Background: Thyroid nodules are commonly encountered in clinical practice and require accurate diagnostic evaluation to differentiate benign lesions from malignancies. Ultrasonography using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), along with fine-needle aspiration cytology (FNAC) interpreted by the Bethesda system, plays an important role in preoperative risk stratification. Aim: This study aimed to evaluate the association between radiological findings and cytopathological diagnosis of thyroid nodules in patients attending a tertiary care center in Uttar Pradesh. Materials and Methods: A retrospective and prospective cross-sectional study was conducted in the Departments of Pathology and Radiology at VIMS, Gajraula, from January 2023 to September 2024. Patients presenting with palpable or incidental thyroid nodules underwent high-resolution ultrasonography followed by ultrasound-guided FNAC. Thyroid nodules were categorized according to ACR TI-RADS, and cytological findings were reported using the Bethesda system. The diagnostic accuracy, specificity, and positive predictive value of FNAC and TI-RADS were assessed and compared with histopathological findings wherever available. Results: A total of 127 patients were included, with a mean age of 43.2 ± 11.4 years and female predominance. The mean thyroid nodule size was 2.14 ± 1.2 cm. FNAC findings showed that 80.0% of lesions were non-cancerous, while 20.0% were cancerous. Papillary carcinoma was reported in 13.0% of cases, follicular neoplasm in 7.4%, AUS/FLUS in 5.6%, and suspicious follicular neoplasm in 3.7%. Most nodules belonged to benign or probably benign TI-RADS categories, while suspicious and moderately suspicious lesions constituted a smaller proportion. FNAC demonstrated an accuracy of 90.74% and a positive predictive value of 81.82%. Specificity for benign lesions was 95.24% for FNAC and 93.33% for TI-RADS, whereas specificity for malignant lesions was 93.02% and 95.45%, respectively. Conclusion: The combined use of ultrasonographic TI-RADS scoring and FNAC improves diagnostic precision in the evaluation of thyroid nodules. This dual-modality approach is useful for identifying malignant lesions, reducing unnecessary surgical interventions, and improving preoperative management in tertiary care settings. Further studies with larger cohorts and long-term follow-up are recommended to validate these findings.

Background: Acute respiratory infections are one of the most frequent causes of pediatric outpatient visits, and are a significant contributor to antibiotic consumption. There are many infections that are viral and self-limiting, and inappropriate antibiotic prescribing is a preventable contributor to antimicrobial resistance. Antibiotics are the most commonly used drugs in children with ARI, and their use is guided by evidence-based clinical guidelines. Objective: To evaluate antibiotic prescribing practices and adherence to clinical guidelines in pediatric outpatients with ARI. Methods: The study was a cross-sectional, observational study of 420 prescriptions for children aged 1 month to 12 years who were seen in a pediatric outpatient department. A structured proforma was used to record diagnosis, clinical features, investigations, antibiotic use, drug class, dose, duration and appropriateness. Results: In 238/420 encounters (56.7%) an antibiotic was prescribed. The most frequent diagnoses were acute upper respiratory tract infection/common cold (33.8%), acute pharyngitis/tonsillitis (21.4%), acute otitis media (13.6%), bronchitis/bronchiolitis (12.6%), pneumonia (10.7%) and acute sinusitis (7.9%). In total, 152 of the antibiotic prescriptions (63.9%) were guideline-concordant and 86 (36.1%) were inappropriate. The most common inappropriate prescriptions were for common cold/viral upper respiratory infection (72.7%) and bronchitis/bronchiolitis (66.7%). Amoxicillin-clavulanate was the most commonly used antibiotic (39.1%), followed by azithromycin (24.4%) and amoxicillin (18.5%). Documentation of diagnosis, fever, respiratory rate and danger signs was complete in 61.2% of encounters, and was associated with lower inappropriate prescribing (27.4% vs 49.2%, p=0.001). Conclusions: The use of antibiotics for pediatric acute respiratory infections was widespread and over one-third of the prescriptions were inappropriate. Diagnosis-based stewardship, documentation and following pediatric outpatient guidelines are required.

Background: Iron deficiency anemia is the most prevalent nutritional anemia in children and can affect growth, immunity, cognition and development. Where iron studies are not available, hematological indices may be useful in determining the severity and for early diagnosis. Methods: This cross sectional study involved 210 children aged 6 months to 12 years who were diagnosed with IDA by hemoglobin, red cell indices, peripheral smear, serum ferritin and transferrin saturation. Children who had hemoglobinopathies, chronic kidney disease, acute infection, recent transfusion, or hematinic therapy were excluded. The hematological parameters were compared between the mild, moderate and severe anemia groups. Results: Mean age was 4.8 +/- 3.1 years; 116 children (55.2%) were male. The most common anemia was moderate (46.7%), followed by mild (31.9%) and severe (21.4%). Mean hemoglobin was 10.4 +/- 0.5 g/dL in mild, 8.3 +/- 0.8 g/dL in moderate, and 6.4 +/- 0.7 g/dL in severe anemia (p<0.001). As the severity increased, MCV, MCH, ferritin and transferrin saturation decreased, whereas RDW and platelet count increased. Hemoglobin correlated positively with ferritin (r=0.52, p<0.001) and MCV (r=0.61, p<0.001), and negatively with RDW (r=-0.58, p<0.001). Conclusion: Routine haematological parameters are significantly related to the severity of paediatric IDA and can be used as an aid to early grading and treatment decisions.

Background: Exclusive breastfeeding is recommended for optimal growth, but information on longitudinal anthropometric changes throughout the first year of life is limited in the local context. Objective: To evaluate the relationship between exclusive breastfeeding for 6 months and growth parameters in the first year of life. Methods: 180 term singleton infants were recruited and followed from birth to 3, 6, 9 and 12 months. Infants who were only breastfed for six months were compared with infants who were mixed or formula fed prior to six months. Weight, length, head circumference and WHO z-scores were measured. Results: 180 infants, 112 (62.2%) were exclusively breastfed for six months and 68 (37.8%) were non-exclusively breastfed. Baseline birth weight was comparable between groups (2.94 ± 0.36 kg vs 2.91 ± 0.34 kg, p=0.59). At 12 months, mean weight was slightly lower in the exclusive breastfeeding group (9.28 ± 0.86 kg vs 9.61 ± 0.91 kg, p=0.018), while length (74.9 ± 2.7 cm vs 74.3 ± 2.8 cm, p=0.15) and head circumference (45.9 ± 1.3 cm vs 45.6 ± 1.4 cm, p=0.12) were similar. There was no increased risk of undernutrition, but at 12 months, weight-for-length z-score was lower among exclusively breastfed infants (0.18 ± 0.79 vs 0.49 ± 0.84, p=0.014). Fewer episodes of respiratory illness (0.72 ± 0.84 vs 1.18 ± 1.02, p=0.002) were associated with exclusive breastfeeding. Conclusion: Adequate linear and head growth was observed during exclusive breastfeeding, and the weight gain was relatively leaner with relatively lower morbidity.

Background: Nocturnal enuresis is a common paediatric condition that may persist beyond early childhood and affect emotional wellbeing, sleep, family functioning, and school participation. Rural school data are important for estimating community burden and identifying modifiable associated factors. Methods: A school-based cross-sectional study was conducted among 416 children aged 6–12 years attending five rural primary schools in Mathura district from March 2024 to September 2025. Data were collected using a pre-tested structured parent questionnaire. Nocturnal enuresis was defined as bedwetting during sleep occurring at least twice per week for at least three months. Variables included demographic characteristics, wet-night frequency, daytime urinary symptoms, bedtime, and evening fluid intake, ease of arousal, snoring, family history, and recent stress. Data were analysed using frequency distributions, percentages, mean ± standard deviation, median with interquartile range, and appropriate statistical tests. Results: The overall prevalence of nocturnal enuresis was 18.8% (78/416). Wet-night frequency among enuretic children ranged from 2 to 7 nights/week, with a mean of 3.56 ± 1.46 and median of 3.0 (IQR: 2–4). Primary enuresis was present in 64 children (82.1%), while secondary enuresis was present in 14 children (17.9%). Monosymptomatic nocturnal enuresis accounted for 48 cases (61.5%), and non-monosymptomatic nocturnal enuresis accounted for 30 cases (38.5%). Nocturnal enuresis was significantly associated with maternal education, daytime urgency, daytime frequency, daytime wetting, later bedtime, evening fluid intake after 6 pm, type of evening drink, and difficulty in arousal from sleep. Parental night waking was common among affected children and reflected a family management practice. Age group, sex, number of siblings, birth order, snoring, family history of bedwetting, and recent stress were not statistically significant. Conclusion: Nocturnal enuresis affected nearly one-fifth of rural school children aged 6–12 years. The condition was mainly primary and monosymptomatic, although a substantial subgroup had daytime urinary symptoms. Later bedtime, evening fluid intake, difficulty in arousal, and daytime urinary symptoms were important associated factors, supporting the need for early identification and structured, non-stigmatizing counselling.

Background: Laparoscopic cholecystectomy is now a procedure of choice for cholelithiasis and chronic cholecystitis. Laparoscopic procedures are being done under general anaesthesia with muscle relaxants and controlled ventilation. Postoperative nausea and vomiting (PONV) is a common and a distressing complication after surgery. PONV may be mild or transient, but its impact on patients can be much more severe, it can cause inability to mobilize after surgery, restricted oral intake, complications of protracted vomiting and delayed recovery and discharge after surgery. Methods: Sixty patients, of either sex, ASA physical status I or II, undergoing elective laparoscopic cholecystectomy, were randomly allocated into two groups containing thirty patients each. Group A received intravenous inj. Amisulpride 5 mg i.v. over 1-2 minutes before induction of anaesthesia. Group O received intravenous inj. Ondansetron 4 mg i.v. over 1-2 minutes before induction of anaesthesia. Results: In Group A, total 4 patients had nausea and/or vomiting, while other 26 patients were asymptomatic, while in Group O, total 13 patients had nausea and/or vomiting, while 17 other patients were asymptomatic. Conclusion: Amisulpride can be considered as a safe and a promising alternate option for PONV in place of Ondansetron.

Background: Neostigmine, the conventional agent for neuromuscular blockade reversal, acts indirectly by inhibiting acetylcholinesterase and is associated with unpredictable recovery times and muscarinic side effects. Sugammadex, a modified γ-cyclodextrin, reverses steroidal neuromuscular blocking agents by direct encapsulation, offering the potential for rapid and predictable reversal. While prior studies demonstrated its efficacy in deep blockade, evidence comparing both agents in moderate blockade under inhalational anaesthesia was limited.  Methods: One hundred twenty patients, of either sex, ASA physical status I or II, undergoing elective Laparoscopic cholecystectomy under general anaesthesia, were randomly allocated into two groups containing sixty patients each. Group A received Sugammadex for Reversal of muscle relaxant and Group B received Neostigmine/Glycopyrrolate for Reversal of Muscle Relaxant. Results: Sugammadex achieved TOF ≥ 0.9 significantly faster than Neostigmine (89 second versus 399 second, P < 0.0001). 98% of patients receiving Sugammadex recovered within 2 minutes showing greater predictability, while with neostigmine some patients required more than 7 minutes to recover. Conclusion: Sugammadex provides markedly faster, more predictable, and reliable reversal of moderate rocuronium-induced neuromuscular blockade compared with neostigmine during sevoflurane anaesthesia, with a comparable safety profile.

Background and Aims: Emergency laparotomy carries a significantly higher risk of morbidity and mortality compared to elective gastrointestinal surgery. Preoperative risk stratification is essential for identifying high-risk patients and guiding perioperative management. This study aimed to determine and compare the accuracy of the Portsmouth-POSSUM (P-POSSUM) score and the National Emergency Laparotomy Audit (NELA) score in predicting 30-day and 60-day postoperative mortality in patients undergoing emergency laparotomy at a tertiary care centre in Eastern India. Methods: This retrospective cohort study included 116 consecutive patients who underwent emergency laparotomy at KPC Medical College and Hospital, Kolkata, from January 2021 to March 2023. Demographic variables, laboratory parameters, and operative details were retrieved from medical records. P-POSSUM and NELA scores were calculated using electronic risk calculators. Mortality at postoperative day 30 and 60 was the primary outcome. Statistical analysis was performed using SPSS version 19.0; an independent samples t-test was used for group comparison. Discriminatory accuracy was assessed using receiver operating characteristic (ROC) curve analysis and comparison of area under the curve (AUC) values. Results: Among 116 patients, the 30-day mortality rate was 8.6% (n = 10) and the 60-day mortality rate was 13.8% (n = 16). ROC curve analysis revealed that the AUC for the NELA score was significantly superior to that of the P-POSSUM score for both 30-day mortality [AUC 0.873 (95% CI 0.799–0.948) vs. 0.533 (95% CI 0.361–0.726), p < 0.001] and 60-day mortality. Conclusion: The P-POSSUM score demonstrated significantly greater discriminatory accuracy in predicting both early and late postoperative mortality following emergency laparotomy compared to the NELA score in this Eastern Indian cohort. The authors recommend adoption of the P-POSSUM score as the preferred risk stratification tool for patients undergoing emergency laparotomy.

Background: Tuberculosis is a preventable and curable disease. In 2022, TB was the world’s second leading cause of death from a single infectious agent. Isoniazid is the first line medicine for the treatment of active tuberculosis and latent TB infection, with high bactericidal activity. Resistance to isoniazid reduces the effectiveness of TB treatment and increases the risk of acquiring resistance to other first line drugs. This leads to increase risk of multidrug resistant TB. Aim and objectives: The objective is to study clinical profile and treatment outcome in isoniazid mono resistant pulmonary TB under programmatic conditions. Materials and Methods: This study is a prospective, observational and longitudinal single center study performed at the tertiary health care center in South Gujarat (DRTB NODAL Center). Diagnosed isoniazid (mono- H) resistant pulmonary tuberculosis patients during study period were enrolled and followed up during study to record demographic data, clinical characteristics and treatment outcomes. Results: In our study, 30 patients of isoniazid mono resistance pulmonary TB were enrolled. The mean age of patients was 36.7 years. Two-third of the patients were male (70%). 63.3% of patients were underweight (BMI < 18.5 kg/m²). All patients presented with symptoms of cough, fever and anorexia. Primary H mono resistant was detected in 83.3% patients. Most common INH mutation detected on FL-LPA was in the Kat G gene in 60% patients followed by InhA gene in 36.7% patients and one patient had both gene mutation. The most common ADRs observed were gastritis and GIT symptoms (43.3%). In our study favorable outcomes with treatment regimen as per national program guidelines was observed in 28 (93.34%) patients. Unfavorable outcome was observed in form of treatment failure in 1 patient and death in 1 patient. Conclusion: Most of isoniazid mono resistant TB patients present with primary resistance to isoniazid. Patients who have microbiologically confirmed TB with rifampicin sensitive need to be checked for FL-LPA for isoniazid sensitivity. The availability of rapid diagnostic test and treatment regimen under national program is effective for diagnosis and management of H mono resistant TB.

Background: Pertrochanteric fractures in elderly patients are associated with significant morbidity, mortality, and functional impairment. Bipolar hemiarthroplasty has emerged as an effective treatment option for unstable fractures in osteoporotic patients. However, evidence comparing metaphyseal and diaphyseal fit stems remains limited. Aim: To compare the functional outcomes of metaphyseal and diaphyseal fit bipolar hemiarthroplasty in elderly patients with pertrochanteric fractures. Methods: This prospective observational cohort study included 54 elderly patients with unstable pertrochanteric fractures treated with bipolar hemiarthroplasty. Patients were divided equally into diaphyseal stem and metaphyseal stem groups. Functional outcomes were assessed using Harris Hip Score (HHS) and Visual Analogue Scale (VAS) at multiple postoperative intervals. Operative time, blood loss, mobilization, and full weight-bearing status were also evaluated. Results: The mean age of participants was 72.91 ± 9.35 years, with females constituting 61.1% of cases. Diaphyseal stem fixation demonstrated significantly higher HHS at 2 weeks, 6 weeks, 3 months, and 6 months compared to metaphyseal stems (p<0.001). Mean operative time and blood loss were significantly higher in the diaphyseal group (162.00 ± 51.59 minutes and 663.70 ± 280.40 mL respectively) compared to the metaphyseal group (114.67 ± 18.79 minutes and 411.48 ± 132.74 mL respectively). However, patients in the diaphyseal group achieved earlier full weight bearing. Conclusion: Diaphyseal fit bipolar hemiarthroplasty demonstrated superior functional outcomes and earlier mobilization compared to metaphyseal fit stems despite increased operative time and blood loss. Diaphyseal fixation may therefore be preferred in elderly patients with unstable pertrochanteric fractures.

Aim: The aim of this paper is to describe how nociceptive pathways in the peripheral nervous system, thalamus, and cortical areas respond to NSAIDs and opioids, with emphasis on the biological basis of analgesia and the clinical implications of central and peripheral modulation of pain transmission. Materials and Methods: This paper was prepared as a narrative review of published literature on nociception, pain transmission, thalamic relay function, cortical pain processing, and the pharmacology of NSAIDs and opioids. Sources describing peripheral transduction, ascending spinothalamic signaling, thalamocortical integration, and descending inhibitory pathways were synthesized to build a structured account of drug effects across the pain axis. Result: The literature shows that NSAIDs reduce pain mainly by blocking cyclooxygenase-mediated prostaglandin synthesis in inflamed tissue and also by lowering central prostaglandin signaling, thereby reducing peripheral sensitization and central amplification of nociceptive input. Opioids act through μ, δ, and κ receptors to inhibit neurotransmitter release, hyperpolarize nociceptive neurons, and strengthen descending inhibitory control at spinal and supraspinal levels, including thalamic and cortical circuits. Conclusion: Nociception is not a single linear pathway but a distributed network involving peripheral receptors, spinal relays, thalamic integration, and cortical perception, all of which can be modified by analgesic drugs. NSAIDs are most effective where inflammation drives prostaglandin-dependent sensitization, whereas opioids exert broader central inhibition but carry greater risks of tolerance, dependence, and adverse effects.

Aim: Dexmedetomidine and clonidine are alpha-2 adrenergic agonists frequently used as adjuvants to local anaesthetics in brachial plexus block because they may shorten onset time, improve block quality, and prolong postoperative analgesia. The clinical question addressed in this review is whether dexmedetomidine provides superior efficacy to clonidine when used in axillary brachial plexus block, while maintaining acceptable haemodynamic and safety outcomes. Materials and Methods: A structured clinical evidence synthesis was undertaken using indexed comparative literature on dexmedetomidine versus clonidine as perineural adjuvants in brachial plexus block. Core evidence was drawn from a 2022 meta-analysis of 24 randomized controlled trials 2017 systematic review and meta-analysis of 14 randomized controlled trials. Both reviews compared dexmedetomidine and clonidine as adjuvants to local anaesthetics for upper-limb surgery and analyzed sensory block duration, motor block duration, analgesia duration, onset characteristics, and adverse events. Result: Across comparative brachial plexus block evidence, dexmedetomidine consistently outperformed clonidine on efficacy endpoints. In the 2022 meta-analysis, dexmedetomidine significantly prolonged sensory block duration by a mean difference of 173.31 minutes, motor block duration by 158.35 minutes, and duration of analgesia by 203.92 minutes compared with clonidine. Dexmedetomidine also hastened onset of sensory block by 1.58 minutes and motor block by 1.46 minutes, and improved the likelihood of higher-grade block quality. The 2017 meta-analysis similarly found that dexmedetomidine increased sensory, motor, and analgesic duration by an estimated ratio of means of about 1.2 each, while also accelerating onset. The 2017 review signaled increased transient bradycardia and postoperative sedation with dexmedetomidine, whereas the 2022 review found no statistically significant difference in hypotension. Conclusion: The best available evidence suggests that dexmedetomidine is clinically more effective than clonidine as a perineural adjunct in brachial plexus block, with longer sensory and motor blockade, longer postoperative analgesia, and somewhat faster onset.

Aims: To compare the fetomaternal outcomes in gestational thrombocytopenia with thrombocytopenia due to hypertensive disorders of pregnancy. Objectives: The objectives of the study were to evaluate fetomaternal outcomes in gestational thrombocytopenia, to assess fetomaternal outcomes in thrombocytopenia associated with hypertensive disorders of pregnancy, and to compare the fetomaternal outcomes between gestational thrombocytopenia and thrombocytopenia secondary to hypertensive disorders of pregnancy. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, over a period of 18 months. A total of 304 antenatal women beyond 20 weeks of gestation with persistent thrombocytopenia (<1.5 lakh/mm³) were enrolled. Patients were divided into Group A comprising 152 women with thrombocytopenia associated with hypertensive disorders of pregnancy and Group B comprising 152 women with gestational thrombocytopenia. Detailed history, clinical examination, complete blood count, coagulation profile, liver and renal function tests, and obstetric ultrasonography were performed. Maternal and fetal outcomes were assessed until discharge. Statistical analysis was performed using SPSS version 17.0, and p value <0.05 was considered statistically significant. Results: Majority of patients in both groups belonged to the 21–30 years age group and presented at term gestation. Moderate thrombocytopenia was the most common presentation in both groups. Deranged liver enzymes, elevated bilirubin, renal dysfunction, coagulation abnormalities, postpartum hemorrhage, and platelet transfusion requirements were significantly more common in Group A compared to Group B. Vaginal delivery was the most common mode of delivery in both groups, although cesarean section rates were higher in hypertensive thrombocytopenia. Neonatal complications including NICU admission, neonatal demise, and neonatal thrombocytopenia were also more frequent in Group A. Conclusion: Gestational thrombocytopenia is generally a benign condition with favorable maternal and fetal outcomes and spontaneous postpartum recovery. In contrast, thrombocytopenia associated with hypertensive disorders of pregnancy is associated with increased maternal complications such as postpartum hemorrhage, coagulation abnormalities, liver and renal dysfunction, along with poorer neonatal outcomes. Early diagnosis, close monitoring, and multidisciplinary management are essential to improve fetomaternal outcomes in thrombocytopenic pregnancies.

Background: Anatomical Variations of Renal Arteries and Their Surgical Significance in Laparoscopic Procedures deals with a clinically relevant diagnostic and anatomical problem in the routine practice of tertiary care. The objective of this study was to document renal artery variations and explain their significance for laparoscopic donor nephrectomy, pyeloplasty and renal hilar surgery. Method: The study design was a cross sectional observational study using CT angiographic and cadaveric approach in the Department of Anatomy, Radiology and Surgery of a tertiary care centre. A total of 150 renal units of 75 adults were included in the study, which was performed using multidetector CT angiography and additional cadaveric observations. The participants/specimens were divided into single renal artery, accessory renal artery and early branching patterns. Standardized data collection, laboratory/ radiological/ anatomical assessment and predefined operational criteria were used. Results: A single renal artery was found in 72.0% of renal units, accessory renal arteries in 21.3% and early branching in 18.7%. The left side had more accessory arteries (25.3%) than the right side (17.3%), but this difference was not significant (p=0.228). Inferior polar arteries were found in 9.3% and were deemed to be surgically significant in the lower pole. Conclusion: Variations in the renal arteries were frequent and significant. Vascular mapping is crucial prior to laparoscopic renal surgery to minimize vascular injury and ischemic complications.

Background: End-stage kidney disease is increasing worldwide, primarily in the developing countries. It is affecting mainly the productive age group. We therefore sought to describe the clinical and epidemiological characteristics of hemodialysis patients. Aims and Objective: To identify the socio-demographic characteristics, comorbidities and clinical profile of patients treated with hemodialysis. Material and Methods: This was a descriptive, cross-sectional study conducted among 40CKD patients undergoing hemodialysis at I.Q City medical college and Hospital, Durgapur, West Bengal. The study was based on the patients’ attending Hemodialysis Unit in between April 2025 to March 2026. The ethical clearance for the research was taken. 40 patients were retrieved and data was collected according to Performa. Socio demographic profiles including age, sex and clinical data including etiology, duration of CKD, duration of hemodialysis and laboratory parameters including hemogram and renal function test were recorded. Patients more than 20 years and above and receiving hemodialysis more than six months included in the study. Results: Among all 40 patients, range age is 24 to 66 years with mean (SD) 45.46(±12.32) years. Almost half of the patients 20(50%) belongs to the middle age group (36-56) years followed by 10(25%) comprises as senior citizens (60 and above) years. Twenty-six (65%) are male and 14(35%) patients are female. Similarly, 27(67.5%) are married and majority 32(80%) belongs to Hindu community. 33(82.5%) were as nuclear family. Regarding education level, eighteen (45%) were illiterate and only 3(7.5%) had University level education and 36(90%) were dependent on their family after starting the treatment. Conclusion: Hypertension and diabetes were the leading cause of End stage renal disease in most of the patients. Early diagnosis, treatment and proper follow up of the risk factors will be the key to prevent progression of chronic kidney disease into the end stage requiring hemodialysis or Renal Transplant.

Background: Parotidectomy remains the standard treatment for a variety of benign and malignant parotid gland lesions. However, the extent of gland excision may influence postoperative morbidity, particularly facial nerve dysfunction. This study compared the surgical outcomes and complications associated with total and near-total parotidectomy. Material and Methods: A retrospective comparative study was conducted on 94 patients who underwent parotidectomy between January 2018 and December 2024. Patients were divided into a total parotidectomy group (n=46) and a near-total parotidectomy group (n=48). Demographic characteristics, operative parameters, postoperative complications, facial nerve function, and oncological outcomes were analyzed and compared. Results: The baseline demographic and clinical characteristics were comparable between the groups. Near-total parotidectomy was associated with significantly shorter operative time (136.2±23.4 vs. 154.8±26.5 minutes; p=0.001), reduced hospital stay (4.3±1.2 vs. 5.2±1.4 days; p=0.002), and shorter drain duration (2.8±0.8 vs. 3.4±0.9 days; p=0.001). Temporary facial nerve weakness occurred significantly less frequently following near-total parotidectomy than total parotidectomy (10.4% vs. 28.3%; p=0.028). Overall postoperative complications were also significantly lower in the near-total parotidectomy group (20.8% vs. 43.5%; p=0.019). Permanent facial nerve weakness, Frey’s syndrome, salivary fistula, seroma, hematoma, and surgical site infection were less common after near-total parotidectomy, although these differences were not statistically significant. Negative surgical margins (90.9% vs. 91.7%) and local recurrence rates (9.1% vs. 8.3%) were comparable between the groups. Conclusion: Near-total parotidectomy was associated with reduced postoperative morbidity and improved perioperative outcomes while maintaining oncological effectiveness comparable to total parotidectomy. It may therefore be considered a safe and effective surgical alternative in appropriately selected patients.

Aim: Breast implant surgery has traditionally been judged through technical outcomes and aesthetic assessment, yet modern evaluation increasingly prioritizes patient-reported outcomes, longitudinal quality of life, and safety transparency. This critical review aims to synthesize current evidence on quality-of-life outcomes after breast implant surgery, evaluate the strengths and limitations of patient-reported outcome measures, and examine the growing significance of systemic concerns in shared decision-making. Materials and Methods: A narrative critical review approach was undertaken using contemporary peer-reviewed evidence and registry-based analyses focused on patient-reported outcome measures after breast implant surgery. Core source material included a 2024 systematic review and meta-analysis of Breast-Q augmentation outcomes involving 39 studies, 53 cohorts, and 18,322 patients, together with a 2022 registry-based qualitative analysis from the Australian Breast Device Registry examining 268 open-ended patient responses after augmentation. The review prioritized domains relevant to health-related quality of life: satisfaction with breasts, psychosocial well-being, sexual well-being, physical well-being, complications, revision burden, and patient perceptions of systemic illness. Results: Breast implant surgery often produces substantial improvements in patient-reported psychosocial well-being, sexual well-being, and satisfaction with breast appearance. In the 2024 meta-analysis, psychosocial well-being improved by a mean difference of 38.10 points, sexual well-being by 40.20 points, and satisfaction with breasts by 47.88 points, whereas physical well-being improved only slightly and inconsistently. Registry-based qualitative data deepen this picture by showing that satisfaction frequently depends not only on appearance but also on surgeon communication, aftercare, and the natural feel of implants. At the same time, dissatisfaction arose from asymmetry, rippling, pain, altered sensation, tightness, rupture, revision surgery, and perceptions of inadequate counseling. Emerging systemic concerns included self-reported fatigue, joint pain, cognitive complaints, hair loss, and other symptoms interpreted by some patients as breast implant illness. Conclusion: The strongest lesson from current evidence is that aesthetic success alone is an insufficient endpoint. High-quality breast implant care requires long-term surveillance, standardized patient-reported outcome measures, transparent disclosure of device-specific risks, and a consent process that addresses both proven complications and uncertain systemic concerns without dismissing patient experience. The future of implant evaluation therefore lies in integrating surgical outcomes, registry surveillance, symptom monitoring, and person-centered counseling rather than relying on appearance-based judgments alone.

Aim: Cyanide is one of the most labile toxicants encountered in forensic practice, and interpretation of postmortem cyanide concentrations is often complicated by storage-related instability. The aim of this review-style paper is to examine how different storage conditions influence cyanide levels in postmortem tissues and how these changes affect forensic interpretation. Cyanide’s instability in cadavers and stored specimens is well recognized, and the magnitude and direction of concentration changes may depend on the specimen type, initial cyanide burden, temperature, elapsed storage time, and preservative use. Materials and Methods: A focused literature-based synthesis was prepared using published studies on cyanide stability in blood, solid organs, and gastric contents, with particular attention to studies comparing refrigerated, frozen, and room-temperature storage. Evidence from cadaveric studies, animal models, and authentic casework was reviewed to identify common stability patterns and practical laboratory implications. Key variables extracted from the literature included temperature, duration of storage, tissue matrix, preservation with sodium fluoride, and analytical technique. Result: Across the literature, cyanide demonstrated variable stability in postmortem tissues, with blood often showing apparent concentration increases during storage, likely from postmortem redistribution, diffusion, or matrix effects, whereas liver, kidney, and brain exhibited inconsistent rises and falls. Refrigeration at 4°C and freezing at -20°C generally improved preservation, but neither condition completely prevented change, especially over longer storage intervals. In a cadaveric review, cyanide transformation was shown to depend strongly on time in the body, time in storage, concentration at death, and sample preservation. More recent work also suggests that chromatographic methods may show more stable long-term patterns than older spectrophotometric techniques. Conclusion: Postmortem cyanide interpretation must always account for storage conditions, because cyanide levels may change significantly after collection. Frozen storage is usually preferable for delayed analysis, refrigerated storage is acceptable for short intervals, and immediate preservation is ideal. Forensic conclusions should be based on the full case context rather than a single cyanide value alone, especially when specimens have been stored under nonstandard conditions.

Introduction: Cancer-associated thrombosis is a well-recognized contributor to morbidity and mortality in patients with malignancies. Although venous thromboembolism is common, arterial thrombosis is rare and often overlooked, particularly when it precedes typical cancer-related symptoms. Gastric adenocarcinoma initially presenting with arterial thrombosis is exceedingly uncommon. This report describes an unusual presentation in which upper-limb arterial thrombosis served as the first clinical indication to an underlying gastric malignancy. Case Report: A 50-year-old woman with well-controlled hypertension presented with headache and dizziness and was noted to have absent peripheral pulses in the right upper limb. She had no history of diabetes, dyslipidemia, smoking, autoimmune disease, or thrombotic events. Vascular imaging revealed thrombosis of the distal right brachial artery extending to the bifurcation, with collateral formation. Brain imaging revealed acute and chronic lacunar infarcts, suggesting recurrent silent ischemic events. However, as the conventional cardiovascular risk factors or an identifiable embolic source were not present, the etiology initially remained unclear.
Further evaluation of secondary causes of thrombosis revealed an acquired hypercoagulable state, with reduced levels of protein C, protein S, and antithrombin III, along with elevated homocysteine levels. Autoimmune and antiphospholipid antibody test results were negative. During hospitalization, the patient developed upper gastrointestinal bleeding, prompting endoscopic evaluation. Upper gastrointestinal endoscopy revealed ulceroproliferative growth involving the gastric antrum and pylorus, and histopathology confirmed poorly differentiated gastric adenocarcinoma with signet ring cell features. Computed Tomography showed diffuse gastric wall thickening with regional and para-aortic lymphadenopathy, consistent with advanced disease, without evidence of additional arterial thrombosis. Discussion and Conclusion: This case highlights the diagnostic challenges posed by malignancy-associated arterial thrombosis, particularly when it precedes overt oncological symptoms. The combination of arterial ischemic events and acquired deficiencies in natural anticoagulants supports a paraneoplastic hypercoagulable state. Clinicians should maintain a high index of suspicion for occult malignancy in patients presenting with unexplained arterial thrombosis, as early recognition may facilitate timely diagnosis and appropriate management.

Background: Acute kidney injury (AKI) is a serious complication of tropical acute febrile illness (TAFI) and contributes significantly to morbidity, mortality, and healthcare burden in endemic regions. Early recognition of AKI and associated systemic complications is essential for improving clinical outcomes. Methods: A hospital-based observational study was conducted among 100 patients with AKI complicating TAFI. Demographic characteristics, clinical presentation, laboratory parameters, etiological profile, AKI severity according to the RIFLE classification, complications, dialysis requirement, intensive care unit (ICU) admission, and clinical outcomes were evaluated. Statistical analysis was performed to assess associations between selected variables and AKI severity. Results: The mean age of participants was 40.14 ± 15.04 years, with male predominance (62%). Fever was present in all patients, while myalgia (51%), vomiting (50%), rash (50%), and decreased urine output (49%) were common presenting symptoms. Pedal edema (57%), tachycardia (53%), conjunctival congestion (48%), and icterus (47%) were the predominant clinical signs. Dengue (32%) was the leading etiology, followed by malaria (21%), leptospirosis (17%), scrub typhus (14%), enteric fever (8%), and undifferentiated fever (8%). RIFLE classification showed Risk in 38%, Injury in 34%, and Failure in 28% of patients. Major complications included sepsis (53%), ARDS (52%), shock (51%), and MODS (51%). Dialysis was required in 26% and ICU admission in 34% of patients. Complete recovery occurred in 64%, partial recovery in 22%, and mortality was 14%. A significant association was observed between age category and AKI severity (p=0.026). Conclusion: TAFI-associated AKI is a multisystem disorder with substantial morbidity, dialysis requirement, and mortality. Early recognition, strict renal monitoring, and prompt management of sepsis, shock, and respiratory failure are crucial to improve renal recovery and reduce adverse outcomes.

Aims and Objectives: To estimate serum vitamin B12 and ferritin levels in infants with iron deficiency anaemia and vitamin B12 deficiency anaemia, and to assess their correlation with maternal serum vitamin B12 and ferritin levels. Methods: This descriptive cross-sectional study included 280 infants aged 29 days to 1 year admitted to the Department of Pediatrics, J.K. Lon Hospital, Kota, between March 2023 and March 2024. Infants with anaemia admitted for common medical conditions were enrolled. Complete blood count, serum ferritin, and serum vitamin B12 levels were measured in infants and their mothers. Data were analysed using SPSS software. Results: Iron deficiency anaemia was the most common cause of anaemia (69.3%). Dimorphic anaemia predominated (41.8%), followed by vitamin B12 deficiency anaemia (32.9%) and isolated iron deficiency anaemia (12.9%). Isolated vitamin B12 deficiency accounted for 32.9% of severe anaemia cases. The mean serum vitamin B12 level in infants was 107.12 pg/mL. A strong correlation was observed between maternal and infant serum vitamin B12 and ferritin levels, with infants of deficient mothers more likely to have similar deficiencies. Conclusion: Vitamin B12 deficiency is a significant and under-recognized cause of anaemia in infants and is strongly associated with maternal nutritional status. Maternal iron and vitamin B12 deficiencies increase the risk of corresponding deficiencies in infants. Routine evaluation of serum vitamin B12, along with iron studies and peripheral smear examination, should be included in the workup of anaemic infants. Maternal vitamin B12 supplementation during pregnancy and lactation is essential to prevent infant anaemia.

