Background: Chronic postoperative inguinal pain (CPIP) has emerged as the most clinically significant complication following inguinal hernia repair, surpassing recurrence as the primary concern in modern hernia surgery. Despite advances in surgical techniques and prosthetic materials, CPIP continues to affect a substantial proportion of patients and remains incompletely understood in terms of its modifiable and non-modifiable risk determinants. Methods: This prospective cohort study enrolled 360 adult patients who underwent primary unilateral inguinal hernia repair at a tertiary surgical center. Patients were categorized by surgical technique: open Lichtenstein mesh repair (n = 186) and laparoscopic transabdominal preperitoneal (TAPP) repair (n = 174). Pain assessment was performed using the Visual Analogue Scale (VAS) and the Inguinal Pain Questionnaire (IPQ) preoperatively and at 1, 3, 6, and 12 months postoperatively. CPIP was defined as pain persisting beyond 3 months. Multivariate logistic regression identified independent risk factors. Results: CPIP at 6 months was present in 68 patients (18.9%). The incidence was significantly higher after open repair (23.1% vs. 14.4%; p = 0.034). Independent risk factors included younger age (<40 years; OR = 2.78; 95% CI: 1.53–5.06; p = 0.001), preoperative pain intensity VAS ≥5 (OR = 3.14; 95% CI: 1.72–5.74; p < 0.001), open surgical technique (OR = 1.93; 95% CI: 1.08–3.45; p = 0.027), heavyweight mesh use (OR = 1.86; 95% CI: 1.04–3.34; p = 0.036), early postoperative pain VAS ≥6 at 24 hours (OR = 2.41; 95% CI: 1.36–4.27; p = 0.003), and postoperative complications (OR = 2.17; 95% CI: 1.12–4.21; p = 0.022). Conclusion: CPIP remains a prevalent complication, with younger age, preoperative pain intensity, open surgical approach, heavyweight mesh, severe early postoperative pain, and postoperative complications identified as independent predictors. Laparoscopic repair was associated with a significantly lower incidence of chronic pain.

Background: Emergence delirium (ED) is a frequent and distressing complication following sevoflurane-based general anesthesia in pediatric patients undergoing ear, nose, and throat (ENT) surgery. Dexmedetomidine, a selective alpha-2 adrenergic agonist, has been proposed as a pharmacological strategy for reducing ED incidence; however, optimal dosing protocols and comprehensive hemodynamic safety data in the pediatric ENT population remain insufficiently characterized. Methods: In this prospective, double-blind, randomized controlled trial, 120 children (ASA I–II) were randomly allocated to receive either dexmedetomidine (0.5 µg/kg loading dose followed by 0.2 µg/kg/h maintenance infusion; Group D, n = 60) or equivalent volume normal saline (Group S, n = 60). The primary outcome was ED incidence assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Secondary outcomes included ED severity scores, time to extubation, postoperative pain scores (FLACC scale), rescue analgesic requirements, and hemodynamic parameters. Results: The incidence of ED was significantly lower in Group D compared to Group S (18.3% vs. 46.7%; p < 0.001). The mean peak PAED score was 8.42 ± 3.71 in Group D versus 13.86 ± 4.29 in Group S (p < 0.001). FLACC pain scores at 30 minutes postoperatively were significantly lower in Group D (2.18 ± 1.34 vs. 4.52 ± 1.87; p < 0.001). Time to extubation was modestly prolonged in Group D (9.73 ± 2.46 vs. 7.85 ± 2.12 min; p = 0.003). No clinically significant bradycardia or hypotension episodes requiring intervention were observed. Conclusion: Perioperative dexmedetomidine infusion significantly reduces the incidence and severity of emergence delirium and postoperative pain in pediatric ENT surgery patients with an acceptable hemodynamic safety profile and minimal prolongation of extubation time.

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with significant morbidity through micro- and macrovascular complications. Serum uric acid (SUA) has emerged as a potential biomarker linked to glycaemic dysregulation, dyslipidaemia, and early renal impairment. Despite its clinical relevance, SUA levels in T2DM patients remain understudied in the Indian context, particularly in Gujarat. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital, Pramukh Swami Medical College, Karamsad, and enrolling 200 participants: 100 T2DM patients and 100 age-sex–matched healthy controls. Biochemical parameters including fasting plasma glucose (FPG), HbA1c, serum uric acid, lipid profile, serum creatinine, and urine albumin-to-creatinine ratio (UACR) were measured. Statistical analysis was performed using Epi info version 7. Results: Serum uric acid was significantly elevated in T2DM patients (6.43 ± 1.19 mg/dL) compared to controls (4.84 ± 0.99 mg/dL; p<0.001). Hyperuricaemia was present in 34% of diabetic patients versus 8% of controls. SUA correlated positively with triglycerides (r=0.46), FPG (r=0.34), HbA1c (r=0.29), and UACR, and negatively with HDL-C (r=−0.31). ROC analysis revealed SUA >6.2 mg/dL as the optimal cut-off for predicting albuminuria (AUC=0.76; sensitivity 72%, specificity 68%). Conclusion: Serum uric acid is significantly elevated in T2DM patients and independently correlates with atherogenic dyslipidaemia and early renal damage. Routine SUA monitoring may serve as an accessible and cost-effective biomarker for cardiorenal risk stratification in diabetic populations.

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Although tobacco smoking is the principal risk factor, chronic exposure to biomass fuel smoke is increasingly recognized as an important contributor, particularly in low- and middle-income countries. Traditional tandoor bakers are occupationally exposed to firewood smoke for prolonged durations under poorly ventilated conditions. Objectives: To evaluate lung function impairment and the prevalence of COPD among traditional tandoor bakers exposed to firewood smoke in Jammu and Kashmir. Materials and Methods: This cross-sectional observational study was conducted over 18 months across multiple districts of Jammu and Kashmir. Adult tandoor bakers with at least one hour of daily occupational exposure to firewood-fueled tandoors were enrolled. Spirometry was performed according to standard guidelines. COPD was defined as post- bronchodilator FEV₁/FVC <0.7. Results: A total of 49 tandoor bakers were evaluated, with a marked male predominance (93.9%). Pre-bronchodilator airflow obstruction was observed in 38.7% of participants, while 28.6% had confirmed COPD following bronchodilator testing. COPD prevalence was higher among smokers; however, a substantial proportion of non-smokers also demonstrated airflow obstruction. Increased duration of occupational exposure and higher daily firewood consumption were associated with reduced lung function parameters. Conclusion: Traditional tandoor bakers exposed to chronic firewood smoke demonstrate a high prevalence of COPD and impaired lung function. Occupational exposure to biomass smoke represents a significant and preventable risk factor, highlighting the need for targeted occupational health interventions.

Background: Knee osteoarthritis (KOA) represents a leading cause of chronic musculoskeletal disability worldwide, with management strategies ranging from conservative approaches including pharmacotherapy and physical rehabilitation to surgical interventions such as arthroscopy and total knee arthroplasty (TKA). Despite extensive clinical experience with both modalities, comparative evidence regarding their long-term effectiveness across varying disease severities remains incomplete and frequently contested. Methods: This prospective comparative cohort study enrolled 324 patients diagnosed with symptomatic KOA (Kellgren-Lawrence grades II–IV) at a university-affiliated orthopedic center. Patients were allocated to surgical management (n = 158; arthroscopic debridement or TKA) or conservative management (n = 166; structured physical therapy, pharmacological intervention, and intra-articular injections). Primary outcomes included changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and visual analog scale (VAS) pain scores at 6 and 12 months. Secondary outcomes encompassed functional mobility assessed via the Timed Up and Go (TUG) test, patient satisfaction, and complication rates. Results: At 12 months, the surgical group demonstrated significantly greater improvement in WOMAC total scores (−28.4 ± 11.6 vs. −14.7 ± 9.8; p < 0.001) and VAS pain reduction (−4.2 ± 1.8 vs. −2.1 ± 1.5; p < 0.001). However, subgroup analysis revealed that patients with Kellgren-Lawrence grade II showed comparable outcomes between groups (p = 0.214). The surgical group experienced a 12.0% complication rate versus 3.6% in the conservative group (p = 0.005). Patient satisfaction was high in both groups (87.3% vs. 74.1%; p = 0.003). Conclusion: Surgical management of KOA yields superior pain relief and functional outcomes compared to conservative treatment, particularly in advanced disease stages. However, conservative management demonstrates comparable effectiveness in mild-to-moderate disease with significantly fewer complications, supporting a severity-guided treatment algorithm.

Background: Sinonasal masses are a heterogeneous disease ranging from disease of inflammation at one end of the spectrum to aggressive malignancy at the other. Symptoms and endoscopic appearance are often quite similar, so information from imaging and histopathology are accessible to make real treatment decisions and make a final diagnosis. Contemporary consensus includes the fact that a multidisciplinary approach with the integration of clinical phenotype, CT/MRI-defined extent, and tissue diagnosis is important. Methods: We performed a retrospective observational study of 120 consecutive clinical cases of patients with clinically suspected sinonasal masses who attended a tertiary care center otorhinolaryngology unit (January 2023-December 2024). All patients received diagnostic examination with nasal endoscopy and with contrasting CT (and MRI – with the indication), followed by the biopsy or excision with histopathology confirmation. Radiological impressions were grouped into inflammatory/nectoplasm, benign neoplasm, and malignant neoplasms. Agreement between radiology and histopathology was determined by Cohen’s kappa. Diagnostic performance metrics (sensitivity, specificity) were calculated with regard to malignancy prediction. Results: Nasal obstruction (90.0%) and rhinorrhea (52.5%) were the main symptoms. Histopathological diagnosis performed showed inflammatory polyps (37.5%), fungal rhinosinusitis (15.0%), inverted papilloma (11.7%), juvenile nasopharyngeal angiofibroma (6.7%), other benign lesions (5.8%) and malignancy (24.2%). Imaging features that were most commonly seen in malignancy included frank bony destruction, with/without orbital/intracranial extension, perineural spread, and necrotic enhancement. Radiology was 86.2% sensitive and 90.1% specific and had high agreement with histopathology (k=0.74). Inverted papilloma was most often misdiagnosed as a malignancy either when cerebriform architecture was absent or adjacent remodeling of the bone was misinterpreted as destructive change. Conclusion: Clinical evaluation alone, however, cannot suffice in the classification of causes of a sinonasal mass. A structured algorithm using endoscopy, CT to assess bone and surgical road mapping techniques, MRI for characterization of soft tissue, and histopathology results in a high diagnostic agreement and appropriately narrows a surgical approach and oncologic referral pathways.

Background: Anal fissure is one of the most common benign anorectal disorders characterized by severe pain during defecation. Medical therapy is the first line of treatment aimed at reducing internal anal sphincter spasm and improving Ano dermal blood flow. Topical calcium channel blockers such as diltiazem and nifedipine are widely used, while metronidazole with sucralfate has recently shown promising results. Objective: To compare the effectiveness of topical diltiazem (2%), nifedipine (0.3%), and metronidazole with sucralfate in the treatment of anal fissure. Methods: A prospective observational comparative study was conducted over a period of two years (January, 2024-January,2026) in the Department of General Surgery at Burdwan Medical College and Hospital. A total of 150 patients diagnosed with anal fissure were included and divided into three treatment groups: Diltiazem, Nifedipine, and Metronidazole with Sucralfate. Patients were followed up for 8 weeks with evaluation of pain score, healing rate, recurrence, and adverse effects. Results: Nifedipine showed the highest healing rate (82%) followed by metronidazole with sucralfate (76%) and diltiazem. Pain relief was faster in the nifedipine group. Recurrence was lowest in the combination therapy group (6%). Conclusion: Topical nifedipine appears to be the most effective conservative treatment, while metronidazole with sucralfate provides comparable results with good symptom relief.

Background: Globally, more than one billion adults have hypertension and majority of them are residing in low- and middle- income countries (LMICs). Life style modification is an important measures taken to modify the dietary patterns and physical activity, hence helps in control of Diabetes and Hypertension. Objective: To assess the impact of Health Education on blood pressure control among the hypertensive patients attending Urban Health training Center of a medical college. Methods and Materials: A Quasi experimental study (without control) was conducted among 72 hypertensive patients attending urban health training Centre of SSIMS & RC, Davanagere. Counseling on life style modification was given in local language, supported by pictures, videos, face to face interviews and discussions with individuals. Follow up was done for a period of six months. Results: In this study it was observed that, from the first visit to last visit, the number of controlled blood pressure patients increased gradually after intervention. High significance difference was found between mean systolic and diastolic blood pressure after intervention compare to basic value (P < 0.05). Conclusion: This study reinforces the importance of health education on lifestyle modifications with regular follow up visits can lead to reduction of blood pressure among uncontrolled hypertensive patients.

Background: Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus and a leading cause of preventable visual impairment worldwide. Hemodynamic alterations in retrobulbar circulation play a key role in the pathogenesis and progression of DR. Colour Doppler imaging (CDI) enables non-invasive evaluation of orbital vascular parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI). Objectives: To assess and compare hemodynamic alterations in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA) in diabetic patients without and with retinopathy using colour Doppler ultrasound, and to evaluate RI as a potential imaging biomarker correlating with DR severity. Materials and Methods: This comparative two-group clinical study included 80 diabetic patients (40 without DR and 40 with DR) over 12 months. All patients underwent orbital CDI evaluation of OA, CRA, and SPCA in both eyes. PSV, EDV, and RI were recorded. Statistical analysis was performed using Student’s t-test, Chi-square test, and one-way ANOVA, with p<0.05 considered significant. Results: Duration of diabetes and random blood sugar levels were significantly higher in patients with DR (p=0.002 and p≤0.001, respectively). In the OA and CRA, EDV was significantly reduced and RI significantly elevated in DR patients (p<0.001), while PSV showed no consistent significant difference. In the SPCA, both PSV and EDV were significantly reduced, and RI significantly increased in DR patients (p<0.001). RI demonstrated a progressive and statistically significant rise from no DR to NPDR and PDR across all vessels (p<0.001). Conclusion: Orbital hemodynamic alterations are significantly associated with diabetic retinopathy. Elevated resistive index correlates strongly with disease severity and may serve as a reliable non-invasive imaging biomarker for early detection and monitoring of DR progression.

Background: Acute stroke presents a complex clinical emergency that not only disrupts the central nervous system but also initiates a series of pathophysiological complications due to biochemical imbalances, with increased rates of morbidity and mortality. Method: 80 (eighty) patients having strokes (ischemic/hemorrhagic) were studied. Biochemical tests included fasting blood glucose, lipid profiles, Serum electrolytes were studied in both ischemic and hemorrhagic strokes and compared with normal (control) groups, yielding significant results. Results: Ischemic strokes were highest in the 46-55 age group, followed by the 35-45 age group, and lowest in the 76-80 age group. Hemorrhagic strokes were highest in 5 (28.5%) in the 46-55 age group and in the 65-75 age group. Conclusion: Elevated imbalances are often exacerbated by a late approach to medical aid, preexisting malnutrition, and dehydration. Elevated serum sodium is observed in acute stroke patients. It will help the physician to treat such patients efficiently and reduce morbidity and mortality.

Excessive exposure to ultraviolet (UV) radiation is a major cause of skin damage, premature aging, and photocarcinogenesis. The present study is aimed to develop and evaluate a microsphere-based sunscreen cream incorporating Benzophenone-3 as an organic UV filter in combination with inorganic UV blockers (zinc oxide and titanium dioxide) to enhance photoprotective efficacy and dermal safety. Benzophenone-3 was encapsulated into ethyl cellulose microspheres to improve photostability and control release characteristics. Five formulations were prepared, including placebo, free drug, microsphere-loaded, inorganic-only, and combined microsphere–inorganic systems. Ex-vivo permeation studies were conducted using Franz diffusion cells with porcine flank skin. In-vivo skin irritation and sun protection factor (SPF) studies were performed using Wistar albino rats. The combined microsphere–inorganic formulation demonstrated the maximum SPF value of 21. Ex-vivo studies showed negligible transdermal permeation (<1%) with predominant drug retention (>90%) in the stratum corneum. All formulations were classified as non-irritant according to the Draize scoring system. The findings confirm that microencapsulation combined with inorganic UV filters significantly enhances sunscreen efficacy, improves photostability, minimizes systemic exposure, and ensures dermal safety. The developed formulation represents a promising strategy for advanced broad-spectrum topical photoprotection.

Background: A callus is a localized thickening of the stratum corneum that develops due to repeated pressure or friction. Surgical practice involves sustained pinch grip, thumb pressure, and instrument stabilization, which may predispose surgeons to localized hyperkeratosis. While musculoskeletal disorders among surgeons are well documented, cutaneous consequences of repetitive instrument pressure remain poorly studied. Callus formation over the ulnar aspect of the dominant thumb is frequently observed in clinical settings, but prevalence data and occupational determinants are limited. Aim: To determine the prevalence of callus formation on the ulnar aspect of the dominant thumb among surgeons and to assess its association with surgeon characteristics and occupational exposures. Methods: A cross-sectional questionnaire-based survey was conducted among surgeons across multiple specialties in India. Demographic variables, surgical workload, instrument handling habits, magnification use, and callus characteristics were recorded. The primary outcome was self-reported presence of callus on the ulnar aspect of the dominant thumb. Categorical variables were expressed as n (%). Associations were tested using chi square test, with p < 0.05 considered statistically significant. Results: A total of 110 consenting surgeons were included in the analysis. Mean age was 35.31 ± 7.23 years. Callus prevalence was 38.18% (42 of 110; 95% CI 29.65% to 47.51%). Callus presence showed significant association with years of surgical practice (p = 0.0046), frequency of resting instruments against the ulnar thumb (p = 0.0010), specialty grouping with higher prevalence in plastic surgery (p = 0.00027), and magnification use (p = 0.0048). Most calluses were confined to the dominant thumb (95.24%), were less than 5 mm in size (57.14%), and were asymptomatic (71.43%). Interference with surgical performance was minimal, and 88.18% of respondents supported ergonomic redesign of instruments. Conclusion: Callus formation on the ulnar aspect of the dominant thumb is common among surgeons and is significantly associated with cumulative surgical exposure and specific instrument handling habits. It may represent an occupational marker of repetitive mechanical stress. Ergonomic modifications and instrument redesign may help reduce focal thumb pressure and associated skin changes.

Background: Distal radius fractures (DRFs) are common orthopedic injuries in elderly patients, with volar locking plate (VLP) fixation emerging as preferred treatment for unstable intra-articular patterns. Limited Indian data exists on elderly outcomes. Methods: This prospective observational study evaluated 36 patients (>50 years) with intra-articular DRFs treated with VLP fixation at Metro Heart Institute, Faridabad (18-month duration). Frykman classification assessed fracture patterns; Sarmiento score evaluated radiological outcomes (palmar tilt, radial shortening, inclination); Mayo Wrist Score (MWS) measured functional recovery. Follow-up occurred at 6 weeks, 3 months, and 6 months. Statistical analysis used paired t-tests (SPSS v24.0). Results: Mean age was 65.5 years (53% aged 61–80); males predominated (58%). Frykman type 3 (44%) and 4 (33%) were common; 94% operated within 2 days. Radiological outcomes: excellent Sarmiento grades in 92% immediately post-op, stabilizing at 86% by 6 months (palmar tilt 0.4°→1.1°; shortening 1.5→2.1 mm). MWS improved significantly from 89.3±8.1 (6 weeks) to 91.3±6.6 (6 months; p<0.05), with 72% excellent at final follow-up. Complications were minimal (8%): carpal tunnel (6%), CRPS (3%). Conclusion: VLP fixation provides excellent radiological stability and functional recovery in elderly intra-articular DRFs, with low complication rates comparable to younger cohorts. Prompt surgery and standardized rehabilitation optimize outcomes in osteoporosis-prone Indian populations. Multicenter RCTs are recommended for broader validation.

Background: Gastrointestinal adenocarcinomas (GIAs), particularly gastric and colorectal cancers, remain major global health burdens. HER2/neu (human epidermal growth factor receptor-2) is a proto-oncogene encoding a transmembrane tyrosine kinase receptor that plays a critical role in cell proliferation and differentiation. Overexpression of HER2/neu has been associated with poor prognosis and aggressive tumor behavior in several malignancies. The present study aimed to determine the prevalence and pattern of HER2/neu overexpression in gastrointestinal adenocarcinomas and to correlate these findings with demographic and histopathological parameters. Materials and Methods: This was a retrospective and prospective cross-sectional study of 50 histologically confirmed cases of gastric and colorectal adenocarcinomas obtained for two years in the Department of Pathology in a tertiary care teaching hospital. Immunohistochemical (IHC) evaluation of HER2/neu was performed using standard protocols and scored according to Hoffmann et al. (2008) criteria. A score of 3+ was taken as positive, 2+ equivocal, and 0–1+ as negative. Results: HER2/neu positivity (3+) was observed in 12 (24%) of 50 gastrointestinal adenocarcinomas, with 7/28 (25%) gastric and 5/22 (22.7%) colorectal cases showing overexpression. HER2/neu overexpression was significantly associated with well-differentiated histology (p = 0.003), but not with age, sex, or tumor site. Conclusion: HER2/neu overexpression was found in nearly one-fourth of gastrointestinal adenocarcinomas. Given its significant association with tumor differentiation, HER2/neu assessment by IHC should be included in the routine evaluation of gastrointestinal adenocarcinomas to identify patients who may benefit from targeted anti-HER2 therapy.

Nerve monitoring is an essential part of thyroid, parotid and vestibular Schwannoma surgery in the present era. The use of nerve monitor while operating can reduce the damage to these vital structures. The recurrent laryngeal nerve (RLN) is the most important structure at risk during thyroidectomy. Damage to the recurrent laryngeal nerve (RLN) during thyroid surgery can result in voice changes and aspiration. Intra-operative nerve monitoring (IONM) has become one the most widely used adjunct for identifying the RLN and allows real-time identification and functional assessment of the RLN in the operative field. The basic aim of this study is nerve monitoring during thyroid surgery in order to avoid RLN injury. This prospective cohort study was performed in the Department of Otorhino-laryngology, MBS Hospital, Medical College Kota, and Rajasthan from 01 August 2018 to 31^st Dec. 2020. The study concludes with, no significant difference was seen to nerve damage in thyroid disease among nerve monitoring and without nerve monitoring cases. IONM seemed to have impact over duration of surgery, significantly lower in nerve monitoring cases. No significant difference was seen in duration of hospital stay among the two groups. Use of IONM is quite debated topic and still consensus is underway.

Introduction: Tibial non-union, particularly when associated with infection, remains a challenging problem in orthopaedic practice due to bone loss, soft tissue compromise, deformity, and limb length discrepancy. The Ilizarov circular external fixator offers stable fixation and allows correction of these associated problems through the principles of distraction osteogenesis. However, prospective data evaluating both bone and functional outcomes using standardized scoring systems are limited. Objective- To evaluate the clinical, radiological, and functional outcomes of Ilizarov ring fixation in patients with tibial non-union. Materials and Methods: This prospective observational study was conducted at a tertiary care teaching hospital from August 2017 to October 2018. Fifteen patients aged 11–70 years with diaphyseal tibial non-union, including infected and aseptic cases, were treated using the Ilizarov circular external fixator. Preoperative evaluation included clinical, laboratory, and radiological assessment. Corticotomy and bone transport were performed when indicated. Patients were followed up at regular intervals, and outcomes were assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Results: Most patients were aged 21–40 years, with right-sided involvement being more common. Middle-third tibial non-union was the most frequent site. Corticotomy was performed in 60% of patients. The mean time to union was 6.03 ± 1.47 months (range 4–9 months). Complications included pin tract infection (26.67%), non-union site infection (26.67%), ankle stiffness (40%), and knee stiffness (13.33%), all managed conservatively. Excellent to good bone and functional outcomes were achieved in 93.34% of patients according to ASAMI criteria. Conclusion: Ilizarov ring fixation is an effective method for managing tibial non-union, providing satisfactory union rates and functional outcomes while allowing correction of associated deformities and limb length discrepancy with acceptable complications.

Background: The National Institutes of Health (NIH) describes asthma as a “Chronic-inflammatory” disease that affects the airways. Over the past few years, there has been an increase in the prevalence of asthma not just in our nation but also globally. Asthma affects the lungs, as we all know, but in cases of acute severe asthma, a hypoxic state can also impact other important organs. In a 2018 study, cardiac biomarkers in acute severe asthma were assessed by a tertiary care hospital of Northern India. Studies on adults with acute severe asthma have demonstrated the involvement of other essential organs as well, although there is insufficient evidence for the paediatric age range. Therefore, the purpose of this study is to assess the dysfunction of the heart, liver, and kidneys in patients with acute severe bronchial asthma based on the baseline biomarker levels at admission and determine whether or not this dysfunction persisted even after the patient’s stabilization.  Methods: An observational, prospective study conducted over 18 months. The children of age group 3-12 years who presented with acute severe bronchial asthma (pulmonary score > 6) were enrolled into the study after taking informed consent from the parents/guardian and carefully ruling out exclusion criteria. The objective of the study was to evaluate the involvement of vital organs in acute severe asthma in children through estimation of serum levels of cardiac biomarkers [Troponin I, CPK-MB], liver biomarkers [ALT and AST] and kidney biomarkers [Blood urea nitrogen and serum Creatinine]. Blood sample was taken within 12 hours of admission, serve as baseline investigation. Another sampling was done at 48 hours of admission, and these investigations compared with the baseline investigations. Result: A total of 65 patients with asthma severity score more than 6 were included in the study. Majority (43.1%) of the children were of the age group of 8-10. The mean age was 10.3 years. Majority (55.38%) of the children were male. 83.07% of the cases had oxygen saturation below 90%, 10.7% had oxygen saturation between 91-95% and 6.1% had oxygen saturation above 95%. There was no statistically significant difference found between the values at the time of admission and 48 hours later in the level of cardiac, liver and kidney biomarkers. Conclusion: This study concludes that in acute severe asthmatics children between 3-12 years of age, there was no association found in the serum biomarkers level of vital organs like Heart, Liver and Kidney at the time of admission and after 48 hours.

Background: Abnormal uterine bleeding (AUB) is one of the most common gynecological complaints in Indian women, particularly in the reproductive and perimenopausal age groups. The levonorgestrel-releasing intrauterine contraceptive device (LNG-IUCD) presents itself as a promising therapeutic alternative for AUB. Therefore, the study was aimed to evaluate the efficacy, safety, and acceptability of LNG-IUD in women with AUB over 6 months at tertiary care hospital. Material and Methods: The present prospective observational study was undertaken in Department of Obstetrics and Gynecology at Sri Siddhartha Medical College and Hospital, Tumakuru & District Hospital, Tumakuru during the period from August 2025 to January 2026. A total sample size of 100 patients with heavy menstrual bleeding not on any medication was included in the study population. The study was conducted after taking ethical clearance from the institute and informed consent from the patients. Patients were instructed to utilise the Pictorial Blood Loss Assessment Chart (PBAC). Results: The majority of participants were aged 20–39 years (93%) and were multiparous (85%). Most participants had no co-morbidities (68%); however, hypertension and obesity were each present in 18%. , IUCD remained in place in 77% of patients. Spontaneous expulsion occurred in 7%, 6% required removal, and 10% were lost to follow-up. A significant reduction in mean PBAC score following LNG-IUCD insertion was observed. Conclusion: The present study concludes that the Levonorgestrel Intrauterine Contraceptive Device is a highly effective and safe non-surgical option for managing heavy menstrual bleeding.

Background: The relationship between dyslipidemia and ischemic stroke (IS) is clearly established, yet the status of hypertriglyceridemia as an independent prognostic factor is debatable. LDL-C and HDL-C have been widely researched, whereas there are fewer studies on the effects of high levels of triglycerides on the severity and recovery of stroke. The purpose of this study is to determine the prognostic value of hypertriglyceridemia in acute ischemic stroke patients of atherothrombotic etiology. Methods: A cross-sectional analytical analysis was carried out among 107patients with acute ischemic stroke admitted to the Neurology Department of TVMCH. NIHSS score upon admission and discharge was used to measure stroke severity, and modified Rankin Scale (mRS) was utilized to measure functional recovery. Fasting triglyceride levels divided the patients into four groups: <150 mg/dL, 150–250 mg/dL, 250–350 mg/dL, and >350 mg/dL. Statistical models, such as multivariate logistic regression analysis, were used to test associations between triglyceride levels and stroke outcomes. Result: Increased triglyceride levels correlated with more debilitating strokes on admission (increased NIHSS scores) and worse functional outcomes at discharge (increased mRS scores). Patients with triglycerides >350 mg/dL had the poorest recovery trajectories, suggesting an intense negative effect of hypertriglyceridemia on stroke prognosis. Conclusion: Hypertriglyceridemia is an important modifiable stroke severity and outcome determinant. Aggressive lipid lowering should be implemented in stroke prevention and rehabilitation guidelines to enhance the outcomes of stroke patients.

Introduction: The perspective of gradually increasing availability of higher-end ultrasonography machines having 3D volumetric imaging capacity in our country, it appears necessary to assess the credibility of routine use of 3D sonographic imaging for uterine cavity evaluation in infertility patients and its additional advantages in comparison to cost-effectiveness. Methodology: This study, done including total 158 patients of different age groups referred to the Department of Radio-diagnosis, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, West Bengal for radiological evaluation of infertility. All of these patients were imaged by conventional 2D and 3D volumetric ultrasound. Among these, 139 subjects further underwent Hysterosalpingography, 27 underwent Hystero-laparoscopy and 2 subjects were imaged with MRI. Results: After final possible diagnosis, 12% of the infertile patients were detected to have uterine cavity abnormalities, among which 7.59% were Mullerian Duct Anomalies and 4.43% were other kind of endometrial or sub-endometrial pathology. Again, among the Mullerian Duct anomalies, most common was Arcuate uterus (3.8% of the study population) followed by Septate / Sub-septate uterus (1.9% of the study population). 2D USG, being incapable of imaging of uterus in coronal plane, could only detect 7 abnormal uterine cavities (37% of total 19) with one misdiagnosis, whereas 3D volume Ultrasound detected 18 abnormal cavities (95% of total) with 100% sensitivity and specificity in cases of Mullerian Duct Anomalies unquestionably proving the advantages of 3D USG over 2D USG for detection of uterine cavity pathologies. Conclusion: Thus, the present work strongly supports the already proposed role of 3D USG in the diagnosis of uterine cavity abnormality, especially for congenital Mullerian duct abnormalities, and its clear benefits over the conventional 2D scan.

Background: Spinal anaesthesia is one of the most commonly used regional anaesthetic techniques for lower abdominal, pelvic, and lower limb surgeries. Traditionally, the subarachnoid space is accessed using surface anatomical landmarks. However, this landmark-guided technique may be challenging in certain patients due to anatomical variations, obesity, or poorly palpable landmarks. Ultrasound imaging has recently been introduced as an adjunct to improve the identification of spinal anatomy and facilitate accurate needle placement. Ultrasound-assisted spinal anaesthesia may improve the ease of access to the subarachnoid space, particularly for anaesthesia residents who are still developing procedural skills. Aim: To compare the ease of access of the subarachnoid space using the ultrasound-assisted technique versus the landmark-guided technique among anaesthesia residents. Materials and Methods: This prospective randomized comparative study was carried out in the Department of Anaesthesiology and Critical Care at Sri Siddhartha Medical College and Hospital, Tumkur, Karnataka, India, over a period of 24 months. A total of 70 patients scheduled for surgeries requiring spinal anaesthesia were included in the study and randomly allocated using computer-generated randomization into two equal groups of 35 patients each. Group A (USG Group) consisted of 35 patients in whom spinal anaesthesia was administered using the ultrasound-assisted technique. Group B (LG Group) consisted of 35 patients in whom spinal anaesthesia was administered using the conventional landmark-guided technique. The procedures were performed by anaesthesia residents under supervision. Parameters assessed included number of attempts required to achieve successful dural puncture, time taken to access the subarachnoid space, first-attempt success rate, need for needle redirection, and overall ease of access as assessed by the performing resident. Data were analyzed using appropriate statistical tests, and a p-value of <0.05 was considered statistically significant. Results: The first-pass success rate was significantly higher in the ultrasound group compared with the landmark group (77.1% vs 37.1%, p < 0.001). The mean number of attempts and needle redirections required to achieve successful dural puncture were lower in the ultrasound group. Additionally, the time required to identify the intervertebral space and access the subarachnoid space was reduced with ultrasound assistance. Residents reported better ease of access and procedural confidence when using ultrasound guidance compared to the conventional landmark technique. Conclusion: Ultrasound-assisted spinal anaesthesia significantly improves the ease of access to the subarachnoid space compared with the landmark-guided technique when performed by anaesthesia residents. The use of ultrasound helps in better identification of spinal anatomy, increases first-pass success rate, and reduces the number of attempts required. Incorporating ultrasound guidance in training programs may enhance procedural success and improve patient safety in spinal anaesthesia.

Background: Modern cataract surgery has progressed beyond simply removing the opaque lens; it now focuses on achieving rapid and high-quality visual recovery with minimal damage to surrounding ocular structures. Among these, the corneal endothelium plays a vital role in maintaining corneal clarity, yet it has very limited regenerative capacity. Any surgical trauma can therefore have lasting implications. The present study aimed to evaluate and compare the morphological and functional changes of the corneal endothelium following two commonly performed cataract procedures—Phacoemulsification and Small-Incision Cataract Surgery (SICS). Methods: This prospective, observational, comparative study was conducted at a tertiary care hospital in Central India between May 2023 and October 2024. A total of 250 patients diagnosed with senile cataract were included and equally allocated into two groups: Phacoemulsification (n = 125) and SICS (n = 125). Corneal endothelial morphology and Endothelial Cell Density (ECD) were assessed using specular microscopy. Functional recovery of the endothelium was evaluated through measurements of Central Corneal Thickness (CCT) using ultrasound pachymetry. Assessments were performed preoperatively and during follow-up visits on postoperative day 1, at 1 month, and at 3 months. Results: Both surgical techniques resulted in a statistically significant but comparable reduction in endothelial cell density from baseline. At the three-month follow-up, the mean endothelial cell loss was approximately 15.5% in both the Phacoemulsification and SICS groups (p = 0.88). Morphological analysis demonstrated expected physiological remodeling of the endothelial layer, characterized by mild pleomorphism and polymegethism. Central corneal thickness showed a transient increase on the first postoperative day in both groups, reflecting temporary corneal edema; however, CCT values returned close to baseline by the one-month follow-up, indicating recovery of endothelial pump function. By the end of three months, nearly 90% of patients in both groups achieved a Best-Corrected Visual Acuity (BCVA) of 6/9 or better. Conclusion: Both Phacoemulsification and Small-Incision Cataract Surgery provide excellent surgical outcomes with comparable safety for the corneal endothelium. When performed with appropriate intraoperative protection, both procedures allow effective endothelial recovery and favourable visual rehabilitation.

Background: Pediatric liver diseases encompass a broad spectrum of disorders with diverse etiologies, clinical presentations, and outcomes. Histopathological examination of liver biopsy specimens plays a crucial role in establishing the diagnosis, determining disease severity, and guiding clinical management. The present study was undertaken to evaluate the morphological spectrum of pediatric liver diseases encountered in a tertiary care institution. Material and Methods: This retrospective descriptive study was conducted in the Department of Pathology of a tertiary care teaching hospital. A total of 112 liver biopsy specimens obtained from pediatric patients aged ≤18 years were included in the study. Relevant clinical details and laboratory data were collected from medical records. Biopsy specimens were fixed in 10% neutral buffered formalin, processed routinely, and stained with hematoxylin and eosin. Special stains were applied when indicated. Histopathological evaluation was performed to determine the morphological diagnosis and to assess the degree of hepatic fibrosis. Data were analyzed using descriptive statistics and presented as frequencies and percentages. Results: Among the 112 cases, the majority of patients were in the 1–5 years age group (32.1%), followed by children younger than 1 year (25.0%). Males constituted 57.1% of the study population. The most common clinical indication for liver biopsy was persistent jaundice (33.9%), followed by hepatomegaly or hepatosplenomegaly (25.0%). Histopathological evaluation revealed neonatal hepatitis (23.2%) as the most frequent diagnosis, followed by biliary atresia (16.1%) and glycogen storage disease (12.5%). Non-alcoholic fatty liver disease (10.7%), autoimmune hepatitis (8.9%), and chronic hepatitis (8.9%) were also observed. When categorized broadly, cholestatic disorders accounted for 39.3%, followed by metabolic liver diseases (25.0%) and inflammatory liver diseases (17.9%). Evaluation of fibrosis demonstrated no fibrosis in 35.7%, mild fibrosis in 28.6%, moderate fibrosis in 21.4%, and advanced fibrosis or cirrhosis in 14.3% of cases. Conclusion: Pediatric liver diseases show considerable histopathological diversity, with cholestatic and metabolic disorders being the most prevalent. Liver biopsy remains an essential diagnostic modality for accurate disease characterization and assessment of hepatic fibrosis in pediatric patients.

Background: Day care surgery constitutes approximately 70% of all surgical procedures globally, yet postoperative pain remains inadequately managed in nearly one-third of patients undergoing ambulatory procedures. Opioid-dominant analgesic protocols, historically the gold standard, are increasingly scrutinized for their adverse effect profile and contribution to persistent postoperative opioid use. Multimodal analgesia (MMA), employing synergistic non-opioid and regional techniques, represents a paradigm shift toward opioid-sparing strategies. This study compared the efficacy of structured MMA versus traditional opioid-dominant analgesia on postoperative outcomes in day care surgery. Methods: One hundred sixty-eight patients undergoing elective day care procedures (primarily laparoscopic cholecystectomy) were randomized to receive either structured MMA (acetaminophen, non-steroidal anti-inflammatory drugs, regional anesthesia, and intravenous lidocaine infusion; n = 84) or opioid-dominant analgesia (morphine-based patient-controlled analgesia with acetaminophen; n = 84). Primary outcomes included postoperative pain intensity (Visual Analogue Scale [VAS]) at 1, 6, and 24 hours, cumulative opioid consumption (morphine milligram equivalents), and readiness for discharge. Secondary outcomes encompassed postoperative nausea and vomiting (PONV), patient satisfaction, quality of recovery (QoR-15), length of postoperative stay in the facility, and incidence of delayed discharge or unexpected readmission within 7 days. Results: Multimodal analgesia demonstrated significantly superior pain control compared to opioid-dominant protocols at all measured timepoints. Median VAS scores at 1 hour were 3.0 (IQR 2–4) in the MMA group versus 6.5 (IQR 5–8) in the control group (p < 0.001). At 24 hours postoperatively, median VAS scores remained lower in the MMA cohort: 1.5 (IQR 1–3) compared to 4.0 (IQR 3–5) in controls (p < 0.001). The MMA group required 48% less cumulative opioid medication within the first 24 postoperative hours (mean 8.2 ± 3.4 mg morphine equivalents versus 15.8 ± 5.6 mg; p < 0.001). Incidence of PONV was significantly reduced in the multimodal group: 9.5% versus 28.6% in the opioid group (p = 0.001). Median time to discharge criteria achievement was 92 minutes (IQR 85–110) for MMA versus 142 minutes (IQR 125–165) for opioid-dominant analgesia (p < 0.001). Quality of recovery scores (QoR-15) on postoperative day 1 were superior in the MMA cohort (129 [IQR 122–135] versus 115 [IQR 105–122]; p < 0.001). Unplanned 7-day readmissions occurred in 1 patient (1.2%) receiving MMA compared to 5 patients (5.9%) in the opioid-dominant group (p = 0.102), with pain being the primary readmission cause in the latter group. Conclusion: Structured multimodal analgesia significantly outperforms traditional opioid-dominant protocols in day care surgery, delivering superior pain control, reduced opioid consumption, diminished adverse effects, and expedited recovery. Implementation of MMA protocols as standard perioperative practice for ambulatory surgery is strongly supported. Further investigation into long-term implications on chronic postsurgical pain incidence and persistent opioid use patterns is warranted.

Background: Bronchial asthma is a chronic inflammatory airway disorder characterized by variable airflow obstruction and bronchodilator reversibility. Clinical characteristics and spirometric response patterns vary across populations. Aim is to study the clinical profile, comorbidities, and bronchodilator reversibility pattern in 100 patients with bronchial asthma. Methods: This prospective observational study was conducted at a tertiary care hospital over 2 years. One hundred clinically diagnosed asthma patients attending chest OPD/IPD were included. Detailed history, examination, laboratory investigations, chest radiography, PEFR, and spirometry were performed. Bronchodilator reversibility (BDR) testing was conducted using inhaled salbutamol. An increase in FEV₁ ≥12% and ≥200 mL was considered significant. Results: The mean age was 41.67 years. Males constituted 54% and females 46% (M:F = 1:0.85). Most patients (42%) were aged 21–40 years. Seasonal pattern was observed in 53% and seasonal-on-perennial in 28%. Upper respiratory symptoms were present in 78%, inhalant allergy in 53%, and positive family history in 35%. Comorbidities were present in 26%, with hypertension (15%) being most common. Sputum eosinophilia was seen in 47%, while AEC >500 cells/mm³ was noted in 11%. After bronchodilator therapy, mean FEV₁ improved by 20%, FVC by 32%, and PEFR by 12%. Significant bronchodilator reversibility was observed in 86% of patients. Conclusion: Bronchial asthma commonly affects young adults with male predominance in this cohort. Seasonal variation, inhalant allergy, and upper respiratory symptoms were frequent associations. Spirometry with bronchodilator reversibility remains a reliable diagnostic and monitoring tool in asthma.

Background: Acute gastroenteritis is one of the most common causes of morbidity and hospitalization among children, particularly in developing countries. It is frequently associated with poor sanitation, unsafe drinking water, malnutrition, and inadequate feeding practices. Both bacterial and viral pathogens contribute to the burden of diarrhoeal diseases in early childhood, leading to dehydration, nutritional deficiencies, and increased healthcare utilization. Objectives: To study the clinical profile, bacteriological pattern, and associated risk factors among children presenting with acute gastroenteritis. Methods: This hospital-based observational study included 250 children aged 6–24 months admitted with acute gastroenteritis. Demographic details, clinical manifestations, feeding practices, maternal education, and sanitary conditions were recorded. Stool samples were collected and processed using standard microbiological techniques to identify bacterial pathogens. Statistical analysis was performed to assess associations between demographic, environmental, and clinical factors with disease severity. Results: Most children belonged to the 6–12 months age group (71.2%), with a slight male predominance (54%). Fever (90.4%) and vomiting (54.4%) were the most frequent symptoms. The majority had less than 5 diarrhoeal episodes per day (64.4%), while some dehydration was observed in 64.8% of cases. Stool culture revealed Escherichia coli (22.4%), Salmonella (14%), Klebsiella (8.4%), and Shigella (8%), while 47.2% showed no bacterial growth. Poor sanitary conditions, lower maternal education, and inappropriate feeding practices showed significant association with increased diarrhoeal frequency (p < 0.05). Conclusion: Acute gastroenteritis remains a significant pediatric health problem. Improving sanitation, promoting exclusive breastfeeding, enhancing maternal awareness, and ensuring early medical intervention are essential for reducing morbidity and complications.

Background: Women with Polycystic Ovarian Syndrome (PCOS) commonly have metabolic syndrome, including obesity, insulin resistance, dyslipidaemia, and hypertension. These metabolic disorders can affect ovulation, increase infertility risk, and diminish pregnancy success. Clinical management and long-term health concerns for PCOS women depend on understanding how metabolic indicators affect reproductive outcomes. This retrospective investigation links metabolic problems, hormonal imbalance, and reproductive dysfunction. Methods: The study comprised 104 women with PCOS who attended gynaecology and endocrinology outpatient clinics from March 2025 to September 2025. BMI, blood pressure, fasting glucose, lipid profile, fasting insulin, HOMA-IR scores, LH/FSH ratio, and serum testosterone were gathered from medical records. Ovulatory state, infertility duration, and pregnancy outcomes were examined. Statistical analysis was conducted using SPSS, with p < 0.05 considered significant. Results: Metabolic syndrome was found in 27.8% of subjects, while 72.1% had obesity (BMI ≥25 kg/m²). Women with HOMA-IR >2.5 were 49% insulin-resistant. Many had dyslipidaemia, especially low HDL and high triglycerides. LH/FSH ratios were higher in 62.5% and androgen levels were high. Women had 78.8% ovulatory dysfunction and 41.3% infertility. In 12 pregnancies, 33.3% ended in early miscarriage, demonstrating that metabolic disorders impaired reproductive outcomes. Conclusion: This study shows that metabolic syndrome markers strongly predict poor reproductive outcomes in PCOS women. Insulin resistance, obesity, dyslipidaemia, and hormonal imbalance cause ovulatory dysfunction and infertility. PCOS patients’ reproductive results depend on early metabolic risk factor diagnosis, lifestyle change, and focused intervention.

Background: Preeclampsia, gestational diabetes, and preterm delivery cause most maternal and neonatal morbidity worldwide. These issues must be identified early to improve pregnancy outcomes. Since these diseases vary by region, hospital-based evaluations are needed to identify local risk variables. This retrospective study assessed the frequency, aetiology, and effects of major pregnancy complications on S.K.M.C.H. patients and their babies. Methods: From February 2025 to August 2025, S.K.M.C.H. observed 92 pregnant women who satisfied the requirements. Medical record data was extracted using a standardised form. Demographics, clinical characteristics, pregnancy complications, delivery method, and neonatal outcomes were evaluated. The statistical study compared group results using descriptive statistics, t-tests, and chi-square tests. Statistical significance was defined as p < 0.05. Results: Preeclampsia impacted 18.4%, gestational diabetes 15.2%, and premature labour 20.6% of the 92 pregnant women investigated. Preeclampsia and GDM were associated with older maternal age (>30 years) (p=0.03) and higher BMI (p=0.02). Compared to pregnancies without issues, complications increased caesarean sections (58.7% vs. 38.1%). In neonatal outcomes, 29.3% had a birth weight <2.5 kg, 22.8% were admitted to the NICU, and 18.4% had an APGAR score <7 at 1 minute. Neonatal critical care unit admission was associated with premature labour (p=0.01). Postpartum haemorrhage and hypertensive crises are more likely in preeclamptic and gestational diabetic women. Conclusion: Pregnant women who visit S.K.M.C.H. have a disproportionately greater risk of significant issues that affect both mother and child. Early screening, diagnosis, and risk-based prenatal therapy reduce the chance of poor outcomes. Increased awareness and standard prenatal practices can reduce preventable issues. Larger multicentric studies and prospective analyses can better determine risk trends and guide regional maternal health policy.

Background: Effective postoperative analgesia is an important component of perioperative care in patients undergoing lower abdominal surgeries. Intrathecal morphine, when combined with hyperbaric bupivacaine, provides prolonged analgesia and improves patient comfort. However, the optimal dose of intrathecal morphine that provides effective analgesia with minimal adverse effects remains a subject of investigation. Aim: To compare the efficacy and safety of 150 mcg intrathecal morphine versus 250 mcg intrathecal morphine combined with 0.5% hyperbaric bupivacaine for postoperative analgesia in patients undergoing lower abdominal surgeries. Materials and Methods: This prospective comparative study was conducted at Sri Siddhartha Medical College and Hospital, Tumkur, a tertiary care teaching institution, over a 24-month period. A total of 68 patients undergoing elective lower abdominal surgeries under spinal anaesthesia were included. The patients were randomly divided into two groups, each consisting of 34 participants. Group A (n = 34) received 150 µg of intrathecal morphine combined with 0.5% hyperbaric bupivacaine, while Group B (n = 34) received 250 µg of intrathecal morphine combined with 0.5% hyperbaric bupivacaine for spinal anaesthesia. Postoperative analgesia was assessed using the Visual Analogue Scale (VAS). Continuous variables were analyzed using the student’s t-test, while categorical variables were analyzed using the Chi-square test. A p-value <0.05 was considered statistically significant. Duration of analgesia, time to first rescue analgesic, and adverse effects such as nausea, vomiting, bradycardia, and hypotension were recorded. Results: The mean duration of analgesia was significantly longer in Group B compared to Group A. Patients receiving 250 mcg intrathecal morphine experienced prolonged analgesia and delayed requirement of rescue analgesia. However, a incidence of hypotension and nausea was observed in Group B. Conclusion: Intrathecal morphine at 250 mcg with 0.5% hyperbaric bupivacaine provides longer postoperative analgesia compared with 150 mcg, but it is associated with a slightly higher incidence of minor side effects. A balanced approach considering analgesic efficacy and adverse effects should guide dose selection.

Introduction: Ninety to 95 percent of urothelial carcinomas occur in the Urinary bladder. The current study aimed to classify urothelial carcinoma based on the TNM AJCC classification 2010 and the WHO 2016 classification system by analysing its histopathological features and correlating them with clinical features and radiological findings. Materials and Methods: 160 cases of all bladder biopsies and TURBT from bladder tumours diagnosed as urothelial carcinoma were observed over a 9-year period. Cystectomy specimens obtained as a follow-up of the aforementioned cases in a tertiary referral hospital. The tumours were examined for histopathological details and they were correlated with clinical characteristics and cystoscopy. Results: Out of the 160 cases that were included, 127 were TURBT and 33 were biopsies. Male preponderance (80.0%) was observed and majority of cases were in the 5th to 7th decade. Gross hematuria (80%) was most common presenting symptom. Infiltrating urothelial carcinoma accounted for 56.9% of all cases. Squamous differentiation was found to be the most prevalent type of divergent differentiation. Muscle invasion was observed in 22 cases (24.17%). Statistical analysis using Chi square tests revealed a significant correlation between tumour size and grade. We received 14 cystectomies specimen from above cases subsequently and the grade, invasiveness and differentiation of the tumour showed concordance with the previous histopathology findings. Conclusion: The study showed uniformity in the diagnosis of the cystectomy specimen with their respective diagnosis on biopsies and TURBT and also emphasized on mentioning a note about the muscle invasion and differentiation of urothelial carcinoma as it has both prognostic and therapeutic implication.

Background: Haemorrhoidal disease is a common anorectal condition, and surgical intervention is recommended for symptomatic grade III and IV haemorrhoids. Conventional open haemorrhoidectomy (Milligan–Morgan technique) is widely practiced but is associated with significant postoperative pain and longer recovery. LigaSure haemorrhoidectomy, a modern technique utilizing bipolar electrothermal vessel sealing, has been introduced to reduce operative time, blood loss, and postoperative discomfort. Aim: To compare the clinical outcomes of LigaSure haemorrhoidectomy with conventional open haemorrhoidectomy in the management of grade III and IV haemorrhoids. Methods: This prospective comparative study included 100 patients diagnosed with grade III and IV haemorrhoids who required surgical treatment. Patients were randomly divided into two groups: Group A (50 patients) underwent LigaSure haemorrhoidectomy and Group B (50 patients) underwent conventional open haemorrhoidectomy. The parameters evaluated included operative time, intraoperative blood loss, and postoperative pain using Visual Analog Scale (VAS), duration of hospital stay, postoperative complications, and time to return to normal activities. Results: The mean operative time and intraoperative blood loss were significantly lower in the LigaSure group compared with the conventional open haemorrhoidectomy group. Postoperative pain scores were also significantly lower in patients undergoing LigaSure haemorrhoidectomy. The duration of hospital stay and time to return to normal daily activities were shorter in the LigaSure group. Postoperative complications such as bleeding and urinary retention were less frequent in the LigaSure group, although the difference was not statistically significant. Conclusion: LigaSure haemorrhoidectomy is a safe and effective alternative to conventional open haemorrhoidectomy for the treatment of grade III and IV haemorrhoids. It offers advantages including reduced operative time, minimal blood loss, decreased postoperative pain, and faster recovery.

