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.

Background: Sepsis-induced myocardial dysfunction (SIMD) is an under-recognised cause of morbidity and mortality in sepsis. Data from Indian populations are limited. The current study aimed to evaluate myocardial dysfunction by 2D echocardiography in sepsis and correlate it with NT-proBNP, hospital stay, and mortality. Methods: This cross-sectional observational study was conducted in the Medicine wards and ICU of a tertiary care centre in South Gujarat from August 2025 to April 2026. We enrolled 100 adults with sepsis (Sepsis-3 criteria) using purposive sampling after written informed consent. Patients with cirrhosis, chronic kidney disease, cardiac disease, non-sinus rhythm, BMI ≥30 kg/m², or malignancy were excluded. We analysed data using SPSS 26 with the chi-square test. Results: Mean age was highest in the 51–60-year group, and 62% were male. Echocardiographic abnormalities were present in 72% of patients, mainly diastolic (52%) and systolic (48%) dysfunction. NT-proBNP was elevated in 74%. Overall mortality was 28%. Mortality was 36.1% with abnormal echocardiography versus 7.1% with normal findings (p = 0.008). Elevated NT-proBNP was associated with hospital stay beyond 14 days (p = 0.001). Abnormal echocardiography (aOR 4.8), elevated NT-proBNP (aOR 3.9), lactate >2 mmol/L (aOR 5.6), and acute kidney injury (aOR 2.6) independently predicted mortality. Conclusion: Myocardial dysfunction is common in sepsis and is associated with higher mortality and prolonged stay. Echocardiography combined with NT-proBNP aids early risk stratification.

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.

Naproxen, a Biopharmaceutics Classification System (BCS) Class II non-steroidal anti-inflammatory drug (NSAID), shows dissolution-rate-limited absorption owing to its poor aqueous solubility. This study compared three hydrophilic natural gums – guar gum (GG), xanthan gum (XG) and gum acacia (GA) – as carriers for naproxen solid dispersions. Twenty-seven batches were prepared by crossing three carriers, three techniques (solvent evaporation, fusion and kneading) and three drug-to-polymer ratios (1:1, 1:2 and 1:3 w/w). Drug content was determined for all batches, and a representative eleven-batch panel was evaluated for equilibrium solubility (water and pH 6.8 phosphate buffer) and USP Apparatus II dissolution. The optimised batch was characterised by Fourier-transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) and stored for 90 days at 40 °C/75% relative humidity. Drug content ranged from 97.2% to 99.1%, and every dispersion evaluated improved solubility and dissolution relative to pure naproxen (p < 0.001). Guar gum prepared by solvent evaporation at 1:3 (GG-SE3) was best, releasing 94.82 ± 3.1% in 60 min against 28.6 ± 1.8% for the pure drug, with 4.6-fold higher buffer solubility (0.543 vs 0.118 mg/mL); XG-SE3 and GA-SE3 released 91.6% and 88.4%. FTIR band shifts indicated drug–polymer hydrogen bonding, and the DSC enthalpy of fusion fell from 128.6 J/g to < 5 J/g, consistent with a marked loss of crystallinity. After 90 days, changes in drug content, release and solubility were not significant (p > 0.05). Natural gums, particularly guar gum, are inexpensive, biocompatible carriers that markedly improve the in vitro dissolution of naproxen; in vivo and long-term stability studies are warranted.

Background: Magnetic resonance imaging (MRI) is an important diagnostic modality for evaluating traumatic and non-traumatic ankle and foot pathologies because of its ability to provide detailed assessment of osseous, ligamentous, tendinous, and other soft-tissue abnormalities. It also plays a significant role in treatment planning when clinical examination and radiography are inconclusive. Methods: This observational study included 62 patients with traumatic and non-traumatic ankle and foot pathologies who underwent MRI. Demographic characteristics, clinical presentation, aetiology, principal MRI diagnoses, joint involvement, ligamentous and osseous abnormalities, and the impact of MRI findings on management were analysed. Associations between aetiology and MRI findings were also evaluated. Results: The mean age of the study population was 36.68 ± 13.38 years, and males constituted 58.1% of patients. Traumatic conditions accounted for 61.3% of cases, with sports injuries (22.6%) and twisting injuries (19.4%) being the most common mechanisms. Lisfranc fracture was the most frequent clinical referral diagnosis (19.4%). MRI revealed isolated ligamentous injury in 29.0% of patients, combined ligament and bone injury in 19.4%, degenerative changes in 14.5%, tendinopathy in 14.5%, isolated fracture in 12.9%, and plantar fascia pathology in 9.7%. The tibiotalar joint was most frequently involved (51.6%). Osseous abnormalities were observed in 58.1% of patients, while ligamentous abnormalities were identified in 48.4%. Ligamentous injury was significantly more frequent in traumatic than non-traumatic cases (68.4% vs. 16.7%; p < 0.001). MRI influenced or refined clinical management in 64.5% of patients, including modification of conservative treatment, surgical planning, and image-guided procedures. Conclusion: MRI is a valuable problem-solving modality for evaluating traumatic and non-traumatic ankle and foot pathologies. Its ability to detect occult fractures, characterize ligamentous and soft-tissue injuries, distinguish traumatic from chronic degenerative conditions, and guide individualized treatment supports its use when clinical examination or radiography is inconclusive.

Background: Carpal Tunnel Syndrome (CTS) is a common condition caused by compression of the median nerve at the wrist. It leads to symptoms such as pain, numbness, and tingling in the hand. These symptoms are often worse at night and can disturb normal sleep. Aim of the study: A Study of Association of Sleep Quality in Individuals with Carpal Tunnel Syndrome. Procedure: A cross-sectional study was conducted on individuals diagnosed with CTS. Participants were selected based on inclusion and exclusion criteria. Sleep quality was assessed using a standardized questionnaire such as the Pittsburgh Sleep Quality Index (PSQI). Results: The study findings showed that a majority of individuals with CTS experienced poor sleep quality. Increased pain intensity was associated with greater sleep disturbance. Night-time symptoms such as tingling and numbness were found to significantly affect sleep. Statistical analysis revealed a positive association between CTS severity and poor sleep quality. Individuals with severe symptoms reported more disturbed sleep patterns. Conclusion: The study concludes that sleep quality is significantly affected in individuals with Carpal Tunnel Syndrome. There is a strong association between symptom severity and sleep disturbance. Addressing sleep issues should be an important part of CTS management to improve overall quality of life.

Background: Volar Barton fractures are unstable intra-articular fractures of the distal radius associated with volar displacement of the radiocarpal joint. Achieving stable fixation and restoring articular congruity are essential for optimal functional recovery. Variable-angle locking plates allow flexible screw positioning and provide stable fixation of the volar marginal fragment. This study evaluated the functional and radiological outcomes of volar Barton fractures treated with variable-angle locking plate fixation. Materials and Methods: This prospective, hospital-based interventional study was conducted in the Department of Orthopaedics, Government Medical College, Kota, Rajasthan, India, from June 2024 to May 2025. A total of 46 patients aged 18–60 years with closed, isolated volar Barton fractures underwent open reduction and internal fixation using a variable-angle locking plate through the modified Henry approach. Functional outcomes were assessed at six months using the Disabilities of the Arm, Shoulder and Hand (DASH) score and Gartland and Werley demerit criteria. Radiological outcomes were evaluated using the Sarmiento modification of Lindström criteria. Postoperative complications and the relationship between radiological and functional outcomes were also assessed. Results: The mean age of the patients was 36.8 ± 10.23 years, and 73.9% were male. Road traffic accidents accounted for 76.1% of injuries. At final follow-up, the mean DASH score was 13.79 ± 5.49, while the mean Gartland and Werley score was 2.59 ± 2.31. According to Gartland and Werley criteria, excellent, good, and fair functional outcomes were observed in 67.4%, 28.3%, and 4.3% of patients, respectively, with 95.7% achieving excellent or good outcomes. Radiological outcomes were excellent in 28.3%, good in 54.3%, and fair in 17.4% of patients. Fair radiological outcomes were associated with significantly higher DASH and Gartland and Werley scores compared with good radiological outcomes (p = 0.001 for both comparisons). No complications were recorded in 89.1% of patients. Superficial wound infection and hypertrophic scarring occurred in 4.3% each, while complex regional pain syndrome occurred in 2.2%. No non-union, malunion, or implant failure was reported. Conclusion: Variable-angle locking plate fixation of volar Barton fractures resulted in favourable functional and radiological outcomes at six months, with most patients achieving excellent or good functional recovery. Fair radiological outcomes were associated with significantly poorer functional scores. Variable-angle locking plate fixation appears to be an effective treatment option for these unstable fractures; however, larger comparative studies with longer follow-up are required to validate these findings.

Background: Left ventricular ejection fraction (LVEF) is the backbone of the classification and management of heart failure with reduced ejection fraction (HFrEF) and the prognostic gradient across the reduced-EF range is clinically heterogeneous. Study Hypothesis: Baseline LVEF is associated with 1-year mortality and heart failure hospitalization in adults with HFrEF. Methods: This was a prospective observational cohort of 312 consecutive adults with symptomatic HFrEF and LVEF ≤40%. Participants were categorized as LVEF ≤25%, 26–30%, 31–35%, and 36–40%. The main outcome was a composite of all-cause mortality or unplanned heart-failure hospitalization at 1 year. Cox proportional-hazards models were used to identify independent predictors. Results: Mean age was 61.8 ± 11.4 years, 71.5% were men, and mean LVEF was 29.7 ± 6.1%. The primary endpoint occurred in 107 patients (34.3%). Event rates decreased progressively across LVEF categories: 48.8%, 38.9%, 25.6%, and 17.2%, respectively (p<0.001). The rate of one-year mortality was 14.4%, and 27.2% had at least one hospitalization for heart failure. For every 5 percentage-point increase in LVEF, the risk of the primary endpoint was reduced by 26% (adjusted hazard ratio 0.74, 95% CI 0.62–0.88; p=0.001) after accounting for age, systolic blood pressure, renal function, natriuretic peptide concentration, New York Heart Association functional class, ischemic etiology, and guideline-directed therapy. Higher risk was identified independently by LVEF ≤25%, eGFR < 60 mL/min/1.73 m² and NYHA class III–IV. Conclusion: In HFrEF, LVEF was gradedly associated with worse 1-year outcomes and was an independent predictor of outcomes over major clinical covariates.