Background: Diabetes mellitus (DM) is one of the most common metabolic disorders. Type-2 diabetic patients have increased risk of cardiovascular disease including atherosclerosis and dyslipidaemia. Materials and Methods: A total of N=50 control who were between 35-50 years both sexes matched, healthy non-smokers, non-alcoholics were included and N=50 diabetic patients who were on anti-diabetic treatment were enrolled. Aim is to assess the lipid profile of diabetic patients and to compare them with that of the controls. Results: Triglyceride (TG), very low-density lipoprotein (VLDL), total cholesterol (TC) and low-density lipoprotein (LDL) values were significantly increase whereas high density lipoprotein (HDL) values were decrease in diabetics than controls. Conclusion: Diabetes mellitus has an impact on lipid metabolism. Dyslipidaemia was reported in the diabetic group. Diabetic patients are prone to cardiovascular and coronary artery diseases. Hence, regular lipid profile monitoring will help to prevent above diseases.

Background and Aims: Laryngoscopy and tracheal intubation provoke transient but potentially hazardous sympathetic responses. Adequate neuromuscular blockade and depth of anaesthesia at the moment of intubation may attenuate this response. We compared haemodynamic changes and intubating conditions when the appropriate moment for tracheal intubation was determined by combined train-of-four (TOF) and bispectral index (BIS) monitoring versus conventional clinical assessment. Methods: In this prospective, randomised, single-centre study, 68 adult patients of either sex, ASA physical status I–II, scheduled for elective laparoscopic cholecystectomy under general anaesthesia, were allocated by lottery to two groups of 34 each. In Group M (monitor-guided), the trachea was intubated when TOF count at the adductor pollicis was zero and BIS was ≤ 40. In Group C (clinical assessment), the trachea was intubated after clinical judgement of jaw-muscle relaxation and loss of the eyelash reflex. Heart rate (HR), systolic, diastolic and mean arterial pressures (SAP, DAP, MAP), peripheral oxygen saturation (SpO₂) and intubating conditions (Copenhagen score) were recorded at baseline (T0), after induction (T1), pre-intubation (T2), and 1 (T3), 3 (T4) and 5 (T5) minutes after intubation. Data were analysed with Student’s t-test and the chi-square or Fisher’s exact test, as appropriate. Results: HR, SAP, DAP and MAP were significantly higher in Group C than in Group M at all post-intubation time points (P < 0.05). The peak HR after intubation was 107.5 ± 12.7 bpm in Group C versus 97.0 ± 3.0 bpm in Group M (P < 0.0001), and peak MAP was 112.0 ± 2.0 mmHg versus 100.0 ± 4.1 mmHg, respectively (P < 0.0001). Excellent intubating conditions (score 5) were achieved in all 34 patients in Group M, whereas all Group C patients had only moderate conditions (score 3–4; P < 0.0001). Conclusion: Combined TOF and BIS monitoring to time tracheal intubation produces significantly better intubating conditions and attenuates the haemodynamic stress response compared with conventional clinical assessment.

Introduction: Type 2 diabetes mellitus (T2DM) increases cardiovascular risk due to chronic hyperglycemia and dyslipidemia. Poor glycemic control and abnormal lipid profiles, particularly elevated LDL-C and low HDL-C, contribute to adverse cardiovascular events. This study examines their association with cardiovascular outcomes in T2DM to guide risk assessment and preventive care. Methods: A five-month prospective observational study was conducted at Government Medical College, Machilipatnam, including T2DM patients aged 35–75 years. Demographic, clinical, and laboratory data were collected. Patients were followed for cardiovascular events, confirmed through clinical, biochemical, and imaging evaluations. Exclusion criteria included prior CVD, T1DM, CKD, infections, or malignancy. Results: In this study of 120 T2DM patients, 25% experienced cardiovascular events over five months. Higher HbA1c, LDL-C ≥ 130 mg/dL, and hypertension significantly predicted events. HbA1c ≥ 9% had the strongest association (OR 3.25, p=0.031), highlighting poor glycemic control as a key cardiovascular risk factor. Conclusion: Poor glycemic control, elevated LDL-C, and hypertension significantly increased cardiovascular event risk in T2DM patients. HbA1c ≥ 9% was the strongest predictor. The study underscores the need for comprehensive management of metabolic parameters to prevent cardiovascular complications and improve outcomes in individuals with T2DM.

Background: Intrathecal opioids are commonly used as adjuvants to local anaesthetics during spinal anaesthesia to prolong postoperative analgesia and improve block quality. Nalbuphine and buprenorphine have different receptor profiles and may produce different analgesic effects. Aim: To compare intrathecal nalbuphine and intrathecal buprenorphine as adjuvants to hyperbaric bupivacaine for postoperative analgesia in patients undergoing lower limb surgeries under spinal anaesthesia. Methods: This comparative study included patients undergoing lower limb surgeries under spinal anaesthesia. Patients were divided into two groups: group BN received intrathecal bupivacaine with nalbuphine, while group BB received intrathecal bupivacaine with buprenorphine. Onset and duration of sensory and motor block, duration of analgesia, time to rescue analgesia, haemodynamic parameters, sedation score, and adverse effects were compared. Results: Nalbuphine produced significantly earlier onset of sensory and motor blockade. Buprenorphine produced significantly prolonged sensory and motor block, longer duration of analgesia, and delayed rescue analgesic requirement. Haemodynamic parameters remained stable in both groups, and adverse effects were minimal. Conclusion: Intrathecal buprenorphine was superior for prolonged postoperative analgesia, while nalbuphine provided faster onset of blockade with good safety.

Background: Hepatitis B virus (HBV) infection remains an important public health problem because of its potential to cause chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hospital-based screening helps in identifying the burden of infection and guiding preventive strategies. Aim: To determine the prevalence of HBV infection among patients attending a tertiary care hospital. Methods: This retrospective observational study was conducted in the department of Microbiology, Government Medical College, Rajamahendravaram, from April 2023 to March 2024. Laboratory records of patients screened for HBV were reviewed. A total of 6,712 individuals were included, comprising 2,613 male, 1,708 non-antenatal female, and 2,391 antenatal female. Known hepatitis B-positive cases were excluded. Data were analyzed using frequencies, percentages, and chi-square test. Results: Overall, 211 of 6,712 screened individuals were positive, giving an HBV prevalence of 3.14%. Among males, positivity was 4.36%; among non-antenatal females, 4.57%; and among antenatal females, 0.79%. Age-wise variation was significant among males and the non-antenatal population, whereas it was not significant among antenatal women. HBV positivity was significantly lower in antenatal women compared with the non-antenatal population. Conclusion: Although HBV prevalence was relatively low, continued screening, vaccination, and health education are essential, particularly in antenatal women, to reduce transmission and disease burden.

Background: Decompensated chronic liver disease is frequently associated with electrolyte abnormalities, among which hyponatremia is an important marker of advanced circulatory dysfunction and poor prognosis. Aim: To study serum sodium levels in patients with decompensated chronic liver disease (CLD) and to observe their clinical significance. Methods: This prospective observational cross-sectional study was conducted at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation from July 2023 to May 2025. Sixty patients with decompensated CLD were enrolled. Clinical evaluation, liver function tests, serum electrolytes, coagulation profile, ultrasonography abdomen, portal vein Doppler, and ascitic fluid analysis were performed. Statistical analysis was done using SPSS version 23. Results: The mean age was 52 ± 10.50 years, and 95% were males. Alcohol was the commonest etiology (95%). The mean serum sodium level was 126.45 ± 5.66 mEq/L. Hyponatremia (serum sodium ≤130 mEq/L) was observed in 66.7% of patients. Significant associations were found between low serum sodium and ascites, portal hypertension, upper gastrointestinal bleed, coagulopathy, and hepatorenal syndrome. No significant association was observed with spontaneous bacterial peritonitis. Conclusion: Serum sodium is a valuable and easily measurable prognostic marker in decompensated CLD and may help identify patients at greater risk of complications.

Background: Thoracolumbar spine fractures represent a significant proportion of spinal injuries encountered in trauma centers and are frequently associated with substantial morbidity, neurological deficits, chronic pain, spinal deformity, and functional disability. Accurate assessment of fracture stability and neurological involvement is essential for determining the appropriate treatment modality. The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed as a comprehensive classification system incorporating fracture morphology, neurological status, and posterior ligamentous complex integrity to guide treatment decisions. Despite its widespread acceptance, evidence regarding its reliability and effectiveness in predicting functional outcomes remains limited in the Indian population. Aim: To assess the reliability and safety of the Thoracolumbar Injury Classification and Severity Score (TLICS) in choosing the treatment modality (surgical or conservative) for thoracolumbar spine fractures involving D5–L5 vertebral levels. Material and Methods: This prospective observational study was conducted in the Department of Orthopaedics, Government Medical College, Kozhikode, over a period of one year following Institutional Ethics Committee approval. Sixty-eight adult patients aged 18–65 years presenting with thoracolumbar fractures between D5 and L5 levels were included. Patients were evaluated clinically and radiologically using X-ray, CT scan, and MRI. TLICS scores were calculated based on fracture morphology, neurological status, and posterior ligamentous complex integrity. Patients with TLICS ≤3 received conservative treatment, while those with scores ≥5 underwent surgical management. Patients with a score of 4 were managed according to clinical judgment. Functional outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), American Spinal Injury Association (ASIA) impairment scale, and Cobb’s angle measurements during follow-up at 2 months, 4 months, 6 months, and 1 year. Results: The study evaluated the association between TLICS scores and treatment decisions while assessing pain relief, neurological recovery, functional improvement, and radiological correction. Patients managed according to TLICS recommendations demonstrated significant improvements in VAS scores, ODI scores, ASIA grades, and Cobb’s angle measurements over the follow-up period. Surgical treatment was predominantly performed in patients with higher TLICS scores and neurological deficits. Conclusion: TLICS is a reliable and practical tool for guiding treatment decisions in thoracolumbar spine fractures. The classification system facilitates appropriate selection of surgical or conservative management and is associated with favorable functional and radiological outcomes. Adoption of TLICS-based management protocols may improve treatment standardization and patient outcomes in thoracolumbar trauma.

Background: Traumatic brain injury (TBI) is a major cause of mortality and long-term disability worldwide. Secondary brain injury following TBI significantly influences prognosis, and hyperglycemia has been recognized as an important contributing factor. Elevated blood glucose levels may aggravate neuronal damage through metabolic and ischemic mechanisms. The relationship between random blood sugar (RBS) and neurological status assessed by Glasgow Coma Scale (GCS) may provide valuable prognostic information. Aim: To determine the correlation between random blood sugar levels and Glasgow Coma Scale scores in patients with traumatic brain injury. Materials and Methods: This prospective observational study was conducted on 90 patients with TBI admitted to the Department of Neurosurgery over 18 months in a Tertiary Care Hospital. Adult patients (>18 years) with mechanical brain injury and GCS scores between 3–15 were included. Patients with diabetes, metabolic disorders, malignancies, and other causes of brain injury were excluded. RBS levels and GCS scores were recorded at admission, 24 hours, 72 hours, and discharge. Statistical analysis was performed using SPSS version 26 with Pearson correlation, chi-square test, ANOVA, and logistic regression analysis. A p-value <0.05 was considered statistically significant. Results: The majority of patients were males (75.6%) with the highest incidence in the 21–40 years age group (41.1%). Road traffic accidents accounted for 67.8% of injuries. Mean admission RBS was 192.14±58.65 mg/dL and progressively decreased to 131.84±28.22 mg/dL at discharge. Severe TBI patients had higher admission glucose levels (261.33±25.03 mg/dL) compared with moderate and mild injuries. A significant inverse correlation was observed between admission RBS and GCS (r = −0.843, p<0.0001). Discussion: Hyperglycemia was associated with increased TBI severity and poorer neurological outcomes. Higher blood glucose levels corresponded with lower GCS scores and increased mortality risk. Conclusion: Early hyperglycemia showed a strong negative correlation with GCS and may serve as an important predictor of TBI severity and prognosis. Early monitoring and management of elevated glucose levels could improve clinical outcomes.

Background: This study is designed to compare the efficacy of ultrasound (USG) guided Ilioinguinal nerve block (IIN) versus USG guided Erector spinae plane block (ESP) for paediatric inguinal surgeries with respect to postoperative analgesia. Methods: Hospital based randomized prospective interventional study. 50 children of either sex aged 2 to 10 yrs of ASA grade ⅠorⅡ scheduled for elective inguinal surgery were included in study. Interventions: Patients were randomized into 2 groups with 25 patients in each group undergoing elective inguinal surgeries (n=25/group). In group A, ESP block was performed with 0.5 ml/kg of 0.2% ropivacaine and in group B IIN block was performed with 0.5ml/kg of 0.2% ropivacaine. The post-operative pain was assessed by using CHEOPS Score. The time of need to first rescue analgesic was noted. CHEOPS score was assessed every 30 minutes, 1hr, 2hr, 4hr, 6hr, 12hr, 16hr and 24hr postoperatively. Results: Significant difference was observed between the groups on post-operative CHEOPS scores at the 16^th and 24^th hour (p value < 0.05). In group A – 3 (12%) patients required rescue analgesia. While in group B 11(44%) patients required rescue analgesia. There differences were statistically significant. The total dose of rescue analgesia and mean dose of analgesia postoperatively were significantly higher in IIN group. Conclusions: The ESP group showed a better CHEOPS score and a longer duration of analgesia than the IIN group for controlling postoperative pain in pediatric inguinal surgeries.

Introduction: Breast milk Amrit for newborn is complete food and plays crucial role in immunity, growth, and neurodevelopment .Maternal apprehension and anxiety during early neonatal period can adversely affect lactation during this period. Limited studies are available on effect of music therapy and breast milk secretion. Aim: To evaluate the effect of Indian classical music, Raga Ahir bhairav on breast milk secretion in mothers of late preterm and term newborns. Material and Methods: Total 110 mothers -newborn pairs (late preterm and term) were included out of which 55 pairs were music therapy group and 55 pairs control group. Music therapy group received raga Ahir Bhairav for15 minutes four times daily (Total 12 sessions) for three consecutive days. Breast milk volume was measured daily using breast pump under standard aseptic conditions. Statistical analysis was performed using t test and chi square test. Result: Mean milk volume in music therapy group increased from 9.0 ml at session 1 to 30.7 ml at session 12 compared to 8.8 ml and 24.5 ml respectively in controlled group (p 0.001). Multiparous mothers and mothers who delivered vaginally showed greater milk production than primiparous (p 0.03) and caesarean delivered (p 0.02) respectively. Mothers of term newborns demonstrated higher milk secretion as compared to preterm. Conclusion: Music therapy had a positive effect on breast milk secretion among mothers of late preterm and term newborns with statistically significant increase in breast milk volume. It may serve as simple, cost effective and non-pharmocological adjunct to enhance lactation during early neonatal period.

Background: Anemia is the most frequently encountered hematological complication in non-hematological malignancies, adversely affecting quality of life, treatment tolerance, and prognosis. The European Cancer Anemia Survey (ECAS) documented a prevalence of 39.3% at enrollment, rising to 67% during the survey period. Objectives: To study the incidence, pattern, and severity of anemia in adult patients with solid malignancies, and to evaluate comprehensive hematological and iron study parameters. Methods: A prospective observational study was conducted (October 2023–June 2025) at the Department of Pathology, MGMCH. Sixty newly diagnosed, treatment-naïve patients (34 males, 26 females; aged 19–69 years; Hb <12 g/dL) with confirmed non-hematological malignancies underwent complete hemogram (Sysmex XP-100), peripheral blood film (Leishman stain), and iron studies (serum iron, TIBC, serum ferritin by CLIA). Results: Mean age was 54.82 ± 11.70 years with male predominance (56.7%). Mild anemia predominated (51.7%), followed by moderate (33.3%) and severe (15%). Normocytic normochromic pattern was most common on peripheral blood film (56.7%). Serum ferritin was elevated in 50%, normal serum iron in 68.3%, and normal TIBC in 73.3% of patients. Conclusion: Anemia is universal in non-hematological malignancies and increases in severity with age. Integrated early hematological assessment is essential for optimal oncological management.

Background: Anemia is the most frequently encountered hematological complication in non-hematological malignancies, adversely affecting quality of life, treatment tolerance, and prognosis. The European Cancer Anemia Survey (ECAS) documented a prevalence of 39.3% at enrollment, rising to 67% during the survey period. Objectives: To study the incidence, pattern, and severity of anemia in adult patients with solid malignancies, and to evaluate comprehensive hematological and iron study parameters. Methods: A prospective observational study was conducted (October 2023–June 2025) at the Department of Pathology, MGMCH. Sixty newly diagnosed, treatment-naïve patients (34 males, 26 females; aged 19–69 years; Hb <12 g/dL) with confirmed non-hematological malignancies underwent complete hemogram (Sysmex XP-100), peripheral blood film (Leishman stain), and iron studies (serum iron, TIBC, serum ferritin by CLIA). Results: Mean age was 54.82 ± 11.70 years with male predominance (56.7%). Mild anemia predominated (51.7%), followed by moderate (33.3%) and severe (15%). Normocytic normochromic pattern was most common on peripheral blood film (56.7%). Serum ferritin was elevated in 50%, normal serum iron in 68.3%, and normal TIBC in 73.3% of patients. Conclusion: Anemia is universal in non-hematological malignancies and increases in severity with age. Integrated early hematological assessment is essential for optimal oncological management.

Background: Progestogen supplementation is commonly used in the management of threatened miscarriage (TM) and recurrent pregnancy loss (RPL). While both oral dydrogesterone and vaginal micronized progesterone are widely prescribed, direct comparative evidence evaluating their relative efficacy remains sparse and has not been systematically synthesized. Objective: To compare the efficacy of oral dydrogesterone versus vaginal micronized progesterone for pregnancy continuation in women diagnosed with TM or RPL. Methods: PubMed, Cochrane Library and Google Scholar were searched from inception through January 2026 following a pre-registered PROSPERO protocol (CRD420261287005). Randomised controlled trials (RCTs) comparing oral dydrogesterone to vaginal progesterone were included. Risk ratios (RR) were pooled using inverse-variance random-effects meta-analysis. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was graded using the GRADE framework. Results: Four RCTs (n = 416) met inclusion criteria for the primary analysis. Oral dydrogesterone was associated with significantly higher pregnancy continuation rates compared with vaginal progesterone (RR 1.12, 95% CI 1.02–1.23, p = 0.02; I² = 0%; NNT = 10). Sensitivity analysis excluding one high-risk study yielded borderline non-significance (RR 1.10, 95% CI 0.99–1.21, p = 0.07). Secondary analysis from one additional RCT (n = 160) showed no significant differences in late pregnancy outcomes. The overall certainty of evidence was rated LOW. Conclusions: Low-certainty evidence suggests oral dydrogesterone may improve pregnancy continuation compared with vaginal progesterone in women with TM or RPL. Late pregnancy outcomes appear comparable. Larger, adequately powered, double-blind RCTs with live birth as the primary outcome are needed to confirm these findings.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with persistent hyperglycemia and systemic complications. This study evaluated alterations in red blood cell (RBC) indices, platelet indices, and white blood cell (WBC) counts in patients with T2DM of more than 10 years’ duration compared to healthy controls. Methods: This case-control study was conducted over an 18-month period at a tertiary healthcare center in Northern India. A total of 272 patients with long-standing T2DM (>10 years post-diagnosis) and 272 age- and sex-matched healthy controls were enrolled. Complete blood counts and glycemic profiles (HbA1c and fasting plasma glucose) were analyzed. Statistical analysis was executed using SPSS version 24.0. Results: The study included 272 diabetic patients and 272 controls, mostly aged 40–60 years. Gender distribution differed significantly between groups (p = 0.002). Obesity was more common among diabetics with higher BMI (p < 0.001), along with poor glycaemic control. Significant haematological changes in diabetics included altered RBC count (p = 0.03), RDW (p = 0.04), platelet indices, PDW (p = 0.002) and MPV (p = 0.004) and abnormal WBC counts (p = 0.036). Overall, long-standing diabetes was associated with obesity, hyperglycaemia, and significant blood cell alterations. Conclusion: Long-standing T2DM is strongly associated with distinct modifications in hematological profiles. The statistical elevations in RDW, MPV, PDW, and leukocyte abnormalities highlight ongoing subtle red cell structural fragility, enhanced thrombotic platelet activation, and sustained low-grade systemic inflammation. Routine monitoring of these simple hematological markers can serve as reliable indicators to gauge cellular risk and prevent vascular complications.

Background: Relapse following a successful acute course of electroconvulsive therapy (ECT) remains a significant clinical challenge. Continuation electroconvulsive therapy (C-ECT) is used to maintain remission and prevent relapse in patients with severe psychiatric disorders, though data on its real-world effectiveness are limited. Aim: To evaluate the clinical characteristics and treatment response in patients receiving continuation electroconvulsive therapy. Materials and Methods: A total of 100 patients who received C-ECT following an acute ECT course were included. Data regarding sociodemographic profile, clinical characteristics, ECT parameters, treatment response, relapse, and adverse effects were collected from medical records. Results: The mean age of patients was 42.6 ± 13.8 years, with a male predominance (56%). Major depressive disorder was the most common diagnosis (48%), followed by bipolar disorder (32%) and schizophrenia (20%). A good treatment response was observed in 72% of patients, while 18% showed partial response and 10% had poor response. Adverse effects were mostly mild, with memory impairment being the most common (28%). Conclusion: Integration of C-ECT with pharmacotherapy and individualized treatment protocols can significantly improve long-term outcomes. Further prospective studies are warranted to validate these findings.

Background: Acute appendicitis is the most common surgical emergency in children. Early differentiation between uncomplicated and complicated appendicitis remains challenging, and inflammatory biomarkers such as C-reactive protein (CRP) may assist in assessing disease severity and guiding management. Aim: To evaluate the correlation between preoperative serum CRP levels and the severity of appendicitis in pediatric patients. Materials and Methods: This prospective observational study was conducted at a tertiary care medical college hospital in Western India from January to December 2025. A total of 106 pediatric patients diagnosed with acute appendicitis were included. Clinical evaluation, imaging findings, and laboratory parameters including CRP, total white blood cell (WBC) count, and neutrophil percentage were recorded. Ninety-nine patients underwent appendectomy, while seven were managed conservatively. Histopathological examination was used to classify cases as uncomplicated or complicated appendicitis. Statistical analysis was performed using SPSS version 19, with p<0.05 considered significant. Results: The mean age of patients was 9.85 years, with a male predominance (75.5%). Histopathology revealed uncomplicated appendicitis in 41 (41.4%) patients and complicated appendicitis in 57 (57.6%) patients. The mean WBC count (18.88 ± 14.64 vs. 12.56 ± 3.04 ×10³/mm³; p=0.033) and neutrophil percentage (84.96 ± 7.54% vs. 80.68 ± 7.41%; p=0.042) were significantly higher in complicated appendicitis. CRP demonstrated the strongest association with severity, with mean levels of 101.38 ± 68.08 mg/L in complicated cases compared to 22.74 ± 17.80 mg/L in uncomplicated cases (p<0.001). CRP values progressively increased from simple inflammation to gangrenous, necrotic, and perforated appendicitis. Conclusion: Elevated CRP levels strongly correlate with the severity of acute appendicitis in children. CRP, particularly when combined with WBC count and neutrophil percentage, serves as a valuable adjunctive marker for identifying complicated appendicitis and facilitating timely clinical decision-making.

Background: Neonatal hyperbilirubinaemia is one of the most frequent morbidities of the first week of life, occurring in approximately 60% of term and 80% of preterm infants. Phototherapy is the first-line treatment, but it is increasingly recognised to perturb mineral and vitamin D homeostasis. Hypocalcaemia and disturbances in 25-hydroxy-cholecalciferol [25(OH)D] levels are potentially preventable complications that remain under-investigated in the Indian subcontinent. Objectives: To determine the effect of phototherapy on serum total calcium and 25-hydroxy-cholecalciferol concentrations in term neonates receiving phototherapy for unconjugated hyperbilirubinaemia at a tertiary care hospital, and to identify clinical correlates of post-phototherapy mineral changes. Materials and Methods: This prospective analytical study was conducted in the Special Newborn Care Unit (SNCU), Department of Paediatrics, R. G. Kar Medical College and Hospital, Kolkata, over 18 months. A total of 150 term neonates weighing ≥2500 g and on exclusive breastfeeding who required phototherapy for unconjugated hyperbilirubinaemia were enrolled. Total serum bilirubin, total serum calcium and 25-hydroxy-cholecalciferol were measured before initiation of phototherapy and after 48 hours of continuous phototherapy. Hypocalcaemia was defined as total serum calcium <8 mg/dL and vitamin D deficiency as 25(OH)D <20 ng/dL. Data were analysed with SPSS v16.0 using paired t-test, Mann-Whitney U test, McNemar’s test and Pearson correlation; p<0.05 was considered significant. Results: The mean age of neonates was 4.17 ± 1.28 days; 60% were male; mean birth weight was 2.98 ± 0.27 kg; mean gestational age was 38.77 ± 0.76 weeks. Mean total serum bilirubin decreased significantly from 14.35 ± 2.04 mg/dL to 11.47 ± 1.74 mg/dL (mean change 2.88 ± 2.33 mg/dL; p=0.0001). Mean total serum calcium declined from 11.05 ± 1.62 mg/dL to 8.96 ± 1.05 mg/dL (mean change 2.09 ± 1.63 mg/dL; p=0.0001), and mean 25(OH)D fell from 36.64 ± 6.54 ng/dL to 14.06 ± 5.28 ng/dL (mean change 22.58 ± 6.02 ng/dL; p=0.0001). The incidence of hypocalcaemia rose from 0.7% to 8.7% (p=0.002) and that of vitamin D deficiency rose from 2.7% to 90.7% (p=0.0001). The mean fall in calcium was significantly greater in male neonates (2.35 ± 1.55 mg/dL) than in females (1.69 ± 1.68 mg/dL; p=0.01), and birth weight correlated positively with the magnitude of calcium decline (r=0.27, p=0.001). Conclusion: Phototherapy administered for 48 hours to term neonates with unconjugated hyperbilirubinaemia produces a statistically significant fall in both serum calcium and 25-hydroxy-cholecalciferol concentrations and substantially increases the incidence of biochemical hypocalcaemia and vitamin D deficiency. Routine monitoring of serum calcium and vitamin D should be considered in neonates undergoing prolonged phototherapy, with prophylactic calcium and vitamin D supplementation in those receiving phototherapy beyond 48 hours.

Introduction: The present study shares the knowledge of normal and the variant anatomy in the branching pattern of main trunk of Left coronary artery which has a vital role in clinical application to overcome the problems that encounter during various surgical procedures of heart. Materials and Methods: The study was conducted in 30 formalin fixed human cadaveric hearts of both sexes obtained from the department of Anatomy and carefully dissected to observe the main trunk of left coronary artery. Results: It was observed that Left coronary artery shows bifurcation in 80%, trifurcation in 16.6%, and quadrification in 3.33% of specimens. Conclusion: The present study helps the physician and the cardiac surgeons for interpretation of the coronary angiograms and their surgical repair.

Background: Invasive fungal infections represent a major challenge in solid organ transplantation due to the risk of reactivation under immunosuppression. Aspergillus pericarditis is an uncommon manifestation associated with high mortality, and data guiding transplant decisions after such infections are limited. Case Presentation: A 48-year-old female with end-stage renal disease on hemodialysis presented with constrictive pericarditis and severe hypotension. Aspergillus fumigatus isolated by tissue culture after subtotal pericardiectomy. She was treated with voriconazole for four months with complete clinical resolution and underwent deceased donor kidney transplantation two months after treatment. The patient required temporary hemodialysis due to immediate postoperative delayed graft function and tacrolimus was started four days later. Secondary prophylaxis from transplantation onwards was with isavuconazole, due to its mild, highly predictable CYP3A4 inhibition that allowed safe titration of calcineurin inhibitors without volatile toxic spikes. Kidney transplantation was successful with no rejection or major infection. Over a 2-year follow-up, the patient had stable allograft function without fungal recurrence. Conclusion: Kidney transplantation may be feasible in selected patients with previously treated invasive aspergillosis when careful risk stratification, pre-transplant mycological eradication with the strategic deployment of newer-generation triazoles like isavuconazole to safely manage complex post—transplant pharmacokinetic interactions and tailored immunosuppression.

Objective: To present a case of staghorn renal calculus diagnosed through clinical and radiological evaluation and managed successfully with percutaneous nephrolithotomy (PCNL) at a specialized urology centre. Methods: A 58-year-old male presented with chronic right-sided flank pain, burning micturition, recurrent urinary tract infections, decreased appetite, and occasional fever. Clinical examination, laboratory investigations, and CT urography were performed for diagnostic evaluation. Results: CT urography revealed a 2.5 × 1.9 cm right renal staghorn calculus with multiple smaller calculi and upper pole calyceal dilatation. The patient was referred to the urology team, where PCNL was performed successfully with complete stone clearance. The postoperative period was uneventful except for transient fever, and the patient was discharged in stable condition. Conclusion: This case highlights the importance of early diagnosis, appropriate imaging, and timely referral in the management of staghorn renal calculi. Coordinated care with specialized teams can lead to favorable clinical outcomes.

Background: Pain and disability from knee osteoarthritis is a major problem, and excess body weight is a significant modifiable risk factor. Body mass index (BMI), clinical symptoms and radiographic severity are important for early intervention. Methods: A cross sectional study of 220 adults with symptomatic knee osteoarthritis. The clinical severity was evaluated by pain visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The Kellgren-Lawrence (KL) system was used to grade weight-bearing anteroposterior and lateral knee radiographs. BMI was classified as normal, overweight, obese class I and obese class II or higher. Results: Mean age was 58.9 +/- 8.7 years; 128 patients (58.2%) were female. Mean BMI was 28.7 +/- 4.6 kg/m2. 94 patients (42.7%) had KL grade III-IV disease. There was a significant correlation between BMI and VAS, WOMAC and KL grade (p<0.001). The mean WOMAC score was 61.8 +/- 13.4 in patients with a BMI of class II or higher, and 38.6 +/- 12.1 in normal BMI patients. BMI correlated positively with KL grade (r=0.46), VAS (r=0.41), and WOMAC (r=0.49; all p<0.001). Conclusion: Increased BMI was significantly associated with worse clinical and radiological knee osteoarthritis. Weight management should be a key part of osteoarthritis treatment.

Background: Pneumoperitoneum during laparoscopic surgery under general anesthesia is known to cause a decrease in pulmonary compliance and increase in airway pressures. Traditionally, endotracheal tubes (ETTs) have been used because they create a definitive airway, while second generation supraglottic airway devices (SGAs) have been shown to seal the airway better and to drain the stomach with less stimulation of the airway. The aim of the present study was to compare the incidence of airway complications in ETT and SGA in elective laparoscopy. Methods: This was a prospective comparative study of 120 adult ASA physical status I-II patients undergoing elective laparoscopic surgery. Patients were randomized to either ETT (n=60) or SGA (n=60; second generation device with gastric drainage channel). The following were used: standardized induction, neuromuscular blockade, controlled ventilation, pneumoperitoneum pressure, and postoperative assessment. The main outcome was the composite of airway complications within 24 hours. Secondary outcomes were device insertion characteristics, ventilatory variables, hemodynamic responses, postoperative sore throat, cough, and hoarseness, nausea-vomiting, and PACU discharge time. Results: There were no differences in baseline characteristics between groups. The mean insertion time was significantly less for SGA than ETT (15.2±3.8 vs. 22.8±5.4 seconds; p<0.001). Peak airway pressure following pneumoperitoneum was similar (23.4±3.8 vs. 24.1±4.2 cmH2O; p=0.34), and the increase in mean arterial pressure during insertion was less with SGA (8.6±5.7 vs. 15.8±7.1 mmHg; p<0.001). The composite airway complication rate was significantly greater in the ETT group (43.3%) compared to the SGA group (20.0%) (p=0.006). Sore throat (31.7% vs. 11.7%; p=0.008), emergence cough (26.7% vs. 8.3%; p=0.009), and hoarseness (18.3% vs. 5.0%; p=0.024) were more frequent after ETT. None of the patients had aspiration, regurgitation or clinically significant bronchospasm. Conclusions: In the right adult patient undergoing elective laparoscopic surgery, second-generation SGA was effective for ventilation and was found to be associated with fewer postoperative airway complications and a more stable hemodynamic response than ETT.

Background: Comparative Study of Nutrient Foramina Distribution in Long Bones among Different Age Groups, is a clinically relevant diagnostic and anatomical problem that is encountered in routine tertiary care practice. The aim of this study was to compare the number, topography, direction and foraminal index of nutrient foramina of long bones in various age groups. Method: The methods used were comparative osteological observational study in the Department of Anatomy bone museum and osteology laboratory. The study included 240 dry adult and adolescent long bones categorized into three age groups using documented skeletal collections. The participants/specimens were divided into adolescent, young adult and older adult bone groups. Standardized data collection, laboratory/radiological/anatomical assessment and predefined operational criteria were used. Results: 81.7% of the bones had a single nutrient foramen, 15.0% had two and 3.3% had none. The most frequent location was the middle third (62.1%). There was a greater percentage of accessory foramina in older adult bones compared to adolescent bones (21.3% vs 10.0%, p=0.031). In 94.6% of cases, direction was in accordance with the rule, away from the growing end. Conclusion: Age-group differences were found to be relatively small, but accessory foramina were more common in older adult bones, highlighting the need for preservation of the vascular entry zones of the diaphyses in orthopedic surgery.

Introduction: Elective surgery often leads to pain that is not amenable to simple measures. Intranasal use provides systemic access without an intravenous route; tramadol, used intravenously, shares one mechanistic feature with the dual acting agent but not the second. Aim: To compare analgesic efficacy provided by Intranasal Tapentadol and Intravenous Tramadol in patients undergoing Elective General Surgery. Objectives: (1) To compare analgesic efficacy between the two study drugs. (2) To compare the hemodynamic stability between the two study groups. (3) To determine incidence of post-operative nausea and vomiting between the two study drugs. Study Design: The study was designed as a Prospective Randomized. Controlled study Study Place: The study was carried out at Kempegowda Institute of Medical Sciences, Bengaluru. Study Period: The study was conducted over the course of one year. Study Participants: After IEC approval is obtained, 72 patients satisfying the inclusion and the exclusion criteria will be included in the study. Sample Size: For 2 groups, the total sample size will be 72 subjects (36 subjects in each group). Result: A total of 72 patients were enrolled and equally randomized into two groups (n = 36 each). Baseline characteristics were comparable between the groups, ensuring the internal validity of the study. Discussion: In this study, hemodynamic parameters (SBP, DBP, MAP, and PR) were monitored across both Intranasal Tapentadol and Intravenous Tramadol groups. Baseline values for all parameters were comparable between the groups.

