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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Background: Macular edema (ME) is a major cause of visual impairment and can occur secondary to diabetic macular edema (DME), retinal vein occlusion (RVO), and pseudophakic cystoid macular edema (CME). It results from the breakdown of the blood–retinal barrier due to vascular hyper permeability, ischemia, and inflammation. Intravitreal dexamethasone (DEX) implants provide sustained anti-inflammatory, anti-angiogenic, and anti-permeability effects, potentially reducing treatment burden compared to anti-VEGF therapy. This study aimed to evaluate morphological and functional changes after a single intravitreal DEX implant in ME of varied etiologies. Material and Methods: A prospective, non-randomized observational study was conducted at a tertiary eye care hospital from July 2018 to August 2020, including 30 eyes with ME secondary to DME, non-ischemic RVO, or pseudophakic CME. Exclusion criteria included prior intravitreal therapy, uncontrolled glaucoma, active infection, or traumatic ME. Baseline evaluation included best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp and fundus examination, and optical coherence tomography (OCT) for central foveal thickness (CFT). All patients received a single 0.7 mg intravitreal DEX implant under aseptic conditions. Follow-up visits were at day 1, week 1, month 1, and month 3, assessing BCVA, CFT, IOP, and adverse events. Results: Of 30 patients (mean age 57.8 years; 53.3% male), 15 had DME, 12 RVO, and 3 pseudophakic CME. Mean CFT decreased significantly from 641.8 ± 195.9 μm at baseline to 323.7 ± 132.6 μm at month 3 (p < 0.001). Mean BCVA improved from 1.05 ± 0.37 to 0.59 ± 0.26 logMAR (p < 0.001), with maximum recovery in the first month. IOP remained stable (p = 0.70). Minor adverse events included subconjunctival hemorrhage (13.3%), pain (6.7%), and floaters (6.7%); no serious complications occurred. Conclusion: A single intravitreal DEX implant produced significant anatomical and visual improvement in ME secondary to DME and RVO, with minimal adverse effects and stable IOP. The treatment was less effective in pseudophakic CME, likely due to small sample size. DEX implants are a safe and effective short-term option, particularly in DME and RVO.

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Aims and Background: A prolonged pregnancy is defined as any pregnancy beyond 280 days. These pregnancies are more complicated and are also associated with compromised foeto- maternal outcomes. This study is to evaluate the foeto-maternal outcome in pregnancies after 40 weeks of gestation. Materials and Methods: This is a prospective observational study of 12 months duration, and includes all the antenatal exceeding 40 weeks of pregnancy. Pregnancies with any complication and any fetal congenital anomalies were excluded. The spontaneous labor or induction rate, mode of delivery, and foeto-maternal complications were evaluated. The statistical analysis was done using SPSS software. Results: Induction of labor found to be more in primigravida in comparison to multigravida. Cesarean section rate was found higher in induction of labor, 70%, than the spontaneous group, 24%, which is statistically significant. Conclusion: Complication rates are higher with increasing gestational age. Clinical significance: Pregnancies crossing 40 weeks should be monitored intensively and wisely.

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Background: Left ventricular (LV) function assessment is crucial in patients with acute myocardial infarction (AMI), as both systolic and diastolic dysfunction are known predictors of early in-hospital heart failure. Two-dimensional (2D) echocardiography provides a non-invasive and reliable method to evaluate LV performance and risk stratify patients. This study aimed to assess the prevalence of systolic and diastolic dysfunction in acute STEMI and correlate these findings with clinical risk factors and early heart failure. Material and Methods: This hospital-based observational study included 150 patients with acute ST-elevation myocardial infarction (STEMI) admitted to the Intensive Coronary Care Unit. All patients underwent 2D and Doppler echocardiography within 48 hours of admission. LV ejection fraction (LVEF), regional wall motion score index (RWMI), and diastolic function grading were assessed. Clinical data including age, sex, infarct type, diabetes, smoking status, and Killip classification were recorded. Heart failure was defined as Killip class ≥ II. Statistical analysis included univariate and multivariate logistic regression to identify predictors of early heart failure. Results: Among 150 patients, 72.7% were male and 58% were aged between 51–60 years. Anterior MI was observed in 64% of cases. LVEF was significantly lower in anterior MI (42.4%) than inferior MI (47.8%, p = 0.034), while RWMI was significantly higher in anterior MI (1.56 vs. 1.31, p = 0.001). Diastolic dysfunction was found in 47.3% of patients, mostly Grade I. Early heart failure occurred in 29.3% of patients and was significantly associated with diabetes, smoking, lower LVEF, and diastolic dysfunction. In multivariate analysis, only LVEF ≤ 40% (OR = 13.7, p = 0.002) and diastolic dysfunction (OR = 5.6, p = 0.030) remained independent predictors of heart failure. Conclusion: Early echocardiographic evaluation in STEMI patients provides vital prognostic information. Reduced LVEF and diastolic dysfunction were the most reliable predictors of early in-hospital heart failure. Clinical factors such as diabetes and smoking further contributed to adverse outcomes. Timely risk stratification using echocardiography can help guide early therapeutic interventions in acute MI management.

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Background: Groove pancreatitis is a rare form of chronic pancreatitis that becomes problematic when it suppresses the head of the pancreas or compresses the main pancreatic duct and causes stenosis. Then it becomes a challenge to the radiologist for proper diagnosis or remarks. Method: 32 patients with Groove pancreatitis (GP) were studied with CE motion 64 multislice CR scanner. With non-ionic IV contrast, 12 patients were additionally examined by MRI, including MRCP, using a 1.5 T closed MRI scanner. Results: 24 (75%) were hyperdense in CT, 8 (66.6%) in MRI, 20 (62.5%) had duodenal wall thickening in CT, 12 (100%) in MRI, 20 (62.5%) had CBD dilatation and distal tapering, 8 (66.6%) in MRI, 16 (50%) and 6 (50%) had pancreatic head enlargement, 16 (50%), 8 (66.6%) had pancreatic duct dilatation, 12 (37.5%) in CT, 6 (50%) in MRI had delayed enhancement, and 12 (37.5%) in CT and 8 (66.6%) in MRI had duodenal cysts. Conclusion: The differential diagnosis of the pancreatic groove (PG) should be considered along with co-morbidities of the patient it will avoid the surgical intervention.

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Background and Aim: The high prevalence of gallstones globally, particularly in females and individuals consuming high-fat diets, has been consistently linked with chronic irritation and mucosal damage of the gallbladder epithelium, leading to a cascade of pathological events. This study aims to explore the histopathological spectrum of lesions in gallbladder specimens obtained post-cholecystectomy, offering insights into patterns of disease and their associations with gallstone presence. Material and Methods: A total of 120 cholecystectomy specimens were included based on availability and completeness of clinical and histopathological data. All histological diagnoses were classified into inflammatory, metaplastic, dysplastic, or neoplastic categories. The presence or absence of gallstones was noted in correlation with histopathological findings. Results: Chronic cholecystitis was the most frequently encountered lesion, seen in 66 cases, of which 90.9% were associated with gallstones. This strong correlation supports the hypothesis that persistent mechanical irritation and chemical inflammation from calculi play a major role in gallbladder mucosal injury and chronicity. Metaplasia and dysplasia showed particularly high associations with stones, highlighting the risk of neoplastic transformation in chronically inflamed gallbladders. Conclusion: This study demonstrates that the gallbladder harbors a diverse range of histopathological lesions, with chronic cholecystitis being the most prevalent. Gallstones were significantly associated with most inflammatory and metaplastic changes, and strongly linked to dysplasia and carcinoma, reinforcing their pathogenic role in gallbladder disease progression.

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Rehabilitation of partial edentulism presents unique challenges in medically compromised patients due to the influence of systemic conditions on oral health, treatment planning, and prognosis. Precision attachment-retained partial dentures offer enhanced function, aesthetics, and patient comfort compared to conventional clasp-retained dentures. A 53-year-old female patient with a medical history of hypothyroidism and rheumatoid arthritis presented with missing posterior teeth, loss of vertical dimension, and compromised mastication. She was rehabilitated with extracoronal castable precision attachments in the maxillary arch and a conventional removable partial denture in the mandibular arch. The treatment restored masticatory efficiency, improved aesthetics, and enhanced speech. Over six months of follow-up, the prosthesis remained stable with no complications, and the patient reported high satisfaction. Precision attachment-retained partial dentures are a viable treatment option for medically compromised patients when supported by meticulous planning, proper execution, and patient compliance.

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Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity, which may affect oral health maintenance, compliance with dental treatment, and prosthetic adaptation. Patients with ADHD often exhibit poor oral hygiene, dietary habits predisposing to caries, and difficulties in adapting to complex dental prostheses. A 26-year-old male with a confirmed diagnosis of ADHD, under methylphenidate therapy, presented with missing teeth, impaired mastication, and dissatisfaction with his appearance. Clinical and radiographic assessment revealed partial edentulism, generalized attrition, and reduced vertical dimension. A treatment plan was designed involving extracoronal precision attachments for the maxillary arch and a conventional removable partial denture for the mandibular arch, with modifications to ensure simplified maintenance and improved compliance.
The prosthetic rehabilitation restored function, aesthetics, and patient confidence. Over six months of follow-up, the patient adapted well to the prostheses, with improved masticatory efficiency, speech, and oral hygiene adherence through caregiver-assisted instructions. Prosthetic rehabilitation of ADHD patients requires tailored strategies that emphasize simplicity, durability, and patient compliance. With proper planning and patient education, precision attachment-retained prostheses can provide functional and aesthetic success.

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Background: Laparoscopic surgeries are associated with significant hemodynamic fluctuations due to pneumoperitoneum and surgical stress, which may compromise patient safety. Intraperitoneal instillation of local anesthetics has been proposed to improve perioperative stability. Aim: To compare postoperative hemodynamic stability and analgesia following intraperitoneal instillation of Ropivacaine 0.375% versus placebo in laparoscopic abdominal surgeries. Material and Methods: Eighty patients undergoing elective laparoscopic abdominal surgery were randomized into two groups. Group R received intraperitoneal Ropivacaine 0.375% and Group S received placebo saline. Hemodynamic parameters and analgesic outcomes were measured perioperatively. Results: Patients in the Ropivacaine group demonstrated significantly improved systolic, diastolic, and mean arterial pressures along with more stable heart rates compared to placebo. Postoperative analgesia was superior with reduced rescue analgesic requirements. Conclusion: Intraperitoneal instillation of Ropivacaine 0.375% enhances both hemodynamic stability and postoperative analgesia, supporting its role as an effective adjunct in laparoscopic anesthesia practice.

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Background: COVID-19 vaccination has significantly reduced disease severity and mortality worldwide. However, breakthrough infections in fully vaccinated individuals have emerged as a public health concern, necessitating systematic evaluation of their clinical and microbiological profiles. Objective: To assess the demographic, clinical, and microbiological characteristics of COVID-19 vaccine breakthrough infections among hospitalized patients at a tertiary care teaching hospital in Assam. Methods: This hospital-based, observational study was conducted from October 2021 to July 2022. Adult patients admitted with confirmed SARS-CoV-2 infection, who had completed both doses of COVID-19 vaccination at least 14 days before testing positive, were included. Clinical, laboratory, and vaccination data were collected and analyzed using IBM SPSS version 25. RT-PCR was used for confirmation of infection. Whole genome sequencing was not performed due to logistical constraints. Results: Out of 122 patients with breakthrough infections, 73 (59.8%) were males. The mean age was 56.2 ± 14.7 years. The majority (85.2%) were vaccinated with Covishield and the rest with Covaxin. Comorbidities were present in 78 (63.9%) patients, with diabetes (36.9%) and hypertension (29.5%) being the most common. Fever (90.2%), cough (72.1%), and dyspnea (65.6%) were the predominant symptoms. Based on severity, 34.4% had mild disease, 37.7% moderate, and 27.9% severe. Oxygen support was needed in 60 (49.2%) cases, and 18 (14.8%) required ICU care. The in-hospital mortality rate was 13.1% (n=16). RT-PCR Ct values ranged from 15.8 to 29.4 (mean: 22.3), suggesting high viral loads. Conclusion: Breakthrough infections, though generally less severe, can still result in significant morbidity and mortality, especially in individuals with underlying comorbidities. Continued surveillance, genomic monitoring, and booster vaccination strategies are essential to mitigate the impact of evolving SARS-CoV-2 variants.

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Background: These days, heart attacks and cardiac fatalities are so regular that when an elderly person passes away, it’s hardly noticed because it seems predictable and natural. The risk of coronary artery disease in Indians is substantially correlated with conventional risk factors, as it is in all other populations. The purpose of this study was to assess the association between traditional risk factors and early coronary artery disease by examining the levels of triglycerides, lipoproteins, and HbA1c. Methods: From January 2024 to December 2024 total 180 patients, 116 males and 64 females, underwent echocardiography which we analyzed. Three stages of analysis were conducted on the study population: first, their demographic representation according to risk factors; second, the presence and type of echocardiographic findings; third, a case control type analysis to demonstrate the independent significance of risk factors in relation to CAD; and finally, a risk factor analysis based on the severity of the echocardiographic findings. Calculations were made for weight, BMI, HbA1c, pulse, systolic and diastolic blood pressure, LDL, VLDL, HDL, total cholesterol, and triglycerides. Result: The controls had a mean age of 51±6.3 years while the patients had a mean age of 50±7.3 years, with a male preponderance [3.5:1]. The most common conventional risk factors found in the entire study sample were alcohol use (43%), tobacco use (38%), dyslipidemia (41%), family history (32%), hypertension (53%), diabetes (50%), and dyslipidemia (41%); in contrast, the most common conventional risk factors found in cases of CAD were alcohol use (60%), tobacco use (53%), dyslipidemia (62%), and family history (73%). The following risk factors were statistically significant: total cholesterol, triglycerides, LDL, BMI, and HbA1c. Dyslipidemia and the severity and development of CAD were 20% related. Conclusion: Additionally, multifactorial causation of CAD is demonstrated by our study, with a higher number of risk variables in cases and a lower number in controls. In 2% of cases, there were eight risk factors, while in 31% of cases, there were six.

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Background: Right ventricular (RV) dysfunction and dilatation are correlated to limited exercise capacity and poor outcome, dilated cardiomyopathy and ischemic heart disease can both lead to RV dysfunction. The aim of this study to assessment of Echocardiographic of right ventricular functions in patients with dilated cardiomyopathy and Strain imaging study. Methods: The study included 50 patients with impaired left ventricular systolic function with EF% less than 40% and 15 healthy subjects with no history of medical or cardiac disease served as a control group. Patients were classified into ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM). Full history, clinical examination, ECG, full conventional echocardiography and assessment of LV & RV mechanics using speckle tracking imaging was done. Results: Results showed impairment of systolic strain values in both ICM and DCM groups compared to control group and a highly significant difference between both groups regarding global peak systolic longitudinal strain being impaired in DCM more than ICM group. The difference regarding cumulative systolic strain rate between DCM & ICM groups was highly significant being more impaired in DCM than ICM group. Also, the difference regarding cumulative early and late diastolic strain rate between DCM& ICM groups was highly significant being impaired in DCM group than ICM group. Conclusion: Our study showed that RV dysfunction is a prominent feature & an independent determinant of outcomes in patients with HFrEF. 2D strain imaging by STE seems to be a reliable quantification tool for assessment of RV function and for better discrimination between ICM & DCM patients.

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Background: Chordae tendinae (CT) are strong cord-like fibro-collagenous structures between valve leaflets and papillary muscles (PM). They are critical in conveying the systolic contraction of the PM to the valve and therefore prevent the collapse and regurgitation. Disintegration of CT can affect the valve competence. Aims and Objective: To study the number, length, types and branching pattern of chordae tendinae. Material and Method: The study was carried out on 100 formalin fixed hearts regardless of sex. Dissection was performed according to standard techniques. CT were observed on the basis of number, length, types and branching pattern. Observations and Results: The mean number of CT attached to anterior cusp were found to be 12.24 in LAVV and 14.81 in RAVV, in posterior cusp 12.39 in LAVV and 12.62 in RAVV, in accessory cusp 12.75 in LAVV and 9.17 in RAVV. In case of RAVV, the mean number of CT found in septal cusp were 10.96. For RAVV, length of the largest and the shortest CT of tricuspid heart valves were significantly higher than those of LAVV. For posterior heart valves,length of the largest CT was significantly higher in LAVV as compared to RAVV. 4 types of CT were found i.e., muscular, tendinous and membranous. The branching pattern observed were straight, branched, spiral and web forming. Conclusions: This knowledge would help cardiac surgeon during procedures like chordal cutting and chordal dislocation for correction of valve dysfunctions.

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Background: For the prevention, diagnosis, and treatment of all diseases, drugs are essential. In addition to being helpful to patients, they can cause undesirable side effects known as adverse drug reactions (ADRs). This study’s objective was to assess and examine antibiotic-related adverse drug responses in patients in a tertiary care hospital in Bhagalpur, Bihar. Methods: From February 2025 to June 2025, the Department of Pharmacology at Jawaharlal Nehru Medical College and Hospital in Bhagalpur, Bihar, conducted this prospective observational study. Patients were collected from the hospital ward and various OPD departments of JLNMCH in Bhagalpur, Bihar. Results: A total of 69 adverse drug reactions were chosen for this investigation. There were 20 female and 49 male. The department of general medicine had the most patients, followed by general surgery and dermatology. The Naranjo scale was used to assess a drug’s relationship to adverse drug reactions. The safety of drugs used in medicine must be evaluated and monitored, as well as public health, in order to prevent or lessen patient harm and hence enhance public health. Conclusion: The most often prescribed drugs are antibiotics, therefore tracking adverse drug reactions (ADRs) may help clinicians identify and treat ADRs early on, protecting patients’ quality of life as soon as possible.

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Methotrexate (MTX) forms the backbone of maintenance cycles in childhood acute lymphoblastic leu­kemia (ALL) chemotherapy, including interim mainte­nance. There is sufficient published data describing toxicities of high dose MTX (HD-MTX), but toxicities with escalating doses of MTX (Capizzi regimen) is not well documented. Capizzi regimen is thought to be rela­tively safe; we contend that even low escalating doses of MTX have significant toxicities. Our study intends to characterise such events with Capizzi MTX in comparison to that seen with HD-MTX. The retrospective study was conducted at a tertiary care centre of Bikaner, Rajasthan, India. We looked for the presence of six main toxicities: febrile neutropenia, thrombocytopenia, mucositis, hepatic toxicity, renal toxicity and skin toxicity from the clinical records of children with newly diagnosed acute lymphoblastic leu­kemia and lymphoma (intermediate and high risk disease), treated at our centre from November 2022 to July 2023. Intermediate risk ALL whereas high risk ALL (HR-ALL/T-NHL), received HD-MTX. Both these regimens do not use L-asparaginase. A total of 237 cycles of Capizzi escalating MTX and 151 cycle of high-dose MTX.

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Introduction: Degenerative Disc Disease and lumbar instability are common disorders which lead to low back pain and radicular leg pain. Instrumented TLIF provides various advantages including load sharing, maintaining the disc height, formation of three-column stability, with allowance for wider decompression, prevention of graft dislodgment, and improved fusion rate. Consequently, rods can be contoured to preserve or restore physiological lumbar lordosis. Materials and Methods: It is a prospective clinical study of 15 consecutive patients, who underwent one level instrumented transforaminal lumbar interbody fusion surgery, with single cage and local bone graft. The duration of study is for one year (July 2023 to June 2024). The indications of surgery are massive disc prolapse, lumbar canal stenosis, clinical and radiological features of instability with PIVD and spondylolisthesis. Clinical outcome is assessed using Oswestry Disability Index and Visual analog score. The radiological outcome is assessed using intervertebral disc height and Modified Lee’s criteria of fusion. Results: Out of 15 patients, 10 were males and 5 females, with the mean age of 42.66 years. Clinically the preoperative and postoperative ODI score, VAS score and JOA score improved and are statistically significant p<0.0001 (the result is significant at p ≤ 0.05). The surgery restored the disc height and at a mean follow up of 6 months 93.33% shows possible fusion and 6.67% shows possible pseudoarthrosis. Conclusion: A single cage with local bone graft are adequate for one level fusion. Transforaminal lumbar interbody fusion is a safe technique to alleviate pain arising out of instability and segmental degeneration of the lumbar spine.

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Background: The aim of this study is to evaluate the validity of RIPASA score – a new scoring system for diagnosis of acute appendicitis – in our local population. Methodology: The study was conducted from March 2019 to August 2020, for a period of 18 months in Bankura Sammilani Medical College and Hospital, Bankura. The study was conducted in a group of 87 patients who underwent appendicectomy in the Department of General surgery of this institution after satisfying inclusion and exclusion criteria. The study involved applying of RIPASA in all 87 patients and findings were correlated with that of intra-operative and HPE findings. Results: RIPASA score had sensitivity of 96.6%, specificity of 72.4%, and positive predictive value of 87.5% and negative predictive value of 91.3%. Conclusion: These findings have suggested that RIPASA score is a good diagnostic scoring system in predicting acute appendicitis when applied in our local population. In addition there has been prediction of significant reduction in the number of negative appendicectomies, which will lead to less morbidity to the patient and also help in reducing unnecessary expenditure of health resources in a country where there is limited resources like our country.

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Introduction: Lumbosacral Meningomyelocele (MMC) is a common form of spinal dysraphism. Pure dorsal form is quite rare accounting for only 1–8% of all spinal dysraphism. There are only a few case series related to dorsal MMC in the literature. This study presents a series of dorsal meningomyelocele, reviewing its clinical features, surgical management and other management strategies. Objective: To discuss the clinical features, surgical management and other management strategies in accordance with the literature. Materials and Methods: We conducted a retrospective analysis from January 2019 to December 2023. 360 cases of spinal dysraphism were diagnosed during this period out of which 18 cases were dorsal meningomyelocele. All cases of open and closed spinal dysraphism admitted in our hospital were included in the study except those patients who were in sepsis or low birth weight. Results: Out of 18 patients of dorsal MMC, 11% (n=2) were infants. The youngest patient was 5 days old and the oldest patient was 9 years of age. There was equal sex distribution. The most common sites of dorsal meningomyelocele were D5-D8 region which constituted 61% (n=11). The most common associated anomalies were hydrocephalus (22%) followed by Chiari II (16%). 50% of neural tube defect (NTD) babies were born to mothers who had hyperemesis gravidarum. 72% of mothers did NT scan and among them 61% were not diagnosed of NTD. Among 18 patients, 16 had tethering at same level and 2 had tethering at lower level for which separate incision was made and detethering of filum terminal was done. 22% had skin tag, 11% had hair and dermal sinus as neurocutaneous markers. All patients underwent microsurgical sac excision with intra operative neuro monitoring. Pre- and postoperative neurological examination of all patients were normal. Patients are still under regular follow up and showed no neurological impairment with a mean follow up of 12 – 18 months. Conclusion: Dorsal meningomyelocele is structurally and clinically different from lumbosacral meningomyelocele and has more favourable outcomes after surgery. Preoperative magnetic resonance imaging and detailed patient evaluation are recommended to identify the dorsal meningomyelocele’s sac, spinal cord structure and additional anomalies. Surgical treatment should be done early and intradural exploration is recommended in addition to resection of the sac. Folic acid supplements should be recommended within three months, for a minimum period of 100 days before pregnancy to prevent NTD.

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Introduction: Physiologically ovary is considered to be a cystic organ. Cysts occurring in the ovary can be functional or pathological, simple or complex. The actual prevalence of ovarian cysts is unknown, as many patients are believed to be asymptomatic and undiagnosed. Management depends on the patient’s age, menopausal status, size, and characteristics of the cyst. Aim: 1) To study the prevalence of various types of ovarian cysts and their relation to parameters like age and menopausal status of the patient. 2) To assess the relationship of gross characteristics of the cysts to their nature. Materials and Methods: This is a retrospective study of 122 ovarian specimens received at the Department of Pathology, GMC/GGH, Ananthapuramu, for a period of 5 years. Results: A total of 122 cases were studied. Out of which 48 (39%) were Non-Neoplastic and 74 (61%) were Neoplastic. The most common non-neoplastic condition was a Simple follicular cyst, followed by ovarian torsion. Among the neoplasms, Benign were 59 cases (80%), borderline 2 (2%), and malignant 13 (18%). The commonest benign neoplasm was serous cystadenoma, and the malignant was high-grade serous cystadenocarcinoma. Conclusion: Both non-neoplastic and neoplastic ovarian lesions frequently exhibit similar clinical and radiological characteristics. Thus, the diagnosis and prognosis of ovarian lesions depend on histological evaluation.

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Background: Tuberculosis remains a significant burden on Tribal population of India. Prevalence of CKD is also higher in some tribal populations. Aim of the study: The aim is to detect clinical spectrum of TB & CKD, co-occurrence and its treatment outcome in tribal population. Method: This is a Descriptive Observational Study, carried out in PRM MCH, Baripada, Mayurbhanj, and Odisha during the period between February 2022 to January 2023. Clinical characteristics and outcomes of anti Tb treatment in patients of Tuberculosis with CKD were collected and studied. Results: In 52 cases of TB-CKD co existing cases , the chief complains of patients in this study is cough(80.76%) with maximum cases as Pulmonary tuberculosis with most common associated stage of CKD is stage 4(71.15%) with Mean Age 55.3±11.2 years; Male : Female ratio= 9.4:1; Mean BMI= 17.6±3.2 kg/m²; The patients had Anaemia  associated with TB-CKD which is statistically significant. There is a borderline non-significant association between CKD stage and TB treatment outcome, in this study. Conclusion: This study highlights a high burden of undernutrition and advanced CKD among TB patients in tribal regions. While BMI and CKD stage showed potential clinical relevance to outcomes, statistical significance was not achieved-likely due to limited sample size.

