Introduction: Dyslipidemia is a major modifiable risk factor for cardiovascular disease and is characterized by abnormalities in lipid metabolism. Omega-3 fatty acids have demonstrated triglyceride-lowering properties and potential cardioprotective effects and may provide additional benefit when used in combination with statins. Therefore, the study aimed to compare the effectiveness of atorvastatin alone and atorvastatin plus omega-3 fatty acid in improving lipid profile parameters among patients with dyslipidemia attending a tertiary care hospital. Materials and Methods: This prospective, randomized, open-label comparative study was conducted in a tertiary care hospital and included 60 newly diagnosed dyslipidemic patients aged 18–60 years. Participants were randomly allocated into two groups: Group A received atorvastatin 10 mg daily, and Group B received atorvastatin 10 mg daily plus omega-3 fatty acids 2 g/day for 12 weeks. Lipid profile parameters were measured at baseline and at 4, 8, and 12 weeks. Results: Baseline demographic and clinical characteristics were comparable between the two groups. Both treatment regimens resulted in significant reductions in total cholesterol, triglycerides, LDL-C, and VLDL-C and a significant rise in HDL-C over 12 weeks (p < 0.001 within groups). There was no statistically significant difference between the two groups in total cholesterol, LDL-C, or HDL-C at any time point. However, triglyceride and VLDL-C reductions were significantly greater in the combination therapy group compared with atorvastatin alone. Conclusion: Atorvastatin combined with omega-3 fatty acids provides superior triglyceride and VLDL-C reduction compared with atorvastatin monotherapy, with similar effects on total cholesterol, LDL-C, and HDL-C and a favorable safety profile.

Background: A prescription-based survey about drug utilization pattern is considered to be one of the effective methods to assess and evaluate the prescribing attitude of physicians with the aim to improve rational drug use. The incidence of respiratory diseases is increasing and in almost all the respiratory diseases treatment with more than one class of drug and more than one route of administration is necessitated as many patients seek immediate symptomatic relief. All these factors affect the drug prescribing habit of physicians in the pulmonary medicine department. With this view, this study was conducted with the objectives of studying the type of pulmonary diseases and drug prescribing pattern by prescription analysis. Materials and Methods: 200 outpatients and inpatients irrespective of the diagnosis attending the pulmonary medicine department of Trichy SRM Medical College Hospital & Research centre. Relevant demographic data and data regarding diagnosis and treatment was collected after informed written consent. Results: The common diagnosis were acute exacerbation of chronic obstructive pulmonary disease (40.5%), followed by lower respiratory tract infections (LRTIs) (28%), acute exacerbation of bronchial asthma (16%) and Pulmonary Tuberculosis (7%). The common drugs prescribed were β‑agonists in inhalation form (73%) followed by methyl xanthine (used in 70% of prescriptions) and antibiotics (64.5%). Among antibiotics, co-amoxiclav was the most commonly used (48.1% of antibiotics) followed by macrolides in 28.7%. Conclusion: In spite of rational drug use in the current study, following standard institution-based antibiotic prescribing guidelines and other standard guidelines will help in standardizing treatment plans and prescriptions. It is recommended that the microbiological spectrum of respiratory infections be determined so as to define antibiotic treatment protocol specific for the institution.

Background: Plant-based dietary patterns have garnered substantial scientific and public health attention as potentially effective strategies for chronic disease prevention. The accumulating evidence base warrants systematic synthesis to inform clinical practice and public health recommendations regarding plant-based diets in preventive medicine. Methods: Systematic searches were conducted in PubMed, Scopus, Embase, and the Cochrane Library for studies published from January 2000 to December 2024. Prospective cohort studies, randomized controlled trials, and meta-analyses examining plant-based diets (vegetarian, vegan, or predominantly plant-based) in adult populations were included. Outcomes of interest encompassed disease incidence, mortality, and cardiometabolic biomarkers. Quality assessment utilized the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for trials. The review adhered to PRISMA guidelines. Results: Forty-two studies comprising over 1.2 million participants were included. Consistent evidence demonstrated significant associations between plant-based dietary patterns and reduced cardiovascular disease risk (15-32% reduction), lower type 2 diabetes incidence (20-35% reduction), and decreased all-cause mortality (12-25% reduction). Moderate evidence supported cancer risk reduction, particularly for gastrointestinal malignancies. Interventional studies demonstrated significant improvements in body weight, glycemic control, and lipid profiles. Conclusion: Plant-based dietary patterns are associated with substantial reductions in chronic disease risk and represent an evidence-based approach to preventive medicine. Healthcare providers should consider recommending appropriately planned plant-based diets as part of comprehensive disease prevention strategies.

