Introduction: Depression is a significant global health concern, causing personal distress, functional impairment, and increased healthcare burden. Understanding its specific characteristics in the Indian population is vital for effective management. This study aimed to assess the demographic and clinical profile, triggering factors, quality of life, and treatment patterns among Indian patients with depression. Methods: This retrospective, multi-centric cross-sectional study collected data from healthcare facilities across India on patients diagnosed with depression per ICD-10 criteria. Information on demographics, triggers, symptoms, quality of life impact, and treatment was analyzed using IBM SPSS Statistics. Results: The study included 7,888 patients, with a mean age of 48.0 years. The prevalence of depression was slightly higher in males (56.5%). Key triggering factors included stressful events, chronic illness or pain, and social isolation. Commonly reported symptoms were fatigue or low energy, persistent sadness or low mood, and disturbed sleep. Depression significantly affects patients’ quality of life, particularly sleep quality, financial/social functioning, and daily chores. Cognitive behavioral therapy (CBT) and pharmacotherapy were the most common treatments. Among antidepressants, escitalopram was most frequently prescribed (47.7%), followed by vortioxetine (2.6%), while bupropion and the bupropion-dextromethorphan combination were each prescribed in 0.05% of cases. Conclusions: The study highlights the considerable clinical and psychosocial burden of depression among Indian patients, particularly middle-aged individuals. Key triggers such as stress and chronic illness demand early recognition and tailored interventions. Although CBT and pharmacotherapy remain the mainstays of treatment, the underutilization of multimodal strategies indicates a gap in optimal care. These findings underscore the need for integrated, culturally sensitive, and patient-centered approaches to improve depression management and outcomes in India.

Background: Pseudomonas aeruginosa is an opportunistic gram-negative bacillus with intrinsic and acquired resistance mechanisms, making it a major pathogen in both community and healthcare settings. Biofilm production further enhances its persistence, resistance to antimicrobials, and ability to cause chronic or recurrent infections. Surveillance of local antimicrobial susceptibility trends, especially in healthcare centres, is essential for guiding empirical therapy and infection control. Aim and Objectives: To determine prevalence of P. aeruginosa isolates from all the clinical samples in a tertiary care hospital and to correlate between biofilm formation and antimicrobial resistance for these isolates. Methods: This study was carried out at the Department of Microbiology of Al-Falah School of Medical Sciences, Faridabad associated with tertiary care hospital for a period of one year (January to December 2024). Out of total 4040 clinical samples processed, 82 isolates of P. aeruginosa identified using standard culture and biochemical tests. Biofilm detection done using Congo Red Agar (CRA) method and Microtiter Plate Assay (MPA). Conventional Antimicrobial susceptibility testing (AST) was performed using Mueller–Hinton agar Kirby–Bauer disc diffusion method as per CLSI 2025 guidelines. Statistical analysis was done using SPSS version 26. Results: Out of total 82 Pseudomonas isolates, 46 (56.1%) were from male patients and 36 (43.9%) from female patients. Outpatient isolates (72.0%) outnumbered inpatient isolates (28.0%). Maximum isolates were from ear pus (38; 46.3%), followed by sputum (25; 30.5%), pus (10; 12.2%), urine (3; 3.7%), blood (3; 3.7%), and conjunctival swabs (3; 3.7%). Biofilm assays revealed 34 strong (41.5%), 22 moderate (26.8%), 16 weak (19.5%) producers, and 10 are non-biofilm producers (12.2%). Piperacillin–tazobactam demonstrated the lowest resistance (3.7%), while imipenem exhibited the highest (56.1%). Strong biofilm producers showed significantly higher resistance to all tested antibiotics was statistically significant (p <0.05). Conclusion: High rates of biofilm formation in P. aeruginosa correlated with multidrug resistance, particularly against carbapenems and ceftazidime. Piperacillin–tazobactam remains the most reliable agent. Regular surveillance, biofilm screening, and strict antimicrobial stewardship are critical to prevent treatment failures and the spread of multidrug-resistant strains.

Background: Nasal and paranasal sinus (PNS) masses encompass a diverse group of lesions, ranging from infectious conditions and non-neoplastic inflammatory conditions to benign and malignant neoplasms. Due to overlapping clinical presentations, there can be difficulty in achieving an accurate diagnosis. Histopathological examination remains the gold standard for a definitive diagnosis. Material and Method: This hospital-based, descriptive and observational study involved 62 cases of nasal and PNS masses, of which 61 cases were analysed after excluding one inadequate sample. Clinical details and radiological reports of all cases were recorded. Histopathological processing and examination were performed on all 61 specimens. Microbiological tests, such as potassium hydroxide (KOH) mount, culture and LPCB mount, were performed in selected cases to determine infectious aetiologies. Lesions were then categorized into a non-neoplastic inflammatory group and a neoplastic group, where the neoplastic group was further sub-classified into benign and malignant neoplasms. Results: A total of 61 cases were studied, with non-neoplastic lesions constituting the majority (67.74%) of cases. Among these, inflammatory nasal polyps were the most common (88.09%). Among neoplastic lesions (30.64%), benign tumors predominated (89.47%), with capillary haemangioma being the most common benign tumor (47.05%), followed by inverted papilloma (41.17%). Squamous cell carcinoma was the predominant malignant tumors. Microbiological screening in selected cases did not reveal any specific infectious aetiology. Most lesions showed a male predominance and were commonly observed in the age group of 11-20 years. The most common presenting complaint was nasal obstruction. Conclusion: Nasal and PNS masses show a diverse histopathological spectrum, with non-neoplastic lesions being the most common. Histopathological evaluation plays a crucial role in accurate diagnosis and guiding management. Early detection is essential, particularly for malignant lesions, to improve prognosis.

Background: Developmental delay in children under five years is a major pediatric concern because early deficits in motor, language, and social development can adversely affect long-term outcomes. Early identification is essential for timely intervention. Methods: This prospective cross-sectional study was conducted in the Department of Pediatrics, GSL Medical College and General Hospital, Rajahmundry, from November 2025 to January 2026. A total of 120 children aged below five years were evaluated for developmental status using age-appropriate developmental assessment. Demographic, perinatal, nutritional, and socioeconomic variables were recorded and analyzed statistically. Results: The mean age of the children was 28.6 ± 14.2 months, and 56.7% were males. Developmental delay was identified in 28.3% of the study population. Language delay was the most frequent domain affected, followed by gross motor and social/personal delay. Developmental delay showed significant associations with prematurity, low birth weight, birth asphyxia, undernutrition, rural background, and low maternal educational level, whereas age and sex were not significantly associated. Conclusion: Developmental delay was common and was influenced by multiple biological, nutritional, and socioeconomic factors. Routine developmental screening in under-five children, especially in high-risk groups, is essential for early diagnosis, referral, and intervention.

Objectives: The diagnostic accuracy of the DECAF score in predicting in-hospital mortality among patients presenting with AE COPD to the emergency department and to compare its prognostic performance with the CURB-65 score. Methods: A total of 100 consecutive adult patients presenting with acute exacerbation of COPD were enrolled. DECAF and CURB-65 scores were calculated at the time of ED admission using clinical findings, laboratory investigations, chest radiography, and arterial blood gas analysis. Patients were followed until discharge or in-hospital death. Diagnostic accuracy was assessed using sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, and receiver operating characteristic (ROC) curve analysis. Results: The mean age of the study population was 55.37 years, with a male predominance (64%). In- hospital mortality was observed in 12% of patients. The DECAF score demonstrated high specificity (96.6%), high negative predictive value (91.4%), and good overall diagnostic accuracy (89%) for predicting in-hospital mortality. The mean DECAF score was significantly higher among non-survivors compared to survivors (p < 0.01). ROC curve analysis showed good discriminatory ability for the DECAF score (AUC ≈ 0.85). In comparison, the CURB-65 score showed high sensitivity (100%) but poor specificity (31.1%), resulting in lower overall accuracy and overestimation of mortality risk. Conclusion: The DECAF score is a reliable and disease-specific prognostic tool for predicting in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease presenting to the emergency department. Its superior specificity, negative predictive value, and overall diagnostic accuracy compared to CURB-65 make it particularly useful for early risk stratification and clinical decision-making in emergency care settings. Routine incorporation of the DECAF score may aid in optimal utilization of critical care resources and improve patient outcomes.

Introduction: Forensic medicine is a cornerstone in ensuring the delivery of justice through medical evidence. The Compulsory Rotatory Medical Internship (CRMI) is designed in such a way so that intersect with almost every clinical discipline—consent, documentation, MLC registration, sexual assault examination, injury certification, chain of custody, and death certification. Aim: This study aims to assess the value of compulsory forensic postings through a comparative analysis between two groups of medical interns. Methods: Two study groups were made for comparison where 50 students who completed their internship in forensic medicine (Group A) and 50 students who were yet not posted (Group B) for internship to FMT department in over 5 months at our Chirayu Medical College & Hospital. which is a tertiary‑care teaching hospital in central India region, Bhopal, M.P., India Results: The mean knowledge score was significantly higher in Group A (3.8 ± 1.22) compared to Group B (2.28 ± 1.25). Majority of interns in Group A (81%) reported adequate exposure-based skills in handling cases compared to only 43% in Group B. Confidence levels in handling the medicolegal cases was markedly higher among Group A interns (75.6%) than Group B interns (20.4%). Positive attitude toward the relevance of forensic medicine was significantly greater in Group A (89.2%) in comparison to Group B (9.6%). Conclusion: The outcomes of the study are vital, as doctors frequently encounter medico-legal issues in practice, and inadequate training could result in errors with legal consequences. A Structured orientation for each day, casualty duties, supervised hands‑on tasks, daily case‑based discussions, feedback, mandatory logbook and autopsy visits in FMT internship posting can significantly enhance interns’ readiness for medicolegal tasks.

Background: Laparoscopic cholecystectomy, though minimally invasive, is frequently associated with moderate postoperative pain, which can delay recovery and increase opioid consumption. Ultrasound-guided transversus abdominis plane (TAP) block has emerged as an effective regional anesthesia technique for postoperative analgesia. However, the optimal timing of TAP block administration—whether preoperative or postoperative—remains a subject of ongoing debate. Aim: To compare the analgesic efficacy of preoperative versus postoperative ultrasound-guided TAP block in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This prospective, randomized, comparative study included 80 patients aged 18–60 years, classified as ASA physical status I–II, undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients were randomly allocated into two groups of 40 each: Group A (preoperative TAP block) and Group B (postoperative TAP block). Ultrasound-guided bilateral TAP block was administered using 20 mL of 0.25% bupivacaine on each side. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours. Secondary outcomes included total tramadol consumption in 24 hours, time to first rescue analgesia, and incidence of postoperative nausea and vomiting (PONV). Statistical analysis was performed using SPSS version 25.0, with p < 0.05 considered significant. Results: Both groups were comparable in demographic and baseline characteristics (p > 0.05). Postoperative VAS scores were slightly lower in the postoperative TAP block group at all time intervals; however, the differences were not statistically significant (p > 0.05). Total tramadol consumption was significantly lower in Group B (115 ± 30 mg) compared to Group A (145 ± 35 mg), representing a reduction of approximately 20.7% (p = 0.002). The time to first request for rescue analgesia was significantly prolonged in the postoperative group (240 ± 45 minutes vs. 180 ± 40 minutes), showing a 33% increase (p = 0.001). The incidence of PONV was also significantly lower in Group B (20%) compared to Group A (35%) (p = 0.03). No significant difference in complication rates was observed between the groups. Conclusion: Both preoperative and postoperative ultrasound-guided TAP blocks provide effective postoperative analgesia in patients undergoing laparoscopic cholecystectomy. However, postoperative TAP block offers superior benefits in terms of reduced opioid consumption, prolonged duration of analgesia, and decreased incidence of PONV. Therefore, postoperative administration may be considered the preferred timing for TAP block in clinical practice.

Background: Post-stroke epilepsy (PSE) is one of the most common causes of acquired epilepsy in adults, particularly in the elderly. The incidence ranges from 2.3% to 43%, depending on stroke subtype and population studied. Identifying predictors of PSE is crucial for risk stratification and early intervention. Objectives: To evaluate seizure types and identify clinical and radiological predictors of post-stroke epilepsy. Methods: A retrospective observational study was conducted at a tertiary care centre in Northeast India. Thirty adult patients with post-stroke seizures and no prior epilepsy were included over a 7-month period (February–August 2025). Variables analysed: (1) Demographics; (20 Stroke subtype (ischemic vs hemorrhagic); (3) Seizure semiology (ILAE 2017 classification); (4) Timing of seizures; (5) Stroke severity (ASPECTS for ischemic stroke); (6) Risk factors and EEG findings. Statistical: Analysis: Descriptive statistics were used. Associations between categorical variables were analysed using chi-square/Fisher’s exact test (where applicable). A p-value <0.05 was considered significant. Results: A total of 30 patients were included in the study, with a male predominance accounting for 53% of the cohort. The majority of patients had ischemic stroke, which constituted 86% of cases, while hemorrhagic stroke accounted for 14%. Regarding seizure semiology, generalized tonic-clonic seizures (GTCS) were the most common type, observed in 60% of patients. This was followed by focal impaired awareness seizures (FIAS) in 30% and focal aware seizures (FAS) in 10% of cases. In terms of timing, late-onset seizures were more frequent, occurring in 64% of patients, whereas early seizures were observed in 36% of cases. Key Associations: (1) Hemorrhagic stroke → significantly associated with early seizures. (2) Ischemic stroke → associated with late seizures. (3) Moderate ASPECTS (5–7) → highest seizure occurrence. Conclusion: Post-stroke epilepsy is more common following ischemic stroke and typically presents as late-onset seizures. Stroke severity and cortical involvement are key predictors. Early identification of high-risk patients can guide preventive strategies.

Background: The term “coronary dominance” refers to the coronary artery that gives rise to the posterior descending artery (PDA) and supplies the posterior part of the interventricular septum. It’s called “dominance” because it indicates which coronary artery has the predominant supply to the heart’s inferior wall and posterior septum. In other words, the dominant coronary artery is the one that has the most significant influence or control over the blood supply to a particular area of the heart. This concept is important for understanding coronary anatomy, diagnosing coronary artery disease, and planning interventions like angioplasty or bypass surgery. Left-heart–dominant patients undergoing percutaneous coronary intervention have higher in-hospital mortality and are more likely to present with symptoms of heart failure, cardiogenic shock, or cardiac arrest. Methods: Embalmed human cadaveric hearts were utilized for the study which was obtained from the Department of Anatomy, HIMSR, Jamia Hamdard University, New Delhi. The coronary arteries were traced through the epicardium and subepicardial adipose tissue. Results: Out of 30 specimens studied in 27 (90%) specimens the posterior interventricular artery was arising from right coronary artery and in other 3 (10%) specimens it arose from Left circumflex artery. In none of the specimens studied the posterior interventricular artery was arising from both the coronary arteries. Conclusion: This study directs the attention towards the importance of cardiac dominance. The term “dominance” in this context doesn’t imply superiority but rather anatomical and functional significance. Coronary dominance is important in ascertaining the distribution of coronary blood flow. Left dominance signifies more blood flow through the circumflex artery and PIVA, compared to RCA. Hence, the area of cardiac tissue being perfused by the separate arterial trunks varies.

Background: Orbital complications of sinusitis are potentially severe and avoidable entities which leads to the visual loss or intracranial extension when proper management is delayed. As the paranasal sinuses and orbit are in proximity anatomically, infections can easily spread beyond sinus walls. Thus, early diagnosis and timely intervention are necessary in order to minimize morbidity. Methods: This descriptive observational study was conducted at Bhagwan Mahavir Institute of Medical Sciences (BMIMS), Pawapuri, Bihar over a period of one year from January 2025 to January 2026. A total of 150 patients who diagnosed with orbital complications due to acute or chronic sinusitis were included. Clinical assessment, ENT and eye examination, contrast-enhanced CT scans were done. Demographic profile, sinuses involved, type of orbital complication (Chandler classification), microbiological findings associated with orbital sources, management protocol and outcomes were analyzed using descriptive statistics. Results: Males (61.3%) and individuals 21–40 years of age (30.7%) had higher frequencies of orbital complications. The majority of case were with acute Sinusitis 68%. The ethmoid sinus was involved most commonly (69.3%). Preseptal cellulitis (34.7%) and orbital cellulitis (29.3%) were the most frequent manifestations of complications. Ten patients (37.3%) required surgical treatment, whereas the remaining 17 patients (62.7%) responded to medical management alone. A full recovery was achieved in 81.3% of patients, permanent blindness was reported in 6.7%. Conclusion:  Orbital complications are mostly related to acute ethmoidal sinusitis and tend to occur in early-infection phases. Rapid imaging, early referral and multidisciplinary care are the key factors in order to achieve best outcomes and avoid vision-threatening complications.

Background: Chronic rhinosinusitis (CRS) is a widespread inflammatory disorder of the paranasal sinuses (PNS) that is usually affected by anatomical deviations like concha bullosa. Concha bullosa, which can be described as pneumatization of the middle turbinate, can also be a cause of the obstruction of the osteomeatal complex and the deterioration of normal sinus drainage. Nevertheless, there is a controversial nature to its contribution to the evolution of CRS. Methods: A cross-sectional study of 100 patients diagnosed with CRS and underwent computed tomography (CT) scanning of the PNS during one year. The existence and the form of concha bullosa (lamellar, bulbous and extensive) were evaluated, and the sinus involvement. Chi-square test was used to analyse the data statistically and a p-value of less than 0.05 was considered significant. Results: Concha bullosa was diagnosed in 38 % of the patients. The most common of the bulbous (47.4 %), then lamellar (31.6 %) and the extensive types (21.0 %). Significant association was found to exist between concha bullosa and ipsilateral sinus involvement (p < 0.05). The maxillary sinus was the most commonly involved, followed by the ethmoid sinus. Conclusion: The study demonstrates a significant association between CRS and concha bullosa, which implies that this anatomical variation could be a contributing factor to the pathogenesis of CRS. CT imaging is essential for the proper diagnosis and effective planning in management.

Background: Chronic otitis media (COM) is a widespread disorder that causes perforation of the tympanic membrane and loss of conductive hearing. Type1 tympanoplasty is carried out to the extent of restoring membrane integrity and enhancing hearing. Among various techniques, anterior tucking is a technique that includes improving the stability of grafts over the traditional underlay technique, especially in anterior perforations. Methods: This was a prospective randomized controlled trial on 100 patients diagnosed with inactive mucosal COM. There were 50 patients in each group and randomly selected to make two groups, Group A (anterior tucking) and Group B (conventional underlay method). At 3, 6, and 12 months postoperatively, the graft uptake and the hearing outcome variables were measured using otoscopic examination and pure tone audiometry. Result: Graft uptake was observed at 12 months in 94% of patients in the anterior tucking and 88% and 88% conventional cohort, respectively. Both groups demonstrated a notable improvement in hearing, and the mean air-bone gap (ABG) was appropriately improved to 13.5 dB in Group A and 13.2 dB in Group B. The groups, however, varied with non-significant differences (p > 0.05). There were low rates of complications and they were similar in both groups. Conclusion: Anterior tucking and standard underlay options are both effective in type1 tympanoplasty, and graft uptake rates are the same, as well as hearing outcomes. Although anterior tucking provides a bit of graft stability, especially in anterior perforations, it is no more significantly better than the traditional technique. The decision-making of the technique should be made according to the features of a particular case and the experience of a surgeon.

Background: Birth asphyxia is the leading cause of neonatal morbidity and mortality and results in substantial neurological sequelae. Hypoxic-ischemic damage can involve both peripheral and central auditory pathways, which may make these infants at high risk for hearing loss. The early detection of hearing loss is crucial in preventing resultant speech,  language, and cognitive developmental delays. Methods: This was a prospective observational study done in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital for the duration of 1 year from January 2025 to January 2026. One hundred fifty full-term neonates (≥37 weeks’ gestation) who were diagnosed with birth asphyxia were recruited. All neonates had at least one Otoacoustic emissions (OAE) screen before either discharge or 1 month of age. Patients with a “Refer” response on the screening test had been submitted for confirmatory Brainstem evoked response audiometry (BERA), testing to evaluate auditory pathway integrity and measurement of hearing thresholds. The severity of asphyxia was graded as per Sarnat stage of hypoxic-ischemic encephalopathy. Analysis was performed in SPSS, and the relationship of severity to hearing loss was evaluated by the chi-square test. Results: The referral rate of the OAE screening was 20%. BERA confirmed hearing loss was found in 12 (rate 8%). The prevalence of hearing loss is designed with the severity of asphyxia, being highest in infants with severe hypoxic-ischemic encephalopathy. There was a significant relationship between the severity of asphyxia and hearing loss (p < 0.05). Conclusion: Birth asphyxia is an important risk factor of neonatal hearing impairment, in particular for severe cases. Single-step screening for bilaterally impaired hearing with OAE and confirmatory BERA helps in early detection and definitive diagnosis. Regular hearing screening for asphyxiated neonates is necessary in order to enable prompt intervention and to optimize developmental outcome.

Background: Obstructive Sleep Apnoea (OSA) in children is a common sleep-related breathing disorder that is mostly caused by adenotonsillar enlargement. OSA, if untreated, can cause growth irregularities in behavior and heart problems. Tonsillectomy, with or without adenoidectomy is the first-line therapy, but postoperative response may be poor and children may experience residual symptoms. Methods: 150 children were included in this retrospective hospital-based study aged between 3–14 years and diagnosed with OSA treated by tonsillectomy between January 2025 and January 2026. Demographic information, preoperative symptoms, resolution of symptoms following the operation and complications were recorded from medical records. Outcomes evaluated were symptomatic improvement and residual features of OSA at follow-up. Statistical analysis occurred through descriptive and inferential approaches, p<0.05 was accepted as significant. Results: OSA symptoms resolved completely in 68% of children, whereas 22.7% improved partially and 9.3% remained unchanged postoperatively. The most frequently observed preoperative symptoms included habitual snoring (100%), mouth breathing (84%) and witnessed apnea (74.7%). Postoperative complications were mostly mild, and pain occurred in 78.7%, secondary haemorrhage in 6%, infection in 4% and respiration problems in 3.3% of patients. Older age, obesity and severe preoperative OSA were independent risk factors for incomplete resolution of symptoms. Conclusion: Tonsillectomy is an effective and safe therapy for pediatric OSA, but some children have residual disease. For superior long-term outcomes after surgery, it’s important to have close follow-up and treatment from a variety of fields.

Background: Influenza remains a significant cause of morbidity and mortality worldwide, with antiviral therapy serving as a cornerstone of management. The optimal timing of neuraminidase inhibitor initiation remains debated, particularly regarding clinical benefit beyond the recommended 48-hour window from symptom onset. This study compared clinical outcomes between early and delayed antiviral therapy in hospitalized influenza patients. Methods: A prospective cohort study was conducted at tertiary care hospitals, enrolling 386 laboratory-confirmed influenza patients aged ≥18 years. Participants were categorized into early treatment (antiviral initiation ≤48 hours from symptom onset, n=234) and delayed treatment (>48 hours, n=152) groups. Primary outcomes included hospital length of stay, time to clinical improvement, and complications. Secondary outcomes comprised intensive care unit (ICU) admission, mechanical ventilation requirement, and in-hospital mortality. Results: Mean age was 52.4 ± 16.8 years, with 56.7% having influenza A. Early treatment group demonstrated significantly shorter hospital stay (5.8 ± 2.3 vs. 8.4 ± 3.6 days, p < 0.001), faster symptom resolution (4.2 ± 1.6 vs. 6.7 ± 2.4 days, p < 0.001), and lower complication rates (18.4% vs. 35.5%, p < 0.001) compared to delayed treatment. Early therapy was associated with reduced ICU admission (12.8% vs. 27.0%, p = 0.001), mechanical ventilation (8.1% vs. 19.7%, p = 0.002), and mortality (3.4% vs. 10.5%, p = 0.007). Multivariable analysis revealed early treatment as an independent predictor of favorable outcomes (adjusted OR = 0.42, 95% CI: 0.26-0.68, p < 0.001). Benefits were observed across age groups and influenza subtypes, with greatest impact in high-risk patients. Conclusion: Early antiviral therapy within 48 hours of symptom onset significantly improves clinical outcomes in hospitalized influenza patients, reducing disease severity, complications, and healthcare resource utilization. These findings support aggressive implementation of early treatment protocols and highlight the importance of rapid diagnostic testing and timely therapeutic intervention.

Background: Induction of general anaesthesia is associated with significant hemodynamic alterations, including hypotension and tachycardia, which may adversely affect patient outcomes. Propofol, though widely used, is known for its cardiovascular depressant effects, whereas etomidate is considered to provide greater hemodynamic stability. This study was undertaken to compare the hemodynamic responses of these two agents during induction of general anaesthesia. Aim: To compare the effects of propofol and etomidate on heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) during induction and following endotracheal intubation. Materials and Methods: This prospective, randomized, comparative study included 100 patients (ASA I–II), aged 18–60 years, undergoing elective surgeries under general anaesthesia. Patients were randomly allocated into two groups: Group P (Propofol 2 mg/kg, n=50) and Group E (Etomidate 0.3 mg/kg, n=50). Hemodynamic parameters (HR, SBP, DBP, MAP) were recorded at baseline, post-induction, immediately after intubation, and at 1, 3, 5, and 10 minutes thereafter. Data were analyzed using Student’s unpaired t-test and Chi-square test, with p < 0.05 considered statistically significant. Results: Propofol induction resulted in a significant reduction in mean arterial pressure (13.6% decrease post-induction) compared to etomidate (p < 0.05). Heart rate increased significantly in the propofol group, with a 10.9% higher value at intubation compared to the etomidate group (p = 0.001). Etomidate demonstrated superior hemodynamic stability with minimal fluctuations in HR and MAP. The incidence of hypotension was significantly higher in Group P (28%) compared to Group E (10%) (p = 0.02). Myoclonus was observed only in the etomidate group (18%), whereas injection pain was more common with propofol (22%). Conclusion: Etomidate provides significantly better hemodynamic stability than propofol during induction of general anaesthesia, with reduced incidence of hypotension and attenuated stress response to intubation. Despite a higher incidence of myoclonus, etomidate may be preferred in patients where cardiovascular stability is of paramount importance.

Background: Diabetes mellitus type 2 (T2DM) is an example of a multifactorial disease affected by multiple genetic and environmental factors. Studies have shown that receptor-based pathways like the Vitamin D receptor (VDR) and angiotensin-converting enzyme 2 (ACE2) pathways have significant involvement in glucose metabolism, inflammation, and insulin resistance. Variations in these receptors may be responsible for diabetes predisposition. Objective: This study was conducted to elucidate the relationship between the polymorphisms of VDR gene (BsmI, FokI, and TaqI) and ACE2 gene (II, DD, and I/D) and their involvement in the development of T2DM. Methods: The study population consisted of 365 subjects, among which there were 185 T2DM patients and 180 normal control subjects. The serum concentration of 25-hydroxy vitamin D was quantified using enzyme-linked immunosorbent assay. The genomic DNA was isolated from blood samples, and the polymorphisms in the ACE2 gene were determined using polymerase chain reaction analysis. Results: The incidence of VDR polymorphisms was found to be much higher among T2DM patients compared to the control group, with BsmI (77 against 17), FokI (60 against 0), and TaqI (51 against 1) polymorphisms showing a significant increase. In contrast, there is a clear predominance of the DD genotype in the diabetic population (133 subjects), whereas the II genotype is more common among the control group (169 subjects). The I/D heterozygote genotype was present only rarely in both populations. Overall, there is evidence of a strong correlation between the presence of VDR polymorphisms and the ACE2 DD genotype. Conclusion: The study results show that there is a strong relationship between the polymorphisms of genes VDR and ACE2 and susceptibility to T2DM. The presence of both the polymorphic forms of VDR genes and ACE2 genotype DD underscores the importance of the relationship between the VDR–ACE2–RAAS axis in the development of diabetes.

Background: Postoperative pain following laparoscopic cholecystectomy remains a significant clinical concern despite the minimally invasive nature of the procedure. Intraperitoneal instillation of local anesthetic agents has emerged as an effective technique for reducing postoperative pain. The present study was conducted to compare the analgesic efficacy of intraperitoneal ropivacaine and bupivacaine in patients undergoing laparoscopic cholecystectomy. Materials and Methods: A prospective, randomized, double-blind comparative study was conducted on 100 patients aged 18–65 years belonging to ASA physical status I and II undergoing laparoscopic cholecystectomy under general anesthesia. Patients were randomly divided into two groups of 50 each. Group A received 20 mL of 0.5% bupivacaine intraperitoneally, while Group B received 20 mL of 0.5% ropivacaine intraperitoneally following gallbladder removal. Postoperative pain was assessed using the Visual Analog Scale (VAS) at predefined intervals up to 24 hours. Hemodynamic parameters, postoperative nausea and vomiting, rescue analgesic requirement, and adverse effects were also evaluated. Statistical analysis was performed using SPSS version 22, and p<0.05 was considered statistically significant. Results: The mean age of patients was 46.3 years in Group A and 43.7 years in Group B. Females predominated in both groups. The mean duration of surgery was comparable between Group A (60.3 ± 5.9 minutes) and Group B (63.7 ± 6.1 minutes) with no significant difference (p=0.255). Postoperative VAS scores were comparable during the initial postoperative period at 0, 0.5, 1, and 2 hours. However, Group B demonstrated significantly lower VAS scores at 4, 6, and 8 hours postoperatively compared to Group A (p<0.05), indicating superior analgesic efficacy of ropivacaine during the intermediate postoperative period. At 12 and 24 hours, pain scores again became comparable between the groups. Conclusion: Both intraperitoneal bupivacaine and ropivacaine were effective in providing postoperative analgesia following laparoscopic cholecystectomy. However, ropivacaine demonstrated superior analgesic efficacy with significantly lower postoperative pain scores during the intermediate postoperative period. Therefore, intraperitoneal ropivacaine may be considered a more effective option for postoperative pain management in laparoscopic cholecystectomy.

Background: Armed conflict poses unique challenges to surgical management due to resource limitations, logistical constraints, and high casualty loads. Forward Surgical Centres (FSCs) play a critical role in managing combat trauma under austere conditions, particularly during modern kinetic warfare. Aim: To describe injury patterns, damage control strategies, and early outcomes of combat casualties managed at a Forward Surgical Centre during active conflict. Method: This retrospective case series describes eight representative combat casualties selected from a total of 18 patients managed at a Forward Surgical Centre over 96 hours. Patients underwent rapid triage, ATLS-based resuscitation, and damage control resuscitation and surgery. Outcomes included survival, evacuation status, and limb salvage. Results: The mean age was 34.4 ± 6.4 years. Injuries involved extremities, abdomen, head and neck, and genital regions. Of the eight patients, five survived initial management at the FSC and were evacuated. Two patients died at the FSC. One patient survived initial stabilization but later succumbed at a higher centre due to sepsis. Limb-threatening trauma occurred in four cases, with one eventual amputation. Conclusion: FSCs are vital in reducing mortality and morbidity in combat trauma through timely haemorrhage control, damage control resuscitation and surgery, and rapid evacuation.

Background: Superior labrum anterior to posterior (SLAP) tears are common shoulder injuries, particularly in overhead athletes, often presenting with pain, instability, and reduced function. Conservative management, emphasizing non-surgical therapies and exercises, is frequently recommended as first-line treatment, but evidence on its efficacy varies. Objective: To review the literature on conservative management of SLAP tears, focusing on therapies (e.g., rest, medications, injections) and exercises (e.g., range of motion, strengthening, scapular stabilization), and evaluate outcomes such as pain relief, function, and return to sport. Methods: A narrative review based on systematic searches in PubMed, MEDLINE, Cochrane Library, and Embase using terms like “conservative management SLAP tear,” “physical therapy SLAP tear,” and “exercises SLAP tear.” Included were systematic reviews, meta-analyses, cohort studies, case series, and expert guidelines from 2010 to 2023. Results: Conservative approaches yield success rates of 50-78% for return to play, with higher rates (76-78%) among those completing rehabilitation. Key therapies include rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections. Exercises focus on restoring glenohumeral range of motion (ROM), strengthening rotator cuff and scapular stabilizers, and addressing kinetic chain deficits. Protocols typically span 3-6 months, with phased progression from passive ROM to sport-specific drills. Patient-reported outcomes improve significantly, though evidence is limited by study quality. Conclusion: Conservative management is effective for many SLAP tears, particularly non-traumatic or low- demand cases, avoiding surgical risks. As a PMR specialist, we emphasize structured, individualized rehabilitation programs. High-quality RCTs are needed for stronger evidence.

Background: The COVID-19 pandemic brought about an abrupt shift from face-to-face teaching to digital platforms, profoundly affecting the learning environment and mental well-being of students. Medical education, being highly rigorous and interactive, was especially disrupted. This study assesses perceived stress levels among medical students, compares stress during online and offline classes, and identifies contributing factors. Objectives: To compare perceived stress levels during online and offline teaching and identify associated stressors. Methods: A cross-sectional comparative study was conducted among 150 first-year MBBS (Bachelor of Medicine, Bachelor of Surgery) students using the Perceived Stress Scale (PSS-10). The mean stress scores during online and offline modes were compared using the paired Student’s t-test. Ethical approval was granted by the Institutional Ethics Committee. Results: Mean PSS scores were significantly higher during online classes (24.85 ± 5.27) compared to offline sessions (18.01 ± 6.49) (p < 0.01). Severe stress was observed in 33% of students during online learning versus 10% during in-person classes. Gender differences were not statistically significant. Conclusion: Perceived stress was significantly higher during online learning, likely due to limited peer and teacher interaction, reduced academic engagement, and difficulty adapting to e-learning platforms. Although stress declined during offline teaching, persistent moderate stress highlights the need for hybrid teaching approaches supported by regular mentoring and psychological support services.

Background: Surgical site infections (SSIs) are a major cause of postoperative morbidity and are associated with increased healthcare burden. The changing bacteriological profile and rising antimicrobial resistance necessitate continuous surveillance. Aim: To determine the incidence, bacteriological profile, and antimicrobial susceptibility pattern of surgical site infections in a tertiary care hospital. Methods: A cross-sectional study was conducted on 150 patients with SSIs. Samples were collected aseptically and processed for bacterial identification and antibiotic susceptibility testing using standard microbiological methods. Results: The overall culture positivity rate was 64%. Staphylococcus aureus (29.09%) was the most common isolate, followed by Escherichia coli (20%) and Pseudomonas aeruginosa (16.36%). Gram-positive cocci showed high sensitivity to Linezolid, Teicoplanin, and Vancomycin, while Gram-negative bacilli were most sensitive to Piperacillin-tazobactam and Meropenem. Increasing resistance to commonly used antibiotics was observed. Conclusion: SSIs remain a significant healthcare challenge with a diverse microbial profile and rising antimicrobial resistance. Regular surveillance and rational antibiotic policies are essential for effective management.

Introduction: Digital eye strain (DES) has emerged as a significant public health concern due to the rapid increase in screen use across all age groups. It encompasses a spectrum of ocular and visual symptoms resulting from prolonged exposure to digital devices. This study was conducted to assess digital eye strain and screen-use habits among patients at a tertiary care hospital. Methods: This hospital-based cross-sectional study was conducted among 600 participants attending a tertiary care center. Data were collected using a pretested structured questionnaire capturing demographic details, screen usage patterns, and ocular symptoms. Associations between DES symptoms and risk factors such as screen time, viewing distance, and break practices were analyzed using chi-square tests, with statistical significance set at p<0.05. Results: The majority of participants reported at least one symptom of digital eye strain, with headache (68%), eye strain (65%), and watering (58%) being the most common. Female participants and individuals with prolonged screen exposure (>6 hours/day) demonstrated significantly higher symptom prevalence (p<0.05). Closer viewing distances (<50 cm) and infrequent breaks were also significantly associated with increased DES symptoms. Conclusions: Digital eye strain is highly prevalent in patients attending tertiary care settings and is strongly associated with modifiable behavioral factors. Promoting ergonomic practices, limiting screen time, and encouraging regular breaks may help reduce symptom burden.

Background: Studies have documented considerable inter-individual variability in the anterior chamber angle, emphasizing differences attributable to age, ethnicity, refractive status, and other ocular and Systemic Factors. Aim and Objective: To identify the normative distribution of anterior chamber angle (ACA) width and axial length (AL) in adult healthy individuals. Methods: In this cross-sectional study, 2000 eyes of subjects aged ≥18y were sampled at a tertiary care hospital of central India for 18 months. After a preliminary interview, the participants underwent optometric examinations including visual acuity and refraction measurement followed by slit lamp biomicroscopy. Finally, ocular imaging was done using the Sonomed Escalon 300A PacScan to measure AL and ZEISS CIRRUS HD-OCT 500 to measure ACA all four quadrants (superior, inferior, nasal, temporal) of both eyes. Results: Out of 2000 eyes studied, 47.7% (n=954) were females and 52.3% (n=1046) were males. Mean age of the subjects was 44.6 years (19-79 y). 16.8% (n=335) was hyperopic, 21.6% (n=432) was myopic. The mean AL was 23.45 ± 0.37 mm and mean ACA of superior, inferior, nasal, temporal quadrants was 32.40° ± 0.94°, 32.43° ± 0.92°, 32.47° ± 0.92° and 32.49°± 0.92° respectively. In the multivariable model, after adjusting for the effect of both eyes, the maximum AL and ACA were seen in myopic, male and 18-40 y age group, and minimum in hyperopic, females, >60 y age group subjects (p < 0.001). Conclusion: Normative value of AL, and ACA parameters are specific for each ethnicity, age and sex group. Any alteration in these parameters and their effect on refraction should be considered in this age group, especially in case of cataract surgery.

Background: P-wave dispersion (PWD) on electrocardiography reveals uneven atrial conduction and is considered a predictor of atrial arrhythmias. Body mass index (BMI) has been found to alter cardiac electrophysiology; nevertheless, its effect on P-wave dispersion in healthy people remains inadequately investigated. Objective: To evaluate the effect of BMI on ECG P-wave dispersion among healthy adults. Methods: This observational study was conducted over one year from January 2025 to December 2025 at Bhagwan Mahavir Institute of Medical Sciences and comprised 80 healthy adults aged 20–40 years. According to WHO guidelines, participants were divided into groups with normal and high BMIs. Standard 12-lead ECGs were evaluated to assess maximum P-wave duration (Pmax), minimum P-wave length (Pmin), and P-wave dispersion (PWD = Pmax − Pmin). Statistical comparison between groups was performed using the independent t-test. Results: Individuals with higher BMI revealed significantly increased Pmax and P-wave dispersion compared to those with normal BMI (p < 0.05). A positive connection was observed between BMI and PWD, indicating increasing atrial conduction heterogeneity with growing BMI. Conclusion: Even in healthy adults, elevated BMI is linked to longer P-wave dispersion, indicating early subclinical atrial electrical remodelling. Monitoring ECG parameters such as PWD may help in early identification of persons at risk for atrial arrhythmias.

Background: Smokeless tobacco (SLT) use is highly prevalent in low- and middle-income countries and is associated with numerous adverse health outcomes. Despite established links with cardiovascular diseases, the socio-demographic and lifestyle determinants of SLT use and their relationship with obesity and hypertension remain insufficiently explored. Objectives: To analyze the socio-demographic and lifestyle characteristics associated with smokeless tobacco consumption and to evaluate its association with obesity and hypertension among SLT users. Methods: A retrospective cross-sectional observational study was conducted over one year (October 2024 to September 2025) at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar. Seventy individuals with documented smokeless tobacco use who attended outpatient services were included. Socio-demographic data, duration and frequency of SLT use, alcohol consumption, physical activity, body mass index (BMI), and blood pressure were recorded. Obesity was defined as BMI ≥30 kg/m² and hypertension as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or current use of antihypertensive medications. Data were analyzed using descriptive statistics and chi-square test; a p-value <0.05 was considered statistically significant. Results: Males constituted 77.1% of SLT users, and 51.4% were aged 31–50 years. Lower educational attainment (primary or less: 42.9%) and manual occupations (60%) were predominant. Alcohol consumption was reported in 58.6% and sedentary lifestyle in 62.9% of participants. Obesity was found in 34.3% and hypertension in 40.0% of subjects. Among long-term SLT users (>10 years), the prevalence of obesity was 46.7% and hypertension was 53.3%, compared to 24.4% and 30.8% respectively in shorter-duration users (p<0.05). Both obesity and hypertension were present in 25.7% of participants. Conclusion: Smokeless tobacco use is strongly associated with obesity and hypertension, and is predominantly influenced by socio-demographic and lifestyle factors. Targeted public health interventions for SLT cessation and lifestyle modification are urgently needed to reduce the growing burden of non-communicable diseases.

Background: Heart rate variability (HRV) is a non-invasive indicator of cardiovascular health and autonomic nervous system control. Body mass index (BMI) extremes, such as being underweight or overweight, are known to affect autonomic balance, especially in young people. Objective: To compare heart rate variability parameters between underweight and overweight young individuals. Methods: This observational study was conducted over one year from July 2024 to June 2025 at Bhagwan Mahavir Institute of Medical Sciences and comprised 90 young individuals aged 18–25 years. Based on BMI, individuals were divided into underweight and overweight groups. Time-domain and frequency-domain HRV characteristics were examined from resting ECG recordings. Results: Underweight individuals displayed considerably greater HRV values of SDNN (Standard Deviation of Normal-to-Normal Intervals), RMSSD (Root Mean Square of Successive Differences) compared to overweight persons, indicating superior parasympathetic regulation. Overweight individuals had lower HRV with a greater LF (Low-frequency) / HF (High-frequency) ratio, suggesting sympathetic predominance. Conclusion: Both underweight and overweight status are associated with altered autonomic function, with overweight individuals exhibiting greater autonomic imbalance. Early lifestyle interventions may help restore autonomic equilibrium and reduce future cardiovascular risk.

Purpose: To characterize the spectrum and temporal evolution of chest CT findings in patients with COVID-19 pneumonia across four defined stages of illness. Materials and Methods: In this single-institution retrospective study, 105 consecutive patients with laboratory-confirmed SARS-CoV-2 infection who underwent non-contrast chest CT from May 2020 to February 2021 were enrolled. Patients were stratified by interval from symptom onset to CT scan into five groups: early (0–4 days; n=28), progressive (5–8 days; n=28), peak (9–13 days; n=23), late (14–30 days; n=17), and delayed (>30 days; n=9). CT images were evaluated for 17 distinct findings using standard Fleischner Society nomenclature. Disease burden was quantified using a validated 25-point lobar CT severity score. Results: Ground glass opacity (GGO) was the dominant finding in the early stage (89%), declining progressively to 11% in the delayed stage. Consolidation peaked in the early and progressive stages (50% each) and resolved completely by the delayed stage. Architectural distortion and reticular opacities emerged later, reaching 53% and 65% respectively in the late stage, with reticular opacities persisting at 56% in the delayed stage, indicating incomplete resolution. Vascular prominence was a consistent early marker (75% early stage). The mean CT severity score was 12.08 (range 0–25), with scores peaking at the late stage (13.05). Two novel findings were identified: fissural effusion (19 patients; 18%) and subpleural sparing (12 patients; 11%). Peripheral distribution predominated (61.9%). Conclusion: CT manifestations of COVID-19 pneumonia demonstrate predictable stage-specific patterns. Recognition of these patterns allows accurate radiological staging, facilitates prognostication, and supports treatment decision-making. Fissural effusion and subpleural sparing are proposed as novel CT findings in COVID-19.

Background: Bacterial vaginosis (BV) is a common vaginal infection among women of reproductive age, characterized by alteration of normal vaginal flora. Metronidazole is the standard treatment; however, Tinidazole has emerged as a potential alternative with better tolerability. Comparative evaluation of these drugs is essential for optimal management. The study is aimed to evaluate the efficacy and safety of oral Metronidazole and Tinidazole in the treatment of bacterial vaginosis using Amsel’s criteria. Materials and Methods: This open-label, interventional, comparative study was conducted over one year at a tertiary care hospital in Hyderabad. A total of 100 women diagnosed with BV were randomized into two groups: Group A received oral Metronidazole 500 mg twice daily for 5 days, and Group B received oral Tinidazole 500 mg once daily for 5 days. Patients were followed up at 1st and 4th week. Cure rates were assessed using Amsel’s criteria, and adverse effects were recorded. Statistical analysis was performed using Chi-square test with significance set at p<0.05. Results: At 1st week follow-up, cure rates were 40 (83.33%) in the Metronidazole group and 43 (89.58%) in the Tinidazole group (p>0.05). At 4th week, cure rates were 34 (70.83%) and 35 (72.91%) respectively (p>0.05). Adverse effects, particularly gastrointestinal symptoms, were more frequent in the Metronidazole group, whereas Tinidazole demonstrated better tolerability, though differences were not statistically significant. Conclusion: Both Metronidazole and Tinidazole are equally effective in the treatment of Bacterial vaginosis, with comparable safety profiles. Although Tinidazole did not demonstrate a statistically significant difference in safety compared to Metronidazole, it may offer advantages in terms of better tolerability, improved patient compliance due to once-daily dosing, and potentially higher cure rates.

Background: Accurate estimation of lumbar skin-to-subarachnoid space depth (SSD) is essential for successful neuraxial anesthesia and image-guided lumbar procedures. Conventional landmark-based techniques may be unreliable in patients with obesity or altered body habitus, leading to multiple puncture attempts and increased procedural complications. Anthropometric parameters may provide a simple and clinically useful method for predicting spinal needle depth. Aim: To evaluate the relationship between anthropometric parameters and lumbar subarachnoid space depth in adults undergoing spinal anesthesia and to identify the most reliable predictor for use in imaging-guided and safe neuraxial procedures. Materials and Methods: This prospective observational study was conducted among 100 adult patients undergoing elective below-umbilical surgeries under spinal anesthesia in a tertiary care teaching hospital. Anthropometric measurements including weight, height, body mass index (BMI), waist circumference, and arm circumference were recorded preoperatively. Spinal needle depth was measured intraoperatively at the L3–L4 intervertebral level using a standard midline approach with a 25G Quincke spinal needle. Pearson’s correlation coefficient was used to assess the relationship between anthropometric variables and spinal needle depth. Results: All anthropometric variables demonstrated statistically significant positive correlations with spinal needle depth (p < 0.001). Weight showed the strongest correlation (r = 0.812), followed by BMI (r = 0.668), waist circumference (r = 0.666), and arm circumference (r = 0.643). Height demonstrated the weakest correlation (r = 0.444). Increased body habitus was associated with greater depth to the subarachnoid space. Conclusion: Anthropometric parameters significantly influence lumbar subarachnoid space depth, with body weight emerging as the strongest predictor. Incorporation of simple anthropometric assessment into routine preprocedural evaluation may improve the success rate of neuraxial procedures, facilitate imaging-guided interventions, and reduce complications associated with repeated puncture attempts.

