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.

Background: Ovulatory dysfunction is one of the most common and potentially treatable causes of female infertility. Accurate identification of ovulation is essential for appropriate infertility evaluation and management. Various clinical and biochemical methods are used to detect ovulation; however, their diagnostic accuracy varies, and a comparative evaluation is required to guide optimal clinical practice. Aim and Objectives: To assess the accuracy of clinical and biochemical methods for the detection of ovulation in infertile women. Materials and Methods: This hospital-based retrospective observational cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Kamala Nehru Memorial Hospital, Prayagraj, over a period of two years from October 2020 to October 2022. A total of 100 infertile women of reproductive age were included. Ovulation was assessed using basal body temperature charting, cervical mucus examination, and mid-luteal serum progesterone estimation. Detection of the urinary luteinizing hormone (LH) surge using a commercial LH kit was considered the reference standard. Diagnostic accuracy parameters, including sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy, were calculated. Statistical analysis was performed using SPSS version 23.0, and a p-value <0.05 was considered statistically significant. Results: Out of 100 infertile women, 78 (78.0%) were ovulatory and 22 (22.0%) were anovulatory based on LH surge detection. Serum progesterone estimation showed the highest diagnostic accuracy (84.0%) with high specificity (94.87%), followed by cervical mucus examination with an accuracy of 80.0%. Basal body temperature monitoring demonstrated lower sensitivity and an overall accuracy of 71.0%. Serum prolactin levels were significantly higher in anovulatory women (p<0.05), while other hormonal parameters showed no significant difference between ovulatory and anovulatory groups. Conclusion: Ovulatory dysfunction contributes significantly to female infertility. Among the evaluated methods, serum progesterone estimation is the most accurate biochemical marker for ovulation detection, while cervical mucus examination serves as a reliable and cost-effective clinical indicator. Basal body temperature monitoring alone is insufficient for accurate ovulation assessment. A combined approach incorporating clinical assessment and biochemical confirmation provides a more reliable strategy for ovulation detection, particularly in resource-limited settings.

Background: Gingivitis remains a prevalent oral health condition affecting a significant proportion of the global population. Effective plaque control through mechanical oral hygiene devices is fundamental to gingivitis prevention and management. However, comparative evidence regarding the efficacy of toothbrushing aids versus interdental cleaning devices remains limited. Methods: A total of 120 participants diagnosed with moderate gingivitis were randomly allocated to three groups: powered toothbrush group (n=40), interdental brush group (n=40), and dental floss group (n=40). Clinical parameters including Gingival Index (GI), Plaque Index (PI), and Bleeding on Probing (BOP) were assessed at baseline, 4 weeks, 8 weeks, and 12 weeks. Results: All three groups demonstrated significant improvements in clinical parameters. The powered toothbrush group exhibited the greatest reduction in GI (1.82 ± 0.31 to 0.68 ± 0.22, p<0.001) and PI (2.14 ± 0.28 to 0.72 ± 0.19, p<0.001). The interdental brush group showed superior improvement in interproximal sites (BOP reduction: 78.4% to 22.6%, p<0.001) compared to dental floss (76.2% to 34.8%, p<0.001). Combined use of powered toothbrush with interdental devices yielded optimal outcomes. Conclusion: Both toothbrushing aids and interdental devices effectively manage gingivitis, with powered toothbrushes demonstrating superior overall plaque removal and interdental brushes showing enhanced efficacy at interproximal sites. A combined approach is recommended for comprehensive gingivitis management.

Background: Bronchiectasis is a chronic airway disease frequently associated with comorbid conditions that influence clinical outcomes. Bronchial asthma represents an important overlapping airway disorder. Aim: To determine the coexistence of bronchial asthma in patients with bronchiectasis and to compare the clinico-radiological profile between patients with bronchiectasis alone and those with concomitant bronchial asthma. Materials and Methods: A cross-sectional observational study was conducted on 80 patients with radiologically confirmed bronchiectasis. Clinical features, radiological findings, and exposure history were compared between patients with bronchiectasis alone and those with coexisting bronchial asthma. Results: Bronchial asthma was present in a substantial proportion of patients with bronchiectasis and was associated with increased breathlessness, wheezing, atopic manifestations, and specific environmental exposures. Conclusion: Coexisting bronchial asthma significantly modifies the clinical profile of bronchiectasis, highlighting the need for routine evaluation and tailored management strategies.

Background: Laparoscopy was first introduced as a therapeutic alternative to laparotomy more than a century ago. Since then, the field of laparoscopic surgery has undergone enormous development and expansion, to the point where it is now the standard treatment for a wide range of surgical procedures, including cholecystectomy, appendicectomy, gynecologic surgeries, bariatric surgery, hernia repair and even complex oncologic operations. However, laparoscopic surgeries are associated with high incidence of postoperative nausea and vomiting (PONV) of 40%-80%. A number of drugs have been used for its prevention. Dexamethasone, a glucocorticoid, having an antiemetic effect along with anti-inflammatory and analgesic effect has been shown to reduce the incidence of PONV. However, the optimal dose for reducing PONV has not been clearly defined. In this study, we aim to study 4mg dose of dexamethasone on incidence of PONV in patients undergoing laparoscopic surgery. Methods: A double blind randomized controlled study was performed on 70 patients posted for elective laparoscopic surgeries under general anesthesia to assess the efficacy of 4mg dose of dexamethasone in preventing PONV. Patients were randomly assigned into two groups: 4mg dexamethasone (1ml) and 1ml normal saline group. The incidence of nausea, vomiting and the need for anti-emetic were evaluated during first 24 postoperative hours. Results: Patients who received IV dexamethasone 4mg had significant reduction of PONV (P<0.01) and the need for rescue anti emetic drugs was also lower in dexamethasone group compared to normal saline group. Conclusion: Inj Dexamethasone 4mg given before induction of anesthesia effectively controls postoperative nausea and vomiting in laparoscopic surgeries.

Introduction: Although the mortality rate for preterm infants and the gestational age-specific mortality rate have dramatically improved over the last three to four decades, infants born preterm remain vulnerable to many complications, including respiratory distress syndrome, chronic lung disease, and injury to the intestines, a compromised immune system, cardiovascular disorders, hearing and vision problems, and neurological insult. Aims and Objectives: To determine the effect of exposure of antenatal magnesium sulfate on neonatal APGAR score at 1 minute and 5 minutes of birth, on need of respiratory support and duration of hospitalization of neonates. Materials and Methods: This prospective interventional study was conducted on 70 women admitted to labor room in the Department of Obstetrics and Gynaecology, Sawai Mansingh Medical College, Jaipur. Women with singleton pregnancy between 28 to 32 weeks gestational age with expected delivery within 24 hours were included. Groups were allocated using flip coin method into cases and controls, and the treatment group was administered with Magnesium Sulphate. At birth Apgar scoring at 1 and 5 minutes were noted. Duration of stay of hospitalisation, need of oxygen, CPAP/ventilator were noted. Results: The APGAR score at 1 and 5 minutes after birth were found to be improved in the MgSO₄ group. The mean duration of stay in the hospital among neonates who received MgSO₄ was 9.86 days compared to 11.06 days in controls. Also babies requiring CPAP/ventilator were more in control group as compared to who did not received MgSO₄. Conclusion: Antenatal MgSO₄, if judiciously used, can do wonders. But for generalized norms, it has to be evaluated thoroughly.

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy and is associated with significant adverse maternal and neonatal outcomes. With the rising prevalence of GDM in India and limited region-specific data from Northeast India, evaluating fetomaternal outcomes in this population is essential. Aim and Objectives: To assess and compare maternal and neonatal outcomes in pregnancies complicated by gestational diabetes mellitus with those in normoglycaemic pregnancies, and to evaluate the association between glycaemic control and pregnancy outcomes. Materials and Methods: This hospital-based observational comparative study was conducted at a tertiary care hospital in Northeast Tezpur, Assam, from August 2021 to July 2024. A total of 120 pregnant women were enrolled, comprising 60 women diagnosed with GDM and 60 normoglycaemic controls. Participants were followed from diagnosis until delivery and the early neonatal period. Maternal demographic characteristics, antenatal complications, mode of delivery, and neonatal outcomes were recorded. Results: Women with GDM were significantly older and had higher body mass index compared to controls. Gestational hypertension and polyhydramnios were more common in the GDM group. Caesarean section rates were substantially higher among women with GDM. Neonates born to mothers with GDM had significantly higher birth weight, increased incidence of macrosomia, neonatal hypoglycaemia, and higher rates of NICU admission. Poor glycaemic control within the GDM group was significantly associated with increased operative delivery and adverse neonatal outcomes. Conclusion: Pregnancies complicated by gestational diabetes mellitus are associated with increased risk of adverse fetomaternal outcomes. Effective glycaemic control plays a crucial role in improving maternal and neonatal prognosis. Early screening, timely diagnosis, and appropriate management of GDM are essential to reduce pregnancy-related complications, particularly in high-risk populations.

Aim: To compare the clinical outcomes, disease severity patterns, and complications between alcohol-induced and gallstone-induced acute pancreatitis in a tertiary care center. Materials and Methods: This prospective observational comparative study was conducted over an 18-month period. A total of 152 consecutive patients diagnosed with acute pancreatitis were enrolled and categorized into two groups: alcohol-induced (n=101) and gallstone-induced (n=51) pancreatitis. Patients were evaluated for demographics, clinical presentation, severity assessment using Revised Marshall Score and BISAP criteria, and documented for outcomes including duration of nil per oral (NPO), length of hospital stay (LOS), organ failure, local complications (pancreatic necrosis, pseudocyst, acute necrotic collection), and mortality. Results: Alcohol-induced pancreatitis demonstrated higher prevalence (66.45%) with predominance in younger males (mean age 37.8±8.2 years, 97% male; p<0.0001). Gallstone-induced pancreatitis was more frequent in older females (mean age 46.5±12.1 years, 84.3% female). No mortality was recorded in either group. Mean NPO duration was comparable (alcohol: 2.49±1.12 days vs gallstone: 2.75±1.02 days; p=0.1656). Length of hospital stay was similar (alcohol: 3.55±1.81 days vs gallstone: 3.41±1.3 days; p=0.617). Alcohol-induced cases demonstrated significantly higher incidence of acute necrotic collection (ANC) at 21.8% versus 3.92% in gallstone group. Conclusion: Both alcohol-induced and gallstone-induced acute pancreatitis demonstrated favorable short-term clinical outcomes with zero in-hospital mortality when managed with appropriate supportive care and timely interventions. While complication patterns differed between etiologies, with alcohol-induced cases prone to necrosis and gallstone-induced cases predisposed to pseudocyst formation, overall outcome measures remained comparable. Etiology-specific monitoring protocols are recommended to optimize patient management and enable early intervention for anticipated complications based on the causative factor.

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy and is associated with significant adverse maternal and neonatal outcomes. With the rising prevalence of GDM in India and limited region-specific data from Northeast India, evaluating fetomaternal outcomes in this population is essential. Aim and Objectives: To assess and compare maternal and neonatal outcomes in pregnancies complicated by gestational diabetes mellitus with those in normoglycaemic pregnancies, and to evaluate the association between glycaemic control and pregnancy outcomes. Materials and Methods: This hospital-based observational comparative study was conducted at a tertiary care hospital in Northeast Tezpur, Assam, from August 2021 to July 2024. A total of 120 pregnant women were enrolled, comprising 60 women diagnosed with GDM and 60 normoglycaemic controls. Participants were followed from diagnosis until delivery and the early neonatal period. Maternal demographic characteristics, antenatal complications, mode of delivery, and neonatal outcomes were recorded. Results: Women with GDM were significantly older and had higher body mass index compared to controls. Gestational hypertension and polyhydramnios were more common in the GDM group. Caesarean section rates were substantially higher among women with GDM. Neonates born to mothers with GDM had significantly higher birth weight, increased incidence of macrosomia, neonatal hypoglycaemia, and higher rates of NICU admission. Poor glycaemic control within the GDM group was significantly associated with increased operative delivery and adverse neonatal outcomes. Conclusion: Pregnancies complicated by gestational diabetes mellitus are associated with increased risk of adverse fetomaternal outcomes. Effective glycaemic control plays a crucial role in improving maternal and neonatal prognosis. Early screening, timely diagnosis, and appropriate management of GDM are essential to reduce pregnancy-related complications, particularly in high-risk populations.

Background: Dietary practices formed in childhood strongly influence long-term health. During adolescence, parental supervision declines and peer influence rises, resulting in unhealthy habits such as skipping meals, television viewing during meals, eating out, and increased junk food intake. Early nutritional education can positively shape dietary habits. Objectives: 1. To assess the dietary practices of middle school children. 2. To evaluate the effect of a structured nutritional education program on their dietary practices. Methods: A quasi-experimental study was conducted among 90 middle school children aged 11–14 years from three private schools in North Chennai (January 2019–November 2020). Group A (n=30) received structured nutritional education with periodic reinforcement; Group B (n=30) received a one-time intervention; Group C (n=30) served as control. Educational tools included trifold brochures, food plate models, display boards, painted pots, stadiometers, and digital weighing machines. Results: The mean dietary practices scores improved significantly across all groups (p = 0.000), with the highest gain in Group A (6.73 ± 3.48), followed by Group B with moderate improvement (2.90 ± 0.49) and Group C with less significant improvement (2.06 ± 2.03). In Group A, breakfast intake increased from 66.7% to 93.3%, television viewing during meals reduced from 83.3% to 53.3%, family meal participation rose from 66.7% to 76.7%, and hotel food consumption declined in 80% of children. Balanced diet adherence improved from 10% to 43.3%, while healthy dietary practices showed a remarkable rise from 40% to 96.7% highlighting the superior effectiveness of structured nutritional education in Group A. Conclusion: Structured nutritional education with periodic reinforcement significantly improved knowledge and dietary practices among middle school children compared with one-time interventions. Continuous engagement of children and parents is crucial for fostering healthy eating behaviours and nurturing healthier adolescents.

Introduction: The study evaluate the impact of an educational intervention on the knowledge, attitude, and practice (KAP) of parents of children with beta thalassemia. The study involved 147 participants, providing a comprehensive overview of how targeted educational efforts can enhance understanding and management of the disease. Overall, the study emphasizes the value of education as a tool for enhancing health literacy and promoting proactive health behaviours among parents of children with beta thalassemia. By continuing to invest in and develop such educational initiatives, we can significantly improve the quality of life for affected families and contribute to better disease management and prevention strategies. Material And Method:  A hospital based Prospective Quasi-experimental Pre- Post test design to evaluate the Effectiveness of an educational intervention. Beta-thalassemia Children of age 6 month to 14 years with their parents (care giver) presented to MKCG Medical College & Hospital for regular blood transfusion  This prospective quasi-experimental study was conducted in the department of paediatrics, MKCG, MCH, Berhampur from the period of October 2022 to September 2024. Study population included parents or care givers of thalassemia children of age group 6 month to 14 year. Result:  More number of questionnaire regarding KAP about thalassemia will helpful on strength of the study. Scoring or Grading of KAP could may give more light on the performance of the Study. Long term follow up will yield better result in assessing KAP of thalassemia parents. Smaller sampling size will give more bias in the study and large size of the sample will give better result in KAP assessment regarding thalassemia. Conclusion: Study concludes; More significant improvement of knowledge of parents and care givers observed in different aspects regarding thalassemia disease like about general awareness, symptoms, disease transmission, screening and diagnosis and healthy living and treatment. Overall, the study emphasizes the value of education as a tool for enhancing health literacy and promoting proactive health behaviours among parents of children with beta thalassemia. By continuing to invest in and develop such educational initiatives, we can significantly improve the quality of life for affected families and contribute to better disease management and prevention strategies.

Introduction: The World Health Organization defines over-the-counter drugs as medications that can be bought without a prescription. They are generally used for common symptoms like fever, cough, cold, headache, toothache and are generally treated symptomatically and not as substitute for prescription drugs. But this also leads to an irrational use of over-the-counter drugs due to their easy availability and lack of proper knowledge about their adverse effects. Although OTC medicines allow greater access to treatment of people at large at lower cost for minor or self-limiting illnesses and it gives General Practitioners (GPs) more time to deal with serious health problems. There associated some risks of OTC medications which include Increase Drug Resistance, increase cost to the patients, failure to follow label instructions, increase risk of drug-drug Interactions and potential for misuse and abuse. The prevalence of usage of over-the-counter drugs world-wide varies between 32.5% to 81.5% while the same for India is 53.57%. Objectives: The study was conducted to assess the knowledge, attitude, practice of MBBS undergraduate students on Over the Counter (OTC) Medicine along with prevalence of usage of OTC drugs in Undergraduate Medical Students of BBMCH. Methodology: It was a cross-sectional observational Study conducted in a tertiary care teaching hospital among 405 undergraduate medical students. A questionnaire consisting of questions about knowledge, attitude, and practice toward OTC drugs was framed. After educational activities, the same questionnaire on knowledge and attitude aspects was shared to the participants in google form and their response was collected and analyzed. Results: Out of the Total 405 MBBS undergraduate students who participated in the study, 87(21.5%), 83(20.5%), 83(20.5%), 90(22.2%), 62(15.3%) were belongs to 1st year, 2nd year, 3rd year, 4th year, 5th year of MBBS respectively. 246(60.7%) students were didn’t have any relatives from medical background. Around 45(11.1%) students were having 1st degree (parents) relatives from medical backgrounds. At the same time 31(7.7%), 45(11.1%) students were having 2nd degree (Brothers, Sisters, Grandparents), 3rd degree relatives (Uncle, Aunt, Nephew, Nice) from medical background, respectively. Out of the 405 students only 250(61.7%) were previously heard about the term “Over the Counter” (OTC) medicine. Only 282(69.6%) out of 405 students answer correctly that the medicine that can be purchased without prescription is called OTC medicine.153 (37.8%) students were of the opinion that availability of Over-the-counter medicine was beneficials to general publics. 364 (89.9%) participants were of the opinion that consumption of OTC medicine contributed to Antimicrobial Resistance. 282 (69.6%) were found purchased OTC medicines at least once during the last 3 months. Whereas 245(60.5%) students had purchased medicine for self-consumption, 122(30.1%), 83(20.5%) students purchased it for family members & friends respectively. OTC medicines were purchased most commonly for fever (51.6%) followed by Common cold/Cough (40.7%), Acidity/Gastritis (38%), Headache & myalgia (29.6%), Loose motion (26.2%), allergy (16.0%). Conclusions: This study highlights the high prevalence of self-medication with OTC drugs among medical students. While many have basic knowledge, significant gaps remain regarding drug safety, regulations, and potential risks. The casual attitude toward OTC drug misuse—such as exceeding doses or ignoring expiry dates—is concerning. Raising awareness among medical students is crucial, as they will serve as future healthcare providers and influence public health behaviors.

Introduction: Topical analgesics, caudal block, and ring block of the penis are a few examples of regional anesthesia that have been utilized during circumcision and have varying degrees of effectiveness. Transient motor block has been linked to caudal block. The dorsal penile nerve block is a successful anesthetic technique, with extended postoperative analgesia, according to earlier investigations. However, it has a 4-6.7% failure rate that has been documented. To compare the analgesic and anesthetic efficacy of bilateral nerve stimulator-guided pudendal nerve block with that of dorsal nerve block for perioperative and postoperative analgesia in children undergoing circumcision, we conducted a prospective randomized controlled clinical trial based on this background Methods: A prospective, single-blinded, randomized investigation was carried out from March 2020 to February 2025 with the approval of the institutional review board and the signed agreement of the parents. 50 ASA-1 male children between the ages of 3 and 5 who were scheduled for elective circumcision were included in the study. A pre-existing coagulopathy, an infection at the injection site, and a known allergy to local anesthetic were among the exclusion criteria. One group received a pudendal nerve block, while the other group received a dorsal nerve block. For the first day, pain ratings were taken at various intervals (0, 6 and 12 h, and once per day for the next 5 days). It was measured using the Objective Pain Scale as modified by Hannallah et al. Result: Age, hemodynamic stability, and duration of surgery were comparable across the two groups (Table 1). In the group of patients who had their pudendal nerves blocked, every patient underwent circumcision as planned without requiring any analgesics. 3 patients (12%) in the dorsal nerve block group experienced an incomplete block, necessitating further local infiltration. In the dorsal nerve block group, one patient (4%) had total block failure and underwent general anesthesia (Table 2). In conclusion, as compared to the dorsal nerve block, the guided pudendal nerve block method has been shown to be more precise and successful in circumcising children.

Background: Mental health disorders, such as schizophrenia and bipolar affective disorder (BPAD), impose significant burdens on patients and their caregivers. Schizophrenia is characterized by psychotic symptoms and cognitive decline, while BPAD involves episodic mood fluctuations. Both conditions require long-term caregiving, often leading to emotional, physical, and financial strain on family members. Despite the critical role of caregivers, their quality of life (QoL) remains understudied. This study aimed to compare the sociodemographic profiles of patients with schizophrenia and BPAD and assess the QoL of their caregivers. Materials & Methods: A cross-sectional study was conducted over 16 months at a tertiary care psychiatric centre, involving 120 participants (60 schizophrenia and 60 BPAD patients) and their primary caregivers. Caregivers were assessed using the WHOQOL-BREF questionnaire, while patient symptom severity was measured using PANSS (schizophrenia), YMRS, and HAM-D (BPAD). Statistical analysis included chi-square tests, independent t-tests, and correlation analyses. Results: Sociodemographic analysis showed no significant differences between schizophrenia and BPAD patients except for illness duration (p=0.002), with BPAD patients having longer illness durations. Caregiver QoL did not differ significantly between groups across physical, psychological, social, and environmental domains. However, illness duration negatively correlated with psychological QoL in both groups (schizophrenia: r=-0.226, p=0.013; BPAD: r=-0.220, p=0.018). Negative symptoms in schizophrenia (PANSS-N) were linked to poorer environmental QoL (r=-0.265, p=0.04), while depressive symptoms in BPAD (HAM-D) correlated with worse psychological QoL (r=-0.360, p=0.027). Conclusion: Caregivers of schizophrenia and BPAD patients experience similar QoL challenges, though symptom-specific burdens exist. Longer illness duration worsens psychological well-being, highlighting the need for targeted caregiver support programs. Interventions should address chronicity, symptom management, and psychosocial support to improve caregiver resilience and mental health outcomes.

Background: Allergic Rhinitis (AR) is an IgE (Immunoglobulin-E) mediated immunological response of nasal mucosa characterized by watery nasal discharge, nasal obstruction, sneezing and itching in the nose. AR is hazardous diseases rising at a very fast rate. Increase in knowledge and complications regarding AR expected to have a better outcome of the disease. Objective: The study was cross-sectional type, planned in north Bihar to assess the awareness and diagnosis about AR, and includes 600 participants. Method Demographic data and knowledge of participants on various aspects of AR were collected by a well-prepared questionnaire asking from patients of ENT Department during January 2025 to December 2025. Nasal cytology was taken from the inferior turbinate from the selected patient. Results: Diagnosis was based on symptom and nasal eosinophilia in cytology of nasal smear. It was found that 39.83% of participants had knowledge of AR. Only 10.67% knew that Allergic rhinitis was caused by insufficient antihistamines.73.67% of respondents did not know any Allergic rhinitis symptoms. 61% of respondents did not know how this disease can be prevented. 88.33% of respondents did not have any idea about the complication of Allergic Rhinitis. This study indicated that awareness of Allergic rhinitis was very poor, especially in subjects with low education. Conclusion: The study concluded that there is an urgent requirement of different strategies like Allergic Rhinitis health campaigns, issuing pamphlets of information about AR, public speaking sessions, etc. to spread awareness among the general population.

Introduction: HoLEP (Holmium Laser Enucleation of Prostate) surgery has lower morbidity due to a lower transfusion rate and lesser risk of dilutional hyponatremia; nevertheless, the disadvantages are attributed to a longer procedure time and a steep learning curve. The anesthetic aspects of HoLEP have not yet been fully established. The majority of published studies concentrated on HoLEP’s urological features. The aim of the current study was to assess different regional anesthesia techniques for HoLEP surgery and to identify the most effective regional anesthesia technique. Material and Methods: Following approval from Institutional Ethics Committee (IES-SSMC-0145), a prospective, randomized, comparative study was conducted. The study included 45 patients who were scheduled for HoLEP. Patients who had severe systemic infections or local infections at the injection site, coagulopathy, serious disorders of the central nervous system or peripheral nerves, and history of allergies to local anesthetics, were excluded from the study. Patients (n=15) were randomly assigned to one of three groups (epidural block, spinal block, or saddle block) using the sealed envelope method. Result: Time to T10 dermatome block (P=.024) and time to maximal sensory level block (P=.003) were statistically different between groups A and B. The maximal sensory block level was comparable between groups B and C but higher between groups A and C. The time to 2-segment sensory regression differed statistically substantially between groups and was significantly longer in group A than in group C (P=.007). Conclusion: we conclude that saddle block has a quicker onset, more effective sensory block, and faster recovery in HoLEP surgery.

The current research evaluates the effectiveness and perceptions of Competency-Based Medical Education (CBME) among 400 medical students. The survey explored CBME’s focus on medical competencies, clarity of learning objectives, adequacy of feedback, engagement in self-directed learning, and the value of clinical-oriented practical experiences. Results indicate that CBME encourages a focused approach to learning competencies, offers clearer objectives, and improves clinical readiness. Participants reported receiving adequate feedback and viewed self-directed learning positively within their medical education. Clinical-oriented practical experiences were highly valued, enhancing motivation and preparedness for future practice. Areas for improvement include the foundation course for CBME and enhancing clinical practical experiences. Challenges in implementing CBME involve adapting teaching methods, ensuring resources, and aligning assessments with competency outcomes. The study concludes that CBME shows promise for preparing future medical professionals, but ongoing adjustments are needed to address challenges and optimize its implementation.

Background and Aim: Surgical site infections (SSI) are a major postoperative complication in diabetic patients, with hyperglycemia recognized as a significant risk factor. This study aimed to evaluate the impact of preoperative glycemic control on postoperative wound infections in diabetic patients. Methods: A hospital-based prospective study was conducted over one year in a tertiary care hospital, enrolling 184 diabetic patients undergoing general surgery. Preoperative fasting blood glucose and HbA1c levels were recorded, and patients were followed postoperatively for wound infections and other complications. Patients were categorized based on glycemic control as good, fair, or poor. Data were analyzed to assess the association between glycemic status and postoperative outcomes. Results: The study included predominantly female patients (67.4%) with the most common age group being 51–60 years (26.1%). Overall, 50% of patients developed SSI, with the highest incidence in the poor glycemic control group (67.6%). Postoperative blood glucose levels on days 1, 3, and 7 were significantly higher in patients with SSI (p < 0.05). Other complications, including delayed wound healing and urinary tract infections, were also more frequent in patients with suboptimal glycemic control. Conclusion: Poor preoperative glycemic control is associated with higher rates of surgical site infections and postoperative complications in diabetic patients. Optimizing blood glucose before surgery may reduce morbidity and improve outcomes.

Background: Type 2 diabetes mellitus is a growing public health challenge requiring long-term pharmacotherapy, and evaluating prescribing patterns helps assess the rational use of antidiabetic drugs. This study aimed to analyze the prescription pattern of antidiabetic medications among patients with type 2 diabetes mellitus attending a tertiary care hospital. Methods: A hospital-based cross-sectional study was conducted over one year at a tertiary care hospital. A total of 166 patients with type 2 diabetes mellitus attending the diabetic outpatient clinic were included. Data on demographic characteristics, comorbidities, and prescribed antidiabetic drugs were collected from prescriptions and medical records. The data were analyzed using descriptive statistics with SPSS software. Results: Most patients were aged 51–60 years (38.0%) and had a diabetes duration of 1–5 years (46.4%). Hypertension was the most common comorbidity (49.4%). The mean number of antidiabetic drugs per prescription was 2.9, with oral agents alone prescribed in 66.9% of patients. Metformin was the most commonly prescribed oral drug, while lispro mix insulin was the predominant injectable, and combination therapy was frequently used. Conclusion: The study demonstrates a preference for metformin-based combination therapy in the management of type 2 diabetes mellitus, reflecting contemporary and rational prescribing practices.

Background: Spinal anesthesia is the preferred anesthetic technique for cesarean section because of its rapid onset, effective sensory blockade, and minimal fetal drug exposure. However, post-spinal hypotension remains the most common complication and may adversely affect both maternal comfort and uteroplacental perfusion. Aim: To determine the incidence of post-spinal hypotension and identify associated risk factors in patients undergoing cesarean section. Methodology: This prospective observational study was conducted on 90 patients undergoing elective or emergency cesarean section under spinal anesthesia. Maternal demographics, obstetric variables, baseline hemodynamic parameters, sensory block level, intraoperative management, and neonatal outcomes were recorded. Hypotension was defined as a fall in systolic blood pressure ≥20% from baseline or an absolute systolic blood pressure <90 mmHg. Statistical analysis was performed to identify factors associated with post-spinal hypotension. Results: Post-spinal hypotension occurred in 64.4% of patients, most commonly within the first 10 minutes following spinal anesthesia. Higher body mass index, lower baseline systolic blood pressure, higher sensory block level (≥T4), primigravida status, and emergency cesarean section were significantly associated with hypotension. Vasopressor support was required in the majority of affected patients. Conclusion: Post-spinal hypotension remains a frequent and clinically significant complication during cesarean section under spinal anesthesia. Early identification of high-risk patients and timely preventive strategies are essential to improve maternal and neonatal outcomes.

Background: Diabetic retinopathy is a common microvascular complication of type 2 diabetes mellitus and a leading cause of preventable blindness. Glycated haemoglobin (HbA1c) reflects long-term glycaemic control and is strongly associated with the risk of retinopathy. This study aimed to compare HbA1c levels in diabetic patients with and without retinopathy. Methods: A hospital-based cross-sectional comparative study was conducted at Muzaffarnagar Medical College and Hospital over one year. A total of 180 patients with type 2 diabetes mellitus were enrolled and divided into two groups: 90 patients with diabetic retinopathy (DR group) and 90 without retinopathy (Non-DR group). Clinical evaluation, fundoscopic examination, and HbA1c estimation by high-performance liquid chromatography (HPLC) were performed. Data were analysed using SPSS v21; mean HbA1c levels were compared using the Student’s t-test, with p < 0.05 considered significant. Results: The mean HbA1c level was significantly higher in the DR group (9.1 ± 1.4%) compared to the Non-DR group (7.2 ± 1.1%; p < 0.001). A higher proportion of patients with diabetic retinopathy had HbA1c ≥9%. Longer duration of diabetes and older age were also associated with retinopathy. Conclusion: Poor glycaemic control, reflected by elevated HbA1c, is strongly associated with diabetic retinopathy. Regular monitoring of HbA1c and timely ophthalmological screening are essential to prevent vision-threatening complications in patients with type 2 diabetes mellitus.

Background: Vitamin D has immunomodulatory properties and may influence the clinical course of lower respiratory tract infections in infants; however, its association with bronchiolitis severity remains inconsistent. Objectives: To evaluate the association between serum vitamin D status at hospitalization and disease severity among infants admitted with bronchiolitis. Methods: In this prospective observational study conducted from January to December 2024 at SMS Medical College, Jaipur, infants aged <12 months hospitalized with bronchiolitis were enrolled. Serum total 25-hydroxyvitamin D [25(OH)D], albumin, and vitamin D–binding protein were measured within 24 hours of admission. Free and bioavailable 25(OH)D concentrations were calculated. Disease severity was assessed by intensive care unit (ICU) admission, need for continuous positive airway pressure (CPAP) or mechanical ventilation, and length of hospital stay. Statistical analyses were performed using SPSS version 25. Results: A total of 403 infants were included (mean age, 5.8 ± 3.1 months). Vitamin D deficiency and insufficiency were present in 38.5% and 52.9% of infants, respectively. ICU admission was required in 24.3%, CPAP in 19.6%, and mechanical ventilation in 10.4%. Vitamin D status was not significantly associated with ICU admission or the requirement for CPAP. However, lower serum 25(OH)D levels were significantly associated with the need for mechanical ventilation (p = 0.035). Total and free 25(OH)D concentrations demonstrated weak but significant negative correlations with duration of hospitalization (p = 0.004 and p = 0.026, respectively). Conclusions: Hypovitaminosis D is highly prevalent among Indian infants hospitalized with bronchiolitis. While vitamin D status does not predict ICU admission or CPAP requirement, lower vitamin D levels are associated with prolonged hospitalization and increased need for mechanical ventilation.

The Medico-Legal Examination and Post-Mortem Reporting System (MedLEaPR) represents a major digital transformation in medico-legal infrastructure of Rajasthan following the enforcement of the new criminal codes the Bharatiya Sakshya Adhiniyam (BSA), Bharatiya Nagarik Suraksha Sanhita (BNSS) and Bharatiya Nyaya Sanhita, 2023. Historically, medico-legal documentation in the state relied on paper-based reports that were often handwritten, non-standardized & vulnerable to loss, manipulation and chain-of-custody breaches. These limitations frequently resulted in procedural delays and impaired judicial efficiency. MedLEaPR, developed by the National Informatics Centre (NIC), provides a secure, centralized and standardized digital platform for generating, authenticating and transmitting medico-legal case reports (MLCs) and post-mortem reports (PMRs). Its technical architecture incorporates digital signatures, structured templates, graphical tools and real-time integration with police systems through the Crime and Criminal Tracking Network & Systems (CCTNS) and the Inter-operable Criminal Justice System (ICJS). Rajasthan’s government mandated daily uploading of all MLCs and PMRs from May 2025, ensuring statewide compliance and enhancing accountability. Early outcomes indicate improved evidence integrity, reduced documentation errors, faster interdepartmental communication and greater transparency in the medico-legal workflow. While infrastructural limitations and training needs persist, MedLEaPR establishes a foundational digital framework critical for timely, reliable and legally defensible medico-legal evidence under India’s reformed criminal justice system.

Background: Preterm labour is a major cause of neonatal morbidity and mortality. Tocolytic therapy aims to delay delivery to allow corticosteroid administration and improve neonatal outcomes. This study compared the efficacy and safety of magnesium sulphate and nifedipine in managing preterm labour. Methods: A prospective observational study was conducted at Government Maternity Hospital, Hanumakonda, from July 2023 to December 2024. A total of 100 women with preterm labour were enrolled, with 50 receiving intravenous magnesium sulphate and 50 receiving oral nifedipine. Baseline characteristics, tocolytic efficacy, maternal adverse effects, and neonatal outcomes were systematically recorded and analysed. Results: Baseline demographics were comparable between groups. Nifedipine achieved a significantly greater mean delay in delivery (6.1 ± 3.2 days) compared with magnesium sulphate (4.6 ± 2.4 days). Prolongation of pregnancy beyond 48 hours and 7 days was higher in the nifedipine group. Maternal adverse effects were mild; nifedipine produced more headache and flushing, while magnesium sulphate showed occasional hypotension and reduced reflexes. Neonatal outcomes, including birth weight, APGAR scores, and NICU admissions, were similar between groups. Conclusion: Nifedipine demonstrated superior tocolytic efficacy with good maternal tolerability, making it a preferable first-line agent for preterm labour.

Background: Sinonasal diseases are common in otorhinolaryngology, ranging from inflammation to complex infections and neoplasms. Anterior rhinoscopy is often used for initial evaluation but is limited to the anterior nasal structures thus missing deeper pathologies. Nasal endoscopy offers a more comprehensive view allowing detailed visualization of both the anterior and posterior nasal cavities. Despite its superior diagnostic capabilities, nasal endoscopy is still underused due to factors like cost and expertise. Objective: To compare merits and demerits of nasal endoscopy vs. anterior rhinoscopy in diagnosis of sinonasal disease. Methods: A prospective observational study was conducted on 110 patients presenting in the department of ENT, PMCH, Udaipur from April 2024 to March 2025 with symptoms of sinonasal disease. Each patient underwent both anterior rhinoscopy and diagnostic nasal endoscopy. Results: Nasal endoscopy proved significantly better than anterior rhinoscopy for detecting sinonasal abnormalities, identifying conditions like concha bullosa (40.90% vs. 2.72%), ethmoidal polyps (19.09% vs. 9.09%) etc. It also provided a more detailed assessment of regions such as the sphenoethmoidal recess and superior turbinates and nasopharynx, which were not accessible with anterior rhinoscopy. Conclusion: The study highlights the critical role of nasal endoscopy in accurately diagnosing sinonasal disease, particularly in chronic or refractory cases where subtle or posterior pathology may be present. Despite being more resource-intensive, nasal endoscopy should be integrated into routine clinical practice for comprehensive evaluation, as it enables precise diagnosis, better treatment planning, and improved patient outcomes.

Background: Acute kidney injury (AKI) is a common clinical syndrome in hospitalized children and it imposes heavy burden of mortality and morbidity. Acute kidney injury is an acute and reversible increment in serum creatinine (SCr) levels with a reduction in urine output oliguria, or anuria. Objective: To Study the Etiology, Clinical Profile and Outcome of Acute Kidney Injury (AKI) In Neonates Admitted in NICU of JK Lon Hospital Kota. Materials and Methods: A prospective cross-sectional study was conducted in NICU JK loan with 255 neonates. Neonates (≤28 days) having acute kidney injury according to AKI criteria were included. Results: Among 255 neonates, mortality was 16.9%. Low birth weight, sex, gestational age, and mode of delivery showed no significant association with outcome. Sepsis was the most common etiology, while asphyxia and higher HIE grades, especially grade 3, were strongly linked to mortality. Significant predictors of death included metabolic acidosis, elevated urea and creatinine levels, and AKI stage 3. Most cases occurred in summer, but deaths were more common during monsoon. Overall, severe metabolic and renal abnormalities were key determinants of poor outcome. Conclusion: Severity of illness, hypoxic injury, metabolic acidosis, and advanced AKI stage are the primary determinants of mortality in neonatal AKI, rather than demographic factors.

Background: Chronic kidney disease (CKD) is associated with significant alterations in thyroid hormone metabolism. Understanding these changes is crucial for comprehensive patient management. Aim of this study is to evaluate thyroid function abnormalities in patients with chronic kidney disease and correlate these changes with the severity of renal impairment. Methods: A cross-sectional observational study was conducted on 100 CKD patients and 50 age and sex-matched healthy controls. Thyroid function tests including T3, T4, TSH, FT3, and FT4 were measured. Patients were categorized according to CKD stages based on estimated glomerular filtration rate (eGFR). Statistical analysis was performed using appropriate tests. Results: The mean age of CKD patients was 52.3±12.4 years with male predominance (64%). Significantly lower levels of T3 and FT3 were observed in CKD patients compared to controls (p < 0.001). T4, FT4, and TSH levels showed no significant difference. The prevalence of low T3 syndrome increased with advancing CKD stages, being present in 78% of stage 5 CKD patients. A significant negative correlation was found between serum creatinine and T3 levels (r = -0.542, p < 0.001). Conclusion: Thyroid dysfunction, particularly low T3 syndrome, is highly prevalent in CKD patients and correlates with disease severity. Regular thyroid function monitoring should be considered in CKD management.

Objectives: The present study was to evaluate the various factors of menstruation hygiene and to assess reproductive morbidities of adolescent girls in slum area of Dehradun, Uttarakhand, India. Methods: Data was collected by house‑to‑house survey in the community, and girls were asked questions using a predesigned questionnaire. The questionnaire consisted of sociodemographic details, knowledge about menstruation, menstrual patterns and practices, hygiene followed, and associated serious ill-health ranging from Dysmenorrhea, genital tract infections, urinary tract infections, and bad odour etc. Results: Out of 250 adolescent girls, most of girls were in age group of 14-16 years. Mean age of menarche was 12.7 years. Most of the mothers 136(54.4%) were illiterate and belonged from lower socioeconomic starta 170(68%). Non disposable linen was used by 55.2% girls. 67.6% girls were used 2-3 pad per day. 78.8% girls were reused of pad. Out of 250 girls, 188(75.2%) girls had reproductive morbidities. Mos common morbidities were dysmenorrhoea 84(33.6%), menstrual irregularities 55(22%), itching in genitalia 18(7.2%) and burning micturition 13(5.2%). 35.2% girls were taken heath care services. Conclusions: Reproductive morbidities are more common in adolescent girl of slum region. Dysmenorrhea and menstrual irregularities are the most common morbidities. Illiterate mother, lower socioeconomic strata and lack of awareness of menstruation and its hygiene are the most common factors of reproductive morbidities in adolescent girls.  Hence, we should organise regular health check-up camp in slum area to diagnose and treatment of reproductive morbidities in adolescent girls as well as to educate the mothers and adolescent girls for menstruation hygiene and prevention from morbidities.

Background: Normal cardiac function is contingent on electrolyte balance. Post-surgical changes, including surgical stress, fluid shifts, blood loss, anesthetic agents, and alterations in renal function, make the post-operative period highly vulnerable to electrolyte disturbances. Such disturbances may grossly affect cardiac electrophysiology, resulting in arrhythmias and other cardiac complications. It becomes, therefore, imperative that early recognition and correction of electrolyte disturbances are necessary in reducing both morbidity and mortality during this period. Objectives: The study aimed to determine the prevalence of electrolyte disturbances in post-operative patients and their relationship with cardiac complications during the early post-operative period. Materials and Methods: A total of 176 patients were enrolled in the prospective observational study conducted over a period of one year in a tertiary care hospital. A consecutive sampling technique was used. Measurement of serum electrolytes, namely sodium, potassium, calcium, and magnesium, was done within 72 hours following surgery. Cardiac complications were recorded based on clinical assessment with the aid of electrocardiography. Data analysis was done by descriptive statistics and association of electrolytes with cardiac complication using the Chi-square test, having a p-value <0.05 as statistically significant. Results: Electrolyte imbalance was a common finding in post-operative patients, and the most common imbalance was hyponatremia and hypokalemia. Cardiac complications, especially arrhythmias, occurred relatively often in patients who had electrolyte imbalance. The odds ratio for cardiac complications was highest for hypokalemia, followed by hyponatremia and then hypocalcemia. Cardiac complications occurred significantly less often in patients who had normal electrolyte values. Conclusion Electrolyte imbalance is common in the postoperative period and is independently related to cardiac complications. Electrolyte imbalance in the postoperative period must be closely monitored and corrected in order to prevent cardiac morbidity.

Introduction: Colon adenocarcinoma (COAD) is a common and fatal cancer in the world, with a high death rate in India as a result of late diagnosis. Conventional screening techniques, such as stool tests and colonoscopies, are expensive, invasive, and often insensitive in identifying early-stage illnesses. The development of reliable, non-invasive biomarkers is therefore crucial to improving prognosis and early diagnosis. Epigenetic alterations, especially DNA methylation changes, occur early in tumor development and can be detected in circulating cell-free DNA (cfDNA), making them promising candidates for liquid biopsy-based diagnostics. Objective: The purpose of this study was to identify and validate epigenetic biomarkers for the non-invasive diagnosis and prognosis of COAD, with a particular emphasis on SEPT9 and SDC2. The objective was to utilize computational techniques to assess their expression patterns and methylation status, with a focus on developing methylation assays suitable for early diagnosis and disease monitoring. Materials and Methods: The Human Protein Atlas, TCGA, UALCAN, GEPIA, and other publicly available multi-omics datasets were utilized to evaluate gene expression, promoter methylation, protein localization, and survival relationships for SDC2 and SEPT9. By comparing tumor and normal tissues, bioinformatics analyses revealed variations in methylation. The analysis of single-cell RNA sequencing data, with an emphasis on epithelial lineage, confirmed the expression of specific genes in distinct cell types. Results and Discussion: Bioinformatics analysis revealed significant promoter hypermethylation of SEPT9 and SDC2 in COAD samples compared to normal colon tissue. SDC2 demonstrated subtype-specific downregulation, whereas SEPT9 showed significant overexpression, especially in non-mucinous malignancies. Immunohistochemistry confirmed variable SDC2 expression and elevated SEPT9 protein levels. RNA sequencing of single cells has shown that both genes are highly expressed in epithelial cells, indicating their specificity as epigenetic biomarkers. The increased expression of both genes correlated with reduced overall survival, as indicated by survival analysis, underscoring their potential as prognostic indicators.

Background: Retinopathy of prematurity is a leading cause of preventable childhood blindness, particularly among preterm and low birth weight neonates. Understanding its incidence and associated risk factors is essential for effective screening and prevention. Objectives: To determine the incidence of retinopathy of prematurity in preterm and low birth weight neonates and to assess the association between various perinatal and neonatal risk factors with its occurrence. Material and Methods: This prospective observational study included 520 preterm and/or low birth weight neonates admitted to a tertiary care neonatal intensive care unit. All eligible neonates underwent serial retinal examinations, and relevant maternal and neonatal risk factors were analyzed. Results: Retinopathy of prematurity was diagnosed in 84 neonates, with an incidence of 16.15%. Lower gestational age, lower birth weight, prolonged oxygen therapy, and respiratory distress syndrome were significantly associated with ROP development, while sex, twin status, prenatal steroid exposure, and maternal systemic diseases showed no significant association. Conclusion: Retinopathy of prematurity remains a significant morbidity among preterm neonates. Early screening and identification of high-risk infants, along with careful management of modifiable risk factors, are crucial in preventing disease progression and visual impairment.

Background: Nail disorders are common in the geriatric population and often pose diagnostic challenges due to overlapping clinical features and age-related changes. Onychoscopy has emerged as a useful non-invasive tool for detailed nail assessment. Objectives: To study the clinico-epidemiological profile and onychoscopic patterns of nail disorders in the geriatric population. Material and Methods: A cross-sectional observational study was conducted on 120 geriatric patients with nail disorders. Detailed clinical examination and onychoscopic evaluation of nail fold, nail plate, nail bed, and hyponychium were performed and correlated. Results: Degenerative nail changes were predominant. Onychoscopy identified a higher frequency of nail abnormalities compared to clinical examination and showed strong correlation with clinical findings across all nail components. Conclusion: Onychoscopy significantly enhances the evaluation of nail disorders in elderly patients and should be incorporated into routine geriatric dermatological practice.

Background: Chronic kidney disease (CKD) is a progressive systemic disorder associated with multiple dermatological manifestations that significantly affect patients’ quality of life. Objectives: To study the spectrum and frequency of cutaneous manifestations in patients with chronic kidney disease. Materials and Methods: This hospital-based observational study was conducted from February 2023 to November 2025 at Nirmala Hospital & Research Center, Jaipur. All diagnosed CKD patients were included. Patients with acute kidney injury or pre-existing primary dermatological disorders unrelated to CKD were excluded. Detailed clinical, dermatological, and laboratory evaluations were performed. Data were analyzed using descriptive statistics. Results: A total of 327 CKD patients were studied (mean age 52.4 ± 11.6 years; male:female ratio 1.8:1). The most common etiology of CKD was obstructive uropathy (41%). Non-specific cutaneous manifestations were predominant. Pruritus (72.7%), hyperpigmentation (70%), and xerosis (67.8%) were the most frequent findings. Among specific lesions, acquired perforating dermatosis (8.5%) and porphyria cutanea tarda (3.2%) were observed. Conclusion: Cutaneous manifestations are highly prevalent in CKD patients, with non-specific lesions being more common than specific dermatoses. Early identification and appropriate dermatological care should be integrated into routine CKD management.

