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.