Background: Bronchoalveolar lavage (BAL) sample is the fluid specimen obtained from bronchoalveolar washing during bronchoscopy to diagnose various lung pathologies. This research aims to isolate organisms from BAL samples and determine their antibiotic sensitivity pattern to treat infected patients. Materials and Methods: This is a prospective observational study conducted at Government Medical College Namakkal in the Department of Microbiology for one year, involving 75 BAL samples from lower respiratory tract infection patients. BAL samples were obtained via bronchoscopy and processed as per standard laboratory guidelines. Results: Among 75 BAL samples processed, 39 (52%) were culture positive for bacterial growth. The most common organisms isolated were Pseudomonas aeruginosa 19 (48%), Acinetobacter baumannii 10 (25%), Klebsiella pneumoniae 9 (23%), and Burkholderia species 1 (2%). Klebsiella pneumoniae showed high sensitivity to piperacillin-tazobactam 8 (88%), meropenem 8 (88%), and cefotaxime-sulbactam 7 (77%). Pseudomonas aeruginosa was susceptible to ceftazidime-avibactam 15 (78%), meropenem 16 (84%), and piperacillin-tazobactam 16 (84%). Acinetobacter species were susceptible to ceftazidime-avibactam 3 (75%), meropenem 3 (75%), and piperacillin-tazobactam 3 (75%). Among the 19 isolates of Pseudomonas aeruginosa, three were multidrug-resistant organisms (MDROs), and one among the ten Acinetobacter isolates was an MDRO. Conclusion: BAL sample culture is more useful in diagnosing lung infections compared to sputum culture, where normal flora may overgrow pathogens. Determining antibiotic sensitivity patterns aids clinicians in selecting appropriate antibiotics.

Introduction: Dexmedetomidine is widely used as a premedication because of its sympatholytic and sedative properties, which help attenuate the hemodynamic response to laryngoscopy and endotracheal intubation. While intravenous dexmedetomidine provides rapid and predictable effects, intranasal administration has emerged as a non-invasive alternative with good bioavailability. The present study aimed to compare the hemodynamic effects of intravenous and intranasal dexmedetomidine in patients undergoing ENT surgeries under general anesthesia. Materials and Methods: This prospective comparative study was conducted at Government Medical College, Mancherial, from January 2024 to June 2025. 100 adult patients (ASA I–II) undergoing elective ENT surgeries under general anesthesia were randomly allocated into two groups (n = 50 each). Group I received intravenous dexmedetomidine 1 µg/kg over 10 minutes, and Group II received intranasal dexmedetomidine 1 µg/kg 40 minutes before induction. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, at 10, 20, 30, and 40 minutes after drug administration, at induction, and at 1, 2, 4, 5, 7, and 10 minutes after intubation. Results: Baseline variables were comparable between the groups. HR and MAP decreased progressively in both groups after drug administration. From 20 to 40 minutes and at induction, the IV dexmedetomidine group demonstrated significantly lower HR and MAP compared with the intranasal group (p < 0.05). Following intubation, transient increases in HR and MAP were observed in both groups, but values were consistently lower in the IV group, with significant differences at 7 and 10 minutes for MAP. Conclusion: Both intravenous and intranasal dexmedetomidine effectively attenuate peri-intubation hemodynamic responses. However, intravenous dexmedetomidine provides faster and more pronounced early control of heart rate and mean arterial pressure, while intranasal dexmedetomidine offers a safe, non-invasive alternative when adequate premedication time is available.

Background: Effective postoperative analgesia is essential in patients undergoing modified radical mastectomy (MRM). Regional anesthesia techniques, such as the ultrasound-guided modified Pectoralis II (PECS II) block, have gained popularity for providing targeted analgesia while reducing opioid consumption. Levobupivacaine is a commonly used local anesthetic; however, its duration of action is limited. Dexamethasone, when used as an adjuvant, has shown promise in prolonging the effects of local anesthetics. Aim: To compare the postoperative analgesic efficacy of levobupivacaine alone versus levobupivacaine combined with dexamethasone in PECS II block among patients undergoing MRM. Methods: This prospective, randomized, double-blind study included 62 female patients aged 18–60 years, ASA grade I–II, scheduled for MRM under general anesthesia. Participants were randomized into two groups: (1) Group L (n=31): received 30 mL of 0.25% levobupivacaine. (2) Group LD (n=31): received 30 mL of 0.25% levobupivacaine + 8 mg dexamethasone. Primary outcome was duration of postoperative analgesia (time from block completion to first rescue analgesic). Secondary outcomes included pain scores (VAS at 1, 3, 6, 12, 24 hrs), total rescue analgesic consumption in 24 hrs, hemodynamic parameters, patient satisfaction, and adverse effects. Results: The mean duration of analgesia was significantly longer in Group LD compared to Group L (518 ± 62 vs. 310 ± 54 minutes, p < 0.001). VAS scores at 6, 12, and 24 hrs were significantly lower in Group LD (p < 0.05). Rescue analgesic requirement within 24 hrs was also reduced in Group LD (p = 0.002). No significant hemodynamic instability or adverse effects were noted in either group. Conclusion: Addition of dexamethasone to levobupivacaine in PECS II block significantly prolongs analgesia, lowers pain scores, and reduces rescue analgesic requirement, making it an effective adjuvant for postoperative pain management in MRM patients.