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Background: The present study was conducted in Dermatology OPD of Bankura Sammilani Medical College between February 2015 to January 2016. The aim of the study was to find epidemiological pattern, most common type and sites affected in vitiligo in <12 yr age group. Methodology: All the patients below 12 yrs with vitiligo attending Dermatology Outdoor, satisfying the inclusion criteria were enlisted. Detailed history taking & thorough clinical examination was done & all this was recorded in case record form to determine epidemiological profile of the paediatric patients. The patients were divided in to 2 age groups (0-5yrs & 6 to 12 years). To find the types of vitiligo prevalent in paediatric age group and also to find the most common type seen in those age groups (0-5yrs & 6 to 12). To find common sites affected in these age groups and also the most common site affected overall in such age groups. History taking and clinical examination as per case record form were done to study clinic-epidemiological profile of childhood vitiligo. The descriptive statistics were expressed as frequency, percentage. Microsoft excel were used for drawing the graph. Microsoft Power Point was used for drawing the road map. Results: In this study 8.65% children had family history of vitiligo and 91.35% didn’t have. About 8.65% of children had stable vitiligo and 91.35% had unstable vitiligo. Koebner’s phenomena was noted in 17.31% and was absent in other 82.69%. Leukotrichia was present in 22.12% cases and absent in 77.88% cases. In my study Halo nevi was present in 5.77% cases and melanocytic nevi, alopecia areata and psoriasis in 0.96% cases. Autoimmune disease was present in 1.92% cases in which 0.96% is psoriasis and other 0.96% is alopecia areata. Most common sites affected in males was right leg with 35.9% and in females was face with 49.23%. Mean age of onset of vitiligo was 5.77 yrs in males and 6.46 yrs in females. Conclusion: itiligo is occasionally associated with autoimmune disease and hence a patient with vitiligo should be evaluated to rule out these conditions. Social stigma associated with the disease should be combated with awareness in the society.

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Background: Diabetes mellitus (DM) is a well-recognized risk factor for gallstone disease and may influence intraoperative findings during laparoscopic cholecystectomy (LC). Dense adhesions, contracted gallbladder, and difficult Calot’s triangle dissection are frequently reported in diabetic patients, potentially complicating surgery and prolonging operative time. Objective: To compare intraoperative findings of elective LC between diabetic and non-diabetic patients. Methods: This retrospective study was conducted in the Department of Surgery, JLNMCH Bhagalpur, over one year. Medical records of 80 patients who underwent elective LC for symptomatic cholelithiasis were analyzed, including 35 diabetics and 45 non-diabetics. Intraoperative parameters assessed were gallbladder wall thickness, adhesions at Calot’s triangle, presence of contracted or distended gallbladder, intraoperative bile spillage, conversion to open surgery, and operative duration. Data were compared between groups using chi-square and t-tests. Results: Diabetic patients had a significantly higher incidence of dense adhesions at Calot’s triangle (57.1% vs. 24.4%, p=0.01) and thickened gallbladder wall (>3 mm) (62.9% vs. 26.7%, p=0.002). Contracted gallbladder was observed in 31.4% of diabetics versus 13.3% of non-diabetics (p=0.04). Bile spillage occurred in 22.9% of diabetics compared to 9.8% of non-diabetics. Conversion to open cholecystectomy was higher in diabetics (11.4% vs. 2.2%), though not statistically significant. Mean operative duration was longer in diabetics (74.2 ± 12.6 min vs. 61.8 ± 10.4 min, p<0.01). Conclusion: Diabetic patients undergoing LC have more technically challenging intraoperative findings, including thickened gallbladder walls, dense adhesions, and longer operative times. These results emphasize the need for careful preoperative evaluation, anticipation of difficult dissection, and readiness for conversion in diabetic patients. Biliary spillage percentage should be minimized in both conditions to some extent.

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Background: Perioperative hyperglycemia and insulin resistance are common physiological responses to surgical stress, influenced not only by the surgery itself but also by the anesthetic agents used. These metabolic disturbances are correlated with increased postoperative complications, even in non-diabetic patients. The role of anesthetic drugs in modulating glucose metabolism remains under-explored in Indian surgical populations. Aim: To evaluate the influence of anesthetic agents—sevoflurane and isoflurane—on glucose metabolism and insulin sensitivity in patients undergoing elective surgery under general anesthesia. Methods: A prospective observational study was conducted at BMIMS, Pawapuri, Nalanda, Bihar, over a period of six months (Feb 28 to July 28, 2025). Sixty adult patients undergoing elective surgeries were enrolled. Blood glucose, insulin levels, and HOMA-IR were measured preoperatively and at 6 and 24 hours postoperatively. Patients were grouped based on the anesthetic agent received (sevoflurane or isoflurane). Data were analyzed using SPSS version 23.0. Statistical significance was set at p < 0.05. Results: There was a significant increase in mean blood glucose (from 92.4 ± 8.7 mg/dL to 131.6 ± 15.4 mg/dL) and insulin levels (from 8.3 ± 2.1 µIU/mL to 15.1 ± 3.5 µIU/mL) at 6 hours post-surgery (p < 0.001). HOMA-IR values peaked at 6 hours, indicating transient insulin resistance. Patients receiving sevoflurane had significantly lower postoperative glucose and HOMA-IR levels compared to those receiving isoflurane (p < 0.01). A moderate positive correlation was observed between BMI and postoperative insulin resistance (r = 0.48, p = 0.001). Conclusion: Anesthetic drugs significantly influence perioperative glucose metabolism and insulin sensitivity. Sevoflurane demonstrated a more favorable metabolic profile compared to isoflurane. Higher BMI was correlated with increased insulin resistance. Recommendations: Routine perioperative monitoring of blood glucose and insulin sensitivity is recommended, even in non-diabetic patients. Preference may be given to sevoflurane in patients with higher BMI or metabolic risk. Further large-scale, randomized studies are warranted to confirm these findings.

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Introduction: Prolonged digital screen use is increasingly linked to dry eye disease in young adults due to reduced blink rate and tear film instability. Studies show longer screen time correlates with lower TBUT, Schirmer’s scores, and higher OSDI scores. This study prospectively assesses screen time’s impact on tear film and symptoms. Methods: This six-month prospective study conducted at Prathima Relief Institution of Medical College and Gitam Institute of Medical Sciences included adults aged 18–35 using digital screens ≥4 hours/day. Participants were grouped by screen time and assessed at baseline, 3, and 6 months using Schirmer’s test, TBUT, and OSDI questionnaire to evaluate changes in tear film and dry eye symptoms. Results: Among 92 participants, group C (>8 hrs screen time) showed the lowest TBUT and Schirmer’s values and highest OSDI scores, indicating worse dry eye symptoms. Parameters declined over 6 months, especially in group C. Strong correlations were found, negative with TBUT and Schirmer’s, positive with OSDI (P < 0.001). Conclusion: This study found that increased digital screen time significantly worsened tear film stability and dry eye symptoms in young adults. Longer screen use correlated with lower TBUT and Schirmer’s values and higher OSDI scores. Limitations include self-reported screen time, lack of environmental control, and short follow-up duration.

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Introduction: Thyroid dysfunction, including subclinical hypothyroidism and euthyroid sick syndrome, is common in Acute Coronary Syndrome (ACS) and may worsen outcomes like arrhythmias and mortality. This study aims to assess the prevalence and patterns of thyroid abnormalities in ACS patients and their association with clinical outcomes and in-hospital complications. Methods: This 5-month prospective observational study at Government Medical College, included ACS patients aged >18 years. Thyroid function (TSH, free T3, free T4) was assessed within 24 hours of admission. Clinical data, complications, and outcomes were recorded. Patients with known thyroid disease or chronic illnesses were excluded. Ethical clearance was obtained. Results: Among 115 ACS patients, 38.3% had thyroid dysfunction, predominantly subclinical hypothyroidism and euthyroid sick syndrome. ST-elevation myocardial infarction (STEMI) was the most common presentation. Thyroid dysfunction was more frequent in STEMI but not statistically significant. Patients with thyroid dysfunction had longer hospital stays, higher rates of arrhythmias, cardiogenic shock, and in-hospital mortality. Conclusion: This study highlights a significant prevalence of thyroid dysfunction in ACS patients, particularly associated with worse in-hospital outcomes. Thyroid screening may serve as a useful prognostic tool. However, the single-center design and limited sample size warrant larger studies to validate these findings and assess long-term implications.

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Introduction: Psoriasis is a chronic inflammatory skin disorder affecting 2%–3% globally. This study compares methotrexate (MTX) monotherapy with its combination with narrowband ultraviolet B (NBUVB), aiming to evaluate efficacy in moderate to severe psoriasis, especially in resource-limited settings where optimizing affordable, conventional treatments is essential for improving outcomes and achieving sustained remission. Methods: This comparative study, conducted at Malla Reddy Institute from Sept 2022 to Dec 2023, evaluated MTX monotherapy versus MTX with NBUVB in psoriasis patients. Eligible adults were randomized into two groups, treated for 12 weeks, and assessed using PASI scores to determine therapeutic efficacy between the modalities. Results: Among 60 patients, majority were aged 31–40 years and male. Group B (MTX+NBUVB) showed significantly greater PASI reduction (83.3%) than Group A (77.03%) at 12 weeks (P = 0.013). Common adverse effects included nausea and abnormal LFTs (MTX), and erythema and itching (NBUVB). Conclusion: This study confirms that combination therapy is more effective than methotrexate alone in reducing PASI scores. It highlights the importance of patient-specific factors like BMI and comorbidities in psoriasis management. These findings support personalized treatment strategies, offering clinicians valuable guidance to improve outcomes and quality of life for patients.

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Background: Ureteral stones, particularly in the middle and lower ureters, often cause significant discomfort and complications. Medical expulsive therapy (MET) has emerged as a non-invasive option to facilitate stone passage. This study evaluates the therapeutic efficacy of tamsulosin, an α1-adrenergic antagonist, when administered alone or in combination with deflazacort, a corticosteroid, for the expulsion of ureteral stones. Methods: A prospective, comparative study was conducted on patients diagnosed with radiologically confirmed ureteral stones (5–10 mm) located in the middle or lower ureter. Participants were divided into two groups: Group A received tamsulosin 0.4 mg once daily, and Group B received a combination of tamsulosin 0.4 mg and deflazacort 30 mg once daily. Patients were monitored for stone expulsion rate, time to expulsion, analgesic requirements, and adverse events over a four-week period. Results: The combination therapy group (Group B) demonstrated a significantly higher stone expulsion rate (82%) compared to the tamsulosin-only group (Group A: 62%) (p < 0.05). The mean time to stone expulsion was shorter in Group B (9.4 ± 2.1 days) than in Group A (13.6 ± 2.8 days). Group B also reported reduced analgesic use and fewer colicky episodes. Both treatment regimens were well tolerated with no serious adverse effects. Conclusion: The addition of deflazacort to tamsulosin significantly enhances the effectiveness of medical expulsive therapy for stones in the middle and lower ureters. This combination appears to improve expulsion rates, reduce time to passage, and minimize pain, supporting its use as a superior conservative treatment approach.

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Background: Vascular dementia (VaD) is the second most common form of dementia, frequently associated with significant functional decline and caregiver burden. While cholinesterase inhibitors and NMDA receptor antagonists are widely prescribed, comparative data on their real-world efficacy and safety in VaD, particularly in the Indian subcontinent, remain limited. Objective: To evaluate and compare the efficacy and safety of rivastigmine monotherapy versus a combination of memantine and donepezil in patients diagnosed with vascular dementia over a two-year observational period in a tertiary care hospital in Northern India. Methods: A total of 312 patients with clinically diagnosed VaD (per NINDS-AIREN criteria) were enrolled from January 2023 to December 2024. Patients were divided into two cohorts: Group A received rivastigmine (oral or transdermal), and Group B received a combination of memantine and donepezil. Cognitive function (measured using MMSE and MoCA), neuropsychiatric symptoms (NPI score), and daily living activities (ADL/IADL scales) were assessed at baseline, 6 months, 12 months, and 24 months. Adverse events and treatment discontinuation rates were also recorded. Results: At 24 months, Group B (memantine + donepezil) demonstrated a statistically significant improvement in MMSE and MoCA scores compared to Group A (p < 0.05). Neuropsychiatric symptoms were better controlled in the combination group, with lower mean NPI scores. However, rivastigmine showed better tolerability, with fewer gastrointestinal side effects and lower discontinuation rates (9.4% vs. 17.8%). No severe adverse drug reactions were reported in either group. Conclusion: The combination of memantine and donepezil offers superior cognitive and behavioral benefits compared to rivastigmine alone in patients with vascular dementia. However, rivastigmine may be better tolerated. Individualized treatment based on patient comorbidities and tolerance is recommended. Further randomized controlled trials are warranted to validate these observational findings.

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Background: Enormous cardiovascular adaptation occurs during Pregnancy as changes in autonomic functions are marked. Heart rate variability (HRV) throws light on these autonomic changes affecting cardiovascular system which is indicated by beat-to-beat variations in RR intervals in ECG. Objective: Short term HRV of 5 minutes was taken in normal pregnant females of all the three trimesters, compared to control group. Methodology: We took 50 normal pregnant females and had taken follow up HRV in each trimester. First trimester was considered as control group. Five minutes resting HRV was measured by Kubios Iworx 100 with Labscribe software. Standard protocols were followed to study time-domain & frequency domain parameters. They were further compared between case & control study groups for difference. Results: Case study groups, second & third trimester’s subjects and control group i.e. first trimester were compared. Decreased HRV was found in study group than control group. Statistical significance found in frequency domain & time-domain parameters in 9 subjects between 21 to 30 weeks of gestation. Second and third trimester study group was linked with major decline in HRV parameters. Conclusion: HRV is generally found to be reduced during pregnancy in all trimesters, may be associated with many factors. Pregnancy itself is a significant risk for PIH with reference to changed cardiac balance. HRV may prove as a decent tool to evaluate these changes.

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Background: Medical autopsies conducted in hospitals are an important tool for education and quality assurance. It has been observed that in many instances gross pathology alone could not help to decide the cause of death, histopathology can conclusively opine the involved cardiac pathology. Hence this study was done to study various histomorphological changes in autopsied heart specimens and also to study association of acute coronary events with myocardial infarction. Methodology: A retrospective study of 38 cases of heart specimens was conducted in the Pathology department of SSIMS&RC, Davangere, and four years period. Aims: To study the histomorphological changes in autopsied heart specimens and categorize the lesions. Post-mortem analysis of heart is the irreplaceable method to study detail changes in healthy or unhealthy heart. Materials and Methods: Specimens received from the Forensic Medicine and Toxicology Department were examined macroscopically and dissected according to Virchow’s method. Representative tissue bits were processed by automated machine and Hematoxylin and eosin-stained sections were studied under light microscopy. Results: About 27 cases were male and eleven were female. Maximum (26.31%) number of cases were seen in 4^th decade. Abnormal findings on heart autopsy were non-significant relation between heart weight with age, atheromatous changes on aorta (50%), Ischemic Heart Disease (71.05%), myocardial infarction (15.79%) and Rheumatic heart disease (7.88%). Conclusion: The study presented perturbing high prevalence of atherosclerosis with predominant involvement of double coronary vessels. In envenomation microscopically heart showed myocarditis, thrombosis, infarction, anaphylactic reaction. Conclusions: Histomorphological study of heart in medico legal autopsies may quite often tell natural disease pathology and its relative impact towards death.

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Introduction: There was an urgent need for a trained healthcare workforce during the COVID-19 pandemic for the care of patients. Quality education and training were required to strengthen the health workforce and ensure that they are confident and skilled in the delivery of care in COVID Care Centers, Dedicated COVID Health Centers, and Dedicated COVID Hospitals. Objective: To capacitate the different categories of health workforce by different training modalities conducted for COVID-19 pandemic preparedness in Assam Medical College and Hospital, Dibrugarh. Material and Method: This capacity building program was initiated in 2020 and offered to the health workforce of 5 districts in Upper Assam. Quality education and training were given through hands-on training, video conferences, webinars, and slide presentations. An online survey for the effectiveness of the training was assessed. The training programs were coordinated by the Department of Community Medicine, Assam Medical College and Hospital, and data analysis was done for the health workforce trained in different modalities, and results were presented as percentages. Results: Overall, 4827 health professionals from 5 districts in Upper Assam were trained. Out of these, 10.31% (498) were faculty members of the medical college, 19.43% (938) were medical officers, 25.87% (1249) were nursing staff, 8.92% (431) were medical students, and 28.42% (889) were other paramedical staff. Conclusion: The capacity building of a sustainable and strong health workforce was an urgent need during the COVID-19 pandemic, which proved feasible and effective in tackling the public health emergency.

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Background: The appropriate duration of antibiotic prophylaxis in clean-contaminated surgeries remains debated, especially in resource-constrained settings like India. This study evaluates the efficacy of single-dose versus multiple-dose antibiotic prophylaxis in preventing surgical site infections (SSIs). Methods: A prospective, comparative study was conducted over 17 months in a tertiary care center in India. Patients undergoing clean-contaminated surgeries were randomized into two groups: Group A (single-dose prophylaxis) and Group B (multiple-dose prophylaxis for 72 hours). SSI rates, hospital stay, antibiotic-related adverse effects, and cost implications were analyzed. Results: A total of 300 patients were included, with 150 in each group. SSI occurred in 8% of Group A and 7% of Group B (p = 0.78). The average hospital stay was comparable (4.2 vs 4.4 days, p = 0.43). Antibiotic-related side effects were significantly lower in Group A (4% vs 12%, p = 0.03). Antibiotic cost was significantly lower in Group A. Conclusion: Single-dose antibiotic prophylaxis is as effective as multiple-dose regimens in preventing SSIs in clean-contaminated surgeries, with fewer side effects and lower costs. This approach is beneficial in optimizing resources in Indian healthcare settings.

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Introduction: Type 2 diabetes mellitus (T2DM) is associated with a variety of hepatic abnormalities, ranging from non-alcoholic fatty liver disease (NAFLD) to advanced fibrosis, often reflected by alterations in liver function tests (LFTs). Early detection of such abnormalities is important for comprehensive management and prevention of complications. Objectives: To determine the prevalence of liver function test abnormalities in patients with T2DM and to identify associated clinical and biochemical factors, compared with non-diabetic controls. Methods: This comparative cross-sectional study was conducted over a period of one year at Raiganj Government Medical College and Hospital. A total of 100 adult patients diagnosed with type 2 diabetes mellitus attending the outpatient department were enrolled. The study variables included demographic factors such as age, sex distribution (male and female), duration of diabetes, and body mass index (BMI). Laboratory parameters assessed, comprised glycosylated hemoglobin (HbA1c) and liver function tests including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), bilirubin, and albumin levels. Data were collected through patient interviews, clinical examinations, and biochemical investigations. The aim was to compare liver function parameters and their association with glycemic control and diabetes duration among type 2 diabetic patients. Results: Liver function test abnormalities are common in patients with type 2 diabetes mellitus, with elevated ALT and AST levels observed in 38% and 34% of patients, respectively. These abnormalities were significantly associated with poor glycemic control and higher BMI. Patients with HbA1c ≥7% had significantly higher ALT and AST levels and lower albumin compared to those with better glycemic control. Additionally, the prevalence of elevated liver enzymes increased progressively with higher BMI categories. Multivariate analysis identified male sex, longer diabetes duration (≥5 years), overweight/obesity (BMI ≥25 kg/m²), and poor glycemic control as independent risk factors for liver dysfunction, with poor glycemic control being the strongest predictor. Conclusion: LFT abnormalities are common in patients with T2DM and are associated with obesity, longer disease duration, poor glycemic control, and dyslipidemia. Routine monitoring of liver enzymes in T2DM patients may help in early identification and management of underlying hepatic disorders.

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Background: Histopathological grading is an essential prognostic tool in breast cancer management. In rural India, limited healthcare access often leads to late diagnosis and poor survival. Understanding the clinico-pathological profile of various tumor grades can help to optimize treatment strategies in resource-constrained settings. Aim: To evaluate the clinico-pathological characteristics and survival outcomes associated with different histological grades of newly diagnosed breast cancer patients in a rural cancer centre. Methods: A retrospective observational study was conducted on 486 patients diagnosed with breast cancer between June 2021 and June 2023. Tumors were graded using the Nottingham system. Demographic, pathological, and treatment details were analyzed. Survival outcomes—disease-free survival (DFS) and overall survival (OS)—were assessed using Kaplan-Meier analysis, and associations were evaluated using Chi-square and log-rank tests. Results: Of the 486 patients, 21.0% had Grade I, 45.7% Grade II, and 33.3% Grade III tumors. Higher tumor grade was significantly associated with larger size, lymph node positivity, HER2 positivity, and triple-negative phenotype (p<0.001). Hormone receptor positivity declined with increasing grade. Grade I tumors had superior 3-year DFS (89.2%) and OS (93.1%) compared to Grade III (58.1% and 71.6%, respectively) (p<0.001). BMI was also correlated with grade and survival—obese patients (≥30 kg/m²) had a higher proportion of Grade III tumors and poorer outcomes. Conclusion: Histological grade is a strong predictor of aggressive tumor biology and poor prognosis in breast cancer. In rural settings, early diagnosis and grading-based risk stratification can guide effective treatment planning. Improving access to diagnostic tools and targeted therapies is vital to reducing rural-urban disparities in breast cancer outcomes.

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Background: Aging is linked to elevated oxidative stress, which arises from an imbalance between the production of reactive oxygen species (ROS) and the body’s antioxidant defense mechanisms. Key antioxidant enzymes, including superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), are crucial for preserving redox balance. However, their activity varies across age groups, contributing to age-related functional decline. Material and Methods: A cross-sectional observational study was conducted on 180 healthy individuals stratified into three age groups: Group I (18–30 years), Group II (31–50 years), and Group III (51–70 years), with 60 participants in each. Fasting venous blood samples were analyzed for erythrocyte SOD, CAT, and GPx activities using standard spectrophotometric methods. Inclusion criteria comprised apparently healthy individuals without chronic illness, smoking, or alcohol consumption. Subjects with diabetes, cardiovascular disease, or antioxidant supplementation were excluded. Statistical analysis was performed using ANOVA with p <0.05 considered significant. Results: A significant decline in antioxidant enzyme activity was observed with advancing age. Mean SOD activity was highest in Group I and lowest in Group III (p <0.001). CAT activity showed a gradual reduction from Group I to Group III (p <0.01). GPx activity followed a similar decreasing trend (p <0.05). Conclusion: The study demonstrates a significant age-associated decline in major antioxidant enzymes, indicating a progressive reduction in endogenous defense against oxidative stress. These findings highlight the importance of dietary and lifestyle interventions to enhance antioxidant capacity in older populations.

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Background: Oxidative stress, caused by an imbalance between reactive oxygen species (ROS) and antioxidant defenses, plays a central role in aging. Vitamins C and E are potent dietary antioxidants that may counteract age-related oxidative damage. This study aimed to evaluate the effect of vitamin C and E supplementation on oxidative stress parameters in elderly individuals. Material and Methods: A randomized, placebo-controlled study was conducted in 120 participants divided into two groups: elderly (≥60 years, n=60) and young adults (20–30 years, n=60). Each age group was further subdivided into control and supplementation subgroups. Participants in supplementation groups received oral vitamin C (500 mg/day) and vitamin E (400 IU/day) for 12 weeks. Blood samples were analyzed for malondialdehyde (MDA, a marker of lipid peroxidation), superoxide dismutase (SOD), and glutathione peroxidase (GPx) using spectrophotometric methods. Results: At baseline, elderly participants showed significantly higher MDA levels and lower antioxidant enzyme activity compared to young adults (p <0.05). Following supplementation, elderly subjects exhibited a significant reduction in MDA (p <0.01) and an increase in SOD and GPx activities (p <0.05). Improvements were modest in young adults. Placebo groups showed no significant changes. Conclusion: Vitamin C and E supplementation effectively reduced oxidative stress and improved antioxidant enzyme activities in the elderly. These findings suggest that targeted antioxidant supplementation may mitigate age-related oxidative damage and promote healthy aging.

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Introduction: Cervical cancer is the fourth most common cancer in women globally, and the second most common in India, where it accounts for a large portion of global cases and deaths. Most of these cases occur in low- and middle-income countries, where access to vaccines, screening, and treatment is limited. Among all Human papilloma virus plays a major role in cervical carcinoma pathogenesis. The progression of healthy cervix to cervical carcinoma have long phase of preceding cytological changes for over a decade. Hence through early diagnosis and intervention in precancerous stages, cervical cancers are preventable. Materials and Methods: It is retrospective comparative study conducted on 3854 Pap smears received by Department of Pathology, in a Tertiary care hospital over a period of 18 months. Smears were processed, diagnosed and categorized according to Bethesda system of cervical cytology 2020. Among 207 abnormal smears identified, same cervical biopsies where examined, compared and analyzed. Results: Out of 207 abnormal smears most common was reactive atypia (n=82, 39.61%) and least was adenocarcinoma (n=01,0.48%). Among histopathological examination most common was chronic cervicitis (n=98, 47.34%), and least was mixed neuroendocrine and non-neuroendocrine neoplasm. Both cytology and histopathology results compared and analyzed. Conclusion: Histopathology is gold standard, it has more sensitivity and accuracy when compared to Pap smear. By combining Pap smear with histopathological examination can maximize the sensitivity and specificity in diagnosing of cervical cancer.

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Introduction: Acute liver failure (ALF) in children is a rare but life-threatening condition with varied etiology and rapid progression. Understanding its clinical profile, management, and outcomes is crucial for timely intervention and improving prognosis. Aims and Objectives: To analyze the etiology, clinical features, management strategies, and outcomes of pediatric acute liver failure cases admitted to the Pediatric Intensive Care Unit (PICU) of Burdwan Medical College. Materials and Methods: This hospital-based prospective observational study was conducted in the Department of Pediatrics and Pediatric Intensive Care Unit (PICU) at Burdwan Medical College and Hospital, West Bengal, India, over a period of one year from July 2022 to August 2023. The study included 100 children aged 1 month to 12 years who were admitted to the PICU with a diagnosis of acute liver failure (ALF). Results: The most affected age group was 1–5 years (40%), with highest mortality in children <1 year (60%). Viral hepatitis was the most common etiology (35%), followed by indeterminate causes (30%) and metabolic disorders (15%). Hepatic encephalopathy (60%), coagulopathy (70%), and hypoglycemia (25%) were significantly associated with higher mortality (P < 0.05). Use of N-acetylcysteine improved survival (75%, P = 0.005), while the need for mechanical ventilation and presence of cerebral edema were linked with poor prognosis (P < 0.001). Overall mortality was 40%, with only 8% referred for liver transplantation. Conclusion: Pediatric ALF in this region is predominantly due to viral hepatitis and indeterminate causes, with significant mortality, especially in infants and those with metabolic etiologies. Early diagnosis, identification of poor prognostic indicators, and aggressive supportive care are essential to improving outcomes. Strengthening metabolic screening and expanding transplant access remain critical challenges.