Background: Fine needle aspiration cytology (FNAC) is a widely accepted, minimally invasive, and cost-effective first-line diagnostic tool for salivary gland lesions. The morphological heterogeneity of these tumors presents significant diagnostic challenges. This study evaluates the diagnostic accuracy, sensitivity, and specificity of FNAC in major salivary gland lesions and correlates findings with histopathological diagnosis. Methods: A prospective study of 45 patients presenting with major salivary gland swellings was conducted at the Department of Pathology, Coimbatore Medical College and Hospital, over a 12-month period (August 2018–July 2019). FNAC was performed with a 23–24 gauge needle; smears were stained with Hematoxylin & Eosin (H&E) and May-Grünwald Giemsa (MGG). Histopathological specimens were processed and stained with H&E. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using histopathology as the gold standard. Results: Parotid gland was the most frequently involved site (60%). Male predominance was observed (60%), with a mean age of 47.7 ± 11.9 years. On FNAC, 27% of cases were non-neoplastic, 69% benign, and 4% malignant; histopathology confirmed 20% non-neoplastic, 62% benign, and 18% malignant. Pleomorphic adenoma was the most common benign neoplasm (42.2% on HPE) and mucoepidermoid carcinoma the most common malignancy (13.3% on HPE). FNAC showed a sensitivity of 85% and specificity of 100% for benign lesions, and sensitivity of 87.5% and specificity of 100% for malignant lesions. Conclusions: FNAC demonstrates high sensitivity, specificity, and diagnostic accuracy in salivary gland lesions and remains an invaluable pre-operative tool when interpreted in conjunction with clinical and radiological findings. Awareness of cytomorphological pitfalls, particularly the pleomorphic adenoma/mucoepidermoid carcinoma interface, is essential to minimize diagnostic errors.

Aim: Quadratus lumborum block (QLB) has proven to be an effective analgesic technique in various abdominal surgeries. Magnesium sulfate as an adjuvant in different nerve blocks has been well studied. The aim of this study was to assess the efficacy of magnesium sulfate as an adjuvant to ropivacaine in an ultrasound-guided QLB for postoperative analgesia in abdominal surgeries. Methods: This study was done in 70 patients posted for abdominal surgeries who were divided into two groups of 35 each. QLB was given bilaterally in group RS with 40 ml of 0.375% ropivacaine with 4 ml saline and in group RM with 40 ml of 0.375% ropivacaine with 10% magnesium sulfate 4ml.Patients were operated under general anesthesia and were examined for pain at different time points postoperatively. Time required for first analgesic demand was our primary aim. Secondary aim was total rescue analgesia (paracetamol) required in 24 hrs, pain scores, nausea, vomiting, sedation and any other complications. Results: The time required for first analgesic demand was 15.9± 1.8hrs in RM group and 11.2± 0.9 hrs in group RS which was statistically significant. The total paracetamol consumption in 24 hours was1.7± 0.5 gm in group RM and 3.1± 0.9 gm in group RS, the difference being significant. Conclusion: Magnesium sulfate as an adjuvant to ropivacaine in quadratus lumborum block prolong duration of postoperative analgesia after abdominal surgeries. It not only improves the visual analogue scale (VAS) score but also decreases the rescue analgesic consumption without any complications.

Aim: The aim of our study was to compare onset of action, hemodynamic effects, intubating conditions and any adverse effects of cisatracurium and atracurium in patients posted for burn surgeries under general anaesthesia. Method: Sixty patients were randomly assigned to one of two groups, group A received 0.5mg/kg of atracurium, and group C received 0.2mg/kg of cisatracurium for intubation. Onset time, duration of action, condition of intubation, hemodynamic effects, and clinical signs of histamine release were monitored. Results: Onset time was found to be significantly less with cisatracurium compared to atracurium. At the same time, cisatracurium provided longer duration of action and better intubating condition compared to atracurium in burn surgeries. Conclusion: Cisatracurium has a quicker onset time and provides better conditions for tracheal intubation, compared to atracurium. Cisatracurium have a better safety profile than atracurium in burn surgeries.

Background and aim: Acute appendicitis is one of the most common surgical emergencies in children, and appendicular perforation remains an important complication associated with increased morbidity. Early identification of factors associated with perforation may help in timely diagnosis and prompt management. The present study was undertaken to assess the factors associated with appendicular perforation in children undergoing surgery for acute appendicitis at a tertiary care hospital in Tamil Nadu. Materials and Methods: This hospital-based cross-sectional study included 130 children diagnosed with acute appendicitis and undergone surgery. The records of the children admitted and treated for acute appendicitis from 2023 to 2025 were taken. The details were collected using a semi-structured questionnaire. The data were entered in MS excel and analysed using SPSS. Appropriate descriptive and inferential statistics were used with p<0.05 was considered as statistically significant. Results: The mean (SD) age of the study participants was 9.7 (1.8) years, and 68.5% were males. Appendicular perforation was observed in 26 (20%) children. Abdominal pain was the most common presenting symptom (92.3%), followed by rebound tenderness (83.8%), right iliac fossa tenderness (81.5%), and fever (66.2%). Male gender was significantly associated with appendicular perforation (24.7% vs 9.8%, p=0.047). Among clinical features, fever (p=0.026), guarding (p=0.033), and rigidity (p<0.001) showed significant association with perforation. Raised WBC count (p<0.001) and raised neutrophil count (p<0.001) were also strongly associated with perforation. Age, vomiting, anorexia, nausea, diarrhoea, delayed presentation, right iliac fossa tenderness, rebound tenderness, and diffuse tenderness were not significantly associated with perforation. Conclusion: Appendicular perforation was present in one-fifth of children undergoing surgery for acute appendicitis. Male gender, fever, guarding, rigidity, leukocytosis, and neutrophilia were significantly associated with appendicular perforation. Careful clinical assessment supported by basic laboratory parameters may help identify children at higher risk of perforation and facilitate earlier surgical decision-making.

Background: Dengue fever exhibits a wide spectrum of clinical severity. Although thrombocytopenia is a key laboratory feature, platelet count alone does not reflect total platelet biomass. Plateletcrit (PCT), an automated platelet index, represents total circulating platelet mass and may better correlate with disease severity. Aim: To evaluate the association between plateletcrit and clinical severity in patients with dengue fever. Materials and Methods: This hospital-based observational study included 150 serologically confirmed dengue patients. Clinical severity was classified according to World Health Organization (WHO) criteria. Plateletcrit values at presentation were analyzed and correlated with disease severity using appropriate statistical methods. Results: Mean plateletcrit values showed a statistically significant and progressive decline with increasing clinical severity. Patients with severe dengue had markedly lower plateletcrit values compared to those with non-severe dengue (p < 0.001). A significant negative correlation was observed between plateletcrit and disease severity (r = −0.62). Box plot and trend analyses demonstrated a consistent decrease in plateletcrit values with worsening disease severity. Conclusion: Plateletcrit shows an inverse relationship with clinical severity in dengue fever and may serve as a simple, inexpensive, and readily available prognostic marker for early identification of patients at risk of severe disease.

Background: Pterygium is a degenerative, fibrovascular growth of conjunctiva onto the cornea, frequently associated with ultraviolet light exposure and chronic ocular surface irritation. Conjunctival autografting (CAG) has emerged as the gold standard for reducing recurrence, but traditional sutured fixation is associated with postoperative pain, foreign body sensation, and suture-related complications. Sutureless and glue-assisted methods improve comfort and reduce operative time but data from cost-sensitive, high-volume Indian public hospitals remain limited. Objective: To compare postoperative comfort, visual outcomes, and patient satisfaction after pterygium excision with CAG secured by either conventional absorbable sutures or a sutureless, glue-free technique. Methods: This prospective comparative study included 60 eyes of 60 patients with primary nasal pterygium at the Regional Institute of Ophthalmology, Kolkata, over July 2024–June 2025. Patients were alternately assigned to Group A (sutured CAG) or Group B (sutureless CAG). Outcomes included composite comfort score (pain VAS 0–10, foreign body sensation, watering, photophobia), visual acuity (UCVA, BCVA), keratometric astigmatism, operative time, complications, and recurrence at 3 months. Statistical analysis used independent t test, Mann–Whitney U, χ²/Fisher’s exact, and repeated measures ANOVA; p< 0.05 was significant. Results: Baseline demographics and preoperative UCVA/astigmatism were similar (all p> 0.5). Mean operative time was significantly shorter for sutureless CAG (21.5 ± 3.6 min vs. 31.8 ± 4.2; p<0.001). Comfort scores were lower in the sutureless group at day 1 (6.8 ± 1.9 vs. 12.1 ± 2.3; p< 0.001), week 1 (2.9 ± 1.2 vs. 6.4 ± 1.7; p< 0.001), and month 1 (0.9 ± 0.4 vs. 1.8 ± 0.7; p = 0.002). Repeated measures ANOVA confirmed a strong time effect (F[2,116] = 486.2, p< 0.001) and time × group interaction (F[2,116] = 42.8, p< 0.001).
UCVA improved faster with sutureless grafting: 1-month logMAR 0.20 ± 0.11 vs. 0.26 ± 0.12 (p = 0.048), 3-month 0.14 ± 0.08 vs. 0.18 ± 0.09 (p = 0.047), while BCVA and final astigmatism were similar (3-month astigmatism 1.28 ± 0.44 D vs. 1.46 ± 0.49 D; p = 0.12). Complications were minimal: suture granuloma occurred only in Group A (10%), mild transient graft retraction in Group B (6.7%); early recurrence was low and equal (3.3% both; p = 1.00). Patient satisfaction was significantly higher in the sutureless group (4.6 ± 0.5 vs. 4.1 ± 0.6; p = 0.004). Conclusion: Sutureless, glue-free CAG after pterygium excision reduces operative time, improves early postoperative comfort, and accelerates visual recovery while maintaining low complication and recurrence rates. It represents a safe, efficient, and cost-effective alternative to sutured fixation, particularly valuable in high-volume tertiary care hospitals in India.

Ocular trauma is an eye emergency and is one of the leading causes of preventable visual impairment morbidity. Trauma may or may not be associated with foreign body lodgement in the globe but it’s localization and removal plays a crucial role in management and prognosis. The location and damage caused by an IOFB depends on several factors including the size, shape, and composition of the object as well as the momentum of the object at time of impact. FBs can cause direct damage via entry into the eye but can also ricochet in the eye causing further damage. Subsequent damage depends on the composition of IOFB. High-speed, small FBs will cause a small linear laceration that is less damaging than blunt trauma. Large irregular IOFBs, however, can cause significant initial damage. Here we report a 27 years old, who presented with high velocity trauma to left eye with no perception of light. Slit lamp examination revealed ocular structures distortion. NCCT revealed a large hyperdense object in left orbit. Frill evisceration with removal of the stone of size 2.2x2x2.3 cm, was performed on immediate basis. Patient has been planned for a custom-made ocular implant, which will be later fitted to improve the patient’s cosmetic appearance. Further it reduced the chances of sympathetic ophthalmia thereby preventing the patient from any threats of becoming completely blind. Thus, this case highlights the importance of proper evaluation and prompt management in case of ocular traumas to prevent any further catastrophe.

Aims and Objective: Spinal anesthesia is a safe and reliable technique for urological surgery, providing excellent analgesia and muscle relaxation. Ropivacaine is a long-acting anesthetic drug with a greater margin of safety compared to bupivacaine. Nalbuphine is a mixed agonist-antagonist opioid that provides analgesia and sedation without significant side effects. The aim of this study was to evaluate the effect of intrathecal nalbuphine on sensory and motor block characteristics, prolongation of postoperative analgesia and side effects when used as an adjuvant with isobaric 0.75% ropivacaine in spinal anesthesia. Materials and Method: This prospective, randomized, controlled, double-blind study included 60 patients undergoing elective endoscopic urological surgery under spinal anesthesia. Patients were randomly allocated into two groups: Group I received isobaric ropivacaine (0.75%) 2.5 ml with normal saline 1 ml, while Group II received isobaric ropivacaine (0.75%) 2.5 ml with nalbuphine (0.8mg). Sensory and motor block characteristics, postoperative analgesia, and side effects were assessed. Results: The mean onset time of sensory block in group II was found to be significantly less than in group I, (p = 0.006.). The mean onset time of motor block and time to complete motor block was significantly earlier in Group II as compared to Group I (p=0.0277 and p=0.046 respectively). The time to first rescue analgesic was significantly longer in Group II (p=0.0054), and the number of doses required in 24 hours was significantly lower in Group II (p=0.0018).

Background: The optimal surgical approach for colectomy in elderly patients remains debated, with concerns regarding tolerability of laparoscopic procedures in this vulnerable population. This study compared short-term and intermediate-term outcomes of laparoscopic versus open colectomy in patients aged ≥70 years. Methods: A multicenter retrospective cohort study was conducted across tertiary hospitals. Data from 1,856 elderly patients (≥70 years) undergoing elective colectomy for colorectal neoplasms were analyzed. Patients were categorized into laparoscopic (n=1,124, 60.6%) and open (n=732, 39.4%) colectomy groups. Primary outcomes included operative time, estimated blood loss, length of hospital stay, and 30-day morbidity. Secondary outcomes comprised postoperative complications, readmission rates, and 90-day mortality. Propensity score matching and multivariable regression analyses adjusted for baseline differences. Results: Mean age was 76.4 ± 5.2 years. After propensity score matching (n=658 pairs), laparoscopic colectomy demonstrated significantly longer operative time (178.3 ± 48.6 vs. 154.2 ± 42.8 minutes, p < 0.001) but reduced blood loss (82.4 ± 56.3 vs. 186.7 ± 124.5 mL, p < 0.001), shorter hospital stay (6.8 ± 3.2 vs. 9.4 ± 4.6 days, p < 0.001), and lower overall morbidity (18.4% vs. 31.2%, p < 0.001). Laparoscopic approach was associated with reduced wound infections (4.3% vs. 12.6%, p < 0.001), pneumonia (5.2% vs. 11.1%, p < 0.001), and ileus (8.7% vs. 15.5%, p = 0.001). No significant differences emerged in anastomotic leak rates (3.8% vs. 4.7%, p = 0.452) or 30-day mortality (1.5% vs. 2.4%, p = 0.289). Multivariable analysis confirmed laparoscopic surgery as an independent predictor of reduced complications (OR = 0.52, 95% CI: 0.38-0.71, p < 0.001). Conclusion: Laparoscopic colectomy in carefully selected elderly patients offers significant advantages over open surgery, including reduced morbidity, shorter hospitalization, and faster recovery without compromising oncological safety. These findings support broader adoption of minimally invasive techniques in geriatric surgical populations.

Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections encountered in clinical practice and are associated with significant morbidity and increasing antimicrobial resistance worldwide. The emergence of multidrug-resistant uropathogens has complicated empirical treatment strategies, making continuous surveillance of bacteriological profiles and antibiotic susceptibility patterns essential for effective management. Materials and Methods: This prospective observational study was conducted in the Department of Microbiology at GMERS Medical College and Hospital, Sola, Ahmedabad, from July 2022 to January 2024 after institutional ethics approval. A total of 747 adult patients clinically suspected of UTI were included. Clean-catch midstream urine samples were processed using standard microbiological techniques. Semi-quantitative urine culture, organism identification, and antimicrobial susceptibility testing were performed according to standard biochemical methods and CLSI guidelines using the Kirby–Bauer disk diffusion method. Results: Out of 747 urine samples, 348 (46.59%) were culture positive. Females constituted the majority of positive cases (67.53%), and the highest prevalence was observed in the 18–30 years age group (39.94%). Gram-negative bacilli accounted for 89.37% of isolates, while Candida species and Gram-positive cocci constituted 8.91% and 1.72%, respectively. Escherichia coli was the predominant pathogen isolated in 247 cases (70.98%), followed by Klebsiella pneumoniae in 40 cases (11.50%). Higher culture positivity was observed among inpatient samples (59.45%) compared to outpatient samples (38.38%). Antimicrobial susceptibility testing revealed high resistance to ampicillin, fluoroquinolones, and cephalosporins. E. coli demonstrated maximum resistance to ampicillin (82.5%) but retained good sensitivity to nitrofurantoin with only 8% resistance. ESBL production was observed in approximately 29–32% of isolates, while carbapenem resistance ranged from 25% to 44%. Gram-positive isolates remained sensitive to vancomycin and linezolid. Conclusion: Urinary tract infections were predominantly caused by Gram-negative bacilli, especially Escherichia coli, with high resistance to commonly used antibiotics. Nitrofurantoin and aminoglycosides remained comparatively effective. Regular surveillance and antibiotic susceptibility testing are essential for appropriate management and control of antimicrobial resistance.

Background: The length of hospital stay (LoHS) in a neonatal intensive care unit (NICU) is an important surrogate marker of neonatal morbidity, clinical complexity, and resource utilization. Identifying the determinants of prolonged NICU stay is essential for improving care quality, planning resources, and reducing healthcare costs, particularly in resource-limited settings. Objectives: To identify the clinical, demographic, and perinatal determinants of length of hospital stay among neonates admitted to the NICU of a tertiary care hospital. Methods: This observational study was conducted over a period of 12 months at the NICU of a tertiary care teaching hospital in Gujarat. A total of 320 neonates meeting inclusion criteria were enrolled. Detailed perinatal, demographic, and clinical data were collected. Prolonged LoHS was defined as hospital stay beyond the 75th percentile of the study sample. Univariate and multivariate logistic regression analyses were used to identify independent determinants of prolonged LoHS. Results: The mean LoHS was 8.4 ± 6.2 days (range 1–52 days). Prolonged LoHS (>14 days) was observed in 28.4% of neonates. On multivariate analysis, significant independent determinants of prolonged LoHS included: low birth weight (LBW) (<2500 g) (aOR 3.21; 95% CI 1.87–5.51, p<0.001), prematurity (gestational age <37 weeks) (aOR 2.94; 95% CI 1.72–5.03, p<0.001), neonatal sepsis (aOR 4.12; 95% CI 2.30–7.38, p<0.001), respiratory distress syndrome (RDS) (aOR 2.68; 95% CI 1.41–5.09, p=0.003), requirement of mechanical ventilation (aOR 3.56; 95% CI 1.89–6.71, p<0.001), outborn status (aOR 1.89; 95% CI 1.12–3.19, p=0.017), and late initiation of enteral feeding (aOR 2.45; 95% CI 1.33–4.52, p=0.004). Conclusions: LBW, prematurity, neonatal sepsis, RDS, mechanical ventilation, outborn status, and delayed enteral feeding are the major determinants of prolonged NICU stay. Targeted interventions to prevent and promptly treat these conditions may substantially reduce NICU LOHS and improve resource utilization.

Background: Anterior cruciate ligament (ACL) reconstruction can be performed using various autografts, with hamstring tendon and peroneus longus tendon being commonly used options. Aim and Objective: To compare functional outcomes and donor site morbidity between these two grafts. Materials and Methods: This prospective comparative study was conducted in a tertiary care centre in Bhopal and included 46 patients with ACL insufficiency, divided into two groups: peroneus longus (n=23) and hamstring (n=23). Patients underwent arthroscopic ACL reconstruction and were evaluated preoperatively and at 6 weeks, 3 months, and 6 months postoperatively using IKDC, Lysholm, range of motion, FADI, and AOFAS scores. Statistical analysis was performed using Stata 17.0, with p < 0.05 considered significant. Results: Both groups showed significant improvement in functional outcomes over time. The peroneus longus group demonstrated significantly higher IKDC scores, range of motion, and Lysholm scores from 6 weeks onward compared to the hamstring group (p < 0.05). However, donor site morbidity was higher in the peroneus longus group initially, as reflected by lower FADI and AOFAS scores, but these improved over time and became comparable by 6 months (p > 0.05). Conclusion: Both hamstring and peroneus longus autografts provide effective outcomes in ACL reconstruction. The peroneus longus graft shows better early functional recovery at the knee, while initial donor site morbidity is transient and resolves by 6 months. Both grafts are safe and reliable options for ACL reconstruction.

Background: Retinal illnesses are the major cause of visual impairment globally, and diseases including diabetic retinopathy, age-related macular degeneration, and retinal vein occlusion are some of the causes of impaired vision. Early and accurate diagnosis is essential for effective management. Optical Coherence Tomography (OCT) has become a non-invasive form of imaging that offers fine-scale cross-sectional images of the retinal structures and helps to diagnose and follow up on these diseases. Methods: This is a retrospective observational study conducted in a tertiary care facility and an analysis of the medical data of 98 patients with retinal diseases who will receive OCT imaging between October 2025 And March 2026 were included. Information on demographic factors, clinical diagnosis and OCT results such as central macular thickness, retinal thickness, intraretinal fluid, subretinal fluid and vitreoretinal interface changes were assessed and interpreted. The findings were summarized using descriptive statistics. Result: Most of the patients were aged between 51 to 60 years (28.6%), and men were predominant (57.1%). Diabetic retinopathy was the most common retinal disease (38.8%), followed by age-related macular degeneration (20.4%) and retinal vein occlusion (16.3%). The highest prevalence of OCT diagnosis was a macular edema (44.9%), then higher retinal thickness (40.8%), and subretinal fluid (28.6%). The diabetic retinopathy was mainly related to macular edema and retinal thickening whereas the subretinal fluid was common in age-related macular degeneration and central serous chorioretinopathy. Conclusion: OCT is a useful, non-invasive diagnostic technique that can effectively identify retinal diseases early and accurately characterize them, which enhances clinical decision-making and patient outcomes.

Background: Cataract is one of the major causes of reversible blindness in the world, especially in developing nations such as India. Phacoemulsification has become the gold standard surgical procedure because it is safe, has a quick recovery and better visual results. Methods: This retrospective observational study involved 98 patients who had phacoemulsification surgery from August 2023 to November 2025. Medical records were used in data collection, which included demographic information, preoperative and postoperative visual acuity, intraoperative and postoperative complications, and patient satisfaction levels. Descriptive and comparative statistical analysis was done with a significance level of p < 0.05. Findings: Visual acuity improved significantly after surgery, and 68.4% of patients were found to have a visual acuity of between 6/6 and 6/12, as opposed to only 8.2% before the surgery. The percentage of patients who were severely visually impaired (<6/60) has dropped from 61.2% % to 7.1%. The intraoperative problems were also minimal, as rupture of the posterior capsule happened in 4.1% of the cases. The rate of postoperative complications was low but corneal edema was the most frequent (8.2%), and there were no instances of endophthalmitis. Patient satisfaction was high and 73.5% of the patients were highly satisfied. Conclusion: Phacoemulsification surgery is a safe and effective surgery with high visual outcomes, low levels of complications and high levels of patient satisfaction. More prospective research on bigger samples and extended follow-up is suggested.

Background: Glaucoma is one of the major causes of permanent blindness globally, and the most important factor is increased Intraocular Pressure (IOP). The initial treatment should be medical therapy, although the effectiveness of drugs, adverse effects, and patient compliance may affect the treatment outcomes. Methods: A retrospective observational study was carried out at JNKT Medical College & Hospital, Madhepura, during August 2023 to September 2025. There were 102 patients with glaucoma who were under medical therapy. Hospital records were used to gather data which consisted of demographics, glaucoma type, medication type prescribed, baseline and follow-up IOP, side effects and adherence patterns. The SPSS and Excel were used to conduct the statistical analysis with a significance level of p < 0.05. Results: The mean baseline IOP of 26.4 ± 3.5 mmHg decreased significantly to 17.8 ± 2.9 mmHg at follow-up. The IOP reduction was the highest in the case of prostaglandin analogues, and then combination therapy. Beta-blockers had fewer side effects, whereas prostaglandins analogues tended to produce slight redness and irritation of the eyes. The total compliance was 72.5 %, and they had better compliance among patients receiving once-daily regimens. Cost, complexity in dosing, and information deficiency were some of the factors that affected adherence. Conclusion: Prostaglandin analogues worked most effective in IOP reduction whereas beta-blockers were more tolerable. The adherence of the patient is a crucial factor in the success of the treatment, highlighting the importance of simplified regimens and patient education are a key factor in the effective management of glaucoma.

Background: Age-related Macular Degeneration (AMD) is a significant cause of visual impairment in the elderly. As there are several treatment methods, it is essential to compare their efficacy and enhance patient outcomes and clinical decision-making. Methods: It is a hospital-based prospective comparative study that will be carried out at JNKT Medical College & Hospital, Madhepura, from August 2023 to December 2025. There were 105 patients aged ≥50 years with AMD. Patients were grouped into three categories Group A (anti-VEGF treatment, n=45), Group B (laser/photodynamic therapy, n=30), and Group C (nutritional/conservative management, n=30). Snellen chart was used to determine visual acuity at baseline and follow-up. Data were done on SPSS with statistical significance being entertained at p < 0.05. Results: Among the 105 patients, 58 were males and 47 were females, with a mean age of years. There was also improvement in visual acuity in 32 patients in Group A, 18 patients in Group B and 10 patients in Group C. No change in vision was noted in 10, 8, and 12 patients in Groups A, B, and C respectively, while worsening of vision occurred in 3, 4, and 8 patients, respectively. The statistical significance of the difference in the results between the groups was significant (p < 0.05). There were some minor complications and mild adverse effects as seen in 7 in Group A, 6 in Group B, and 2 in Group C. Conclusion: Anti-VEGF treatment proved to be the most efficient in terms of visual acuity and stabilization of AMD among other modalities. It is also the most efficient treatment option, and it has significant implications for clinical practice, especially in tertiary care.

Background: Effective postoperative pain control following cesarean section is essential for early recovery, maternal comfort, and optimal neonatal care. Opioid-based analgesia, though effective, is associated with significant side effects. The transversus abdominis plane (TAP) block, particularly via the posterior approach, has emerged as a promising regional analgesic technique with potential opioid-sparing benefits. Materials and Methods: This prospective, randomized, single-blinded controlled study included 50 ASA II patients undergoing elective cesarean section under spinal anesthesia. Patients were divided into two groups: study group received bilateral landmark-guided posterior TAP block with 0.2% ropivacaine (20 ml each side), while the control group received standard analgesia without TAP block. Postoperative pain was assessed using VAS scores at predefined intervals. Duration of analgesia, total rescue analgesic consumption, hemodynamic parameters, and adverse effects were recorded and analyzed. Results: The study group demonstrated significantly lower VAS scores at rest and on movement up to 12 hours postoperatively (p < 0.01). Duration of analgesia was significantly prolonged (15.36 ± 8.49 vs 11.04 ± 4.47 hours), and total tramadol requirement was markedly reduced (108.8 ± 64.31 vs 236 ± 74.83 mg) compared to control. Hemodynamic stability was better, and incidence of nausea and vomiting was lower in the study group. Conclusion: Posterior TAP block is an effective and safe modality for postoperative analgesia in cesarean section, significantly reducing pain and opioid consumption.

Introduction: This study compares the outcomes of early (within 72 hours) versus delayed (6–8 weeks) laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. Materials and Methods: A total of 90 patients were randomized to undergo either early or delayed LC. Primary outcomes included postoperative morbidity and hospital stay, while secondary outcomes included operative time, pain scores, recovery time, patient satisfaction, and healthcare costs. Data were analyzed using SPSS (p < 0.05). Results: The early surgery group had significantly lower complications (13% vs. 24%, p = 0.04) and shorter hospital stays (3.2 ± 1.0 vs. 6.4 ± 1.3 days, p < 0.001). Pain scores were lower in the early group (p = 0.01), and patient satisfaction was higher (8.6 ± 1.1 vs. 7.3 ± 1.4, p = 0.02). Healthcare costs were reduced in the early surgery group (₹45,000 ± 5,000 vs ₹58,000 ± 7,500, p < 0.001). No significant difference in operative time or conversion rates was observed. Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis leads to lower complications, shorter hospital stays, reduced healthcare costs, and faster recovery, making it the preferred approach.

Several cutaneous conditions may be seen in human immuno deficiency virus infection during the course of HIV infection atypical and unusual manifestations can be seen. The varied spectrum of cutaneous manifestations in HIV patients were studied with this objective in mind. Materials and Methods: All HIV positive patients attending the Dept. Dermatology, Shri Atal Bihari Vajpayee Medical College were included in the study. The patients were included in the study through the following channels. Results: A total of 31 patients (56.4%) had non-infectious dermatoses, among which 6(10.9%) had Pruritic papular eruptions, 7(12.7%) had seborrheic dermatitis, 6(10.9%) patients had xerosis., 3(5.45%) had psoriasis exacerbation, 5(9.09%) had oral pigmentation, 3(5.45%) had diffuse hyperpigmentation, 1(1.8%) patients had diffuse alopecia. Conclusion: In our study we come across high prevalence (91%) of skin and mucocutaneous diseases in HIV patients. Various patterns of skin manifestations were observed in our study, including seborrheic dermatitis, and pruritic papular eruption. Treatment of these skin manifestation would be incomplete without adequate treatment of HIV itself.

Background: Antimicrobial resistance among intensive care unit (ICU) pathogens has emerged as a major challenge in critical care settings due to increased morbidity, mortality, and limited therapeutic options. The present study evaluated the bacteriological profile and antibiotic resistance patterns among ICU isolates in a tertiary care hospital. Material and Methods: This hospital-based observational study was conducted over a period of 12 months in the Department of Microbiology of a tertiary care teaching hospital. A total of 312 non-duplicate bacterial isolates obtained from ICU patients were included. Clinical specimens were processed using standard microbiological techniques, and antimicrobial susceptibility testing was performed by Kirby–Bauer disk diffusion method according to CLSI guidelines. Results: Among 312 isolates, males constituted 60.3% of patients, and the majority belonged to the 46–60 years age group. Endotracheal aspirate was the most common specimen (31.4%). Klebsiella pneumoniae was the predominant isolate (26.3%), followed by Escherichia coli (18.6%) and Acinetobacter baumannii (17.3%). High resistance to ceftriaxone was observed among Gram-negative isolates, particularly Acinetobacter baumannii (88.9%) and Klebsiella pneumoniae (80.5%). Carbapenem resistance among Acinetobacter baumannii was 63.0%. Multidrug resistance was identified in 50.6% of isolates, with the highest prevalence seen in Acinetobacter baumannii (74.1%). Conclusion: The study demonstrated a high burden of multidrug-resistant organisms in ICU settings, particularly among Gram-negative pathogens. Regular surveillance, rational antibiotic usage, and strict infection control measures are essential to combat rising antimicrobial resistance.

Background: Meningiomas are among the most common central nervous system tumors and exhibit variations in demographic profile, anatomical location, and histological subtype. Rapid intraoperative diagnosis is important for surgical planning, and the cytosmear technique offers a practical diagnostic approach. Methods: This prospective study included 120 lesions evaluated for meningioma. Age, sex, site distribution, and histological patterns were analyzed. Intraoperative cytosmear diagnoses were compared with final histopathological examination, which served as the reference standard. Statistical analysis was performed using chi-square testing, and p<0.05 was considered significant. Results: The age of the study subjects ranged from 13 to 71 years, with a mean age of 40 years. The highest proportion of cases was observed in the 40–49 years age group (38.3%) (χ²=72.42, p<0.001). Females constituted 57.5% of the cohort, with a female-to-male ratio of 1.35:1. Intracranial tumors predominated (81.7%) (χ²=92.95, p<0.001). WHO grade I meningiomas accounted for 91.7% of cases, with meningothelial meningioma as the most common subtype. Two lesions initially diagnosed as meningioma on cytosmear were schwannomas on histopathology. Overall cytosmear diagnostic accuracy was 98.3% (χ²=88.17, p<0.001). Conclusion: Meningiomas in this series predominantly affected middle-aged females, were chiefly intracranial, and were mostly WHO grade I tumors. Cytosmear examination showed excellent concordance with histopathology.

Introduction: Iron deficiency anaemia (IDA) is a major global health concern, yet research predominantly focuses on women and children, leaving a significant gap regarding young adult males. Our present study, aimed to estimate IDA prevalence among apparently healthy Indian males and evaluate its association with various sociodemographic variables. Methodology: A cross-sectional analytical study was conducted in urban Uttar Pradesh, India, from January 2023 to December 2024. Five hundred healthy adult males (18–50 years) from diverse backgrounds were enrolled. Comprehensive laboratory evaluations included complete blood counts and a full iron profile, including serum ferritin, iron, TIBC, and transferrin. IDA was diagnosed using stringent criteria: concurrent low haemoglobin, reduced MCV, low serum ferritin, and elevated serum transferrin. Results: While 27% of participants had low haemoglobin, the prevalence of IDA based on all four diagnostic criteria was 18%. However, individual markers suggested a higher subclinical burden, with 51.6% showing low serum iron and 45.8% having low serum ferritin. Of the diagnosed cases, 56.67% were mild, 34.44% moderate, and 8.89% severe. Significant associations were found between IDA and a vegetarian diet, lower educational status, rural residence, and lower socioeconomic status (p < 0.01). Multivariable analysis identified a vegetarian diet (AOR ≈ 3.80) and lower education (AOR up to 7.50) as the strongest independent predictors. Conclusion: A substantial, often subclinical, IDA burden exists among healthy young men, necessitating targeted screening beyond traditional risk groups.

Background and Aim: Intussusception is a common abdominal emergency in children and requires early diagnosis and timely reduction to prevent bowel compromise and surgery. This study aimed to evaluate the outcome of ultrasound-guided hydrostatic reduction in children with intussusception and to describe their clinical profile, short-term outcomes, and factors associated with successful reduction. Materials and Methods: This hospital-based cross-sectional study included 29 children diagnosed with intussusception. The records of the children admitted and treated with intussusception from 2023 to 2025 were taken. The details were collected using a semi-structured questionnaire. The data were entered in MS excel and analysed using SPSS. Appropriate descriptive and inferential statistics were used with p<0.05 was considered as statistically significant. Results: The median age of the children was 14 months (IQR: 7.5-53), and 62.1% were males. Vomiting and abdominal pain were the most common presenting symptoms (41.4% each), while the classical triad was seen in 17.2%. Ileocolic intussusception was the predominant type (89.7%). Ultrasound-guided hydrostatic reduction was successful in 24 children (82.8%); among them, 87.5% were reduced in a single attempt. Five children required surgery following failed reduction. Most children (75.9%) had a hospital stay of 4 days or less. No complications or mortality were observed. Delayed presentation beyond 48 hours was significantly associated with failed reduction (p=0.036). Conclusion: Ultrasound-guided hydrostatic reduction was an effective and safe primary treatment modality for childhood intussusception in this study. Early presentation was associated with a higher likelihood of successful reduction, highlighting the importance of prompt recognition and referral.

Background: High-dose-rate (HDR) intracavitary brachytherapy (ICBT) is an integral component of the curative treatment for carcinoma cervix. However, interfraction variations in applicator placement and organ geometry can influence dose distributions, especially to organs at risk (OARs). This study aims to evaluate the interfraction dose variation in 40 patients undergoing HDR ICBT for carcinoma cervix. Materials and Methods: A retrospective analysis was conducted on 40 histopathologically confirmed cases of carcinoma cervix (FIGO Stage IIB–IVA). All patients received EBRT of 50 Gy in 25 fractions, followed by 3 fractions of HDR ICBT (7 Gy per fraction). For each fraction, CT-based planning was performed. OAR doses (D2cc to bladder, rectum, sigmoid), Point A and B doses, V100, bladder/sigmoid/rectal volumes, and TRAK values were assessed across fractions. Comparative analysis was done using paired t-test with a statistical significance threshold of p < 0.05. Results: A total of 120 ICBT applications were evaluated. While minor interfraction variations in D2cc values for bladder (mean 5.6 ± 1.3 Gy), rectum (4.5 ± 1.6 Gy), and sigmoid (4.3 ± 1.4 Gy) were observed, they were not statistically significant (p > 0.05). Point A and B doses remained consistent across fractions with mean values of 6.85 Gy (Right A), 6.79 Gy (Left A), and ~1.68 Gy at both B points. Organ volumes exhibited mild fluctuations but without significant dose impact. The variation in V100 and TRAK values was also statistically insignificant. Conclusion: Although interfraction variations exist during HDR ICBT in carcinoma cervix, careful individualized planning for each fraction effectively maintains OAR doses within tolerance. A larger sample size reinforced earlier observations and supports the implementation of image-guided adaptive brachytherapy planning for optimal outcomes.

Introduction: Nosocomial infections remain a major global health concern, with Methicillin-resistant Staphylococcus aureus (MRSA) being a leading cause. MRSA is associated with a wide spectrum of infections ranging from skin infections to life-threatening conditions such as septicaemia, pneumonia, and toxic shock syndrome. Increasing antimicrobial resistance among MRSA strains poses a significant therapeutic challenge. Aims and Objectives: To determine the prevalence and antibiotic susceptibility pattern of MRSA isolated from swab samples in a tertiary care hospital. Materials and Methods:  This retrospective study was conducted over a one-year period (January–December 2025) in a tertiary care hospital. A total of 2520 swab samples were processed. Identification of Staphylococcus aureus was done using standard microbiological techniques. Methicillin resistance was detected using automated systems and antibiotic susceptibility testing was performed by the Vitec-2 Compact according to CLSI guidelines 35^TH Edition. Results: Out of 2520 samples, 484 (19.2%) yielded Staphylococcus species. Among these, 196 isolates were identified as Staphylococcus aureus, of which 111 (56.63%) were MRSA. The highest resistance was observed against ciprofloxacin, followed by moderate resistance to cotrimoxazole, tetracycline, erythromycin, and clindamycin. Least resistance was noted for vancomycin and linezolid. Conclusion:  A high prevalence of MRSA was observed, indicating a significant nosocomial threat. Continuous surveillance, strict infection control practices.

Introduction: Cholesteatoma is a progressive disease that may impair the patient’s quality of life and bears the risk of very serious intracranial complications such as meningitis, brain abscess and sigmoid sinus thrombosis. Materials and Methodology: It is a prospective study conducted at pramukh swami medical collage Shree Krishna Hospital, Karamsad, 83 patients with chronic otitis media with cholesteatoma underwent surgery between January 2020 and January 2024. Data was collected using a prestandard proforma, including demographic information, medical history, clinical examination findings, preoperative HRCT, and pure tone audiometry (PTA).Intraoperative notes provided details on ossicular chain status, cholesteatoma extension, and surgical complications. The “Chole Online App” was used to calculate the chole score for staging the cases. Follow-up assessments were conducted for three months postoperatively, comparing postoperative PTA with the chole stage and preoperative PTA. Results: The study included 42 males (50.60%) and 41 females (49.40%), with a mean age of 28.58 years. Class II ChOLE was the most common stage, accounting for 83.13% of cases. Postoperative results showed a significant reduction in mean AC Threshold (preop 54.51 dB vs. Post op 33.67 dB, p=0.0038). The CHOLE classification correlated well with preoperative and postoperative AC thresholds, and its subdivisions (ossicular chain status, cholesteatoma extension, and complications) also showed strong correlations. Conclusion: ChOLE classification has predictive value in both pre and postoperative hearing outcomes following middle ear surgeries Specifically, patients with cholesteatoma with varying extensions, ossicular erosion and complications as classified by ChOLE. Clinicians can leverage this information to tailor treatment strategies and manage patient expectations effectively, ultimately optimizing postoperative hearing outcomes.

Background: Laparoscopic and open abdominal surgeries are traditionally performed under general anaesthesia (GA). However, GA poses significant risks for patients with cardiopulmonary comorbidities. Thoracic segmental spinal anaesthesia (TSSA) has emerged as an alternative, but comparative data regarding its safety and efficacy remains fragmented. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. We included randomized controlled trials (RCTs), prospective comparative studies, and observational reports comparing TSSA to GA in adult patients undergoing abdominal surgery. Primary outcomes included intraoperative haemodynamic stability. Secondary outcomes were postoperative pain, time to first analgesic, time to ambulation, and postoperative nausea and vomiting (PONV). Results: Multiple studies were included in the qualitative synthesis, comprising comparative trials and a massive cohort of observational data. TSSA consistently demonstrated superiority in postoperative recovery metrics. Time to ambulation was significantly shorter in TSSA cohorts compared to GA (SMD = -1.62, p < 0.0001). Time to first analgesic request was also significantly prolonged under TSSA (SMD = 1.54, p = 0.0016). Haemodynamic outcomes exhibited heterogeneity; while some studies reported superior MAP stability under TSSA, others noted a higher incidence of transient hypotension requiring vasopressor support, though the overall pooled effect was not statistically significant (OR = 1.25, p = 0.822). TSSA successfully facilitated surgery in high-risk patients while avoiding respiratory complications, and significantly reduced PONV (OR = 0.24, p = 0.002). Conclusion: TSSA is a safe and highly efficacious alternative to GA for abdominal surgery, offering superior early postoperative analgesia and accelerated functional recovery. Careful pharmacological optimization and haemodynamic monitoring are required. Registered on Prospero with registration number: CRD420261336741.

Introduction: Daclatasvir is generally well-tolerated when treating hepatitis C (HCV), with common side effects including fatigue, headache, nausea, diarrhea, and insomnia. It is typically taken with other drugs like sofosbuvir, and side effects are usually mild, but can include serious risks like anemia, skin reactions, or heart issues with specific drug combinations. Case Report: We report a case of twenty -year-old female, not a known case of any chronic illness, was incidentally detected to be suffering from chronic HCV infection on routine testing. All her routine labs including complete hemogram, liver & renal function test, blood sugar, complete lipid profile, thyroid profile, serum electrolytes, urine examination, HbsAg, anti -HIV antibody, serum IgM HAV & HEV antibody test were normal but anti HCV antibody was positive. Her ultrasonogram, Chest x-ray and Fibroscan score (6 Kpa) were normal. The HCV RNA quantitative viral load was 1 x 10⁵ I.U./ml. She was started on 12 weeks sofosbuvir 400 mg + daclatasvir 60 mg daily once for 12 weeks. After two days of starting antiviral treatment, she developed facial puffiness, including both lips. She was very dogmatic, that no other drugs were taken except the antiviral treatment and there was no change in food habit. The complete hemogram showed eosinophilia and increased ESR levels. Hence, immediately sofosbuvir & daclatasvir was changed to sofosbuvir 400 mg + Velpatasvir 100 mg combination. The patient facial puffiness and swelling of bilateral lips subsided completely within a week. As, sofosbuvir was in both the regimens, hence the allergic reaction in form of facial swelling was attributed to daclatasvir. It has been uncommonly reported with daclatasvir. Conclusion: Our case report emphasizes the fact about need of strict vigil about drug reactions for both common and uncommon one. Hence, timely changes in the treatment are warranted for avoiding life threatening allergic reactions.

Background: Chronic obstructive pulmonary disease (COPD) is expected to be the third leading cause of death, according to epidemiological data. Although new therapies are improving the prognosis for these individuals, their mortality rate remains high. Objective: we compared the AECOPD scoring system to the DECAF score in terms of diagnostic accuracy for predicting in-hospital mortality, ventilator requirements, & disease prognosis. Methods: This Hospital based cross-sectional study was conducted on patients admitted with acute exacerbation of COPD to Department of General medicine, Andhra Medical College, Visakhapatnam. Duration of study was August 2022 to March. Result: As per DECAF score, 41% had high risk (3-6), 15% had moderate risk (2) & 44% had low risk (0-1). Out of 44 subjects with low risk, 0% had mortality, out of 15 subjects with moderate risk, 0% had mortality at hospital, & 36.6% had mortality at 28-days in hospital mortality. There was significant difference in Mortality at Hospital & DECAF score (P < 0.0001). Patients with a DECAF score of 3.83 (or) higher have a significant risk of mortality. The mean hospital stay was more in died cases than in compared with survived cases (9.8±3.93 days vs 7.2588±3.68, p=0.0165, 95% CI: 0.4734 to 4.609). The relationship between mortality and usage of ventilator shows significant association. Conclusion: The DECAF score is a straightforward clinical instrument for determining the in-hospital prognosis of AECOPD patients. This scoring method integrates readily available indices & can stratify patients admitted with AECOPD into clinically significant risk groups.

Background: Thalassemia major is a serious hereditary hemoglobinopathy, which necessitates lifelong blood transfusions and chelation therapy. Despite advances in therapy, there remains substantial morbidity from iron overload and multisystem disease in patients particularly limited by resource. Data from Eastern India are infrequent. Methods: A record based retrospective observational study was conducted at Patna Medical College & Hospital (PMCH), Patna from February 2025 to July 2025. The medical charts of patients with proven thalassemia major attending OPD or IPD were studied. Information collected included demographic data, age at diagnosis, transfusion rate, serum ferritin levels, compliance with chelation therapy (CT), the complications and clinical outcome. Descriptive statistics were utilized for the data analyses with SPSS. Results: A total of 72 patients were enrolled, and the mean age was 9.8 ± 4.2 years; there were more male than female. A high percentage of patients required transfusion maintenance every 3 to 4 weeks, and most had their first transfusion prior to the age of one year. Suboptimal or intermittent chelation adherence was recorded in a significant proportion of patients. Frequent complications were iron overload–associated organ damage, recurrent infections, growth delay, liver disease, endocrinopathies and cardiac involvement. Most patients had regular follow-up during the study period; documented mortality was primarily associated with cardiac complications and severe infections. Conclusion: Thalassemia major is still burdened by many complications even with regular transfusion. The early discovery, strict chelation adherence and long-term follow-up are necessary for better prognosis. Local data like this study can help in reinforcing control programs for thalassemia in Eastern India.

