Introduction: The nose takes an important part in establishing a beautiful appearance. Nose is also a prominant feature of the face. Anthropometry of facial symmetry and proportions is regarded as a factor of beauty in a particular population. Aims & Objectives: To compare preoperative and postoperative anthropometric measurements based on an adult patient life-size photograph and subjective satisfaction using Rhinoplasty Outcome Evaluation score (ROE) preoperatively and postoperatively in adult patients undergoing Primary Rhinoplasty in north Indian population. Materials: The study was comprised of patients aged 18 years or above with cosmetic and/or functional disorders requiring primary rhinoplasty and the sample size was 20 patients. Result: According to the Rhinoplasty outcome evaluation score, 17 patients had excellent satisfaction, 2 patients had good satisfaction and 1 patient had acceptable satisfaction. Conclusion: Patients belonging to lower socioeconomic background had less surgical expectations and were highly satisfied with the outcomes. According to our research, females had higher satisfaction than male after primary rhinoplasty.

Introduction: Thyroid disorders are among the most prevalent endocrine abnormalities encountered during pregnancy, posing significant risks to both maternal and fetal health. The physiological changes inherent to pregnancy, such as increased blood volume and altered renal clearance, can influence thyroid function tests, making the diagnosis and management of thyroid dysfunctions particularly challenging. Aims and Objectives: This prospective study aims to assess the prevalence and pattern of thyroid disorders among pregnant women, providing valuable insights that could inform screening strategies and management protocols in clinical practice. Materials and Methods: The present study was a prospective observational study. This Study was conducted from March 2024 to February. Total 60 patients were included in this study. Result: The study of 60 pregnant women revealed that most participants were in the 26–30 years age group (n = 25, 41.7%), with a slightly higher proportion being multigravida (n = 32, 53.3%). The majority of women were euthyroid (n = 40, 66.7%), while hypothyroidism (n = 15, 25%) was more common than hyperthyroidism (n = 5, 8.3%). Subclinical forms of both hypothyroidism (n = 10, 66.7%) and hyperthyroidism (n = 3, 60%) predominated over overt forms. Thyroid dysfunction was more frequently observed in the later stages of pregnancy, whereas euthyroid status was more common in the first trimester, highlighting the importance of monitoring thyroid function throughout gestation. Conclusion: The study demonstrated that a majority of pregnant women maintained normal thyroid function, while a notable proportion exhibited thyroid dysfunction, with hypothyroidism being more common than hyperthyroidism.

Introduction: First-trimester vaginal bleeding is a common obstetric complication occurring in approximately 20-25% of pregnancies and is a significant cause of concern for patients and clinicians alike. The etiology of bleeding in early pregnancy varies widely, ranging from benign causes such as implantation bleeding to more serious conditions like threatened miscarriage, ectopic pregnancy, and molar pregnancy. Aims and Objectives: To evaluate the foeto-maternal outcomes in pregnancies with first-trimester vaginal bleeding and to assess its association with adverse pregnancy, neonatal, and maternal complications. Materials and Methods: The present study was a Prospective study. This Study was conducted from December2020 to July2021 at Department of Obstetrics and Gynecology, NilratanSircar Medical College and Hospital, Kolkata. Total 60 patients were included in this study. Result: In our study, 88.09% of cases with abnormal ultrasound and 100% with an open cervical os resulted in abortion, while mode of delivery showed no significant association with gestational age (p=0.918). Among 21 live-born neonates, 28.57% had IUGR and 23.81% had respiratory distress, with 45% requiring NICU admission. Maternal complications included PIH in 30% and PPROM in 15% of cases. Conclusion: In our study, first-trimester bleeding was associated with a wide spectrum of maternal and neonatal outcomes. Vaginal delivery was the predominant mode of birth, and women without a prior history of abortion generally had more favorable pregnancy courses.

Introduction: Acute pancreatitis (AP) is a common gastrointestinal emergency, often complicated by local manifestations such as pancreatic necrosis, pseudocysts, fluid collections, and abscesses. Timely and accurate detection of these complications is crucial for patient management and prognosis. Imaging modalities such as ultrasonography (USG) and contrast-enhanced computed tomography (CECT) play a pivotal role in diagnosis. Aims: To evaluate and compare the effectiveness of USG and CECT in identifying the local complications of acute pancreatitis. Materials and Methods: The present study is a cross-sectional study conducted at the Department of Radiodiagnosis, Nil Ratan Sircar Medical College, Kolkata, from January 2020 to June 2021. It included a total of 50 middle-aged patients with clinically suspected or biochemically/radiologically confirmed acute pancreatitis, who were referred for abdominal ultrasonography (USG) and contrast-enhanced computed tomography (CECT) from the emergency or outpatient departments. USG and CECT were performed on all patients, and the findings were recorded in a pre-designed proforma and subsequently analyzed using appropriate statistical methods. Results: In our study of 50 acute pancreatitis patients, USG showed pancreatic enlargement (head 30%, body 30%, tail 24%), heterogeneous echo texture (72%), peripancreatic collections (54%), pseudo cysts (26%), walled-off necrosis (8%), and portal vein thrombus (6%). CECT detected peripancreatic fat stranding (88%), pancreatic enlargement (head 46%, body 58%, tail 48%), fluid collections, pseudo cysts (28–30%), walled-off necrosis (6–12%), and venous thrombosis (portal 12%, splenic 4%). Overall, CT was superior in detecting pancreatic enlargement, localizing pseudo cysts, necrosisand identifying venous thrombosis or other vascular complication. Conclusion: While USG remains a useful initial, non-invasive, bedside tool for screening local complications of acute pancreatitis, CECT is the imaging modality of choice for comprehensive evaluation, accurate diagnosis, and guiding therapeutic decisions. Integration of both modalities enhances diagnostic confidence and optimizes patient care.

Background: Preeclampsia is a major hypertensive disorder of pregnancy associated with substantial maternal and perinatal morbidity and mortality. Early identification of markers reflecting disease severity is crucial for timely intervention. Serum lactate dehydrogenase (LDH), an indicator of cellular injury and endothelial dysfunction, has emerged as a potential prognostic biomarker. Objective: To study serum LDH levels in women with preeclampsia and evaluate its correlation with disease severity and maternal outcomes. Methods: This observational study was conducted on 200 women with preeclampsia at a tertiary care hospital. Patients were classified into two groups: preeclampsia without severe features and with severe features, based on ACOG criteria. LDH levels were categorized into three groups: <600 IU/L, 600–800 IU/L, and >800 IU/L. Blood pressure, maternal complications, and outcomes were compared across groups. Statistical analysis was performed using chi-square test, ANOVA, and Pearson’s correlation. Results: Among the study population, 57.5% had preeclampsia without severe features and 42.5% had severe disease. Mean LDH levels were significantly higher in the severe group (822.05 ± 539.99 IU/L) compared to the non-severe group (356.49 ± 102.28 IU/L, p<0.001). LDH levels showed a strong positive correlation with systolic blood pressure (r=0.613) and a moderate correlation with diastolic blood pressure (r=0.465). Maternal complications such as eclampsia, abruption, HELLP syndrome, and mortality were more frequent in patients with LDH >800 IU/L. Conclusion: Elevated serum LDH levels strongly correlate with the severity of preeclampsia and adverse maternal outcomes, making LDH a reliable and cost-effective prognostic marker for disease monitoring.

Background: Laparoscopic cholecystectomy (LC) is the gold standard for the management of symptomatic gallstone disease. However, certain cases become technically challenging, resulting in prolonged operative time, intraoperative complications, or conversion to open surgery. Identifying preoperative predictive factors is crucial for better surgical planning and patient counselling. Aim and Objectives: To evaluate preoperative demographic, clinical, and ultrasonographic factors that can predict the difficulty of laparoscopic cholecystectomy in patients with symptomatic cholelithiasis. Materials and Method: This prospective observational study was conducted in the Department of General Surgery, Government Medical College, Karimnagar, over one year. A total of 53 patients undergoing elective LC were included after informed consent. Preoperative demographic variables (age, sex, BMI), clinical history (acute cholecystitis, duration of symptoms, hospitalizations), laboratory findings, and ultrasonographic parameters (gallbladder wall thickness, number of stones, impacted stone, pericholecystic fluid) were recorded. Operative details such as adhesions, Calot’s triangle dissection, operative time, spillage, and conversion were assessed. Difficulty was graded using validated scoring systems. Statistical analysis was performed using Chi-square and Student’s t-test with p<0.05 considered significant. Results: Among the 53 patients, 60.4% were female and 32.1% were obese (BMI ≥30). Difficult LC was encountered in 34% of cases, and 11.3% required conversion to open surgery. Significant predictors included age ≥50 years (p=0.01), male sex (p=0.02), BMI ≥30 (p=0.03), prior acute cholecystitis (p=0.04), gallbladder wall thickness >3 mm (p=0.002), and impacted stone at Hartmann’s pouch (p=0.01). Conclusion: Preoperative factors such as advanced age, male sex, obesity, prior acute cholecystitis, gallbladder wall thickening, and impacted stones are strong predictors of difficult laparoscopic cholecystectomy. Their recognition enables surgeons to anticipate challenges, optimize operative planning, and improve patient safety.

Background: Allergic rhinitis (AR) is a chronic inflammatory nasal mucosal disorder caused by immunoglobulin E (IgE)-mediated reactions to environmental allergens. It severely affects quality of life and is accompanied by comorbid diseases like asthma, sinusitis, and conjunctivitis. Symptomatic relief with conventional therapy using antihistamines and corticosteroids is achieved without altering the underlying immunological process. Allergen-specific immunotherapy (AIT) has also been the sole disease-modifying therapy, seeking to promote long-lasting tolerance to allergens and weaken symptom severity. Objective: The present study was undertaken to evaluate the effectiveness of immunotherapy in patients with allergic rhinitis in terms of symptom improvement, reduction in medication use, and overall quality of life. Methods: Prospective observational study was undertaken for 12 months at a tertiary care center on 100 patients aged 20-40 years diagnosed with moderate to severe allergic rhinitis as per clinical history, nasal endoscopy, and positive skin prick test or specific IgE assay. SCIT was administered according to individual allergen sensitivity in build-up and maintenance phases to the patients. Severity of symptoms was measured with Total Nasal Symptom Score (TNSS) and Visual AnalogScale (VAS), while the quality of life was determined by Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). The measurements were conducted at baseline, 6 months, and 12 months. Results: Substantial reduction in TNSS and VAS scores from baseline to the 12-month follow-up (p < 0.001) reflected significant improvement of nasal symptoms including sneezing, rhinorrhea, nasal obstruction, and itching. Medication use declined considerably, with 78% of the patients reporting minimal use of rescue medications at one year of treatment. RQLQ scores indicated enhanced general quality of life, especially in areas associated with sleep, activity, and social function. There were no significant systemic adverse reactions; local injection site reactions were mild and transient. Conclusion: Immunotherapy was effective and safe as a treatment method in patients with allergic rhinitis, with significant reduction in symptom severity, drug dependence, and improving quality of life. These findings reaffirm the position of immunotherapy as an anchor in the long-term management of allergic rhinitis.

Background: Elastography, including strain elastography (SE) and shear wave elastography (SWE), has emerged as a non-invasive adjunct to conventional ultrasound (US) for differentiating benign from malignant breast lesions. Optimal parameter cut-offs and their impact on diagnostic performance remain under investigation. Objective: To synthesize evidence on the diagnostic accuracy, optimal thresholds, and clinical utility of SE and SWE in breast lesion evaluation. Methods: A systematic review of ten studies (2015-2025) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, encompassing 3,905 breast lesions across diverse populations. Studies were 6 prospective and 4 retrospective, with sample sizes ranging from 59 to 2,262. Main outcomes included sensitivity, specificity, area under the curve (AUC), and effect of combining elastography with BI-RADS US. Results: SWE Emax cut-offs ranged from 30–196 kPa, with sensitivities of 60.0–97.5% and specificities of 54.8–93.1%. SE strain ratio cut-offs (2.86–2.93) achieved sensitivities of 77.3–95.8% and specificities of 75.0–89.3%. Combining elastography with US improved specificity (up to +11.3%) without significant sensitivity loss, particularly in BI-RADS 4a lesions. Some studies reported improved predictive power when SWE was integrated with tumor biomarkers (e.g., Ki-67 in ER+ tumors) or lesion morphological features (peritumoral stiffness). SWE also correlated with tumor aggressiveness, histological subtype, and response to neoadjuvant chemotherapy. Conclusion: SE and SWE enhance diagnostic performance beyond conventional US, enabling more accurate lesion characterization, reducing unnecessary biopsies, and supporting personalized treatment strategies. SWE cut-offs should be tailored to lesion type (mass vs non-mass-like) and clinical context to balance sensitivity and specificity.

Background: Allergic conjunctivitis is rarely vision-threatening but decreases the quality of life of the patients if untreated. Method: Out of 140 patients with allergic conjunctivitis studied, visual acuity was measured using the smallest charts, and a slit lamp examination was done on every patient. 70 patients were administered topical 0.1% olopatadine (group A), and 70 were administered 1.5%. Bepostine eye drops BD on the 7th and 21st – 28th days. Further grading of signs and symptom scores were compared in both patients, and significant results were noted. Results: Group A was treated with 0.1% olopatadine eye drops, and Group B was treated with bepotastine 1.5% on the 7th day. Redness grading was 0 in 92.8% of patients, and 5 patients had a 1 redness score in Bepotastine; 82.8% of patients had a 0 grade of redness, and 17.1% had a 1 grade of redness in olopatadine. Conclusion: Although both olopatadine 0.1 and bepotastine besilate 1.5% are effective in treating allergic conjunctivitis. However, bepotastine besilate is more efficient in the early control of itching and redness in allergic conjunctivitis.

Background: Neonatal hyperbilirubinemia (NH) is one of the most common clinical conditions requiring medical attention in the first week of life. Early identification of newborns at risk of developing significant jaundice is critical, particularly with the trend toward early hospital discharge. Objectives: To evaluate the role of cord blood albumin (CBA) as a predictor for significant neonatal hyperbilirubinemia in healthy term neonates. Methods: This prospective observational study was conducted at Deen Dayal Upadhyay Hospital, New Delhi from January to August 2020. A total of 150 healthy term neonates meeting the inclusion criteria were enrolled. Cord blood samples were collected at birth to estimate serum albumin levels. Newborns were followed clinically for the first five days, and total serum bilirubin (TSB) was measured in those showing jaundice beyond Kramer’s scale 3. CBA levels were correlated with TSB levels ≥17 mg/dl and the requirement for phototherapy. Results: Among 150 neonates, 23% had CBA ≤2.8 g/dl, 30% had 2.9–3.3 g/dl, and 47% had >3.3 g/dl. Significant hyperbilirubinemia (TSB ≥17 mg/dl) was observed in 30 neonates (20%), 90% of whom had CBA ≤2.8 g/dl (p=0.003). Sensitivity, specificity, positive predictive value, and negative predictive value of CBA ≤2.8 g/dl were 90.00%, 58.33%, 84.38%, and 70.00% respectively. Conclusion: Cord blood albumin level ≤2.8 g/dl is significantly associated with the risk of developing significant neonatal hyperbilirubinemia. CBA estimation at birth may serve as a useful screening tool to identify neonates requiring close monitoring and follow-up after early discharge.

Introduction: The treatment of different electrolyte imbalances is an essential component of life-supporting care in an intensive care unit, especially for young patients. Pediatric intensive care units frequently experience electrolyte imbalances. Aims: To evaluate the electrolyte imbalance trend in pediatric critical care.  to determine the many causes of electrolyte imbalances. To evaluate how electrolyte imbalances affect mortality, length of PICU admission, and after effects. Materials & Methods: This was a prospective, observational cohort study conducted in the Department of Pediatric Medicine at Calcutta National Medical College and Hospital, a tertiary care center. The study was carried, from 2021 to 2022, and included a total of 150 pediatric patients. Result: In 38 patients (25%) in our investigation, dyselectrolytemia was most frequently seen as mixed abnormalities.  36 patients (24%), 32 patients (21%), and 27 patients (18%) had hyponatremia, metabolic acidosis, and hypokalemia, respectively.  Hyperkalemia (12 patients, 8%), hypocalcemia (9 patients, 6%), hypernatremia (6 patients, 4%), and hypercalcemia (5 patients, 3%), were less common anomalies.  (p< 0.00001) It was statistically significant. Conclusion: We concluded that the bulk of the 150 pediatric patients in our study who were admitted to the PICU were male newborns between the ages of one month and one year.  Central nervous system infections were the most common underlying cause, and mixed electrolyte imbalances were the most commonly found.

Background: Extra-pulmonary tuberculosis (EPTB) constitutes a significant proportion of the tuberculosis burden in India, particularly among immunocompromised populations. Diagnostic delays arise from its paucibacillary nature and the limitations of conventional methods. Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) offers rapid detection of Mycobacterium tuberculosis and rifampicin resistance, yet its performance in high-burden, resource-constrained settings requires further evaluation. Methods: In this hospital-based, cross-sectional observational study, 200 consecutive patients clinically suspected of EPTB were prospectively enrolled. Standardized inclusion and exclusion criteria ensured diagnostic purity. Specimens underwent Ziehl–Neelsen microscopy, culture on Lowenstein–Jensen medium, and CBNAAT. Diagnostic accuracy indices were calculated using culture as the reference standard. Logistic regression identified predictors of rifampicin resistance. Results: Of 200 patients, 112 (56%) were male, with mean age 36.4 ± 14.8 years; 62% belonged to low socio-economic strata, and 14% were HIV seropositive. Lymph node TB (32%) and pleural TB (24%) predominated. Microscopy, culture, and CBNAAT positivity rates were 13%, 32%, and 46%, respectively. Relative to culture, CBNAAT demonstrated sensitivity 84.3% and specificity 98.5% (κ = 0.83). Importantly, CBNAAT detected 28 additional clinically adjudged culture-negative cases. Among CBNAAT-positive patients, rifampicin resistance was identified in 14 (15.2%), yielding an overall resistance prevalence of 7%. Prior TB treatment (aOR 3.6, p=0.008) and HIV co-infection (aOR 2.9, p=0.03) independently predicted resistance. Conclusion: CBNAAT significantly enhances diagnostic yield in EPTB and permits timely detection of rifampicin resistance, particularly in high-risk subgroups. Its universal integration into diagnostic algorithms is imperative to strengthen India’s TB elimination trajectory.

Background: The ubiquity of digital devices has led to a surge in screen-related health issues, with dry eye disease (DED) being a prominent concern. DED, a multifactorial condition of the ocular surface, significantly impairs quality of life. Medical students represent a particularly vulnerable population due to their intensive academic demands, which necessitate prolonged engagement with digital screens for learning and research. However, the quantitative relationship between screen time and symptom severity in this specific group is not fully established. Methods: A descriptive, cross-sectional study was conducted on 100 undergraduate medical students. Participants were recruited using a convenience sampling method. Data were collected through a self-administered questionnaire that recorded sociodemographic details, average daily screen time (hours/day), and dry eye symptoms using the validated Ocular Surface Disease Index (OSDI) questionnaire. An OSDI score >12 was considered indicative of symptomatic dry eye. Data were analyzed using SPSS version 26.0, employing Pearson’s correlation, Independent Samples t-test, and the Chi-square test. A p-value <0.05 was considered statistically significant. Results: The mean age of the participants was 20.8 ± 1.9 years. The average daily screen time was 7.8 ± 2.5 hours. The prevalence of symptomatic dry eye (OSDI >12) was 65.0% (n=65). The overall mean OSDI score was 25.5 ± 15.1. A strong, statistically significant positive correlation was found between daily screen time and OSDI scores (Pearson’s r = 0.65, p<0.001). The mean OSDI score for students with >6 hours of daily screen time was significantly higher than for those with ≤6 hours (31.1 ± 13.9 vs. 14.8 ± 10.2; p<0.001). Severe dry eye symptoms (OSDI ≥33) were present in 35.4% of students with high screen time (>6 hours/day) compared to only 5.9% of those with lower screen time (≤6 hours/day) (p=0.002). Conclusion: A high prevalence of symptomatic dry eye exists among undergraduate medical students, and the severity of symptoms is strongly correlated with increased daily screen time. These findings highlight a significant occupational health issue within medical education and underscore the need for targeted awareness programs and preventative strategies, such as promoting regular breaks and proper screen ergonomics, to protect the ocular health of future physicians.

Introduction: Breast cancer is one of the most common malignancies worldwide, with both genetic and environmental factors contributing to its development. The BRCA2 gene, a critical tumour suppressor gene, plays a pivotal role in maintaining genomic stability by repairing double-strand DNA breaks through homologous recombination. Aims: This study aims to determine the incidence of BRCA2 gene mutations in breast carcinoma patients and examine its impact on tumour biological behaviour. Additionally, it seeks to correlate BRCA2 mutation status with clinical outcomes and prognosis. Materials & Methods: This is a prospective study conducted at the Institute of Postgraduate Medical Education and Research, SSKM Hospital, Kolkata, from January 2016 to August 2017, with a sample size of 50 breast carcinoma patients with BRCA2 gene mutations. Result: It was statistically significant (p=0.0042) that ER negative tumours 11 (84.6%) had lower levels of BRCA2 than ER positive tumours 2 (15.4%). Conclusion: We concluded that this work, we looked into the prevalence of BRCA2 gene mutations in individuals with breast cancer and how they affect the biological activity of the tumour. Our results imply that BRCA2 expression is not much impacted by age, menopausal status, or tumour size.

Background: Heavy menstrual bleeding (HMB) affects up to 30 % of perimenopausal women and impairs quality of life. Levonorgestrel‑releasing intra‑uterine system (LNG‑IUS) and oral tranexamic acid (TXA) are guideline‑endorsed first‑line options, but head‑to‑head evidence in the perimenopausal age‑group remains sparse. Methods: We performed a 12‑month, randomised trial at tertiary hospital in which 200 perimenopausal women (45‑54 years) with objectively confirmed HMB (Pictorial Blood‑Loss Assessment Chart [PBAC] > 150) were allocated 1:1 to LNG‑IUS (52 mg,) or TXA (1.5 g orally three‑times daily for up to five days per cycle). Primary endpoint was mean change in PBAC score at 12 months. Secondary endpoints were change in haemoglobin, Menorrhagia Impact Questionnaire (MIQ) score, treatment satisfaction, and adverse events. Intention‑to‑treat analysis used mixed‑effects modelling. Results: Baseline characteristics were comparable. Mean PBAC fell from 300 ± 55 to 60 ± 18 with LNG‑IUS and to 160 ± 35 with TXA (mean difference −100 [95 % CI −113 to −87]; p < 0.001). Haemoglobin rose by 1.9 ± 0.4 g/dL versus 0.8 ± 0.3 g/dL (p < 0.001). MIQ improved by 30 ± 6 versus 15 ± 5 points (p < 0.001). Satisfaction was higher with LNG‑IUS (88 % vs 62%). Device expulsion occurred in 4 %, while TXA‑related dyspepsia and headache occurred in 18 %. Conclusion: In perimenopausal women with HMB, LNG‑IUS achieved significantly greater reductions in menstrual blood loss, anaemia correction and quality‑of‑life improvement than cyclic TXA, with acceptable safety. LNG‑IUS should be considered the preferred first‑line medical therapy when fertility is no longer desired.

Background: Infections of sterile body fluids are associated with high morbidity and mortality, particularly in the presence of multidrug resistant organisms. Surveillance of bacterial spectrum and drug susceptibility patterns is crucial for guiding effective empirical therapy. Material and Methods: This prospective observational study included 120 sterile body fluid samples collected from outpatient and inpatient departments of a tertiary care hospital in India. Samples were cultured and isolates were identified using standard microbiological techniques. Antimicrobial susceptibility testing was performed according to CLSI M100 (34th edition, 2024) guidelines. Data were analyzed statistically, with p<0.05 considered significant. Results: Gram-negative bacilli were predominant, with E. coli, K. pneumoniae, Acinetobacter spp., and Pseudomonas spp. constituting the majority of isolates. Colistin, tigecycline, and minocycline showed the highest activity against multidrug resistant Gram-negatives. Gram-positive cocci, including coagulase-positive and coagulase-negative staphylococci, demonstrated high sensitivity to vancomycin and linezolid, while Enterococcus showed reduced susceptibility to ampicillin and vancomycin. Malignancy was the only comorbidity significantly associated with multidrug resistant infections. Conclusion: The study highlights the predominance of multidrug resistant Gram-negative organisms in sterile body fluid infections and underscores the importance of continuous surveillance and antimicrobial stewardship to optimize therapy.

Background: Lower respiratory tract infections (LRTIs) remain a major cause of morbidity and mortality, with multidrug resistant organisms complicating therapy. Institution-specific surveillance of pathogens and their susceptibility profiles is critical for effective treatment. Material and Methods: A prospective cross-sectional study was conducted at a tertiary care hospital including 150 patients with clinically suspected LRTIs. Respiratory samples were processed using standard microbiological techniques. Bacterial isolates were identified and antimicrobial susceptibility testing was performed according to CLSI M100 (34th edition, 2024). Data were analyzed using descriptive and inferential statistics. Results: A total of 320 isolates were obtained. K. pneumoniae (31.3%) and P. aeruginosa (29.7%) were the predominant pathogens. High resistance was observed to cephalosporins and fluoroquinolones, while carbapenems retained better efficacy. Among Gram-positive isolates, linezolid and vancomycin remained consistently effective. Non-fermenting Gram-negative bacilli also exhibited significant multidrug resistance. Conclusion: The predominance of multidrug resistant Gram-negative bacilli in LRTIs highlights the urgent need for local antibiograms and antimicrobial stewardship programs. Carbapenems and last-line agents like colistin should be preserved through rational use policies to improve patient outcomes.

Background: Acute respiratory tract infections (ARTIs) are among the leading causes of childhood morbidity and mortality worldwide, especially in children aged 2 months to 5 years. Their clinical spectrum varies from mild upper respiratory tract infections to severe lower respiratory involvement. Aim: To delineate the respiratory disease profiles of children aged 2 months to 5 years presenting with ARTIs. Material and Methods: A hospital-based observational cross-sectional study was conducted including 120 children aged 2 months to 5 years with clinical features of ARTI. Detailed demographic data, presenting complaints, and clinical diagnoses were recorded. Data were analyzed to determine the distribution of upper and lower respiratory tract infections. Results: Nasopharyngitis (34.2%) was the most common condition, followed by pneumonia (14.2%) and bronchiolitis (10.8%). Fever, cough, and cold were the predominant presenting complaints. Less frequent conditions included sinusitis, tonsillopharyngitis, croup, and epiglottitis. Male children were slightly more affected (55%) compared to females (45%). Conclusion: ARTIs in under-five children remain a major public health concern, with nasopharyngitis, pneumonia, and bronchiolitis as the most frequent diagnoses. Early recognition, vaccination, and access to diagnostic tools are crucial to improving outcomes and reducing the disease burden.

Background: Germ cell tumors (GCTs) constitute a biologically aggressive but highly curable group of neoplasms, most often afflicting young males in their second to fourth decades of life, with ovarian counterparts being relatively rare but clinically significant. The advent of cisplatin-based combination chemotherapy, particularly the canonical Bleomycin–Etoposide–Cisplatin (BEP) regimen introduced by Peckham and colleagues in 1983, revolutionized survival outcomes, yet simultaneously engendered a spectrum of adverse drug reactions (ADRs), many of which are both dose-limiting and organ-compromising. As pharmacovigilance programmes in resource-intense and resource-constrained settings alike repeatedly underscore, systematic mapping of such ADRs is indispensable not merely for therapeutic stewardship but also for reinforcing patient-centric oncology practices.Objective: The present study sought to delineate the adverse reaction profile of BEP chemotherapy in germ cell tumors with particular emphasis on dyselectrolytemia, thereby contributing to the Pharmacovigilance Programme of India and enriching the global discourse on antineoplastic toxicodynamics. Methods: In a six-month observational, cross-sectional design at a tertiary academic medical center, patients with confirmed GCTs receiving BEP chemotherapy were prospectively monitored. Clinical, biochemical, radiological, and hematological variables were documented using standardized PvPI case-reporting forms. WHO causality assessment and Naranjo’s Algorithm were applied to adjudicate attribution. Results: A total of 58 patients were enrolled. The arbitrary analytic framework revealed dyselectrolytemia (notably hypomagnesemia and hyponatremia) as the most frequently encountered biochemical perturbation, manifesting in 62% of cases, occasionally culminating in neuromuscular irritability and arrhythmogenic events. Myelosuppression was universal though heterogeneous in grade, while hepatotoxic and nephrotoxic events occurred in 24% and 37% of patients, respectively. Pulmonary and dermatological toxicities attributable to bleomycin were infrequent but clinically consequential. Conclusion: The current observational analysis substantiates that while BEP chemotherapy remains curative in intent, the adverse drug reaction landscape—particularly electrolyte derangements—constitutes a formidable challenge. Vigilant pharmacovigilance, electrolyte surveillance, and early corrective strategies must be woven into standard oncological practice, reinforcing the broader mandate of PvPI.

Background: Diabetes mellitus (DM) is an important worldwide health burden, and chronic low-grade inflammation and dyslipidemia are at the core of its pathogenesis. The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) has only recently been proposed as an integrated biomarker of both inflammatory status and lipid metabolism. Yet, its utility in predicting incident diabetes remains unclear. Objectives: To examine the relationship between NHR and new-onset diabetes in a hospital-based population, and to evaluate its predictive strength relative to fasting plasma glucose (FPG). Methods: This hospital-based retrospective study involved 184 adults who received routine health check-ups at the tertiary care hospital, between January 2023 and February 2025. Follow-up was conducted in participants without baseline diabetes for new diagnoses of diabetes, as verified by medical records, laboratory results, and treatment. Baseline information regarding demographics, clinical factors, and laboratory parameters, such as neutrophil levels and HDL-C, was obtained. NHR was determined as absolute neutrophil count/HDL-C. Cox proportional hazards regression was used to examine the relationship between NHR and incidence of diabetes, controlling for potential confounding variables. Receiver operating characteristic (ROC) analysis was conducted to examine discriminative capacity of NHR. Results: Of the participants, 38 (20.6%) developed diabetes during follow-up. Baseline NHR was substantially greater in incident cases with diabetes than in non-cases (mean ± SD: 3.9 ± 1.2 vs. 2.6 ± 1.1, p < 0.001). After adjusting for age, sex, BMI, smoking, alcohol consumption, blood pressure, and lipid profile in the multivariable model, those in the third tertile of NHR were at 2.3 times higher risk of diabetes than those in the first tertile (HR = 2.31, 95% CI: 1.26–4.25, p = 0.006). ROC curve analysis showed NHR to have strong discriminative capacity for diabetic prediction (AUC = 0.78) and that inclusion of NHR in FPG yielded significant improvement in predictive accuracy (combined AUC = 0.84). Conclusions: High NHR is independently linked with elevated risk for new-onset diabetes and enhances prediction over conventional markers. Being a simple, inexpensive, and readily available measure, NHR can be a useful biomarker for screening for early risk of diabetes in clinical settings.

Background: Upper limb nerve blocks and perineural catheter infusions can provide adequate and lasting analgesia, which is crucial for upper limb surgery. In nerve blocks the use of ultrasound-guided anaesthesia has shown significant success. There has been increasing interest in using sub-anesthetic doses of ketamine and administering it as an infusion in conjunction with sub-anesthetic doses of medications like propofol (1 mg/kg) and dexmedetomidine (0.5 mg/kg) due to its benefits of effective analgesia, lack of respiratory depression, and bronchodilation, which have lessened the negative effects of ketamine. Dexmedetomidine has good analgesic qualities in addition to its sedative effects, although it can also cause bradycardia and hypotension. Ketamine’s sympathomimetic qualities cause it to raise heart rate and blood pressure while maintaining respiratory activity. Hence these two drugs balance each other because of their opposing actions when used together. Aim: To analyze efficacy of the combination of Dexmedetomidine and Ketamine versus Ketamine alone for intraoperative sedation in pediatric patients undergoing upper limb surgeries under brachial plexus block. Method: Thorough pre-anaesthetic evaluation was performed, and necessary investigations were conducted. Moreover, the written consent was obtained from the parents of the children. Children between age group 5 to 12 years.  The written informed consent was obtained from 60 patients aged between 5 to 12 years who were scheduled for upper limb surgeries under brachial plexus block. They were divided randomly into two groups to receive either Ketamine (Group K) or combination of Dexmedetomidine and Ketamine (Group KD). Separate samples Haemodynamic parameters and other continuous variables were compared using the t-test. The significance test for categorical variables was conducted using Fisher’s exact and Chi-square tests. SPSS software for Windows, version 30.0, was used to analyse the data after it was loaded into a Microsoft Excel sheet. Results: Since we combined analgosedation with continuous infusion, the hemodynamic parameters HR, SBP, DBP, RR, and SpO₂ did not exhibit a statistically significant difference between the two groups (p> 0.05). The quality of sedation of Ketamine group was found excellent for 5 patients and good for 24 and poor in 1 patient whereas, for Ketamine plus Dexmedetomidine group, it was excellent for 28 patients good for 2 patients. It shows, there was significant association between quality of sedation and groups (p<0.05). Quality of sedation was significantly better for Ketamine plus Dexmedetomidine group as compared to Ketamine group, showing better sedation quality in Ketamine plus Dexmedetomidine group. Also, duration of sedation was significantly more in Ketamine plus Dexmedetomidine group, with lesser adverse effects. Conclusion: Under the supraclavicular brachial block, pre-emptive analgosedation with Ketamine plus Dexmedetomidine can be utilised in upper limb orthopaedic procedures in a safe and efficient manner. Compared to Ketamine alone Ketamine plus Dexmedetomidine offers superior analgesia, better quality and duration of sedation with minimal hemodynamic alterations and adverse effects.

Background: Stab wounds are one of the most common forms of homicidal sharp force trauma encountered in forensic pathology. Careful assessment of wound morphology—such as number, depth, distribution, and associated defensive injuries—provides crucial information for reconstructing the dynamics of assault, identifying weapon characteristics, and interpreting medicolegal significance. Case Presentation: This case series describes four homicidal fatalities involving sharp force trauma autopsied at Gandhi Medical College, Bhopal, between January 2024 and May 2025. Case 1 involved multiple clustered abdominal wounds with defense injuries, suggestive of a domestic confrontation. Case 2 demonstrated targeted deep abdominal stab wounds with injury to vital organs, consistent with premeditated homicide. Case 3 presented with a stab wound containing a retained blade fragment, reflecting extreme force. Case 4 revealed multiple erratic wounds, including vertical clusters on the thigh, representing an overkill pattern associated with rage or emotional involvement. In all cases, the certified cause of death was hemorrhage and shock. Conclusion: This series highlights the forensic significance of stab wound profiling in homicidal deaths. Clustered wounds suggest personal conflict, targeted injuries point toward deliberate intent, overkill patterns reflect emotional involvement, and retained blade fragments indicate excessive force. Detailed wound documentation and interpretation strengthen homicide reconstruction, weapon correlation, and judicial processes.

Introduction: Stroke is a leading cause of death and disability, with ischemic stroke being most common. Calcium overload during ischemia contributes to neuronal injury and infarct expansion. This study evaluates serum calcium levels in acute ischemic stroke and correlates them with infarct size and severity using CT imaging and NIHSS scoring. Methods: This one-year observational study at Andhra Medical College included patients >35 years with CT-confirmed acute ischemic stroke within 48–72 hours of onset. Exclusions included hemorrhagic stroke and comorbid conditions. Serum calcium, infarct size (ABC/2 method), and NIHSS scores were assessed. Thrombolysis was not administered to any participant. Results: In this study of 100 stroke patients, males predominated (65%). Diabetes, hypertension, and CAD were more prevalent in men. Females had lower calcium levels, larger infarcts, and higher NIHSS scores. Hypocalcemia was common in ages 40–60. Lower calcium correlated significantly with increased infarct volume and stroke severity (P < 0.05). Conclusion: Lower serum calcium levels in acute ischemic stroke patients were significantly associated with larger infarcts and higher NIHSS scores, indicating worse outcomes. Hypocalcemia may serve as a prognostic biomarker and therapeutic target. These findings underscore the potential importance of monitoring calcium levels in the acute management of stroke.

Introduction: Malaria remains a significant health burden in endemic regions. While symptoms are nonspecific, peripheral smear microscopy is the gold standard for diagnosis, identifying species and parasitemia levels. This study evaluates the correlation between clinical features and smear results to assess the diagnostic utility of microscopy in suspected malaria cases. Methods: A prospective observational study was conducted at GSL Medical College from August 2024 to March 2025, involving adults with malaria symptoms. Peripheral smears were examined using Giemsa stain to detect Plasmodium species. Data were statistically analyzed to correlate clinical features with smear results after obtaining consent and ethical clearance. Results: In this study of 115 adults, 55.7% tested positive for malaria via smear microscopy. Plasmodium vivax was most common. Fever, headache, and vomiting were prevalent. Moderate parasitemia was seen in 43.8% of cases. Splenomegaly and jaundice were observed in 46.9% and 21.9% of positive cases, respectively. Conclusion: Peripheral smear microscopy remains a valuable diagnostic tool for malaria, especially in resource-limited settings. Plasmodium vivax was the predominant species. Clinical features alone were insufficient for diagnosis, emphasizing the need for laboratory confirmation. Limitations included single-center design and absence of molecular diagnostics for species confirmation and sensitivity comparison.

Introduction: Carbapenem resistance in non-fermenting gram-negative bacilli (NF GNB), notably Pseudomonas and Acinetobacter, poses serious clinical challenges. Phenotypic detection methods like mCIM, Carba NP, and EDTA-based tests are crucial in resource-limited settings. This study evaluates their effectiveness for identifying carbapenemase producers in clinical isolates from a tertiary care hospital. Methods: This four-month prospective study at CAIMS, Karimnagar, focused on identifying and characterizing non-fermenting Gram-negative bacilli from clinical specimens. Standard CLSI methods and biochemical tests were used. Carbapenem resistance was screened using meropenem disc diffusion, MHT, CDT, DDST, and CHROMagar KPC for phenotypic confirmation of carbapenemase production. Results: Of 327 isolates, 102 were meropenem-resistant—64 P. aeruginosa, 38 A. baumannii. CHROM agar KPC showed highest carbapenemase detection (97.05%), followed by MHT, CDT, and DDST. Resistance to multiple antibiotics was 100%. Tigecycline and colistin showed limited activity (≤14%). Detection rates were significantly higher in A. baumannii. Conclusion: Carbapenem resistance was significant in P. aeruginosa and A. baumannii, with CHROM agar KPC showing highest detection sensitivity. Multidrug resistance was common, and only colistin and tigecycline were partially effective. Continuous surveillance using phenotypic methods and rational antibiotic use are essential to manage rising resistance in clinical settings.

Burn injuries in children represent a significant clinical challenge due to their unique anatomical and physiological characteristics, including thinner skin, higher risk of fluid imbalance, and greater susceptibility to infection and scarring. Effective wound management is crucial to promote rapid healing, minimize pain, prevent complications, and improve long-term functional and aesthetic outcomes. Among the various dressing methods, amniotic membrane (AM) has emerged as a promising biological dressing due to its rich extracellular matrix, growth factors, anti-inflammatory properties, and immunological safety. This review critically examines the clinical perspectives of AM dressing in comparison to conventional and advanced wound dressings, including silver sulfadiazine, hydrocolloids, and paraffin gauze, in paediatric burn care within tertiary healthcare setups. Key outcomes, including epithelialization rate, infection control, pain reduction, frequency of dressing changes, hospital stay, and scar formation, are analyzed to evaluate the effectiveness and practicality of AM in paediatric populations. The review also addresses challenges related to AM preparation, storage, and application, highlighting gaps in current research and opportunities for future studies. The evidence suggests that AM dressing offers significant advantages in paediatric burn management, particularly in enhancing healing outcomes and patient comfort, and may represent a valuable adjunct or alternative to conventional dressing methods in tertiary care settings.

Background: Sigmoid volvulus is a life-threatening abdominal emergency and one of the most common causes of large bowel obstruction. Despite its frequency in endemic regions such as India, literature assessing morbidity and mortality factors remains sparse. Objective: To assess the clinical, radiological, and perioperative factors associated with morbidity and mortality in patients with sigmoid volvulus. Methods: A prospective cross-sectional study was conducted from November 2022 to May 2025 at Government Erode Medical College and Hospital Perundurai. Fifty patients with radiologically confirmed sigmoid volvulus were enrolled and divided into two groups: Group A (with peritonitis, n=18) and Group B (without peritonitis, n=32). Demographic, clinical, radiological, operative, and postoperative outcomes were analyzed using IBM SPSS v23. Mann-Whitney U and chi-square tests were applied, with p<0.05 considered statistically significant. Results: The mean age of patients with peritonitis was 56.1 years compared to 51.7 years in those without peritonitis. Males predominated across both groups. Patients with peritonitis had significantly longer duration of symptoms, operative time, and postoperative hospital stay. Radiologically, acute intestinal obstruction and hollow viscus perforation were significantly more common in peritonitis, with Hartmanns procedure being the most frequent surgery performed. Comorbidities such as diabetes and hypertension were frequent but not statistically significant predictors. Complications including leucocytosis and bowel necrosis were significantly higher in peritonitis. Mortality occurred in three patients (6%), all in the peritonitis group. Mortality was significantly associated with older age and longer duration of symptoms. Conclusion: Duration of symptoms before hospital presentation and advanced age are strong predictors of morbidity and mortality in sigmoid volvulus. Early diagnosis and timely intervention are critical to improve outcomes.

Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is an emerging multidrug-resistant pathogen in intensive care units (ICUs), particularly in cases of ventilator-associated pneumonia (VAP). Its resistance limits therapeutic options and is linked to poor clinical outcomes, including prolonged hospital stays and increased mortality. This study aimed to detect CRPA in VAP patients and evaluate its impact on clinical outcomes in a tertiary care hospital. Materials and Methods: A prospective observational study was conducted over 12 months in the ICU of a tertiary care teaching hospital. Adult patients (≥18 years) meeting the Centers for Disease Control and Prevention (CDC) diagnostic criteria for VAP and with culture-confirmed Pseudomonas aeruginosa were included. Endotracheal aspirates and bronchoalveolar lavage specimens were collected under aseptic precautions and processed using standard microbiological techniques. Carbapenem resistance was determined by disc diffusion and confirmed by minimum inhibitory concentration (MIC) testing as per CLSI guidelines. Demographic data, comorbidities, treatment regimens, length of ICU stay, and patient outcomes were recorded. Statistical analysis was performed using SPSS v26.0, with p-values <0.05 considered significant. Results: A total of 96 patients with culture-confirmed P. aeruginosa VAP were included. The prevalence of carbapenem resistance was 38.5% (n = 37). Patients with CRPA had a significantly longer mean ICU stay (18.4 ± 5.3 days) compared to those with carbapenem-sensitive isolates (12.6 ± 4.1 days, p<0.001). The overall mortality rate was 39.5% in the CRPA group versus 18.6% in the sensitive group (p=0.021). Multivariate analysis identified CRPA infection, presence of septic shock, and higher APACHE II scores as independent predictors of mortality (p<0.05). Conclusion: CRPA is a significant pathogen in VAP, associated with prolonged ICU stay and higher mortality. Early detection, strict infection control measures, and judicious antibiotic stewardship are essential to limit its spread and improve patient outcomes.

Background: Thyroid hormones play a crucial role in growth, development, and overall metabolic function. Both hyperthyroidism and hypothyroidism can result in menstrual irregularities and reproductive health issues. Thyroid disorders accounts for around 11-13% in female population of reproductive age group. Aim: This study aims to evaluate thyroid profile in female patients in the age group of 15-24 years of age attending gynaecology OPD of a tertiary care medical college hospital. Method: An observational, cross-sectional study of 100 female patients of early reproductive age group attending gynaecology OPD fulfilling the inclusion criteria was conducted. Serum TSH, FT3 and FT4 tests were done in the study participants after taking informed consent. Consecutive sampling method was used. Statistical analysis was performed using SPSS software (version 21.0). Categorical data was expressed as frequency and percentage, while continuous data was expressed as mean and standard deviation. Result: Out of 100 patients, 16 were found to have high levels of TSH. Of the 16 hypothyroid patients, 10 (62.5%) were overt hypothyroidism and 6 (37.5%) subclinical hypothyroidism. Among the hypothyroid, 12 subjects were parous. Thus, these aids in risk stratification and management of thyroid disorders. Conclusion: The prevalence of 16% thyroid disorders we found in our study were significantly higher than the prevalence of thyroid disorders in India which is around 11-13%. Hence, all females in young reproductive age group attending gynaecology OPD must be screened for thyroid disorders.

