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.

Background: Pneumonia remains a major cause of morbidity and mortality worldwide, particularly in developing countries like India. Regional data on clinical presentation, microbiological etiology, radiological patterns, and outcomes are essential for optimizing management strategies. Objectives: To study the clinical, microbiological, and radiological profile of adult pneumonia patients and to determine their outcomes using severity assessment tools. Methods: This prospective observational study included 50 adult inpatients with clinically and radiologically confirmed pneumonia at a tertiary care teaching hospital. Detailed clinical evaluation, laboratory investigations, sputum microbiology, radiological assessment, and severity scoring using CURB-65 and Pneumonia Severity Index (PSI) were performed. Patients were followed until discharge or death. Results: The mean age of patients was 55.2 ± 14.3 years, with male predominance (68%). Cough (94%) and fever (78%) were the most common symptoms. Diabetes mellitus (38%) was the most frequent comorbidity. Klebsiella pneumoniae (26%) and Pseudomonas aeruginosa (20%) were the most commonly isolated organisms. Lower lobe involvement was predominant on imaging. Most patients had CURB-65 scores ≤2. Overall mortality was 10%, predominantly among patients with higher CURB-65 scores and those requiring ICU care. Conclusion: Pneumonia predominantly affected older males and commonly presented with cough and fever. Gram-negative organisms were frequent etiological agents. Severity scores such as CURB-65 were effective in predicting outcomes and guiding the level of care.

Background: Degenerative rotator cuff tears extending into the full thickness are common and often symptomatic, but the best management of these individuals will never be seen to agree. While structured physiotherapy offers a sustained improvement in symptoms for many patients, surgical repair of the injury may be superior in terms of function in selected patients but do carry a risk of a retear and a greater resource use. Methods: This emulated study manuscript adopts a retrospective approach using a comparison group from a tertiary shoulder service at the time of data collection. Adults between age 45-75 years with degenerative full-thickness supraspinatus + infraspinatus tears confirmed by MRI were managed initially with either (1) structured conservative care (12-week standardized physiotherapy protocol +/subacromial corticosteroid injection) or (2) arthroscopic rotator cuff repair with standardized rehabilitation. Propensity-score matching (1:1) of age, sex, size of tear, baseline Constant-Murley score, diabetes, smoking, and duration of symptoms. Primary outcome was 12 month Constant-Murley Score. The secondary outcomes were ASES, VAS pain and ROM, strength, satisfaction, complications and MRI integrity at 12 months. Mixed-effects models were used to estimate the differences between groups. Results: Following matching, 140 (70 patients in each group) were analysed. At 12 months of age, surgical repair was associated with both higher Constant Murley scores (mean 78.4±10.2, V madian 71.1±11.8, adjusted mean difference [AMD] 7.0, 95% CI 3.3-10.7, p<0.001) and ASES (86.8±12.0, V madian 80.1±13.6, AMD 6.1 (-1.8-10.4), p=0. Retear/nonhealing on MRI was observed 18.6% of surgical patients and tear enlargement >5 mm was observed 28.6% of conservative patients (p=0.16). Conclusion: In terms of this worked example, repairing on Arthroscopically the results were found to be modestly better but significantly better function and pain at 12 months when compared with structured conservative therapy, although the imaging results had traded off between the integrity of the repairs and the progression of the tears. These findings are consistent with findings from randomized evidence which suggests small to moderate functional benefits of repair in selected degenerative tears.

Background: Post-spinal hypotension has a negative impact on parturients and fetal outcome. Parturients may suffer from nausea and vomiting, and the fetus will have acidosis and a lower Apgar score. Hence, prevention of hypotension will be safer for both mother and fetus. Method: 60 (sixty) obstetric patients undergoing spinal anesthesia for cesarean section were studied. ASA grade II, BMI 35 kg/m², pleth variability index, and perfusion index were measured before and after spinal anesthesia. The data was analyzed using ROC and multiple linear regression. Results: In the hypotension group, PVI and PI at one minute are higher than without-hypotension (controlled) group. PVI at one minute is an independent factor for predicting hypotension following spinal anesthesia (p < 0.001). It has significant sensitivity and specificity. The comparative study between the hypotension group and the controlled group had a significant p-value (p<0.001). Conclusion: Baseline PVI is not a predictor of hypotension, but a one-minute PVI value >19.2 can predict hypotension following spinal anesthesia, and a one-minute PI ≥ 5.13 is more ideal to predict hypotension.

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by cardiovascular comorbidities, yet the relationship between the extent of parenchymal destruction quantified by computed tomography (CT) and cardiac functional parameters remains incompletely characterized. Understanding this association may facilitate early identification of patients at risk for cardiac dysfunction and guide integrated management strategies. Methods: This cross-sectional observational study enrolled 196 patients with stable COPD (GOLD stages I–IV) from a tertiary pulmonary center. Quantitative CT analysis was performed to determine the low attenuation area percentage below −950 Hounsfield units (LAA−950%) as a measure of emphysema severity. Cardiac function was assessed using transthoracic echocardiography, including left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and estimated pulmonary artery systolic pressure (PASP). Correlations were examined using Pearson and Spearman analyses, and multivariable linear regression was performed adjusting for confounders. Results: The mean age was 64.7 ± 9.2 years, and 68.4% were male. The mean LAA−950% was 18.3 ± 12.6%. Patients with severe emphysema (LAA−950% ≥ 25%) demonstrated significantly lower LVEF (56.1 ± 7.8% vs. 62.4 ± 6.1%, p < 0.001), reduced RVFAC (32.4 ± 6.9% vs. 39.7 ± 5.8%, p < 0.001), decreased TAPSE (16.2 ± 3.4 mm vs. 20.8 ± 3.1 mm, p < 0.001), and elevated PASP (42.6 ± 11.3 mmHg vs. 29.4 ± 8.7 mmHg, p < 0.001). LAA−950% was independently associated with RVFAC (β = −0.38, p < 0.001) and PASP (β = 0.44, p < 0.001) after multivariable adjustment. Conclusion: Emphysema severity quantified by CT densitometry is independently and significantly associated with both right and left cardiac dysfunction in COPD patients. Quantitative CT may serve as a valuable adjunctive tool for cardiovascular risk stratification in this population.

Background: Recurrent tonsillitis is a common pediatric condition characterized by repeated episodes of inflammation of the palatine tonsils, most often caused by viral or bacterial infections, particularly Group A β-hemolytic Streptococcus. Children typically present with recurrent sore throat, fever, dysphagia, cervical lymphadenopathy, halitosis, and tonsillar exudates, which can significantly affect school attendance and quality of life. Diagnosis is primarily clinical, supported by throat culture or rapid antigen detection tests when bacterial infection is suspected. Management includes symptomatic treatment with analgesics and antipyretics, and appropriate antibiotic therapy for confirmed bacterial tonsillitis. Preventive strategies focus on infection control and adequate treatment of acute episodes. Tonsillectomy is considered in children with severe or frequent recurrences, complications, or failure of medical management, following established clinical criteria. Early recognition and appropriate management are essential to reduce morbidity and prevent complications. Conclusion: Recurrent tonsillitis is a common pediatric condition that significantly affects a child’s health, school attendance, and quality of life. It is most frequently seen in school-aged children and is commonly associated with recurrent sore throat, fever, dysphagia, and cervical lymphadenopathy. Group A β-hemolytic Streptococcus remains the most important bacterial pathogen implicated in recurrent infections.

Background: Hearing loss is increasingly recognized as a common but underdiagnosed complication in patients with diabetes mellitus and hypertension. Both conditions contribute to microvascular damage, oxidative stress, and neuropathic changes that can impair cochlear function and auditory nerve pathways. This abstract reviews the association between diabetes, hypertension, and hearing impairment, highlighting possible mechanisms, clinical patterns, and the importance of early screening. Evidence suggests that individuals with diabetes have a higher prevalence of sensorineural hearing loss, often affecting high-frequency thresholds, while hypertension may worsen cochlear blood flow and accelerate age-related auditory decline. The coexistence of diabetes and hypertension appears to increase the risk and severity of hearing impairment compared to either condition alone. Early identification through routine audiological evaluation, along with strict glycemic and blood pressure control, may help reduce progression and improve quality of life. Integrating hearing assessment into chronic disease management can support timely intervention, including counseling, hearing aids, and preventive strategies. Conclusion: Hearing loss is a frequent and often overlooked complication in patients with diabetes and hypertension, mainly presenting as sensorineural hearing loss. The combined effect of poor glycemic control and elevated blood pressure can worsen cochlear microvascular damage and neuropathy, increasing both the risk and severity of auditory impairment. Routine hearing screening, early diagnosis, and strict control of blood sugar and blood pressure are essential to prevent progression and improve overall quality of life in these patients.

Background: Intra-abdominal infections (IAIs) represent a significant cause of surgical morbidity and mortality, characterized by polymicrobial etiology involving complex interactions between aerobic and anaerobic pathogens. Comprehensive characterization of the microbial spectrum and its impact on clinical outcomes remains essential for optimizing antimicrobial therapy. Methods: A prospective observational study was conducted over 24 months, enrolling 324 patients undergoing surgical intervention for complicated intra-abdominal infections. Intraoperative specimens were collected for aerobic and anaerobic culture using standardized protocols. Bacterial identification and antimicrobial susceptibility testing were performed using conventional and molecular methods. Clinical outcomes including treatment success, complications, and mortality were assessed. Results: Polymicrobial infections were identified in 78.4% of cases, with a mean of 3.2 ± 1.4 isolates per patient. Aerobic organisms were recovered in 94.1% of cases, while anaerobes were isolated in 67.6%. Escherichia coli (58.3%) and Bacteroides fragilis (42.0%) were the predominant aerobic and anaerobic pathogens, respectively. Mixed aerobic-anaerobic infections demonstrated higher treatment failure rates (24.2% vs. 12.8%, p=0.018) and prolonged hospitalization (16.4 ± 8.2 vs. 11.8 ± 5.6 days, p<0.001) compared to purely aerobic infections. Overall mortality was 8.6%, with anaerobic presence independently associated with mortality risk (OR 2.34, 95% CI 1.12-4.89, p=0.024). Conclusion: Intra-abdominal surgical infections exhibit complex polymicrobial ecology with significant anaerobic involvement. Mixed aerobic-anaerobic infections are associated with worse clinical outcomes, emphasizing the importance of appropriate anaerobic coverage in empirical antimicrobial regimens.

Background: Multiple considerations exist for the anesthesiologists in covid-19 recovered patients with added problems arising due to rhino-orbital-cerebral mucormycosis and adverse effects of antifungal drugs. Overall morbidity and mortality are more in such patients. Managing such patients posted for surgical debridement presents a unique challenge to the anesthesiologist. Methods: A retrospective analysis of 118 patients operated for surgical debridement and histopathology confirmed mucormycosis cases were analysed from the medical record. A review of preoperative clinical and laboratory data, intraoperative anaesthesia details and postoperative outcome was done. Results: 118 confirmed mucormycosis patients were analysed. 98 patients tested covid positive, out of which 73 were hospitalized. 101 patients presented with diabetes mellitus. 53 patients were operated after 8 weeks of corona virus infection. 41 patients had increased creatinine levels. 7 patients presented with difficult intubation. Intraoperatively anesthesia concerns were tachycardia, hypertension, tachycardia combined with hypotension, arrythmias, hyperglycemia, raised end tidal carbon dioxide concentration (ETCO2), increased peak airway pressure and oozing in various patients. All patients were extubated. Postoperatively, 15 patients required oxygen, 92 were discharged and death resulted in 9 patients. Conclusion: Knowledge of disease, preoperative optimization and proper preparation of patients and postoperative icu care is must for successful management of mucormycosis patients undergoing surgical debridement.

Background: Childhood vaccination remains one of the most effective public health interventions globally. However, variability in immune responses among vaccinated children suggests that factors beyond vaccine formulation and administration influence immunogenicity. Social determinants of health (SDOH)—including household income, parental education, nutritional status, housing conditions, and access to healthcare—may modulate vaccine-induced immunity through complex biological and behavioral pathways. Despite growing recognition of health inequities, the relationship between SDOH and vaccine immunogenicity in children remains insufficiently characterized. Methods: A cross-sectional analytical study was conducted among 412 children aged 12–24 months attending primary healthcare centers in an urban setting. Sociodemographic data were collected using a structured questionnaire addressing household income, parental education, housing density, food security, and healthcare access. Nutritional status was assessed anthropometrically. Serum antibody titers against measles, diphtheria, and hepatitis B were measured using enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression was used to identify independent predictors of suboptimal immune response. Results: Among participants, 23.1% demonstrated suboptimal antibody titers to at least one antigen. Children from low-income households had significantly lower geometric mean titers (GMTs) for measles (1,245 ± 487 vs. 2,118 ± 612 mIU/mL; p < 0.001) and diphtheria (0.82 ± 0.34 vs. 1.47 ± 0.51 IU/mL; p < 0.001) compared to higher-income counterparts. Stunting (OR = 2.31; 95% CI: 1.42–3.76; p = 0.001), low maternal education (OR = 1.89; 95% CI: 1.18–3.02; p = 0.008), and food insecurity (OR = 2.14; 95% CI: 1.33–3.44; p = 0.002) were independent predictors of suboptimal immune response. Conclusion: Social determinants of health significantly influence immune responses to routine childhood vaccinations. Addressing socioeconomic inequities may enhance vaccination effectiveness and reduce disparities in vaccine-preventable disease burden.

Background: Thyroid hormone insufficiency is the hallmark of hypothyroidism, a common endocrine condition that profoundly affects cellular metabolism. According to recent research, hypothyroidism and increased cardiovascular risk are strongly correlated and may be mediated by hyperhomocysteinemia. The metabolism of homocysteine (Hcy) is closely associated with B vitamins, particularly folate and vitamin B12. Objective: This study’s main goals were to assess serum homocysteine and vitamin B12 levels in patients with primary hypothyroidism in comparison to healthy controls and to examine the relationship between these metabolic markers and thyroid function parameters (TSH, fT₃, and fT₄) in an Eastern Indian population. Methods: Over the course of six months, the Department of General Medicine and Biochemistry at Patna Medical College and Hospital (PMCH), Patna, carried out this observational cross-sectional study. 115 patients with primary hypothyroidism and 115 healthy controls who were matched for age and sex made up the study population. Chemiluminescence immunoassay (CLIA) was used to evaluate the levels of serum free T₃ (fT₃), free T₄ (T₄), thyroid stimulating hormone (TSH), vitamin B12, and homocysteine. Using SPSS version 26.0, statistical analysis was carried out, utilizing Pearson’s correlation coefficient to evaluate associations between variables and the student’s t-test for group comparisons. Results: In comparison to controls (2.3 ±1.1 mIU/mL), the mean serum TSH in the case group was considerably higher (14.2 ± 6.1 mIU/mL). The mean serum homocysteine levels of hypothyroid patients were substantially higher ( ) than those of the control group (10.2 ± 3.1 mIU/mL; p<0.001). On the other hand, hypothyroid patients had considerably lower mean vitamin B12 levels (210 ± 85 pg/mL) than controls (450 ± 112 mIU/mL; p<0.001). TSH and homocysteine showed a substantial positive association (r=0.68, p < 0.01) whereas TSH and vitamin B12 levels showed a negative correlation. Conclusion: The study shows a high correlation between low levels of vitamin B12, hyperhomocysteinemia, and hypothyroidism. These results imply that those with hypothyroidism are more susceptible to cardiovascular events and atherosclerosis. To reduce long-term metabolic and cardiovascular problems, routine monitoring for serum homocysteine and vitamin B12 is advised in hypothyroid therapy.

Background: Lung function parameters are linked to body mass index (BMI), which is a frequent predictor of overweight and obesity as well as body size. The simplest test for diagnosing lung disease is the pulmonary function test. Objective: To study the association of BMI and pulmonary function. Material and Methods: 110 participants in the 18–22 age range participated in the current cross-sectional prospective study, which was carried out in Nalanda medical college and hospital, Bihar. Participants having a history of smoking, cardiovascular diseases, bronchial asthma, restrictive lung diseases, or other respiratory conditions were not allowed to participate in the study. The Medical College’s Ethical Committee gave its approval to the project. PFT, anthropometry, and the subject’s demographic profile were among the data. The resulting data was tallied and statistical analysis was performed. Results:  Participants who were obese showed noticeably lower FVC and FEV₁ than those with normal BMI. In all BMI categories, the FEV₁/FVC ratio stayed within normal bounds, indicating a primarily restrictive pattern of lung damage in those with higher BMIs. Conclusion: Compared to individuals with a normal BMI, those who are underweight or obese have worse lung function measures. Fostering the best potential respiratory health may depend on maintaining a healthy body mass index (BMI) through regular exercise and a well-balanced diet.

Introduction: Smoking is a significant global health issue, with a rising prevalence among younger populations, and is known to detrimentally impact the respiratory system. Lung function tests may reveal a decline in pulmonary function before the emergence of clinical symptoms, allowing for early detection and intervention. Cigarette smoking contributes to the onset of malignancies, cardiovascular illnesses, and respiratory conditions, including COPD. It presents a health issue in mitigating morbidity and mortality in developing nations such as India. Spirometry in smokers may indicate a decline in lung function metrics. Materials and Methods: A cross-sectional study was conducted in conducted at Nalanda medical college and hospital, Patna, Bihar on 107 smokers and non-smokers asymptomatic male subjects. Spirometry by RMS Helios spirometer 401 was conducted according to American Thoracic society guidelines after enrolling the subject based on inclusion and exclusion criteria and collected data was analysed with independent t-test was used to compare smokers and non-smokers Results: The groups were comparable in the parameters of weight, height, and age, and body mass index. The mean FEV₁, FVC, and PEFR values were considerably lower in smokers than in non-smokers (p < 0.05). Smokers also had a lower FEV₁/FVC ratio, which suggests an obstructive pattern of lung damage. Lower spirometric indices show that smokers have substantially worse lung function than non-smokers. Conclusion: All lung function test values exhibit a considerable reduction in asymptomatic smokers compared to non-smokers. Consequently, performing spirometry, particularly in smokers, may facilitate the early detection of cases and subsequently reduce morbidity.

Background: Psychological distress has been increasingly recognized as a contributing factor to cardiovascular dysfunction. Alterations in cardiac autonomic regulation may represent early physiological changes linking psychological stress to future cardiovascular risk. Objective: To evaluate the association between psychological distress and cardiovascular autonomic function in young adults using resting cardiovascular parameters and short-term heart rate variability (HRV) analysis. Methods: This cross-sectional study included 100 young adults aged 18–25 years, comprising 50 healthy controls and 50 psychologically distressed participants categorized using a validated self-reported stress scale. Resting heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded under standardized laboratory conditions. Short-term HRV was assessed from 360-second R–R interval recordings using Kubios software. Time-domain (Mean RR, SDNN, RMSSD, NN50, pNN50) and frequency-domain (Total Power, LF, HF, LF/HF ratio) parameters were analyzed. Pearson correlation was used to assess associations between stress scores and HRV indices. Results: Psychologically distressed participants demonstrated significantly higher resting HR, SBP, and DBP compared to controls (p < 0.01). Time-domain HRV parameters were significantly reduced in the distressed group, including Mean RR, SDNN, RMSSD, NN50, and pNN50 (p < 0.001). Frequency-domain analysis revealed significantly lower Total Power and HF power, with significantly higher LF power and LF/HF ratio (p < 0.001), indicating sympathetic predominance and reduced parasympathetic modulation. Stress scores showed strong negative correlations with parasympathetic indices (r ranging from –0.55 to –0.65) and positive correlations with LF power and LF/HF ratio (r = 0.48 and 0.66, respectively; p < 0.001). Conclusion: Psychological distress in young adults is significantly associated with cardiovascular autonomic imbalance characterized by reduced vagal activity and increased sympathetic dominance. These findings suggest that psychological distress may contribute to early autonomic dysregulation and potential long-term cardiovascular risk.

Background: Laryngoscopy and intubation trigger sympathetic surges that increase heart rate (HR) and blood pressure (BP), posing significant risks for patients with coronary artery disease (CAD). Dexmedetomidine, a sympatholytic alpha-2 agonist, may mitigate these stress responses. Aim: To compare the effectiveness and safety of intravenous (IV) versus nebulized dexmedetomidine in attenuating hemodynamic stress responses during laryngoscopy and intubation in CAD patients undergoing elective coronary artery bypass grafting (CABG). Materials and Methods: Seventy-eight elective CABG patients were randomized into two groups (n=39 each). Group A received nebulized dexmedetomidine (1 µg/kg) over 10 minutes, while Group B received IV dexmedetomidine (1 µg/kg) over 10 minutes. HR, systolic BP, diastolic BP, and mean arterial pressure (MAP) were monitored at baseline and peri- intubation. Results: Both routes effectively blunted the pressor response to laryngoscopy. However, the IV group experienced a more precipitous decline in MAP and a significantly higher incidence of bradycardia and hypotension. Nebulized administration maintained superior cardiovascular stability and was associated with a lower incidence of postoperative sore throat. Post-operative recovery times were comparable between groups. Conclusion: While both routes attenuate hemodynamic responses during laryngoscopy and intubation in CAD patients, nebulized dexmedetomidine is a clinically advantageous, non- invasive alternative for high-risk CAD patients. Its superior safety profile—specifically the reduced risk of cardiovascular instability—makes it a viable and attractive option for perioperative management.

Background: Hypothyroidism is a common endocrine disorder with significant metabolic consequences. Apart from iodine, trace elements such as zinc (Zn) and copper (Cu) play an essential role in thyroid hormone synthesis, metabolism, and action. Alterations in these micronutrients may contribute to the pathophysiology of hypothyroidism. Aim: To evaluate serum zinc and copper levels in patients with hypothyroidism and compare them with euthyroid healthy controls, and to assess their association with thyroid hormone levels. Materials and Methods: This hospital-based case–control study included 100 subjects aged 18–65 years. Fifty patients with biochemically confirmed hypothyroidism constituted the case group, while fifty age- and sex-matched euthyroid individuals served as controls. Serum T3, T4, and TSH were estimated by chemiluminescence immunoassay. Serum zinc and copper levels were measured using spectrophotometric methods. Statistical analysis was performed using Student’s t-test and correlation analysis. Results: Mean serum zinc levels were significantly lower in hypothyroid patients compared to controls (32.3 ± 19.1 vs 86.0 ± 17.9 µg/dL; p < 0.001). Serum copper levels showed no statistically significant difference between cases and controls (p > 0.05). Serum zinc demonstrated a significant negative correlation with TSH and a positive correlation with T3 and T4 levels. Conclusion: Hypothyroidism is associated with significantly reduced serum zinc levels, while serum copper levels remain largely unchanged. Zinc deficiency may play an important contributory role in thyroid dysfunction and may warrant attention during clinical evaluation of hypothyroid patients.

Background: Heart failure with reduced ejection fraction (HFrEF) is characterized by progressive left ventricular (LV) remodeling driven by maladaptive fibrotic and inflammatory processes. Galectin-3 (Gal-3), a β-galactoside-binding lectin implicated in myocardial fibrosis and inflammation, has emerged as a promising biomarker for risk stratification in heart failure. However, the precise relationship between circulating Gal-3 concentrations and echocardiographic parameters of LV remodeling across varying HFrEF severities remains insufficiently characterized. Methods: This cross-sectional analytical study enrolled 286 patients with established HFrEF (left ventricular ejection fraction [LVEF] ≤40%) at a tertiary cardiac center. Serum Gal-3 levels were quantified using enzyme-linked immunosorbent assay (ELISA). Comprehensive transthoracic echocardiography was performed to assess LV end-diastolic volume index (LVEDVi), LV end-systolic volume index (LVESVi), LV mass index (LVMi), LVEF, left atrial volume index (LAVi), and global longitudinal strain (GLS). Correlation and multivariable regression analyses were performed to evaluate associations between Gal-3 and remodeling parameters. Results: The median serum Gal-3 level was 21.4 ng/mL (IQR: 15.8–29.6). Patients in the highest Gal-3 tertile (>26.2 ng/mL) demonstrated significantly greater LVEDVi (118.4 ± 32.6 vs. 86.2 ± 24.8 mL/m²; p < 0.001), LVMi (148.6 ± 38.4 vs. 112.8 ± 28.6 g/m²; p < 0.001), and worse GLS (−8.2 ± 2.4% vs. −12.6 ± 3.1%; p < 0.001) compared to the lowest tertile. In multivariable analysis, Gal-3 remained independently associated with LVEDVi (β = 0.34; p < 0.001), LVMi (β = 0.31; p < 0.001), and GLS (β = 0.28; p = 0.001) after adjustment for age, NT-proBNP, estimated glomerular filtration rate, and NYHA functional class. Conclusion: Elevated serum Gal-3 levels are independently associated with adverse LV remodeling parameters in HFrEF patients, suggesting that Gal-3 may serve as a clinically informative biomarker reflecting the degree of myocardial structural deterioration beyond conventional markers.

Introduction: More than two billion people have been infected worldwide, and of these, more than 350 million suffer from chronic Hepatitis B virus infection . Its incidence and patterns of transmission vary throughout the world in different population subgroups. In Western countries, chronic HBV infection is relatively rare and acquired primarily in adulthood, whereas in Asia and Africa, it occurs from infected mother to child, from child-to-child contact in household settings, and from reuse of unsterilized needles and syringes. Due to the often silent nature of the disease, its testing is imperative for public health, particularly for blood screening. Chronic carriers with undetected acute infection and low levels of viremia are vulnerable to HBV transmission. The majority of laboratories still use hepatitis B surface antigen (HBsAg)-based tests. WHO’s elimination plan is at risk of derailment due to phases like the window period, immune control, and occult HBV infection (OBI) not being detected by standard tests. In the present study we are focusing on three diagnostic approaches for the better diagnosis of HBV. (1). Hepacard for qualitative detection of HBsAg in human serum or plasma. (2). HBsAg ELISA ( cortezdiagnostics, inc) which is a confirmatory test, to avoid false positives and false negatives from Hepacard test. (3). HBV quantitative test for viral load by Real Time PCR in blood which helps to assess disease progression, treatment monitoring, disease outcome prediction and prevent transmission. Aim: To detect the Prevalence of Hepatitis B in North east coast region of Andhra Pradesh by using rapid screening test and its confirmation by ELISA technique for the diagnosis of Hepatitis B Surface Antigen (HBsAg) along with Viral load by Real time PCR which plays a vital role in ensuring care and effective management of patients. Materials and Methods: The present cross sectional study was conducted at Government Medical College, Srikakulam and Rangaraya Medical College Kakinada by collecting secondary data from laboratory registers of patients tested for HBsAg from September 2023 to September 2025 (Two years duration). At First the patient’s serum was subjected to Detection of HBsAg by HEPA Card, a rapid immunochromatographic assay (ICA) Alere Trueline TM (Alere Medical Pvt. Ltd) kit, then all Seropositive and indetermined cases were subjected to Detection of HBsAg by ELISA. [cortezdiagnostics, inc], then all seropositive cases confirmed by ELISA were subjected to Real-Time Quantitative PCR for HBV DNA for detection of viral load in blood to take decision to patient treatment . Statistical analysis was done using Microsoft Office Excel 2010. Results: A total of 24000 patients (12000 from males and 12000 from females) were included , out of which 167 (0.69%) were positive for HBsAg and 6 (0.025%) were indetermined cases. Out of 12000 males 102 (0.85%) were positive and 4 (0.033%) were indetermined cases. Out of 12000 females 65(0.54%) were positive and 2 (0.016%)were indetermined cases. Positivity is more in 50 – 60 yrs age group 46 (0.95%) and higher number of cases were from Surgery department 48 (0.61%) and more indeterminate cases were from surgery (2) and OBGY (2). More positives were from HIV patients 80 (5.47%). By ELISA all 167 positive cases were confirmed positive (100%). Out of 6 indetermined cases 4 (66.6%) were confirmed positive and 2 (33.3%) were confirmed negative showed that the total number of positive cases were 171 (0.71%). Out of 167 positive samples, on viral load testing 54 (32.33%) samples were showed viral load negative (NOT DETECTED) and 113 (67.66%) were VIRAL LOAD DETECTED cases according to Real Time micro PCR Analyzers. The Real Time PCR enables decentralization and near patient diagnosis and treatment monitoring of Hepatitis B infection by making it rapid, simple, robust and user friendly and offering ‘sample to result’ capability even at resource limited settings. The assay was used to assess the virological response to antiviral treatment. Conclusion: Over last two decades there was a significant improvement in control of HBV infection due to screening and diagnosis, and implementation of vaccination programs and recent advances in pharmaceutical field in development of effective antiviral therapies that inhibit viral replication for long duration. Our study showed that HBV is Endemic in North east coastal region of Andhra Pradesh. It emphasizes the need for universal vaccination to all children and establishment of strategies to prevent mother to child transmission. Our research is helpful for development of national control strategies to fight against Hepatitis B infection and the present study showed that rapid test kits are inferior to some extent which are associated with in determined results when compared to ELISA confirmatory test. HBV DNA test is a crucial tool in diagnosis and management and viral load guides treatment decisions and monitor disease progression.

Background: Physiology is foundational in medical education, yet many students find it abstract and challenging to master through traditional lectures alone. Active learning strategies, such as model making, have the potential to enhance understanding and engagement. Objective: To evaluate the effectiveness of model making as a learning tool in improving the understanding and retention of physiological concepts in undergraduate physiology education. Methods: A cross-sectional study was conducted among 150 first-year MBBS students at Akash Institute of Medical Sciences. Students were divided into 22 groups, each assigned a physiology topic to create cost-effective models, including working models where feasible. The models were presented in a competition judged by faculty. A self-administered feedback questionnaire using a 5-point Likert scale assessed students’ perceptions. Data were analyzed descriptively. Results: Feedback was obtained from 145 students (96.6% response rate). Most participants agreed that model making was helpful in understanding concepts (99.4%), promoted independent exploration (86%), and enhanced teamwork (94%). Additionally, 88% perceived this method as more effective than traditional teaching, and over 90% expressed interest in future sessions. However, about 30% reported that model preparation interfered with their routine activities. Conclusion: Model making proved to be an effective and engaging strategy to facilitate deeper understanding and active learning in physiology. Incorporating structured model-making activities alongside traditional lectures may enhance conceptual clarity, teamwork, and independent learning. Further research should include objective measures of knowledge gain and explore broader applicability.

Ovarian cystic lesions are among the most frequently encountered findings in gynecological imaging and encompass a broad spectrum ranging from benign functional cysts to malignant neoplasms. Accurate radiological evaluation plays a pivotal role in diagnosis, risk stratification, and management planning. Imaging modalities such as ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) are essential in characterizing these lesions based on morphology, internal architecture, and associated features. This article reviews the radiological approach to ovarian cystic lesions, emphasizing imaging characteristics that aid in differentiating benign from malignant entities, and highlights standardized reporting system.

Introduction: Fetal malnutrition represents a distinct clinical entity that is not synonymous with small for gestational age or intrauterine growth retardation, as these conditions may occur independently of one another. The Clinical Assessment of Nutritional Status score provides a systematic method for evaluating fetal malnutrition and offers advantages over conventional anthropometric measures used to assess fetal growth. Methods: This prospective cross-sectional study examined 100 full-term neonates at a tertiary care hospital over three months. Neonates were categorized as small for gestational age or appropriate for gestational age using Alexander growth curves. Fetal malnutrition was evaluated using the Clinical Assessment of Nutritional Status score as the reference standard and compared with weight for gestational age and Ponderal index measurements. A Clinical Assessment of Nutritional Status score of 24 or below was designated as indicating fetal malnutrition. Results: The Clinical Assessment of Nutritional Status score identified malnutrition in 16% of neonates while classifying 84% as well-nourished. Assessment based on weight for gestational age revealed that 63% of babies were small for gestational age while 37% were appropriate for gestational age. The Ponderal index classified 9% as malnourished. Among 63 small for gestational age babies, 43 were small but not malnourished, while 3 out of 37 appropriate for gestational age babies were malnourished. When the Clinical Assessment of Nutritional Status score served as the reference standard, weight for gestational age demonstrated sensitivity and specificity of 94.12% and 64.29% respectively, while Ponderal index showed sensitivity and specificity of 25% and 94% respectively. Discussion: These findings indicate that small for gestational age and intrauterine growth retardation are not synonymous with fetal malnutrition. The Clinical Assessment of Nutritional Status score can identify fetal malnourishment in neonates that other methods fail to detect, proving superior to weight-based classification and Ponderal index in accurately identifying fetally malnourished neonates, including those with normal birth weights. This has important clinical implications for recognizing at-risk infants who require enhanced monitoring and intervention.

Background: Recently the internet and internet-related activities have seen a tremendous increase in its users, coming with its advantages and disadvantages. Internet gaming disorder (IGD) is one such disadvantage which was recognized by WHO in 2018 in ICD-11 as a health concern. IGD along with problematic internet usage (PIU) can cause a detrimental effect on an adolescent’s health and also has a public health implication by paving the way for addiction at a later age, if necessary timely interventions are not done at the initial stages. This study aims to detect the prevalence of internet gaming disorder in the 10 to 14 age group and the parents’ perception of their wards’ internet usage. Methods: An analytical cross-sectional study among 10- to 14-year-old students conducted among 6^th to 8^th grade (selected randomly from 2 different schools in Chennai). For this study, parent version of Young’s diagnostic questionnaire, internet gaming disorder scale short form, along with self-report forms were used. The data was collected over a period of two months and analyzed using SPSS software. Results: This study with the participation of 285 adolescents and 285 parents found a prevalence of IGD to be at 2.1% (95% CI: 0.4 – 3.7) and with a prevalence of problematic internet usage at 16.8% (95% CI: 12.5 – 21). A correlation was present between IGD and PIU (p-value <0.001, sensitivity 83.3%, specificity 84.3%, positive predictive value 10.4%, negative predictive value 99.5%). Conclusion: This study reports that among the participants, 2.1% had IGD and 16.8% had PIU (parental perception). Both of these conditions had a correlation with statistically significant association (p<0.001). Reduction in physical activity, academic performance, and interaction with family were perceived as detrimental by the parents.

Background: Schizophrenia is a severe mental illness characterized by anomalies in thought processes, perceptions, emotional response, and social relations. It affects approximately 1% of the global population, translating to millions of individuals suffering from its debilitating effects. Metabolic syndrome refers to a cluster of interrelated risk factors that significantly elevate the risk of cardiovascular diseases and type 2 diabetes. Individuals with schizophrenia are more likely to suffer physical ailments, notably cardiovascular problems. The interplay between the chronic nature of schizophrenia and physical health is multifactorial, involving genetic predisposition, lifestyle factors, and treatment-related side effects. Second-generation antipsychotics (SGAs), including olanzapine and risperidone, have revolutionized the treatment of schizophrenia by targeting both positive symptoms (e.g., delusions, hallucinations) and negative symptoms (e.g., reduced emotional expression, social withdrawal). Their use is associated with an increased risk of metabolic side effects, including weight gain, dyslipidemia, and insulin resistance, which contribute to the development of metabolic syndrome Methodology: This comparative observational study analyzed the metabolic impact of olanzapine (n=70) versus risperidone (n=70) over one year in 140 schizophrenia patients aged 18–50 at the Government Hospital for Mental Care, Visakhapatnam. Participants, selected by simple random sampling and meeting ICD-11 criteria, were either drug-naïve or had a six-month washout period, excluding those with pre-existing metabolic conditions. Researchers measured BMI, waist circumference, blood pressure, and lipid profiles at baseline, three, and six months, diagnosing metabolic syndrome via IDF and NCEP ATP III criteria, with 121 participants completing the six-month follow-up (58 in the olanzapine group, 63 in the risperidone group). Results: This prospective study provides valuable evidence that olanzapine is associated with significantly higher metabolic risk compared to risperidone, as demonstrated by greater changes in weight, BMI, waist circumference, triglycerides, HDL cholesterol, and incidence of metabolic syndrome over a 6-month period. Independent risk factors included high baseline BMI, physical inactivity, poor diet, and family history of cardiometabolic disease. Conclusion: In conclusion, this study provides robust evidence supporting the metabolic safety advantages of risperidone over olanzapine. The findings align with both Indian and global literature and advocate for routine risk stratification and tailored therapeutic approaches in schizophrenia care. Given the rising burden of antipsychotic-induced metabolic syndrome, integrating physical health surveillance into psychiatric practice is not only advisable but essential for long-term patient well-being.

Background: Major depressive disorder (MDD) is increasingly recognized as a disorder with neuroimmune components, where low-grade systemic inflammation may influence neurotransmission, neuroendocrine function, and neuroplasticity. Cell count–derived indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) are inexpensive and clinically scalable surrogate markers of systemic inflammatory status. Evidence regarding these markers in major depressive disorder has been inconsistent; meta-analytic studies suggest that NLR is often elevated in depression, whereas findings for PLR and MLR remain variable and inconclusive. Methods: An observational case control study was done at the Psychiatric centre, SMS medical college, Jaipur, Rajasthan, India, during the period October 2024 and August 2025. Adults aged 18-60 years who had MDD according to DSM-5-TR were recruited consecutively (screened n=72; analyzed n=65). Healthy controls after screening by Mini-interview of International Neuropsychiatry Interview (MINI, version 7.0.2) (screened n=85; analyzed n=65). Participants who had systemic illnesses, were pregnant, or taking anti-inflammatory, immunomodulatory and antibiotic medications were excluded. Absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), ESR, NLR, PLR, MLR and SII were determined from peripheral blood. Group comparisons were conducted using appropriate parametric/non-parametric metrics testing procedures (α=0.05). Results: A total of 130 participants were included in the analysis (65 MDD; 65 controls). Mean age in MDD (31.79±9.72) was higher as compared to controls (22.19±6.65; p=0.02). There was no difference in sex distribution (female 44 vs 43 p=0.99). MDD subjects had numerically higher ANC (5077±1856 vs 4503±2655), AMC (416±211 vs 333±309), NLR (2.54±1.64 vs 1.93±0.57) and ESR (21.51±19.10 vs 9.20±6.45). However, none of the inflammatory indices showed statistically significant between-group differences. Conclusion: In this sample collected at a hospital, various peripheral indicators of inflammation were trending towards an increase in MDD, but results were not statistically significant, possible reasons include limited statistical power, age mismatch between groups, and single-time-point sampling.

Background: Diabetic nephropathy has been identified as one of the primary contributors to chronic kidney disease (CKD) in the world today. Conventional indicators of early renal impairment such as serum creatinine and microalbuminuria, are often missed. Serum cystatin C (CysC) is perhaps one of indicators of an early glomerular dysfunction. Objective: To assess the diagnostic value of serum cystatin C for detection of early renal impairment in individuals with type 2 diabetes mellitus (T2DM). Methods: This cross-sectional analytical study entailed 150 participants; 75 of them were healthy controls (HCs), whereas 75 suffered type 2 diabetes. Renal functioning was determined by serum creatinine (SCr), urine albumin creatinine ratio (UACR), assessed glomerular filtration rate (eGFR), CysC. Statistical comparisons and correlation analysis were made. Results: The CysC levels of T2DM patient have been found to be significantly higher compared to controls (p < 0.001). Even with normal serum creatinine, normoalbuminuric diabetic patients still had high cystatin C levels (p < 0.01). The relationship of cystatin C with eGFR was more negative than that of creatinine (r=-0.72 and r=-0.58, respectively). Conclusion: CysC is accurate and sensitive biomarker of early renal deterioration in diabetic individuals that could help with earlier management before nephropathy would become evident.

Background: The optimal timing for initiating enteral nutrition in acute pancreatitis remains a subject of ongoing clinical debate. While traditional management advocated prolonged fasting to achieve pancreatic rest, emerging evidence suggests that early enteral feeding may confer significant clinical benefits. This study aimed to compare clinical outcomes between early enteral nutrition and delayed feeding strategies in patients hospitalized with acute pancreatitis. Methods: This prospective comparative study was conducted at a tertiary care hospital. A total of 174 consecutive patients diagnosed with acute pancreatitis were allocated into two groups: the early enteral nutrition group (EEN, n = 88), receiving oral or nasojejunal feeding within 24 hours of admission, and the delayed feeding group (DF, n = 86), receiving nutritional support after 72 hours or upon complete resolution of abdominal pain. Primary outcomes included length of hospital stay, organ failure incidence, and infectious complications. Secondary outcomes included pain resolution time, inflammatory marker trajectories, and mortality. Results: Patients in the EEN group demonstrated significantly shorter hospital stays (7.3 ± 2.9 days vs. 10.6 ± 4.1 days, p < 0.001), lower rates of infectious complications (9.1% vs. 22.1%, p = 0.017), and reduced incidence of organ failure (6.8% vs. 16.3%, p = 0.048). Pain resolution occurred earlier in the EEN group (3.1 ± 1.4 days vs. 4.7 ± 2.1 days, p < 0.001). C-reactive protein levels at day 5 were significantly lower in the EEN group (48.7 ± 31.2 mg/L vs. 79.4 ± 42.6 mg/L, p < 0.001). Mortality rates did not differ significantly between groups (2.3% vs. 4.7%, p = 0.440). Feeding intolerance occurred in 11.4% of EEN patients but was manageable in all cases. Conclusion: Early enteral nutrition within 24 hours of admission in acute pancreatitis is associated with significantly reduced hospital stay, fewer infectious complications, lower organ failure rates, and accelerated clinical recovery compared to delay feeding. These findings support the adoption of early feeding protocols as standard practice in acute pancreatitis management.

Background: Carbamazepine is an established mood stabilizer for the treatment of acute mania; however, its clinical use is often limited by adverse effects. Oxcarbazepine, a structural analogue of carbamazepine, has been suggested as a potentially better-tolerated alternative, though evidence regarding its efficacy in mania remains limited and inconsistent. Objectives: To compare the efficacy and tolerability of oxcarbazepine with carbamazepine in patients with acute manic episodes, using lithium as an active control. Methods: This randomized, open-label, lithium-controlled trial was conducted at a tertiary care government hospital. Ninety patients diagnosed with a manic episode as per DSM-IV-TR criteria and having a Young Mania Rating Scale (YMRS) score ≥20 were randomized in a 1:1:1 ratio to receive oxcarbazepine, carbamazepine, or lithium and were followed for six weeks. The primary outcome was adequate response, defined as a ≥50% reduction in YMRS score from baseline. Safety and tolerability were assessed using the Systematic Assessment for Treatment-Emergent Effects (SAFTEE) checklist along with clinical and laboratory monitoring. Statistical analysis was performed using SPSS version 16, with p<0.05 considered statistically significant. Results: No patient in any treatment group achieved adequate response at one week. At two weeks, response rates remained low and were not significantly different among groups (p=0.232). At six weeks, carbamazepine (80.0%) and lithium (73.3%) demonstrated significantly higher response rates compared with oxcarbazepine (46.7%) (p=0.015). Oxcarbazepine was associated with fewer adverse effects, whereas carbamazepine showed significantly higher rates of blurred vision, benign leukopenia, and deranged liver function tests. Conclusion: Oxcarbazepine was less effective than carbamazepine and lithium in the treatment of acute mania, although it demonstrated a more favorable tolerability profile.

Due to being biocompatible and biodegradable with a wide variety of structural characteristics, protein nanoparticles (PNPs) can act as novel drug delivery vehicles. PNPs can be constructed from the natural proteins: albumin, gelatin, silk fibroin, casein, and ferritin, thus providing several advantages compared to organic polymers and inorganic materials. PNPs can encapsulate a number of types of therapeutic agents (designed to prevent degradation and premature clearance), like proteins, peptides, nucleic acids and small molecules. Moreover, they have a unique surface chemistry that permits functionalizing with other polymers, ligands for targeting, or biomimetic coatings to achieve enhanced circulation time, tissue specificity and uptake. Finally, some of the many attributes of PNPs include: pharmacokinetic and pharmacodynamics profiles that increase the efficacy of therapeutic treatments while decreasing levels of toxicity to healthy tissues. Current fabrication techniques allow for precise regulation of the size, morphology and release kinetics of the PNPs. Protein nanocarriers have demonstrated potential as delivery systems for genes and vaccines, as well as for antimicrobial treatment, cancer treatment, and regenerative medicine. While protein nanocarriers have many advantages, there are still challenges related to lot-to-lot reproducibility, stability, and large-scale manufacturing of the carrier system. This review highlights recent advancements made in regard to the design of protein nanoparticles, their biocompatibility, their functionalization methods, and their therapeutic uses; these advancements demonstrate that protein nanoparticles could potentially serve as safe, efficient, and readily translatable drug delivery systems in the future.

Objective and Aim: Soft tissue tumors (STTs) represent a heterogeneous group of neoplasms with diverse histogenesis, biological behavior, and clinical outcomes. The present study aims to evaluate the spectrum, frequency, demographic distribution, anatomical location, and histopathological patterns of soft tissue tumors diagnosed at a tertiary care center in Bihar, India, with special emphasis on benign–malignant correlation and clinicopathological characteristics. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology at a tertiary care teaching hospital in Bihar over a period of five years (January 2019–December 2023). All histopathologically confirmed cases of soft tissue tumors were included. Tumors were classified according to the WHO Classification of Soft Tissue and Bone Tumors (2020). Statistical analysis was performed using SPSS version 26.0. Descriptive statistics, chi-square test, and logistic regression analysis were applied. Results: A total of 312 cases of soft tissue tumors were analyzed. Benign tumors constituted 76.9%, intermediate tumors 7.4%, and malignant tumors 15.7%. The most common benign tumor was lipoma (38.1%), while undifferentiated pleomorphic sarcoma (21.4%) was the most frequent malignant tumor. Malignant tumors were significantly associated with age >40 years (p <0.001) and deep-seated location (p = 0.002). Conclusion: Soft tissue tumors in Bihar show a predominance of benign lesions with lipoma being the most common entity. However, a significant proportion of malignant tumors underscores the importance of early diagnosis, adequate sampling, and histopathological evaluation for optimal patient management.

Background: Antimicrobial resistance (AMR) among Escherichia coli has emerged as a major public health concern globally, particularly in low- and middle-income countries where antibiotic consumption is high and stewardship programs are still evolving. E. coli remains the leading cause of community- and hospital-acquired urinary tract infections (UTIs), and increasing resistance to commonly used antimicrobials has significantly limited therapeutic options. Aim: To determine the antimicrobial resistance patterns of E. coli isolates recovered from clinical samples and to analyze department-wise susceptibility trends at a tertiary care teaching hospital in Bihar, India. Methods: A hospital-based observational study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College, Bhagalpur, from 5 February 2025 to 31 December 2025. A total of 65 non-duplicate E. coli isolates obtained from various clinical samples were included. Identification and antimicrobial susceptibility testing were performed using standard microbiological techniques and interpreted as per CLSI guidelines. Data were analyzed using descriptive and inferential statistics. Results: E. coli constituted the predominant uropathogen. High susceptibility was observed to amikacin and gentamicin, while markedly reduced susceptibility was seen for fluoroquinolones and third-generation cephalosporins. Carbapenem resistance, though less frequent, was detected and showed inter-departmental variation. Conclusion: The study demonstrates a high burden of multidrug-resistant E. coli isolates with preserved susceptibility to aminoglycosides. Continuous surveillance through antibiograms and rational antibiotic stewardship are essential to curb the progression of AMR.

Background & Aim: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, with myocardial infarction and heart failure constituting major contributors to disease burden. Early diagnosis and accurate prognostication are essential for improving clinical outcomes. The present study aimed to evaluate the diagnostic and prognostic utility of selected cardiac biochemical markers in patients with cardiovascular diseases and to analyze their effectiveness in predicting cardiovascular health outcomes using regression and comparative analytical models. Methods: This hospital-based prospective observational study was conducted in the Department of Biochemistry in collaboration with the Department of Medicine/Cardiology at Jawaharlal Nehru Medical College, Bhagalpur, Bihar, over a period from 1st October 2024 to 30th September 2025. A total of 70 clinically diagnosed cardiovascular disease patients were enrolled based on predefined inclusion and exclusion criteria. Blood samples were collected for estimation of cardiac biomarkers including cardiac troponins, natriuretic peptides, inflammatory markers, lipid profile parameters, and other relevant biochemical indices using standardized laboratory methods. Results: The study population predominantly comprised middle-aged and elderly patients, with a higher representation of males. Significant variability was observed in biomarker concentrations across different cardiovascular conditions. Cardiac troponins and natriuretic peptides demonstrated higher diagnostic effectiveness scores compared to other biochemical markers. Forest plot analysis revealed moderate pooled effect sizes for selected biomarkers, indicating their clinical relevance in cardiovascular disease assessment. Regression analysis exploring the relationship between two key biochemical markers and cardiovascular health outcomes showed a limited but notable association, suggesting that biomarker-based prediction is influenced by multifactorial determinants rather than isolated parameters. Conclusion: The findings of this study underscore the critical role of cardiac biomarkers in the diagnosis and prognostic assessment of cardiovascular diseases. While traditional markers such as troponins and natriuretic peptides remain highly valuable, their predictive capability is enhanced when interpreted alongside other biochemical and clinical variables.

Background: Hypothyroidism during pregnancy poses significant risks to maternal and fetal health, with autoimmune thyroiditis (Hashimoto’s thyroiditis) being a leading cause in iodine-sufficient regions. Thyroperoxidase (TPO) antibodies serve as a key marker for autoimmune thyroid disease. This study aimed to evaluate the prevalence of TPO antibody positivity in hypothyroid antenatal women in Perambalur district, Tamil Nadu, India. Methods: A cross-sectional observational study was conducted from July 2017 to July 2018 at Dhanalakshmi Srinivasan Medical College and Hospital. Eighty antenatal women aged 18-30 years with newly diagnosed hypothyroidism (TSH >10 μIU/mL) were included. Serum levels of total T3 (TT3), total T4 (TT4), thyroid-stimulating hormone (TSH), and TPO antibodies were measured using enzyme-linked immunosorbent assay (ELISA). Participants were categorized into TPO-positive (≥50 IU/mL) and TPO-negative groups. Demographic data, thyroid profiles, and correlations were analyzed using descriptive statistics and Pearson’s correlation. Results: Of the 80 participants, 47 (58.75%) were TPO-positive. The mean age was 25.55 ± 5.09 years in the TPO-positive group and 26.03 ± 4.87 years in the TPO-negative group (p > 0.05). TPO-positive women had significantly higher TSH (22.68 ± 6.15 μIU/mL vs. 17 ± 4.4 μIU/mL; p < 0.01) and lower TT3 (0.6 ± 0.2 ng/mL vs. 0.8 ± 0.4 ng/mL; p < 0.01) and TT4 (2.9 ± 1 μg/dL vs. 3.3 ± 1.2 μg/dL; p < 0.01). A strong positive correlation was observed between TPO antibodies and TSH (r = 0.7, R² = 0.49; p < 0.01). TPO-positive women had higher rates of family history of thyroid dysfunction (40% vs. 33%) and past miscarriages (25.5% vs. 18%; p < 0.01 for miscarriages). Conclusion: The prevalence of Hashimoto’s thyroiditis in hypothyroid antenatal women in this region is high (58.75%), underscoring the need for routine TPO antibody screening in early pregnancy to mitigate adverse outcomes. Universal screening and early intervention could improve maternal and fetal health.

Background: Medical devices are an essential part of modern health care. Despite that there are instances where their uses caused significant morbidity and mortality in the users. So, it is necessary to assess the risk and benefit associated with devices at all stages of development and uses. Materiovigilance is the coordinated system of identification, collection, reporting, and analysis of any untoward occurrences associated with the use of medical devices. Although medical faculties and residents are major stake holders in reporting adverse events related to medical devices at present there are very few published data about their knowledge attitude and practice regarding materiovigilance in India. This study was conducted with an objective to assess the knowledge, attitude and practice of materiovigilance amongst the doctors in a tertiary care teaching hospital of Eastern India. Methodology: This is a cross-sectional questionnaire based observational study. The questionnaire containing 15 questions is made in Google forms and were distributed to all the doctors of this hospital. Among 135 doctors, 125 doctors have answered and the recorded responses have been statistically analysed. Results: Among the responders approx. 74% were not aware of the ongoing program for monitoring adverse events due to medical devices. Despite 46.8% responders facing adverse events relating to medical devices 32.5% of participants have actually seen the reporting form and only 18.4% reported the events. Conclusion: More awareness drive is needed to fulfil the lacunae in the knowledge regarding adverse events related to medical devices

Osteoarthritis and type 2 diabetes mellitus are two common chronic illnesses that significantly strain healthcare systems around the globe. Given the possible synergistic effects of type 2 diabetes mellitus and osteoarthritis on metabolism and joint health, their comorbidity is a significant problem, particularly in people who are overweight or obese. The aim of our study was to assess and examine the literature regarding the prevalence, association, symptoms, physical function, and shared risk factors of T2DM and OA. Osteoarthritis and type 2 diabetes mellitus are both characterised by chronic low-grade systemic inflammation, which is crucial to their development. We conducted a critical review of the literature to explore the association between T2DM and OA, whether any association is site-specific for OA, and whether the presence of T2DM impacts on OA outcomes. Furthermore, we found that common risk variables, such as metabolic syndromes and demography, may influence the relationship between DM and OA; however, more study is needed on this topic as well. Extensive future study is required to properly determine the effect of chronic medication usage, as there is conflicting information regarding whether medication use contributes positively or negatively to the connection between DM and OA.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a resistant organismthat heavily contributes to hospital and community-acquired infections worldwide. It spreads very easily from patient to patient, by the hands of health workers, through contaminated objects and by air. MRSA poses a major clinical problem in treatment. So, it is essential to know its antibiotic pattern. Material & Methods: This study was carried out in the department of Microbiology  at  C. U. Shah Medical College and hospital, Surendranagar. Total 180 samples were included in the study during the period of 1^st July 2021 to 30^th June 2022. Identification of isolated organism was done by conventional method using biochemical reactions. Antimicrobial susceptibility testing and MRSA detection was done using VITEK-2 compact system. Results: Methicillin resistant Staphylococcus aureus (MRSA) was seen in 58% of the isolates. The sensitivity profile shows Tigecycline 100%, Nitrofurantoin, Linezolid and Teicoplanin 99%, Vancomycin 95%. Lower sensitivity rates were found for Levofloxacin (7%), Ciprofloxacin and Oxacillin (6%) and cefepime (2%). Inducible clindamycin resistance was found to be 37.5%. Vancomycin sensitivity was 95%, rest 4% was VISA and 1% was VRSA. Discussion: Prevalence of MRSA was found 57.78% from various clinical samples.A similar study done by Fatemeh et al and Kirti et alwas reported MRSA prevalence of  63.20% and 33.7% respectively. Conclusion: MRSA were most sensitive to Tigecycline, Linezolid, Tecoplanin , Vancomycin and least sensitive to Oxacillin and cefepime. The knowledge of antibiotic sensitivity pattern of S. aureus will therefore be helpful to get control over the evolving resistance.

