at the Department of Medicine in a tertiary care hospital in Northeast India. All patients with a confirmed history of paraquat ingestion and positive urine dithionite test were included. Demographic data, amount of paraquat consumed, time to presentation, clinical signs and symptoms, laboratory parameters (including renal, hepatic, and respiratory functions), and treatment outcomes were recorded. Patients were followed up until discharge or death. Descriptive statistics and relevant analytical tests were applied using SPSS. Results: This prospective study on paraquat poisoning patients at a tertiary care hospital in Northeast India revealed that the majority were young adults aged 21–30 years (42.1%), predominantly from rural areas (72.4%) and engaged in farming (39.4%). Most had formal education (up to class X) and were from non-tribal communities, with a significant proportion reporting suicidal intent (36.8%) and a history of psychiatric illness (26.3%). The quantity of poison consumed was mostly between 21–30 ml (36.9%), with clinical manifestations including vomiting (92.1%), oral ulceration (84.2%), swallowing difficulty (81.6%), and respiratory symptoms. Vital signs often showed tachycardia, tachypnea, hypoxia, and blood pressure abnormalities. Organ dysfunction was frequent, notably acute liver injury (73.7%), acute kidney injury (71.1%), ARDS (47.4%), and lung fibrosis (36.8%). Hematological findings revealed normal mean hemoglobin (12.8 ± 1.9 gm/dL) and elevated WBC in 43% of cases. Hospital stay was prolonged in many, with 27.6% requiring more than 30 days of admission, reflecting the severity and systemic impact of paraquat poisoning. Conclusion: Paraquat poisoning remains a significant health concern in Northeast India with high mortality, especially among young adults. Early diagnosis, aggressive supportive care, and awareness among the rural population regarding its lethality are crucial to reduce fatal outcomes. Regional policies regulating its sale and usage are urgently warranted.

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Introduction: One of the most important phases in the handover of surgical patients is the postoperative care discharge from the post anesthesia care unit (PACU) to the common ward. Time-based discharge has historically been implemented in the majority of PACUs; however, due to a huge rise in surgical cases in a large hospital with a restricted number of PACU beds, time-based discharge and delayed shifting created a bottleneck. Aims: To study the advantage and disadvantage of SAMPE scoring system as compared to Whites and modified Aldrete scoring system in PACU undergoing surgical procedures after general anesthesia. Materials & Methods: The study was a prospective, observational design conducted in the Department of Anesthesiology. The study period spanned 10 months, with a total sample size of 392 participants. Result: The mean time of discharge according to Aldrete score was 12.78, Sampe 10.74 and White is 3.72 minutes which was clinically and statistically significant compared to the mean of actual time of discharge which was 74.12 minutes. Therefore, the difference in time of discharge of patients based on Criteria-Based Discharge (CBD) versus actual time of discharge was found to be clinically and statistically significant. Conclusion: We conclude that, comparative effectiveness, safety, and efficiency of the three PACU (Post-Anesthesia Care Unit) discharge criteria—Aldrete, White, and SAMPE—in patients undergoing surgical procedures under general anesthesia. It would summarize Aldrete is incomplete because it doesn’t include nausea vomiting and bleeding, White can be used for fastracking for daycare cases (eg endoscopy, urology) while Sampe is well rounded scoring system and can be used for routine shifting from PACU to ward. The conclusion might also discuss the implications of adopting one criterion over the others in clinical practice and recommend the most suitable approach based on the study’s findings.

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Introduction: Locally advanced cervical cancer (LACC) remains a significant therapeutic challenge, with standard treatment involving concurrent chemoradiation. Neoadjuvant chemotherapy (NACT) before chemoradiation may improve tumor shrinkage, facilitate better local control, and reduce distant metastasis. This study evaluates the efficacy and safety of weekly cisplatin and paclitaxel as neoadjuvant chemotherapy followed by chemoradiation in patients with LACC. Methods: This prospective observational study was conducted over a period of one year at R G Kar Medical College. A total of 80 patients with histologically confirmed locally advanced cervical cancer (FIGO stages IB2 to IIIB) were enrolled. Key study variables included patient age, FIGO stage, tumor histology, and Eastern Cooperative Oncology Group (ECOG) performance status. Patients received neoadjuvant chemotherapy with weekly cisplatin and paclitaxel followed by chemoradiation. Treatment response was assessed using clinical and radiological parameters, while toxicity was monitored and graded according to standard criteria. Outcomes measured included tumor response, toxicity profile, progression-free survival, and overall survival. Results: The study included 80 patients with locally advanced cervical cancer, predominantly FIGO stage IIB and squamous cell carcinoma. Following neoadjuvant chemotherapy with weekly cisplatin and paclitaxel, 85% of patients achieved an overall response (30% complete, 55% partial). Tumor size significantly decreased from 5.4 cm to 3.2 cm (p < 0.001). The treatment was well tolerated, with manageable hematological and non-hematological toxicities. At 12 months follow-up, progression-free survival was 72.5%, and overall survival was 85%. Patients with complete or partial response had significantly better survival outcomes than those with stable or progressive disease (PFS: 14 vs. 8 months, p = 0.002; OS: 18 vs. 11 months, p = 0.004). Conclusions: Weekly cisplatin and paclitaxel as neoadjuvant chemotherapy followed by standard chemoradiation is feasible and well tolerated in LACC patients, with encouraging early clinical response and survival outcomes. Further randomized controlled trials are warranted to confirm the benefit of this sequential approach compared to chemoradiation alone.