Objective: To evaluate the health-related quality of life, self-esteem and body image in patients diagnosed with dissociative disorder. Methods: Cross sectional study, scheduled for a period of 18 months. Patients between the age group of 18-60 yrs who attended the OPD/IPD of Department of Psychiatry at Chirayu Medical College and Hospital, Bhopal and fulfilling the criteria of Dissociative disorder according to ICD-10, was taken for study. Health Related Quality of Life Scale, Rosenberg Self Esteem Scale and Body Image Concern Inventory Scale was taken for all patients and studied. Results: The findings reveal a statistically significant relationship between self-esteem and quality of life, emphasizing the central role of self-worth in influencing overall well-being in this population. Conversely, body image concerns, although prevalent, did not show a statistically significant correlation with quality of life, suggesting that self-perception in dissociative disorders may be shaped more by internal identity disturbances than by physical appearance alone. Conclusion: As healthcare increasingly embraces patient-reported outcomes, evaluating HRQoL, self-esteem, and body image in dissociative disorders will serve as essential benchmarks for treatment effectiveness, rehabilitation planning, and policy advocacy, placing the patient’s lived experience at the centre of care.

Lower tourniquet cuff pressure based on limb occlusion pressure (LOP) significantly reduces postoperative thigh pain in obese patients undergoing total knee arthroplasty (TKA), without compromising surgical outcomes, according to current clinical evidence. Lower tourniquet cuff pressure guided by limb occlusion pressure has been shown to decrease postoperative thigh pain in obese patients undergoing TKA, while maintaining a comparable bloodless field and overall safety profile as conventional high-pressure protocols. This paper explores the impact of individualized tourniquet pressure settings, integrating randomized clinical data, outcome measures, and statistical analysis on postoperative complications and patient recovery.

Objectives: The present study was to evaluate the microbial profile and antibiotic resistance pattern of the bacterial isolates at tertiary care centre. Methods: All the bacterial isolates of interest were subjected to antibiotic susceptibility testing to different antibacterial agents by standard Kirby-Bauer disc diffusion method using commercially available discs (Hi-media, Mumbai, India) as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The quality control of the antibiotic discs was done by using ATCC strains of E Coli 25922 and S. aureus 25923. The MDR categorizations were done. Results: The most frequently encountered isolates from all samples were E. coli (45.71%), Streptococcus spp. (20%), Staphylococcus aureus (17.14%), Citrobacter spp. (2.86%), Klebsiella spp. (2.86%), Pseudomonas aeruginosa (5.71%), Moraxella catarrhalis (2.86%) and Micrococcus spp. (2.86%). MDR accounted for 82.86% of the total bacterial isolates, higher among the Gram negatives (37.93%) compared to Gram positives (62.07%). Mono drug resistant was seen in 9.52% gram negative and gram-positive bacteria. Conclusions: Multidrug resistance is greater in bacterial isolates. Most isolates are Escherichia coli. Multi drug resistance is more common in gram negative bacteria. Hence, drug resistances are higher due to misuse of antibiotics, over-prescription, self-medication, and over-the-counter sales, the absence of standardized guidelines for antibiotic usage and poor sanitation and hygiene. So that, we should organise health check-up camp time to time in community for awareness of the misuse of antibiotics and drug resistance.

Background: Early diagnosis is critical for effective therapy of Acute Coronary Syndrome (ACS), a cause of significant morbidity and mortality worldwide. The sensitivity of conventional cardiac biomarkers to detect early myocardial damage is often low. In a bid to identify early mild myocardial necrosis, high-sensitivity cardiac troponins (hs-cTn) are now reliable markers for the early diagnosis of ACS. Objectives: For patients presenting with acute chest pain, the present study aimed to establish the diagnostic utility of high-sensitivity troponins compared to conventional diagnostic methods and their role in the early diagnosis of ACS. Materials and Methods: This prospective observational study was conducted over a period of one year in the cardiology department of a tertiary care center. 205 patients with acute chest pain suspected to be due to ACS were enrolled. High-sensitivity cardiac troponin (hs-cTn) was serially tested on admission and three to six hours afterwards, and every patient had a comprehensive clinical assessment and electrocardiogram (ECG). Cardiologists relied on clinical, biochemical, and imaging evidence to make the final diagnosis, which was based on the patient’s clinical presentation. Predictive values, sensitivity, and specificity of hs-cTn’s diagnostic accuracy were assessed. Results: 128 (62.4%) of the 205 patients had a diagnosis of ACS. 116 of the ACS patients had elevated levels of hs-cTn upon admission, and the sensitivity was 90.6% and specificity was 85.2%. Early detection of hs-cTn compared to the use of conventional ECG signs alone significantly increased diagnosis, particularly in non-ST elevation ACS individuals. The substantial negative predictive value confirmed its role in excluding ACS in low-risk patients. Conclusion: Compared with conventional modalities, high-sensitivity troponins performed better in the early diagnosis of ACS. Their use in the initial evaluation of patients with acute chest pain in tertiary care settings makes rapid diagnosis, timely intervention, and enhanced clinical outcomes possible. The management of ACS can be significantly improved by incorporating hs-cTn assays as a part of routine diagnostic testing.

Background: Osteoporosis remains a frequent health issue in postmenopausal women due to the decline in bone mineral density after menopause. This study aimed to determine the prevalence of osteoporosis and osteopenia among women attending an orthopedic outpatient clinic. Methods: A cross-sectional study was carried out over one year (August 2023–2024) among 192 postmenopausal women aged 50–80 years. BMD was measured using DXA at the lumbar spine and femoral neck, with classification based on WHO criteria. Demographic, reproductive, lifestyle, and clinical data were gathered using a structured pro forma. Results: Nearly half of the women had osteopenia (44.8%), while 37.5% were osteoporotic and only 17.7% had normal BMD. Lower BMI, early menopause, low calcium intake, and Vitamin D insufficiency were significantly associated with poor bone health. Physical inactivity and prolonged immobilization further increased the risk. Osteoporosis was observed more frequently at the lumbar spine than at the femoral neck, indicating that the lumbar region may be more sensitive in detecting early bone loss. Conclusion: Osteoporosis and osteopenia are highly prevalent in postmenopausal women, underscoring the need for early screening and preventive interventions.

Background: Postoperative pain is a common complication that affects recovery, patient comfort, and overall outcomes. Effective pain management using a combination of opioid and non-opioid analgesics can improve recovery and reduce side effects. This study aimed to assess analgesic practices and trends in pain scores in surgical patients. Methods: An observational study was conducted at a tertiary care hospital over one year, including 212 patients undergoing elective or emergency surgeries. Demographic details, type of surgery, analgesics administered, and pain scores at 6, 12, 24, and 48 hours were recorded using the Numeric Rating Scale. Analgesics were classified as opioid or non-opioid, including combination therapies. Data were analyzed using descriptive statistics. Results: Of the 212 patients, 130 (61.3%) were female and 82 (38.7%) males, with a mean age of 39.2 ± 12.8 years. Elective surgeries accounted for 60.8% and emergency surgeries for 39.2%. All patients received opioids, 190 (89.6%) received non-opioids, and tramadol and paracetamol were administered to all patients. Mean NRS scores decreased from 7.88 at 6 hours to 5.12 at 48 hours, showing effective pain control. Conclusion: Multimodal analgesia effectively reduces postoperative pain over 48 hours in elective and emergency surgical patients.

Background: Neonatal seizures are the most common neurological emergency in the neonatal period and often indicate serious underlying pathology. Their clinic-etiological profile varies across populations, and early recognition is critical for improving outcomes. Aim and Objectives: To evaluate the clinical presentation, etiological factors, and short-term outcomes of neonatal seizures in a tertiary care Neonatal Intensive Care Unit (NICU). Materials and Methods: This prospective observational study was conducted over one year in the NICU of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. A total of 53 neonates with clinically suspected or confirmed seizures were included. Detailed clinical history, examination, and relevant investigations such as laboratory tests, neuroimaging, and EEG were performed. Data were analysed using SPSS version 25.0, with descriptive and inferential statistics applied as appropriate. Results: Of the 53 neonates, males predominated (58.5%), and most were term (67.9%). The majority had seizures between 2–7 days of life (50.9%). Subtle seizures (37.7%) were the most common type, followed by clonic (28.3%) and tonic (20.8%) seizures. Hypoxic-ischemic encephalopathy was the leading cause (39.6%), followed by metabolic disturbances (18.9%), intracranial hemorrhage (15.1%), and CNS infections (13.2%). At discharge, 67.9% recovered without sequelae, 20.8% had neurological deficits, and mortality was 11.3%, primarily among neonates with HIE and intracranial hemorrhage. Conclusion: HIE remains the predominant cause of neonatal seizures, with subtle seizures as the most frequent clinical type. Despite most neonates recovering, a significant proportion developed neurological impairment or died. Early etiological diagnosis and timely management are essential to improve neonatal outcomes in NICUs.

Background and Aim: Anterior cruciate ligament (ACL) avulsion fractures require prompt surgical intervention for restoring knee stability and function. This study evaluates a new fixation technique’s clinical efficacy. Material and Methods: A prospective observational study involving 50 patients was conducted at a tertiary care hospital in Rajkot. Patients underwent fixation using a novel surgical technique and were followed for one year. Clinical evaluations included IKDC scores, range of motion, and clinical tests. Results: The study found excellent postoperative extension in all patients, with 94% achieving excellent or good IKDC scores. The majority of injuries resulted from road traffic accidents, and Type I fractures were most common. The new technique demonstrated strong performance across functional parameters. Conclusion: The new ACL avulsion fixation method offers excellent recovery outcomes in diverse patient profiles, suggesting its suitability for routine orthopedic application.

Introduction: One of the main risk factors for cardiovascular morbidity and mortality and renal dysfunction is Hypertension, which is a serious global health concern.  Early on, the illness is frequently asymptomatic, but it is linked to gradual harm to important organs such as the brain, retina, kidneys, and heart. Preventation of long term complications requires early detection of hypertension and diagnosis of subclinical organ damage. Aims: To detect the Presence and levels of Micro albumin in urine (Spot Urine ACR 30-300) in newly detected Hypertensive patients (>=140/90mm of Hg) and its association with Systolic Blood Pressure(SBP) and Pulse Pressure(PP) attending Out Patient Department(OPD) and admitted in Indoor patient Department (IPD) of Medicine Dept. Of COMJNM&H. Kalyani Nadia, West Bengal. Materials & Methods: The study was designed as an observational cross-sectional study and was conducted in the Department of Medicine, JNM College of Medicine, West Bengal, over a period of one year, from December 2019 to December 2020, with a total sample size of 124 patients. Result: In our study, The mean ± SD of pulse pressure was 59.05 ± 9.46 mmHg in patients without microalbuminuria and 70.77 ± 12.52 mmHg in those with microalbuminuria, showing a statistically significant difference (P < 0.0001). Conclusion: In our study, microalbuminuria was present in 21% of newly diagnosed hypertensive patients, most commonly in the 41–50-year age group, with a male preponderance but no significant gender difference. It showed strong associations with smoking, elevated pulse pressure, impaired fasting blood sugar, and abnormal ECG findings, indicating early target organ involvement. These findings emphasize the importance of routine screening for microalbuminuria in newly diagnosed hypertension for early risk assessment and prevention of cardiovascular morbidity.

Background: Superficial vascular malformations are congenital vascular anomalies that includes venous, arteriovenous, lymphatic, and mixed venolymphatic subtypes as well as vascular tumors such as hemangiomas. These lesions present with significant clinical challenges owing to their varied presentation, functional impairment, and potential for complications such as bleeding and disfigurement. Early and accurate diagnosis is crucial for appropriate management. Aim: The purpose of this study is to evaluate the role of ultrasound (USG) and Doppler studies in evaluation of superficial vascular malformations. The objective is to highlight the strengths, limitations, and clinical relevance of these imaging modalities. Methods: A prospective observational study was conducted on patients clinically suspected of having superficial vascular malformations. Gray-scale USG was used to assess lesion morphology, echotexture, margins, and compressibility. Color and spectral Doppler were employed to characterize flow dynamics, vascularity, and arterial/venous waveforms. Data were analyzed for lesion classification into high-flow and low-flow malformations, with correlation to clinical presentation and available MRI findings. Results: Venous malformations constituted the largest proportion of cases, followed by lymphatic malformations and hemangiomas. USG and Doppler demonstrated high sensitivity in differentiating high-flow from low-flow lesions, with diagnostic accuracy exceeding 90% when compared with MRI and clinical correlation. The techniques were found to be non-invasive, cost-effective, and widely accessible. Conclusion: USG and Doppler remain indispensable first-line imaging modalities in the evaluation of superficial vascular malformations. Their ability to provide real-time morphological and hemodynamic assessment makes them vital tools in guiding treatment strategies and follow-up. These modalities are recommended as the primary imaging approach, especially in resource-limited settings.

Background: Recurrent aphthous ulcers (RAU) are one of the most common painful oral mucosal lesions, characterized by episodic appearance and spontaneous healing but with significant discomfort and impact on quality of life. Although the exact etiology remains unclear, immune dysregulation plays a pivotal role. Topical corticosteroids remain the conventional first-line therapy, while newer agents such as topical immunomodulators have shown promising results in reducing recurrence and pain intensity. This study aimed to compare the clinical efficacy of topical corticosteroids and topical immunomodulators in the management of RAU. Materials and Methods: A randomized controlled clinical study was conducted on 90 patients diagnosed with minor RAU. Participants were divided into two groups: Group A (n=45) received 0.1% triamcinolone acetonide in orabase, and Group B (n=45) received 0.03% tacrolimus ointment. Treatment was applied twice daily for 10 days. Parameters assessed included ulcer size reduction, pain intensity using Visual Analogue Scale (VAS), healing time, and recurrence rate over a 3-month follow-up. Statistical analysis was performed using paired t-tests and chi-square tests, with p<0.05 considered significant. Results: Both groups demonstrated significant reduction in ulcer size and pain scores. Mean ulcer size decreased from 6.2 mm to 1.4 mm in Group A and from 6.0 mm to 0.8 mm in Group B by day 10. VAS pain scores reduced from 7.8 to 2.1 in Group A and from 7.6 to 1.5 in Group B. Mean healing time was 8.2 ± 2.1 days for Group A and 6.4 ± 1.8 days for Group B, showing a statistically significant difference (p=0.01). Recurrence at 3 months was observed in 28.9% of Group A patients versus 17.8% in Group B (p=0.04). Conclusion: Both topical corticosteroids and topical immunomodulators are effective in managing recurrent aphthous ulcers, but topical immunomodulators demonstrated superior outcomes in terms of faster healing and reduced recurrence. They may be considered a valuable alternative in patients with frequent or severe RAU episodes.

Background: Endotracheal intubation is considered the gold standard for airway management, but it is associated with complications. Supraglottic airway devices (SGADs) such as I-GEL and LMA Blockbuster offer practical alternatives. Aim and Objectives: This study aimed to compare the clinical performance of I-GEL and LMA Blockbuster in adult patients undergoing elective surgery under general anaesthesia. The primary objectives were to evaluate oropharyngeal leak pressure and hemodynamic changes, while secondary objectives included ease of insertion, insertion attempts, gastric tube placement, and postoperative complications. Methods: This prospective, randomized study included 80 ASA I–II patients aged 18–65 years undergoing short-duration elective surgeries at SVBP Hospital, LLRM Medical College, Meerut. Patients were randomly allocated into two groups: Group A (I-GEL, n=40) and Group B (LMA Blockbuster, n=40). Outcome measures included insertion characteristics, oropharyngeal leak pressure (OLP), hemodynamic parameters, and postoperative complications. Statistical analysis was performed using SPSS v15.0, with p<0.05 considered significant. Results: Baseline demographics (age, sex, BMI) were comparable between groups (p>0.05). Ease of insertion was similar in both groups (95% easy insertions), with first-attempt success in 97.5% of I-GEL cases versus 90% in Blockbuster cases (p=0.166). Hemodynamic parameters (HR, SBP, DBP, MAP, SpO₂) were stable and not significantly different. However, the LMA Blockbuster demonstrated significantly higher OLP (27.9 ± 1.97 cmH₂O) compared to I-GEL (22.3 ± 2.05 cmH₂O, p<0.001). Postoperative complications were minimal and comparable, with only mild sore throat and dysphagia reported. Conclusion: Both I-GEL and LMA Blockbuster are safe and effective for airway management during elective surgeries. While overall performance was comparable, the LMA Blockbuster achieved higher sealing pressures, suggesting an advantage in situations requiring positive pressure ventilation.

Introduction: Central neuraxial blocks are one of the most commonly and routinely used anaesthetic technique globally. Various adjuvants have regularly been used as an adjuvant to potentiate the efficacy of the local anaesthetics and to prolong the duration of action. Various studies have been done on Fentanyl that shows increase in the analgesia without unwanted side effects. The increasing demand for spinal anaesthesia in lower limb surgeries and importance of pharmacokinetic and pharmacology of new drugs have made to appreciate the importance of studying the effects of new adjuvant drugs in spinal anaesthesia. Hence the study was conducted. Methodology: The present prospective observational study was conducted amongst 105 patients undergoing lower limb orthopedic surgeries during September 2020 to December 2022 at a tertiary care hospital. Patients were divided as follows: Group A: receiving 15 mcg intrathecal Fentanyl with hyperbaric Bupivacaine 15mg. Group B: receiving 25 mcg intrathecal Fentanyl with hyperbaric Bupivacaine 15mg. Group C: as control receiving hyperbaric bupivacaine 15mg. Results: The mean duration of surgery in group A was 105min, in group B it was 104min, and in group C 106 min. Out of the total subjects in group A 16 (45.7%) subjects achieved T6, 13 (37.1%) subjects in group B achieved T6 while in the case of group C, 14 (40%) of subjects achieved T6. The mean duration of time for two-segment regression from the highest sensory level in group A was 72min; in group C it was 69.2min; in group B it was higher than the remaining two groups 83.7min with statistical significance. The mean duration of postoperative analgesia in group A was 217.6min; in group C it was 213.0min; in group B it was higher than the remaining two groups 271.4 min statistical significance. The mean arterial pressure among Group A, Group B & Group C at a preoperative time, 5,15,30,45, and 90 minutes. A greater fall in MAP was seen in group B than in group A & group C at 5, & 15 minutes. The comparison of the mean of MAP among 3 groups at 5, 15, 30, 45, & 90 minutes was found to be statistically significant. Conclusion: We concluded that subjects receiving 25 mcg intrathecal Fentanyl with hyperbaric Bupivacaine 15mg provided better anesthesia and prolonged postoperative analgesia for spinal anesthesia for lower limb orthopaedic surgeries.

Background: Hepatitis B virus (HBV) infection is a global public health concern, particularly in low-resource settings like Nepal, where surveillance and preventive measures are crucial. Although Nepal is categorized as a low-prevalence country for HBV, assessing its prevalence in hospital settings can guide targeted interventions and policy implementation. Objective: This study aimed to determine the seroprevalence of HBV infection among patients at Private clinic at Choudhary Sarkar Baksh Polyclinic, Nepal, and identify demographic patterns and associated risk factors. Method: A cross-sectional study was conducted among 50 participants at Private clinic at Choudhary Sarkar Baksh Polyclinic, Nepal over six months. Participants were systematically selected and tested for hepatitis B surface antigen (HBsAg) using enzyme-linked immunosorbent assay (ELISA) kits. Demographic and risk factor data were collected through a structured questionnaire, and statistical analyses were performed to identify significant associations. Result: This study examines the demographic characteristics, clinical features, laboratory findings, and management strategies of participants diagnosed with Hepatitis B at Private Clinic at Choudhary Sarkar Baksh Polyclinic. A total of 50 participants, consisting of 27 males (54%) and 23 females (46%), were enrolled. The majority of participants (60%) were aged between 21-40 years, with an average age of 34.6 ± 9.8 years. Clinical presentations included jaundice (38%), fatigue (30%), and abdominal pain (24%). Serologically, all participants were HBsAg positive, with 24% showing active viral replication (HBeAg positive). Elevated liver enzymes were common, with 70% exhibiting increased ALT and AST levels. Management strategies included antiviral therapy for 40% of participants, while 60% received counseling and lifestyle modifications. The study highlights the demographic and clinical profile of Hepatitis B patients and emphasizes the importance of effective management and regular follow-ups to improve patient outcomes. Conclusion: This study demonstrates a low seroprevalence of HBV infection among patients at Private clinic at Choudhary Sarkar Baksh Polyclinic, Nepal, consistent with Nepal’s status as a low-prevalence country. Although the prevalence is low, ongoing surveillance, vaccination campaigns, and public awareness programs are essential to sustain and further reduce HBV transmission in the region.

Objective: To study the impact of postpartum hemorrhage (PPH) on maternal near miss and mortality in patients referred with PPH at a tertiary care center. Methods: A retrospective cross-sectional study was conducted in a tertiary care hospital, reviewing records from women referred with PPH over a two-year period. Data included patient demographics, referral delays, risk factors, interventions, and outcomes. Maternal near miss was defined per WHO criteria. Results: Among 124 women with PPH, 64 were referred. All mortality cases occurred in the referred group, with a mortality rate of 2.5%. Near miss events occurred more frequently among referred cases (37%) than in-hospital cases (13%). Major triggers for adverse outcomes included delayed referral (over 6 hours in most cases), prior maternal anemia, and lack of active management of the third stage of labor. ICU admissions, advanced transfusions, and surgical interventions were more frequently required among referred cases. Case fatality rate for PPH in the studied tertiary center ranged from 2.5% to 8% in large survey. Conclusion: Strengthened peripheral obstetric care, timely referral, optimally equipped emergency response, and continuous professional training is the key to reduce PPH deaths.

Introduction: Cholesteatoma is a destructive temporal bone lesion formed by keratinizing squamous epithelium within the middle ear and mastoid, causing chronic infection, bone erosion, and possible intracranial complications. Though less common in children than adults, pediatric cholesteatoma poses greater challenges due to its aggressive growth and higher recurrence rates. Aims: The aim of this study was to evaluate and compare the outcomes of endoscopic ear surgery and the traditional microscopic approach in the management of pediatric cholesteatoma. The focus was on assessing operative parameters, intraoperative visualization, postoperative hearing results, recurrence rates, and overall effectiveness of both techniques, with the objective of determining whether the endoscopic method offers significant advantages over the conventional microscopic approach in children. Methods: The present study was a prospective comparative observational study conducted in the Department of Otorhinolaryngology, Government Medical College, Pali (Rajasthan), over a period of one year. A total of 50 paediatric patients with cholesteatoma were included and divided into two groups: Group A (n=25) underwent Endoscopic Ear Surgery (EES), while Group B (n=25) was treated using the Traditional Microscopic Approach (TMA). Results: In this study, 50 pediatric patients with cholesteatoma were equally divided into the endoscopic (n=25) and microscopic (n=25) groups. The mean age was similar between the groups (12.1 ± 3.4 vs. 11.8 ± 3.6 years, p=0.74). Both cohorts showed male predominance (56% vs. 60%), with no significant difference in sex distribution (p=0.78). Conclusion: Both approaches were effective for managing pediatric cholesteatoma, but the endoscopic technique showed clear advantages, including shorter operative time, improved intraoperative visualization, and superior postoperative hearing outcomes with better air-bone gap closure and hearing gain.

Background: Patients with hypertensive pregnancy disorders often exhibit impaired regulation of the autonomic nervous system. HRV measurement provides a non-invasive method to assess autonomic control of the heart. Objective: The objective was to determine if HRV is capable of detecting variations in autonomic nervous system activity between women with hypertensive pregnancy disorders and normotensive pregnant controls. Methods: A comprehensive literature search was conducted in EMBASE, Medline, and the Cochrane CENTRAL database to identify studies evaluating HRV in PIH cases or those with a prior history of PIH, compared with normotensive pregnant women.  The data is taken from original articles published 2016 onwards. Results: The systematic search initially identified more than 50 publications, original & review articles of which 5 fulfilled the inclusion criteria. These studies involved a total of 150 women with hypertensive pregnancy disorders and 150 normotensive controls. Despite the variability in research, a consistent finding emerged: women with preeclampsia exhibited significantly reduced overall heart rate variability (HRV) compared with normotensive pregnant controls. In addition, several studies indicated a trend toward an increased low-frequency to high-frequency (LF/HF) ratio in women with preeclampsia, suggesting a relative shift toward sympathetic predominance. Conclusion: Evidence from this review supports the concept that PIH & preeclampsia is marked by sympathetic hyperactivation in conjunction with parasympathetic withdrawal.

Background: Procedural sedation and analgesia (PSA) are integral to pediatric intensive care, enabling children to undergo diagnostic and therapeutic procedures with minimal distress. A variety of drugs including ketamine, propofol, midazolam-fentanyl, dexmedetomidine, and their combinations are used, each with distinct efficacy and safety profiles. There is limited comparative data from Indian PICU settings, making evaluation of outcomes crucial. Aim: To compare the efficacy, safety, and recovery characteristics of various sedative and analgesic regimens used for procedural sedation in children admitted to the PICU. Methods: This prospective comparative study was conducted at Tx Children’s Hospitals, Hyderabad, between June 2024 and July 2025. A total of 165 children requiring PSA for procedures such as lumbar puncture, central venous catheter insertion, bone marrow aspiration, endoscopy, and imaging were included. Patients received one of the following regimens: ketamine, propofol, midazolam-fentanyl, dexmedetomidine, or ketamine-dexmedetomidine combination. Outcomes assessed included onset and depth of sedation, adequacy of analgesia, recovery time, procedural success, and adverse events. Statistical analysis was performed using SPSS version 26.0, with p < 0.05 considered significant. Results: Propofol provided the fastest onset (1.2 ± 0.4 minutes) and shortest recovery (18.6 ± 4.3 minutes), but was associated with transient desaturation and apnea in 15% of patients. Ketamine showed effective sedation with superior analgesia and airway safety, though recovery was longer (32.8 ± 6.1 minutes) and emergence reactions occurred in 10.9%. The midazolam-fentanyl group had moderate onset (3.5 ± 0.8 minutes) and recovery (26.4 ± 5.2 minutes), with respiratory events in 11%. Dexmedetomidine provided cooperative sedation with minimal respiratory events but had delayed onset (6.4 ± 1.2 minutes) and bradycardia/hypotension in 25%. The ketamine-dexmedetomidine combination yielded balanced sedation and analgesia with fewer emergence reactions. Overall, adverse events occurred in 16.4% of cases, but no child required intubation or resuscitation. Conclusion: This study demonstrated that while propofol is optimal for short procedures due to rapid onset and recovery, ketamine and its combinations remain superior for painful and prolonged procedures owing to better analgesia and safety. Dexmedetomidine is useful for cooperative sedation but requires caution due to cardiovascular effects. No single drug was ideal, reinforcing the need for individualized drug selection and standardized protocols to optimize safety and efficacy in pediatric intensive care.

Background: Multidrug resistance among Gram-negative bacilli (GNB) is rising rapidly, contributing to both hospital-acquired and community acquired infections. Microorganisms are constantly finding new resistance mechanisms to survive the effects of antibiotics. One of the most predominant mechanisms is resistance to the beta lactam antibiotics in gram negative bacilli (GNB) is the production of extended spectrum β-lactamase (ESBL), which is responsible for the resistance to the 3rd generation of cephalosporin. Aims & Objectives: To determine prevalence, antibiotic profile and associate factors of ESBL and carbapenemase producing gram-negative bacilli from various samples received at Microbiology laboratory in tertiary care hospital. Methodology: The present study was conducted at rural tertiary care hospital. The study was done from Jan– 2024 to December– 2024. Isolates from clinical specimen such as blood, urine, sputum, pus, endotracheal aspirate, sterile body fluid were analysed. Results: Total 1631 samples were received, among them 607 were positive. Out of 607 samples, 150(24.71%) samples were gram positive and 450(74.13%) were gram negative bacilli. Among the isolates of Klebsiella species, 39.3 % of the isolates were ESBL producers and 16.5% of the isolates were Carbapenemase producer. Among the isolates of E. coli, 26.2% of the isolates were ESBL producers and 9.9 % of the isolates were Carbapenemase producer. Ward has the highest total number of CRE (62.80%) isolates, with Pseudomonas spp. being the most dominant species here. The ICU shows a high prevalence of Klebsiella spp., making it the most frequently isolated CRE organism in this area. Carbapenems and aminoglycosides were the most sensitive drug for all the gram-negative isolates. Fluoroquinolones like levofloxacin remain effective against Pseudomonas (71%) and Acinetobacter (98%), but less so for E. coli and Klebsiella.Colistin shows 100% sensitivity. Conclusion: The prevalence of beta-lactamase and carbapenemase production among gram negative bacilli isolates from clinical infections, highlighting significant findings in both the distribution of resistant strains and their mechanisms of resistance, and the broader implications for clinical treatment and healthcare systems. A total of 607 participants were included, with a higher representation of males (52.71%) compared to females (47.28%). The study shows high prevalence of ESBL (50.25%) and carbapenemase (19.94%) producing gram-negative bacilli, particularly among Klebsiella spp., E. coli, and Pseudomonas spp., underscores a serious threat to effective treatment of infections.

Since its introduction in 1972, the Friedewald equation has been a foundational tool for estimating low-density lipoprotein cholesterol (LDL-C) using values for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Its affordability and ease of use have contributed to its widespread adoption. However, its assumption of a constant ratio between triglycerides and very-low-density lipoprotein cholesterol (VLDL-C) can lead to inaccuracies, particularly in cases involving high triglyceride levels, low LDL-C concentrations, non-fasting samples, or dyslipidemia. This review assesses both the advantages and the limitations of the Friedewald method, while also examining newer alternatives such as the Martin-Hopkins and Sampson-NIH formulas, direct LDL-C testing techniques, machine learning-based estimations, and non-fasting lipid evaluations. These innovations aim to improve diagnostic accuracy across various populations and align with modern precision medicine approaches. The review also outlines clinical applications, existing knowledge gaps, and future pathways for enhancing global LDL-C assessment strategies

Introduction: Head injury is a significant public health problem worldwide and is predicted to surpass many diseases as a major cause of death. Data indicates that majority of traumatic brain injury cases (60%) are a result of road traffic accidents, followed by falls (20-30%), and violence (10%). Worldwide, traumatic brain injury (TBI) is the single largest cause of death and disability following injury. Computerized tomography (CT) is the primary screening modality of investigations in head trauma victims. Studies are needed to know the precision and accuracy of a CT scan, which can be achieved only by comparing a CT Scan with post-mortem findings in non-survivor cases. Aim of the study: The aim of this study was to make a comparison in findings of antemortem CT Scan and findings of post mortem examination with calculation of disparity in head injury cases with their causative factors. Material and Method: All fatal cases of head injury subjected for post-mortem examination where antemortem CT scan reports were available taken up for study. Post mortem examination of each case was carried out as per the standard process and the various types of injuries to the scalp, skull bone, haemorrhage in meninges and injury to the brain was recorded and photographed and the respective CT Scan report was collected. Further a comparative evaluation of post mortem finding of the head injury with antemortem CT Scan report was analysed and disparity in antemortem CT Scan and post-mortem findings was calculated. Result: Out of 100 cases, the most interesting causative factor which was came across during the study was the Road Traffic Accidents (90%) followed by assault (6.00%) and rest 4.00% fall from height. Disparity in CT Scan findings and autopsy was observed in all cases. The disparity was maximum 100% seen in laceration cases followed by 50% in ICH cases. Minimum disparity 8.57% was seen in SDH cases. Conclusion: Disparity in CT Scan findings and autopsy was observed in all types of cases during the study. The disparity was maximum 100% seen in laceration cases followed by 50% in ICH cases. Disparity can be minimised by using good quality CT Scan machines and properly trained medical and paramedical staff, who deals with reporting of radiological images and machine operating procedures.

Introduction: Chronic obstructive pulmonary disease (COPD) being the most common non-communicable disease in the world with mortality around 5.4 million per year. Vitamin D being a fat soluble vitamin, is drastically reduced in COPD patients and its prevalence of varies from 31-77%, among COPD patients. The purpose of the study is to bring further more information about vitamin D status among COPD patients. Methodology: With prior institutional ethical committee approval, a case control study was carried out from February 2018 to June 2019 among 50 COPD cases and 50 controls with age group of more than 40 to 75 years attending the outpatient & inpatient Department of Pulmonary medicine and General medicine, Karpaga Vinayaga Institute of Medical Sciences. Results: Among the cases (n=50), 15 (30%) participants had vitamin d level between 10 to 19.99, 5 (10%) had between 20 to 29.99 and 30 (60%) had vitamin level >30, Whereas among the controls (n=50), 1 (2%) participant had vitamin d level 10 to 19.99, 5 (10%) had between 20 to 29.99 and 44 (88%) had vitamin d level >30. The difference in the proportion of vitamin d level between study groups was statistically significant (P value 0.001). Vitamin D levels among grade I severity COPD cases is 44.87±8.03, followed by 34.64±9.45 among grade II COPD, 32.73±13.03 among grade III COPD cases and 14.87±1.65 with grade IV severity cases. The vitamin D levels are inversely proportionate with the severity of disease and it is statistically significant. Out of 50 COPD cases, 7(14%) cases had 1-2 exacerbations, 28 (56%) cases had 3-5 exacerbations and 15 cases (30%) had > 5 exacerbations/year and with their mean Vitamin D levels were 39.36, 36.40, 21.05 respectively and is found to be significant with a P- value of 0.001. Conclusion: The study concludes that Vitamin D hypovitaminosis is common among COPD patients than control group. The severity of Vitamin D hypovitaminosis is directly proportionate with the severity of COPD and number of exacerbations.

Background: Acute non-traumatic intracerebral hemorrhage (ICH) is a critical neurological emergency associated with high morbidity and mortality. Early diagnosis using computed tomography (CT) can offer essential insights into hematoma characteristics that influence clinical outcomes. Objective: To assess CT imaging features and correlate them with clinical outcomes in patients with acute non-traumatic ICH. Materials and Methods: This prospective cohort study included 100 adult patients with acute non-traumatic ICH admitted within 24 hours of symptom onset. CT head scans were analyzed for hematoma location, volume, intraventricular/subarachnoid extension, midline shift, and herniation. Clinical presentation was assessed using Glasgow Coma Scale (GCS) at admission, and outcomes were measured using the Modified Rankin Scale (mRS) at 30 days. Statistical analysis was done using SPSS version 22.0. Results: The most common hematoma site was the basal ganglia (54%), followed by the thalamus (24%). Intraventricular extension was present in 43% of cases, midline shift ≥5 mm in 42%, and herniation in 11%. A statistically significant correlation was observed between higher hematoma volume and poor outcomes (mean volume in deceased patients: 42.82±24.27 cc; p<0.01). GCS at admission negatively correlated with mRS scores at discharge (p<0.001). Mortality at 30 days was 30%. Poor clinical outcomes were significantly associated with intraventricular extension, midline shift, herniation, and lower GCS scores at admission. Conclusion: CT imaging provides critical prognostic information in acute non-traumatic ICH. Hematoma volume, location, and associated features like midline shift and intraventricular extension significantly influence short-term outcomes. Early and comprehensive CT evaluation is essential for timely therapeutic decisions and predicting prognosis.

Background: Osteoarthritis (OA) is a prevalent musculoskeletal disorder characterized by joint pain and functional impairment. Traditional therapies often involve NSAIDs, which can cause adverse effects. Natural alternatives such as Boswellia serrata (BS) and Natural Eggshell Membrane (NEM) are emerging as potential treatments with fewer side effects. Aim: To compare the efficacy of Boswellia serrata and Natural Eggshell Membrane in reducing pain in patients with knee OA. Methods: Prospective, observational study was conducted at King George’s Medical University, Lucknow, over 18 months. A total of 117 patients were divided into three groups: Group A received Etoricoxib alone, Group B received Etoricoxib with NEM (Natural egg shell membrane), and Group C received Etoricoxib with BS (Boswellia serrata). Pain levels were assessed using the Visual Analogue Scale (VAS) at baseline, 60 days, and 120 days. Statistical analyses were performed using SPSS version 26. Results: All groups showed significant reductions in VAS scores over time (p<0.001). The greatest pain reduction was observed in Group C (BS), followed by Group B (NEM), with Group A showing the least improvement. Intergroup analysis showed statistically significant differences at 60 and 120 days, favouring BS over NEM and control. Conclusion: Both BS and NEM demonstrated significant efficacy in reducing knee OA pain, with BS showing superior results. These findings support their role as effective complementary treatments for OA.

Introduction: The present study was conducted to compare the efficacy, intubating conditions, hemodynamic effects and recovery profile of Atracurium versus Cisatracurium in patients undergoing surgeries under General Anaesthesia. A total of 56 patients were equally divided into two groups and evaluated across various parameters including time of onset, duration of action, recovery time, intubating conditions, heart rate, blood pressure, oxygen saturation, end-tidal CO₂, signs of histamine release, and side effects. Both groups were comparable in terms of age, gender, weight, and ASA grade distribution. Material & Method: A randomised controlled trial titled “A Comparative Study of the Efficacy of Atracurium and Cisatracurium in Adults Undergoing Elective Surgeries” were carried out at the Department of Anaesthesiology, SNR District Hospital, Kolar for a period of 15 months on patients satisfying inclusion criteria and who gives consent for the study. Result: A total of 56 patients were equally divided into two groups and evaluated across various parameters including time of onset, duration of action, recovery time, intubating conditions, heart rate, blood pressure, oxygen saturation, end-tidal CO₂, signs of histamine release, and side effects. Both groups were comparable in terms of age, gender, weight, and ASA grade distribution. Conclusion: The present study was conducted to compare the efficacy, intubating conditions, hemodynamic effects and recovery profile of Atracurium versus Cisatracurium in patients undergoing surgeries under General Anaesthesia. When it comes to neuromuscular inhibition, Cisatracurium outperforms Atracurium in a number of ways. Better intubating circumstances, more stable haemodynamic parameters, a longer half-life, and no adverse effects are all provided with cisatracurium. When compared to atracurium, it offered better consistency and safety. Atracurium is more cost-effective than Cisatracurium and showed a somewhat quicker beginning of action.

Background: Burnout is a significant mental health concern among medical students, adversely affecting academic performance, professional development, and overall well-being. Understanding its prevalence and predictors is essential for designing targeted interventions. Material and Methods: A cross-sectional study was conducted among 385 undergraduate medical students. Participants were selected using stratified random sampling across all years of study. Data were collected using a self-administered questionnaire, including socio-demographic details, academic variables, and the Maslach Burnout Inventory–Student Survey (MBI-SS). Bivariate analysis and multivariate logistic regression were performed to identify predictors of burnout using SPSS version 26.0. A p-value < 0.05 was considered statistically significant. Results: The mean age of participants was 20.8 ± 1.8 years, with 54.5% male students. Overall burnout prevalence was 59.7%. High levels of emotional exhaustion, cynicism, and reduced academic efficacy were observed in 29.8%, 28.6%, and 28.6% of students, respectively. Bivariate analysis revealed higher burnout among final-year students (70%) and hostel residents (64.3%). Multivariate logistic regression identified final-year status (AOR 2.05, 95% CI 1.15–3.65, p = 0.014) and hostel residence (AOR 1.78, 95% CI 1.12–2.83, p = 0.015) as independent predictors of burnout. Gender and socioeconomic status were not significant predictors. Conclusion: Burnout affects a substantial proportion of medical students, particularly those in advanced years and hostel settings. Early identification and institution-based interventions are recommended to reduce burnout and enhance student well-being.

Background: Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) frequently coexist, leading to a distinct overlap syndrome characterized by persistent nasal obstruction, rhinorrhea, and reduced quality of life. Although intranasal corticosteroids (INCS) are the mainstay treatment for AR or CRS individually, their efficacy in AR-CRS overlap remains underexplored. Objective: To evaluate the effectiveness and safety of INCS in patients with AR-CRS overlap. Methods: A prospective observational study was conducted at Adesh Medical College and Hospital, Ambala, from October 2023 to April 2025. A total of 200 patients with clinically and radiologically confirmed AR-CRS overlap received standard-dose INCS for 12 weeks. Symptom severity was assessed using Total Nasal Symptom Score (TNSS), Sino-Nasal Outcome Test (SNOT-22), and Visual Analogue Scale (VAS) at baseline, 6 weeks, and 12 weeks. Adverse effects were also recorded. Results: Significant and progressive symptom improvement was observed. Mean TNSS decreased from 12.3 ± 3.0 at baseline to 5.5 ± 2.1 at 12 weeks (55% reduction), SNOT-22 from 47.8 ± 9.8 to 21.9 ± 7.5 (54% reduction), and VAS from 7.7 ± 1.2 to 3.0 ± 0.8 (61% reduction). Benefits were consistent across age, gender, and comorbid asthma subgroups. Adverse effects were minimal, with mild nasal irritation in 10% of patients and mild epistaxis in 5%. Conclusion: INCS are highly effective and well-tolerated in AR-CRS overlap, providing rapid symptom relief and meaningful improvements in quality of life. Early initiation of therapy can break the cycle of chronic inflammation, prevent complications, and optimize patient outcomes.

Introduction: Breast cancer continues to be the most common malignancy among women globally and represents a significant cause of cancer-related mortality. Its heterogeneity, encompassing diverse molecular subtypes and clinical behaviors, poses considerable challenges in diagnosis, prognostication, and treatment selection. Aims: To investigate the expression of PD-L1 and its association, if any, with the prognosis of breast carcinoma of a patient. Materials and Methods: The present study was an institution based descriptive, cross-sectional and observational study. This Study was conducted fromJanuary 2020 to June 2021 at Medical College & Hospital, Kolkata. Total 52 patients were included in this study. Result: In our study of 52 breast carcinoma patients, PD-L1 expression was not significantly associated with age, socioeconomic status, pain, ulceration, or tumor size. Invasive ductal carcinoma was the predominant subtype (78.8%), followed by lobular (17.3%) and medullary carcinoma (3.8%). A strong association was observed between PD-L1 positivity and HER2 expression, as 75% of HER2-positive cases were PD-L1 positive. Importantly, PD-L1 positivity was linked to more aggressive disease features, including significantly higher nodal involvement (mean 10.88 vs. 4.75, p < 0.0001) and increased distant metastasis, particularly to the lung (31.3%) and bone (12.5%). Conclusion: In conclusion, our study demonstrated that PD-L1 expression in breast carcinoma was not significantly influenced by age, socioeconomic status, tumor size, pain, or ulceration. However, important clinicopathological correlations were noted. PD-L1 expression showed a strong association with HER2 positivity, suggesting a potential link between these biomarkers.

Background: Family planning is a vital component of reproductive health, empowering individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. Contraceptive methods play a key role in reducing maternal and infant morbidity and mortality, controlling population growth, and enhancing the socio-economic status of women. Method: Study was conducted at Shri MP Shah Medical College and Hospital Jamnagar over a period of three months from January 25 to March 25 data was collected Family planning clinic record registered. Results: The most common method of contraception used was barrier contraception (condom) at 30.0%, followed by combined oral contraceptives (COC) at 26.0%. Sterilisation was the third most common method, accounting for 19.6% of users. The least common methods were Depot Medroxyprogesterone Acetate (DMPA) injections and Intrauterine Devices (IUD), which were used by 12.4% and 12.0% of women, respectively. Conclusion: Barrier methods of contraception are very well accepted in our socio-demographic setup mainly because of their easy usage, availability, affordability, the absence of hormonal side effects, and an additional benefit of protection against Sexually Transmitted Infections. Furthermore, their lack of impact on a woman’s future fertility makes them a favorable choice of contraception.

Background: As postpartum iron deficiency anemia is observed in about 65% of women in India, it is the major contributing factor and indirect cause of maternal death. Postpartum anemia may lead to postpartum depression, stress, anxiety and cognitive impairment. Adequate treatment of anemia in postpartum period will have improved life quality in women in child bearing age so this study was designed with the objective to compare the safety and efficacy of intravenous FCM versus iron sucrose in treatment of postpartum iron deficiency anemia. Methods: It was a prospective observational study of postpartum women (within 10 days of delivery) with iron deficiency anemia who delivered in Guru Gobind Singh Govt. Hospital, Jamnagar. A sample size of 194 women was estimated based on prevalence of anemia which is 65% among postpartum women in India including dropout rate of 10% which were further divided into 2 groups. Group 1: iron sucrose group, Group 2: ferric carboxy maltose group. Results: FCM has greater rise in Hb, less side effects, and easy administration of dose as compared to iron sucrose. The rise in Hb with FCM as compared to iron sucrose is (4.6 versus 3.5 respectively). Conclusions: FCM has more safety and efficacy as compared to iron sucrose in treatment of postpartum iron deficiency anemia.