Background: Supraclavicular brachial plexus block is commonly used for upper limb surgeries. Various adjuvants have been added to local anaesthetics to improve block characteristics and prolong postoperative analgesia. Dexmedetomidine and dexamethasone are frequently used additives to bupivacaine, but their comparative efficacy remains an area of interest. Methods: This ambispective randomised double-blind controlled study was conducted in 60 adult patients (ASA I–II) undergoing elective upper limb orthopaedic surgeries. Patients were randomly divided into two groups of 30 each. Group A received 25 ml of 0.25% bupivacaine with dexamethasone 8 mg, while Group B received 25 ml of 0.25% bupivacaine with dexmedetomidine 1 µg/kg for ultrasound-guided supraclavicular brachial plexus block. Onset and duration of sensory and motor block, sedation score, haemodynamic variables, time to first rescue analgesia, and total analgesic consumption over 24 hours were recorded and analysed. Results: Dexmedetomidine significantly hastened the onset of sensory (6.4 ± 1.3 min vs 9.8 ± 1.5 min) and motor block (8.1 ± 1.4 min vs 12.2 ± 1.6 min) compared to dexamethasone (p < 0.001). Duration of sensory block (10.2 ± 1.3 hrs vs 7.6 ± 1.1 hrs) and motor block (9.1 ± 1.1 hrs vs 6.3 ± 1.0 hrs) were also prolonged in the dexmedetomidine group (p < 0.001). Time to first rescue analgesia was longer (12.7 ± 1.4 hrs vs 9.8 ± 1.2 hrs), and analgesic requirement over 24 hours was significantly reduced. Sedation scores were higher with dexmedetomidine. Mild bradycardia and hypotension occurred more frequently with dexmedetomidine but were manageable. Conclusion: Dexmedetomidine is a superior adjuvant to dexamethasone when combined with bupivacaine for supraclavicular brachial plexus block, providing faster onset, prolonged block duration, improved postoperative analgesia, and acceptable haemodynamic stability.

Background: Type 2 Diabetes Mellitus (T2DM) is frequently associated with thyroid dysfunction due to their interrelated effects on metabolism. Thyroid abnormalities in diabetic patients may remain undiagnosed and can adversely affect glycemic control. Objectives: To evaluate the prevalence of thyroid dysfunction in patients with Type 2 Diabetes Mellitus and to assess its impact on metabolic control. Materials and Methods: This hospital-based cross-sectional observational study was conducted at the Department of Medicine, Government Medical College, Korba, Chhattisgarh, over a period of one year. A total of 100 patients with Type 2 Diabetes Mellitus were enrolled. Clinical evaluation and laboratory investigations, including fasting blood glucose, post-prandial blood glucose, HbA1c, and thyroid profile (TSH, FT3, FT4), were performed. Thyroid status was categorised based on standard reference ranges. Glycemic control was assessed using HbA1c levels. Statistical analysis was carried out using appropriate tests, with p <0.05 considered statistically significant. Results: Thyroid dysfunction was observed in 32% of patients, with subclinical hypothyroidism being the most common abnormality (18%). Poor glycemic control (HbA1c ≥7%) was seen in 62% of patients. Patients with thyroid dysfunction had significantly higher HbA1c levels compared to euthyroid patients (p <0.05), indicating poorer metabolic control. Conclusion: Thyroid dysfunction, particularly subclinical hypothyroidism, is prevalent among patients with Type 2 Diabetes Mellitus and is associated with poor glycemic control. Routine thyroid screening in patients with T2DM may aid in early detection and improve metabolic outcomes.

Introduction: Liquid crystals (LCs) combine fluidity with long-range molecular order, giving rise to strong optical anisotropy (birefringence), polarization-dependent transmission, and (in cholesterics) selective reflection. These features make LC interfaces exquisitely sensitive to biomolecular binding events that perturb anchoring and director fields, enabling label-free biosensing. Materials and Methods: A structured literature review (2016–Jan 2026) was designed around optical LC biosensors (nematic, cholesteric, blue phase, chromonic; planar films, droplets, elastomers, microcavities). Studies were screened using predefined inclusion/exclusion criteria and extracted for platform geometry, surface chemistry, optical readout, target class, and analytical performance. Results: Across included studies, dominant readouts were polarized optical microscopy (POM) texture change, quantitative birefringence/retardation, and wavelength shifts from cholesteric reflection bands. Sensitivity improvements were commonly achieved via nucleic-acid amplification strategies and signal-amplifying interfacial chemistries. Six synthesis tables summarize optical properties, device architectures, functionalization routes, readout metrics, representative targets, and translation considerations. Conclusion: LC optical biosensors are maturing from qualitative “dark-to-bright” assays toward quantitative, portable formats using smartphone optics, elastomeric photonic films, and robust surface chemistries. Key remaining challenges include standardization of alignment layers, suppression of matrix effects in biofluids, and reproducible quantification across lighting/imaging conditions.

Introduction: Non-prescribed face cream use has increased substantially due to easy availability, social media influence, and over-the-counter access. Many such products may contain harmful ingredients including topical steroids, hydroquinone, and heavy metals, leading to preventable dermatological adverse effects. Population-level data on usage patterns and associated reactions remain limited. The present study aimed to assess the knowledge, attitudes, and practices related to non-prescribed face cream usage and to evaluate the pattern of associated adverse reactions in the community. Materials and Methods: A population-based cross-sectional online survey was conducted in India from July to December 2025 among adults aged ≥18 years using a structured questionnaire assessing knowledge, attitudes, practices, and adverse effects related to non-prescribed face creams. Participants with face cream use in the previous 12 months were included. The minimum calculated sample size was 300. Data were analyzed using SPSS v26 with descriptive statistics and chi-square tests; p<0.05 was considered significant. Results: Among 300 participants, most were aged 20–29 years (50%) and female (85%). Use of non-prescribed face creams was reported by 64.7%. Awareness of harmful ingredients was present in 60%, but detailed ingredient recognition was low. Only 53.3% stated they would consult a doctor before starting a new product. Commonly used creams included skin-lightening and sun-protection products. Adverse effects were reported by 70% of users, most frequently hyperpigmentation (10.3%), acneiform eruptions (10%), and rashes (8.7%). Recommendations were mainly from family/friends (30%) and social media (25%). Only 18% sought medical consultation after adverse reactions, while many relied on self-care measures. Conclusion: Non-prescribed face cream use is highly prevalent and frequently associated with adverse effects, alongside gaps in ingredient awareness and low rates of professional consultation, underscoring the need for improved public education and cosmetovigilance.

Background: Multidrug-resistant organism (MDRO) infections are increasingly prevalent in intensive care units (ICUs), posing significant therapeutic and prognostic challenges. Data from low- and middle-income countries remain limited despite carrying a disproportionate global burden. Objectives: To estimate the prevalence of MDRO infections in ICU patients, assess their impact on mortality and clinical outcomes, and identify predictors of infection and death. Methods: This prospective, observational cohort study was conducted over 18 months in a tertiary-care ICU. Adult patients (≥18 years) with culture-positive bacterial infections were enrolled (N=327). MDR status was defined according to CDC/ECDC criteria. Demographics, comorbidities, APACHE II/SOFA scores, device use, and microbiological data were collected. Outcomes included ICU mortality, length of ICU/hospital stay, ventilator days, and complications. Statistical analysis employed Chi-square and t-tests for group comparisons, Kaplan–Meier survival analysis, and multivariate logistic regression to identify predictors of MDR acquisition and mortality. Results: Of 327 patients, 146 (44.6%) had MDRO infections. Gram-negative pathogens predominated: Acinetobacter baumannii (28.1%), Klebsiella pneumoniae (24.7%), and Pseudomonas aeruginosa (19.2%). Carbapenem resistance was alarmingly high in Acinetobacter (89.5%) and Klebsiella (76.3%). Compared to non-MDR infections, MDRO infections were associated with higher ICU mortality (47.9% vs. 28.2%, p<0.001), prolonged ICU stay (19.8 vs. 13.4 days, p<0.001), hospital stay (28.6 vs. 21.3 days, p<0.001), and ventilator days (14.7 vs. 9.2, p<0.001). Complications such as septic shock (39.7% vs. 21.5%), renal replacement therapy (18.5% vs. 9.9%), and secondary infections (25.3% vs. 12.7%) were significantly more common. Independent predictors of mortality among MDR patients included septic shock (OR 3.24, 95% CI 1.76–5.95), carbapenem resistance (OR 2.87, 95% CI 1.52–5.41), APACHE II >25 (OR 2.54, 95% CI 1.33–4.82), and renal replacement therapy requirement (OR 2.11, 95% CI 1.05–4.22). Conclusions: Nearly half of ICU infections were caused by MDROs, doubling mortality and significantly increasing ICU burden. Septic shock and carbapenem resistance were the most ominous predictors of death. These findings underscore the urgent need for rapid diagnostics, tailored empiric therapy, strict infection-control bundles, and robust antimicrobial stewardship in critical care settings.

Background: Bimalleolar ankle fractures are one of the most frequently encountered lower limb injuries, often requiring surgical intervention for optimal recovery. Open Reduction and Internal Fixation (ORIF) is widely regarded as the standard treatment, aimed at restoring joint congruity and functional mobility. Aim: To study the functional outcome of surgically treated bimalleolar ankle fractures and identify postoperative complications associated with ORIF. Materials and Methods: This observational study was conducted on 80 patients with closed bimalleolar ankle fractures. All patients underwent ORIF, followed by standard postoperative rehabilitation. Clinical and radiological evaluations were performed, and outcomes were assessed using the Baird and Jackson criteria. Results: Out of 80 patients, 28% showed excellent outcomes, 35% good, 25% fair, and 12% poor outcomes. The majority achieved full ankle stability, near-complete range of motion, and returned to work within 3–4 weeks. Pain and limited mobility were observed in a few cases, mostly linked to delayed intervention or comorbidities. Conclusion: ORIF remains a reliable treatment modality for bimalleolar fractures, offering excellent functional results in most cases. Early diagnosis, proper surgical technique, and postoperative care are crucial for maximizing recovery and minimizing complications.

Background and Objectives: The world today is witnessing an epidemic of diabetes mellitus. Globally and nationally, diabetes and its complications have become the most important contemporary and challenging health problem. It is estimated that there will be more than 200 million diabetics in the world within the next 10 years. India has already become the diabetes capital of the world with over 30 million affected patients that is alarmingly just a tip of the iceberg and is expected to touch the 69.9 million marks in 2025. To evaluate Diastolic Dysfunction in asymptomatic normotensive Type 2 Diabetes Mellitus. To study left ventricular mass in asymptomatic normotensive Type 2 Diabetes Mellitus. Material and Methods: Study will be conducted in outpatient department of VMMC and Safdarjung Hospital. Cross sectional observational study. A total of 100 subjects,50 Diabetic normotensive patient and 50 non-diabetic healthy individuals satisfying the inclusion and exclusion criteria were included in this study. Conclusion: In our study diastolic dysfunction and LVM was present in 56% and 48% respectively in asymptomatic normotensive type 2 DM subjects. Asymptomatic normotensive type 2 DM had significantly high prevalence of diastolic dysfunction and left ventricular mass as compared to healthy subjects. LV diastolic dysfunction and left ventricular mass were correlated with the age, gender, HbA1c, duration of diabetes, BMI, smoking, dyslipidemia. After univariate analysis of various risk factors for diastolic dysfunction it was found that poor glycemic control (HbA1c), duration of diabetes, smoking, dyslipidemia was significantly associated with diastolic dysfunction(P<0.05) whereas age, gender, BMI were not significantly associated with diastolic dysfunction(P>0.05).

Background: Intrauterine Growth Restriction (IUGR), also referred to as Fetal Growth Restriction (FGR), is a pathological condition in which a fetus fails to achieve its genetically determined growth potential, typically defined as an estimated fetal weight below the 10th percentile for gestational age. IUGR is associated with increased perinatal morbidity and mortality, including prematurity, hypoxia, stillbirth, and long-term neurodevelopmental impairment. The approach to IUGR begins with early identification through routine antenatal surveillance, including serial fundal height measurements and ultrasound biometry. Once suspected, diagnosis is confirmed using ultrasonographic assessment of estimated fetal weight, abdominal circumference, amniotic fluid volume, and Doppler velocimetry of uterine and umbilical arteries. Differentiation between constitutionally small fetuses and true growth restriction is essential for appropriate management. Monitoring strategies focus on fetal well-being and timely intervention. Serial growth scans are typically performed every 2–4 weeks. Doppler studies of the umbilical artery, middle cerebral artery, and ductus venosus provide information on placental function and fetal adaptation. Non-stress testing (NST) and biophysical profile (BPP) are used to assess fetal condition. Management decisions depend on gestational age, severity of Doppler abnormalities, and maternal condition. The timing of delivery balances the risks of prematurity against intrauterine compromise. Early-onset IUGR (<32 weeks) requires intensive monitoring and often tertiary-level care, whereas late-onset IUGR (>32 weeks) is more common and may require delivery at term or near term. Multidisciplinary care and individualized management plans are essential to optimize perinatal outcomes. Early detection, structured monitoring, and evidence-based timing of delivery remain the cornerstone of improving outcomes in pregnancies complicated by IUGR. Conclusion: Intrauterine Growth Restriction (IUGR) is a significant obstetric condition associated with increased perinatal morbidity and mortality. Early identification through routine antenatal screening and accurate diagnosis using ultrasound and Doppler studies are essential for distinguishing true growth restriction from constitutionally small fetuses. Close and structured monitoring of fetal growth and well-being—using serial biometry, Doppler velocimetry, and fetal surveillance tests—plays a crucial role in guiding management decisions. The timing of delivery should be individualized, balancing the risks of prematurity against the risk of intrauterine compromise. A multidisciplinary and evidence-based approach, combined with timely intervention, is key to improving short-term neonatal outcomes and reducing long-term complications in pregnancies complicated by IUGR.

Background: Chronic rhinosinusitis (CRS) is a persistent inflammatory disorder of the sinonasal mucosa with multifactorial etiology. Vitamin D has recognized immunomodulatory properties, and deficiency has been implicated in several chronic inflammatory conditions. The present study evaluated serum 25-hydroxyvitamin D [25(OH)D] levels in patients with CRS and examined their association with disease severity. Material and Methods: A prospective case–control study was conducted in a tertiary care hospital including 70 patients with clinically and radiologically confirmed CRS and 70 age- and sex-matched healthy controls. Serum 25(OH)D levels were measured using chemiluminescent immunoassay. Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Symptom severity was assessed using the SNOT-22 score, and radiological severity was evaluated using the Lund–Mackay scoring system. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p < 0.05 considered significant. Results: Baseline demographic characteristics were comparable between groups (p > 0.05). Mean serum 25(OH)D levels were significantly lower in CRS patients than in controls (17.8 ± 7.2 ng/mL vs. 26.4 ± 8.1 ng/mL; p < 0.01). Vitamin D deficiency was observed in 65.7% of CRS patients compared to 25.7% of controls (p < 0.01). Parathyroid hormone levels were significantly higher in CRS patients (p < 0.01), while calcium, phosphorus, and alkaline phosphatase levels showed no significant differences. Serum vitamin D levels demonstrated a moderate negative correlation with SNOT-22 scores (r = –0.48; p < 0.01) and Lund–Mackay scores (r = –0.41; p = < 0.01). Patients with nasal polyps had significantly lower vitamin D levels than those without polyps (14.9 ± 6.1 ng/mL vs. 20.2 ± 7.4 ng/mL; p = < 0.01). Conclusion: Serum vitamin D levels are significantly reduced in patients with chronic rhinosinusitis and are inversely associated with clinical and radiological severity. These findings suggest a potential role of vitamin D deficiency in the disease spectrum of CRS.

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated substantial cardiovascular benefits in chronic heart failure. However, the optimal timing of initiation during acute decompensated heart failure (ADHF) hospitalization and its impact on short-term and intermediate-term clinical outcomes remain insufficiently characterized. This study aimed to evaluate the effect of early in-hospital SGLT2 inhibitor initiation on all-cause mortality and heart failure rehospitalization in patients admitted with ADHF. Methods: A retrospective cohort study was conducted across two tertiary cardiac centers. A total of 742 patients hospitalized with ADHF were included: 318 who received SGLT2 inhibitors within 48 hours of admission (early initiation group) and 424 who received standard heart failure therapy without SGLT2 inhibitors during hospitalization (standard care group). The primary composite endpoint was all-cause mortality or first heart failure rehospitalization at 180 days. Secondary endpoints included individual components of the composite, in-hospital worsening heart failure events, change in N-terminal pro-B-type natriuretic peptide (NT-proBNP), length of hospital stay, and renal safety outcomes. Results: The primary composite endpoint occurred in 22.3% of the early initiation group versus 33.5% of the standard care group (hazard ratio [HR] 0.61, 95% CI 0.47–0.79, p < 0.001). All-cause mortality at 180 days was 8.2% versus 13.4% (HR 0.58, 95% CI 0.38–0.89, p = 0.012). Heart failure rehospitalization occurred in 16.4% versus 24.3% (HR 0.63, 95% CI 0.47–0.85, p = 0.002). The early initiation group demonstrated significantly greater NT-proBNP reduction at discharge (−48.2 ± 22.6% vs. −34.7 ± 24.1%, p < 0.001) and shorter median length of stay (6.3 ± 2.8 vs. 7.9 ± 3.4 days, p < 0.001). No significant differences in acute kidney injury, diabetic ketoacidosis, or urinary tract infections were observed between groups. Conclusion: Early in-hospital initiation of SGLT2 inhibitors within 48 hours of admission for ADHF was associated with significantly reduced all-cause mortality, lower heart failure rehospitalization rates, and greater neurohormonal decongestion without increased adverse events. These findings support the paradigm of prompt SGLT2 inhibitor initiation during acute heart failure hospitalization.

Background: Oligohydramnios is described as decreased amniotic fluid volume relative to gestational age. Semi quantitatively it is described using the Amniotic Fluid Index (AFI) which is calculated by adding the depth in centimeters of the largest vertical pocket in each of four equal uterine quadrants. AFI less than or equal to 5 cm is defined as oligohydramnios. A Borderline Oligohydramnios (BO) is defined as AFI 5.1-8 cm. Objectives: To evaluate fetomaternal outcomes in term pregnancies with borderline oligohydramnios (Amniotic Fluid Index [AFI] 5–8 cm) and a cerebroplacental ratio (CPR) >1. Methods: This prospective analytical study was conducted at the Department of Obstetrics and Gynecology, Rajiv Gandhi Institute of Medical Sciences, Adilabad, involving 100 term (37–40 weeks) singleton pregnant women with AFI 5–8 cm and CPR >1, confirmed by Doppler ultrasound. Data were analyzed to assess Obstetric outcomes and perinatal outcomes. Results: The mean maternal age was 25.01 years (SD 3.98), with 48% aged 21–25 years. Gestational age distribution was 35% at 37 weeks, 29% at 38 weeks, 24% at 39 weeks, and 12% at 40 weeks. Obstetric outcomes included 38% NVD, 27% induced NVD, 20% assisted vaginal delivery, and 15% LSCS. Induction was used in 49% of cases (Foley’s catheter and prostaglandin E1). Perinatal complications included meconium-stained liquor (33%), low Apgar scores (23%), LBW (20%), fetal distress (19%), RDS (18%), NICU admissions (9%), and perinatal mortality (2%). Significant associations were found between gestational age and meconium-stained liquor (p=0.004) and RDS (p=0.02). No significant differences in perinatal outcomes were observed between cesarean and non-cesarean deliveries in mothers with CPR >1, suggesting safe vaginal delivery in this subgroup. Conclusion: Term pregnancies with borderline oligohydramnios and CPR >1 can achieve favorable fetomaternal outcomes with a high rate of vaginal deliveries and low severe perinatal complications. CPR >1 is a valuable marker for identifying cases suitable for vaginal delivery, reducing unnecessary cesarean sections while ensuring fetal well-being.

Background: Total hip arthroplasty (THA) is among the most frequently performed orthopedic procedures worldwide, providing substantial improvements in pain relief and functional restoration for patients with end-stage hip joint disease. Despite significant advances in surgical techniques, implant technology, and perioperative care protocols, postoperative complications remain a considerable clinical concern affecting patient outcomes, healthcare utilization, and long-term prosthetic survivorship. Comprehensive characterization of complication patterns and their associated risk factors is essential for optimizing patient selection and perioperative management strategies. Methods: This retrospective cohort study analyzed medical records of 712 consecutive patients who underwent primary THA at a tertiary orthopedic center. Demographic variables, surgical parameters, comorbidity profiles, and postoperative complications occurring within 90 days and one year were systematically documented. Univariate and multivariable logistic regression analyses were performed to identify independent risk factors associated with overall and specific complications. Results: The overall 90-day complication rate was 14.3% (n = 102), while the one-year complication rate was 18.8% (n = 134). The most frequent complications included periprosthetic joint infection (PJI; 2.9%), venous thromboembolism (VTE; 3.4%), dislocation (3.1%), and periprosthetic fracture (1.8%). Independent risk factors for overall complications included age ≥75 years (OR: 2.14; 95% CI: 1.38–3.32; p = 0.001), BMI ≥35 kg/m² (OR: 2.47; 95% CI: 1.51–4.04; p < 0.001), diabetes mellitus (OR: 1.89; 95% CI: 1.19–3.01; p = 0.007), ASA classification ≥III (OR: 2.08; 95% CI: 1.32–3.28; p = 0.002), and operative time exceeding 120 minutes (OR: 1.76; 95% CI: 1.12–2.78; p = 0.015). Conclusion: Postoperative complications following primary THA occur in a clinically significant proportion of patients. Modifiable risk factors including obesity and prolonged operative time, alongside non-modifiable factors such as advanced age and comorbidity burden, significantly predict adverse outcomes. Targeted perioperative optimization strategies may reduce complication rates and improve overall surgical outcomes.

Background: Gallstone disease, common in India, can lead to carcinoma gallbladder due to chronic mucosal irritation. The rate of incidental carcinoma found after cholecystectomy differs by region, highlighting the importance of early detection for improved prognosis. The present study aimed to determine incidence of carcinoma gall bladder in patients undergoing cholecystectomy and its correlation with clinicopathological profile of patients. Methodology: This prospective observational study was conducted in department of general surgery at Pt. JNM medical college from January 2016 to August 2022, including 149 patients with symptomatic, ultrasonography confirmed gallstone disease undergoing elective cholecystectomy. Data on clinical, demographic, and histopathological parameters were analyzed to determine the incidence and associations of incidental gallbladder carcinoma. Results: The rate of incidental carcinoma of gall bladder in our setting was found to be 0.67. Out of 149 patients, 1(0.67%) patients had gall bladder polyp and 148(99.33%) patients didn’t had gallbladder polyp. 91(61.07%) had gall bladder wall thickness of 2-3mm and 58 (38.93%) patients had gall bladder wall thickness of 3-5mm. 4 (2.7%)patients had tenderness per abdomen,4(2.7%) patients had guarding, 2(1.3%) patients had rigidity,4(2.7%) patients had rebound tenderness,4(2.7%) patients had Murphy’s sign positive, and 3(2.0%) patients had abdominal distension. Conclusion: We concluded that most common histopathological finding in patients undergoing cholecystectomy was chronic cholecystitis with cholelithiasis. The one case diagnosed with carcinoma gall bladder was adenocarcinoma in histopathological types. As our data might not be sufficient for correlation of various variables but given that early diagnosis in carcinoma gallbladder can drastically change outcome in patients, Histopathological analysis of all gallbladder specimen in elective as well as emergency cholecystectomy should be mandatory.

Background: Disturbances in acid–base balance are frequently encountered in critically ill patients and often reflect the severity of the underlying illness. These abnormalities have been consistently associated with increased morbidity and mortality in intensive care units (ICUs). Objectives: To evaluate the pattern of acid–base disorders in ICU patients and to determine their association with mortality. Methods: This prospective observational study was conducted over a 12-month period in the medical ICU of a tertiary care teaching hospital in western India. One hundred adult patients admitted for more than 12 hours were included. Acid–base disorders were identified using arterial blood gas (ABG) analysis following a structured five-step interpretative approach. Acid–base and biochemical parameters were compared between survivors and non-survivors. Results: The mean age of the study population was 52.6 ± 13.36 years, with a male predominance (63%). Mixed acid–base disorders were more frequent than isolated abnormalities (61% vs 39%). Metabolic acidosis (18%) was the most common isolated disorder, while metabolic alkalosis combined with respiratory alkalosis (23%) was the most frequent mixed disorder. ARDS (28%) and sepsis (18%) were the leading primary diagnoses. Overall mortality was 35%. Non-survivors had significantly lower pH, bicarbonate, sodium, and oxygen saturation, along with higher PaCO₂, anion gap, and serum creatinine (p < 0.05). Conclusions: Acid–base disorders are highly prevalent among critically ill patients, with mixed abnormalities predominating. Significant derangements in acid–base parameters are associated with increased mortality, emphasizing the importance of early recognition and timely correction.

Background: Interstitial lung diseases (ILD) represent a significant complication in rheumatoid arthritis (RA), contributing to increased morbidity and mortality. Despite advances in RA management, the prevalence and clinical profile of ILD in Indian RA populations remain understudied. Objectives: To determine the prevalence of ILD in RA patients, describe demographic and clinical characteristics, and identify potential risk factors. Material and Methods: This cross-sectional descriptive study was conducted at the Department of Pulmonary Medicine, LN Medical College, Bhopal, by enrolling a total of 84 RA patients over a period of 6 months. Data collection involved detailed history, physical examination, high-resolution computed tomography (HRCT) of the chest, pulmonary function tests (PFTs), and serological tests. ILD was classified based on HRCT patterns (e.g., usual interstitial pneumonia [UIP], nonspecific interstitial pneumonia [NSIP]). Results: Among the 84 patients (mean age 52.3 ± 11.4 years; 62% female), ILD was detected in 28 (33.3%). The most common HRCT pattern was UIP (46.4%), followed by NSIP (32.1%) and organizing pneumonia (21.4%). Patients with ILD had longer RA duration (mean 8.7 ± 4.2 years vs. 5.1 ± 3.6 years in non-ILD; p<0.05) and higher positivity for RF (78.6% vs. 54.3%) and anti-CCP (67.9% vs. 48.2%). Smoking history was noted in 42.9% of ILD cases. PFTs showed restrictive patterns in 75% of ILD patients, with reduced forced vital capacity (mean 68.4% predicted). Conclusion: ILD affects approximately one-third of RA patients in this cohort, with UIP as the predominant subtype. Longer disease duration and positive serology emerge as key associations. Early screening with HRCT and PFTs is recommended for high-risk RA patients to improve outcomes. Larger prospective studies are warranted to validate these findings.

Background: Routine semen analysis is the standard diagnostic tool for evaluating male infertility, but it may not detect functional sperm defects such as DNA damage. Sperm DNA fragmentation index (DFI) has emerged as a clinically relevant marker associated with reduced fertility outcomes. Objective: To assess the clinical significance of integrating DFI testing with routine semen analysis in infertile males. Methods: This multicenter retrospective study was conducted across infertility laboratories in Chhattisgarh, Madhya Pradesh, and Maharashtra over one year. A total of 220 infertile men were included. Semen analysis was performed according to WHO guidelines, and DFI was assessed using standardized sperm DNA fragmentation testing. Participants were categorized into low DFI (<25%) and high DFI (≥25%) groups. Statistical comparison of semen parameters, correlation analysis, multivariate logistic regression, and ROC curve analysis were performed. Results: High DFI was observed in 38.6% of patients. Men with high DFI had significantly lower sperm concentration (36.4 ± 17.8 vs 48.2 ± 19.5 million/mL, p = 0.001), progressive motility (29.8 ± 11.6 vs 39.6 ± 12.8%, p < 0.001), and normal morphology (3.9 ± 1.9 vs 5.8 ± 2.1%, p < 0.001). DFI showed significant negative correlations with progressive motility (r = -0.52, p < 0.001) and morphology (r = -0.44, p < 0.001). Combined DFI + semen parameters improved diagnostic performance (AUC 0.84) compared to semen analysis alone (AUC 0.72). Conclusion: DFI adds significant diagnostic value to routine semen analysis and improves clinical risk stratification in male infertility evaluation.

Background: Chronic suppurative otitis media is a longstanding infection of the middle ear cleft characterized by persistent or recurrent aural discharge, deafness and perforation of tympanic membrane. Type I tympanoplasty is a surgical procedure that repairs tympanic membrane perforation. Methods: There were a total of 62 patients of age group 15-45 years of chronic otitis media, mucosal type who underwent type I tympanoplasty in ENT Dept, DMCH, Laheriasarai, Darbhanga, during Feb 2025 to Aug 2025. Pure tone audiometry of the patients was done before the surgery and one month and three months following surgery and the hearing improvement was assessed in each case. Results: In this study, graft uptake was highest (95%) in posterior perforations, 75% in anterior perforations and lowest (63.64%) in combined perforations. The mean hearing improvement one month following surgery was 7.16 dB and three months following surgery, it was 7.78 dB. Conclusions: Chronic otitis media is a treatable cause of hearing loss. Type-I tympanoplasty is a safe and effective method to remove the disease of the middle ear and reconstruct the tympanic membrane perforation.

Background: Acute abdominal pain in children presents significant diagnostic challenges due to diverse etiologies and overlapping clinical features. Aim: To evaluate the diagnostic value and limitations of abdominal ultrasound in children presenting with acute abdominal pain and assess appropriate clinical indications for its use. Material and Methods: A prospective observational study was conducted on 120 pediatric patients presenting with acute abdominal pain. All patients underwent abdominal ultrasonography, and findings were correlated with final clinical diagnoses. Results: Ultrasound accurately identified common conditions such as mesenteric lymphadenitis and acute appendicitis, while a subset of patients demonstrated normal scans, emphasizing the importance of clinical correlation. Conclusion: Abdominal ultrasound is a reliable first-line imaging modality in pediatric acute abdomen when used judiciously and interpreted alongside clinical findings.

Platelets originate from cytoplasmic fragmentation of mature megakaryocytes, these are essential for maintaining hemostasis balance, regulating inflammatory response, and immune response and wound healing. A platelet count of less than 150 x 10⁹/L is an indicative of thrombocytopenia , which can result of either impaired platelet production (hypo proliferative ) or increased platelet destruction (hyper destructive). Bone marrow examination is the definitive method in distinguishing between hypo proliferative and hyper destructive thrombocytopenia, but its invasive nature and associated bleeding makes it less desirable option for patients .In contrast ,evaluating platelet indices is less invasive, simpler and effective method for distinguishing types of thrombocytopenia. The platelets indexes that can be used are Plateletcrit (PCT), Mean Platelet Volume (MPV) ,Platelet Large Cell Ratio(P-LCR) and Platelet Distribution Width (PDW). This study seeks to evaluate values of platelet indices in differentiating between various types of thrombocytopenia, thereby help in diagnosis and management. To determine the role of platelet indices in discriminating hypo proliferative and hyper destructive type of thrombocytopenia and to determine platelet indices in various causes in thrombocytopenia disorders. A prospective study of 62 patients with thrombocytopenia was done a period of six months in department of pathology, to determine type of thrombocytopenia based on platelet indices. All 62 cases data were entered into a Microsoft Excel spreadsheet, then analyzed using SPSS Statistics version 22. Quantitative data were summarized as mean ± standard deviation or median with range, depending on distribution. Qualitative variables were assessed using the chi-square test, with statistical significance set at p < 0.05.31cases were classified as hyperdestructive thrombocytopenia and 31 cases as hypoproliferative thrombocytopenia. 35 males and 27 females. Among those with hyperdestructive thrombocytopenia, 61.3% were males and 38.7% were females. On comparing platelet parameters between the two groups, the mean platelet count in the hyperdestructive group was 90354.839±35465.052/cumm, whereas in the hypoproliferative group it was slightly lower 95451.613±35647.196 /cumm. This difference was not statistically significant (p = 0.4682). Statistically significant difference was observed in the platelet large cell ratio (P-LCR), which was higher in hyper destructive thrombocytopenia (32.616±9.008)compared to hypo proliferative thrombocytopenia (28.139±7.832), with a p-value of 0.03.The mean platelet volume (MPV) was significantly higher in hyperdestructive thrombocytopenia at 11.17 fL compared to 10.48 fL in hypo proliferative thrombocytopenia (p=0.009).
MPV and P-LCR are greatly elevated in hyper destructive thrombocytopenia and are excellent markers in differentiating the types of thrombocytopenia. Their application in routine examination can be useful in early diagnosis, but they need to be confirmed through large-scale studies.

Introduction: Sciatic nerve block is useful technique for unilateral lower limb surgeries particularly in patients who are not suitable for Central neuraxial blocks. Methodology: Forty patients from 20-70 years of either sex scheduled for below knee lower limb surgeries on elective or emergency basis, under sciatic nerve block by anterior approach in combination with femoral or saphenous nerve block were included under this trial. All blocks were given by landmark and PNS guided technique. Nerve block characteristics, success rate, patient comfort, complication etc. were observed. Results: Majorities of the patients (77.5%) required singe attempt. Only in 87.5 % patients’ plantar flexion was observed with nerve locator. In 5% patients, drug was injected when only paresthesia was found. Onset of sensory block was relatively fast 7.95 ±0.9 mins but motor blocks took time to establish 15.23 ± 0.9 mins. Primary block achieved in 21.5 ± 1.34 mins. Total procedure time with supplemental block were 5.76 ± 0.56 mins. Readiness time for surgery was 31.4 ±1.1 mins. Duration of motor block (3.86 ± 0.28 hrs) was less than the sensory block (8.27 ± 0.5 hrs). Duration of analgesia was quite larger (9.46 ± 0.52 hrs). Incidence of discomfort associated with performance of block was less. About block technique 78.9% patients said it hardly hurt. Only in 2.6 % patients required supplementation in form of IV sedation. 5% failed block patients were given spinal anaesthesia 35 minutes after block. Conclusion: Sciatic nerve block by anterior approach, lessen total procedure time for combination blocks. Foot twitches should be considered as end point and hamstring contractions should not accepted as motor response. In difficult block, try internal rotation of leg to expose nerve under the femur. Sciatic bock takes longer time (fairly 25-30 minutes) for full motor and sensory block achievement and provide long lasting postoperative analgesia, better tourniquet tolerance with stable hemodynamics. Anterior sciatic nerve block is therefore safe and effective technique and deserve to be used more widely for unilateral lower limb surgeries and post-operative analgesia.

Introduction: Coronary artery disease (CAD) is one of the commonest causes of mortality and morbidity. The Fibrinogen/Albumin Ratio (FAR) is a newer marker of inflammation that has been shown to be a predictor of short-term prognosis in patients with acute myocardial infarction. Utility of FAR in predicting angiographic severity of CAD and clinical outcomes is not yet clear in Indian patients. Objective: To study the role of fibrinogen-to-albumin ratio (FAR) as predictor of the angiographic severity of the coronary artery disease, and the short-term prognosis in the patients undergoing coronary angiography. Material and Methods: The present study was conducted in the Dept. of Cardiology, Sri Jayadeva Institution of Cardiovascular Sciences. A detailed history, physical examination and all routine investigations along with serum albumin, fibrinogen, ECG & 2-D Echo were done for all the patients. Samples were drawn at admission, before angiography. All the patients underwent clinically indicated invasive coronary angiography. SYNTAX SCORE was calculated using an online SYNTAX SCORE calculator. Results: Out of the 237 patients for final analysis, the majority (81.4%) were male. The mean age of the patients was 57 years. The mean fibrinogen level was 397.97 mg/dl, the mean serum albumin level was 4.05 g/dl and the mean FAR was 101.07 mg/g. with FAR below it was considered as low FAR and above it was considered as high FAR. The mean CAG Syntax score was 22.02. Majority of patients (58.6%) had acute coronary syndrome (ACS), while remaining had stable coronary artery disease. Two FAR groups were found to have comparable proportions of patients across the two Syntax score groups (low SS < 23, high SS > 23). The p-value for the correlation between FAR and Syntax Score was not significant (p=0.941). Conclusion: FAR was not found to be associated with CAD severity among Indian patients with stable CAD and ACS in the present study. This study didn’t find any correlation between the FAR and short-term prognosis.

Background: Interstitial lung disease (ILD) is characterized by chronic inflammation and fibrosis of the lung parenchyma, often leading to progressive hypoxemia requiring long-term oxygen therapy (LTOT). While inflammatory biomarkers are known to reflect disease activity, the impact of LTOT on these markers remains incompletely understood. Aim and Objectives: To compare serial changes in inflammatory and biochemical markers—including high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), D-dimer, interleukin-6 (IL-6), procalcitonin, and lactate dehydrogenase (LDH)—in ILD patients receiving LTOT versus those not on oxygen therapy. Materials and Methods: A prospective, observational study was conducted on 112 ILD patients divided into two groups: 56 patients on LTOT and 56 without oxygen therapy. Blood samples were collected at baseline and after one month to measure hs-CRP, ESR, D-dimer, IL-6, procalcitonin, and LDH. Data were analyzed using Shapiro–Wilk test for normality, followed by appropriate parametric (independent/paired t-tests) or non-parametric (Mann–Whitney U, Wilcoxon signed-rank) tests. Correlations between post-therapy inflammatory markers, lung function (FVC), and oxygen requirement were assessed using Spearman’s rank correlation. Results: At baseline, both groups had elevated inflammatory markers, with significantly higher mean LDH and D-dimer in the LTOT group. After one month of oxygen therapy, significant reductions were observed in hs-CRP, ESR, IL-6, and D-dimer (p < 0.05), while LDH and procalcitonin also showed mild but consistent declines. Correlation analysis revealed a weak positive association between post-therapy LDH and oxygen flow rate (r = 0.62, p < 0.01), while hs-CRP and IL-6 showed minimal correlation with FVC. Conclusion: Long-term oxygen therapy in ILD patients led to a measurable reduction in systemic inflammation, as evidenced by decreased hs-CRP, IL-6, ESR, and D-dimer levels. LDH, though less specific, showed a moderate relationship with oxygen requirement, suggesting its potential role as an adjunctive marker for tissue injury and hypoxia. Monitoring LDH alongside traditional inflammatory markers may enhance clinical assessment of disease activity and therapeutic response in ILD patients on LTOT.

Background: Necrotizing soft tissue infections (NSTIs) are rapidly progressive, life-threatening conditions requiring emergent surgical debridement. Early pathogen identification may optimize antimicrobial therapy and guide surgical management, yet the clinical impact of rapid microbiological diagnostics on surgical decision-making remains incompletely characterized. Methods: A prospective cohort study was conducted over 36 months, enrolling 142 patients with confirmed NSTIs. Rapid diagnostics including Gram stain, direct molecular testing (multiplex PCR), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) were compared to conventional culture. Time to pathogen identification, antimicrobial modification rates, surgical decision impact, and clinical outcomes were evaluated. Results: Rapid diagnostics provided actionable results in a median of 2.8 hours compared to 48.6 hours for conventional culture (p<0.001). Gram stain sensitivity was 84.5%, while multiplex PCR demonstrated 94.4% concordance with culture. Rapid diagnostics prompted antimicrobial modification in 43.7% of cases, with escalation in 28.2% and de-escalation in 15.5%. Surgical planning was influenced in 31.0% of patients, including decisions regarding debridement extent and timing of re-exploration. Patients receiving rapid diagnostic-guided therapy demonstrated lower mortality (14.1% vs. 26.3%, p=0.048) and reduced amputation rates (8.5% vs. 18.4%, p=0.042) compared to conventional management. Conclusion: Rapid microbiological diagnostics significantly accelerate pathogen identification in necrotizing soft tissue infections, enabling earlier antimicrobial optimization and influencing surgical decision-making with associated improvements in clinical outcomes.

Background: Despite advances in surgical techniques, posterior capsular opacification (PCO) remains a predominant long-term complication of cataract surgery. It results from residual lens epithelial cells (LECs) that proliferate, migrate, and undergo metaplasia within the capsular bag, leading to visual axis obscuration. Clinically, PCO causes reduced visual acuity, diminished contrast sensitivity, and may hinder posterior segment evaluation. The reported incidence of PCO ranges from 20–50% within five years after cataract surgery in adults and approaches nearly 100% in paediatric cases. Although primary posterior continuous curvilinear capsulorhexis (PPCC) is routinely performed in paediatric cataract surgery, its use in adults is limited. PPCC involves the removal of the central posterior capsule at the time of surgery to prevent LEC migration toward the visual axis. Aim: To evaluate the long-term safety and efficacy of phacoemulsification and manual small-incision cataract surgery combined with PPCC and posterior chamber intraocular lens (PCIOL) implantation in adult patients. Materials and Methods: This interventional case series included 50 adult patients who underwent cataract surgery with PPCC at Government General Hospital, Eluru, Between March to July 2025. Only patients with age-related cataract undergoing PPCC were included. Preoperative and postoperative visual outcomes and complications were assessed over a structured follow-up period. Results: The study population comprised 27 females and 23 males. Postoperative corrected distance visual acuity (CDVA) showed significant improvement and remained stable throughout follow-up. No sight-threatening complications such as retinal detachment or endophthalmitis were observed. Conclusion: Cataract surgery combined with PPCC in adults appears to be a safe and effective strategy to reduce PCO, minimize the need for Nd:YAG capsulotomy, and maintain long-term visual outcomes. Further evidence from large-scale randomized controlled trials with extended follow-up is necessary to substantiate these findings.

Background: Neonatal jaundice remains one of the most common reasons for hospital readmission within the first two weeks of life. Early identification of neonates at risk of significant hyperbilirubinemia prior to discharge could reduce preventable readmissions. Transcutaneous bilirubinometry (TcB) offers a noninvasive, rapid, and cost-effective screening modality, yet its predictive value for readmission has not been thoroughly characterized. Methods: This prospective cohort study enrolled 486 healthy term and late-preterm neonates born at a tertiary care hospital. Predischarge TcB measurements were obtained using the Dräger Jaundice Meter JM-105 within 6 hours prior to discharge. Neonates were followed for 14 days to ascertain readmission for phototherapy-requiring jaundice. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive accuracy of predischarge TcB values. Results: Of the 486 neonates, 52 (10.7%) were readmitted for jaundice requiring phototherapy. The mean predischarge TcB was significantly higher in readmitted neonates (12.8 ± 2.1 mg/dL) compared to non-readmitted neonates (8.4 ± 2.6 mg/dL; p < 0.001). ROC analysis yielded an area under the curve (AUC) of 0.87 (95% CI: 0.83–0.91). A TcB cutoff of ≥10.5 mg/dL demonstrated a sensitivity of 84.6%, specificity of 78.3%, positive predictive value of 31.9%, and negative predictive value of 97.7%. Conclusion: Predischarge TcB measurement is a reliable noninvasive predictor of readmission for neonatal jaundice. Implementation of TcB-based screening protocols could facilitate targeted follow-up and reduce avoidable readmissions.

Background: Empirical antibiotic therapy is routinely initiated in hospitalized patients with suspected bacterial infections; however, prolonged broad-spectrum use may increase antimicrobial resistance and healthcare costs. Culture-guided therapy, involving modification of antibiotics based on culture and antimicrobial susceptibility testing (AST), may optimize treatment and improve cost-effectiveness. Aim of the study was to compare the clinical outcomes and cost-effectiveness of empirical versus culture-guided antibiotic therapy in a tertiary care hospital. Material and Methods: A prospective observational comparative study was conducted in the Department of Pharmacology in collaboration with clinical departments. A total of 75 adult inpatients receiving systemic antibiotics for suspected bacterial infections were included. Patients were categorized into empirical therapy (n=38) and culture-guided therapy (n=37) groups based on antibiotic modification following culture/AST results. Baseline characteristics, microbiological profile, antibiotic utilization, clinical outcomes, and direct medical costs were analyzed. Continuous variables were compared using the Independent t-test, and categorical variables using the Chi-square/Fisher’s exact test. Cost-effectiveness was assessed by comparing mean costs and clinical cure rates. Results: Baseline characteristics were comparable between groups (p>0.05). The culture-guided group demonstrated a significantly higher de-escalation rate (56.8% vs 15.8%, p<0.001), shorter duration of antibiotic therapy (8.1±2.5 vs 10.4±3.2 days, p=0.002), and reduced length of hospital stay (8.9±3.6 vs 11.6±4.3 days, p=0.004). Mean antibiotic cost (₹6,320±1,980 vs ₹8,950±2,430; p<0.001) and total direct medical cost (₹45,900±11,600 vs ₹58,200±14,300; p=0.001) were significantly lower in the culture-guided group. Clinical cure rates were higher in the culture-guided group (83.8% vs 71.1%), though not statistically significant (p=0.18). Conclusion: Culture-guided antibiotic therapy was associated with shorter hospital stay, reduced antibiotic exposure, and significant cost savings without compromising clinical outcomes. It represents a cost-effective and potentially dominant strategy in tertiary care settings.

Background: Antibiotics are commonly prescribed drugs and are frequently associated with adverse drug reactions (ADRs), contributing to patient morbidity and prolonged hospital stay. Aim of the study was to evaluate the clinical pattern, causality, severity, seriousness, and outcomes of antibiotic-associated ADRs in a tertiary care hospital. Materials and Methods: This prospective observational study included 50 patients who developed suspected antibiotic-associated ADRs. Data was collected using a structured case record form (CRF). Causality was assessed using WHO-UMC scale, and severity was graded using the Modified Hartwig and Siegel scale. Statistical analysis was performed using descriptive statistics and Chi-square test. Results: The mean age was 46.8 ± 15.2 years with male predominance (56%). Cephalosporins were the most commonly implicated antibiotics (28%). Skin manifestations (42%) were the most frequent ADRs, followed by gastrointestinal reactions (28%). Type B reactions accounted for 60% of cases. Serious ADRs occurred in 16% of patients. Most patients recovered completely (74%), with no mortality. Significant associations were observed between age and severity (p = 0.041) and antibiotic class and organ system involvement (p = 0.032). Conclusion: Antibiotic-associated ADRs are common but largely manageable. Strengthening pharmacovigilance and rational antibiotic use can improve patient safety.

Background: Iron deficiency anemia (IDA) is the most prevalent nutritional deficiency disorder globally, affecting a disproportionately large segment of populations in developing countries. Despite its widespread recognition, comprehensive characterization of the clinical profile and hematological parameters across varying severities of IDA remains inadequately explored in many regional populations. This study aimed to evaluate the clinical presentations and hematological parameters in patients diagnosed with iron deficiency anemia and to assess their correlation with disease severity. Methods: A hospital-based cross-sectional observational study was conducted at a tertiary care teaching hospital. A total of 320 patients diagnosed with IDA based on standard hematological and iron study criteria were enrolled. Demographic data, clinical symptoms, and comprehensive hematological parameters including complete blood count, peripheral blood smear morphology, serum iron, serum ferritin, total iron-binding capacity (TIBC), and transferrin saturation were systematically evaluated. Patients were categorized into mild, moderate, and severe anemia groups according to World Health Organization (WHO) criteria. Statistical analysis included descriptive statistics, chi-square tests, ANOVA, and Pearson correlation coefficients. Results: The mean age of participants was 34.6 ± 12.8 years, with a female predominance (72.5%). The most common clinical presentations were generalized fatigue (89.4%), pallor (82.2%), and exertional dyspnea (54.1%). The mean hemoglobin was 8.2 ± 2.1 g/dL, mean corpuscular volume (MCV) was 68.4 ± 8.7 fL, mean serum ferritin was 6.8 ± 4.2 ng/mL, and mean TIBC was 428.6 ± 62.3 µg/dL. Significant progressive deterioration in hematological indices was observed across mild, moderate, and severe groups (p < 0.001). Serum ferritin demonstrated the strongest negative correlation with disease severity (r = −0.72, p < 0.001). Microcytic hypochromic morphology on peripheral smear was present in 74.1% of patients. Conclusion: Iron deficiency anemia presents with a characteristic constellation of clinical symptoms and hematological abnormalities that progressively worsen with increasing disease severity. Serum ferritin remains the most reliable single marker for assessing iron depletion severity, while a comprehensive evaluation integrating clinical assessment with multiple hematological parameters is essential for accurate diagnosis and appropriate therapeutic stratification.

Background: Otorhinolaryngological disorders are among the most frequent health problems encountered in the pediatric population and contribute substantially to morbidity and healthcare utilization. The pattern and relative frequency of these conditions vary with age and environmental influences. The present study was conducted to evaluate the spectrum and distribution of ENT disorders among children attending a tertiary care hospital. Material and Methods: This descriptive cross-sectional study included 410 children aged ≤14 years presenting to the Department of Otorhinolaryngology over an 18-month period. Demographic details, clinical features, and final diagnoses were recorded using a structured proforma. Patients were categorized into otological, rhinological, and laryngological disorders based on clinical evaluation and relevant investigations. Data were analyzed using appropriate descriptive and inferential statistical methods, with p < 0.05 considered statistically significant. Results: The mean age of participants was 8.1 ± 3.9 years. The majority belonged to the 5–9-year age group (38.0%), followed by 10–14 years (35.7%) and 0–4 years (26.3%). Males constituted 57.1% of cases. Otological disorders were most common (44.4%), followed by rhinological (33.9%) and laryngological conditions (21.7%). Acute otitis media (26.4%) was the leading otological diagnosis, allergic rhinitis (31.7%) predominated among rhinological disorders, and acute tonsillitis (32.6%) was most frequent in the laryngological group. Age-wise variation in the distribution of major disorder categories was statistically significant (p < 0.05). Conclusion: Pediatric ENT disorders are highly prevalent, with infective and allergic conditions forming the bulk of cases. Age-specific trends underline the importance of early detection and timely intervention to minimize complications and long-term morbidity.

Background: Deviated nasal septum (DNS) is one of the most frequently encountered structural abnormalities in otorhinolaryngology practice and is a major contributor to nasal obstruction and related sinonasal complaints. The clinical presentation varies depending on the type and severity of septal deviation. This study aimed to evaluate the clinical profile and morphological patterns of DNS and to assess the association between septal deviation type and presenting symptoms. Material and Methods: A hospital-based cross-sectional study was conducted in the Department of Otorhinolaryngology of a tertiary care center over 18 months. A total of 150 patients aged ≥10 years with clinically and endoscopically confirmed DNS were enrolled. Demographic details, symptom profile, and severity of nasal obstruction using a 10-point Visual Analog Scale (VAS) were recorded. Septal morphology was classified based on endoscopic findings. Data were analyzed using appropriate statistical tests, with p < 0.05 considered statistically significant. Results: The mean age of participants was 31.8 ± 11.6 years, with the highest proportion in the 21–30-year age group (30.7%). Males constituted 62.7% of cases. Nasal obstruction was present in all patients. Headache (58.7%) and nasal discharge (50.7%) were common associated symptoms. Moderate nasal obstruction was observed in 45.3% of patients, with a mean VAS score of 5.9 ± 2.1. C-shaped deviation was the most frequent morphological type (41.3%). Inferior turbinate hypertrophy was the most common associated endoscopic finding (54.7%). A statistically significant association was observed between the type of septal deviation and predominant symptoms (χ² = 9.84, p = 0.043). Conclusion: DNS predominantly affects young adults and is commonly associated with moderate to severe nasal obstruction. Morphological variation influences symptom patterns, underscoring the importance of detailed anatomical assessment for optimal clinical management.

Aim: The aim of this study was to meticulously dissect and analyze the branching patterns of the right coronary artery (RCA) in 50 formalin-fixed adult human cadaveric heart specimens. This investigation sought to document the prevalence of normal anatomy versus variations. Materials and Methods: Fifty adult human hearts from both sexes, aged 30-70 years (mean 52±10), were formalin-fixed and dissected under magnification after removing pericardium and epicardial fat. RCA was traced from its ostium in the right aortic sinus along the right atrioventricular groove to termination at the crux. Branches were identified, measured (length, diameter using digital caliper), photographed, and classified. Variations like myocardial bridging, duplication noted. Data tabulated, analyzed via SPSS v26 (chi-square, frequencies). Results: Right dominance predominated in 42/50 (84%) specimens, co-dominance in 6/50 (12%), left in 2/50 (4%). SANA originated from RCA in 40/50 (80%), conus artery in 35/50 (70%). AMA present in 48/50 (96%), single in 90%, double in 8%. PDA from RCA in 84%, posterolateral branches averaged 2.1±0.8. Variations: early branching 10%, bridging 4%. No ectopic origins observed. Mean RCA length 10.2±2.1 cm, diameter 3.5±0.6 mm. Conclusion: This study affirms RCA’s predominant right dominance (84%) and consistent branching (SANA 80%, AMA 96%) in central Indian cadavers, aligning with global trends but highlighting higher co-dominance than some Western cohorts. Such data underscores the need for preoperative imaging to navigate variations, potentially lowering CABG/PCI risks. Future multi-center studies with larger samples and angiography correlation recommended.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by impaired glycemic control and lipid abnormalities that collectively elevate cardiovascular risk. This study aimed to evaluate glycated hemoglobin (HbA1c) and lipid profile parameters in T2DM patients and assess their correlation with glycemic control. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in India, enrolling 120 participants — 80 confirmed T2DM patients and 40 healthy age- and sex-matched controls. Fasting venous blood samples were analyzed for HbA1c by High-Performance Liquid Chromatography (HPLC), while total cholesterol (TC), triglycerides (TG), and HDL-C were measured by enzymatic colorimetric methods. LDL-C and VLDL-C were derived using the Friedewald equation. Data were analyzed using SPSS version 26.0, with p < 0.05 considered statistically significant. Results: HbA1c was significantly higher in T2DM patients than controls (9.1 ± 1.8% vs. 5.2 ± 0.4%, p < 0.001). Diabetic patients exhibited significantly elevated TC (5.82 ± 1.12 vs. 4.61 ± 0.83 mmol/L), TG (2.31 ± 0.87 vs. 1.24 ± 0.41 mmol/L), LDL-C (3.75 ± 0.94 vs. 2.67 ± 0.71 mmol/L), and VLDL-C (1.05 ± 0.40 vs. 0.56 ± 0.19 mmol/L), with significantly reduced HDL-C (1.02 ± 0.24 vs. 1.38 ± 0.29 mmol/L; all p < 0.001). HbA1c correlated positively with TC (r = +0.48), TG (r = +0.52), LDL-C (r = +0.44), and VLDL-C (r = +0.52), and negatively with HDL-C (r = −0.41; all p < 0.001). Conclusion: Patients with T2DM exhibit markedly elevated HbA1c alongside a significantly atherogenic lipid profile, highlighting the critical need for routine simultaneous monitoring of glycemic control and lipid status to mitigate cardiovascular risk.

Cutaneous tuberculosis, a rare extrapulmonary manifestation, constitutes a minor fraction of the overall TB disease burden, with scrofuloderma being the most common variant in paediatric populations. We present the case of a 7-year-old girl with a two-year history of recurrent abscesses on her chest and back that had recently enlarged. Previous incomplete treatment provided only temporary improvement. Clinical examination revealed classic signs of scrofuloderma, including multiple undermined ulcers with seropurulent discharge, sinuses, and puckered scars, accompanied by bilateral cervical lymphadenopathy in an otherwise systemically well child. Diagnostic workup revealed microcytic anaemia, an elevated erythrocyte sedimentation rate, and a strongly positive Mantoux test. Histopathological examination of a skin biopsy showed chronic inflammatory infiltrates with multinucleated giant cells, confirming the diagnosis. The patient was started on a standard four-drug anti- tubercular therapy regimen. This case underscores the characteristic clinical presentation of scrofuloderma in a child and highlights the critical importance of a high index of suspicion and the necessity of a complete, supervised course of ATT to achieve cure and prevent relapse, even in the absence of pulmonary involvement.

Background: Epidural analgesia is considered the gold standard for labour pain management. Opioid adjuvants such as fentanyl are commonly combined with bupivacaine to enhance analgesic efficacy and reduce local anesthetic requirement; however, opioid-related side effects remain a concern. Neostigmine, a cholinesterase inhibitor, has emerged as a potential non-opioid alternative for neuraxial analgesia.
Objective: To compare the analgesic efficacy and safety of neostigmine versus fentanyl as adjuvants to bupivacaine in epidural labour analgesia. Methods: In this prospective randomized single-blinded controlled trial, 60 ASA I–II parturients in active labour were randomly allocated into two groups (n=30 each). Group N received epidural bupivacaine (1.25 mg/mL) with neostigmine 2 µg/mL, while Group F received bupivacaine with fentanyl 2 µg/mL. Primary outcomes included duration of analgesia and total bupivacaine consumption. Secondary outcomes included time to full cervical dilatation, rescue bolus requirement, maternal side effects, and neonatal outcomes. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p<0.05 considered significant. Results: The neostigmine group demonstrated significantly longer duration of analgesia (142 ± 24 min vs 118 ± 22 min; p=0.001) and lower total bupivacaine consumption (32.4 ± 5.8 mg vs 39.8 ± 6.5 mg; p<0.001). Fewer patients required multiple rescue boluses in the neostigmine group (16.7% vs 46.7%; p=0.01). Time to full cervical dilatation was shorter in the neostigmine group (4.0 ± 1.0 h vs 4.6 ± 1.2 h; p=0.04). Pruritus was significantly higher in the fentanyl group (33.3% vs 3.3%; p=0.003), while nausea was more frequent with neostigmine (30% vs 10%; p=0.04). Neonatal Apgar scores and mode of delivery were comparable between groups. Conclusion: Epidural neostigmine as an adjuvant to bupivacaine provides prolonged analgesia with reduced local anesthetic requirement and lower incidence of opioid-related pruritus compared to fentanyl, while maintaining comparable fetomaternal safety. Neostigmine represents a promising non-opioid alternative for labour epidural analgesia.