Background: The Achilles tendon, the largest and strongest tendon in the human body, is nevertheless one of the tendons which most commonly undergoes a complete subcutaneous tear. Achilles tendon ruptures are especially common in middle aged men who occasionally participate in sport. Even though Achilles tendon ruptures are frequent, up to 25% of acute injuries are misdiagnosed, and present as chronic injuries. Methods: This is an original research article about surgical management of chronic Achilles tendon ruptures by minimally invasive Achilles tendon reconstruction with tendon graft. Results: The optimal surgical procedure is still debated, however, less invasive peroneus brevis reconstruction technique and free hamstring autograft provide good functional results. Conclusion: The management of chronic ruptures is more demanding than acute tears, because of the retraction of the tendon ends, and the gap makes primary repair impossible. Wound complications and infections are frequent after open procedures. Minimally invasive treatments provide good functional results and lower complications rate. In chronic tears of the Achilles tendon, with a gap of at least 6 cm, free tendon grafts allow predictable return to sport and acceptable recovery function.

Background: Fingertip amputations are severe hand insjuries. Their treatment must restore the sensation and metabolic activity needed for pain-free finger function. The cross-finger flap (CFF) can be used for this purpose. The goal of this study was to assess the long-term clinical outcome following use of this flap. Methods: This was a retrospective analysis of 26 patients operated because of fingertip amputation: 14 type 3, 8 type 2 and 4 type 4. The CFF was harvested from an adjacent finger on the dorsal side of the middle phalanx down to the epitenon. A dorso-palmar hinge was preserved to ensure vascularisation. The CFF was divided an average of 21 days later. The following parameters were evaluated: pulp volume (injured compared to contralateral finger), presence of neuroma, occurrence of complications (necrosis, infection, and donor site morbidity), cold discomfort, static and tactile discrimination, and patient satisfaction (0 to 10 on VAS). Results: The average follow-up was 2 years; all the patients were re-examined in person. The average healthy pulp to reconstructed pulp ratio was 1.03. No postoperative complications such as neuroma were found. Cold sensitivity was present in 7 patients. The flap was re-sensitised in all the patients. There was no donor site morbidity. The average patient satisfaction score was 9 (range 8–10). Conclusions: Over the long-term, use of the CFF results in nearly normal fingertip metabolism, no complications and good distal sensitivity without pain or neuromas. This is a simple, reliable, long-lasting reconstruction technique.

Background: Heart failure (HF) is a major global health challenge, affecting over 64 million individuals worldwide. India faces a growing burden of HF, necessitating rational pharmacological management. Guideline‑directed medical therapy (GDMT) has evolved with agents such as renin–angiotensin system inhibitors/angiotensin receptor–neprilysin inhibitors (ARNI), β‑blockers, mineralocorticoid receptor antagonists (MRAs), and sodium‑glucose cotransporter‑2 (SGLT2) inhibitors. However, real‑world prescribing practices often vary, creating gaps in evidence‑based therapy. Objective: To evaluate prescription patterns and pharmacological management of congestive heart failure in a tertiary care hospital, with emphasis on cardiovascular drug utilization and WHO/INRUD prescribing indicators. Methods: A prospective observational study was conducted among 600 adult HF patients attending outpatient or inpatient services. Prescriptions were analyzed for demographic details, drug classes, generic versus brand prescribing, injections, antibiotics, and Essential Medicines List inclusion. WHO/INRUD indicators were applied to assess rational prescribing. Results: Of 600 prescriptions, 58% were male patients. A total of 3,420 drugs were prescribed, averaging 5.7 per prescription, indicating polypharmacy. Loop diuretics (76%) and β‑blockers (67%) were most frequently prescribed, followed by ACE inhibitors/ARBs (49%), SGLT2 inhibitors (46%), MRAs (44%), and ARNI (28%). Generic prescribing accounted for 94%, while 89% of drugs were from the Essential Medicines List. Injections were used in 27% of encounters, antibiotics in 12%. Conclusion: Pharmacological management of HF predominantly involved combination therapy with substantial incorporation of GDMT. High rates of generic prescribing and Essential Medicines List use reflect favorable practices, though polypharmacy underscores the need for periodic prescription review and optimization.

Background: Caesarean section (CS) performed in the second stage of labour is technically demanding and is associated with greater maternal and perinatal morbidity than CS performed earlier in labour. Indian data on this subgroup remain limited. Objectives: To evaluate the maternal and perinatal outcomes of CS performed in the second stage of labour. Materials and Methods: This hospital-based prospective observational study was conducted in the Department of Obstetrics & Gynaecology, Assam Medical College & Hospital, Dibrugarh, over one year (September 2024–September 2025) on 70 women who underwent CS in the second stage of labour and their newborns. Maternal demographics, indications, operative technique, intra- and post-operative complications, and neonatal outcomes were recorded and analysed using descriptive statistics. Results: The mean maternal age was 25.76 ± 3.86 years; 55.71% were primigravida and 74.29% were referred cases. Cephalopelvic disproportion (37.14%) was the commonest indication, and the Patwardhan technique (80.0%) was the commonest method used for delivering the impacted head. Uterine incision extension (45.71%) and postpartum haemorrhage (35.71%) were the leading intra-operative complications; paralytic ileus (22.86%) and prolonged catheterisation (21.43%) were the leading post-operative complications. Low 1-minute Apgar score occurred in 68.57% of neonates, 40.0% required NICU admission, and perinatal mortality was 2.86%. Conclusion: CS in the second stage of labour carries substantial maternal and perinatal morbidity. Early recognition of labour abnormalities, timely decision-making and skilled operative technique are essential to minimise complications.

Background and Objectives: Cardiovascular disease is the leading cause of morbidity and mortality in patients with Type 2 Diabetes Mellitus (T2DM). Subclinical Left Ventricular Diastolic Dysfunction (LVDD) with preserved Left Ventricular Ejection Fraction (LVEF ≥ 50%) represents Stage B pre-clinical Heart Failure with Preserved Ejection Fraction (HFpEF). This study evaluated the utility of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a non-invasive screening biomarker for pre-clinical HFpEF in asymptomatic T2DM outpatients, establishing its optimal diagnostic threshold and sensitivity/specificity profile. Methods: A hospital-based cross-sectional study was conducted on 96 asymptomatic adult T2DM patients (>18 years) with a disease duration ≥3 years. Patients with systemic hypertension, advanced renal failure (eGFR < 30 mL/min/1.73m²), or primary heart failure were excluded. All participants underwent serum NT-proBNP quantification, metabolic profiling, and comprehensive 2D Doppler echocardiography per ASE/EACVI guidelines. A Receiver Operating Characteristic (ROC) curve simulation was performed to derive the optimal cut-off threshold (Youden Index J), area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Pre-clinical HFpEF (LVDD) was identified in 39.6% (n=38) of participants (Grade 1 impaired relaxation: 22.9%, n=22; Grade 2 pseudonormal filling: 16.7%, n=16). Advancing age (50.7±6.1 vs 62.7±3.6 years; p<0.001), extended diabetes duration (5.74±2.45 vs 13.13±0.77 years; p<0.001), and elevated HbA1c (7.44±0.62% vs 8.96±0.80%; p<0.001) significantly correlated with advancing HFpEF grade. Serum NT-proBNP levels were significantly higher in HFpEF patients (Grade 0: 142.4±102.9 pg/mL vs Grade 2: 335.2±153.8 pg/mL; p<0.001). ROC curve analysis demonstrated robust diagnostic accuracy for serum NT-proBNP with an AUC of 0.697 (95% CI: 0.586–0.802). An optimal cut-off threshold of 145.7 pg/mL yielded a Sensitivity of 78.9%, Specificity of 56.9%, PPV of 54.5%, and NPV of 80.5%. Conclusion: Pre-clinical HFpEF is highly prevalent in asymptomatic T2DM outpatients. Serum NT-proBNP at an optimal cut-off of 145.7 pg/mL serves as an effective biochemical screening tool to identify asymptomatic diabetic patients with subclinical HFpEF who warrant comprehensive echocardiographic evaluation.

Background: Hypertension is a major public health concern associated with cardiovascular, cerebrovascular and renal complications. Its occurrence is influenced by demographic, clinical and lifestyle-related factors. Objective: To assess the clinical profile and identify factors associated with hypertension among patients attending a tertiary care hospital. Methods: A hospital-based cross-sectional study was conducted among 300 adult patients. Demographic characteristics, medical history, lifestyle factors, anthropometric measurements and blood pressure readings were recorded. Associations between hypertension and selected risk factors were assessed statistically. Results: Hypertension was identified in 126 (42.0%) participants. Higher age, overweight or obesity, family history of hypertension and physical inactivity were associated with hypertension. Increasing age, overweight or obesity and family history remained significantly associated in multivariable analysis. Conclusion: Routine blood pressure screening and early identification of associated risk factors may improve hypertension prevention and management.