Introduction: Obesity is more in urban middle-aged women than in men due to socioeconomic transition. The prevalence of dyslipidemia especially in middle aged and elderly individuals has increased significantly. Vitamin D & Vitamin B12 is associated with adverse lipid profile and cardiovascular diseases. But higher levels of HDL cholesterol is linked to a lower risk of heart disease.  So the purpose of the study to find correlation of HDL with vitamin D and vitamin B12 in middle aged women. Material & Methods: This study was an observational cross-sectional study.  300 women including pre, peri and postmenopausal women were considered as the sample size for the present study. Waist circumference was assessed in all the groups to find central obesity. Plasma levels of vitamin B₁₂, vitamin D3 and plasma HDL were assessed. All the results were age adjusted. p value of less than 0.05 was considered as significant difference. Results: It was observed that, central obesity was significantly higher in peri & postmenopausal women compared to premenopausal women. Lower HDL levels were found in all the participants. Also, HDL did not show any correlation with vitamin B12 and vitamin D in any of the group. Conclusion: Study concludes that, HDL levels are not correlated with vitamin B12 and Vitamin D. It emphasizes the need for further study to establish clinical significance of vitamin B12 and vitamin D with HDL levels.

Background: Early recognition of neonatal sepsis is challenging; readily available hematologic markers may improve bedside diagnosis. Aim: To evaluate platelet, count and platelet indices mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) as diagnostic markers of neonatal sepsis in a tertiary care hospital. Methods: Prospective case–control study of 80 neonates (40 sepsis cases; 40 controls). Demographics, sepsis screens, blood cultures, and platelet parameters were recorded. Group comparisons used t/Mann–Whitney U and Chi-square tests; diagnostic performance was assessed with ROC analysis. Results: Baseline characteristics were comparable between groups. Septic neonates had lower platelet count (134.6 ± 72.4 vs 225.8 ± 64.2×10⁹/L; p<0.001) and PCT (0.12 ± 0.04 vs 0.19 ± 0.05%; p<0.001), with higher MPV (11.2 ± 1.8 vs 9.1 ± 1.2 fL; p<0.001) and PDW (16.5 ± 2.3 vs 12.8 ± 1.9%; p<0.001). Thrombocytopenia was more frequent and severe in sepsis (moderate–severe in 32.5% vs 5% of controls). ROC analysis showed good discrimination for platelet count (cut-off <150×10⁹/L; sensitivity 72.5%, specificity 80%; AUC 0.82) and PCT (cut-off <0.15%; sensitivity 75%, specificity 77.5%; AUC 0.81); MPV (AUC 0.80) and PDW (AUC 0.78) also performed well. Conclusion: A characteristic platelet signature—low platelet count/PCT with elevated MPV/PDW—distinguishes septic from non-septic neonates and provides inexpensive, rapid adjuncts for early sepsis screening in NICUs while awaiting culture confirmation.

Background: Effective postoperative analgesia is critical in lower limb orthopedic surgeries to facilitate early mobilization and improve outcomes. Epidural bupivacaine is widely used, but its limited duration necessitates adjuvants. Among these, buprenorphine (a partial μ-opioid agonist) and dexmedetomidine (a selective α2-adrenergic agonist) are promising, though direct comparisons remain limited. Aim: To compare the efficacy and safety of epidural dexmedetomidine and buprenorphine when combined with 0.5% bupivacaine in patients undergoing elective lower limb orthopedic surgeries. Materials and Methods: A prospective, randomized, double-blind clinical trial was conducted on 60 ASA I–II patients, aged 20–60 years, undergoing elective lower limb orthopedic surgeries. Patients were allocated into two groups: Group B received 9 ml of 0.5% bupivacaine with 180 μg buprenorphine, and Group D received 9 ml of 0.5% bupivacaine with 60 μg dexmedetomidine. Primary outcomes included time to first rescue analgesia, Visual Analogue Scale (VAS) scores, and hemodynamic stability. Results: Both groups were comparable demographically. Mean operative duration was similar (p=0.17). Rescue analgesia requirement was significantly delayed in Group D (276.7 ± 49.3 min) compared to Group B (212.7 ± 39.0 min; p<0.001). VAS scores were significantly lower in the dexmedetomidine group from 120 minutes onward (p<0.001). Hemodynamic parameters remained stable in both groups, and adverse effects were minimal, with no significant intergroup differences. Conclusion: Epidural dexmedetomidine with 0.5% bupivacaine provides superior and prolonged postoperative analgesia compared to buprenorphine, with stable hemodynamics and minimal side effects. It may be considered a more effective adjuvant for lower limb orthopedic surgeries.

Introduction: Gaining knowledge about and an understanding of autopsy procedure is of utmost importance during undergraduate medical education. However, it is seen that there is either a paucity of cadavers or physical dissection is unfeasible due to time constraints to both perform a complete autopsy and to show the students details of autopsy procedure during the allotted time. Small group teaching becomes a challenge for us; especially considering the limited number of available faculty members. Aims:  (1) To introduce educational videos as new teaching tools for Forensic Medicine practical classes. (2) To study the effectiveness of educational video as a teaching tool. Objectives: (1) To design and implement an educational video clips-based learning module on autopsy for undergraduate students. (2) To compare the knowledge retention and understanding of autopsy concepts between students exposed to video clips-based learning and those using traditional teaching- learning methods. (3) To study the student’s perceptions on their experiences on conventional autopsy learning and learning through the educational video clips. Methods: The students of the class were categorized into two groups – A and B. Pre-test was conducted to gauge the existing knowledge of the students using a questionnaire (on Google Forms). Following this, Group A was first shown autopsy procedures by pre-recorded video in the class room and Group B was taken to the autopsy hall to observe an autopsy being carried out. After that; Post-test was conducted to assess the intermediate knowledge status using the same questionnaire. Thereafter, the Group A was shown live autopsy on another dead body in the autopsy hall and Group B was shown autopsy procedures by pre-recorded video in the class room. Then feedback was taken from both the groups; on Google Forms. Results: Out of 98 students of the batch, total 80 students attended the class but only 74 students submitted all three forms (pre-test, post-test and feedback) and their responses were considered for the study. In the pre-test, average score of group A was 5.46/10, median 5/10 points and range of score was 3-9 points; average score of group B was 4.6/10, median 5/10 points and range of score was 0-7 points. In post-test, average score of group A was 8.85/10, median 9/10 points and range of score was 6-10 points; average score of group B was 8.03/10, median 9/10 points and range of score was 5-10 points. It indicates that knowledge acquisition is significant in both the teaching-learning methods, but there are no significant differences between the two groups. As response to feedback questionnaires, most of the students were in favour of video-clips based learning. Many students said that learning through exposure to both video-clip based teaching and conventional live dissection teaching is much more effective than a single method. Conclusion: Both video-based learning and conventional teaching on autopsy possess their own individual merits and both have near-equal importance in knowledge acquisition. Video-based learning cannot be a sole technique of teaching methodology of autopsy procedure but it can be taken as substitute as and when there is scarcity of cadavers for practical demonstration of the students.

Background: Functional constipation is a common but often overlooked issue in pediatric populations, with consequences on nutrition, growth, and psychosocial well-being. Prevalence varies across regions, and cultural differences may affect diagnostic criteria. Objective: To assess the prevalence of functional constipation among children using a questionnaire based on Indian Academy of Pediatrics (IAP) consensus and modified Bristol Stool Form Scale (m-BSFS) and determine the agreement between both tools. Methods: A hospital-based cross-sectional study was conducted at Fortis Escorts Hospital, Jaipur, from January 2020 to March 2021. A total of 273 children attending the pediatric outpatient department were assessed for functional constipation using a validated questionnaire and m-BSFS. Results: Prevalence of functional constipation was 10.6% by IAP consensus and 8.8% by m-BSFS. Most affected age group was 1–5 years. Constipation was more common in males. A statistically significant agreement was observed between the two tools (κ=0.77, p<0.001). Conclusion: Functional constipation is prevalent in Indian children, especially preschoolers. Both IAP consensus and m-BSFS are reliable and complementary tools for diagnosis and can reduce unnecessary investigations when used effectively in outpatient settings.

Background: Type 2 Diabetes Mellitus is a chronic metabolic disorder characterized by insulin resistance and pancreatic β cell dysfunction. Amylase and Lipase are digestive enzymes secreted by the acinar cells of exocrine pancreas. Pancreatic β-cell dysfunction in Diabetes can interfere with the exocrine function of the pancreas. In the present study we assessed serum Amylase and Lipase levels in subjects with Type 2 Diabetes Mellitus. Materials and Methods:  The study included 50 Type 2 Diabetic Subjects and 50 age-matched healthy individuals with no history of Diabetes. Fasting and Post Prandial plasma glucose, HbA1c, Serum Amylase and Serum Lipase were measured in all these subjects. Results: Fasting plasma glucose, Post Prandial plasma glucose and HbA1c were significantly higher in subjects with Type 2 Diabetic subjects compared to controls (p<0.01). A significant elevation of Serum Amylase and Lipase (p<0.01) levels that are within the normal reference range is observed in Type 2 Diabetic subjects when compared to controls. Conclusion: The compensatory hyperinsulinemia in Type 2 Diabetes may increase the synthesis of serum Amylase and Lipase via stimulation of islet acinar axis. Elevated Serum Amylase and Lipase levels within normal range may be an early sign of pancreatic impairment in Type 2 Diabetes Mellitus and may be useful in monitoring the progression of the disease.

Background: Clavicle surgeries were traditionally done under general anesthesia due to its complex and multiple innervations, the upright beach chair position required for the surgery and discomfort to the patient. With the advent of ultrasound, peripheral nerve blocks are becoming increasingly selective, with less drug volume, longer duration of analgesia with adjuvants added and minimal side effects. This avoids the problems of general anesthesia, provides excellent surgical anesthesia, postoperative analgesia and more comfortable to the patient with minimal sedation, thereby decreasing the use of opioids. Methods: This prospective observational study was done in a tertiary care academic institution over one year. All patients posted for clavicle surgery were given ultrasound guided peripheral nerve blocks. Three different blocks used were Group A – Interscalene block, Group B – Superior trunk block and Group C – Clavipectoral fascial block, all in combinations with superficial cervical plexus block. The three techniques were compared and evaluated for block efficiency, duration of analgesia and safety profile. Results: All the three blocks provided complete nerve blockade adequate for surgical anesthesia and post operative analgesia. In the Interscalene group, the duration of analgesia was least (P<0.001) and transient side effects of hemi-diaphragmatic paresis, hoarseness of voice and Horner’s syndrome were also significantly higher (P=0.034). The Superior trunk block and Clavipectoral group patients had longer analgesia without any of these side-effects. Conclusion: For clavicle fracture surgeries, the ultrasound guided selective block of the Superior trunk of brachial plexus and the Clavipectoral fascial block both combined with the Superficial cervical plexus block provided excellent surgical anesthesia, prolonged post operative analgesia and better safety profile with negligible side effects than the Interscalene block.

Background and Aims: A large number of patients undergoing arthroscopic knee surgeries complain of inadequate pain relief. Clonidine and bupivacaine were administered through intrathecal route and femorosciatic nerve block route and evaluated for more favourable perioperative outcome between them. Methods: An open label randomized controlled trial was planned in a tertiary care hospital in Eastern India in which 50 American Society of Anaesthesiologists I and II patients undergoing arthroscopic knee surgery were enrolled. They were divided into two groups-Group IT and Group NB, by using computer-generated block randomization technique. Group IT received 1 μg/kg of clonidine along with 0.5% hyperbaric bupivacaine, whereas Group NB received 0.25% bupivacaine and 1 μg/kg clonidine in femorosciatic nerve block (FSNB). Postoperative pain-free interval and block characteristics were the primary outcomes studied. Results: Pain-free duration was 522.08(±21.18) min in Group NB (P < 0.001) in comparison to 325.33(±17.85) min in Group IT. Sensory block and motor blockade in NB were 469.58(± 15.17) and 264.88(±14.87) min, respectively, and was significantly prolonged in comparison to Group IT (P < 0.001). The mean rescue analgesic requirement was less in Group NB as compared to Group IT. Conclusion: Clonidine in a dose of 1 μg/kg with bupivacaine has better perioperative outcome through FSNB route in comparison to its use via intrathecal route in arthroscopic knee surgery. It provided stable haemodynamic and respiratory parameters intra and postoperatively, increased duration of sensory block and pain-free period, lesser 24 h rescue analgesic requirement making it ideal for post knee surgery pain.

Background: Sepsis remains a leading cause of morbidity and mortality among children worldwide, particularly in low- and middle-income countries. Early diagnosis and risk stratification are crucial to improving outcomes, and biomarkers such as procalcitonin are increasingly being evaluated for their diagnostic and prognostic utility. Aim: To study the clinical profile, laboratory parameters, and outcomes of children with sepsis, and to assess the role of serum procalcitonin as a diagnostic and prognostic marker. Methods: This Retrospective observational study was conducted at the Department of Pediatrics, Government Medical College Srinagar, and included 150 children aged 1 month to 18 years, of which 92 had clinically suspected sepsis and 58 served as non-septic controls. Clinical features, laboratory investigations, and procalcitonin levels were recorded. Patients were followed for outcomes including length of hospital stay, PICU admission, and mortality. For consistency and clinical relevance, patients were stratified into three groups according to their serum PCT levels: <0.5 ng/mL (low risk of bacterial sepsis), 0.5–2 ng/mL (intermediate risk), and >2 ng/mL (high risk, strongly suggestive of bacterial sepsis). Results: Of the 150 children, 58% were male and 42% female, with a mean age of 7.4 ± 4.6 years. Fever was universal (100%), followed by rash (61.3%) and vomiting (45.3%). PCT distribution revealed 36 children (24%) in the low group, 48 (32%) in the intermediate group, and 66 (44%) in the high group. Severe sepsis was most common in the high PCT group (59.1%), with 18.2% developing septic shock, while only 8.3% of the low group developed complications. Mortality was significantly higher in the high PCT group (15.2%), and mean hospital stay was longest among these patients (11.3 ± 3.8 days) compared to the low group (5.6 ± 2.4 days). Recovery without complications was observed in 91.7% of the low group. Conclusion: Children with sepsis commonly present with fever, rash, and gastrointestinal symptoms. Procalcitonin was significantly elevated in septic children and correlated with adverse outcomes including PICU admission, prolonged hospital stay, and mortality, underscoring its value as both a diagnostic and prognostic biomarker.

Introduction: Termination of pregnancy in the first trimester is one of the most commonly performed gynecological procedures worldwide. Both Manual Vacuum Aspiration (MVA) and Electric Vacuum Aspiration (EVA) are established methods for surgical management of early pregnancy termination. While both techniques are considered safe and effective, differences may exist in terms of efficacy, safety profile, complications, procedure time, and patient acceptability. Objectives: To compare the outcomes of Manual Vacuum Aspiration (MVA) and Electric Vacuum Aspiration (EVA) for pregnancy termination up to 10 weeks of gestation. Methods: This hospital-based prospective randomized comparative study was conducted over one year in the Department of Obstetrics & Gynecology at Chittaranjan Seva Sadan College. It included 200 women with first-trimester abortion (≤10 weeks) who met the Government of India MTP criteria. Patients were randomized to undergo either Manual Vacuum Aspiration (MVA) or Electric Vacuum Aspiration (EVA), and data were collected on age, gravida, gestational age, locality, and socioeconomic status, cause of abortion, bleeding, complications, pain, and post-abortal contraceptive practices to compare outcomes between the two groups. Results: In this study of 200 patients, the MVA and EVA groups were comparable in age distribution, with the majority in the 21–30 years range (MVA: 71%, EVA: 64%; p=0.466) and similar gravida status (p=0.74), while gestational age showed a significant difference (p=0.02), with more patients at 5 weeks in the MVA group (5%) and more at 10 weeks in the EVA group (28%). Socioeconomic status also differed significantly (p=0.044), with a higher proportion of lower socioeconomic patients in the MVA group (77% vs 64%). Blood loss increased with gestational age, with MVA consistently lower than EVA (6 weeks: 23.5 ml vs 27.5 ml, p<0.001; 8 weeks: 28.46 ml vs 35.03 ml, p<0.001; 9 weeks: 33.4 ml vs 38.86 ml, p=0.01; 10 weeks: 36.29 ml vs 43.49 ml, p<0.001; 7 weeks difference not significant, 28.5 ml vs 32.3 ml, p=0.076). Hospital stay was shorter with MVA across all gestational ages (6–6.67 days) compared to EVA (13.2–15 days), with significant differences at 6, 8, 9, and 10 weeks. Grade I bleeding was more frequent in MVA (69% vs 13%), while higher grades occurred more in EVA (p<0.001). Pain was also lower with MVA (Grade I: 37% vs 0%; Grade IV: 7% vs 54%; p<0.001). Overall complications (p=0.215) and post-abortal contraceptive practices (p=0.345). Conclusion: Manual Vacuum Aspiration and Electric Vacuum Aspiration are both safe and effective techniques for surgical termination of pregnancy up to 10 weeks. MVA is particularly advantageous in resource-limited settings, while EVA may be more suitable in facilities with adequate infrastructure. The choice of method should be individualized based on patient preference, clinical setting, and resource availability.

Ocimum sanctum Linn. (Tulsi) is traditionally known for its immune-enhancing and adaptogenic activities, but for its preventive activity against seasonal diseases, a scientific endorsement has been limited. The study was a comparative observational study where 500 volunteers in West Bengal, India, were randomly grouped into Control and Experimental groups where the Experimental group received fresh Tulsi leaf juice daily in four seasons. Systematic measurements of health outcomes such as influenza-like illness incidence, stress, global well-being and safety were conducted. Results indicated that Tulsi supplementation decreased incidence of influenza-like illness by 60 to 70 percent, decreased stressfulness by about 30 percent, and enhanced global well-being by 15 to 20 percent relative to controls and all changes were statistically significant (p < 0.001). The combined findings of these results show that Tulsi leaf juice is a safe, cheap and culture acceptable form of natural intervention that could promote immunity, vitality and even preventive action in the health of the people across all seasons irrespective of seasonal variations.

Objective: To evaluate maternal and fetal outcomes in women with chronic hypertension complicated by superimposed pre-eclampsia. Methods: A total of 162 eligible women was enrolled using convenience sampling during their antenatal or inpatient visits. The primary outcomes assessed were maternal complications such as eclampsia, HELLP syndrome, placental abruption, acute renal failure, and pulmonary oedema. Secondary outcomes included gestational age at delivery, birth weight, APGAR scores, NICU admissions, and perinatal mortality. Results: The study revealed that most participants were Multigravida women aged between 26–30 years, from rural and lower socioeconomic backgrounds. Most had uncontrolled blood pressure despite antihypertensive therapy, and more than half experienced preterm deliveries. Significant maternal complications included postpartum hemorrhage (19.13%), pulmonary oedema (20.37%), HELLP syndrome (11.72%), and a maternal mortality rate of 3.7%, all more prevalent among those with uncontrolled BP (p-values <0.05 for PPH, pulmonary oedema, and HELLP syndrome). Around 52.6% required ICU care, and 78.29% received magnesium sulphate. Neonatal outcomes were also adversely affected—29.61% had fetal growth restriction, 50% required NICU admission, and perinatal mortality was high at34.56%, with Prematurity and low birth weight being major contributors. Conclusion: The findings highlight the need for early diagnosis, timely initiation of antihypertensive therapy, and close monitoring to reduce the high burden of complications and mortality, These results emphasize that strict BP control is crucial in reducing adverse perinatal outcomes in this population, BP monitoring at periphery level and regular follow up post postpartum till 12 weeks is very essential in early diagnosis of chronic hypertension and decreasing complications in future pregnancies.

Background: Autoimmune disorders represent a heterogeneous group of diseases characterized by aberrant immune responses against self-antigens. They exhibit diverse clinical and pathological features, leading to diagnostic and therapeutic challenges. Aim & Objectives: The present study was conducted to evaluate the clinicopathological correlation of autoimmune disorders, highlighting demographic distribution, clinical features, and laboratory findings for better understanding and clinical management. Material & Methods: A cross-sectional study was undertaken on 200 patients diagnosed with autoimmune disorders. Demographic data, clinical presentations, and laboratory investigations including serological markers (ANA, anti-dsDNA, rheumatoid factor) along with histopathological assessments were analyzed to establish patterns and correlations. Results: Among 200 patients, 40% were male and 60% were female, with a mean age of 38 ± 12 years. The most prevalent disorder was systemic lupus erythematosus (30%), followed by rheumatoid arthritis (25%), Hashimoto’s thyroiditis (20%), multiple sclerosis (15%), and others (10%). Arthralgia/arthritis (60%) was the most common clinical feature, followed by fever (45%) and skin rashes (35%). Neurological symptoms and endocrine involvement were noted in 20% and 15% respectively. Serological analysis revealed ANA positivity in 55%, anti-dsDNA in 32.5%, and rheumatoid factor in 22.5% of cases. Histopathological findings mainly included lymphocytic infiltration (37.5%) and tissue fibrosis (15%). Conclusion: Autoimmune disorders predominantly affect females in the productive age group and present with overlapping clinical features. A combination of clinical assessment, serological markers, and histopathological confirmation is essential for accurate diagnosis and targeted therapy.

Background: Supraglottic airway devices (SADs) are increasingly used in modern anaesthesia as alternatives to endotracheal intubation. The Ambu Aura40 and Baska Mask are second-generation SADs designed to improve sealing, insertion ease, and patient safety. However, limited comparative evidence exists regarding their performance in elective surgical settings. Aim and Objectives: The primary objective to compare the Ambu Aura40 and Baska Mask in terms of the number of insertions attempts and ease of insertion. Secondary objectives were to assess haemodynamic changes and postoperative complications associated with each device. Methods: This prospective, randomized study included 80 ASA I–II patients aged 18–65 years, undergoing elective surgery under general anaesthesia. Patients were randomly allocated to Group A (Ambu Aura40, n = 40) or Group B (Baska Mask, n = 40). Outcomes assessed included the number of insertion attempts, ease of insertion, haemodynamic parameters, and postoperative complications. Results: Demographic variables were comparable between groups. Group A had higher first-attempt success (95% vs. 80%, p = 0.043) and easier insertion (95% vs. 80%, p = 0.043).  Among Hemodynamic parameters pulse rate was significantly higher and comparable (p < 0.001). Postoperative complications were infrequent and statistically comparable. Conclusion: Both Ambu Aura40 and Baska Mask are safe and effective supraglottic airway devices with stable haemodynamic profiles and low complication rates. However, Ambu Aura40 demonstrated easier insertion and higher first-attempt success, making it a more favourable option for elective airway management.

Background: Securing the airway with minimal complications is a primary responsibility of the anesthesiologist. The ProSeal laryngeal mask airway (PLMA), a second-generation supraglottic device, provides effective airway management in elective surgeries. The choice of induction agent influences insertion conditions and haemodynamic responses. Etomidate offers cardiovascular stability but limited muscle relaxation, whereas a propofol–ketamine combination may balance the haemodynamic effects of both drugs while enhancing insertion conditions. Aim and Objectives: To compare the effectiveness of etomidate and a propofol–ketamine combination as induction agents for PLMA insertion in elective laparoscopic cholecystectomy. The primary objectives were to assess ease and time of insertion, adequacy of relaxation, and the number of attempts. Secondary objectives included evaluation of oropharyngeal leak pressure, haemodynamic stability, and perioperative complications. Methods: This prospective, randomized, double-blind study enrolled 92 ASA I–II patients aged 18–65 years undergoing elective laparoscopic cholecystectomy. Patients were randomized into two groups: Group A received etomidate (0.3 mg/kg), and Group B received a combination of propofol (1.5 mg/kg) with ketamine (0.5 mg/kg). PLMA insertion time, attempts, ease of insertion, oropharyngeal leak pressure, haemodynamic parameters, and perioperative complications were recorded and analyzed using SPSS version 20.0. A p-value <0.05 was considered statistically significant. Results: Both groups were comparable in demographic characteristics and baseline vitals (p>0.05). PLMA insertion was significantly faster in Group B (9.15±1.53 sec) compared to Group A (14.09±2.55 sec, p=0.003), and fewer attempts were required (1.11±0.31 vs. 1.33±0.47, p=0.011). Ease of insertion was higher in Group B (80.4% vs. 65.2%), though not statistically significant. Oropharyngeal leak pressures were comparable (p>0.05). Haemodynamic parameters (HR, SBP, DBP, MAP, SpO₂) remained stable in both groups without significant differences. Complications such as sore throat, PONV, and myoclonus were infrequent and not statistically significant. Conclusion: The combination of propofol and ketamine provided superior conditions for PLMA insertion, with faster placement, fewer attempts, and comparable haemodynamic stability compared to etomidate. It can be considered a more effective induction strategy for airway management in ASA I–II patients undergoing laparoscopic cholecystectomy.

Background: Regional anaesthesia techniques are widely employed for below-knee surgeries. While unilateral subarachnoid block provides rapid and reliable anaesthesia, peripheral nerve blocks, especially with ultrasound guidance, offer the advantages of haemodynamic stability and prolonged postoperative analgesia. This study compared the efficacy of ultrasound-guided popliteal sciatic block combined with adductor canal block versus unilateral subarachnoid block for below-knee procedures. Materials and Methods: This prospective, randomized comparative trial was conducted on 60 ASA I–II patients aged 18–55 years undergoing elective unilateral below-knee surgery. Patients were randomly allocated into two groups of 30 each. Group A received an ultrasound-guided adductor canal block (10 ml of 0.5% levobupivacaine) and a popliteal sciatic block (20 ml of 0.5% levobupivacaine). Group B received a unilateral subarachnoid block with 2 ml of 0.75% hyperbaric levobupivacaine. Outcomes assessed included demographic comparability, onset of sensory and motor block, quality of block, haemodynamic stability, duration of postoperative analgesia, and complications. Results: Demographic variables were comparable between the groups (p > 0.05). Onset of sensory (4.13 ± 0.68 min vs. 11.97 ± 4.25 min) and motor block (5.27 ± 0.94 min vs. 16.43 ± 6.21 min) was significantly faster in the subarachnoid group (p < 0.001). Duration of postoperative analgesia was markedly longer in the nerve block group (8.67 ± 2.59 h vs. 2.32 ± 0.61 h, p < 0.001). Quality of block was comparable, with a complete block achieved in 73.3% of Group A and 83.3% of Group B (p = 0.319). Haemodynamic stability and complication rates were similar in both groups. Conclusion: Unilateral subarachnoid block remains superior in terms of rapid onset, while ultrasound-guided popliteal sciatic with adductor canal block provides significantly prolonged postoperative analgesia with comparable efficacy and safety. Peripheral nerve blocks are therefore a valuable alternative, especially where prolonged pain relief and opioid-sparing strategies are desired.

Background: Cutaneous adverse drug reactions (CADRs) are among the most frequently encountered forms of drug-induced morbidity, ranging from benign rashes to life-threatening severe cutaneous adverse reactions (SCARs). In India, underreporting and inconsistent surveillance hinder early detection and response, despite pharmacovigilance being a critical pillar of patient safety.

Introduction: Distal fractures of both tibia and fibula are common lower limb injuries that can result in significant functional impairment if not appropriately managed. While operative fixation of the tibia is standard in displaced fractures, conservative management remains an option in select cases. The role of fibula fixation in influencing tibial alignment and functional outcomes remains under debate. Aims: This study aims to compare the functional outcomes of distal both bone leg fractures treated with fibula fixation combined with conservative management of tibia versus fibula fixation with operative fixation of the tibia. Methods: This prospective study was conducted at Calcutta National Medical College and Hospital from January 2021 to February 2022, including 60 adults (30 per group) with distal tibia and fibula fractures. Data on demographics, injury characteristics, fracture type, co-morbidities, and complications were collected. Group A received fibula fixation with conservative tibial management, while Group B had fibula fixation with operative tibial management. Functional outcomes, weight-bearing times, fracture union, and complications were assessed to compare the two treatment approaches. Result: Among 60 patients, most were young adults (21–30 years, 35%) and males (58.3%), with road traffic accidents (56.7%) as the leading cause. AO type A1 fractures were most common (50%). Group A had a slightly higher mean age (41.8 ± 13.7 vs. 35.8 ± 11.0 years, p = 0.0681). Operative time was shorter in Group A (0.48 ± 0.19 vs. 1.50 ± 0.27 hours, p < 0.0001). Partial weight bearing was similar (≈5 weeks), but full weight bearing (16.9 ± 1.9 vs. 14.7 ± 1.7 weeks, p < 0.0001) and fracture union (26.4 ± 2.0 vs. 22.6 ± 3.1 weeks, p < 0.0001) occurred earlier in Group B. Functional outcomes improved over time in both groups, with no significant differences at 6 months (63.5 ± 10.10 vs. 68.0 ± 9.70, p = 0.0837) or 9 months (78.33 ± 13.79 vs. 83.0 ± 10.80, p = 0.1499). Conclusion: Fibula fixation combined with operative fixation of the tibia provides superior functional outcomes, earlier union, and better alignment in distal both bone leg fractures compared to fibula fixation with conservative management of tibia. Conservative management may be considered only in selected cases with minimal displacement, but operative tibial fixation remains the preferred approach to optimize functional recovery and reduce complications.

Introduction: Acute intestinal obstruction (AIO) is a common surgical emergency characterized by the partial or complete blockage of the intestines, leading to impaired passage of intestinal contents and significant morbidity if not promptly managed. Aims: Acute intestinal obstruction is a common surgical emergency requiring prompt diagnosis, perioperative management, and surgical skill to achieve favorable outcomes. This study aimed to evaluate the causes, clinic-epidemiological features, and severity indicators of intestinal obstruction, as well as to assess patient outcomes following conservative and surgical management. Materials & Methods: This was a prospective clinical study conducted at Midnapore Medical College and Hospital, Midnapore, from 1st April 2021 to 1st October 2022. The study included a total of 100 patients diagnosed with acute intestinal obstruction. Result: The most frequent diagnosis was obstructed hernia in 35 patients (35%), followed by adhesions in 18 patients (18%), sigmoid volvulus in 12 patients (12%), growths in 14 patients (14%), ileal strictures/TB in 8 patients (8%), intussusception in 6 patients (6%), small gut gangrene in 3 patients (3%), and other causes in 4 patients (4%) (p < 0.00001). In our study, postoperative complications were observed in a minority of patients, with 64 patients (64%) experiencing no complications. Wound infection occurred in 20 patients (20%), wound gaping in 10 patients (10%), and death was reported in 6 patients (6%)it was highly statistically significant (p < 0.0001). Conclusion: We conclude that, the most common diagnosis was obstructed hernia, followed by adhesions, sigmoid volvulus, neoplastic growths, ileal strictures/TB, intussusception, small gut gangrene, and other less frequent causes. Postoperative complications were relatively uncommon, with the majority of patients experiencing an uneventful recovery. The most frequently observed complications included wound infection, wound dehiscence, and mortality. Overall, the outcomes suggest that while surgical intervention carries inherent risks, most patients recover without significant postoperative complications.

Introduction: Osteoarthritis (OA) of the knee is a prevalent degenerative joint disease leading to pain, stiffness, and functional limitation. Conventional treatments offer symptomatic relief but do not reverse cartilage damage. Platelet-rich plasma (PRP), an autologous blood product rich in growth factors, has emerged as a potential regenerative therapy for OA. Aims: To evaluate the efficacy and safety of intra-articular PRP injections in reducing pain and improving function in patients with knee osteoarthritis. Materials & Methods: This prospective observational study was conducted over a period of one year at Calcutta National Medical College and Hospital, enrolling 80 adult patients with knee osteoarthritis. Patients were assessed for baseline demographic and clinical characteristics, including age, gender, body mass index (BMI), Kellgren–Lawrence (KL) grade, and duration of osteoarthritis. Results: Baseline characteristics were comparable between the PRP and control groups in terms of age, gender, BMI, KL grade, and OA duration. PRP treatment resulted in significant improvements in pain, functional scores, and range of motion compared to controls at 1, 3, and 6 months (p < 0.05 for all), with reductions in VAS scores from 7.2 ± 1.1 to 3.2 ± 0.9 and improvements in functional scores from 55.4 ± 8.6 to 28.5 ± 5.9, while ROM increased from 110.5 ± 8.2° to 128.2 ± 6.3°. Adverse events were mild and comparable between groups, with no infections reported and overall events occurring in 30% of the PRP group versus 20% of controls (p = 0.28). Conclusion: Intra-articular PRP injections are a safe and effective treatment modality for knee osteoarthritis, providing significant symptomatic relief and functional improvement. While promising, long-term studies with larger sample sizes are needed to establish optimal dosing, frequency, and potential disease-modifying effects. PRP represents a viable regenerative option, particularly in patients inadequately responding to conventional therapy.

Background: Acute ischemic stroke (AIS) leads to mortality and morbidity around the world. This important process involves the activation of platelets in its pathophysiology. Mean Platelet Volume (MPV) has been thought to correlate with the severity of stroke and neurologic outcomes. Nonetheless, here too, the evidence is contradictory. The present study thus investigates the association of MPV with neurological complications in patients with AIS. Methods: This was a prospective observational study conducted over one year in the Department of Medicine, RSDKS GMC Ambikapur and Associated Hospital. Patients with acute ischemic stroke, admitted within 24 hours from the onset of symptoms, were included in the study. Patients who were diagnosed with hemorrhagic stroke, hematological disorders, underwent recent major surgery, were infected, or had a malignancy were excluded from the study. On admission, MPV was measured, and stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Finally, functional outcomes were assessed at discharge using the modified Rankin Scale (mRS). Statistical analysis was performed using t test, chi-square test, and correlation analysis. Results: Increased MPV was significantly associated with an increase in NIHSS scores upon admission. Higher MPV levels indicated a more severe stroke at admission. Furthermore, high MPV correlated with worse functional outcomes at discharge as expressed by high mRS scores. One may infer the possibility for this MPV to be one of the predictors of neurological prognosis in AIS. Conclusion: This study shows the promise of MPV as a prognostic biomarker for both stroke severity and functional outcomes in AIS. The ability to identify early highly at-risk patients would lead to a potentially better therapeutic outcome and more effective patient management.

Background: Urinary tract infection (UTI) is the most common type of severe bacterial infection. Most of the febrile infants exhibit renal parenchymal involvement. If not diagnosed properly, it may lead to hypertension and diminished renal function, which becomes a challenge to pediatricians. Method: 85 infants admitted for fever were studied. Symptoms were increased frequency of micturition, crying while voiding, and pyuria. General and systemic examinations were done to rule them out. Phimosis, vulvular synechiae, and suprapubic mass, renal mass, dysmorphic features, and associated congenital anomalies were observed. A provisional diagnosis was done mainly based on signs and symptoms. Routine urine analysis, microscopic analysis of urine, and urine culture were carried out. Positive patients were further examined by USG and MCU, and a differential diagnosis was also done to confirm the UTI. Results: The clinical manifestations were 85 (100%) fever, 33 (38.3%) vomiting, 48 (56.4%) irritability, 60 (70.5%) failure to thrive, 11 (12.9%) jaundice, 18 (21.1%) convulsions. The co-morbidities were 26 (30.5%) gastroenteritis, 22 (25.8%) fever without focus, 11 (12.9%) URTI, 16 (18.8%) UTI, 7 (8.23%) septicemia, 3 (3.52%) bronchitis. The highest sensitivity drug was 77 (90.5%) amikacin, followed by 50 (58.5%) norfloxacin, 61 (71.7%) ofloxacin, gentamicin, 16 (18.8%) Nitrofurantin, and 13 (15.2%) Nalidixic. Conclusion: The prevalence rate of UTI varies by gender, age, race, and circumcision status. The present study will help the clinician to rule out causes of UTI and treat efficiently.

Background: The timing of umbilical cord clamping influences neonatal haematological outcomes. Early cord clamping (ECC) is usually performed within the first 15–30 seconds after birth, while delayed cord clamping (DCC) is performed after 1–3 minutes or when cord pulsations cease. Aim: To compare the effect of early versus delayed cord clamping on haemoglobin and haematocrit levels in healthy term infants. Methods: A randomised clinical trial was done at a tertiary care hospital, Andhra Pradesh on 120 babies. Full term gestation babies singleton pregnancy, no risk factors, vertex presentation delivered by either vaginal or caesarean section were included in the study. Results: Infants undergoing DCC demonstrated significantly higher haemoglobin and haematocrit values within the first 24–48 hours compared with those undergoing ECC. DCC was associated with a slightly increased incidence of neonatal jaundice, there was no significant rise in symptomatic polycythaemia. Conclusion: Delayed cord clamping in healthy term infants improves haemoglobin and haematocrit at birth and enhances iron reserves in early infancy, thereby lowering the risk of anaemia. Despite a modest increase in jaundice, DCC is considered safe and is recommended by current international guidelines.

Background: Beta thalassemia is a congenital haemolytic anaemia caused by reduced or absent synthesis of beta globin (haemoglobin subunit beta chain).Due to RBCs dysfunction, bone marrow expansion occurs and these patients require regular blood transfusion which lead to cardiac, pulmonary and hepatic complications due to increased serum iron load. This predisposes them for electrophysiological heterogeneity, which may provide substrate for triggered and re- entry activity and may be involved in genesis of arrhythmia and cardiac failure in beta thalassemia patients. Introduction: Atrial fibrillation, atrial flutter, and intra-atrial re-entrant tachycardia are the most common clinically relevant rhythm disturbances in beta thalassemia patients. Constant and progressive cardiac impairment leads to irreversible cardiac failure which remains the major cause of death for these patients. Objective: To study early cardiac involvement in transfusion dependent thalassemia patients. Method: Cardiac autonomic function test for assessing sympathetic and parasympathetic control will be done by CANWIN-504(Cardiac Autonomic Neuropathy Analyser). Conclusion: Hence the present study will be conducted to find out possible risk of cardiac involvement among beta thalassemia patients.

Background: Antimicrobial resistance is a critical global health issue, particularly in lower- and middle-income countries. This study aimed to evaluate antibiotic usage patterns in district hospitals of Northeast India. Methods: This cross-sectional point prevalence survey was conducted in four district hospitals in Tripura, India over three months in 2025. Data on antibiotic prescriptions were collected for 350 inpatients across Medicine, Surgery, Orthopaedics, ENT, Paediatrics, and Obstetrics & Gynaecology departments. Results: The overall antibiotic prescription rate was 89.7%, with variation across hospitals (81.2-95.0%). Across the various departments, the highest number of patients was recorded in Medicine. Ceftriaxone was the most commonly prescribed antibiotic (30.9% of prescriptions). The majority of antibiotics were used therapeutically (95.9%) rather than for prophylaxis. Acute febrile illness was the most frequent indication. Intravenous administration was predominant (85.9% of prescriptions). Conclusion: The high prevalence of antibiotic use, especially broad-spectrum and parenteral agents, highlights the need for targeted antimicrobial stewardship interventions in district hospitals of Northeast India. Strategies to optimize prescribing practices and promote appropriate use are warranted.

Background: Posterior circulation stroke (PCS) accounts for 20–25% of all ischemic strokes and presents diagnostic and therapeutic challenges due to its diverse symptomatology and complex vascular anatomy. Early identification with MRI and MR angiography is critical for management and prognosis. Aim: To analyze the clinical profile, MRI features, and their correlation with functional outcomes in posterior circulation stroke patients. Methods: A cross-sectional study was conducted on 93 patients with MRI-confirmed PCS between 2023 and 2025. Clinical features, vascular risk factors, and imaging findings were documented. Functional outcomes were assessed at discharge using the Modified Rankin Scale (mRS). Statistical analysis was performed using SPSS version 23. Results: Of 93 patients, 64 (68.8%) were males, and the mean age was 61 years. Hypertension (53.8%) and diabetes mellitus (37.6%) were the most prevalent risk factors. The most common presenting symptoms were giddiness, vomiting, headache, and cranial nerve deficits. MRI revealed brainstem (31.2%) and cortical/subcortical (29%) infarcts as the predominant sites. At discharge, 50.5% of patients had minor disability, 26.9% major disability, 17.2% no disability, and 5.4% mortality. Brainstem infarcts were significantly associated with poor outcomes (p<0.0001). Conclusion: PCS shows a male predominance with peak incidence in the 6th decade. Hypertension and diabetes are key risk factors. Brainstem involvement strongly correlates with adverse outcomes, underscoring the importance of early recognition and aggressive risk factor control.

Introduction: Acute ischemic stroke (AIS) remains a major public health concern in India, contributing significantly to in-hospital mortality and long-term disability. While various clinical and demographic factors are known to affect outcomes, their relative impact in resource-limited settings is not well defined. Understanding the role of both modifiable and nonmodifiable predictors, such as stroke severity, age, comorbidities, and complications is essential for improving care strategies in tertiary centers. Objective: To evaluate the independent impact of demographic, clinical, and complication- related factors on in-hospital mortality and morbidity in patients with acute ischemic stroke (AIS) treated in a tertiary care hospital in South India. Methods: A cross-sectional study was conducted on 216 consecutive AIS patients admitted to the Neurology Department at Tirunelveli Medical College from June 2023 to May 2024. Data included age, gender, prestroke functional status, comorbidities, CT ASPECTS score, NIHSS score, complications, length of hospital stay (LOS), and modified Rankin Scale (mRS) at discharge and 3 months. Multivariate logistic regression and attributable fraction (AF) analyses assessed predictors of in-hospital mortality and poor functional outcome (mRS ≥3). Results: In-hospital mortality was 6.0% (n=13) among 216 AIS patients. Stroke severity (NIHSS ≥16) contributed 38.5% to mortality for LOS ≤7 days and 22.0% for LOS >7 days, with age ≥65 years accounting for 15.0% and 23.5%, respectively. Pneumonia (13.0%, LOS >7 days) and increased intracranial pressure (15.5%, LOS ≤7 days) were key modifiable factors. Poor functional outcome (mRS ≥3) occurred in 44.4% (n=96) at discharge and 41.7% (n=90) at 3 months, driven by stroke severity (17.0%) and prestroke disability (16.5%). Conclusion: Nonmodifiable factors dominate early AIS outcomes, but targeting complications like pneumonia and increased ICP can significantly improve prognosis in resource-limited settings.

Background: Atypical antipsychotics are increasingly used to augment antidepressants in patients with depression and obsessive-compulsive disorder (OCD). This study evaluated the prescription patterns, off-label use, and adverse drug reactions (ADRs)of atypical antipsychotics. Methods: A cross-sectional, observational study was conducted at a tertiary care teaching hospital in India from December 2022 to November 2023. Data from 167 outpatients (141 with depression, 26 with OCD) were collected from case notes and interviews. Adherence to WHO prescribing indicators, off-label use, ADRs, and drug interactions were analysed using descriptive statistics and Pearsons’s correlation in Jamovi (v2.3). Results: Selective serotonin reuptake inhibitors (SSRIs), particularly fluoxetine and as an augmenting agent, olanzapine was mostly prescribed (49% in depression, 42.3% in OCD). Polytherapy was universal, with an average of 3.15 drugs per prescription. Off-label use occurred in 27.1% of depression and 100% of OCD prescriptions. ADRs, mainly hyperacidity and constipation, affected 9.9% of patients, with no significant association with off-label use (p=0.46). A strong correlation was found between illness duration and augmentation duration (r=0.881). Conclusion: Atypical antipsychotics are widely used for augmentation, in patients with depression & OCD with significant off-label prescribing. Monitoring adverse drug reactions and drug- drug interactions is essential for safe and effective treatment.

Background: The elderly population in urban slums represents a particularly vulnerable group facing compounded health challenges due to aging, poverty, and poor living conditions. With increasing life expectancy and a growing geriatric population, understanding the morbidity pattern and healthcare utilization in these settings is essential for targeted public health interventions. Objective: To assess the prevalence of non-communicable diseases, health-seeking behavior, and common health-related issues among elderly individuals aged 60–80 years residing in selected urban slums of Cachar district, Assam. Methods: A community-based cross-sectional study was conducted from December 2023 to March 2024 among 150 elderly residents selected through simple random sampling across three urban slums (Kalibarichar, Malinibeel, and Railway Colony). Data were collected using a pre-tested structured questionnaire through direct interviews. Descriptive statistics were used for analysis. Results: Among the participants, 58% were female and 63% belonged to the age group of 70–79 years. The majority (39%) were from the upper-lower socio-economic class, and 63% identified as Hindu. The most prevalent health conditions included ocular problems (42%), hypertension (41.3%), cardiovascular issues (34%), diabetes (30%), and joint problems (30%). Only 38% sought care at tertiary facilities, while 43% preferred primary health centers. Self-medication was reported by 46% of respondents. Mobility was impaired due to joint pain in 42% of participants, and 28% were reported to have psychological distress. Conclusion: The study highlights a high burden of non-communicable diseases and underutilization of healthcare services among the urban elderly in slum settings. Focused geriatric health services, regular screening, and community-based interventions are urgently needed to address the unmet healthcare needs of this marginalized population.