Background: Hemoglobinopathies are among the most common inherited disorders worldwide, with a significant burden in India. High-performance liquid chromatography (HPLC) has become the gold standard for detecting and classifying these disorders, offering precise quantification and identification of hemoglobin variants. Aim: To estimate the prevalence and distribution of various hemoglobinopathies detected by HPLC in a tertiary care center in India. Material and Methods: This cross-sectional observational study included 310 patients screened for the duration of one year. Patients of all age groups and both sexes, referred for hemoglobinopathy screening were enrolled. Detailed clinical data were collected and venous blood samples were analyzed using HPLC. Demographic details,age-wise distribution, and prevalence of hemoglobinopathies were recorded. Results: Of the 310 patients, 125 (40.3%) were male and 185 (59.7%) were female. The majority of patients belonged to the 21–30 years age group (33.9%). HPLC analysis showed 235 (75.8%) had normal hemoglobin while 38 (12.3%) had β-thalassemia trait, 12 (3.9%) had sickle cell trait, 4 (1.3%) had sickle cell-β-thalassemia compound heterozygosity, and 2 (0.6%) had sickle cell homozygosity. Thalassemia trait was most commonly diagnosed in the 21–30 years group. Among thalassemia carriers, RDW was predominantly in the 16–20 range. Conclusion: This study highlights the considerable burden of hemoglobinopathies, particularly β-thalassemia trait in the regional population. HPLC proved highly effective for screening and diagnosis. Strengthening screening programs, especially among young adults along with public awareness initiatives are essential to reduce the hemoglobinopathy burden in India.

Introduction: Preeclampsia remains a leading cause of maternal and perinatal morbidity worldwide. The importance of vitamin D for placental function, endothelial integrity, and immunological regulation is increasing. The purpose of this study was to measure serum vitamin D levels in pregnant women with preeclampsia and normotension and to see if it could be used as a biomarker to rate the severity of the condition. Aims and Objectives: The objectives of this study were: (i) to estimate serum vitamin D levels in pregnancies with normotension, severe pre-eclampsia, and mild pre-eclampsia, (ii) to determine the relationship between the severity of the disease and vitamin D levels. Material and Methods: A tertiary care teaching hospital served as site of this cross-sectional case-control study. A total of 120 third-trimester pregnant women has been recruited and split into three groups: 40 normotensive controls, 40 with mild preeclampsia, and 40 with severe preeclampsia. Competitive enzyme-linked immunoassay (ELISA) was used to measure serum vitamin D levels. Biochemical and clinical parameters were compared among groups. One-way ANOVA and Pearson correlation were used for statistical analysis. Results: Women with preeclampsia have been significantly lower mean serum vitamin D levels than normotensive controls (p <0.00001). As the severity of preeclampsia increased, vitamin D levels gradually decreased. Diastolic blood pressure (DBP), systolic blood pressure (SBP), and proteinuria were all significantly correlated negatively with serum vitamin D. Conclusion: Serum vitamin D levels are markedly lower in preeclampsia and show a negative correlation with the severity of the illness. One possible biomarker for identifying high-risk pregnancies and grading preeclampsia is vitamin D.

Background: Laparoscopy was first introduced as a therapeutic alternative to laparotomy more than a century ago. Since then, the field of laparoscopic surgery has undergone enormous development and expansion, to the point where it is now the standard treatment for a wide range of surgical procedures, including cholecystectomy, appendicectomy, gynecologic surgeries, bariatric surgery, hernia repair and even complex oncologic operations. However, laparoscopic surgeries are associated with high incidence of postoperative nausea and vomiting (PONV) of 40%-80%. A number of drugs have been used for its prevention. Dexamethasone, a glucocorticoid, having an antiemetic effect along with anti-inflammatory and analgesic effect has been shown to reduce the incidence of PONV. However, the optimal dose for reducing PONV has not been clearly defined. In this study, we aim to study 4mg dose of dexamethasone on incidence of PONV in patients undergoing laparoscopic surgery. Methods: A double blind randomized controlled study was performed on 70 patients posted for elective laparoscopic surgeries under general anesthesia to assess the efficacy of 4mg dose of dexamethasone in preventing PONV. Patients were randomly assigned into two groups: 4mg dexamethasone (1ml) and 1ml normal saline group. The incidence of nausea, vomiting and the need for anti-emetic were evaluated during first 24 postoperative hours. Results: Patients who received IV dexamethasone 4mg had significant reduction of PONV (P<0.01) and the need for rescue anti emetic drugs was also lower in dexamethasone group compared to normal saline group. Conclusion: Inj Dexamethasone 4mg given before induction of anesthesia effectively controls postoperative nausea and vomiting in laparoscopic surgeries.

Aim: To evaluate the presence, frequency, and anatomical location of lateral canals in extracted maxillary premolars using cone-beam computed tomography (CBCT). Materials and Methods: Three hundred extracted human maxillary premolars were subjected to CBCT imaging under standardized parameters. Axial, sagittal, and coronal sections were evaluated for root canal configuration according to Vertucci’s classification and for the presence of lateral canals. Data were recorded and analyzed using descriptive statistics. Results: The majority of maxillary premolars exhibited Vertucci Type I canal configuration. Lateral canals were identified in 1.0% of specimens (3 out of 300 teeth). When present, lateral canals were predominantly located in the middle and apical thirds of the root. Complex canal configurations including Vertucci Types II, IV, V, VI, and VIII were also observed. Conclusion: Lateral canals in maxillary premolars are relatively rare but clinically significant anatomical variations. CBCT is a reliable non-destructive imaging modality for detecting lateral canals and complex root canal morphology, thereby aiding in improved endodontic diagnosis and treatment planning.

Background: Effective postoperative pain control after breast cancer surgery is essential to reduce morbidity, opioid consumption, and patient discomfort. Thoracic paravertebral block (TPVB) is an established regional anesthesia technique that provides unilateral analgesia with minimal systemic effects. Ropivacaine is commonly used for TPVB due to its favorable safety profile. Dexmedetomidine, a highly selective α₂-adrenergic agonist, has been increasingly used as an adjuvant to local anesthetics to enhance analgesic efficacy. This study evaluated the efficacy of dexmedetomidine as an adjuvant to ropivacaine in TPVB for patients undergoing modified radical mastectomy. Material and Methods: This prospective, randomized, controlled study was conducted on 50 female patients aged ≥18 years, belonging to ASA physical status I–III, scheduled for modified radical mastectomy. Patients were randomly allocated into two groups: Group PR received TPVB with 0.5% ropivacaine, while Group PRD received TPVB with 0.5% ropivacaine plus dexmedetomidine (1 μg/kg). TPVB was performed at T1, T3, and T5 levels before induction of general anesthesia. Primary outcomes included duration of analgesia and total postoperative opioid consumption. Secondary outcomes included onset of sensory block, hemodynamic parameters, and postoperative pain scores using the Visual Analogue Scale (VAS), Ramsay Sedation Scores, patient satisfaction, and adverse effects. Results: Group PRD demonstrated a significantly faster onset of sensory block, prolonged duration of analgesia, lower postoperative VAS scores at all time intervals, and significantly reduced tramadol consumption compared to Group PR (p < 0.001). Hemodynamic parameters showed a controlled and stable reduction in heart rate and blood pressure in the dexmedetomidine group without clinical instability. Patient satisfaction was higher in Group PRD, with no significant increase in adverse effects. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in TPVB significantly improves postoperative analgesia, reduces opioid requirement, and enhances patient satisfaction without increasing complications.

Background: Chronic rhinosinusitis (CRS) is a common inflammatory condition of the nasal cavity and paranasal sinuses persisting for more than 12 weeks and causing significant morbidity worldwide. Accurate diagnosis and precise delineation of disease extent are essential for effective management. With the advent of Functional Endoscopic Sinus Surgery (FESS), diagnostic nasal endoscopy and computed tomography (CT) of paranasal sinuses have become integral to preoperative evaluation. However, discrepancies between radiological findings and intraoperative observations still exist, particularly regarding anatomical variations and sinus involvement. Establishing a correlation between clinical, radiological, and operative findings is therefore crucial to optimize surgical planning and outcomes. Material and Methods: This prospective observational study was conducted in the Department of Otorhinolaryngology at a tertiary care teaching hospital in Western India between May 2023 and August 2024. A total of 42 patients diagnosed with chronic rhinosinusitis and planned for endoscopic sinus surgery were included. All patients underwent detailed clinical evaluation, diagnostic nasal endoscopy, and CT scan of paranasal sinuses prior to surgery. CT findings were compared with intraoperative observations to assess diagnostic accuracy. Sensitivity, specificity, accuracy, and Cohen’s kappa coefficient were calculated to evaluate agreement between CT and operative findings. Results: Among the 42 patients, males predominated (54.76%), with the most affected age group being 31–40 years. Nasal obstruction was the most common symptom (92.85%). Maxillary sinus was the most frequently involved sinus on CT, followed by ethmoid sinuses. CT scan demonstrated high sensitivity for detecting sinus disease and osteomeatal complex obstruction, with substantial agreement for osteomeatal complex blockage and deviated nasal septum. However, lower sensitivity and agreement were observed for certain anatomical variations such as concha bullosa and Onodi cells. Conclusion: CT scan of paranasal sinuses is a highly sensitive tool for evaluating CRS and guiding surgical management. When combined with clinical assessment and nasal endoscopy, it provides optimal preoperative planning and improves intraoperative safety.

Background: Stigma is one of the major obstacles to timely mental health service use and engagement. While caregivers may act to shorten treatment delay, they may act to transmit stigmatizing beliefs that influence the help-seeking behavior of patients. This study compared self-stigma of seeking help and attitudes of community toward mental illness between psychiatric patients and their primary care givers in the Malwa region using the Self Stigma of Seeking Help (SSOSH) and the 12 item Community Attitudes toward the Mentally Ill scale (CAMI 12). Methods: In a hospital-based comparative cross – sectional design, psychiatric patients and their primary family caregivers were recruited consecutively from outpatient and inpatient psychiatry services for the study. Sociodemographic and clinical data were collected. SSOSH (10 items; higher scores = greater self-stigma of help seeking) and CAMI 12 (12 items; higher scores = less stigmatizing community attitudes after reverse coding) were performed with both groups. Group differences were tested, and after independent samples t tests, effect sizes. Multivariable linear regression was conducted to examine a set of predictors of SSOSH and CAMI 12 scores controlling for some key covariates. Results: A total of 160 patients and 160 caregivers were analyzed. Patients scaled higher SSOSH scores than caregivers, 31.6 (SD 7.5) and 25.4 (SD 6.8), mean difference 6.2, p<0.001, Cohen’s d=0.88. Caregivers had more stigmatizing community attitudes (lower CAMI 12 total) than patients did (40.1+-6.5 vs 43.2+-6.0; p < 0.001; d = 0.49). In the adjusted models, rural residence and lower education were independently associated with higher SSOSH and lower CAMI 12 scores for both groups. Caregiver CAMI 12 “prejudice/exclusion” scores were negatively linked to patient SSOSH (beta -0.24 per unit CAMI 12; p=0.002), suggesting patient-caregiver dyad attitudinal contagion. Conclusion: Patients weighed with great internalized barriers to help seeking whereas caregivers exhibited comparatively more negative community attitudes. Interventions in Malwa should be dyad focussed (patient centred stigma reduction, as well as psychoeducation for caregiver) to enhance engagement and continuity of care.

Introduction: Bone marrow examination (BME) is a cornerstone diagnostic procedure for evaluating hematological disorders, providing critical insights into cellular morphology, architecture, and iron stores. This study aimed to describe the clinico-morphological spectrum of bone marrow findings and assess the diagnostic utility of bone marrow aspiration (BMA) and biopsy (BMB) in a tertiary care center in the Bundelkhand region of Madhya Pradesh, India. Materials and Methods: A prospective, observational study was conducted over a specified period, including 90 patients who underwent BME for various hematological indications. Peripheral blood parameters, clinical features, and bone marrow morphology from both aspiration and trephine biopsy were analyzed. Special stains (Perls’ Prussian blue, Reticulin) were employed as needed. Results: The study population had a mean age skewing towards younger adults (20-29 years, 31.1%), with a slight male predominance (53.3%). The most common clinical features were weakness (90%) and pallor (88.9%). Megaloblastic anemia (MA) was the most frequent diagnosis (31.1%), followed by mixed deficiency anemia (MDA, 20.0%) and iron deficiency anemia (IDA, 11.1%). Non-neoplastic disorders constituted 85.5% of cases, while neoplastic conditions like acute leukemia, aplastic anemia, and myelofibrosis accounted for 14.4%. Bone marrow biopsy was pivotal in cases of dry tap or when architectural assessment was crucial, such as in myelofibrosis and aplastic anemia. Conclusion: Nutritional deficiency anemias, particularly megaloblastic anemia, are the predominant hematological disorders in the Bundelkhand region. Bone marrow examination remains an indispensable, cost-effective tool for definitive diagnosis, especially in differentiating between nutritional deficiencies, marrow failure syndromes, and hematological malignancies.

Background: Lesions of the nasal cavity, paranasal sinuses, and nasopharynx encompass a wide range from non-neoplastic inflammatory conditions to benign and malignant neoplasms. Because of overlapping clinical features, histopathological examination remains the gold standard for diagnosis. Aims: To evaluate the histopathological spectrum of lesions in the nasopharynx and sinonasal region, analyze their demographic distribution, and compare findings with previous studies. Materials and Methods: This retrospective cross-sectional study was conducted from June 2022 to June 2024 in the Department of Pathology, Sardar Patel Medical College, and Bikaner. A total of 150 biopsies from sinonasal and nasopharyngeal regions were studied. Hematoxylin and eosin staining was performed; special stains were used when indicated. Data were analyzed statistically. Results: Among 150 cases, 81 (54%) were non-neoplastic and 69 (46%) were neoplastic. Males predominated (63.3%), and the mean age was 40.08 years. The nasal cavity was the most common site (46.7%), followed by tonsillar region (26%). Inflammatory polyp was the most frequent non-neoplastic lesion, while squamous cell carcinoma was the most common malignant tumor. The association between age and lesion type was statistically significant (p < 0.001). Conclusion: The sinonasal and nasopharyngeal regions show a diverse spectrum of lesions. Non-neoplastic inflammatory conditions predominate, but malignant neoplasms, particularly squamous cell carcinoma, constitute a significant subset, emphasizing the role of histopathology in accurate diagnosis and management.

Aim: To determine the effect of smartphone use and prolonged screen time on digital eye strain (DES), visual acuity, refraction and overall ocular health among medical students. Materials and Methods: A cross-sectional study was conducted at Government Medical College Srinagar, Kashmir, India. This study included 225 students of 2^nd year to 5^th year MBBS, who consented to participate. Information regarding participants’ bio-data, screen time, and DES symptoms was gathered through a meticulously crafted self-administered questionnaire. A Snellen’s chart was used to assess the best corrected visual acuity and refraction of participants was noted. Chi-Square and Pearson Correlation were used and analysis conducted using SPSS software. Results: Out of 225 participants, 186 (82.6%) reported at least one symptom of digital eye strain. Headache (n=96; 42.6%) and eye pain/discomfort (n=73; 32.44 %) were the most common reported symptoms. Refractive error was reported in 102 (45.33 %) students, including myopia (n=78; 34.66%), hyperopia (n=13; 5.77%), and astigmatism (n=11; 4.88 %). Mobile Phone (n=225; 100%), Laptop (n=175; 78.22%) and Tablet/Ipad (n=76: 33.77%) were the main electronic gadgets used by participants. Headache, ocular discomfort, redness, watering of the eyes, itching of the eyes and burning of eyes along with neck / shoulder pain were significantly associated with increased screen time and most common refractive error noted among the students having prolonged screen time was myopia (p<0.05). Conclusion: This study reveals an alarming 82.6% prevalence of DES among medical students in GMC Srinagar as a direct result of increased screen time and smart phone usage and a strong association of prolonged screen-exposure with refractive errors especially myopia. Our study reveals a significant association between screen time and DES, with headache & eye pain/discomfort being the most common symptoms.

Ischemic cerebrovascular stroke constitutes the majority of stroke burden worldwide and remains a leading cause of mortality and long-term disability. Despite advances in neuroimaging and reperfusion therapies, early identification of individuals at increased risk remains a major clinical challenge. Red cell distribution width (RDW), a routinely reported parameter in complete blood count, reflects variability in erythrocyte size and has emerged as a novel biomarker associated with adverse cardiovascular and cerebrovascular outcomes. Elevated RDW has been linked to systemic inflammation, oxidative stress, endothelial dysfunction, altered blood rheology, and prothrombotic states—key mechanisms implicated in ischemic stroke pathogenesis. This review examines the association between elevated RDW levels and ischemic stroke, synthesizing epidemiological evidence, exploring biological mechanisms, and evaluating clinical implications. Particular emphasis is placed on the relevance of RDW as a cost-effective biomarker in resource-limited settings such as South Gujarat. The potential role of RDW in stroke risk stratification and future research directions is discussed.

Background: Cataract is the most common preventable cause of bilateral blindness in India and the leading cause of vision loss in the elderly worldwide. It is also the primary cause of reversible blindness globally. Cataract refers to any opacity in the lens of the eye or its capsule, whether developmental or acquired. B-scan ultrasonography is a powerful, safe, cost-effective, non-ionizing, and non-invasive diagnostic tool for evaluating the hidden posterior segment lesions in eyes with opaque media caused by corneal opacities, dense cataracts, or vitreous hemorrhage, which complicate the ophthalmic evaluation. B-scan ultrasound, a two-dimensional imaging system, is particularly useful when the fundus cannot be accessed through direct or indirect ophthalmoscopy, such as in the presence of dense cataracts. It is routinely performed preoperatively in cases of dense cataract to evaluate posterior segment abnormalities that may influence visual prognosis after surgery. Aim: Evaluation of posterior segment pathology in opaque media due to mature and advanced cataract thus plan management and determine visual prognosis accordingly. Objectives: (1) To evaluate the posterior segment pathology in patients with Mature and advanced cataract by B scan. (2) To plan the management protocol based on B scan findings. (3) To determine visual prognosis pre operatively. Materials and Methods: This prospective study was conducted in 200 patients with mature and advanced cataract. Relevant details with history were collected. Detailed ophthalmic was done for classification into groups. Results: Out of 200 patients, 77 eyes were with Advanced IMSC, 90 eyes with MSC and 33 eyes with HMSC. Our findings demonstrated that B Scan ultrasonography is useful tool in evaluating posterior segment pathology in patients with advanced and mature cataract. In this study, the majority of patients (89.5%) had a normal B scan, indicating no significant abnormalities detected in most cases. Mild vitreous degenerations were observed in 3.5% of the patients, which is a common finding in the aging population and often not associated with severe visual impairment. Moderate vitreous degenerations were also found in 2.0% of the patients, while severe vitreous degenerations were observed in 1.0%, indicating a progression in the degenerative changes affecting the vitreous humor. Conclusion: This study concluded that B Scan ultrasonography should be used in pre-operative evaluation of advanced and mature cataract to diagnose hidden posterior segment pathology enhancing surgical planning and prognosis.

Background: Glaucoma is the world’s second largest cause of blindness, with permanent visual loss. Angle-closure glaucoma is regarded as the primary cause of permanent blindness globally, with a greater incidence among Asians.¹ PACG is characterized by narrow or closed anterior chamber angle, which leads to increased intraocular pressure and optic nerve damage Anatomical risk factors include shallow anterior chamber depth, small axial length and lens thickness. Need for Screening: Gonioscopy is the gold standard for angle evaluation, but it is technique – sensitive and not always practical for mass screening. ACD measurement is simple non-invasive screening alternative. Objectives: (1) To evaluate anterior chamber depth measurement as a method of screening for PACG. (2) To compare the parameters in eyes with PACS, PAC, and PACG. Materials and Methods: This is a prospective study conducted on 150 patients with shallow anterior chamber and patients presenting with signs and symptoms of angle closure. Detailed history was collected. Detailed ophthalmic examination was done for classification into groups. Results: Out of 150 patients, 36 eyes of open angles, 46 eyes of PACS, 33 eyes of PAC and 35 eyes with PACG were identified. Our findings demonstrated that ACD is a significant for identifying individuals at risk for primary angle closure glaucoma. This study revealed that there is statistically significant difference between the mean ACD of PACS, PAC, and PACG. Conclusion: This study concluded that anterior chamber depth measurement as a screening tool for primary angle closure glaucoma is effective especially in primary outreach centres where sophisticated equipment may not be available.

Diclofenac sodium is a frequently prescribed painkiller in OPD and IPD setups of most clinicians. It is also preferred as an analgesic to deal with postoperative pain. The drug is economical and has better efficacy. Dermatological adverse reactions to diclofenac may manifest in a moderate to severe form. Early identification of ADR and prompt treatment are necessary, which helps in the patient’s faster recovery. Delayed identification of ADR sometimes manifests in a severe form that can lead to fatality. Here we report three cases of diclofenac-induced ADRs with varied cutaneous manifestations.

Background: Diabetes mellitus (DM) is a long-term metabolic disease marked by elevated blood glucose levels, resulting from inadequate insulin production, resistance to insulin effects, or a combination of both. The interplay between diabetes and cardiovascular health is particularly important in the context of diastolic dysfunction, a precursor to heart failure with preserved ejection fraction (HFpEF). Objective: This study investigates the occurrence of diastolic dysfunction in individuals newly diagnosed with type 2 diabetes mellitus (T2DM) and examines its association with glycosylated haemoglobin (HbA1c), a key indicator of long-term blood glucose regulation. Methods: The prospective non interventional study was conducted for one year duration on 52 newly diagnosed type 2 diabetes mellitus aged between 18 to 60 years. ECG, 2D ECHO, FBS, PPBS, HBA1C was done. The study was conducted on the basis of presence of diastolic dysfunction on echocardiography. Quantitative data was analysed with the help of ‘t’ test and qualitative data with the Chi Square and Fisher Exact Test. Statistical significance was taken as P < 0.05. Results: Among 52 participants, individuals aged ≤55 years, only 5 (22.7%) had LV diastolic dysfunction, while among those older than 56 years, a substantial 24 (80.0%) had LV diastolic dysfunction. The distribution based on gender shows equal prevalence of LV diastolic dysfunction among both males and females. Among individuals with HbA1c <6.4%, 4 (50.0%) had LV diastolic dysfunction, while those with HbA1c ≥6.5%, a larger proportion, 25 (56.8%), had LV diastolic dysfunction. Among individuals with FBS <125 mg/dL, 9 (42.9%) had LV diastolic dysfunction, while those with FBS ≥126 mg/dL, 20 (64.5%) had LV diastolic dysfunction. Among individuals with PPBS <200 mg/dL, 10 had LV diastolic dysfunction, while those with PPBS ≥200 mg/dL, 19 had LV diastolic dysfunction. Conclusion: Left ventricular diastolic dysfunction (LVDD) is frequently present in newly diagnosed, normotensive type 2 diabetes mellitus (T2DM) patients, indicating that subclinical cardiac involvement may start early in the disease course. Implementation of early cardiac evaluation, combined with stringent glycemic control and lifestyle modifications, may potentially delay or prevent the progression to overt heart failure in diabetic individuals.

Background: Cardiotocography is a fetal surveillance modality used to detect fetal hypoxia and help reduce perinatal morbidity and mortality. Abnormal findings on CTG can lead to early intervention and improve perinatal outcomes. Methods: This was an observational study where 94 low-risk pregnant patients with abnormal CTG tracings were selected. All of them underwent emergency caesarean section. Perinatal outcome was measured by noting APGAR scores at 1 minute and 5 minutes and the need for NICU admission. Results: Out of the 94 patients, 42 (44.6%) were ≤25 years and 52 (55.4%) were >25 years. Primigravida accounted for 64 (68%) and multigravida 30 (32%). Gestational age was <37 weeks in 21 (22.3%) and ≥37 weeks in 73 (77.6%). There were 52 (55.4%) male babies and 42 (44.6%) female babies. Birth weight was <2.5 kg in 26 (27%) and ≥2.5 kg in 68 (73%). APGAR scores at 1 minute were ≥7 in 89 (95%) and <7 in 5 (5%). At 5 minutes, APGAR scores were ≥7 in 90 (96%) and <7 in 4 (4%). NICU admission was required for 57 (60%) babies. CTG findings were suspicious in 61 (65%) and abnormal in 33 (35%). NICU admission was noted in 22 (23.4%) of the abnormal CTG group and 35 (37.3%) of the suspicious CTG group. No statistical significance was found in the association between CTG findings and NICU admission (p=0.247) or between CTG findings and low APGAR scores at 1 minute (p=0.353) and 5 minutes (p=0.304). Conclusion: The study showed that while CTG abnormalities lead to emergency interventions, they do not necessarily predict poor immediate neonatal outcomes. The association between abnormal CTG findings and NICU admission or low APGAR scores was not statistically significant. Further research with larger sample sizes is needed to explore these associations more definitively.

Background: To Assess The Prevalence, Severity, And Long-Term Impact Of Thyroid Dysfunction Following Intensity-Modulated Radiotherapy (Imrt) In Patients With Non-Thyroidal Head And Neck Cancers And To Evaluate The Potential Need For Routine Thyroid Function Monitoring In This Patient Population. Methodology: This study is a prospective cohort study conducted at a single tertiary care institute, specifically the Radiotherapy Department of Government General Hospital (GGH), Guntur. The primary aim of this study is to assess the incidence and pattern of thyroid dysfunction following Intensity-Modulated Radiotherapy (IMRT) in patients with non- thyroid head and neck cancers. A total of 70 patients with non-thyroid head and neck squamous cell carcinoma (HNSCC) were prospectively evaluated for thyroid dysfunction following radiation treatment. Results:  In this prospective study 70 patients with non-thyroid head and neck squamous cell carcinoma (HNSCC) were recruited. Of these 70 patients, 8 patients (11.4%) developed subclinical hypothyroidism following treatment, whereas 62 (88.6%) retained normal thyroid function during the follow-up period. Median period for the development of the subclinical hypothyroidism is 3 months. Results were observed. Conclusion:  In conclusion, the study strongly advocates for early and sustained thyroid function monitoring post-radiotherapy, even in asymptomatic patients. Detecting subclinical hypothyroidism early opens a window for potential intervention before clinical symptoms arise. Future research should aim to explore long-term outcomes with larger sample sizes, integrate autoimmune and endocrine markers, and optimize radiation planning to mitigate risks. Such efforts are essential for improving survivorship quality and reducing the burden of preventable late effects in cancer care.

Background: Proximal humerus fractures make up about 5% of all fractures, with a higher occurrence in older adults due to osteoporosis. Non-displaced fractures can be treated with conservative methods, but displaced fractures need surgery. Two main fixation methods, locking plates and intramedullary nails, are commonly used in orthopedic practice, but there is still debate about which is more effective. Locking plates offer better control in the metaphysis with fixed-angle constructs, while intramedullary nails provide biological fixation with less disruption to soft tissue. This study aimed to compare functional outcomes, complication rates, and radiological union between these two techniques in an Indian population. Methods: A prospective comparative cohort study was carried out over 18 months at the Department of Orthopedic Surgery from January 2023 to June 2024. Seventy-five patients with displaced proximal humerus fractures (Neer classification II-IV) were assigned to either locking plate fixation (n=37) or intramedullary nail fixation (n=38). We measured functional outcomes using the Constant-Murley Score and the American Shoulder and Elbow Surgeons (ASES) score at 6 weeks, 3 months, 6 months, and 12 months. Secondary outcomes included the rates of radiological union, complication rates, need for revision surgery, and time to union. We performed statistical analysis with independent t-tests for parametric data, Mann-Whitney U tests for non-parametric data, and Chi-square tests for categorical data (p < 0.05). Results: At 12 months, the mean Constant-Murley score was 76.2±8.4 for the locking plate group and 74.8±9.1 for the intramedullary nail group (p=0.436). The ASES scores were 78.4±7.6 for locking plates and 76.9±8.3 for intramedullary nails (p=0.352). Radiological union was seen in 94.6% of locking plate cases and 92.1% of intramedullary nail cases (p=0.601). Varus collapse occurred in 8.1% of locking plate cases compared to 5.3% for intramedullary nails (p=0.486). Revision surgery was necessary for 5.4% of the locking plate group and 7.9% of the intramedullary nail group (p=0.512). Both groups showed similar functional recovery and acceptable complication rates. Conclusion: Both locking plate and intramedullary nail fixation are effective surgical options for displaced proximal humerus fractures, with similar functional outcomes and complication rates. Treatment should be tailored to the individual, considering fracture complexity, bone quality, and the surgeon’s expertise. These results support using both techniques as primary surgical options in Indian orthopedic practice, providing evidence-based outcomes that facilitate a return to daily activities and work.

Background: The ascites analysis provides the etiology of portal hypertension, and elevation of the serum ascitic albumin gradient (SAAG) shows the accuracy of portal hypertension. Method: 90 adult patients with liver disease were studied. USG was carried out for the diagnosis of cirrhosis of the liver. Blood examination included CBC, liver function test, a renal function test, and a coagulation profile; Child-Pugh scores were calculated for severity of disease, and paracentesis of ascitic fluid was performed. Ascitic fluid was analyzed for SAAG calculation. Results: In the study of esophageal varices, the grading of esophageal varices had a significant p-value (p<0.001). Apart from the elevation of SAAG serum albumin (g/dl), bilirubin (mg/dl) levels also increased. Conclusion: The present pragmatic study shows there is a strong correlation between SAAG and the presence and severity of esophageal varices in patients with chronic liver disease having portal hypertension.

Background: Competency-based medical education (CBME) has highlighted the importance of formative assessment methodologies that evaluate real-time clinical performance. Traditional assessment methods frequently fail to assess critical qualities like communication, professionalism, and clinical reasoning during actual patient encounters. Mini-Clinical Evaluation Exercise (Mini-CEX) is a systematic workplace-based assessment method that aims to close this gap. Objectives: The present study was conducted to introduce Mini-CEX as a formative assessment tool for MBBS interns during their dermatology posting. The study also aimed to assess the impact of Mini-CEX on interns’ clinical competencies, including history taking, examination, clinical judgment, communication skills, and professionalism. Additionally, the perceptions of interns and faculty regarding the usefulness and feasibility of Mini-CEX were evaluated. Methods: A prospective interventional study was conducted among MBBS interns posted in the Department of Dermatology. Interns underwent multiple Mini-CEX encounters using a standardized assessment proforma. Scores from initial and subsequent encounters were compared and feedback responses were analyzed. Results: There was a statistically significant improvement in mean Mini-CEX scores across all assessed domains after repeated encounters. Interns and faculty reported high satisfaction with Mini-CEX, particularly highlighting its role in improving clinical confidence and feedback-based learning. Conclusion: Mini-CEX is an effective, feasible, and acceptable formative assessment tool for MBBS interns in dermatology, contributing significantly to competency development.

Background: Tuberculosis (TB) remains one of the most significant infectious diseases globally, with inflammatory markers serving as potential indicators of disease severity and treatment response. Aim and Objectives: To compare the levels of hs-CRP, ESR, WBC, LDH, and procalcitonin between patients with drug-sensitive pulmonary tuberculosis (DS-PTB) and rifampicin-resistant pulmonary tuberculosis (RR-PTB) before and after two months of anti-tubercular therapy (ATT) under NTEP guidelines. Materials and Methods: A prospective comparative study was conducted from March 2025 to September 2025 including 70 DS-PTB and 68 RR-PTB patients. Baseline and 2-month inflammatory markers were analyzed. Statistical tests included Shapiro-Wilk, Mann-Whitney U, independent t-test, paired t-test/Wilcoxon signed-rank test, Chi-square/Fisher’s exact test, and Spearman correlation. A p-value <0.05 was considered statistically significant. Results: Baseline inflammatory markers were higher in the RR-PTB group compared to DS-PTB (p>0.05 for most). After two months of ATT, both groups showed a decline in hs-CRP, ESR, LDH, and procalcitonin, though not statistically significant (p>0.05). No significant correlation was observed between post-therapy inflammatory markers and treatment type. Conclusion: The study found no statistically significant improvement in inflammatory markers after two months of therapy in either arm, suggesting that short-term biochemical response may not directly correspond with microbiological improvement.

Background: Language models based on artificial intelligence (AI) are being looked into more and more as clinical support tools to make healthcare more efficient and help with decision-making. Their function in resource-constrained hospital environments is still insufficiently researched. Objectives: To assess the feasibility, usability, and safety of an AI-based language model as a supervised clinical support tool in a resource-constrained Indian hospital. Methods: This prospective observational study was carried out over two years (2023–2025) at Hariram Hospital, Motihari. About 200 clinical contacts, both inpatient and outpatient, were evaluated. The AI tool was utilised with the help of a doctor to help with paperwork, support differential diagnosis, and teach patients. The results were better workflow, less time spent on paperwork, happier doctors, and fewer safety incidents. Results: The AI technology cut down on the time it took to write reports and made clinical notes clearer. There were no bad clinical events associated to AI. Doctors were very happy with the service. Conclusion: Using an AI-based language model under supervision is possible and helpful in hospitals with few resources, as it makes things more efficient without putting patients at risk.

Background: Pregnancy-induced hypertension (PIH) represents a significant obstetric complication affecting maternal and fetal outcomes. Regional anaesthesia has emerged as the preferred modality for labour analgesia in these patients, offering potential benefits in blood pressure modulation and stress response attenuation. However, careful consideration of haemodynamic implications and coagulation status is essential. Methods: This prospective observational study was conducted at a tertiary care hospital over 18 months, enrolling 156 parturients with PIH requiring labour analgesia. Participants were categorized into epidural analgesia (Group E, n=82) and combined spinal-epidural analgesia (Group CSE, n=74). Haemodynamic parameters, analgesic efficacy, maternal complications, and neonatal outcomes were assessed. Results: Mean arterial pressure demonstrated significant reduction following regional anaesthesia initiation in both groups (Group E: 112.4 ± 8.6 to 94.2 ± 7.3 mmHg; Group CSE: 114.1 ± 9.2 to 91.8 ± 6.9 mmHg; p<0.001). Pain scores decreased significantly from baseline (7.8 ± 1.2 to 2.1 ± 0.9; p<0.001). Hypotension occurred in 14.6% of Group E versus 23.0% of Group CSE patients (p=0.042). No cases of post-dural puncture headache or neurological complications were observed. Neonatal Apgar scores at 5 minutes were comparable between groups (8.7 ± 0.6 vs 8.5 ± 0.7; p=0.108). Conclusion: Regional anaesthesia provides safe and effective labour analgesia in PIH patients with favourable haemodynamic profiles. Epidural analgesia demonstrated greater haemodynamic stability compared to combined spinal-epidural technique, suggesting its preference in moderate-to-severe PIH cases.

Introduction: Oxytocin has essentially been used to prevent uterine atony in pregnant females. However its administration should be done cautiously as it is associated with certain hemodynamic altercations. Moreover, there is associated desensitisation of its receptors. Therefore, in our study we compared changes in heart rate and mean arterial pressure that occur after administration of two different doses of 1 and 3 units of IV oxytocin bolus. Additionally, we studied the adequacy of subsequent uterine contractions and need for additional uterotonic agents along with any adverse events. Material and Methods: Pregnant women posted for elective LSCS under spinal anaesthesia and those meeting the inclusion criteria were recruited for the study. They were randomly divided into two groups of 52 each and were given 1 unit and 3 unit of oxytocin bolus respectively followed by regular oxytocin infusion of 10units/hour by adding 20 units of drug in 500ml of 0.9% NS after delivery of baby. Hemodynamic parameters HR, SBP, DBP and MAP were recorded and compared to baseline. Uterine tone adequacy was checked at 2,5 and 15 minutes. Use of any additional uterotonic drugs and any adverse effects were noted. Results: Better uterine tone was achieved in the group that was administered 3 units of oxytocin bolus. The need for rescue uterotonics was observed with the 1 unit bolus group and none of the participants in 3 units group required them. Hemodynamic variations in SBP, DBP, MAP and HR were observed in the 3 unit’s bolus group. There was no significant difference in the adverse effects of nausea and vomiting in the two groups. Conclusion: 3 units of oxytocin bolus followed by infusion of 10 units per hour could provide satisfactory uterine tone with minimal hemodynamic changes and adverse effects.

Background: Attitude, Ethics and Communication (AETCOM) is the formal affective domain spine as part of competency-based undergraduate medical education in India but the translation of AETCOM into the classroom highly depends upon the faculty readiness. In many educational establishments, there is faculty report of uncertainty in relation to AETCOM competences, teaching/learning practices and assessment practices resulting in variability in their implementation. Methods: A single-group quasi-experimental study was carried out in Chhindwara Institute of Medical Sciences, Chhindwara, MP, and India. Faculty involved in undergraduate teaching were enrolled for a 3-day structured Faculty Development Programme (FDP) on AETCOM. Understanding was evaluated by using a 30 questions AETCOM Faculty Understanding Questionnaire (AFUQ; score range 0-120) and a 25 questions knowledge test (0-25), at baseline (T0), immediately post FDPs (T1) and at 12 weeks (T2). Secondary outcomes were self-efficacy for facilitation and assessment (10-item scale, 10-50) and implementation products (session plans, assessment blueprints). Paired comparisons and repeated measures analyses were conducted; effect sizes were reported. Results: Of 54 eligible faculty, 48 participated (mean age 38.9±7.6 yrs; 54.2% female). Mean, AFUQ increased during and was maintained at T1 (58.1±10.9 at T0 vs. 94.7±9.8 at T1 and 88.3±10.7 at T2) and remained significant (p<0.001; ηp2=0.62). Knowledge of 19.8±2.7 were increased from 11.3±3.4 (P<.001; Cohen’s d=2.79). Self-efficacy improved from 27.6±5.9 to 40.9±4.8 (p<0.001). Faculty developed 36 AETCOM micro-session plans and a common assessment blueprint focusing on workplace-based assessment and embodied writing addressing previously reported issues of dependence on written exam Conclusion: A structured FDP led to large and sustained gains in faculty understanding and readiness to implement AETCOM. Institutionalization of longitudinal mentoring and assessment support could yield a ‘solidification and decrease of variability’ effect.

This study aims to evaluate the hearing improvement in patients undergoing ossiculoplasty with total ossicular replacement prosthesis (TORP). The correlation between posterior canal wall status and hearing outcomes have also been analysed. Preoperative and postoperative audiometry results were analysed alongside patient demographics and complications. Out of 30 patients, 27 patients showed significant hearing improvement with an average of 25dB. Hearing improvement is better at lower frequencies when compared to higher frequencies. Even though presence of posterior canal wall did not show any significant impact on hearing, larger sample size may be needed to generalise this observation. The study highlights the significance of surgical techniques, patient selection, and ossiculoplasty technique in improving auditory outcomes. The findings are particularly relevant in the Indian context, where resource limitations, anatomical variability and high prevalence of complicated cases pose unique challenges.

Background: Lifestyle behaviours such as physical activity, sedentary time and sleep play a central role in the management of Type 2 diabetes. Advances in smartphone technology now allow continuous, real-world monitoring of these behaviours at scale. While overall physical activity has a well-established relationship with glycemic control, less is known how the patterning of sedentary behaviour, sleep regularity and routine post-meal walking influence long-term glycemic outcomes and cardiometabolic risk. Objectives: To evaluate whether smartphone-derived sedentary bout length, daily step count, post-meal steps, and regularity predict 12-month change in HbA1c and incident metabolic syndrome among overweight and obese adults. Methods: We conducted a 12 months observational cohort study of 252 adults (18-60 years) with type 2 diabetes using smartphone-based activity and sleep tracking. Average Sedentary bout length (minutes), daily steps, post-meal steps and sleep regulatory score were derived from passively collected smartphone data. Clinical measurements included baseline and 12-month HbA1c and 12 month metabolic syndrome status. Sleep regularity was assessed using the Sleep Regularity Questionnaire (SRQ). For Aim 1, we fit a multivariable linear regression with 12-month HbA1c change as outcome and sedentary bout length as primary predictor, adjusted for age, sex, BMI, baseline HbA1c, and daily steps. For Aims 2 and 3, we used multivariable logistic regression models with incident metabolic syndrome at 12 months as outcome and sleep regularity (Aim 2) or post-meal steps (Aim 3) as primary predictor, adjusting for age, sex, BMI, baseline HbA1c, and daily steps. Results: Longer sedentary periods were independently linked to less favorable HbA1c changes. Each extra minute in average sedentary bout length was associated with about 0.002 percentage point higher HbA1c over 12 months (β) 0,0021, 95% CI roughly 0.001-0.003, p < 0.001) after adjustment. This means a 0.06 percentage point increase in HbA1c over 12 months for a 30-minute difference in sedentary bout length. In contrast, sleep regularity score was not significantly connected with incident metabolic syndrome at 12 months in adjusted logistic regression (odds ratio near 1.0, 95 % CI including 1). Similarly, post-meal steps showed no statistically significant protective link with incident metabolic syndrome after adjustment. Conclusions: In this smartphone-based cohort of adults with diabetes, longer sedentary bouts, independent of total daily steps, predicted worse 12-month HbA1c trajectories. Sleep regularity and post-meal stepping were not clearly associated with incident metabolic syndrome, though limited power and measurement error may have influenced results. Targeting interruptions in sedentary periods could be a practical focus for digital health interventions aimed at improving glycemic control control.

Background: Scaphoid fractures are common carpal injuries with a high propensity for nonunion and long-term functional impairment. Surgical fixation using open reduction internal fixation (ORIF) or percutaneous fixation is widely employed, yet the optimal approach remains debated. Objectives: To compare functional outcomes of scaphoid fractures treated with ORIF versus percutaneous fixation. Methods: This retrospective comparative study was conducted at the NRI Institute of Medical Sciences, Sangivalasa, Visakhapatnam. Records of 30 patients treated surgically over two years were reviewed. Functional outcomes, union rates, and complications were analyzed. Results: Both techniques achieved satisfactory union. Percutaneous fixation allowed earlier functional recovery, whereas ORIF was effective for displaced fractures. Final functional outcomes were comparable. Conclusions: Both techniques are effective, surgical approach should be individualized based on fracture characteristics.

Introduction: The sickle cell anaemia is defined as a hemoglobinopathy due to a single point mutation in the beta-chain of human haemoglobin. The homozygous inheritance of this mutation produces haemoglobin SS and heterozygous forms stands for sickle cell trait. Individuals with this Hb-SS genotype suffer from sickle cell anaemia. Methodology: Total 120 patients are included in study and the study design is observational cross sectional study. Patients having sickle cell disease (homozygous for HB-SS type) have been assessed for haematological profile like Complete blood count by Sysmex 3 part analyser and biochemistry tests like Liver function test, Serum LDH, Renal function tests, these all biochemistry tests have been assessed by using EM-200 fully automated chemistry analyser. Result: Out of 120 cases in 85 patients (70.84%) values for total bilirubin are elevated. In remaining 35 patients (29.16%) of sickle cell disease total bilirubin is within normal limit. Mean value for total bilirubin is 1.8 mg%. Here in study out of 120 cases of sickle cell disease 62(51.66%) patients have serum creatinine in normal range while 58(48.44%) patients value are not in normal range. Mean value for serum creatinine is 1.18 mg%. Out of 120 patients 106(88.4%) patients have s. urea in normal range while only 14(11.6%) patients have abnormal value for serum urea. Mean for serum urea is 24.48 mg%. Conclusion: It has been observed that parameters of liver function test are elevated because of event of hemolysis which happens to sickle cell disease patients. In present study 67.5%, 78.3%, 87.5% and 70.84% cases have elevated values for SGOT, SGPT, S.ALP and serum total bilirubin respectively. There is also seen that renal function is not that much altered as compared to liver function and the data suggests that by only 11.6% cases and 48.4% cases have elevated values for S. urea and S. creatinine respectively.

Background: The Competency-Based Medical Education (CBME) curriculum introduced by the National Medical Commission emphasizes the AETCOM (Attitude, Ethics, and Communication) module to foster humanistic qualities in medical students. Integrating AETCOM into preclinical subjects like Physiology may enhance students’ ethical sensitivity, empathy, and communication skills, which are not effectively assessed through traditional examinations. Objectives: To integrate selected AETCOM modules into the first-year MBBS Physiology curriculum and evaluate their impact on students knowledge, communication skills, attitudes, and perceptions. Methods: A cross-sectional mixed-methods study was conducted among 100 first-year MBBS students at a tertiary medical college (June–December 2024). Two, AETCOM modules—what does it mean to be a patient? & Doctor–Patient Relationship—were integrated with relevant Physiology topics. Sessions employed small-group discussions, role plays, simulated encounters, and reflective journaling. Assessment included pre-/post-tests, OSCEs with a 3-point rubric, reflective writing evaluated by a 5-criteria rubric, and structured feedback on a 5-point Likert scale. Quantitative data were analyzed descriptively; qualitative reflections underwent thematic analysis. Results: Mean knowledge scores improved significantly from 61.3 ± 9.2 to 79.6 ± 7.8 (p < 0.001). In OSCEs, 68% of students performed satisfactorily and 22% exemplarily in communication and empathy skills. Reflective writings showed 54% analytical and 28% critical reflections, highlighting themes of enhanced empathy, ethical sensitivity, and professional identity formation. Student feedback indicated high satisfaction: 94% reported increased empathy, 91% improved communication skills, and 96% recommended broader AETCOM integration. Conclusion: Embedding AETCOM modules within Physiology effectively enhanced cognitive learning while strengthening empathy, ethical understanding, and communication skills. This integrative model is feasible, well-received, and supports early professional identity development in line with CBME goals. Broader implementation across preclinical subjects is recommended.