Background: Maxillary bones are pneumatic bones, which lighten the skull and play an important role in voice resonance. Maxillary sinuses are air filled cavities in the maxillae. Infection of these sinuses is quite common due to erect posture. Untreated maxillary sinus infection may spread to the meninges and brain as well. Moreover, variations in the diameters in both genders have medico-legal importance. Method: 25 adult male and 25 adult female healthy volunteers were studied with CT images to measure the mediolateral, super inferior, and anteroposterior dimensions, and the volumes of both maxillary sinuses in both genders were studied and compared. Results: ML (right), SIR (right), AP (right), ML (left), SIL (left), and APL (left) parameters were compared in both genders and have significant P-values (p<0.001). Similarly, comparison of the dimension of the maxillary sinus (MS) was studied, and the p-value was highly significant (p<0.001). Conclusion: Present findings compared in both sexes have anatomical, anthropological, and medicolegal importance; moreover, these normal parameters can be compared with pathological MS in radiological studies.

Background: For beta thalassemia major, there is advanced treatment and chelation therapy. But the unexpected complications like renal dysfunction is emerging nowadays. Aim: To study the significant role of serum beta2 microglobulin as the early biomarker to find the hidden renal dysfunction in children with beta thalassemia major (β-TM). Subjects and Methods: The study was performed on 30 children with β-TM and 30 apparently healthy children matched for age and sex as a control group. For all the enrolled children, a comprehensive medical history was obtained, and complete physical examination was performed, blood urea, serum creatinine, estimated glomerular filtration rate (eGFR) by original Schwartz formula and protein creatinine ratio in urine, serum beta2 microglobulin level were measured. Results: A total of 60 children (30 cases and 30 controls) were included in the study. Children with ẞ-thalassemia major had significantly higher serum ẞ2-microglobulin (B2MG) levels than controls 4.58 (3.91–15.6) vs. 1.35 (1.27-1.48), p < 0.001. Significant differences were also observed in serum creatinine, eGFR, urine protein, PCR, and hemoglobin levels (all p < 0.001 ) ROC curve analysis demonstrated that serum B2MG showed excellent diagnostic performance for the early detection of renal dysfunction, with an area under the curve (AUC) of 0.967, 96.7% sensitivity, and 100% specificity at a cut-off value of 1.79 mg/L. PCR also demonstrated excellent diagnostic accuracy (AUC = 0.962) followed by serum creatinine (AUC = 0.902) eGFR (AUC = 0.862) urine protein (AUC = 0.86) and urine creatinine (AUC = 0.647). Conclusion: Beta2 microglobulin can be used as specific and sensitive early biomarker to monitor glomerular and tubular dysfunction in children with β-TM.

Background: Nasal obstruction is among the commonest ENT complaints and impairs sleep, mood and daily function. Objective: To compare disease-specific quality of life (QoL) and nasal obstruction severity before and after treatment using the 23-item Sino-Nasal Outcome Test (SNOT-23) and a Visual Analogue Scale (VAS). Methods: This prospective observational study enrolled 62 patients with nasal obstruction by convenience sampling at the ENT department of a tertiary-care teaching hospital in South Gujarat (November 2023–May 2024). SNOT-23 and a 0–10 VAS were recorded before treatment and at one month after treatment. Pre- and post-treatment scores were compared with the paired t-test; p<0.05 was significant. Results: There were 31 males and 31 females (mean age 30 years; range 5–80); 41.9% were aged 5–20 years. Nasal blockage was present in all patients, nasal discharge in 29% and nasal bleeding in 5%. Significant improvement (p<0.05) occurred in 19 of 24 parameters, most markedly nasal blockage/congestion (3.60±0.69 to 1.37±0.49; p<0.001) and VAS for nasal obstruction (8.02±0.71 to 1.98±0.71; p<0.001). Satisfaction with outcome was 78%. Conclusion: Treatment of nasal obstruction significantly improves disease-specific QoL across nasal, otologic/facial, sleep and emotional domains. SNOT-23 with VAS is a practical outcome measure for routine clinical use.

Introduction: Post-spinal hypotension remains one of the most common and clinically significant complications of spinal anaesthesia for caesarean section. Although several maternal and obstetric factors influence the extent of hypotension and sensory block spread, prediction remains difficult. Symphysiofundal height (SFH) and abdominal girth (AG) are simple, non-invasive bedside measurements that may reflect uterine size and intra-abdominal pressure and potentially influence the spread of intrathecal anaesthesia and haemodynamic response. The present study evaluated the relationship of SFH and AG with post-spinal hypotension and other anaesthetic outcomes in parturients undergoing caesarean section under spinal anaesthesia using bupivacaine with fentanyl as an adjuvant. Aim: To study the effect of symphysiofundal height (SFH) and abdominal girth (AG) on the occurrence of hypotension in patients undergoing caesarean section under spinal anaesthesia using bupivacaine with fentanyl as an adjuvant, and to assess their association with sensory block level, haemodynamic changes, vasopressor requirement, recovery characteristics, and anaesthesia-related side effects. Result: This quasi-experimental observational study was conducted over 18 months among 146 pregnant women undergoing elective caesarean section under spinal anaesthesia. The mean height was 154.8 ± 5.3 cm, mean weight 68.4 ± 8.7 kg, mean BMI 28.5 ± 3.6 kg/m², mean gestational age 38.6 ± 0.9 weeks, and mean estimated fetal weight 3.01 ± 0.38 kg. Overall, post-spinal hypotension occurred in 80/146 (54.8%) participants. Hypotension increased progressively with SFH, from 4 (18.2%) in the 30–32 cm group to 14 (29.2%), 40 (78.4%), and 22 (88.0%) in the 33–35, 36–38, and 39–40 cm groups, respectively (p < 0.001). Similarly, hypotension increased with AG from 1 (5.3%) in the 85–89 cm group to 31.8%, 75.0%, and 85.2% in the 90–94, 95–99, and 100–104 cm groups, respectively (p < 0.001). SFH and AG demonstrated positive correlations with hypotension incidence (rₛ = +0.612 and +0.648, respectively; p < 0.001), sensory block level (rₛ = +0.578 and +0.603, respectively; p < 0.001), and ephedrine requirement (r = +0.534 and +0.572, respectively; p < 0.001). Higher SFH and AG were also associated with greater cephalad sensory block spread and increased anaesthesia-related side effects. Conclusion: Higher symphysiofundal height and abdominal girth are significantly associated with increased incidence and severity of post-spinal hypotension, higher sensory block levels, and greater vasopressor requirement during caesarean section. SFH and AG are simple, non-invasive, and readily available bedside measurements that may be useful for preoperative risk stratification and anticipation of haemodynamic instability. Incorporating these measurements into routine obstetric anaesthetic assessment may facilitate closer monitoring, early vasopressor preparedness, and more individualized haemodynamic management.

Background: Neuropathic pain is a heterogeneous condition, and how well a treatment works depends on the patient, the drug, the pain phenotype and the underlying cause. We brought together 318 randomised controlled trials (RCTs) of pharmacological and non-invasive neuromodulation treatments and ran quantitative analyses only within clinically sensible comparisons. Methods: We treated the 318 RCTs, which covered both pharmacological and non-invasive neuromodulation interventions, as a single evidence pool. Trial characteristics were taken from the study-level dataset. Where numerical forest-plot information was available, we reconstructed published continuous-pain results as standardised mean differences (SMDs) with standard errors. Compatible continuous and dichotomous outcomes were combined using random-effects models. Head-to-head and formulation comparisons were analysed separately from the placebo-controlled class analyses because their comparators and outcomes differ. Trials without sufficiently compatible numerical data stayed in the evidence base and were synthesised narratively; we did not impute effect sizes for them. Findings: The pool contained 318 RCTs with 49,629 randomised participants: 289 pharmacological and 29 neuromodulation trials. For continuous pain, the pooled SMD was 0.65 (95% CI 0.23–1.07; I²=78.2%) for tricyclic antidepressants (TCAs), 0.36 (0.26–0.46; I²=22.6%) for serotonin–norepinephrine reuptake inhibitors (SNRIs) and 0.39 (0.25–0.53; I²=88.4%) for α2δ-ligands. Across the compatible α2δ-ligand comparisons, the pooled risk difference for ≥30% response was 0.110 (95% CI −0.003 to 0.223; I²=34.4%). Two pregabalin formulation trials found no important difference between prolonged/sustained-release and immediate-release treatment (MD 0.064 points on a 0–10 scale, 95% CI −0.244 to 0.371). One small head-to-head trial favoured pregabalin over gabapentin by 2.00 VAS points (95% CI −2.57 to −1.43). In a four-arm study of older adults, pregabalin produced a greater improvement in mTCNS than amitriptyline or duloxetine, although pain VRS did not differ significantly. A bicentre trial of leprosy-associated neuropathic pain found no significant difference in the primary pain outcome between amitriptyline and placebo. Conclusion: The evidence supports TCAs, SNRIs and α2δ-ligands as the main first-line drug classes, but effects vary widely between treatments and between causes of neuropathic pain. The findings are best read through clinically coherent comparisons rather than as a single ranking of drugs. Direct comparisons, formulation studies, responder outcomes, safety data and aetiology-specific results all point towards individualised treatment selection.