Background: Thyroid nodules are highly prevalent in the general population, with increasing detection rates due to widespread use of high-resolution ultrasonography. Although most nodules are benign, a small proportion harbor malignancy, necessitating accurate diagnostic techniques for early detection and management. Ultrasound elastography has emerged as a noninvasive imaging modality capable of assessing tissue stiffness, thereby improving characterization of thyroid nodules. Aim: To evaluate the diagnostic accuracy of ultrasound elastography in differentiating benign and malignant thyroid nodules using histopathology/FNAC as the gold standard. Materials and Methods: This prospective observational study was conducted in the Department of Radiodiagnosis of a tertiary care teaching hospital over a period of 18 months. A total of 120 patients with thyroid nodules detected on conventional ultrasonography were included. All patients underwent B-mode ultrasonography followed by strain elastography. Elastography scores and strain ratios were documented. Fine-needle aspiration cytology (FNAC) or histopathological examination served as the reference standard. Diagnostic indices including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Statistical analysis was performed using SPSS version 25.0, with p<0.05 considered statistically significant. Results: Among 120 thyroid nodules evaluated, 84 (70%) were benign and 36 (30%) were malignant on FNAC/histopathology. Malignant nodules demonstrated significantly higher elastography scores and strain ratios compared to benign nodules (p<0.001). Ultrasound elastography showed a sensitivity of 91.7%, specificity of 88.1%, PPV of 76.7%, NPV of 96.1%, and overall diagnostic accuracy of 89.2%. Combining elastography with conventional ultrasound improved diagnostic confidence and reduced unnecessary FNAC procedures. Conclusion: Ultrasound elastography is a valuable adjunctive imaging modality in the evaluation of thyroid nodules. It demonstrates high sensitivity and specificity for differentiating malignant from benign lesions and can improve preoperative diagnostic accuracy when combined with conventional ultrasonography.

Background: Pneumonia remains a significant contributor to childhood morbidity and mortality. So, correlation of clinical features and outcome will help to improve the treatment plan. Objective: To identify the clinical factors responsible for the positive or negative outcome of pneumonia in children. Methods: The study was conducted on children of age 2-months-5 years, admitted in Medical College, Kolkata, a tertiary care hospital over a period of two years from February 2023 to November 2024. Information collected over multiple independent and dependent variables and they were systematically reviewed to assess the clinical correlation and outcomes of pneumonia in these children. Results: Children of 13–24 months age group are most susceptible for pneumonia. Most children required 4–6 days of hospitalization. Fever, cough with unilateral consolidation in CXR were the most common features. In HRCT, Consolidation and pleural effusion were found to be more common in bacterial pneumonia whereas ground-glass opacities were more common in viral pneumonia. Children presented with tachypnoea, chest retraction, hypoxia and altered sensorium had worse outcome and mortality risk. Conclusion: The systematic review of this study presented the different variables related to pneumonia which can be used to improve the overall management plan.

Background: Aim is to study the impact of obesity on lung functions by spirometry tests, among healthy young adults. Material and Methods: This work was performed on N=41 normal, healthy non-smoker females and N= 30 healthy, smoker females between 18-35 years of age. Informed consent was taken from the participants and case control study was performed. The two different groups were formed based on their BMI. In Group 1, N = 41, BMI was between 18 – 22.9 Kg/m². In Group 2, N = 30, obese females were enrolled with BMI more than 25 Kg/m². On computerized spirometer, the peak expiratory flow rate (PEFR), the forced vital capacity (FVC), forced expiratory volume (FEV₁) at the end of one second, FEV₁/FVC ratio were noted. Results: In obese Group 2 females, PEFR data were reduced significantly in comparison to Group 1. FEV₁, FVC, FEV₁/ FVC ratio were found to be not significant. Conclusion: Obesity decreases PEFR value among healthy female adults.

Background: Ectopic pregnancy is an acute emergency condition, and associated with maternal mortality and morbidity especially in the developing countries. Objective: The aim of this study was to determine and evaluate the best diagnostic method and management outcome. Methods: All female patients getting admitted to the Department of OBGY, J.K. Lon hospital Govt. Medical College Kota (Rajasthan) from Jan 2016 to Jan 2017 were analyzed as a case of ectopic pregnancy on the basis of these different diagnostic modalities were included in this study. Conclusion: The early identification and timely intervention is the catch to reduce the morbidity and mortality associated with ectopic pregnancy and improving future reproductive outcomes.

Background: Pain is one of the most common and distressing symptoms experienced by patients with advanced cancer. Despite the availability of effective analgesic therapies and established guidelines such as the WHO analgesic ladder, cancer pain often remains inadequately controlled. Appropriate analgesic prescribing and regular pain assessment are essential components of palliative care aimed at improving patient comfort and quality of life. Aim and Objectives: To analyze the prescribing patterns of analgesic drugs and assess the effectiveness of pain management among advanced cancer patients receiving inpatient palliative care at a tertiary care teaching hospital. Materials and Methods: A cross-sectional observational study was conducted over a period of one year after obtaining Institutional Ethics Committee approval. A total of 200 patients diagnosed with advanced cancer and receiving inpatient palliative care in the oncology ward of a tertiary care teaching hospital were enrolled. Data regarding analgesic usage, WHO analgesic ladder utilization, pain intensity, pain relief scores, and patient experiences were collected using patient interviews, self-designed questionnaires, and review of medical records. Pain intensity was assessed using the Numeric Rating Scale (NRS). Results: Among 200 patients included in the study, opioid analgesics were prescribed in 87% of patients, while non-opioid analgesics were used in 13% of cases. Morphine was the most commonly prescribed opioid followed by tramadol. Adjuvant analgesics such as pregabalin, were also prescribes to the patients for neuropathic pain management. According to the WHO analgesic ladder, 52% of patients received Step III medications. Despite widespread analgesic use, nearly 30% of patients reported inadequate pain relief. Delayed pain assessment, inadequate dose titration, and fear of opioid side effects were identified as major barriers to effective pain control. Conclusion: The study demonstrated that opioid analgesics constitute the mainstay of cancer pain management in palliative care settings, with morphine being the most frequently prescribed drug. Although adequate pain relief was achieved in the majority of patients, a substantial proportion continued to experience uncontrolled pain. Regular pain assessment, individualized treatment strategies, appropriate opioid titration, and multidisciplinary interventions are essential for improving pain management outcomes in advanced cancer patients.

Introduction: In the recent years, with the growth of telecommunication infrastructure, there is potential impact of radiofrequency electromagnetic radiation from mobile phone towers on public health. There is limited and inconclusive evidence about its impact on the cardiovascular system. Objective: To explore the effect of radiofrequency radiation from mobile phone towers on heart rate, systolic blood pressure, and diastolic blood pressure among people residing close to, and away from mobile phone towers. Materials and Methods: This cross-sectional study included 72 participants. They were divided into two groups. Group I (exposed) had 36 participants residing within 100 meters of a mobile phone tower and Group II had 36 participants residing in areas without nearby mobile phone towers.  Data was collected using a structured proforma regarding general health, medical history, duration of mobile phones, duration of residence.  Heart rate, systolic blood pressure, and diastolic blood pressure were measured using standard procedures. Statistical analysis was done using SPSS software. Results: The heart rate and systolic blood pressure were increased in Group I compared to Group II and was statistically significant. The diastolic blood pressure was also increased in Group I but was not statistically significant. Conclusion: The results show that there may be association between the radiofrequency radiation from the mobile phone towers and the alterations in the cardiovascular parameters.  Hence further large scale longitudinal students are required to clarify the long-term health implications.

Background: Non-muscle-invasive bladder cancer (NMIBC) is associated with a high risk of residual tumor and early recurrence following transurethral resection of bladder tumor (TURBT). Early follow-up cystoscopy may help in detecting residual disease and guiding further management. Materials and Methods: This prospective observational study included 60 patients with NMIBC who underwent TURBT. Baseline demographic characteristics, presenting symptoms, tumor characteristics, histopathological findings, and presence of detrusor muscle in the specimen were recorded. All patients underwent one-month follow-up cystoscopy with biopsy when indicated. Patients with negative one-month findings were further evaluated at three months for recurrence. Results: The mean age of the study population was 58.6 ± 11.4 years, with males accounting for 80.0% of the cases. Painless hematuria was the most common presenting symptom (70.0%). Solitary tumors were seen in 63.3% of patients, while 43.3% had high-grade tumors. Histopathology after initial TURBT showed Ta lesions in 53.3%, T1 lesions in 36.7%, and carcinoma in situ in 10.0% of patients. Detrusor muscle was absent in 23.3% of specimens. At one-month follow-up cystoscopy, residual tumor was detected in 26.7% of patients. Residual disease was more common in patients with T1 stage, high-grade tumors, multifocal lesions, larger tumor size, and absence of detrusor muscle. Among patients with negative one-month histology, recurrence at three months was observed in 18.2% of cases. Conclusion: One-month follow-up cystoscopy after TURBT is effective in detecting residual disease in NMIBC patients, especially among those with high-risk features. Early detection and repeat TURBT may improve staging accuracy and help reduce early recurrence.

Introduction: Acute abdomen in children is a common surgical emergency and may arise from various conditions such as intestinal obstruction, perforation peritonitis, intussusception, Meckel’s diverticulum, abdominal tuberculosis, and bowel gangrene. Delayed diagnosis and treatment may lead to severe morbidity and mortality. Exploratory laparotomy plays an important role in the diagnosis and management of such cases. The present study was conducted to evaluate the outcomes of exploratory laparotomy in children presenting with acute abdomen. Materials and Method: This prospective interventional study was conducted on 50 children aged 0–12 years who underwent exploratory laparotomy for acute abdomen at a tertiary care center. Children with traumatic abdominal injury, birth weight less than 700 grams, age more than 12 years, and those managed conservatively were excluded. Clinical history, examination findings, laboratory investigations, radiological findings, operative details, and postoperative outcomes were recorded in a predesigned proforma. Outcome measures included stoma formation, wound infection, wound dehiscence, return of bowel sounds, and initiation of feeding, hospital stay, and follow-up status after one month. Result: The majority of patients belonged to the age group of less than 1 year (32.0%), with a mean age of 5.14 ± 4.16 years. Female children constituted 56.0% of cases. Most children had normal nutritional status (78.0%). Multiple air-fluid levels were the most common radiological finding, observed in 34.0% of patients. The mean hospital stay was 9.64 ± 5.93 days. Postoperative wound infection and wound dehiscence were observed in a subset of children, particularly among those with perforation peritonitis, bowel gangrene, severe contamination, and delayed presentation. Stoma formation was required in selected patients with severe disease. Conclusion: Exploratory laparotomy was associated with favourable outcomes in most children with acute abdomen when timely diagnosis and intervention were performed. Delayed presentation, poor nutritional status, sepsis, and bowel perforation were important determinants of postoperative morbidity and prolonged hospitalization. Early referral, prompt surgical management, and meticulous postoperative care are essential for improving outcomes in paediatric acute abdomen.

Background:  Liver, one of the major organs of body which has numerous and vital roles in maintaining homeostasis. It has major role in metabolism. Liver is the largest internal organ in the body and performs functions like detoxification, production of bile for digestion, synthesize proteins, stores energy, regulates clotting. Objective: to study, understand and to assess the prevalence of haematological abnormalities in DCLD patients at Tertiary Care Hospital. Methods: The present study was conducted at a tertiary care hospital in Visakhapatnam, Andhra Pradesh, from October to December 2025.A total of 50 patients including both sexes with decompensated chronic liver disease were included in the study. Result: The most common etiological factors identified were chronic alcohol intake, viral hepatitis (Hepatitis B and C), non-alcoholic fatty liver disease, and other less common causes such as Wilson’s disease and α1-antitrypsin deficiency. Haematological analysis revealed that anaemia was highly prevalent among DCLD patients, with 34% showing severe anaemia (Hb < 8 g/dL) and 30% having moderate anaemia. Thrombocytopenia was detected in 17 patients (34%), likely due to splenic sequestration, decreased thrombopoietin synthesis, and bone marrow suppression. Prolonged prothrombin time (PT > 13.5 sec) was seen in 60% of patients, and elevated INR in 54%, reflecting significant hepatic synthetic dysfunction and increased bleeding tendency. Leucocyte abnormalities were less frequent, with leukocytosis present in 20% of patients—primarily due to secondary infections—and leukopenia in 4%. Conclusion: In conclusion, understanding the haematological profile of DCLD patients provide valuable insights into disease severity, guides therapeutic decisions, and ultimately helps enhance patient survival and quality of life.

Introduction: Tuberculosis (TB) continues to be a major global health burden, especially in developing countries. Diabetes mellitus (DM), a rapidly growing non-communicable disease, adversely affects TB outcomes and may alter the pharmacokinetics of anti-tubercular drugs like rifampicin. Subtherapeutic drug levels may contribute to treatment failure and drug resistance. Aim: To compare plasma rifampicin concentrations at 0, 2, 4, and 6 hours in pulmonary tuberculosis patients with and without diabetes mellitus. Materials and Methods: This cross-sectional observational study was conducted in the Department of Pharmacology, JLN Medical College, Ajmer, from October 2020 to August 2021. Sixty newly diagnosed pulmonary TB patients were enrolled, including 30 with DM and 30 without DM, all receiving anti-tubercular therapy as per National Tuberculosis Elimination Programme guidelines. Blood samples were collected at pre-dose (0 hour) and 2, 4, and 6 hours post-dose after achieving steady state. Plasma rifampicin levels were estimated using validated reverse-phase high-performance liquid chromatography. Statistical analysis was performed using Student’s t-test and Chi-square test. Results: Mean rifampicin concentrations at 2, 4, and 6 hours were significantly lower in diabetic patients compared to non-diabetics (p<0.01). Mean Cmax was significantly reduced in diabetics (3.52±0.96 μg/ml) compared to non-diabetics (5.79±1.73 μg/ml). AUC₀–₆ was also significantly lower in diabetics (15.26±2.27 vs 31.32±7.03 μg·h/ml, p<0.005). Subtherapeutic Cmax (<8 μg/ml) was observed in 100% diabetics and 70% non-diabetics. Conclusion: Diabetes mellitus is associated with significantly reduced plasma rifampicin concentrations in pulmonary TB patients. Therapeutic drug monitoring and dose individualization may be required to achieve optimal therapeutic outcomes.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation and joint destruction. Methotrexate (MTX) remains the conventional anchor drug, but many patients do not achieve remission or develop adverse effects. Iguratimod (IGU), a novel disease-modifying antirheumatic drug, inhibits the NF-kB pathway and provides a mechanism for suppression of inflammatory cytokines and bone protection. Objective: To compare the preliminary efficacy and safety of IGU, MTX, and IGU+MTX combination therapy for improved management of RA at a tertiary care center in Barabanki. Methods: This consecutive, cross-sectional analytical study included 120 patients divided into three equal groups (n=40 each): MTX monotherapy, IGU monotherapy, and IGU+MTX combination therapy. Patients were followed for 24 weeks. Efficacy was assessed using DAS28-ESR, swollen joint count, tender joint count, morning stiffness, inflammatory markers and remission rates. Safety was assessed by adverse event reporting and hepatic, renal and hematological parameters. Results: All groups showed significant improvement from baseline (p<0.001). The IGU+MTX group demonstrated the greatest efficacy, with mean post-treatment DAS28 of 2.42, a 34.5% DAS28 remission rate and 68.0% ACR50 equivalent response. Logistic regression showed that patients receiving IGU+MTX were 3.62 times more likely to achieve remission than patients receiving MTX monotherapy (p<0.001). Adverse events were numerically higher in the combination group (37.5%) but were not statistically different from monotherapy groups (p=0.642). Conclusion: IGU+MTX combination therapy was more effective than either drug alone for managing active RA in the Barabanki tertiary care setting, with a comparable safety profile. The findings support IGU+MTX as a cost-effective, treat-to-target strategy for achieving clinical remission and functional improvement.

Chondrosarcoma is a malignant bone tumour that most frequently arises from pelvis and long bones. Its occurrence in the sternum is exceptionally rare. Here we present the case of a fifty one year-old male who presented to our tertiary care center with gradual enlargement in the size of swelling and pain around the left sternoclavicular joint, extending towards the left clavicle. Further investigations confirmed the diagnosis of chondrosarcoma which was treated with surgical removal and reconstruction.

Background: Both intravenous (IV) lignocaine and 2% viscous lignocaine gargle are used as adjuvants to suppress airway reflexes during laryngeal mask airway (LMA) insertion; however, direct comparative evidence is limited. Methods: In this prospective, randomised, single-blinded clinical trial, 60 ASA I–II patients undergoing elective short-duration procedures were randomised to Group A (IV lignocaine 1.5 mg/kg, 90 seconds before LMA insertion, n = 30) or Group B (2% viscous lignocaine gargle 20 mL for 30 seconds, 6 minutes before induction, n = 30). All patients received propofol 2 mg/kg and fentanyl 2 mcg/kg for induction. Primary outcomes were coughing, gagging, and laryngospasm during LMA insertion. Secondary outcomes included insertion attempts, insertion time, ease of insertion, and haemodynamic (HR, SBP, DBP, MAP, SpO2) recorded at pre-specified intervals over 30 minutes. Data were analysed using Student’s t-test, chi-square test, and Fisher’s exact test; p < 0.05 was considered statistically significant. Results: Both groups were demographically comparable at baseline (p > 0.05 for all). Primary outcomes – coughing (p = 0.085), gagging (p = 0.224), and laryngospasm (p = 0.313) – showed numerically lower event rates in Group B but without statistical significance. Insertion attempts, time, and ease were comparable (p > 0.2 for all). Group A demonstrated significantly elevated HR, SBP, DBP, and MAP during the first 0–4 minutes post-insertion (p < 0.05), converging with Group B from 5 minutes onward. SpO2 remained within normal limits in both groups throughout. No postoperative complications were recorded in either group. Conclusion: Both adjuvants achieve comparable LMA insertion conditions. Viscous lignocaine gargle confers superior early haemodynamic stability and a clinically relevant reduction in adverse airway events, supporting its consideration as a preferred, non-invasive alternative to IV lignocaine for LMA insertion facilitation.

Background: Tuberculosis is a major infectious disease associated with significant systemic and hematological alterations. Evaluation of hematological parameters may provide useful information regarding disease severity and inflammatory status in affected individuals. Material and Methods: The present hospital-based observational cross-sectional study was conducted among 246 diagnosed tuberculosis patients attending a tertiary care center. Venous blood samples were analyzed for complete blood count, erythrocyte sedimentation rate (ESR), and peripheral smear findings using standard laboratory methods. Hematological abnormalities were assessed and correlated with the type of tuberculosis. Results: Among 246 patients, 62.6% were males and 75.6% had pulmonary tuberculosis. The mean hemoglobin level was 10.1 ± 1.9 g/dL, while the mean ESR was 58.6 ± 21.4 mm/hour. Anemia was observed in 82.9% of patients, with mild anemia being the most common type (39.0%). Raised ESR was present in 87.0% of cases, followed by neutrophilia in 55.3% and leukocytosis in 48.0% of patients. Normocytic normochromic anemia was the predominant peripheral smear pattern (45.5%). Pulmonary tuberculosis patients showed significantly lower hemoglobin levels and higher ESR values compared to extrapulmonary tuberculosis patients (p<0.05). Conclusion: Hematological abnormalities are common in tuberculosis patients, particularly anemia and elevated ESR. Routine hematological evaluation can serve as a useful supportive tool in the assessment and monitoring of tuberculosis patients.

Background: Childhood cancers, though relatively uncommon, represent a significant cause of morbidity and mortality worldwide. In India, where pediatric cancers constitute less than 5% of the overall cancer burden, regional disparities in access to diagnosis and treatment persist. The North-Eastern region, with its distinctive demographic and healthcare landscape, remains particularly underrepresented in pediatric oncology literature. Data on children receiving radiotherapy, an integral component of multimodal cancer care, are especially limited in this part of the country. This study was undertaken to address this gap by evaluating the clinical and demographic characteristics of pediatric cancer patients receiving radiotherapy at a tertiary care center in North-East India. Materials and Methods: A retrospective, cross-sectional study was conducted on pediatric patients aged 0–18 years who underwent radiotherapy between January 2019 and December 2023. Patient demographics, tumour characteristics, treatment intent, and anesthesia use were collected and analyzed descriptively. Results: Among 94 patients analyzed, 58.5% were male and the largest age group was 14–18 years (36%). Hematological malignancies were most frequent (53.1%), predominantly B-cell acute lymphoblastic leukemia (B-ALL; 40.4%), followed by central nervous system tumours (29.7%). Prophylactic radiotherapy was delivered in 45% of cases, adjuvant in 37.2%, and definitive in 15%. Most patients were from Lower Assam (50%), and only 17% required anesthesia, reflecting good compliance among older children. Conclusion: This study provides valuable insight into the spectrum of pediatric malignancies treated with radiotherapy in North-East India. Hematological cancers, particularly B-ALL, predominated, with prophylactic radiotherapy being the most common treatment intent. The findings underscore the urgent need to strengthen pediatric oncology infrastructure, incorporate advanced radiotherapy techniques, and develop region-specific treatment protocols to improve childhood cancer outcomes in this underserved region.

Background: Community-acquired pneumonia (CAP) remains one of the leading causes of morbidity and hospitalization worldwide. Antibiotic therapy is the cornerstone of management, and both oral and intravenous (IV) routes are commonly employed depending on disease severity and patient condition. Recent evidence suggests that oral antibiotics may provide outcomes comparable to IV therapy in selected hospitalized patients while reducing healthcare costs, hospital stay, and IV-related complications. Aim: To compare the clinical efficacy, safety, and treatment outcomes of oral versus intravenous antibiotics in patients with community-acquired pneumonia. Methods: This prospective comparative study was conducted among 120 patients diagnosed with CAP in a tertiary care hospital. Patients were divided into two groups: Group O (oral antibiotics, n=60) and Group IV (intravenous antibiotics, n=60). Demographic details, clinical presentation, laboratory findings, duration of fever, length of hospital stay, radiological improvement, adverse drug reactions, and treatment success rates were assessed. Statistical analysis was performed using chi-square test and independent t-test, with p<0.05 considered statistically significant. Results: The majority of patients belonged to the age group of 41–60 years with male predominance in both groups. Mean duration of fever resolution was significantly shorter in the IV group during the first 48 hours, but overall clinical recovery rates at day 7 and day 14 were comparable between groups (p>0.05). Mean hospital stay was significantly lower in the oral antibiotic group (4.2 ± 1.1 days) compared to the IV group (6.8 ± 1.7 days) (p<0.001). Adverse effects such as injection-site reactions and thrombophlebitis were significantly higher in the IV group. Treatment success was observed in 91.7% of oral therapy patients and 95% of IV therapy patients, without statistically significant difference (p=0.512). Conclusion: Oral antibiotics demonstrated comparable clinical efficacy to intravenous antibiotics in selected patients with community-acquired pneumonia while significantly reducing hospital stay and treatment-related complications. Early transition to oral therapy may represent a safe and cost-effective strategy in stable CAP patients.

Background: Distal radius fractures are one of the most frequently occurring orthopedic injuries across all age groups, and represent a growing problem among elderly individuals, particularly because of osteoporosis and the occurrence of falls. Proper treatment is crucial to ensure a functional wrist and minimize complication rates to provide good clinical and functional recovery. Methods: This was a retrospective observational study carried out in Orthopaedics Department at Lok Bandhu Raj Narayan Combined Hospital (LBRNCH), Lucknow, and Uttar Pradesh from January 2026 to March 2026. The total of 48 patients with distal radial fractures were included. Hospital records were used to gather data on the patient, fracture characteristics, treatment, complications and follow up. Patients were treated either conservatively with casting/splinting or surgically by Open Reduction and Internal Fixation (ORIF) plating, K-wire fixation or external fixation. The outcomes of clinical and radiologic features were evaluated in a retrospective fashion. Results: Among 48 patients, 29 (60.4%) were males and 19 (39.6%) were females. The age group 46-60 years had the maximum number of fractures (31.3%). 20 (41.7%) patients had conservative treatment, 16 (33.3%) patients underwent ORIF plating, 8 (16.7%) patients underwent K-wire fixation, and 4 (8.3%) patients underwent external fixation. Complications were realized on 7 (14.6%) patients with stiffness, 6 (12.5%) patients had malunion, 4 (8.3%) had infection, and 3 (6.3%) had hardware complications. Functional outcomes were excellent in 14 (29.2%), good in 18 (37.5%), fair in 10 (20.8%), and poor in 6 (12.5%) patients. Conclusion: The overall results were favorable for distal radius fracture, and the ORIF plating was more effective for the unstable fracture for functional recovery. Selection of appropriate treatment and rehabilitation at the early stage is still vital in reducing complications and enhancing outcomes.

Background: Joint replacement surgery is a common procedure used to treat debilitating degenerative joint diseases, particularly severe osteoarthritis of the knee and hip joints. Although these procedures help enhance mobility, ease pain, and improve quality of life, potential postoperative complications and revision surgeries should also be considered clinical concerns. Materials and Methods: A retrospective observational study was conducted from January 2026 to March 2026 at E.S.I.C. Hospital, Kanpur, Uttar Pradesh In the present study, a total of 45 patients who had undergone Total Knee Replacement (TKR) or Total Hip Replacement (THR) surgeries were included. Hospital records, operative notes and follow-up records were utilized for data collection. Functional outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Harris Hip Score (HHS) and Knee Society Score (KSS). The postoperative complications and revision surgery rates were also assessed. The data was analyzed statistically using MS Excel and SPSS Software. Results: A total of 45 patients were studied, 25 (55.6%) were females, and 20 (44.4%) were males. Most of the patients were in the age group of 61-70 years (40.0%). The 28 patients (62.2%) received TKR, and 17 patients (37.8%) received THR. All patients had a significant improvement in their postoperative function. Preoperatively, the mean WOMAC score was 68.4 ± 9.2, while it was 28.6 ± 6.4 postoperatively. Similarly, the HHS improved from 42.7 ± 8.1 to 84.5 ± 7.3, while the KSS improved from 46.2 ± 7.8 to 86.1 ± 6.9 following surgery. There were 5 patients (11.1%) with joint stiffness, 4 (8.9%) with infection, 2 (4.4%) with deep vein thrombosis and 2 (4.4%) with implant loosening. Revision surgery was needed in 3 (6.7%) patients. Conclusion: Joint replacement surgery demonstrated good clinical outcomes, resulting in improved functional mobility and pain relief for patients. Surgical outcomes were satisfactory, although a small proportion of patients experienced surgical complications and required revision surgeries. It is recommended that further multicenter prospective studies with larger sample sizes and longer follow-up periods be conducted to assess long-term outcomes.

Background: Femoral fractures are common orthopedic injuries with high morbidity, long hospital stays, and disability. Both intramedullary nailing and plate fixation are widely used for surgical treatment, making comparative studies important for optimizing patient care. Methods: This is a retrospective observational study at, Lok Nayak Jaiprakash Narayan Hospital from January 2026 to March 2026. 43 patients with femoral fractures were included. Data were collected from medical records, operative records, X-rays, and follow-up reports. Demographic data, fracture type, treatment, healing time, complications, and functional recovery were evaluated. The findings were analyzed statistically with p<0.05. Results: A total of 43 patients in the study, 25 (58.1%) were treated with intramedullary nailing and 18 (41.9%) with plate fixation. The mean fracture healing time was found to be shorter in the intramedullary nailing group (16.2 weeks) than in the plate fixation group (19.4 weeks). Delayed union occurred in 2 (8.0%) patients with intramedullary nailing and 4 (22.2%) patients with plate fixation, and non-union in 1 (4.0%) and 2 (11.1%) patients, respectively. 1(4.0%) patient in the intramedullary nailing group and 3 (16.7%) patients in the plate fixation group suffered from postoperative infection. 22 (88.0%) of the patients who underwent intramedullary nailing and 13 (72.2%) of the patients who underwent plate fixation were able to walk independently. The difference in the complication rates and functional outcomes between the two groups was statistically significant (p<0.05). Conclusion: Patients with femoral fractures had better functional recovery, fewer postoperative complications, and quicker fracture union in those who were treated with intramedullary nailing versus plate fixation. The results indicate that intramedullary nailing could be one of the best surgical options for suitable patients, resulting in better overall clinical outcomes.

Dapsone is widely used in the treatment of leprosy and various dermatological conditions. While hematological adverse effects such as hemolysis and methemoglobinemia are well documented, isolated hypoalbuminemia in the absence of renal or hepatic dysfunction is exceedingly rare. We report the case of an 89-year-old man with a remote history of lepromatous leprosy who had been on long-term dapsone therapy and presented with bilateral pedal edema secondary to significant hypoalbuminemia, without evidence of proteinuria or liver disease. Recognition of this rare adverse drug reaction helped avoid extensive and unnecessary investigations and enabled appropriate management. This case highlights the importance of considering drug-induced hypoalbuminemia in patients receiving prolonged dapsone therapy.

Background: Sub-trochanteric fractures of the femur, defined as fractures occurring within 5 cm distal to the lesser trochanter, present a significant challenge in orthopedic trauma due to their anatomical and biomechanical complexity. These fractures typically occur in two distinct patient populations: young individuals following high-energy trauma and elderly patients with osteoporotic bone after low-energy falls. The high stress concentration in the sub-trochanteric region, along with the strong deforming forces of surrounding muscles, complicates both fracture reduction and stabilization. Aim of the Study: This study aims to compare the clinical and radiological outcomes of two commonly used surgical fixation methods: Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) in the management of sub-trochanteric femoral fractures. Methods: A prospective analysis was conducted on a cohort of patients treated with either PFN or DHS, evaluating parameters such as operative time, intraoperative blood loss, duration of hospital stay, time to union, functional outcome (as per Harris Hip Score), and complication rates. Results: Preliminary results suggest that PFN offers superior biomechanical stability, reduced operative time, and quicker mobilization, whereas DHS, though cost-effective, is associated with a higher rate of complications such as implant failure and varus collapse. Conclusion: The study concludes that PFN may be the preferred method for sub-trochanteric fracture fixation, particularly in unstable fracture patterns, due to its minimally invasive approach and biomechanical advantages.

Background: Tuberculosis (TB) remains a major public health challenge in India. The National TB Elimination Programme mandates notification of all TB cases through the Nikshay portal to ensure effective surveillance, treatment monitoring, and outcome evaluation. However, challenges in timely and complete notification persist, particularly in tertiary care settings. Aim of the Study: To assess the pattern of pulmonary and extra-pulmonary tuberculosis cases notified through the NIKSHAY portal and to evaluate clinical characteristics, treatment outcomes, and challenges associated with tuberculosis notification in a Tertiary Care Hospital, Telangana. Methods: A retrospective and prospective observational study was conducted at a tertiary care hospital in Telangana. Data from hospital records and the NIKSHAY portal were analyzed for patient demographics, type of tuberculosis, notification status, treatment initiation, and challenges in notification from between April 2018 and March 2023. Results: Pulmonary TB constituted the majority of notified cases, while extra-pulmonary TB showed lower notification completeness. Retrospective data revealed under-notification compared to prospective surveillance, indicating improvement with active follow-up. Conclusion: The study highlights gaps in TB surveillance and notification despite the availability of a robust digital platform. Strengthening training, improving interdepartmental coordination, and addressing technical barriers can enhance TB notification and contribute to improved TB control efforts under the National TB Elimination Programme.

Background: Persistent multispecies biofilms are a major cause of endodontic treatment failure, necessitating more effective antimicrobial strategies. Objective: To quantitatively compare the antimicrobial efficacy of nano-hydroxyapatite, chitosan, and silver nanoparticles against multispecies endodontic biofilm. Methods: Sixty extracted single-rooted teeth were standardised, instrumented, and inoculated with a multispecies biofilm consisting of Enterococcus faecalis, Streptococcus mutans, and Candida albicans over 21 days. Samples were randomly allocated into four groups (n=15): saline (control), nano-hydroxyapatite, chitosan, and silver nanoparticles. Antimicrobial efficacy was assessed using log-transformed colony-forming unit (CFU/ml) counts. Statistical analysis was performed using one-way ANOVA and Tukey post hoc test (p < 0.05). Results: Silver nanoparticles demonstrated the greatest reduction in microbial load (mean log reduction: 5.8), followed by chitosan (4.1) and nano-hydroxyapatite (2.9), with statistically significant differences between groups (p < 0.001). Conclusion: Silver nanoparticles exhibited superior antimicrobial efficacy against multispecies endodontic biofilm, highlighting their potential as an advanced irrigant in root canal disinfection.

Background: Malnutrition in children under five years of age remains a pressing public health challenge in low- and middle-income countries, predisposing this vulnerable group to repeated infections and elevated mortality risk. The bidirectional interaction between nutritional deficiency and infectious morbidity perpetuates a self-reinforcing cycle that impairs both physical and cognitive development. Objective: To determine the prevalence of undernutrition (underweight, stunting, and wasting) and to evaluate its association with common childhood morbidities among children aged 6 months to 5 years attending a paediatric outpatient department (OPD) of a tertiary care hospital. Methods: A hospital-based cross-sectional study was conducted over six months in the paediatric OPD of a tertiary care centre. Three hundred children aged 6–60 months were enrolled by systematic random sampling. Nutritional status was assessed anthropometrically using WHO 2006 Growth Standards. Morbidity data covering diarrhoeal disease, acute respiratory infection (ARI), and fever were ascertained for the preceding two weeks. Statistical analysis included chi-square tests and odds ratios (OR) using SPSS version 25. Results: The prevalence of underweight, stunting, and wasting was 38.0%, 42.0%, and 25.0%, respectively; 66.0% of children had at least one form of undernutrition. Malnourished children had significantly higher odds of diarrhoea (OR 2.5; 95% CI 1.3–4.8; p=0.01), ARI (OR 2.2; 95% CI 1.1–4.3; p=0.02), and fever (OR 1.9; 95% CI 1.0–3.6; p=0.03. Conclusions: Malnutrition is highly prevalent in this hospital-based paediatric population and is significantly associated with increased morbidity. Integrated interventions addressing nutritional rehabilitation and infection prevention are urgently needed.

Background: Internet addiction has emerged as a significant behavioral health concern among medical students due to increasing dependence on digital technology for academic and social activities. Excessive internet use may adversely affect sleep quality and psychological well-being. This study aimed to assess the association between internet addiction and sleep quality among medical students. Methods: A cross-sectional observational study was conducted among 150 MBBS students at Dr. S.N. Medical College. Participants aged 18–24 years who had been using mobile internet for more than one year were included. Data were collected using a pre-structured questionnaire along with standardized assessment tools: Young’s Internet Addiction Test (IAT), Pittsburgh Sleep Quality Index (PSQI), and Depression Anxiety Stress Scale-21 (DASS-21). Statistical analysis was performed using appropriate tests, and a p-value <0.05 was considered statistically significant. Results: The mean age of participants was 20.30 years. The prevalence of internet addiction was 13.33%, while 31.33% were classified as internet over-users. Poor sleep quality was observed in 50.7% of participants. A significant positive correlation was found between internet addiction and depression (r=0.565), anxiety (r=0.509), stress (r=0.549), and poor sleep quality measured by PSQI (r=0.484), with all p-values <0.0001. Male students demonstrated significantly higher IAT and PSQI scores compared to females. Night-time internet use and prolonged internet exposure (>6 hours/day) were highly prevalent. Conclusion: Internet addiction is significantly associated with poor sleep quality and psychological distress among medical students. Early identification, sleep hygiene education, and promotion of healthy internet usage practices are essential to improve mental well-being and academic performance.

Background: Hypertension and dyslipidemia commonly coexist and may contribute to peripheral nerve dysfunction through vascular and metabolic injury. This study evaluated the effect of dyslipidemia on nerve conduction parameters in normotensive and hypertensive individuals. Methods: This observational cross-sectional comparative study was conducted in the Department of Physiology in collaboration with the Department of Medicine at tertiary care centre of north India. A total of 180 subjects aged 18–60 years were enrolled and divided into two groups: 90 normotensive dyslipidemic individuals (controls) and 90 hypertensive dyslipidemic individuals (study group). Clinical examination, anthropometric assessment, blood pressure measurement, lipid profile analysis, and bilateral nerve conduction studies were performed. Motor conduction parameters of median, ulnar, common peroneal, and posterior tibial nerves and sensory parameters of median and sural nerves were assessed using standard techniques. Statistical analysis was performed using SPSS version 20.0, with p<0.05 considered significant. Results: Age, BMI, and lipid profile parameters were comparable between groups, while systolic and diastolic blood pressures were significantly higher in the hypertensive dyslipidemic group. Significant reduction in motor amplitude was observed in bilateral median and posterior tibial nerves in hypertensive dyslipidemic subjects. Motor nerve conduction velocity was significantly reduced in the left ulnar, left common peroneal, and bilateral posterior tibial nerves, while sensory conduction velocity of the right sural nerve was also significantly decreased. Motor nerves were more affected than sensory nerves. Conclusion: Hypertension with dyslipidemia is associated with early subclinical peripheral neuropathic changes. Nerve conduction studies may serve as a useful non-invasive tool for early detection of neuropathy in such patients.

Background: Post-operative pain after orthopaedic surgery remains a major clinical problem even when regional anaesthesia is used. Orthopaedic procedures often involve bone manipulation, periosteal irritation and soft-tissue trauma, leading to inflammatory and nociceptive pain that may delay mobilisation and recovery. Current practice therefore favours multimodal analgesia rather than reliance on a single agent. [1-5] Buprenorphine transdermal patch offers continuous opioid analgesia, whereas intramuscular diclofenac provides rapid non-steroidal anti-inflammatory analgesia. Objective: To systematically review and synthesize evidence on the comparative efficacy, rescue analgesic requirement and safety profile of buprenorphine transdermal patch versus intramuscular diclofenac for management of post-operative analgesia following orthopaedic surgery under regional anaesthesia. Methods: A systematic narrative review was drafted using the uploaded institutional dissertation as index evidence and peer-reviewed literature on post-operative pain, regional anaesthesia, buprenorphine patches, diclofenac and multimodal analgesia. The index study was a prospective, randomized, open-label controlled study of 70 patients aged 20-59 years undergoing upper or lower limb orthopaedic surgery under regional anaesthesia. Results: Intramuscular diclofenac showed better early pain control at 8 and 12 hours, while buprenorphine transdermal patch showed superior sustained analgesia from 32 to 72 hours. Rescue analgesia was required in 31.4% of the buprenorphine group and 45.7% of the diclofenac group in the index study. Injection-site pain was more frequent with diclofenac, whereas mild local pruritus was observed with the patch. Conclusion: Diclofenac remains useful for immediate post-operative pain, but buprenorphine transdermal patch provides more sustained analgesia and avoids repeated painful injections. The most rational protocol is pre-operative patch application with short-acting bridge analgesia during the early block-regression phase.

Introduction: Three-dimensional ultrasonography (3D US) and hysterosalpingography (HSG) are crucial, often complementary, imaging modalities for assessing the uterine cavity, specifically in infertility. 3D US is non-invasive and superior for diagnosing congenital anomalies (septate vs. bicornuate) and cavity lesions. The aim of this study is to establish the role of 3D transvaginal ultrasonography in the evaluation of various uterine cavity abnormalities in infertile patients in local population. 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: The values were calculated for 2D USG, 3D USG and HSG separately for Mullerian duct abnormalities and for endometrial and sub-mucosal pathologies. The cases were taken to be true positive when they were confirmed by either hystero-laparoscopy or by MRI, which are taken to be gold-standard for the diagnosis. So only 28 subjects were taken into account for these calculations where either of these two modalities was available. The calculated sensitivity 2D USG in detection of mullerian duct abnormality is 57.14% (0.95 CI 18.41% – 90.10%), Specificity is 100% (0.95 CI 83.89% – 100.00%), positive predictive value 100% (0.95 CI 39.76% – 100.00%) and Negative predictive value 87.50% (0.95 CI 67.64% – 97.34%). The calculated sensitivity 3D USG in detection of mullerian duct abnormality is 100.00% (0.95 CI 59.04% – 100.00%), Specificity is 100.00% (0.95 CI 83.89% – 100.00%), positive predictive value 100.00% (0.95 CI 59.04% – 100.00%) and Negative predictive value 100.00% (0.95 CI 83.89% – 95.46%) (66). Conclusion: All the uterine cavities which are abnormal in 2D USG, needs evaluation with definite diagnostic modalities for further detailing. All the patients with infertility should have at least one 3D USG screening to exclude any uterine cavity abnormality, even if the conventional 2D scanning is negative. The routine use of invasive procedures like Hysterosalpingography should be gradually decreased and replaced by non-invasive volume USG, where only the uterine cavity abnormalities are in question. For Mullerian duct abnormalities; 3D USG, showing excellent sensitivity and specificity, may be taken as a definite diagnostic modality and when there is no expected therapeutic benefit, the invasive procedures like hystero-laparoscopy may be avoided on the basis of 3D USG diagnosis.

Introduction: Acute confusional state (delirium) is a common neuropsychiatric syndrome in hospitalized elderly and is associated with increased morbidity, mortality, length of hospital stay and healthcare expenditure. However, studies in Northeast India are scarce despite being clinically important. Aims: (1). To study clinical profile of elderly patients presenting with acute confusional state. (2). To find out the etiological and precipitating factors of acute confusional state. (3). To evaluate short term outcome of geriatric patients with acute confusional state. Materials and Methods: A hospital based observational study was conducted in Department of Medicine, Gauhati Medical College and Hospital during the period from July 2016 to June 2017. We included 80 patients, aged ≥ 60 years, who met the Confusion Assessment Method (CAM) criteria for an acute confusional state. We evaluated demographic variables, comorbidities, predisposing factors, precipitating causes, distribution of subtypes and outcomes. Results: Participants’ mean age was 70.81±8.82 years. The study population consisted of 60% males. Hypoactive delirium was the most frequent subtype (43.8%). The most common comorbidities were hypertension (73.7%) and diabetes mellitus (56.2%). The main predisposing factors were hypoalbuminemia (66.2%), frailty (60%) and poor activities of daily living (58.7%). The most frequent precipitating factors were infection (67.5%), hyponatremia (42.5%) and catheter/tube insertion (35%). The most common infectious etiology was urinary tract infection (31.2%). Most patients had several predisposing and precipitating factors at the same time. Conclusion: In older patients, there are multiple causes of acute confusional state, of which infection and metabolic disturbances are important. Early recognition of vulnerable patients and correction of reversible causes may reduce morbidity and improve clinical outcomes.

Background: In India, tuberculosis (TB) is still a significant public health issue. Adverse drug reactions (ADRs) during treatment with antitubercular therapy (ATT), tend to lead to poor adherence to treatment and negative treatment outcomes. Patients with drug resistant tuberculosis (DR-TB) who are on extensive second-line regimens are especially at risk for serious ADRs. There is a lack of data on the differences in ADR profiles between patients with drug-sensitive TB (DS-TB) and DR-TB under programming conditions in India. This study aimed to assess and compare the ADR profiles of both DS-TB and DR-TB patients receiving ATT under the National Tuberculosis Elimination Programme (NTEP). Methods: From January 2023 to January 2025, a prospective study of tuberculosis (TB) patients on anti-TB therapy was conducted at a tertiary level care medical school hospital located in Gujarat, India. The study consisted of 100 TB patients (50 DS-TB; 50 DR-TB) who received treatment in the outpatient department (OPD) of the hospital. Baseline demographic and clinical data were captured at the beginning of the treatment period, along with a record of any adverse drug reactions (ADRs) that occurred during that time. Health records were monitored for the occurrence of ADRs throughout the entire treatment period. Causality was assessed using the WHO-Uppsala Monitoring Centre (WHO-UMC) causality assessment scale, and severity was assessed using the modified Hartwig and Siegel severity assessment scale. Chi-square (χ2) and Fisher’s exact tests were used to perform statistical analyses of the data. A p-value of 0.05 was used to determine statistical significance. Results: One hundred patient participants had 148 AD events recorded in their medical records. GI AD events were seen at the highest frequency (35.1%); however, there were also many hepatobiliary (18.2%) and neurologic (16.2%) reports too. Compared to DS-TB patients, DR-TB patients had higher rates of peripheral neuropathy (36.4% vs. 6.4%, p < 0.001), psych manifestations (18.2% vs. 1.3%, p = 0.002), arthralgia/myalgia (27.3% vs. 11.5%, p = 0.048), ototoxicity (9.1% vs. 0%, p = 0.009), and QT interval prolongation (9.1% vs. 0%, p = 0.009). As well, most AD events (91.9%) were of mild to moderate intensity. Per WHO-UMC guidelines, most AD events are determined to have a probable relationship. 50% of AD events were treated symptomatically only; 19.6% of AD events required temporary suspension of the drug causing the AD event. Conclusion: Patients with tuberculosis (TB) on antitubercular therapy (ATT) through the national tuberculosis elimination program (NTEP) are at risk for experiencing adverse drug reactions (ADRs). Drug-resistant TB patients treated with second-line drugs are especially at risk of developing neuropsychiatric and cardiotoxic ADRs. Early identification of ADRs, active methods of monitoring side effects, and prompt treatment of ADRs will improve adherence to treatment and improve the overall outcome of treatment for DR-TB patients.

Background: Type 2 diabetes mellitus is a chronic metabolic disorder frequently associated with endocrine abnormalities, among which thyroid dysfunction is one of the most common. Thyroid hormones influence carbohydrate metabolism, insulin sensitivity, and glucose homeostasis. The coexistence of thyroid dysfunction with diabetes mellitus may adversely affect glycemic control and increase the risk of diabetic complications. Aim: To study the thyroid function tests in type 2 diabetes mellitus patients. Objectives: To estimate the levels of thyroid function tests in patients with type 2 diabetes mellitus. Methodology: The present hospital-based observational cross-sectional study was conducted among 120 patients with type 2 diabetes mellitus attending a tertiary care centre. Patients fulfilling the inclusion criteria were enrolled after obtaining informed consent. Clinical evaluation and laboratory investigations including thyroid function tests such as serum T3, T4, and TSH were performed. Data were analyzed using appropriate statistical methods, and a p-value less than 0.05 was considered statistically significant. Results: The majority of patients belonged to the 51–60 years age group (35.0%). Females constituted 56.7% of the study population. Thyroid dysfunction was present in 25.8% of patients, while 74.2% were euthyroid. Subclinical hypothyroidism was the most common thyroid abnormality observed in 16.7% of patients, followed by hypothyroidism in 6.7% and hyperthyroidism in 2.5%. Thyroid dysfunction was more common among females compared to males, although the association was statistically insignificant (p>0.05). Conclusion: Thyroid dysfunction is common among patients with type 2 diabetes mellitus, with subclinical hypothyroidism being the predominant abnormality. Routine screening for thyroid dysfunction in diabetic patients may help in early diagnosis and better metabolic management.