Background: Effective post-operative analgesia is crucial for enhancing recovery and reducing opioid requirements in patients undergoing total knee arthroplasty (TKR). Levobupivacaine is a commonly used local anaesthetic in adductor canal blocks (ACB) for TKR; however, its duration of analgesia can be limited. Dexmedetomidine, an alpha-2 adrenergic agonist, is recognized for its analgesic properties and potential to extend the effects of local anaesthetics. This study evaluates the effectiveness of Levobupivacaine versus Levobupivacaine combined with Dexmedetomidine in enhancing analgesic duration and quality in patients undergoing total knee arthroplasty. Objectives: This study aimed to assess the duration of analgesia, 24-hour opioid consumption, success of early ambulation, patient satisfaction, and to look for any adverse effects or complications in patients receiving Levobupivacaine versus Levobupivacaine with Dexmedetomidine in ACB after total knee arthroplasty. Methods: A prospective, randomized clinical trial was conducted among a total of 100 patients with two patient groups undergoing TKA. Patients undergoing elective TKR surgeries, aged between 18 and 70 years of age and categorized under American Society of Anesthesiologists (ASA) class 1 to 3 were included in this study. Group A (50 patients) received Levobupivacaine alone in ACB, while Group B (50 patients) received a combination of Levobupivacaine with Dexmedetomidine. Heart rate and blood pressure were monitored at baseline, every 15 minutes for the first hour, then at 2, 5, 12, and 24 hours post-operatively. Quadriceps power was recorded preoperatively and at 6, 12, and 24 hours after the block. Patient satisfaction and any adverse events were noted at 24 hours. Rescue analgesia was provided with 75 mg diclofenac or 100 mg tramadol with 4 mg ondansetron intravenously, and total 24-hour requirements for tramadol and diclofenac were documented. The data was collected were tabulated using Microsoft excel sheet and was analyzed in SPSS trial version 23.0 using chi-square test or Fishers exact test. p<0.05 was considered to be statistically significant. Results: Group B showed a significantly delayed need of rescue analgesia of around 6 hours compared to Group A of around 3 hours. VAS pain scores were generally lower in Group B from 2 to 12 hours post-operatively, although a slight increase was noted at 24 hours, indicating extended pain relief. The mean total dose of rescue analgesia in Group A was significantly higher (301.5 mg) of tramadol compared to Group B (139.5 mg) of tramadol, indicating that the total dose of rescue analgesia requested is significantly higher in Group A than in Group B. Both groups demonstrated comparable physiological stability, with no significant differences in heart rate, blood pressure, or oxygen saturation. Differences in ASA grade and BMI were noted between the groups but did not significantly affect primary or secondary outcomes. Conclusion: Adding Dexmedetomidine to Levobupivacaine in ACB for TKR significantly enhanced the duration and quality of post-operative analgesia without compromising physiological stability. This combination reduced immediate opioid requirements and improve patient comfort, supporting its broader application in clinical settings for post-operative pain management.

Background: Solitary thyroid nodule (STN) is one of the most common endocrine surgical presentations encountered in clinical practice. Although the majority of thyroid nodules are benign, the possibility of malignancy necessitates detailed clinical evaluation, radiological assessment, cytological investigation, and appropriate surgical management. Fine Needle Aspiration Cytology (FNAC), ultrasonography (USG), and histopathological examination remain the cornerstones in the diagnosis and management of solitary thyroid nodules. Aim: To study the clinicopathological features, diagnostic modalities, incidence of malignancy, and management outcomes in patients presenting with solitary thyroid nodules. Materials and Methods: A hospital-based cross-sectional observational study was conducted in the Department of General Surgery at RCSM Government Medical College, Kolhapur, Maharashtra, India, from September 2017 to February 2019. A total of 60 patients with clinically diagnosed solitary thyroid nodules were included using systematic random sampling. Detailed clinical history, examination findings, thyroid function tests, ultrasonography, FNAC, indirect laryngoscopy, and histopathological examination were performed. Data were analyzed using Epi Info 7.2 software. Descriptive and inferential statistical analyses were applied. Results: The majority of patients belonged to the age group of 20–39 years (48.3%), with a mean age of 38.1 ± 6.8 years. Female predominance was observed (81.7%). Right lobe involvement was more common (61.7%). Most patients were euthyroid (86.7%). FNAC revealed benign lesions in 43.3% of cases and malignancy in 18.3% of cases. Histopathological examination demonstrated follicular adenoma in 26.7%, multinodular goiter in 26.6%, and carcinoma in 21.7% of cases. Papillary carcinoma was the commonest malignant lesion (61.5%). Hemithyroidectomy was the most frequently performed surgical procedure (83.3%). Conclusion: Solitary thyroid nodules are more common in females and predominantly occur in the third and fourth decades of life. FNAC and ultrasonography are highly valuable diagnostic tools for preoperative evaluation. Papillary carcinoma remains the most common malignant lesion. Early diagnosis and timely surgical intervention significantly improve prognosis and reduce complications.

Background: Accurate estimation of skin-to-subarachnoid space depth (SSD) is essential for successful spinal anesthesia and minimizing complications. Anthropometric parameters such as body mass index (BMI) may influence spinal needle depth; however, their predictive accuracy requires validation using advanced statistical models. Methods: A prospective observational study was conducted on 100 patients undergoing elective below-umbilical surgeries under spinal anesthesia. Anthropometric variables (weight, height, BMI, arm circumference [AC], and waist circumference [WC]) were recorded. Spinal needle depth (SND) was measured intraoperatively at L3–L4 interspace. Pearson correlation, multivariate linear regression, and receiver operating characteristic (ROC) analysis were performed (Table 3, Table 4, Table 5, Table 6). Results: Mean SND was 5.20 ± 0.73 cm, while predicted depth using Bonadio’s formula was 5.62 ± 0.66 cm (Table 3). Significant correlations were observed between SND and weight (r = 0.812), BMI (r = 0.668), WC (r = 0.666), and AC (r = 0.643) (p < 0.001) .Multivariate regression identified weight (β = 0.031, p < 0.001) and BMI (β = 0.018, p = 0.002) as independent predictors. SND = 1.96 + (0.031 × weight) + (0.018 × BMI) (R² = 0.72). ROC analysis demonstrated excellent predictive ability: weight AUC = 0.91 (sensitivity 88%, specificity 82%); BMI AUC = 0.84 (sensitivity 81%, specificity 75%). Conclusion: Weight and BMI are strong independent predictors of spinal needle depth. A multivariate model enhances predictive accuracy and may improve clinical outcomes by reducing procedural attempts. Keywords: Spinal anesthesia; BMI; Needle depth; Anthropometry; ROC analysis.

Background: Type 2 diabetes mellitus (T2DM) is a major contributor to global cardiovascular morbidity and mortality. Silent myocardial ischemia (SMI), characterized by objective evidence of ischemia without anginal symptoms, is particularly prevalent in diabetic individuals due to cardiac autonomic neuropathy. Microalbuminuria (MAU), a marker of endothelial dysfunction, has emerged as a predictor of cardiovascular disease. This study aimed to evaluate the association between MAU and SMI in asymptomatic T2DM patients. Methods: A hospital-based cross-sectional study was conducted over one year (June 2024–May 2025) involving 50 asymptomatic T2DM patients aged 30–60 years with confirmed microalbuminuria (urine albumin-to-creatinine ratio >30 mg/g). Patients with known coronary artery disease (CAD), hypertension, resting ECG abnormalities, or contraindications to treadmill testing were excluded. All participants underwent detailed clinical evaluation, BMI calculation using Quetelet’s index, resting 12-lead ECG, spot urine albumin-to-creatinine ratio, and symptom-limited treadmill exercise testing (TMT) using the modified Bruce protocol. A positive TMT was defined as ≥1 mm horizontal or down-sloping ST-segment depression measured 60–80 ms after the J-point in three consecutive beats without anginal symptoms. Statistical analysis was performed using SPSS version 20.0. Continuous variables were expressed as mean ± SD; categorical variables as frequencies and percentages. Chisquare test was used for associations; p < 0.05 was considered statistically significant. Odds ratios (OR) with 95% confidence intervals (CI) were calculated where applicable. Results: The mean age of the study population was 49.8 ± 6.1 years (range 34–58 years). Males constituted 58% (n=29). Mean BMI was 25.8 ± 3.1 kg/m²; 40% (n=20) had normal BMI, 46% (n=23) were overweight, and 14% (n=7) were obese. Duration of diabetes was <5 years in 14% (n=7), 6–9 years in 60% (n=30), and >10 years in 26% (n=13). SMI was detected in 64% (32/50; 95% CI: 50.6–77.4%) by TMT. A highly significant association existed between SMI and duration of diabetes (p < 0.001), with 100% prevalence in patients with >10 years duration. BMI showed a significant association (p = 0.041; OR for overweight = 2.8, 95% CI: 1.1–7.3). No statistically significant association was observed with age (p > 0.05) or sex (p > 0.05). Conclusion: Microalbuminuria is strongly associated with silent myocardial ischemia in asymptomatic T2DM patients, with a prevalence of 64%. Duration of diabetes and higher BMI are independent predictors. Routine screening with urine albumin-to-creatinine ratio followed by TMT enables early detection and may reduce cardiovascular risk in this high-risk population.

Background: Endotracheal tube (ETT) cuff pressure (CP) monitoring is essential during general anaesthesia to prevent airway complications associated with overinflation and underinflation of the cuff. Laparoscopic surgeries, particularly those involving pneumoperitoneum and positional changes, are associated with significant physiological alterations that may influence ETT cuff pressure. Elevated cuff pressure may compromise tracheal mucosal perfusion and increase postoperative airway morbidity. Aim: To compare changes in endotracheal tube cuff pressure during laparoscopic surgeries performed in head-up and head-down positions with open abdominal surgeries. Materials and Methods: A prospective comparative study was conducted in the Department of Anaesthesiology at a tertiary care teaching hospital over a period of 21 months. A total of 150 adult patients undergoing elective abdominal surgeries under general anaesthesia were included and divided equally into three groups: Group A – open abdominal surgeries, Group B – laparoscopic surgeries in head-up position, and Group C – laparoscopic surgeries in head-down position. Endotracheal tube cuff pressure was adjusted to 25 cm H2O after intubation using an aneroid cuff manometer and serial measurements were obtained intraoperatively. Postoperative airway complications including sore throat, throat pain, hoarseness of voice, and blood-streaked expectoration were assessed. Results: Baseline demographic characteristics were comparable among the three groups. Mean cuff pressure increased progressively in all groups; however, the increase was significantly greater in laparoscopic procedures, especially in head-down position. At 60 minutes, mean cuff pressures were 25.2±0.5 cm H2O in Group A, 28.2±0.6 cm H2O in Group B, and 30.2±1.5 cm H2O in Group C (p=0.004). Postoperative sore throat and throat discomfort were more frequent in Group C compared to Groups A and B. Conclusion: Laparoscopic surgeries, especially those performed in Trendelenburg position, are associated with significant increases in endotracheal tube cuff pressure. Continuous intraoperative cuff pressure monitoring and periodic adjustment are recommended to minimize postoperative airway complications.

Background: Anal fissures are among the most painful conditions and are incredibly common. It can be extremely concerning since, in the case of an acute lesion, the degree of discomfort and handicap experienced by the patient significantly surpasses what would be anticipated from a relatively insignificant lesion. The two most popular treatments for anal fissures, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS), are compared in this study. Methods: From May 2025 to October 2025, GMCH, Bettiah, West Champaran, Bihar, was conducted a prospective study comparing MAD with LAS for the treatment of persistent anal fissures. Thirty patients who satisfied the inclusion criteria were randomly assigned to receive either MAD or LAS, and their post-operative discomfort, complications, hospital stay, recurrence rates, and compliance were examined. Results: A total of thirty patients were assigned at random to either LAS or MAD. Patients who have had LAS experience improved pain alleviation and a somewhat higher risk of infection. Compared to LAS, those who have had MAD had a lower risk of infection, recurrence rates, and sequelae. Conclusion: For the treatment of acute anal fissures, MAD and LAS are similarly safe, efficacious, and have lower recurrence rates. However, the MAD group experienced somewhat more postoperative pain.

Background: A stoma is a surgically externalization of the colon or ileum to the front of the abdominal wall. The most common causes of fecal stomas include acute abdominal trauma, carcinoma, and inflammatory bowel disease. A person with a stoma may experience both physical and psychological distress. In accumulation, complications during stoma are very common. Methods: The study, which was held August 2025 to January 2026 at the Department of General Surgery, GMCH, Bettiah, West Champaran, Bihar, involved fifty patients. All patients who had stoma closure and satisfied the inclusion criteria made up the study population. Patients of all ages who underwent stoma closure for a non-malignant condition were included in the study. Stoma closure for patients undergoing surgery for cancer, inflammatory bowel disease, or tuberculosis was not included by the study. This study group had a variety of issues, complications with different treatments, and complications with different stoma closure intervals. Results: There were less postoperative linked to early stoma closure and intraoperative application of the direct stoma closure technique. By using subcutaneous drain implantation, we can reduce the risk of wound infection and dehiscence. Conclusion: Postoperative problems can be utilizing the appropriate technique and closing the stoma at the appropriate time.

Background: Sepsis remains one of the leading causes of morbidity and mortality among critically ill children worldwide. Early identification of patients at high risk of adverse outcomes is essential for timely intervention and optimization of intensive care management. Lactate clearance has emerged as a dynamic biomarker reflecting tissue perfusion and response to resuscitation. However, evidence regarding its prognostic utility in pediatric sepsis remains limited. Aim: To evaluate the prognostic value of early lactate clearance in predicting mortality among critically ill children with sepsis admitted to a pediatric intensive care unit (PICU). Materials and Methods: A prospective observational study was conducted among 120 children with sepsis admitted to the PICU of a tertiary care teaching hospital. Blood lactate levels were measured at admission, 6 hours, and 12 hours after admission. Lactate clearance was calculated at 6 and 12 hours. Demographic characteristics, clinical parameters, vasoactive inotropic score (VIS), Pediatric Risk of Mortality (PRISM) score, duration of mechanical ventilation, PICU stay, and survival outcomes were recorded. Statistical analyses included independent t-tests, Mann–Whitney U tests, chi-square tests, receiver operating characteristic (ROC) analysis, correlation analysis, and logistic regression. Results: The overall mortality rate was 34.2%. Survivors demonstrated significantly higher lactate clearance at both 6 hours and 12 hours compared with non-survivors (p<0.001). Median 12-hour lactate clearance was 71.1% among survivors and −27.3% among non-survivors. Logistic regression identified 12-hour lactate clearance as an independent predictor of survival (OR=0.925; 95% CI: 0.895–0.947; p<0.001). Lactate clearance showed significant correlations with PRISM scores, VIS scores, mechanical ventilation duration, and PICU stay. Conclusion: Early lactate clearance, particularly at 12 hours, is a reliable and independent predictor of mortality in pediatric sepsis. Serial lactate monitoring may serve as a valuable bedside tool for risk stratification and therapeutic monitoring in critically ill children.

Background: Critically ill children admitted to pediatric intensive care units (PICUs) are at increased risk of morbidity and mortality due to severe underlying illnesses, multiorgan dysfunction, hemodynamic instability, and acute kidney injury (AKI). Early identification of risk factors and prognostic indicators is essential to improve outcomes and optimize resource utilization in critically ill pediatric patients. Aim: To evaluate the clinical profile, risk factors, and outcomes of critically ill children admitted to a Pediatric Intensive Care Unit and to assess factors associated with adverse outcomes including acute kidney injury and mortality. Methods: A prospective observational study was conducted among 300 children admitted to the PICU of a tertiary care teaching hospital from September 2022 to February 2024. Children aged 1 month to 18 years requiring intensive care admission were enrolled. Demographic characteristics, nutritional status, primary diagnosis, need for mechanical ventilation, vasopressor support, nephrotoxic medication exposure, duration of PICU stay, Pediatric Risk of Mortality (PRISM-III) scores, Renal Angina Index (RAI), and outcomes were recorded. AKI was diagnosed using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Statistical analysis was performed using SPSS software. Results: Among 300 enrolled children, 57.0% were aged below 2 years and 50.7% were males. Gastrointestinal (33.0%), respiratory (28.0%), and central nervous system disorders (19.3%) were the most common primary diagnoses. Malnutrition was observed in 18.7% of patients. Mechanical ventilation was required in 11.0%, vasopressor support in 7.3%, and nephrotoxic medications were administered to 28.7% of patients. The mortality rate was 4.7%. Higher PRISM-III scores were significantly associated with mortality. Patients with RAI ≥8 demonstrated significantly increased mortality and higher risk of AKI development. RAI showed significant correlation with illness severity and KDIGO staging. Conclusion: Critically ill pediatric patients admitted to the PICU are at substantial risk for adverse outcomes. Younger age, severe illness, requirement for organ support, nephrotoxic exposure, elevated PRISM-III scores, and higher RAI values were associated with worse outcomes. Early risk stratification and intensive monitoring may improve clinical outcomes and reduce mortality.

Introduction: In recent years, the use of LCPs (Locking Compression Plates) has emerged as a promising treatment approach for tibial plateau fractures. LCPs provide rigid fixation and allow for the preservation of the fracture biology, which may improve the overall clinical and radiological outcome. This work was carried out to study the functional outcome of the fracture of proximal tibia and to evaluate the advantages and disadvantages in terms of positive outcome of fracture union, patient compliance and complication of surgical correction with locking compression plates. Materials and Methods: This was a prospective study conducted over a period of 18 months involving 34 adults aged 18 – 65 years having closed tibial fracture of Schatzkers type 1-5 treated with MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis). Patients were followed up for a period of 6 months with both clinical and radiological parameters according to Rasmussen’s score. Results: Rasmussen’s scores were higher for Schatzker II-III (~29) than for Schatzker V-VI (~25). Patients with simple fractures regained ROM of ~130°, while complex fractures exhibited significant variability (90–120°). Fracture union occurred within 14–20 weeks in most patients. Early weight-bearing (~12 weeks) was achieved in Schatzker II-III but delayed for Schatzker V-VI (~16–20 weeks) to ensure stability. Complex fractures (Schatzker VI) showed higher complication rates (~20%) compared to simpler ones (~10%). Conclusion: Excellent clinical and radiological outcomes of tibial plateau fractures managed with locking compression plates were observed, as evidenced by better Rasmussen’s score, faster union, better range of motion and early weight-bearing especially among Schatzker I and II cases, when the surgery is performed early with minimal complications.

Background: Tuberculosis (TB) remains a major public health problem in India and continues to contribute substantially to childhood morbidity and mortality. Information regarding the sociodemographic characteristics and treatment outcomes of pediatric tuberculosis patients is essential for strengthening tuberculosis control programmes. Objectives: To assess the sociodemographic profile and treatment outcomes among pediatric tuberculosis patients attending a tertiary care hospital in Dehradun, Uttarakhand. Methods: A hospital-based descriptive longitudinal study was conducted among 100 pediatric tuberculosis patients aged 0–14 years registered under the National Tuberculosis Elimination Programme (NTEP) from February 2025 to November 2025. Eligible patients were consecutively enrolled and followed up until completion of treatment. Data regarding sociodemographic characteristics, history of contact, and treatment outcomes were collected using a structured questionnaire and analysed using descriptive statistics. Results: A total of 100 pediatric tuberculosis patients were included in the study. Females constituted 61% of cases and the highest proportion of patients (39%) belonged to the 1–5 years age group. Most patients belonged to nuclear families (74%), had illiterate parents or guardians (52%), and were from lower socioeconomic strata (93%). A history of contact with tuberculosis was present in 21% of patients, of whom 85.7% had contact with a sputum-positive adult tuberculosis patient. Regarding treatment outcomes, 91% completed treatment, 8% were declared cured, and 1% died, resulting in an overall treatment success rate of 99%. Among 10 patients with tuberculous meningitis, sequelae were observed in one patient. Conclusions: Pediatric tuberculosis was more common among females and children aged 1–5 years. Most patients belonged to socioeconomically disadvantaged families. The high treatment success rate observed in the study reflects the effectiveness of NTEP services. Strengthening contact tracing, community awareness, early diagnosis, and timely treatment may further improve outcomes among children with tuberculosis.

Background: Prurigo nodularis (PN) is a chronic, intensely pruritic skin disorder characterized by hyperkeratotic nodules, significantly impacting the quality of life. The disease is often recalcitrant to conventional treatments such as topical corticosteroids, antihistamines, and immunosuppressants. Emerging evidence suggests that the Janus kinase (JAK)-STAT pathway plays a crucial role in the pathophysiology of PN, making JAK inhibitors such as tofacitinib a promising therapeutic option. Objective: This study aims to evaluate the efficacy and safety of oral tofacitinib in patients with recalcitrant PN who have failed conventional treatments. Methods: A prospective observational study was conducted on 50 patients with histopathologically confirmed recalcitrant PN. Patients received oral tofacitinib (5 mg twice daily) for 12 weeks. The primary outcome was assessed using the Investigator Global Assessment (IGA) scale and the Numeric Rating Scale (NRS) for pruritus. Secondary outcomes included Dermatology Life Quality Index (DLQI) scores, the percentage of patients achieving 50% improvement in pruritus, and safety assessments. Results: At the end of 12 weeks, 80% (40/50) of patients showed significant improvement in IGA scores (p < 0.001), while NRS scores decreased from 8.2 ± 1.4 to 2.3 ± 1.1 (p < 0.001). DLQI scores improved significantly, reflecting a better quality of life (p < 0.01). Mild adverse effects such as headaches and gastrointestinal discomfort were reported in 10% of patients, but no serious adverse events occurred. Conclusion: Tofacitinib demonstrates significant efficacy in reducing pruritus and improving quality of life in patients with recalcitrant PN. It may serve as an effective alternative for patients unresponsive to conventional treatments, with a favorable safety profile.

Background: Dermatophytosis is a common superficial fungal infection with increasing chronicity, recurrence and treatment resistance in India. As dermatophytes are confined mainly to the cornified epidermis, keratolytic peeling with salicylic acid may reduce fungal burden by promoting exfoliation of infected stratum corneum. Materials and Methods: This hospital-based prospective interventional study included 40 adults with clinically active tinea infection and positive potassium hydroxide mount. A 35% salicylic acid solution was applied to selected lesions and neutralized after 5 minutes. The procedure was repeated once weekly for 4 weeks. Repeat KOH examination was performed at week 5. The primary outcome was mycological clearance. Results: The mean age was 35.52 ± 11.69 years, and 22 patients (55.0%) were male. After four weekly sittings, KOH negativity was achieved in 22 patients (55.0%), while 18 patients (45.0%) remained KOH-positive. Sustained clearance without recurrence was observed in 15 patients (37.5%). Response was significantly higher among resistant or recurrent cases than among non-resistant/new cases (80.0% versus 40.0%; p=0.022). Burning sensation was the commonest local adverse effect, and no serious systemic adverse event was observed. Conclusion: A 35% salicylic acid peel achieved KOH negativity in more than half of patients with localized tinea infection and showed better response among treatment-resistant or recurrent cases. It may serve as an inexpensive, resistance-sparing adjunct or alternative in selected cases, although controlled trials with longer follow-up are required.

Background: Pathologists require an adequately filled requisition form to ensure a reliable and good quality cytopathological report. Inadequately filled laboratory requisition forms may result in error and negatively affect patient care. Objectives: To assess the completeness of Fine needle aspiration cytology (FNAC) laboratory requisition forms (LRFs) submitted to the laboratory. Materials and Methods: This is a retrospective cross sectional study where 312 Fine needle aspiration cytology forms sent to the Cytopathology Laboratory of Shija Academy of Health sciences, Imphal, Manipur, India over a period of six months were retrieved from the archives and evaluated for their completeness regarding various parameters. Also clarity of data was assessed. Results: Patient details such as name, age, gender, and unique identification number were consistently mentioned (100%) in all the FNAC LRFs. The clinician’s name was mentioned in a majority of the forms, however rest of the clinician details were missing in most forms. The clinical detail present in most forms was the site of the lesion. Conclusion: Several deficiencies have been found in a majority of the LRFs which can impact the cytopathological diagnosis and the overall patient care.

Introduction: Breast cancer, a type of cancer that originates in the breast tissue, is considered as an important public health problem in all the countries, especially in the developing countries. It is the commonest malignancy affecting women worldwide and is the leading cause of cancer related deaths. Aim: The aim of this study was to analyze the sociodemographic and clinical profile of confirmed breast cancer patients. Materials and Methods: This was a retrospective observational study done at State Cancer Institute, Guwahati. Data of Breast Cancer patients registered during the five-year study period (2018- 2022) were collected from Hospital Based Cancer Registry (HBCR) and the institutional ICMR-NCDIR (National Centre for Disease Informatics and Research Department). The parameters taken for study were age, sex, marital status, religion, education level, residence (urban/rural), stage at time of presentation, primary histology and morphology, histological type, laterality (right/left), the quadrant of the breast involved and metastasis. Results: A total of 1563 cases were analyzed of which 1529 were female (97.83%) and 34 were male (2.17%) with a male female ratio of 1:45. The age of patients ranged between 16 to 84 years and majority were urban based. Carcinoma on right breast was more common, upper outer quadrant of the breast was the most commonly affected site. Most of the patients presented in Stage II (41%) and 15% of the patients were in Stage IV with metastasis. Bony metastasis was the commonest (47%) followed by lung metastasis (27%). NOS was the most common Primary Histology –Morphology. Conclusion: The pattern found in our study was similar to other Indian studies where breast cancer is common among younger age groups in contrast to western countries where breast cancer is seen in post-menopausal women. Most of the patients presented in the advanced stage. The results show a trend in rise of prevalence in younger age groups, more males affected than previous studies and presentation in the advanced stage. There is urgent need for awareness programs, population screening for early diagnosis of breast cancer which will improve the overall outcome of management of breast cancer.

Introduction: Leprosy is an infection caused by Mycobacterium leprae that affects the skin and nerves. The presenting features of leprosy include macules and papules, anesthesia or paresthesia over lesions, neuritis and reactions that vary in each leprosy patient. Histological features of skin biopsy are an important tool in diagnosing leprosy and determining the type of leprosy. Clinical and histopathological findings in leprosy vary according to the immunological status of each patient. Aim: To study clinical and histopathological correlation among the newly diagnosed leprosy cases. Materials and Methods: Twenty-one untreated clinically diagnosed cases of leprosy between December 2022 to November 2023, classified according to RIDLEY AND JOPLING`S (1966) classification system were included in the study. Hematoxylin & Eosin (H & E) and Fite-Faraco staining techniques were used. Upon confirmation, the diagnoses were correlated, concordance and discordance were noted and analyzed. Results: In this study, the male to female ratio was 1.3:1. The most commonly affected age group was 31-40 years and maximum clinic-histopathological correlation was seen in lepromatous leprosy (75%) followed by tuberculoid leprosy (66.66%). Fite-Faraco stain was positive only in 6 cases (28.57%). Conclusion: Clinico-pathological correlation is maximum in polar groups as they are stable. However, maximum disparity is seen in borderline cases as they have histopathological changes that vary based on different sites as well as different lesions in the same patient.

Background: Respiratory distress is one of the most common causes of neonatal intensive care unit (NICU) admission. Early identification of neonates requiring ventilatory support is critical for timely intervention and improved outcomes. Point-of-care lung ultrasound (LUS) has emerged as a rapid, radiation-free bedside tool for assessing neonatal lung pathology. Objective: To evaluate the role of point-of-care lung ultrasound in predicting the need for ventilatory support in neonates presenting with respiratory distress. Methods: A prospective observational study was conducted in the NICU of a tertiary care hospital. Neonates with clinical signs of respiratory distress were enrolled. Lung ultrasound was performed at admission using a standardized scanning protocol. LUS scores were calculated based on lung aeration patterns. Clinical outcomes, including requirement for non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), were recorded. Diagnostic accuracy of LUS in predicting ventilatory support was analyzed. Results: A total of 80 neonates were included. Higher LUS scores were significantly associated with the need for ventilatory support (p < 0.001). An LUS score ≥8 predicted the need for ventilation with a sensitivity of 88% and specificity of 82%. Neonates requiring invasive ventilation had significantly higher mean LUS scores compared to those managed conservatively. Conclusion: Point-of-care lung ultrasound is a reliable, non-invasive bedside tool for early prediction of ventilatory support requirement in neonates with respiratory distress. Incorporation of LUS into routine NICU assessment may enhance clinical decision-making and reduce delays in respiratory support.

Background: Despite primary percutaneous coronary intervention (PCI) and guideline-directed therapy, patients who survive ST-segment elevation myocardial infarction (STEMI) continue to be at risk of major adverse cardiovascular events (MACE). Personalized follow-up may be aided by prediction models, but there is limited reporting on model performance across subgroups. Methods: A retrospective cohort of 680 adults with STEMI who underwent primary or rescue PCI was analysed. The primary outcome was 12-month major adverse cardiovascular events, defined as all-cause death, recurrent myocardial infarction, stroke, target-vessel revascularization or heart failure hospitalization. A total of 42 baseline clinical, angiographic, laboratory and treatment parameters were used to develop logistic regression, random forest and gradient boosting models. Model discrimination and calibration and subgroup performance were assessed. Results: 118 patients (17.4%) had 12-month MACE. MACE patients were older than non-MACE patients, had more diabetes, chronic kidney disease, anterior wall infarction, multivessel disease, higher Killip class and lower left ventricular ejection fraction. Gradient boosting had the highest discrimination (AUC 0.84; 95% CI 0.79-0.89), followed by random forest (AUC 0.82) and logistic regression (AUC 0.78). Gradient boosting had a sensitivity of 78.0%, and a specificity of 77.4%. The best performance was observed in non-diabetic patients (AUC 0.86) and the worst in chronic kidney disease (AUC 0.77). Killip class, LVEF, creatinine, diabetes, symptom-to-balloon time, multivessel disease, final TIMI flow and discharge statin/non-adherence risk were important predictors. Conclusion: Gradient boosting model outperformed MACE prediction following STEMI and demonstrated clinically significant differences between subgroups. Prediction tools should be reported to be calibrated and perform well in subgroups before clinical use.

Background: Physical inactivity and psychological stress are becoming more and more common among undergraduate students, and this ends up affecting both their mental well-being and physical fitness. Yoga, which is a holistic mind-body practice, has been shown in several studies to improve both physical and psychological parameters in young adults. Objectives: To evaluate the effect of a structured yoga intervention on the WHO Well-being Index and spinal flexibility among undergraduate students. Material and Methods: This prospective interventional study was carried out on 97 students of both genders belonging to age group 18–22 years. All participants followed a structured yoga program for 60 minutes daily, five days a week, for a period of six months. The WHO-5 Well-being Index and spinal flexibility (using the Sit & Reach Test) were assessed before and after the intervention. Statistical analysis was done by using Z-test and Mann–Whitney test, with p < 0.05 considered significant. Result and Analysis: There was a statistically significant improvement in spinal flexibility in both male and female participants after the yoga intervention (p < 0.0001). The WHO Well-being Index also showed noticeable improvement, with more participants shifting into the “normal well-being” category. Conclusion: Structured yoga intervention significantly improves both psychological well-being and spinal flexibility in undergraduate students, and it can be considered as a useful preventive health strategy.

Background: Femoral nerve block (FNB) is an effective analgesic technique for knee surgery, and adjuvants are commonly added to local anesthetics to enhance block quality and duration. This study compared clonidine and fentanyl as adjuvants to ropivacaine in FNB for postoperative analgesia following arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods: This prospective observational study included 40 ASA I-II patients (18-60 years) undergoing arthroscopic ACL reconstruction under spinal anesthesia. Patients received postoperative FNB with 20 mL of 0.2% ropivacaine containing either clonidine 1 μg/kg (Group C, n=20) or fentanyl 1 μg/kg (Group F, n=20). The primary outcome was duration of postoperative analgesia. Secondary outcomes included pain scores (Numerical Rating Scale, NRS), rescue analgesic consumption, block characteristics, hemodynamic parameters, and side effects over 24 hours. Results: Duration of analgesia was comparable between groups (Group F: 10.50 ± 5.67 hours vs Group C: 9.82 ± 4.53 hours; p=0.676). NRS scores were similar at all time points, and no patient experienced severe pain. Total 24-hour diclofenac consumption was identical (90 mg) in both groups. Sensory block at 6 hours persisted in more patients in Group F (20% vs 0%; p=0.035). Hemodynamic parameters remained stable with no significant differences. No respiratory depression or serious adverse events occurred. Conclusion: Both clonidine and fentanyl (1 μg/kg) as adjuvants to 0.2% ropivacaine in FNB provide comparable postoperative analgesia of approximately 10 hours following arthroscopic ACL reconstruction, with similar efficacy and favorable safety profiles.

Background: Bipolar disorder (BD) is a chronic mood disorder associated with substantial psychiatric and medical comorbidity. Increasing evidence suggests that autonomic nervous system dysfunction may contribute to the elevated cardiovascular morbidity and mortality observed in individuals with BD. Heart rate variability (HRV), a non-invasive marker of autonomic regulation, provides valuable insights into sympathetic-parasympathetic balance during different mood states. Aim: To evaluate longitudinal changes in heart rate variability among patients with bipolar disorder during manic episodes and subsequent euthymic states. Methods: A prospective longitudinal observational study was conducted among 12 patients diagnosed with bipolar affective disorder presenting with mania. Diagnosis was confirmed using the Mini International Neuropsychiatric Interview (MINI 5.0.0) and ICD-10 criteria. Severity of mania was assessed using the Bech-Rafaelsen Mania Scale. HRV recordings were obtained during the manic phase and repeated after achieving euthymia. Time-domain, frequency-domain, and non-linear HRV parameters were analyzed using Kubios HRV software. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, effect size estimation, and Spearman correlation analyses. Results: Mean heart rate was higher during mania (89 beats/min) compared with euthymia (80.1 beats/min), while mean RR intervals were shorter during mania (689 ms vs. 754 ms). Frequency-domain parameters demonstrated reduced low-frequency and high-frequency power during mania. Non-linear HRV indices also showed reduced complexity during manic episodes. Although most differences did not reach statistical significance (p>0.05), several variables demonstrated moderate effect sizes, suggesting clinically meaningful autonomic alterations. Correlation analyses revealed weak associations between manic symptom severity and HRV parameters. Conclusion: Patients with bipolar disorder exhibited lower HRV during manic episodes compared with euthymic states, indicating reduced autonomic flexibility and potential cardiovascular vulnerability. Longitudinal HRV assessment may serve as a useful biomarker for monitoring autonomic dysfunction and cardiovascular risk in bipolar disorder.