Background: Lipoprotein(a) [Lp(a)] is an inherited atherogenic lipoprotein and an established cardiovascular risk factor. D-dimer reflects activation of coagulation and fibrinolysis, but the relationship of these biomarkers in early, uncomplicated hypertension remains incompletely defined. We evaluated serum Lp(a) and plasma D-dimer in adults with stage 1 hypertension and normotensive comparison participants and examined their correlation. Methods: This hospital-based cross-sectional pilot study was conducted at R.N.T. Medical College and associated M.B. Hospital, Udaipur between April 2024 and March 2025. The study enrolled adults aged 30–60 years with stage 1 hypertension and normotensive comparison participants. There were 35 hypertensive and 30 normotensive participants. Lp(a) was measured by immunoturbidimetry on a Cobas c311 analyser and D-dimer by turbidimetric immunoassay on a STA Compact Max analyser. Between-group comparisons used Welch’s t test and Mann–Whitney U test; categorical variables were assessed using Fisher’s exact test; Pearson and Spearman correlations were calculated. Results: Mean Lp(a) was 34.74±29.49 mg/dL in the hypertensive group versus 14.96±11.62 mg/dL in controls (Welch p = 0.00067; Mann–Whitney p = 0.0126). Mean D-dimer was 0.403±0.164 mg/L versus 0.287±0.124 mg/L, respectively (Welch p = 0.00192; Mann–Whitney p = 0.00143). Lp(a)>30 mg/dL occurred in 16/35 (45.7%) hypertensive and 5/30 (16.7%) normotensive participants (Fisher p = 0.0169; OR 4.21, 95% CI 1.29–13.77). D-dimer>0.5 mg/L occurred in 9/35 (25.7%) and 2/30 (6.7%), respectively (Fisher p = 0.0517; OR 4.85, 95% CI 0.99–23.73). Within-group correlations between Lp(a) and D-dimer were weak and not statistically significant (hypertension r = 0.219, p = 0.207; controls r = 0.255, p = 0.174). Conclusions: In this small hospital-based pilot cohort, stage 1 hypertension was associated with higher Lp(a) and D-dimer concentrations, but Lp(a) and D-dimer were not significantly correlated within either group. The findings support further adequately powered prospective studies to determine whether these biomarkers provide complementary rather than directly linked information in early hypertension.

Background and Aims: Laryngoscopy and tracheal intubation provoke a transient sympathetic surge that can compromise hemodynamic stability even in healthy adults. Fentanyl and remifentanil are both used to blunt this response but differ in pharmacokinetics. We compared their efficacy and safety in adults undergoing elective laparoscopic surgery. Methods: In this prospective, randomized, double-blind, controlled trial, 60 ASA I–II adults aged 18–60 years posted for elective laparoscopic surgery were allocated to receive either intravenous fentanyl 2 µg/kg (Group A, n=30) or a remifentanil infusion 0.1 µg/kg/min (Group B, n=30) before induction. Heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, 3 minutes post-drug, and 1, 3, 5 and 10 minutes post-intubation. Adverse effects and postoperative rescue analgesic requirement were recorded. Results: The two groups were comparable for age, sex and ASA status (p>0.05). Three minutes after drug administration, HR, DBP and MAP were significantly lower in Group A than Group B (p=0.0001, 0.0199 and 0.0082 respectively). At 1 minute post-intubation, Group A showed a significantly higher rise from baseline in HR, SBP, DBP and MAP than Group B (all p<0.05). No significant between-group differences persisted from 3 minutes post-intubation onward. Bradycardia (13.3% vs 6.7%) and hypotension (10.0% vs 3.3%) were more frequent with fentanyl, while postoperative rescue analgesia was required more often after remifentanil (23.3% vs 3.3%). Conclusion: Remifentanil provided better hemodynamic stability than fentanyl in the immediate peri-intubation period and had a more favourable adverse-effect profile, but its rapid offset increased the need for postoperative rescue analgesia. Drug choice should be individualized to clinical priority — hemodynamic control versus sustained analgesia.

Background: Rotator cuff disorders are a common cause of shoulder pain and may range from tendinopathy and bursitis to partial- and full-thickness tendon tears. Magnetic resonance imaging (MRI) is considered the reference imaging modality because of its excellent soft-tissue contrast and ability to assess associated muscle and joint abnormalities. However, MRI is relatively expensive, less accessible, time-consuming, and may be contraindicated in some patients. High-resolution ultrasonography (USG) offers a rapid, non-invasive, cost-effective and dynamic method for evaluating rotator cuff and related shoulder pathology. Methodology: A prospective, observational, and descriptive study was conducted at a tertiary care institute over a period of 18 months after obtaining Institutional Ethics Committee approval. A total of 50 patients aged 15–60 years, irrespective of gender, presenting with clinically suspected rotator cuff disorders and referred for both shoulder USG and MRI were included. Patients with previous shoulder surgery or dislocation, fractures, neoplastic lesions, congenital deformities, referred shoulder pain, MRI contraindications, or claustrophobia were excluded. USG evaluation included the biceps tendon, subscapularis, supraspinatus, infraspinatus, acromioclavicular joint, subacromial bursa, and impingement. MRI was considered the gold-standard reference investigation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and correlation between USG and MRI findings were assessed. Results: Ultrasonography demonstrated statistically significant correlation with MRI for all evaluated shoulder structures (p<0.001). For the biceps tendon, USG showed 88.5% sensitivity, 100% specificity, 100% PPV, and 88.9% NPV. Subscapularis assessment showed 77.3% sensitivity, 100% specificity, 100% PPV, and 84.6% NPV. The highest diagnostic performance was observed for the supraspinatus tendon, with 96.8% sensitivity, 94.7% specificity, 96.8% PPV, and 94.7% NPV. For the infraspinatus tendon, sensitivity was 92.0%, specificity 96.0%, PPV 97.9%, and NPV 85.7%. USG demonstrated 90.0% sensitivity and 100% specificity for acromioclavicular joint abnormalities, while subacromial bursal pathology showed 85.0% sensitivity and 100% specificity. For impingement, USG demonstrated 91.3% sensitivity, 100% specificity, 100% PPV, and 87.5% NPV. Conclusion: Ultrasonography demonstrated good diagnostic agreement with MRI across the evaluated shoulder structures, with high sensitivity, specificity, and predictive values. Its diagnostic performance was particularly strong for supraspinatus tendon pathology. Therefore, USG is an effective, accurate, accessible, and cost-effective imaging modality for the evaluation of shoulder pain and rotator cuff disorders and may serve as an appropriate initial imaging investigation in clinically suspected cases.

Background: Cancer is a major health concern, and the identification of natural products with potential anticancer and antioxidant properties is an important area of research. Almond Oil and Eucalyptus Oil contain bioactive constituents that may contribute to their pharmacological activities. Methods: Swiss albino mice were divided into seven groups, with six animals per group. The groups included normal control, EAT tumor control, Vincristine-treated standard control (0.5 mg/kg, intraperitoneal), Almond Oil-treated groups (100 and 200mg/kg, orally), and Eucalyptus Oil-treated groups (100 and 200mg/kg, orally). Antitumor activity was evaluated by measuring tumor volume and tumor weight. Hematological parameters, liver and kidney biochemical markers, antioxidant parameters (SOD, CAT, GSH and MDA), and tumor histopathology were also assessed. Results: The illustrative study dataset showed that the EAT control group had a mean tumor volume of 1850.42 ± 82.36 mm³ and tumor weight of 2.18 ± 0.11 g. Almond Oil at 100 and 200mg/kg produced tumor growth inhibition of 32.11% and 50.46%, respectively, whereas Eucalyptus Oil produced inhibition of 37.16% and 56.88%, respectively. Vincristine showed 65.14% tumor growth inhibition. Both oils also showed dose-related improvement in hematological and biochemical parameters, increased SOD, CAT and GSH levels, and reduced MDA levels. Histopathological descriptions indicated a reduction in viable tumor cells and increased cellular degeneration and necrosis in the treated groups. Conclusion: The findings suggest that Almond Oil and Eucalyptus Oil may possess dose-dependent antitumor and antioxidant potential against Ehrlich solid tumor in mice. Eucalyptus Oil at 200mg/kg showed comparatively greater activity among the test treatments. Further studies using experimentally verified data and appropriate statistical analysis are required to establish efficacy, safety and possible mechanisms of action.

Background: Fast-dissolving tablets are intended to disintegrate rapidly in the oral cavity without water. Fexofenadine hydrochloride is a bitter, second-generation antihistamine; a rapidly disintegrating dosage form may improve ease of administration. A hybrid disintegrant system combining the swelling action of Plantago ovata (isabgol) mucilage with the wicking action of crospovidone was therefore investigated. Objective: To formulate, statistically optimise and evaluate 60 mg fexofenadine hydrochloride fast-dissolving tablets prepared by direct compression using Plantago ovata mucilage and crospovidone. Methods: Nine 200 mg tablet batches (F1–F9) were prepared using a 3² full factorial design. Plantago ovata mucilage (4%, 7% and 10% w/w) and crospovidone (2%, 4% and 6% w/w) were the independent variables. Blends and tablets were evaluated for micromeritic properties, physical quality, wetting, water uptake, dispersion, disintegration and dissolution. Drug–excipient compatibility was examined by FTIR and DSC. The selected batch was compared with a marketed conventional tablet and stored for three months at 40 ± 2°C/75 ± 5% RH. Results: All blends exhibited good flow and all tablet batches complied with the specified mechanical and assay limits. F5, containing 7% mucilage and 4% crospovidone, gave a hardness of 3.5 ± 0.2 kg/cm², friability of 0.62%, drug content of 99.6 ± 0.4%, wetting time of 16 ± 1 s, disintegration time of 22 ± 2 s and 96.8% drug release at 10 min. Its ten-minute release exceeded the marketed conventional tablet (41.6%). The factorial models were significant (p ≤ 0.0014), and prediction errors for F5 were below 1.5%. After three months of accelerated storage, F5 retained 98.5% drug content, disintegrated in 25 s and released 95.7% at 10 min. Conclusion: The combination of 7% Plantago ovata mucilage and 4% crospovidone produced a mechanically acceptable fast-dissolving fexofenadine tablet with rapid disintegration and early drug release. Formal taste testing, longer-term stability, scale-up and in-vivo evaluation remain necessary.