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Introduction: Vitamin D is a secosteroid hormone with pleiotropic actions that extend beyond skeletal homeostasis to immunomodulatory, anti-inflammatory and anti-fibrotic effects—pathways that are highly relevant to chronic liver disease (CLD) of non-cholestaticaetiology, including metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD), alcohol-related liver disease (ALD) and chronic viral hepatitis. Aims and Objectives: To assay vitamin D in patients with non-cholestatic chronic liver disease and to compare the parameters of liver function test (LFT) with vitamin D levels and correlate the two if possible. Materials and Methods: The present study was a descriptive observational study with cross sectional design. This Study was conducted over 1 year period from the date of approval of protocol at Nadia district hospital, Krishnanagar, West Bengal. Result: In this study of patients with chronic non-cholestatic liver disease, serum vitamin D status was associated with variations in liver function and disease etiology. While age, sex, and BMI did not differ significantly across vitamin D groups, anti-HCV positivity and underlying etiology showed significant associations, with alcohol-related liver disease more common in patients with lower vitamin D levels and NASH predominating in those with sufficient levels. Liver function parameters—including SGOT, SGPT, ALP, GGT, bilirubin, albumin, and globulin—differed significantly among the groups, indicating greater hepatic dysfunction in patients with vitamin D deficiency or insufficiency. Conclusion: This study highlights a significant association between serum vitamin D status and both liver function and disease etiology in patients with chronic non-cholestatic liver disease. Patients with lower vitamin D levels tended to exhibit more pronounced alterations in liver function markers, including elevated liver enzymes and reduced serum albumin, suggesting greater hepatic dysfunction.

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Introduction: Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes. Early identification of high-risk women is essential for timely intervention. Hemoglobin A1c (HbA1c) reflects average glycemia over 8–12 weeks and may serve as a practical early screening tool. The objective is to evaluate the utility of first-trimester HbA1c in predicting GDM and its associated maternal and neonatal outcomes. Materials and Methods: This prospective observational study included 200 high-risk pregnant women attending the antenatal clinic at Pacific Institute of Medical Sciences, Udaipur, Rajasthan, from January 2024 to January 2025. HbA1c was measured in the first trimester, and a 75 g oral glucose tolerance test (OGTT) performed between 24–28 weeks served as the reference standard. Maternal outcomes (pharmacological therapy, mode of delivery, complications) and neonatal outcomes (birth weight, APGAR score, NICU admission) were recorded. Statistical analyses included Chi-square and t-tests, with p<0.05 considered significant. Results: GDM was diagnosed in 171 (85.5%) participants. Women with GDM had significantly higher first-trimester HbA1c (5.75 ± 0.3% vs. 5.27 ± 0.2%, p<0.001) and glycaemic indices. A first-trimester HbA1c cut-off of 5.45% predicted GDM with 89.5% sensitivity and 82.8% specificity. Maternal complications such as polyhydramnios, PROM, and hypertensive disorders were more frequent among GDM cases. Neonates of GDM mothers had higher rates of NICU admission (22.8% vs. 6.9%). Conclusion: First-trimester HbA1c is a reliable and practical early screening tool for predicting GDM in high-risk pregnancies, allowing timely interventions that may improve maternal and neonatal outcomes.

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Introduction: Menopause is well established to be associated with decreasing estrogen level. Declining estrogen levels contributes to inflammation and can explain the onset of mood disorders in women in the peri-menopausal age, particularly depression. This study aims to examine the association between inflammatory markers and depression in perimenopausal women. Methods: A cross-sectional study of 110 perimenopausal women were conducted, and they were divided into 55 depressed (cases) and 55 non-depressed (control) groups based on the PHQ – 9 questionnaire. Both groups rated their menopausal symptoms using MRS. All 110 women were tested for Total Leucocyte count, N-L Ratio, CRP, IL-6 and Serum Estrogen levels. Results: No statistically significant association was found between any of the inflammatory markers and the severity of depression amongst both the groups or between Serum estrogen levels and depression. Conclusion: The negative result could either suggest that such an association does not exist or that the relationship between inflammation and subthreshold, mild and moderate depression is more complex than previously understood and requires a deeper exploration between the interplay of hormones, inflammation, and depression.

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Background: Maternal mortality remains a major public health issue in India despite significant progress. Birth Preparedness and Complication Readiness (BPCR) is a key strategy to reduce delays in seeking and receiving care during obstetric emergencies. Objectives: To assess the knowledge and practices regarding birth preparedness and complication readiness, identify associated factors, and enhance awareness about danger signs among pregnant women in the field practice areas of Jhalawar Medical College. Methods: A community-based cross-sectional study was conducted among 388 pregnant women during [March to August 2024] in rural (Mandawar) and urban (Jhalrapatan) field practice areas. Data were collected using a pretested semi-structured questionnaire adapted from the JHPIEGO BPCR matrix. Descriptive statistics and chi-square tests were applied using SPSS (Ver. 28 Trial). Results: Out of 388 participants, the mean JHPIEGO BPCR index was 58.9. Based on criteria, 69.1% were classified as ‘well prepared’, while 30.9% were ‘less prepared’. Birth preparedness was significantly associated with higher maternal age (≥30 years), urban residence, higher education, employment, better socioeconomic status, longer marriage duration, multigravidity, previous obstetric complications, and absence of addiction (p<0.05). Conclusion: The study revealed that although 69.1% of pregnant women were well prepared for birth and complications, gaps remain in financial planning, transport, and blood donor arrangements. Preparedness was positively associated with education, urban residence, higher socioeconomic status, and obstetric experience. Targeted interventions focusing on rural, less educated, unemployed, and primigravid women are crucial to reduce preventable maternal and neonatal mortality.

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Background: Oral health is a fundamental part of the general health and well-being of an individual. Oral hygiene refers to the practice of maintaining a clean oral cavity to prevent dental problems like dental cavities, bad breath, gingivitis, and periodontitis which contributes to general well-being the dental caries among Indian children over the past 25 years was reported to be 56.7%. Oral health problems also reduce people’s ability to smile, eat, and talk, and have a detrimental effect on their social and mental health The age of 12 years has been universally accepted as global monitoring age for caries since all permanent teeth except third molars would most likely have erupted by this age thus assessing oral hygiene practices are even more meaningful at this age. Material & Methods: A Cross-sectional study carried out in 341 school children from two school in rural field area of Mandawar between class 5 to 10 standard. The self-structured questionaries were used to collect information regarding oral health practices and oral health status. The data obtained from the responses copied in Microsoft excel software. Statistical analysis done with the help of IBM SPSS software (trial version 27.0) using chi square test. Chi square test is used to measure the data. Oral health status is significantly associated for the applied statistical tests. Observation: The study conducted among school going children in rural area that show plaque and mottling present 62.9% and 60.3% respectively. Oral health status such as carries, mottling, bleeding gums, and ulcer are significantly associated. Conclusion: Oral hygiene practices were poor needs educational modification regarding duration of brushing, appropriate way to brush the teeth and use of mouth washing.

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Background: High-risk pregnancies are associated with increased maternal and perinatal morbidity and mortality. Conventional monitoring methods often fail to detect early fetal compromise. Doppler ultrasound provides a non-invasive means of assessing fetoplacental circulation and detecting abnormal hemodynamic patterns that precede clinical deterioration. This study aimed to evaluate the role of Doppler ultrasound in the management of high-risk pregnancies. Methods: This prospective observational study was conducted at a tertiary care referral hospital over 12 months and included 100 high-risk pregnant women beyond 28 weeks of gestation. Participants were randomized into two equal groups: Group A (n=50) managed without Doppler and Group B (n=50) managed with Doppler assessment of umbilical and uteroplacental arteries. Maternal and neonatal outcomes were compared between the groups. Data were analyzed using SPSS, with p<0.05 considered significant. Results: The mean gestational age at delivery was significantly higher in Group B compared to Group A (37.1 vs. 36.1 weeks; p=0.041). Caesarean delivery was more frequent in the Doppler group (80% vs. 50%; p=0.006). Adverse fetal outcomes, including stillbirths and intrauterine deaths, were significantly reduced in Group B (2% vs. 18%; p=0.008). Mean birth weight was higher in Group B (2.73 ± 0.67 kg) compared to Group A (2.34 ± 0.67 kg; p=0.004). NICU admissions were lower in Group B (26% vs. 44%), though not statistically significant (p=0.059). Abnormal Doppler indices (10%) and reduced cerebroplacental ratio (8%) correlated with IUGR, low birth weight, and NICU admission. Conclusion: Doppler ultrasound significantly improves perinatal outcomes in high-risk pregnancies by facilitating earlier detection of fetal compromise and guiding timely interventions. Despite a higher rate of caesarean sections, its use is justified by reductions in perinatal mortality and morbidity. Doppler should be considered an essential tool in the routine management of high-risk pregnancies.

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Background: Self-medication (SM) is a widespread practice among medical students due to easy access to medicines and growing pharmacological knowledge. While it may provide quick relief for minor ailments, irrational SM—especially involving antibiotics—can lead to adverse drug reactions and antimicrobial resistance. This study aimed to assess the prevalence, patterns, and determinants of self-medication among undergraduate medical students. Material and Methods: A cross-sectional study was conducted among 250 MBBS students of a tertiary care teaching hospital over three months (March–May 2025). Students from all years, including interns, were enrolled using stratified random sampling. Data were collected using a pre-tested, semi-structured questionnaire covering demographics, knowledge, attitudes, and practices of self-medication in the preceding three months. Prevalence was estimated with 95% confidence intervals, and associations were analyzed using Chi-square test, and binary logistic regression. Results: The overall prevalence of self-medication was 68.4% (95% CI: 62.4–74.0). Females reported higher prevalence (72.7%) compared to males (63.6%), and prevalence increased significantly with academic year (p = 0.02). The most common indications were headache/fever (65.6%), upper respiratory tract infections (42.7%), and gastritis (29.3%). Analgesics and antipyretics were most frequently used (72.5%), followed by antibiotics (21.9%), antihistamines (18.7%), and gastrointestinal drugs (16.5%). Pharmacies (46.8%) and leftover medicines (34.1%) were the main sources, while prior prescriptions (52.9%) and the internet (33.1%) were the main information sources. Only 41.2% reported completing the full course of medicines, and among antibiotic users, just 38.2% adhered to full duration. Conclusion: Self-medication is highly prevalent among medical undergraduates, particularly among females and senior students. Although commonly practiced for minor ailments, unsafe behaviors such as incomplete antibiotic use raise concern. Targeted educational interventions and stricter enforcement of dispensing regulations are warranted to promote rational drug use among future prescribers.

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Background: Hypertension, once considered a disorder of middle and old age, is increasingly being recognized among young adults. Body Mass Index (BMI) has emerged as a key modifiable determinant of blood pressure. Early evaluation of this relationship in Indian college students is important to identify at-risk groups and initiate preventive strategies. Material and Methods: This cross-sectional study was conducted among 200 college students aged 18–25 years in Gujarat over six months. Sociodemographic details and lifestyle factors were collected using a structured questionnaire. Height and weight were measured to calculate BMI (kg/m²), classified according to WHO Asian cut-offs. Blood pressure was recorded using a validated automated sphygmomanometer after adequate rest, and categorized according to ACC/AHA 2017 guidelines. Data were analyzed using descriptive statistics, Pearson’s correlation, t-test/ANOVA, and Chi-square test, with p < 0.05 considered significant. Results: The mean age of participants was 20.4 ± 1.8 years; 54% were male. The mean BMI was 22.8 ± 3.5 kg/m², and the mean systolic and diastolic blood pressures were 118.9 ± 9.3 mmHg and 76.4 ± 7.2 mmHg, respectively. Based on BMI, 15% were underweight, 55% normal, 17% overweight, and 13% obese. According to ACC/AHA classification, 64% had normal BP, 15% elevated BP, 12% stage 1 hypertension, and 9% stage 2 hypertension. The overall prevalence of hypertension was 21%. BMI showed a significant positive correlation with SBP (r = 0.34, p < 0.001) and DBP (r = 0.29, p < 0.001). Mean BP values increased progressively from underweight to obese categories (ANOVA, p < 0.05). The prevalence of elevated BP and hypertension was significantly higher among overweight and obese students compared to those with normal BMI (Chi-square, p < 0.01). Conclusion: BMI is significantly associated with both systolic and diastolic blood pressure among young adults, with overweight and obese individuals showing a higher prevalence of hypertension. These findings emphasize the need for early screening and lifestyle interventions in college populations to mitigate long-term cardiovascular risk.

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Introduction: Thoracotomy is a commonly performed procedure surgical procedure in infants and children. The thoracotomy incision may result in long-term physical impairment and deformity. Altered pulmonary function is the main factor influencing morbidity and mortality in thoracic surgery. The normal pulmonary function is dependent on an intact thoracic cage, normal pleural cavity, and healthy lung parenchyma. Aims and Objectives: To study the midterm outcomes after Thoracotomy and Thoracoscopy in children. (1) Changes in pulmonary function. (2) Cosmesis of scar. (3) Effect of surgery on the spine. Place of Study: Narayana Hrudayalaya Hospitals, Bangalore. Duration of Study: 3 years (1/9/2012 to 31/08/2015). Type of Study: Prospective and observational study of a cohort of patients undergoing thoracic surgery Sample Size: 45 (Thoracotomy + VATS). Result: The mean age at surgery was 6 years, range between 1 day and 17 years. 55.55% ( 25) were Male and 44.45 % (20) were Female. Discussion: In this study, out of 76 patients who underwent thoracic surgery, 45 came for follow up. Patient details were entered and analysed. The mean age of patients was 6 years. Total numbers of Male were 25, Female 20.

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Background: Excision of primary pterygium with conjunctival autograft (CAG) is standard care. Securing the graft with sutures is reliable but may prolong surgery and discomfort. Using autologous blood (AB) as a biologic adhesive is an appealing alternative, though concerns remain about graft stability. Aim: To compare operative efficiency, early postoperative course, complications, and 12-month recurrence between AB-fixed CAG and suture-fixed CAG. Methods: Retrospective review of 100 consecutive eyes operated between March 2023 and February 2025. Patients were grouped as AB-CAG (n=50) or Suture-CAG (n=50). Primary endpoints were operative time and recurrence. Secondary endpoints included discomfort indicators, graft-related issues, and patient-reported satisfaction. Group differences were analyzed with t-test or chi-square as appropriate. Results: Mean operative time was ~22.6 ± 4.1 min in AB-CAG and ~32.3 ± 5.4 min in Suture-CAG (p<0.001). Early postoperative discomfort occurred less often with AB-CAG (18% vs 42%, p=0.02). Graft dislodgement was more frequent with AB-CAG (10% vs 2%, p=0.09). Recurrence at 12 months was comparable (8% vs 6%, p=0.64). Satisfaction favored AB-CAG. Conclusion: Autologous blood fixation shortens surgery and improves early comfort without increasing recurrence, at the expense of a modest rise in graft dislodgement that is usually manageable. Careful case selection and technique optimization are key.

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Background: Enteral feeding has traditionally been delayed following gastrointestinal (GI) surgeries due to concerns of impaired gut motility, aspiration, and anastomotic leakage. However, modern surgical recovery protocols such as Enhanced Recovery After Surgery (ERAS) recommend early postoperative nutrition to reduce catabolism and enhance gut function. This study compares the effects of early versus late enteral feeding on patient outcomes following elective GI surgeries. Objective: To evaluate the safety, tolerance, and benefits of early enteral feeding (within 24 hours post-op) compared to late feeding (after 72 hours post-op), focusing on bowel recovery, postoperative complications, and hospital stay. Methods: A prospective observational study was conducted on 70 patients. Group A (n=35) received early enteral feeding within 24 hours of surgery, while Group B (n=35) received late feeding (≥72 hours). Outcomes analyzed included feed tolerance, duration of ileus, wound infection, anastomotic leak, mortality, and length of hospital stay. Results: Early feeding significantly reduced the duration of ileus (4.23 vs 5.60 days, p<0.01), decreased overall complications (5.7% vs 20.0%), and shortened mean hospital stay (5.74 vs 7.11 days, p<0.01). No anastomotic leaks occurred in the early feeding group, while 8.6% occurred in the late group. Mortality was reported only in the late group (5.7%). Conclusion: Early enteral feeding is safe, well tolerated, and significantly improves postoperative outcomes in GI surgery patients. It accelerates return of bowel function and reduces hospital stay without increasing complication rates. Early feeding should be incorporated as a standard element of enhanced recovery protocols in elective gastrointestinal surgeries.

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Introduction: Spinal anaesthesia is commonly preferred for infra-umbilical surgeries due to its rapid onset and reliable efficacy. Hyperbaric ropivacaine 0.75% offers advantages such as better hemodynamic stability and less motor blockade compared to bupivacaine. However, its relatively shorter duration limits postoperative analgesia. Dexmedetomidine, a selective α2-adrenergic agonist, has shown promise as an intrathecal adjuvant to prolong block duration and analgesia. This study aimed to compare the efficacy and safety of hyperbaric ropivacaine 0.75% alone versus in combination with 5 µg dexmedetomidine in spinal anaesthesia for infra-umbilical surgeries. Materials and Methods: A prospective, randomized comparative study was conducted on 60 ASA I–II patients scheduled for elective infra-umbilical surgeries under spinal anaesthesia. Patients were randomized into two groups of 30 each: Group A received 3 ml of 0.75% hyperbaric ropivacaine, and Group B received 3 ml of 0.75% hyperbaric ropivacaine with 5 µg dexmedetomidine. Onset and duration of sensory and motor blocks, duration of postoperative analgesia, and hemodynamic parameters were recorded and analyzed. Results: Group B showed a significantly faster onset of sensory (1.78 ± 0.14 min) and motor (2 ± 0.42 min) block compared to Group A (3.48 ± 0.98 min and 6.8 ± 2.36 min, respectively). The duration of sensory block, motor block, and analgesia were significantly prolonged in Group B. Mild hypotension and bradycardia were observed in a few cases in Group B but were not statistically significant. Conclusion: Intrathecal dexmedetomidine (5 µg) as an adjuvant to 0.75% hyperbaric ropivacaine enhances block quality and prolongs postoperative analgesia with minimal hemodynamic effects, making it a preferred choice in hemodynamically stable patients.

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Introduction: TB lymphadenitis is the commonest form of EPTB, but its diagnosis remains a challenge. FNAC is widely used, though it lacks specificity. ZN staining provides confirmation, but sensitivity is low. CBNAAT has emerged as rapid and reliable diagnostic tool in this context. Aim: To evaluate the utility of FNAC with ZN stain in comparison to CBNAAT for rapid diagnosis of tuberculous lymphadenitis in a tertiary care center in Eastern India. Materials and Methods: This cross-sectional study was conducted at Burdwan Medical College and Hospital, from June’23-May’24. Sixty clinically suspected cases of TB lymphadenitis were evaluated. FNAC smears were examined for cytomorphology and stained with ZN stain. Remaining aspirated material was tested using CBNAAT. Diagnostic performance parameters were calculated. Results: Mean age of participants was 37.77 ± 19.52 years, with majority being male (68.33%) and belonged to 31–50 years group. Cervical lymph node was most commonly involved site (86.67%). FNAC findings were reactive lymphoid hyperplasia (30.00%), epithelioid granuloma without necrosis (21.67%), suppurative lesions (21.67%), epithelioid granuloma with necrosis (13.33%), and caseous necrosis without epithelioid cells (11.67%). CBNAAT positivity was 36.67%, double that of ZN stain (18.33%). Epithelioid granuloma with necrosis showed the highest positivity (87.50% CBNAAT, 87.50% ZN stain). All suppurative aspirates were ZN stain negative but 30.77% CBNAAT positive. Compared with CBNAAT, ZN stain showed sensitivity of 45.45%, specificity 97.37%, PPV 90.91%, NPV 75.51%, diagnostic accuracy 78.33%, and a weak agreement (κ = 0.48). Conclusions: FNAC is a good first test for TB lymphadenitis, ZN stain is specific but often misses cases, while CBNAAT detects more, even in ZN-negative samples. Using all three together gives faster, more accurate diagnosis in high-burden, low-resource settings.

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Breast lumps are among the most common clinical presentations in women, ranging from benign conditions such as fibroadenomas and cysts to malignant tumors, particularly breast cancer. Globally, breast cancer is the most frequent cancer in women, and in India, it now accounts for nearly one-third of all female malignancies. Despite improvements in awareness and early detection in urban populations, women in rural India continue to experience significant delays in diagnosis, resulting in late-stage presentation and poorer outcomes. The epidemiology of breast lumps in rural areas shows that while benign conditions predominate, the burden of malignancy is rising, with younger age at onset and higher rates of advanced disease compared to Western populations. Multiple factors contribute to these delays, including lack of awareness, cultural stigma, reliance on traditional healers, financial hardship, limited female autonomy, and systemic barriers such as poor diagnostic infrastructure and inadequate referral mechanisms. The consequences are severe, with advanced-stage diagnosis, increased treatment costs, reduced survival, and psychological as well as socio-economic strain on families and communities. Addressing these challenges requires multifaceted interventions, including community-based awareness programs, training of frontline health workers, integration of breast health education into rural health schemes, technology-driven solutions such as telemedicine, and strengthening diagnostic capacity at the district level. This review synthesizes current evidence on presentation patterns, barriers to timely diagnosis, and strategies to improve breast health outcomes in rural India.

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Postoperative morbidity following inguinal hernia and hydrocele surgeries, including pain, scrotal edema, and hematoma, remains a significant concern, particularly in low-resource settings. Scrotal support is an effective intervention to reduce these complications, with both commercial devices and improvised methods such as coconut bandages showing clinical benefits. Evidence indicates that improvised supports are comparable to commercial devices in reducing pain and swelling, improving patient satisfaction, and facilitating early mobilization, while being significantly more cost-effective. This review synthesizes current evidence on the efficacy, patient acceptability, and economic feasibility of low-cost scrotal supports, highlighting their potential as practical alternatives in resource-constrained healthcare settings. Further high-quality randomized studies are required to establish standardized protocols and long-term outcomes.

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Background: Cardiovascular disease is commonly seen in patients with Chronic Obstructive Pulmonary Disease (COPD). Brain Natriuretic Peptide (BNP) is a marker of ventricular dysfunction and troponin I is of myocardial necrosis. Elevations of these markers have been found in many disorders, COPD being one of them. The aim of the study is to assess the association of elevated cardiac biomarkers with the 6-month mortality in patients with Acute Exacerbation of COPD (AECOPD). Materials and Methods: 109 patients admitted with acute exacerbation of COPD were included in this prospective study. Cardiac Biomarkers- BNP and troponin-T were measured on admission. Patients were followed up for the next 6 months and mortality over this duration was recorded and analysed. Statistical Analysis- Pearson X2 testing was used. Setting and Design- The study was conducted in the Department of Medicine, Gauhati Medical College and Hospital, Gauhatir, Assam. It was a prospective hospital-based observational study. Results: 109 patients who met the inclusion and exclusion criteria were included in the study. Among them 100 were males and 09 were female.34 were in the age group 50-59 years 47 were between 60-69 years 26 were between 60-69 years 26 were in between 70-79 years and 2 patients were abiove 80 years. TROP I was found to be positive in 41 patients and negative in 68 patients. Conclusion: In COPD patients presenting with acute exacerbation, an isolated elevation of troponin level or a combined elevation of BNP and troponin-T levels are strong predictors of mortality (9 fold and 12 fold increase respectively). However, elevated BNP in isolation is not associated with increased mortality.

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Hernia surgery is one of the most common surgical procedures worldwide, yet outcomes in tribal adults are often compromised by underlying malnutrition and anemia. These conditions, prevalent due to chronic food insecurity, cultural dietary practices, parasitic infestations, and poor healthcare access, significantly increase perioperative risks. Malnutrition impairs wound healing and immune defense, while anemia reduces tissue oxygenation, collectively leading to higher rates of intraoperative instability, postoperative complications, recurrence, and mortality. This paper explores the etiology of malnutrition and anemia in tribal populations, their impact on hernia surgery outcomes, and the importance of perioperative optimization. Strategies such as nutritional assessment, iron therapy, protein and micronutrient supplementation, and community-based interventions are emphasized. Furthermore, the role of tailored Enhanced Recovery After Surgery (ERAS) protocols—adapted to tribal contexts with locally accessible dietary modifications, culturally sensitive counseling, and community health worker follow-up—is highlighted. Bridging cultural, economic, and systemic barriers through government and NGO initiatives is essential for sustainable improvement. Addressing malnutrition and anemia through targeted perioperative strategies and customized ERAS pathways can significantly enhance surgical outcomes for tribal adults undergoing hernia repair, while also promoting long-term health equity.

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Background: Polycystic ovarian syndrome (PCOS) is associated with chronic low-grade inflammation, with elevated C-reactive protein (CRP) levels being a key inflammatory marker. Metformin, commonly used in PCOS management, may have anti-inflammatory properties. This study evaluated the long-term impact of metformin therapy on CRP levels in women with PCOS over a one-year period. Methods: A prospective observational study was conducted on 186 women diagnosed with PCOS according to Rotterdam criteria. Participants were initiated on metformin 500mg twice daily and followed for 12 months. Serum CRP levels were measured at baseline, 3 months, 6 months, 9 months, and 12 months using high-sensitivity CRP assay. Additional parameters including BMI, waist circumference, fasting glucose, insulin levels, and hormonal profiles were assessed. Statistical analysis was performed using SPSS version 25.0. Results: The mean age of participants was 25.2 ± 4.6 years. Baseline CRP levels were significantly elevated (4.6 ± 2.1 mg/L) compared to normal reference values. Following metformin therapy, CRP levels decreased progressively: 3 months (3.1 ± 1.6 mg/L, p<0.001), 6 months (2.4 ± 1.3 mg/L, p<0.001), 9 months (2.0 ± 1.1 mg/L, p<0.001), and 12 months (1.7 ± 1.0 mg/L, p<0.001). The reduction in CRP levels correlated positively with improvements in insulin resistance (r=0.689, p<0.001) and BMI reduction (r=0.591, p<0.001). Maximum therapeutic benefit was observed after 9 months of treatment. Conclusion: Long-term metformin therapy significantly reduces CRP levels in women with PCOS, with progressive improvement over 12 months. The sustained reduction in inflammatory markers suggests metformin’s potential role in reducing long-term cardiovascular risk in PCOS patients.