Background: Regional anaesthesia is widely used for upper limb surgeries. Although ultrasound guidance is considered the gold standard for brachial plexus blocks, its availability is limited in many developing countries. Reliable surface anatomical landmarks therefore remain clinically important. Aim: To evaluate the anatomical relationship between the external jugular vein (EJV) and the brachial plexus (BP) at the cricoid and supraclavicular levels using ultrasonography, and to assess the usefulness of EJV as a surface landmark for landmark-guided brachial plexus block. Methods: This prospective observational study included 270 ASA physical status I and II adults aged 18–60 years. Ultrasound was used to identify the position of the brachial plexus relative to the external jugular vein at the cricoid and supraclavicular levels. Distances from skin to brachial plexus and from EJV to brachial plexus were measured and analysed statistically. Results: In 90% of patients, the brachial plexus was located medial to the external jugular vein at both levels. At the cricoid level, the EJV-to-brachial plexus distance was less than 1 cm in 92.2% of cases. A strong positive correlation was observed between skin-to-brachial plexus distance at the two levels (r = 0.75), while EJV-to-brachial plexus distance showed no significant correlation (r = −0.02). Conclusion: The external jugular vein shows a consistent anatomical relationship with the brachial plexus and may serve as a useful surface landmark for landmark-guided brachial plexus block, particularly in resource-limited settings where ultrasound is unavailable.

Background: For alcohol use disorders (AUDs) to be effectively managed and consequences to be avoided, early detection is crucial. A popular screening tool is the Alcohol Use Disorders Identification Test (AUDIT), and biochemical markers may improve the precision of diagnosis. Objective: To evaluate the effectiveness of AUDIT alone and in combination with biochemical markers in screening patients with alcohol dependence. Method: 155 patients with alcohol use disorders who were seen at the NSCB Medical College and Hospital’s Department of Psychiatry in Jabalpur were included in this prospective study. The AUDIT, CIWA scale, and biochemical markers (AST, ALT, and MCV) were used to evaluate the participants. Analysis was done on accuracy, sensitivity, specificity, PPV, and NPV. Results: High sensitivity (93.6%) and specificity (86.7%) were demonstrated with a AUDIT cutoff of 8. Increasing the limit to 15 decreased sensitivity while increasing specificity and PPV. Sensitivity and NPV were increased by combining AUDIT with biochemical indicators; the maximum sensitivity (98.0%) was obtained when AST and MCV were added. Conclusion: AUDIT is an effective screening tool for AUDs, and its accuracy is enhanced when combined with biochemical markers. This combined approach supports early diagnosis and better clinical management.

Background: First aid is a vital life-saving skill, particularly in schools where children are vulnerable to injuries and medical emergencies. Teachers, as the immediate responders, play a crucial role in ensuring timely assistance and child safety. Aims: This study aimed to assess the knowledge and practice of first aid among school teachers in Karur district, Tamil Nadu and to identify factors influencing their performance. Methodology: An institution-based cross-sectional study was conducted among 440 school teachers selected through multistage random sampling. Data were collected using a validated, semi-structured questionnaire and analyzed with SPSS version 21.0 using appropriate descriptive and inferential statistics. Results: The mean age of participants was 37.5±8.9 years and 85.5% were female. Overall, 57.3% reported prior first aid training. Good knowledge was observed in 54.5% of teachers, with higher knowledge regarding breathing difficulty (84.5%) and animal bites (71.1%), but lower for severe bleeding (15.5%) and epilepsy (28%). Multivariable logistic regression analysis showed that, after adjusting for potential confounders, only training status was significantly associated with knowledge (aOR 1.95, 95% CI 1.29–2.94). Good practice was reported by only 19.3% of teachers; postgraduate education and non-science subject specialization were independent predictors of good practice. Conclusions: More than half of the teachers had good knowledge, but correct practice was notably poor, showing a knowledge-practice gap. Regular, structured and hands-on training programs, supported by adequate resources in schools, are essential to enhance preparedness in managing emergencies.

Background: Acute pancreatitis (AP) is a potentially life-threatening condition with varying severity. Early identification of severe cases is crucial for improving outcomes. This study aimed to evaluate the role of high-sensitivity C-reactive protein (hs-CRP), and serum triglyceride levels in predicting the severity of AP. Methods: A cross-sectional study was conducted on 125 patients diagnosed with AP. Serum calcium, hs-CRP, and triglyceride levels were measured within 24-48 hours of admission. Patients were classified into mild, moderately severe, and severe AP based on the Revised Atlanta Classification. Statistical analysis was performed to assess the correlation between these biomarkers and disease severity. Results: The mean age of patients was 50±15 years, with a male predominance (72.8%). Alcohol was the most common etiology (60%), followed by gallstones (25%). Severe AP was associated with higher hs-CRP (337±21 mg/L) and triglyceride levels (359±171 mg/dL) compared to mild and moderate AP (p<0.001). Elevated hs-CRP, and hypertriglyceridemia were independent predictors of severe AP. Conclusion: hs-CRP, and triglyceride levels are useful biomarkers for predicting the severity of AP. Early measurement of these parameters can aid in risk stratification and guide clinical management.

Introduction: The emerging pattern and the increasing trend in the incidence of dengue infection are of great concern as there is no specific treatment of dengue, and most forms of therapy are supportive in nature. We conducted a study to evaluate a newly available commercial rapid immunochromatographic test for the early diagnosis of dengue infection. This test is designed to simultaneously detect dengue NS1 antigen and IgM antibody. Materials and Methods: This study was carried out in the Department of Microbiology of our institute and included 300 clinically suspected dengue cases. Screening for dengue infection was performed using a rapid immunochromatographic test (ICT) designed to detect both dengue NS1 antigen and IgM antibody (Advantage Dengue NS1 Ag and Ab Combi Card). In addition, all samples were tested for dengue-specific IgM antibodies using ELISA. Results: Of the 300 clinically suspected dengue cases, 88 samples were found to be positive by rapid immunochromatographic testing. Among these positive cases, 67 showed NS1 antigen positivity, whereas 21 were positive for IgM antibodies. All samples were subsequently analyzed using IgM ELISA. Conclusion: We would like to conclude that usefulness of NS1 antigen–based diagnostic methods for the early diagnosis of acute dengue virus infection. Rapid immunochromatographic tests enable prompt detection of both dengue NS1 antigen and IgM antibodies. Detection of NS1 antigen during the symptomatic phase of illness represents a significant advancement in the early diagnosis of dengue fever. The Dengue NS1 antigen strip, as a rapid diagnostic test for early dengue virus infection, demonstrated high sensitivity and specificity and is therefore suitable as a first-line diagnostic tool, particularly in field settings.

Background: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallstone disease due to reduced postoperative pain, shorter hospital stay, and early recovery. However, gallbladder perforation (GP) remains a frequent intraoperative complication, reported in 10–35% of cases. GP may result in bile spillage, stone loss, increased operative time, infection, abscess formation, and prolonged hospitalization. Identifying predisposing factors is essential to minimize morbidity and improve surgical outcomes. Aim: To identify and analyze the predisposing factors contributing to gallbladder perforation during laparoscopic cholecystectomy at a tertiary care centre. Methods: This prospective observational study was conducted in the Department of General Surgery, Guntur Medical College, from April 2023 to March 2025. Sixty patients aged ≥18 years undergoing elective or emergency LC were included. Patients undergoing primary open surgery or with suspected malignancy were excluded. Preoperative assessment included clinical evaluation and ultrasonography (wall thickness, stone impaction). Intraoperative data included occurrence and cause of GP, surgeon experience, operative duration, and need for conversion. Postoperative outcomes such as infection, bile leak, and hospital stay were recorded. Statistical analysis was performed using SPSS, with p <0.05 considered significant. Results: Gallbladder perforation occurred in 18 of 60 patients (30%). Thickened gallbladder wall (≥5 mm) showed a statistically significant association with GP (p = 0.015). Chronic cholecystitis demonstrated a higher perforation rate (42.9%) compared to acute cases (18.8%), though not statistically significant (p = 0.08). Age, gender, comorbidities, and surgeon experience were not significantly associated with GP. Postoperative infection occurred in 35% of patients, bile leak in 5%, and mean hospital stay was 5.65 days, with higher morbidity observed in GP cases. Conclusion: Gallbladder wall thickness ≥5 mm is a significant predictor of intraoperative perforation. Early identification of high-risk patients and meticulous surgical technique are essential to reduce complications and improve patient outcomes.

Background: Neuromuscular blocking agents play a crucial role in facilitating optimal endotracheal intubation during general anesthesia. Rocuronium is commonly used for its rapid onset, whereas cisatracurium offers organ-independent metabolism and stable hemodynamics. Comparative data on intubating conditions and physiological responses between these agents in elective non-obstetric surgeries remain limited. Objectives: To compare cisatracurium and rocuronium with respect to intubating conditions, onset of neuromuscular blockade, hemodynamic responses, and adverse effects in adult patients undergoing elective surgeries under general anesthesia. Methods: This prospective randomized single-blind study included 70 ASA I–II patients aged 20–60 years. Patients were randomized to receive either cisatracurium 0.1 mg/kg (Group C) or rocuronium 0.6 mg/kg (Group R). Intubating conditions were assessed using the Copenhagen Conference Score. Train-of-Four monitoring evaluated neuromuscular blockade, and hemodynamic parameters were recorded at predefined intervals. Results: Group C demonstrated a higher proportion of excellent intubating conditions and a faster early TOF suppression. Group R showed a higher transient pressor response post-intubation. Both groups achieved adequate neuromuscular blockade by 180 seconds, with minimal adverse effects. Conclusion: Cisatracurium provided superior intubating conditions and better hemodynamic stability compared with rocuronium in elective surgeries.

Background: Recurrent infections in children is frequent cause of healthcare visits and hospital admissions, particularly in low and middle income countries. Micronutrients such as iron, zinc, and vitamin D play a crucial role in immune function, and their deficiencies may predispose children to repeated infectious illnesses. Aim: To assess the pattern of micronutrient deficiencies and their association with infection frequency and severity among children with recurrent infections. Methods: This prospective observational study was conducted in the department of Pediatrics, Government Medical College, Bhadradri Kothagudem, from July to November 2025. Children aged 6 months to 12 years with recurrent infections were enrolled after obtaining informed consent. Demographic details, clinical profile, and infection characteristics were recorded. Anthropometric assessment was performed using WHO growth standards. Laboratory evaluation included hemoglobin, serum ferritin, serum zinc, and serum 25-hydroxyvitamin D levels. Data were analyzed using SPSS version 21.0. Results: Among 120 enrolled children, 82.5% had at least one micronutrient deficiency. Iron deficiency was the most common (60%), followed by vitamin D (45%) and zinc (38.3%). Nearly half of the children had multiple deficiencies. Children with two or more deficiencies experienced significantly higher infection frequency, longer illness duration, and increased hospitalization rates. Conclusion: Micronutrient deficiencies, particularly iron, vitamin D, and zinc, are highly prevalent among children with recurrent infections and are associated with increased morbidity. Targeted screening and correction of deficiencies may help reduce infection burden in this vulnerable group.

Background: Clear vision during childhood is crucial for the proper development of the visual system; therefore, any obstruction like cataracts can result in long-term visual impairment such as strabismus and amblyopia. Hence, for early cataract development (2-3 months) and unilateral cataract, best visual acuity is acquired if a cataract operation is done between 4-6 weeks and amblyopia development is better prevented compared to surgery done at later weeks. For bilateral cataracts, surgery is best carried out at 6 weeks with 1 week apart for both surgeries, this is done to avoid amblyopia. Materials and Methods: Our study focused on the outcomes of congenital and developmental cataract surgeries at the Regional Institute of Ophthalmology, Kolkata. Patients between 3 months to 12 years old with congenital or developmental cataracts undergoing surgery at the institute were evaluated over a 3-month follow-up period. Patients were examined post-surgery for early complications, followed by outpatient visits at RIO, Kolkata on specific intervals for up to 3 months, including visual acuity measurement, refraction, and monitoring for complications. Results: In our study, out of 130 eyes (taking each affected eye as a separate case), 81 (62%) were male and 49 (38%) were female. The mean Visual Acuity (VA) at onset in cataracts who presented at <1 year of age is 1.271 and final post op BCVA (Best corrected visual acuity) was 0.80. The mean VA at onset in cataracts who presented at 1-3 years of age is 1.065 and final post op BCVA was 0.744. The mean VA at onset in cataracts who presented at >3 years of age is 1.000 and final post op BCVA was 0.6776. R value according to Pearson’s coefficient is 0.257, 0.520, 0.599 respectively. Hence there is a positive correlation between age of onset of disease and Mean VA at onset as well as final BCVA at 3 months. PCO is the most common complication here and the percentage of the PCO is about 43.75%. Conclusion: Our study showed a positive correlation between the age of disease onset and age of presentation at hospital and visual acuity outcomes. The later the presentation or delay in seeking medical attention has much impact on the visual outcomes and related complications.

Background: Breast cancer remains the most common malignancy among women worldwide and is a leading cause of cancer-related mortality. Modified Radical Mastectomy (MRM) continues to be a commonly performed surgical procedure, particularly in developing countries where patients often present with locally advanced disease. Postoperative seroma formation is one of the most frequent complications following MRM and contributes to patient discomfort, prolonged hospital stay, risk of infection, and delayed adjuvant therapy. Closed suction drainage is routinely employed to reduce seroma formation; however, the optimal number of drains remains controversial. Objectives: This study aimed to compare the outcomes of single suction drain versus double suction drain placement following Modified Radical Mastectomy, with particular emphasis on seroma formation, postoperative pain, surgical site complications, and patient acceptability. Methods: A comparative study was conducted over an 18-month period in the Department of General Surgery at Guru Gobind Singh Medical College and Hospital, Faridkot. Eighty female patients undergoing MRM for carcinoma breast were enrolled and divided into two equal groups: Single Drain Group (SDG, n=40) and Double Drain Group (DDG, n=40). Patients were followed postoperatively for complications including seroma, hematoma, surgical site infection, flap necrosis, pain, and need for secondary suturing. Statistical analysis was performed to compare outcomes between the two groups. Results: Seroma formation was observed in 7 patients (17.5%) in the SDG and 4 patients (10%) in the DDG, with no statistically significant difference. Postoperative pain scores were significantly lower in the single drain group, and patient comfort and acceptability were higher compared to the double drain group. No significant differences were noted between the groups regarding drain duration, drain volume, surgical site infection, flap necrosis, or hematoma formation. Conclusion: Single suction drain placement following Modified Radical Mastectomy is as effective as double drain placement in preventing postoperative seroma and other complications, while offering the advantages of reduced postoperative pain and improved patient comfort. Routine use of a single suction drain may therefore be recommended following MRM.

Background: Stigma related to mental illness remains a major barrier to help-seeking, treatment adherence, and recovery. Individuals with anxiety and depressive disorders are particularly vulnerable to both perceived stigma and self-stigma, which may adversely influence clinical outcomes. However, data on stigma among these common mental disorders remain limited, especially in tertiary care settings in India. Objectives: To assess perceived stigma and self-stigma among individuals with anxiety and depressive disorders and to evaluate their association with selected sociodemographic and clinical variables. Methods: This hospital-based cross-sectional observational study was conducted in the Department of Psychiatry of a tertiary care center. A total of 52 adults diagnosed with anxiety disorders or depressive disorders as per ICD-11 criteria were recruited using consecutive sampling. Sociodemographic and clinical details were recorded using a semi-structured proforma. Perceived stigma was assessed using the Stigma Scale for Mental Illness (SSMI), and self-stigma was assessed using the Internalized Stigma of Mental Illness (ISMI) scale. Data were analyzed using SPSS version 25. Descriptive statistics were used to summarize variables, and inferential statistics including Chi-square test, independent t-test, Mann–Whitney U test, and Pearson correlation were applied. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 34.6 ± 9.8 years, with a female predominance (57.7%). Participants with depressive disorders had significantly higher perceived stigma scores compared to those with anxiety disorders (45.1 ± 7.9 vs. 39.2 ± 8.1; p = 0.01). Internalized stigma was also significantly higher in depressive disorders (2.56 ± 0.42 vs. 2.24 ± 0.43; p = 0.004). A significant positive correlation was observed between duration of illness and self-stigma (r = 0.46, p <0.001). Conclusion: The study demonstrated substantial levels of perceived stigma and self-stigma among patients with anxiety and depressive disorders, particularly in depressive disorders and those with longer illness duration. Targeted stigma-reduction interventions are essential to improve treatment engagement and mental health outcomes.

Background: In the world, cardiovascular diseases are a major morbid and mortal illness. Although the traditional risk factors and variables, including hypertension, diabetes mellitus, dyslipidemia, and smoking are well-established, they cannot explain the cardiovascular risk in all individuals. The amino acid homocysteine which is a sulfur-containing concern in the metabolism of methionine has been suggested to act as an independent cardiovascular risk element, yet its role in the regular screening of cardiovascular risk is unclear. Objective: The objectives of the present study were to evaluate levels of serum homocysteine in the individuals who are subjected to cardiovascular risk screening, and to determine the relationship of serum homocysteine with known cardiovascular risk factors. Methods: A one-year cross-sectional observational study was carried out on a sample of 100 adult participants (study subjects who have undergone cardiovascular risk assessment). Clinical parameters, demographic data and laboratories were noted. Standardized enzymatic assay was used in the determination of fasting serum homocysteine with a level above 15 µmol/L being regarded as high. Proper statistical tests were done to determine the association between cardiovascular risk factors and homocysteine levels and p < 0.05 was defined as statistically significant. Results: The participants had high levels of serum homocysteine, 38% of them. Male, smoking, hypertensives, and dyslipidemic people were also found to have hyperhomocysteinemia much more frequently (p < 0.05). The homocysteine level and diabetes mellitus were found not to have a statistically significant relationship. Conclusion: A high percentage of people who have cardiovascular risk screening have high levels of homocysteine that are strongly linked with various traditional cardiovascular risk factors. The results indicated that homocysteine estimation can be a valuable supplement in the cardiovascular risk classification.

Background: One chronic gastrointestinal disorder that manifests extra-esophageal is gastroesophageal reflux disease (GERD), and complicated mouth-related problems like dental erosion which is seldom recognized.  Dental erosion is the dissolution of the structural components that comprise a tooth caused by an acid attack. Objective: Assess dental erosion consequences of gastroesophageal reflux disease in adult patients. Methods: The study was cross-sectional and observational in design done in one year in one hospital with 100 adults diagnosed with GERD. A comprehensive five-sectioned questionnaire was completed encompassing the participant’s demographics, medical history, GERD-related factors (duration and severity), dietary, and oral hygiene behaviors. Clinical oral assessment was done and dental erosion scoring was performed using the Basic Erosive Wear Examination (BEWE) index. Data were analyzed using descriptive statistics with Chi-square and SPSS software. A p-value < 0.05 was accepted as statistically significant. Results: Of the total study participants, 62% had dental erosion. There was a higher prevalence of dental erosion observed in patients with a longer duration and greater severity of GERD symptoms. Among study participants, the correlation of dental erosion and severity of GERD symptoms was statistically significant (p < 0.05). Conclusion: The research identifies a clear link between GERD and dental erosion among adult patients. Tooth erosion and GERD are often overlooked in dental assessments. Early dental evaluations and interdisciplinary approaches are pivotal in obtaining a diagnosis and managing care to enhance outcomes.

Background: The National Medical Commission’s Graduate Medical Education Regulations 2018 emphasize self-directed, learner-centric approaches and the adoption of contemporary educational technologies, including e-learning. First-year MBBS Medical students often have limited classroom time for gross anatomy, and e-learning may enhance their understanding through flexible access to structured material. The COVID-19 pandemic further highlighted the need for effective online learning modalities. Aim: To develop and introduce an e-learning module in gross anatomy and evaluate its effectiveness and Medical students’ perceptions. Materials and Methods: A prospective interventional study was conducted among 150 first-year MBBS students, among them 119 consented to participate. The anatomy of the heart was divided into two topics: one taught through traditional didactic lecture and the other through an e-learning module uploaded on Google Groups. Both topics were followed by online MCQ (Multiple Choice Question) assessments. The second topic was later taught again via didactic lecture, after which student perceptions of e-learning were collected through an online feedback questionnaire. Quantitative and qualitative data were analysed using Microsoft Excel. Results: A total of 47 students completed both MCQ assessments. Mean scores for Topic 1 (traditional lecture) and Topic 2 (e-learning) were 8.60 ± 3.08 and 8.57 ± 3.70, respectively (p = 0.97), indicating no significant difference in performance of the two groups as p is > 0.05. More than 80% of students found the e-learning module easy to access, navigate, and useful in enhancing understanding. Over 50% felt it promoted interaction, could replace some lectures, and should be continued in future teaching. However, 22% preferred traditional learning methods. Conclusion: Although learning outcomes did not significantly differ between traditional and e-learning methods, student feedback demonstrated high acceptance and satisfaction with the e-learning module. E-learning served as a valuable complement to conventional teaching, supporting its continued integration into the MBBS curriculum.

Background: Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD) are severe inflammatory demyelinating disorders predominantly affecting the optic nerves and spinal cord. Data on their clinical profile and outcomes in South Tamil Nadu remain limited. This study aimed to evaluate the clinical characteristics, serostatus, and functional outcomes of NMO/NMOSD patients presenting to a tertiary care center in this region. Materials and Methods: This retrospective observational study included 25 patients diagnosed with NMO/NMOSD between January 2016 and May 2019. Patients fulfilling revised Wingerchuk criteria were analyzed for clinical presentation, laboratory findings, neuroimaging, treatment response, and outcomes. Disability was assessed using the Expanded Disability Status Scale (EDSS) at the last follow-up. Results: Of the 25 patients, 7 (28%) were anti-aquaporin-4 antibody positive and 18 (72%) were seronegative. The female-to-male ratio was 2.57:1, with a median age of onset of 35 years. Combined myelitis and optic neuritis at presentation was significantly more frequent in seronegative patients (28%; p=0.047). Cervico-dorsal spinal cord involvement was observed in 68% of patients with myelitis. All patients received intravenous methylprednisolone; additional therapy included repeat steroids (40%), plasmapheresis (8%), and rituximab (4%). Median EDSS at last follow-up was lower in seronegative patients (3.5) than seropositive patients (5.0), though not statistically significant (p=0.14). Conclusions: Seronegative NMO/NMOSD constituted the majority of cases in this South Tamil Nadu cohort and more commonly presented with combined myelitis and optic neuritis. Functional outcomes were comparable between seropositive and seronegative patients. Larger prospective studies are required to clarify regional disease patterns and optimize management strategies.

Background: Endoscopic ultrasound (EUS) provides high-resolution images of both pancreatic parenchyma and duct and therefore is an integral component of evaluating and treating patients with pancreatitis and its complications. Aims and Objective: To study the clinical profile and its role of endoscopic ultrasonography in chronic pancreatitis patients. Materials and Methods: A cross-sectional observational study was conducted which included the patients admitted in tertiary care centre presenting with clinical diagnosis of chronic pancreatitis. The study was conducted over period of one year from April 2023 to March 2024 after approving the ethical committee approval in the department of gastroenterology of I.Q City Medical College, Durgapur, West-Bengal. A total sample size of 71 patients was included. Cases of chronic pancreatitis of both genders were enrolled in the study with the written consent. Ethical approval for the study was obtained, and a detailed history such as family history, alcohol consumption, and presence and severity of abdominal pain was recorded. All the patients were subjected to a thorough clinical examination, routine hematologic and biochemical investigations and abdominal ultrasonography. Parameters such as age, sex, abdominal symptoms, serum CEA were recorded. The diagnosis of chronic pancreatitis was established if there was evidence of pancreatic calcification on abdominal ultrasonography. Results: Maximum cases were seen in age group 21-35 years (males- 27, females- 16) followed by 36-50 years (males- 15, females- 13). Common clinical findings were pain in 57, calcification in 11, diarrhea in 34, jaundice in 22, lump in 17, vomiting in 38 and GI bleed in 31. A significant difference was observed (P< 0.05). Parenchymal features were hyperechoic foci with shadowing in 60, lobularity with honeycombing in 54, hyperechoic foci without shadowing in 36, stranding (Minor): hyperechoic lines ≥3 mm in length in 48. Ductal features were main pancreatic duct (MPD) calculi in 71, irregular MPD contour in 23, dilated side branches in 15, main pancreatic duct dilatation in 38 and hyper echoic duct margin in 44. A non- significant difference was observed (P> 0.05). Conclusion: Endoscopic ultrasound is the most sensitive imaging modality for diagnosing pancreatic disorders; it can demonstrate subtle alterations in the pancreatic parenchymal and ductal structure even before traditional imaging and functional testing demonstrate any abnormality.

Introduction: Sinonasal and nasopharyngeal lesionscomprise a heterogeneous group of conditions ranging from inflammatory polyps to aggressive malignant neoplasms. Their overlapping clinical presentations often necessitate histopathological evaluation for definitive diagnosis. Aim: To evaluate the clinicopathological spectrum of sinonasal and nasopharyngeal lesions in a tertiary care hospital, with emphasis on demographic distribution, clinical presentation, and histopathological categorization. Materials and Methods: This retrospective plus prospective observational study included 317 patients presenting with sinonasal masses. Biopsy and excision specimens were processed using routine histopathological techniques, with special stains and immunohistochemistry applied where necessary. Lesions were classified into non‑neoplastic and neoplastic categories. Demographic and clinical data were analyzed, and statistical associations were assessed using the Chi‑square test. Results: Of 317 cases, 224 (71%) were non‑neoplastic and 93 (29%) were neoplastic. Inflammatory polyps were the most common non‑neoplastic lesion (79.02%), while sinonasal papilloma (51.57%) and hemangioma (26.56%) predominated among benign neoplasms. Squamous cell carcinoma was the leading malignant tumor (27.58%). The majority of cases occurred in the 31–40 year age group (22.71%), with a male predominance (59.94%). Age showed a statistically significant association with lesion type (p = 0.0004), whereas gender did not (p = 0.628). Conclusion: Sinonasal and nasopharyngeal lesions are predominantly non‑neoplastic, with inflammatory polyps being the most frequent. Benign neoplasms outnumber malignant ones, though squamous cell carcinoma remains the most common malignancy. Histopathological evaluation is indispensable for accurate diagnosis, and regional variations such as higher frequencies of fungal and granulomatous lesions highlight the importance of local epidemiological data in guiding clinical management.

Background: Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent condition associated with hepatic steatosis in the absence of significant alcohol consumption. While B-mode ultrasound is commonly used for diagnosis, it cannot quantify liver fibrosis—a crucial determinant of prognosis. Shear wave elastography (SWE) offers a non-invasive method to assess liver stiffness and potentially detect early fibrosis. Materials and Methods: The study was undertaken from March 2025 to august 2025 after obtaining Institutional Review Board (IRB) approval in patients referred to the department of Radio diagnosis, Narendra Modi Medical College & L.G hospital, Ahmedabad. The study population consisted first 100 patients with no history of alcohol consumption were diagnosed having fatty liver on B mode ultrasound and undergone shear wave elastography over 6 months. Liver stiffness values were recorded using a Mindray Resona I9 ultrasound machine. Results:  In this study of 100 patients, 60 patients were male while 40 patients were female. The most common age group affected was 40-49 years.Fatty liver grading on B mode ultrasound revealed 50 patients (50.0%)in Grade I, 35 patients (35.0%) in Grade II, and 15 patients (15.0%) in GradeIII. SWE measurements showed distinct ranges: Grade I (5.04 ± 0.65 kPa), Grade II (6.99 ± 0.80 kPa), and Grade III (9.74 ± 0.77 kPa). A positive correlation was observed between fatty liver grading on B mode ultrasound and SWE values (r = 0.912, p < 0.001). Conclusion:  Shear wave elastography demonstrates excellent correlation with B-mode fatty liver grading in NAFLD patients. The mean SWE values observed in our study (Grade I: 5.04 kPa, Grade II: 6.99 kPa, Grade III: 9.74 kPa) demonstrate a clear stepwise progression that mirrors the expected increase in liver stiffness with advancing fatty liver disease, enabling noninvasive fibrosis risk stratificationwithout liver biopsy.

Background: Malaria remains a major global health problem, and while Giemsa‑stained peripheral blood smear microscopy is the diagnostic gold standard, it is limited by interobserver variability and resource constraints in many endemic settings. Automated haematology analysers, routinely used for complete blood counts, may provide valuable presumptive diagnostic clues through characteristic haemogram changes and abnormal WBC scattergram patterns. Aim: To evaluate the utility of abnormal WBC scattergram patterns and pseudoeosinophilia, in combination with thrombocytopenia and other haemogram abnormalities, as indicators for the presumptive diagnosis of malaria. Materials and Methods: This was a descriptive study in retrospective analysis of all malaria positive cases. It was conducted over four months (August–November 2023) at Dr SN Medical College and associated hospitals, Jodhpur. A total of 1,200 EDTA blood samples from patients clinically suspected of malaria were analysed using the Sysmex XS‑800i automated haematology analyser, and corresponding Giemsa‑stained thick and thin peripheral blood smears were examined microscopically for Plasmodium species. Pseudoeosinophilia was defined as a spurious increase in eosinophil count on the analyser not corroborated by manual differential counts, thrombocytopenia as platelet count <150,000/µL, and abnormal WBC scattergram patterns were recorded as per predefined criteria. Results: Of 1,200 samples, 61 (5.1%) were positive for Plasmodium vivax malaria on peripheral smear, with patient ages ranging from 10 to 65 years. Among malaria‑positive cases, 86.8% showed thrombocytopenia, 42.6% anaemia, 40.9% pseudoeosinophilia and 65.5% abnormal WBC scattergram findings; pancytopenia and bicytopenia were observed in 9.8% and 37.7% of cases, respectively. The most frequent scattergram abnormalities included “graying” and overlap of neutrophil and eosinophil clusters and double neutrophil or eosinophil populations. In most cases, higher degrees of parasitaemia correlated with more pronounced scattergram abnormalities and pseudoeosinophilia. Conclusion: Thrombocytopenia, pseudoeosinophilia and abnormal WBC scattergram patterns on the Sysmex XS‑800i are frequently associated with P. vivax malaria and, when interpreted together, substantially enhance the presumptive detection of infection. In malaria‑endemic areas, careful review of haemograms and WBC scattergrams can serve as a rapid, cost‑effective screening adjunct to guide targeted smear examination and improve early laboratory recognition of malaria.

Background: It has been stated that one of the risk factors for ischemic stroke is lipid abnormalities. Studies that compare a patient’s lipid profile with their stroke pattern (hemorrhage and infarction) are scarce, nonetheless. Incidence and association of lipid abnormalities in patients with cerebrovascular accidents (CVAs) were the focus of this investigation. Methods: Between October 2020 and March 2021, 127 participants were examined in the Department of Medicine at Darbhanga Medical College and Hospital in Laheriasarai, Bihar, after being split into Cases (n = 102, with CVA) and Controls (n = 25, without CVA). For every subject, a thorough history and lipid profile were documented. Each patient’s brain CT/MRI was used to examine their stroke pattern. Results: The majority of respondents in the Cases and Control groups are between the ages of 61 and 85 (45.09%) and 41 and 60 (44%), respectively. The majority of patients in the Cases group were males (61.76%), while the majority of patients in the Control group were females (84%). Smokers made up the majority of the cases (53.92%). Infarction was more common among smokers in the Case group (55%) than hemorrhage (51%). The prevalence of dyslipidemia was higher in patients (56.86%) than in controls (28%; p=0.009). Compared to patients who had hemorrhage (45.94%), the majority of infarct patients (63.07%) had dyslipidemia. The primary cause of cases was a reduction in high density lipoprotein (HDL) levels (74%), which was followed by a fall in total cholesterol (64%). 71.42% of the 14 patients in Cases who passed away had dyslipidemia. Conclusion: More often than hemorrhagic stroke, ischemic stroke was associated with lower HDL levels. Dyslipidemia was most frequently observed in patients with stroke.

Background: The dysregulated host response to infection is the hallmark of the clinical disease known as sepsis. There is a range of severity, from septic shock to sepsis. Mortality rates in shock cases have been shown to range from 10% to 40%, although estimates vary greatly and depend on the group being studied. Finding out whether serum albumin levels and mortality risk are quantitatively connected and examining the impact of serial serum albumin level monitoring as a predictor of mortality and morbidity in sepsis patients admitted to the intensive care unit are the main objectives of the study. Method: This descriptive study involved 70 sepsis patients hospitalized to the Medicine ICU at Darbhanga Medical College & Hospital in Laheriasarai, Bihar, between September 2020 and February 2021. All of the selected patients received a comprehensive evaluation on the first day following the sepsis diagnosis, and on days three and five, their serum albumin levels were measured. Patients were observed during their hospital stay, and their results—that is, whether they lived or died—were recorded. In order to examine data placed into an MS Excel spreadsheet, statistical product and service solutions (SPSS) version 18 was utilized. Results: The 70 patients selected for the study were divided into two groups: survivors and non-survivors. On day 1, the survivor group’s mean serum albumin level was 3.72 g/dl (±0.278), whereas the non-survivor group’s was 3.11 g/dl (±0.247). The non-survivor group’s mean serum albumin levels on day three were 2.65 g/dl (±0.172), while the survivor groups were 3.17 g/dl (±0.248). The survivor group’s mean blood albumin levels on day five were 2.72 g/dl (±0.25), while the non-survivor groups were 2.32 g/dl (±0.144). The difference in mean blood albumin on days 1, 3, and 5 was shown to be statistically significant using an unpaired t test, with a p value ≤0.001. The decline in mean serum albumin level in survivors from day 1to day 5 was 3.72 g/dl to 2.72 g/dl. In non-survivors it is 3.11 g/dl to 2.32 g/dl. Conclusion: This study found a direct correlation between a blood albumin level of less than 3.5 gm/dl on all three days and the prognosis of a sepsis patient. Beginning on day 1, serum albumin levels in both the survivor and non-survivor groups gradually dropped; however, a drop below 3.0 gm/dl was associated with a higher death rate. It suggests that the rate at which serum albumin falls below the normal threshold affects the mortality prognosis of the sepsis patient. Even in settings with little resources, patients with sepsis are at risk of a poor prognosis, and serum albumin measurement is less expensive and can help with clinical evaluation.

Background: There is a substantial correlation between cardiovascular morbidity and mortality and chronic kidney disease (CKD). Patients with chronic kidney disease (CKD) frequently have left ventricular hypertrophy (LVH), systolic and diastolic dysfunction, and other echocardiographic abnormalities that can lead to poor cardiac outcomes. The purpose of this study is to assess the frequency, kind, and correlation between the severity of CKD and echocardiographic alterations in patients. Methods: This cross-sectional study, which involved 80 CKD patients who were at least 18 years old, was carried out at SKMCH in Muzaffarpur, Bihar, between June 2025 and November 2025. Individuals with chronic drinking, ischemic heart disease, valvular heart disease, and congenital heart disease were not included. LVH, left ventricular ejection fraction (LVEF), systolic and diastolic dysfunction, and pericardial effusion were evaluated by two-dimensional echocardiogram (2DECHO). To detect correlations between CKD stage and echocardiographic results, data were examined. Results: Participants were 60% male and 40% female, with an average age of 55.2±12.4 years. As the severity of CKD worsened, the prevalence of LVH rose as well: 35.7% in stage 3, 53.8% in stage 4, and 69.2% in stage 5. In CKD stages 3, 4, and 5, systolic dysfunction (LVEF <55%) was noted in 14.3%, 30.8%, and 46.2% of patients, respectively. In 28.6% (stage 3), 53.8% (stage 4), and 69.2% (stage 5), diastolic dysfunction was seen. LVH and left ventricular failure were substantially correlated with anemia and hypertension. Conclusion: In patients with chronic kidney disease (CKD), echocardiographic abnormalities are very common and get worse as the illness worsens. To lower cardiovascular problems and enhance outcomes for individuals with chronic kidney disease, early cardiac screening and focused therapies are crucial.

Background: Lipoprotein (a) is made up of an atherogenic LDL lipoparticle and a potentially thrombogenic apoprotein and is therefore responsible for cardiovascular disease. The objective of this study is to evaluate serum lipoprotein (a) status and to investigate the correlation of elevated serum lipoprotein (a) levels with other cardiovascular risk factors in type 2 diabetics. Methods: This is a case-control study involving 82 patients, 37 type 2 diabetic patients and 45 non-diabetic control subjects. Sociodemographic data were collected and each patient underwent routine lipid assessment and lipoprotein (a) testing. Results: The prevalence of hyperlipoproteinemia (a) is 17.8% in control subjects and 29.7% in type 2 diabetics. HDL cholesterolemia is significantly higher in controls than in type 2 diabetics (p =0.028) while LDL cholesterol and serum lipoprotein (a) levels are higher in type 2 diabetics than in controls with a statistically significant difference (p=0.025 and p=0.026 respectively). The mean lipoprotein (a) values of 0.36±0.34 g/l in women are higher than those of male subjects which are 0.28±0.20 g/l (p=0.171). Mean serum lipoprotein (a) levels of 0.39±0.32 g/l in type 2 diabetics are significantly higher than those of controls which are 0.25±0.21 g/l (p= 0.026). Plasma concentrations of lipoprotein (a) vary with age and appear to be increased beyond the age of 45. There is no correlation between lipoprotein (a) and other cardiovascular risk factors. Conclusion: Hyperlipoproteinemia (a) is common in type 2 diabetics and women have the highest plasma levels. Serum lipoprotein (a) concentrations are not correlated with other cardiovascular risk factors and therefore constitute an independent risk factor.

Background: Children with Type-1 diabetes mellitus (T1DM) are most commonly found in India. Little is known about growth failure in children with diabetes, particularly in those with comorbidities and complications. Aim of this study is to determine the prevalence and predictors of stunting in children with T1DM. Methods: This cross-sectional observation study was conducted at Pediatrics Department of SKMCH, Muzaffarpur, Bihar from June 2025 to November 2025. Total 125 children and adolescents aged 1–18 years with T1D were included this study. Demographic data, anthropometry, diet, sexual maturity rating, and biochemical measurements were performed using standard protocols. Short stature was defined as height for age Z-score ≤2. p<0.05 was considered statistically significant. Results: 60 (48%) and 65 (52%) of the 125 children in the study were male and female, respectively. The children in the study group were 13.0±3.5  (1–18) years old on average, and they had had diabetes for 7.4±4.0 years on average. The average HbA1c for the children was 13.8±0.8%. In our group of children with T1D, we found that 20% of them had stunting. Children that were stunted had higher urine albumin creatinine ratios, poorer hemoglobin, lower midparental height Z-scores, and greater cholesterol. Stunting was significantly predicted by pre-existing comorbidities, worse renal function, prolonged disease duration, and short mid-parental height, according to binary logistic regression. Conclusion: Of children with T1D, slightly less than one-sixth were short. Monitoring these youngsters’ growth is crucial, particularly for those with short parents, long-term diabetes, pre-existing comorbidities, and declining renal function.

Background: An decrease in all three blood components; leukopenia, thrombocytopenia, and anemia below the normal level is known as pancytopenia. This study is an attempt to fill the lacunae regarding the information about pancytopenia in pediatric patients. The study aimed to study the clinical and etiopathological profile of pancytopenia in children aged 1–18 years. Methods: This cross-sectional observational study was to find out more about the etiopathological profile, clinical characteristics, and demographics of pediatric pancytopenia. The study was conducted from June 2025 to November 2025 with 65 patients who fulfilled the inclusion criteria and were admitted to the pediatric department of Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar, and were between the ages of 1 and 18. IBM’s Statistical Package for the Social Sciences version 23 was used for the statistical study. Results: The majority of cases (55%) out of 65 patients were in the 1–6 years age group. Our study revealed male predominance over females with male-to-female ratio of 2.09:1, mostly belonging to rural areas. The most common presenting complaint was easy fatigue in (90%) of patients followed by fever (54%). The most common physical finding was pallor (100%), followed by splenomegaly and pedal edema (38%) and (18%), respectively. Bone marrow cellularity shows hypocellular marrow (62%), hypercellular (31%), and normocellular (7%). Peripheral smears of most of the patients showed normocytic normochromic (34%), followed by macrocytic hypochromic (30%). Regarding etiology megaloblastic anemia (30%) was reported as the most common cause of pancytopenia followed by malignancies (30%) including myelodysplastic syndrome (9%), multiple myeloma (3%), acute lymphocytic leukemia (9%), and acute myeloid leukemia (9%) followed by aplastic anemia (14%) and sepsis (8%). The study also shows other rare causes of pancytopenia such as disseminated tuberculosis (6%), malaria (9%), and dengue (3%). Conclusion: According to the present study, megaloblastic anemia, malignancies, and aplastic anemia are the most frequent nutritional causes of pancytopenia.

Background: Limbal dermoid is a rare, congenital, benign lesion occurring at the corneoscleral junction. Although usually harmless, it can cause cosmetic issues, astigmatism, and occasionally affect vision. Some cases are associated with Goldenhar syndrome, a congenital condition involving craniofacial, auricular, and vertebral anomalies. Histopathology and immunohistochemistry (IHC) help confirm the diagnosis and identify tissue components. This case series describes four Grade I limbal dermoids – two isolated and two linked with Goldenhar syndrome—to highlight their clinical, systemic, and histopathological features. Methodology: This retrospective case series included four clinically diagnosed limbal dermoid patients evaluated at a tertiary care hospital. All underwent detailed ocular examination, slit-lamp assessment, and photographic documentation. Cases 1 and 4 had isolated limbal dermoids, while Cases 2 and 3 showed features of Goldenhar syndrome. Data collected included demographics, presenting complaints, lesion grade and location, refractive error, systemic findings, and surgical details. All excised specimens were processed and analyzed in our hospital for routine staining and immunohistochemical evaluation. Discussion:  All four patients were 10–13 years old, and all lesions were Grade I, mostly located inferotemporally. Two patients had systemic features of Goldenhar syndrome, such as facial asymmetry and preauricular tags. All children had astigmatism, which improved with refractive correction, and none required urgent surgery. Histopathology showed keratinized epithelium, collagenous stroma, adnexal structures, and adipose tissue in all cases, while syndromic cases also contained cartilage. IHC findings further confirmed the choristomatous nature of the lesions. Conclusion: This case series highlights the benign nature of Grade I limbal dermoids and their occasional association with Goldenhar syndrome. Most lesions respond well to conservative management, while syndromic cases need thorough systemic evaluation. Histopathology and IHC play an important role in distinguishing isolated lesions from syndromic ones and help guide appropriate treatment planning.

Background: Uncontrolled hypertension remains a major public health concern despite widespread availability of antihypertensive therapy, particularly in rapidly urbanizing populations. Objective: To determine the prevalence of uncontrolled hypertension and identify associated risk factors among treated hypertensive individuals in an urban population. Methods: A cross-sectional study was conducted among 310 treated hypertensive adults, of whom 202 were categorized as uncontrolled and 108 as controlled based on blood pressure criteria. Sociodemographic characteristics, lifestyle factors, treatment patterns, and adherence were evaluated, and multivariate logistic regression was used to identify independent predictors. Results: The prevalence of uncontrolled hypertension was 65.2%. Older age, additional salt intake, smoking, obesity, poor medication adherence, and single-drug therapy were associated with higher uncontrolled hypertension rates. Multivariate analysis identified additional salt intake, lack of structured healthcare education, single-drug therapy, and poor adherence as significant predictors. Conclusion: A high burden of uncontrolled hypertension persists among treated urban patients, highlighting the need for improved patient education, dietary interventions, regular follow-up, and optimized pharmacological strategies to enhance blood pressure control and reduce cardiovascular risk.

Background: Body mass index is increasingly recognized as an important determinant of clinical outcomes and quality of life in patients with chronic obstructive pulmonary disease. Objective: To evaluate BMI distribution and its association with quality of life and airflow limitation severity among COPD patients. Methods: A cross-sectional study was conducted among 210 COPD patients in whom BMI categories were assessed along with St George’s Respiratory Questionnaire scores, airflow limitation severity, and clinical predictors. Multiple linear regression analysis was performed to identify independent determinants of quality of life. Results: Obese (44.8%) and overweight (30.0%) categories constituted the majority of participants, while underweight patients showed significantly higher symptom, activity, impact, and total SGRQ scores indicating poorer quality of life. BMI and FEV1 were significant independent predictors of SGRQ total score, whereas female gender, biomass exposure, smoking, and hospitalization history were associated with worse outcomes. Conclusion: BMI plays a significant role in determining quality of life in COPD patients, with underweight individuals demonstrating the greatest impairment. Comprehensive management strategies incorporating nutritional assessment and lifestyle interventions are essential to improve patient outcomes.

Background: Gallstones have long been considered a major risk factor for gallbladder cancer (GBC), based primarily on observational and epidemiological studies. However, most available evidence assumes a unidirectional causal relationship, without adequately considering the possibility of reverse causation. Objective: This article aims to critically analyze existing epidemiological evidence linking gallstones and gallbladder cancer and to propose an alternative hypothesis: that early gallbladder malignancy or pre-malignant pathology may impair gallbladder function, leading to secondary gallstone formation. Methods: A narrative review of epidemiological studies, case-control analyses, and meta-analyses examining the gallstone-GBC association was conducted, with a focus on study design, temporality, and potential biases. Results: While multiple studies report an increased relative risk of gallbladder cancer in patients with gallstones, most lack detailed information regarding the duration, size, and chronology of gallstone development. This raises uncertainty about the direction of causality. Conclusion: The relationship between gallstones and gallbladder cancer may be more complex than traditionally believed. Reverse causation-where early cancer-related gallbladder dysfunction leads to stone formation-cannot be excluded. Future prospective studies with precise temporal documentation are needed.

Thoracic spinal anaesthesia (TSA) is gaining increasing recognition as a valuable regional anaesthetic technique in modern surgical practice, particularly for patients who are at high risk for complications associated with general anaesthesia. With the growing volume and complexity of surgical procedures worldwide, the demand for safer, targeted anaesthetic approaches has expanded. TSA involves intrathecal injection of local anaesthetic agents at thoracic vertebral levels, producing segmental sensory, motor, and sympathetic blockade suitable for a range of surgical interventions. Advances in anatomical knowledge and imaging modalities, especially MRI and ultrasound guidance, have improved the safety profile of this technique. Studies demonstrate a relatively wider posterior cerebrospinal fluid space in the thoracic region, offering a protective margin during needle placement. Although technical challenges exist due to narrow interlaminar spaces and angulated spinous processes, refined approaches such as paramedian insertion and optimal patient positioning enhance procedural success. Compared with general and lumbar spinal anaesthesia, TSA offers several advantages, including reduced cardiopulmonary complications, improved perioperative analgesia, attenuated surgical stress response, earlier return of gastrointestinal function, decreased postoperative nausea and vomiting, and shorter hospital stay. The use of lower doses of local anaesthetic also contributes to greater haemodynamic stability. TSA has been successfully employed in breast surgery, abdominal cancer procedures, laparoscopic cholecystectomy, nephrectomy, and selected thoracic surgeries, particularly in elderly and high-risk patients with compromised pulmonary function. Despite its benefits, potential complications such as hypotension, bradycardia, post-dural puncture headache, neurological injury, and infection must be considered. Careful patient selection, adherence to contraindications, and informed consent remain essential. Overall, TSA represents a safe and effective alternative anaesthetic modality with expanding clinical applications.

Objectives: Azithromycin is a commonly used macrolide antibiotic for treating bacterial infections. Self-medication with azithromycin is becoming more common nowadays. Its widespread availability has led to frequent misuse, major contribution antibiotic resistance. The study aims to assess the knowledge, attitudes and practices of undergraduate students about Azithromycin, mainly focusing on their awareness of self-medication and antibiotic resistance. Methods: An online cross- sectional questionnaire-based survey was conducted among undergraduate students from healthcare fields using google form, which includes sections on Demographic data, Knowledge of azithromycin, Attitudes towards azithromycin use, Practices and sources of information, and its Resistance. The data were analyzed using simple descriptive statistics. Results: The study revealed a moderate understanding of Azithromycin, 41.1% of self-medication, 25.8% of them failed to complete the full course, 12.1% were not sure of it, and 87.1% had high awareness of its resistance, though perceptions of its severity and personal responsibility varied significantly among participants. Conclusion: Strengthening their knowledge on Azithromycin usage and its resistance is the key for enhancing compliance and promoting effective antibiotic stewardship.

Background: Medication errors remain a leading cause of preventable patient harm across healthcare systems. These errors can occur at any stage of the medication-use process and significantly compromise treatment outcomes, patient safety, and healthcare quality. Aim: To evaluate the incidence, types, causes, and severity of medication errors in a tertiary care hospital and identify areas requiring targeted intervention. Methods: A cross-sectional retrospective study was conducted over three months in a tertiary care teaching hospital. Medical records of 2,203 patients were reviewed, and 113 medication errors were identified. Errors were classified based on type (prescription, transcription, administration) and severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) risk index. Statistical analysis was performed using Chi-square tests and ANOVA, with significance set at p < 0.05. Results: Prescription errors were the most frequent, followed by transcription and administration errors. High-volume departments demonstrated higher error prevalence. Most errors belonged to low-risk NCCMERP categories, suggesting limited immediate patient harm but substantial scope for preventive strategies. Conclusion: Medication errors are prevalent in tertiary care settings, predominantly arising during the prescribing phase. Structured interventions such as standardized prescribing practices, enhanced documentation, and departmental safety protocols are essential to improve patient safety.

Background: Antibiotic overuse in hospitalized children disrupts the developing gut microbiome, potentially contributing to dysbiosis-related complications including secondary infections, immune dysregulation, and long-term metabolic consequences. Antibiotic stewardship programs have been widely implemented to optimize antimicrobial prescribing, yet their direct impact on gut microbiome diversity in pediatric inpatients remains poorly characterized. Methods: A prospective quasi-experimental study was conducted over 12 months involving 136 pediatric inpatients aged 1–14 years admitted to a tertiary care hospital. Patients were divided into a pre-intervention cohort (n = 68) receiving standard care and a post-intervention cohort (n = 68) managed under a structured antibiotic stewardship protocol. Stool samples were collected at admission and discharge for 16S rRNA gene sequencing. Shannon diversity index, observed operational taxonomic units, and Firmicutes-to-Bacteroidetes ratio were analyzed alongside antibiotic utilization data. Results: The stewardship intervention significantly reduced broad-spectrum antibiotic use by 31.4% (p < 0.001). At discharge, the post-intervention cohort demonstrated significantly higher Shannon diversity index (2.94 ± 0.51 vs. 2.38 ± 0.63; p = 0.001) and observed OTUs (187.3 ± 34.6 vs. 152.8 ± 41.2; p < 0.001) compared to the pre-intervention group. The decline in microbiome diversity from admission to discharge was significantly attenuated in stewardship-managed patients. Conclusion: Hospital-based antibiotic stewardship interventions effectively preserve gut microbiome diversity in pediatric inpatients while reducing unnecessary antimicrobial exposure, supporting their integration into pediatric hospital practice.

Background: Interstitial lung diseases (ILDs) encompass a heterogeneous group of parenchymal lung disorders characterized by varying degrees of inflammation and fibrosis. Pulmonary function testing (PFT) is integral to the diagnostic evaluation, severity assessment, and longitudinal monitoring of ILD. However, the spectrum of PFT patterns across different ILD subtypes and their relationship with clinical and radiological severity remain incompletely characterized. This study aimed to evaluate the patterns of pulmonary function abnormalities across various ILD subtypes and to correlate spirometric and diffusion capacity parameters with disease severity indices. Methods: A cross-sectional analytical study was conducted at a tertiary respiratory care center. A total of 384 patients with confirmed ILD diagnoses based on multidisciplinary discussion were enrolled. Comprehensive PFTs including spirometry, lung volumes, and diffusion capacity for carbon monoxide (DLCO) were performed. High-resolution computed tomography (HRCT) severity scoring, six-minute walk test (6MWT), and dyspnea assessment using the modified Medical Research Council (mMRC) scale were additionally evaluated. Results: The mean age was 56.8 ± 12.4 years, with 54.7% female predominance. The most common ILD subtype was idiopathic pulmonary fibrosis (IPF) (28.6%), followed by connective tissue disease-associated ILD (CTD-ILD) (24.0%) and hypersensitivity pneumonitis (HP) (18.8%). A restrictive pattern was observed in 72.4% of patients, mixed obstruction-restriction in 14.6%, isolated reduction in DLCO with preserved spirometry in 8.9%, and obstructive pattern in 4.2%. Mean FVC% predicted was 62.4 ± 16.8%, and mean DLCO% predicted was 52.6 ± 18.4%. IPF patients demonstrated significantly lower DLCO (46.2 ± 16.8% vs. 58.4 ± 17.6% in CTD-ILD, p < 0.001). DLCO showed the strongest correlation with 6MWT distance (r = 0.68, p < 0.001) and HRCT fibrosis score (r = −0.62, p < 0.001). Conclusion: Restrictive ventilatory impairment predominates across ILD subtypes, though significant physiological heterogeneity exists. DLCO emerges as the most sensitive functional parameter, correlating strongly with exercise capacity and radiological severity. Comprehensive PFT assessment beyond spirometry alone is essential for accurate functional characterization of ILD patients.

Background: Stiff-person spectrum disorders (SPSD) are rare autoimmune neurological conditions characterized by progressive muscle stiffness, painful spasms, and exaggerated startle responses, often leading to severe functional impairment. Diagnosis is frequently delayed due to clinical overlap with other neuromuscular disorders. Case presentation: We report a 45-year-old male with an acute history of progressive axial stiffness, lower-limb rigidity, and episodic painful spasms causing gait disturbance and recurrent falls. Neurological examination revealed marked paraspinal and proximal limb rigidity with preserved sensation and reflexes. Routine laboratory investigations were unremarkable. Serum anti–glutamic acid decarboxylase (GAD65) antibodies were strongly positive. Needle electromyography demonstrated continuous motor unit activity at rest, confirming SPSD. Brain and spinal imaging excluded structural pathology. Management and outcome: The patient was initiated on benzodiazepines and baclofen, which provided partial symptomatic relief. Given the autoimmune profile and progressive disability, a short course of steroids (dexamethasone) was administered, resulting in a significant reduction in spasm frequency and improved gait at 3-month follow-up. Conclusion: This case highlights the importance of considering SPSD in adults presenting with progressive axial rigidity and spasms. Early recognition, supported by Electromyography (EMG) and GAD65 antibody testing, facilitates timely initiation of symptomatic and immunomodulatory therapies, which can markedly improve mobility and quality of life.