Introduction: Plantar fasciitis is a common cause of heel pain that can significantly interfere with daily activities when symptoms persist despite conservative treatment. Corticosteroid injections are widely used for rapid pain relief, although concerns regarding their safety and effectiveness remain. This study evaluated the efficacy and safety of local Triamcinolone acetate injection in patients with plantar fasciitis. Materials and Methods: A prospective, open-label interventional study was conducted in the Department of Orthopaedics, HIMS Teaching Hospital, Hassan, from December 2018 to January 2020. Sixty patients aged 20–60 years with plantar fasciitis, persistent heel pain for more than three months, and baseline VAS pain score ≥4 were included. Patients received 1 mL (40 mg) Triamcinolone acetate injection at the most tender point of the heel, with a second dose administered at three weeks when adequate pain relief was not achieved. Pain intensity was assessed using the Visual Analog Scale and Wong-Baker Faces Pain Rating Scale at baseline, three weeks, and six weeks. Safety was assessed by recording treatment-related adverse effects. Statistical analysis was performed using SPSS 15.0, with p<0.05 considered statistically significant. Results: Among the 60 patients, 33 (55%) were males and 27 (45%) were females. The mean baseline VAS score was 8.45±0.79, which decreased to 3.65±1.96 at three weeks and 1.05±2.17 at six weeks (p<0.001). The mean percentage improvement in VAS score was 57.41% at three weeks and 88.33% at six weeks. At six weeks, 45 (75%) patients reported no pain, 10 (16.7%) had mild pain, 3 (5%) had moderate pain, and 2 (3.3%) had severe pain. No significant treatment-related adverse effects were reported. Conclusion: Local Triamcinolone acetate injection produced significant and progressive reduction in pain among patients with plantar fasciitis over six weeks and was well tolerated. The findings suggest that Triamcinolone acetate injection may be an effective and safe option for short-term symptomatic management of plantar fasciitis.

Introduction: Tuberculosis remains a major public health problem, and adjunctive strategies that improve treatment response and minimize treatment-related toxicity are of clinical interest. Vitamin C possesses antioxidant, immunomodulatory, and potential antimycobacterial properties. This study evaluated the clinical, microbiological, and liver biochemical changes associated with adjunctive vitamin C supplementation during anti-tubercular therapy. Materials and Methods: A hospital-based, open-label, randomized interventional study was conducted among 220 newly diagnosed sputum-positive pulmonary tuberculosis patients from February 2021 to February 2022. Participants were randomized into a Vitamin C group (n=110), receiving standard anti-tubercular treatment plus vitamin C 500 mg once daily for 8 weeks, and a control group (n=110), receiving standard anti-tubercular treatment alone. Clinical parameters, sputum microscopy, chest radiography, and liver function tests were assessed at baseline, 4 weeks, and 8 weeks. Data were analyzed using SPSS 22.0 and R 3.2.2. Results: Mean age was comparable between groups. Appetite improved in both groups, while body weight increased from 60.74 ± 8.17 kg to 62.84 ± 7.93 kg in the Vitamin C group but declined in controls. By 8 weeks, sputum microscopy was negative in all participants in both groups, with no significant intergroup difference. Bilirubin, total protein, and albumin showed significantly different changes between groups. AST, ALT, and ALP increased at 4 weeks and subsequently declined, with significant overall differences between groups (*P* = 0.006, <0.001, and <0.001, respectively). Conclusion: Adjunctive vitamin C supplementation was associated with favorable clinical and liver biochemical changes during intensive-phase anti-tubercular therapy, although sputum conversion was comparable between groups. Larger studies are warranted to confirm its potential clinical and hepatoprotective benefits.

Introduction: Tennis elbow, or lateral epicondylitis, is a common painful tendinopathy that can impair upper-limb function and occupational activities. Local corticosteroid injection is frequently used for rapid symptomatic relief. This study evaluated the clinical efficacy and safety of local triamcinolone acetate infiltration in patients with tennis elbow. Materials and Methods: A prospective interventional study was conducted at a tertiary care hospital from June 2025 to June 2026. A total of 100 adults with clinically diagnosed lateral epicondylitis were enrolled. Patients received local infiltration of triamcinolone acetate at the site of maximal tenderness under aseptic precautions. Pain and functional status were assessed using the Visual Analogue Scale (VAS) and Patient-Rated Tennis Elbow Evaluation (PRTEE) score at baseline and at 2, 6, 12, and 24 weeks. Treatment response and adverse events were also documented. Repeated-measures analysis of variance was used to assess changes over follow-up, with p<0.05 considered statistically significant. Results: The mean age of participants was 44.1 ± 9.2 years, and 58.0% were male. The mean baseline VAS score decreased from 7.1 ± 1.0 to 4.2 ± 1.3 at 2 weeks and 3.1 ± 1.4 at 6 weeks, with a score of 4.0 ± 1.7 at 24 weeks (p<0.001). Mean PRTEE score decreased from 64.3 ± 9.8 at baseline to 34.8 ± 11.0 at 6 weeks and remained improved at 24 weeks (40.9 ± 12.3; p<0.001). Good or excellent clinical response was observed in 74.0% at 6 weeks and 60.0% at 24 weeks. Adverse events were predominantly mild; injection-site pain occurred in 14.0%, and no infection or tendon rupture was observed. Conclusion: Local triamcinolone acetate infiltration provided significant short-term improvement in pain and functional status and was generally well tolerated in patients with tennis elbow. The greatest clinical benefit was observed at 6 weeks, with some reduction in treatment effect during later follow-up.

Background: Blood culture and antimicrobial susceptibility testing guide targeted antibiotic therapy in patients with suspected sepsis. The association of qSOFA score with blood culture positivity and multidrug resistance remains unclear, warranting evaluation alongside local bacterial susceptibility patterns. Aim: To characterize blood culture isolates and their antimicrobial susceptibility patterns in patients with suspected sepsis and assess the association of qSOFA score with blood culture positivity and multidrug resistance. Methods: A cross-sectional study of 100 adults with suspected sepsis at SMS Hospital, Jaipur, assessed qSOFA scores, blood cultures, and antimicrobial susceptibility. Associations with culture positivity and multidrug resistance were analyzed using chi-square or Fisher’s exact tests (p<0.05). Results: Blood cultures were positive in 39 of 100 patients (39%). Gram-negative bacteria accounted for 84.6% of isolates, predominantly Klebsiella pneumoniae (33.3%) and Acinetobacter baumannii (23.1%). Multidrug resistance was reported in 22/39 isolates (56.4%). Culture positivity was significantly higher in patients with qSOFA ≥2 than in those with qSOFA 0–1 (52.7% vs 22.2%; p=0.004). Among culture-positive patients, multidrug resistance did not differ significantly between these groups (58.6% vs 50.0%; p=0.721). Conclusion: Gram-negative isolates predominated, with frequent multidrug resistance. Higher qSOFA scores were associated with culture positivity but not significantly with multidrug resistance.

Introduction: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity and represents a major public health problem in India due to its high incidence and late-stage presentation. Despite advances in treatment, prognosis remains poor, highlighting the need for reliable biomarkers to identify aggressive tumor behavior. The tumor suppressor protein p53 has been implicated in oral carcinogenesis and disease progression. Objectives: To evaluate the immunohistochemical expression of p53 in oral squamous cell carcinoma and to assess its association with clinicodemographic and histopathological parameters. Materials and Methods: This prospective, hospital-based cross-sectional observational study was conducted in the Department of Pathology, Government Medical College, Kota, from October 2023 to September 2024. A total of 61 histopathologically confirmed cases of OSCC were included. Immunohistochemical staining for p53 was performed using the DO-7 monoclonal antibody. p53 expression was assessed based on staining pattern and percentage positivity. Associations with clinicodemographic variables and histopathological features were analyzed using the chi-square test. Results: Most patients were males in the fourth and fifth decades of life, with the buccal mucosa being the most commonly involved site. Well-differentiated squamous cell carcinoma was the predominant histological grade. Parabasal or diffuse p53 overexpression was the most frequent staining pattern, and overall p53 positivity was observed in 80.3% of cases. No significant association was found between p53 positivity and age, sex, tumor site, or histological grade. However, p53 positivity showed a statistically significant association with lymphovascular invasion and perineural invasion. Conclusion: p53 immunohistochemical expression is common in OSCC and shows a significant association with adverse histopathological features, suggesting its potential role as an adjunct marker of tumor aggressiveness.

Background: This study introduces a new soft tissue release technique designed to balance valgus knees, aiming to prevent unacceptably high rates of late-onset instability and the necessity for primary constrained implants. This study describes the soft tissue release technique and its long-term results when performed during primary total knee replacement in patients with severe valgus knee deformity. Method: 66 adult patients aged between 18 and 35 underwent unilateral total knee replacement. 11 (16.6%) patients required screws and alignment, 33 (50%) required release of the post-lat capsule, and 22 (33%) patients underwent both post-lat and pie-crusting of the iliotibial band. Results: Clinical manifestations were 25 (37.8%) who had rheumatoid arthritis, 19 (28.7%) who had osteoarthritis, and 11 (16.6%) who had childhood metabolic disorders (rickets). The parameters of effects of lateral release pre- and post-surgery, viz., valgus angle, flexion deformity, ROM, pain, walking score, total knee score, and total functional score, had a significant p-value (p<0.001); 33 (50%) had release of the post-lateral capsule; 22 (33%) had both post-lateral and pie-crusting of the iliotibial tract; 11 (66.6%) had screw alignments; 25 (37.8%) had rickets; and 11 (16.6%) had post-traumatic arthritis. Conclusion: The present study is a standard procedure with excellent results for the treatment of advanced arthritis, which leads to genu valgum.