Introduction: Hepatitis B virus (HBV) has infected affected thirty three percent of the world population, two billion have been infected worldwide and out of them, 350 million suffer from chronic HBV infection. Out of these, approximately 15–40% of patients will develop cirrhosis, liver failure and hepatocellular carcinoma. The most common side effects of tenofovir are nausea, vomiting, diarrhea, bloating, flatulence, indigestion, loss of appetite, headache, weakness (asthenia), dizziness, insomnia, rash, itching, back pain, pain, renal failure, lactic acidosis, alopecia and osteoporosis. There is paucity of research regarding overdosage of tenofovir. Hence, the need of this case report. Case Report: We are reporting a thirty-year-old male of chronic hepatitis B who was in active phase thus was put on Tenofovir disoproxil fumarate (TDF) 300 mg daily once. The six -month therapy was issued to him free of cost under National viral hepatitis control program (NVHCP). As the six bottles of tenofovir were of different time period of expiry, hence they were numbered from 1-6, for ease of patient, so that number 1 bottle is finished first and number 6 was to be taken in last. It was clearly explained to him that only one tablet has to be taken in a day. There were no accompanying family members at the time of dispensing of drugs. The patient reported after one month with complaints of irritability, vertigo, restlessness, red eyes, feeling of radiation of heat from body and headache. We have never seen these kinds of side effects with tenofovir in 2500 patients in last 13 years who are on regular treatment and follow-up. There was no history of any kind of drug intake with tenofovir, alteration in food habits, any kind of drug or alcohol abuse in last one month when tenofovir was started. On probing further, he admitted that he was taking six tablets of tenofovir per day. The reason given was that by mistake on reading number 6 written on one bottle, he understood that six tablets per day are to be taken in a day. The reality is that number 6 was written on that particular bottle for depicting that this bottle has to be used in last i.e. in sixth month. The patient all biochemical labs including liver function & renal function, blood sugar, thyroid profile, serum electrolytes, serum calcium and phosphorus levels, urine complete examination, ECG, chest x-ray and ultrasonogram abdomen was essentially normal. He was immediately shifted on daily once dosage of tenofovir. All his symptoms subsided within a week. Conclusion: Every drug has well documented side effects but it is not necessary that manifestations due to overdosage are available for all the available drugs. Similarly, there is scarcity of data regarding overdose of tenofovir which occurred in our case. The relieving side was that patient did not develop life threatening complications like lactic acidosis and renal failure. Our case report re-affirms the need of repeatedly explaining to the patients about proper dosage of drugs.

Background: Blood donor deferral is an essential component of ensuring the safety of both donors and recipients; however, it can adversely affect blood availability and donor retention. Understanding the prevalence and causes of donor deferral is crucial for improving blood transfusion services. This study aimed to determine the prevalence and determinants of blood donor deferral in a tertiary care apex institute and to analyze the pattern of temporary and permanent deferrals. Materials and Methods: This cross-sectional observational study was conducted in the blood bank of a tertiary care apex institute over a period of one year (June 2023–June 2024). A total of 1220 prospective blood donors aged 18–65 years were evaluated according to standard eligibility criteria. Donors were categorized as accepted or deferred, and deferrals were further classified as temporary or permanent based on the underlying cause. Data were analyzed using SPSS version 20, and associations were assessed using the Chi-square test, with p < 0.05 considered statistically significant. Results: Out of 1220 prospective donors, 125 were deferred, resulting in a deferral rate of 10.2%. The deferral rate was significantly higher among females (18.2%) compared to males (8.5%) (p < 0.001). Temporary deferrals constituted 80.0% of cases, while permanent deferrals accounted for 20.0%. Low hemoglobin was the most common cause of temporary deferral (45.0%), followed by recent illness (20.0%). Among permanent deferrals, hypertension (32.0%) was the leading cause, followed by diabetes mellitus and high-risk behavior (24.0% each). No significant association was observed between gender or age and the type of deferral. Conclusion: Blood donor deferral in the studied population was primarily due to temporary and preventable causes, with anemia being the most significant factor. Targeted interventions such as nutritional improvement, donor education, and effective counseling, along with structured follow-up of deferred donors, can reduce deferral rates and enhance donor retention, thereby improving the availability of safe blood.

Introduction: Blood and blood components are essential, yet scarce therapeutic resources in modern healthcare. Despite advances in transfusion medicine, their limited shelf life and strict storage requirements lead to significant wastage, driven by expiry, transfusion-transmitted infection (TTI) reactivity, and operational inefficiencies. Monitoring wastage is vital to improve utilization and reduce avoidable losses. Materials and Methods: A retrospective study was conducted at a tertiary care hospital from January 2023 to December 2025, analyzing 20,000 blood units. Data were extracted from blood bank records to assess wastage, utilization efficiency, and transfusion indicators. Wastage categories and associated factors were analyzed using descriptive statistics and logistic regression. Results: A total of 20,000 blood units were collected, with 1,165 discarded, giving a 5.8% wastage rate. Packed red blood cells (PRBCs) and platelets contributed most to wastage. Expiry was the leading cause (44.6%), followed by TTI reactivity. Wastage was higher in replacement donors and peripheral storage areas. Logistic regression identified platelet units, replacement donation, and peripheral storage as significant predictors of wastage. Transfusion indicators showed relatively efficient utilization overall. Conclusion: Blood wastage was 5.8%, mainly due to PRBCs and platelets. Expiry, replacement donation, and peripheral storage were key factors. Improved inventory management, staff training, and voluntary donation can reduce wastage and enhance blood utilization efficiency.

Background: Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric condition where abnormal obsessions and compulsions occur repeatedly which particularly disrupt functional and daily living activities. The disorder has a negative impact on psychological functioning, social interactions, and work functioning and quality of life (QOL). A psychosocial burden is important to understand for planning effective therapeutic and rehabilitation strategies for OCD. Methods: The study is designed as a cross-sectional observational study of 94 patients who were admitted to psychiatric outpatient clinics for OCD from August 2025 to March 2026 at R.D.J.M. Medical College and Hospital, Turki, Muzaffarpur. The participants were selected by convenience sampling. Standardized assessment instruments such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for the severity of OCD, the WHOQOL-BREF for QOL assessment, and the Social and Occupational Functioning Assessment Scale (SOFAS) were used to collect data. Data was analyzed statistically in SPSS and in Microsoft Excel. Descriptive statistics, percentage, mean scores, chi-square test and correlation analysis were used. Results: The gender distribution of the 94 participants was 53.2% male and 46.8% female. Most of the participants were in the 21-30 age group (38.3%). 48.9% of participants had moderate OCD and 29.8% had severe OCD symptoms. The mean WHOQOL-BREF scores were found to be lower in social relationship domain (45.3 ± 11.1) and psychological health domain (48.7 ± 10.5) which showed poor QOL. 64.9% of the participants reported relationship difficulties and 61.7% reported social withdrawal. The level of occupational impairment was significant, with 67.0% of the respondents stating a decrease in their productivity and 50.0% stating that they had a longer period from which they were absent from work. A significant negative correlation was found between severity of OCD and QOL (r = -0.68, p < 0.001) and occupational functioning (r = -0.59, p < 0.001) in the correlation analysis. Conclusion: The results of the study also indicated that OCD has a significant impact on QOL, social functioning and occupational performance. The more severely a child had OCD symptoms, the more psychosocial and occupational dysfunction occurred. Psychological intervention, counseling support, identification and occupational rehabilitation are all important to help achieve better function and well-being of persons with OCD.

Background: Schizophrenia is a chronic psychiatric disorder characterized by disturbances in perception, thought, emotion and behavior, leading to significant impairment in social and occupational functioning. The disease impacts on quality of life (QoL) and significant cause of disability, unemployment, social isolation and emotional distress among affected individuals. Although schizophrenia is a growing burden, few regional studies in Bihar have evaluated the effects of schizophrenia on psychosocial functioning and QoL. Methods: This study was a retrospective observational study conducted in the department of Psychiatry at R.D.J.M. Medical College & Hospital from August 2025 to February 2026. A total of 92 diagnosed schizophrenia patients were included. Demographic profiles, WHOQOL-BREF scale, Social Functioning Scale (SFS), and occupational functioning assessment tools were used to collect the data from the hospital records. Descriptive and inferential statistics were used with p value <0.05 was taken as significant. Results: Among 92 patients, 58.7% were male and 40.2% were in the age group 31–40 years. There was moderate social impairment seen in 46.7% of patients, and severe social dysfunction in 31.6% of patients. 55.4% had been without employment. The lowest average scores in the QoL scale were in the social relationship domain (39.8) and psychological domain (42.3). There was a significant relationship between the duration of illness and decreased QoL (p=0.003) and impaired social functioning (p=0.011). Conclusion: Schizophrenia has a profound impact on life functioning and QoL, and adversely affects and occupational functioning. To achieve optimal long-term patient outcomes and social reintegration, early psychiatric intervention, psychosocial rehabilitation, occupational therapy and family support are essential.

Background: The COVID-19 pandemic has been accompanied by a surge of secondary fungal infections, particularly mucormycosis, in India. Post-COVID mucormycosis has emerged as a severe opportunistic infection, largely affecting patients with uncontrolled diabetes mellitus and those treated with corticosteroids. We undertook the study to determine the occurrence of COVID associated mucormycosis, establish the association of risk factor(s), identify and characterize the agents of mucormycosis. Methods: This prospective observational and cross-sectional descriptive study was conducted at a tertiary care hospital in West Bengal, India. A total of 107 COVID-19 patients with clinical suspicion of mucormycosis were included. Microbiological diagnosis relied on KOH wet mount examination, fungal culture, histopathological staining, and molecular methods like RT-PCR for confirmation. Results: The study revealed a high mortality rate of 21.5% among post-COVID mucormycosis patients. Uncontrolled diabetes with diabetic ketoacidosis, chronic kidney disease, chronic liver disease, and shorter interval between COVID recovery and mucormycosis onset were significant predictors of mortality. Rhizomucor pusillus was the predominant fungal isolate. Combined surgical and medical therapy, including aggressive debridement and antifungal therapy, was the mainstay of treatment. Conclusion: Post-COVID mucormycosis was a major public health concern in India, with high mortality rates despite early intervention. Strict glycemic control, early diagnosis, and comprehensive management of comorbidities are essential to improve survival outcomes. Our study highlights the need for rational corticosteroid use, diabetes control, and multidisciplinary management to prevent future outbreaks. Future research should focus on understanding host-pathogen interactions, resistance patterns, and developing rapid diagnostic assays to enable timely intervention in high-risk patients.

Background: Chronic otitis media (COM) is a persistent inflammatory condition of the middle ear that often leads to ossicular chain damage, resulting in conductive hearing loss. Intraoperative assessment remains the gold standard for evaluating ossicular status and guiding surgical management. Aim: To assess the intraoperative ossicular chain status and determine the pattern and predictors of ossicular erosion in patients with long-standing chronic otitis media. Materials & Methods: This hospital-based cross-sectional study was conducted in the Department of Otorhinolaryngology at ESIC Medical College & Hospital, Bihta, Patna. A total of 100 patients aged 7–60 years with chronic otitis media undergoing surgery were included. Detailed clinical evaluation, otoscopic examination, and Pure Tone Audiometry (PTA) were performed preoperatively. Intraoperative assessment of ossicular chain status was carried out. Data were analyzed using SPSS version 27.0. Statistical tests included Chi-square test and independent t-test. Multivariate logistic regression analysis was used to identify predictors of ossicular erosion. A p-value <0.05 was considered statistically significant. Results: Ossicular erosion was observed in 66% of patients, while 34% had an intact ossicular chain. The incus was the most commonly affected ossicle (56%), particularly its long process (42%), followed by the stapes (28%) and malleus (18%). Single ossicle involvement (38%) was most frequent. A highly significant association was found between ossicular erosion and type of COM, with squamosal disease showing a markedly higher prevalence (94.74%) compared to mucosal disease (48.39%) (p < 0.001). Patients with ossicular erosion had significantly higher mean PTA thresholds (48.72 ± 8.94 dB vs 32.84 ± 6.12 dB) and air–bone gap (29.41 ± 6.37 dB vs 18.26 ± 4.85 dB) (p < 0.001). Multivariate analysis identified duration of disease >5 years (AOR = 3.76; p = 0.004), squamosal COM (AOR = 12.48; p < 0.001), presence of cholesteatoma (AOR = 8.92; p < 0.001), and granulation tissue (AOR = 2.67; p = 0.039) as significant predictors of ossicular erosion. Conclusion: Ossicular erosion is a common finding in long-standing chronic otitis media, particularly in squamosal disease. The incus is the most frequently affected ossicle. Significant predictors include prolonged disease duration, cholesteatoma, and granulation tissue. Early diagnosis and timely surgical intervention are essential to prevent ossicular damage and improve hearing outcomes.

Introduction: 200 patients with either ischaemic or hemorrhagic stroke detected by CT/MRI were included in the study, which had a prospective, observational design. On Days 0, 90, and 180, NIHSS and MRS scores were noted. Additionally recorded were the location of radiological lesions, risk factors (such as smoking, diabetes, and hypertension), demographic information, and lab results (such as RFT, LFT, and HbA1c). Both univariate (t-tests, chi-square) and multivariate (ordinal and multinomial regression) statistical techniques were used in the data analysis. Studies such as ERICH, SOOP, IOSR, Dhiman et al., and Alawneh et al. were compared. Material and Method: The study was conducted over a period of 24 months from [MARCH 2023] to [MARCH 2025] including admission, evaluation, and follow-up at 3 months (Day 90) and 6 months (Day 180). The study was carried out in the departments of General Medicine SCBMCH, CUTTACK. This is a prospective, observational, comparative study conducted at a tertiary care teaching hospital SCB MCH in Odisha, India. The study aims to evaluate and compare the motor outcomes in patients with ischemic stroke (cerebral infarction) and intracerebral hemorrhage (ICH) using clinical scales — the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (MRS) — while correlating outcomes with radiological findings. Result: The study used a prospective, observational design and enrolled 200 patients diagnosed via CT/MRI with either ischemic or hemorrhagic strokes. NIHSS and MRS scores were recorded on Day 0, Day 90, and Day 180. Radiological lesion localization, risk factors (e.g., hypertension, diabetes, and smoking), demographic details, and lab values (e.g., HbA1c, RFT, and LFT) were also captured. Data analysis involved both univariate (t-tests, chi-square) and multivariate (ordinal and multinomial regression) statistical methods. Comparisons were made with studies including ERICH, SOOP, IOSR, Dhiman et al., and Alawneh et al. Conclusion: Using approved neurological assessment techniques (NIHSS and MRS) throughout three important follow-up intervals (Day 0, Day 90, and Day 180), this study examined the comparative motor outcomes in individuals with ischaemic and hemorrhagic strokes. A dataset of 200 patients from a tertiary care facility in Odisha, India, served as the basis for the analysis, which was thoroughly contrasted with established results from institutional studies and global stroke registries.

Background: Anaemia is one of the most common hematological disorders, particularly in developing countries. Objective- To evaluate the morphological patterns of anaemia and correlate them with red blood cell indices and platelet indices in anaemic patients attending a tertiary care hospital. Materials and Methods: The present hospital-based cross-sectional observational study was conducted in the Department of Pathology at RVRS Medical College, Bhilwara over a period of one year from September 2024 to August 2025. A total of 276 patients diagnosed with anaemia were included in the study. Patients with hematological malignancies, recent blood transfusion, acute hemorrhagic conditions, and inadequate samples were excluded. Results: The majority of patients belonged to the age group of 21–30 years (27.9%), and females constituted 62.0% of the study population. Microcytic hypochromic anaemia was the most common morphological type, observed in 132 patients, followed by normocytic normochromic anaemia in 77 patients. The overall mean hemoglobin level was 8.35 ± 1.53 g/dL, and the difference among various morphological types was statistically significant (p=0.038). The differences in red blood cell indices among different morphological patterns were statistically significant (p<0.001). Significant differences were observed in MPV, PDW, and PCT among various morphological types of anaemia (p<0.001). Conclusion: Microcytic hypochromic anaemia was the predominant morphological pattern. Significant variations in red blood cell and platelet indices were observed among different morphological types of anaemia. Correlation of peripheral smear morphology with automated red blood cell and platelet indices provides a better understanding of the hematological profile of anaemic patients and may aid in early diagnosis and classification of anaemia.

Introduction: Electrolyte disturbances, particularly involving magnesium, are frequent yet under-recognized in intensive care settings. As a vital intracellular cation and enzymatic cofactor, magnesium is essential for cardiovascular stability, neuromuscular transmission, and metabolic processes. This study aimed to evaluate serum magnesium levels at the time of ICU admission and determine their association with clinical outcomes, including mechanical ventilation requirements, length of stay, and mortality. Materials & Methodology: This prospective observational study was conducted over two years (2023–2025) at MGM Medical College and Hospital, Aurangabad. A total of 179 critically ill adult patients (APACHE II score >10) were enrolled. Serum magnesium was measured on Day 1 and Day 5 using the colorimetric endpoint method, with levels <1.7 mg/dL defined as hypomagnesemia. Primary outcomes included the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality. Results: Hypomagnesemia was highly prevalent, affecting 77.09% of the study population. While age and gender showed no significant correlation with magnesium levels, hypomagnesemia was strongly associated with adverse clinical outcomes. Patients with low magnesium had a significantly longer mean ICU stay (5.87 ± 4.13 days vs. 4.13 ± 3.98 days; P = 0.048) and a higher requirement for mechanical ventilation (72.46% vs. 42.31%; P = 0.0025). Furthermore, mortality was significantly higher in the hypomagnesemic group (61.59%) compared to the normomagnesemic group (30.77%; P = 0.0036). Significant associations were also observed between hypomagnesemia and other electrolyte imbalances, specifically hypokalemia (P < 0.0001) and altered calcium levels (P = 0.001). Conclusion: Hypomagnesemia is a significant predictor of poor prognosis in critically ill patients, associated with prolonged hospitalization, increased ventilatory support, and higher mortality rates. These findings suggest that serum magnesium monitoring should be a routine part of ICU admission protocols to facilitate early detection and timely intervention, potentially improving clinical outcomes in high-risk patients.

Introduction: Hypertension affects over a billion of people globally and is a major contributor to cardiovascular diseases such as heart disease, stroke, and kidney failure. Essential hypertension, influenced by genetic and environmental factors, is associated with chronic inflammation, where high-sensitivity C-reactive protein (hs-CRP) serves as a key marker. The minerals zinc and magnesium are crucial for blood pressure regulation. This study examines the relationship between hs-CRP, zinc, and magnesium levels in essential hypertension and their implications for cardiovascular risk. Methodology: A total of 170 participants, including 85 newly diagnosed hypertensive patients and 85 normotensive controls, were evaluated. Serum hs-CRP was measured using the turbidimetry method, magnesium by the colorimetric method, and zinc via inductively coupled plasma mass spectrometry (ICP-MS). Statistical analysis was performed using SPSS (version 21.0). Results: Hypertensive individuals had significantly higher systolic (151.14 ± 9.86 mmHg) and diastolic (94.51 ± 8.21 mmHg) blood pressure compared to controls (p < 0.001). hs-CRP levels were significantly elevated in hypertensive participants (4.67 ± 4.74 mg/L) versus controls (1.71 ± 2.28 mg/L; p < 0.001). Serum magnesium levels were lower in hypertensive individuals (1.94 ± 0.35 mg/dL; p < 0.001), while no significant difference in serum zinc levels was observed (p = 0.36). A negative correlation was found between serum magnesium and blood pressure, but no correlation with zinc was evident. Conclusion: Elevated hs-CRP levels and magnesium deficiency are critical markers in essential hypertension. Monitoring these biomarkers could enhance hypertension management and reduce cardiovascular risks.

Introduction: Maternal and child health is a key public health priority, yet maternal mortality and morbidity remain high in rural India despite national improvements due to poor access, sociocultural constraints, and low quality of care. Client satisfaction is increasingly recognized as a key indicator of healthcare quality, influencing service utilization, adherence to medical advice, and continuity of care this study was conducted to assess client satisfaction among puerperal women which is crucial to bridge service gaps and improve outcomes. Methods: A community-based cross-sectional study was conducted over one year in 16 villages under the RHTC, Digod, attached to the Department of Community Medicine, Government Medical College, Kota, and Rajasthan. A total of 200 puerperal women were selected using standard sample size calculation. Data were collected through interviewer method using a semi-structured questionnaire after ethical approval. Data analysis was done using appropriate statistical test. Results: Majority of respondents in this study were Hindus (90.5%). It was observed that the majority of participants (61%) reported high satisfaction (score range: 40–50), followed by 30.5% with moderate satisfaction (score range: 30–39), and only 8.5% reported low satisfaction (score range: 10–29). Conclusion: The study revealed that a majority of puerperal women were highly satisfied with maternal healthcare services. However, lower satisfaction in domains like breastfeeding and nutrition counselling highlights the need to strengthen interpersonal communication and health education efforts.

Background: Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disorder characterized by destruction of pancreatic β-cells resulting in absolute insulin deficiency. During childhood and adolescence, T1DM significantly affects growth, nutritional status, and body composition. Alterations in lean body mass and fat distribution may adversely influence metabolic health and long-term cardiovascular outcomes. Aim: To compare body composition parameters between pediatric patients with T1DM and healthy age-matched controls. Materials and Methods: This hospital-based case–control study was conducted in the Department of Physiology in collaboration with the Department of Pediatrics at BPS Government Medical College for Women, Khanpur Kalan, Sonipat, and Haryana. Ninety participants were enrolled, including 45 pediatric patients with T1DM and 45 healthy age-matched controls. Anthropometric and body composition parameters including body weight, Body Mass Index (BMI), Fat-Free Mass (FFM), Soft Lean Mass (SLM), Skeletal Muscle Mass (SMM), Body Fat Mass (BFM), and Percent Body Fat (PBF) were assessed using Bioelectrical Impedance Analysis (BIA). Statistical analysis was performed using SPSS version 25.0. Results: The mean body weight was significantly lower in cases compared to controls (27.84 ± 11.19 kg vs 34.38 ± 11.81 kg; p = 0.008). BMI was significantly lower among T1DM children (15.39 ± 3.69 kg/m² vs 19.08 ± 2.14 kg/m²; p < 0.001). Fat-Free Mass and Soft Lean Mass were also significantly reduced in cases (p = 0.002 and p = 0.005 respectively). No statistically significant difference was observed in Skeletal Muscle Mass, Body Fat Mass, or Percent Body Fat between groups. Conclusion: Children and adolescents with T1DM exhibit significant reductions in body weight, BMI, Fat-Free Mass, and Soft Lean Mass compared to healthy peers. The findings suggest that pediatric T1DM predominantly affects lean body compartments rather than adiposity. Routine body composition monitoring may help optimize growth and metabolic outcomes in pediatric T1DM.

Background: Type 2 diabetes mellitus is strongly associated with atherogenic dyslipidemia and increased cardiovascular risk. Statins remain the cornerstone pharmacological therapy for lipid control and prevention of cardiovascular events, but their influence on glucose metabolism requires careful interpretation in diabetic patients. Objective: To evaluate the effect of statin therapy on triglycerides, cholesterol, and blood glucose levels in patients with type 2 diabetes mellitus. Methods: This prospective clinical study involved 70 subjects with type 2 diabetes mellitus. The principal biochemical domains assessed were triglycerides, cholesterol, and blood glucose levels in relation to statin therapy. The interpretation focused on lipid response, glycemic response, and the clinical balance between cardiovascular protection and metabolic monitoring. Results: The study framework demonstrated the expected pharmacological benefit of statin therapy on lipid parameters, particularly cholesterol control, while also emphasizing the need for parallel glycemic surveillance. The overall interpretation is that statins provide essential cardiovascular protection in diabetes, but require monitoring of blood glucose because of their potential diabetogenic tendency. Conclusion: The dissertation concludes that statin therapy significantly improves lipid parameters in patients with type 2 diabetes mellitus, supporting its role in cardiovascular risk reduction. However, its possible effect on glycemic control highlights the need for regular monitoring and individualized treatment.

Background: Cervical health may be impacted by a number of physiological changes that perimenopausal women go through. An illuminated, enlarged view of the cervix and the tissues of the vagina and vulva is examined during a colposcopy, a diagnostic procedure. The most reliable method for identifying cervical lesions is histopathological examination (HPE). The purpose of this study is to assess the prevalence of cervical anomalies in perimenopausal women and to ascertain the relationship between colposcopic findings and histopathological examination results. Methods: Between March 2025 and February 2026, 100 perimenopausal women participated in this observational study at the Department of Obstetrics and Gynecology at Darbhanga Medical College and Hospital in Laheriasarai, Bihar. A biopsy for HPE was performed on patients with abnormal colposcopic results, which were documented. To determine the relationship between colposcopy findings and HPE outcomes, data were examined using the chi square test and percentage. Results: Colposcopy revealed 60 cases with aberrant results out of 100 perimenopausal women. Three cases of aggressive carcinoma and fifteen cases of cervical intraepithelial neoplasia (CIN) were confirmed by HPE. There was a significant association between colposcopic results and HPE. It was shown that high-grade squamous intraepithelial lesions (HSIL) were common. Conclusion: According to the study, perimenopausal women’s histopathological outcomes and colposcopic findings are strongly correlated.

Background: Premature rupture of membranes is such a condition in which there is a high risk of maternal and perinatal adverse outcomes. Premature rupture of membranes has an incidence of 5-10%. About 60% of cases of PROM occur at term. Aim of this study is to assess feto-maternal outcomes following PROM in term pregnancy and the role of the duration of membrane rupture in the development of complications. Methods: The Department of Obstetrics and Gynecology at Darbhanga Medical College and Hospital in Laheriasarai, Bihar, conducted this hospital-based observational study from March 2025 to February 2026. Total 75 cases of rupture of membranes spontaneously after 37 completed weeks who admitted in obstetrics and gynaecology department were included in this study.  All the Data were analyzed using SPSS version 26. Results: History of term PROM was seen in 15% of the patients, History of abortion was seen in 12% of the patients and history of preterm PROM was observed in 7% of patients. When risk factors and PROM were compared, anaemia was 20%, UTI was 10%, lower genital infections were 8%, cervical stich was 2%, mal presentations were 4%, hydramnias were 4% and there were no risk factors in 27% of the patients. Favourable bishop score was observed 30 patients undergoing vaginal delivery, 10 in LSCS, and unfavourable bishop score was observed in 20 patients undergoing vaginal delivery, 9 in LSCS. Number of cases in maternal morbidity was highest in > 24 hours i.e. 26.7%, perinatal morbidity cases were highest in 12-24 hours i.e. 30% and mortality among perinatal cases were 5% in 12-24 hours and >24 hours of PROM. Conclusion: PROM is associated with poor fetomaternal outcome which can be prevented by early diagnosis and prompt management.

Background: General anesthesia (GA) is usually used during total laparoscopic hysterectomy (TLH). Thoracic spinal anesthesia (TSA), however, might be a useful substitute, particularly for patients who are at high risk. The purpose of this randomized controlled experiment was to evaluate the safety and effectiveness of GA and TSA in TLH patients. Methods: Group T (TSA) and group G (GA), each consisting of 15 patients, were randomly assigned to 30 patients scheduled for elective TLH. While group T received TSA (sub-arachnoid block at T8/9 or T9/10 with hyperbaric levo-bupivacaine 0.5%, 0.7 ml along with dexmedetomidine 4 g, followed by isobaric levo-bupivacaine 0.5% 1.5 ml with dexmedetomidine 6 g while seated), group G received conventional GA with intubation and mechanical ventilation. Our main goal was to examine the hemodynamic changes, and our secondary goal was to compare the two methods’ intraoperative and postoperative side effects and need for rescue analgesia. Results: For the study, all 30 individuals were examined. Patients in Group T had better hemodynamic stability, and after 30 minutes, the mean SBP of the two groups differed significantly (at 40 minutes p=0.043, at 60 minutes p=0.007). In group G, there were noticeably more patients in need of rescue analgesia. Group G experienced greater adverse events, such as intraoperative hypertension and postoperative sore throat. Conclusion: For TLH, TSA offers a safe substitute for GA with improved hemodynamic stability, fewer adverse effects, and a lower need for rescue analgesia.

Background: A high-risk pregnancy that has become more common in recent years is multiple pregnancy. Compared to singleton pregnancies, they are linked to significantly higher rates of maternal and perinatal morbidity and mortality. Methods: From August 2013 to July 2014, a prospective case control study was carried out in the Department of Obstetrics and Gynecology, PMCH, Patna. The study included 50 singleton pregnancies (controls) and 50 cases of multiple pregnancies (cases) that were delivered at our hospital. Following the collection of a patient’s history, the protocol called for an examination and pertinent investigations. Numerous feto-maternal parameters were noted, and statistical analysis was performed on the data. Results: The majority of patients were between the ages of 21 and 25, and the incidence of multiple pregnancies was 1.75%. In our study, multigravida made up the majority of the patients. Eight percent of twin pregnancies had iatrogenic conception. In multiple pregnancies, the mean gestational age of presentation was 33.3 weeks, whereas in singleton pregnancies, it was 36.4 weeks. In 64% of twin pregnancies, DCDA was the most prevalent type of placentation. The three main problems in multiple pregnancies—preterm labor (62%), anemia (59%), and malpresentation (35%)—were far more common than in singletons. Twin pregnancies also had higher rates of other problems, such as PROM (23%), hypertensive disorders (17%), PPH (11%), and hyperemesis (5%). Multiple pregnancies had significantly higher rates of LSCS (62%) than singleton pregnancies (42%). Compared to 21% of singleton births, 89% of twin pregnancies resulted in low birth weight baby. Neonatal morbidities and death in multiple pregnancies were primarily caused by complications related to low birth weight and preterm. In our study, the perinatal mortality rate was 19% for the first twin and 26% for the second twin, both of which were considerably higher than the 12% for singletons. Conclusion: Significant feto-maternal morbidity and mortality are linked to multiple pregnancies. To enhance the maternal and newborn outcomes associated with multiple pregnancies, early discovery of high-risk cases, prompt referral, early hospitalization with a neonatal care setup, and frequent prenatal checkups are essential.

Background: Lower respiratory tract infections are a significant cause of illness and death, especially in tertiary care hospitals where antimicrobial resistance is rising. Sputum culture remains an important tool for identifying pathogens and guiding appropriate treatment. This study analysed the bacterial profile and antimicrobial susceptibility pattern of culture-positive sputum samples. Methods: A retrospective observational study was conducted in the Department of Microbiology, Government Medical College, Nagpur, from January 2021 to December 2025. Sputum samples received from outpatient departments, wards, and intensive care units were included. Only satisfactory samples based on Gram-stain Barlett’s criteria were processed. Cultures were performed on blood agar and MacConkey agar, and organisms were identified using standard biochemical methods. Antimicrobial susceptibility testing was carried out by Kirby–Bauer disc diffusion method according to CLSI guidelines. Results: A total of 2068 culture-positive sputum samples were analysed. Most isolates were from the respiratory-chest department (62.5%), followed by medicine (17.2%), surgery (8.9%), paediatrics (5.2%), obstetrics and gynaecology (5.0%), and orthopaedics (1.2%). Klebsiella pneumoniae was the most common isolate (71.4%), followed by Pseudomonas aeruginosa (18.0%), Acinetobacter spp. (5.6%), and Staphylococcus aureus (4.2%). Enterobacterales showed high resistance to beta-lactams and fluoroquinolones, with carbapenem resistance of 38–40%. Non-fermenters demonstrated variable resistance, with higher resistance in Acinetobacter spp. Colistin resistance was not detected. Conclusion: Klebsiella pneumoniae predominated among sputum isolates with notable multidrug resistance. Rising carbapenem resistance among Enterobacterales and Acinetobacter spp. underscores the need for antimicrobial stewardship and regular surveillance to guide empirical therapy.

The study aimed to investigate the use of computed tomography (CT) staging of the medial clavicular epiphysis ossification in forensic bone age determination and find a CT criterion to determine whether an individual is adult or not. Methods: Chest CT and pulmonary CT angiography exams of 354 patients between 10 and 30 years of age (mean, 21.4 years) were retrospectively evaluated for epiphyseal ossification phase of the bilateral medial clavicles (708 clavicles) and compared with the sex and chronologic age of the individuals. The ossification phase of the medial clavicular epiphyses was classified from stage I to stage V using a modified staging system. Results: Epiphyseal ossification center appeared from 11 to 21 years of age. Partial fusion occurred between 16 and 23 years of age. Complete fusion was first achieved at the ages of 18 and 19 years for male and female individuals, respectively. The probability of an individual being ≥18 years old was 70.8% in stage III A and 100% in stages III B, IV, and V in females and males. Conclusion: CT evaluation of the medial clavicular epiphysis is helpful in forensic age determination and stage III B can be used as a criterion to make the prediction that an individual is older than 18 years.

Background: Primary infertility, defined as the inability to conceive after at least 12 months of regular unprotected intercourse, is a significant reproductive health issue affecting women worldwide. It has profound medical, psychological, and social consequences. The prevalence of primary infertility varies across regions due to differences in socio-demographic and lifestyle factors. Objective: To estimate the prevalence of primary infertility among women of reproductive age (15–49 years) and to identify associated risk factors. Methods: A community-based cross-sectional study was conducted among women in the reproductive age group. Data were collected using structured questionnaires covering socio-demographic characteristics, reproductive history, and lifestyle factors. Primary infertility was defined as failure to conceive despite regular unprotected intercourse for one year or more. Statistical analysis was performed to determine prevalence and associated factors. Results: A total of 84 women in the reproductive age group were included in the study. The majority of women with primary infertility belonged to the age group of 20–30 years, followed by 30–40 years. Increased prevalence was observed among women with a longer duration of marriage (>5 years). Menstrual irregularities were reported in a significant proportion of infertile women, suggesting a possible association. Lifestyle factors such as stress, nutritional status, and body mass index also showed a correlation with primary infertility. Conclusion: Primary infertility is a considerable public health concern among women of reproductive age. The observed prevalence highlights the need for early detection, awareness, and appropriate intervention strategies. Addressing modifiable risk factors and improving access to reproductive healthcare services can help reduce the burden of infertility.

Aim: This paper evaluates the comparative role of synthetic and biological mesh in laparoscopic groin hernia repair, with emphasis on recurrence, postoperative pain, seroma formation, infection risk, integration with host tissue, and current guideline recommendations. The central aim is therefore to compare these two mesh classes in the setting of laparoscopic groin hernia surgery and to determine whether biologic mesh offers a meaningful clinical advantage over synthetic mesh in routine adult practice. Materials and Methods: A narrative review paper was prepared using peer-reviewed guideline and indexed literature on groin hernia management and comparative mesh outcomes. The principal evidence base consisted of the 2018 Hernia Surge international guidelines for groin hernia management and the associated summary publication emphasizing that mesh-based repair is recommended, laparo-endoscopic repair is favored in appropriate settings, and mesh characteristics should be understood beyond simplistic weight-based classification. Result: The available evidence consistently supports synthetic mesh as the benchmark material for laparoscopic groin hernia repair. International guidelines endorse mesh-based repair and note that laparo-endoscopic techniques are associated with faster recovery, lower chronic pain risk, and cost effectiveness. Guideline summaries further emphasize that large-pore monofilament synthetic implants have favorable integration properties and that mesh selection should be based on intrinsic characteristics rather than marketing claims or weight alone. Taken together, current evidence does not show superiority of biological mesh for routine laparoscopic groin hernia repair. Conclusion: Synthetic mesh remains the standard material in laparoscopic groin hernia repair because it combines broad evidence support, durable reinforcement, established guideline acceptance, and generally favorable cost-effectiveness. Biological mesh may retain a theoretical role in selected situations where surgeons seek a degradable scaffold or wish to minimize the burden of permanent foreign material, but the presently available comparative evidence does not establish better overall outcomes in routine adult laparoscopic groin hernia surgery.

Background: Allergic rhinitis is a chronic inflammatory disorder of the nasal mucosa characterized by nasal obstruction, rhinorrhoea, sneezing, and itching, significantly affecting quality of life. Persistent nasal obstruction secondary to inferior turbinate hypertrophy may remain refractory to medical treatment, necessitating surgical intervention. Inferior turbinate reduction surgery aims to improve nasal airflow while preserving mucosal function. The present study evaluated the clinical outcomes of inferior turbinate reduction surgery in patients with allergic rhinitis. Aim and Objective: To assess the efficacy of inferior turbinate reduction surgery in patients with allergic rhinitis using postoperative symptomatic improvement, Total Nasal Symptom Score (TNSS), nasal airway patency, and clinical outcomes. Materials and Methods: A prospective observational study was conducted in the Department of Otorhinolaryngology at Bundelkhand Medical College, Sagar, Madhya Pradesh, India, over 18 months (September 2023–February 2025). Ninety patients with allergic rhinitis associated with inferior turbinate hypertrophy and persistent symptoms despite medical therapy were included. Patients underwent submucosal inferior turbinate reduction surgery and were followed up for 90 days postoperatively. Clinical evaluation included TNSS assessment, anterior rhinoscopy, diagnostic nasal endoscopy, assessment of nasal airway patency, and postoperative healing. Results: Among the 90 participants, the majority belonged to the 18–25-year age group (43.3%), with a mean age of 31.8 years, and males constituted 70% of the study population. Nasal obstruction was the most common presenting symptom (90%), followed by rhinorrhoea (71%). Mean TNSS significantly decreased from 10.4 preoperatively to 5.4 at 90 days postoperatively (p<0.05), indicating substantial symptomatic improvement following surgery. Postoperative follow-up demonstrated satisfactory healing and improved nasal airway patency. Crusting was the most common postoperative complaint and resolved with conservative management, while no cases of severe hemorrhage or empty nose syndrome were observed. Conclusion: Inferior turbinate reduction surgery was associated with significant improvement in symptom severity, reduction in nasal obstruction, and favorable postoperative outcomes with minimal complications among patients with allergic rhinitis. The findings support submucosal inferior turbinate reduction as a safe and effective treatment option for selected patients with persistent symptoms despite medical therapy.

Background: Childhood obesity is increasingly prevalent in India and is associated with chronic low-grade inflammation and metabolic disturbances. Inflammatory cytokines such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) have been implicated in the development of insulin resistance (IR). Objective: To evaluate the association between inflammatory markers and insulin resistance in obese children in the Indian population. Methods: A cross-sectional analytical study was conducted among obese children aged 5–18 years and age- and sex-matched controls. Anthropometric parameters, biochemical markers (fasting glucose, insulin), and inflammatory markers (hs-CRP, IL-6, TNF-α) were assessed. Insulin resistance was calculated using HOMA-IR. Results: Obese children demonstrated significantly higher fasting insulin, HOMA-IR, and inflammatory markers. hs-CRP and IL-6 showed a strong positive correlation with HOMA-IR. A significant proportion of obese children exhibited insulin resistance. Conclusion: Chronic low-grade inflammation plays a crucial role in the development of insulin resistance in obese Indian children. Early screening and intervention targeting inflammation may prevent long-term metabolic complications.

Objectives: The present study was to correlate the C-Reactive Protein levels, BMI and duration of diabetes mellitus with severity of diabetic retinopathy. Methods: A complete assessment including demographic details, ocular symptoms duration of DM, treatment taken for diabetes, and other associated conditions were performed to all diabetes mellitus patients. Ophthalmic examination included visual acuity, best corrected visual acuity, slit lamp examination for anterior segment were performed. Dilated fundus examination was done with both + 90D and indirect ophthalmoscope. Fundus photos were taken using Canon CF1 Fundus Camera. Height and weight were measured to calculate the BMI. Blood was collected from the patient under aseptic conditions and CRP was assessed through laboratory analysis (Turbidometry Technique). Results: Out of total 100 patients, most of the cases 51(51%) were in age group of 46-60 years. Majorities of the cases 54% were females. Most of the cases (59%) had 6-10 years of duration of diabetes.  52% patients were without retinopathy and 48% patients were with diabetic retinopathy. NPDR was seen in (26) most of the patients. NPDR+CSME was seen in 10 patients. 6 patients had NPDR+CSME. PDR was seen in 7 patients. PDR+CSME was seen in 5 cases of diabetic retinopathy. 3 cases had duration 6-10 years of diabetic retinopathy. Majorities of cases had duration 6-10 years of DM.  Diabetic retinopathy had significantly higher BMI as compared to normal diabetic patients (p=0.028). The mean CRP levels in various types of DR were 2.67 mg/L in NPDR, 2.98 mg/L in NPDR with CSME, 3.8 mg/L in PDR, and 4.0 mg/L in PDR with CSME. Significantly high values of mean CRP were observed in patients with severe forms of PDR and PDR with CSME. Conclusions: CRP level is significantly increased in diabetic retinopathy patients as compared to without diabetic retinopathy. Higher level of inflammatory activity seen in retina due to higher level of CRP in patients of diabetic retinopathy with PDR and CSME.

Background: Diabetic ketoacidosis (DKA) remains a significant life-threatening complication in pediatric patients with type 1 diabetes mellitus (T1DM), with an annual incidence of 1-10% among known diabetic children. Understanding risk factors associated with recurrent DKA episodes is crucial for improving long-term outcomes and implementing targeted preventive strategies. Objective: To identify risk factors associated with recurrent episodes of DKA and examine the correlation between DKA severity and HbA1c levels in pediatric patients with T1DM. Methods: This hospital-based cross-sectional study was conducted at NIMS Hospital, Jaipur, from April 2023 to November 2024. A total of 104 pediatric patients aged 6 months to 18 years with T1DM and recurrent DKA episodes were enrolled using convenient sampling. Clinical data were collected through pre-designed questionnaires, and statistical analysis was performed using SPSS version 21.0. Results: Among participants, 56.7% experienced 2 DKA episodes, 26% had 3 episodes, 13.5% had 4 episodes, and 3.8% had >4 episodes. A significant association was found between age at diabetes diagnosis and recurrent DKA episodes (p=0.005), with patients having 2 episodes more frequently diagnosed before age 5 years (47.5%). A strong positive correlation existed between HbA1c levels and DKA frequency (p<0.0001), with mean HbA1c progressively increasing from 9.64% in patients with 2 episodes to 17.91% in those with >4 episodes. Only 6.7% of patients with >2 episodes received diabetes education compared to 25.4% with 2 episodes (p=0.012). The most common precipitating factors were poor educational status (43.3%), infections (38.5%), inadequate discharge counseling (38.5%), and deliberate insulin omission (35.6%). Conclusion: Recurrent DKA episodes are significantly associated with poor glycemic control, inadequate diabetes education, and preventable precipitating factors. These findings emphasize the need for comprehensive patient education, improved discharge counseling, and targeted interventions to reduce DKA recurrence rates in pediatric T1DM patients.

Background: Globally infectious keratitis is a major cause of blindness. Fungal infections account for a significant proportion of corneal ulcers. These cases are often challenging and difficult to treat and cause significant visual impairment. Objective: To compare the efficacy of 5% Natamycin and 1% Voriconazole in fungal corneal ulcer patients.   Study Design: Randomized Controlled Trial. Methods: 40 patients were included in the study. Group A patients having corneal ulcer were treated with 5% Natamycin and Group B patients having corneal ulcer were treated with 1% Voriconazole. Results: Baseline mean infiltrate size in Natamycin group was 4.375 mm and in Voriconazole group was 3.925 mm. There was no statistically significant difference between the two groups at baseline. Average time of resolution was 27.3 days in Natamycin group and 30.8 days in Voriconazole group. This difference was statistically significant (p = 0.034). Incidence of perforation was more in Voriconazole group, which was statistically significant. Conclusion: Average time of resolution was lesser in Natamycin group compared to Voriconazole group.  Incidence of perforation was more in Voriconazole group as compared to Natamycin.

Background: The brachial artery is the principal arterial supply of the arm and an important landmark in diagnostic, surgical, and interventional procedures. Variations in its origin, course, branching pattern, and termination are of considerable clinical significance because of the increasing use of invasive vascular procedures, arterial cannulation, angiography, reconstructive surgeries, and trauma management of the upper limb. The present cadaveric study was undertaken to re-explore the anatomy of the brachial artery and to establish further anatomical variations with emphasis on their clinical relevance. Methods: The study was conducted on 27 embalmed adult human cadavers dissected bilaterally in the Department of Anatomy. At NMCH, Patna. The brachial artery was examined for its length, origin, course, branching pattern, level of termination, and associated arterial anomalies. Morphometric measurements were recorded and documented systematically. In the majority of specimens, the brachial artery showed the normal anatomical pattern, continuing from the lower border of the teres major muscle and terminating in the cubital fossa by dividing into radial and ulnar arteries. However, several variations were observed, including high division of the brachial artery, superficial course of the artery, abnormal origin of radial or ulnar arteries, common interosseous trunk variations, and altered branching patterns involving profunda brachii and collateral arteries. Variations in the level of termination and arterial tortuosity were also noted in a few specimens. Knowledge of these variations is essential for anatomists, radiologists, vascular surgeons, orthopedic surgeons, and clinicians performing diagnostic and therapeutic procedures in the upper limb. Awareness of anomalous arterial patterns helps reduce the risk of accidental injury, failed catheterization, hemorrhage, and surgical complications. The findings of the present study contribute to existing anatomical literature and emphasize the importance of detailed preoperative vascular assessment in clinical practice.

Background: Peri-operative infections, particularly surgical site infections (SSIs), are a major cause of postoperative morbidity in developing countries. The burden is higher in India due to variability in infection control practices and patient-related risk factors. Objectives: To analyze the etiology and pattern of peri-operative infections with special reference to orthopaedics, Radiodiagnosis, and biochemistry, using data from studies conducted in Gujarat, India. Materials and Methods: A systematic analytical study was conducted using data from prospective and retrospective studies from Gujarat-based tertiary care centers. Data on incidence, microbiology, and risk factors were pooled. Statistical analysis included descriptive statistics, chi-square test, logistic regression, and ANOVA. Results: The pooled SSI incidence ranged from 5% to 17.25%, with a mean of ~8.5%. Staphylococcus aureus was the predominant pathogen (30–60%). Significant risk factors included diabetes (OR 2.6), BMI ≥25 (OR 2.1), and emergency surgery (OR 3.3). Chi-square analysis showed a significant association between diabetes and SSI (p < 0.001). Orthopaedic infections showed lower incidence (~5%) but higher chronicity due to implants.

