Background: Scar revision surgery is commonly performed to improve the appearance and function of mature scars. However, satisfactory healing is not always achieved, and some patients develop poor scar quality after surgery. Platelet-rich plasma (PRP), prepared from the patient’s own blood, contains a high concentration of platelets and growth factors that may improve wound healing and scar maturation. Objective: To compare the outcomes of surgical scar revision with intraoperative PRP application and surgical scar revision alone in terms of scar quality, wound healing, postoperative complications, and patient satisfaction. Methods: This prospective randomized study included 60 patients with mature linear or post-traumatic scars. Patients were randomly divided into two equal groups. Group A underwent surgical scar revision with intraoperative PRP application, while Group B underwent surgical scar revision alone. All patients were followed for six months. Scar quality was assessed using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Wound healing time, postoperative complications, and patient satisfaction were also evaluated. Results: Both groups showed improvement after surgery. However, patients treated with PRP had better scar outcomes. The mean VSS score improved from 8.2 ± 1.4 before surgery to 3.3 ± 1.2 at six months in the PRP group, compared with 8.1 ± 1.5to 5.0 ± 1.4 in the control group. The average wound healing time was shorter in the PRP group (12.3 ± 2.2 days) than in the control group (15.1 ± 2.6 days). Patient satisfaction was higher in the PRP group (90%) compared with the control group (70%). Postoperative complications were fewer in the PRP group, and no PRP-related adverse effects were observed. Conclusion: Intraoperative PRP application during surgical scar revision improved scar quality, promoted faster wound healing, and increased patient satisfaction without increasing complications. PRP appears to be a safe and useful adjunct in scar revision surgery.

Background: Proximal humerus fractures are among the most common fractures of the upper extremity and are frequently encountered in both elderly individuals with osteoporotic bone and younger adults following high-energy trauma. Open reduction and internal fixation (ORIF) using a proximal humerus locking plate (PHILOS) has become a widely accepted treatment option for displaced fractures because of its ability to provide stable fixation and facilitate early mobilization. However, evaluation of functional recovery, radiological healing, and postoperative complications remains essential to determine the effectiveness of this treatment modality. Aim: To evaluate the functional and radiological outcomes of proximal humerus fractures in adults treated with open reduction and internal fixation using a proximal humerus locking plate. Methods: A prospective observational study was conducted in the Department of Orthopaedic Surgery at Ramkrishna Care Hospital, Raipur, Chhattisgarh, from April 2025 to March 2026. A total of 40 adult patients with proximal humerus fractures underwent ORIF using a proximal humerus locking plate. Patients were followed for six months. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Constant–Murley Score, and Disabilities of the Arm, Shoulder and Hand (DASH) Score, while radiological union and postoperative complications were evaluated at regular follow-up intervals. Data were analyzed using SPSS version 26.0. Repeated measures ANOVA was used for comparison of continuous variables, and a p-value of <0.05 was considered statistically significant. Results: The mean VAS score significantly decreased from 7.02 ± 0.69 at baseline to 1.07 ± 0.72 at six months (p < 0.001). The mean Constant–Murley score improved significantly from 37.45 ± 2.77 to 77.67 ± 3.92 (p < 0.001), while the mean DASH score decreased from 72.82 ± 6.12 to 20.67 ± 2.21 (p < 0.001). Radiological union was achieved in 90% of patients by three months, and complete fracture consolidation was observed in 100% of patients at six months. Postoperative complications were minimal, with only isolated cases of stitch line infection, stiffness, malunion, and avascular necrosis observed during follow-up. Conclusion: Open reduction and internal fixation using a proximal humerus locking plate is a safe and effective treatment modality for proximal humerus fractures in adults. The procedure provides excellent pain relief, significant functional improvement, satisfactory radiological healing, and a low complication rate, supporting its role as a reliable option for the surgical management of displaced proximal humerus fractures.

Background: Hyperbaric 0.75% ropivacaine has been widely used nowadays due to early recovery and better safety profile. We planned this study to compare the effect of intrathecal hyperbaric 0.75% ropivacaine and hyperbaric 0.5% bupivacaine in spinal anaesthesia for transurethral resection of prostate surgeries to evaluate effect on post spinal hypotension, sensory motor block characteristics and adverse effects. Materials and Methods: 120 patients were randomly allocated into 2 groups of 60 patients each in Group B and R to receive spinal anaesthesia with 2.8 ml (14 mg) of 0.5% hyperbaric bupivacaine and 2.8 ml (21 mg) of 0.75% hyperbaric ropivacaine, respectively. The primary outcome measured was the incidence of hypotension. The secondary outcomes measured were vasopressor requirement, onset and duration of sensory‐motor block, degree of motor block, haemodynamic profile and adverse effects. P < 0.05 was considered statistically significant. Results: Group R patients had significantly lower incidence of hypotension (20 % vs 45%, P = 0.01) and bradycardia (3.3% vs 16%, p=0.03) compared to group B. The mean time for the onset of sensori-motor block was faster in Group B. The duration of sensory and motor block were lesser in ropivacaine group. The patients in ropivacaine group exhibited a lesser degree of motor block as compared to bupivacaine group. The duration of analgesia and haemodynamic parameters in both groups were statistically comparable. Conclusion: Despite a slower onset time of block, intrathecal hyperbaric ropivacaine provides a better alternative to intrathecal hyperbaric bupivacaine for transurethral resection of prostate surgeries by providing a stable haemodynamic profile, shorter duration of sensorimotor block, a lesser degree of motor block, and thus allowing early ambulation.