Background and Objective: Cataract secondary to uveitis remains surgically challenging due to inflammatory sequelae and a higher risk of postoperative complications. We prospectively evaluated visual outcomes, complications, and prognostic factors after cataract surgery in uveitic eyes at a tertiary center in Eastern India. Methods: Prospective, hospital-based observational cohort of 90 eyes (82 patients) undergoing phacoemulsification or manual small-incision cataract surgery (SICS) between July 2024 and June 2025. Eyes were quiescent ≥3 months preoperatively and followed to 12 months. Primary outcome was the proportion achieving BCVA ≥6/18 at 6 and 12 months. Secondary outcomes included change in BCVA (logMAR), postoperative complications, uveitis recurrence (Kaplan–Meier), and predictors of poor final vision (<6/18) using multivariable logistic regression. Results: Mean age was 41.6 ± 13.2 years; 58.5% were female. Uveitis subtypes: chronic anterior 46.7%, intermediate 20.0%, panuveitis 20.0%, posterior 13.3%. Surgery: phaco 60% (n=54), SICS 40% (n=36). Mean BCVA improved from 1.48 ± 0.39 preoperatively to 0.42 ± 0.31 (1 month), 0.28 ± 0.29 (6 months), and 0.30 ± 0.34 (12 months) (repeated-measures ANOVA F(3,267)=182.5, p<0.001); 6-month mean gain 1.20 logMAR (95% CI 1.08–1.31). Proportion achieving ≥6/18 rose to 67.8% (1 month), 78.9% (6 months), 77.8% (12 months). Phaco yielded higher 6-month success than SICS (85.2% vs 69.4%, χ²=3.96, p=0.047). Complications: PCO 34.4% (higher with SICS 47.2% vs phaco 25.9%; χ²=4.91, p=0.027), CME 12.2%, secondary glaucoma 8.9%. Uveitis recurred in 17.8% by 12 months (flare-free survival 80%); longer preoperative quiescence reduced recurrence (HR 0.41, 95% CI 0.17–0.98, p=0.036). Independent predictors of poor final vision were preoperative macular pathology (OR 4.27, 95% CI 1.78–10.2, p=0.001), panuveitis/posterior uveitis (OR 3.08, 1.32–7.21, p=0.009), postoperative CME (OR 6.75, 2.07–22.0, p=0.002), and preoperative quiescence <6 months (OR 2.48, 1.01–6.09, p=0.048). Conclusions: With stringent inflammation control and modern technique—preferably phacoemulsification with hydrophobic acrylic IOLs—most uveitic eyes achieve good functional vision at one year. Outcomes are primarily determined by macular status, uveitis subtype, and duration of preoperative quiescence. Routine macular OCT, sustained quiescence (>6 months when feasible), perioperative NSAIDs/steroids, and vigilant follow-up for PCO/CME/glaucoma are recommended.

Background: Excessive smartphone use has emerged as a behavioral concern among young adults and may influence autonomic nervous system regulation. Heart rate variability (HRV) provides a noninvasive measure of cardiac autonomic function and can detect early autonomic imbalance before overt clinical disease. This study assessed HRV in young adults with smartphone overuse compared with non-overusers. Material and Methods: A cross-sectional comparative study was conducted among 150 apparently healthy adults aged 18–25 years. Participants were categorized into smartphone overuse (n = 75) and non-overuse (n = 75) groups using the Smartphone Addiction Scale–Short Version. Short-term resting HRV was recorded under standardized conditions using a 5-minute supine protocol. Time-domain and frequency-domain HRV parameters were analyzed. Group comparisons were performed using appropriate parametric or nonparametric tests. Multivariable linear regression was used to examine independent associations between smartphone overuse and HRV indices after adjustment for potential confounders. Results: Baseline demographic characteristics were comparable between groups; however, smartphone overusers had significantly higher resting heart rate and shorter sleep duration. Time-domain analysis showed significantly lower mean RR interval, SDNN, RMSSD, and pNN50 in the overuse group (all p < 0.01). Frequency-domain analysis demonstrated reduced total power and high-frequency power, along with a significantly higher LF/HF ratio among smartphone overusers (p < 0.01). After adjustment for age, sex, body mass index, sleep duration, physical activity, caffeine intake, and resting blood pressure, smartphone overuse remained independently associated with lower RMSSD, SDNN, and HF power, and a higher LF/HF ratio. Conclusion: Smartphone overuse in young adults is independently associated with reduced heart rate variability, indicating diminished parasympathetic activity and altered sympathovagal balance, even in an otherwise healthy population.

Background: Sleep patterns are increasingly recognized as important determinants of cardiovascular autonomic regulation. While total sleep duration has been widely studied, emerging evidence suggests that irregular sleep patterns may adversely affect cardiac autonomic function. Heart rate variability (HRV) provides a noninvasive index of autonomic modulation and may help elucidate the physiological impact of sleep regularity in young individuals. Material and Methods: An analytical cross-sectional study was conducted among 110 apparently healthy young adults aged 18–30 years. Sleep patterns were assessed using a 7-day sleep diary, and sleep regularity was quantified as intra-individual variability in nightly sleep duration. Participants were stratified into tertiles of low, moderate, and high sleep variability. Short-term resting HRV was recorded using 5-minute electrocardiographic recordings under standardized conditions. Time-domain and frequency-domain HRV parameters were analyzed. Intergroup comparisons, correlation analysis, and multivariable linear regression were performed to evaluate associations between sleep variability and HRV indices after adjusting for relevant covariates. Results: Baseline demographic, anthropometric, and blood pressure parameters were comparable across sleep variability tertiles, and mean sleep duration did not differ significantly between groups. Resting heart rate increased progressively with higher sleep variability. Individuals with greater sleep irregularity demonstrated significantly lower SDNN and RMSSD values, along with reduced high-frequency power, indicating diminished parasympathetic activity. Conversely, low-frequency power and the LF/HF ratio increased across tertiles, reflecting a shift toward sympathetic predominance. Sleep duration variability showed significant correlations with multiple HRV indices and remained independently associated with reduced parasympathetic modulation and increased sympathovagal imbalance after multivariable adjustment. Conclusion: Greater irregularity in habitual sleep duration is associated with unfavorable cardiac autonomic modulation in healthy young adults, independent of total sleep time. Promoting consistent sleep patterns may be important for maintaining optimal autonomic balance and early cardiovascular health.