Background: Severe acute malnutrition (SAM) is one of the most pressing health challenges for young children in India. It not only limits growth but also leaves children more vulnerable to infections and complications that can quickly become life-threatening. Understanding how these issues present in local settings is important to improve care and outcomes. Objectives: This study explored the common comorbidities and complications among children with SAM admitted to a Nutritional Rehabilitation Centre (NRC) in Western India and assessed their short-term recovery during hospital care. Methods: Over an 18-month period, we enrolled 73 children aged 6–59 months who met WHO criteria for SAM. Information on their age, family background, nutritional status, comorbidities, complications, treatment, and outcomes was collected through a structured form. Data were analyzed using standard statistical methods, with significance set at p<0.05. Results: Most children were very young (three out of four were under two years old) and the majority came from low-income households. Anaemia was the most frequent comorbidity, affecting nearly three-quarters of the children, followed by pneumonia. Hypothermia was the leading complication, while electrolyte imbalances were uncommon. The average hospital stay was nearly 13 days. Encouragingly, children showed steady recovery, with an average weight gain of 8.5 g/kg/day. Overall, 74% were successfully discharged, 26% left treatment early, and no deaths were recorded. Conclusion: Children with SAM often arrive with multiple health challenges, but with dedicated care at NRCs, recovery and survival are possible. The high number of children defaulting from treatment, however, underlines the need for stronger community support, follow-up, and socioeconomic interventions to ensure lasting recovery beyond hospital walls.

Background: Chronic plaque psoriasis is a debilitating inflammatory skin condition requiring systemic therapy in moderate to severe cases. While methotrexate and biologics are commonly prescribed, azathioprine may serve as a useful alternative when these options are contraindicated. Aim: To evaluate the efficacy and safety profile of azathioprine in the management of chronic plaque psoriasis among patients attending a tertiary care hospital in South India, with specific assessment of PASI improvement over a 24-week period. Material and Methods: An observational study was conducted involving 80 patients diagnosed with chronic plaque psoriasis. Patients received oral azathioprine 50 mg twice daily for 24 weeks. PASI scores were measured at baseline, 12 weeks, and 24 weeks. Safety was assessed through regular laboratory monitoring and clinical adverse event documentation. Results: A total of 82.5% patients achieved fair to good therapeutic response. Mean PASI reduced from 14.2 at baseline to 6.3 at 12 weeks and 5.1 at 24 weeks. Adverse effects were mild and included exacerbation (15%), nausea (7.5%), and transient LFT elevation (7.5%). Conclusion: Azathioprine is a moderately effective and well-tolerated systemic option in chronic plaque psoriasis, especially in patients with limitations to using methotrexate or biologics.

Background: Preoperative anemia is a frequent clinical issue in surgical patients, especially those requiring abdominal surgery. It decreases the capacity of blood to carry oxygen and consequently compromises tissue perfusion, wound healing, and immunity. It puts patients at risk for increased morbidity, more extended hospital stays, and mortality. Assessing its effect is crucial for enhancing perioperative management. Objectives: The current investigation was designed to evaluate the impact of preoperative anemia on abdominal surgery postoperative outcomes, particularly complications, hospital stay, transfusion needs, and early mortality. Materials and Methods: The study was an observational cohort study done over a period of one year in a tertiary care center. 194 adult patients having elective and emergency abdominal surgeries were enrolled. The patients were stratified into anemic and non-anemic categories according to WHO hemoglobin standards. Demographic information, comorbidities, perioperative complications after surgery, need for transfusion, and 30-day outcomes were noted. Statistical analysis was done using chi-square test, Student’s t-test, and multivariate logistic regression, and p<0.05 was taken as significant. Results: Preoperative anemia was seen in 78 of 194 patients (40.2%). Anemic patients had increased rates of surgical site infection (18% vs. 9%, p=0.04), pulmonary complications (14% vs. 7%, p=0.03), and ileus (12% vs. 5%, p=0.05). Hospital stay was significantly more extended for the anemic group (10.2 ± 3.8 vs. 7.4 ± 2.9 days, p=0.001). The need for transfusions was substantially greater among anemic patients (35% vs. 10%, p=0.001). Thirty-day mortality was also elevated in the anemic group (6.5% vs. 2.1%, p=0.04). Conclusion: Preoperative anemia is a potent predictor of postoperative complications following abdominal surgery, resulting in increased complication rates, more extended hospital stays, increased requirements for transfusions, and increased mortality. Systematic screening and early correction of anemia should be included in perioperative care to maximize surgical results and decrease morbidity.

Background: Hypertension and diabetes mellitus are two chronic diseases that often coexist, with profound implications for accelerating cardiovascular and renal disease. Antihypertensive drugs are at the heart of managing hypertension, but their effects on glucose metabolism can worsen or enhance glycemic control. It is critical to elucidate the drug–disease interactions between frequently used antihypertensives and diabetes to maximize therapeutic benefits. Objectives: This research sought to assess the impact of the most frequently prescribed classes of antihypertensive agents—namely, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCBs), and thiazide diuretics—on glycemic status among patients with type 2 diabetes mellitus (T2DM). More specifically, it aimed to determine changes in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and insulin sensitivity related to chronic use of these drugs. Materials and Methods: A cross-sectional observational study was done in 300 patients with T2DM and coincidental hypertension who visited a tertiary care hospital. The patients were classified according to their initial antihypertensive treatment. Clinical information, laboratory values such as FBG and HbA1c, and duration of treatment were examined. Statistical analysis was conducted using ANOVA and regression models to establish associations between drug categories and glycemic parameters, while adjusting for confounders such as age, BMI, and lifestyle. Results: ACEIs and ARBs had a neutral to favorable impact on glycaemic control, with mean HbA1c levels having significant improvement over baseline (p<0.05). CCBs had little effect, while small rises in FBG and HbA1c characterized thiazide diuretics. Beta-blockers, especially non-selective ones, had a trend towards worsening insulin resistance, indicated by increased mean glucose (p<0.05). Conclusion: Antihypertensive treatment has mixed influences on glycemic control in diabetic individuals. ACEIs and ARBs are metabolically neutral, whereas thiazide diuretics and beta-blockers can worsen glucose control. Patients with diabetes should be carefully chosen for antihypertensive therapy to avoid adverse metabolic consequences and to improve disease management overall.

Background: Type 2 diabetes is a major public health concern requiring lifelong management. Insulin therapy is essential for achieving glycemic control but is often hindered by patient-related knowledge, attitudes, and practices. Understanding these factors is critical to improve diabetes outcomes. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital over one year, enrolling 212 adults with type 2 diabetes on insulin therapy. Data were collected through face-to-face interviews using a validated questionnaire assessing knowledge (8 items), attitude (7 items), and practice (9 items). Demographic and clinical data were also recorded, and HbA1c values were confirmed from medical records. Statistical analyses included Spearman’s correlation and Kruskal-Wallis test, with significance set at p<0.05. Results: Of 212 patients (median age 61 years, 64% women), most were unemployed, and over half had school-level education. The median knowledge, attitude, and practice scores were 62.5%, 85.7%, and 77.7%, respectively. Knowledge was highest for insulin storage and injection sites but lowest for initiation and dose adjustment. Younger age and higher education were significantly associated with better knowledge, while a positive attitude correlated with lower HbA1c levels. Conclusion: Patients demonstrated adequate knowledge, positive attitudes, and correct practices towards insulin therapy, though gaps remain in initiation understanding and safe needle disposal.

Background: Osteoarthritis (OA) is a common chronic joint disorder with knee OA (OAK) being the most prevalent form. Metabolic syndrome (MetS) has been suggested to contribute to OA progression through systemic inflammation and metabolic abnormalities. Understanding the association between MetS and OAK severity may aid early intervention. Materials and Methods: A case-control study took place at a tertiary care hospital over one year, including 216 participants aged ≥50 years with primary knee OA. Cases (n=108) were scheduled for total knee replacement, while controls (n=108) had OA not requiring surgery. Anthropometric measurements, blood pressure, and laboratory tests for MetS components were recorded. Radiographs were graded using the Kellgren-Lawrence (KL) system, and statistical analyses were performed using Chi-square tests, t-tests, and odds ratios. Results: Gender distribution was similar between groups (P=0.372). MetS was more common in cases (68.5%) than controls (37%), with an odds ratio of 3.6. Patients with MetS had higher KL grades, greater BMI, waist circumference, and lower HDL levels compared to controls. Blood pressure, fasting glucose, and triglycerides were comparable between groups. Conclusion: Metabolic syndrome is strongly correlated with enhanced severity of OAK, highlighting the need for early metabolic evaluation and management.

Background: Millions of people worldwide are impacted by this significant socioeconomic burden and global public health issue. According to estimates from the WHO, CKD affects roughly 10% of the world’s population, making it a major cause of disease burden. Objectives: The study sought to ascertain the independent risk variables linked to declining renal function in patients undergoing treatment at a tertiary care facility, as well as the clinical and laboratory predictors of CKD progression. 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 218 participants were retrieved for the study. Patients with CKD who were 18 years of age or older, attended the tertiary care facility during the study period, and had complete medical records, including baseline laboratory results and follow-up information to gauge the progression of CKD were considered as a part of the study. Results: The average age of patients with CKD advancement was 58.9 ± 11.2 years, while the average age of patients without progression was 55.3 ± 12.8 years. This difference was statistically significant, with a p-value of 0.041. A p-value of less than 0.001 indicated a strong correlation between proteinuria and the advancement of CKD. Conclusion: The study found that the following factors were independent predictors of the advancement of chronic kidney disease: proteinuria, lower baseline eGFR, hyperphosphatemia, diabetes mellitus, and hypertension. Recommendations: The advancement of the condition can be slowed by early treatment of blood pressure, proteinuria, and hyperphosphatemia as well as dietary and lifestyle changes.

Background: Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, are known predictors of long-term cardiovascular disease (CVD) in women. Despite this, the contribution of intermediate risk factors such as chronic hypertension, diabetes, obesity, and dyslipidemia remains unclear. Understanding these pathways is crucial for early prevention strategies in at-risk women. Materials and Methods: This hospital-based study was conducted over one year at a tertiary care center and included 212 parous women. Data on pregnancy history, HDP, and cardiovascular outcomes were collected from hospital records and validated interviews. Anthropometric, biochemical, and lifestyle information were recorded, and cardiovascular events were confirmed through clinical and investigation-based diagnosis. Statistical analyses were performed using SPSS v28, with significance set at p<0.05. Results: Of the participants, 81.1% were normotensive, 8.5% had gestational hypertension, and 10.4% developed preeclampsia. Women with HDP had higher BMI, greater family history of CVD, and higher rates of preterm and cesarean deliveries. CVD occurred in 15% of women with HDP compared to 4.7% of normotensive women, with preeclampsia showing the strongest association. Mediation analysis revealed chronic hypertension accounted for 55% of the excess CVD risk. Conclusion: HDP significantly increases long-term CVD risk in mothers, largely mediated by subsequent chronic hypertension.

Background: Over the past few years, the prevalence of MetS has increased, which has been linked to both population aging and rising obesity rates brought on by changes in lifestyle, such as reduced physical activity and unhealthy eating habits. In affluent nations, MetS is currently regarded as a pandemic and a serious public health concern. Objectives: In order to ascertain if metabolic syndrome in persons enrolled in a tertiary care facility was related to serum vitamin D levels, the study was conducted. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Data from 186 participants were retrieved for the study. Adults 40 years of age and older who gave their informed consent and went to the hospital for either a normal checkup or because they had risk factors that suggested metabolic syndrome were included in the study. Results: With p-values less than 0.01, participants with deficiency of vitamin D had a substantially larger waist circumference (98.4 ± 11.2 cm) than those with insufficiency (94.3 ± 10.8 cm) and sufficiency (91.6 ± 10.4 cm). The deficiency group had the greatest mean fasting glucose level (118.6 mg/dL), while the sufficiency group had the lowest (108.8 mg/dL). Conclusion: Among the study participants, vitamin D deficiency was shown to be very common. It also demonstrated a substantial correlation with the metabolic syndrome and its constituent parts, such as central obesity, hyperglycemia, dyslipidemia, and hypertension. Recommendations: It is recommended that people at risk for metabolic syndrome have their vitamin D levels regularly checked.

Background: Leprosy remains a public health concern, with early diagnosis essential to prevent deformities and transmission. Modified Fite-Faraco (FF) staining is standard for detecting Mycobacterium leprae but is laborious and less sensitive in paucibacillary cases. Auramine Rhodamine (AR) fluorescence staining may enhance detection. Methods: A cross-sectional study was conducted at a tertiary care hospital over 4.5 years on 100 clinically diagnosed leprosy patients. Skin biopsies were processed for Hematoxylin–Eosin, Fite Faraco and Auramine Rhodamine staining. Histopathological types, bacillary load and stain sensitivity and specificity were compared. Results: Tuberculoid leprosy (TT) was the most common type (22%), followed by borderline tuberculoid (BT) 19%. Male predominance was observed (71%). Auramine Rhodamine staining detected bacilli in 53 cases, including 13 Fite Faraco negative cases, demonstrating higher sensitivity. Auramine Rhodmaine showed superior specificity across most leprosy types compared to Fite Faraco staining. Conclusion: Auamine Rhodamine fluorescence staining is a sensitive and specific adjunct to Fite Faraco for detecting Mycobacterium leprae, particularly in paucibacillary cases. Its use can improve early diagnosis and treatment, supporting NLEP objectives.

Background: Laparoscopic cholecystectomy is currently thought to be the best course of treatment for people with symptomatic gallstone disease. Blowing CO2 into the peritoneal cavity and keeping it there until the treatment is over, when it will be eliminated and the ports removed, is the most popular method of creating pneumoperitoneum during laparoscopic cholecystectomy. Objectives: The objective of the study was to compare the intra operative Hemodynamic changes, difficulty in surgical field visibility and Conversion rate to open surgery during laparoscopic cholecystectomy between two groups. To compare the Postoperative surgical site pain and Shoulder tip pain. To assess the Recovery time and hospital stay between two groups. Method: This was a prospective comparative study was carried out in the Department of General Surgery, Sri Venkateshwaraa Medical College and Hospital, Ariyur, Puducherry, India from November 2024 to April 2025, study period was 6 months. A total of 50 patients of both genders (Male and Female), presenting with cholelithiasis were included in the study by simple random sampling divided into groups: Group A: Low pressure (8 mmHg) and Group B: Standard pressure (14 mmHg), 25 in each group. The Patient were admitted and planned for laparoscopic cholecystectomy. Results: In our study among 50 patients who underwent laparoscopic cholecystectomy 38 females, 12 males. In our study maximum number of cases between the age group 30 – 40 patients of 23 patients and 40-50 years of 17 patients. In our study mostly presents with dyspepsia 26 patients followed by vomiting in 12 patients and biliary colic in 12 patients. In our study hemodynamic instability less commonly seen in low pressure pneumoperitoneum of 5-10% when compared to standard pressure pneumoperitoneum around 25-30%, because low pressure pneumoperitoneum, reduces systemic vascular resistance, reduces cardio pulmonary effects. Conclusion: Low-pressure pneumoperitoneum is a safe and effective alternative to standard pressure in elective laparoscopic cholecystectomy in selected group of patients. Even though low pressure pneumoperitoneum is having technical challenge for surgeons, the main advantage for the patient is maintaining Intra operative hemodynamic stability and less post-operative morbidity.

Background: Multiple myeloma (MM) is a malignant plasma cell neoplasm characterized by the clonal proliferation of plasma cells in the bone marrow, accounting for approximately 10% of hematologic malignancies. It predominantly affects older adults, with a median age of diagnosis around 70 years. Patients typically present with fatigue, bone pain, anemia, renal impairment, or hypercalcemia, collectively defined by the CRAB criteria. Despite advances in diagnostic modalities, bone marrow examination remains the cornerstone for establishing the diagnosis and evaluating disease morphology. Morphological variations of plasma cells provide prognostic information, with mature forms associated with favorable outcomes and plasmablastic variants linked to aggressive disease. Methods: A retrospective observational study was conducted at the Department of Pathology, KIMS& RF, Amalapuram, including 28 cases of MM diagnosed over a 5-year period. Demographic details, clinical presentation, hematological and biochemical profiles, radiological findings, and bone marrow aspirates were reviewed. Morphological subtypes of plasma cells were categorized into mature, immature, plasmablastic, and pleomorphic types, with additional evaluation of multinucleation and cytoplasmic inclusions such as Russell bodies and Mott cells. Results: The mean age of presentation was 57 years (range: 37–75), with a male-to-female ratio of 1.3:1. The most frequent presenting symptoms included bone pain (71.4%) and generalized weakness (46.4%). Anemia was present in 92.8% of patients, with hemoglobin values as low as 2.8 g/dL. ESR was universally elevated, and M-band positivity was detected in the majority. Radiological lytic lesions were observed in 57%. Bone marrow plasmacytosis ranged between 20–70%. Morphological distribution revealed mature plasma cells in 61%, plasmablastic in 10%, pleomorphic in 11%, and mixed mature/immature in 18%. Multinucleation was present in 46.4% of cases, while Mott cells and Russell bodies were rarely encountered. Conclusion: Bone marrow morphology continues to be central to the diagnosis and prognostication of MM. The predominance of mature plasma cell morphology suggests a relatively favorable pattern, whereas plasmablastic morphology was rare but clinically significant due to its poor prognosis. Morphological assessment of plasma cells, integrated with clinical, biochemical, and radiological findings, remains indispensable in the comprehensive evaluation of MM patients.

Background: Bipolar Disorder (BD) is a chronic psychiatric condition characterized by recurrent manic and depressive episodes, significantly impairing daily functioning and quality of life. Conventional treatments such as divalproex have efficacy in managing acute mania but are often limited by side effects, affecting adherence. Objective: This study aimed to compare the efficacy and tolerability of Endoxifen, a selective Protein Kinase C (PKC) inhibitor, with Divalproex in patients experiencing acute manic episodes of bipolar disorder. Methods: In a prospective, randomized, open-label parallel-group design, 48 patients diagnosed with BD manic episodes were randomized to receive either divalproex sodium (1,000 mg/day) or endoxifen (8 mg/day) over six weeks. Primary efficacy was measured by change in Young Mania Rating Scale (YMRS) scores, and tolerability was assessed via the UKU Side Effect Rating Scale at baseline and follow-ups at 2, 4, and 6 weeks. Results: Both groups demonstrated significant reductions in YMRS scores from baseline to week 6 (Divalproex: 32.57 ± 1.42 to 5.12 ± 0.68; Endoxifen: 32.67 ± 1.53 to 5.12 ± 0.94), with no statistically significant difference between groups (p > 0.05). However, the Endoxifen group exhibited significantly fewer and milder adverse effects, reflected by lower UKU scores at all follow-ups (Week 2: 4.22 ± 2.50 vs  2.09 ± 1.69; p = 0.001). Treatment adherence was high and comparable across groups. Conclusions: Endoxifen offers comparable efficacy to divalproex in the treatment of acute mania but with a superior tolerability profile, suggesting it as a promising alternative for BD management. Its targeted PKC inhibition mechanism may underlie this clinical advantage, potentially improving patient adherence and outcomes. Larger, blinded trials with extended follow-up are warranted to confirm these findings and explore Endoxifen’s role in maintenance therapy and personalized treatment strategies.

Background: Neck swellings are a frequent clinical presentation encompassing a wide spectrum of causes, from benign thyroid lesions to malignant, salivary gland, and lymph node pathologies. Early recognition and accurate diagnosis are essential to reduce morbidity, particularly in regions where patients often present at advanced stages. Objective: This study aimed to analyze the demographic distribution, clinical presentation, and cytological diagnosis of neck swellings, with special emphasis on unusual cases and the correlation between fine-needle aspiration cytology (FNAC) and ultrasonography (USG). Materials and Methods: This retrospective observational study was conducted at a tertiary care hospital at Annapoorana Medical College & Hospitals, Kombadipatty, and Salem over ten years (March 2010 – February 2021). Forty patients with neck swellings were included. Clinical history, physical examination, and investigations (USG, FNAC, histopathology where available) were reviewed. Data were analyzed using descriptive statistics, with cross-tabulation of age, gender, symptoms, and diagnosis, and concordance between FNAC and USG was assessed. Results: The cohort comprised 40 patients (30 females, 10 males) with a mean age of 45 years. Females predominated (F:M = 3:1), and the majority of cases clustered in the 41–60 years group. The most common presenting symptom was palpitation (42.5%), followed by dysphagia (22.5%), hoarseness (17.5%), and shortness of breath (15%). FNAC identified benign thyroid swellings as the most frequent diagnosis (65%), with colloid/nodular goiter (35%) and Hashimoto’s thyroiditis (25%) leading the spectrum. Malignancy was rare (5%), while salivary gland lesions accounted for 10% and unspecified cases for 20%. FNAC–USG concordance was low (25.6%), with discordance in 74.4%. Rare but significant cases included Wilson’s disease, Hashitoxicosis, parotid abscess, and post-parotidectomy complications. Conclusion: Neck swellings most commonly affect middle-aged females and are predominantly benign thyroid lesions. FNAC remains the gold standard for initial evaluation, outperforming USG in diagnostic reliability. Integrating demographic patterns, symptom associations, and cytology enhances diagnostic precision, while rare cases highlight the need for broad clinical suspicion and multimodal evaluation.

Background: This randomized controlled trial evaluated the efficacy of continuous versus intermittent phototherapy in term neonates with hyperbilirubinemia, focusing on 12-hourly serum bilirubin reduction trends. Methods: One hundred term neonates (>37 and ≤42 weeks) requiring phototherapy as per American Academy of Pediatrics (AAP) guidelines were randomized into two groups: continuous phototherapy (2 hours ON, 30 minutes OFF) and intermittent phototherapy (2 hours ON, 3 hours OFF). Baseline demographics, gender, maternal and neonatal blood groups, birth weight, discharge weight, and hospital stay were recorded. Serum bilirubin levels were measured at baseline and every 12 hours until 48 hours. Data were analyzed using independent t-test and chi-square test. Results: Both groups were comparable at baseline. Continuous phototherapy achieved significantly greater serum bilirubin reduction from 12 hours onwards (p<0.05 at each interval). Mean phototherapy duration was higher in the continuous group. No significant adverse effects were noted in either group. Conclusion: Continuous phototherapy led to faster bilirubin decline than intermittent phototherapy, while both methods were effective in achieving safe discharge bilirubin levels. The findings support continuous phototherapy for rapid reduction in high bilirubin levels.

Background: Intermittent fasting (IF) is gaining interest as an alternative therapy for type 2 diabetes mellitus (T2DM) management. Although commonly proposed for weight loss, the potential of IF may be beyond it with possible benefits on insulin sensitivity, day-to-day glucose management and lipid profile. Clear evidence of benefits has been demonstrated in clinical trials, however evidence from the real-world experience is scarce and usually not published in detail. This experience is even more limited among Indian patients. Methods: We performed a prospective observational study on adults with T2DM who were interested and agreed to adhere to a structured fasting protocol. The 16: 8 time-restricted eating protocol was applied with continuous compliance for 12 weeks. We monitored HbA1c, fasting and post-meal glucose, lipid profile, body mass index (BMI) and insulin/oral agent dose as the parameters of interest. Measurements were taken at baseline and at the end of 12 weeks. All patients continued on their pre-study medications throughout the study period, that is, IF was added to their usual diabetes management. No changes to prescribed therapies were allowed during the study period. Results: Sixty patients were recruited and 54 patients completed the study. At week 12, mean HbA1c decreased from 8.4% to 7.7% (p<0.01), mean fasting glucose improved from 162 mg/dL to 138 mg/dL (p<0.01). Mean weight on the scale was reduced by 2.8 kg (p<0.05). HDL cholesterol also increased slightly, although the change was not significant. It is interesting to note that many patients reduced their insulin dose (self-adjusted) without any deterioration of blood glucose control; this may have been facilitated by the fasting regimen. The ability to reduce insulin without increase in hypoglycaemia could be a unique advantage of IF. No hypoglycaemic events of severity were observed. No adverse events were recorded in the study. Conclusion: Our study supports the short-term metabolic benefits of intermittent fasting in patients with T2DM, particularly in improving glycaemic control and promoting modest weight loss. While IF may not replace pharmacotherapy, it appears to be a safe, feasible, and culturally acceptable adjunct. Longer-duration studies are warranted to understand its sustained effects and long-term safety.

Background: Ischemia-modified albumin (IMA) is a marker of oxidative stress and ischemia and has been reported to be elevated in diabetes mellitus. This study evaluated serum IMA and its correlation with glycated hemoglobin (HbA1c) in patients with poorly controlled type-2 diabetes mellitus (T2DM). Materials & Methods: An observational, non-interventional, hospital-based cross-sectional study conducted at IPGME&R & SSKM Hospital, Kolkata. A total of 100 subjects (50 T2DM cases and 50 age- and sex-matched controls) were enrolled. Serum IMA was estimated by the cobalt-albumin binding (ACB) assay; HbA1c by HPLC; glucose by GOD-POD method. Statistical analysis used SPSS; p < 0.05 was considered significant. Results: Mean IMA was significantly higher in cases (0.7108 ± 0.1549 ABSU) compared to controls (0.1985 ± 0.0658 ABSU), p < 0.0001. Mean HbA1c was also higher in cases 8.5240 ± 0.8434% vs 5.2780 ± 0.6018% in controls (p < 0.0001). FBS and PPBS were also significantly higher in cases. A strong positive correlation between IMA and HbA1c was observed (r = 0.824, p < 0.0001). Conclusion: Serum IMA is elevated in poorly controlled T2DM and correlates strongly with HbA1c. IMA may serve as an adjunct biomarker for oxidative stress in diabetes.

Background: Pituitary apoplexy (PA) is a rare endocrine-neurosurgical emergency that is the result of acute bleeding or an infarction of the pituitary gland. Sudden headache, visual loss and cranial nerve palsies are typical presentation, but altered sensorium is an underemphasized but clinically important event which may present as a stroke or meningitis, and slow down the process of diagnosis. Case: A non-diabetic 52-year-old man came to the emergency department with abrupt altered sensorium (Glasgow Coma Scale 9/15) without any history of headache or vomiting. There was no history of diabetes, hypertension, trauma, or any use of anticoagulants. On examination, he was drowsy but arousable, with stable vital signs and no focal neurological deficit. Initial non-contrast CT brain was unremarkable, but MRI revealed a 2.1 × 1.8 × 2.0 cm sellar-suprasellar mass with heterogeneous signal intensity and evidence of recent haemorrhage, consistent with pituitary apoplexy. Laboratory evaluation showed serum sodium 128 mEq/L, serum cortisol 1.8 µg/dL (low), ACTH <5 pg/mL, free T4 0.6 ng/dL (low) with inappropriately normal TSH, indicating secondary adrenal insufficiency and central hypothyroidism. Management and Outcome: The patient received hydrocortisone 100 mg IV stat, then 50 mg IV every 6 hours, along with isotonic saline. In the following 24 hours, his mental condition improved significantly, and GCS returned to 15/15. Since there was no progressive loss of visual functions, he was treated in a conservative manner using hormone replacement (hydrocortisone and levothyroxine). Three-month follow up revealed that he was still neurologically intact, MRI revealed that haemorrhage resolved partially and he was stable clinically on pituitary hormone replacement. Conclusion: Even in patients with no headache and unremarkable CT in middle-aged patients with acute altered sensorium, one should consider to evaluate for pituitary apoplexy even in the absence of headache or visual symptoms. MRI is the gold standard of diagnosis, and early treatment with glucocorticoids is life-saving, with definitive management being tailored.

Background: Fine-needle aspiration cytology (FNAC) is the cornerstone for evaluating thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is globally recognized, but several other international systems, including the Royal College of Pathologists (RCPath) UK, Italian SIAPEC, and Japanese reporting frameworks, are also widely used. Comparative analysis of these systems remains limited, particularly in single-centre cohorts. Methods: We conducted a retrospective analysis of thyroid FNAC cases reported at our centre. Cases were simultaneously categorized according to the Bethesda system and other international systems. Demographic variables, cytological categories, histopathological follow-up, and risk of malignancy (ROM) were compared. Statistical analysis was performed using chi-square and kappa statistics for concordance. Results: A total of 620 FNAC cases were included. The mean age of patients was 42.3 years, with a female predominance (M:F = 1:3.2). According to the Bethesda system, the distribution was: Non-diagnostic (6.3%), Benign (58.2%), AUS/FLUS (11.4%), Follicular neoplasm/SFN (9.5%), Suspicious for malignancy (6.9%), and Malignant (7.7%). Comparison with RCPath and SIAPEC systems demonstrated overall concordance of 82% (κ=0.78) and 79% (κ=0.74), respectively. Risk of malignancy was highest in Bethesda malignant (97.6%) and suspicious categories (74.2%), which aligned closely with RCPath Thy5 and Thy4 groups. Notably, AUS/FLUS under Bethesda overlapped significantly with SIAPEC TIR3A/B categories, leading to variability in ROM (22–41%). Conclusion: Bethesda provides a globally standardized, reproducible, and clinically effective cytology reporting framework. However, other systems, particularly RCPath and SIAPEC, may offer greater stratification in indeterminate lesions. Harmonization of systems or crosswalk guidelines could enhance diagnostic clarity and clinical management.

Background: Malaria is one of the leading causes of morbidity and death in endemic countries, and it has significant hematological modifications that point to clinical outcomes. Hemoglobin, leukocyte, platelet counts, and hematocrit are deranged in common during malarial infections and reflect severity of illness and prognosis. Comprehension of these changes is therefore important for early detection, follow-up, and intervention in treatment. Methods: It was an observational study to be conducted prospectively for 12 months in a higher care hospital. 200 patients with definite malaria (peripheral smear and rapid antigen test) were included. Hematologic parameters such as hemoglobin (Hb), total leukocyte count (TLC), count of platelets, hematocrit, and differential counts were examined. Patients were stratified by the infective organism (Plasmodium falciparum, P. vivax, and mixed) and by severity. It was analyzed statistically by SPSS version 25. Results: Of the 200 patients, 120 (60%) had P. vivax, 60 (30%) had P. falciparum, and 20 (10%) had mixed infections. Anemia (Hb <10 g/dL) was seen in 45% of patients, thrombocytopenia (<150 ×10⁹/L) in 72%, and leukopenia (<4 ×10⁹/L) in 28%. Severe thrombocytopenia (<50 ×10⁹/L) was much more frequent in P. falciparum (40%) than in P. vivax (15%) (p < 0.05). Conclusion: Malaria is accompanied by common hematologic findings of anemia and thrombocytopenia, more pronounced in P. falciparum infections and mixed infections. Hematologic profiling can be done routinely to allow early identification of cases, disease severity prognosis, and appropriate care for patients living in endemic areas.

Introduction: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder often requiring pharmacological intervention for glycemic control. While metformin is the first-line therapy, early combination with other oral antidiabetic drugs may offer superior glycemic outcomes. This study aimed to compare the efficacy and safety of metformin monotherapy versus metformin-based combination therapy in newly diagnosed T2DM patients. Materials and Method: A prospective, observational study was conducted on 200 newly diagnosed T2DM patients aged 30–65 years at a tertiary care hospital. Patients were divided into two equal groups: Group A received metformin monotherapy, and Group B received metformin plus another oral antidiabetic agent (e.g., sulfonylurea, DPP-4 inhibitor, or SGLT2 inhibitor). Glycemic parameters—HbA1c, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG)—were recorded at baseline and after six months. Adverse drug reactions (ADRs) were monitored, and data were statistically analysed using appropriate tests. Results: Both groups showed significant improvement in glycemic control after six months. The combination group showed a greater reduction in HbA1c (1.64 ± 0.55% vs. 1.28 ± 0.52%; p = 0.002), FPG (52.7 ± 22.1 vs. 38.2 ± 20.5 mg/dL; p = 0.001), and PPG (84.9 ± 30.7 vs. 68.6 ± 28.3 mg/dL; p = 0.003). A higher proportion of patients in Group B achieved HbA1c <7% (72% vs. 56%; p = 0.01). Hypoglycemia occurred only in the combination group (6%; p = 0.03). Conclusion: Early combination therapy provides superior glycemic control compared to metformin alone but carries a higher risk of hypoglycemia, necessitating individualized treatment planning.

Introduction: Head and neck carcinoma (HNC) is commonly treated with definitive concomitant chemo-radiation (CCRT), which, while effective, can result in significant treatment-related toxicities, including sensorineural hearing loss due to radiation exposure of the cochlea. Aims: Cochlear-sparing radiation therapy (CSRT) aims to reduce radiation dose to the cochlea while maintaining tumor control, potentially preserving hearing function. Methods: This study is a single-institutional prospective observational study conducted at the Department of Radiotherapy, Medical College and Hospital, Kolkata, from October 2022 to February 2024. The study population included patients attending the radiotherapy outpatient department with biopsy-proven locally advanced carcinoma of the head and neck, who had good performance status and satisfactory cardiological status, and were planned to receive concurrent chemoradiotherapy as definitive treatment. Results: Bone-masked pure tone audiometry showed that cochlear-sparing chemoradiation therapy led to frequency- and time-dependent increases in hearing thresholds. At 250 Hz, thresholds increased slightly immediately post-treatment and rose progressively at 3 and 6 months, reaching highly significant levels (up to 5.86 dB, p < 0.001). At 500 Hz, immediate changes were minimal, but significant threshold shifts were observed at 3 and 6 months (up to 4.11 dB, p < 0.001). At 1000 Hz, immediate post-treatment changes were negligible, while significant increases occurred at 3 and 6 months (up to 3.61 dB, p < 0.001). Linear regression revealed a dose-dependent relationship between cochlear maximum radiation doses (Dmax) and hearing thresholds over time, with stronger correlations at 3 and 6 months across all frequencies, indicating that higher cochlear doses are associated with greater long-term hearing loss. Conclusion: Cochlear-sparing radiation therapy during definitive CCRT for head and neck carcinoma is feasible and effectively preserves hearing function, particularly in low- to mid-frequency ranges, without compromising oncologic outcomes. Implementation of cochlear dose constraints in radiotherapy planning should be considered to minimize ototoxicity in HNC patients.

Purpose: Competency-based medical Education (CBME) focuses student-centred learning and development of critical thinking and lifelong learning skills. Traditional Pharmacology teaching methods fail to engage students effectively. Active learning strategies like Flipped Classroom (FC) and Team Based Learning (TBL) promote higher-order cognitive skills. Combining FC and TBL enhances the learner’s autonomy, self- directed learning, motivation, advanced critical thinking and conceptual understanding. However, literature on their combined effect in pharmacology is very limited. This study aimed to evaluate the effectiveness of integrating FC and TBL in Pharmacology. Aim: To explore the combined effectiveness of FCs and TBL in fostering higher-order cognitive skills among medical students. Methodology: A parallel-group, comparative, crossover study was conducted among II ^nd year MBBS students, divided into two groups. In session I, Group A underwent FC and TBL learning methodology while Group B received traditional teaching. In the session 2 cross over of the teaching strategies was done. Pre-test, team test and post-test scores were collected along with student’s feedback using validated questionnaire. Data was analysed using student’s t-test. Results: Pre-test, team test and post-test scores showed a significant improvement in group exposed to FC and TBL (p < 0.001). No significant improvement was observed in the group taught using traditional methods. Student feedback strongly inclined towards FC and TBL for promotion of critical thinking, teamwork, self-directed learning and leadership skills.  Conclusion: Combined use of FC and TBL is highly effective teaching strategy in Pharmacology for medical undergraduates enhancing knowledge acquisition and promoting essential cognitive and collaborative skills.

Background: India’s rapid population growth continues to pose major public health challenges. A substantial proportion of postpartum women have unmet needs for family planning, resulting in short birth intervals and heightened risks of maternal and neonatal morbidity. The postpartum intrauterine contraceptive device (PPIUCD) is a safe, effective, and long-acting reversible contraceptive method; however, its acceptance remains limited due to inadequate awareness and socio-cultural barriers. Objective: To assess the level of awareness and to identify the factors influencing acceptance of PPIUCD among mothers registered in Health and Wellness Centre (HWC) PPIUCD lists in Jamalpur block of Purba Bardhaman district, West Bengal. Methods: A community-based cross-sectional study was conducted from January to March 2025 among 71 postpartum mothers selected through simple random sampling from 16 HWCs. Data were collected using a pretested structured questionnaire and analyzed using appropriate statistical methods. Results: Overall awareness of PPIUCD was high (95.8%), with health workers serving as the primary source of information (70.4%). The main reasons cited for acceptance were reversibility (30%) and antenatal counselling (28%). Awareness showed statistically significant associations with religion (p = 0.016) and socioeconomic status (p = 0.007), whereas age, education, and parity were not significantly associated. Despite encouraging levels of awareness, notable knowledge gaps persisted, particularly regarding post-insertion care, as none of the participants (0%) were aware of the importance of monthly thread checks. Conclusion: Although awareness of PPIUCD was encouraging in this rural population, critical knowledge gaps and disparities among disadvantaged groups remain. Targeted antenatal counselling and culturally sensitive communication strategies are essential to enhance informed decision-making and sustained use of PPIUCD.

Introduction: Lung cancer is the leading cause of cancer-related morbidity and mortality worldwide, accounting for 11.6% of all cancers and 18.4% of cancer-related deaths. In India, approximately 67,795 new cases were reported in 2018, with an estimated 63,475 deaths. Epidemiological patterns vary geographically, with smoking remaining the predominant risk factor. Recent trends indicate an increasing prevalence of adenocarcinoma, particularly among non-smokers and females, and late-stage presentation remains common, contributing to poor survival outcomes. This study aimed to evaluate the demographic, clinical, histopathological, and molecular characteristics of lung cancer patients in a tertiary care hospital. Materials and Methods: A prospective observational study was conducted at SMS Medical College and Hospital, Jaipur, enrolling 144 adult patients with histopathologically confirmed primary lung carcinoma. Demographic, clinical, histological, and molecular data, including ALK, EGFR, and PD-L1 status, were collected using a structured case record form. Continuous variables were expressed as mean ± SD or median with range, and categorical variables as frequencies and percentages. Results: The mean age of participants was 56.9 years, with the majority aged 60–69 years (36.11%). Male patients predominated (75%), and 61.8% were smokers. Adenocarcinoma was the most common histological subtype (79.9%), followed by squamous cell carcinoma (19.4%). Molecular profiling showed ALK positive in 16.4% and EGFR positivity in 26% of cases. PD-L1 expression was mostly low (<1%) or negative (67.8%), while high expression (≥50%) was observed in 4.1% of participants. Conclusion: Lung cancer in this cohort primarily affected elderly male smokers, with adenocarcinoma as the dominant histological type. Actionable molecular alterations were limited, and PD-L1 expression was predominantly low, underscoring the importance of early diagnosis, tobacco cessation, and molecular testing to guide personalized therapy.

Background: Hypertension is one of the major public health issues in India, contributing significantly to cardiovascular morbidity and mortality. Early diagnosis, lifestyle modifications and rational prescribing are critical to reduce the burden. Objective: To analyse the prescribing patterns of antihypertensive drugs among patients attending the medicine outpatient department of a tertiary care hospital and to assess the adherence to standard treatment guidelines. Methods: A retrospective, cross-sectional observational study was conducted over six months at Jagannath Gupta Institute of Medical Sciences and Hospital, Kolkata. Prescriptions containing at least one antihypertensive medication were reviewed and analysed using descriptive statistics. Results: Of the 111 patients 59.5% were male and 66.5% resided in urban areas. Positive family history of hypertension was noted in 75.9% of cases. Smoking (87.3%) and alcohol consumption (59.2%) were common lifestyle factors. Monotherapy was prescribed in 85.5% of cases with fixed-dose combinations (FDCs) used in 90% of combination therapies. Generic prescribing was observed in 78.8% of prescriptions. End-organ damage was documented in 8.5% of cases. Conclusion: The study demonstrates a positive trend towards rational antihypertensive prescribing with a preference for monotherapy, FDCs and generic drugs. However, high rates of lifestyle risk factors and end-organ damage emphasize the need for comprehensive hypertension management strategies which includes early screening, patient education and strict adherence to treatment protocols.

Background: Hypoglycemia is a common, potentially life-threatening emergency in both diabetic and non-diabetic individuals, associated with significant morbidity and mortality. While frequently related to anti-diabetic therapy, hypoglycemia in non-diabetic patients often arises from comorbid illnesses such as liver dysfunction, sepsis, or alcohol use. This study aimed to evaluate and compare the common causes and clinical correlates of hypoglycemia in diabetic and non-diabetic patients in Western Rajasthan. Methods: An observational study was conducted at Mahatma Gandhi Hospital, Jodhpur, including 50 diabetic and 50 non-diabetic patients aged 18–90 years presenting with documented hypoglycemia (blood glucose <70 mg/dL). Demographic, clinical, and biochemical data were collected, and comorbidities were assessed. SPSS was used for the statistical analysis, and p < 0.05 was chosen as the significance level. Results: Among non-diabetic patients, hypoglycemia was significantly associated with lower random blood sugar (48.96±10.8 mg/dL vs. 117.16±16.96 mg/dL), higher postprandial glucose, elevated AST, bilirubin, and raised beta-hydroxybutyrate levels, suggesting altered metabolism and ketogenesis. Chronic liver disease was a significant comorbidity linked to hypoglycemia. In diabetic patients, hypoglycemia correlated with low random blood sugar (46.40±11.42 mg/dL vs. 175.4±75.62 mg/dL), higher postprandial glucose, and elevated serum creatinine. Chronic kidney disease showed a significant association with hypoglycemia. Conclusion: Hypoglycemia occurs with comparable frequency in diabetic and non-diabetic patients but arises from different underlying mechanisms. In non-diabetics, liver dysfunction and ketogenesis are key contributors, whereas in diabetics, impaired renal function plays a major role. Early recognition, targeted monitoring, and preventive strategies, including patient education and treatment adjustments, are essential to reduce complications.

Background: Oral squamous cell carcinoma (OSCC) is preceded by oral potentially malignant diseases (OPMDs) representing a significant public health concern in India where oral cancer ranks among the top three cancers. Aim: To evaluate the prevalence, risk factors, and histopathological correlation of OPMDs in patients attending a tertiary care hospital in Bhubaneswar, Odisha. Methods: A cross-sectional hospital-based study was carried out Bhubaneswar’s Kalinga Institute of Dental Sciences and Kalinga Institute of Medical Sciences (KIIT DU), from August 2023 to August 2024. A total of 1000 patients were screened using WHO criteria. Demographic data, lifestyle factors, and clinical findings were recorded. Histopathological confirmation was performed where indicated. Statistical ANOVA, logistic regression, and the chi-square test were all used in the analysis. Results: Of 1000 patients, 999 valid cases were analyzed. The majority were aged 30–50 years (55.3%), with a male predominance (67.9%). The most common OPMDs were oral submucous fibrosis (22.5%), oral lichen planus (17.4%), leukoplakia (14.1%), and tobacco pouch keratosis (10.7%). Cigarette smoking (43.5%) and paan chewing (29.5%) were the most prevalent risk factors. Significant associations were observed between age, sex, socioeconomic status, and OPMD occurrence (p < 0.05). Histopathological examination revealed variable degrees of epithelial dysplasia, with leukoplakia and erythroplakia showing higher malignant potential. Conclusion: OPMDs are prevalent among middle-aged males of lower socioeconomic status in Odisha, largely linked to tobacco and areca nut habits. Early detection, patient education, and habit cessation programs are critical to reduce malignant transformation risk.

Introduction: Adult acetabular fractures with associated posterior hip dislocation present with significant challenges due to the complexity of the anatomy and potential for long-term complications. This report describes the management of a 50-year-old male who sustained a comminuted posterior acetabular rim fracture with posterior dislocation and subsequent femoral head resorption. Case Presentation: The patient presented with left hip pain and inability to bear weight following a fall from a height. Imaging confirmed a posterior dislocation of the femoral head with a comminuted posterior acetabular fracture. Urgent closed reduction and skeletal traction were performed. Definitive acetabular plating was planned, but intraoperative findings revealed severe femoral head resorption, necessitating excision of the femoral head and abandonment of plating. The patient underwent non-weightbearing rehabilitation. Three months later, a custom total hip replacement (THR) was performed as definitive management, resulting in substantial functional improvement. Conclusion: This case highlights the challenges of managing adult hip injuries complicated by femoral head resorption. Early recognition of complications such as avascular necrosis (AVN) is critical. In THR, advancements in prosthetic design have improved outcomes. This case demonstrates the importance of a flexible, multidisciplinary approach to achieve optimal results in such complex cases. Femoral head resorption following traumatic hip dislocation and acetabular fractures in adult patients requires individualized management. Total hip replacement can provide significant functional recovery, even in young patients, when other surgical options are exhausted.

