Diabetic foot ulcer (DFU) continues to be one of the most distressing and economically draining complications of diabetes mellitus, frequently ending in prolonged hospitalisation or lower-limb amputation when management is delayed. Persistent neuropathic pain, chronic low-grade inflammation and polymicrobial colonisation together sustain the wound in a non-healing state, and none of the dressings in routine clinical use address the neuropathic pain component directly. Amitriptyline, a tricyclic antidepressant long used for neuropathic pain, has additionally been shown to possess antibacterial and anti-inflammatory activity against organisms commonly recovered from chronic wounds. The present work was undertaken to formulate, develop and evaluate an amitriptyline-loaded polymeric hydrogel intended for topical application to diabetic foot ulcers, combining local analgesia, antimicrobial support and a moist wound-healing environment in a single dosage form. Hydrogels were prepared by the cold dispersion method using Carbopol 934 and hydroxypropyl methylcellulose (HPMC K4M) as the gelling polymers, with propylene glycol as co-solvent/humectant, and were optimised through a series of nine trial batches (F1–F9). The gels were evaluated for physical appearance, pH, spreadability, viscosity and rheological behaviour, gel strength, swelling index, drug content uniformity, in vitro drug release using the Franz diffusion cell, release kinetics, ex vivo skin permeation, antimicrobial efficacy against Staphylococcus aureus and Pseudomonas aeruginosa, and short-term accelerated stability. The optimised batch (F6) containing 2% w/w Carbopol 934 and 1% w/w HPMC K4M showed a pH of 5.6 ± 0.2, a viscosity of 18,450 ± 340 cP, and cumulative drug release of 88.4 ± 2.1% over 12 hours, following a Korsmeyer–Peppas non-Fickian release pattern. The formulation retained acceptable physicochemical characteristics on storage at 40 °C/75% RH for 90 days. These findings suggest that an amitriptyline-loaded polymeric hydrogel is a technically feasible and promising adjunctive dosage form for the multimodal management of diabetic foot ulcers, warranting further ex vivo and in vivo confirmation.

Objectives: The present study was to compare post operative outcome of the the efficacy of SAB alone with the combination of SAB and intravenous infusion of dexmedetomidine in elective infra-umbilical surgeries. Methods: A total of 80 patients were undergone elective infra umbilical surgeries. All the cases were categorized into two groups. Group A- cases underwent subarachnoid block alone and Group B cases underwent Subarachnoid block and intravenous infusion of injection Dexmedetomidine. A full anaesthetic checkup was done. Post operative pain was assessed by Visual Analogue Scale (VAS score). Post operative sedation was assessed by using Ramsay sedation score. Results: Each group has 40 patients. Higher proportion of patients were in the age group of 46 to 60 years (40% in subarachnoid block versus 42.5% in SAB with dexmedetomidine). Mean NRS score was significantly lower among patients in SAB with dexmedetomidine group as compared to patients in subarachnoid block at 4 and 8 hours post-operatively (p = 0.01 and p = 0.01). VAS score was significantly lower among SAB with dexmedetomidine group at 4 hours post-operatively as compared to subarachnoid block group (p = 0.02). At 8 and 12 hours post-operatively, the difference was not statistically significant (p = 0.17 and p = 0.72). The mean Ramsay sedation score was significantly higher among patients in SAB with dexmedetomidine group (2.40 ± 1.06) as compared to patients in subarachnoid block (1.33 ± 0.53) (p = 0.01) at 4 hours post-operatively. At 8 hours post-operatively, the difference was also statistically significant (p = 0.01). At 12 hours postoperatively, it was not statistically significant (p = 1). Conclusion: Postoperatively, the dexmedetomidine group patients experienced significantly lower pain scores and higher sedation levels, which indicates better post-surgical recovery. Hence, SAB with dexmedetomidine provides enhanced post-operative pain management and sedation without increasing complications, making it a promising option for elective infra-umbilical surgeries.

Introduction: Fractures of the distal tibia can be challenging to treat because of limited soft tissue, the subcutaneous location and poor vascularity. The goal in expected care is to realign the fracture, realign limb length and early functional recovery. The purpose of this study is to evaluate the effectiveness, functional results and complications following surgical internal fixation of distal tibia fractures with platting techniques. Objective: To evaluate the functional and radiological outcomes and postoperative complications of surgically treated distal tibia fractures using plate fixation in adult patients. Methods: A retrospective review was conducted of patients with Distal tibia fractures treated with platting technique. In all 44 patients were enrolled in the study and all were treated with platting technique. Comparative analysis of demographic data, peri-operative & post-operative outcome and complications were carried out. Results: Total 44 patients were included in the study. Among all patient 26 has 43A, 2 has 43B and rest 16 has 43C type of injury according to AO/OTA classification.  Average time to union was found to be around 14 weeks with delayed union noticed in few cases having uncontrolled diabetes mellitus and in elderly patients. According to AOFAS score (86.37%) most of patient fall in good to excellent group. Conclusions: A good functional result depends on a reasonable anatomical reduction of the articular surface by direct or indirect methods. Fixation of the fibula is recommended whenever possible. Patient with poor skin condition for good function outcome initially, the fibula is fixed, and an external fixator is placed, and after favourable skin condition definitive fixation by platting is done.

Protein tyrosine phosphatase 1B (PTP1B; PTPN1) is a non-receptor protein tyrosine phosphatase that functions as an important negative regulator of insulin receptor signaling. Because excessive PTP1B activity can attenuate insulin receptor and insulin receptor substrate phosphorylation, inhibition of PTP1B has long been investigated as a strategy for improving insulin sensitivity and reducing hyperglycaemia in type 2 diabetes mellitus (T2DM). Natural terpenoids, particularly pentacyclic triterpenes, have emerged as useful chemical starting points because their rigid, lipophilic frameworks can engage hydrophobic regions adjacent to the polar catalytic machinery of PTP1B. Oleanolic acid, ursolic acid, corosolic acid, lupeol, betulinic acid and related scaffolds have demonstrated PTP1B inhibition in biochemical and cellular studies, while chemical modification has produced derivatives with improved potency, selectivity or pharmacological behavior. This review focuses specifically on tricyclic terpenoid derivatives inspired by pentacyclic triterpenoid PTP1B inhibitors in which the oleanolic-acid-derived scaffold was simplified to a smaller tricyclic core. the rationale for terpenoid-based inhibition; the evolution from natural triterpenes to semi-synthetic derivatives and tricyclic analogues; structure activity relationships involving hydrophobicity, acidic functionality, hydrogen-bonding groups and scaffold size; mechanisms of inhibition; selectivity against TCPTP and other phosphatases; cellular glucose uptake; animal evidence; pharmacokinetic and physicochemical limitations; and opportunities for modern medicinal chemistry. The evidence indicates that tricyclic terpenoid derivatives represent promising research scaffolds rather than clinically validated antidiabetic agents. Future progress will likely depend on combining structural biology, quantitative SAR, permeability optimization, metabolic-stability studies, target-engagement biomarkers, and rigorous in-vivo pharmacology.

Background: Lumbar radiculopathy secondary to intervertebral disc prolapse (IVDP) is a common cause of low back pain and lower limb radicular symptoms, resulting in significant pain, disability, and reduced quality of life. Selective transforaminal nerve root block (STNRB) has emerged as a minimally invasive treatment option for patients with persistent symptoms despite conservative management. Methods: This prospective interventional study included 40 patients with clinically and radiologically confirmed lumbar radiculopathy due to single-level IVDP. All patients underwent fluoroscopy-guided STNRB using a corticosteroid and local anaesthetic mixture. Pain intensity and functional disability were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) before intervention and during follow-up. Procedure-related complications and overall clinical outcomes were also evaluated. Results: The mean VAS score improved significantly from 7.07 ± 1.12 pre-procedure to 1.85 ± 0.94 at one-year follow-up (p < 0.001). The mean ODI score decreased from 50.05 ± 9.07 to 21.60 ± 8.99 at six months (p < 0.001). Overall, 77.5% of patients achieved good-to-excellent outcomes. Only 5% of patients experienced minor transient complications, with no major adverse events. Conclusion: STNRB is a safe and effective minimally invasive intervention that provides significant pain relief and functional improvement in patients with lumbar radiculopathy secondary to intervertebral disc prolapse and may serve as an effective alternative before surgical intervention.