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Introduction: The knee joint is a compound synovial joint. Upper end of tibia is an important component of knee joint. Hence the knowledge regarding the morphometry of the articular surface of the tibial condyles as well as intercondylar area is utmost necessary to formulate a baseline data for future studies and to compare the current data with previous literature. Aims and Objectives: This study measures the upper end of the tibia in the West Bengal population to provide accurate anatomical data. It also compares these measurements with existing knee prostheses used in total knee replacement to assess their suitability and guide better prosthesis design. Materials and Methods: The study has been carried out on 50 dry adult tibia of unknown sex in the department of Anatomy in a tertiary care hospital of West Bengal. Measurements were taken by using the digital Vernier’s caliper and statistical analysis has been done. Results: It was observed that the mean Antero-posterior and Transverse diameter of Medial Tibial Condyle (MTC) are more than Antero-posterior and Transverse diameter of Lateral Tibial Condyle (LTC). The mean of transverse diameter of total condylar area is greater than that of Antero-posterior diameter of total condylar area. Conclusion: The present study is to deliver a baseline data consisting of morphometric details of upper end of tibia which will help for knee arthroplasty procedure.

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Background: Acute appendicitis is a common surgical emergency, with delayed diagnosis leading to complications such as gangrene and perforation. Differentiating simple from complicated appendicitis remains challenging. Biochemical markers like serum bilirubin and C-reactive protein (CRP) may enhance diagnostic accuracy. Aim: To evaluate the role of hyperbilirubinemia and CRP as predictors of appendiceal gangrene and perforation. Methods: This prospective observational study was conducted at Government Medical College, Karimnagar, over one year and included 55 patients undergoing appendicectomy for clinically diagnosed acute appendicitis. Patients with liver disease, hemolytic disorders, or conditions affecting bilirubin/CRP levels were excluded. Preoperative total bilirubin, direct bilirubin, and CRP levels were measured and correlated with intraoperative and histopathological findings. Statistical analysis included ROC curve assessment for diagnostic accuracy. Results: Of 55 patients, 32 (58.2%) had simple appendicitis and 23 (41.8%) had complicated appendicitis. Mean total bilirubin (1.74 ± 0.48 mg/dL), direct bilirubin (0.64 ± 0.17 mg/dL), and CRP (42.7 ± 10.6 mg/dL) were significantly higher in complicated cases compared to simple appendicitis (0.82 ± 0.23, 0.26 ± 0.08, and 18.4 ± 7.2, respectively; p <0.001). ROC analysis showed CRP ≥20 mg/L had the best diagnostic performance (sensitivity 87%, specificity 81.2%, AUC 0.85). Combined use of bilirubin and CRP further improved predictive accuracy.

Conclusion: Both hyperbilirubinemia and elevated CRP are reliable predictors of complicated appendicitis. CRP demonstrated slightly higher diagnostic accuracy; however, combining both markers enhances predictive reliability, aiding timely surgical decision-making.

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Antimicrobial resistance (AMR) has emerged and spread around the world as a result of the overuse and inappropriate use of antibiotics, which has become a major public health concern. In order to evaluate the frequency, indications, routes, and adherence to guidelines of antibiotic usage, this study was conducted to examine the pattern of antibiotic prescriptions in a tertiary care hospital. Materials and Methods: Over the course of four months, the present prospective observational study was done at a tertiary care hospital in Northwest Maharashtra. The purpose of the study was to evaluate the trend of antibiotic prescriptions in both outpatient and inpatient settings. Results: Out of 240 patients, the majority belonged to the age group of 21-35 years comprising of 133 (55.4%) patients. cephalopsorin class was most commonly prescribed contributing to 100 (42%) of total prescriptions, followed by penicillin in 57 (26%) patients, fluoroquinolones in 36 (14%) patients and carbapenem and tetracycline class of antibiotics were least prescribed, each in 5 (2%) patients. Most commonly prescribed antibiotic in penicillin class was amoxicillin, while cefixime in cephalosporin group was most commonly prescribed. Conclusion: Findings of the present study highlights the need for antimicrobial resistance containment, standard treatment recommendations, and antimicrobial policy urgently.