Background: Rotator cuff tears play a crucial role in the movement and stabilization of the shoulder joint. It may be traumatic or degenerative, chronic or acute, and partial or complete. A tear of the rotator cuff muscle, small, medium, large, or massive, has to be evaluated accurately to stabilize the shoulder joint and proper movements. Method: 50 (fifty) adult patients underwent arthroscopy and MRI procedures; moreover, a clinical examination was also carried out to study the range or degree of movements that take place at the shoulder joint to predict the severity of the tear of the rotator cuff. Results: Out of 50 (fifty) 31 (62%) right shoulders, 19 (38%) left shoulder are affected; the PPV of the supraspinatus is 937, followed by 60 subscapulae and 307 infraspinatus in the arthroscopic study. MRI study has a higher PPV than arthroscopy. Conclusion: In addition to clinical examination, noninvasive MRI plays a vital role in diagnosing the severity of rotator cuff tears, which helps determine whether conservative treatment or surgical interventions are needed, although arthroscopy remains the gold standard method.

Background: Oral isotretinoin is effective for acne and selected keratinization disorders, but treatment requires surveillance for clinical and laboratory adverse events. Objectives: To describe dermatological, ophthalmic, psychiatric, menstrual and laboratory events during isotretinoin therapy and their reported timing. Methods: A prospective descriptive study enrolled 60 dermatology outpatients at Maharajah’s Institute of Medical Sciences, Nellimarla, Andhra Pradesh, between December 2016 and May 2018. Patients received isotretinoin at a fixed dose of 20 mg daily. Baseline evaluation included clinical examination, ophthalmic testing, Hamilton anxiety and depression assessments, and laboratory investigations. Follow-up was scheduled at months 1, 2, 3 and 6. Findings were summarized as frequencies and percentages. Results: Participants comprised 36 males (60.0%) and 24 females (40.0%); mean age was 23.16 years. Acne accounted for 52 prescriptions (86.7%). Cheilitis occurred in 37 patients (61.7%), cutaneous xerosis and hair loss in 24 each (40.0%), and reduced tear production in 20 (33.3%). Corneal xerosis affected 10 patients (16.7%) and blurred vision six (10.0%). Depression was recorded in seven patients (11.7%); anxiety and suicidal ideation were not reported. Menstrual irregularities occurred in eight of 24 females (33.3%). Headache affected 20 patients (33.3%); elevated triglycerides and alkaline phosphatase were recorded in four (6.7%) and one (1.7%), respectively. Mucocutaneous symptoms appeared early, while several other events were documented around the third month. Conclusion: Mucocutaneous and ocular findings predominated. Hair loss, depressive symptoms and menstrual disturbances warrant attention during follow-up. The uncontrolled design establishes observed event frequencies rather than drug-attributable risks.

Background: Retained products of conception (RPOC) are an important cause of post-abortion and postpartum bleeding, infection, and other reproductive complications. Ultrasonography is widely used as the first-line imaging modality, although its diagnostic accuracy may vary according to the technique and sonographic criteria used. This study evaluated the diagnostic accuracy of ultrasonography for detecting RPOC using histopathology as the reference standard. Methods: A prospective observational study was conducted in the Department of Radiodiagnosis, D. Y. Patil Medical College, Hospital and Research Institute, Kolhapur, over 18 months. Women with clinical suspicion of RPOC following abortion or delivery underwent transabdominal ultrasonography (TAS), transvaginal ultrasonography (TVUS), or both including assessment of endometrial thickness, echogenic intrauterine mass, and Doppler vascularity. Sonographic findings were correlated with histopathological examination of evacuated tissue. Diagnostic performance was assessed using sensitivity, specificity, predictive values, accuracy, agreement, and ROC analysis. Results: Among 98 participants, ultrasonography diagnosed RPOC in 93 (94.9%), while histopathology confirmed RPOC in 86 (87.8%). Overall ultrasound showed significant association with histopathology (χ²=22.51, p<0.001) with moderate agreement (κ=0.429). TAS demonstrated 100% sensitivity, 25% specificity, and 90.6% accuracy, while TVUS showed 97.6% sensitivity, 33.3% specificity, and 89.6% accuracy. Combined TAS+TVUS achieved 100% sensitivity, 50% specificity, 94.1% PPV, 100% NPV, and the highest accuracy of 94.4%, with substantial agreement (κ=0.640, p=0.004). ROC analysis showed the highest AUC for TAS (0.808). Conclusion: Ultrasonography is a highly sensitive first-line modality for suspected RPOC. Combined TAS and TVUS provides the best overall diagnostic accuracy and agreement with histopathology. However, ultrasound findings should be interpreted comprehensively with clinical features, endometrial thickness, and Doppler vascularity, while histopathology remains the definitive reference standard.

Background: Hypertension causes progressive structural and haemodynamic changes in the arterial wall, contributing to subclinical atherosclerosis and increased cardiovascular risk. Carotid intima-media thickness (CIMT) and carotid resistive index (RI), assessed using high-resolution ultrasonography and colour Doppler, may provide non-invasive markers of early vascular injury. Methods: An observational comparative study was conducted in the Department of Radiodiagnosis at Dr. D. Y. Patil Medical College, Hospital and Research Institute, Kolhapur. Participants were divided into hypertensive and normotensive groups and underwent standardized bilateral common carotid artery B-mode ultrasonography and colour Doppler examination. CIMT was measured at the distal common carotid artery, while RI was calculated from peak systolic and end-diastolic velocities. Associations with duration of hypertension and blood pressure were also evaluated. Results: Hypertensive participants demonstrated significantly higher combined CIMT than normotensive subjects (0.835 ± 0.119 vs. 0.620 ± 0.101 mm; p<0.001). Combined RI was also significantly higher among hypertensive participants (0.7869 ± 0.045 vs. 0.6595 ± 0.033; p<0.001). Abnormal CIMT (>0.70 mm) was observed in 90.8% of hypertensive subjects compared with 15.4% of normotensive subjects (χ²=74.158, p<0.001). Duration of hypertension showed positive correlations with CIMT (r=0.456) and RI (r=0.663), both p<0.001. CIMT was positively correlated with SBP (r=0.649) and DBP (r=0.599). Multivariate analysis identified hypertension as an independent predictor of increased CIMT (AOR=47.6; 95% CI: 15.1–142.9; p<0.001). Conclusion: Hypertension is strongly associated with increased CIMT and RI, indicating early structural and haemodynamic vascular changes. High-resolution ultrasonography and colour Doppler may therefore provide useful non-invasive tools for detecting subclinical vascular injury and facilitating cardiovascular risk assessment.

Background: Artificial intelligence (AI) tools are increasingly being incorporated into medical education, but their association with academic performance and students’ perceptions in undergraduate physiology learning remains uncertain. This study evaluated the relationship between students’ preferred learning methods involving AI and their academic performance, perceptions of AI-assisted learning, and study-related factors in undergraduate physiology. Methods: A cross-sectional study was conducted among 60 undergraduate medical students learning Endocrine Physiology. Students were categorized according to their primary learning method as traditional learning alone, traditional learning supplemented with AI, or predominantly AI-based learning. Academic performance was assessed using a formative assessment comprising knowledge (Knows), case-based, reasoning, and Knows-how components. Students’ perceptions regarding the educational benefits, responsible use, and concerns related to AI were assessed using a structured Likert-scale questionnaire. Group differences were assessed using the Kruskal–Wallis test, and associations between academic performance, study time, previous academic performance, and AI-related perceptions were examined using Spearman’s correlation. Results: Of the 60 students, 21 (35.0%) reported traditional learning alone, 31 (51.7%) traditional learning supplemented with AI, and 8 (13.3%) predominantly AI-based learning. Total formative assessment scores did not differ significantly across the three groups (p = .189), although the mean score was numerically higher in the traditional + AI group (52.4 ± 19.7%) than in the traditional-only (42.5 ± 17.7%) and AI-based (43.5 ± 26.3%) groups. No significant differences were observed for the Knows, case-based, reasoning, or Knows-how components. Overall perceptions of AI were favourable, with 63.4% of students rating AI as good or excellent and 81.7% recommending its use for future batches. Most students agreed that AI should supplement rather than replace teachers (88.3%) and that faculty guidance was necessary for effective AI use (83.4%). Previous academic performance showed significant positive correlations with Total FA score (ρ = 0.599, p < .001) and all individual performance components. Study time was also positively correlated with Total FA score (ρ = 0.333, p = .014), the Knows component (ρ = 0.406, p = .002), and reasoning performance (ρ = 0.369, p = .006). Perceived educational benefits were not associated with improved academic performance. Conclusion: Students demonstrated favourable attitudes towards the use of AI in physiology learning, particularly when AI was viewed as a supplement to conventional teaching. However, the learning method involving AI was not significantly associated with academic performance. Previous academic achievement and study time showed stronger associations with current performance, suggesting that AI may serve as a supportive educational tool rather than an independent determinant of academic achievement. Faculty guidance and appropriate integration of AI into conventional teaching may be important for its effective use in undergraduate medical education.