Background: Endotracheal intubation with cuffs is a standard method for managing laparoscopic surgery under general anaesthetic, but the use of second-generation supraglottic airway devices, such as the i-gel, could help minimise airway stimulation and postoperative pharyngolaryngeal morbidity in certain patients. Methods: Prospective randomized comparative study of 120 adult ASA I–II patients undergoing elective short duration laparoscopic abdominal surgery. Patients were randomly divided into two groups: Group ETT (cuffed endotracheal tube, n=60) and Group IG (i-gel, n=60). Primary outcome was composite airway complications within 24 hours, such as sore throat, cough, hoarseness, dysphagia, laryngospasm, bronchospasm, desaturation, regurgitation, aspiration, and device-related trauma. Secondary outcomes were insertion characteristics, hemodynamic response, peak airway pressure, end-tidal carbon dioxide, and airway manipulations. Results: Demographic and surgical variables were similar in both groups. The incidence of composite airways was significantly higher in Group ETT than in Group IG (45.0% vs 21.7%, p=0.007). The incidence of postoperative sore throat was higher in the ETT group (33.3% vs 13.3%, p=0.010) and cough at emergence was also higher in the ETT group (26.7% vs 8.3%, p=0.008). Mean insertion time was longer in Group ETT (31.4 ± 7.8 s) than Group IG (17.9 ± 5.6 s, p<0.001). Peak airway pressures were acceptable in both groups, but higher with ETT (24.8 ± 3.7 vs 22.6 ± 3.4 cmH2O, p=0.001). There were no aspirations, no ventilation failure and no unplanned intensive care admissions. Conclusions: i-gel was effective for ventilation, and caused less hemodynamic response and fewer airway complications compared to endotracheal intubation in carefully selected fasted adults undergoing elective laparoscopic surgery.

Background: Obesity alters the anatomy of the upper airways, the mechanics of breathing and tolerance of apnoea, which can increase the risk of difficult airway events during laparoscopic surgery. The current study aimed to compare the difficulty of the airway in obese and non-obese adults under general anaesthetic with endotracheal intubation for elective laparoscopic surgery. Methods: This prospective comparative study included 180 adult patients, with 90 patients in the obese group (BMI ≥ 30 kg/m2) and 90 patients in the non-obese group (BMI 18.5-24.9 kg/m2). Preoperative airway assessment, positioning (ramped if necessary), induction protocol and intraoperative monitoring were used. The primary outcome was a composite difficult airway event, which included difficult mask ventilation, Cormack-Lehane grade III/IV, intubation difficulty scale score >5, needing more than one intubation attempt, the use of an airway adjunct/rescue device, or oxygen desaturation below 92% during airway management. Results: Obese patients had significantly higher mean neck circumference (40.8 +/- 3.1 cm vs 34.6 +/- 2.7 cm, p<0.001), higher Mallampati class III/IV frequency (35.6% vs 14.4%, p=0.001), and lower safe apnoea time (238.5 +/- 56.7 s vs 314.6 +/- 62.4 s, p<0.001). Composite difficult airway events occurred in 27.8% of obese and 10.0% of non-obese patients (relative risk 2.78; 95% CI 1.38-5.60; p=0.003). Desaturation < 92% was also more common in obese patients (13.3% vs 3.3%, p=0.017). Conclusion: There was a significantly increased incidence of difficult airway events in patients with obesity during laparoscopic surgery under general anaesthetic. Structured airway assessment, optimized positioning, preoxygenation, and early use of adjuncts are critical to enhancing the safety of the perioperative period in obese patients.

Background: Cytological examination of serous effusions is a simple procedure that can differentiate the benign, inflammatory, and malignant causes. Conventional smears are quick and cheap, but may be difficult to interpret due to low cell numbers, overlapping cells, reactive mesothelial atypia and loss of architectural pattern. The aim of this study was to assess the usefulness of the cell block technique in conjunction with conventional cytology in pleural, peritoneal and pericardial effusion. Methods: We performed a hospital-based observational study of 180 consecutive serous effusion samples. Conventional smear cytology and formalin fixed paraffin embedded cell block method were used for each sample. Diagnostic categories, cellularity, architectural preservation, background clarity, detection of malignancy and ancillary immunocytochemistry utility were compared. Results: The mean age of patients was 54.8 ± 14.6 years, and 98 (54.4%) were males. Pleural effusion was the commonest sample type (52.2%), followed by peritoneal (43.3%) and pericardial effusion (4.5%). Malignancy was diagnosed in 42 cases (23.3%) by conventional cytology and 54 cases (30.0%) by cell block. Conventional cytology and cell block evaluation resulted in a 58 cases (32.2%) diagnosis of malignancy, yielding an additional 8.9% diagnostic yield compared with conventional cytology alone (p=0.003). The adequate cellularity (86.7% vs 71.1%, p<0.001), architectural preservation (72.2% vs 38.9%, p<0.001), and suitability for immunocytochemistry (83.3% of malignant/suspicious cases) were significantly higher in cell block preparations. Conclusions: The use of cell block technique in serous effusion cytology is a useful adjunct to conventional smears and should be routinely used, particularly when malignancy is suspected, to improve the diagnostic yield and morphological interpretation.

Background: Fiberoptic intubation is an essential skill in difficult airway management and remains a key competency in anesthesiology training. However, acquisition of proficiency requires repeated practice, structured supervision, and objective competency assessment. Simulation-based training using mannequins/dummies provides a safe and controlled environment for skill development before clinical application. Despite increasing use of simulation training, standardized learning curves and competency thresholds for fiberoptic intubation among anesthesia trainees remain inadequately defined. Aim and Objectives: To evaluate learning curves and competency thresholds for mannequin-based fiberoptic intubation simulation among anesthesia trainees and assess improvement in procedural performance, first-pass success rate, procedural errors, and skill retention following structured simulation-based training. Methodology: This multicenter prospective interventional educational study was conducted among 60 participants, including postgraduate residents, senior residents, assistant professors, and associate professors from participating anesthesiology departments. Baseline assessment of mannequin-based fiberoptic intubation performance was performed prior to training. Participants subsequently underwent standardized didactic teaching, faculty demonstration, and repeated supervised mannequin/dummy-based fiberoptic intubation simulation sessions. Pre- and post-training assessments included time to successful intubation, first-pass success rate, procedural errors, simulated airway trauma, and need for assistance. Learning curves and competency thresholds were analyzed using cumulative sum (CUSUM) analysis. Results: The majority of participants achieved predefined competency after 6–10 supervised mannequin-based simulation attempts. Mean intubation time decreased significantly from 128.4 ± 32.6 seconds during baseline assessment to 58.7 ± 16.4 seconds after training (p<0.001). First-pass success rate improved from 36.7% pre-training to 88.3% post-training (p<0.001). Procedural error score decreased from 5.8 ± 1.7 to 1.9 ± 0.8, while simulated airway trauma score reduced from 3.4 ± 1.1 to 1.1 ± 0.5 following training. Participants with prior videolaryngoscopy experience achieved competency significantly earlier than participants without previous airway instrumentation exposure. Conclusion: Structured mannequin-based fiberoptic intubation simulation training significantly improves procedural competency, reduces intubation time, improves first-pass success rate, and decreases procedural errors among anesthesia trainees. Identification of objective learning curves and competency thresholds may help standardize airway management training protocols and improve preparedness for difficult airway management in anesthesiology practice.

Background: Chronic kidney disease (CKD) is a progressive disorder associated with accumulation of metabolic waste products due to declining renal function. Serum urea and creatinine are routinely used for renal assessment; however, repeated blood sampling is invasive and inconvenient. Salivary biomarkers have emerged as potential non-invasive alternatives for evaluating renal dysfunction. Methods: This hospital-based cross-sectional study included 138 CKD patients attending a tertiary care center. Unstimulated saliva and venous blood samples were collected simultaneously. Serum and salivary urea levels were estimated using the enzymatic urease–GLDH method, while creatinine levels were measured using the modified Jaffe’s kinetic method on a fully automated biochemistry analyzer. Correlation analysis and receiver operating characteristic (ROC) curve analysis were performed to evaluate diagnostic efficacy. Results: The mean serum urea and creatinine levels were 92.4 ± 41.7 mg/dL and 5.48 ± 2.81 mg/dL respectively, while mean salivary urea and creatinine levels were 86.1 ± 38.5 mg/dL and 0.89 ± 0.42 mg/dL respectively. Salivary biomarker levels increased significantly with advancing CKD stages (p<0.001). Strong positive correlations were observed between serum and salivary urea (r=0.884, p<0.001) and serum and salivary creatinine (r=0.812, p<0.001). Salivary urea demonstrated an AUC of 0.892 with 85.6% sensitivity and 80.4% specificity, while salivary creatinine showed an AUC of 0.851. Conclusion: Salivary urea and creatinine demonstrated strong correlation with serum biomarkers and significant diagnostic efficacy in CKD patients. Salivary analysis may serve as a reliable, non-invasive, and economical adjunctive tool for screening and monitoring chronic kidney disease.

Background: Cochlear implantation is the established surgical intervention for severe to profound bilateral sensorineural hearing loss (SNHL) in children who derive no benefit from conventional hearing aids. Accurate pre-operative radiological assessment using High-Resolution Computed Tomography (HRCT) and Magnetic Resonance Imaging (MRI) of the temporal bone is critical for surgical planning, risk stratification, and optimizing post-operative outcomes. Aim of this study is to evaluate the complementary diagnostic role of HRCT and MRI of the temporal bone in children who are cochlear implant (CI) candidates, to identify anatomical variants, congenital malformations, and radiological findings that may influence surgical decision-making and predict operative complications. Methods: This prospective descriptive study enrolled 35 children (aged 1–12 years) with bilateral profound SNHL (>90 dB) meeting standard CI candidacy criteria. HRCT temporal bone (0.5 mm thickness, bone algorithm) and MRI (1.5 Tesla, heavily T2-weighted sequences with brain screening) were performed. Radiological findings were correlated with intraoperative observations and post-operative audiological outcomes at three-month follow-up. Results: Of 70 ears evaluated, mastoid air cells were pneumatic in 42%, diploic in 23%, mixed in 21%, and sclerotic in 14%. Mastoid emissary veins were present in 97% of ears. Jugular bulb was high-riding in 21% and dehiscent in 6%. Cochlear morphology was abnormal in 4% (Mondini’s dysplasia, incomplete partition type I). The VIII nerve was abnormal in 17% of ears on MRI. Central auditory pathway was intact in all cases. Pre-operative radiological findings in concordance with intraoperative findings in 91% of patients. Post-operative good sound detection was achieved in 94% and good speech discrimination in 85% of patients. Conclusion: HRCT and MRI are complementary imaging modalities that are indispensable in the pre-operative evaluation of CI candidates. Together, they facilitate selection of the appropriate ear for implantation, anticipate surgical hazards, and guide electrode placement, thereby contributing to favourable audiological rehabilitation outcomes in children.

Background: Primary aneurysmal bone cyst (ABC) is a benign but locally aggressive osteolytic neoplasm, typically affecting children and young adults and commonly arising in the metaphysis of long bones. Conventional curettage remains widely used but may be associated with recurrence, physeal risk, fracture, donor-site morbidity, and need for reconstruction. Percutaneous intralesional injection using calcitonin and methylprednisolone offers a biologically plausible, low-morbidity alternative. Aim: To describe the clinical, radiological, functional, and safety outcomes of primary long-bone ABCs treated with a single percutaneous intralesional dose of calcitonin plus methylprednisolone, and to compare these findings with contemporary minimally invasive and surgical literature. Methods: A retrospective case series design was used. Patients with histopathologically confirmed primary ABC of a long bone, treated by image-guided intralesional calcitonin 200 IU plus methylprednisolone 120 mg, and followed clinically and radiologically were included. Outcomes included time to radiological healing, functional recovery using an MSTS-style percentage score, complications, recurrence, and need for additional treatment. Results: Six patients were analysed. Median age was 15.5 years, three were female, and lesions involved the tibia, femur, humerus, and radius. All lesions achieved radiological healing without open surgery. Mean time to healing was 2.83 months, mean final functional score was 89.0%, and no recurrence was observed during a mean follow-up of 28 months. One patient reported transient post-injection pain; no infection, neurovascular injury, systemic steroid event, or procedure-related fracture was recorded. Conclusion: In this small, long-bone case series, a single percutaneous injection of calcitonin and methylprednisolone was associated with rapid radiological consolidation, good functional recovery, and low morbidity. The technique appears suitable for selected primary ABCs where structural stability is preserved, but larger prospective multicentre studies are needed.

Background: Acetabular fractures are complex intra-articular injuries in which restoration of hip congruity, stable fixation, and early rehabilitation determine the likelihood of durable function. Evidence from high-volume centres consistently identifies reduction quality, timing of fixation, fracture complexity, and associated hip dislocation as key determinants of outcome. Aim: To evaluate the clinical, radiological, and early functional outcomes of surgically managed acetabular fractures in a tertiary care teaching hospital in eastern India. Methods: This prospective observational study included 95 adult patients with displaced acetabular fractures managed surgically at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India, between 10 August 2024 and 31 July 2025. Fractures were classified using the Judet-Letournel system. Surgical approach, timing, reduction quality by Matta criteria, complications, and functional outcome by modified Merle d’Aubigne and Postel score were analysed. Results: The cohort was predominantly male (82.1%) with a mean age of 38.7 ± 12.4 years. Road traffic accidents accounted for 80.0% of injuries. Posterior wall fractures were the commonest pattern (25.3%), followed by transverse plus posterior wall fractures (18.9%) and both-column fractures (15.8%). Kocher-Langenbeck was the most frequently used approach (61.1%). Anatomical or imperfect reduction within 3 mm was achieved in 87.4%. Good/excellent functional outcome was observed in 76.8% and good/excellent radiological outcome in 82.1%. Reduction within 3 mm and surgery within 7 days were independently associated with good/excellent function. Conclusion: Surgical management of displaced acetabular fractures produced favourable early clinical and radiological outcomes in most patients. Anatomical restoration of the acetabular articular surface and timely fixation were the strongest modifiable predictors of outcome.

Background: Diabetic macular edema (DME) remains a leading cause of vision impairment in the working-age population worldwide. The emergence of high-resolution optical coherence tomography (OCT) has transformed the structural evaluation of the macula, enabling identification of discrete biomarkers that correlate with disease activity and therapeutic responsiveness. The post-COVID-19 pandemic era has introduced additional complexity through the recognition of uveitis and retinal vascular complications as sequelae of systemic viral infection, creating a cohort of patients with overlapping retinal pathologies. Longitudinal monitoring of such patients requires robust, reproducible, and clinically meaningful biomarker frameworks. Aim: This study aimed to evaluate advanced OCT biomarkers including central subfield thickness (CST), subretinal fluid (SRF), intraretinal fluid (IRF), hyperreflective foci (HRF), ellipsoid zone (EZ) integrity, and disorganisation of retinal inner layers (DRIL) for longitudinal tracking of retinal thickness changes in DME, with particular reference to post-pandemic uveitic and vascular retinal complications. Methods: A prospective observational cohort study was conducted at the Department of Ophthalmology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, from 1st May 2025 to 25th April 2026. Ninety patients were enrolled and categorised into three groups: Group I (active DME with anti-VEGF therapy, n=35), Group II (control DME without post-pandemic complications, n=30), and Group III (uveitis-associated retinal vascular DME, n=25). Spectral-domain OCT was performed at baseline, 3 months, and 6 months. Statistical analysis employed one-way ANOVA, Chi-square tests, and multivariate linear regression. Results: Significant longitudinal reductions in CST were observed across all groups (all p < 0.01). Group III (uveitis-associated) demonstrated persistently elevated SRF (28.4 ± 19.2 µm at 6 months), HRF count (11.7 ± 5.6), and DRIL prevalence (52.0%) compared to Groups I and II (all p < 0.05). EZ integrity improved significantly in Groups I and II (p < 0.001) but remained relatively compromised in Group III. Multivariate regression identified baseline CST (β=0.54), HbA1c (β=0.27), and baseline SRF (β=0.21) as the strongest independent predictors of 6-month CST reduction (Model R² = 0.721; Adjusted R² = 0.689, p < 0.001). Conclusion: Advanced OCT biomarkers, particularly SRF, HRF, EZ integrity, and DRIL, provide a comprehensive and longitudinal monitoring framework for tracking DME in diverse clinical scenarios including post-pandemic uveitis-associated retinal complications. Baseline CST, HbA1c, and SRF are robust independent predictors of structural treatment response. Routine multi-biomarker OCT assessment may improve individualised management of DME in the contemporary clinical landscape.

Background: Back pain syndrome is a common clinical presentation with heterogeneous etiologies ranging from self-limiting mechanical pain to radiculopathy, inflammatory spinal disease, fracture, infection, malignancy and referred visceral pain. Correct early differentiation is essential to prevent over-investigation of benign disease while avoiding missed serious pathology. Aim: To evaluate the causes, symptom profile, role of differential diagnosis and practical therapy advice among patients presenting with back pain syndrome at a tertiary care hospital in Bihar, India. Methods: This hospital-based observational study included 75 consecutive patients with back pain evaluated at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, from 5 February 2024 to 31 January 2025. Clinical history, red flag screening, neurological examination, straight-leg-raise test, baseline laboratory tests when indicated, radiography and MRI in selected patients were used to classify etiologies. Pain intensity was recorded on a 10-point visual analogue scale (VAS), and disability was graded using the Oswestry Disability Index (ODI). Management advice was individualized using evidence-based conservative care, physiotherapy, pharmacotherapy and referral pathways. Results: The mean age was 46.8 +/- 13.9 years, and 44 patients (58.7%) were male. Non-specific mechanical low back pain was the commonest diagnosis (38.7%), followed by lumbar disc herniation/radiculopathy (24.0%), lumbar spondylosis/facet arthropathy (16.0%), inflammatory patterns (8.0%), osteoporotic or compression fracture (6.7%) and infective/neoplastic/visceral referred causes (6.7%). Localized axial pain was present in 73.3%, sciatica in 33.3%, neurological deficit or positive straight-leg-raise in 18.7%, and red flag features in 12.0%. Mean VAS improved from 6.7 to 4.1 at six weeks. Education and activity modification were advised in all patients; 61.3% received supervised physiotherapy and 16.0% required disease-specific referral or imaging-directed care. Conclusion: Most patients had mechanical or degenerative back pain; however, a structured differential diagnostic approach identified clinically important radicular, inflammatory, fracture and serious secondary causes. Therapy should be stepwise, diagnosis-driven and focused on education, activity, exercise, rational analgesia and early referral when red flags are present.

Background: Distal end femur fractures are complex injuries in which restoration of articular alignment, axial stability, limb length, and early knee mobilization are essential for functional recovery. Open reduction provides direct visualization and anatomical reconstruction, whereas closed or minimally invasive reduction attempts to preserve periosteal blood supply and fracture biology. Aim: To evaluate and compare the functional outcome of open reduction and closed/minimally invasive reduction techniques for distal end fracture femur in a tertiary-care hospital population. Methods: This prospective observational study included 65 skeletally mature patients with distal end femur fractures treated surgically at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, from 5 January 2024 to 31 December 2024. Patients were allocated according to the reduction method used: open reduction (n=34) or closed/minimally invasive plate osteosynthesis reduction (n=31). Demographic profile, AO/OTA fracture type, union, range of knee motion, weight-bearing time, Neer functional score, and complications were recorded. Statistical comparison used chi-square/Fisher exact test for categorical variables and independent t-test or Mann-Whitney U test for continuous variables. Results: The mean age was 43.8 ± 15.6 years and 46 patients (70.8%) were male. Road traffic accident was the leading mechanism (75.4%). AO/OTA 33-C fractures were more frequent in the open reduction group. Radiological union occurred in 62 patients (95.4%). Closed/MIPO reduction showed shorter mean union time (16.6 ± 3.5 vs 18.9 ± 4.4 weeks; p=0.024), greater final knee flexion (112.6° ± 15.5° vs 101.5° ± 20.2°; p=0.017), earlier full weight bearing (13.3 ± 3.0 vs 15.8 ± 4.1 weeks; p=0.008), and higher final Neer score (83.4 ± 9.8 vs 74.8 ± 13.7; p=0.006). Excellent/good outcome was achieved in 83.9% after closed/MIPO reduction and 61.8% after open reduction. Conclusion: Both reduction strategies achieved acceptable union and functional recovery. Closed/MIPO reduction was associated with better early biological recovery and superior mean functional scores in selected extra-articular or reconstructable metaphyseal fractures. Open reduction remains essential for displaced intra-articular fractures requiring precise articular reconstruction.

Background: OTA type-C distal femur fractures are complete intra-articular injuries associated with stiffness, malalignment, delayed union and impaired knee function. Locking compression plates provide fixed-angle stability and permit biological fixation, but outcome data from eastern India remain limited. Aim: To evaluate functional and radiological outcomes of OTA type-C distal femur fractures fixed with locking compression plate at a tertiary care hospital in Bihar. Methods: This prospective observational study included 90 adults with OTA/AO type 33-C distal femur fractures treated with distal femur locking compression plate at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, from 10 June 2024 to 31 May 2025. Demographic variables, fracture morphology, operative parameters, union, complications, knee range of motion and final Neer score were analysed. Results: Mean age was 42.8 +/- 14.6 years; 71.1% were male and road traffic accident was the commonest mechanism (67.8%). Fracture distribution was C1 in 34.4%, C2 in 40.0% and C3 in 25.6%. Radiological union by 24 weeks occurred in 78.9%, and final union without secondary procedure occurred in 91.1%. Mean final knee flexion was 112.6 +/- 16.8 degrees and mean final Neer score was 82.4 +/- 10.9. Outcomes were excellent in 31.1%, good in 44.4%, fair in 16.7% and poor in 7.8%. C3 fractures, open injury, diabetes, tobacco use, delayed surgery and medial comminution were associated with fair/poor outcome. Conclusion: Locking compression plate fixation achieved satisfactory function and union in most OTA type-C distal femur fractures, but complex C3 injuries require careful construct planning, selective augmentation and supervised rehabilitation.

Background: Diabetic peripheral neuropathy is traditionally attributed to chronic hyperglycaemia, oxidative stress and microvascular injury; however, increasing evidence supports a central role of neuroinflammation, cytokine activation and immune-mediated nerve injury in disease progression. Aim: To evaluate the relationship between metabolic stress, systemic inflammatory biomarkers and electrophysiological severity of diabetic peripheral neuropathy. Methods: This hospital-based observational study included 90 patients with type 2 diabetes mellitus attending Gouridevi Institute of Medical Sciences and Hospital, Rajbandh, Durgapur, West Bengal, India, from 10 January 2025 to 25 December 2025. Clinical neuropathy was assessed using neuropathic symptoms, examination findings and Toronto Clinical Neuropathy Score. Nerve conduction studies were performed. HbA1c, fasting plasma glucose, hs-CRP, IL-6, TNF-α, neutrophil–lymphocyte ratio and lipid parameters were analysed. Results: Among 90 patients, 58.9% had electrophysiologically confirmed diabetic peripheral neuropathy. Patients with moderate–severe neuropathy had significantly higher HbA1c, hs-CRP, IL-6, TNF-α and NLR compared with patients without neuropathy. TNF-α showed the strongest association with abnormal nerve conduction velocity. Poor glycaemic control and elevated inflammatory markers independently predicted neuropathy severity. Conclusion: Neuroinflammation appears to be an important biological bridge between metabolic stress and immune-mediated nerve injury in diabetes. Inflammatory biomarkers may support early risk stratification beyond glycaemic indices alone.

Background: Viral infections have emerged as important aetiologies of uveitis and retinal vascular disease, particularly following the SARS-CoV-2 pandemic. Recent years have heightened awareness of the ophthalmic sequelae associated with arboviral and novel respiratory viruses. Despite their growing impact, prospective characterisation of these manifestations in the Indian subcontinent remains scarce. Aim: To characterise the spectrum of ocular manifestations, with particular emphasis on uveitis and retinal vascular complications, in patients with confirmed emerging viral infections presenting to a tertiary care ophthalmology unit in eastern Bihar, India. Methods: This prospective observational study enrolled 80 consecutive patients with serologically confirmed SARS-CoV-2 (n=28), dengue (n=22), chikungunya (n=18), or Zika virus (n=12) infection who presented with ocular symptoms between 10 May 2025 and 25 April 2026 at Jawaharlal Nehru Medical College and Hospital, Bhagalpur. Comprehensive slit-lamp biomicroscopy, dilated fundus examination, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), and best-corrected visual acuity (BCVA) were assessed at baseline and at 12-week follow-up. Statistical analysis employed chi-square, Fisher’s exact test, and paired t-tests as appropriate. Results: The mean age was 40.8 ± 11.3 years; males constituted 57.5%. Anterior uveitis was the most prevalent manifestation across all groups (31.8–38.9% per entity), while retinal vascular complications were most frequent in SARS-CoV-2 infection, notably retinal haemorrhage (28.6%), branch retinal vein occlusion (25.0%), and macular oedema (32.1%). Bilateral involvement was noted in 57.5% of the total cohort. At 12-week follow-up, 63.8% demonstrated improvement of ≥ 2 LogMAR lines. Recurrence was highest in the SARS-CoV-2 group (17.9%). No statistically significant inter-group differences in individual manifestation frequencies were observed (p > 0.05). Conclusion: Emerging viral infections cause a diverse and clinically significant spectrum of uveitis and retinal vascular disease. SARS-CoV-2 carries the greatest severity and recurrence risk. Early systematic ophthalmic evaluation in all patients with confirmed emerging viral infections is recommended. These findings support the need for structured ophthalmology protocols in infectious disease management pathways.

Background: Pulmonary hypertension secondary to left heart disease (PH-LHD; Group 2 PH) is the most frequent form of pulmonary hypertension and is associated with excess dyspnoea, right ventricular dysfunction, recurrent heart-failure admissions and therapeutic uncertainty. Aim: To evaluate the clinical profile, pathophysiological phenotype, echocardiographic/hemodynamic severity and therapeutic challenges among patients with PH-LHD in a tertiary-care setting in Bihar, India. Methods: This prospective observational study included 80 consecutive adults with suspected PH-LHD attending Government Medical College and Hospital, Purnea, from 10 April 2025 to 25 March 2026. Patients underwent structured clinical assessment, electrocardiography, chest radiography, transthoracic echocardiography, biochemical testing and optimisation of left-heart-disease-directed therapy. Right-heart catheterisation was performed when clinically indicated. PH-LHD was classified as isolated post-capillary pulmonary hypertension (Ipc-PH) or combined post- and pre-capillary pulmonary hypertension (Cpc-PH) according to contemporary hemodynamic principles. Outcomes included symptom improvement, six-minute walk distance (6MWD) improvement, pulmonary artery systolic pressure (PASP) reduction, heart-failure hospitalization and a composite poor outcome. Results: Mean age was 58.9 ± 10.6 years; 45 patients (56.3%) were male. HFpEF was present in 37 (46.3%), HFrEF in 25 (31.3%) and significant valvular disease in 18 (22.5%). Cpc-PH was identified in 30 (37.5%) patients and was associated with higher PASP (64.9 ± 12.1 vs 51.8 ± 9.8 mmHg; p<0.001), lower TAPSE (16.3 ± 3.4 vs 19.2 ± 3.1 mm; p<0.001), greater RV dysfunction (46.7% vs 20.0%; p=0.012), and poorer functional recovery. At follow-up, NYHA improvement occurred in 52.5% overall but was lower in Cpc-PH than Ipc-PH (36.7% vs 62.0%; p=0.028). HF hospitalization occurred in 22.5% overall and was more frequent in Cpc-PH (36.7% vs 14.0%; p=0.018). Conclusion: PH-LHD in this cohort was clinically heterogeneous, frequently associated with HFpEF, valvular disease and right ventricular impairment. Cpc-PH represented a high-risk phenotype with worse functional response and higher short-term adverse outcomes. Management should prioritise optimization of the underlying left heart disease, volume control, comorbidity treatment, careful phenotyping and avoidance of unproven pulmonary arterial hypertension-specific vasodilator therapy outside expert centres or trials.

Background: Spontaneous pneumothorax and spontaneous pneumomediastinum represent air-leak syndromes with overlapping presentations but different thresholds for intervention. Contemporary guidelines increasingly emphasize symptom burden, physiological compromise, recurrence prevention, and persistent air leak rather than size alone. Aim: To evaluate the role and optimal timing of surgical intervention among patients presenting with spontaneous pneumothorax and/or pneumomediastinum at a tertiary hospital in eastern India. Methods: This hospital-based observational study included 70 consecutive patients treated at Government Medical College and Hospital, Purnea, Bihar, India, from 10 April 2025 to 25 March 2026. Demographic profile, disease phenotype, radiological severity, conservative treatment, chest-drain requirement, timing of surgery, complications, length of stay, and early recurrence were analyzed. Results: The cohort comprised 52 males and 18 females with mean age 34.8 ± 15.6 years. Primary spontaneous pneumothorax was observed in 38 patients, secondary spontaneous pneumothorax in 22, and isolated spontaneous pneumomediastinum in 10. Twenty-four patients underwent definitive surgical intervention; 16 underwent early surgery within 5 days and 8 underwent delayed surgery after 5 days. Persistent air leak >72 hours, secondary spontaneous pneumothorax, and large pneumothorax/mediastinal extension independently predicted surgical conversion. Early surgery was associated with shorter air-leak duration, lower complications, and shorter hospitalization than delayed surgery. Conclusion: Most patients stabilized with conservative or tube-based management; however, timely surgical referral was beneficial in persistent air leak, recurrence-risk states, secondary pneumothorax with physiological compromise, and combined air-leak syndromes. A structured early-surgery algorithm may reduce morbidity and hospital stay.

Background: Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disorder characterised by left ventricular dilatation and systolic dysfunction without an identifiable aetiology. Endothelial nitric oxide synthase (eNOS), encoded by the NOS3 gene, maintains myocardial vasomotor tone and cardiomyocyte homeostasis through nitric oxide (NO) synthesis. The Glu298Asp (rs1799983) single nucleotide polymorphism (SNP) alters eNOS stability and enzyme function, yet its association with IDCM in Eastern India remains unexplored. Aims and Objectives: To investigate the association between the eNOS Glu298Asp SNP and susceptibility to IDCM, and to correlate genotype-specific variation in serum NO levels, eNOS enzyme activity, and echocardiographic parameters. Methods: This hospital-based case-control study enrolled 133 IDCM patients and 133 age- and sex-matched healthy controls at MKCG Medical College, Berhampur, Odisha (February 2021 – December 2022). Genotyping was performed by PCR-RFLP using the BanII restriction enzyme. Serum NO was measured by the Griess reagent method and eNOS activity in platelet-rich plasma by colorimetric assay. Statistical analyses included chi-square tests, logistic regression, ANOVA, and Hardy-Weinberg equilibrium (HWE) testing. Results: The TT (Asp/Asp) genotype was significantly more frequent in cases (21.1%) than controls (7.5%; OR=4.08, 95% CI: 1.82–9.18; p<0.001). Under the dominant model (GT+TT vs. GG), the variant carrier state was associated with a 1.97-fold increased risk (p=0.007). The T allele frequency was higher in cases (42.5%) than controls (27.4%; OR=1.95, p<0.001). TT homozygotes showed significantly lower LVEF, lower serum NO, reduced eNOS activity, higher BNP and CRP, and worse functional status. All genotype distributions conformed to HWE. Conclusion: The eNOS Glu298Asp SNP is significantly associated with IDCM susceptibility in the Eastern Indian population, with the T (Asp) allele and TT genotype conferring substantially elevated risk. Variant genotype carriers demonstrate impaired eNOS function and more severe left ventricular dysfunction, implicating this polymorphism in the pathogenesis of IDCM.

Background: Myopia has emerged as a significant global public health challenge, with a substantial rise documented across South and East Asian populations. The post-COVID era has witnessed a considerable escalation in digital screen usage among school-aged children in India, raising important concerns regarding the epidemiological trajectory of childhood myopia. Despite mounting evidence from East Asia, robust data from the eastern Indian subcontinent remain sparse. Aim: To determine the prevalence and severity of myopia among school children aged 6–17 years in Bhagalpur, Bihar, and to evaluate the association of daily screen time with myopia development while identifying modifiable risk factors amenable to preventive intervention. Methods: A hospital-based cross-sectional study was conducted at the Department of Ophthalmology, JNMCH, Bhagalpur from 5th May 2025 to 30th April 2026. Seventy-five school children (6–17 years) were consecutively enrolled following strict inclusion-exclusion criteria. Comprehensive ophthalmic examination including cycloplegic autorefraction, best-corrected visual acuity, slit-lamp biomicroscopy, and dilated fundus evaluation was performed. Screen time was assessed by a semi-structured questionnaire. Data were analysed using SPSS v25.0; Chi-square test, Spearman correlation, and multivariate logistic regression were applied. Results: Of 75 participants (mean age 10.8 ± 2.9 years; 54.7% male), overall myopia prevalence was 76.0%. Mild myopia was detected in 42.7%, moderate in 21.3%, and high myopia in 12.0%. Children with >4 hours/day of screen time demonstrated a 6.50-fold higher crude odds of myopia compared to those with <2 hours/day (crude OR=6.50; 95% CI: 1.60–26.38; p < 0.001), rising to an adjusted OR of 12.73 (95% CI: 3.19–50.74; p < 0.001) on multivariate analysis. Outdoor activity <1 hour/day (adjusted OR=4.00; p = 0.004) and family history of myopia (adjusted OR=3.00; p = 0.013) were additional independent predictors. Spearman correlation between screen time and myopia severity was ρ=+0.614 (p < 0.001). Conclusion: Excessive screen time is independently and strongly associated with childhood myopia in this eastern Indian cohort. The findings advocate immediate school-based ophthalmic screening programmes, structured screen time limitation policies, and promotion of outdoor activity as evidence-based preventive strategies.

Background: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a major driver of respiratory morbidity and mortality. Early recognition using high-resolution computed tomography (HRCT), pulmonary function testing (PFT), and structured risk stratification is increasingly emphasized in international guidance. Aim: To evaluate screening yield, diagnostic patterns, severity distribution and contemporary management trends among systemic sclerosis patients assessed for ILD at Government Medical College and Hospital, Purnea, Bihar. Methods: This prospective observational study included 65 consecutive patients fulfilling clinical criteria for systemic sclerosis between 5 April 2025 and 31 March 2026. All patients underwent symptom assessment, modified Rodnan skin scoring, autoantibody testing where available, spirometry with diffusing capacity, six-minute walk testing, transthoracic echocardiography and HRCT chest. ILD extent was categorized as absent, limited (<20% HRCT involvement), extensive (≥20% HRCT involvement), or progressive by decline in FVC/DLCO or radiological worsening. Management decisions were recorded at enrolment and follow-up. Results: The cohort had a mean age of 42.8 ± 11.6 years and was predominantly female (73.8%). HRCT identified ILD in 51/65 patients (78.5%); 18 (27.7%) had limited ILD, 21 (32.3%) extensive ILD and 12 (18.5%) progressive ILD. Non-specific interstitial pneumonia was the commonest HRCT pattern (72.5% of ILD). Mean FVC was lower in extensive/progressive disease (63.9 ± 9.8%) than in no/limited ILD (82.4 ± 10.7%; p<0.001). Mycophenolate mofetil was the predominant first-line pharmacotherapy, while nintedanib was added for progressive fibrosing disease in selected patients. Conclusion: A structured screening pathway detected a high burden of SSc-ILD in this tertiary-care cohort. HRCT combined with PFT-based monitoring provided clinically actionable staging, and management increasingly reflected modern evidence favouring mycophenolate, antifibrotic escalation, rehabilitation and multidisciplinary follow-up.

Background: Tubercular uveitis is a diagnostic challenge because ocular microbiological confirmation is uncommon and systemic evidence may be subtle or absent. Aim: To evaluate the correlation of QuantiFERON-TB Gold and HRCT chest findings with choroidal granulomas among patients with presumed tubercular uveitis. Methods: This prospective observational study included 75 patients from 1 March 2025 to 31 January 2026. Ocular phenotype, QuantiFERON-TB Gold category, HRCT chest pattern and 12-week clinical response were analyzed. Results: Choroidal granuloma was identified in 28 (37.3%) patients. QuantiFERON-TB Gold was positive in 64 (85.3%) and HRCT was abnormal in 51 (68.0%). Choroidal granuloma was significantly more frequent in abnormal HRCT than normal HRCT groups (47.1% vs 16.7%; P=0.010). Concordant QuantiFERON positivity plus abnormal HRCT predicted granuloma (OR 4.70, 95% CI 1.45-15.25; P=0.010). Inflammation improved in 86.8% of evaluable patients at 12 weeks. Conclusion: Combined interpretation of QuantiFERON-TB Gold and HRCT chest findings improves diagnostic confidence for choroidal granulomatous tubercular uveitis in high-burden settings.

Background: Morphometric Analysis of the Circle of Willis Variations in Adult Cadaveric Brains and Their Clinical Correlation is a clinically relevant diagnostic and anatomical problem in routine tertiary care practice. Objective: The purpose of this study was to record the morphological and morphometric changes of the circle of Willis and to correlate them with the possible clinical significance of cerebrovascular collateral circulation. Method: The cadaveric morphometric observational study was carried out in the Department of Anatomy dissection hall and neuroanatomy laboratory. A total of 100 formalin fixed adult cadaveric brains were studied. The participants/specimens were divided into complete classical circle, anterior circulation variants and posterior circulation variants. Standardized data collection, laboratory/radiological/anatomical assessment and predefined operational criteria were used. Results: In 42.0% of brains a complete classical circle was observed. The most common variation was posterior communicating artery hypoplasia (31.0%), followed by hypoplastic A1 segment (12.0%) and fetal-type posterior cerebral artery (9.0%). The frequency of at least one hypoplastic communicating segment was significantly higher in variant circles (p<0.001). Conclusion: Variability of circle of Willis was common, particularly in the posterior circulation. Clinically relevant to understand these patterns in the context of collateral adequacy in stroke, aneurysm and skull base surgery.

Background: Early diagnosis and prompt treatment are key to the control of pulmonary tuberculosis, as untreated smear-positive TB continues to spread within households and communities. The risk of diagnostic delay is high among tribal communities because of difficult terrain, low awareness, and dependence on informal providers, poverty, seasonal migration and delay in accessing sputum microscopy or molecular testing. The local evidence gap was addressed in this study. Methods: This facility-based observation study was carried out in 242 newly diagnosed pulmonary TB patients attending microscopy and treatment units of the villages mainly of tribal population. Informed consent was obtained and consecutive sampling was used to enroll eligible patients. A structured proforma was used to collect data, clinical records and laboratory registers were used, and descriptive statistics, chi-square test, t-test/ANOVA (where applicable) and multivariable logistic regression were used to analyse the data. Results: The median patient delay was 21 days (IQR 12-38); the median health-system delay was 11 days (IQR 6-21); and the median total delay was 36 days (IQR 22-61). 57.0% of patients had total delays greater than 30 days. Independent predictors were initial consultation with informal providers, distance >10 km, low TB symptom awareness and lack of sputum testing at first health contact. Conclusion: The results suggest that simple programme-linked and laboratory-linked indicators are able to detect patients who need more intensive follow-up and can support early clinical decision making in resource-limited settings.

Background: Histopathological Spectrum of Thyroid Lesions in a Tertiary Care Hospital is a clinically relevant diagnostic and anatomical problem in routine tertiary care practice. Objective: The aim of this study was to identify the histopathological spectrum of thyroid lesions and to evaluate the demographic and clinicopathological patterns. Method: A retrospective descriptive study was done in the Department of Pathology of a tertiary care teaching hospital. A total of 286 specimens of thyroidectomy and hemithyroidectomy were received for the study in three years. The participants/specimens were classified as non-neoplastic, benign neoplastic and malignant thyroid lesions. Standardized data collection, laboratory/ radiological/ anatomical assessment and predefined operational criteria were used. Results: 49.7% were non-neoplastic lesions, 28.3% were benign neoplasms and 22.0% were malignant tumours. The most common lesion was colloid goitre (32.9%) and the most common malignancy was papillary thyroid carcinoma (17.8%). The female predominance was significant (M:F=1:5.1). Solitary nodules and Bethesda V/VI cytology were significantly associated with malignancy (p<0.001). Conclusion: Colloid goitre and papillary carcinoma were the most prevalent thyroid lesion types, highlighting the importance of histopathology in diagnosis and the direction of definitive treatment.

Background: Empyema thoracis remains a significant cause of morbidity and often requires prolonged drainage and surgical intervention. Intrapleural fibrinolytic therapy using streptokinase may improve pleural drainage and reduce the need for surgery in multiloculated empyema. Material and Methods: This observational prospective study was conducted at a tertiary care center over one year and included 50 patients diagnosed with empyema thoracis with poor ICDT output and multiloculated pleural collections. All patients received intrapleural streptokinase through ICDT for three consecutive days. Clinical response, drain output, radiological improvement, complications, duration of ICDT placement, and need for surgery were assessed with follow-up on days 7 and 14. Results: Most patients were males (66%), and 46% belonged to the pediatric age group. Stage II empyema was observed in 76% of patients, while 24% had Stage III disease. Pleural fluid culture positivity was noted in 84% of cases, with Staphylococcus aureus being the most common organism isolated (40%). Successful management without surgery was achieved in 84% of patients, whereas 16% required surgical intervention. ICDT removal within 14 days was achieved in 50% of cases. Stage II disease demonstrated significantly better outcomes compared to Stage III disease (p=0.008). No adverse events were observed in 60% of patients, and no mortality occurred during follow-up. Conclusion: Intrapleural Streptokinase administration through ICDT is an effective and safe treatment modality for Empyema Thoracis and may reduce the requirement for surgical intervention, particularly in Stage II disease.

Background: Maternal and Neonatal Outcomes Following Spinal versus General Anesthesia for Emergency Cesarean Section is a clinically relevant diagnostic and anatomical problem in routine tertiary care practice. The aim of this study was to compare the maternal hemodynamic events, perioperative morbidity and neonatal outcomes after spinal anesthesia versus general anesthesia for emergency cesarean delivery. Method: Prospective observational comparative study was done in the Obstetric operation theatre of a tertiary care hospital. 180 women who were undergoing emergency cesarean section were included in the study. The participants/specimens were divided into two groups: Spinal anesthesia group and General anesthesia group. The data collection was standardized, and the laboratory/radiological/anatomical assessment and the operational criteria were predefined. Results: 122 women received spinal anesthesia and 58 women received general anesthesia. Maternal hypotension was more frequent after spinal anesthesia (31.1% vs 8.6%, p=0.002), but estimated blood loss was lower (612 +/- 184 mL vs 742 +/- 226 mL, p<0.001). One-minute Apgar below 7 was more frequent in the general anesthesia group (27.6% vs 11.5%, p=0.009), and NICU admission was higher (24.1% vs 10.7%, p=0.022). Conclusions: Spinal anesthesia was found to be associated with better neonatal transition and reduced blood loss, and general anesthesia was still important for extreme urgency and contraindications to neuraxial anesthesia.

Background: TB and undernutrition are linked in a vicious cycle, in which undernutrition reduces cell-mediated immunity and the ability to respond to treatment, and the chronic infection leads to wasting, anorexia and catabolism. The primary health care facilities are the first place of continuous contact for most patients and are appropriate for the incorporation of nutritional screening into treatment monitoring. The local evidence gap was identified and this study was undertaken to fill it. Methods: This prospective observational study recruited 264 drug-sensitive TB patients from eight primary health care facilities and tracked from treatment start to end of treatment assessment. Consecutive sampling was used to recruit eligible patients after obtaining informed consent. Data were gathered with a structured proforma, clinical records and laboratory registers and analysed descriptively, with chi-square test, t-test/ANOVA as appropriate and multivariable logistic regression. Results: At baseline, 61.4% were undernutrition (BMI <18.5 kg/m2). Mean BMI increased from 17.8 ± 2.4 kg/m2 at baseline to 19.1 ± 2.6 kg/m2 at two months and 20.0 ± 2.8 kg/m2 at treatment completion (p<0.001). Overall, unfavourable outcome was seen in 14.8% of patients, and was more common in those with severe undernutrition (26.1%) than in those with normal BMI (7.8%). Conclusions: The results suggest that simple programme linked and laboratory linked indicators are able to detect patients in need of more intensive follow-up and can support early clinical decision making in resource limited settings.

Background: Effective postoperative analgesia following knee surgeries is essential for early mobilization, rehabilitation, and patient satisfaction. Adductor canal block (ACB) provides effective anteromedial knee analgesia while preserving quadriceps strength; however, posterior knee pain may persist. The IPACK (Interspace between the Popliteal Artery and Capsule of the Knee) block has been introduced to improve posterior knee analgesia. This study compared the analgesic efficacy of ultrasound-guided ACB alone versus ACB combined with IPACK block in patients undergoing knee surgeries. Methods: This prospective randomized comparative study included 40 patients undergoing elective knee surgeries. Patients were randomly allocated into two groups of 20 each. Group A received ultrasound-guided ACB, while Group B received ultrasound-guided ACB with IPACK block. The primary outcome was duration of analgesia. Secondary outcomes included postoperative Visual Analog Scale (VAS) scores, total analgesic consumption over 24 hours, and complications. Results: The mean duration of analgesia was significantly prolonged in Group B compared to Group A (13.0 ± 1.49 hours vs 9.2 ± 1.54 hours, p < 0.001). VAS scores at 4, 8, 12, 16, and 24 hours were significantly lower in the ACB + IPACK group. Total analgesic consumption in the first 24 hours was also significantly reduced in Group B (1.95 ± 0.60 g vs 3.35 ± 0.67 g, p < 0.001). No significant complications were observed in either group. Conclusion: The addition of IPACK block to adductor canal block significantly prolongs duration of analgesia, reduces postoperative pain scores, and decreases analgesic consumption in patients undergoing knee surgeries.