Background: Dysphonia is a common otorhinolaryngological complaint with diverse etiological factors ranging from benign inflammatory conditions to malignant laryngeal disorders. Understanding the etiological spectrum and clinical presentation of dysphonia is essential for early diagnosis and appropriate management. This study aimed to evaluate the etiology and clinical characteristics of patients presenting with dysphonia in a tertiary care setting. Material and Methods: This hospital-based cross-sectional study was conducted in the Department of Otorhinolaryngology over an 18-month period. A total of 167 adult patients presenting with voice change of more than two weeks’ duration were included. Detailed clinical evaluation, including history, otorhinolaryngological examination, and laryngeal visualization using indirect and/or flexible fiberoptic laryngoscopy, was performed in all patients. Etiological diagnosis was established based on clinical, endoscopic, and histopathological findings where indicated. Data were analyzed using descriptive statistics, and associations between categorical variables were assessed using the Chi-square test. Results: The majority of patients were in the 41–50-year age group (25.1%), with a marked male predominance (67.1%). Most patients presented within 1–3 months of symptom onset (34.7%). Inflammatory laryngeal lesions were the most common etiology (32.3%), followed by benign vocal fold lesions (27.5%) and malignant laryngeal lesions (18.6%). Vocal cord paralysis and functional dysphonia accounted for 12.6% and 9.0% of cases, respectively. A statistically significant association was observed between gender and etiology, with malignant lesions occurring predominantly in males (p = 0.004). Tobacco smoking (47.3%) and vocal abuse (31.1%) were the most frequently identified risk factors. Conclusion: Dysphonia most commonly affects middle-aged males and is predominantly caused by inflammatory and benign laryngeal conditions; however, a considerable proportion of patients harbor malignant lesions. Early and systematic laryngeal evaluation is essential, particularly in high-risk individuals, to ensure timely diagnosis and management.

Background: Nutritional anemia remains a major health concern among adolescents, with iron deficiency being the predominant underlying factor. Red blood cell (RBC) indices are routinely available hematological parameters that may reflect alterations in iron absorption and utilization, yet their relationship with iron absorption physiology in adolescents is not well characterized. Material and Methods: A cross-sectional analytical study was conducted among 123 adolescents aged 10–19 years diagnosed with nutritional anemia. Complete blood counts were performed to assess RBC indices, including mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width. Biochemical markers of iron absorption physiology, namely serum iron, total iron-binding capacity, transferrin saturation, and serum ferritin, were measured under standardized conditions. Correlations between hematological indices and biochemical parameters were evaluated using appropriate statistical tests. Results: The mean hemoglobin concentration was 9.6 ± 1.1 g/dL, with microcytic and hypochromic indices evident. Serum iron (42.8 ± 13.6 µg/dL), transferrin saturation (10.9 ± 4.3%), and serum ferritin levels (14.2 ± 6.1 ng/mL) were reduced, while total iron-binding capacity was elevated (392.4 ± 46.9 µg/dL). Mean corpuscular volume and mean corpuscular hemoglobin showed moderate positive correlations with serum iron and transferrin saturation and negative correlations with total iron-binding capacity. Red cell distribution width demonstrated inverse correlations with serum iron, transferrin saturation, and serum ferritin. Moderate anemia was the most prevalent severity category (58.5%). Conclusion: RBC indices show significant correlations with biochemical markers of iron absorption physiology in adolescents with nutritional anemia, indicating their potential utility as accessible indicators of impaired iron availability and utilization in this population.

Background: Early electrocardiographic findings provide rapid risk stratification in ST-elevation myocardial infarction (STEMI), yet data from rural Indian tertiary-care settings remain limited. ECG markers such as ischemia grade, rhythm disturbances, and conduction abnormalities may predict short-term outcomes. This study evaluated the prognostic value of admission ECG variables in STEMI patients in a rural Indian cohort. Methods: This single-center observational study included 212 consecutive patients with STEMI presenting to a tertiary hospital in rural India over one year. Baseline clinical data, admission ECG characteristics, angiographic findings, and in-hospital outcomes were collected. Standard ECG definitions were applied, and ischemia severity was graded where applicable. Associations between ECG variables and in-hospital mortality were analyzed using p values. Results: Anterior and inferior STEMI were the most common presentations, with most patients in sinus rhythm and normal heart rate at admission. QRS abnormalities, pathological Q waves, and grade 3 ischemia were observed in a subset of patients. In-hospital mortality was significantly higher in those with anterior wall involvement, tachycardia, atrial fibrillation/flutter, conduction disturbances, pathological Q waves, and grade 3 ischemia. These ECG features showed strong associations with adverse outcomes. Conclusion: Admission ECG parameters, particularly ischemia grade and conduction abnormalities, are valuable early predictors of in-hospital mortality in STEMI patients in rural tertiary-care settings.