Background: Thrombocytopenia is a common hematological abnormality encountered in routine clinical practice and may result from a wide spectrum of pathological conditions ranging from benign transient disorders to life-threatening diseases. Platelet volume indices such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) are increasingly recognized as useful diagnostic markers for differentiating the underlying causes of thrombocytopenia. These platelet parameters are readily available through automated hematology analyzers and may reduce the need for invasive investigations. Aim: To assess the diagnostic utility of platelet volume parameters in patients with thrombocytopenia and evaluate their correlation with different etiological categories. Materials and Methods: A retrospective observational study was conducted in the Department of Pathology, All India Institute of Medical Sciences (AIIMS), over a period of three years from January 2022 to December 2024. A total of 300 thrombocytopenic patients with platelet count below 150 × 10⁹/L were included. Platelet parameters including MPV, PDW, plateletcrit (PCT), and P-LCR were analyzed using an automated hematology analyzer. Cases were categorized into hyperdestructive and hypoproductive thrombocytopenia based on clinical and bone marrow findings. Statistical analysis was performed using IBM SPSS Statistics version 26.0. Independent t-test, Chi-square test, and ROC curve analysis were applied. A p-value <0.05 was considered statistically significant. Results: Among 300 cases, hyperdestructive thrombocytopenia constituted 188 cases (62.7%), while hypoproductive thrombocytopenia accounted for 112 cases (37.3%). Mean MPV and PDW values were significantly higher in hyperdestructive thrombocytopenia compared to hypoproductive thrombocytopenia (p<0.001). ROC analysis demonstrated MPV cutoff value of 10.4 fL with sensitivity of 84.6% and specificity of 78.3% in differentiating hyperdestructive from hypoproductive thrombocytopenia. Significant association was observed between platelet indices and underlying etiology. Conclusion: Platelet volume parameters, particularly MPV and PDW, are valuable non-invasive diagnostic tools in evaluating thrombocytopenia and may help differentiate hyperdestructive from hypoproductive causes. Combined assessment of platelet indices improves diagnostic accuracy and may reduce unnecessary invasive procedures.

Background: The radial forearm free flap (RFFF) is widely used for head and neck reconstruction because of its reliable anatomy, long vascular pedicle, pliability, and high success rate. However, venous congestion and thrombosis remain important causes of flap compromise. The communicating vein provides a connection between the superficial and deep venous systems and may permit dual-system drainage through a single venous anastomosis. Aim: To evaluate the reliability of single venous anastomosis using the communicating vein in RFFF reconstruction for head and neck cancer. Methods: This prospective study included 60 patients who underwent RFFF reconstruction for head and neck squamous cell carcinoma between March 2023 and September 2025. Venous drainage patterns, number of venous anastomoses, re-exploration, venous thrombosis, venous congestion, hematoma, flap salvage, partial flap loss, and total flap loss were recorded. Results: Single-vein anastomosis was performed in 51 cases (85.0%), while two- and three-vein anastomoses were performed in 8 (13.3%) and 1 (1.7%) cases, respectively. The common trunk using the median cubital or common cephalic vein was used in 35 cases (58.3%). Venous congestion occurred in 4 cases (6.7%), including 3 cases of venous thrombosis, all successfully salvaged. Hematoma requiring re-exploration occurred in 7 cases (11.7%). One total and one partial flap loss occurred. Overall complete flap survival was 96.7%. Conclusion: Single venous anastomosis using the communicating vein is a reliable option for RFFF reconstruction, providing dual-system venous outflow while simplifying microvascular anastomosis.

Background: Prolonged mechanical ventilation can increase significantly both mortality and morbidity of patient. It is imperative to initiate weaning procedures at the earliest. Recent advancements in lung and diaphragmatic ultrasound techniques have shown promising avenues for evaluating lung aeration, diaphragmatic function and assessing suitability for extubation. Objectives: To assess the ability and accuracy of diaphragmatic and lung ultrasound in predicting successful extubation among adult patients on invasive mechanical ventilation. Methods: This is a hospital-based, prospective cohort study conducted among patients presenting to the Department of Critical Care Medicine between January 2023 to June 2024. Results: Out of 40 patients studied, 92.5% were successfully extubated, while 7.5% experienced extubation failure. Patients who failed extubation had a significantly longer duration of ventilation (8.0 vs. 4.3 days, p<0.05), ICU stay (12.3 vs. 6.5 days, p<0.05), and total hospital stay (15.0 vs. 10.0 days, p<0.05). The Rapid Shallow Breathing Index (RSBI), Lung Aeration Score (LAS), diaphragm excursion (DE), and diaphragm thickening fraction (DTF) were significantly different between the successful and failed extubation groups. RSBI was higher (80.3 vs. 51.4, p<0.05), and DE was lower (1.4 vs. 1.6, p<0.001) in the failed extubation group and these parameters were useful predictors of weaning outcomes. RSBI, LAS, DE, and DTF all demonstrated statistically significant predictive value with AUCs ranging from 0.787 to 0.843. RSBI had a sensitivity of 66.7% and specificity of 88.9%, while the LAS, DE, and DTF also showed high positive predictive values, indicating their utility in predicting extubation success. Conclusion: The findings highlight the potential use of lung and diaphragmatic ultrasound in guiding clinical decisions regarding weaning and extubation from mechanical ventilation.Thus, using lung and diaphragmatic ultrasound provides information to improve extubation success.

Background: Tuberculosis (TB) remains the leading cause of infectious disease mortality worldwide, and vitamin D (Vit-D) has emerged as a potentially important modulator of host defense against TB infection. Methods: This cross-sectional study was conducted over one year at a tertiary care hospital, enrolling 180 patients aged 18–60 years with confirmed pulmonary TB through simple random sampling. Serum 25(OH)D levels were measured using the Elecsys Vit-D3 assay and classified per Endocrine Society guidelines, with associations analyzed using SPSS version 20. Results: The majority of patients (55.6%) were above 51 years, with a male preponderance (62.2%). Vitamin D deficiency was highly prevalent, affecting 75% of patients, while 19.4% had insufficient and only 5.6% had sufficient levels (mean 25(OH)D: 16.68 ng/mL). Deficiency was significantly associated with female gender (92.6% deficient, p=0.026) and bilateral lung involvement (p=0.002), while age (p=0.473) and area of residence (p=0.829) showed no significant association. Conclusion: Vitamin D deficiency is highly prevalent among pulmonary TB patients, particularly among women and those with more extensive lung disease, supporting routine screening and supplementation as a potential therapeutic adjunct.