Introduction: Thyroid hormones are secreted from the thyroid gland, an important endocrine organ. These hormones are important in regulating metabolism, growth, weight, and thermogenesis. Kashmir is a part of the Himalayan belt of India, where the soil is deficient in iodine. The prevalence of thyroid disorders in Kashmir Valley are rising at an alarming rate. The study was carried out to determine the normal physiological range of thyroid hormones (TSH, T3, and T4) in normal, euthyroid subjects of ethnic Kashmiri origin. This would aid in the screening, diagnosis, and treatment of various thyroid disorders. Methods: In this study, 400 healthy volunteers falling in the age group 20-60 years were enrolled and their serum TSH, T3, and T4 levels were assessed after taking proper history and general physical and systemic examination. Results: We found that the TSH levels ranged from 0.27-4.20μIU/ml, T3 levels were 0.50-1.80 ng/ml, and T4 levels were 5.30-13.60 μg/dl in the study subjects. There was no significant difference in thyroid hormone levels with respect to the age and sex of the study participants. Conclusion: the results show that the range of serum TSH, T3, and T4 levels in the Kashmiri population is in close agreement with the range established in the other populations. Larger sample sizes of studies need to be carried out to better understand the reference range in the population. Also, we recommend including free T3, and free T4 levels to be assessed.

Introduction: Workplace-based assessment has gained importance in postgraduate medical education as it allows evaluation of clinical performance in real-life settings. The Mini-Clinical Evaluation Exercise (Mini-CEX) is a structured assessment tool that involves direct observation of clinical encounters and provision of immediate feedback, which may enhance learning and professional development. Its educational impact in psychiatry residency training warrants evaluation. Aim: To assess the educational impact of introducing the Mini-Clinical Evaluation Exercise (Mini-CEX) on psychiatry residents. Materials and Methods: This prospective observational educational study was conducted in the Department of Psychiatry at a tertiary care teaching hospital in Jaipur, India, after Institutional Ethics Committee approval. Ten first- and second-year psychiatry residents were included after obtaining informed consent. Faculty members were sensitized and trained in the use of Mini-CEX. Each resident underwent five Mini-CEX encounters involving patients of moderate clinical complexity. Residents were assessed across seven domains using a 9-point rating scale. Perceptions of residents and evaluators were collected using validated questionnaires. Data were analysed using descriptive statistics with SPSS version 24. Results: Among the residents, 70% rated the Mini-CEX experience as satisfactory and 30% as just satisfactory. Progressive improvement was observed across successive encounters. Resident satisfaction scores increased from 5.5 in the first encounter to 7.2 by the fifth encounter, while evaluator satisfaction scores increased from 6.0 to 8.1, which was statistically significant (p<0.05). Residents reported improvement in communication skills, history taking, and clinical examination, along with appreciation for immediate feedback. Conclusion: Mini-CEX is a feasible, acceptable, and effective formative assessment tool for psychiatry residents. Its implementation in routine clinical settings has a positive educational impact and contributes to improvement in multiple clinical competency domains.

Introduction: Adenocarcinoma of the prostate may be clinically suspected based on elevated serum PSA (Prostate Specific Antigen) and/or abnormal digital rectal examination. Patients with high S/PSA are at  increased risk of advanced carcinoma prostate and screening at an earlier stage would help to manage it accordingly. The aim of this study is to determine association between pretreatment serum prostatic specific antigen (PSA) levels and Gleason grade group in prostatic adenocarcinoma patients. Material and Method: A total 50 prostatic carcinoma cases were studied in this hospital based cross sectional study carried out in the department of pathology, Gauhati Medical College and hospital. Trans rectal ultrasound (TRUS) guided biopsy specimen sent from urology and renal transplant department were processed for H&E stain and studied histomorphologically. Adenocarcinoma cases were assigned Gleason score and Gleason grade group. Pretreatment serum PSA level is correlated with Gleason grade group using chi square test, a  P value of <0.05 was considered statistically significant. Result: all 50 cases were adenocarcinoma. The mean PSA level 77.38±49.14 ng/ml. Grade group 1 was seen in 5(10%) cases, Grade Group 2 was seen in 11(22%) cases grade group 3 was seen in 22(44%) cases, Grade group 4 was seen in 5(10%) cases and grade group 5was seen in 7(14%) cases. A statistically significant correlation was found between pretreatment serum PSA level and Gleason Grade Group (P<0.028). Conclusion: Carcinoma of prostate associated with an elevated serum PSA level is more likely to be of higher grade than carcinoma with normal PSA levels.

Introduction: Several human viruses contribute directly or indirectly to lymphomagenesis by driving chronic antigenic stimulation, immune evasion, oncogenic signaling, and/or genomic instability. Epstein–Barr virus (EBV), Kaposi sarcoma herpesvirus (KSHV/HHV-8), human T-cell leukemia virus type 1 (HTLV-1), hepatitis C virus (HCV), and HIV (largely via immune dysregulation and cooperation with EBV/KSHV) represent the most clinically relevant viral associations in modern lymphoma classification. Materials and Methods: A structured narrative review was performed using recent WHO/ICC classifications and post-2015 peer-reviewed literature addressing viral mechanisms, diagnostic approaches (histopathology, EBER-ISH, IHC, PCR/viral load, serology), and therapeutics including antivirals, immunotherapy, and adoptive cellular therapy. Results: Viral-associated lymphomas show recognizable clinicopathologic patterns: EBV-associated B/T/NK lymphomas and PTLD; KSHV-driven primary effusion lymphoma and HHV8-associated large B-cell lymphomas; HTLV-1–driven adult T-cell leukemia/lymphoma; HCV-associated indolent B-cell lymphomas with potential regression after direct-acting antiviral therapy; and HIV-associated lymphomas influenced by immune suppression and high EBV/KSHV burden. Key therapeutic opportunities include etiologic viral suppression (HCV DAAs), immune reconstitution, targeted antibodies, checkpoint blockade in selected EBV-associated entities, and EBV-specific T-cell therapy (e.g., tabelecleucel) for EBV+ PTLD. Conclusion: Integrating viral testing into lymphoma diagnostics improves classification, prognostication, and enables mechanism-based therapy—particularly antiviral cure for HCV-related lymphomas and cellular immunotherapy for EBV+ PTLD.

Background: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with vitamin D deficiency, which may worsen lung function and exacerbate disease severity. Forced Vital Capacity (FVC) is a major indicator of pulmonary performance. Objective: To evaluate the relationship between serum vitamin D levels and FVC among COPD patients in a tertiary care hospital. Methods: A prospective study was conducted over 12 months involving 50 stable COPD patients. Serum 25-hydroxyvitamin D [25(OH) D] levels were measured and categorized into deficient (<20 ng/mL), insufficient (20–30 ng/mL), and sufficient (>30 ng/mL). FVC (% predicted) was assessed using spirometry. Results: Of 50 patients, 32 (64%) had vitamin D deficiency, 12 (24%) had insufficiency, and 6 (12%) had sufficient levels. Mean FVC was significantly lower in vitamin D–deficient patients (56.8 ± 9.4%) compared to insufficient (63.2 ± 8.1%) and sufficient groups (70.1 ± 7.3%) (P < 0.01). A positive correlation was observed between serum vitamin D and FVC (r = 0.52, p = 0.001). Conclusion: Lower vitamin D levels are significantly associated with reduced FVC in COPD patients. Screening and correction of vitamin D deficiency may improve lung function outcomes.

Background: Tuberculosis remains a major public health problem in developing countries, with pulmonary being most common and extrapulmonary involvement contributing significantly to morbidity. Ocular tuberculosis, though often underdiagnosed, can lead to visual impairment if not detected and treated early. Understanding the pattern and determinants of ocular involvement is essential for timely intervention. Objectives: To evaluate the prevalence and pattern of ocular manifestations in patients with tuberculosis, assess associated visual impairment, and determine the relationship between disease duration and ocular involvement. Materials and Methods: This cross-sectional study was conducted at a tertiary care centre in South Gujarat from April 2023 to October 2024. A total of 167 patients with tuberculosis were included. All patients underwent a detailed ophthalmic examination, including visual acuity assessment, slit-lamp biomicroscopy, and fundus evaluation. Data were analyzed using SPSS version 20. Associations between categorical variables were assessed using the chi-square test, with a p value <0.05 considered statistically significant. Results: Ocular manifestations were observed in 33 patients (19.8%). Posterior segment involvement was more common than anterior segment involvement, with choroiditis (36.4%) being the most frequent manifestation, followed by retinitis (21.2%) and retinal vasculitis (15.2%). Visual impairment was present in 42.4% of patients with ocular tuberculosis. No significant association was found between gender and ocular involvement or visual impairment. A statistically significant association was noted between longer duration of tuberculosis and the presence of ocular manifestations (p = 0.042). Conclusion: Ocular involvement was present in a substantial proportion of tuberculosis patients, particularly in those with prolonged disease duration. Posterior segment manifestations were the main contributors to visual impairment. Routine ophthalmic screening in tuberculosis patients, especially those with long-standing disease, may facilitate early diagnosis and help prevent irreversible visual loss.

Introduction: Catheter-associated bacteriuria (CA-bacteriuria) is the presence of significant bacterial growth in the urine of patients who are currently or recently catheterized, with or without urinary symptoms. When symptoms are present, termed a catheter-associated urinary tract infection (CAUTI). CAUTI is the most prevalent healthcare-associated infection worldwide, primarily linked to the widespread and often inappropriate use of urinary catheters in hospitals and long-term healthcare facilities. Aim and Objectives: 1) To identify urinary pathogens and assess their antimicrobial resistance patterns in catheterized patients. 2) To determine the rate of CA-bacteriuria. 3) To explore the relationship between CA-bacteriuria and high-risk clinical conditions. Methodology: The study analyzed 682 urine samples from patients catheterized for over 48 hours (June 2022–May 2023), processing them per standard protocols, with pathogen identification and antibiotic susceptibility testing performed using the VITEK 2 Compact system. Results: Catheter-associated bacteriuria was detected in 132 patients (19.35%), with gram-negative bacilli accounting for 61.36% of isolates, predominantly Escherichia coli (21.21%). The highest prevalence was observed among male patients and individuals aged 50 years or older, with diabetes emerging as the most frequent associated risk factor. In most cases, catheterization duration was under 10 days. E. coli isolates showed complete susceptibility to colistin, while Candida species demonstrated 100% sensitivity to micafungin. Conclusion: Catheter-associated bacteriuria is a significant healthcare issue. Key factors include age, diabetes, catheter duration, and antimicrobial resistance. Colistin effectively treats gram-negative bacteria, while Vancomycin, Daptomycin, Teicoplanin, and Linezolid are effective against gram-positive bacteria.

Background: Hepatitis A virus (HAV) and Hepatitis E virus (HEV) cause acute viral hepatitis in humans and are transmitted mainly through the fecal-oral route. Objective: This study was done to determine the seroprevalence of Hepatitis A virus (HAV) and Hepatitis E virus (HEV) among the patients presenting with symptoms of acute viral hepatitis (AVH) in southern Rajasthan. Setting and Design: It was a prospective observational study conducted from July 2024 to June 2025 involving patients presenting with acute viral Hepatitis visiting our tertiary care hospital. Material and Methods: The study population included 333 patients (outdoor and hospitalized) having clinical features of AVH. Serum samples collected from those patients were tested in duplicate for anti‑HAV IgM and anti‑HEV IgM antibodies using commercially available enzyme‑linked immunosorbent assay (ELISA) kits. Result: A total of 333 samples; were included in this study, out of which 133 patients were found to be positive for HAV and HEV; IgM anti HAV antibodies were detected in 132 (39.6%) serum samples tested and 1 (0.30%) serum sample was positive for IgM HEV antibodies. HAV positivity rate was significantly high among males (27.6%) in comparison to females (12.31%). HAV infection was common in all age groups and it was more prevalent in the age group between 1 to 15 years with the highest prevalence 77 (23.12%) with HAV infection Maximum number of cases were observed in the month of September and October. Conclusion: Health and civic authorities should make efforts to increase the awareness among general public, to encounter outbreak or epidemic, thereby to reduce morbidity, mortality and economic burden. The data collected through this study can be used in planning the vaccination strategies, it also emphasizes on implementation of better sanitation programme and hygiene measures in our geographical region.

Gastrointestinal motility is regulated by complex neurohormonal mechanisms involving multiple neurotransmitter systems, with serotonin and acetylcholine playing pivotal roles in modulating intestinal smooth muscle contractility. This experimental study aimed to evaluate and compare the effects of serotonergic and cholinergic agents on intestinal motility using isolated rabbit ileum preparations. The study was conducted using Dale’s organ bath assembly with ileal segments from six healthy rabbits. Contractile responses including amplitude and frequency were recorded following exposure to acetylcholine chloride (10⁻⁶M), serotonin hydrochloride (10⁻⁶M), and fluoxetine (1.4×10⁻⁵M). Basal amplitude and frequency were 5.50±2.25 mm and 8.16±2.85 contractions/min respectively. Acetylcholine significantly increased amplitude (8.00±2.75 mm, p<0.01) and frequency (13.66±4.32/min, p<0.01) compared to baseline. Serotonin produced comparable excitatory effects with amplitude of 7.41±3.20 mm (p<0.05) and frequency of 17.16±5.19/min (p<0.01). Conversely, fluoxetine demonstrated inhibitory effects, reducing amplitude to 2.58±2.01 mm (p<0.01) and frequency to 4.33±2.94/min (p<0.01). The percentage increase in frequency was highest with serotonin (110.3%) compared to acetylcholine (67.4%), while fluoxetine produced 46.9% reduction from baseline. These findings demonstrate that while direct serotonergic stimulation enhances gut motility comparable to cholinergic activation, selective serotonin reuptake inhibition paradoxically decreases intestinal contractility, potentially through receptor desensitization mechanisms. The study provides experimental evidence supporting the differential roles of serotonergic pathways in gastrointestinal physiology and has implications for understanding drug-induced gastrointestinal effects.

Background: Hip fractures in the elderly carry high morbidity and mortality, especially when several comorbidities are present, the risks rise sharply. In India, late presentations, delayed surgeries and a heavy burden of chronic diseases often lead to poorer results compared to Western countries. This study evaluated functional recovery and identified factors predicting mortality in such high-risk geriatric patients treated at a tertiary hospital in western Gujarat. Material and Methods: A prospective observational study was conducted for a year, at the Department of Orthopaedics and Medicine, at a tertiary care centre Gujarat. Patients aged ≥65 years presenting with low-energy hip fractures and having at least two major comorbidities were included. Polytrauma, pathological fractures and patients refusing surgery were excluded. Data on demographics, comorbidities, Charlson Comorbidity Index (CCI), time to surgery, laboratory parameters and type of surgery were recorded. Follow-up was done at 3, 6 and 12 months for mortality and functional assessment using Modified Harris Hip Score (MHHS) and Parker Mobility Score (PMS) in survivors. Results: Of 138 patients enrolled (mean age 78.6 ± 8.2 years, 56% female), 61% had intertrochanteric fractures. Mean CCI was 5.4 ± 1.8 and mean delay to surgery 4.9 ± 3.1 days. In-hospital mortality was 9.4%, 30-day mortality 13.8%, and one-year mortality 27.5%. On multivariate analysis, independent predictors of one-year mortality were age >80 years (p=0.002), male gender (p=0.009), CCI ≥6 (p<0.001), delay to surgery >72 hours (p=0.004), serum albumin <3.0 g/dL (OR 3.88, p=0.007) and preoperative haemoglobin <10 g/dL (p=0.012). Among survivors at 12 months (n=100), mean MHHS improved from 42.6 ± 12.4 at 3 months to 68.3 ± 16.8 at 12 months; only 38% regained pre-fracture mobility (PMS ≥7). Conclusion: One-year mortality in geriatric hip fracture patients with multiple comorbidities remains high (27.5%) in western India and is largely driven by advanced age, higher comorbidity burden, male sex, delayed surgery and malnutrition. Functional recovery is modest, with less than two-fifths returning to pre-injury mobility levels. Aggressive perioperative optimisation and reduction in surgical delay may improve survival and function.

Polycystic ovary syndrome (PCOS) is a complex endocrine metabolic disorder characterized by chronic anovulation, hyperandrogenism, and insulin resistance, affecting women of reproductive age worldwide. This study aimed to evaluate key hormonal and metabolic alterations in women with PCOS by comparing luteinizing hormone (LH), follicle-stimulating hormone (FSH), and insulin resistance (HOMA-IR) between affected women and healthy controls. A total of 400 women aged 18-45 years were enrolled in a hospital-based case control design, including 200 clinically diagnosed PCOS cases and 200 age-matched controls. Fasting blood samples were collected and analyzed for LH, FSH, fasting glucose, and fasting insulin using standardized chemiluminescent immunoassays, and insulin resistance was calculated using the HOMA-IR formula. The results demonstrated significantly elevated LH levels in PCOS subjects compared with controls, indicating altered hypothalamic pituitary regulation. FSH levels also differed significantly between the groups, reflecting possible population-specific endocrine variations. HOMA-IR values were markedly higher in the PCOS group, confirming substantial insulin resistance as a key metabolic feature of the disorder. Correlation analysis showed a positive association between LH and HOMA-IR and a negative association between FSH and HOMA-IR, highlighting the strong interaction between hormonal imbalance and metabolic dysfunction. These findings reinforce PCOS as a multifaceted condition driven by interconnected endocrine and metabolic mechanisms. The study emphasizes that early recognition of hormonal abnormalities and insulin resistance is essential for improving reproductive outcomes, preventing long-term metabolic complications, and guiding comprehensive clinical management in women with PCOS.

Background: Automated antimicrobial susceptibility testing (AST) systems such as Vitek 2 are increasingly used in diagnostic microbiology. Cefoxitin screening via Vitek 2 serves as a surrogate for mecA-mediated methicillin resistance. However, discrepancies with conventional Oxacillin susceptibility testing remain a concern. Objectives: To assess the diagnostic concordance between Vitek 2 Cefoxitin screening and Oxacillin disc diffusion in Staphylococcus aureus isolates. Materials and Methods: This cross-sectional study analyzed 604 consecutive S. aureus isolates from diverse clinical samples tested at a tertiary care hospital in Central India (January–December 2024). Cefoxitin screening was performed using the Vitek 2 Compact (AST-GP 628 cards). Oxacillin susceptibility was determined by Kirby–Bauer disc diffusion (1 µg) on Mueller–Hinton agar with 2% NaCl as per CLSI M100 (2024). Diagnostic indices were calculated using Oxacillin results as comparator. Results: Among 604 isolates, 471 (78.0%) were Cefoxitin-positive and 133 (22.0%) Cefoxitin-negative by Vitek 2.Oxacillin disc diffusion identified 386 (63.9%) resistant and 218 (36.1%) sensitive isolates. Cefoxitin-Vitek 2 screening demonstrated sensitivity 99.5%, specificity 60.1%, positive predictive value 81.5%, negative predictive value 98.5%, and overall accuracy 85.2%. Eighty-seven (18.5%) isolates were Cefoxitin-positive but Oxacillin-sensitive, while two (0.3%) were Cefoxitin-negative yet Oxacillin-resistant. Conclusion: Vitek 2 Cefoxitin screening is highly sensitive but moderately specific for MRSA detection. Discordant results underline the need for confirmatory mecA/PBP2a testing to prevent overestimation of MRSA prevalence.

Introduction: Our study is a single center study. Multicenter studies with larger number of cases of different geographic locations would provide additional insight regarding this study. More no of case-control studies are required with large sample size to determine the severity of serum bilirubin level with birth asphyxia particularly in term neonates. Additional newborn screening to be done in cases of prolonged high serum bilirubin level like hypothyroidism, G-6-PD deficiency, hemolytic anemia, Galactosemia so that it could have been intervened early, like hypothyroidism is a treatable cause which should be treated early to prevent developmental delay and hearing loss, similarly G-6- PD screening should be done to prevent hematuria and hemoglobinuria caused by drug. Material And Method: This prospective study was conducted in newborn unit of a tertiary care teaching hospital in Odisha, from August 2022 – July 2024 (2 years). All the neonates satisfying the inclusion criteria admitted to SCBMCH and SVPPGIP newborn unit were included in the study. Informed consent was taken from the parents/ guardians of all the enrolled patients for obtaining relevant history, clinical examination and performing necessary investigations. Antenatal history of mother will be collected in detail to study the relevant risk factors. The cases were then diagnosed clinically using previously established criteria for Hypoxia ischemic encephalopathy (HIE), General examination and systematic examination were done in details to establish clinical diagnosis. Result: “Incidence Of Hyperbilirubinemia In Asphyxiated Newborn In A Tertiary Care Hospital” which was an institution based prospective observational study undertaken from August, 2022 to July, 2024 in SVPPGIP and SCBMCH, Cuttack that included 80 newborns with birth asphyxia and 50 non asphyxiated neonates, satisfying the inclusion criteria. Conclusion: Birth asphyxia continues to be one of the major causes of perinatal mortality in developing nation where obstetric care and neonatal resuscitation is still in their struggling phase. Birth asphyxia is a substantial cause of unconjugated hyperbilirubinemia in newborns. Assay of total serum bilirubin and indirect serum bilirubin can be used as an easy early diagnostic marker to differentiate between babies with birth asphyxia and those without asphyxia.

Background: With the rapid proliferation of mobile phones, their impact on health, particularly auditory function, has garnered increasing attention. Prolonged exposure to electromagnetic radiation, acoustic overload, and thermal effects from mobile phone use may pose risks to hearing, especially among young adults who are frequent users. Previous studies have reported mixed findings on the association between mobile phone usage and hearing loss, with some highlighting high-frequency hearing impairments in the dominant ear. This study investigates the impact of prolonged mobile phone usage on hearing thresholds in medical students, emphasizing differences in air and bone conduction across frequencies. Objective: To evaluate the effect of prolonged mobile phone usage on hearing status and to determine the correlation between the duration of mobile phone use and auditory function. Methodology: A total of 146 medical students were included for a prospective observational study was conducted at ENT Department, PMCH, Udaipur, over a period of 1 year between March 2024 and Feb 2025 to explore the relationship between mobile phone usage and hearing status in medical students. Result: The study revealed that prolonged mobile phone usage (>60 minutes daily) was significantly associated with mild hearing loss in the right ear, commonly used for calls. Among prolonged users, 40% exhibited mild hearing loss in the right ear compared to only 1% among short-duration users (<60 minutes daily) (p < 0.0001). Air conduction thresholds showed significant elevation at 4000 Hz, with the left ear exhibiting higher thresholds than the right (p < 0.0001). Bone conduction thresholds also showed significant differences at specific frequencies, particularly 250 Hz (p = 0.038) and 4000 Hz (p = 0.004). The findings suggest that prolonged mobile phone usage contributes to high-frequency hearing impairment, particularly in the dominant ear. Conclusions: Prolonged mobile phone usage is linked to mild high-frequency hearing loss, especially in the dominant ear commonly used for calls. This study emphasizes the potential auditory health risks associated with extended mobile phone use and underscores the importance of preventive strategies, such as limiting call duration and promoting hands-free devices, to safeguard hearing among frequent users.

Background: Liver dysfunction is increasingly recognized as an important complication of type 2 diabetes mellitus and may coexist with early renal microvascular damage. Objectives: To evaluate liver dysfunction in patients with type 2 diabetes mellitus and to assess its correlation with microalbuminuria. Methods: A cross-sectional study was conducted among 120 patients with type 2 diabetes mellitus. Liver function tests, ultrasonography, glycated hemoglobin, body mass index, and urinary albumin excretion were assessed and correlated. Results: Liver dysfunction was significantly associated with longer duration of diabetes, poor glycemic control, higher body mass index, abnormal ultrasonography findings, and presence of microalbuminuria. Conclusion: Liver dysfunction is common in type 2 diabetes mellitus and shows a significant correlation with microalbuminuria, highlighting the need for integrated hepatic and renal assessment in diabetic care.

Background: Rapid urbanization and biodiversity loss are increasingly recognized as major contributors to the global epidemic of allergic diseases. Reduced environmental microbial exposure, increased air pollution, and altered lifestyle patterns associated with urban living are believed to dysregulate immune tolerance and promote allergic sensitization. Objectives: To evaluate the clinical pattern of allergic diseases in an urban population and assess the association between urban exposure indicators and allergy burden. Methods: A one-year observational study was conducted among 100 patients attending an urban allergy clinic. Demographic characteristics, clinical diagnosis, and urban exposure indicators were recorded and analyzed. Results: Allergic rhinitis was the most prevalent condition (42%), followed by asthma (25%). Higher allergy burden was observed among patients with high urban exposure. Age-wise distribution, allergy pattern, and urban exposure associations are presented in tables and figures. Conclusion: Urbanization and biodiversity loss appear to significantly influence the rising burden of allergic diseases. Integrating biodiversity conservation and urban green planning may be essential strategies to reduce allergy epidemics.

Background: Chronic kidney disease (CKD) is frequently associated with thyroid dysfunction, yet the prevalence and hormonal patterns remain inadequately characterized in the Indian population. This study aimed to determine the prevalence of thyroid dysfunction among CKD patients and evaluate correlations between thyroid hormone levels and renal function parameters. Methods: A retrospective cross-sectional study was conducted over 24 months (January 2023 to December 2024) at a tertiary care hospital. Medical records of 168 CKD patients (stages 3-5) were analyzed. Demographic data, renal function tests (serum creatinine, blood urea, eGFR), and thyroid profiles (TSH, FT3, FT4) were extracted. Thyroid dysfunction was classified based on standard reference ranges. Statistical analysis included Pearson correlation, independent t-tests, ANOVA, and multiple regression analysis with significance set at p<0.05. Results: Of 168 patients (mean age 54.6±12.3 years, 61.9% male), 72.6% had thyroid dysfunction. Low T3 syndrome was most prevalent (45.8%), followed by subclinical hypothyroidism (18.5%) and overt hypothyroidism (8.3%). FT3 showed strong positive correlation with eGFR (r=0.642, p<0.001) and significant negative correlations with serum creatinine (r=-0.598, p<0.001) and blood urea (r=-0.567, p<0.001). TSH levels showed weak negative correlation with eGFR (r=-0.243, p=0.002). Hemodialysis patients had significantly higher prevalence of thyroid dysfunction compared to conservatively managed patients (84.2% vs 63.5%, p=0.002). Thyroid dysfunction prevalence increased progressively from CKD stage 3 (58.3%) to stage 5 (86.4%). Conclusion: Thyroid dysfunction is highly prevalent among CKD patients, with low T3 syndrome being the predominant pattern. Significant inverse correlations between thyroid hormones and declining renal function suggest routine thyroid screening in CKD patients for early detection and appropriate management.

Background: Anemia remains a critical public health issue in India, particularly among adolescent girls, driven by nutritional demands of puberty and menstruation. In Gujarat, where adolescents form a significant demographic, anemia prevalence is high, influenced by socioeconomic disparities, dietary patterns, and healthcare access. Previous studies in Gujarat suggest higher rural prevalence, yet recent data are limited. This study aimed to assess anemia prevalence among adolescent girls in rural versus urban Gujarat, evaluating hemoglobin levels and associated factors to inform targeted interventions. Material and Methods: A cross-sectional study was conducted for one year among 500 adolescent girls aged 10–19 years, equally divided between rural (n=250) and urban (n=250) areas. Participants were selected via multistage random sampling from schools and community centers. Hemoglobin was measured using the cyanmethemoglobin method (anemia: <12 g/dL, WHO criteria). Data on socio demographics, diet, and menstrual history were collected via questionnaires. Ethical approval was obtained, with informed consent from guardians. Chi-square tests and logistic regression were applied using SPSS 25.0 (p<0.05). Results: Anemia prevalence was 48% overall, significantly higher in rural (56%) than urban (40%) areas (p<0.001). Mild anemia predominated (58% of cases), followed by moderate (32%) and severe (10%). Rural girls had higher odds of anemia (OR=1.89, 95% CI: 1.32–2.70), linked to lower income and limited access to iron-rich foods. Urban girls benefited from better nutrition and healthcare. Conclusion: This study highlights the need for region-specific interventions, particularly in rural Gujarat, emphasizing nutritional supplementation and education to bridge disparities. Addressing anemia will enhance adolescent health and future maternal outcomes, aligning with national nutrition goals.

Background: Congenital syphilis remains a preventable cause of perinatal morbidity and mortality, particularly in low- and middle-income countries. Despite universal antenatal screening policies, cases continue to occur due to delayed diagnosis, inadequate treatment, and poor follow-up. Artificial intelligence (AI) offers a novel approach to integrate multiple maternal risk factors for early prediction of adverse outcomes. Objectives: To develop and evaluate an AI-assisted risk stratification model for predicting congenital syphilis in pregnant women diagnosed with syphilis. Methods: A prospective cohort study was conducted among pregnant women with confirmed syphilis attending antenatal clinics of a tertiary care hospital. Clinical, demographic, serological, and treatment-related variables were collected. Machine learning models including logistic regression, random forest, and gradient boosting were developed and compared. Model performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Results: Out of 280 enrolled participants, 23 neonates (8.2%) were diagnosed with congenital syphilis. The gradient boosting model demonstrated the highest predictive accuracy (AUC 0.88), significantly outperforming conventional risk assessment. High maternal non-treponemal titers, delayed initiation of treatment, inadequate serological response, and lack of partner treatment were the strongest predictors. Conclusion: AI-assisted risk stratification improves prediction of congenital syphilis and may enable targeted antenatal interventions, optimized follow-up, and reduction of preventable adverse neonatal outcomes.

Background: Digital Health Literacy (DHL) is the ability to deal with health relevant digital information and information options with the aim of promoting and maintaining health and wellbeing of oneself and one’s environment. Preventive healthcare is critical for reducing disease burden, yet rural populations in India continue to face barriers to accessing and utilizing preventive services. Digital health literacy the ability to seek, understand, and use digital platforms for health-related purposes has the potential to bridge these gaps. However, limited evidence exists on how digital health literacy directly influences preventive care uptake in rural settings. Methods: Around100 rural participants participated in a cross-sectional study from January to June 2024. Collection methods included medical records, systematic digital usage surveys, and community health intervention records. The level of digital health literacy among participants was categorised using the Digital Health Literacy Instrument (DHLI). Based on DHLI scoring guidelines, participants were classified into low, medium, and high digital health literacy groups according to their total score distribution. Low, medium, or high digital health literacy was the independent variable. Dependent variables included immunisations, prenatal checkups, screening, and health camp attendance. Descriptive statistics described participant demographics, and chi-square tests and logistic regression investigated digital literacy and preventative care. Results: Out of 100 participants, 36% had poor digital health literacy, 44% medium, and 20% high. High and low digital literacy significantly affected immunisation (90%), prenatal visits (82% vs. 43%), and screenings (70% vs. 28%). The study found a significant association (p < 0.05) between digital health literacy and preventative healthcare use. Conclusion: Digital health literacy plays a pivotal role in improving preventive care uptake in rural Varanasi. Policy measures focused on digital training, infrastructure development, and localized awareness campaigns could substantially enhance preventive healthcare outcomes in similar rural settings across India.

Background: Antibiotics are among the most commonly prescribed medications worldwide, playing a vital role in combating bacterial infections. However, their extensive use is often associated with Adverse Drug Reactions (ADRs), which can range from mild allergic manifestations to severe life-threatening events. Understanding the frequency and pattern of antibiotic-induced ADRs is essential for promoting patient safety and guiding rational drug use. Methods: A prospective observational study was conducted over eight months (January–August 2025) involving 100 patients who developed ADRs following antibiotic therapy. Data were collected using analyzed using descriptive statistics and chi-square tests to compare ADR frequency, type, and severity across antibiotic classes. Results: Penicillins were the most frequently implicated antibiotics (32%), followed by fluoroquinolones (26%), cephalosporins (24%), and macrolides (18%). Cutaneous reactions (38%) and gastrointestinal disturbances (33%) were the most common ADRs observed. Most reactions were mild to moderate in severity, and approximately 44% were deemed preventable. A significant association (p < 0.05) was found between antibiotic class and type of ADR. Conclusion: The study highlights that while most antibiotic-related ADRs are mild and manageable, a substantial proportion are preventable through rational prescribing, improved pharmacovigilance, and better patient education. Continuous monitoring and active ADR reporting systems are imperative for enhancing antibiotic safety and minimizing adverse outcomes.

Background: Globally, neonatal sepsis is a leading cause of morbidity and mortality. In order to guide effective treatment, improve patient outcomes, and prevent the establishment of antibiotic resistance, it is essential to comprehend the bacterial profiles and antibiotic susceptibility patterns underlying neonatal sepsis. The purpose of this study is to assess the antimicrobial sensitivity pattern and bacteriological profile of neonatal sepsis. Methods: From February 2025 to October 2025, the pediatrics department at Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, conducted this prospective observational study. Ninety neonates with clinically suspected sepsis had their blood samples taken, processed according to the microbiological technique, and their antimicrobial sensitivity pattern identified. Results: Sixty-one (67.78%) of the ninety cases had positive blood cultures. There were 23 (37.71%) Gram negative isolates and 48 (78.79%) Gram positive isolates. Among the isolates, Staphylococcus aureus was the most prevalent organism (75.51%), followed by E. Coli (27.87%), Klebsiella pneumoniae (9.84%), and Streptococcus pneumonia (3.28%). Ampicillin resistance was 100% present in all three of the common isolates. Gram negative isolates were susceptible to gentamicin and meropenum, while Gram positive isolates were susceptible to amikacin, amoxicillin, and clavulenic acid. Conclusion: In this study, neonatal septicemia was found to be 67.78% supported by blood culture, which is the gold standard investigation for diagnosis. This outcome also demonstrated that the prevalence of antibiotic resistance to widely used antibiotics was rising. These two changes in the microbiological spectrum and antimicrobial susceptibility pattern shown during this investigation will undoubtedly aid in the right antibiotic treatment of such instances, hence reducing infant morbidity and mortality.

Background: The importance of zinc in treating illnesses in children, such as acute lower respiratory tract infections (ALRTIs), has been demonstrated, which has increased interest among researchers. Thus, the aim of this study was to measure serum zinc levels in ALRTI patients and correlate those levels with the disease’s clinical progression. Methods: In the hospital-based case-control study, 61 patients aged 2 months to 5 years had ALRTI along with 61 control subjects who were matched for age and diet. When a patient was admitted, their serum zinc level was measured. Details of the clinical course, including the duration of stay, oxygen requirement, severity of illness, and outcome, were recorded together with a thorough history, sociodemographic information, and examination. Results: The difference between the mean serum zinc levels of patients and controls (patients 58.88±12.40 µg/dl, Controls 85.36±16.27 µg/dl) was determined to be statistically significant (p value = 0.0001). Zinc levels and length of stay had a negative connection (r = -0.052, p value = 0.691). When compared to cases of pneumonia (WHO IMNCI grading), cases of severe pneumonia had considerably lower mean serum zinc levels (p value = 0.0001). As compared to the patients who were released, those who required higher O₂ concentrations and those who died had considerably lower mean serum zinc levels (p value = 0.0001) and respectively. Conclusion: Lower serum zinc levels are significantly associated with ALRTI and the lower the serum zinc levels; the more is the severity of disease and duration of stay in hospital for the patient, along with increased oxygen requirement and also increased incidence of mortality.

Background: Hypoglycemia is a side effect of stringent diabetes control especially in the geriatric population above sixty, who constitute approximately 90 million of the Indian population. This study was undertaken to explore the risk factors of hypoglycemia in elderly inpatients. The aim of this study was to determine the risk factors for two-term mortality in elderly patients with hypoglycemic attack in emergency room (ER). Methods: A total of 111 (41 males, 70 females) geriatric patients (>65 years) presented with hypoglycemia during a period of between October 2024 to March 2025 were included to the study. The data were obtained by screening the patients’ records in our hospital, including age, sex, laboratory parameters, co-morbidities, admission time to hospital, admission results, 15-day and 3-month mortality rates. Results: 63.1% of patients had diabetes mellitus (DM), 51.4% of patients were using OAD and 21.6% were using insulin. The blood glucose levels of the patients who died within the first 15 days after admission were lower than the patients who did not die and it was statistically significant (p=0.014). Blood urea nitrogen (BUN) and creatinin values were significantly higher in patients who died within the first 15 days after admission (p=0.002, p=<0.001). Blood calcium level and platelet (PLT) counts were significantly lower in patients who died within the first 15 days after admission (p=0.006; p=0.001). Red Cell Distribution Width (RDW) was significantly higher in patients who died in the first 15 days after admission (p=<0.001). Neutrophile count was significantly higher in both group patients who died within 15 days and 3 months (p=0.002, p=0.012). Lymphocyte count was significantly lower in patients who died within 3 months (p=0.007). The presence of coexisting DM, coronary artery disease (CAD), hypertension (HT) and malignancy and to use OAD were statistically significant in patients who died within the first 15 days. Conclusion: In this study lower glucose level, impaired renal function, lower calcium and PLT, increased RDW and neutrophile, lower lymphocyte, coexisting DM, CAD, HT, malignancy and to use OAD are risk factors for mortality of geriatric patients with hypoglycemia.

Background: Worldwide, CVD is the leading cause of death and a major cause of disability and lost productivity in adults. Hence, this study tried to Estimate the prevalence and factors associated cardiovascular emergencies and outcome in SKMCH, Muzaffarpur, Bihar. Methods: This cross-sectional study was conducted from April 2025 to September 2025 at Emergency department of SKMCH, Muzaffarpur, Bihar. Total 422 patients included with aged 15 years or more except those with uncompleted medical records. Data collected from questionnaire-based interviews with patients and medical files. Data were processed with Epi Info® 7.2.2.6 and MS Excel® 2019. Dependent variable was cardiovascular emergency regardless of the type. A multiple logistic regression model to estimate adjusted odds ratios (95% Confident interval) of the relation between cardiovascular emergencies and patients’ characteristics with a statistical significance threshold of p-value <0.05. Results: Among 422 patients included in our study, 116 had cardiovascular emergencies, prevalence of 27.5%.  68% (79/116) were over 50 years and 50.9% (59) were male. The most common personal medical history was hypertension with 50.8% (59/116). Among the 15 deaths which were recorded, one third was due to stroke, the main cause of CVD emergency (32/116, 32%). Both hypertensive crisis and heart failure concerned 46.5% (54/116) of all emergencies. History of hypertension [6,09 (3,31-11,21), p <0.0001] and age over than 50 (2.34 [1,33 – 4.10], p=0.002) were independently associated with CVD emergencies. Conclusion: Health promoting strategies targeting adequate management of high blood pressure and positive lifestyle habits in people over 50 years could help in reducing cardiovascular emergencies frequency in hospital settings.

Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus (DM), particularly in India, where high prevalence and poor control exacerbate risks of infection, gangrene, and amputation. This study correlated Wagner grades with outcomes and identified associated risk factors in a tertiary care setting. Methods: In this prospective observational study at SSG Hospital, Government Medical College, Vadodara, 40 adult patients admitted for DFU management were purposively sampled. Data on sociodemographic, DM duration/control, neuropathy, peripheral vascular disease (PVD), comorbidities, foot self-care, and Wagner grades (1–5) were collected via structured proforma, clinical exams, and labs. Outcomes included amputation rates, mortality, and hospital stay. Analysis used descriptive statistics, t-tests, and chi-square/Fisher’s exact tests (SPSS v25; p≤0.05). Results: Mean age was 57.62 years; 65% were male, 92.5% had type 2 DM (mean duration >10 years in most). Poor glycaemic control affected 60%; neuropathy (42.5%) and PVD (37.5%) were common; 95% had poor foot self-care. Amputation rates rose with Wagner grade: 0% (grades 1–2), 23.5% (grade 3), 75% (grade 4), 100% (grade 5). Neuropathy (76.5% vs. 17.4% in amputees/non-amputees; p<0.05) and gangrene (76.5% vs. 8.7%; p<0.05) significantly predicted amputation. Mortality (12.5%) occurred in advanced grades, mainly non-surgical cases due to sepsis. Conclusion: Higher Wagner grades strongly predict amputation and mortality in DFUs. Neuropathy, gangrene, prolonged DM duration, and poor control worsen outcomes. Emphasizing prevention via glycaemic management, neuropathy screening, and foot self-care education is crucial to reduce amputations in resource-limited settings.

Background: Sleep plays a vital role in physical growth, cognitive development, emotional regulation, and overall health in children and adolescents. Chronic illnesses in childhood are frequently associated with physiological, psychological, and behavioral factors that can disrupt normal sleep patterns. Despite this, sleep disturbances in children with chronic diseases often remain under-recognized and under-managed. This study aimed to compare sleep patterns and sleep-related disturbances among children and adolescents with chronic illnesses and age- and sex-matched healthy controls. Methods: A prospective, observational, cross-sectional study was conducted in the Department of Paediatrics at a tertiary care hospital. A total of 100 children aged 6–15 years were enrolled, including 50 children with chronic illnesses of more than six months’ duration (Group A) and 50 healthy controls (Group B). Sleep patterns were assessed using the Sleep Timing Questionnaire (STQ) and the Modified Sleep Disturbance Scale for Children (SDSC). Parameters evaluated included sleep latency, total sleep time, night awakenings, daytime sleepiness, and domain-specific sleep disturbances. Data were analyzed using appropriate descriptive and inferential statistical methods. Results: Children with chronic illnesses had significantly later bedtimes (22:48 ± 0.6 vs. 22:05 ± 0.5 hours), longer sleep latency (42.6 ± 18.4 vs. 24.3 ± 12.1 minutes), and shorter total sleep duration (7.1 ± 0.9 vs. 8.2 ± 0.8 hours) compared to healthy controls (p < 0.001). Disorders of initiating and maintaining sleep, excessive daytime somnolence, sleep–wake transition disorders, and sleep breathing disturbances were significantly more prevalent in Group A. Overall, 88% of children with chronic illness experienced at least one sleep disturbance compared to 42% of healthy controls. Conclusion: Sleep disturbances were significantly more common and severe among children and adolescents with chronic illnesses. Routine screening and early intervention for sleep problems should be integrated into comprehensive pediatric chronic disease management to improve health outcomes and quality of life.

Background: Dengue infection is increasingly recognized to involve the cardiovascular system, contributing to disease severity and adverse outcomes. Objective: To evaluate electrocardiographic changes and clinical cardiac manifestations in dengue patients and assess their association with warning signs, in-hospital morbidity, and mortality. Methods: A prospective observational study was conducted on 150 patients with laboratory-confirmed dengue infection. Clinical features, warning signs, ECG findings, and in-hospital outcomes were analyzed. Results: ECG abnormalities were observed in a significant proportion of patients, with sinus bradycardia being the most common finding. ECG changes showed significant association with severe warning signs such as shock, respiratory distress, and ARDS, correlating with increased morbidity. Conclusion: Cardiac involvement is common in dengue infection and is strongly associated with disease severity. Routine ECG evaluation may aid in early identification of high-risk patients and improve clinical outcomes.

Background: Doppler echocardiography is widely used for non-invasive assessment of pulmonary hypertension, but right heart catheterization remains the diagnostic gold standard. Objective: To assess pulmonary hypertension using Doppler echocardiography and evaluate its correlation with right heart catheterization. Methods: A prospective observational study was conducted in 35 patients with suspected pulmonary hypertension who underwent both echocardiography and right heart catheterization. Echocardiographic indices were correlated with invasive pulmonary artery pressures. Results: Pulmonary artery acceleration time and PAAT/RVET ratio showed strong inverse correlations with invasively measured systolic and mean pulmonary artery pressures, while TR-derived systolic pulmonary artery pressure demonstrated a strong direct correlation. Conclusion: Doppler echocardiography provides reliable estimation of pulmonary hemodynamics and serves as an effective non-invasive screening and follow-up tool, although right heart catheterization remains essential for definitive diagnosis.

Background: Chronic ulcers pose a major clinical challenge due to delayed healing and high recurrence rates. Autologous platelet-rich plasma (PRP) has emerged as a regenerative therapy capable of enhancing wound repair through concentrated growth factors. Objective: To compare the efficacy of autologous PRP and conventional dressing in reducing ulcer surface area and promoting healing in chronic ulcers. Methods: This prospective comparative study included 80 patients with chronic ulcers, randomized into PRP and control groups. Ulcer surface area was measured at baseline and at Days 14, 28, and 56, and percentage reduction was analyzed. Results: While baseline ulcer size was comparable, the PRP group demonstrated significantly greater reduction in ulcer surface area from Day 14 onward, with highly significant differences observed at Days 28 and 56 compared with the control group. Conclusion: Autologous PRP therapy significantly accelerates healing and reduces ulcer surface area in chronic ulcers compared with conventional dressing, supporting its role as an effective adjunctive treatment.

Background: Vitamin D deficiency is common in rheumatoid arthritis and may influence inflammatory activity and pain processing. Objective: To evaluate the relationship between serum vitamin D levels, disease activity, and neuropathic pain in rheumatoid arthritis patients. Methods: A cross-sectional study of 120 rheumatoid arthritis patients assessed serum vitamin D levels, DAS28 disease activity, and neuropathic pain using DN4 scores. Results: Vitamin D deficiency was significantly associated with higher DAS28 scores and increased prevalence of neuropathic pain. Conclusion: Low serum vitamin D levels are linked to greater disease activity and neuropathic pain in rheumatoid arthritis.

Background: Acute coronary syndrome is associated with inflammation and lipid abnormalities that influence plaque instability and myocardial injury. Early biomarker assessment may improve risk stratification and clinical outcomes. Objectives: To evaluate the association of high-sensitive C-reactive protein and lipid profile within 24 hours of symptom onset in patients with acute coronary syndrome. Material and Methods: A hospital-based observational study was conducted on 150 participants comprising 100 ACS patients and 50 controls. ACS patients were subdivided based on symptom onset into <6 hours and ≥6–24 hours groups. hs-CRP and lipid profile were analyzed and compared. Results: hs-CRP levels were significantly higher in ACS patients and increased with delayed presentation. ACS patients showed significantly higher triglycerides, LDL-C, VLDL-C, and lipid ratios with lower HDL-C compared to controls. Late presenters exhibited more pronounced inflammatory and lipid abnormalities. Conclusion: hs-CRP and lipid profile assessment within 24 hours of ACS onset provides valuable insight into inflammatory burden and disease severity and may aid in early risk stratification and therapeutic planning.

Background: Wound closure techniques significantly impact surgical outcomes, wound complications, and cosmetic results. Subcuticular monocryl sutures offer potential advantages over conventional interrupted sutures, but comparative evidence remains limited. Objective: To compare subcuticular monocryl suture closure with conventional closure of surgically incised wounds, evaluating wound complications, cosmetic outcomes, and post-operative pain. Methods: A hospital-based cross-sectional study was conducted at Navodaya Medical College Hospital and Research Centre, Raichur, from January 2021 to June 2022. One hundred patients undergoing clean surgical procedures were randomly allocated to either subcuticular monocryl suture (n=50) or conventional suture (n=50) groups. Primary outcomes included wound complications, duration of hospital stay, antibiotic coverage requirements, wound healing time, post-operative pain, and cosmetic outcomes assessed at follow-up visits up to one month post-operatively. Results: Wound complications occurred in 20% of conventional suture patients versus 6% of monocryl suture patients (p=0.037). Mean hospital stay was significantly shorter in the monocryl group (5.38±1.11 days) compared to conventional group (7.6±1.85 days, p<0.0001). Monocryl sutures required shorter antibiotic coverage (5.16±0.58 vs 7.18±1.47 days, p<0.0001), faster wound healing (5.34±0.97 vs 7.32±1.50 days, p<0.0001), and resulted in less post-operative pain (1.44±0.64 vs 2.24±1.03, p<0.0001). Excellent cosmetic outcomes were achieved in 92% of monocryl cases versus 60% of conventional cases (p=0.0002). Conclusion: Subcuticular monocryl suture closure demonstrated superior outcomes compared to conventional sutures, with significantly reduced wound complications, shorter hospitalization, decreased antibiotic requirements, accelerated wound healing, reduced post-operative pain, and improved cosmetic results.