Background: Oral liquid dosage forms permit flexible, weight-based dosing in children, but poor palatability and unsuitable dosage strength can reduce adherence and therapeutic success. Cefixime trihydrate is poorly water-soluble and bitter, so a stable, readily redispersible and palatable suspension is required. Objective: To formulate and evaluate a pediatric oral suspension of cefixime trihydrate using guar gum as the suspending agent, poloxamer 407 as the wetting and solubilizing agent, and sucralose as the sweetener. Methods: Nine suspensions (F1–F9; 2.0% w/v cefixime trihydrate, equivalent to about 100 mg per 5 mL) were prepared in a three-level, two-factor design in which guar gum and poloxamer 407 were each varied at 0.5%, 1.0% and 1.5% w/v. The batches were evaluated for appearance, pH, rheology, sedimentation volume, redispersibility, particle size, drug content, palatability and in-vitro release. Drug–excipient compatibility was assessed by Fourier-transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). The selected batch was compared with a marketed suspension and stored for three months at 40 ± 2°C/75 ± 5% RH, 25 ± 2°C/60 ± 5% RH and 2–8°C. Results: All batches had pH values of 4.45–4.56 and drug contents of 96.2–99.4%. Viscosity at 50 rpm increased from 186–238 cP at 0.5% guar gum to 758–868 cP at 1.5%, and all batches showed shear-thinning flow. F5 (1.0% guar gum and 1.0% poloxamer 407) was selected as the balanced formulation: viscosity 462 cP, sedimentation volume 0.94 at 14 days, redispersion in two inversions, mean particle size 21.8 µm, drug content 99.4%, and mean palatability score 7.7 on a nine-point scale. F5 released 96.8% of the drug in 45 min, against 97.3% for the marketed product (f1 2.9, f2 78.6). Release followed first-order kinetics (r2 = 0.9958) with a Korsmeyer–Peppas exponent of 0.42. FTIR and DSC showed no evidence of incompatibility. After three months of accelerated storage, F5 remained uniform and retained 98.4% of its initial drug content. Conclusion: A combination of 1.0% w/v guar gum and 1.0% w/v poloxamer 407 produced a physically stable, readily redispersible and palatable cefixime suspension who’s in-vitro release resembled that of a marketed product. Longer stability studies, microbial-limit and preservative-efficacy testing, and scale-up validation are needed before any clinical use.

Background: Itraconazole is a lipophilic antifungal drug with limited aqueous solubility, which may restrict its effective delivery across biological membranes. The present study was undertaken to develop an ultra-deformable lipid-based vesicular system of Itraconazole and incorporate the selected ethosomal formulation into a polymeric gel to improve drug permeation. Methods: Itraconazole was subjected to preformulation studies including UV spectrophotometric identification, FTIR analysis, solubility studies and partition coefficient determination. Ethosomal formulations were prepared by the cold method using different concentrations and combinations of ethanol, phospholipid, surfactants, co-solvents and oil phases. The formulations were screened on the basis of clarity, phase separation, microscopic appearance and stress stability. Selected ethosomal formulations were incorporated into Carbopol 980 NF, HPMC 15000 cps and Xanthan gum gel bases. The prepared formulations were evaluated for vesicle size, polydispersity index, entrapment efficiency, drug content, physical characteristics and in-vitro drug permeation using a Franz diffusion cell. Results: Itraconazole showed a λmax of 264 nm and exhibited a partition coefficient of 5.67, indicating its lipophilic nature. Among the screened ethosomal formulations, F20, F21 and F22 showed satisfactory physical characteristics and stability. F22 exhibited the smallest mean vesicle size of 171.8 ± 4.37 nm, lowest PDI of 0.196 ± 0.010, highest entrapment efficiency of 89.30 ± 1.05% and highest drug content of 98.10 ± 0.64%. These formulations were incorporated into three polymeric gel bases. Among the developed gels, the Carbopol 980 NF-based formulations showed comparatively higher drug permeation. The optimized formulation C22, containing F22 ethosomes in 1.5% w/w Carbopol 980 NF gel, showed 64.83 mg cumulative drug permeation and 86.44% drug permeation at 12 h. Conclusion: The study demonstrated that an ultra-deformable Itraconazole ethosomal gel can be successfully developed using Carbopol 980 NF as the polymeric gel base. Formulation C22 showed satisfactory vesicular characteristics, drug entrapment, drug content and in-vitro permeation, and maintained acceptable physical and performance characteristics during three months of stability evaluation.

Background: Dexamethasone is a potent synthetic glucocorticoid used for its anti-inflammatory and immunosuppressive effects. A mouth-dissolving oral film may offer a convenient unit-dose option for people who experience difficulty swallowing conventional solid dosage forms. This study describes the formulation and evaluation of dexamethasone-loaded hydrogel-based oral films prepared using hydrophilic polymers. Methods: Dexamethasone was examined by FTIR spectroscopy and thermal/melting-point assessment, and drug–polymer compatibility was considered for hydroxypropyl methylcellulose (HPMC), pullulan, polyvinyl alcohol (PVA), sodium alginate, and a combined polymer system. A UV-visible calibration curve was reported over 0–10 µg/mL. Nine film formulations (F1–F9) were evaluated for physical and mechanical characteristics, surface pH, folding endurance, drug content, disintegration time, in-vitro release, release kinetics, and stability-related parameters. Results: The supplied thesis data report film weights of 18.15 ± 0.28 to 23.20 ± 0.37 mg and thicknesses of 0.039 ± 0.012 to 0.050 ± 0.012 mm. Tensile strength ranged from 0.78 ± 0.08 to 2.26 ± 0.07 kg/cm², folding endurance from 214 to 256, surface pH from 6.43 to 6.92, and disintegration time from 11 ± 0.2 to 37 ± 0.5 s. Drug content ranged from 96.40 ± 0.50% to 99.60 ± 0.60%. F5 showed the highest reported drug content (99.60 ± 0.60%), highest folding endurance (256), shortest disintegration time (11 ± 0.2 s), and highest reported cumulative drug release at 10 min (99.10%). The reported first-order correlation coefficient for F5 was R² = 0.998. During the reported three-month stability assessment, drug content declined under each listed storage condition. Conclusion: On the basis of the supplied results, F5 was the most promising of the nine evaluated films for drug content, folding endurance, disintegration, and early drug release. The manuscript should be finalized only after the original laboratory records, formulation composition, full dissolution dataset, and stability protocol have been checked for consistency.

Background: The present study aimed to develop Tizanidine mouth dissolving films to provide a convenient and rapidly disintegrating dosage form. Methods: Nine formulations (F1–F9) were prepared using different water-soluble polymers and plasticizers. The films were evaluated for physical appearance, thickness, weight variation, surface pH, folding endurance, tensile strength, disintegration time, drug content and in-vitro drug release. The optimized formulation was further evaluated for drug-release kinetics and three-month stability. Results: All formulations showed smooth, uniform and flexible films with acceptable physical and mechanical properties. Disintegration time ranged from 42 to 23 seconds, while drug content ranged from 96.42–100.42%. Formulation F9 showed the highest drug release of 98.12% at 60 min, with a disintegration time of 23 seconds, folding endurance of 280 folds and tensile strength of 2.600. The Higuchi model showed the highest correlation (R² = 0.9918). Conclusion: Tizanidine mouth dissolving films were successfully developed, and F9 was selected as the optimized formulation based on its satisfactory film characteristics, rapid disintegration and drug-release performance.

Background: Spinal anaesthesia using hyperbaric bupivacaine is commonly employed for lower limb surgeries. However, its limited duration of action necessitates the addition of adjuvants. Dexmedetomidine, a selective α2-adrenergic agonist, prolongs sensory and motor blockade, although the optimal intrathecal dose remains uncertain. Aim: To compare the efficacy of 5 µg, 7.5 µg, and 10 µg intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine in patients undergoing lower limb surgeries. Materials and Methods: This prospective, single-blind, randomized comparative study was conducted among 90 ASA physical status I–II patients aged 18–60 years undergoing lower limb surgeries under spinal anaesthesia. Patients were randomly allocated into three equal groups. Group D5 received 15 mg hyperbaric bupivacaine with 5 µg dexmedetomidine, Group D7.5 received 15 mg hyperbaric bupivacaine with 7.5 µg dexmedetomidine, and Group D10 received 15 mg hyperbaric bupivacaine with 10 µg dexmedetomidine. Sensory and motor blockade characteristics, hemodynamic parameters, and adverse effects were evaluated. Results: The onset of sensory blockade was significantly faster in Group D10 (4.9 ± 0.9 minutes) compared with Group D7.5 (5.6 ± 1.3 minutes) and Group D5 (5.8 ± 1.6 minutes). The time for two-segment sensory regression was longest in Group D10 (111.4 ± 11.4 minutes), followed by Group D7.5 (100.2 ± 11.0 minutes) and Group D5 (95.0 ± 12.2 minutes; p<0.005). The onset of complete motor blockade was fastest in Group D10 (5.8 ± 1.1 minutes), while motor block regression to Bromage I was longest in Group D10 (365.0 ± 26.52 minutes), followed by Group D7.5 (340.0 ± 27.25 minutes) and Group D5 (331.0 ± 28.11 minutes). Greater hemodynamic variations and a higher reported incidence of hypotension, bradycardia, and nausea were observed in Group D10. Conclusion: Intrathecal dexmedetomidine demonstrated dose-dependent prolongation of sensory and motor blockade when combined with hyperbaric bupivacaine. Although 10 µg provided the longest blockade, 7.5 µg appeared to offer a more favorable balance between anaesthetic efficacy and hemodynamic stability.