Background: Thalassemia major causes chronic anemia and iron overload from repeated transfusions, both of which contribute to impaired growth in affected children. Elevated serum ferritin and inadequate pretransfusion hemoglobin are believed to independently and jointly worsen linear growth outcomes. This study examines their combined impact in a large pediatric cohort. Methods: A prospective, hospital-based cohort study enrolled 174 transfusion-dependent thalassemia major patients aged 1–16 years over a 1-year period. Patients were stratified by mean pretransfusion Hb (<8 g/dL vs ≥8 g/dL), and anthropometric measurements were compared against serum ferritin levels using SPSS-based statistical analysis. Results: Short stature was present in 35 patients (20.1%), significantly more common in the Hb <8 g/dL group (32.8%) than the Hb ≥8 g/dL group (13.8%, P = 0.045). Serum ferritin showed a strong inverse relationship with height percentile (P = 0.0004), with short-statured patients having markedly higher mean ferritin (6380 ng/mL) than taller patients (3050 ng/mL). Patients with Hb <8 g/dL also had significantly higher mean ferritin (5300 ng/mL) than those with Hb ≥8 g/dL (4230 ng/mL, P = 0.012). Conclusion: Growth failure in transfusion-dependent thalassemia major is strongly associated with both suboptimal pretransfusion hemoglobin and elevated serum ferritin, emphasizing the need for optimized transfusion and chelation practices.

Introduction: Mixed acid base disorder in CCU patients can be defined as independently coexisting disorder characterised by varied proportions of metabolic acidosis (decreased bicarbonate, decreased pH), metabolic alkalosis (increased bicarbonate, increased pH), respiratory acidosis (increased PaCO₂) and metabolic alkalosis (decreased PaCO₂) depending on specific diagnosis of the patient. AIM (Objective): To identify incidence of acidosis and alkalosis (respiratory and metabolic) in CCU patients of SCCGMCH, Uluberia, based on ABG parameters considering their normal range. Method:  Cases comprised of 100 CCU patients whose blood samples were tested in ABG analyser of the institutional CCU within a period of six months. Diagnosis of acid base disorder was made considering normal ranges of the parameters ascertained by prevailing worldwide standards. Result: Incidence of metabolic acidosis in our sample of CCU patients was found to be higher followed by respiratory alkalosis, while incidence of metabolic alkalosis was much lower followed by respiratory acidosis. Conclusion: The early diagnosis of acid base imbalance and its monitoring has been helpful in the diagnosis and treatment of the terminally ill patients. Improved arrangement for more running ABG analysers in peripheral medical colleges like SCCGMCH will surely help to reduce the mortality and morbidity of rural population.

Introduction: Urolithiasis is a common and recurrent condition influenced by metabolic, dietary, and environmental factors, with calcium-containing stones accounting for the majority of cases. Although calcium plays a central role in stone formation, the relationship between serum calcium levels and the calcium content of urinary stones remains unclear. This study aimed to evaluate whether serum calcium can serve as a reliable indicator of stone calcium burden in patients with urolithiasis. Methodology: A cross-sectional observational study was conducted over one year (November 2024 to October 2025) at KPC Medical College, Kolkata. A total of 70 patients aged 18–80 years with diagnosed urolithiasis were included. Urinary stones were collected post-surgically, processed, and analyzed qualitatively and quantitatively using standard biochemical methods. Serum calcium levels were estimated using the OCPC method on an full-automated analyzer. Statistical analysis, including Spearman correlation, was performed using SPSS version 23. Results: The study population had a mean age of 45.57 ± 17.17 years, with a male predominance (47 males, 23 females). Most patients were overweight or obese (mean BMI: 27.24 ± 4.14 kg/m²). The mean stone weight was 2.93 ± 2.55 g, with a mean calcium content of 0.74 ± 0.73 g. Serum calcium levels were within the normal range (9.32 ± 0.9 mg/dL). Correlation analysis revealed a very weak negative and statistically insignificant relationship between serum calcium and stone calcium content (rs = -0.05, p = 0.69). Conclusion: Serum calcium levels do not correlate with the calcium content of urinary stones and are not a reliable marker for assessing stone burden. These findings highlight that urolithiasis is primarily driven by urinary and metabolic factors rather than systemic calcium levels. Comprehensive metabolic evaluation, particularly urinary analysis, is essential for effective management and prevention of stone disease.

Background: Vaginal hysterectomy (VH) is a cornerstone gynecological procedure prioritized for its minimized postoperative morbidity, reduced pain, and rapid convalescence. However, maintaining optimal intraoperative visualization remains a challenge due to vascularity during dissection. Hydrodissection with standard or vasoconstrictive agents is widely utilized to establish surgical planes and minimize bleeding. Objectives: To evaluate and compare the quantitative efficacy and physiological impact of diluted adrenaline, diluted vasopressin, and plain normal saline infiltration during hydrodissection in elective vaginal hysterectomy. Material and Method: A double-blind Randomized Controlled Trial (RCT) was conducted over 1 .5 years at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, involving 69 women randomized into three equal groups (n=23 each). Group 1 received 40 mL of plain Normal Saline; Group 2 received 40 mL of diluted Adrenaline (1:1 20,000 in 1 % lignocaine); Group 3 received 40 mL of diluted Vasopressin (0.1 U/mL, total 4 U). Primary outcomes measured quantitative intraoperative blood loss using calibrated sponge weight differentials. Secondary outcomes included surgical ease of dissection, intraoperative hemodynamic trends, and postoperative complications. Results: The mean intraoperative blood loss was significantly lower in the vasoconstrictor arms compared to the saline arm (p < 0.05). Group 2 (Adrenaline) and Group 3 (Vasopressin) provided superior surgical cleavage planes with reduced requirements for electrocautery. Hemodynamically, Group 3 (Vasopressin) exhibited a transient yet statistically significant spike in systolic blood pressure at 1 minute (1 25.39 ± 1 0.31 mmHg, p = 0.01 7), while Group 2 (Adrenaline) exhibited a significant increase in pulse rate at 5 minutes (94.43 ± 5.1 5 bpm, p < 0.001). All vital parameters normalized to baseline values within 5 minutes without clinical intervention. Conclusion: Both diluted vasopressin and diluted adrenaline are highly effective pharmacological adjuncts for hydrodissection in vaginal hysterectomy. They substantially minimize intraoperative hemorrhage and enhance the clarity of surgical planes. The associated transient hemodynamic fluxes are brief and self-limiting, confirming safety profiles appropriate for elective clinical deployment when screening rules are strictly implemented.