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Background: Cataract surgery is one of the most frequently performed ophthalmic procedures worldwide, with Small Incision Cataract Surgery (SICS) and Phacoemulsification (PHACO) being the two most commonly used techniques. Although both procedures offer excellent visual outcomes, their impact on central corneal thickness (CCT)—a marker of corneal health—varies and may influence postoperative recovery. Aim: To compare the changes in central corneal thickness following SICS and PHACO in patients undergoing cataract surgery at a tertiary care hospital. Methods: This prospective observational study included 250 patients diagnosed with senile cataract at Mata Gujri Memorial Medical College and LSK Hospital, Kishanganj, Bihar, over a period of 15 months. Patients were randomly assigned to either the SICS group (n=125) or the PHACO group (n=125). Central corneal thickness was measured preoperatively and postoperatively at Day 1, Week 1, and Week 6 using a standardized pachymeter. Data were analyzed using SPSS version 23.0, and statistical significance was set at p<0.05. Results: Both surgical groups showed a significant increase in CCT on postoperative Day 1, with gradual normalization by Week 6. The mean increase in CCT was slightly higher in the PHACO group (11.7 ± 4.9 µm) compared to the SICS group (9.8 ± 4.2 µm), and the difference was statistically significant (p=0.042). Visual acuity improved significantly in both groups, with mean postoperative BCVA reaching 0.3 ± 0.2 logMAR at Week 6. No major complications were observed, and minor transient corneal edema resolved by the final follow-up. Conclusion: Both SICS and PHACO are effective and safe cataract surgical techniques with favorable visual outcomes. However, PHACO is associated with a slightly greater transient increase in central corneal thickness in the early postoperative period. Recommendations: Postoperative monitoring of CCT is recommended, especially in patients with pre-existing corneal pathology or compromised endothelial health. Future studies with longer follow-up and endothelial cell count analysis could provide further insights into the long-term effects of both procedures.

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Background: Epidural analgesia is a widely used regional anaesthesia technique in lower limb orthopaedic surgery, offering effective pain control with minimal side effects. While reviewing the available literature on the use of ropivacaine–dexmedetomidine for postoperative epidural analgesia, there appears to be limited evidence comparing the efficacy of continuous infusion versus programmed intermittent bolus administration. Aim and Objective: To compare the efficacy and quality of epidural analgesia, along with haemodynamic stability, between programmed intermittent bolus administration of ropivacaine–dexmedetomidine and continuous elastomeric infusion of the same combination in patients undergoing lower limb orthopaedic surgeries. Materials and Methods: This single-centre, open-label (assessor-blinded), parallel-group randomized controlled trial was conducted at LLRM Medical College, Meerut, and included 80 patients of both genders, aged 18–75 years, with American Society of Anesthesiologists physical status II or III, who underwent lower limb orthopaedic surgery. Patients were block-randomized (1:1) into two groups of 40 each, both receiving epidural ropivacaine (0.2%) combined with dexmedetomidine (1 μg/kg), but via different delivery methods: continuous elastomeric infusion pump (Group P) or programmed intermittent bolus dose (Group B). Efficacy of analgesia (VAS Score) and haemodynamic stability is compared between two groups Up to 48 hours postoperatively. Results: Both groups demonstrated good analgesic efficacy, with no statistically significant difference in mean VAS scores (p = 0.100). The continuous infusion group reported more consistent analgesia and higher subjective satisfaction. Regarding haemodynamic stability, Group B maintained better control than Group P, with Group P showing a higher incidence of hypotension, particularly within the first 8 hours postoperatively (p = 0.010). Conclusion: Both continuous epidural infusion and programmed intermittent bolus administration of ropivacaine combined with dexmedetomidine provided comparable durations of postoperative analgesia in lower limb orthopaedic surgeries. However, Group B was superior in terms of haemodynamic stability. Future studies should standardize surgical procedures to minimize confounding factors.

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Background: Depression is the biggest contributor to non-fatal health loss globally and is one of the main causes of disease burden. WHO reveals depression to be the fourth most common cause of disability globally and will rank as the second most common cause of mortality by 2020. Objectives: The aim of the study was to evaluate the patterns of antidepressant use among patients with depression and to assess their treatment response in terms of adequate response, partial response, and non-response across different demographic and clinical variables. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Data from 182 participants were retrieved for the study. The study included adults who were 18 years of age or older, had a clinical diagnosis of MDD, visited the psychiatry outpatient department during the study period, were prescribed an antidepressant, and had at least one follow-up with full medical records. Results: Only 11.5% of the 182 participants were older than 60, with the majority (33.5%) falling into the 31–45 age bracket, followed by the 18–30 age group (28.6%) and the 46–60 age group (26.4%). With a p-value of 0.04, a statistically significant correlation between treatment response and age group was discovered. With a p-value of 0.35, gender differences in treatment outcomes were not statistically significant. Conclusion: The present study highlights that antidepressant treatment response in patients with major depressive disorder varies across age groups, with younger adults demonstrating relatively better outcomes compared to older patients. Recommendations: It is recommended that antidepressant therapy in patients with MDD should be individualized according to age, clinical profile, and response patterns.

