Background: Effective postoperative pain management is crucial for early mobilization, reduced morbidity, and improved patient satisfaction. Ultrasound-guided truncal blocks such as the transversus abdominis plane (TAP) block and quadratus lumborum (QL) block are increasingly used as part of multimodal analgesia for lower abdominal surgeries. Objective: To compare the efficacy of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing elective lower abdominal surgeries. Materials and Methods: This quasi-experimental study was conducted at a tertiary care teaching hospital between October 2022 and March 2024. Sixty patients aged 20–40 years with ASA physical status I–II undergoing elective lower abdominal surgeries under spinal anesthesia were enrolled. Patients were divided into two groups: Group Q (Quadratus Lumborum block, n=30) and Group T (Transversus Abdominis Plane block, n=30). Both groups received bilateral blocks using 0.125% bupivacaine at 0.3–0.4 ml/kg. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at predefined intervals up to 24 hours. Duration of analgesia, number of rescue analgesic doses, hemodynamic parameters, and adverse effects were recorded. Results: Demographic variables, ASA status, type and duration of surgery, and hemodynamic parameters were comparable between groups (p>0.05). VAS scores were similar up to 4 hours postoperatively. From 8 hours onward, Group Q demonstrated significantly lower VAS scores compared to Group T (p<0.05). The mean duration of analgesia was significantly longer in Group Q (12.23 ± 1.94 hours) than in Group T (8.76 ± 0.81 hours; p<0.0001). Rescue analgesic requirement was significantly lower in Group Q (p<0.0001). No block-related complications or adverse effects were observed in either group. Conclusion: Ultrasound-guided quadratus lumborum block provides superior and prolonged postoperative analgesia with reduced rescue analgesic requirements compared to transversus abdominis plane block in patients undergoing elective lower abdominal surgeries.

Background: Nasogastric tube (NGT) insertion in anaesthetized and intubated patients is often challenging due to altered airway anatomy and decreased muscle tone. Several bedside techniques have been described to facilitate smooth insertion, but evidence directly comparing commonly practiced methods remains limited. Aim and Objective: To compare the ease of NGT insertion using three techniques—additional neck flexion, standard sniffing position with lateral neck pressure, and reverse Sellick’s manoeuvre—in intubated adult patients undergoing elective surgeries. Materials and Methods: This prospective, randomized comparative study included 120 adult patients (ASA I–II) undergoing elective surgery under general anaesthesia. Patients were allocated into three groups (n = 40 each): Group A Additional neck flexion, Group B—standard sniffing position with lateral neck pressure, and Group C—reverse Sellick’s manoeuvre. The primary outcomes assessed were number of attempts and time required for successful NGT insertion. Secondary outcomes included hemodynamic changes and complications such as kinking, coiling and nasal bleeding. Results: Baseline demographic and clinical characteristics were comparable across all groups. Group A demonstrated the highest first-attempt success rate and the shortest insertion time. Group B showed moderate ease of insertion, while Group C had the lowest first-attempt success and longest insertion time. Complications were least frequent in Group A and most common in Group C. Hemodynamic parameters remained stable in all groups, and no major adverse events occurred. Conclusion: Additional neck flexion is the most effective technique for NGT insertion in intubated patients, offering superior first-attempt success, shorter insertion time, and fewer complications compared with lateral neck pressure and reverse Sellick’s manoeuvre. Its simplicity and safety make it a preferred method in routine anaesthetic practice.

Background: Prediction of difficult laryngoscopy remains a critical component of preoperative airway evaluation, as unanticipated airway difficulty can lead to severe complications. Aim and Objective: To compare ultrasound-guided mandibular condylar mobility with traditional airway assessment parameters, inter-incisor gap (IIG), upper lip bite test (ULBT), mandibular protrusion distance, and maximum condyle–tragus distance in predicting difficult laryngoscopy. Methods: This prospective observational study included 90 adult patients undergoing elective surgery under general anaesthesia. Preoperative measurements included ultrasound-guided condylar mobility and four clinical airway tests. Laryngoscopy was performed using a standard technique, and Cormack–Lehane (CL) grading was recorded. CL grade III–IV was defined as difficult laryngoscopy. Diagnostic accuracy was analysed using sensitivity, specificity, predictive values, and odds ratios. Results: The majority [79 (87.8%)] had easy laryngoscopy, and 11 (12.2%) had difficult laryngoscopy. Ultrasound-guided mandibular condylar mobility demonstrated the highest sensitivity (81.8%) and perfect specificity (100%). Maximum condyle–tragus distance and IIG also showed strong diagnostic performance, with sensitivities of 72.7% and 97.5%, respectively, and specificities of 98.7% and 98.7%, respectively. Mandibular protrusion distance and ULBT had perfect specificity (100%) but lower sensitivity (36.4% and 27.3%). All parameters showed significant association with difficult laryngoscopy (p < 0.0001). Conclusion: Ultrasound-guided mandibular condylar mobility is the most accurate single predictor of difficult laryngoscopy, demonstrating superior sensitivity and perfect specificity. However, multivariate analysis showed that no parameter independently predicted difficult laryngoscopy. A combined approach using both ultrasound-based and conventional tests enhances the reliability of airway assessment and improves preparedness for difficult laryngoscopy.