Introduction: Megaloblastic anaemia (MA) is an important cause of macrocytic anaemia and pancytopenia among children in developing countries. Deficiency of vitamin B12 and folate remains a significant nutritional problem in India, particularly among socioeconomically disadvantaged populations. Early diagnosis is essential because MA is potentially reversible with appropriate supplementation. Aim: To determine the prevalence, clinical presentation, haematological profile, and etiological factors associated with megaloblastic anaemia among children aged 1–14 years attending a tertiary care teaching hospital. Materials and Methods: This retrospective observational study was conducted in the Department of Biochemistry, Swamy Vivekanandha Medical College Hospital and Research Institute, Namakkal, Tamil Nadu, India, from January 2025 to December 2025. Medical records of children aged 1–14 years diagnosed with megaloblastic anaemia were reviewed. Diagnosis was based on macrocytosis, peripheral smear findings, bone marrow examination, and serum vitamin B12 and folate levels. Demographic, clinical, laboratory, and treatment outcome data were analysed using descriptive and inferential statistics. Statistical significance was considered at p<0.05. Results: Among 524 anaemic children screened, 150 fulfilled the diagnostic criteria for MA, yielding a prevalence of 28.6%. The mean age was 5.2±2.8 years and 52% were males. Pallor (98%), anorexia (85.3%), weakness (72%), irritability (65.3%), and knuckle hyperpigmentation (45.3%) were common clinical manifestations. Macrocytosis was observed in all patients with a mean haemoglobin of 6.8±1.5 g/dL and mean MCV of 102.4±8.2 fL. Pancytopenia was present in 68% of cases. Vitamin B12 deficiency accounted for 78% of patients, folate deficiency for 15.3%, and combined deficiency for 6.7%. Haematological recovery following supplementation occurred in 95.3% of children. Conclusion: Megaloblastic anaemia constitutes a major cause of nutritional anaemia in children and is predominantly related to vitamin B12 deficiency. Characteristic peripheral smear findings and early biochemical evaluation facilitate prompt diagnosis and effective treatment.

PCOS is a heterogeneous pathological condition characterized by reproductive disorders, and frequently associated with hyperandrogenism, obesity, and hyperinsulinemia and insulin resistance. Advances in imaging technology have introduced Color Doppler ultrasonography (CD-USG) as a means to assess vascular changes in PCOS, particularly variations in ovarian and uterine blood flow. This was an observational, cross sectional study. Total 140 women with PCOD enrolled in this study with mean age was 22.42±3.20 years. The mean BMI was 28.62±3.41 kg/m², mean FSH was 8.51±3.98 and mean LH was 15.32±4.18. Mean LH/FSH Ratio was 2.38±0.32. Mean follicle count was 13±2. Most common symptoms in women with PCOS was oligomenorrhea 48.2% followed by infertility 28.3%. LH/FSH ratio showed a significant positive correlation with uterine artery PI (p = 0.013). From this study we conclude that, CD-USG is a useful non-invasive method for assessing hemodynamic alterations in PCOS. The results of the study indicate that uterine and ovarian hormonal imbalances are correlated with arterial Doppler indices, which may be useful for PCOS monitoring and early identification. Larger sample numbers and long-term follow-ups are required for additional study to provide standardized Doppler criteria for prediction and diagnosis of PCOS.

Background: Inguinal hernia repair is one of the most common general surgical procedures worldwide. Chronic postoperative pain and reduced quality of life (QoL) remain significant concerns. While the open Lichtenstein tension-free mesh repair is a time-tested standard, laparoscopic techniques such as totally extra peritoneal (TEP) repair are increasingly preferred. However, comparative data on QoL, particularly using validated tools like the Carolinas Comfort Scale (CCS), are limited in the Indian context. Objective: To compare postoperative QoL—specifically mesh sensation, pain, and movement limitation—at 1 and 3 months after TEP versus Lichtenstein repair. Methods: This prospective observational study was conducted at Government Medical College, Kottayam, from August 2023 to February 2025. A total of 154 patients (77 per group) undergoing elective unilateral or bilateral inguinal hernia repair were enrolled. QoL was assessed using the CCS at 1 and 3 months post-surgery. Statistical analysis used chi-square, t-test, Wilcoxon signed-rank, and Mann-Whitney U tests. Results: Baseline characteristics were comparable except for age (TEP: 53.3±13.7 vs. Lichtenstein: 59.0±12.4 years; p=0.007). At 1 month, 97.4% of TEP patients reported no pain versus 90.9% in Lichtenstein (p=0.085); by 3 months, 100% of TEP versus 96.1% of Lichtenstein patients were pain-free (p=0.081). For unilateral hernias, TEP showed significantly less pain at 1 month (100% vs. 88.4% pain-free; p=0.033). No significant differences were observed in mesh sensation or movement limitation at either time point. Within the Lichtenstein group, pain decreased significantly from 1 to 3 months (p=0.018). Conclusion: Laparoscopic TEP repair provides comparable or superior early postoperative quality of life, especially reduced pain at 1 month for unilateral hernias, compared to open Lichtenstein repair. Both techniques are highly effective, but TEP offers faster pain resolution.

Background & Aims: To study the clinical profile of movement disorders presenting in outpatient and emergency settings of a tertiary neurology department. Methodology: Hospital-based observational study conducted from September 2024 to August 2025. A total of 162 patients were included. Detailed history, neurological examination, and relevant investigations were performed. Results: Majority were males aged 40–60 years. Tremor was the most common movement disorder followed by Parkinsonism and chorea. Neurodegenerative disorders and stroke were the leading etiologies. Conclusion: Tremor and neurodegenerative disorders constituted the major burden of movement disorders in this tertiary care setting.

Background: Galeazzi fracture–dislocation is a complex forearm injury involving a fracture of the distal third of the radius associated with distal radioulnar joint (DRUJ) instability. If inadequately managed, it can result in persistent pain, reduced grip strength, and long-term functional impairment. Aim: To evaluate the clinical and functional outcomes of Galeazzi fractures treated with open reduction and internal fixation (ORIF) with DRUJ stabilization. Materials and Methods: This prospective observational study included 40 adult patients with Galeazzi fracture–dislocations managed surgically with ORIF of the radius and stabilization of the DRUJ. Patients were followed up at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year. Functional outcomes were assessed using Visual Analog Scale (VAS) for pain, QuickDASH score, grip strength percentage, and range of motion (ROM). Statistical analysis was performed using paired t-test, with p < 0.05 considered significant. Results: The mean VAS score showed a significant increase in the immediate postoperative period followed by a progressive decline over time (p < 0.001). QuickDASH scores worsened initially but demonstrated significant improvement by 6 months and 1 year (p < 0.001). Grip strength and ROM showed continuous improvement throughout the follow-up period. Persistent DRUJ instability was observed in 10% of patients, and secondary procedures were required in 5%. Conclusion: ORIF with DRUJ stabilization in Galeazzi fracture–dislocations results in significant improvement in pain, functional status, grip strength, and range of motion, with low complication rates. Early surgical intervention combined with appropriate stabilization and rehabilitation is essential for optimal functional recovery.

Introduction: Allergic rhinitis is a common IgE-mediated inflammatory disorder of the nasal mucosa characterized by sneezing, rhinorrhea, nasal obstruction, and itching. The relationship between disease severity, immunological markers, and nasal bacterial colonization remains inadequately explored. This study evaluated these parameters in relation to ARIA-based severity classification. Methods: A hospital-based cross-sectional study was conducted on 247 patients with allergic rhinitis fulfilling ARIA diagnostic criteria. Clinical evaluation, ARIA classification, absolute eosinophil count, serum IgE estimation, and nasal bacterial culture were performed. Data were analyzed using appropriate statistical tests, and p<0.05 was considered significant. Results: Moderate-severe persistent allergic rhinitis was the most common ARIA category (38.9%). Elevated eosinophil counts and serum IgE levels were observed in most patients. Staphylococcus aureus was the predominant isolate (29.6%). Serum IgE levels and bacterial colonization showed significant association with ARIA severity (p<0.001). Conclusion: The present study demonstrated that allergic rhinitis severity is associated with objective immunological and microbiological parameters. Serum IgE levels increased significantly with increasing ARIA severity and may serve as a useful marker of disease burden. Nasal bacterial colonization was significantly more common in patients with severe disease, suggesting a possible role in persistence and amplification of airway inflammation. However, the type of bacterial isolate did not independently influence disease severity. These findings support an integrated approach combining clinical assessment, laboratory markers, and microbiological evaluation for better understanding, stratification, and management of allergic rhinitis patients.

Background: This study focused on evaluating the efficacy and safety of esmolol in attenuating the hemodynamic response associated with laryngoscopy and intubation. The study included the comparison between two different doses of esmolol given before intubation in general anaesthesia and evaluating which dose is better at attenuating the pressor response of laryngoscopy. It aimed to provide insights into optimal dosing strategies and comparative effectiveness amongst two different doses of esmolol. Methods: This study is a prospective randomised comparative study which was conducted in the Department of Anaesthesiology, Sardar Patel Medical College and A.G of Hospitals, Bikaner after obtaining approval from Institute Ethical Committee and written informed consent from patients. Results: In the present study using Esmolol, the overall incidence of complications was low across all groups. Bradycardia and hypotension were more frequent in Group B but were not statistically significant indicating a mild dose-related effect. Tachycardia and hypertension were significantly higher in the control group, demonstrating effective attenuation of the pressor response with esmolol. No cases of bronchospasm or arrhythmias were observed. Intervention was required in only two patients in Group B, which was not statistically significant. Overall, esmolol was effective and safe, with minimal, transient, and manageable complications. Conclusion: Based on the observed hemodynamic profile, esmolol can be considered a safe and effective agent for attenuation of the pressor response to laryngoscopy and endotracheal intubation. Furthermore, the higher dose evaluated in this study appears to provide more pronounced hemodynamic stability and may be preferable in patients where exaggerated cardiovascular responses are undesirable.

Background: This study aims to evaluate the effectiveness of ketamine as an adjuvant to intrathecal bupivacaine in patients undergoing caesarean section, comparing outcomes such as onset and duration of sensory and motor block, postoperative pain scores, and requirement for rescue analgesia. By conducting this study, we will aim to contribute valuable evidence regarding the benefits and risks associated with the combined use of ketamine and bupivacaine in this clinical setting. Methods: This study was a prospective randomised comparative study which was conducted in the Department of Anaesthesiology, Sardar Patel Medical College and A.G of Hospitals, Bikaner after obtaining approval from Institute Ethical Committee and written informed consent from patients. Result: The mean onset time of sensory block was significantly lower in Group K compared to Group B. This difference was statistically significant (p = 0.004). The mean duration of sensory block was higher in Group K compared to Group B. This difference was statistically significant (p = 0.028). The mean onset time of motor block was significantly lower in Group K compared to Group B. This difference was highly statistically significant (p < 0.001). The mean duration of motor block was significantly higher in Group K compared to Group B. This difference was highly statistically significant (p < 0.001). The mean time for first rescue analgesia was significantly higher in Group K compared to Group B. This difference was highly statistically significant (p< 0.001). The mean number of analgesic doses was significantly higher in Group B compared to Group K. This difference was highly statistically significant (p < 0.001). Conclusion: The present study concludes that the addition of preservative-free ketamine (0.1mg/kg) as an adjuvant to intrathecal hyperbaric bupivacaine (0.5%) in patients undergoing elective lower segment caesarean section significantly improves the quality and duration of spinal anaesthesia. The ketamine group demonstrated a significantly faster onset and prolonged duration of both sensory and motor blockade compared to bupivacaine alone.

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of hospitalization and constitutes the principal driver of COPD-related healthcare expenditure, with prolonged hospital stay representing a major contributor to this burden. Methods: This retrospective observational study analyzed medical records of 205 patients admitted with AECOPD at ABC Hospital over a one-year period. COPD was diagnosed per GOLD criteria and exacerbation severity classified using The Rome Proposal; prolonged length of hospital stay (LHS) was defined as ≥7 days. Clinical, demographic, and investigational parameters were extracted, and their associations with LHS were evaluated using binary and multiple logistic regression analysis with statistical significance set at p <0.05. Results: The mean LHS was 10.7 ± 5.1 days, with 144 patients (70.2%) experiencing prolonged hospitalization. The cohort was predominantly male (89.8%), with a mean age of 64.2 ± 8.4 years, and 68.3% presented with type II respiratory failure. Binary logistic regression identified advancing age (p = 0.04), prior AECOPD hospitalizations (p = 0.03), arterial hypoxemia (p = 0.04), NIV requirement (p = 0.01), and severe AECOPD (p = 0.004) as significantly associated with prolonged LHS. On multiple logistic regression, severe AECOPD at admission was the only independent predictor of prolonged hospitalization (OR: 5.0; 95% CI: 1.4–18.2; p = 0.01). Conclusion: Severe AECOPD at admission is the strongest independent determinant of prolonged hospitalization, highlighting the importance of early severity stratification to guide timely intervention and optimize resource utilization in AECOPD management.

Background: Scleritis and episcleritis are inflammatory ocular disorders that may occur as isolated eye diseases or as manifestations of systemic autoimmune, infectious, or local inflammatory conditions. Identification of associated extraocular diseases is clinically important because systemic disease may influence severity, recurrence, treatment response, and visual prognosis. Objective: To describe the extraocular diseases in patients presenting with scleritis and episcleritis. Methods: This hospital-based cross-sectional observational study was conducted in the Department of Ophthalmology, Government Medical College, Kottayam, Kerala, India, over 12 months after Institutional Review Board approval. A total of 256 patients clinically diagnosed with episcleritis or scleritis and satisfying the eligibility criteria were included by consecutive sampling. Patients with other anterior segment diseases such as conjunctivitis and anterior uveitis were excluded. All participants underwent detailed history taking, ocular examination, and phenylephrine blanching test, slit-lamp evaluation, posterior segment examination, intraocular pressure measurement, and B-scan ultrasonography when posterior scleritis was suspected. Basic investigations included complete blood count, ESR, CRP, VDRL, rheumatoid factor, chest X-ray, and Mantoux test. Relevant specialty referrals were made for confirmation of systemic or local disease. Data were entered in MS Excel and analysed using SPSS version 16.0. Qualitative variables were expressed as frequency and percentage, and Fisher’s exact test was used where applicable. Results: Among 256 patients, 54 patients (21.1%) had associated extraocular disease, while 202 patients (78.9%) had no identifiable systemic or local association. Rheumatoid arthritis was the most common associated disease, observed in 22 patients (8.6%), followed by tuberculosis in 10 patients (3.9%), ankylosing spondylitis in 8 patients (3.1%), and Wegener’s granulomatosis/granulomatosis with polyangiitis in 8 patients (3.1%), and systemic lupus erythematosus in 6 patients (2.3%). The association between type of scleritis/episcleritis and extraocular disease was statistically significant (Fisher’s exact test, p<0.001). Systemic autoimmune diseases were more frequent in scleritis, particularly non-necrotizing diffuse anterior scleritis and necrotizing anterior scleritis without inflammation, whereas tuberculosis was seen in selected episcleritis/nodular anterior scleritis cases. Conclusion: Extraocular diseases were present in nearly one-fifth of patients with scleritis and episcleritis. Rheumatoid arthritis was the commonest systemic association. Scleritis, especially severe anterior forms, showed stronger association with autoimmune diseases than episcleritis. Routine systemic evaluation and multidisciplinary referral are essential in patients presenting with scleritis and recurrent or atypical episcleritis.

Background: Scleritis and episcleritis are inflammatory disorders affecting the scleral and episcleral tissues of the eye. Although episcleritis is generally a benign and self-limiting condition, scleritis may be associated with significant ocular morbidity and visual impairment. Understanding the clinical profile of patients presenting with these disorders is important for early diagnosis, appropriate classification, and timely management. Aim: To describe the clinical profile of patients presenting with scleritis and episcleritis at a tertiary care ophthalmology center. Material and Methods: A hospital-based cross-sectional observational study was conducted in the Department of Ophthalmology, Government Medical College, Kottayam, Kerala, India, over a period of 12 months following Institutional Review Board approval. A total of 256 consecutive patients clinically diagnosed with episcleritis or scleritis were enrolled. Detailed history taking and comprehensive ophthalmological examination were performed, including assessment of visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, posterior segment evaluation, and B-scan ultrasonography whenever posterior scleritis was suspected. Clinical parameters including demographic profile, ocular symptoms, duration of illness, visual acuity, ocular examination findings, posterior segment findings, intraocular pressure, and subtype of scleritis or episcleritis were analysed. Data were entered into Microsoft Excel and analysed using SPSS version 16.0. Results were expressed as frequencies and percentages. Results: The majority of patients belonged to the 31–40 years age group (50.4%), and females constituted 60.9% of the study population. Right eye involvement was observed in 49.6% of cases, while bilateral disease occurred in 16.8%. Redness of the eye was the most common presenting symptom (91.4%), followed by defective vision (63.3%), pain (58.2%), watering (52.0%), and photophobia (24.6%). Most patients presented within 1–2 weeks of symptom onset (45.3%). Diffuse episcleritis was the most common diagnosis (39.8%), followed by non-necrotizing diffuse anterior scleritis (23.4%) and posterior scleritis (16.0%). Good visual acuity (6/6–6/9) was maintained in 72.3% of patients. Posterior segment findings were predominantly observed in posterior scleritis, with choroidal folds being the most common abnormality. Raised intraocular pressure was uncommon and observed in 2.7%. Conclusion: Episcleritis and scleritis exhibit distinct clinical patterns with regard to age distribution, symptomatology, visual status, and ocular findings. Diffuse episcleritis and non-necrotizing anterior scleritis constituted the majority of cases. Recognition of characteristic clinical features facilitates early diagnosis and appropriate management, thereby minimizing ocular morbidity and preserving visual function.

Background: Infective neck swellings are frequently encountered in pediatric otorhinolaryngology and may range from uncomplicated cervical lymphadenitis to deep neck space infections requiring urgent intervention. Early diagnosis and appropriate management are essential to prevent complications such as abscess formation, airway compromise, septicemia, and prolonged morbidity. Aim: To evaluate infective neck swellings in pediatric age group patients who underwent diagnosis and treatment and to assess their clinicopathological profile and management outcomes. Methods: This hospital-based prospective observational study included 150 pediatric patients presenting with infective neck swellings. Detailed history, clinical examination, laboratory investigations, imaging, microbiological evaluation, fine needle aspiration cytology, and histopathological examination where indicated were performed. Patients were managed conservatively or surgically according to clinical diagnosis, imaging findings, abscess formation, treatment response, and institutional protocol. Data were analyzed using appropriate statistical methods. Results: The highest proportion of patients belonged to the 1–5 years age group, with 63 cases (42.0%), followed by 49 cases (32.7%) in the 6–10 years age group. Male patients were slightly predominant, accounting for 80 cases (53.3%). Neck swelling was the most common symptom, observed in 138 patients (92.0%), and followed by fever in 76 patients (50.7%) and local pain in 63 patients (42.0%). Among deep neck space infections, submandibular infection was most common, accounting for 24 cases. Suppurative lymphadenopathy was the commonest final diagnosis, accounting for 30 cases (46.2%), followed by Ludwig’s angina in 16 cases (24.6%). Surgical intervention was required in 50 of 64 deep neck infection cases, with incision and drainage being the most common modality. Conclusion: Infective neck swellings are common in pediatric patients, particularly in younger children. Suppurative lymphadenopathy and submandibular space infections represent important clinicopathological entities. Early clinical recognition, appropriate imaging, microbiological evaluation, rational antibiotic therapy, and timely surgical intervention are essential for favorable outcomes.

Background: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in mechanically ventilated patients and is associated with increased morbidity, mortality, and length of ICU stay. Accurate diagnosis and knowledge of local bacterial etiology are essential for appropriate management. Objectives: To monitor adult mechanically ventilated ICU patients for the development of VAP using clinical and radiological criteria, to analyse the associated risk factors, and to identify bacterial etiological agents by quantitative processing of endotracheal aspirates. Methods: This prospective study included adult ICU patients on mechanical ventilation for more than 48 hours at Rangaraya Medical College, Kakinada, from December 2017 to August 2019. VAP was diagnosed using clinical pulmonary infection score, chest radiographic findings, and clinical criteria. Endotracheal aspirates were processed quantitatively for bacterial isolation and identification. Clinical variables were analysed as possible risk factors. Results: Of 100 ventilated patients, 33 were confirmed to have VAP. Although 75 endotracheal aspirates were culture positive, only 33 yielded significant pathogens, while 42 represented colonisers. Prior antibiotic use, stress ulcer prophylaxis, nasogastric tube placement, and reintubation were common associated factors. Pseudomonas aeruginosa and Klebsiella pneumoniae were the most frequent isolates. Conclusion: VAP constituted a significant problem in ventilated ICU patients, with gram-negative bacteria predominating. Quantitative endotracheal aspirate culture was useful for confirming infection and differentiating colonisation.

Background: Effective postoperative pain management is essential for enhanced recovery after laparoscopic surgeries. Ultrasound-guided transversus abdominis plane (TAP) block and local anesthetic port-site infiltration are widely used analgesic techniques, but their comparative efficacy remains uncertain. Aim: To evaluate postoperative pain scores, opioid requirement, and recovery outcomes following TAP block versus local infiltration in elective laparoscopic surgeries. Methods: This prospective randomized study was conducted at Government Medical College, Quthbullapur, from October 2025 to Feb 2026. Sixty ASA I–II adults undergoing elective laparoscopic procedures were randomized into two groups: TAP block (n = 30) and local infiltration (n = 30). Pain was assessed using a Visual Analog Scale (VAS) at 0, 2, 6, 12, and 24 hours. Secondary outcomes included total tramadol consumption, time to first rescue analgesia, PONV, complications, and patient satisfaction. Results: TAP block produced significantly lower VAS scores at all time points (p < 0.05). Time to first rescue analgesia was longer, and total opioid consumption was lower in the TAP group. Patient satisfaction was higher, and no major complications occurred. Conclusion: TAP block provided superior and sustained analgesia compared with local infiltration, supporting its routine use in laparoscopic surgeries.

Background: Intraoperative hypotension during general anesthesia is a modifiable risk factor that is linked to organ hypoperfusion and poor postoperative outcomes, but traditional monitoring methods may fail to detect hypotension until it has reached a critical level. This prospective randomized study aimed to assess the ability of artificial intelligence (AI) based hemodynamic monitoring to predict and mitigate intraoperative hypotension (IOH) in adults undergoing elective noncardiac surgery under general anesthesia. Method: A total of 160 patients who needed radial arterial pressure monitoring were randomly assigned to the AI-assisted waveform monitoring group with an alert-driven treatment protocol (n=80) or the standard arterial pressure monitoring group (n=80). Intraoperative hypotension was defined as mean arterial pressure (MAP) <65 mmHg for at least 1 minute. Alerts were triggered by AI if the hypotension risk index was >=85. Predictive accuracy, incidence of hypotension, duration of hypotension, use of vasopressors, fluid therapy, lactate, urine output and early postoperative complications were documented. Results: The incidence of intra-operative hypotension was 22 patients (27.5%) in the AI group and 39 patients (48.8%) in the standard group (p=0.006). Median hypotension duration was lower with AI monitoring (4.0 [IQR 0-8] vs 11.0 [IQR 3-22] min; p<0.001), and time-weighted average MAP <65 mmHg decreased from 0.24±0.31 to 0.08±0.16 mmHg (p=0.002). The sensitivity, specificity, PPV, NPV, and AUC of the AI alerts for predicting hypotension were 86.2%, 80.4%, 71.4%, 91.2%, and 0.89, respectively. Conclusion: The mean warning time prior to hypotension was 6.7±2.8 minutes. AI-based hemodynamic monitoring had excellent predictive accuracy and minimized hypotensive exposure during general anesthesia.

Background: Microvascular changes in the retina, choroid, and optic nerve head are caused by systemic hypertension. Ocular signs can be present but not cause any symptoms, and can be a visible sign of systemic vascular injury. Methods: This was a cross sectional study of 250 adults with a diagnosis of systemic hypertension seen in a tertiary care outpatient department. Demographic data, hypertension duration, blood pressure control, treatment status, and systemic comorbidities were recorded. All participants had visual acuity testing, slit-lamp examination, intraocular pressure measurement, and dilated fundus examination. The modified Keith-Wagener-Barker criteria were used to grade hypertensive retinopathy. Results: The mean age was 54.6 +/- 10.8 years and mean duration of hypertension was 7.1 +/- 5.4 years. Ocular manifestations were found in 146 patients (58.4%). The most frequent abnormalities were hypertensive retinopathy (52.8%), narrowing of the retinal arterioles (44.0%), arteriovenous nicking (31.6%), retinal haemorrhages (12.8%), cotton wool spots (8.4%) and optic disc oedema (1.6%). Patients with a duration of hypertension >10 years had a significantly higher prevalence of retinopathy (76.3%) than patients with a duration of hypertension of <=5 years (37.6%; p<0.001). Poor blood pressure control (OR=3.48, 95% CI: 1.92-6.31; p<0.001) was strongly associated with grade II or higher retinopathy. Conclusion: Ocular findings are frequently seen in patients with hypertension and are related to the duration and control of hypertension. Routine examination of the fundus may be useful for systemic risk assessment in hypertension.

Background: Evaluation of Parental Involvement Programs on Neonatal Outcomes in Intensive Care Settings addresses a clinically relevant and measurable question in biomedical science. Methods: This prospective comparative study in a level III neonatal intensive care unit included 110 neonates and used standardized measurements, predefined eligibility criteria and appropriate statistical analysis. Results: Compared with standard care, the parental involvement program increased exclusive breast milk feeding at discharge (63.6% vs 40.0%, p=0.013), improved mean daily weight gain (18.9 ± 4.8 vs 15.7 ± 5.2 g/kg/day, p=0.001), shortened hospital stay (18.4 ± 7.1 vs 22.7 ± 8.8 days, p=0.006) and reduced 30-day readmission (5.5% vs 16.4%, p=0.049). Conclusion: Structured parental involvement in the neonatal intensive care unit improved exclusive breast milk feeding, daily weight gain, length of stay and 30-day readmission without safety concerns. Family-centred, supervised parental participation should be considered a low-cost quality-improvement strategy in neonatal care.

Background: Preoperative anxiety is a common peri-operative issue which can lead to greater requirements for anaesthetic and a delay in early recovery from general anaesthetic. The aim of this prospective randomized controlled study was to determine whether a structured anxiety reduction program delivered via a smartphone could decrease perioperative anxiety, anaesthetic consumption and early postoperative morbidity in adult patients undergoing elective laparoscopic surgery. Method: One hundred twenty patients were randomized to a smartphone program group (n=60) or standard counselling group (n=60). The intervention consisted of video-based procedural education, guided breathing, mindfulness audio, frequently asked questions, and medication/fasting reminders for five days prior to surgery. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to measure anxiety, standardized protocols of propofol, sevoflurane and remifentanil were used to record anesthetic consumption, Modified Aldrete score, PACU stay, pain score, PONV and QoR-15 score were used to assess recovery. Results: The smartphone group showed greater reduction in APAIS anxiety score (12.8±3.2 to 7.6±2.7) than controls (12.6±3.1 to 11.3±3.4; p<0.001). The induction dose of propofol, consumption of sevoflurane and requirement of remifentanil were significantly reduced in the intervention group (all p<0.01). Extubation was faster (6.8±2.3 vs 8.9±3.1 min; p<0.001), PACU stay was shorter (44.2±12.6 vs 52.8±15.4 min; p=0.001), and 24-hour QoR-15 score was higher (127.4±14.1 vs 119.2±16.3; p=0.004). Conclusion: A structured pre-operative anxiety reduction program using a smartphone seems to be a viable non-pharmacological adjunct that can decrease the amount of anesthetic required and enhance early recovery after surgery.

Aim & Background: Artificial intelligence (AI) is increasingly transforming orthopaedic practice through advancements in machine learning, deep learning, computer vision, and natural language processing. AI applications now support fracture detection, imaging interpretation, surgical planning, robotic-assisted surgery, rehabilitation monitoring, and resident training. This narrative review summarizes the current applications of AI in orthopaedic along with its future potential in musculoskeletal healthcare. Material & Methods: A literature review was conducted using PubMed, Scopus, and Embase and Google Scholar databases for studies published from January 2020 to March 2026. Keywords included “artificial intelligence,” “machine learning,” “orthopaedics,” “deep learning,” “robotics,” “rehabilitation,” and “resident training.” Peer-reviewed studies, systematic reviews, observational studies, and narrative reviews related to AI in orthopaedics were included. Result: AI improved fracture detection, imaging interpretation, osteoarthritis grading, clinical prediction, surgical planning, implant positioning, rehabilitation monitoring, and resident training. However, challenges related to data privacy, algorithmic bias, validation, ethical concerns, and implementation costs remain. Conclusion: AI has the potential to significantly improve orthopaedic healthcare and education. However, further validation, ethical regulation, and standardized clinical integration are necessary before widespread adoption.

Background and Aim: Spinal anaesthesia is widely used for lower limb orthopaedic surgeries due to its effectiveness, safety, and ability to provide excellent intraoperative and postoperative analgesia. Levobupivacaine and ropivacaine are newer long-acting local anaesthetics with reduced cardiotoxicity compared to bupivacaine. This study compared the anaesthetic and analgesic efficacy of intrathecal 0.5% hyperbaric levobupivacaine and 0.75% hyperbaric ropivacaine. Methods: A randomized double-blind controlled study was conducted on 100 patients (ASA I–II, aged 18–75 years) undergoing elective lower limb orthopaedic surgeries under spinal anaesthesia. Patients were randomly allocated into two groups: Group L received 3 mL of 0.5% hyperbaric levobupivacaine and Group R received 3 mL of 0.75% hyperbaric ropivacaine intrathecally. Sensory and motor block characteristics, haemodynamic parameters, postoperative pain scores, time to first rescue analgesia, analgesic consumption, and adverse effects were assessed. Results: Group R demonstrated a significantly faster onset of sensory blockade (88.8±15.5 s vs. 142.4±16.1 s; p<0.001) and earlier attainment of peak sensory level. However, Group L showed significantly longer sensory regression time (125.2±11.7 min vs. 88.5±9.4 min; p<0.001), prolonged motor block duration (243.8±17.6 min vs. 184.1±12.8 min; p<0.001), and longer duration of analgesia (245.2±11.3 min vs. 198.4±14.7 min; p<0.001). Rescue analgesic requirements were lower in Group L. Haemodynamic parameters remained comparable between groups, and adverse effects were minimal. Conclusion: Both agents provided effective spinal anaesthesia. Hyperbaric ropivacaine offered faster onset and earlier recovery, whereas hyperbaric levobupivacaine provided prolonged sensory and motor blockade with superior postoperative analgesia.

Background: Medical therapy for benign prostatic enlargement (BPE) has reduced the need for surgery but may delay definitive intervention, potentially worsening perioperative outcomes. Objectives: To evaluate perioperative morbidity and outcomes in patients undergoing TURP after long-term versus short-term medical therapy and to assess the impact of urinary retention and preoperative 5-alpha reductase inhibitor therapy. Methods: Eighty patients undergoing TURP between January 2024 and July 2025 were analyzed. Patients were categorized into long-term medical therapy (≥6 months) and short-term medical therapy (<6 months). Perioperative morbidity, transfusion requirement, clot retention, failed TWOC, urinary tract infection, hemoglobin drop, and hospital stay were evaluated. Results: Long-term medical therapy patients demonstrated clinically higher rates of postoperative complications including clot retention, blood transfusion, failed TWOC, and urosepsis. Patients presenting with urinary retention had significantly greater postoperative Hb/PCV reduction and failed TWOC rates. No mortality or TUR syndrome was observed. Conclusion: Delayed surgical intervention after prolonged medical therapy may adversely affect perioperative outcomes in selected BPE/LUTS patients.

Introduction: Coronavirus disease 2019 (COVID-19) has been associated with several complications, among which COVID-19-associated mucormycosis is a rare but severe invasive fungal infection. Caused by Mucorales species, it predominantly affects immunocompromised individuals and is associated with high morbidity and mortality, especially when diagnosis and treatment are delayed. Aims: To evaluate the association between uncontrolled diabetes and the development of mucormycosis in patients with COVID-19, and to assess the role of poor glycaemic control as a major risk factor for COVID-19–associated mucormycosis. Methods: This was a hospital-based observational study conducted at Dr. VithalraoVikhe Patil’s Foundation Medical College and Hospital, Ahilyanagar, Maharashtra, over a one-year period from January 2021 to December 2022. The study included 100 patients diagnosed with COVID-19 who were evaluated for mucormycosis during the study period and fulfilled the inclusion criteria. Result: Among the 100 study participants, most were aged 41–60 years (46%) and were predominantly male (68%). Uncontrolled diabetes was the most common glycaemic status (62%). Mucormycosis occurred significantly more frequently in patients with uncontrolled diabetes (90.3%) compared to those with controlled diabetes (42.9%) and newly detected diabetes (80%), demonstrating a highly significant association between poor glycaemic control and the development of mucormycosis (p < 0.001). Conclusion: The study demonstrates that poor glycaemic control and steroid use are strongly associated with mucormycosis, with middle-aged and elderly males being most affected. Uncontrolled diabetes was identified as the primary risk factor, highlighting the critical role of chronic hyperglycaemia in the development of the infection.

Breast cancer occurs in every country in the word. Prognosis and management of breast cancer are influenced by classic variables such as grade, stage, hormone receptor status of estrogen, progesterone and Her2neu over expression. A study was conducted at M.B.S. Hospital and NMCH Hospital associated with Government Medical College Kota from 2018 to Sept 2019 in the department of Pathology with basic aim to ascertain correlation of various Histo-pathological score with ER, PR and Her2/neu receptor status of breast carcinomas. Maximum numbers of breast cancer patients were seen in 5th decade. ER and PR positivity was seen in 37.64% and 35.29% of cases. The hormonal expression in our study suggests that percentage of hormonal expression in India is lower when compared to western countries. ER and PR positivity was more commonly associated with small tumor size and low tumor grade and score signifying higher percentage of ER/PR positivity in differentiated tumors. HER-2/neu over expression was seen in 23.52% cases, these observations were similar to other international studies. HER-2/neu over expression was significantly associated with large tumor size and negative ER, PR status.

Background: Assessment of Stress-Induced Changes in Cardiovascular Responses during Clinical Training addresses a clinically relevant and measurable question in biomedical science. Methods: This prospective repeated-measures study among clinical-phase students during routine and high-stress clinical training sessions included 96 and used standardized measurements, predefined eligibility criteria and appropriate statistical analysis. Results: Mean perceived stress score increased from 17.8 ± 5.3 on routine days to 26.9 ± 6.1 during procedural assessment (p<0.001). Systolic pressure increased by 9.8 ± 8.2 mmHg, heart rate by 13.6 ± 10.4 beats/min and low-frequency/high-frequency HRV ratio by 0.86 ± 0.71 (all p<0.001). Stress score correlated with heart-rate rise (r=0.42, p<0.001). Conclusion: Procedural clinical assessment produced significant acute increases in perceived stress, blood pressure, heart rate and LF/HF ratio, indicating sympathetic cardiovascular activation. Structured preparation, sleep support and supportive assessment practices may reduce avoidable stress while preserving clinical training standards.