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Background: There are currently no well-defined procedures in our nation for determining when a C-section is necessary. The decision to have LSCS is therefore currently primarily individualized and dependent on the obstetrician caring for the parturient. Objectives: With an emphasis on maternal and newborn morbidity and death, the study’s objective was to examine the patterns, indications, and results of cesarean sections performed in a tertiary care hospital during the previous ten years. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Records of 168 participants who underwent CS were retrieved. The study included all women who underwent cesarean section, whether elective or emergency, during the study period at the tertiary care hospital. Results: The cesarean rate increased gradually in the first several years, rising from 3.8% in 2015–16 to 4.8% in 2019–20. It is noteworthy that there was a significant drop in 2020–21 (2.3%) and 2021–22 (2.7%). The trend was significant, as indicated by the p-value of 0.041. The majority of women experienced no complications, 124 cases (73.8%). The most frequent was postpartum hemorrhage, 14 cases (8.3%), followed by wound infection, 12 cases (7.1%), and febrile morbidity, 10 cases (6.0%). Conclusion: The study highlights a steady increase in cesarean section rates over the last decade, with previous CS, fetal distress, and non-progress of labor as the most common indications. Maternal and neonatal outcomes were largely favorable, though complications such as postpartum hemorrhage and wound infections were observed. Recommendations: Efforts should be made to encourage VBAC in eligible women and to adopt standardized protocols to avoid unnecessary cesarean deliveries.

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Background: End-of-life (EOL) care preferences vary widely among patients and are influenced by awareness, cultural values, and prior discussions. Understanding these preferences is crucial for patient-centered care planning. Limited data exist on EOL preferences and advance directive awareness in the local population. Methods: A cross-sectional study was carried out at BANAS Medical College and Research Centre among 168 adult participants. Data were collected using a structured questionnaire assessing EOL preferences, awareness of advance directives, and decision-making approaches. Responses were analyzed descriptively using frequency and percentage distributions. Ethical approval and informed consent were obtained. Results: Comfort-oriented care was preferred by 61.9% of participants, while 48.2% accepted ventilator support and 36.3% supported CPR. Non-invasive symptom management was favored by 73.8%, but only 42.3% had prior EOL discussions. Awareness of advance directives was 20.8%, with 57.7% willing to create one post-interview. Shared decision-making was preferred by 48.8%, followed by independent (31.0%) and family-only (20.2%) approaches. Conclusion: Most participants favored comfort-oriented care and non-invasive management, but awareness of advance directives was low, highlighting the need for community education.

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Background: Reducing the associated modifiable risk factors has been shown to considerably lower the incidence of CVDs. Although peripheral vascular disease (PVD), myocardial infarction, and stroke are typical middle-aged CVD symptoms, atherosclerosis can start early in childhood. Objectives: The study was done to ascertain the distribution of CVD among young adults, as well as to pinpoint important modifiable factors that may help guide early preventative measures. Materials and Methods: It was a prospective, cross-sectional study. The study was carried out at a BANAS Medical College and Research Centre, Palanpur, Gujarat, India. Overall, 172 participants were enrolled. Participants in the study had to be young individuals between the ages of 18 and 35 who could fill out the questionnaire and offer informed consent. Results: Of the 172 young adults, 45 (26.2%) were between the ages of 18 and 23, 62 (36.0%) were between the ages of 24 and 29, and 65 (37.2%) were between the ages of 30 and 35. There was no significant correlation between the age distribution and cardiovascular risk (p=0.412). There was no discernible variation in the risk distribution between the 98 (57.0%) male and 74 (44.0%) female participants (p=0.621). 78 participants (45.3%) had comorbidities, which were substantially linked to increased cardiovascular risk (p=0.034). Conclusion: According to this study, young persons have a significant burden of modifiable cardiovascular risk factors, with smoking, being overweight, and not exercising being the most common. Recommendations: In addition to early cardiovascular risk assessment, the study suggests encouraging young adults to avoid alcohol and tobacco use, maintain a balanced diet, and engage in physical activity.

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Background: There is a rising incidence of breast cancer in India with increasing cases in younger age groups. Ultrasound-based BI-RADS categories 4 and 5 lesions have a wide range of malignancy risk, often leading to unnecessary biopsies due to overlapping imaging features between benign and malignant cases. Methods: This retrospective observational study took place at a tertiary care hospital in India over one year (March 2024–March 2025). A total of 184 female patients with BI-RADS 4A–5 lesions on mammography and/or ultrasound, and histopathological confirmation, were included. Statistical analysis was performed using p-values, with significance set at <0.05. Results: This study found patients with benign lesions to be younger than the ones with malignant lesions (51.9 years versus 44.2 years). Malignant lesions were also larger in size (29.4 mm vs. 13.5 mm) and more frequently classified as BI-RADS 4C or 5 (p < 0.001). Increasing age, lesion diameter, and higher BI-RADS category were connected with greater odds of malignancy on univariate analysis. In multivariate analysis, age, diameter, and BI-RADS 4C remained significant independent predictors. Conclusion: Higher BI-RADS category, older age, and larger lesion size significantly increase the likelihood of breast malignancy.