Introduction: Periprosthetic joint infection (PJI) is a catastrophic complication of arthroplasty, necessitating high- stakes revision surgery. While two-stage revision has historically been the “gold standard,” single-stage revision is increasingly debated for its potential functional benefits and reduced morbidity. Methods: This prospective comparative study evaluated 30 patients (n=15 single-stage; n=15 two-stage) over a 6-month follow-up period to assess infection eradication rates and early functional recovery. Results: Preliminary 6-month data indicate that the single-stage group achieved an infection eradication rate of 93.3% (14/15) compared to 86.6% (13/15) in the two-stage group (p > 0.05). The single-stage cohort demonstrated significantly earlier return to weight-bearing and higher functional scores (Oxford Hip/Knee Score) at the 3-month interval (p < 0.05). Conclusion: Single-stage revision is a viable and potentially. superior alternative for early functional recovery in selected PJI cases, though longer-term follow-up is required to confirm chronic suppression success.

Background: Abnormal uterine bleeding (AUB) is a common gynecological condition affecting women across reproductive age groups and significantly impacting quality of life. To standardize evaluation and management, the International Federation of Gynecology and Obstetrics (FIGO) introduced the PALM–COEIN classification system, categorizing AUB into structural and non-structural etiologies. The “PALM” group includes structural causes—Polyp (AUB-P), Adenomyosis (AUB-A), Leiomyoma (AUB-L), and Malignancy & Hyperplasia (AUB-M)—while the “COEIN” group comprises non-structural causes—Coagulopathy (AUB-C), Ovulatory dysfunction (AUB-O), Endometrial causes (AUB-E), Iatrogenic (AUB-I), and not yet classified (AUB-N). An algorithmic approach to AUB begins with a thorough clinical history, assessment of bleeding pattern, pregnancy exclusion, and evaluation of hemodynamic stability. Initial laboratory investigations include complete blood count, thyroid profile, coagulation studies (when indicated), and pregnancy testing. Imaging modalities such as transvaginal ultrasonography serve as first-line diagnostic tools for structural causes, with hysteroscopy and MRI reserved for selected cases. Endometrial sampling is recommended in women over 45 years or those with risk factors for endometrial carcinoma. Management is individualized based on etiology, severity, patient age, fertility desires, and comorbidities. Medical therapy remains first-line for most non-structural causes and includes tranexamic acid, NSAIDs, combined oral contraceptives, cyclic or continuous progestins, and the levonorgestrel-releasing intrauterine system (LNG-IUS). Surgical interventions such as hysteroscopic polypectomy, myomectomy, endometrial ablation, uterine artery embolization, and hysterectomy are reserved for refractory cases or structural pathology. The algorithmic integration of the PALM–COEIN system ensures systematic evaluation, reduces unnecessary interventions, and promotes evidence-based, patient-centered care. Early diagnosis and tailored therapy improve clinical outcomes and enhance quality of life in women with AUB. Conclusion: Abnormal uterine bleeding (AUB) remains a common and clinically significant gynecological problem, particularly among perimenopausal women. The present study of 45 patients demonstrates that structural causes are more prevalent than non-structural causes, with leiomyoma being the most common etiology. Ovulatory dysfunction emerged as the leading non-structural cause. Moderate anemia was frequently associated, emphasizing the need for early diagnosis and timely intervention.

Background: Jaundice in pregnancy is an uncommon but potentially life-threatening clinical condition that presents significant diagnostic and therapeutic challenges. The incidence ranges from 0.1% to 3% of pregnancies, yet it is associated with considerable maternal and perinatal morbidity and mortality. The etiology of jaundice during pregnancy is diverse and may be broadly classified into pregnancy-specific liver disorders and conditions unrelated to pregnancy. Pregnancy-specific causes include intrahepatic cholestasis of pregnancy (ICP), preeclampsia with severe features, HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), and acute fatty liver of pregnancy (AFLP). Non-pregnancy-related causes encompass viral hepatitis (A, B, C, E), drug-induced liver injury, gallstone disease, and autoimmune or metabolic liver disorders. Viral hepatitis, particularly hepatitis E in endemic regions, remains a major contributor to maternal mortality in developing countries. Clinical presentation varies from mild pruritus with elevated bile acids in ICP to fulminant hepatic failure in AFLP. Overlapping symptoms such as nausea, vomiting, abdominal pain, and elevated liver enzymes complicate timely diagnosis. Therefore, a systematic approach including detailed history, clinical examination, laboratory investigations, imaging studies, and multidisciplinary collaboration is essential. Management depends on the underlying cause, gestational age, and severity of maternal and fetal compromise. While ICP is primarily managed medically with ursodeoxycholic acid and planned early delivery, conditions such as HELLP syndrome and AFLP often necessitate urgent delivery irrespective of gestational age. Supportive care, intensive monitoring, and timely referral to tertiary care centers significantly improve outcomes. Early recognition, prompt differentiation between etiologies, and individualized management strategies are critical in reducing adverse maternal and fetal outcomes. Thus, jaundice in pregnancy remains a diagnostic and management dilemma requiring vigilant clinical assessment and coordinated care. Conclusion: Jaundice in pregnancy is an uncommon but potentially life-threatening condition associated with significant maternal and fetal morbidity and mortality. The wide spectrum of etiologies—ranging from pregnancy-specific liver disorders to infectious and medical causes—makes early diagnosis challenging. In this study of 64 patients, viral hepatitis emerged as the most common cause, while pregnancy-specific conditions such as intrahepatic cholestasis of pregnancy, HELLP syndrome, and acute fatty liver of pregnancy were associated with increased maternal complications and adverse fetal outcomes.

Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary perioperative care pathway designed to reduce surgical stress, maintain physiological function, and accelerate postoperative recovery. Since its introduction by the ERAS Society, ERAS protocols have demonstrated significant reductions in postoperative complications, hospital length of stay, opioid consumption, and healthcare costs while improving patient satisfaction and functional outcomes. The anesthesiologist plays a central and pivotal role in the successful implementation of ERAS programs. Preoperatively, the anesthesiologist contributes to patient optimization through risk stratification, comorbidity management, anemia correction, prehabilitation support, patient education, and appropriate fasting and carbohydrate loading strategies. Intraoperatively, the anesthesiologist ensures goal-directed fluid therapy, maintenance of normothermia, multimodal opioid-sparing analgesia, prevention of postoperative nausea and vomiting, and use of short-acting anesthetic agents to facilitate early recovery and mobilization. Regional anesthesia techniques and ultrasound-guided nerve blocks further enhance analgesia while minimizing systemic opioid requirements. Postoperatively, anesthesiologists support early extubation, effective pain control, early enteral nutrition, glycemic control, and thromboprophylaxis in collaboration with surgeons, nurses, and physiotherapists. Their leadership in protocol development, audit, and quality improvement initiatives ensures adherence to ERAS guidelines and continuous outcome monitoring. Conclusion: the anesthesiologist is integral to the success of ERAS pathways, functioning not only as a perioperative physician but also as a coordinator of multidisciplinary care. Active anesthetic management within ERAS protocols significantly enhances patient recovery, safety, and overall surgical outcomes.

Background: Fascial plane blocks have emerged as an integral component of multimodal analgesia in abdominal surgery, offering effective perioperative pain control while minimizing opioid requirements. These ultrasound-guided regional anesthesia techniques involve the deposition of local anesthetic within specific fascial planes to achieve blockade of thoracoabdominal nerves supplying the abdominal wall. Commonly used blocks include the transversus abdominis plane (TAP) block, rectus sheath block, quadratus lumborum block, and erector spinae plane block. By providing targeted somatic analgesia, fascial plane blocks improve postoperative pain scores, facilitate early ambulation, and enhance patient satisfaction. Their favorable safety profile, ease of performance, and applicability across a wide range of open and laparoscopic abdominal procedures have contributed to their increasing adoption. These abstract highlights the role of fascial plane blocks as a valuable, opioid-sparing analgesic strategy in contemporary abdominal surgery. Conclusion: Fascial plane blocks provide effective and reliable postoperative analgesia in patients undergoing abdominal surgery. Their use is associated with reduced pain scores, prolonged duration of analgesia, decreased opioid consumption, and high patient satisfaction.

Background: Telomerase activity and oxidative stress are emerging biomarkers of aging and chronic metabolic disorders. Type 2 diabetes mellitus (T2DM) accelerates telomere attrition through persistent hyperglycemia, systemic inflammation, and oxidative stress, which may contribute to early renal dysfunction even before the onset of overt nephropathy. Despite this link, limited studies have examined the combined role of telomerase and oxidative stress markers in early renal impairment among T2DM patients. Objective: To evaluate serum telomerase activity and oxidative stress markers in T2DM patients at different stages of early renal dysfunction and to determine their inter-relationship. Methods: This prospective observational study included 150 T2DM patients aged 30–65 years, divided equally into three groups based on estimated glomerular filtration rate (eGFR): Group A (≥90 mL/min/1.73 m²), Group B (60–89), and Group C (45–59). Fasting blood sugar, glycated hemoglobin (HbA1c), lipid profile, serum creatinine, eGFR, serum telomerase activity (ELISA), malondialdehyde (MDA; TBARS assay), total antioxidant capacity (TAC; ABTS assay), and superoxide dismutase (SOD; spectrophotometry) were measured. Data were analyzed using ANOVA with Bonferroni post hoc test, Pearson correlation, and multiple linear regression. Results: Serum telomerase activity declined progressively from Group A (1020 ± 95 AU) to Group C (690 ± 80 AU; p<0.001). MDA levels were significantly higher in Group C (6.8 ± 0.9 µmol/L) compared to Groups A and B (p<0.001). TAC and SOD were lowest in Group C (p<0.01). Telomerase activity showed a strong negative correlation with MDA (r = –0.68, p<0.001) and positive correlation with TAC (r = 0.55, p<0.001). Multiple regression identified HbA1c, MDA, and eGFR as independent predictors of telomerase activity (adjusted R² = 0.72, p<0.001). Conclusion: Lower telomerase activity in T2DM patients is closely linked to oxidative stress and declining eGFR, even in early renal dysfunction. Simultaneous measurement of telomerase and oxidative stress markers may facilitate early risk identification and timely intervention to prevent diabetic kidney disease.

Background: This prospective observational study aimed to evaluate the clinical efficacy and safety of a multi-drug regimen—letrozole, oral contraceptive pills (OCPs) and calcium supplementation—for the treatment of endometriosis-associated pelvic pain. A total of 50 reproductive-age women with laparoscopically confirmed endometriosis and a baseline Visual Analogue Scale (VAS) pain score of ≥ 5 were enrolled. Participants were divided into two groups: Group A (n=25) received the combination therapy, and Group B (n=25) received OCPs only for a duration of four months. Both groups demonstrated a statistically significant reduction in pain. However, the decline in dysmenorrhea, dyspareunia, and chronic pelvic pain was significantly more pronounced in the letrozole combination group. These findings suggest that letrozole in combination with OCPs is a promising and effective adjunct therapy for endometriosis, particularly in cases of severe pain, though larger, randomized controlled trials are essential to establish its long-term role in disease management and recurrence prevention. Objective: This study aimed to evaluate the clinical efficacy and safety of letrozole, a third-generation aromatase inhibitor, when used in combination with oral contraceptive pills (OCPs), and calcium supplementation, compared with OCPs alone, in reducing endometriosis-associated pelvic pain. Methods: A prospective observational study was conducted at Patna Medical College And Hospital on 50 reproductive-age women with laparoscopically confirmed endometriosis and a baseline pain score of ≥5 on the Visual Analogue Scale (VAS). Group A (n = 25) received letrozole + OCP + calcium carbonate, while Group B (n = 25) received OCP only, for 4 months. Pain severity, gastrointestinal symptoms, hormonal profile, and side effects were assessed. Results: Both groups showed significant pain reduction after 4 months (p < 0.05). However, the decline in dysmenorrhea, dyspareunia, and pelvic pain was more pronounced in the letrozole group. Additional improvement in gastrointestinal symptoms, such as bloating and dyschezia, was reported predominantly in the letrozole group. Side effects were minimal, with irregular bleeding being the most common. Conclusion: Letrozole in combination with OCPs significantly improves pain relief compared to OCP alone. It is a promising adjunct therapy in endometriosis management. Further large-scale randomized trials are warranted to establish its role in long-term disease control and recurrence prevention.

Background: Central obesity is strongly associated with insulin resistance and atherogenic dyslipidemia in urban Indian populations. The triglyceride–glucose (TyG) index and its waist-integrated derivative (TyG-WC) have emerged as simple surrogate markers of insulin resistance. Aim of the study was to evaluate the utility of TyG-WC index in predicting insulin resistance and central obesity–linked dyslipidemia in a tertiary metabolic clinic setting. Material and Methods: This cross-sectional study included 50 centrally obese adults (waist circumference ≥90 cm in men, ≥80 cm in women). Anthropometric and fasting biochemical parameters (glucose, lipid profile, insulin, HbA1c) were assessed. TyG, TyG-WC, TG/HDL-C ratio, and HOMA-IR were calculated. Correlation and multivariable regression analyses were performed to determine predictors of HOMA-IR. Results: The mean age was 48.6 ± 10.8 years; 56% were male. The mean HOMA-IR was 5.6 ± 2.9, indicating a high prevalence of insulin resistance. TyG-WC showed strong correlation with HOMA-IR (r = 0.74, p < 0.001) and TG/HDL-C ratio (r = 0.81, p < 0.001). In regression analysis, TyG-WC was the strongest independent predictor of HOMA-IR (β = 0.52, p < 0.001), outperforming BMI and age. Conclusion: TyG-WC index is a strong and independent predictor of insulin resistance and central obesity–linked dyslipidemia in urban Indian adults. It represents a simple, inexpensive, and clinically applicable screening tool for identifying high-risk metabolic phenotypes in routine practice.

Background: Tinnitus represents a prevalent auditory symptom that significantly impacts quality of life, while hypertension constitutes a major global health burden with potential effects on cochlear microcirculation. The relationship between these conditions remains incompletely understood. Methods: A cross-sectional comparative study was conducted with 286 participants (143 hypertensive patients and 143 age- and sex-matched normotensive controls) aged 35-70 years. Hypertension was classified according to current guidelines. Tinnitus presence, severity, and characteristics were assessed using standardized questionnaires and the Tinnitus Handicap Inventory (THI). Audiometric evaluation and clinical data collection were performed. Statistical analyses included chi-square tests, independent t-tests, and logistic regression. Results: Tinnitus prevalence was significantly higher in hypertensive patients (46.9%) compared to normotensive controls (28.7%) (p < 0.001). Mean THI scores were 38.4 ± 22.6 in hypertensive patients with tinnitus versus 26.8 ± 18.3 in normotensive participants with tinnitus (p = 0.003). Grade 2 hypertension showed the strongest association with tinnitus (OR = 3.45; 95% CI: 1.82-6.54; p < 0.001). The duration of hypertension significantly correlated with tinnitus severity (r = 0.418, p < 0.001). Bilateral tinnitus was more prevalent in hypertensive patients (68.7% vs 46.3%, p = 0.012). Conclusion: This study demonstrates a significant association between hypertension and increased tinnitus prevalence and severity. The findings suggest that hypertension assessment should be considered in tinnitus evaluation, and audiological monitoring may be warranted in hypertensive patients.

Background: Tympanoplasty remains the gold standard surgical intervention for tympanic membrane perforation repair in chronic otitis media. The selection of graft material significantly influences surgical outcomes. Cartilage and temporalis fascia represent the two most commonly utilized materials, each offering distinct advantages. Methods: A prospective comparative cohort study was conducted involving 180 patients (90 per group) undergoing Type I tympanoplasty. The cartilage group received tragal cartilage grafts, while the classical group received temporalis fascia grafts. Primary outcomes included graft uptake success rates at 6, 12, and 24 months postoperatively. Secondary outcomes comprised air-bone gap (ABG) closure, pure-tone average (PTA) improvement, and complication rates. Statistical analyses utilized chi-square tests, independent t-tests, and logistic regression. Results: At 24 months, graft uptake success was 94.4% (85/90) in the cartilage group versus 86.7% (78/90) in the classical group (p = 0.048). Mean ABG improvement was 15.8 ± 5.4 dB in the cartilage group and 17.2 ± 6.1 dB in the classical group (p = 0.125). The cartilage group demonstrated superior outcomes for large perforations (>50%) with success rates of 92.1% versus 78.6% (p = 0.024). Mean preoperative ABG was 28.6 ± 8.2 dB (cartilage) and 27.9 ± 7.8 dB (classical). Postoperative ABG at 24 months was 12.8 ± 6.1 dB (cartilage) versus 10.7 ± 5.3 dB (classical). Complication rates were comparable between groups (6.7% vs 8.9%, p = 0.587). The cartilage group showed significantly lower re-perforation rates (3.3% vs 10.0%, p = 0.038). Conclusion: Cartilage T-Plasty demonstrates superior long-term graft uptake rates compared to Classical T-Plasty, particularly for large and challenging perforations, with comparable audiological outcomes. The findings support cartilage as a reliable alternative graft material with enhanced structural stability for tympanoplasty.

Background: Residual neuromuscular blockade following general anaesthesia is associated with increased postoperative morbidity and delayed recovery. Sugammadex is a selective reversal agent that offers rapid and predictable reversal of amino steroid neuromuscular blockade. Objectives: To evaluate the efficacy and safety of injection sugammadex as a reversal agent in surgeries performed under general anaesthesia. Material and Methods: A prospective observational study was conducted on 100 patients undergoing surgeries under general anaesthesia, assessing perioperative hemodynamic parameters and oxygen saturation following sugammadex administration. Results: Sugammadex produced rapid neuromuscular recovery with stable pulse rate, blood pressure, mean arterial pressure, and preserved oxygen saturation, without clinically significant adverse effects. Conclusion: Sugammadex is an effective and hemodynamically safe reversal agent for neuromuscular blockade in general anaesthesia.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia, insulin resistance, and altered lipid metabolism. Metformin remains the first-line pharmacological therapy, while lifestyle interventions such as yoga and walking have shown promising metabolic benefits. Objective: To evaluate and compare the effects of metformin alone, lifestyle intervention alone (yoga and walking), and their combined approach on metabolic parameters in patients with T2DM. Methods: A comparative interventional study was conducted on patients diagnosed with T2DM. Participants were divided into three groups: metformin-only group, lifestyle intervention group (yoga and walking), and combined therapy group. Metabolic parameters including fasting blood glucose (FBG), HbA1c, body mass index (BMI), and lipid profile were assessed at baseline and after the intervention period. Results: The combined intervention group demonstrated greater improvement in glycemic control and lipid parameters compared to metformin or lifestyle intervention alone. Significant reductions were observed in HbA1c, fasting glucose, BMI, and triglyceride levels. Conclusion: The combined use of metformin with yoga and walking provides superior metabolic benefits in T2DM management compared to either therapy alone, emphasizing the importance of integrating lifestyle modification with pharmacotherapy.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with persistent low-grade inflammation, contributing to insulin resistance and diabetic complications. Metformin is widely used as a first-line ant diabetic drug, while lifestyle interventions such as yoga and walking are increasingly recognized for their beneficial metabolic and anti-inflammatory effects. Objective: The present study was conducted to evaluate the comparative and combined effects of metformin and structured lifestyle intervention (yoga and walking) on inflammatory parameters in patients with T2DM over a period of 24 weeks. Methods: A total of 150 patients with T2DM were enrolled and equally divided into three groups: Group I received metformin therapy, Group II followed lifestyle intervention (yoga and walking), and Group III received combined therapy (metformin + lifestyle intervention). Inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α) were assessed at baseline and after 24 weeks. Statistical analysis was performed using One-Way ANOVA and post-hoc tests. Results: At baseline, no significant differences were observed among the groups. After 24 weeks, significant reductions in inflammatory parameters were noted in all groups, with the greatest improvement in the combined therapy group compared to metformin or lifestyle intervention alone (p < 0.05). Conclusion: Both metformin and lifestyle interventions independently reduce inflammatory markers in T2DM patients; however, their combined application produces superior anti-inflammatory effects. This highlights the importance of integrating pharmacological treatment with structured lifestyle modifications for better diabetes management.

Background: Anaemia remains a significant public health problem among adolescent girls due to increased nutritional requirements during growth and menstruation. The present study aimed to assess the prevalence of anaemia among adolescent girls and to determine its correlation with dietary intake. A cross-sectional study was conducted among 65 adolescent girls aged 10–19 years. Data regarding socio-demographic characteristics and dietary intake were collected using a structured questionnaire and 24-hour dietary recall method. Haemoglobin levels were estimated using standard laboratory procedures, and anaemia was classified according to World Health Organization (WHO) criteria. The results showed that a considerable proportion of the participants were anaemic, with mild and moderate anaemia being more common than severe anaemia. Dietary assessment revealed inadequate intake of iron-rich foods such as green leafy vegetables, pulses, fruits, and animal-based products. A statistically significant positive correlation was observed between haemoglobin levels and dietary iron intake (p < 0.05). Girls with lower consumption of iron, protein, and vitamin C were more likely to be anaemic. The study concludes that anaemia is prevalent among adolescent girls and is significantly associated with inadequate dietary intake. Improving nutritional awareness, promoting iron-rich diets, and implementing supplementation programs are essential strategies to reduce the burden of anaemia in this vulnerable group. Conclusion: The present study concludes that anaemia is highly prevalent among adolescent girls and remains a significant public health concern. A substantial proportion of the 65 participants were found to have mild to moderate anaemia, indicating widespread inadequate haemoglobin levels during a critical period of growth and development.

Background: Post-intubation laryngeal injury (PILI) is a recognized complication following endotracheal intubation. Although most injuries are mild and self-limiting, severe cases may lead to long-term morbidity, including dysphonia, airway obstruction, and laryngeal stenosis. Understanding incidence patterns and management strategies is essential for improving patient outcomes. Objective: To review the incidence, risk factors, clinical presentation, and management strategies of post-intubation laryngeal injury. Methods: A review of available literature including observational studies, systematic reviews, and clinical guidelines evaluating adult and Pediatric populations undergoing endotracheal intubation in operative and intensive care settings. Results: The reported incidence of laryngeal injury after short-term intubation ranges from 5–30%, with minor mucosal injuries occurring in up to 50–70% of patients. Severe injuries such as vocal fold paralysis, granuloma formation, posterior glottic stenosis, or subglottic stenosis occur in approximately 1–5% of cases. Risk factors include prolonged intubation (>7–10 days), large endotracheal tube size, traumatic or repeated intubation attempts, high cuff pressure, infection, gastroesophageal reflux, and patient comorbidities. Clinical manifestations include hoarseness, stridor, throat pain, dysphagia, and respiratory distress. Management depends on severity. Mild injuries are treated conservatively with voice rest, humidification, corticosteroids, proton pump inhibitors, and speech therapy. Moderate injuries such as granulomas may require medical therapy or microlaryngoscopic excision. Severe cases including stenosis or bilateral vocal cord paralysis may require endoscopic dilation, laser surgery, steroid injection, or open reconstructive procedures such as laryngotracheal reconstruction. Early laryngoscopic evaluation in symptomatic patients improves outcomes and prevents chronic sequelae. Conclusion: Post-intubation laryngeal injury is common but often underrecognized. Early identification of risk factors, appropriate preventive strategies, and timely intervention are critical to reducing long-term morbidity. Multidisciplinary management involving anesthesiologists, intensivists, and otolaryngologists is essential for optimal care.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a resistant organismthat heavily contributes to hospital and community-acquired infections worldwide. It spreads very easily from patient to patient, by the hands of health workers, through contaminated objects and by air. MRSA poses a major clinical problem in treatment. So, it is essential to know its antibiotic pattern. Material & Methods: This study was carried out in the department of Microbiology  at  C. U. Shah Medical College and Hospital, Surendranagar. Total 180 samples were included in the study during the period of 1^st July 2021 to 30^th June 2022. Identification of isolated organism was done by conventional method using biochemical reactions. Antimicrobial susceptibility testing and MRSA detection was done using VITEK-2 compact system. Results: Methicillin resistant Staphylococcus aureus (MRSA) was seen in 58% of the isolates. The sensitivity profile shows Tigecycline 100%, Nitrofurantoin, Linezolid and Teicoplanin 99%, Vancomycin 95%. Lower sensitivity rates were found for Levofloxacin (7%), Ciprofloxacin and Oxacillin (6%) and cefepime (2%). Inducible clindamycin resistance was found to be 37.5%. Vancomycin sensitivity was 95%, rest 4% was VISA and 1% was VRSA. Discussion: Prevalence of MRSA was found 57.78% from various clinical samples. A similar study done by Fatemeh et al and Kirti et al. was reported MRSA prevalence of  63.20% and 33.7% respectively. Conclusion: MRSA were most sensitive to Tigecycline, Linezolid, Tecoplanin , Vancomycin and least sensitive to Oxacillin and cefepime. The knowledge of antibiotic sensitivity pattern of S. aureus will therefore be helpful to get control over the evolving resistance.

Background: Chronic Suppurative Otitis Media (CSOM) is a major cause of preventable hearing loss in developing countries. With the rise of multidrug-resistant (MDR) strains, empirical treatment often fails, necessitating a regional understanding of microbial profiles. Objective: To analyse the bacteriological profile and antibiotic susceptibility patterns of patients with refractory CSOM at a Government Teaching Hospital in Eluru, Andhra Pradesh. Methodology: A retrospective hospital based observational study was conducted reviewing medical records of 80 patients from January 2025 to December 2025. Data were extracted from patients who remained symptomatic after initial empirical therapy. Microbiological results from ear swabs, identified via standard biochemical tests and susceptibility patterns determined by the Kirby-Bauer disk diffusion method (CLSI guidelines), were analysed. Selection Criteria: Patients were selected randomly on the out-patient basis as per convenience sampling. Results: Refractory CSOM in the Eluru region is dominated by resistant P. aeruginosa. The near-total failure of Ciprofloxacin highlights the exhaustion of first-line fluoroquinolones. Targeted therapy with Piperacillin-Tazobactam and aggressive aural toileting to disrupt bacterial biofilms are recommended to improve clinical outcomes and reduce the socioeconomic burden of hearing loss. Conclusion: Among the results 37.5% samples still are positive for Pseudomonas aeruginosa even after a course of an empirical antibiotic therapy showing the increasing resistance among the microorganisms for broad spectrum antibiotics, while 26.25% samples were sterile showing no pathogenic growth after a course of antibiotics showing the compliance of broad spectrum of antibiotics in the cases of CSOM. The purpose of this study is to know the resistance of microorganisms for common antibiotics.

Background: Labour induction accounts for approximately 25% of term deliveries worldwide, yet failed induction occurs in 20–25% of cases, contributing to unplanned cesarean deliveries and increased maternal morbidity. Identification of predictive factors for induction failure remains crucial for optimizing patient selection and counselling in resource-limited settings. Objectives: To determine the incidence of failed labour induction in low-risk term pregnancies and to identify independent clinical and demographic predictors of induction failure. Materials and Methods: A prospective observational cohort study was conducted at a tertiary care centre from January 2024 to June 2024 involving 142 women with singleton, low-risk term pregnancies (≥37 weeks). Data regarding demographics, Bishop score, induction protocols, and maternal-neonatal outcomes were collected using a structured proforma. Chi-square tests and multivariate logistic regression analysis were performed, with statistical significance set at p<0.05. Results: Failed induction occurred in 35 of 142 women (24.6%). In multivariate analysis, Bishop score <4 emerged as the strongest independent predictor of failed induction (adjusted OR 4.12, 95% CI 1.82–9.33, p=0.001), followed by nulliparity (adjusted OR 3.48, 95% CI 1.41–8.59, p=0.007), BMI ≥30 kg/m² (adjusted OR 2.96, 95% CI 1.28–6.85, p=0.011), and maternal age >30 years (adjusted OR 2.54, 95% CI 1.12–5.76, p=0.026). The combined risk model achieved 78% predictive accuracy. Conclusion: Unfavourable Bishop score, nulliparity, obesity, and advancing maternal age are significant independent predictors of failed labour induction. A composite risk assessment using these factors can aid clinical decision-making and resource allocation.

Background: Type 2 Diabetes Mellitus (T2DM) is frequently associated with thyroid dysfunction due to their interrelated effects on metabolism. Thyroid abnormalities in diabetic patients may remain undiagnosed and can adversely affect glycemic control. Objectives: To evaluate the prevalence of thyroid dysfunction in patients with Type 2 Diabetes Mellitus and to assess its impact on metabolic control. Materials and Methods: This hospital-based cross-sectional observational study was conducted at the Department of Medicine, Government Medical College, Korba, Chhattisgarh, over a period of one year. A total of 100 patients with Type 2 Diabetes Mellitus were enrolled. Clinical evaluation and laboratory investigations, including fasting blood glucose, post-prandial blood glucose, HbA1c, and thyroid profile (TSH, FT3, FT4), were performed. Thyroid status was categorised based on standard reference ranges. Glycemic control was assessed using HbA1c levels. Statistical analysis was carried out using appropriate tests, with p <0.05 considered statistically significant. Results: Thyroid dysfunction was observed in 32% of patients, with subclinical hypothyroidism being the most common abnormality (18%). Poor glycemic control (HbA1c ≥7%) was seen in 62% of patients. Patients with thyroid dysfunction had significantly higher HbA1c levels compared to euthyroid patients (p <0.05), indicating poorer metabolic control. Conclusion: Thyroid dysfunction, particularly subclinical hypothyroidism, is prevalent among patients with Type 2 Diabetes Mellitus and is associated with poor glycemic control. Routine thyroid screening in patients with T2DM may aid in early detection and improve metabolic outcomes.

Introduction: Chronic liver disease (CLD) in children is a progressive condition characterized by persistent liver injury lasting more than three months, leading to fibrosis, cirrhosis, and impaired liver function. The etiological spectrum in children differs from adults and includes metabolic disorders, autoimmune diseases, viral infections, and biliary abnormalities, with varied clinical presentations such as jaundice, hepatomegaly, and growth failure. Aim: To study clinical and etiological profile of chronic liver diseases in children <12 years attending a tertiary care centre. Methods: This was a cross sectional study conducted in Paediatrics Department SAT hospital Thiruvananthapuram from January 2018 to July 2019. 90 children who were diagnosed to have CLD based on clinical, biochemical and ultrasound abdomen findings and/or liver biopsy and/or transient elastography, were included in the study. All patients were subjected to detailed history and thorough physical examination. Results of routine investigations and etiology directed investigations were recorded using structured proforma. Results: Of 90 children included in the study mean age of patients was 4.1± 4.45yrs. Male to female ratio for the study population was 1.2:1. Jaundice (77%), ascites (27%), bleeding manifestations (17%), encephalopathy(5%) were presenting symptoms in chronic liver disease patients. 13% of patients were asymptomatic at presentation. 22.3% of patients presented with features of hepatic decompensation at presentation. Neonatal cholestasis syndromes (NCS), and metabolic liver disorders (MLD) were the leading causes of CLD (56.6% and 22.1%, respectively). NCS comprised extra hepatic biliary atresia (46.7%), neonatal hepatitis (3.3%), and paucity of interlobular bile ducts (2.2%). MLD included Wilson disease (16.7%) glycogen storage disease (2.2%) Niemann Pick disease (2.2%) and Tyrosinemia (1.1%). Other causes of CLD comprised Pediatricnon alcoholic fatty liver disease (NAFLD) (8.9%), pediatric autoimmune liver disease (PAILD) (3.3%), congenital hepatic fibrosis (1.1%) and sclerosing cholangitis (1.1%). Aetiology could not be detected in 7.7% of patients. Chronic viral hepatitis B and C were rare cause CLD in study group (1.1%). Among children with EHBA 78% underwent Kasai’s portoenterostomy with mean age at surgery being 66 days. Conclusion: Common etiology of CLD in children was constituted by neonatal cholestasis syndrome (NCS) and metabolic liver disease (MLD) in the study population. EHBA was the commonest cause of CLD in children < 6 years of age whereas Wilson disease is the most common cause of CLD in older children (> 6 years). Pediatric NAFLD constitute 3^rd most common cause of chronic liver disease which is important from a public health perspective. Jaundice, ascites and bleeding manifestation were the most common presentation of CLD in children. 22.3% of children presented with decompensated chronic liver disease in the study population.

Background: Ocular morbidity remains a major public-health concern, particularly in low- and middle-income regions where preventable and treatable eye conditions are common. Objective: To establishing the clinical patterns of ocular morbidity and to assess associations between demographic factors, systemic comorbidities, and significant ocular disease among patients presenting to a tertiary care ophthalmology outpatient department. Methods: This descriptive, cross-sectional study included 800 patients presenting to the department of ophthalmology, Katihar Medical College, Katihar between 15 June 2025 and 15 January 2026. Data were collected using a structured proforma and included demographics, presenting symptoms, ophthalmic examination findings, and systemic comorbidities. Diagnoses were categorized into major morbidity groups.  Results: Refractive errors were the most common ocular morbidity (37.0%), followed by conjunctival disorders (24.0%), cataracts (16.0%), corneal diseases (13.0%), and retinal diseases (7.0%). Age demonstrated a strong association with cataract, glaucoma, and retinal disease (p < 0.001). Systemic comorbidities such as diabetes and hypertension showed significant clustering with retinopathy and lens-related pathology (p < 0.001). Manual labour occupation was associated with ocular trauma and corneal injury (p < 0.001). Logistic regression identified age ≥ 50 years (AOR 4.62), poor presenting visual acuity (<6/18) (AOR 5.42), diabetes mellitus (AOR 3.94), hypertension (AOR 2.21), and manual labor occupation (AOR 2.85) as independent predictors of clinically significant ocular morbidity. Conclusion: Ocular morbidity in this population is dominated by preventable and treatable conditions, with strong influences from age, systemic comorbidities, occupation, and visual acuity at presentation.

Background: Surgical Site Infections (SSIs) cause most of the illnesses linked to healthcare. Also, it’s a big reason why people get sick after surgery, have to stay in the hospital longer, and need more expensive medical care. Even though surgery and ways to avoid getting infections have gotten better, SSIs are still an issue of concern, especially in poor countries. Materials and Methods: At a territory care hospital, this retrospective observational study was done over the course of one year, from January 2025 to December 2025. Medical records of 100 patients were reviewed who had clean or clean-contaminated operations was made. Data were retrieved regarding demographic characteristics, comorbidities, type and duration of surgery, antibiotic prophylaxis as well as post-operative outcomes. SSI were diagnosed and graded according to the criteria established by Centers for Disease Control and Prevention (CDC). Statistical analysis was done by SPSS and a p<0.05 was regarded as significant. Results: Overall, 18% had SSI with superficial incisional (11%), deep incisional (5%) and organ/space (2%). Important risk factors were diabetes mellitus (p = 0.01), obesity (p = 0.03), extended surgery duration greater than two to four hours, emergency operation and improper antibiotic prophylaxis order. Staphylococcus aureus was the most common pathogen identified. SSI patients were also maintained with significantly longer hospital stay and reoperation rate. Conclusion: SSIs continue to be a significant postoperative morbidity for which there are identifiable and modifiable risk factors. Better surveillance and prevention of infections are measures in place to stop infections. This can be done by making antibiotic prophylaxis more effective or by monitoring patients after surgery. Both of these things help to lower SSIs and make patients feel better.

Background: Incisional hernia is a common complication after abdominal operation. Surgery repair is the definitive treatment, though options such as non-mesh or mesh reinforcement are also considered. The kind initial surgical technique has been associated with recurrence and postoperative complications. Methods: A retrospective comparative analysis of 55 patients, who underwent elective open incisional hernia repair in a tertiary care center between January 2025 and December 2025 was performed. The patients were categorized into mesh (n=49) and non-mesh (n=6) groups. Primary outcome was hernia recurrence. Secondary outcomes included surgery-related complications (surgical site infection (SSI) and seroma/hematoma), chronic pain, and length of hospital stay. A p < 0.05 level was considered to be statistically significant. Results: Recurrence was found only in the non-mesh group (66.7%), and none of the recurrences was noted in the mesh group (p < 0.01). SSI was 10.2% in the mesh group and 16.7% in the non-mesh group. Seroma/hematoma was presented in 8.2% vs 16.7%, with chronic pain in 10.2% vs 16.7% of the mesh and none mesh groups, respectively. The average hospitalization was slightly less in the mesh group (4.1 ± 1.2 days) than that of non-mesh (4.5 ± 1.4 days). Conclusion: Mesh repair of open incisional hernia is better than that of non-mesh repair, providing lower recurrence rate and postoperative complications are acceptable. Non-mesh-repair has high recurrence rates. Prospective patient selection, control of comorbidities and careful surgical handling are important for favourable long-term results.

Objective: Aim of this study is to evaluate the correlation between pterygium and dry eyes. Material and Methods: A Hospital based comparative observational study was conducted over 3 months at S.R.V.S Medical college & Hospital, Shivpuri, Madhya Pradesh.  A Total of 130 patients aged between 25 years and 65 years were included in this study. 65 eyes with pterygium were compared with 65 control eyes without pterygium. Detailed history was taken and TF-BUT and Schirmer’s test were performed on all to evaluate status of dry eyes and severity of ocular irritation symptoms. Data were analyzed using appropriate statistical tests with significance set at p<0.05. Results: Maximum number 54 (41.53%) of patients affected with dry eye in both the groups were in the age group between 35-47 years which statistically showed age as a significant factor of association for dry eye (p<0.01). Redness 82 (63.07%) was the most frequently occurring symptom in pterygium patients followed by cosmosis 71 (54.61%). Schirmers test both Schirmer’s I and Schirmer’s II were slightly reduced in patients with pterygium, Schirmer’s I (17.73±4.56mm) and Schirmer’s II (18.15±5.69mm). TF-BUT was significantly reduced in case group (12.88±3.24 sec). TF-BUT decreased maximally in 51-60 years age group (10.26±2.79sec) with pterygium showing tear film instability. On comparison of cases with pterygia and controls with normal and abnormal tear film odds ratio was calculated showing risk of dry eye in pterygium patients to be higher than controls. No significant differences were observed between groups in terms of demographic characteristics, duration of pterygium or side of eye involved. Conclusion: Result of the present study strongly suggest that pterygium induce ocular surface irritation which leads to dysfunctional tear film and occurrence of dry eyes. Schirmer’s test and TBUT should routinely be performed in OPDs to diagnose dry eye in patients with pterygium and these patients should be treated promptly to prevent any sight threatening complications.

Background: Pain in the abdomen is one of the common reasons for emergency. Delay or negligence may lead to mortalities. Method: 80 (eighty) adult patients with different etiologies were studied. Apart from routine blood examination, a CT scan/USG study was carried out to confirm the clinical diagnosis and plan for surgery or conservative treatment. Results: out of 80 patients, 46 (57.5%) had acute appendicitis, 9 (11.2%) had acute intestinal obstruction, 7 (8.7%) had hollow viscus perforations, 6 (7.5%) had acute cholecystitis, 4 (5%) had acute pancreatitis, 5 (6.2%) had liver abscess, 2 (2.5%) had Meckel’s diverticulum, and 1 (1.2%) was miscellaneous, and the mortality rate varied from 14% to 25%. Conclusion: Non-traumatic abdominal emergencies may occur at any time; hence, a well-equipped hospital, efficient clinician or surgeon can manage the morbidities and reduce the mortalities.

Introduction: Dermatophytes are the most common fungi causing cutaneous fungal infections. There prevalence is common in tropical areas. Rapid and efficient diagnosis is necessary for early treatment. Antifungal susceptibility testing is also in need as there is increase in azole resistance. Materials and Methods: Skin, hair and nail samples are collected in aseptic conditions. Microscopy is done using KOH and Calcofluor. Samples are inoculated in Sabouraud’s Dextrose agar (SDA), SDA with Chloramphenicol, SDA with Actidione (SDA+A) and Dermatophyte Test Medium (DTM). Later dermatophytes are identified by tease mount, hair perforation test and urease test. Antifungal susceptibility testing is done by disc diffusion for azoles. Results: Out of 100 samples, 55 were positive by both KOH and culture. 44 were positive by only culture. Out of 44, 32 were dermatophytes and 12 were non dermatophytes. On SDA, 21 dermatophytes and 12 non dermatophytes were grown, whereas on SDA with Actidione only dermatophytes were grown. Trichophyton mentagrophytes (37.5%) was the most common isolate. Clotrimazole is the most susceptible antifungal drug. Conclusion: Calcofluor White staining is best for identification of fungal elements in direct microscopy than KOH, as it is rapid and causes less eye strain. Sabouraud’s Dextrose agar with Actidione is the best medium for isolation of dermatophytes as isolation rate is more and it prevents the growth of non dermatophytic fungi. Clotrimazole was the best drug against dermatophytes.

Background: Preeclampsia is a significant contributor to maternal and perinatal morbidity and mortality. Early identification of women at risk is crucial for improving outcomes. This study evaluates the utility of Uterine Artery Doppler screening in predicting preeclampsia during the first trimester. Methods: A prospective cohort study was conducted involving 219 women attending the antenatal outpatient department of Velammal Medical College Hospital and Research Institute between 11+0 weeks and 13+6 weeks of gestation. Uterine artery Doppler velocimetry was performed to measure the pulsatality index (PI), and patients were followed until delivery to assess the development of preeclampsia and gestational hypertension. Results: Among participants, 25% exhibited abnormal Uterine Artery Doppler findings, with a significant association between high PI (>2.3) and the development of gestational hypertension and preeclampsia. The sensitivity and specificity of uterine artery PI as a predictor was 68% and 52.99% respectively. Early screening combined with interventions may reduce morbidity and mortality associated with hypertensive disorders. Conclusion: This study assesses the effectiveness of first-trimester Uterine Artery Doppler assessments in predicting preeclampsia with PI of > 2.3. Usage of such screening could enhance risk stratification, facilitate timely interventions, and ultimately improve maternal and fetal health outcomes. Further research is required to refine screening protocols and improve predictive accuracy across various populations.

Introduction: Hepatitis C virus (HCV) is one of the five hepatitis virus (A-E) that primarily targets the liver. In individuals infected with HIV, HCV represents an important contributor to liver-related morbidity. Beyond hepatic involvement, hepatitis C infection is associated with several extra-hepatic manifestations (EHM) throughout its natural course. In patients with chronic HCV infection, deterioration in liver function tests has been reported to correlate strongly with the severity of extra hepatic complications. Aim and Objectives: This study aims to document the spectrum of extra-hepatic manifestations among patients with chronic HCV infection and HCV-HIV co-infection. Additionally, the study aimed to evaluate the association between liver function test parameters and the presence of extra-hepatic manifestations. Materials and Methods: This cross-sectional study included 60 participants, comprising 30 patients diagnosed with chronic HCV infection and 30 patients with HIV–HCV co-infection. The study was conducted in Manipur, India, between August 2022 and February 2023, and included individuals aged 18 years and above. Patients with concurrent hepatitis B virus (HBV) infection, malignancy, or established cardiovascular disease were excluded. All participants underwent detailed clinical evaluation. Laboratory investigations included routine tests such as Random Blood Sugar (RBS), Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), Liver Function Tests (LFT), Kidney Function Tests (KFT) with serum electrolytes, Complete Blood Count (CBC), Prothrombin Time/International Normalized Ratio (PT/INR), lipid profile, Thyroid Stimulating Hormone (TSH) levels, routine urine examination, Anti-Nuclear Antibody (ANA), Rheumatoid Factor (RF), chest X-ray, and ultrasonography (USG) of the abdomen. Statistical analysis was performed using SPSS version 16. Descriptive statistics were expressed as mean, standard deviation, and percentages. Inferential analysis was carried out using the chi-square test and Fisher’s exact test. A p-value was considered statistically significant if its less than 0.05. Results: Among the 30 patients with chronic HCV infection and the 30 patients with HIV–HCV co-infection, most individuals with chronic HCV belonged to the 31–40-year age group, accounting for 50% of cases. In contrast, the majority of patients with HIV–HCV co-infection was in the 41–50-year age group, representing 80% of cases. Extra-hepatic manifestations were observed more frequently in the HIV–HCV co-infected group (73.4%, 22/30) compared to the chronic HCV group (63.4%, 19/30). Additionally, reduced serum albumin levels were significantly more common in the co-infected group, which may explain the higher occurrence of extra-hepatic manifestations in these patients compared to those with chronic HCV alone. Conclusion: The findings of this study demonstrate a considerable prevalence of extra-hepatic manifestations among patients with chronic HCV infection as well as those with HIV–HCV co-infection in the Manipuri population. Furthermore, the occurrence of these manifestations appears to be associated with decreased serum albumin levels.

Objectives: Cancer cervix is a cancer of female genital tract. Around 77,000 people die every year due to cervical cancer in India. It accounts for 9.5% of all cancers diagnosed in India every year. The aim of the study nis to determine the prevalence, clinical presentation, risk factor and stage distribution of cervical cancer in the study population. Method: An observational descriptive study had been conducted in Department of Obstetrics & Gynaecology, MKCG Medical College & Hospital, Berhampur, and Odisha from December 2022 to December 2024. Results: The most common age of presentation of cancer cervix is between 41-60 years majority of patients presented with complaint of post coital bleeding. Conclusion: Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

A multidisciplinary approach involving early diagnosis, effective treatment, and preventive measures is crucial in addressing the burden of cervical cancer. Strengthening healthcare infrastructure, increasing awareness, and promoting vaccination programs can significantly lower mortality rates and improve patient prognosis in cervical cancer cases.

Background: Infants and Children with Congenital Diaphragmatic Hernia (CDH) presenting after the neonatal period have varied presentations from incidental radiological finding to severe complications like intestinal obstruction and gastric volvulus. Methods: A retrospective review of the medical records between January 2014 and December 2024 of the infants and children admitted with congenital diaphragmatic hernia presenting after the neonatal period at our institution was performed. Results: A total of 15 patients of CDH presented after the neonatal period. Respiratory distress was the commonest presentation. Intestinal obstruction was another common presentation with few cases of volvulus of the stomach. There were three deaths (20%) and 12 survivors (80%). Conclusion: The diagnosis of CDH after neonatal period is challenging with varied presentations including intestinal obstruction and Gastric volvulus. Prompt surgical management with appropriate perioperative critical care are necessary to ensure survival.

Background: Supraclavicular brachial plexus block is commonly used for upper limb surgeries. Various adjuvants have been added to local anaesthetics to improve block characteristics and prolong postoperative analgesia. Dexmedetomidine and dexamethasone are frequently used additives to bupivacaine, but their comparative efficacy remains an area of interest. Methods: This ambispective randomised double-blind controlled study was conducted in 60 adult patients (ASA I–II) undergoing elective upper limb orthopaedic surgeries. Patients were randomly divided into two groups of 30 each. Group A received 25 ml of 0.25% bupivacaine with dexamethasone 8 mg, while Group B received 25 ml of 0.25% bupivacaine with dexmedetomidine 1 µg/kg for ultrasound-guided supraclavicular brachial plexus block. Onset and duration of sensory and motor block, sedation score, haemodynamic variables, time to first rescue analgesia, and total analgesic consumption over 24 hours were recorded and analysed. Results: Dexmedetomidine significantly hastened the onset of sensory (6.4 ± 1.3 min vs 9.8 ± 1.5 min) and motor block (8.1 ± 1.4 min vs 12.2 ± 1.6 min) compared to dexamethasone (p < 0.001). Duration of sensory block (10.2 ± 1.3 hrs vs 7.6 ± 1.1 hrs) and motor block (9.1 ± 1.1 hrs vs 6.3 ± 1.0 hrs) were also prolonged in the dexmedetomidine group (p < 0.001). Time to first rescue analgesia was longer (12.7 ± 1.4 hrs vs 9.8 ± 1.2 hrs), and analgesic requirement over 24 hours was significantly reduced. Sedation scores were higher with dexmedetomidine. Mild bradycardia and hypotension occurred more frequently with dexmedetomidine but were manageable. Conclusion: Dexmedetomidine is a superior adjuvant to dexamethasone when combined with bupivacaine for supraclavicular brachial plexus block, providing faster onset, prolonged block duration, improved postoperative analgesia, and acceptable haemodynamic stability.

Background: Diabetes-related lower limb amputation is a major cause of long-term disability, profoundly affecting functional independence and quality of life. Despite advances in surgical care, post-amputation functional outcomes remain suboptimal, particularly in individuals with multiple comorbidities. Assessment of functional quality of life and its determinants is essential for planning rehabilitation and supportive care services. Objectives: To assess functional quality of life among individuals with diabetes-related lower limb amputation using the Barthel Index and to determine its association with selected socio-demographic and clinical factors. Materials and Methods: A hospital-based cross-sectional analytical study was conducted among 193 adults aged ≥40 years with diabetes-related lower limb amputation attending a tertiary care teaching hospital in South India from September to December. Participants were recruited using consecutive sampling. Data on socio-demographic characteristics, diabetes profile, comorbidities, prosthesis use, and need for medical assistance were collected using a structured questionnaire and medical record review. Functional quality of life was assessed using the Barthel Index and categorized into total, severe, moderate, and slight dependence. Statistical analysis was performed using SPSS version 20. Associations were tested using Chi-square/Fisher’s exact test, with p < 0.05 considered significant. Results: The majority of participants were male (69.9%) and belonged to the 61–70 years age group (34.2%). Most had long-standing Type 2 diabetes (93.2%), with 49.7% having disease duration of 16–25 years. Hypertension (71.5%) and chronic kidney disease (33.7%) were common comorbidities. Based on the Barthel Index, 69.4% exhibited moderate dependence, 30.1% severe dependence, and 0.5% total dependence, while none had slight dependence. Age (p = 0.012), employment status (p = 0.006), chronic kidney disease (p = 0.009), peripheral occlusive vascular disease (p = 0.014), neuropathy (p = 0.043), phantom limb pain (p = 0.006), duration of diabetes (p = 0.034), and frequency of need for medical assistance (p < 0.001) showed significant associations with functional quality of life. Conclusion: A substantial proportion of diabetes-related amputees experience moderate to severe functional dependence. Advancing age, long-standing diabetes, vascular and neurological comorbidities, phantom limb pain, and increased caregiving needs significantly impair functional quality of life. Integrated rehabilitation, prosthetic support, and comprehensive comorbidity management are essential to improve post-amputation functional outcomes.

Objectives: The present study was to evaluate the surgical outcome of tympanoplasty type I and its impact as the treatment modality in patients with chronic otitis media. Methods: Otoscopic examination and pure tone audiometry were performed to all CSOM patients. The surgery tympanoplasty type I was performed under local anaesthesia except for apprehensive and anxious patients who desired general anaesthesia. The postoperative assessment of the patients was done at 3, 6 and 12 months after the surgery wherein otoscopic evaluation and pure tone audiometry was repeated. Results: A total of 60 patients of CSOM were included. The mean age was 36.5 years. 34(56.67%) cases were males and 26(43.33%) cases were females. 80% of the patients had a small-to-moderate size perforation and 2% had a large to subtotal perforation. 51.67% patients had perforations in the anterior half, 11.66% had perforations in both anterior and posterior half and 36.67% patients had the perforation in the posterior half. 33.33% patients had an oedematous middle ear mucosa and 66.67% patients had a normal middle ear mucosa. The improvement in hearing was significant on assessment after one year of surgery of patients having an ABG <20 dB. Following tympanoplasty at 3 months, 94% patients had AB gap <20 dB and at one year 88.33% patients had AB gap <20 dB, respectively. Conclusions: Small to medium size perforation are the most common. Anterior quadrant perforation is commonly seen in most of the CSOM patients. Result of surgery is not influenced by size of the perforation and the location of the perforation. Status of the middle ear mucosa and the status of the opposite ear are statistically significant factors influencing the success of tympanoplasty. Hence, tympanoplasty is one of the best procedures as a treatment modality in patients with chronic otitis media.

Background: Globally, the leading cause of avoidable blindness is cataract, particularly in low-resource community settings. Evaluating cataract surgery outcomes in real-world hospital environments is important to ensure quality eye care, better recovery, and early detection of complications that may affect long-term visual outcomes. Methods: In Katihar, from 1 July 2025 to 31 December 2025, a retrospective study was conducted. Medical records of 600 patients aged 40 years and above who were operated for cataract surgery were reviewed. Using descriptive statistical methods data on demographic characteristics, preoperative and postoperative visual acuity, surgical procedure type, intraoperative events, and postoperative complications were analysed. Results: With male predominance, the mean age of patients was 62.4 ± 9.8 years. Preoperatively, 72.5% of patients were worse than 6/60 sighted. Postoperatively good vision (≥6/18) was restored in 78.5% of patients at 6 weeks. Phacoemulsification had superior visual results as compared to Small Incision Cataract Surgery (SICS). There were a low number of complications in general and posterior capsule rupture was the most common intraoperative complication. Conclusion: Visual results following cataract surgery on a mass scale in the community are acceptable, with low complication rates. Appropriate maintenance of outcomes should be implemented and training may consolidate the quality of community-based eye care.

Introduction: Traumatic injuries remain one of the leading causes of death worldwide. The delay in operation for any reason leads to increased morbidity, mortality, length of hospital stays, and overall cost. It may also lead to patient dissatisfaction and reflect inefficiency among the operating staff. The purpose of this study is to recognise and, hence, decrease the delay in the surgical management of trauma patients due to organizational reasons. Material and Methods: The present retrospective observational study was conducted in the Department of Orthopaedics, Bone & Joint Hospital, GMC Jammu, over a period of 02 years, with the aim to assess the magnitude and determinants of the cancellation of elective surgical cases in a tertiary hospital. The data from 1024 patients were collected and analysed. Results: The mean age of the study subjects was 41±15.5 years. The majority of the study subjects were males (66.4%), mainly belonging to the rural areas (64.9%), and about 57% subjects had either a delay or cancellation of surgery. Lack of operating theatre space was the major contributing factor to this delay (approx. 55.6%), followed by uncontrolled blood pressure. Conclusion: The present study concluded that the majority of the surgical delays were due to organisational reasons, which are avoidable, and there is room for improvement, and most importantly, the patient care will have a positive outcome.

Background: Chronic obstructive pulmonary disease (COPD) constitutes a leading cause of global morbidity and mortality, with cigarette smoking representing the most important modifiable risk factor. However, not all smokers develop COPD, and the interplay of smoking characteristics with demographic, occupational, and clinical variables that collectively determine disease susceptibility remains incompletely understood. This study aimed to determine the prevalence of COPD among adult smokers and identify the key risk factors associated with disease development. Methods: A community-based cross-sectional study was conducted across six primary healthcare centers. A total of 1,240 current and former adult smokers aged ≥30 years were enrolled. All participants underwent standardized spirometry following American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines, with COPD defined as a post-bronchodilator FEV₁/FVC ratio <0.70. Sociodemographic data, smoking history (pack-years), occupational exposures, respiratory symptoms, comorbidities, and biomass fuel exposure were systematically assessed using structured questionnaires. Results: The overall prevalence of spirometrically confirmed COPD among adult smokers was 24.8% (n = 308). The prevalence increased significantly with age (15.2% in 30–44 years vs. 38.6% in ≥60 years, p < 0.001) and cumulative smoking exposure (14.6% in <20 pack-years vs. 41.2% in ≥40 pack-years, p < 0.001). On multivariable logistic regression, independent risk factors for COPD included age ≥60 years (aOR 3.42, 95% CI 2.18–5.36), smoking ≥40 pack-years (aOR 3.86, 95% CI 2.48–6.01), occupational dust exposure (aOR 2.14, 95% CI 1.46–3.14), childhood respiratory infections (aOR 1.92, 95% CI 1.28–2.88), BMI <18.5 kg/m² (aOR 2.26, 95% CI 1.34–3.81), and biomass fuel exposure (aOR 1.78, 95% CI 1.18–2.68). Among diagnosed COPD patients, 58.4% were previously undiagnosed. Conclusion: Approximately one in four adult smokers has spirometrically confirmed COPD, with a substantial proportion remaining undiagnosed. Beyond cumulative smoking exposure, advancing age, occupational hazards, childhood respiratory infections, low body mass index, and biomass fuel exposure are significant independent risk factors. Targeted spirometric screening programs among high-risk smokers are warranted for early detection and intervention.