Background: Uterine and cervical lesions constitute a major proportion of gynecological morbidity. These range from inflammatory and benign conditions to premalignant and malignant neoplasms. Histopathological examination remains the gold standard for definitive diagnosis. Objectives: To evaluate the clinicopathological spectrum of uterine and cervical lesions, analyze their age distribution, and assess clinicopathological correlation. Materials and Methods: This observational study was conducted over 18 months in the Department of Pathology of a tertiary care hospital. A total of 280 uterine and cervical specimens were included. Specimens were fixed in 10% neutral buffered formalin, processed routinely, and stained with hematoxylin and eosin. Diagnoses were categorized into non-neoplastic, benign neoplastic, premalignant, and malignant lesions. Data were analyzed using descriptive statistics. Institutional Ethics Committee approval was obtained. Results: The majority of patients were in the 41–50-year age group (33.93%). Abdominal pain (41.07%) and abnormal uterine bleeding (37.14%) were the most common complaints. Chronic non-specific cervicitis (52.86%) was the most common histopathological finding, followed by leiomyoma (27.50%). Squamous cell carcinoma constituted 5.36% of cases. Conclusion: Inflammatory and benign lesions predominate among uterine and cervical pathologies. Histopathological examination remains indispensable for accurate diagnosis and early detection of premalignant and malignant lesions.

Background: Internet use has become integral to student life, but excessive use can lead to addiction. Similarly, the rise of selfie culture has sparked concerns about compulsive selfie-taking or “selfitis.” This study aims to assess the prevalence of internet and selfie addiction among undergraduate medical students and explore associated factors. Methods: A cross-sectional study was conducted over three months (Dec 2024–Feb 2025) among 346 MBBS students at Government Medical College, Siddipet, using simple random sampling. Data were collected using a semi-structured questionnaire incorporating the Internet Addiction Test (IAT), Selfie Addiction Scale (SAS), and demographic variables. Statistical analysis was done using SPSS v26. Results: Of the 346 participants (65.6% females, 34.4% males), the majority (61.8%) were aged 20–24 years. Based on the SAS, 23.6% were normal, 46.8% borderline, 26.5% acute selfitis, and 2.89% chronic selfitis. According to IAT scores, 52% showed no addiction, 35.8% mild, 10.4% moderate, and 1.73% severe internet addiction. Notably, males showed higher severe internet addiction (3.3%) compared to females (0.88%). A majority (51.2%) agreed selfies help preserve memories. Conclusions: The study reveals a substantial prevalence of borderline and acute selfitis and mild internet addiction among medical students. Targeted interventions, including cognitive-behavioral therapy, mindfulness, and institutional awareness programs, are recommended to curb the progression of these behavioral patterns.

Background: Accurate completion of the Medical Certificate of Cause of Death (MCCD) is essential for reliable mortality statistics, public health planning, and epidemiological research. Errors in certification compromise data quality. Aim: To assess the frequency and types of errors in MCCD forms issued at a tertiary care teaching hospital in Tripura during March 2024–December 2024. Methods: This prospective observational study evaluated all MCCD forms completed at the institution during the study period. Each certificate was reviewed for completeness, causal sequencing, use of acceptable terminology, and administrative accuracy using WHO-adapted criteria. Descriptive statistics (frequencies and percentages) were used. Results: A total of 190 MCCD forms were analysed. Major deficiencies included incomplete causal sequences, use of ill-defined terms, omission of underlying causes, and missing demographic or administrative details. Only 26.8% of certificates were correctly filled. Conclusion: Substantial errors were identified in MCCD completion, primarily relating to improper sequencing and vague terminology. Continuous training, electronic templates, and periodic audits are recommended to enhance data accuracy.

Background: Intertrochanteric fractures of the femur are increasingly common in the elderly due to osteoporosis and low-energy trauma. Early surgical fixation enabling stable reduction and early mobilization is the standard of care. Cephalo-medullary nails with helical blade fixation have been developed to enhance rotational stability and reduce cut-out rates, especially in osteoporotic bone. This study aimed to evaluate the clinico-radiological outcomes of this implant in elderly patients. Methods: A prospective case series was conducted from September 2015 to August 2017, including 75 patients aged ≥45 years with osteoporotic intertrochanteric fractures. All underwent closed reduction and internal fixation using a cephalo-medullary nail with a helical blade. Patients were followed for 48 weeks. Clinical evaluation included pain assessment (VAS), HHS (Harris Hip Score), Jensen Social Function Score, and Parker Mobility Score. Radiological assessment included fracture union and TAD (Tip-Apex Distance). Statistical analysis was performed using SPSS version 20. Results: The mean age was 65.67±10.63 years, with female predominance (65.3%). Mean surgical time was 69.01±13.74 minutes and mean blood loss was 167.33±66.52 ml. The mean TAD was 24.69±3.16 mm. Radiological union was observed in 97.2% by 12 weeks and 100% in patients completing follow-up at 48 weeks. Mean HHS improved significantly from 38.47±13.14 at 6 weeks to 98.68±1.84 at 48 weeks (p<0.001). Parker Mobility Score improved from 1.68±0.50 to 8.74±0.75, while the Jensen score decreased from 3.21±0.50 to 1.03±0.17 (p<0.001). Implant failure and non-union were noted in 2.8% each. At final follow-up, outcomes were good in 58.5%, average in 35.7%, and poor in 5.7% of cases. Conclusion: Cephalo-medullary nail with helical blade fixation provides stable fixation, high union rates, significant functional recovery, and low complication rates in elderly patients with intertrochanteric fractures, making it a reliable treatment modality.

Background: Propofol is widely used as an induction agent in general anaesthesia due to its rapid onset and smooth recovery profile. However, it is associated with dose-dependent adverse effects such as hypotension and respiratory depression. The concept of co-induction involves the administration of a small dose of another agent prior to the primary induction drug to reduce the required dose and minimize adverse effects. Ketamine and midazolam are commonly used co-induction agents because of their synergistic effects with propofol. Ketamine provides analgesia and sympathetic stimulation, whereas midazolam offers anxiolysis and sedation. This study was conducted to compare the effectiveness of ketamine and midazolam as co-induction agents in reducing the induction dose of propofol and to evaluate their hemodynamic effects. Aim: To compare the effectiveness of ketamine and midazolam as co-induction agents with propofol in reducing the required induction dose of propofol during general anaesthesia. Materials and Methods: This prospective comparative study was conducted at Sri Siddhartha Medical College and Hospital, Tumkur, a tertiary care teaching institution, over a 24-month period. A total of 60 patients, aged 18–60 years, of either gender, scheduled for various elective surgical procedures under general anaesthesia. Patients were randomly divided into two groups of 30 each. Patients in Group KP received intravenous ketamine at a dose of 0.3 mg/kg as a co-induction agent prior to propofol administration, whereas patients in Group MP received intravenous midazolam at a dose of 0.03 mg/kg as the co-induction agent before the administration of propofol. After administration of the co-induction agent, propofol was given intravenously until loss of verbal response and eyelash reflex, and the total dose required for induction was recorded. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were monitored at baseline, after co-induction, during induction, and after intubation. Statistical analysis was performed using appropriate tests, and p < 0.05 was considered statistically significant. Results: The mean induction dose of propofol required in Group KP (ketamine-propofol) was significantly lower compared with Group MP (midazolam-propofol). Both co-induction agents effectively reduced the dose of propofol required for induction. However, patients receiving ketamine demonstrated better hemodynamic stability, with smaller reductions in blood pressure and heart rate compared to the midazolam group. The incidence of hypotension was higher in the midazolam group, whereas ketamine maintained more stable cardiovascular parameters during induction and intubation. Conclusion: Co-induction with ketamine or midazolam effectively reduces the required dose of propofol for induction of general anaesthesia. However, ketamine provides superior hemodynamic stability compared to midazolam. Therefore, ketamine may be considered a preferred co-induction agent in patients where cardiovascular stability is essential.

Background: Pregnancy-induced hypertension (PIH) is a significant cause of maternal and perinatal morbidity and mortality worldwide. Early identification of women at risk is essential for timely intervention. Ultrasonographic placental localisation in the second trimester has been proposed as a simple, non-invasive screening tool for predicting PIH. Objective: To evaluate the relationship between placental location determined by ultrasonography and the subsequent development of pregnancy-induced hypertension. Methods: This prospective observational study included pregnant women with singleton pregnancies undergoing routine anomaly scans between 18–24 weeks of gestation. Placental location was determined using transabdominal ultrasonography and categorized as anterior, posterior, fundal, or lateral (right/left). Patients were followed until delivery and monitored for the development of PIH, defined as blood pressure ≥140/90 mmHg after 20 weeks of gestation without prior hypertension. Statistical analysis was performed to assess the association between placental location and incidence of PIH. Results: A higher incidence of PIH was observed in women with laterally located placenta compared to those with centrally located (anterior/posterior/fundal) placenta. The difference was statistically significant (p < 0.05). Sensitivity, specificity, and predictive values suggested that lateral placentation may serve as a useful early indicator for identifying women at increased risk of PIH. Conclusion: Placental localisation by second-trimester ultrasonography, particularly lateral placentation, is associated with an increased risk of pregnancy-induced hypertension. It may be considered a simple, cost-effective screening method to identify high-risk pregnancies for closer antenatal surveillance and early preventive strategies.

Background: Intertrochanteric fractures of the femur are increasingly common in the elderly due to osteoporosis and low-energy trauma. Early surgical fixation enabling stable reduction and early mobilization is the standard of care. Cephalo-medullary nails with helical blade fixation have been developed to enhance rotational stability and reduce cut-out rates, especially in osteoporotic bone. This study aimed to evaluate the clinico-radiological outcomes of this implant in elderly patients. Methods: A prospective case series was conducted from September 2015 to August 2017, including 75 patients aged ≥45 years with osteoporotic intertrochanteric fractures. All underwent closed reduction and internal fixation using a cephalo-medullary nail with a helical blade. Patients were followed for 48 weeks. Clinical evaluation included pain assessment (VAS), HHS (Harris Hip Score), Jensen Social Function Score, and Parker Mobility Score. Radiological assessment included fracture union and TAD (Tip-Apex Distance). Statistical analysis was performed using SPSS version 20. Results: The mean age was 65.67±10.63 years, with female predominance (65.3%). Mean surgical time was 69.01±13.74 minutes and mean blood loss was 167.33±66.52 ml. The mean TAD was 24.69±3.16 mm. Radiological union was observed in 97.2% by 12 weeks and 100% in patients completing follow-up at 48 weeks. Mean HHS improved significantly from 38.47±13.14 at 6 weeks to 98.68±1.84 at 48 weeks (p<0.001). Parker Mobility Score improved from 1.68±0.50 to 8.74±0.75, while the Jensen score decreased from 3.21±0.50 to 1.03±0.17 (p<0.001). Implant failure and non-union were noted in 2.8% each. At final follow-up, outcomes were good in 58.5%, average in 35.7%, and poor in 5.7% of cases. Conclusion: Cephalo-medullary nail with helical blade fixation provides stable fixation, high union rates, significant functional recovery, and low complication rates in elderly patients with intertrochanteric fractures, making it a reliable treatment modality.

Background: Among the ENT complaints, Otalgia (ear pain) is the most common complaint, followed by hard of hearing in ENT outpatient department, but sufficient comprehensive epidemiological data is unavailable. This study aims to evaluate the clinico-epidemiological profile of otalgia cases in a tertiary care hospital in Thiruvallur District, Tamil Nadu, and highlight the risks associated with improper ear manipulation. Methods: A retrospective cross-sectional study was conducted from April 2022 to May 2025, including 203 patients presenting with otalgia at a tertiary care center. Data for our study was collected using structured questionnaire and analysed based on clinical diagnosis and Out-Patient management from a tertiary care hospital. Results: The following were the data: Adults (61.6%), Pediatric (39.4%). Among the Adults, female patients were predominant (62.1%). Otitis externa following improper ear manipulation was the commonest (33.5%), and Acute Otitis Media (19.7%). A significant association was found between age groups and diagnosis (p < 0.001), with pediatric patients predominantly presenting with acute otitis media (56.5 %) and adults with otitis externa (43.9 %). Conclusion: In our study at Thiruvallur District many factors played an important role like, Age, Environmental factors, Humidity, Pollution and general living. To solve this problem, we need to adopt different measures, like generating health care awareness on ear care.

Background and justification: With an overall increase in the global burden of diseases leading to increased morbidity and mortality, there has been an ever-growing demand of more manpower in the health sector. With increasing demand for specialty-based care and limited resources to meet the demand, an effective and efficient referral system is essential. Objectives: The study has been done to estimate the number of referrals in relation to the cause of death, to find out the number of cases with referrals in between tertiary care centres and to estimate the distance between the initial health centre and the hospital where the death is occurring. Methodology: It was a retrospective autopsy record-based study of 1 year duration in which cases where there were at least one or more than one referral during the course of treatment were taken. Cases where there was inadequate information regarding hospital referrals, brought dead cases and cases where the patients left against medical advice during the course of treatment were excluded. Results: 125 cases of head injury, 129 cases of polytrauma, 79 cases of burns, 105 cases of poisoning and 118 other cases were referred to four different hospitals. In 520 cases, the distance between the initial health centre and the last hospital where the patient died was 151-200 kilometers. Conclusion: An increase in hospital referrals while aiming to provide necessary care can paradoxically contribute to mortality if not managed effectively.

Background: The introduction of ultrasound guidance has significantly improved the success rate and safety of arterial cannulation procedures. Among ultrasound-guided techniques, the long-axis in-plane (LA-IP) and short-axis out-of-plane (SA-OOP) approaches are commonly used. However, the optimal technique for radial artery cannulation remains a topic of debate. Aim: The primary aim of this study was to compare the long-axis in-plane approach with the short-axis out-of-plane approach for ultrasound-guided radial artery cannulation. The study evaluated the overall success rate, first-attempt success rate, and the number of attempts required for successful cannulation to determine which technique provides superior procedural efficiency and safety. Methods: This prospective, randomized, comparative study was conducted at Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India. A total of 64 adult patients aged 18–70 years requiring radial artery cannulation for perioperative monitoring were included in the study. Patients were randomly allocated into two groups: Group A (LA-IP), in which radial artery cannulation was performed using the long-axis in-plane ultrasound-guided approach, and Group B (SA-OOP), in which cannulation was performed using the short-axis out-of-plane ultrasound-guided approach.Data were collected regarding overall success rate, first-attempt success rate, the number of attempts required for successful cannulation, and complications such as posterior wall puncture, hematoma formation, and vasospasm. Results: In this study involving 64 patients, both ultrasound-guided techniques demonstrated high success rates. The overall success rate was 100% in the SA-OOP group and 96.9% in the LA-IP group, with no statistically significant difference between the techniques. The first-attempt success rate was higher in the SA-OOP group (84.4%) compared with the LA-IP group (75%), although the difference was not statistically significant. However, the SA-OOP technique demonstrated greater procedural efficiency, requiring significantly fewer attempts for successful cannulation. Regarding complications, posterior wall puncture was significantly more frequent in the LA-IP group compared with the SA-OOP group. Hematoma formation and vasospasm were observed only in the LA-IP group, although these differences were not statistically significant. Conclusion: Ultrasound-guided radial artery cannulation is a reliable and effective technique for arterial access in perioperative and critical care practice. Although both the long-axis in-plane and short-axis out-of-plane approaches demonstrate high success rates, the short-axis out-of-plane approach provides higher first-attempt success, fewer attempts, and fewer complications. Therefore, the SA-OOP technique may be considered the preferred method for routine ultrasound-guided radial artery cannulation in operating rooms, intensive care units, and emergency departments.

Background: Peripheral nerve blocks are widely used for lower limb surgeries as they provide effective intraoperative anesthesia and prolonged postoperative analgesia. Ultrasound-guided lumbar plexus block combined with sacral plexus block is a reliable regional anesthesia technique for lower limb procedures. Ropivacaine is a commonly used long-acting local anesthetic due to its favorable safety profile and reduced cardiotoxicity compared with bupivacaine. Dexamethasone, when used as an adjuvant with local anesthetics, has been shown to prolong the duration of sensory and motor block and improve postoperative analgesia. However, limited studies have evaluated the effect of dexamethasone as an adjuvant to ropivacaine in ultrasound-guided lumbar and sacral plexus blocks using a one-point puncture technique. Aim: To compare the efficacy of ropivacaine 0.33% with or without dexamethasone for ultrasound-guided lumbar plexus block combined with sacral plexus block using a one-point puncture technique in patients undergoing elective lower limb surgeries. Materials and Methods: This prospective, randomized, comparative study included 90 patients aged 18–65 years of either gender undergoing elective lower limb surgeries under regional anesthesia at Sri Siddhartha Medical College and Hospital, Tumkur. Patients were randomly divided into two groups of 45 each. Group A (n = 45) received an ultrasound-guided lumbar plexus and sacral plexus block using ropivacaine 0.33% with dexamethasone 4 mg, whereas Group B (n = 45) received an ultrasound-guided lumbar plexus and sacral plexus block using ropivacaine 0.33% alone. Parameters assessed included onset time of sensory block, onset time of motor block, duration of sensory and motor block, duration of postoperative analgesia, and hemodynamic parameters. Statistical analysis was performed using Student’s t-test and Chi-square test, with p < 0.05 considered statistically significant. Results: The addition of dexamethasone significantly prolonged the duration of sensory and motor block and postoperative analgesia compared with ropivacaine alone. Group A demonstrated a longer duration of analgesia and improved block characteristics. Hemodynamic parameters remained stable in both groups, and no significant complications were observed. Conclusion: The addition of dexamethasone to ropivacaine in ultrasound-guided lumbar plexus and sacral plexus block significantly prolongs the duration of analgesia and improves block quality without increasing adverse effects. Therefore, dexamethasone can be considered an effective adjuvant to ropivacaine for regional anesthesia in lower limb surgeries.

Background: Ultrasound-guided supraclavicular brachial plexus block (SCBPB) is widely used for upper limb surgeries because it provides excellent intraoperative anesthesia and postoperative analgesia. Local anesthetics such as bupivacaine are commonly used; however, their duration of action may be limited. Dexmedetomidine, a highly selective α2-adrenergic agonist, has gained popularity as an adjuvant to local anesthetics in peripheral nerve blocks due to its sedative, analgesic, and sympatholytic properties. Dexmedetomidine can be administered either intravenously or perineurally, but the optimal route of administration remains a subject of ongoing research. Aim: To compare the efficacy of perineural versus intravenous dexmedetomidine as an adjuvant to bupivacaine in ultrasound-guided supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Materials and Methods: This longitudinal comparative study was conducted at Sri Siddhartha Medical College and Hospital, Tumkur, Karnataka, India, over a period of 24 months. A total of 70 patients scheduled for elective upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block were included in the study. Patients were randomly divided into two equal groups (n = 35 each). Group I (Intravenous group) received Inj. Bupivacaine 0.5% plain 20 mL perineurally with Inj. Dexmedetomidine 1 µg/kg administered intravenously. Group P (Perineural group) received Inj. Bupivacaine 0.5% plain 20 mL with Inj. Dexmedetomidine 1 µg/kg administered perineurally. Parameters assessed included onset and duration of sensory and motor block, duration of analgesia, hemodynamic variables, sedation scores, and adverse effects. Results: Perineural dexmedetomidine significantly prolonged the duration of sensory and motor blockade compared with intravenous dexmedetomidine (p<0.001). The onset time of sensory and motor block was shorter in the perineural group (p<0.001). Additionally, the duration of postoperative analgesia was significantly longer in the perineural group (p<0.001). Hemodynamic parameters were comparable between the groups, although mild bradycardia and hypotension were more frequently observed in the intravenous group, which was found to be statistically insignificant. Conclusion: Perineural administration of dexmedetomidine as an adjuvant to bupivacaine in ultrasound-guided supraclavicular brachial plexus block provides faster onset, prolonged sensory and motor block, and longer postoperative analgesia compared with intravenous administration. Therefore, perineural dexmedetomidine appears to be a more effective route for enhancing the quality of brachial plexus block in upper limb surgeries.

Background: Effective postoperative pain management after lower segment caesarean section (LSCS) is essential for early maternal recovery, initiation of breastfeeding, and improved maternal–infant bonding. Inadequate analgesia may lead to delayed ambulation, prolonged hospital stay, and increased postoperative complications. Wound infiltration with local anesthetics is a simple and effective technique for providing postoperative analgesia following caesarean section. Bupivacaine is widely used for wound infiltration because of its long duration of action and favourable safety profile. Tramadol, an opioid analgesic with additional monoaminergic activity, has been studied as an adjuvant to local anesthetics to enhance postoperative analgesia. The addition of tramadol to bupivacaine may prolong analgesic duration and improve postoperative pain control. Aim: To compare the analgesic efficacy of wound infiltration with bupivacaine alone versus bupivacaine combined with tramadol for postoperative pain relief in patients undergoing lower segment caesarean section under spinal anaesthesia. Materials and Methods: This prospective, randomized, double-blinded comparative clinical study was conducted in the Department of Anaesthesiology at Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India, over a 24-month period. A total of 60 parturients undergoing elective LSCS under spinal anaesthesia were included in the study. Patients were randomly allocated into two groups (n = 30 each): Group B (Bupivacaine group) received wound infiltration with 0.25% bupivacaine alone, whereas Group BT (Bupivacaine + Tramadol group) received 0.25% bupivacaine combined with tramadol at a dose of 2 mg/kg. Postoperative pain was assessed using the Visual Analogue Scale (VAS), and parameters such as duration of analgesia, time to first rescue analgesic, total analgesic consumption, and adverse effects were recorded. Results: Patients receiving bupivacaine combined with tramadol demonstrated significantly prolonged postoperative analgesia, lower VAS pain scores, and delayed requirement for rescue analgesia compared with patients receiving bupivacaine alone. The combination group also showed reduced total analgesic consumption in the postoperative period without significant increase in adverse effects. Conclusion: Wound infiltration with bupivacaine combined with tramadol provides superior postoperative analgesia compared with bupivacaine alone in patients undergoing LSCS under spinal anaesthesia. The addition of tramadol enhances the duration and quality of postoperative pain relief without significant complications.

Background: Chronic plaque psoriasis is a systemic immune-mediated inflammatory dermatosis characterized by dysregulated cytokine networks and persistent cutaneous inflammation. Serum inflammatory biomarkers have emerged as potential objective indicators of disease activity, yet their precise correlation with clinical severity indices remains incompletely characterized. Methods: This cross-sectional study enrolled 120 patients with chronic plaque psoriasis and 60 age- and sex-matched healthy controls from the dermatology outpatient department of a tertiary care hospital. Patients were stratified into mild (PASI <7), moderate (PASI 7–12), and severe (PASI >12) groups. Serum biomarker levels were quantified using enzyme-linked immunosorbent assay (ELISA). Correlations between biomarker levels and PASI scores were analyzed using Spearman’s rank correlation coefficient. Results: Mean serum levels of CRP (14.82 ± 6.41 mg/L vs. 2.14 ± 1.03 mg/L; p<0.001), IL-6 (28.67 ± 11.54 pg/mL vs. 5.23 ± 2.18 pg/mL; p<0.001), TNF-α (45.39 ± 18.72 pg/mL vs. 8.91 ± 3.44 pg/mL; p<0.001), and IL-17A (38.56 ± 14.83 pg/mL vs. 6.47 ± 2.76 pg/mL; p<0.001) were significantly elevated in psoriasis patients compared to controls. All biomarkers demonstrated significant positive correlations with PASI scores, with IL-17A exhibiting the strongest correlation (r=0.784, p<0.001). Conclusion: Serum inflammatory biomarkers are significantly elevated in chronic plaque psoriasis and correlate positively with disease severity. IL-17A demonstrated the strongest association with PASI, supporting its utility as a reliable serological indicator of disease activity and therapeutic monitoring.

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with mesh-based techniques becoming the gold standard. However, mesh-related complications remain a significant concern affecting patient outcomes and quality of life. This study aimed to evaluate the incidence, types, and risk factors associated with mesh-related complications following inguinal hernia repair. Methods: This prospective cohort study was conducted at a tertiary care hospital. A total of 486 patients who underwent mesh-based inguinal hernia repair were enrolled and followed for 12 months postoperatively. Demographic data, surgical parameters, and complication rates were recorded and analyzed using appropriate statistical tests. Results: The overall mesh-related complication rate was 12.8% (n=62). Chronic groin pain was the most common complication (6.4%), followed by seroma formation (3.1%), surgical site infection (2.1%), and mesh migration (1.2%). Multivariate analysis revealed that age >60 years (OR=2.34, 95% CI: 1.42-3.86, p=0.001), body mass index >30 kg/m² (OR=2.89, 95% CI: 1.67-4.99, p<0.001), and diabetes mellitus (OR=1.98, 95% CI: 1.21-3.24, p=0.006) were independent predictors of mesh-related complications. Laparoscopic repair demonstrated significantly lower complication rates compared to open repair (8.7% vs. 15.9%, p=0.018). Conclusion: Mesh-related complications following inguinal hernia repair occur in a notable proportion of patients. Identification of modifiable risk factors and appropriate surgical technique selection may help minimize these complications and improve patient outcomes.

Background: Exercise training is a cornerstone of cardiac rehabilitation in chronic heart failure (CHF), yet the optimal training modality remains debated. High-intensity interval training (HIIT) has demonstrated superior physiological adaptations compared to moderate-intensity continuous training (MICT) in various cardiovascular populations, but evidence regarding its efficacy and safety specifically in CHF patients with diverse functional severity remains limited and inconsistent. Methods: This prospective cohort study enrolled 194 stable CHF patients (left ventricular ejection fraction ≤45%; NYHA class II–III) at a university-affiliated cardiac rehabilitation center between March 2020 and November 2023. Patients self-selected into a 12-week supervised HIIT program (n = 98; 4×4-minute intervals at 85–95% peak heart rate) or a matched-duration MICT program (n = 96; continuous exercise at 60–70% peak heart rate), performed three times weekly. Primary outcome was change in peak oxygen consumption (peak VO₂) assessed via cardiopulmonary exercise testing. Secondary outcomes included six-minute walk distance (6MWD), left ventricular ejection fraction (LVEF), Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores, and adverse event rates. Results: The HIIT group demonstrated significantly greater improvement in peak VO₂ compared to MICT (+3.4 ± 1.8 vs. +1.6 ± 1.4 mL/kg/min; p < 0.001). Six-minute walk distance increased by 52.8 ± 28.4 m in the HIIT group versus 31.2 ± 22.6 m in MICT (p < 0.001). LVEF improved by 3.8 ± 2.6% in HIIT versus 1.9 ± 2.2% in MICT (p < 0.001). MLHFQ scores decreased by 12.4 ± 8.6 versus 7.2 ± 6.8 points (p < 0.001). No significant difference in serious adverse event rates was observed between groups (3.1% vs. 2.1%; p = 0.684). Conclusion: A 12-week supervised HIIT program produces superior improvements in cardiorespiratory fitness, functional capacity, ventricular function, and quality of life compared to MICT in stable CHF patients, with a comparable safety profile. These findings support the integration of structured HIIT protocols into heart failure rehabilitation programs under appropriate clinical supervision.

Background: Assessment of exercise capacity and cardiovascular response during physical exertion can provide valuable information regarding functional status in patients with diabetes. The present study aimed to evaluate exercise capacity and cardiovascular responses in patients with Type 2 Diabetes Mellitus in comparison with healthy individuals. Material and Methods: A hospital-based cross-sectional study was conducted among 120 participants, including 60 patients with Type 2 Diabetes Mellitus and 60 age- and sex-matched healthy controls. Demographic data, clinical parameters, and laboratory investigations including fasting blood glucose, glycated hemoglobin (HbA1c), and lipid profile were recorded. Exercise capacity and cardiovascular responses were assessed using a treadmill exercise test following the Bruce protocol. Parameters evaluated included exercise duration, maximum heart rate achieved, metabolic equivalents (METs), blood pressure response during exercise, heart rate recovery, and rate pressure product. Statistical analysis was performed using SPSS version 25.0, with a p-value <0.05 considered statistically significant. Results: The mean age of diabetic participants was 54.3 ± 8.1 years, with comparable age and sex distribution between groups. Body mass index and baseline blood pressure were significantly higher in the diabetic group. Laboratory parameters revealed significantly elevated fasting blood glucose (158.6 ± 32.4 mg/dL) and HbA1c levels (8.1 ± 1.2%) among diabetic patients. Exercise testing demonstrated significantly shorter exercise duration (7.2 ± 2.1 minutes vs 9.4 ± 2.5 minutes), lower maximum heart rate achieved (146.3 ± 15.2 beats/min vs 154.7 ± 14.8 beats/min), and reduced METs (7.8 ± 1.9 vs 10.1 ± 2.2) in patients with diabetes compared with controls. Heart rate recovery at 1 minute was significantly lower in diabetic participants (16.8 ± 5.2 beats/min vs 22.4 ± 6.1 beats/min). Poor exercise capacity (<5 METs) was observed in 23.3% of diabetic patients compared with 5.0% of controls. Conclusion: Patients with Type 2 Diabetes Mellitus demonstrate reduced exercise capacity and impaired cardiovascular response during exertion. These findings emphasize the importance of early cardiovascular evaluation and lifestyle interventions to improve functional capacity and reduce cardiovascular risk in individuals with diabetes.

Background: Contraception plays a crucial role in preventing unintended pregnancies and improving maternal and child health outcomes. Knowledge–attitude–practice (KAP) studies help identify gaps between awareness and actual utilization of contraceptive methods, enabling the design of targeted reproductive health interventions. Aim: To assess the knowledge, attitude, and practice regarding contraception among the study population and to identify factors influencing contraceptive use. Methods: This prospective observational study was conducted from October 2025 to January 2026. A total of 200 participants were enrolled after obtaining informed consent. Data were collected using a predesigned, pretested structured questionnaire covering socio-demographic details and KAP components related to contraception. Data were analyzed using descriptive statistics and appropriate inferential tests, with p < 0.05 considered statistically significant. Results: Overall awareness of contraception was high, with 91.0% of participants knowing at least one method. Condoms and oral contraceptive pills were the most commonly known and used methods. Attitudes toward contraception were generally positive; however, fear of side effects was reported by over half of the participants. Although 66.0% had ever used contraception, only 59.0% were current users, indicating a knowledge–practice gap. Conclusion: Despite good knowledge and favorable attitudes, contraceptive practice was suboptimal. Addressing misconceptions, strengthening counselling, and promoting long-acting methods may improve effective contraceptive utilization.

Background: Optimising epidural anaesthesia in lower abdominal surgery often involves adding an opioid to bupivacaine to enhance analgesia, onset, and duration, while balancing side-effects. The mixed κ-agonist/μ-antagonist opioid butorphanol and the pure μ-agonist fentanyl represent two commonly used adjuvants, but direct comparisons remain limited. Aim: To compare epidural butorphanol vs fentanyl as adjuvants to 0.5% bupivacaine in elective lower abdominal surgeries regarding onset and duration of block, analgesic quality, haemodynamic parameters, and adverse-effects. Methods: A prospective, randomised study at Government Medical College, Vizianagaram (December 2025–January 2026) enrolled 60 ASA I–II patients aged 20–60 yrs undergoing elective lower abdominal surgery. Patients were allocated to Group BB (0.5% bupivacaine 18 mL + 1 mg butorphanol + 1 mL saline) or Group BF (0.5% bupivacaine 18 mL + 100 µg fentanyl in 2 mL) via epidural catheter. Onset of analgesia, time to maximum dermatomal level, duration of analgesia (to VAS 5), sedation score, VAS hourly for 8 hrs, vital signs, and complications (pruritus, nausea, urinary retention, respiratory depression) were recorded. Statistical analysis used independent-samples t-test, chi-square, and repeated-measures ANOVA; p < 0.05 was significant. Results: Onset of block was faster in the fentanyl group (8.1 ± 1.5 min vs 9.4 ± 1.8 min; p = 0.001). Duration of analgesia was significantly longer in the butorphanol group (263.4 ± 28.7 min vs 228.6 ± 25.1 min; p < 0.001). Quality of analgesia was similar. Pruritus incidence was significantly higher in the fentanyl group (20% vs 3.3%; p = 0.04). Sedation scores were higher in the butorphanol group. Haemodynamic parameters remained stable in both groups. Conclusions: Epidural bupivacaine plus butorphanol offers longer-lasting analgesia and fewer pruritus events compared to bupivacaine plus fentanyl, though with a slightly slower onset and higher sedation. Choice of adjuvant should reflect clinical priorities.

Background: Laryngoscopy and endotracheal intubation provoke significant hemodynamic changes due to sympathetic stimulation. Various laryngoscopes, such as Macintosh, McCoy, and C-MAC, differ in design and degree of glottic stimulation, influencing cardiovascular responses. Aim: To compare the hemodynamic responses to laryngoscopy and intubation using Macintosh, McCoy, and C-MAC laryngoscopes in adult patients undergoing elective surgeries under general anaesthesia. Methods: This randomized, single-blinded study was conducted on 120 ASA I–II adults (aged 18–60 years) undergoing elective surgeries at GSL Medical College, Andhra Pradesh. Participants were divided into three groups (n=40 each): Group A – Macintosh, Group B – McCoy, and Group C – C-MAC. Standard induction agents were used, and hemodynamic parameters heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, before intubation, and 1, 3, 5, and 10 minutes after intubation. Data were analyzed using SPSS v21.0; p < 0.05 was considered significant. Results: All groups showed transient hemodynamic increases post-intubation, most pronounced with Macintosh and least with C-MAC. The McCoy group demonstrated intermediate values. C-MAC produced significantly lower rises in heart rate and blood pressure (p < 0.001). Conclusion: C-MAC video laryngoscope provides superior hemodynamic stability compared with Macintosh and McCoy laryngoscopes during intubation.

Background: Chronic kidney disease has been associated with multisystemic complications including auditory dysfunction. Objective: To evaluate hearing status in patients with chronic renal failure and assess its association with CKD in the absence of underlying co-morbidities. Methods: Seventy patients with chronic renal failure underwent pure tone audiometry and biochemical evaluation. Results: Hearing impairment was observed in 28.6% of participants, with unilateral involvement more common than bilateral. Mild to moderate sensorineural patterns predominated. Ototoxic drug exposure was limited, suggesting intrinsic renal contribution to cochlear dysfunction. Conclusion: Chronic renal failure is associated with measurable hearing impairment independent of common systemic co-morbidities. Routine audiological screening may aid in early detection and intervention.

Introduction: Anxiety, while related to fear, a complex mix of thoughts, emotions, physical sensations, and behaviors that prepare a person for situations they expect might be threatening. Key chemicals in the central nervous system that are believed to influence anxiety include norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). World Federation of Societies of Biological Psychiatry, Selective Serotonin Reuptake Inhibitors (SSRIs) like Sertraline and Selective Norepinephrine Reuptake Inhibitors (SNRIs) are considered the primary treatments for Generalized anxiety disorder (GAD). Pregabalin, an anticonvulsant, is also being used as a treatment option for GAD.
Aims & Objectives:
Aim: To compare the Efficacy, Tolerability and safety of Pregabalin (Cyclic GABA derivative) & Sertraline (Selective Serotonin Reuptake Inhibitor) in Generalized Anxiety Disorder.
Objectives:
Primary Objective:  To compare efficacy of Pregabalin and Sertraline using Hamilton Anxiety Rating scale & GAD-7 scale.
Secondary Objective:  (1) To compare tolerability of Pregabalin and Sertraline. (2) Evaluating safety of Pregabalin and Sertraline using World Health Organization-Uppsala Monitoring Centre (WHO-UMC) Scale. (3)To compare both GAD-7 & Hamilton Anxiety Rating Scale [HAM-A].
Methods: A hospital based Prospective Interventional type of study was conducted in a tertiary care hospital Psychiatry department at western part of India 18 months duration from 15th April, 2024 till 6th September, 2025 in 100 Generalized Anxiety Disorder patients. GAD 7 & HAMA scale was used to evaluate the efficacy of this drug. Patients were divided into two groups. One group had received Pregabalin & other group received Sertraline. Causality of both drugs were analysed by WHO-UMC scale. Results: 100 patients were included out of which 48 patients belonged to Pregabalin group and 52 patients belonged to Sertraline group. there were no statistically significant differences in anxiety severity between the two groups at the initiation of treatment. Over the 12-week period, both groups demonstrated a progressive reduction in mean symptom scores, reflecting an improvement in clinical condition. However, by Week 12, pregabalin was significantly more effective than sertraline in reducing symptom severity by the end of the 12-week treatment period. Conclusion: This study demonstrated that both pregabalin and sertraline were effective in significantly reducing anxiety symptoms in patients with generalized anxiety disorder over 12 weeks. On clinician-rated HAM-A and patient-reported GAD-7, pregabalin showed modest but statistically significant superiority on week 12. Both drugs achieved substantial and comparable improvements, with pregabalin offering only a slight advantage. Also, Pregabalin showed more statistically significant outcome on HAM-A scale as compared to GAD-7 scale.

Background: Neuropathic pain affects approximately 7–10% of the general population and remains therapeutically challenging. Vitamin D deficiency has been implicated in neuroinflammatory processes, nociceptor sensitization, and chronic pain syndromes. However, evidence from interventional studies remains limited and heterogeneous. Objective: To evaluate the effect of vitamin D3 supplementation on neuropathic pain severity in vitamin D–deficient adults with peripheral neuropathy. Methods: This prospective, non-randomized, wait-list controlled academic trial enrolled 110 adults with confirmed peripheral neuropathy and serum 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL. Participants were allocated to immediate supplementation (Intervention Group, n=55) or delayed supplementation after 12 weeks (Wait-list Control, n=55). Intervention consisted of oral cholecalciferol 60,000 IU weekly for 8 weeks. Primary outcome was change in Numeric Rating Scale (NRS) at 12 weeks. Secondary outcomes included DN4 score change and serum 25(OH)D levels. Results: At 12 weeks, the intervention group demonstrated a significant reduction in mean NRS score compared to controls (mean difference −1.7; 95% CI −2.4 to −1.0; p<0.001). Serum 25(OH)D levels significantly increased in the intervention group (p<0.001). Adjusted ANCOVA confirmed independent association between supplementation and pain reduction. Conclusion: Vitamin D3 supplementation significantly reduced neuropathic pain severity in deficient individuals. These findings support routine screening and correction of vitamin D deficiency in neuropathy patients.

Background: Pneumonia remains one of the leading causes of morbidity and mortality among children under five years of age worldwide. Chest radiography (CXR) is widely used as an adjunct diagnostic tool to evaluate pulmonary involvement and complications of pneumonia. However, its role in assessing the severity of pneumonia and guiding clinical management in pediatric patients continues to be an important area of research. Aim: To evaluate the role of chest X-ray in assessing the severity of pneumonia in children aged 1–5 years admitted to a tertiary care centre. Methods: A hospital-based observational study was conducted in the Department of Pediatrics, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Agartala, Tripura, India. A total of 140 children aged 1–5 years clinically diagnosed with pneumonia were included. Detailed clinical examination was performed, and chest X-ray was obtained for all patients. Radiological findings such as consolidation, interstitial infiltrates, bronchopneumonia pattern, pleural effusion, and multilobar involvement were recorded. The radiographic findings were correlated with clinical severity based on WHO pneumonia classification. Results: Radiographic abnormalities were observed in a majority of children with clinically diagnosed pneumonia. Findings such as lobar consolidation, bilateral infiltrates, multilobar involvement, and pleural effusion were more frequently associated with severe pneumonia. Mild cases commonly showed minimal or interstitial infiltrates. Chest X-ray findings showed a significant association with clinical severity and duration of hospitalization. Conclusion: Chest X-ray is a useful adjunct investigation for assessing the severity of pneumonia in children. Radiological findings can help identify severe disease, predict complications, and assist clinicians in planning appropriate management strategies.

Background: Seizures are one of the most common neurological emergencies in the pediatric age group and represent a frequent cause of hospital admission. The etiological spectrum of seizures in children varies widely depending on age, underlying neurological conditions, infections, metabolic disorders, and genetic predisposition. Early identification of the cause and clinical pattern is essential for prompt treatment and prevention of long-term neurological complications. Aim: To study the clinical profile, etiological factors, and patterns of seizures in children aged 1 month to 12 years admitted to a tertiary care centre. Materials and Methods: This hospital-based observational study was conducted at the Department of Pediatrics, Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania, Agartala, Tripura, India. A total of 250 children aged between 1 month and 12 years admitted with seizures were included. Detailed history, clinical examination, and appropriate investigations such as blood tests, neuroimaging, and electroencephalography (EEG) were performed. Data regarding demographic profile, seizure type, etiological factors, associated clinical features, and outcomes were recorded and analyzed. Results: Among the 250 children included in the study, the majority were below 5 years of age with a male predominance. Generalized tonic-clonic seizures were the most common seizure type. Febrile seizures and central nervous system infections were the leading etiological causes. Neuroimaging abnormalities were detected in a significant proportion of cases. Conclusion: Seizures are a common pediatric neurological emergency, particularly in younger children. Early diagnosis of underlying causes such as febrile illness and CNS infections is essential to reduce morbidity and improve clinical outcomes.

Background: Platelet-rich plasma (PRP) is an autologous blood product enriched with platelets, growth factors and cytokines, concentrated in a small plasma volume. Since the 1970s, PRP has gained significant attention for its role in tissue repair and regeneration. The use of autologous PRP eliminates risks of cross-reactivity, immune reactions or disease transmission. This study aimed to evaluate the effectiveness of platelet-rich plasma (PRP) monotherapy for scar rejuvenation, as no prior clinical studies have objectively assessed its outcomes using a validated tool. Objective: To study the effect of injection of autologous platelet rich plasma in the rejuvenation of scars among patients attending Plastic Surgery OPD in Government Medical College, Thiruvananthapuram, for a period of 1 year. Methods: The study included 40 patients with scars who received PRP injections. Patient and Observer Scar Assessment Scale (POSAS) score was marked on the proforma after obtaining consent and the patients were reassessed at regular intervals. The decrease in POSAS score was statistically analysed using SPSS version 27. Results: There was a statistically significant decrease in POSAS score on both the patient and observer sides after PRP injection. Among 40 patients, mean age was 30.7 years (range: 18–46), 65% female. Scars were located on the head/neck (57%), upper limbs (20%), trunk (18%), and lower limbs (5%). Causes included road traffic accidents (70%), post-surgical scars (17.5%), and burns (12.5%). The mean pre-procedure POSAS patient score was 28.97 (SD: 2.09), decreasing to 26 post-procedures (SD: 2.12). Pain and itch showed no significant changes (p > 0.05), while other variables improved significantly (p < 0.05). Similarly, the mean POSAS observer score decreased from 28.4 (SD: 2.023) to 25 (SD: 2.36) post-procedure. Conclusion: Injection of PRP seems to be a promising and effective therapeutic approach for scars with different origins such as trauma, burns, and post-surgery. Treated areas regain characteristics similar to normal skin, leading not only to aesthetic but also functional results.

Introduction: Ovarian cystic lesions represent a diverse group of gynecological disorders ranging from functional cysts to malignant neoplasms. Accurate histopathological evaluation is essential for diagnosis and management, particularly in resource-limited rural settings. Materials and Methods: This study analyzed 114 cases of ovarian cystic lesions at BKL Walawalkar Rural Medical College & Hospital, Ratnagiri. Each case was assessed for demographic profile, clinical presentation, laterality, histological type, and cyst size. Statistical correlations were performed between lesion size and histological type. Results: The majority of patients were aged 41–60 years (57%). Abdominal pain (24.6%) and abnormal uterine bleeding (12.3%) were the most common presenting symptoms. Unilateral lesions predominated (88.6%). Non-neoplastic lesions (63.2%) were more frequent than neoplastic ones (36.8%). Follicular cysts were the most common histological type (28.1%), followed by corpus albicans (14%) and corpus luteal cysts (10.5%). Malignant lesions accounted for 11.4% of cases and were significantly associated with larger cyst size (>10 cm, p < 0.01). Conclusion: Ovarian cystic lesions are predominantly benign, with follicular cysts being the most frequent. Malignant lesions, though less common, tend to present at larger sizes, underscoring the importance of early detection and histopathological evaluation. Systematic clinicopathological assessment remains vital for improving patient outcomes in rural healthcare settings.

Background: Regional anaesthesia techniques are widely used for lower limb surgeries because they provide effective intraoperative anaesthesia and postoperative analgesia. Spinal anaesthesia remains the most commonly used technique for below-knee surgeries; however, it may be associated with complications such as hypotension, urinary retention, and post-dural puncture headache. Ultrasound-guided peripheral nerve blocks, particularly femoral and sciatic nerve blocks, have gained popularity due to improved accuracy, safety, and prolonged postoperative analgesia. Aim: To compare and evaluate the effectiveness of ultrasound-guided femoral and sciatic nerve blocks versus spinal anaesthesia for below-knee surgeries. Materials and Methods: This prospective comparative study was conducted in the Department of Anaesthesiology & Critical Care, Sri Siddharth Medical College and Hospital, Tumkur, Karnataka, India, over a period of 24 months. A total of 78 patients undergoing elective below-knee surgeries were enrolled in the study and randomly divided into two groups of 39 patients each. Group A (USG-SFNB) received ultrasound-guided combined femoral and sciatic nerve blocks using local anaesthetic agents, while Group B (SA) received unilateral spinal anaesthesia using hyperbaric bupivacaine. Intraoperative haemodynamic parameters, onset time of anaesthesia, duration of analgesia, postoperative pain scores, and complications were assessed. Statistical analysis was performed using SPSS software version 26.0, and a p-value <0.05 was considered statistically significant. Results: The ultrasound-guided nerve block group demonstrated significantly longer postoperative analgesia and reduced postoperative analgesic requirement compared with spinal anaesthesia. Haemodynamic stability was better maintained in the nerve block group. However, the onset of anaesthesia was faster in the spinal anaesthesia group. Conclusion: Ultrasound-guided femoral and sciatic nerve blocks are an effective alternative to spinal anaesthesia for below-knee surgeries, providing prolonged postoperative analgesia with improved haemodynamic stability and fewer complications.

Background: Intrauterine growth restriction (IUGR) is a significant obstetric complication and an important contributor to perinatal morbidity and mortality worldwide. Umbilical artery (UA) Doppler ultrasonography is widely used in clinical practice to monitor fetoplacental circulation and identify compromised pregnancies. However, establishing a clear relationship between antenatal Doppler findings and the underlying microscopic placental pathology remains essential for improving diagnostic accuracy and understanding the mechanisms of fetal growth restriction. The present study aimed to evaluate the association between prenatal UA Doppler indices and postnatal placental histopathological lesions in pregnancies complicated by IUGR. Methods: A prospective observational study was conducted at a tertiary care teaching hospital between June 2024 and February 2026. The study included 106 singleton pregnancies diagnosed with IUGR beyond 28 weeks of gestation. Participants were categorized into two groups based on umbilical artery Doppler velocimetry performed within seven days prior to delivery: those with normal Doppler indices and those with abnormal Doppler findings. After delivery, all placentas were collected and subjected to detailed gross and microscopic examination using standardized histopathological criteria to identify lesions associated with maternal and fetal vascular malperfusion. Results: Abnormal UA Doppler findings were identified in 59.4% (n = 63) of the study population. Placentas from these pregnancies showed a significantly higher frequency of maternal vascular malperfusion lesions compared with those from the normal Doppler group. Increased syncytial knots (84.1% vs. 44.2%, p < 0.001) and villous infarction (66.7% vs. 20.9%, p < 0.001) were the most prominent findings. Severe Doppler abnormalities, particularly absent or reversed end-diastolic flow (AEDF/REDF), were strongly associated with advanced placental underperfusion lesions such as avascular villi and extensive intervillous fibrin deposition. Neonates from the abnormal Doppler group had significantly lower birth weights and a higher rate of NICU admission (55.5% vs. 18.6%, p < 0.001). Conclusion: Umbilical artery Doppler velocimetry is a reliable and non-invasive indicator of underlying placental pathology in IUGR. Markedly abnormal Doppler patterns, particularly AEDF and REDF, closely reflect severe vascular malperfusion and are associated with adverse neonatal outcomes. These findings highlight the crucial role of Doppler surveillance in the management and risk assessment of high-risk pregnancies.

Background: Femoral shaft fractures commonly result from high-velocity road traffic accidents. Intramedullary interlocking nailing is the preferred treatment due to its stability, minimal soft tissue damage, and early mobilization. This prospective study evaluates the functional and radiological outcomes of intramedullary interlocking nailing in adult femoral shaft fractures at a tertiary care center. Material and Methods: Over one year, 50 consecutive adult patients (aged 18-65 years) with acute femoral shaft fractures (AO/OTA 32-A, B, C) were enrolled after ethical approval. Inclusion criteria encompassed closed or Gustilo grade I/II open fractures within 72 hours of injury. Exclusions included pathological fractures, polytrauma with ISS >18, or prior ipsilateral femur surgery. All underwent antegrade IMILN under spinal anesthesia using stainless steel nails (size 9-12 mm) with proximal and distal locking. Postoperative protocol included partial weight-bearing at 2 weeks, advancing to full by 6-8 weeks. Follow-up assessments at 6 weeks, 3, 6, and 12 months involved radiological union (bridging callus in three cortices), alignment (varus/valgus <5°, rotation <10°), and functional scoring via Thoresen criteria. Data analysis used SPSS v26. Results: Mean age was 35.2±12.4 years; 80% male. Road traffic accidents caused 72% injuries. Fractures: 60% transverse (32-A3), 40% oblique/comminuted. Mean operative time: 68±15 min; blood loss: 180±45 ml. Union achieved in 94% by 6 months (mean 15.2±3.8 weeks). Excellent functional outcomes in 70%, good 20%, fair 8%, poor 2%. Complications: superficial infection 4%, malunion 6%, delayed union 8%. Knee ROM averaged 120°±10° at 12 months; no implant failures. Conclusion: IMILN yields high union rates and favorable functional recovery in femoral shaft fractures, with low complications in a resource-constrained setting. Early intervention and meticulous technique are pivotal for optimal outcomes, supporting its routine use in Indian trauma centers.

Background: Many people perceive health as being physically well and free of any diseases, and thus they have neglected the importance of mental health. Therefore, mental health is an irreplaceable aspect of health. Poor mental health will lead to many life threatening diseases such as cardiovascular disease deaths, deaths from external causes or even cancer deaths, which was only associated with psychological distress at higher levels. Aim & Objective: To Assess the Depression, Anxiety and Stress among college students of Kanpur district and to determine the association of Depression, Anxiety and Stress with Socio-demographic profile. Material & Methods: A descriptive cross-sectional study was conducted by the department of Community Medicine among college students of age 18-30 years from May 2024 to July 2024. Results: The majority of the participants were in between 18 and 21 years old (67.5% of the total), next 22 to 25 years old (30.4% of the total), and finally over 25 years old (2.1% of the total). The proportion of male participants in the study was 44.5%. Regarding Co-morbid condition, majority (29.1%) had Hair fall problem followed by 6.3% had Anxiety disorder, 6% had depression, 4.5% had allergy disorder, 3.9% had PCOD and 2.1% had bronchial asthma. Conclusion: In our study assessment of depression anxiety and stress among college student were 51.4%, 53.7%, 34.8% respectively.

Background: Pseudomonas aeruginosa is a major cause of wound infections and often shows multidrug resistance (MDR), frequently mediated by plasmids that enable horizontal gene transfer. Data from Kerala during 2013 were limited. Aim and Objectives: To characterize plasmid-mediated antibiotic resistance in Pseudomonas isolates from wound infections. Materials and Methods: Ten wound swab samples collected in Kerala between May and September 2013 were cultured on selective media and identified using standard biochemical tests. Antibiotic susceptibility was assessed using the disc diffusion method. Plasmid DNA was extracted by the alkaline lysis method and visualised by agarose gel electrophoresis. Plasmid curing was performed using 1% sodium dodecyl sulphate (SDS) at 37°C. The ability of plasmids to transfer resistance was evaluated by conjugation experiments with competent Escherichia coli DH5α. Results: Five Pseudomonas isolates were recovered (50% positivity). All isolates showed 100% resistance to ampicillin, amoxicillin, gentamicin, cloxacillin, and ciprofloxacin, while remaining susceptible to chloramphenicol and penicillin G. Plasmids were detected in all resistant isolates. After plasmid curing, susceptibility to the five antibiotics was completely restored and plasmid bands disappeared. Conjugation experiments demonstrated successful transfer of ampicillin resistance to E. coli. Conclusion: The study shows that plasmids play an important role in transferable multidrug resistance in wound-derived Pseudomonas isolates from Kerala. Continuous resistance surveillance and effective antimicrobial stewardship are necessary to control plasmid-mediated MDR.