Background: Acute respiratory illness (ARI) is a major cause of pediatric hospitalization and mortality. Identification of respiratory pathogens and associated clinical outcomes is essential for effective management. Aim: To evaluate the clinico-etiological spectrum, disease severity, and hospital outcomes of acute respiratory illness among children admitted to a tertiary care hospital. Materials and Methods: This prospective observational study included 255 children aged 2 months to 18 years admitted with ARI at Indira Gandhi Institute of Child Health, Bengaluru, over 18 months. Clinical characteristics, multiplex RT-PCR findings, disease severity, and hospital outcomes were evaluated. Statistical significance was defined as p < 0.05. Results: Children younger than two years constituted 55.7% of participants, and 57.3% were male. RSV was the predominant pathogen (34.5%), followed by Streptococcus pneumoniae (11.8%) and Influenza B (6.7%). Severe pneumonia was observed in 12.2% of children. Respiratory etiology was significantly associated with disease severity (p < 0.001). Overall mortality was 6.3%, with ARDS being the strongest predictor of mortality (OR = 89.82; p < 0.001). Conclusion: RSV was the leading identified cause of pediatric ARI, while Influenza A and SARS-CoV-2 were associated with greater disease severity. Early pathogen identification and timely management of respiratory complications may improve clinical outcomes.

Background: Econazole is a broad-spectrum imidazole antifungal used in topical therapy, but its low aqueous solubility and limited delivery to deeper skin layers can constrain local treatment. Nanostructured lipid carriers (NLCs), formed from solid and liquid lipids, may improve drug incorporation, colloidal characteristics, and prolonged release. Objective: This study aimed to formulate, optimize, characterize, and evaluate econazole-loaded NLCs intended for topical delivery to skin affected by fungal infection. Methods: Five formulations (F1–F5) were prepared using Compritol® 888 ATO as solid lipid, oleic acid as liquid lipid, Tween 80 as surfactant, and Poloxamer 188 as stabilizer. Hot homogenization followed by probe ultra-sonication was used. The formulations were evaluated for particle size, polydispersity index (PDI), zeta potential, drug content, entrapment efficiency (EE), drug loading, pH, viscosity, spreadability, in vitro release, ex vivo skin permeation, morphology, and stability. Release data were fitted to common kinetic models. Results: Formulation F4 was identified as the preferred formulation. It exhibited a mean particle size of 158.6 ± 3.5 nm, PDI of 0.24 ± 0.01, zeta potential of −31.6 ± 1.1 mV, drug content of 99.32 ± 0.61%, EE of 89.72 ± 1.43%, and drug loading of 11.37 ± 0.41%. Cumulative release at 24 h was reported as 97.4 ± 1.2%. The Higuchi model gave the highest reported coefficient of determination (R² = 0.992), followed closely by Korsmeyer–Peppas (R² = 0.989). After six months, the reported drug content and EE remained 96.84 ± 0.75% and 86.62 ± 1.61%, respectively, under accelerated conditions. Conclusion: The reported data support F4 as the most promising of the five tested formulations in terms of physicochemical properties and sustained release. The work is formulation-level evidence; clinical efficacy, safety, and superiority in patients remain unestablished and require further validation.

Objective: To investigate the effects of a supplied co-processed Plantago ovata (Isabgol) excipient and crospovidone on the quality and early dissolution of directly compressed ondansetron orally disintegrating tablets. Methods: A 3² full factorial design comprised nine 200 mg formulations containing 5 mg ondansetron hydrochloride dihydrate, approximately equivalent to 4 mg ondansetron. The supplied excipient and crospovidone were varied at 10–30 mg and 4–12 mg per tablet, respectively. Tablet properties, disintegration, wetting and dissolution in pH 6.8 phosphate buffer were evaluated. Quadratic models were refitted to the nine reported batch means. A selected composition was evaluated as F-OPT and stored at 40 ± 2 °C/75 ± 5% relative humidity for three months. Results: Across design batches, disintegration ranged from 12 to 44 s, friability from 0.32 to 0.61%, and drug release at 10 min from 67.2 to 93.1%. Crospovidone had the larger standardized-range main effect on disintegration. The disintegration model had an R² of 0.9990, although only three residual degrees of freedom were available. F-OPT contained 20 mg supplied excipient and 12 mg crospovidone, disintegrated in 13 ± 1.0 s, and showed 0.54% friability and approximately 92.0% release at 10 min. At three months, disintegration was 16 s and 10 min release was 89.4%. Conclusion: The selected combination supported rapid in vitro disintegration with low friability. Undefined co-processing composition, limited independent batch replication and analytical-range uncertainties restrict reproducibility and interpretation. Additional material qualification, analytical validation and stability studies are needed.

Luliconazole is an imidazole antifungal drug with poor aqueous solubility, which may limit its dissolution and formulation performance. The present study aimed to develop luliconazole cocrystals using fumaric acid as a coformer to improve solubility and dissolution. Fumaric acid was selected based on in-silico binding energy studies, showing the lowest binding energy of −11.341 kcal/mol. Luliconazole–fumaric acid (LUZ-FUM) cocrystals were prepared in a 1:1 molar ratio by solvent evaporation using ethanol and evaluated for drug content, FTIR, PXRD, DSC, solubility, antifungal activity, and in-vitro dissolution. The prepared cocrystals showed a drug content of 94.39 ± 1.21% and improved solubility compared with pure luliconazole and the physical mixture, with the highest solubility of 157.65 ± 0.04 µg/mL at pH 1.2. FTIR, PXRD, and DSC results supported the formation of a new crystalline phase. In-vitro dissolution showed approximately 80% of the drug release from the cocrystals after 60 min, compared with 24% from the physical mixture and 12% from pure luliconazole. The cocrystals also showed improved antifungal activity against Candida albicans. Overall, cocrystallization with fumaric acid demonstrated potential for enhancing the solubility and dissolution performance of luliconazole.

Bedaquiline fumarate is described in the thesis as a poorly water-soluble drug, creating a formulation challenge for oral delivery. The study aimed to formulate and evaluate a bedaquiline-loaded nanoemulsion using poly(δ-decalactone) (PDL) as the polymeric oil phase and Pluronic F-68 as surfactant. Pre-formulation investigations included organoleptic assessment, melting point determination, FTIR, X-ray diffraction, differential scanning calorimetry, UV analysis, partition coefficient determination, calibration curves and solubility studies. Nanoemulsions were prepared by a nanoprecipitation approach, followed by evaluation of particle size, polydispersity index (PDI), zeta potential, drug content/entrapment, in-vitro release, release kinetics, stability and in-vitro antibacterial activity. The thesis reports poor solubility of the drug in water compared with acetone and methanol. The calibration curves showed reported R² values of 0.9969 and 0.9999 for the specified solvent systems. In-vitro release data in PBS pH 6.8 showed greater cumulative release from the drug-loaded nanoemulsion than from free bedaquiline at the reported time points. The zero-order model had the highest reported correlation coefficient (R² = 0.9777). The thesis reports a zone of inhibition of 2.8 ± 0.52 mm for bedaquiline-loaded nanoemulsion and 1.56 ± 0.06 mm for bedaquiline suspension. Storage observations indicated better stability under refrigerated conditions than under the stated accelerated condition. Some formulation identifiers and values differ across thesis sections; this article preserves the values and terminology as presented rather than attempting to reconcile them.

Background: Traumatic diaphragmatic rupture (TDR) is an uncommon but serious condition often missed in the acute setting due to non-specific clinical and radiological findings. Aim: To highlight the diagnostic accuracy of multidetector CT (MDCT) in identifying diaphragmatic injuries across varied trauma scenarios and its correlation with surgical confirmation. Methods: We present a series of four patients who presented to the L.T.M.M.C & L.T.M.G.H. Sion, Mumbai in department of Radio-diagnosis with suspected thoracoabdominal trauma. The mechanisms of injury included: three cases of road traffic accidents, one case of penetrating stab injury, and one case of fall from height. All patients underwent contrast-enhanced multidetector computed tomography (MDCT) on a 160-slice CT scanner (Cannon aquilion prime SP) as part of the trauma protocol. The scans revealed classical signs of diaphragmatic discontinuity, herniation of abdominal contents into the thoracic cavity, and associated thoracoabdominal injuries. Each diagnosis was later confirmed intraoperatively during emergency surgical exploration. Imaging findings were retrospectively reviewed and correlated with operative reports. Conclusion: MDCT is a highly sensitive tool in the early detection of diaphragmatic rupture. Prompt identification can guide timely surgical intervention, reducing morbidity and preventing complications such as visceral herniation and strangulation.

Background: Electrolyte disturbances are common after traumatic brain injury (TBI) and can add to secondary brain damage. We measured serum sodium, potassium, calcium and magnesium during the first week of intensive care and related them to Glasgow Coma Scale (GCS) severity. Methods: This prospective observational study enrolled 60 consecutive adults with TBI admitted within two weeks of injury to the intensive care unit of Assam Medical College and Hospital, Dibrugarh, from July 2019 to June 2020. Electrolytes and GCS were recorded daily for seven days. Day 1 and day 7 means were compared by t-test, and electrolyte status was related to GCS category by Fisher’s exact test. Results: Mean age was 41.32 ± 13.55 years; 95.0% were men, 85.0% were injured in road traffic accidents and 61.7% had subdural haemorrhage. Over the week, hypernatraemia occurred in 33.3%, hypokalaemia in 23.3%, hypocalcaemia in 20.0%, hyponatraemia in 18.3%, hyperkalaemia in 15.0% and hypomagnesaemia in 13.3% of patients. Mean GCS rose from 7.58 ± 2.66 to 10.42 ± 2.51 (p < 0.0001) and abnormal values became less frequent. On day 1, sodium (p = 0.006) and potassium (p = 0.027) status were associated with GCS, while calcium and magnesium were not. On day 7 all four were associated with GCS (p = 0.024, 0.011, 0.007 and 0.010, respectively), with abnormalities concentrated in patients who remained severely injured. Conclusion: Sodium and potassium disturbances are common after TBI and cluster in severe injury. Daily monitoring of all four cations through the first week of intensive care is advisable.