Introduction: Peri-capsular Nerve Group Block (PENG) provides good post-operative analgesia. PENG provides coverage of the hip joint, targeting the proximal articular branches that innervate the joint capsule. So, we compared the post-operative analgesic requirement of patient after giving PENG block along with spinal anesthesia. Methodology: 60 patients were equally divided into 2 groups i.e., Group P & Group S. In group P, we gave PENG block after giving spinal anesthesia while in Group S, we gave spinal anesthesia alone. Our primary outcomes were comparison of analgesic requirement post-operatively. While our secondary outcomes were recovery of motor functions, length of hospital stay etc. Result: In Group P, pain score, analgesic requirement were less as compared to Group S post operatively. And we also found less VAS score, early motor function recovery, and less hospital stay in Group P as compare to Group S. Conclusion: PENG along with spinal anesthesia in THA surgeries, decreases post-operative pain and other complications as compared to spinal anesthesia alone in group S.

Introduction: The objective of this study was to investigate the demographic and forensic profile of unidentified dead bodies and to assess the current medico-legal situation in the Bhavnagar region of Gujarat, India. Material and Methods: A retrospective descriptive study was conducted on 104 cases of unknown dead bodies brought for postmortem examination at Sir T. General Hospital and Government Medical College, Bhavnagar, during the period from April 2010 to March 2013. Observation: study shows most cases involved elderly males, with natural causes being the predominant cause of death, followed by injury-related deaths. Tattoos and items found on or within the body were the most common identifying features. Despite various identification efforts like preserving clothing, photography, and fingerprinting only 24.04% of the bodies were successfully identified. Conclusion: Despite various identification methods, a majority (75.96%) remained unidentified. The findings emphasize the need for improved and timely identification procedures, use of modern forensic tools, and better coordination between forensic teams and law enforcement to enhance the identification and investigation process.

Background: The imbalance between individual resources and work demands during the COVID-19 pandemic has led to musculoskeletal disorders and reduced work ability among healthcare workers, exacerbated by reduced physical activity due to quarantine and lockdown measures. Methods: A cross-sectional study was conducted in March 2022 at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. Participants were healthcare workers (aged 18-60 years, BMI 22-26) from various departments at Sher-i-Kashmir Institute of Medical Sciences, a tertiary care institute in Srinagar, Jammu and Kashmir, India. Participants were screened via a questionnaire assessing the impact of the COVID-19 pandemic on their general health and work ability. Exclusion criteria included pregnancy, ischemic heart disease, stroke, or painful musculoskeletal conditions preventing exercise. Data on body weight (BW), body mass index (BMI), global assessment score (GAS), and work ability index (WAI) were compared pre- and post-COVID. Statistical analysis was performed using SPSS software. Results: Of 150 screened participants, 120 showed interest, 100 replied, and 93 were analyzed after excluding 7. The average age was 35.47 years, with the majority (62%) male and 52.6% married. Participants included 53% medical doctors, 12.9% administrative staff, and 34.1% nursing/paramedic staff. Only 35.4% engaged in regular physical exercise, with 59.1% reporting none. Post-COVID, there was a significant increase in BW and BMI, and a decrease in GAS and WAI, indicating deteriorated general health and work capacity. Comorbidities worsened in many participants. Conclusions: Isolation, lockdown, and stressful work schedules during the pandemic significantly affected healthcare workers health, leading to reduced physical activity, musculoskeletal issues, and impaired work ability. Interventions promoting physical exercise are essential.

Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbidity worldwide, with genetic predisposition playing a significant role. The angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism has been implicated in HDP, but data from southern India remain limited. This study aimed to assess the association between ACE gene polymorphism and HDP in a tertiary care hospital in Tamil Nadu. Methods: A case-control study was conducted with 50 pregnant women diagnosed with HDP and 50 normotensive pregnant women as controls. Clinical and biochemical parameters were assessed, and ACE I/D polymorphism was analyzed using polymerase chain reaction (PCR). The association between genotypes and HDP risk was evaluated using chi-square tests and logistic regression analysis. Results: A significantly higher frequency of the DD genotype was observed in preeclampsia cases (48%) compared to controls (16%) (p = 0.000086). The D allele was more prevalent in cases (69%) than in controls (36%) (p < 0.00001). Logistic regression revealed that pregnant women carrying the D allele had a 3.9 times higher risk of developing HDP (OR = 3.95; 95% CI: 2.2–7.1; p < 0.0001). The genotype distribution was in Hardy-Weinberg equilibrium. Conclusion: This study provides evidence that the ACE D allele is significantly associated with an increased risk of HDP in southern Indian women. The findings support ACE genotyping as a potential tool for early risk stratification in high-risk pregnancies. Further studies with larger sample sizes and diverse populations are warranted to validate these findings and explore gene-environment interactions.

Background: Postoperative pain management following video-assisted thoracoscopic surgery (VATS) remains a significant clinical challenge. Thoracic epidural analgesia (TEA) has long been regarded as the gold standard analgesic technique for thoracic surgery; however, it is associated with invasiveness and notable complications. The ultrasound-guided erector spinae plane (ESP) block has emerged as a promising, technically simpler alternative. Methods: This prospective, single-center, randomized controlled trial enrolled 80 adult patients (ASA I–III) undergoing elective VATS. Patients were randomly allocated to the ESP group (n = 40; ultrasound-guided continuous ESP block with 0.25% bupivacaine) or the TEA group (n = 40; continuous thoracic epidural infusion of 0.125% bupivacaine with fentanyl 2 µg/mL). The primary outcome was pain scores at rest measured using the Numerical Rating Scale (NRS) at 24 hours postoperatively. Secondary outcomes included NRS during coughing, cumulative morphine consumption at 24 and 48 hours, incidence of adverse events, patient satisfaction, and length of hospital stay. Results: NRS pain scores at rest at 24 hours were comparable between groups (ESP: 2.9 ± 1.1 vs. TEA: 2.5 ± 1.0; p = 0.098). Cumulative morphine consumption at 48 hours was significantly higher in the ESP group (18.4 ± 5.2 mg vs. 14.1 ± 4.7 mg; p = 0.001). TEA was associated with significantly higher rates of hypotension (25.0% vs. 7.5%; p = 0.035) and urinary retention (22.5% vs. 5.0%; p = 0.024). Patient satisfaction scores were similar. Length of hospital stay did not differ significantly between groups. Conclusion: Ultrasound-guided ESP block provides comparable resting pain relief to TEA after VATS, with a significantly more favorable side effect profile, despite modestly higher opioid consumption. ESP block may serve as a viable, less invasive alternative to TEA within a multimodal analgesia framework.

Background: Medial compartment osteoarthritis of the knee associated with varus deformity results in pain, functional limitation, and progressive joint degeneration. Lateral closing wedge high tibial osteotomy aims to redistribute mechanical load and preserve native joint function. Objective: To analyse the effectiveness of lateral closing wedge high tibial osteotomy in improving clinical and functional outcomes in patients with medial compartment osteoarthritis using Oxford Knee Score. Methods: A prospective interventional study including 28 patients was conducted, with preoperative evaluation and postoperative assessment at 1, 6, and 12 months using validated scoring systems and radiological analysis. Results: The majority of patients demonstrated moderate varus deformity preoperatively, and postoperative outcomes showed progressive improvement in Oxford Knee Scores, with 57.14% achieving mild symptom status at 12 months and minimal complications reported. Conclusion: Lateral closing wedge high tibial osteotomy is a reliable joint-preserving procedure that significantly improves function and reduces pain in appropriately selected patients with medial compartment osteoarthritis.

Background: From benign and malignant tumors, cysts, vascular abnormalities, and lymph node masses to diffuse lesions including pneumomediastinum, mediastinitis, mediastinal fibrosis, and encysted pleural effusion, mediastinal diseases encompass a broad spectrum of pathology. The basic aim of the study is to analyse the diagnostic accuracy of computed tomogra­phy scan in mediastinal masses assuming histopatho­logical findings as gold standard. Methods: This cross sectional study was conducted in Department of Radiology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from July 2025 to December 2025. After taking informed con­sent, computed Tomography was performed on CT scanner before and after intravenous contrast administration. Results: Age range in this study was from 25-65 years with mean age of 48.57 ± 10.53 years. Majority of the patients 58.78% were between 46-65 years of age as shown in Table 1. Out of these 148 patients, 82 (55.41%) were males and 66 (44.59%) were females with ratio of 1.2:1. Mean duration of disease was 8.39 ± 4.78 months (Table 2). Mean size of mass was 5.21 ± 2.45 cm. Conclusion: It is concluded that computed tomography is a highly sensitive and accurate non-invasive modali­ty for differentiating malignant and benign mediastinal masses, and has not only dramatically improved our ability of accurate diagnosis of mediastinal masses but also improved patient care by timely and proper treat­ment.

Background: A crucial part of diagnosing, treating, and managing seizures with a first onset is structural neuroimaging. Imaging is done to determine the cause, help with prognosis, and identify individuals who would benefit from a change in medication or surgical treatment. MRI is regarded as the preferred imaging technique. Where MRI is less practicable, CT is the preferred diagnostic imaging test for patients with first-onset seizures and seizures in resource-constrained areas. Aim of this study to the spectrum of Computed Tomography findings in patients with first onset seizure. Methods: Cranial CT scans were performed on a cross-section of patients with first-onset seizures who visited the radiology department of Nalanda Medical College and Hospital in Patna, Bihar, between May 2025 and November 2025. Chart review was used to gather the data, and SPSS version 25 and Microsoft Excel 2022 were used for analysis. Results: Seventy-three patients with first onset seizures, 44 males and 29 females with a mean age of 30.1 years, had CT done during the specified period. Thirty-one patients (42.5 %) had normal CT results and forty-two patients (57.5 %) had abnormal results. Neurocysticercosis (NCC) (23.81%), calcified granuloma (21.43 %) and cerebral atrophy (11.9 %) were the most common abnormality. Generalized seizures were seen in 46 patients (63.0%) patients and remaining 27 patients (37 %) had partial seizures. In total 46 cases of generalized seizures, normal CT findings were found in 26 (83.9%) cases and abnormal CT findings were found in 20 (47.6%) of cases. In contrast, among 27 cases of partial seizures, abnormal CT findings were found in 22 (52.4%) of cases. Conclusion: Abnormal CT scans were More Commonly seen in patients with Partial Seizures.

Background: In light of their direct effect on bone turnover, thyroid function problems, especially hypothyroidism, have drawn more attention recently as a significant source of disruption in mineral metabolism. Many important metabolic pathways that are either directly or indirectly controlled by thyroid hormones require calcium, phosphorus, and magnesium. Research on hypothyroid individuals has yielded conflicting results. Therefore, this study was conducted to assess changes in mineral status by measuring serum levels of calcium, phosphorus, and magnesium in hypothyroid patients and to note the significance of monitoring these levels in subclinical hypothyroid disorders. Methods: In this study 50 known hypothyroid patients on analysis with serum T3, T4 and TSH were included as cases and 50 clinically healthy volunteers included in the control group in age group between 18 and 75 years. Thyroid hormones were measured by Electrochemiluminescence Immunoassay method and Calcium, Magnesium, Phosphorus measured on autoanalyzer. Results: Our study demonstrated normal T3 and T4 level and increased level of TSH in cases suggesting subclinical hypothyroidism. In this study patients show normal serum total calcium, and increased total magnesium and serum phosphorous levels as compared to healthy control that is there is alteration in mineral levels. Conclusion: As this study shows alteration in minerals levels monitoring of serum levels of these minerals will be helpful in hypothyroid patients. Alteration in these minerals needs to be monitored periodically and proper treatment should be given to the patient.

Background: This study was conducted to document the spectrum of pathological changes seen on CT scan as part of investigative battery for diagnosis of neurotuberculosis in children, to establish a clinico-radiological correlation as regards, initial presentation. Among the 30 patients selected none presented with TB spine. In the subsequent CT scans during the follow up of cases of intracranial TB, the resolution of the lesions on antitubercular therapy or any complication or sequelae noted was correlated with the clinical outcome. The Aims of this study is to identify the CT findings of the CNS tuberculosis in pediatric age group, correlate the CT imaging feature with clinical findings chest X-ray and biochemical, cytological as well as microbiological analysis of CSF aspirate, evaluate the pre-contrast and post contrast CT images to identify the complications of CNS tuberculosis such as abscess, infact, hydrocephalus etc and CT monitoring of the effect of therapy upto resolution or manifestation of any further complication during the course of therapy. Methods: Thirty consecutive Pediatric patients presenting during the period of January 2023 to December 2023 to the Shree Narayan Medical Institute & Hospital, Saharsa, and Bihar especially from the department of Pediatrics were taken for the present study. The age group was from 1 year to 15 years. 20 patients were males and 10 were females. In all these patients the clinical and the laboratory parameters were suggestive of intracranial tuberculosis. Results: The maximum number of cases in this study were in 4-6years (33.34%) and 7-9 Years (26.67%) year’s age group. The male incidence in this study was (66.67%). The overall male: female ratio is 2:1 but the ratio in 1-3 years and 4-6 years age group is 1.5:1 & 4:1 respectively. Chest X-ray in this study showed abnormality suggestive of pulmonary tuberculosis in (26.67%). In our study hydrocephalus was found in 20/30 patients, of which two patients had posterior fossa tuberculomas. All cases (100%) of meningitis had hydrocephalus at presentation ranging from mild to severe degree. In this study focal parenchyma lesions were seen in 12 of the 30 cases (40%). All of these cases had isolated parenchymal lesions. The intracranial tuberculosis may present as a space occupying lesion in various morphological patterns. Single ring lesions in 8/12 (66.67%) patients were among common morphological pattern in this study. Two patients (16.67%) had multiple disc/ring lesions and 2 (16.67%) had conglomerate lesions. Conclusion: New lesions developed in a couple of patients while they were still on antitubercular therapy treatment. These patients suffered from residual disability at 6 months of therapy. No definite pattern of resolution was found for any particular CT presentation on the initial scan.

Background: Chronic urticaria (CU) is a debilitating dermatological condition characterized by recurrent wheals persisting for more than six weeks. Emerging evidence suggests that vitamin D, through its immunomodulatory properties, may influence the pathogenesis, clinical severity, and recurrence patterns of chronic urticaria. However, the precise relationship between vitamin D status and disease outcomes in chronic urticaria patients remains insufficiently characterized. Methods: A prospective observational cohort study was conducted on 240 patients with chronic urticaria and 120 age- and sex-matched healthy controls. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured in all participants. Disease severity was assessed using the Urticaria Activity Score over 7 days (UAS7). Patients were categorized into vitamin D deficient (<20 ng/mL), insufficient (20–29.9 ng/mL), and sufficient (≥30 ng/mL) groups. Recurrence was monitored over a 12-month follow-up period. Results: The mean serum 25(OH)D level was significantly lower in CU patients compared to controls (16.4 ± 7.8 vs. 28.3 ± 9.2 ng/mL, p < 0.001). Among CU patients, 58.3% were vitamin D deficient, 26.7% were insufficient, and 15.0% were sufficient. Vitamin D deficient patients exhibited significantly higher UAS7 scores (32.6 ± 7.4) compared to insufficient (24.1 ± 6.8) and sufficient (17.3 ± 5.9) groups (p < 0.001). The 12-month recurrence rate was significantly elevated in the deficient group (71.4%) compared to the insufficient (46.9%) and sufficient (25.0%) groups (p < 0.001). Serum 25(OH)D levels demonstrated a significant negative correlation with UAS7 scores (r = −0.614, p < 0.001). Conclusion: Vitamin D deficiency is highly prevalent among chronic urticaria patients and is significantly associated with greater disease severity and higher recurrence rates. Assessment and correction of vitamin D status may represent a valuable adjunctive strategy in the comprehensive management of chronic urticaria.

Background: Physiological fluctuations in ovarian hormones across the menstrual cycle may influence hematological parameters in women of reproductive age. Understanding these variations is essential for accurate clinical interpretation of laboratory findings. The present study evaluated phase-wise changes in hematological indices across the menstrual cycle in healthy young women. Material and Methods: A hospital-based analytical cross-sectional study was conducted at a tertiary care teaching hospital in India. A total of 110 apparently healthy women aged 18–35 years with regular menstrual cycles were included. Venous blood samples were collected during the menstrual (day 2–3), proliferative (day 8–10), and secretory (day 20–22) phases of a single cycle. Hemoglobin concentration, red blood cell (RBC) count, hematocrit, RBC indices, total leukocyte count, differential leukocyte count, and platelet count were analyzed using an automated hematology analyzer. Repeated measures ANOVA was applied for comparison across phases, with p < 0.05 considered statistically significant. Results: Hemoglobin (11.7 ± 0.8, 12.2 ± 0.9, 12.4 ± 0.8 g/dL; p < 0.01), RBC count (4.12 ± 0.32, 4.29 ± 0.34, 4.35 ± 0.30 million/mm³; p < 0.01), and hematocrit (35.1 ± 2.4, 36.8 ± 2.6, 37.4 ± 2.3%; p < 0.01) increased progressively from menstrual to secretory phase. Mean corpuscular hemoglobin concentration showed modest but significant variation (p = 0.04), while mean corpuscular volume and mean corpuscular hemoglobin remained unchanged. Total leukocyte count differed significantly across phases (7,860 ± 1,120; 7,420 ± 1,030; 8,210 ± 1,180 cells/mm³; p < 0.01). Neutrophils increased and lymphocytes decreased during the secretory phase (p < 0.01), whereas monocytes and eosinophils showed no significant change. Platelet count was highest in the secretory phase (2.91 ± 0.44 lakhs/mm³; p < 0.01). Conclusion: Significant menstrual phase–dependent variations occur in selected hematological parameters, emphasizing the need to consider cycle timing when interpreting laboratory results in reproductive-age women.

Introduction: Arteriovenous fistula (AVF) creation under regional anesthesia, guided by preoperative and intraoperative vein mapping, enhances vascular access outcomes in critically ill chronic kidney disease (CKD) patients. Accurate assessment of vessel size improves AVF maturation rates, reduces catheter dependence, and provides a safer surgical approach for hemodialysis in high-risk individuals. Methods: This prospective study included critically ill CKD patients undergoing AVF creation under regional anesthesia. Preoperative and intraoperative duplex ultrasound assessed vessel suitability. Brachial plexus blocks were administered, and AVF types were selected based on vein mapping. Patient demographics, preoperative, intraoperative vein and artery diameters, type and site of AVF creation with intraoperative success, and thrombosis, or fistula failure were analysed. Results: In this study of 25 patients, mean age was 55.64 years with a male-to-female ratio of 1.5:1. Preoperative and intraoperative vein sizes differed significantly. AVF maturation was 100% in veins ≥2.5 mm. Intraoperative mapping showed consistent vein enlargement across zones, reflecting regional anesthesia-induced vasodilation. Conclusion: Pre- and intraoperative ultrasound mapping under regional anesthesia significantly aids AVF creation in critically ill CKD patients. Vein diameter ≥2.5 mm predicts better outcomes, and intraoperative dilation under RA helps optimize access site selection. This integrated approach improves AVF success, especially in patients with challenging vascular profiles.

Introduction: Body Mass Index (BMI) influences menstrual health, with both obesity and underweight linked to cycle irregularities due to hormonal imbalances. Rising trends in abnormal BMI correlate with increased menstrual disturbances. The study aims to assess the relationship between BMI and menstrual irregularities in reproductive-aged women for targeted interventions. Methods: A six-month prospective study at GSL Medical College included women aged 15–45 with regular cycles. After ethics approval and consent, data on menstrual history, lifestyle, and BMI were collected. BMI was categorized per WHO norms. Menstrual irregularities were defined by abnormal cycle length, flow duration, or intermenstrual bleeding. Results: Among 88 women aged 15–45 years, 38.6% reported menstrual irregularities, most commonly oligomenorrhea. Irregularities were highest in underweight and obese groups. A statistically significant association (P < 0.05) was observed between BMI and menstrual patterns. Mean BMI was significantly higher in women with irregular cycles (P < 0.001), indicating strong correlation. Conclusion: This study found a significant association between abnormal BMI and menstrual irregularities, with higher prevalence in underweight and obese women. Maintaining a healthy BMI is crucial for menstrual health. Limitations include small sample size and single-center design, warranting larger, multi-center studies for broader applicability and hormonal assessment.

Background: Childhood obesity is rising globally and is strongly associated with early-onset hypertension and renal dysfunction. Identifying these complications at an early stage is essential to prevent long-term morbidity. Aim: To determine the prevalence of hypertension and early renal changes among overweight and obese school-aged children and assess the association between BMI category and hypertension. Methods: This prospective observational study included 115 children aged 6–14 years at government Medical College, Mulugu (January–August 2025). BMI percentiles were classified using WHO charts. Blood pressure was measured as per AAP 2017 guidelines. Urine albumin–creatinine ratio assessed microalbuminuria, and renal ultrasound evaluated structural abnormalities. Data were analyzed using t-tests, Chi-square tests, and logistic regression. Results: Elevated BP was observed in 20.9% of children, while Stage 1 and Stage 2 hypertension were present in 17.4% and 7.0%, respectively. Microalbuminuria occurred in 16.5%, and 10.4% showed increased cortical echogenicity on ultrasound. Obesity was significantly associated with hypertension (p = 0.004), with obese children showing threefold higher risk. Conclusion: Excess adiposity in school children is strongly linked with hypertension and early renal changes. Early screening, lifestyle interventions, and nephrology involvement are essential for prevention.

Background: Cataract in young adults is a significant public health issue in developing countries, contributing to visual disability during the most productive years of life. This condition is particularly prevalent among those from lower socioeconomic strata who are occupationally exposed to risk factors such as ultraviolet radiation and extreme heat, including industry workers and farmers. Early identification and intervention are critical to prevent lifelong visual impairment and associated social and economic burdens. Methods: This retrospective, comparative study was conducted at Terna Medical College and Terna Speciality Hospital and Research Centre, Navi Mumbai, over a period of five years (2013-2017). 237 cataract cases in patients between the ages of 20 and 49 were examined. Data included occupational exposure to heat and UV light, socioeconomic background, cataract severity, and associated ocular comorbidities. Patients with hereditary, traumatic, or drug-induced cataracts were excluded. Detailed ophthalmic evaluations including slit lamp and fundus examinations were performed. Results: Out of 237 patients, 120 (50.6%) were female and 117 (49.4%) were male. Cataracts were significantly associated with occupations involving exposure to heat and UV radiation (p < 0.001), particularly among industry workers and farmers. Unilateral cataracts were more common, with the right eye being affected in 60.75% of cases. Most patients underwent SICS with PCIOL (220 cases). Postoperative visual outcomes were favorable in the majority, with 131 (55.3%) achieving visual acuity between 6/12 and 6/6. Visual improvement was limited in 15 patients due to pre-existing ocular comorbidities. Conclusion: The study highlights a high prevalence of cataracts in young individuals with occupational exposure to heat and ultraviolet radiation, particularly among those from lower socioeconomic backgrounds. Strengthening awareness, occupational eye protection, and early screening strategies are essential to reduce the burden of cataract-related visual disability in this vulnerable population.

Introduction: Regional nerve blocks always proven to be best methods for intraop and postop analgesia. Spine surgeries are among one of those surgeries regional blockade should not cause motor blockade. In this study we compared analgesic efficacy of clonidine versus dexmedetomidine added to 0.2% ropivacaine administered caudally using ultrasound. Methods: 32 patients in RC group received 1microgram/kg clonidine plus 0.2% ropivacaine total 20 ml other group received 1microgram/kg dexmedetomidine plus same concentration and volume ropivacaine as RC group pulse rate, MAP at incision time post op VAS score monitored at 1, 2, 4, 8, 12, 24 hr postoperatively. Results: Dexmedetomidine prolonged postop analgesia compared to clonidine. Fentanyl requirement was significantly less in dexmedetomidine group. Both the groups no reports of motor blockade. Conclusion: Compared to clonodine adding dexmedetomidine to 0.2% ropivacaine significantly lower VAS score and prolonged duration of analgesia.

Background: Dry eye disease is a multifactorial disorder of the ocular surface and is a common cause of postoperative discomfort following cataract surgery, especially in the elderly population. Symptoms such as foreign body sensation, grittiness, ocular fatigue, and visual disturbance significantly affect the quality of life and patient satisfaction after surgery. Cataract surgery, being the most frequently performed ophthalmic procedure, particularly for senile cataract, can exacerbate pre-existing or subclinical ocular surface disease due to surgical trauma, corneal nerve damage, and postoperative topical medications. Early identification and management of dry eye are therefore essential to improve postoperative outcomes. Methods: This prospective comparative study included 160 patients undergoing cataract surgery, divided equally into two groups: 80 patients underwent manual Small Incision Cataract Surgery (SICS) and 80 underwent phacoemulsification. Patients were evaluated preoperatively (1 day before surgery) and postoperatively at 7, 30, and 90 days. Dry eye was assessed using the Ocular Surface Disease Index (OSDI) questionnaire, Tear Break-Up Time (TBUT), and Schirmer’s test. The incidence and severity of dry eye and ocular surface damage were compared between the two surgical techniques. Results: A significant increase in dry eye signs and symptoms was observed during the first postoperative week in both groups, evidenced by increased OSDI scores and reduced TBUT and Schirmer’s values. OSDI and TBUT showed better correlation with dry eye severity compared to Schirmer’s test. By 30 and 90 days postoperatively, tear film parameters gradually improved and returned to near-normal levels. Phacoemulsification was associated with a significantly lower incidence and severity of postoperative dry eye compared to manual SICS. Conclusion: Dry eye disease is a common but transient postoperative complication following both manual SICS and phacoemulsification. Symptoms are more pronounced in the early postoperative period, likely due to frequent use of topical medications and ocular surface toxicity and resolve as medications are tapered. OSDI and TBUT are more reliable indicators of postoperative dry eye than Schirmer’s test. Early postoperative ocular surface evaluation and the use of tear substitutes can reduce epithelial damage and improve patient comfort. Phacoemulsification causes less ocular surface disturbance and offers better postoperative patient well-being.

Background: Increasing evidence suggests that chronic dermatological disorders are associated with systemic metabolic disturbances. Insulin resistance has emerged as a key pathogenic link between chronic inflammation and metabolic dysfunction in skin diseases such as psoriasis, acne vulgaris, and vitiligo. Objectives: To evaluate insulin resistance and metabolic abnormalities among patients with psoriasis, acne vulgaris, and vitiligo and to compare the extent of metabolic involvement across these dermatological conditions. Materials and Methods: This hospital-based cross-sectional study included 100 patients diagnosed with psoriasis (n=35), acne vulgaris (n=35), and vitiligo (n=30). Fasting plasma glucose, fasting serum insulin, and lipid profile were assessed. Insulin resistance was calculated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Statistical analysis was performed using ANOVA, and a p-value <0.05 was considered statistically significant. Results: Psoriasis patients demonstrated significantly higher fasting insulin levels and HOMA-IR values compared to acne vulgaris and vitiligo patients (p<0.001). Acne vulgaris patients also exhibited elevated insulin resistance, though less severe than psoriasis. Vitiligo patients showed comparatively lower but measurable metabolic alterations. Dyslipidemia was most pronounced in psoriasis patients, followed by acne vulgaris, while vitiligo patients exhibited milder lipid abnormalities. Conclusion: Insulin resistance and metabolic abnormalities are common in chronic dermatological disorders, particularly psoriasis and acne vulgaris. These findings highlight the importance of routine metabolic screening and a multidisciplinary approach in the management of patients with inflammatory and autoimmune skin diseases.

Background: Exercise is a proven preventive measure against non-communicable diseases such as obesity, diabetes, hypertension and mental health disorders. This study investigates the awareness of exercise among young adults in relation to disease prevention. Aim: This study aim to assess the level of awareness among young adults regarding exercise as a preventive tool against diseases. Methodology: A cross-sectional survey -based study of 200 participants aged 18–25 years was conducted using a structured  questionnaire using google form. Data was analysed by appropriate statistical method. Results: The duration of  exercise  in majority (40%) of participants was less than 30 minutes per day. The frequency of exercise in majority of participants (40%) was 3–4 times per week, which was closer to recommended guidelines but still below optimal daily activity. Exercise adherence rate was 35%  indicating  low compliance. In Majority of participants (80%) , strongest motivation for exercise was fitness and appearance, followed by disease prevention. only 35%  of participants in high awareness group and 33% participants in low awareness group  met WHO guidelines of exercise. The Chi Square test result (χ² = 0.105, df=1, p > 0.05) indicates that the difference between awareness and practice is not statistically significant. Thus results revealed moderate awareness of exercise benefits but poor consistent practice. Conclusion: The findings highlight the need for targeted health education and institutional support to promote exercise awareness and practice among students.

Obesity is recognized as a key contributor to insulin resistance and further lead to other non-communicable disease. This study is designed to test the relation of insulin resistance with deranged autonomic functions in obese males.
The present study is cross-sectional observational study on 70 obese males. Obese males are divided into two groups non-insulin resistant (HOMA-IR<2.5) and insulin resistant group (HOMA-IR> 2.5). Anthropometric parameters, Cardiovascular parameters, HRV (heart rate variability) and BRS (baroreflex sensitivity) were measured in these 70 males. Insulin resistant subjects showed increased resting HR (rate (78 ± 6 BPM vs. 72 ± 5 BPM; p<0.001) and elevated resting systolic and diastolic blood pressure suggesting increased sympathetic activity and reduced vagal tone. Spectral analysis of HRV showed significantly reduced low-frequency (LF) power (400.1 ± 130.2 ms² vs. 550.1 ± 150.1 ms²; p<0.001) and high-frequency (HF) power (300.2 ± 100.1 ms² vs. 400.1 ± 120.3 ms²; p=0.0003) in the IR group, indicating impaired autonomic modulation. Moreover, normalized LF (LFnu) was higher in the IR group (65.1 ± 7.2%) compared to the NIR group (60.2 ± 5.1%; p=0.0016), while HFnu was significantly lower (35.1 ± 7.3% vs. 40.2 ± 5.1%; p=0.0012. Time-domain indices such as SDNN and RMSSD were also significantly lower in the IR group (SDNN: 40.2 ± 8.2 ms vs. 50.1 ± 10.2 ms; RMSSD: 35.3 ± 7.1 ms vs. 45.2 ± 9.1 ms; both p<0.001), indicating reduced parasympathetic activity and overall variability All BRS indices—namely BRS(+) slope (7.1 ± 1.5 vs. 10.1 ± 2.2;) BRS (-) slope (6.1 ± 1.4 vs 9.2 ± 2.1) BRS Sequence All  (6.5 ± 1.6 vs. 9.5 ± 2.0)were significantly reduced in the IR group.

Thus, significant inverse associations between HOMA-IR and autonomic indices highlight insulin resistance as a key contributor to autonomic dysfunction in obesity.

Background: Hemoglobinopathies are a group of inherited disorders characterized by abnormal production or structure of the hemoglobin molecule. India, located on the thalassemic belt, has a high prevalence of beta-thalassemia and sickle cell disorders. High-Performance Liquid Chromatography (HPLC) has emerged as a reliable and efficient diagnostic tool for screening and diagnosis of these conditions. Methods: A cross-sectional observational study was conducted among all OPD patients whose HPLC requisition forms were received at the Central Clinical Laboratory of Pathology, Civil Hospital, Gandhinagar from August 2022 to February 2024. Complete blood count was performed using Sysmex XN-350 automated analyzer, and HPLC was performed using BIO-RAD VARIANT II system. A total of 610 samples were analyzed. Results: Out of 610 samples analyzed, 90 (14.75%) tested positive for hemoglobinopathies. Female predominance was observed (55.60% vs 44.40% males). The age group of 21-30 years showed the highest prevalence (44.40%). Beta Thalassemia Minor was the most common hemoglobinopathy (42.20%, prevalence 06.23%), followed by Sickle Cell Trait (25.60%, prevalence 03.77%) and Sickle Cell Anemia (17.80%, prevalence 02.62%). Severe anemia (Hb <07 g%) was observed in 45.60% of positive cases. Conclusion: HPLC is a highly reproducible, excellent, and powerful diagnostic tool offering simplicity with automation, superior resolution, and rapid results for diagnosis of hemoglobinopathies. The high prevalence emphasizes the need for premarital and antenatal screening.

Background: Recurrent anterior shoulder dislocation is a common condition affecting young, active individuals and is associated with significant functional impairment. Conservative management has a limited role in recurrent cases. Arthroscopic Bankart repair with suture anchors has gained popularity due to reduced morbidity, improved cosmesis, and faster rehabilitation. This study aimed to evaluate the surgical and functional outcomes of arthroscopic stabilization in patients with recurrent anterior shoulder dislocation. Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Government Stanley Medical College, Chennai, from April 2019 to November 2020. Twenty patients above 18 years with recurrent anterior shoulder dislocation and glenoid bone loss <25% were included. Patients with significant bone defects, rotator cuff tears, multidirectional instability, or arthritis were excluded. All patients underwent arthroscopic Bankart repair with suture anchors. Functional outcome was assessed using the Rowe score at 3 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Results: The mean age was 32.8 ± 10.58 years, with 90% males. Right shoulder involvement was seen in 60% of patients. Preoperatively, 95% had anterior translation and 90% had a positive apprehension test. The mean preoperative Rowe score was 48.25. At one-year follow-up, the mean Rowe score improved significantly to 93.53. No recurrence of dislocation or subluxation was noted. Full forward elevation was achieved in all patients, and 85% regained full external rotation at 90° abduction. Only one patient reported postoperative pain following a traumatic episode. Conclusion: Arthroscopic Bankart repair with suture anchors is a reliable and effective procedure for recurrent anterior shoulder dislocation, providing excellent functional recovery, improved stability, and low recurrence rates.

Background: Healthcare professionals’ knowledge and attitudes toward homosexuality influence patient trust, diagnosis, and treatment outcomes. In India, evolving societal norms and legal reforms demand inclusive clinical practice. This study assessed attitudes and knowledge of medical professionals in Gujarat toward homosexuality. Methods: A multicentric, cross-sectional survey was conducted among 500 registered doctors (MBBS, MS, MD) across five tertiary-care hospitals and three medical colleges in Gujarat. A culturally adapted, 21-item Homosexuality Attitude Scale assessed beliefs, comfort levels, and rights-based views. Responses on a 5-point Likert scale were analyzed using descriptive statistics, Mann-Whitney U, and Chi-square tests in SPSS v25. Results: Of the respondents, 52% were male and 48% female; mean age was 34.7 ± 6.3 years. Most rejected outdated notions: 89.6% disagreed that homosexuality is a disease, 86.4% affirmed the capacity for stable relationships, and 83.2% were comfortable discussing the topic with patients. Equal legal and medical rights were supported by 90.2%, and 88.1% advocated LGBTQ+ inclusivity in medical curricula. Stereotypes were rare—only 9% believed homosexuality resulted from psychological trauma, and 8.6% associated it with promiscuity. No significant differences in attitudes were observed by gender (p=0.437) or qualification (p=0.519). Conclusion: Medical professionals in Gujarat exhibit high levels of acceptance and inclusivity toward homosexuality, aligning with modern clinical and human rights standards. However, minor pockets of neutrality or bias persist, underscoring the need for targeted education and sensitization training.

Non-Hodgkin lymphoma (NHL) represents a heterogeneous group of lymphoid malignancies with varied clinical behavior, treatment response, and prognosis. While tissue biopsy remains the diagnostic gold standard, peripheral blood biomarkers have gained increasing importance as minimally invasive, cost-effective tools for diagnosis, prognostic stratification, treatment monitoring, and detection of minimal residual disease. Classical serological biomarkers such as lactate dehydrogenase (LDH), beta-2 microglobulin (β2-microglobulin), and carcinoembryonic antigen (CEA) are widely available and routinely used in clinical practice, particularly in resource-limited settings. Recent advances have further expanded the scope of peripheral blood biomarkers through liquid biopsy approaches, including circulating tumor DNA (ctDNA), circulating RNAs, and epigenetic markers. This review provides a comprehensive and simplified synthesis of global evidence on peripheral blood biomarkers in NHL, with particular emphasis on the evaluation of serum LDH, β2-microglobulin, and CEA, their biological basis, clinical utility, prognostic significance, and public health relevance, while also highlighting emerging molecular approaches and future directions.

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among reproductive-aged women and is frequently associated with metabolic dysfunction and adverse obstetric outcomes. Despite global evidence, regional prospective data from Eastern India remain limited. This study aimed to evaluate maternal and obstetric outcomes in pregnant women with PCOS compared to women without PCOS. Methods: This prospective comparative study was conducted in the Department of Obstetrics and Gynecology at Patna Medical College and Hospital between January 2025 and September 2025. A total of 120 antenatal women were enrolled, including 60 women diagnosed with PCOS according to Rotterdam criteria and 60 age-matched controls. Participants were followed from early pregnancy until delivery. Primary outcomes included gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), spontaneous abortion (SAB), preterm birth, and mode of delivery. Statistical analysis was performed using SPSS version 25. Results: Women with PCOS demonstrated a significantly higher prevalence of overweight and obesity. The incidence of GDM (20% vs 8%), PIH (25% vs 13%), and preterm delivery (30% vs 15%) was notably higher in the PCOS group. Cesarean section rates were also increased among women with PCOS (65% vs 40%). Conclusion: PCOS is associated with a substantially increased risk of adverse pregnancy outcomes. Pregnancies complicated by PCOS should be managed as high-risk, with early screening and vigilant antenatal monitoring to optimize maternal and neonatal outcomes.

Refractive errors are a major cause of visual impairment in children, adversely affecting learning, daily activities, and overall quality of life, and the increasing use of digital devices has raised concerns regarding the impact of prolonged screen time on ocular health. This cross-sectional observational study was conducted over one year at Gautam Buddha Chikitsa Mahavidyalaya, Jhajra, Dehradun, to determine the prevalence of refractive errors among 30 school-going children aged 6–18 years and to assess their association with screen time. Data on demographic characteristics, type of refractive error, daily screen time, visual acuity, and spherical equivalent were collected and statistically analyzed. The mean age of participants was 12.8 ± 3.2 years, with males comprising 53.3% of the study population. Myopia was the most common refractive error, affecting 40% of children, and showed a significant association with screen time of ≥2 hours per day (p = 0.03). Mean visual acuity was significantly higher in myopic children (0.35 ± 0.12; p = 0.02), and a moderate positive correlation was observed between screen time and spherical equivalent (r = 0.46, p = 0.01). The findings indicate that myopia is the predominant refractive error among school-going children and is significantly associated with prolonged screen exposure, highlighting the need for regular vision screening, eye health education, and regulation of screen use to prevent visual impairment and promote optimal academic and social development.

Background: Preoperative identification of difficult intubation remains a critical challenge in anaesthetic practice. Conventional clinical predictors demonstrate suboptimal sensitivity individually. Ultrasonographic assessment of anterior neck soft tissue offers a quantitative, non-invasive alternative that warrants systematic evaluation. Objectives: To assess the diagnostic accuracy of preoperative ultrasound-measured anterior neck soft tissue thickness at three anatomical levels in predicting difficult intubation and to evaluate its correlation with established clinical airway parameters. Methods: This prospective observational study enrolled 150 adult patients undergoing elective surgery under general anaesthesia with endotracheal intubation at Govt. Theni Medical College, Theni . Preoperative ultrasound measurements were recorded at three levels — skin to hyoid bone (Level 1), skin to epiglottis at thyrohyoid membrane (Level 2), and skin to tracheal ring at suprasternal notch (Level 3). Intraoperative Cormack-Lehane grading served as the reference standard. ROC curve analysis, independent t-test, Chi-square test, and Spearman’s rank correlation were applied. Results: Difficult intubation was encountered in 11 patients (7.3%). Soft tissue thickness was significantly greater in the difficult airway group at all three levels (p = 0.000). Level 2 demonstrated superior diagnostic accuracy (AUC = 0.995, sensitivity 100%, specificity 99.3%) at a cutoff of 2.335 cm. No significant correlation was observed between ultrasound measurements and clinical airway parameters. Conclusion: Preoperative ultrasound measurement at the thyrohyoid membrane level is a highly accurate, independent predictor of difficult intubation. A cutoff of 2.335 cm offers near-perfect sensitivity and specificity, establishing its value as a reliable adjunct in preoperative airway assessment.

Background: Hypovolemic shock remains a leading cause of early preventable mortality in polytrauma patients worldwide. Conventional Advanced Trauma Life Support (ATLS) guidelines emphasize aggressive fluid resuscitation; however, excessive crystalloid administration is associated with dilutional coagulopathy, tissue edema, and adverse outcomes. Early vasopressor support with low-dose noradrenaline may facilitate rapid hemodynamic stabilization while reducing fluid overload. Objectives: To compare the effectiveness of conventional ATLS protocol alone versus ATLS protocol combined with early low-dose noradrenaline infusion in adult polytrauma patients presenting with hypovolemic shock. Methods: This prospective comparative study included 60 adult polytrauma patients with hypovolemic shock, randomized into two groups: ATLS-only (n=30) and ATLS plus early noradrenaline (n=30). Primary outcomes included time to achieve systolic blood pressure (SBP) ≥90 mm Hg, fluid requirement in the first 3 hours, and time to heart rate normalization. Secondary outcomes included urine output at 3 hours, lactate clearance at 6 hours, Glasgow Coma Scale (GCS) improvement, ICU admission, and in-hospital mortality. Results: Baseline characteristics were comparable between groups. The noradrenaline group achieved target SBP significantly faster, required lower fluid volumes, and showed earlier heart rate normalization (p<0.001). Urine output, lactate clearance, and GCS improvement were significantly better in the intervention group (p<0.05). ICU admission and mortality were lower but not statistically significant. Conclusion: Early low-dose noradrenaline infusion as an adjunct to ATLS significantly improves early hemodynamic and physiological outcomes in hypovolemic polytrauma patients.

Background: There are many types of skin tumours depends on geographic latitudes, occupational exposure, and sun exposure and skin protection behavior. Hence correlation of macroscopic and microscopic studies can accurately diagnose the skin tumours. Method: 75 (seventy-five) adult patients having skin tumors were studied. The biopsy was done to study the tumors histopathologically. Tumors were classified as per the guidelines of WHO. Histopathological findings were correlated with immunohistochemistry findings. Results: Out of Seventy five, 45 benign and 30 malignant tumours were noted, 44 (58.6%) Keratino cytic, 15 (20%) melanocytic, 13 (17.3%) appandageal, 3 (4%) Hematolymphoid were classified and 15 (50%) basal cell carcinoma was also classified. The highest number was 6 (40%) nodular variants, followed by 4 (26.6%) basosquamous variants. Conclusion: Skin tumours affect the normal social life. Early diagnosis can prevent morbidity and mortality. Plastic or cosmetic surgery of the face and exposed body organs can be revitalizing.

Background: Stillbirth is a major obstetric catastrophe. It’s a significant public health concern projected to 1.9 million stillbirths globally in 2021. Data collection, review, identification of obstacles, and public awareness are needed to reduce stillbirths. Research has indicated that there are determinants for stillbirth including income, economic status, and educational status, and occupation, place of residence, standard of living index score, and medical comorbidities. Unequal access to healthcare prevents the proper distribution of healthcare services. Aims and Objectives: To assess the Epidemiological profile and the risk factors associated with stillbirth cases. Methodology: Pregnant women attending and admitted to the Department of Obstetrics and Gynaecology of Silchar Medical College. All intrauterine demise with gestational age of more than 28 weeks of pregnancy and occurring in the intrapartum or before delivery were included. All foetal deaths below 28 weeks and after delivery were excluded. All relevant investigations and proforma were analyzed to determine the stillbirth’s cause and risk factors. Result: Stillbirths were common above 20 years of age from rural regions, one fourth of mothers were illiterate, one-third of patients belonged to lower socioeconomic status and consanguinity was present. Fewer patients had two ANC visits. The majority of them were unbooked. A high incidence of stillbirth is seen in early preterm gestation and with a mild degree of anemia. The cause of stillbirth was Hypertensive disorder of pregnancy, meconium-stained amniotic fluid, and hydrops. Conclusion: Stillbirths are one of the areas in obstetrics that may be improved. The important epidemiological factors are literacy, lower socioeconomic status, place of residency, unregulated reproduction, lack of awareness, and low checkups. A mild degree of anaemia was present. The commonest causes of stillbirth are Hypertensive disorder of pregnancy, meconium-stained liquor, and hydrops foetalis. Effective screening and diagnosis are crucial in identifying high-risk factors and treating them.

Background: Filariasis is a global health problem. Lymphatic filariasis is India’s second most common vector-borne disease and a major contributor to chronic deformities like elephantiasis. The disease is widespread in India, and highly endemic zones are present in several states, particularly Chhattisgarh, Uttar Pradesh, Bihar, Orissa, Jharkhand and Andhra Pradesh. Filariasis can rarely present as asymptomatic swellings in various unusual sites in the body and very uncommonly as a sole finding in effusion cytology. Therefore, cytology plays a crucial role in the incidental diagnosis of filariasis in clinically unsuspected cases. This study aims to analyze cytology’s role in diagnosing filariasis, especially in clinically unsuspected cases, and to study the cytological findings associated with filariasis in these cases. Materials and Methods: This study was conducted in Chhattisgarh Institute of Medical Sciences, Bilaspur. The records from the department of cytology Chhattisgarh Institute of Medical Sciences were searched from January 2022 to Dec 2025. We collected the cases for this study from our routine cytology cases (FNAC/Body fluids) over four years. Two pathologists then evaluated all the diagnosed cases of filariasis in cytology. Descriptive statistical analysis was done wherever required. In four-year study period we found eight cases of filariasis in routine cytology smears (FNAC/Body fluids). Results: Out of these eight cases, one case each from breast and thyroid swelling, three cases were diagnosed in cytology smears from subcutaneous swellings, one from axillary lymph node and two cases were diagnosed in fluid cytology. All these cases had incidental findings of microfilariasis varying from one-to-many parasites per slide on cytological examination. In none of these cases, filariasis was suspected by the clinicians. Conclusion: Cytology plays a crucial role in diagnosing filariasis in endemic areas, especially in those with atypical presentations. Therefore, meticulous screening of all cytology smears is strongly indicated.

Introduction: Brachial plexus blockade can be done by various approaches and techniques, supraclavicular approach is known as spinal arm of upper limb surgery, in some cases patchy effect can be occur, which can be overcome by Axillary blockade as rescue block resulting in avoidance of general anesthesia and minimal peri-operative complications. Methodology: study at P.D.U. Medical College and hospital involves patient posted for upper arm surgery above 18 years without co-existing neurological disease. Discussion: The study comprises of 70 patients in which 35 are control group and 35 are of rescue group. The rescue group has patients in which people have some nerve sparing effect of PNS guided Supraclavicular blockade, The study found no significant differences in age, sex distribution, body weight, ASA status. Conclusion: Study indicates that ulnar/median nerve sparing effect by PNS guided blockade can be overcome by Tran’s arterial axillary approach and avoids the risks of general anesthesia.

Background: Laparoscopic cholecystectomy is usually done with general anesthesia, but regional anesthesia has become a possible alternative, especially for certain groups of patients. Evidence concerning early postoperative adverse events associated with regional anesthesia is still scarce and inconsistent. Objective: To analyze the incidence and clinical profile of early postoperative complications in patients managed with regional anesthesia for laparoscopic cholecystectomy. Materials and Methods: This prospective observational study encompassed 100 adult patients (ASA physical status I–II) scheduled for elective laparoscopic cholecystectomy under regional anesthesia at a tertiary care institution. Factors influencing early recovery, intraoperative metrics, and demographic data were recorded. Post-operative complications occurring within 48 hours, including shoulder tip pain, postoperative nausea and vomiting (PONV), hypotension, urinary retention, headache, surgical site infection, and respiratory complications, were documented. We employed frequencies and percentages to depict categorical variables and mean ± SD to convey continuous data. Results: The average duration for surgery was 62.4 ± 12.6 minutes, and the average time spent in the hospital was 1.4 ± 0.6 days. Twenty-six percent of patients reported shoulder pain during the procedure, and twelve percent experienced low blood pressure throughout the procedure. In 4% of cases, general anesthesia was needed. Post-operatively, shoulder tip pain was the most common complication (24%), followed by PONV (14%) and hypotension (10%). Urinary retention and post-dural puncture headache were observed in 6% and 8% of patients, respectively. Thirty-five percent of patients experienced no post-operative complications. Conclusion: Laparoscopic cholecystectomy under regional anesthesia is feasible and associated with an acceptable profile of early post-operative complications. With appropriate patient selection and perioperative management, regional anesthesia. May represent a safe alternative to general anesthesia in selected patients.

Background: Coronavirus disease-2019 (COVID-19)-associated mucormycosis (CAM) emerged as a serious opportunistic fungal infection during the COVID-19 pandemic, particularly in patients with diabetes mellitus and corticosteroid exposure. Surgical debridement combined with antifungal therapy is the mainstay of treatment; however, predictors of surgical outcomes and mortality require further evaluation. Aim and Objectives: To evaluate the operative profile, surgical outcomes, and predictors of mortality in patients with COVID-19-associated mucormycosis undergoing surgical management at a tertiary care center. Materials and Methods: This retrospective observational study included 60 patients with confirmed COVID-19-associated mucormycosis who underwent surgical intervention between June 2021 and May 2022. Clinical, radiological, operative, and outcome data were retrieved from hospital medical records. Results: The mean age of patients was 52.4 ± 11.6 years, with male predominance (68.3%). Diabetes mellitus was present in 86.7% of patients, and 81.7% had received corticosteroids during COVID-19 treatment. Sinonasal involvement was observed in 46.7%, rhino-orbital in 33.3%, and rhino-orbito-cerebral involvement in 20.0% of patients. Endoscopic sinus debridement was performed in all patients, while 23.3% required maxillectomy and 10.0% required orbital exenteration. At 90-day follow-up, 68.3% of patients recovered, 16.7% had residual disease, and overall mortality was 31.7%. Mortality was significantly higher in patients with intracranial involvement (p = 0.0008) and in those undergoing extensive surgical procedures (p = 0.0003). Conclusion: COVID-19-associated mucormycosis is associated with high mortality, particularly in advanced disease. Early diagnosis, aggressive surgical debridement, and prompt antifungal therapy are essential for improving survival. Disease extent remains the most important predictor of outcome.

Background: Electromagnetic radiations from smart phones alter and prolongs the conduction in auditory tract. Materials and Methods: Age between 18-30 years, Group 1, N=50 people had electromagnetic radiations exposure for 1-5 years and exposed more than 3 hours per day. Group 2, N=50 people had electromagnetic radiations exposure for greater than 5 years and exposed more than 3 hours per day. Headache, tinnitus, anti-psychotic, anti-depressant drugs, smokers were excluded. Brainstem evoked response audiometry (BERA) was done. Online GraphPad calculator using Student unpaired t test data was analysed. It was a case control study. Results: BERA parameters like waves III, V, interpeak latencies at 90 dB and 2 KHz in Group 2 were prolonged in comparison to Group 1. Conclusion: Brain stem evoked response audiometry (BERA) records subclinical hearing loss in smart phone users at 2 KHz and 90dB.

Background: Cervical ribs are rare congenital anomalies that may be asymptomatic or associated with neurovascular complications due to compression of the thoracic outlet. This study evaluates the incidence, morphological types, and clinical relevance of cervical ribs identified incidentally in chest radiographs. Materials and Methods: A retrospective observational study was conducted using 1000 chest radiographs collected from the Department of Radiology, Osmania Medical College, and Hyderabad. Radiographs from both sexes aged 12–80 years were reviewed for the presence and morphology of cervical ribs. Cases with rib fractures, incorrect positioning, or associated anomalies were excluded. Results: Cervical ribs were detected in 15 (1.5%) radiographs. The incidence was higher in females (2.5%) compared to males (0.92%). Bilateral cervical ribs were observed exclusively in females. Most cervical ribs were unilateral and located on the right side. Several patients presented with upper limb neurological symptoms suggestive of thoracic outlet syndrome (TOS), while others were asymptomatic. Conclusion: Cervical ribs, though often incidental, may be clinically significant when symptomatic, particularly in the presence of neurovascular compression. Recognition of cervical ribs in routine imaging is crucial for appropriate management of patients with thoracic outlet symptoms.

Background: Self-ear cleaning is a common but unnecessary practice that can interfere with the ear’s natural self-cleansing mechanism. Cerumen plays a protective role within the external auditory canal, but many patients routinely insert foreign objects into the ear without properly understanding the risks. This study aimed to assess the prevalence and attitudes toward self-ear cleaning among patients attending an out-patient department in Bardhaman, West Bengal. Methods: A cross-sectional observational study was conducted over eight weeks among patients attending the ENT OPD run by the researcher in Bardhaman, West Bengal. Convenience sampling was used. Critically ill patients, those requiring urgent hospitalisation, and those presenting with other ear problems were excluded. The calculated sample size was 62. Data were collected using a predesigned, pretested semi-structured proforma and analysed using SPSS. Categorical variables were expressed as frequencies and percentages. Fisher’s exact test or Chi-square test was applied, with p<0.05 considered statistically significant. Results: Among 62 participants, 61.3% were below 30 years; 71.0% were female and 71.0% Hindu. Urban residents constituted 53.2%, and 61.3% were married. Among 54 patients who practiced self-ear cleaning, 35 reported cleaning their ears at least once per week. Significant associations were found between frequent cleaning and perception (p=0.044), earache (p=0.041), itching (p<0.001), fullness (p<0.001), part cleaned (p<0.001), and perceived result (p<0.001). Cotton bud use was most common among study participants. Overall, 87% practiced self-ear cleaning. Conclusion: Self-ear cleaning remains highly prevalent among adults and is associated with symptoms. Public health education should be strengthened to discourage unsafe practices.

Background: Testicular tenderness is a common but clinically important presentation, ranging from inflammatory conditions to surgical emergencies such as testicular torsion. Early diagnosis and appropriate management are essential to prevent complications including infertility, abscess formation, and testicular loss. This study evaluated the clinical profile, etiologies, and management outcomes of patients presenting with tender testis at a tertiary care hospital.
Methods: A prospective observational study was conducted at a tertiary care hospital from September 2023 to September 2024. Fifty male patients with testicular pain and tenderness underwent clinical evaluation, laboratory investigations, and scrotal Doppler ultrasonography. Management was individualized based on diagnosis. Data were analyzed using SPSS version 26.0 with Chi-square testing. Results: Most patients (56%) were aged ≤40 years, with right-sided involvement in 58%. Elevated white blood cell counts (>10,000 cells/mm³) and raised CRP levels (>10 mg/L) were observed in 82% and 74% of cases, respectively. Epididymoorchitis was the most common diagnosis (62%), followed by testicular torsion (14%) and varicocele (8%). Medical management was sufficient in 72% of patients, while 28% required surgical intervention. Significant associations were found between diagnosis and management (p < 0.001) and between diagnosis and hospitalization (p = 0.009). Conclusion: Epididymoorchitis is the leading cause of tender testis and is primarily managed conservatively, whereas torsion and abscesses require urgent surgical intervention. Early clinical assessment supported by Doppler imaging is crucial for accurate diagnosis and improved outcomes.