Background: Dyslipidemia frequently coexists with non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease, contributing to increased morbidity and mortality. While statins are widely prescribed to manage lipid abnormalities and reduce cardiovascular risk, their effect on liver enzyme levels in dyslipidemic patients with NAFLD remains incompletely understood. Evaluating this effect is critical to ensure both efficacy and safety of statin therapy in this high-risk population. Methods: This prospective observational study enrolled 146 adult patients aged 18–80 years with dyslipidemia, NAFLD, and cardiovascular disease at a tertiary care hospital over one year. Patients receiving statins (n = 88) were compared with non-statin users (n = 58). Liver enzymes (ALT, AST) and lipid profiles (total cholesterol, LDL-C) were measured at baseline and follow-up. Demographic, clinical, and treatment-related data were also collected. Results: At baseline, ALT and AST levels were similar between the statin and non-statin groups (43.1 ± 18.0 vs 40.1 ± 15.9 U/L and 38.0 ± 14.9 vs 35.2 ± 13.1 U/L, respectively; p > 0.1). After follow-up, statin therapy significantly reduced ALT (36.0 ± 14.0 U/L; p < 0.01) and AST (31.1 ± 11.7 U/L; p = 0.04), whereas non-statin patients showed minimal change. Total cholesterol decreased from 210.5 ± 30.9 to 180.9 ± 24.6 mg/dL (p < 0.01) and LDL-C from 135.4 ± 28.7 to 104.6 ± 21.0 mg/dL (p < 0.01) in the statin group, with no significant reductions in the non-statin group. Statins were well tolerated, with only minor side effects reported. Conclusion: Statin therapy significantly improves liver enzyme levels and lipid profiles in dyslipidemic patients with NAFLD and cardiovascular disease. These results support the dual hepatic and cardiovascular benefits of statins in this population.

Background: Stroke is a leading cause of disability, often resulting in motor and neurological impairments. Electrolyte disturbances, particularly in sodium, potassium, and calcium, may influence stroke severity and outcomes. This study aimed to evaluate the association between serum electrolyte levels and functional outcomes in ischemic stroke patients. Methods: A prospective study was conducted over one year at a tertiary care hospital including 168 adult ischemic stroke patients. Stroke severity and motor function were assessed using NIHSS and MAS scores. Serum sodium, potassium, and calcium levels were measured at admission. The primary outcome was death or major disability at 3 months (mRS 3–6). Results: Patients with death or major disability were older (74.2 vs. 66.5 years) and had higher NIHSS scores (median 6 vs. 3) and lower MAS scores (median 15 vs. 20). Abnormal calcium levels were significantly associated with adverse outcomes (p = 0.01), while sodium and potassium showed no significant correlation (p = 0.12 and 0.43). Conclusion: Calcium disturbances are linked to worse functional outcomes in ischemic stroke. Monitoring and correcting calcium levels may help improve prognosis.

Background: In order to identify higher-risk patients who might be the focus of additional treatment measures, a wide range of factors related to CHF can be assessed. By doing a bedside examination, it is quite simple to identify patients who exhibit symptoms and signs while at rest. Even with the best medical care, these patients still have an annual mortality rate of more than 40%, but their share of the overall heart failure population is quite modest. Objectives: In patients with chronic heart failure, the study sought to determine the association between HRV parameters and blood catecholamine levels as well as the usefulness of these measurements in indicating autonomic dysfunction and the severity of the condition. Materials and Methods: It was a retrospective, observational study. The study was carried out at a tertiary care centre. The study data that was retrieved was for one year. Data from 184 participants were retrieved for the study. Patients 18 years of age and older who had a diagnosis of chronic heart failure verified by clinical assessment and echocardiography and whose medical records had information on heart rate variability, blood catecholamine levels, and NYHA functional class were included in the study. Results: A significant proportion of patients (64.1%) demonstrated reduced left ventricular ejection fraction (<40%). Common associated conditions included hypertension in 55.4%, diabetes mellitus in 41.3%, and ischemic heart disease in 48.4% of patients. Heart rate variability analysis showed reduced autonomic control of the heart. The mean SDNN was 92.6 ms, and RMSSD was 21.4 ms. Conclusion: Reduced time-domain and frequency-domain HRV characteristics show that patients with chronic heart failure have severe autonomic dysfunction, according to this study. Increased sympathetic activation is linked to compromised autonomic regulation, as seen by elevated serum catecholamine levels and a moderately negative connection with HRV indices. Recommendations: Larger studies are required to validate the predictive utility of HRV and catecholamine monitoring, which can help evaluate autonomic dysfunction in CHF and direct tailored therapy.