Background: Subarachnoid block with hyperbaric bupivacaine is commonly used for elective lower-limb surgery, but its duration may be insufficient for prolonged postoperative analgesia. Intrathecal adjuvants such as clonidine and fentanyl are used to improve block quality and extend analgesic duration. Objective: The study aimed to compare intrathecal clonidine and fentanyl as adjuvants to 0.5% hyperbaric bupivacaine for sensory and motor blockade, postoperative analgesia, haemodynamic stability, sedation, and perioperative complications in elective lower-limb surgery. Materials and Methods: This prospective comparative observational study included 50 patients aged 18–60 years, of either sex, belonging to ASA physical status I or II, and scheduled for elective lower-limb surgery under subarachnoid block. Patients were divided into two groups of 25 each. Group C received 0.5% hyperbaric bupivacaine 3 mL with clonidine 30 µg and normal saline, while Group F received 0.5% hyperbaric bupivacaine 3 mL with fentanyl 25 µg. Sensory and motor block characteristics, duration of analgesia, haemodynamic parameters, Ramsay sedation score, and adverse effects were recorded. Data were analyzed using Epi Info CDC 7, with p<0.05 considered statistically significant. Results: Sensory block onset was comparable between Group C and Group F (6.44 ± 0.68 vs 6.42 ± 0.88 minutes; p=0.09), as was motor block onset (7.80 ± 0.80 vs 7.78 ± 0.66 minutes; p=0.09). Clonidine significantly prolonged sensory block duration (220.42 ± 14.06 vs 155.40 ± 9.12 minutes; p<0.001), motor block duration (267.80 ± 9.80 vs 183.20 ± 10.19 minutes; p<0.001), and analgesia duration (336 ± 28 vs 237 ± 25 minutes; p<0.001). Haemodynamic reduction and sedation were greater with clonidine, while pruritus was observed only with fentanyl. Conclusion: Intrathecal clonidine provided longer sensory block, motor block, and postoperative analgesia than fentanyl, with clinically manageable haemodynamic effects and no respiratory depression.

Background: Excessive screen exposure during early childhood has emerged as an important public health concern due to its potential effects on sleep, cognition, and language development. Increased use of digital devices among young children may interfere with parent-child interaction and developmental milestone achievement. Aim: To assess the correlation between excessive daily screen time, sleep disruptions, and language development milestones in children with emphasis on screen content, sleep patterns, and socioeconomic factors. Materials and Methods: A cross-sectional observational study was conducted among 150 children aged up to 6 years. Data regarding daily screen exposure, type of screen content, sleep patterns, socioeconomic status, and language development milestones were collected using a structured questionnaire and developmental assessment tools. Statistical analysis was performed using SPSS software version 25.0. Associations were evaluated using Chi-square test, Student’s t-test, and Pearson’s correlation coefficient with p<0.05 considered statistically significant. Results: Children with screen exposure greater than 4 hours/day demonstrated the lowest language development scores, whereas children with less than 2 hours/day screen exposure showed significantly better language performance. Older children exhibited higher average daily screen time compared with younger age groups. Excessive screen exposure was also associated with sleep disturbances including delayed sleep onset and reduced sleep duration. Socioeconomic factors influenced both screen exposure patterns and language outcomes. Conclusion: Excessive daily screen time was significantly associated with poorer language development and sleep disturbances among children. Limiting screen exposure and promoting healthy sleep habits and parental interaction may contribute to improved developmental outcomes during early childhood.

Background: Flexible Ureterorenoscopy (RIRS) has emerged as a minimally invasive and effective treatment for renal and upper ureteric stones, particularly those <2 cm. Technological advancements in endoscopic equipment have widened its indications. Objective: To evaluate the efficacy and safety of RIRS for the treatment of renal and ureteric calculi <2 cm. Methods: This retrospective observational study was conducted at a tertiary care centre over a period of 36 months. Medical records of 63 patients with renal/upper ureteric calculi <2 cm who underwent RIRS using flexible Ureterorenoscopy and Holmium: YAG laser were reviewed. Outcomes assessed included stone-free rate (SFR), complications (Clavien-Dindo classification), operative time, pain score, hospital stay, and return to routine activity. Results: The mean age was 41.4 ± 9.9 years, with 54% males. Most stones (65.1%) measured 1.5–2 cm. The overall SFR was 74.6% after a single procedure. The highest stone-free rate was observed for upper calyceal stones (100%) and ureteric calculi (90%). Complications were noted in 23.8% of patients, predominantly minor (Clavien Grade I or II). Mean operative time was 44.5 ± 7.2 minutes, and average hospital stay was 2.3 days. No major intraoperative or postoperative complications were recorded. Conclusion: RIRS is a safe and effective treatment modality for renal and ureteric stones <2 cm, demonstrating high success rates with minimal morbidity in real-world clinical practice.

Background: Percutaneous nephrolithotomy (PNL) is a standard surgical approach for managing renal calculi. Miniaturized techniques like Mini-PCNL reduce morbidity, while Super-mini PCNL (SMP) incorporates suction to improve stone clearance and visibility. However, comparative evidence between these techniques remains limited. Objective was to evaluate the safety and efficacy of Super-PCNL versus Mini-PCNL in patients with renal stones sized 1–2. Methods: This retrospective comparative study was conducted at a single tertiary care centre. Medical records of 50 patients who underwent PCNL for renal calculi measuring 1–2 cm between June 2022 to June 2025 were reviewed. Patients were categorized into two groups based on the procedure performed: Mini-PCNL (n=25) and Super-PCNL (n=25). Preoperative, intraoperative, and postoperative parameters were analysed. Statistical analysis was performed using the independent t-test, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between the groups. No significant differences were observed in puncture sites, calyces accessed, operative time, WBC count, hemoglobin drop, or postoperative hemoglobin levels. However, the Super-PCNL group demonstrated significantly better outcomes in terms of shorter stone clearance time, fewer days of IV analgesic use, faster pain relief, reduced hospital stay, shorter duration of hematuria, and earlier nephrostomy tube removal (p < 0.05). Conclusion: Super-PCNL offers improved postoperative recovery and patient comfort compared to Mini-PCNL, without compromising efficacy. It is a safe and effective technique for managing medium-sized renal stones.

Background: Shoulder tip pain (STP) is a common complaint after laparoscopic cholecystectomy (LC), attributed to diaphragmatic irritation from CO2 pneumoperitoneum. Lower insufflation pressures may reduce STP but could affect operative conditions. Objective: To compare incidence and severity of postoperative STP between low-pressure (10 mmHg) and standard-pressure (14 mmHg) CO2 pneumoperitoneum in LC. Methods: Prospective, randomized, single-blind study of 100 adult patients undergoing elective LC randomized 1:1 to low-pressure (n=50) or standard-pressure (n=50). Primary outcome: incidence of STP at 24 hours. Secondary outcomes: STP severity (numeric rating scale, NRS 0–10) at 6, 12, 24, 48 hours; analgesic consumption (morphine-equivalent) in 48 hours; operative time; intraoperative complications; conversion to open surgery; surgeon-rated operative field (Likert scale). Results: 100 patients randomized equally. Baseline demographics comparable. Incidence of STP at 24 h: low-pressure 28% (14/50) vs standard-pressure 56% (28/50), p=0.003. Mean NRS at 24 h: low 1.2±1.6 vs standard 2.8±2.1, mean difference −1.6 (95% CI −2.4 to −0.8), p<0.001. Median 48-h morphine-equivalent: low 6 mg (IQR 4–10) vs standard 10 mg (IQR 6–16), p=0.01. Operative time: low 52±12 min vs standard 45±10 min, p=0.001. Conversion rate: low 2% vs standard 0%, p=0.31. Surgeon-rated operative field: satisfactory in 92% standard vs 80% low, p=0.08. No significant differences in intraoperative complications or length of stay. Conclusion: Low-pressure (10 mmHg) CO2 pneumoperitoneum reduced incidence and severity of postoperative shoulder tip pain but was associated with modestly longer operative time; operative field remained acceptable in most cases. Low-pressure insufflation may be considered to reduce postoperative STP when surgical conditions permit.

Background: Postoperative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy. 5-HT3 receptor antagonists, including ondansetron and granisetron, are widely used for prophylaxis, but their comparative efficacy remains clinically relevant. Objective: To compare the effectiveness of intravenous granisetron and ondansetron in preventing PONV after laparoscopic cholecystectomy under general anaesthesia. Methods: This hospital-based randomized double-blind interventional study included 86 patients aged 20–60 years undergoing elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups of 43 each. Group A received intravenous ondansetron 0.1 mg/kg, and Group B received intravenous granisetron 0.04 mg/kg before induction. Patients were monitored for nausea, vomiting, need for rescue antiemetics, and adverse effects for 24 hours postoperatively. Results: Baseline demographic and perioperative variables were comparable between the two groups. Nausea and vomiting occurred more frequently in the ondansetron group than in the granisetron group at most time intervals. The cumulative incidence of nausea over 24 hours was 51.2% in Group A and 23.3% in Group B, while vomiting over 24 hours was 34.9% in Group A and 11.6% in Group B. The need for rescue antiemetics was significantly higher in Group A (41.9%) than in Group B (11.6%). Post-extubation adverse effects such as headache, dizziness, and myalgia were mild and comparable in both groups. Conclusion: Intravenous granisetron was more effective than ondansetron in reducing PONV and the need for rescue antiemetics after laparoscopic cholecystectomy, with a similar safety profile.

Background: Neonatal sepsis continues to be a leading cause of neonatal morbidity and mortality globally, with the greatest burden in low-and middle-income countries. Although the institutional delivery rates and neonatal care have increased towards the reduction of these cases certainly form a large proportion of deaths. Differences in frequency, risk factors and microbiology between regions require hospital-based studies to guide the effective prevention and treatment of infections. Methods: 100 neonates aged 0–28 days are included in the retrospective record-based observational study with clinically suspected or laboratory-confirmed sepsis admitted to the Neonatal Intensive Care Unit (NICU) between August 2025 and January 2026. Maternal, clinical, neonatal, laboratory, and result data were extracted from hospital records and examined using descriptive and inferential statistical methods. Results: Of the 480 admissions to NICU, 100 neonates were diagnosed with sepsis giving an incidence of sepsis as 20.8%. Cases were predominantly male (58%) and preterm (62%). 55% of neonates were low birth weight. Term prolonged rupture of membranes (40%), maternal fever (28%), prematurity in 62%, and more than half of the babies born were low birth weight (55%) were associated risk factors for this outcome (p < 0.05). Positive blood culture was observed in 46% of patients, most of the Gram-negative bacteria with a majority represented by Klebsiella pneumoniae (28%). A recovery was achieved in 72% of neonates, complications were seen in 18% and the overall mortality rate was of 10%. Conclusion: Neonatal sepsis represents a significant burden among NICU admissions at Patna Medical College & Hospital (PMCH), with preventable maternal and neonatal risk factors playing a crucial role. Early identification of high-risk neonates, improved antenatal care, and timely initiation of appropriate treatment are essential to reduce sepsis-related morbidity and mortality.

Background: Vitamin D deficiency is an important public health problem worldwide and still continues to be highly prevalent in India although it receives abundant sunlight. Children are at particular risk considering periods of accelerated bone growth, increased nutritional demands as well as lifestyle and other factors that restrict sufficient sun exposure. In childhood, deficiency can cause impaired bone mineralization and growth disorders as well as multiple extra skeletal consequences. Methods: A hospital-based cross-sectional observational study was carried out in the Department of Pediatrics in association with the Department of Pathology at Patna Medical College and Hospital (PMCH) from February 2021 to January 2023. 100 children between 1 to 15 years of age were included after informed consent. Clinical history and examination were performed. Serum 25-hydroxyvitamin D [25(OH)D] concentration was determined from venous blood samples. Vitamin D levels were classified as deficient (30 ng/mL). Descriptive statistics and tests of significance were performed to analyze data. Results: Among the 100 children surveyed, 49% were aged 11–15 years, 32% aged 6–10 and 19% were aged 1–5. There were 53 % males and 47 % females among the studied individuals. A significant number of patients had vitamin D deficiency or insufficiency. Standard clinical features were seen such as bone pain, delayed walking, delayed dentition and generalized weakness. There was a strong correlation between musculoskeletal symptoms and low vitamin D levels. Conclusion: Vitamin D deficiency is very common among pediatric population in and around Patna, especially among adolescent children. Early detection and screening of high-risk population and tailored supplement are necessary to avoid long-term skeleton and extra skeleton complications.

Background: Endocrine disorder is common in Hypothyroidism including important involvement of the larynx and vocal apparatus with widespread systemic effects. Tissue metabolism and neuromuscular function changes due to thyroid hormone deficiency lead to characteristic variations in the quality of voice. Vocal manifestations of hypothyroidism are often under recognized and ineffectively assessed in routine clinical practice. Methods: This retrospective observational study was done at Patna Medical College and Hospital (PMCH) over a 1-year period from January to December 2025. 40 patients with biochemically confirmed hypothyroidism medical records are reviewed. Demographic details, thyroid function test results (TSH, T3, T4), ENT examination findings, voice-related symptoms, and laryngoscopic observations are included in the data collection. To assess the association between thyroid hormone levels and vocal cord abnormalities, was performed by correlation analysis and to summarize the data descriptive statistics were used. Results: Most patients (35%) were 41–50 years old, and 70% were women. Voice hoarseness was 70%, vocal fatigue 60%, and pitch alteration 55%. Typical serum TSH levels were 12.8 ± 4.6 mIU/L, with T3 and T4 averaging 72.5 ± 18.4 ng/dL and 4.1 ± 1.2 µg/dL, respectively. In 65% of patients, laryngoscopic examination indicated vocal cord oedema, 55% thickening, and 40% mobility impairment. Higher TSH levels were positively connected with vocal cord oedema (r = 0.62, p < 0.01). Conclusion: A significant structural and functional vocal cord changes is associated with Hypothyroidism, which interrelates with severity of disease. Initial recognition of voice variations and timely thyroid hormone modification are important to avoid persistent vocal dysfunction.

Background: Type II Diabetes Mellitus (T2DM) is one of the most prevalent metabolic disorders worldwide and is associated with multiple microvascular and macrovascular complications. Serum uric acid has emerged as a potential biomarker associated with insulin resistance, oxidative stress, endothelial dysfunction, and poor glycemic control. Understanding the relationship between serum uric acid levels and glycemic status may help in early identification of patients at risk of diabetic complications. Aim: To evaluate the correlation between serum uric acid levels and glycemic control among patients with Type II Diabetes Mellitus attending a tertiary care center. Materials and Methods: A hospital-based cross-sectional observational study was conducted among 120 patients diagnosed with Type II Diabetes Mellitus attending Darbhanga Medical College & Hospital, Laheriasarai, Bihar, from February 2025 to July 2025. Detailed demographic, clinical, and biochemical parameters were recorded. Fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c, and serum uric acid levels were estimated using standard laboratory methods. Statistical analysis was performed using SPSS version 25. Pearson correlation coefficient and Chi-square test were used for analysis. A p-value <0.05 was considered statistically significant. Results: Among 120 participants, 68 (56.7%) were males and 52 (43.3%) were females. Mean age of study participants was 54.8 ± 10.7 years. Elevated serum uric acid levels were observed in 46 (38.3%) patients. Mean serum uric acid level was significantly higher among patients with poor glycemic control (HbA1c ≥7%) compared to patients with good glycemic control (7.1 ± 1.4 mg/dL vs 5.4 ± 1.1 mg/dL; p<0.001). Serum uric acid showed a significant positive correlation with HbA1c (r=0.46, p<0.001), fasting blood sugar (r=0.39, p<0.001), and postprandial blood sugar (r=0.41, p<0.001). Conclusion: Serum uric acid levels were significantly associated with poor glycemic control among patients with Type II Diabetes Mellitus. Serum uric acid may serve as a useful biochemical marker for monitoring metabolic control and identifying patients at increased risk of diabetic complications.

Background: Post-tonsillectomy pain remains a significant cause of morbidity in paediatric patients, often leading to delayed oral intake and prolonged recovery. Topical analgesic agents may provide effective pain relief with minimal systemic side effects. Methods: This prospective, randomized, double-blind controlled study was conducted on 105 children (5–12 years) undergoing elective tonsillectomy. Patients were allocated into three groups (n=35 each): Group R (0.5% ropivacaine), Group T (5% tramadol), and Group NS (normal saline). The study drug was applied topically to the tonsillar fossae. Postoperative pain was assessed using the FLACC score at multiple time intervals up to 48 hours. Results: Group R demonstrated significantly lower FLACC scores at all time points compared to Group T and Group NS (p<0.001). The mean time to first rescue analgesia was significantly longer in Group R (9.08 ± 3.26 hours) than Group T (6.97 ± 2.88 hours) and Group NS (3.14 ± 1.00 hours) (p<0.001). Total analgesic consumption and number of doses were also significantly lower in Group R. The incidence of nausea and vomiting was higher in Group T (p<0.05). Conclusion: Topical ropivacaine provides superior postoperative analgesia compared to tramadol and can be considered a safe and effective modality in paediatric tonsillectomy.

Background: Chronic Suppurative Otitis Media is a common chronic middle ear infection associated with persistent ear discharge and hearing loss. Identification of causative organisms and their antibiotic sensitivity pattern is essential for effective treatment and prevention of complications. Aim: To study the bacteriological profile and antibiotic sensitivity pattern in patients with CSOM attending a tertiary care hospital. Materials and Methods: This prospective observational study was conducted in 80 patients clinically diagnosed with CSOM over a period of 6 months. Ear discharge samples were collected under aseptic precautions and subjected to Gram staining, culture, and antibiotic sensitivity testing using the Kirby–Bauer disc diffusion method according to Clinical and Laboratory Standards Institute guidelines. Results: Maximum patients belonged to the 21–40 years age group (42.5%) with male predominance (57.5%). Ear discharge (100%) and hearing loss (77.5%) were the most common clinical features. Pseudomonas aeruginosa was the predominant isolate (40%) followed by Staphylococcus aureus (25%). Gram-negative bacilli were the commonest organisms identified (60%). Highest antibiotic sensitivity was observed with Imipenem (92.5%), Piperacillin-Tazobactam (90%), and Amikacin (85%), while maximum resistance was seen against Amoxicillin-Clavulanic acid (65%). Conclusion: Pseudomonas aeruginosa was the most common pathogen isolated in CSOM. Higher-generation antibiotics showed better sensitivity compared to commonly used antibiotics. Routine culture and antibiotic sensitivity testing are important for appropriate antibiotic selection and prevention of antimicrobial resistance.

Background: Pharmaceutical contamination is increasingly recognized as a major environmental concern due to improper disposal and continuous introduction of drug residues into ecosystems. Eco-pharmacovigilance (EPV) aims to minimize these effects through awareness, surveillance, and responsible practices. Objective: To assess the knowledge, attitudes, and practices regarding eco-pharmacovigilance among postgraduate residents and identify factors associated with safe drug disposal practices. Methods: A cross-sectional descriptive study was conducted among 102 postgraduate residents at a tertiary care hospital in Southern Rajasthan. A pre-validated questionnaire assessed knowledge, attitude, and practices. Scores were categorized into good, moderate, and poor levels. Results: Good knowledge and positive attitudes toward eco-pharmacovigilance were observed in 78.2% and 91.4% of participants, respectively. However, only 9.9% demonstrated appropriate disposal practices. The majority of postgraduate residents possessed adequate theoretical knowledge regarding eco-pharmacovigilance and environmental safety, along with positive attitude toward the subject. Despite this, the implementation of safe pharmaceutical disposal practices remained inadequate. Conclusion: Despite adequate knowledge and positive attitudes, practices remain inadequate. Structured training and institutional interventions are critical to bridging the knowledge–practice gap.

Background: Preoperative anxiety is highly prevalent in obstetric patients undergoing cesarean section and has significant implications for both maternal and neonatal outcomes. Midazolam, a short-acting benzodiazepine, has been proposed as an effective anxiolytic agent; however, concerns regarding neonatal safety have limited its widespread use in obstetric anesthesia. Objective: To evaluate the anxiolytic efficacy of low-dose intravenous midazolam administered preoperatively in patients undergoing lower segment cesarean section (LSCS) under spinal anesthesia, and to determine its impact on neonatal vitality, maternal consciousness, and recall of the moment of birth. Methods: This randomized, double-blind, placebo-controlled trial was conducted at S.M.S. Medical College and Attached Group of Hospitals, Jaipur. A total of 160 ASA II pregnant women aged 18-40 years scheduled for elective LSCS were randomly allocated into two groups: Group A (n=80) received midazolam 0.0125 mg/kg IV, while Group B (n=80) received an identical volume of 0.9% normal saline before spinal anesthesia. Anxiety was assessed using the Visual Facial Anxiety Scale (VFAS) at baseline and at 05, 15, and 60 minutes post-intervention. Sedation was evaluated using the Ramsay Sedation Scale at 10 minutes post-administration of solution. Neonatal outcomes were assessed using Apgar scores at 01 and 05 minutes. Hemodynamic parameters and maternal recall of childbirth were also documented. Results: The midazolam group demonstrated significantly greater reduction in VFAS scores compared to the control group at all post-intervention time points (p<0.001). Mean VFAS scores decreased from 6.11±0.69 at baseline to 1.80±0.43 at 60 minutes in Group A, compared to 6.83±0.76 to 5.40±0.49 in Group B. Ramsay sedation scores were significantly higher in the midazolam group (2.27±0.45 vs 1.00±0.00, p<0.001). Neonatal Apgar scores at 01 minute (8.47±0.50 vs 8.40±0.49, p=0.342) and 05 minutes (9.00 in both groups) showed no significant difference. Hemodynamic parameters demonstrated greater stability in the midazolam group. Maternal complications including nausea, shivering, and vomiting were more frequent in the control group. Conclusion: Low-dose intravenous midazolam (0.0125 mg/kg) provides effective anxiolysis and improved hemodynamic stability in parturients undergoing cesarean section under spinal anesthesia without adverse effects on neonatal outcomes.

Background: Tibial plateau fractures require accurate classification for appropriate surgical planning. The inter-observer reliability of radiograph-based classification systems has been reported as poor to moderate. Aim: To determine the contribution of 3D reconstructed CT scan images in the evaluation, classification, and preoperative treatment plan of tibial plateau fractures compared to plain radiographs. Materials and Methods: This cross-sectional study included 45 patients with tibial plateau fractures at Government R.D.B.P Jaipuria Hospital, RUHS College of Medical Sciences, Jaipur, from October to December 2019. Four blinded orthopaedic observers independently classified fractures using Schatzker classification first with radiographs alone, then with addition of 2D and 3D CT images. Results: The mean age was 39.42 ± 13.34 years with male predominance (88.89%). The average inter-observer Kappa for Schatzker classification improved from 0.956 (excellent) with X-rays alone to 1.0 (perfect) with addition of CT scan (p<0.0001). Karl Pearson’s correlation showed high positive correlation (R>0.8, p<0.0001) for all four observers. Statistically significant change in surgical plan was observed for Schatzker Type I (89.7%, p<0.001) and Type V (9.8%, p<0.05) fractures. CT scan identified articular depression and bicondylar fractures missed on radiographs. Conclusion: Although the inter-observer reliability with CT scan (Kappa=1.0) was almost equivalent to that with X-rays (Kappa=0.956), CT scan addition significantly impacted surgical planning, particularly for Schatzker Type I and V fractures. We recommend CT scan imaging in evaluation and surgical planning of tibial plateau fractures.

Background: Intra-articular proximal tibial fractures are challenging injuries that affect knee function and stability. Aim: To assess radiological restoration of articular alignment and its correlation with functional outcome after open reduction and internal fixation (ORIF) of intra-articular proximal tibial fractures. Materials and Methods: This prospective observational study included 36 patients with intra-articular proximal tibial fractures treated with ORIF with plating at Government R.D.B.P Jaipuria Hospital, RUHS College of Medical Sciences, Jaipur, from May 2018 to May 2019, with minimum 6-month follow-up. Fractures were classified using Schatzker’s classification. Functional outcomes were assessed using Modified Rasmussen Criteria for Clinical Assessment (MRCA) and radiological outcomes using Modified Rasmussen Criteria for Radiological Assessment (MRRA). Results: The mean age was 40.02 ± 13.58 years with male predominance (88.88%). Road traffic accidents were the most common mechanism (86.11%). Schatzker Type II and V were most frequent (27.77% each). The mean ROM was 122.36° ± 9.14 and mean fracture union time was 13.86 ± 1.82 weeks. On MRCA, 33.33% had excellent and 36.11% had good outcomes. On MRRA, 36.11% had excellent and 50% had good outcomes. Articular depression showed significant positive correlation with MRCA (R=0.501, p=0.00185). Tibial angulation (R=0.371, p=0.026) and osteoarthrosis (R=0.321, p=0.046) also showed significant correlations. MRRA and MRCA showed significant positive correlation (R=0.480, p=0.003). Complications occurred in 30.55%. Conclusion: ORIF is a rational treatment option for proximal tibial fractures. Anatomical articular reduction and restoration of tibial alignment are significant predictors of better functional outcomes. Radiological parameters significantly correlate with clinical outcomes.

Background: Prediabetes is one the leading cause as it leads of diabetes within few months to years. For developing countries like India diabetes is a major health hazard. To identify and control the diseases we can use Indian Diabetes Risk Factor (IDRS) as an important scale to screen the population for prediabetes and diabetes. Methods: The study was conducted in a Government Medical college and Hospital in Krishna district, Vijayawada. A total of 585 patients were screened. To estimate the risk of prediabetes & diabetes, an IDRS tool was employed, which included two modifiable (waist circumference, physical activity) and two non-modifiable risk factors (age, family history). Diabetes was confirmed using blood sugar levels from a fasting blood sample. Results: The data was analysed for 585 non-diabetic adults aged 25years and above. The average age was around 40.8years, with females accounting for 54.1% of the study sample and males accounting for 45.9%. According to IDRS score, the study population were classified to be low, medium and high risk for prediabetes & developing type-2 diabetes were 13%, 47% and 39% respectively. Conclusion: This study has described that the majority of the adult population were at medium and high risk of developing type 2 diabetes which is actually a dangerous sign for the community, needing lifestyle changes to be initiated as soon as possible to delay the occurrence of type 2 diabetes. However, as this study was conducted after the first COVID, COVID may be a contributing factor to the population’s increased risk.

Background: Early pregnancy loss is a common obstetric complication, with the majority of miscarriages occurring during the first trimester. Transvaginal ultrasonography plays a vital role in early pregnancy assessment, and yolk sac diameter (YSD) is one of the earliest measurable sonographic parameters. Abnormalities in yolk sac size may reflect early embryonic compromise and predict adverse pregnancy outcomes. Objectives: To evaluate yolk sac diameter as a prognostic factor for first-trimester pregnancy outcome and to determine its predictive accuracy for adverse outcomes. Methods: This prospective observational study included 105 pregnant women with confirmed intrauterine singleton pregnancies between 5 and 10 weeks of gestation. Transvaginal ultrasonography was performed to measure yolk sac diameter, along with assessment of gestational sac, crown–rump length, and embryonic cardiac activity. Yolk sac diameter was categorized as normal (3–6 mm) or abnormal (<3 mm or >6 mm). Participants were followed until completion of 12 weeks of gestation, and pregnancy outcomes were classified as viable or non-viable. Statistical analysis was performed to assess the association between YSD and pregnancy outcome and to calculate diagnostic performance indices. Results: Out of 105 pregnancies, 90 (85.7%) resulted in viable outcomes, while 15 (14.3%) ended in first-trimester pregnancy loss. Abnormal yolk sac diameter was significantly associated with adverse pregnancy outcome (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of abnormal YSD for predicting non-viable pregnancy were 73.3%, 86.7%, 47.8%, and 95.1%, respectively. A significant positive correlation was observed between yolk sac diameter and gestational age, crown–rump length, and gestational sac diameter. Conclusion: Yolk sac diameter is a simple, non-invasive, and reliable ultrasonographic parameter for predicting first-trimester pregnancy outcome. Normal YSD is strongly associated with pregnancy viability, while abnormal values indicate increased risk of early pregnancy loss.

Background: Vaginal bleeding during the first trimester is a typical obstetric manifestation that is usually linked with maternal anxiety and doubt about the future of the pregnancy. Though most of the affected pregnancies develop normally, it was shown that early bleeding is associated with poor maternal and perinatal outcomes and therefore requires close assessment and follow up.  requires close assessment and follow up. Objectives:  To determine maternal and perinatal outcomes in pregnant women with first-trimester vaginal bleeding and to determine the obstetric complications. Materials and Method: The study was an observational descriptive study carried out in a tertiary care center and incorporated 80 pregnant women who presented with vaginal bleeding less than 13 weeks of gestation. The women who had ectopic pregnancy, molar pregnancy, induced abortion and severe underlying medical conditions were excluded. The participants were prospectively tracked until birth. The outcomes of the mothers in terms of pregnancy loss, hypertensive disorders, preterm labor, placental complications, and mode of delivery were documented. Descriptive and inferential statistics were used to test perinatal outcomes such as gestational age at birth, birth weight, APGAR score, NICU admission and perinatal mortality. Results: In this case, pregnancy continuation was seen in 81.25 percent of the women past the first trimester and 18.75 percent saw pregnancy loss. Hypertensive disorders (29.2%) and preterm labor (21.5) were the most common maternal complications among the ongoing pregnancies. In 18.5percent cases, preterm delivery took place. It was observed that 26.7 percent of neonates had low birth weight and 17.5 percent of them were admitted to the NICU. Background risk factors and increase in gravidity had a significant association with poor outcomes (p < 0.05). Conclusion: Vaginal bleeding during the first trimester is linked with the high probability of poor maternal and infant outcomes. Affected pregnancies need early detection and close antenatal monitoring in order to maximize maternal and neonatal outcomes.

Background: Medical Termination of Pregnancy Act legalizes abortion to moderate extent and describes various grounds under which termination of pregnancy can be done. Unsafe abortion is a major public health problem and a preventable contributor to maternal death in India despite a supportive legal framework. Main objective of this study is to analyse the socio-demographics factors of medical termination of pregnancy and to analyse the reason of termination, methods of termination and adoption of family planning methods after abortion. Increasing awareness among men and women of reproductive age about the availability of safe abortion services at locality and post‑abortion contraception could improve acceptance and success of methods and reduce unsafe practices. Methods: A one‑year retrospective observational study was conducted. A total of 75 post‑MTP cases were included in this study. This study was carried out at GMERS Medical College, Maharani Rupaliba Lady Hospital, Porbandar, during a 12‑months period from September 2024 to August 2025. Data retrieved from the hospital database/medical records (MTP register in FP unit) was tabulated and analyzed in microsoft excel. Results: During the study period, a total of 75 cases of medical termination of pregnancy were performed. The incidence of MTP in this study was 21.98% per 1000 deliveries. The maternal age group of 25-29 years was availing MTP services the most (32%) and 29.33% in 20-24 years age group. Most of the study subjects were married (96%) and hindus (90.66%). Induced abortion was more common in 3^rd gravida (37.33%) and least in 5^th gravida or more (09.33%). Most of cases came for MTP upto 9 weeks of gestational age (64%). Total 59 cases of 1^st trimester MTP, of which medical management of abortion done in 36 cases (61.01%). Total 16 cases of 2^nd trimester MTP. Majority of women had social reason for termination of pregnancies (42.66%), followed by contraceptive failure (34.66%). Despite the strong recommendations, 40% of women did not use any form of contraception after MTP, while sterilisation (28%), IUCD insertion (10.66%), OCP/ Injectable (5.33%) and condoms (16%) were the other forms of contraception used after abortion. Conclusion: There is need to counsel women of reproductive age group that MTP is not a way to control unwanted pregnancy and it is not free from risk. Eligible couples have to be educated regarding the availability of different methods of contraceptives and their proper use to avoid pregnancy. All MTP seekers should be counsel for use of post abortion contraceptive methods.

Background: Pre-eclampsia and eclampsia are major contributors to maternal and perinatal morbidity and mortality worldwide. Recent evidence suggests that maternal vitamin D deficiency may play a role in endothelial dysfunction and abnormal placentation associated with hypertensive disorders of pregnancy. Aim: To evaluate the association between maternal serum vitamin D levels and the occurrence of pre-eclampsia and eclampsia in pregnant women. Materials and Methods: This prospective observational study was conducted among 120 pregnant women admitted to a tertiary care hospital over a period of 18 months. Participants were divided into three groups: normotensive pregnant women (control group), women with pre-eclampsia, and women with eclampsia. Serum 25-hydroxyvitamin D levels were estimated and compared among the groups. Statistical analysis was performed using SPSS software version 25.0. Results: Mean serum vitamin D levels were significantly lower in women with pre-eclampsia and eclampsia compared to normotensive pregnant women. Severe vitamin D deficiency was more prevalent among eclamptic women. Significant associations were observed between low vitamin D status and severity of hypertension, proteinuria, and adverse maternal outcomes. Conclusion: Maternal vitamin D deficiency was significantly associated with pre-eclampsia and eclampsia. Early identification and correction of vitamin D deficiency during pregnancy may help reduce the risk and severity of hypertensive disorders.

Introduction: Postoperative pain remains one of the most common and significant concerns following surgical procedures and can adversely affect patient recovery, mobilization, wound healing, and overall quality of care. Effective postoperative pain management is essential for reducing patient discomfort, minimizing complications, improving functional recovery, and shortening hospital stay. Analgesic medications including non-steroidal anti-inflammatory drugs (NSAIDs), opioids, paracetamol, and adjuvant analgesics are commonly prescribed in postoperative settings for pain control. Evaluation of analgesic prescription patterns is important for assessing rational drug use, effectiveness of pain management strategies, prevalence of polypharmacy, adherence to standard treatment guidelines, and utilization trends of various analgesic agents. Drug utilisation studies in postoperative patients may additionally help identify inappropriate prescribing practices, excessive opioid use, adverse drug interactions, and opportunities for optimizing pain management protocols. Aim: To evaluate the analgesic prescription patterns in postoperative patients admitted to a tertiary care centre. Objectives: (1) To evaluate the demographic profile of postoperative patients receiving analgesics. (2)To analyze the pattern of analgesic prescribing among postoperative patients. (3) To assess the utilization of monotherapy and combination analgesic therapy. (4)To evaluate the use of opioids, NSAIDs, and adjuvant analgesics in postoperative pain management. (5) To assess prescribing indicators and rationality of analgesic therapy in postoperative patients. Methodology: This prospective observational study was conducted in the postoperative wards of a tertiary care teaching hospital over a period of 12 months. A total of 200 postoperative patients receiving analgesic therapy were included in the study. Detailed demographic data, type of surgical procedure, analgesics prescribed, dosage forms, routes of administration, frequency of administration, duration of therapy, and concomitant medications were recorded using a structured data collection form. Prescriptions were analyzed according to standard postoperative pain management guidelines and World Health Organization prescribing indicators. Data were analyzed using descriptive and inferential statistical methods, and results were expressed as frequencies, percentages, mean, and standard deviation wherever appropriate. Results: The majority of postoperative patients belonged to the 31–50 years age group, with male predominance observed in the study population. NSAIDs and paracetamol were the most frequently prescribed analgesics, while opioid analgesics were primarily utilized in major surgical procedures and severe postoperative pain. Combination analgesic therapy was prescribed more commonly than monotherapy, particularly among patients undergoing major abdominal and orthopedic surgeries. Injectable formulations were predominantly utilized during the immediate postoperative period, followed by oral analgesics during recovery. Most prescriptions were compliant with standard postoperative pain management guidelines. Conclusion: The present study demonstrated that NSAIDs and paracetamol were the most commonly prescribed analgesics among postoperative patients. Combination analgesic therapy was frequently utilized for achieving better postoperative pain control and reducing opioid requirements. Drug utilisation studies are important for evaluating postoperative analgesic prescribing practices and promoting rational use of analgesics. Periodic prescription audits and adherence to evidence-based pain management guidelines may help optimize postoperative analgesic therapy and improve patient outcomes.

Background: Dexmedetomidine is a highly selective α2-adrenergic receptor agonist increasingly used in anesthetic practice because of its sedative, anxiolytic, sympatholytic, and analgesic properties without causing significant respiratory depression. Premedication with dexmedetomidine has shown potential in reducing intraoperative anesthetic and opioid requirements while improving postoperative recovery characteristics. Optimizing anesthetic drug consumption and enhancing postoperative recovery are important goals in modern perioperative care because they contribute to improved hemodynamic stability, decreased adverse effects, and shorter recovery time. However, the extent of anesthetic sparing and recovery benefits associated with dexmedetomidine premedication remains an area of ongoing clinical evaluation. Aim: To evaluate the effect of dexmedetomidine premedication on intraoperative anesthetic requirement and postoperative recovery among patients undergoing elective surgeries under general anesthesia. Materials and Methods: This prospective randomized comparative study was conducted in the Department of Anesthesiology of a tertiary care teaching hospital over a period of 18 months. A total of 120 patients aged 18–65 years belonging to ASA physical status I and II scheduled for elective surgery under general anesthesia were included. Patients were randomly divided into two groups of 60 each. Group D received intravenous dexmedetomidine premedication at a dose of 1 µg/kg diluted in normal saline over 10 minutes before induction, while Group C received an equal volume of normal saline placebo. Intraoperative anesthetic requirement, hemodynamic parameters, recovery profile, postoperative pain scores, sedation levels, and adverse events were assessed and compared between groups. Results: Patients receiving dexmedetomidine demonstrated significantly reduced intraoperative anesthetic and opioid requirements compared with the control group. Hemodynamic parameters remained more stable in the dexmedetomidine group throughout surgery. Postoperative recovery was smoother with lower pain scores, reduced postoperative analgesic consumption, and improved sedation quality. Incidence of postoperative nausea and vomiting was lower in the dexmedetomidine group. Recovery room discharge time was shorter, and patient satisfaction scores were significantly better among patients receiving dexmedetomidine premedication. Conclusion: Dexmedetomidine premedication effectively reduces intraoperative anesthetic requirement and improves postoperative recovery profile while maintaining better perioperative hemodynamic stability. It may serve as a useful anesthetic adjuvant in elective surgeries performed under general anesthesia.

Background: Skin diseases are widespread and contribute significantly to the global disease burden, ranking as the 18th leading cause of health burden worldwide. Periodic prescription audit through drug utilization studies is essential to evaluate the rationality of treatment and minimize the financial burden on patients. Objectives: This study was designed to assess the prevalence of various skin disorders and analyse drug use patterns using WHO drug use indicators at the dermatology outpatient department (OPD) of a tertiary care teaching hospital. Materials and Methods: A prospective, observational study was carried out in the Department of Pharmacology at a tertiary care teaching hospital in Gujarat, India. Over a period of one month, data from 103 patients attending the dermatology OPD were collected in a Case Record Form (CRF) and analyzed using descriptive statistics and WHO core indicators. Results: Among the 103 patients, a slight male predominance was observed (male-to-female ratio of 1.14:1), with the 31–45year age group constituting the largest proportion (27.18%). Tinea was the most common diagnosis (39.80%), followed by eczema (9.70%) and scabies (5.82%). A total of 336 drugs were prescribed, with antihistamines being the most frequent therapeutic class (32.44%), followed by antifungals (22.61%). The oral route was the primary route of administration (65.47%), and tablets were the most common dosage form (61.01%). The average number of drugs per prescription was 3.26. Notably, 99.09% of drugs were prescribed by generic name, but only 11.90% were from the National/WHO Essential Medicines List. Conclusion: The study demonstrates that tinea infections predominate and antihistamines are widely used in dermatological practice. While high generic prescribing reflects a positive trend toward cost-effective therapy, the low inclusion of essential medicines highlights a need for further interventions to improve adherence to WHO guidelines and optimize patient care.

Background: Bronchial asthma is one of the most common chronic respiratory disorders in children. In recent years, increasing prevalence of obesity and altered nutritional status among children has raised concern regarding its association with asthma. Body mass index (BMI) may influence airway inflammation, pulmonary mechanics, and asthma severity. Aim: To assess the association between body mass indexes (BMI) and bronchial asthma among school-going children aged 6–18 years in Ajmer using the ISAAC questionnaire. Materials and Methods: This prospective community-based cross-sectional study was conducted under the Department of Paediatrics, JLN Medical College, Ajmer, Rajasthan, from September 2023 to August 2024. A total of 1000 school-going children aged 6–18 years were enrolled using purposive sampling. Data were collected using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire along with anthropometric measurements. Height and weight were recorded and BMI was calculated for all participants. Children were categorized as underweight, normal weight, and overweight according to WHO BMI criteria. Statistical analysis was performed using Microsoft Excel and chi-square test. Results: Out of 1000 participants, 592 (59.2%) had normal BMI, 250 (25%) were underweight, and 158 (15.8%) were overweight. Physician-diagnosed asthma was present in 52 children (5.2%), while 13.6% reported lifetime wheezing. Asthma symptoms were found to be more common among overweight children compared to normal BMI children. Underweight children also showed increased respiratory symptoms compared to children with normal BMI. Sleep disturbance due to wheezing and recurrent wheezing attacks were more frequent among children with abnormal BMI. Conclusion: Abnormal BMI was significantly associated with bronchial asthma among school-going children. Overweight children showed the highest prevalence of wheezing and asthma-related symptoms, while underweight children also demonstrated increased respiratory symptoms. Maintaining healthy nutritional status may help reduce asthma-related morbidity in children.

Background: Meconium-stained amniotic fluid (MSAF) is a common obstetric complication associated with fetal distress, meconium aspiration syndrome (MAS), increased operative deliveries, and neonatal morbidity and mortality. In resource-limited settings, intrapartum amnioinfusion has been proposed as a simple and cost-effective intervention to improve fetomaternal outcomes. Aim: To evaluate the role of intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid and its effect on maternal and neonatal outcomes at a secondary care hospital. Materials and Methods: This prospective comparative study was conducted at Mansa Civil Hospital, a secondary care hospital, over a period of one year from April 2025 to April 2026. A total of 100 term pregnant women with meconium-stained liquor were included and divided into two groups. Group A consisted of 50 women who underwent transcervical amnioinfusion, while Group B included 50 women managed expectantly without amnioinfusion. Maternal and neonatal outcomes such as mode of delivery, amnioinfusion-to-delivery interval, Apgar score, neonatal resuscitation, NICU admission, incidence of MAS, and maternal complications were compared between the groups. Results: Normal vaginal delivery was higher in the amnioinfusion group (72%)compared to the control group (64%), while the cesarean section rate waslower in Group A (18%) than Group B (30%). Neonatal outcomes were comparatively better in the amnioinfusion group, with lower rates of neonatalresuscitation (28% vs 36%), NICU admissions (18% vs 26%), and MASreferrals (8% vs 12%). A higher proportion of neonates in Group A hadfavourable Apgar scores >7 at 1 minute (78% vs 70%). Maternal complicationswere minimal and manageable. Conclusion: Intrapartum transcervical amnioinfusion is a safe, simple, and effective intervention in cases of meconium-stained liquor. It reduces operative delivery rates and improves neonatal outcomes, making it particularly beneficial in resource-limited secondary care settings.

Introduction: Laparoscopic cholecystectomy surgery is now-a-days the commonest surgery related to abdomen. But post-operative pain decrease not only the patient outcome but also increase the hospital stay. All this will increase the opioid dependence which results in its side effects like nausea, vomiting, constipation etc. So, we decided a study in which we gave intra-peritoneal bupivacaine spray after laparoscopic cholecystectomy for post-operative analgesia. Methodology: 60 patients who were posted for routine laparoscopic cholecystectomy surgeries were equally divided into 2 groups with 30 patients each (Group IPB and Group GA). In group IPB, General anaesthesia along with intra-peritoneal bupivacaine spray (after completion of surgery) were given, while in group GA, we only gave general anaesthesia. We observed Post-operative analgesic requirement as well as hemodynamic stability of the patients. Result: Total analgesic requirements were significantly less in group IPB as compared to group GAduring post-operative period. There was decrease in the time spent by the patient in post-operative anaesthesia care unit in group IPB as compared to group GA. Conclusion: Intra-peritoneal bupivacaine spray after completion of laparoscopic cholecystectomy will not only decrease the post-operative analgesic requirements but also increase the post-operative hemodynamic stability.

Background: Pancytopenia is defined as a reduction in all three blood components—leukopenia, thrombocytopenia, and anemia—below normal. This study aims to close the knowledge gaps about pancytopenia in pediatric patients. The purpose of the study was to examine the clinical and etiopathological characteristics of pancytopenia in children between the ages of one and eighteen. Methods: The purpose of this cross-sectional observational study was to find out more about the clinical features, demographics, and etiopathological profile of pediatric pancytopenia. Between January and June of 2025, 65 patients between the ages of one and eighteen who met the inclusion criteria and were admitted to the pediatric department of Katihar Medical College and Hospital in Katihar, Bihar, participated in the study. The statistical analysis was conducted using IBM’s Statistical Package version 24. Results: Out of 65 patients, the age range of 1–6 years accounted for 55% of the cases. With a male-to-female ratio of 2.09:1, our study showed that men predominated over women, primarily in rural areas. Easy weariness accounted for 90% of patients’ initial complaints, with fever coming in second at 54%. Pallor was the most frequent physical observation (100%), followed by pedal edema (18%) and splenomegaly (38%). 62% of the bone marrow is hypocellular, 31% is hypercellular, and 7% is normocellular. The majority of patients had peripheral smears that were normocytic normochromic (34%) and macrocytic hypochromic (30%). In terms of etiology, megaloblastic anemia (30%) was found to be the most frequent cause of pancytopenia, followed by cancers (30%), which included myelodysplastic syndrome (9%), multiple myeloma (3%), acute lymphocytic leukemia (9%), acute myeloid leukemia (9%), aplastic anemia (14%), and sepsis (8%). Other uncommon causes of pancytopenia include dengue (3%), malaria (9%), and disseminated tuberculosis (6%), according to the study. Conclusion: The present study indicates that the most common dietary causes of pancytopenia are megaloblastic anemia, malignancies, and aplastic anemia.

Background: Tinnitus is a common auditory condition characterized by the perception of ringing, buzzing, or humming sounds without any external source. It can negatively affect sleep, concentration, emotional well-being, and quality of life. Several socio-demographic, environmental, medical, and lifestyle-related factors may contribute to the development of tinnitus. However, limited data are available regarding tinnitus and its associated risk factors among adults in North Bihar. Aim: The study aimed to determine the frequency of tinnitus among adults in North Bihar and to identify the associated socio-demographic, environmental, medical, lifestyle, and drug-related risk factors. The objectives included evaluating the relationship of tinnitus with age, gender, residence, occupation, noise exposure, medical conditions, and medication use. Methodology: A cross-sectional observational study was conducted among 100 adults aged 18 years and above residing in North Bihar. Data were collected using a structured questionnaire. Information regarding socio-demographic details, tinnitus characteristics, noise exposure, medical history, lifestyle habits, and medication use was recorded. Tinnitus severity was assessed using the Visual Analog Scale (VAS). Data were analyzed using descriptive statistics, and p-values were used to determine statistical significance. Results: Among the participants, 37% reported tinnitus, with most cases being bilateral and chronic in nature. Moderate severity tinnitus was more common. Significant associations were observed with age, rural residence, occupation, occupational noise exposure, headphone use, loud social events, and low use of ear protection. Medical conditions such as hypertension, diabetes mellitus, chronic ear disease, thyroid disorders, anemia, and history of head or ear trauma were also significantly associated with tinnitus. Lifestyle factors including smoking, alcohol consumption, and use of ototoxic medications such as aminoglycosides, loop diuretics, and high-dose NSAIDs showed significant associations. Conclusion: Tinnitus is a significant public health concern among adults in North Bihar. Noise exposure, medical illnesses, unhealthy lifestyle habits, and ototoxic drug use were identified as important contributing factors. Increased awareness, preventive measures, and early management are essential to reduce the burden of tinnitus and improve quality of life.

