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.