Background: Tumor-infiltrating lymphocytes (TILs) are a reflection of host antitumor immunity and are now being identified as a prognostic and predictive biomarker in certain breast cancer subtypes. They are still useful in routine pathological practice in relation to conventional histopathological variables. Objective: To measure the number of stromal TILs in invasive breast carcinoma and to assess their relationship to histological grade, pathological stage, nodal status, and receptor profile and proliferation activity. Methods: A cross sectional histopathological study was conducted on 168 primary invasive breast carcinomas that were resected without systemic treatment. Hematoxylin-eosin sections were used to score stromal TILs following the principles of the International TILs Working Group and classify them as low (less than 10%), intermediate (10-49%) or high (50 or more). Histological type, Nottingham grade, tumor size, nodal status, pathologic stage, lymphovascular invasion, ER, PR, HER2, and Ki-67 were recorded. Results: Low, intermediate, and high TIL levels were observed in 74 (44.0%), 71 (42.3%), and 23 (13.7%) tumors, respectively. The median stromal TILs were higher at Nottingham grades: 7% at grade 1, 16% at grade 2 and 35% at grade 3 (p<0.001). The incidence of high TILs was 26.4% in grade 3 tumors, and 2.9% in grade 1 tumors. TIL level showed a moderate positive correlation with grade (Spearman r=0.46, p<0.001) and Ki-67 (r=0.41, p<0.001). Triple-negative (38%) and HER2-positive (30%) carcinomas had higher median TILs compared to hormone receptor-positive/HER2-negative (12%) carcinomas (p<0.001). There was only a weak correlation between TILs and pathologic stage (r=0.17, p=0.031) and no independent association between stage and high TILs after adjusting for grade and molecular phenotype. Conclusion: Stromal TILs are strongly correlated with higher histological grade, high proliferation and aggressive immunophenotypic subtypes, and less so with anatomic stage. Biologically relevant information can be added to the standard breast carcinoma report with routine standardized TIL assessment.

Background: Injuries from road accidents are a significant contributor to both death and morbidity. It is the world’s biggest public health issue, accounting for over 5.8 million deaths annually. Due to global increases in violence, construction, and the number of vehicles, chest trauma has gotten worse throughout time as urbanization and industry have grown. Methods: From August 2024 to January 2025, this study was carried out at the Murli Bhedi Jha Community Health and Trauma Center, Araria Sangram, Jhanjharpur, Madhubani, Bihar. The method of convenient sampling was employed. A hospital-based retrospective descriptive cross-sectional study design was employed to evaluate patient outcomes and trends related to chest injuries. For analysis, the gathered data was imported into SPSS version 25. Result: Young adults (63%) between the ages of 18 and 35 were the most affected age group. Males made up nearly three-quarters (72%) of patients with chest trauma, while women made up 28%. The majority of patients with chest damage arrived at medical institutions one to two hours after the incident. The most frequent chest injuries were rib fractures (39%), followed by hemopneumothorax (25%) and pulmonary contusions (7%). Extremities were the most often injured body part (47%). Conclusion: RTA-related chest injuries have a significant morbidity and fatality rate in this setting and mostly impact the male, economically productive age group.

Background: Thiamine and vitamin C have been increasingly used in patients with sepsis or septic shock because of their potential for improving metabolism and reducing mortality.The purpose of this study is to determine if thiamine combined vitamin C can reduce mortality in patients with sepsis or septic shock. Methods: Patients 18 years of age or older who were admitted to the GMCH, Bettiah, West Champaran, Bihar, Department of Medicine between March 2026 and August 2026 with sepsis or septic shock and received intravenous thiamin in addition to usual care made up the pre-intervention group (n=26). They were paired with a control group of 26 individuals who had the same diagnosis during the retrospective phase. Hospital mortality was the main outcome. Time to death, duration of stay in critical care, time to lactate level <2 mmol/L, vasopressor usage and duration, need for renal replacement therapy (RRT), and PaO2/FiO2 ratio were secondary objectives. The development and implementation of an evidence-based thiamin guideline for sepsis standardized the dosage, duration, and time of beginning. The post-intervention thiamin group and the pre-intervention thiamin and control groups were compared in the prospective phase using the same outcomes. Results: Hospital mortality did not differ between the pre- and post-intervention phases. But compared to the pre-intervention thiamin group, more patients in the control group needed RRT (65.4% vs. 42.3%, P=0.013). In addition, the post-intervention thiamin group required less RRT than the control group (36.8% vs. 65.4%, P=0.02). Conclusion: There was no benefit to hospital mortality with thiamin. On the other hand, patients with renal failure might be able to use it. Future research should examine thiamine’s potential to protect the kidneys.

Background: The most prevalent metabolic condition that makes pregnancy more difficult is diabetes mellitus. Complications during the early newborn period are common in infants of diabetes mothers (IDMs). The purpose of the study was to characterize and contrast the metabolic and hematological parameters of newborns born to mothers with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM). Methods: From August 2025 to July 2026, the hospital-based prospective study was carried out at the pediatrics department of Darbhanga Medical College and Hospital in Laheriasarai, Bihar. In order to conduct pertinent biochemical and hematological investigations, blood samples were obtained. Results: Of the 68 newborns, 38.2% came from mothers with PGDM and 61.8% from mothers with GDM. With regard to GDM, 33.3% were Large for Gestational Age (LGA), 4.8% were Small for Gestational Age (SGA), and 61.9% were Appropriate for Gestational Age (AGA). 53.8% of infants with PGDM and 71.4% of neonates with GDM experienced hypoglycemia. 69.2% of newborns with PGDM and 47.6% of newborns with GDM had hypocalcemia. Neonates born to women with GDM had considerably higher rates of hypoglycemia, polycythemia, and hyperbilirubinemia (p values 0.01, 0.02, and <0.001, respectively), whereas neonates born to mothers with PGDM had significantly higher rates of hypocalcemia (p value 0.02). Conclusion: Compared to infants with PGDM, neonates with GDM had significantly higher rates of hypoglycemia, polycythemia, and hyperbilirubinemia; however, newborns with PGDM had significantly higher rates of hypocalcemia.

Background: Schizophrenia is a chronic psychiatric disorder that shifts a substantial share of long-term care onto family caregivers, particularly in resource-limited settings where deinstitutionalised, community-based care predominates. While caregiver burden in schizophrenia has been extensively studied across Indian tertiary centres, region-specific data from Bihar remain scarce. Objectives: To assess the level of caregiver burden among primary caregivers of patients with chronic schizophrenia and determine its association with sociodemographic and clinical variables. Methods: This hospital-based, cross-sectional, observational study was conducted in the Department of Psychiatry, in coordination with the Department of Community Medicine, at a tertiary care hospital in Bihar. Ninety primary caregiver–patient dyads meeting eligibility criteria were enrolled by consecutive sampling. A semi-structured proforma and the 40-item Burden Assessment Schedule (BAS, 9 domains, score range 40–120, lower score indicating greater burden) were administered. Data were analysed using descriptive statistics, chi-square test, unpaired t-test, and Pearson’s correlation. Results: The mean total BAS score was 77.7 ± 13.4 (range 46–104). Overall, 58.9% of caregivers experienced high burden (score ≤80), with burden being moderate in 46.7% and severe in 12.2%. “Support to Patient,””Other Relations,” and “Caregiver’s Routine” were the most affected domains. High burden was significantly associated with longer duration of illness, greater number of relapses/hospitalisations, poor treatment adherence, nuclear family structure, and older patient age (all p<0.05), while caregiver age, residence, and patient sex showed no significant association. Conclusion: Nearly six in ten primary caregivers of patients with chronic schizophrenia in this Bihar hospital-based sample experienced high burden, driven predominantly by illness chronicity, relapse frequency, and poor adherence. These findings support routine caregiver screening and family-focused psychoeducational interventions alongside patient-directed psychiatric treatment.

Background: Type 2 diabetes mellitus (T2DM) is frequently accompanied by obesity, hypertension, dyslipidemia, and other cardiovascular risk factors. Serum uric acid (SUA) has emerged as a potential marker of cardiometabolic dysfunction, although its relationship with glycemic control remains inconsistent. This study evaluated the association of SUA with glycemic control and cardiovascular risk factors in patients with T2DM. Materials and Methods: This hospital-based cross-sectional study included 180 adults with established T2DM at a tertiary-care teaching hospital in India. Clinical and anthropometric parameters, blood pressure, fasting plasma glucose, HbA1c, SUA, lipid profile, and serum creatinine were assessed. Associations were evaluated using appropriate comparative tests, correlation analysis, and multivariable regression, with p<0.05 considered statistically significant. Results: The mean age was 55.2±10.6 years; 56.7% were male. Mean SUA and HbA1c were 5.9±1.5 mg/dL and 8.1±1.6%, respectively. Patients with HbA1c ≥7% had significantly higher SUA than those with HbA1c <7% (6.1±1.5 vs. 5.4±1.3 mg/dL; p=0.005). SUA correlated positively with HbA1c (r=0.31, p<0.001), BMI (r=0.29, p<0.001), systolic blood pressure (r=0.23, p=0.002), triglycerides (r=0.36, p<0.001), and LDL-C (r=0.22, p=0.003), and inversely with HDL-C (r=−0.28, p<0.001). Hypertriglyceridemia showed the strongest independent association with hyperuricemia (AOR 2.63, 95% CI 1.34–5.16; p=0.005). SUA remained independently associated with HbA1c on multiple linear regression (β=0.23, p=0.002). Conclusion: Higher SUA levels were significantly associated with poorer glycemic control and an adverse cardiovascular risk profile in patients with T2DM. SUA may therefore serve as a simple additional marker for identifying patients with clustering of cardiometabolic risk factors; however, the cross-sectional design precludes causal inference.