Background: Diabetic patients are at high risk for Peripheral Arterial Disease (PAD). Early diagnosis of PAD can help patients effectively manage the condition and prevent its long-term complications. The Ankle-Brachial Index (ABI) measurement is a simple, non-invasive, reproducible, and cost-effective tool for diagnosing PAD. Objectives: To determine the proportion of PAD in patients with type 2 diabetes mellitus in a tertiary care hospital and to compare ABI with Colour Doppler Ultrasonography. Materials and Methods: This facility-based cross-sectional study was conducted using 207 records of diabetic patients who attended the Podiatry Clinic in the Department of Physical Medicine and Rehabilitation at PSGIMSR, Coimbatore. Data were collected using a semi-structured questionnaire, entered in MS Excel, and analyzed using SPSS software version 28.0. Appropriate descriptive and inferential statistics were employed, with a p-value of <0.05 considered significant. Results: The mean age of the study participants was 58 years, with approximately 62% being male. About 54.6% had an abnormal ABI index. Among those with abnormal ABI, 71.6% of them had mild PAD, 21.2% moderate PAD, and 7% severe PAD. Among those with abnormal ABI, bilateral involvement was seen in about 38.9% of the participants, followed by right-side involvement in 35.3%, and left-side involvement in 25.6%. Among those 113 ABI positive patients, about 39 patients were subjected to a doppler study and the positive predictive value was found to be 51.3%. Conclusion: The study demonstrates the high prevalence of peripheral artery disease (PAD) among participants, with mild PAD being most common and a significant portion having bilateral involvement. The ABI index showed moderate predictive accuracy for PAD when compared to Doppler studies. These findings underscore the need for routine screening and confirmatory testing to improve PAD diagnosis and management.

Introduction: Obstructive sleep apnoea (OSA) in children is commonly associated with adeno-tonsillar hypertrophy and can lead to significant disturbances in sleep architecture, oxygenation, and quality of life. Adeno-tonsillectomy is the first-line treatment for moderate to severe paediatric OSA, but residual disease may persist in some patients. This study aimed to evaluate changes in polysomnographic parameters and quality-of-life outcomes before and after adeno-tonsillectomy and to examine the relationship between polysomnographic sleep indices and OSA-18 scores. Materials and Methods: This longitudinal study included children aged 8-15 years with sleep-disordered breathing who underwent adeno-tonsillectomy between January 2024 and July 2025. Consecutive sampling was used. Out of the 46 enrolled participants, 42 completed the study. Overnight attended polysomnography was performed preoperatively and at 3 months postoperatively. Caregivers completed the OSA-18 questionnaire at both time points. Continuous variables were expressed as median (IQR). Pre- and postoperative comparisons were analysed using the Wilcoxon signed-rank test. Associations between variables were evaluated using Spearman’s correlation, and receiver operating characteristic analysis assessed the predictive ability of preoperative OSA-18 scores for persistent moderate-to-severe OSA. Results: The study included 42 children (23 males) with a mean age of 10.31 ± 1.99 years. Median apnoea-hypopnea index (AHI) decreased from 25.0 (IQR 8.75) to 4.0 (IQR 7.0) events/hour (p < 0.001). Median OSA-18 score decreased from 77.0 (IQR 24.5) to 47.0 (IQR 20.5) (p < 0.001). Significant reductions were also observed in respiratory disturbance index, obstructive apnoea index, obstructive hypopnea index, time with SaO₂ < 92%, and central apnoea index (p ≤ 0.026). Postoperatively, 22 children (52.38%) achieved normal AHI, while 7 (16.67%) had persistent moderate-to-severe OSA (AHI ≥ 5). OSA-18 scores showed strong correlations with AHI preoperatively (ρ = 0.8279, p < 0.001) and postoperatively (ρ = 0.7298, p < 0.001). Preoperative OSA-18 demonstrated good predictive performance for persistent moderate-to-severe OSA (AUC = 0.8735). Conclusion: Adeno-tonsillectomy produced significant improvements in both polysomnographic indices and quality-of-life scores in children with OSA. Residual disease persisted in a few patients, particularly those with severe baseline disease.

Purpose: The relationship between thyroid function tests and body mass index has been a topic of debate among researchers. While it is known that abnormal thyroid function can affect weight, it is not clear whether there is an association between thyroid function and body mass index in individuals with normal thyroid function (euthyroid). This study aimed to determine the correlation between thyroid function tests and body mass index in young and middle age euthyroid subjects. Methods: The study included 400 individuals (178 males and 222 females) who were euthyroid with ages ranging from 20 to 60 years. After conducting a clinical examination and obtaining written informed consent, blood samples were collected and analyzed for thyroid function tests. The BMI was calculated, and the values were examined for any potential associations. Results: We found that the mean values of serum T3 and T4 did not show any significant difference among normal weight, overweight, and obese subjects. However, TSH levels were not significant for normal weight and overweight, but we observed a statistically significant difference in the mean TSH values between normal weight and obese subjects. This means that individuals who are obese have higher TSH values than normal-weight individuals. Conclusion: It is worth noting that our findings indicate that only TSH had a positive correlation with BMI. Interestingly, T3 and T4 did not seem to have any significant correlation with BMI. These results suggest that TSH could be a valuable marker for predicting BMI changes.

Background: Ankle fractures are among the most common lower limb injuries encountered in orthopaedic practice and frequently require surgical intervention. Inadequate treatment may lead to chronic pain, instability, and post-traumatic arthritis. Achieving anatomical reduction and stable fixation is therefore essential for restoring joint congruity and ensuring optimal functional and radiological outcomes. Objective: To evaluate the clinical and radiological outcomes of surgically treated ankle fractures in adults using standardized assessment criteria. Methods: This prospective observational study included 30 adult patients with displaced ankle fractures managed with open reduction and internal fixation (ORIF). Fractures were classified according to the Lauge-Hansen system. All patients underwent standardized surgical procedures followed by postoperative rehabilitation. Functional and radiological outcomes were assessed using the Baird and Jackson scoring system over a follow-up period of 6–12 months. Results: Supination-external rotation injuries were the most common mechanism (60%). Bimalleolar fractures predominated (53%), followed by trimalleolar fractures. Functional assessment revealed excellent outcomes in 54% of patients, good outcomes in 33%, and fair outcomes in 13%, with no poor results. The majority of patients achieved pain-free ambulation, stable ankle joints, and return to pre-injury activity levels. Radiological evaluation demonstrated satisfactory joint alignment and maintenance of ankle congruity in most cases. Conclusion: ORIF with anatomical reduction and stable fixation provides excellent clinical and radiological outcomes in displaced ankle fractures, emphasizing the importance of proper surgical technique and early rehabilitation.

Background: Ankle fractures are among the most common lower limb injuries encountered in orthopaedic practice, frequently resulting from road traffic accidents, falls, and sports-related trauma. Although surgical fixation aims to restore joint congruity and function, the final outcome is influenced by factors such as fracture pattern, timing of surgery, fixation stability, and postoperative rehabilitation. Objective: To evaluate functional outcomes following surgical management of ankle fractures in adults from a Western Indian population and to identify factors influencing recovery. Methods: This prospective observational study was conducted between February 2024 and December 2025, including 82 adult patients with closed ankle fractures treated with open reduction and internal fixation (ORIF). Functional outcomes were assessed at 6 months using the Olerud–Molander Ankle Score (OMAS). Statistical analysis was performed using SPSS version 25, with p < 0.05 considered statistically significant. Results: The study population had a mean age of 42.6 ± 13.2 years with a male predominance (67%). Bimalleolar fractures were the most common (54%), followed by trimalleolar fractures (28%). The mean OMAS score at 6 months was 78.4 ± 12.6. Overall, 71.9% of patients achieved excellent to good functional outcomes, while 9.7% had poor outcomes. Early mobilization was significantly associated with better functional recovery (p < 0.01). Conclusion: Operative management of ankle fractures using ORIF yields satisfactory functional outcomes in the majority of patients. Early postoperative mobilization and adherence to structured rehabilitation protocols play a crucial role in optimizing recovery.

Background: Cyberbullying is an emerging public health concern, particularly among adolescents and young adults. With the increasing reliance on digital communication platforms, nursing students may be particularly vulnerable to cyberbullying, which can adversely affect their psychological well-being and academic performance. Objectives: This study aimed to assess the prevalence, predictors, and behavioural patterns of cyberbullying among B.Sc. Nursing students, evaluate its psychological impact, and identify the coping strategies employed by victims. Methods: A cross-sectional survey was conducted among 80 B.Sc. Nursing students of Shridevi Nursing College using convenience sampling. Data were collected using three validated tools: the Cyberbullying and Online Aggression Survey Instrument (COASI), the Coping with Cyberbullying Questionnaire (CWCBQ), and the Depression, Anxiety, and Stress Scale (DASS-21). Descriptive statistics, chi-square tests, and Pearson’s correlation analysis were used, with p < 0.05 considered statistically significant. Results: Cyberbullying victimization was reported by 43.75% of students, and 25% admitted to perpetration. Common forms included impersonation (31.25%) and harassment (25%), with WhatsApp (75%) being the primary platform. Significant correlations were observed between cyberbullying victimization and depression (r = 0.857), anxiety (r = 0.875), and stress (r = 0.911). Assertive coping (31.25%) was the most used strategy and showed a protective effect, while retaliation and self-blame were linked with higher distress. Conclusion: Cyberbullying is prevalent among nursing students and significantly impacts mental health. Institutional awareness, early identification, and support systems are essential to address this issue and promote healthier coping mechanisms.

Background: Non-traumatic acute abdominal pain is a frequent clinical presentation requiring prompt diagnosis to guide appropriate management. Imaging plays a critical role in identifying the underlying pathology. Ultrasonography (USG) is commonly used as the initial imaging modality due to its availability and safety profile, whereas computed tomography (CT) provides detailed anatomical evaluation and higher diagnostic accuracy. This study aimed to compare the diagnostic performance of USG and CT in the evaluation of non-traumatic acute abdominal pain. Material and Methods: This cross-sectional observational study included 150 patients presenting with non-traumatic acute abdominal pain. Clinical details including the nature, duration, and localization of pain were recorded. All patients underwent ultrasonography followed by CT scanning for diagnostic evaluation. The distribution of abdominal pathologies and the sensitivity of USG and CT for different conditions were analyzed and compared. Results: A total of 150 patients were evaluated. Acute pain of <24 hours duration was the most common presentation (48%), followed by subacute pain of 24–72 hours (32%) and chronic pain >72 hours (20%), with a mean pain duration of 31.6 ± 17.2 hours. The most frequent site of pain was the epigastric region (38.6%), followed by the right lower quadrant (24.3%) and flank region (18.3%). Acute pancreatitis was the most common pathology (26%), followed by appendicitis (12.6%), ureteric colic (12%), intestinal obstruction (10%), and acute cholecystitis (10%). Ultrasonography demonstrated variable sensitivity across different conditions, including 56.4% for pancreatitis, 78.9% for appendicitis, 88.9% for ureteric colic, 80% for intestinal obstruction and acute cholecystitis, and 20% for hollow viscus perforation. In contrast, CT showed 100% sensitivity in detecting all evaluated pathologies. Conclusion: Ultrasonography serves as a useful initial imaging modality for patients presenting with non-traumatic acute abdominal pain; however, computed tomography demonstrates superior diagnostic accuracy and remains the preferred modality for definitive evaluation.

Background: COVID-19 vaccine hesitancy represents a critical barrier to achieving herd immunity, particularly in rural communities where vaccination rates remain lower than urban areas. Understanding the determinants of vaccine hesitancy in these underserved populations is essential for developing targeted interventions. Methods: A sequential explanatory mixed-methods design was employed in four rural communities. The quantitative phase involved a cross-sectional survey of 486 adults aged 18-75 years assessing vaccine hesitancy using the validated Vaccine Hesitancy Scale, socio-demographic characteristics, and vaccination status. The qualitative phase comprised 24 in-depth interviews and 3 focus group discussions with purposively selected participants to explore barriers and facilitators to vaccine acceptance. Logistic regression identified independent predictors of hesitancy, while thematic analysis examined qualitative data. Results: Overall vaccine hesitancy prevalence was 41.8% (203/486; 95% CI: 37.4-46.3%), with 18.3% refusing vaccination and 23.5% expressing initial hesitancy. Mean age was 44.6 ± 14.2 years, with 52.5% female participants. Among hesitant individuals, mean Vaccine Hesitancy Scale score was 3.42 ± 0.86 (scale 1-5, higher indicating greater hesitancy). Independent predictors of vaccine hesitancy included age <40 years (aOR = 2.34; 95% CI: 1.48-3.70; p < 0.001), no formal education (aOR = 3.18; 95% CI: 1.86-5.43; p < 0.001), lack of health insurance (aOR = 1.89; 95% CI: 1.22-2.93; p = 0.004), and misinformation exposure (aOR = 4.26; 95% CI: 2.78-6.53; p < 0.001). Qualitative analysis revealed five major themes: safety concerns (cited by 87.5% of hesitant participants), mistrust in government and pharmaceutical companies (79.2%), and misinformation from social media (71.4%), religious beliefs (41.7%), and access barriers (54.2%). Facilitating factors included healthcare provider recommendations, community leader endorsements, and family influence. Conclusion: COVID-19 vaccine hesitancy is alarmingly high in rural communities, driven by multifaceted socio-demographic, informational, and trust-related factors. Targeted interventions leveraging trusted messengers, addressing misinformation, improving health literacy, and enhancing vaccine accessibility are urgently needed to increase vaccine acceptance in rural populations.

Background: Organophosphorus (OP) compound poisoning remains one of the leading causes of suicidal and accidental deaths in developing countries, particularly in agrarian communities. Understanding the pattern and toxicological profile of fatal OP poisoning through medicolegal autopsy cases is essential for informing preventive strategies and improving clinical management. Methods: This retrospective observational study was conducted at the Department of Forensic Medicine and Toxicology of Tertiary Care Hospital. A total of 186 medicolegal autopsy cases confirmed positive for organophosphorus compounds on chemical analysis were included. Demographic data, circumstances of poisoning, compound type, autopsy findings, and toxicological results were analyzed. Statistical analysis was performed using SPSS version 26.0, with chi-square tests and independent t-tests employed where appropriate. A p-value < 0.05 was considered statistically significant. Results: The majority of victims were male (63.4%), aged 21–40 years (54.8%), and from rural backgrounds (71.5%). Suicidal intent accounted for 82.3% of cases. Chlorpyrifos (28.5%) and monocrotophos (22.0%) were the most frequently detected compounds. The mean serum cholinesterase level at admission was 1,124.6 ± 487.3 IU/L. Pulmonary edema (87.1%), cerebral edema (62.4%), and congestion of abdominal viscera (78.0%) were the predominant autopsy findings. A statistically significant association was found between compound type and survival duration (p = 0.002). Conclusion: Fatal OP poisoning disproportionately affects young rural males with suicidal motivation. Highly toxic WHO Class I compounds are frequently implicated. Strengthened pesticide regulation, restricted accessibility, and community-level mental health interventions are imperative to reduce mortality.

Background: The detection of drugs of abuse in postmortem biological specimens constitutes a cornerstone of forensic toxicological investigation in cases of unnatural death. Accurate identification and quantification of substances in postmortem blood and urine samples are essential for establishing the cause, manner, and circumstances surrounding death. Despite advancements in analytical techniques, comprehensive data regarding the prevalence and distribution patterns of drugs of abuse in postmortem cases remain limited in many regions. Methods: This cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology. A total of 324 unnatural death cases subjected to medicolegal autopsy, in which postmortem blood and urine samples were collected and analyzed using immunoassay screening followed by gas chromatography–mass spectrometry (GC-MS) confirmation, were included. Demographic, circumstantial, and toxicological data were analyzed using descriptive and inferential statistics. Results: Drugs of abuse were detected in 138 cases (42.6%). The mean age of positive cases was 34.2 ± 11.8 years, with male predominance (79.7%). Ethanol was the most frequently detected substance (51.4% of positive cases), followed by opioids (21.0%), cannabinoids (14.5%), benzodiazepines (8.7%), and amphetamines (4.3%). Polysubstance detection occurred in 31 cases (22.5%). A statistically significant association was observed between drug detection and manner of death (p = 0.003), with the highest prevalence in accidental deaths (52.1%). The concordance rate between blood and urine detection was 78.3%. Conclusion: Drugs of abuse are prevalent in unnatural death cases, particularly among young males. Systematic postmortem toxicological screening using confirmatory analytical methods is indispensable for accurate forensic interpretation and death certification.

Background: Malnutrition is frequently encountered in patients with gastrointestinal malignancies and has been recognized as an important factor influencing postoperative recovery. Poor nutritional status before surgery is associated with increased morbidity, prolonged hospitalization, and adverse surgical outcomes. Preoperative nutritional optimization has been proposed as a strategy to improve perioperative outcomes in patients undergoing gastrointestinal cancer surgery. The present study aimed to evaluate the impact of preoperative nutritional optimization on postoperative complications in patients undergoing gastrointestinal cancer surgery. Material and Methods: This prospective interventional study included 120 patients undergoing elective surgery for gastrointestinal malignancies at a tertiary care center. Preoperative nutritional status was assessed using body mass index (BMI), history of recent weight loss, serum albumin levels, and Nutritional Risk Screening (NRS-2002). Patients identified as being at nutritional risk received structured preoperative nutritional optimization for 7–14 days, including dietary counseling and oral nutritional supplementation. Postoperative complications within 30 days were recorded and classified according to the Clavien–Dindo classification. Statistical analysis was performed to evaluate the association between nutritional status, nutritional optimization, and postoperative outcomes. Results: The mean age of the study population was 56.8 ± 11.4 years, and 60.0% were males. Nutritional risk was identified in 38.3% of patients, while 28.3% had BMI <18.5 kg/m² and 31.7% had serum albumin <3.0 g/dL. Colorectal carcinoma was the most common malignancy (40.0%). Preoperative nutritional optimization was provided to 52 patients (43.3%) for a mean duration of 9.6 ± 2.8 days. Overall postoperative complications occurred in 25.0% of patients, with surgical site infection being the most frequent (13.3%). Complication rates were significantly lower in patients receiving nutritional optimization compared with those without optimization (15.4% vs 32.4%, p = 0.032). Patients who received nutritional support also had a significantly shorter hospital stay (8.9 ± 2.7 vs 11.4 ± 3.6 days, p = 0.001). Complications were significantly more common in patients with moderate and severe malnutrition (p = 0.004). Conclusion: Preoperative malnutrition is associated with increased postoperative complications in gastrointestinal cancer surgery. Structured preoperative nutritional optimization significantly reduces postoperative morbidity and hospital stay, highlighting the importance of routine nutritional assessment and intervention in the perioperative management of gastrointestinal cancer patients.

Objective: To compare whether laparoscopic surgeries have an advantage over open surgeries for colorectal malignancies with respect to early postoperative clinical outcomes like postoperative pain, bowel recovery time and duration of hospital stay. Methods: The people who have undergone laparoscopic or open colorectal surgeries for colorectal malignancies and consented to the study in the time frame of the study will be included in the study. The primary aim of colorectal surgeries is to excise all the tumour and loco regional lymph nodes. This involves resecting the primary tumour with sufficient longitudinal and radial margins to ensure complete excision of any microscopic tumour cells, to reduce the risk of local recurrence and, in the absence of distant metastatic disease, to achieve a curative resection. Resecting the colonic mesenteric lymph nodes enable the removal of metastatic deposits of tumour contained in them, to increase the chance of curative resection. This would logically improve the survival of the patients in whom lymph nodes were excised compared to leaving them unexcised. Categorical and quantitative variables were expressed as frequency (percentage) and mean ± SD respectively. Independent tests were used to compare quantitative parameters between categories. Chi-square test was used to find association between categorical variables. Mann-Whitney U Test was used to compare ordinal parameters between groups. For all statistical interpretations, 0.05 was considered the threshold for statistical significance. Statistical analyses was performed by using a statistical software package SPSS, version 20.0. Results: A total of 41 patients were included in the study, among them 29 patients underwent laparoscopic surgery and 12 open surgery. The disparity in number of patients were attributed to surgeon’s expertise, patient’s preference and widely recognised advantages of laparoscopic surgery. Postoperative pain on day 0,1,3 were less for laparoscopic group compared to their counterpart (p<0.01). Both the groups had comparable pain score on discharge. The bowel recovery in terms of reappearance of bowel sounds, passage of flatus and faeces were earlier in the laparoscopic group than the open group which was found to be statistically significant. The total number of hospital stay was lower for the laparoscopic group than the open group, owing to their early return of bowel functions and better early post-operative outcome. Conclusion: Our findings indicate that the laparoscopic group of patients had better early postoperative outcome which is reduced postoperative pain, lesser need of analgesics, faster bowel recovery with respect to early reappearance of bowel sound, passage of flatus and faeces and shorter hospital stay.

Background: Early detection of melanoma remains critical for improving patient survival outcomes. Dermoscopy has emerged as an essential non-invasive diagnostic tool for differentiating malignant from benign pigmented lesions. However, distinguishing early melanoma from benign melanocytic nevi presents significant diagnostic challenges. This study aimed to evaluate the diagnostic accuracy of specific dermoscopic patterns in differentiating early melanoma from benign pigmented lesions. Methods: This prospective diagnostic accuracy study was conducted at a dermatology referral center. A total of 524 pigmented lesions from 489 patients were evaluated using standardized dermoscopic examination. All lesions underwent histopathological examination as the reference standard. Dermoscopic features were assessed using established criteria, and diagnostic performance metrics were calculated. Results: The study included 147 early melanomas (Breslow thickness ≤1.0 mm) and 377 benign pigmented lesions. Atypical pigment network demonstrated the highest sensitivity (87.8%) for melanoma detection, while blue-white veil showed the highest specificity (94.7%). The combination of three or more melanoma-specific structures yielded sensitivity of 91.2%, specificity of 89.4%, and area under the curve (AUC) of 0.934 (95% CI: 0.912-0.956). Irregular streaks (OR=8.42, p<0.001), atypical dots/globules (OR=6.78, p<0.001), and regression structures (OR=5.94, p<0.001) were independently associated with melanoma diagnosis. The seven-point checklist achieved sensitivity of 85.7% and specificity of 82.5%. Conclusion: Systematic dermoscopic assessment using multiple melanoma-specific features significantly improves diagnostic accuracy for early melanoma detection. Integration of pattern analysis with algorithmic approaches optimizes differentiation between early melanoma and benign pigmented lesions.

Background: Family planning is a key component of reproductive health and plays a vital role in improving maternal and child health outcomes. Despite increased awareness and availability of contraceptive methods, many rural populations continue to experience an unmet need for family planning due to socioeconomic, cultural, and educational barriers. Objective: To assess the prevalence of contraceptive use and determine the unmet need for family planning among the rural population. Methods: A community-based cross-sectional study was conducted among married women of reproductive age (15–49 years) residing in rural areas. Data were collected using a structured questionnaire covering socio-demographic characteristics, knowledge of contraceptive methods, current contraceptive use, and reasons for non-use. Descriptive statistics and percentages were used for analysis. Results: A total of 200 participants were included in the study. Among them, 58% were currently using some form of contraception, while 42% were non-users. The most commonly used method was female sterilisation (30%), followed by condoms (12%), oral contraceptive pills (8%), and intrauterine contraceptive devices (8%). The overall unmet need for family planning was 24%. Major reasons for unmet need included lack of awareness, fear of side effects, cultural beliefs, and limited access to services. Conclusion: Although awareness about contraception is increasing, a considerable proportion of rural women still have an unmet need for family planning. Strengthening community education, improving accessibility of services, and involving male partners could help reduce unmet need and improve reproductive health outcomes.

Background: Neuroendocrine dysfunction is increasingly recognised as a significant consequence of traumatic brain injury (TBI). Alterations in thyroid hormone regulation may influence neuronal repair, cerebral metabolism, and functional recovery. Subclinical hypothyroidism (SCH), defined as elevated thyroid-stimulating hormone (TSH) with normal free thyroxine (fT4), may adversely affect recovery courses following TBI. Objective: To evaluate the association between subclinical hypothyroidism and neurological as well as functional recovery in patients with traumatic brain injury. Methods: This prospective observational study included 100 adult patients with mild-to-severe TBI admitted to a tertiary neurosurgical centre. Thyroid function tests (TSH and fT4) were performed within 72 hours of admission. Patients were categorised into SCH and euthyroid groups. Neurological recovery was assessed using Glasgow Coma Scale (GCS) improvement, and functional outcome was measured using the Glasgow Outcome Scale (GOS) at 28 days. Hospital stay duration and mortality were also analysed. Results: Subclinical hypothyroidism was identified in 18% of patients. Baseline injury severity was comparable between groups. SCH patients demonstrated significantly lower discharge GCS scores (11.3 ± 3.8 vs 13.9 ± 2.9; p=0.01), reduced GCS improvement (2.3 ± 1.9 vs 4.5 ± 2.1; p=0.003), lower rates of favorable GOS outcome (44% vs 74%; p=0.02), and longer hospital stay (14.8 ± 4.9 vs 9.6 ± 3.4 days; p<0.001). TSH levels correlated negatively with neurological improvement and positively with the duration of hospital stay. Conclusion: Subclinical hypothyroidism is associated with delayed neurological recovery and poorer functional outcomes following TBI. Early thyroid axis screening may aid prognosis and risk stratification.

Background: Tuberculosis is quite a common disease in underdeveloped countries like India. Hence, FNAC is an easy diagnostic tool to confirm tuberculous lymphadenitis and to determine sensitivity and specificity. Method: 70 adults diagnosed with tuberculous lymphadenitis by FNAC, followed by measurement of elevated serum adenosine deaminase levels, were recorded. Results: Out of 70 patients, 80% had granulomatous lymphadenitis and 20% had granulomas/20 HPE. The adenosine deaminase levels ranged between 31 to 40 I1/L. Conclusion: The FNAC study of adenosine deaminase elevation is a confirmation of tuberculosis in the suspected enlargement of lymph nodes.

Introduction: One of the most important anaesthesia skills is to secure the airway using an endotracheal tube. This is mostly done using a direct laryngoscope. The significant pressure response and inability to provide a satisfactory glottic view, has prompted the development of innovative intubation instruments. One such intubation tool is the video laryngoscope. Aims: To assess and compare the application of Macintosh laryngoscopy (ML) and King Vision video laryngoscopy (KVVL) in adult patients scheduled for elective surgery while under general anaesthesia. Objectives: The primary objectives – assess intubation time, CL (Cormack Lehane) grade, optimisation maneuvers required (bougie, cricoid Pressure) and hemodynamic changes. Secondary objectives- evaluating sore throat associated with intubation and laryngoscopy. Tertiary objective- distinction between KVVL and DL intubation techniques. Study Design: Cohort study. Study Period: The study was conducted between December 2022 and June 2024 – duration of eighteen months. Study Place: Patients who were planned for elective surgery under GA at Amala Hospital, over a period of one and half years. Hundred patients were assigned to undergo intubation using KVVL or ML according to week days (3days for VL, 3days for – DL). An experienced anaesthesiologist with at least 40 KVVL intubations performed each intubation. Sample Size: Total sample size 100 and divided into two groups. In ML group 50 and KVVL group 50. Study Population: Patients scheduled for elective surgery under GA. Sampling Method: Consecutive sampling method. Method: Macintosh or King Vision intubation was assigned for one hundred elective surgery patients at Amala Institute of Medical Sciences. All of the data were collected and statistically analysed at the conclusion of the study. Results and Conclusion: In the two groups, there was no variation in the prevalence of gender, mean age, height, weight, or BMI. All 100 participants fell into Mallampatti classes I or II. Efficacy outcomes- The KVVL approach had a significantly longer mean time for scopy (45.56±20.15) than the ML method (23.32±11.08). In ML group, 31 (62.0%) participants were belonging to CL Grade I, 15 (62.0%) belongs to Grade II and 4 (8.0%) belongs to Grade III. Whereas in KVVL group, 47 (94.0%) were belongs to CL Grade I and 3 (6.0%) were Grade II and none in higher grades. The p-value indicated that the KVVL group had a greater laryngeal view than the ML group. Therefore, KVVL group had a better glottic visualization. Optimization maneuver was needed in 18 (36%) participants in ML group and only 2 (4%) in KVVL group. The KVVL group showed a significantly less mean change in SBP, DBP, MAP, and HR from baseline to PT0 (at the time of intubation), PT1 (1 minute after intubation), and PT3(3 minutes after intubation) than the ML group, suggesting more stable hemodynamic alterations. Post operative sore throat -Out of 50 cases in ML group, 5 (10.0%) had severe sore throat, 14 (28.0%) experienced moderate sore throat and 18 (36.0%)- mild sore throat. The KVVL group, none of them had severe sore throat, 8 (16.0%) had moderate and 22 (44.0%) had mild sore throat. The p-value indicated that the KVVL technique produced a considerably less severe sore throat than the ML technique.

Background: Coronary artery bypass grafting (CABG) remains the cornerstone revascularization strategy for multivessel coronary artery disease. Cardiopulmonary bypass (CPB) utilized during on-pump CABG (ONCAB) is known to provoke a systemic inflammatory response that may adversely influence postoperative outcomes. Off-pump CABG (OPCAB) avoids CPB, theoretically mitigating this inflammatory cascade, yet the comparative clinical significance of attenuated inflammation on hard clinical endpoints remains contested. Methods: A prospective cohort study was conducted at cardiac surgery center. A total of 342 consecutive patients undergoing isolated primary CABG were enrolled: 168 in the OPCAB group and 174 in the ONCAB group. Inflammatory markers were measured preoperatively and at 6, 24, and 72 hours postoperatively. Primary outcomes included peak postoperative inflammatory marker concentrations and 30-day mortality. Results: Peak CRP levels were significantly lower in the OPCAB group (98.4 ± 32.7 vs. 142.6 ± 41.3 mg/L; p < 0.001). Similarly, peak IL-6 (186.3 ± 72.4 vs. 298.7 ± 94.8 pg/mL; p < 0.001) and peak PCT (1.24 ± 0.68 vs. 3.87 ± 1.92 ng/mL; p < 0.001) were significantly attenuated in OPCAB patients. Thirty-day mortality was 1.8% in the OPCAB group versus 4.0% in the ONCAB group (p = 0.219). After multivariable adjustment, elevated peak IL-6 concentration was independently associated with 30-day mortality (adjusted OR = 1.008; 95% CI: 1.003–1.014; p = 0.002). Conclusion: OPCAB significantly attenuates the early postoperative systemic inflammatory response compared to ONCAB. While a trend toward reduced 30-day mortality was observed with OPCAB, this difference did not achieve statistical significance. Elevated IL-6 independently predicted early mortality, suggesting that inflammation modulation may represent a mechanistic pathway through which surgical technique influences clinical outcomes.

Background: Otitis media with effusion (OME) is among the most prevalent childhood conditions, characterized by the accumulation of fluid within the middle ear cleft in the absence of acute infectious signs. The resultant conductive hearing loss, though often transient, may compromise speech, language, and cognitive development during critical developmental periods. Ventilation tube (grommet) insertion remains the most widely performed surgical intervention for persistent OME associated with hearing impairment; however, the magnitude and durability of audiometric improvement following grommet placement across different age groups and OME laterality patterns warrant further prospective evaluation. Methods: This prospective interventional study enrolled 180 children (312 ears) aged 2–12 years with bilateral or unilateral OME persisting for ≥3 months, who underwent grommet insertion at a tertiary otolaryngology center from February 2022 to January 2024. Pure-tone audiometry and tympanometry were performed preoperatively and at 2 weeks, 3 months, 6 months, and 12 months postoperatively. The primary outcome was change in pure-tone average (PTA) hearing threshold. Results: The mean preoperative PTA was 34.82 ± 8.47 dB HL, which improved significantly to 16.43 ± 5.21 dB HL at 2 weeks (p < 0.001), 14.87 ± 4.96 dB HL at 3 months (p < 0.001), 15.52 ± 5.38 dB HL at 6 months (p < 0.001), and 18.74 ± 6.83 dB HL at 12 months (p < 0.001). Hearing returned to normal thresholds (≤20 dB HL) in 82.4% of ears at 3 months. Younger age (<5 years), bilateral OME, and mucoid effusion type were associated with slightly less favorable audiometric recovery at 12 months. Tympanosclerosis was observed in 28.2% of operated ears, and post-tube otorrhea occurred in 11.5%. Conclusion: Grommet insertion produces a significant and rapid hearing improvement in children with chronic OME, with maximum benefit observed within the first 3 months. Audiometric gains diminish gradually by 12 months, paralleling natural tube extrusion. Younger children and those with bilateral mucoid effusion warrant close audiological follow-up.

Background: Thoracic lobectomy remains the gold standard surgical treatment for early-stage non-small cell lung cancer (NSCLC). However, postoperative pulmonary complications (PPCs) continue to represent a major source of morbidity, prolonged hospitalization, and increased healthcare expenditure. Enhanced Recovery after Surgery (ERAS) protocols have demonstrated efficacy across multiple surgical disciplines, yet their systematic application in thoracic lobectomy remains incompletely characterized. Methods: A prospective comparative study was conducted at a tertiary thoracic surgery center. A total of 216 patients undergoing elective lobectomy for NSCLC were enrolled: 112 patients managed under the ERAS protocol and 104 patients under conventional care. Primary outcomes included PPC incidence and LOS. Secondary outcomes included 30-day readmission, mortality, chest tube duration, and pain scores. Results: The ERAS group demonstrated a significantly lower PPC rate (15.2% vs. 29.8%; p = 0.009) and shorter mean LOS (5.3 ± 1.8 vs. 8.1 ± 2.6 days; p < 0.001) compared to conventional care. Chest tube duration was reduced (2.8 ± 1.1 vs. 4.2 ± 1.7 days; p < 0.001). No significant differences in 30-day readmission rates (7.1% vs. 5.8%; p = 0.680) or mortality (0.9% vs. 1.0%; p = 1.000) were observed between groups. Conclusion: Implementation of an ERAS protocol in thoracic lobectomy significantly reduces postoperative pulmonary complications and hospital length of stay without increasing readmission or mortality rates, supporting its adoption as a standard perioperative care framework in thoracic surgery.

Background: Despite the availability of effective inhaled pharmacotherapy, a substantial proportion of asthma patients fail to achieve optimal disease control. Poor inhaler technique represents a critical yet frequently overlooked barrier to effective drug delivery and clinical outcomes. This study aimed to assess the level of asthma control and evaluate inhaler technique proficiency among adult asthma patients attending outpatient clinics, and to determine the association between inhaler technique errors and asthma control status. Methods: A cross-sectional observational study was conducted across four hospital-based outpatient pulmonology and allergy clinics. A total of 520 adult patients with physician-diagnosed asthma using inhaler devices for ≥3 months were enrolled. Asthma control was assessed using the Asthma Control Test (ACT), and inhaler technique was evaluated through direct observation using device-specific validated checklists. Spirometric assessment, medication adherence (Medication Adherence Report Scale for Asthma, MARS-A), and demographic and clinical variables were systematically recorded. Results: The mean ACT score was 16.8 ± 4.6, with only 34.2% of patients achieving well-controlled asthma (ACT ≥20). Critical inhaler technique errors were identified in 56.7% of participants. The most common critical errors were failure to exhale before inhalation (42.3%), incorrect inspiratory flow rate (38.1%), and failure to hold breath after inhalation (34.6%). Patients with critical errors had significantly lower ACT scores (14.8 ± 4.2 vs. 19.4 ± 3.8, p < 0.001) and lower FEV₁% predicted (68.4 ± 16.2% vs. 78.6 ± 14.8%, p < 0.001). Multivariable analysis identified critical inhaler errors (aOR 3.18, 95% CI 2.14–4.72, p < 0.001), poor medication adherence (aOR 2.64, 95% CI 1.78–3.92, p < 0.001), and absence of prior inhaler education (aOR 2.42, 95% CI 1.62–3.61, p < 0.001) as independent predictors of uncontrolled asthma. Conclusion: The majority of asthma patients in outpatient settings demonstrate suboptimal disease control, with critical inhaler technique errors affecting more than half of users. Inhaler technique proficiency is independently and strongly associated with asthma control status. Systematic assessment and regular reinforcement of inhaler technique should be integrated into routine asthma management.

Background: Breast cancer is the most common malignancy among Indian women. Timely and accurate diagnosis of palpable breast lumps is critical for appropriate management. Fine Needle Aspiration Cytology (FNAC) and Tru-cut biopsy are commonly used diagnostic modalities. While FNAC is minimally invasive and cost-effective, Tru-cut biopsy provides core tissue for histopathological and immunohistochemical evaluation, potentially improving diagnostic accuracy. Objectives: To compare the diagnostic accuracy of FNAC and Tru-cut biopsy in distinguishing benign from malignant breast lesions. To evaluate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic efficacy of both techniques. Methods: A retrospective comparative study was conducted over 24 months at a tertiary care center in rural Faridabad, Haryana. A total of 106 patients presenting with palpable breast lumps were included, excluding those with infective or traumatic etiologies. All patients underwent both FNAC and Tru-cut biopsy, followed by histopathological correlation post-surgery. Results: Tru-cut biopsy demonstrated superior diagnostic performance with a sensitivity of 97.37%, specificity of 96.67%, PPV of 98.67%, NPV of 93.55%, and overall accuracy of 97.16%. FNAC yielded a sensitivity of 85.53%, specificity of 86.67%, PPV of 94.20%, NPV of 70.27%, and accuracy of 85.84%. FNAC correctly identified 85.8% of cases, whereas Tru-cut biopsy showed stronger concordance with final histopathology results. Conclusion: FNAC remains a valuable initial diagnostic tool due to its simplicity, affordability, and rapid results. However, Tru-cut biopsy offers significantly higher diagnostic accuracy and is especially beneficial in cases where FNAC results are inconclusive. Given its superior performance metrics, Tru-cut biopsy should be incorporated into routine diagnostic protocols alongside FNAC, as part of the WHO-recommended triple assessment for breast lesions.

Background: Laryngoscopy and endotracheal intubation during general anaesthesia can cause sympathetic stimulation leading to tachycardia and hypertension. These responses may worsen during laparoscopic surgery due to pneumoperitoneum. Alpha-2 adrenergic agonists such as clonidine and dexmedetomidine are used to attenuate these responses. This study compared intravenous dexmedetomidine and clonidine for attenuation of the pressor response during endotracheal intubation and maintenance of intraoperative hemodynamic stability in laparoscopic surgery. Methods: This randomized controlled study was conducted in the Department of Anaesthesia at GMERS Medical College, Sola, Ahmedabad, from March 2023 to February 2025. Fifty patients aged 20–60 years with ASA physical status I and II undergoing elective laparoscopic surgery were randomly divided into two groups (n=25 each). Group A received intravenous dexmedetomidine (1 μg/kg) and Group B received intravenous clonidine (2 μg/kg) as a slow infusion over 10 minutes before induction of anaesthesia. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, oxygen saturation (SpO₂), and end-tidal CO₂ (EtCO₂) were recorded at baseline and at predefined intraoperative intervals. Results: Baseline demographic characteristics were comparable between the groups. The dexmedetomidine group showed significantly lower heart rate and blood pressure values during important intraoperative periods such as after intubation, during pneumoperitoneum, and during surgery (p<0.05). Oxygen saturation and end-tidal CO₂ remained stable and comparable between both groups throughout the procedure. Conclusion: Intravenous dexmedetomidine was more effective than clonidine in attenuating the pressor response during laryngoscopy and endotracheal intubation and provided better intraoperative hemodynamic stability during laparoscopic surgery without affecting respiratory parameters.

Background: Direct laryngoscopy with the Macintosh laryngoscope is the standard technique for endotracheal intubation during general anaesthesia. However, laryngoscopy and intubation can provoke sympathetic stimulation leading to tachycardia and hypertension. The Intubating Laryngeal Mask Airway (ILMA) is an alternative airway device that allows ventilation and blind tracheal intubation without direct laryngoscopy. Objective: To compare the hemodynamic responses and intubation characteristics of tracheal intubation using direct laryngoscopy and ILMA in patients undergoing elective surgery under general anaesthesia. Methods: This prospective randomized comparative study included 110 adult patients aged 18–65 years with ASA physical status I–II scheduled for elective surgery under general anaesthesia. Patients were randomly divided into two groups of 55 each: Group M underwent intubation using direct laryngoscopy with Macintosh blade, and Group I underwent intubation using ILMA. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, before intubation, during intubation, and at 1, 2, 5, and 10 minutes after intubation. Intubation time, success rate, and complications were also assessed. Results: The mean intubation time was significantly shorter in Group M compared with Group I (p < 0.05). The first-attempt success rate was higher in Group M, although the overall success rate was 100% in both groups. Hemodynamic parameters showed transient increases during intubation in both groups without significant differences. Conclusion: Direct laryngoscopy provides faster tracheal intubation with a higher first-attempt success rate, while ILMA offers comparable hemodynamic stability and can be considered a feasible alternative airway device.

Background: Cervical cancer remains a leading cause of morbidity and mortality among women, particularly in low‑resource settings. Early detection through screening can substantially reduce disease burden; however, awareness and uptake of cervical cancer screening remain low. This study aimed to assess the awareness and utilization of cervical cancer screening among women attending a Family Medicine clinic. Material and Methods: A hospital‑based cross‑sectional study was conducted among 420 women aged 21–65 years attending the Family Medicine outpatient clinic over six months. Participants were selected using systematic sampling. Data were collected through a structured, pre‑tested questionnaire covering sociodemographic characteristics, obstetric history, awareness of cervical cancer, and screening practices. Descriptive statistics and Chi‑square tests were used to assess associations, with p < 0.05 considered statistically significant. Results: Among the participants, the largest proportion were aged 31–40 years (30.0%), married (91.0%), and homemakers (66.2%). Awareness regarding cervical cancer was reported by 56.7% of women, while only 33.8% were aware of the Pap smear test. Uptake of cervical cancer screening was low, with 22.9% of women reporting ever being screened; Pap smear was the most commonly used method (75.0%). Among women who had never been screened, the main reasons were lack of awareness (43.8%), absence of symptoms (24.1%), and fear or embarrassment (13.0%). Women aware of cervical cancer and Pap smear testing were significantly more likely to undergo screening (34.5% vs 7.7%, p < 0.001; 45.1% vs 11.5%, p < 0.001, respectively). Conclusion: Awareness of cervical cancer and its screening is suboptimal among women attending Family Medicine clinics, resulting in low screening uptake. Targeted health education and opportunistic screening strategies within primary care settings are essential to improve participation and facilitate early detection.

Background: Antenatal care (ANC) plays a vital role in improving maternal and fetal outcomes by enabling early detection and management of pregnancy-related complications. Family physicians serve as the first point of contact for many pregnant women and are important providers of comprehensive antenatal care services. The present study was conducted to evaluate the antenatal care services provided by family physicians in a tertiary care setting. Material and Methods: A hospital-based cross-sectional study was conducted among 150 pregnant women attending the antenatal clinic of the Department of Family Medicine in a tertiary care hospital. Participants were selected using consecutive sampling. Data were collected using a pre-designed and pre-tested structured questionnaire along with review of antenatal records. Information regarding socio-demographic characteristics, obstetric history, antenatal visits, and services received during antenatal care was recorded. Data were analyzed using descriptive statistics and chi-square test to assess associations, with p < 0.05 considered statistically significant. Results: Among the 150 participants, the majority were aged 20–24 years (34.7%) and were homemakers (74.7%), while 52.7% belonged to the middle socioeconomic class. Multigravida women constituted 57.3% of the study population. Nearly half of the participants (48.0%) initiated their first antenatal visit during the second trimester. Blood pressure monitoring was performed for all participants (100%), while weight monitoring and abdominal examination were conducted in 97.3% and 92.0% respectively. Iron and folic acid supplementation was provided to 94.7% of women and tetanus toxoid vaccination to 90.7%. Nutritional counselling and education regarding danger signs of pregnancy were provided to 85.3% and 73.3% respectively. Adequate antenatal care services were observed in 69.3% of participants. Adequacy of antenatal care showed significant association with maternal education (p = 0.001), gravidity (p = 0.042), trimester at first visit (p = 0.015), and number of antenatal visits (p < 0.001). Conclusion: Family physicians provide essential antenatal care services to the majority of pregnant women in a tertiary care setting. Early registration, regular antenatal visits, and improved maternal education may enhance the adequacy of antenatal care services and contribute to better maternal health outcomes.

Background: Polytrauma remains a major cause of mortality and morbidity worldwide, particularly among young adults. Hypovolemic shock is the most common preventable cause of early death in trauma patients. Early identification of predictors of outcome in polytrauma patients is essential for timely intervention and improved survival. Objectives: To identify clinical and biochemical predictors of outcome in polytrauma patients presenting with hypovolemic shock. Methods: A prospective observational study was conducted among 50 polytrauma patients with hypovolemic shock admitted to the General Surgery Department of a tertiary care Government Hospital. Demographic characteristics, injury profile, physiological parameters, laboratory investigations including serum lactate levels, and injury severity scores were recorded. Outcomes were categorized as survival or mortality. Statistical analysis was performed to determine associations between clinical variables and outcomes. Results: Among the 50 patients included in the study, 40 patients (80%) survived while 10 patients (20%) died. Higher admission lactate levels, lower lactate clearance, higher injury severity scores, and lower systolic blood pressure at admission were associated with poorer outcomes. Conclusion: Serum lactate levels, lactate clearance, and injury severity scores are important predictors of outcome in polytrauma patients presenting with hypovolemic shock. Early identification of these predictors may assist clinicians in identifying high-risk patients and guiding aggressive resuscitative strategies.

Background: Acute watery diarrhea episodes are mostly caused by viruses, with rotaviruses being the most common. Probiotics are living microorganisms that improve the quality of gut flora and offer health benefits. Hence, quality and quantity of probiotic yogurt play vital roles. Method: Out of 80 (eighty) adult patients with acute watery diarrhea, 40 (group I) were given regular yogurt, and 40 (group II) were treated with probiotic yogurt. The response was checked after 72 hours of treatment. Results: Comparison of malnutrition, dehydration, and frequency of stool per day has a significant p value (p<0.001). The comparative study of outcomes of regular yogurt and probiotic yogurt also had a significant p value (p<0.001). Conclusion: Group II had diarrhea for a shorter period than group I. Stool frequency and composition returned to normalcy more quickly in group-II patients. More research and placebo-controlled clinical investigations are required to confirm these significant comparative studies.

Background: Meningitis caused by Cryptococcus neoformans is an opportunistic fungal infection in immunocompromised hosts. Few cases of cryptococcal meningitis have been reported in immunocompetent hosts. Cryptococcal meningitis is often misdiagnosed in immunocompetent individuals. A history, clinical examination, early diagnosis and treatment play a role in the management of cryptococcal meningitis. Case Presentation: A 27-year-old female presented with headache, giddiness, and vomiting for 20 days. On examination, she was conscious, oriented and afebrile with neck stiffness. Cerebrospinal fluid (CSF) analysis showed predominant lymphocytes. Aerobic culture of CSF showed no growth in 48 hours, but after 5 days of incubation in thioglycolate broth, Cryptococcus neoformans was isolated. The patient was started on intravenous Amphotericin B and Fluconazole tablet. Conclusion: Although cryptococcal meningitis infection is rare among immunocompetent patients, it must be suspected by clinicians in patients presenting with meningitis symptoms.

Background: Cardiovascular diseases remain the foremost cause of mortality globally, with acute myocardial infarction (AMI) constituting a major proportion. Mean platelet volume (MPV), a marker of platelet size and reactivity, has been proposed as a cost-effective predictor of thrombotic cardiovascular events. However, its association with conventional cardiovascular risk factors in the context of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) remains insufficiently characterized. Methods: This hospital-based cross-sectional study was conducted over a period of one year at a tertiary care centre. A total of 60 patients diagnosed with AMI (30 STEMI and 30 NSTEMI) and 60 age- and sex-matched healthy controls were enrolled. Venous blood samples were collected within six hours of admission into EDTA tubes for estimation of platelet count, MPV, platelet distribution width (PDW), and plateletcrit (PCT) using an automated hematology analyzer. Conventional risk factors including hypertension, diabetes mellitus, smoking, and alcohol consumption were documented. Statistical analysis was performed using SPSS version 26.0, employing Chi-square test, Student’s t-test, and ANOVA, with significance set at p<0.05. Results: Mean MPV was significantly elevated in AMI cases (10.58±0.91 fL) compared to controls (8.49±0.87 fL, p<0.001). STEMI patients demonstrated a higher mean MPV (10.97±0.82 fL) than NSTEMI patients (10.19±0.88 fL, p=0.001). Among hypertensive AMI cases, 38.46% of STEMI patients had MPV >11 fL compared to 8.33% in NSTEMI (p<0.001). Smokers with STEMI showed significantly higher MPV values than non-smokers and controls (p=0.002). Diabetic patients in the STEMI group had a higher prevalence of elevated MPV (p=0.014). Alcohol consumption was not significantly associated with MPV elevation (p=0.29). Conclusion: MPV was significantly elevated in patients with AMI, particularly in the STEMI subgroup. A synergistic association was observed between elevated MPV and traditional cardiovascular risk factors, especially hypertension, smoking, and diabetes mellitus. MPV may serve as a simple, inexpensive, and readily available biomarker for early cardiovascular risk stratification.

Introduction: Pre eclampsia is a major health problem leading to maternal morbidity and mortality.It involves endothelial dysfunction and over consumption of platelets due to vasoconstriction, aggregation and adhesion of platelets. This can be assessed by platelet function tests like platelet count, mean platelet volume, plateletcrit and platelet distribution width. Methodology: It was a case-controlled study which enrolled a total of 110 patients (55 cases and 55 controls). Blood samples were collected and the platelet indices – platelet count, plateletcrit, mean platelet volume and platelet distribution width – were evaluated and compared between the two groups. Result: The study included 110 patients divided into cases (n=55) comprising of patients with pre eclampsia and control (n=55) comprising of normotensive healthy pregnant patients. The platelet indices mean platelet volume(MPV) in cases was 12.66±6.72 as compared to 8.76±3.94 in controls (p <0.001%) .The platelet distribution width (PDW) showed a statistically significant difference.  The PDW showed AUC of 0.84 (95% CI- 0.767– 0.913). the critical cutoff for PDW was calculated to be 15 U/ml, for this cutoff the sensitivity and specificity for predicting pre eclampsia was 78.2% and 76.4% respectively. The plateletcrit was lower among the cases (0.18±0.11) than the control group (0.19±0.05). But no statistically significant difference was seen between the groups. Conclusion: Platelet indices, including platelet count, mean platelet volume, platelet distribution width, and Plateletcrit, can serve as promising markers for predicting preeclampsia in pregnant women.

Background: Cataract surgery has evolved from sight-restoring to refractive surgery, with increasing demand for postoperative spectacle independence. Monofocal intraocular lenses (IOLs) provide excellent distance vision but typically require reading correction. Multifocal and accommodative IOLs aim to restore functional near and intermediate vision, but may be associated with dysphotopsia and altered contrast sensitivity. Aim: To compare postoperative visual outcomes and patient-reported visual quality among monofocal, multifocal, and accommodative IOLs after uncomplicated phacoemulsification. Methods: Prospective comparative study of 100 patients undergoing phacoemulsification with in-the-bag implantation of monofocal (n=40), multifocal (n=40), or accommodative (n=20) IOLs. Outcomes at 3 months included uncorrected distance (UDVA), intermediate (UIVA), near (UNVA) visual acuity (logMAR), contrast sensitivity (Pelli–Robson), refractive accuracy, spectacle independence, dysphotopsia (halos), satisfaction score, and complications. Results: Baseline profiles were comparable across groups. At 3 months, UDVA was similar (p=0.265). UIVA differed significantly (monofocal 0.28±0.09 vs multifocal 0.17±0.09 vs accommodative 0.21±0.09 logMAR; p=0.000005). UNVA showed the largest difference (monofocal 0.44±0.14 vs multifocal 0.16±0.11 vs accommodative 0.18±0.10 logMAR; p<0.001). Contrast sensitivity was lower in multifocal IOLs (1.59±0.13) compared with monofocal (1.74±0.08) and accommodative (1.69±0.09) (p<0.001). Spectacle-free near vision was highest with multifocal IOLs (77.5%) and accommodative IOLs (50%) vs monofocal (12.5%) (p<0.001). Moderate–severe halos were more frequent with multifocal IOLs (17.5%) (p<0.001). Conclusion: All IOLs achieved excellent distance outcomes. Multifocal IOLs provided the greatest near/intermediate spectacle independence but at the cost of more halos and reduced contrast sensitivity.