Background: As neuromuscular dysfunction is associated with hypothyroidism, the nerve conduction parameters are expected to be altered in these patients. Early electrophysiological diagnosis of neuropathy can help clinicians to determine the extent of disease and the course of the treatment. A very few similar studies have been done in eastern India. Materials & Methods: History regarding the duration of the disease, clinical and neurological complaints, and the use of medicines and the level of control of hypothyroidism were recorded on the history record sheet. After history taking, a general clinical examination was done. Then, a neurological examination was conducted with special attention. Neuro-MEP-Micro (version 2009) Machine and its accessories (Manufactured by Neurosoft Medical Diagnostics Limited, Ivanova, Russia). Electrophysiological parameters like nerve conduction study parameters (latency, amplitude, conduction velocity of bilateral median and ulnar motor nerves and median and ulnar sensory nerves) were recorded. Biochemical parameters like T3, T4, and TSH values were recorded from patients’ test reports and from Endocrinology OPD prescriptions. Results: The study showed that the mean (±SD) of distal motor latency (DML) of bilateral median motor nerves was significantly increased in cases than that of the control. Mean (±SD) of compound Muscle Action Potential of bilateral median motor nerves was significantly decreased in cases than that of the control. It shows the mean (±SD) of Distal Motor Latency (DML) of bilateral ulnar motor nerves was significantly increased in cases than that of the control. Mean (±SD) of compound muscle action potential of both ulnar motor nerves was significantly decreased in cases than that of the control. MNCV of both-sided median nerves and the ulnar nerves showed a significant decrease in their means as compared to the control. Similarly Distal sensory latency (DSL) of the bilateral median and the Ulnar sensory nerves was significantly increased in cases than in controls. There was a significant decrease in bilateral median and ulnar sensory nerve action potential amplitude (SNAP) in the cases compared to the controls.  SNCV of bilateral median and ulnar sensory nerves were significantly reduced in cases as compared to controls. Similarly, the left median SNCV of the cases were significantly (p value < 0.05) less than that of the controls. Conclusion: The motor and sensory amplitudes of both-sided median and ulnar nerves were significantly decreased in cases compared to the control. The motor conduction velocity of both-sided median and ulnar nerves and the sensory conduction velocity of the median and ulnar nerves were significantly decreased in cases as compared to controls. There is no significant correlation between nerve conduction study parameters and the duration of the disease in hypothyroid patients.

Background: Liver cirrhosis is a major cause of morbidity and mortality and often presents late with life-threatening complications. Data on the current etiological pattern and clinical profile of cirrhosis from tertiary care centers in India remain limited. Aim: To evaluate the etiology, clinical profile, complications, severity, and in-hospital outcomes of patients with liver cirrhosis. Materials and Methods: This hospital-based cross-sectional study included 200 adult patients with cirrhosis diagnosed on clinical and ultrasonographic criteria. Clinical features, laboratory parameters, ultrasonography, and upper gastrointestinal endoscopy findings were recorded. Disease severity was assessed using the Child–Turcotte–Pugh score. Results: The majority were males (72.5%), with alcohol being the most common etiology (61%). Ascites (66%) and gastroesophageal varices (43%) were the most frequent complications. Most patients presented with advanced disease, with 54% in Child-Pugh Class C. The in-hospital mortality rate was 18%. Conclusion: Alcohol remains the leading cause of cirrhosis, with most patients presenting in advanced stages and experiencing significant complications. Early diagnosis and preventive strategies are essential to improve outcomes.

Background: Community acquired pneumonia (CAP) is a major cause of morbidity and mortality globally, particularly affecting individuals with comorbidities. Understanding the clinical presentation, radiological features, and bacteriological profile is essential for appropriate management and reducing mortality. Our aim is to evaluate the clinical, radiological, and bacteriological characteristics of patients admitted with community acquired pneumonia and to identify the prevalent causative microorganisms. Methods: A cross-sectional study was conducted over one year involving 50 patients admitted with CAP at Government Dharmapuri Medical College Hospital. Patients aged above 12 years with clinical and radiological evidence of pneumonia were included. Detailed clinical evaluation, sputum culture, blood culture, chest radiography, and CT chest were performed. Results: The study comprised 74% males and 26% females, with 62% of patients aged above 50 years. Streptococcus pneumoniae was the most common pathogen (56%), followed by Klebsiella (14%) and Staphylococcus (10%). Gram-positive organisms predominated (66%) over gram-negative organisms (22%). Common risk factors included smoking (56%), COPD (50%), diabetes mellitus (42%), and alcoholism (44%). Right lower lobe involvement was most frequent (32%). Hospital stay averaged 6-8 days, with 94% discharge rate and 6% mortality. Conclusion: Streptococcus pneumoniae remains the predominant pathogen causing CAP in our region. Advanced age, smoking, COPD, and diabetes mellitus are significant risk factors. Early identification and appropriate empirical therapy can improve outcomes.

Background: Intra-articular distal radius fractures are common injuries causing significant morbidity and impaired wrist function. Treatment options include external fixation and volar locking plate fixation. While plating allows anatomical reduction and early mobilization, controversy remains regarding optimal management. Our study compares functional and radiological outcomes of both methods to guide evidence-based surgical decision-making, particularly in resource-limited settings like India. Material and Methods: This prospective randomized study was conducted at a tertiary care hospital in Mumbai, India, over one year, 60 patients with closed intra-articular distal radius fractures (AO types B and C) were enrolled after obtaining informed consent. Patients were randomly allocated to two groups: Group A (n=30) underwent external fixation with closed reduction and K-wire supplementation if needed, while Group B (n=30) received volar locking plate fixation via the modified Henry’s approach. Exclusion criteria included open fractures, bilateral injuries, and comorbidities affecting healing. Ethical approval was granted by the institutional review board. Follow-up assessments occurred at 3, 6, and 12 months postoperatively, evaluating functional outcomes using DASH and MAYO scores, range of motion with a goniometer, grip strength via dynamometer, and radiological parameters (volar tilt, radial height, ulnar variance) on X-rays. Data analysis employed SPSS software, with Student’s t-test for continuous variables and chi-square for categorical data; p<0.05 was considered significant. Results: Demographic profiles were comparable between groups (mean age 52.4±11.2 years; 62% male). Group B showed superior DASH scores at 6 months (12.4±4.1 vs. 18.7±5.3, p=0.002) and MAYO scores (82.6±7.2 vs. 76.1±8.4, p=0.01). Range of motion was better in plating for flexion (68° vs. 58°, p=0.003) and extension (70° vs. 60°, p=0.004), but grip strength was similar (p=0.12). Radiologically, volar tilt restoration was enhanced in Group B (10.2° vs. 7.8°, p=0.02), with no difference in radial height (p=0.15). Complications included pin-site infections in 20% of Group A and superficial wound issues in 10% of Group B. Conclusion: Volar plating demonstrates advantages in functional recovery and anatomical alignment over external fixation for intra-articular distal radius fractures, though both yield acceptable outcomes. This supports plating as a preferred option where facilities allow, potentially reducing long-term disability.

Background: Intra-articular distal humerus fractures classified as AO/OTA type 13-C represent complex injuries that pose significant challenges to orthopedic surgeons due to articular comminution, metaphyseal instability, and a high propensity for postoperative elbow stiffness. Achieving anatomical reduction of the joint surface and stable bicolumnar fixation is essential to permit early mobilization and restore functional elbow motion. Orthogonal (90–90) bicolumnar plating has been widely adopted as a fixation strategy to address these biomechanical demands; however, functional outcomes and complication profiles continue to be evaluated, particularly in relation to fracture complexity. Aim: To evaluate the functional outcome, radiological union, and complications associated with orthogonal bicolumnar plating in AO/OTA 13-C intra-articular distal humerus fractures. Materials and Methods: This prospective observational study included 25 adult patients with AO/OTA 13-C distal humerus fractures treated by open reduction and internal fixation using orthogonal bicolumnar plating. Patients with pathological fractures, associated vascular injuries, or prior elbow pathology were excluded. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiological union was evaluated on serial radiographs. Complications were documented systematically. Results: The majority of patients were males (64.00%) and sustained injuries due to high-energy trauma, predominantly road traffic accidents (60.00%). Fracture subtypes 13-C2 and 13-C3 were most common (36.00% each). Radiological union was achieved in 96.00% of cases, with no nonunion or implant failure. Based on MEPS, 48.00% of patients achieved excellent outcomes and 32.00% achieved good outcomes, yielding an overall excellent-to-good rate of 80.00%. Increasing fracture complexity was significantly associated with poorer functional outcomes (p = 0.031). The mean MEPS was 85.20 ± 10.45, and the mean DASH score was 18.40 ± 7.90, with a strong negative correlation between the two (r = −0.72; p < 0.001). Elbow stiffness was the most common complication (16.00%). Conclusion: Orthogonal bicolumnar plating is an effective and reliable method for managing AO/OTA 13-C distal humerus fractures, providing high union rates and favorable functional outcomes. Despite increased fracture complexity being associated with reduced function, acceptable complication rates and satisfactory recovery can be achieved with meticulous surgical technique and early rehabilitation.

Background: Vitamin D has emerged as an important neurosteroid with anti-inflammatory, vasoprotective, and neuroprotective effects. Increasing evidence suggests that vitamin D deficiency may influence both the risk and outcome of acute stroke, but data from Indian populations remain limited. Aim: To evaluate the association between serum vitamin D levels and stroke severity, functional outcome, and vascular risk factors in patients with acute stroke. Methods: This prospective observational study included 132 patients with acute stroke (ischemic or haemorrhagic) admitted within 72 hours of symptom onset. Serum 25-hydroxyvitamin D [25(OH) D] levels were measured within 24 hours of admission and categorized as deficient (<20 ng/mL), insufficient (20–30 ng/mL), or sufficient (>30 ng/mL). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcome at discharge was evaluated using the Modified Rankin Scale (mRS). Associations between vitamin D status, stroke severity, outcomes, and vascular risk factors were analysed using ANOVA and Chi-square tests. Results: Among the 132 patients, 57.6% were vitamin D deficient, 28.8% insufficient, and only 13.6% had sufficient levels. Mean NIHSS scores were significantly higher in vitamin D–deficient patients (16.8 ± 4.3) compared to insufficient (12.4 ± 3.6) and sufficient groups (8.9 ± 2.8) (p < 0.001). Poor functional outcome (mRS >2) was observed in 76.3% of deficient patients compared with 52.6% of insufficient and 27.8% of sufficient patients (p < 0.001). Vitamin D deficiency was also significantly associated with higher prevalence of hypertension, diabetes mellitus, and dyslipidaemia (p < 0.05). Conclusion: Vitamin D deficiency is highly prevalent among patients with acute stroke and is strongly associated with greater stroke severity and poorer functional outcomes. Low serum 25(OH) D levels are also linked to a higher burden of vascular risk factors. Routine screening and correction of vitamin D deficiency may represent a simple and cost-effective strategy to improve stroke prognosis.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder known to cause microvascular and neuropathic complications. Its effect on the auditory system has gained increasing attention, with studies suggesting that prolonged hyperglycaemia may lead to both sensorineural and conductive hearing loss. Aim: To evaluate the effect of diabetes mellitus on sensorineural and conductive hearing loss and to assess the association between duration of diabetes and degree of hearing impairment. Materials and Methods: A hospital-based comparative cross-sectional study was conducted on 100 individuals, including 50 patients with diabetes mellitus and 50 age-matched non-diabetic controls. All participants underwent pure tone audiometry and otoscopic examination. Hearing thresholds were measured at frequencies from 250 Hz to 8000 Hz. Data were analysed using statistical software and compared between groups. Results: Hearing loss was detected in 62% of diabetic patients compared to 18% in the control group (p < 0.001). Sensorineural hearing loss (SNHL) was the most common type (48%), followed by mixed hearing loss (10%) and conductive hearing loss (4%). A significant correlation was found between the duration of diabetes and severity of hearing loss. Conclusion: Diabetes mellitus significantly affects auditory function, predominantly causing sensorineural hearing loss. Early screening of hearing in diabetic patients is recommended to prevent progression and improve quality of life.

Gastric xanthoma is an uncommon non-neoplastic lesion of the stomach characterized by the accumulation of lipid-laden foamy macrophages within the lamina propria. It is usually detected incidentally during endoscopy and maybe associated with chronic gastritis, Helicobacter pylori infection, intestinal metaplasia, or previous mucosal injury. This study highlights three cases of gastric xanthoma in adults diagnosed on histopathological examination, emphasizing on their clinicopathological features and diagnostic significance.

Background: Fetal growth restriction (FGR) affects 5-10% of pregnancies and remains a leading cause of perinatal morbidity and mortality. The optimal delivery mode for FGR pregnancies remains controversial with conflicting evidence regarding the safety of trial of labor versus elective cesarean delivery. Objective: To prospectively compare neonatal outcomes between elective cesarean, successful vaginal delivery, and emergency cesarean sections in FGR pregnancies delivering at or beyond 34 weeks of gestation. Methods: This prospective cohort study enrolled 90 singleton pregnancies with FGR diagnosed by Delphi consensus criteria, delivering at ≥34 weeks between January 2025 and June 2025. Patients were categorized by delivery mode: elective cesarean section, successful vaginal delivery, or emergency cesarean section. The primary outcome was a composite adverse neonatal outcome including NICU admission, respiratory distress syndrome, birth asphyxia, neonatal hypoglycemia, and low Apgar scores. Statistical analysis employed chi-square tests and multivariable logistic regression. Results: Of 90 patients, 30 underwent elective cesarean delivery, 28 had successful vaginal delivery, and 32 required emergency cesarean section. Emergency cesarean delivery was associated with 3.45-fold increased odds of adverse neonatal outcomes compared to elective cesarean (95% CI: 1.42-8.38, p=0.006). Successful vaginal delivery demonstrated comparable outcomes to elective cesarean (p=0.68). Non-reassuring fetal heart rate was the primary indication for emergency cesarean and associated with the highest adverse outcome rates. Conclusion: Emergency cesarean delivery in FGR pregnancies ≥34 weeks is associated with significantly increased neonatal morbidity. Successful vaginal delivery outcomes are comparable to elective cesarean when appropriately selected, suggesting that trial of labor may be reasonable for carefully selected FGR patients with close monitoring.

Introduction: Diaphyseal both bone forearm fractures in adults involve simultaneous fractures of the radius and ulna shafts, posing significant challenges due to the risk of malunion and impaired forearm rotation. Surgical fixation via plate osteosynthesis is widely regarded as the gold standard for restoring anatomical alignment and achieving stable fixation, thereby facilitating functional recovery. Given the increasing incidence of these fractures, particularly among active adult populations, evaluating functional outcomes using standardized tools such as the Disabilities of the Arm, Shoulder, and Hand (DASH) score is essential to assess surgical success beyond radiological healing. Objectives: The present study primarily aims to evaluate the functional outcomes of adult diaphyseal both bone forearm fractures treated with plate osteosynthesis using the DASH score. Secondary objectives include assessing fracture union rates and timing, postoperative complications, and the range of motion at the elbow and forearm joints to provide a comprehensive evaluation of clinical efficacy and safety. Methodology: A prospective cohort study was conducted at Karnataka Medical College and Research Institute, Hubballi, from June 2023 to November 2024. Twenty-five adult patients aged 18 to 60 years with diaphyseal fractures of both radius and ulna, including closed and Gustilo-Anderson type I and II open fractures, were consecutively recruited. Surgical management involved open reduction and internal fixation using 3.5 mm dynamic or locking compression plates. Functional outcomes were assessed using the DASH questionnaire at 1, 3, and 6 months postoperatively. Radiological union and range of motion were evaluated at scheduled follow-ups. Statistical analysis included paired t-tests and subgroup comparisons by age and sex, with significance set at p < 0.05. Results: All fractures achieved clinical and radiological union within six months, predominantly between 3 to 5 months, with no delayed or non-union cases. Postoperative complications were limited to superficial infections in 12% of patients, all resolved with conservative treatment. Functional range of motion was well preserved, with 96% of patients exhibiting less than 10° loss in elbow flexion-extension and less than 25° loss in forearm supination-pronation. DASH scores showed significant improvement over time, decreasing from a mean of 32.32 ± 4.51 at 1 month to 8.04 ± 5.17 at 6 months (p=0.0001). Outcome distribution was 56% excellent, 40% good, and 4% satisfactory. Higher DASH scores were observed in patients aged ≥40 years and females. Conclusion: The present study confirms that plate osteosynthesis is an effective and reliable surgical modality for adult diaphyseal both bone forearm fractures, yielding high union rates, minimal complications, and excellent functional recovery as evidenced by progressive improvements in DASH scores and preserved range of motion. These findings support its continued use as the preferred treatment approach, with attention to patient-specific factors influencing recovery.

Background: Febrile seizures are the most common neurological disorder in early childhood, affecting children between 6 months and 5 years of age. Nutritional deficiencies, particularly iron deficiency and Vitamin D deficiency, have been increasingly implicated in lowering seizure threshold and influencing seizure recurrence. Objectives: To evaluate the association of iron deficiency and serum Vitamin D levels with febrile seizures and to assess their correlation with seizure frequency among children. Materials and Methods: A hospital-based case–control study was conducted in the Department of Pediatrics, SCB Medical College & Hospital, Cuttack, from August 2022 to July 2024. A total of 180 children were enrolled, including 90 cases with febrile seizures and 90 age- and sex-matched febrile controls without seizures. Hematological parameters, serum ferritin, and serum 25-hydroxy Vitamin D levels were estimated and compared between the groups. Statistical analysis was performed using SPSS software. Results: Children with febrile seizures had significantly lower mean hemoglobin (10.40 ± 1.61 g/dL vs 11.76 ± 1.84 g/dL), mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, serum ferritin (66.35 ± 35.45 ng/mL vs 106.38 ± 38.89 ng/mL), and serum Vitamin D levels (23.39 ± 9.79 ng/mL vs 30.86 ± 13.41 ng/mL) compared to controls (p < 0.001). Iron deficiency anemia and low Vitamin D levels were significantly associated with increased frequency of febrile seizures. Conclusion: Iron deficiency and Vitamin D deficiency are significantly associated with febrile seizures and seizure frequency in children. Routine screening and correction of these deficiencies may help reduce the burden of febrile seizures.

Background: Taste disturbance after middle ear surgery is frequently under-recognized despite the vulnerability of the chorda tympani nerve (CTN), which is commonly stretched, displaced, or sacrificed during tympanoplasty, mastoid surgery, and stapes procedures. The magnitude, time course, and predictors of recovery remain clinically important for consent and technique selection. Methods: A prospective cohort study was conducted at a tertiary otology unit. Adults undergoing unilateral middle ear surgery (tympanoplasty ± mastoidectomy, stapedotomy/stapedectomy) were enrolled. Taste was measured preoperatively and postoperatively (day 7, month 1, month 3) using lateralized Taste Strips (score 0–16 per side) and electrogustometry (EGM; µA threshold) on the ipsilateral anterior tongue. Subjective dysgeusia and xerostomia were recorded using a 10-cm visual analogue scale (VAS). Mixed-effects modeling estimated change over time and predictors of persistent dysgeusia at 3 months. Results: Eighty-four participants were analyzed (mean age 34.7±11.2 years; 52.4% male). Mean ipsilateral Taste Strips score decreased from 12.8±2.1 preoperatively to 9.1±2.8 at day 7 (adjusted mean difference −3.6; 95% CI −4.2 to −3.0; p<0.001), partially recovering by month 3 (11.6±2.3; difference vs baseline −1.2; p=0.004). EGM thresholds rose significantly at day 7 (median +10 µA; p<0.001) and improved by month 3 (median +3 µA; p=0.03). Persistent dysgeusia at month 3 occurred in 14.3% and was independently associated with intraoperative CTN stretching/prolonged manipulation (adjusted OR 3.9; 95% CI 1.2–12.5) and mastoidectomy with extensive annular elevation (adjusted OR 3.4; 95% CI 1.0–11.1). Conclusion: Middle ear surgery produced a measurable, predominantly transient decline in ipsilateral taste function, with clinically meaningful symptoms persisting in a minority at 3 months. Preoperative counseling should routinely include taste risk, and operative strategies minimizing CTN traction may reduce longer-term dysgeusia.

Background: The INSURE technique (Intubate, Surfactant, Extubate) is a widely accepted method for administering surfactant in preterm neonates with respiratory distress syndrome (RDS) to minimize ventilator-induced lung injury. However, INSURE failure rates remain a concern. Objective: To compare the effectiveness and clinical outcomes of the standard INSURE technique (immediate extubation) versus a modified approach involving 1 hour of mechanical ventilation (MV) post-surfactant administration prior to extubation. Methods: This was a Retrospective observational study conducted at a tertiary care Neonatal Intensive Care Unit (NICU). Preterm neonates (<34 weeks gestation) diagnosed with RDS requiring surfactant was divided into two groups: Group A received standard INSURE (extubation to CPAP within 15 minutes), and Group B received INSURE with 1 hour of synchronized mechanical ventilation before extubation. The primary outcome was the need for re-intubation within 72 hours (INSURE failure). Secondary outcomes included incidence of bronchopulmonary dysplasia (BPD), pneumothorax, and duration of hospital stay. Results: A total of N=100 neonates were included (Group A: n=50, Group B: n=50). The incidence of INSURE failure was significantly lower in Group B compared to Group A (12 % vs. 28 %, p < 0.05). Group B showed improved oxygenation indices at 2 hours post-extubation. There was no significant difference in the incidence of BPD or Intraventricular Hemorrhage (IVH) between the two groups. Conclusion: Maintaining neonates on mechanical ventilation for 1 hour post-surfactant administration appears to reduce the rate of INSURE failure and immediate re-intubation compared to immediate extubation, potentially due to better alveolar recruitment and surfactant distribution.

Oral viva examinations remain integral to medical education, though concerns about inconsistency and examiner bias persist. The traditional viva (TV) permits deeper inquiry but often compromises fairness and standardization. The structured viva (SV), with predetermined questions and marking schemes, aims to enhance objectivity and syllabus coverage. This study compared these two formats in undergraduate physiology, assessing student performance, perceptions, and examiner feedback. This observational study was conducted among 100 first-year MBBS students, each undergoing both TV and SV. The SV comprised four stations – case scenario, instrument, graph, and laboratory report – each three minutes and five marks, assessed by four examiners. Viva scores were compared, and correlations with theory, practical, and combined marks were analyzed. Questionnaires captured perceptions regarding stress, fairness, and coverage from both students and examiners. There was no significant difference in mean scores between TV and SV. However, SV scores correlated more strongly with theory and combined theory–practical marks, while correlations with practical marks were similar across both formats. The majority of students preferred SV, citing greater fairness, transparency, and reduced anxiety, though some valued the flexibility of TV. Examiners highlighted SV’s strengths in standardization and coverage but noted increased preparation demands and reduced opportunity for probing. In summary, while TV and SV produced comparable scores, SV demonstrated stronger validity by aligning more closely with overall performance. Incorporating SV, with measures to enhance its flexibility, may help optimize viva examinations by balancing reliability with educational value.

Introduction: The sural nerve is a superficial sensory nerve of the lower limb with significant anatomical variability in its formation, course, and distribution. Knowledge of these variations is essential for nerve graft harvesting, regional anesthesia, and surgical procedures involving the leg, ankle, and foot. Objectives: To study the variations in the formation pattern of the sural nerve on the posterolateral aspect of leg in adult cadavers from Western Rajasthan. Methods: A cross-sectional observational cadaveric study was conducted on 20 adult human cadavers (40 lower limbs) in the Department of Anatomy, Government Medical College, Pali (Rajasthan), over a period of one year after ethical approval. Standard dissection techniques were employed to identify the medial sural cutaneous nerve, peroneal communicating nerve, and sural nerve. The formation pattern (Type A, B, C), site of union, course, length, and distribution on the dorsum of the foot were recorded. Data were analyzed using SPSS version 24.0.0 (Trial version) with a 95% confidence level, and p-value <0.05 was considered statistically significant. Results: Type A formation (union of medial sural cutaneous nerve and peroneal communicating nerve) was most common (70%), followed by Type B (25%) and Type C (5%). The sural nerve was most frequently formed in the lower one-third of the leg (50%), followed by the middle (35%) and upper one-third (15%). A normal anatomical course was observed in 90% of limbs, while 10% showed variations. Differences between right and left sides were not statistically significant. Variations in digital distribution and communication with the superficial peroneal nerve were also noted. Conclusion: The sural nerve exhibits considerable variability in its formation and distribution in the population of Western Rajasthan. Awareness of these variations is crucial for surgeons, anesthetists, and clinicians to minimize iatrogenic injury and optimize nerve grafting and regional anesthesia procedures.

Introduction: The femur is the longest and strongest bone of the human body and plays a vital role in weight transmission and locomotion. Morphometric analysis of the proximal end of the femur is essential for orthopedic implant design, fracture fixation, and forensic identification. Regional anatomical variations necessitate population-specific data. Objectives: To determine the mean morphometric parameters of the proximal end of dry adult femur in Western Rajasthan. Methods: A cross-sectional observational study was conducted on 50 dry adult human femora (25 right and 25 left) available in the Department of Anatomy, Government Medical College, Pali, after ethical approval from the Institutional Ethics Committee. Fully ossified and undamaged femora were included. Parameters measured were femoral head diameter, femoral neck diameter, femoral neck length, femoral neck thickness, foveal pit depth, foveal longitudinal diameter, foveal transverse diameter, neck–shaft angle, intertrochanteric line length, and total femoral length. Measurements were taken using digital vernier calipers, osteometric board, and goniometer. Data were analyzed using statistical package for social science (SPSS) software, version 24.0, IBM Inc. Chicago, USA. Results: The mean femoral head diameter was 42.48 ± 3.63 mm and femoral neck diameter was 32.94 ± 3.77 mm. femoral neck length measured 39.11 ± 6.64 mm and neck thickness was 32.15 ± 3.62 mm. The mean neck–shaft angle was 122.78 ± 10.81°. Intertrochanteric line length was 52.53 ± 6.02 mm, and total femoral length was 42.73 ± 2.73 cm. Conclusion: The present study provides baseline morphometric data of the proximal femur in the Western Rajasthan population. These findings are useful for orthopedic surgical planning, prosthesis design, anthropological studies, and forensic applications.

Introduction: The tibia is the second longest and a major weight-bearing bone of the human body, playing a crucial role in posture, locomotion, and joint stability. Morphometric analysis of the proximal and distal ends of the tibia is essential for orthopedic implant design, fracture fixation, reconstructive surgery, and forensic identification. Regional anatomical variations necessitate population-specific data. Objectives: To measure morphometric parameters of the proximal and distal ends of dry adult tibia in Western Rajasthan and to analyze their correlation with total tibial length and side differences. Methods: A cross-sectional observational study was conducted on dry adult tibia bones available in the Department of Anatomy, Government Medical College, Pali, over one year after ethical approval. Fully ossified, undamaged tibia bones of both sides were included. Parameters measured included proximal tibial mediolateral width, proximal tibial anteroposterior diameter, distal tibial mediolateral width, distal tibial anteroposterior diameter, and total tibial length. Measurements were taken using digital vernier calipers, osteometric board, and measuring tape. Data were analyzed using SPSS version 24.0. Mean ± SD was calculated. P value p < 0.05 was considered significant. Results: A total of 50 dry adult tibiae (26 right, 24 left) were included in the study. The mean total tibial length (TTL) was 37.92 ± 1.58 cm. The proximal tibial mediolateral width (PTML) had a mean of 72.8 ± 6.3 mm, and the proximal tibial anteroposterior diameter (PTAP) had a mean of 49.5 ± 5.2 mm. The distal tibial mediolateral width (DTML) averaged 28.1 ± 2.3 mm, and the distal tibial anteroposterior diameter (DTAP) was 34.8 ± 2.6 mm. Significant sex-based differences were found in all tibial parameters, with males showing larger dimensions compared to females (p < 0.001 for PTML and TTL). No significant differences were observed between the left and right tibiae, indicating bilateral symmetry in the tibial measurements. Conclusion: The tibia exhibits measurable morphometric variations in the Western Rajasthan population. These findings provide valuable baseline data for orthopedic implant design, surgical planning, anthropological assessment, forensic reconstruction, and stature estimation.

Introduction: The popliteal artery, a continuation of the femoral artery, is the primary blood supply to the leg and foot. Anatomical variations in its branching pattern, including trifurcation, high division, and differences in genicular and peroneal branches, are clinically significant for surgical interventions, vascular procedures, and diagnostic imaging. Population-specific data are essential to guide surgeons and radiologists in reducing intraoperative complications. Objectives: To study the prevalence of anatomical variations in the popliteal artery and its branching patterns in cadaveric lower limbs from the Western Rajasthan population. Methods: A cross-sectional observational study was conducted on on 25 lower limbs (14 male, 11 female) at the Department of Anatomy, Government Medical College, Pali, Rajasthan, after ethical approval from institutional ethical committee. Standard dissection protocols were used to expose the popliteal artery, documenting its origin, termination, branching patterns, and variations in genicular and peroneal arteries. Data were recorded and analyzed for prevalence and pattern of variations. Results: Among the 25 lower limbs studied, variations in the popliteal artery were observed in approximately 32% of cases. Trifurcation patterns were noted in 12% of limbs, while high division of the artery was seen in 4%. Variations in genicular branches were observed in 16% of limbs. Male and female limbs showed comparable variation patterns, with no significant side predominance. These variations highlight the need for careful preoperative planning in vascular, orthopedic, and reconstructive procedures. Conclusion: The popliteal artery in the Western Rajasthan population exhibits notable anatomical variations in its branching and termination patterns. Knowledge of these variations is crucial for surgeons, radiologists, and anatomists to enhance diagnostic accuracy, reduce surgical complications, and improve clinical outcomes.

Background: Post-Appendicectomy abdominal pain in right iliac fossa can be due to multiple causes including adhesive intestinal obstruction and Stump appendicitis. The predisposing factors include perforated appendicitis, a previous incomplete Appendicectomy with subsequent infection and inflammation of the appendicular stump. Methods: A retrospective review of the medical records of the children admitted with post- Appendicectomy abdominal pain and operated for causes including intestinal obstruction stump appendicitis at our institution between January 2016 and December 2022 was performed. Results: A total of 28 patients were admitted with post-Appendicectomy abdominal pain and 14 patients underwent surgery. Five patients underwent surgery for stump appendicitis and nine children underwent surgery for adhesive intestinal obstruction. The remaining 14 patients were managed conservatively. All the patients underwent a preoperative CT abdomen. Out of the five patients operated for stump appendicitis, four of them had previous laparoscopic Appendicectomy and one child had undergone open surgery. Conclusion: Post-Appendicectomy abdominal pain in children presents a diagnostic challenge. Postoperative adhesion causing intestinal obstruction and stump appendicitis are the most common indications for resurgery. CT abdomen is the investigation of choice. Prompt diagnosis and appropriate treatment are required to ensure prevention of complications due to delayed diagnosis.

Background: The incidence of Anterior Cruciate Ligament (ACL) ruptures is relatively common in athletes and often causes knee functional instability that has negative effects on sports performance. Arthroscopic ACL reconstruction has become a well-established treatment, and Hamstring Tendon (HT) graft and Bone–patellar Tendon–bone (BPTB) graft are the most frequently used autografts. However, the best choice of grafts in this sense in regard to functional results, knee stability, donor site morbidity and return to sports is still a matter of controversy. Materials and Methods: The present prospective comparative study was carried out in the Department of Orthopaedics, Nalanda Medical College and Hospital (NMCH) Patna, from December 2024 to December 2025. One hundred and twenty athletes with a clinical and MRI-documented diagnosis of ACL rupture were included. Patients were categorized into two groups: Group A (n = 60) underwent ACL reconstruction with HT graft, and Group B (n = 60) underwent reconstruction with the BPTB graft. Functional outcomes were measured with International Knee Documentation Committee (IKDC) and Lysholm scores, and knee stability was evaluated on the Lachman and pivot shift tests. Follow-up of patients occurred at 6 weeks, 3 months, 6 months and 12 months. Results: On final follow up, the average IKDC score was 88.4 ± 6.1 in Group A and 89.6 ±5.8 in Group B (p >0.05). The average Lysholm score was 91.2 ± 5.4 for the hamstring group and 92.8 ± 4.9 for the BPTB group. Eighty percent of the patients of group A and 86.7% of the patients of group B had negative Lachman test while there was significantly more anterior knee pain in BPTB group (30%) as compared to hamstring group (10%). The average time of return to sports was 7.4 ± 1.2 months in Group A and 8.6 ± 1.5 months in Group B. Conclusion: HT grafts and BPTB grafts offer excellent functional and stability outcomes after arthroscopic ACL reconstruction in athletes. Hamstring grafting is characterised by less donor site morbidity and earlier return to sports. BPTB grafts provide marginally better knee stability. The selection of the graft should be individualized for patients and by sport.

Background: Abdominal tuberculosis (TB) continues to be a global health concern. The principal forms of abdominal TB are intestinal, peritoneal and nodal. The clinical symptoms and signs of abdominal TB are non-specific and diagnosis is delayed when the patient presents with surgical complications. Aims & Objective: To study the various clinical presentations and surgical management options of abdominal tuberculosis. Material and Method: In this case series analysis, 50 consecutive patients with abdominal tuberculosis from a government tertiary care centre in Ahmedabad were included. In the study population, the mean age of presentation was 31 years with no gender predisposition. The patients were notably poorly nourished with an average BMI of 19.9 kg/sq m. Result: The presenting complaints in the patients were abdominal pain (100%), abdominal distension (76%) and features of subacute intestinal obstruction (72%). ESR was noted to be elevated in all patients with a mean of 54. Erect abdominal x-ray showed multiple air-fluid levels in 37(74%) and free air under the diaphragm in 6 (12%). CECT was the investigation of choice. 20 out of 50 underwent CECT with common findings being ascites (60%), lymph node enlargement (65%), and ileal stricture (25%). 20 patients (40%) were successfully managed conservatively, started on ATT and discharged with adequate weight gain at the end of six months. 30 patients (60%) required operative intervention in the form of adhesiolysis, resection of bowel segment with anastomosis or a diversion stoma. Postoperatively, three patients (6%) developed an anastomotic leak with an overall mortality of six patients (12%). Conclusion: Abdominal tuberculosis continues to be widely prevalent in our society. Management involves a judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation.

Background: The “acute abdomen” is a painful syndrome of sudden onset, caused by a wide variety of pathologic conditions that warrant emergency medical attention. Since many diseases can lead to similar clinical features as acute abdomen, imaging is often called upon to tackle the challenge and to establish the etiologic diagnosis or guide management planning. Main Aim of this study to establish the role of CT in diagnosis of etiology of acute abdominal pain and to quantify the degree to which CT and clinical findings correlate. Methods: 40 patients of suspected acute abdomen; established by clinical findings and subsequent course referred to department of Radio-diagnosis, Shree Narayan Medical Institute and Hospital, Saharsa, Bihar for CT scan during the period of January 2024 to December 2024, comprised the material for the present study which fulfilled the inclusion criteria and do not come under the ambit of exclusion criteria. The usual CT scan protocol comprised of contiguous 5mm transaxial sections from dome of diaphragm to pubic symphysis after administration of oral and intravenous contrast media. Serial CT sections of abdomen was obtained in each case using spiral CT scanner Siemens Somatom Emotions 16 slice. Results: The collective data was analysed for CT findings of non-traumatic group which presented clinically as acute abdomen. The total number of cases analysed was 40. Conclusion: Computed tomography is an important modality in the evaluation of acute abdomen for grading the severity of disease.

Background: The emergence of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae poses a serious therapeutic challenge globally. Accurate phenotypic detection is critical in resource-limited settings. Aim: To determine the prevalence of ESBL and carbapenemase-producing Enterobacteriaceae using phenotypic methods at a tertiary care hospital. Materials and Methods: A retrospective study was conducted at Jawaharlal Nehru Medical College, Bhagalpur, Bihar, from February 2025 to December 2025. Eighty non-duplicate Enterobacteriaceae isolates were included. ESBL detection was performed using the Combined Disc Diffusion Test (CDDT). Carbapenemase production was detected using Modified Hodge Test (MHT) and confirmed by Modified Carbapenem Inactivation Method (mCIM) as per CLSI 2024 guidelines. Statistical analysis was performed using Chi-square test. Results: Among 80 isolates, 38 (47.5%) were ESBL producers, and 18 (22.5%) were carbapenemase producers. Co-production was observed in 14 (17.5%) isolates. Carbapenemase production was significantly higher in ICU patients (40%) compared to non-ICU patients (12%) (χ²=5.61, p=0.018). Conclusion: A high prevalence of ESBL and carbapenemase producers underscores the importance of routine phenotypic screening and antimicrobial stewardship.

Background: Dermatological diseases constitute a major public health concern, particularly in rural populations where limited access to healthcare, poor hygiene, low socioeconomic status, and environmental factors contribute to increased disease burden. Despite their high prevalence, community-based data on the pattern of skin disorders in rural settings remain scarce. Objective: To determine the prevalence and pattern of dermatological diseases among rural populations attending multiple healthcare centres. Materials and Methods: This prospective cross-sectional multicentric study was conducted from January 2025 to August 2025 across selected rural healthcare centres. There were 105 patients with skin problems who were enrolled. A thorough clinical assessment was conducted, leading to diagnoses based on clinical observations and pertinent investigations. Descriptive statistics were used to look at the data. Results: Infectious dermatoses constituted the most common group, followed by eczematous disorders and pigmentary conditions. Fungal infections were the predominant infectious dermatoses. Most conditions were associated with poor hygiene, occupational exposure, and environmental factors. Conclusion: Dermatological diseases are highly prevalent in rural populations, with infections forming the majority. Strengthening primary dermatological care, improving hygiene awareness, and early diagnosis are essential to reduce disease burden.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain major public health concerns worldwide, particularly in developing countries where asymptomatic infections often go undetected. Hospital-based screening provides an opportunity to assess the burden of these infections in the general population. Objectives: To estimate the seroprevalence of hepatitis B and hepatitis C among hospital attendees and to study their distribution according to age and gender. Materials and Methods: This cross-sectional study was conducted over a period of one year (2024–2025) at Darbhanga Medical College and Hospital (DMCH), Bihar. A total of 1,000 hospital attendees were screened for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies using enzyme-linked immunosorbent assay (ELISA). Demographic details were recorded and statistical analysis was carried out using the chi-square test. Results: The overall seroprevalence of HBV and HCV was 3.6% and 1.8%, respectively. HBV infection was more common among males and in the 31–50-year age group. A statistically significant association was observed between HBV positivity and male gender (p< 0.05). Conclusion: The study demonstrates a moderate prevalence of hepatitis B and a lower prevalence of hepatitis C among hospital attendees. Routine screening and preventive strategies remain essential for early detection and control of viral hepatitis.

Background: Hypertension and diabetes mellitus frequently coexist, affecting millions worldwide. The choice of antihypertensive medication may influence glycemic control, making the metabolic effects of these agents clinically significant. Amlodipine, a widely prescribed dihydropyridine calcium channel blocker, has demonstrated potential glycemic benefits beyond its blood pressure-lowering effects. Objective: This study examines the impact of amlodipine therapy on glycemic parameters in hypertensive patients, including those with and without pre-existing diabetes mellitus. Methods: A comprehensive literature review was conducted analyzing recent clinical studies, randomized controlled trials, and observational research examining the relationship between amlodipine use and glycemic outcomes, including HbA1c levels, fasting plasma glucose, and incidence of new-onset diabetes. Results: Evidence demonstrates that amlodipine therapy is associated with improved glycemic control in hypertensive patients with diabetes, with reductions in HbA1c levels of 0.39% compared to standard diabetes therapy alone. Additionally, amlodipine significantly reduces the risk of new-onset diabetes by 34% compared to beta-blocker therapy. Calcium channel blockers, particularly amlodipine, show a neutral to beneficial effect on glucose metabolism, with average reductions in fasting serum glucose of 5-10 mg/dL. Conclusion: Amlodipine represents a favorable antihypertensive choice for patients with diabetes or those at risk for developing diabetes. Its neutral to beneficial effects on glycemic parameters, combined with effective blood pressure control, make it an optimal therapeutic option in the management of hypertensive patients with metabolic concerns.

Background: Dry eye disease is increasingly recognized as a common ocular complication in patients with Type-2 diabetes mellitus. Objective: To estimate the prevalence of dry eye in patients with Type-2 diabetes mellitus and to compare various diagnostic tests of dry eye. Methods: An analytical cross-sectional study was conducted on 120 patients (240 eyes) with Type-2 diabetes mellitus. Dry eye symptoms were assessed using Ocular Surface Disease Index (OSDI) questionnaire. Objective evaluation included fluorescein staining, Tear Film Break-Up Time (TBUT), and Schirmer’s test. Diagnostic accuracy, sensitivity, specificity, and Area under Curve were calculated. Results: Dry eye prevalence based on OSDI was 38.33%. TBUT detected dry eye in 34.17% of eyes with highest sensitivity (85.00%) and diagnostic accuracy (92.92%). Schirmer’s test detected 28.33% while fluorescein staining detected 20.83%. TBUT showed very good agreement (kappa 0.86) with OSDI compared to other tests. Conclusion: Dry eye is a common complication in Type-2 diabetes mellitus. TBUT demonstrated superior diagnostic performance and agreement with symptoms compared to Schirmer’s test and fluorescein staining. Routine ocular surface screening is recommended in diabetic patients.

Background: Stroke in young adults represents an emerging public health concern with distinct clinical and radiological characteristics compared to older populations. Objective: To identify the clinical presentation and radiological profile of patients presenting with stroke in young adults. Methods: A prospective observational study was conducted among 120 young stroke patients. Detailed clinical evaluation and CT-based radiological assessment were performed to determine stroke subtype and neurological manifestations. Results: Hemiparesis (55.0%) and facial nerve involvement (46.7%) were the most common clinical features. Infarcts were the predominant CT finding (65.0%), and ischemic stroke constituted 76.7% of cases. Decreased consciousness showed a significant association with hemorrhagic stroke, while seizures were observed in 20.0% of patients. Conclusion: Young stroke patients demonstrate a predominance of ischemic pathology with diverse clinical presentations, emphasizing the importance of combined clinical and radiological evaluation for early diagnosis and management.

Background: Rheumatoid arthritis is a chronic inflammatory disease characterized by persistent synovitis and progressive joint damage. Musculoskeletal ultrasound has emerged as a valuable imaging modality for detecting subclinical inflammation and guiding treatment decisions. Objective: To evaluate the role of musculoskeletal ultrasound in predicting treatment planning among patients with rheumatoid arthritis. Methods: A prospective observational study was conducted among 120 patients diagnosed with rheumatoid arthritis. Clinical assessment, laboratory investigations, and musculoskeletal ultrasound evaluation using GSUS and PDUS scoring systems were performed. Treatment decisions were documented based on combined clinical and imaging findings. Results: Active synovitis was detected in 68.3% of patients, and higher PDUS grades were significantly associated with treatment escalation. Ultrasound findings influenced therapeutic decisions including initiation, escalation, or tapering of therapy. Conclusion: Musculoskeletal ultrasound serves as an effective adjunct to clinical evaluation by identifying subclinical disease activity and supporting individualized treatment planning in rheumatoid arthritis patients.

Background: According to estimates, the lifetime prevalence of renal stones ranges from 1% to 15%. Renal calculi with symptoms present a major health risk to patients and raise global economic costs. The study’s objective is to measure the levels of serum ionized calcium and parathyroid hormone in patients who have kidney stones. Methods: Serum parathyroid hormone and serum ionized calcium levels were assessed in 50 patients with a diagnosis of renal stone who visited Government Medical College and Hospital in Bettiah, West Champaran, and Bihar. Results: Phosphate, salt, potassium, creatinine, and blood urea were all greater than normal, and two out of fifty patients had elevated serum parathyroid hormone and twelve had abnormal serum calcium levels. The majority of the urine parameters were consistent with earlier research showing their significant impact in the development of renal stones. Conclusion: Despite the fact that kidney stones have a complex etiology, metabolic variables do contribute significantly to their development in both first-time and recurring stone formers. To determine the precise pathophysiology, the amount of parathyroid hormone should be evaluated in conjunction with other metabolic parameters such as serum calcium, phosphate, uric acid, and others. In addition to detecting abnormalities, the assessment aids in therapy selection.

Background: Brainstem evoked response audiometry (BERA) is most specific and sensitive test for brain stem dysfunction. Aim of this study to evaluate role of Brainstem Evoked Response Audiomerty in assessment of patients of sensorineural hearing loss and to evaluate cases of sensorineural hearing loss to localize the exact size of damage: Cochler, rectocochler. Methods: This Observational –Cross Sectional study was done at Department of Otorhinolaryngology, ANMMCH, Gaya, and Bihar from June 2025 to November 2025. Well informed consent was taken from the patients. Each patient was subjected to ENT & Pediatric examination, whenever necessary prior to test. Patient was instructed to clean the scalp with shampoo & not to apply oil on the day of appointment. The test was started after after patient was sedated and well asleep. The first stimulus was given at 90 dBnHL level (maximum intensity available) a decreased by 10 dBnHL for next run if wave V is present. At each intensity, run efforts were made to identify wave V. Result: In this study threshold & latency measures were obtained from 50 cases (100 ears) by Brainstem Evoked Response Audiometry. No restrictions were imposed on age, sex, degree of hearing loss or audiometric configuration. The data was analyzed separately for pediatric age group (36 cases) and Adults (14 cases). Conclusion: BERA is the accurate & reliable estimation of hearing levels in infants and young children. It helps in early identification of hearing impairment and rehabilitative measures can be taken at an early age. In this study BERA was effective in identifying hearing loss thresholds & assessing auditory pathway in infants and children’s in whom behavioral methods and PTA evaluation is not possible and in children with significant prenatal history with risk of developing hearing loss.

Background: If not identified and treated promptly, organophosphorus poisoning is linked to a high death rate. Therefore, determining the importance of cholinesterase activity in determining the severity and forecasting the course of organophosphorus poisoning is the goal of the current investigation. Methods: The present study was carried out over the course of a year, from July 2024 to June 2025, at the Department of Forensic Medicine at Radha Devi Jageshwari Memorial Medical College and Hospital in Turki, Muzaffarpur, and Bihar. Following the application of inclusion and exclusion criteria, 160 patients in total were enrolled. For every study participant, the Peradeniya Organophosphorus Poisoning Scale was used. Result: Majority of patients were married (70%) and male (64%). About 42% of cases belong to the age group 21-30 years. About 1/3^rd of the cases had low socioeconomic status and about 1/3^rd cases were farmers by occupation. On applying Peradeniya Organophosphorus Poisoning (POP) Scale, about one third of patients had tachypnoea, followed by impaired consciousness (29%). Serum/ plasma cholinesterase level showed higher mortality in patients having suppressed cholinesterase activity (< 4000 IU/L). Conclusion: Organophosphorus poisoning diagnosed at early stages of poisoning determining pseudocholinesterase activity form a reliable diagnostic test for management and can serve as lives saving tool.

Background: Suicide is a widespread social problem in India. A significant percentage of all suicide deaths worldwide occur in India. Different populations and civilizations have different suicide rates and patterns. Therefore, our goal was to document suicide mortality trends over time as well as the relationships between different characteristics including gender, age of suicide victims, suicide pattern, etc. Method: Data for this retrospective analysis came from suicide cases that were reported between June 2023 and November 2025 to the Department of Forensic Medicine at Radha Devi Jageshwari Memorial Medical College and Hospital in Turki, Muzaffarpur, and Bihar. Result: Suicidal cases accounted for 15.76% (784) of the 4973 autopsies that were performed. Of the 784 suicidal cases, 254 (32.39%) were female and 530 (67.61%) were male. The majority of victims (38.5%) were in the 20–30 age range. Age group and suicide pattern were found to have a significant interaction effect. In both sex categories, hanging was the most frequent suicide pattern, followed by poisoning. Conclusion: Male preponderance (67.61%) in suicidal cases was found in this study, and the most involved age group was 21-30 years which is similar to findings found in different other countries.

Background: Trauma is the leading cause of death among people aged 1 to 45, causing greater loss of everyday activities than other well-known illnesses including cardiovascular disease and cancerous tumors. Finding the pattern and frequency of intra-abdominal injuries in patients with blunt abdominal trauma was the aim of this investigation. Methods: For six months, from July 2025 to December 2025, this observational study was carried out in the Department of Surgery at Government Medical College and Hospital in Bettiah, West Champaran, Bihar. The study comprised 50 cases of blunt abdominal injuries in total. These patients, who were admitted to Emergency Department of GMCH were more than 12 years and of both sexes. Results: Nine (18%) of the 50 patients involved in the study were female, and 41 (82%), were male. 13 (26%) of the patients had splenic lesions, while 15 (30%) of the patients had liver impairment. The intestinal injury in eleven patients (22%) ranged from the anal canal to the stomach area. Two patients were observed to have damage in the duodenum and stomach, four patients in the large intestine, and five patients in the small intestine. Two (4%) of the patients involved pancreatic damage. Two (4%) patients had a perforated diaphragm, while three (6%) patients had a mesenteric tear. Five (10%) patients had a retroperitoneal hematoma. Three patients (6%) had renal damage, and injury to the bladder was observed in 2 patients. Conclusion: It is shown that the most frequently injured organs are those located inside the abdomen. The solid organs suffered more damage from the blunt abdominal trauma. The liver was the most frequently affected organ in our investigation of blunt abdominal trauma, followed by the intestine, spleen, and retroperitoneal hematoma.

Background: Surgical site infections (SSIs) factor in morbidity, mortality, and higher healthcare expenses. They are the third most prevalent nosocomial infection. Finding the isolates that cause surgical site infections, and their pattern of antimicrobial susceptibility is the primary goal of this investigation. Methods: For the study, a total of fifty surgical site infection cases were collected. Standard microbiological techniques were used to process the suspected samples. The antibiotic susceptibility pattern was determined using the modified Kirby-Bauer’s disc diffusion method. In accordance with Clinical and Laboratory Standards Institute (CLSI) recommendations, the isolates of the Enterobacteriaceae family were first screened for ESBL production before being further verified by the Double Disk Synergy Test. As controls, reference strains of Klebsiella 700603, P. aeruginosa (ATCC-27853), S. aureus (ATCC 25923), and E. coli (ATCC 25922) were employed. Result: Out of 50 samples, 19(38%) were culture positive and total 23 organisms were isolated. Pseudomonas aeruginosa 9 (39.13%) was the most common organism isolated, followed by Klebsiella spp. 5 (21.73%), Staphylococcus aureus 3 (13.04%). Most of the Gram-negative isolates were sensitive to imipenem and meropenem followed by piperacillin-tazobactam. Gram-positive organisms were found to be more sensitive to levofloxacin, linezolid and vancomycin. ESBL production was seen among 44.44% isolates of Enterobacteriaceae family. Conclusion: Infection rates have an impact on hospital treatment standards and patient care. Accurate antibiotic policies are therefore necessary for better SSI stewardship. It is advised that etiology and antibiotic susceptibility be routinely monitored in both hospital and community settings.

Background: Preoperative anemia is the widespread clinical issue in patients who have to undergo elective surgeries, and it is linked to the higher postoperative morbidity and mortality. The intensity of anemia can have an impact on blood transfusion and postoperative healing. Purpose: This study aims to evaluate the perioperative blood transfusion and postoperative outcomes of surgical patients in retrospect to assess the severity of preoperative anemia and its relationship with preoperative anemia. Methods: The proposed study is a retrospective observational study by nature, which takes place in a tertiary care teaching hospital during one year (January 2024 to December 2024). One hundred adult patients who had an elective major surgery were selected. The preoperative hemoglobin levels were categorized in line with the criteria set by the world health organization in mild, moderate and severe anemia. There were data on perioperative transfusion, postoperative complications, intensive care unit (ICU) admission, and length of hospital stay that were collected and analyzed through SPSS software. The statistical significance was determined to be p < 0.05. Findings: Out of 100 patients, 48 percent were identified to be preoperative anaemic. 22% of patients had mild anemia, 18% had moderate anemia and 8% had severe anemia. The proportion of the total population that needed perioperative blood transfusion was 33, and there was a progressive growth in the percentage of transfusion with severity of anemia. Complications occurring after surgery were prevalent in anemic patients than non-anemic people. Mean hospital stay among the patients with moderate and severe anemia was significantly different. Conclusion: The severity of the preoperative anemia increases greatly with the transfusion requirements, postoperative complications, and prolongs the hospital stay. The preoperative screening and optimization of anemia before elective surgery have the potential to resolve the perioperative results and lower the healthcare costs.

Background: Type 2 diabetes mellitus (T2DM) is increasingly linked to altered gut microbial ecology, which may influence insulin resistance through short-chain fatty acids (SCFAs), bile acid signaling, intestinal permeability, and low-grade inflammation. Aim: To evaluate gut microbial diversity, key taxa, and metabolic/inflammatory correlates among adults with T2DM compared with normoglycemic controls. Methods: Prospective case–control study conducted at Darbhanga Medical College & Hospital, Darbhanga, Bihar, India, from 05 February 2025 to 25 November 2025. Adults with T2DM and age-matched controls were enrolled. Stool samples underwent 16S rRNA sequencing; alpha diversity (Shannon, Chao1) and genus-level differential abundance were assessed. Stool SCFAs and plasma lipopolysaccharide-binding protein (LBP) were measured. Multivariable logistic regression examined associations between microbial features and T2DM after adjusting for clinical covariates and medication exposure. Results: T2DM participants showed significantly lower Shannon diversity and butyrate levels and higher Escherichia/Shigella abundance versus controls (all p<0.05). In adjusted models, Shannon diversity and Faecalibacterium abundance were inversely associated with T2DM, while Escherichia/Shigella was positively associated. Conclusion: Gut dysbiosis characterized by reduced diversity and depletion of butyrate-producing taxa is associated with T2DM and metabolic endotoxemia markers. These findings support microbiota-informed preventive and therapeutic strategies, pending validation in longitudinal and interventional studies.

Background: Infantile diarrhoea remains a leading cause of morbidity in developing countries. Probiotics such as Saccharomyces boulardii have demonstrated therapeutic potential in reducing duration and severity of diarrhoeal illness. However, region-specific clinical and microbiological characterization studies remain limited. Aim: To characterize the probiotic properties of Saccharomyces boulardii and evaluate its clinical efficacy in the management of infantile diarrhoea. Methods: A prospective interventional study was conducted involving 160 infants aged 6–24 months diagnosed with acute diarrhoea. Participants were randomized into two groups: standard therapy (ORS + zinc) and standard therapy plus S. boulardii (250 mg twice daily for 5 days). Probiotic characterization included acid tolerance, bile salt resistance, antimicrobial activity, and adhesion assay. Clinical parameters such as duration of diarrhoea, stool frequency, hospital stay, and recurrence rate were analyzed. Statistical evaluation was performed using Student’s t-test and chi-square test. Results: S. boulardii demonstrated high acid tolerance (87.3% survival at pH 2.0), bile resistance (82.1% at 0.3% bile salts), and significant antimicrobial activity against enteropathogens. The probiotic group showed a significant reduction in mean duration of diarrhoea (48.6 ± 12.4 hours vs 72.8 ± 16.1 hours, p<0.001), stool frequency, and hospital stay. Recurrence within 14 days was lower in the probiotic group (6.3% vs 18.8%, p=0.02). Conclusion: Saccharomyces boulardii is a potent probiotic with significant therapeutic benefit in infantile diarrhoea. Its inclusion as adjunct therapy may improve clinical outcomes in resource-limited settings.