Background: Spinal anesthesia is the preferred anesthetic technique for cesarean section; however, spinal-induced hypotension frequently necessitates vasopressor use. Emergency cesarean sections are often associated with greater hemodynamic instability compared to elective procedures. Aim: To compare vasopressor requirements in patients undergoing elective versus emergency cesarean section under spinal anesthesia. Methodology: This prospective observational study included 100 patients, divided into elective (n = 50) and emergency (n = 50) cesarean section groups. Hypotension was defined as a fall in systolic blood pressure ≥20% from baseline or an absolute systolic blood pressure <90 mmHg. Vasopressor requirement, cumulative dose, and maternal and neonatal outcomes were recorded and analyzed. Results: Hypotension occurred in 56% of elective and 76% of emergency cesarean sections. Vasopressor support was required in 48% of elective cases compared to 80% of emergency cases. The mean cumulative vasopressor dose was significantly higher in the emergency group (15.8 ± 4.6 mg) than in the elective group (9.4 ± 3.2 mg). Maternal symptoms such as nausea and vomiting were more frequent in emergency cesarean sections, and neonatal outcomes showed a higher incidence of low Apgar scores and NICU admissions in this group. Conclusion: Emergency cesarean section under spinal anesthesia is associated with significantly higher vasopressor requirements than elective cesarean section. Anticipation of hypotension and early vasopressor preparedness are essential to optimise maternal and neonatal outcomes.

Introduction: Chronic wounds, especially non healing types are one of the most common surgical conditions a surgeon comes across. One of the most feared complication of long term diabetes is loss of leg or foot. It has been estimated that one in five of all diabetic admissions to hospitals are for foot ulcers. The diabetic foot ulcers arrest in inflammatory stage of healing due to neuropathy, angiopathy and infections. Aims: The aim of this study was to compare the effectiveness of topical phenytoin dressing with normal saline dressing in promoting healing of diabetic foot ulcers. It also aimed to evaluate associated outcomes such as infection rates and need for surgical intervention. Materials & Methods: This hospital-based prospective randomized comparative study was conducted at Tezpur Medical College and Hospital from January 2024 to June 2025 and included 100 patients with diabetic foot ulcers. Result: In our study secondary infection was significantly lower in the phenytoin group (6 patients, 12%) compared to the saline group (14 patients, 28%) (p = 0.04). The need for surgical intervention was also less in the phenytoin group (4 patients, 8%) than in the saline group (11 patients, 22%) (p = 0.04). Conclusion: We concluded that topical phenytoin dressing is markedly more efficacious than regular saline dressing in the treatment of diabetic foot ulcers. Due to similar baseline characteristics across the two groups, the enhanced outcomes may be reliably ascribed to the intervention.

Background: Oesophageal atresia with tracheo-oesophageal fistula (OA/TOF) is a life-threatening congenital anomaly requiring immediate surgical intervention. Despite advances in surgical techniques and perioperative care, the condition continues to present significant challenges, particularly in developing countries where late presentation and associated complications are common. Objectives: To describe the management outcomes of OA/TOF, identify perioperative complications, and evaluate the association of prognostic factors with surgical outcomes. Methods: A prospective observational study was conducted over 22 months (November 2018 to August 2020) at J.J.M Medical College, Davanagere, involving 30 consecutive neonates with OA/TOF. All patients underwent detailed clinical assessment, radiological evaluation, and surgical management via right posterolateral thoracotomy with primary oesophago-oesophagostomy. Results: The cohort comprised 60% males and 40% females (male:female ratio 1.5:1). Gross type C was the predominant anatomical variant (96.66%). Low birth weight was present in 66.66% of cases, pneumonia in 56.66%, and associated congenital anomalies in 46.66%. Twenty-nine patients (96.66%) underwent primary repair. Overall mortality was 53.33%, with sepsis (50%) and respiratory failure (37.5%) being the leading causes of death. Postoperative complications included anastomotic leak (43.5%), dysphagia (48.3%), and stricture formation (14.3%). Waterston group A patients demonstrated 100% survival, group B 60% survival, and group C 29.4% survival. Conclusion: Primary thoracotomy with oesophageal anastomosis remains the definitive surgical treatment for Gross type C OA/TOF. Significant postoperative complications and high mortality rates are influenced by low birth weight, pneumonia, sepsis, associated congenital anomalies, and anastomotic leak. Multidisciplinary care involving neonatologists, paediatric surgeons, and intensivists is essential for improving outcomes.

Background: Total hip replacement (THR) is a highly successful surgical procedure for end-stage hip disorders. The posterior and lateral approaches are the most commonly used techniques, yet controversy persists regarding their comparative outcomes. Objectives: To compare posterior and lateral approaches in primary THR with respect to early functional outcome, perioperative parameters, and short-term complications. Methodology: This prospective comparative study was conducted at a tertiary care hospital over 4–6 months. A total of 100 patients undergoing primary THR were equally divided into posterior (n=50) and lateral (n=50) approach groups. Functional outcome was assessed using the Harris Hip Score (HHS). Data were entered in Microsoft Excel and analyzed using SPSS version 26. Appropriate statistical tests were applied. Results: Both groups showed significant improvement in functional outcome. The posterior approach demonstrated slightly higher early HHS and lower incidence of abductor weakness. No dislocations were observed in either group. Conclusion: Both posterior and lateral approaches provide comparable short-term outcomes following THR. The posterior approach may offer better early functional recovery, while overall complication rates remain similar.

Background: Traditional teaching in microbiology is largely lecture-based, leading to passive learning and limited student engagement. To enhance understanding and motivation, active learning strategies such as Case-Based Learning (CBL) can be introduced. Aim: To evaluate the effectiveness of case-based learning compared to didactic lectures and to assess students’ perception toward this method. Methods: A total of 70 volunteer students from the 2nd Professional M.B.B.S. were enrolled after informed consent and randomly divided into two groups (A and B, 35 each). Group A underwent Case-Based Learning, further divided into smaller groups of 11–12 students, while Group B attended traditional lectures on the same topic. Validated clinical cases, post-test MCQs, and a feedback questionnaire were used for evaluation. Faculty were sensitized and trained for CBL sessions. Learning outcomes were assessed through post-test performance and feedback analysis. Results: Students exposed to CBL showed higher engagement, improved understanding of microbiology concepts, and better problem-solving skills compared to those attending lectures. Feedback revealed that CBL increased student interest, promoted active learning, and improved teacher–student interaction. Conclusion: Case-Based Learning is an effective student-centered teaching method in microbiology. It enhances motivation, understanding, and application of concepts and should be incorporated as a regular component of undergraduate medical education.

Background: Studies suggest that myocardial infarction is the major cause of mortality worldwide. Atherogenic index of plasma (AIP) is a sensitive marker in the diagnosis of myocardial infarction. In this study, we aim to find out the association of AIP with myocardial infarction. Methods: AIP was calculated by taking the logarithm of the ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C). The data analyzed using the odds ratio (RR) along with a 95% confidence interval (CI) and univariable logistic regression analysis. Results: Total 28 diagnosed MI patients from emergency ward and 28 patients who attended OPD of Tripura Medical College with no known cardiovascular diseases were selected in the study. Study showed a higher level of TG in MI patients as compared to healthy Non MI patients. HDL-C was higher in Non MI patients than MI patients. The mean atherogenic index of plasma was markedly higher among myocardial infarction patients (0.358 ± 0.310) compared to Non MI patients (0.034 ± 0.159), and the difference was statistically significant (p < 0.001). Conclusion: Atherogenic index of plasma (AIP) has a strong association with myocardial infarction and it can be used as a predictive risk factor for cardio vascular diseases like myocardial infarction.

Background: The aim & objective is to study the Microvessel density (MVD) and Vascular endothelial growth factor (VEGF) as prognostic indicator in colorectal carcinoma and correlate with PTNM staging. Materials and Methods: The present study is an observational study and cross sectional done on 50 colorectal resection specimens received by the Department of Pathology, Gandhi Hospital, and Secunderabad for a period of 18 months from October 2022- March 2024. Relevant clinical details of all the 50 patients diagnosed with colorectal carcinoma are documented. The specimens received are fixed, processed and embedded in paraffin wax. Serial sections of 4-5 µ thickness are obtained and stained with H&E. Results: Routine processing and H&E staining were done followed by immunohistochemistry with MVD and VEGF. In the present study, the age of the patients with Colorectal carcinoma was ranging from 36-70 years and majority of the subjects were males with M:F ratio of 1.77:1. Majority of the tumours were moderately differentiated and poorly differentiated adenocarcinoma belonged to stage III and IV. MVD and VEGF immune expression was correlated with clinicopathological parameters like grade and stage of the tumour to analyse the usefulness of these immunomarkers in prognosis. In Present study, MVD and VEGF expression was more in moderately differentiated tumours and poorly differentiated tumours than in well differentiated tumors. Present study shows that there is a statistically significant correlation of MVD and VEGF positivity with stage of the tumor. There is higher expression of MVD and VEGF in higher stage tumours (Stage III and Stage IV). Conclusion: The present study concluded that, MVD and VEGF represent important prognostic indicators in colorectal carcinoma. As the predominant angiogenesis factors in the growth and maturation of new vessels- MVD, VEGFs are associated with incidence of metastases and decreased survival. Combined targeting of MVD and VEGF pathways may offer a novel and potentially promising chemotherapeutic strategy for treatment and/or prevention of colorectal neoplasia.

Background: Sepsis and septic shock are life-threatening conditions with high mortality rates. Early identification and accurate prognostic markers are crucial for improving patient outcomes. This study aims to compare the prognostic values of serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) with the Sequential Organ Failure Assessment (SOFA) score in patients with sepsis and septic shock. Methods: A cross-sectional observational study was conducted on 400 patients admitted to the medical ward and ICU of Jawahar Lal Nehru Hospital, Ajmer, Rajasthan, India, from October 2022 to September 2023. Patients were categorized into two groups based on outcome: mortality (death) and survival. Serum hs-CRP, IL-6, and SOFA scores were measured on days 0, 3, and 7. Statistical analysis was performed using SPSS 20 software. Results: The mortality rate in the sepsis cohort was 15%. The mean age of the patients was 52.13±13.82 years, with no significant difference between the mortality and survival groups. The prevalence of diabetes and hypertension was significantly higher in the mortality group. Mean hs-CRP and IL-6 levels were significantly higher in the mortality group compared to the survival group at all time points. The SOFA score was also significantly higher in the mortality group. ROC analysis showed that IL-6 had the highest sensitivity (98%) and specificity (99%) in predicting mortality, followed by hs-CRP (95% sensitivity, 95.6% specificity). Conclusion: Serum hs-CRP and IL-6 are valuable prognostic markers for sepsis and septic shock. IL-6, in particular, demonstrated superior sensitivity and specificity in predicting mortality. Combining these biomarkers with the SOFA score can enhance prognostic accuracy and guide early intervention strategies.

Background: Meconium aspiration syndrome (MAS) is a major respiratory condition in term neonates, occurring when meconium-stained amniotic fluid (MSAF) is aspirated, causing airway obstruction, inflammation, and surfactant dysfunction. MSAF is seen in 10-20% of term deliveries worldwide, with MAS developing in 5-30% of those cases depending on setting and meconium thickness. In India, higher rates are often reported in tertiary centers due to referral patterns and delayed care. Risk factors include post-term gestation, fetal distress, and thick meconium. Complications range from respiratory failure and pneumothorax to persistent pulmonary hypertension of the newborn (PPHN), hypoxic-ischemic encephalopathy, and mortality. Despite improvements in perinatal care, MAS contributes significantly to neonatal intensive care admissions. This study examined the incidence and complications of MAS in term neonates at a tertiary hospital in Gujarat, India, to provide local insights and support improved protocols. Material and Methods: This prospective observational study was carried out over a year at a tertiary care hospital in western Gujarat, screening 940 term deliveries. Neonates with MSAF were followed for MAS signs. Institutional Ethics Committee approval was obtained, following Helsinki guidelines, with parental informed consent. Inclusion: term (37-42 weeks) neonates with MSAF. Exclusion: preterm/post-term extremes, congenital anomalies, non-MSAF births, or incomplete data. Data included demographics, clinical features, complications, and outcomes via records and follow-up. SPSS version 25 was used; chi-square for associations, logistic regression for risks, p<0.05 significant. Results: Of 940 term deliveries, 132 (14%) had MSAF, and 16 (12.1%) developed MAS, giving an incidence of 1.7 per 100 live births. Males were 62.5% (10/16). Complications included respiratory failure (68.8%), pneumothorax (18.8%), PPHN (12.5%), neurological injury (12.5%), and sepsis (6.3%). Mortality was 6.25% (1 case). Detailed tables cover demographics, incidence by gestation, complications, and outcomes. Conclusion: MAS incidence in this cohort matches regional Indian trends, with notable preventable complications. Strengthening antenatal surveillance and timely delivery interventions could lower burden. Enhanced neonatal management in high-risk cases remains key.

Background: Distal end radius fractures require stable fixation to achieve anatomical restoration and optimal functional recovery. Aim: To compare the functional and radiological outcomes of distal end radius fractures treated with K-wire fixation and volar locking plate fixation. Materials and Methods: A prospective comparative study was conducted on 50 patients with distal end radius fractures treated by either percutaneous K-wire fixation or volar locking plate fixation. Functional outcome was assessed using the Mayo Wrist Score, while radiological outcomes were evaluated using radial height, radial inclination, volar tilt, and ulnar variance at follow-up. Results: The volar locking plate group demonstrated superior functional outcomes and better maintenance of radiological parameters compared to the K-wire group. Conclusion: Volar locking plate fixation provides better functional and radiological outcomes; however, K-wire fixation remains a viable option in selected cases.

Background: Adequate sedation during regional anesthesia improves patient comfort and operating conditions while preserving spontaneous respiration and hemodynamic stability. Dexmedetomidine, a selective α₂-adrenergic agonist, has emerged as a useful sedative agent due to its anxiolytic and analgesic properties with minimal respiratory depression. Material and Methods: This prospective, randomized, double-blind, controlled study included 60 adult patients (ASA physical status I–II) undergoing elective surgery under regional anesthesia. Patients were randomly allocated into two groups of 30 each. Group D received intravenous dexmedetomidine with a loading dose of 0.5 µg/kg followed by a maintenance infusion of 0.2–0.5 µg/kg/h, while Group C received an equivalent volume of normal saline. Sedation was assessed using the Ramsay Sedation Scale. Hemodynamic parameters, adverse events, need for rescue sedation, and patient and surgeon satisfaction were recorded and analyzed statistically. Results: Demographic variables and baseline characteristics were comparable between the groups. Sedation scores were significantly higher in Group D at all measured time points (10, 30, and 60 minutes; p < 0.01). The lowest recorded heart rate and mean arterial pressure were significantly lower in the dexmedetomidine group compared to the control group (p < 0.01), though these changes were clinically manageable. The requirement for rescue sedation was significantly greater in Group C (20%) compared to Group D (0%; p = 0.01). The incidence of bradycardia and hypotension was higher in Group D but did not reach statistical significance. Patient and surgeon satisfaction scores were significantly higher in the dexmedetomidine group (p < 0.01). Conclusion: Dexmedetomidine provides effective and reliable sedation during regional anesthesia, with improved sedation quality and satisfaction and a reduced need for rescue sedation, while maintaining acceptable hemodynamic safety.

Background: Induction of general anesthesia is frequently associated with hemodynamic fluctuations, which may be clinically significant, particularly in susceptible patients. Propofol and etomidate are commonly used intravenous induction agents with differing cardiovascular effects. This study aimed to compare the hemodynamic responses and adverse effect profile of propofol and etomidate during induction of anesthesia in adult surgical patients. Material and Methods: This prospective, randomized study included 60 adult patients (ASA physical status I–II) scheduled for elective surgery under general anesthesia. Patients were randomly allocated into two equal groups: Group P received propofol (2 mg/kg) and Group E received etomidate (0.3 mg/kg) for induction. Heart rate and mean arterial pressure were recorded at baseline, after induction, immediately after intubation, and at 1, 3, 5, and 10 minutes post-intubation. Adverse events such as hypotension, bradycardia, pain on injection, myoclonus, and need for vasopressor support were documented. Statistical analysis was performed using appropriate parametric and non-parametric tests, with a p value <0.05 considered significant. Results: Demographic variables and baseline hemodynamic parameters were comparable between the two groups. Following induction, heart rate and mean arterial pressure were significantly lower in the propofol group compared to the etomidate group. Post-intubation increases in heart rate and means arterial pressure were observed in both groups, with significantly higher values in the propofol group during the early post-intubation period. Hypotension and pain on injection were significantly more frequent with propofol, whereas myoclonus occurred exclusively in the etomidate group. A higher proportion of patients in the propofol group required vasopressor support, although this difference was not statistically significant. Conclusion: Etomidate provides superior hemodynamic stability during induction of anesthesia compared to propofol, while propofol is associated with a higher incidence of hypotension and pain on injection. Etomidate may therefore be preferred when cardiovascular stability is a priority.

Background: Hemolytic anemia is characterized by increased destruction of red blood cells leading to release of intracellular enzymes and hemoglobin metabolites into circulation. Simple biochemical markers such as serum lactate dehydrogenase (LDH), indirect bilirubin, and haptoglobin are routinely available in most medical college laboratories and can assist in assessing the degree of hemolysis, particularly in resource-limited settings. Objectives: (1) To assess serum LDH, indirect bilirubin, and haptoglobin levels in patients with hemolytic anemia. (2) To correlate biochemical markers of hemolysis with hematological parameters, namely hemoglobin level and reticulocyte count. (3) To evaluate the diagnostic utility of routine biochemical investigations in assessing severity of hemolysis. Materials and Methods: This hospital-based cross-sectional study was conducted at Government Medical College, Jhalawar, Rajasthan, over a period of one and a half years. A total of 51 patients diagnosed with hemolytic anemia were included. Hematological investigations included complete blood count, reticulocyte count, and peripheral blood smear examination. Biochemical parameters included serum LDH, total and indirect bilirubin, and serum haptoglobin. Statistical analysis was performed using SPSS software, and correlations were assessed using appropriate tests. Results: Serum LDH and indirect bilirubin levels were significantly elevated, while serum haptoglobin levels were reduced in the majority of patients. A significant negative correlation was observed between hemoglobin levels and serum LDH and indirect bilirubin, whereas reticulocyte count showed a significant positive correlation with these biochemical markers. Serum haptoglobin demonstrated a positive correlation with hemoglobin concentration and a negative correlation with LDH. Conclusion: Routine biochemical markers such as serum LDH, indirect bilirubin, and haptoglobin correlate significantly with hematological indices of hemolysis and can serve as reliable, cost-effective indicators for assessing hemolytic anemia in resource-limited tertiary care settings.

Background: Chronic anemia leads to reduced oxygen-carrying capacity of blood and triggers physiological compensatory mechanisms, particularly involving the cardiovascular and respiratory systems. Assessment of these adaptations using simple, non-invasive physiological parameters may provide valuable insights into the severity and functional impact of anemia, especially in resource-limited settings. Objectives: (1) To assess resting oxygen saturation and heart rate in patients with chronic anemia. (2) To correlate hemoglobin levels with oxygen saturation and resting heart rate. (3) To evaluate the physiological compensatory response to chronic anemia using routinely available clinical parameters. Materials and Methods: This hospital-based cross-sectional study was conducted at a tertiary care center over a defined study period. Patients diagnosed with chronic anemia were enrolled after obtaining informed consent. Hemoglobin levels were estimated using automated hematology analyzers. Resting oxygen saturation was measured using a finger pulse oximeter, and heart rate was recorded after adequate rest. Statistical analysis was performed to assess correlations between hemoglobin concentration and physiological parameters. Results: A significant negative correlation was observed between hemoglobin levels and resting heart rate, indicating increasing tachycardia with declining hemoglobin concentration. Hemoglobin levels showed a mild but statistically significant positive correlation with oxygen saturation. These findings reflect physiological cardiovascular compensation in chronic anemia. Conclusion: Hemoglobin levels in chronic anemia correlate significantly with resting heart rate and, to a lesser extent, with oxygen saturation. Simple physiological measurements such as pulse rate and oxygen saturation can serve as useful adjuncts in assessing the functional severity of chronic anemia, particularly in resource-constrained healthcare settings.

Background and Aims: Awake fibreoptic intubation (AFOI) tend to be safer than conventional laryngoscopy for difficult airway conditions. Dexmedetomidine can be used for sedation as it ensures spontaneous breathing with airway patency. We aim to assess the effect of intravenous versus nebulized dexmedetomidine on intubating conditions during AFOI. Methods: In this prospective randomized double blind comparative study, after IEC approval, CTRI registration and informed written consent, ASA grade I, II patients of either gender aged 18-60 year with Mallampati grade I, II undergoing elective surgery under general anaesthesia were allocated into two groups –Group N and I to receive dexmedetomidine 1mcg/kg via nebulization and intravenous route respectively. Patients were intubated with fibreoptic bronchoscope. The primary outcome assessed was cough score. Secondary outcomes were- time taken for AFOI, intubating conditions, vocal cord position, post intubation score, Ramsay sedation scale, haemodynamic parameters, patient comfort, cooperativeness and satisfaction. Data were analysed using SPSS version 25. Continuous, ordinal and categorical data were presented as mean±SD, median±IQR and proportion respectively. Student-t test, Mann Whitney U test and Chi-square test were applied where deemed appropriate. p<0.05 was considered statistically significant. Results: Greater proportion of patients in Group I (56.66%) showed lesser severity of cough as compared to Group N (10%, p=0.0001). Group I also reported a faster intubation time (176±58.54 v/s 245±84.14, p=0.0001), better vocal cord position(p=0.00003), better sedation [2(2-2) v/s 1(1-1), p=0.000] and more stable haemodynamic parameters. Conclusion: Compared to nebulized route, dexmedetomidine administered through intravenous route provides better intubating conditions for AFOI with reduced cough severity.

Background: Emergency laparotomy is commonly performed for acute abdominal conditions and is associated with significant postoperative morbidity and prolonged hospital stay. Traditionally, enteral feeding is delayed to allow bowel recovery; however, recent evidence supports early enteral nutrition for improved outcomes. This prospective study, conducted over a year at a tertiary care center in North Gujarat, India, compared early (within 24 hours) versus delayed (48–72 hours) enteral feeding following emergency laparotomy. Adult patients with conditions such as perforation peritonitis, intestinal obstruction, and trauma were included, while those with severe comorbidities were excluded. The study aimed to assess postoperative morbidity and length of hospital stay. Material and Methods: This was a randomized controlled trial involving 120 patients divided equally into two groups: early enteral feeding (EEF) starting within 24 hours via nasogastric tube with gradual progression to oral intake, and delayed enteral feeding (DEF) initiated after return of bowel sounds (typically 48-72 hours). Inclusion criteria encompassed patients aged 18-65 years undergoing emergency laparotomy for non-malignant conditions. Exclusion criteria included preoperative malnutrition, mechanical ventilation >48 hours, or anastomotic concerns. Data collection involved daily monitoring for complications like wound infections, ileus, anastomotic leaks, and pneumonia. Statistical analysis used SPSS software, with chi-square tests for categorical variables and t-tests for continuous data; p<0.05 was considered significant. Results: The EEF group showed significantly lower morbidity rates (18% vs. 35% in DEF, p=0.02), with reduced incidences of wound infections (8% vs. 18%), paralytic ileus (5% vs. 12%), and pneumonia (3% vs. 8%). No significant difference in anastomotic leaks (2% vs. 3%). Mean hospital stay was shorter in EEF (7.2 ± 2.1 days) compared to DEF (10.5 ± 3.4 days, p<0.001). Nutritional status improved faster in EEF, with better albumin levels at discharge. Conclusion: Early enteral feeding post-emergency laparotomy is safe and beneficial, reducing morbidity and hospital stay without increasing complications. This approach should be adopted in resource-limited settings like North Gujarat to optimize patient outcomes and healthcare efficiency.

Background: Anastomotic leak (AL) is a serious complication after colorectal resections, leading to increased morbidity, prolonged hospitalization, and mortality. Despite advances in surgical care, AL rates remain variable, especially in India where colorectal cancer incidence is rising. Risk factors such as male gender, malnutrition, diabetes, and low rectal anastomosis are recognized, but Indian prospective data are limited. This study aimed to identify risk factors and evaluate outcomes of AL in patients undergoing colorectal resections at a tertiary care center in North Gujarat, providing region-specific evidence for improved risk assessment and management. Material and Methods: This prospective observational study enrolled 182 consecutive patients undergoing elective colorectal resections with primary anastomosis over a year. Data on demographics, comorbidities, preoperative nutrition, operative details, and postoperative outcomes were collected prospectively. Ethical clearance was obtained from the institutional review board, with written informed consent from all participants. Inclusion criteria included adults aged 18-80 years with benign or malignant colorectal diseases requiring resection and anastomosis. Exclusions were emergency surgeries, diverting stomas, or incomplete follow-up. AL was diagnosed clinically or radiologically within 30 days. Risk factors were evaluated via univariate and multivariate logistic regression. Outcomes like mortality and reintervention were compared. Analysis used SPSS version 26, with p<0.05 significance. Results: AL occurred in 7.7% (14/182) of patients. Independent risk factors on multivariate analysis were male gender (OR 2.4, 95% CI 1.3-4.5, p=0.008), diabetes (OR 2.1, 95% CI 1.2-3.8, p=0.015), preoperative albumin <3.5 g/dL (OR 2.8, 95% CI 1.5-5.2, p=0.002), rectal anastomosis (OR 3.5, 95% CI 1.9-6.4, p<0.001), and operative time >180 minutes (OR 2.6, 95% CI 1.4-4.8, p=0.004). AL patients had higher 30-day mortality (14.3% vs. 1.8%, p=0.002), reoperation rates (50% vs. 5.4%, p<0.001), and longer hospital stays (mean 19.5 vs. 8.1 days, p<0.001). Conclusion: This prospective study from North Gujarat identifies male gender, diabetes, hypoalbuminemia, rectal anastomosis, and prolonged surgery as key risk factors for anastomotic leak, with a 7.7% incidence significantly affecting outcomes.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases with overlapping clinical features. Despite similar symptomatology, they differ in pathophysiology, reversibility of airflow obstruction, and systemic involvement. Differentiating these entities and quantifying disease burden is crucial for appropriate management. Objectives: To compare pulmonary function, symptom burden, exercise capacity, and health-related quality of life between asthma and COPD patients using spirometry, COPD Assessment Test (CAT), dyspnea grading, functional indices, and quality-of-life measures. Methods: A case–control study was conducted in 180 participants including COPD patients and asthma subjects. Spirometry (FVC, FEV1, FEV1/FVC), CAT score, modified Medical Research Council (mMRC) dyspnea scale, six-minute walk distance (6MWD), Body Mass Index (BMI), BODE index, and St. George’s Respiratory Questionnaire (SGRQ) were evaluated. Group comparisons were performed and significance was assessed using p-values. Results: Mean FVC and FEV1 were lower in COPD than asthma, though not statistically significant (p=0.136 and p=0.073, respectively). However, the FEV1/FVC ratio was significantly lower in COPD compared with asthma (62.04 ± 20.01 vs 72.59 ± 11.30; p=0.011), confirming more severe and irreversible airflow limitation. COPD patients exhibited higher CAT, mMRC, BODE, and SGRQ scores and reduced exercise capacity, indicating greater symptom burden and poorer quality of life. Conclusion: Although asthma and COPD share clinical manifestations, COPD is associated with significantly greater airflow limitation, functional impairment, and quality-of-life deterioration. Integration of spirometry with symptom-based and multidimensional tools such as CAT, BODE index, and SGRQ enhances differentiation and comprehensive disease assessment.

Background: Scrub typhus, a mite-borne infectious disease caused by Orientia tsutsugamushi, is a significant cause of acute febrile illness in endemic regions, particularly in Asia. Despite the availability of antibiotics, the optimal treatment regimen in pediatric patients remains a subject of ongoing research. Objective: To compare the efficacy of doxycycline and azithromycin in the treatment of scrub typhus. Methods: This study was conducted on 20 pediatric patients (≤12 years of age) presenting with fever lasting for seven or more days and confirmed scrub typhus infection in the Department of Paediatrics at Vinayaka Missions Medical College & Hospital, Karaikal, Puducherry. Results: The study included 20 pediatric patients diagnosed with scrub typhus, with 10 receiving azithromycin and 10 receiving doxycycline. The mean age of patients was comparable between the two groups, with no statistically significant difference (P = 0.098). Gender distribution was also similar, with the azithromycin group comprising seven males and three females, while the doxycycline group had five males and five females (P = 0.361). The mean fever clearance time was significantly longer in the azithromycin group (53.1 hours, SD: 2.0) compared to the doxycycline group (44.2 hours, SD: 2.1), with a statistically significant difference (P = 0.001). The mean duration of hospital stay was slightly longer in the azithromycin group (46.2 hours, SD: 4.0) compared to the doxycycline group (45.2 hours, SD: 4.2), but this difference was not statistically significant (P = 0.317). No mortality was reported in either treatment group (P = 1.000). However, adverse drug reactions were observed in two patients (20.0%) in the azithromycin group, while none were reported in the doxycycline group, a statistically significant finding (P = 0.045). These results indicate that doxycycline was more effective in achieving faster fever resolution and had fewer adverse drug reactions than azithromycin. Conclusion: Doxycycline is more efficacious in achieving fever defervescence and in preventing adverse drug reactions in patients with scrub typhus.

Background: Nocturnal enuresis in children is the result of emotional problems in the majority of them. Hence, the cause of NE has to be ruled out as either organic or emotional. Method: A midstream morning urine sample was collected and examined within 30 minutes for proteinuria, glucosuria, and infection. An abdominal ultrasound was carried out for a bladder volume and bladder capacity study. Behavioral therapy, i.e., fluid restriction, star charting, lifting and waking, bladder retention exercise, and counseling for psycho-social factors, was carried out. Monthly follow-up for at least six months was done. Results: In the clinical manifestation, 23.3% daily bed wetting, followed by 18.3% urgency and 15% frequency, was noted. In the study of comorbidities, 16.6% disturbed family followed by 15% poor attention is studied, and at least 3.3% congenital anomalies are noted. In the comparative study of non-pharmacological results, relapse was significant in pharmacological results. Conclusion: In the present pragmatic study, it is proved that stressful conditions of children lead to phobia and anxiety, resulting in nocturnal enuresis.

Background: Acute necrotizing pancreatitis occurs in 10%–20% of patients with acute pancreatitis which is one of the most important acute abdominal diseases that require hospital admission. In the past 20 years, the treatment of pancreatic necrosis has shifted from open necrosectomy to minimally invasive techniques, such as endoscopic interventions. With the development of endoscopic techniques, the safety and effectiveness of endoscopic interventions have improved, but there exist several unresolved problems. Endoscopic transmural drainage (ETD) and Direct endoscopic necrosectomy (DEN)—often performed via Endoscopic Ultrasound-guided (EUS-guided) techniques—have emerged as the preferred, less-invasive, first-line, or “step-up” approach for managing walled-off pancreatic necrosis (WON) and infected necrotizing pancreatitis (INP), significantly reducing morbidity compared to traditional surgical necrosectomy. Aim: It was aimed to compare the outcomes of minimally invasive surgery vs endoscopic approaches for patients with infected necrotizing pancreatitis. Methods: A total of 90 patients, aged 18-70, both sexes with confirmed or suspected infected necrotizing pancreatitis, randomly divided into two groups. Patients were randomly assigned to groups that received minimally invasive surgery (Direct Endoscopic Necrosectomy, DEN, N=44) or Endoscopic Transmural Drainage ETD, N=46). The primary endpoint was a composite of major complications (new-onset multiple organ failure, new-onset systemic dysfunction, enteral or pancreatic-cutaneous fistula, bleeding and perforation of a visceral organ) or death during 6 months of follow-up. Results: None of the patients assigned to the ETD approach developed enteral or pancreatic-cutaneous fistulae compared with 12/27.27% of the patients who underwent DEN (P=0.01). The mean number of major complications per patient was significantly higher in the DEN group (0.69 ± 1.03) compared with the endoscopy group (0.15 ± 0.44) (P=0.05). The physical health scores for quality of life at 3 months was better with the ETD approach (P =0.39) and mean total cost was lower as compared to DEN (P =0.03). Conclusion: In a randomized trial of 90 patients, an endoscopic transluminal (ETD) approach for infected necrotizing pancreatitis, compared with minimally invasive surgery (DEN), significantly reduced major complications, lowered costs, and increased quality of life.

Introduction: The evaluation of global longitudinal strain (GLS) is recognised in cardio-oncology for the early detection of cardiotoxicity associated with anticancer therapies. Baseline left ventricular (LV) global longitudinal strain (GLS) and right ventricular (RV) GLS evaluations can detect patients predisposed to systolic dysfunction and heart failure resulting from the cardiotoxic effects of many cancer therapies. Progress in the early identification and management of cancer has markedly decreased mortality rates. The outcome is the formation of a group of patients whose survival is adequate to demonstrate the side effects of the administered medicines. Cardiotoxicity refers to the array of cardiovascular disorders induced by onco-hematological therapies. Objectives: To assess the significance of global longitudinal strain in the early identification of cardiotoxicity in individuals receiving chemotherapy. Method: A quantitative, analytical, prospective, longitudinal study was carried out in 100 patients diagnosed with breast cancer or lymphoma, who started chemotherapy treatment at Department of Cardiology, S.C.B. Medical College and Hospital, Cuttack, Odisha. Primary and secondary methods were used for raw data collection and several statistical tests were used for its analysis. Results: The notable association between GLS and chemotherapy dosage underscores the necessity of monitoring cumulative exposure and the potential for early intervention with cardioprotective therapies. this investigation demonstrated a modest positive connection between GLS and LVEF (r = 0.61, p < 0.001), reinforcing the notion that these two echocardiographic parameters are interconnected, but not synonymous. A moderate negative correlation (r = -0.52, p < 0.001) identified in our investigation between cumulative chemotherapeutic dosage and global longitudinal strain (GLS) underscores a distinct dose-dependent association between cardiotoxic exposure and myocardial strain deterioration. The fall in GLS occurs prior to the loss in LVEF, establishing it as a more effective early diagnostic instrument for cardiotoxicity. Conclusions: Global longitudinal strain is an echocardiographic measure of cardiac function that demonstrates strong discriminatory value regarding cardiotoxicity in patients undergoing chemotherapy.

Background: Prolonged postoperative ileus (PPOI) is a significant complication following emergency bowel surgery that increases morbidity, hospital stay, and healthcare costs. Limited evidence exists regarding PPOI risk factors in emergency settings, particularly for hollow viscus perforation with peritonitis. Objective: To identify peri-operative factors predicting PPOI following emergency bowel surgery for hollow viscus perforation. Methods: This single-center cross-sectional analytical study was conducted at Medical College and S.S.G. Hospital, Vadodara, between December 2020 and December 2021. Consecutive sampling enrolled 120 patients undergoing emergency bowel surgery for hollow viscus perforation with peritonitis. PPOI was defined using standardized criteria as two or more of nausea/vomiting, inability to tolerate diet, absence of flatus/stool, abdominal distension, or radiological ileus evidence on or after postoperative day 4. Chi-square test assessed associations between categorical variables and PPOI development. Results: PPOI incidence was 15% (18/120 patients). Significant predictors included male sex (21.8% vs 7.1%, p=0.02), age ≥60 years (25% vs 8.3%, p=0.012), smoking history (66.7%, p=0.019), pre-operative anemia (38.9%, p=0.043), hypoalbuminemia (33.3%, p=0.039), operative time ≥240 minutes (33.3%, p=0.039), resection anastomosis (50%, p=0.014), elevated WBC count on postoperative day 4 (72.2%, p=0.027), and anastomotic leakage (22.2%, p=0.01). Conclusion: Multiple pre-operatives, intra-operative, and post-operative factors predict PPOI development. Risk stratification and targeted perioperative optimization strategies are essential for reducing PPOI incidence in resource-constrained emergency settings.

Background: Since there is currently no effective treatment for EON, stopping EMB as soon as possible is still the best way to stop the disease’s progression and speed up visual recovery. As a result, early risk factor identification and EON detection are crucial. Objectives: The aim of the study was to evaluate the visual outcomes of patients with ethambutol-induced toxic optic neuropathy and to identify clinical and structural factors associated with visual recovery following discontinuation of the drug. 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 and six months, i.e., from April 2024 to October 2025. Data from 65 participants were retrieved for the study. Patients with ethambutol-induced optic neuropathy who were at least eighteen years old and had comprehensive ocular records, including visual acuity and OCT data, were included in the study. Results: Patients were about 55 years old on average. Nearly 80% of individuals had both eyes affected. The majority had moderate to severe visual impairment at the time of presentation, with just 18.5% having relatively good vision (≥ 6/18). Severe vision loss was present in nearly two-fifths of individuals (< 6/60). Conclusion: The study concluded that less than half of individuals with ethambutol-induced optic neuropathy showed improvement in their vision after stopping the medication. Recommendations: All patients on ethambutol therapy should undergo routine baseline and follow-up ocular screening; high-risk people, such as the elderly and those with low baseline vision, should be closely monitored.

Background: Pterygium is a common degenerative ocular surface disorder with variable clinical behaviour and risk of recurrence. Histopathological evaluation helps in understanding disease activity, progression, and factors associated with recurrence. This study aimed to analyse histopathological changes in excised pterygium specimens and their association with clinical features. Methods: A prospective study was conducted on 85 patients who underwent pterygium excision with conjunctival autograft, including fixation using autologous serum. Excised tissues were processed for routine histopathology and stained with H&E, Masson’s trichrome, Gomori’s reticulin, and PAS. Inflammation, vascularisation, and fibrinoid degeneration were graded semi-quantitatively. Clinical and histopathological data were statistically analysed using SPSS software. Results: Mild to moderate inflammation was most common, with Grade 1 changes seen in 34.1% of cases. Moderate to marked vascularisation and fibrinoid degeneration (Grades 2 and 3) were observed in over 60% of specimens, indicating active fibrovascular pathology. Higher grades of inflammation, vascularisation, and fibrinoid change were significantly more frequent in patients with Fuchs’ spots. Recurrent pterygia also demonstrated a greater proportion of moderate to severe histopathological changes. Conclusion: Histopathological severity correlates with clinical progression and recurrence of pterygium, emphasizing the importance of thorough excision and careful postoperative follow-up.

Background: Intertrochanteric femur fractures are common in the elderly population and are associated with significant morbidity and functional decline. Optimal surgical fixation remains a subject of debate, particularly between intramedullary and extramedullary devices. This study aimed to compare clinical, radiological, and functional outcomes of proximal femoral nail (PFN) and dynamic hip screw (DHS) fixation in elderly patients with intertrochanteric femur fractures. Material and Methods: This prospective cohort study was conducted from March 2015 to March 2017 at a tertiary care center and included 120 elderly patients (≥60 years) with intertrochanteric femur fractures. Patients were allocated into two groups based on the fixation method used: PFN (n=60) and DHS (n=60). Demographic variables, intraoperative parameters, postoperative mobilization, radiological union, complications, and functional outcomes were assessed. Functional evaluation was performed using the Harris Hip Score at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Statistical analysis was carried out using appropriate parametric and non-parametric tests, with a p value <0.05 considered significant. Results: Baseline demographic and fracture characteristics were comparable between the two groups. The PFN group demonstrated significantly shorter operative time (58.4 ± 9.6 vs 74.8 ± 11.2 minutes; p<0.01) and lower intraoperative blood loss (118 ± 32 vs 182 ± 44 mL; p<0.01). Earlier mobilization and shorter hospital stay were observed in the PFN group (p<0.01). Mean time to fracture union was significantly shorter with PFN fixation (14.6 ± 2.3 weeks) compared to DHS (16.8 ± 2.9 weeks; p<0.01). Functional outcomes were superior in the PFN group at all follow-up intervals, with higher Harris Hip Scores at 12 months (88.7 ± 5.4 vs 83.1 ± 5.9; p<0.01). Mechanical complications, particularly varus collapse, were less frequent in the PFN group. Conclusion: Proximal femoral nail fixation provides better functional recovery, earlier mobilization, and fewer mechanical complications compared to dynamic hip screw fixation in elderly patients with intertrochanteric femur fractures, supporting its preferential use in this population.

Background: Intra‑articular corticosteroid injections are commonly used for symptomatic relief in knee osteoarthritis (OA). However, the relative efficacy and safety of single versus multiple injections remain debated, particularly in early to moderate disease. Objective: To compare clinical outcomes of single versus multiple intra‑articular steroid injections in patients with Kellgren–Lawrence grade II and III knee osteoarthritis. Methods: A retrospective observational study was conducted at Bhima Bhoi Medical College & Hospital, Balangir, from October 2024 to September 2025. A total of 302 patients with grade II–III knee OA who received either a single injection or multiple injections of intra‑articular corticosteroid were analyzed. Pain and function were assessed using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical analysis included paired and unpaired t‑tests and chi‑square tests, with p < 0.05 considered significant. Results: Both groups showed significant improvement in VAS and WOMAC scores at short‑term follow‑up. Multiple injections demonstrated superior pain relief at 6 months but were associated with a higher recurrence of symptoms by 9–12 months. Conclusion: Single intra‑articular steroid injection provides effective short‑term relief in grade II–III knee OA, while multiple injections may offer prolonged benefit at the cost of potential diminishing returns. Judicious use is recommended.

Background: Giant fibroadenomas are defined as breast fibroadenomas larger than 5 cm—are uncommon benign lesions that often cause significant breast distortion, particularly in younger women. Surgical excision is the treatment of choice; however, traditional approaches may result in undesirable scarring and aesthetic compromise. Objective: This study compares two minimally invasive circumareolar surgical techniques—the Saw-Tooth and Swiss Roll methods—for the excision of giant fibroadenomas, with an emphasis on cosmetic outcomes, surgical feasibility, and preservation of breast architecture. Methods: Both techniques were performed via a circumareolar incision, offering direct access while minimizing visible scarring. The Saw-Tooth technique involved alternating partial incisions on the mass to facilitate gradual extraction, whereas the Swiss Roll technique employed spiral enucleation through a smaller incision. Intraoperative parameters, cosmetic outcomes, and specimen integrity were compared. Conclusion: Both methods proved effective for complete tumor excision with minimal complications. The Swiss Roll technique demonstrated superior cosmetic outcomes and better specimen preservation, making it more suitable for histopathological evaluation. The Saw-Tooth method, while technically easier, involved partial fragmentation of the mass but still achieved satisfactory aesthetic results. Circumareolar approaches offer safe, cosmetically favorable options for managing giant fibroadenomas in young patients. Selection between the Saw-Tooth and Swiss Roll techniques should be based on tumor characteristics and surgeon experience, with both techniques yielding excellent outcomes when appropriately applied.

Tracheal intubation in the critically ill is associated with serious complications, mainly cardiovascular collapse and severe hypoxemia. In this narrative review, we present an update of interventions aiming to decrease these complications. MACOCHA is a simple score that helps to identify patients at risk of difficult intubation in the intensive care unit (ICU). Preoxygenation combining the use of inspiratory support and positive end expiratory pressure should remain the standard method for preoxygenation of hypoxemic patients. Apneic oxygenation using high-flow nasal oxygen may be supplemented, to prevent further hypoxemia during tracheal intubation. Face mask ventilation after rapid sequence induction may also be used to prevent hypoxemia, in selected patients without high-risk of aspiration. Hemodynamic optimization and management are essential before, during and after the intubation procedure. All these elements can be integrated in a bundle. An airway management algorithm should be adopted in each ICU and adapted to the needs, situation and expertise of each operator. Videolaryngoscopes should be used by experienced operators.

Postoperative nausea and vomiting (PONV) continues to be a concern even after spinal anaesthesia, a technique traditionally considered to have low emetogenic potential. This retrospective study evaluated the incidence of PONV within 24 hours of surgery and identified patient- and treatment-related predictors using electronic medical records from a tertiary care hospital. Records of 500 ASA I and II adult patients who underwent surgery under spinal anaesthesia between March and December 2024 were analysed. The overall PONV incidence was 26.8% (n = 134), with nausea alone occurring in 18.8%, vomiting ± nausea in 8.0%, and rescue antiemetic use in 10.6%. The 95% confidence interval for overall PONV was 23.0–30.9%. On multivariable logistic regression, female sex (aOR 1.91; p = 0.001), history of prior PONV or motion sickness (aOR 2.29; p < 0.001), and postoperative opioid use (aOR 1.58; p = 0.026) were independently associated with PONV. Non-smoking status did not retain significance after adjustment. These findings reinforce the continued relevance of simplified risk models in peri operative populations and highlight the importance of opioid-sparing postoperative analgesia and individualized prophylaxis strategies.

Introduction: The human microbiota develops from newborn time period as a neonate is not born with any microbiota. Colonization of the infant gut represents the de novo assembly of a complex microbial community. This process is influenced by several environmental and host factors. Different child rearing practices like early initiation of breastfeeding, administration of colostrum, ghutti, ghasa and prelacteal feed are likely to affect the microbiota. Aim and Objective: To evaluate impact of different antenatal, natal, postnatal factors and various childcare practices on the development of microbiota in neonates. Primary Objective: To find out proportion of various organisms that first colonise the neonate. Secondary Objective: To evaluate whether there is any change in development of microbiota with gestational age, sex, mode of delivery and method of feeding. Methodology: Type of study was prospective quantitative cross-sectional observational clinical research with a prospective design and was conducted in Department of Paediatrics, Dr S. N. Medical College, Jodhpur, and Rajasthan, India.  Samples of 128 newborns were taken. Seven samples (skin of right upper limb, skin of left lower limb, surface of umbilical cord, mucosa of oropharynx, mucosa of conjunctiva, stool sample, air sample) of each baby with swab were taken. Result: In babies with initiation of feeding less than 24 hours first bacterial growth appeared in within first three days of life in 77 babies in pharynx which was statistically significant (P value – 0.00001), in 78 babies in stool (P value – 0.014958) which was statistically significant. The first microbiota isolated in stool in babies with initiation of breastfeeding in less than 24 hours was E. coli (77.5%), in pharynx streptococcus (65%), in skin nonpathogenic staphylococcus (57.5%). Conclusion: Our study concluded that early initiation of feeding helps in early establishment of microbiota in pharynx and stool and the first organism isolated in stool, skin and pharynx in babies with early initiation of breastfeeding is E coli, non-pathogenic staphylococcus and streptococcus respectively.