Background: Surgical site infections (SSIs) remain a significant cause of postoperative morbidity, prolonged hospitalization, and increased healthcare costs. Understanding the microbiological spectrum and antimicrobial resistance patterns is essential for optimizing empirical therapy and infection control strategies. Methods: A prospective observational study was conducted over 18 months, enrolling 1,248 patients undergoing elective surgical procedures classified as clean or clean-contaminated. Patients developing SSI were identified using Centers for Disease Control and Prevention (CDC) criteria. Wound cultures were obtained, and bacterial isolates were subjected to identification and antimicrobial susceptibility testing using standard microbiological methods. Results: The overall SSI rate was 6.7% (84/1,248), with significantly higher rates in clean-contaminated (9.2%) compared to clean procedures (4.1%, p<0.001). Gram-positive organisms predominated in clean surgeries (68.2%), while Gram-negative bacteria were more common in clean-contaminated procedures (61.8%, p=0.002). Staphylococcus aureus was the most frequent isolate overall (34.5%), with methicillin resistance observed in 42.1% of S. aureus isolates. Extended-spectrum β-lactamase (ESBL) production was detected in 38.6% of Enterobacteriaceae. Multidrug resistance was identified in 31.0% of all isolates, with significantly higher rates in clean-contaminated SSIs (38.2% vs. 22.7%, p=0.041). Conclusion: Surgical site infections demonstrate distinct microbiological profiles based on wound classification, with concerning rates of antimicrobial resistance. These findings emphasize the need for surveillance-guided antimicrobial stewardship and procedure-specific prophylaxis protocols.

Background: Vaccine hesitancy among caregivers represents a growing public health challenge that may compromise infant immunization coverage and subsequent immune protection. However, the direct relationship between caregiver vaccine hesitancy and infant immunologic outcomes remains inadequately characterized. Methods: A prospective cohort of 412 caregiver-infant dyads was recruited from six pediatric centers. Caregiver vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines (PACV) questionnaire, with scores ≥50 indicating hesitancy. Infant serum samples were collected at 7 and 13 months of age to measure antibody responses to diphtheria, tetanus, pertussis, and measles antigens using enzyme-linked immunosorbent assays. Results: Vaccine hesitancy was identified in 23.5% of caregivers (n=97). Infants of hesitant caregivers demonstrated significantly lower geometric mean antibody titers for all measured antigens compared to infants of non-hesitant caregivers (p<0.01). Seroprotection rates were reduced in the hesitant group for diphtheria (78.4% vs. 94.6%, p<0.001), tetanus (82.5% vs. 96.2%, p<0.001), and measles (71.1% vs. 93.0%, p<0.001). Vaccination delay (≥30 days behind schedule) was observed in 67.0% of infants with hesitant caregivers versus 12.1% in the non-hesitant group (p<0.001). Conclusion: Caregiver vaccine hesitancy is significantly associated with suboptimal immunologic protection in infants, mediated primarily through vaccination delays and incomplete series completion. Targeted interventions addressing caregiver concerns are essential for ensuring adequate infant immunization.

Introduction and Objective: Epidural anaesthesia is a neuraxial technique in which anaesthetic agents are injected into the epidural space to block sensory and motor nerves supplying the thoracic, abdominal, pelvic, and lower limb regions. Many drugs are administered via the epidural route, most commonly local anaesthetics (lidocaine, bupivacaine, ropivacaine) and opioids (fentanyl, morphine, nalbuphine), along with adjuvants such as dexamethasone, ketamine, magnesium, midazolam, neostigmine, ziconotide, and baclofen. There are not many studies that directly compare bupivacaine alone versus epidural nalbuphine in combination. Aim: The study aims to compare the effects of epidural Nalbuphine and 0.5% Bupivacaine with those of 0.5% Bupivacaine alone in infra-umbilical surgeries. Methods: This prospective, randomized, comparative study included 60, ASA I-II patients undergoing elective infraumbilical surgeries. Patients were allocated into two groups: Group N received 0.5% bupivacaine with nalbuphine, and Group B received 0.5% bupivacaine alone. Outcomes assessed included onset and duration of sensory and motor blockade, postoperative analgesia using VAS scores, hemodynamic parameters, and adverse effects. Results: The onset of sensory and motor block was comparable between groups (p > 0.05). The duration of sensory and motor blockade was significantly longer in Group N compared to Group B (p < 0.001 and p = 0.006, respectively). Postoperative analgesia was superior in Group N, with significantly lower VAS scores (p < 0.001). Hemodynamic stability was better maintained in Group N, with no incidence of hypotension, whereas 20% of patients in Group B experienced hypotension. Adverse effects were minimal in both groups. Conclusion: The addition of nalbuphine to epidural bupivacaine significantly prolongs sensory and motor blockade, improves postoperative analgesia, and maintains stable hemodynamics with minimal side effects. Nalbuphine is a safe and effective adjuvant to bupivacaine for epidural anaesthesia in infraumbilical surgeries.