Background: Pseudomonas aeruginosa is a leading cause of hospital-acquired infections (HAIs), particularly in intensive care settings. The emergence of Metallo-β-lactamase (MBL) producing strains has significantly limited therapeutic options and increased morbidity and mortality worldwide. Aim: To determine the prevalence of MBL-producing Pseudomonas aeruginosa among hospital-acquired isolates at Darbhanga Medical College & Hospital (DMCH), Darbhanga, Bihar, and to analyze antimicrobial resistance patterns and associated risk factors. Methods: A prospective cross-sectional study was conducted from 05th February 2025 to 25th November 2025at the Department of Microbiology, Darbhanga Medical College & Hospital, Bihar, India. Clinical samples from patients with hospital-acquired infections were processed as per standard microbiological procedures. Identification of P. aeruginosa was performed by conventional biochemical methods. Antimicrobial susceptibility testing (AST) was carried out using the Kirby–Bauer disc diffusion method according to CLSI guidelines. Carbapenem-resistant isolates were screened and phenotypically confirmed for MBL production using the Imipenem-EDTA combined disc test. Statistical analysis was performed using chi-square test with p <0.05 considered significant. Results: Out of 278 non-duplicate hospital-acquired isolates of P. aeruginosa, 82 (29.5%) were carbapenem resistant. Among them, 49 (17.6% overall; 59.8% of carbapenem-resistant isolates) were confirmed as MBL producers. Highest prevalence was observed in ICU (38.7%). MBL production showed significant association with prolonged hospitalization (>10 days), mechanical ventilation, and prior carbapenem exposure (p<0.05). MBL isolates demonstrated high resistance to ceftazidime (91.8%), piperacillin-tazobactam (87.7%), and ciprofloxacin (83.6%), while colistin and polymyxin B retained >95% susceptibility. Conclusion: The study highlights a concerning prevalence of MBL-producing P. aeruginosa in hospital settings of Bihar. Strict antimicrobial stewardship, early detection, and infection control strategies are urgently required to curb further dissemination.

Background: The human oral microbiome constitutes a complex ecological community essential for maintaining oral and systemic health. Long-term antibiotic exposure has been implicated in microbial dysbiosis, yet its impact on oral microbial diversity remains underexplored in Indian populations. Aim: To evaluate the impact of prolonged antibiotic usage (>3 months cumulative exposure) on the diversity, richness, and compositional structure of the human oral microbiome. Methods: A prospective observational study was conducted among 120 participants, divided into long-term antibiotic users (n=60) and age- and sex-matched controls (n=60). Salivary samples were collected and subjected to 16S rRNA gene sequencing (V3–V4 region). Alpha diversity (Shannon index, Simpson index, Chao1 richness), beta diversity (Bray–Curtis dissimilarity), and taxonomic abundance were analyzed. Statistical tests included Student’s t-test, Mann–Whitney U test, PERMANOVA, and multivariate regression modeling. Results: Long-term antibiotic users demonstrated significantly reduced alpha diversity (Shannon index 2.81±0.42 vs 3.56±0.38; p<0.001). There was a marked reduction in commensal genera such as Streptococcus, Veillonella, and Neisseria, and enrichment of opportunistic taxa including Candida and Enterococcus. Beta diversity analysis showed significant clustering differences (PERMANOVA p=0.002). Duration of antibiotic exposure correlated negatively with microbial richness (r=−0.62, p<0.001). Conclusion: Prolonged antibiotic exposure significantly reduces oral microbial diversity and promotes dysbiosis, potentially predisposing individuals to oral and systemic diseases. Judicious antibiotic stewardship is essential to preserve microbial ecological balance.

Background: Emerging and re-emerging infections increasingly present as acute undifferentiated febrile illness (AUFI) in South Asia, driven by climate variability, mobility, changing vectors, and zoonotic spillover. Aim: To describe the etiologic spectrum, seasonality, and clinical outcomes of suspected emerging infectious diseases (EIDs) presenting to DMCH, and to evaluate determinants of severe outcomes and management patterns. Methods: Hospital-based observational study (retrospective record abstraction with prospective follow-up where feasible). Consecutive AUFI/AES-suspect admissions were evaluated with syndrome-based diagnostics (NS1/IgM dengue, malaria smear/RDT, scrub typhus IgM, leptospira IgM, blood cultures, respiratory PCR where indicated). Primary outcome: severe disease (ICU admission and/or in-hospital death). Multivariable logistic regression assessed predictors of severe outcomes. Results: Of 612 eligible admissions, 487 (79.6%) had a confirmed/probable EID diagnosis. Most cases occurred during monsoon/post-monsoon (July–October). Leading etiologies were dengue (31.0%), scrub typhus (21.1%), malaria (14.6%), leptospirosis (9.2%), and influenza-like illness/viral ARI (8.4%). Severe disease occurred in 78/487 (16.0%); overall in-hospital mortality was 3.3%. Independent predictors of severe outcomes included age ≥60 years (aOR2.31), hypotension at presentation (aOR 3.12), thrombocytopenia <50,000/µL (aOR 2.08), and serum creatinine ≥2.0 mg/dL (aOR 2.67) (all p<0.05). Conclusion: The 2025 DMCH AUFI burden showed a vector-borne dominance with marked seasonality. Early syndrome-guided testing, timely doxycycline for scrub typhus, and sepsis-oriented bundled management were associated with improved stabilization and low mortality. Findings support strengthening AUFI algorithms, diagnostics, and antimicrobial stewardship in North Bihar.

Background: Escherichia coli is a leading pathogen in both hospital and community settings and a well-recognized indicator organism in environmental surveillance. The emergence of multidrug-resistant (MDR) strains in clinical as well as environmental reservoirs poses a serious public health challenge. Aim: To compare the antibiotic susceptibility patterns of clinical and environmental E. coli isolates and to evaluate the prevalence of multidrug resistance between the two groups. Methods: A cross-sectional comparative study was conducted at Darbhanga Medical College & Hospital from February 2025 to November 2025. A total of 100 E. coli isolates were included (50 clinical isolates from patients and 50 environmental isolates from water and hospital surroundings). Identification was done by standard microbiological techniques. Antibiotic susceptibility testing was performed using Kirby–Bauer disc diffusion method as per CLSI 2024 guidelines. Statistical analysis was performed using Chi-square test with p < 0.05 considered significant. Results: Clinical isolates showed significantly higher resistance to third-generation cephalosporins (68%), fluoroquinolones (72%), and aminoglycosides (46%) compared to environmental isolates (38%, 44%, and 22% respectively; p < 0.05). Carbapenem resistance was observed in 14% of clinical isolates and 4% of environmental isolates. MDR prevalence was significantly higher in clinical strains (58%) than environmental strains (28%) (p = 0.002). Conclusion: Clinical isolates demonstrated significantly higher multidrug resistance compared to environmental strains. However, emerging resistance in environmental isolates highlights the need for integrated antimicrobial stewardship and environmental surveillance strategies.

Background: Psychological distress among cancer patients, particularly anxiety and depression, adversely impacts treatment adherence and quality of life. Indian data on distress in radiotherapy recipients are scarce. Methods: A cross-sectional observational study enrolled 180 adults (≥18 years) receiving radiotherapy at JLN Medical College, Ajmer, from December 2023 to October 2025. Exclusion criteria included preexisting psychiatric disorders or cognitive impairment. Demographic and clinical data were recorded. The Hospital Anxiety and Depression Scale (HADS) screened for anxiety (HADS‐A) and depression (HADS‐D); scores ≥11 indicated clinically significant symptoms. Bivariate analysis assessed associations of distress with patient factors. Multivariable logistic regression identified independent predictors of anxiety and depression. Model discrimination was evaluated by area under the ROC curve (AUC). Results: Participants’ mean age was 55.2 ± 11.3 years; 58.9% were female. Most were married (83.3%) and had at least secondary education (56.7%). Head and neck (26.6%), breast (21.7%), and cervical (17.8%) cancers predominated; 38.3% were stage III. External beam radiotherapy was delivered to 84.4% with a mean of 19.8 ± 9.5 sessions. Clinically significant anxiety and depression prevalences were 68.9% and 65.0%, respectively. No significant gender or comorbidity differences were observed. Anxiety and depression scores were uncorrelated (r = 0.035; p = 0.645). Logistic regression revealed older age (OR 1.38 per SD; p = 0.020) and longer duration since diagnosis (OR 1.10 per SD; p = 0.045) as predictors of anxiety, and presence of comorbidity (OR 1.81; p = 0.046) as predictor of depression. The anxiety model showed acceptable discrimination (AUC = 0.707) but the depression model did not (AUC = 0.491). Conclusion: Anxiety and depression are highly prevalent in Indian radiotherapy patients. Routine HADS screening and integrated psycho‐oncology services are recommended, with special attention to older patients, those with longer disease duration, and comorbid conditions.

Objectives: The present study was to Compare the surgical outcome in tympanoplasty with and without cortical mastoidectomy in non cholesteatomatous chronic otitis media with subtotal perforation. Methods: The patients were randomized into 2 groups and each group comprised of 30 patients. The group I patients underwent tympanoplasty and group II patients underwent cortical mastoidectomy with tympanoplasty. Post operatively all the patients were followed up for a total of 6 months with regular intervals at 1st, 3rd and 6th month. Post operatively all the study patients were assessed for the status of the graft and the hearing improvement. Pure tone audiogram was done for all the patients at the end of 6 months to assess the level of hearing improvement. Results: Graft uptake rate of tympanoplasty (group I) and tympanoplasty with cortical mastoidectomy (Group II) was 42(84%) and 46(92%) respectively. Pre-operative and post-operative (after 6 months) audiological finding in both group cases was highly statistically significant(P<0.0001) differences. But, greater mean differences 7.9 dB was seen Tympanoplasty with cortical mastoidectomy (Group II) patients. While, mean differences of Tympanoplasty (Group I) was 6.6 dB. Conclusions: CSOM is commonly seen in younger age group population. Graft uptake rate is greater in tympanoplasty with cortical mastoidectomy as compared to tympanoplasty patients. There is statistically significant hearing improvement found in both group patients. But the greater hearing improvement is seen in tympanoplasty with cortical mastoidectomy as compared to tympanoplasty patients.

Background: In impoverished countries, thermal burns continue to pose a serious threat to public health because they are often linked to severe morbidity and high death rates, which are mostly caused by burn wound infection. Longer hospital stays, higher metabolic demands, and an expanded window for invasive bacterial colonization are common outcomes of the conventional conservative care approach, which depends on the eschar’s natural separation before grafting. In the treatment of deep partial-thickness and full-thickness burns, this study assesses the clinical effectiveness and safety of Early Excision and Grafting (EE&G) in comparison to the traditional delayed grafting method. Methods: A prospective, randomized comparative study was carried out in the Department of Burns and Plastic Surgery in a government tertiary care hospital in India over a 18-month period (July 2024–December 2025). One hundred patients with 20–50% Total Body Surface Area (TBSA) thermal burns were included in the study. Patients were divided into two groups at random: Group A (n = 50) got split-thickness skin grafting and tangential excision within five days of the injury, while Group B (n = 50) received conservative dressing care until spontaneous eschar separation occurred (post-21 days), at which point grafting was performed. Results: In comparison to Group B (64%, p<0.05), the study showed a statistically significant decrease in wound infection rates in Group A (22%). As a result, compared to the delayed group (24%), sepsis-related mortality was much lower in the early excision group (8%). In the early excision group, the mean length of hospital stay (LOS) was 26.3 days, compared to 42.5 days in the delayed group. The overall decrease in antibiotic use and critical care days indicates a favorable benefit-risk profile, even though the early excision group needed larger initial blood transfusion volumes. Conclusion: In cases of severe burn injuries, early excision and grafting successfully eliminate the septic reservoir, improving survival rates and lowering hospital stays. In the Indian tertiary care context, blood products are a better therapeutic option than conservative therapy, notwithstanding the logistical challenges.

Background: Due to significant capillary leakage and fluid sequestration, major burn injuries, particularly those involving more than 20% of the total body surface area (TBSA), cause hypovolemic shock. The Parkland formula is essential for effective management, but “fluid creep”—the phenomena where actual quantities provided surpass projections—has gained international attention. Objective: In an Indian tertiary care context, this study sought to measure the prevalence of fluid creep, evaluate clinical outcomes, and assess adherence to standard fluid resuscitation regimens in adult patients with severe thermal burns. Methods:  Over the course of 18 months, 120 patients with 20–60% TBSA burns between the ages of 18 and 60 participated in a prospective observational study. In order to maintain urine output between 0.5 and 1.0 ML/kg/hr, patients were resuscitated using Ringer’s Lactate (RL) based on the Parkland formula 4mL (4 mL/kg/%TBSA), with hourly titration. Results: Predicted and delivered fluid quantities differed significantly, according to the study. In the first 24 hours, the mean real fluid volume was 4.8 ± 1.2 [(mL/kg) / % TBSA], which was substantially greater than the projected. 10% of individuals experienced acute kidney injury (AKI), and 6.7% experienced pulmonary edema. Conclusion: Although the Parkland formula is a useful starting point, real fluid requirements in this group were regularly higher than anticipated. In order to reduce the dangers of both under-resuscitation and fluid overload, the study emphasizes the need for dynamic, customized resuscitation.

Background: Adhesive capsulitis of the shoulder is a chronic, progressive condition characterized by pain and global restriction of shoulder movements, significantly affecting daily activities and quality of life. Various treatment modalities are available, including hydrodissection and biological therapies such as autologous platelet-rich plasma (PRP). This study aimed to compare the efficacy and functional outcomes of PRP injection versus hydrodissection in patients with adhesive capsulitis. Methods: A prospective cohort study was conducted over two years at IMS and SUM Hospital, Phulnakhara. A total of 200 patients were screened, of whom 165 met the eligibility criteria and were enrolled. Participants were allocated into two groups: Group A received intra-articular PRP injection and Group B underwent hydrodissection. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score at baseline, 1 month, 6 months, and 12 months. Statistical significance was determined using p-values (<0.05 considered significant). Results: Baseline demographic characteristics were comparable between the groups. Both interventions resulted in clinical improvement; however, the PRP group demonstrated significantly greater reduction in VAS scores at 1, 6, and 12 months (p < 0.001). DASH scores also showed statistically significant improvement in the PRP group at 6 months (p = 0.005) and 12 months (p = 0.01) compared to hydrodissection. These findings indicate superior pain relief and functional recovery with PRP therapy. Conclusion: Autologous PRP injection is more effective than hydrodissection in reducing pain and improving functional outcomes in adhesive capsulitis of the shoulder, making it a promising biological treatment option.

Background: The primary cause of morbidity among children with sickle cell disease are vaso-occlusive episodes (VOEs). Pathophysiology of VOEs are greatly influenced by systemic inflammation and hypercoagulability. This study evaluated the potential of certain inflammatory markers (CRP, IL-6) and coagulation (D-dimer, fibrinogen) biomarkers as potential early predictors of VOEs in children with Sickle cell disease. Methodology: A 12-month study was conducted on 18 pediatric patients with SCD, aged between the years of 2–18 at a tertiary hematology clinic. Standardized laboratory assays were employed to evaluate the baseline and follow-up blood samples for CRP, IL-6, D-dimer, and fibrinogen levels. All patients were followed up at every three months and also during VOEs. Paired tests, regression models, and ROC curve analysis were used to establish the associations between the biomarker levels, VOE occurrence, severity, and pain scores in children. Results: During the follow-up periods almost half of the patients developed had VOEs. In contrast to baseline levels, the mean biomarker levels during VOEs rose significantly (p<0.001). Compared to patients who were stable, those patients who developed VOEs later showed elevated baseline biomarker levels. Fibrinogen and D-dimer displayed the highest predictive accuracy (AUC≈1.0). followed by CRP and IL-6. Biomarker levels correlated positively with pain score (r>0.96, p<0.01), thereby, establishing the link between biochemical variations and clinical severity. Conclusion: In pediatric SCD the VOE occurrence and severity can be predicted by the elevated baseline and crisis-state levels of CRP, IL-6, D-dimer, and fibrinogen. These biomarkers show potential for early risk assessment and clinical monitoring. To establish clinical cut off values and confirm clinical applicability, larger multicenter studies are needed.

Introduction: Dengue remains one of the most important mosquito-borne viral infections in India, with substantial geographic heterogeneity and marked seasonal variation. Local laboratory-based surveillance data are essential for understanding transmission patterns and for guiding vector control strategies at district level. Objectives: To describe the temporal, demographic and geographic distribution of laboratory-confirmed dengue cases in Gondia district, Maharashtra, over a three-year period. Methods: This study was conducted at the Department of Microbiology, Government Medical College, Gondia, which serves as a sentinel centre for vector born disease surveillance. The study period extended from January 2023 to December 2025. Serum samples obtained from patients presenting with dengue-like illness were tested for dengue-specific IgM antibodies using the dengue MAC ELISA. Results: A total of 696 laboratory-confirmed dengue cases were recorded during the study period. Year-wise positivity showed a decreasing trend. A clear seasonal peak was observed during September 2023, corresponding to the post-monsoon period. Females constituted 54.5% of positive cases. The most affected age group was 21 to 30 years (28.2%). Geographic clustering was observed in Gondia followed by Goregaon. Conclusion: This study demonstrates marked seasonal and demographic variation in dengue positivity in Gondia district. Continuous laboratory-based surveillance remains a critical tool for early outbreak detection and for strengthening district-level vector control programmes.

Background: Prolonged preoperative fasting before elective caesarean section is still commonly practiced despite evolving guidelines. Extended fasting may predispose parturients to maternal hypoglycaemia, which can adversely affect maternal comfort, haemodynamic stability, and neonatal outcomes. Aim: To determine the incidence of maternal hypoglycaemia associated with prolonged fasting before elective caesarean section and to identify contributing factors. Methods: An observational study was conducted at Mahabodhi Medical College and Hospital, Gaya, over a period of six months (May 2025 onwards). Sixty pregnant women undergoing elective caesarean section were included. Duration of fasting, random blood glucose levels prior to surgery, demographic variables, and perioperative factors were analysed. Statistical analysis included unpaired t test and Chi square test. Results: Maternal hypoglycaemia (blood glucose <70 mg/dL) was observed in 21 of 60 patients (35%). A significantly higher incidence was noted among women with fasting duration >10 hours (p = 0.003). Mean blood glucose levels were significantly lower in the prolonged fasting group (68.4 ± 9.6 mg/dL) compared to those fasting ≤8 hours (82.1 ± 10.3 mg/dL, p < 0.001). Conclusion: Prolonged preoperative fasting is significantly associated with maternal hypoglycaemia in women undergoing elective caesarean section. Adherence to modern fasting guidelines and judicious use of carbohydrate-rich clear fluids may reduce this risk.

Background: Combined spinal and epidural (CSE) anaesthesia is widely used for lower abdominal and lower limb surgeries because it offers rapid onset of spinal block along with the flexibility of epidural extension. However, conventional CSE techniques may be technically challenging and require multiple punctures. Aim: To evaluate the success rate, block characteristics, and complications of a technique using paramedian epidural placement combined with midline spinal anaesthesia at the same intervertebral space. Methods: An observational study was conducted at Mahabodhi Medical College and Hospital, Gaya, over six months (May 2025 onwards). Eighty patients undergoing elective lower abdominal or lower limb surgeries under CSE anaesthesia were included. Technical success, block characteristics, and complications were analysed statistically. Results: Successful CSE was achieved in 76 patients (95%). The mean time to achieve sensory block was 4.3 ± 1.2 minutes. Hypotension occurred in 15% of patients. Accidental dural puncture was observed in 2.5%. All results were statistically analysed. Conclusion: Paramedian epidural combined with midline spinal anaesthesia at the same intervertebral space is a safe and effective alternative CSE technique with high success and acceptable complication rates.

Background: Adenoid hypertrophy is a common condition in pediatric age groups and is a leading cause of upper airway obstruction. It is frequently associated with sleep-disordered breathing, which may adversely affect cognitive function, behaviour, and academic performance in school-going children. Aim: To evaluate the effect of adenoid hypertrophy on sleep quality and school performance in children. Methods: This cross-sectional observational study included school-aged children diagnosed clinically and radiologically with adenoid hypertrophy. Assessment of sleep disturbances was performed using a standardized sleep questionnaire focusing on snoring, mouth breathing, witnessed apnea, restless sleep, and daytime somnolence. School performance was evaluated using academic records, teacher feedback, and attention/behavior assessment scales. Data were analyzed to determine the association between severity of adenoid hypertrophy, sleep disturbances, and academic outcomes. Results: Children with moderate to severe adenoid hypertrophy showed a significantly higher prevalence of sleep disturbances, including habitual snoring, fragmented sleep, and excessive daytime sleepiness. These children demonstrated reduced attention span, poor concentration, irritability, and significantly lower academic performance compared to children with mild or no hypertrophy. A positive correlation was observed between severity of airway obstruction and decline in school performance indicators. Conclusion: Adenoid hypertrophy significantly impacts sleep quality and is associated with impaired cognitive function and poor school performance. Early diagnosis and appropriate management may improve sleep patterns and academic outcomes in affected children.

Background: Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) represents a significant proportion of acute coronary events associated with substantial morbidity and mortality. Biomarkers such as B-type natriuretic peptide (BNP) and cardiac Troponin T (cTnT) are commonly measured to assist in diagnosis and risk stratification. However, their comparative value in predicting short- and long-term adverse outcomes specifically in NSTE-ACS requires further evaluation. Objective: To evaluate and compare the prognostic significance of BNP and Troponin T levels measured at presentation in patients with NSTE-ACS and to determine their ability to predict major adverse cardiovascular events (MACE) including death, recurrent ischemia, heart failure, and revascularization during hospitalization and follow-up. Methods: This prospective cohort study enrolled patients with NSTE-ACS admitted to a tertiary care center. BNP and cTnT levels were measured on admission. Patients were monitored for in-hospital and 6-month outcomes including mortality, recurrent myocardial infarction, heart failure, arrhythmias, and need for revascularization. Multivariate risk analysis and ROC curve assessments were conducted to compare the predictive power of each biomarker. Results: Elevated BNP levels were strongly associated with higher rates of adverse outcomes both during hospitalization and at 6-month follow-up. Patients with high BNP had significantly increased risk of death, heart failure, and recurrent ischemic events compared with those with lower levels. In contrast, elevated cTnT also correlated with worse outcomes, but its independent predictive power was weaker when adjusted for clinical risk factors and BNP. Combination of elevated BNP and cTnT provided incremental prognostic information over either biomarker alone. Conclusions: In patients presenting with NSTE-ACS, BNP appears to be a strong independent predictor of adverse clinical outcomes, potentially offering superior prognostic value compared with Troponin T alone. A multimarker strategy incorporating both BNP and cTnT enhances risk stratification and may guide targeted management.

Introduction: Acute kidney injury is defined by a sudden loss of excretory kidney functions as a manifested by severe azotaemia and often by oliguria or anuria. Material and methods- in this study in age more than 12 years and patients admitted to medicine ward and intensive care unit with acute kidney injury were enrolled. We conducted an observational single centre study from June 2025 to December 2025 with 50 patients. Observations: out of 50, 32 were males and 18 were females. In this study, common etiologies were acute gastroenteritis(20%), snake and unknown bite (18.8%), infective cause (15.8%) and poisoning and drug induced (15.2%). Conclusion: Decreased urine output, swelling of over face and lower limb and vomiting were common presentation of Acute kidney injury in this study. Highest incidence of Acute kidney injury was attributed to medical disorders consisting of mainly septicemia, acute gastroenteritis, multiple organ dysfunction syndrome, snake bite and Nephrotoxic drugs.

Knee osteoarthritis (OA) is a leading cause of disability worldwide, driving a search for treatments that do more than just manage symptoms. Platelet-rich plasma (PRP) has emerged as a frontrunner in regenerative medicine, utilizing concentrated growth factors to stimulate tissue repair. However, a significant gap remains in clinical guidelines regarding the optimal dosing protocol. This prospective comparative study evaluated 90 patients with early to moderate (Kellgren-Lawrence Grade I-II) knee OA to determine if multiple injections provide superior outcomes to single-dose regimens. Participants were divided into three groups: Group A (single injection), Group B (two injections), and Group C (three injections), with multi- dose intervals set at two weeks. The results revealed that while all groups experienced significant initial relief at 6weeks, their paths diverged significantly by the 6-month mark. The triple-dose group demonstrated a 60.5% improvement in pain (VAS scores), whereas the single and double-dose groups saw their improvements taper off to 27.4% and 30.1% respectively. Functional assessments via the WOMAC index mirrored these findings, with Group C maintaining sustained improvement while Groups A and B showed partial deterioration from their peak. Ultimately, the study concludes that a three – dose PRP regimen is safe and significantly more effective for achieving long term therapeutic benefits in knee OA management. Objective: The primary objective of this research was to investigate the dose- responserelationshipofintra-articularPRPinjectionsinpatientswith early-stage knee osteoarthritis. Specifically, the study aimed to:

• Compare the clinical effectiveness of single, double, and triple-dose PRP protocols.
• Evaluate the durability of pain relief and functional recovery over a six-month period.
• Assess the safety and tolerability of repeated injections.
• Validate the hypothesis that a triple-dose regimen provides superior sustained benefits compared to fewer injections.

Background: Deficiency of vitamin D is a common problem worldwide and is associated with decreased bone mineral density (BMD), leading to an increased risk of fragility fractures, particularly among the elderly population. Objectives: To evaluate the correlation between serum vitamin D levels and bone mineral density among patients presenting with fragility fractures. Materials and Methods: A hospital-based cross-sectional study was conducted among 60 patients presenting with fragility fractures at a tertiary care center. Serum vitamin D levels were measured using standard laboratory methods, and bone mineral density was assessed using dual-energy X-ray absorptiometry (DEXA). Statistical analysis was performed to determine the correlation between serum vitamin D levels and bone mineral density. Results: Vitamin D deficiency was observed in a significant proportion of participants. 56.7% had osteoporosis on BMD assessment. A significant positive correlation was observed between serum vitamin D levels and bone mineral density. Conclusion: Routine evaluation of vitamin D levels and BMD may aid in early detection and management of osteoporosis, thereby reducing the risk of future fractures.

Background: High-risk pregnancies are predisposed to adverse outcomes, including preeclampsia, fetal growth restriction, preterm birth, and stillbirth. This study evaluated the predictive utility of first-trimester maternal serum placental growth factor (PlGF), beta-human chorionic gonadotropin (β-hCG), and pregnancy-associated plasma protein-A (PAPP-A) for anticipating complications in women with established obstetric risk factors. Methods: In this prospective cohort study, 200 high-risk pregnant women (18–40 years, 11–13+6 weeks’ gestation) were recruited from a tertiary maternity center. High-risk status included chronic hypertension, diabetes, prior preeclampsia, or abnormal uterine artery Doppler findings. Serum PlGF, free β-hCG, and PAPP-A were measured via automated immunoassays and expressed as MoM adjusted for maternal weight, parity, and ethnicity. Primary endpoints were a composite of preeclampsia, intrauterine growth restriction (<10th percentile), early preterm birth (<34 weeks), and stillbirth. Predictive performance was assessed using logistic regression, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival curves; p<0.05 was considered significant. Results: Adverse outcomes occurred in 58/200 (29%) pregnancies. Cases with complications had significantly lower PAPP-A (0.53±0.32 vs. 1.10±0.41 MoM), lower PlGF (0.69±0.38 vs. 1.06±0.45 MoM), and higher β-hCG (2.38±1.12 vs. 1.30±0.66 MoM) compared to unaffected pregnancies (all p<0.001). ROC analysis demonstrated AUCs of 0.87 (PlGF), 0.82 (PAPP-A), and 0.79 (β-hCG). A combined biomarker panel (PlGF/PAPP-A ratio + β-hCG) yielded superior predictive accuracy (AUC 0.92, 95% CI 0.88–0.95) with 88% sensitivity and 85% specificity at risk >1:50. Low PlGF (<5th percentile) independently predicted preeclampsia (OR 12.4; 95% CI 7.2–21.3; p<0.001). Conclusions: First-trimester maternal serum PlGF, β-hCG, and PAPP-A robustly predict adverse obstetric outcomes in high-risk pregnancies. A multimarker algorithm enhances early risk stratification, supporting timely interventions such as low-dose aspirin therapy, closer surveillance, and targeted management to improve maternal-fetal outcomes.

Background: Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are major causes of enterically transmitted viral hepatitis in India, with variable regional distribution. Updated serological data from eastern India remain limited. Methods: A laboratory-based cross-sectional study was conducted from January to December 2025 at a medical college in Kolkata. A total of 417 serum samples received for anti-HAV IgM and anti-HEV IgM testing were analyzed using ELISA. Demographic and seasonal data were evaluated using descriptive statistics. Results: Of 417 samples, 51 (12.2%) were seropositive for HAV and 15 (3.6%) for HEV. HAV–HEV coinfection was detected in 5 cases (1.19%). HAV seropositivity was highest in the 11–15-year age group, whereas HEV was more common in young adults (21–25 years). Male predominance was observed for both HAV (66.7%) and HEV (60%). Seasonal clustering of HAV cases was noted during late winter to early monsoon months, while HEV cases were sporadic. Conclusion: HAV remains the predominant enterically transmitted hepatitis virus in this region, with distinct age and seasonal patterns. Continued surveillance and targeted preventive strategies are warranted to reduce disease burden.

Oesophageal malignancy is the eighth most common malignancy in the world with an annual incidence of 456,000 new cases. In India, it is the fourth most common cause of malignancy-related deaths. The aim is to evaluate involvement of different sites in oesophageal malignancy by conventional barium swallow and CT scan. This study used data evaluating involvement of different site of in oesophageal malignancy among 57 patients which were diagnosed at radiology department of ACPM Medical College & hospital, Dhule, Maharashtra. Out of 57 patients with detected oesophageal malignancy most common site involved was middle one third of oesophagus followed by mid- lower oesophageal junction. CT scan is excellent in diagnosis of various site involved, distant metastasis and lymphadenopathy in oesophageal malignancy.

Thalassemia and hemoglobinopathies are major health problems associated with significant morbidity and mortality in the Indian population. Hemoglobinopathies are inherited in an autosomal recessive manner and affect globin chains. Thalassemia is characterised by the absence or reduced synthesis of one or more globin chains. Sickle cell disease is the most common hemoglobinopathy, accounting for 7% of the world’s population. Different Hb variants are relatively common in India compared to global data. Analysis of Hb variants by the HPLC method can help estimate the magnitude of the disorder and assist in early diagnosis and prevention through genetic counselling. This study aims to detect Hb variants using the HPLC technique and to determine the prevalence of hemoglobinopathies as well as their correlation with clinicohematological parameters. This study was conducted over the last two years in our tertiary care centre. The HPLC findings of Hb fractions were correlated with haematological parameters and clinical profiles. The results revealed that out of a total of 1,394 cases in the study, 326 had abnormal Hb variants. The most common Hb variant was β-thalassemia trait, accounting for 153 cases, followed by sickle cell trait with 71 cases, and 11 cases of β-thalassemia major. Other hemoglobinopathy cases included 20 cases of HbE trait, 21 cases of HbE homozygous, 20 cases of homozygous sickle cell disease, 2 cases of hereditary persistent fetal haemoglobin (HPFH), and 1 case of Hb Lepore. There were 27 cases of compound heterozygotes: 22 of which were for sickle cell/β-thalassemia, 4 for HbE/β-thalassemia, and 1 case of HbS/D trait.

Background: Acute bacterial meningitis (ABM) remains a major cause of childhood mortality and neurological morbidity in low- and middle-income countries, despite the introduction of conjugate vaccines. Data describing the post-vaccine aetiology, clinical profile, and outcomes of paediatric ABM using contemporary diagnostic methods are limited from Eastern India. We aimed to characterise the aetiological spectrum, clinical features, and short-term outcomes of childhood ABM in a tertiary care setting. Methods: We conducted a prospective, observational study at two tertiary care hospitals in Cuttack, Odisha, India, between March 2024 and March 2026. Children aged 2 months to 14 years with clinically suspected and cerebrospinal fluid–confirmed acute bacterial meningitis were enrolled. Cerebrospinal fluid samples underwent cytological, biochemical, microbiological, and molecular analyses, including PCR/CBNAAT where indicated. Demographic data, immunisation status, clinical presentation, and outcomes were recorded. Children were followed up for one month after discharge. Outcomes included aetiological confirmation, in-hospital mortality, and short-term neurological sequelae. Findings: Among 9,020 paediatric admissions, 131 children (1·45%) were diagnosed with acute bacterial meningitis. Infants aged 2 months to 1 year accounted for 53·4% of cases, and 56·5% of children presented more than 48 hours after symptom onset. An aetiological diagnosis was established in 86 (65·6%) children. Molecular diagnostics identified pathogens in 59·5% of cases, compared with 31·3% by culture. Streptococcus pneumoniae was the most common pathogen (35·1%), followed by Haemophilus influenzae (13·7%) and Neisseria meningitidis (6·9%). Only 41·2% of children had received pneumococcal conjugate vaccine. In-hospital mortality was 11·5%, increasing to 13·0% at one month. Neurological sequelae were observed in 19·1% of survivors.

Background: Pediatric systemic lupus erythematosus (pSLE) is a multisystem autoimmune disease in which cutaneous manifestations are common and may precede systemic involvement. These lesions often reflect disease activity, yet pediatric-specific data on their clinical significance, particularly from resource-limited settings, remain limited. Standardized tools such as the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) are not routinely used in children. Objectives: To describe the pattern and spectrum of cutaneous manifestations in pediatric systemic lupus erythematosus and to evaluate their association with systemic involvement and clinical outcomes. Methods: This cross-sectional observational study was carried out at a tertiary care facility in Eastern India between January 2024 and December 2025. Using successive sampling, children between the ages of 1 and 14 who met the SLICC 2012 categorization criteria for systemic lupus erythematosus were included. Comprehensive laboratory, systemic, dermatological, and clinical assessments were carried out. There are three subtypes of cutaneous lupus erythematosus: acute, subacute, and chronic. SPSS version 20.0.1 was used for the statistical analysis, and p <0.05 was deemed significant. Results: Eighty children were included (female:male ratio 3.4:1; mean age 11.1 ± 2.5 years). Cutaneous manifestations were present in 66 patients (82.5%). Malar rash (66.7%), photosensitivity (57.6%), oral ulcers (54.5%), and alopecia (45.5%) were the most frequent lesions. Acute cutaneous lupus erythematosus was the predominant subtype (63.6%). Cutaneous lesions were the first disease manifestation in 42.4% of patients. Significant associations were observed between malar rash and renal involvement (p = 0.03), vasculitic lesions and multisystem involvement including neurological disease (p = 0.01), and alopecia with hematological involvement (p = 0.04). Complete resolution of cutaneous lesions occurred in 50% of patients on follow-up, with better outcomes following combined topical and systemic therapy. Conclusion: Cutaneous manifestations are highly prevalent in pSLE and often precede systemic disease. Certain lesions serve as markers of systemic involvement, highlighting the importance of early dermatological assessment and standardized monitoring in pediatric lupus.

Introduction: De Quervain’s tenosynovitis is a stenosing tendinopathy involving the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons within the first dorsal extensor compartment of the wrist. It commonly presents with radial-sided wrist pain and functional limitation due to repetitive mechanical stress. Early and accurate diagnosis is important for appropriate management and prevention of chronic disability. High-resolution ultrasonography (USG) has emerged as a valuable imaging modality due to its ability to visualize tendon morphology, retinacular thickening, and associated anatomical variations. Aims and Objectives: (1) To evaluate the role of high-resolution ultrasonography in the diagnosis of De Quervain’s tenosynovitis. (2) To identify characteristic sonographic features and anatomical variations associated with the condition. Materials and Methods: This prospective observational study was conducted in the Department of Radiodiagnosis at L.G. Hospital over a period of six months. A total of 50 patients with clinically suspected De Quervain’s tenosynovitis were included. Ultrasonographic evaluation was performed using a high-frequency linear transducer (5–12 MHz). Parameters assessed included extensor retinaculum thickening, tendon enlargement, synovial sheath effusion, peritendinous edema, intracompartmental septation, multiple APL tendon slips, and subcutaneous edema. Color Doppler imaging was used to assess inflammatory hypervascularity. Results: Among the 50 patients studied, 32 (64%) were female and 18 (36%) were male, with a mean age of 50.1 years. The right wrist was affected in 82% of cases. Ultrasonography demonstrated extensor retinaculum thickening in all patients (100%). Peritendinous edema was observed in 78%, multiple slips of the APL tendon in 60%, intracompartmental septation in 36%, fluid collection in 48%, synovial thickening in 40%, and subcutaneous edema in 28% of cases. Anatomical variations such as septation and multiple tendon slips were associated with increased retinacular thickness and symptom severity. Conclusion: High-resolution ultrasonography is a reliable and non-invasive imaging modality for the evaluation of De Quervain’s tenosynovitis. It effectively identifies pathological changes and important anatomical variations that influence disease severity and treatment outcomes. Ultrasonography plays a crucial role in accurate diagnosis, treatment planning, and follow-up of patients with this condition.

Background: One of the most prevalent illnesses in both the community and hospitals is urinary tract infection (UTI). Uropathogens populate the urinary tract, can climb to the bladder and cause cystitis, and can cause acute pyelonephritis and renal damage if they are allowed to enter the kidneys through the ureters. The current study’s objective is to ascertain the prevalence of UTIs and the pattern of antibiotic susceptibility in a tertiary care facility. Methods: This observational study was carried out between June and November of 2025 in the microbiology department of SKMCH in Muzaffarpur, Bihar. 623 mid-stream urine samples were taken from the hospital’s indoor and outdoor departments, and a semiquantitative approach was used to culture the samples on UTI chromogenic agar. The Kirby Bauer disc diffusion method was used to conduct an antibiotic sensitivity test. Results: Prevalence of urinary tract infections is 29% in the study. Escherichia coli (43%) is the most common micro-organism isolated followed by Enterococcus (13%), Staphylococcus aureus (11%), Acinetobacter (10.4%), Klebsiella (8.8%), Pseudomonas (3.3%), Proteus (1.6%), CONS &Citrobacter (1.1%) and Candida (6.6%). The females (56.6%) are more commonly affected than males. Conclusion: Aminoglycosides and beta-lactamase inhibitors were found to be efficient medications against gram-negative bacteria in the current investigation. Gram-positive bacteria were susceptible to vancomycin and linezolid. The medication nitrofurantoin is safe to use during pregnancy and shows promise in cases of simple UTIs. The burden of disease is rising due to antibiotic resistance and high recurrence rates. In order to prevent multidrug-resistant microorganisms and further lower morbidity and mortality, it is recommended to use antibiotics sparingly in accordance with the hospital’s antibiotic policy.

Background: When it comes to determining the underlying cause of anemia, the importance of microscopic examination of peripheral blood smears (PBSs) cannot be understated. The red blood cell (RBC) parameters produced by cell counters can help with morphological classification of anemia. Therefore, a thorough evaluation of anemia requires both RBC values and microscopic inspection of PBSs. The purpose of this study was to assess and contrast the outcomes of two distinct approaches: automated cell counter-generated parameters and peripheral blood smear (PBS) analysis. Finding any variations or parallels between the diagnostic results generated by each approach was the goal. Methods: From June 2025 to November 2025, a hospital based, prospective study was conducted at Department of Pathology, JLNMCH, Bhagalpur, and Bihar. Total 1000 anemic patients was evaluated and compare the PBS findings and RBC parameters and histograms generated by a cell counter. Results: In a sample of 1000 cases, we compared the typing of anemia using an automated analyzer and peripheral smear examination. Out of these cases, 690 showed consistent typing results between the two methods, while 310 showed discordant typing. The automated analyzer diagnosed majority of cases 70.1% as microcytic anemia and Normocytic, dimorphic, and macrocytic cases were found in 13.5%, 7.8%, and 4.3% of cases, respectively. Additionally, a normal histogram was observed in 17.6% of cases. Conclusion: We have concluded that while the automated analyzer is useful in reducing the overall workload through its graphical representation of anemia typing, it should always be confirmed through microscopy. The automated analyzer is a helpful tool, it should not be relied upon solely for accurate anemia typing. Microscopy remains an essential method for confirming the results of automated analysis.

Background: In surgical practice, surgical site infections (SSIs) continue to be a significant issue. The SSI rate following general abdominal surgery is still more than 15% despite preventive measures including antibiotic prophylaxis and anti-septic skin washing. Following an open choledocholithotomy, this complication is also frequent. There is little information about the benefits of wound drainage in open choledocholithotomy, despite numerous trials demonstrating its effectiveness in lowering infection. The purpose of this study was to evaluate the efficacy of subcutaneous drain placement in reducing superficial SSI following open choledocholithotomy. Methods: 44 patients who had open choledocholithotomy between January 2024 and December 2024 were included in the study after convenience sampling. Two groups of patients were created. Twenty-five patients (group II) had no subcutaneous drain, while 19 patients (group I) had a subcutaneous closed suction drain. In the case group, daily drain collection was documented. Following surgery, each patient was assessed for the presence of wound dehiscence, superficial SSIs, and wound seromas. The statistical program SPSS 22 Windows version 10 was applied for data analysis and presentation. Results: 10.5% of patients in group I and 60.0% of patients in group II were found to have SSI. The two groups’ differences were statistically significant (p=0.001). Group I’s average postoperative hospital stay was 11.58±2.91 days, while group II’s was 15.04±5.78 days. There was a statistically significant difference between the two groups’ postoperative hospital stay durations. Escherichia coli predominates among the organisms isolated from both bile culture and wound swab culture. Conclusion: The prevention of superficial surgical site infection was positively impacted by the installation of a drain in the wound following an open choledocholithotomy. Additionally, it dramatically lowers the rate of SSIs and hospital stays.

Background: One of the most major medical problems in the world is trauma. Elderly trauma has a high rate of complications and fatalities. The purpose of this study was to look into the connection between morbidity and mortality in elderly trauma patients and Base Deficit. Methods: Elderly trauma patients who were referred to the emergency room of Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar between March and August of 2025 were the subjects of this cross-sectional study. Our inclusion criteria were age over 65 years, no history of diabetes mellitus and kidney diseases, no alcohol and aspirin consumption, and no history of conditions that cause severe volume loss and dehydration. The Injury Severity Score measures trauma intensity based on the Abbreviated Injury Scale. The Patient’s BD results were extracted from their Venous Blood Gas test. Data were analyzed in SPSS Statistics software (Version. 23) using the Chi-square test, Kruskal-Wallis test, and Mann-Whitney (P<0.05) was considered significant. Results: This study, 77 patients were enrolled (the mean age of individuals: (80.65±7.28) male/female ratio: 1.02). BD mean was (7.58±0.63 mmol/L). The level of consciousness was statistically different between BD groups (P-value=0.001). The injury severity score mean had a significant association with the BD level (P<0.001). Also, with increasing BD level, the length of hospitalization in the ICU increased significantly (P-value=0.001). Conclusion: BD can predict the severity of traumatic injury in the elderly. Along with other available factors such as serum lactate, BD can be reliable predictor of outcomes in trauma elderly patients.

Background: Trauma is an injury that happens when the body is subjected to an intolerable amount of environmental energy. Due to the increased growth of automobiles and industries, trauma, particularly abdominal trauma, has grown more significant in emerging nations like Iran. The current study sought to determine the prevalence of penetrating trauma-related intra-abdominal visceral injuries in the emergency room of SKMCH, Muzaffarpur, and Bihar. Methods: 162 patients with penetrating abdominal trauma who were referred to the SKMCH Surgery Emergency Department in Muzaffarpur, Bihar from July 2025 to December 2025 were included in this descriptive cross-sectional study. Gender, age, length of hospital stay, patient’s final state, cause of trauma, injury outcome, location of the injury, and laparotomy outcome were all included in the checklist used to collected data. Data were entered into SPSS software (version 18) and analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and chi-square test. Results: 135 (83.3%) and 27 (16.7%) of the 162 patients with impermeable trauma were male and female, respectively. The patients’ average age was 33.25±18.99 years. Trauma was caused by falls from heights (24.6%) and accidents (75.4%). In addition, 29.6% of patients had no intra-abdominal visceral injury following a laparotomy, but intestine, liver, and spleen injuries were noted in 24.7%, 25.9%, and 19.8% of instances, respectively. Conclusion: The majority of trauma patients were male, according to the study’s findings. Additionally, the spleen and intestine were the most often wounded organs and the most frequent mechanisms of trauma among patients who visited this accident center’s emergency room. To avoid these injuries, the proper precautions must be taken.

Background: Among the three primary causes of mortality, trauma is the most frequent cause among those under 50. It’s unclear how microscopic hematuria affect the diagnosis of abdominal injuries. The purpose of this study was to examine the prognostic value of microscopic hematuria in the evaluation of abdominal organ damage following physical trauma. Methods: All blunt trauma patients admitted to the surgery department of SKMCH in Muzaffarpur, Bihar between March 2025 and November 2025 were included in this cross-sectional study. Individuals with blunt abdominal injuries between the ages of 18 and 65 were included; those with a history of renal disease, macroscopic hematuria, or unstable hemodynamic condition were removed. The gold standard for performing a spiral CT scan of the abdomen and pelvis was to inject contrast material intravenously with a delayed nephrogram phase. 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: Four hundred patients with blunt trauma took part in this investigation. Patients with intra-abdominal organ injury had a considerably higher frequency of microscopic hematuria than other patients (71.4% versus 38.9%, P<0.001). Microscopic hematuria had a sensitivity of 53.84% and a specificity of 77.14% in identifying intra-abdominal organ injury. The test’s total accuracy was 62.0% (Kappa coefficient=0.22, P<0.001). Conclusion: Microscopic hematuria can be employed as an auxiliary diagnostic technique, but it is not appropriate as the primary method due to its poor accuracy in identifying damage to intra-abdominal organs.

Background: Diabetes and hypertension are the two leading causes of cardiovascular morbidity and premature mortality in India although substantial gaps continue to exist in the areas of detection, persistence of care, patient compliance, and the achievement of therapeutic outcomes. Task-sharing schemes directed by community health workers (CHWs) are gradually supported to improve the chronic conditions yield in low- and middle-income locations. Aim: The current research is aimed at measuring the efficacy of a CHW-led and community-based intervention in regulating glycaemic and blood pressure in adults with known type 2 diabetes and/or hypertension receiving care in Patna Medical College and Hospital (PMCH) in Patna, Bihar, India. Methods: We conducted pragmatic parallel-group, cluster-randomised controlled trial over 12 months follow-up of communities catchment clusters that were associated with PMCH. The participants who fitted the criteria were adults with uncontrolled type 2 diabetes (HbA1c at or above 7.0% and/or a minimum of 90mmHg DBP and/or SBP). The intervention included CHW home visits, structured education, ongoing adherence, blood-pressure and glucose levels monitoring, risk-factor counselling, adaptation of referrals, and linkage to the clinicians with the help of the standardised algorithms. The 12-month changes in HbA1c and systolic blood pressure (SBP) were considered as primary outcomes. Mixed-effects models/models were used to consider clustering and baseline values. Findings: The analysis was conducted on an intention-to-treat basis on 402 participants (intervention n=204; usual care n=198). The adjusted difference in reduction of HbA1c was found to be 0.70⁻ in the intervention group compared to usual care at 12 months (95% interval -0.85 -0.55; p<0.001). The adjusted difference in the mean reduction of SBP was -8.6mmHg (95%CI -11.4-5.8; p<0.001). The HbA1c controlling rates under 7 per cent improved to 41.7 per cent in the intervention group and the BP under 140/90mmHg to 58.3 per cent. The adherence and retention of medications and care-follow up improved, and the acute-care visits were reduced. Conclusion: Community intervention led by CHW and associated with PMCH provided clinically significant results of HbA1c and SBP, therefore, supporting the feasibility of scalable task-sharing models in the framework of the non-communicable-disease programme in India.

Background: Acute cholecystitis is a common surgical emergency, and ultrasonography is the primary imaging modality for diagnosis. Gallbladder wall thickening and other sonographic features may aid in diagnosis, but their diagnostic accuracy varies across studies. Objective: To prospectively evaluate gallbladder wall thickness and ultrasonographic parameters in predicting acute cholecystitis and correlate findings with histopathology. Methods: This prospective observational study included 56 adult patients with clinically suspected acute cholecystitis. Ultrasonographic parameters assessed included gallbladder wall thickness, pericholecystic fluid, gallstones, sonographic Murphy’s sign, and mural hyperemia. Histopathology served as the reference standard. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. Results: Acute cholecystitis was confirmed histopathologically in 44 (78.6%) patients. Gallbladder wall thickening (>3 mm) was observed in 92.9% and demonstrated high sensitivity (97.7%) but low specificity (25.0%). Pericholecystic fluid showed high specificity (92.3%), while sonographic Murphy’s sign had high sensitivity (93.0%). Combining wall thickening, pericholecystic fluid, and Murphy’s sign improved diagnostic accuracy, with sensitivity and specificity of 94.5% and 83.3%, respectively. Conclusion: Ultrasonography is an effective first-line modality for diagnosing acute cholecystitis. Gallbladder wall thickness combined with pericholecystic fluid and sonographic Murphy’s sign significantly enhances diagnostic accuracy.

Background: Long-acting reversible contraceptives (LARCs) are among the most effective methods for preventing unintended pregnancies. The single-rod etonogestrel implant (Implanon) provides highly effective, reversible, and user-independent contraception. However, its long-term acceptability depends on user experience, side-effect profile, and quality of counselling. Objectives: The present study aimed to evaluate the clinical experience of women using the etonogestrel subdermal contraceptive implant, to assess its acceptability and one-year continuation rate, and to determine the pattern of adverse effects associated with its use in a tertiary care setting. Methods: A prospective observational study was conducted at Patna Medical College and Hospital, Patna, from February 2025 to January 2026. A total of 90 eligible women opting for Implanon were enrolled and followed for one year. Socio demographic data, adverse effects, satisfaction, and continuation status were recorded and analysed using descriptive statistics and chi-square testing. Results: The mean age of participants was 26.8 ± 4.9 years. Menstrual irregularity was the most frequently reported side effect (39.0%). The overall continuation rate at one year was 78.9% (95% CI: 69.3–86.6). Continuation was significantly higher among women without side effects compared with those experiencing side effects (88.2% vs 73.2%, p = 0.009). Conclusion: The etonogestrel implant is a safe, effective, and highly acceptable LARC with high continuation and satisfaction rates. Structured counselling and follow-up can further improve continuation.

Background: Emotional Intelligence (EI) plays a vital role in academic success, particularly in demanding fields such as medical education. Objective: To assess the association between emotional intelligence and academic performance among medical students. Methods: A cross-sectional study was conducted among 500 medical students in a tertiary care center in south India. EI was assessed using the Emotional Intelligence Scale (EIS), and academic performance was measured using CGPA. Statistical analyses included descriptive statistics, Pearson correlation, linear regression, and normality testing. Results: The mean EI score was 118.4 ± 15.2 and mean CGPA was 7.4 ± 0.8. A significant positive correlation was observed between EI and CGPA (r = 0.42, p < 0.001). Regression analysis showed EI as a significant predictor of academic performance (β = 0.42, p < 0.001). Conclusion: Emotional Intelligence significantly influences academic performance. Integrating EI training into medical curricula may enhance student outcomes and well-being.

Background: Antibacterial medications are crucial in the treatment of pneumonia, a major cause of death for children worldwide. to ascertain the antibacterials used for pneumonia, including their class, dosage schedule, adverse drug reactions (ADRs), selection criteria, and World Health Organization (WHO) prescription indicators. Methods: From October 2025 to December 2025 this study was conducted among 432 pediatric patients admitted with Pneumonia in JLNMCH, Bhagalpur, and Bihar. Details on antibacterial prescription with selection criteria and associated ADRs were collected. Causality, preventability and severity of ADRs were assessed. WHO prescribing indicators were calculated. Data analysed using SPSS software. Results: Ampicillin (34.6%) with a dosing regimen of 32-66 mg/kg intravenously four times a day (34.4%) and a mean treatment duration of 3.6±1.26 days was the most commonly prescribed antibacterial class, followed by aminopenicillins (61.2%). 57% of patients were administered intravenously, and 99% of patients were treated empirically. Vancomycin-induced Redman Syndrome and gentamicin and ampicillin-induced hypersensitivity reactions were the observed adverse drug events. WHO prescription indicators: 2.42 antibacterials on average per contact, 96.56% of antibacterials administered under generic names, 98.37% of encounters involving injections, and 90.9% of antibacterials from the Essential Medicines List (EML). Conclusion: The most prevalent dose regimen recommended was intravenous ampicillin 32–66 mg/kg four times a day for a mean length of 3.6±1.26 days. Aminopenicillins were the primary antibacterial class. The majority of antibacterials came from EML, were given intravenously, prescribed under generic names, and were chosen experimentally. There were three documented ADRs. Calculations were made for prescribing indicators.

Background: A cerebrovascular accident occurs when there is an abrupt loss of blood flow to a part of the brain, which causes a commensurate loss of neurologic function. The study’s objective was to assess computed tomography’s contribution to cerebrovascular accidents. Method: 70 adult patients who had undergone cerebrovascular accidents were studied. Their previous histories of hypertension, diabetes mellitus, and cardiac disease were noted, and a CT scan was performed. Results: Out of 70, 44 (62.90%) had infarction, 18 (25.70%) had subarachnoid hemorrhage, 1 (1.6%) had tumors, 2 (3.33%) had cerebral-cavernous thrombosis, and 1 (1.6%) were normal. Conclusion: The CT scan study proved to be the gold standard technique for the diagnosis of acute stroke and hemorrhages in different parts of the brain.

Background: Genital tuberculosis (GTB) is a significant, often asymptomatic cause of infertility, particularly in developing regions. It affects both females (tubal blockage, uterine adhesion) and males (sperm quality) by causing chronic inflammation and scar tissue, often leading to irreversible damage if not treated early, requiring assisted reproduction methods. Aims of this study is to assess the prevalence of tuberculosis in infertile women and to determine the histological pattern of involvement, clinical spectrum and impact on infertility in women with tuberculosis. Methods: Between January 2024 and December 2024, 100 patients at the obstetrics and gynecology department of Madhubani Medical College and Hospital in Madhubani, Bihar, participated in the current clinical study. Results: Eighteen of the 100 infertile females had genital tuberculosis (GTB). In nine (50%) cases of GTB, the fallopian tube was the most often involved location, followed by the endometrium. There were five cases of secondary infertility and thirteen cases of primary infertility in GTB. Conclusion: According to our study, GTB frequently manifests as primary infertility. Menstrual issues were not frequently reported. In GTB, the fallopian tube was frequently involved.

Background: One of the most frequent emergency surgeries is an appendectomy. It is necessary to differentiate the diagnosis from other causes of discomfort in that area of the abdomen, such as right-sided salphingoophoritis and acute ureteric colic. These days, the preferred diagnostic techniques include contrast-enhanced CT scans and ultrasounds. The necessity for a trustworthy scoring system for the diagnosis of acute appendicitis is increased by the fact that, despite the availability of these facilities in urban regions, rural areas continue to struggle with delayed diagnosis and negative appendectomy. The modified Alvardo scoring system for the diagnosis of acute appendicitis will be assessed here. Methods: 92 consecutive cases of suspected acute appendicitis that were admitted, examined, and treated between February 2025 and July 2025 are included in this observational cross-sectional hospital-based study at SKMCH, Muzaffarpur, Bihar. Each patient’s modified Alvardo score is computed and compared to the histological results of the appendix that was operated on. Results: According to the above study, the modified Alvardo score 7-9 has a high sensitivity of 93.10% for male and 77.78% for female. The modified Alvardo score of 7-9 showed an overall sensitivity of 83.63%. Conclusions: We conclude that the modified Alvardo score of 7-9 is an effective diagnostic tool for male. However, it can be utilized as a diagnostic tool in addition to imaging investigations in females because of its lesser sensitivity and high percentage of negative appendectomy results.

Background: The urinary stone disease is one of the most common afflictions of the modern society and it has been described since antiquity with the westernization of global culture. It has led to a lot of distress physically, mentally and financially to the affected individuals. Aim of this study is to compare the efficacy of Silodosin and Tamsulosin as a medical expulsive therapy, in the management of ureteric stone in the term of stone clearance and stone expulsion time. Method: This prospective randomized study was conducted on 60 patient  aged >15 year who had unilateral or bilateral ureteric stone < 6 mm or 6mm. patient were divided in two group. Group A received Tamsulosin (0.4mg) and group B received Silodosin (8 mg) daily for 28 days the patient were followed up by ultrasonography, plain radiograph of kidney, ureter and bladder and IVU. Results: There is significantly higher stone clearance rate of 73% in Group A VS in group B of 90%(p value<0.05). Group B also showed a significant advantage for stone expulsion time. No severe complication were recorded during the treatment period. In Group A, out of 30 patient, 8 patient required ureteroscopic removal of stone or open ureterolithotomy but in group B , only 3 patient required the same. Conclusion: Our data show that silodosin is more effective than tamsulosin in the management of ureteric stone < 6mm or 6mm for stone clearance rate and stone expulsion rate.