Background: Celiac disease (CD) is chronic autoimmune disorder triggered by ingestion of gluten in genetically predisposed individuals. It has a wide spectrum of clinical presentations, ranging from classical gastrointestinal symptoms to silent or atypical forms. CD is strongly associated with genetic factors, particularly HLA-DQ2 and HLA-DQ8 haplotypes, and is more common among first-degree relatives of affected individuals. This study focuses on magnitude of CD among siblings of confirmed paediatric celiac patients. Objective: To determine magnitude of celiac disease in siblings of children diagnosed with CD at tertiary care center in Rajasthan and to assess clinical presentation, serological, and histopathological characteristics in this high-risk group. Methods: This hospital-based, cross-sectional study was conducted at Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India from May 2021 to May 2022. Fifty siblings of 44 biopsy-confirmed CD patients were recruited. All participants underwent serological testing for anti-tissue transglutaminase (tTG-IgA) antibodies, and those with positive serology were subjected to upper gastrointestinal endoscopy and biopsy. Histopathological examination using Modified Marsh Classification was performed to confirm diagn. Results: prevalence of celiac disease among siblings was found to be 14%, with 7out of 50participants testing positive for tTG-IgA. Among these, 57%were female, and most were asymptomatic or presented with non-classical symptoms such as abdominal pain, short stature, and pallor. Endoscopic and histopathological examination confirmed diagnosis of CD in all serologically positive cases, with Marsh Grade 3a and 3b being most common findings. Conclusion: Study highlights a significant prevalence of CD among siblings of affected individuals, underscoring importance of targeted screening in this high-risk group. Early diagnosis and intervention, particularly in asymptomatic or non-classical cases, can prevent long-term complications. Routine screening for CD in siblings of confirmed cases should be recommended to ensure timely diagnosis and management.

Introduction: Unintended pregnancies significantly impact healthcare systems globally. Family planning can avert approximately one-third of maternal deaths and 10% of childhood mortality. Postpartum intrauterine contraceptive device (PPIUCD) insertion offers a safe, effective, and convenient long-term contraceptive solution immediately following delivery. This study aims to assess the acceptance of PPIUCD based on demographic factors and mode of delivery, while evaluating immediate complications. Methodology: This retrospective observational cross-sectional study was conducted at Silchar Medical College from January to December 2023. Data from 200 women who accepted PPIUCD (100 following vaginal delivery and 100 intra-caesarean) were analyzed. Follow-ups were conducted at 6 weeks, 12 weeks, and 6 months to monitor complications like pain, bleeding, and expulsion. Results: Acceptance of PPIUCD was significantly higher in the caesarean section (CS) group (41.2%) compared to the normal vaginal delivery (NVD) group (4.9%) (p < 0.001). Voluntary willingness was also higher in the CS group (60.2%) versus the NVD group (2.2%). Acceptance was highest among women aged 21–25 and primipara mothers. Literate and urban-based women showed greater motivation. Regarding complications, the expulsion rate at 6 months was 6% in the CS group and 0% in the NVD group (p = 0.038). Other complications, including abdominal pain, menstrual irregularities, and abnormal discharge, showed no statistically significant differences between the two groups over the study period. Conclusion: PPIUCD is a safe and effective postpartum contraceptive method regardless of the mode of delivery. While complication rates are low, limited awareness and fear of side effects remain significant barriers to acceptance. Comprehensive antenatal counseling and family involvement are essential to dispelling misconceptions and improving utilization.

Aim: The study was done to determine astigmatic and visual acuity changes following pterygium excision with conjunctival autograft. Methods: 100 patients who underwent pterygium excision with conjunctival autograft in Government Dharmapuri medical college were included in the study. Their preoperative visual acuity and keratomertic values were recorded and compared with the postoperative values at the end of third month. The surgical procedure done was pterygium excision with conjunctival autograft using autologous serum. Results: In the study it is found that pterygium causes with the rule astigmatism. There is reduction in keratometric and refractive astigmatism after pterygium excision and the amount of decrease in astigmatism correlated with the size of pterygium. There is also improvement in visual acuity after pterygium excision with autograft. Conclusion: In our study, it was observed that Pterygium causes with the rule astigmatism. The amount of induced keratometric astigmatism is directly proportional to the grade of pterygium. The study concludes that pterygium excision with auto conjunctival graft induces the reversal of the pterygium induced corneal flattening resulting in decrease of refractive astigmatism and significant improvement in visual acuity.

Background: Femoral nerve block, a relatively easy and safe peripheral nerve block, provides prolonged and effective perioperative analgesia in lower limb surgeries. A good landmark technique avoids unnecessary needle punctures and complications during block performance. We decided to find a simple technique to locate block puncture site and confirm it with ultrasonography. Materials and Methods: The aims were to find the correlation between finger width and femoral nerve-artery distance with ultrasonographic imaging, BMI, hip and waist circumferences and femoral nerve depth in Indian population. 360 subjects with planned femoral nerve block or healthy volunteers were studied. Patient’s age, height, weight, waist circumference, hip circumference was noted. Finger width of both hands at distal inter-phalangeal joint was measured using vernier’s calliper. Femoral nerve-artery distance and nerve depth were measured using ultrasonography. Results: Finger widths ranged from 1.24± 0.0481 cm to 1.42± 0.0623 cm. The femoral nerve-artery distances were in the range of 1.14 mm to 1.46 mm with median of 1.24 mm. Correlation coefficients between nerve-artery distance and finger width were 0.36 (Right little finger), 0.61 (Right middle finger), 0.44 (Left little finger) and 0.65 (Left index finger). Regression analysis yielded the model NA = 0.18 + 0.86 d with NA as the femoral nerve-artery distance and d the distal inter-phalangeal joint finger width. On simplification owing to the negligible constant (0.18) and multiplier (0.86) being close to one, femoral nerve – artery distance can be said to correspond to distal inter-phalangeal joint finger width of index finger of left hand. An association between BMI>25 kg/m² and femoral NA distance (P value =0.0000) and hip circumference and femoral NA distance in males (P value =0.017) was found. Conclusion: A simplified, individualized landmark approach not requiring any additional, costly technical aids for needle insertion site for femoral nerve block was found. Puncture site should be lateral to the lateral most point of pulsating femoral artery at a distance equivalent to the width of the patient’s index finger of the non-dominant hand measured at the distal inter-phalangeal joint. It is especially useful for patients with intermediate BMI values.

Background: To meet the expectations of patients, informed consent is a time-consuming and labour-intensive process. A variety of clinical practice issues can contribute to patient dissatisfaction with the preoperative informed consent process. This study evaluated patient satisfaction and factors related to the informed consent process for elective surgery subjects. Methods: A cross-sectional study included 202 postoperative patients who provided informed consent for elective surgery. The study participants were selected using a systematic sampling procedure. The modified Leiden perioperative patient satisfaction tool was used to evaluate patient contentment with the preoperative informed consent approach. Data was analysed by SPSS 20.0. Bivariate and multivariable logistic regression were used to find independent variables linked with patient satisfaction with the preoperative informed consent process. A p-value of less than 0.05 was utilized to determine the statistical importance. Results: The general rate of patient satisfaction with the preoperative informed consent process was 70.3%. A multivariable logistic regression analysis found that male gender (AOR: 4.75), primary school (AOR: 8.42), secondary school (AOR: 2.17), rural residence (AOR: 1.8), and general anaesthesia (AOR: 2.92) were all considerably associated with client satisfaction with the informed consent process. Conclusion: In summary, patients were not very satisfied with the preoperative informed consent procedure. Patient satisfaction with the informed consent procedure was substantially correlated with being male, having a low level of education, residing in a rural region, and undergoing general anaesthesia. More has to be done by surgeons and anaesthesiologists to increase patient satisfaction with the preoperative informed consent procedure. Periodically evaluating patient satisfaction and the factors influencing it is demanded of researchers.

Background: Diabetic peripheral neuropathy is a frequent and disabling complication of type 2 diabetes mellitus, often remaining clinically silent in its early stages. Nerve conduction studies provide an objective means of detecting subclinical neural dysfunction and assessing the extent of peripheral nerve involvement. Material and Methods: This cross-sectional study included 160 participants, comprising 80 individuals with type 2 diabetes mellitus and 80 age- and sex-matched healthy controls. Motor and sensory nerve conduction studies were performed under standardized laboratory conditions using surface electrodes. Upper and lower limb nerves were evaluated for latency, amplitude, and conduction velocity. Glycaemic status and duration of diabetes were documented in diabetic subjects. Statistical comparisons between groups and correlation analyses with disease duration and glycaemic control were undertaken. Results: Baseline demographic variables were comparable between diabetic subjects and controls. Individuals with type 2 diabetes mellitus demonstrated significant abnormalities in both motor and sensory nerve conduction parameters, characterized by delayed latencies, reduced amplitudes, and slowed conduction velocities. Lower limb nerves exhibited greater impairment than upper limb nerves, indicating a length-dependent pattern of neuropathy. Sensory nerves, particularly distal nerves, showed marked involvement. Nerve conduction velocities demonstrated significant inverse associations with both duration of diabetes and levels of glycated hemoglobin, suggesting progressive and metabolically driven neural dysfunction. Conclusion: Type 2 diabetes mellitus is associated with widespread electrophysiological evidence of peripheral nerve involvement affecting both motor and sensory fibers. The severity of nerve conduction abnormalities increases with longer disease duration and poorer glycaemic control. Nerve conduction studies serve as a valuable objective modality for early detection and evaluation of diabetic neuropathy.

Background: Dexmedetomidine is widely used as an adjuvant to local anesthetics in brachial plexus blocks to improve block quality and prolong postoperative analgesia. While its efficacy is established, the optimal perineural dose that balances block enhancement with hemodynamic stability remains unclear. Objectives: (1). To compare the efficacy of 25 µg vs 50 µg dexmedetomidine as an adjuvant to 0.5% bupivacaine in supraclavicular brachial plexus block. (2). To assess the quality of postoperative analgesia using pain scores and rescue analgesic consumption. (3). To evaluate sedation levels and patient satisfaction. (4). To compare incidence of adverse effects between the two doses. Methods: Sixty ASA I–II patients undergoing elective upper limb surgery were randomized into two groups. Group D25 received 20 mL 0.5% bupivacaine + 25 µg dexmedetomidine, while Group D50 received 20 mL 0.5% bupivacaine + 50 µg dexmedetomidine. Sensory and motor block characteristics, duration of analgesia, VAS pain scores, sedation score, hemodynamic parameters, and adverse effects were recorded. Results: Group D50 demonstrated significantly longer analgesia compared to Group D25 (p < 0.05). However, Group D50 had a higher incidence of bradycardia and deeper sedation. Postoperative pain scores and rescue analgesic requirement were lower in Group D50. Conclusion: Both doses are effective, but 25 µg provides a safer hemodynamic profile, whereas 50 µg offers superior and longer analgesia. Dose selection should be individualized based on patient comorbidities and surgical duration.

Introduction: Breast lesions encompass wide spectrum of pathologies, ranging from benign conditions such as fibroadenomas to malignant neoplasms like invasive ductal carcinoma. Early and accurate characterization of these lesions is critical for appropriate clinical management, timely intervention, and avoidance of unnecessary invasive procedures. Conventional B-mode ultrasonography is widely used, non-invasive imaging tool for initial evaluation of breast abnormalities. However, it has limitations, particularly in differentiating benign from malignant lesions, which can lead to false positives and unnecessary biopsies. Sonoelastography, an advanced ultrasound technique that assesses tissue stiffness, has emerged as valuable adjunct in breast imaging. Malignant lesions tend to be stiffer compared to benign ones, and elastography leverages this difference to improve diagnostic specificity. Aims and Objectives: (1). To evaluate the role of sonoelastography in the characterisation of breast lesions. (2). To study added benefit of sonoelastography in differentiation of benign and malignant breast lesions with histopatho/cytological correlation. Materials and Methods: Females with complaints of pain / lump in breast referred to Department of Radio-diagnosis who have positive ultrasonography findings from period of July 2024 to July 2025 were taken. A prospective analytical study of all patients was subjected to B-mode ultrasound and sonoelastography. Histopatho/cytological results were taken as gold standard. 80 patients of age groups 20 to 70 years were evaluated. Ultrasound machine equipped with real time elastography software and Linear probe with bandwidth of 3-12 MHz for B mode ultrasound and elastography was used for US and elastography. Results: Overall breast lesions are most common in age group 31 to 40 years. Number of benign lesions decreases as age increases, highest in age groups 31- 40 years. Number of malignant lesions increases as age increases, is highest in age groups 41- 50 years. The results indicate that elastography could be as effective as conventional ultrasound in characterizing breast lesions, as it enhances diagnostic specificity and thereby reduces the false positive rate. Conclusion: Sonoelastography is a useful adjunct to conventional ultrasound, improving differentiation of benign and malignant breast lesions. Its correlation with histopathology/cytology supports its role in enhancing diagnostic accuracy and potentially reducing unnecessary biopsies.

Introduction: Cervical cancer is among the leading cause of death in Indian women owing to lack of awareness and lack of a proper screening program. Objectives: To assess incidence of various cervical lesions by Pap smear in the study area and to evaluate the accuracy of Pap smear with respect to histopathology wherever possible by estimating sensitivity, specificity, predictive values so as to find the usefulness of Pap smear in screening for cervical cancer. Methodology: This was a prospective and retrospective study comprising 110 specimens subjected to Pap smears followed by Histopathological examination. Results: The most common lesion on Pap smear was atypical cells followed by positive for malignancy, SCC and HSIL. The accuracy of cytological test considering histopathological diagnosis as gold standard yielded 80% sensitivity and 92% specificity with 97.14% PPV and 57.50% NPV. Conclusion: Pap smears should be routinely advised to enable early detection of premalignant and malignant cervical lesions.

Background: Intrauterine growth restriction (IUGR) remains one of the major challenges in obstetrics, carrying a high risk of perinatal illness and death. To improve early detection, uterine artery Doppler studies during the second trimester are now widely used, as they provide valuable insight into placental blood flow and help identify pregnancies at risk for adverse outcomes. Aim and Objective: The aim of this study is to assess how well second-trimester uterine artery Doppler indices can predict intrauterine growth restriction (IUGR) in high-risk pregnancies, and to compare neonatal outcomes between those with normal versus abnormal Doppler findings. Materials and Methods: Between March 2023 and February 2024, we conducted a prospective observational study at a tertiary-level teaching hospital. The study population included 120 pregnant women identified as high risk and presenting between 20 and 24 weeks of gestation. Women were categorized as high risk if they had conditions such as prior intrauterine growth restriction, preeclampsia, chronic hypertension, or gestational diabetes. Each participant underwent uterine artery Doppler assessment with a high-resolution ultrasound system. The evaluation focused on calculating the mean pulsatility index (PI) and checking for the persistence of an early diastolic notch. Doppler findings were classified as abnormal when the mean PI exceeded 1.45 and/or bilateral notching was observed. All women were followed until delivery, and pregnancy outcomes including the occurrence of IUGR, neonatal birth weight, requirement for NICU care, and perinatal mortality—were systematically recorded. Results: Out of the 120 women studied, abnormal uterine artery Doppler findings were observed in 38 cases (31.7%). Among these, more than half [22 women (57.9%)] subsequently developed IUGR, whereas only 10 women (12.2%) with normal Doppler readings were affected, a difference that was highly significant (p <0.001). When assessed as a screening tool, abnormal Doppler demonstrated a sensitivity of 68.8% and a specificity of 81.8% for predicting IUGR. Infants diagnosed with IUGR had notably poorer outcomes, with mean birth weights markedly lower than those without growth restriction (2.14 ± 0.28 kg vs. 2.87 ± 0.36 kg, p <0.001), along with a substantially higher likelihood of requiring NICU admission (43.8% compared with 10.2%, p <0.001). Conclusion: Uterine artery Doppler assessment during the second trimester serves as an effective, non-invasive approach for identifying high-risk pregnancies likely to develop intrauterine growth restriction. Integrating this technique into routine evaluation can facilitate earlier recognition of compromised fetal growth and enable timely management strategies, ultimately improving neonatal outcomes.

Background: Chronic mental illnesses frequently necessitate long-term, ongoing medication. It is well recognized that using these drugs might have negative side effects. An adverse drug reaction (ADR) can have a major negative effect on a patient’s quality of life if it is not identified. For family and community physicians who are currently in practice, their prevention and monitoring are essential. Therefore, the current study was conducted to determine the pattern of adverse drug reactions (ADRs) reported as a result of psychiatric medication. Method: The purpose of this retrospective observational study is to examine every spontaneous adverse drug response (ADR) that was reported during a 12-month period from the psychiatry department to the ADR Monitoring Center at SRM Medical College in Bhwanipatna. Results: There were 200 reported ADRs. The majority of the ADRs were observed from antipsychotics (47%) followed by antidepressants (21%) and Mood stabilizers medicines (38%). The most common ADR reported was sedation, EPS, and tremors (36%) followed by metabolic & weight gain (20%), gastrointestinal (36%), and cardiovascular (12%). Conclusion: Understanding common adverse drug reactions (ADRs) aids in the better treatment of illnesses and psychotropics, as they have a variety of common ADRs. Early detection and timely action can aid the community physicians in the proper treatment of the patients and rational use of pharmaceuticals.

Because clinical documentation guarantees the accuracy, consistency, and completeness of patient information, it is essential to hospital quality assurance. In addition to ensuring ongoing patient care, good documentation is essential for tracking treatment results and following clinical recommendations. Healthcare professionals can follow a patient’s medical history, facilitate staff communication, and make well-informed clinical decisions with the use of high-quality documentation. Furthermore, accurate documentation is necessary to conduct audits that evaluate the safety and quality of healthcare as well as to comply with regulatory criteria. Clinical documentation makes it easier to spot patterns and places where hospital procedures need to be improved in the context of quality assurance. Hospitals may improve patient care, streamline treatment pathways, and lower errors by analysing recorded data and putting focused initiatives into practice.
This methodical approach helps performance measuring initiatives in addition to helping assess the efficacy of interventions. In the end, thorough clinical recording forms the basis for creating quality improvement initiatives that put patient safety first and guarantee the provision of top-notch medical treatment.

Spinal dysraphisms are a spectrum of congenital malformations arising from defective closure of the neural tube. They range from open anomalies such as myelomeningocele to occult lesions like dermal sinus tracts and tethered cords. Early diagnosis through imaging is crucial for timely surgical intervention and preventing neurological sequelae. Eleven cases were retrospectively analyzed. Imaging modalities included spinal ultrasonography (for neonates and infants), MRI (T1/T2 sagittal and axial sequences), and CT in selected cases to evaluate bony anomalies. Clinical presentation and imaging findings were correlated. The spectrum includes lipomeningoceles (n=3), myelomeningoceles (n=3), meningocele (n=2), diastematomyelia (n=2), dermal sinus tract (n=1), and associated anomalies including tethered cord, hydrosyrinx, and Arnold Chiari malformation type II. MRI was the most sensitive tool for delineating neural structures, while USG was invaluable in neonates. CT contributed significantly to identifying osseous abnormalities in diastematomyelia. Multimodal imaging plays a pivotal role in detecting and classifying spinal dysraphisms in children. USG is the preferred initial tool in infants, while MRI remains the gold standard for comprehensive evaluation. Early recognition significantly impacts surgical planning and prognosis.

Background: Dermatoglyphics reflects genetically determined epidermal ridge patterns established during early fetal life and remains unaltered thereafter. Vitiligo, a depigmenting disorder characterized by selective melanocyte loss, is believed to have a multifactorial etiology with a significant genetic component. The atd angle, formed by the digital triradii ‘a’ and ‘d’ and the axial triradius ‘t’, serves as an important quantitative palmar parameter indicative of developmental variations. Objective: To evaluate alterations in the atd angle in individuals with vitiligo and to compare these findings with age- and sex-matched healthy controls. Methods: A case–control study was conducted involving clinically diagnosed vitiligo patients and healthy controls from the same institution. Palmar dermatoglyphic prints were obtained using the standardized ink method described by Cummins and Midlo. The atd angle was measured bilaterally using established anatomical landmarks. Statistical analysis was performed to compare mean values between cases and controls. Results: The mean atd angle was found to be increased in both male and female vitiligo patients on the right and left palms compared with controls, although the differences did not reach statistical significance in all parameters. Conclusion: The observed tendency toward increased atd angles in vitiligo supports the hypothesis of an underlying developmental and genetic predisposition. Dermatoglyphic assessment of the atd angle represents a simple, noninvasive, and cost-effective adjunct tool for studying genetic susceptibility in vitiligo.

Background: Enteric bacterial pathogens remain a major cause of morbidity and mortality worldwide, particularly in developing countries. Disease pathogenesis is critically influenced by host–pathogen protein–protein interactions (HPIs), which enable bacterial survival, immune evasion, and intracellular persistence. Comparative analysis of HPIs across multiple enteric pathogens provides valuable insights into conserved and pathogen-specific virulence strategies. Aim: To investigate and compare host–pathogen protein–protein interaction (HPI) profiles among major enteric bacterial genera—Escherichia, Shigella, Salmonella, and Vibrio—using a previously validated in silico prediction framework. Methods: An in silico HPI prediction pipeline was employed to evaluate interactions between human host proteins and representative strains of Escherichia coli, Shigella spp., Salmonella spp., and Vibrio spp. Comparative analyses were performed to identify common HPIs, genus-specific interactions, and inter-species variations. Functional enrichment analysis of host targets was conducted to elucidate biological pathways affected by pathogen interactions. Results: Despite genus- and species-specific variations, a conserved repertoire of HPIs targeting host immune signaling, cytoskeletal regulation, apoptosis, and vesicular trafficking pathways was identified across all enteric pathogens. Shigella exhibited unique interactions related to actin polymerization and immune suppression. Salmonella demonstrated distinct interactions with vesicle trafficking and intracellular survival pathways absent in E. coli. Vibrio species displayed specific interactions affecting epithelial barrier integrity and ion transport. Significant inter-species variations were observed within Salmonella and Vibrio strains. Conclusion: The study highlights a shared core of host interaction strategies among enteric pathogens, alongside pathogen-specific adaptations that underlie distinct disease phenotypes. These findings provide a systems-level understanding of enteric bacterial pathogenesis and identify potential targets for broad-spectrum and pathogen-specific therapeutic interventions.

Objective: Using predetermined relative thresholds as benchmarks, the study aims to quantify the anatomical and dosimetric changes that patients with head and neck cancer undergoing intensity-modulated radiation treatment experience and assess the necessity of adaptive radiotherapy. Methods: 31 consecutive participants participated in this trial. For preliminary treatment planning and a halfway evaluation, two computed tomography (CT) scans were used. In order to apply primary dose calculation to midpoint CT, the study used rigid registration and contour transfer techniques. This resulted in a hybrid plan and an adaptive plan on the midpoint CT. Results: The PTV70, PTV60, and PTV54 volumes showed statistically significant volume reductions, according to the results. In the majority of patients, the parotid glands’ volume showed volumetric reductions. Comparisons between hybrid and adaptive plans revealed notable differences in the maximal doses, while hybrid plans showed poorer dose coverage of the tumor regions. Conclusion: Replanning was mostly justified by anatomical variations that required a second CT scan and the use of a new immobilization mask. Before a replan is implemented, indicators such as a breach of 95% dose coverage for 95% of the tumor volume, maximum doses exceeding 50 Gy in the spinal cord and 59 Gy in the brainstem, and lateral neck displacement exceeding 1 cm from the initial position serve as benchmarks.

Background: Road traffic accidents (RTAs) constitute a major public health challenge worldwide, particularly in low- and middle-income countries like India, where rapid urbanization, vehicular growth, and inconsistent enforcement of traffic regulations contribute to high mortality. Autopsy-based studies provide crucial insights into injury patterns, mechanisms of death, and preventable factors associated with RTA fatalities. Aim: To analyze the epidemiological profile, injury patterns, and causes of death among road traffic accident victims subjected to medico-legal autopsy at a tertiary care hospital in Gurgaon, Haryana. Methods: A retrospective descriptive study was conducted on 70 medico-legal autopsies of road traffic accident fatalities at Al-Falah Medical College, Haryana, from 10 January 2019 to 31 December 2019. Demographic variables, accident characteristics, injury distribution, fracture patterns, intracranial hemorrhages, and causes of death were analyzed using descriptive statistics. Results: Most victims were males, predominantly in the productive age group. Two-wheeler users constituted the largest victim category. Head injury was the most frequently involved body region, with intracranial hemorrhage being the leading cause of death. Subdural and subarachnoid hemorrhages, either alone or in combination, were the most common intracranial findings. Conclusion: Road traffic accident fatalities in this region predominantly affect young and middle-aged males, with head injuries playing a pivotal role in mortality. Strengthening road safety measures, strict enforcement of helmet and seat-belt laws, and improvement in trauma care facilities are imperative to reduce preventable deaths.

Background and Aim: An epidemic of dengue disease had broken out in West Bengal, India. A wide range of unusual dengue fever presentations were noted during the summer during the outbreak period. Our goal in this study was to determine the key clinical and laboratory factors that predict dengue patients’ mortality. Methods: In this prospective cross sectional observational study, 254 individuals with dengue-like fever admitted to a tertiary care hospital were examined, and the source of the fever was thoroughly probed. The ELISA method was used to measure IgM and IgG. Patients with fever from other causes were not allowed to participate in the trial. Every patient had pertinent clinical and laboratory data gathered. Using the proper statistical techniques, the relationship between clinico-laboratory parameters and mortality was investigated. Results: Of the 254 patients, 59.4% (n = 151) were adults and 40.6% (n = 103) were old. Co-morbid disorders linked to DHF included diabetes, hypertension, and IHD; these conditions were statistically significant when compared to the adult group. The elderly cohort had a considerably higher incidence of DHF (30/130, 29.1%) compared to the adult cohort (32/151, 21.2%) (p=0.003). Similarly, SD was more common in older people (30/103, 29.1%) than in younger people (30/151, 19.9%) (p=0.005). Heart rate, systolic blood pressure, diastolic blood pressure, and respiration rate all had nonsignificant p-values (p>0.05) according to a straightforward logistic regression analysis. Conclusion: These findings may enhance knowledge of dengue in older people. DHF, SD, and HAI are more common in elderly dengue patients, who also show atypically. For proper monitoring, early diagnosis is essential. DHF and SD are more common in elderly people, particularly those who already have concomitant conditions.

Objective: For patients with few metastases, including those in difficult-to-reach body locations, stereotactic ablative body radiation (SABR) emerges as a safe and successful treatment. Because it delivers a high dosage to the target tissue and a low dose to the surrounding tissue, stereotactic body radiation therapy (SBRT) is a promising treatment for oligometastatic illness in bone. This study aims to evaluate the treatment’s effectiveness and toxicity in individuals with oligometastatic bone disease who have not previously received radiation therapy. Methods: Patients with oligometastatic bone disease—defined as ≤3 active sites of disease—were treated with SBRT. The fractionation schedule and SBRT dose were not required per protocol. There were reports on overall survival, prostate specific antigen progression, local progression-free survival, and progression-free survival. There have also been reports of treatment-related toxicity. Results: This study includes 126 lesions from different tumor histologies and 98 patients in total. Patients were 80.6% male and 19.4% female, with a median age of 72.8 years. 26.7 months was the median follow-up. Prostate cancer was the most prevalent histology (68.4%, 67/98). 27/30 Gy in 3 parts (27.0%, 34/126), 30 Gy in 5 fractions (16.7%, 21/126), or 30/35 Gy in 5 fractions (16.7%, 21/126) were the most often prescribed doses. Dose painting, which uses a greater dose to the gross tumor volume and a lower dose to the clinical target volume, is reflected in multiple doses each treatment regimen. For every patient (3.2%, 4/126), four patients (4.1%, 4/98) had local progression at one site. 2-year local progression-free survival (includes death without local progression) for the complete cohort Patients were 80.6% male and 19.4% female, with a median age of 72.8 years. 26.7 months was the median follow-up. Prostate cancer was the most prevalent histology (68.4%, 67/98). 27/30 Gy in 3 parts (27.0%, 34/126), 30 Gy in 5 fractions (16.7%, 21/126), or 30/35 Gy in 5 fractions (16.7%, 21/126) were the most often prescribed doses. Dose painting, which uses a greater dose to the gross tumor volume and a lower dose to the clinical target volume, is reflected in multiple doses each treatment regimen. For every patient (3.2%, 4/126), four patients (4.1%, 4/98) had local progression at one site. This study includes 126 lesions from different tumor histologies and 98 patients in total. Conclusion: Our research demonstrates that SBRT is both efficacious and tolerable in patients with oligometastatic bone disease, which is consistent with previous research. To ascertain long-term efficacy and toxicity, larger trials are both reasonable and necessary.

Objective & Aim: Palliative radiation therapy’s primary objective is to lessen patients’ discomfort. However, when a patient’s overall condition rapidly deteriorates, they may not benefit from this treatment at all. This prospective, monocentric study evaluated how well palliative radiation was administered. Methods: All consecutive patients getting palliative radiation at our hospital between March 1, 2025, and August 31, 2025 were included. The successful administration of palliative radiation in accordance with the original prescription (total dose, overall treatment period, and fractionation) was the main outcome. The number of treatment breaks, the clinical benefit, the number of deaths, and the length of time it took to be admitted to the palliative care unit were the secondary objectives. Results: A total of fifty-nine patients and sixty-four treatments were examined. The brain (21.9%) and bone (70.3%) were the therapy locations. Pain control alone (43.8%), decompression alone (21.9%), pain control with decompression (32.8%), and hemostatic aim (1.6%) were the therapy objectives. In 57 cases (89%), palliative therapy was successful. Six cases (9.4%), three for medical reasons and three for logistical reasons, required a temporary halt to the radiation treatment. Worsening performance status was the primary cause of the permanent disruption (seven cases). In 44 cases (68.8%), palliation of symptoms (full or partial responses) was achieved. In the month following the conclusion of treatment, seven patients (11.9%) passed away. There were no instances of admission delays or cancellations in the palliative care unit. Conclusion: In 51 cases (79.9%), palliative radiation was finished as intended, and in 44 cases (68.8%), there was a therapeutic benefit. When it comes to palliative care, radiation therapy should not be disregarded.

Background: Acute ST-elevation myocardial infarction (STEMI) is characterized by an intense inflammatory response that significantly influences infarct size, complications, and short-term prognosis. Identifying simple and cost-effective inflammatory markers for early risk stratification is crucial, particularly in resource-limited settings. Objective: To evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in patients with acute STEMI and to assess its association with clinical severity, TIMI risk score, Killip class, and in-hospital outcomes. Methods: A prospective observational study was performed involving 100 patients with acute STEMI and 100 age- and sex-matched controls. Hematological parameters at admission were recorded, and NLR was calculated. Clinical risk stratification was performed using TIMI score and Killip classification. In-hospital outcomes were documented and analyzed statistically. Results: STEMI patients demonstrated significantly higher neutrophil counts and lower lymphocyte counts, resulting in elevated NLR compared to controls (p < 0.001). NLR showed a strong positive correlation with TIMI risk score and Killip class. Higher NLR values were significantly associated with adverse in-hospital outcomes including cardiogenic shock, reduced left ventricular ejection fraction, ICU admission, complications, and mortality. Conclusion: NLR is a simple, inexpensive, and reliable prognostic marker in acute STEMI. Its strong association with disease severity and adverse outcomes supports its routine use for early risk stratification.

Background: Caesarean section rates have risen dramatically worldwide, necessitating systematic monitoring using standardized classification systems. The World Health Organization recommends Robson’s ten-group classification as the global standard for analyzing caesarean section rates. This study aimed to analyze caesarean section patterns using Robson’s classification in a tertiary care setting. Methods: This prospective cross-sectional study was conducted over three months at a tertiary care hospital. All 430 women with gestational age ≥28 weeks were classified according to Robson’s ten-group system based on parity, gestational age, fetal presentation, onset of labor, and previous caesarean history. Data on demographic characteristics, delivery outcomes, and indications were analyzed using descriptive statistics and chi-square tests. Results: The overall caesarean section rate was 56.3% (242/430). Group V contributed most to caesarean sections (28.9%), followed by Group I (16.5%) and Group X (12.4%). Group V showed 100% caesarean rate with no vaginal births after caesarean. Groups VI-IX also had 100% caesarean rates, while Group III had the lowest (15.2%). Previous caesarean section was the leading indication (28.9%), followed by fetal distress (22.3%). Groups V, I, and II collectively contributed 57.8% of all caesarean sections. Conclusion: Groups V, I, and II were the largest contributors to caesarean sections. The complete absence of vaginal birth after caesarean section and high primary caesarean rates in nulliparous women indicate significant opportunities for intervention. Robson’s classification provides valuable insights for developing evidence-based strategies to optimize caesarean section utilization.

Introduction: Spinal anaesthesia is widely used for lower-limb surgeries, conventional bilateral spinal anaesthesia is often associated with adverse effects such as hypotension, bradycardia, postoperative nausea and vomiting, urinary retention, and delayed motor recovery, mainly due to extensive sympathetic blockade. Low-dose hyperbaric local anaesthetic solutions, slow injection techniques, prolonged lateral positioning, and the use of intrathecal opioid adjuvants have been shown to improve the success of unilateral spinal anaesthesia. Objective- To evaluate the success rate, block characteristics, hemodynamic changes, and adverse effects of unilateral spinal anaesthesia using low-dose hyperbaric bupivacaine combined with intrathecal buprenorphine in patients undergoing unilateral lower-limb surgery. Materials and Methods: This hospital-based prospective observational study was conducted over 18 months in a tertiary care centre in Rajasthan, India. Eighty-eight patients aged 18–65 years, belonging to ASA physical status I and II, undergoing elective unilateral lower-limb surgeries were included. Unilateral spinal anaesthesia was performed using 6 mg of 0.5% hyperbaric bupivacaine combined with 90 µg of buprenorphine, administered intrathecally at a rate of 0.5 ml/min with patients maintained in the lateral decubitus position for 20 minutes. Sensory, motor, and sympathetic blocks were assessed, along with hemodynamic parameters and postoperative adverse events. Data were analysed using appropriate statistical tests. Results: The mean age of patients was 46.9 ± 14.8 years. Hemodynamic parameters showed statistically significant reductions after spinal anaesthesia (p < 0.001), but these changes were clinically acceptable. Dense motor block was achieved predominantly on the dependent side, while most patients showed minimal or no motor and sensory block on the non-dependent side. Postoperative nausea was observed in 3.4% of patients, and no vomiting was reported. Conclusion: Unilateral spinal anaesthesia using low-dose hyperbaric bupivacaine with intrathecal buprenorphine provides effective surgical anaesthesia with good hemodynamic stability, limited contralateral spread, and a low incidence of adverse effects. It is a safe and effective alternative to conventional bilateral spinal anaesthesia for selected unilateral lower-limb surgeries.

Background: For lower segment caesarean sections (LSCS), spinal anaesthesia (SA) is the recommended anaesthetic method. Nonetheless, 50–80% of parturients experience spinal anesthesia-induced hypotension (SAIH), a serious complication that results in decreased placental perfusion and poor maternal-fetal outcomes. Goal: The goal is to develop a useful risk stratification strategy for clinical application by identifying independent predictors of spinal anesthesia-induced hypotension in parturients undergoing LSCS and assessing the effectiveness of various preventive strategies in various risk groups. Materials and Methods: Over the course of 18 months (January 2024 to June 2025), 286 women (ASA I–II, ages 18–45) undergoing LSCS under spinal anaesthesia participated in a prospective observational study. Clinical, haemodynamic, and demographic factors were methodically documented. Systolic blood pressure (SBP) of less than 90 mmHg, MAP of less than 65 mmHg, or a decrease of more than 20% from baseline were considered hypotension. To find independent predictors, univariate and multivariate logistic regression analyses were carried out. Preventive measures such as crystalloid preloading, positional modification, and vasopressor therapy were guided by risk stratification into low, moderate, and high-risk groups based on identified factors. Results: 18.5% of patients had severe hypotension (SBP <80 mmHg), and the overall incidence of SAIH was 67.8% (194/286). There were found to be four independent predictors: Age <30 years (OR 2.14, 95% CI 1.12-4.08, p=0.018), BMI <20 kg/m² (OR 2.87, 95% CI 1.35-6.11, p=0.006), baseline SBP <130 mmHg (OR 3.42, 95% CI 1.98-5.91, p<0.001), and sensory block height ≥T5 (OR 2.91, 95% CI 1.41-6.004). The incidence of SAIH differed significantly between risk groups: low-risk was 53.7%, moderate-risk was 69.5%, and high-risk was 83.6% (p<0.001). In patients at moderate risk, crystalloid preloading with 1000 ml decreased incidence by 22%, while in patients at high risk, it decreased incidence by 31%. Preloading left lateral tilt, and phenylephrine infusion (0.5 mcg/kg/min) together reduced risk by 78% in high-risk patients (18.3% incidence). Neonates in the high-risk group had higher NICU admission rates (16.4% vs. 2.1%, p<0.001) and significantly lower Apgar scores (p=0.032) and cord arterial pH (7.23±0.10 vs. 7.28±0.06 in low-risk, p=0.001). Conclusion: In conclusion, precise risk assessment and focused prevention in LSCS are made possible by the identification of four major predictive factors. In addition to improving maternal haemodynamic stability and neonatal outcomes, a multimodal approach that combines risk-based crystalloid preloading (500–1000 ml), positional modification (left lateral tilt), and prudent vasopressor therapy significantly reduces the incidence and severity of SAIH. This risk-stratified protocol can be implemented and ought to be used in clinical settings.

Objective: To evaluate the efficacy and clinical outcomes of open dorsal approach for managing Kaplan’s dislocation (dorsal metacarpophalangeal joint dislocation) in patients with failed closed reduction. Methods: A prospective case series of 11 patients with Kaplan’s dislocation was conducted at the Department of Orthopaedics, Gauhati Medical College and Hospital from 2022 to 2023. Patients aged 18-60 years with confirmed dorsal MCP joint dislocation requiring open reduction were included. An open dorsal approach with precise reduction and K-wire fixation was performed. Postoperative rehabilitation included ROM exercises. Clinical outcomes have been assessed by employing Visual Analog Scale (VAS) for pain and goniometric measurements for range of motion (ROM) at 6 and 12 weeks post-surgery. Results: All 11 patients achieved successful joint reduction and stabilization. Mean VAS scores improved from preoperative 7.72 ± 0.65 to 1.45 ± 0.69 at 12 weeks (p < 0.001). Total Active Motion (TAM) score at 12 weeks was 316.5° ± 32.8° with a mean recovery of 90.4% compared to the contralateral unaffected joint. Clinical outcomes were excellent in 8 patients (72.7%) and good in 3 patients (27.3%). No major complications were observed during follow-up. Conclusion: The open dorsal approach for Kaplan’s dislocation provides a reliable surgical technique for achieving anatomical reduction and stable joint fixation. This approach minimizes complications associated with repeated closed reduction attempts and facilitates early functional recovery, making it a viable surgical option for managing these complex injuries.

Background: Postoperative pain following major spine surgery is often severe and requires effective analgesic strategies to facilitate early recovery and improve patient outcomes. Intravenous patient-controlled analgesia (IV-PCA) is widely used for postoperative pain management, and many regimens include a continuous background infusion to maintain stable analgesia. However, the routine use of background infusion remains controversial due to concerns regarding increased opioid consumption and opioid-related adverse effects, with limited evidence specific to spine surgery patients. Objective- To compare postoperative opioid consumption, pain intensity, rescue analgesic requirement, opioid-related adverse effects, and IV-PCA discontinuation rates between IV-PCA with and without background infusion in patients undergoing major spine surgery. Materials and Methods: This hospital-based prospective observational comparative study included 240 adult patients undergoing elective major spine surgery under general anesthesia. Patients were allocated into two groups: IV-PCA with background infusion (basal group, n = 120) and IV-PCA without background infusion (no-basal group, n = 120). IV-PCA was administered using morphine or fentanyl according to institutional protocol. Postoperative pain was assessed using the Numeric Rating Scale at rest and for maximum pain during the first 24 hours and 24–48 hours. Total opioid consumption via IV-PCA, requirement for rescue analgesics, opioid-related adverse effects, and IV-PCA discontinuation were recorded over the first 48 postoperative hours. Results: Baseline demographic and perioperative characteristics were comparable between the two groups. Total opioid consumption during the first 24 hours, 24–48 hours, and overall 0–48 hours postoperatively was significantly higher in the basal group compared to the no-basal group (p < 0.05). Postoperative pain scores and rescue analgesic requirements were similar between the groups (p > 0.05). Opioid-related adverse effects, particularly nausea, vomiting, and sedation, as well as IV-PCA discontinuation due to side effects, were significantly more frequent in the basal group (p < 0.05). Conclusion: IV-PCA without background infusion provides comparable postoperative analgesia with lower opioid consumption and fewer opioid-related adverse effects compared to IV-PCA with background infusion in patients undergoing major spine surgery. Demand-only IV-PCA may represent a safer and equally effective analgesic strategy in this population.

Background: Gestational diabetes mellitus (GDM) is increasingly recognized as an early indicator of future cardiometabolic disease in women. Objectives: To assess the risk of ischemic heart disease (IHD), hypertension, and type 2 diabetes mellitus (T2DM) in women with a history of GDM. Methods: A hospital-based observational comparative study was conducted at RDJM Medical College & Hospital, Muzaffarpur, from 2024–2025. Cardiometabolic outcomes in women with previous GDM were compared with women without GDM history. Results: Women with prior GDM had significantly higher prevalence of T2DM (42% vs 12%), hypertension (36% vs 14%), and IHD (12% vs 3%) (p < 0.05 for all). Conclusion: Previous GDM is associated with a significantly increased long-term risk of cardiometabolic disorders, emphasizing the need for structured postpartum follow-up.

Background and Objectives: Smell loss (anosmia/hyposmia) is a common complaint in otorhinolaryngology and may arise from post-viral olfactory dysfunction (PVOD) or chronic rhinosinusitis (CRS). Differentiating these conditions is important because mechanisms, evaluation, and treatment response differ. To compare clinical characteristics, pathophysiology, diagnostic features, and management outcomes of anosmia due to PVOD versus CRS. Methods: A comparative narrative synthesis was performed focusing on onset pattern, nasal symptoms, endoscopic/imaging findings, olfactory testing profiles, and response to medical and procedural interventions. Key domains included inflammatory vs conductive components, duration, prognosis, and evidence-based therapies. Results: PVOD typically presents with sudden smell loss following an upper respiratory infection, often without prominent nasal obstruction. Mechanisms are primarily sensorineural, involving olfactory neuroepithelium injury and inflammatory-mediated dysfunction. Nasal endoscopy and imaging are often normal or minimally inflamed. Recovery is variable, with the greatest improvement usually occurring in the first months; olfactory training is central, while short courses of corticosteroids may be selectively used. In contrast, CRS-related smell loss is commonly gradual or fluctuating, frequently associated with nasal blockage, discharge, facial pressure, and may worsen during exacerbations. It is driven by mucosal inflammation and airflow limitation to the olfactory cleft, with possible neuroepithelial changes in long-standing disease. Endoscopy may reveal mucosal edema, purulence, or polyps, and CT often shows sinus opacification/osteomeatal complex disease. Smell outcomes improve more consistently with intranasal corticosteroids, saline irrigation, and in selected cases systemic steroids and endoscopic sinus surgery, especially in CRS with nasal polyps. Conclusion: PVOD and CRS cause anosmia through distinct dominant mechanisms—sensorineural injury in PVOD versus inflammatory/conductive dysfunction in CRS—leading to different clinical patterns and treatment responses. Careful history, nasal examination, and targeted investigations (endoscopy/CT when indicated) support accurate diagnosis and guide management, with olfactory training emphasized for PVOD and anti-inflammatory plus sinus-directed therapy prioritized for CRS.

Background: Glue ear, medically known as otitis media with effusion (OME), is a common pediatric condition characterized by the accumulation of non-purulent fluid in the middle ear without signs of acute infection. It is one of the leading causes of temporary conductive hearing loss in children. The presence of middle ear fluid restricts the normal movement of the tympanic membrane and ossicles, resulting in reduced sound transmission and mild to moderate hearing impairment.
Persistent OME during early childhood can negatively impact auditory perception during critical periods of language and speech development. Children with untreated or prolonged OME may exhibit delayed speech and language acquisition, poor articulation, reduced vocabulary development, and difficulties in academic performance and social communication. Risk factors include recurrent upper respiratory infections, Eustachian tube dysfunction, allergy, adenoid hypertrophy, and environmental factors such as passive smoking and poor socioeconomic conditions. Diagnosis is typically made through otoscopic examination, tympanometry, and audiological assessment. Management may involve watchful waiting, medical treatment of underlying conditions, speech therapy, and surgical interventions such as tympanostomy tube insertion in persistent or severe cases. Early detection and timely intervention are essential to prevent long-term communication and developmental consequences in affected children. Conclusion: Otitis media with effusion (glue ear) is a common condition in children and a significant cause of reversible conductive hearing loss. The present study demonstrates a strong association between persistent glue ear, hearing impairment, and speech delay, particularly in cases with bilateral involvement and prolonged duration of middle ear effusion. Even mild to moderate hearing loss was found to adversely affect speech and language development during critical periods of childhood.

Background: Urinary tract infections (UTIs) rank among the most prevalent bacterial infections observed in clinical settings. The rise in antimicrobial resistance has made empirical therapy more difficult, especially in tertiary care settings. Objectives: To determine the bacterial profile of UTIs and examine antibiotic resistance patterns among uropathogens isolated at a tertiary care hospital. Methods: A hospital-based prospective observational study was carried out over one year (2024–2025) at Jawahar Lal Nehru Medical College, Bhagalpur. Midstream urine samples from 100 clinically suspected UTI patients were processed using standard microbiological techniques. The Kirby–Bauer disc diffusion method was used to test for antimicrobial susceptibility, as per CLSI guidelines. Descriptive statistics and the chi-square test were used to do the statistical analysis. Results: 62% of the samples showed significant bacteriuria. Escherichia coli was the most common isolate (45.2%), followed by Klebsiella pneumoniae (21.0%). There was a lot of resistance to ampicillin and cotrimoxazole, but nitrofurantoin and carbapenems were more sensitive. Conclusion: The study highlights a high prevalence of multidrug-resistant uropathogens, emphasizing the need for continuous surveillance and rational antibiotic use.