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Background: Maternal-infant factors (e.g., lack of breast milk, parent HIV status, and perinatal morbidity), cultural factors (e.g., discarding colostrum), and social factors (e.g., rural residence and place of delivery) are among the factors linked to delayed breastfeeding initiation. Objectives: In a tertiary care facility, the study’s objective was to determine and examine the factors that contributed to postpartum moms’ delayed breastfeeding initiation during the golden hour, which is the first hour after delivery. Materials and Methods: It was a retrospective, analytical 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 178 participants has been retrieved. The study included all postnatal moms who gave birth to live, term neonates at the tertiary care facility during the one-year study period. Mothers were eligible to participate if their medical records were complete, easily accessible, and included information on when they started nursing as well as pertinent clinical and sociodemographic characteristics. Results: Of the 96 women who gave birth naturally, 18 (18.8%) started nursing during the first hour, 27 (28.1%) between one and four hours, 28 (29.2%) between four and eight hours, and 23 (24.0%) after more than eight hours. Additionally, there was a significant correlation between early initiation and educational background, with a p-value of 0.012; moms with post-graduate 15 (78.9%) and graduation 16 (76.2%) education had higher rates than mothers with no education 05 (35.7%). Conclusion: The study highlights a significant delay in the initiation of breastfeeding within the recommended golden hour, particularly among mothers who underwent cesarean sections, were primiparous, or had lower levels of education. Recommendations: Antenatal education and counseling on breastfeeding, emphasis on immediate skin-to-skin contact, and post-operative support for cesarean mothers should be prioritized.

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Background: Geographically, the prevalence of gestational diabetes varies greatly in India. Research from the southern region of the nation shows that the burden of gestational diabetes is higher than in the northern regions. Objectives: The purpose of the study was to assess maternal and fetal outcomes in GDM subjects. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Data from 186 participants were retrieved for the study. Included were the records of GDM patients treated at the facility. Women who had numerous gestations, pregnancies complicated by significant congenital abnormalities, or pregestational diabetes, including type 1 and type 2 diabetes, were not included. Results: Of the 186 women who were diagnosed with GDM, 115 (61.8%) were between the ages of 25 and 34, 52 (28.0%) were under 25, and 19 (10.2%) were 35 years of age or older. The mean birth weight of kids born to women with normal BMI (<25 kg/m2) was 3.05 ± 0.42 kg, the mean birth weight of babies born to women with overweight (25–29.9 kg/m2) was 3.32 ± 0.47 kg, and the mean birth weight of babies born to obese women (≥30 kg/m2) was the highest (3.68 ± 0.55 kg). A p-value of less than 0.001 indicated that the correlation was significant. Conclusion: The study shows that a higher prevalence of problems for both mothers and newborns is linked to GDM. In addition to negative neonatal outcomes like macrosomia, hypoglycemia, respiratory distress, and an increase in NICU admissions, there was a significant correlation between rising maternal BMI and birth weight. Recommendations: Nutritional guidance, lifestyle modification, and a multidisciplinary approach should be integrated into care.

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Background: Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality worldwide. Identifying predictors of in-hospital mortality can guide early risk stratification and management. This study evaluated clinical, laboratory, and treatment-related factors associated with short-term outcomes in ACS patients. Methods: A retrospective cohort study was conducted on 178 ACS patients admitted to a tertiary care hospital from January 2024 to December 2024. Data on demographics, clinical presentation, laboratory findings, treatments, and outcomes were extracted from medical records. Predictors of mortality were analyzed using regression models. Ethical approval was obtained from the institutional committee. Results: Overall mortality was 10.7%, higher in females (20.5% vs. 7.5%, p=0.042) and patients >75 years (25%, p=0.027). Hemodynamic instability (cardiac arrest, SBP <90 mmHg, HR >100 bpm, cardiogenic shock) was strongly linked to death (p<0.001). Elevated creatinine (>2.0 mg/dL, p<0.001) and glucose ≥200 mg/dL (p=0.010) predicted mortality. Use of PCI, beta-blockers, and statins significantly reduced mortality risk. Conclusion: Age, female sex, hemodynamic compromise, renal dysfunction, and hyperglycemia were key predictors of mortality in ACS, while early reperfusion and evidence-based therapies improved survival.