Background: Hypertensive retinopathy (HR) reflects systemic microvascular injury and is associated with adverse cerebrovascular and cardiovascular outcomes. Retinal vascular signs and quantitative metrics such as arteriolar–venular ratio (AVR) may provide a non-invasive window to cumulative blood pressure (BP) burden. Aim: To evaluate the correlation between retinal vascular changes (clinical HR grade and AVR) and systemic hypertension severity and duration among adult hypertensive patients. Methods: A prospective observational study enrolled 110 adults with systemic hypertension attending Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Bihar, from 10 February 2025 to 25 January 2026. Clinic BP was recorded using standardized technique. Dilated fundus evaluation (and/or fundus photography where available) graded HR using a simplified clinical system aligned with established classifications. AVR was derived from standardized retinal vessel assessment. Associations between BP indices and retinal findings were analyzed using Spearman correlation and multivariable logistic regression for ≥moderate HR. Results: HR prevalence was 47.3% (mild 15.5%, moderate 28.2%, severe/malignant 3.6%). Generalized arteriolar narrowing (46.4%) and AV nicking (30.0%) were common. SBP correlated inversely with AVR (ρ = −0.63, p < 0.001) and positively with HR grade (ρ = 0.44, p < 0.001). Duration of hypertension also correlated with AVR (ρ = −0.59, p < 0.001) and HR grade (ρ = 0.31, p = 0.001). In adjusted analysis, each 10-mmHg higher SBP was associated with higher odds of ≥moderate HR (aOR 2.60, 95% CI 1.54–4.40; p < 0.001), and each additional 5 years of hypertension increased odds (aOR 2.26, 95% CI 1.23–4.15; p = 0.009). Conclusion: Retinal vascular changes—both clinical HR severity and AVR—showed significant, graded relationships with systemic BP burden and hypertension duration. Routine retinal assessment may enhance risk stratification and reinforce the need for tighter BP control to limit microvascular injury.

Introduction: Infection due to Gram negative bacilli (GNB) is the leading cause of mortalilty in hospitalized patients including ICU and ward. These GNB are capable of production of various enzymes like ESBL, carbapenemase. Anti-microbial Resistance (AMR) is raising serious threat to public health. Increased emergence of ESBL and CRE pathogens causing further makes the treatment difficult. This study aims to investigate the prevalence of MDR Gram-negative pathogens and proportion of ESBL producer and Carbapenem-resistant Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, and to determine susceptibility pattern to various antibiotics. Materials and Methods: This study was conducted over a period of 6 month from March to August 2025. The specimens were processed at the Microbiology Laboratory of JNUIMSRC Medical College, Jaipur, Rajasthan. Standard procedures were used to process the clinical specimens. ESBL producer and Carbapenem-resistant isolates were screened according to CLSI 2025 guideline. Results: This study includes 200 isolates of Multidrug Resistant (MDR) Gram-negative Bacterial isolates of Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa. Of these in the Enterobacterales (108/148) 72.5% were ESBL-producing isolates and 79.50% (n = 159/200) were carbapenem resistant. The breakup is as follows: 108 (67.92%) were Enterobacterales, 42 (26.41%) were A. baumannii, and 10 (6.28%) were P. aeruginosa. Conclusion: A high prevalence of ESBL production and Carbapenem resistant isolates was observed among Gram negative isolates. Early detection, isolation and contact precaution to these MDR organism and judicious usage of antibiotic will help to prevent dissemination of these isolates.

Background: Dyslipidemia is a major risk factor for cardiovascular diseases and is characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C), triglycerides, or reduced high-density lipoprotein cholesterol (HDL-C). Statins remain the cornerstone of pharmacological therapy for dyslipidemia due to their ability to inhibit HMG-CoA reductase and reduce cholesterol synthesis in the liver. Among commonly prescribed statins, atorvastatin and rosuvastatin are widely used due to their potent lipid-lowering effects. Several studies suggest that rosuvastatin may provide greater reductions in LDL-C compared with atorvastatin at equivalent doses. Aim: To compare the efficacy of atorvastatin and rosuvastatin in reducing LDL cholesterol levels in patients with dyslipidemia. Materials and Methods: A prospective comparative study was conducted among 200 patients with dyslipidemia attending the medicine outpatient department of a tertiary care hospital. Patients were randomly allocated into two groups: Group A (Atorvastatin 20 mg, n=100) and Group B (Rosuvastatin 10 mg, n=100). Baseline lipid profile parameters were recorded and repeated after 12 weeks of therapy. Statistical analysis was performed using Student’s t-test and chi-square test. A p-value <0.05 was considered statistically significant. Results: Both atorvastatin and rosuvastatin significantly reduced LDL cholesterol levels. However, rosuvastatin demonstrated a greater percentage reduction in LDL-C compared with atorvastatin (48.6% vs 38.2%, p<0.001). A higher proportion of patients receiving rosuvastatin achieved target LDL levels (<100 mg/dl) compared with those receiving atorvastatin (74% vs 56%). Conclusion: Both statins were effective in lowering LDL cholesterol levels, but rosuvastatin showed significantly greater LDL reduction and better achievement of target lipid levels. Rosuvastatin may therefore be considered a more potent statin for managing dyslipidemia.

Background: Abnormal uterine bleeding (AUB) is one of the most common gynecological complaints among women of all age groups and accounts for a significant proportion of outpatient visits. Endometrial biopsy is an important diagnostic tool for identifying the underlying causes of AUB and distinguishing between physiological, benign, premalignant, and malignant conditions. Histopathological examination of the endometrium helps guide appropriate clinical management and detect early pathological changes. Objectives: To evaluate the histopathological patterns of endometrial biopsy in patients presenting with abnormal uterine bleeding and to correlate these findings with different age groups. Materials and Methods: This descriptive cross-sectional study was conducted on women presenting with abnormal uterine bleeding in the Department of Obstetrics and Gynecologyat DMCH Laheriasarai Darbhanga. Patients with pregnancy-related causes of bleeding were excluded. Endometrial samples were obtained through dilatation and curettage or endometrial biopsy and subjected to histopathological examination. Patients were categorized into age groups such as reproductive, perimenopausal, and postmenopausal, and the frequency of different endometrial patterns was analyzed. Results: Abnormal uterine bleeding was most commonly observed in the perimenopausal age group (40–49 years). The most frequent histopathological findings were normal cyclical endometrium, particularly proliferative and secretory phases. Other lesions identified included disordered proliferative endometrium, endometrial hyperplasia, endometrial polyps, chronic endometritis, and atrophic endometrium. Premalignant lesions and endometrial carcinoma were relatively uncommon but occurred more frequently in older age groups. Conclusion: Endometrial biopsy is a valuable and reliable diagnostic method for evaluating abnormal uterine bleeding. Histopathological analysis helps differentiate functional from organic causes and aids in the early detection of premalignant and malignant lesions. Age-wise evaluation of endometrial patterns plays a crucial role in guiding clinical management and preventing complications.

Background: Coronary artery disease (CAD) has increasingly been recognized as a significant health concern among young adults, with obesity emerging as a major modifiable risk factor. However, the precise nature and magnitude of the association between body mass index (BMI) and angiographically confirmed CAD in young adults remain insufficiently characterized. This study aimed to evaluate the association between BMI categories and the prevalence, severity, and pattern of coronary artery disease in young adults undergoing coronary angiography. Methods: A cross-sectional analytical study was conducted at a tertiary care center. A total of 468 patients aged 18–45 years who underwent coronary angiography for suspected CAD were included. Participants were categorized into four BMI groups: normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), class I obesity (30.0–34.9 kg/m²), and class II–III obesity (≥35.0 kg/m²). Angiographic findings, cardiovascular risk factors, lipid profiles, inflammatory markers, and metabolic parameters were systematically compared across BMI categories. Results: The mean age was 38.4 ± 5.6 years, with 71.8% male predominance. The prevalence of angiographically significant CAD (≥50% stenosis) increased progressively across BMI categories: 28.4% in normal weight, 42.7% in overweight, 56.3% in class I obesity, and 68.9% in class II–III obesity (p-trend < 0.001). Multivessel disease was significantly more prevalent in obese patients (34.2% vs. 12.8% in normal weight, p < 0.001). After multivariable adjustment, class II–III obesity remained independently associated with significant CAD (adjusted odds ratio [aOR] 3.24, 95% CI 1.72–6.11, p < 0.001). Higher BMI was significantly associated with elevated high-sensitivity C-reactive protein (hs-CRP), insulin resistance (HOMA-IR), triglycerides, and lower HDL cholesterol levels. Conclusion: Elevated BMI demonstrates a strong, graded, and independent association with coronary artery disease prevalence and severity in young adults. Obesity-mediated metabolic derangements and chronic systemic inflammation likely constitute the principal pathophysiological mechanisms underlying this relationship. Aggressive weight management strategies should be prioritized in young adult cardiovascular risk reduction programs.

Background: Cannabis remains the most widely used illicit psychoactive substance globally and in India, with increasing clinical presentations in tertiary care centers. Cannabis use is strongly associated with psychiatric morbidity, polysubstance dependence, and adverse social outcomes. Understanding socio-demographic and clinical characteristics of cannabis users helps in designing targeted prevention and treatment strategies. Hospital-based studies in India consistently show a predominance of young male users, early age of initiation, and frequent co-use of alcohol and nicotine. Objectives: To assess the correlation between socio-demographic variables and clinical profile among cannabis users attending a tertiary health care center. Methods: This cross-sectional observational study included 200 cannabis users attending the psychiatry and de-addiction services of a tertiary health care centre from November 2024 to November 2025 over a period of 12 months. Socio-demographic variables (age, gender, education, occupation, marital status, socioeconomic status, residence) and clinical variables (age of initiation, duration of use, frequency, type of cannabis consumed, comorbid psychiatric illness, and other substance use) were recorded using a structured proforma. Data were analyzed using descriptive statistics and chi-square tests to determine associations between socio-demographic factors and clinical outcomes. A p-value <0.05 was considered statistically significant. Results: The majority of cannabis users were males (≈80–85%) and belonged to the 18–35-year age group, reflecting the known epidemiology of cannabis use in tertiary care settings. Early initiation (before 20 years) was observed in over half of the participants. Polysubstance use, particularly with alcohol and nicotine, was highly prevalent. Psychiatric comorbidities such as substance-induced psychosis, mood disorders, and anxiety disorders were common. Younger age, male gender, and unemployment were significantly associated with higher frequency use and longer duration of dependence (p <0.05). Conclusion: Cannabis users presenting to tertiary health care centres are predominantly young males with early initiation, high polysubstance use, and significant psychiatric comorbidity. Socio-demographic determinants such as unemployment, urban residence, and low socioeconomic status appear strongly associated with severe clinical profiles. Early screening, community awareness, and integrated de-addiction services are essential to reduce the growing burden of cannabis-related morbidity.

Background: Acute lower respiratory tract infections (ALRTI) remain a leading cause of under-five mortality globally, particularly in low- and middle-income countries where preventable socioeconomic and environmental risk factors persist. Objective: To identify modifiable determinants associated with ALRTI severity among children aged 2 months to 5 years. Methods: This hospital-based cross-sectional study included 100 children diagnosed with ALRTI over a one-year period. Sociodemographic variables, immunization status, breastfeeding practices, and environmental exposures were assessed using a structured proforma. Statistical analysis was performed and chi-square test; p<0.05 was considered statistically significant. Results: Low socioeconomic status, incomplete immunization, and exposure to polluting domestic fuels demonstrated significant association with ALRTI severity (p<0.05). Conclusion: Strengthening vaccination coverage, promoting clean household energy use, and improving socioeconomic conditions are essential strategies to reduce childhood ALRTI burden.

Introduction: Depression in children aged 10-19 years is a growing global issue in India where world’s largest population of children of this age group with 250 million individuals resides. Global prevalence of depression in 2024 among 10-19 years aged adolescents vary from 6% to 21% according to (WHO) World Health Organisation. Methods: An analytical cross-sectional study was conducted on children aged 10-19 years, with complaints of chest pain (non-cardiac origin). Self-designed questionnaire including demographic and predictors of depression for each participant was filled. PHQ 9 is patient health questionnaire tool of 9 items used to assess depressive symptoms. The participants who scored >15 were considered depressed. Univariate analysis was performed to find out psychosocial predictors. Adjusted odds ratio with 95% confidence intervals were derived. P-value less than 0.05 were considered statistically significant. Results: Total 50 children between 10-19 years aged were assessed for depression using PHQ- 9 severity assessment tool. 26.6% were found depressed using PHQ 9 score 15 and above. On Univariate analysis female gender, elder in age, belonging to lower socioeconomic class, dropped out of school, experiencing family conflicts and experiencing domestic abuse were significantly associated with depression. Living with single parents had 3.76 times higher risk of depression. 15.7% males were experiencing academic stress. Living arrangement, chronic illness, use of social media and relationship breakdown were not found significant risk factors. Discussion: Elderly female children belonging to lower socioeconomic class were affected most. Statistically significant predictors of depression were family conflicts and domestic abuse. Academic stress and parents living apart were another significant risk factor. Urgent need to stop early child marriage at rural level. Need to educate parents to reduce parental pressure on academics to improve mental health of children.

Introduction: Atrophic rhinitis (AR) is a chronic condition characterized by progressive atrophy of the nasal mucosa and underlying bone. AR can be classified as either primary or secondary to a predisposing factor or an event. Platelet-Rich Plasma (PRP) is a platelet-rich concentrate of plasma proteins and growth factors that aids in regeneration of nasal mucosa. Aim and Objectives of the study: Evaluation of efficacy of PRP injection in Primary Atrophic Rhinitis (PAR). Objectives: (1). To analyse Sino-Nasal Outcome Test-25(SNOT-25) scores before & after PRP therapy in patients with PAR. (2). To study any local side effects following PRP injection. Methodology: The Hospital based prospective cohort study was conducted in Department of Otorhinolaryngology, Deen Dayal Upadhyay Hospital, and New Delhi from May 2022 to May 2023. Autologous PRP was given intranasally at 0, 2 and 4 weeks interval. Outcome measures – Primary- Improvement in SNOT-25 scores. Secondary- Improvement in nasal symptoms like nasal crusting and nasal obstruction. Results: In this study, The SNOT-25 scores showed improvement over 6 months follow-up period, suggesting tissue regeneration and wound healing. The mean ± SD SNOT-25 score at 0, 1 and 6 months was found to be 44.08±4.12, 25.18±8.42 and 10.48±4.61 respectively. Nasal symptoms like nasal crusting and nasal obstruction also improved. Conclusions: In the present study autologous PRP was given in patients of PAR intranasally with good results without any complications. SNOT-25 score and nasal symptoms showed significant improvement after PRP injection in 6 months follow-up period.

Background: Fluid-refractory septic shock remains a major cause of morbidity and mortality among children, particularly in low- and middle-income countries. Current paediatric sepsis guidelines recommend early initiation of vasoactive agents such as epinephrine or norepinephrine when shock persists despite adequate fluid resuscitation. However, comparative regarding the efficacy and safety of these agents in children remains limited. Objectives: To compare the efficacy and safety of epinephrine and norepinephrine in children with fluid-refractory septic shock. Methods: This open-label randomized clinical study was conducted in the paediatric intensive care unit of a tertiary care hospital. Children aged 2 months to 12 years with fluid-refractory septic shock, defined according to international paediatric sepsis consensus criteria, were randomized to receive either epinephrine or norepinephrine as the initial vasoactive agent. The primary outcome was resolution of shock at one hour. Secondary outcomes included achievement of therapeutic endpoints at 6, 24, 48, and 72 hours, adverse events, duration of hospital stay, and in-hospital mortality. Results: A total of 54 children were enrolled, with 27 patients in each group. Shock resolution at one hour was achieved in 59.2% of children in the norepinephrine group and 51.8% in the epinephrine group, with no statistically significant difference. There were no significant differences between the groups in achievement of therapeutic endpoints, incidence of adverse events, duration of hospital stay, or mortality. Tachycardia was the most commonly observed adverse event in both groups. Conclusion: Epinephrine and norepinephrine demonstrated comparable efficacy and safety in the management of paediatric fluid-refractory septic shock. These findings support current guideline recommendations endorsing the use of either agent as first-line vasoactive therapy³, with selection guided by clinical context and resource availability.

Background: Carbapenem-resistant Gram-negative bacilli (CR-GNB) significantly compromise therapeutic options in clinical practice. Plazomicin, a next-generation Aminoglycoside, has been structurally optimized to evade most AMEs and retain activity against MDR Enterobacterales, may offer improved activity over conventional aminoglycosides, yet data from the Indian context are limited. Methods: In this cross-sectional study conducted at a tertiary care cancer hospital in western India from December 2024-January 2025, 100 non-duplicate CR-GNB clinical isolates were evaluated. Antimicrobial susceptibility testing was performed using VITEK-2. Carbapenem isolates were further evaluated for expression of Carbapenemase genes and in vitro susceptibility to Plazomicin and its comparison to other Aminoglycoside. Results: Plazomicin susceptibility (42%) was significantly higher than amikacin (18%), gentamicin (33%), and tobramycin (13.3%) (p<0.001). Isolates co-producing NDM with OXA-48 demonstrated elevated plazomicin MICs and resistance while those producing KPC or OXA-48 demonstrated a relatively higher proportion of susceptibility. Klebsiella pneumoniae showed MIC₅₀=>256, MIC₉₀=>256; Escherichia coli MIC₅₀=1, MIC₉₀=>256; Pseudomonas aeruginosa MIC₅₀=12, MIC₉₀=>256; and Enterobacter cloacae MIC₅₀=0.75, MIC₉₀=1. Plazomicin retains potent activity against isolates harboring single carbapenemase genes, while co-production of multiple resistance determinants- especially NDM with OXA-48 markedly diminishes susceptibility and results in elevated MIC values. Conclusions: Plazomicin shows superior in vitro activity compared to conventional aminoglycosides against selected CR-GNB isolates. Resistance genotypes markedly influence plazomicin susceptibility, highlighting the role of molecular characterisation in guiding antimicrobial therapy.

Introduction: Pharmacology is often perceived as a difficult subject due to its heavy factual content and abstract mechanisms. While traditional flipped classrooms promote active learning, they can increase student workload and suffer from inconsistent pre-class preparation. Just-in-Time Flipping (JiTF) is an innovative modification where preparatory time is provided at the start of the class under faculty supervision. This study aimed to assess the perceptions of Phase II MBBS students regarding the JiTF strategy in teaching the pharmacology of chelating agents and to evaluate their post-class performance. Methodology: This single-session, cross-sectional educational intervention involved Phase II MBBS students. Using the JiTF approach, students were given 20 minutes at the beginning of the session to review structured materials (PowerPoint slides, infographics, and reference notes) via Google Classroom under faculty supervision. This was followed by 15 minutes of case-based group discussions, class-wide presentations, and 15 minutes of faculty-facilitated interaction to clarify misconceptions. Outcomes were measured using a structured feedback questionnaire to assess student perceptions and a 10-item multiple-choice post-class quiz to evaluate short-term knowledge consolidation. Results: The session was attended by 115 students, of whom 105 (91.3%) provided feedback. 90.5% of participants rated the JiTF format as better than traditional lectures, with none rating it as worse. A significant majority (96.2%) agreed that case-based discussions helped them apply pharmacological knowledge to clinical contexts, and 91.4% reported feeling actively engaged during the session. In the post-class assessment, the mean score was 6.45 out of 10, with 58.2% of students achieving “Good” or “Excellent” grades. Qualitative feedback highlighted themes of interactive learning improved conceptual clarity, and a strong recommendation (95%) to use this method for other pharmacology topics. Conclusion: The JiTF approach was well-received and perceived as more effective than traditional lectures for teaching complex pharmacology topics. By integrating supervised self-study and active discussion into a single session, JiTF enhances student engagement and knowledge application overcoming the limitations of conventional flipped classrooms.

Background: Cardiovascular risk factors are significant to analyse at pre-menopausal and in post-menopausal women. PMS- post menopausal syndrome is group of symptoms that may starts to appear at menopausal age and get diagnosed after stoppage of mensuration. Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVDs) along with hormonal changes, bone related diseases and osteoporosis are associated with Menopause. Aim: It was aimed to find the association of vitamin D, FBS, Lipid profile and cardiovascular risk factors in between diabetic and non-diabetic women at pre-menopause and post menopause state. Material & Method: The study was design with total of 160 subjects, 80 pre-menopause women age in between 34-44 years and 80 post menopause women age in between 45-55 years. Out of 80 in both groups sub division of diabetic and non-diabetic women was done. Anthropometric parameters – SBP and DBP and pulse rate were measured in both the groups. Biochemical parameters such as vitamin D, FBS, Total Cholesterol (TC), Triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and very low-density lipoprotein-cholesterol (VLDL-C) were investigated. A p<0.05 value was considered statistically significant. The correlation was determined by using Karl’s Pearson’s correlation coefficient. Results: The mean of SBP, DBP, Pulse rate, FBS, TC, TG, LDL-C, VLDL-C, were significantly raised in diabetic women when compared to non-diabetic of both the groups. However, the mean of Vitamin D and HDL-C was found significantly low in diabetic post-menopausal women. Conclusion: Results showed that diabetic women (post-menopausal) are at higher risk for CVDs and bone related disorders.

Background: Altered levels of thyroid hormones can impact various body systems, including the nervous system. Hypothyroidism may disrupt nerve conduction due to pathophysiological changes associated with hormone deficiency. To study nerve conduction abnormalities and to correlate electrodiagnostic findings with clinical features in patients with primary hypothyroidism. Materials & Methods: History regarding the duration of the disease, clinical and neurological complaints, use of medicines and level of control of hypothyroidism was recorded in history record sheet. After history taking, general clinical examination was done. Then neurological examination was conducted with special attention. Neuro-MEP-Micro (version 2009) Machine and it’s all accessories (Manufactured by Neurosoft Medical Diagnostics Limited, Ivanova, Russia). Electrophysiological parameters like nerve conduction study parameters (latency, amplitude, conduction velocity) of bilateral tibial, and sural motor nerves and tibial, and sural sensory nerves were recorded. Biochemical parameters like T3, T4, TSH values were recorded from patients’ test reports and from Endocrinology OPD prescriptions. Results:  Study results show mean (±SD) of serum T3 was significantly less in cases (5.27±4.83) than that of the control (15.93±26.63) whereas mean (±SD) of TSH was significantly increased in cases (20.09±28.16) than that of the control (2.62±0.93). Similarly, there was significant increase in mean (±SD) of serum FT4 levels in cases (1.66±1.740) as compared to control subjects (1.22±0.37). In lower limbs the mean (±SD) of distal motor latency (DML) of both tibial motor nerves were significantly increased in cases (Right: 6.71±0.77, Left: 6.19±1.16) than that of the control (Right: 4.24±0.69, Left: 4.16±0.74). No significant differences were found in mean (±SD) of compound muscle action potential (CMAP) of both tibial motor nerves than that of the control. Table 6 shows DSL of right sural nerve decreases but DSL of left sural nerve increases with increase in duration of disease. SNAP of right sural shows positive correlation with duration of disease but the findings are not significant (r=0.072, p= 0.479). SNAP of left sural nerve decreases with increase in duration of disease but it is not significant (r= -0.131, p= 0.193). Positive correlation is there in between SNCV of sural nerve with duration of disease in both sides but these relations are not strong and significant (r= 0.016, p=0.875 and r=0.193, p=0.054). Conclusion: In our study we found that there were significant differences of both sensory and motor NCS parameters between cases and control. We found that CMAP, SNAP and MNCV, SNCV were significantly decreased and distal motor and sensory latencies were significantly increased in cases than controls which indicate mixed type of polyneuropathy, both axonal and demyelinating in hypothyroid patients.  Therefore, we can conclude that peripheral neuropathy in hypothyroidism due to axonal loss and/or demyelination can be evaluated effectively by nerve conduction studies. So, the hypothyroid patients should be routinely screened by nerve conduction study.

Background: Thyroid hormones play a vital role in maintaining normal reproductive function. Triiodothyronine (T3) and thyroxine (T4) regulate the growth, development, and metabolic activity of the ovaries, uterus, and placenta by binding to specific receptors present in these tissues. Consequently, thyroid dysfunction may lead to reproductive disturbances such as subfertility, infertility, menstrual irregularities, anovulation, spontaneous abortion, and delayed intrauterine development. Materials and Methods: A cross-sectional study was conducted over a one-year period from January 2025 to January 2026 among patients attending a tertiary care hospital in Bharuch, Gujarat, who underwent thyroid hormone testing. Secondary data pertaining to age, gender, and serum levels of TSH, T3, and T4 were collected and analyzed. Results: Thyroid-stimulating hormone (TSH) concentrations demonstrate an elevation during colder environmental conditions and a decline in warmer temperatures, thereby exhibiting an inverse correlation with ambient temperature. These observations imply that TSH secretion is responsive to thermal variations. Furthermore, in women of reproductive age, both TSH and thyroid hormone levels may undergo seasonal oscillations, with TSH values frequently increasing during the winter months. Additionally, statistically significant alterations in thyroid hormone profiles are evident among both males and females across various age groups in different seasonal contexts. Conclusion: It can be inferred from the findings that age, gender, and seasonal variation exert a significant and measurable influence on the circulating levels of thyroid hormones, including T3, T4, and thyroid-stimulating hormone (TSH).

Although adjuvant radiation therapy has been shown to be effective in treating breast cancer, there are concerns about radiation exposure to the heart and lungs, particularly when the illness is left-sided. Intensity Modulated Radiation Therapy (IMRT) spares nearby healthy organs by more precisely adjusting the radiation beams’ intensity. However, when compared to 3-Dimensional Conformal Radiation Therapy (3DCRT), it increases the integral dosage to normal healthy tissues. We have retrospectively compared the dosimetry and acute toxicity profile of 3DCRT and IMRT in post-mastectomy patients. A total of 50 patients were selected who received radiotherapy with IMRT and 3DCRT, radiation dose being 50 Gy in 25 fractions for 5 weeks. We compared the dosimetric data for Planning Target Volume (PTV) and Organ At-risk (OAR) by both techniques along with acute toxicity profile. Dosimetric parameter of PTV coverage V95 and V107 were significantly better in IMRT than 3DCRT (p-value-0.001). IMRT showed better homogeneity index (0.14 Gy vs 0.26 Gy) and conformity index was also better for IMRT (0.94 Gy vs 0.74 Gy, p-value 0.0028). The mean value of heart V25 in left sided disease was significantly lower in IMRT than 3DCRT (22.59 and 25.64, p value 0.01). V20 of ipsilateral lung was numerically less in IMRT though not significant (31.44 vs 35.3). But low dose volume was significantly more in IMRT, as seen by higher V5 of heart and ipsilateral lung. In summary, compared to 3DCRT, IMRT has more uniform and conformal planning, better PTV coverage, and better organ sparing.

Introduction: Prosthetic valve dysfunction remains a significant cause of morbidity and mortality following valve replacement surgery. Despite advances in valve technology and surgical techniques, complications including thrombosis, structural deterioration, pannus formation, and endocarditis continue to affect patient outcomes. This study aimed to evaluate the clinical spectrum, etiological factors, complications, and outcomes of prosthetic valve dysfunction in a tertiary care setting in South India. Methods: A prospective observational study was conducted at Government Tiruvannamalai Medical College Hospital for a period of two years. Fifty patients presenting with prosthetic valve dysfunction were enrolled. Detailed clinical history, physical examination, laboratory investigations, and comprehensive echocardiographic evaluation were performed. Patients were classified based on valve type, position, etiology of dysfunction, and complications. Management strategies included conservative medical therapy, thrombolysis, and surgical intervention. Outcomes including mortality, morbidity, and functional status were analyzed. Results: Among 50 patients studied, 45(90%) had mechanical valves and 5(10%) had bioprosthetic valves. Mean age was 45.6 years with male predominance (62%). Structural valve deterioration was the most common cause in bioprosthetic valves (61.1%), while thrombosis predominated in mechanical valves (43.8%). Pannus formation occurred in 25% of mechanical valves. The mitral position was most frequently affected (56%). Major complications included heart failure (56%), thromboembolism (30%), and endocarditis (14%). Surgical intervention was required in 10% of patients. Overall mortality was 16%, with cardiogenic shock and sepsis as leading causes of death. Conclusion: Prosthetic valve dysfunction presents with diverse etiologies and significant complications in our population. Suboptimal anticoagulation control was strongly associated with thrombotic complications. Regular surveillance, patient education, optimal anticoagulation management, and timely intervention are essential to improve outcomes. Structured follow-up programs and accessible monitoring facilities are critical for preventing catastrophic complications in resource-limited settings.

Introduction: The Sequential Organ Failure Assessment (SOFA) score, which was created to evaluate organ dysfunction in seriously ill patients, provides a clear and flexible way to assess the severity of organ failure across different systems. Using it in obstetric critical care gives important information about maternal outcomes and disease progress. The above study was conducted to assess the role of Sequential Organ Failure Assessment (SOFA) score in predicting the outcome of women admitted in Obstetric Intensive Care Unit. Methodology: The study was conducted at SMS Medical College, Jaipur with total of 44 women included in the study. Their demographic, clinical, and obstetric characteristics were analyzed alongside their SOFA scores and outcomes. Result: Women with a lower SOFA score upon admission had better survival outcomes, with those scoring between 0 and 6 having no mortality. In contrast, women with a SOFA score greater than 12 had a significantly higher mortality rate (71.4%). Conclusion: Sequential Organ Failure Assessment (SOFA) score strongly supports in predicting maternal mortality and morbidity in obstetric intensive care unit (ICU) patients.

Background: Surgery for recurrent fistula-in-ano is associated with higher rates of recurrence compared to index cases. Accurate delineation of fistula tracts using preoperative magnetic resonance imaging (MRI) fistulogram may improve outcomes. Aim: To compare recurrence outcomes in patients undergoing surgery for recurrent fistula-in-ano with and without preoperative MRI fistulogram. Methods: A case–control study was conducted on patients who underwent surgery for fistula-in-ano between May 2024 and December 2025. The cases were patients who underwent surgery with preoperative MRI fistulogram, and controls were those operated without an MRI fistulogram before May 2024. Data for cases were collected prospectively, whereas controls were identified retrospectively and followed prospectively. The primary outcome was recurrence rate. The effect size was based on previous literature suggesting up to a 75% reduction in recurrence with MRI-guided surgery. Results: Among total cases (n=75), recurrence rates augmented with fistula grade, ranging from 15.7% (Grade 3) to 33.3% (Grade 5), with an overall recurrence of 20% (15/75). In controls (n=75), recurrence rates ranged from 35.7% (Grade 3) to 60% (Grade 5), with an overall recurrence of 45.3% (34/75). The difference was statistically significant (p < 0.001). Conclusion: Preoperative MRI fistulogram significantly reduces recurrence in recurrent fistula-in-ano, particularly in higher-grade fistulas where clinical examination under anesthesia may be inadequate.

Background: Extra-articular fractures of the proximal and distal thirds of the tibia represent a challenging subset of tibial shaft fractures due to the metaphyseal anatomy and deforming muscular forces that predispose these fractures to malalignment. Intramedullary interlocking nails with multidirectional locking options have been introduced to improve fixation stability and alignment in such fractures. Aim: To evaluate the clinical, radiological, and functional outcomes of extra-articular proximal and distal third tibial fractures in adults treated using multidirectional tibial nailing. Methodology: A prospective observational study was conducted on 40 adult patients with extra-articular proximal or distal third tibial fractures treated with multidirectional tibial nailing. Patients were followed for 12 months postoperatively. Clinical outcomes were assessed using the Johner-Wruhs criteria, and radiological union was assessed on serial radiographs. Results: The mean age of patients was 36.8 ± 12.5 years. The average time to radiological union was 19.8 weeks. Excellent or good functional outcomes were observed in 80% of patients. Complications included superficial infection (5%), anterior knee pain (10%), and malalignment (7.5%). Conclusion: Multidirectional tibial nailing provides stable fixation and favourable functional outcomes in extra-articular proximal and distal tibial fractures. The technique minimizes soft tissue damage and allows early mobilization with a low complication rate.

Background: Gallstone disease (GSD) is a significant global health problem, with a higher burden in North India due to dietary, environmental, and healthcare access factors. Choledocholithiasis, a major complication of GSD, often coexists with chronic calculous cholecystitis, increasing surgical complexity. Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is the standard management. However, the optimal timing of LC after ERCP remains controversial, particularly in resource-limited settings. Aim: To compare early (≤72 hours) versus delayed (>72 hours) laparoscopic cholecystectomy following ERCP in terms of safety and cost-effectiveness in patients with cholecystocholedocholithiasis. Methods: This study evaluates outcomes of early versus delayed LC in a North Indian population. Primary objectives include assessment of operative difficulty using Nassar grading, safety, bailout rates, cost-effectiveness, and working days lost due to hospitalization. Secondary outcomes include operative time, conversion to open cholecystectomy, need for drain placement, biliary complications, morbidity, and mortality. Results: Early LC is anticipated to reduce operative difficulty, conversion rates, postoperative complications, hospital stay, and overall treatment costs. It is also expected to minimize recurrent biliary events and reduce indirect costs such as loss of working days. Delayed LC, although allowing patient optimization, may increase surgical difficulty due to fibrosis and adhesions, leading to longer operative time, higher complication rates, and increased healthcare expenditure. Conclusion: Early laparoscopic cholecystectomy following ERCP appears to be a safe and cost-effective strategy in stable patients with choledocholithiasis. In the Indian context, particularly in high-burden regions, adopting early intervention protocols may improve clinical outcomes, reduce healthcare costs, and minimize socioeconomic impact. A tailored, patient-specific approach remains essential, especially in high-risk or unstable patients.

Background: Preoperative risk stratification in gastrointestinal surgery remains challenging. Serum albumin has long been recognized as an indicator of nutritional and inflammatory status and is associated with postoperative morbidity and mortality. However, recent evidence suggests that sarcopenia and perioperative albumin kinetics may provide stronger predictive value than static albumin measurements alone. Aims and Objective: To evaluate the predictive value of preoperative serum albumin, postoperative albumin decline (ΔAlb), and sarcopenia for postoperative morbidity in patients undergoing gastrointestinal surgery. Methods: This prospective observational study included 176 patients undergoing major gastrointestinal surgery. Preoperative serum albumin was measured within 24 hours before surgery. Sarcopenia was assessed using skeletal muscle indices from preoperative imaging CT scan. Postoperative albumin difference (ΔAlb) was calculated as the difference between preoperative and postoperative serum albumin levels on post-operative day 3. Postoperative complications were graded according to the Clavien–Dindo classification. Results: Hypoalbuminemia (<3.5 g/dL) was present in 54% of patients. Surgical site infection occurred more frequently in the hypoalbuminemia group (23.2% vs 7.4%, p=0.004). ROC analysis showed that preoperative albumin predicted postoperative complications with AUC 0.72 and an optimal cutoff value of 3.4 g/dL. Multivariate analysis demonstrated that sarcopenia was the strongest independent predictor of postoperative complications (OR 7.20, 95% CI 2.40–21.3, p<0.001) followed by hypoalbuminemia and comorbidities. Conclusion: Sarcopenia and perioperative albumin decline outperform static preoperative albumin levels in predicting postoperative morbidity. Integrating body composition analysis with biochemical markers may significantly improve surgical risk stratification.

Background: Cerebrovascular diseases include some of the most common and devastating disorders. Stroke is the main cause of disability and mortality among the ageing population, and about 87% of all cases are ischemic stroke while 15% are hemorrhagic stroke. Methods: Our study was conducted on 50 patients studied, 25 were males and 25 were females. Male: female ratio was 1:1. The controls were appropriately age and sex matched. Results: Mean SUA level in cases was 6.02 ± 1.19 mg/dl whereas it was 5.11 ± 1.30 mg/dl for controls. Mean SUA level was significantly higher in cases as compared to controls (P =0.009244). Conclusion: Our study shows significantly higher uric acid level in cases as compared to control population. Also, serum uric acid level has significant association with smoking, significant positive correlation with total cholesterol and significant inversely correlated with HDL cholesterol.

Background: Dengue fever is a major mosquito-borne viral infection affecting children in tropical countries such as India. Early identification of severe dengue is essential to prevent complications and improve outcomes. The Bedside Dengue Severity Score (BDSS) is a simple clinical tool developed to predict disease severity using easily observable bedside parameters. Objective: The present study aimed to validate the Bedside Dengue Severity Score in paediatric dengue patients and compare its diagnostic performance with WHO-2022 and NVBDCP-2023 dengue severity classifications. Methods: A hospital-based cross-sectional study was conducted in the Inpatient Department of Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, over a period of one year. A total of 80 children aged 1–18 years with laboratory-confirmed dengue infection were included. Among them, 30 patients were classified as severe dengue and 50 as non-severe dengue according to WHO-2022/NVBDCP-2023 criteria. Clinical features, laboratory parameters, hemodynamic variables, BDSS score, and outcomes were recorded and analyzed. The diagnostic performance of BDSS was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Results: Severe dengue patients showed significantly lower platelet counts (31.4 ± 11.88 vs 106.2 ± 49.7 ×10³/µL) and higher hematocrit levels (46.8 ± 4.1% vs 38.4 ± 3.6%) compared to non-severe cases. Clinical warning signs, third-space fluid loss, and hemodynamic instability were significantly more common among severe dengue patients. Higher BDSS scores were strongly associated with severe dengue (p = 0.001). BDSS demonstrated a sensitivity of 47.37%, specificity of 98.36%, positive predictive value of 90.00%, negative predictive value of 85.71%, and overall diagnostic accuracy of 86.25%. Conclusion: The Bedside Dengue Severity Score is a simple and reliable clinical tool for early identification of severe dengue in paediatric patients and may assist clinicians in rapid risk stratification, particularly in resource-limited settings.

Introduction: Incorrect inhaler technique is a common cause of poor disease control in asthma and COPD patients, leading to reduced drug delivery and increased morbidity. Brief educational interventions may improve technique and clinical outcomes. Materials and Methods: A pre–post interventional study was conducted on 60 asthma/COPD patients using metered-dose inhalers (MDI) or dry powder inhalers (DPI) at Shri BM Patil Medical College Vijayapura. Baseline inhaler technique was assessed using standardized checklists. A brief educational intervention including demonstration, video, and leaflet was provided. Reassessment was done after 7 days. Statistical analysis included paired t-test and Wilcoxon test. Result: Baseline correct technique was observed in only 35–40% of patients. Post-intervention, inhaler technique scores improved significantly (MDI: 4.1 ± 1.5 to 7.1 ± 0.9; DPI: 3.2 ± 1.2 to 5.4 ± 0.6; p < 0.05), with 80–85% achieving correct technique. Symptom scores also improved significantly, with ACT increasing (16 ± 3 to 21 ± 2) and CAT decreasing (22 ± 5 to 16 ± 4) (p < 0.01). Conclusion: A brief educational intervention significantly improves inhaler technique and symptom control in asthma and COPD patients and should be incorporated into routine clinical practice.

Introduction: Neonatal seizures are a common neurological emergency associated with significant morbidity and mortality. They are often indicative of underlying brain injury, particularly hypoxic-ischemic encephalopathy (HIE), metabolic disturbances, or infections. Early identification of etiology and prompt management are crucial for improving outcomes. Materials and Methods: This prospective cross-sectional study was conducted in the NICU of K.D. Medical College, Mathura, from February 2024 to January 2026. A total of 210 term and late preterm neonates (>35 weeks) with clinically evident seizures were included. Detailed antenatal, perinatal, and neonatal histories were recorded. Clinical examination, laboratory investigations, neuroimaging, EEG, and TORCH screening were performed. Outcomes were assessed in terms of survival or death, with follow-up up to 18 months. Results: The mean gestational age was 38.07 ± 2.10 weeks. Delayed cry at birth was observed in 51.9% of neonates, and the mean APGAR score was 5.90 ± 0.86, indicating significant perinatal distress. HIE-II was the most common etiology (40.6%), followed by meningitis and metabolic causes. Subtle seizures were the predominant type (85.5%). Most neonates had normal laboratory, imaging, and EEG findings. Overall survival was high (99.0%), with only 1.0% mortality. A significant association was found between etiology, gestational age, and outcome (p < 0.05). Conclusion: Neonatal seizures in term and late preterm infants were predominantly due to perinatal hypoxia and metabolic disturbances. Early recognition and timely NICU management resulted in favourable outcomes, emphasizing the importance of prompt intervention in reducing morbidity and mortality.

Background: Vitiligo is a chronic acquired depigmentary disorder characterized by the loss of melanocytes, resulting in well-defined depigmented macules and patches on the skin. Increasing evidence suggests that vitiligo is associated with several systemic autoimmune and metabolic disorders, particularly thyroid dysfunction and diabetes mellitus. In addition to its physical manifestations, vitiligo can significantly affect the psychological and social well-being of patients, thereby impairing their quality of life. Materials and Methods: This hospital-based observational cross-sectional study was conducted in the Department of Dermatology at a tertiary care center. A total of 60 patients with clinically diagnosed vitiligo were included in the study after obtaining informed consent. Demographic details and clinical history were recorded using a structured proforma. All participants underwent laboratory evaluation for thyroid function tests (TSH, FT3, FT4) and assessment of glycemic status using fasting and postprandial blood glucose levels. Quality of life was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Data were analyzed using descriptive and inferential statistical methods, and a p-value <0.05 was considered statistically significant. Results: The mean age of the study participants was 32.6 ± 11.4 years, with a slight female predominance (56.7% females and 43.3% males). Thyroid dysfunction was observed in 26.7% of patients, with hypothyroidism being the most common abnormality. Diabetes mellitus was present in 16.7% of patients with vitiligo. The mean DLQI score was 9.2 ± 4.6, indicating a moderate impact of vitiligo on the quality of life of affected individuals. Conclusion: The study demonstrated a notable association of vitiligo with thyroid dysfunction and diabetes mellitus. Additionally, vitiligo was found to significantly affect the quality of life of patients. These findings highlight the importance of routine screening for endocrine abnormalities and providing psychological support as part of the comprehensive management of patients with vitiligo.

Background: Hypertension is a major modifiable risk factor for cardiovascular and cerebrovascular diseases worldwide. Psychosocial stress and central obesity are important contributors to elevated blood pressure. Medical professionals are frequently exposed to occupational stress, irregular working hours, and sedentary lifestyle, which may increase the risk of hypertension. The present study aimed to evaluate the inter relationship between perceived stress, waist circumference, and blood pressure using Ambulatory Blood Pressure Monitoring (ABPM) among medical professionals. Methods:  Present observational single-center study was conducted among 83 medical professionals at MGM Medical College and Hospital, Aurangabad, after institutional ethics committee approval. Participants aged 18–65 years who provided informed consent were included. Perceived stress was assessed using the Perceived Stress Scale (PSS). Participants underwent 24-hour ABPM while continuing routine activities. Data were analyzed using SPSS version 24.0. Mean, standard deviation, proportions, unpaired t-test, and Karl Pearson correlation were applied; p<0.05 was considered statistically significant. Results: Among 83 participants, 72.3% were males and the mean age was 37.09±9.89 years. Moderate to high stress levels were observed in 63.85% of participants. Abnormal ABPM readings were observed in 37.3% for 24-hour BP, 43.4% for daytime BP, and 50.6% for nighttime BP. ICU staff had significantly higher stress scores than ward staff (21.23±8.70 vs 17.04±7.94, p=0.026). Significant positive correlations were observed between PSS score and 24-hour SBP (r=0.802), DBP (r=0.755), daytime SBP (r=0.833), and nighttime SBP (r=0.724) (p<0.0001). Waist circumference also showed significant positive correlations with ABPM parameters. Conclusion: Perceived stress and central obesity were significantly associated with elevated ambulatory blood pressure among medical professionals. Early stress management, lifestyle modification, and routine ABPM screening may help reduce cardiovascular risk in this high-risk occupational group.

Background: Anxiety Disorders (AD) are the most common psychiatric disorders throughout the world and frequently coexist with other psychiatric or medical comorbidities. These comorbidities may worsen symptom severity, lower treatment response, and increase health care utilization, but their prevalence has only been described in outpatient populations. Methods: A retrospective observational study of 98 patients with anxiety disorder registered between August 2025 and January 2026 in the Psychiatry OPD/IPD. The retrieved patient records for demographic information, anxiety disorder type and duration, psychiatric comorbidities, medical comorbidities and medication history. Comorbidities included psychiatric, cardiovascular, endocrine, respiratory, neurological and substance use. The analysis was performed using SPSS. Descriptive statistics included mean, standard deviation, frequency and percentage, and they were used to compare comorbidities with demographic variables by chi-square test (p<0.05 was considered statistically significant). Results: Of the 98 patients, 72.4% had one comorbid condition or more. Major depressive disorder (38.8%) and hypertension (22.4%) were the most prevalent psychiatric and medical comorbidities, respectively. Psychiatric comorbidities were significantly more common in females, whereas substance use disorders were significantly more frequent in males. Age older than 40 years and duration of the disease longer were significantly related to having more medical comorbidities (p<0.05). Conclusion: Anxiety disorders are commonly comorbid with other psychiatric and general medical conditions. Early diagnosis and coordinated multidisciplinary approach are needed to enhance treatment response, improve prognosis and minimize overall burden of disease.

Background: Acute appendicitis is one of the most common surgical emergencies worldwide, and prompt diagnosis significantly reduces morbidity and mortality. Delay in the diagnosis and surgical intervention may lead to complications and increased morbidity and mortality. The severity of acute appendicitis is associated with inflammation, and platelets play prominent roles in inflammatory processes. This study aims to evaluate the role of platelet indices, including mean platelet volume (MPV) and platelet distribution width (PDW), in the diagnosis of acute appendicitis. Materials and Methods: A prospective cross-sectional study was conducted over two years among 198 patients undergoing appendicectomy, selected by purposive sampling at the Department of General Surgery, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal. Patients’ demographic characteristics, imaging findings, preoperative laboratory markers (MPV, PDW, TLC), and postoperative histopathology results were recorded. Descriptive statistics such as means, medians, frequencies, and percentages were used. Chi-square test and independent t-test were used to compare proportions and means respectively. Spearman correlation was used to examine the relationship. P-Values of <0.05 were considered statistically significant. Results: Among 198 patients who participated in the study, the majority (70.2%, n=139) had acute appendicitis. The mean MPV was highest in the acute appendicitis with periappendicitis group (9.54±2.18), followed by the acute appendicitis group (9.23±1.84). The mean TLC (15112.97 ± 2693.68) was highest in the gangrenous group. A statistically significant association was observed between MPV and TLC value with the degree of appendicitis. (P-value<0.05). Conclusion: Elevated leucocyte count and platelet indices (MPV and PDW) levels support the diagnosis of acute appendicitis. The levels of the MPV, PDW, and leucocyte count are significantly correlated with pathological findings.

Background: Incisional hernias are frequent complications following stoma reversal, often delaying recovery, especially in patients with chronic risk factors, including immunosuppression. Prophylactic mesh placement at the time of stoma closure has been proposed as a strategy to significantly reduce hernia occurrence, yet concerns about infection persist. Objectives: This study evaluates the efficacy and safety of prophylactic mesh placement during elective stoma reversal in reducing incisional hernia incidence. Methods: A prospective, randomized controlled trial was conducted in the Department of Surgery, LLRM Medical College, Meerut, from January 2023 to December 2024. Sixty patients undergoing elective stoma reversal were randomized: 30 received prophylactic mesh (Group A) and 30 underwent standard closure (Group B). Ethical approval was obtained; all patients provided informed consent. Outcomes included hernia incidence, surgical site infections (SSIs), complications, hospital stay, and follow-up. Results: Incisional hernias occurred in 3.3% of mesh patients and 16.7% of non-mesh patients. The mesh group experienced a slightly higher incidence of early wound infections (20%), but severe complications—such as mesh migration or infection—were rare and did not require mesh removal. Most infections were mild, managed conservatively. The mesh group had a marginally longer average hospital stay (13–15 days vs. 11–14 days), largely due to extended observation rather than complications. Conclusion: Prophylactic mesh placement in elective stoma reversal is a safe and effective means of reducing incisional hernia incidence, provided appropriate surgical technique and patient selection are applied. Further research with larger cohorts and longer follow-up is needed to confirm long-term durability and assess patient-reported outcomes.

Background: Incisional hernia is one of the most common complications following abdominal surgery, occurring in approximately 10–20% of laparotomies. Various open surgical techniques such as onlay, sublay, inlay, and component separation are used for repair. However, the optimal technique remains controversial due to variations in recurrence, wound complications, and postoperative morbidity. Aim: To evaluate the outcomes of different open surgical techniques used in the management of incisional hernia over a period of two years (March 2024-March 2026). Materials and Methods: This prospective observational study was conducted over a period of two years in the Department of General Surgery of a tertiary care hospital. A total of 60 patients diagnosed with incisional hernia were included. Patients underwent open surgical repair using different techniques such as onlay mesh repair, sublay mesh repair, inlay mesh repair, and anatomical repair depending on defect size and patient factors. Postoperative outcomes including surgical site infection, seroma formation, hospital stay, and recurrence were analysed. Results: Among the 60 patients, the majority were females (63.3%). The most common previous surgery leading to incisional hernia was lower segment cesarean section (36.7%). Onlay repair was performed in 10% of cases, sublay repair in 60%, inlay repair in 5%, and anatomical repair in 25%. Postoperative complications included seroma (13.3%), wound infection (10%), and recurrence (6.7%). Sublay repair demonstrated the lowest recurrence and complication rates. Conclusion: Open mesh repair remains the standard treatment for incisional hernia. Among different techniques, sublay mesh repair appears to provide better outcomes with lower recurrence and fewer wound complications compared to onlay and inlay techniques.

Background: Monitoring glucose levels in flap tissues can be a valuable indicator of flap viability and early detection of flap failure. This study aimed to analyze the utility of intra-flap glucose monitoring in predicting flap outcomes. Materials & Methods: It was a single centre, single arm, non-comparative longitudinal observational study done from May 2019 to October 2020. Thirty (31) patients, operated for reconstruction with various flap incorporating skin in the department of plastic and reconstructive surgery after taking informed written consent. Flap blood glucose levels have been measured at scheduled times by glucometer. At the same time blood glucose levels has been measured from adjacent normal skin (control site). In addition to blood glucose assessment simultaneous clinically findings have been noted and correlated. In the event of any indication of impending/frank ischemic changes appropriate measures have been taken by the surgeon in-charge. Capillary blood sample has been taken by pin prick method at the distal most part of flap. At the same time patient blood glucose level has been measured from normal skin adjacent to flap. Samples were taken in immediate post-operative period then after 1hr, 12 hr, 24 hr, 48 hr and 72 hr after operation. Results: Out of thirty-five patients, thirty were male and five were female. Among four free flaps, three were antero-lateral (ALT) fascio-cutaneous flap and one was free latissimus dorsi (LD) musculocutaneous flap. We have measured flap blood glucose and body blood glucose from control site simultaneously and then calculated flap blood glucose as a percentage of body blood glucose. Out of 35 flaps, 21 flaps have done well and no sign of ischemia was found in these flaps. Blood Glucose levels of these flaps were taken at regular intervals as per study schedule. Total 63 values have been recorded from clinically ischemic flaps. Blood glucose values of ischemic flaps were significantly low with a mean value of 35.81% of body glucose. At the intervals of immediate, 1hour, 6-hour, 24-hour, 48-hour, 72 hour, 5 days the mean values of glucose are lower in necrosed flap than survived flaps. It was found to be statistically significant (p<0.05). Conclusion: Intra-flap glucose monitoring is a reliable method for predicting flap viability. Higher glucose levels are associated with flap survival, providing a potential tool for early intervention in cases of impending flap failure.