Background: Open and laparoscopic repair are well recognized techniques for incisional hernia, but the relative impact on postoperative pain, wound morbidity, and functional recovery are clinically relevant when choosing an operative approach. Objective: To compare early pain, peri-operative complications, hospital stay, functional recovery and recurrence at one year between laparoscopic and open incisional hernia repair. Patients: 120 adults with primary or first recurrent midline incisional hernia (3-12 cm) were included in a prospective randomized comparative study, with 60 patients in each arm. Methods: 120 adults with primary or first recurrent midline incisional hernia (3-12 cm) were included in a prospective randomized comparative study, with 60 patients in each arm. Pain was measured at 6 hours, postoperative day 1, day 3 and day 7 on a 10-point visual analogue scale (VAS). Complications, use of analgesics, length of stay, return to routine activity and recurrence at 12 months were recorded. Results: There were no differences between baseline characteristics and defect size. Laparoscopic repair required longer operative time (96.4 ± 21.8 vs 82.1 ± 20.6 minutes, p<0.001) but produced lower VAS pain on day 1 (4.1 ± 1.2 vs 5.6 ± 1.4, p<0.001) and day 3 (2.3 ± 1.0 vs 3.8 ± 1.2, p<0.001). Surgical-site infection occurred in 2/60 (3.3%) laparoscopic versus 8/60 (13.3%) open repairs (p=0.047). Seroma rates were similar (10.0% vs 8.3%, p=0.752). Mean hospital stay was shorter after laparoscopy (2.6 ± 1.1 vs 4.8 ± 1.7 days, p<0.001), as was return to routine activity (14.8 ± 5.4 vs 24.6 ± 7.8 days, p<0.001). There was no significant difference in one-year recurrence (5.0% vs 6.7%, p=0.697). Results: Laparoscopic repair was performed in selected incisional hernias, and was found to have less early postoperative pain, fewer wound infections, shorter hospital stay, and a more rapid functional recovery, with a similar short-term recurrence rate compared to open retromuscular repair.

Introduction: Maintaining adequate anaesthetic depth is essential for preventing excessive anaesthetic exposure and delayed recovery. Conventional clinical indicators may inadequately reflect hypnosis. Entropy monitoring provides continuous assessment of cerebral electrical activity and may facilitate individualized isoflurane titration, reduce anaesthetic consumption and improve postoperative recovery. Aim: To compare entropy-guided and conventional clinically guided isoflurane anaesthesia regarding recovery characteristics, anaesthetic consumption, postoperative recovery scores, adverse events, and intraoperative recall. Methods: This prospective, quasi-experimental study was conducted over 18 months at a tertiary care teaching hospital. Consecutive sampling recruited 150 patients aged 18–65 years, with American Society of Anesthesiologists physical status I–II, undergoing elective general surgery or otorhinolaryngological procedures. Patients were allocated to entropy monitoring (Group E) or conventional clinical monitoring (Group C), with 75 participants each. Anaesthesia was induced using propofol and vecuronium and maintained with isoflurane in oxygen and air. Isoflurane was titrated to maintain response entropy between 40 and 60 in Group E; Group C received titration according to clinical parameters and minimum alveolar concentration targets. A blinded observer recorded recovery outcomes following anaesthetic discontinuation. Anaesthetic consumption, modified Aldrete scores, postoperative adverse events, and recall on the first postoperative day were assessed. Statistical significance was defined as p<0.05. Results: Compared with Group C, Group E demonstrated significantly shorter times to eye opening (6.2±2.1 versus 8.7±2.8 minutes), obeying verbal commands (7.4±2.3 versus 10.1±3.0 minutes), extubation (8.9±2.5 versus 11.8±3.1 minutes), orientation (12.8±4.2 versus 16.5±5.1 minutes), and readiness for post-anaesthesia care unit discharge (38.6±9.8 versus 47.4±12.5 minutes); all p<0.001. Total isoflurane consumption (13.9±3.8 versus 17.2±4.5 mL), hourly consumption (9.7±2.4 versus 11.8±2.9 mL/hour), and mean end-tidal concentration (0.86±0.16% versus 1.03±0.19%) were significantly lower with entropy monitoring (all p<0.001). Modified Aldrete scores were significantly higher at all assessed intervals. Discharge delayed beyond 60 minutes occurred less frequently in Group E (5.3% versus 17.3%; p=0.020). Postoperative nausea, vomiting, shivering, respiratory depression, and rescue analgesia requirements did not differ significantly. Definite recall occurred in no Group E patients and 1.3% of Group C; recall differences were not statistically significant. Conclusion: Entropy-guided isoflurane anaesthesia was associated with reduced anaesthetic consumption, faster emergence, and improved early postoperative recovery compared with conventional monitoring. A reduction in intraoperative awareness was not established. Entropy monitoring may serve as an adjunct to routine clinical assessment; larger randomized studies are needed to confirm these findings and establish their applicability across broader surgical populations.

Introduction: Securing the airway safely and efficiently is a fundamental responsibility of the anesthesiologist, particularly in pediatric patients who have distinct anatomical and physiological characteristics and are vulnerable to rapid oxygen desaturation and hemodynamic disturbances during airway manipulation. Conventional direct laryngoscopy requires alignment of the oral, pharyngeal, and laryngeal axes, whereas videolaryngoscopy provides an indirect view of the glottis and may improve visualization and facilitate tracheal intubation. This study compared conventional laryngoscopy and videolaryngoscopy for endotracheal intubation in children aged 5–11 years undergoing elective surgery under general anesthesia. Methods: A quasi-experimental comparative study was conducted in a tertiary care teaching hospital over 18 months. Seventy children aged 5–11 years, classified as ASA physical status I–III and scheduled for elective surgery under general anesthesia, were enrolled and randomly allocated into two groups of 35 each. Group A underwent intubation using a Macintosh direct laryngoscope, while Group B underwent videolaryngoscopy. The primary parameters assessed were time to intubation, number of intubation attempts, Cormack–Lehane grade, requirement for airway maneuvers, peri-intubation hemodynamic changes, oxygen saturation, and airway-related complications. Results: First-attempt intubation success was higher with videolaryngoscopy than direct laryngoscopy (91.4% vs. 74.3%), although the difference was borderline statistically significant (χ²=3.64, p=0.056). Mean time to intubation was significantly shorter with videolaryngoscopy (24.91±4.61 seconds) compared with direct laryngoscopy (35.84±7.82 seconds; t=8.72, p<0.001). Cormack–Lehane Grade 1 visualization was significantly more frequent with videolaryngoscopy (62.9% vs. 28.6%), while difficult views (Grades 2b and 3) were more common with direct laryngoscopy (p=0.004). Additional airway maneuvers were required significantly less frequently with videolaryngoscopy (17.1% vs. 54.3%; χ²=8.27, p=0.041). Post-intubation pulse rate and blood pressure were significantly higher in the direct laryngoscopy group at most observed intervals, indicating greater hemodynamic response. Complications were also significantly more frequent with direct laryngoscopy, with no complication in 88.6% of videolaryngoscopy patients compared with 60.0% of direct laryngoscopy patients (χ²=9.84, p=0.020). Conclusion: Videolaryngoscopy provided significantly better glottic visualization, shorter intubation time, reduced requirement for airway maneuvers, improved hemodynamic stability, and fewer peri-intubation complications compared with conventional direct laryngoscopy. Although first-attempt success was higher with videolaryngoscopy, the difference was not statistically significant. Videolaryngoscopy appears to be a useful and effective technique for endotracheal intubation in school-aged children undergoing general anesthesia.

Background: Adherence to anti-tubercular therapy is essential for successful treatment. Adverse drug reactions and patient- and treatment-related factors may contribute to irregular medication use and unfavourable outcomes. Objectives: To assess treatment adherence, associated factors and outcomes among patients receiving FDC-ATT for drug-sensitive tuberculosis. Methods: A prospective observational study was conducted in the Department of Pulmonary Medicine, Civil Hospital, Ahmedabad, from January to December 2022. Fifty adult patients with drug-sensitive tuberculosis receiving FDC-ATT were evaluated. Demographic and clinical characteristics, treatment adherence, reasons for non-adherence, ADR characteristics and treatment outcomes were assessed during follow-up. Results: The mean age was 38.5 ± 15.9 years; 58% were males and 66% had pulmonary tuberculosis. In the proposed secondary analysis, 42 (84%) patients were adherent and 8 (16%) were non-adherent. ADRs/treatment intolerance accounted for 50% of reasons for non-adherence. Non-adherence was higher among alcohol users (26.7%), patients with comorbidities (26.3%), those developing ADRs within two months (24.1%) and those experiencing moderate/severe ADRs (29.2%). Overall, 58% improved, 28% remained on treatment, 8% defaulted and 6% died. Conclusion: Most patients remained adherent to FDC-ATT; however, treatment-related adverse effects appeared to contribute importantly to treatment irregularity. Early ADR management, individualized counselling and targeted adherence support may improve treatment continuity and outcomes.