Background: Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition associated with severe maternal hemorrhage, hysterectomy, intensive care admission, and adverse neonatal outcomes. Early diagnosis remains challenging, particularly in resource-limited settings where advanced imaging modalities are not readily available. Objectives: To evaluate maternal serum alpha-fetoprotein (MSAFP) as a biomarker for placental adherence in women with low-lying placenta and to assess associated fetomaternal outcomes. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, over one year. Sixty antenatal women with ultrasonographically documented low-lying placenta or placenta previa in the third trimester were included. Maternal serum AFP levels were measured by ELISA and correlated with intraoperative findings and fetomaternal outcomes. Results: Among 60 women studied, 8 (13.3%) had PAS. Mean MSAFP levels were significantly higher among PAS cases compared to non-PAS cases (731.92 ± 421.37 ng/mL vs. 155.53 ± 69.73 ng/mL; p<0.001). Elevated MSAFP (>250 ng/mL) was observed in 100% of PAS cases compared with only 7.7% of non-PAS cases. Placenta accreta accounted for 62.5% of PAS cases, placenta increta 12.5%, and placenta percreta 25%. All PAS cases underwent cesarean hysterectomy. Maternal morbidity was significantly higher in PAS cases, including ICU admission, bladder injury, and vesicovaginal fistula. One maternal death and one early neonatal death were reported. Conclusion: MSAFP is a promising, inexpensive, and easily accessible biomarker for the early identification of PAS in women with low-lying placenta. Its incorporation into antenatal risk assessment may facilitate timely referral and improve maternal and neonatal outcomes.

Introduction: Subclinical hypothyroidism (SCH) is the most common thyroid disease in patients with type 2 diabetes mellitus (T2DM). There is growing evidence that SCH may adversely affect glycemic control and contribute to the development of diabetic microvascular complications. However, data from the Indian subcontinent are limited and inconsistent. Objectives: To determine the prevalence of SCH in patients with T2DM and to assess its correlation with glycemic status and microvascular complications like diabetic nephropathy, diabetic retinopathy and diabetic neuropathy. Methods: A cross-sectional study was conducted in a tertiary care teaching hospital among 114 adult patients with T2DM. Thyroid function tests, fasting blood glucose, postprandial blood glucose, glycated hemoglobin (HbA1c), urinary microalbumin estimation, fundus examination, nerve conduction studies were done. SCH was defined as elevated serum thyroid stimulating hormone (TSH) levels (>4 mIU/L) with normal free thyroxine (FT4) concentrations. Statistical analysis was carried out using SPSS version 20. Results: Among 114 participants, 42 patients (36.8%) had SCH. Mean HbA1c was significantly higher in SCH group in comparison to euthyroid individuals (9.19±2.21% vs. 8.16±1.65%; p=0.005). Neuropathy was present in 15 (13.2%) participants, retinopathy in 30 (27.0%) and nephropathy in 53 (46.5%) . There was a finding of SCH in 8 patients with neuropathy (54%) and 15 patients with retinopathy, but these associations were not statistically significant. Conversely, diabetic nephropathy was significantly associated with SCH with 39 of 53 patients with nephropathy having SCH (p<0.001). Conclusion: SCH is very common in T2DM patients and is associated with worse glycemic control and significantly increased burden of diabetic nephropathy. Routine screening of the thyroid may help to identify early those patients who are at increased risk for microvascular complications.

Background: Etomidate is a commonly used intravenous agent because of its stable haemodynamic properties but the myoclonus following etomidate induction may be the distressing and clinically undesirable effect. Aim & Objectives: To evaluate the efficacy of dexmedetomidine pre-treatment in reducing the incidence and severity of etomidate induced myoclonus during induction of general anaesthesia. Material & method: In this double blind prospective, randomized study of 88 adult surgical patients, allocated into two equal groups: Group I received Dexmedetomidine (0.5ug/kg) pre-treatment and Group II received saline over 10 minutes prior to 0.3 mg/kg Etomidate induction. Patients were observed continuously for 1 minute for the occurrence and severity of myoclonus. Haemodynamics and saturation were recorded at different intervals and complication were noted if occurred. The presentation of the Categorical variables was done in the form of number and percentage (%). The quantitative data were presented as the means ± SD. Result: Myoclonus was absent in 77.27% of patients in the Dexmedetomidine group versus saline group (p < 0.0001). Moderate and severe myoclonus were also markedly lower in the Dexmedetomidine group. Hemodynamic parameters showed favourable trends. While systolic blood pressure (SBP) was significantly lower in the Dexmedetomidine group from 4 minutes post-induction onward (p < 0.0001), values remained clinically stable. Diastolic blood pressure (DBP) and heart rate were largely comparable, with a few intervals showing significantly lower values in the Dexmedetomidine group, suggesting its expected hypotensive and mild bradycardia effects. Oxygen saturation (SpO₂) remained stable in both groups throughout. Conclusion: Dexmedetomidine in a dose of 0.5 µg/kg can be used safely as premedication prior to the induction with etomidate to reduce Etomidate induced myoclonus.

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus associated with delayed healing, prolonged hospitalization, and increased risk of amputation. Topical insulin has emerged as a promising adjunct in wound management. Methods: This interventional study was conducted in the Department of General Surgery, People’s Hospital, Bhopal, from March 2024 to October 2025. Fifty patients with Wagner Grade I and II diabetic foot ulcers were enrolled and divided into two groups: topical insulin dressing (Group 1) and normal saline dressing (Group 2). Wound depth, ulcer size, granulation tissue formation, hospital stay, satisfaction, adverse events, and healing outcomes were assessed over 3 weeks. Results: Baseline characteristics were comparable between groups. The insulin group showed significantly greater reduction in wound depth and ulcer size from Week 2 onward (p<0.05). Granulation tissue formation and overall patient satisfaction were higher in the insulin group. Mean hospital stay was significantly shorter in the insulin group (12.38 ± 2.14 days vs 22.72 ± 2.67 days; p<0.0001). No major adverse effects were observed. Conclusion: Topical insulin dressing significantly accelerates healing of diabetic foot ulcers and appears safe, effective, and economical compared to normal saline dressing.

Background: Collagenous fibroma (desmoplasticfibroblastoma) is a rare benign fibroblastic soft tissue tumor. It typically involves subcutis or skeletal muscle, but occasionally primarily involves the dermis. We present a case series of 7 cases with varied anatomic distribution. Methods: Cases of skin lesion presenting with nodule/swelling and histomorphologically diagnosed as collagenous fibroma over a period of 4 years (2022–2025) were included. Malignancies, autoimmune diseases, and skin adnexal lesions were excluded. Results: Seven cases were identified comprising four women and three men, ranging in age from 29 to 61 years (mean 41 years). Tumors involved the right trunk (1), forehead (1), left index finger (1), hard palate (1), left arm (1), right forearm (1), and right middle finger (1). Each case demonstrated a hypocellular proliferation of bland stellate to spindled fibroblasts in a collagenous stroma without cellular atypia, mitotic activity, or necrosis. All patients were treated by simple surgical excision with no recurrence on follow-up. Conclusions: Collagenous fibroma may present at varied anatomic locations and poses a potential diagnostic challenge. Recognition of characteristic histopathologic features and awareness of this entity within the differential diagnosis of fibrous soft tissue tumors is essential for accurate diagnosis.