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. This study aimed to compare the systemic inflammatory response and postoperative pain following two tension-free methods of inguinal hernioplasty using polypropylene mesh: Transabdominal Preperitoneal Repair (TAPP) and Open Lichtenstein Hernia Repair. Methodology: This prospective randomized study included 50 patients (25 in each group) with primary unilateral inguinal hernias. Systemic inflammatory markers (C-reactive protein, ESR, lymphocytes and neutrophils) were measured preoperatively, 24 hours postoperatively and on the 10th postoperative day. Pain assessment was performed using the Visual Analog Scale (VAS) at 24 hours, 10 days, 1 month, 3 months and 6 months postoperatively. Intraoperative and postoperative complications were also recorded and compared. Results: Both groups showed similar demographic characteristics. TAPP patients had significantly shorter hospital stays (2.20 ± 0.40 days vs. 2.48 ± 0.51 days, p=0.03). While both procedures elicited inflammatory responses, CRP levels were significantly lower in the TAPP group by the 10th postoperative day (0.40 ± 0.31 mg/dl vs. 1.15 ± 1.21 mg/dl, p=0.004). Lymphocyte counts were significantly higher in the TAPP group on the 10th postoperative day (2563.28 ± 733.14 cells/mm³ vs. 1842.00 ± 260.45 cells/mm³, p<0.001). Pain scores at 24 hours postoperatively were significantly lower in the TAPP group (5.64 ± 0.76 vs. 7.16 ± 0.94, p<0.001), though this difference diminished by the 10th day. Both procedures had similar complication profiles with low incidence of seroma (8%) and infection (2%) and no recurrences during the follow-up period. Conclusion: TAPP repair offers advantages over Open Lichtenstein repair in terms of reduced inflammatory response, lower immediate postoperative pain and shorter hospital stay. Both techniques demonstrate similar safety profiles and long-term pain outcomes, suggesting that surgeon expertise and patient factors should guide the choice between these effective approaches.

Background: The COVID-19 pandemic witnessed an unprecedented surge in mucormycosis cases, particularly among patients with uncontrolled diabetes mellitus and corticosteroid exposure. Understanding the microbiological spectrum and antifungal susceptibility patterns of causative agents is essential for optimizing therapeutic strategies. Methods: This prospective observational study was conducted. Clinical specimens from 156 confirmed CAM patients were processed for fungal culture, molecular identification, and antifungal susceptibility testing using the broth microdilution method following CLSI M38-A2 guidelines. Results: Among 156 patients, culture positivity was achieved in 124 cases (79.5%). Rhizopus arrhizus was the predominant species (58.1%), followed by Rhizopus microsporus (16.9%), Mucor circinelloides (10.5%), and Lichtheimia corymbifera (8.1%). Rhino-orbital-cerebral mucormycosis was the most common presentation (82.7%). Diabetes mellitus was present in 142 patients (91.0%), with mean HbA1c of 10.8 ± 2.4%. Among antifungals tested, amphotericin B demonstrated lowest geometric mean MIC (0.38 µg/mL), followed by posaconazole (0.52 µg/mL) and isavuconazole (0.86 µg/mL). Elevated MICs to amphotericin B (≥2 µg/mL) were observed in 8.9% of isolates. All isolates showed high MICs to fluconazole (>64 µg/mL) and voriconazole (>8 µg/mL). Mortality rate was 34.6%, with significantly higher mortality in disseminated disease (71.4%) compared to localized infection (28.2%, p<0.001). Conclusion: Rhizopus arrhizus remains the predominant etiological agent in CAM. While amphotericin B and posaconazole maintain good in vitro activity, emergence of isolates with elevated MICs warrants continued surveillance. Species-level identification and susceptibility testing are crucial for optimizing antifungal therapy.

Background: Fetuin-A is a hepatokine implicated in insulin resistance and vascular dysfunction in type 2 diabetes mellitus. Its role as a biomarker linking metabolic derangement and vascular complications remains under investigation. Objectives: To evaluate the association of serum fetuin-A levels with insulin resistance severity and vascular complications in individuals with type 2 diabetes mellitus. Methods: A cross-sectional analytical study was conducted among 120 patients with T2DM. Serum fetuin-A, insulin resistance indices, and vascular complications were assessed and analyzed using multivariate statistical methods. Results: Patients with vascular complications demonstrated significantly lower serum fetuin-A levels. Fetuin-A emerged as an independent predictor of vascular complications after adjusting for glycemic control, insulin resistance, and renal parameters. Conclusion: Serum fetuin-A may serve as a valuable biomarker for vascular complications in type 2 diabetes mellitus.