Medication adherence is essential for achieving optimal glycaemic control and preventing complications in patients with type 2 diabetes mellitus (T2DM). However, long-term adherence to oral hypoglycaemic agents remains challenging and may be influenced by patient-, medication-, and healthcare-related factors. This study aimed to assess medication adherence among patients with T2DM receiving oral hypoglycaemic agents and to identify factors affecting adherence. Methods: A hospital-based cross-sectional study was conducted over 12 months among 400 patients with T2DM receiving oral hypoglycaemic medications. Participants attending the outpatient and inpatient departments of General Medicine and Endocrinology of Dr. PSIMS & RF were recruited using purposive sampling. Socio-demographic characteristics, clinical details, medication-related factors, and healthcare-related factors were collected using a semi-structured questionnaire. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Data were analysed using Microsoft Excel and IBM SPSS version 21. Descriptive statistics were used to summarise the data. Results: Among the 400 participants, 59% were female and 41% were male, with the largest proportion aged 50–59 years (36%). Most participants were receiving a single prescribed medication (73%), and 48% reported taking medication once daily. Forgetfulness was reported by 17% of participants, while 13% identified medication cost as a factor affecting adherence. Regular follow-up was reported by 77% of participants, whereas 56% reported using alternative medications. MMAS-8 responses demonstrated that forgetfulness, missed doses, travel, perceived disease control, and inconvenience associated with daily medication were important barriers to adherence. Conclusion: Medication adherence among patients with T2DM receiving oral hypoglycaemic agents is influenced by multiple patient-, medication-, and healthcare-related factors. Identification of individual barriers and targeted patient education and counselling may help improve medication adherence and support effective long-term diabetes management.

A medicinally potent dose may be administered transdermally by use of patches that adhere to the skin’s surface. It is necessary to consider the skin’s extensive physicochemical, morphological, and biological characteristics when administering medicinal medications topically for systemic effects. There are less systemic adverse effects and more stable blood level profiles with transdermal medication delivery systems than with other dose forms because of the regulated release of medicinal compounds into the skin. Transdermal application is an easy and pleasant way to provide medication. By bypassing first pass metabolism, it enhances patient compliance and is an improvement over injectables and the oral route. A cutting-edge method of pharmaceutical administration is the transdermal drug delivery system (TDDS).

Background: Liver biopsy remains an important reference standard for histological assessment of diffuse liver diseases, particularly when diagnosis, grading, or staging cannot be established adequately by non-invasive methods. However, hepatic fibrosis may be heterogeneously distributed, resulting in sampling variability and potential underestimation of disease severity. Real-time shear wave elastography (RT-SWE) provides quantitative assessment of liver stiffness and may therefore help identify a region with greater likelihood of clinically relevant fibrosis before biopsy. Aim: To evaluate the role of real-time shear wave elastography in identifying the optimal site for ultrasound-guided liver biopsy in patients with diffuse liver disease and to determine the relationship between shear wave velocity, histological fibrosis stage, and biopsy adequacy. Methods: This retrospective observational study included 100 patients with diffuse liver disease who underwent ultrasound-guided liver biopsy at Government Siddhartha Medical College and General Hospital, Vijayawada, between 2023 and 2026. Pre-biopsy RT-SWE was used to assess liver stiffness at multiple sites in the right hepatic lobe. The biopsy site was selected based on accessibility and the region demonstrating relatively higher stiffness while avoiding vessels, bile ducts and focal lesions. Shear wave velocity was recorded in m/s. Histopathological fibrosis was graded using an appropriate semiquantitative fibrosis staging system. Biopsy length, number of portal tracts and diagnostic adequacy were recorded. Statistical analysis included correlation analysis, analysis of variance and receiver operating characteristic (ROC) analysis. Results: The mean age of patients was 47.6 ± 12.8 years, with male predominance (62%). Metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic viral hepatitis were the commonest underlying conditions. Mean liver stiffness increased progressively with histological fibrosis stage, from 1.42 ± 0.18 m/s in F0–F1 disease to 2.48 ± 0.31 m/s in F4 disease (p<0.001). Significant correlation was observed between biopsy-site shear wave velocity and fibrosis stage (Spearman’s ρ=0.78, p<0.001). Patients in whom the biopsy was obtained from the elastographically stiffer region had a higher proportion of advanced fibrosis detection than those in whom the site was selected using conventional ultrasound alone. A shear wave velocity ≥1.94 m/s demonstrated good diagnostic performance for significant fibrosis (≥F2), with an estimated sensitivity of 90.2%, specificity of 84.6% and area under the ROC curve of 0.93. Conclusion: RT-SWE can identify regional variations in liver stiffness and may assist in selecting an optimal biopsy site in patients with diffuse liver disease. Elastography-guided targeting may reduce sampling error and improve detection of significant and advanced fibrosis while retaining the advantages of minimally invasive ultrasound-guided biopsy.

Background: Magnesium plays an important role in myocardial electrical stability, and reduced serum magnesium may predispose patients with acute myocardial infarction (AMI) to arrhythmias. This study evaluated the association between serum magnesium levels and arrhythmias in patients with AMI. Methods: A hospital-based observational study was conducted among 112 patients with AMI over one year. Patients presenting within 12 hours of symptom onset underwent clinical evaluation, ECG, routine investigations, and echocardiography. Serum magnesium was measured on Days 1 and 5. Patients were monitored for arrhythmias during hospitalization. Results: The mean serum magnesium level increased from 1.88 ± 0.26 mg/dL on Day 1 to 1.98 ± 0.47 mg/dL on Day 5. Arrhythmias occurred in 63 (56.3%) patients. Magnesium levels were significantly lower in patients with arrhythmias than in those without on Day 1 (1.70 ± 0.16 vs. 2.10 ± 0.19 mg/dL) and Day 5 (1.76 ± 0.51 vs. 2.26 ± 0.20 mg/dL; p<0.001). Conclusion: Lower serum magnesium was significantly associated with arrhythmias in AMI.

Background: The optimal pneumoperitoneum pressure in laparoscopic cholecystectomy remains debated, particularly in difficult laparoscopic cholecystectomy and patients with significant cardiopulmonary comorbidity. Aim: To evaluate whether laparoscopic cholecystectomy can be completed without pneumoperitoneum pressure escalation beyond 12 mmHg and to assess the feasibility of pressure reduction in high-risk patients. Methods: This single-center retrospective observational cohort study included 246 consecutive patients undergoing laparoscopic cholecystectomy over the study period. Data were extracted from prospectively maintained hospital records. Pneumoperitoneum was maintained at 12 mmHg as the maximum operating pressure. In selected high-risk patients with significant cardiopulmonary comorbidity, lower pressures were permitted at the discretion of the operating surgeon. Outcomes assessed included operative feasibility, complications, and hospital stay. Difficult laparoscopic cholecystectomy was classified into predictive and intraoperative categories based on established preoperative risk factors and operative findings respectively. Preoperative predictors were derived from established risk factors described in standard surgical literature and textbooks. Study reporting adhered to STROBE recommendations. Results: Mean age was 54.5 ± 17.4 years; 145 patients (58.9%) were female. Comorbidities included 41 patients (16.8%) with hypertension, 18 patients (7.4%) with diabetes, and 26 patients (10.5%) with COPD/asthma. Difficult cases accounted for 205/246 patients (83.2%; 95% CI 78.1–87.4). The high proportion of difficult cases reflects broad predefined difficulty criteria and tertiary-care referral patterns. Predictive difficult cases accounted for 164/246 patients (66.7%). Mean operative time was 62.1 ± 14.9 minutes (95% CI 60.2–64.0), and mean blood loss was 21.9 ± 6.7 mL (95% CI 21.1–22.7). Median hospital stay was 3 days (IQR 2–4). Critical View of Safety was achieved in 240 patients (97.6%). Mean VAS pain scores were 2.51 ± 1.10 at 6 hours, decreasing to 0.24 ± 0.54 at 24 hours. Laparoscopic cholecystectomy was completed in all included patients without escalation of pneumoperitoneum pressure beyond 12 mmHg. In 8 high-risk patients, pneumoperitoneum pressure was reduced to a mean of 10 mmHg without conversion or procedure-related complications. Operative time was significantly longer in difficult cases than non-difficult cases (68.4±12.1 vs 42.3±8.7 min; p<0.001). No major complications (bile duct injury, bile leak) were observed within the study cohort during the 30-day follow-up period. Conclusion: Laparoscopic cholecystectomy was completed in this retrospective cohort without requirement for pressure escalation beyond 12 mmHg, even in difficult cases. In selected high-risk patients, pressure reduction appeared feasible in carefully selected patients with significant cardiopulmonary comorbidity while maintaining operative feasibility; however, larger prospective comparative studies are required for validation.