Background: Percutaneous dilatational tracheostomy (PDT) is a widely performed bedside procedure in intensive care units. Real-time ultrasound guidance (USG-PDT) and bronchoscopic guidance (Broncho-PDT) represent the two dominant modalities for tracheal needle puncture in contemporary practice. Their comparative performance with respect to procedural efficiency, oxygenation, and safety in the Indian critical care setting remains incompletely characterized. Aim: To compare ultrasound-guided and bronchoscopy-guided percutaneous dilatational tracheostomy with respect to procedural outcomes, periprocedural oxygenation, complication rates, and clinical outcomes in mechanically ventilated critically ill patients. Methods: A prospective randomized comparative study was conducted in the Intensive Care Unit, Narayan Medical College and Hospital, Sasaram, Bihar, India, from 10th April 2025 to 10th June 2025. Thirty mechanically ventilated adult patients requiring bedside tracheostomy were randomized equally into Group A (USG-PDT, n = 15) and Group B (Broncho-PDT, n = 15). Primary outcomes were total procedure time and first-pass needle success rate. Secondary outcomes included periprocedural SpO2, PaCO2, operator ease, complication rates, ICU length of stay, and 30-day all-cause mortality. Results: Baseline demographics and clinical severity were comparable between the two groups. The USG-PDT group demonstrated significantly shorter total procedure time (12.1 ± 3.3 vs. 18.8 ± 4.4 minutes; mean difference −6.7 min, 95% CI: −9.6 to −3.8; p < 0.001) and skin-to-tracheal lumen time (5.2 ± 1.9 vs. 8.4 ± 2.5 minutes; mean difference −3.2 min, 95% CI: −4.9 to −1.5; p < 0.001). Optimal midline tracheal puncture was more frequently achieved with ultrasound guidance (93.3% vs. 60.0%; risk difference +33.3%, 95% CI: 5.5% to 61.1%; p = 0.04). Mean periprocedural SpO2 (96.2 ± 2.3% vs. 91.4 ± 3.9%; mean difference +4.8%, 95% CI: 2.4% to 7.2%; p < 0.001) and lowest SpO2 (92.8 ± 2.9% vs. 85.9 ± 4.8%; mean difference +6.9%, 95% CI: 3.9% to 9.9%; p < 0.001) were significantly better in the USG-PDT group. PaCO2 at 30 minutes post-procedure was significantly lower with USG-PDT (44.2 ± 5.4 vs. 52.8 ± 8.1 mmHg; mean difference −8.6 mmHg, 95% CI: −13.7 to −3.5; p < 0.001). The overall complication rate did not reach conventional statistical significance (26.7% vs. 60.0%; risk difference −33.3%, 95% CI: −66.7% to 0.1%; p = 0.07), a finding consistent with the study being underpowered for this secondary endpoint. First-pass needle success, ICU length of stay, and 30-day mortality were comparable between the groups. Conclusion: Ultrasound-guided PDT demonstrated superior procedural efficiency, significantly better periprocedural oxygenation, and a clinically meaningful reduction in complication burden compared to bronchoscopy-guided PDT. USG-PDT is a safe, time-efficient, and logistically practical alternative for bedside tracheostomy in the ICU setting and may be considered the preferred guidance modality in resource-sensitive Indian critical care environments.

Introduction: Antimicrobials are commonly used in post-operative obstetric and gynecological patients to prevent infections. Monitoring prescribing patterns is essential to promote rational use and reduce the risk of antimicrobial resistance. Objective: To assess the pattern of antimicrobial use among post-operative obstetric and gynecological patients in a tertiary care teaching hospital in North Gujarat. Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital in North Gujarat. Medical records of 260 post-operative patients were reviewed. Data regarding demographic characteristics, type of surgery, antimicrobial prescribing pattern, and WHO prescribing indicators were collected using a structured proforma and analyzed using descriptive statistics. Results: Around two-fifths (43.1%) of patients belonged to the 18–28 years age group. More than half (52.3%) underwent lower segment cesarean section. Ceftriaxone (70.0%) was the most frequently prescribed antimicrobial, followed by metronidazole (64.6%) and amikacin (36.2%). More than half of the patients (56.2%) received two antimicrobials, while 26.2% received three antimicrobials. The average number of drugs and antimicrobials per prescription was 7.4 and 2.3, respectively. Injectable antimicrobials were prescribed in 88.5% of prescriptions, while 91.4% of antimicrobials were prescribed from the Essential Medicines List. Conclusions: Cephalosporins, particularly ceftriaxone, formed the backbone of post-operative antimicrobial therapy, and combination therapy was commonly practiced. Regular prescription audits and antimicrobial stewardship interventions may help optimize antimicrobial use and promote rational prescribing.

Diabetic peripheral neuropathy remains one of the most disabling complications for patients with type 2 diabetes mellitus. Recent studies have identified metabolic issues like low magnesium and phosphate levels as risk factors for developing this condition. This prospective observational study evaluated the role of these electrolytes in neuropathy severity in adults at a government medical college hospital in Chennai. Eighty patients were assessed using the Toronto Clinical Neuropathy Score, nerve conduction studies, and biochemical tests. The prevalence of neuropathy was 75%. Severity correlated significantly with age over fifty, male gender, HbA1c above nine percent, and diabetes duration over ten years. There were negative correlations between serum magnesium levels and neuropathy severity; however, the correlation with serum phosphate was stronger. A magnesium level below 1.25 mg/dL predicted neuropathy with high sensitivity of 0.806, while a phosphate level below 1.95 mg/dL had an AUC of 0.745. One key finding of this study is the impact of low magnesium and low phosphate levels on increasing neuropathy severity.

Introduction: Total thyroidectomy is a commonly performed surgical procedure for benign and malignant thyroid disorders. Despite its effectiveness, it is associated with a range of postoperative complications, which may vary depending on the surgical approach used. Understanding these complications and their relationship with different operative techniques is essential for improving patient outcomes. Aims and Objectives: To evaluate the complications associated with total thyroidectomy with special emphasis on different surgical approaches. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, from April 2022 to December 2025. A total of 90 patients undergoing total thyroidectomy for thyroid disorders were included and evaluated for postoperative outcomes and complications. Results: In the present study, indications for surgery were comparable between the two groups. In Group A (n = 50), 24 patients (48%) had multinodular goiter, 18 patients (36%) had thyroid carcinoma, and 8 patients (16%) had toxic goiter. In Group B (n = 40), 18 patients (45%) had multinodular goiter, 16 patients (40%) had thyroid carcinoma, and 6 patients (15%) had toxic goiter. There was no statistically significant difference in the distribution of indications between the two groups (p = 0.82). Conclusion: Total thyroidectomy is a safe and effective procedure when performed with careful surgical planning and technique. The occurrence of complications is influenced by the surgical approach adopted. A meticulous operative technique and appropriate selection of surgical approach can significantly reduce postoperative morbidity and improve overall surgical outcomes.

Background: Proton pump inhibitors (PPIs) are widely prescribed for the management of acid-related gastrointestinal disorders. Emerging evidence suggests that prolonged PPI therapy may adversely affect calcium and vitamin D metabolism, potentially increasing the risk of skeletal complications. Aim: To evaluate serum vitamin D and calcium levels among chronic PPI users and determine their relationship with duration of therapy. Methods: A hospital-based cross-sectional observational study was conducted among 100 participants comprising 50 chronic PPI users and 50 age- and sex-matched healthy controls. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured using chemiluminescent immunoassay, while serum calcium levels were estimated using laboratory autoanalyzer based on  spectrophotometric estimation  . Group comparisons were performed using independent sample t-tests and chi-square tests. Pearson correlation analysis was used to assess associations between duration of PPI therapy and biochemical parameters. Results: Mean duration of PPI therapy was 24.34 ± 7.95 weeks. Serum vitamin D levels were significantly lower among PPI users compared with controls (18.4 ± 5.2 vs. 26.7 ± 6.1 ng/mL, p<0.001). Serum calcium levels were also significantly reduced in PPI users (7.92 ± 1.07 vs. 8.61 ± 0.52 mg/dL, p<0.001). Duration of therapy demonstrated a moderate negative correlation with vitamin D levels (r = −0.42, p = 0.002) and a weak negative correlation with serum calcium levels (r = −0.31, p = 0.028). Conclusion: Chronic PPI therapy is associated with lower serum vitamin D and calcium concentrations. Longer duration of therapy may further exacerbate these deficiencies, highlighting the need for periodic monitoring in long-term users.

Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality, predominantly due to uterine atony. Oxytocin is the standard prophylactic uterotonic; however, its short duration of action and requirement for cold chain storage limit its effectiveness in certain settings. Carbetocin, a long-acting and heat-stable oxytocin analogue, offers the advantage of sustained uterine contraction. This study aimed to compare the effectiveness of carbetocin and oxytocin in the prevention of PPH at a tertiary care centre. Methods: Prospective comparative study was conducted at T.S. Misra Medical College and Hospital, Lucknow, from July 2024 to December 2025. A total of 100 pregnant women aged 18–40 years were included and equally allocated into two groups: carbetocin (100 µg intravenous bolus) and oxytocin (10 IU intramuscular), administered at delivery of the anterior shoulder. Blood loss was assessed using both objective and visual methods. The primary outcome was the incidence of PPH (>500 mL after vaginal delivery or >1000 mL after caesarean section within 24 hours). Secondary outcomes included total blood loss, changes in haemoglobin and haematocrit levels, need for additional uterotonics, uterine tone, requirement of blood transfusion, and adverse effects. Statistical analysis was performed using appropriate tests, with p < 0.05 considered significant. Results: Baseline demographic and clinical characteristics were comparable between the two groups (p > 0.05). The incidence of PPH was lower in the carbetocin group (2%) compared to the oxytocin group (10%), although the difference was not statistically significant (p = 0.092). Atonic PPH was the most common type observed. In vaginal deliveries, blood loss >500 mL was significantly lower in the carbetocin group (0% vs. 4%; p = 0.030). Mean blood loss and the decline in haemoglobin and haematocrit levels were comparable between groups. A significantly higher proportion of women in the carbetocin group had a firm uterus at 15 minutes postpartum (92% vs. 78%; p = 0.049). The need for blood transfusion (6% vs. 18%) and additional uterotonics was higher in the oxytocin group, although these differences were not statistically significant. Conclusion: Carbetocin is a safe and effective alternative to oxytocin for the prevention of postpartum haemorrhage. It demonstrates superior early uterine tone and favourable clinical trends in reducing PPH incidence and intervention requirements. Carbetocin may be particularly advantageous in resource-limited settings due to its prolonged action and heat stability.

Background: Venous thrombosis is a frequent cause of hospitalization worldwide; however, data describing its clinical profile in Indian patients, particularly from hilly regions, remain limited. Aims and Objective: Our study predominantly aims at studying the clinical profile, risk factors, and the clinical outcomes in patients presenting to a single tertiary care center to rapidly detect the disease. Material and Methods: A prospective observational study involving 40 patients of confirmed cases of VTE who presented to this tertiary care hospital during a period from October 2025 to March 2026. Data collected included the age, sex, clinical presentation, risk factors, diagnostic modalities, and their clinical outcomes. Descriptive analysis was carried out by mean and standard deviation for quantitative variables; frequency and proportion for the categorical variables. Results: Among the study groups, 28 (70%) had DVT, 3 (7.5%) had PE, and 9 (22.5%) had both. Major risk factors detected included smoking history (58%), recent surgery (11%), malignancy (8%), history of immobility (9%), and past history of DVT (12%). The clinical presentation mainly included leg pain (68%) and leg swelling (78%). The outcomes were predominantly re-canalization (36%), recurrent DVT (16%), recurrent PE (1%), chronic DVT (22%), chronic venous insufficiency (33%), chronic venous ulcer (4%), pulmonary hypertension (13%), and death (3%). Conclusion: we have highlighted the possible risk factors, clinical presentation, and clinical outcomes to identify the disease early and help us initiate appropriate thrombo prophylaxis to reduce morbidity.The established direct risk factors for deep vein thrombosis were immobilization, major surgery, trauma, malignancy, pregnancy and puerperium, smoking.

Introduction: Amniotic fluid volume is a key indicator of fetal well-being, particularly in the third trimester, where abnormalities often reflect placental insufficiency and fetal compromise. The amniotic fluid index (AFI) is a simple, non-invasive ultrasonographic method widely used for antenatal surveillance. Abnormal AFI has been associated with adverse fetomaternal outcomes, necessitating evaluation in tertiary care settings. Objectives: To assess the association between third-trimester amniotic fluid index and fetomaternal outcomes in pregnant women attending a tertiary care centre. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at T.S. Misra Medical College and Hospital, Lucknow, from July 2024 to June 2025. A total of 100 pregnant women with singleton pregnancies and gestational age ≥28 weeks were enrolled after applying inclusion and exclusion criteria. AFI was measured using the four-quadrant technique described by Phelan JP between 28 weeks and delivery. Participants were categorized into normal AFI, oligohydramnios, and polyhydramnios groups. Maternal outcomes (mode of delivery, prolonged labour, postpartum hemorrhage) and fetal/neonatal outcomes (birth weight, APGAR scores, need for resuscitation, NICU admission, and complications) were recorded. Statistical analysis was performed, with p < 0.05 considered statistically significant. Results: Among the participants, 83% had normal AFI, 14% had oligohydramnios, and 3% had polyhydramnios. Maternal age, parity, socioeconomic status, gestational age, and obstetric history showed no significant association with AFI. However, pre-existing maternal medical disorders and previous caesarean section were significantly associated with abnormal AFI. Abnormal AFI demonstrated a strong association with non-reassuring fetal heart rate patterns (p < 0.001), and all such cases required caesarean delivery (p < 0.001). Maternal complications, particularly prolonged labour and postpartum hemorrhage, were significantly higher in abnormal AFI groups. Neonates in these groups had lower birth weight, reduced APGAR scores, increased need for resuscitation, and higher NICU admission rates (p < 0.001). All mothers and neonates were discharged in stable condition. Conclusion: Abnormal third-trimester AFI, particularly oligohydramnios, is significantly associated with adverse fetomaternal outcomes. Routine AFI assessment is a valuable, non-invasive tool for early identification of high-risk pregnancies and timely obstetric intervention.

Background: Non-union and delayed union of long bone fractures remain a significant challenge in orthopaedics. Minimally invasive biological techniques such as percutaneous autologous bone marrow grafting have gained attention as an alternative to conventional bone grafting. Aim: To evaluate the clinical and radiological outcomes of percutaneous autologous bone marrow grafting in non-union and delayed union of long bone fractures. Methods: A prospective observational study was conducted on 30 patients aged ≥18 years presenting with aseptic delayed union or non-union of long bones. Bone marrow aspirate was harvested from the iliac crest and injected percutaneously at the fracture site. Patients were followed up clinically and radiologically at regular intervals up to 16 weeks using union scale score. Results: The mean age of patients was 35.9±12.5 years, with male predominance (83.33%). Majority of cases involved femur (46.66%) and tibia (43.33%). Union was achieved in a significant proportion of patients, particularly in delayed union cases. Mean bone marrow volume injected was 18.03±4.95 ml. The procedure showed 80% success rates with no major complications. Conclusion: Percutaneous autologous bone marrow grafting is a safe, minimally invasive, and effective technique for treating delayed union and selected cases of non-union, with good clinical and radiological outcomes.

Background: Acne vulgaris is a common dermatological condition among adolescents and young adults. Medical students, due to their knowledge of drugs, are at higher risk of self-medicating without professional guidance. Objective: To assess the knowledge, attitude, and practices regarding self-medicationfor acne among medical students. Methods: A descriptive cross-sectional study was conducted over 3 months among 300 undergraduate medical students of a tertiary care medical college. A pretested, structured questionnaire assessed socio-demographic details, knowledge, attitude, and self-medication practices for acne. Data were analyzed using descriptive statistics and the chi-square test.Results: Mean age of participants was 21.4 ± 1.8 years; 58% were females. The prevalence of self-medication for acne was 64%. The most commonly used agents were topical antibiotics (45%), benzoyl peroxide (28%), herbal/home remedies (15%), and oral antibiotics (12%). Main reasons cited were convenience (52%), previous experience with the drug (35%), and cost-saving (13%). The internet (42%) and friends/seniors (28%) were the most common information sources. Only 39% were aware of possible side effects. Attitude assessment revealed that 46% considered self-medication safe for mild acne, while 81% agreed that a dermatologist should be consulted for severe acne. Conclusion: Self-medication for acne is common among medical students, often without adequate knowledge of potential side effects. Educational interventions are needed to promote rational and safe medication use.

Background: Peri-orbital hypermelanosis (POH) is a common multifactorial dermatosis affecting the periorbital skin and is increasingly relevant among young adults with high digital screen exposure. Objective: To estimate the prevalence of POH among undergraduate MBBS students and assess its association with screen time and selected lifestyle factors. Methods: A cross-sectional observational study was planned among 100 undergraduate MBBS students at RKDF Medical College, Bhopal. Data were collected using a semi-structured questionnaire and clinical assessment of POH using a standardized grading scale. Results: In the dataset, the prevalence of POH was 44.0%. POH was more frequent among students using screens for >6 hours/day (67.6%) compared with 4-6 hours/day (39.5%) and 2-4 hours/day (21.4%). Screen use before bedtime, prolonged uninterrupted screen use, poor sleep duration, eye strain, family history and atopy showed statistically significant associations with POH. Grade 2 pigmentation was the commonest severity grade. Conclusion: The findings suggest a moderately strong association between excessive screen exposure and POH among undergraduate medical students, with sleep-related and ocular strain factors acting as important contributors. Screen hygiene, regular breaks, adequate sleep and early dermatological counselling may help reduce the burden of POH in this group.

Background: Modified radical mastectomy is commonly associated with significant postoperative pain, which may adversely affect recovery and patient satisfaction. Ultrasound-guided fascial plane blocks such as Erector Spinae Plane Block (ESPB) and Serratus Anterior Plane Block (SAPB) have emerged as effective regional analgesic techniques for breast surgery. Aim: To compare the postoperative analgesic efficacy of ESPB and SAPB in patients undergoing modified radical mastectomy under thoracic segmental spinal anaesthesia. Materials and Methods: This prospective observational study was conducted in the Department of Anaesthesiology and Critical Care, VIMSAR, Burla, Odisha. A total of 88 female patients aged 20–60 years, belonging to ASA physical status I and II, were enrolled and divided into two groups: ESPB (n=44) and SAPB (n=44). Postoperative analgesic outcomes, pain scores, rescue analgesic requirements, recovery parameters, hemodynamic variables, and adverse effects were recorded and analyzed. Results: The mean duration of analgesia was significantly longer in the ESPB group than in the SAPB group (10.8 ± 2.4 vs. 7.2 ± 2.1 hours; p<0.001). Time to first rescue analgesia was also prolonged in the ESPB group (10.8 ± 2.4 vs. 7.2 ± 2.1 hours; p<0.001). Patients receiving ESPB required fewer rescue analgesic doses and lower tramadol consumption (78 ± 35 mg vs. 122 ± 40 mg; p<0.001). VAS pain scores were significantly lower at all postoperative intervals from 2 to 24 hours. ESPB facilitated earlier ambulation and bladder evacuation and was associated with a lower incidence of postoperative nausea and vomiting (15.9% vs. 34.1%; p=0.045). Conclusion: ESPB provided superior postoperative analgesia, reduced analgesic requirements, improved recovery outcomes, and decreased postoperative adverse effects compared with SAPB. It may be considered the preferred regional analgesic technique for modified radical mastectomy under thoracic segmental spinal anaesthesia.

Background: Alcohol use disorder (AUD) is not only a psychiatric and behavioural condition; it also produces systemic biological effects, including disturbances along the hypothalamo-pituitary-thyroid axis. In routine Indian psychiatric practice, thyroid testing is often reserved for clinically obvious endocrine symptoms, although subtle alterations may influence fatigue, sleep, mood, withdrawal distress, and recovery. Objectives: To compare thyroid function parameters among male patients with AUD and male control subjects, and to examine the relationship of AUDIT score and duration of alcohol use with TSH, T3, and T4 levels among male AUD patients. Methods: A comparative cross-sectional study was framed with 50 male patients with AUD as the principal clinical sample and 50 male control subjects for biochemical comparison. Age, duration of alcohol use, AUDIT score, thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were analysed. Group comparisons were performed using independent-samples t-test/Welch correction for continuous variables. Spearman correlation was used within the AUD group. Results: The AUD and control groups were comparable in age (41.24 ± 9.08 vs 41.00 ± 9.79 years; p=0.899). All participants in both groups were male. AUD patients had a mean duration of alcohol use of 16.32 ± 8.54 years and mean AUDIT score of 28.58 ± 5.96. Mean T3 was lower in the AUD group than controls (78.64 ± 15.82 vs 118.42 ± 18.36 ng/dL; p<0.001), whereas TSH (2.21 ± 0.63 vs 2.34 ± 0.59 μIU/mL; p=0.290) and T4 (7.42 ± 1.26 vs 7.68 ± 1.31 μg/dL; p=0.314) remained within the usual clinical range and did not differ significantly. Within the AUD group, duration of alcohol use and AUDIT score showed strong inverse correlations with T3, while correlations with TSH and T4 were weak and not statistically significant. Conclusion: Male patients with AUD showed significantly reduced T3 levels with relatively preserved TSH and T4 values. The reduction in T3 was more evident alongside longer alcohol-use duration and higher AUDIT scores. These findings support the value of thyroid profile assessment in AUD care pathways, while recognising that longitudinal and clinically adjudicated endocrine evaluation is required before causal conclusions are drawn.

Background: Prehypertension is considered a precursor to systemic hypertension and has been implicated in various vascular alterations. IOP (Intraocular Pressure) and OPP (Ocular Perfusion Pressure) are key factors in the development of glaucoma and are crucial indicators of the health of the optic nerve. Changes in these factors may raise the risk of glaucomatous damage and impair ocular blood flow. The purpose of this study was to assess the connection between glaucoma-related alterations and IOP and MOPP (Mean Ocular Perfusion Pressure) in prehypertensive and normotensive people. Methods: A hospital-based cross-sectional study was conducted in the Department of Ophthalmology, Nil Ratan Sircar Medical College and Hospital, over 18 months. A total of 244 participants were enrolled, comprising 122 prehypertensive subjects and 122 age- and sex-matched normotensive controls. Blood pressure was measured using a sphygmomanometer, and IOP was assessed using Goldmann applanation tonometry. Mean arterial pressure and mean ocular perfusion pressure were calculated using standard formulas. Statistical analysis was performed to compare ocular parameters between the two groups. Results: Prehypertensive individuals demonstrated significantly higher IOP values than normotensive subjects (right eye: 16.08 ± 4.15 vs. 14.40 ± 2.23 mmHg, p=0.011; left eye: 16.11 ± 4.20 vs. 14.57 ± 2.21 mmHg, p=0.039). MOPP was significantly lower in the prehypertensive group (right eye: 47.44 ± 3.87 vs. 49.34 ± 4.94 mmHg; left eye: 47.26 ± 3.74 vs. 49.30 ± 4.95 mmHg; p<0.001). A strong negative correlation was observed between IOP and MOPP among prehypertensive subjects. Glaucomatous disc changes (neuroretinal rim thinning) were significantly more frequent in the prehypertensive group than in normotensive individuals. Conclusion: Prehypertensive individuals exhibit significantly higher IOP and lower MOPP compared with normotensive individuals, indicating altered ocular perfusion dynamics. These changes may increase susceptibility to glaucomatous optic nerve damage. Early identification and management of prehypertension may help preserve ocular health and reduce the risk of glaucoma.

Background: Tympanic membrane (TM) perforation is a common otological condition often associated with conductive hearing loss and recurrent infections. Minimally invasive techniques such as chemical cauterisation and fat plug myringoplasty have gained popularity for the management of small central perforations due to their simplicity and cost-effectiveness. Aim: To compare the efficacy of chemical cauterisation and fat plug myringoplasty in the closure of small central tympanic membrane perforations with respect to anatomical closure, hearing improvement, complications, and patient satisfaction. Materials and Methods: This prospective, randomized interventional study was conducted in the Department of Otorhinolaryngology at ESIC Medical College & Hospital, Bihta, Patna, India. A total of 100 patients with small central tympanic membrane perforations were enrolled and randomly divided into two groups: Group I (chemical cauterisation) and Group II (fat plug myringoplasty), with 50 patients in each group. Patients were evaluated using otoscopic examination and Pure Tone Audiometry (PTA) preoperatively and at 3 months post-procedure. Outcomes assessed included closure rate, PTA improvement, postoperative complications, and patient satisfaction. Statistical analysis was performed using SPSS version 27.0, with p < 0.05 considered statistically significant. Results: Baseline characteristics were comparable between the two groups (p > 0.05). The closure success rate was significantly higher in the fat plug myringoplasty group (88.0%) compared to the chemical cauterisation group (70.0%) (p = 0.028). Postoperative PTA improvement was significantly greater in Group II, with a higher mean PTA gain (11.74 ± 3.08 dB) compared to Group I (6.52 ± 2.31 dB) (p < 0.001). Complication rates were lower in the fat plug group, with a higher proportion of patients experiencing no complications (78.0% vs 54.0%; p = 0.041). Patient satisfaction scores were significantly higher in Group II (8.62 ± 1.18) compared to Group I (6.84 ± 1.52) (p < 0.001). Conclusion: Both chemical cauterisation and fat plug myringoplasty are effective minimally invasive techniques for the management of small central tympanic membrane perforations. However, fat plug myringoplasty demonstrates superior outcomes in terms of closure rate, hearing improvement, complication profile, and patient satisfaction. It can be considered a preferred treatment modality in suitable clinical settings.

Background: The first six months of life are a critical period for infant feeding and healthy growth, immune maturation and early neurodevelopment. Comparative data on infants who are fed exclusively with breastmilk, donor human milk or mixed feeding in routine postnatal care, however, are still limited. Methods: A prospective cohort study of 170 clinically stable term and late-preterm infants followed from birth to six months in a tertiary-care maternal-child health unit. Infants were categorized into three groups: exclusive breastmilk (EBM; n=62), pasteurized donor human milk when maternal milk was not enough (DHM; n=48), and mixed feeding (MF; n=60) with breastmilk and formula. Anthropometry was measured monthly and analysed using WHO growth standards. Structured age-appropriate developmental screening was used to measure development at 6 months of age. Results: There were no differences in baseline gestational age and anthropometry of the children. At six months, mean weight was 7.42±0.74 kg in the EBM group, 7.18±0.68 kg in the DHM group and 7.55±0.79 kg in the MF group (p=0.041). There was no significant difference between length and head circumference. Mean cognitive scores were highest in EBM infants (101.6±7.4), followed by DHM (100.4±7.2) and MF (98.2±8.1; p=0.032). The rate of any developmental concern was 3.2%, 4.2% and 11.7% of infants, respectively (p=0.046). Diarrhoeal episodes were more frequent in the MF group (23.3%) than in the EBM (8.1%) and DHM (10.4%) groups (p=0.018). Conclusion: Exclusive breastmilk and donor human milk-supported feeding was correlated with satisfactory growth and marginally better early developmental and morbidity profile than mixed feeding. Enhanced lactation support and controlled access to donor milk could have a positive impact on early life outcomes.

Background: Intracranial space occupying lesions (ICSOLs) comprise a diverse group of neoplastic and non-neoplastic conditions affecting the central nervous system. Histopathological examination remains the gold standard for definitive diagnosis and classification of these lesions. Aim: To study the histomorphological spectrum, demographic characteristics, and anatomical distribution of intracranial space-occupying lesions at a tertiary care centre and to establish an accurate pretherapeutic diagnosis for guiding optimal therapeutic management and achieving better clinical outcomes. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology, All India Institute of Medical Sciences, over a period of 3 years from January 2022 to December 2024. A total of 320 intracranial biopsy and resection specimen were analyzed. Histopathological evaluation was performed using hematoxylin and eosin staining. Lesions were classified on the basis of histomorphological features and graded according to WHO grading criteria wherever applicable. Statistical analysis was performed using SPSS version 26.0. Results: Out of 320 cases, 274 (85.6%) were neoplastic and 46 (14.4%) were non-neoplastic lesions. The highest incidence was observed in the 41–60 years age group (38.1%). Male predominance was noted with a male-to-female ratio of 1.3:1. Gliomas were the most common neoplastic lesions (41.2%), followed by meningiomas (24.5%). Glioblastoma was the predominant glioma subtype. Supratentorial lesions accounted for 68.4% of cases. Statistical analysis showed a significant association between age group and lesion category (p<0.001). Conclusion: Gliomas remain the most common intracranial tumors encountered in tertiary care practice. Histopathological evaluation continues to play a pivotal role in accurate diagnosis, grading, and management of intracranial lesions.

Introduction: Ptosis is drooping of the upper eyelid due to levator muscle dysfunction, leading to functional and cosmetic impairment. Surgical correction depends mainly on levator function, with levator resection used in good function and frontalis sling in poor function. This study compared outcomes of levator resection versus frontalis sling procedure. Materials and Method: This prospective comparative study included 100 patients, divided into two groups: levator resection (n=50) and frontalis sling (n=50). Preoperative assessment included MRD-1 and levator function. Outcomes evaluated were eyelid height, symmetry, functional and cosmetic improvement, and complications with follow-up. Result: Postoperative MRD-1 improved to 3.4 ± 0.6 mm in levator resection and 3.1 ± 0.7 mm in frontalis sling group. Good symmetry was achieved in 84.0% vs 78.0%, functional improvement in 90.0% vs 88.0%, and cosmetic satisfaction in 86.0% vs 80.0% respectively. Complications were slightly higher in the sling group. Conclusion: Both procedures are effective for ptosis correction. Levator resection showed slightly better cosmetic outcomes and fewer complications, while frontalis sling was more suitable for severe ptosis with poor levator function.

Background: Inguinal hernia is one of the most common surgical conditions, and both open Lichtenstein repair and laparoscopic Transabdominal Preperitoneal (TAPP) repair are widely used techniques. The choice of the optimal procedure remains debated due to differences in operative time, postoperative pain, recovery, complications, and cost. Aim: To compare the clinical outcomes of Lichtenstein repair and laparoscopic TAPP repair in patients with inguinal hernia. Materials and Methods: This prospective cohort study was conducted in the Department of General Surgery at People’s College of Medical Sciences & Research Centre and associated People’s Hospital from April 2024 to December 2025. A total of 75 patients with uncomplicated unilateral or bilateral inguinal hernia were included. Sixty patients underwent open Lichtenstein tension-free mesh repair, while fifteen patients underwent laparoscopic TAPP repair. Operative time, postoperative pain using Visual Analogue Scale, hospital stay, return to work, postoperative complications, and early recurrence were assessed. Data were analyzed using appropriate statistical tests, with p<0.05 considered significant. Results: The mean operative time was significantly longer in the TAPP group compared with the Lichtenstein group. However, TAPP repair was associated with significantly lower postoperative pain scores, shorter hospital stay, and earlier return to work. Wound hematoma, wound infection, groin pain, and early recurrence were comparatively higher in the Lichtenstein group. Conclusion: Both Lichtenstein and TAPP repairs are safe and effective for inguinal hernia management. TAPP repair offers better postoperative comfort, faster recovery, shorter hospitalization, and improved cosmetic outcomes, while Lichtenstein repair remains a simpler, cost-effective, and reliable option, especially in resource-limited settings.

Introduction: Correct inhaler technique is essential for effective treatment of asthma and chronic obstructive pulmonary disease. This study assessed inhaler technique errors and the effect of structured education on device use and symptom control. Methods: This prospective interventional study included 100 adult patients with asthma or chronic obstructive pulmonary disease (COPD) who were receiving inhaled therapy at a tertiary care hospital in Western India. Inhaler technique was assessed using device-specific checklists. Patients received individualised demonstration-based training and were reassessed after 3 months. Symptom control was evaluated using the Asthma Control Test (ACT) for asthma and the COPD Assessment Test (CAT) for COPD. Results: COPD was present in 67% of participants, and asthma in 33%. Dry powder inhalers were the most commonly used device (59%). Correct technique improved after education among metered dose inhaler users from 45.5% to 81.8%, dry powder inhaler users from 33.3% to 50.9%, and nebuliser users from 50% to 68.8%. Median technique scores improved significantly for metered dose inhalers (p = 0.002), dry powder inhalers (p < 0.001), and nebulisers (p = 0.034). ACT and CAT scores also showed significant improvement in most device groups. Conclusion: Incorrect inhaler technique was common among patients with asthma and COPD. Structured, device-specific education improved inhaler technique and was associated with better symptom control.

Introduction: Nucleated red blood cells (nRBCs) in umbilical cord blood are recognized as markers of fetal hypoxia, inflammation, and intrauterine stress. Elevated cord blood nRBC counts have been associated with adverse perinatal outcomes, including low APGAR scores, neonatal intensive care unit (NICU) admission, respiratory distress, sepsis, and mortality. Aim: This study aimed to evaluate the association of cord blood nRBC counts with antenatal risk factors and neonatal outcomes. Materials and Methods: A prospective observational study was conducted from July 2025 to January 2026. A total of 130 mother -neonate’s pairs were included. Cord blood samples were collected immediately after delivery and analyzed for complete blood count and nRBC estimation using an automated hematology analyzer and peripheral smear examination. Maternal, intrapartum, and neonatal variables were recorded. Statistical analysis was performed using SPSS version 45, with p<0.05 considered significant. Results: Among 130 neonates, 55 (42.3%) had elevated nRBC counts (>10/100 WBC). Elevated nRBC counts were significantly associated with pregnancy-induced hypertension (p=0.0074), maternal anemia (p=0.0134), antepartum hemorrhage (p=0.0122), thick meconium-stained liquor (p=0.0074), and multiple antenatal risk factors (p=0.0203). Neonates with elevated nRBC counts had higher rates of respiratory distress syndrome, hypoxic-ischemic encephalopathy, meconium aspiration syndrome, abnormal APGAR scores, NICU admission, prolonged NICU stay (Spearman’s rho=0.83), and mortality. Out of 10 neonatal deaths, 9(90%) had elevated nRBC counts (p=0.0019). Conclusion: Umbilical cord blood nRBC count is a simple, inexpensive, and reliable marker of antenatal fetal stress. Elevated nRBC levels are strongly associated with neonatal morbidity, prolonged NICU stay, and mortality, making them a valuable adjunct for early risk stratification and prediction of neonatal outcomes.

Background: Sepsis-associated acute kidney injury (SA-AKI) is a major cause of morbidity and mortality among critically ill children admitted to Pediatric Intensive Care Units (PICUs). The coexistence of systemic infection and renal dysfunction significantly worsens outcomes and increases healthcare burden. Aim: To evaluate the association between sepsis and acute kidney injury and identify predictors of mortality and adverse clinical outcomes among children admitted to a PICU. Methods: A prospective observational study was conducted among 130 children aged 1 month to 12 years diagnosed with acute kidney injury and admitted to the PICU of a tertiary care teaching hospital. Demographic characteristics, nutritional status, clinical features, laboratory parameters, culture positivity, AKI severity, and outcomes were recorded. AKI was classified according to KDIGO criteria. Statistical analysis was performed using SPSS version 26.0. Results: Among 130 children with AKI, 91 (70%) had clinical sepsis. Children with sepsis demonstrated significantly higher mortality compared to non-septic patients (62.6% vs. 7.7%, p<0.00001). Severe acute malnutrition, elevated CRP, leukocytosis, abnormal chest radiographs, advanced AKI stages, and nephrotoxic drug exposure were associated with adverse outcomes. Blood culture positivity was observed in 82% and urine culture positivity in 78.9% of septic patients. Overall mortality was 46.2%. Conclusion: Sepsis is strongly associated with increased mortality, prolonged hospitalization, and greater AKI severity in critically ill children. Early diagnosis, prompt antimicrobial therapy, nutritional rehabilitation, and renal-protective strategies are essential for improving outcomes.