Background: Despite metformin being the established first-line pharmacotherapy for type 2 diabetes mellitus, many patients require additional antidiabetic agents to achieve glycemic targets. The comparative effectiveness of second-line oral antidiabetic drug classes in real-world clinical settings requires further evaluation. Methods: A prospective observational study was conducted involving 180 patients with inadequately controlled type 2 diabetes on metformin monotherapy, who were prescribed either sulfonylurea (n=60), DPP-4 inhibitor (n=60), or SGLT-2 inhibitor (n=60) as add-on therapy. Glycemic parameters, body weight, and adverse events were assessed at baseline and after 24 weeks of treatment. Results: All three drug classes significantly reduced HbA1c from baseline. The SGLT-2 inhibitor group demonstrated the greatest HbA1c reduction (-1.18 ± 0.42%), followed by sulfonylurea (-1.08 ± 0.48%) and DPP-4 inhibitor (-0.86 ± 0.38%) groups (p=0.001). Significant weight reduction occurred with SGLT-2 inhibitors (-2.84 ± 1.42 kg; p<0.001), while weight gain was observed with sulfonylureas (+1.62 ± 1.18 kg; p<0.001). Hypoglycemia incidence was highest with sulfonylureas (18.3% vs. 3.3% DPP-4 inhibitors vs. 5.0% SGLT-2 inhibitors; p=0.006). Conclusion: SGLT-2 inhibitors and sulfonylureas provide superior glycemic efficacy compared to DPP-4 inhibitors when added to metformin, with SGLT-2 inhibitors offering additional weight reduction benefits and lower hypoglycemia risk.

Background: Diabetic foot ulcers (DFUs) represent a major complication of diabetes mellitus, associated with significant morbidity, mortality, and healthcare costs. The optimal management strategy—conservative versus surgical intervention—remains debated, particularly for moderate-severity ulcers where either approach may be appropriate. Methods: This prospective comparative study enrolled 186 patients with diabetic foot ulcers (Wagner grades 2-4). Patients were categorized into conservative management group (n=92) receiving standard wound care, offloading, and antibiotics, and surgical management group (n=94) undergoing debridement with or without reconstructive procedures. Primary outcomes included complete wound healing rate and time to healing. Secondary outcomes included amputation rate, recurrence, and quality of life. Results: Complete wound healing was achieved in 67.4% of conservative group versus 81.9% of surgical group (p=0.021). Median time to healing was significantly shorter in surgical group (8.4 ± 3.2 weeks vs. 14.6 ± 5.8 weeks, p<0.001). Major amputation rate was lower in surgical group (5.3% vs. 13.0%, p=0.048). Ulcer recurrence at 12 months was comparable between groups (18.5% vs. 15.9%, p=0.642). Multivariate analysis identified Wagner grade ≥3 (OR: 3.42, 95% CI: 1.68-6.94, p<0.001), peripheral arterial disease (OR: 2.86, 95% CI: 1.42-5.76, p=0.003), and HbA1c >9% (OR: 2.14, 95% CI: 1.12-4.08, p=0.021) as independent predictors of treatment failure. Conclusion: Surgical management demonstrates superior healing rates, shorter healing times, and reduced major amputation rates compared to conservative treatment in moderate-to-severe diabetic foot ulcers. Early surgical intervention should be considered for appropriately selected patients.

Background: Early identification of Autism Spectrum Disorder (ASD) is crucial for timely intervention and improved developmental outcomes. However, debate persists regarding whether universal screening protocols yield superior diagnostic timing compared to targeted screening approaches based on clinical concern or risk factors. Methods: This population-based retrospective cohort study compared diagnostic timing outcomes between universal screening (US) and targeted screening (TS) protocols across 24 pediatric primary care practices in a metropolitan healthcare network. Children born between January 2018 and December 2020 were followed until ASD diagnosis. The primary outcome was age at ASD diagnosis. Secondary outcomes included screening sensitivity, positive predictive value, and time from initial concern to diagnosis. Results: Among 18,742 children enrolled, 312 (1.67%) received an ASD diagnosis. Children in the US cohort (n=156) received diagnosis significantly earlier than those in the TS cohort (n=156), with mean ages of 26.4 ± 8.2 months versus 34.7 ± 11.6 months (p<0.001). Universal screening demonstrated higher sensitivity (78.3% vs. 52.1%, p<0.001) with comparable positive predictive values (41.2% vs. 43.8%, p=0.62). Time from initial screening to diagnosis was reduced by 8.3 months in the US cohort (95% CI: 6.1–10.5, p<0.001). Children identified through universal screening showed increased enrollment in early intervention services before age 36 months (84.6% vs. 61.5%, p<0.001). Conclusion: Universal autism screening significantly reduces age at diagnosis and facilitates earlier intervention enrollment compared to targeted screening approaches. Implementation of standardized universal screening protocols in pediatric primary care may substantially improve developmental trajectories for children with ASD.

Background: Urinary tract infections are among the most common infectious diseases encountered in clinical practice. Although Escherichia coli remains the predominant uropathogen, Enterococcus species have emerged as important pathogens, particularly in healthcare-associated infections. The increasing prevalence of Vancomycin-resistant Enterococcus is a serious therapeutic and infection control challenge worldwide. This study sought to determine the distribution of bacterial uropathogens, characterize Enterococcus species with emphasis on vancomycin resistance and assess gastrointestinal colonization as a potential reservoir for infection. Materials and Methods: In a prospective manner, a total of 250 urine samples were collected from patients presenting with suspected UTIs. Isolation and identification of uropathogens were done using standard microbiological techniques. The Enterococcus isolates were screened phenotypically for vancomycin resistance and differentiated into species level, Enterococcus faecalis and Enterococcus faecium. Stool samples from the patients with enterococcal UTIs were cultured to assess the gastrointestinal colonization. Results: Of the total 250 urine specimens analyzed, 147 (58.8%) had evidence of bacteriuria. E. coli was most predominantly isolated (56.5%), followed by Enterococcus spp. (25.2%), Klebsiella pneumoniae (12.2%), and then by Staphylococcus spp. (6.1%). Of the total 37 Enterococcus species isolated, 12 (32.4%) were Vancomycin-resistant Enterococcus (VRE), and 25 (67.6%) were susceptible to Vancomycin. Of 12 Vancomycin-resistant Enterococcus species, 7 (58%) were E. faecium, while 5 (42%) were E. faecalis. Among the non-VRE species, 15 (60%) were E. faecium, and 10 (40%) were E. faecalis gastrointestinal colonization were seen. Conclusion: Enterococci species, such as VRE, constitute a large percentage of uropathogens, and their ability to colonize the gastrointestinal tract adds to the importance of the gastrointestinal tract as a reservoir. Strict surveillance is required to contain the spread of resistance among enterococci.