Background: Abdominal tuberculosis remains a major health problem in developing countries and is associated with significant diagnostic and therapeutic challenges because of its nonspecific clinical presentation and varied radiological manifestations. The present study aimed to evaluate the diagnostic predictors and treatment outcomes of abdominal tuberculosis. Methods: This descriptive observational and analytical study was conducted in the Department of General Surgery, People’s Hospital, Bhopal, from April 2024 to March 2026. A total of 58 clinically suspected cases of abdominal tuberculosis were enrolled. Clinical profile, radiological findings, operative details, diagnostic predictors, and treatment outcomes were analyzed. Diagnostic modalities including AFB Ziehl–Neelsen staining, CBNAAT, AFB culture, and histopathology were evaluated using an Integrated Reference Standard (IRS) as the gold standard. Results: The mean age was 37.31 ± 13.91 years, with male predominance (55.17%). Common symptoms included loss of appetite (82.75%), weight loss (79.31%), abdominal pain (74.13%), and fever (67.2%). Acute intestinal obstruction was the most common presentation. CBNAAT demonstrated the highest sensitivity (100%) and diagnostic accuracy (95.83%). Operative management was required in 79.31% of patients, with resection and end-to-end anastomosis being the commonest procedure. Mortality was 6.52%. Conclusion: Early diagnosis using molecular techniques such as CBNAAT and timely surgical intervention significantly improve outcomes in abdominal tuberculosis.

Background: The foramen magnum (FM), located in the occipital bone at the cranial base, is the largest opening of the skull and serves as the conduit for the medulla oblongata, vertebral arteries, spinal accessory nerves, meninges, and associated vascular structures. Its morphology has attracted considerable attention because of its importance in forensic anthropology, neurosurgery, radiology, and craniovertebral junction surgery. The dimensions and shape of the FM demonstrate inter-population variability and may aid in sex estimation when other skeletal components are unavailable. Accurate morphometric assessment is also essential for planning surgical approaches to lesions involving the craniovertebral junction while minimizing neurovascular injury. Aim: To evaluate the morphometric characteristics of the foramen magnum in adult human dry skulls and determine their forensic and neurosurgical significance. Materials and Methods: A cross-sectional osteological study was conducted on 150 adult human dry skulls obtained from the Department of Anatomy of a tertiary care teaching institution. The anteroposterior diameter, transverse diameter, circumference, and foramen magnum index were measured using a digital Vernier caliper with an accuracy of 0.01 mm. The shape of the foramen magnum was classified into predefined morphological categories based on visual assessment. Morphometric parameters were analyzed descriptively and compared according to sex where identification was available. Statistical analysis included descriptive statistics, independent-samples t-test, chi-square test, and Pearson correlation. Statistical significance was considered at p < 0.05. Results: The mean anteroposterior diameter of the foramen magnum was 35.18 ± 2.41 mm, while the mean transverse diameter was 29.42 ± 2.08 mm. The average foramen magnum index was 1.20 ± 0.09. Oval morphology constituted the most common shape (38.7%), followed by round (22.0%), hexagonal (14.7%), tetragonal (10.0%), pentagonal (8.7%), and irregular forms (6.0%). Male skulls demonstrated significantly greater anteroposterior and transverse diameters than female skulls (p < 0.001). The morphometric measurements showed moderate positive correlations, suggesting proportional growth of the cranial base. Conclusion: The present study provides comprehensive morphometric data regarding the foramen magnum in adult human skulls. The findings contribute valuable baseline anatomical information for forensic identification, anthropological research, radiological interpretation, and neurosurgical planning. The observed sexual dimorphism supports the use of foramen magnum measurements as supplementary indicators for sex estimation when complete skeletal remains are unavailable.

The growing prevalence of multidrug-resistant microorganisms, driven by the overuse and misuse of antibiotics, poses a major global public health challenge by reducing the effectiveness of existing drugs. This study evaluated the antibacterial activities of Persicaria odorata (Phakpai) extracts to assess their potential as natural therapeutic alternatives.  Antibacterial activity was tested against Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Streptococcus pneumoniae using the agar disc diffusion method at dose of 150, 300, and 600 µg. Gentamicin and ampicillin (10 µg) served as positive controls. The ethanolic extract at 600µg demonstrated the highest antibacterial efficacy, producing inhibition zones of 9.93 mm against E. coli and K. pneumoniae, 9.50 mm against P. aeruginosa, and 16.27 mm against S. aureus. Ampicillin inhibited E. coli, and S. aureus, but not P. aeruginosa and K. pneumoniae, while gentamicin was effective against all tested organisms. The superior antimicrobial potency of the ethanolic extract is likely attributed to its higher solubility for bioactive compounds, such as phenolics and alkaloids, which enhance bacterial cell wall permeability, particularly in Gram-positive strains. These findings suggest that P. odorata is a promising source of natural antimicrobial and antioxidant compounds and may provide a foundation for developing novel agents to combat antibiotic-resistant pathogens.