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Background: Thyroid swellings are common clinical presentations with varied aetiologies ranging from benign physiological enlargements to aggressive malignancies. Differentiation between benign and malignant lesions is crucial for appropriate management. In resource-limited settings, FNAC and USG neck are primary diagnostic tools. Objectives: To study the demographic and clinical profile of thyroid swellings, identify their cytological spectrum using FNAC, assess ultrasonographic patterns using TI-RADS, and evaluate the diagnostic accuracy of USG against FNAC. Methods: A descriptive observational study was conducted at Government Teaching General Hospital, Vizianagaram, from January 2023 to December 2024. All patients with palpable thyroid swellings underwent detailed clinical evaluation, serum thyroid function testing, USG neck, and FNAC. USG findings were classified according to ACR TI-RADS (2017), and FNAC results were categorized using the Bethesda System (2017). Statistical analysis included sensitivity, specificity, and diagnostic accuracy of USG compared to FNAC. Results: A total of 126 patients were studied (mean age: 38.4 ± 12.6 years; F:M ratio is 4.25:1). The most common presentation was solitary thyroid nodule (47.6%), followed by multinodular goitre (34.1%) and diffuse goitre (18.3%). On FNAC, benign lesions accounted for 73.8% (nodular goitre 49.2%), malignant lesions for 14.3% (papillary carcinoma 8.7%), and indeterminate lesions for 11.9%. USG classified 77.8% of nodules as benign (TI-RADS 2 – 3) and 22.2% as suspicious/malignant (TI-RADS 4 – 5). USG and FNAC showed 87.3% concordance, with a sensitivity of 88.9%, specificity of 86.0%, and diagnostic accuracy of 87.3%. Conclusion:  Thyroid swellings are common in middle-aged females, with benign lesions predominating. FNAC remains the gold standard for diagnosis, while USG plays a vital role in risk stratification and FNAC guidance. The combined use of USG and FNAC ensures high diagnostic accuracy and optimizes management in tertiary care settings.

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Background: Eclampsia contributes heavily to maternal mortality & morbidity of India. To prevent eclampsia, MgSO4 regimes most commonly used across the globe are Pritchard regime, Zuspan & Sibai regime. These regimes are standardised for western women. Adverse effects & toxicities are higher with conventional MgSO4 regimes in Indian women. Hence, the search for an effective & safe dose of the drug suited for Indian population. Materials & Methods: 60 pregnant women with severe pre-eclampsia received Low dose MgSO4 regime (case) & 60 pregnant women with severe pre-eclampsia received Standard dose MgSO4 regime i.e. Pritchard regime (control). Occurrence of seizures, clinical signs of Magnesium sulphate toxicity & serum level of Magnesium were seen. Results: Both groups were statistically comparable in terms of seizure occurrence (Pritchard regime group=1.67%, Low dose MgSO4 regime group=8.33%, P value 0.09). Patients receiving Pritchard regime exhibited higher levels of serum Magnesium (P value <0.001) & more cases of toxicity (Pritchard regime group=20% & Low dose MgSO4 regime group=6.66%, P value 0.48). Conclusion: The control of fits with low dose Magnesium Sulphate regime is statistically comparable with the standard Pritchard regime & it also maintains serum magnesium level within the therapeutic range(4.2 to 8.4 mg/dL) during therapy.

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Background: Subclinical hypothyroidism (SCH) is a mild form of thyroid failure characterized by elevated thyroid-stimulating hormone (TSH) levels with normal free T3 and T4 concentrations. It is often asymptomatic but may be associated with dyslipidaemia, thereby increasing the risk of cardiovascular diseases. The aim of this study was Analysis of thyroid function test, C-reactive protein (CRP), CKNAC, LDH and lipids profile in subclinical hypothyroidism (SCH) as indicators of cardiovascular disease. Material and Method: This cross-sectional study was conducted in the Clinical Biochemistry Department of Jhalawar Medical College over a period of one year. A total of 100 participants were included, comprising 50 SCH cases and 50 healthy controls. Serum levels of TSH, T3, T4, CRP, CK, LDH and lipid profile parameters were measured and analyzed. Results: Patients with subclinical hypothyroidism showed significantly elevated levels of total cholesterol, LDL-C, VLDL, and triglycerides, CK, CRP, LDH along with decreased HDL-C levels, compared to controls. Conclusion: Subclinical hypothyroidism is significantly associated with dyslipidemia , including increased levels of CRP, CK, LDH total cholesterol, LDL-C, VLDL, and triglycerides, and decreased HDL-C levels. These alterations can contribute to the early development of atherosclerosis and increased cardiovascular risk. Therefore, screening for thyroid function in patients with abnormal lipid profiles is recommended. Further large-scale studies are warranted to confirm this association and guide the development of preventive strategies in the Indian population.

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Background: The COVID-19 pandemic has resulted in significant health impacts, including a rise in cardiovascular complications like myocarditis and sudden cardiac death, particularly in the post-COVID era. Inflammation, indicated by elevated hs-CRP levels, is a key factor in these conditions. This study compares hs-CRP levels between post-COVID and non-COVID adults to identify individuals at higher cardiovascular risk and facilitate timely clinical intervention. Methods: This hospital-based observational cross-sectional study was conducted in the Department of Medicine, AMCH, Dibrugarh, from November 2023 to October 2024. It included 90 post-COVID adults who were hospitalized for COVID-19 infection and 90 adults with no history of clinical COVID-19. Data collection involved history taking, clinical examination, and serum hs-CRP assessment using an ELISA kit. Results: The study included participants aged 20–60 years, with most in the 41–50 age group. Males predominated in both post-COVID (53.33%) and non-COVID (61.11%) groups. Elevated hs-CRP was significantly more frequent in post-COVID individuals (38.89%) compared to non-COVID (10.00%). Mean hs-CRP levels were slightly higher post-COVID, with overall differences statistically significant. Symptom analysis revealed that post-COVID individuals experienced more exercise intolerance (28.89%), fatigue (27.78%), and palpitations (12.22%), with significant associations between raised hs-CRP and both exercise intolerance (p=0.004) and fatigue (p=0.005). In contrast, symptoms in non-COVID individuals showed no significant correlation with hs-CRP. These findings highlight persistent inflammation and higher symptom burden post-COVID. Conclusion: The study found significantly higher hs-CRP levels in post-COVID individuals, indicating persistent systemic inflammation. Since prolonged hs-CRP elevation is linked to cardiovascular risks such as atherosclerosis and myocardial infarction, the findings highlight the need for routine cardiovascular assessment and long-term follow-up in post-COVID patients to prevent future complications.