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Background: Blood is an irreplaceable therapeutic resource, and its judicious use is critical to patient care. However, wastage of blood and blood components remains a significant challenge for transfusion services worldwide. Aim: This study aimed to identify the causes and trends of blood component discards in a tertiary care teaching hospital and provide evidence-based recommendations to minimize wastage. Materials and Methods: A retrospective study was conducted at a tertiary care hospital blood centre in South India over four years (May 2021–April 2025). Data were collected from donor, discard, and transfusion registers. Blood components prepared included packed red blood cells (PRBC), fresh frozen plasma (FFP), platelet-rich concentrate (PRC), whole blood, and cryoprecipitate. Discard rates and causes were analysed. Results: A total of 7,436 blood units were collected, yielding 16,124 components. Overall discard rate was 4.1% (662 units). PRC recorded the highest discard rate (28.24%), followed by whole blood (24.89%), cryoprecipitate (4.54%), FFP (1.41%), and PRBC (1.29%). Expiry was the leading cause of wastage (59.8%), followed by quality control purposes (13.3%), leakage (12.4%), and transfusion-transmitted infections (6.8%). Platelet discards were disproportionately high due to their short shelf life, while whole blood discards were mainly due to seropositivity, predominantly hepatitis B. Conclusion: Despite acceptable discard rates for PRBC and FFP, high wastage of PRC and whole blood underscores the need for strengthened donor screening, improved inventory management, better handling protocols, and enhanced interdepartmental coordination. Adoption of electronic blood bank information systems, strict first-expiry-first-out practices, and regular audits can substantially reduce avoidable wastage, ensuring more efficient utilization of this scarce, life-saving resource.

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We report the case of a 38-year-old male who presented with a single episode of loss of consciousness, left-sided chest pain, and acute left upper limb weakness. Evaluation revealed two rare but clinically significant findings: cerebellar tonsillar herniation (~8.8 mm descent, likely Chiari I malformation) and myocardial bridging of the mid-left anterior descending artery (LAD). The patient improved with conservative management and remains asymptomatic on follow-up. This case highlights the importance of thorough evaluation of syncope with neurological and cardiac overlap.

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Aim: This study was aimed at determining the ocular manifestations of patients presenting with clinical features suggestive of scleroderma in dermatology department in a tertiary care centre. Settings and Design: Tertiary care referral centre in Tamilnadu, Prospective, Single institution, interventional case series. Materials and Methods: A prospective cross sectional review of patients presenting with clinical features suggestive of scleroderma, in dermatology department, in a tertiary care centre in Tamilnadu was conducted between Nov 2017 to Feb 2019. Fifty patients with systemic clinical features suggestive of scleroderma were included. Investigations done and systemic associations were confirmed. Ocular investigations including visual acuity, intra ocular pressure, Slit lamp examination, colour vision, visual fields, Schirmer’s test, Tear Film Break Up Time and fundus examination were done in all cases. Results: Among fifty cases 45 were females (90%) and 5 were males (10%) and the mean age was45±15 years. Slit lamp examination and oblique examination revealed inability to retract the lower eyelid (Ingram’s sign) in 40 out of fifty cases due to tightening of lid skin. Schirmer’s test and TBUT revealed moderate to severe dry eye in 25 out of 50 cases. Colour vision, fields and fundus were normal in all cases. Conclusion: Eyelid abnormalities and defective tear secretion were the most common ocular findings in patients with scleroderma.

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Background: Histological subtypes of cancer are known to influence disease progression, treatment response, and patient survival. However, limited data exist on the comparative outcomes of different cancer histologies within specific regional populations. This study aims to evaluate and compare clinical outcomes among patients with various histological subtypes of cancer treated at Nalanda Medical College & Hospital, Patna, Bihar. Methods: A prospective observational study was conducted from January to December 2024, including 88 patients diagnosed with confirmed histological subtypes of cancer. Inclusion criteria comprised patients treated within the study period and having complete medical records. We collected demographics, cancer type, stage, treatment mode, and results. OS and DFS were primary outcomes, while response to therapy, recurrence rates, and comorbidities were secondary. SPSS was used for Kaplan-Meier survival curves, Chi-square testing, and ANOVA. A p-value < 0.05 indicated significance. Results: Among the 88 patients, adenocarcinoma was the most common histological subtype and showed the best outcomes with a 1-year OS of 83.3% and DFS of 72.2%. Small cell carcinoma had the poorest prognosis with a 1-year OS of 41.7% and a DFS of 33.3%. Undifferentiated tumors demonstrated intermediate outcomes. The results showed that different subtypes had significantly different survival rates and treatment responses (p < 0.05). Treatment modalities varied by subtype, with adenocarcinoma patients more likely to receive multimodal therapy. Conclusion: Histological subtype is a critical determinant of cancer prognosis. Adenocarcinoma was associated with superior survival and treatment response, while small cell and undifferentiated carcinomas exhibited poor outcomes. These findings underscore the importance of histology-specific treatment planning and support the need for larger, multicenter studies to guide personalized oncology care in the Indian clinical context.

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Background: The physical, mental, and social health of people with psoriasis is greatly affected by the disease, which is a chronic skin condition caused by an immune system response that manifests as red, inflamed plaques. With a varying degree of severity, its management requires tailored therapeutic approaches, including topical and systemic therapies. In resource-limited settings such as Bihar, India, evaluating the real-world effectiveness of these treatments is critical for informed clinical decision-making. Methods: From January to June 2025, researchers at Bhagwan Mahavir Institute of Medical Science (BMIMS) in Pawapuri, Nalanda, Bihar, looked back at past patients’ records. One group of 100 psoriasis patients received systemic treatment (methotrexate, biologics, etc.), whereas the other group received topical treatment (e.g., corticosteroids, vitamin D analogues). The Dermatology Life Quality Index (DLQI) and the Psoriasis Area and Severity Index (PASI) were used to measure effectiveness at baseline, 1 month, 3 months, and 6 months. Also documented were adverse effects and compliance. Results: Both treatment modalities led to significant clinical improvement. However, systemic therapy demonstrated superior efficacy, with a 68.4% reduction in PASI scores compared to 45.1% in the topical group. DLQI improvements mirrored these findings. Systemic therapy was associated with more side effects but offered greater overall disease control and quality-of-life improvement. Conclusion: Systemic therapies are more effective than topical treatments for moderate to severe psoriasis, though topical agents remain essential for mild cases. Individualized treatment plans and further prospective studies are recommended to optimize psoriasis care in resource-constrained settings.

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Background: Acne vulgaris is a common dermatological condition that predominantly affects adolescents and young adults, often leading to physical scarring and psychological distress in severe cases. Isotretinoin, a systemic retinoid, is considered one of the most effective treatments for severe nodulocystic acne, targeting multiple pathogenic factors simultaneously. However, limited clinical data exist on its efficacy and tolerability in rural Indian populations. Methodology: This prospective, observational study was conducted at Bhagwan Mahavir Institute of Medical Science (BMIMS), Pawapuri, Nalanda, Bihar, over six months from January to June 2025. A total of 100 patients aged 16–35 years with clinically diagnosed severe acne were administered oral isotretinoin at a dose of 0.5 mg/kg/day. Patients were followed monthly to assess changes in acne severity using the Global Acne Grading System (GAGS), monitor adverse effects, and evaluate treatment satisfaction. Key Findings: The mean GAGS score significantly reduced from 32.8 at baseline to 8.2 at the end of the treatment period, indicating substantial clinical improvement. Most patients showed visible improvement by the second month. Common side effects included dry lips (76%) and dry skin (52%), which were manageable with supportive care. No severe psychiatric or systemic adverse effects were observed. Conclusion: Isotretinoin proved to be a highly effective and generally well-tolerated treatment for severe acne in this semi-urban population. Its integration into rural dermatological care could significantly improve patient outcomes when combined with proper monitoring.

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Background: Cancer remains an important cause of mortality and morbidity in India, with prognosis often dependent on late-stage diagnosis and inconsistent follow-up. Identifying reliable, cost-effective prognostic biomarkers can enhance early intervention and guide personalized treatment decisions, particularly in resource-constrained settings. This research aimed to assess the prognostic value of specific serum biomarkers in cancer patients treated at Nalanda Medical College and Hospital, Patna. Method: A retrospective review of medical records from 94 cancer patients was conducted. Data on demographics, clinical stage, and biomarker levels were extracted where available. Statistical analysis included descriptive measures, comparative evaluation across clinical stages, and survival associations. Result: Based on available records, elevated CA-125 and LDH levels were significantly associated with advanced disease stages (CA-125: Early = 32.5 ± 19.2 U/mL vs. Advanced = 55.6 ± 34.1 U/mL, p = 0.01; LDH: Early = 275 ± 76 U/L vs. Advanced = 324 ± 95 U/L, p = 0.03). Other markers (CEA, AFP, CA 19-9) showed upward trends but without statistical significance (p > 0.05). Descriptive statistics indicated mean levels exceeding reference ranges for multiple biomarkers, particularly LDH and CA-125. Conclusion: Elevated CA-125 and LDH levels demonstrated prognostic potential in identifying advanced disease stages. While this retrospective review shows important associations, its scope was limited by the absence of routine biomarker testing. Findings should therefore be interpreted with caution, and larger, multicentric prospective studies are needed to confirm clinical utility.

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Background: Breast, lung, and colon cancers are among the most common malignancies worldwide and significantly contribute to cancer-related morbidity and mortality. In India, late-stage presentation, limited diagnostic resources, and variable treatment responses pose major challenges, particularly in resource-constrained regions like Bihar. At a tertiary care centre in Eastern India, this study examined tumour features and clinical outcomes in these cancer patients. Method: A retrospective observational study was conducted at Nalanda Medical College & Hospital, Patna, Bihar, over a 12-month period from January 2024 to December 2024. A total of 51 patients with histologically confirmed breast, lung, or colon cancer were included. Data were collected from hospital records, pathology reports, and treatment charts. Variables studied included patient demographics, cancer type, histological grade, tumor stage, treatment modalities, and outcomes. Results: Among 51 patients, breast cancer was the most common (46.1%), followed by lung cancer (31.5%) and colon cancer (22.5%). The majority of patients were female (58.4%) as well as aged between 41–60 years (52.8%). Most tumors were moderately differentiated (48.3%) and presented in Stage III (43.8%). Infiltrating ductal carcinoma and adenocarcinoma were the dominant histological types. Chemotherapy was administered in 79.8% of cases, surgery in 64%, and radiotherapy in 59.6%. Remission was achieved in 46.1% of patients, while recurrence occurred in 19.1%, metastasis in 13.5%, and mortality was observed in 14.6%. Fifteen patients (16.9%) were lost to follow-up. Conclusion: This study highlights the predominance of advanced-stage cancer presentation in a tertiary care setting in Eastern India. Despite the use of multimodal therapies, recurrence and mortality remain significant, emphasizing the need for early detection, standardized treatment protocols, as well as improved follow-up. The findings underscore the importance of region-specific data in guiding clinical decision-making and public health strategies.

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Germinomas are primary malignant tumours derived from neuroectodermal tissue. Their presentation can be varied based on the tumour location. This is a case of a 16-year-old female who presented with limb weakness, cognitive dysfunction, polyuria and polydipsia and menstrual disturbances. The patient’s subsequent neuroimaging revealed a large lesion in the left cerebral hemisphere with extension into the frontotemporal region extending to the deep white matter, corpus callosum, basal ganglia and thalamus. There was also pituitary stalk thickening. Histological examination confirmed the presence of a germinoma. She was treated with neoadjuvant chemotherapy with bleomycin, etoposide and cisplatin followed by radiotherapy.

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Introduction: Falling coconuts are a well-documented but under reported cause of traumatic head injury, particularly in tropical regions. Due to the weight and velocity of falling coconuts, injuries can be severe. In this study, we conducted a retrospective study of patients presenting with head injuries due to coconut falls who underwent CT evaluation. The objective was to describe the demographic distribution and CT findings. Materials and Methods: This retrospective study was conducted from 2022 to June 2025, over a period of more than one year, reviewing CT scans of patients who presented with head trauma due to coconut falls at a tertiary care center. Inclusion criteria included all age groups with documented history of coconut-related head injury and CT imaging. Data were analyzed for type, severity, and location of cranial injuries. All eligible patients were identified. Results: In our study, Gender Distribution shows a clear male predominance (75.6%). Skull fractures were seen in 5 patients (12.2%). Scalp/Soft Tissue Swelling was observed in 8 cases (19.5%). In this study CT Spine Evaluation revealed that nearly half the patients (46.3%) underwent spinal imaging, though no spinal injuries were reported. Conclusion: Coconut-related head trauma, although rare, can cause serious injuries. Prompt imaging and early management are essential to reduce morbidity.

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Background: Undisplaced spiral tibial fractures in young children (“toddler’s fractures”) are common and typically managed with immobilisation with above-knee plaster of Paris (AK-POP) casts. Paediatric controlled ankle motion (CAM) boots are increasingly used, with emerging trial data suggesting earlier functional recovery without compromising union. Objective: To compare functional and radiological outcomes of AK-POP cast versus Paediatric CAM boots in children with undisplaced spiral tibial fractures. Methods: Single-centre, parallel-group randomised controlled trial of children aged 1–8 years with radiographically confirmed, undisplaced spiral tibial fractures. Participants were randomised 1:1 to AK-POP cast or Paediatric CAM boot. Primary outcome was time to radiographic union (weeks). Secondary outcomes included time to independent weight-bearing (days), caregiver reported pain at weeks 1, 2, and 4 (0–15 scale), return to baseline activities (days), and complications. Results: 40 Children were randomised (AK-POP n=20; CAM boot n=20). Mean time to union was shorter with CAM boots (4.8 ± 1.1 vs 5.6 ± 1.3 weeks; p=0.001). CAM boot patients achieved independent weight-bearing sooner (10 ± 3 vs 16 ± 4 days; p<0.001) and reported lower pain at weeks 1–2. Complication rates were lower with CAM boots (6 vs 2), with fewer skin/pressure problems. There were no differences in loss of alignment, malunion, or refracture. Conclusion: In undisplaced paediatric spiral tibial fractures, Paediatric CAM boots yield faster functional recovery with equivalent radiological healing and fewer device-related complications compared with AK-POP Cast.

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Background: Obesity in children is a significant public health concern globally, contributing to various long-term health complications such as cardiovascular diseases, type 2 diabetes, and psychosocial issues. Accurate and easily accessible screening tools are necessary to identify children at risk of obesity early. Traditionally, Body Mass Index (BMI) has been used to assess overweight and obesity in children. However, due to its limitations, such as not accounting for fat distribution, central obesity, alternative anthropometric measurements like neck circumference (NC) and waist circumference (WC) have gained attention as potential screening tools, for better predictor of cardiovascular risk in future. Objectives: Primary Objective: To determine the accuracy of Neck circumference (NC) and Waist circumference (WC) as a measure for screening overweight and obesity in children aged 6-15yrs, by correlating the results with Body mass index (BMI). Secondary Objective: To estimate the prevalence of overweight and obesity in school going children aged 6- 15 years in B.G. Nagara, Rural Mandya. Methods: An Observational cross-sectional study was conducted among 804 school going children aged between 6 years– 15 years from schools in Nagamangala taluk, Mandya district. After obtaining Ethical Committee clearance and permission from school principal, data was collected after from students, in the form of self-formulated questionnaire, which included anthropometric measurements. Data was analysed using licensed version of SPSS 30. The description of data is in the form of mean (±) SD for quantitative data and frequency and proportion for qualitative data. Student-t test was used to compare continuous variables and χ2 (Chi-square) test was used to compare categorical variables. P value <0.05 was considered statistically significant. Results: The area under the ROC curve (AUC) was 0.841, for neck circumference and 0.834 for waist circumference indicating excellent discriminatory ability of neck and waist circumference in identifying obesity. The prevalence of overweight and obesity combined was significantly high, with 29.2% categorized as overweight and 24.1% as obese, while 46.6% had a normal BMI and 3.4% underweight. The mean BMI of the study population was 19.74 kg/m² (SD ± 2.72). Interpretation & Conclusion: The present study provides comprehensive insights into the role of neck circumference (NC) and waist circumference (WC) as screening tools for overweight and obesity among children aged 6-15 years. Neck circumference and waist circumference can serve as reliable anthropometric markers in conjunction with BMI to screen for obesity. Increased Neck circumference and waist circumference are associated with obesity-related risks such as cardiovascular diseases, metabolic syndrome, and sleep apnea. BMI, NC, and WC together could improve obesity assessment, especially in predicting metabolic risks.

The high prevalence of overweight and obesity identified in this study further underscores the urgent need for early detection and intervention.

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Introduction: TB lymphadenitis is the commonest form of EPTB, but its diagnosis remains a challenge. FNAC is widely used, though it lacks specificity. ZN staining provides confirmation, but sensitivity is low. CBNAAT has emerged as rapid and reliable diagnostic tool in this context. Aim: To evaluate the utility of FNAC with ZN stain in comparison to CBNAAT for rapid diagnosis of tuberculous lymphadenitis in a tertiary care center in Eastern India. Materials and Methods: This cross-sectional study was conducted at Burdwan Medical College and Hospital, from June’23-May’24. Sixty clinically suspected cases of TB lymphadenitis were evaluated. FNAC smears were examined for cytomorphology and stained with ZN stain. Remaining aspirated material was tested using CBNAAT. Diagnostic performance parameters were calculated. Results: Mean age of participants was 37.77 ± 19.52 years, with majority being male (68.33%) and belonged to 31–50 years group. Cervical lymph node was most commonly involved site (86.67%). FNAC findings were reactive lymphoid hyperplasia (30.00%), epithelioid granuloma without necrosis (21.67%), suppurative lesions (21.67%), epithelioid granuloma with necrosis (13.33%), and caseous necrosis without epithelioid cells (11.67%). CBNAAT positivity was 36.67%, double that of ZN stain (18.33%). Epithelioid granuloma with necrosis showed the highest positivity (87.50% CBNAAT, 87.50% ZN stain). All suppurative aspirates were ZN stain negative but 30.77% CBNAAT positive. Compared with CBNAAT, ZN stain showed sensitivity of 45.45%, specificity 97.37%, PPV 90.91%, NPV 75.51%, diagnostic accuracy 78.33%, and a weak agreement (κ = 0.48). Conclusions: FNAC is a good first test for TB lymphadenitis, ZN stain is specific but often misses cases, while CBNAAT detects more, even in ZN-negative samples. Using all three together gives faster, more accurate diagnosis in high-burden, low-resource settings.

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Introduction: Elective modules are inherent to medical education, promoting problem-solving, self-directed learning, and clinical skills. This study explored perceptions of students and faculty regarding Physiology electives—Electrocardiogram (ECG) and Pulmonary Function Test (PFT)—and assessed their impact on knowledge gain. Methods: A mixed-methods study was conducted at Rampurhat Government Medical College, West Bengal, among 30 MBBS students of the 2022 batch. Participants selected ECG or PFT electives. Data were collected through pre- and post-tests, a Likert-scale survey, and focus group discussions. Paired t-tests analyzed quantitative data, while qualitative responses underwent thematic analysis. Results: Post-test scores significantly improved (p &lt; 0.05). Students appreciated hands-on training, diagnostic skills, and communication. Faculty complimented student involvement but pointed out short duration as a limitation. Conclusion: Well-structured Physiology electives upgrade knowledge and clinical readiness, supporting their continued inclusion in the MBBS curriculum.

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Background: Migraine is a highly prevalent and disabling neurological disorder, often underdiagnosed and inadequately treated, prompting the need for effective and well-tolerated prophylactic interventions. Objective: To evaluate the efficacy of Coenzyme Q10 (100 mg/day) as an adjunctive therapy to standard prophylactic medication in patients with migraine. Methods: This was a prospective, open-label, randomized controlled study conducted on 68 migraine patients over a three-month treatment period. Participants were assigned to receive either standard prophylactic therapy alone or in combination with Coenzyme Q10 at a dose of 100 mg/day. Results: At baseline, both the Coenzyme Q10 and control groups (n = 32 each) were comparable in age, gender distribution, migraine duration, frequency of attacks, pain severity, and associated symptoms, with no statistically significant differences. The 50% responder rate for migraine frequency in the Coenzyme Q10 group increased from 6.25% in the first month to 50% by the third month, significantly higher than the control group (21.87%, p = 0.001). Mean monthly attack frequency and pain scores also declined more in the Coenzyme Q10 group (p < 0.001), with a 40.62% responder rate in pain reduction by the third month (vs. 15.62% in control; p = 0.025). Monthly migraine days decreased significantly (from 9.87 to 5.21; p < 0.001), and key symptoms like photophobia and phonophobia were markedly reduced in the Coenzyme Q10 group by the third month (p < 0.001). During follow-up, symptoms partially recurred in the Coenzyme Q10 group, with no significant differences between groups after discontinuation. Conclusion: Coenzyme Q10 at a dose of 100 mg/day demonstrated significant efficacy and good tolerability as an adjunctive therapy in the prophylaxis of migraine.

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Background and Aim: Thrombophlebitis is often linked to peripheral venous cannulation. Sometimes thrombophlebitis goes undiagnosed. Thrombophlebitis comes with major problems and unknown treatment, prevention is best. Prophylactic topical heparin helps minimize thrombophlebitis and its consequences, such as deep venous thrombosis and pulmonary embolism, which lengthen hospital stays. This study examined the efficacy of topical quick penetration solution (QPS) in preventing phlebitis in routine surgery patients who needed a 72-hour IV line. Material and Methods: In this comparative prospective observational study, we observed 100 patients undergoing regular major surgery. We divided these patients in groups A and B of 50 patients in each group. In both the groups, 20G IV cannula was inserted and secured with a micropore. In group B patients, 10 drops of topical heparin 1000 IU/ml were applied along the vein. We used the Phlebitis Assessment Grading (PAG) scale to monitor the cannula site at 0, 12, 24, 48, and 72 hours. Results: According to the PAG scale, at 12 hours, in Group A 48 patients had a score of 0 and two patients had a score of 1. While all 50 patients in Group B scored 0 (p<0.05). At 24 hours, in Group A, 14 patients had scored 0, 30 patients had scored 1 and 6 patients had scored 2. While in group B, 48 patients scored 0 and 2 patients scored 1 (P = 0.01). At 48 hours, in Group A, 18 patients scored 1 and 32 patients scored 2, while in  Group B,  30 patients scored 0 and 20 patients scored 1 (P <0.05). At 72 hours, in Group A, 16 patients scored 1, 22 patients scored 2 and 12 patients scored. While in group B, 18 patients scored 0 and 24 patients scored 1 and 8 patients scored 2. Maximum score in group A was observed to be 3 which constituted 24% of the patients. In group B, the maximum score observed was 2 that too in only 8 patients which constituted 16% of the patients. This proves the efficacy of topical QPS of heparin. Conclusion: Prophylactic application of QPS of heparin significantly decreases the incidence of thrombophlebitis. It may be of particular importance in high risk groups and in patients who require IVC for the long time.

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This study was aimed to assess the histopathological spectrum of non-neoplastic and neoplastic lesions of nephrectomy specimens. We also studied the age and sex distribution, neoplastic and non-neoplastic distribution of cases along with histomorphological features. This was a retrospective study conducted in the Department of Urology, S.C.B. Medical College and hospital, Cuttack, Odisha over a period of two years. A total 89 nephrectomy specimens were received. The clinical details, gross and histomorphological features were noted. Age of the patients ranged from 5 months to 72 years. Average age at the time of nephrectomy was 47.48 years. Amongst the 89 cases, 50 (56.18%) were males and 39 (43.82%) were females. Male to female ratio was 1.28:1. Non neoplastic lesions were 60 (67.42%) while neoplastic were 29 (32.58%). In non- neoplastic category, most common lesion was chronic pyelonephritis 16 (126.66%) whereas renal cell carcinoma 24 (82.75%) was the most common neoplastic lesion. Clear cell variant of renal cell carcinoma 8 (33.33%) was the most common, followed by chromophobe variant 7 (29.17%). Nephrectomy was indicated in both non- neoplastic and neoplastic renal pathologies, essentially as a therapeutic option; in many instances, histological assessment of the specimen can aid a definitive diagnosis and better characterization of the disease entity.

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Introduction: Skin closure is a fundamental step in surgery, directly influencing wound healing, infection risk, scar quality, and overall patient satisfaction. Suturing is time-consuming, requires technical finesse, and improper technique may lead to increased pain, infection, or poor scarring. Skin staplers allow for rapid and consistent wound closure, reducing operative time and intraoperative contamination. Aim and Objective: To compare the efficacy, healing outcomes, complication rates, cosmetic results, and patient satisfaction between skin sutures and skin staplers in surgical wound closure. Material and Method: This was a prospective, randomized, comparative study conducted in the Department of General Surgery in F.M. Medical College and Hospital, Balasore, Odisha, over a period of 18 months. Conducted on 100 patients undergoing elective surgeries. Patients were randomly divided into two groups: Group A (n=50): Skin closure with sutures, Group B (n=50): Skin closure with staplers. Result: Staplers were also associated with shorter healing times and lower pain scores, suggesting reduced tissue trauma and better early recovery. Although infection and dehiscence rates were slightly lower in the stapler group, the differences were not statistically significant. Conclusion: Skin staplers provide significant advantages over sutures in terms of faster closure, less pain, quicker healing, and better patient satisfaction. Sutures remain essential in areas requiring precision and cosmetic finesse, and are invaluable for surgical training.

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Introduction: Supraclavicular lymphadenopathy is frequently associated with significant underlying pathology. Fine Needle Aspiration Cytology (FNAC) serves as a cost-effective, rapid, and minimally invasive diagnostic method that plays an essential role in the initial evaluation of lymph node lesions. This study analyses the spectrum of supraclavicular lymph node lesions diagnosed via FNAC in a tertiary care centre over a one-year period. Methods: This retrospective observational study was conducted in the Department of General Surgery, F.M. Medical College and Hospital, Balasore, Odisha, included 50 patients presenting with supraclavicular lymphadenopathy who underwent FNAC from January to December 2024. FNAC was performed using a 23-gauge needle. Smears were stained with May-Grünwald-Giemsa (MGG) and special stains like Ziehl-Neelsen were applied when indicated. Cytological diagnoses were categorized into reactive lymphadenitis, acute suppurative lymphadenitis, granulomatous lymphadenitis, metastatic malignancy, lymphoma, and miscellaneous cases. Results: Out of 50 cases, 66% were male and 34% female. Metastatic malignancy was the most common diagnosis (50%), followed by granulomatous lymphadenitis (24%) and reactive lymphadenitis (18%). Left-sided lymphadenopathy was more frequent (60%). Most metastatic cases occurred in the age group of 40–80 years. FNAC is a dependable and cost-effective diagnostic tool in evaluating supraclavicular lympha. Conclusion: denopathy. In this study, metastatic malignancies were the leading cause, especially in older adults. The technique is invaluable for early diagnosis and directing further investigations and treatment.