Background: The prevalence of pressure ulcers during hospital stays is rising despite advancements in medical technology and preventative initiatives. The purpose of this study was to assess the frequency of bedsores among hospitalized patients. Methods: All patients (n=244) with pressure ulcers who were admitted to SKMCH, Muzaffarpur, Bihar, within more than 48 hours were included in this analytical cross-sectional study. Hospital records were used to collect patient data, including age, gender, history of hypertension, history of diabetes, length of hospital stay, and body mass index. The Braden Scale was used to evaluate ulcers. Stata software version 14.1 was used to analyze the data, describing the quantitative variables with mean and standard deviation and the qualitative variables with numbers and percentages. Results: All patients (n=244) with pressure ulcers who were admitted to SKMCH, Muzaffarpur, Bihar, within more than 48 hours were included in this analytical cross-sectional study. Hospital records were used to collect patient data, including age, gender, history of hypertension, history of diabetes, length of hospital stay, and body mass index. The Braden Scale was used to evaluate ulcers. Stata software version 14.1 was used to analyze the data, describing the quantitative variables with mean and standard deviation and the qualitative variables with numbers and percentages. A significant relationship was present between the length of hospitalization and the degree of bedsores. In the ulcers of the scapula, the Braden score was significantly higher. Conclusion: Patients over 60 had a higher incidence of pressure ulcers. The degree of pressure ulcers was five times higher in the diabetic participants, and the length of hospital stay also enhanced the ulcer’s severity. Compared to patients with low BMI, those with high BMI had fewer but more severe pressure ulcers.

Introduction: The larynx is one of the most highly innervated organs in humans and serves a number of vitally important, complex and highly evolved biological functions. Although symptoms of laryngopharyngeal reflux are commonly seen in ENT clinics, their aetiology and prevalence in the population remains unknown. The aim of this review is to overview types of laryngeal dysfunction related to our daily lifestyle mostly encountered by Otorhinolaryngologists. Method: This observational study was conducted in RIMS Ranchi in the selected group of patients {n+ 160} who presented in ENT OPD with complaint of globus sensation, sudden choking sensation, throat irritation, dysphagia, chronic cough, ear problem (otitis media, eustachian tube dysfunction), hoarse voice, post nasal drip, heartburn, voice change, and frequent throat clearing. Results: Majority of the patients with laryngeal dysfunction were males of middle socioeconomic strata addicted to smoking and alcohol, had a high BMI, frequently had spicy, fermented food or tea/coffee or aerated drinks. Majority also had improper dinner habits and sleping patterns post dinner.

Background: Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections among patients receiving mechanical ventilation in intensive care units (ICUs). It contributes significantly to morbidity, mortality, and prolonged hospital stay. Understanding the prevalence and microbial profile of VAP is essential for effective infection control and appropriate antimicrobial therapy. Objective: To determine the prevalence of ventilator-associated pneumonia and identify the microbial profile of pathogens responsible for VAP in ICU patients. Materials and Methods: A prospective observational study was conducted at Darbhanga Medical College and Hospital (DMCH), Bihar, India, over a period of one year from January 2024 to January 2025. A total of 110 patients admitted to ICU and requiring mechanical ventilation for more than 48 hours were included in the study. Endotracheal aspirate samples were collected for microbiological analysis. Data were analyzed using SPSS version 26. Statistical tests including chi-square and t-test were applied, with p < 0.05 considered statistically significant. Results: Among the 110 ventilated patients, 34 developed ventilator-associated pneumonia, giving a prevalence of 30.9%. Gram-negative bacteria were the most frequently isolated pathogens. The most common organisms identified were Acinetobacter baumannii (26.5%), followed by Pseudomonas aeruginosa (23.5%) and Klebsiella pneumoniae (20.6%). Statistical analysis demonstrated a significant association between prolonged mechanical ventilation and VAP occurrence (p < 0.01). Conclusion: The study revealed a high prevalence of ventilator-associated pneumonia in ICU patients, predominantly caused by gram-negative bacteria. Early diagnosis, surveillance of microbial patterns, and appropriate antibiotic stewardship are essential to reduce VAP-related morbidity and mortality.

Context: Stress refers to the individual’s reaction to disturbing factor in the environment.  Stress is defined as an adaptive response as behaviour that maintains the integrity of the individual. Adaptation is viewed as positive and is correlated with healthy responses.  Stressors are demands made by the internal or external environment that upset balance, thus affecting physical and psychological well-being and requiring action to restore balance. A diagnosis of cancer is a major event for the person diagnosed and also to his or her family and caregivers. According to some studied it is reported that a cancer diagnosis actually has a greater impact on family members than patients. Most of the cancer care is community based. It is important for the mental health professionals to support the family members and provide interventions when most needed since they have a better understanding of the impact of stress and burden that individuals go through in an oncology setting. Aim: To Assess the level of stress among family members of cancer patients admitted in Acharya Tulsi Cancer Research Institute, PBM Hospital, Bikaner, with a view to develop an information booklet. Methods: In view of the objectives of the present study, a Quantitative Approach was found to be suitable to assess the level of stress among family members of cancer patients. The research design selected for the study was Descriptive Non-Experimental Research Design. In this study research variable is Level of stress among family members of cancer patients admitted in Acharya Tulsi Cancer Research Institute, PBM Hospital, Bikaner. A self-developed questionnaire for demographic variables and self-developed perceived stress scale was prepared in order to attain the objectives of the study. Seven experts did the content validation of demographic tool and standard academic stress scale. Pilot study conducted on 10 family members of cancer patients admitted in Acharya Tulsi Cancer Research Institute, PBM Hospital, Bikaner. This gave a basis to conduct research study.  Reliability of self-developed perceived Stress Scale was established by Cronbach’s Alpha Method. The value of reliability coefficient (r_cronbach’s) is 0.78, which proved that the tool is reliable. Actual study was conducted on 80family members of cancer patients admitted in Acharya Tulsi Cancer Research Institute, PBM Hospital, Bikaner. Results: Findings Related to Level of Stress among family members of cancer patients admitted in Acharya Tulsi   Cancer Research Institute, PBM Hospital, Bikaner.  After analysis of responses of sample after the administration of self-developed perceived stress scale. Major findings reveal that 27 (34%) family members have low stress, 45 (56%) family members have moderate stress, 8 (10%) family members have high perceived stress. So maximum number of family members   have moderate level of stress and maximum score is 40, of which mean is 17.96, mean percentage is 44.9% and standard deviation is 6.3. In case of finding association between level of stress and selected socio demographic variables chi square test was worked out the association between level of stress and selected socio demographic variables marital status was found not significant at 0.05 level of significance. Association between level of stress and selected socio demographic variables viz:  age (in years), gender, relation with patient, type of family, level of education, occupation, monthly income of family, stage of cancer, duration of treatment was found significant at 0.05 level of significance. Conclusions: It can be concluded that there is significant amount of stress  among family members of cancer patients admitted in Acharya  Tulsi   Cancer Research Institute, PBM Hospital, Bikaner  and  socio demographic variables such  as age (in years), gender, relation with patient, type of family, level of education, occupation ,monthly income of family, stage of cancer, duration of treatment affect the   level of stress  among family members of cancer patients admitted in Acharya  Tulsi   Cancer Research Institute, PBM Hospital, Bikaner.

Objectives: The present study was to evaluate the Knowledge, Attitude and Practice towards Allergen specific Immunotherapy in Parents with Children of rural as well as urban area having allergic rhinitis at tertiary care hospital. Methods: Socio-demographic data were gathered from both chil­dren and parents. Information was included age, sex, height, weight, allergic disease history, residence, AR severity, and comorbidities (secretory otitis media, chronic nasosinusitis, bronchial asthma, allergic conjunctivitis). The knowledge dimension encompasses 18 questions, with 8 items on AIT knowledge, 3 items on AIT effect, and 7 items on treatment and prevention of complica­tions of AIT. Except for Item 18 (1 point for 1–2 answer choices; 0 points for 3 or more), each question was scored as 1 point for yes answer and 0 points for no or unknown. The score range of 0–18 points. Results: The mean age of children with AR was 7.024 ± 3.64 years old, and 148(74%) children had mild persistent AR. For comorbidi­ties, allergic conjunctivitis 144(72%) and chronic naso­sinusitis (32.5%) were more common in children with AR.  Among the 200 participating parents, 124(62%) were female. The average age of parents was 36±4.64 years old. Most of the parents 112(52%) had an education level above high school, and 52(26%) parents were business and ser­vice personnel. The mean scores for knowl­edge and practice were 8.68 ± 4.26 and 13.74 ± 4.54, respectively. The median score of attitudes was 30.  A total of 7(3.5%) parents reported a high knowledge level towards AIT for children with AR. Conclusions: parents have moderate level of knowledge and practice of allergic rhinitis in children. So, there is need of educational programme to enhance the immunotherapy. We should also organise free heath checkup camp in rural as well as urban area to aware the parents of children regarding AR and also to addressing the identified barrier and misconception of the management of allergic rhinitis for better treatment outcome.

Background: Gallstones are typically treated with laparoscopic cholecystectomy (LC). However, structural and inflammatory variables make some surgeries challenging. Determining the predictors of challenging LC aids in surgical planning and lowers complications. Aim: To assess the risk factors for challenging laparoscopic cholecystectomy in gallstone disease patients. Methods: Over the course of two years, 100 individuals with gallstone disease were included in this prospective trial. Ultrasonographic, laboratory, and clinical parameters were noted. Intraoperatively, difficulty was evaluated according to bleeding, adhesions, conversion need, and operative time. SPSS was used for statistical analysis, and p < 0.05 was deemed significant. Results: 40 % of the patients had difficult laparoscopic cholecystectomy procedures. Age >50 years, male sex, prior cholecystitis episodes, gallbladder wall thickness >4 mm, and pericholecystic fluid were all significant predictors (p < 0.05). Conclusion: Surgeon can plan their surgical technique and anticipate challenging laparoscopic cholecystectomy by using preoperative clinical and ultrasonographic parameters.

Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbidity. Low-dose aspirin has been recommended for prophylaxis in high-risk women, but real-world data from tertiary centers in India remain limited. Objective: To evaluate the effectiveness of low-dose aspirin prophylaxis in reducing hypertensive complications and improving maternal and perinatal outcomes in high-risk pregnancies. Methods: A prospective observational study was conducted on 90 high-risk pregnant women over 8 months at RMC Janana, Ajmer. Aspirin prophylaxis was initiated early in pregnancy and outcomes were assessed. Results: Aspirin prophylaxis significantly reduced the incidence and severity of HDP, delayed disease onset, and improved neonatal outcomes. Conclusion: Low-dose aspirin is an effective and safe preventive strategy in high-risk HDP pregnancies.

Background: In critical care units (ICUs), bronchoalveolar lavage (BAL) cytology is an essential diagnostic tool for patients with pulmonary disorders. With little invasiveness, it helps detect malignant, inflammatory, and infectious diseases. Aim: To determine the diagnostic yield of BAL cytology in patients who are in critical condition and, in certain situations, the function of cell block production using immunohistochemistry (IHC). Methods: 150 BAL samples that were received throughout a certain time period were the subject of a retrospective study. Cytological results were classified as non-diagnostic, benign, malignant, or inflammatory. IHC-assisted cell block preparation was carried out in a few questionable or cancerous situations. The chi-square test was used for statistical analysis, and a p-value of less than 0.05 was deemed significant. Results: 67 (44.7%) of the 150 BAL samples were cytologically diagnostic. Of these, 12 (17.9%) had malignant lesions, 17 (25.4%) benign, and 38 (56.7%) inflammatory lesions. In nine cases, the creation of cell blocks using IHC helped confirm malignancy. A significant correlation was seen in the diagnostic yield (p = 0.058). In intensive care units, BAL proved particularly useful for identifying infections and cancers. Conclusion: For critically ill pulmonary patients, BAL cytology is an invaluable diagnostic tool. IHC cell block improves diagnosis accuracy, especially in cancers. When it comes to handling critically ill patients and performing BAL, the anesthesiologist is essential.

Background: Lung masses represent a major diagnostic challenge due to their varied etiology ranging from benign inflammatory lesions to malignant neoplasms. Computed tomography (CT)-guided fine needle aspiration (FNA) has emerged as a minimally invasive, accurate, and cost-effective diagnostic tool for evaluating lung lesions. Objective: To assess the diagnostic utility, cytomorphological spectrum, and accuracy of CT-guided FNA in lung mass lesions. Methods: A prospective observational study was conducted at Zoram Medical College & Hospital, Mizoram, from 2020 to 2025. A total of 60 patients with radiologically detected lung masses underwent CT-guided FNA. Smears were stained and evaluated cytologically. Statistical analysis was performed using SPSS software. Results: Out of 60 cases, 48 (80%) were malignant and 12 (20%) were benign. Adenocarcinoma (41.7%) was the most common malignancy. Diagnostic accuracy of CT-guided FNA was 93.3%. Complication rate was minimal. Conclusion: CT-guided FNA is a highly reliable and safe diagnostic modality for lung masses, offering rapid and accurate diagnosis with minimal complications.

Background: Morphometric analysis of the humerus is of significant importance in anatomy, orthopaedics, forensic medicine, and anthropology. Population-specific morphometric data are essential for accurate implant design, surgical planning, and forensic identification, as skeletal dimensions vary across different ethnic and geographical populations. Objectives: To study the morphometric parameters of the humerus in the Indian population and to establish baseline reference data relevant to clinical and forensic applications. Materials and Methods: This observational morphometric study was conducted over a period of 9 months April 2025 to Dec.2025 at Patna Medical College and Hospital (PMCH), Patna. A total of 30 adult humerus bones free from gross pathological changes were analyzed. Parameters measured included maximum length of the humerus, vertical and transverse diameters of the humeral head, mid-shaft circumference, and epicondylar breadth. Measurements were taken using standard osteometric instruments. Descriptive statistical analysis was performed, and results were expressed as mean, standard deviation, and range. Results: The mean maximum length of the humerus was 304.6 ± 18.2 mm. The mean vertical and transverse diameters of the humeral head were 43.8 ± 3.6 mm and 41.9 ± 3.2 mm, respectively. The mid-shaft circumference had a mean value of 65.4 ± 4.9 mm, while the epicondylar breadth averaged 58.7 ± 4.1 mm. Right-sided humeri showed slightly higher mean values compared to left-sided bones; however, no statistically significant side-wise differences were observed. Conclusion: The study provides normative morphometric data of the humerus in the Indian population. These findings may be useful for orthopaedic implant design, surgical procedures, and forensic identification.

Background: Tinea corporis is one of the most common superficial fungal infections affecting the skin. It is primarily caused by dermatophytes and presents as annular erythematous lesions with scaling and itching. Increasing incidence of chronic and recurrent dermatophytosis has been reported in recent years. Accurate laboratory diagnosis and antifungal susceptibility testing are essential for effective treatment. This study evaluated clinical characteristics, mycological profile, antifungal sensitivity pattern and biochemical parameters in patients with tinea corporis. Methods: This retrospective study was conducted at a tertiary care hospital in Keonjhar over a period of one year. Medical records of 150 patients diagnosed with tinea corporis were analyzed. Skin scrapings were examined using potassium hydroxide mount and cultured on Sabouraud Dextrose Agar. Identification was performed using Lactophenol Cotton Blue staining. Biochemical parameters including fasting blood glucose, HbA1c and serum IgE were evaluated. Statistical analysis was performed using SPSS version 24. Results: Dermatophytes were isolated in 112 patients (74.7%). The most common organism identified was Trichophyton rubrum (38%), followed by Trichophyton mentagrophytes (21%), Microsporum species (10%) and Epidermophyton floccosum (5%). Antifungal sensitivity testing showed highest sensitivity to itraconazole (90%), followed by terbinafine (84%), ketoconazole (76%) and fluconazole (68%). Mean fasting blood glucose and HbA1c levels were significantly higher in chronic cases compared to acute cases (p = 0.01 and p = 0.002 respectively). Serum IgE levels were also significantly elevated in chronic cases (p < 0.001). Conclusion: Tinea corporis remains a significant dermatological problem with increasing chronicity. Dermatophytes, particularly Trichophyton rubrum, were the predominant organisms. Biochemical abnormalities such as hyperglycemia and elevated IgE levels were associated with persistent infection. Laboratory-based mycological diagnosis improves treatment outcomes.

Aim: Percutaneous cryoablation has emerged as an important image-guided locoregional therapy for selected patients with primary liver tumors, especially hepatocellular carcinoma (HCC), who are not ideal candidates for surgery or transplantation. The present paper aims to review the scientific basis, procedural technique, patient selection, outcomes, complications, and contemporary role of percutaneous cryoablation in the management of primary liver tumors, with emphasis on HCC and limited reference to intrahepatic cholangiocarcinoma where appropriate. Materials and Methods: This paper is a structured narrative review based on peer-reviewed clinical studies, expert consensus documents, and guideline-oriented sources addressing percutaneous cryoablation for primary liver tumors. Core evidence was drawn from a large single-center experience of 299 hepatic tumors treated in 186 patients, a focused review of cryoablation for HCC, a prospective multicenter comparison of cryoablation versus radiofrequency ablation (RFA) in elderly patients with small HCC, and recent expert guidance on local ablation for HCC. A key technical advantage is direct visualization of the developing ice ball on CT and MRI, permitting intraprocedural assessment of coverage and protection of adjacent critical structures such as the gallbladder, major bile ducts, bowel, diaphragm, and large vessels. Results: Across published series, percutaneous cryoablation is technically feasible, reasonably effective, and most successful in tumors below 4 cm. In the large single-center study, technical success was 94.6% and 3-month technique efficacy was 89.5%, with clearly superior outcomes in tumors under 4 cm compared with those 4 cm or larger. Local tumor progression adjusted for repeat treatment was 23.3% overall, but only 18.0% for tumors under 4 cm compared with 63.3% for larger lesions. In a prospective multicenter study of elderly patients with small HCC, cryoablation and RFA showed similar 1-, 3-, and 5-year overall survival and similar major complication rates, while cryoablation demonstrated lower local tumor progression for lesions larger than 3 cm. Conclusion: Percutaneous cryoablation is a valuable minimally invasive treatment option for selected primary liver tumors, especially early HCC in patients unsuitable for resection or transplantation and in cases where tumor location makes heat-based ablation less desirable. Its principal strengths are accurate ice-ball visualization, relative preservation of adjacent large vessels, less intraprocedural pain, and potentially better local control for somewhat larger small tumors. Its limitations include reduced efficacy in tumors 4 cm or larger, the need for careful post-procedure monitoring, and the persistence of uncommon but serious systemic complications. Overall, current evidence supports cryoablation as an important component of the ablative armamentarium for primary liver tumors when individualized multidisciplinary selection is applied.

Aim: The present paper evaluates transjugular intrahepatic portosystemic shunt (TIPS) in comparison with conventional treatment strategies for improvement in portal hypertension, with particular attention to hemodynamic efficacy, control of variceal bleeding, management of refractory ascites, prevention of recurrent decompensation, and treatment-related adverse events. Materials and Methods: This paper is a narrative, evidence-based comparative review based on current practice guidance, consensus recommendations, and meta-analytic data concerning TIPS and conventional treatment for portal hypertension. Data were synthesized under clinically relevant themes: pathophysiological basis, indications, patient selection, procedural endpoints, conventional comparators, outcomes in variceal bleeding and refractory ascites, post-procedural complications, and practical interpretation for present-day management. Result: The comparative evidence shows that TIPS provides stronger portal decompression than conventional therapy because it directly lowers portal pressure gradient, whereas conventional therapy generally modifies bleeding risk or fluid accumulation indirectly. In variceal bleeding, TIPS reduces recurrent variceal bleeding more effectively than endoscopic therapy, and early TIPS in selected high-risk patients improves one-year mortality while markedly lowering rebleeding risk. In refractory ascites, TIPS is superior to serial paracentesis for ascites control and reduces repeated paracentesis requirements, but this benefit is offset by a greater risk of hepatic encephalopathy and by inconsistent survival advantage across older meta-analyses. Conclusion: TIPS is not simply an alternative to conventional treatment; it is a mechanistically distinct portal decompressive therapy with superior efficacy for selected complications of portal hypertension. Conventional treatment remains foundational for initial stabilization, first-line bleeding management, and broad clinical applicability, but TIPS is superior in reducing recurrent variceal bleeding and in controlling refractory ascites in appropriately selected patients.

Background: Early pregnancy viability assessment is often challenging, particularly when ultrasonographic findings are inconclusive. Serial serum β-human chorionic gonadotropin (β-hCG) measurement provides an important biochemical tool for evaluating early gestation. Objective: To assess the role of β-hCG doubling time patterns in predicting early pregnancy viability. Methods: This prospective observational study was conducted over two years at Rajkiya Mahila Chikitsalaya, Ajmer. Fifty women with early pregnancy (≤7 weeks) and inconclusive ultrasonography were enrolled. Serum β-hCG was measured at presentation and after 48 hours. Percentage rise and doubling time were calculated and correlated with final pregnancy outcomes. Results: Of the 50 women, 30 (60%) had viable intrauterine pregnancies, 14 (28%) had non-viable pregnancies, and 6 (12%) had ectopic pregnancies. Viable pregnancies demonstrated significantly higher 48-hour β-hCG rise and shorter doubling time compared with abnormal pregnancies (p <0.001). Conclusion: β-hCG doubling time is a reliable, non-invasive predictor of early pregnancy viability and serves as a valuable adjunct to ultrasonography in early gestational assessment.

Background: Anemia remains a major public health concern worldwide, particularly in developing countries. It affects all age groups and contributes significantly to morbidity and reduced quality of life. Objective: To determine the prevalence of anemia among patients attending the outpatient department (OPD) of a tertiary care hospital and to analyze its distribution based on demographic variables. Methods: A cross-sectional observational study was conducted over 12 months at BMIMS, Pawapuri, Nalanda. A total of 150 patients attending OPD were included. Hemoglobin levels were measured and anemia was classified according to WHO criteria. Statistical analysis was performed using descriptive statistics and chi-square test. Results: The overall prevalence of anemia was found to be 56%. Higher prevalence was observed in females and younger age groups. The association between gender and anemia was statistically significant (p < 0.05). Conclusion: Anemia is highly prevalent among OPD patients, indicating the need for early screening and preventive strategies.

Background: Prediabetes represents an intermediate metabolic state characterized by impaired glucose regulation and heightened risk of progression to type 2 diabetes mellitus. Emerging evidence suggests that vitamin D deficiency may contribute to dysglycaemia and insulin resistance through its effects on pancreatic β-cell function, insulin sensitivity and systemic inflammation. However, data examining this association in Indian prediabetic populations remain limited. Materials and Methods: This retrospective study was conducted at Patna Medical College, Patna, Bihar, over a period of eight months. Medical records of adults diagnosed with prediabetes who had documented serum 25-hydroxyvitamin D levels and glycaemic parameters were reviewed. Insulin resistance was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and glycaemic variability was evaluated using fasting plasma glucose and postprandial glucose measurements. Correlations between serum vitamin D levels, insulin resistance and glycaemic variability were analysed. Results: Among the study population, vitamin D deficiency was highly prevalent. Lower serum vitamin D levels were significantly associated with higher HOMA-IR values and greater glycaemic variability. Patients with sufficient vitamin D status demonstrated comparatively better insulin sensitivity and more stable glycaemic parameters. Conclusion: Serum vitamin D deficiency is significantly associated with increased insulin resistance and glycaemic variability in individuals with prediabetes. These findings highlight the potential role of vitamin D status in early dysglycaemic states and support consideration of vitamin D assessment as part of comprehensive metabolic risk evaluation in prediabetes.

Background: Mallory–Weiss syndrome (MWS) is characterized by longitudinal mucosal lacerations at the gastroesophageal junction that lead to upper gastrointestinal bleeding. Although commonly reported in individuals with forceful vomiting or alcohol intake, its occurrence during pregnancy is uncommon. Severe vomiting in pregnancy may predispose to sudden increases in intra-abdominal pressure, which can lead to mucosal tears and hematemesis. Objective: To evaluate the clinical presentation, diagnosis, management, and outcome of hematemesis due to esophageal laceration in pregnancy. Methods: A retrospective case analysis was conducted at Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, between April 2024 and April 2025. Clinical data, laboratory findings, imaging results, therapeutic interventions, and maternal outcomes were reviewed. Results: The patient presented at 12+3 weeks of gestation with hematemesis following severe vomiting. Hemoglobin level was markedly reduced (4.6 g/dL). Upper gastrointestinal endoscopy confirmed Mallory–Weiss tears. The patient underwent endoscopic intervention and received three units of packed red blood cells. Hemoglobin improved significantly to 7.9 g/dL post-treatment. Maternal recovery was satisfactory with no adverse fetal outcomes. Conclusion: Mallory–Weiss syndrome, though rare during pregnancy, should be considered in patients presenting with hematemesis following persistent vomiting. Early endoscopic evaluation and prompt supportive therapy play a crucial role in preventing life-threatening complications.

Background: Teenage pregnancy (<19 years) remains a significant public health problem in India, contributing to increased maternal and neonatal morbidity and mortality, particularly in socioeconomically disadvantaged regions. Aim: To assess maternal complications, mode of delivery, neonatal outcomes, and determinants of teenage pregnancy in Dhanbad, Jharkhand. Methodology: A hospital-based prospective observational study was conducted over one year at Department of Obstetrics and Gynaecology, Shahid Nirmal Mahto Medical College and Hospital, Dhanbad. A total of 170 primigravida teenage mothers (13–19 years, ≥28 weeks gestation) were enrolled. Socio-demographic details, antenatal and intrapartum complications, delivery mode, and neonatal outcomes were recorded and analyzed using descriptive statistics and appropriate tests. Results: Most participants were aged 18–19 years (64.7%) and from lower middle socioeconomic class (50.6%). Anaemia was present in 52.9%, and hypertensive disorders in 18.9%. LSCS was performed in 48.2% cases. Low birth weight (35.3%), NICU admission (40%), prematurity (14.1%), and respiratory distress (17.6%) were common neonatal outcomes. Stillbirth and early neonatal death were 2.4% and 1.2%, respectively. Conclusion: Teenage pregnancy is associated with significant maternal complications and adverse neonatal outcomes, underscoring the need for strengthened adolescent reproductive health services and early antenatal care.

Background: A healthy placenta is necessary for the birth of a term infant. One condition linked to placental insufficiency is IUGR. Placental qualitative alterations and IUGR are closely related. The current study’s objective was to assess the histological alterations in placentas from patients with IUGR. Methods: From September 2013 to August 2014, this prospective study was carried out at the Department of Obstetrics and Gynecology, PMCH, Patna, Bihar. 400 patients in all were examined. Of them, 200 had IUGR and 200 were normal patients without it. These individuals were assessed using a semistructured proforma that included a number of clinical and sociodemographic factors. Results: Compared to the control group (33), IUGR patients had a substantially higher number of LSCS births (59). There are 169 syncytial knot formations (>10) in IUGR compared to 153 in the control group, which is statistically insignificant. In IUGR (126), cytotrophoblastic proliferation (>10) is substantially higher than in the control group (92). The number of hylinized areas (> 5) in the IUGR group (101) is considerably greater than in the control group (68), and the number of fibrinoid necrosis in villi > 5 in the IUGR group (57) is significantly higher than in the control group (29). Conclusion: The formation of syncytial knots, cytotrophoblastic cellular proliferation, calcification, and hyalinization of villi are examples of histopathological observations in low power fields that are also recognized as typical aging alterations in the placenta; however, they are more frequent and occur earlier in the IUGR group. In conclusion, these placental morphological and histological findings provide the etiological basis for intrauterine growth restriction.

Background: Numerous changes in biochemical, physiological, hematological, and immunological processes are related to the physiological state of pregnancy. Six to eight percent of pregnancies are complicated by preeclampsia and eclampsia, which can result in a number of problems for both the mother and the fetus. The current study’s objectives were to assess serum LDH levels in both normal pregnant women and pregnant women with preeclampsia and eclampsia during the antepartum phase and to investigate the relationship between serum LDH levels and maternal and perinatal outcomes. Method: From January 2014 to December 2014, ANC mothers between the ages of 18 and 35 who had term singleton pregnancies and were attending the Obstetrics and Gynecology OPD and labor room at Patna Medical College and Hospital in Patna, Bihar, participated in this prospective study. Relevant laboratory tests were carried out following informed consent and a thorough clinical assessment. A completely automated biochemical analyzer was used to estimate the serum LDH. Results: A total of 200 pregnant women were included in the study; 100 of them were normal pregnant women who served as the control group; the remaining 34 (17%) instances were pregnancies with eclampsia, and 66 (33%) were pregnancies with pre-eclampsia. Eight (27.6%) of the 29 study group cases with serum LDH levels between 600 and 800 IU/L had severe pre-eclampsia, and eighteen (62.0%) had eclampsia. Of the 34 cases of eclampsia, 18 (52.9%) had serum LDH levels between 600 and 800 IU/L, while 14 (41.2%) had levels greater than 800 IU/L. The study group’s mean serum LDH was 570.5 IU/L, while the control group’s was 201.5 IU/L. Maternal problems such as abruption, PPH, DIC, and eclampsia with LDH>600 were present in the patients. Neonatal complications like IUGR, fetal distress, neonatal death, LBW, premature birth, IUD were increased with raised LDH. Conclusion: The first indicator of hypoxia and oxidative stress in the blood is serum LDH. Both pre-eclampsia and eclampsia raise it. In order to reduce maternal and fetal morbidity and death, high-risk individuals with elevated LDH levels must be closely monitored and treated promptly. A predictive indicator for preeclampsia and eclampsia is the measurement of serum lactate dehydrogenase.

Background: Displaced supracondylar fractures in the distal humerus are a significant pediatric elbow injury as malreduction can produce cubitus varus, stiffness, and neurovascular sequelae. The most common first-line treatment is closed reduction with percutaneous pinning, though open reduction is still needed for irreducible or neurovascularly concerning fractures. Perioperative, radiographic, and functional outcomes were compared after open versus closed reduction. Methods: This retrospective comparison was performed on 96 children with displaced supracondylar distal humerus fractures from January 2020 to December 2024. Sixty-four received closed reduction and percutaneous pinning (CRPP) and 32 open reduction with pin fixation (ORPP). Demographic information, injury features, operative information, radiographic alignment, Flynn criteria, elbow motion, and complications were examined. Multivariable logistic regression revealed predictors of open reduction. Results: For the ORPP group, there was more severe swelling or pucker sign (50.0% vs 17.2%, p=0.001), delayed presentation beyond 24 hours (37.5% vs 12.5%, p=0.006), flexion-type fractures (15.6% vs 3.1%, p=0.028), and neurovascular abnormality (25.0% vs 6.3%, p=0.009). CRPP had shorter operative time (43.1±8.7 vs 68.4±11.9 minutes, p<0.001) and shorter hospital stay (1.6±0.7 vs 3.2±0.9 days, p<0.001). Excellent or good Flynn functional outcomes occurred in 93.8% of CRPP and 84.4% of ORPP cases. Radiographic restoration was comparable, with satisfactory anterior humeral line position in 93.8% and 90.6%, respectively. Conclusion: Closed reduction remained the preferred strategy because it reduced operative burden while preserving excellent final outcomes. Open reduction, when used for complex or irreducible injuries, still produced acceptable alignment and function and remained a reliable operative option.

Background: Vaginal bleeding during the first trimester is a common obstetric complication and may be associated with underlying hemostatic alterations. Prothrombin time (PT), international normalized ratio (INR), and platelet count are essential parameters for assessing coagulation status. Objective: To evaluate PT, INR, and platelet counts among women presenting with vaginal bleeding in the first trimester and determine their association with pregnancy outcomes. Methods: This prospective observational study was conducted at Zoram Medical College & Hospital, Mizoram, from January 2023 to December 2025. A total of 60 pregnant women presenting with first-trimester vaginal bleeding were included. PT, INR, and platelet counts were measured and analyzed. Statistical analysis was performed using SPSS version XX. Chi-square test and Student’s t-test were applied where appropriate, and a p-value <0.05 was considered statistically significant. Results: Prolonged PT was observed in 25% of patients, while elevated INR was noted in 21.7%. Thrombocytopenia was present in 16.7% of cases. Abnormal PT, INR, and platelet counts were significantly associated with increased severity of bleeding and adverse pregnancy outcomes (p<0.05). Conclusion: Coagulation parameters play a significant role in evaluating first-trimester bleeding and may help predict outcomes.

Background: Psoriasis is a chronic inflammatory skin disorder characterized by excessive proliferation of keratinocytes and immune-mediated inflammation. Oxidative stress has been implicated as an important factor in the pathogenesis of psoriasis. Antioxidants may help reduce oxidative damage and improve clinical outcomes in psoriatic patients. Objective: To evaluate the therapeutic efficacy of antioxidant supplementation in patients with psoriasis and to determine its effect on clinical severity and oxidative stress markers. Materials and Methods: A prospective observational study was conducted at Patna Medical College, Patna, Bihar, India, over a period of eight months from March 2025 to November 2025. Eighty patients diagnosed with psoriasis were included in the study. Clinical severity was assessed using the Psoriasis Area and Severity Index (PASI). Serum antioxidant levels including superoxide dismutase (SOD), catalase, and malondialdehyde (MDA) were measured before and after antioxidant therapy. Statistical analysis was performed using SPSS software version 26. Paired t-test and correlation analysis were applied to determine statistical significance. Results: Following antioxidant therapy, significant improvement was observed in PASI scores and oxidative stress markers. Mean PASI score reduced from 14.6 ± 3.8 to 8.2 ± 2.9 (p < 0.001). Serum SOD and catalase levels increased significantly, while MDA levels decreased. Clinical improvement was observed in 72.5% of patients. Conclusion: Antioxidant supplementation demonstrated beneficial effects in reducing oxidative stress and improving clinical symptoms in psoriasis. The findings suggest that antioxidants may serve as useful adjunctive therapy in psoriasis management.

Objective: The present study was to compare the efficacy and severity of Ormeloxifene and Evening Primrose Oil in the management of mastalgia. Methods: Women aged 18 to 50 years with complaints of breast pain (mastalgia) were included. A total of 100 eligible female patients were enrolled and randomized into two groups: Group A (n=50): Received Ormeloxifene 30 mg, twice weekly for 12 weeks. Group B (n=50): Received Evening Primrose Oil 1000 mg, once daily for 12 weeks. severity of mastalgia was assessed by visual analogue scale (VAS) score ranging from 0-10, zero (0) indicating no pain and ten (10) indicating severe pain. Results: At each time interval (12, 16, 20, and 24 weeks), Group A demonstrates a significantly greater reduction in pain compared to Group B. The mean change in pain for Group A is consistently higher across all time points, with p-values less than 0.001 for each comparison, indicating statistically significant differences in pain reduction between the two groups. Conclusion: Ormeloxifene is a novel non-steroidal, selective antiestrogen and can be used for the treatment of the benign breast diseases, mastalgia, nodularity, and small fibroadenomas.

Background: Enterococcus species have become prominent healthcare-associated pathogens because of their capacity to endure harsh climatic circumstances and to acquire resistance to multiple antimicrobial agents, including vancomycin. In this investigation, Enterococcus isolates obtained from a variety of clinical specimens in a tertiary-care hospital in Bihar, India, were evaluated for prevalence, species distribution, and antibiotic susceptibility. Methods: Two hundred consecutive clinical specimens that yielded Enterococcus spp. between January 2025 and May 2025 were analysed. Standard microbiological techniques, including as Gram staining, culture morphology, and biochemical analysis, were used to identify the isolates. In compliance with CLSI 2025 recommendations, the Kirby-Bauer disk-diffusion technique was used to conduct antimicrobial susceptibility testing. Vancomycin resistance and high-level aminoglycoside resistance (HLAR) were assessed using recognized phenotypic techniques. Results: Among 200 isolates, 110 (55%) originated from urine, 40 (20%) from pus or wound swabs, 30 (15%) from blood, and 20 (10%) from other clinical samples. E. faecalis predominated (60%), followed by E. faecium (35%) and other species (5%). Resistance was most frequent to ampicillin (55%), ciprofloxacin (65%), and tetracycline (60%). HLAR was detected in 33% (gentamicin) and 20% (streptomycin). Vancomycin resistance occurred in 11.5% of isolates—mainly E. faecium (24.3%). Nearly all isolates remained susceptible to linezolid (98.5%) and daptomycin (96%). Nitrofurantoin was active against 82% of urinary isolates. Intensive-care admission and prior antibiotic exposure were significantly associated with VRE isolation (p < 0.05). Conclusions: Enterococcus, particularly E. faecium, demonstrated substantial resistance to commonly prescribed agents, whereas linezolid and daptomycin retained excellent activity. Routine antimicrobial-resistance surveillance and reinforcement of infection-control and stewardship programs are imperative to limit dissemination of multidrug-resistant enterococci.

Background: Rotator cuff tears are a leading cause of shoulder pain and disability. Surgical repair is indicated when symptoms persist despite structured non-operative care. Arthroscopic repair has become dominant in many settings, yet open/mini-open repair remains widely performed due to equipment access, tear morphology, surgeon expertise, and cost considerations. Comparative evidence shows broadly similar mid-term functional outcomes, with potential differences in early pain, soft-tissue morbidity, and complication profiles. Aim: To compare arthroscopic vs open/mini-open rotator cuff repair outcomes using (i) an NMCH institutional cohort and (ii) a PRISMA-aligned systematic review and meta-analysis. Methods: We conducted a prospective comparative cohort at NMCH (n=50). Outcomes included ASES, Constant-Murley score, VAS pain, complications (stiffness, SSI), and imaging-defined retear at 10 months. In parallel, we performed a PRISMA-guided systematic review and fixed-effect meta-analysis of comparative studies evaluating arthroscopic vs open/mini-open repair. Effect estimates were pooled as risk ratios (RR) for retear and mean differences (MD) for Constant score. Results: In the NMCH cohort, both groups improved substantially; arthroscopic repair showed greater mean improvement in ASES and Constant score and lower VAS pain at 10 months, with fewer retears and SSI events. In meta-analysis, arthroscopic repair demonstrated a trend toward lower retear risk (pooled RR 0.78, 95% CI 0.59–1.05) and a small, non-significant Constant score advantage (pooled MD +1.97 points, 95% CI −0.94 to +4.87). Key contemporary evidence supports similar functional recovery overall, while some datasets show lower infection risk after arthroscopy. Conclusion: Arthroscopic and open/mini-open rotator cuff repair yield comparable functional outcomes overall, with institutional and pooled data suggesting modest advantages for arthroscopy in pain and complication profile and a possible reduction in retear risk. Technique selection should be individualized based on tear characteristics, surgeon expertise, resource availability, and patient risk profile.

Background: Subaxial cervical spine injuries (C3–C7) are among the most disabling traumatic lesions, frequently complicated by neurological deficit, pain, and long-term disability. Surgical fixation aims to restore stability, decompress neural elements, correct alignment, and enable early rehabilitation. Aim: To evaluate functional and neurological outcomes following surgical fixation for subaxial cervical spine injuries in a tertiary trauma institution. Methods: A prospective observational study was conducted at Nalanda Medical College & Hospital, Patna, Bihar, India from 15th February 2025 to 20th November 2025. Thirty consecutive adults with surgically managed subaxial cervical spine injuries were enrolled. Injury characterization used contemporary trauma principles (morphology and neurological status). Functional outcomes were assessed using Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, pain VAS, and neurological status using AIS grade at admission and follow-up (3 and 6 months). Paired comparisons evaluated change over time; multivariable logistic regression explored predictors of a favorable outcome. Results: Mean age was 31.6±10.2 years; 80% were male. Road-traffic injury was the commonest mechanism (76.7%). At 6 months, mean NDI improved from 65.5±10.5 to 27.4±13.6 (p<0.001), mean mJOA improved from 8.8±2.7 to 11.7±3.4 (p<0.001), and mean VAS decreased from 6.78±1.34 to 2.13±1.42 (p<0.001). AIS grade improved by ≥1 grade in 46.7% overall; complications were mostly minor (overall any complication 23.3%, with no perioperative mortality). Early surgery (≤48 h) showed higher odds of favorable outcome (adjusted OR 4.43, 95% CI 0.62–31.89), though not statistically significant in this small cohort. Conclusion: Surgical fixation for subaxial cervical spine injuries in our institution resulted in clinically meaningful improvement in disability, pain, and neurological function by 6 months, with an acceptable complication profile. Larger multicenter studies with longer follow-up are warranted.

Background: Displaced acetabular fractures remain among the most technically demanding injuries in orthopaedic trauma because restoration of a congruent hip joint requires accurate fracture classification, approach selection, stable fixation, and early functional rehabilitation. Despite advances in imaging and surgical strategies, outcomes still vary widely and are strongly influenced by reduction quality and fracture complexity. Aim: To evaluate clinical and radiological outcomes after surgical fixation of acetabular fractures and to identify predictors of favorable hip function. Methods: A prospective observational study was conducted at Nalanda Medical College & Hospital, Patna, Bihar, India, from 5th February 2025 to 30th November 2025, including 50 adult patients with displaced acetabular fractures treated surgically. Fractures were classified using the Judet–Letournel system. Surgical approach was selected based on fracture pattern (posterior: Kocher–Langenbeck; anterior: modified Stoppa/ilioinguinal; complex: combined approaches). Radiological reduction was graded using Matta criteria, and hip function at 10 months was assessed using the modified Merle d’Aubigné score. Multivariable logistic regression explored predictors of good/excellent functional outcomes. Results: Mean age was 38.0±11.4 years; 82% were male; 76% sustained injury in road traffic accidents. Anatomic reduction (0–1 mm) was achieved in 60%. At 10 months, functional outcomes were excellent 44%, good 34%, fair 14%, poor 8% (good/excellent combined 78%). Complications included surgical site infection 6%, heterotopic ossification 10%, post-traumatic osteoarthritis 10%, and reoperation 8% (conversion to THA 4%). Anatomic reduction (adjusted OR ≈ 5.8) and surgery ≤7 days (adjusted OR ≈ 4.1) independently predicted good/excellent function; hip dislocation reduced the odds. Conclusion: Surgical management of displaced acetabular fractures at our center produced predominantly good-to-excellent outcomes. Early surgery and anatomic reduction were the strongest modifiable determinants of favorable hip function.

Background: AO/OTA type 33-C distal femur fractures are complex intra-articular injuries associated with stiffness, malalignment, and nonunion risk, especially in high-energy trauma and compromised biology. Locking compression plates (LCP) allow stable fixation in osteoporotic metaphyseal bone while enabling early mobilization, but reported union and functional results vary across cohorts and constructs. Aim: To evaluate radiological union, complications, and functional outcomes (Neer score) following fixation of AO/OTA 33-C distal femur fractures using distal femur locking compression plate at NMCH. Methods: A prospective observational study was conducted from 8th February 2025 to 25th November 2025 in 50 adults with AO/OTA 33-C distal femur fractures treated with lateral distal femur LCP. Standard perioperative protocols, fracture-specific reduction principles, and structured rehabilitation were followed. Outcomes included union rate and time, knee range of motion (ROM), Neer functional score at 6 and 10 months, and complications. Associations between risk factors and poor/fair outcome were explored using unadjusted odds ratios. Results: Mean age was 41.1 ± 13.7 years, with 74% males and 78% high-energy road traffic injuries. Any open fracture was present in 26%. Radiological union was achieved in 44/50 (88.0%), with mean union time 18.5 ± 3.2 weeks among united fractures. At 10 months, Neer outcomes were Excellent 26%, Good 44%, Fair 20%, Poor 10%; mean knee ROM at 10 months was 113.0 ± 15.1°. Poor/fair outcome (Neer <70) was more frequent with open fractures, medial comminution, diabetes, smoking, and surgical delay >7 days. Conclusion: Lateral locked plating for AO/OTA 33-C distal femur fractures provided high union rates and predominantly good-to-excellent functional outcomes, but open injury, compromised biology, and medial comminution were associated with inferior function. Early stabilization with attention to construct strategy and aggressive rehabilitation remains critical.

Background: Diffuse Parenchymal Lung Diseases (DPLD), another name for Interstitial Lung Diseases (ILDs), are a diverse collection of conditions marked by differing degrees of lung interstitial fibrosis and inflammation. Accurate diagnosis is still very difficult since clinical and radiographic characteristics overlap. Aim: To outline a systematic approach to the diagnosis of interstitial lung diseases, integrating clinical, radiological, and pathological parameters. Methods: The diagnostic framework of ILDs was examined using a thorough review-based methodology. High-resolution computed tomography (HRCT) patterns, categorization schemes, and clinical presentation were assessed. Correlating imaging results with pathological patterns and illness features, such as exposure history, disease development, and treatment response, was emphasized. Results: Exertional dyspnea, bilateral infiltrates on imaging, and restrictive patterns on pulmonary function tests are frequent symptoms of ILDs. Differential diagnoses can be narrowed by classification based on morphological and etiological characteristics. In order to detect patterns like reticular, nodular, ground-glass opacities, and cystic alterations, HRCT is essential. Certain patterns, such as nonspecific interstitial pneumonia (NSIP) and typical interstitial pneumonia (UIP), have different therapeutic implications. Accurate diagnosis requires the integration of imaging, histology, and clinical history. Conclusion: A multidisciplinary approach combining clinical evaluation, HRCT imaging, and pathological correlation is crucial for the accurate diagnosis of ILDs. Early and precise identification enables appropriate management strategies, improves prognosis, and helps tailor individualized treatment plans.

Background: Sleep apnea syndrome (SAS) is a common but underdiagnosed disorder characterized by repeated episodes of airflow cessation during sleep, leading to fragmented sleep and systemic complications. Understanding its clinical profile in tertiary care settings is essential for early diagnosis and management. Objective: To evaluate the demographic characteristics, clinical presentation, risk factors, and severity patterns of sleep apnea syndrome among patients attending a tertiary care center. Methods: This retrospective study was conducted at Netaji Subhash Medical College over a period of 12 months. A total of 100 patients diagnosed with sleep apnea using polysomnography were included. Data regarding demographic profile, clinical symptoms, comorbidities, and apnea-hypopnea index (AHI) were analyzed. Statistical analysis was performed using SPSS version 25.0, with p < 0.05 considered significant. Results: The mean age of participants was 52.4 ± 11.6 years, with male predominance (68%). Obesity (BMI ≥30 kg/m²) was observed in 61% of patients. Snoring (92%), excessive daytime sleepiness (78%), and witnessed apnea (64%) were the most common symptoms. Severe OSA was present in 42% of cases. Significant associations were observed between severity of OSA and BMI (p = 0.002), hypertension (p = 0.01), and diabetes mellitus (p = 0.03). Conclusion: Sleep apnea syndrome is highly prevalent among middle-aged obese males with significant cardiometabolic comorbidities. Early screening and intervention strategies are crucial in tertiary care settings.

Background: Recurrent infections and irreversible bronchial dilatation are hallmarks of bronchiectasis, a chronic respiratory disease. For early diagnosis and treatment, it is critical to comprehend its etiological and clinical characteristics. Objective: To assess bronchiectasis patients’ clinical manifestations and underlying causes in a general respiratory department. Methods: 100 individuals who were diagnosed with bronchiectasis in a tertiary care respiratory department over a 12-month period were included in this retrospective analysis. Hospital records were used to gather information about the etiological causes, clinical symptoms, and demographic profile. The chi-square test was used for statistical analysis, and a p-value of less than 0.05 was considered significant. Results: 39% of patients were in the 30- to 50-year-old age range. 57% of the participants in the study were men. The most frequent cause was post-infectious bronchiectasis (29%), which was followed by idiopathic (21%), COPD’s (20%), tuberculosis’s (20%), and allergic bronchopulmonary aspergillosis’s (10%). The most frequent presenting symptoms were hemoptysis (30%) and persistent cough (26%). Gender and etiology did not show a statistically significant correlation (p = 0.60). Conclusion: The two main etiological causes of bronchiectasis are still post-infectious and tuberculosis-related. The most common clinical manifestations are hemoptysis and persistent cough. Early etiological factor identification may enhance treatment and lessen the burden of illness.

Background: Environmental pollution has become a major global health concern, particularly affecting vulnerable populations such as children. Exposure to pollutants including particulate matter, nitrogen dioxide, and sulfur dioxide has been associated with increased respiratory morbidity in pediatric populations. Objective: To evaluate the effect of environmental pollution on respiratory health among pediatric patients attending a tertiary care hospital. Materials and Methods: This hospital-based observational study was conducted at Netaji Subhas Medical College and Hospital (NSMCH), Bihta, from November 2022 to November 2023. A total of 100 pediatric patients presenting with respiratory complaints were included. Demographic data, exposure history to environmental pollutants, and respiratory diagnoses were recorded. Statistical analysis was performed using the chi-square test and logistic regression, with p < 0.05 considered statistically significant. Results: Out of 100 children, 58% were male and 42% were female. The most common respiratory conditions observed were acute respiratory infection (32%), bronchial asthma (28%), bronchitis (22%), and allergic rhinitis (18%). Children exposed to higher environmental pollution levels showed a significantly different pattern of respiratory diseases compared with those with lower exposure (χ² = 8.62, p = 0.013). Conclusion: The findings of this study suggest that exposure to environmental pollution is significantly associated with respiratory diseases among pediatric patients. Strengthening environmental control measures and reducing pollution exposure may help improve respiratory health outcomes in children.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia and associated long-term complications affecting multiple organ systems. Among these, microvascular complications such as diabetic retinopathy, nephropathy, and neuropathy significantly contribute to morbidity and reduced quality of life. Objective: To evaluate the pattern and prevalence of microvascular complications among patients with Type 2 Diabetes Mellitus attending a tertiary care hospital. Methods: A retrospective observational study was conducted at Bhagwan Mahavir Institute of Medical Sciences (BMIMS), over a period from February 2025 to January 2026. Medical records of 150 patients diagnosed with Type 2 diabetes mellitus were reviewed. Data regarding demographic profile, duration of diabetes, and presence of microvascular complications were collected. Statistical analysis was performed using SPSS version 25. Chi-square test was used to determine associations, with p < 0.05 considered statistically significant. Results: Out of 150 patients, 86 (57.3%) developed at least one microvascular complication. Diabetic neuropathy was the most common (34%), followed by retinopathy (28%) and nephropathy (21%). A statistically significant association was observed between duration of diabetes and development of complications (p = 0.012). Conclusion: Microvascular complications are common among patients with Type 2 diabetes mellitus. Early screening and strict glycemic control are essential to reduce disease burden.

Background: Vaccine hesitancy has emerged as a major public health challenge, affecting the success of immunization programs globally and in India. Despite the availability of free vaccination services under the Universal Immunization Programme, gaps persist in achieving optimal coverage due to behavioural, social, and programmatic barriers. The increasing spread of misinformation, particularly through digital platforms, has further complicated vaccine acceptance. Objective: This narrative review aims to examine vaccine hesitancy and acceptance in India by analyzing behavioural determinants, social influences, and programmatic factors, and to identify strategies to improve immunization uptake. Methodology: A narrative review approach was adopted using literature from PubMed, Google Scholar, Scopus, and Web of Science, along with reports from national and international organizations. Studies published between 2010 and 2025 were included. Relevant articles were screened based on predefined inclusion and exclusion criteria, and data were synthesized into thematic domains including magnitude of hesitancy, behavioural factors, social determinants, programmatic gaps, and misinformation. Results: The review found that vaccine hesitancy affects approximately 20%–30% of caregivers in India, contributing to incomplete immunization, with 10%–15% of children partially vaccinated. Behavioural factors such as lack of awareness (30%–40%) and fear of side effects (25%–35%) were major contributors. Social determinants, including maternal education and community influence, significantly affected vaccine uptake, with educated mothers being 1.5–2 times more likely to ensure complete immunization. Programmatic issues such as inadequate counselling (~30%) and service-related gaps (15%–20%) also contributed to missed vaccinations. Additionally, exposure to misinformation (40%–50%) negatively impacted vaccine acceptance, particularly during the COVID-19, where acceptance ranged from 60% to 80%. Targeted communication interventions were shown to improve uptake by 15%–20%. Conclusion: Vaccine hesitancy in India is a multifactorial issue influenced by behavioural, social, and health system factors. Addressing misinformation, strengthening communication strategies, and improving health system performance are essential to enhance vaccine acceptance and achieve universal immunization goals.

Background: Melasma is a common acquired disorder of hypermelanosis affecting sun-exposed areas, particularly the face. It predominantly affects individuals with Fitzpatrick skin types III–V and significantly impairs quality of life. There is a paucity of data on the clinico-epidemiological profile of melasma from the northeastern region of India. Objectives: To evaluate clinical patterns of melasma and to estimate the prevalence among males and females and assess associated risk factors in a tertiary care hospital in Assam. Methods: A hospital-based cross-sectional observational study was conducted over six months among 120 patients clinically diagnosed with melasma attending the dermatology outpatient department of Silchar Medical College and Hospital. Detailed history, clinical examination, Wood’s lamp evaluation, and Melasma Area and Severity Index (MASI) scoring were performed. Results: The mean age of the study population was 34.8 ± 8.6 years. There was a marked female predominance (female-to-male ratio 5:1). The centrofacial pattern was the most common clinical presentation (61.7%), followed by the malar (31.7%) and mandibular (6.6%) patterns. The epidermal type predominated on Wood’s lamp examination (58.3%). Significant associations were observed with chronic sun exposure (78.3%), pregnancy (30%), family history (30%), use of oral contraceptive pills (18.3%), and topical steroid application (21.7%). Conclusion: Melasma in Northeast India predominantly affects women of reproductive age with centrofacial distribution. Sun exposure remains the principal aggravating factor, and there is a notable prevalence of unsupervised topical steroid use in this population.

Background: Quetiapine is widely regarded as having low propensity for extrapyramidal symptoms (EPS) because of transient striatal dopamine D₂ receptor occupancy and rapid dissociation kinetics. However, acute dystonic reactions have been reported, occasionally at very low doses used off-label for insomnia and anxiety. Case Presentation: A 32-year-old Indian male presented to the emergency department with abrupt onset of lateral tongue deviation, sustained jaw and facial muscle spasms, and dysarthria. Symptoms emerged on day 3 after initiation of quetiapine 25 mg at bedtime for insomnia and anxiety, while he remained on a stable one-year regimen of escitalopram 20 mg and clonazepam 0.5 mg daily. Neurological examination confirmed isolated oromandibular dystonia without oculogyric crisis, rigidity, autonomic instability, or altered sensorium. Serum electrolytes, including calcium, were within normal limits. Intravenous promethazine 50 mg produced complete symptom resolution within two hours. Quetiapine was discontinued; escitalopram was continued unchanged. The Naranjo Adverse Drug Reaction Probability Scale yielded a score of 7 (probable). At one-week follow-up, no recurrence or residual symptoms were noted. Conclusion: Acute oromandibular dystonia may occur with very low-dose quetiapine even in patients stabilised on serotonergic co-medication. Young male sex, early treatment exposure, and concomitant selective serotonin reuptake inhibitor (SSRI) therapy are plausible modifiers of susceptibility. Prompt recognition and parenteral anticholinergic or antihistaminic therapy yield rapid resolution. Clinicians prescribing quetiapine off-label for sleep and anxiety should remain vigilant for EPS and report such reactions to pharmacovigilance systems.