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Background: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with rapid ventricular rate (RVR) episodes, contributing to increased morbidity and heart failure progression. Emerging evidence suggests that Angiotensin Receptor–Neprilysin Inhibitors (ARNI), beyond their role in heart failure, may offer benefits in atrial stabilization through reverse remodeling. Aim: To evaluate the role of ARNI therapy in reducing RVR episodes in patients with chronic AF and its impact on left atrial (LA) morphology and function as assessed by cardiac MRI. Methods: A prospective observational study was conducted on 100 patients with chronic AF at the Department of Medicine and Cardiology, ANMMCH. Patients received ARNI therapy for six months. Frequency of RVR episodes was recorded monthly, and cardiac MRI was performed at baseline and after therapy to assess changes in LA volume, strain, and fibrosis. Data were analyzed using SPSS version 23.0, with p < 0.05 considered statistically significant. Results: Mean RVR episodes per month decreased significantly from 6.2 ± 1.4 to 2.1 ± 1.2 (p < 0.001). MRI revealed a reduction in mean LA volume (62.1 mL to 53.6 mL, p < 0.01), improvement in LA strain (18.3% to 24.7%, p < 0.001), and a decrease in LA fibrosis score (2.6 to 1.8, p < 0.01). Therapy was well-tolerated with minimal adverse effects. Conclusion: ARNI therapy significantly reduced RVR episodes and improved LA structural and functional parameters in chronic AF patients, suggesting a potential role in atrial stabilization and long-term arrhythmia control. Recommendations: ARNI may be considered as an adjunctive treatment in chronic AF, especially in patients with heart failure. Further randomized controlled trials are recommended to validate these findings and explore long-term outcomes.

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Background: Brachial plexus block is a useful alternative to general anaesthesia in upper limb surgeries. Various adjuvants have been tried for prolonging the duration of postoperative analgesia and also to enhance the quality of block. This study compared effectiveness of 0.375% bupivacaine with potassium chloride and buprenorphine in brachial plexus block, focussing on onset time, duration, hemodynamic stability and postoperative analgesia. Materials and methods: Sixty patients of ASA grade I and II aged 20-60 years, scheduled for elective upper limb orthopaedic surgeries, were randomized into 2 groups of 30 each. Group A received 0.375% bupivacaine with 0.2 mmol KCL and Group B received 0.375% bupivacaine with 0.15 mg buprenorphine via supraclavicular approach. Sensory and motor blockades were assessed using modified Hollmen’s and Bromage scales. Postoperative pain was evaluated by VAS scores for 12 hours. Hemodynamic parameters and time to first rescue analgesia were recorded. Results: Both the groups were comparable in demographics and ASA grading. Group A showed rapid onset of sensory and motor block compared to Group B (P<0.001). Conversely, Group B had significantly prolonged duration of sensory and motor block (P<0.001) and lower VAS scores postoperatively (P<0.001). Group B also had an extended time to receive first rescue analgesia (10.1±0.23 hours) compared to Group A (8.21±0.36 hours, P<0.001). Hemodynamic parameters remained stable across both groups. Conclusion: This study showed that in brachial plexus block, addition of potassium chloride as an adjuvant shortened block onset, while buprenorphine prolonged block duration and enhanced postoperative analgesia.

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Background: Asthma is a common chronic respiratory condition in children that significantly impacts psychological well-being. Children with asthma are at increased risk of developing psychiatric comorbidities, particularly anxiety and depression, which can adversely affect disease control and quality of life. Objective: To determine the prevalence of anxiety and depression in children aged 5-18 years with asthma and investigate their association with asthma severity and control. Methods: A descriptive cross-sectional study was conducted over 18 months at Cheluvamba Hospital, Mysore, involving 176 children aged 5-18 years with bronchial asthma. Participants were selected through consecutive sampling. Asthma diagnosis, severity, and control were assessed using GINA 2023 guidelines. Psychiatric disorders were evaluated using the Revised Children’s Anxiety and Depression Scale (RCADS-47). Statistical analysis was performed using SPSS version 22. Results: The mean age of participants was 12.03 years with slight male predominance (51.1%). Cough was the most common presenting symptom (56.3%). Moderate persistent asthma was most prevalent (58.5%), with 47.2% having well-controlled asthma. Overall, 21.6% of children had psychiatric disorders, with Separation Anxiety Disorder being most common (13.1%). Combined anxiety and depression occurred in 9.7% of participants. Significant associations were found between asthma severity and psychiatric disorders (p<0.001), and between poor asthma control and psychiatric comorbidities (p=0.005). Conclusion: Psychiatric disorders, particularly combined anxiety and depression, are prevalent in children with asthma. Severity and poor control of asthma are significantly associated with increased psychiatric morbidity, highlighting the need for integrated physical and mental healthcare approaches.