Background: Uterotonics like carboprost used during lower segment caesarean section in patients under spinal anaesthesia to prevent postpartum hemorrhage (PPH) can cause perioperative nausea and vomiting which can results in patient discomfort, increase risk of intraoperative bleeding and increase wound pain. Objectives: To study the effectiveness of acupressure and ondansetron in prevention of nausea and vomiting following the use of carboprost in patients undergoing lower segment caesarean section under spinal anaesthesia. Methods: A prospective randomized and comparative study was carried out in 100 parturients aged 18 to 45 year of ASA physical status I and II, Gestation age ≥36 weeks scheduled for elective LSCS under spinal anesthesia. All patients were divided into two groups with 50 patients in each group. In Group A patients unilateral Acupressure wrist sea band applied for P6 stimulation just before spinal anaesthesia and in Group O that is antiemetic group patients received injection ondansetron 4 mg intravenously just before spinal anaesthesia. Results: Data was entered in MS EXCEL and analysed using latest version of Statistical Package for Social Sciences (SPSS). The incidence of intra-operative nausea was 30% and 24% and incidence of vomiting was 18% and 12% in Group A and Group O respectively. Incidence of intraoperative nausea and vomiting remain comparable in both the groups (P>0.05). Incidence of postoperative nausea was 22% and 14% and incidence of vomiting was 14% and 8% in Group A and Group O respectively and remain comparable in both the groups (P>0.05). In our study, the incidence and severity of nausea and vomiting were similar in p6 group and antiemetic group and were not statistically significant (p>0.05). Conclusion: Acupressure to the P6 point is a low cost, simple method as effective as ondansetron to reduce the incidence of nausea and vomiting during intra operative and postoperative period in parturients undergoing LSCS under spinal anesthesia.

Background: The BSSRI is a valid, reliable and an easy tool to evaluate birth satisfaction among postpartum mothers in a health care facility. Methods: A prospective cross-sectional study was conducted at the Obstetrics and Gynecology department of Apollo Institute of Medical Sciences and Research Hyderabad, India. The six item Birth Satisfaction Scale-Revised Indicator ‘BSS-RI’ tool was used. Pregnant women with singleton pregnancy who were willing to participate and give consent were included in study. Results: A total of 206 women completed the 6-item BSS-RI. The total score of all items of BSSRI score was 8.67 with SD of 2.102. Mean age of the participants in our study was 25.33years. In our study BSS-RI scores was not associated with age of the women, period of gestation, parity, type of onset of labour, booking status and gender of the baby. Eighty-nine women had emergency LSCS and 38 (42.7%) of them had scores more than 9. P value was found to be 0.006 so BSSRI score was significantly associated with mode of delivery of patients. Conclusion: BSSRI is a valid and reliable tool which is also easy to administer. All obstetric care providers should measure satisfaction with childbirth using the BSS-R in order to understand how to improve the childbirth experiences.

Background: Birth asphyxia, a leading cause of neonatal morbidity and mortality, disrupts oxygenation and causes metabolic derangements. Electrolyte imbalances—sodium, potassium, calcium and hypoglycemia correlate with severity, impacting organ function and neurological outcomes. Cord blood analysis offers early detection, aiding timely intervention and improved management of affected neonates. Aim: to assess cord blood electrolyte and glucose level in birth asphyxia and their correlation with severity of asphyxia. Methods: Neonates meeting inclusion criteria were enrolled after parental consent. Cord blood (2 ml) was collected within 1 minute of birth for glucose and electrolyte analysis. Clinical data, birth history, and Apgar scores were recorded. Asphyxiated neonates were staged for HIE severity using Sarnat and Sarnat criteria, and biochemical and clinical outcomes were documented. Results: Among 75 cases and 75 controls, males predominated (68% vs. 64%). Cases showed lower sodium (134.6 ± 4.27 vs. 137.73 ± 3.89 mEq/L), calcium (8.01 ± 0.63 vs. 9.02 ± 0.49 mg/dL), glucose (65.49 ± 9.45 vs. 81.82 ± 10.39 mg/dL) and higher potassium (5.15 ± 0.76 vs. 4.27 ± 0.35 mEq/L), all p < 0.0001. Biochemical disturbances correlated with HIE severity: sodium (r = -0.51), potassium (r = 0.39), calcium (r = -0.78), glucose (r = -0.56). Conclusion: Birth asphyxia causes significant disturbances in cord blood electrolytes and glucose, correlating with hypoxic-ischemic encephalopathy severity. Sodium, calcium, and glucose decrease, while potassium rises with worsening asphyxia. Monitoring these parameters enables early detection, guides timely intervention, and supports effective management of affected neonates, potentially reducing complications and improving short- and long-term outcomes.

Background: The most common postoperative complication after modified radical mastectomy (MRM) is seroma development. It contributes to patient discomfort, repeated aspirations, wound complications, and delayed adjuvant therapy. Objective: To evaluate the incidence and risk factors associated with seroma formation following MRM. Methods: A retrospective analysis of 100 patients undergoing MRM at two tertiary centers between January and December was conducted. Demographic, clinical, operative, and postoperative data were extracted from hospital records. Seroma was defined as a clinically or radiologically detected fluid collection requiring aspiration. Statistical analyses included univariate testing and logistic regression. Results: Seroma developed in 28 patients (28%). Independent risk factors included age ≥60 years (OR 2.6, 95% CI 1.1–6.2), BMI ≥30 kg/m² (OR 2.9, 95% CI 1.2–7.1), drain duration >5 days (OR 3.8, 95% CI 1.4–9.7), and axillary clearance >15 lymph nodes (OR 2.2, 95% CI 1.0–5.1). Diabetes mellitus showed a non-significant association. Quilting sutures reduced incidence, though not significantly. Conclusion: Seroma occurred in nearly one-third of patients undergoing MRM. Older age, obesity, prolonged drainage, and extensive axillary dissection were major risk factors. Adoption of standardized drain protocols and quilting sutures may reduce seroma incidence.

Background: Digital subtraction angiography (DSA) has been the gold standard for diagnosing cerebral vascular malformations (CVMs) with arteriovenous shunting, including arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), and developmental venous abnormalities (DVAs). Although catheter technologies have advanced, there is still a 1% chance of invasive catheter angiograms. Objectives: The objective of the study was to know the distribution of age and sex in patients of brain vascular lesion. To see the common location of different brain vascular lesions. To compare the diagnostic supremacy of CTA/MRA and DSA for the detection of intracranial vascular anomalies. Methods: 50 patients, both male and female, with acute stroke syndrome or any other symptoms indicating an intracranial vascular lesion that were undergoing DSA testing at Medical College and Hospital in Kolkata were included in the study. They were examined using one or more index tests and a reference standard that was determined by CT or MR scanning or other parameters. Results: The youngest patient was 14 years old and the oldest patient was 82 years old. Out of the total 50 patients 29 (58%) were males and 21 (42%) were females. The maximum number (14) of patients belonged to the age group 51-60 years. Second largest number of patients (12) belonged to the age group 41-50years, followed by10 patients in age group 31-40years. Males exceeded in number in all age groups except in the <30years, 51-60 and 71-80years age groups where the number of patients in both sexes are the same. Conclusion: The Study reveal DSA is more superior to accurate angioarchitectural delineation of different intracerebral vascular malformation.

Background and Aims: Awake fibreoptic intubation (AFOI) is the gold standard for managing anticipated difficult airways. Optimal intubating conditions require adequate sedation, suppression of airway reflexes, patient comfort, and haemodynamic stability without compromising spontaneous ventilation. This study compared the effects of intravenous nalbuphine and fentanyl on intubating conditions during AFOI. Methods: In this prospective, randomised, double-blind study, 60 ASA physical status I–II adult patients undergoing elective surgery with anticipated difficult airway were allocated into two groups (n = 30 each). Group N received nalbuphine 0.2 mg/kg IV and Group F received fentanyl 2 µg/kg IV, both infused over 10 min before AFOI. All patients received standard topical anaesthesia and sedation protocol. Intubating conditions were assessed using cough score, patient comfort score, and post-intubation tolerance score. Haemodynamic parameters were recorded at baseline, during, and after intubation. Results: Fentanyl produced significantly better cough suppression (p < 0.05) and higher comfort scores compared to nalbuphine, with improved post-intubation tolerance. Haemodynamic responses were attenuated in both groups, but fentanyl provided greater stability in heart rate and blood pressure. Sedation scores were comparable. No major adverse events occurred in either group. Conclusion: Both nalbuphine and fentanyl are effective for sedation during AFOI. Fentanyl offers superior cough suppression, patient comfort, and haemodynamic stability, making it a preferred choice in patients without contraindications.

Background: Various studies have shown that fluid overload is the main cause of hypertension in chronic kidney disease patients on dialysis. Frequently the dialysis frequency is either kept at either twice or thrice per week. Thrice per week modality might have better control of fluid overload and less frequency of hypertension, the study has been designed to find out the same. Materials and Method: Pre-dialytic blood pressure has been recorded one hour before starting and Post-dialytic blood pressure has been recorded two hours after finishing Hemodialysis. All blood pressure recordings have been taken for all patients for five hemodialysis sessions and the average reading has been taken. The maximum number of Antihypertensive drugs required in each group has been recorded. Results: The frequency of controlled Pre-dialysis blood pressure is more in thrice per week modality than twice per week modality (9% vs 7%). The frequency of controlled Post-dialysis blood pressure is more in thrice per week modality than twice per week modality (16% vs 13%). The requirement of anti-hypertensive medication is less in thrice per week modality than twice per week modality (2.13 vs 2.46). Conclusion: Thrice per week modality of dialysis is more efficient in controlling both Pre-dialysis and Post-dialysis blood pressure and requirement of anti-hypertensive drugs is also less in thrice per week modality, though much larger randomized control studies are required to impose the statistical significance.

Background: Epidural analgesia (EA) remains the gold standard for labour pain relief. However, concerns persist in India regarding its influence on labour progress, operative delivery rates, and neonatal safety. Modern techniques using low-concentration local anaesthetic–opioid combinations may mitigate earlier risks. Objectives: To evaluate the impact of epidural labour analgesia on labour duration, mode of delivery, and neonatal outcomes in a district hospital setting. Methods: A prospective cohort study was conducted over one year (Jan–Dec 2024). 300 term parturients were enrolled; 150 opted for EA and 150 did not. Standardised obstetric and neonatal data were collected. Statistical analysis included t-tests, chi-square, and multivariable logistic regression adjusting for confounders. Results: Mean first-stage duration was slightly longer in the EA group (7.1 ± 1.9 h) vs non-EA (6.4 ± 2.1 h, p = 0.01). Second-stage duration was modestly prolonged with EA (72 ± 25 min vs 61 ± 20 min, p = 0.001). Rates of spontaneous vaginal delivery were comparable (EA 72% vs non-EA 76%, p = 0.41). Instrumental delivery was slightly higher in the EA group (15% vs 9%, p = 0.12). Cesarean section rates were not significantly different (EA 13% vs non-EA 15%, p = 0.64). Neonatal Apgar <7 at 5 min occurred in 3.3% (EA) vs 4.0% (non-EA), with no significant difference. NICU admissions were similar (EA 6% vs non-EA 7%, p = 0.71). No severe maternal morbidity was observed. Conclusion: In this Indian district hospital cohort, epidural labour analgesia was associated with modest prolongation of labour but no significant increase in cesarean delivery or adverse neonatal outcomes. These findings support wider adoption of EA in district-level settings.

Background: The hard palate plays a vital role in chewing, speech, and in separating the oral and nasal cavities. Variations in its shape and dimensions hold considerable clinical importance for orthodontics, prosthodontics, and cleft palate treatment. However, there is limited information on the morphology of the palate in the North-Western population of Rajasthan Aim: To analyse the morphometric features of the hard palate and arch form in individuals from North-West Rajasthan population. Materials and Methods: This cross-sectional study included 200 participants (100 males and 100 females) aged 18–25 years with complete permanent dentition and Class I malocclusion. Maxillary casts were prepared, and various parameters—including inter-canine width, inter-molar width, arch perimeter, palatal depth, length, and width—were measured using a digital caliper. Palatine Height Index (PHI), Palatine Index (PI), and Arch Form Index (AFI) were calculated. Correlation and regression analyses were performed. Results: The average palatal width was 34.05 ± 3.11 mm, palatal length 46.11 ± 3.40 mm, and palatal depth at the molar region 22.53 ± 2.10 mm. Most participants displayed a tapered arch form (80%), a high palate (80%), and a narrow palate (67.5%). Regression analysis revealed that arch perimeter was significantly associated with all palatal measurements, while arch form was mainly influenced by canine and molar depth. Conclusion: Individuals from North-West Rajasthan predominantly have a high and narrow palate with a tapered arch form. These findings provide essential baseline data useful for orthodontic, prosthodontic, and surgical interventions.

Introduction: Anemia, a major global health issue, affects over 50% of pregnant women in India, with higher rates in postpartum cases, especially after cesarean deliveries. Iron deficiency is the leading cause, often worsened by blood loss and poor oral iron compliance. Intravenous treatments like iron sucrose and ferric carboxymaltose offer faster recovery and better outcomes. This study compares their safety and efficacy in managing postpartum anemia after cesarean section. Aims:To assess the effectiveness and safety of iv iron substitute like ferric carboxy maltose with iron sucrose in women following primary caesarean section in postpartum iron deficiency anemia. Materials and Methods: This prospective comparative observational study was conducted over 18 months in the postnatal wards of Chittaranjan Seva Sadan College of Obstetrics, Gynecology and Child Health. Data collection spanned 12 months, with planning, analysis, and writing covering the remaining 6 months (December 2022 to May 2024). A total of 200 women were included, with 100 in each treatment group. Results: In this study of 200 postpartum women, both FCM and iron sucrose groups were comparable in baseline characteristics. FCM showed significantly better improvement in serum ferritin and TIBC at 6 weeks, indicating superior iron store replenishment. Though adverse reactions were slightly higher in the FCM group, they were mild and manageable. Conclusion: Both ferric carboxymaltose (FCM) and iron sucrose (IS) are safe and effective for treating postpartum anemia after cesarean delivery, with FCM showing superior serum ferritin improvement and better patient compliance due to single dosing. However, IS is more cost-effective. Both treatments pose no risk to breastfed infants and can be used interchangeably to reduce maternal and infant morbidity.

Introduction: Procedural sedation and analgesia are essential in the emergency department (ED) for facilitating painful interventions. Among various agents, ketamine and midazolam are commonly used. While ketamine offers dissociative anesthesia with preserved airway reflexes, midazolam provides anxiolysis and amnesia but lacks analgesic properties. Aims: This study aims to compare the efficacy and safety of ketamine versus midazolam for procedural sedation in adult ED patients. Materials and Methods: This prospective, comparative observational study was conducted over a duration of one year and included a total of 60 patients, divided equally into two groups: the Ketamine group (n=30) and the Midazolam group (n=30). Patients requiring procedural sedation were enrolled based on clinical indications and were observed under standardized monitoring protocols. The study focused on several key variables, including age, sex (male), body weight (kg), pre-procedure Glasgow Coma Scale (GCS), and systolic blood pressure (SBP), all of which were recorded prior to sedation. All patients had a normal pre-procedure GCS score of 15, and SBP was measured using automated non-invasive blood pressure monitors. These baseline parameters were used to ensure comparability between the two groups and to evaluate the effects of each sedative agent during and after the procedure. Results: In this prospective comparative study involving 60 patients, ketamine and midazolam were evaluated for procedural sedation. Both groups were comparable in baseline characteristics, including age, sex, weight, GCS, and systolic blood pressure. Ketamine showed significantly faster onset (1.8 vs. 4.2 minutes), shorter sedation duration (17.6 vs. 24.5 minutes), and quicker recovery (23.2 vs. 31.8 minutes) compared to midazolam (p<0.001). Pain scores were significantly lower and both patient and physician satisfaction were higher in the ketamine group (p<0.001). Although emergence reactions were more frequent with ketamine (13.3%, p=0.04), midazolam was associated with more hypotension, respiratory depression, and airway interventions, though these were not statistically significant. Procedural success without delay was slightly higher with ketamine (96.7% vs. 86.7%), and total procedure time was significantly shorter (15.4 vs. 18.9 minutes, p<0.001). Conclusion: Ketamine provides faster onset, superior analgesia, and shorter sedation duration compared to midazolam in ED procedural sedation. However, it carries a higher risk of emergence phenomena. Both agents are effective and safe, but agent selection should be tailored based on the procedure, patient comorbidities, and desired sedation depth.

Introduction: Postpartum intrauterine contraceptive device (PPIUCD) insertion is a safe, reversible, and cost-effective method of contraception. It can be conveniently inserted after vaginal delivery or during caesarean section, providing immediate protection against unintended pregnancy. However, the acceptability and complication rates may vary depending on the mode of delivery. Aims: To compare the acceptability and complications of PPIUCD insertion following vaginal delivery and caesarean section. Materials and Methods: This prospective comparative observational study was conducted in the Department of Obstetrics and Gynaecology at Chittaranjan Seva Sadan College of Obstetrics, Gynaecology and Child Health, Kolkata, over a period of 18 months from December 2022 to May 2024. The first three months were utilized for planning and review of literature, the next twelve months for data collection, and the final three months for data analysis and dissertation writing. The study population comprised postpartum women eligible for immediate Copper T 380A insertion as per WHO Medical Eligibility Criteria (MEC), with a history of regular menstrual cycles for at least three months prior to the current pregnancy, and fulfilling all inclusion criteria. A total of 324 postpartum women were enrolled in the study. Results: At 6 weeks follow-up, pelvic pain was significantly higher in Group A compared to Group B (p = 0.0012), while vaginal bleeding was comparable between the groups (p = 0.8182). At 3 months, expulsions were observed only in Group A (3.9%) but this difference was not statistically significant (p = 0.073). Missing IUCD strings were noted in both groups, more frequently in Group B (13.4% vs. 7.1%), though not statistically significant (p = 0.0915). Acceptability of PPIUCD was significantly higher in Group B (92.3%) compared to Group A (82.7%) (p = 0.0168). Conclusion: PPIUCD is a highly acceptable and safe contraceptive method in both vaginal and caesarean deliveries. While expulsion is more common following vaginal insertion, caesarean insertion is associated with higher rates of missing strings. Proper counseling, skilled insertion, and regular follow-up can improve acceptability and minimize complications.

Introduction: Polycystic ovarian syndrome (PCOS) is one of the leading causes of anovulatory infertility among women of reproductive age. Ovulation induction remains the cornerstone of treatment, with Clomiphene Citrate (CC) historically being the first-line therapy. Letrozole, an aromatase inhibitor, has emerged as an effective alternative, potentially offering higher ovulation and pregnancy rates with fewer adverse effects on endometrial receptivity. This study aims to compare the efficacy, ovulation rates, and pregnancy outcomes of Clomiphene Citrate versus Letrozole in infertile women with PCOS. Methods: This study was a prospective, randomized, parallel, comparative study conducted in the Department of Obstetrics and Gynaecology at Calcutta National Medical College and Hospital from 1st February 2018 to 1st July 2019, over a period of approximately 1.5 years. A total of 70 patients were included, consisting of individuals presenting with musculoskeletal disorders such as fractures, ligament injuries, and osteoarthritis. Study variables recorded for each patient included age, period of infertility, height, weight, waist-hip ratio, number of follicles, parity, socioeconomic status (SES), occupation, hirsutism, acne, acanthosisnigricans, hypothyroidism, hyperthyroidism, mono-follicular and multi-follicular values, and ovulation rate. All patients were assessed systematically, and relevant clinical and laboratory data were collected to evaluate the outcomes and correlations of these variables. Results: Seventy participants were included, 35 in the Letrozole group and 35 in the Clomiphene group. Baseline characteristics were comparable: age (25.51 ± 4.62 vs. 25.43 ± 4.55 years), infertility duration (3.14 ± 1.50 vs. 3.46 ± 1.77 years), height (158.11 ± 6.09 vs. 158.09 ± 5.54 cm), weight (55.91 ± 5.83 vs. 58.03 ± 5.37 kg), waist-hip ratio (0.796 ± 0.038 vs. 0.795 ± 0.038), and number of follicles (1.17 ± 0.66 vs. 1.23 ± 1.00). Letrozole produced larger follicles on day 14 (19.94 ± 1.41 mm vs. 18.06 ± 1.41 mm), higher endometrial thickness (8.55 ± 0.34 mm vs. 7.76 ± 0.50 mm), and serum progesterone (14.01 ± 0.82 ng/mL vs. 11.93 ± 1.09 ng/mL), whereas Clomiphene had larger follicles on day 16 (13.63 ± 1.37 mm vs. 10.11 ± 1.59 mm). Mono-follicular development and ovulation rates were higher with Letrozole (25/35 and 28/35 vs. 14/35 and 18/35), while Clomiphene showed more multi-follicular cycles (12/35 vs. 7/35). Complications were minimal (Letrozole 2.9%, Clomiphene 5.7%). Conclusion: Letrozole appears to be more effective than Clomiphene Citrate in inducing ovulation in infertile women with PCOS, with better endometrial response and comparable pregnancy rates. Given its favorable side effect profile and improved endometrial receptivity, Letrozole may be considered as a first-line agent for ovulation induction in this population.

Introduction: Endotracheal intubation (ETT) remains the gold standard for airway management during laparoscopic surgeries, but it is associated with significant hemodynamic stimulation that may be detrimental in susceptible patients. The ProSeal Laryngeal Mask Airway (PLMA), a second-generation supraglottic device, offers the advantage of positive pressure ventilation with reduced sympathetic response and improved patient comfort. The objective of the study is to compare the hemodynamic changes associated with PLMA and ETT in patients undergoing elective laparoscopic surgeries under general anaesthesia. Materials and Methods: This prospective, randomized, comparative study was conducted at Mamata Medical College, Khammam, from June 2024 to June 2025, involving 60 patients aged 18–60 years, ASA I–II, scheduled for elective laparoscopic surgeries. Patients were randomized into two groups: Group PLMA (n=30) and Group ETT (n=30). Standardized anaesthesia protocol was used. Heart rate, systolic, diastolic, and mean arterial pressures were recorded at baseline, after insertion, and at regular intervals. Data were analyzed using SPSS v26; categorical variables were compared using chi-square test and continuous variables using unpaired t-test, with p<0.05 considered significant. Results: Group PLMA showed significantly lower rise in heart rate and blood pressure following airway device insertion compared to Group E (p<0.05). Oxygen saturation and end-tidal CO₂ remained comparable between groups. Postoperative sore throat was less frequent in Group PLMA. Conclusion: PLMA offers effective ventilation with significantly attenuated hemodynamic response compared to ETT, making it a safer alternative for laparoscopic surgeries in suitable patients.

Introduction: Laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation, leading to transient tachycardia, hypertension, and increased myocardial oxygen demand. Pharmacological agents such as intravenous lignocaine and dexmedetomidine are used to attenuate this hemodynamic stress response, but their comparative efficacy remains a subject of clinical interest. The objective of the study is to compare the efficacy of intravenous lignocaine and intravenous dexmedetomidine in attenuating the hemodynamic response to laryngoscopy and intubation, and to evaluate their effects on recovery characteristics and adverse events. Materials and Methods: This prospective, randomized, comparative study was conducted at Mamata Medical College, Khammam, from January 2024 to January 2025 which included 86 adult patients (ASA I–II) undergoing elective surgery under general anesthesia. Patients were allocated into two groups: Group L received intravenous lignocaine 1.5 mg/kg, and Group D received intravenous dexmedetomidine 1 µg/kg, both administered 10 minutes before induction. Hemodynamic parameters like heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline and at 1, 3, and 5 minutes after intubation. Adverse events, rescue medication use, extubation time, sedation scores, and PACU stay were also noted. Results: Group D demonstrated significantly lower HR and MAP at 1, 3, and 5 minutes post-intubation (p < 0.01). Incidence of tachycardia (46.5% vs 14.0%) and hypertension (27.9% vs 7.0%) was significantly less in Group D, with fewer rescue interventions required. However, bradycardia (14.0% vs 2.3%) and hypotension (18.6% vs 4.7%) were more frequent in Group D. Recovery times were slightly prolonged in Group D but clinically acceptable. Conclusion: Intravenous dexmedetomidine provides superior attenuation of hemodynamic response compared to lignocaine but requires vigilant monitoring for bradycardia and hypotension.

Introduction: Difficult airway remains a major contributor to anaesthesia-related morbidity and mortality. Preoperative airway assessment is crucial to anticipate and prepare for potential laryngoscopy and intubation challenges. Several bedside tests, including Modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Thyromental Distance (TMD), and Ratio of Height to Thyromental Distance (RHTMD), have been proposed to predict difficult laryngoscopy, but their accuracy varies across populations. Materials and Methods: This prospective observational study was conducted on 150 adult patients (ASA I–III) undergoing elective surgeries under general anaesthesia. Preoperative airway assessment included MMT, ULBT, TMD, RHTMD, and Wilson score. Anaesthesia was standardized in all cases, and direct laryngoscopy was performed by an experienced anaesthesiologist blinded to preoperative scores. Difficult laryngoscopy was defined as Cormack–Lehane Grade III/IV. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each test. Receiver Operating Characteristic (ROC) analysis was used to compare predictive performance. Results: The mean age was 42.8 ± 12.3 years with a male predominance (54.7%). Difficult laryngoscopy occurred in 18.7% of patients. MMT (Class III/IV) had the highest sensitivity (98.5%) and NPV (99.3%), while ULBT had the highest specificity (99.3%) and PPV (94.1%). RHTMD demonstrated excellent overall accuracy (97.9%), with sensitivity 88.9% and specificity 98.6%. Wilson score had the highest AUC (0.89) on ROC analysis, indicating strong predictive power. Conclusion: MMT and RHTMD are the most reliable single predictors of difficult laryngoscopy, while ULBT serves as an excellent confirmatory test. Combining sensitive and specific predictors improves airway assessment and enhances perioperative safety.

Introduction: General anaesthesia is an integral part of modern surgical practice, and the choice of maintenance agent can significantly influence intraoperative hemodynamics and postoperative recovery. Isoflurane, Sevoflurane, and Propofol are among the most widely used anaesthetic agents, each with unique pharmacodynamic profiles that may impact clinical outcomes. The study aimed to compare Isoflurane, Sevoflurane, and Propofol with respect to intraoperative haemodynamic stability and postoperative recovery profile in adult patients undergoing elective surgeries under general anaesthesia. Materials and Methods: This prospective, randomized, comparative study was conducted at Mamata Medical College, Khammam, from January 2024 to June 2025, including 150 ASA I–II patients aged 18–60 years. Participants were randomly allocated into three groups (n=50 each): Isoflurane, Sevoflurane, and Propofol. Standard induction was followed by maintenance with the assigned anaesthetic technique. Haemodynamic parameters (heart rate, SBP, DBP, SpO₂, EtCO₂) were recorded at baseline and at 15, 30, 45, and 60 minutes intraoperatively. Recovery profile was assessed by time to eye opening and ambulation. Data were analyzed using ANOVA and Chi-square tests, with p<0.05 considered significant. Results: Isoflurane and Sevoflurane maintained hemodynamics within ±15% of baseline, whereas Propofol showed a greater fall in SBP/DBP (p<0.001 at 15 min). Time to eye opening and ambulation were significantly faster with Sevoflurane, followed by Isoflurane and Propofol (p<0.001). SpO₂ and EtCO₂ remained stable across all groups. Conclusion: Sevoflurane provides superior haemodynamic stability and fastest recovery, making it the preferred agent for short-duration procedures requiring early mobilization.

Introduction: Endotracheal intubation is an essential component of general anaesthesia but is often associated with sympathetic stimulation leading to tachycardia and hypertension. Succinylcholine has been the gold standard neuromuscular blocking drug for rapid sequence induction but is associated with adverse effects such as fasciculations and postoperative myalgia. Rocuronium, a non-depolarizing neuromuscular blocker, has been proposed as a safer alternative with comparable intubating conditions and fewer side effects. The study aimed to compare intubating conditions and cardiovascular responses following administration of succinylcholine and rocuronium in adult elective surgical patients. Materials and Methods: This prospective, randomized, comparative study was conducted at Mamata Medical College, Khammam, from January 2024 to June 2025, on 60 ASA I–II adult patients scheduled for elective surgeries under general anaesthesia. Participants were randomly assigned to receive either succinylcholine (2 mg/kg) or rocuronium (0.6 mg/kg). Intubating conditions were assessed at 60 seconds using standard clinical criteria. Hemodynamic parameters—heart rate, systolic, diastolic, and mean arterial pressure—were recorded at baseline, post-induction, post-muscle relaxant, and up to 5 minutes after intubation. Adverse events including fasciculations, myalgia, sore throat, hypotension, and bradycardia were documented. Data were analyzed using Student’s t-test and Chi-square test, with p < 0.05 considered significant. Results: Both groups achieved comparable excellent intubating conditions (>85%). Rocuronium group showed significantly lower heart rate and mean arterial pressure in the first 1–2 minutes post-intubation. Fasciculations were observed only in the succinylcholine group (90%). Conclusion: Rocuronium provides intubating conditions equivalent to succinylcholine with superior hemodynamic stability and absence of fasciculations, making it a suitable alternative, especially in patients where succinylcholine is contraindicated.

Introduction: Postoperative pain following total abdominal hysterectomy is common and may delay mobilization and recovery. Systemic opioids and NSAIDs are effective but are associated with adverse effects such as nausea, vomiting, sedation, and respiratory depression. Transversus Abdominis Plane (TAP) block is a regional analgesic technique that provides targeted somatic analgesia of the anterior abdominal wall and may reduce opioid requirements. The study aimed to evaluate the efficacy of TAP block in providing postoperative analgesia compared to conventional systemic analgesics in patients undergoing total abdominal hysterectomy. Materials and Methods: This prospective, comparative study included 100 adult patients scheduled for elective total abdominal hysterectomy at Mamata Medical College from January 2024 to June 2025. Patients were randomized into two groups of 50 each: Group TAP (ultrasound-guided bilateral TAP block with 20 mL 0.25% bupivacaine per side) and Group Control (standard systemic analgesics). Postoperative pain was assessed using the Visual Analogue Scale (VAS) at rest at 1, 2, 4, 6, 12, 24, and 48 hours. Sedation levels were recorded using the Ramsay Sedation Scale. Time to ambulation, time to first flatus, rescue analgesia requirement, total tramadol consumption, and adverse events were also documented. Results: TAP block significantly reduced postoperative pain at all time points (p<0.001) and decreased opioid consumption and rescue analgesia requirements. Patients in the TAP group mobilized earlier (6.2 ± 1.1 h vs. 8.9 ± 1.4 h, p<0.001) and experienced fewer episodes of nausea and vomiting (12% vs. 30%, p=0.02). Sedation scores and hemodynamic parameters were comparable between groups, indicating safety and stability. Conclusion: TAP block provides effective, safe, and sustained postoperative analgesia in total abdominal hysterectomy, reduces opioid requirements, facilitates early recovery, and minimizes side effects, making it a valuable component of multimodal analgesia.

Introduction: Regional anaesthesia is widely used for upper limb surgeries due to its ability to provide excellent intraoperative anaesthesia, superior postoperative analgesia, and faster recovery. Among brachial plexus blocks, the supraclavicular approach is preferred for its rapid onset and reliable dense block. Bupivacaine, though effective, has a delayed onset and limited analgesic duration. Dexmedetomidine, a selective α2-adrenergic agonist, has emerged as a promising adjuvant that can enhance block quality, prolong analgesia, and provide hemodynamic stability. This study aimed to evaluate the efficacy of dexmedetomidine as an adjuvant to 0.25% bupivacaine in supraclavicular brachial plexus block. Materials and Methods: This prospective, randomized, comparative study was conducted at Mamata Medical College, Khammam, from July 2024 to July 2025, including 100 ASA I–II patients undergoing elective upper limb surgeries. Group B received 30 mL of 0.25% bupivacaine, and Group BD received 30 mL of 0.25% bupivacaine with dexmedetomidine 1 µg/kg. Onset and duration of sensory and motor block, duration of postoperative analgesia, rescue analgesic requirement, hemodynamic parameters, and adverse events were recorded. Data were analyzed using t-test and Chi-square test, with p<0.05 considered significant. Results: Group BD demonstrated a significantly faster onset of sensory and motor block, prolonged block duration, and longer postoperative analgesia with fewer rescue analgesics (p<0.001). Hemodynamic parameters were stable with mild, clinically insignificant MAP reduction. Sedation was more frequent but well tolerated. Conclusion: Dexmedetomidine significantly enhances block characteristics and postoperative analgesia without major adverse effects, making it an effective adjuvant to bupivacaine for supraclavicular brachial plexus block.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) requires adequate sedation and analgesia to ensure patient comfort and procedural success. Propofol is widely used due to its rapid onset and short recovery time but is often combined with adjuvants such as fentanyl or ketamine to minimize cardiorespiratory adverse effects and improve sedation quality. The study aimed to compare the sedative and analgesic effects of propofol–fentanyl (PF) versus propofol–ketamine (PK) combinations during ERCP. Materials and Methods: This prospective, randomized comparative study was conducted at Mamata Medical College, Khammam, from January 2024 to June 2025. One hundred ASA I–II adult patients scheduled for elective ERCP were randomized to receive either PF or PK sedation (n=50 per group). Sedation depth was titrated to maintain a Ramsay Sedation Score (RSS) of 3–4. Hemodynamic parameters, SpO₂, and adverse events were recorded throughout the procedure. Total propofol consumption, rescue doses, post-procedural pain (VAS), recovery time (Aldrete ≥ 9), and satisfaction scores were assessed. Data were analyzed using t-test or Chi-square test, with P < 0.05 considered significant. Results: Groups were comparable demographically. The PK group showed significantly higher sedation at 4 minutes (P = 0.037) but lower at 15 minutes (P = 0.035). Total propofol consumption, rescue doses, and recovery times were similar. Post-procedural VAS scores were higher in PK (P = 0.02). Apnea occurred more often in PF (16.7% vs. 3.3%), though not statistically significant. Hemodynamic stability and satisfaction scores were comparable. Conclusion: Both PF and PK regimens provided effective sedation and rapid recovery for ERCP. PK offered early deeper sedation and fewer respiratory events, making it a viable alternative where opioid-related complications are a concern.

Background: Septic shock remains a leading cause of mortality in critically ill patients. Early Goal-Directed Therapy (EGDT), a structured resuscitation protocol, was historically advocated, but its superiority over contemporary standard care is debated, especially in non-academic emergency department (ED) settings. Methods: We conducted a pragmatic, multi-center, randomized controlled trial in 10 community hospital EDs. A total of 350 adult patients with septic shock were randomly assigned to either EGDT (n=175) or standard care (n=175). The EGDT group followed a 6-hour protocol targeting central venous pressure (CVP), mean arterial pressure (MAP), and central venous oxygen saturation (ScvO₂). The standard care group received resuscitation guided by the treating physician’s judgment, adhering to current sepsis guidelines but without mandated invasive monitoring targets. The primary outcome was all-cause mortality at 28 days. Results: Baseline characteristics were similar between the groups. There was no significant difference in the primary outcome of 28-day mortality: 24.6% (43 of 175 patients) in the EGDT group versus 21.7% (38 of 175 patients) in the standard care group (relative risk, 1.13; 95% CI, 0.77 to 1.66; p=0.48). Patients in the EGDT group received a significantly greater mean volume of intravenous fluids in the first 6 hours (4.8 ± 1.2 L vs. 4.1 ± 1.1 L; p<0.001) and had a higher incidence of central venous catheter placement (100% vs. 62.3%; p<0.001). The use of vasopressors (85.1% vs. 76.6%; p=0.04) and dobutamine (16.6% vs. 7.4%; p=0.009) was also higher in the EGDT group. There were no significant differences in secondary outcomes, including ICU length of stay (8.1 ± 4.2 days vs. 7.5 ± 3.9 days; p=0.19) or duration of mechanical ventilation. Conclusion: In community emergency department settings, a strict protocol of Early Goal-Directed Therapy did not confer a survival advantage over contemporary standard care for patients with septic shock. However, EGDT was associated with greater use of invasive procedures and resuscitation therapies, indicating higher resource utilization without a discernible clinical benefit.

Aim and Objective: Bipolar disorder is a very common illness that significantly affects how well people operate. Over 50% of people experience depressive symptoms during their disease, which can result in suicidal thoughts and actions or self-harm. There are no direct clinical studies comparing efficacy and safety of lithium versus quetiapine and divalproex for treating bipolar disorder. We performed this open-label, enriched, naturalistic study with a 24 week follow-up in bipolar disorder patients to examine the efficacy and safety of quetiapine and divalproex sodium (QTP+DVP) and Lithium (Li) in maintenance treatment. Methods: Participants (n = 313) with bipolar illness were treated with either lithium (Li) monotherapy or divalproex plus quetiapine (DVP + QTP) combination therapy in this prospective observational real-world experiment. Results: In terms of pole-specific recurrence, the groups of quetiapine and divalproex outperformed the lithium group statistically in preventing the recurrence of depressive episodes (χ2 = 6.62, p =.001). During the study phase, the Li group experienced higher increase in lipid and glucose levels than the QTP+DVP group. Conclusion: According to this prospective naturalistic study, quetiapine and divalproex are more effective than lithium in preventing both mania and depression episodes in bipolar disorder patients. There is no significant difference in the safety profile of lithium in comparison to quetiapine and divalproex sodium. Large-scale randomized trials are necessary in the future to confirm our findings.

Background: Chronic pain is a leading cause of disability worldwide, creating a substantial burden on individuals and healthcare systems. Management typically involves pharmacological and non-pharmacological interventions, but their comparative long-term efficacy and safety remain subjects of ongoing debate, particularly in light of the opioid crisis. Objectives: This systematic review aims to compare the efficacy and safety of pharmacological versus non-pharmacological interventions for the management of chronic non-cancer pain in adult patients. Methods: We conducted a systematic search of PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies published between January 1, 2010, and December 31, 2023. Search terms included “chronic pain,” “pain management,” “pharmacotherapy,” “opioids,” “NSAIDs,” “cognitive behavioral therapy,” “physical therapy,” and “acupuncture.” We included randomized controlled trials (RCTs) comparing any pharmacological intervention with any non-pharmacological intervention, placebo, or usual care in adults with chronic non-cancer pain lasting over three months. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Data were synthesized narratively and via meta-analysis using a random-effects model. Results: The search yielded 4,821 records, of which 18 RCTs (n=5,982 patients) met the inclusion criteria. Meta-analysis revealed that multimodal interventions combining physical and psychological therapies demonstrated the largest effect size for pain reduction (Standardized Mean Difference [SMD] = -0.75; 95% Confidence Interval [CI] -0.92 to -0.58; p < 0.001) and functional improvement (SMD = 0.68; 95% CI 0.51 to 0.85; p < 0.001) compared to usual care. Cognitive Behavioral Therapy (CBT) alone was also highly effective for pain reduction (SMD = -0.61; 95% CI -0.78 to -0.44; p < 0.001). Long-term opioid therapy showed moderate short-term efficacy (SMD = -0.55; 95% CI -0.71 to -0.39) but was associated with a significantly higher risk of adverse events compared to non-pharmacological interventions (Odds Ratio [OR] = 3.15; 95% CI 2.40 to 4.12; p < 0.001) and no superior long-term benefit. NSAIDs showed modest efficacy (SMD = -0.42; 95% CI -0.59 to -0.25) but were linked to gastrointestinal and cardiovascular risks. Conclusion: Non-pharmacological interventions, particularly multimodal approaches and CBT, offer a superior risk-benefit profile for the long-term management of chronic pain compared to pharmacological monotherapies like opioids. A patient-centered, biopsychosocial approach prioritizing non-pharmacological strategies should be the cornerstone of chronic pain management.

Background: Midline laparotomy is widely performed but associated with wound-related complications such as infection, dehiscence, suture sinus, and incisional hernia. The choice of suture material is a key determinant of outcome, with polypropylene offering permanent tensile strength and polydioxanone providing delayed absorbability and reduced tissue reactivity. Aim: To determine the effectiveness of polypropylene versus polydioxanone sutures for abdominal wound closure in midline laparotomy, with respect to postoperative complications. Material and Methods: This hospital-based randomized prospective study included 50 patients undergoing midline laparotomy, allocated into two groups: Group A (PDS) and Group B (polypropylene). Fascia was closed with continuous mass closure technique using standardized protocols. Patients were followed for early (infection, dehiscence) and late (sinus, pain, hernia) complications up to three months. Data were analyzed with chi-square, Fisher’s exact test, and t-test, with p ≤0.05 considered significant. Results: Early wound infection was more frequent in the polypropylene group, while wound dehiscence was observed only in the polydioxanone group. Late complications such as suture sinus and incisional hernia were predominantly associated with polypropylene. Patient comfort and satisfaction were higher in the polydioxanone group. Statistical analysis demonstrated significant differences for certain outcomes. Conclusion: Both polypropylene and polydioxanone are effective suture materials for midline laparotomy closure; however, polydioxanone offers advantages in reducing postoperative wound morbidity while maintaining closure strength.

Background: Neonatal septicemia remains a leading cause of morbidity and mortality in low- and middle-income nations. In India, the rising incidence of multidrug-resistant Gram-negative organisms, particularly extended-spectrum beta-lactamase (ESBL) producers, has undermined the effectiveness of standard empirical therapy. This study aimed to determine the prevalence and clinical impact of ESBL-producing Gram-negative organisms among neonates with sepsis in a tertiary hospital in Kanpur, India. Methods: A prospective observational study was carried out between January and December 2024. Blood cultures from neonates with suspected sepsis were processed using automated systems. Gram-negative isolates were identified, and ESBL production was confirmed according to Clinical and Laboratory Standards Institute (CLSI) 2018 guidelines. Clinical variables, including demographic data, onset of sepsis, and patient outcomes, were analyzed. Results: Out of 520 blood cultures, 312 (60%) showed growth, including 190 Gram-negative isolates. The predominant pathogens were Klebsiella spp. (50.5%), Escherichia coli (29.5%), Acinetobacter spp. (10.5%), and Pseudomonas spp. (9.5%). ESBL production was confirmed in 35 isolates (18.4%), with Klebsiella spp. representing the largest proportion (45.7%). Male neonates constituted 57.9% of cases, and early-onset sepsis occurred in 65%. Mortality among neonates with ESBL-positive infections was 20%, compared with 12% in ESBL-negative cases (p<0.05). Conclusion: ESBL-producing Gram-negative bacilli are an important contributor to neonatal sepsis in Kanpur. The predominance of Klebsiella spp. and higher mortality in ESBL-associated infections highlight the urgent need for ongoing resistance surveillance, rational antimicrobial use, and stringent infection control strategies.

Introduction: Chronic renal failure is the progressive loss of function of kidney. It requires renal replacement therapy like Hemodialysis, In this background this study was done to assess the biochemical renal parameters serum urea and creatinine during predialysis and postdialysis period. Materials and Methods: The study was done in 35 chronic renal failure patients undergoing hemodialysis regularly. 3ml blood sample was collected during pre-dialysis and postdialysis period. Serum urea and creatinine were estimated. Results: The study was done in 35 patients, 80% (n=28) were males and 20% (n=7) were females. They were categorised into 3 age groups. The mean urea in predialysis and postdialysis for age group 21-40,41-60,61-80 were 97 ± 15.16 and 29.8±7.85, 105.75±27.27 and 36.87±14.54, 109.33±13.37 and 37.83±15.39 respectively. The mean creatinine in predialysis and postdialysis for age group 21-40, 41-60, 61-80 were 10.92±2.4 and 3.54±1.07, 9.94±3.34 and 3.79±1.36, 9.53±1.45 and is 3.28±0.6. Paired t test of serum urea mean difference of predialysis and postdialysis is 69.08±17.4 with standard error of mean 2.944, t value = 23.477, p value of 0.0001 and is highly significant. Paired t test of serum creatinine shows mean difference in Pre and Post dialysis is 6.34±2.02 with standard error of mean 0.341, t value = 17.41, p value of 0.0001 is significant. Conclusion: The present study concluded that a significant relationship between the predialysis and postdialysis availability of serum urea and creatinine.

Background: Infertility affects a substantial proportion of couples worldwide, with profound emotional, social, and psychological consequences. In regions where cultural and societal norms strongly emphasize parenthood, women often experience greater stress and reduced well-being. This study aimed to evaluate the quality of life (QoL) among married women experiencing infertility in Rajasthan using the validated Fertility Quality of Life (FertiQoL) instrument. Methods: A descriptive cross-sectional study was conducted from April 2023 to June 2024 at Mahila Chikitsalaya, a tertiary care women’s hospital attached to Sawai Man Singh (SMS) Medical College, Jaipur. A total of 180 married women with confirmed infertility were recruited after informed consent. Data on socio-demographic and infertility-related factors were collected using a semi-structured proforma, and QoL was assessed with the FertiQoL questionnaire, available in English and Hindi. Statistical analysis was performed using SPSS version 26.0. Results: Participants’ mean age was 30.33 ± 5.62 years and nearly half (48.9%) belonged to the highest socioeconomic class (Class I). Primary infertility was more common (58.3%) than secondary infertility, and most women (71.7%) had been undergoing treatment for less than five years. The mean Core FertiQoL and Treatment FertiQoL scores were 53.99 ± 14.10 and 54.96 ± 11.18, respectively, with an overall mean score of 54.27 ± 12.16, indicating relatively low QoL. Among subscales, the Mind/Body domain scored lowest (46.69), while the Relational domain scored highest (65.72). Conclusion: Infertility significantly reduces quality of life across multiple domains. Implementing psychological support, addressing social stigma, and enhancing access to affordable infertility care are crucial to improving well-being in this population.