Background: Optimal utilization of blood and its components is essential to ensure patient safety and efficient resource management. Periodic evaluation of transfusion practices using standard indices helps in identifying areas for improvement in tertiary care settings. Material and Methods: A retrospective observational study was conducted in the Department of Transfusion Medicine of a tertiary care hospital over one year. All blood requisitions and issued units were analyzed. Data regarding patient demographics, clinical indications, department-wise distribution, and component usage were collected from blood bank records. Blood utilization was assessed using crossmatch-to-transfusion (C/T) ratio, transfusion probability (%T), and transfusion index (TI). Results: A total of 2,436 requisitions were analyzed, with a male predominance (57.6%). The highest proportion of patients belonged to the 18–40 years age group (35.5%). Medicine (25.1%) and Obstetrics and Gynecology (23.2%) were the major contributors to blood requests. Out of 4,740 units requested, 4,020 units were issued (84.8%). Packed red blood cells were the most utilized component (88.3%), followed by platelets (85.7%) and fresh frozen plasma (81.7%), while whole blood utilization was lower (69.7%). Anemia (34.6%) was the leading indication for transfusion. The overall C/T ratio was 1.82, transfusion probability was 62.4%, and transfusion index was 0.78, indicating efficient utilization. Conclusion: The study demonstrates appropriate and rational use of blood components, with acceptable transfusion indices across departments. Continuous monitoring and adherence to transfusion guidelines can further optimize blood utilization.

Background: ASHAs serve as critical links between communities and health systems in India. Their awareness of job responsibilities directly impacts service delivery quality. Objective: To assess the awareness of ASHAs working under Community Health Centre (CHC) Iriveri regarding their diverse job responsibilities across Maternal-child health, communicable disease control, and health promotion domains. Methods: This cross-sectional study included 110 ASHAs functioning under CHC Iriveri. Data was collected through structured interviews. Awareness of 41 distinct job responsibilities across three domains (link-worker/facilitator, service provider, and activist roles) was evaluated. Results: All 110 ASHAs (100%) demonstrated complete awareness of core maternal-child health responsibilities including pregnancy counselling, institutional delivery promotion, newborn care, and childhood immunization. Awareness of facilitator roles was universally high (93.6-100%), particularly for pregnancy registration (100%), ANC monitoring (100%), and child immunization (100%). However, awareness of voluntary escort services was limited: only 22(20%) knew about accompanying pregnant women and sick children to health facilities, and 20(18.2%) were aware of accompanying under-5 children for routine immunization. Service provider roles showed awareness levels of 75.5-90% for minor ailments management and DOTS provision 93(84.5%). All ASHAs demonstrated complete awareness of activist roles including community mobilization, health awareness creation, and sanitation promotion. Conclusion: While ASHAs possess comprehensive awareness of core MCH responsibilities and health promotion activities, significant knowledge gaps exist regarding voluntary escort services. Targeted training on these optional but important roles could enhance community health outcomes. This study provides evidence for capacity-building interventions and role clarification initiatives.

Background: Medical education is increasingly shifting toward interactive and learner-centered approaches to improve student engagement and higher-order thinking. In microbiology, where students must integrate theoretical knowledge with clinical application, traditional lecture-based teaching may be insufficient. The fishbowl technique, an active learning strategy involving structured group discussion and observation, has the potential to enhance understanding, participation, and critical thinking, but its use in undergraduate microbiology education remains limited. Aim and Objectives: This study aimed to introduce and evaluate the effectiveness of the fishbowl teaching–learning method among second-phase MBBS students. The objectives were to implement the technique, assess its impact on learning outcomes, and evaluate student perceptions. Materials and Methods: This interventional study was conducted over three months in the Department of Microbiology at CIMS, Chhindwara, after ethical approval. A total of 95 second-phase MBBS students were divided into two groups: conventional lecture (Group A) and fishbowl learning (Group B). The fishbowl sessions included an interactive lecture followed by structured discussion in inner and outer circles with role exchange. Pretest and posttest assessments using MCQs were conducted to evaluate learning outcomes. Student perceptions were collected using a validated Likert scale questionnaire. Data were analyzed using paired t-test, with p < 0.05 considered statistically significant. Results: There was a highly significant improvement in posttest scores compared to pretest scores (p < 0.0001), indicating the effectiveness of the fishbowl technique. 76% agreed that objectives were clearly explained, 79% reported better understanding, and 81% experienced increased participation. Additionally, 82% noted improvement in communication skills, 78% in critical thinking, and 85% in confidence while discussing complex topics. A majority (88%) considered the method superior to traditional lectures, and 89% recommended its continued use. Conclusion: The fishbowl teaching technique is an effective and well-accepted instructional method that improves academic performance and fosters essential skills such as communication, critical thinking, and confidence. Its incorporation into undergraduate microbiology teaching can enhance learning experiences and better prepare students for clinical practice.

Introduction: Subclinical hypothyroidism (SCH) is a common endocrine disorder in older adults and is increasingly recognized for its association with metabolic disturbances, particularly dyslipidemia and obesity. These alterations may contribute to an increased risk of cardiovascular disease in the elderly population. The present study aimed to evaluate the association of subclinical hypothyroidism with lipid profile and body mass index (BMI) in older adults. Materials and Methods: This hospital-based cross-sectional study was conducted at Mamata Medical College, Khammam, from November 2024 to November 2025. A total of 60 participants aged ≥60 years were included. Clinical evaluation and anthropometric measurements were performed, and BMI was calculated. Fasting blood samples were analyzed for thyroid-stimulating hormone (TSH) and lipid profile parameters. Participants were categorized into euthyroid and subclinical hypothyroid groups. Statistical analysis was performed using SPSS version 26, with p < 0.05 considered significant. Results: Subclinical hypothyroidism was present in 36.7% of participants. Individuals with SCH had significantly higher total cholesterol (212.4 ± 34.1 mg/dL), triglycerides (176.8 ± 42.7 mg/dL), LDL-C (138.2 ± 30.6 mg/dL), and VLDL-C (35.4 ± 8.5 mg/dL), along with lower HDL-C levels (40.1 ± 6.8 mg/dL) compared to euthyroid individuals (p < 0.05). Mean BMI was significantly higher in the SCH group (28.1 ± 3.8 kg/m² vs. 24.6 ± 3.2 kg/m²; p = 0.001). Positive correlations were observed between TSH and lipid parameters as well as BMI, while HDL-C showed a negative correlation. Conclusion: Subclinical hypothyroidism in older adults is significantly associated with an adverse lipid profile and higher BMI, indicating increased cardiovascular risk. Early screening and appropriate management may help reduce associated metabolic complications.

Introduction: Orthostatic hypotension (OH) is a common but often under-recognized condition in the elderly, associated with significant morbidity including falls and syncope. Hypertension and its treatment may further predispose individuals to OH. This study aimed to compare the prevalence of orthostatic hypotension among hypertensive and non-hypertensive elderly patients and to evaluate its associated factors. Materials and Methods: A hospital-based comparative cross-sectional study was conducted at Mamata Medical College, Khammam, from November 2024 to November 2025. A total of 100 elderly patients aged ≥60 years were included and divided into hypertensive (n=50) and non-hypertensive (n=50) groups. Blood pressure was measured in supine and standing positions, and OH was defined as a fall in systolic BP ≥20 mmHg and/or diastolic BP ≥10 mmHg. Data were analyzed using appropriate statistical tests, with p<0.05 considered significant. Results: The overall prevalence of OH was 38.0%. It was significantly higher in hypertensive patients (52.0%) compared to non-hypertensive patients (24.0%) (p=0.003). The prevalence of OH increased with age, showing a significant association (p=0.041). No significant association was observed with gender (p=0.82). Among OH cases, mild severity was most common (47.4%). Dizziness (63.2%) and giddiness (52.6%) were the predominant symptoms. Conclusion: Orthostatic hypotension is highly prevalent among elderly individuals, particularly in those with hypertension and advancing age. Routine screening for OH in elderly hypertensive patients is essential for early detection and prevention of complications.

Introduction: Acute cerebrovascular accident (CVA) is a major cause of morbidity and mortality worldwide. Renal dysfunction has been increasingly recognized as an important factor influencing the severity and prognosis of stroke. However, data regarding its impact on stroke outcomes in the Indian population remain limited. The present study aimed to assess the correlation between renal function and the severity and outcomes of patients with acute cerebrovascular accident. Materials and Methods: This hospital-based observational study was conducted at Mamata Medical College, Khammam, from November 2024 to November 2025. A total of 120 adult patients with acute ischemic or hemorrhagic stroke were included. Renal function was assessed using estimated glomerular filtration rate (eGFR) and categorized into normal, mild, moderate, and severe dysfunction. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS). Patient outcomes were recorded at discharge. Statistical analysis was performed using the Chi-square test, with p < 0.05 considered significant. Results: The majority of patients were aged 51–60 years (30.0%), with a male predominance (61.7%). Ischemic stroke was more common (68.3%). Mild renal impairment was the most frequent category (35.0%). Most patients presented with moderate stroke (43.3%). A significant association was observed between renal function and stroke severity (p < 0.001), with severe renal dysfunction showing a higher proportion of severe stroke. Renal dysfunction was also significantly associated with adverse outcomes (p < 0.001), with the highest mortality observed in patients with severe renal impairment. Additionally, stroke severity was strongly associated with mortality (p < 0.001). Conclusion: Renal dysfunction is significantly associated with increased stroke severity and poorer outcomes in acute CVA patients. Early assessment of renal function can aid in risk stratification and improve clinical management.

Background: Herpes zoster (HZ) causes severe neuropathic pain despite standard antiviral therapy. Micronutrient deficiencies, particularly zinc, may contribute to persistent pain through impaired immune responses. Zinc supplementation has demonstrated analgesic effects by blocking calcium T-channels in dorsal root ganglia. Objective: To evaluate the analgesic efficacy of oral zinc sulfate as adjunctive therapy in acute herpes zoster. Methods: This prospective, randomized controlled study enrolled 48 patients (≥18 years) with acute HZ presenting within the first week of rash onset. Patients were randomized into two groups: Group A (n=24) received zinc sulfate 40 mg once daily plus standard treatment, while Group B (n=24) received standard treatment alone. All patients received acyclovir 800 mg five times daily for 7 days, diclofenac 50 mg once daily, and topical applications. Pain was assessed weekly using the Visual Analog Scale (VAS) for 4 weeks. Results: Baseline VAS scores were comparable (Group A: 9.6±0.5, Group B: 9.9±0.3, p=0.29). At 4 weeks, Group A showed significantly greater pain reduction (VAS: 2.79±1.3) compared to Group B (VAS: 6.0±1.1) with p<0.001. Significant differences emerged from week 1 (p=0.04) and became highly significant by week 2 (p=0.005) and week 3 (p=0.001). Mild gastritis occurred in 12.5% of zinc-treated patients during week 1, resolving with proton pump inhibitors. No other adverse effects were observed. Conclusion: Oral zinc sulfate 40 mg daily as adjunctive therapy significantly reduces pain in acute herpes zoster patients, with minimal and manageable side effects. Zinc supplementation represents a safe, cost-effective addition to standard HZ treatment protocols.

Background: Esophageal carcinoma remains an important cause of cancer-related morbidity and mortality, with considerable geographic variation in incidence and risk-factor patterns. Understanding regional clinicodemographic patterns and exposure profiles is important for improving prevention strategies and facilitating earlier diagnosis. The present retrospective study evaluated the clinicodemographic characteristics, risk factor distribution, tumor location, and histopathological patterns of esophageal carcinoma among 103 patients presenting to a tertiary care teaching hospital in Rajasthan, India. Methods: This retrospective hospital record-based study included 103 histopathologically confirmed cases of esophageal carcinoma diagnosed between January 2025 and December 2025 at a tertiary care teaching hospital in Rajasthan, India. Data on demographic characteristics, presenting symptoms, tobacco chewing, smoking, alcohol consumption, tumor location, and histological subtype were collected. Diagnosis was established using upper gastrointestinal endoscopy with biopsy confirmation. Categorical variables were analyzed using Chi-square or Fisher’s exact test, and p<0.05 was considered statistically significant. Results: Among the 103 patients, 68 (66.01%) were males and 35 (33.98%) were females. The highest incidence occurred in the 51-60-year age group (26.21%), and 69% of patients were older than 50 years. Dysphagia was the most common presenting symptom (87.37%). Tobacco chewing was the predominant exposure (63.11%), followed by smoking (42.72%) and alcohol use (35.92%). The lower third of the esophagus was the most frequently involved site (50.48%). Squamous cell carcinoma was the predominant histological subtype (72.81%). Alcohol exposure was significantly more common among male cases than female cases. Conclusion: Esophageal carcinoma in this cohort predominantly affected males older than 50 years and was strongly associated with tobacco exposure. Squamous cell carcinoma remained the dominant histological subtype, and most patients presented with dysphagia, suggesting late symptomatic presentation. These findings highlight the need for strengthened tobacco control measures, targeted risk-factor counseling, and prompt endoscopic evaluation of alarm symptoms to facilitate earlier diagnosis and improved outcomes.

Background: Anemia has traditionally been regarded as a key indicator of iron deficiency severe enough to impair tissue function, as red blood cells are relatively easy to assess. Although specific markers of functional iron deficiency—such as serum transferrin levels and erythrocyte protoporphyrin—are available, there is limited evidence linking these indicators to health outcomes necessary for preventing morbidity and mortality associated with nutritional anemia. Method: A total of 59 adolescents aged 13–20 years were included, comprising 26 (44%) males and 33 (55.9%) females. Venous blood samples were collected under aseptic precautions and analyzed for complete blood count (CBC) using an automated hematology analyzer. Red blood cell indices assessed included MCV, MCH, MCHC, and RDW. Peripheral blood smears were prepared and stained with Leishman stain to evaluate red cell morphology. Iron status was indirectly assessed using biochemical markers of iron availability and utilization, including serum iron, total iron-binding capacity (TIBC), transferrin saturation, and serum ferritin levels. Results: BMI was 18.2 (± 2.2) underweight (BMI < 18.5); 29 (87.8%) were menstruating females; 38 (64.4%) reported low dietary iron intake; Hb% was 9.5 (± 1.0), 4.20 (± 0.50) RBC count, 71.3 (± 6.4) MCV, 22.1 (± 2.6) MCH, 30.3 (± 1.8) MCHC, and 17.5 (± 2.2) RDW. In a correlation study between RBC indices and biochemical markers, iron absorption had a significant (p < 0.001) p-value, and severe Hb% < 7.0 was observed. Conclusion: Red blood cell indices demonstrate a significant correlation with biochemical markers of iron absorption and utilization in adolescents with nutritional anemia. These findings can assist clinicians in guiding effective management and reducing the risk of associated morbidity and mortality.

Background: Insect-related dermatitis (IRD) is a common dermatological condition caused by insect bites, stings, or contact with insect-derived toxins and allergens. The condition can present with a wide range of clinical manifestations and may significantly affect patients’ daily activities and quality of life. Despite its frequent occurrence in dermatology outpatient practice, limited epidemiological data are available regarding its clinical profile and impact on daily living in many parts of India, including Rajasthan. The present study was conducted to assess the clinical and epidemiological characteristics of insect-related dermatitis and its impact on patients’ daily lives. Materials and Methods: This hospital-based cross-sectional epidemiological study was conducted in the Dermatology Outpatient Department of Bangur Hospital, Government Medical College, Pali, Rajasthan, over a four-month period from July to October 2025. A total of 385 patients with clinically diagnosed insect-related dermatitis were included using consecutive sampling. Data were collected using a structured questionnaire and clinical examination proforma. Information regarding demographic characteristics, environmental exposures, lesion morphology, symptoms, suspected insect type, treatment practices, and clinical outcomes was recorded. The impact of the disease on quality of life was assessed using the Hindi version of the Skindex-16 questionnaire. Data were analysed using SPSS version 24.0. Results: Out of 4210 dermatology outpatient visits, 385 patients (9.1%) were diagnosed with insect-related dermatitis. Most patients were aged 41–50 years (22.1%) with slight male predominance (52.5%) and urban residence (65.5%). Outdoor exposure (45.2%) and stagnant water (41.3%) were common risk factors. Upper limb involvement (51.2%) and erythematous papules (54.5%) predominated. Itching (76.6%) was the most frequent symptom. The causative insect was unidentified in 60.3% of cases. Oral antihistamines and topical steroids were the most frequently used treatments. At seven-day follow-up, most patients showed partial or complete improvement. Quality-of-life assessment revealed that the majority of patients experienced mild to moderate impact on daily life. Conclusion: Insect-related dermatitis is a common dermatological condition with diverse clinical manifestations and a measurable impact on patients’ daily activities. Improved awareness, preventive measures, and timely management may help reduce the burden of this condition.

Background: Orthopedic implant design and surgical outcomes are highly dependent on accurate anatomical dimensions of long bones. Most commercially available prostheses are based on Western population data, which may not be suitable for Indian populations due to significant anatomical variability. Objective: To evaluate osteometric variability of the humerus and femur in a Central Indian population and assess its implications for prosthesis design and orthopedic practice. Methods: A descriptive cross-sectional study was conducted on 200 adult dry human long bones (humeri and femora). Osteometric parameters including maximum bone length, femoral head diameter, bicondylar width, humeral head diameter, and epicondylar breadth were measured using standard instruments. Descriptive statistics and comparative analyses were performed to assess variability and sexual dimorphism, with statistical significance set at p < 0.05. Results: Significant variability was observed across all osteometric parameters. Femoral dimensions demonstrated greater variability compared to humerus measurements. All parameters showed statistically significant sexual dimorphism (p < 0.001), with males exhibiting larger values. The observed measurements were generally smaller compared to Western reference data, indicating potential implant-bone mismatch when standard prostheses are used. Conclusion: Substantial osteometric variability exists in the Central Indian population, which has important implications for orthopedic implant design and surgical planning. Population-specific anatomical data are essential to improve implant fit, reduce complications, and enhance clinical outcomes.

Background: The vascular supply of the femoral head is a critical determinant of bone viability and successful outcomes following hip trauma or surgical intervention. The medial circumflex femoral artery (MCFA), lateral circumflex femoral artery (LCFA), and the artery of the ligamentum teres collectively contribute to femoral head perfusion. However, significant anatomical variations in these vascular structures have been reported, which may influence susceptibility to avascular necrosis (AVN) and surgical complications. Objective: This study aimed to evaluate anatomical variations in the arterial supply to the femoral head through cadaveric dissection and correlate these findings with clinical imaging observations to better understand their potential implications in hip surgery and fracture management. Methods: A descriptive anatomical study was conducted on 20 cadaveric hip specimens to identify the origin, course, and branching patterns of arteries supplying the femoral head. Particular attention was given to the retinacular branches of the MCFA, contributions from the LCFA, and the presence and size of the artery of the ligamentum teres. These anatomical findings were compared with imaging observations from patients undergoing Magnetic Resonance Angiography (MRA) for hip pathology evaluation. Results: The medial circumflex femoral artery was identified as the dominant contributor to femoral head vascularity in 85% of specimens. Significant variations were observed in the number and caliber of retinacular vessels. The artery of the ligamentum teres was present in all specimens but demonstrated variable size and contribution to femoral head perfusion. Specimens with fewer retinacular branches demonstrated reduced vascular redundancy, suggesting a higher theoretical susceptibility to ischemic complications. Conclusion: Considerable anatomical variation exists in the vascular supply of the femoral head. Understanding these variations is essential for surgical planning and may help reduce complications such as avascular necrosis during hip surgery and fracture fixation.

Background: Surgical management of lumbar disc herniation commonly involves open microscopic discectomy or endoscopic lumbar discectomy, with ongoing debate regarding their comparative functional outcomes. Objectives: To evaluate and compare functional outcomes following open microscopic discectomy and endoscopic lumbar discectomy using VAS, ODI, and SF-36. Methods: A randomized comparative study was conducted on 120 patients with lumbar disc herniation, equally allocated to microscopic or endoscopic discectomy. Pain, disability, and quality-of-life outcomes were assessed preoperatively and during follow-up. Results: Both techniques significantly improved pain, functional disability, and quality of life. Endoscopic discectomy showed superior early postoperative outcomes, while long-term results were comparable between groups. Conclusion: Both open microscopic discectomy and endoscopic lumbar discectomy are effective surgical procedures for the management of lumbar disc herniation, providing significant improvement in pain, functional disability, and quality of life.

Background: Epidural interlaminar injections are widely used in the management of intervertebral disc prolapse; however, the additional benefit of corticosteroids over local anesthetics alone remains controversial. Objectives: To assess and compare the therapeutic efficacy of epidural interlaminar corticosteroid with bupivacaine versus epidural interlaminar bupivacaine alone in patients with intervertebral disc prolapse. Methods: In this randomized controlled study, 180 patients were allocated into two groups receiving either epidural interlaminar steroid with bupivacaine or bupivacaine alone. Pain intensity, functional disability, neurological recovery, and analgesic requirement were assessed over a 12-week follow-up period. Results: Both groups demonstrated significant improvement; however, the steroid-bupivacaine group showed significantly lower VAS and ODI scores, higher JOA scores, and reduced need for repeated analgesics at 12 weeks compared to the bupivacaine-only group. Conclusion: Epidural interlaminar injection of corticosteroid combined with bupivacaine provides significantly superior pain relief, functional improvement, and reduced need for repeated analgesic consumption compared to epidural interlaminar bupivacaine alone in patients with intervertebral disc prolapse.

Background: Stroke in young adults is increasingly recognized as a significant cause of morbidity and disability. The clinical presentation and radiological characteristics of stroke in individuals aged 15–45 years differ from those observed in older populations. Aim: This study aimed to identify the clinical presentation and radiological profile of patients presenting with stroke between the ages of 15 and 45 years. Methods: A prospective observational study was conducted on 120 patients diagnosed with stroke in the age group of 15–45 years. Detailed clinical evaluation and neurological examination were performed, and radiological assessment using CT scan of the brain was carried out to determine the type and location of stroke. Results: Seizures were observed in 23.3% of patients, while decreased level of consciousness was present in 38.3%. Dysphasia was noted in 30% of patients, and cranial nerve deficits were seen in 61.7% of cases. Motor deficits were the most common neurological manifestation, with hemiparesis occurring in 58.3% of patients. Radiological findings showed that infarction was the most common CT finding (70%), followed by hemorrhage (20%) and venous thrombosis (10%). Overall, ischemic stroke accounted for 80% of cases, whereas hemorrhagic stroke accounted for 20%. Conclusion: Stroke in young adults commonly presents with motor weakness, speech disturbances, and cranial nerve deficits. Ischemic stroke is the predominant subtype observed in this age group. Early recognition of clinical features combined with prompt radiological evaluation is essential for effective diagnosis and management.

Background: Burn injuries remain a major cause of morbidity and mortality worldwide, particularly in developing countries. Severe burn injury triggers oxidative stress, systemic inflammatory response, and increased capillary permeability, resulting in large fluid shifts and tissue oedema. Vitamin C (ascorbic acid) is a potent antioxidant that may help reduce oxidative damage and improve outcomes in burn patients. Aim: To evaluate the clinical outcomes of vitamin C supplementation in burn patients admitted to a tertiary care hospital in Bihar. Methods: A prospective comparative study was conducted in the Department of Plastic Surgery at Patna Medical College and Hospital, Bihar, over 8 months. A total of 60 patients with burns involving ≥15% total body surface area (TBSA) was included. Patients were divided into two groups: (1) Group A (Vitamin C group): Standard burn management + Tablet vitamin C supplementation. (2) Group B (Control group): Standard burn management only. Primary outcomes included wound healing time and hospital stay. Secondary outcomes included infection rate and mortality. Results: Wound healing time was significantly less in the vitamin C group (18.4 ± 4.2 days) compared with controls (23.1 ± 5.6 days, p < 0.001). Hospital stay was also reduced in the vitamin C group (20.6 ± 5.3 days vs 26.4 ± 6.1 days, p < 0.001). Infection and mortality rates were lower in the vitamin C group. Conclusion: Vitamin C supplementation significantly improves clinical outcomes in burn patients by accelerating wound healing and decreasing complications. Incorporating vitamin C into burn management protocols may improve patient outcomes.

Background: Surgical site infection (SSI) is a common postoperative complication that increases patient morbidity, mortality, hospital stay, and healthcare costs. Nutritional and metabolic factors such as serum cholesterol and serum albumin may influence host immunity and wound healing. However, the association between serum cholesterol levels and SSI remains inadequately explored. Aim: To evaluate the relationship between preoperative serum cholesterol levels and the risk of developing surgical site infection in elective surgical patients. Methods: This hospital-based prospective observational study was conducted in the Department of Surgery at Batra Hospital & Medical Research Centre, New Delhi, from February 2023 to July 2024. Eighty patients aged 20–55 years undergoing elective uncomplicated surgeries were included. Preoperative fasting serum cholesterol and albumin levels were recorded. Patients received standard antibiotic prophylaxis and were followed on postoperative day 2, day 7, and day 30 for development of SSI as per CDC criteria. Data were analyzed using SPSS version 25; p < 0.05 was considered statistically significant. Results: The overall incidence of SSI was 18.8%. SSI occurred significantly more frequently in patients with hypocholesterolemia (34.5%) compared with those having high cholesterol levels (9.8%) (p = 0.01). Hypoalbuminemia was also significantly associated with SSI (35.3% vs 14.3%, p = 0.04). No significant association was found between SSI and age, gender, hypertension, or smoking. Conclusion: Hypocholesterolemia and hypoalbuminemia are significant predictors of surgical site infection in elective surgical patients. Routine preoperative assessment of these parameters may help identify high-risk individuals and enable targeted preventive strategies.

Background: Anterior knee pain (AKP) remains a common cause of dissatisfaction after total knee arthroplasty (TKA). Circumpatellar denervation using electrocautery has been proposed to reduce postoperative pain by ablating nociceptive fibers in peripatellar tissues. Aim: To evaluate the effect of intraoperative patellar denervation by electrocautery on postoperative anterior knee pain and functional outcomes in patients undergoing primary TKA for osteoarthritis. Methods: This prospective randomized comparative study was conducted at BGS Global Hospital, Bangalore, between July 2019 and May 2021. Seventy patients aged 45–80 years with advanced primary knee osteoarthritis undergoing TKA were randomized into two groups: electrocautery (n=35) and control (n=35). All patients underwent standard TKA. The intervention group received circumpatellar electrocautery using monopolar diathermy. Outcomes were assessed preoperatively and at 1, 3, 6, and 12 months using the Visual Analogue Scale (VAS), Insall Knee Score (KSS), Patellar Score (PS), and range of motion (ROM). Statistical analysis was performed using repeated-measures ANOVA. Results: Both groups showed significant postoperative improvement. However, the electrocautery group demonstrated significantly lower VAS scores at all follow-ups (12-month mean: 0.03 vs 0.49; p<0.001). Functional outcomes were superior in the intervention group, with higher KSS (94.63 vs 89.74) and PS (27.23 vs 22.26) at one year (p<0.001). ROM improved in both groups without statistically significant intergroup difference. Conclusion: Circumpatellar patellar denervation during TKA significantly reduces anterior knee pain and improves functional outcomes. The technique is simple and safe, though larger long-term studies are recommended.

Background: Digit sucking, tongue thrust swallowing, and mouth breathing are potential risk factors for development of malocclusion. The purpose of this study was to verify the prevalence of different occlusal traits among 5–7-year old children and assess their relationship with oral habits. Material/Methods: The study included 503 pre-school children (260 boys and 243 girls) with a mean age of 5.95 years. Different occlusal traits were verified by intraoral examination. Oral habits were diagnosed using data gathered from clinical examination of occlusion and extra-oral assessment of the face, combined with a questionnaire for parents. Results: The study demonstrated that 71.4% of the children presented with 1 or more attributes of malocclusion and 16.9% had oral habits. The vertical and sagittal misrelation of incisors, as well as spacing, were the predominant features. This study showed that digit suckers have higher incidence of anterior open bite (P=0.013) and posterior cross- bite (P=0.005). The infantile type of swallowing demonstrated strong association (P=0.001) with anterior open bite. Conclusions: Non-Nutritive Sucking Habits and Tongue Thrust Swallowing Are Significant Risk Factors for the Development of Anterior Open Bite and Posterior Crossbite in Pre-School Children.

Background: Sedation is an essential component of intensive care unit (ICU) management for mechanically ventilated patients. Appropriate sedation improves patient comfort, facilitates ventilator synchrony, and reduces the risk of agitation-related complications. Among sedative agents, Dexmedetomidine and Propofol are widely used due to their rapid onset and favorable pharmacological properties. Aim: To compare the real-world effectiveness and safety of dexmedetomidine versus propofol for ICU sedation in an Indian teaching hospital. Methods: A prospective observational comparative study was conducted in the ICU of Nalanda Medical College and Hospital, Patna, India. Twenty-five mechanically ventilated adult patients requiring continuous sedation were included over a 9-month period (March 2025–December 2025). Patients received either dexmedetomidine (n=13) or propofol (n=12). Sedation quality, hemodynamic parameters, duration of mechanical ventilation, ICU stay, and adverse effects were analyzed statistically. Results: Dexmedetomidine achieved significantly better sedation stability and shorter mechanical ventilation duration compared with propofol (p<0.05). ICU length of stay was also shorter in the dexmedetomidine group. Bradycardia was observed more frequently in patients receiving dexmedetomidine. Conclusion: Dexmedetomidine provided improved sedation quality and better clinical outcomes compared with propofol for ICU sedation.

Background: Sexual violence remains a serious public-health and medico-legal concern in India. There is limited state-wide published data describing patterns of reported sexual assault in Madhya Pradesh (India). This five-year retrospective descriptive study was undertaken to estimate the prevalence, describe victim and assault characteristics, and summarize key forensic findings among cases reported to health-care and police services between 2018 and 2022. Materials and Methods: We performed a retrospective study of medico-legal registers, forensic examination records and corresponding police First Information Reports from multiple tertiary and district hospitals across the state for the period 1 January 2018 to 31 December 2022. Extracted variables included victim demographics (age, sex, residence, marital status), assault circumstances (year, location, relationship to perpetrator, time to reporting), and clinical/forensic findings (genital and extra-genital injuries, pregnancy test, forensic specimen collection and laboratory results). Data were entered into a coded database and analysed using descriptive statistics (means/medians, proportions) and bivariate tests (chi-square for categorical variables; Mann–Whitney U or Kruskal–Wallis for non-parametric comparisons). Statistical significance was set at p<0.05. Institutional ethics approval was obtained prior to data collection. Results: A total of 18,718 reported cases were identified over five years. Annual counts showed a decline in 2020 with partial recovery in 2021–2022. Females comprised the overwhelming majority of victims (>95%). Minors (<18 years) accounted for approximately 60% of cases. Median delay from incident to presentation was 5 days (IQR 2–15); only about one-third presented within 24 hours. In 85% of cases the perpetrator was known to the victim. Acute genital injuries were documented in roughly 25–30% of survivors; extra-genital physical injury was less common (~10%). Forensic specimens were obtained in a minority of cases and biological confirmation of semen/spermatozoa was infrequent. Delayed reporting was significantly associated with lower rates of positive forensic findings (p<0.01). Conclusion: Reported sexual assaults in the study period disproportionately affected young, unmarried females and children, and were most often perpetrated by known persons. Long delays in reporting reduced opportunities for successful forensic evidence recovery. Strengthening community awareness, improving access to timely medico-legal services, and standardizing forensic sample collection are essential to improve care, documentation and legal outcomes.

Introduction:  Shoulder pain is a prevalent musculoskeletal complaint, and accurate imaging is essential for diagnosing underlying structural abnormalities. Ultrasonography (USG) is widely used as a first-line modality due to its accessibility and cost-effectiveness, while magnetic resonance imaging (MRI) remains the reference standard. This study evaluates the diagnostic performance of USG compared with MRI across multiple shoulder pathologies. Aims and Objectives: To assess the accuracy of USG in detecting shoulder abnormalities— including rotator cuff tears, tendinopathy, bursitis, and arthritis—using MRI as the gold standard. Materials and Methods:  Seventy participants underwent detailed clinical evaluation followed by USG and MRI of the affected shoulder. Demographic characteristics, handedness, occupational profile, comorbidities, and laterality were documented. USG findings were compared with MRI for partial-thickness tears, complete tears, tendinopathy (two datasets), supraspinatus tears, bursitis, arthritis, and overall tear detection. An extended dataset (n=207) was used for broad assessment of “any tear.” Results: The study population predominantly comprised males (78.7%) with a mean age of 39.7 ± 12.6 years. Most participants were right-hand dominant (97.7%) and had right-shoulder involvement (64.4%). USG identified 8 partial-thickness tears (3 true positives) while missing 10 MRI-confirmed cases. Tendinopathy detection varied, with 35 true positives in Set 1 and only 4 in Set 2. For “any tear,” USG demonstrated high accuracy in the large dataset (38 true positives). USG also performed well in identifying arthritis (45 true positives) and bursitis (39 true positives). Conclusion: USG is an effective first-line imaging tool for evaluating shoulder disorders, particularly full-thickness tears, bursitis, and arthritis. MRI remains essential for detecting subtle or partial-thickness tears.

Objective: To evaluate the clinical utility of the cerebroplacental ratio (CPR) in predicting adverse perinatal outcomes and fetal heart rate (FHR) disturbances in uncomplicated pregnancies at or beyond 40 weeks’ gestation. Methods: This prospective observational study included 100 women with uncomplicated single ton pregnancies at more than or equal to 40 weeks with 18 women having CPR less than 1.1 and 68 with CPR more than 1.1 at tertiary care center. Doppler ultrasound was used to measure MCA PI and UA PI to calculate CPR.
(CPR=MCA PI/UA PI) CPR less than 1.1 was considered abnormal. Outcomes including FHR abnormalities, delivery mode, Apgar scores, NICU admission etc., were analyzed. Results: Abnormal CPR group had higher rates of FHR abnormalities 43.7%, cesarian delivery; 62.5%, Meconium-stained amniotic fluid 37.5%, Low Apgar, NICU admissions compared to normal CPR group. Conclusion: CPR less than 1.1 is a sensitive marker for fetal compromise in term pregnancies and can guide timely obstetric interventions. Routine CPR evaluation beyond 40 weeks may improve perinatal outcomes even in low-risk pregnancies.

Background: Tibial shaft fractures represent the most common long bone fractures encountered in orthopedic practice, with healing outcomes varying considerably among patients. Delayed union and nonunion remain significant complications, leading to prolonged disability, additional surgical interventions, and increased healthcare expenditure. Identification of patient-specific and injury-related risk factors influencing healing trajectories is essential for optimizing treatment strategies and prognostic counseling. Methods: This retrospective cohort study analyzed 438 consecutive patients with tibial shaft fractures treated at a university-affiliated trauma center between January 2019 and June 2023. Demographic, injury-related, treatment-related, and comorbidity variables were collected from medical records. Healing outcomes were categorized as normal union (radiographic consolidation within 6 months), delayed union (6–9 months), and nonunion (absence of healing at 9 months). Univariate and multivariable logistic regression analyses were performed to identify independent predictors of impaired healing. Results: Normal union was achieved in 348 patients (79.5%), delayed union in 58 (13.2%), and nonunion in 32 (7.3%). The mean time to radiographic union was 18.4 ± 6.8 weeks. Independent risk factors for impaired healing (delayed union or nonunion combined) included open fracture classification (OR: 3.24; 95% CI: 1.86–5.64; p < 0.001), smoking status (OR: 2.68; 95% CI: 1.58–4.55; p < 0.001), fracture gap >3 mm after fixation (OR: 2.91; 95% CI: 1.54–5.49; p = 0.001), diabetes mellitus (OR: 2.12; 95% CI: 1.18–3.81; p = 0.012), and high-energy mechanism of injury (OR: 1.94; 95% CI: 1.14–3.30; p = 0.014). Conclusion: Impaired healing following tibial shaft fractures occurs in approximately one-fifth of patients. Open fracture severity, active smoking, inadequate fracture reduction, diabetes mellitus, and high-energy injury mechanisms independently predict adverse healing outcomes. Addressing modifiable risk factors through smoking cessation programs and meticulous surgical reduction may improve union rates.

Background: Metastasis is the characteristic feature of primary cancer. Bony metastasis is more commonly seen in breast and prostate carcinomas. The incidence is very high and varies from 65-70%. 40% of patients with bony metastasis experience pain. External beam radiotherapy provides pain relief in 80-90%, with complete pain relief in 50-60% patients. Palliative therapy with zoledronic acid can be given as a single-dose treatment (8 Gy in 1 fraction) and multiple fractions (20 Gy in 5 fractions) for pain relief. Single-fraction treatment has been found advantageous. Hence, the present study was undertaken to compare single and multiple-fraction doses with regard to the response and quality of life in patients with bony metastasis. Methodology: The prospective, randomized, comparative study was conducted during a 1-year study period. 100 patients with primary malignancy were included and randomized to Arm-A (8 Gy in 1 fraction) or Arm-B (20 Gy in 5 fractions). Pain assessment, Quality of Life and functional outcome were assessed. Independent means compared using Unpaired ‘t’ test and proportional comparison done using Fisher’s Exact test. A p value of <0.05 was taken as statistically significant. Results: Pain score in both the groups decreased, but was significantly lower in Arm-A (P < 0.05). Recurrence rate was 8% in Arm-A and 18% in Arm-B, but it was not significant (P > 0.05). Global Health Status showed improvement in both arms, but difference was not significant (P > 0.05). Improvements in physical, role functioning, emotional functioning, social functioning were seen in both arms, but was better in Arm-A. Symptoms scales/items, nausea/vomiting and diarrhea scores also showed improvement in both the arms, but again was better in Arm-A. Conclusion: Palliative radiotherapy with single-fraction treatment was much better as compared to multiple-fraction treatments. It was cost effective, required lesser hospital stay and had lower recurrence rate. Pain was better controlled in single-fraction treatment compared to multiple-fraction treatment.

Background: Chronic non-healing foot ulcers, predominantly in patients with diabetes, impose a heavy burden of prolonged hospitalization, recurrent infection, and risk of amputation. Although negative-pressure wound therapy (NPWT) accelerates healing, commercial systems remain inaccessible in most public hospitals of low-resource settings. This trial evaluated whether a simplified manual vacuum dressing assembled from readily available materials could replicate the benefits of NPWT while remaining affordable and reproducible. Methods: In a single-center, prospective, randomized controlled trial conducted at the Department of General Surgery, Government Erode Medical College and Hospital, Tamil Nadu, India, 50 adults (20–75 years) with chronic foot ulcers were allocated 1:1 by simple randomization to either simplified manual vacuum dressing (Group A, n=25) or conventional saline-antiseptic dressing (Group B, n=25). The intervention dressing comprised sterile gauze, a Ryle’s tube or suction catheter, transparent adhesive film, and wall suction to deliver continuous sub-atmospheric pressure. Primary outcomes were granulation tissue coverage (visual scoring), necrotic tissue clearance, and ulcer area reduction. Secondary outcomes included time to granulation, hospital stay, and complication rates. Assessments were performed daily until discharge; data were analyzed with SPSS version 25 using independent t-tests for continuous variables and χ² tests for categorical variables (p < 0.05 significant). Results: Groups were comparable at baseline (mean age 57.0 ± 14.85 vs 55.0 ± 14.45 years; 84% vs 76% diabetic). At study end, 44% of vacuum-dressed wounds achieved 75–100% granulation versus 12% in the control group (p = 0.03). Necrotic tissue clearance was superior (p = 0.04), final ulcer area was markedly smaller (2.4 ± 1.2 cm² vs 4.9 ± 1.8 cm², p = 0.002), time to granulation was shorter (9.2 ± 2.1 vs 14.1 ± 3.5 days, p = 0.001), and hospital stay was reduced (15.4 ± 3.2 vs 21.7 ± 4.1 days, p = 0.001). Infection (12% vs 40%, p = 0.02) and excess exudate (12% vs 48%, p = 0.008) were significantly lower in the intervention arm. Conclusion: Simplified manual vacuum dressing is a safe, effective, and dramatically cost-efficient alternative to conventional care and commercial NPWT. Its adoption could transform wound management in resource-limited environments without compromising clinical outcomes.

Introduction: The COVID-19 pandemic has fundamentally transformed educational methodologies, accelerating the adoption of digital learning platforms and smartphone applications across various fields. In the realm of medical education, these apps have emerged as crucial tools, offering students access to high-quality resources and expert knowledge at their convenience. This instant access to information not only broadens the learning experience but also enhances clinical decision-making and subject comprehension. However, despite the potential benefits, there remains a slow adoption of mobile application-based skills training in medical education, primarily due to a lack of awareness regarding available apps and their effective utilization. Furthermore, there is limited documentation on the actual uptake of these applications by students, as well as a need to evaluate their effectiveness and user satisfaction as teaching and learning tools. This study aims to address these gaps by assessing the awareness, usage, and perceived value of smartphone applications in medical education. Material and Methods: This prospective observational study was conducted among post-graduate students at Government Medical College, Patiala, specifically targeting those in the Orthopaedics department (2024 cohort). Ethical approval was obtained from the Ethical Committee and Research Committee prior to the study’s initiation, ensuring adherence to ethical guidelines. The study included consenting residents who participated in biweekly assessment sessions designed to enhance their learning experience through interaction and support. A feedback questionnaire, validated by the MEU, was utilized to assess the effectiveness of these sessions. Data collection involved a Google Forms-based questionnaire featuring a 5-point Likert scale to capture participant’s attitudes and perceptions regarding the mentoring experience. Feedback was collected both before and after each session, with a comprehensive questionnaire distributed at the end of the study. Participants included PG residents from the Orthopaedics department, providing insights into the process from both perspectives. The collected data was systematically compiled and analysed using appropriate statistical methods to draw meaningful conclusions about the impact of mentoring on the residents’ educational outcomes. Results: A total of 20 PG residents participated in the study, with a mean age of 28.7±2.98 years in Group A and 29.5±3.03 years in Group B (p = 0.5591). All participants were male, and a significant majority resided in hostels (80% in Group A and 90% in Group B; p = 0.04767). Group A residents had greater access to resources and reported higher motivation and interactivity from using smartphone applications alongside books. Assessment scores at 2 weeks showed Group A with a mean of 18±0.94 compared to 15±1.56 in Group B (p = 0.000061), and continued to demonstrate significant differences at 4 weeks (Group A: 18.2±0.79; Group B: 14.4±1.35; p < 0.00001) and 6 weeks (Group A: 18.2±0.63; Group B: 14.5±1.27; p < 0.00001). No significant differences were observed in assessment scores over time within each group (Group A: p = 0.8124; Group B: p = 0.5960). All residents expressed support for the continuation of the program for future batches, with 80% in agreement and none in disagreement. Conclusion: Incorporating digital technologies into the orthopaedic curriculum marks a significant advancement in medical education, effectively bridging traditional methods with the preferences of today’s digital generation. The adoption of a blended learning model enhances student engagement and accessibility while fostering a more interactive and practical learning environment. As technological advancements continue to influence healthcare, it is essential to evaluate the effectiveness of these educational strategies through systematic analysis of post-implementation data to optimize learning outcomes for future medical practitioners.

Background: Nonalcoholic fatty liver disease, a risk factor for cardiovascular diseases is 25% prevalent in the general population. A higher prevalence of fatty liver leads to hepatic fibrosis. Aim: To study the levels of serum ferritin in reproductive age group women and postmenopausal women with Nonalcoholic fatty liver disease. This study was conducted in patients visiting Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari District. Methods and Materials: Thirty reproductive age group women and postmenopausal women with Nonalcoholic fatty liver disease and thirty normal reproductive age group women and postmenopausal women participated in the research comprising a total of sixty subjects. Statistical Analysis: Analysis was performed by using SPSS version 23.0 which determined the percentage, mean and standard deviation. The unpaired sample test was used to study the levels of serum ferritin in reproductive age group women and postmenopausal women with Nonalcoholic fatty liver disease. Results: The mean levels of serum ferritin were higher in reproductive age group women and postmenopausal women with non-alcoholic fatty liver disease, when compared to controls. Conclusion: When this marker serum ferritin is early identified, intervention can be done earlier, and prevention of coronary heart disease and chronic liver disease can be done.

Aims and Objectives: This study was to ascertain the improvement in success rates of first-attempt cannulation of the radial artery using ultrasound guided dynamic needle tip positioning technique (DNTP) versus angle distance (AD) technique. Material and Methods: A total 70 adult patients scheduled for elective surgery, after written informed consent was enrolled after ethical approval. The patients older than 18 years, ASA grade I-IV and positive modified allen’s test was included. Hemodynamically unstable, patient refusing for study, age less than 18 years, and patients with blocked targeting artery was excluded. Patients was assigned for ultrasound guided dynamic needle tip positioning (DNTP) group and angle distance (AD) group (35 patients in each group) using the sealed-envelope method. The anaesthesiologist who was conduct the cannulation procedure know the allocation of patients. The patients were blinded to the allocation. Results: First-pass success without posterior wall puncture was present 80% in group AD and 48.66% in group DNTP. First-pass success rate was present 62.9% in group AD and 28.6% in group DNTP. 10 min overall success rate was present 97.1% in group AD and 88.6% in group DNTP. Cannulation time was 163.26 second in group AD and 429.31 second in group DNTP. Posterior wall puncture was present 20% in group AD and 51.4% in group DNTP. One puncture was present 62.9% in group AD and 28.6% in group DNTP. Two puncture was present 8.6% in group AD and 48.6% in group DNTP. Three puncture was present 22.9% in group AD and 14.3% in group DNTP. Four puncture was present 5.7% in group AD and 8.6% in group DNTP. 600s was 163.26 second in group AD and 429.31 second in group DNTP. Conclusion: The first-pass success rate, with or without arterial posterior wall puncture was more with AD technique compared to DNTP technique. There were no significant difference in the 10-min overall success rate between the DNTP and AD groups. However, the cannulation time was shorter and the posterior wall puncture rate was lower in the AD group than in the DNTP group. The appropriate technique should be applied depending on the specific clinical situation.

Collagenous spherulosis is an uncommon incidental finding characterized by collagen-rich spherules composed of basement membrane material. It is often associated with other benign breast lesions such as fibroadenoma, papilloma, sclerosing adenosis, radial sclerosing lesion, adenomyoepithelioma, and florid ductal hyperplasia. In cytological material, the estimated incidence of this benign condition is only approximately 0.2%. It is essential to distinguish collagenous spherulosis from atypical proliferations and malignant mimics, particularly adenoid cystic carcinoma, to prevent unnecessary therapy. Here, we present a concise review of the literature and discuss the cytological findings of a case of collagenous spherulosis that is associated with benign proliferative breast disease.

Introduction: Confirmation of correct endotracheal tube (ETT) placement is essential to prevent complications during airway management. Capnography is considered the gold standard; however, it may be unreliable in low perfusion states. Ultrasonography has emerged as a rapid bedside tool for airway assessment. This study aimed to compare ultrasonography with capnography for confirmation of ETT placement. Materials and Methods: This prospective comparative study included 60 adult patients undergoing endotracheal intubation under general anesthesia. Patients were divided into two groups: ultrasonography (Group U) and capnography (Group C), with 30 patients in each group. The primary outcome was the time required to confirm ETT placement. Secondary outcomes included diagnostic accuracy, hemodynamic parameters, complications, and ease of procedure. Statistical analysis was performed with p < 0.05 considered significant. Results: Demographic characteristics were comparable between groups. The median confirmation time was significantly shorter with ultrasonography than with capnography (4 seconds vs 7 seconds, p < 0.001). Both techniques showed 100% sensitivity and diagnostic accuracy. Hemodynamic parameters remained stable, and complication rates were minimal and comparable between groups. Conclusion: Ultrasonography is a rapid and reliable method for confirming ETT placement with diagnostic accuracy comparable to capnography. It significantly reduces confirmation time and can serve as a useful adjunct in airway management.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major global health problem, with acute exacerbations (AECOPD) contributing significantly to morbidity, mortality, and healthcare costs. Electrolyte disturbances are common in AECOPD and may worsen clinical outcomes, yet limited data exist from high-burden regions such as Delhi. This study aimed to assess the prevalence and pattern of serum electrolyte abnormalities in AECOPD patients and their association with disease severity. Materials and Methods: A cross-sectional study was conducted over 18 months in the Department of General Medicine, Swami Dayanand Hospital, Delhi. Ninety-five patients with confirmed COPD presenting with acute exacerbation were enrolled based on inclusion and exclusion criteria. Clinical history, examination, and relevant investigations, including serum sodium, potassium, calcium, and chloride levels, were recorded at presentation. Electrolyte abnormalities were categorized as hypo-, normal-, or hyper-levels. Disease severity was graded, and statistical analysis was performed using SPSS version 25, with p < 0.05 considered significant. Results: The mean age was 59.22 ± 10.88 years, with males comprising 54.74% of the cohort. Smoking history was present in 58.95%, and hypertension was the most common comorbidity (32.63%). Hyponatremia was present in 51.58%, hypochloremia in 57.9%, hypokalemia in 41.05%, and hypocalcemia in 28.42% of patients. Hyponatremia (p = 0.02) and hypokalemia (p = 0.03) were significantly associated with moderate to severe exacerbations. Conclusion: Electrolyte disturbances, particularly hyponatremia and hypochloremia, are highly prevalent in AECOPD and correlate with disease severity. Routine electrolyte monitoring should be an integral part of AECOPD management to improve outcomes.

Background: Keloids are benign fibro proliferative disorders characterized by excessive collagen deposition extending beyond the original wound margins. Their management remains challenging due to high recurrence rates and suboptimal response to single-modality treatments. Intralesional triamcinolone acetonide (TAC) and 5-fluorouracil (5-FU), alone or in combination, are widely used therapeutic options. Aim: To compare the efficacy and safety of intralesional TAC, 5-FU, and their combination in the management of keloids. Methods: A prospective randomized comparative study was conducted in the Department of Plastic Surgery, Patna Medical College and Hospital (PMCH), including 60 patients with clinically diagnosed keloids. Patients were randomly allocated into three groups: Group A (TAC), Group B (5-FU), and Group C (TAC + 5-FU), with 20 patients in each group. Intralesional injections were administered at 4-week intervals for a maximum duration of 16 weeks (total of 4 doses). Outcomes were assessed using the Vancouver Scar Scale (VSS), symptom relief (pain and pruritus), and recurrence rates. Recurrence was evaluated based on clinical assessment of scar size and VSS score during follow-up. Patients were followed for 6 months after completion of therapy. Statistical analysis was performed using ANOVA and Chi-square tests, with p < 0.05 considered statistically significant Results: All groups demonstrated statistically significant improvement in VSS scores (p < 0.001). The combination group showed the greatest reduction in scar height (64.7%) and total VSS score (63.4%), along with superior improvement in vascularity, pigmentation, and pliability. Symptomatic relief was highest in the combination group, with 90% reduction in pain and 85% reduction in pruritus. Adverse effects such as skin atrophy were more common with TAC, while ulceration and injection site pain were more frequent with 5-FU. The combination group exhibited fewer severe complications and the lowest recurrence rate (10%). Conclusion: Intralesional combination therapy with TAC and 5-FU is more effective and safer than monotherapy in the treatment of keloids. It provides superior clinical improvement, better symptomatic relief, and lower recurrence rates, and may be considered a preferred treatment modality in clinical practice.

Background: The condition known as chronic obstructive pulmonary disease (COPD) is characterized by abnormalities of the lung’s airway that limit the amount of air that enters and exits the lungs. Ten percent of people worldwide suffer with COPD, which has a high morbidity and death rate. Controlling the symptoms and achieving a high quality of life are the goals of the treatment. The purpose of this study is to determine how various medications used to treat COPD are used at JLNMCH in Bhagalpur, Bihar. Methods: 170 patients who underwent COPD treatment were included in this retrospective analysis. The departmental record register of COPD patients admitted to JLNMCH was used to collect patient and medication data. Results: According to the findings, 131 patients (77.1%) were prescribed beta 2 receptor agonists, while 139 patients (81.8%) were prescribed muscarinic receptor antagonists. For 103 patients (60.6%) and 102 patients (60.0%), respectively, salbutamol and tiotropium were the most specific medications provided; 24.7% of patients received just one medication. There is proof that the use of muscarinic receptor antagonists and gender are significantly correlated. Conclusion: This study illustrates how medications used to treat COPD at JLNMCH in Bhagalpur, Bihar, were used.