Introduction: Diabetes mellitus is a longstanding chronic illness that predates the advent of Christ. The prevalence of diabetes mellitus has significantly risen in recent years, both in India and worldwide. Diabetes mellitus typically impacts the nervous system, resulting in three pathological conditions: retinopathy, nephropathy, and neuropathy. Despite often being asymptomatic, autonomic neuropathy is associated with an increased risk of death and other diabetes-related complications. Dysfunction of the autonomic nerve system is believed to indicate cardiovascular reflex impairment in other areas. The present study aimed to evaluate autonomic nerve system abnormalities in individuals with type II diabetes mellitus through the application of straightforward bedside autonomic function testing. Methods: This study is a cross-sectional prospective examination conducted from March 2025 to November 2025. One hundred Type II diabetes patients, aged 25 to 45 years and free of any comorbidities or disorders, were enrolled. The total number of patients was classified into two groups based on the duration of diabetes: group A and group B. Assessments of the autonomic nervous system were performed on all patients. Observations and Results: In T2DM patients, HRV analysis showed a significant decrease in time-domain parameters (SDNN and RMSSD), suggesting a decline in parasympathetic activity and overall HRV. Reduced HF power and an elevated LF/HF ratio were revealed by frequency-domain analysis, Indicating sympathetic predominance. Conclusion: The findings of this investigation revealed anomalies in the active sympathetic and parasympathetic nervous systems in patients with diabetes. Considering the engagement of both elements of the autonomic nervous system and the manifestation of symptoms, it is likely that these diabetics have had autonomic dysfunction for a prolonged duration.

Background: Acute appendicitis is still one of the most prevalent surgical emergencies. To lower the rates of negative appendectomies and complications, it is important to make an accurate diagnosis as soon as possible. The Modified Alvarado Score (MAS) is a simple clinical scoring system that helps doctors make diagnoses, especially in places where resources are limited. Objectives: To evaluate the diagnostic accuracy of the Modified Alvarado Score in patients with suspected acute appendicitis. This prospective study took place at PMCH in Patna, Bihar, over a span of 10 months, from February 2025 to December 2025. A total of 76 patients were clinically suspected of having acute appendicitis. We estimated MAS for all patients and compared it to what we found after surgery and in the histopathological examination (HPE). Results: Of the 76 patients (48 males, 28 females), those with MAS ≥7 exhibited significant sensitivity and specificity. The diagnostic accuracy of MAS was 88.2%. Higher scores were substantially correlated with histopathologically confirmed appendicitis (p < 0.05). Conclusion: The Modified Alvarado Score is a reliable, cost-effective, and simple tool for diagnosing acute appendicitis, especially in settings with limited access to advanced imaging technology.

Background: Rheumatoid arthritis (RA) is a progressive, systemic autoimmune disease characterized by chronic inflammation of synovial joints, systemic manifestations, and progressive joint and bone destruction. The current study was conceptualized to assess serum calcium, magnesium, phosphorus, and alkaline phosphatase levels in middle-aged patients with RA. Methodology: A total of 30 RA patients and 30 healthy controls (matched by age and sex) were recruited. After ethical clearance and informed consent, participants were subjected to clinical examination, routine blood investigations, and specific tests to estimate: Serum Calcium – Arsenazo III method, Serum Magnesium – Calmagite method, Serum Phosphorus – Ammonium molybdate method, Serum ALP – IFCC kinetic method. Results: Among all the variables studied, mineral metabolism markers (calcium, phosphorus, magnesium, ALP) and liver function abnormalities were significantly associated with RA positivity, whereas demographic and lifestyle factors were not. Conclusion: These findings may aid clinicians in early recognition of systemic involvement in RA and promote comprehensive patient management strategies.

Background: Biochemistry is a core subject in undergraduate medical training, yet many students find it difficult to understand and retain due to the abstract nature of biochemical pathways and molecular processes. Conventional lecture-based teaching methods may not sufficiently support conceptual learning for all students. In recent years, generative artificial intelligence tools, including Generative Pre-trained Transformer (GPT) models, have been increasingly used by students as supplementary learning aids. Objective: To examine the association between GPT-assisted learning and academic performance, concept retention, and learner satisfaction among undergraduate medical students. Methods: A multicentre retrospective observational study was conducted across medical colleges in Rajasthan, over a one-year period. A total of 150 undergraduate medical students were included and divided into two groups: GPT-assisted learners (n = 75) and conventional learners (n = 75). Academic performance was assessed using internal biochemistry examination scores and concept retention tests, while learner satisfaction was measured using a five-point Likert scale. Statistical analysis included independent t-tests, correlation analysis, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis, with statistical significance set at p < 0.05. Results: Students who used GPT-assisted learning achieved higher mean examination scores compared with those using conventional learning methods (68.9 ± 9.2 vs 61.4 ± 10.5; p < 0.001). Concept retention scores were also higher among GPT users (72.3 ± 8.6 vs 64.1 ± 9.3; p < 0.001). Learner satisfaction was significantly greater in the GPT-assisted group (4.2 ± 0.6 vs 3.4 ± 0.7; p < 0.001). Multivariate analysis identified GPT usage as an independent predictor of high academic performance (adjusted OR = 2.86; p = 0.003). The combined predictive model demonstrated good accuracy on ROC analysis (AUC = 0.82). Conclusion: The use of GPT-assisted learning was associated with improved academic performance, better concept retention, and higher satisfaction among undergraduate medical students studying biochemistry. When applied responsibly as a supplementary tool, GPT-based systems may offer meaningful support within medical education.

Background: The rise of extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae is a significant danger to world health, attributed to restricted treatment alternatives and heightened morbidity and mortality rates. Timely identification of these resistance mechanisms is crucial for effective antibiotic treatment and infection management. Objectives: To identify ESBL and carbapenemase-producing Enterobacteriaceae by phenotypic approaches over the course of one year. Methods: A laboratory-based cross-sectional investigation was performed over one year, encompassing 235 unique Enterobacteriaceae isolates sourced from diverse clinical cases. Isolates were detected with standard microbiological methods. Antimicrobial susceptibility testing was conducted using the Kirby–Bauer disc diffusion method. ESBL production was identified by the combined disc diffusion test (CDDT), whilst carbapenemase production was determined using the Modified Hodge Test (MHT) and the Carba NP test. The data were examined employing descriptive statistics. Results: Of the 235 Enterobacteriaceae isolates, 92 (39.1%) were identified as producers of extended-spectrum beta-lactamases (ESBL), while 28 (11.9%) were identified as makers of carbapenemases. Escherichia coli was the primary bacteria creating extended-spectrum beta-lactamases, whereas Klebsiella pneumoniae was the most prevalent generator of carbapenemases. Significant resistance was noted against third-generation cephalosporins and fluoroquinolones, although colistin and tigecycline maintained effective action. Conclusion: A considerable percentage of Enterobacteriaceae isolates were makers of ESBL and carbapenemase. Systematic phenotypic screening and rigorous antimicrobial stewardship are essential to mitigate the proliferation of multidrug-resistant pathogens.

Introduction: One of the most prevalent illnesses in people is a urinary tract infection (UTI). Despite the availability and widespread usage of antimicrobial medications, bacterial UTIs have been on the rise. Antibiotic resistance is a serious global issue that has emerged in recent years as a direct result of the widespread and improper use of antimicrobial drugs. Materials and Methods: The study was carried out over a 12-month period at Bhagwan Mahavir Institute of Medical Sciences among various age groups of both males and girls. Urine samples from 270 patients in the intensive care unit and various hospital and medical college units were collected. After being collected, all pee samples were processed for aerobic bacterial culture within an hour. Results: Out of a total of 270 patients, 180 (66.66%) samples isolates were detected positive. The most common organism found positive was Escherichia Coli. Gram-negative isolates shown better sensitivity to nitrofurantoin and gentamicin whereas, Gram-positive isolates demonstrated good susceptibility to vancomycin and linezolid, and showed resistance to penicillin. Conclusion: The pattern of resistance to commonly used antibiotics for treating UTI alerts us against indiscriminate usage of antibiotics.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating event of early childhood, presenting with acute onset polyfocal Neurological deficits, accompanied by encephalopathy and MRI changes consistent with demyelination. It is usually a mono-phasic illness. Many children come across a transient febrile illness prior to onset of ADEM, triggers commonly being viruses, rarely atypical bacteria like mycoplasma. Any focal deficit with accompanying seizures when acute in onset vascular aetiology (i.e., stroke) is also thought of. On the other hand, Rasmussen encephalitis is a variety of chronic encephalitis manifesting with unilateral intractable partial seizures, progressive hemiparesis of the affected side and progressive atrophy of the involved hemisphere associated with cognitive decline. We describe a 4-year-old male who has apparently been well till 1 month back starting with fever for 3 days followed by behavioural changes including irritability, some sleep changes over the month, headache for 6 days associated with weakness of left lower limb along with multiple focal seizures involving the left lower limb. Keeping space occupying lesion vs stroke as primary diagnosis, neuro-imaging of the brain was ordered. NCCT brain being feasible was done which came out to be normal. During hospitalisation, the child threw some focal seizure, similar pattern as that of prior to admission. Multiple refractory focal seizures, SOL being ruled out, Rasmussen encephalitis and ADEM were brought into differentials. Meanwhile MRI brain was being planned, the child was initiated immunotherapy i.e., (IV methylprednisolone + IVIG). MRI brain showed T2 and FLAIR, DWI predominant sub cortical hyper-intensity, with parallel clinical response to immunotherapy with improving focal deficit and 5 -seizure free days prior to discharge and overall cognitive as well as clinical well-being achieved. Thus, narrowing down our provisional diagnosis to ADEM.

Background: Adenoid hypertrophy is a frequent cause of nasal obstruction, mouth breathing, snoring, and otologic symptoms in children. Lateral nasopharyngeal radiography is commonly used, while nasal endoscopy allows direct visualization. Objective: To compare grading and diagnostic performance of lateral nasopharyngeal X-ray with rigid nasal endoscopy for adenoid hypertrophy in children and adolescents. Methods: This prospective observational comparative study included symptomatic patients aged 4–16 years attending a tertiary ENT center. Each participant underwent lateral nasopharyngeal X-ray (Fujioka adenoid–nasopharyngeal [A/N] ratio grading) and rigid nasal endoscopy (Clemens grading) within 48 hours. Agreement between modalities was assessed using weighted Cohen’s kappa. Diagnostic accuracy of X-ray was calculated using endoscopy as the reference standard for clinically significant adenoid hypertrophy (grade ≥2). Results: A total of 97 participants were analyzed (mean age 8.4 ± 3.1 years; 59.8% male). Nasal obstruction was present in all patients (100%), followed by mouth breathing (93.8%) and snoring (87.6%). Exact grade concordance between X-ray and endoscopy was 74.2%, with excellent agreement (weighted kappa = 0.812; p < 0.001). For clinically significant hypertrophy (grade ≥2), X-ray showed sensitivity 91.9%, specificity 82.6%, PPV 96.3%, NPV 67.9%, and overall accuracy 90.7%. Conclusion: Lateral nasopharyngeal X-ray demonstrates high sensitivity and accuracy with excellent agreement compared with nasal endoscopy for clinically significant adenoid hypertrophy. Endoscopy remains preferable when detailed anatomical assessment is required, while X-ray is a useful alternative when endoscopy is unavailable or not feasible.

Aim: To evaluate diagnostic performance and clinical utility of preoperative high-resolution computed tomography (HRCT) temporal bone in squamous type chronic otitis media (COM) patients and to compare intraoperative findings with radiological. Materials and Methods: A prospective observational study was conducted on 100 clinically diagnosed adult patients with squamous type COM in Krishna Mohan Medical College and Hospital. All the patients were subjected to complete ENT examination, tuning fork tests, pure tone audiometry, and preoperative HRCT temporal bone imaging. Intraoperative findings were recorded systematically using the same checklist as HRCT parameters and were considered the reference standard for comparison with preoperative HRCT. Results: The most common symptom was ear discharge (97%), followed by hearing loss (84%). On HRCT, middle ear soft tissue was seen in 94% and mastoid soft tissue/opacification in 91% of patients. Scutum erosion was detected in 69%, with ossicular erosion involving the incus (61%), malleus (46%), and stapes (30%). Tegmen erosion and LSCC erosion/fistula were seen in 16% and 10% of cases, respectively. Intraoperatively, middle ear soft tissue and mastoid disease were confirmed in 97% and 94%, scutum erosion in 67%, malleus erosion in 40%, incus erosion in 55%, and stapes necrosis in 45%, indicating that some findings, especially stapes pathology and facial canal dehiscence, were more frequently detected intraoperatively than on HRCT. Conclusion: HRCT temporal bone is an invaluable preoperative imaging modality in squamous COM, with greater precision in the identification of important anatomical variations and in surgical access planning. It significantly improves surgical preparedness and patient counselling. Restrictions remain in the identification of facial nerve dehiscence and stapes pathology. HRCT in difficult cases can be selectively applied for improved surgical success.

Background: Rhinolithiasis is an uncommon condition in which mineral salts deposit around an endogenous or exogenous nidus inside the nasal cavity, gradually forming a calcified mass. Because symptoms are non-specific, it is often misdiagnosed as chronic rhinosinusitis. Case Presentation: A 45-year-old woman presented with 5 years of right-sided nasal obstruction with foul-smelling discharge, intermittent epistaxis, and headache. Nasal endoscopy showed a hard irregular mass, and CT of the paranasal sinuses confirmed a densely calcified lesion without bony erosion. The rhinolith was removed endoscopically under general anaesthesia. Outcome: Recovery was uneventful. On follow-up, the patient had complete symptom relief and healthy nasal mucosa with no recurrence at 6 months. Conclusion: Rhinolithiasis should be suspected in long-standing unilateral nasal obstruction with fetid discharge. Nasal endoscopy and CT help confirm the diagnosis and guide safe endoscopic removal.

Background: Road traffic accidents (RTAs) are a leading cause of trauma-related mortality in India. Spinal injuries, particularly cervical spine injuries, significantly contribute to fatal outcomes due to associated neurological compromise and polytrauma. Objective: To evaluate the demographic profile, pattern, and level of spinal injuries in fatal RTAs in Eastern Uttar Pradesh. Methods: A retrospective observational study was conducted on 70 fatal RTA cases with documented spinal injuries. Data were collected from medico-legal records and hospital case files. Statistical analysis was performed using SPSS v26. Chi-square test was applied; p < 0.05 was considered significant. Results: Males constituted 78.6% of cases. The 21–40-year age group was most affected (45.7%). Cervical spine injuries were most common (41.4%). A significant association was found between cervical spine injury and instant death (χ² = 9.47, p = 0.002). Conclusion: Cervical spine injuries are the predominant and most lethal spinal injuries in fatal RTAs in this region. Strengthened road safety enforcement and early trauma care access are essential.

Aim: This study aims to evaluate the clinical patterns, diagnostic approaches, and management outcomes of abnormal uterine bleeding (AUB) in 200 reproductive-age women attending a tertiary care center in Bhopal, India, from January 2025 to December 2025. The primary objective was to classify AUB using the PALM-COEIN system, assess treatment efficacy, and identify predictors of recurrence. Materials and Methods: A prospective observational study was conducted on 200 non-pregnant women aged 18-50 years with AUB. Inclusion criteria included menstrual frequency <24 days or >38 days, duration >7 days, or blood loss >80 mL/cycle. Exclusion criteria comprised pregnancy, coagulopathy, and malignancy. Evaluation involved detailed history, pelvic examination, transvaginal ultrasound (TVUS), endometrial biopsy, and hematological tests. Management followed FIGO guidelines: medical (tranexamic acid, NSAIDs, hormonal therapies) for initial control, with surgical options (endometrial ablation, hysterectomy) for refractory cases. Results: PALM-COEIN classification showed structural causes (PALM) in 42% (polyps 18%, adenomyosis 12%, leiomyoma 10%, malignancy 2%) and non-structural (COEIN) in 58% (ovulatory dysfunction 32%, endometrial 15%, coagulopathy 6%, iatrogenic 3%, neoplasia 2%). Medical management succeeded in 78% at 6 months, with combined oral contraceptives (COCs) most effective (85% response). Recurrence occurred in 22%, higher in adenomyosis (35%). Hemoglobin improved from 9.2±1.8 g/dL to 11.4±1.5 g/dL (p<0.001). Conclusion: Tailored evaluation using PALM-COEIN and stepwise management significantly improves outcomes in AUB, with medical therapy as first-line. Early TVUS and biopsy enhance diagnostic yield, reducing surgical interventions by 40%. Future studies should explore long-term LNG-IUS efficacy in Indian cohorts.

Background: Pterygium is a common ocular surface disorder in tropical regions and is known to cause visual impairment by inducing corneal astigmatism and altering corneal curvature. Surgical excision with conjunctival autografting has been shown to improve corneal morphology and visual outcomes. Objectives: To evaluate changes in corneal curvature and visual acuity following pterygium excision using a modified sutureless, glueless limbal-conjunctival autograft technique. Materials and Methods: A retrospective analysis of 55 South Indian adults who underwent pterygium excision at Rajarajeswari Medical College and Hospital, Bengaluru, over 18 months was performed. Preoperative and postoperative (1 month and 3 months) keratometric values and best-corrected visual acuity were compared statistically. Results: There was a statistically significant reduction in corneal astigmatism and improvement in best-corrected visual acuity following surgery (p = 0.0001). Conclusion: Modified sutureless, glueless limbal-conjunctival autograft is an effective technique for pterygium surgery with significant improvement in corneal curvature and visual acuity.

Background: Dyslipidemia has a major role in cardiovascular disease (CKD), which is the primary cause of death for those with chronic kidney disease (CKD). Therefore, it is essential to look into the lipid profile of CKD patients in order to lower morbidity and mortality. Methods: Each of the 50 subjects is divided into three groups: CKD patients without hemodialysis (group 2), CKD patients with hemodialysis (group 3), and healthy controls (group 1). In all cases, the lipid profile is evaluated following a 12-hour fast. Results: Total cholesterol (TC), low density lipoprotein (LDL), very low density lipoprotein (VLDL), and triglycerides (TG) are all higher in CKD patients than in healthy controls, but high density lipoprotein (HDL) is lower (p-value for each parameter <0.001). Diabetic CKD patients have higher levels of TC, TG, and VLDL than non-diabetic CKD patients, and the p-value for each of these parameters is less than 0.05. There was no discernible difference in TC and LDL between groups 3 and 2, however there was a statistically significant rise in TG and VLDL and a drop in HDL when compared to group 2 (p-value for each <0.05). Conclusion: According to the current study, dyslipidemia occurs in CKD patients regardless of their management approach; however, the hemodialysis group had a much greater level of dyslipidemia and, as a result, a higher risk of cardiovascular disease. Since it slows the growth of the disease and dyslipidemia, it is better to start using lipid-lowering medicine.

Background: Chronic liver disease (CLD) is defined as the long-term, ongoing destruction and regeneration of the liver; cirrhosis and hepatic fibrosis (scarring) frequently appear as the disease advances. Given that the liver is involved in the production of bile salts, the absorption of vitamin D, and the 25-hydroxylation of vitamin D, it seems sense that vitamin D deficiency would be common in individuals with chronic liver disease (CLD). Methods: From March 2025 to August 2025, 60 patients participated in the present hospital-based observational comparison analysis, which was carried out in the Department of Medicine at SKMCH, Muzaffarpur, Bihar. In order to confirm the anticipated difference of 58.6% in the proportion of cases with vitamin D deficiency in the non-cholestatic chronic liver disease group with age and sex matched control group (hospital staff and patient attendants) (76.5% vs. 17.96%), a minimum sample size of 30 was needed in each group at 95% confidence interval and 80% power. Results: 30 study participants were cases and 30 study participants were controls. Out of the total study participants 23 (38.3%) were female and 37 (61.7%) patients were male and the male to female sex ratio was 1.6 : 1. The mean age of 30 cases in our study was 39.1 ± 8.69 years and the mean age of 30 controls was 38.4 ± 8.02 years and no significant difference was observed. Mean serum Vitamin D3 was lower in CLD cases (23.4 ± 6.44 ng / L) as compared to controls (43.8 ± 5.18 ng/ L). This difference was statistically significant with a p value <0.001. In univariate analysis in patients with non-cholestatic CLD, significant (P<0.05) positive correlations were found between serum level of vitamin D and serum bilirubin, serum albumin, platelet count, & haemoglobin. Also, there were significant (P<0.05) negative correlations between vitamin D concentration and serum bilirubin, INR & MELD score. No significant correlation was seen between vitamin D and age, serum level of PTH, calcium, phosphate, ALT, AST, ALP, urea, or creatinine. Conclusion: In non-cholestatic CLD patients, vitamin D deficiency is quite prevalent and is correlated with the disease’s severity. Therefore, we advise that the evaluation of each patient’s vitamin D level be included of clinical guidelines for the management of non-cholestatic CLD. More research is needed to evaluate and replace vitamin D in the treatment of patients with non-cholestatic CLD.

Background: Non-alcoholic fatty liver disease (NAFLD) is often overlooked in clinical practice, despite its significant clinical implications in Type 2 diabetes mellitus. Finding the prevalence of NAFLD in individuals with diabetes mellitus was the aim of this investigation. Methods: From June 2025 to November 2025, this cross-sectional, non-interventional study was carried out at the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. This study comprised 150 participants with Type 2 diabetes mellitus. Results: The prevalence of NAFLD was 51.3%; it was higher in patients with central obesity and dyslipidemia as well as among females (42.6%). Conclusion: NAFLD has frequently been correlated with diabetes mellitus and raises the risk of problems for patients, therefore early detection is crucial for putting preventative measures into place.

Background: Atherosclerotic cardiovascular diseases, or ASCVD, are a significant consequence of Type 2 diabetes mellitus (T2DM), affecting a significant portion of the population and posing a healthcare burden. The purpose of this study is to show that lipoprotein (a) [Lp (a)] is a marker of ASCVD and to establish a likely association between it and type 2 diabetes. Methods: There were 200 participants in this case-control study: 50 healthy volunteers who were matched for age and gender and 150 diabetic patients. A comprehensive history of type 2 diabetes was taken, and vascular diabetic complications were evaluated. Every participant had their fasting plasma glucose, HbA1c, lipid profile, s. creatinine, and Lp (a) level measured. Results: Lp (a) levels were significantly low in diabetic patients (19.8 ± 13.4 mg/dl) compared to control group (32.6 ± 20.8 mg/dl) (p <0.001). Lp (a) level was significantly higher in diabetics with macro-vascular complications (22.7 ± 14.4 mg/dl) than diabetics with micro-vascular complications (11.7 ± 6.5 mg/dl). Lp (a) level among diabetics with macro-vascular complications was insignificant higher than diabetics without vascular complications (p= 0.08). Conclusion: Given the substantial correlation between Lp (a) and type 2 diabetes and accompanying vascular consequences, more research is necessary, particularly in the area of genetics.

Background: Of all the visceral abscesses, 48% are liver abscesses. Every year, between 40 and 50 million people worldwide suffer from abscesses. It is prevalent and has the second-highest incidence in India as a result of inadequate nutrition, overcrowding, and poor sanitation. This study aims to assess the etiology, clinical characteristics, and biochemical abnormalities of patients with liver abscesses. Methods: From September 2020 to February 2021, 104 patients with liver abscesses identified by ultrasonography were examined in the Medicine department of Darbhanga Medical College and Hospital in Laheriasarai, Bihar. Every patient undergoes biochemical testing and a thorough clinical evaluation. Three groups were established based on the microbiological study: the pyogenic liver abscess (PLA) group (n = 28), the amoebic liver abscess (ALA) group (n = 39), and the not aspirated group (n = 37). Results: Most of the patients belong to ALA group (58.2%) with male preponderance (90.1% in ALA and 60.7% in PLA group) (P = 0.0038). Maximum number of patients of ALA were in <40 years of age group (92.3%) compared to PLA (17.8%) (P = 0.003). Most common comorbidity was cholelithiasis (23.52% in ALA and 37.71% in PLA), and common symptoms were fever (92.30% in ALA and 68.96% in PLA), hypotension (39.2% in PLA and 20.5% in ALA), icterus (42% in ALA and 46% in PLA), and right quadrant tenderness (65.6%). Raised alkaline phosphatases (66% in ALA and 75% in PLA) were the most common liver function test abnormality. Conclusion: PLA was more common in individuals over 40 with concomitant conditions such diabetes, cholelithiasis, or cholangitis and pulmonary findings, while ALA is more common in young males under 40 with a history of diarrhea and soreness or pain in the abdomen. Unlike PLA, ALA can be controlled without ambition.

Background: Light’s criteria were the traditional method of distinguishing between exudative and transudative pleural effusions, which wrongly categorizes 15-20% of transudates as exudates. To distinguish between exudative and transudative pleural effusions, the study aims to ascertain the value of combining total protein and cholesterol from pleural fluid. Methods: The study included patients who had pleural effusions. To determine their use in classifying the pleural effusions, the combined pleural fluid cholesterol and total protein were compared with Light’s criteria as well as with the discharge diagnosis. Results: Forty-two (51.9%) of the 81 individuals who were enrolled in the trial were men. 11.1% of pleural effusions were determined to be transudates and 88.8% to be exudates using Light’s criteria. More pleural fluids were classified as exudates by Light’s criteria than under the discharge diagnosis. For the classification of exudative and transudative pleural fluid, 62.9% of 81 samples fell under exudates, and 37.03% under transudates, with a sensitivity of 87.9% and a specificity of 100%, based on pleural fluid cholesterol >60 mg/dL and protein >3 g/dL. Conclusion: Even though Light’s criteria are still the gold standard for distinguishing between transudates and exudates, combining pleural fluid cholesterol and total protein produces findings that are almost identical without the need for simultaneous blood tests.

Background: Newborn sepsis is a serious medical conditions with a high death rate. Neonatal sepsis is a major problem in India and other developing countries. Determining the antibiotic action pattern and bacterial spectrum in neonatal sepsis is the aim of this study. Methods: This cross-sectional study was performed at the Pediatrics Department of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from March 2025 to August 2025. A total of 120 neonates admitted with the clinical suspicion of sepsis in this study period. Nonprobability convenience sampling technique was used. Data regarding clinical characteristics of neonates, type of bacteria isolated and antibiotic susceptibility results were recorded. SPSS version 20 was used for statistical analysis. The results were written as frequencies / percentages. Results: Neonatal sepsis was suspected in 120 newborns but blood culture proven infection was present in 32 (13.3%) neonates with 23(71.8%) having early onset sepsis. The mean age on admission was 7.61±3.61 days. Acinetobacter was the commonest bacteria implicated in sepsis followed by Klebsiella, Burkholderia and Serratia. The mortality rate in study population was 8.3%. Mortality was highest in Klebsiella sepsis. None of the bacterial species were sensitive to ampicillin while Acinetobacter and Burkholderia species responded to colistin, polymyxin and meropenem but showed resistance to imipenem. Conclusion: Early-onset neonatal sepsis has a high prevalence especially with gram-negative bacteria. Antimicrobial resistance to first line empiric therapy is common.

Background: C-reactive protein (CRP) is an acute-phase reactant protein of hepatic origin that increases following interleukin-6 secretion by macrophages and T cells. Its levels in the body rise or fall in response to various pathological and physiological conditions. CRP is used mainly as a marker of inflammation and infection. Measuring and charting CRP values can prove useful in determining disease progress or the effectiveness of treatments. The Aims of this study is to estimate of CRP in suspected infections at the time of admission and after 48 hrs, correlate CRP values with respect to suspected infection among children reporting in the Pediatrics/NICU; OPD and to find association of CRP levels with possible neonatal sepsis. Methods: It was a descriptive, prospective, observational, clinical, correlative study. The study was conducted at Department of Pediatrics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from June 2025 to November 2025. Each pediatric patient who came to SKMCH, Muzaffarpur was initially categorized according to age till 2 months of age. Neonates were graded according to the signs and symptoms of IMNCI. IMNCI considers bacterial infections in young infants when signs or symptoms of sepsis, pneumonia or meningitis are present. Results: A total 59 cases were enrolled in the study in which infection was suspected at the time of admission based on the category in IMNCI for suspicion of infection. Out of these, 50 cases were successfully followed up to 48 hours as was aimed at the beginning of the study and 9 cases failed to complete a 48 hour study period due to various reasons. Majority of babies had shown positivity in HS-CRP at admission (43/50) as well as after 48 hours (46/50). Neonates were further categorised in 3 groups depending on clinical improvement and fall or rise of Hs CRP level was studied. It was seen that Hs CRP levels have decreased in group which had shown clinical improvement, however in both other groups it was showing rise. We have calculated independent t-value also for each group and it was seen that change in Hs CRP values after 48 hours was significant. Conclusion: The study revealed that Hs CRP levels were increased in all cases of suspected neonatal sepsis. They remained high in neonates who had deteriorated or remained same clinically at 48 hours of follow up. However, they significantly reduced in neonates showing clinical improvement.

Minimally invasive (MI) approaches to total hip arthroplasty (THA) have been promoted to reduce tissue trauma, blood loss, pain and recovery time, but controversy exists regarding their true benefit over conventional THA. We reviewed recent high-quality evidence comparing MI-THA with conventional THA in terms of surgical metrics, clinical outcomes, functional scores, radiological results, and long-term implant survival. Meta-analyses of randomized trials indicate that MI approaches yield some perioperative advantages: average incisions are significantly shorter (~9.0 cm vs. 13.1 cm), and in many series total blood loss and transfusion rates are modestly lower. MI-THA is also associated with slightly reduced early postoperative pain and a marginally shorter hospital stay. However, MI techniques often require similar or slightly longer operative time (e.g. ~10 min longer on average), and randomized trials report equivalent implant positioning and component alignment. Importantly, pooled analyses show no significant differences in major complications (infection, dislocation, fracture, hematoma) or in functional outcomes at intermediate and long-term follow-up. For example, recent meta-analyses found MI- and conventional-THA to have statistically equivalent revision rates and similar Harris Hip Scores beyond the early postoperative period. Some studies note a higher rate of lateral femoral cutaneous nerve palsy with MI approaches, but overall complication profiles are comparable. In summary, MI-THA produces slightly faster short-term recovery without compromising safety or long-term implant survival. The differences, however, tend to be small and often fall below clinically important thresholds. Surgeons should weigh modest early advantages of MI approaches against technical demands and individual patient factors. Ultimately, the choice of approach may be guided by surgeon experience and patient preference, as evidence to date suggests comparable mid- to long-term outcomes with MI versus conventional THA.

Background: Aggressive posterior retinopathy of prematurity (APROP) is a rapidly progressive and severe form of retinopathy of prematurity (ROP) with a high risk of unfavorable visual outcomes. Intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy has become a primary treatment modality, often followed by laser photocoagulation. However, the optimal timing of laser therapy after intravitreal ranibizumab remains controversial. Objectives: To compare anatomical and clinical outcomes of early versus deferred laser photocoagulation following intravitreal ranibizumab in infants with APROP. Methods: A retrospective study was conducted at Rajarajeswari Medical College and Hospital, Bengaluru, over 18 months. Thirty eyes of infants diagnosed with APROP and treated with intravitreal ranibizumab were included. Patients were divided into two groups: early laser (≤2 weeks after injection) and deferred laser (>2 weeks). Anatomical regression, recurrence, need for additional treatment, and complications were analyzed. Results: Early laser following ranibizumab was associated with significantly lower recurrence rates and reduced need for retreatment compared to deferred laser. Favorable anatomical outcomes were achieved in the majority of cases. Conclusion: Early laser photocoagulation after intravitreal ranibizumab appears to provide better anatomical stability and lower recurrence rates in APROP compared to deferred laser treatment.

Ganglion cysts are fluid filled sacs which develop near joints and tendons and are usually asymptomatic. Lower limb ganglion cysts are rare occurrences especially those situated around joint spaces causing nerve compression. We present the case of a 21 years male sports person presented with acute onset pain in left knee, non-radiating pain, localized to knee joint more on lateral side with difficulty in squatting. All stress tests were negative except pain on full flexion which is located postero-laterally in left knee. Paraesthesia on anterolateral aspect of leg. Magnetic resonance imaging (MRI) revealed a ACL tear, injury to anterior horn of medial meniscus and large proximal tibiofibular joint ganglion cyst causing peroneal nerve compression. We discuss etiology, symptoms, and management of lower limb ganglion cysts.

Background: Respiratory distress in mechanically ventilated patients requires prompt adjustment of pressure support settings. Traditional adjustment methods based on tidal volume and respiratory rate (VT/RR) may not capture the dynamic nature of patient-ventilator interaction as effectively as Rapid Shallow Breathing Index (RSBI). Objective: To compare the impact of RSBI-guided versus VT/RR-guided pressure support adjustment on the severity of respiratory distress assessed using Respiratory Distress Observation Scale (RDOS). Methods: Prospective, randomized, single-blind, interventional study of 86 adult patients (aged 20-50 years) at SMS Medical College ICU, Jaipur (January-December 2024). Patients randomly allocated to RSBI group (n=43) or VT/RR group (n=43). Primary outcome: RDOS scores at 0, 15, and 30 minutes post-intervention. Secondary outcomes: heart rate, respiratory rate, RSBI values, and clinical signs including accessory muscle use, restlessness, paradoxical breathing, grunting, and nasal flaring. Results: Mean age RSBI group 34.05±8.39 years, VT/RR group 33.63±8.50 years (p=0.756). Baseline RDOS scores comparable (RSBI: 6.09±1.32, VT/RR: 6.01±1.21, p=0.773). At 15 minutes, RSBI group showed significantly lower RDOS (3.09±0.55) versus VT/RR group (5.85±0.75), p<0.001, indicating rapid distress relief. By 30 minutes, both groups improved (RSBI: 2.89±0.57, VT/RR: 3.06±0.58, p=0.189). Heart rate decreased more rapidly in RSBI group: 110.09→94.74→90.30 bpm versus VT/RR 111.28→108.16→106.30 bpm (p<0.001 at 15 and 30 minutes). Respiratory rate reduced faster in RSBI group: 35.26→26.05→23.93 breaths/min versus VT/RR 34.86→33.70→32.51 breaths/min (p<0.001 at 15 and 30 minutes). RSBI values decreased markedly in RSBI group: 135.42→76.88→64.33 versus VT/RR 134.56→124.42→114.63 (p<0.001). Clinical signs showed no significant differences between groups. Conclusion: RSBI-guided pressure support adjustment provides significantly faster reduction in respiratory distress compared to VT/RR-guided approach, as evidenced by superior RDOS scores at 15 minutes (p<0.001) and more rapid improvement in heart rate, respiratory rate, and RSBI values. RSBI-based strategy should be preferred for timely relief of respiratory distress in mechanically ventilated ICU patients.

Background: Newborn health remains a major public health concern, particularly in rural areas where access to healthcare services is limited. Early recognition of newborn danger signs and prompt health-care seeking behaviour are critical to reducing neonatal morbidity and mortality. This study aimed to assess the level of awareness and health-care seeking behaviour regarding newborn danger signs among mothers in rural areas. A community-based cross-sectional study was conducted among mothers who had delivered within the past 12 months. Data were collected using a structured and pretested questionnaire focusing on knowledge of key newborn danger signs—such as poor feeding, fever, hypothermia, fast breathing, convulsions, lethargy, jaundice, and umbilical infection—and patterns of health-care seeking. Descriptive and inferential statistical analyses were performed to determine associations between socio-demographic factors and awareness levels. The findings revealed that while a majority of mothers recognized at least one danger sign, comprehensive knowledge of multiple critical signs was limited. Fever and difficulty in breathing were the most commonly identified danger signs, whereas hypothermia and convulsions were less frequently recognized. Although many mothers reported seeking care from government or private health facilities, delays in decision-making and preference for home remedies or traditional healers were noted in some cases. Maternal education, antenatal care attendance, and exposure to health education were significantly associated with better awareness and timely health-care seeking behavior. The study concludes that awareness of newborn danger signs among rural mothers remains inadequate, which may contribute to delays in appropriate care. Strengthening community-based health education programs and promoting maternal counseling during antenatal and postnatal visits are recommended to improve early recognition and prompt treatment, thereby reducing preventable neonatal deaths. Conclusion: The present study highlights that awareness of newborn danger signs among mothers in rural areas remains moderate but not comprehensive. Although most mothers were able to identify at least one danger sign—particularly fever and difficulty in breathing—knowledge of other critical signs such as hypothermia, convulsions, and lethargy was limited.

Background: Laryngopharyngeal reflux (LPR) is an extraesophageal presentation of gastroesophageal reflux disease (GERD), characterized by reflux of gastric contents into the laryngopharynx. Symptoms often include chronic throat clearing, cough, hoarseness, globus sensation, and dysphagia, which frequently overlap with GERD presentations. Diagnosis remains challenging due to nonspecific symptoms and variable objective findings.  Objective: To evaluate the correlation between clinical symptoms and laryngeal signs of reflux in patients with suspected LPR, and to compare clinical scoring systems (RSI/RFS) with standard reference criteria for LPR diagnosis. Methods: A prospective cohort of 68 patients presenting with symptoms suggestive of LPR (e.g., throat clearing, cough, globus sensation, hoarseness) was enrolled. Inclusion criteria required RSI >13 and/or RFS >7. Participants underwent comprehensive clinical evaluation, including symptom questionnaires (RSI), laryngoscopic examination (RFS), and pharyngolaryngeal assessment. A control group of patients with low RSI/RFS scores was also evaluated for comparison. Results: The LPR cohort (n = 68) demonstrated significantly higher mean RSI and RFS scores compared with controls, indicating more severe symptoms and laryngeal findings. Common symptoms included frequent throat clearing, chronic cough, globus sensation, hoarseness of voice, and dysphagia. Endoscopic assessment showed laryngeal erythema, vocal cord edema, and other inflammatory changes more frequently in the LPR group. The Reflux Symptom Index correlated strongly with clinical suspicion of LPR, supporting its utility in symptom assessment; RFS was useful in identifying laryngeal signs, although neither score perfectly matched objective reflux measures. Conclusions: This study of 68 patients with suspected LPR confirms a strong association between clinical symptom burden (RSI) and laryngeal inflammatory findings (RFS), supporting the correlation between GERD/LPR and chronic throat symptoms. Although clinical scoring tools are helpful, objective measures remain essential for definitive diagnosis due to the nonspecific nature of symptoms.

Background: Cerebral palsy children have musculoskeletal deformities, motor skill impairments, and muscle tone abnormalities. Orthotics increase gait biomechanics, functional independence, and repaired anomalies. Even though postoperative rehabilitation optimizes surgical benefits, the combined impact of surgery and rehabilitation on functional outcomes is underreported, especially in low-resource settings. At Nalanda Medical College and Hospital, cerebral palsy patients who underwent rehab surgery were referred for physical therapy. Methods: Between August 2024 and February 2025, 60 CP children aged 3–18 who had rehab Surgery like tendon lengthening, combination therapy, and soft tissue release were selected for this study. Prior to and three months after surgery, the FMS, step length, cadence, gait speed, and VAS for discomfort were utilized to assess function. All tests employed pair t-tests, and p-values below 0.05 indicated there significance. Results: After surgery, all functional findings improved dramatically. The average GMFM-88 score increased from 52.6 ± 10.4 to 67.8 ± 9.8 (p < 0.001). At a p-value < 0.001, FMS scores increased from 2.1 ± 0.8 to 3.0 ± 0.9 at 5 m and from 1.8 ± 0.7 to 2.7 ± 0.8 at 50 m. The improvements were considerable (p < 0.001): gait speed increased from 0.42 ± 0.12 to 0.57 ± 0.14 m/s, step length decreased from 23.4 ± 6.2 to 31.0 ± 5.8 cm, and cadence increased from 76.8 ± 10.5 to 88.6 ± 12.2 steps/min. Patient improvement was modest to significant in 87%. Functional gains were strongly correlated with rehabilitation adherence. The only modest effects were transitory stiffness (5%) and mild wound infection (6.7%). Conclusion: Orthopaedic surgery and intense rehabilitation improved motor function, gait metrics, and mobility in cerebral palsy children. Early, ongoing rehabilitation improved results. Functional rehabilitation for CP sufferers requires surgery and therapy. Long-term, multicentre trials are recommended to confirm and expand these findings.

Background: Distal femoral fractures account for approximately 3–6% of all femoral fractures and remain a formidable challenge owing to complex fracture patterns, periarticular involvement, and frequent association with osteoporotic bone. Although multiple fixation strategies exist, there is no clear consensus regarding the optimal implant. Distal femoral locking compression plates (LCPs) provide angular stability and biomechanical advantages, particularly in comminuted and osteoporotic fractures. This study aimed to evaluate fracture union, functional outcomes, and complication rates following LCP fixation of distal femoral fractures. Patients and Method: This prospective observational study included 24 adult patients with closed or Gustilo–Anderson type I open distal femoral fractures treated with LCP fixation. Standardized surgical techniques and postoperative rehabilitation protocols were employed. Patients were followed for a minimum of 18 months. Clinical and radiological outcomes were assessed at regular intervals, with functional evaluation performed using Neer’s scoring criteria. Results: Fracture union was achieved in 23 patients (95.8%), with a mean time to union of 15.1 weeks (range, 12–20 weeks). Functional outcomes were graded as excellent in 37.5%, good in 54.2%, and fair in 8.3% of patients. More than half of the cohort achieved knee flexion ≥90°. Reported complications included knee stiffness (19.3%), limb shortening (8.3%), superficial infection (8.3%), and varus malalignment in one patient. No cases of implant failure or non-union were observed. Conclusion: Locking compression plate fixation for distal femoral fractures yields high union rates and favourable functional outcomes with an acceptable complication profile. This technique is particularly advantageous in osteoporotic and comminuted fracture patterns. Meticulous surgical technique, appropriate implant selection, and early mobilization are essential for optimizing clinical outcomes.

Background: Opportunistic fungal infections (OFIs) remain a significant cause of morbidity and mortality among patients with HIV/AIDS, particularly in resource-limited settings. Despite widespread antiretroviral therapy (ART), fungal infections such as candidiasis, cryptococcosis, and aspergillosis continue to pose clinical challenges. Objectives: To determine the spectrum, prevalence, and associated risk factors of opportunistic fungal infections among HIV/AIDS patients attending JLNMCH in Eastern India. Methods: A cross-sectional study was conducted among 150 HIV-positive patients. Clinical evaluation, CD4 count estimation, direct microscopy (KOH mount, India ink), culture, and fungal identification were performed. Statistical analysis was conducted using chi-square test and logistic regression. A p-value <0.05 was considered significant. Results: Out of 150 patients, 68 (45.3%) had confirmed fungal infections. Oropharyngeal candidiasis (26.7%) was the most common infection, followed by cryptococcosis (8.7%), dermatophytosis (5.3%), and aspergillosis (4.6%). A strong association was observed between CD4 count <200 cells/µL and occurrence of fungal infection (χ²=18.42, p<0.001). Conclusion: Opportunistic fungal infections remain prevalent among HIV patients with low CD4 counts. Early screening and timely antifungal therapy are crucial to reduce morbidity.

Introduction: Thick wall gallbladder (TWGB) is a frequent observation on ultrasonography, particularly in areas with a high incidence of gallstone disease. The preoperative differentiation between benign and malignant causes of TWGB is crucial, as the surgical interventions vary significantly. Despite extensive investigation using numerous imaging modalities, a clear diagnosis cannot often be achieved. Imaging, especially ultrasonography (USG), is extensively utilized in assessing gallbladder disorders, with gallbladder wall thickness (GBWT) recognized as a possible indicator of underlying malignancy. Aim: To investigate the prognostic significance of gallbladder wall thickness in distinguishing benign from malignant gallbladder conditions and to analyze its association with histological results. Methods: A retrospective observational study was conducted at Shri shankaracharya institute of medical science over a period of 12 months. Patients undergoing cholecystectomy for suspected gallbladder pathology were included. Preoperative ultrasonographic assessment of gallbladder wall thickness was documented. Based on USG findings, patients were stratified into normal (10 mm) categories. The diagnostic accuracy of GBWT was calculated, and associations with demographic and clinicopathological variables were analysed. Results: A total of 100 patients were studied, with a mean age of 45 years; females constituted 65%. Among them, 45 cases were benign (chronic cholecystitis), while 18 were malignant. 14 pateints with garde 3 undergoes difficult surgery, out of which 6 patients underwent conversion to open surgery, all of whom exhibited Grade 2 or Grade 3 vascularity. Conclusion: The thickness of the gallbladder wall observed via ultrasound is a straightforward, economical, and non-invasive indicator that significantly correlates with gallbladder cancer. It may function as a crucial instrument for early detection, especially in high-risk demographics.

Background: Ultrasonography is the primary first diagnostic tool for suspected biliary abnormalities, and computed tomography (CT) and ultrasonography (USG) have transformed the diagnosis process. Although the infiltrative nature of certain tumors and the presence of gallstones, inflammation, and debris may make tumor identification impossible, it might be useful for identifying gadolinium-based contrast agents (GBCA). According to reports, CT is a complete imaging and staging tool for GBCA. Aim of this study to evaluate USG and CT assessment of gallbladder (GB) masses and correlate to cytological findings. Methods: From February 2025 to July 2025, this study was carried out in the Department of Radiology at Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar, in collaboration with the departments of surgery, medicine, and pathology. Our investigation comprised 50 patients with suspected GB masses in total. Result: Maximum number of patients were in the age group between 41 and 50 year, about 32%, and age group between 51 and 60 years, about 28%. GB masses 33 (66%) were detected in females and 17 (34%) were detected in males. Mass detection as per diffuse wall and mass detection as per heterogeneous echotexture was seen in 35 patients, about 70% in USG, and 36 patients, about 72% in CT. Thickening of GB was seen in 7 patients, about 14% in USG and CT. Conclusion: In our study, overall detection of GB carcinoma USG could detect 94% of cases and CT could detect 96% of cases same as fine-needle aspiration cytology detection of GB carcinoma showing that CT is more sensitive than USG to detect the GB carcinoma.