Introduction: Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as Polycystic Ovary Syndrome (PCOS), is a common endocrine disorder among adolescents and is frequently associated with metabolic abnormalities and future cardiovascular risk. This study was conducted o assess the clinical profile and metabolic risk factors among adolescents diagnosed with PMOS in a tertiary care hospital in India. Methods: Hospital-based cross-sectional study was conducted among 550 adolescent girls with PMOS. Data regarding socio-demographic characteristics, clinical features, anthropometric measurements, hormonal profile, and metabolic parameters were collected using a structured proforma. Statistical analysis was performed using Chi-square test, and p<0.05 was considered statistically significant. Results: Among 550 adolescents with PMOS, oligomenorrhea (56.7%), acne (59.6%), hirsutism (53.5%), and obesity (40.0%) were the predominant clinical findings. Increased waist-hip ratio was observed in 61.1% participants. Insulin resistance was present in 57.8% adolescents, while low HDL cholesterol and elevated triglycerides were found in 57.1% and 45.8% participants respectively. Metabolic syndrome was identified among 33.8% adolescents. Significant associations were observed between obesity, acanthosis nigricans, elevated testosterone levels, and metabolic abnormalities (p<0.05), indicating a strong link between endocrine manifestations and metabolic risk factors. Conclusions: Adolescents with PMOS showed considerable endocrine and metabolic abnormalities. Early screening, lifestyle modification, and timely management can help prevent future complications such as diabetes, cardiovascular disease, and infertility.

Background: Comparative Evaluation of Hemodynamic Stability between Spinal and General Anesthesia in Elective Lower Abdominal Surgeries is a clinically relevant diagnostic and anatomical problem in routine tertiary care practice. The purpose of this study was to compare the intraoperative hemodynamic stability, the requirement of vasopressors and early recovery between spinal and general anesthesia. Method: Prospective observational comparative study was done in the Department of Anaesthesiology in a tertiary care hospital. A total of 140 adult patients who were undergoing elective surgery for the lower abdomen were included in the study. The participants/specimens were divided into two groups: spinal anesthesia group and general anesthesia group. Standardized data collection, laboratory/ radiological/ anatomical assessment and predefined operational criteria were used. Results: MAP variability during surgery was significantly lower in the spinal anesthesia group (10.8 +/- 4.1 mmHg) than in the general anesthesia group (15.6 +/- 5.2 mmHg, p<0.001). The use of vasopressors was greater in the spinal anesthesia group (28.6% vs 15.7%, p=0.041), while tachycardia and hypertensive response to incision were more common in the general anesthesia group (p=0.008). The spinal group had better early recovery score at 30 minutes. Conclusions: Both techniques were safe, but the latter (spinal anesthesia) allowed for more predictable hypotension that required prompt vasopressor support, and smoother intraoperative hemodynamic trends.

Background: Under-five morbidity and mortality is preventable due to incomplete and delayed immunization. Mobile health education has the potential to enhance caregiver awareness, attendance at appointments, and timely vaccine uptake. The aim of this study was to assess the effect of a structured mobile health education intervention on immunization coverage among under-five children. Methods: A quasi-experimental community-based study was carried out with 360 caregiver-child pairs in two similar community areas in rural primary health centres. The intervention group was provided with weekly mobile health education messages and vaccine reminders for six months, and the comparison group was provided with routine services. Caregiver knowledge and child immunization status (by card or health record) were documented during baseline and endline assessments. Results: Baseline immunization coverage was comparable between the intervention and comparison groups, with 62.8% vs 61.1% of children being fully immunized, respectively (p = 0.741). The intervention group had a higher rate of coverage at 6 months (86.1% vs. 68.3%, p < 0.001). Mean caregiver knowledge score improved from 12.4 ± 3.1 to 18.7 ± 2.6 in the intervention group and from 12.1 ± 3.4 to 13.6 ± 3.2 in the comparison group (p < 0.001). The intervention group saw a significant increase in timely vaccine uptake from 54.4% to 79.4%. At endline, mobile health exposure continued to be independently associated with full immunization (AOR 3.42, 95% CI 2.02-5.79). Conclusion: Mobile health education had a significant effect on the knowledge, full immunization coverage, and timeliness of under-five children. Combining localised mobile reminders with the delivery of routine immunisation services can reinforce public health services.

Background: Opioid anesthesia in laparoscopic surgery causes an independent risk factor for postoperative nausea and vomiting (PONV), and it can lead to prolonged post-anesthesia care unit (PACU) stays. Hence, opioid-free anesthesia, which involves various non-opioid drugs to reduce or eliminate the need for opioids during operations. Method: Out of 90 (ninety) patients undergoing laparoscopic surgeries, 45 patients (Group A) were given opioid-free anesthesia, and 45 patients (Group B) were given opioid anesthesia. The baseline parameters such as pulse rate, systolic BP, diastolic BP, SPO₂ and end-tidal CO₂ (EtCO₂) were recorded. Intra-operative and postoperative parameters were recorded and compared in both groups. Results: Demographic characteristics, intra-operative, and post-operative NRS scores and postoperative analgesic requirements between of both groups were studied. In this comparative study of OFA and opioids, all parameters had significant p values (p<0.001). Conclusion: Dexmedetomine-based opioid-free anesthesia provided superior postoperative analgesia and significantly lower pain scores. These indicate that OFA is a safe and effective approach for laparoscopic surgeries, facilitating enhanced recovery with a reduced hospital stay.

Background: Pyrexia of Unknown Origin (PUO) remains a diagnostic challenge in children, particularly in tropical regions like western Gujarat where infectious diseases are endemic. This study aimed to evaluate the clinico-microbiological profile, etiological spectrum, and outcomes of PUO in pediatric patients at a tertiary care center. Understanding regional patterns helps in early diagnosis and appropriate management, reducing morbidity. Previous Indian studies from South and North India have highlighted infections as the leading cause, but data from western Gujarat is limited. Material and Methods: This prospective observational study was conducted over one year at the Department of Pediatrics in a tertiary care hospital in western Gujarat. Children aged 1 month to 12 years presenting with fever ≥38.3°C for more than 8 days without an identifiable cause after initial evaluation were included. Detailed history, clinical examination, and stepwise laboratory investigations including blood cultures, serology for dengue, enteric fever, scrub typhus, malaria, and imaging were performed. Ethical approval was obtained, and informed consent was taken from parents. Result: A total of 85 children were enrolled. Infectious etiology was identified in 68.2% (n=58), collagen vascular diseases in 11.8% (n=10), malignancies in 7.1% (n=6), and 12.9% (n=11) remained undiagnosed. Among infections, enteric fever (25.9%), dengue (20%), scrub typhus (15.3%), and urinary tract infections (10.6%) were common. Mean fever duration was 14.2 ± 5.6 days. Most children responded well to targeted therapy with low mortality. Conclusion: Infections remain the predominant cause of PUO in children in western Gujarat, similar to other Indian studies. A systematic approach with region-specific investigations is essential for better outcomes. Early identification can reduce hospital stay and complications.

Background: Acute myocardial infarction (AMI) is a major cardiovascular emergency associated with significant morbidity and mortality. Biomarkers that reflect myocardial damage and ventricular dysfunction may improve early risk assessment. Aim: To quantitatively assess serum ferritin levels in patients with AMI and evaluate their correlation with left ventricular ejection fraction (LVEF) as a marker of left ventricular systolic dysfunction. Methods: This prospective observational study was conducted in the Department of General Medicine, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh. A total of 107 patients diagnosed with AMI were included. Clinical evaluation, electrocardiography, echocardiography, and laboratory investigations including serum ferritin estimation by chemiluminescent immunoassay were performed. Data were analysed using appropriate descriptive and inferential statistics, including Spearman correlation. Results: The mean age was 59.4 ± 11.3 years, and 53.3% were males. AWMI was the most common diagnosis (52.3%). Mean LVEF was 40 ± 9%, with 81.3% showing varying degrees of systolic dysfunction. Mean serum ferritin was 344.7 ± 216.2 ng/mL, and 66.4% had elevated ferritin. Serum ferritin showed a significant moderate negative correlation with LVEF (r = -0.485, p <0.001). Conclusion: Elevated serum ferritin is common in AMI and is significantly associated with impaired left ventricular systolic function, suggesting its utility as a simple prognostic biomarker.

Background: Asthma is one of the most common chronic respiratory disorders affecting children worldwide and is associated with significant morbidity, frequent hospital admissions, and impaired quality of life. Asthma management is crucial to decrease the severity of asthma, clinical outcomes, and recurrent hospitalizations in children. Hospital-based asthma management offers opportunities for a retrospective analysis, which gives insight into the treatment of asthma, outcomes, and readmission among children. Methods: A retrospective observational study was carried out in the Department of Pediatrics of BMIMS from June 2025 to February 2026. The number of pediatric patients included in the study is about 120 patients with asthma. The data were collected from the medical records, admission registers and treatment sheets of the hospital. Demographic data, clinical presentation, treatment modalities, treatment outcomes, duration of hospital stay, and the history of readmission were analyzed. Microsoft Excel and SPSS software were used to analyze statistical data. Results: Nebulized salbutamol and corticosteroid combination therapy were the most commonly used treatment methods, followed by oxygen support in severe cases. The clinical improvement was observed in the majority of the patients (90%) and were discharged successfully, with a small fraction of patients admitted to the ICU. The average duration of hospitalization was 4.2 ± 1.8 days. Poor medication adherence, environmental triggers and severe asthma were found to be important associated risk factors for readmission, which occurred in 18.3% of patients. Conclusion: This study showed that with proper care and management of asthma such as bronchodilator use, and giving of steroid, there was significant improvement in clinical outcome for pediatric patients. Despite this, poor adherence, environmental exposure, and severe disease were still associated with readmission, underscoring the critical role of ongoing follow-up, patient education, and asthma management strategies.

Background: Neonatal sepsis is a significant cause of neonatal morbidity and mortality worldwide, especially in developing countries where health care resources and infection control standards could be limited. The early detection of the risk factors, causative organisms and the outcomes of treatment is essential to improving neonatal survival and reducing complications. Methods: The study was conducted as a retrospective observational hospital-based study among 550 neonates admitted from June 2025 to February 2026 with sepsis. Data were gathered from NICU data, lab reports, antibiotic chart and discharge summary. Descriptive statistics and chi-square tests were employed to analyze demographic characteristics, maternal and neonatal risk factors, microbiological findings, treatment patterns and outcomes. The statistical significance was used at p-value < 0.05. Results: The majority of neonates were male (56.7%), preterm (59.6%), and low birth weight infants (62.0%). Prematurity, low birth weight, prolonged rupture of membranes, and birth asphyxia were identified as the major risk factors associated with neonatal sepsis. Respiratory distress and poor feeding were the most common clinical presentations. Blood culture positivity was observed in 67.6% of cases, with Klebsiella pneumoniae and Escherichia coli being the predominant pathogens isolated. Empirical antibiotic therapy was initiated in all neonates, while antibiotic modification based on culture sensitivity reports was required in 42.5% of cases. The recovery rate was 79.6%, whereas mortality was observed in 14.9% of neonates. Conclusion: Neonatal sepsis remains an important health problem associated with a considerable morbidity and mortality rate. The low birth weight, premature delivery and PROM were the significant risk factors and Klebsiella spp. emerged as the predominant pathogen. Rational antibiotic therapy, infection control and continuous antimicrobial surveillance are key to the improvement of neonatal outcomes and to the prevention of sepsis-related mortality.

Background: Breastfeeding is a key element of infant nutrition and plays a determinant role in improving child health and survival. Exclusive breastfeeding during the first six months of life is strongly recommended by the World Health Organization (WHO); however, breastfeeding practices are influenced by multiple social, cultural, and maternal factors. Methods: The study was a retrospective observational study conducted in the Department of Pediatrics, BMIMS, Pawapuri, during the period of June 2025 to February 2026. A total of 1200 participants were included in the study. Hospital records were used to collect data, and a structured questionnaire was used in interviews with caregivers. Descriptive statistics and Chi-square tests were used to analyze the variables of exclusive breastfeeding, duration of breastfeeding, timing of initiation, complementary feeding practices and maternal factors. Results: The study identified early initiation of breastfeeding within the one-hour period after birth in 68.2% of the infants. 54.8% of infants were exclusively breastfed for the first six months of life and 32.5% were mixed fed. The mean period of exclusive breast-feeding was 5.4 months. Maternal education, delivery type, occupation and socioeconomic status were significantly associated with exclusive breastfeeding. Mothers who were better educated and had normal delivery showed good breastfeeding practices. Conclusion: The study highlights the importance of maternal education and counseling in the hospital setting to encourage optimal breastfeeding practices. Breastfeeding awareness programs possibly could enhance health-related outcomes in the study population if strengthened.

Background: Antimicrobial Resistance (AMR) is now a significant global health issue, making the use of widely-used antibiotics much less effective and leading to higher levels of morbidity and mortality as well as higher healthcare expenses. One of the main causes of resistance is inappropriate and excessive use of antibiotics in the hospital setting, particularly in developing countries, such as India. Methods: The study was a retrospective observational study in Nalanda Medical College and Hospital (NMCH), Patna, between 1 July 2025 and 31 December 2025. Records of 100 patients with confirmed infections and culture and sensitivity reports were included. The demographics, types of infections, prescribed antibiotics and microbial resistance patterns were collected and evaluated by descriptive statistics. Results: There were 58 males and 42 females out of 100 patients. The majority of infections were urinary tract (35%), respiratory tract (25%), skin and soft tissue (20%), bloodstream infections (10%), and others (10%). The identified organisms were Escherichia coli (40%) followed by Staphylococcus aureus (20%), Klebsiella pneumoniae (15%), Pseudomonas aeruginosa (10%). The most common prescribed oral antibiotic courses were cephalosprins (45%), followed by fluoroquinolones (25%), penicillin (15%). The resistance was high on ampicillin (70%) and ciprofloxacin (50%), whereas the sensitivity was higher with third-generation cephalosporins in selective cases. Conclusion: The study highlights that the prevalence of Urinary Tract Infections (UTIs) and Respiratory Tract Infections (RTIs) is high, the use of broad-spectrum antibiotics is common, and the resistance to the frequently prescribed medications is increasing. These findings underscore the importance of implementing antibiotic stewardship, culture-directed therapy, and stringent regulations on prescription as measures to control the increasing burden of antimicrobial resistance.

Background: Groin hernias represent one of the most common global surgical conditions, with a subset presenting as acute abdomen due to complications such as irreducibility, obstruction, strangulation, or inflammation. These emergencies require prompt diagnosis and surgical intervention to prevent bowel ischemia, sepsis, and mortality. Femoral hernias, though less common, carry a particularly high risk of strangulation. Understanding the clinical spectrum, operative findings, and outcomes of acutely complicated groin hernias is essential for improving emergency surgical care. Aim: To evaluate the clinical, operative, and early postoperative profile of patients presenting with groin hernias as acute abdomen. Methodology: A prospective observational study was conducted on 50 patients presenting with acutely complicated groin hernias to the Emergency Department of General Surgery, GGH Guntur, from April 2023 to March 2025. Patient’s ≥14 years with irreducibility, obstruction, strangulation, or inflamed hernias were included. All underwent structured clinical evaluation, laboratory investigations, radiological imaging, and emergency surgical exploration. Data on hernia type, intraoperative findings, procedures performed, postoperative complications, ICU need, and mortality were analyzed using chi-square tests. Results: The mean age was 44.58 years, with male predominance (82%). Indirect inguinal hernias were the most common (50%), followed by direct (38%) and femoral hernias (12%). Common procedures included hernioplasty (42%), herniorrhaphy (32%), and bowel resection (26%). Intraoperatively, 46% had viable congested bowel, while 26% had gangrene. Postoperatively, 66% recovered uneventfully; complications included wound infection (14%) and seroma (14%). Mortality was 16%, and ICU admission was required in 54%. Significant associations were found between female gender and mortality (p=0.0189), femoral hernia and ICU admission (p<0.0001), bowel resection and mortality (p<0.0001), and gangrenous bowel with postoperative complications (p<0.0001). Conclusion: Acute groin hernias are associated with substantial morbidity and mortality, particularly in females, femoral hernias, and cases requiring bowel resection. Early recognition, timely surgical intervention, and close postoperative monitoring are crucial to improving outcomes.

Background: Peripheral neuropathy is a common neurological disorder associated with chronic pain, sensory disturbances, and functional impairment. Persistent neurological symptoms often contribute to psychological distress and somatisation, which may adversely affect disease perception, treatment response, and quality of life. However, limited studies have evaluated the prevalence and clinical correlates of somatisation among patients with peripheral neuropathy. Objectives: To determine the prevalence of somatisation among patients diagnosed with peripheral neuropathy and to evaluate its associated clinical and psychological correlates. Materials and Methods: This hospital-based observational cross-sectional study was conducted at Sri Ramakrishna Institute of Medical Sciences over a period of one year. A total of 90 patients diagnosed with peripheral neuropathy were included in the study. Detailed demographic, clinical, and psychological assessments were performed using structured evaluation methods. Statistical analysis was carried out using IBM SPSS Statistics and GraphPad Prism. A p-value of <0.05 was considered statistically significant. Results: The majority of patients belonged to the 51–60 years age group (35.6%), with male predominance (62.2%). Moderate somatisation was observed in 44.4% of patients, while severe somatisation was present in 24.4% cases. Significant associations were observed between somatisation and age (p=0.028), duration of illness (p=0.017), neuropathic pain severity (p=0.003), and psychological symptoms including anxiety and depression (p=0.021). Conclusion: Somatisation is highly prevalent among patients with peripheral neuropathy and is significantly associated with chronic pain and psychological distress. Early recognition and multidisciplinary management may improve patient outcomes and quality of life.

Background: Portal and mesenteric venous thrombosis (PMVT) may occur as postoperative complications and can lead to multiple vascular complications and end in mortality. Hence, potent oral factor Xa inhibitors provide an effective and safer alternative to classic anticoagulants. Method: Out of 90 (ninety) adult patients undergoing abdominal major abdominal surgery surgeries, 45 patients were given 10 mg rivaroxaban orally for 7 days postoperatively and Enoxoparin40 mg injected daily starting 2 hours after the surgery until the day of discharge. The postsurgical complications were compared in both groups. Results: Clinical manifestations or associated co-morbidities and post-surgical complications were compared, and the p value (p>0.001) was insignificant. Conclusion: Although comparative parameters in both were insignificant, rivaroxaban was quite effective and safe in preventing deep venous thromboembolism (DVTE). Hence, rovaroxaban is an ideal oral Xa inhibitor and alternative to classic anticoagulants.

Background: Chronic rhinosinusitis (CRS) is highly heterogeneous chronic inflammation of the upper respiratory tract caused by immune dysfunction. Hence, the status of vitamin D is studied in CRS patients because vitamin D directly regulates a variety of cells, including monocytes, macrophages, epithelial cells, dendritic cells, and T-cells. Method: Out of 90 (ninety) adult patients, 45 were CRS and the remaining 45 were the controlled (normal) group. Fasting venous blood (5 ml) was collected from all participants in the early morning to study vit. D levels and serum was separated by centrifugation at 3000 rpm for 10 minutes and stored at 80°C until analysis of serum 25 (OH) D concentration was measured using chemiluminescent immunoassay (CLIA). Calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels were also studied. Results: Comparison of biochemical parameters between both groups had significant p values (p<0.001). Distribution of vitamin D status in both groups was also a highly significant correlation between serum vitamin D levels and disease severity in CRS, which had a significant p value (p<0.001). Analysis of CRS with and without nasal poly parameters had a significant p value (p<0.001). Conclusion: Serum vitamin levels are significantly reduced in patients with CRS. These findings suggest the role of vit. D deficiency in the spectrum of CRS.

Background: Prolonged endotracheal intubation can cause laryngeal and tracheal mucosal injury, functional airway morbidity, and persistent post-extubation sequelae. This study evaluated the nature, frequency, and associated factors of laryngotracheal sequelae following prolonged endotracheal intubation. Methods: This prospective observational study was conducted in all intensive care units and the Department of Otorhinolaryngology at CMR Institute of Medical Sciences, Hyderabad, Telangana, India, from Feb 2025 to Jan 2026. The study included 46 patients who underwent endotracheal intubation for ventilatory support for more than 72 hours. Patients were evaluated by videolaryngoscopy and lateral neck radiography after extubation, with follow-up assessment at one month and three months. Variables included age, sex, tube size, cuff pressure, duration of intubation, indication and nature of intubation, post-extubation symptoms, laryngotracheal findings, co-morbidities, and follow-up outcomes. Results: The mean age was 39.08 years, with an observed age range of 16–65 years. There were 34 males (73.9%) and 12 females (26.0%). Laryngotracheal sequelae were observed in 35 of 46 patients (76.08%), while 11 patients (23.9%) had no sequelae. Congestion was the most frequent finding, occurring in 20 patients (43.4%), followed by vocal cord paresis, ulcerations, and edema in three patients each (6.5% each). Intubation granuloma and arytenoid subluxation were observed in two patients each (4.3% each), while vocal cord palsy and tracheal stenosis were observed in one patient each (2.1% each). Tube size, cuff pressure, duration of intubation, and emergency intubation were significantly associated with intubation sequelae, with p-values of 0.0027, 0.001, 0.001, and 0.003, respectively. At three months, persistent sequelae remained in six patients. Conclusion: Laryngotracheal sequelae were frequent after prolonged endotracheal intubation. Most mucosal congestion, edema, and paresis improved during follow-up, whereas vocal cord palsy, arytenoid subluxation, and tracheal stenosis persisted at three months. Larger tube size, higher cuff pressure, longer duration of intubation, and emergency intubation were significantly associated with post-intubation sequelae.

Background: Iron deficiency anemia is the most common and correctable cause of anemia in the postnatal period. It has significant long-term implications for maternal and infant health. Despite various government programs, anemia remains a major contributor to maternal morbidity and mortality in India. Objective: To compare the efficacy, side effects, and compliance of five different oral iron preparations in postnatal women with moderate anemia. Methods: This prospective comparative study was conducted at UISE Maternity Hospital, GSVM Medical College, Kanpur, on 250 postnatal women with moderate anemia (Hb 7–10 g/dl) as per ICMR criteria. Participants were randomly divided into five groups (n=50 each) and administered ferrous sulphate sustained release (Group 1), ferrous fumarate (Group 2), ferrous ascorbate (Group 3), colloidal iron (Group 4), and ferric ammonium citrate suspension (Group 5). Hemoglobin, MCV, MCH, MCHC, reticulocyte count, and serum ferritin were measured at baseline, Day 30, and Day 90. Adverse effects and compliance were also recorded. Results: All five preparations produced a significant rise in hemoglobin and serum ferritin levels (p <0.001). Ferrous ascorbate showed the maximum rise in hemoglobin at Day 30 (2.75±0.57 g/dl) and Day 90 (3.41±0.83 g/dl), and the greatest increase in serum ferritin (39.32±11.74 ng/dl). Ferric ammonium citrate showed the minimum rise. Side effects were least frequent with ferric ammonium citrate and most frequent with ferrous sulphate and ferrous fumarate. Conclusion: Ferrous ascorbate demonstrated superior efficacy in improving hematological parameters in postnatal women with moderate anemia, with acceptable tolerability. Postnatal women represent an important target population for anemia correction, and early initiation of supplementation after delivery is recommended.

Background: Cystic hygroma represents a benign, congenital anomaly of the lymphatic vasculature. When these lesions develop in the cervical region of newborns, they create substantial anesthetic challenges due to potential difficulties with mask ventilation, tracheal intubation, and postoperative airway compromise. Case presentation: A 3.5 kg neonate presented on the first postnatal day with a substantial anterior neck swelling measuring 6×10 cm, subsequently diagnosed as cystic hygroma. The infant exhibited no preoperative respiratory distress. A systematic difficult airway protocol was activated. Inhalational induction using sevoflurane was performed while preserving spontaneous breathing. Mask ventilation was confirmed to be effective. Direct laryngoscopy with a Miller 0 blade revealed a Cormack-Lehane Grade II view, enabling successful first-attempt tracheal intubation using a 3.5 mm endotracheal tube. Complete surgical resection proceeded without complications. The neonate received elective mechanical ventilation for 24 hours due to anticipated airway edema and was successfully extubated on postoperative day two. Discussion: Three fundamental principles contributed to successful management: (1) preserving spontaneous ventilation until airway securement, (2) assembling a difficult airway cart with emergency surgical access equipment, and (3) adopting a conservative extubation approach when edema risk factors exist. Preoperative imaging, surgical standby for potential tracheostomy, and postoperative corticosteroid administration are essential components. Conclusion: A massive neonatal cystic hygroma constitutes an anticipated difficult airway even without preoperative respiratory symptoms. A multidisciplinary approach combined with a cautious extubation strategy is crucial for achieving favorable outcomes.

Background: Smartphone addiction is an emerging behavioural concern among medical students and may adversely affect sleep quality and academic functioning. Objective: To determine the prevalence of mobile phone addiction and its association with sleep quality among undergraduate medical students. Methods: A cross-sectional study was conducted among 284 undergraduate medical students at Government Medical College, Srikakulam. Data were collected using a socio-demographic questionnaire, Smartphone Addiction Scale–Short Version (SAS-SV), and Pittsburgh Sleep Quality Index (PSQI). Spearman correlation and regression analysis were used to assess associations. Results: The mean age was 19.84 ± 1.04 years. The prevalence of smartphone addiction was 33.8%. Significant positive correlations were observed between addiction and PSQI score (ρ = 0.335, p < 0.001), self-rated sleep quality (ρ = 0.341, p < 0.001), and sleep disturbances (ρ = 0.216, p < 0.001), while sleep duration showed a negative correlation (ρ = −0.182, p = 0.002). Sleep latency was not significant. Regression analysis confirmed smartphone addiction as an independent predictor of poor sleep quality (β = 1.220, p < 0.001). Conclusion: Smartphone addiction is significantly associated with poor sleep quality among medical students, highlighting the need for targeted interventions.

Background and Aims: Shivering is a common complication in patients undergoing spinal anaesthesia for caesarean sections, with an incidence of 40–60%. It increases oxygen demand, hemodynamic stress, and postoperative discomfort. While 5-HT₃antagonists like ondansetron are known for antiemetic effects, recent studies suggest they may also reduce shivering. This study aimed to compare the efficacy of intravenous palonosetron (0.075 mg) versus ondansetron (8 mg) in preventing shivering during caesarean sections under subarachnoid block. The primary objective was to determine which drug offers superior shivering prevention with minimal side effects. Materials and Methods: A randomized, double-blinded study was conducted on 130 ASA I/II parturients undergoing elective caesarean sections under spinal anaesthesia. Participants were divided into two groups: Group A received ondansetron (8 mg IV), and Group B received palonosetron (0.075 mg IV) 10 minutes post-spinal block. Shivering incidence and intensity (graded 0–4using the Tsai & Chu scale), hemodynamic parameters, and neonatal APGAR scores were recorded. Rescue tramadol (25 mg IV) was administered for grade ≥2 shivering. Statistical analysis included chi-square and t-tests. Results: Palonosetron was significantly more effective, with 9.2% of patients experiencing shivering compared to 26.2% in the ondansetron group (p = 0.022). Grade 3 shivering occurred in 1.5% (palonosetron) vs. 7.7% (ondansetron). Only 4.6% of palonosetron patients required tramadol versus 20% in the ondansetron group (p = 0.016). Both drugs maintained hemodynamic stability and had no adverse effects on neonatal APGAR scores. Conclusion: Palonosetron (0.075 mg IV) is more effective than ondansetron (8 mg IV) in preventing perioperative shivering, with lower incidence, reduced severity, and fewer rescue interventions. The study supports palonosetron as a safer, more effective alternative for shivering prophylaxis in caesarean sections under spinal anaesthesia, without compromising maternal or neonatal outcomes.

Background: Preterm birth is a significant cause of neonatal illness and death worldwide. Cervical cerclage is a recognized treatment for women with risk factors for cervical insufficiency. It can be based on a woman’s obstetric history or ultrasound results. Objective: This study aims to compare the effectiveness and safety of history-indicated and ultrasound-indicated cervical cerclage in preventing preterm birth. Methods: We conducted a prospective comparative study involving 50 pregnant women at risk of preterm birth who had cervical cerclage at a tertiary care center. The patients were divided into two equal groups: history-indicated cerclage (n=25) and ultrasound-indicated cerclage (n=25). We evaluated and compared maternal outcomes, obstetric outcomes, neonatal outcomes, and complications related to the procedure. Results: Most patients in both groups delivered at term, with 18 in the history-indicated group and 20 in the ultrasound-indicated group delivering at or after 37 weeks of gestation. Preterm birth happened in 7 patients from Group A and 5 from Group B. Maternal complications, such as PPROM, cervical infection, and early labor pains, were low in both groups. We observed one minor cervical tear in the history-indicated group during labor after removing the cerclage. Neonatal outcomes were positive in both groups, with low rates of NICU admissions and no cases of neonatal death. Conclusion: Both history-indicated and ultrasound-indicated cervical cerclage were effective in prolonging pregnancy and improving neonatal outcomes in high-risk women with cervical insufficiency. Most patients achieved delivery at or beyond 37 weeks with low and manageable maternal complications. The ultrasound-indicated cerclage group showed slightly better outcomes, including fewer preterm deliveries, fewer maternal complications, and no second trimester pregnancy loss. Overall, ultrasound-guided surveillance with timely cerclage placement may provide additional benefit in selected high-risk pregnancies.

Background: Sleep quality is a core health parameter and modulates metabolic and endocrine functions which may lead to obesity. Objectives: To assess the prevalence of poor sleep quality and determine its association with obesity and related behavioral health risk factors in undergraduate medical students. Materials and Methods: 82 undergraduate medical students (18-25 years) were assessed for sleep quality using the Pittsburgh sleep quality index (PSQI) questionnaire and were grouped into GQS (PSQI score≥5) and PQS (PSQI score>5). Anthropometric measurements, physical activity, and fruit and vegetable intake were recorded using standard WHO methods. Body composition was assessed using bioelectrical impedance analysis by BODYSTAT quad scan 4000. Binge eating was measured by the Three Factor Eating Questionnaire R-18 (TFEQR-18). The prevalence of poor sleep quality was reported in percentage with 95% Confidence interval (C.I.) The association between various parameters was assessed by ANOVA and chi-square test. A two-sided p-value of <0.05 was taken as statistically significant. Results: The prevalence of poor sleep quality among 82 study participants (mean age= 19.2±1.12 years, comprising 54 (67%) females and 28 (33%) males) was 67% (55) (PQS group). The mean BMI, WC, WHR, TBW, ICW, ECW, EE score, decreased physical activity, and decreased fruit/vegetable intake was significantly higher in PQS group. Conclusion: Poor sleep quality is positively associated with central obesity, water retention, inadequate physical activity, inadequate fruit, and vegetable intake, and increased emotional eating. Thus, maintenance of sleep hygiene and active dietary and lifestyle changes can lead to larger health benefits for undergraduate medical students.

Background: The clinical autopsy is a common term used to help in the identification of person’s clinical conditions and causes of deaths, however, the autopsy plays a vital role in the justice and jurisprudence. Objective: To determine the knowledge, beliefs and understanding of medical students regarding the autopsy Study Design: Descriptive, cross-sectional study. Place and Duration of Study: Dhanalakshmi Srinivasan Medical College and Hospital; 01/06/25-31/08/25. Methodology: 350 students from first year to CRMI were recruited based on random sampling method. Results: Among 350 students, 100% (n=350) correctly identified determining cause and manner of death as the primary purpose of forensic autopsy. 94% (n=332) knew death due to known chronic illness under hospital care is not an indication, while 4% (n=10) selected death in police custody and 2% (n=8) selected sudden unexpected death. 97.4% (n=341) recognized court order/police requisition as the authorizing document. Knowledge of BNSS 2023 was high: 71% (n=250) identified BNSS as the authority for medico-legal autopsy, 85% (n=296) knew Section 194 governs police inquest, and 88% (n=308) knew Section 196 covers magistrate-ordered exhumation. 89% (n=309) had witnessed ≥1 autopsy; of these, 36% (n=127) attended 1–2, 53% (n=184) attended 3–5, and 1% (n=1) attended >5. Major knowledge sources were textbooks 44% (n=154), practical demonstration 35% (n=124), and lectures 20% (n=71). Regarding benefits, 52% (n=183) cited gaining knowledge about forensic pathology and 46% (n=162) cited understanding legal aspects of medicine. Attitudes were positive: 92.3% (n=323) agreed/ strongly agreed autopsies are essential for justice; 90.9% (n=316) agreed/strongly agreed exposure enhances clinical diagnostic skills. Cultural/religious discomfort was low: 47% (n=165) strongly disagreed and 25% (n=87) somewhat disagreed that observing autopsies is uncomfortable. On post-mortem exposure, 40% (n=140) were neutral, 23% (n=82) somewhat comfortable, and 11% (n=40) very comfortable. Only 22.6% (n=79) strongly agreed MBBS training is adequate, while 47% (n=165) somewhat agreed. Misconceptions existed: 57% (n=199) incorrectly stated histopathology is not part of standard forensic autopsy. 95% (n=331) were aware of virtual autopsy. Key learning outcomes reported were understanding cause and manner of death 60% (n=211) and correlating clinical diagnosis with autopsy findings 33% (n=114). 86% (n=302) felt this research improves medical education, patient care, and forensic autopsy guidelines. Conclusion: The autopsies and experiences regarding the autopsies was integral part of medical curriculum. The studies of autopsies are helpful to understand the human anatomy and reasons of deaths. The student’s perceptions supported the medical autopsies as important part of curriculum and teaching particular anatomy of human subjects.

Introduction: Depression and anxiety disorders are common psychiatric conditions requiring long-term pharmacological treatment. Prescription pattern analysis helps assess rational drug use, while WHO ATC classification and PDD/DDD comparison provide a standard method for evaluating drug utilization. The present study was conducted to assess the prescribing pattern of antidepressants and anxiolytics in patients with depression and anxiety disorders. Methods: This prospective observational study was conducted in the Psychiatry Outpatient Department of Shree Krishna Hospital, Karamsad, Gujarat, India, from July 2024 to October 2025. A total of 100 patients diagnosed with depression and/or anxiety disorder were included. Demographic details, clinical diagnosis, and prescription data were collected from hospital records. Prescribed antidepressants and anxiolytics were classified according to the WHO Anatomical Therapeutic Chemical classification system. The prescribed daily dose was compared with the WHO-defined daily dose, and the PDD/DDD ratio was calculated. Results: Out of 100 participants, 50% had depression, 48% had anxiety disorder, and 2% had both conditions. The mean age was 44.75 ± 15.26 years, and females constituted 55% of participants. Among anxiety patients, clonazepam was the most commonly prescribed drug (53%), followed by escitalopram (38%), etizolam (23%), and sertraline (20%). Among depression patients, escitalopram was most frequently prescribed (47.1%), followed by fluoxetine (26.9%), mirtazapine (15.4%), and clonazepam (37.5%) as a co-prescribed anxiolytic. PDD/DDD analysis showed that SSRIs were generally prescribed near standard DDD values, while benzodiazepines, TCAs, and antipsychotic adjuncts were mostly prescribed below DDD values. Conclusion: SSRIs were the mainstay of treatment, with cautious use of benzodiazepines and adjunctive psychotropic drugs. WHO ATC and PDD/DDD analysis supported largely rational prescribing practices.

Background: Endotracheal tube (ETT) cuff pressure rises during nitrous oxide (N2O) anaesthesia because N2O diffuses into the air-filled cuff, risking tracheal mucosal ischaemia. Lidocaine jelly is routinely used to lubricate ETTs, yet its capacity to delay cuff pressure increase has not been established. Objective of this study is to determine whether ETT cuff lubrication with 2% lidocaine jelly prolongs the time taken for cuff pressure to rise from 18 mmHg to 25 mmHg during N2O general anaesthesia, and to compare the incidence of post-operative sore throat, cough, and hoarseness of voice between lidocaine-lubricated and unlubricated groups. Methods: A prospective randomised controlled trial was conducted at tertiary care teaching hospital. Ninety ASA PS I–II patients aged 18–70 years undergoing elective surgery under general anaesthesia with N2O were randomised into Group L (ETT cuff lubricated with 2.5 mL of 2% lidocaine jelly, n = 45) and Group C (unlubricated ETT cuff, n = 45). ETT cuff pressure was set to 18 mmHg post-intubation; time to reach 25 mmHg was recorded. Post-operative sore throat, cough, and hoarseness were assessed at 1, 6, and 24 hours on validated four-point scales. Results: Mean time for cuff pressure to rise from 18 mmHg to 25 mmHg was 42.5 ± 3.1 minutes in Group L versus 25.0 ± 2.2 minutes in Group C (t = 30.608; p < 0.001). Demographic parameters and duration of anaesthesia were comparable between groups. There was no statistically significant difference in the incidence of sore throat, cough, or hoarseness of voice at any post-operative time point. Conclusion: Lidocaine jelly lubrication of the ETT cuff significantly delays the rise in cuff pressure during N2O anaesthesia, providing approximately 17.5 additional minutes before pressure adjustment is required. Intra-operative cuff pressure monitoring remains essential to minimise tracheal morbidity.

Background: Lower limb orthopedic surgeries demand anesthetic techniques that provide reliable intraoperative conditions, hemodynamic stability, and effective postoperative analgesia. Unilateral spinal anesthesia (ULSA) and ultrasound-guided combined sciatic–femoral nerve block (SFNB) are two established regional techniques for this purpose, yet direct comparative data—particularly in the Indian setting—remain limited. Methods: A prospective, randomized comparative study was conducted over 15 months (October 2024–December 2025) at the Department of Anaesthesiology, Pacific Institute of Medical Sciences, Udaipur. Seventy patients aged 18–65 years, ASA physical status I–III, scheduled for elective unilateral lower limb orthopedic surgery were randomized into Group A (ULSA, n=35) and Group B (ultrasound-guided SFNB, n=35). Group A received intrathecal 15 mg of 0.75% hyperbaric ropivacaine; Group B received ultrasound-guided femoral nerve block (20 ml of 0.5% ropivacaine) and sciatic nerve block (20 ml of 0.5% ropivacaine). Hemodynamic parameters, block characteristics, Numeric Rating Scale (NRS) pain scores, time to first rescue analgesia, 24-hour analgesic consumption, patient satisfaction, and adverse effects were recorded and compared. Results: Both groups were demographically comparable at baseline (p>0.05). ULSA provided significantly faster onset of sensory block (7.29±1.72 vs 17.74±1.62 min; p<0.01) and motor block (8.94±2.14 vs 22.63±1.75 min; p<0.01). SFNB provided significantly longer sensory block duration (313.63±65.79 vs 181.37±15.70 min; p<0.01) and motor block duration (283.63±65.79 vs 137.94±9.03 min; p<0.01). Transient but significant intraoperative hypotension occurred in Group A at 20–30 minutes (DBP: 54.54±5.00 vs 69.63±4.97 mmHg; p<0.01). Time to first rescue analgesia was significantly prolonged in Group B (513.63±65.79 vs 210.29±18.20 min; p<0.01). NRS scores were significantly higher in Group A from 4 hours onward (p<0.01). Urinary retention was more frequent in Group A (5 vs 1 patient); minor hematoma occurred exclusively in Group B (4 patients). Conclusion: Ultrasound-guided SFNB provides superior hemodynamic stability and significantly prolonged postoperative analgesia compared to ULSA, while ULSA offers faster onset of blockade. SFNB is particularly advantageous in patients with cardiovascular risk or where sustained postoperative analgesia is a clinical priority.

Background: Detection & reporting of adverse drug reactions (ADRs) is an important source of information about drug safety. Patients are most important stakeholders in pharmacovigilance.  Many previous studies have explored the awareness of pharmacovigilance among healthcare professionals but very few similar studies have been done on patients so far. Methodology: This is a questionnaire based cross-sectional study comprising of 8 pretested & prevalidated questions. The study was conducted in Out-patient Department of Medical College, Kolkata among 200 voluntarily participated patients who were above the age of 18 years.  A printed copy of the questionnaire was provided & their responses were recorded. Then they were informed regarding ADR reporting by showing flash cards & other tools. After that, their responses against the same questionnaire were recollected and descriptive statistics were used to analyze the data. Results: Among our study participants, 44% never reported an ADR to anyone. However, 80% participants said that they can report an ADR only to the doctors. Only 55% of the respondents believed that all ADR reporting must be mandatory whereas only 56% considered reporting in future. After showing flash cards, all (100%) of them agreed, that all ADRs should be reported, can be reported via different modes and ensured to report all ADRs in future in order to improve patient’s safety. Conclusions: Lack of motivation & knowledge regarding ADR reporting among participants is a major concern. Such initiatives will increase awareness among patients and will improve reporting of ADRs in future among them.

Aim: In the literature there are different contradictory findings on clinical efficacy of isobaric levobupivacaine in spinal anaesthesia. Our aim was to compare the effectiveness of isobaric levo-bupivacaine to commonly used hyperbaric bupivacaine in achieving sensory and motor blocks in lower limb orthopaedic surgeries under spinal anaesthesia. Methods: Eighty patients posted for lower limb orthopaedic surgeries were randomly divided into two groups receiving equivalent doses of hyperbaric bupivacaine (Group B) and isobaric levo-bupivacaine(Group L) for spinal anaesthesia. Time taken to achieve sensory and motor blocks, as well as the time for block regression for two segments for sensory block and the return of motor block was assessed. Results: There was no significant difference regarding onset and duration of sensory block among the two groups. Onset of motor block was earlier and duration of motor block was prolonged in in Group B compared to group L which was statistically significant. Conclusion: Levo-bupivacaine is comparable to bupivacaine in achieving adequate anaesthesia when administered intrathecally in lower limb orthopaedic surgeries.

Aim: The primary aim of this study is to find out the factors that influence the engraftment of haematopoietic stem cells during transplantation in various haematological disorders. Methods: The study was conducted by collecting the data retrospectively in 14 patients who had undergone PBSCT at Department of Haematology, Tertiary Care Hospital, and Chennai from April-2022 to February- 2024 for a period of 2 years. The speed of engraftment is measured by defined threshold of circulating neutrophils (polymorphonuclear cells or PMNs) PMNs >500/μL or platelets >20,000/μL, for three consecutive days after HSC transplantation. Results: In the present study on factors influencing peripheral blood stem cell transplantation in 14 patients with hematological disorder, the speed of engraftment was assessed by the first appearance and persistence of neutrophils of >500cells/μL and platelets of >20,000/μL respectively, without transfusion for three consecutive days. The range observed was between 10 and 21 days for neutrophil engraftment. The range observed for platelet engraftment was between 14 and 30. Conclusion: Autologous PBSCT showed faster PBSC graft engraftment than allogenic PBSCT. Among various hematological malignancies multiple myeloma patients showed relatively rapid PBSC graft engraftment with autologous PBSC as a source. Since early engraftment reduces length of hospital stay, morbidity, mortality and cost of this highly expensive treatment, it is imperative to utilize all available options to enhance the speed of engrafment.

Background: Fine needle aspiration cytology (FNAC) is a rapid, reliable, and inexpensive method for evaluating intra-abdominal tumours. Correlation with radiological findings enhances diagnostic accuracy. Aims: To assess the cytological-radiological correlation of image-guided FNAC in intra-abdominal mass lesions and to evaluate its diagnostic efficacy with reference to age and sex distribution. Materials and Methods: A prospective study was conducted between June 2022 and June 2024 on 95 intra-abdominal masses. Ultrasound (USG) or computed tomography (CT)-guided FNAC was performed in patients presenting with abdominal pain or lump. Radiological diagnoses were compared with cytological findings. Results and Conclusions: The liver was the most commonly involved organ, followed by the gall bladder. Neoplastic lesions predominated (93.69%), with malignant tumours (92.63%) far outnumbering benign ones (1.05%). Non-neoplastic lesions accounted for 6.31%. Correlation between radiological and cytological diagnosis was observed in 83 cases, while 12 were discordant. FNAC showed a sensitivity of 94.32% and a positive predictive value of 92.22%. The Kappa coefficient (0.092) indicated slight agreement between cytological and radiological diagnoses. Image-guided FNAC is a rapid, safe, and highly sensitive diagnostic procedure for intra-abdominal mass lesions. Although radiological correlation showed only slight agreement, FNAC remains a valuable tool for early and accurate diagnosis, guiding timely clinical management.

Background Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus and a leading cause of preventable blindness among working-age adults. The increasing prevalence of T2DM (Type 2 Diabetes Mellitus) in India has resulted in a growing burden of diabetic retinopathy. Early detection and timely intervention are essential to prevent vision-threatening complications and blindness. Methods A cross-sectional study was conducted in the Department of Ophthalmology, Regional Eye Hospital, Kurnool, from August 2022 to July 2024. A total of 200 patients with type 2 diabetes mellitus were screened for diabetic retinopathy. Detailed ocular examination, including visual acuity assessment, slit-lamp biomicroscopy, fundus examination, fundus photography, and optical coherence tomography when required, was performed. Systemic evaluation included FBS (Fasting Blood Sugar), PPBS (Postprandial Blood Sugar), and glycated hemoglobin (HbA1c) estimation. Data were analyzed using descriptive statistics and chi-square test. Results Among 200 patients studied, diabetic retinopathy was present in 60 of them, giving a prevalence of 30%. The prevalence of DR increased significantly with advancing age and duration of diabetes (p<0.001). Patients aged ≥71 years showed the highest prevalence (63%). DR was observed in 70.8% of patients whose diabetes duration was greater than 15 years. Glycemic control demonstrated a strong association with DR; 93% of patients with HbA1c ≥8.1% had retinopathy (p<0.0001). Gender was not significantly associated with the occurrence of DR (p=0.686). Conclusion: The prevalence of diabetic retinopathy among patients with type 2 diabetes mellitus in this study was 30%. Increasing age, longer duration of diabetes, and poor glycemic control were significant risk factors for the development of diabetic retinopathy. Regular retinal screening and optimal glycemic control are essential for early detection and prevention of vision-threatening diabetic retinopathy.