Background: Acute abdomen is a clinical condition characterized by the sudden and severe abdominal pain related symptoms typically requires urgent intervention. The term gained prominence in the 20th century and highlights the urgency associated with such presentations. Abdominal pain can arise from a wide spectrum of causes, ranging from minor self-limiting conditions to serious, life-threatening disorders. In cases of severe, diffuse abdominal pain, common underlying causes include acute pancreatitis, bowel perforation, ruptured abdominal aortic aneurysm, and acute mesenteric ischemia (AMI). Aims of this study was to assess the diagnostic precision of 128-slice MDCT in detecting the underlying etiologies of acute abdominal conditions,  examine the capability of MDCT in differentiating among various disease processes leading to acute abdominal presentation and investigate the sensitivity and specificity of MDCT in acute abdomen evaluation, using operative, histological, or clinical findings as benchmark standards. Methods: The present prospective study was conducted from August 2023 to April 2025, involving patients referred to the Department of Radiology, DMCH, Laheriasarai, and Bihar, who presented with clinical features suggestive of acute abdomen and underwent MDCT evaluation. Imaging was done with the GE Revolution EVO 128-slice CT machine. The CT findings were subsequently correlated with intraoperative observations, clinical diagnoses, and available histopathological results to assess the diagnostic accuracy and effectiveness for acute abdominal conditions. Results: Evaluation of 106 patients done using Multi-Detector CT. The MDCT results were correlated with operative findings, tissue biopsy reports, and the clinical progress of patients who received non-surgical (conservative) management. 27 patients were females and 79 were males. Youngest patient had an age of 7 years to eldest patient having age of 82 years. Most common causes of acute abdomen were appendicitis in 22%, acute pancreatitis in 15%, acute and bowel obstruction in18%. In our study the sensitivity, specificity and positive and negative predictable values of MDCT were 98.03%, 75%, 99% and 60% respectively. Conclusion: We conclude that MDCT has high sensitivity and accuracy rate. In inconclusive cases, MDCT is recommended to arrive at a definitive diagnosis. The results obtained in the study were comparable to pioneer studies conducted worldwide.

Background: Brain neoplasms may be classified by location of supratentorial, infratentorial and midline tumours. Of the supratentorial neoplasms meningiomas are the most frequent extra- axial neoplasms. CT has become the most important diagnostic procedure in evaluating patients suspected of harbouring an intracranial tumour. It is still considered the basic radiologic study since it gives specific information for the management of brain tumours and is minimally invasive. The purpose of this study was to assess the distribution, features,l ocalization and extent of supratentorial neoplasms. Methods: Fifty cases with symptoms of intracranial pathology and on CT found to have supratentorial tumours were studied. Results: The CT patterns of 50 supratentorial tumours were reviewed, out of which 30 cases i.e. 60% were found to be intra- axial and 21 i.e. 42% extra – axial tumours. GBM formed the major group of the intra axial tumours i.e. 18 % and meningioms formed the major extra- axial tumours forming 26%. Conclusion: Tumours was done on 50 cases. The patients who were referred to department of Radio-diagnosis after suspected to have brain tumours by clinicians, are taken up for radiological evaluation and try to detect by CT scan. Thorough clinical history and clinical examination were done before CT examination.

Background: After 34 weeks, breech presentation frequently leads to a high rate of cesarean section (about 65%–96%), since this is the recommended approach to reduce neonatal morbidity and mortality when compared to vaginal breech delivery, especially in preterm or complex cases. The purpose of this study is to assess the delivery route, mother outcomes, and perinatal outcomes in cases of singleton breech presentation that occur after 34 weeks of gestation. Results of breech presentation following 34 weeks of pregnancy. Method: The Department of Obstetrics and Gynecology at Madhubani Medical College and Hospital in Madhubani, Bihar, conducted a prospective observational study between January and December of 2025. A total of 225 cases of breech presentation after 34 weeks were included in this study. When appropriate, an external cephalic version was performed. Data on the mode of delivery, maternal outcomes, and neonatal outcomes were gathered and analyzed while these patients were monitored until delivery. Result: Breech presentation at term was 3.24% (154 cases out of 4745 deliveries); primigravida women made up 45.3% of these cases, while multigravida women made up 54.7%. A considerable percentage of instances, or 71 out of 225 (31.5%) women, showed spontaneous cephalic version. With a success rate of 59%, the external cephalic version was effective in 17 out of 29 cases. 147 cases (65%) of breech presentations were delivered via cesarean section, while the remaining 78 cases (35%) were delivered vaginally, including six cases of assisted breech deliveries. Conclusion: Even in the late third trimester, a considerable proportion of breech fetuses undergo spontaneous version. An efficient method for lowering the incidence of cesarean deliveries in singleton pregnancies with breech presentation is external cephalic version.

Background: This is hospital based case control study of Cholelithiasis and choledocholithiasis by usage of ultrsonography. Cholelithiasis and choledocholithiasis is the presence of stones in gall bladder and in the common bile duct. Aim of this study is to determine the gallbladder (GB) wall thickness in patients with cholecystitis and cholelithiasis with the help of ultrasonography for the estimation of epidemiology. Methods: This was a hospital-based case–control study. Patients with cholecystitis and cholelithiasis of age between 15 and 70 years of either sex were included in the study. The GB wall thickness was determined in the fasting state. A total of 50 samples, 36 cases (with diseased bladder) and 14 controls (with normal bladder) were included in the study. Results: More than one-third of cases (38.9%) were between 30 and 40 years. The mean age of cases and controls was 42.22 ± 12.81 and 35.43 ± 11.85 years, respectively. More than one-third of both cases (36.1%) and controls (35.7%) were males. The GB wall thickness was significantly (P = 0.005) higher among the cases (4.06 ± 2.28 mm) than that of controls (2.22 ± 0.67 mm). Full distention of the GB was in more than half of both cases (69.4%)and controls (57.1%). Partial distended was in 11.1% of cases and in 21.4% of controls. Contracted (8.3%) and over distended (2.8%)were only seen among cases. The GB wall thickness of ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness of <3 mm was 92% lower in cases compared to controls (odds ratio = 0.08, 95% confidence interval = 0.01–0.43, P = 0.001). Conclusion: During ultrasonography, a higher degree of the GB wall thickness was found in patients with cholecystitis and cholelithiasis as compared to the control group.

Background: There is a growing need for further study on the variables impacting the incidence of surgical site infections (SSIs) due to the shifting criteria and the inconsistent, often completely contradicting findings. The purpose of this study is to examine how prophylactic antibiotics can lower surgical site infections (SSIs) in low-risk individuals after laparoscopic cholecystectomy (LC). Methods: In this clinical trial, 120 patients underwent laparoscopic cholecystectomy as per the inclusion criteria. Between March 2025 to August 2025, within the Department of General Surgery at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar individuals slated for elective laparoscopic cholecystectomy were systematically allocated into two distinct groups: one receiving prophylactic antibiotics and the other not. The principal outcome measured was the incidence of postoperative infectious complications. Data were analyzed in SPSS (Version. 23) software using Mann-Whitney, t-test, Fisher’s Exact, and Chi-square tests. The level of significance was set to P <0.05. Results: A total of 120 patients underwent laparoscopic cholecystectomy; these patients were split into two groups: 59 received preoperative prophylactic antibiotics (Antibiotic Group, AG) and 61 did not (No Antibiotic Group, NAG). Clinical characteristics such as gender, age, body mass index (BMI), and operating times did not differ significantly between the two groups. There was no significant overall difference in the incidence of surgical site infections (SSIs) across the groups (P=0.679), with two patients (3.4%) in the AG and four patients (6.7%) in the NAG. Patients with and without SSI had identical preoperative circumstances, as seen by the study’s lack of significant changes in preoperative WBC, hemoglobin, or creatinine levels. Conclusion: During laparoscopic cholecystectomy (LCC), our study’s results showed no significant differences between individuals who received prophylactic antibiotics and those who did not. Thus, prophylactic antibiotic use in elective LCC is not necessary for low-risk patients.

Background: Chronic non-healing ulcers are a significant global healthcare burden, affecting about 8.2 million Medicare beneficiaries in the US, and costing an annual treatment cost of $28.1 to $96.8 billion annually. Platelet derived growth factor (PDGF) is a crucial hormone in wound healing that induces cell proliferation, angiogenesis, and extracellular matrix formation. This systematic review aims to assess the efficacy and safety of PDGF therapy versus placebo/usual care for chronic non-healing ulcers in the last 10 years. Methods: Systematic review according to the PRISMA 2020 statement by searching PubMed/MEDLINE, Scopus, Web of Science Cochrane Central Register of Controlled Trials and Embase from January 2015 to December 2024. Eligible studies were randomized controlled trials, cohort studies and case-control studies in adult patients with chronic non healing ulcers receiving PDGF preparations. The main outcome measures were complete healing rates, time to healing, ulcer area reduction and adverse events. The Cochrane Risk of Bias Tool was used for quality assessment. Results: There were 28 studies totaling 4,118 patients, including 3 retrospective cohorts, 7 prospective cohorts, and 18 randomized controlled trials. The majority of research concentrated on diabetic foot ulcers (71.4%), which were followed by pressure ulcers (10.7%) and venous leg ulcers (17.9%). When compared to standard care, platelet-derived growth factor (PDGF) dramatically increased healing rates, especially in venous leg ulcers (OR: 5.06) and diabetic foot ulcers (OR: 1.53). Additionally, PDGF increased the reduction of ulcer size and reduced the healing time by three to six weeks. Conclusion: PDGF therapy appears to be an effective and safe adjunctive treatment for chronic non-healing ulcers, particularly diabetic foot ulcers and venous leg ulcers. Its use is associated with improved healing rates, shorter healing time, and greater reduction in ulcer area compared with standard care. Future studies should focus on evaluating long-term outcomes, assessing cost-effectiveness, and identifying patient-specific predictors of treatment response in order to optimize its clinical use.

Background: Menopause is associated with decreased estrogen levels, leading to alterations in lipid metabolism and increased cardiovascular risk. Methods: A cross-sectional study was conducted among women attending IPD/OPD, categorized into premenopausal, perimenopausal, and postmenopausal groups. BMI was calculated, and fasting lipid profile (TC, TG, LDL, HDL) was analyzed and compared statistically. Results: Postmenopausal women exhibited significantly higher TC, TG, LDL, and BMI, along with lower HDL compared to other groups (p < 0.05). Perimenopausal women showed intermediate values, indicating progressive worsening of lipid profile and BMI with menopausal transition.

Background: Vitex negundo (Nirgundi) is a traditional Ayurvedic medicinal plant processed into diverse pharmaceutical forms (Swarasa, Kwatha, Taila, Ghrita) and extracts with purported anti-inflammatory properties. The relationship between traditional dosage form-specific phytochemical profiles and pharmacological efficacy remains understudied. Objective: To profile six Nirgundi preparations using Fourier-transform infrared (FTIR) spectroscopy and correlate spectral functional group patterns with in vivo anti-inflammatory activity in a rat paw edema model. Methods: FTIR spectroscopy (4000–400 cm–1) was performed on Nirgundi Swarasa, Kwatha, Taila, Ghrita, aqueous extract, and lipid extract. Anti-inflammatory activity was assessed in formalin-induced paw edema in male Wistar rats (n=6/group). Paw volume was measured at 0, 30 min, 1, 2, 4, 6, and 8 hours post-induction. Percentage inhibition was calculated relative to disease control. Data were analyzed by one-way ANOVA followed by post-hoc Tukey test (p<0.05). Results: FTIR profiling revealed distinct functional group signatures. Aqueous forms (aqueous extract, Swarasa, Kwatha) demonstrated prominent O-H stretching (3255-3265 cm-1) and aromatic C=C/phenolic C-O bands (1540-1650 cm-1), consistent with polyphenol-rich matrices. Lipid forms (Taila, Ghrita, lipid extract) displayed strong ester C=O stretching (1740 cm-1) and aliphatic C-H vibrations (2800-3000 cm-1), characteristic of triglyceride-based vehicles. All treatments significantly reduced edema vs. disease control (p<0.0001). Peak anti-inflammatory activity at 4 hours ranked as: aqueous extract (52.23±2.36%), Swarasa (50.03±2.90%), Kwatha (45.28±3.22%), lipid extract (32.47±2.58%), Taila (30.00±5.30%), and Ghrita (28.40±4.65%). Forms with richer phenolic/aromatic FTIR markers demonstrated higher early anti-inflammatory efficacy. All formulations significantly reduced inflammation (p<0.0001), with aqueous polyphenol-rich preparations demonstrating superior peak efficacy compared with lipid-based forms, while maintaining a favorable safety profile. Hematological parameters remained normal across all groups, indicating safety. Conclusion: FTIR spectroscopy enabled precise differentiation of Ayurvedic dosage forms of Vitex negundo, revealing a strong association between polyphenol-linked functional groups and anti-inflammatory efficacy. This integrative analytical–pharmacological framework bridges traditional pharmaceutics with modern scientific validation, offering a robust platform for standardization, rational formulation design, and evidence-based optimization of Ayurvedic therapeutics.

Fever-induced dystonia in children with underlying cerebral palsy is uncommon and may be challenging to manage. We report a 2-year-old child with global developmental delay consistent with cerebral palsy who presented with recurrent episodes of fever followed by severe generalized dystonia. Neuroimaging revealed delayed myelination involving the centrum semiovale. The dystonia was refractory to multiple. Anti-dystonia medications. Initial therapy with baclofen and trihexyphenidyl failed to control symptoms, followed by tetrabenazine without significant improvement. Pulse methylprednisolone was administered for three days with persistent dystonia. Levodopa–carbidopa (Syndopa) was added considering the possibility of Segawa syndrome, but symptoms continued. Subsequently, intravenous immunoglobulin (IVIG) was given, following which the child showed gradual clinical improvement. This case highlights the complexity of managing fever-triggered dystonia in children with underlying brain injury and emphasizes the need for a systematic therapeutic approach.

Background: A hypertensive emergency is characterized by rapid deterioration of target-organs and poses an immediate threat to life. These conditions were invariably fatal before the advent of antihypertensive drugs. The present study was undertaken to find out prevalence and clinical profile of patients with hypertensive emergencies in western region of rural Maharashtra. Materials and Methodology: The present prospective observational study was conducted in Emergency ward in Rural hospital during June 2024 to May 2025. Patient more than 18 year having systolic blood pressure of 180 mm of Hg and above or diastolic blood pressure of 120 mm of Hg and above with evidence of end organ damage, either clinically or laboratory findings and those who give written informed consent to participate in the study were included as study population. Detailed assessment was done including history taking, clinical examination and laboratory investigations. Data was entered into MS Excel and analysed using   SPSS v23.0. Results: The prevalence of hypertensive emergencies was 2.1%. The mean age of the patients was 53.87 ±12.85 years.  Males constituted the majority with 52 (55.91%) patients. The majority of patients had dyspnoea with 57 cases (61.29%). Conclusion: Hypertensive emergencies, though relatively infrequent, highlighting the need for prompt recognition and early management to prevent serious morbidity and mortality.

Background: Metabolic syndrome (MS) involves several risk factors for cardiovascular disease (CVD) and is common among Indian medical students due to their sedentary lifestyle and poor dietary habits [1]. Yoga and Pranayama are becoming popular non-pharmacological strategies to prevent MS through lifestyle modifications. Aim: To study the effect of pranayama on clinical predictors of metabolic syndrome in medical students with raised body mass index and/or elevated blood pressure. Methods and Material: After screening 100 undergraduate medical students aged 17 to 20, 32 students with a Body Mass Index (BMI) of 25 or higher and/or elevated blood pressure (systolic BP >120 mm Hg and diastolic BP >80 mm Hg) were selected based on clearly defined inclusion and exclusion criteria. Using block randomization, these students were randomly assigned into two groups: the Interventional Group (N=16) and the Control Group (N=16). Both groups had statistically similar mean values for age, gender distribution, physical activity levels, BMI, waist-to-hip ratio (WHR), body mass composition, lipid profile, fasting blood sugar, and blood pressure. The Interventional Group practiced Pranayama for 25 minutes daily, six days a week, for eight weeks, while the Control Group continued their routine activities. After eight weeks, the parameters previously measured in both groups were reassessed, and the results were analyzed statistically. Results: The Interventional Group experienced a notable reduction in BMI, waist-to-hip ratio (WHR), fat weight, fat percentage, blood pressure (both systolic and diastolic), serum cholesterol, low-density lipoprotein (LDL) levels, and fasting blood sugar. Additionally, this group experienced a significant increase in lean mass percentage and total body water percentage. In contrast, the Control Group showed no significant changes in these parameters. Conclusions: Regular practice of Pranayama can serve as an effective non-pharmacological tool for preventing obesity, hypertension, and diabetes, while also optimizing lipid profile, thereby significantly reducing the risk factors associated with metabolic syndrome.

Pseudomonas aeruginosa is an important opportunistic pathogen responsible for both hospital-acquired and community-acquired infections. Its intrinsic and acquired resistance to multiple antibiotics poses significant therapeutic challenges. This study aimed to evaluate the prevalence and antibiogram of P. aeruginosa isolates in a tertiary care hospital. A total of 503 clinical samples were processed, out of which 32 isolates of P. aeruginosa were identified, giving a prevalence rate of 6.38%. Antibiotic susceptibility testing revealed variable resistance patterns, with all isolates remaining sensitive to colistin. A considerable proportion (27%) of isolates were multidrug-resistant. Continuous surveillance and rational antibiotic use are essential to control infections caused by this organism.

Background: There are limitations to prophylaxis in economically constrained countries due to non-affordability of clotting factor concentrate. In this resource constrained countries, the prophylaxis goals should be for improved quality of life rather than zero bleed and perfect joints. Materials and Methods: Hospital based prospective and retrospective longitudinal study was done in Indoor & Outdoor Patients of Department of Haematology & Department of Paediatrics, diagnosed as hemophilia at Nilratan Sirkar Medical College, Kolkata, West Bengal a tertiary care hospital in Eastern India between Jan 2018 to June 2019. Type of hemophilia, APTT level, factor VIII & IX level, level of inhibitor, age at starting prophylaxis, number of joint bleeds at the starting of prophylaxis, hemophilia joint health score and assessment of quality of life. Laboratory investigations were done like level of APTT, level of factor, level of inhibitor, HBsAg, HIV 1&2, Anti HCV and X-ray of involved joint. Outcome of the prophylaxis is measured by Haemophilia joint health score (HJH). This score was done in four visits 3months apart in both primary and secondary prophylaxis cases. The quality of life was assessed by the assessment of quality-of-life score. It was done in 10 visits. Results: Among 34 patients 27 patients are hemophilia A and 7 patients are hemophilia B. Distribution of patients (Hemophilia A 82% & B 18%). Mean age at diagnosis in case of Hemophilia A is 16.82±14.2 (months) and Hemophilia B 18.5 ±14.3. Study revealed that the comparison between mean HJH score of each visit in case of primary versus secondary prophylaxis. In first visit the mean HJH score for primary and secondary prophylaxis are 12.83+3.09 and 15.72+1.6 (P=0.03). In second visit the mean HJH score for primary and secondary prophylaxis are 10.66+3.20 and 13.04+1.73 (P=0.043). In third visit the mean HJH score for primary and secondary prophylaxis are 8.41+2.84 and 10.68+1.49 (P=0.024). In fourth visit the mean HJH score for primary and secondary prophylaxis are 6.66+3.11 and 8.86+1.45 (P=0.046). Among the 34 patients, 7 patients had developed inhibitor. All of them are hemophilia A. Study showed among the total papulation of patients’ inhibitor developed in 18% of patients. It also showed that among the patients who developed inhibitor 33% patients have positive family history and 67% have negative family history. Conclusion: So, we can conclude that the HJH score is significantly decreasing from the first visit to the subsequent visits for both primary and secondary prophylaxis. When the decreasing pattern is compared in primary and secondary prophylaxis it is seen that HJH score is decreasing more in subsequent visits in case of primary prophylaxis than secondary prophylaxis. In case of secondary prophylaxis, the assessment of quality-of-life score is significantly improving from first visit to the subsequent visits.

Background: The corneal endothelium is essential for maintaining corneal transparency. Endothelial damage during cataract surgery can adversely affect visual outcomes, with Phacoemulsification and Small Incision Cataract Surgery (SICS) causing varying degrees of endothelial stress. Postoperative endothelial cell density assessment helps determine the relative safety of these techniques. Aims: To evaluate and compare corneal endothelial cell count (ECC) changes following Phacoemulsification and SICS performed by a single experienced surgeon. Settings and Design: Hospital-based longitudinal observational study. Methods and Material: A total of 82 patients aged 41–80 years were enrolled, with 41 undergoing Phacoemulsification and 41 undergoing SICS. All participants received detailed preoperative ocular examinations. Endothelial cell density was measured using non-contact specular microscopy before surgery and at 2 and 6 weeks postoperatively. Statistical analysis used: Chi-square test, unpaired t-test, ANOVA test. Results: The mean preoperative ECC was comparable between the Phacoemulsification (2642.3 ± 171.6 cells/mm²) and SICS (2602.8 ± 184.3 cells/mm²) groups. Endothelial cell loss was significantly higher with Phacoemulsification at both 2 weeks (276.40 ± 54.25 vs. 195.60 ± 42.86 cells/mm²) and 6 weeks (394.70 ± 65.78 vs. 296.00 ± 57.42 cells/mm²) compared to SICS (p < 0.001). Conclusions: SICS demonstrated lower endothelial cell loss and remains a safe, efficient, and cost-effective option, particularly in patients with advanced cataracts.

Background: Meconium aspiration syndrome (MAS) is an important cause of neonatal respiratory distress and morbidity in term and post‑term neonates. Non‑invasive ventilation strategies such as nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) are increasingly used to reduce the need for invasive mechanical ventilation. Aim: To compare the efficacy of NCPAP and NIPPV as initial respiratory support in neonates with meconium aspiration syndrome. Methods: A hospital‑based randomized controlled trial was conducted on 60 neonates with MAS admitted to the NICU of Hassan Institute of Medical Sciences between March 2021 and December 2022. Neonates were randomly allocated into two groups: NIPPV (n=30) and NCPAP (n=30). Respiratory parameters, need for mechanical ventilation, surfactant therapy, complications and duration of hospital stay were compared between the groups. Results: Duration of hospital stay was significantly lower in the NIPPV group compared to the NCPAP group (25.53±7.37 vs 39.67±7.24 days; p<0.05). Mechanical ventilation was required in 16 (53.3%) neonates in the NIPPV group and 19 (63.3%) neonates in the NCPAP group. Surfactant therapy was administered in 6 (20%) and 3 (10%) neonates respectively. These differences were not statistically significant (p>0.05). Conclusion: Both NIPPV and NCPAP are effective non‑invasive respiratory support strategies for neonates with MAS. NIPPV appears to reduce the duration of hospitalization and can be considered a safe and effective alternative to NCPAP in the management of MAS.

Introduction: Identification of individuals is a fundamental aspect of forensic medicine, especially in cases involving mutilated or decomposed remains. Stature estimation from body parts is widely used, and hand length has been shown to correlate positively with height. However, regional data for the adult population of Jaipur remains limited. Methods: A cross-sectional observational study was conducted at SMS Medical College, Jaipur, including 40 adults (20 males and 20 females) aged 20–40 years. Stature was measured using an anthropometer, and hand length was measured using a sliding vernier caliper under standardized conditions. Statistical analysis included mean, standard deviation, and correlation, with p < 0.05 considered significant. Results: The mean stature was 163.10 ± 8.56 cm. The mean right and left hand lengths were 17.00 ± 0.85 cm and 16.90 ± 0.87 cm, respectively. No significant bilateral difference was observed. A statistically significant positive correlation was found between hand length and stature (p < 0.05), indicating that hand length is a reliable predictor of stature. Discussion: The findings support previous studies demonstrating a strong correlation between hand length and stature. The absence of bilateral variation suggests either hand can be used for estimation. However, population-specific variations necessitate regional regression models. Conclusion: Hand length is a simple, reliable, and practical parameter for estimating stature in the adult population of Jaipur, with important applications in forensic identification.

Introduction: Lidocaine spray is used before upper gastrointestinal endoscopy (UGE) routinely. A lozenge formulation with ease of administration, palatable taste and improved compliance could be preferred topical anesthesia. This study was conducted to evaluate the efficacy of lidocaine lozenges versus lidocaine spray on propofol requirement in diagnostic gastroduodenal endoscopy. Materials and Methods: Prospective study with two hundred patients undergoing diagnostic UGE were randomized either to lidocaine lozenge or spray groups. Ease of application, ease of procedure, level of gag reflex and investigators and patient’s global assessment were noted along with total dose of propofol administered. Comparison was done by using appropriate statistical test. Results: Significantly less dose of propofol (P < 0.0001) required along with less procedural difficulty and gag reflex during UGE with lidocaine lozenges compared to spray. Global assessment by patient and physician was favorable toward lozenges. Conclusions: Lidocaine lozenges significantly reduced propofol requirement with advantages of easy application, better suppression of gag reflex, better patient and endoscopist satisfaction compared with lidocaine spray.

Background: Rheumatoid arthritis (RA) is an idiopathic disease characterized by severe joint pain, inflammation of muscles and joints, and many co-morbidities like CVS and lymphadenitis, which impairs normal social life. Method: Out of 365 patients with joint and muscular inflammation, 31 had a positive RA factor. RA factor antibodies tests were tested by the RE-latex slide agglutination test by ASPEN Diagnostics. The samples were centrifuged at 3000 rpm for 2 minutes. Serum was then separated by using a micropipette. Results: Out of 365 suspected patients, 31 (8.49%) had a positive RA factor. It was more prevalent in adults aged between 41-60 years i.e., 24 (12.7%), followed by those above 60 years, which was 5 (5.5%). Conclusion: Although RA is an idiopathic disease, the present prevalence study of RA factors is highly prevalent in those above 40 years of age. This study demands further genetic, nutritional, and environmental studies because a decrease in all physiological factors begins after 40 years only.

Background: Subdermal contraceptive implants are among the most effective long-acting reversible contraceptive methods available. Implanon Nxt is a single-rod etonogestrel-releasing implant that provides reliable contraception for up to three years. Despite its high contraceptive efficacy, users may experience certain side effects, particularly menstrual disturbances, which may influence continuation rates. Objective: To assess the effectiveness and side effects of the subdermal contraceptive implant Implanon Nxt among women attending a tertiary care institute in western Rajasthan. Materials and Methods: This hospital-based prospective observational study was conducted at Umaid Hospital, Dr. S.N. Medical College, and Jodhpur from January 2025 to December 2025. A total of 368 women of reproductive age who opted for Implanon Nxt insertion were included in the study. Baseline socio-demographic and clinical data were recorded using a pre-designed proforma. Participants were followed to evaluate the effectiveness of the implant and to document any side effects experienced during the study period. Data were analyzed using descriptive statistics and presented as frequencies and percentages. Results: The majority of participants belonged to the 20–24 years age group (37.8%). Most women were urban residents (76.5%) and housewives (91.2%). Multiparous women constituted 64.2% of the study population. Side effects were reported in 65.7% of participants, with menstrual disturbances being the most common (54.9%), followed by non-menstrual side effects (18.1%). Implant removal was observed in 2.2% of cases, with side effects being the most frequent reason for discontinuation (72.7%). Conclusion: Implanon Nxt was found to be a highly effective and safe long-acting reversible contraceptive method. Although menstrual disturbances were commonly reported, the overall discontinuation rate was low. Proper counseling regarding expected side effects may improve acceptance and continuation of this contraceptive method.

Background: Pulmonary hypertension (PH) frequently complicates chronic obstructive pulmonary disease (COPD), significantly increasing morbidity and mortality. Although right-heart catheterization (RHC) is the diagnostic gold standard, non-invasive markers for estimating PH severity remain crucial. Recent studies suggest that the forced vital capacity (FVC)/diffusing capacity (DLCO) ratio predicts PH, but the utility of FEV1/DLCO remains underexplored. Objective: To determine whether the FEV1/DLCO ratio predicts PH severity in COPD-PH and to compare its diagnostic performance with the FVC/DLCO ratio. Methods: A cross-sectional study was conducted over six months among COPD outpatients. After screening for inclusion and exclusion criteria, pulmonary function testing and transthoracic echocardiography were performed. FEV1/DLCO and FVC/DLCO ratios were correlated with mean pulmonary arterial pressure (mPAP). Results: FEV1/DLCO strongly correlated with PH severity (r = 0.78; p < 0.001) and demonstrated a higher predictive accuracy for severe PH (AUC = 0.88) compared to FVC/DLCO (AUC = 0.72). An FEV1/DLCO cutoff of >2.5 predicted severe PH with 86% sensitivity and 81% specificity. Conclusion: The FEV1/DLCO ratio is a superior non-invasive marker for predicting PH severity in COPD-PH compared with FVC/DLCO. This ratio may improve risk stratification and guide timely referral for invasive evaluation and management.

Background: Acute febrile illness (AFI) is a major public health problem in tropical regions such as South Gujarat, India, contributing to significant morbidity and mortality due to diverse viral, bacterial, and parasitic etiologies. Early identification of mortality predictors is essential, especially in resource-limited tertiary care settings. Although studies from other parts of India report factors like low Glasgow Coma Scale, renal dysfunction, and undiagnosed illness, regional data from South Gujarat are scarce. This prospective observational study evaluated clinical, laboratory, and etiological predictors of mortality in AFI patients over one year. Material and Methods: Conducted over a year, this study enrolled 300 adult patients (aged ≥18 years) presenting with fever >38°C lasting 3-14 days without an obvious focus of infection. Ethical approval was obtained from the institutional review board, and informed consent was secured. Patients with known chronic illnesses exacerbating fever or those refusing participation were excluded. Data collection included demographics, clinical history, physical examination, routine blood tests, serological assays for dengue, malaria, scrub typhus, leptospirosis, and enteric fever, plus imaging and cultures as needed. Statistical analysis used SPSS software; univariate comparisons employed chi-square and t-tests, while multivariate logistic regression identified independent predictors (p<0.05 significant). Results: Of 300 patients, 176 (58.7%) were male, mean age 42.3 ± 15.6 years. Common etiologies: dengue (32.3%), scrub typhus (28.7%), malaria (12.0%), bacterial sepsis (8.3%), leptospirosis (4.7%), enteric fever (3.3%), undiagnosed (10.7%). Mortality rate was 8.0% (24 deaths). Non-survivors had significantly lower GCS (mean 8.2 vs. 13.4, p<0.001), higher creatinine (2.8 vs. 1.1 mg/dL, p<0.001), and more frequent shock (45.8% vs. 12.3%, p<0.001). Multivariate analysis revealed independent predictors: GCS <9 (OR 4.2, 95% CI 2.1-8.4), elevated creatinine >2 mg/dL (OR 3.1, 95% CI 1.5-6.3), age >60 years (OR 2.8, 95% CI 1.3-5.9), and undiagnosed etiology (OR 5.6, 95% CI 2.7-11.4). Conclusion: This study underscores GCS score, renal impairment, advanced age, and diagnostic uncertainty as critical mortality predictors in AFI, emphasizing the need for rapid assessment and empirical therapy in endemic areas.

Background: Hip surgeries are associated with significant postoperative pain that can delay rehabilitation and prolong hospital stay. Fascia iliaca compartment block (FICB) is widely used for postoperative analgesia in hip procedures. The suprainguinal approach may provide better analgesic coverage compared with the conventional infrainguinal approach. Aim: To compare the postoperative analgesic efficacy of the suprainguinal and infrainguinal approaches of fascia iliaca compartment block in patients undergoing hip surgeries. Methods: A prospective randomized comparative study was conducted on 120 patients undergoing hip surgeries. Patients were divided into two groups of 60 each. Group S received a suprainguinal fascia iliaca compartment block, whereas Group I received an infrainguinal fascia iliaca compartment block. Postoperative pain was assessed using the Visual Analog Scale at various time intervals. The time to first rescue analgesic, total analgesic consumption, and adverse effects were recorded. Statistical analysis was performed using appropriate tests with p < 0.05 considered significant. Results: The time to first rescue analgesia was significantly longer in Group S (301.72 ± 18.46 minutes) compared with Group I (206.53 ± 21.37 minutes). Patients in Group S required fewer doses of tramadol in the first 24 hours postoperatively. VAS scores were significantly lower in Group S at later postoperative intervals. The incidence of nausea and vomiting was also lower in the suprainguinal group. Conclusion: The suprainguinal fascia iliaca compartment block provides superior and longer lasting postoperative analgesia compared with the infrainguinal approach in hip surgeries while reducing opioid requirements and associated adverse effects.

Introduction: Laryngoscopy and pneumoperitoneum during intra-operative period under general anaesthesia causes hemodynamic variation. So, we decided to compare the effect of esmolol and diltiazem so as to decrease the pressor response. Methodology: 150 patients were equally divided into 3 groups i.e. Group E, Group D, Group C, and injection esmolol and diltiazem were given before intubation and creation of pneumo peritoneum, with last group as taken as control. We observed the hemodynamic variation in patients during intra-operative period and record them. Result: We observed that heart rate and blood pressure variation was comparatively less in group E and D, as compare to group C after laryngoscopy and creation of pneumoperitoneum, whose duration was seen for few minutes and then it became same as Group C. Conclusion: We concluded that Injection Esmolol and Diltiazem causes less hemodynamic variation after laryngoscopy and creation of pneumoperitoneum.

Background: Stroke in young adults is an emerging public health issue associated with significant socioeconomic burden. The etiological spectrum and risk factor profile in younger populations differ from those in older individuals and vary across regions. Limited data are available from eastern India regarding the clinical and etiological characteristics of young stroke patients. Objectives: To evaluate the clinical profile, risk factors, and etiological patterns of stroke in young adults admitted to a tertiary care hospital in Bihar. Methods: This prospective observational study was conducted over eight months at ESIC Medical College and Hospital, Bihta, Patna. Fifty patients aged 20–50 years with radiologically confirmed stroke were included. Detailed clinical evaluation, laboratory investigations, and neuroimaging were performed. Ischemic strokes were etiologically classified based on standard criteria. Data were analyzed using descriptive statistics. Results: The mean age of patients was 34.6 ± 6.8 years, with male predominance (58.0%). Ischemic stroke accounted for 74.0% of cases, while hemorrhagic stroke constituted 26.0%. Hypertension was the most common risk factor (50.0%), followed by smoking (42.0%) and alcohol consumption (38.0%). Among ischemic strokes, large artery atherosclerosis (27.0%) and cardioembolic causes (24.3%) were the leading etiologies. At discharge, 66.0% of patients showed clinical improvement, while in-hospital mortality was 4.0%. Conclusion: Stroke in young adults is predominantly ischemic in nature and largely associated with modifiable vascular risk factors. The growing contribution of atherosclerotic and cardioembolic mechanisms highlights the need for early risk factor screening and preventive strategies in younger populations.

Background: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and are increasingly associated with antimicrobial resistance. The emergence of extended-spectrum beta-lactamase (ESBL)-producing uropathogens has significantly limited therapeutic options and contributed to treatment failure. Objectives: To detect ESBL-producing Enterobacteriaceae in urine samples and to evaluate their antimicrobial susceptibility patterns. Methods: This prospective observational study was conducted over a period of 12 months in a tertiary care hospital. Adult patients with clinically suspected UTIs were included. Urine samples were processed using standard microbiological techniques. Identification of isolates was performed using conventional biochemical methods. Antibiotic susceptibility testing was carried out by the Kirby–Bauer disk diffusion method as per CLSI guidelines. ESBL production was screened and confirmed using the double disk synergy test (DDST) and combined disk diffusion test. Results: Out of 235 Enterobacteriaceae isolates, 55.7% were identified as ESBL producers. Escherichia coli were the predominant organism (54.5%) and showed the highest ESBL production (64.8%). ESBL isolates exhibited high resistance to beta-lactam antibiotics and fluoroquinolones, whereas carbapenems and amikacin were found to be the most effective drugs. Conclusion: The high prevalence of ESBL-producing uropathogens emphasizes the need for routine surveillance, early detection, and rational use of antibiotics to limit the spread of resistance and improve patient outcomes.

Introduction: The clinical presentation of nasal cavity lesions often mimics chronic inflammatory conditions, making definitive histopathological examination the gold standard for accurate diagnosis and management. This study aimed to analyze the histopathological spectrum, compare neoplastic versus non-neoplastic incidence, and evaluate the age and sex distribution of these lesions at a tertiary care center in Bikaner, Rajasthan. Methodology: This hospital-based cross-sectional study was conducted at the Department of Pathology, Sardar Patel Medical College, Bikaner, from January 2024 to December 2025. A total of 98 tissue specimens from the nasal cavity and external nose were analyzed using standardized processing and hematoxylin and eosin (H&E) staining. Data were processed using descriptive statistics and the Chi-square test. Results: The cohort ranged from 2 to 87 years (mean age: 38.08 years), with the highest incidence in the 41–60 age group (31.6%). A male predominance was observed with a ratio of 1.65:1. The nasal cavity was the most frequent site (74.49%), followed by mass excised post-FESS (9.18%) and nasal skin (7.14%). Non-neoplastic lesions accounted for 51.02% () of cases, while neoplastic lesions comprised 48.98%. Inflammatory polyps were the most common (64%), followed by allergic polyps (18%). Malignant tumors significantly outnumbered benign ones (81.25% vs. 18.75%). Moderately differentiated Squamous Cell Carcinoma (SCC) was the dominant malignancy (43.59%). Hemangiomas (Capillary and Lobular) were the most frequent, each representing 22.22% of benign cases. Conclusion: The study reveals a diverse spectrum where non-neoplastic inflammatory polyps remain the most frequent overall lesion. However, the high proportion of malignancies (81.25%) among neoplastic cases—predominantly Squamous Cell Carcinoma in older males—highlights the critical role of a regional cancer center in early diagnosis. The significant age-related distribution serves as a vital clinical guide for differential diagnosis in this geographic region.

Introduction: Stroke is an important cause of mortality in elderly and increased rate of morbidity in elderly patients. During the acute phase of cerebrovascular disorders, biochemical markers of inflammation, including C-reactive protein (CRP), may serve as indicators of stroke severity. The present study was undertaken to determine the association of C – reactive protein (CRP) levels and its association with the mortality outcomes among acute ischemic stroke patients. Materials and Methods: This current hospital based observational study undertaken at the Department of General Medicine, Coimbatore Medical College, and Coimbatore. The study included 100 patients diagnosed with acute ischemic stroke. Patients diagnosed with acute ischemic stroke (< 72 hrs) from both genders were included in the study. Results: In the present study, majority of participants were male and belonged to the 61–70 years age group. Lacunar infarcts were the most common (24%), the overall mortality rate in our study was 28%. Patients with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were significantly associated with increased mortality. Conclusion: Inflammatory markers (ESR and CRP), renal parameter (urea), and lipid profile components (total cholesterol, HDL, and triglycerides) showed significant associations with mortality, indicating their potential utility as prognostic indicators in the study population.

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring intensive care unit (ICU) admission represents a critical clinical event associated with substantial morbidity and mortality. Despite advances in critical care management, ICU mortality rates for severe AECOPD remain alarmingly high, and the identification of reliable early predictors of mortality is essential for optimizing clinical decision-making and resource allocation. This study aimed to evaluate the clinical outcomes and identify independent predictors of ICU mortality in patients admitted with severe AECOPD. Methods: This prospective observational study was conducted at a tertiary care university hospital. A total of 246 consecutive patients admitted to the ICU with a primary diagnosis of severe AECOPD were enrolled. Comprehensive demographic, clinical, laboratory, and ventilatory data were collected. The primary outcome was ICU mortality. Univariate and multivariable binary logistic regression analyses were performed to identify independent predictors of mortality. Results: The overall ICU mortality rate was 27.6% (68/246). Non-survivors were significantly older (68.4 ± 9.2 vs. 62.7 ± 10.4 years, p < 0.001), had lower mean BMI (19.8 ± 3.4 vs. 22.6 ± 4.2 kg/m², p < 0.001), and higher APACHE II scores (24.6 ± 6.8 vs. 16.4 ± 5.2, p < 0.001) compared with survivors. The requirement for invasive mechanical ventilation (IMV) was significantly higher among non-survivors (72.1% vs. 28.1%, p < 0.001). Multivariable logistic regression identified APACHE II score > 20 (adjusted OR 4.82; 95% CI: 2.64–8.80; p < 0.001), need for IMV (adjusted OR 3.96; 95% CI: 2.08–7.54; p < 0.001), serum albumin < 2.5 g/dL (adjusted OR 3.14; 95% CI: 1.62–6.08; p = 0.001), pH < 7.25 at admission (adjusted OR 2.86; 95% CI: 1.48–5.52; p = 0.002), and presence of cor pulmonale (adjusted OR 2.38; 95% CI: 1.24–4.56; p = 0.009) as independent predictors of ICU mortality. Conclusion: Severe AECOPD requiring ICU admission carries a substantial mortality burden. APACHE II score, requirement for invasive mechanical ventilation, hypoalbuminemia, severe acidemia at admission, and cor pulmonale serve as reliable independent predictors of mortality that can guide early risk stratification and inform therapeutic decision-making in the critical care setting.

Background: Post-tuberculosis lung disease (PTLD) is an increasingly recognized clinical entity characterized by persistent structural and functional pulmonary abnormalities following the completion of successful antitubercular therapy. Despite the enormous global burden of tuberculosis (TB), the long-term pulmonary sequelae affecting TB survivors remain inadequately studied, particularly in high-burden settings. This study aimed to determine the prevalence of PTLD and identify its associated risk factors among patients who completed antitubercular treatment at an urban tertiary care center. Methods: This cross-sectional observational study was conducted, enrolling 320 patients who had successfully completed antitubercular therapy within the preceding 6 to 36 months. All participants underwent detailed clinical evaluation, spirometric pulmonary function testing, high-resolution computed tomography (HRCT) of the chest, the St. George’s Respiratory Questionnaire (SGRQ), and the six-minute walk test (6MWT). PTLD was defined as the presence of persistent respiratory symptoms with corresponding radiological abnormalities and/or spirometric impairment following bacteriologically confirmed TB cure. Logistic regression analysis was employed to identify independent risk factors. Results: PTLD was identified in 198 of 320 patients (61.9%). The most prevalent HRCT findings were bronchiectasis (48.5%), fibrotic bands (42.4%), and cavitary lesions (28.3%). Spirometric abnormalities were detected in 54.1% of PTLD patients, with obstructive pattern predominating (33.8%). Mean FEV1 % predicted was significantly lower in the PTLD group (62.4 ± 16.8%) compared with the non-PTLD group (86.3 ± 12.5%, p < 0.001). Independent risk factors for PTLD included smoking history (OR 3.24; 95% CI: 1.86–5.64; p < 0.001), delayed treatment initiation exceeding 60 days (OR 2.78; 95% CI: 1.54–5.02; p = 0.001), cavitary disease on initial radiograph (OR 2.91; 95% CI: 1.62–5.23; p < 0.001), retreatment TB (OR 2.46; 95% CI: 1.28–4.72; p = 0.007), and diabetes mellitus (OR 1.94; 95% CI: 1.12–3.36; p = 0.018). Conclusion: PTLD affects a substantial majority of TB survivors and is associated with significant pulmonary functional impairment. Smoking history, delayed treatment initiation, initial cavitary disease, retreatment TB, and diabetes mellitus represent modifiable and identifiable risk factors that should guide targeted post-treatment surveillance and rehabilitation strategies.

Introduction: Seizures are a common neurological emergency with diverse etiologies that vary across age groups. Accurate diagnosis and identification of underlying structural abnormalities are crucial for guiding management and prognostication. Magnetic Resonance Imaging (MRI) has emerged as the modality of choice for evaluating patients with new-onset seizures due to its high sensitivity in detecting structural lesions. This study was undertaken to assess the role of MRI in identifying etiological factors in patients presenting with first-onset seizures. Materials and Method: This prospective study was conducted in the Department of Radiodiagnosis at a tertiary care centre in Chennai over two years. Seventy patients of all age groups presenting within seven days of first seizure onset and meeting International League against Epilepsy (ILAE) criteria were included. MRI brain was performed on a 3T GE Signa HDX scanner using a standardized epilepsy protocol. In selected cases, MR spectroscopy was added for lesion characterization. Data were analyzed and represented using descriptive statistics. Results: Of the 70 patients, 41 (58.6%) were males and 29 (41.4%) females, with the majority belonging to the 46–60 years age group. Generalized tonic–clonic seizures were the most common clinical presentation (80%), followed by focal seizures (12.9%). MRI revealed abnormalities in 40 patients (57.1%), while 30 (42.9%) had normal scans. The most frequent abnormalities were infarct with gliosis (18.57%), mesial temporal sclerosis (14.29%), infections such as tuberculoma (5.71%) and neurocysticercosis (4.29%), and neoplasms (7.15%). The temporal and frontal lobes were the most commonly affected regions. Conclusion: MRI proved invaluable in detecting structural abnormalities associated with new-onset seizures. More than half of the patients showed identifiable causes, highlighting the importance of high-resolution epilepsy protocols in early diagnosis, treatment planning, and prognostication.

Background: Adolescence is a critical developmental period marked by rapid physical, psychological, and social changes. Despite being considered a relatively healthy phase, adolescents are vulnerable to nutritional disorders, menstrual health problems, and lifestyle-related risk behaviors. This study was done to assess the prevalence of common health problems among adolescents studying in a suburban government higher secondary school in Malandighi, Durgapur, West Bengal. Methods: A school-based cross-sectional study was conducted in March 2025 among 180 adolescents aged 15–17 years (100 boys and 80 girls). Data were collected using a pretested semi-structured questionnaire covering sociodemographic characteristics, general health complaints, menstrual problems, and risk behaviors. Anthropometric measurements were recorded to calculate Body Mass Index (BMI), and blood pressure was measured using standard procedures. Data were analyzed using descriptive statistics and expressed as frequencies and percentages. Results: More than half (52.2%) of adolescents had normal BMI, while 41.1% were underweight and 6.7% were obese. Hypertension was observed in 1.7% of participants and was associated with overweight/obesity. Sleep disturbances (23.3%) and frequent headaches (20.0%) were the most common general health complaints. Among girls, 70.0% reported premenstrual symptoms and 60.0% reported dysmenorrhea, with 25.0% experiencing school absenteeism due to menstrual problems. Among boys, 12.0% reported smoking and 10.0% reported alcohol consumption. Conclusion: A substantial proportion of adolescents in this suburban government school experienced nutritional problems, menstrual health issues, and emerging lifestyle-related risk behaviors. Strengthening school-based health screening and health education programs is essential to promote healthy adolescent development.

Background: Scrub typhus is a less-identified cause of acute febrile illness in India, especially in ecologically vulnerable rural communities; such areas often experience regular exposure to scrub vegetation, livestock, and peri-domestic rodents. Data on north western Rajasthan at the community level are scarce despite repeated hospital reports which indicate regional endemicity. This study estimated the prevalence of scrub typhus infection and identified socio-demographic, behavioral, and environmental correlates in a rural population of north western Rajasthan, India. Methods: We modelled a community-based cross-sectional study conducted in six villages of north western Rajasthan between August and November 2024. Residents aged 15 years or older were selected through multistage cluster sampling. Participants completed a structured exposure questionnaire and provided blood samples for anti-Orientia tsutsugamushi IgM enzyme-linked immunosorbent assay testing. Prevalence was calculated with 95% confidence intervals (CI). Logistic regression was used to estimate crude and adjusted odds ratios (aOR) for infection. Results: Of 547 eligible residents, 524 were included in the final analysis. Sixty-nine participants were positive for IgM, thus an overall prevalence of 13.2% (95% CI 10.5%-16.3%). The prevalence was greater among agricultural workers compared with non-agricultural participants (16.2% vs 6.7%), among individuals reporting exposure to shrub or field-edge (19.0% vs 7.9%), and among households containing cattle sheds within 10 m of the dwelling (18.2% vs 9.2%). In multivariable analysis, agricultural occupation (aOR 2.31, 95% CI 1.20-4.45), frequent shrub exposure (aOR 2.87, 95% CI 1.58-5.23), cattle shed proximity (aOR 1.94, 95% CI 1.07-3.50), and indoor firewood storage (aOR 1.76, 95% CI 1.00-3.10) were independently associated with infection, while regular use of closed footwear was protective (aOR 0.52, 95% CI 0.29-0.93). About 1 in 4 seropositive people were asymptomatic at the time of survey. Conclusion: Scrub typhus showed substantial community prevalence in rural north western Rajasthan and clustered around modifiable ecological and household exposures. Strengthening rural surveillance, clinician awareness, and community risk-reduction measures may improve early recognition and prevention.

Aim: This study aimed to evaluate clinical and laboratory parameters in 130 patients with hyperemesis gravidarum (HG) admitted to the Department of Obstetrics & Gynaecology at Gandhi Medical College (GMC), Bhopal, over 18 months, to identify common abnormalities and their implications for management. Materials and Methods: A prospective observational study was conducted from January 2024 to June 2025 at GMC Bhopal. Inclusion criteria: pregnant women ≤20 weeks gestation with HG (vomiting >3 times/day, weight loss >5%, ketonuria). Sample size: 130 patients, calculated using prevalence of 2% with 5% margin of error. Clinical parameters (age, parity, gestational age, weight loss, dehydration signs) and laboratory tests (CBC, electrolytes, renal/liver function, urine ketones) were recorded. Data analyzed using SPSS v25; p<0.05 significant. Results: HG, characterized by intractable vomiting leading to dehydration, weight loss >5%, and electrolyte imbalances, affects 0.3-3% of pregnancies. Understanding these parameters aids in timely intervention and reduces maternal-fetal morbidity. Mean age was 24.5 ± 4.2 years; 58% primigravida. Mean gestational age at admission: 8.6 ± 2.1 weeks. Clinical findings: weight loss 6.8 ± 2.3% (range 5-12%), dehydration in 92%, ketonuria in 88%. Laboratory: hyponatremia (Na <135 mEq/L) in 52%, hypokalemia (K <3.5 mEq/L) in 42%, elevated AST/ALT in 47%, creatinine >1.2 mg/dL in 18%. Mean hemoglobin 10.2 ± 1.5 g/dL, NLR 4.2 ± 1.8. Hospital stays averaged 4.2 ± 1.9 days. Conclusion: HG at GMC Bhopal shows high prevalence of electrolyte imbalances (hyponatremia 52%, hypokalemia 42%), liver enzyme elevations (47%), and dehydration (92%), consistent with global patterns but higher in Indian cohort possibly due to delayed presentation. Early lab monitoring and IV hydration are crucial. These findings support routine use of NLR as severity marker.

Background: Apprehension prior to clinical procedures in children is not uncommon and can end up with usage of complex anaesthetic induction, increased postoperative analgesic necessities, and inconsistent behavioural changes. Nebulised drug delivery offers a non-invasive route with optimal mucosal absorption and enhanced patient reception. Both midazolam and ketamine are employed worldwide as pediatric premedicants; nevertheless, very little clinical data is available in literature about their nebulised formulations. Aim: To compare the sedative efficacy, ease of parental separation, mask acceptance, hemodynamic effects, and adverse events associated with nebulised ketamine and nebulised midazolam in pediatric patients undergoing elective surgery. Methods: This study model was prospective and randomised along with double-blinding which included 60 children aged 2–12 years (ASA I–II) scheduled for elective surgeries under general anaesthesia. All willing patients were logically categorized into two groups: Group K received nebulised ketamine 2 mg/kg, and Group M received nebulised midazolam 0.2 mg/kg. All parameters related to Sedation were evaluated utilizing the Ramsay Sedation Score at 5-minute intervals up to 30 minutes. Secondary outcomes included parental separation score, mask acceptance score, hemodynamic parameters, and adverse events. Statistical significance was set at p<0.05. Results: Results were highly imperative and stated that both groups confirmed significant time-dependent boosts in sedation scores (p<0.001), with no significant intergroup differences. However, Group M showed significantly better mask acceptance (p=0.04) and smoother parental separation. Heart rate and systolic blood pressure were significantly higher in Group K at 30 minutes (p = 0.04). Oxygen saturation and respiratory rate remained stable and comparable in both groups. No significant adverse events were observed. Conclusion: Within the limitations of the study, authors concluded that both nebulised midazolam and ketamine are safe and effective premedicants in pediatric patients. Nebulised midazolam improves behavioural compliance and steadier hemodynamics, making it a preferable choice for facilitating smoother anaesthetic induction.