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Objectives: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to significant morbidity and mortality worldwide. Omicron variant has generated a new wave, evidenced by high infection rates worldwide and is very high compared to the waves of the variants such as the Alpha and Beta. This study aims to investigate the relationship between third wave of COVID-19 and seizures by analyzing the clinic-demographic profiles of affected patients. Methods: This retrospective, cross-sectional, record-based study was conducted at Department of Pediatrics, Malankara Orthodox Syrian Church Medical College, Kerala, India, to assess the risk of seizures in children with SARS-CoV-2 infection during the third wave (Omicron variant) of the COVID-19 pandemic. The study included pediatric patients aged from 2 months to 18 years admitted in the Department of Pediatrics between December 28, 2021, and March 15, 2022. Data on demographics, clinical features, seizure characteristics, laboratory findings, and imaging results were systematically extracted from hospital records and analyzed using EZR software. Statistical tests, including the Chi-square test and Mann-Whitney U test, were used to determine significant associations. Ethical approval was obtained, and patient confidentiality was maintained. Results: A total of 276 children were admitted during the Omicron wave of COVID-19, 81 of whom had COVID-19. The study participants had a median age of 23 months (IQR: 12–51 months). Most were male (65.9%), while females made up 34.1%. Most COVID-19 cases were mild (97.6%), with only one participant (2.4%) experiencing moderate severity. Among the 49 children with confirmed COVID-19, 41 (50.62%) had seizures, compared to 8 (4.10%) without seizures, showing a statistically significant association (p < 0.001) with an odds ratio (OR) of 23.95 (95% CI: 10.43–54.99). Seizures were predominantly generalized (97.6%), with febrile seizures accounting for most cases (70.7% simple, 24.4% complex). Anemia had statistically significant association with seizures (p = 0.019, OR = 4.26 [1.20, 15.04]), while other laboratory parameters, including lymphocyte count and sodium levels, were not. Conclusions: The study results align with emerging evidence that COVID-19 can impact the central nervous system (CNS) and the need for heightened vigilance for seizure activity in patients with COVID-19, especially those with severe disease.

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Background: The temporal bone houses critical neurovascular and sensory organs within a complex anatomical space, making the diagnosis and management of its pathologies exceptionally challenging. High-Resolution Computed Tomography (HRCT) has emerged as a primary imaging modality for evaluating this region. Objective: This study aims to determine the diagnostic accuracy and pivotal role of HRCT in the comprehensive evaluation of a wide spectrum of temporal bone pathologies, including infective, traumatic, neoplastic, and congenital conditions, and to correlate imaging findings with clinical presentations to guide surgical management. Methods: A prospective, single-center observational study was conducted over 1 year (july2024– July 2025) at a tertiary care hospital. A total of 200 patients with clinically suspected temporal bone pathologies were enrolled. All patients underwent HRCT of the temporal bone using a 128-slice MDCT scanner with a standardized protocol, including thin axial sections and multiplanar reformations. Intravenous contrast was used for suspected neoplastic or complicated inflammatory cases. Data on patient demographics, clinical symptoms, and detailed HRCT findings were systematically collected and analyzed. Results: The study included 200 patients, with a male majority (113, 56.5%). The 21–30 year age group was most frequently affected (30%). Ear discharge (otorrhea) was the most common symptom (75%). The etiological distribution was predominantly infective (148 cases, 74%), followed by traumatic (38 cases, 19%), neoplastic (12 cases, 6%), and congenital (2 cases, 1%). Infections: Acquired cholesteatoma was the most common infection (41.8%), characterized on HRCT by loss of mastoid pneumatization (96.8%) and bony erosion (83.8%). The incus was the most commonly eroded ossicle (59.6%). Trauma: Petrous bone fractures were the most common traumatic injury (47.3%), with the longitudinal type predominating (77.8%). Neoplasms: All 12 neoplasms were benign, with acoustic schwannoma (33.3%) being the most frequent, followed by meningioma (25%) and epidermoid cyst (25%). Congenital: Two cases of microtia with external auditory canal hypoplasia were identified. Conclusion: HRCT is an indispensable, first-line imaging tool for the definitive diagnosis and preoperative assessment of temporal bone pathologies. Its exceptional spatial resolution provides a detailed anatomical roadmap, enabling the precise characterization of lesions, delineation of their extent, and identification of complications. This study validates the utility of HRCT in guiding therapeutic strategies and improving patient outcomes across a broad spectrum of temporal bone diseases.

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