Background: Medical students undergo tremendous academic load, clinical exposure, and emotional pressure, and they have a greater incidence of depression, anxiety, and stress. Conventional methods of management such as counselling and pharmacotherapy have a low rate of success among them. Hasya Yoga (Laughter Yoga), introduced by Dr. Madan Kataria, is an eclectic combination of voluntary laughter, yogic breathing, clapping and group interaction to promote psychological well-being. Objectives: To evaluate the impact of Hasya Yoga on depression, anxiety, and stress levels in first-year MBBS students of Maharashtra using the DASS-21 (Depression, Anxiety, Stress Scale). Material and Methods: An interventional, randomized controlled trial was conducted among 120 first-year MBBS students from Maharashtra. Random allocation was done for the participants into an intervention (Study) group (n=60) receiving Hasya Yoga and a control group (n=60) to which no intervention was provided. Intervention in study group was for 40 minutes daily, 5 times a week, for 4 weeks. Pre- and post-intervention DASS-21 was administered. Statistical analysis was conducted using paired and unpaired t-tests and Pearson’s correlation. Results and Analysis: Post Hasya yoga intervention, the study group showed a highly significant reduction in the three parameters: depression (18.7 ± 4.4 to 9.8 ± 3.6), anxiety (17.3 ± 4.1 to 8.5 ± 3.3), and stress (21.4 ± 4.6 to 12.3 ± 3.8). Post-intervention scores of the study group were significantly lower than the control group. A strong negative Correlation was found between Hasya Yoga Practice and Depression, Anxiety & Stress Scores. Conclusion: Hasya Yoga is a simple, cost-effective, and non-pharmacological intervention that effectively reduces depression, anxiety, and stress in medical students. Its inclusion in medical curricula may offer a long-term solution for mental health promotion.

Background: Children with congenital heart disease (CHD) frequently exhibit immune dysregulation that may influence postoperative recovery following cardiac surgery. However, comprehensive characterization of early-life immune profiles and their predictive value for surgical outcomes remains limited. Methods: A total of 186 infants (aged 1-12 months) undergoing surgical repair for CHD were enrolled. Preoperative immune profiling included lymphocyte subset enumeration, immunoglobulin quantification, T-cell receptor excision circle (TREC) analysis, and cytokine assessment. Primary outcomes included postoperative infections, intensive care unit (ICU) length of stay, and 30-day mortality. Results: Compared to age-matched healthy controls (n=50), CHD infants demonstrated significantly reduced CD4+ T-cell counts (1,842 ± 624 vs. 2,856 ± 718 cells/μL, p<0.001), lower TREC levels (median 42 vs. 128 copies/μL, p<0.001), and decreased IgG concentrations (412 ± 156 vs. 586 ± 142 mg/dL, p<0.001). Postoperative infections occurred in 31.7% of patients. Preoperative CD4+ counts <1,500 cells/μL (OR 3.42, p=0.002), TREC levels <30 copies/μL (OR 2.87, p=0.008), and cyanotic defects (OR 2.24, p=0.021) were independently associated with postoperative infections. ICU stay was prolonged in patients with immune deficiencies (8.4 ± 4.2 vs. 5.1 ± 2.8 days, p<0.001). Conclusion: Infants with CHD demonstrate significant immune abnormalities prior to surgery, and preoperative immune profiling identifies patients at elevated risk for postoperative complications. Integration of immune assessment into preoperative evaluation may facilitate risk stratification and targeted immunomodulatory interventions.

Fungal keratitis causes significant corneal blindness in tropical regions, primarily from Aspergillus and Fusarium species, with dematiaceous fungi like Curvularia emerging as pathogens following ocular trauma with soil or vegetation. Rare species such as Fusarium chlamydosporum and Aspergillus nidulans can produce rapidly progressive keratitis. This case series reports three instances of post-traumatic fungal keratitis due to Curvularia lunata (58-year-old male, wooden particle injury), Fusarium chlamydosporum (54-year-old male, outdoor exposure), and Aspergillus nidulans (28-year-old male, concrete trauma), confirmed morphologically via culture. Each responded favourably to topical natamycin combined with oral itraconazole or voriconazole within two weeks, achieving ulcer healing without surgery. These findings from a small case series highlight rare mycotic etiologies, underscore the critical role of clinical expertise, and demonstrate the value of early culture-guided antifungal therapy for trauma-related mycotic corneal ulcers in resource-limited settings.