Background: Massive hemorrhage is one of the most common preventable causes of death in a trauma and/or emergency patient. In massive transfusion (MT), Massive Transfusion Protocols (MTPs) allow for rapid and coordinated blood transfusion administration to treat and control life-threatening bleeding in the management of trauma patients to optimize patient outcomes. Objective: To carry out the retrospective analysis of utilization of Massive Transfusion Protocol in trauma and emergency patients at SSIMS. Methodology: Patients using the department of Transfusion Medicine and Emergency Services in the Department from May 2025 to April 2026 were included in the study. The data were extracted from the blood bank records, the MTP activation forms, trauma registry, the records from the emergency departments and electronic medical records. Descriptive statistical methods are used to analyze the demographic, clinical indications, blood component utilization, transfusion ratios, patient outcomes and adverse events. Results: During the study period, 50 activations of MTP were found. There were 72% male patients, the highest proportion of which were from the age group of 18–30 years. 70% of the cases were trauma related and 30% were non-trauma cases. The most common indications were due to road traffic accidents and polytrauma. Overall, 410 PRBC units and 360 FFP units, 205 platelet units and 95 units of cryoprecipitate (cryo) were given. In 56% the transfusion ratio achieved was three to one or above. All the patients survived, with low incidence of adverse transfusion reactions. Conclusion: MTPs play an important role in the management of massive bleeding. Early protocol activation and balance regimen in transfusion approach helps to produce better clinical results and also utilizing the blood resources.

Background: Primary headache disorders are among the most common neurological conditions and are increasingly recognized as multidimensional disorders with significant psychological and functional impact. Objective: To assess the prevalence and severity of psychological distress and disability among patients with primary headache using the Depression Anxiety Stress Scale-42 (DASS-42) and the Indian Disability Evaluation and Assessment Scale (IDEAS). Methods: This hospital-based cross-sectional study was conducted among 210 patients diagnosed with primary headache according to ICHD-3 criteria. Psychological distress was assessed using DASS-42, and functional disability was evaluated using IDEAS. Data were analyzed using descriptive and inferential statistics, with p <0.05 considered significant. Results: The majority of participants were female (75.7%) with a mean age of 33.03 ± 10.69 years. Migraine was the most common headache subtype (59.52%). Moderate to severe psychological distress was highly prevalent, with over 70% of patients demonstrating moderate to extremely severe DASS scores. Anxiety was the most prominent domain, followed by depression and stress. All participants exhibited some degree of disability, with 54.29% having ≥40% disability, indicating clinically significant impairment. Conclusion: Primary headache disorders are associated with a high burden of psychological distress and significant functional disability. These findings emphasize the need for routine psychological assessment and integrated multidisciplinary management to improve patient outcomes.

Background: Gaming disorder has been formally recognised by the World Health Organization in the 11th Revision of the International Classification of Diseases (ICD-11) and is increasingly reported among young adults. Social anxiety disorder is a common psychiatric morbidity in college students, and recent literature has suggested a bidirectional relationship between problematic gaming behaviour and social anxiety symptoms. Data on this association in Indian medical undergraduates remain limited. Aim: To estimate the prevalence of gaming addiction among undergraduate medical students and to determine its association with social anxiety disorder. Materials and Methods: A cross-sectional, web-based questionnaire survey was conducted among undergraduate medical students of a tertiary medical college in Rajasthan over a period of two months. A pre-validated, self-administered Google Form questionnaire was circulated to all undergraduate students. The instrument captured socio-demographic details, the seven-item Gaming Addiction Scale (GAS-7; Lemmens et al. 2009) and the 20-item Social Interaction Anxiety Scale (SIAS; Mattick and Clarke 1998). Gaming addiction was defined as meeting four or more of the seven GAS criteria, and probable social anxiety was defined as a SIAS score of 36 or more (Peters 2000). Data were analysed using SPSS version 21 and Microsoft Excel; chi-square test, independent t-test and Pearson correlation were applied; p < 0.05 was considered statistically significant. Results: A total of 493 medical undergraduates participated. Mean age was 20.71 ± 1.53 years; 54.4% were female; 90.1% resided in hostel/PG accommodation. The prevalence of gaming addiction was 22.1% (109/493) and that of probable social anxiety was 18.1% (89/493). Gaming addiction was significantly more common in male students (28.6% vs 16.8%; χ² = 9.15, p = 0.002). Probable social anxiety was numerically higher in female students (20.9% vs 14.7%; p = 0.099). Gaming-addicted students had significantly higher mean SIAS scores than non-addicted students (28.47 ± 16.68 vs 22.65 ± 12.49; t = 3.38, p < 0.001). Social anxiety was significantly more prevalent in gaming-addicted students (27.5% vs 15.4%; χ² = 7.68, p = 0.006; OR 2.09, 95% CI 1.26–3.46). Gaming addiction was significantly associated with hand pain (26.6% vs 12.0%, p < 0.001) and eye-related symptoms (28.4% vs 16.1%, p = 0.006). The Pearson correlation between GAS-7 and SIAS total scores was significant (r = 0.207, p < 0.001). Conclusion: Nearly one in five medical undergraduates in this study population were classified as gaming-addicted, and one in five had probable social anxiety. Gaming addiction was significantly associated with social anxiety, supporting an important and clinically meaningful relationship that warrants targeted screening, counselling and student-wellbeing interventions in Indian medical colleges.

Background: Head and neck squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide and contributes a disproportionately high burden to the Indian population, where tobacco use—both smoked and smokeless—remains the dominant aetiological factor. Western Rajasthan has a long-standing cultural pattern of smokeless tobacco consumption, yet contemporary site- and subsite-level epidemiological data from this region are limited. Objectives: To describe the distribution of HNSCC across the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx in reference to demographic profile, tobacco addiction, clinical presentation, anatomical subsites, and stage at diagnosis. Materials and Methods: An observational descriptive cross-sectional study was conducted in the Department of Otorhinolaryngology, Mathuradas Mathur Hospital, Jodhpur, between 1 February 2024 and 1 May 2024. Ninety-two newly diagnosed, biopsy-proven HNSCC patients were enrolled by consecutive sampling. Data on demographics, tobacco use, presenting complaints, anatomical site/subsite, and TNM stage (AJCC 8th edition) were collected on a structured proforma. Statistical analysis was performed using SPSS version 22.0; categorical variables were expressed as frequencies and percentages. Results: Of 92 patients, 71 (77.17%) were male and 21 (22.82%) female. The most common age group was >60 years (33.69%), closely followed by 51–60 years (32.60%). Oral cavity was the leading site (51 cases; 55.43%), followed by oropharynx (18.47%), larynx (14.13%), hypopharynx (10.86%), and nasopharynx (1.08%). Tobacco addiction was identified in 91 of 92 patients (98.91%); smokeless tobacco predominated in oral cavity SCC (48/51; 94.11%), while combustible tobacco predominated in pharyngeal and laryngeal sites. The commonest oral cavity subsite was the anterior two-thirds of the tongue (29.41%), followed by the gingivobuccal sulcus and alveolus (27.45%). Locally advanced disease (Stage III–IV) was present in 90.21% of patients at presentation. Conclusion: HNSCC in western Rajasthan affects a predominantly male, older, rural, low-income, and tobacco-using population, with the oral cavity as the dominant site and overwhelming presentation at advanced stages. Strengthening tobacco-cessation programmes and early-detection strategies remains an urgent public-health priority.

Background: Calcineurin inhibitors (CNIs) are the standard of care for maintenance immunosuppression in renal transplantation but are associated with long-term nephrotoxicity and other systemic complications. Mammalian target of rapamycin (mTOR) inhibitors offer a non-nephrotoxic alternative. Methods: We conducted a retrospective analysis of 151 renal transplant recipients between February 2022 and June 2024 to evaluate the outcomes of patients converted from CNIs to mTOR inhibitors. Results: Eight patients required conversion. Indications included drug-induced nephrotoxicity, Posterior Reversible Encephalopathy Syndrome (PRES), and Hemolytic Uremic Syndrome (HUS). Following conversion to everolimus, serum creatinine levels returned to baseline, and neurological symptoms resolved without recurrence. Conclusion: Early conversion to mTOR inhibitors is an effective strategy for managing CNI-related complications while preserving graft function.

Background: Idiopathic menorrhagia is a prevalent gynecological condition characterized by excessive menstrual blood loss without regular structural or organic pelvic pathology. It severely disrupts systemic quality of life and leads to progressive iron deficiency anemia. Levonorgestrel-releasing intrauterine system (LNG-IUS) and oral cyclical norethisterone represent two distinct standard medical approaches requiring structured comparative verification. Objective: To evaluate and compare the therapeutic efficacy, safety parameters, and overall patient acceptability of LNG-IUS versus oral norethisterone in women suffering from idiopathic menorrhagia. Materials and Methods: This prospective comparative study spanned an 18-month duration at the Department of Obstetrics and Gynecology, RIMS, Ranchi. Sixty-four reproductive-age females diagnosed with idiopathic menorrhagia were recruited based on explicit criteria and assigned to two equal intervention groups (n=32 per arm). Group A received the intrauterine insertion of an LNG-IUS (Mirena, 52 mg), while Group B was treated with oral Norethisterone tablets (5 mg three times daily from Day 1 to Day 21 of each cycle) for 6 sequential cycles. Serial clinical follow-ups were carried out at 1, 3, and 6 months. Primary outcomes included change in menstrual blood loss quantified via the Pictorial Blood Assessment Chart (PBAC) scores and hemoglobin (Hb) levels. Secondary indices included transvaginal ultrasound assessment of endometrial thickness, intervention failure rates necessitating hysterectomy, and absolute patient satisfaction scores. Results: Baseline parameters were homogenous across both cohorts. Pre-treatment mean PBAC scores were statistically similar (LNG-IUS: 470.34±51.00 vs Norethisterone: 478.59±55.93, p=0.540). At the 6-month review, the LNG-IUS cohort exhibited an extensive decline in mean PBAC scores to 54.13±11.42, which was significantly lower than the 139.09±110.76 recorded in the norethisterone group (p<0.001). Conclusion: The levonorgestrel-releasing intrauterine system offers superior clinical efficacy over oral cyclical norethisterone, providing profound management of menstrual blood loss, higher correction of chronic anemia, minimization of subsequent major hysterectomies, and excellent overall patient satisfaction.

Background: Traumatic brain injury associated with faciomaxillary trauma is a major cause of morbidity and mortality, particularly following high-velocity road traffic accidents. The close anatomical relationship between the facial skeleton and cranial structures makes early clinicoradiological assessment essential for identifying intracranial injuries and planning multidisciplinary management. Materials and Methods: This single-centre retrospective study included 124 adult patients with radiologically confirmed traumatic brain injury and concomitant faciomaxillary trauma admitted to the Department of Neurosurgery, Government General Hospital, Kakinada, between August 2023 and August 2025. Demographic characteristics, mechanism of injury, clinical presentation, Glasgow Coma Scale score, computed tomography findings, facial fracture patterns, associated systemic injuries, management modalities and outcomes were analysed using descriptive statistics and appropriate tests of association. Results: The majority of patients were male (94.4%), with a mean age of 37 years, and the predominant age group was 20–30 years. Road traffic accidents accounted for 80.5% of injuries. Alcohol consumption was reported in 58.6% of assessed patients, while 99% of evaluated patients were not wearing helmets. Maxillary fractures were the most frequent facial injuries, followed by nasal bone, orbital wall, zygomatic and mandibular fractures. Multiple facial fractures were observed more commonly than isolated fractures. The common intracranial findings were pneumocephalus (45.7%), cerebral contusion (33.7%), epidural haematoma (16.3%), subarachnoid haemorrhage (16.3%) and subdural haematoma (13.0%). Epistaxis, loss of consciousness and vomiting were the most frequent clinical presentations. Neurosurgical intervention was required in eight patients, while 40 patients underwent surgical treatment for faciomaxillary fractures. Four deaths were recorded, mainly among patients with polytrauma and associated systemic injuries. Conclusion: Traumatic brain injury frequently coexists with faciomaxillary fractures, particularly following road traffic accidents. Midfacial and frontal bone fractures should raise a high index of suspicion for associated intracranial pathology. Combined CT evaluation of the brain and facial bones, early neurological assessment and coordinated multidisciplinary management are essential for reducing morbidity and mortality. Improved helmet use, road-safety awareness and strict enforcement of traffic regulations may substantially reduce the burden of craniofacial trauma.

Purpose of the study: To study the comparison of intra operative and post-operative anterior segment complications in manual small incision cataract surgery in eyes with high and normal axial length. Materials and methods: 100 eyes were included in our study (50 eyes of normal axial length and 50 eyes of high axial length). We have calculated the sample size by using the formula of simple random sampling method. Eligible cases will be around 100 as per inclusion, exclusion criteria and error of loss of follow up. Intra operative and post-operative complications were depicted with different charts and diagram. Result and Observation: Intra operative complications were present in 10 (20%) patients in normal axial length group (NALG), whereas it was 21 (42%) patients in high axial length group (HALG). So in our study HALG patients had significantly higher (p=0.029) intra operative complications as compared to their counterparts. It was observed that patients with high axial length had significantly (p=0.045) higher rates of postoperative day 1 complications as compared to their normal axial length counterparts. There was no statistically significant (p=0.061) two-week post-operative complication as well as 6 weeks postoperative complications rates (p=0.275) in NALG and HALG. It was observed that the commonest 6-week postoperative complications in the patients with high axial length were corneal edema, posterior synechia, and pseudophakic bullous keratopathy. That for the patients in normal axial length was de-centered IOL. Conclusion: SICS remains a viable and effective option for cataract surgery across different axial lengths, a tailored approach is imperative for high axial length eyes. By incorporating advanced preoperative planning, refined surgical techniques, and robust postoperative care, the risk of anterior segment complications can be minimized, ensuring optimal visual outcomes for all patients.

Background: Empyema thoracis is defined as presence of pus in the pleural space. Objective: To study the clinicopathologic profile of patients with empyema thoracis including surgical interventions and final outcome. Methods: It is a single-centred, prospective, observational analysis of 93 patients of empyema thoracis treated in CTVS department of R. G. Kar Medical College, Kolkata, India. Results: Mean patient age was 48.2 years with male predominance (75.27%) and adult population being commonly involved (90.32%). 61.29% patients were of non-tubercular etiology and Klebsiella was the   commonest organism isolated from the pleural fluid (19.29%).  Most patients presented in Stage III empyema (75.3%).  Thoracotomy and decortication were done in 85 patients (91.4%) whereas decortication with some form of lung resection was offered in remaining 8 patients. Prolonged air leak (more than 7 days) was observed in 35.48% cases post-operatively and 1 patient died due to sepsis. Average blood loss was around 600ml in perioperative period. Prolonged intercostal tube drainage was required in 26 patients (27.96%) out of whom 10 were discharged with the tube in-situ. Prolonged ICU stay beyond 3 days was needed in 8 patients and hospital stay beyond 3 weeks was observed in 13 patients. 12 patients needed a second surgery in later period.

Introduction: Atrial fibrillation is a common postoperative complication after CABG, mainly linked to oxidative stress and inflammation, occurring in 30–50% of patients. Risk factors include age, diabetes, hypertension, and heart disease. Vitamin C, an antioxidant, may reduce POAF by limiting oxidative injury and improving endothelial function. Despite beta-blocker use, additional prevention is needed, warranting further studies on vitamin C therapy. Aims: The aim of this study is to determine the effect of oral ascorbic acid in combination with beta-blockers on the incidence of postoperative atrial fibrillation in patients undergoing elective off-pump CABG. The objectives are to assess and compare the effectiveness of perioperative oral ascorbic acid with beta-blockers versus beta-blockers alone in preventing atrial fibrillation in these patients, and to evaluate any adverse events occurring in both treatment groups. Materials and Methods: This randomized controlled single-blinded study was conducted in the Department of Cardiac Anaesthesia, NRSMCH, Kolkata, over 18 months (August 2024–February 2025). The study included 100 patients undergoing elective CABG. Participants were allocated to receive oral ascorbic acid with beta-blockers or beta-blockers alone, and outcomes were compared for POAF incidence. Result: The study groups were comparable in baseline, comorbidities, perioperative variables, echocardiographic parameters, and medication use. Postoperative atrial fibrillation was significantly lower in Vitamin C group (6% vs 28%, p=0.003). Other outcomes including transfusion, ventilation, ICU stay showed no significant difference. Conclusion: The study concluded that oral ascorbic acid with beta-blockers is more effective than beta-blockers alone in preventing postoperative atrial fibrillation after off-pump CABG. Older age, diabetes mellitus, and postoperative blood transfusion were identified as independent risk factors for developing atrial fibrillation.

Background: Erythrocyte sedimentation rate (ESR) is a commonly used, simple, and inexpensive laboratory marker for detecting inflammatory and chronic disease activity. Although the Westergren method is considered the reference method for ESR estimation, conventional methods are time-consuming and require manual handling. Automated ESR methods have been introduced to provide faster reporting and reduce technical errors. Therefore, comparing conventional and automated ESR methods is important in routine laboratory practice. Aim and Objectives: The present study aimed to compare ESR estimation by Westergren, Wintrobe, and VES-Matic automated methods and to evaluate their utility in patients with liver, pulmonary, and renal disorders. Materials and Methods: This prospective observational study was conducted in admitted patients with liver, pulmonary, and renal disorders at a tertiary care hospital. A total of 182 patients were included. Patients of both sexes and all age groups with deranged liver function tests, deranged renal function tests, or pulmonary disorders diagnosed clinically and radiologically were enrolled. ESR was estimated in all patients by Westergren, Wintrobe, and VES-Matic automated methods. Data were analyzed using frequencies, percentages, means, standard deviations, and the chi-square test. A p-value <0.05 was considered statistically significant. Results: Out of 182 patients, 126 were males, and 56 were females, with a male-to-female ratio of 2.25:1. Liver disorders were present in 62 patients (34.1%), lung disorders in 69 patients (37.9%), and renal disorders in 51 patients (28.0%). Overall, abnormal ESR was detected in 147 patients (80.8%) by the Westergren method, 129 patients (70.9%) by the Wintrobe method, and 131 patients (72.0%) by the automated method. The mean ESR was highest by the Westergren method (45.79±27.83 mm/hr.), followed by the automated method (36.97±25.10 mm/hr.), and lowest by the Wintrobe method (29.68±17.70 mm/hr.). The difference between the three methods was statistically significant (p<0.001). Disease-wise, abnormal ESR by the Westergren method was observed in 46 liver disease patients (74.2%), 57 lung disease patients (82.6%), and 44 renal disease patients (86.3%). The Westergren method showed a statistically significant association with disease category (p=0.03), whereas Wintrobe and automated methods did not. Conclusion: The Westergren method detected the highest number of abnormal ESR values and remains the most sensitive and reliable method for ESR estimation, particularly in patients with high ESR values. The Wintrobe method showed lower ESR values and may underestimate abnormal ESR in some cases. The VES-Matic automated method showed closer agreement with the Westergren method than the Wintrobe method. It may be used as a faster and safer alternative in routine laboratories after proper validation.

Background: Oligohydramnios, defined as a reduced volume of amniotic fluid, is a common obstetric complication associated with adverse maternal and perinatal outcomes. It is commonly diagnosed by ultrasonography using the amniotic fluid index (AFI) of ≤5 cm or a single deepest pocket of <2 cm. Oligohydramnios has been linked to increased rates of labor induction, cesarean delivery, fetal distress, meconium-stained liquor, low birth weight, and neonatal morbidity. Objectives: To evaluate the maternal and perinatal outcomes in pregnancies complicated by oligohydramnios and to assess its impact on the mode of delivery and neonatal outcome. Materials and Methods: A prospective observational study was conducted among 100 pregnant women with singleton pregnancies diagnosed with oligohydramnios after 37 weeks of gestation. Detailed obstetric history, clinical examination, and ultrasonographic assessment were performed. Maternal outcomes including mode of delivery and intrapartum complications were recorded. Perinatal outcomes such as birth weight, Apgar score, meconium-stained liquor, NICU admission, and perinatal mortality were analyzed. Results: The majority of patients were primigravidae and presented at term. Labor induction was required in a significant proportion of cases. Cesarean section rates were increased, predominantly due to fetal distress. Meconium-stained liquor was observed frequently. A considerable number of neonates had low birth weight and low Apgar scores at 5 minutes. NICU admissions were higher among neonates born to mothers with severe oligohydramnios. Perinatal morbidity was increased, although perinatal mortality remained low with timely obstetric intervention. Conclusion: Oligohydramnios is associated with increased maternal interventions and adverse perinatal outcomes. Early diagnosis, close fetal surveillance, and appropriate obstetric management can significantly improve neonatal outcomes and reduce complications. Careful monitoring of pregnancies complicated by oligohydramnios is essential to ensure favorable maternal and perinatal outcomes.

Background:  The foramen magnum is a large opening located in the occipital bone at the base of the skull, serving as a passage for the medulla oblongata, vertebral arteries, spinal roots of the accessory nerve, and associated meninges. Morphometric analysis of the foramen magnum is of considerable importance in anatomy, anthropology, forensic medicine, neurosurgery, and radiology. Variations in its dimensions and shape can aid in sex determination and provide valuable information for surgical approaches to the craniovertebral junction. Objectives:  To determine the morphometric dimensions and shape variations of the foramen magnum in adult dry human skulls and assess their anatomical significance. Materials and Methods: A cross-sectional observational study was conducted on 28 adult dry human skulls of unknown sex obtained from the Department of Anatomy. Damaged skulls and those with deformities involving the cranial base were excluded. The anteroposterior diameter (length) and transverse diameter (width) of the foramen magnum were measured using a digital vernier caliper. The foramen magnum index was calculated, and the shape was visually classified into oval, round, hexagonal, tetragonal, pentagonal, and irregular types. Data were analyzed using descriptive statistics and expressed as mean ± standard deviation. Conclusion: The present study demonstrates significant variations in the dimensions and morphology of the foramen magnum in adult dry human skulls. These findings provide valuable baseline data for anatomists, forensic experts, anthropologists, and neurosurgeons, contributing to the understanding of cranial anatomy and facilitating clinical and forensic applications.

Introduction: Gallstone disease is one of the most common hepatobiliary disorders and is associated with significant morbidity worldwide. The disease shows considerable variation in incidence, gallstone morphology, and histopathological manifestations across different populations. Identification of associated risk factors and pathological changes is important for early diagnosis and appropriate management. The study aimed to assess the clinicopathological spectrum of gallstone variants and correlate them with risk factors and histopathological findings. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology, Government Medical College, Anantapuramu, over a period of 18 months from December 2023 to June 2025. A total of 112 cholecystectomy specimens with gallstones from patients of all age groups were included in the study. Gross examination was performed to classify gallstones into pigmented, cholesterol, and mixed variants based on morphology. Histopathological examination was carried out using hematoxylin and eosin-stained sections. Clinicodemographic parameters, risk factors, presenting complaints, and histopathological findings were analyzed using descriptive statistics. Results: The majority of patients belonged to the 31–40 years age group [35 (31.3%)], with a female predominance [80 (71%)]. Urban residents constituted 87 (78%) cases. Pigmented stones were the most common variant [65 (58%)], followed by cholesterol stones [32 (28.6%)] and mixed stones [15 (13.4%)]. Most patients were asymptomatic [72 (64.3%)], while right hypochondrial pain was the most common presenting complaint among symptomatic cases [16 (14.3%)]. Chronic cholecystitis was the predominant histopathological lesion [82 (73.2%)], followed by acute cholecystitis [25 (22.3%)]. Carcinoma gallbladder was identified in 2 (1.7%) cases. Conclusion: Gallstone disease is strongly associated with demographic and metabolic risk factors, particularly female gender, middle age, urban residence, and dyslipidemia. Histopathological evaluation of cholecystectomy specimens remains essential for identifying inflammatory lesions and detecting clinically silent malignancies.

Background: Postoperative complications following elective major abdominal surgeries remain a significant cause of morbidity and healthcare burden. The Clavien–Dindo Classification (CDC) provides an objective, therapy-based framework for standardized grading of surgical complications. This study aimed to assess postoperative complications using the CDC system and correlate their severity with postoperative morbidity. Methods: A prospective cross-sectional observational study was conducted over 18 months in the Department of General Surgery, Gandhi Medical College and Hamidia Hospital, Bhopal. A total of 102 patients undergoing elective major abdominal surgeries were enrolled consecutively. Complications were graded using the Clavien–Dindo Classification (Grades I–V). Statistical analysis was performed using SPSS; Chi-square test and Student’s t-test were applied. A p-value <0.05 was considered significant. Results: Of 102 patients, 68.6% were male. The majority belonged to the 30–60 years age group. Comorbidities were present in 30.4% of patients. Grade I complications were the most frequent (39.2%), followed by Grade II (22.5%), Grade III (19.6%), Grade IV (11.8%), and Grade V (death) in 6.9%. Surgical site infections, wound gaping, seroma, and postoperative fever were the commonest complications. Higher CDC grade correlated significantly with prolonged hospital stay, ICU admission, and need for reintervention (p<0.05). Conclusion: Most postoperative complications in elective major abdominal surgeries are low-grade and manageable. The Clavien–Dindo Classification is a simple, reliable, and reproducible tool for standardized complication reporting. Higher CDC grades reliably predict greater postoperative morbidity, making it a valuable prognostic instrument in surgical audit and clinical practice.

Background: Effective postoperative analgesia is essential for early mobilization and reduced morbidity following lower limb surgeries. Epidural administration of local anaesthetics like bupivacaine and opioids such as tramadol are widely used, but their comparative efficacy remains debated. Methods: A prospective, randomized comparative study design is proposed including patients undergoing elective lower limb surgeries under epidural anesthesia. Patients are allocated into two groups: Group B (0.25% bupivacaine) and Group T (tramadol 2 mg/kg epidurally). Pain was assessed using Visual Analog Scale (VAS), duration of analgesia, time to first rescue analgesia, and adverse effects were recorded. Results: Epidural bupivacaine demonstrated significantly lower VAS scores in the immediate postoperative period (0–4 hours), indicating superior analgesic quality. However, tramadol showed a prolonged duration of analgesia and delayed requirement for rescue analgesia. Incidence of nausea and vomiting was higher in the tramadol group, whereas motor blockade was more prominent in the bupivacaine group. Conclusion: Epidural bupivacaine provides superior early postoperative analgesia, whereas tramadol offers prolonged but less intense pain relief. Selection should be individualized based on surgical needs and patient profile.

Background: Awake fibreoptic nasal intubation (AFOI) is the gold standard for managing anticipated difficult airways. Achieving optimal sedation without compromising respiratory function and hemodynamic stability remains a clinical challenge. Aim: To compare the efficacy and safety of dexmedetomidine versus fentanyl in facilitating awake fibreoptic nasal intubation. Methods: This prospective, randomized, double-blind comparative study included 50 patients (ASA physical status I–II) aged 20–50 years undergoing elective surgery requiring AFOI. Patients were randomly allocated into two groups: Group D received dexmedetomidine (1 µg/kg), and Group F received fentanyl (2 µg/kg), both administered as intravenous infusion over 10 minutes. Sedation was assessed using the Ramsay Sedation Score (RSS). Intubation conditions were evaluated using cough score and post-intubation tolerance score. Hemodynamic parameters and oxygen saturation were recorded. Statistical analysis was performed using SPSS version 27, with p < 0.05 considered significant. Results: Dexmedetomidine provided significantly better sedation with higher proportion of patients achieving optimal RSS scores (p = 0.03). Intubation conditions were superior in Group D, with reduced cough response (p = 0.01) and improved post-intubation tolerance (p = 0.02). Hemodynamic stability was better maintained with dexmedetomidine, showing minimal changes in heart rate and mean arterial pressure compared to fentanyl (p < 0.01). The incidence of oxygen desaturation was significantly lower in Group D (4%) than Group F (28%) (p = 0.02). First-attempt intubation success was higher and intubation time shorter in the dexmedetomidine group. Conclusion: Dexmedetomidine is superior to fentanyl for awake fibreoptic nasal intubation, providing better sedation, improved intubation conditions, enhanced hemodynamic stability, and reduced respiratory complications. It can be considered the preferred sedative agent for AFOI in patients with anticipated difficult airway.

Background: Intramedullary interlocking nailing is the standard treatment for tibial shaft fractures; however, the optimal surgical approach remains controversial. The suprapatellar approach has recently gained popularity because of easier fracture reduction and improved alignment, while concerns regarding intra-articular injury persist. The present study compared suprapatellar and infrapatellar approaches for tibial intramedullary nailing with respect to operative, radiological, functional, and complication-related outcomes. Methods: This prospective comparative observational study included 87 patients with tibial shaft fractures managed with intramedullary interlocking nailing. Patients were divided into suprapatellar (Group A, n=44) and infrapatellar (Group B, n=43) groups based on the surgical approach used. Operative parameters including operative time, fluoroscopy duration, blood loss, and hospital stay were recorded. Radiological outcomes, fracture union, malalignment, knee range of motion, Lysholm Knee Score, and postoperative complications were evaluated during follow-up. Statistical analysis was performed using SPSS version 25.0, and p<0.05 was considered statistically significant. Results: The suprapatellar group demonstrated significantly shorter operative time (78.4 ± 11.2 vs 92.6 ± 13.8 minutes; p<0.001), reduced fluoroscopy exposure (78.9 ± 16.5 vs 104.3 ± 21.6 seconds; p<0.001), and lower blood loss (108.5 ± 28.7 vs 126.4 ± 31.5 mL; p=0.007). Mean fracture union time was significantly lower in the suprapatellar group (18.6 ± 3.1 vs 20.4 ± 3.8 weeks; p=0.019). Malalignment was significantly less frequent in Group A (4.5% vs 18.6%; p=0.041). Functional outcomes were superior in the suprapatellar group with higher Lysholm Knee Scores (91.8 ± 5.7 vs 84.6 ± 7.9; p<0.001) and lower incidence of anterior knee pain (13.6% vs 37.2%; p=0.011). Conclusion: The suprapatellar approach for tibial intramedullary nailing offers significant advantages over the infrapatellar approach, including improved operative efficiency, better fracture alignment, superior functional outcomes, and reduced anterior knee pain without increasing complication rates. It represents a safe and effective alternative for the management of tibial shaft fractures.

Background: Knee osteoarthritis is a major cause of pain, disability, and reduced quality of life worldwide. In recent years, knee preservation techniques have gained importance as alternatives to joint replacement in appropriately selected patients. The present study compared the clinical, functional, and radiological outcomes of commonly employed knee preservation strategies in patients with osteoarthritis of the knee. Methods: This prospective comparative study included 94 patients with Kellgren–Lawrence grade II–III knee osteoarthritis treated at a tertiary care center. Patients were allocated to High Tibial Osteotomy (HTO) (Group A, n=32), arthroscopic cartilage preservation procedures (Group B, n=31), or Platelet-Rich Plasma (PRP) therapy (Group C, n=31). Baseline demographic and clinical characteristics were recorded. Outcomes were assessed using Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), range of motion (ROM), radiological progression, and complications over a 12-month follow-up period. Results: Baseline demographic and clinical characteristics were comparable among the groups (p>0.05). At 12 months, all interventions resulted in significant clinical improvement; however, HTO demonstrated superior outcomes. Mean VAS scores improved from 7.6±1.0 to 2.1±0.9 in the HTO group compared with 3.1±1.2 following arthroscopy and 4.2±1.4 after PRP (p<0.001). HTO also achieved the greatest improvements in WOMAC (38.4±10.2), KSS (37.4±11.3), and ROM (15.6±8.7°) (all p<0.001). Radiological progression was absent in 81.3% of HTO patients compared with 64.5% and 48.4% of arthroscopy and PRP patients, respectively (p=0.018). Conversion to total knee arthroplasty was lowest following HTO (3.1%). Complication rates were low and comparable among groups. Conclusion: All three knee preservation techniques were effective in improving symptoms and function in knee osteoarthritis. However, HTO provided the most favorable clinical, functional, and radiological outcomes, suggesting superior joint-preserving efficacy in appropriately selected patients. Arthroscopic procedures offered moderate benefits, while PRP provided symptomatic improvement with minimal invasiveness but less durable structural preservation.

Background: Intertrochanteric femur fractures are common in the elderly population and are associated with significant morbidity and mortality. Proximal Femoral Nail Antirotation 2 (PFNA2) is widely used for fixation; however, controversy persists regarding the optimal nail length. The present study compared the surgical, radiological, and functional outcomes of Short PFNA2 and Long PFNA2 in the management of intertrochanteric femur fractures. Methods: This prospective comparative observational study included 137 patients with intertrochanteric femur fractures treated surgically using PFNA2 fixation. Patients were divided into Group A (Short PFNA2, n=69) and Group B (Long PFNA2, n=68). Baseline demographics, intraoperative parameters, postoperative outcomes, fracture union, complications, and functional outcomes using Harris Hip Score were compared between the groups. Results: The mean operative duration, blood loss, fluoroscopy exposure, incision length, and distal locking time were significantly lower in the Short PFNA2 group (p<0.001). Hospital stay and time to partial weight bearing were also significantly shorter in Group A (p≤0.004). Fracture union rates were comparable between the groups. However, Long PFNA2 demonstrated significantly better Harris Hip Scores at 6 months and 1 year follow-up (p=0.024 and p=0.007, respectively). Limb shortening and anterior thigh pain were significantly higher in the Short PFNA2 group (p≤0.049). Implant-related complications were comparatively lower with Long PFNA2 fixation. Conclusion: Short PFNA2 offers important perioperative advantages including reduced operative time, blood loss, and earlier mobilisation, whereas Long PFNA2 provides better functional recovery and mechanical stability, particularly in unstable fractures. Nail length selection should therefore be individualised according to fracture pattern, patient profile, and surgeon preference.

Background: Laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation, resulting in transient increases in heart rate and blood pressure. Although these responses are generally tolerated in healthy individuals, they may precipitate serious cardiovascular complications in susceptible patients. Various pharmacological agents have been employed to attenuate this stress response. This study compared the efficacy of dexmedetomidine and fentanyl in controlling the hemodynamic response to laryngoscopy and endotracheal intubation. Aim: To evaluate and compare the effectiveness of intravenous dexmedetomidine and fentanyl in attenuating the hemodynamic stress response during laryngoscopy and endotracheal intubation. Materials and Methods: This prospective randomized comparative study was conducted in 60 ASA I and II patients aged 18–60 years undergoing elective surgeries under general anesthesia. Patients were allocated into two groups of 30 each. Group D received dexmedetomidine 1 μg/kg diluted in 100 mL normal saline over 10 minutes, while Group F received fentanyl 2 μg/kg similarly diluted and administered. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline and at 1, 3, 5, and 10 minutes following intubation. Statistical analysis was performed using SPSS version 26.0. Results: Baseline demographic and hemodynamic parameters were comparable between the groups. Following intubation, Group D demonstrated significantly lower HR, SBP, DBP, and MAP values compared to Group F at most observation intervals. The rise in HR and blood pressure at 1 minute post-intubation was markedly attenuated in the dexmedetomidine group. Hemodynamic parameters returned to baseline earlier and remained more stable in Group D throughout the study period. No significant adverse effects were observed. Conclusion: Dexmedetomidine 1 μg/kg administered before induction is superior to fentanyl 2 μg/kg in attenuating the hemodynamic stress response associated with laryngoscopy and endotracheal intubation. Its ability to provide better cardiovascular stability makes it a valuable anesthetic adjunct, particularly in patients at risk of adverse cardiovascular events.