Background: Bleeding in the first trimester is frequently caused by molar pregnancy, ectopic pregnancy, and abortions. Aim of this study to evaluate the first trimester bleeding and prognosticate and predict the status of abnormal pregnancies using ultrasound scan. Methods: In this observational study, total 100 pregnant of aged from 22 to 34 years with first-trimester vaginal bleeding were examined by Ultrasonography. Demographics, obsestric history such as age, parity, gravidity bleeding severity, ultrasonography results, and clinical diagnosis referred in categorical data and analysed using Chi-square analysis. Statistical analyses were done by SPSS ver. 24. Results: Spotting in 40%, light in 28%, and heavy in 32% of the pregnants in heaviness of bleeding. 73% of pregnant reported spontaneous bleeding. Threatened abortion clinically diagnosed in 52 cases; Ultrasonography confirmed 24 pregnant as threatened abortions and aids in correctly diagnosing 8 cases that were missed on clinical examination. 24 pregnant women out of 36 threatened abortions were continued to term, with a 66 % success rate. Ultrasonography correctly diagnosed pregnant women who were threatened with abortion (n=36), incomplete abortion (n=20), missed abortion (n=8), ectopic (n=8), inevitable abortion (n=8), blighted ovum (n=4), and Hydatidiform mole (n=4). 96 out of 100 pregnants were correctly diagnosed by Ultrasound when compared to 72 out of 100 cases on the basis of clinical diagnosis with a disparity of 64%. On follow-up, six cases of threatened abortion were terminated. Conclusion: Ultrasonography plays an important role in the etiological diagnosis of bleeding in the first trimester of pregnancy; in most cases, a responsible abnormality of bleeding is easily identified. Using Ultrasonography, misdiagnosis at first trimester can be avoided.

Background: Based on their echo characteristics and vascularity on CD, USG can distinguish between several types of liver lesions; FNAC can only be performed on patients who have been chosen and require additional testing. Therefore, the invasive, painful, and time-consuming FNAC technique will not be performed on patients who have benign lesions based on USG and color Doppler. Methods: This cross-sectional study was conducted at Department of Radiology, Nalanda Medical College and Hospital, Patna, Bihar from February 2025 to July 2025. Results: Our study group consisted of 100 patients with focal hepatic lesions, of whom 47 had abscesses, 2 had adenoma, 1 had a hepatic cyst, 1 had cholangiocarcinoma, 22 had HCC, and 21 had metastases on FNAC. USG had a sensitivity of 87.23%, specificity of 93.33%, PPV of 93.18%, NPV of 87.5%, and diagnostic accuracy of 90.21% for diagnosing abscess. When using USG to diagnose HCC, the diagnostic accuracy was 79.34%, the sensitivity was 63.64%, the specificity was 84.28%, the PPV was 56%, and the NPV was 88.05%. When using USG to diagnose metastases, the diagnostic accuracy was 78.26%, the sensitivity was 52.38%, the specificity was 85.91%, the PPV was 52.38, and the NPV was 85.91%. Conclusion: Our study found that USG had a higher diagnostic accuracy of over 75% in identifying the most prevalent focal liver lesions, such as abscess, hepatocellular carcinoma, and metastatic lesions, than FNAC, which was regarded as a confirmatory test in our institution.

Background: A metabolic disease called diabetes mellitus affects how different trace elements are metabolized. Present study has been carried out to determine association between serum ferritin and type 2 diabetes mellitus. Aim of this study to analyze level of serum ferritin in type 2 diabetes mellitus patients in comparison with healthy controls. Methods: The present cross-sectional study was carried at Clinical Laboratory of Department of Biochemistry, Darbhanga Medical College, Laheriasarai, and Bihar from February 2025 to May 2025. There were 100 cases having minimum 5 years history of type 2 diabetes mellitus. There were 100 healthy controls in this study. ELISA (Enzyme-Linked Immunosorbent Assay) method was used for estimation of Glucose. Nephelometry method was used for estimation of Ferritin and HbA1c. Results: In comparison to healthy controls; Serum ferritin level was found high in Type 2 DM patients. Conclusion: High level of serum ferritin was found in patients of type 2 diabetes mellitus patients who have poor glycemic control.

Background: To assess serum TSH and Prolactin in women with PCOS in comparison with healthy women as controls and to find correlation between TSH & Prolactin in PCOS subjects. Methods: A comparative study including 30 women diagnosed as PCOS and 30 age and BMI matched healthy women as controls was conducted. The age group for the study was 18-35 years. Fasting blood samples were drawn to measure serum thyroid stimulating hormone (TSH) and prolactin. Results: Mean TSH and prolactin were found elevated in the PCOS cases compared to controls but they were not statistically significant. No significant correlation was found between TSH and prolactin. Conclusion: We could not find any significant correlation between serum TSH and serum prolactin. Further, studies with larger number of PCOS subjects will be beneficial. However monitoring of Prolactin and TSH in PCOS should be done.

Background: Diffuse lung diseases describe a heterogeneous group of disorders of the lower respiratory tract characterized by inflammation and derangement of the interstitium and loss of functional alveolar units. The disease is not restricted to the interstitium only, as it involves epithelial, endothelial and mesenchymal cells with the disease process extending into the alveoli, acini and bronchioles. Thus, the entire pulmonary parenchyma is involved. Aim of this study to determine the diagnostic accuracy of chest radiography in diffused lung diseases and interstitial lung diseases confirmed by chest HRCT. Methods: 30 patients with signs and symptoms of diffused lung diseases (DLD) were included in study. Findings like ground glass haze (GGO), reticular opacities, nodular opacities, fissure thickening, emphysematous changes, fibrotic changes, architectural distortion, honeycombing, septa thickening, consolidation, bronchiectasis, hilar and mediastinal lymphadenopathy, pleural effusion were documented in them and comparison was done between chest radiography and HRCT. Results: The correlation between X-ray and HRCT among the study subjects having symptoms of diffuse lung disease. Approximately similar distribution of reticular opacities and emphysematous changes was revealed on X ray as well as HRCT. HRCT revealed more cases of GGO/haziness, septal thickening, nodular opacities, bronchiectatic changes, Hilar& mediastinal lymphadenopathy, fibrotic lesions and NHO/Consolidation as compared to X ray with statistically significant difference as p<0.05. Conclusion: This study concluded that HRCT of the chest has proven to be better method for evaluating and diagnosing the patients with diffuse lung disease than conventional chest radiography. Chest HRCT scan is essential for diagnostic workup; however, chest radiography serves as initial investigation for screening the patients and for their follow up.

Background: Neonatal sepsis is a leading cause of neonatal morbidity and mortality, particularly in developing countries. Early diagnosis remains challenging due to nonspecific clinical features. Inflammatory biomarkers such as interleukin-6 (IL-6) and resistin have emerged as potential tools for early diagnosis and prognostication in neonatal sepsis. Objectives: To evaluate alterations in serum resistin and IL-6 levels in neonates with sepsis and to assess their association with disease severity and clinical outcomes. Materials and Methods: This retrospective observational study was conducted in the Neonatal Intensive Care Unit of Indira Gandhi Institute of Medical Sciences, Patna, Bihar, over a period of 24 months. Medical records of 90 neonates diagnosed with sepsis were analyzed. Serum IL-6 and resistin levels measured at the time of sepsis evaluation were recorded. Clinical outcomes, including survival and mortality, were assessed. Statistical analysis was performed using appropriate parametric and non-parametric tests. Results: Among the 90 neonates studied, 60% were male and 58.9% were preterm. Mean serum IL-6 and resistin levels were significantly elevated in septic neonates. Non-survivors had significantly higher IL-6 and resistin levels compared to survivors (p < 0.001). Late-onset sepsis was associated with higher biomarker levels than early-onset sepsis. Elevated IL-6 and resistin levels were also associated with increased need for mechanical ventilation and higher mortality. Conclusion: Serum IL-6 and resistin levels are significantly elevated in neonatal sepsis and are strongly associated with disease severity and mortality. These biomarkers may serve as useful adjuncts for early diagnosis and risk stratification in neonatal sepsis.

Background: Neonatal sepsis is a leading cause of morbidity and mortality in newborns. Early diagnosis is challenging due to nonspecific clinical signs, and conventional markers such as blood culture and C-reactive protein have limitations. Interleukin-6 (IL-6) is a pro-inflammatory cytokine that rises early in response to infection and may serve as a useful diagnostic biomarker. Objectives: To evaluate the diagnostic efficacy of serum IL-6 as an early marker of neonatal sepsis and its association with disease severity and mortality. Materials and Methods: This retrospective study was conducted in the Neonatal Intensive Care Unit of Indira Gandhi Institute of Medical Sciences, Patna, Bihar, over 24 months. Medical records of 100 neonates evaluated for suspected sepsis were reviewed. Serum IL-6 levels were measured at the time of initial sepsis evaluation. Diagnostic performance of IL-6 was assessed using sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curve analysis. Associations between IL-6 levels, type of sepsis, and outcomes were also analyzed. Results: Among the 100 neonates, 62% were male and 56% were preterm. Serum IL-6 levels were significantly elevated in septic neonates compared to non-septic neonates (p < 0.001). At a cutoff of ≥80 pg/mL, IL-6 demonstrated sensitivity 91.7%, specificity 85.7%, and AUC 0.93. Non-survivors had significantly higher IL-6 levels than survivors (212.8 ± 44.9 pg/mL vs 144.2 ± 36.5 pg/mL, p < 0.001). Late-onset sepsis was associated with higher IL-6 levels than early-onset sepsis (181.9 ± 49.6 pg/mL vs 148.6 ± 40.2 pg/mL, p = 0.003). Conclusion: Serum IL-6 is a highly sensitive and specific early biomarker for neonatal sepsis. Elevated IL-6 levels are associated with disease severity, late-onset sepsis, and increased mortality. Incorporating IL-6 measurement in early sepsis evaluation may facilitate prompt diagnosis, risk stratification, and improved neonatal outcomes.

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign but locally aggressive vascular tumor predominantly affecting adolescent males. The tumor commonly arises from the posterolateral wall of the nasopharynx and has a strong tendency to extend into the pterygopalatine fossa, infratemporal fossa, orbit, and intracranial region. Surgical excision remains the treatment of choice. Traditionally, open surgical approaches were employed for extensive lesions; however, endoscopic techniques have gained popularity due to improved visualization, reduced morbidity, and shorter recovery time. Aim: To compare outcomes of endoscopic and open surgical approaches in extensive juvenile nasopharyngeal angiofibroma in terms of operative time, blood loss, complications, recurrence, and hospital stay. Methods: This prospective comparative study was conducted at Nalanda Medical College and Hospital, Patna, from November 2023 to November 2025. A total of 30 diagnosed cases of extensive JNA were included. Patients underwent either endoscopic excision or open surgical excision depending on tumor stage and surgical feasibility. Preoperative embolization was performed in eligible cases. Data were analyzed using SPSS software. Continuous variables were compared using independent t-test and categorical variables using Chi-square test. A p-value <0.05 was considered statistically significant. Results: Out of 30 patients, 17 underwent endoscopic excision and 13 underwent open surgery. Mean intraoperative blood loss was significantly lower in the endoscopic group (p<0.001). Hospital stay was shorter in the endoscopic group (p<0.001). Complication rates were higher in open approaches. Recurrence was slightly higher in open group but was not statistically significant. Conclusion: Endoscopic surgery is a safe and effective option for extensive juvenile nasopharyngeal angiofibroma with reduced blood loss, fewer complications, and shorter hospitalization. Open approaches remain useful for select advanced lesions with extensive intracranial or lateral extension.

Background: Small dry central tympanic membrane (TM) perforations are commonly encountered in clinical practice and can lead to recurrent ear discharge and conductive hearing loss. For selected small central perforations, minimally invasive options such as fat plug myringoplasty and chemical cauterization are used to achieve closure, but their relative effectiveness varies across settings. Objectives: To compare the anatomical closure rate and post-procedure hearing status following fat plug myringoplasty versus 10% trichloroacetic acid (TCA) chemical cauterization for closure of small central dry TM perforations. Methods: This prospective comparative study was conducted in the Department of Otorhinolaryngology, from October 2020 to July 2022. A total of 50 patients aged >10 years with small central dry TM perforation (dry for ≥4 weeks) were included and randomly divided into two groups:  Group A (n=25) underwent fat plug myringoplasty using ear-lobule fat. Group B (n=25) underwent 10% TCA chemical cauterization of the perforation margin repeated weekly for 5 weeks. Patients were followed up for 3 months, and perforation closure at 3 months was assessed. Hearing status was evaluated using pure tone audiometry and categorized for analysis. Data were entered in MS Excel and analysed using SPSS (chi-square test; p<0.05 considered significant). Results: The mean age of participants was 38.20 ± 14.4 years and 60% (n=30) were female. At 3 months, TM closure was achieved in 23/25 (92%) patients in the fat myringoplasty group compared with 16/25 (64%) in the chemical cauterization group (p=0.0168). A post-operative hearing category of <26 dB was observed in 23/25 (92%) patients after fat myringoplasty versus 16/25 (64%) after chemical cauterization (p=0.0168). Conclusion: For small central dry TM perforations, fat plug myringoplasty achieved a significantly higher closure rate than 10% TCA chemical cauterization at 3-month follow-up, with a more favourable post-operative hearing category distribution.

Background: Postpartum depression (PPD) and postpartum anxiety (PPA) are major public health concerns affecting maternal wellbeing, infant care, and family functioning. In India, sociocultural and economic factors significantly influence maternal mental health, yet routine screening remains inadequate. This study aimed to assess the prevalence of PPD and PPA among postpartum mothers and identify associated risk factors. Methods: A cross-sectional observational study was conducted among 100 postpartum mothers attending the postnatal clinic at C. U. Shah Medical College, Surendranagar. Participants within six weeks postpartum were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) and Hamilton Anxiety Rating Scale (HAM-A). Socio-demographic and obstetric variables were collected through structured interviews. Data were analyzed using SPSS version 25, applying descriptive statistics and Chi-square tests. Significance was considered at p < 0.05. Results: PPD prevalence was 28%, with 14% showing mild and 14% moderate–severe depression. Moderate–severe anxiety was observed in 40% of participants. Younger mothers and cesarean deliveries showed higher depressive tendencies, though not statistically significant. Nuclear family structure was significantly associated with higher anxiety (p < 0.05). Depression was significantly more prevalent in low socioeconomic groups (p < 0.05). EPDS and HAM-A scores demonstrated a strong positive correlation (r = 0.68, p < 0.001). Conclusion: Postpartum psychological distress is substantial, emphasizing the need for routine screening, early detection, and strengthened psychosocial support in postnatal care systems.

Background: Early identification of critically ill patients with high risk of mortality is fundamental to intensive care management. The Shock Index (SI), defined as the ratio of heart rate to systolic blood pressure, has emerged as a simple bedside indicator of hemodynamic instability. Objectives: To assess the efficacy of the Shock Index at ICU admission as a prognostic indicator of mortality in critically ill patients. Materials and Methods: This prospective observational study was carried out in the Intensive Care Unit of Nalanda Medical College and Hospital, Patna, from October 2024 to June 2025. A total of 95 severely ill adult patients were recruited. Patient’s heart rate and systolic blood pressure were recorded and Shock Index was calculated on admission to ICU. Patients were followed up until discharge from the ICU or demise. Shock Index values of survivors and non-survivors were recorded. Results: Patients who did not survive exhibited markedly elevated Shock Index values upon admission in contrast to survivors. A higher Shock Index was substantially linked to a higher mortality rate in the ICU, which means that the person’s hemodynamic condition was compromised at the time of ICU admission. Conclusion: Shock Index is a rapid, cost-effective and reliable predictor of mortality in critically ill ICU patients. Routine assessment at ICU admission may facilitate early risk stratification and timely clinical intervention.

Background: Occupational dermatoses represent a significant proportion of work-related diseases worldwide and are particularly common among agricultural workers due to continuous exposure to chemicals, plant materials, ultraviolet radiation, and mechanical trauma. In India, epidemiological data on occupational dermatoses among rural farmers remain limited. Aim: To assess the epidemiological profile, clinical pattern, and occupational risk factors associated with occupational dermatoses among rural farmers. Materials and Methods: This observational, multicentric, cross-sectional study. A total of 115 rural farmers aged ≥18 years with clinically suspected occupational dermatoses were included. Detailed occupational history, clinical examination, and relevant investigations (KOH mount, Gram staining, patch testing where feasible) were performed. Data were analyzed using SPSS version 26.0. Categorical variables were expressed as frequencies and percentages. Chi-square test and logistic regression were applied where appropriate, with p <0.05 considered statistically significant. Results: Of the 115 participants, 72 (62.6%) were males, and the majority (46.1%) belonged to the 31–50 years age group. Occupational contact dermatitis was the most common condition (38.3%), followed by photodermatoses (22.6%) and infective dermatoses (20.0%). Among contact dermatitis cases, irritant contact dermatitis (63.6%) predominated over allergic contact dermatitis (36.4%). Fungal infections (56.5%) were the most frequent infective dermatoses. Inadequate use of personal protective equipment (71.3%) and pesticide/fertilizer exposure (69.6%) were the most common occupational risk factors. Conclusion: Occupational dermatoses pose a substantial health burden among rural farmers, with contact dermatitis being the predominant condition. Modifiable risk factors, particularly inadequate PPE use and chemical exposure, play a significant role. Strengthening occupational health education and preventive strategies is essential to reduce morbidity in this population.

Background: Suicidal poisoning remains a major public health concern in India, especially in agriculturally dominant regions where toxic agents are easily accessible. Eastern Uttar Pradesh represents a high-risk belt due to widespread pesticide use. Aim: To analyze the epidemiological profile, toxicological spectrum, and clinical determinants of lethal suicidal poisoning cases in Eastern Uttar Pradesh. Methods: A hospital-based observational descriptive study was conducted at the Department of Emergency Medicine, Maa Vindhyavasini Autonomous State Medical College, Mirzapur, Uttar Pradesh, India, over a period of two years (1st July 2023 to 30th June 2025). The study included 60 confirmed fatal suicidal poisoning cases. Demographic details, type of poison, time to hospital presentation, residence, requirement of ventilatory support, and survival duration were analyzed. Statistical analysis included Chi-square test and independent t-test. A p-value <0.05 was considered statistically significant. Results: Organophosphorus compounds were the most common poison (41.7%). Majority were males (63.3%) and belonged to the 21–40 years age group (48.3%). Rural residence (71.7%) and delayed hospital presentation (>6 hours) (65%) were significantly associated with poor survival duration (p = 0.03 and p = 0.01 respectively). Mean time to presentation was 7.2 ± 3.4 hours. Conclusion: Organophosphorus poisoning remains the leading cause of suicidal deaths in Eastern Uttar Pradesh. Early intervention and pesticide regulation are crucial preventive strategies.

Background: Laryngoscopy and endotracheal intubation are associated with a significant sympathetic response resulting in tachycardia and hypertension. Attenuation of this hemodynamic response is particularly important in patients with limited cardiovascular reserve. Dexmedetomidine and midazolam are commonly used premedicants, but their comparative effectiveness in blunting intubation-induced hemodynamic changes remains an area of clinical interest. Objective: To compare dexmedetomidine and midazolam as premedication for attenuation of hemodynamic responses to laryngoscopy and intubation. Methods: This prospective comparative study included 100 adult patients undergoing elective surgery under general anesthesia. Patients received either dexmedetomidine (Group D) or midazolam (Group M) as premedication. Hemodynamic parameters including heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, after premedication, at laryngoscopy, and at 1, 3, and 5 minutes post-intubation. Data were analyzed statistically. Results: Dexmedetomidine produced significantly lower heart rate and blood pressure responses during and after intubation compared to midazolam (p < 0.001). Conclusion: Dexmedetomidine is superior to midazolam in attenuating the hemodynamic response to laryngoscopy and intubation.

Background: Critically ill patients frequently develop disturbances in acid–base balance, oxygenation, and ventilation due to underlying respiratory, metabolic, and systemic illnesses. Arterial blood gas (ABG) analysis provides rapid and comprehensive assessment of these disturbances and plays a crucial role in diagnosis, monitoring, and management in critical care settings. Objectives: To evaluate the clinical significance of arterial blood gas analysis in critically ill patients by assessing patterns of acid–base disorders and abnormalities in oxygenation and ventilation. Methods: An observational analytical study was conducted in the Central Laboratory of the Biochemistry Department, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India, over a one-year period from January 2025 to December 2025. A total of 70 critically ill patients requiring ABG analysis as part of routine clinical care were included. Arterial blood samples were collected using standard aseptic techniques and analyzed for pH, PaO₂, PaCO₂, bicarbonate, base excess, and oxygen saturation. Acid–base and respiratory abnormalities were interpreted using standard criteria. Data were analyzed descriptively. Results: The majority of patients demonstrated abnormal ABG findings. Metabolic acidosis was the most common acid–base disturbance, followed by respiratory acidosis and mixed acid–base disorders. Hypoxemia was frequently observed, indicating impaired oxygenation in a significant proportion of patients. Ventilatory abnormalities, including hypercapnia and hypocapnia, were also noted. ABG analysis provided clinically relevant information that supported diagnosis, guided therapeutic interventions, and aided in monitoring response to treatment in critically ill patients. Conclusion: Arterial blood gas analysis is an essential investigative tool in critical care, offering valuable insights into acid–base balance, oxygenation, and ventilation. Its routine use facilitates early detection of physiological derangements and supports effective clinical management. Integration of ABG analysis into standard critical care protocols can enhance diagnostic accuracy and improve patient care.

Background: Eclampsia is a serious obstetric emergency and a leading cause of morbidity and mortality among mothers and new-borns, particularly in developing nations. In the Indian state of Bihar, where the healthcare system regularly falls short of meeting the demands of a dense rural population, the prevalence of eclampsia is disproportionately high. Objectives: The primary objective of this study was to evaluate the sociodemographic characteristics and clinical profile of women who presented with eclampsia. Secondary objectives included assessing perinatal outcomes and investigating the specific causes of maternal illness and mortality in order to identify flaws in the current healthcare delivery system. Methods: Over the course of a year, this prospective observational study was carried out at Sri Krishna medical college and hospital, Bihar. 100 women having an eclampsia diagnosis were included in the study. Analysis was done on clinical presentation, delivery method, and feto-maternal complications. Results: Young primigravidae had the highest incidence (64%), with an astounding 70% of referrals being unbooked. The most common presentation was antepartum eclampsia (68%). In 66% of instances, a cesarean section was necessary. Postpartum hemorrhage and Pulmonary edema were the two main maternal consequences. The rate of maternal death was 5%. With a high incidence of low birth weight (60%) and a perinatal mortality rate of 52%, perinatal outcomes were compromised. Conclusion: Mothers and new-borns are continuing to suffer greatly from eclampsia. To improve results, early diagnosis, sufficient prenatal care, prompt referral, and standardised management procedures are crucial. To stop eclampsia and its terrible effects, targeted community and primary healthcare initiatives are required.

Background: One of the most prevalent congenital genital abnormalities for which early surgery is recommended is hypopadias. The surgical approach is gradually evolving, frequently by reiterating therapy approaches that were employed decades ago. In fact, one-stage operations historically took the role of two-stage procedures, but two-stage procedures are becoming more popular these days. Aim of this study is to the comparative result of hypospadias repair by dividing the patients in two groups Asopa single stage and snodgrass technique and evaluate the complication rates between these two groups especially in reference to incidence of urethrocutaneous fistula. Methods: From March 2025 to August 2025, a prospective study was conducted in the Department of Surgery at the Govt. Medical College and Hospital in Bettiah, West Champaran, Bihar, with 36 cases complaining of hypospadias, or the position of the urethral meatus on the underside of the penis. Result: In the present study, most of our cases (83.33%) were of less than 8 years of age. Most common type was middle hypospadias (50%), followed by proximal (27.77%) and distal (22.22%). Chordee was present in 66.66% of our cases. 11.11% cases had penile torsion in pre-operative period. Asopa technique was used in cases with significant chordee and Snodgrass technique used in cases without significant chordee. Urethral plate was well formed and grooved in 66.66% cases, shallow in 27.77% cases and distorted in 5.55% cases. Waterproofing of neourethra was done in 55.55% cases, 44.44% cases were without Water proofing layer. Without Water proofing group had better cosmetic results (87.5%) than with water proofing (70%) but more chances of metal stenosis and skin flap necrosis that leads to urethrocutaneous fistula formation. So Waterproofing decrease the chances of metal stenosis and skin flap necrosis with poor cosmetic results.

Background: Breast cancer prognosis and treatment outcomes are poorly understood. The clinico-epidemiological component of breast cancer with ER/PR positivity is the focus of this investigation. Methods: A retrospective analysis of patients with breast cancer aged ≥70 years was conducted at Government Medical College and Hospital in Bettiah, West Champaran, Bihar, between March 2025 and August 2025. Disease-free survival (DFS) and Kaplan Meir overall survival (OS) analysis were performed and associated with various prognostic markers. Results: 139 of the 186 elderly individuals were examined. With a mean age of 75, the median age at diagnosis was 73.4 years. The majority of patients (70.4%) had a co-morbidity score of < 2, were from metropolitan regions (89.2%), had a performance status of 1-2 (90.6%), and were between the ages of 70 and 74. In stages III and IV, 43.9% was shown. PR and ER were 75.5% and 83.4%, respectively. With a 62.6% modified radical mastectomy, a 15.1% conservative lumpectomy, and axillary clearance, surgery was performed in 77.7% of cases. The majority of the treatment consisted of hormones (79.9%), followed by radiation (47.5%) and chemotherapy (18.7%). The 5-year OS was 52%, and the DFS was 53.4%. Metastatic patients had a median progression-free survival (PFS) of four months. The DFS was significantly affected by performance status (PS), tumor stage, and presence of metastasis. (P-value = 0.018, <0.001, 0.003 respectively). Conclusion: Compared to the developed country, the 3-year OS was lower. Most deaths (55.7%) had nothing to do with breast cancer. For DFS, metastasis and primary tumor stage were important prognostic factors.

Background: A collection of symptoms affecting the nose is linked to the diagnosis of allergic rhinitis. The following are some ways to treat allergic rhinitis: antihistamines, decongestants, nasal corticosteroid sprays, leukotriene inhibitors, and allergy injections (immunotherapy). In both contemporary and conventional treatment regimens, nasal irrigation is used. It is commonly known that using regular saline, diluted betadine saline, and hypertonic saline improves mucociliary clearance. Aim of this study was to compare the efficacy of hypertonic saline nasal irrigation over that of normal saline over that of diluted betadine saline nasal irrigation in the treatment of allergic rhinitis. Methods: This prospective randomized comparative study was conducted in Department of Otorhinolaryngology, ANMMCH, Gaya, and Bihar from February 2025 to July 2025. 60 diagnosed cases of allergic rhinitis patients by dividing into three groups and treated with 3% hypertonic saline, normal saline and 0.5% diluted betadine saline. The outcome between pre and post treatment was compared. Results: Among the three groups no statistically significant difference is seen in outcome. Conclusion: There was significant outcome following nasal irrigation, in all the three treatments but no significant differences between the treatments. All three modalities of treatment improve the quality of life.

Background: There are several methods to estimate time since death, but no method, used singly, is totally reliable. After death, several morphological changes occur in all the cellular components of blood, including the white blood cells. Aim of this study to correlated between the times since death with morphological changes in neutrophils. Methods: In this study morphological changes in neutrophils were studied in autopsy cases. Blood samples from 57 different autopsy cases were taken and smears were prepared after staining them with Leishman stain. The samples were examined using light microscope under 40X and 100X magnification. Results: Among 57 cases no degenerative changes were seen in 8. Mild degenerative changes were seen in among 23, Moderate among 12 and Marked among 14 cases. Among 57 cases while observing degenerative changes in neutrophils nuclear changes were seen in 47 cases in form of pyknosis among them 40 reached to level of nuclear fragmentation. Cytoplasmic changes were seen in form of cytoplasmic vacuolation seen in 49 cases. Among them loss of cytoplasm was seen in 36 and cytoplasmic degeneration seen in 26. There was only 8 case in which no change was seen. No changes were seen upto 6 hrs. Conclusion: The present study proves that changes in the morphology of neutrophils can be helpful as supplementary procedure for estimating time since death.

Background: One of the most frequent side effects following abdominal surgery is an incisional hernia. After inguinal hernias, incisional hernias are the second most prevalent type of hernia. Anatomical, mesh, and laparoscopic repairs can address this significant cause of morbidity. Despite recent advancements in anesthetic, surgery, antibiotics, and suture materials, the frequency of this hernia remains high. We intend to investigate the genesis, presentation patterns, treatment options, and results of incisional hernias. Aim of this study to epidemiology, etiology, modes of presentation, modality of treatment and outcome with post-operative complications in incisional hernias. Methods: 25 patients with incisional hernias who were admitted under the general surgery department were included in this prospective study, which was carried out in the surgery department of Government Medical College and Hospital in Bettiah, West Champaran, Bihar, between June 2025 and November 2025. Results: It was found that the second most prevalent types of hernia was an incisional hernia. The prevalence was higher in females who had lower midline incisions made for gynecological procedures. The 30–60 age range was shown to have a higher prevalence of it. The two main risk factors are obesity and wound infection. It was discovered that infra-umbilical midline incisions were more frequent than other types. After emergency surgery, incisional hernias developed in the majority of patients. The most common postoperative consequences were seroma and wound infections. Conclusion: For incisional hernias, mesh repair is less likely to recur than anatomical repair. Women are more likely than men to experience an incisional hernia because of weakness in the abdominal wall brought on by more pregnancies, more caesarean sections, and gynecological operations. To lower the incidence of incisional hernia, sterile aseptic approach and careful administration of pre-operative antibiotics are required.

Background: Gram-stained sputum samples can be examined under a microscope to help diagnose lower respiratory tract infections in patients. When determining if a sputum sample is suitable for cultivation in the lab, Gram stain is crucial. Determining the sample’s representativeness for the targeted collecting site is helpful. The purpose of this study was to evaluate the application of Gram stain in sputum examination in diagnostic microbiology and to connect Gram stain results with culture. Methods: From February 2025 to July 2025, a total of 133 sputum samples were quality assessed using Bartlett’s grading system. The total scoring was done and sample showing score of 1 and above were cultured and identified based on colony characteristics, gram staining morphology and biochemical reactions. Results: One hundred and thirty-three sputum samples were collected from patients with suspected lower respiratory tract infection. Of the 133 samples, 110(79%) were accepted and 23 (21%) were found to be unacceptable by Bartlett criteria. Potential pathogens were grown in 84 samples in the acceptable category. Normal respiratory flora were grown in 26 samples. Out of 84 samples, 63 samples were positive for bacterial growth and 21 showed fungal growth. Out of 63 bacterial growth, 44 were from in-patients and 19 were from out-patients. Among these bacterial isolates, 23 isolates were Pseudomonas aeruginosa followed by 16 isolates were Klebsiella pneumoniae, 10 isolates were E.coli, 6 isolates were Staphylococcus aureus, 2 isolates were Streptococcus species, 3 isolates were Proteus mirabilis and 3 isolates were Serratia marcesens. Conclusion: All the sputum samples should be subjected to gram staining before culture to differentiate true pathogens from contaminating flora on culture.

Background: Upper respiratory tract infections (URTIs) are among the most common infectious conditions encountered in clinical practice and contribute significantly to outpatient visits and medication use. Despite most URTIs being viral in origin, antibiotics are frequently prescribed, leading to irrational drug utilization and increasing antimicrobial resistance. Objectives: To evaluate the drug utilization pattern and antimicrobial sensitivity profile among patients suffering from URTIs at a tertiary care hospital. Methods: This prospective observational study was conducted at KMC Medical College and Hospital, Maharajganj, Uttar Pradesh, over a period of 11 months and included 100 patients clinically diagnosed with URTIs. Demographic details, clinical features, and prescribed medications were recorded. Throat or nasal swabs were collected for microbiological culture and antibiotic susceptibility testing using standard laboratory methods. Data were analyzed using descriptive statistics. Results: The majority of patients were between 21 and 40 years of age, with a slight male predominance. Sore throat, cough, and fever were the most common presenting symptoms. Antibiotics were prescribed in 82% of cases, with amoxicillin-clavulanic acid and azithromycin being the most frequently used agents. Bacterial growth was observed in 62% of samples, predominantly Streptococcus pyogenes. Sensitivity testing revealed higher susceptibility to macrolides and third-generation cephalosporins, while resistance was commonly noted with amoxicillin and cotrimoxazole. Conclusion: The study highlights excessive antibiotic use in URTI management despite a significant proportion of cases being self-limiting. The observed resistance patterns emphasize the need for rational prescribing practices and routine antimicrobial sensitivity testing to guide appropriate therapy and reduce the burden of antimicrobial resistance.

Background: Postoperative pain following mastectomy is often significant and may impair recovery if inadequately managed. Serratus anterior plane block (SAPB) has emerged as an effective regional analgesic technique for breast surgeries. Magnesium sulphate, owing to its NMDA receptor antagonistic properties, has been used as an adjuvant to enhance analgesic efficacy of local anesthetics. Aim: To compare the analgesic efficacy of bupivacaine alone versus bupivacaine combined with magnesium sulphate in serratus anterior plane block for postoperative pain relief following mastectomy. Materials and Methods: This study included 80 patients who underwent mastectomy at Mahabodhi Medical College and Hospital, Gaya. Patients were divided into two groups: Group B received bupivacaine alone, and Group BM received bupivacaine with magnesium sulphate for SAPB. Postoperative pain scores, duration of analgesia, opioid consumption, and adverse effects were analyzed. Results: Group BM showed significantly lower pain scores, longer duration of analgesia, and less opioid requirement compared to Group B (p < 0.05). Conclusion: Magnesium sulphate is a safe and effective adjuvant to bupivacaine in SAPB, giving superior postoperative analgesia after a mastectomy.

Background: Brachial plexus block is widely used for upper limb surgeries, providing effective intraoperative anesthesia and postoperative analgesia. Ropivacaine and levobupivacaine are newer long-acting amide local anesthetics with improved safety profiles compared to bupivacaine. However, evidence comparing their clinical efficacy in brachial plexus block remains limited. Aim: To compare the onset, duration, quality of sensory and motor block, duration of analgesia, and adverse effects of ropivacaine versus levobupivacaine in brachial plexus block. Materials and Methods: This study included 60 patients who underwent upper limb surgery under brachial plexus block at Krishnanagar Institute of Medical Sciences, West Bengal, from July 2024 to July 2025. Patients were divided into two groups: Group R (ropivacaine) and Group L (levobupivacaine). Block characteristics, duration of analgesia, and complications were analyzed statistically. Results: Levobupivacaine demonstrated significantly longer duration of sensory and motor block and prolonged postoperative analgesia compared to ropivacaine (p < 0.05). Onset time was comparable between groups. No major adverse effects were observed. Conclusion: Levobupivacaine provides longer duration of anesthesia and analgesia than ropivacaine, making it a preferable choice for prolonged upper limb surgeries requiring extended postoperative pain relief.

Background: Preoperative anxiety is a common but often under-recognized condition among surgical patients and is associated with increased anesthetic requirements, postoperative pain, delayed recovery, and reduced patient satisfaction. Orthopaedic procedures frequently involve fear related to pain, disability, and functional outcome. Aim: To determine the prevalence of preoperative anxiety and identify contributing factors among adult patients undergoing elective orthopaedic surgery. Methods: A study was conducted at Krishnanagar Institute of Medical Sciences, West Bengal, over one year (July 2024–June 2025). Sixty adult patients undergoing elective orthopaedic surgery were included. Preoperative anxiety scores (APAIS scale), demographic variables, clinical characteristics, and perioperative factors were analyzed. Statistical analysis included chi-square test and unpaired t-test. Results: Preoperative anxiety was present in 38 of 60 patients (63.3%). Higher anxiety was significantly associated with female gender (p=0.02), first-time surgery (p=0.01), lack of prior anesthesia exposure (p=0.03), and major surgery category (p=0.004). Mean APAIS anxiety score was 13.8 ± 3.2 in anxious patients versus 7.1 ± 2.4 in non-anxious patients. Conclusion: Preoperative anxiety is highly prevalent among elective orthopaedic patients and is significantly influenced by gender, surgical magnitude, and prior surgical exposure. Early screening and targeted counseling may improve perioperative outcomes.

Background: Anticipating a difficult airway is crucial during emergency endotracheal intubation. Conventional clinical predictors have limited accuracy in emergency settings. Point-of-care ultrasound (POCUS) offers a rapid and objective method for airway assessment. Objectives: To evaluate the diagnostic accuracy of selected POCUS parameters in predicting difficult airway during emergency intubation. Materials and Methods: A prospective observational study was conducted at the Emergency Department of Darbhanga Medical College and Hospital (DMCH), Darbhanga, from December 2023 to December 2024. One hundred adult patients requiring emergency intubation were enrolled. Ultrasound parameters including anterior neck soft tissue thickness (ANST) and hyomental distance ratio (HMDR) were measured. Intubation difficulty was assessed using the Cormack–Lehane (CL) grading. Statistical analysis included chi-square test, sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) analysis. Results: Difficult intubation occurred in 28% of patients. Both ANST and HMDR showed statistically significant association with difficult airway (p <0.001). POCUS parameters demonstrated high sensitivity, specificity, and diagnostic accuracy. Conclusion: Point-of-care ultrasound is a reliable and statistically significant tool for predicting difficult airway in emergency intubations.

Background: On biotic and abiotic surfaces, bacteria can form biofilms in both natural and therapeutic environments. The extracellular matrix that bacteria produce within biofilms is what makes up the bacterial clumping. The common bacterium Staphylococcus aureus (S. aureus) is linked to biofilm infections. Because biofilms enable antibiotic resistance, staphylococcal infections present significant therapeutic challenges. With an emphasis on the differences in resistance patterns between bacteria that produce biofilms and those that do not, this study describes the biofilm formation and antimicrobial resistance profiles of Staphylococcus isolates taken from a variety of clinical samples in a tertiary care hospital. Methods: 100 consecutive, non-duplicate Staphylococcus isolates (44 from wound swabs, 26 from blood, 18 from urine, and 12 from respiratory samples) obtained between January 2025 and December 2025 were examined in the current study’s laboratory-based cross-sectional analysis. The tube adherence method was used to identify the production of biofilm. Using the Kirby-Bauer disk diffusion method, antimicrobial susceptibility testing was carried out in compliance with CLSI 2023 criteria. Results: Among 100 clinical Staphylococcus isolates, 62% demonstrated biofilm production, with notable variation across sample types: pus samples showed the highest prevalence (56%, 14/25), followed by urine (50%, 20/40) and sputum (40%, 14/35). Biofilm-producing strains exhibited significantly greater antibiotic resistance compared to non-producers, particularly to erythromycin (61% vs. 33.4%, p<0.001). Conclusions: The results show that compared to non-producers, biofilm-forming Staphylococcus isolates exhibit significantly higher resistance rates to first-line antibiotics such ampicillin, vancomycin, and cotrimoxazole. Given the high rate of biofilm formation (48%) and the growing prevalence of vancomycin resistance (25% among producers), it is imperative that: Preference for teicoplanin in cases associated with biofilms, and routine biofilm evaluation in persistent infections. enhanced antimicrobial stewardship with an emphasis on empirical treatment methods. These results provide crucial information for treating Staphylococcal infections caused by biofilms in clinical settings.

Background: Early identification of critically ill patients with high risk of mortality is fundamental to intensive care management. The Shock Index (SI), defined as the ratio of heart rate to systolic blood pressure, has emerged as a simple bedside indicator of hemodynamic instability. Objectives: To assess the efficacy of the Shock Index at ICU admission as a prognostic indicator of mortality in critically ill patients. Materials and Methods: This prospective observational study was carried out in the Intensive Care Unit of Nalanda Medical College and Hospital, Patna, from October 2024 to June 2025. A total of 95 severely ill adult patients were recruited. Patient’s heart rate and systolic blood pressure were recorded and Shock Index was calculated on admission to ICU. Patients were followed up until discharge from the ICU or demise. Shock Index values of survivors and non-survivors were recorded. Results: Patients who did not survive exhibited markedly elevated Shock Index values upon admission in contrast to survivors. A higher Shock Index was substantially linked to a higher mortality rate in the ICU, which means that the person’s hemodynamic condition was compromised at the time of ICU admission. Conclusion: Shock Index is a rapid, cost-effective and reliable predictor of mortality in critically ill ICU patients. Routine assessment at ICU admission may facilitate early risk stratification and timely clinical intervention.

Aim: This study investigates the interplay between genetic predispositions and environmental triggers in common skin disorders including atopic dermatitis (AD), psoriasis, and vitiligo. The primary objective was to assess how genetic variants interact with factors like UV exposure, pollution, and microbial dysbiosis to influence disease susceptibility and severity in a cohort from Indore, India. By analysing 500 patients and 500 controls, we quantified these interactions to inform personalized prevention strategies. Materials and Methods: Participants (aged 18-65) were recruited from local clinics. Genetic analysis used GWAS-targeted SNPs in FLG, HLA-Cw6, and MC1R genes via PCR and sequencing. Environmental exposure was assessed via questionnaires on UV exposure, smoking, pollution levels, and family history. Odds ratios (OR) for interactions were calculated using logistic regression, adjusted for age and sex. Ethical approval was obtained from the institutional review board. Results: Significant gene-environment interactions were found: FLG mutations with high pollution increased AD risk (OR 3.2, 95% CI 2.1-4.8), HLA-Cw6 with UV exposure elevated psoriasis odds (OR 4.5, 95% CI 3.0-6.7), and MC1R variants with stress triggered vitiligo (OR 2.8, 95% CI 1.9-4.1). Heritability estimates aligned with twin studies at 70-80%. Conclusion: Genetic vulnerabilities amplify environmental risks in skin disorders, supporting targeted interventions like UV protection for high-risk genotypes. Future prospective studies could validate these findings for clinical use.

Aim: This study aimed to compare early cord clamping (ECC, <30 seconds) versus delayed cord clamping (DCC, 60-120 seconds) in term and preterm neonates regarding hematological parameters, transfusion needs, morbidity, and long-term iron status. Primary outcomes included hemoglobin at birth/48 hours, ferritin at 4 months, and neonatal mortality. Secondary outcomes encompassed intraventricular hemorrhage (IVH), jaundice, polycythemia, and transfusions. ECC deprives infants of 20-40 mL/kg placental blood, risking anemia, while DCC enhances iron stores but risks hyperbilirubinemia. Materials and Methods: A prospective randomized controlled trial was conducted at a tertiary care hospital Department of Pediatrics Chirayu Medical College and Hospital, Bhopal, India, from Jan-Dec 2025 (n=400; 200 ECC, 200 DCC). Inclusion: singleton live births ≥32 weeks gestation, no congenital anomalies. Randomization via sealed envelopes; blinding for lab analysis. ECC: clamp <30s post-delivery; DCC: 60-120s with infant below placenta level. Outcomes measured: Hb/Hct at birth/48h/4mo, ferritin 4mo, bilirubin peak, transfusions, IVH (ultrasound), mortality. Statistical: t-tests, chi-square, p<0.05 significant. Results: DCC group showed higher birth Hb (17.2 vs 15.8 g/dL, p<0.001), 48h Hb (16.5 vs 14.9 g/dL, p<0.001), 4mo ferritin (96 vs 65 ng/mL, p=0.03). Transfusions reduced (10% vs 21%, RR 0.48, p<0.01); mortality lower in preterm subgroup (5% vs 11%, RD -6%, p=0.02). Jaundice incidence similar (22% vs 25%, p=0.4); polycythemia higher but asymptomatic (8% vs 3%, p=0.03). IVH reduced in preterm (12% vs 22%, p=0.04). Conclusion: DCC significantly improves neonatal hematology, reduces transfusions/anemia risk, and lowers preterm mortality without excess harm, aligning with WHO/ACOG guidelines (≥60s delay). Benefits prominent in iron-deficient populations like India. Recommend routine DCC barring resuscitation needs.

Introduction: Abnormal uterine bleeding is a prevalent gynecological issue and one of the most frequent severe menstruation disorders affecting women of all ages. AUB adversely impacts patient quality of life and is linked to financial detriment, diminished productivity, and compromised health. Abnormal uterine bleeding (AUB) is a prevalent issue impacting women at various life stages. Aim: This study aimed to ascertain the spectrum of abnormal uterine bleeding (AUB) among community. Methods:  This is retrospective research conducted at a hospital with women with abnormal uterine bleeding (AUB). Baseline demographic data and clinical details regarding menstruation problems were gathered using a pre-validated, semi-structured proforma following the acquisition of informed consent. Results:  Proliferative and secretory endometrium were more abundant in the rural cohort, but hyperplasia and cancer were comparatively more frequent in the urban cohort. Endometrial cancer was predominantly identified in women aged over 50. The results indicated proliferative endometrium in 35% of cases, secretory endometrium in 18%, hyperplasia in 19%, and cancer in 9%. Conclusion: AUB affects women across all age groups, significantly affecting their quality of life. AUB-N, AUB-O and AUB-L contribute to a major proportion of AUB.

Chronic Liver Disease (CLD) represents a major global health burden, characterized by the progressive destruction and regeneration of liver parenchyma leading to fibrosis and cirrhosis. While existing literature extensively covers CLD in the general population—often skewed toward male cohorts due to a higher prevalence of alcoholic liver disease—the clinical profile and etiological spectrum in female patients remain under- researched. This study, conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, aims to bridge this gap by evaluating the specific clinical manifestations and underlying causes of CLD in women presenting to a tertiary care center in Bihar. By identifying gender-specific trends, this research seeks to improve early diagnostic accuracy and optimize management strategies for this demographic.

Background: Globally, liver disease accounts for approximately 2 million deaths per year. In India, the burden is shifting from predominantly infectious etiologies (such as Hepatitis B and C) to metabolic-related conditions. Historically, women have been perceived to have a lower risk of chronic liver injury; however, recent epidemiological data suggest a rising incidence of Non-Alcoholic Fatty Liver Disease (NAFLD) and Autoimmune Hepatitis (AIH) among females.

In the context of Bihar, socio-economic factors and limited health literacy often result in female patients presenting at advanced stages of the disease (Child-Pugh Class C). Furthermore, the unique intersection of nutritional deficiencies, environmental toxins, and a rising prevalence of metabolic syndrome in the region necessitates a focused clinical audit of the female patient profile at tertiary institutions like IGIMS.

Introduction: Recent investigations have established the predictive relevance of spot urine sodium (UNa+) in acutely decompensated chronic HF (ADCHF) patients. However, there is little information available on the predictive significance of spot urine chloride (UCl−) and UNa+ in patients with advanced heart failure. Spot assessment of urine sodium (UNa+) has emerged as a viable method for monitoring diuretic responsiveness in patients with acute heart failure (AHF). In the present prospective pilot study, we evaluated the prognostic value of spot UNa+ and UCl− concentration at baseline, at 2 h and at 24 h after admission for all-cause mortality and HF re-hospitalization up to 6-month post discharge. Methods: Consecutive advanced HF patients (n = 90) admitted with ADCHF and aged > 18 years were included in the study. Loop diuretics were administered based on the natriuresis-guided algorithm recommended by the recent HF guidelines. Exclusion criteria were Stage 5 chronic kidney disease, Severe hepatic dysfunction, Inability to collect adequate urine samples. Result: A total of 90 patients were included. A poor diuretic response was observed in 26 (28.8%). Survival analysis tests demonstrated significant differences showing a higher proportion of all-cause mortality (ACM) and HF re-hospitalization in the poor-diuretic-response group. Conclusions: In outpatients with chronic HF, decreased UNa+ was related with a higher risk of recurrent WHF episodes. Patients with an adequate diuretic response demonstrated significantly higher decongestion at 48 h and a better prognosis regarding ACM and/or HF re-hospitalizations.