Background: Small for gestational age (SGA) neonates carry a disproportionate burden of perinatal morbidity and mortality, and both maternal and placental determinants contribute to this outcome. Region-specific data linking clinical, nutritional, and placental morphometric variables are limited, particularly from tertiary centres in Tamil Nadu. Objectives: To evaluate the association of maternal socio-demographic, clinical, and nutritional factors, along with placental morphometric parameters, with the occurrence of SGA neonates at a tertiary care hospital. Methods: This analytical cross-sectional study was conducted over one year in the Department of Neonatology of a Government Medical College Hospital, Tamil Nadu. Sixty-eight neonates classified as SGA and 68 appropriate-for-gestational-age (AGA) controls, categorised using INTERGROWTH-21st standards, were enrolled after ethics committee approval. Maternal demographic, anthropometric, antenatal, and haematological data were collected using a structured proforma, and placentas were subjected to standardised gross morphometric examination. Data were analysed in SPSS using chi-square/Fisher’s exact tests, independent t-tests, Mann-Whitney U tests, and multivariable logistic and linear regression, with p<0.05 considered significant. Results: Mean birth weight was significantly lower in the SGA group than the AGA group (2227.32 ± 322.78 g vs 2888.68 ± 405.65 g; p<0.001), while gestational age and sex distribution did not differ between groups. Moderate maternal anaemia (OR 15.00, 95% CI 3.07–73.29), inadequate gestational weight gain (OR 18.75, 95% CI 2.39–147.08), a previous history of SGA delivery (OR 18.75, 95% CI 2.39–147.08), a short interpregnancy interval (OR 5.06, 95% CI 2.03–12.62), and irregular antenatal supplementation (OR 3.19, 95% CI 1.56–6.47) were significantly associated with SGA. Among placental parameters, abnormal placental thickness (OR 7.75), volume (OR 4.88), weight (OR 4.86) and other structural abnormalities (OR 3.58) were significantly associated with SGA, whereas the placental ratio was not (p=0.146). Maternal weight gain correlated positively with birth weight (r=0.440, p<0.001). Conclusion: SGA in this population is driven by a multifactorial interaction of maternal nutritional and haematological status and placental morphometric insufficiency. Routine antenatal anaemia screening, monitoring of gestational weight gain, and gross placental examination at delivery are recommended as feasible, low-cost adjuncts for risk stratification in similar tertiary care settings.

Background: Non-alcoholic fatty liver disease (NAFLD) is commonly associated with type 2 diabetes mellitus (T2DM) and may progress silently to steatohepatitis and fibrosis. Early identification of clinical and biochemical predictors is useful for risk stratification. Aim: To evaluate the clinical and biochemical predictors of NAFLD among patients with T2DM. Methods: This prospective observational study was conducted at GSL Medical College, Rajahmundry, from January to May 2026. A total of 124 patients with T2DM were included. Clinical details, anthropometric measurements, glycaemic parameters, lipid profile and liver enzymes were recorded. Abdominal ultrasonography was used to diagnose NAFLD. Patients with and without NAFLD were compared, and predictors were analysed statistically. Results: NAFLD was detected in 78 patients (62.9%), while 46 patients (37.1%) had no fatty liver. Patients with NAFLD had significantly higher BMI, waist circumference, systolic blood pressure, fasting blood glucose, postprandial blood glucose, HbA1c, triglycerides, LDL cholesterol, ALT and AST levels. Multivariate analysis identified BMI ≥25 kg/m², high-risk waist circumference, HbA1c ≥8%, triglycerides ≥150 mg/dL and ALT elevation as independent predictors. Conclusion: NAFLD was highly prevalent among T2DM patients. Obesity markers, poor glycaemic control, hypertriglyceridaemia and ALT elevation were useful predictors for identifying high-risk diabetic patients.

Background: Abdominal tuberculosis remains a major health problem in developing countries and is associated with significant diagnostic and therapeutic challenges because of its nonspecific clinical presentation and varied radiological manifestations. The present study aimed to evaluate the diagnostic predictors and treatment outcomes of abdominal tuberculosis. Methods: This descriptive observational and analytical study was conducted in the Department of General Surgery, People’s Hospital, Bhopal, from April 2024 to March 2026. A total of 58 clinically suspected cases of abdominal tuberculosis were enrolled. Clinical profile, radiological findings, operative details, diagnostic predictors, and treatment outcomes were analyzed. Diagnostic modalities including AFB Ziehl–Neelsen staining, CBNAAT, AFB culture, and histopathology were evaluated using an Integrated Reference Standard (IRS) as the gold standard. Results: The mean age was 37.31 ± 13.91 years, with male predominance (55.17%). Common symptoms included loss of appetite (82.75%), weight loss (79.31%), abdominal pain (74.13%), and fever (67.2%). Acute intestinal obstruction was the most common presentation. CBNAAT demonstrated the highest sensitivity (100%) and diagnostic accuracy (95.83%). Operative management was required in 79.31% of patients, with resection and end-to-end anastomosis being the commonest procedure. Mortality was 6.52%. Conclusion: Early diagnosis using molecular techniques such as CBNAAT and timely surgical intervention significantly improve outcomes in abdominal tuberculosis.

Background: Reactive Infectious Mucocutaneous Eruption (RIME) is a recently recognized infection-associated mucocutaneous syndrome characterized by severe mucositis with minimal or absent cutaneous involvement. Mycoplasma pneumoniae is the most frequently implicated pathogen. RIME is increasingly distinguished from Stevens–Johnson syndrome (SJS) due to differences in etiology, management, and prognosis. Case Series: We report a retrospective case series of three young adults presenting with prominent oral, ocular, and/or genital mucositis following febrile respiratory illness. All patients were admitted to General ward in department of General Medicine, GMERS Medical College and Hospital, Vadodara, Gujarat, India, and had laboratory-confirmed Mycoplasma pneumoniae infection by polymerase chain reaction and/or serology. None had a history of recent drug exposure. Clinical features, laboratory parameters, radiological findings, treatment, and outcomes were analyzed. Conclusion: This case series highlights the importance of recognizing Mycoplasma pneumoniae–associated RIME as a distinct clinical entity. Early diagnosis can prevent misclassification as drug-induced SJS, avoid unnecessary lifelong drug avoidance labelling, and guide appropriate supportive and antimicrobial management.

Background: Non-fermenting gram-negative bacilli (NFGNB) are important nosocomial pathogens associated with significant morbidity due to their multidrug resistance (MDR) and production of metallo-β-lactamases (MBL). This study aimed to evaluate the distribution, antimicrobial resistance patterns, and MBL production among NFGNB isolates in a tertiary care hospital. Methods: This cross-sectional study included 1750 clinical samples collected from patients aged 12 years onward admitted in Critical Care Unit (CCU) and were processed in the microbiology laboratory, of which 155 NFGNB isolates were identified. Organisms were identified using standard microbiological techniques. Antimicrobial susceptibility testing was performed using the VITEK 2 compact system ((bioMérieux) as per CLSI guidelines. MBL production by the isolates were also detected by Vitek 2 compact system. Results: Out of 1750 samples, 155 (8.86%) were identified as NFGNB. Pseudomonas aeruginosa (n=52) and Acinetobacter baumannii (n=44) were the predominant organisms, mainly isolated from sputum samples. Carbapenem resistance was notably high in Acinetobacter baumannii compared to Pseudomonas aeruginosa. MBL production was detected in 72.73% of Acinetobacter baumannii and 36.54% of Pseudomonas aeruginosa, with all MBL producers being multidrug-resistant. Colistin and minocycline showed relatively better susceptibility across most isolates. Conclusion: A high prevalence of MDR and MBL-producing NFGNB, particularly Acinetobacter baumannii, was observed. The increasing resistance to commonly used antibiotics and reliance on last-resort drugs highlight the urgent need for antimicrobial stewardship, strict infection control, and continuous surveillance.