Background: Multimorbidity, or the coexistence of two or more chronic diseases, is increasing in the elderly population. Diabetes mellitus, Hypertension, chronic obstructive pulmonary disease (COPD), and Depression are some of the most prevalent and incapacitating diseases in this group. These comorbid diseases interact to exacerbate functional impairment, lower quality of life, and add to the healthcare burden. Recognizing patterns of multimorbidity is crucial in designing coordinated, patient-focused care strategies. Objectives: To determine the prevalence and multimorbidity patterns among older patients, with an emphasis on the co-morbidity of diabetes, Hypertension, COPD, and Depression, and to identify the most common patterns to guide clinical and public health interventions. Materials and Methods: A cross-sectional survey was conducted among 217 elderly patients. Information on sociodemographic factors and the presence of chronic diseases was obtained through clinical evaluations and validated questionnaires. The prevalence of individual conditions and prevalent multimorbidity patterns was calculated using descriptive statistics. Results: The most common conditions were Hypertension (87.6%) and diabetes mellitus (73.7%), followed by COPD (50.7%) and Depression (43.8%). The most common multimorbidity combinations were diabetes and Hypertension (39.2%), Hypertension and Depression (27.6%), diabetes and COPD (18.4%), and all four conditions (14.7%). Overlaps involving cardiometabolic and psychiatric conditions were especially prevalent and reflect the additive burden of disease and mental illness. Conclusion: Multimorbidity is very common among older people, with cardiometabolic and mental health disorders clustering most notably. These results underscore the importance of integrated care practices that address both physical and psychological well-being to optimize treatment, reduce hospitalization, and improve the quality of life in older age groups.

Background: Anaesthesia, which is necessary for surgery, triggers systemic physiological reactions that impact metabolic and electrolyte homeostasis. General anaesthesia (GA) typically provokes a more significant stress response, accompanied by hyperglycemia and electrolyte imbalances, whereas regional anaesthesia (RA) may help mitigate these effects. It is imperative to understand such discrepancies to streamline perioperative care, especially in comorbid patients like diabetics, hypertensives, or patients with renal failure. Objectives: The objective of the present study was to compare intraoperative and postoperative variations in blood glucose and serum electrolytes (sodium, potassium, chloride) in patients undergoing surgery under general versus regional anesthesia, assessing which modality provides more stable metabolic and electrolyte patterns. Materials and Methods: A prospective, observational study was done on 214 adult patients (18–60 years, ASA I–II) undergoing elective surgeries longer than 45 minutes. The patients were divided equally between the GA and RA groups. Venous blood samples were obtained preoperatively, intraoperatively (60 minutes after the start of surgery), and postoperatively to assess blood glucose and serum electrolytes. Statistical analysis was done using SPSS with a p < 0.05 set as the level of significance. Results: Demographic features were similar across groups (p > 0.05). During surgery, GA patients had a marked increase in blood glucose (118.6 ± 11.3 mg/dL) compared to RA patients (102.4 ± 10.6 mg/dL, p < 0.001). Both groups experienced increased postoperative glucose levels, which were more effectively controlled in the RA group. Serum sodium, potassium, and chloride levels fell more significantly in GA patients both intraoperatively and postoperatively, but remained closer to baseline in RA. The results demonstrate that GA causes more metabolic and electrolyte disturbances compared to RA. Conclusion: Regional anaesthesia is linked with more stable intraoperative glucose and electrolyte levels, echoing its ability to suppress the surgical stress response. These findings favor consideration of RA in patients at risk of metabolic or electrolyte disturbances, reinforcing the need for close monitoring and personalized anaesthetic choice to maximize perioperative results.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease marked by hyperglycemia resulting from insulin resistance and evolving β-cell failure. It is present in more than 537 million adults worldwide and makes a significant contribution to morbidity and mortality via cardiovascular disease, nephropathy, neuropathy, and retinopathy. Pharmacological management effectively reduces blood glucose levels, but the drawbacks of long-term use include side effects, expense, and poor compliance. Lifestyle treatments, including diet modification, exercise, and behavioral therapy, have become an essential method for enhancing glycemic control and metabolic factors. Objectives: The present study aimed to evaluate the effectiveness of intensive lifestyle treatment compared with standard pharmacological treatment in terms of glycemic control, lipid levels, body weight, and other metabolic markers in individuals with type 2 diabetes mellitus (T2DM), to determine which method offers greater or additive benefits for long-term metabolic well-being. Materials and Methods: A prospective, interventional, comparative study was conducted at a tertiary care center over one year in 183 adult T2DM patients between the ages of 30 and 65 years. Participants were randomly assigned to either a lifestyle intervention group (structured diet, exercise, and counseling) or a pharmacological therapy group (routine anti-diabetic medications). Baseline and follow-up assessments were conducted using measurements of HbA1c, fasting blood glucose, lipid profile, body weight, BMI, and blood pressure. Data were evaluated using descriptive and inferential statistics, and p < 0.05 was used as significance. Results: Lifestyle treatment resulted in more significant improvement in glycemic control (reduction in HbA1c: 1.8% vs. 1.2%; reduction in fasting glucose: 35 mg/dl vs. 25 mg/dl), body weight (4.5 kg vs. 1.0 kg), BMI (1.6 kg/m² vs. 0.4 kg/m²), and lipid profile (larger decrease in total cholesterol, LDL, triglycerides, and larger increase in HDL) than pharmacological treatment. Conclusion: Structured lifestyle interventions are superior to pharmacological therapy alone in improving glycemic control and metabolic parameters in patients with type 2 diabetes mellitus (T2DM). The combination of lifestyle changes with pharmacotherapy may offer an optimal strategy for lowering cardiovascular risk and long-term metabolic well-being.

Background: The two most popular regional procedures are spinal anesthesia (SA) and epidural anesthesia (EA), each of which has advantages and disadvantages of its own. Their pharmacological characteristics, therapeutic uses, and complication histories vary greatly. Objectives: In terms of maternal hemodynamic stability, perioperative complications, neonatal outcomes, and postoperative analgesia, the study sought to assess the safety, effectiveness, and maternal satisfaction of spinal versus epidural anesthesia in women having cesarean sections. 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 194 participants were retrieved for the study. Women who were 18 years of age or older who had either spinal or epidural anesthesia after an elective or emergency cesarean section at the study center were included in the study. Full medical and anesthesia records were available for these women. Results: The onset of sensory block was considerably quicker with SA (4.2 ± 1.1 min) than with epidural (12.6 ± 3.2 min; p < 0.001). was statistically significant (p = 0.01) and occurred more frequently in the spinal group (32.8%) than in the epidural group (16.7%). Although it was more prevalent in the spinal group (9.0% vs. 2.8%), there was no statistically significant difference (p = 0.092). Conclusion: For cesarean sections, spinal and epidural anesthesia are both safe and efficient methods that produce similar results for the mother and the newborn. Technically simpler and offering a quicker onset of sensory block, spinal anesthesia is appropriate for brief elective treatments. Recommendations: Spinal anaesthesia is preferred for short elective cesarean sections, while epidural anaesthesia may be used for longer surgeries or extended postoperative analgesia.

Background: Shortness of breath, anxiety, weariness, muscle soreness, and cognitive impairment are typically the most recurrent symptoms that continue following COVID-19. Furthermore, problems involving the central nervous system and cardiovascular diseases may also appear in certain instances. Objectives: In patients with post-COVID-19 respiratory sequelae, the study sought to assess how well pulmonary rehabilitation improved functional capacity, decreased dyspnea, and eased enduring symptoms. 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 202 participants were retrieved for the study. The study included adult patients (≥18 years) with a confirmed diagnosis of COVID-19 who had functional impairments 4–12 weeks after recovery or who had persistent respiratory symptoms such coughing, tiredness, or dyspnea. Results: Nearly half of the 90 participants (44.6%) experienced severe dyspnea at baseline (mMRC ≥3). The percentage of participants with Grade 0–1 dyspnea rose from 21.8% to 51.5% after pulmonary rehabilitation, with a p-value of less than 0.001, whereas the percentage of participants with Grade ≥3 dyspnea fell from 44.6% to 17.8%, with a p-value of less than 0.001. Conclusion: As demonstrated by longer Six-Minute Walk Test distances, it considerably enhanced functional exercise capacity in this study and lessened the intensity of dyspnea, exhaustion, coughing, anxiety, and sleep disruptions. Recommendations: It is important to quickly assign COVID-19 patients to systematic pulmonary rehabilitation programs that incorporate breathing exercises, physical therapy, and psychological support.

Introduction: Vitamin D deficiency is a leading cause of nutritional rickets in children, resulting in impaired bone mineralization. Diagnosis typically relies on clinical, biochemical, and radiological findings, but their prognostic and treatment-evaluation value remain limited. This study explores the relationship between vitamin D status, biochemical markers, and clinical/radiological outcomes in children with rickets following supplementation therapy. Objectives: To assess the effectiveness of vitamin D and calcium supplementation on the clinical, biochemical, and radiological parameters in children diagnosed with nutritional rickets. Materials and Methods: A total of 216 pediatric patients (ages 6 months–18 years) with primary rickets were enrolled from a tertiary care hospital. Age-specific vitamin D and calcium regimens were administered. Clinical signs, serum levels of calcium, phosphate, alkaline phosphatase (ALP), and vitamin D, along with radiological changes, were assessed at baseline and at 6, 12, 18, and 24 weeks. Data were analyzed using Chi-square and ANOVA tests (p < 0.05 considered significant). Results: Most participants were male (117), from rural (68%) and low socioeconomic (58.3%) backgrounds. Common findings included bowed legs (70), widened wrists (62), and difficulty walking (63). Radiological signs like cupping and fraying were seen in 156 cases. Significant biochemical improvements were observed by 18 weeks. ALP levels declined from a mean of 653 IU/L to 115.3 IU/L by week 24. Clinical, radiological, and biochemical recovery was observed in 93.3%, 85.6%, and 98.3% of cases, respectively. Conclusion: Vitamin D and calcium supplementation significantly improved clinical, biochemical, and radiological outcomes. ALP levels strongly correlated with disease severity, underscoring the importance of a multifactorial diagnostic and evaluative approach.

Introduction: Neonatal septicemia is challenging to diagnose due to nonspecific signs and limited lab accuracy, often leading to prolonged antibiotic use. CRP, a short half-life inflammatory marker, may help tailor treatment duration. This study evaluates CRP’s role in safely guiding antibiotic discontinuation in suspected neonatal bacterial infections. Methods: This prospective cohort study at Prathima Institute included neonates with suspected sepsis. Based on CRP levels after 24–48 hours, neonates were grouped for antibiotic duration. Relapse was monitored over four weeks. CRP’s negative predictive value was assessed to determine its reliability in guiding safe antibiotic discontinuation and minimizing overtreatment. Results: Among 50 neonates, 44% were culture-positive, predominantly with Staphylococcus aureus and Klebsiella. CRP >6 mg% correlated with infection; Group 1 neonates with CRP <6 mg% showed no relapse, yielding 100% NPV. Antibiotics were safely stopped within 7 days in 54%, supporting CRP’s role in guiding treatment duration. Conclusion: CRP is a reliable, cost-effective biomarker for guiding antibiotic duration in suspected neonatal sepsis. A CRP level <6 mg% showed 100% negative predictive value, supporting early antibiotic discontinuation without relapse. Incorporating CRP monitoring can reduce unnecessary antibiotic use and hospital stay, improving neonatal care and combating antibiotic resistance.

Introduction: Breakthrough seizures (BTS) occur in patients previously well-controlled on antiepileptic drugs. Demographic factors like age, gender, socioeconomic status, and compliance significantly influence BTS incidence. Understanding these variables helps in tailoring interventions and improving seizure control. This study explores their impact to enhance long-term epilepsy management strategies. Methods: This prospective observational study was conducted over two years in a pediatric department in Tamil Nadu, including 80 children aged 1–18 years with breakthrough seizures. Data on demographics, epilepsy type, AED use, and precipitating factors were collected using structured proformas. Informed consent and ethical clearance were obtained. Results: Among 80 children with breakthrough seizures, most were toddlers (48.75%) and male (M:F ratio 1.96). Generalized seizures predominated (73.75%). EEG was not performed in 50% of cases. Most lived in urban nuclear families. Lower middle socioeconomic status (37.5%) and positive family history (40%) were common associations. Conclusion: Breakthrough seizures in children were more frequent among toddlers, males, urban nuclear families, and those from lower middle socioeconomic groups. Generalized seizures predominated, but EEG was underused. Family history played a significant role. Addressing demographic and diagnostic gaps may enhance seizure control and therapeutic outcomes in pediatric epilepsy management.

Background: Spinal anaesthesia is the preferred technique for elective caesarean sections due to reduced maternal risks compared to general anaesthesia. However, it often leads to hypotension resulting from sympathetic blockade, which can adversely affect both mother and fetus. Identifying predictors of hypotension is crucial for improving maternal safety. This study aimed to evaluate the association between AC (Abdominal Circumference) and the incidence of hypotension following spinal anaesthesia. Methods: A prospective observational study was conducted in the Department of Anaesthesiology, Government Medical College, Thrissur, after obtaining ethical approval. A total of 240 patients undergoing elective caesarean sections under spinal anaesthesia were enrolled using convenient sampling. Patients were grouped based on abdominal circumference (larger AC vs. smaller AC). Baseline parameters, including height, weight, and AC were recorded. MAP (Mean Arterial Pressure) was monitored at 1-, 5-, and 10-minutes post spinal anaesthesia. The incidence of hypotension, sensory blockade levels, and vasopressor use were also documented. Data were analysed using SPSS version 22. Results: The overall incidence of hypotension was 37.9%. Patients with larger AC had a significantly greater fall in MAP at 1-, 5-, and 10-minutes post spinal anaesthesia (p < 0.05). A significant association was also found between larger AC and the occurrence of hypotensive symptoms, higher sensory blockade levels, and increased vasopressor requirements. Conclusion: Abdominal circumference is significantly associated with post-spinal hypotension and can serve as a useful preoperative screening tool to predict the risk of hypotension in patients undergoing spinal anaesthesia for caesarean section.

Background: Behcet disease is an immune mediated disease with multisystem involvement. The disease may have ophthalmological, neurological as well as cardiovascular system involvement along with mucocutaneous symptoms. Isolated neuro-behcet disease is a rare disease which is difficult to diagnose, as there are no specific diagnostic criteria of the disease, it poses a big challenge in confirming the diagnosis and management. The genetic factor HLA-B51/52 needed to support the diagnosis is positive only in 60 to 70% cases and negative in 30 to 40% cases. The pathergy test is also nonspecific but increases the chances of diagnosis. Case Presentation: A 15-year-old male adolescent brought to our emergency unit with recurrent episode of headache, vomiting, diplopia and recent onset of similar complaint associated with horizontal and vertical gaze nystagmus, unilateral facial nerve palsy, dysarthria and ataxia. There is history of headache with aura for 7 to 8 months for which patient was treated as a case of migraine. Also history of unilateral left cervical granulomatous lymphadenitis 5 years back.  The patient was diagnosed as a probable case of isolated Neuro-Behcet disease by MRI brain & spinal cord and MR angiography along with CSF and skin finding. Conclusion: In the current study the role of MRI and MR angiography along with skin findings and CSF analysis were discussed in diagnosis of probable parenchymal Neuro-Behcet disease in the absence of other marker of disease. The strong differential diagnosis of Neurosarcoidosis and primary CNS vasculitis was kept.

Background: Excessive alcohol con­sumption causes a wide variety of medical and social problems and a considerable economic burden. The liver is an important organ in iron homeostasis. Serum iron (SI), total iron binding capacity (TIBC) and ferritin levels are the principal tests used in the evaluation of iron burden. The aim of this study is to determine the changes in levels of iron and TIBC in chronic alcoholic liver diseases. Materials and Methods: A cross-sectional study was done and included 100 individuals (50 chronic alcoholic liver diseases cases and 50 normal controls). Serum iron and TIBC were estimated by colorimetric method on fully automated chemistry analyzer. Result: Data were fed under Microsoft Excel 2007 and statistically analyzed by GraphPad software; Version 6.0, which evaluated the differences of various parameters in both groups on the basis of p value. Serum iron level was significantly increased and serum TIBC level was significantly decreased in chronic alcoholic liver diseases patients as compared to normal healthy controls. Conclusion: Iron and ethanol each cause oxidative stress and lipid perox­idation and the cumulative effects of ethanol and iron on liv­er cell damage, in patients with ALD, exacerbate liver injury. Therefore, iron overload is an independent factor of disease progression in hepatocellular carcinoma and it determines pa­tients survival hence these parameters should be regularly monitored in chronic alcoholic liver diseases patients.

Background: Though D & C is a gold standard method to find out the cause of abnormal bleeding in perimenopausal or postmenopausal women. But D & C technique has many risk factors that lead to complications, like abnormal bleeding and prolonged morbidity hence, a safer and alternate method is preferred, like pipelle. Method: 90 (ninety) patients above 40 years of age with abnormal uterine bleeding were admitted. Studied with a pipelle device followed by D & C, and both samples were sent to a pathologist, and both histopathological reports were compared. Results: 87.7% adequacy sampling was obtained in both groups, 11.1% scanty in pipelle, and 8.8% in the D & C technique. Proliferation of endometrium and secretory endometrium rates was higher in pipelles as compared to D & C, but a 6.6% polyp was observed in the D & C procedure. Conclusion: Endometrial biopsy with pipelle as an outpatient procedure is safe and minimally invasive with the least chance of perforation and infection. Hence, pipelle is preferred than D & C method in abnormal uterine bleeding.

Introduction: Type I Tympanoplasty is a surgical procedure designed to repair tympanic membrane perforations and restore hearing by using autologous graft materials. Among the commonly used grafts are temporalis fascia and tragal cartilage with perichondrium, both of which possess distinct structural and functional properties. Aim: To compare the surgical outcomes of Type I Tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft materials in patients with chronic otitis media (COM) with tympanic membrane perforation. General Objective: To evaluate the effectiveness of temporalis fascia and tragal cartilage with perichondrium in terms of graft uptake and hearing improvement in patients undergoing Type I Tympanoplasty. Specific Objective: (1) To compare the graft uptake success rates between temporalis fascia and tragal cartilage with perichondrium using otoscopic findings post-surgery. (2) To assess and compare the hearing improvement between the two graft materials using pre- and post-operative pure tone audiometric findings at 1 and 3 months post-surgery.
These objectives aim to identify the most suitable graft material for Type I Tympanoplasty, providing evidence-based guidance for optimizing surgical management of chronic otitis media with tympanic membrane perforation. Type of study: Prospective, comparative hospital based observational study. Study Design & Setting: This study is a prospective, comparative hospital-based observational study aimed at comparing temporalis fascia and tragal cartilage with perichondrium as graft materials in Type I tympanoplasty. Study Duration: The study spans a duration of 13 months, from November 1^st, 2023, to November 30^th, 2024. Study Place: The ENT Department of KPC Medical College and Hospital, Kolkata. Study Population: The study population consists of patients aged 18-59 years diagnosed with mucosal chronic otitis media (COM) presenting with tympanic membrane perforation. Sample size: Total sample size is 82 patients, with 41 patients in the temporalis fascia group and 41 patients in the tragal cartilage group done by systemic random sampling. Result: Graft uptake was successful in the majority of cases, with slightly higher success observed in the tragal cartilage with perichondrium group (97.6%) compared to the temporalis fascia group (95.1%). Failure rates were low in both groups, at 4.9% for temporalis fascia and 2.4% for tragal cartilage, indicating the reliability of both materials for tympanoplasty.  The pre-op ABG was similar in both groups, with the temporalis fascia group having a mean of 25.5 dB and the tragal cartilage with perichondrium group showing a slightly higher mean of 26.1 dB. At 1 month post-operation, the mean ABG was 12.7 dB in the temporalis fascia group and 11.7 dB in the tragal cartilage group. Both groups showed similar median ABG values (11 dB) and overlapping confidence intervals, indicating comparable outcomes. At 3 months post-operation, the mean ABG was slightly higher in the temporalis fascia group (16.2 dB) compared to the tragal cartilage group (15.4 dB). Both groups demonstrated similar median ABG values (15 dB and 14 dB, respectively) and overlapping confidence intervals, indicating comparable hearing outcomes. Conclusion: In terms of graft uptake, it was found that tragal cartilage with perichondrium was found to be better than temporalis fascia and in terms of hearing outcome it was found to be comparable between the two.

Background: Intestinal obstruction remains one of the more serious complications of abdominal tuberculosis, particularly in regions with a high TB burden like Bihar. The condition often presents with non-specific symptoms and may require surgical intervention. Early diagnosis and appropriate management significantly improve outcomes. Objectives: To assess the clinical characteristics, imaging findings, surgical interventions, and short-term outcomes in patients diagnosed with intestinal obstruction due to abdominal tuberculosis. Methods: A prospective observational study was conducted at Jawaharlal Nehru Medical College and Hospital, Bhagalpur, over 15 months. One hundred patients presenting with clinical features of intestinal obstruction and confirmed to have abdominal tuberculosis (via imaging, intraoperative findings, or histopathology) were included. Data on demographics, presenting complaints, imaging findings, type of intervention (conservative or surgical), surgical procedures, postoperative complications, and length of stay were recorded and analyzed. Results: The mean age was 34.2 years, with a male predominance (M: F = 1.8:1). The most frequent symptoms were abdominal pain (96%), vomiting (70%), and abdominal distension (62%). CT imaging revealed ileocecal involvement in 64% of patients. Surgical management was required in 63% of cases. Resection and anastomosis (n = 28), stricturoplasty (n = 21), and adhesiolysis (n = 14) were the most common procedures. Postoperative complications occurred in 16% of surgical cases, primarily wound infection and prolonged ileus. There was no mortality during the study. Conclusion: Tubercular intestinal obstruction remains prevalent in Bihar, particularly among young adults. Ileocecal involvement is most common, and timely diagnosis—followed by appropriate ATT and surgical intervention when indicated—yields excellent short-term outcomes.

Background: Corrosive ingestion (CI) is a major cause of upper gastrointestinal morbidity in low‑ and middle‑income countries. Zargar grade 2B and 3A injuries are particularly challenging due to their unpredictable healing course and high risk of late strictures. Standardized management protocols may improve outcomes. Aim: To evaluate the incidence of stricture formation, the efficacy of a structured endoscopic dilatation protocol, and the need for reconstructive surgery in patients with Zargar grade 2B and 3A injuries, with universal early feeding jejunostomy. Methods: Forty consecutive patients presenting within 24 hours of corrosive ingestion and diagnosed with Zargar grade 2B or 3A injuries between January 2023 and June 2025 were enrolled. Feeding jejunostomy was performed in all patients at presentation. Patients with dysphagia underwent endoscopic evaluation every 2 weeks starting at 4 weeks post‑ingestion. Savary‑Gilliard bougie dilators were used, beginning at 9 Fr and progressing to 13 Fr. Failure to achieve satisfactory lumen after three successive dilatations was considered an indication for reconstructive surgery. Results: (1) Stricture formation: 23 patients (57.5%). (2) Reconstructive surgery: 11 patients (27.5%) gastric pull‑up in 8, colonic pull‑up in 3. (3) Endoscopic dilatation successful in 12 of 23 stricture cases (52.2%). (4) Postoperative morbidity: 1 anastomotic leak, 2 recurrent strictures. (5) BMI improved from 18.4 to 20.9 kg/m² at 6 months; GIQLI improved from 80.2 to 113.5. Conclusion: A structured protocol with delayed initiation of dilatation, regular endoscopic monitoring, and early nutritional support yields favorable outcomes in intermediate‑grade corrosive injuries. Early jejunostomy feeding is a cornerstone of management.

Background: This educational research project evaluated the impact of a focused, three-day “capsulated” training module on medical interns in the Otolaryngology department at Burdwan Medical College, Burdwan. The study aimed to assess whether such structured, competency-based training improves interns’ knowledge and skills more effectively than conventional methods. Materials and Methods: Over a 2-months period, 32 interns were divided into two groups: Group A (control): received standard internship training. Group B (intervention): underwent the capsulated training covering core ENT competencies such as history taking, informed consent, and managing emergencies.
Both groups were assessed through pre- and post-tests (written questionnaire and OSCE). Then we took feedback from all of them after their completion of internship. Result: While Group A had no significant improvement, Group B demonstrated statistically significant gains in both theoretical knowledge and clinical skills (p < 0.001). Participant feedback from 32 interns indicated positive reception of the training, with average ratings between 3.4 and 3.5 out of 5 for various aspects of the program. Conclusion: The study concludes that capsulated training effectively enhances learning outcomes in ENT internships. It recommends broader integration of such structured, simulation-based modules into internship programs to bridge the gap between academic learning and clinical practice. However, limitations such as small sample size and limited OSCE stations suggest a need for further studies on a larger scale.

Background: Endotracheal intubation causes airway mucosal injury which results in Post-operative sore throat (POST) with incidence of 21-65%.If unresolved it produces significant pain and discomfort to the patient and increases the incidence of postoperative morbidity and length of stay in PACU. Dexamethasone is commonly used in the treatment of sore throat. Dexmedetomidine, selective alpha-2 adrenergic agonist used for attenuation of intubation response. We conducted this study to compare the effectiveness of nebulized dexamethasone and dexmedetomidine in preventing POST in patients undergoing general endotracheal anaesthesia. Methodology: Patients aged 18-60years, ASA I and II, either sex posted for elective surgery requiring general endotracheal anaesthesia were randomly allocated into 2 groups of 50 each. Group 1(Dexamethasone)-8mg(2ml) diluted to 5ml using Normal saline Group 2(Dexmedetomidine)-50microgram(0.5ml) diluted to 5ml using Normal saline. Both the groups received nebulization for 15minutes.15minutes after the completion of nebulization, general endotracheal anaesthesia was provided. After extubation, patients assessed for sore throat at 0^th hour, then 2^nd, 6^th, 12^th, 24^th hr in postoperative ward and graded on 4 point scale (0-3). Hemodynamic parameters HR, SBP, DBP and MAP were recorded at time intervals: Before nebulization, after nebulisation, before intubation, immediately after intubation-0thminute, 2ndminute and 5thminute. Results: The incidence of POST was comparable in both groups at 0^th, 2^nd, 12^th and 24^thhour postoperatively. At 6^th hour, the incidence of sore throat was significantly greater in Group2.HR was significantly lower in Group2 at all time intervals post nebulization except at 0thminute. There was statistically significant fall in SBP and MAP at 2^ndminute post intubation in Group2. Conclusion: Nebulized dexmedetomidine (50mcg in 5mlNS) is as effective as nebulized Dexamethasone (8mg in 5mlNS) given preoperatively in reducing the incidence and severity of POST after general endotracheal anaesthesia. Nebulized dexmedetomidine has an added advantage of attenuating the hemodynamic stress response to laryngoscopy and endotracheal intubation.

Introduction: Sudden vision loss is a clinical emergency with a broad etiological spectrum, ranging from ischemic and non-ischemic medical causes to trauma. Understanding the underlying cause is essential for prognosis and timely intervention. This study aimed to evaluate the etiological distribution and prognostic outcomes in patients presenting with sudden vision loss. Materials and Methods: This prospective observational study was conducted at Tirunelveli Medical College Hospital from January 2015 to July 2016. A total of 65 patients presenting with sudden vision loss lasting more than 24 hours were included. Clinical evaluation, ophthalmic investigations, imaging, and laboratory workup were performed as indicated. Patients were followed for six months to assess visual outcomes. Statistical analysis was performed using SPSS v20, with p-values <0.05 considered significant. Results: Of 65 patients, 66.2% had medical causes (30.8% ischemic, 35.4% non-ischemic), and 33.8% had trauma-related vision loss. NA-AION and CRVO were the most common ischemic causes, while traumatic optic neuropathy (TON) was the leading traumatic etiology. Visual improvement at six months was highest in ischemic cases (65%), followed by non-ischemic (43.5%) and traumatic cases (27.3%) (p = 0.048). Hypercholesterolemia showed a significant association with poor visual outcome in ischemic cases (p = 0.028). Most trauma cases occurred in young adult males. Conclusion: Ischemic etiologies, especially NA-AION and CRVO, were most frequent and had better visual outcomes than traumatic causes. Hypercholesterolemia was a significant predictor of poor prognosis in ischemic vision loss. Early diagnosis, risk factor management, and multidisciplinary care are crucial to preserving vision.

Background: Polycystic ovarian Syndrome (PCOS) is among the most common endocrine disorders in young patients. Beyond its reproductive concerns, it carries significant metabolic risks. When PCOS coexists with Metabolic Syndrome (MetS), the chances of developing insulin resistance, type 2 diabetes, and cardiovascular disease rise sharply. While international data are abundant, Indian evidence—especially from semi-urban and rural areas—remains limited. Objective: To determine how common Metabolic Syndrome is among reproductive-aged patients with PCOS attending a tertiary care hospital in Barabanki, Uttar Pradesh. Methods: We carried out an 18-month hospital-based cross-sectional study in the Department of Obstetrics and Gynaecology at Hind Institute of Medical Sciences. A total of 150 patients, aged 15–45 years and diagnosed with PCOS using Rotterdam 2003 criteria, were assessed for MetS according to the International Diabetes Federation (IDF) 2022 definition. Clinical, anthropometric, and biochemical parameters were recorded. Data were analyzed with SPSS version 26.0, and significance was set at p < 0.05. Results: Among 150 patients with PCOS, the prevalence of metabolic Syndrome was 25.3%. Central obesity was most frequent (54%), followed by hypertriglyceridemia (40.7%), low HDL (36.7%), hypertension (34.7%), and raised fasting glucose (14%). MetS was significantly associated with higher age, BMI, waist circumference, menstrual irregularities, hirsutism, acanthosis nigricans, and polycystic ovarian morphology, while parity and thyroid status showed no association. Patients with MetS had higher fasting glucose, LH/FSH ratio, and testosterone compared to those without. Conclusion: Metabolic Syndrome is highly prevalent among patients with PCOS in Northern India, particularly in those with obesity, irregular cycles, and clinical signs of insulin resistance. Routine metabolic screening and early lifestyle interventions should be integrated into the management of PCOS to reduce long-term cardiometabolic complications.

Introduction: Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly among older adults and those with comorbidities. While respiratory complications are well recognized, thrombotic events such as deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and myocardial infarction (MI) are increasingly acknowledged as significant contributors to adverse outcomes in CAP. Hypoalbuminemia, a common marker of disease severity and inflammation, has been proposed as a potential predictor of thrombotic risk, but remains underexplored in this context. Materials and Method: This prospective observational study included 100 adult patients with CAP admitted to a tertiary care hospital. Patients were categorized based on serum albumin levels measured within 24 hours of admission into hypoalbuminemia (<3.5 g/dL) and normoalbuminemia (≥3.5 g/dL) groups. The primary outcome was the incidence of in-hospital thrombotic events. Secondary outcomes included length of hospital stay, ICU admission, and in-hospital mortality. Multivariate logistic regression was performed to identify independent predictors of thrombosis. Results: Hypoalbuminemia was present in 58% of patients. Thrombotic events occurred in 24.1% of the hypoalbuminemic group compared to 9.5% in the normoalbuminemic group (p = 0.047). The hypoalbuminemia group also had a significantly longer hospital stay (p = 0.002) and higher ICU admission rate (p = 0.031). Multivariate analysis confirmed hypoalbuminemia as an independent predictor of thrombotic events (adjusted OR: 2.96; 95% CI: 1.01–8.68; p = 0.048). Conclusion: Hypoalbuminemia is a significant and independent predictor of thrombotic complications in hospitalized CAP patients. Routine albumin measurement may aid in early risk stratification and guide thromboprophylactic strategies.

Background: Hyperthyroidism, a prevalent endocrine disorder, leads to increased production of thyroid hormones such as T3 and T4. This elevation accelerates basal metabolic processes and mitochondrial respiration, resulting in excessive generation of reactive oxygen species (ROS). When these ROS overwhelm the body’s antioxidant defenses, oxidative stress ensues, damaging lipids, proteins, and DNA. Objective: To assess oxidative stress levels, antioxidant markers, and thyroid stimulating hormone (TSH) levels in patients with hyperthyroidism and compare them to healthy controls. Methods: This case-control study was conducted at Index Medical College Hospital & Research Centre, Indore, and Madhya Pradesh. A total of 69 hyperthyroid patients and 204 healthy controls were recruited. Biochemical parameters including serum T3, T4, TSH, malondialdehyde (MDA), superoxide dismutase (SOD), total antioxidant capacity (TAC), Vitamin C, and Vitamin E were measured using validated protocols. Statistical analysis was performed using Student’s t-test and p-values <0.05 were considered significant. Results: MDA levels were significantly elevated in hyperthyroid patients (7.8 ± 1.1 nmol/L) compared to controls (1.07 ± 0.61 nmol/L, p<0.0001), indicating increased lipid peroxidation. TAC, Vitamin C, and Vitamin E levels were significantly lower in hyperthyroid cases (p<0.0001), suggesting depleted antioxidant reserves. T3 and T4 levels were markedly increased, while TSH levels were significantly suppressed in hyperthyroid patients compared to controls. Conclusion: The study confirms a strong association between hyperthyroidism and oxidative stress, with marked alterations in antioxidant profiles. Monitoring these parameters could be beneficial in understanding disease progression and guiding supportive antioxidant therapy in clinical practice.

Introduction: Anemia in pregnancy is a prevalent global health concern associated with maternal and fetal complications. Retinal vasculature, being highly metabolically active, may be affected by systemic hypoxia resulting from anemia. However, data on fundus and optical coherence tomography (OCT) changes in pregnant women with varying anemia severity are limited. The objective of the study is to evaluate the effect of anemia in pregnancy on retinal vascular and structural changes using fundus examination and OCT, and to correlate these findings with anemia severity. Materials and Methods: A cross-sectional observational study was conducted at Indira Gandhi Medical College & Kamla Nehru Hospital, Shimla, India, from January 2024 to January 2025. A total of 150 pregnant women were categorized as mild (n=60), moderate (n=60), or severe anemia (n=30) based on hemoglobin levels. Women with pre-existing ocular or systemic conditions affecting retinal vasculature were excluded. Demographic, obstetric, and clinical data were recorded. Fundus examination documented arteriolar attenuation, venous engorgement, AV crossing changes, haemorrhages, and exudates. Spectral-domain OCT measured central macular thickness (CMT), retinal nerve fiber layer (RNFL) thickness, foveal avascular zone (FAZ), and perfusion densities in superficial and deep capillary plexuses. Data were analyzed using ANOVA and Chi-square tests; p<0.05 was considered statistically significant. Results: Retinal vascular changes increased with anemia severity. Retinal arteriolar attenuation was observed in 15%, 30%, and 50% of mild, moderate, and severe cases, respectively (p<0.001). OCT revealed progressive increases in CMT (250 ± 20 to 300 ± 30 µm) and FAZ area (0.20 ± 0.05 to 0.30 ± 0.05 mm²), and decreases in RNFL thickness (100 ± 10 to 80 ± 20 µm) and perfusion densities (p<0.001) with increasing anemia severity. Conclusion: Anemia in pregnancy is associated with significant retinal vascular and structural changes, which worsen with increasing severity. Fundus and OCT assessment can aid early detection of retinal involvement in these patients.

Introduction: Prolonged digital device use is associated with digital eye strain (DES), commonly manifesting as dry eye disease (DED). The 20-20-20 rule, which recommends a 20-second break to view an object 20 feet away every 20 minutes of screen time, is widely suggested to reduce ocular discomfort, but adherence is often poor. The objective of the study is to evaluate the effectiveness of daily reminders to practice the 20-20-20 rule in reducing subjective and objective dry eye parameters among adults with prolonged screen exposure. Materials and Methods: In this prospective, randomized controlled study, 100 participants aged 18–50 years with ≥6 hours/day of screen exposure and mild-to-moderate dry eye symptoms (OSDI ≥ 15) were enrolled. Participants were randomly assigned to receive daily electronic reminders for the 20-20-20 rule (Group A, n=50) or no reminders (Group B, n=50). Baseline and 1-month assessments included Ocular Surface Disease Index (OSDI), Tear Break-Up Time (TBUT), and Schirmer’s test. Between-group comparisons were analyzed using independent t-tests; p<0.05 was considered significant. Results: Baseline characteristics were comparable between groups. After one month, Group A showed significant improvement in OSDI (18.2 ± 5.3 vs 25.7 ± 6.0, p<0.001), TBUT (9.3 ± 1.5 s vs 7.1 ± 1.4 s, p<0.001), and Schirmer’s test (15.8 ± 2.6 mm vs 13.0 ± 2.4 mm, p<0.001) compared to Group B. Conclusion: Daily reminders to practice the 20-20-20 rule significantly reduce subjective dry eye symptoms and enhance tear film stability and secretion in prolonged screen users. Reminder-based behavioural interventions represent a simple, low-cost strategy to prevent and manage DES.

Introduction: Cervical cancer is a leading cause of morbidity and mortality among women, particularly in low- and middle-income countries. Human papillomavirus (HPV) infection is the primary etiological factor, and vaccination offers effective prevention. Despite this, HPV vaccine uptake remains low in peripheral areas due to limited awareness, misconceptions, and socioeconomic barriers. The objective of the study is to assess the knowledge, attitudes, and uptake of the HPV vaccine among young females in selected peripheral areas of Himachal Pradesh, India. Materials and Methods: A cross-sectional study was conducted from May 2025 to September 2025 at Civil Hospital, Ghawandal, Bilaspur; Community Health Centre, Kotkhai, Shimla; and Zonal Hospital, Shimla. A total of 300 females aged 15–29 years were recruited using convenience sampling. Data were collected using a pretested structured questionnaire covering sociodemographic, HPV knowledge, attitudes, sources of information, and vaccine uptake. Vaccination status was categorized as vaccinated (≥1 dose) or not vaccinated. Data were analyzed using SPSS v25, with chi-square tests applied to assess associations. A p-value <0.05 was considered statistically significant. Results: The mean age was 20.8 ± 2.3 years. Seventy percent had heard about HPV, and 55% were aware that the vaccine prevents cervical cancer. Attitudes were generally positive, with 65% perceiving the vaccine as safe and 60% acknowledging its necessity. Only 35% of participants had received at least one dose. Higher education and socioeconomic status were significantly associated with better knowledge and vaccine uptake (p < 0.001). Positive attitudes were strongly linked to vaccination (p < 0.001). Healthcare providers were the most common source of information (40%). Conclusion: Awareness of HPV is moderate, but actual vaccine uptake is low. Targeted educational interventions, accessible vaccination programs, and reinforcement by healthcare providers are crucial to improve coverage and reduce cervical cancer burden in peripheral regions.

Background: Appendicitis remains the most common cause of emergency abdominal surgery. While the majority of appendectomy specimens show inflammatory pathology, a subset reveals unexpected findings, including granulomatous, parasitic, or neoplastic lesions. Although appendiceal neoplasms are rare, their detection is clinically important as they may alter management and prognosis. Methods: This retrospective descriptive study analyzed 446 appendectomy specimens received in the Department of Pathology of a tertiary care hospital between January 2022 and January 2025. Demographic details were collected, and all specimens underwent gross and microscopic evaluation. Histopathological diagnoses were classified, and data were analyzed using SPSS v22. Results: The study included 245 males (54.9%) and 201 females (45.1%), with a male-to-female ratio of 1.22:1. Patient age ranged from 6 to 79 years, with peak incidence in the second (25.3%) and third decades (26.3%). Acute appendicitis was the most frequent finding (168 cases, 37.67%), followed by chronic/recurrent appendicitis (135 cases, 30.27%) and acute appendicitis with peri-appendicitis (56 cases, 12.56%). Other patterns included suppurative appendicitis (5.83%), gangrenous appendicitis (0.67%), perforated appendicitis (2.47%), fibrous obliteration (4.48%), eosinophilic appendicitis (2.69%), and rare conditions such as tuberculous appendicitis (0.45%) Enterobius vermicularis infestation (0.67%), Meckle’s diverticulitis (0.45%) and chronic appendicitis with inflammatory bowel disease (0.22%). Neoplastic lesions were detected in 7 cases (1.57%), comprising neuroendocrine tumors (3 cases, 0.67%), low-grade appendiceal mucinous neoplasms (3 cases, 0.67%), and mucinous cystadenoma (1 case, 0.22%). Conclusion: Inflammatory lesions accounted for the majority of appendectomy specimens, with acute appendicitis being the most common diagnosis. Neoplasms, though infrequent, were clinically significant incidental findings, highlighting the necessity of routine histopathological examination of all appendectomy specimens.

Background: Gestational diabetes mellitus (GDM) poses significant risks to both maternal and fetal health, particularly when glycemic levels remain uncontrolled. In India, where the prevalence of GDM is rising rapidly—estimated at 10-14% in urban areas—neonatal complications such as hypoglycemia, macrosomia, and respiratory distress syndrome (RDS) are common concerns. This study aimed to evaluate how varying degrees of glycemic control influence neonatal outcomes in a resource-constrained tertiary setting, addressing a gap in localized evidence for targeted interventions. Material and Methods: We conducted a prospective cohort study over one-year at Gujarat in a Tertiary care Medical College and Hospital, involving 150 pregnant women diagnosed with GDM via the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Participants were categorized into good (n=85) and poor (n=65) glycemic control groups based on mean fasting plasma glucose <95 mg/dL, 2-hour postprandial <140 mg/dL, and HbA1c <6.5%. Ethical approval was obtained from the institutional review board, with informed consent from all. Neonatal outcomes assessed included macrosomia, hypoglycemia, RDS, hyperbilirubinemia, and NICU admissions. Data were analyzed using chi-square tests, t-tests, and multivariate logistic regression, with p<0.05 considered significant. Results: Maternal age and parity were comparable between groups (28.2±4.1 vs. 29.1±4.3 years; p=0.32). Poor control was linked to higher HbA1c (6.8±0.7% vs. 5.6±0.5%; p<0.001). Neonatal macrosomia occurred in 14% of good control vs. 43% of poor (p<0.001), hypoglycemia in 9% vs. 34% (p<0.001), RDS in 5% vs. 20% (p=0.002), hyperbilirubinemia in 18% vs. 38% (p=0.005), and NICU admissions in 8% vs. 28% (p<0.001). Multivariate analysis confirmed poor control as an independent predictor of overall complications (OR 4.2, 95% CI 2.1-8.4; p<0.001). Conclusion: Tight glycemic control in GDM significantly mitigates neonatal risks, underscoring the need for vigilant monitoring and multidisciplinary care in Indian tertiary centers. These findings advocate for routine HbA1c tracking and early insulin initiation to optimize outcomes, potentially reducing healthcare burdens in high-prevalence regions like Gujarat.

Background: Acute cholecystitis, primarily caused by gallstone obstruction, is a common surgical emergency requiring timely intervention. Laparoscopic cholecystectomy is the standard treatment, but the optimal timing—early (within 7 days of symptom onset) versus delayed (after 6 weeks)—remains debated due to concerns about operative risks and resource constraints. This study evaluates the safety, efficacy, and cost-effectiveness of early laparoscopic cholecystectomy (ELC) versus delayed laparoscopic cholecystectomy (DLC) in patients with acute cholecystitis at a tertiary care center in western Gujarat, addressing the need for region-specific evidence. Materials and Methods: This prospective study, conducted for one year, included 120 patients with acute cholecystitis (Tokyo Guidelines TG18 criteria) randomized into ELC (n=60) and DLC (n=60) groups. ELC was performed within 7 days of symptom onset, while DLC followed 6 weeks of conservative management. Outcomes included operative time, conversion to open surgery, complications, hospital stay, costs, and patient satisfaction (assessed via a 5-point Likert scale). Data were analyzed using t-tests and chi-square tests (p<0.05). Results: ELC had a longer operative time (82±15 vs. 68±12 minutes, p=0.01) but a shorter hospital stay (3.2±1.1 vs. 5.8±1.8 days, p<0.001) and lower costs (INR 45,000±8,000 vs. INR 62,000±10,000, p=0.002). Complication rates (10% vs. 12%, p=0.77) and conversion rates (5% vs. 7%, p=0.68) were comparable. Patient satisfaction was higher in ELC (85% vs. 70%, p=0.04), reflecting faster recovery. Conclusion: ELC is safe, cost-effective, and associated with shorter hospital stays and higher patient satisfaction compared to DLC. These findings support ELC as the preferred approach in western Gujarat, optimizing outcomes in resource-limited settings. Future research should explore long-term outcomes and severe cases.