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Introduction: Community acquired pneumonia is one of the commonest respiratory illnesses seen globally. However in some patients the radiological infiltrates fail to resolve by 50% at 2 weeks or complete resolution by 4 weeks despite 10 days of minimum standard antibiotic therapy. Factors like inadequate antibiotic therapy, impaired host defence mechanisms, antibiotic resistance, extremely virulent organisms, nonbacterial aetiologies, endo-bronchial lesionsetc are associated with slow resolution of pneumonia. Methods: This is a prospective hospital-based study conducted in the department of Pulmonary Medicine Gauhati Medical College and Hospital for a duration of 12 months from March 2023 to February 2024 among 49 patients. Detailed history and physical examination was taken. Routine blood investigation, sputum analysis, chest X ray and CT thorax was done. Bronchoscopy for lavage, TBLB, TBNA, endobronchial biopsy and CT guided biopsy was done wherever indicated. Additional investigations included ANCA profile, Hypersensitivity pneumonitis panel and Serum/ BAL for galactomannan. Results: Mean age of the population was 47.83 years +/- 14.11 years with a slight male preponderance of 1.2:1. Majority of the cases (28.6%) belonged to the age group of 40-49 years. The most common symptom was cough. Smoking and diabetes was found to be the most common comorbidity. TBNA was done in 6.1%, endobronchial biopsy in 18.4% and CT guided biopsy 18.4 % of cases. Majority 32.7% are diagnosed with NSCLC followed by 22.4% with pulmonary tuberculosis, 8.2% with bacterial pneumonia, 8.2% with aspergilloma, 6.1% with bronchiectasis, 4.1% with organizing pneumonia, 4.1% with lung abscess, 4.1% with vasculitis, 2% with Progressive Massive Fibrosis, 2% with hypersensitivity pneumonitis and 2% with pleural effusion. Conclusion: From this study the most common etiology of non-resolving pneumonia was found to be lung malignancy (non-small cell lung cancer) followed by tuberculosis. Bronchoalveolar lavage was found have higher yield in comparison to sputum analysis for infective causes. Bronchoscopy and CT thorax also aided in guided biopsy.

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Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia, leading to multiple microvascular and macrovascular complications. Although its impact on cardiovascular, renal, and ocular systems is well recognized, pulmonary involvement remains underexplored. This study aimed to evaluate the clinico-radiological pulmonary manifestations of type 2 diabetes mellitus (T2DM) and to assess the correlation between pulmonary function tests (PFTs) and glycaemic control. Materials and Methods: A hospital-based observational study was conducted in the Department of Pulmonary Medicine and Allied Specialties, Gauhati Medical College, Guwahati, Assam, over 12 months (March 2023–February 2024). A total of 115 T2DM patients aged 21–90 years were enrolled, irrespective of respiratory symptoms. Demographic, clinical, radiological, and laboratory data were collected. PFTs were performed in eligible patients. Statistical analysis included chi-square tests, t-tests, and Pearson’s correlation. Results: The study population was predominantly male (74.8%), with a mean age of 53.6 ± 12.6 years and mean diabetes duration of 8.2 ± 4.9 years. Respiratory symptoms were present in 65.2%, most commonly cough (90.7%). Pulmonary tuberculosis (PTB) was diagnosed in 34.7% of patients, with consolidation being the most frequent radiological finding (44%). Notably, atypical distribution involving the lower or middle lobes was observed in 57.6%, and most cases were unilateral (57.6%). Among asymptomatic patients, 62.5% demonstrated a restrictive pattern on spirometry. Duration of diabetes showed moderate negative correlations with FEV₁ (r = –0.421, p = 0.007) and FVC (r = –0.379, p = 0.016). Glycaemic markers (HbA1c, FBS, and PPBS) demonstrated weak, non-significant correlations with PFT parameters. Conclusion: T2DM is associated with a high prevalence of respiratory manifestations, particularly pulmonary tuberculosis with atypical radiological patterns. Subclinical restrictive impairment is common in asymptomatic individuals. Pulmonary function declines with longer duration of diabetes, while glycaemic indices such as HbA1c show limited correlation. These findings emphasize the need for routine pulmonary evaluation in diabetic patients, especially those with long-standing disease.

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Tuberculosis (TB) is one of the leading causes of morbidity and mortality. TB induces an acute phase response, resulting in elevated levels of blood reactants like C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin and albumin/globulin ratio (AGR). This study aims to evaluate values of acute phase inflammatory markers, including ESR, CRP, ferritin and AGR prior to treatment, end of intensive phase (IP), and end of continuation phase (CP). Material & Methods: This hospital-based prospective observational study was carried out over 14 months (January 2023 to March 2024) in the Department of Pulmonary Medicine at Gauhati Medical College and Hospital, Guwahati. A total of 73 adult patients with newly diagnosed pulmonary TB and treated with anti-tubercular treatment (ATT) were enrolled. Inflammatory markers such as CRP, ESR, ferritin and AGR were measured at baseline, end of IP (8 weeks) and end of CP (16 weeks). Results: The cohort predominantly comprised females (57.53%) with a mean age of 48.49 ± 10.74 years. Most patients presented with a cough (95.89%) and 13% had a history of TB. Moderate pulmonary TB was found in 49.32% of the patients. A majority of patients were microbiologically positive and showed nodular patterns on radiological exams (50.68%). At the end of CP, significant reductions were noted in ESR, CRP and ferritin levels, while the AGR increased significantly (p < 0.0001). Conclusion: Treatment during the IP and CP led to a significant decrease in inflammatory markers, including ESR, CRP, and ferritin, with a notable increase in AGR. These changes suggest a positive response to ATT, observed across varying severities of pulmonary tuberculosis.

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Background and Objective: Respiratory failure is defined as inability of respiratory system to either oxygenate the blood or remove CO2 from blood. The initial treatment for hypoxemia in ARF patients is oxygen therapy. It is applied using devices such as nasal cannulas, face masks or masks with reservoir bags, HFNC etc. HFNC makes use of heated, humidified air combined with oxygen.¹ High oxygen flows (60 L/min) are delivered by HFNCs, and their FiO2 is in the range of 0.21 to 1. Failure of HFNC is characterized by the necessity of endotracheal intubation in spite of HFNC administration.² Therefore, in order to assess the predictors for HFNC failure in patients with ARF, we conducted an observational study at the hospital. Method: This was a hospital-based observational study in which adult patients more than 18 yrs presenting with ARF and managed with HFNC in the Department of Pulmonary Medicine and Allied Specialties were included. Important parameters included in the study were GCS, RR, FiO₂, SpO₂, ROX index, and arterial blood gas parameters, including pH, PaO₂, and PO₂. Outcome characteristics Included survival or mortality, and failure or success of HFNC treatment. Result: The majority of patients experienced HFNC failure (60%). Causes of respiratory failure (p>0.05), FiO₂ (p=0.199), PaCO₂ (p=0.381), PaO₂ (p=0.702) were comparable among patients with success and failure of HFNC. The ROX index was significantly lower in HFNC failure patients than HFNC success patients at 1 hour (p=0.022) and 12 hours (p=0.004) after HFNC treatment. Conclusion: ROX index has good performance in prediction of failure of HFNC treatment; however, the sensitivity and specificity are higher at 12 hours after HFNC treatment than at 1 hour.

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Background and Aim: Laparoscopic cholecystectomy, while minimally invasive, involves creation of pneumoperitoneum, inducing physiological changes that can be exacerbated by smoking. This study compares the impact of pneumoperitoneum on arterial blood gas (ABG) and ventilatory parameters in smokers versus non-smokers undergoing this procedure. Methodology: A prospective, comparative study was conducted on smokers and non-smokers undergoing laparoscopic cholecystectomy under general anaesthesia. ABG parameters (pH, pCO2, HCO3, Lactate) and ventilatory parameters (ETCO2, PEEP, Ppeak) were measured at baseline, during pneumoperitoneum, and post-extubation. Hemodynamic parameters, oxygen saturation and occurrence of complications were also compared. Result: Smokers exhibited significantly lower pH, higher pCO2, and elevated lactate levels compared to non-smokers during pneumoperitoneum and post-extubation (p<0.05). ETCO2 levels were higher in smokers at all time intervals (p<0.001) and Ppeak was significantly higher in smokers post-pneumoperitoneum. There were significant haemodynamic changes in smokers compared to non-smokers at various time intervals. There were no statistically significant differences in complication rates between the two groups. Conclusion: Smokers demonstrated altered ABG and ventilatory parameters during laparoscopic cholecystectomy with pneumoperitoneum, indicating greater respiratory and metabolic stress. This highlights the need for tailored perioperative management in smokers.

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Background: Understanding normal anatomic variation on CT is essential for accurate interpretation and teaching. Objective: To quantify key airway, vascular, and fissural features on chest CT in adults with radiology reports of “normal,” and to document common variants. Methods: Seventy consecutive adult chest CTs (≤1.25 mm slices) were analyzed. Tracheal/AP and transverse diameters (1 cm above carina), carinal angle, main bronchial diameters, pulmonary artery (PA) diameters, fissure completeness, accessory fissures, and azygos lobe were recorded. Two observers assessed 20 scans twice for reliability. Results: Mean age was 42.3 ± 13.9 years; 42/70 (60%) were male. Mean tracheal AP and transverse diameters were 17.6 ± 2.4 mm and 20.9 ± 2.6 mm; mean carinal angle was 69.4° ± 9.3°. Right and left main bronchus inner diameters measured 12.0 ± 1.7 mm and 10.6 ± 1.6 mm. Mean main PA diameter was 27.3 ± 2.9 mm (PA:A ratio <1 in 93%). Major fissure completeness was 79% right, 83% left; minor fissure complete in 57%. Accessory fissures occurred in 19% (95% CI, 11–30%), and an azygos lobe in 7% (95% CI, 3–15%). Sex‑stratified analyses showed larger airway diameters in males (p < 0.01) but similar carinal angles (p = 0.21). Reliability was excellent (ICC 0.88–0.95 for continuous measures; κ = 0.78 for fissure grading). Conclusion: In this cohort of normal CTs, airway calibers and carinal angle values provide practical reference ranges, and variants such as accessory fissures (~1 in 5) and azygos lobe (~1 in 14) were not rare. These baselines can support teaching files and local reporting standards.

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Background: Worldwide, cataracts are the primary preventable cause of blindness, and the most common surgical procedures are manual small incision cataract surgery (SICS) and phacoemulsification. While both restore vision effectively, refractive predictability and surgically induced astigmatism (SIA) remain critical determinants of postoperative outcomes. Objective: To evaluate visual outcomes and pre- and postoperative refractive errors in patients receiving manual SICS and phacoemulsification. Methods: A retrospective research was carried at the Department of Ophthalmology, Darbhanga, from March 2023 to February 2025. Records of 200 patients (100 phacoemulsification, 100 SICS) were analyzed. Astigmatism, spherical equivalent (SE), pre- and postoperative refraction, and best corrected visual acuity (BCVA) at six weeks were evaluated. SPSS v25 was used to analyze the data, and the t-test and chi-square test were used. A p-value < 0.05 was considered statistically significant. Results: Both groups were comparable in baseline demographics and preoperative refractive status (p > 0.05). At six weeks, mean postoperative SE was closer to emmetropia in the phacoemulsification group (−0.25 ± 0.40 D) compared to SICS (−0.50 ± 0.60 D, p = 0.01). Mean postoperative astigmatism was significantly lower with phacoemulsification (−0.75 ± 0.40 D) than SICS (−1.25 ± 0.55 D, p < 0.001). BCVA ≥ 6/9 was achieved in 88% of phacoemulsification patients versus 76% of SICS patients (p = 0.03). Conclusion: Phacoemulsification provides superior refractive predictability, induces less astigmatism, and results in better visual outcomes compared to manual SICS. However, SICS remains a safe, effective, and cost-efficient technique, particularly suitable for high-volume cataract surgery in resource-limited settings.

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Background: One of the main causes of permanent vision loss in people over 50 worldwide is age-related macular degeneration (ARMD). Its prevalence is increasing in India due to demographic transition and lifestyle risk factors. Understanding regional prevalence patterns and determinants is crucial for planning preventive and therapeutic strategies. Methods: A retrospective study was conducted in the Upgraded Department of Ophthalmology, Darbhanga, over two years (March 2023–February 2025). A total of 100 patients aged ≥50 years diagnosed with ARMD were included. Demographic details, systemic and lifestyle risk factors, and clinical profiles were analyzed. ARMD was classified into early and late forms, with late ARMD further divided into geographic atrophy and neovascular types. Statistical analysis was performed to identify significant determinants. Results: The mean age of patients was 64.8 years, with the majority (42%) in the 60–69 years age group. ARMD prevalence increased with advancing age, with late ARMD most frequent in patients ≥70 years. Females accounted for 56% of cases. Early ARMD was observed in 62% of patients, while 38% had late ARMD, of which the neovascular form (24%) was more common than geographic atrophy (14%). Hypertension (46%) and smoking (30%) showed strong associations with late ARMD, whereas diabetes and prior cataract surgery were not significantly correlated. Conclusion: ARMD is prevalent among the elderly population in this region, with age, hypertension, and smoking emerging as important determinants. Early ARMD was more common overall, but late neovascular ARMD posed a higher risk of visual loss. The findings underscore the importance of targeted screening, lifestyle modification, and systemic disease control to reduce the burden of ARMD-related blindness.

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Background: The brachial artery is a continuation of the axillary artery that usually bifurcates opposite to the neck of the radius in the cubital fossa. Variation in the position of bifurcation may be injured by a surgeon’s knife; hence, knowledge of the position of bifurcation of the brachial artery is essential to a clinician or surgeon. Method: 30 male cadavers were studied. The length of the upper limb is measured from the acromion process to the tip of the middle finger of the cadaver. The position of bifurcation was measured from the olecranon process of the humerus. Both measurements were carried out by tailor’s tape. Results: The mean values of the length of the upper limb and the position of the brachial artery have a significant p-value when both parameters are correlated. Conclusion: The present metrical correlative coefficient study between the length of the upper limb and the position of the brachial artery is an important tool or method for surgeons to approach the cubital fossa without injury to the brachial artery and its branches.

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Background: Postoperative complications in gastrointestinal (GI) cancer patients often go undetected due to delayed symptom reporting and inadequate follow-up, particularly in low-resource settings. Remote patient monitoring (RPM) systems have demonstrated potential in enhancing postoperative care through early detection of complications and timely clinical interventions. This study explores the implementation and evaluation of a language model-integrated RPM system tailored for postoperative GI cancer patients at Narayan Medical College and Hospital, Sasaram, Bihar, over a two-year period. Materials and Methods: A prospective observational study was conducted on 68 patients who underwent surgery for gastrointestinal malignancies for two years. Patients were enrolled pre-discharge and monitored remotely for six weeks using a custom-built RPM system incorporating a large language model (LLM) to support daily symptom tracking, patient queries, and clinical decision support. The system was co-designed with input from surgical staff and patients. Patient-reported outcomes, vital signs (captured via connected devices), and symptom narratives were processed by the LLM to generate alerts and suggestions for clinical review. User engagement, alert accuracy, patient satisfaction, and clinical outcomes were recorded. Results: Out of 68 enrolled patients, 64 (94.1%) completed the follow-up. The RPM system recorded a total of 213 symptom alerts, of which 47 (22.1%) resulted in clinical interventions. Common flagged issues included fever, surgical site discomfort, nausea, and reduced oral intake. The language model demonstrated 89.4% sensitivity in detecting actionable symptoms. Patient adherence to daily reporting was 91.2%, and 85.9% of patients reported the system as helpful or very helpful in managing postoperative recovery. The median response time by clinicians was reduced by 35% compared to routine telephonic follow-up methods. No adverse events were linked to missed alerts. Conclusion: The integration of a large language model within a remote monitoring system significantly improved postoperative symptom management in gastrointestinal cancer patients. High levels of patient engagement, alert accuracy, and clinical utility suggest that such AI-augmented systems are viable and beneficial in resource-constrained tertiary care settings. The findings support further deployment and larger-scale evaluation of LLM-driven RPM systems in surgical oncology care pathways.

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Introduction: Asymptomatic bacteriuria (ASB) is the presence of significant bacteriuria without UTI symptoms, commonly affecting school-aged girls due to anatomical and hygiene factors. This study aims to assess ASB prevalence, risk factors, and microbial profile, and evaluate the need for routine screening and management in this pediatric population. Methods: A prospective observational study was conducted at government Medical College, Bhadradri Kothagudem (Feb–May 2025) among asymptomatic girls aged 6–12 years. Clean-catch urine samples were cultured on CLED agar. Significant bacteriuria was ≥10⁵ CFU/mL. Isolates underwent biochemical identification and antibiotic susceptibility testing. Risk factors were assessed via structured questionnaires. Results: Among 92 school-aged girls, ASB was found in 13%. E. coli was the most common isolate. Nitrofurantoin showed highest sensitivity (83.3%), while Cotrimoxazole had high resistance. ASB was significantly associated with poor perineal hygiene, infrequent voiding, and family history of UTI, indicating key preventable risk factors. Conclusion: The study found a 13% ASB prevalence among schoolgirls, with poor hygiene, infrequent voiding, and family UTI history as significant risk factors. E. coli predominated among isolates. Nitrofurantoin was the most effective antibiotic. Promoting hygiene and targeted screening may help reduce ASB-related complications and limit unnecessary antibiotic use.

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Introduction: Contact dermatitis (CD) is a common occupational skin condition among healthcare workers (HCWs), primarily caused by repeated exposure to irritants like disinfectants, gloves, and soaps. This study aims to assess its prevalence, clinical patterns, and risk factors, emphasizing the importance of preventive strategies to safeguard skin health and occupational well-being. Methods: A prospective study was conducted at GSL Medical College from February to May 2025 among HCWs. Data on demographics, hygiene practices, glove use, and atopy were collected using a structured proforma. Clinical diagnosis and severity grading of CD were performed using standard criteria and HECSI. Results: Among 134 HCWs, 44% had CD, predominantly irritant type (71.2%). Most affected were females (64.2%) and nurses (36.6%). Common symptoms included hand dryness (69.5%) and itching (64.4%). Significant associations were found with female gender, prolonged glove use, frequent hand washing (HW), and atopy history, highlighting key occupational risk factors. Conclusion: CD is common among HCWs, particularly females and those with atopy, due to frequent HW and prolonged glove use. Preventive strategies, including barrier protection and moisturization, are vital. Regular monitoring and education can reduce disease burden and protect the occupational health of healthcare professionals.

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Introduction: Wound closure critically affects healing, scar quality, and patient satisfaction. Absorbable and non-absorbable sutures offer distinct advantages, yet their comparative effectiveness remains debated. This study aimed to evaluate wound healing, infection rates, scar appearance, and patient satisfaction between absorbable (Vicryl) and non-absorbable (nylon) sutures in clean surgical wounds. Methodology: This prospective randomized controlled trial was conducted from October 2024 to April 2025 in the department General Surgery at government Medical College, Mahabubabad. Patients aged 18–65 years undergoing elective clean surgeries were randomized to absorbable or non-absorbable sutures. Wound healing, infection, scar appearance, and satisfaction were systematically assessed. Results: A total of 120 patients were included, with comparable baseline characteristics between groups. No significant differences were found in healing time, wound infection rates, or scar appearance. Patient satisfaction scores were similar between absorbable and non-absorbable suture groups, with 85% and 80% reporting high satisfaction, respectively. Conclusion: Absorbable and non-absorbable sutures showed similar outcomes for wound healing, infection rates, scar appearance, and patient satisfaction in clean surgeries. Absorbable sutures offered greater patient comfort by avoiding suture removal. The choice of suture material should be individualized, focusing on surgical site needs and patient-centered care.

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Background: Gallstone disease, including cholelithiasis and chronic cholecystitis, is a global health concern with multifactorial etiologies. The role of Helicobacter pylori (H. pylori) in gallstone disease has been debated, but emerging studies suggest its presence in extra gastric sites, including the gallbladder. This study aims to evaluate the prevalence of H. pylori in gastric and gallbladder mucosa and investigate its potential association with gallstone disease. Aim: To determine the prevalence of H. pylori in the gastric and gallbladder mucosa and assess its association with gallstone disease. Methods: A prospective cohort study was conducted at PSG Hospitals, Coimbatore, India, over one year. Seventy-two patients diagnosed with symptomatic cholelithiasis or chronic cholecystitis scheduled for laparoscopic cholecystectomy were included. Biopsy samples from both gastric and gallbladder mucosa were analyzed using the Rapid Urease Test (RUT) and Giemsa staining. Statistical analysis was performed using SPSS software. Results: Among the 72 patients, 58.3% tested positive for H. pylori in gastric mucosa, and 43.1% in gallbladder mucosa via RUT. Giemsa staining confirmed H. pylori in 36.1% of gallbladder samples. Statistically significant associations were found between younger age and H. pylori positivity in both gastric and gallbladder mucosa (p = 0.049 and p = 0.041, respectively). Dual positivity for H. pylori in both gastric and gallbladder mucosa was observed in 43.1% of patients, with strong correlations to triple positivity across all testing methods (p < 0.001). Conclusion: This study supports the hypothesis that H. pylori may contribute to the pathogenesis of gallstone disease. The findings advocate for the potential clinical benefit of screening for and eradicating H. pylori in patients with gallstone disease, especially younger individuals. Further research is needed to elucidate the molecular mechanisms linking H. pylori to gallstone formation and to validate its role as a preventive target.

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Background: Sleep is a critical determinant of physical, cognitive, and emotional development in children. However, the prevalence of sleep disturbances among Indian children and their association with various socio-demographic, personal, family, and environmental factors remain underexplored. Objective: To assess the prevalence, frequency, and types of sleep disturbances and their associations with selected socio-demographic, personal, family, and environmental variables among children aged 3 to 12 years. Methods: A hospital-based cross-sectional study was conducted on 200 children attending the pediatric department of a tertiary care hospital in Noida, India. Sleep patterns were assessed using the validated Hindi version of the Sleep Disturbance Scale for Children (SDSC). Data on demographic, familial, and environmental variables were collected through caregiver interviews. Statistical analysis was performed using SPSS 22, with significance set at p<0.05. Results: Sleep disturbances were observed in 27% of children, with 23% having borderline and 4% pathological disturbances. The most prevalent types included disorders of initiating and maintaining sleep (33.3%), sleep breathing disorders (22.2%), and sleep-wake transition disorders (22.2%). Significant associations were found with urban residence (p=0.002), higher BMI (p<0.01), and nuclear family structure (p=0.001). No significant difference was found based on gender. Conclusion: Sleep disturbances are common in children, particularly those living in urban areas, with higher BMI and from nuclear families. Early identification and targeted interventions are crucial to mitigate long-term developmental impacts.

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Background: India’s Competency-Based Medical Education (CBME) framework underscores in early, supervised acquisition of clinical and procedural skills alongside AETCOM competencies. Simulation-based training offers a safe, standardized, and feedback-rich environment for such learning; however, Indian undergraduate programs that holistically integrate simulation-based training across both General Surgery and Obstetrics & Gynecology domains remain deficient. Objective: To assess the effectiveness and retention of a structured simulation-based skills training program in General Surgery and OBG for second-year MBBS students. Methods: A randomized controlled trial was conducted among 80 second-year MBBS students, randomized equally into intervention and control groups. The intervention group underwent 4 weeks of structured simulation-based training (2 weeks surgery + 2 weeks OBG) covering 16 essential skills. The control group received traditional teaching. Skills were assessed using Objective Structured Assessment of Technical Skills (OSATS) and Mini-Clinical Evaluation Exercise (Mini-CEX) at baseline, immediately after training, 3 months, and 6 months. Results: Baseline comparable. Post-training higher scores in intervention (OSATS 85.1 ± 5.4 vs 69.3 ± 6.1; Mini-CEX 8.4 ± 0.8 vs 6.2 ± 1.0; p<0.001). At 6 months, retention superior (OSATS 74.0 ± 5.8 vs 59.8 ± 6.5; Mini-CEX 7.2 ± 0.9 vs 5.4 ± 1.0; p<0.001). Repeated-measures ANOVA showed significant group×time interaction (p<0.001). Conclusion: Integrated Surgery-OBG simulation training significantly improves and sustains skills in second-year MBBS. Integration into ACMET-aligned CBME with skills labs and workplace-based assessment is recommended.

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Background: Varices (Oesophageal or gastric) being one of the dreaded complication of portal hypertension seen in most of the cirrhotic patients. Eventually most of them develop this catastrophe and upper GI endoscopy is the only novel tool available for screening as well as for therapeutics. As it is a semi invasive procedure and universally not available everywhere. Hence there is immense need of non-invasive method to predict varices. Objectives: Predicting clinically significant oesophageal varices using simple blood tests. Methods: During the cross sectional study duration, 107 patients from the hospital were considered using the inclusion and exclusion criteria. Results: Study has predominantly male population with 44 years is being the median age. Ethanol induced cirrhosis is the common etiology.60 patients had large varices which is clinically significant and they are prone for variceal bleed. Majority of the subjects with cirrhosis had platelet count <1.5 lakhs. Clinically significant varices are better predicted by AAR and FIB-4. Conclusion: AAR, FIB-4 and platelet counts were better predictor of clinically significant oesophageal varices and has modest accuracy. It identifies the group of patient needs prophylactic endoscopy and reduces the financial burden of managing oesophageal varices.