Background: Postoperative nausea and vomiting (PONV) is a common complication following laparoscopic surgery. This study compared the efficacy of palonosetron–dexamethasone combination with palonosetron or dexamethasone alone for PONV prophylaxis. Materials and Methods: This prospective, randomised, double-blind study included 135 patients undergoing elective laparoscopic abdominal and pelvic surgeries, randomly allocated into three groups (n=45 each). Group PD received palonosetron 0.075 mg with dexamethasone 8 mg, Group P received palonosetron 0.075 mg, and Group D received dexamethasone 8 mg intravenously. PONV incidence, severity and rescue antiemetic requirements were assessed over 24 hours postoperatively. Results: Baseline characteristics were comparable across groups. PONV incidence was significantly lower in Group PD (4.4%) than in Groups P (22.2%) and D (28.9%) at 1 hour (p=0.005). Similar findings were observed at 2 hours (4.4%, 15.6% and 26.7%, respectively; p=0.010). Rescue antiemetic requirements were significantly lower in Group PD at 1 hour (p<0.001) and 2 hours (p=0.010). Differences at 6 hours were statistically insignificant. Conclusion: Palonosetron–dexamethasone combination demonstrated greater efficacy in preventing early PONV and reducing rescue antiemetic requirements compared with either drug alone.

Introduction: Persistent elevation of low-density lipoprotein cholesterol (LDL-C) despite statin therapy remains a common challenge in dyslipidemia management. Bempedoic acid provides an additional lipid-lowering option through inhibition of ATP-citrate lyase. This study evaluated changes in LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) following its addition to stable statin therapy. Materials and Methods: This retrospective comparative study included 60 adults with dyslipidemia receiving stable statin therapy at a government hospital in Telangana. Patients were divided into a bempedoic acid group (n=30), receiving bempedoic acid 180 mg once daily in addition to statin therapy, and a control group (n=30), continuing statin therapy alone. Lipid parameters were assessed at baseline and after 12 weeks. The primary outcomes were absolute and percentage changes in LDL-C and non-HDL-C. Results: Baseline lipid parameters were comparable between the groups. At 12 weeks, mean LDL-C decreased from 129.4±26.1 to 105.2±24.5 mg/dL in the bempedoic acid group, compared with 127.8±25.7 to 125.9±25.1 mg/dL in controls. The percentage reduction was 18.7% versus 1.5%, respectively (p<0.001). Non-HDL-C decreased by 13.3% in the bempedoic acid group compared with 1.2% in controls (p<0.001). No serious adverse events were observed. Conclusion: Addition of bempedoic acid to stable statin therapy was associated with significantly greater reductions in LDL-C and non-HDL-C over 12 weeks compared with statin therapy alone.

Mouth dissolving films are thin oral dosage forms that dissolve quickly when placed in the mouth and can be useful for patients who have difficulty swallowing conventional tablets. Hydrogel-based mouth dissolving films combine the film-forming properties of polymers with the water-absorbing and swelling properties of hydrogels. This review discusses the basic concept of hydrogel-based mouth dissolving films, commonly used polymers and excipients, methods of preparation, drug release behaviour and different evaluation parameters. The review also covers the factors that affect film properties, including polymer concentration, plasticizer level, film thickness, moisture content and drug-polymer interaction. Their use in pediatric, geriatric and patients with swallowing difficulties is also discussed. Current research on natural polymers, biodegradable materials and improved drug delivery approaches is included. The review aims to provide a simple overview of the formulation, evaluation, advantages, limitations and future scope of hydrogel-based mouth dissolving films as an oral drug delivery system.

Background: Hippophae Rhamnoides L. (sea buckthorn) contains diverse phytochemicals and has been investigated for potential neuroprotective effects. The present work evaluated behavioral effects of a hydroalcoholic root extract (CPE) in rodent models relevant to antidepressant-like and anxiety-related activity. Methods: Root material purchased in Jaipur, India, was extracted by Soxhlet extraction using a hydroalcoholic solvent, giving a reported yield of 6.3%. Preliminary qualitative phytochemical tests were reported for resins, saponins, tannins, flavonoids and alkaloids. Behavioral outcomes were extracted from the supplied study record for the forced swim test (FST), tail suspension test (TST), elevated plus maze (EPM), and light–dark transition test (LDT). CPE was administered orally at 200 or 400 mg/kg. The reported sample size was n=6 per group; data were expressed as mean ± SD. Results: CPE at 200 and 400 mg/kg was associated with lower immobility times than vehicle control in the FST (78.0 ± 2.57 and 73.6 ± 1.31 s vs 143.33 ± 6.7 s) and TST (116.0 ± 3.5 and 105.3 ± 4.3 s vs 165.5 ± 5.8 s). In the EPM, open-arm time was 47.0 ± 3.20 and 62.43 ± 7.51 s for CPE 200 and 400 mg/kg, respectively, compared with 12.36 ± 1.66 s for control. Time in the bright chamber in the LDT was 19.0 ± 3.78 and 23.1 ± 1.79 s for CPE 200 and 400 mg/kg, compared with 12.0 ± 0.76 s for control. Conclusion: The supplied results suggest antidepressant-like and anxiety-related behavioral effects of hydroalcoholic H. rhamnoides root extract in rodents. Interpretation is limited by inconsistencies in the source methods and incomplete reporting of ethics identifiers, group allocation, model induction, and cognitive-test numerical results.

Background: Laryngoscopy and tracheal intubation are associated with transient sympathetic stimulation resulting in increases in heart rate and arterial blood pressure. Attenuation of this haemodynamic response is desirable to reduce cardiovascular stress during airway manipulation. Dexmedetomidine, an α2-adrenergic agonist with sympatholytic properties, may provide more effective haemodynamic control than opioids such as fentanyl. The present study compared intravenous dexmedetomidine and fentanyl for attenuation of the haemodynamic response to laryngoscopy and tracheal intubation. Methods: This prospective, randomized, comparative study was conducted in 50 patients belonging to ASA physical status I or II, aged 20–60 years, scheduled for elective surgery under general anaesthesia. Patients were randomly allocated into two groups of 25 each. Group D received dexmedetomidine 1 µg/kg and Group F received fentanyl 2 µg/kg, with both drugs diluted in 20 mL normal saline and administered intravenously over 10 minutes before induction. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation were monitored. Haemodynamic parameters were recorded before induction, at induction, after induction, immediately after intubation, and at 1, 2, 3, 4, 5, 10, and 15 minutes after intubation. Results: The demographic characteristics of the two groups were comparable. Both dexmedetomidine and fentanyl attenuated the haemodynamic response associated with laryngoscopy and tracheal intubation. Heart rate was significantly lower in the dexmedetomidine group at multiple time points from after induction through 10 minutes after intubation, while the groups were comparable at 15 minutes. Systolic blood pressure showed significantly better attenuation with dexmedetomidine at post-intubation and selected subsequent time points. Diastolic blood pressure was significantly lower in the dexmedetomidine group during several measurements between 1 and 5 minutes after intubation. Mean arterial pressure also demonstrated significantly better attenuation with dexmedetomidine at post-intubation and several early post-intubation intervals. No patient required rescue medication or repetition of the study drug. One patient developed hypotension and two developed bradycardia in the dexmedetomidine group after the predefined 15-minute observation period; these events were managed without serious complications. Conclusion: Both dexmedetomidine 1 µg/kg and fentanyl 2 µg/kg administered intravenously over 10 minutes before induction were effective in attenuating the haemodynamic response to laryngoscopy and tracheal intubation. Dexmedetomidine provided more consistent and superior haemodynamic stability than fentanyl, particularly during the early post-intubation period, with no significant serious adverse effects observed during the study period.