Background: Thyroid disorders are among the most common endocrine abnormalities and often remain undiagnosed due to nonspecific clinical presentation. Routine laboratory testing plays a crucial role in the early detection of thyroid dysfunction, including subclinical cases. Aim: To evaluate the pattern and prevalence of thyroid function test abnormalities in patients undergoing routine laboratory investigations at a tertiary care center Materials and Methods: This hospital-based cross-sectional study was conducted in the Department of Pathology over a period of 12 months. A total of 300 patients undergoing thyroid function testing were included. Serum levels of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were measured using a chemiluminescence immunoassay method. Patients were categorized as euthyroid, hypothyroid, hyperthyroid, subclinical hypothyroid, and subclinical hyperthyroid based on standard reference ranges. Data were analyzed using descriptive statistics. Results: Out of 300 patients, 180 (60%) were euthyroid, while 120 (40%) showed thyroid dysfunction. Hypothyroidism was the most common abnormality (16.7%), followed by subclinical hypothyroidism (13.3%), hyperthyroidism (6.7%), and subclinical hyperthyroidism (3.3%). Thyroid disorders were more prevalent in females (60%) compared to males (40%). The majority of abnormalities were observed in the 21–60 years age group. Conclusion: A significant proportion of routine laboratory patients exhibit thyroid dysfunction, predominantly hypothyroidism and subclinical hypothyroidism. Routine screening, especially in females and middle-aged individuals, is essential for early diagnosis and management to prevent complications.

Background: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic, progressive, suppurative airway disease characterised by permanent bronchial dilatation. The clinico-radio-microbiological spectrum of NCFB in the Indian subcontinent, particularly in eastern India, remains insufficiently characterised. Post-tubercular sequelae constitute a distinct aetiological entity with unique radiological and microbiological signatures that differ substantially from those described in Western cohorts. Methods: A cross-sectional observational study was conducted at the Department of Respiratory Medicine, MKCG Medical College & Hospital, Berhampur, Odisha, over a period of 24 months (2022–2025). Seventy consecutive patients aged >18 years with radiographically confirmed NCFB were enrolled. Each patient underwent detailed clinical assessment, digital chest radiography, HRCT thorax, spirometry, sputum cytology (Gram stain, ZN stain), sputum culture and sensitivity (C/S), and sputum TB CBNAAT (Xpert MTB/RIF). Statistical analysis employed SPSS v26.0; binary logistic regression was used for multivariate analysis. Results: Mean patient age was 47.94 ± 13.91 years (range 18–>70); peak incidence occurred in the 51–60-year age group (30%). Males predominated (61.43% vs. 38.57%). Post-tubercular aetiology accounted for 61.43% of cases. Cough and expectoration were the dominant symptoms (77.14% each); crackles (90%) and digital clubbing (77.14%) were the most prevalent signs. Obstructive spirometry was observed in 52.86% of patients. On HRCT, the cystic pattern predominated (45.71%) with bilateral involvement in 55.71% and upper-lobe predominance (74.29%). Sputum culture was positive in only 32.86% of cases; Pseudomonas aeruginosa (17.14%) was the most frequent isolate, preferentially associated with cystic HRCT morphology and obstructive physiology (OR 4.82, 95% CI 1.92–12.10; p = 0.001). All sputum AFB smears were negative; TB CBNAAT detected Mycobacterium tuberculosis in 1.43% of specimens. Conclusion: NCFB in eastern India is predominantly post-tubercular in aetiology, affects middle-aged males, and is characterised by bilateral cystic HRCT changes, obstructive physiology, and Pseudomonas aeruginosa as the dominant isolate. The high rate of culture negativity underscores the need for advanced microbiological techniques including anaerobic and fungal cultures. These findings have direct implications for empirical antibiotic selection and infection-control strategies in resource-limited tertiary care settings.

Background: Chronic Kidney Disease (CKD) is a progressive systemic disorder associated with widespread hematological and biochemical derangements. Anemia is an early, debilitating complication predominantly driven by reduced erythropoietin (EPO) synthesis, chronic inflammation, and defective iron homeostatic mechanisms. Serum hepcidin has recently emerged as a key regulatory hormone implicated in functional iron deficiency during CKD progression. Aim: A Study aim is to analyze the clinical significance of specific hematopoietic markers (Erythropoietin and Hepcidin), liver aminotransferases (SGPT/ALT and SGOT/AST), and renal function markers (Serum Creatinine) in non-dialysis dependent (NDD) CKD patients, evaluating their cross-correlations across progressive disease stages. Methodology: A cross-sectional observational clinical study evaluated 150 non-dialysis dependent CKD patients aged over 18 years. Laboratory assessments quantified serum erythropoietin, hepcidin (via ELISA), and serum glutamate pyruvate transaminase (SGPT/ALT), and serum glutamic oxaloacetic transaminase (SGOT/AST), and serum creatinine levels across stages 3, 4, and 5. Statistical cross-correlations were calculated to establish the systemic pathophysiological relationships. Results: Serum creatinine and serum hepcidin levels increased progressively and significantly with advancing stages of renal dysfunction. In contrast, serum erythropoietin levels exhibited a continuous decline as kidney disease progressed. Changes in liver aminotransferases (SGOT and SGPT) were relatively minor and did not show a direct association with serum hepcidin levels. However, SGOT levels demonstrated a noticeable reduction from baseline with increasing severity of renal impairment. Conclusion: As chronic kidney disease (CKD) progresses to more advanced stages, serum creatinine and hepcidin levels rise concurrently. The negative relationship between declining erythropoietin production and increasing hepcidin concentrations underscores the complex mechanisms contributing to anemia in non-dialysis-dependent CKD (NDD-CKD). Regular assessment of these biomarkers can provide valuable clinical insight for the early management of systemic complications prior to the initiation of dialysis.

Background: Antimicrobial resistance (AMR) has evolved into a formidable challenge for contemporary healthcare systems, particularly within tertiary care hospitals where extensive antimicrobial exposure accelerates selective pressure. Institutional resistogram surveillance provides a dynamic and evidence-based framework for understanding local resistance ecology and for guiding rational empirical therapy. Objectives: This study aimed to delineate the spectrum of bacterial pathogens isolated from diverse clinical specimens and to comprehensively analyze their antimicrobial resistance patterns in a tertiary care hospital setting. Methods: A cross-sectional resistogram-based study was conducted over a six-month period (June–November 2025). Clinical specimens including urine, blood, sputum, pus/wound swabs, endotracheal tube secretions, and bronchoalveolar lavage fluid were processed using standard bacteriological methods. Antimicrobial susceptibility testing was performed by disc diffusion and interpreted as per established guidelines. Results: Among 2392 clinical samples analyzed, culture positivity demonstrated marked specimen-wise variability, ranging from 15.77% in blood to 81.48% in wound swabs. Gram-negative bacilli constituted the predominant isolates, with Klebsiella spp. and Acinetobacter spp. emerging as the most frequent pathogens. Alarmingly high resistance rates were observed against third-generation cephalosporins, fluoroquinolones, and carbapenems. Conversely, fosfomycin, netilmicin, aztreonam, and tigecycline retained notable activity against multidrug-resistant organisms. Conclusion: The findings reveal a concerning escalation of antimicrobial resistance alongside a clinically significant re-emergence of susceptibility to selected older antimicrobials. Periodic, institution-specific resistogram analysis remains indispensable for optimizing empirical therapy and reinforcing antimicrobial stewardship strategies.

Introduction: Non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) are increasingly prevalent metabolic disorders that frequently coexist and share common risk factors such as obesity, insulin resistance, dyslipidaemia, and type 2 diabetes mellitus. Although several studies have demonstrated an epidemiological association between these conditions, limited data are available regarding the influence of NAFLD on the biochemical composition of gallstones. Objectives: To evaluate the association between the chemical composition of gallstones and NAFLD diagnosed by ultrasonography, to assess the relationship between serum biochemical parameters and gallstone composition, and to determine whether gallstone constituents vary according to the severity of NAFLD. Methodology: This cross-sectional observational study was conducted in the Departments of Biochemistry and General Surgery, KPC Medical College and Hospital, Kolkata, over a period of eighteen months. A total of 246 patients with gallstone disease were included, comprising 123 patients with ultrasonographically diagnosed NAFLD and 123 controls without NAFLD. Serum cholesterol and bilirubin levels were estimated, and gallstones obtained after cholecystectomy were analysed for cholesterol and bilirubin content using standard biochemical methods. Statistical analysis was performed using SPSS, and a p-value <0.05 was considered statistically significant. Results: Low physical activity (67.48% vs 38.21%, p=0.002), oral contraceptive use (23.42% vs 7.14%, p=0.01), type 2 diabetes mellitus (35.77% vs 17.89%, p=0.003), and previous gastrointestinal surgery (19.51% vs 9.76%, p=0.02) were significantly associated with NAFLD. Mean gallstone cholesterol (154.94 ± 120.92 mg/g vs 138.14 ± 106.32 mg/g, p=0.024) and bilirubin concentrations (1.46 ± 0.98 mg/g vs 1.09 ± 0.86 mg/g, p=0.037) were significantly higher among NAFLD patients. A significant positive correlation was observed between serum and gallstone cholesterol and bilirubin levels in the NAFLD group. Gallstone cholesterol and bilirubin concentrations increased progressively with increasing grades of NAFLD (p=0.001). Conclusion: NAFLD is significantly associated with altered gallstone composition, particularly increased cholesterol and bilirubin content. The progressive rise in gallstone constituents with increasing NAFLD severity suggests that worsening hepatic steatosis contributes to a more lithogenic biliary environment. Early identification and management of metabolic risk factors may help reduce the burden of both NAFLD and gallstone disease.

Background: Pain is a debilitating sensory and emotional experience that remains undertreated globally. Vortioxetine, a multimodal serotonergic antidepressant with antagonism at 5-HT3, 5-HT7, and 5-HT1D receptors and agonism at 5-HT1A receptors, has pharmacological properties that may confer analgesic benefits through modulation of spinal nociceptive pathways. Methods: Swiss albino mice (n=24) were divided into four groups (n=6 each): control (distilled water 0.4 ml oral), tramadol 10 mg/kg (standard), vortioxetine 5 mg/kg, and vortioxetine 10 mg/kg. Drugs were administered orally for seven days. Analgesic response time was assessed before and after treatment using Eddy’s hot plate, tail immersion, and tail clip methods. Data were analysed using paired t-test and one-way ANOVA with post-hoc Tukey’s test. Results: All active treatment groups demonstrated significantly increased response times compared to control (p<0.001). One-way ANOVA showed highly significant differences across groups for all three methods (F=172.11, 172.71, and 131.78 respectively; p<0.00001). The analgesic response followed the order: tramadol 10 mg/kg > vortioxetine 10 mg/kg > vortioxetine 5 mg/kg > control. Vortioxetine 5 mg/kg and 10 mg/kg showed comparable efficacy in the tail immersion test (p>0.05). Conclusion: Vortioxetine exhibits significant, dose-dependent analgesic activity in Swiss albino mice, albeit of lesser magnitude than tramadol, supporting its potential role as an adjuvant analgesic, particularly in patients with comorbid depression and chronic pain.

Background: Anxiety disorders are among the most prevalent psychiatric conditions worldwide, affecting approximately one-eighth of the global population [1]. Current pharmacological management predominantly relies on benzodiazepines, azapirones, selective serotonin reuptake inhibitors (SSRIs), and beta-blockers, many of which are associated with sedation, dependence, and abuse potential [3]. Ondansetron, a selective 5-HT3 receptor antagonist, modulates serotonergic neurotransmission through allosteric inhibition and represents a promising candidate for anxiolytic therapy with a potentially superior tolerability profile. Objective of this study is to evaluate and compare the anxiolytic activity of ondansetron at two dose levels (0.5 mg/kg and 1 mg/kg, oral) against alprazolam (0.25 mg/kg, oral) as the standard drug, using three validated rodent behavioural models in Swiss albino mice. Methods: Twenty-four adult Swiss albino mice were randomly divided into four groups (n=6 each). Group I received distilled water (0.4 ml oral, control); Group II received alprazolam 0.25 mg/kg oral (standard); Group III received ondansetron 0.5 mg/kg oral; and Group IV received ondansetron 1 mg/kg oral. Drugs were administered for seven consecutive days, after which behaviour was assessed using the Elevated Plus Maze (EPM), Open Field Test (OFT), and Hole Board Apparatus Test (HBT). One-way ANOVA followed by Tukey’s post-hoc test was used for statistical analysis. Results: Ondansetron at 1 mg/kg significantly increased time spent in the open arm (159.33 ± 12.37 sec) and reduced time in the closed arm (140.67 ± 12.37 sec) on EPM, comparable to alprazolam (154.50 ± 12.36 sec; 145.50 ± 12.36 sec). Similarly, ondansetron 1 mg/kg increased locomotor activity (88.17 ± 6.76 squares), time spent in the centre square (76.00 ± 4.86 sec) on OFT, and head-poking frequency (10.48 ± 1.47) on HBT. One-way ANOVA revealed highly significant differences across all parameters (F values 31.66–115.79; p < 0.00001). Post-hoc analysis showed no significant difference between ondansetron 1 mg/kg and alprazolam 0.25 mg/kg, confirming equipotent anxiolytic activity. Conclusion: Ondansetron demonstrates significant dose-dependent anxiolytic activity in Swiss albino mice, with the higher dose (1 mg/kg) producing effects comparable to the standard benzodiazepine alprazolam. This positions ondansetron as a potential anxiolytic agent warranting further clinical evaluation.

Background: Psoriasis is a long-term immune-mediated skin condition marked by keratinocyte hyperproliferation. The anterior pituitary secretes the multifunctional neuropeptide hormone prolactin, which has been linked to immunological regulation and keratinocyte proliferation, indicating a possible role in the pathogenesis of psoriasis. There are still few data from the Indian subcontinent despite several studies conducted worldwide. Objectives: to compare psoriasis patients’ blood prolactin levels to those of controls and to establish a correlation between prolactin levels and clinical metrics such as disease severity indicators (PASI and BSA). Methods: A case-control study was conducted at Navodaya Medical College, Hospital & Research Centre, Raichur, from February 2024 to June 2025. A total of 140 participants, 70 psoriasis patients and 70 age- and sex-matched controls were enrolled. Serum prolactin levels were measured and correlated with epidemiological variables, BSA, and PASI scores using independent t-test, Chi-square test, ANOVA, and Pearson/Spearman correlation analysis. Results: The mean serum prolactin level was significantly higher in cases (13.24 ± 9.12 ng/mL) compared to controls (6.84 ± 2.91 ng/mL; p < 0.001). Elevated prolactin was observed in 15 cases (21.4%) compared to only 4 controls (5.7%). Female patients exhibited significantly higher prolactin levels (18.62 ± 13.07 ng/mL) than males (11.03 ± 6.24 ng/mL; p = 0.003). Prolactin levels were associated significantly with PASI score (p = 0.001) and BSA (p = 0.041). The highest mean prolactin was noted in the PASI 41–55 group (19.84 ± 12.43 ng/mL). Conclusion: Psoriasis patients have significantly higher serum prolactin levels, which are correlated with the severity of the condition as determined by PASI and BSA. Prolactin should be taken into account in the immunopathogenesis of psoriasis and may be a clinically available biomarker for tracking its severity.

Introduction: The uncertainty tool has an important role for evaluation of analytical performance in any clinical laboratory. For having the quality of the analytical performance & planning the strategy of quality control, sigma metrics and QGI ratio are used as an uncertainty measurement tools. The study was done to estimate the analytical performance of clinical biochemistry laboratory of College of Medicine & Sagore Dutta Hospital by calculating Sigma metrics and QGI ratio. Methodology: the study was done in the Department of Biochemistry, College of Medicine and Sagore Dutta Hospital. The past 6 months’ (September 2025 to February 2026) of internal Quality Control reports of daily QC run as a part of routine analytical and maintenance performance of autoanalyzer ERBA XL 640 of routine parameters were analysed. The common Laboratory Parameters were used Blood glucose, Urea, Creatinine, Cholesterol, Triglyceride, HDL, LDL, ALP, SGPT, SGOT, Total Protein, Albumin, Total Bilirubin and Direct Bilirubin. Result:  The sigma levels of Level 1 the values of urea, creatinine, ALP and total protein are having their sigma levels in between 3 and 4. Sigma level L2 the value of total bilirubin is also is below 3 (2.99Ϭ) indicating unacceptable performance. Which can be considered as marginal performance and needs to improve the performance to maintain the quality. According to the Quality goal indicator values of these marginal and unacceptable performances indicate the possibilities of random errors. Conclusion: the marginal and unacceptable performences are mostly due to random errors which indicates the need of strict adherence to the SOPs and regular practices.

Background: Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity all over the world, with uterine atony accounting for nearly 70–80% of cases. Calcium plays an important role in myometrial contraction, and hypocalcaemia may impair uterine contractility, thereby increasing the risk of atonic PPH. However, serum calcium levels are not routinely evaluated in women in labour. This study was conducted to assess the association between serum calcium levels and atonic postpartum haemorrhage (PPH). Aim and Objectives: To estimate serum calcium levels in pregnant women during labour and compare serum calcium levels in women with and without atonic postpartum haemorrhage. Materials and Methods: This hospital-based comparative observational study was conducted in the Department of Obstetrics and Gynaecology, Assam Medical College and Hospital, Dibrugarh, over a period of one year. A total of 330 pregnant women in labour were included, comprising 110 women with atonic postpartum haemorrhage (Group I) and 220 women without postpartum haemorrhage (Group II). Serum calcium levels were measured at the time of labour.  Demographic characteristics, obstetric variables, duration of labour, mode of delivery, haemoglobin levels, and management outcomes were recorded. SPSS software was used for the statistical analysis, and a p-value of less than 0.05 was deemed statistically significant. Results: Most participants in both groups were aged 18–25 years, with comparable demographic characteristics. Labour duration was significantly longer in women with atonic PPH (64.55% had labour >12 hours) compared to women without PPH (26.82%) (p <0.001). Hypocalcaemia was observed in 68.18% of women with atonic PPH compared to 12.27% in women without PPH (p <0.001). The mean serum calcium level in women with atonic PPH was significantly lower (7.67 ± 0.52 mg/dL) compared to women without PPH (8.91 ± 0.44 mg/dL). Additionally, a higher requirement for blood transfusions and surgical procedures was linked to lower serum calcium levels. Conclusion: Low serum calcium levels were significantly associated with atonic postpartum haemorrhage. Estimation of serum calcium during labour may help identify women at risk for atonic PPH and allow early correction, thereby improving maternal outcomes and reducing morbidity and mortality.

Objective: To evaluate the efficacy and safety of half-dose magnesium sulphate therapy in the management of preeclampsia and eclampsia among mothers with BMI less than 30 kg/m2 at Assam Medical College and Hospital, Dibrugarh. Methods: This hospital-based prospective observational study included 80 pregnant women diagnosed with preeclampsia or eclampsia and having BMI <30 kg/m2. All participants received half-dose magnesium sulphate therapy as per the study protocol. Demographic characteristics, obstetric details, seizure control, adverse effects, maternal complications, mode of delivery, and perinatal outcomes were recorded using a structured proforma. Results: Most patients were in the reproductive age group of 19-35 years (57.5%), while 42.5% were at the extremes of maternal age. Primigravida constituted the largest parity group (47.5%). Effective seizure control was achieved in 79 of 80 patients (98.75%), with only one breakthrough seizure. Mild side effects included flushing, nausea, vomiting, injection-site pain, and one case of loss of deep tendon reflex after full-dose therapy was given for intractable seizure. Vaginal delivery was the most common mode of delivery (55%), followed by caesarean section (40%). Live births occurred in 77 pregnancies (96.25%). Conclusion: Half-dose magnesium sulphate therapy was effective in controlling seizures and preventing recurrence in preeclampsia and eclampsia with a favorable safety profile. This regimen may be a practical alternative in populations with lower BMI, though larger multicentric studies are required to validate dosing protocols.

Background: Early Clinical Exposure (ECE) is a substantial component of Competency-Based Medical Education (CBME) that fosters integration of basic sciences with clinical practice. Blood bank visits during Physiology teaching may intensify understanding of transfusion medicine, blood grouping, and patient care among undergraduate medical students. However, evidence regarding the impact of blood bank-based ECE in rural medical colleges remains limited. Objectives: To determine the effect of a structured blood bank visit on knowledge, perception, and clinical orientation among first-year MBBS students. Methods: A cross-sectional observational study was performed among 100 Phase I MBBS students at a rural medical college in West Bengal after obtaining Institutional Ethics Committee approval and informed consent. Students participated a structured blood bank visit following a lecture on blood grouping and transfusion-related physiology. Knowledge accession was evaluate using pre-test and post-test questionnaires. Student perceptions toward the educational usefulness of the ECE activity were rated using a validated Likert-scale questionnaire. Data were analyzed using Microsoft Excel, and statistical significance was considered at p<0.05. Results: Post-test scores substantiate significant progress compared with pre-test scores (p=0.023), denoting augmented understanding following the intervention. Most participants reported improved topic retention, better clinical correlation, increased interest in Physiology, and greater awareness regarding patient care and voluntary blood donation. The intervention showed a small-to-moderate educational effect size (Cohen’s d=0.33). Conclusion: Structured blood bank visits as part of ECE significantly upgraded knowledge, perception, and clinical orientation among first-year MBBS students. Integration of experiential learning modules into Physiology teaching may strengthen competency-based undergraduate medical education and encourage clinically relevant learning.

Background: Chronic Kidney Disease (CKD) is associated with progressive impairment of renal function and disturbances in iron metabolism. Hepcidin, a key regulator of iron homeostasis, has emerged as an important biomarker in CKD-related anemia and inflammation. Aim: To evaluate serum hepcidin levels and their association with ferritin, serum creatinine, and blood urea among non-dialysis dependent CKD patients. Methodology: A cross-sectional study was conducted on 150 CKD patients categorized into Stage 3, Stage 4, and Stage 5 CKD. Serum hepcidin, ferritin, creatinine, a blood urea was measured and compared across CKD stages. Correlation between ferritin and hepcidin was assessed. Results: Serum hepcidin increased significantly from Stage 3 (52.71±8.52 ng/ml) to Stage 5 CKD (74.88±12.22 ng/ml) (p<0.001). Serum ferritin also showed a significant increase from 242.04±171.30 ng/dl in Stage 3 to 446.16±414.84 ng/dl in Stage 5 (p<0.001). Blood urea and serum creatinine demonstrated progressive elevation with advancing CKD stages (p<0.001). A significant positive correlation was observed between ferritin and hepcidin in Stage 3 (r=0.36, p=0.05), Stage 4 (r=0.66, p<0.001), and Stage 5 CKD (r=0.45, p=0.001). Conclusion: Serum hepcidin, ferritin, serum creatinine, and blood urea increase significantly with worsening CKD. Hepcidin shows a positive association with ferritin, suggesting its role in altered iron metabolism and inflammation in CKD patients.

Background: Stroke remains a major contributor to mortality and disability worldwide. Although traditionally considered a disease of older individuals, the incidence of ischemic stroke among young adults has increased substantially over recent decades. Emerging evidence suggests important sex-specific differences in risk factor profiles and etiological mechanisms among young stroke patients. Objectives: To evaluate gender-based differences in vascular risk factors, stroke subtypes, severity, and functional outcomes among young adults with arterial ischemic stroke. Methods: This prospective observational study was conducted at the Department of Neurology, Gauhati Medical College and Hospital, Guwahati, India, from November 2024 to August 2025. Fifty-two consecutive patients aged 15–45 years with acute ischemic stroke were enrolled. Demographic characteristics, vascular risk factors, neuroimaging findings, etiological classification according to TOAST criteria, stroke severity using the National Institutes of Health Stroke Scale (NIHSS), and 3-month outcomes using the modified Rankin Scale (mRS) were assessed. Statistical analyses compared male and female patients. Results: Among 52 patients, 34 (65.4%) were male and 18 (34.6%) were female. Smoking (64.7% vs. 16.7%, p<0.001) and diabetes mellitus (32.4% vs. 11.1%, p=0.018) were significantly more common among males. Females demonstrated higher frequencies of mitral stenosis (33.3% vs. 0%, p=0.019), vasculitis (11.1% vs. 0%, p=0.042), oral contraceptive use (11.1% vs. 0%, p=0.031), and pregnancy/puerperium-related stroke (5.6% vs. 0%, p=0.042). Large artery atherosclerosis predominated among males (44.1% vs. 22.2%, p=0.048), whereas other determined etiologies were more frequent among females (33.3% vs. 8.8%, p=0.021). No significant gender differences were observed in NIHSS severity categories or 3-month functional outcomes. Conclusions: Young ischemic stroke demonstrates distinct sex-related differences in risk factors and etiological patterns. Males are predominantly affected by modifiable vascular risk factors, whereas females exhibit greater contributions from cardioembolic, inflammatory, and reproductive factors. Recognition of these differences may facilitate targeted prevention strategies and individualized clinical management.

Background: Type 2 diabetes mellitus (T2DM) is a major global health challenge associated with insulin resistance, obesity, and microvascular and macrovascular complications. Vaspin (Visceral Adipose Tissue-Derived Serine Protease Inhibitor) is an adipokine implicated in glucose homeostasis and insulin sensitivity. Its role as a biomarker for diabetic complications remains incompletely understood. Aim: To estimate serum vaspin levels in patients with T2DM and evaluate its association with obesity, glycemic status, lipid profile, and diabetic complications. Materials and Methods: A hospital-based comparative cross-sectional study was conducted among 50 participants. Twenty-five patients with T2DM and established complications were compared with 25 T2DM patients without complications. Anthropometric parameters, fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1c), lipid profile, renal function parameters, microalbuminuria, and serum vaspin levels were assessed. Statistical analysis was performed using appropriate parametric tests, and correlations were determined. Results: Patients with diabetic complications demonstrated significantly lower serum vaspin levels compared with those without complications. Serum vaspin exhibited significant negative correlations with BMI, FBS, PPBS, and HbA1c. Triglycerides, LDL cholesterol, urea, creatinine, and microalbuminuria were significantly higher in patients with complications. Reduced serum vaspin levels were associated with increased risk of diabetic complications. Conclusion: Serum vaspin levels are significantly reduced in T2DM patients with complications and correlate with markers of insulin resistance and metabolic dysfunction. Vaspin may serve as a promising biomarker for early identification and monitoring of diabetic complications.

Aim: The Aim of the study is to compare Dexmedetomidine-Propofol and Fentanyl-Propofol on Propofol consumption, perioperative haemodynamics, Fentanyl requirements and post-operative recovery profile in patients undergoing functional endoscopic sinus surgery (FESS). Primary Objective: To compare dexmedetomidine-propofol with fentanyl-propofol combination on propofol consumption during induction and maintenance Secondary objective: To compare intraoperative hemodynamics, additional fentanyl requirements, recovery profile, side effects, post-operative analgesia. Method: The study was conducted in ENT operation theatre at Thanjavur Medical College after obtaining approval from the Institutional Ethical Committee. Written informed consent was taken from all study participants before conduct of the study. Pre-anaesthesia assessment was done in PAC clinic. On the day of surgery standard monitoring was applied, two IV line were secured with 18G IV cannula. GROUP DP-patients who received Dexmedetomidine 1 µg/kg as IV infusion in 100ml normal saline 10 minutes prior to induction. GROUP FP –patients who received Fentanyl 2 µg/kg as IV infusion in 100ml normal saline 10 minutes prior to induction. All the collected data were entered in Microsoft Excel worksheet and double checked for any clerical errors. The variables with normal distribution were expressed as mean with standard deviation. The variables that were not normally distributed were expressed as median with range. Frequencies are expressed in percentage. Proportions were reported with 95% confidence intervals. Conclusion: From our study we conclude that Dexmedetomidine and Propofol combination resulted in reduced intraoperative Propofol consumption during induction and maintenance, provided improved hemodynamic stability, reduced intraoperative Fentanyl requirements, early recovery and prolonged postoperative analgesia when compared to Fentanyl and Propofol combination in patients undergoing FESS with no significant side effects in both the groups.

Aim: The goal of this study was to compare the analgesic efficacy of dexamethasone and levobupivacaine in adductor canal block (ACB) in total knee arthroplasty surgeries. Methods: Sixty patients were randomized into two groups; Group L received 20 mL of 0.25% levobupivacaine and Group LD received 20 mL of 0.25% levobupivacaine plus dexamethasone 8 mg for ACB. The time for the first analgesic request, the rescue analgesia consumption in a 24-hour period, the postoperative pain score, and the range of motion (ROM), 100-foot walking test and any other adverse effects were measured. Results: LD group had lower scores of VAS both at rest and on movement at all-time intervals. The mean time to first analgesic request in group LD was delayed compared to group L. The mean total dose of paracetamol consumed in first 24 h postoperative was significantly lower in LD group when compared to L group. There were significant differences in ROM test and 100 foot test between both groups. Conclusion: The study concludes that adding dexamethasone to levobupivacaine for ACB may significantly improve postoperative pain relief in TKA patients without causing any harmful side effects.

Background: Fingertip injuries are very common due to occupational accidents, which range widely from minor cuts to nailbed injuries, as well as traumatic amputations and crush injuries. It is always preferable to conserve as much natural tissue as possible when feasible. Among the various reconstruction techniques available, it is essential to select one that preserves finger length while delivering a pain-free fingertip with a durable skin covering. Aim & Objectives: To evaluate the management and outcome of fingertip injury. Materials & Methods: This is an observational study involving 16 cases of fingertip injuries spanning 24 months from April 2024 to March 2026. Reconstructive approaches were evaluated based on size, shape, location, condition of adjacent soft tissues, and exposure of the affected structures. This case series on traumatic fingertip injuries encompasses 16 cases, classified and described according to Allen’s system. This will assist us in determining the severity of soft tissue injuries and skeletal damage. In the fingertip reconstruction surgery, methods including the V-Y flap, cross-finger flap, nail bed reconstruction, and bone shortening have been employed. Observation and Results: The age range spanned from 10 to 55 years, with a greater prevalence of males. Various reconstructive techniques were applied depending on the patient’s age, injury location, and injury type. The fingers’ length, shape, and sensation remained intact. Conclusion: The majority of fingertip injuries resulted from machines. Public education and compliance with workplace safety protocols can prevent these injuries to a significant degree. Treatment should be tailored to each patient according to the structure of their defect.

Background: Rising cesarean section (CS) rates are a major public health concern, particularly in tertiary care settings in low- and middle-income countries. The WHO Labour Care Guide (LCG, 2020) was developed as a woman‑centred, flexible alternative to the modified WHO partograph, with the potential to reduce unnecessary CS and improve fetomaternal outcomes. Objectives: To compare the impact of the WHO Labour Care Guide (2020) versus the modified WHO partograph on: 1. Mode of delivery and fetomaternal outcome (primary objective), and 2. Ease of use and acceptability among healthcare providers (secondary objective). Materials and Methods: This cross‑sectional, randomized comparative study was conducted over 18 months in the Department of Obstetrics and Gynaecology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India. A total of 124 term pregnant women (37–40 weeks) in spontaneous labour with cephalic presentation were randomized into two equal groups: Group A monitored with WHO Labour Care Guide (2020) and Group B with modified WHO partograph (62 in each group). Women with medical comorbidities, obstetric complications, previous CS, malpresentation, multiple gestation, post‑dated pregnancy, and those undergoing CS in latent phase were excluded. Labour events, maternal outcomes, neonatal outcomes, drug and analgesia use, and duration of hospital stay were recorded. Data were analysed using SPSS v21. Chi‑square test and independent‑sample t‑test were applied; p<0.05 was considered statistically significant. Results: Both groups were comparable in age, residence, occupation, parity, gestational age and socioeconomic status. LSCS rate was significantly lower with LCG (11.29%) than with modified partograph (46.77%) (p<0.001). Vaginal delivery rate was higher in the LCG group (88.71% vs 53.23%). The active phase of labour was longer with LCG (8.03±0.92 h vs 7.14±1.00 h; p<0.001), and the second stage more often exceeded 1 hour in the LCG group (p=0.010. Third‑stage complications and haemoglobin deficit were similar. Neonatal outcomes were better with LCG, with higher Apgar ≥7 at 1 and 5 minutes (83.87% vs 54.84%, p=0.001; and 85.48% vs 58.06%, p=0.003) and fewer NICU admissions (6.45% vs 43.55%, p<0.001). Hospital stay ≤3 days was more frequent in the LCG group (88.71% vs 50.00%; p<0.001). Most healthcare providers rated LCG as easy (46.77%) or neutral (41.94%) to use. Conclusion: The WHO Labour Care Guide (2020) significantly reduced primary cesarean section rates, improved neonatal outcomes, reduced NICU admissions and shortened hospital stay compared with the modified WHO partograph, while being acceptable and user‑friendly for healthcare providers. LCG can be recommended as an effective labour monitoring tool in tertiary care settings to promote safe, woman‑centred and less interventionist intrapartum care.

Background: Laryngoscopy and intubation can trigger powerful reflexes that cause significant cardiovascular changes which leads to myocardial ischemia, heart failure, elevated intracranial pressure. Video-laryngoscope provides better visualization of airway making orotracheal intubation easy and minimal hemodynamic changes. Aims and Objectives: The aims of this study was to compare the time taken for endotracheal intubation and hemodynamic stability when used Macintosh laryngoscope or video-layngoscope (Mac-Grath MAC and King Vision). Materials and Methods: After obtaining approval from Institutional research Ethical board this prospective, randomized study was conducted on 135 patients aged 18-80, either sex, Mallampati grade 1 or 2, ASA physical status I- III. Patients were randomly divided into three group Group D (n=45): Intubated using the Direct Macintosh Laryngoscope with blade size 3 or 4, Group K (n=45): Intubated using the King Vision Video Laryngoscope with a channeled blade, Group M (n=45): Intubated using the McGrath MAC Video Laryngoscope with blade size 3 or 4. Time taken in intubation, number of attempt, hemodynamic parameters were recorded. Results: Group D has the significant less intubation time (seconds) (12.35±2.95), as compared to Group M (16.38±3.62) and Group K (20.12±3.75 seconds) p<0.0001. Group M achieved the best visualization with 73.3% Grade I views, compared to 60% in Group K and 44.4% in Group D(p=0.015). Conclusion: The time required for intubation was increased in King Vision and McGrath MAC compared to the direct Macintosh laryngoscope but offer better glottic visualization and improve first-attempt intubation success compared to the conventional Macintosh laryngoscope in routine airway management.

Background: Laparoscopic intraperitoneal onlay mesh (IPOM plus) repair has become a widely accepted technique for ventral hernia repair due to reduced postoperative pain, shorter hospital stay, and faster recovery. Ventralight™ ST mesh is a partially absorbable composite mesh designed to provide durable fascial integration while minimizing adhesions. The Echo PS™ positioning system facilitates accurate mesh deployment and fixation. This study evaluated the safety, feasibility, and clinical outcomes of Ventralight™ ST mesh with Echo PS™ in laparoscopic ventral hernia repair. Methods: A prospective observational study was conducted on 100 consecutive patients undergoing laparoscopic IPOM plus repair for primary, incisional, or recurrent ventral hernias at a tertiary care center. Patients aged ≥18 years with hernia defects measuring 3–10 cm were included. Intraoperative parameters such as mesh deployment time, fixation time, and ease of placement were recorded. Postoperative outcomes assessed included seroma formation, surgical site infection (SSI), mesh infection, pain scores (VAS), chronic pain, hospital stay, and hernia recurrence during follow-up. Results: The majority of patients were aged 41–60 years (53%), and males constituted 58% of the study population. Incisional hernia was the most common type (42%). Mesh deployment was achieved within 15–20 seconds in 54% of patients, while fixation was completed within 7–8 minutes in 52%. No cases of seroma or mesh infection were observed. SSI occurred in only one patient (1%). Mean postoperative pain scores decreased progressively from 4.8 ± 1.2 on postoperative day 1 to 0.4 ± 0.3 at 3 months. Chronic pain was reported in 4% of patients. During follow-up, hernia recurrence occurred in 3% of cases, with 97% remaining recurrence-free. Conclusion: Ventralight™ ST mesh with the Echo PS™ positioning system is a safe and effective option for laparoscopic IPOM plus repair of ventral hernias. The system enables rapid mesh deployment, facilitates accurate positioning, and is associated with low postoperative morbidity, minimal chronic pain, and a low recurrence rate. These findings support its use as a reliable prosthetic solution in laparoscopic ventral hernia surgery.