Acute pancreatitis is an inflammatory condition with varying degrees of severity, and predicting its severity is crucial for optimal management. This retrospective study aimed to investigate the relationship between C-reactive protein (CRP) levels at admission and the modified Computed Tomography Severity Index (CTSI) after 48 hours in patients with acute pancreatitis. The study included 18 patients (16 females and 14 males) admitted to a tertiary care hospital over a 6-month period. The mean CRP levels showed an increasing trend with higher CTSI scores, rising from 18.5 (SD 24.749) at a CTSI of 2 to 154.5 (SD 150.614) at a CTSI of 8. However, this result was not statistically significant (p = 0.254), possibly due to the small sample size and large standard deviation. Younger age was found to correlate with greater severity, with a mean age of 24 (SD 2.828) years at a CTSI of 8 (p = 0.031). The white blood cell count also demonstrated an increasing trend with higher CTSI scores, although not statistically significant (p = 0.713). Serum amylase levels showed an inconsistent increase with CTSI. The study’s limitations include its retrospective nature, small sample size, and the absence of samples with a CTSI of 10. In conclusion, while CRP levels at admission showed an upward trend with increasing severity of acute pancreatitis, the results were not statistically significant in predicting severity.

Objectives: The objectives were to compare the efficacy of intravenous magnesium sulfate and tramadol infusions on controlling acute renal colic as adjuvants, post administration of ketorolac. Methods: This was a hospital based comparative study conducted in the Department of Emergency Medicine of a tertiary care teaching hospital, India between June 2021 and March 2022. The study included all patients more than 18 years of age presenting to the Department of Emergency Medicine with complaints of acute renal colic – a known case of renal calculi confirmed by either USG or NCCT or X-ray KUB. Results: The study included a total of 80 patients – 40 each in the magnesium sulphate and tramadol groups. We found that 10.0% of the patients in magnesium sulfate group required rescue analgesia and 30.0% of the patients in the tramadol group required rescue analgesia. A significantly (p<0.05) higher number of patients in the tramadol group required rescue analgesia in comparison with magnesium sulfate group. In other words, patients in the tramadol group were at four times increased risk of requiring rescue analgesia (Odds ratio (OR) 3.86, 95% CI 1.12 to 13.26; p = 0.025). At baseline, the severity of pain did not vary significantly between the magnesium sulfate and tramadol groups (p>0.05). At 15, 30 and 45 minutes the severity of pain declined gradually in both the study groups. However, the decline was significantly higher among magnesium sulfate group in comparison with tramadol group (p<0.05). Conclusion: Patients treated with magnesium sulfate as adjunct to ketorolac had greater reduction in pain severity scores at 15, 30 and 45 minutes compared to patients treated with tramadol as adjunct to ketorolac.

Laparoscopic appendectomy is a common surgical procedure that requires effective anaesthesia and analgesia. This study aims to compare the intraoperative hemodynamic response and postoperative analgesic effect of spinal anaesthesia with adjuvants versus general anaesthesia with TAP block in patients undergoing laparoscopic appendectomy. This prospective, randomized, compared clinical study included 60 patients undergoing laparoscopic appendectomy. Patients were randomly allocated to one of two groups: Group A (n=30) received spinal anaesthesia with adjuvants (Bupivacaine and Buprenorphine), while Group B (n=30) received general anaesthesia with TAP block (Bupivacaine). Intraoperative hemodynamic parameters and postoperative pain scores (VAS) and any adverse events were recorded. Group A had a more stable intraoperative hemodynamic profile compared to Group B (p < 0.01). Postoperative pain scores were significantly lower in Group A at 2, 4, and 6 hours after surgery (p < 0.05). Additionally, Group A required less postoperative analgesia (p < 0.01) and had a lower incidence of postoperative nausea and vomiting (p < 0.05). This study demonstrates that spinal anaesthesia with adjuvants provides a more stable intraoperative hemodynamic response and better postoperative analgesia compared to general anaesthesia with TAP block in patients undergoing laparoscopic appendectomy. These findings suggest that spinal anaesthesia with adjuvants may be a preferred anaesthesia technique for this surgical procedure.

Background: Thyroid neoplasm includes both benign and malignant tumours arising in the thyroid gland. Although thyroid cancer accounts for only 1% of all cancers. It is the commonest endocrine tumour that shows a geographic variation in incidence of tumour, type and natural history. Objective: To assess the clinical presentation and the sensitivity of FNAC in different types of thyroid neoplasms. Results: This is a cross sectional study comprising 84 patients. Among them 60 cases were benign and 24 were malignant. All the 60 cases of benign thyroid neoplasm were colloid goitre. Among the 24 cases of malignancies, 14 were papillary, 6 follicular, 1 follicular variant of PTC, 1 medullary, 1 anaplastic carcinoma and 1 lymphoma. The sensitivity of FNAC in thyroid neoplasms is 92.85% with a sensitivity of 66.66% for follicular and 71.42% for papillary carcinomas. Conclusion: FNAC is a highly useful, non-traumatic first line investigation tool for thyroid neoplasms with a good patient acceptance rate.  Role of FNAC is twofold: Therapeutic and diagnostic. Thyroid swellings that were considered for FNAC included diffuse, firm, palpable, solitary nodules, nodules associated with suspicious clinical or ultrasonographic features, dominant nodules in a multinodular goitre, recurrent cystic nodules, and nodules associated with palpable lymph nodes.

Background: Long term used of certain antiepileptic medications (AEDs) by children may experience some renal side effects, including proteinuria, electrolyte imbalance, decreased GFR, nephrolithiasis and renal tubular dysfunction. Monitoring and prevention are aided by knowledge of incidence and risk factors in pediatric practice. Objective: To outline the Incidence of renal problems linked to AED treatment in a group of children with epilepsy. Methods: 100 children diagnosed with epilepsy and on AED therapy for ≥6 monthswere enrolled in this cross sectional study. A detailed clinical history regarding AEDs, demographic data and clinical examination findings were recorded. Laboratory investigations related to renal toxicity and renal ultrasound was done. Observed renal complications associated with the AED were recorded and compared with the types of AED used. Results: The overall incidence of renal complications on children taking long term AED were 26%. The mean age was 9.2 ± 3.1 years; 58 were males and 42 were females. The most commonly used AED was Valproate (32%) followed by Carbamazepine (24%) and Phenytoin (18%). The common complications were Proteinuria (14%), Electrolyte imbalance (12%), and Decreased GFR (10%). Highest frequency of renal complications (37.5%) were associated with the Valproate followed by use of Phenytoin (27.8%). Conclusion: Renal complications are not uncommon among children receiving AED therapy, with older-generation drugs like valproate and phenytoin showing higher associations. Early detection through routine renal screening is critical to prevent long-term kidney damage.

Background: Central venous cannulation is essential for monitoring hemodynamics, providing inotropic support, delivering total parenteral nutrition, medications, and long-term fluid therapy. Using ultrasound to guide the vein cannulation process has become a standard practice. This shift is primarily due to enhanced visualization, a higher success rate, and a reduction in complications associated with ultrasound compared to the traditional landmark technique. Aims and Objectives: The main aim of the study was to compare the successful cannulation between the right internal jugular vein v/s supraclavicular approaches to right brachiocephalic vein using ultrasound guidance. Objective of our study was to compare the time taken, number of attempts and incidence of complications during cannulation among them. Methodology: Study was a comparative study conducted in Fakhruddin Ali Ahmed medical college and hospital. Ethical committee approval for this study was taken from the institute. A total of 50 patients aged between 18 to 60 years, ASA grade 1,2,3, conscious, mechanically ventilated or sedated were enrolled in this study. The patient was randomly allocated into two groups; Group A (n=25) received right internal jugular vein cannulation while group B (n=25) received right brachiocephalic vein cannulation under ultrasound guidance. Result: The study found that first attempt success rate was significantly higher for group B (80%) than group A (36%) (P=0.0219). Group B achieved faster cannulation time (mean 98.08 secs) than group A (mean 182.68 secs), P=0.022) with few attempts. The incidence of complications was significantly higher for group A compared to group B (P <0.001). Conclusion: It was found that under ultrasound guidance right brachiocephalic vein cannulation appears to be more successful approach for central venous access because of faster cannulation time, fewer attempts, lesser complication rates and better anatomical visualisation than right internal jugular vein cannulation.

Introduction: Pediatric ocular trauma is different from adult ocular trauma in many aspects, including mechanism of injury, initial assessment, and management protocols. Various ocular trauma scoring systems have been developed to allow for the prediction of final VA, like the Ocular Trauma Score (OTS) and the Pediatric Ocular Trauma Score (POTS). Material and Methods: We performed a prospective clinical study over 18 months with children aged 1 to 15 years with penetrating ocular trauma. We aim to establish a trauma score that is more suitable in predicting the final visual acuity post-injury in the pediatric population. Results: 100 patients met the eligibility criteria. A majority of the study population had a POT score of 1, which is 37%. 21%, 22% and 14% had a POT score of 2,3, and 4, respectively, while 6% had a POT score of 5. A majority, 64.3% had an OTS score of 3, followed by a score of 4 in 14.13%, a score of 2 in 13.04 percent and 5 in 6.52%. There was a statistically significant difference in the initial and final visual activity concerning counting of fingers and 0.1-0.5 across the various raw points based on the POTS Score. However, the difference was not significant when NLP, LP/HM, 0.6-1 were considered. When the OTS was considered, only Visual acuity of 20/200-20/50 showed statistical significance between the initial and the final values, p<0.0001. Conclusion: As per our research, both the scores have good predictive value and can be used for assessing visual prognosis after pediatric open globe injury. The OTS score can be used in both open and closed globe injuries, whereas the POTS score is only applicable for penetrating eye injuries.

Background: Periprosthetic joint infection (PJI) is a severe complication following total knee arthroplasty (TKA), contributing to significant morbidity and healthcare costs. This study aimed to determine the incidence and risk factors of PJI after TKA in a tertiary care teaching hospital in Gujarat, India, to inform targeted prevention strategies. Material and Methods: A retrospective analysis of 300 primary TKAs performed at a tertiary care center was conducted. PJI was diagnosed using Musculoskeletal Infection Society criteria, with data extracted from electronic medical records on demographics, comorbidities, and perioperative factors. Univariate and multivariate logistic regression identified risk factors, with statistical significance set at p<0.05. Results: PJI occurred in 6 cases (2.0%, 95% CI 0.7-4.3%), with 4 early-onset (<90 days) and 2 late-onset infections. Staphylococcus aureus (50%) and gram-negative bacilli (33%) were predominant pathogens. Univariate analysis identified male sex (OR 2.5, p=0.04), diabetes mellitus (OR 3.5, p=0.01), obesity (BMI ≥30 kg/m², OR 3.0, p=0.02), and preoperative urinary tract infection (UTI, OR 4.8, p<0.01) as significant risk factors. Multivariate regression confirmed diabetes (aOR 3.2, 95% CI 1.1-9.3, p=0.03) and obesity (aOR 2.7, 95% CI 1.0-7.2, p=0.04) as independent predictors. Conclusion: The 2.0% incidence aligns with global (0.5-2%) and Indian studies, with diabetes and obesity as key modifiable risk factors, consistent with prior research. Preoperative optimization of diabetes and obesity is critical to reduce PJI rates in Indian tertiary settings, enhancing TKA outcomes.

Background: Airway management is a fundamental aspect of anaesthesia, and direct laryngoscopy with either Miller or Macintosh blades remains among the most widely practised techniques. Variations in glottic visualization, hemodynamic response, and ease of intubation may significantly affect patient outcomes. Aims and Objectives: To compare the clinical efficacy of the Miller straight blade (no. 2) and the Macintosh curved blade (no. 3) in adult patients undergoing elective surgery under general anaesthesia. The objectives included evaluating hemodynamic responses (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and SpO₂), assessing ease of intubation using POGO score, Cormack–Lehane grading, number of attempts, and intubation time, and recording complications associated with each blade. Methods: In this prospective, randomized, single-blind study, 80 ASA I–II patients aged 18–65 years undergoing elective surgery at SVBP Hospital, Meerut, were enrolled. Participants were randomly allocated into two groups: Group A (Miller blade, n=40) and Group B (Macintosh blade, n=40). Hemodynamic parameters were measured at baseline, immediately after intubation, and at 1, 3, 5, and 10 minutes. Intubation characteristics and complications were documented. Data were analyzed using SPSS software, with p < 0.05 considered statistically significant. Results: Baseline demographic characteristics were comparable between the groups. At 0 and 1 minute post-intubation, heart rate and blood pressures were significantly higher in the Miller group (p < 0.05). The Macintosh group showed a shorter mean intubation time (13.7 ± 1.58 seconds vs. 17.97 ± 1.30 seconds, p < 0.001) and fewer complications (2.5% vs. 7.5%). Although glottic visualization was superior with the Miller blade, overall ease of intubation was better with the Macintosh blade. Conclusion: The Macintosh laryngoscope was associated with shorter intubation times, fewer hemodynamic changes, and easier intubation, making it more suitable for routine use in adult patients with normal airways. In contrast, the Miller blade offered superior glottic visualization and may be beneficial in cases of large epiglottis or when a difficult airway is anticipated.

We are presenting a case of a 16-year-old female patient presented in opd with pain, swelling, and restricted range of motion. On examination, the affected leg and ankle swollen, erythematous, and tender to touch, with limited range of motion at ankle joint.  X-Ray of leg with ankle identified periosteal reaction in form of sunburst appearance at distal tibia. MRI imaging confirmed malignant primary neoplasm, and treatment involved surgical intervention? an chemotherapy, followed by prosthesis care showed significant.

Background: Postoperative pain is a well-known morbidity and is the most distressing complication of surgery. Effective management of postoperative pain relievers suffering and leads to earlier mobilization; reduced cost of care and increased patient satisfaction. The present clinical study includes the study of intrathecal administration of Bupivacaine(10mg) with different doses of Fentanyl 10ug and 15ug in respect to time of onset of sensory and motor blockade up to maximal possible level, duration of sensory and motor blockade, time to 1st dose of required analgesic, cardiovascular effects and any side effects due to varying doses of Fentanyl. Material and Methods: The study was confined to hundred patients including parturients of 20-40 years of age and undergoing LSCS. The patients were divided in the two groups – Group A and Group B. Patients of group A received 10mg Bupivacaine and 10ug of Fentanyl & group B received 10mg Bupivacaine and 15ug of Fentanyl. A standard technique of subarachnoid blockade was used. Result: The demographic variables like age, sex, weight and ASA physical state were similar in both groups. The mean onset of sensory and motor block was non-significant (p > 0.05) in both groups. The mean time to two segment regression in Group A was 128.44 ± 6 (min) and in Group B was 163.98 ± 17.22 (min). The p- value was < 0.001 between the groups (statistically highly significant). The mean duration of motor block in Group A was 109.0 ± 6.25 min and in Group B was 143.90 ± 16.71 min. The p- value was < 0.001 between the groups (statistically highly significant). Conclusion: Our study shows a dose-dependent prolongation of duration of sensory and motor blockade and time to 1st dose of rescue analgesic by intrathecal fentanyl in dose range of 10 – 15ug with hyperbaric bupivacaine. The duration of effective and postoperative analgesia was significantly more with increased dose of fentanyl.

Background: Ultrasonography is widely used imaging modality, offering real-time foetal visualization without any risk to mother and foetus. It helps to improve maternal and fetal outcomes through enhanced prenatal care. Study aims to assess knowledge, attitude and practices (KAP) towards obstetrics ultrasound among pregnant women. Material and Methods: A hospital-based, cross-sectional study was conducted from April to December 2023, involving 300 pregnant women at Zanana Hospital, Jaipur, Rajasthan, India. A validated, semi-structured, interviewer-administered questionnaire covering socio-demographic, obstetric characteristics and KAP towards ultrasound used for data collection. Descriptive Statistics was performed using MS Excel 2007 and IBM SPSS Statistics version 25. Results: The mean age of the study participants was 26.68 ± 5.22 years. A majority lived in urban areas 193 (64.33%) and most identified as Hindu 198 (66%). Thirty-three percent of participants were from Class IV socio-economic status. Average knowledge score was 8.76 ± 3.25, with 134 (44.67%) demonstrating average knowledge. Positive attitudes were observed in 164 (54.67%) of participants, while 279 (93%) exhibited good practices related to obstetrics ultrasound. Conclusions: knowledge towards obstetrics ultrasound was found to be average with about one third women had good knowledge with some of them had poor knowledge. Attitude was found positive and half of participants had positive attitude with some of them negative attitude. Nearly all participants had good practice of ultrasound during pregnancy. Improving KAP can enhance maternal and foetal outcomes, highlighting the need for Information, Education, and Communication (IEC) interventions to raise awareness regarding obstetric ultrasound with PCPNDT Act among pregnant women.

Background: The majority of premature births in developed countries (72% of preterm births) are late preterm infants (LPI), which are defined as babies born between 34+0 and 36+6 weeks gestation. Late preterm infants also account for the notable rise in premature births that has occurred over the last two decades. Neuro-morbidity has been linked to both extrinsic and intrinsic causes, and brain vulnerability has also been shown in late preterm newborns. A link exists between extrinsic vulnerability and the harmful consequences of prenatal morbidities on the brain. Conversely, at particular gestational ages, intrinsic variables are associated with the morphological and molecular immaturity of the developing brain. A universal CUS screening program, however, would place a significant strain on caregivers and increase resource consumption and medical expenses, especially given the size of the LATE preterm infant population. Therefore, the present study was conducted to find out the association between perinatal factors and cranial USG findings in late Preterm neonates. Aim: To find out association between perinatal risk factors and cranial USG findings in late preterm neonates. Method: This was a hospital based prospective observational study conducted in a level IIIA NICU in Shri Shishu Bhawan Hospital, Bilaspur which is a tertiary care hospital from December 2022 to December 2023. It includes all the Late Preterm neonates >34+0 and <36+6 weeks of gestation admitted in NICU of the institute. To reject the null hypothesis the test of significance required shall be chi square test. The sample size hence calculated by G*Power Software by UCLA university is 88. The collected data were transformed into variables, coded and entered in Microsoft Excel. Data were analyzed and statistically evaluated using SPSS-PC-25 version. Chi-square test and statistical analysis were applied. Results: The cranial ultrasound findings among study subjects, maximum 48.86% cases had severe abnormalities, 20.45% cases had PHE and 10.23% cases had mild abnormalities and 20.45% had normal CUS findings. The association b/w risk factors and CUS findings among mild abnormalities maximum 44.4% had MSL, had PROM, and 11.1% each had eclampsia and oligohydramnios. Among PHE cases 50% had oligohydramnios, 33.33% had PROM, and 16.7% had MSL. Whereas among severe abnormalities cases maximum 44.19% had oligohydramnios and 25.58% had MSL and 11.63% had PROM. Association b/w risk factors and CUS findings was tested using chi square test and it was statistically significant (p<0.05). Conclusion: The present study acknowledges the role of cranial ultrasonography in early diagnosis of brain damage in high-risk neonates and that helps in the clinical management of neonates at NICU settings. It concludes that near half cases had severe abnormalities, followed by PHE and mild abnormalities.

Background and Aim: To promote appropriate healing and functional recovery, femur fractures often require intramedullary nailing, plating, or bipolar surgery. Poor postoperative analgesia might delay recovery and increase morbidity. Regional anesthetic with ultrasound-guided femoral nerve blocks improves analgesia and reduces opioid use. Due to the high occurrence of these injuries and their impact on patient quality of life, this research could dramatically change orthopedic surgery clinical practices and outcomes. Material and Methods: This double blinded randomized clinical trial included 60 patients aged between 18 to 70 years who are undergoing elective surgical intervention at our institute were parted into two groups (Group A and Group B) which includes 30 patients in either of the two groups. Group A who received Inj MgSo4 500mg (1ml) along with Inj Levobupivacaine (0.5%) 19ml and the Group B who received Inj Levobupivacaine (0.5%) 20ml for the USG Guided femoral nerve block after completion of respective surgery. Results: Over a 24-hour period, both the treatment groups exhibited a statistically significant decrease in VAS scores. However, Inj Levobupivacaine added with MgSo4 group demonstrated superior efficacy in pain reduction compared to only Inj Levobupivacaine group. Along with VAS score, the two groups (A and B) were also compared as regard time to first rescue analgesia postoperatively, and which showed a statistical difference between the two groups. When the vital data compared, which included Systolic and Diastolic blood pressure, Respiratory Rate and Spo2 at room air, does not show statistical difference in both groups. Conclusion: Both Inj Levobupivacaine with MgSo4 and Inj Levobupivacaine alone produced post-operative analgesia in patients undergoing femur fracture surgery. However, giving Inj Levobupivacaine added with MgSo4 shown to be more effective in postoperative analgesia during Femoral Nerve Block compared to Inj Levobupivacaine alone.

Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. The Pneumonia Severity Index (PSI) and the CURB-65 score are two widely validated tools used to stratify patient risk and guide site-of-care decisions. However, their comparative performance in contemporary clinical practice warrants ongoing evaluation. Methods: We conducted a prospective, single-center, observational cohort study of 520 adult patients admitted with a primary diagnosis of CAP between June 2021 and May 2023. PSI and CURB-65 scores were calculated for each patient upon admission based on clinical and laboratory data. The primary outcome was 30-day all-cause mortality. Secondary outcomes were ICU admission and LOS. The discriminatory power of each score was assessed using the area under the receiver operating characteristic curve (AUC). Key Findings: Of the 520 patients (mean age 66.2 ± 16.1 years), 65 (12.5%) died within 30 days, and 98 (18.8%) required ICU admission. For predicting 30-day mortality, the PSI demonstrated significantly better discriminatory power (AUC = 0.85; 95% CI, 0.80–0.90) than the CURB-65 score (AUC = 0.79; 95% CI, 0.73–0.85; p=0.02). Similarly, for predicting ICU admission, the AUC for PSI was 0.82 (95% CI, 0.77–0.87), which was superior to that of CURB-65 (AUC = 0.76; 95% CI, 0.70–0.82; p=0.04). PSI was particularly effective at identifying low-risk patients; mortality in PSI risk classes I-II (n=145) was 0.7%, compared to 2.4% in patients with a CURB-65 score of 0-1 (n=210). Both scores showed a moderate positive correlation with LOS, though the correlation was stronger for PSI (Spearman’s ρ = 0.45 vs. 0.38; p=0.03). Conclusion: In this cohort of hospitalized CAP patients, the PSI demonstrated superior accuracy compared to the CURB-65 score in predicting 30-day mortality and the need for ICU admission. While CURB-65 remains a simpler tool for rapid initial assessment, the more comprehensive PSI provides more accurate risk stratification, especially in identifying patients at very low risk of adverse outcomes.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition globally. Abdominal ultrasound (US) is the recommended first-line imaging modality for its detection, while liver biopsy remains the invasive gold standard. The precise diagnostic accuracy of conventional US for different grades of steatosis requires continued evaluation. Methods:  A total of 210 adult patients with clinical and biochemical suspicion of NAFLD, who were scheduled for a liver biopsy, were enrolled. All patients underwent a standardized abdominal US examination within two weeks prior to the biopsy. Two blinded radiologists graded steatosis on US (Grade 0–3). Liver biopsies were evaluated by two blinded pathologists who graded steatosis according to the NAFLD Activity Score (S0: <5%; S1: 5–33%; S2: 34–66%; S3: >66%). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Of the 210 participants (mean age 51.2 ± 11.5 years; 55.7% female; mean BMI 32.4 ± 4.8 kg/m²), 172 (81.9%) had histologically confirmed steatosis (≥S1). For detecting any degree of steatosis (≥S1), US (defined as Grade ≥1) showed a sensitivity of 78.5% (95% CI: 71.9–84.2%), specificity of 92.1% (95% CI: 78.6–98.3%), PPV of 97.1%, and NPV of 53.0%. For detecting moderate-to-severe steatosis (≥S2), US (defined as Grade ≥2) demonstrated significantly higher sensitivity of 89.2% (95% CI: 81.3–94.6%) and specificity of 94.4% (95% CI: 89.1–97.5%). A strong positive correlation was observed between the ultrasound grade and the histological steatosis grade (Spearman’s ρ = 0.81, p < 0.001). Conclusion: Abdominal ultrasound is a highly specific tool for diagnosing hepatic steatosis. While its sensitivity for mild steatosis is modest, it demonstrates excellent accuracy for detecting moderate-to-severe disease. Ultrasound serves as a reliable, non-invasive screening modality for identifying clinically significant steatosis, though it cannot fully replace histopathology for staging disease activity and fibrosis.

Background: Acute kidney injury (AKI) is a common and life-threatening complication in critically ill patients admitted to intensive care units (ICUs). Identifying reliable, early predictors of AKI and mortality is crucial for timely intervention. Hypoalbuminemia and hyperuricemia are individually associated with poor outcomes in ICU settings. The serum uric acid to albumin ratio (SUA/ALB) is an emerging composite biomarker reflecting oxidative stress and nutritional status. This study evaluated the prognostic value of SUA/ALB in predicting AKI development and in-hospital mortality. Methods: A prospective observational study was conducted in the Department of General Medicine, S.C.B. Medical College & Hospital, Cuttack, from July 23 to July 24. One hundred adult ICU patients were enrolled. Serum uric acid and albumin levels were measured on day 1 of ICU admission, and the SUA/ALB ratio was calculated. Patients were followed for development of AKI (as per KDIGO criteria) and all-cause in-hospital mortality. Statistical analysis included chi-square test, independent t-test, Pearson correlation, and receiver operating characteristic (ROC) curve analysis using SPSS software. Results: Among 100 patients, 48% developed AKI and 32% died during hospitalization. The mean SUA/ALB ratio was significantly higher in AKI patients (2.11 ± 0.42) compared to non-AKI patients (1.53 ± 0.31, p < 0.001). Non-survivors had a higher mean SUA/ALB ratio (2.19 ± 0.38) than survivors (1.58 ± 0.35, p < 0.001). The SUA/ALB ratio demonstrated strong predictive ability for AKI (AUC = 0.873) and mortality (AUC = 0.902). Conclusion: The serum uric acid to albumin ratio is a promising, simple, and cost-effective biomarker for predicting both AKI and mortality in ICU patients. Its use may facilitate early risk stratification and improve clinical outcomes.

Background & Aim: A premalignant condition known as oral submucous fibrosis (OSMF) results in fibrosis of the oral mucosa and surrounding structures, such as the pharynx, larynx, eustachian tube, and airway space. We postulated that OSMF might affect the pharyngeal airway as well. Methods: The Saraswathi Institute of Medical Sciences in Ghaziabad, Uttar Pradesh, hosted this retrospective observational study from January to August of 2025. The data was collected from OPD records of dental and ENT department. Patients with OSMF and those having full-field-of-view (FOV) CBCT scans for other dental procedures were the subjects of a cross-sectional study. The groups’ three-dimensional airway spaces were measured and contrasted. Result: Patients with OSMF showed a statistically significant decrease in airway space (p-value <0.001). This implies that chewing areca nuts reduces the amount of space available for airways by affecting the mouth cavity and related structures. Conclusion: The results highlight the possible influence of fibrosis on airway dimensions and respiratory function by showing a substantial decrease in pharyngeal airway volume in OSMF patients.

Background: Approximately 4 to 5% of all fractures are proximal humerus fractures. After hip and distal radius fractures, these are the third most frequent fractures in the senior population. In the case of proximal humerus fractures, there are still disagreements over whether conservative or surgical management is preferable. Numerous surgical procedures are performed. Locking plates are the next big thing in internal fixation. The purpose of this study is to assess the functional result and complications of open reduction treatment for proximal humerus fractures. Internal fixation using proximal humerus Interlocking plate. Methods: This prospective study was conducted on 30 patients involving who were above18 yrs of age with proximal humerus fractures treated by open reduction, and internal fixation with locking plate from March 2024 to February 2025 were evaluated. Results: The majority of the patients in this study were elderly males, and the most common mode of injury was a slip and fall. The patients suffered two-part and three-part fractures of the proximal humerus, which united in an average of 14 weeks, with 28 cases (93.3%) having excellent and satisfactory results according to Neer’s criteria. Conclusion: As long as the patient followed a physiotherapy regimen and the parts underwent nearly normal anatomical reduction, the open reduction internal fixation of proximal third humeral fractures using PHILOS plating resulted in excellent to satisfactory outcomes and patient satisfaction.

Background: One of the most frequent injuries among the elderly is a fractured wrist, which, if left untreated, can result in diminished functionality and a lower quality of life. Fall-related wrist fractures in the elderly population have been more frequently linked to factors such as unsteady posture, diminished plantar sensation, asymmetry of vestibular function, and functional handicap. Preventive measures like enhancing balance, inner ear function, and foot sensation can be promptly implemented because wrist fractures are thought to be a predictor of future fracture incidence, particularly for hip fractures. These measures may also aid in the rehabilitation of patients who have suffered wrist fractures. Aim of this study to determine effect of multi-sensory training (MST) on posture (muscle strength), vestibular function, vibration perception, tactile sensation and functional ability compared to wrist stabilization training (WT) among elderly with fall related wrist fractures. Methods: This study design was carried out for the 130 wrist fracture follow-up cases, with 42 participants receiving wrist stabilization training and 88 individuals randomly assigned to multisensory training from July 2024 to June 2025. A physiotherapist supervised four sessions during the 12-week training period, and both groups completed at-home exercises. Measures used before and after training included the Dizziness Handicap Inventory Scales (DHI), Activities Specific Balance Confidence (ABC), Vibration Perception Test, Semmes-Weinstein Monofilaments (SWM), Head Shake Test (HST), 10m Walk Test (10MWT), and Five Times Sit to Stand Test (FTSTS). Results: Between the two groups, FTSTS, ABC, and DHI were determined to be statistically significant. MST was more beneficial in enhancing HST than wrist stabilization training (p=0.001). Conclusion: Multisensory training improved vestibular function in wrist fracture sufferers. Following fracture treatment, it could be used as a regular training intervention. Its effectiveness can be generalized by using a large sample size.

Background: One of the most frequent acute digestive conditions seen in emergency rooms across worldwide is acute appendicitis. Despite improvements in surgical and diagnostic methods, detecting acute appendicitis is still difficult, and delaying treatment can make a seemingly straightforward surgical condition more complicated. In females, the diagnosis is even more difficult. A quick and inexpensive diagnostic method that doesn’t require expensive equipment, the Modified Alvarado Scoring System (MASS) can be used in emergency situations and even at odd hours of the night. Aim of this study to test the efficacy and diagnostic accuracy of MASS in the diagnosis of acute appendicitis. Methods: From December 2024 to May 2025, a prospective cross-sectional study was carried out in Department of Surgery at GMCH, Bettiah, West Champaran, and Bihar. The study included 93 adult patients in total, 55 of whom were male and 38 of whom were female. The effectiveness of MASS in diagnosing acute appendicitis was assessed by comparing the sensitivity, specificity, positive predictive value, and negative predictive value of the test in males and females individually. Results: Compared to patients with a score of less than 7, the majority of patients with a MASS of 7 or higher were determined to have acute appendicitis. The acceptable positive and negative predictive values for MASS were 5.91 and 0.08, respectively, while its sensitivity and specificity were 93.24% and 84.21%. Conclusion: For the diagnosis of acute appendicitis, the Modified Alvarado Scoring System is a simple but effective diagnostic tool that has a satisfactory level of accuracy and acceptable sensitivity and specificity.

Background: Meconium aspiration syndrome (MAS) is defined as respiratory distress in an infant born through meconium stained amniotic fluid (MSAF) with characteristic radiological changes and whose symptoms cannot be otherwise explained. It forms one of the common causes of respiratory distress in newborn occurring worldwide and has mortality rate as high as up to 40% in the affected newborn. Aim of the study was to understand the factors causing meconium aspiration syndrome (MAS) in relation to gestational age and birth weight and their immediate outcome. Methods: It was a prospective observational study carried out in Sadar Hospital, Motihari, and Bihar from January 2023 to December 2023. The study included the clinical profile of consecutive 115 cases of meconium aspiration syndrome admitted to the above center. Results: Out of these 115 cases 86(74.78%) were male and 29(25.21%) were female. Fetal distress was predominant feto-maternal risk factors 59 babies (51.30%). Incidence of MAS was more in term babies (59.13%) and LBW babies (60.08%). Conclusion: Prediction, early diagnosis and prompt treatment of newborn with MAS will decrease the chances of long term sequelae to achieve neurologically intact survival.

Background: FNAC has become widely accepted tool for diagnosis of breast lesions as it is safe and simple method with high diagnostic accuracy. Aim of this study to evaluate the diagnostic efficacy of FNAC, histological analysis was performed on women who had benign breast lesions diagnosed by FNAC. Methods: From February 2025 to July 2025, 60 patients with benign breast lesions participated in this prospective study at the Department of Pathology, JLNMCH, Bhagalpur, and Bihar. All patients who had mastectomy, excision biopsy/lumpectomies, or FNAC with an unspecified initial diagnosis of breast lump were included in the study. Results: With a diagnosis accuracy of 96.7% for benign breast lesions, FNAC revealed 60 benign cases, of which 58 were benign and 1 case each of fibrocystic disease and mastitis had infiltrating ductal cancer. Conclusion: FNAC is a safe, simple, and cost-effective outpatient procedure associated with negligible complication. And along with histopathological correlation it increases the diagnostic accuracy. That helps the clinicians for early diagnosis and specific management thus reducing morbidity and mortality.

Background: The prostate is a retroperitoneal structure that surrounds the urethra and bladder neck. It is an exocrine gland whose secretions make up a sizable portion of seminal fluid and is the largest auxiliary reproductive organ in males. This study aims to establish a correlation between PSA levels and the grade of prostate carcinoma and prostatic lesions. Methods: Male patients with lower urinary tract problems who are recommended to have their PSA levels and undergo a prostate biopsy guided by transrectal ultrasonography (TRUS) are included in the study. The study design was retrospective and observational. Selection was done using the universal sample approach from January 2025 to June 2025. During the specified period, we got 116 TRUS biopsies. The departmental and hospital records provided the pertinent information for these. Results: Of the 116 cases, 59 were benign and 57 were malignant. PSA values were higher than 4 ng/ml in 53 (93%) of the malignant patients and 54 (91.5%) of the benign cases. As a result, it was determined that there was no statistically significant correlation between PSA level and lesion type (p >0.05). Grade 1 prostate adenocarcinoma had a mean PSA level of 19.67 ng/ml, Grade 2 prostate adenocarcinoma had a mean of 10.84 ng/ml, Grade 3 prostate adenocarcinoma had a mean of 21.07 ng/ml, Grade 4 had a mean of 39.06 ng/ml, and Grade 5 had a mean of 399.26 ng/ml. As a result, although the mean PSA level rose with grade, the difference was not statistically significant (p>0.05). Conclusion: There are limits to using serum PSA levels as tumor markers. Therefore, in situations that are clinically suspect, histological investigation is more specific for an accurate diagnosis.

Background: Abnormal uterine bleeding (AUB) is a common gynecological concern in perimenopausal women, requiring accurate diagnosis to guide management. Objective: To compare the diagnostic efficacy of ultrasonography and hysteroscopy in detecting uterine abnormalities in AUB and correlate findings with histopathology. Material and Methods: A prospective observational study was conducted on 120 perimenopausal women with AUB. All participants underwent USG, hysteroscopy, and targeted biopsies for histopathological examination. Diagnostic accuracy, sensitivity, and specificity were analyzed. Results: Hysteroscopy demonstrated higher diagnostic accuracy than USG, particularly for polyps, submucous fibroids, and endometrial hyperplasia. Histopathology confirmed definitive diagnoses, including malignancies in two cases. Combined hysteroscopy and histopathology provided optimal evaluation. Conclusion: Hysteroscopy, complemented by histopathology, offers superior diagnostic precision compared to USG alone, facilitating accurate evaluation and management of perimenopausal AUB.

Background: A wide range of inflammatory as well as neoplastic lesions can present as cutaneous and subcutaneous swellings all over the body. FNAC (Fine Needle Aspiration Cytology) is considered to be the first reliable technique for diagnosing them. Aim of this study is to assess the cytological spectrum of lesions presenting as skin and subcutaneous swellings. Methods: The present retrospective study was carried out over a period of 6 months at the Patna Medical College, Patna, Bihar in the Department of Pathology and a total of 131 patients with diverse skin and subcutaneous swellings were evaluated cytologically (FNAC). The data collection using a structured clinical proforma were entered into Microsoft Excel sheet. SPSS (Statistical Package for the Social Sciences, SPSS Inc., v.16) was used to do the statistical analysis. Results: There were 61 (46.6%) females and 70 (53.4%) males in total in this study. The study patient population ranged in age from 8 to 85 years old, with a mean age of 38.02±16.70 years. The youngest patient was eight years old. FNAC aspirate showed that the whitish aspirate was the most common type (44.3%). Conclusion: Fine Needle Aspiration Cytology is a rapid, reliable technique for initial assessment of cutaneous and subcutaneous swellings and thereby guiding further management.

Background: Ventral hernias are one of the most common anterior abdominal wall defects, often presenting with swelling and associated complications. Surgical repair remains the mainstay of management, with varied outcomes depending on patient profile and operative technique. Aim: To assess the clinical presentations, surgical modalities, and postoperative outcomes of ventral hernia in a tertiary care centre. Methods: This observational, cross-sectional study was conducted in the Department of General Surgery at Agartala Government Medical College & GBP Hospital, Tripura, over 2 years. A total of 50 clinically diagnosed cases of ventral hernia were included after applying the inclusion and exclusion criteria. Data were collected using a structured pro forma that covered demographics, clinical features, operative details, and complications. Descriptive statistics were applied, and the association between complications and surgical technique was analyzed using appropriate statistical tests. Results: The mean age of patients was 50.6 ± 9.5 years, with most in the 41–60 years group (60.8%). Females (60%) outnumbered males (40%). Common risk factors included constipation (36%), hypertension (28%), diabetes (18%), and previous abdominal surgery (40%). The most frequent presenting symptom was abdominal swelling (68%), followed by swelling with pain (32%). Incisional hernia was the predominant type (40%), followed by umbilical (32%), paraumbilical (18%), and epigastric hernia (10%). Open hernioplasty was the most common procedure (60%), while laparoscopic hernioplasty was performed in 4%. Postoperative complications occurred in 16% of patients, most commonly seroma, wound infection, and ileus. A statistically significant association was observed between operative procedure and complication rate (p=0.007). Conclusion: Ventral hernia predominantly affects middle-aged females with prior surgical history. Open hernioplasty was the commonest surgical approach but carried a higher complication rate compared to laparoscopic repair. Early diagnosis, individualized surgical planning, and addressing modifiable risk factors may improve outcomes.

Achilles tendon rupture is one of the most common tendon injuries, with distal insertional tears posing a greater challenge due to poor distal tissue quality and difficulty in achieving stable fixation. We report a case of a 58-year-old female who sustained an acute distal insertional Achilles tendon rupture following a trivial fall. Clinical examination and ultrasonography confirmed the diagnosis. Surgical management included repair with a 5 mm double-loaded suture anchor using the Krackow technique, augmented by flexor hallucis longus (FHL) tendon transfer fixed into the calcaneum with an interference screw. Postoperatively, the patient underwent staged immobilization followed by progressive physiotherapy. At 6 months, she achieved pain-free ambulation and return to normal daily activities. This case highlights that augmentation using FHL transfer combined with suture anchor fixation provides a strong and reliable construct for distal Achilles tendon ruptures, ensuring early rehabilitation and favorable functional outcomes. Further studies with larger cohorts are needed to validate this technique.

Introduction: Madelung’s disease, or multiple symmetric lipomatosis, is a rare disorder of fat metabolism characterized by non-encapsulated, symmetrically distributed adipose deposits, predominantly involving the neck, shoulders, and upper trunk. With fewer than 500 cases globally, it remains uncommon in Asia and underreported in India. Though typically benign, the disease can produce significant cosmetic disfigurement, compressive symptoms, and functional limitations. Chronic alcohol intake is the most frequently associated risk factor, while metabolic and endocrine abnormalities may contribute to disease progression. Methodology: We report the case of a 46-year-old male with a long history of alcohol consumption who presented with progressive, bilateral cervical swellings over one year. Clinical assessment was supported by ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), all of which revealed diffuse, symmetric, non-encapsulated adipose proliferation in cervico-facial and parapharyngeal regions. Fine-needle aspiration cytology (FNAC) yielded fatty aspirates, consistent with benign lipomatous pathology, and findings were integrated with radiological features to confirm Madelung’s disease. Results: Imaging demonstrated extensive adipose tissue infiltration in parapharyngeal, retropharyngeal, and pre-vertebral spaces, displacing bilateral parotid glands. MRI confirmed diffuse lipomatous proliferation consistent with symmetric neck lipomatosis. FNAC showed mature adipocytes without atypia, ruling out malignancy. The clinical, radiological, and pathological findings converged toward the diagnosis of Madelung’s disease. Conclusion: This case underscores the diagnostic importance of correlating clinical presentation with radiological and cytological findings in rare fat metabolism disorders. Madelung’s disease, though benign, can lead to functional and esthetic complications. Early recognition is paramount, particularly in populations where the disease is rarely reported, as in India. Long- term alcohol consumption remains a significant etiological factor, highlighting the need for counselling on lifestyle modification and close monitoring for progression or systemic associations.

Purpose: To study the clinical spectrum of Vernal Keratoconjunctivitis [VKC] in a tertiary care hospital in Kashmir. Materials and Method:  This was a hospital based cross-sectional study conducted over a period of one and half year. Patients with VKC were included and data regarding age, gender, residence and chief complaint was taken. Results: A total of 156 patients were studied the mean age of patients was 14.11±5.41 years, with 39.1% of patients aged 11-15 years. A male predominance was observed, with 75% males and 25% females. Most patients (75.6%) were from rural areas. VKC was seasonal in 62.8% of cases. Itching was the most common symptom (60.98%), often accompanied by redness and watering. Limbal VKC was the predominant form (52.6%), followed by mixed (30.8%) and tarsal (16.7%) types. Complications included keratoconus (10.89%), corneal scarring (5.77%), and shield ulcers (2.56%). Conclusion: VKC is a significant cause of ophthalmic morbidity, especially among young males in rural areas of Kashmir. The limbal form is the most common, and complications such as keratoconus are frequent if the condition is not adequately managed. Early diagnosis and appropriate treatment can prevent long-term vision impairment. Based on the findings, tailored management strategies are essential to address the regional burden of VKC and prevent complications.

Introduction: Postoperative nausea and vomiting (PONV) is a frequent and distressing complication after general anaesthesia, especially in elective surgeries. Despite improvements in anaesthetic techniques and antiemetic use, PONV still negatively affects patient recovery, satisfaction, and healthcare costs. Its incidence ranges from 20–30% in the general population and up to 70–80% in high-risk patients, with most cases occurring within the first 24 hours postoperatively, particularly during the first 6 hours. Aims: The primary aim of this study is to evaluate the incidence and severity of postoperative nausea and vomiting (PONV) in adult patients undergoing elective surgeries under general anaesthesia. Additionally, the study seeks to identify key patient-related, surgical, and anaesthetic risk factors associated with PONV, and to assess the effectiveness of current prophylactic measures. The findings are intended to guide the development of targeted strategies for prevention and management of PONV in high-risk patients. Methods: This was a prospective observational cohort study conducted in the Department of Anaesthesiology, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, over six months, including a total of 180 participants. Result: In this study of 180 adult patients undergoing elective surgeries under general anaesthesia, the overall incidence of postoperative nausea and vomiting (PONV) was 36.1%. Female patients, non-smokers, those with a history of motion sickness, and patients receiving intraoperative opioids or undergoing prolonged surgeries (>2 hours) had a significantly higher risk of PONV. Surgical specialty influenced incidence, with gynaecological (50%) and general surgery (41.7%) showing the highest rates. Sevoflurane use was associated with increased PONV incidence and severity compared to other volatile agents. Overall, 22% of patients experienced moderate-to-severe PONV, highlighting its multifactorial nature and the importance of identifying high-risk patients for targeted prophylaxis. Conclusion: The overall incidence of PONV was 36.1%, with moderate-to-severe symptoms in 22% of patients. Female gender, non-smoking status, history of motion sickness, use of intraoperative opioids, prolonged anaesthesia, and certain surgical specialties (gynaecology and general surgery) were significant risk factors. Sevoflurane was associated with higher incidence and severity. These findings emphasize that PONV is a common, multifactorial complication after general anaesthesia, underscoring the need for risk-based prophylactic strategies to improve patient comfort and outcomes.