Background: Arteriovenous (AV) fistula remains the preferred vascular access for maintenance hemodialysis. Surgical technique, particularly the method of electrocautery used for dissection and haemostasis, may influence endothelial integrity, tissue trauma, and fistula outcomes. Comparative evidence regarding different electrosurgical modalities in AV fistula creation is limited. Methods: This prospective pilot observational study included 25 patients undergoing primary brachiocephalic AV fistula creation at a tertiary care centre over 12 months. Patients were allocated into three groups based on the electrosurgical modality used: monopolar cautery (n = 8), bipolar cautery (n = 8), and Colorado needle electrocautery (n = 9). Allocation was non-randomized and based on surgeon preference. Intraoperative parameters assessed included operative time, blood loss, ease of dissection, and vessel wall thermal injury. Postoperative outcomes included complications and fistula maturation at 6 weeks. Data were analysed descriptively. Results: The Colorado needle group demonstrated the shortest operative time (48 ± 12 minutes) and lowest blood loss (24 ± 8 mL), compared to bipolar (56 ± 7 minutes; 32 ± 10 mL) and monopolar cautery (62 ± 8 minutes; 49 ± 6 mL). Thermal injury was minimal with the Colorado needle, low with bipolar cautery, and moderate with monopolar cautery. Dissection precision was rated highest in the Colorado needle group. Postoperative complications were infrequent across all groups, with a slightly higher incidence in the monopolar cautery group. Fistula maturation at 6 weeks was observed in 88.9% of patients in the Colorado needle group, 87.5% in the bipolar group, and 75% in the monopolar cautery group. Given the small sample size and non-randomized design, results should be interpreted cautiously. Conclusion: The Colorado needle electrocautery demonstrated favourable intraoperative characteristics, including improved precision, reduced thermal injury, and lower blood loss, with a trend toward higher fistula maturation rates. Bipolar cautery remains a reliable alternative with effective haemostasis. These findings are preliminary and require validation through larger, randomized controlled studies.

Introduction: Postoperative pain following below-knee orthopaedic surgery can impair comfort and recovery. Ultrasound-guided combined popliteal and saphenous nerve blockade offers targeted analgesia and may reduce systemic analgesic requirements compared with intramuscular diclofenac. Aim: To compare ultrasound-guided combined popliteal and saphenous nerve blocks with intramuscular diclofenac for postoperative analgesia following below-knee orthopaedic surgery. Methods: This two-arm, quasi-experimental comparative study was conducted over 18 months among 70 consenting adults aged over 18 years with American Society of Anesthesiologists physical status I or II. Patients were allocated equally to Group B and Group D, with 35 participants each. All underwent surgery under spinal anaesthesia. At surgery completion, Group B received ultrasound-guided combined popliteal and saphenous nerve blocks, whereas Group D received intramuscular diclofenac 75 mg. Patients were monitored for 24 hours. The primary outcome was time to first rescue analgesia. Secondary assessments included total diclofenac consumption, block duration, Numerical Rating Scale pain scores, patient satisfaction, complications, and haemodynamic parameters. Results: Baseline demographic characteristics and physical status were comparable between groups. Time to first rescue analgesia differed significantly between groups (p<0.001). In Group B, 71.4% required rescue analgesia at 12–18 hours and 20.0% at 18–24 hours; all Group D patients required rescue analgesia within 12 hours. Recorded block duration was up to 12 hours in 77% and 12–16 hours in 23%. Total diclofenac consumption was significantly lower in Group B (p<0.001): 77.1% received 75 mg and 22.9% received 150 mg, whereas 37.1% of Group D received 150 mg and 62.9% received 225 mg. At two hours, all Group B patients and 85.7% of Group D patients were pain-free. At 24 hours, severe pain affected 48.6% versus 77.1%, respectively (p=0.005). Complication profiles favoured Group B (p=0.002), with no complications in 94.3% versus 60.0%. Nausea occurred in 5.7% versus 20.0%, while epigastric discomfort occurred only in Group D (20.0%). Good or excellent satisfaction was reported by all Group B patients, compared with 45.7% in Group D (p<0.001). Haemodynamic parameters remained within clinically acceptable ranges. Conclusion: Ultrasound-guided combined popliteal and saphenous nerve blockade provided longer postoperative analgesia, reduced diclofenac requirements, and improved satisfaction compared with intramuscular diclofenac. However, substantial severe pain at 24 hours highlights the need for continued pain assessment and supplementary multimodal analgesia. Larger studies are required to confirm effectiveness and assess uncommon adverse events. Interpretation should consider the small sample, limited postoperative follow-up, and uncertainty regarding allocation methods, as the manuscript describes both quasi-experimental design and random assignment procedures.

Introduction: Sleep quality plays an important role in cognitive function, memory, concentration, and learning. This study assessed sleep quality and its association with academic performance among undergraduate MBBS students. Materials and Methods: A cross-sectional observational study was conducted among 100 MBBS students at a tertiary-care teaching institution in Western Gujarat over six months. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and academic performance was evaluated using examination marks. Results: Among 100 students, 65% had poor sleep quality and 35% had good sleep quality. Mean examination marks were higher among students with good sleep quality than those with poor sleep quality (72.4 ± 8.2% versus 66.8 ± 9.1%). A negative correlation between global PSQI scores and academic performance was reported (ρ = −0.32, p = 0.001). Conclusion: Poor sleep quality was common among undergraduate medical students and was associated with lower academic performance. Promoting healthy sleep habits may support students’ academic achievement and overall well-being.

Background: The median nerve’s communicating branches in the forearm and its terminal branching pattern at the wrist show substantial anatomical variability with direct relevance to electrodiagnosis, forearm surgery, and the safety of carpal tunnel release. Combined, statistically compared cadaveric data addressing these two domains together remain scarce for Central India. Methods: Thirty embalmed cadavers (60 upper limbs) were bilaterally dissected at a single institution. The presence, level, length, and width of any Martin–Gruber anastomosis; the presence and origin of the palmar cutaneous branch; and the terminal branching pattern of the median nerve, classified according to Lanz, were recorded using a standardised proforma, together with overall nerve morphometry. Findings were compared between sides and between sexes using the chi-square or Fisher’s exact test (categorical variables) and the independent-samples t-test (continuous variables). Results: A Martin–Gruber anastomosis was present in 4 of 60 limbs (6.7%) — 3 of 30 right limbs (10.0%) and 1 of 30 left limbs (3.3%) — with a mean length of 54.62 ± 3.48 mm and width of 1.75 ± 0.17 mm. The palmar cutaneous branch was identified in 55 of 60 limbs (91.7%), arising a mean of 4.66 ± 1.56 cm proximal to the wrist crease. The standard (Lanz Group I) terminal branching pattern was seen in 76.7% of limbs, with Groups II, III and IV accounting for 13.3%, 5.0%, and 5.0% respectively. Mean total nerve length was 32.38 ± 3.30 cm and mean mid-forearm diameter was 3.57 ± 0.54 mm, with no significant correlation between the two (r = -0.005, p = 0.971). No statistically significant difference between sides or sexes was found for any parameter (p > 0.05 throughout). Conclusion: Communicating branches and non-standard terminal branching patterns of the median nerve, while individually uncommon, together affected close to one-third of limbs in this Central Indian cadaveric sample, with no significant side or sex difference — findings relevant to electrodiagnosis, forearm surgery, and carpal tunnel release safety.

Background: Total laparoscopic hysterectomy (TLH) is increasingly used for the management of benign gynaecological conditions because of its minimally invasive nature and favourable postoperative recovery. However, it may require greater surgical expertise and longer operative time than total abdominal hysterectomy (TAH). This study compared the safety and perioperative outcomes of TLH and TAH. Methods: This comparative study included women undergoing hysterectomy for benign gynaecological conditions. Patients were divided into TLH and TAH groups and compared with respect to baseline characteristics, operative time, intraoperative blood loss, intraoperative complications, and postoperative analgesic and antibiotic requirements, duration of hospital stay, postoperative complications, and patient satisfaction. Results: The baseline demographic and clinical characteristics, including age, BMI, uterine size, and indications for surgery, were comparable between the groups. Fibroid uterus was the most common indication. TLH was associated with significantly longer operative time than TAH (98.72 ± 21.36 vs. 74.38 ± 16.44 minutes; p<0.0001), but significantly lower intraoperative blood loss (118.56 ± 46.38 vs. 286.44 ± 84.72 mL; p<0.001). Intraoperative complication rates were comparable between groups (6% vs. 6%; p=0.51), with conversion to laparotomy required in 6% of TLH cases. Prolonged analgesic requirement was significantly lower following TLH (14% vs. 36%; p=0.03). Hospital stay was also significantly shorter with TLH (3.42 ± 1.16 vs. 6.18 ± 1.94 days; p<0.0001). Patient satisfaction was significantly higher following TLH (94% vs. 78%; p=0.02). Conclusion: TLH provides significant advantages over TAH in terms of reduced blood loss, postoperative analgesic requirement, shorter hospital stay, and greater patient satisfaction, despite a longer operative time. With appropriate patient selection and adequate surgical expertise, TLH represents an effective and safe approach for hysterectomy in women with benign gynaecological conditions.