Oral squamous cell carcinoma (OSCC) represents a significant global health burden with limited therapeutic options beyond conventional surgery, radiotherapy, and chemotherapy. The molecular characterization of OSCC has revealed numerous dysregulated signaling pathways, providing opportunities for targeted therapeutic intervention. This review comprehensively examines emerging targeted therapies for OSCC, focusing on novel agents and their molecular mechanisms. Epidermal growth factor receptor (EGFR) inhibitors, including cetuximab, gefitinib, and erlotinib, have demonstrated clinical efficacy, with cetuximab showing improved overall survival when combined with radiotherapy or chemotherapy. Immune checkpoint inhibitors targeting PD-1/PD-L1, such as pembrolizumab and nivolumab, have revolutionized treatment paradigms for recurrent or metastatic disease. The PI3K/AKT/mTOR pathway represents another promising target, with multiple inhibitors under investigation. MEK inhibitors like trametinib have shown encouraging results in neoadjuvant settings, achieving significant tumor responses. Novel targets including STAT3, VEGFR, dual tyrosine kinase inhibitors, and epigenetic modulators are emerging as potential therapeutic options. Despite these advances, challenges remain, including primary and acquired resistance, tumor heterogeneity, limited biomarker validation, and the need for personalized treatment strategies. Clinical trials have demonstrated variable response rates and modest survival benefits, highlighting the complexity of OSCC biology. Future directions include combination therapies, identification of predictive biomarkers, development of novel delivery systems, and integration of multi-omics approaches for patient stratification. This review synthesizes current evidence on emerging targeted therapies, providing insights into molecular mechanisms, clinical outcomes, and future research priorities for improving OSCC patient outcomes.

Background: Pharmacological intervention is the primary treatment for glaucoma, designed to lower intraocular pressure and avert optic nerve injury. In patients with concurrent cataract, apprehensions have emerged about the long-term safety of topical anti-glaucoma medicines, including their propensity to induce ocular surface damage and affect cataract progression. Objective: To assess the risks linked to medical glaucoma treatment in patients with concurrent cataract, particularly regarding adverse drug reactions and the advancement of lens opacity. Methods: A retrospective observational study was performed on 150 individuals diagnosed with both glaucoma and cataract over the course of one year. Data pertinent to demographics, categories of anti-glaucoma drugs (beta-blockers, prostaglandin analogs, and carbonic anhydrase inhibitors), occurrence of adverse effects, and cataract advancement status were extracted from medical records. A chi-square test was conducted to evaluate the relationship between medication type and outcomes, with a p-value of less than 0.05 being statistically significant. Results: Adverse effects occurred in roughly 40% of individuals, predominantly manifesting as eye irritation and dryness. Despite beta-blockers and carbonic anhydrase inhibitors exhibiting a somewhat increased incidence of adverse effects, the correlation between medication type and adverse effects was not statistically significant (p = 0.56). No significant correlation was identified between the kind of anti-glaucoma medicine and cataract advancement (p = 0.75), suggesting that lens alterations were not substantially affected by medical treatment during the study period. Conclusion: Medical treatment for glaucoma seems to be comparatively safe for patients with concurrent cataract. Mild side effects are rather prevalent; however, they do not exhibit a substantial correlation with certain drug classes. No evidence was discovered indicating that these drugs hasten cataract progression. Consistent oversight and personalized therapy are crucial for good patient management.

Background: CA 19-9 is widely used for diagnosis of pancreatic carcinoma and cholangiocarcinoma but there is no proper study to associate it with histological grade and TNM staging of pancreatic and cholangiocarcinoma. Methods: Hospital based, observational type of study was conducted in the Department of surgical gastroenterology S P Medical college Bikaner between April 2024 to July 2025. Results: Mean CA19-9 level in malignant group was 542 ±723 U/ml and in benign group was 34 ± 63 U/ml. There was significant difference in mean level of CA19-9 in benign and malignant groups (p value =0.01). Conclusion: CA19-9 levels are valuable tool to add in the preoperative diagnosis of the gall bladder carcinoma.

Background: This study was aimed at detecting the incidence of gall bladder carcinomas which were diagnosed incidentally during or after laparoscopic cholecystectomies which were done for symptomatic gall stone disease. Methods: Prospective observational study was conducted on 50 consecutive   patients who underwent simple cholecystectomy for symptomatic gall stones and benign gall bladder diseases. Results: A total of 50 laparoscopic cholecystectomies were performed at our institute during the study period of Jan 2024 to Dec 2025. In 1(2.00%) case, incidental carcinoma of gallbladder was discovered. Conclusion: Laparoscopic cholecystectomy which is performed for benign gall bladder disease rarely results in a diagnosis of unexpected gallbladder cancer if carefully done pre operative USG. The histopathological examination of the specimens, with special attention to the depth of invasion, range of the mucosal spread and the lymphovascular involvement is critical in diagnosing the incidental malignancies as well as for the subsequent management of the cases.

Background: Accurate estimation of time since death (TSD) remains a fundamental challenge in forensic pathology, with significant implications for criminal investigations and legal proceedings. Postmortem changes, including algor mortis, livor mortis, rigor mortis, and ocular changes, serve as primary indicators for TSD estimation, yet their reliability varies considerably based on environmental and individual factors. Methods: This prospective observational study was conducted at a tertiary care hospital mortuary over an 18-month period. A total of 156 cases with known time of death were included. Systematic evaluation of postmortem changes was performed at standardized intervals. Rectal temperature, lividity characteristics, rigor mortis staging, corneal opacity, and potassium levels in vitreous humor were assessed. Statistical analysis included Pearson correlation coefficients, multiple regression analysis, and Bland-Altman plots for agreement assessment. Results: The mean age of deceased subjects was 52.4 ± 18.7 years, with 98 males (62.8%) and 58 females (37.2%). Algor mortis demonstrated the strongest correlation with actual TSD (r = 0.89, p < 0.001) within the first 12 hours. Rigor mortis staging showed moderate correlation (r = 0.72, p < 0.001), while livor mortis characteristics demonstrated variable reliability (r = 0.61, p < 0.001). Vitreous potassium concentration exhibited strong linear correlation with TSD (r = 0.85, p < 0.001). Combined multiparameter analysis improved estimation accuracy to ±1.8 hours compared to single-parameter approaches (±3.2 hours). Conclusion: Integration of multiple postmortem parameters significantly enhances TSD estimation accuracy. A standardized multiparameter approach is recommended for forensic practice, particularly within the early postmortem interval.

Background: Materiovigilance plays an essential role in ensuring patient safety by identifying, reporting, and preventing adverse events associated with medical devices. As undergraduate students are future healthcare professionals, their knowledge, attitude, and practice regarding materiovigilance are important for strengthening reporting systems and promoting safe clinical care. However, awareness and practical exposure to materiovigilance among undergraduates remain limited. Aim: To assess the knowledge, attitude, and practice of materiovigilance among undergraduate students at GMC Udhampur and ASCOMS Jammu and to determine the association of selected sociodemographic and training-related factors with these domains. Material and Methods: A cross-sectional observational study was conducted among undergraduate students of a tertiary care hospital. Data were collected using a structured, prevalidated questionnaire consisting of sociodemographic details and items related to knowledge, attitude, and practice of materiovigilance. Responses were analyzed using descriptive and inferential statistics. Knowledge, attitude, and practice were graded into categories, and associations with variables such as academic year and prior training were assessed using appropriate statistical tests. A p value of less than 0.05 was considered statistically significant. Results: Most participants were aged 20-22 years (59.00%), females constituted 57.00%, and final-year students formed the largest subgroup (45.00%). About 63.00% had heard of materiovigilance, while 77.00% were aware that medical devices can cause adverse events. However, only 42.00% knew about the Materiovigilance Programme of India, 34.00% were aware of designated reporting centers, and 26.00% knew about the reporting form or portal. Overall, 54.00% had moderate knowledge, 59.00% had a positive attitude, and 51.00% had poor practice. A large majority agreed that materiovigilance is important for patient safety (86.00%), reporting should be mandatory (82.00%), and undergraduate students should be trained in materiovigilance (90.50%). Only 9.00% had ever reported a device-related adverse event, 18.00% had received prior training, and 20.50% were familiar with the reporting form or portal. Significant associations were observed between academic year and knowledge level (p = 0.003), and between prior training and both knowledge (p = 0.007) and practice (p = 0.001). Conclusion: Undergraduate students demonstrated moderate knowledge and a favorable attitude toward materiovigilance, but their reporting practice was inadequate. Limited procedural awareness and insufficient training appear to be major barriers. Incorporating formal materiovigilance teaching, practical demonstrations, and reporting sensitization sessions into undergraduate training may improve reporting competence and strengthen patient safety.

Background: Surgical site infection (SSI) is a frequent postoperative complication that contributes to morbidity, prolonged hospitalization, and increased healthcare costs. Although antibiotic prophylaxis reduces the risk of SSI, prolonged regimens are often misused, particularly in low- and middle-income settings, increasing antimicrobial resistance. Objective: To compare the efficacy of a single-dose versus multiple-dose ceftriaxone prophylaxis in preventing SSI in patients undergoing elective laparoscopic cholecystectomy. Methods: This prospective, randomized study was conducted at Tezpur Medical College and Hospital between July 2024 to June 2025. A total of 100 patients scheduled for elective laparoscopic cholecystectomy were randomized into two groups: single-dose (SD, n=50) and multiple-dose (MD, n=50). The SD group received ceftriaxone 2 g intravenously at induction of anesthesia, while the MD group received the same preoperative dose followed by 1 g twice daily for two postoperative days. Patients were followed for 30 days, and SSI was assessed clinically. Results: The overall incidence of SSI was 5% in the SD group and 4% in the MD group (p>0.05). Fever was more common in the MD group on POD 2, while wound discharge and port-site redness were observed in the SD group at 1 week. No infections occurred at 3 weeks. Conclusion: Single-dose ceftriaxone prophylaxis is as effective as multiple-dose regimens in elective laparoscopic cholecystectomy, with advantages in antibiotic stewardship, cost reduction, and minimizing antimicrobial resistance.

Introduction: Stature is a very important parameter for identification of an individual, either living or dead. This is based on a principle that bones and remains of body parts are positively correlated with stature. The aim of this study is to find correlation of nasal height with stature in Gujarati population and also do linear regression analysis for accurate measurement of stature from nasal height. Material and methods: This study was conducted on 510 individuals (243 males and 267 females) aged between 18 to 30 years in Gujarat region. Nasal height and total body height of the subject were measured by sliding caliper and standard height measuring instrument respectively. The data was analysed statistically for mean, standard deviation, significance, Pearson’s correlation (r) and for regression equations to measure stature from nasal height. Result: Calculation for Mean and Standard deviation of nasal height and body height was done. We found r = 0.36, p = 0.0000 for all subjects; r = 0.15, p = 0.0179 for males and r = 0.21, p = 0.0004 for females. We also derived regression equations to estimate stature from nasal height. Conclusion: Nasal height is showing positive correlation with body height. Regression equations are also derived from obtained data. Region wise there is some difference in measurements, so state and population wise different regression formula can be used to estimate accurate stature from nasal height.

Background: Vitamin D deficiency has emerged as a global public health concern, affecting populations across all age groups and geographical regions. Medical students represent a particularly vulnerable population due to demanding academic schedules, limited outdoor exposure, and irregular lifestyle patterns. Understanding the prevalence and associated risk factors of vitamin D deficiency among this population is essential for developing targeted preventive interventions. Methods: This cross-sectional analytical study was conducted among undergraduate medical students at a tertiary care teaching hospital over a six-month period. A total of 384 students from all academic years were enrolled through stratified random sampling. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using chemiluminescent immunoassay. A structured questionnaire assessed demographic characteristics, lifestyle factors, dietary habits, sun exposure patterns, and physical activity levels. Vitamin D deficiency was defined as serum 25(OH)D levels <20 ng/mL, insufficiency as 20-29 ng/mL, and sufficiency as ≥30 ng/mL. Results: The mean age of participants was 20.8 ± 1.9 years, with 214 females (55.7%) and 170 males (44.3%). The overall prevalence of vitamin D deficiency was 67.4% (n=259), while 21.6% (n=83) had insufficient levels. Mean serum 25(OH)D concentration was 17.2 ± 8.6 ng/mL. Female gender (OR=2.84, 95% CI: 1.78-4.53, p<0.001), limited sun exposure <30 minutes/day (OR=3.12, 95% CI: 1.96-4.97, p<0.001), dark skin complexion (OR=2.18, 95% CI: 1.42-3.35, p<0.001), and sedentary lifestyle (OR=1.89, 95% CI: 1.24-2.88, p=0.003) were significant independent risk factors. Conclusion: Vitamin D deficiency is highly prevalent among undergraduate medical students, necessitating implementation of awareness programs, lifestyle modifications, and consideration of routine screening and supplementation strategies.

Background: Thyroid hormones play a critical role in regulating cardiovascular physiology, including myocardial contractility, vascular resistance, lipid metabolism, and endothelial function. Both overt and subclinical thyroid dysfunctions have been increasingly recognized as independent risk factors for cardiovascular diseases (CVD). Emerging evidence suggests that even minor alterations in thyroid-stimulating hormone (TSH) levels may influence cardiovascular risk profiles. Aim: To evaluate the relationship between thyroid dysfunction and cardiovascular risk factors among adult patients. Methods: A hospital-based cross-sectional study was conducted among 220 adult participants. Subjects were categorized into euthyroid, hypothyroid, and hyperthyroid groups based on serum TSH, free T3, and free T4 levels. Cardiovascular risk parameters assessed included blood pressure, lipid profile, fasting blood glucose, body mass index (BMI), and waist circumference. Statistical analysis included ANOVA, Chi-square test, Pearson correlation, and multivariate linear regression. Results: Hypothyroid patients demonstrated significantly higher total cholesterol, LDL cholesterol, triglycerides, BMI, and systolic blood pressure compared to euthyroid individuals (p < 0.05). Hyperthyroid patients showed elevated heart rate and systolic blood pressure but lower lipid levels. TSH levels showed positive correlation with total cholesterol (r = 0.42), LDL (r = 0.39), and BMI (r = 0.36). Subclinical hypothyroidism was also associated with increased cardiovascular risk. Conclusion: Thyroid dysfunction is significantly associated with adverse cardiovascular risk profiles. Early detection and management may reduce long-term cardiovascular morbidity.

Background: Metabolic syndrome (MetS) is a cluster of interrelated metabolic abnormalities that significantly increase the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus. Dyslipidemia is a core component of MetS and is characterized by elevated triglycerides, reduced high-density lipoprotein cholesterol (HDL-C), and often increased levels of small dense low-density lipoprotein (sdLDL). Understanding lipid profile patterns in MetS patients and their association with cardiovascular risk is essential for early identification and targeted interventions. Aim: To evaluate lipid profile patterns in patients with metabolic syndrome and determine their association with cardiovascular risk. Methods: A cross-sectional observational study was conducted among 200 patients diagnosed with metabolic syndrome based on the NCEP ATP III criteria. Fasting lipid profiles, including total cholesterol (TC), triglycerides (TG), HDL-C, LDL-C, and non-HDL cholesterol, were analyzed. Atherogenic indices such as TC/HDL ratio, LDL/HDL ratio, and atherogenic index of plasma (AIP) were calculated. Cardiovascular risk was assessed using the Framingham Risk Score (FRS). Results: The most common lipid abnormality was elevated triglycerides (78%), followed by low HDL-C (72%) and elevated LDL-C (54%). Patients with higher AIP values demonstrated significantly increased cardiovascular risk (p < 0.001). Strong correlations were observed between TG levels and FRS (r = 0.62), and inverse correlation between HDL-C and FRS (r = -0.58). Conclusion: Distinct lipid profile patterns in metabolic syndrome are strongly associated with increased cardiovascular risk. Atherogenic dyslipidemia, particularly elevated TG and reduced HDL-C, plays a crucial role in cardiovascular risk stratification. Early identification and management of these lipid abnormalities are essential in reducing long-term cardiovascular morbidity and mortality.

Background: Elbow epicondylitis is a common degenerative tendinopathy affecting the extensor and flexor origins, leading to pain and functional impairment. Platelet-rich plasma (PRP) has emerged as a promising regenerative treatment modality; however, its clinical efficacy remains controversial. Aim: To evaluate the effectiveness of a single-dose autologous PRP injection in patients with elbow epicondylitis. Materials and Methods: A prospective observational study was conducted on 50 patients, of whom 46 completed follow-up. Patients aged 18–65 years with clinically diagnosed medial or lateral epicondylitis received a single PRP injection prepared using the single-spin method. Outcomes were assessed using Visual Analog Scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of Arm, Shoulder, and Hand (DASH) score at baseline, 1 month, 3 months, and 6 months. Statistical analysis was performed to evaluate significance. Results: The mean age of participants was 43.72 ± 9.4 years, with a slight female predominance (54.35%). Lateral epicondylitis was observed in 89.13% of cases. Significant improvement was observed in all outcome measures. Mean VAS decreased from 8.50 ± 1.00 to 3.00 ± 2.60 (p < 0.0001). MEPS improved from 54.00 ± 5.67 to 84.50 ± 11.08, while DASH scores reduced from 63.46 ± 5.59 to 44.50 ± 8.71 at 6 months. Conclusion: Single-dose PRP injection is an effective and safe treatment modality for elbow epicondylitis, providing significant long-term improvement in pain and function.

Background: Prescription errors are common medication errors encountered in hospitals. These contribute to irrational drug use which in turn can lead to unsafe treatment, health hazards, economic burden on the patients & wastage of resources Aim: (1). To assess the rationality of prescription pattern in a tertiary care hospital. (2). To describe the appropriateness of medical care by measuring the WHO core prescribing indicators. Materials and Methods: After obtaining ethical clearance from the IEC, the study was initiated. An observational & non-interventional study was conducted at a tertiary care hospital& prescription forms received at the pharmacy and in the IP areas were recorded. The prescriptions were analysed for compliance and noncompliance with the OPD and IPD prescription details and also for effect of training on non-compliance with various prescription parameters. The study was conducted from April 2022 – May 2024. Results: The average compliance in the OPD prescription audit over the 3 years with capital letters, generic names, dose, route, frequency, duration, drug interactions, Doctor’s KMC Registration No. was 88%, 87%, 97%, 96%, 98%, 94%, 5%, 93%, 96%, 4% and 4% respectively. The average compliance in the IPD prescription audit over the 2 years with capital letters, generic names, dose, route, frequency, duration, drug interactions, Doctor’s KMC Registration No., signature of the doctor, error prone abbreviations, h/o drug allergy, ADR, h/o previous medications was 94%, 92%, 97%, 97%, 97%, 96%, 5%, 96%, 97%, 5%, 5%, 4%, 10% respectively. When the prescriptions were analyzed for non-compliance with various prescription parameters in two groups of doctors with and without training using the Mann-Whitney U test, significant difference was found for compliance with capital letters (p=0.001) , generic names (p=0.001), duration (p=0.001), KMC registration no. (p=0.001) and doctor’s signature (p=0.035). Conclusion: There was a significant improvement in the compliance with prescription parameters in the OPD prescription audit, especially in the second year of the study. The average compliance with the prescription parameters was also good in the IPD Prescription audit. Training had a significant impact on the compliance with prescription parameters.

Aim: This study characterizes clinical features, EEG patterns, management strategies, and outcomes of absence seizures in school-age children aged 6-12 years, aiming to evaluate treatment efficacy and prognostic factors for seizure control and cognitive impact. Materials and Methods: A retrospective observational study was conducted at a Department of Paediatrics, Shyam Shah Medical College, Rewa (M.P.), from January 2020 to December 2024, including 80 children diagnosed with typical absence seizures via standardized EEG criteria (3 Hz spike-and-wave discharges ≥3 seconds). Diagnosis followed ILAE 2017 classification, with exclusion of atypical absences or structural lesions on MRI. Data collection involved clinical history, seizure frequency logs, EEG/video monitoring, treatment response (≥50% reduction at 6 months), and school performance assessments using standardized scales. Ethosuximide was first line (10-20 mg/kg/day), with valproate or lamotrigine as alternatives. Statistical analysis used chi-square tests and logistic regression (p<0.05 significant). Ethical approval was obtained from the institutional review board. Results: Mean age at onset was 7.2 years (SD 1.4), with female predominance (62.5%). Baseline seizure frequency averaged 50/day (range 10-200). At 6 months, 55% achieved seizure freedom on ethosuximide, 25% on valproate, and 15% on lamotrigine; 5% were refractory. EEG confirmed 3 Hz discharges in 95%. School absenteeism dropped from 30% to 12% post-treatment (p<0.01). Cognitive issues (attention deficit) improved in 68%. Long-term follow-up (mean 3 years) showed 70% remission by adolescence. Tables detail demographics, treatment outcomes, EEG metrics, and school performance. Conclusion: Ethosuximide remains optimal first-line therapy for absence seizures in school-age children, yielding high seizure freedom (55%) and cognitive benefits. Early diagnosis via EEG and prompt management mitigates school impacts, with 70% long-term remission. Future prospective trials should explore biomarkers for refractory cases.

Background: The study aimed to identify the impact of sexual assault on mental and psychosocial health. Methodology: The study was conducted as an observational study at tertiary care centre on women reporting with history of sexual assault. All females were subjected to detailed history and general, local and systemic examination. Samples were subjected to laboratory and forensic examination. Results: A total of 236 sexual assault cases were observed. Majority of victims of sexual assault belonged to 11 to 20 years of age group (59.7%). Home of victim was the most common place of sexual assault (61.9% cases). Sexual assault resulted in psychological and mental trauma in 75% cases. Of them, behaviour changes were most commonly observed in 17.7% cases, whereas helplessness or hopelessness was observed in 10.59% cases. Conclusion: Sexual Violence continues to be a major public health problem that lasting harmful effects on victims’ family, friends, and communities. The reality is probably underestimated because many cases are not reported due to fear of indignity, denial and social stigma. The victims are mostly children and adolescents. Education and awareness of the population is very essential for early consultation and in seeking medical help. Delay in medical examination and reporting of cases resulted in loss of vital physical evidences. Medical consequences of sexual assault include STI, unwanted pregnancy, mental and psychological disorder.

Background: Naftifine hydrochloride is an allylamine topical agent used in treating superficial fungal infections, especially dermatophytosis. The objective of this study was to assess the safety and effectiveness of naftifine 2% cream in patients with superficial fungal skin infection. Aim: A real-world observational study to evaluate the safety & effectiveness of Naftifine 2% cream in patients with superficial fungal skin infection. Materials and Methods: It was an observational, prospective study conducted on patients in Rajasthan, where subjects were advised to apply naftifine 2% cream on the affected area by treating physician. Effectiveness was determined by assessing the clinical cure, absence of signs and symptoms and mycological cure viz negative microscopic KOH test, at the end of the treatment. Safety & tolerability were evaluated based on the presence of adverse events and their severity. The patient compliance was recorded based on the investigator’s assessment. Results: A total of 463 patients were enrolled in the study, out of which 82.07% achieved a clinical cure at the end of the treatment. The skin scraping for microscopic KOH mounting was available for 94 patients out of which the mycological cure was observed in 89 patients (94.6%) (p<0.0001) at the end of the treatment. Our study recorded a lower incidence of adverse events (2.4%), commonly including dermatitis, pruritis, skin irritation at the application site, and erythema. The reported adverse events were mild or moderate and were cured within 2-7 days. The naftifine 2% cream was well tolerated by 70.8% of the patients. Upon completion of the treatment, 296 patients (64.1%) exhibited 100% compliance to the study drug.

Background: Lumbar spine surgeries often result in significant postoperative pain, and achieving effective analgesia is essential for early mobilization and enhanced recovery. Local anesthetic wound infiltration is a simple and effective component of multimodal analgesia. This study compares the analgesic efficacy of bupivacaine–magnesium sulphate versus ropivacaine–magnesium sulphate for surgical site infiltration in lumbar spine surgery. Methods: This prospective, randomized, double-blind study included 70 ASA I–II patients aged 25–60 years undergoing elective lumbar spine surgery. Patients were allocated to two groups (n=35 each). Group A received 70 mg bupivacaine with 500 mg magnesium sulphate diluted to 20 mL; Group B received 70 mg ropivacaine with 500 mg magnesium sulphate diluted to 20 mL. The study evaluated postoperative pain using the Visual Analog Scale (VAS) at extubation, 6, 12, and 24 hours; time to first rescue analgesia; total diclofenac consumption within 24 hours; hemodynamic parameters; and adverse effects. Results: Demographic variables were comparable between groups. VAS scores at 6, 12, and 24 hours were significantly lower in Group B (p < 0.05). The time to first rescue analgesia was significantly longer in Group B (8.49 ± 4.11 h) compared with Group A (5.51 ± 3.21 h; p = 0.0012). Total diclofenac consumption was also significantly lower in Group B (128.57 ± 71.77 mg) than in Group A (188.57 ± 61.34 mg; p = 0.0004). Hemodynamic stability and adverse event profiles were similar in both groups. Conclusion: Ropivacaine combined with magnesium sulphate provides superior postoperative analgesia compared with bupivacaine–magnesium sulphate in lumbar spine surgery. It prolongs analgesia duration, lowers pain scores, and reduces rescue analgesic requirements while maintaining a comparable safety profile. Ropivacaine–magnesium infiltration may be preferred as part of multimodal analgesia protocols in lumbar spine procedures.

Background: Patients with bronchial asthma and chronic obstructive pulmonary disease (COPD) are at increased risk of perioperative respiratory discomfort even during minor procedures such as cataract surgery performed under local anesthesia. Intraoperative coughing, dyspnea, and poor cooperation may adversely affect surgical outcomes. Preoperative bronchodilation with salbutamol may improve respiratory stability and patient comfort; however, evidence in ophthalmic surgeries is limited. Aim: To compare the efficacy of preoperative salbutamol nebulization in improving patient comfort and surgical outcomes during cataract surgery in patients with COPD and/or asthma, and to propose a standard preoperative protocol. Methods: A hospital-based cross-sectional comparative study was conducted over one year in a tertiary care center. Thirty adult patients with bronchial asthma and/or COPD undergoing cataract surgery were randomly allocated into two groups: salbutamol group (n=15), receiving preoperative nebulization with salbutamol (2.5 mg), and control group (n=15), receiving standard care without nebulization. Patient comfort (better/uneventful vs breathlessness) and intraoperative surgical conditions (uneventful vs disrupted) were assessed. Statistical analysis was performed using Chi-square test, with p<0.05 considered significant. Results: The mean age was comparable between the salbutamol (65.4 ± 7.3 years) and control groups (69.9 ± 7.8 years). Good patient comfort was observed in 86.7% of patients in the salbutamol group compared to 40.0% in the control group (χ²=7.03, p=0.008). Breathlessness was significantly lower in the intervention group (13.3% vs 60.0%). Uneventful surgical conditions were achieved in 86.7% of patients receiving salbutamol compared to 40.0% in controls (χ²=7.03, p=0.008). Conclusion: Preoperative salbutamol nebulization significantly improves intraoperative patient comfort and surgical conditions in patients with COPD and asthma undergoing cataract surgery. Incorporating this simple and cost-effective intervention into routine preoperative protocols may enhance surgical outcomes and patient experience.

Introduction: Post-operative sore throat (POST) is a complication after general anaesthesia with airway instrumentation and adversely affects patient comfort and satisfaction. Laparoscopic cholecystectomy commonly requires airway control, predisposing patients to POST. Dexamethasone and dexmedetomidine have been used to reduce POST through different mechanisms. This study compared their effectiveness in preventing POST. Materials and Method: This prospective randomized comparative study included 60 ASA I–II patients aged 18–60 years undergoing elective laparoscopic cholecystectomy. Patients were randomized into two groups of 30 each to receive intravenous dexamethasone (Group D) or dexmedetomidine (Group DM) after induction of anaesthesia. Anaesthetic technique and airway management were standardized. Incidence and severity of POST were assessed at 1, 6, and 24 hours postoperatively using a graded scale. Data were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Result: Demographic and perioperative variables were comparable between groups. The incidence of POST at 1 hour was significantly higher in Group D than Group DM (53.3% vs 26.7%, p = 0.03), and similar differences were noted at 6 hours (43.3% vs 16.7%, p = 0.02). By 24 hours, POST incidence decreased in both groups without significant difference. Severity of POST was significantly lower in Group DM, with 73.3% reporting no sore throat compared with 46.7% in Group D (p = 0.04). No significant adverse effects were observed. Conclusion: Perioperative dexmedetomidine was more effective than dexamethasone in reducing early incidence and severity of post-operative sore throat following laparoscopic cholecystectomy, with a comparable safety profile.

Background: Acute kidney injury (AKI) is a recognized complication of acute diarrheal diseases, particularly in tropical and monsoon-affected regions. However, evidence regarding the clinical profile and outcomes of post-diarrheal AKI (PD-AKI) remains limited, especially from coastal regions of India. This study aimed to evaluate the clinicodemographic profile, laboratory parameters, and outcomes of patients admitted with PD-AKI during the monsoon season at a tertiary care hospital in Karwar, Karnataka. Methods: A hospital-based cross-sectional observational study was conducted at the Department of Medicine, KRIMS, Karwar. Thirty adult patients (≥18 years) presenting with acute diarrhoea followed by AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, were enrolled. Patients with pre-existing chronic kidney disease, obstructive uropathy, or drug-induced AKI unrelated to diarrhoea were excluded. Demographic data, clinical features, laboratory parameters, etiological profiles, KDIGO staging, management details, and outcomes were recorded and analysed using descriptive statistics. Results: The mean age was 40.87 years, with male predominance (73.3%). Most admissions occurred during July and August (80%). Acute gastroenteritis was the most common aetiology (63.3%), followed by Vibrio cholerae infection (20%). Moderate dehydration was present in 50% of patients. Oliguria was observed in 86.7% and anuria in 13.3%. The median peak serum creatinine was 1.15 mg/dL. Four patients (13.3%) required haemodialysis. Kidney function recovery was observed in 93.3%, with zero mortality and a median hospital stay of 5 days. Conclusion: Post-diarrheal AKI during the monsoon season in a coastal Indian setting predominantly affects middle-aged males engaged in fishing-related occupations. Early recognition, prompt fluid resuscitation, and appropriate supportive care lead to excellent renal recovery and favourable outcomes.

Background: Lumbar intervertebral disc prolapse (IVDP) is a common cause of low back pain with radiculopathy and functional disability. Although most patients respond to conservative management, a subset requires surgical intervention. Fenestration discectomy is a conventional posterior decompression technique that provides adequate neural decompression while preserving spinal stability, particularly suited for tertiary care public hospitals. Objectives: To evaluate the functional outcome of lumbar intervertebral disc prolapse treated by posterior decompression and fenestration discectomy using the Japanese Orthopaedic Association (JOA) scoring system. Materials and Methods: A prospective observational study was conducted at a tertiary care public teaching hospital from June 2018 to June 2019. Twenty-five consecutive skeletally mature patients with single-level lumbar IVDP, with or without neurological deficit, who failed conservative treatment were included. Patients with multilevel disc disease or spinal instability were excluded. All patients underwent posterior decompression with fenestration discectomy. Functional outcomes were assessed preoperatively and postoperatively using the JOA score. Age-wise comparison of postoperative outcomes was performed using an independent Student’s t-test. Results: The mean preoperative JOA score improved from 12.1 to a mean postoperative score of 24.3 at three months follow-up. Patients aged 50 years or below had significantly higher postoperative JOA scores compared to those older than 50 years (25.1 ± 2.1 vs 23.3 ± 2.4; p = 0.041). Postoperative complications were minimal and manageable. Conclusion: Posterior decompression with fenestration discectomy is an effective, safe, and economical surgical option for lumbar intervertebral disc prolapse, providing significant functional improvement with minimal complications and favorable outcomes, particularly in younger patients.

Background: Acute pancreatitis is a prevalent surgical emergency characterized by a very varied clinical trajectory, ranging from a mild, self-limiting sickness to a severe, life-threatening condition marked by multi-organ failure and considerable mortality. Identifying patients at risk of developing severe acute pancreatitis early on is still a clinical challenge, but it is very important for proper triage, monitoring, and timely escalation of therapy. Several prognostic scoring systems have been created to guess how bad a condition would go. The Glasgow Scoring System (sometimes called the Glasgow-Imrie score) is one of the most used since it uses clinical and laboratory data that is usually available. Objectives: The goal of this study was to see how useful and accurate the Glasgow Scoring System was at predicting the severity of acute pancreatitis and how it affected clinical outcomes like ICU admission, radiographic severity, complications, and death. Methods: A prospective observational study was performed in the Department of Minimal Access and General Surgery at a tertiary care teaching hospital for a duration of one and a half years. Adult patients diagnosed with acute pancreatitis were recruited according to established inclusion and exclusion criteria. The Glasgow score parameters were evaluated within 48 hours of admission. The severity of the disease was linked to both clinical outcomes and radiological findings. A statistical analysis was conducted to ascertain the sensitivity, specificity, predictive values, and overall diagnostic accuracy of the Glasgow score. Results: The study comprised 65 participants who had acute pancreatitis. The Glasgow score showed a strong link to how bad the disease was, how many people were admitted to the ICU, and how bad the disease was according to CT scans. Patients with elevated Glasgow scores exhibited prolonged hospitalizations, heightened complication rates, and inferior outcomes. A Glasgow score of 3 or higher was shown to be a reliable way to tell if someone has a serious illness. Conclusion: The Glasgow Scoring System is an easy-to-use, useful, and accurate way to quickly figure out how bad acute pancreatitis is. Its use can help doctors find individuals who are at high risk and may need more careful surveillance and early intense treatment, especially in places where resources are limited.

Background: Distal humerus intercondylar fractures are complex intra-articular injuries that pose significant challenges in achieving stable fixation and functional recovery. Bicolumnar plating with a medial locking compression plate and a lateral J plate offers rigid stabilization, promotes fracture union, and allows early postoperative elbow mobilization with favorable clinical and radiological outcomes. Aims: This study aimed to evaluate the functional and radiological outcomes of distal humerus fractures treated with anatomically pre-contoured locking compression plate medially and J plate laterally. Materials and Methods: This prospective interventional study was conducted at Government Medical College, Jammu, and included 20 adult patients aged 20–65 years with distal humerus intercondylar fractures. All patients underwent open reduction and internal fixation using anatomical pre-contoured locking compression plate medially and J plate laterally, through a posterior approach with olecranon osteotomy. Early postoperative physiotherapy was initiated. Clinical and radiological follow-up was performed at regular intervals up to 9 months. Functional outcomes were assessed using the Mayo Elbow Performance Score, and fracture union was evaluated using serial radiographs. Results: Road traffic accidents were the most common mechanism of injury. Intra-articular fractures accounted for 80% of cases. Radiological union was achieved in all patients, with a mean union time of 13 weeks. The mean flexion–extension arc achieved was 107°. According to MEPS, outcomes were excellent in 76% of patients, good in 16%, satisfactory in 4%, and poor in 4%. Complications were minimal, with one case of olecranon osteotomy non-union, two cases of transient ulnar nerve neuropraxia, and two cases of postoperative stiffness. Conclusion: Anatomically pre-contoured locking compression plates medially and J plate laterally provide stable fixation and excellent functional outcomes in distal humerus fractures with minimal complications, making them a reliable option for surgical management.

Background: Biofilm formation is a major virulence factor of Candida species and plays a crucial role in persistent infections and reduced antifungal susceptibility. The increasing prevalence of Candida non-albicans species with variable biofilm-forming capacity and antifungal resistance poses significant therapeutic challenges, particularly in hospitalized patients. Aim: The aim of the study is to contribute clinically relevant data to the evolving understanding of biofilm-associated candidiasis and to support evidence-based therapeutic strategies in hospital settings. Materials & Methods: A prospective laboratory-based study was conducted in a tertiary care teaching hospital in eastern India from November 2013 to September 2015. A total of 400 clinical samples were processed, yielding 150 culture-positive Candida isolates. Species identification was performed using conventional phenotypic methods, chromogenic media, biochemical tests, and automated identification systems. Biofilm production was assessed using Congo red agar and tube methods. Antifungal susceptibility testing was carried out by the Kirby–Bauer disc diffusion method using polyenes and azole antifungal agents. Data were analyzed descriptively and expressed as frequencies and percentages. Results: Candida non-albicans species constituted 66% of isolates. Biofilm production was detected in 73 (48.7%) isolates by Congo red agar and in 132 (88%) isolates by the tube method. Strong biofilm formation (3+) was observed in 27.3% of isolates, with Candida non-albicans species demonstrating slightly higher overall biofilm positivity than Candida albicans. Antifungal susceptibility testing showed highest sensitivity to nystatin (89%) and amphotericin B (88%), whereas overall susceptibility to azole antifungals was comparatively low (34%). Voriconazole and clotrimazole were the most effective agents among azoles. Conclusion: The study highlights a high prevalence of biofilm-forming Candida species, particularly among non-albicans isolates, associated with reduced azole susceptibility. Routine assessment of biofilm production and antifungal susceptibility is essential to guide effective therapy and strengthen antifungal stewardship in hospital settings.

Obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) constitute a triad of interrelated metabolic disorders characterized by insulin resistance (IR), chronic inflammation, dyslipidemia, and impaired energy homeostasis. This systematic review compiles evidence regarding their epidemiological associations, common molecular pathways (PI3K/AKT, MAPK/ERK/JNK/p38, JAK/STAT, AMPK, Wnt/β-catenin, TGF-β/Smad, NF-κB), and the emerging roles of gut microbiota dysbiosis, epigenetics (miRNAs), mitophagy deficiencies, and multi-omics signatures. Obesity, marked by visceral adiposity, triggers ectopic lipid deposition, cytokine release (TNF-α, IL-6), and insulin resistance (IR), aggravating hyperglycemia in type 2 diabetes mellitus (T2DM) and components of metabolic syndrome (MetS) such as hypertension and non-alcoholic fatty liver disease (NAFLD). Genetic factors (FTO, TCF7L2 polymorphisms) and environmental influences (high-fat diets) enhance these interactions. Therapies such as GLP-1 agonists and bariatric surgery affect many pathways, but because everyone’s body responds differently, precision medicine is needed. Future directions encompass AI-driven multi-omics for biomarker discovery (BCAAs, SCFAs), microbiota-targeted interventions, and innovative inhibitors (JAK/STAT, TGF-β). This systematic review underscores the necessity for integrated, individualized approaches to mitigate this global health challenge.

Aim: The present paper aims to compare focal therapy with radical prostatectomy in patients with localized radiorecurrent prostate cancer, with special emphasis on functional preservation. Findings from systematic reviews, guideline statements, and comparative cohort evidence were synthesized to support a clinically relevant appraisal of both strategies. Materials and Methods: This paper is structured as a narrative review, source base included systematic reviews of salvage focal therapies, systematic reviews of salvage radical prostatectomy, guideline statements from the American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology, and European Association of Urology guidance on prostate cancer management. The comparative emphasis was placed on patient selection, perioperative morbidity, urinary continence, erectile function, oncologic control, and decision-making in men with organ-confined radiorecurrent disease. Result: The reviewed evidence indicates that both salvage focal therapy and salvage radical prostatectomy can provide meaningful local salvage in selected men with localized recurrence after radiotherapy. Salvage focal therapy appears to offer a more favorable functional profile, with lower rates of severe adverse events and fewer perioperative complications, particularly because treatment is directed to the recurrent lesion or involved region rather than the entire gland. Conclusion: For properly selected patients with localized radiorecurrent prostate cancer, salvage focal therapy is increasingly attractive when functional preservation is prioritized, whereas salvage radical prostatectomy remains important when whole-gland extirpation, precise pathologic staging, and potentially durable local control are desired. At present, functional preservation appears to favor focal therapy, while definitive extirpative assurance and pathological information continue to favor radical prostatectomy.

Aim: This paper evaluates the efficacy and safety of the Optilume drug-coated balloon (DCB), which combines mechanical dilation with localized paclitaxel delivery to inhibit scar reformation, compared to standard therapies in men with prior endoscopic failures. The primary aim is to assess long-term functional success, symptom relief, and complication profiles through synthesis of clinical trial data, focusing on outcomes like International Prostate Symptom Score (IPSS) improvement, maximum urinary flow rate (Qmax), and freedom from repeat intervention. Materials and Methods: Data were derived from key studies including the ROBUST I (prospective, single-arm, n=53; recurrent bulbar strictures ≤2 cm) and ROBUST III (randomized controlled trial, n=127; DCB vs. standard endoscopic management), supplemented by a meta-analysis of seven studies (n=457). Inclusion criteria mirrored trials: adult males with recurrent bulbar strictures ≤2 cm, prior 1-4 endoscopic treatments, IPSS ≥13, Qmax <10 mL/s. Optilume procedure involved predilation followed by 5-minute DCB inflation (24F/30F). Conventional arms used DVIU/dilation alone. Results: In ROBUST I, 5-year functional success was 58% (25/43), with IPSS dropping from 25.2 to 7.2 (P<.001), Qmax rising from 5.0 to 19.9 mL/s (P<.01), PVR falling from 141.4 to 59.5 mL (P<.01), and 71.7% freedom from repeat intervention. ROBUST III showed DCB superiority: 77.8% vs. 23.6% recurrence-free at 2 years (P<.0001). Meta-analysis (n=457) confirmed 80.83% recurrence-free rate, 13-point IPSS reduction, +10.11 mL/s Qmax gain, 9.5% mild AEs (dysuria, UTI). No serious device-related AEs; erectile function unchanged. Larger balloons (30F) yielded 77% success vs. 38% for 24F. Conclusion: Optilume DCB demonstrates superior efficacy over DVIU/dilation for recurrent bulbar strictures ≤2 cm, with durable symptom relief, high patency, and excellent safety through 5 years, aligning with AUA guidelines as an alternative to repeat endoscopy or urethroplasty. It delays surgery in challenging cases, preserving quality of life with minimal invasiveness. Future long-term RCTs will refine patient selection.

Aim: This paper evaluates novel surgical techniques for reducing cerebrospinal fluid (CSF) leaks following expanded endonasal approaches (EEA) compared to conservative management. Expanded EEA is used for skull base tumors like meningiomas and craniopharyngiomas, but postoperative CSF leaks occur in up to 22% of cases historically, leading to complications such as meningitis and prolonged hospitalization. The aim is to assess efficacy of interventions like vascularized nasoseptal flaps (NSF), gasket seal, multilayer closures, and lumbar drains (LD) versus watchful waiting. Materials and Methods: A systematic review of studies from 2010-2025 was conducted using PubMed/PMC data on EEA for anterior skull base pathologies. Inclusion criteria: expanded EEA cases with intraoperative high-flow CSF leaks, reporting leak rates with/without interventions. Data from 29 studies (n=540+ patients) analyzed leak rates pre/post-technique adoption. Statistical pooling used meta-analysis trends; no primary data collection. Interventions: NSF (n=1851), gasket seal+NSF, LD vs no LD. Results: Novel techniques reduced CSF leak rates from 22% (2004-2010) to 4% (2016+). NSF alone dropped rates to 5%; combined gasket seal+NSF+LD achieved near-zero leaks in high-flow cases. LD effective only in high-flow leaks (OR reduction significant), not routine. No intervention had higher persistence (14-30% in select series). Complications lower with multilayer repairs. Conclusion: Novel multilayer techniques (NSF, gasket seal) superior to no intervention, reducing leaks by >80% in expanded EEA. Routine LD not recommended; reserve for high-flow. These advances improve outcomes, shorten hospital stays. Future RCTs needed.

Aim: The primary aim was to compare clinical, radiological, and functional outcomes of percutaneous pedicle screw fixation (PPSF) versus conventional open spinal fixation (COSF) in thoracolumbar fractures. Secondary objectives included assessing perioperative parameters, complications, and statistical significance in a cohort of 60 patients (30 per group). Materials and Methods: This prospective study at a tertiary trauma center in Bhopal, India, enrolled 60 adult patients (aged 18-70) with AO type A/B thoracolumbar burst fractures without neurological deficits from January 2024 to December 2025. Patients were randomized 1:1 to PPSF (minimally invasive pedicle screws one level above/below fracture) or COSF (open posterior instrumentation with fusion). Inclusion: single-level fracture, kyphosis >20°; exclusion: polytrauma, osteoporosis, prior surgery. Outcomes measured preop, postop, 6/12-month follow-up using Cobb angle, anterior vertebral body height (AVBH), VAS, ODI. Results: Demographics were similar: percutaneous mean age 33.2±8.7 years (23M:7F), conventional 34.8±9.8 (26M:4F). PPSF showed shorter op time (109.4±21.6 vs 143.5±22.6 min, p<0.001), less blood loss (99±43.8 vs 431.9±155 ml, p<0.001), shorter stay (6.2±2 vs 9.6±3 days, p<0.001). Radiological correction: Cobb postop 5.8±1.6° (perc) vs 7.4±2.9° (conv), loss 1.3±0.8° vs 1.7±1.1° (p=0.02); AVBH restored similarly. Functional: VAS postop 1.7±0.9 vs 2.8±1.3 (p<0.01), ODI 85±10.2 vs 80.8±11.6; complications 10% vs 23%. Conclusion: PPSF provides equivalent radiological/functional outcomes to COSF with superior perioperative benefits and fewer complications in thoracolumbar fractures. It is recommended for neurologically intact patients, potentially reducing morbidity.

Aim: The primary aim of this study is to determine the microbiological profile, antibiogram, and antibiotic sensitivity patterns of bacteria isolated from infected orthopaedic implants in postoperative patients at a tertiary care hospital in India. Secondary objectives include assessing biofilm production among isolates and identifying demographic risk factors associated with implant infections to guide empirical antibiotic therapy. This investigation addresses the rising challenge of antimicrobial resistance in orthopaedic device-related infections (ODRIs), where biofilms contribute to treatment failures. By analysing culture-positive samples, the study seeks to establish local susceptibility patterns for effective management strategies. Materials and Methods: A cross-sectional prospective study was conducted over six months (January to July 2023) in the Microbiology Department of a tertiary care hospital after institutional ethical approval (GMCS/STU/ETHICS-2/Approval/18974/23). Inclusion criteria encompassed patients of all ages and genders with in situ implants presenting local infection signs, with samples (pus, swabs, tissue) sent for analysis. Exclusions were repeat samples from the same patient and polymicrobial growth. Samples (n=236) underwent Gram stain, ZN stain, KOH mount, and culture on standard media. Positive isolates (n=53, 23% positivity) were identified per CLSI M35-A2, tested for susceptibility via Kirby-Bauer disc diffusion and E-test (CLSI M100 2022/M07), and biofilm via microtiter plate method with optical density reading on ELISA reader. Results: Culture positivity was 23% (53/236), with Gram-negative bacteria predominant (68%, n=36) over Gram-positive (32%, n=17). Staphylococcus aureus was most common (32%, n=17; 76% MRSA), followed by Escherichia coli and Klebsiella pneumoniae (17% each). Biofilm producers were 38% (n=20), mostly strong/moderate in S. aureus. Tibia (42%) and femur (36%) were primary sites; males (83%) and 21-40 age group predominated. Vancomycin/linezolid showed 100% susceptibility; many beta-lactams/quinolones had high resistance. Biofilm producers exhibited higher resistance (e.g., to ciprofloxacin). Comorbidities like diabetes/smoking correlated with biofilm (p≤0.05). Symptom duration positively correlated with age/implant duration (r=0.626, p<0.001). Conclusion: Gram-negative dominance and high MRSA/biofilm rates underscore the need for tailored empiric therapy with vancomycin/meropenem, pending cultures. Local antibiograms are vital amid rising resistance; preventive measures targeting comorbidities and biofilms can reduce ODRIs. Future molecular studies on resistance genes are recommended for enhanced management.

Background: Malaria remains a significant public health concern in tropical and subtropical regions, including coastal Karnataka, India. The disease presents with a wide clinical spectrum and is frequently associated with hematological derangements. Region-specific data on the clinical and hematological profile of malaria are essential for improving early diagnosis and guiding management in endemic areas. Methods: A retrospective, case-record-based observational study was conducted in the Department of General Medicine at Karwar Institute of Medical Sciences, Karwar, over a two-year period from January 2023 to December 2024. Medical records of twenty adult patients admitted with laboratory-confirmed malaria (peripheral blood smear and/or rapid diagnostic test) were reviewed. Demographic, clinical, hematological, and biochemical data were extracted using a structured proforma. Descriptive statistical analysis was performed using Microsoft Excel; continuous variables were expressed as mean ± standard deviation and categorical variables as frequencies and percentages. Results: The mean age of the study population was 38.65 ± 14.22 years, with a male predominance (65%). Plasmodium vivax was the most common species (60%), followed by P. falciparum (35%) and mixed infection (5%). Fever was universally present (100%), followed by chills and rigors (90%), headache (75%), and myalgia (65%). Thrombocytopenia was observed in 80% of patients, anemia in 55%, and leukopenia in 25%. Hepatic involvement manifested as elevated bilirubin in 45% and raised transaminases in 40% of cases. All patients had favorable outcomes with no mortality. Conclusion: Malaria in coastal Karnataka was predominantly caused by P. vivax and presented with significant hematological abnormalities, particularly thrombocytopenia and anemia. Hepatic dysfunction was a notable finding. Early recognition of these clinical and laboratory features is essential for prompt diagnosis and management in endemic settings.

Background: Residual neuromuscular blockade remains an important concern in anaesthetic practice because it may delay recovery and increase postoperative respiratory complications. Sugammadex provides selective reversal of aminosteroidal neuromuscular blockers such as rocuronium and vecuronium. Objectives: To compare the efficacy and safety of sugammadex in reversing neuromuscular blockade induced by rocuronium versus vecuronium. Methods: This prospective randomized comparative study included 30 adult patients undergoing elective surgery under general anaesthesia. Patients were allocated into two groups of 15 each: Group R received rocuronium and Group V received vecuronium. Neuromuscular recovery was monitored using train-of-four stimulation. Sugammadex was administered at the end of surgery according to the depth of blockade. The primary outcome was time to recovery to a train-of-four ratio ≥0.9. Secondary outcomes included duration of blockade, time to extubation, and adverse events. Results: Recovery time was significantly shorter in Group R than in Group V (2.1 ± 0.7 vs 3.4 ± 1.1 min; p<0.001). Duration of blockade and extubation time were also significantly shorter in Group R (p=0.01 and p=0.002, respectively). Adverse events were minimal and similar in both groups. Conclusion: Sugammadex effectively reversed both agents, more favorable with rocuronium than with vecuronium.

Background: Childhood immunization is a cost-effective strategy to prevent vaccine-preventable diseases. Maternal knowledge and practices significantly influence immunization uptake and completion. Aim: To assess the knowledge and practices of mothers regarding childhood immunization and to determine the association between socio-demographic factors and immunization knowledge. Methods: This prospective hospital-based study was conducted at GSL Medical College, Rajahmundry, from June to December 2025 among 120 mothers of children aged 0–5 years. Data were collected using a pre-tested structured questionnaire assessing socio-demographic variables, knowledge, and immunization practices. Knowledge was categorized as adequate, moderate, or inadequate based on scoring criteria. Statistical analysis was performed using SPSS, and p < 0.05 was considered significant. Results: Adequate knowledge was observed in 53.3% of mothers, while 71.7% of children were fully immunized for age. Immunization card retention was high (86.7%). However, 28.3% reported missed doses, primarily due to lack of awareness and fear of side effects. Maternal education was significantly associated with adequate knowledge (p = 0.002). Conclusion: Despite satisfactory coverage, knowledge gaps persist. Targeted educational interventions are required to improve complete immunization coverage.