Background: Neurodevelopmental disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intellectual disability (ID) are commonly associated with nutritional deficiencies, including altered iron status. Iron plays a critical role in brain development, and disturbances in iron metabolism may influence neurodevelopmental outcomes. This study aimed to evaluate differences in serum iron indices among children with different neurodevelopmental disorders. Methods: This hospital-based observational study included 186 children aged 4–12 years diagnosed with ASD, ADHD, or ID. Neurodevelopmental diagnoses were established using standardised assessment tools. Serum iron, serum ferritin, and serum transferrin levels were measured using standard laboratory methods. Iron parameters were compared across the three diagnostic groups using appropriate statistical analyses, with a p-value <0.05 considered statistically significant. Results: Among the 186 children enrolled, 68 had ASD, 79 had ADHD, and 39 had ID. Serum ferritin levels showed a statistically significant difference among the three groups (p = 0.003), with higher mean ferritin levels observed in children with ASD and lower levels in children with ADHD and ID. In contrast, no statistically significant differences were observed in serum iron (p = 0.087) or serum transferrin levels (p = 0.156) among the diagnostic groups. Conclusion: Serum ferritin levels differ significantly among children with ASD, ADHD, and ID, indicating variations in iron storage status across neurodevelopmental disorders. These findings suggest that assessment of serum ferritin may be useful in the clinical evaluation of children with neurodevelopmental disorders, even when serum iron and transferrin levels are within normal limits.

Background: Psoriasis is a chronic immune-mediated inflammatory disease increasingly recognised to be associated with metabolic syndrome and cardiovascular morbidity. Systemic inflammation in psoriasis may contribute to metabolic abnormalities and accelerated atherosclerosis. Objectives: To evaluate the prevalence of metabolic syndrome and assess subclinical cardiovascular risk markers among patients with psoriasis. Methods: This retrospective observational study included 190 adult patients with clinically diagnosed psoriasis attending a tertiary care centre. Demographic data, clinical characteristics, metabolic parameters, and cardiovascular risk markers were extracted from medical records. Metabolic syndrome was defined using modified NCEP ATP III criteria. Subclinical cardiovascular disease was assessed using carotid intima-media thickness (CIMT), high-sensitivity C-reactive protein (hs-CRP), ankle-brachial index (ABI), and echocardiographic evaluation. Results: The mean age of participants was 44.8 ± 11.3 years, with a mean disease duration of 8.6 ± 4.8 years and a mean PASI score of 13.4 ± 5.6. Metabolic syndrome was present in 103 patients (54%). Abdominal obesity was the most common component (78%), followed by elevated triglycerides (63%) and low HDL cholesterol (59%). Increased CIMT (>0.8 mm) was observed in 48% of patients, elevated hs-CRP (>3 mg/L) in 61%, reduced ABI (<0.9) in 12%, and echocardiographic diastolic dysfunction in 18%, indicating a high burden of subclinical cardiovascular disease. Conclusion: Patients with psoriasis demonstrate a high prevalence of metabolic syndrome, systemic inflammation, and subclinical cardiovascular abnormalities, even at moderate disease severity. These findings support routine cardiometabolic screening and integrated multidisciplinary management to reduce long-term cardiovascular risk in psoriasis patients.

Background: Complex acid-base and electrolyte abnormalities are prevalent in intensive care units. The blood pH rapidly moves in either of the extreme directions, which can result in serious multi-organ issues, even though in most cases the acid-base changes are small and self-limited. Objectives: The purpose of the study was to assess the relationship between the severity and clinical outcomes of sepsis patients admitted to the intensive care unit and acid-base abnormalities. 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 162 participants were retrieved for the study. Included were adult patients with sepsis or septic shock who were hospitalized to the intensive care unit (ICU) and had complete clinical, laboratory, and ABG data at the time of admission. Results: The largest subgroup consisted of patients with metabolic acidosis, who also had the highest mean SOFA score (9.6 ± 3.2) and the highest percentage of septic shock (58.8%). In a similar vein, patients with a combined acid-base problem had a significantly higher mean SOFA score (8.9 ± 2.8) and a high rate of septic shock (52.9%). Conclusion: Acid-base imbalances were found to be closely linked to the severity and results of sepsis in this investigation. Compared to patients with normal acid-base status, those with metabolic acidosis and mixed acid-base disorders had far greater rates of septic shock, higher SOFA scores, longer ICU stays, and higher mortality. Recommendations: Since patients with metabolic acidosis or mixed acid-base abnormalities are more likely to experience septic shock, organ failure, and death, early evaluation and monitoring of acid-base status should be a crucial component of sepsis care.