Background: Anger has a significant impact on people’s mortality and is a major contributing cause to beatings and traffic accidents. The World Health Organization’s statistics show that beatings and car crashes are the most common causes of trauma events. An rise in violence has a significant influence in occurrences and is an effective risk factor for traumatic and mental health impairments. The purpose of this study was to examine the association between anger management and post-event mental health in trauma patients. Method: From July 2025 to June 2026, the Murli Bhedi Jha Community Health and Trauma Center in Araria Sangram, Jhanjharpur, Madhubani, Bihar, conducted a cross-sectional study on 214 patients who were chosen using the available sampling method and systematic randomization. The General Mental Health Questionnaire and Novaco’s Anger Control Questionnaire, a common questionnaire, were used to evaluate mental health and compare anger control, respectively. The independent t-test and Pearson correlation coefficient were used in SPSS program (Version 18) to examine the gathered data. Statistical significance was defined as a p-value of less than 0.05. Results: The demographic parameters revealed that the patients’ mean age was 32.65±8.318 years. 120 and 94 of the 214 patients who took part in this study suffered injuries from beatings and car crashes, respectively. Statistical research revealed a strong correlation between these respondents’ mental health and their ability to regulate their anger. Conclusion: Injuries brought on by an upsurge in beatings and traffic accidents pose a serious risk to the populace and do irreversible harm to the nation’s economy. These results demonstrated a strong correlation between mental health and anger management in the two categories of beatings and traffic accidents. Consequently, the creation of anger management training programs helps lessen the harm that rage does to individuals.

Background: Trauma is the most common cause of death for people under 50 out of the three main reasons. The impact of microscopic hematuria on the diagnosis of abdominal injuries is unknown. Examining the predictive significance of microscopic hematuria in the assessment of abdominal organ damage after physical trauma was the aim of this investigation. Methods: This cross-sectional study included all blunt trauma patients admitted between May 2025 and April 2026 to the Murli Bhedi Jha Community Health and Trauma Center in Araria Sangram, Jhanjharpur, Madhubani, Bihar. Those between the ages of 18 and 65 who had blunt abdominal injuries were included; those with a history of renal illness, macroscopic hematuria, or an unstable hemodynamic situation were excluded. Intravenous contrast material with a delayed nephrogram phase was the gold standard for performing a spiral CT scan of the abdomen and pelvis. The SPSS software was used to analyze the data. McNemar’s test and the Chi-square test were applied. (P<0.05) was considered significant. Results: This study included one hundred blunt trauma patients. Microscopic hematuria was much more common in individuals with intra-abdominal organ damage than in other patients (71.4% versus 38.9%, P<0.001). The sensitivity and specificity of microscopic hematuria in detecting intra-abdominal organ damage were 53.84% and 77.14%, respectively. The overall accuracy of the test was 62.0% (Kappa coefficient=0.22, P<0.001). Conclusion: Due to its poor accuracy in diagnosing injury to intra-abdominal organs, microscopic hematuria can be used as an auxiliary diagnostic tool but should not be used as the primary method.

Background: Chronic obstructive pulmonary disease (COPD) is a systemic condition with numerous extrapulmonary complications. However, studies investigating the connection between COPD and renal impairment are few. The purpose of this study was to determine the relationship between estimated glomerular filtration rate (eGFR) and chronic obstructive pulmonary disease assessment test (CAT) score, modified medical research council (mMRC) scale, 6-minute walking test (6MWT), and postbronchodilator forced expiratory volume (FEV1) in COPD, as well as to compare the reduction in eGFR across GOLD stages. Methods: Between March 2026 and August 2026, 60 stable COPD patients attending the outpatient department (OPD) were selected at random. Participants underwent spirometry, Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging, CAT score, mMRC grading, and a 6MWT. Serum creatinine was measured, and eGFR was computed. The interpretation was obtained by comparing the eGFR and GOLD stage findings with various parameters. Results: Among patients with normal eGFR, the average mMRC score was 2.00 ± 0.86, 6MWD was 324.98 ± 47.08 m, and CAT score was 14.23 ± 6.09. In patients with lowered eGFR, the average mMRC score was 2.32 ± 1.17, 6MWD was 278.30 ± 75.98 m, and CAT score was 19.38 ± 9.05. The results were statistically significant (p = 0.0145, p < 0.0001, and p < 0.0001, respectively). There was a negative association between eGFR and GOLD stages, with a Pearson correlation coefficient of -0.014. Conclusion: In stable COPD patients with higher GOLD stages, eGFR levels were reduced. Patients with lower eGFR had a higher mMRC grade, higher CAT score, and lower 6MWD. To determine renal involvement in patients with stable COPD, routine eGFR measurement is recommended.

Background: Candida isolated from immunocompromised patients must be correctly identified as species because the activity and susceptibility interpretive criteria vary by species. Objective: To typify Candida isolates using internal transcribed spacer (ITS) sequencing, and to compare the identification with the standard phenotypic methods and to investigate species-specific antifungal susceptibility. Methods: One isolate of Candida from each of 180 immunocompromised adults was used in a hospital-based cross sectional laboratory study. Colony morphology and biochemical identification were compared to ITS sequencing, while fluconazole, micafungin and amphotericin B MICs were determined by reference broth microdilution. Susceptibility categories were based on species appropriate criteria and where required, provisional guidance. Results: Candida albicans accounted for 62/180 isolates (34.4%), followed by C. tropicalis (26.7%), C. parapsilosis (18.9%), C. glabrata (12.2%), C. auris (5.6%), and C. krusei (2.2%). Phenotypic and molecular species identification matched in 163/180 isolates (90.6%) with 6/10 C. auris isolates being misidentified or not resolved using the standard workflow. Fluconazole resistance was found in 40/180 isolates (22.2%) (9/10 C. auris and 12/48 C. tropicalis); micafungin resistance was found in 5/180 (2.8%). Higher fluconazole resistance was found in patients with prior azole exposure (36.8% vs 13.4%, p<0.001). Molecular identification took 21.4 ± 5.9 hours compared with 44.6 ± 12.1 hours for routine identification (p<0.001). Conclusions: ITS-based species identification confirmed clinically relevant species identification including C. auris and assisted with susceptibility interpretation in an immunocompromised patient population.

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease, and the choice of dissecting instrument influences operative efficiency and patient outcomes. Aim: To compare the L-hook and Maryland forceps as dissecting instruments in laparoscopic cholecystectomy with respect to intraoperative and postoperative outcomes. Materials and Methods: This prospective comparative study was conducted in the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur, from May 2025 to June 2026. A total of 100 patients undergoing elective laparoscopic cholecystectomy were divided equally into Group A (L-hook, n=50) and Group B (Maryland forceps, n=50). Operative time, intraoperative bleeding, stone spillage, bile duct injury, postoperative pain (Visual Analog Scale), hospital stay, and return to normal activity were recorded and compared using the Chi-square test and independent Student’s t-test, with p<0.05 considered statistically significant. Results: The mean operative time was significantly shorter in the L-hook group than in the Maryland forceps group (74.42±28.83 vs 98.50±27.06 minutes; p<0.001). Postoperative pain scores (3.38±1.19 vs 4.78±0.95), duration of hospital stay (3.10±0.64 vs 3.66±0.79 days), and time to return to normal activity (1.96±0.49 vs 2.46±0.76 days) were also significantly lower in the L-hook group (p<0.001 for all). Intraoperative bleeding and stone spillage were comparable between the groups, and no common bile duct injury or postoperative bile leak occurred in either group. Conclusion: The L-hook provides significantly shorter operative time, reduced postoperative pain, and faster recovery compared with Maryland forceps, with a comparable safety profile, supporting its use as an efficient primary dissecting instrument in elective laparoscopic cholecystectomy.

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities that substantially increases the risk of type 2 diabetes mellitus and cardiovascular disease. Rapid urbanization, sedentary lifestyles, obesity, and unhealthy dietary practices have contributed to its increasing burden. This study assessed the prevalence of MetS and its association with lifestyle and dietary risk factors among adults attending an urban health centre. Materials and Methods: This cross-sectional observational study included 110 adults attending an urban health centre. Sociodemographic characteristics, lifestyle behaviours, dietary practices, anthropometric measurements, blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol were assessed. MetS was diagnosed using modified NCEP ATP III/harmonized criteria with Asian-specific waist circumference cut-offs. Associations were evaluated using appropriate statistical tests and multivariable logistic regression. Results: The mean age was 44.6 ± 13.2 years, and 52.7% were male. MetS was present in 39 (35.5%) participants. Abdominal obesity (53.6%) was the most frequent component, followed by reduced HDL-C (51.8%), elevated triglycerides (43.6%), elevated blood pressure (40.0%), and elevated fasting glucose (38.2%). MetS was significantly associated with inadequate physical activity (74.4% vs 45.1%; p=0.003), high sedentary behaviour (64.1% vs 39.4%; p=0.013), overweight/obesity (79.5% vs 49.3%; p=0.002), and several unhealthy dietary practices. On multivariable analysis, overweight/obesity (AOR 3.12; p=0.022), inadequate physical activity (AOR 2.68; p=0.039), and frequent fried-food consumption (AOR 2.54; p=0.048) were independent predictors of MetS. Conclusion: MetS was common among urban adults and was strongly associated with modifiable lifestyle and dietary factors. Routine screening, weight management, regular physical activity, and dietary modification may help reduce future cardiometabolic risk.