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Background: Migration is a complex process often driven by the pursuit of better livelihood, financial stability, and improved opportunities. However, its hidden cost is frequently paid through mental health challenges. Emigrant workers, especially those in labor-intensive and low-income sectors, face significant psychological stressors such as cultural displacement, job insecurity, poor living conditions, and social isolation. Language barriers, cultural differences, and acculturation pressures further complicate their mental well-being. The MIRAGE study (Mental Illness and Related Adversities in Global Emigrants) investigates the prevalence of psychiatric disorders and assesses how stress impacts the quality of life among emigrant workers. These individuals often endure internalized and unspoken struggles—what we term a “silent struggle”—exacerbated by stigma, limited awareness, and inadequate mental health support. The aim of the study is to assess psychiatric morbidity, determine the prevalence of specific psychiatric disorders, and evaluate the impact of migration-related stress on the quality of life in emigrant workers. Methodology: It is a hospital based cross sectional study conducted in Institute of mental health Kadapa, Andhra Pradesh. Sample size of the study is 60. The socio-demographic details of reverse migrants were noted down. Self-Reporting Questionnaire (SRQ) of the World Health Organization was used to determine the presence of a common mental disorder, Perceived stress scale assessment of distress. WHOQOL BREFfor quality -of -life assessment. MINI for diagnosis and Pittsburgh sleep quality indexfor sleep quality assessment. Results: A total of 60 emigrants were included in the study. The prevalence of major depressive disorder, alcohol use disorder, and generalized anxiety disorder are higher than general population. The prevalence of depressive disorder is highest with 55% that is 15 out of 60 participants. Nearly two-third (39) of study population experience moderate high perceived stress in perceived stress scale.55% of people participated in study have some level of psychological distress. In Pittsburgh sleep quality index overall quality of sleep is Poor in 22 individuals. Quality of life is impaired with psychological, physical and social domains taking major hits. Conclusion: The study concludes that prevalence of major depressive disorder, alcohol use disorder and other psychiatric illness in emigrant population is significantly higher than the general population. They experience significant distress and poor quality of sleep resulting in an impaired quality of life.

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Background: The two most frequent causes of acute pancreatitis (AP) are gallstones and alcohol misuse.  With a reported prevalence of 2-4%, hypertriglyceridemia is a rare but well-established cause of acute pancreatitis.  Objectives: The Objective of the study was to analyze demographic data (age, sex, comorbidities such as diabetes, alcohol use, etc.) of patients presenting with HTG-AP. To assess the correlation between amylase, lipase levels with various factors causing acute pancreatitis. To assess the severity of pancreatitis in various aetiologies. To evaluate recurrence rates and long-term follow-up outcomes in patients with HTG-AP. Method: This  prospective observational study was conducted at Sri Venkateshwara Medical College and Research Centre, Department of General Surgery over one year period between May 2024 to April 2025. Clinical data during hospitalization were collected including demographic and laboratory data, radiological, disease severity, organ failure and outcome. Results: Out of 112 cases, sex distribution level of acute pancreatitis was high in Males 62 and females were 50. Also, number of AP cases with hypertriglyceridemia (HTG) were higher in the males as 5 (5.6%) and females were 04 (4.5%), out of 09 (10.1%) total cases. In 18-20 years age group there was only 1 patient found AP and no any acute pancreatitis with hypertriglyceridemia. In 20–29 years age group there were 8 patients found AP and no any acute pancreatitis with hypertriglyceridemia seen. In 30–39 years age group there were 44 patients found AP and 2 patients acute pancreatitis with hypertriglyceridemia seen. Middle age male populations were more prone to develop acute pancreatitis due to hypertriglyceridemia. Regarding CT Severity Score, there was no significant difference in score with respect to aetiologies (alcohol, gall stones, hypertriglyceridemia). Conclusion: HTG-induced acute pancreatitis is a clinically significant and potentially severe form of pancreatitis.  HTGAP is the third most common cause of AP and is often associated with normal or minimally elevated serum amylase and lipase levels. Early recognition and targeted therapy, including triglyceride-lowering measures, are crucial for improving outcomes. Diet and lifestyle changes, weight reduction, strict control of diabetes along with lipid-lowering medications is critical in preventing recurrence of AP in these patients.

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Background: Chronic Otitis Media (COM) is a persistent middle ear infection that can lead to hearing loss, recurrent infections, and significant morbidity if left untreated. Surgical intervention remains the primary treatment for managing COM, with techniques including tympanoplasty, mastoidectomy, and modified radical mastoidectomy (MRM). However, the choice of surgical technique depends on disease severity, middle ear pathology, and the need for long-term hearing preservation. This study aims to compare the outcomes of different surgical techniques in terms of hearing improvement, postoperative complications, recurrence rates, and patient quality of life. Methods: A retrospective observational study was conducted at Patna Medical College & Hospital, Bihar, from February 2023 to August 2024, including 100 patients diagnosed with COM who underwent surgical treatment. Patients were categorized based on the surgical technique used: tympanoplasty (with or without mastoidectomy), MRM, and canal wall up (CWU) vs. canal wall down (CWD) mastoidectomy. Outcomes were assessed using pre- and post-operative audiometric evaluations, postoperative complication rates, and patient-reported quality-of-life measures. Statistical analysis was performed using SPSS to compare surgical outcomes across different groups. Results: Tympanoplasty without mastoidectomy showed the highest hearing improvement (16.6 dB) and lowest complication rates. MRM and CWD mastoidectomy had lower hearing improvement (11.3 dB and 9.8 dB, respectively) but were more effective in disease eradication. Complication rates, including infection, graft failure, and recurrence, were significantly higher in radical surgeries. Conclusion: Tympanoplasty is the preferred surgical approach for patients with minimal disease involvement, offering better functional outcomes. Radical procedures are necessary for extensive disease but require long-term postoperative care. The findings underscore the importance of individualized surgical decision-making based on disease severity and patient expectations.

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Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, characterized by brief episodes of dizziness triggered by head movements. It results from dislodged otoliths within the semicircular canals, leading to abnormal vestibular signaling. Various repositioning maneuvers, including the Epley, Semont, and Brandt-Daroff exercises, are used for symptom resolution, but their comparative effectiveness remains a subject of clinical interest. Objective: This study aims to analyze and compare the outcomes of different repositioning maneuvers in patients with BPPV in terms of symptom resolution, recurrence rates, and treatment efficacy. Methods: A retrospective observational study was conducted at PMCH from February 2023 to August 2024. A total of 40 patients diagnosed with BPPV based on clinical evaluation and the Dix-Hallpike test were included. Patients received Epley, Semont, or Brandt-Daroff treatment. Medical records were analysed for treatment outcomes, recurrence rates within 1–3 months, and side effects. Statistical analysis was performed using SPSS software, with a p-value <0.05 indicating significance. Results: The Epley manoeuvre demonstrated the highest success rate, with 88.9% of cases resolved and 11.1% of recurrences. The Semont manoeuvre was also effective, with a 75% resolution rate and a 25% recurrence rate. The Brandt-Daroff exercises had the lowest success rate (50%) and the highest recurrence rate (40%). None of the groups encountered significant challenges. The results of treatment varied significantly between the manoeuvres (p<0.05). Conclusion: Epley manoeuvre is the best BPPV treatment due to its efficacy and low recurrence. Semont manoeuvres are still possible, but Brandt-Daroff drills should be avoided. Additional research is recommended to confirm these findings.

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Background: Fatty liver disease, type 2 diabetes mellitus (T2DM), and dyslipidaemia often coexist and share common pathophysiological pathways, including insulin resistance and hepatic lipid accumulation. Managing these interconnected metabolic disorders poses a clinical challenge. Saroglitazar, a dual PPAR α/γ agonist, has emerged as a potential therapeutic agent due to its combined lipid-lowering and insulin-sensitizing properties. Objective: To evaluate the efficacy and safety of Saroglitazar in the management of patients with fatty liver, T2DM, and dyslipidaemia. Methodology: A prospective, interventional study was undertaken at Soban Singh Jeena Govt. Institute of Medical Sciences and Research (SSJGIMSR) from June to December 2024.  The study included 100 participants aged 30–65 with USG/Fibroscan-diagnosed fatty liver and T2DM or dyslipidemia.  Each participant got 4 mg of Saroglitazar daily for six months.  LFT, HbA1c, lipid profile, and imaging were performed at baseline and follow-up.  Adverse events were reported and renal and hepatic function testing were performed.  Statistical analysis included paired t-tests and Wilcoxon signed-rank tests, with significance set at p < 0.05. Key Results: At the end of six months, significant improvements were observed in liver enzymes (ALT: mean reduction of 22.4 U/L, AST: 18.6 U/L), USG/Fibroscan liver grading, HbA1c (reduction of 0.9%), and lipid profile parameters (LDL, triglycerides, HDL). The safety profile was acceptable, with only mild adverse events reported, and no patient required discontinuation of therapy. Conclusion: Sarolitazar improves hepatic, glycaemic, and lipid markers in metabolic dysfunction patients with promise and manageable safety.   It may help patients with diabetes, dyslipidemia, and fatty liver.

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Background: Comorbidity between psychiatric disorders and physical illnesses significantly complicates clinical outcomes, increasing the burden on both patients and healthcare systems. Identifying and understanding these comorbid conditions is essential for effective, holistic treatment planning in psychiatric care. Methods: A retrospective descriptive study was conducted at Anugrah Narayan Magadh Medical College and Hospital (ANMMCH), Gaya, Bihar, over a six-month period from January to June 2025. Medical records of 100 patients diagnosed with psychiatric disorders were reviewed. Data on demographics, psychiatric diagnoses, and physical comorbidities were collected and analyzed using descriptive statistics and correlational assessment. Results: The most common psychiatric diagnoses were major depressive disorder (34%), schizophrenia (24%), and bipolar disorder (18%). Common comorbidities included hypertension (28%), diabetes mellitus (22%), substance use disorder (18%), and thyroid dysfunction (13%). Notable associations were observed between depression and metabolic conditions, and between schizophrenia and substance abuse. Female patients showed higher rates of thyroid dysfunction, while older patients were more prone to cardiovascular and metabolic comorbidities. Conclusion: The study underscores the high prevalence of physical comorbidities in psychiatric patients and highlights the need for integrated screening as well as treatment approaches. Future research should focus on larger, multi-center longitudinal studies to develop comprehensive care models in psychiatric practice.

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Rationale: The duration between a live birth and the subsequent conception, known as interpregnancy internal (IPI) is a critical, yet modifiable, determinant of maternal and fetal health outcomes. IPIs that have been excessively short or much prolonged are known to be linked to increased risks of obstetric complications, yet limited data exists in localized settings to guide optimal birth spacing. Objectives: This study aims to observe reporting findings of correlation between IPI and fetomaternal health and to identify the interval range with comes with least complexities. Methods: Department of Obstetrics and Gynaecology, Rajkiya Mahila Chikitsalaya, J.L.N. Medical College, Ajmer undertook this prospective observational study between June 2023 and May 2024. 360 unifetal pregnant women with ≥28 gestations weeks were screened and enrolled into this study. The women were categorised into three groups based on IPI – Group 1: Short (IPI <1.5 Years), Group 2: Optimal (IPI Between 1.5 and 5 years) and Group 3: Long (IPI >5 years).  Data on demographic, clinical, maternal, and fetal outcomes were collected and analyzed using Chi-square test and odds ratios Statistical significance was set at p<0.05 Results: Group 1:  Short (IPI <1.5 years) corresponded with increased incidence of maternal anemia (66.67%), preterm labor (up to 33.33%), fetal growth restriction (FGR, up to 46.67%), and low birth weight. Long IPI (>59 months) showed increased rates of preeclampsia (39.58%), gestational diabetes (18.75%), and placental complications. The lowest complication rates were observed in the optimal IPI group (18–59 months). The association of IPI with FGR, anemia, and hypertensive disorders was statistically significant (p < 0.0001). Conclusion: Both Group 1 (Short) and Group 3 (Long) interpregnancy intervals correlated with extensive maternal and fetal complications. Optimal spacing of 24–59 months was associated with the most favorable outcomes. Counselling on birth spacing and postpartum contraception should be integral to antenatal and postnatal care strategies to improve maternal and neonatal health.

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Background: Non-alcoholic steatohepatitis (NASH) is a serious liver condition caused by fat build up that triggers inflammation and damage. Over time, this can lead to fibrosis or cirrhosis. With no approved medicines available, researchers are testing antioxidants like vitamin E and glutathione (GSH), which reduce oxidative stress in the liver. Aims and Objectives: This review summarizes evidence on vitamin E and GSH for NASH, evaluating their benefits, risks, and limitations. Methods: We reviewed studies from 2010–2024, including 22 systematic reviews/meta-analyses and 10 primary studies, reporting effects on liver enzymes, tissue changes, oxidative stress, and safety. Results: Vitamin E (400–800 IU/day) consistently lowered liver enzymes (ALT, AST), reduced liver fat and inflammation, and modestly improved fibrosis, especially in adults without diabetes. GSH (300–1200 mg/day, oral or injectable) reduced enzymes and oxidative stress markers in smaller pilot studies, suggesting promise. Some studies combining antioxidants showed better outcomes, but large trials are lacking. High-dose vitamin E may increase stroke or prostate cancer risk, while long-term GSH safety remains unclear. Conclusion: Vitamin E shows proven benefits for NASH; GSH appears promising but needs further study. Antioxidant therapies could aid NASH, but larger, long-term trials are required to confirm safety and effectiveness.

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Edible coatings are a thin layer of a physical component that can be eaten and provides an effective barrier against oxygen, external microbes, moisture and the chemical/physical changes of the foods. The current study aimed to explore the antioxidant and antimicrobial properties of edible coating fortified with ginger peel extract (GPE). A starch-based edible coating fortified with 70% ethanolic extract of ginger peel was developed. The physical properties, antioxidant and antimicrobial properties of the developed coating were evaluated. The antimicrobial testing of the GPE showed that the minimum inhibitory concentration (MIC) against E. coli and S aureus was 200mg/ml. For the preparation of edible coating, the MIC was used. The addition of GPE increased the lightness of the coating and made it more yellow. The GPE supplementation increased the opacity of the coating, lowered transparency and protects food against lipid oxidation. The water solubility was higher for the supplemented coating. Higher water solubility indicates that the coating will resist more time in moist conditions. The addition of GPE imparted antioxidant activity, and the IC50 value of the total phenolic content of the coating was 53.61 µg GAE/ mg of coating. The addition of GPE imparted antimicrobial properties. The result of the disc diffusion test showed a zone of inhibition of supplemented edible film was 1mm against E. coli and S aureus. The GPE-supplemented edible coating showed good antioxidants and moderate antimicrobial activity.

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Dyspepsia is common disorder with world-wide prevalence. It is derived from the Greek words dys and pepse literally meaning “difficult digestion” which refers to a heterogeneous group of symptoms located in upper abdomen as pain or discomfort centered in the upper abdomen and may include varying symptoms like epigastric pain, post prandial fullness, early satiety, anorexia, belching, nausea and vomiting, upper abdomen. According to the Rome criteria, FD is defined as the presence of early satiety, postprandial fullness, epigastric pain and epigastric burning sensation in absence of organic, systemic or metabolic disease in the setting of a normal upper gastrointestinal endoscopy, abdominal bloating, and even heart burn and regurgitation. Acotiamide a novel GI motility modulator was made available in Japan in June 2013. It’s main pharmaceutical effect is to increase the release of the acetylcholine ligand from cholinergic nerve terminals by inhibition of acetylcholinesterase [9] .It also antagonizes M1 and M2 muscarinic receptors that modulate Acetylcholine release. It also has gastroprokinetic activity, it has been shown to have beneficial effects mainly for improving meal related symptoms such as postprandial fullness, upper abdominal bloating or early satiation without any major side effects. Study subjects were recruited from the General Medicine OPD of College of medicine and Sagore Dutta hospital, Kamarhati. Adult subjects (18-55 years) of either sex, complaining of dyspepsia for at least 1 month and without having any abnormal pathological finding in upper GI endoscopy were included. Subjects who are taking drugs that might cause dyspepsia symptoms and those with serious concomitant disease of vital organs or alarm symptoms (as example-risk of gastroesophageal malignancy or other serious gastrointestinal disorders), were excluded. Subjects were randomized to receive either Acotiamide 300 mg or placebo drug once daily before lunch. Drugs were administered in single blind manner. Treatment was continued for a total period of 4 weeks and subjects would be assessed at the end of 2nd and 4th weeks. Target sample size was 35 patients per group, adjusting for dropouts. The primary objective of this study was to determine the efficacy of Acotiamide in relieving symptoms of dyspepsia by using Global Overall Symptom Scale and Quality of life (QOL) Questionnaire. Effectiveness of drug was assessed by Global Overall Symptom Scale. For each symptom, relief would be taken as a score or 3 or less and resolution as a score of 1 or less. Quality of life assessed by SF8 QOL questionnaire and improvement of score denotes improvement of quality of life. The secondary objective was to assess the Safety Profile of the drug when used chronically in Indian population over a 4 weeks period. Standard biochemical test parameters and treatment emergent adverse events would be recorded as safety variables. It is found in the study that the drug Acotiamide has more effectiveness over the period of 4 weeks as compared to placebo in the patients suffering from functional dyspepsia, and it has been shown in this study that Acotiamide decreased the different symptoms component of functional dyspepsia as measured by global overall scale. It has been seen that quality of life score also increased significantly post treatment compared to pretreatment in Acotiamide group. The limitations of the study was its short duration for only 4 weeks for which long-term follow-up for various adverse events cannot be done. Another limitation of the study was small number of study subjects.

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Background: Chronic inflammation is an important mechanism facilitating the onset of Type II Diabetes Mellitus (T2DM) and its complications. Serum C-reactive protein (CRP) and ferritin are acute-phase reactants that may reflect systemic inflammation. Albuminuria is a commonly accepted early marker of diabetic nephropathy. Understanding the relation of inflammatory markers with albuminuria may aid in identifying patients at greatest risk. Aim: To assess serum CRP and ferritin levels in T2DM patients and analyze their correlation with albuminuria. Methods: This hospital-based cross-sectional study comprised 125 patients with T2DM aged over 35 years from a tertiary care hospital in India. Serum CRP and ferritin levels and spot urine albumin-to-creatinine ratio (ACR) were measured. Based on albumin-to-creatinine ratio levels, “patients were divided into three groups: normoalbuminuria (<30 mg/g), microalbuminuria (30-300 mg/g), and macroalbuminuria (>300 mg/g)”. Pearson’s correlation and ANOVA were used to evaluate the correlations among CRP, ferritin, and ACR. Results: Among the 125 patients, 45.6% had microalbuminuria, and 30.4% had macroalbuminuria. Mean serum CRP and ferritin were 27.09 ± 51.39 mg/L and 276.21 ± 179.81 ng/mL, respectively. “Serum ferritin showed a statistically significant positive correlation with urine ACR (r = 0.250, p = 0.005), whereas CRP did not show a significant association with ACR (r = -0.079, p = 0.383). HbA1c also correlated positively with albuminuria (r = 0.271, p = 0.002)”. Conclusion:  Serum ferritin and HbA1c levels share a parallel relationship, with albuminuria occurring in type II diabetes mellitus (T2DM). This may suggest that bad glycemic control, subclinical inflammation, and early kidney damage all intertwine in their run. It has been shown that ferritin may be a better biomarker than CRP when it comes to assessing the risk of diabetic nephropathy.

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Objectives: The study aims to evaluate vitamin D levels in individuals with type 2 diabetes mellitus (T2DM) and healthy non-diabetic controls, and to determine its impact on glycemic management in those with T2DM, a prevalent global issue linked to bone disorders, cancers, infectious illnesses, and autoimmune diseases. Methods: A Total of 252 participants were taken, out of which 126 were known case of diabetes and 126 were taken as controls which were non diabetic. Results: The mean age in case group was 53.48 years (SD= 9.14) and in control group was 51.79 years (SD=11.22). The case group 83 females (65.9%) and 43 males (34.1%), while the control group had 85 females (67.5%) and 41 males (32.5%). The case group had a mean vitamin D level of 12.79 ng/mL (SD=8.11), while the control group had a mean of 18.05 ng/mL (SD=12.50). In the case group, 88.9% (112) were vitamin D deficient, 8.7% (11) had insufficient levels, and only 2.4% (3) had normal vitamin D levels which was significantly different between both groups (p = 0.0001). A negative correlation was observed between vitamin D and glycemic parameters [HbA1c, FBS, PPBS] which was not significant. However, a moderate negative correlation was observed (Pearson correlation = -0.277), between vitamin D and duration of diabetes which was statistically significant (p = 0.002). Conclusion: The study found a higher prevalence of vitamin D deficiency in type 2 diabetics, with a significant inverse relationship between vitamin D levels and diabetes duration, suggesting longer diabetes durations lead to lower levels.

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Background: The present study was undertaken to differentiate HCC from metastatic adenocarcinoma by conventional cytology, and cell block preparation and to evaluate whether there is any diagnostic advantages of cell block over conventional image guided FNAC. The present study was aimed to compare the efficacy of cell block with FNAC smears in liver neoplasms. Materials and Methods: Following parameters was studied during imaging like size of the mass and number of mass (es) in liver; echotexture, vascularity, margin of the mass; site of origin of mass outside liver (if possible) and whether any lymphadenopathy is associated with the mass. Following parameters was studied during cytology, cell block and IHC like cytomorphology of the different cell population on smears stained with routine Leishman-Giemsa (LG) and H&E stains; architecture and morphology of cells in cell block preparation and dentification and differentiation of HCC and metastatic adenocarcinomas. Results: In case of HCC, majority of patients were sixth decade of age with male female ratio 2.33:1. In case of metastatic carcinoma, age ranged from 30-79 with male female ratio 1.28:1. The majority of patients were in fifth decade of age. Although serum α feto protein is widely used as biochemical marker of HCC but it is not specific for HCC. It may be evaluated in many tumors other than HCC. Its normal level also does not exclude the chance the HCC. In our study, serum α feto protein level was elevated in 85% HCC (25% mild, 45% moderate, 15% marked) & 21.88 % (15,63% mild, 6.25% moderate) metastatic carcinoma. There was no elevation in 15%% HCC. Cell block having high sensitivity (90%) and specificity (93.75%) can be able to provide more information than conventional smear (sensitivity 88.89% and specificity 91.18%). Conclusion: Cell block having high sensitivity (90%) and specificity (93.75%) can be able to provide more information than conventional smear (sensitivity 88.89% and specificity 91.18%).

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Background: Accurate post-AMI risk stratification is essential for preventing adverse cardiovascular events. Although LVEF is widely used, WMSI may provide additional prognostic value by detecting regional dysfunction. Aim: To assess and compare the predictive value of WMSI and LVEF in AMI patients for all-cause mortality and rehospitalisation due to heart failure. Material and Methods: Seventy AMI patients underwent echocardiographic evaluation of LVEF and WMSI during the index admission and were followed for six months. Outcomes of mortality and heart failure rehospitalisation were recorded and analyzed using regression and ROC curve analysis. Results: Both higher WMSI and lower LVEF were associated with adverse outcomes. WMSI demonstrated incremental predictive power over LVEF, particularly in patients with preserved or mildly reduced LVEF. Conclusion: WMSI is a complementary prognostic tool alongside LVEF for post-AMI risk stratification. Incorporating both indices enhances prediction of mortality and rehospitalisation, supporting their combined use in clinical practice.

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Background: Alterations in trace elements such as zinc and copper have been implicated in the development and progression of cardiovascular disease. Their imbalance, particularly the zinc-to-copper ratio, may influence oxidative stress, inflammation, and endothelial dysfunction. Aim: To analyze zinc and copper levels in chronic and acute myocardial infarction patients, compare them with controls, and determine their association with diabetes and hypertension. Material and Methods: Ninety patients with myocardial infarction and controls were evaluated. Serum zinc and copper levels were measured using atomic absorption spectrophotometry. Patients were stratified by disease status, sex, and comorbidities. Statistical analysis included group comparisons and correlation tests. Results: Acute myocardial infarction patients had significantly lower zinc and higher copper levels compared to chronic patients and controls. Chronic cases showed partial normalization of levels. Diabetes and hypertension influenced trace element distribution, with diabetics demonstrating higher copper levels. The zinc-to-copper ratio was lowest in acute cases, correlating with unfavorable outcomes. Conclusion: Zinc and copper imbalance plays a critical role in myocardial infarction, with lower zinc and higher copper levels contributing to disease severity. Monitoring and correcting these trace elements may improve cardiovascular outcomes.

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Background: The coexistence of Hashimoto’s thyroiditis (HT) poses significant diagnostic challenges in differentiating benign from malignant thyroid lesions using immunohistochemistry. CK-19 and p63 are commonly applied markers, but their reliability diminishes in the presence of autoimmune thyroiditis. Aim: To determine the impact of HT on the diagnostic utility of CK-19 and p63 markers in predicting follicular-derived thyroid cancer. Material and Methods: A cross-sectional analysis was performed on 44 thyroid specimens. CK-19 and p63 immunoexpression were evaluated, and antibody profiles were compared between patients with and without HT. Results: CK-19 positivity was observed in both cancer and non-cancer groups without significant difference. P63 showed limited discriminatory power. Antibody levels, including anti-thyroglobulin and anti-thyroperoxidase, were significantly elevated in HT patients, influencing marker interpretation. Conclusion: HT alters the diagnostic performance of CK-19 and p63, reducing their specificity in thyroid cancer detection. A multimodal approach integrating IHC, molecular assays, and serological markers is essential to improve diagnostic accuracy.

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Background: Exercise induces several biochemical and electrophysiological changes that reflect the cardiovascular and muscular adjustments of the body. Monitoring these shifts helps assess physiological adaptation and cardiac safety. Material and Methods: A study on 60 participants compared serum sodium, potassium, calcium, and magnesium levels along with ECG parameters before and after exercise using paired analysis. Results: Statistically significant increases in all electrolytes and various ECG parameters including heart rate, P wave, QRS complex voltage, ST segment, RR interval, and QTc interval were observed post-exercise. Conclusion: Exercise elicits measurable changes in both biochemical and ECG parameters that are essential to consider in fitness assessments and cardiovascular risk evaluation.

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Background: Hypertension is a growing health concern in women, often exacerbated by a sedentary lifestyle and advancing age. Understanding the interplay between these factors is vital for preventive cardiology. Material and Methods: A total of 120 female participants were classified into sedentary and non-sedentary groups. Blood pressure was measured across three age groups, and comparative analysis was performed. Results: Sedentary participants demonstrated significantly higher systolic and diastolic blood pressure readings compared to active individuals, particularly in older age groups. Conclusion: Age-related elevation in blood pressure is significantly influenced by physical inactivity. Incorporating regular exercise may effectively mitigate this risk.