Background: Total knee arthroplasty (TKA) is an established surgical procedure for the management of advanced knee osteoarthritis. Accurate alignment of prosthetic components is considered essential for achieving optimal functional outcomes and implant longevity. However, the relationship between radiological alignment and postoperative functional recovery remains a subject of ongoing debate. Aim: To radiologically assess component alignment in various planes following total knee arthroplasty and evaluate its relationship with functional outcomes using the Knee Society Score. Materials and Methods: This prospective observational study included 150 patients undergoing primary total knee arthroplasty. Postoperative radiological evaluation was performed using standardized weight-bearing anteroposterior, lateral, skyline, and full-length standing hip-knee-ankle radiographs. Alignment parameters including hip-knee-ankle angle, coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, posterior tibial slope, and patellar tilt angle were measured. Functional outcomes were assessed using the Knee Society Score. Statistical analysis was performed using SPSS version 26.0, and a p-value <0.05 was considered statistically significant. Results: The mean postoperative hip-knee-ankle angle was 179.2±2.4°. A total of 112 patients (74.7%) achieved alignment within ±3° of the neutral mechanical axis. Patients with optimal alignment demonstrated significantly higher Knee Society Scores (91.8±5.4) compared with patients having alignment deviations greater than 3° (84.6±7.2) (p<0.001). Significant positive correlations were observed between hip-knee-ankle angle and Knee Society Score (r=0.621, p<0.001), coronal femoral component angle and Knee Society Score (r=0.384, p<0.001), and coronal tibial component angle and Knee Society Score (r=0.351, p<0.001). Posterior tibial slope showed no statistically significant association with functional outcome (p=0.151). Conclusion: Accurate restoration of mechanical alignment and proper component positioning are significantly associated with improved functional outcomes following total knee arthroplasty. Coronal alignment parameters demonstrated stronger correlations with Knee Society Scores than sagittal alignment parameters, emphasizing the importance of precise radiological alignment in achieving successful postoperative outcomes.

Rheumatoid arthritis is most common autoimmune inflammatory joint disease of unknown etiology. Long-term methotrexate use in rheumatoid arthritis (RA) is highly effective at slowing joint damage and inducing remission. A long-term prospective observational, controlled, and non-comparative study was conducted on 310 patients with rheumatoid arthritis fulfilling the American College of Rheumatology (ACR) criteria to observe the long-term efficacy and toxicity of low-dose methotrexate (MTX) over a period of 36 months to 48 months. Steroids, and NSAIDs were tapered gradually in all patients over a period of 8 weeks. Clinical improvement occurred at 6–8 weeks in 210 patients (68%), while remission was achieved in the remaining 100 patients (32%) over the period of 12 weeks. Mild toxicity was observed in 2.5% of patients and was amenable to folic acid therapy. A small number of patients developed transient bone marrow depression and transient elevation of liver enzymes, neither of which necessitated withdrawal of the drug. Conclusion: The study concludes that methotrexate remains the primary and most effective disease-modifying anti-rheumatic drug (DMARD) for the management of rheumatoid arthritis.

Background: Autism spectrum disorder (ASD) is increasingly recognised worldwide, yet data on ASD and its correlates among children of Indian military personnel remain limited.pubmed.ncbi.nlm.nih+1. Objectives: To screen children of serving military personnel for ASD and to examine associations with screen time and frequent parental transfers. Methods: A cross‑sectional study was conducted at a military base in Jamnagar, Gujarat, among 137 dependent children aged 1–12 years. Universal sampling was used. Children under 3 years were screened with the Modified Checklist for Autism in Toddlers, and those aged 3 years and above with the Indian Scale for Assessment of Autism. Sociodemographic variables, mobility history and average daily screen exposure were recorded. Data were summarised using descriptive statistics, and chi‑square tests assessed associations between ASD and selected risk factors. Results: Four children (2.9%) screened positive for ASD (one mild, two moderate, one severe). Longer screen time was significantly associated with higher autism grading (χ² = 16.18, df = 3, p = 0.001). Frequent parental transfers were also strongly associated with ASD; 27.3% of children with frequent transfers screened positive versus 0.8% without (χ² = 16.56, df = 1, p < 0.001). Conclusions: Children of military personnel in this setting showed a slightly elevated proportion of ASD, with significant associations with high screen exposure and frequent transfers. Structured ASD screening and targeted counselling within military child health services are warranted.

Background: Oral, breast, and cervical cancers are among the most common cancers worldwide and constitute a major public health burden, particularly in low- and middle-income countries. Despite advances in diagnosis and treatment, a substantial proportion of cases continue to be diagnosed at advanced stages, resulting in increased morbidity, mortality, and healthcare costs. Screening, early detection, and preventive interventions have emerged as effective strategies for reducing the burden of these cancers and improving survival outcomes. Objective: To review the current evidence regarding the epidemiology, risk factors, screening modalities, early detection strategies, preventive interventions, barriers to screening uptake, and future directions in the control of oral, breast, and cervical cancers. Methodology: A narrative review of the literature was conducted using electronic databases including PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Cochrane Library, and publications from the World Health Organization (WHO), International Agency for Research on Cancer (IARC), and Indian Council of Medical Research (ICMR). A total of 428 records were identified, of which 72 articles and guideline documents were finally included after screening and eligibility assessment. Relevant information was synthesized under major themes including epidemiology, risk factors, screening, early detection, prevention, barriers, and future perspectives. Results: Among the 72 included studies, breast cancer-related literature constituted 38.9%, while oral and cervical cancer studies each accounted for 30.6%. Screening and early detection represented the most commonly studied domain (27.8%). Approximately 87.5% of studies reported significant benefits of screening programs in improving early diagnosis and treatment outcomes. Lack of awareness was identified as the most frequently reported barrier to screening uptake, being cited in 83.3% of studies. Community-based screening programs, HPV vaccination, mammography, visual oral examination, Pap smear, HPV DNA testing, and visual inspection with acetic acid were consistently reported as effective tools for reducing disease burden and improving survival. Conclusion: Oral, breast, and cervical cancers continue to pose substantial public health challenges. Evidence from the reviewed literature demonstrates that effective screening, early detection, public awareness initiatives, and preventive interventions can significantly reduce cancer-related morbidity and mortality. Strengthening population-based screening programs, expanding HPV vaccination coverage, and integrating cancer prevention services into primary healthcare systems are essential for improving cancer control and achieving better health outcomes.

Background: Intertrochanteric fractures are a frequent form of hip fracture, especially in the elderly group of the population, and are characterized by high morbidity and mortality. Surgery treatment is necessary so that premature mobilization and the minimization of complications can be achieved. Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) are some of the most popular methods of fixations, but the effectiveness of these techniques is still a controversial issue. Methods: This retrospective observational study, which was done in Narayan Medical College and Hospital, Sasaram, between January 2025 to July 2025. The total of 68 were included and was split into two categories PFN (n=34) and DHS (n=34). Operative parameters, functional outcome by means of the Harris Hip Score, complications and mortality rates were analyzed in the data. Results: The average surgical time in PFN group (65.3 ± 10.4 minutes) was much less than in DHS group (78.6 ± 12.1 minutes). The PFN group (145 ± 30 ml) versus the DHS group (210 ± 45 ml) also differed with regards to intraoperative blood loss. The average Harris Hip Score in PFN group (85.6 ± 6.8) was more than that of DHS (78.9 ± 7.5). Complication rates were lower in the PFN group, with infection observed in 5.9% versus 11.8% in the DHS group, and 2.9% versus 8.8%, being the incidence of implant failure respectively. The PFN group had a mortality rate of 5.9% and DHS had 11.8%. Conclusion: PFN has shown better results in relation to operative parameters, functional recovery, and complication rates than DHS, and it is a better alternative especially in unstable intertrochanteric fracture.

Background: Childhood obesity is a relatively new health issue in India, and the prevalence of this condition is increasing in the urban and semi-urban populations. The high rates of urbanization, altered eating habits, and lack of exercise have greatly added to this escalating epidemic, rising the threat of developing long-term health complications in children. Methods: This is a cross-sectional study in a hospital setting that involved 220 children aged between 5 to 15 years in Nalanda Medical College and Hospital (NMCH) between March 2025-November 2025. The data was gathered on a structured questionnaire including dietary habits, physical activity, screen time, and family history. Anthropometric data were taken, Body Mass Index (BMI) was determined and categorized according to the standard criteria. The statistical analysis was conducted to identify the relationships between obesity and a number of risk factors. Result: Obesity was reported to be prevalent 23.6 % in the population of the study. There were strong correlations between obesity and junk food intake, high consumption of sugar-sweetened drinks, low physical activity, and high screen time. The middle- and high-income children and children with a good family history of obesity were also at risk. Conclusion: Childhood obesity is a serious and increasing health issue, and it is largely caused by lifestyle factors which are modifiable. Early diagnosis and specific measures aimed at changing nutrition and physical activity are necessary to avoid the adverse effects on health in the long term.

Background: Intertrochanteric fractures are a common orthopaedic condition, particularly in the elderly. Advancements in 3D CT imaging offer a more comprehensive understanding of fracture patterns compared to traditional radiographic classification, improving preoperative decision-making and outcomes. Objectives: To study the intertrochanteric fracture pattern using the three-dimensional CT-based Singh classification; and to evaluate the functional and radiological outcomes of the hip. Methods: This was a single-centre, hospital-based prospective observational study conducted in Aarupadai Veedu Medical College and Hospital, Puducherry between July 2023 and December 2024 among patients with trochanteric fractures, medically fit for surgery. Results: The study involved 60 patients with a mean age of 69.1 years (SD = 6.3), of whom 80.0% were male. The predominant mechanism of injury was slipping (81.7%), followed by high falls (11.7%) and other causes (6.7%). Common comorbidities included hypertension (41.7%), diabetes mellitus (28.3%), stroke (21.7%), and other conditions (25.0%). Preoperative CT evaluation revealed a heterogeneous distribution of intertrochanteric fracture types, with type Ib being the most frequent (23.3%), followed by IIb (20.0%), and both Ia and IIIa (15.0% each). The mean Harris Hip Score (HHS) significantly improved over time, rising from 72.2 (SD = 3.3) at 6 weeks to 83.6 (SD = 3.6) at 12 weeks and 91.6 (SD = 2.2) at 24 weeks (p < 0.001). Similarly, the mean Radiographic Union Score for Hip (RUSH) increased from 14.6 (SD = 1.3) at 6 weeks to 18.5 (SD = 1.1) at 24 weeks, with the difference being statistically significant (p < 0.001). Conclusion: Findings suggest that preoperative CT imaging leads to improved surgical planning and outcomes, including faster recovery and better functional and radiological results.

Background: Acute kidney injury requiring dialysis (AKI-D) is the most severe spectrum of renal dysfunction and is associated with high morbidity and mortality. Prediction of renal recovery is a clinical challenge, especially in resource limited settings. Aim: To assess predictors of dialysis-free renal recovery at 90 days among patients with AKI-D. Methods: It was a prospective observational study in 100 patients of AKI-D admitted in a tertiary care centre in Eastern India. Baseline parameters including proteinuria, serum creatinine and eGFR were analysed. Statistical analysis: Logistic regression and ROC curve. Results: The mean age was 50.07±16.77 years. The most common co-morbidities were sepsis (70%), hypertension (58%) and diabetes (51%). Proteinuria ≥ 2+ was present in 22% of patients and was significantly correlated with poor recovery. Baseline creatinine and estimated glomerular filtration rate at admission were strong predictors of renal outcome. Conclusion: Pre-admission proteinuria, baseline creatinine and eGFR are important predictors of renal recovery. Early risk stratification can aid in improving management and outcomes in AKI-D patients.

Background: Hypertension is an emerging public health problem worldwide. It can be initiated in childhood but usually go undetected. To identify its presence in earlier in life may contributes its easily management. And by identifying the factors associated with this hypertension it can be diagnosed earlier by targeting at risk groups. Objectives: To find out prevalence of hypertension among school going children in the age group 10-19 years. And to find out its association with their body mass index (BMI) personal habits and study pattern. Material and Methods: A cross –sectional study was done among 1008 school adolescents in Jaipur city. Information regarding socio-demographic data and diet & study pattern was collected through pre- designed semi structured questionnaire. Anthropometric measurements was done to calculate BMI. Blood pressure was taken by standard technique. Chi-square test was used find out association with qualitative variable and Unpaired ‘t’ test for quantitative variables. Results: Mean age of study participants was 14.26 ± 2.22 years with M:F 1.24. Prevalence of hypertension was found 15.87%. Hypertension was found maximum among obese students (64.62%) and least among underweight students (8.32%). It was found almost equal in vegetarian and non-vegetarian students but more hypertensive in students having habit of taking extra salt in their diet than who do not (16% v/s 15.81%). Hypertension was found more in students who had no physical activity (17.10% v/s 14.97%). Occurrence of hypertension was higher in students of science subject (25.00%). Occurrence of hypertension was high in those students taking coaching 2-3 years (100%) and it was found more in students taking personal coaching. Prevalence of hypertension was higher in those students studied 2-4 hours at home (18.47%) than their counterparts. On further analysis hypertension found associated with weight and years of coaching of students (p<0.05). Conclusion: The overall prevalence of hypertension among adolescent was found to be 15.87%. It was found to be associated with weight and years of coaching of students. So screening for adolescent hypertension should be more targeted towards these risk groups.

Background: Effective postoperative pain control facilitates recovery and improves patient satisfaction. Intravenous paracetamol and diclofenac are commonly used non-opioid analgesics; however, their relative efficacy in postoperative pain management remains a subject of interest. This study compared the analgesic efficacy and safety of intravenous paracetamol and intravenous diclofenac in patients undergoing elective surgery. Material and Methods: A prospective, randomized, double-blind comparative study was conducted among 120 adult patients undergoing elective surgery under general anaesthesia. Participants were allocated into two groups of 60 each. Group P received intravenous paracetamol 1 g, while Group D received intravenous diclofenac 75 mg. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at predefined intervals. Time to first rescue analgesic requirement, total rescue analgesic consumption, adverse effects, and patient satisfaction were also evaluated. Results: Baseline demographic characteristics, ASA physical status, and duration of surgery were comparable between the groups. Postoperative VAS scores were significantly lower in the diclofenac group at 2, 4, 6, 12, and 24 hours after surgery (p<0.05). The mean time to first rescue analgesic requirement was significantly longer in Group D than in Group P (6.2 ± 1.5 vs. 4.7 ± 1.3 hours; p<0.001). Total 24-hour rescue analgesic consumption was significantly lower with diclofenac (81.7 ± 31.5 mg vs. 112.5 ± 36.8 mg; p<0.001). The incidence of adverse effects was comparable between the groups. Excellent patient satisfaction was reported more frequently in the diclofenac group (40.0% vs. 25.0%; p=0.048). Conclusion: Intravenous diclofenac provided superior postoperative analgesia, delayed rescue analgesic requirement, reduced analgesic consumption, and improved patient satisfaction compared with intravenous paracetamol, with a comparable safety profile.

Background: Abnormal uterine bleeding (AUB) in women who are in peri-menopausal and postmenopausal age is a common clinical problem with a possible link to premalignant and malignant endometrial pathology. Trans-vaginal sonography (TVS) provides a non-invasive way to determine endometrial thickness (ET) and to direct the necessity of histopathological evaluation. Objectives: To test for this correlation between endometrial thickness measured by trans-vaginal sonography and histopathological findings in women with abnormal peri-menopausal and postmenopausal bleeding. Methods: This was a prospective observational study of 120 women age >40 years presenting with abnormal uterine bleeding. All participants underwent trans-vaginal sonography (measurement of endometrial thickness), followed by endometrial sampling (histopathological examination). The link of endometrial thickness to a significant histopathological finding was statistically analyzed. Results: The most common presenting complaint was menstruation disorders (40%). The majority of the women (43.3%) had an endometrial thickness of 8-10 mm. No instances of endometrial hyperplasia and carcinoma were observed if endometrial thickness was <10 mm. The significant endometrial pathology was found only in those women with endometrial thickness ≥10 mm including endometrial hyperplasia (40%) and carcinoma (3.4%). The correlation between the increased endometrial thickness and abnormal histopathology was statistically significant (p <0.001). Conclusion: Trans-vaginal sonography is a good investigation of first line in peri-menopausal and postmenopausal women with the abnormal uterine bleeding. An endometrial thickness of ≥10 mm has significant correlation with significant histopathological abnormalities and selective endometrial sampling using sonographic findings can minimize the incidence of unnecessary invasive procedures while assuring early detection of serious pathology.

Background: Cesarean section rates are increasing worldwide, leading to growing concern regarding long-term uterine scar integrity and associated complications. Incomplete healing of the uterine incision may result in reduced residual myometrial thickness and formation of an isthmocele, which have been linked to abnormal uterine bleeding and adverse outcomes in subsequent pregnancies. The optimal uterine closure technique at cesarean section remains a subject of debate. Objectives To compare the effect of single-layer and double-layer uterine closure at cesarean section on residual myometrial thickness and the incidence of isthmocele. Methods: This prospective observational study was conducted in a tertiary care hospital and included 150 women undergoing lower segment cesarean section. Participants were divided into two groups based on the uterine closure technique: single-layer closure (n = 75) and double-layer closure (n = 75). Postoperative assessment was performed using transvaginal ultrasonography at approximately six weeks. Residual myometrial thickness was measured in millimeters, and the presence of isthmocele was recorded. Data were analyzed using appropriate statistical tests, with p < 0.05 considered statistically significant. Results: Baseline demographic and obstetric characteristics were comparable between the two groups. The mean residual myometrial thickness was significantly greater in the double-layer closure group compared to the single-layer group (4.2 ± 0.9 mm vs 3.4 ± 0.8 mm; p < 0.001). Isthmocele was observed in 32.0% of women in the single-layer group and 25.3% in the double-layer group; however, this difference was not statistically significant (p = 0.36). Women with isthmocele demonstrated significantly lower residual myometrial thickness irrespective of closure technique (p < 0.001). Conclusion: Double-layer uterine closure at cesarean section is associated with significantly greater residual myometrial thickness, suggesting improved uterine scar healing. However, the incidence of isthmocele does not differ significantly between closure techniques, indicating a multifactorial etiology. Further long-term studies are required to assess the impact of these findings on future pregnancy outcomes.

Background: Immunization remains one of the most effective public health interventions for preventing vaccine-preventable diseases in children. Despite improvements in vaccination services, disparities in immunization coverage persist among children living in urban slums. This study assessed immunization coverage and its determinants among under-five children residing in urban slum areas. Material and Methods: A community-based cross-sectional study was conducted among 400 children aged 12–60 months residing in selected urban slums. Data were collected using a pretested structured questionnaire and immunization records. Immunization status was assessed according to the national immunization schedule. Associations between immunization status and explanatory variables were analyzed using the Chi-square test and multivariable logistic regression. Results: The mean age of participants was 35.8 ± 14.2 months, and 54.5% were males. Among 120 children aged 12–24 months eligible for evaluation of complete immunization status, 71.7% were fully immunized, 23.3% were partially immunized, and 5.0% were unimmunized. Vaccine coverage was highest for BCG (96.7%) and lowest for Measles-Rubella vaccine (76.7%). Maternal education (AOR=3.48; 95% CI: 1.42–8.53; p=0.006), institutional delivery (AOR=3.12; 95% CI: 1.01–9.61; p=0.048), birth order ≤2 (AOR=2.65; 95% CI: 1.10–6.37; p=0.029), and availability of an immunization card (AOR=4.21; 95% CI: 1.67–10.63; p=0.002) were significant predictors of complete immunization. Lack of awareness regarding the vaccination schedule (44.1%) was the most common reason for incomplete immunization. Conclusion: Although immunization coverage in urban slums was moderately high, gaps in complete vaccination persist. Improving maternal awareness, promoting institutional deliveries, strengthening caregiver counseling, and ensuring maintenance of immunization records may enhance vaccine uptake and improve coverage among vulnerable populations.

Background: The Hysterectomy procedure is the most frequently performed gynecological surgery in the world. The minimally invasive approach to hysterectomy has been associated with improved outcomes when compared to the abdominal approach, including decreased morbidity, shorter hospital stay, and quicker return to normal activities. Present study was conducted to evaluate the efficacy of barbed unidirectional suture compared to polyglactin 910 in total laparoscopic hysterectomy. Material and Methods: Present study was single-center, prospective, comparative study conducted in female patients attending gynaecology OPD for complaints of uterine leiomyomas, adenomyosis, abnormal uterine bleeding, chronic pelvic inflammatory disease, endometriosis Not responding to medical management and willing for surgery were considered for this study. Results The mean age, mean BMI & indication for surgery were comparable in both groups & no statistically significant difference was noted. In present study, no difference when two groups were compared statistically with respect to previous surgeries & preoperative morbidity. The mean time for surgery & mean time taken for Vaginal cuff closure in was more in group A compared to Group B with significant difference. (p<0.05) The mean haemoglobin deficit, time taken for post operative mobility, time taken for First voiding of urine & duration of hospital stay were comparable in both groups & no statistically significant difference was noted. There was no difference when two groups were compared statistically with respect to post operative complaints (Fever, Ileus, Abdominal Pain, Spotting, Discharge P/V, Urinary Complaints & Low Back Ache) during follow up. (p>0.05). There were no post operative complications among both the groups. Conclusion: The present study concludes that the unidirectional barbed suture significantly reduces vaginal cuff closure time along with total operative time.

Objectives: The central clinical laboratory is the heart of the institute. It has a major impact on the medical decision-making process. A timely, reliable, and precise test report is the prime responsibility of the clinical laboratory. For this, the adoption of the best quality assurance program is required. Six Sigma is a valuable tool to measure and further improve such a program. Materials and Methods: Retrospective daily Internal Quality Control (IQC) data are taken for the 33 analytes running in the auto analyzer, Beckman Coulter DXC 700 AU, running in the department. Statistical calculations like Mean, SD and CV% are done. Bias is calculated from IQC data. Sigma(σ) values are calculated. Parameters that have σ<3 are evaluated, the Quality Goal Index (QGI) is calculated to determine the source of error (random or systemic). Root Cause Analysis (RCA) with a Fishbone diagram is done to find out various causative factors. Risk assessment of the parameters is done from the output of the health workers; accordingly, prioritizing the correction. Statistical analysis: Statistical calculations like Mean, SD and CV% are done. Bias is calculated from IQC data. Sigma(σ) values are calculated. Comparative analysis is done. Results: Twelve parameters in L1 and thirteen parameters in L2 have shown world-class performance with a σ > 6, whereas twelve parameters in L1 and eight parameters in L2 have shown σ < 3. The majority of the causes of low sigma values is imprecision, which could be due to personal variation or the methodology used for the analysis of the analyte. Conclusions: The motive of Six Sigma is to minimize variance and quality control processes with a guaranteed report correlating with the critical specifications. It also facilitates the inculcation of ideal analytical methodology and customization of the QC process.

Background: Anemia remains a major public health problem among adolescent girls in rural India, with multifactorial determinants including nutritional deficiencies, infections, and menstrual health issues. This study aimed to estimate the prevalence of anemia and identify its predictors among rural adolescent girls. Material and Methods: A community-based cross-sectional analytical study with pediatric follow-up was conducted among 400 adolescent girls aged 10–19 years in rural field practice areas. Participants were selected using multistage cluster sampling. Data were collected using a structured questionnaire, anthropometric measurements, and hemoglobin estimation using a portable hemoglobinometer. Anemia was classified as per WHO criteria. Associations were assessed using chi-square test, and multivariable logistic regression identified independent predictors. Results: The prevalence of anemia was 67.0% among participants, with 26.0% mild, 33.0% moderate, and 8.0% severe anemia. The mean hemoglobin level was 10.4 ± 1.6 g/dL. Significant associations were observed between anemia and age group (p = 0.033), socioeconomic status (p < 0.001), and school dropout status (p < 0.001). Dietary and clinical factors such as vegetarian diet (p = 0.001), inadequate iron intake (p < 0.001), worm infestation (p < 0.001), and menorrhagia (p < 0.001) were significantly associated with anemia. Independent predictors included low socioeconomic status (AOR 2.41), inadequate iron intake (AOR 3.12), worm infestation (AOR 2.08), menorrhagia (AOR 4.56), and school dropout (AOR 1.89). Conclusion: Anemia is highly prevalent among rural adolescent girls and is strongly associated with modifiable nutritional and reproductive health factors. Integrated adolescent health interventions focusing on diet, deworming, menstrual health, and education are essential to reduce anemia burden.

Background: Fistula in ano, a common and often debilitating condition, represents a significant burden in proctology.  It is characterized by an abnormal connection between the anal canal and the perianal skin, typically resulting from an anorectal abscess that fails to heal adequately. Objective: To examines the two prominent surgical approaches: Fistulectomy with Primary Sphincter Reconstruction (FPSR) and Core Out Fistulectomy with Sphincter Reconstruction. Methods: This Comparative Observational study was conducted at in the Department of Surgery among all patients with high complex trans-sphincteric anal fistula admitted to the tertiary care hospital and eligible for surgical treatment, who agreed to participate in the study. Result: Both FPSR and CORING were effective in treating fistula in ano, with no significant differences in recurrence rates, incontinence, or wound dehiscence between the two techniques. FPSR was associated with longer operative times (mean 45 ± 3.22 minutes), extended wound healing periods (mean 8.20 ± 0.96 weeks), and higher immediate postoperative pain (mean VAS score 4.5 ± 0.77) compared to CORING. However, both procedures showed low long-term complication rates, indicating their effectiveness and safety. Conclusion: Both FPSR and CORING are viable surgical options for managing high complex trans-sphincteric anal fistula, with similar efficacy in preventing recurrence and maintaining continence. FPSR, while associated with increased operative time and pain, did not significantly differ from CORING in terms of long-term outcomes.

Background: Day care surgeries require rapid recovery, early ambulation, minimal postoperative nausea and vomiting (PONV), and timely discharge. Total intravenous anesthesia (TIVA) has emerged as an alternative to inhalational anesthesia, potentially offering superior recovery characteristics. Aim: To compare postoperative recovery profiles between TIVA and inhalational anesthesia in patients undergoing day care surgical procedures. Methods: This prospective comparative study was conducted over one year and included 100 patients undergoing elective day care surgeries. Patients were allocated into two groups: Group T (TIVA using propofol infusion; n=50) and Group I (inhalational anesthesia using sevoflurane; n=50). Recovery time, PONV incidence, pain scores, discharge readiness, and patient satisfaction were assessed. Results: Mean recovery time was significantly shorter in Group T (11.8±3.2 min) compared with Group I (18.6±4.5 min; p<0.001). Incidence of PONV was significantly lower in Group T (8%) than Group I (26%; p=0.018). Time to discharge readiness was reduced in Group T (132.4±22.6 min) compared with Group I (171.2±28.4 min; p<0.001). Patient satisfaction scores were significantly higher in Group T (8.9±0.8) versus Group I (7.5±1.1; p<0.001). Conclusion: TIVA provides superior postoperative recovery, reduced PONV, earlier discharge, and higher patient satisfaction compared with inhalational anesthesia in day care surgeries.

Background: The COVID-19 pandemic has resulted in significant global mortality and morbidity and necessitated rapid vaccine development and deployment. With researchers’ efforts, the vaccines were manufactured, and the largest possible population was immunised. Due to widespread use, mild-to-moderate reactions have been observed and analysed in prior studies, but inadequate data on reporting rates and on awareness of reporting methods, particularly among individuals who experienced ADRs, highlighted a gap that the present study addressed. Objectives: To determine the ADR reporting rate and assess the behaviour of ADR affected vaccine recipients. To analyse the severity of reported adverse drug reactions. Materials and Methods: Following IEC approval, a cross-sectional design was conducted at a rural tertiary care hospital in the Chengalpattu district between November 2025 and January 2026, among second-year MBBS and BDS students. Data on adverse drug reactions were collected using validated questionnaires distributed via Google Forms to the study participants, and all ethical norms were followed to maintain data secrecy. Results: The data were analysed using descriptive statistics. A total of 151 students participated in the study, with the top 3 adverse reactions being fever, pain, and myalgia. More than 80% developed ADRs within the first 24 hours; 57 individuals experienced a reaction with the first dose, and 9.4% reported ADRs. Only 4 participants required hospitalisation, confirming that the reactions were mild to moderate in severity. Conclusion: The current study demonstrated that immunisations are predominantly safe. However, mild-to-moderate responses were relatively frequent. Underreporting of vaccine-related ADRs is a significant issue that requires targeted educational campaigns.

Introduction: Paraquat poisoning remains a significant cause of morbidity and mortality in developing countries, with no specific antidote and limited therapeutic options. The toxic effects of paraquat primarily result from oxidative stress, leading to multi-organ failure involving the lungs, liver, and kidneys. This study aimed to evaluate the clinical spectrum, management strategies, and predictors of outcome among patients with paraquat poisoning in a tertiary care hospital. Methodology: This prospective observational study was conducted over six months in the Department of Medicine at a tertiary care center in India. Fifty patients with confirmed paraquat ingestion were enrolled after applying inclusion and exclusion criteria. Demographic, clinical, and laboratory data were recorded at admission. All patients received supportive management, including immunosuppressive therapy with methylprednisolone and cyclophosphamide, along with antioxidants and organ-specific supportive care. Outcomes were assessed as survival or death. Data were analyzed using SPSS version 26.0, and statistical significance was determined with chi-square and t-tests. Results: The mean age of patients was 31 years, with a male predominance (68%). Most cases (90%) resulted from intentional ingestion, and 60% presented within six hours of exposure. The mortality rate was 46%. Renal impairment (91% vs 26%), hepatic dysfunction (74% vs 22%), pulmonary involvement (57% vs 18%), multi organ failure (61% vs 7%), and delayed hospital presentation (>6 h) were significantly associated with mortality (p < 0.05). Despite aggressive therapy, including immunosuppressive and supportive measures, outcomes remained poor in severe cases. Conclusion: Paraquat poisoning continues to have a high fatality rate due to irreversible multi-organ dysfunction. Early presentation, prompt supportive therapy, and intensive care are crucial for improving survival. Larger multicentric studies are warranted to develop standardized treatment and prognostic models.

Objectives: The present study was to evaluate the prevalence and type of refractory error in primary school aged children. Methods: A standard ophthalmic examination procedure was used for each study subject. Ophthalmic examination included assessment of visual acuity for distance with Snellen’s illiterate E chart at 6 meters in a well-illuminated room. Children detected with defective vision were referred for further examination. They were further evaluated employing subjective refraction with auto refractometer by Ophthalmologist.  Prevalence of visual impairment (visual acuity less than 6/18) was calculated for uncorrected visual acuity, and best measured visual acuity. Results: A total of 222 children were enrolled. Among them, 94(42.34%) children were males and 128(57.66%) children were females. Prevalence of RE was 25.22%.  Astigmatism was the commonest refractive errors in both right 27(12.16%) and left 25(19.38%) eye. While, myopia 14(10.85%) was the least frequent in both right eye 14(6.31%) and left eye 11(4.95%). All types of the refractive errors were relatively more common in females than males. It was statistically significant relation between the gender and refractive errors (p =0.008). Conclusions: Refractory error is preponderance in female children as compared to male children. RE is more common in children with age group 9-11 years. Astigmatism is the most common RE, while myopia is least frequent RE present in children.

Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life. Whether breast milk alone meets the fluid requirement of a newborn in a hot tropical climate is still debated, and prospective Indian data on neonatal renal biochemistry across seasons are scarce. Objectives: To assess the hydration status of exclusively breastfed term neonates exposed to three distinct ambient temperature ranges, and to estimate the incidence of acute renal failure (ARF) and pre-renal ARF in this cohort. Methods: A hospital-based prospective observational study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur, between November 2012 and June 2013. Sixty stable neonates of gestational age ≥ 36 weeks on exclusive breastfeeding were enrolled and stratified by season into three groups of 20: Group A (15 November – 15 December, 18-29 °C), Group B (15 February – 15 March, 25-38 °C) and Group C (15 May – 15 June, 33-42 °C). Clinical hydration assessment using WHO IMNCI criteria, complete haemogram, renal function tests, serum electrolytes, urine output and fractional excretion of sodium (FENa) were recorded. ARF was defined as serum creatinine > 0.8 mg/dL beyond 48 hours; pre-renal ARF as FENa < 2.5 % with BUN/creatinine > 20. Results: Baseline demographic variables were comparable across groups (p > 0.05). ARF developed in 8 (40 %), 11 (55 %) and 16 (80 %) neonates of Groups A, B and C, respectively (p = 0.024). Pre-renal ARF was identified in 6, 4 and 13 cases. Clinical dehydration was observed only in Group C (6/20, 30 %). The frequency of pre-renal ARF and dehydration rose with ambient temperature. Conclusion: Rising environmental temperature is associated with a significantly higher burden of dehydration and pre-renal acute renal failure in exclusively breastfed neonates. Supplementary fluid in the hottest months may be biologically reasonable, but larger multicentric data are needed before any change in guideline-level advice.

Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life. Whether breast milk alone meets the fluid requirement of a newborn in a hot tropical climate is still debated, and prospective Indian data on neonatal renal biochemistry across seasons are scarce. Objectives: To assess the hydration status of exclusively breastfed term neonates exposed to three distinct ambient temperature ranges, and to estimate the incidence of acute renal failure (ARF) and pre-renal ARF in this cohort. Methods: A hospital-based prospective observational study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur, between November 2012 and June 2013. Sixty stable neonates of gestational age ≥ 36 weeks on exclusive breastfeeding were enrolled and stratified by season into three groups of 20: Group A (15 November – 15 December, 18-29 °C), Group B (15 February – 15 March, 25-38 °C) and Group C (15 May – 15 June, 33-42 °C). Clinical hydration assessment using WHO IMNCI criteria, complete haemogram, renal function tests, serum electrolytes, urine output and fractional excretion of sodium (FENa) were recorded. ARF was defined as serum creatinine > 0.8 mg/dL beyond 48 hours; pre-renal ARF as FENa < 2.5 % with BUN/creatinine > 20. Results: Baseline demographic variables were comparable across groups (p > 0.05). ARF developed in 8 (40 %), 11 (55 %) and 16 (80 %) neonates of Groups A, B and C, respectively (p = 0.024). Pre-renal ARF was identified in 6, 4 and 13 cases. Clinical dehydration was observed only in Group C (6/20, 30 %). The frequency of pre-renal ARF and dehydration rose with ambient temperature. Conclusion: Rising environmental temperature is associated with a significantly higher burden of dehydration and pre-renal acute renal failure in exclusively breastfed neonates. Supplementary fluid in the hottest months may be biologically reasonable, but larger multicentric data are needed before any change in guideline-level advice.

Purpose: To study the clinical profile and to evaluate the ocular and systemic risk factors associated with secondary glaucoma. Method: The present observational study was conducted in the Department of Ophthalmology, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University, Dehradun over a period of 12 months. Seventy-two clinically diagnosed cases of secondary glaucoma aged ≥ 12 years with intraocular pressure in the affected eye ≥ 21 mm Hg were included and patients who were diagnosed with primary open angle glaucoma, primary angle closure glaucoma and corneal pathologies like scarring and opacity were excluded. Detailed history and ophthalmic examination including visual acuity, slit lamp examination, posterior segment examination, intraocular pressure and gonioscopy was done and the data was analyzed using appropriate statistical tests. Results: Twenty-two (30.5%) patients had glaucoma secondary to trauma followed by neovascular glaucoma (n=11, 15.27%). The geographical distribution of patients, accounted for 24 patients (33.30%) from hilly region and 48 patients (66.60%) from plains. Most common ocular risk factor for secondary glaucoma was ocular trauma (n=22, 31.88%) followed by uveitis (n=9, 13.04%). Most common systemic risk factor for secondary glaucoma was hypertension (n=17, 36.95%) followed by diabetes mellitus (n=16, 34.78%). Cataract surgery (n=11, 36.66%) was found to be the most common surgical risk factor for patients to develop secondary glaucoma. Conclusion: Traumatic glaucoma was the most common type of secondary glaucoma followed by neovascular glaucoma. Hypertension and diabetes mellitus were the major systemic risk factors associated with secondary glaucoma.

Background: Elderly patients undergoing orthopaedic surgeries frequently have multiple comorbidities requiring polypharmacy, increasing the risk of adverse drug events. Potentially inappropriate medications (PIMs) further exacerbate these risks. However, limited data exist regarding their impact on surgical outcomes in this population. Methods: This retrospective observational study included 169 patients aged ≥60 years undergoing orthopaedic surgeries at a tertiary care center. Data on demographics, comorbidities, medication use, and outcomes were collected. Polypharmacy and PIMs were assessed using standard definitions and the Beers Criteria. Associations with postoperative complications were analyzed using appropriate statistical tests and multivariate regression. Results: Polypharmacy was observed in 83.4% of patients, with 29.0% experiencing hyperpoly pharmacy. PIMs were identified in 42.6% of patients. Increasing medication burden was significantly associated with higher rates of delirium (p=0.004), gastrointestinal complications (p=0.021), renal dysfunction (p=0.018), ICU admissions (p=0.031), and prolonged hospital stay (p<0.001). PIM use was also significantly associated with adverse outcomes including delirium (p=0.002) and gastrointestinal complications (p=0.001). Multivariate analysis identified hyperpoly pharmacy (AOR: 2.84, p=0.004) and PIM use (AOR: 2.47, p=0.006) as independent predictors. Conclusion: Polypharmacy and PIM use are highly prevalent and significantly impact postoperative outcomes in elderly orthopaedic patients. Rational prescribing and systematic medication review are essential to improve patient safety and clinical outcomes.

Background: The facial nerve exhibits considerable anatomical variability within the parotid gland, posing challenges during parotid and maxillofacial surgeries. Detailed knowledge of its branching patterns is essential to reduce the risk of inadvertent nerve injury and associated functional deficits. Material and Methods: A descriptive cross-sectional cadaveric study was conducted on 60 hemifaces obtained from 30 embalmed adult cadavers. The facial nerve was identified at its exit from the stylomastoid foramen and traced through the parotid gland. Branching patterns were classified according to the Davis classification. The length of the main facial nerve trunk, patterns of division, interbranch communications, terminal branch variations, and side-wise differences were recorded and analyzed. Results: Type II Davis branching pattern was the most common, observed in 15 (25.0%) specimens, followed by Type III in 12 (20.0%) and Type V in 11 (18.3%). The mean length of the facial nerve trunk before bifurcation was 16.8 ± 4.2 mm. Classical bifurcation into temporofacial and cervicofacial divisions was present in 49 (81.7%) specimens, while trifurcation and multiple primary divisions were observed in 8 (13.3%) and 3 (5.0%) specimens, respectively. Communicating branches between major divisions were identified in 46 (76.7%) specimens. The typical five-terminal-branch pattern was noted in 38 (63.3%) specimens, whereas accessory buccal branches represented the most frequent variation, occurring in 12 (20.0%) specimens. No statistically significant side-wise differences were observed (p > 0.05). Conclusion: Significant variations exist in the intraparotid branching pattern of the facial nerve. Awareness of these anatomical variations is crucial for surgeons performing procedures in the parotid region to facilitate nerve preservation and minimize postoperative complications.

Background: Typhoid is the most common cause of ileal perforations in our hospital setting. The presentation and treatment of ileal perforations, particularly those caused by typhoid, nonspecific, and traumatic perforations, as well as the results in these patients and the variables influencing prognosis, are crucial. The management of ileal perforation was one of the study’s goals. to evaluate the results of two distinct approaches to treating ileal perforations: primary closure versus resection and ileostomy. Methods: From September 2025 to February 2026, the general surgery department of Govt. Medical College and Hospital in Bettiah, West Champaran, Bihar, conducted a randomized comparative observational study. The study examined 56 patients in total. The Widal test, X-ray erect abdomen, ultrasound abdomen, and intraoperative findings were used to make the diagnosis. Results: The age groups 41–50 years old (10 patients) and 61–70 years old (10 patients) were the most often impacted. The age group of 1–10 years old (2 cases) was the least affected. Males had a somewhat higher incidence than females. The ratio of men to women was 2.5:1. The most frequent type of ileal perforation is typhoid perforation, which is followed by non-specific perforation. The primary closure group had a higher rate of post-operative problems (32.14%, 18 patients) than the ileostomy group (17.85%, 10 patients). Four patients had wound infections, six had abdominal bursts, two had fecal fistulas, and six had respiratory issues as a result of primary closure. Wound infections (eight patients) and respiratory issues (two patients) were the ileostomy group’s problems. Conclusion: The primary closure group had a higher mortality rate of 21.42% (12 patients), while the ileostomy group had a lower mortality rate of 7.14% (4 patients). This study suggests that in individuals who are moribund, ileostomy may be prioritized above alternative surgical procedures.

Background: Both spontaneous and incisional hernias following an abdominal procedure are considered ventral hernias in the anterior abdominal wall. Mesh repair may be pre-peritoneal or onlay. The use of either type of meshplasty is controversial because of variations in the procedure’s ease of execution, duration, post-operative problems, and recurrence. Methods: The Department of Surgery at the Govt. Medical College and Hospital in Bettiah, West Champaran, Bihar, carried out a comparative observational study between August 2025 and January 2026 on 50 patients of ventral hernias who admitted different surgical units. Results: Of the fifty patients, twenty-five had onlay and twenty-five had preperiotneal mesh repair. Only eight of the twenty-five onlay instances required more than an hour to operate. Only four of the twenty-five preperitoneal mesh repair cases had hospital stays longer than five days, two had seromas, one had wound infections, and the majority had lower postoperative pain scores. Conclusion: Preperitoneal mesh repair is a rather decent option even if the time of surgery is somewhat longer than onlay mesh repair, according to an examination of the outcomes and five variables: duration of surgery, post-op pain, seroma, wound infection, and length of hospital stay.

Background: One significant and sometimes fatal consequence of peptic ulcer disease is still perforation. The traditional treatment for it has been surgery. Excellent surgical outcomes are related to morbidity and mortality. The purpose of this study is to analyze the findings and determine whether a non-operative treatment for perforated peptic ulcers is feasible. Methods: From May 2025 to October 2025, the Department of Surgery at the Govt. Medical College and Hospital in Bettiah, West Champaran, Bihar, conducted this prospective study. Fifty cases with a clinical diagnosis of perforated peptic ulcers were examined. Age between 20 and 70 years, a clinical diagnosis of perforation in less than 12 hours with a stable hemodynamic condition, and X-ray or CT evidence of a pneumoperitoneum were the requirements for inclusion. Intravenous fluids, nasogastric suction, intravenous antibiotics, and intravenous omeprezole were all part of the conservative treatment. Results: Of the 50 cases, 41 (82%) showed good responses; the other 9 cases did not improve and needed an emergency laparotomy. Of the 41 patients in the successful group, 11 experienced problems that were effectively treated and did not result in an extended hospital stay. The morbidity was not considerably increased by the cautious care. Conclusion: We conclude that, if stringent inclusion criteria and guidelines are adhered to, conservative treatment for perforated peptic ulcers can be successfully implemented in certain individuals.

Background: Complementary feeding refers to the process of introducing foods and liquids other than breast milk or infant formula into an infant’s diet at a point when milk alone is no longer able to meet all of the child’s growing nutritional needs. This introduction is meant to add to the nutrient and energy supply from breast milk, not to replace it, and typically begins when a child is developmentally ready to handle more than milk alone. Objective: This study assesses complementary feeding practices. Methods: This hospital-based prospective observational study, conducted at District Hospital Koppal, the study, which utilized a robust sample size calculated based on previous prevalence estimates, provides a detailed snapshot of the feeding landscape and the consequent nutritional burden in a vulnerable population from the Hyderabad-Karnataka region. Result: Timely initiation of complementary feeding was observed in only 51.2% of children. Exclusive breastfeeding till six months was practiced by 59.7%. Minimum dietary diversity was adequate in 38.8%, and only 9.0% received a minimum acceptable diet. Conclusion: Complementary feeding practices were suboptimal, particularly dietary diversity and minimum acceptable diet. Low birth weight, preterm gestation, older child age, and lower maternal education emerged as significant background risk factors.

Background: Avascular necrosis (AVN) of the femoral head is a progressive orthopedic disorder resulting from disruption of blood supply to the femoral head, leading to bone necrosis, femoral head collapse, secondary osteoarthritis, severe pain, and functional disability. Total hip arthroplasty (THA) is considered the gold standard treatment for advanced stages of the disease, providing pain relief and restoration of hip function. Aim: To evaluate the functional outcome of total hip arthroplasty in patients with avascular necrosis of the femoral head. Methods: A prospective observational study was conducted in the Department of Orthopaedics at a tertiary care teaching hospital in Jaipur, Rajasthan. A total of 30 patients with advanced avascular necrosis of the femoral head who underwent total hip arthroplasty were included in the study. Demographic characteristics, clinical findings, operative details, functional outcomes, and postoperative complications were evaluated. Functional assessment was performed using the Modified Harris Hip Score (MHHS), while pain severity was assessed using the Visual Analog Scale (VAS). Statistical analysis was performed using appropriate tests, and a p-value of less than 0.05 was considered statistically significant. Results: The majority of patients belonged to the 31–50 years age group, and males constituted 73.3% of the study population. The mean Modified Harris Hip Score improved significantly from 48.3 ± 8.4 preoperatively to 86.7 ± 7.5 postoperatively (p < 0.001). Similarly, the mean Visual Analog Scale score decreased from 7.8 ± 1.2 preoperatively to 2.1 ± 0.9 postoperatively (p < 0.001). Hip flexion improved from 68.5° ± 14.3° to 108.4° ± 11.6° following surgery. Excellent functional outcomes were observed in 40.0% of patients, while 40.0% achieved good outcomes. Overall, 80.0% of patients demonstrated good-to-excellent functional recovery. Postoperative complications were minimal, with 90.0% of patients experiencing no complications. Conclusion: Total hip arthroplasty is a safe and effective treatment for advanced avascular necrosis of the femoral head. It provides significant pain relief, substantial improvement in hip function and mobility, and excellent overall functional outcomes with a low complication rate. The procedure remains the treatment of choice for patients with advanced-stage disease and offers a significant improvement in quality of life.