Background: Road traffic accidents are an important public health problem and a major cause of preventable morbidity and mortality. Human-related factors such as unsafe driving practices, non-use of protective devices, intoxication, medical conditions and poor compliance with traffic rules play an important role in the occurrence and severity of road traffic injuries. Aim: To study the host-related risk factors among road traffic accident victims presenting to a tertiary care hospital in Jodhpur. Material and Methods: This hospital-based cross-sectional study was conducted in the Accidental Emergency Department and Department of Community Medicine of a tertiary care hospital, Jodhpur, from November 2020 to January 2021. A total of 200 road traffic accident victims who presented within 24 hours of the accident were included. Data were collected using a semi-structured proforma after informed consent. Information regarding socio-demographic profile, role of victim, driving experience, helmet and seat belt use, driving licence, intoxication and medical conditions was recorded. Data were analysed using MS Excel and Epi Info software. Results: Most victims belonged to the 10–29 years age group, 91 (45.5%), followed by 30–49 years, 71 (35.5%). Males constituted 166 (83.0%) cases. Drivers were the most common victims, 81 (40.5%), followed by pedestrians, 58 (29.0%). Among two-wheeler victims, 47 (48.5%) were not wearing helmets. Among four-wheeler victims, 16 (59.3%) were not using seat belts. Intoxication was present in 14 (7.0%) victims, while medical conditions were reported in 52 (26.0%), with refractive error being the most common. Conclusion: Young males, drivers and pedestrians were commonly affected. Strengthening helmet and seat belt use, licensing, drink-driving control and driver health screening may reduce road traffic injuries.

Background: Intrathecal adjuvants are commonly added to local anaesthetics during spinal anaesthesia to improve block characteristics and prolong postoperative analgesia. Midazolam and buprenorphine are two such adjuvants with distinct mechanisms of action and analgesic profiles. The present study compared the efficacy and safety of intrathecal midazolam and intrathecal buprenorphine when used as adjuvants to hyperbaric levobupivacaine in patients undergoing infraumbilical surgeries. Methods: This prospective interventional study was conducted in 60 patients aged 18–60 years with ASA physical status I or II undergoing elective infraumbilical surgeries under spinal anaesthesia. Patients were randomly allocated into two groups of 30 each. Group A received intrathecal midazolam 2 mg with 0.5% hyperbaric levobupivacaine, while Group B received intrathecal buprenorphine 120 µg with 0.5% hyperbaric levobupivacaine. Sensory and motor block characteristics, duration of postoperative analgesia, haemodynamic parameters, visual analogue scale (VAS) scores, sedation scores, and adverse effects were evaluated. Results: Baseline demographic and clinical characteristics were comparable between the groups. Sensory onset was significantly faster in Group A (3.82 ± 0.93 min) than Group B (4.20 ± 1.58 min; p = 0.009). However, Group B demonstrated significantly prolonged two-segment sensory regression (210.83 ± 41.23 vs. 150.53 ± 32.82 min; p = 0.010), longer motor block duration (175.97 ± 40.23 vs. 143.33 ± 36.41 min; p = 0.033), and markedly prolonged postoperative analgesia (602.00 ± 128.99 vs. 307.67 ± 103.38 min; p = 0.005). VAS pain scores were significantly lower and Ramsay sedation scores significantly higher in Group B throughout the postoperative period. The incidence of hypotension, bradycardia, nausea, and vomiting was comparable between the groups. Conclusion: Both intrathecal midazolam and buprenorphine were effective adjuvants to hyperbaric levobupivacaine for spinal anaesthesia. Midazolam provided a faster onset of sensory blockade, whereas buprenorphine produced significantly longer sensory and motor blockade, superior postoperative analgesia, and lower postoperative pain scores without increasing adverse effects. Intrathecal buprenorphine may therefore be the preferred adjuvant when prolonged postoperative analgesia is desired.

Background: Abortion is one of the most common subjects of obstetric practice. Abortion is defined as the expulsion of the fetus until the 20th week and is clinically classified based on ultrasound evaluation. Pain in medical abortion is the most predictable side effect of medical abortion and is a point of concern for patient. Regarding pain in general, WHO advised on documenting pain scores as the fifth vital sign (the four others being temperature, pulse rate, respiratory rate and blood pressure) for all patients experiencing pain. Even for medical abortions, it is imperative to ensure that patients receive safe and effective pain management tailored to their needs.  For women undergoing medical termination of pregnancy, this also means that the level of pain must be ascertained in the routine clinical practice. Objectives: To evaluate and compare the quantitative efficacy and physiological impact of prophylactic ibuprofen for anakgesis in medical method of abortion up to 49 days of gestation. Results: As compared to Group B, Group A had significantly less VAS at 2 hours (5.03 ± 1.12 vs 5.6 ± 0.93, P=0.002), significantly less VAS score at 4 hours (4.45 ± 1.21 vs 5.29 ± 1.12, p=0.0001), and comparable at 6 and 8 hours; comparable change in VAS score at 4, 6, and 8 hours; significantly less median VAS after 1 hour of rescue analgesia (3.5 vs 4, P=0.004); significantly less median highest VAS in patients experienced during hospital stay (5 vs 6, P=0.0002); and significantly less median VAS in 24 hours following discharge (3 vs 4, P<.0001). Conclusion: We found that patients in Group A taking Ibuprofen had significantly lower VAS scores (2 hours and 4 hours after administration of misoprostol) in comparison to placebo, with significantly less need of rescue analgesia, less hospital stay, and more patient satisfaction. Our findings were in line with other studies which showed better efficacy of Ibuprofen for pain management in abortions.