Background and Aims: Seizures in children account for up to 25% of all pediatric emergencies. Midazolam has been administered by various routes, however, there are concerns about bioavailability when the drug is administered by other routes. In our study, we are comparing the efficacy of non-intravenous routes of the midazolam administration for the control of seizures. Methodology: This was a prospective simple randomized control trial conducted at a tertiary care center in India after ethical approval from October 2018 to December 2020.Children in the age group of 6 months to 12 years were enrolled. Enrolled patients were block randomized into two group’s namely intranasal and intramuscular midazolam group. The time taken to abort the seizure was noted and monitoring of vital parameters was done. Results: Out of the 247 enrolled patients, 123 patients received intranasal midazolam whereas 124were treated with intramuscular midazolam. It was observed that there was no statistically significant difference in the therapeutic efficacy of midazolam used for abortion of acute seizures either through the intranasal route or intramuscular route (p=0.4496).  There was no difference in the need of a second anticonvulsant for abortion of acute seizures in both the groups and the incidence of recurrence of seizures within 60 minutes of administration of midazolam through either route. Conclusions: Intranasal midazolam is equally effective as intramuscular in controlling acute seizures in pediatric patients.

Background: Stress, anxiety, and depression are some of the most prevalent mental health conditions in the world and have been found to significantly increase the burden of disease, especially among medical professionals who work in demanding settings like emergency rooms. Due to their long workdays, lack of sleep, and frequent exposure to stressful, life-threatening situations, emergency healthcare workers are particularly vulnerable to psychological distress and burnout. Despite how serious this problem is, not much research has been done on Indian emergency medical personnel. Using the DASS-21 questionnaire, this study sought to determine the prevalence and severity of stress, anxiety, and depression among medical staff in the emergency medicine department of a tertiary care facility in Navi Mumbai. Materials and Methods: In the Emergency Medicine Department of a tertiary hospital in Navi Mumbai, 30 medical professionals—including physicians, nurses, and paramedics—participated in a cross-sectional, observational study. Those on long-term leave or with a history of psychiatric diagnoses were not allowed to participate, but those with at least six months of experience were. The Depression Anxiety Stress Scale-21 (DASS-21) and a sociodemographic and occupational profile sheet were used to gather data. Normal, mild, moderate, severe, and extremely severe levels were assigned to the self-administered, scored responses. SPSS version 27 was used for the statistical analysis, and p < 0.05 was deemed significant. Results: The majority of the 30 participants were under 30 years old, with 53.33% being female. 53.33% had normal stress, 60% had normal anxiety, and 56.67% had normal depression, according to DASS-21 scores. Significant percentages, however, showed clinically relevant distress: 33.33% had moderate to extremely severe anxiety, 36.66% had moderate to extremely severe stress, and 30% had moderate to extremely severe depression. In all three domains, female participants reported scores that were noticeably higher. Compared to their older counterparts, younger professionals (≤25 years) displayed more depressive symptoms. Compared to nurses, paramedics, and students, assistant professors, senior residents, and junior residents reported higher levels of anxiety and depression. Higher stress, anxiety, and depression scores were linked to sedative use, lack of regular exercise, and sleep deprivation (less than 7 hours per night). Conclusion: This study emphasizes the significant psychological toll that emergency medical personnel bear, which is influenced by lifestyle, occupational, and demographic factors. Particularly at risk were women, younger workers, and physicians in positions of greater responsibility. Distress was also influenced by modifiable risk factors, such as insufficient sleep and inactivity. These results highlight the critical need for institutional interventions like structured wellness programs, access to mental health services, and controlled working hours. In addition to being vital for the wellbeing of the providers, addressing mental health in this workforce is also critical for patient safety and care quality.

Background: Cervical cancer is the fourth most common malignancy among women worldwide and a major cause of cancer-related mortality in low- and middle-income countries, with persistent oncogenic human papillomavirus (HPV) infection as the central aetiological event. The prolonged pre-invasive phase permits early detection through Papanicolaou (Pap) smear cytology. This study evaluated the cytological spectrum of cervical lesions and correlated atypical and high-grade abnormalities with follow-up outcomes. Materials and Methods: This retrospective observational study was conducted in the Department of Pathology, MGUMST, Jaipur, between January 2025 and January 2026. Conventional Pap smears from 3650 women aged 21–65 years attending the gynaecology outpatient department were stained by the Papanicolaou technique and reported according to the 2014 Bethesda System. ASC-H, HSIL, and AGC/AIS cases were advised colposcopy and biopsy. Data were analysed using descriptive statistics. Results: Epithelial abnormalities were detected in 700 cases (19.2%), while 2950 cases (80.8%) were negative for intraepithelial lesion or malignancy. LSIL was the most common abnormality (7.6%), followed by ASC-US (4.8%), HSIL (3.7%), ASC-H (1.9%), AGC/AIS (0.8%), and SCC (0.4%). ASC-US and LSIL predominated in younger women, whereas HSIL and malignancies were more frequent above 45 years. Follow-up of high-risk cytology yielded 76.9% CIN2+ lesions. Conclusion: Pap smear screening remains a cornerstone of cervical cancer prevention in resource-limited settings. Age-specific screening, vigilant follow-up of high-risk cytology, and integration of HPV testing can further improve early detection and reduce the cervical cancer burden.

Background: Distal radius fractures are common orthopaedic injuries with significant functional implications. The optimal treatment for unstable fractures remains debated. This study compares functional and radiological outcomes between Joshi’s External Stabilization System (JESS) and volar locking plate fixation. Methods: A prospective observational study was conducted from May 2024 to February 2026 at a tertiary care centre. Thirty patients with intra-articular distal radius fractures (AO type B and C) were divided into JESS (n=15) and plating (n=15) groups. Functional outcomes were assessed using the Green and O’Brien scoring system. Radiological union, time to union, intra-operative blood loss, and complications were evaluated. Statistical analysis was performed using appropriate tests with p<0.05 considered significant. Results: Demographic variables were comparable between groups (p>0.05). The plating group showed significantly better functional outcomes, with higher total Green and O’Brien scores (43.67 ± 2.29 vs 32.67 ± 2.58; p<0.000001), improved pain, and greater range of motion (p<0.001). Time to union was significantly shorter in the plating group (6.80 ± 0.77 weeks) compared to JESS (8.13 ± 1.13 weeks; p=0.0022). In contrast, intra-operative blood loss was significantly lower in the JESS group (p<0.00001). Union rates were comparable in both groups (p=1.000). Conclusion: Both modalities achieve satisfactory union, however, volar locking plate fixation provides superior functional outcomes and faster recovery, whereas JESS offers advantages of minimal invasiveness and reduced blood loss.

Background: Chronic obstructive pulmonary disease (COPD) requires precise structural and functional evaluation to accurately predict disease severity. Objective: This study evaluated the pattern, distribution, and severity of COPD using qualitative and quantitative multidetector computed tomography (MDCT) parameters, correlating these findings with pulmonary function test (PFT) indices. Methods: An observational cross-sectional evaluation was performed on the high-resolution computed tomography (HRCT) scans of 50 COPD cases and 30 healthy controls, and the metric data were correlated with spirometry values. Results: Qualitative emphysema scoring and presence correlated significantly with spirometry indices. Among quantitative metrics, the anterior junction line length, sternoaortic distance, tracheal index, and the thoracic cage ratio and thoracic cross-sectional area normalized to height squared at the inferior pulmonary vein level demonstrated strong correlations with spirometric data. Notably, the quantitative MDCT parameters calculated in this cohort were lower than established Western population standards. Conclusion: HRCT plays a definitive role in diagnosing COPD and predicting emphysema severity; however, regional variations underscore the need for population-specific reference values.

Background: Otitis externa is a common inflammatory condition of the external auditory canal, frequently associated with pain, swelling, and discharge. Various treatment modalities are available, including antibiotic-steroid combinations and conservative osmotic agents; however, comparative evidence regarding their efficacy remains limited. Aim: To compare the efficacy of glycerine magnesium sulfate (MgSO₄) with gentamicin-dexamethasone in the medical management of otitis externa. Objectives: (1) To determine and compare the time taken for symptomatic relief in patients treated with glycerine MgSO₄ and gentamicin-dexamethasone. (2) To compare the proportion of patients developing complications despite treatment in both modalities. (3) To study the age-wise and sex-wise distribution of patients with otitis externa. (4) To identify the common predisposing factors associated with otitis externa. (5) To analyze the most common presenting signs and symptoms among patients with otitis externa. (6) To determine the proportion of patients presenting with localized versus diffuse otitis externa. Methods: A prospective randomized controlled trial was conducted on 200 patients diagnosed with otitis externa. Patients were randomly divided into two groups: Group A (n=100) treated with glycerine MgSO₄ and Group B (n=100) treated with gentamicin-dexamethasone. Clinical evaluation and follow-up were performed at 1 week, 2 weeks, and 1 month. Treatment outcomes were assessed using pain score, edema, redness, and overall clinical improvement. Statistical analysis was done using appropriate tests with p<0.05 considered significant. Results: Among 200 participants, the majority were aged 31–45 years (45%), followed by 18–30 years (30%) and 46–60 years (25%), with male predominance (55%). Earache was the most common symptom (90%), followed by ear swelling (70%) and ear fullness (50%). Predisposing factors included hot and humid climate (60%), frequent bathing/swimming (50%), self-cleaning (40%), and poor hygiene (35%). Diffuse otitis externa (60%) was more common than localized (40%). Pain reduction ≥75% was achieved in 95% of patients in the gentamicin-dexamethasone group compared to 85% in the glycerine MgSO₄ group. Treatment failure was lower in the gentamicin group (5%) compared to the glycerine group (10%), and complications were absent in the gentamicin group but observed in 5% of the glycerine group. Greater improvement in pain, edema, and redness scores was seen in the gentamicin group. Mean clinical scores reduced from 21.7 ± 0.7 to 3.2 ± 0.6 in the gentamicin group compared to 22.3 ± 0.8 to 4.3 ± 0.5 in the glycerine group at 1 month, with statistically significant differences (p < 0.05). Complications such as secondary fungal infection (25% vs 15%), necrotizing otitis externa (5% vs 3%), and malignant otitis externa (2% vs 1%) were higher in the glycerine group. Conclusion: Gentamicin with dexamethasone is more effective than glycerine magnesium sulfate in the management of otitis externa, providing faster symptom relief, better clinical improvement, and fewer complications. It can be considered a more reliable treatment modality in clinical practice.

Background: Bronchial asthma is a chronic inflammatory airway disease in which aeroallergen sensitization plays a major role in symptom development and exacerbations. Identification of region-specific allergens is important for allergen avoidance and targeted management. Limited data are available regarding allergen sensitization patterns among asthmatic patients from desert and non-desert regions of Rajasthan. Methods: A cross-sectional study was conducted in 100 patients with bronchial asthma attending the Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, between December 2015 and November 2016. Asthma diagnosis was confirmed clinically and by spirometry. Skin prick testing (SPT) was performed using standardized aeroallergen extracts. Demographic, clinical, and allergen sensitization profiles were analysed. Results: Significant SPT positivity (≥2+) was observed in 89% of patients. Insect allergens were the most common sensitizers (71%), followed by dust allergens (52%) and house dust mite (HDM) (44%). Among dust allergens, house dust showed the highest positivity (30%), followed by old paper dust (26%) and cotton dust (24%). HDM sensitization was present in 44% of cases. Cockroach (18%) and housefly (18%) sensitization predominated in desert areas, whereas cockroach (60%) and mosquito (31%) sensitization were more frequent in non-desert regions. Allergic rhinitis was the most common associated allergic disorder (77%). Family history of atopy was present in 54% of patients. Dust allergen sensitization, particularly house dust, old paper dust, cotton dust, and wheat dust, was more frequent among patients from desert regions than non-desert regions. Conclusion: Aeroallergen sensitization is highly prevalent among asthmatic patients in Rajasthan. Insect allergens, dust allergens, and HDM are the predominant sensitizers. Distinct differences in allergen profiles between desert and non-desert regions highlight the importance of regional allergen assessment and allergen avoidance strategies in asthma management.

Background: This study aimed to assess the outcomes of early psychiatry training among Phase II MBBS students, with a specific focus on communication skills and ethical principles. Early exposure to psychiatry training was intended to strengthen essential clinical competencies such as rapport building, empathy, ethical decision-making, and patient-centred communication. Introducing psychiatry at an earlier stage of the medical curriculum was expected to reduce stigma toward mental illness and promote a more holistic approach to patient care. Methodology: The study followed a quasi-experimental pre–post design and was conducted at Government Medical College, Dausa, during the period from September 2025 to February 2026. The participants included Phase II MBBS students who provided informed consent during their clinical postings. Universal sampling was adopted. Prior approval was obtained from the Institutional Ethics Committee. A structured training module focusing on communication skills and ethical principles was developed and peer-reviewed by faculty members from Psychiatry, Medicine, Obstetrics & Gynaecology, Community Medicine, and Medical Education. The training was delivered over three days during clinical postings through interactive sessions, role play, video demonstrations, and facilitated group discussions. Students completed a pre-test before the training and a post-test immediately after the training to assess changes in knowledge related to communication skills and ethical principles. Four weeks after the intervention, students were assessed using OSCE stations. Observation & Results: The mean pre-test score was 2.65 ± 1.13 (out of 4), which significantly increased to 7.54 ± 1.16 (out of 10) post-intervention (p < 0.001). The mean OSCE score was 25.26 ± 4.12 (out of 31), indicating good skill acquisition. Acceptability and satisfaction scores were high, with over three-fourths of students reporting good acceptability and high satisfaction. Four weeks after the intervention, skill retention was assessed using Objective Structured Clinical Examination (OSCE) stations based on the Kalamazoo communication framework, which demonstrated good acquisition of communication skills and empathy, along with high student acceptability and satisfaction, supporting feasibility within a competency-based medical education framework. Conclusions: Early psychiatry training significantly improves knowledge and communication skills among undergraduate medical students and is well accepted. Incorporating structured communication training early in the curriculum may enhance preparedness for clinical practice.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder associated with substantial psychological burden. Anxiety and stressful life events may adversely affect self-care behaviors, glycemic control, and overall disease outcomes. The present study assessed anxiety and stressful life events among patients with diabetes mellitus and examined their relationship with demographic and clinical variables. Objectives: To assess anxiety and stressful life events among patients with diabetes mellitus and determine their association with age, gender, comorbidity status, medication burden, and quality of life. Materials and Methods: A hospital-based cross-sectional study was conducted among 90 patients with diabetes mellitus attending the Department of Medicine at a tertiary care teaching hospital in Rajasthan. Sociodemographic and clinical details were recorded. Anxiety was assessed using the Hamilton Anxiety Rating Scale (HAM-A), while stressful life events were evaluated using the Presumptive Stressful Life Events Scale (PSLES). Quality of life was measured using WHOQOL-BREF. Statistical analysis was performed using SPSS version 17.0. Mann–Whitney U test, Kruskal–Wallis test, and Spearman correlation analysis were applied. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 54.73 years, with females constituting 55.56% of the sample. Type 2 diabetes mellitus was present in 95.56% of patients. Mild anxiety was observed in 88 (97.78%) participants, while moderate anxiety was present in only 2 (2.22%). No severe anxiety was detected. No significant association was found between anxiety or stressful life event scores and gender, age group, or number of comorbidities (p>0.05). However, anxiety scores showed a significant positive correlation with the number of medicines (r=0.291, p=0.005) and tablets consumed per day (r=0.441, p<0.0001). Stressful life event scores also demonstrated significant positive correlations with tablet burden. Quality-of-life scores showed significant negative correlations with tablet burden, particularly in physical and environmental domains. Conclusion: Anxiety symptoms and stressful life events are common among patients with diabetes mellitus. Increased medication burden is associated with higher anxiety and stress levels, while quality of life declines with increasing tablet burden. Routine psychological screening should be incorporated into diabetes care to improve holistic patient outcomes.

Objectives: The present study was for comparing the efficacy of thoracic epidural 0.125% bupivacaine and 0.125% bupivacaine with buprenorphine for postoperative analgesia in upper abdominal surgeries at tertiary care hospital. Methods: Postoperative pain relief was provided using thoracic epidural analgesia. Group A patients were administered 8 ml of inj. 0.125% Bupivacaine in normal saline and Group B patients were given 8 ml of inj. 0.125% Bupivacaine with inj. buprenorphine 2 mcg/Kg body weight mixture in normal saline. First dose was given when VAS score was ≥4 or on patient demand for analgesia. Rescue analgesia was given with inj. Diclofenac sodium 75 mg I.M. if patient had pain despite epidural drug administration. Pre-anaesthetic evaluation was done thoroughly in all patients, a day of the surgery. Pain assessment was done by using VAS score. Motor blockade was assessed using the Modified Bromage Scale and sedation was measured by using Ramsay 4 Point Sedation Scale. Onset, duration of analgesia, epidural top-up requirement, VAS score and side effects were recorded. Results: The mean onset of analgesia in group A was 21.78 ± 4.64 min and in group B was 15.84 ± 3.64 min, which was highly statistically significant. Duration of analgesia in group A was 5.76 ± 3.26 hrs and in group B was 11.34 ± 4.25 hrs. which was statistically highly significant (p<0.0001). Nausea and vomiting were observed in 8 patients in group A, and 24 patients in group B. Pruritus was observed in 7 patients in Group-A and 20 patients in Group-B. Conclusions: Bupivacaine 0.125% with buprenorphine is significantly more effective and yielded more prolonged duration of epidural analgesia as compared to alone bupivacaine 0.125%.

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus and is associated with prolonged hospitalization, recurrent infection, and increased risk of lower limb amputation. Vacuum-Assisted Closure (VAC) therapy has emerged as an effective adjunct in diabetic wound management. Objective: To compare the effectiveness of VAC therapy with conventional saline dressing in the treatment of diabetic foot ulcers. Methods: This prospective comparative study included 80 patients with Wagner grade II–IV diabetic foot ulcers. Following surgical debridement, 40 patients received VAC therapy and 40 patients underwent conventional saline dressing. Outcomes assessed included wound area reduction, granulation tissue formation, hospital stay, and limb salvage rate. Results: The VAC group demonstrated significantly greater wound area reduction (66.4% vs. 41.2%, p<0.001), earlier granulation tissue formation (11.6 ± 3.4 vs. 18.9 ± 4.8 days, p<0.001), and shorter hospital stay (12.4 ± 3.7 vs. 19.6 ± 5.2 days, p<0.001) compared with the conventional dressing group. Limb salvage was achieved in 95.0% of patients in the VAC group compared with 80.0% in the conventional group (p=0.04). Conclusion: VAC therapy significantly improves wound healing, accelerates granulation tissue formation, reduces hospital stay, and enhances limb salvage in patients with diabetic foot ulcers.

Background: Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with diverse clinical presentations in children, often mimicking other surgical conditions. Aim: To describe the varied clinical presentations, management strategies, and outcomes of pediatric patients with Meckel’s diverticulum. Methods: A descriptive observational study of nine pediatric patients diagnosed with Meckel’s diverticulum. Clinical presentation, intraoperative findings, surgical management, and outcomes were analyzed. Results: Presentations included perforation peritonitis (22.2%), intussusception (22.2%), umbilical granuloma (22.2%), and small bowel obstruction (11.1%), gastrointestinal bleeding (11.1%), inflamed Meckel’s with appendicitis (11.1%), and neonatal presentation (11.1%). Surgical management primarily involved segmental resection and anastomosis. Mean hospital stay was 4 days with no major complications. Conclusion: Meckel’s diverticulum presents with a wide clinical spectrum in children. Early diagnosis and appropriate surgical management result in excellent outcomes. Minimally invasive approaches are safe and effective.

Background: Conventional chest radiography remains the primary imaging modality for evaluation of pediatric thoracic diseases, while computed tomography (CT) is reserved for advanced assessment. However, radiation exposure and the need for sedation limit their frequent use in children. Objective: To evaluate the role of thoracic ultrasound as a non‑ionizing, bedside imaging modality in the diagnosis and treatment planning of pediatric chest pathologies. Materials and Methods: This observational study was conducted at a tertiary pediatric care center in South India. Children presenting with suspected thoracic pathology underwent chest radiography followed by thoracic ultrasonography. Both low‑frequency curvilinear and high‑frequency linear probes were used depending on the pathology. Ultrasound findings were correlated with clinical features and used for treatment planning, interventions, and follow‑up. Results: Thoracic ultrasound provided valuable diagnostic information in pulmonary, pleural, mediastinal, and chest wall pathologies. It significantly reduced the requirement for repeated radiographs and CT scans. Ultrasound effectively guided interventional procedures such as intercostal drain insertion, pleural fluid aspiration, and mediastinal biopsy. Bedside ultrasound in the emergency room and intensive care units improved decision‑making and reduced radiation exposure and sedation requirements. Conclusion: Thoracic ultrasonography is a reliable, radiation‑free imaging modality that plays a crucial role in diagnosis, treatment planning, and follow‑up of pediatric chest diseases. It can serve as a first‑line imaging tool in many clinical scenarios and effectively supplement conventional radiography.

Background: Chronic kidney disease (CKD) often is hidden among the majority of patients with hypertension, and can only be diagnosed if estimated glomerular filtration rate (eGFR) and albuminuria are evaluated. Objective: To estimate the prevalence of CKD and look for risk factors associated with it in adults attending a general medicine outpatient department having hypertension. Methods: This prospective observational study included 420 adult patients with hypertension that were followed for 6 months. Demographic information, hypertension duration, hypertension management, co-morbidities, drug use, body mass index, blood pressure, serum creatinine, eGFR and urine albumin-creatinine ratio (UACR) were documented. To confirm the diagnosis of CKD, the abnormal eGFR or albuminuria were repeated after 3 months. Results: 408/420 patients enrolled had confirmation testing. The mean age was 58.6 +/- 11.4 years; 222 (54.4%) were male and 164 (40.2%) had diabetes. CKD was confirmed in 115 patients, giving a prevalence of 28.2% (95% CI 23.8-32.8). Reduced eGFR <60 mL/min/1.73 m2 was present in 62 (15.2%), albuminuria in 103 (25.2%), and both abnormalities in 50 (12.3%). Of all the CKD patients, only 31 (27.0%) were already aware of the disease. Age ≥60 years, diabetes mellitus, hypertension duration ≥10 years, uncontrolled blood pressure, regular use of non-steroidal anti-inflammatory drugs and obesity were identified as independent risk factors by multivariable analysis. Conclusions: CKD was present in almost one-third of patients attending the outpatient department for hypertension, with a majority of these having suspected albuminuria and low awareness. There is a need for routine combined eGFR-UACR screening in hypertensive clinics.

Background: Total hip arthroplasty (THA) is a reliable technique for pain relief and mobility restoration in elderly patients; however, the best fixation technique for the femur is still under debate, as cemented stems provide instant stability and uncemented stems minimize the risk of cement-related complication and the number of surgical steps. The aim of this study was to compare the perioperative, functional and radiological outcomes of cemented versus uncemented THA in elderly patients. Methods: A prospective study comparing 80 patients aged 65 years or older with primary THA for advanced hip disease or displaced intracapsular femoral neck fracture was performed. The number of patients receiving cemented and uncemented fixation of the femur was 40 and 40 patients, respectively. The outcomes measured were at discharge, 6 weeks, 3 months, 6 months and 12 months. The primary outcome was Harris Hip Score (HHS) at 12 months. Secondary outcomes were operative time, blood loss, VAS pain, WOMAC score, walking capacity, radiological stability, thigh pain and complications. Results: The groups were similar in terms of age, sex, BMI, comorbidity, indication and preoperative HHS. Cemented THA had longer operative time (101.8 +/- 14.6 vs 87.5 +/- 12.9 minutes; p<0.001) and greater blood loss (482 +/- 92 vs 414 +/- 88 mL; p=0.002). At 12 months, cemented THA showed higher HHS (86.7 +/- 7.4 vs 82.3 +/- 8.1; p=0.014), lower VAS pain (1.3 +/- 0.8 vs 2.0 +/- 1.0; p=0.001), and less thigh pain (7.5% vs 25.0%; p=0.034). Periprosthetic fracture was found in one cemented and four uncemented cases (p=0.166). Conclusion: Cemented THA had better short term pain relief and functional recovery in the elderly population, whereas uncemented THA reduced the operating time and blood loss. Fixation should be individualized based on age, bone quality, and co-morbidity, as well as on intra-operative stability.

Background: There is considerable variation in the approach to rehabilitation following intramedullary nailing of tibial shaft fractures, and delayed loading is frequently recommended due to fear of loss of reduction, implant failure, delayed union and pain. Design: This study aimed to compare functional recovery and radiological union between early and delayed weight-bearing protocol in adults with tibial shaft fractures after locked IMN. Methods: This study compared functional outcome and radiological healing between early and delayed weight bearing after locked IMN of tibial shaft fractures in adult population. The study was a prospective comparative study of 70 adults who had closed or Gustilo-Anderson type 1 tibial shaft fractures treated with reamed, statically locked intramedullary nails. Thirty-five patients were started on supervised weight-bearing as tolerated within 72 hours, while 35 patients were started on delayed weight-bearing at six weeks. Lower Extremity Functional Scale (LEFS), visual analogue scale (VAS), knee and ankle range of motion, and time to full weight-bearing were used to measure functional outcomes. Bridging callus and Radiographic Union Scale for Tibial fractures (RUST) were used for the radiological assessment of union. Results: Baseline age, fracture pattern, injury mechanism and operative variables were similar. Early weight-bearing significantly reduced time to full unsupported weight-bearing (4.1 +/- 1.3 vs 9.6 +/- 2.1 weeks; p<0.001), improved six-month LEFS (73.4 +/- 7.5 vs 69.1 +/- 8.2; p=0.026), and shortened mean union time (17.2 +/- 3.8 vs 19.4 +/- 4.2 weeks; p=0.024). No significant difference was seen in delayed union, malalignment, infection or implant-related complications. Conclusion: Early protected weight-bearing following stable intramedullary nailing of selected tibial shaft fractures led to an improvement in early rehabilitation and radiological outcomes without increasing the complication rate.

Background: Tubal factor infertility remains a major reproductive problem, and the effect of reconstructive tubal surgery on ovarian reserve and subsequent pregnancy requires careful clinical evaluation. Method: This prospective comparative study evaluated 80 reproductive-age women with tubal-factor infertility who either underwent microsurgical tuboplasty (n = 40) or received standard non-reconstructive fertility management after diagnostic laparoscopy (n = 40). Serum anti-Mullerian hormone (AMH), antral follicle count (AFC), day-2 follicle-stimulating hormone (FSH), ovarian volume, postoperative tubal patency, time to conception, clinical pregnancy, ectopic pregnancy, miscarriage, and live-birth/ongoing pregnancy rates were assessed over 12 months. Results: Baseline characteristics were comparable between groups, including age (31.4 +/- 4.2 vs 32.0 +/- 4.1 years, p = 0.518), infertility duration (4.1 +/- 1.8 vs 4.4 +/- 1.9 years, p = 0.472), AMH (2.74 +/- 0.86 vs 2.69 +/- 0.81 ng/mL, p = 0.789), and AFC (11.6 +/- 3.9 vs 11.2 +/- 3.5, p = 0.631). At 6 months, AMH showed no clinically meaningful decline after tuboplasty (2.74 +/- 0.86 to 2.61 +/- 0.83 ng/mL, p = 0.091), and AFC remained stable (11.6 +/- 3.9 to 11.1 +/- 3.7, p = 0.173). Tubal patency was achieved in 32/40 women (80.0%) after tuboplasty. Clinical pregnancy occurred more often after tuboplasty than in controls (55.0% vs 25.0%, p = 0.006), with higher intrauterine pregnancy (50.0% vs 22.5%, p = 0.010) and live-birth/ongoing pregnancy rates (42.5% vs 17.5%, p = 0.015). Conclusion: Microsurgical tuboplasty preserved short-term ovarian reserve and significantly improved spontaneous pregnancy outcomes in carefully selected reproductive-age women.

Background: Morbidity after major abdominal surgery is still high, especially in older patients, which are not adequately represented by chronological age or traditional anaesthetic risk scores. This prospective cohort study aimed to determine whether a structured pre-operative frailty assessment is able to predict 30-day postoperative complications following elective major abdominal surgery. Method: 214 elderly patients (60 years and older) scheduled for elective gastrectomy, colorectal resection, hepatobiliary surgery or major abdominal wall reconstruction were enrolled. The Clinical Frailty Scale and Fried phenotype were used to assess frailty within 7 days prior to surgery. Patients were classified as non-frail (n=116), pre-frail (n=63), or frail (n=35). The main outcome was a Clavien-Dindo grade II or greater complication within 30 days. Secondary outcomes were major complications, length of stay, admission to the intensive care unit, destination at discharge, and readmission. Results: 31.3% of patients had overall 30-day complications. The complication rate rose with increasing frailty strata, with 20.7% in non-frail, 36.5% in pre-frail and 57.1% in frail patients (p<0.001). Frail patients had longer hospital stay (11.8 +/- 5.6 vs. 7.2 +/- 3.4 days, p<0.001), higher ICU admission (31.4% vs. 9.5%, p=0.002), and more non-home discharge (28.6% vs. 4.3%, p<0.001) than non-frail patients. Frailty was independently associated with complications after adjusting for age, sex, ASA class, comorbidity index, surgical complexity, and operative duration (adjusted OR 3.18, 95% CI 1.42-7.09; p=0.005). The AUC increased from 0.71 to 0.80 when frailty was added to the baseline risk model. Conclusion: Preoperative frailty assessment was independently associated with postoperative complications and was superior to risk discrimination following major abdominal surgery. Routine frailty screening could assist with individual counselling, optimization and planning for post-operative management.

Background: Early detection of sight threatening diabetic retinopathy and treatment with laser is the only way to prevent visual deterioration and major visual loss. Methods: The prospective observational study was conducted at the retina clinic of a tertiary eye care centre in South India from June 2021 to June 2022. A total of 248 eyes of 134 PDR [Proliferative Diabetic Retinopathy] patients requiring PRP [Panretinal Photocoagulation] were included. Patients requiring vitreoretinal surgery or intravitreal anti-vascular endothelial growth factor therapy and those with significant media opacity or other ocular comorbidities affecting assessment of vision were excluded. Results: Good visual outcome was found in 192 eyes (77.4%) and poor outcome in 56 eyes (22.6%) at 6 months. Patients with poor prognosis had significantly higher levels of baseline and follow-up HbA1c, fasting and postprandial blood sugar, LDL cholesterol, triglycerides, serum creatinine and proteinuria, and lower levels of haemoglobin (p<0.05 for all). Conclusion: Poor glycaemic control, associated systemic comorbidities and female sex were significant predictors of poor visual outcome following panretinal photocoagulation in proliferative diabetic retinopathy.

Background: Decompressive craniectomy was deemed a useful surgical procedure for severe traumatic brain injury when malignant cerebral swelling or refractory intracranial hypertension posed the risk of death; however, operative outcomes regarding functional outcome vary. Objective: To determine clinical, radiological and peri-operative variables that predict the functional outcome at six months following decompressive craniectomy for severe traumatic brain injury. Methods: A multicenter retrospective cohort study was conducted that analyzed 186 adult patients with severe traumatic brain injury (sTBIs) who underwent primary or secondary decompressive craniectomy (DC) at each of four tertiary teaching hospitals. Admission parameters, computed tomography (CT) parameters, surgical time, postoperative course and complications were analysed. Functional outcome was measured at six months by the Glasgow Outcome Scale-Extended with scores of 5-8 being favourable. Results: The mean age was 38.7 ± 14.9 years, 138 (74.2%) patients were male and the most common mechanism of injury was road traffic injury (67.7%). A favorable outcome was seen in 74 cases (39.8%) and mortality was 22.6%. Patients with favorable outcome were younger (32.6 ± 11.2 vs 42.7 ± 15.4 years, p<0.001), had higher admission Glasgow Coma Scale scores (6.9 ± 1.1 vs 5.4 ± 1.3, p<0.001), lower Rotterdam CT scores (3.2 ± 0.8 vs 4.3 ± 1.0, p<0.001), fewer bilateral pupillary abnormalities (6.8% vs 28.6%, p<0.001) and shorter median injury-to-surgery time (5.8 vs 9.4 hours, p=0.002). In the multivariable regression model, age<45 years, admission GCS >=6, reactive pupils, Rotterdam score <=3 and surgery within six hours and absence of postoperative intracranial hypertension were independent predictors of a favourable outcome. Conclusions: The functional outcome after DCS depends on the preoperative neurological status, the severity of the CT, and the timing of surgery and early control of ICP. Identification of these predictors early could help to better counsel, triage and postoperative prognosticate.

Background: Preterm labour, or the onset of labour at <37 completed weeks of gestation, is a leading cause of neonatal morbidity and mortality globally. Early recognition of women at risk is important for early intervention. Magnesium is important to neuromuscular stability and uterine quiescence and hypomagnesemia has been implicated in the pathophysiology of preterm labour. Estimation of serum magnesium levels may be a useful and inexpensive predictive method for antenatal care. Objectives: To assess the serum levels of magnesium in women with preterm labour and to compare these levels with the level in women delivering at term, and to assess the utility of serum magnesium as a predictive marker for preterm labour. Materials and Methods: This prospective case control study was carried out in a tertiary care hospital and admitted 200 pregnant women; 100 women in the preterm labour group (28-36 weeks of gestation) and 100 women in the term pregnancy group (37-40 weeks). Detailed clinical evaluation was done and socioeconomic status was determined by Modified Kuppuswamy scale. Serum magnesium levels were estimated by colorimetric Calmagite technique. Statistical analysis was done by using Students t test and Chi square test with p<0.05 as significant. Results: The mean serum level of Mg was significantly decreased in preterm labour as compared to term group (1.49 ± 0.09 mg/dL vs 2.06 ± 0.11 mg/dL; p < 0.001). Hypomagnesemia (<1.8 mg/dL) was noted in 61.0% of the women who had preterm labour compared to 29.5% of the women who had delivered in term (p < 0.001). Serum magnesium levels were not significantly related to the maternal age, parity or the socioeconomic. In female studies, those with lower serum levels of magnesium had higher levels of uterine activity and shorter delivery time. Conclusion: A low level of maternal serum magnesium has a significant link to preterm labour. Serum magnesium estimation is an easy-to-perform, inexpensive and clinically useful tool that can potentially help in the identification of women at an increased risk for preterm labour to allow for closer surveillance and early intervention.