Background: Both undernutrition and obesity have been implicated in menstrual disturbances and infertility; however, evidence from Indian settings remains limited. Objectives: To assess the association of BMI with menstrual irregularities and infertility among women of reproductive age group. Material & Methods: A hospital-based cross-sectional study was conducted among 300 women aged 18–45 years attending a tertiary care hospital. BMI was calculated using standard anthropometric measurements and classified as per WHO criteria. Menstrual patterns and infertility status were recorded using a structured questionnaire. Associations were analyzed using Chi-square test, and multivariate logistic regression was performed to identify independent predictors. Results: Menstrual irregularities were observed in 41.3% of participants, while infertility was present in 28.7%. Menstrual irregularities and infertility were significantly higher among underweight and obese women compared to those with normal BMI (p<0.001). On multivariate analysis, underweight, overweight, and obesity were independently associated with menstrual irregularities. Obesity (AOR 3.0; 95% CI: 1.5–5.9) and menstrual irregularity (AOR 3.9; 95% CI: 2.2–6.8) emerged as strong independent predictors of infertility. Conclusion: Maintaining optimal BMI may play a key role in improving menstrual health and fertility outcomes among women of reproductive age.

Background: Mesenchymal tumors include a diverse range of benign and malignant neoplasms exhibiting overlapping histomorphological characteristics. Precise differentiation between benign and malignant mesenchymal tumors is essential for prognosis and management, although frequently presents diagnostic difficulties. Immunohistochemistry (IHC) is crucial for clarifying these uncertainties; yet, the diagnostic value of specific markers differs among research. Objective: To conduct a thorough review and meta-analysis of the diagnostic efficacy of frequently utilized immunohistochemistry markers in distinguishing benign from malignant mesenchymal tumors. Methods: A comprehensive literature search was performed on PubMed, Scopus, Web of Science, and Google Scholar for papers published from January 2000 to December 2024. Studies assessing IHC markers in histologically verified benign and malignant mesenchymal tumors were incorporated. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves were computed utilizing a random-effects model. Results: A total of 42 studies encompassing 3,860 patients were included. Markers including Ki-67, p53, MDM2, CDK4, and HMB45 exhibited significant discriminating efficacy. Ki-67 demonstrated the best pooled sensitivity (0.84; 95% CI: 0.79–0.88), whilst MDM2/CDK4 co-expression displayed the highest pooled specificity (0.91; 95% CI: 0.87–0.94). Substantial heterogeneity was noted among studies, primarily due to tumor subtype and variability in cutoff values. Conclusion: Immunohistochemical markers substantially assist in distinguishing benign from malignant mesenchymal tumors. A panel-based methodology, as opposed to dependence on a solitary marker, yields enhanced diagnostic precision.

Background: Cataract remains the leading cause of reversible blindness in India. Conventional extracapsular cataract extraction (ECCE) and small incision cataract surgery (SICS) are widely practiced surgical techniques, particularly in resource-limited settings. Aim: To compare surgical outcomes, visual recovery, and complications between conventional ECCE and SICS. Materials and Methods: This retrospective study included 100 patients who underwent cataract surgery at Sri Krishna Medical College, Muzaffarpur, Bihar, from January 2025 to May 2025. Fifty patients underwent ECCE and fifty underwent SICS. Postoperative visual acuity, surgically induced astigmatism, and complications were analyzed. Results: SICS showed faster visual recovery, lower astigmatism, and fewer complications compared to ECCE, with statistically significant differences. Conclusion: SICS offers superior postoperative outcomes compared to conventional ECCE and is better suited for high-volume cataract surgery in developing regions.

Background: Inflammation and pus formation can result from the appearance of pyogenic bacteria during or after trauma, burn injuries, and surgical procedures. Wound infections result in significant morbidity, extended hospital stays, and a significant financial burden. The study’s goals are to identify the aerobic bacteria that cause wound infections and to ascertain the isolated organisms’ pattern of antibiotic susceptibility. Methods: At SKMCH in Muzaffarpur, Bihar, a retrospective analysis was carried out between February and July of 2025. Samples of pus were obtained and treated in an aseptic manner. The Kirby Blair disk diffusion method was used to identify and determine the antibiotic susceptibility pattern in accordance with conventional protocols. Results: Out of 536 pus samples, 115 samples showed bacterial growth. Most of the bacterial growth were isolated from 21-40 years of age with 41 (36%). Among 115 bacterial isolates, 62(54%) were Gram-positive cocci and 53 (46%) were gram-negative bacilli. Among gram-positive cocci, the highest isolated organism is Staphylococcus aureus with 26 (42%). In gram-negative bacilli, the most common organism isolated is Enterobacter spp. 13 (24.5%) followed by Pseudomonas spp. with 11 (20.8%). 96% of the Staphylococcus aureus were sensitive to Linezolid and the least sensitivity was observed with Levofloxacin with 17.3%. Conclusion: The pyogenic wound infections were discovered to be common in the tertiary care hospital with staphylococcus aureus isolated and exhibiting the highest occurrence followed by Enterobacter and Pseudomonas spp. When putting empirical treatment options for pyogenic infections into practice, the susceptibility statistics from this article might be worth taking into account.

Background: An increase in lymphocytes in the lymph node brought on by a variety of diseases, including TB, and lymphoproliferative disorders can cause lymphadenopathy. A basic hemogram using TLC and DLC, as well as ratios obtained from it such as NLR (Neutrophil Lymphocyte Ratio) and PLR (Platelet Lymphocyte Ratio), can be used to evaluate the rise in inflammatory biomarkers caused by granulomatous lymphadenitis. Aim of this study to establish the role of hematological and inflammatory biomarkers in granulomatous and nongranulomatous lymphadenitis. Methods: The study was conducted in Department of Pathology, JLNMCH, Bhagalpur, Bihar from February 2025 to July 2025. The study included 150 patients with neck mass taking inclusion and exclusion criteria into account. Cytologically proven cases were categorised into granulomatous and non-granulomatous cases depending on cytological evaluation. Different laboratory parameters like TLC, DLC, ESR, CRP, NLR, and PLR were used to compare granulomatous lymphadenitis to non-granulomatous. Result: In the studied population there were 92(61.3%) females and 58(38.7%) males but when compared to the non-granulomatous lymphadenitis group, females predominated by 70.7% hematological markers like NLR, PLR, and CRP in the granulomatous lymphadenitis group was significantly higher. The mean Neutrophil was considerably higher among granulomatous lymphadenitis but in non-granulomatous lymphadenitis, the group showed considerably greater mean lymphocytes. Conclusion: In this area, the most common clinical condition associated with cervical lymphadenopathy is tuberculosis. Women are involved most of the time. The existence of granulomatous and non-granulomatous lymphadenitis can be indicated by hematological and biochemical indicators such as NLR, PLR, and CRP prior to FNAC. Particularly at the primary care level, it will assist the treating physician in considering early case identification methodically and preventing diagnostic delays in cases such as tuberculosis.

Background: Stapled hemorrhoidectomy is a novel method of treating hemorrhoids that involves removing a circumferential strip of mucosa approximately 1.5 to 2 centimeters above the dentate line. The study’s objective was to assess post-stapled hemorrhoidectomy sequelae. Methods: Grade 3 and grade 4 hemorrhoids were identified in 101 patients between the ages of 20 and 70. Stapled hemorrhoidectomy involves patients. The stapled hemorrhoidectomy procedures carried out between January and September of 2025 were the main focus of the inquiry. Using SPSS 24 software, descriptive analysis was conducted based on the student’s T-test. A significance level of 5% (p < 0.05) was established. Results: Out of 101 patients who experienced immediate (within one week) complications from a stapled hemorrhoidectomy over a 12-month period, 84.16% had none, 5.94% had severe pain, 3.96% had bleeding, 1.98% had thrombosis, 0.99% had urinary retention, 1.98% had anastomotic dehiscence, 0.99% had fissures, 0.99% had perineal intramural hematoma, and 0.99% had submucosal abscess. 90.09% had none, 1.98% had recurrent hemorrhoids, 0.99% had severe discomfort, stenosis, fissures, skin tags, thrombosis, and issues with staples, intramural abscesses, and intussusception. Conclusion: While stapled hemorrhoidectomy seems promising, we think that before the therapy can be recommended, a multicenter randomized controlled trial comparing stapled hemorrhoidectomy and banding with a long-term follow-up is necessary. Following the anatomy of the rectal wall during the procedure can prevent most problems.

Background: Choosing an appropriate approach to lessen cholecystectomy consequences is crucial for patient welfare. We looked into how atorvastatin affected patients having cholecystectomy in terms of inflammatory markers and clinical complaints. Methods: From January to September of 2025, Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar, conducted this double-blind randomized controlled study. In this trial, 47 patients were given 40 mg of atorvastatin (intervention group) and 47 patients were given a placebo every day for four weeks (placebo group). Then, the frequency of fever, abdominal pain, and nausea before and after cholecystectomy, as well as peri-operative data (duration of operation, and intraoperative bleeding) and laboratory data [White Blood Count (WBC), C – reactive protein (CRP), Aspartate Amino Transferase (AST), and Alkaline Phosphatase (ALT)] was collected. The data was analyzed using (SPSS Version 22) based on chi-squared, and independent t-tests at the significance level of (P≤0.05). Results: The duration of hospitalization was not significantly different in both groups (P=0.26), however, the duration of operation was significantly longer in the intervention group (P<0.001). The frequency of fever, abdominal pain, and nausea after cholecystectomy was not statistically different (P>0.05). The volume of intraoperative bleeding in the placebo group was more than the intervention group (P=0.05). The decrease of WBC, CRP, and the ALT levels after cholecystectomy was not statistically different (P>0.05); however, AST level after cholecystectomy was higher in the intervention group (P=0.05). Conclusion: The use of atorvastatin effectively reduced the volume of intraoperative bleeding. However, this intervention with this dose and duration could not have a significant role in reducing the duration of patients’ hospitalization, duration of operation, and levels of WBC, CRP, ALT, and AST.

Background: The best methods for closing infected wounds are not universally agreed upon. Numerous methods have been put forth. Comparing the prevalence of wound infection in laparotomy wounds with perforation peritonitis in primary and delayed primary wound closure is the study’s goal. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay. Methods: The 106 patients in this study had been divided into two groups: primary closure (A), where the wound was primarily closed, and secondary closure (B), where the wound was left open without suturing and saline irrigation was administered before being sutured after it was clean and culture sterile. The Southampton scoring system was used to evaluate the wound infection. Results: There were 106 patients in all, 46 (43.4%) female and 60 (56.6%) males. There were 53 patients in Group A (54.7% males and 45.3% females) and 53 patients in Group B (58.5% males and 41.5% females). In A, the average age was 38.4±11.8, whereas in B, it was 37.02±12.59. Infection rates were 77.4% in group A and only 34% in group B. Group B stayed 9.72±2.57 days in the hospital, while group A stayed 11.74±2.87 days. Conclusion: The best method for closing contaminated wounds, such as perforated peritonitis, is delayed primary closure since it reduces hospital stays and wound infection rates.

Background: One prevalent surgical issue that occurs all throughout the world is gallbladder disease. The common treatment for cholelithiasis and symptomatic gallbladder diseases prior to the development of laparoscopic cholecystectomy was open cholecystectomy. The purpose of this study is to determine the accuracy of clinical diagnosis following ultrasonographic assessment of gallstone and symptomatic gallbladder disease. Methods: Patients with gallstones and symptomatic gallbladder disease who are admitted to surgery wards from emergency and outpatient departments are the subjects of this prospective study. From January 2023 to December 2023, 100 patients who were admitted to Heritage Institute of Medical Sciences in Varanasi, Uttar Pradesh, with a diagnosis of gallstone and symptomatic gallbladder diseases had laparoscopic cholecystectomy. Patients were selected according to their age, gender, or suitability for a laparoscopic cholecystectomy. Results: The experiences of 100 patients who are admitted for laparoscopic cholecystectomy with a clinical and ultrasonographic diagnosis of gallstone and symptomatic gallbladder disease are represented in this study. Operation time was from 30-90 minutes with a mean time of 47.4 minutes. Typical clinical presentation was found in most of the cases. 15 (15%) patients presented with epigastric pain of which 12 (12%) patients were misdiagnosed and were treated for duodenal ulcer for years. 1 (1%) patient was diagnosed incidentally during ultrasonography for gynaecological complaints. All the patients in this study undergone ultrasonography of hepatobiliary system and pancreas. Out of 100 cases 93 (93%) cases were found to have stone in gallbladder sonologically, whereas 96 (96%) cases were found to have stone in the gallbladder peroperatively. Ultrasonography detected normal appearance gallbladder with stone in 73 (73%) cases but peroperatively found them in 76 (76%) cases. In 15 (15%) cases sonography revealed fibrosed and contracted gallbladder with stone, whereas 13 (13%) cases were found to have the findings per-operatively. Sonography commented 7 (7%) patients of thick gallbladder wall where per-operatively it was found in 11 (11%) patients. Distended gallbladder with stones was detected sonologically in 6 (6%) cases but peroperatively found them in 7 (7%) cases. In 1(1%) case sonography detected fibrosed and contracted gallbladder without stones but per-operatively such was found in 2 (2%) cases. Gallbladder polyp was found in 1 (1%) case both sonologically and peroperatively. No adhesions and stone in common bile duct were detected by sonologically. Conclusion: It is possible to draw the conclusion that, in real-time laparoscopic cholecystectomy, a thorough clinical examination combined with ultrasonographic assessment of gallstones and symptomatic gallbladder disease is nearly accurate.

Background: Fine needle aspiration cytology (FNAC) is the primary diagnostic tool for the evaluation of thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides standardized diagnostic categories with implied risk of malignancy and management guidelines. Indeterminate categories remain a diagnostic challenge due to variable malignancy risk. Objectives: To evaluate thyroid FNAC findings using the Bethesda system with special emphasis on indeterminate categories over a one-year period. Methods: A prospective descriptive study was conducted over one year, including 130 patients presenting with thyroid nodules. FNAC was performed and smears were categorized according to TBSRTC. Demographic data, cytological diagnosis, and distribution of indeterminate categories were analyzed using descriptive statistics. Results: Of the 130 thyroid FNAC cases, Bethesda Category II (Benign) was the most common (60.0%). Indeterminate categories (Bethesda III and IV) constituted 18.5% of cases. Bethesda III (AUS/FLUS) accounted for 10.0% and Bethesda IV (Follicular neoplasm/SFN) for 8.5%. Suspicious for malignancy (Bethesda V) and malignant lesions (Bethesda VI) together comprised 11.5% of cases. Conclusion: FNAC using the Bethesda system is an effective diagnostic approach for thyroid nodules. Indeterminate categories form a significant subset and require careful interpretation and appropriate clinical correlation to guide management.

Background: Malignant neoplasms and benign inflammatory diseases are both examples of prostate lesions. PSA, or serum prostate-specific antigen, is frequently used as a diagnostic and screening tool. The accuracy of diagnosis is improved when serum PSA levels and histopathological findings are correlated. Aim: To compare serum PSA levels with the histological spectrum of prostatic lesions. Methods: 110 prostate specimens that were received by the Department of Pathology were included in a one-year retrospective research. Records were searched for clinical information, serum PSA levels, and histopathological results. Among the specimens were samples from prostatectomy, needle biopsies, and transurethral resection of the prostate (TURP). Analysis was done on the statistical relationship between PSA levels and histological diagnosis. Results: The largest age group among 110 cases was 60–69 years old (43.6%). The most prevalent lesion (58.1%) was benign prostatic hyperplasia (BPH). A significant correlation (p<0.001) was seen between elevated PSA (>10 ng/mL) and cancer. The highest mean PSA values were found in cases of carcinoma (32.3 ng/mL), prostatitis (14.3 ng/mL), and BPH (6.6 ng/mL).

Conclusion: The most prevalent prostatic lesion is still BPH. Nonetheless, there is a clear correlation between malignant tumors and noticeably high PSA readings. The most reliable method for making a conclusive diagnosis is still histopathological analysis.

Background: Electrolyte abnormalities frequently occur in critically ill patients and can profoundly influence therapeutic outcomes. This study seeks to examine the correlation between serum electrolyte levels upon admission and ICU outcomes, encompassing length of stay, mechanical ventilation requirements, and mortality rates. Numerous experts have determined that electrolyte imbalance is critical, noting that even with optimal therapy, the prognosis for patients with significant electrolyte disturbances remains difficult. Methods: This is a current retrospective study. The medical information of the patients was obtained from the medical history chart and the reasonable study outcomes were justified. Results: The educational levels and lack of interest of the participants were identified to be negligible which also impacts the good maintenance of the electrolyte balance in the patients. Hypernatremia and hyperkalemia exhibited a statistically significant correlation with ICU mortality p < 0.05). Conclusion: Electrolyte imbalance induces significant alterations in the body’s physiology. Maintaining a high quality of life is crucial for the healthy regulation of electrolyte balance.

Background: Acute pancreatitis (AP) is a potentially lethal illness with a grim prognosis if it progresses to its severe form. The pathogenesis of acute pancreatitis is linked to serum triglyceride levels. The correlation between blood triglyceride (TG) levels and the severity of acute pancreatitis (AP) is inadequately comprehended. This study aims to examine the relationship between serum triglyceride levels and the severity of acute pancreatitis. Aim: To assess the impact of triglyceride levels on the severity of hypertriglyceridemic pancreatitis (HTGP). Methods: Patients were prospectively enrolled using APPRENTICE. Elevated triglyceride levels were established according to the Endocrine Society Clinical Practice Guidelines. HTG was classified as mild (serum TG levels 150 mg/dL), moderate (150–499 mg/dL), severe (500–999 mg/dL), and very severe (≥1,000 mg/dL). The severity of acute pancreatitis was determined according to the updated Atlanta categorization criteria. Results: 46 % of patients exhibited high blood triglyceride levels (>150 mg/dL). The Revised Atlanta Classification indicates that 46 patients experienced mild acute pancreatitis, 32 had moderately severe acute pancreatitis, and 16 suffered from severe acute pancreatitis. Severe acute pancreatitis was more commonly observed in patients with triglyceride levels ≥500 mg/dL. Conclusions: The present investigation identified elevated blood triglyceride levels as an independent predictor of increased severity of acute pancreatitis and unfavorable clinical outcomes in patients with elevated serum triglycerides. This study endorses serum TG levels as a dependable metric for the swift identification of high-risk AP patients, enabling timely interventions and enhanced results.

Background: Septic shock is linked to elevated mortality and is defined by significant circulatory and metabolic dysfunctions. Norepinephrine is the primary vasopressor; however, sustained tachycardia may exacerbate results. Esmolol, a short-acting β1-adrenergic antagonist, has been suggested to enhance hemodynamic and prognosis. Objective: To assess the therapeutic efficacy of norepinephrine in conjunction with esmolol in patients experiencing septic shock and its influence on in-hospital outcomes. Methods: This retrospective analysis encompassed 100 individuals diagnosed with septic shock over a two-year period. Patients were categorized into two groups: Group A (n=50) was administered norepinephrine only, while Group B (n=50) got a combination of norepinephrine and esmolol. Hemodynamic parameters, lactate clearance, vasopressor requirements, duration of ICU stay, and in-hospital mortality were analysed for comparison. Results: The combination group showed significantly improved mean arterial pressure (MAP) at 24 hours (75 ± 8 mmHg vs 62 ± 10 mmHg, p<0.01), greater lactate clearance at 48 hours (52% vs 35%, p<0.001), and lower in-hospital mortality (22% vs 38%, p=0.04). Multivariate analysis demonstrated that combination therapy was independently associated with reduced mortality (Adjusted OR 0.42; 95% CI 0.18–0.95). Conclusion: To evaluate the therapeutic effectiveness of norepinephrine combined with esmolol in patients suffering from septic shock and its impact on in-hospital outcomes.

Background: Acute kidney damage (AKI) is a prevalent clinical issue in hospitalized patients, linked to considerable morbidity and mortality. Timely identification and risk assessment are crucial for enhancing outcomes. Objective: To assess the prevalence of acute kidney injury (AKI) in a general medical ward and ascertain if AKI serves as an independent predictor of in-hospital death. Methods: This retrospective observational study encompassed 100 adult patients admitted to the general medical ward of a tertiary care hospital during a two-year duration. Acute Kidney Injury (AKI) was delineated in accordance with KDIGO criteria. Demographic information, comorbid conditions, laboratory metrics, disease severity, and outcomes were documented. Patients were classified into acute kidney injury (AKI) and non-AKI groups. The statistical study encompassed the chi-square test, independent t-test, and multivariate logistic regression to ascertain independent determinants of mortality. Results: Acute kidney injury (AKI) was reported in 38% of hospitalized patients. The overall in-hospital mortality rate was 26%. The mortality rate was markedly elevated in individuals with acute kidney injury (AKI) compared to those without AKI (47.3% vs 12.9%, p<0.001). Multivariate logistic regression analysis identified AKI (Adjusted OR: 4.8; 95% CI: 1.8–12.7; p=0.002), sepsis (Adjusted OR: 3.6; p=0.01), and hypotension at admission (Adjusted OR: 2.9; p=0.03) were independent predictors of in-hospital death. Conclusion: Acute Kidney Injury (AKI) is a substantial and independent predictor of in-hospital mortality in patients admitted to a general medical ward. Timely recognition and intervention for AKI may enhance patient outcomes.

Background: Gestational diabetes mellitus (GDM) is a prevalent metabolic condition of pregnancy, linked to negative mother and fetal outcomes. Recognizing risk factors is essential for prompt diagnosis and prevention. Objective: To examine maternal risk variables linked to gestational diabetes mellitus at Rajarajeswari medical college and hospital, Bengaluru over two-year duration. Methods: A retrospective case-control study involving 80 pregnant women was conducted. 40 women diagnosed with gestational diabetes mellitus (cases) were compared to 40 age-matched normoglycemic pregnant women (controls). Data were extracted from medical records, encompassing demographic data, obstetric history, familial diabetes history, body mass index (BMI), and comorbidities. Statistical analysis was conducted utilizing the chi-square test and the determination of odds ratios (OR). A p-value of less than 0.05 was deemed statistically significant. Results: Advanced maternal age (>30 years), BMI ≥25 kg/m², familial diabetes history, prior gestational diabetes mellitus (GDM), and a history of macrosomia were substantially correlated with GDM (p<0.05). Obesity exhibited the most significant connection (OR=4.2), succeeded by a familial history of diabetes (OR=3.5). Conclusion: Maternal age, obesity, and a familial predisposition to diabetes are substantial risk factors for gestational diabetes mellitus (GDM). Proactive screening and lifestyle modifications in high-risk women may mitigate maternal and fetal problems.

Introduction: An important component of calcium homeostasis and bone health is vitamin D. One of the vital fat-soluble vitamins, vitamin D serves a variety of purposes in the human body. According to recent studies, vitamin D may also affect lipid metabolism, particularly the amount of blood-circulating lipids. One of the most prevalent metabolic conditions is dyslipidemia. Aim: This study sought to assess the relationship between vitamin D insufficiency and dyslipidemia. Materials and Methods: This is a cross-sectional study which included 50 participants (28 males and 22 females) with a mean age of 44.6 ± 11.2 years and conducted over 2 years. The level of vitamin D was determined for each participant; we also measured the serum levels of cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein. Results: There were 50 persons with vitamin D deficiency, 12 persons were vitamin D insufficient, and 28 were vitamin D sufficient. There were significant differences in the level of cholesterol, triglycerides, high-density and low-density lipoproteins according to the level of vitamin D. Conclusions: Deficiency of vitamin D has a deleterious impact on the levels of cholesterol, triglycerides, high-density and low-density lipoproteins.

Background: Diabetes mellitus predisposes individuals to infections due to impaired immune responses. Community-acquired pneumonia (CAP) is one of the leading causes of hospitalization and mortality among diabetic patients. Aim: To evaluate the clinical profile, radiological patterns, microbiological spectrum, complications, and outcomes of CAP in patients with diabetes mellitus. Materials and Methods: A retrospective study was conducted over two years at Rajarajeswari Medical College and Hospital. Records of 60 diabetic patients admitted with CAP were analyzed. Demographic data, glycemic status, clinical features, radiological findings, microbial etiology, complications, and outcomes were studied. Statistical analysis was performed using chi-square test, with p <0.05 considered significant. Results: Mean age was 56.4 ± 11.2 years. Poor glycemic control (HbA1c ≥8%) was seen in 70%. Lobar consolidation was the most common radiological pattern (48.3%). Streptococcus pneumoniae was the most frequent isolate (23.3%). Complications occurred in 36.6%. Mortality was 8.3% and was significantly associated with poor glycemic control (χ² = 5.21, p = 0.022) and multilobar involvement (χ² = 6.04, p = 0.014). Conclusion: CAP in diabetic patients is associated with increased severity and complications, especially in those with poor glycemic control. Early recognition and aggressive management are crucial.

Background: Acute coronary syndrome (ACS) requires aggressive pharmacotherapy, which increases the risk of adverse drug reactions (ADRs). Systematic evaluation of ADRs is essential to improve patient safety. Objectives: To study the pattern, distribution, causality, severity, and outcomes of ADRs in ACS patients. Methods: Medical records of 100 ACS patients who developed ADRs were retrospectively reviewed. ADRs were assessed using WHO-UMC causality scale and Hartwig and Siegel severity scale. Descriptive statistics and chi-square test were applied. Results: The mean age was 58.6 ± 11.4 years; males predominated (68%). Antiplatelets (42%) and anticoagulants (26%) were the most common suspected drugs. The most affected system was gastrointestinal (34%) followed by hematological (22%). Majority of ADRs were probable (62%) and moderate in severity (55%). Polypharmacy (>5 drugs) was significantly associated with ADRs (p < 0.01). Conclusion: ADRs are frequent in ACS patients, mainly related to antithrombotic therapy. Active pharmacovigilance and rational prescribing can reduce drug-related morbidity.

Background: Gestational diabetes mellitus (GDM) is associated with long-term metabolic and cardiovascular complications. Women with a history of GDM are at increased risk of ischemic heart disease (IHD), hypertension, and type 2 diabetes mellitus (T2DM). Objectives: To evaluate the prevalence and risk pattern of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes. Methods: Medical records of 100 women with documented history of GDM were retrospectively analyzed. Incidence of IHD, hypertension, and T2DM during follow-up was assessed. Descriptive statistics and chi-square test were applied. Results: The mean age was 36.8 ± 5.9 years. Type 2 diabetes developed in 38% of women, hypertension in 29%, and ischemic heart disease in 11%. A significant association was observed between duration since GDM and development of metabolic and cardiovascular disorders (p < 0.05). Conclusion: Women with previous GDM have substantially increased risk of cardiometabolic diseases. Regular screening and early lifestyle interventions are essential.

Background: Acute appendicitis is the most common surgical emergency. Life time prevalence rate of acute appendicitis is approximately one in seven and more common in men than women (8.6% versus 6.7%). About 310,000 appendectomies are performed/year in the United States, of which 250,000 have definite appendicitis, giving a negative appendectomy rate of about 15% to 30%. Methods: This randomized control prospective study. Cases of uncomplicated acute appendicitis undergoing emergency open appendectomy were included in this study. Results: 5 patients (3 in Group A and 2 in Group B) developed wound infection. All the 5 patients developed superficial site infection. None of the patients developed deep surgical site or intra-abdominal infections in either of the two groups. There was no statistically significant difference between the two groups (p value- 0.621). Conclusion: Frequency of post operative wound infection is generally very low in uncomplicated appendicitis. The prolonged use of antibiotics post operatively is unnecessary, can increase antibiotic resistance, can produce side effects and increase cost of treatment.

Background: Currently, very few data is available on Day Care Single Incision Laparoscopic Cholecystectomy (SILC). Hence, in this study we aimed to evaluate the feasibility and safety of in a hilly terrain like Shimla. Methods: This study was done in a single unit of the Department of General Surgery on patients admitted for surgery. Results: Mean duration of hospital stay was 13.5 hours. 70% of patients were discharged within 12 hours, 8 (26.7%) patients within 23 hours and only 1 patient was discharged after 24 hours. Conclusion: Our study demonstrates that it is feasible and safe even in Day Care (outpatient) setting as Day Care surgeries result in decompression of busy hospital beds, less nosocomial infection, early recovery in home environment with the family, less disruption of personal life and reduce expenditure of longer hospital stay.

Background: Laparoscopic surgeries are being used more commonly than ever before for a wide variety of procedures because of the advantages they offer over conventional open surgeries. Similarly, supraglottic airway devices (SADs) provide several benefits over endotracheal intubation, including ease of insertion, reduced hemodynamic changes, and less airway manipulation, making them an attractive alternative in appropriate laparoscopic procedures. Methods: A prospective study which includes 60 ASA 1 & 2 patients belonging to 18-65 years of age groups. They were randomly allocated into 2 groups. Group LMA P; where LMA protractor was used in anesthetised and non-paralysed patients. Group BM; where buska mask was used in anesthetised and non-paralysed patients. The primary objectives of the study was ease of insertion of SAD (number of attempts), Oropharyngeal leak pressure (in cms of H₂O), secondary objectives-Time taken for insertion, Volume of air to achieve the intracuff pressure of 60cms of water (in ml in protector), Vocal cord visibility under fiberoptic scope, Successful gastric tube insertion, adverse effects like blood stained on airway device sore throat and dysphagia. Results: the mean duration of LMA insertion in Group LMA P (12.93 + 3.26, P>0.05), in Group BM (13.00 + 4.46, P>0.05). The mean OLP in group LMA P was 32.83+ 3.29, whereas mean OLP of group BM was 31.70+3.96(P> 0.05). Conclusion: We have concluded that both SADs have similar functional efficacy, in laparoscopic surgeries.

Background: Ankle fractures represent 10% of all skeletal injuries, with an incidence rate of 187 cases per 100,000 people, predominantly affecting individuals aged 60 to 69, especially women over 60 who are more prone to open fractures. This study aims to assess the functional outcomes related to posterior malleolus fractures specifically, exploring various treatment options including the use of screws and plates, and evaluating the resultant range of motion. Methods: This hospital-based observational study conducted at Department of Orthopaedics, Autonomous state medical college, Hardoi, Uttar Pradesh over a period one year. Patients’ posterior malleolar fractures were divided into three treatment groups: conservative, screw-fixed, and plate-fixed. Functional scoring system to assess pain, ankle stability, ability to walk, run, and work, ankle motion, and radiographic results. Total 90 patients aged 18-70 years, either sex, fit for surgery, and eager to participate in the study. Results: Total of 90 patients in three treatment groups 30 each (33.33%). The primary injury mechanism was Motor Vehicle Accident, along with other causes like Twisted Ankle and Jump. The distribution of osteoarthritis grades varied, with Group 1 showing the most common grade. Surgical duration, ankle hindfoot scores, and VAS scores were compared, with Group 3 showing the highest improvement and Group 2 the least. Mean VAS scores decreased across all groups without significant baseline differences. Outcomes distribution was analyzed, revealing 20.00% excellent outcomes in the non-surgical group, while Group 2 had the highest excellent outcome percentage. Conclusion: Plate fixation demonstrated superior functional outcomes for posterior malleolar fractures compared to screw fixation and conservative treatment, which showed the least improvement.

Background: Acute appendicitis is the most common surgical emergency. Life time prevalence rate of acute appendicitis is approximately one in seven and more common in men than women (8.6% versus 6.7%). About 310,000 appendectomies are performed/year in the United States, of which 250,000 have definite appendicitis, giving a negative appendectomy rate of about 15% to 30%. Methods: This randomized control prospective study. Cases of uncomplicated acute appendicitis undergoing emergency open appendectomy were included in this study. Results: 5 patients (3 in Group A and 2 in Group B) developed wound infection. All the 5 patients developed superficial site infection. None of the patients developed deep surgical site or intra-abdominal infections in either of the two groups. There was no statistically significant difference between the two groups (p value- 0.621). Conclusion: Frequency of post operative wound infection is generally very low in uncomplicated appendicitis. The prolonged use of antibiotics post operatively is unnecessary, can increase antibiotic resistance, can produce side effects and increase cost of treatment.

Background: Giant cell tumor of bone (GCTB) is a benign yet locally aggressive neoplasm that predominantly involves the epiphyseal region of long bones. Its occurrence in the small bones of the foot is extremely rare and often leads to diagnostic delay. Case Presentation: A young male presented with pain and swelling over the first metatarsal region. Radiological evaluation revealed an expansile lytic lesion of the first metatarsal. Histopathological examination demonstrated numerous osteoclast-like multinucleated giant cells in a mononuclear stromal background, confirming the diagnosis of giant cell tumor of bone. Surgical management was performed with favourable outcome. Conclusion: Despite its rarity, giant cell tumor should be considered in the differential diagnosis of lytic lesions of the metatarsal bones. Early diagnosis and appropriate surgical intervention are crucial for optimal functional outcome.

Introduction: Haemodynamic stability is a fundamental and crucial objective of any anesthetic management strategy. Laryngoscopy and intubation can induce significant alterations in hemodynamics. The elevation of blood pressure and heart rate mostly results from reflex sympathetic and vagal activation in response to laryngotracheal stimulation, subsequently causing an increase in plasma norepinephrine levels. This study aimed to examine the efficacy of esmolol and fentanyl in mitigating hemodynamic responses associated with laryngoscopy and endotracheal intubation. Methods: A total of 100 patients of either gender, classified as American Society of Anesthesiologists physical status I and II, aged between 20 and 50 years, scheduled for various elective surgeries necessitating general anesthesia with endotracheal intubation at Bankura Sammilani Medical College and Hospital, Bankura, West Bengal. Hundreds of patients were randomized into two groups: Group E (n = 50) and Group F (n = 50). Results: The inhibition of maximum heart rate elevation by Esmolol is statistically significant in comparison to Fentanyl (P<0.001). It remains pertinent for five minutes. By the inference of 10 minutes, the levels in the Esmolol and Fentanyl groups diminish to a clinically insignificant threshold. Conclusion: This clinical comparison investigation shows that both esmolol and fentanyl effectively mitigate the sympathetic hemodynamic response linked to laryngoscopy and endotracheal intubation. Nonetheless, esmolol demonstrated superior efficacy compared to fentanyl in attenuating this reaction.

Background: Nearly one-third of all malignancies in India are head and neck cancers (HNC), making them a serious public health concern. The burden of disease is greatly increased by alcohol intake, tobacco usage, and delayed diagnosis. Objective: To study the epidemiological profile of head and neck cancer patients and evaluate challenges associated with early detection. Methods: Over the course of a year, a prospective observational study was carried out in a tertiary care facility. There were one hundred patients with a head and neck cancer diagnosis. Risk factors, cancer site, stage at diagnosis, time to diagnosis, and demographics were noted. The chi-square test was used for statistical analysis, and a p-value of less than 0.05 was deemed statistically significant. Results: 72% of the patients were men. The age range of 51 to 60 was the most frequently impacted. The most common risk factor (68%) was tobacco use. Oral cavity cancers were the most frequent (42%), followed by laryngeal tumors (25%). Approximately 64% of individuals had advanced (Stage III–IV) presentations. Low awareness and tobacco use were substantially correlated with late presentation (p < 0.05). Conclusion: In India, head and neck malignancies are still very common, and the majority of patients arrive at an advanced stage. To increase early detection and results, tobacco control regulations, awareness campaigns, and early screening must be strengthened.

Neonatal Sepsis is Systemic blood stream infection of neonates during the first 30 days of life. It is one of the most common causes of morbidity and mortality in newborns. Neonatal sepsis may have an early onset (birth to three days) or a late onset (four days or 30days). Onset is more rapid in premature neonates. C-reactive protein is an important inflammatory biomarker of neonatal sepsis in association with blood culture that aids in the timely diagnosis of neonatal septicaemia. The gold standard for diagnosis of bacterial sepsis is blood culture, may be primary or secondary to a focal infection. The risk factors for neonatal sepsis are prematurity, low birth weight etc.  C-reactive protein (CRP) is a part of a protein group called acute phase reactants that is produced by the liver and is considered as an inflammatory biomarker. Materials and Methods: This is prospective and laboratory-based study was conducted in department of Microbiology from Feburary 2024 to July 2024 in NMCH Jamuhar Sasaram. Total 108 blood samples were taken from Clinically suspected patients of neonatal septicemia from NICU, and processed by BACT/ALERT 3D automated Blood culture instrument and quantitative assessment of CRP were done by STANDARD F CRP (SD BIOSENSOR). Isolates were identified by morphological, cultural and biochemical characteristics. Results and Discussion: A total of 108 blood sample of suspected neonatal septicaemia cases is analyzed. 28(26%) cases were blood culture positive while 72 (66.6%) were CRP positive. Out of total blood culture positive, 23(82%) cases are CRP positive. This study shows the sensitivity, specificity, NPV and PPV of CRP to detect neonatal septicaemia are 82.1%,38.75%,86% and 32% respectively. Out of 28 culture positive, 16 are gram negative bacilli, 10 are gram positive cocci and 2 are Candida species isolated. In our study 72 out of 108 total samples had positive results for CRP test i.e. 66.6%. Out of the total 28 culture positive detected sample of neonatal septicemia 23 samples were CRP positive. Conclusion: The specificity and sensitivity of CRP against blood culture strengthen the use of this acute phase protein in the diagnosis of neonatal sepsis. Our study concludes that serum CRP is simple method for diagnosis of neonatal sepsis in resource limited settings.

Background: Cubitus varus is the most common late complication following malunion of pediatric supracondylar humeral fractures, resulting in cosmetic disfigurement and potential functional impairment. The Ilizarov distraction osteogenesis technique offers gradual, controlled, multiplanar correction with the advantage of postoperative adjustability. However, data from single-centre Indian settings remain limited. Aim: To evaluate the functional and cosmetic outcomes of cubitus varus deformity correction in children using the Ilizarov distraction osteogenesis technique. Materials and Methods: This hospital-based, prospective, observational study was conducted in the Department of Orthopedics, SMS Medical College and Hospital, Jaipur, Rajasthan. Twenty-five patients aged less than 20 years with post-traumatic cubitus varus deformity secondary to malunited supracondylar humeral fractures were enrolled. All patients underwent supracondylar osteotomy with Ilizarov ring fixator application followed by gradual distraction. Outcomes were assessed in terms of carrying angle correction, elbow range of motion (flexion and extension), complications, and functional results using the Oppenheim grading and Mayo Elbow Performance Score. Results: The mean age at trauma was 7.05 ± 1.11 years and at surgery was 16.68 ± 1.54 years. Males predominated (76%). The mean carrying angle improved significantly from 12.58° ± 3.75° pre-operatively to 10.01° ± 1.33° at follow-up (p < 0.05), closely approximating the contralateral side (10.54° ± 1.56°). Elbow flexion (134.74° ± 3.81° vs 134.74° ± 3.45°) and extension (−2.58° ± 3.42° vs −2.84° ± 1.90°) were preserved postoperatively (p > 0.05). Complications included pin tract infection (16%), ulnar nerve paraesthesia (4%), flexion deformity (4%), and ulnar claw hand (4%). Excellent functional outcomes were achieved in 88% of patients, good in 8%, and poor in 4%. Conclusion: The Ilizarov distraction osteogenesis technique is a safe, effective, and reliable method for correcting cubitus varus deformity in children, providing excellent carrying angle restoration, preserved range of motion, and high patient satisfaction with minimal complications.

Background: Vitamin D deficiency is a widely prevalent nutritional disorder, particularly among the elderly, and has been implicated as a significant risk factor for osteoporotic fragility fractures. However, data regarding its prevalence specifically in patients with vertebral fragility fractures from Northwestern India remain limited. Aim: To assess the prevalence of vitamin D deficiency in patients presenting with vertebral fragility fractures at a tertiary care hospital in Northwestern India and to evaluate its correlation with demographic and fracture-related variables. Materials and Methods: This hospital-based, cross-sectional descriptive observational study was conducted at the Department of Orthopaedics, S.M.S. Medical College and Hospital, Jaipur, Rajasthan. A total of 45 patients aged >16 years with confirmed vertebral fragility fractures were enrolled after obtaining informed consent. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using chemiluminescent immunoassay (CLIA). Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Demographic data, fracture type (wedge, biconcave, crush), fracture site, and number of fractures were recorded. Data were analyzed using descriptive statistics. Results: Of the 45 patients, 26 (57.8%) were female and 19 (42.2%) were male with a mean age of 62.8 ± 6.4 years. The mean serum 25(OH)D level was 19.22 ± 3.95 ng/mL. All 45 patients (100%) had suboptimal vitamin D levels (<30 ng/mL). Vitamin D deficiency (<20 ng/mL) was observed in 27 patients (60.0%), while insufficiency (20–29 ng/mL) was found in 18 patients (40.0%). The 60–70 years age group had the highest prevalence (44.4%). Wedge fractures were the most common type (57.8%), followed by biconcave (26.7%) and crush fractures (15.6%). Thoracic vertebrae were the most frequently affected site (57.8%). Conclusion: Vitamin D deficiency is universally prevalent among patients with vertebral fragility fractures in this population. These findings strongly support the incorporation of routine vitamin D screening and supplementation as a standard component in the clinical management and secondary prevention of vertebral fragility fractures, particularly in elderly patients from Northwestern India.

Background: Pre-stenting before to ureteroscopy (URS) is routinely conducted to enhance ureteral access and minimize intraoperative problems. Nonetheless, its quantitative effect on ureteral wall stress and surgical complexity remains insufficiently examined. Objective: To evaluate the impact of pre-stenting on ureteral wall stress measures and intraoperative surgical complexity during ureteroscopy. Methods: This retrospective comparative study comprised 36 individuals who had ureteroscopy for ureteral calculi. Patients were categorized into two groups: Group A (pre-stented, n=18) and Group B (non-stented, n=18). Ureteral wall stress was indirectly evaluated by assessing the resistance to ureteral access sheath (UAS) insertion and the necessity for active ureteral dilatation. Surgical complexity was assessed using operating duration, a surgeon-reported difficulty score (visual analog scale 1–10), and intraoperative complications. Results: Pre-stented patients demonstrated significantly lower UAS insertion resistance (mean score 2.0 ± 0.6 vs 5.6 ± 1.3, p<0.001) and decreased need for ureteral dilation (11% vs 61%, p=0.004). Operative time was shorter in the pre-stented group (40 ± 10 min vs 59 ± 12 min, p=0.002), and surgical difficulty scores were significantly lower (3.0 ± 1.3 vs 6.1 ± 1.5, p<0.001). Conclusion: Pre-stenting markedly lowers ureteral wall stress and intraoperative surgical complexity during ureteroscopy. Routine pre-stenting in specific patients may enhance procedure safety and efficiency.

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint, accounting for nearly one-third of outpatient visits. It significantly affects women’s quality of life, particularly in the perimenopausal age group, where the risk of endometrial pathology increases. Aim: To assess the clinical and histopathological profiles of women presenting with abnormal uterine bleeding in the perimenopausal age group. Methodology: A hospital-based descriptive cross-sectional study was conducted over one year among 60 women aged 45 ± 5 years presenting with AUB. Clinical data were collected using a pre-tested questionnaire. Endometrial samples were subjected to histopathological examination. Data were analyzed using SPSS, with p < 0.05 considered significant. Results: Most participants were aged 40–41 years (30%) and multiparous (70%). Menorrhagia was the most common bleeding pattern (63.3%). Abdominal pain (33.3%) was the predominant associated symptom. Histopathology revealed proliferative endometrium in 30%, endometrial hyperplasia in 23.3%, secretory endometrium in 20%, and endometrial carcinoma in 6.7% of cases. Conclusion: AUB in perimenopausal women is predominantly associated with benign endometrial changes, though premalignant and malignant lesions are present in a minority, emphasizing the need for comprehensive clinical and histopathological evaluation.

Background: Diabetic nephropathy remains one of the most common microvascular complications of type-2 diabetes mellitus (T2DM) and is a major cause of chronic kidney disease worldwide. Albuminuria is an early marker of renal damage in diabetic individuals. Recent research suggests that bile acids act as metabolic signaling molecules that regulate glucose metabolism, inflammation, and insulin sensitivity. However, their association with diabetic kidney disease remains inadequately explored. Objective: To evaluate the relationship between serum total bile acid levels and albuminuria in patients with type-2 diabetes mellitus. Materials and Methods: This cross-sectional study was conducted at Patna Medical College, Patna, Bihar, India over a period of eight months (February 2025–October 2025). A total of 80 patients with diagnosed T2DM were enrolled. Serum total bile acid levels were measured using enzymatic assays, and urinary albumin excretion was assessed using the albumin-creatinine ratio (ACR). Patients were categorized into normoalbuminuria, microalbuminuria, and macroalbuminuria groups. Statistical analysis was performed using Pearson correlation and ANOVA tests. Results: The mean serum bile acid level was significantly lower in patients with higher albuminuria levels (p < 0.01). A significant negative correlation was observed between serum total bile acid levels and urinary albumin excretion (r = −0.42, p = 0.002). Conclusion: Serum total bile acid levels show a significant inverse relationship with albuminuria in patients with T2DM. Lower bile acid levels may be associated with worsening renal involvement in diabetic patients.

Background: Adenomyosis is a common benign gynecological disorder characterized by the presence of endometrial tissue within the myometrium. Chronic pelvic pain (CPP) is one of its most debilitating symptoms, significantly affecting quality of life in reproductive-aged women. Objective: To evaluate the correlation between adenomyosis and chronic pelvic pain in reproductive-aged women and to assess associated clinical and imaging parameters. Methods: This observational analytical study included reproductive-aged women diagnosed with adenomyosis based on transvaginal ultrasonography and/or magnetic resonance imaging. The presence, severity, and characteristics of chronic pelvic pain were assessed using a visual analog scale (VAS). Statistical associations between adenomyosis features and pelvic pain were analyzed. Results: A significant positive correlation was observed between adenomyosis and chronic pelvic pain severity. Women with diffuse adenomyosis and increased junctional zone thickness reported higher pain scores. Conclusion: Adenomyosis is significantly associated with chronic pelvic pain in reproductive-aged women, with disease severity correlating with pain intensity. Early diagnosis and targeted management may improve patient outcomes.