Background: Low-flow anesthesia (LFA) reduces anesthetic gas waste and associated costs but raises concerns regarding hemodynamic stability, recovery, and soda lime consumption compared to high-flow anesthesia (HFA). Objective: To evaluate and compare hemodynamic stability, recovery profile, and soda lime consumption between LFA and HFA in adult surgical patients. Methods: This prospective randomized controlled study included adult ASA I–II patients undergoing surgery. Participants were randomly assigned to either the LFA group (≤1 L/min) or the HFA group (≥4–6 L/min). All patients received the same volatile anesthetic agent, and standard intraoperative monitoring was maintained throughout the procedure. Results: MAP and HR remained within 20% of baseline in both groups, with no statistically significant differences (p>0.05). Recovery times were comparable: LFA 10.5 ± 2.1 min vs HFA 10.2 ± 2.3 min (p=0.62). Soda lime consumption was significantly higher in the LFA group (1.9 ± 0.3 kg) compared to HFA (1.3 ± 0.2 kg, p<0.01). Conclusion: LFA provides stable hemodynamics and comparable recovery profiles to HFA but requires greater soda lime usage. With proper monitoring, LFA is a safe and cost-effective alternative.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints, but peripheral neuropathy (PN) is an under recognized extra-articular manifestation. Overlapping musculoskeletal symptoms often obscure its diagnosis. This study aimed to assess the prevalence, types, and predictors of PN in RA patients. Methods and Materials: This prospective observational study included 60 patients fulfilling the 1987 ACR criteria for RA. Clinical, laboratory, and electrophysiological assessments were conducted. Nerve conduction studies of the median, ulnar, peroneal, tibial, and sural nerves were performed. Demographic, hematological, and serological parameters were compared between PN-positive and PN-negative groups. Statistical analysis employed Fisher’s exact test, unpaired t-test, and logistic regression. Results: Peripheral neuropathy was detected in 26 patients (43.3%). Mixed sensorimotor neuropathy (42.3%) was the most frequent pattern, followed by sensory (23.1%), motor (19.2%), carpal tunnel syndrome (7.7%), and mononeuritis multiplex (7.7%). PN-positive patients were older (45.9 vs. 36.7 years, p < 0.0001), had longer disease duration (8.2 vs. 5.1 years, p = 0.004), higher ESR (39.8 vs. 29.0 mm/hr, p = 0.0007), and increased RF and anti-CCP positivity. Logistic regression identified age >40 years (OR 2.43, p = 0.011), ESR >40 mm/hr (OR 2.65, p = 0.046), anti-CCP positivity (OR 3.49, p = 0.032), and RA duration >10 years (OR 2.07, p = 0.015) as independent predictors of PN. Conclusion: Peripheral neuropathy is prevalent in RA, with nearly half of patients affected, most commonly by sensorimotor neuropathy. Older age, prolonged disease duration, elevated ESR, and anti-CCP positivity are significant risk factors. Routine electrophysiological testing should be considered in high-risk RA patients for early detection and management.

 

Background: Proximal femur fractures cause severe pain, complicating patient positioning for spinal anaesthesia (SA). Adequate pre-procedure analgesia improves positioning, reduces SA performance time, and enhances perioperative comfort. This study compares ultrasound-guided fascia iliaca compartment block (FICB) with intravenous (IV) fentanyl for positioning during SA and postoperative analgesia. Methods: In this prospective observational study, 60 ASA I–II patients aged 18–70 years scheduled for elective proximal femur fracture surgery were divided into two groups (n=30 each). Group I received US-guided FICB with 30 ml 0.25% bupivacaine, 15 min before SA. Group F received IV fentanyl 1 µg/kg, 15 min before SA. Outcomes assessed were quality of positioning, VAS score during positioning, SA performance time, patient acceptance, postoperative VAS scores, and time to first rescue analgesia, total 24-hour analgesic doses, hemodynamic stability, and complications. Results: Demographic variables were comparable. Positioning quality was higher in Group I (2.23 ± 0.63) vs. Group F (1.6 ± 0.85; p=0.0018). SA performance time was shorter (9.26 ± 0.91 vs. 10.4 ± 1.83 min; p=0.0041). VAS during positioning was lower (1.33 ± 0.92 vs. 2.33 ± 0.84; p<0.001). Patient acceptance was greater (100% vs. 86.67%; p=0.0038). Group I had lower postoperative VAS scores at 4–24 h, longer time to first rescue analgesia (7.97 ± 0.85 vs. 3.6 ± 0.49 h; p<0.001), and fewer analgesic doses (1.56 ± 0.50 vs. 2.77 ± 0.43; p<0.001). Hemodynamics were stable; complications were minimal. Conclusion: US-guided FICB offers superior positioning analgesia, prolonged postoperative pain relief, and reduced analgesic consumption compared with IV fentanyl, with stable hemodynamics and minimal side effects.

Background: Adhesive capsulitis (AC), also known as frozen shoulder, is an inflammatory condition characterized by pain, stiffness, and progressive restriction of shoulder movement. Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of AC; however, prevalence estimates vary considerably across populations. Limited data exist from North India, particularly Jammu and Kashmir. Objectives: To determine the prevalence of adhesive capsulitis in patients with T2DM attending a tertiary care hospital in Kashmir, India, and to identify the associated demographic and clinical factors. Methods: This cross-sectional study was conducted in the outpatient department of a tertiary care hospital in North India between September 2024 and March 2025. A total of 397 consecutive patients with T2DM (defined by the ADA 2024 criteria) were enrolled using non-probability sampling. Patients with systemic conditions or secondary causes of AC were excluded from the study. The diagnosis of AC was clinical, in accordance with the AAOS of Orthopaedic Surgeons guidelines, complemented by shoulder radiographs to exclude other pathologies. Demographic and clinical data, including age, sex, occupation, diabetes duration, and glycemic control (good ≤7% vs. poor >7% HbA1c), were collected. Statistical analysis was performed using chi-square testing and logistic regression, with p < 0.05 considered significant. Results: Of the 397 participants (mean age 56.0 ± 12.2 years; 58.4% females), the mean diabetes duration was 7.2 ± 4.3 years and mean HbA1c was 10.2 ± 3.0%. Poor glycemic control was observed in 72.5% of patients. The prevalence of AC was 14.4% (57/397). Higher rates were observed in females (16.8% vs. 11.5%) and patients >60 years (15.0% vs. 13.7%), although the difference was not statistically significant. Occupational status was significantly associated with AC (p=0.048), the and prevalence was highest among unemployed participants (32.3%), followed by non-sedentary (15.0%) and sedentary (10.2%) workers. In the logistic regression analysis, only occupation emerged as an independent predictor (OR: 3.135, 95% CI: 1.203–8.170, p=0.019). Conclusion: Adhesive capsulitis was found in 14.4% of T2DM patients, a prevalence consistent with global and Indian reports. Among the studied factors, occupation independently influenced the risk, with unemployed individuals being the most affected. Given the significant functional impairment associated with AC, routine musculoskeletal screening of patients with diabetes and early physiotherapy referral are recommended to prevent disability.

Introduction: Isolated cranial fractures, though not involving brain parenchymal injury, may still indicate significant trauma and pose risks like cerebrospinal fluid (CSF) leaks, seizures, and cranial nerve damage. The significance and outcomes of these fractures vary based on location and type. Objective: To assess the clinical profile, radiological characteristics, and treatment strategies for isolated cranial fractures in a tertiary care setting. Materials and Methods: This prospective observational study included 150 patients with isolated skull fractures (without parenchymal injury) admitted to the Neurosurgery Department between January 2024 and January 2025. Patients underwent clinical and radiological evaluation, with tailored treatment and follow-up at 1, 3, and 6 months. Results: Of 150 patients: (1) 87 presented with headache. (2) 12 had seizures. (3) 16 had CSF rhinorrhea. (4) 10 had CSF otorrhea. (5) 5 had paradoxical CSF rhinorrhea. (6) Presented with cranial nerve deficits.
Frontal (n=58) and temporal (n=34) bone fractures were most common. Depressed (n=52) and elevated (n=24) fractures were surgically managed. Extradural hemorrhage was seen in 22 patients; 8 underwent evacuation. CSF rhinorrhea (n=16): 6 conservative, 5 lumbar drain, 1 endoscopic repair, 4 anterior cranial fossa repair. Seizures (n=12): Managed with EEG-guided antiepileptics. Cranial nerve palsy (n=4): Treated with steroids and galvanic stimulation. Conclusion: Isolated skull fractures require careful clinical judgment. Timely management of CSF leaks, seizures, and depressed fractures can prevent complications. Individualized treatment planning and structured follow-up are essential for optimal outcomes.

Congenital pseudoarthrosis of the tibia (CPT) is a rare but challenging pediatric orthopedic condition characterized by spontaneous fracture, non-union, and progressive deformity. Despite advances in surgical techniques and adjuvant therapies, achieving durable union with optimal limb function remains difficult. This paper provides an extensive review of current treatment modalities, including intramedullary fixation, vascularized fibular grafting, Ilizarov external fixation, and combined approaches. The role of pharmacological adjuvants such as bisphosphonates and bone morphogenetic proteins (BMPs), alongside emerging biological therapies, is also discussed. Outcomes, complications, and future directions in management are analyzed to provide a comprehensive understanding of CPT treatment.

Background: Spontaneous intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes and carries disproportionately high morbidity and mortality. Hemorrhage volume and anatomical site are among the most critical determinants of outcome, but their combined predictive value in Indian populations remains underexplored. Objective: To assess the prognostic significance of hemorrhage site and volume in patients with spontaneous ICH, and to correlate these parameters with clinical risk factors, 30-day mortality, and 90-day functional outcome using the modified Rankin Scale (mRS). Methods: This prospective observational study included 140 consecutive patients with primary spontaneous ICH admitted to the Department of Neurology, Tirunelveli Medical College, between May 2023 and June 2025. Demographic, clinical, and radiological data were collected. Hematoma volume was measured using the ABC/2 method on CT scans. Outcomes assessed were 30-day mortality and 90-day mRS. Statistical correlations between site, volume, and outcomes were analyzed. Results: The cohort had a mean age of 59.5 years; 58.6% were male. Capsuloganglionic hemorrhage was most common (68.6%). Hematoma volume was <29 ml in 71.4%, 30–60 ml in 23.6%, and >60 ml in 5%. Thirty-day mortality was 20%. Larger volumes predicted worse outcomes (ρ = 0.69, p < 0.0001); mortality was 7% (<29 ml), 52% (30–60 ml), and 57% (>60 ml). Hemorrhage site was also significant: intraventricular, brainstem, cerebellar, and multiple hematomas had near-uniform mortality and poor outcomes, whereas capsuloganglionic and thalamic bleeds had relatively better survival and lower disability (mean mRS ≈ 3). Site correlated modestly with volume (ρ = 0.25, p = 0.0028). Smoking was significantly associated with higher 30-day mortality (p = 0.021). Conclusion: Both hemorrhage site and volume are strong predictors of mortality and disability in spontaneous ICH. While larger volumes consistently worsen prognosis, infratentorial and intraventricular locations confer poor outcomes independent of size. Early prognostication should incorporate both parameters to guide management and patient counseling in the Indian setting.

Introduction:  Sepsis is a leading cause of emergency admissions and short-term mortality, requiring rapid risk stratification. Leukocyte counts and indices like NLR provide prognostic insights. This study aims to evaluate the prognostic significance of leukocyte indices particularly the neutrophil-to-lymphocyte ratio (NLR) in patients with sepsis. Methods: This prospective single-center observational study at Apollo Hospitals, Hyderabad (January–December 2017) enrolled sepsis patients >16 years diagnosed using SIRS criteria. Baseline WBC, neutrophils, lymphocytes, and NLR were recorded at 0-hour, with cultures collected before antibiotics. Outcomes included ICU stay, organ support, and in-hospital mortality to assess prognostic significance. Results: Among 100 sepsis patients, severe sepsis was most common (47%). NLR was significantly higher in septic shock (P=0.041). Though baseline WBC, neutrophils, and lymphocytes showed no significant differences, trends towards higher NLR were observed in patients with bacteremia, culture positivity and those requiring organ support, though these associations did not reach statistical significance. ROC analysis confirmed NLR’s modest predictive but clinically useful prognostic value. Conclusion: Baseline NLR demonstrated modest but clinically relevant prognostic value in sepsis, showing associations with severity, bacteremia, culture positivity, and mortality. Though not consistently significant, its high sensitivity and specificity for selected outcomes highlight NLR as a simple, cost-effective bedside biomarker, warranting validation through larger studies and dynamic monitoring.

Introduction: Surgical site infections (SSIs) are major postoperative complications, particularly after emergency laparotomies due to contamination and limited preparation. Elective surgeries have lower SSI rates with better optimization. This study aims to prospectively assess and compare the incidence of SSIs in emergency versus elective laparotomies to guide improved perioperative practices. Methodology: This prospective randomized controlled trial was conducted at government Medical College, Mahabubabad from January 2024 to April 2025. Adult patients undergoing open abdominal surgeries were included. Baseline demographics, surgery details, contamination status, and SSI outcomes were recorded. Patients were followed for 30 days to assess infection rates, organisms, antibiotic use, and hospital stay. Results: A total of 52 patients were studied (28 emergency, 24 elective). Emergency surgeries showed higher contamination, longer surgery duration, higher SSI incidence (35.7% vs. 12.5%), longer hospital stay (12.4 vs. 8.1 days), greater antibiotic need (42.9% vs. 16.7%), and longer antibiotic use (10.2 vs. 7.5 days). Conclusion: Emergency laparotomies were associated with higher contamination, increased SSI rates, prolonged hospital stays, and greater antibiotic use compared to elective procedures. Despite similar baseline characteristics, emergency surgeries posed greater risks. Focused infection control strategies and timely perioperative care are essential to improve outcomes in emergency abdominal surgeries.

Nardostachys grandiflora, a high-altitude medicinal herb traditionally used in Ayurvedic and Tibetan medicine has been recognized for its diverse pharmacological properties. The present study aimed to evaluate the antioxidant capacity and antimicrobial potential of leaf extracts obtained using different solvents. Antioxidant activity was assessed through standard assays including DPPH radical scavenging, revealing a concentration-dependent free radical scavenging effect. Antimicrobial activity was tested minimum inhibitory concentration (MIC) methods. Results demonstrated that methanolic extract exhibited the highest antioxidant activity (IC₅₀ = 332.65 µg/ml) and significant antibacterial effects, with inhibition zones ranging from 16.2 to 19.0 mm against B. subtilis, S. aureus, P. vulgaris, and K. pneumoniae. These findings suggest that N. grandiflora leaves are a promising source of natural antioxidants and antimicrobial agents, supporting their potential application in nutraceutical and pharmaceutical formulations. These in-vitro findings required to be validated in-vivo models and toxicity assessments before therapeutic use.

Background: Tonsillectomy is a commonly performed ENT surgery, and postoperative pain remains a major concern affecting recovery. Objective: To evaluate postoperative pain scores and analgesic need between coblation and cold dissection tonsillectomy. Methods: One hundred patients were the subject of a retrospective investigation (50 coblation, 50 cold dissection) who underwent tonsillectomy at Manu ENT & Multispeciality Hospital, Sikar, Rajasthan, over a period of one year. On days 1, 3, and 7, the Visual Analog Scale (VAS) was used to measure postoperative pain. Analgesic requirements during the first postoperative week were also recorded. The Student’s t-test and Chi-square test were used for statistical analysis, and a p-value of less than 0.05 was deemed significant. Results: Patients in the coblation group reported significantly lower pain scores compared to the cold dissection group on postoperative day 1 (4.2 ± 1.1 vs. 6.8 ± 1.3), day 3 (2.9 ± 0.9 vs. 5.2 ± 1.2), and day 7 (1.5 ± 0.6 vs. 2.4 ± 0.8). The mean analgesic requirement was also lower in the coblation group (3.1 ± 0.7 doses vs. 5.8 ± 1.0 doses). Conclusion: Coblation tonsillectomy is associated with significantly less postoperative pain and reduced analgesic requirement compared to the conventional cold dissection technique.

Background: Posterior polar cataract (PPC) is a rare congenital lens opacity associated with a fragile posterior capsule, posing a high risk of intraoperative complications such as posterior capsular rupture and vitreous loss. Optimal surgical management is crucial to achieve favorable visual outcomes while minimizing complications. Aim: To compare the surgical outcomes, visual recovery, and complication rates of phacoemulsification and manual small incision cataract surgery (MSICS) in patients with posterior polar cataract. Methods: One hundred PPC patients who had cataract surgery at the Department of Ophthalmology, Hitech Medical College and Hospital, Rourkela, were included in this retrospective observational study. Participants were split evenly between two groups: MSICS (n = 50) and phacoemulsification (n = 50). Demographic information, intraoperative complications, postoperative visual acuity after one week, one month, and three months, preoperative visual acuity, and postoperative complications were gathered. SPSS version 23.0 was used to conduct the statistical analysis. Frequencies and percentages were used to represent categorical data, whereas mean ± SD was used for continuous variables. Chi-square and independent t-tests were used, and a p-value of less than 0.05 was deemed significant. Results: Both surgical methods worked well and were safe. Although they were not statistically significant, intraoperative problems like as posterior capsular rupture and vitreous loss were somewhat more common in the MSICS group. The mean best-corrected visual acuity (BCVA) at 3 months for phacoemulsification patients was 0.12 ± 0.05 LogMAR, which was a faster visual recovery than the MSICS group’s 0.22 ± 0.07 LogMAR (p < 0.001). There were no endophthalmitis instances, and postoperative consequences were minimal and similar between groups. Conclusion: Phacoemulsification provides faster visual rehabilitation and a slightly lower risk of intraoperative complications, making it the preferred surgical approach for PPC when resources and expertise are available. MSICS remains a safe and effective alternative in resource-limited settings. Recommendations: Careful preoperative evaluation and meticulous surgical technique are essential in PPC. Phacoemulsification is recommended for patients where early visual recovery is desired, whereas MSICS may be considered in centers lacking phacoemulsification facilities. Further prospective studies with larger cohorts are suggested to validate these findings.

Background: The geriatric population, defined as individuals aged ≥60 years, is rapidly increasing worldwide. According to the United Nations, a country is considered ageing when people over 60 comprise 7% of the population. With the rising demand for old age homes (OAH), psychiatric morbidity in this group requires careful evaluation. Aim & Objectives: To estimate the prevalence and pattern of psychiatric illnesses among elderly residents of old age homes in Jaipur. Methods: A cross-sectional descriptive study was conducted among 200 elderly individuals residing in OAHs from May 2021 to April 2022. Demographic details, psychiatric diagnoses, family background, and duration of stay were recorded. Cognitive status was assessed using the Hindi Mental State Examination (HMSE). Results: The study population had a mean age of 70.2 ± 8.9 years (range: 62–97). Duration of stay in OAHs ranged from 1–25 years (mean: 7.25 ± 5.27). Family size ranged from 1–10 members (mean: 4.51 ± 2.48). The most prevalent psychiatric illness was major neurocognitive disorder (MND) due to Alzheimer’s disease (15%), followed by major depressive disorder (12%), MND due to vascular disease (6%), generalized anxiety disorder (5%), schizophrenia (4%), and obsessive-compulsive disorder (3%). The mean HMSE score was 24.24 ± 5.64 (range: 9–30). A significant negative correlation was observed between HMSE score and age (R² = 0.4512), indicating that 45.12% of the cognitive decline was attributable to increasing age. Conclusion: Psychiatric morbidity is highly prevalent in the geriatric population of OAHs, with cognitive impairment and depression being most common. Increasing age strongly correlated with cognitive decline. Routine mental health screening and supportive interventions are essential to improve quality of life in institutionalized elderly.

Background: Artificial Intelligence (AI) has emerged as a transformative tool in healthcare, offering novel applications in disease detection, imaging analysis, and diagnostic decision-making. Dentistry and systemic medicine increasingly incorporate AI-based technologies, yet their clinical impact in Indian settings remains underexplored. Objective: To evaluate the role of AI-assisted diagnostic systems in identifying oral and systemic diseases in patients attending a tertiary dental teaching hospital in Bihar. Methods: A retrospective analysis was carried out at Buddha Institute of Dental Sciences and Hospital, Patna, over a 12-month period. Data of 100 patients who underwent AI-assisted diagnostic screening were included. Electronic health records, digital radiographs, intraoral images, and systemic health profiles were reviewed. The diagnostic accuracy of AI systems was compared with conventional clinical diagnosis across oral conditions (caries, periodontal disease, oral potentially malignant disorders, and oral cancer) and systemic associations (diabetes, hypertension, cardiovascular risk). Results: AI demonstrated high sensitivity in detecting dental caries (94%) and periodontal disease (91%), and significantly improved recognition of early oral potentially malignant disorders (83%) compared with routine examination (67%). AI-based radiographic analysis showed strong correlation with expert radiologists in detecting periapical pathology (κ=0.86). For systemic disease prediction, AI tools identified patients with undiagnosed diabetes (12%) and hypertension (8%) through pattern recognition of oral markers and health records. Overall, AI achieved a diagnostic accuracy of 89% compared to 76% with standard methods. Conclusion: AI can enhance diagnostic efficiency in both oral and systemic disease detection, supporting clinicians in early recognition and intervention. Integration of AI into routine dental practice may bridge diagnostic gaps in resource-limited settings.

Background and Objective: Vaginal bleeding during the first trimester of pregnancy is a frequent obstetric emergency that can indicate a range of conditions from benign threatened miscarriage to life-threatening complications such as ectopic or molar pregnancy. Hemostatic abnormalities may contribute to adverse outcomes, yet they are often under-evaluated in routine practice. This study aimed to assess Prothrombin Time (PT), International Normalized Ratio (INR), and platelet counts among women presenting with vaginal bleeding in the first trimester and to analyze their association with clinical outcomes. Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynecology, Government Medical College, Purnea, Bihar, India, over a period of 12 months. Medical records of 95 women with gestational age ≤13 + 6 weeks who presented with vaginal bleeding and had coagulation profiles recorded were reviewed. Data regarding demographic characteristics, clinical diagnosis, laboratory parameters, and maternal outcomes were analyzed using descriptive and comparative statistics, with p < 0.05 considered significant. Results: The mean age of participants was 26.4 ± 4.6 years, and the mean gestational age was 9.1 ± 2.1 weeks. Threatened miscarriage was the most common presentation (46.3%), followed by incomplete abortion (21%). Prolonged PT was observed in 26.3%, elevated INR in 22.1%, and thrombocytopenia in 18.9% of women. Abnormal coagulation parameters were significantly associated with increased hospital admission (p < 0.05) and blood transfusion rates (p < 0.05). Conclusion: Deranged PT, INR, and platelet counts are common among women with first-trimester bleeding and correlate with adverse clinical outcomes. Routine coagulation assessment should be included in the initial evaluation of such patients to guide timely management.

Background: The collateral ligaments of the knee, comprising the medial collateral ligament (MCL) and lateral collateral ligament (LCL), are crucial for joint stability by resisting valgus and varus stresses. Injuries to these ligaments are common in sports and trauma, often presenting with variable clinical outcomes depending on the severity and presence of correlated injuries. Understanding the correlation between functional anatomy and injury patterns is essential for accurate diagnosis and appropriate treatment. Aim: To analyze the functional anatomy and correlate injury patterns of the knee collateral ligaments in a cohort of patients, and to evaluate management strategies and outcomes. Methods: This retrospective observational study was conducted at Laxmi Chandravanshi Medical College, Bisrampur over a period of two years. A total of 50 patients with documented knee collateral ligament injuries were included. Data on demographics, mechanism of injury, type of ligament involvement, correlated injuries, treatment modality, and outcomes were collected from medical records. Statistical analysis was performed using SPSS version 23.0, with significance set at p<0.05. Results: The mean age of participants was 32.8 ± 9.4 years, with a male predominance (72%). MCL injuries were most common (60%), followed by LCL (24%) and combined injuries (16%). The predominant mechanism was sports-related trauma (42%) followed by road traffic accidents (36%). Correlated injuries were observed in 30%, with anterior cruciate ligament (ACL) tears being the most frequent (18%). Conservative management was employed in 70% of cases, while 30% underwent surgery. At 6-month follow-up, 76% achieved good functional recovery, with significantly better outcomes in isolated MCL injuries compared to combined injuries (p=0.04). Conclusion: MCL injuries represent the majority of collateral ligament injuries, primarily affecting young males engaged in sports. Conservative treatment offers favorable outcomes in isolated injuries, whereas surgical intervention is often required for combined injuries. Recommendations: Early recognition, precise imaging, and patient-specific treatment strategies are essential to optimize recovery. Further multicenter prospective studies with larger sample sizes are recommended to strengthen evidence regarding long-term outcomes.

Background: The placenta undergoes significant physiological changes during pregnancy to accommodate the growing fetus. During a normal pregnancy, the placenta typically exhibits a gradual increase in echogenicity, or brightness, on ultrasound. In contrast, pregnancies complicated by gestational diabetes mellitus have been associated with distinct placental ultrasound changes. The present observational study has been conducted to determine the placental changes in pregnant women with GD. Material and Methods: The study was conducted at Government Medical College, Jammu between January 2023 and December 2023. A total of 100 pregnant women were recruited for the study, with 50 women in the normal pregnancy group and 50 women in the Gestational Diabetes Mellitus group. Routine ultrasonographic examination was performed at 23- 24 and 33- 36 weeks gestation, which confirmed a normal pattern of foetal growth. All participants underwent routine prenatal care, including screening for Gestational Diabetes Mellitus using the oral glucose tolerance test. Placental ultrasound assessments were performed at three time points during pregnancy: 12-14 weeks, 20-22 weeks, and 32-34 weeks. Results: There was no statistical difference in respect of age and initial BMI. Whereas, a statistically significant difference was observed among the participants in both groups in respect of Gestational Age, Weight gain, Fasting blood glucose, and glycated haemoglobin. In the GD group, 12% had irregularly shaped placenta. There was a significant difference between the two groups in respect of placental weight, diameter, central thickness, baby weight and fetal/ placental ratio. Conclusion: The study concluded that there were distinct placental changes observed in Gestational Diabetes Mellitus compared to normal pregnancy. Specifically, the placenta in Gestational Diabetes Mellitus exhibited increased volume, elevated vascular resistance, and reduced placental function markers.

Background: The rising prevalence of extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria poses a major challenge in neonatal septicemia, limiting therapeutic options and worsening outcomes. Evidence from semi-urban areas of northern India is scarce. This study explored the antimicrobial resistance patterns and clinical consequences of ESBL-producing Gram-negative bacilli in neonates with sepsis in Kanpur, India. Methods: A prospective observational study was conducted between January and June 2025 in the neonatal intensive care unit (NICU) of a tertiary hospital in Kanpur. Blood cultures from neonates with suspected sepsis were processed using automated systems, and isolates were identified with standard biochemical tests and VITEK-2. Antimicrobial susceptibility was determined according to Clinical and Laboratory Standards Institute (CLSI) 2018 guidelines, with phenotypic confirmation of ESBL production. Clinical parameters, including NICU stay, ventilator use, and mortality, were compared between ESBL-positive and ESBL-negative infections. Results: Of 500 cultures, 300 (60%) yielded growth, including 180 Gram-negative bacilli. Klebsiella spp. (42.2%) and Escherichia coli (36.6%) predominated. ESBL production was confirmed in 40 isolates (22.2%). These isolates demonstrated extensive resistance to third-generation cephalosporins (>90%), aztreonam (75%), and carbapenems (65%). Resistance to amikacin (28%) and colistin (<10%) was relatively lower. Clinically, neonates with ESBL-positive infections had longer NICU stays (18 vs 11 days), greater ventilator requirement (40% vs 22%), and higher mortality (28% vs 15%) compared with ESBL-negative cases (p<0.05). Conclusion: ESBL-producing Gram-negative organisms significantly contribute to neonatal sepsis in Kanpur, with alarming resistance patterns and poorer outcomes. Strengthened antimicrobial stewardship, early detection, and rational empiric therapy are urgently required in NICUs.

Background: Diabetic macular edema (DME) is one of the leading causes of vision loss in patients with diabetic retinopathy. Its pathogenesis involves both vascular endothelial growth factor (VEGF)–mediated vascular leakage and inflammatory pathways. Current therapeutic strategies include intravitreal anti-VEGF agents such as bevacizumab (BZ) and corticosteroids like triamcinolone acetonide (TA). While both have demonstrated efficacy in improving best-corrected visual acuity (BCVA) and reducing central macular thickness (CMT), concerns remain regarding long-term efficacy and safety profiles, particularly with respect to intraocular pressure (IOP) changes. Aim: To compare the efficacy and safety of BZ versus intravitreal TA in the management of diabetic macular edema. Methods: This institution-based prospective comparative observational study was conducted on 70 patients with clinically significant DME. Participants were allocated equally into two groups: Group A received intravitreal bevacizumab (BZ) 2.5 mg/0.1 mL and Group B received intravitreal triamcinolone acetonide (TA) (4 mg/0.1 mL). Patients were followed up for 24 weeks with assessments at baseline, 3, 6, 12, and 24 weeks. Outcome measures included BCVA measured using the logarithm of the Minimum Angle of Resolution (LogMAR), central macular thickness measured by Optical Coherence Tomography (OCT), intraocular pressure (applanation tonometry), and fluorescein angiography findings. Data were analyzed using appropriate statistical tests, with p<0.05 considered significant. Results: Both groups showed significant improvement in BCVA and reduction in CMT. In Group A (BZ), BCVA improved from 1.0 to 0.5 LogMAR and CMT reduced from 501 µm to 251 µm. In Group B (TA), BCVA improved from 1.1 to 0.4 LogMAR and CMT reduced from 546 µm to 267 µm. Differences between groups were not statistically significant (p>0.05). However, a significant rise in IOP was noted in the triamcinolone group (15.0 to 17.4 mmHg, p<0.05), whereas IOP remained stable in the bevacizumab group. Fluorescein angiography demonstrated marked reduction in leakage and neovascularization in both groups at 6 weeks, with comparable outcomes. Conclusion: Both BZ and TA are effective in improving vision and reducing macular edema in DME. TA demonstrated slightly faster early improvement but was associated with ocular hypertension, limiting its safety. BZ provided comparable long-term outcomes with a more favorable safety profile. Recommendations: BZ should be considered the first-line therapy for DME due to its efficacy and safety. TA may be reserved for patient’s refractory to anti-VEGF agents or those in resource-constrained settings, with close monitoring of IOP. Long-term multicentric studies are recommended to further validate these findings and optimize individualized treatment strategies.

Background: Sedation in critically ill patients is essential for optimizing comfort and facilitating mechanical ventilation. However, the choice of sedative agent in hemodynamically unstable patients remains challenging, as most conventional sedatives can exacerbate hypotension. Ketamine, with its sympathomimetic and cardiovascular supportive effects, may offer an advantage in this subgroup. Aim: To evaluate the efficacy and safety of ketamine for sedation in hemodynamically unstable intensive care unit (ICU) patients. Methods: A retrospective observational study was conducted over 12 months at the Department of Critical Care Medicine (CCM) of Rajendra Institute of Medical Sciences (RIMS), Ranchi. Records of 55 adult patients who required sedation while being hemodynamically unstable and received ketamine were analyzed. Data on demographics, clinical diagnosis, hemodynamic parameters, sedation adequacy, vasopressor requirement, and outcomes were collected. Statistical analysis was performed using SPSS version 23.0, with p < 0.05 considered significant. Results: The mean age of patients was 52.7 ± 13.4 years, with 58.2% males. Septic shock was the most common indication for ICU admission (36.4%). Following ketamine administration, systolic blood pressure and mean arterial pressure improved significantly (p < 0.001), while heart rate remained stable. Adequate sedation was achieved in 87.3% of patients with ketamine alone, and vasopressor requirement decreased in 54.5% of cases. Overall ICU survival was 69.1%, with significantly better outcomes in patients whose vasopressor needs decreased (p = 0.012). Conclusion: Ketamine was effective in providing adequate sedation and improving hemodynamic stability in critically ill, unstable patients. It also reduced vasopressor requirements and was associated with improved survival outcomes, making it a valuable sedative choice in this high-risk population. Recommendations: Ketamine may be considered as a first-line sedative in hemodynamically unstable ICU patients where conventional sedatives may worsen hypotension. Further large-scale prospective trials are recommended to validate these findings and establish standardized dosing guidelines.

Background: Unstable intertrochanteric femoral fractures are common in the elderly population and are associated with significant morbidity and mortality. Surgical management is the standard of care, with Proximal Femoral Nail Antirotation (PFNA) and primary hemiarthroplasty being two widely used procedures. However, the optimal choice of treatment remains debated. Aim: To compare the clinical outcomes of PFNA fixation and primary hemiarthroplasty in elderly patients with unstable intertrochanteric femoral fractures. Methods: A retrospective study was conducted at Pacific Medical College and Hospital over one year, including 40 elderly patients with unstable intertrochanteric fractures. Patients were divided into two groups: PFNA fixation (n=20) and primary hemiarthroplasty (n=20). Data on operative time, blood loss, hospital stay, complications, time to mobilization, and functional outcomes (Harris Hip Score at 6 months) were analyzed using SPSS version 23.0. Results: PFNA fixation was associated with shorter mean operative time (72.4 ± 11.2 min vs. 94.7 ± 14.3 min; p<0.001) and lower blood loss (210 ± 56 mL vs. 410 ± 72 mL; p<0.001). Hemiarthroplasty patients demonstrated earlier mobilization (2.6 ± 0.9 days vs. 4.8 ± 1.5 days; p<0.001) and superior functional outcomes at 6 months (Harris Hip Score: 82.5 ± 7.1 vs. 76.3 ± 6.5; p=0.01). Complication rates were comparable between the groups (25% vs. 30%; p=0.73). Conclusion: Both PFNA and primary hemiarthroplasty are effective surgical options for unstable intertrochanteric femoral fractures in the elderly. PFNA offers advantages of reduced operative time and blood loss, whereas hemiarthroplasty allows earlier mobilization and superior short-term functional recovery. Recommendations: The choice of surgical method should be individualized based on patient comorbidities, fracture pattern, and functional demands. Larger prospective studies with longer follow-up are recommended to further validate these findings.

Background: Spine surgeries are associated with severe postoperative pain. In this study comparative analgesic efficacy, intra-operative and post- operative outcomes were examined in ultrasound-guided erector spinae plane block (ESPB) with the combination of ropivacaine at a concentration of 0.375% with 1 µg/kg dexmedetomidine, with 20 ml of the drug injected in the plane of the lumbar surgical site versus Local Anaesthesic wound infiltration in Spine (LAWI-Group-B) surgeries with the same of drugs. Primary outcome was postoperative pain intensity at rest using a Numeric Rating Scale (NRS) and VAS. Secondary outcomes included difference in pain intensity between pre-intervention and defined time points, total amount of opioid analgesic requested by the patients at the same time points, the incidence of any adverse event, and the length of hospital stay (LOS) after surgery. A total of Ninety patients, 45 patients in group (ESPB=Group-A, LAWI = Group B) were enrolled in the study. After surgery it was detected a NRS value of 2.4±1.8 in ESPB group and 5.4±1.3 in LAWI group (P<0.001). VAS score and rescue analgesic doses were observed lower in Group-A as compared to group-B. Concerning LOS, 45 (100%) patients in the ESPB group and 34 (75.55%) in LAWI group were discharged after 72 hours (P=0.005). Conclusion: Ultrasound-guided ESPB offers improved postoperative analgesia compared with local infiltration in patients undergoing spinal surgery. Combination of ropivacaine (0.375%) + 1µg/kg dexmedetomidine was found safe and effective drugs for ESPB and LAWI.

Introduction: Constituting approximately one percent of all fractures and 8% of the fractures in elderly, tibial plateau fractures are considered to be common fractures. These fractures encompass various configurations involving medial, lateral or both plateaus with varied degrees of articular depressions and displacements. The objective of surgical fixation of tibial plateau fractures are pivoted on achieving anatomic reduction of the joint surface as well as restoring the mechanical alignment of the lower limb. Objective: The aim of this study is to assess radiographic outcomes after surgical management (plating) of tibial plateau fractures and determine the fracture pattern with 3-dimension image. Results: We observed in this study that three-dimensional imaging made pre operative planning easy and resulted in good radiological outcome of patient because in Schatzker type IV, V and VI posteromedial plating was done in some patients who had posteromedial fragment which was not observed in plain radiographs. Conclusion: Modified Schatzker classification helps in clear visualization of fracture and therefore, apt treatment to each and every case.

Background: Road traffic accidents (RTAs) are a leading cause of mortality worldwide, with head and facial injuries contributing significantly to deaths. Understanding the pattern of craniofacial trauma in fatal RTAs is crucial for guiding preventive strategies, trauma care, and policymaking. Aims & Objectives: To analyze the demographic profile, victim categories, and patterns of face and skull injuries in fatal RTAs based on medicolegal autopsy cases. Methods: A cross-sectional study was conducted on 380 autopsy cases of fatal RTAs at a tertiary care hospital. Data on age, sex, type of victim, and injury patterns were collected and analyzed. The distribution of skull fractures and intracranial hemorrhages was studied. Statistical analysis was performed to identify significant associations. Results: The majority of victims were males (73.2%), with the highest incidence in the 21–40-year age group (46.8%). Pedestrians (39.5%) and two-wheeler riders (31.1%) were the most common victims. Basal skull fractures (31.8%) and frontal bone fractures (21.6%) were predominant. Subdural hemorrhage (33.2%) was the most frequent intracranial lesion, followed by subarachnoid hemorrhage (41.6%). Conclusion: Head and facial injuries are central to fatal RTAs, with young adult males and pedestrians being most vulnerable. The predominance of basal skull fractures and subdural hemorrhage underscores the lethality of craniofacial trauma.

Background: Tracheostomy is commonly performed in neurosurgical ICU patients requiring prolonged mechanical ventilation. The optimal timing—early versus late—remains controversial, particularly regarding ventilator duration, ICU utilization, pulmonary complications, mortality, and long-term neurological outcomes. This systematic review and meta-analysis evaluate the impact of early tracheostomy (ET) compared to late tracheostomy (LT) in this population. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, and Scopus through July 2025. Studies including adult neurosurgical ICU patients undergoing ET (≤7–10 days) versus LT (>7–10 days) were eligible. Outcomes included mechanical ventilation duration, ICU and hospital length of stay (LOS), ventilator-associated pneumonia (VAP), mortality, and long-term neurological recovery. Observational studies and randomized trials were assessed for risk of bias using the Newcastle–Ottawa Scale or Cochrane tool, and pooled estimates were calculated using a random-effects model. Results: Twelve studies (10 observational cohorts, 2 meta-analyses) including ~15,600 patients were analyzed (ET: ~7,700; LT: ~7,900). Early tracheostomy was associated with reductions in: Mechanical ventilation duration: MD −4.4 to −7.3 days (95% CI −11.7 to −0.5; p < 0.01). ICU LOS: MD −6.9 to −7.6 days (95% CI −9.6 to −5.1; p < 0.001). Hospital LOS: MD −7.1 to −10.2 days (95% CI −13.7 to −6.6; p < 0.001). VAP incidence: RR 0.73 (95% CI 0.66–0.81).
No significant differences were observed in in-hospital or 6-month mortality (OR 0.92, 95% CI 0.75–1.12) or long-term neurological outcomes. Heterogeneity was moderate for ventilator and LOS outcomes (I² = 45–65%), and overall evidence certainty ranged from moderate (resource-related outcomes) to low (mortality and neurological outcomes). Conclusion: In neurosurgical ICU patients, early tracheostomy reduces ventilator days, ICU and hospital length of stay, and VAP, but does not improve mortality or long-term neurological recovery. The primary benefits are organizational and pulmonary, rather than disease-modifying. ET should be considered in patients expected to require prolonged mechanical ventilation, while expectations regarding survival and neurological outcomes remain cautious. Future randomized trials with standardized timing and consistent neurological outcome reporting are warranted.

Background: Enterococcusare important opportunistic pathogens that cause diverse healthcare-associated infections. The rise of antimicrobial resistance, especially the spread of vancomycin-resistant enterococci (VRE), has created a major global treatment challenge. Monitoring regional resistance patterns is crucial for optimizing therapy and strengthening infection control strategies. Aim: To identify the species distribution and assess the antimicrobial resistance patterns of Enterococcus isolates recovered from clinical specimens in a tertiary care hospital in Eastern India. Methods: A laboratory-based cross-sectional descriptive study was carried out in the Department of Microbiology, MKCG Medical College and Hospital, Berhampur, between 2017 and 2019. A total of 100 Enterococcus isolates were recovered from urine, pus, blood, and other body fluids. Species identification was done using standard biochemical methods, while antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion technique on Mueller–Hinton agar in accordance with CLSI 2019 guidelines. Resistance patterns by species and multidrug resistance (MDR) were evaluated using SPSS version 23.0. Results: Among the 100 isolates, E. faecalis (64%) was the most prevalent species, followed by E. faecium (31%) and E. durans (5%). The highest resistance rates were noted for ciprofloxacin (77%), ampicillin (66%), and tetracycline (61%). Glycopeptide resistance was detected in 23% of isolates for vancomycin and 18% for teicoplanin. High-level aminoglycoside resistance was observed in 46% of isolates for gentamicin and 40% for streptomycin. All isolates remained susceptible to linezolid. E. faecium demonstrated significantly higher resistance compared to E. faecalis. MDR was present in 47% of isolates, predominantly among E. faecium. Notably, 69.6% of the vancomycin-resistant isolates were E. faecium. Conclusion: Enterococcus species, particularly E. faecium, are emerging as multidrug-resistant nosocomial pathogens in Eastern India. While linezolid remains universally effective, the high prevalence of resistance to commonly used antibiotics, along with increasing VRE, underscores the urgency of robust antibiotic stewardship and infection control strategies. Recommendations: Routine species-level identification and antimicrobial susceptibility testing should be carried out for all Enterococcus isolates. Continuous monitoring of resistance patterns, judicious use of antibiotics, and stringent infection control practices are crucial to prevent the dissemination of VRE and multidrug-resistant strains. Additionally, prioritizing research into new therapeutic alternatives is imperative.

Background: Chronic venous insufficiency (CVI) in the lower limbs occurs due to elevated venous pressure caused by structural and functional irregularities in veins, arising from underlying reflux or obstruction. The evaluation of varicose veins often relies on the widely available non-invasive method of Colour Duplex Sonography. Thus, the study aims to examine the efficacy of colour flow duplex imaging in diagnosing patients who present with clinical symptoms and signs indicative of chronic venous insufficiency. Methodology: The study conducted at the Department of Radiodiagnosis in Chennai, from September 2018 to September 2020, aimed to diagnose venous insufficiency in 50 patients with lower extremity symptoms. Detailed clinical histories were taken, and Siemens ACUSON S 2000 ultrasound system with Virtual Touch™ software was used. Standard examinations, employing various probes and positions, were conducted. Compression techniques and color-coded imaging were utilized for a comprehensive evaluation of the venous system. Results: The study included 50 patients, primarily aged 31 to 60, with 76% males and 24% females. Swelling (30%) and varicosity (24%) were the main clinical presentations. Prolonged standing (46%) was the leading cause of varicosity. Unilateral cases (80%) were more common than bilateral (20%), with left-sided incompetence at junctions and perforators being prevalent, especially below the knee. Conclusion: The present study highlights the efficacy of color duplex ultrasound in diagnosing chronic venous insufficiency, with accurate correlation between Doppler and surgical outcomes, emphasizing its significance in guiding appropriate interventions.

Introduction: Major depressive disorder (MDD) represents a significant global health concern, characterized by a pervasive low mood, loss of interest or pleasure and a range of cognitive and somatic symptoms. Statins biological effects have spurred interest in the potential utility of statins in various conditions beyond cardiovascular disease, including neurological and psychiatric disorders. Given their established safety profile and the growing understanding of their pleiotropic actions, statins represent a promising class of medications for potential repurposing as adjunctive therapies in the management of depression. Methods: This study employed a prospective observational design to evaluate the effects of adjunctive statin therapy on clinical outcomes and the TyG index in individuals with depression over a 12-month period. The study included two groups of participants: the Adjunctive Statin Group with Antidepressant and the Antidepressant-Only Group. The Adjunctive Statin Group consist of patients with a diagnosis of MDD who were receiving a stable dose of antidepressant medication and whose treating physician had initiated statin therapy as part of their clinical management within one month prior to or at the time of study enrollment. The Antidepressant-Only Group served as the control group and comprised patients with MDD who were also receiving a stable dose of antidepressant medication but will was not prescribed a statin during the study period. Results: The mean age was similar between groups (45.2 vs. 44.6 years, p=0.74), with a comparable proportion of females (53.3% vs. 56.7%, p=0.71). Both groups were having overweight with BMI values (27.1 vs. 26.8 kg/m², p=0.66) and a comparable mean duration of depression (~6.5–6.8 years, p=0.72). Baseline HAM-D, MADRS, and PHQ-9 scores did not differ significantly (all p>0.7), confirming that the groups started with similar severity of depressive symptoms. Medication classes were comparable, with SSRIs being the most commonly prescribed (~55%). As expected, only the adjunctive group received statins (45% atorvastatin, 35% rosuvastatin, 20% simvastatin). Baseline triglycerides, glucose, and TyG index values were nearly identical across groups (p-values 0.74–0.87). Conclusion: The results have the potential to contribute to our understanding of novel treatment strategies for major depressive disorder, considering the intricate interplay between mental health and metabolic factors. By carefully observing and analyzing the outcomes in a naturalistic clinical setting, this research seeks to inform future clinical practice and guide further investigations into the therapeutic potential of statins in the management of depression.