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Background: About one-third of RA patients who receive synthetic disease-modifying antirheumatic medications (sDMARDs), such as methotrexate (MTX), chloroquine (CQ), and sulfasalazine (SSZ), either as a monotherapy or combination therapy, experience adequate control of disease activity. Objectives: With a focus on identifying methotrexate resistance and its effect on disease control, the study aimed to compare the safety profile, treatment response, and clinical outcomes of methotrexate plus leflunomide combination therapy to methotrexate monotherapy in patients with RA. 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 234 participants were retrieved for the study. The study included all patients with RA identified by the 2010 ACR/EULAR diagnostic criteria, aged 18–65, receiving either methotrexate monotherapy or methotrexate + leflunomide combination therapy. Results: The study population was 47.2 ± 11.1 years old on average. Eighty-three percent of the 176 participants were female. 5.4 years was the median duration of the disorder (IQR: 3.2–7.6 years). With a mean DAS28 reduction of -2.7 ± 0.8 versus -1.9 ± 0.9 in the MTX group, patients in the MTX+LEF group demonstrated a substantially higher reduction in disease activity (p-value <0.001). 45 (36.3%) patients on MTX+LEF and 25 (22.7%) on MTX alone experienced remission (DAS28 <2.6), with a p-value of 0.01. Conclusion: Although the differences were not statistically significant, the study found that methotrexate and leflunomide combination therapy was linked to a somewhat higher frequency of adverse events than methotrexate only. Recommendations: Patients with RA who do not respond well to methotrexate alone may be candidates for combination therapy that combines leflunomide and methotrexate.

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Background: Obesity is one of the main concerns among the various patient features that have been recognized as significant risk factors for the development of OA. It has been demonstrated that the chance of developing knee OA rises by 35% for every 5 kg/m² increase in body mass. Objectives: Comparing the functional results and postoperative complications of total knee replacement in obese and non-obese patients was the study’s goal. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Data from 164 participants were retrieved for the study. Patients with end-stage knee osteoarthritis who were at least eighteen years old, had undergone total knee replacement, and had complete medical records with a minimum six-month follow-up were included in the study. Results: The mean pre-operative KSS was slightly lower in obese patients, 45.1 ± 6.3 compared to non-obese patients, 47.8 ± 5.9. Although the difference was not statistically significant at p-value of 0.09. Wound infection in obese patients was observed in 07 (7.6%) participants, compared to 2 (2.7%) participants in the non-obese group, with a p-value of 0.04. Deep vein thrombosis occurred in 1 (1.1%) obese patient and in none of the non-obese patients, with a p-value of 0.62. Conclusion: It has been concluded that TKR leads to significant improvement in functional outcomes for both obese and non-obese patients. However, obese individuals show relatively lower postoperative functional scores, higher rates of wound infection, and longer hospital stays compared to non-obese patients. Recommendations: Obese patients should be counseled preoperatively, encouraged for weight reduction, and managed with strict infection-prevention measures.

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Background: Falls are a major cause of morbidity and mortality in the elderly, often linked to functional decline, impaired balance, and psychological factors. Identifying predictors of recurrent falls is crucial for prevention. This study assessed the relationship between functional, cognitive, and affective status with fall incidence in older adults. Methods: A hospital-based cross-sectional study was carried for 1 year among 184 patients aged ≥65 years in a tertiary care hospital. Functional status (Barthel Scale), cognition (AMTS), depression (GDS), and balance/gait (Tinetti Test) were assessed using standardized tools. Data were collected through structured interviews, observation, and medical records. Statistical tests included t-test, Kolmogorov–Smirnov, χ², correlation, and logistic regression with significance at p < 0.05. Results: Fallers had significantly lower Barthel and Tinetti scores compared with non-fallers (p < 0.001), indicating reduced independence and balance as key risk factors. No significant differences were found in cognitive status or depression scores between fallers and non-fallers. However, increasing fall frequency correlated with lower Barthel scores, higher GDS scores, and poorer Tinetti performance (p < 0.05). Balance impairment and depressive symptoms emerged as strong predictors of recurrent falls. Conclusion: Functional decline, impaired balance, and depressive symptoms were significantly associated with fall risk among elderly patients, underscoring the need for comprehensive geriatric assessment in fall prevention.

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Background: Anemia is a major global public health issue, particularly affecting women of reproductive age, and is associated with adverse maternal and fetal outcomes. In India, the prevalence remains high, especially in rural and socio-economically disadvantaged groups. This study aimed to assess the prevalence of anemia and associated factors among women of reproductive age at a tertiary care hospital. Methods: A hospital-based cross-sectional study took place for 1 year among 174 women aged 15–49 years. Data were collected using a structured questionnaire, clinical examination, and hemoglobin estimation with a HemoCue analyzer. Anemia was classified based on WHO criteria. Associations between socio-demographic, reproductive, and lifestyle factors with anemia were analyzed using Chi-square test. Results: Most participants were aged 25–34 years (44.8%), rural residents (62.1%), and homemakers (56.3%). Overall, 67.8% of women were anemic, with moderate anemia being most common (33.3%). Anemia prevalence was significantly higher among younger women (p = 0.04), those with low educational attainment (p = 0.01), and those from lower socioeconomic groups (p = 0.03). Rural residence showed a higher prevalence but was not statistically significant (p = 0.07). Conclusion: Anemia remains highly prevalent among women of reproductive age, with strong associations to education and socioeconomic status, emphasizing the need for targeted interventions.

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Background: AS is the most prevalent VHD in economically developed nations, according to the Euro Heart Survey on Valvular Disease. Its prevalence is rising as the population ages, and although aortic stenosis is present in about 40% of patients over 75, only 2% of these patients develop hemodynamically significant AS. Objectives: Comparing the perioperative, intraoperative, and short-term clinical results of TAVR and SAVR among the participants with severe symptomatic AS was the goal of this study. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Data from 158 participants were retrieved for the study. The study comprised patients with severe symptomatic aortic stenosis who were 50 years of age or older, had been treated with either TAVR or SAVR during the study period, and had full clinical, surgical records. Results: The mean age of patients undergoing TAVR was significantly higher with 78.6 ± 6.4 years compared with those in the SAVR group 69.2 ± 7.8 years, with a p-value of less than 0.01. Perioperative mortality was slightly lower in the TAVR group 03 (4.1%) in comparison to the SAVR group 06 (7.1%), p-value of 0.47. Conclusion: According to the study’s findings, individuals with severe symptomatic aortic stenosis had similar short-term survival results with TAVR and SAVR. Particularly for older and high-risk patients, TAVR is a safer and less intrusive option since it has been linked to noticeably shorter procedure times, shorter ICU and hospital stays, and fewer consequences such severe bleeding, acute renal injury, and wound infections. Recommendations: Long-term follow-up studies are recommended to assess the durability of TAVR prostheses, and treatment decisions should be guided by a multidisciplinary heart team.

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Background: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that adversely affects daily life. Dietary habits, particularly the intake of high-fat and processed foods, are known to influence symptom severity. Junk food consumption, being high in fat, sugar, and additives, may play a significant role in triggering or worsening IBS symptoms. Methods: A case–control study taking place over one year was performed at the Department of Gastroenterology at a tertiary care hospital in rural India. A total of 168 participants (84 IBS patients diagnosed by Rome III criteria and 84 healthy controls) were chosen for this study. Data on sociodemographic details, lifestyle factors, and junk food consumption were gathered using a structured questionnaire. Results: IBS patients and controls were comparable in baseline demographics. Physical inactivity and poor sleep quality were significantly associated with IBS. Frequent consumption of fried snacks, fast food, and sugary beverages showed strong associations with IBS, increasing risk by more than twofold. Irregular eating patterns also significantly raised the likelihood of IBS symptoms. Conclusion: Unhealthy lifestyle habits and frequent junk food consumption are strongly linked with IBS symptoms.

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Background: Mastering direct ophthalmoscopy requires extensive practice, and its single eyepiece limits simultaneous observation, creating challenges for teaching. Smartphone ophthalmoscopes address these limitations by enabling real-time group viewing for teachers and students, facilitating peer-to-peer learning. These devices are also more cost-effective than traditional ophthalmoscopes. User acceptance is crucial for successful adoption. This study aimed to explore medical students’ perspectives on a commercially available smartphone ophthalmoscope for fundus examination and compare its usability with the traditional direct ophthalmoscope, incorporating both student and patient viewpoints. Objectives: 1. To assess the effectiveness of smartphone ophthalmoscopy as a teaching–learning method in ophthalmology. 2.To evaluate perceptions of students and faculty regarding digital teaching aids in ophthalmology. Methodology: A cross-sectional study was conducted with 25 Phase 3 MBBS students at the Ophthalmology Department of N.C. Medical College and Hospital, Israna, following Institutional Ethics Committee approval. Participants attended a 45-minute training session on smartphone ophthalmoscopy, comprising a 10-minute lecture on the working principle, a 5-minute demonstration, and a 30-minute supervised practice on standardized patients. Student and faculty perceptions were collected through structured questionnaires and analyzed. Results: Most students reported that smartphone ophthalmoscopy was easy to use, satisfying, and student-friendly, enhancing their ability to learn fundus imaging and identify disease pathologies. A majority (84%) strongly agreed that smartphone ophthalmoscopy should be incorporated into the medical curriculum. Conclusion: Replacing the direct ophthalmoscope with a smartphone-based alternative may improve the accuracy and effectiveness of fundus examinations by undergraduate students, while enhancing the teaching–learning experience in ophthalmology.

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Background: Antibiotic prophylaxis is critical in preventing surgical site infections (SSIs). However, there is ongoing debate regarding the need for multi-dose regimens over single-dose prophylaxis in clean and clean-contaminated surgeries. Objective: To compare the efficacy of single-dose versus multi-dose antibiotic prophylaxis in preventing SSIs in clean and clean-contaminated surgeries. Methods: This prospective study was conducted at a tertiary care center in Sriganganagar from January 2024 to May 2025. Patients undergoing clean or clean-contaminated surgeries were randomized into two groups: Group A received a single-dose antibiotic preoperatively, while Group B received a multi-dose regimen comprising a preoperative dose followed by postoperative doses for 48 hours. Patients were followed for 30 days to assess the incidence of SSIs. Results: Out of 400 patients (200 per group), SSI rates were 4.5% in the single-dose group vs 5.5% in the multi-dose group (p = 0.62). No significant difference was observed in SSI rates between the two groups for both clean (2.3% vs 3.1%) and clean-contaminated (6.8% vs 7.9%) procedures (p = 0.62). Hospital stay and antibiotic-related adverse events were significantly higher in the multi-dose group (p < 0.05). Conclusion: Single-dose antibiotic prophylaxis is as effective as multi-dose in preventing SSIs in clean and clean-contaminated surgeries and is associated with fewer adverse events and lower costs.

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Background: Cervical cancer is the second most common malignancy among Indian women, with persistent infection by high-risk human papillomavirus (HPV) as its principal cause. Although Pap smear screening has significantly reduced cervical cancer mortality, postmenopausal women are often under-screened due to misperceptions of low risk and obscured pathology from atrophic changes. This study aimed to evaluate the cytomorphological spectrum of cervical lesions in postmenopausal women and assess associations with demographic and clinical factors. Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Pathology at a tertiary care teaching hospital over six months. A total of 100 postmenopausal women attending the outpatient clinic were included after informed consent. Cervical scrap smears were collected, fixed, and stained by the Papanicolaou method and reported using the 2014 Bethesda System. Data were analyzed for correlations between cytological outcomes and variables including age, parity, presenting complaints, and marital history. Fisher’s exact test was applied, with p<0.05 considered significant. Results: Among 100 women, the most common age group was 41–50 years (57%). NILM was reported in 61% of smears, while 39% showed abnormalities including ASC-US (26%), LSIL (5%), HSIL (4%), ASC-H (1%), and SCC (1%). Acute cervicitis (39%) and bacterial vaginosis (17%) were frequent benign findings. Abnormal smears increased significantly with age (p=0.009) but showed no significant association with parity (p=0.241) or symptoms (p=0.404). Conclusion: Pap smear remains an essential screening tool in postmenopausal women, as a considerable proportion harbored premalignant and malignant lesions, including asymptomatic individuals. Routine cytological evaluation should be encouraged in this group for early detection and timely intervention.

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Background: The Prevalence of GDM is increasing around the world due to multiple risk factors. GDM is associated with maternal complications and fetal complications which adversely affects outcomes in both. Method: This retrospective study was carried out among 50 patients diagnosed with gestational diabetes mellitus admitted & delivered at the department of obstetrics and gynecology, Shri M.P. Shah Govt. Medical College, Jamnagar. Results: In our study, 78% of patients with gestational diabetes mellitus (GDM) underwent cesarean delivery and 22% had a normal vaginal delivery. Prevalence of Hypertension was 20% and polyhydramnios was 44% with GDM. In this study, 46% of neonates developed complications and were admitted to NICU out of which 12% had respiratory distress. Macrosomia and Hyperbilirubinemia were seen in 16% and 16% cases respectively. Conclusion: GDM is associated with higher maternal and fetal morbidity. Early detection, treatment, monitoring and intervention are essential for short and long-term maternal and fetal complications.

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Background: Cervical cancer is one of the major causes of mortality among women worldwide. So, the research aimed to study and analyse 100 Pap smear reports from women presenting with various gynecological indications and detection of precancerous lesions. Methods: Study was carried out by taking 100 Pap smears from patient attending gynaecology OPD at M.P Shah Medical College, Jamnagar, Gujarat, Between 12/03/2024 to 12/03/2025. Pap smear was taken from patients between ages 25 to 70 years presenting with different gynaecology complaints and using Ayres Spatula. Smears were reported as per the Bethesda system. Results: Most women were in the age range of 25-70 years. Vaginal discharge was the major clinical complaint, occurring in 36.96% of the women. An irregular menstrual cycle was the complaint of 12.78% and abdominal pain of 25.63% of women, while 15.15% were asymptomatic. The test was negative for malignancy in 6%, and 78% had infection or inflammation. ASCUS, LSIL, and HSIL were detected in 8 %, 6%, and 0%, respectively. Women with Pap tests positive for ASCUS, LSIL, and HSIL underwent a colposcopy and guided biopsy. Conclusions: Pap smear is an easy and economical screening method to detect premalignant and malignant lesions of the cervix which help in proper treatment. It should be established as a routine screening procedure to reduce the treatment burden, morbidity, and mortality.

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Background: Abruptio placenta is one of the common causes of antepartum haemorrhage and is defined as premature separation of normally implanted placenta. It is more common in second half of pregnancy. Abruptio placenta is serious complication of pregnancy and causes high maternal and neonatal morbidity and mortality. Methods: This retrospective study of abruptio and its maternal and perinatal outcome was carried out between October 2023 and March 2025 at Shree MP Shah Government Medical College Jamnagar Gujarat. Results: There were 12640 deliveries during the study period out of which 50 had abruptio placenta, which had incidence of 0.44%. Majority of patients were unbooked (80%). Abruption was commonest among 25-30 years of age had lower educational status, more often had 2-3 deliveries. 70% of cases were associated with severe preeclampsia. Live birth was 54% where is still birth were 46%. PPH occurred in 20% of patients and DIC accounts for 12% of complication, acute renal failure accounts for 10%, shock for 10%, 8% patients had infections and 10% with other complications and remaining 30% patients did not have much complications and were stable. Conclusions: Abruptio placenta is still a life threatening complication of pregnancy and it is associated with poor maternal and fetal outcome if not managed appropriately. Hence early diagnosis and prompt resuscitative measures would prevent both perinatal and maternal mortality and morbidity. The availability of advanced emergency obstetric care across greator number of refferal hospitals has been responsible for decreasing the mortality and morbidity associated with many obstetric conditions. As of now, early referral to tertiary care hospital, better availability of blood and blood products and early interventions have the potential to limit adverse maternal and perinatal outcome.

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Background: Type 1 tympanoplasty is a common surgical procedure to repair tympanic membrane perforations. The anterior tuck technique is a modification intended to improve graft stability, especially in anterior perforations, but its necessity remains debated. Aim: To compare anatomical and functional outcomes of graft placement with and without anterior tuck in Type 1 tympanoplasty. Materials and Methods: This prospective observational study included 60 patients undergoing Type 1 tympanoplasty at ANMMCH, Gaya, from July 2023 to June 2025. Patients were divided into two groups: graft placement with anterior tuck (Group A) and without anterior tuck (Group B). Graft uptake and hearing improvement were assessed over a month’s follow-up. Results: Graft uptake was 93.3% in Group A and 83.3% in Group B (p = 0.28). Mean air-bone gap closure was 14.8 dB in Group A versus 13.2 dB in Group B (p = 0.12). No significant difference was found in complication rates between groups. Conclusion: Both techniques provide satisfactory graft uptake and hearing improvement in Type 1 tympanoplasty. The anterior tuck technique may offer a slight advantage in graft stability, particularly for anterior perforations, but is not essential in all cases.

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Background: Hemodynamic monitoring plays a crucial role in cardiac anesthesia, where intraoperative instability significantly affects postoperative outcomes. While standard modalities such as invasive arterial pressure and central venous pressure (CVP) are widely used, advanced tools like pulmonary artery catheters (PAC) and transesophageal echocardiography (TEE) provide additional insights into cardiac performance. However, controversies remain regarding their routine use in all patients. Aim: To evaluate perioperative hemodynamic monitoring practices in cardiac anesthesia and analyze their association with intraoperative stability and postoperative outcomes. Methods: This retrospective observational study was conducted at Bhagwan Mahabir Manipal Hospitals over one year, including 90 adult patients undergoing cardiac surgery under general anesthesia. Data regarding demographic variables, intraoperative hemodynamic parameters, monitoring modalities, and postoperative outcomes were retrieved from medical records. Statistical analysis was performed using SPSS version 23.0, with results expressed as mean ± SD, percentages, and chi-square or t-tests where appropriate. Results: The mean age of patients was 56.4 ± 11.2 years, with a male predominance (64.4%). CABG was the most common procedure (57.8%). All patients underwent invasive arterial monitoring, while CVP was used in 90%, PAC in 24.4%, and TEE in 53.3%. Intraoperative hypotension occurred in 28.9%, tachycardia in 20%, and vasoactive support was required in 37.8%. Postoperatively, 26.7% developed complications, with arrhythmias being the most frequent (13.3%), followed by low cardiac output syndrome (6.7%) and acute kidney injury (4.4%). Mean ICU stay was 3.8 ± 1.6 days, mean hospital stay was 9.2 ± 3.4 days, and mortality occurred in 3.3%. Patients with intraoperative hemodynamic instability had significantly higher complication rates (p=0.021). Conclusion: Hemodynamic instability is common during cardiac anesthesia and strongly correlates with adverse outcomes. While standard monitoring remains indispensable, advanced modalities such as TEE and PAC provide added value in high-risk cases, facilitating timely interventions and improved recovery. Recommendations: Individualized perioperative monitoring strategies should be adopted, with advanced techniques selectively applied in high-risk and complex surgeries. Future prospective studies are recommended to validate monitoring algorithms and optimize patient outcomes.

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Background: Sedation in (ICU) is a cornerstone in managing critically ill patients, particularly those requiring mechanical ventilation. Propofol and midazolam are two commonly used sedatives, each with distinct pharmacological properties and clinical profiles. While propofol offers rapid onset, shorter half-life, and faster recovery, midazolam provides more stable hemodynamics but is correlated with prolonged sedation. Comparative evidence remains essential to guide sedative choice and optimize ICU outcomes. Aim: To compare the efficacy, safety, and clinical outcomes of propofol and midazolam infusions in the sedation of critically ill ICU patients. Methods: A retrospective, comparative observational study was conducted at Bhagwan Mahabir Manipal Hospitals and Sadar Hospital Khunti, Ranchi, over a one-year period. Eighty adult ICU patients requiring continuous sedation for more than 24 hours were included, with 40 patients in the propofol group and 40 in the midazolam group. Data on demographics, sedation efficacy, recovery profiles, adverse events, and ICU outcomes were analyzed using SPSS version 23.0. Statistical significance was set at p<0.05. Results: Both groups were comparable in baseline characteristics. Propofol achieved target sedation faster (12.4 vs. 23.6 min, p<0.001) and allowed quicker awakening post-infusion (1.8 vs. 9.6 hrs, p<0.001). Midazolam had higher oversedation episodes (17.5% vs. 5%, p=0.04). Propofol was correlated with more hypotension (22.5% vs. 7.5%, p=0.04), while other adverse events were similar. Propofol patients had significantly shorter mechanical ventilation duration (62.3 vs. 89.6 hrs, p<0.001), faster extubation (4.1 vs. 13.5 hrs, p<0.001), and reduced ICU stay (7.6 vs. 10.2 days, p=0.002). Mortality rates were not significantly different (15% vs. 17.5%, p=0.76). Conclusion: Propofol provides faster sedation, quicker recovery, and improved short-term ICU outcomes compared to midazolam, though it carries a higher risk of hypotension. Midazolam may be preferable in patients with cardiovascular instability. Sedative choice should be individualized based on patient condition and therapeutic goals. Recommendations: Future large-scale, multicenter randomized trials are warranted to validate these findings and refine sedation protocols. Hemodynamic monitoring should be prioritized when using propofol, while midazolam may be considered in patients requiring hemodynamic stability or prolonged sedation.

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Background: Caesarean section (CS) is one of the most frequently performed obstetric procedures worldwide. Perioperative blood loss can sometimes necessitate blood transfusion, which increases maternal morbidity, hospital stay, and healthcare costs. Understanding the prevalence and risk factors for transfusion is vital to strengthen obstetric care. Aim: To determine the prevalence of blood transfusion among women undergoing caesarean sections and to identify common indications and associated maternal risk factors. Methods: A prospective, cross-sectional study was conducted over one year at Sadar Hospital, Khunti (Ranchi) and Bhagwan Mahabir Manipal Hospital. A total of 70 women undergoing caesarean section were included. Data regarding maternal age, parity, indication for CS, estimated blood loss, preoperative hemoglobin level, and transfusion requirement were collected. Transfusion prevalence was calculated, and associations with clinical variables were analyzed. Results: Out of 70 CS cases, 18 women (25.7%) required blood transfusion. The most common indications for CS in the transfused group were placenta previa (22%), abruptio placentae (17%), and obstructed labor (17%). Preoperative anemia (Hb <10 g/dL) was significantly associated with transfusion (p=0.01). The mean estimated blood loss was higher in the transfusion group (850 ± 220 mL) compared to the non-transfusion group (560 ± 140 mL, p<0.001). Multiparous women had a slightly higher transfusion rate (28%) than primiparous women (23%), though not statistically significant. Conclusion: Approximately one-fourth of women undergoing caesarean delivery required blood transfusion, with preoperative anemia and obstetric complications being key contributors. These findings highlight the importance of antenatal anemia correction, improved surgical preparedness, and strict blood loss monitoring to reduce transfusion rates and maternal morbidity.

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Adoption of healthy lifestyle by using Sudarshan kriya yoga and Physical exercise interventions in the early course of development of hypertension i.e. in pre-hypertension stage is useful to prevent emergence of hypertensive cases and improvement of their Lipid Profile and Stress level.  A randomized controlled trial was performed to assess the effect of Sudarshan Kriya Yoga (SKY) and Physical Exercise (PE) on Lipid Profile and Perceived Stress in pre-hypertensive subjects. In this study 100 prehypertensive subjects of either gender, age group (30-60 years) were divided into SKY and PE groups having 50 subjects in each group. They were undergone regular practices of SKY and PE respectively, one hour daily for the duration of three months. Statistically significant decrease was noted in TC, TG, LDL and VLDL level (p<0.001) while statistically significant increase in HDL level (p<0.001) was noted after three months of regular SKY practices. Physical exercise performed was brisk walking which after three months also showed statistically significant decrease in TC, TG, LDL and VLDL level (p<0.001) while statistically significant increase in HDL level (p<0.001) was noted. SKY and PE interventions have resulted in statistically significant decrease in Perceived stress also (p<0.001). This is indicative of autonomic nervous system balance with increased parasympathetic activity while decreased sympathetic activity along with improvement of many systemic functions so they can be applied as a mass approach for prevention & control of hypertension as well as improvement of stress and lipid profile.

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Background: Retained lens fragments in the anterior chamber are an uncommon but significant complication following phacoemulsification, often resulting in inflammation, corneal edema, and raised intraocular pressure if not managed promptly. The impact on visual outcomes highlights the importance of early recognition and appropriate intervention. Aim: To assess the clinical characteristics, treatment approaches, and results of individuals who have anterior chamber residual lens fragments following phacoemulsification. Methods: Over the course of a year, a prospective observational study was carried out at the Anugraha Narayan Magadh Medical College and Hospital’s Department of Ophthalmology in Gaya. 110 individuals with fragments of their retained lenses were included in the study. Demographic information, clinical characteristics, management style, and postoperative results were gathered. Follow-up was done for three months after patients were treated conservatively or surgically. SPSS version 23.0 was used for the statistical analysis, and p < 0.05 was chosen as the significance level. Results: Blurred vision was the most common presenting complaint (81.8%), followed by ocular discomfort (65.4%) and redness (36.3%). Raised intraocular pressure was documented in 26.4% of cases. Management included conservative treatment in 34.5% and surgical removal in 65.5%. At 3-month follow-up, 70.9% achieved BCVA ≥6/12, while 29.1% had BCVA <6/12. Surgical removal yielded significantly better visual outcomes compared to conservative management (p = 0.021). Persistently raised intraocular pressure was associated with poorer visual prognosis (p = 0.014). Conclusion: Retained lens fragments in the anterior chamber after phacoemulsification can significantly impair vision if not identified and treated promptly. Surgical intervention provides superior outcomes compared to conservative management, particularly in cases with nuclear fragments or uncontrolled intraocular pressure. Recommendations: It is important to prioritize routine postoperative evaluation with slit-lamp examination in order to guarantee early identification of residual fragments. Surgery should be performed as soon as possible on patients who exhibit severe symptoms or problems in order to maximize visual recovery. To create consistent management guidelines, further extensive multicenter investigations are advised.