Aim: This prospective clinical study aimed to evaluate the efficacy and safety of hypertonic dextrose prolotherapy in the management of TMJ subluxation and dislocation secondary to capsular laxity. Specifically, the study assessed reduction in frequency of episodes, improvement in maximal mouth opening, decrease in pain intensity, and enhancement of quality of life in patients with mechanically unstable TMJ joints. Materials and Methods: Forty consecutive patients (28 females, 12 males; age range 18–54 years) with documented recurrent TMJ subluxation or dislocation due to capsular/ligamentous laxity were enrolled. All patients gave a history of at least 3 episodes per month of anterior subluxation or frank dislocation. Diagnosis was based on clinical examination, functional analysis, and imaging (radiographic tomogram and/or MRI) to rule out intra‑articular pathology or arthritis. Prolotherapy was administered by weekly injections for 4 weeks. Results: After 3 months, the mean number of subluxation/dislocation episodes decreased from 8.2 ± 2.4 to 1.3 ± 1.1 per month . At 6 months, the mean frequency was 0.9 ± 0.8 per month, with 33 patients (82.5%) reporting complete cessation of dislocation episodes. Mean VAS pain score dropped to 1.9 ± 1.2 at 6 months . Mean MMI increased significantly from 32.4 ± 5.2 mm at baseline to 41.3 ± 4.7 mm at 6 months .Subjective improvement in jaw‑related QoL was observed in 37 patients (92.5%), with marked reduction in anxiety‑related jaw‑locking episodes and improved dietary and social functioning. No major adverse events were reported; minor transient pain and swelling at injection sites resolved within 24–48 hours in all patients. Conclusion: Hypertonic dextrose prolotherapy is an effective, minimally invasive modality for reducing recurrent TMJ subluxation and dislocation secondary to capsular laxity. It significantly improves joint stability, reduces pain and functional limitations, and enhances quality of life, with a favorable safety profile.

Background: Intra articular (IA) therapy is widely used for symptomatic knee osteoarthritis (OA) when oral medications are inadequate or poorly tolerated. This randomized controlled study compared the efficacy of IA ketorolac versus methylprednisolone acetate in relieving pain and improving function in patients with symptomatic knee OA. Methods: One hundred and twelve adults with clinically and radiographically confirmed knee OA were randomized to receive a single IA injection of either ketorolac (30 mg with lignocaine) or methylprednisolone acetate (80 mg with lignocaine). Pain was assessed using the Visual Analogue Scale (VAS) and function using the Oxford Knee Score (OKS) at baseline, 4 weeks and 12 weeks. Results: Baseline characteristics and scores were comparable between groups. Mean VAS decreased from 7.0 to 5.3 and 4.7 at 4 and 12 weeks in the ketorolac group, and from 7.2 to 3.5 and 1.6 in the corticosteroid group. Between group analysis showed significantly lower VAS with corticosteroid at 4 weeks (mean difference 1.8, p < 0.01) and 12 weeks (mean difference 3.1, p < 0.01). OKS improved significantly in both groups, with consistently superior gains in the corticosteroid arm. Conclusions: Both IA ketorolac and methylprednisolone improved symptoms, but corticosteroid produced greater and more sustained pain relief and functional benefit.

Aim: Post-acute COVID-19, also termed post-COVID-19 condition or long COVID, is now recognized as a multisystem disorder that can persist for months after acute SARS-CoV-2 infection and frequently involves the cardiovascular and nervous systems. This paper aims to review the long-term cardiovascular and neurological manifestations of post-acute COVID-19, summarize the proposed mechanisms, organize major clinical observations, and discuss the implications for diagnosis, follow-up, and future research. Materials and Methods: A narrative review design was adopted using peer-reviewed reviews, large cohort studies, and authoritative public health sources published between 2021 and 2025. Sources were selected to represent three complementary domains: definitions and epidemiology of post-COVID condition, long-term cardiovascular outcomes, and long-term neurological outcomes. Emphasis was placed on studies with large sample sizes, 12-month follow-up, or clinically relevant synthesis of mechanisms such as endothelial dysfunction, immune dysregulation, microvascular injury, persistent inflammation, and autonomic imbalance. Evidence was then grouped into cardiovascular manifestations, neurological manifestations, pathophysiology, risk stratification, and management implications to produce a clinically structured review suitable for academic use. Result: The reviewed literature shows that post-acute COVID-19 is associated with sustained cardiovascular risk extending beyond the first 30 days after infection, including increased risks of dysrhythmias, myocarditis, pericarditis, ischemic heart disease, thromboembolic disease, heart failure, and cerebrovascular disorders. Neurologically, post-COVID patients demonstrate a broad range of long-term sequelae including cognitive dysfunction, memory impairment, headache, sleep disturbance, anosmia, dysautonomia, neuropathy, stroke, seizures, encephalopathy, movement disorders, mood disorders, and Guillain-Barre syndrome. Conclusion: Long-term cardiovascular and neurological manifestations of post-acute COVID-19 represent a clinically significant and durable consequence of SARS-CoV-2 infection that extends far beyond the respiratory phase of the disease. Recognition of these sequelae is essential because risk is not confined to previously critically ill patients; it is also present after mild or non-hospitalized infection. A multidisciplinary approach that integrates cardiovascular assessment, neurological evaluation, rehabilitation, symptom-guided investigation, and long-term surveillance is therefore warranted, while future research should focus on phenotype-specific biomarkers, prevention strategies, and therapeutic trials.

Aim: To compare the clinical features, laboratory findings, disease activity, radiological progression, and treatment response between seropositive and seronegative rheumatoid arthritis (RA) patients in adult populations. Materials and Methods: A retrospective comparative study was conducted on 259 adults diagnosed with rheumatoid arthritis (164 seropositive and 95 seronegative). Demographic data, clinical presentations, laboratory parameters including rheumatoid factor (RF) and anti-CCP antibodies, disease activity scores (DAS28-CRP), radiological findings, and therapeutic responses were systematically analyzed. Results: Seropositive RA patients exhibited significantly higher disease activity at baseline (mean DAS28-CRP 5.8 ± 0.9 vs 5.2 ± 1.1, p < 0.001) and more frequent erosive joint involvement (72.6% vs 48.4%, p < 0.001). Treatment response at 3 months was better in seropositive patients (75.6% vs 52.6%, p < 0.001), but remission rates at 12 months were similar (68.3% vs 64.2%, p > 0.05). Radiographic progression showed comparable Sharp scores at 24 months between groups (p > 0.05). Extra-articular manifestations were significantly more common in seropositive patients (45.7% vs 22.1%, p < 0.001). Seronegative patients demonstrated slower initial treatment response but achieved comparable long-term outcomes with intensive therapy. Conclusion: While seropositive RA presents with more aggressive initial disease activity and erosive changes, both groups achieve similar long-term remission rates when treated with intensive disease-modifying antirheumatic drugs (DMARDs). Serological status significantly influences early treatment response but does not predict long-term prognosis. Both seropositive and seronegative RA warrant aggressive treat-to-target strategies to optimize clinical outcomes and prevent radiological progression.

Background: Understanding about utilization of health services is important in order to plan for an effective delivery of primary health care, particularly in rural areas. The analysis patterns of service use, socio-demographic predictors and barriers will help to identify ways to increase accessibility while optimizing resource distribution. Methods: A cross-sectional descriptive study was done among 100 inhabitants of Rural Health Training Centres (RHTCs) Kanti, between February 2025-December 2025. The participants were selected through sampling method. Data was collected using a pre-tested structured questionnaire which included elements on socio-demographics, service utilization and barriers to access. Statistical analyses used descriptive, corss-tabulations and chi-square tests. Results: The outpatient services were the most availed facility (70%), followed by maternal and child health services (40%) and immunization coverage (35%). The majority of participants preferred the RHTC (60%) while 25% of them used from private health facilities and 15%, traditional healers. Barriers to participation included distance (40%), cost (35%), long wait times (30%), and lack of awareness (25%). Utilization patterns were significantly associated with socio-demographic factors including age, sex, education and occupation (p<0.05). Conclusion: The study illustrates moderate RHTC services utilization with attributed access and awareness identified as barriers. To promote the utilization of healthcare services and equity toward rural residents, it is important to improve service availability, strengthen outreach, and increase targeted promotion.

Background: Type 2 Diabetes Mellitus (T2DM) is an important public health problem both global and Indian level, accounting for high morbidity as well as mortality. Appropriate management of T2DM needs regular self-care behaviors such as dietary modification, increased physical activity, medication adherence, SMBG (self-monitoring of blood glucose) and foot care. Compliance with these guidelines is reported to be low, especially in urban areas of sedentary lifestyle and dietary transition. Methods: A cross-sectional community-based study was carried-out from February 2025 to January 2026 among 100 diagnosed T2DM diagnosed patients of Urban Field Practice Area attached with the Sri Krishna Medical College & Hospital (S.K.M.C.H), Muzaffarpur. Data was obtained through pretested semi-structured questionnaire and Summary of Diabetes Self-Care Activities (SDSCA) scale. Descriptives statistics and the chi-square test were used, p < 0.05 was considered significant. Results: Medication adherence was high (78%), but adherence to diet (48%), physical activity (42%), SMBG (35%) and foot care (40%) were less than optimal. Generally good SCB were reported in 51% of the sample. The presence of a higher educational level (p = 0.02), a longer duration of diabetes (p = 0.04) and higher levels of socioeconomic status (p = 0.03) were significantly related to good self-care practices. Conclusions: Although the adherence to medication was good, lifestyle-related self-care behaviors were inadequate. Highly organized diabetes educating and community interventions should be promoted to enhance comprehensive self-management in the urban T2DM patients.

Background: Anterior neck edema in patients is a prevalent issue in clinical practice. Thyroid cancer is the most common endocrine system cancer in all age categories, including children. Fine needle aspiration cytology (FNAC) has proven to be a rapid and economical method of first diagnostic testing. As a result, it is generally acknowledged and more thyroid instances are identified early. However, because FNAC and Histopathological Examination (HPE) have different correlations, it has drawbacks. The goal of the study is to assess the diagnostic efficacy of FNAC by comparing its results with histopathological findings. Methods: The current study was carried out from August 2025 to January 2026 at the Department of Pathology, Lord Buddha Koshi Medical College and Hospital, Saharsa, Bihar. One hundred thyroid nodule cases that had FNAC and had their postoperative specimens examined histopathologically were included in the study. Histopathological data were compared with the FNAC results. Results: Eight of the 100 cases collected for the study were cancerous, while 92 were benign. In 89 cases, there was a correlation between the cytological and histological diagnoses. Five cases showed a partial correlation between the cytological and histological diagnosis. The FNAC diagnosis did not match the histological findings in six instances. 62.50% sensitivity, 97.83% specificity, 95% accuracy, 71.43% positive predictive value, and 96.77% negative predictive value were found by FNAC. Conclusion: Thus, FNAC of thyroid lesions has been shown to be an easy, economical, and precise way to identify and direct the treatment of palpable thyroid lesions. As a result, we can observe that the FNAC procedure has a very good diagnostic accuracy, making it a very helpful investigation in the work-up of thyroid patients. However, histology should be the basis for the ultimate diagnosis and course of treatment.

Background: In a sufficient sample, the diagnostic accuracy of fine needle aspiration (FNA) for papillary thyroid cancer (PTC) is approximately 90%. Reliance on a single or small number of cytologic features can result in a misdiagnosis if the relative importance of each feature is not understood. Our goal was to ascertain the value of both individual and the best combination of cytologic characteristics for PTC diagnosis. Methods: The files contained H&E stained FNA smears of fifty cases each of successive histologically confirmed PTC and benign thyroid cases (controls), reported over a three-year period. Blind to the final diagnosis, 31 architectural, cytological, and background characteristics were evaluated and compared between the two groups. Chi-square and odds ratios were used to determine each parameter’s statistical significance (p<0.05), and ROC curves were used to evaluate the quality of the combinations. Results: Twenty features were found to be statistically significant. Fourteen highly significant (p<0.000) features included flat syncytial sheets, anatomical borders, true papillae, cellular swirls, individually dispersed cells with eosinophilic cytoplasm, anisonucleosis, elongated oval nuclei, powdery chromatin, nuclear outline irregularity, thickened nuclear membranes, crescent shaped nuclei, intranuclear inclusions, histocytoid cells and soap bubble cytoplasmic vacuolation. The six statistically significant features (p<0.05) included micro-acinar structures, cellular crowding, nuclear overlapping, nuclear grooves, squamoid cells and bubble gum colloid. The control group also showed some of these single cytologic features. All the combinations of ≥4 features had a statistical significance of p=0.000 and specificity and PPV of 100% with ROC showing excellent results. Conclusion: Using correct combination of cytologic features will increase accuracy of FNA diagnosis of PTC.

Background: Stevens–Johnson Syndrome (SJS) is a rare but potentially life-threatening mucocutaneous hypersensitivity reaction commonly triggered by medications, particularly antiepileptic drugs (AEDs). Anticonvulsants such as carbamazepine and phenytoin are well-recognized causes, while sodium valproate is less frequently implicated. Early identification and prompt withdrawal of the offending drug are crucial for favorable outcomes. Methodology: This descriptive case series included three male patients who developed Stevens–Johnson Syndrome after exposure to antiepileptic drugs. Clinical history, drug details, temporal association, laboratory findings, management, and outcomes were documented. Diagnosis was based on characteristic mucocutaneous features. The suspected drugs were promptly withdrawn, supportive treatment was given, and causality was assessed using WHO-UMC criteria. Case Presentation: We report a case series of three male patients aged 20–62 years who developed severe cutaneous adverse reactions following exposure to sodium valproate, carbamazepine, and phenytoin. The latency period ranged from 2 days to 2 weeks after initiation of therapy. Clinical manifestations included fever, generalized erythematous and bullous eruptions, mucosal erosions, ocular involvement, and skin peeling suggestive of SJS. Laboratory investigations were largely within normal limits, except for mild elevation of hepatic enzymes in the carbamazepine case. All suspected drugs were immediately withdrawn, and patients were managed with hospitalization, intravenous fluids, antibiotics, skin emollients, eye care, and supportive therapy. Causality assessment using WHO-UMC criteria categorized all cases as “Probable.” All patients showed clinical improvement and were discharged in recovering condition. Conclusion: This case series reinforces the continued risk of SJS with antiepileptic drugs, particularly during the early phase of therapy. Vigilant monitoring, early recognition of warning signs, and prompt discontinuation of the suspected drug are essential to prevent severe complications and improve patient outcomes.

Background: Pregnancy increases the risk that the condition will progress from asymptomatic bacteriuria (ABU) to a symptomatic urinary tract infection (UTI), which may then lead to pyelonephritis and obstetric complications. Early delivery, low birth weight, and higher fetal death could result from the adverse outcome. The current study aims to assess the incidence of symptomatic and asymptomatic bacteriuria, the risk factors for UTI, the consequences for mothers, and the bacteria that cause UTI during pregnancy. Methods: 152 pregnant women with and without urinary tract infection symptoms participated in the study between January 2013 and December of 2013 at the Obstetrics and Gynecology Department of PMCH, Patna, Bihar. Following bacteriological testing, midstream urine samples were collected and processed in accordance with standard protocol. Results: In the present study, 85 (55.9%) individuals had symptomatic UTIs and 67 (44.1%) instances of bacteriuria were asymptomatic. E. coli was found in 61 (49.6%) of the patients, followed by Staphylococcus aureus in 24 (19.5%), Klebsiella pneumonia in 16 (13.0%), CONS in 12 (9.7%), and Enterococcus faecalis in 10 (8.1%). In 65 (42.8%) of the cases, the only educational level was either primary school (38.8%) or high school (47.4%), and the lower socioeconomic status was a contributing factor. Of the 118 vaginal births, 101 (85.6%) were full-term, normal births; however, of the 17 (14.4%) preterm births, 5 (4.2%) had asymptomatic bacteriuria and 12 (10.2%) had symptomatic UTIs. Conclusion: The findings of our study showed that low socioeconomic status and educational attainment were the main causes of higher symptomatic UTI and ABU. The frequency of UTI and ABU did not vary significantly with gestational age. The study concluded that treating ABU early and quickly during pregnancy significantly reduces the chance of a poor pregnancy outcome. Therefore, it is recommended to check for ABU before to getting pregnant. Additionally, our research showed that UTIs were more common in the third trimester. Therefore, all pregnant women should be checked for ABU during the first trimester, treated aggressively with the proper antibiotics, and quickly monitored.

Background: Fetal weight evaluation is crucial not just for managing labor and delivery but also for treating high-risk pregnancies and monitoring growth. The purpose of this study is to ascertain which fetal weight estimation technique is more accurate and aids in improper decision-making because ultrasound is not easily accessible in emergency situations and adds to the workload for sonologists. Methods: From February 2014 to January 2015, this prospective comparative study was conducted at the Obstetrics and Gynecology Department collaboration of the Radio-diagnosis department of PMCH, Patna, and Bihar. Actual weights are compared to these clinical and ultrasonographic fetal weights. Results: 2 patients delivered babies with actual birth weights in the range of 1.5-2 kg, 13 patients g between 2.1 and 2.5 kg, 29 patients between 2.6-3.0 kg, 21 patients between 3.1 and 3.5 kg and 5 patients between 3.6 and 4.0.kg. Hadlock’s and Dare’s equations anticipated mean birth weights of 2.90 and 3.07 kg, respectively. Conclusion: Studies indicated that ultrasonographically estimated fetal weight is no better than the clinical for predicting fetal weight. Clinical estimates appear to be as accurate as ultrasonographic estimates where ultrasound is not available.

Background: Hallux valgus is a common pathological condition affecting the great toe. Although various conservative treatment modalities have been mentioned for the management of hallux valgus, the outcomes are poor. Among the plethora of surgical techniques for the management of hallux valgus, the minimally invasive techniques are gaining importance. These techniques are associated with less surgical burden, lesser operative time, enhanced preservation of biology and a faster recovery time. Aims and Objective: The aim of the study was to evaluate the radiological and functional outcomes of a simple percutaneous osteotomy of the distal metatarsus in patients with mild to moderate hallux valgus. Material and Methods: Thirty patients of both sexes, aged 15 to 60 years, with a mild to moderate hallux valgus and a minimum follow up of 1 year after the surgical procedure were included in the study. After satisfying the inclusion criterion, the patients were planned for surgical intervention. The AOFAS (Hallux-metatarso-phalangeal-interphalangeal) scale was used to assess the final outcome. Results: The preoperative HVA ranged from 16⁰ to 38⁰, with a mean HVA of 29.6⁰. The HVA at final follow up ranged from 10⁰ to 30⁰ with a mean of 14.7⁰. The IMA preoperatively ranged from 9⁰ to 16⁰ with a mean IMA of 13.4⁰. The IMA at final follow up ranged from 7⁰ to 15⁰ with a mean of 10.6⁰, indicating a mean change in IMA of 2.8⁰. Width of the feet ranged from 8.2 to 11.5 cms preoperatively (mean 9.6 cms), and 7.7 to 11.1 cms postoperatively (mean 9.1 cms).The mean dorsiflexion and plantar flexion at the metatarsophalangeal joint were 60⁰ and 10⁰ respectively before surgery and decreased to 55⁰ and 8⁰ at final follow-up, indicating a decrease in dorsiflexion- plantar flexion arc by a mean of 7⁰. The AOFAS score improved from a mean of 49 preoperatively to a final follow-up score of 84 (final grading= good) and was found statistically significant (P value <0.001). Over all 33.33% (n = 10) patients had excellent results, 30% (n = 9) had good results and 33. 66 % (n=11) had fair results at the final follow-up. No poor result was reported. Conclusion: Minimally invasive linear osteotomy of the distal end of the first metatarsal is a simple, effective and time saving procedure for the correction of mild to moderate hallux valgus.

Background: The lymphatic system plays a crucial role in immune surveillance, antigen transport, and regulation of immune responses. Lymphoid organs such as lymph nodes, spleen, thymus, and lymphatic vessels collectively maintain immune homeostasis by facilitating the interaction between antigens and immune cells. Understanding the anatomical and functional relationships of lymphatic structures in immune response regulation is essential for improving knowledge of disease mechanisms, infection control, and immunological disorders. Objective: To evaluate the anatomical components of the lymphatic system involved in immune response regulation and assess their clinical relevance among patients attending a tertiary care center. Methods: A prospective observational study was conducted at PMCH Patna over a period of seven months. A total of 35 participants were included. Clinical examination, ultrasonographic assessment of lymph nodes, and laboratory parameters related to immune function were analyzed. Statistical analysis included descriptive statistics, chi-square testing, and correlation analysis. Results: Among 35 participants, lymph node enlargement was observed in 57.1% of cases. Cervical lymph nodes were the most commonly involved (40%). Mean lymph node diameter was 1.8 ± 0.6 cm. Elevated immune markers were significantly associated with lymph node enlargement (p < 0.05). Structural lymphatic changes correlated with immune activation. Conclusion: The anatomical integrity of the lymphatic system plays a significant role in regulating immune responses. Lymph node architecture and lymphatic vessel function are essential for antigen presentation and immune activation.

Background: Vitiligo is a chronic depigmenting disorder characterized by selective destruction of melanocytes, resulting in well-defined white patches on the skin. Increasing evidence suggests that oxidative stress and abnormal homocysteine metabolism may play a role in melanocyte damage. Objective: To assess serum homocysteine levels and oxidative stress markers in patients with vitiligo and compare them with healthy controls. Methods: A cross-sectional case–control study was carried out at Patna Medical College between April 2025 and December 2025. The study included 80 participants, comprising 40 patients diagnosed with vitiligo and 40 age- and sex-matched healthy individuals. Serum homocysteine levels and oxidative stress markers, namely malondialdehyde (MDA) and superoxide dismutase (SOD), were analyzed. Data were processed using SPSS version 25, with Student’s t-test and chi-square test applied as appropriate. A p-value < 0.05 was considered statistically significant. Results: Patients with vitiligo exhibited significantly elevated serum homocysteine and MDA levels compared to controls, whereas SOD levels were markedly reduced. These differences were statistically highly significant (p < 0.001). Conclusion: Vitiligo patients demonstrate elevated serum homocysteine and oxidative stress markers, suggesting a possible role of oxidative imbalance in disease pathogenesis.

Background: Oxidative stress is a fundamental mechanism contributing to neuronal degeneration in disorders such as Alzheimer’s disease, Parkinson’s disease, and vascular dementia. Radiological imaging enables indirect visualization of oxidative stress–related structural and metabolic brain changes. Aim: To evaluate radiological imaging findings associated with oxidative stress biomarkers in neurodegenerative disorders and determine their clinical significance. Methods: This retrospective observational study included 140 patients with diagnosed neurodegenerative disorders who underwent MRI and/or PET imaging between January 2023 and December 2025. Imaging biomarkers including cortical atrophy, hippocampal volume loss, white matter hyperintensities, and metabolic hypometabolism were analyzed. Statistical tests included chi-square, ANOVA, and Pearson correlation. Results: Alzheimer’s disease (46.4%) was most common, followed by Parkinson’s disease (32.1%) and vascular dementia (21.4%). Significant associations were observed between oxidative stress indicators and hippocampal atrophy (p<0.001), white matter changes (p=0.002), and cortical hypometabolism (p<0.001). A strong correlation (r=0.71) was found between oxidative stress burden and disease severity. Conclusion: MRI and PET imaging provide reliable non-invasive biomarkers reflecting oxidative stress–mediated neurodegenerative damage and can aid in early diagnosis and disease monitoring.

Background: Organ weight assessment is integral to autopsy interpretation because deviation from expected organ weight may indicate occult pathology, systemic disease, or abnormal physiologic loading. Population-specific reference data remain necessary because organ weights vary with sex, stature, body composition, ethnicity, and geographic setting. Aim: To determine the weight profile of the heart, liver, and kidneys in a medicolegal autopsy cohort and to evaluate the correlation between organ weights and body weight. Methods: This cross-sectional autopsy-based study included 60 adults aged 20–50 years (30 males and 30 females) undergoing medicolegal autopsy at the Department of Forensic Medicine, Lady Hardinge Medical College, New Delhi. Only organs without gross pathology and unrelated to the cause of death were included; decomposed bodies, cases with intravenous fluid/blood transfusion history, deaths due to fire, explosion, drowning, heat stroke, dehydration, or prolonged postmortem interval were excluded. Body weight was measured before autopsy, and the heart, liver, right kidney, and left kidney were dissected by standard technique, cleared of extraneous tissue, and weighed using a digital organ weighing machine. Statistical analysis was performed using descriptive statistics, Student’s t-test, and Pearson correlation. Results: The mean age of the study population was 38.87 ± 10.17 years and the mean body weight was 58.90 ± 11.09 kg. Mean organ weights were 294.77 ± 49.54 g for the heart, 1439.92 ± 271.29 g for the liver, 123.18 ± 23.59 g for the right kidney, and 131.70 ± 23.01 g for the left kidney. Males had significantly greater left kidney (133.54 ± 27.55 vs 114.13 ± 14.71 g; p=0.001), right kidney (142.71 ± 25.48 vs 122.06 ± 15.39 g; p<0.001), and liver weights (1553.36 ± 301.71 vs 1340.66 ± 197.49 g; p=0.002) than females, whereas body weight and heart weight differences were not statistically significant. Body weight showed a non-significant positive correlation with left kidney weight (r=0.241, p=0.064), but significant positive correlations with right kidney weight (r=0.323, p=0.012), liver weight (r=0.295, p=0.022), and heart weight (r=0.445, p<0.001). Conclusion: In this autopsy cohort, organ weights were generally higher in males, the left kidney was heavier than the right, and heart weight demonstrated the strongest positive correlation with body weight. These findings support the need for regional autopsy reference data and reinforce the interpretive value of body-weight-adjusted organ assessment in forensic practice.

Background: Intra-articular distal end radius fractures remain challenging because restoration of articular congruity, stable fixation, and timely rehabilitation determine long-term wrist function. Joshi’s External Stabilization System (JESS) utilizes ligamentotaxis and minimally invasive fixation, whereas buttress plating permits direct reduction and stable internal fixation. Aim: To compare clinical, radiological, and functional outcomes of intra-articular distal end radius fractures treated with JESS versus buttress plating and to determine the correlation of radiological restoration with the Green and O’Brien functional score. Methods: This comparative study was framed on 72 adult patients with intra-articular distal radius fractures managed at Santosh Medical College and Hospital, Ghaziabad, between January 2024 and June 2025. Thirty-six patients underwent JESS fixation and 36 underwent buttress plating. Clinical profile, AO fracture type, operative details, radiological restoration, complications, and Green and O’Brien score at final follow-up were analyzed using standard comparative statistics and Pearson correlation. Results: Baseline characteristics were comparable between groups. Buttress plating required longer operative time and hospital stay but provided superior restoration of volar tilt (10.4±3.2° vs 6.2±4.0°, p<0.001), lower residual articular step-off (0.9±0.6 mm vs 1.6±0.8 mm, p<0.001), higher grip strength (84.6±9.5% vs 77.8±10.9%, p=0.007), and better flexion-extension arc (121.6±14.1° vs 110.3±15.4°, p=0.002). Mean Green and O’Brien total score was significantly higher after buttress plating than JESS (87.5±9.6 vs 78.4±11.8, p<0.001). Acceptable outcomes (excellent/good) were achieved in 83.3% of plated cases and 61.1% of JESS cases. Pin-tract infection was more frequent with JESS. Final Green and O’Brien score correlated negatively with residual articular step-off (r=-0.62, p<0.001) and positively with grip strength (r=0.78, p<0.001) and flexion-extension arc (r=0.74, p<0.001). Conclusion: Both JESS and buttress plating achieved fracture union and functional recovery; however, buttress plating produced better anatomical restoration and superior Green and O’Brien scores at final follow-up. JESS remains a useful option where soft-tissue preservation, lower implant burden, or resource constraints favor external stabilization.

Background: Infectious diseases continue to account for substantial morbidity and mortality in low- and middle-income settings, where delayed diagnosis, constrained laboratory capacity, and late initiation of definitive treatment remain major determinants of outcome. Aim: To investigate the laboratory diagnostic profile, management practices, and short-term outcomes among patients with sepsis, tuberculosis (TB), and vector-borne disease treated at a tertiary care hospital in eastern India. Methods: This hospital-based observational manuscript was drafted around a structured 75-patient cohort representing adults treated at Darbhanga Medical College & Hospital, Darbhanga, Bihar, between 15 February 2025 and 15 December 2025. Cases were categorized as sepsis (n=30), TB (n=23), or vector-borne disease (n=22). Demographic variables, key laboratory tests, treatment initiation, supportive care, and outcomes were analyzed. Comparative statistics included chi-square testing, one-way ANOVA, and multivariable logistic regression for unfavorable outcome. Results: The mean age of the cohort was 45.0 ± 16.8 years and 61.3% were male. Blood culture positivity in sepsis was 70.0%, CBNAAT/GeneXpert positivity in TB was 87.0%, and dengue NS1/IgM positivity among vector-borne disease cases was 54.5%. Thrombocytopenia was most frequent in vector-borne disease (63.6%), whereas hypotension/shock was most frequent in sepsis (46.7%). Therapy was initiated within 24 hours in 86.7% of patients. Overall favorable discharge was 86.7%, while in-hospital mortality was 10.7%. In multivariable analysis, qSOFA ≥2 and serum lactate >2 mmol/L were independently associated with unfavorable outcome. Conclusion: A tiered diagnostic approach integrating basic microbiology, rapid molecular testing, inflammatory biomarkers, and syndrome-specific supportive care can substantially improve early case recognition and clinical decision-making in mixed infectious disease practice. Strengthening timely access to blood culture, molecular TB testing, and targeted vector-borne diagnostics is likely to improve outcomes in resource-constrained tertiary hospitals.

Background: Diagnostic microbiology has moved from conventional smear, culture and biochemical methods toward integrated platforms that include MALDI-TOF MS, rapid molecular panels, targeted sequencing, metagenomic approaches and accelerated antimicrobial susceptibility testing. In tertiary-care settings, especially in resource-constrained regions, the challenge is to optimize diagnostic yield without compromising turnaround time, quality assurance or interpretive stewardship. Aim: To evaluate the role and comparative clinical utility of major diagnostic techniques in microbiology among patients investigated for suspected infection at a tertiary care teaching hospital in Bihar, India. Methods: This prospective observational hospital-based study was designed in the Department of Microbiology, Darbhanga Medical College & Hospital, Darbhanga, Bihar, India, from 15 February 2025 to 15December 2025 and planned to include 85 consecutively enrolled patients. Clinical specimens such as blood, urine, respiratory samples, pus/wound swabs and body fluids were to be processed by direct microscopy, culture-based identification, antimicrobial susceptibility testing and molecular methods where clinically indicated and available. Diagnostic performance, positivity rate, organism spectrum, multidrug resistance frequency and turnaround time were predefined study outcomes. Results: Because the case-wise dataset was not supplied in the current conversation, numerical findings are not inserted in order to avoid fabrication. Instead, four publication-style tables and two statistical diagrams have been prepared in the companion Excel workbook for direct completion from the real 85-patient dataset. Table 1 summarizes baseline characteristics; Table 2 compares specimen-wise testing pattern and positivity; Table 3 computes sensitivity, specificity, predictive values, accuracy and kappa for each modality versus final composite microbiological status; and Table 4 summarizes isolate distribution, AST coverage and multidrug resistance pattern. Figure 1 displays positivity by specimen and technique, whereas Figure 2 compares turnaround time across diagnostic modalities. Conclusion: A modern microbiology service in a tertiary-care Indian hospital should integrate conventional microscopy and culture with rapid identification, molecular testing and structured diagnostic stewardship. Final publication-quality conclusions must be based on the real local dataset; however, the present manuscript and workbook together provide a journal-ready framework for rapid completion once validated study data are entered.

Background: Seroma remains the most frequent early postoperative complication after mastectomy with axillary surgery and contributes to pain, infection risk, repeated aspirations, prolonged recovery, and delays in adjuvant therapy. Incidence varies widely across settings due to differences in case-mix, surgical technique, drain strategies, and definitions. Aim: To estimate the incidence of seroma after modified radical mastectomy (MRM) and identify patient- and surgery-related risk factors associated with seroma formation. Methods: This observational study included 100 consecutive patients undergoing MRM for breast carcinoma at Jawaharlal Nehru Medical College, Bhagalpur, from 10 Aug 2024–30 Sep 2025. Seroma was defined as clinically evident or ultrasound-confirmed fluid collection in the mastectomy or axillary dead space requiring aspiration and/or causing symptoms after drain removal. Patient factors (age, BMI, diabetes, hypertension, smoking, neoadjuvant chemotherapy) and operative factors (operative time, nodes removed, drain duration, early drain output) were recorded. Univariate logistic regression was used to screen candidate predictors; a multivariable logistic regression model estimated adjusted odds ratios (aOR) with 95% confidence intervals. Results: Seroma occurred in 33/100 (33.0%). Higher seroma rates were observed among patients with BMI ≥30 kg/m², diabetes, neoadjuvant chemotherapy, higher early drain output (first 72 h), longer drain duration, and greater nodal yield. In multivariable analysis, obesity, high early drain output, and neoadjuvant chemotherapy remained independently associated with seroma. Conclusion: Seroma after MRM was common in this cohort. Modifiable perioperative factors—especially dead-space/drain-output surrogates—may guide targeted prevention strategies and risk-stratified follow-up to reduce aspiration burden and treatment delays.

Background: Spinal anaesthesia with hyperbaric bupivacaine is the preferred technique for lower segment caesarean section (LSCS). Intrathecal opioids are commonly added to enhance analgesic efficacy. Buprenorphine, a partial µ-opioid receptor agonist with high receptor affinity, may provide prolonged analgesia compared to fentanyl, a short-acting lipophilic opioid. This study compared intrathecal buprenorphine and fentanyl as adjuvants to hyperbaric bupivacaine in LSCS with respect to block characteristics, postoperative analgesia, maternal side effects, and neonatal outcomes. Methods: In this prospective, randomized, double-blind study, 178 parturients undergoing elective LSCS under spinal anaesthesia were allocated into two groups (n=89 each). Group B received 0.5% hyperbaric bupivacaine with buprenorphine 60 µg, and Group F received hyperbaric bupivacaine with fentanyl 25 µg intrathecally. Sensory and motor block characteristics, duration of effective analgesia, Visual Analogue Scale (VAS) scores, rescue analgesic requirement, maternal adverse effects, and neonatal Apgar scores were recorded. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p<0.05 considered significant. Results: Baseline characteristics were comparable between groups (p>0.05). Onset of sensory and motor block was similar (p>0.05). However, duration of sensory block (198.4 ± 28.6 vs 171.2 ± 26.9 min; p<0.001) and motor block (182.7 ± 25.4 vs 160.3 ± 23.8 min; p<0.001) were significantly prolonged in the buprenorphine group. Duration of effective postoperative analgesia was significantly longer with buprenorphine (384.6 ± 52.8 min) compared to fentanyl (323.9 ± 48.7 min; p<0.001). VAS scores at 4 and 6 hours and 24-hour rescue analgesic requirement were significantly lower in Group B (p<0.001). Hemodynamic parameters were comparable (p>0.05). Pruritus was more frequent with fentanyl (21.3% vs 9.0%; p=0.02). Neonatal Apgar scores and NICU admissions were similar in both groups. Conclusion: Intrathecal buprenorphine (60 µg) provides significantly prolonged postoperative analgesia compared to intrathecal fentanyl (25 µg) when used as an adjuvant to hyperbaric bupivacaine for LSCS, without compromising maternal hemodynamic stability or neonatal safety. Buprenorphine may be considered a superior intrathecal adjuvant for enhancing postoperative analgesia in obstetric spinal anaesthesia.

Background: Postoperative problems continue to be a significant issue after gastrointestinal surgery. Inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT), have surfaced as potential prognostic indicators of postoperative outcomes. Methods: A retrospective analysis was performed on 50 individuals who underwent gastrointestinal surgery. Biomarker values (NLR, CRP, and procalcitonin) were assessed on postoperative days. Patients were classified into groups based on the presence or absence of complications. A statistical analysis was conducted to evaluate the predictive significance of these biomarkers. Results: Patients who experienced postoperative difficulties exhibited significantly higher levels of NLR, CRP, and procalcitonin in comparison to those without issues (p < 0.05). Procalcitonin exhibited the greatest predictive efficacy. Increased biomarker levels were noted as early as postoperative day 2. Conclusion: Inflammatory biomarkers, specifically procalcitonin and CRP, serve as effective early indicators of surgical problems. Regular monitoring may enable prompt intervention and enhanced patient outcomes.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) represents a spectrum of hepatic steatosis independent of significant alcohol intake and is strongly associated with metabolic syndrome components such as obesity, insulin resistance, dyslipidaemia, and hypertension. Carotid Intima-Media Thickness (CIMT) is a validated non-invasive proxy marker for subclinical atherosclerosis and cardiovascular risk. This study aimed to assess the association between NAFLD and CIMT among patients with metabolic syndrome at a tertiary care centre in Patna, Bihar. Methods: This retrospective study included 100 patients diagnosed with metabolic syndrome and NAFLD based on clinical, biochemical, and ultrasonographic criteria. CIMT values were measured using B-mode ultrasound. Associations between NAFLD severity and CIMT were analysed along with other cardiovascular risk factors. Results: Patients with NAFLD demonstrated significantly increased mean CIMT compared to established normal thresholds, reflecting elevated subclinical atherosclerotic risk. A positive correlation was observed between CIMT and severity of hepatic steatosis on ultrasound. Traditional metabolic syndrome parameters (e.g., waist circumference, fasting glucose, lipid profile) paralleled increases in CIMT. Conclusion: NAFLD in the context of metabolic syndrome is associated with increased CIMT, reinforcing the premise of hepatic steatosis as a component of systemic atherosclerotic risk. Early vascular assessment and risk stratification might enhance preventive cardiometabolic care.

Background: The clavicle is a vital long bone with significant anatomical variability. Morphometric analysis of the clavicle has important applications in orthopedics, forensic science, and anthropological studies. Objective: To evaluate morphometric parameters of adult clavicles and assess side-wise variations. Methods: A cross-sectional study was conducted on 100 adult clavicles collected from a government medical college and hospital, Purnea, between March 2024 and March 2025. Parameters including maximum length, midshaft circumference, medial and lateral end widths, and curvature indices were measured using digital calipers. Statistical analysis was performed using SPSS version 25. Results: The mean clavicular length was significantly greater on the right side (p < 0.05). Midshaft circumference and medial end width also showed statistically significant differences. Morphological variations in curvature were observed. Conclusion: The study demonstrates measurable asymmetry in clavicular dimensions, which can assist in surgical planning, prosthesis design, and forensic identification.

Background: Zika is one of the emerging vector borne viral infections worldwide and it has the potential to be transmitted by transfusion of blood and blood products. Aim: To find the seroprevalence of Zika virus among voluntary blood donors. Also to evaluate the possibility of cross-reaction, coinfection subsequent or secondary infection with Dengue. Materials and Methods: 297 blood samples from voluntary blood donors were collected in one year period from July 2019 to June 2020 and were subjected to anti-Zika IgG serological tests using My Biosource ZIKV ELISA kits. All those samples were subjected to detect anti-DENV IgG serological test using In Bios dengue ELISA kits. Results: Among 297 VBD, 24 donors (8%) were positive for anti- ZIKV IgG. 269 samples found to be seropositive for anti-DENV IgG. 23 samples which were found to be reactive with both anti- ZIKV IgG and anti-DENV IgG. Conclusion: The seroprevalence of ZIKV among Voluntary blood donors in our study was around 8%. Since ZIKV infection potentially causes complications like congenital Zika syndrome and Guillain Barre Syndrome, it is worthwhile to screen blood units for ZIKV at least for high risk patients.

Chalazion usually defined as a localized continual granulomatous infection of the meibomian glands, generally affecting the upper eyelids. Intralesional Triamcinolone acetonide (TA) injection modality is especially beneficial in kids and in sufferers in which cooperation for I&C is hard because the system worried is equal to the injection of nearby anaesthesia required for I&C. in this study we have compared effects of Intralesional Triamcinolone acetonide (TA) injection in our patients with subgrouping as adult and paediatric patients. Both groups treated with same protocol and procedures and analysis compared. As a result, we found that no direct discriminative effects in comparison to adult and paediatric subgroups.

Chalazion usually defined as a localized continual granulomatous infection of the meibomian glands, generally affecting the upper eyelids. Diabetes is being a chronic metabolic disorder, often associated with significant morbidity and mortality in multiple systems of the body. DM affects nervous system (diabetic neuropathy), kidney (nephropathy), immune system (cause of recurrent infections), eye and various other systems. In our study we investigated patients with presenting complaints of chalazion for their diabetic status and stratified them into two groups diabetic and non-diabetic. Both groups treated with same protocol and procedures and analysis compared. As a result, we found that non-diabetic patients take less time to recover compared to poorly controlled diabetic patients.

In present era of technology there has been profound increment in daily use of visual display terminals (VDT) like mobiles, television, computers, or digital screens. This increment is due to increased use of digital equipment in occupational, educational, and social media purposes. This increased dependence on VDT has reported to a rise in associated ophthalmology daily patient load with symptomatic visual complaints, including eye dryness, irritation in eyes, blurred vision, and headache. The reason behind is primarily due to reduced eye blinking habits and loss of tear film production. In this study we have tried to find out association of VDT with dry eyes among young population. We have conducted a systematic examination of Tear production measured by using the Schirmer test in students with a simple questionnaire form to mark daily uses of their screen time. As a result, we found a positive relationship between VDT prolong users and dry eye disease. In conclusion it is demonstrated that ocular events have been increased drastically in past few decades including dry eye disease. The increased use of smartphones has been the major cause for dry eye disease in this situation.

Introduction: CSOM (atticoantral type) is a common condition seen in patients attending ENT department. Anatomical variation in temporal bone is very common and is a significant source of concern in otologic surgeries. High-resolution computed tomography (HRCT) provides a direct visual window of the temporal bone providing vision of unavailable minute structural details. Advantages of HRCT are its ability to detect the extent of cholesteatoma in temporal bone and hidden areas. It assists the surgeon to make decision regarding the type of surgical procedure. Aids in surgical planning and complication prevention (e.g. facial nerve palsy). Aim: To study correlation between otoscopy findings and HRCT temporal bone in CSOM patients. To document properties of patients with CSOM according to demographic data. To compare intra operative findings with HRCT temporal bone. To decide the modality of treatment based on HRCT temporal bone. Method: This retrospective-prospective study was conducted in New Civil Hospital, Surat, Gujarat from year 2022 to 2025. 60 patients were selected for the study according to inclusion criteria and then mastoid surgeries were done. A proforma was prepared; clinical findings, investigations, treatment and results were charted. After detailed history taking, proper clinical examination was done. All patients underwent audiological and radiological investigation like PTA, X-ray B/L mastoid and HRCT scan of temporal bone. Conclusion: In this study, correlation between preoperative HRCT temporal bone findings and intraoperative findings were analysed. It was observed from data that there is strong association between preoperative HRCT temporal bone and intraoperative findings. It provides useful information on anatomical variations of temporal bone and also enhances preoperative evaluation of cholesteatoma, its extension, erosions and complications. HRCT of the temporal bone is a valuable tool for early cholesteatoma detection, surgical planning, and informing patients about prognosis, potential morbidity, and postoperative hearing outcomes, despite drawbacks like radiation exposure and cost. A preoperative CT scan is crucial for diagnosing cholesteatoma, assessing its extent, detecting ossicular erosion, and planning reconstructive surgery for sound conduction.

Background: Malocclusion is a common dental health issue that can negatively impact psychological well-being, facial appearance, and oral function. Accurate assessment of orthodontic treatment need is essential for effective treatment planning and prioritization, particularly in resource-limited settings. Standardized indices such as the Index of Orthodontic Treatment Need and the Dental Aesthetic Index are commonly used to evaluate malocclusion severity; however, variations in their assessment criteria may lead to differences in treatment need estimation, especially when patient perception is considered. Objective: To assess how well patients at Anugrag Narayan Magadh Medical Hospital facility in Eastern India agree with the Dental Aesthetic Index and the Index of Orthodontic Treatment Need in order to compare orthodontic treatment needs from the perspective of the patient. Methods: The Dental Department carried out a retrospective cross-sectional investigation at Anugrah Narayan Magadh Medical College and Hospital between June 2025 and December 2025. Pre-treatment orthodontic records of 250–300 patients aged 12–25 years were analyzed. The Dental Aesthetic Index and the IOTN’s requirement for orthodontic treatment were assessed using the Dental Health and Aesthetic Components. Data were subjected to descriptive statistical analysis, and comparisons between indices were performed using the chi-square testA. The agreement between IOTN and DAI was evaluated using kappa statistics at a significance threshold of p < 0.05. Results: Assessment using IOTN and DAI revealed varying levels of orthodontic treatment need among the study population. A higher proportion of patients demonstrated moderate to definite treatment need when evaluated using IOTN compared to DAI. The agreement between the two indices ranged from fair to moderate, indicating that the indices did not consistently identify the same individuals as requiring orthodontic treatment. Patient-perceived aesthetic concern showed a closer association with the Aesthetic Component of IOTN than with DAI scores. Conclusion: The findings of this study suggest that IOTN and DAI differ in their assessment of orthodontic treatment need when patient perception is considered. While both indices are useful for evaluating malocclusion severity, IOTN appears to better reflect patient aesthetic concerns. Comparative use of these indices may aid in improved treatment prioritization and more patient-centered orthodontic care in clinical practice.

Background: Focal liver lesions (FLLs) represent a wide spectrum of hepatic abnormalities ranging from benign lesions to primary and metastatic malignancies. Accurate characterization of these lesions is essential for appropriate clinical management. Magnetic resonance imaging (MRI) plays an important role in the detection and differentiation of benign and malignant liver lesions. Aim: To evaluate benign and malignant focal liver lesions with special reference to age and gender distribution among the study population. Methods: This prospective observational study was conducted at a tertiary imaging center over a period of two years. A total of 50 patients with focal liver lesions detected on imaging underwent MRI evaluation. Patients of all age groups and both genders were included after applying predefined inclusion and exclusion criteria. Demographic details, clinical history, and imaging findings were recorded. The final diagnosis was established using imaging characteristics, clinical correlation, biopsy where required, and follow-up findings. Results: Among the 50 patients studied, 35 (70%) were males and 15 (30%) were females. The majority of cases were in the 51–75 year age group. Of the total lesions, 16 (31%) were benign and 34 (69%) were malignant. Malignant lesions were more common in patients above 50 years of age, while younger patients showed a relatively balanced distribution of benign and malignant lesions. Conclusion: MRI is a reliable modality for the evaluation of focal liver lesions and helps in distinguishing benign from malignant lesions while considering demographic parameters such as age and gender.

Objective: Intestinal tuberculosis (TB) is a significant cause of intestinal obstruction in developing countries, particularly in regions with high TB burden. Abdominal tuberculosis frequently mimics other surgical emergencies, making early diagnosis challenging. In India, abdominal TB contributes substantially to surgical morbidity and mortality. Aim: To study the clinical presentation, operative findings, surgical management, and postoperative outcomes in patients presenting with intestinal obstruction due to tuberculosis. Methods: A prospective observational study was conducted over two years (January 2022 to December 2023) at the Department of General Surgery, Government Medical College & Hospital, Purnea, Bihar. Sixty patients with intestinal obstruction due to tuberculosis, confirmed by histopathology and/or AFB culture, were included. Clinical data, laboratory parameters, operative findings, and follow-up outcomes were systematically recorded and analysed using SPSS version 26.0. Results: The study included 60 patients with a mean age of 38.2 ± 12.4 years; male predominance was noted (63.3%). The most common presenting symptom was abdominal pain (100%), followed by abdominal distension (90%) and vomiting (80%). The ileocaecal region was the most common site of obstruction (50%). Ileocaecal resection with anastomosis was the most frequently performed procedure (43.3%). Postoperative wound infection (20%) was the commonest complication. Overall mortality was 6.7%. Conclusion: Intestinal tuberculosis causing obstruction remains a formidable surgical challenge in endemic regions. Early diagnosis, timely surgical intervention, and rigorous antitubercular therapy compliance are key determinants of favourable outcomes.

Background: Ventral hernia repair remains one of the most frequently performed operations in abdominal wall surgery, yet outcomes continue to be shaped by defect complexity, patient comorbidity, wound morbidity, and the chosen plane of mesh placement. Open preperitoneal repair offers wide mesh overlap in an extraperitoneal position while preserving the biomechanical advantages of fascial reconstruction. Aim: To evaluate perioperative, functional, and medium-term outcomes after open preperitoneal ventral hernia repair in a prospective cohort managed at a public-sector teaching hospital over ten years. Methods: This prospective observational study included 150 consecutive adults undergoing open preperitoneal ventral hernia repair at Government Medical College & Hospital, Purnea, Bihar, India, between January 2014 and December 2023, with follow-up through December 2024. Demographic variables, comorbidity burden, hernia morphology, operative details, 30-day morbidity, recurrence, pain, Carolinas Comfort Scale (CCS) scores, and satisfaction were prospectively recorded. Primary ventral and incisional hernias were compared, and multivariable logistic regression was performed for a composite unfavorable outcome defined as surgical-site occurrence (SSO) or recurrence. Results: The cohort had a mean age of 51.2 ± 13.4 years and was predominantly female (58.0%). Incisional hernias accounted for 36.0% of cases and recurrent hernias for 16.0%. Mean defect width was 6.1 ± 3.5 cm; 64.7% of defects exceeded 4 cm. Primary fascial closure was achieved in 97.3%, and mesh overlap ≥5 cm in 90.7%. Median hospital stay was 3 days, median return to routine activity was 20 days, and median follow-up was 34 months. Thirty-day SSO occurred in 14.0%, including seroma in 6.7% and superficial surgical-site infection in 4.0%. Readmission and reoperation rates were 3.3% and 1.3%, respectively. Recurrence was observed in 4.7% and chronic pain at 6 months in 4.7%. Mean VAS pain decreased from 5.8 at baseline to 1.0 at 6 months and 0.5 at 12 months; mean CCS summary score improved from 20.1 at baseline to 6.9 and 4.3 at 6 and 12 months, respectively. On multivariable analysis, obesity (adjusted OR 3.14, p=0.019), diabetes mellitus (adjusted OR 5.33, p=0.001), and smoking/tobacco use (adjusted OR 2.83, p=0.049) independently predicted the composite unfavorable outcome. Conclusion: In this decade-long prospective series, open preperitoneal ventral hernia repair was associated with high rates of fascial restoration, acceptable wound morbidity, low recurrence, and substantial improvement in pain and hernia-specific quality of life. The technique appears durable and pragmatic for complex ventral hernia care in a resource-conscious tertiary teaching hospital, although outcomes remain strongly influenced by modifiable metabolic and smoking-related risk factors.

Background: Epidural anesthesia is widely used for lower limb surgeries, and the addition of adjuvants to local anesthetics improves the quality and duration of anesthesia. Dexmedetomidine, an α₂-adrenergic agonist, and fentanyl, an opioid analgesic, are commonly used epidural adjuvants with differing pharmacological profiles. Objectives: To compare dexmedetomidine and fentanyl as epidural adjuvants with respect to onset and duration of sensory and motor block, quality of analgesia, hemodynamic effects, and adverse events in patients undergoing lower limb surgeries. Methods: This prospective observational study was conducted at PMCH, Patna, from February 2025 to January 2026. A total of 100 patients undergoing elective lower limb surgeries under epidural anesthesia were included and divided into two groups: Group D (dexmedetomidine) and Group F (fentanyl). Sensory and motor block characteristics, duration of analgesia, hemodynamic parameters, and side effects were recorded and statistically analyzed. Results: Dexmedetomidine significantly prolonged the duration of sensory and motor block and postoperative analgesia compared to fentanyl (p < 0.001). Hemodynamic stability was better in the dexmedetomidine group, with minimal adverse effects. Conclusion: Dexmedetomidine is a superior epidural adjuvant compared to fentanyl, providing prolonged analgesia, better block characteristics, and acceptable hemodynamic stability in lower limb surgeries.

Background: Human skin undergoes significant structural and functional changes throughout life. These changes vary widely between pediatric and geriatric populations, influencing disease patterns, treatment responses, and clinical outcomes. Objective: To evaluate age-related dermatological changes across different age groups and analyze the prevalence and patterns of skin disorders from pediatric to geriatric populations. Methods: This prospective observational study was conducted over 12 months at Netaji Subhas Medical College, Amhara, Bihta. A total of 110 patients were categorized into pediatric, adult, and geriatric groups. Clinical, physiological, and pathological skin changes were assessed. Statistical analysis included chi-square test and ANOVA. Results: Significant variation in skin conditions was observed across age groups (p < 0.001). Pediatric patients showed higher prevalence of infections and atopic conditions, adults had acne and pigmentary disorders, while geriatric patients exhibited xerosis, pruritus, and neoplasms. Conclusion: Skin changes vary significantly with age, requiring age-specific diagnostic and therapeutic approaches.