Background: A parental history of type 2 diabetes mellitus (T2DM) may be associated with early alterations in body composition and cardiac autonomic regulation before the development of overt diabetes. This study compared Anthropometric parameters and heart rate variability (HRV) between normotensive, non-diabetic offspring of diabetic parents and offspring of non-diabetic parents. Methods: This cross-sectional comparative study included 70 age- and sex-matched normotensive, non-diabetic participants, comprising 35 offspring of diabetic parents (cases) and 35 offspring of non-diabetic parents (controls). Anthropometric parameters included body mass index (BMI)kg/(m²⁾, waist–hip ratio, thigh circumference(cms), waist circumference(cms)and body-fat percentage.  frequency domain parameters [ LF power in normalized units (LFnu), HF power in normalized units (HFnu), LF/HF ratio, total power (TP (ms²))), absolute LF power (ms²), and absolute HF power((ms²),] &time domain parameters (mean RR interval(ms), SDRR (ms), and RMSSD (ms)], of HRV was assessed using lead-II ECG. HRV & Anthropometric parameters between two groups were assessed using an unpaired t-test, and Pearson’s correlation was used to examine association between Anthropometric and HRV parameters. Results: offsprings of diabetic parents had significantly higher BMI (23.3 ± 2.2 vs. 22.1 ± 2.4 kg/m², p = 0.035), waist–hip ratio (0.90 ± 0.02 vs. 0.86 ± 0.04, p = 0.004), and thigh circumference (51.6 ± 4.4 vs. 48.69 ± 4.6 cm, p = 0.008). LF power in normalized units was significantly higher in cases (49.2 ± 12.9 vs. 41.5 ± 14.38, p = 0.021), while other HRV indices did not differ significantly. BMI correlated positively with LF (nu) and LF/HF ratio and negatively with HF (nu), heart rate(bpm), and mean RR (ms). Conclusion: Offspring of diabetic parents demonstrated differences in selected Anthropometric measures and LF (nu), with BMI kg/m²showing multiple associations with HRV.

Aim: To evaluate the clinical profile, associated factors especially gastrointestinal dysfunction and medical management of oral aphthous ulcers. Methods: This prospective observational study was conducted over 15 months at a tertiary care centre, enrolling 200 patients aged ≥18 years with oral aphthous ulcers. Patients underwent detailed clinical history-taking and oral examination, and were categorized by demographic profile, addiction history, comorbidities, etiological factors, symptomatology, and treatment modality. Follow-up assessments were performed at 1 week, 2 weeks, and 1 month. Results: The cohort comprised 51% males and 49% females, with 54% aged 18–30 years. Tobacco usage was present in 94% of those with history of addiction. Leading etiological factors were constipation, gastrointestinal dysfunction, and iron deficiency anemia. Common comorbidities included diabetes mellitus and hypertension. Pain while chewing and burning sensation were the predominant symptoms, and 56% of patients experienced 1–2 attacks annually. Multivitamin supplementation, frequently combined with topical steroids, was the mainstay of treatment. Complete resolution occurred within 1 week in 60.5% of patients; delayed healing (up to 1 month) was more common among patients with diabetes mellitus. Conclusion: Oral aphthous ulcers predominantly affect young adults and are influenced by a combination of gastrointestinal, nutritional, and lifestyle factors. Multivitamin supplementation with topical corticosteroids remains an effective first-line strategy, while comorbidities such as diabetes may prolong healing, warranting an integrated management approach.

Background: Allergic rhinitis, nasal polyposis, and bronchial asthma are increasingly regarded as manifestations of a unified inflammatory airway disorder. The concept of “Unified Airway Disease” supports assessment of both upper and lower airway involvement in patients with allergic respiratory disease. Aim: To evaluate the clinical correlation of allergic rhinitis with nasal polyposis and bronchial asthma and to assess selected demographic and clinical characteristics among patients presenting with allergic rhinitis. Methods: This observational cross-sectional study included 100 patients aged ≥18 years diagnosed with allergic rhinitis who attended a tertiary care teaching hospital in Saurashtra, Gujarat for 2 years. Results: Males constituted 54% of the study population and females 46%. Patients aged 18–40 years constituted 69% of the cohort. Persistent allergic rhinitis accounted for 59% of patients. Nasal polyps were reported in 56% of patients. Pulmonary function testing demonstrated obstructive lower airway findings in 26% of patients. Conclusion: A substantial proportion of patients with allergic rhinitis had concomitant nasal polyposis and obstructive lower airway disease. The findings support the unified airway concept and highlight the value of routine nasal endoscopy and consideration of pulmonary function assessment in long standing patients with allergic rhinitis.

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammatory disease of the middle ear characterized by persistent or recurrent ear discharge through a perforated tympanic membrane. Local bacteriological profiles and antimicrobial susceptibility patterns may vary over time and between regions, making periodic surveillance clinically relevant. Aim: To study the bacteriological profile and antimicrobial susceptibility pattern of ear discharge in adult patients who have not used medication. Method: A prospective observational cross-sectional study was conducted, including sixty patients aged more than 18 years with untreated tubo-tympanic CSOM. Ear discharge samples were collected under aseptic conditions and subjected to Gram staining and aerobic culture. Results: Pseudomonas aeruginosa was the predominant isolate in 31 cases (51.7%), showing the highest susceptibility to meropenem (100%) and imipenem (93.5%), with lower susceptibility to ciprofloxacin (45.2%) and levofloxacin (35.5%). Staphylococcus aureus was found in 13 cases (21.7%), showing maximum susceptibility to linezolid (100%), clindamycin (92.3%), and gentamicin (92.3%), while resistance was highest to penicillin G (69.2%) and ciprofloxacin (61.5%). Conclusion: Reduced susceptibility to commonly used fluoroquinolones highlights the importance of culture-directed treatment, rational antimicrobial use, periodic surveillance of local resistance patterns, and the use of adjuvant methods like regular aural toileting and acetic acid ear drops.

Background: Gartland type III supracondylar fractures of the humerus are common displaced elbow injuries in children requiring stable fixation to achieve satisfactory functional and cosmetic outcomes. Although crossed medial-lateral pinning provides biomechanical stability, it carries a risk of iatrogenic ulnar nerve injury. Lateral-entry pinning avoids medial pin placement but may offer comparatively less stability. This study compared the clinical, radiological, and functional outcomes of the two fixation techniques. Methods: This comparative observational study included 52 children aged 2–12 years with Gartland type III supracondylar fractures of the humerus treated with closed reduction and percutaneous Kirschner wire fixation at the Department of Orthopaedics, Medical College Kota. Twenty children underwent lateral-entry pinning, while 32 underwent crossed medial-lateral pinning. Patients were followed for a mean duration of 17.53 months. Outcomes assessed included fracture union, loss of elbow range of motion, change in carrying angle, complications, and functional results according to the Mitchell and Adams criteria. Results: The mean age of the study population was 5.67 years, and 73.1% were boys. All fractures united radiologically, and no patient developed cubitus varus deformity. The mean loss of elbow range of motion was 9.2° in the lateral-pinning group and 7.2° in the crossed-pinning group (p = 0.204). The mean loss of carrying angle was 3.3° and 2.5°, respectively (p = 0.345). Excellent functional outcomes were observed in 70.0% of children treated with lateral pinning and 81.3% of those treated with crossed pinning, while the remaining children in both groups had good outcomes; no poor outcomes were recorded. The difference in functional outcome was not statistically significant (p = 0.366). Pin-tract infection occurred in five patients (9.6%). Iatrogenic ulnar nerve palsy occurred in one patient (5.0%) in the lateral-pinning group and three patients (9.4%) in the crossed-pinning group. All iatrogenic nerve palsies recovered completely. Conclusion: Both lateral-entry and crossed medial-lateral pinning provided satisfactory functional and radiological outcomes in children with Gartland type III supracondylar humerus fractures. Although crossed pinning showed numerically better preservation of elbow motion and carrying angle, the differences were not statistically significant. Lateral-entry pinning remains an effective alternative, particularly when medial pin placement poses a potential risk to the ulnar nerve.

This prospective study evaluated laparoscopic TEP mesh repair for lumbar hernia in 10 patients. Most patients had primary and superior lumbar hernias. The procedure had a mean operative time of 92.5 minutes, low blood loss, mild postoperative pain, and a hospital stay of about 3 days. Minor complications included seroma and hematoma, with no major complications, infections, or conversions to open surgery. No recurrence was observed during an average 8.6-month follow-up. Overall, TEP repair appeared feasible and safe in selected patients, although larger studies with longer follow-up are needed.