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Background: Glaucoma and cataract are common age-related ocular diseases that frequently coexist. While medical therapy remains the mainstay of glaucoma management, the long-term use of topical antiglaucoma medications may pose significant hazards, including ocular surface damage, cataract progression, and systemic side effects. Understanding these risks is essential for optimizing patient care. Aim: To evaluate the ocular and systemic hazards of medical glaucoma therapy in patients with coexisting cataract. Methods: A prospective observational study was conducted at the Department of Ophthalmology, Anugraha Narayan Magadh Medical College and Hospital, Gaya, over a period of 12 months. A total of 107 patients with cataract receiving medical therapy for glaucoma were enrolled. Detailed ocular examinations, including best corrected visual acuity, intraocular pressure measurement, slit-lamp biomicroscopy, and lens opacity grading (LOCS III), were performed at baseline and follow-up visits. Adverse ocular and systemic effects of glaucoma medications were recorded. Statistical analysis was carried out using SPSS version 23.0, with p<0.05 considered significant. Results: The mean age of patients was 62.8 ± 8.4 years, with a male-to-female ratio of 1.3:1. Primary open-angle glaucoma was the most common type (66.4%), and prostaglandin analogues were the most prescribed drugs (40.2%). Cataract progression was observed in 61 patients (57.0%), with posterior subcapsular cataract showing significant association with prostaglandin analogue use (p=0.021). Ocular adverse effects were noted in 46 patients (43.0%), predominantly conjunctival hyperemia (21.5%) and ocular surface dryness (15.9%). Systemic side effects occurred in 11 patients (10.3%), mainly in those on beta-blockers, including bradycardia and respiratory symptoms. Conclusion: Medical therapy for glaucoma, while effective in lowering intraocular pressure, is associated with significant ocular and systemic hazards in cataract patients. Prostaglandin analogues were significantly linked to posterior subcapsular cataract progression, while beta-blockers contributed to systemic complications. Recommendations: Regular monitoring for ocular and systemic side effects, cautious selection of drug regimens, use of preservative-free formulations when possible, and individualized therapy based on patient comorbidities are recommended. Further long-term studies are warranted to assess the cumulative effects of glaucoma therapy on cataract progression and surgical outcomes.

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Background: (CSCR) is a retinal condition that can cause blindness and is characterized by damage to photoreceptors and chronic subretinal fluid. Acute CSCR may go away on its own, but persistent cases frequently need help. Eplerenone and other mineralocorticoid receptor antagonists have been studied as possible therapies, while the available data is still inconclusive. Aim: To assess how well oral eplerenone therapy works and how safe it is for enhancing anatomical and visual results in patients with chronic CSCR. Methods: Over the course of 11 months, this randomized controlled experiment was carried out at the Anugraha Narayan Magadh Medical College and Hospital’s Department of Ophthalmology in Gaya. One hundred patients with chronic CSCR were recruited and randomly assigned to one of two groups: Group B received supportive care and monitoring, whereas Group A was given oral eplerenone 50 mg once daily for three months. At one, three, and six months, baseline and follow-up assessments included fundus examination, OCT, and BCVA. SPSS version 23.0 was used for the statistical analysis, and a p-value of less than 0.05 was deemed significant. Results: Clinical and baseline demographic traits were similar among the groups. In comparison to Group B (0.62 ± 0.18 to 0.54 ± 0.16 logMAR, p < 0.001), Group A’s mean BCVA improved significantly after 3 months (0.64 ± 0.15 to 0.32 ± 0.12 logMAR). Comparing Group A to Group B, OCT results revealed a larger decrease in central retinal thickness (395 ± 48 µm to 265 ± 34 µm, p < 0.001). 72% of Group A showed complete subretinal fluid clearance, compared to 34% of Group B. Mild side effects such as dizziness (6%) and hyperkalemia (4%) were reported in the eplerenone group but were manageable. No serious adverse events occurred. Conclusion: In chronic CSCR, eplerenone therapy significantly improved anatomical and functional outcomes as compared to observation alone. The drug was well tolerated with minimal adverse effects, supporting its role as a safe and effective therapeutic option. Recommendations: To validate these results, improve dosage regimens, and pinpoint patient subgroups most likely to benefit from eplerenone medication, more multicenter, long-term research is necessary.

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Background: A multifactorial disorder that causes significant morbidity, dry eye disease (DED) is characterized by decreased quality of life, tear film instability, and ocular pain. Despite variations in retention and complication rates among plug types, punctal occlusion with silicone lacrimal plugs is a proven treatment to improve tear retention. Aim: To evaluate the complications and retention rates of two distinct silicone lacrimal punctal plug types in the treatment of individuals with moderate to severe dry eye illness. Methods: Over the course of 13 months, a prospective comparative clinical study was carried out at the Anugraha Narayan Magadh Medical College and Hospital’s Department of Ophthalmology in Gaya. One kind of silicone punctal plug was given to each of the two groups of 60 patients with moderate to severe DED who were randomly assigned to each group. At 1, 3, 6, and 12 months, the patients were monitored. We gathered information on retention, issues, and progress in OSDI, TBUT, and Schirmer’s test scores. SPSS version 23.0 was used for the statistical analysis, and a p-value of less than 0.05 was deemed significant. Results: The groups’ baseline characteristics were similar. Group A had considerably greater retention rates (83.3%) at 12 months than Group B (70.0%) (p=0.048). Plug extrusion was the most common complication, occurring in 16.7% of Group A compared to 30.0% of Group B (p=0.04). At 12 months, there was no statistically significant difference between the two groups in terms of clinical improvement, but both groups showed significant improvements in OSDI scores, Schirmer’s test values, and TBUT when compared to baseline. Conclusion: Both silicone punctal plug types were effective in improving symptoms and clinical parameters of DED. However, Group A plugs exhibited superior retention and fewer complications, making them a more reliable option for long-term management. Recommendations: Further large-scale, multi-center randomized studies are recommended to validate these findings and to assess cost-effectiveness, patient comfort, and long-term safety across diverse populations. Individualized plug selection based on anatomical and disease characteristics should be considered to optimize outcomes.

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Background: Turnaround time (TAT) is a widely recognized indicator of laboratory efficiency and quality. In tertiary care hospitals, timely reporting of laboratory results is critical for effective patient management, especially in emergency and critical care settings. Delays in TAT can compromise patient outcomes, prolong hospital stay, and reduce clinician satisfaction. Aim: To evaluate the turnaround time in the clinical biochemistry laboratory of a tertiary care hospital and to identify the major factors contributing to delays. Methods: This observational cross-sectional study was conducted in the Department of Biochemistry, IGIMS, Patna, from April 2020 to June 2020. A total of 260 blood samples from OPD and IPD patients were included. Samples with abnormal results, rare tests, and those requiring pathologist review were excluded. TAT was defined as the time from sample receipt in the laboratory to release of the report. Data were analyzed using SPSS version 23.0, and descriptive as well as inferential statistics were applied. Results: Out of 260 samples, 155 (59.6%) were processed within the acceptable TAT, while 105 (40.4%) were delayed. Among delayed samples, 57.1% had TAT between 60–90 minutes, 26.7% between 90–120 minutes, 10.5% between 120–180 minutes, and 5.7% exceeded 180 minutes. Inpatient (IPD) samples showed a significantly higher delay rate (46.7%) compared to outpatient (OPD) samples (35.7%) (p < 0.05). The main reasons identified for delays were time consumption at the sample collection counter (25%), barcode and labeling issues (20%), segregation and transfer delays (18%), instrument malfunction (22%), and staff shortage during morning hours (15%). Conclusion: A considerable proportion of laboratory samples experienced delayed turnaround time, with inpatients being more affected than outpatients. Both technical and operational factors contributed to the delays. Improving workflow efficiency, addressing staff shortages, and ensuring preventive maintenance of analyzers are essential for optimizing TAT. Recommendations: Implementation of real-time monitoring systems, strengthening of pre-analytical processes (especially barcode and sample handling), preventive maintenance schedules, and adequate manpower allocation during peak hours are recommended. Incorporating Lean Six Sigma methodologies may further streamline workflows and sustain long-term improvements.

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Background: Mask use among the elderly who have heightened vulnerability to infections due to age-related comorbidities and immune decline was both a protective necessity and a behavioural adaptation during the COVID pandemic. Mask-wearing remains a vital component of standard airborne infection control measures today in both healthcare and community settings even in the post pandemic phase. Gaining insight into the factors that influence mask use in this age group can guide tailored health education to promote sustained preventive habits for safeguarding the elderly. Objectives: This study aims to explore the current perceptions, attitudes and practices related to mask use among the elderly, highlighting barriers and facilitators that influence behaviour. Methods: This was a cross-sectional study done among 366 persons aged 60 years and above attending a primary health care setting in Ambalappuzha South panchayat in the district of Alappuzha during January to June 2021. Information about the perceptions, knowledge and practice of face mask use was collected from the study participants attending the outpatient clinics and vaccination clinics in the health centre using a self-prepared semi structured questionnaire. Data was entered in Microsoft Excel and analysed using SPSS version 27. Continuous variables were summarized as mean (SD), and categorical variables as proportions. Associations were tested with chi-square test and a p value of less than 0.05 was considered as statistically significant. Results: The mean age (SD) of the study population was 67.28 (5.96) years with the age ranging from 60 years to 87 years. Majority of the study population 250 (68.3%) belonged to the 60 to 69 year age group and around 250 (68.3%) of the elderly had comorbidities. The knowledge regarding the use of mask and the disease COVID-19 was good among the study participants and almost over 90% of them had knowledge about COVID-19, about the airborne mode of spread of the disease and about the proper use of the mask but only 51.6% were aware that triple layer mask cannot be reused. The questions on perceptions and attitude towards the use of mask showed that majority believed that mask alone cannot offer complete protection against COVID-19 and that wearing mask and practising social distancing is essential for protection. The practices followed was assessed which showed that good proportion of them were following proper mask use practices. Younger elderly (<65 years) showed better knowledge regarding hand hygiene and proper disposal of mask, practice of hand hygiene and mask replacement after six hours compared to older participants which was found to be statistically significant. Conclusion: Elderly individuals in the study demonstrated high knowledge, positive perceptions, and generally good practices regarding mask use. Age stratified analysis showed that younger elderly (<65 years) showed better adherence to hand hygiene, mask replacement, and knowledge regarding hand hygiene and proper disposal compared to older participants. These findings highlight the need for targeted interventions to reinforce optimal mask handling and disposal practices among older adults, ensuring effective protection against other airborne infections.

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Background: Scalp-Ear-Nipple (SEN) syndrome represents a rare autosomal dominant ectodermal dysplasia characterized by aplasia cutis congenita of the scalp, breast malformations, and ear anomalies. Case Presentation: We present a 15-year-old female with classical features of SEN syndrome including athelia, aplasia cutis of the scalp, ear dysplasia, and neurological complications. The patient demonstrated delayed pubertal development, epilepsy, and multiple dysmorphic features. Genetic analysis confirmed a pathogenic mutation in the KCTD1 gene. Conclusion: Early recognition of SEN syndrome facilitates appropriate multidisciplinary management and genetic counseling. This case highlights the variable expressivity of the condition and emphasizes the importance of comprehensive clinical evaluation.

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Background: Glaucoma is a chronic optic neuropathy and a leading cause of irreversible blindness worldwide. Reduction of intraocular pressure (IOP) remains the cornerstone of treatment. Glaucoma filtering surgery effectively lowers IOP, but its impact on retinal nerve fiber layer (RNFL) thickness, as assessed by optical coherence tomography (OCT), remains a subject of ongoing investigation. Aim: To use OCT to compare the RNFL thickness changes before and after glaucoma filtering surgery, and to analyze the relationship between these structural results and the decrease in IOP. Methods: Over the course of two years (March 2023–February 2025), this retrospective clinical investigation was carried out at the Upgraded Department of Ophthalmology, Darbhanga. 50 patients with full pre- and after OCT scans who had glaucoma filtering surgery were included. All quadrants’ RNFL thickness, pre- and postoperative IOP, and demographic information were noted. SPSS version 23.0 was used for statistical analysis, and paired t-tests were used for comparison. P-values less than 0.05 were deemed statistically significant. Results: The mean age of patients was 54.6 ± 10.8 years; 28 (56%) were males and 22 (44%) were females. Mean preoperative IOP was 26.2 ± 4.5 mmHg, which significantly reduced to 14.8 ± 3.1 mmHg postoperatively (p < 0.001). Global RNFL thickness improved from 82.4 ± 7.2 μm to 89.6 ± 6.8 μm (p < 0.001). The superior and inferior quadrants demonstrated the greatest improvement, while the nasal and temporal quadrants also showed statistically significant changes. Overall, 88% of patients exhibited measurable RNFL improvement following surgery. Conclusion: Glaucoma filtering surgery significantly reduces IOP and leads to measurable improvements in RNFL thickness across all quadrants, suggesting a protective effect on optic nerve structure in addition to functional pressure control. Recommendations: OCT should be routinely employed in the postoperative follow-up of glaucoma patients to monitor structural recovery and surgical outcomes. To confirm these results and investigate long-term structural alterations, more prospective studies with bigger sample sizes and longer follow-up are advised.

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Introduction: Breakthrough seizures (BTS) occur despite antiepileptic therapy, often due to poor compliance or triggers like fever or sleep loss. Affecting 30–40% of treated children, BTS impact quality of life. This study assesses the incidence, clinical profile, and risk factors of BTS in Indian children aged 1–18 years. Methods: This prospective observational study was conducted at Masonic Medical Centre for Children, Coimbatore (2018–2020), including 80 children aged 1–18 years with breakthrough seizures on AED therapy. Data on demographics, risk factors, clinical features, and investigations were collected. Ethical approval and informed consent were obtained before enrolment. Results: Among 80 children with BTS, generalized seizures predominated. Significant associations were found between seizure frequency and age group, polytherapy, non-compliance, and fever. EEG findings and factors like video games, sleep deprivation, exertion, or stress showed no significant correlation. Fever emerged as the only notable trigger for increased seizure recurrence. Conclusion: BTS frequency in children was significantly influenced by age, polytherapy, non-compliance, and fever. Generalized seizures predominated, while EEG findings and lifestyle factors showed no strong associations. Improved compliance, cautious use of multiple drugs, and prompt fever management are vital strategies to minimize BTS and enhance pediatric epilepsy outcomes.

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Introduction: Recurrent anterior shoulder instability is a common orthopedic challenge, particularly in young, active individuals, and is frequently associated with glenoid bone loss. The Latarjet procedure has emerged as an effective surgical option for managing such cases, especially when bone defects exceed 15%. Despite substantial global evidence, there is limited research on outcomes among Indian patients. Methods: This prospective study enrolled 16 patients with recurrent anterior shoulder instability and glenoid bone loss >15%, treated with the open Latarjet procedure at Jhalawar Medical College, India, between January 2023 and April 2025. Clinical, radiological, and functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) and UCLA scores at 12 and 24 weeks postoperatively. Results: The mean age was 27.8 years; 81.25% were male. Most injuries were sports-related (37.5%) or due to falls/occupational trauma (31.25% each). Preoperative dislocation frequency ranged from 1 to >10 episodes. At 24 weeks, UCLA scores showed 3 patients (18.75%) with excellent outcomes, 8 (50%) good, 4 (25%) fair, and 1 (6.25%) poor. ASES scores demonstrated progressive improvement, with most patients transitioning from fair to good categories. Range of motion recovery was satisfactory; mild restriction in external rotation persisted in some, consistent with global literature. Complications were minimal, with 11 patients reporting none. Conclusion: The open Latarjet technique is a reliable and effective option for recurrent anterior shoulder instability with substantial glenoid bone loss in Indian patients. It provides favourable functional outcomes, early return to activity, low recurrence, and an acceptable complication profile. Meticulous surgical technique and structured rehabilitation are essential for optimal results. Larger, longer-term studies are warranted for further validation.

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Background: The purpose of this study was to compare the clinical results and functional outcomes of two groups of patients: those treated with MIPO and the other treated with ORIF. Methods: This is a hospital based prospective longitudinal study. Patients with 20- 70 years of age having closed fractures of humerus attending Department of orthopaedics as OPD/IPD patients’ basis were included in study group after taking informed written consent. Patient’s functional results were evaluated. After that data were collected and result was analysed. Results: In present study, significantly lower mean operative time 105.4±7.76 min in the MIPO group as compared to 123.8±7.27 min in the conventional group (P <0.001). Mean UCLA score at 6 weeks in MIPO group was 17.17 ± 2.72 and in conventional group was 15.5 ± 2.78, At 12 weeks in MIPO group was 23.27 ± 3.12and in conventional group was 21.4 ± 3.56. At 6 months in MIPO group was 31.03 ± 2.72 and in conventional group was 29.63 ± 2.59. Mean Myao elbow score at 6 weeks in MIPO group was 77.33 ± 6.79 and in conventional group was 71.33 ± 5.07. At 12 weeks in MIPO group was 85.33 ± 7.18 and in conventional group was 80.33 ± 5.86. At 6 months in MIPO group was 94.5 ± 7.11and in conventional group was 87.5 ± 5.69. 5 patients in the conventional group and 2 patients in MIPO group developed an infection. four patients in conventional and two patients in the MIPO group showed screw loosening. In one patient of each group, malunion was present. 4 patients in conventional group and 1 patient in MIPO group non-union was present. 4 patients in conventional group and 2 patients in MIPO group radial nerve palsy was present. Mean time of union was significantly lower in conventional group (16.12±0.82 mint.) as compared to MIPO group (16.66±1.17 mint). Conclusion: Minimally invasive plate osteosynthesis may achieve comparable results with the open plate osteosynthesis method in simple as well as complex fractures of humeral shaft. Although MIPO potentially has the radiation hazard, it may reduce the perioperative complications with a shortened operation time.

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Background: Purpose of this study to compare these two treatment methods and assess the ability of each technique to obtain and maintain fracture reduction in proximal tibia extraarticular fractures. Methods: The study was prospective, time bound, hospital based randomized comparative study. Patients was followed up for a period of 6 months to 1 year and evaluated clinically with Knee Score (Intsall modification) and range of motion and operation time and hospital stay time and union time the outcome was used for comparison. Patients were divided into two groups for undergoing surgery with Intramedullary Nailing (IMN) for one group and Locked Plating (LP) for the other group by randomization using the chit and box method. Results: At final one year follow-up by Knee Society scoring system, 64% had excellent results in Intramedullary Nailing (IMN) group and 43% patients had excellent results in Locked Plating (LP) group, 32% had good results in Intramedullary Nailing (IMN) group and 39% had good results in Locked Plating (LP) group, 4% had fair results in Intramedullary Nailing (IMN) group and 18% had fair results in PTP group. Conclusion: Our comparison of intramedullary nail and proximal tibia platting for the treatment of extraarticular proximal tibia fractures showed advantage of intramedullary nailing and provides a newer alternative for a proximal tibia platting with the benefits of minimal invasive, shorter operative time, lesser hospital stay, early return to activities, and a higher percentage to near pre injury functional status, though through the ages proximal tibia platting provide an acceptable treatment option by MIPPO technique but better results can be achieved by high bend multiple locking intramedullary nailing which cause less complication like infection, soft tissue strapping nonunion stiffness decrease range of motion rehabilitation to routine life style, As we felt in our study period. In earlier period of our study alignment of fracture fragment is better in proximal tibia platting group but as a follow up of one year we conclude that both forms of treatment provide adequate fracture stability and union.

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The prevalent cause of shoulder pain is rotator cuff tears (RCT), which induce profound discomfort and morbidity. Hence, their detection and appropriate management become important to alleviate morbidity and enhance quality of life. Imaging has an important role in the diagnosis of such patients to guide for further management.  The aim of the study is to compare the efficacy of MRI in diagnosing shoulder pathologies in comparison to arthroscopy, considering arthroscopy as the gold standard. 30 Patient with suspected rotator cuff injury patients were included in the study. MRI of the shoulder joint was done followed by shoulder arthroscopy. The accuracy of MRI in diagnosis of rotator cuff partial tears, was 90%, while sensitivity and specificity was 100.00%, 78.57% and positive predictive value was 84.21% and negative predictive value was 100.00% and accuracy of MRI in diagnosis of rotator cuff full tears, was 86.67%, while sensitivity and specificity was 63.64%, 100.00%) and positive predictive value was 100.00% and negative predictive value was 82.61% in our study. Our study demonstrates a high sensitivity and specificity for the MRI diagnosis of both partial and full thickness rotator cuff tears and good correlation with arthroscopic findings.

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Globally, coronary artery disease (CAD) has become a major public health issue and main contributor to mortality and morbidity and its prevention and effective treatment modalities are key strategies in reducing the mortality. India is in epidemiological transition. To estimation serum homocysteine level in coronary artery disease patients and normal controls. This descriptive study was conducted on 30 patients with confirmed CAD and 30 healthy age matched subjects as controls.  In this study, serum homocysteine (34.16±15.32 µmol/l) levels were significantly elevated in CAD patients compared to controls. Lipid profile parameters such as serum cholesterol (210.39±41.23mg/dl), TGL (210.36±53.26 mg/dl), LDL (131.02±44.0 mg/dl), VLDL (43.02±9.12 mg/dl) were significantly increased and HDL (37.12±9.12 mg/dl) levels were decreased in CAD patients compared with healthy subjects. This study show that the serum homocysteine level are significantly elevated in CAD patients compare to controls.

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Early detection often leads to prompt and accurate diagnosis, expeditious management, avoidance of unnecessary procedures. 65 patients of acute spinal trauma were included in the study. Detailed neurological examination of the patient was done during the scan. Detailed neurological examination of the patient was also done during his or her discharge from the Hospital. Clinical assessment was done at the time of admission and discharge using ASIA impairment scale. MRI findings were subsequently compared were clinical profile and neurological outcome. The strength of association between extent of spinal cord injury and outcome were described using Odd’s ratio. Chi square test of significance (p<0.005) was used to assess the association between MR findings and clinical outcome.

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Estimates of CHD incidence in diabetic patients vary across studies and countries. Source data are remarkably heterogeneous with regard to selection criteria and risk assessment, and few observational studies provide information on the natural course of CHD in patients who periodically refer to hospital-based outpatient clinics. Furthermore, the natural history of CVD in diabetes is changing. Hospital based cross-sectional study was conducted on 200 type-2 DM patients. In present study, incidence of IHD was 17.00%. The results of this review revealed that there is a high prevalence rate of cardiovascular disease in patients with type 2 DM. Our study has suggested the dyslipidemia is associated with DM with increased TG, low HDL, high cholesterol and LDL. The increased Non-HDL/HDL and TG/HDL could be better indicator than single lipid abnormality which needs to be verified prospectively by including large population and controls. DM patients should be screened regularly for dyslipidemic condition and proper management should be instituted to risk associated with CHD and atherosclerosis.

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Meningitis is a serious clinical condition which proceeds immediately and can lead to significant morbidity. Even with proper treatment, meningitis can damage the brain and cause long-term complications. To study the MRI findings and CSF analysis in patient diagnosed with meningitis. It was a cross-sectional observational study conducted on patients with meningitis. In the present study, Mean age of the patients was 28.36±16.21 years, ranging from 16 months to 71 years. MRI had a sensitivity of 91.00%, specificity of 92.00%, PPV and NPV of 82.00% and 96.00% respectively with a diagnostic accuracy of 92.00%. MRI and CSF analysis are used for diagnosis of meninigitis. MRI has a huge potential superiority in the diagnosis of meningitis.

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Background: Bicondylar tibial plateau fractures are complex intra-articular injuries commonly associated with high-energy trauma. These fractures pose challenges in achieving anatomical reduction and stable fixation while preserving soft tissues. Open reduction and internal fixation (ORIF) carry risks of wound complications, infection, and delayed rehabilitation. External ring fixators offer stable fixation with minimal soft tissue compromise. Methods: A prospective study was conducted on 15 patients (age 18–65 years) with Schatzker type V and VI bicondylar tibial plateau fractures, managed with external ring fixator at Jhalawar Medical College (June 2023– June 2025). Functional outcomes were evaluated using Neer’s Rating System and radiological outcomes using Modified Rasmussen’s Score. Patients were followed up for 6 months. Results: Mean age was 41.5 years; 66.7% were male. Road traffic accidents were the cause in 73.3% of cases. Schatzker type V constituted 53.3% and type VI 46.7%. Mean time to union was 16.9 weeks. Functional outcome was Excellent in 40%, Good in 46.7%, Fair in 13.3%. Radiological outcome was Excellent in 46.7%, Good in 40%, Fair in 13.3%. Complications included pin-tract infection (13.3%) and joint stiffness (6.7%). Conclusion: External ring fixation provides reliable stability, early mobilization, satisfactory union and good functional outcomes in bicondylar tibial plateau fractures, especially in high-energy injuries with soft tissue compromise.

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Background: Intra-articular distal end radius fractures are common and challenging to treat. This study compares functional and radiological outcomes of pinning with ligamentotaxis versus volar plating. Methods: 60 patients were studied prospectively at Jhalawar medical college, Jhalawar (from April 2023 to march 2025), divided into two equal groups. Group A underwent pinning with ligamentotaxis, while Group B was treated with volar plating. Functional and radiological evaluation was done at 3 months using Gartland & Werley score. Results: Mean age was 44 years, with female predominance (55%). Fall on outstretched hand was the commonest mode of injury. Functional outcomes: Pinning with Ligamentotaxis Excellent 50%, Good 26.7%, Fair 16.7%, Poor 6.7%; Plating, Excellent 43.3%, Good 26.7%, Fair 20%, Poor 10%. Union was achieved in all patients (mean 8 weeks). Complications included stiffness, DRUJ pain, malunion, and infection, slightly higher in plating. Conclusion: Both techniques provide satisfactory result, pinning with ligamentotaxis gave slightly better radiological and functional outcome.

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Background: Malaria is a protozoal disease spread by bite of infected anopheles mosquito. It is caused by species of genus plasmodium i.e. P. vivax, P. falciparum, P. ovale & P. malariae. It is one of the important parasitic diseases of human presenting with fever, chills with rigor, malaise, headache, myalgia, anorexia, vomiting, anemia & enlarged spleen. Materials and Methods: This two-year prospective study involved 150 confirmed malaria patients over 10 years old, assessed with clinical exams and hematological tests (CBC, RBC indices, platelet parameters) using automated analyzers. Results: This study of 150 confirmed malaria cases in India revealed that Plasmodium vivax was the most prevalent species (68.6%), followed by P. falciparum (20.6%) and mixed infections (10.6%). The study highlighted significant hematological complications, including anemia (94% of cases), thrombocytopenia (84.6%), and altered RBC and platelet indices. Discussion: Anemia and thrombocytopenia are prevalent hematological complications in malaria, with notable reductions in hemoglobin, RBC count, hematocrit, platelet count, and plateletcrit. The findings emphasize the importance of hematological parameters in diagnosing and monitoring malaria, particularly in endemic regions.

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