Oral rehabilitation in medically and psychologically compromised patients presents considerable clinical challenges due to the influence of systemic diseases, psychological disorders, and associated pharmacological therapies on treatment planning and prognosis. This case report describes the comprehensive oral rehabilitation of a 26-year-old Caucasian female with a history of anemia requiring blood transfusions, depression managed with antidepressant therapy, and ongoing Suboxone treatment. Clinical examination revealed generalized severe dental caries, retained root fragments, missing teeth, compromised periodontal health, and occlusal instability, resulting in impaired function and esthetics. A comprehensive diagnostic evaluation, including clinical examination, radiographic assessment, periodontal charting, and occlusal analysis, was performed to formulate an individualized multidisciplinary treatment plan. The proposed rehabilitation involved extraction of non-restorable teeth, preservation of strategically important teeth, implant-supported prosthetic rehabilitation, and restoration of occlusal harmony. Careful consideration of the patient’s medical and psychological status enabled safe treatment planning and successful rehabilitation. The final outcome demonstrated marked improvement in oral function, esthetics, and occlusal stability, highlighting the importance of a holistic, patient-centered approach in managing complex dental cases. This case emphasizes that meticulous diagnosis, interdisciplinary collaboration, and individualized treatment planning are essential for achieving predictable functional and esthetic outcomes in medically and psychologically compromised patients.

Background: Maternal body mass index (BMI) is an important indicator of nutritional status and has a significant influence on pregnancy, labour and neonatal outcomes. Both low and high maternal BMI have been associated with adverse obstetric and perinatal outcomes, including altered birth weight, increased operative delivery and neonatal morbidity. Aim and Objectives: This study aimed to assess the association of maternal BMI with mode of delivery and perinatal outcomes among term pregnant women. The primary objective was to evaluate the association between maternal BMI and mode of delivery, particularly caesarean section. The secondary objectives were to assess the association between maternal BMI and induction of labour, birth weight, 5-minute Apgar score, and neonatal intensive care unit admission. Methods: This prospective observational study included 120 term pregnant women with singleton pregnancies admitted for delivery. Maternal BMI was calculated as weight in kilograms divided by height in metres squared, and women were categorized into underweight, normal BMI, overweight and obese groups. Labour details, induction of labour, mode of delivery and neonatal outcomes were recorded prospectively. Perinatal outcomes included birth weight, 5-minute Apgar score and neonatal intensive care unit admission. Data were analysed using appropriate statistical tests, and a p value of less than 0.05 was considered statistically significant. Results: Among 120 women, 18 were underweight, 48 had normal BMI, 34 were overweight, and 20 were obese. Induction of labour increased significantly with increasing BMI and was highest among obese women (60.0%; p = 0.018). Caesarean section rate was lowest among women with normal BMI (25.0%) and highest among obese women (55.0%; p = 0.041). Mean birth weight increased significantly across BMI categories, from 2.54 ± 0.36 kg in underweight women to 3.28 ± 0.52 kg in obese women (p = 0.003). Low birth weight was significantly more frequent among underweight women (p = 0.027). Macrosomia, low 5-minute Apgar score and neonatal intensive care unit admission were more frequent among obese women; however, these associations did not reach statistical significance. Conclusion: Maternal BMI was significantly associated with induction of labour, caesarean section and birth weight. Obese women had higher rates of induction of labour and caesarean section, whereas underweight women had a greater frequency of low-birth-weight neonates. Routine BMI assessment during antenatal care may help in early risk identification, nutritional counselling, individualized labour planning and appropriate neonatal preparedness.

Background: Community-acquired pneumonia is an important cause of hospitalization, respiratory failure, ICU admission, and mortality. HRCT provides a detailed assessment of lung parenchymal involvement and may help in predicting clinical outcomes. Aim and Objective: To assess the role of HRCT chest severity score in predicting clinical outcomes among patients with community-acquired pneumonia. Materials and Methods: This prospective observational study included 120 adult patients diagnosed with community-acquired pneumonia. HRCT of the chest was performed, and the severity score was calculated using a semi-quantitative lobar involvement method. Patients were categorized into low-score (0–7), moderate-score (8–15), and severe-score (>15) groups. Clinical outcomes, including oxygen requirement, non-invasive ventilation, ICU admission, mechanical ventilation, hospital length of stay, and mortality, were assessed. Results: Among 120 patients, 35 (29.2%) had a low HRCT severity score, 52 (43.3%) a moderate score, and 33 (27.5%) a severe score. Oxygen requirement increased from 10 patients (28.6%) in the low-score group to 36 patients (69.2%) in the moderate-score group and 32 patients (97.0%) in the severe-score group. ICU admission was required in 1 patient (2.9%), 8 patients (15.4%), and 19 patients (57.6%) in the low, moderate, and severe groups, respectively. Mean hospital stays increased from 4.6 ± 1.8 days to 7.2 ± 2.6 days and 11.4 ± 4.1 days across the three groups. Mortality was observed in 10 patients (8.3%), with the highest mortality in the severe HRCT score group. Conclusion: HRCT chest severity score is a useful radiological marker for predicting oxygen requirements, ICU admission, hospital stay, and mortality in patients with community-acquired pneumonia. It may be used as an adjunct to clinical assessment for early risk stratification and treatment planning.

Background: Brachial plexus block is a widely used regional anaesthetic technique for upper limb surgeries. Adjuvants are frequently added to local anaesthetics to enhance block quality and duration. This study evaluated the effect of fentanyl (50 mcg) as an adjuvant to Ropivacaine 0.5% on the onset and duration of sensory and motor block in patients undergoing supraclavicular brachial plexus block. Methods: This prospective, randomised, comparative study included 70 ASA I and II patients aged 20–70 years undergoing upper limb surgery under supraclavicular brachial plexus block. Patients were allocated to Group I (n=35): 0.5% ropivacaine 30 ml + 1 ml normal saline (31 ml total) or Group II (n=35): 0.5% ropivacaine 30 ml + fentanyl 50 mcg in 1 ml (31 ml total). Blocks were performed using a nerve stimulator-guided supraclavicular approach. Onset and duration of sensory and motor block were the primary outcomes. Statistical analysis was performed using the Mann-Whitney U test and Chi-square/Fisher’s Exact test where appropriate; p<0.05 was considered significant. Results: Demographic parameters and baseline characteristics were comparable between groups (p>0.05). Group II demonstrated significantly prolonged sensory block duration (Median 8.00 [7.50–8.50] hrs vs 4.00 [4.00–4.50] hrs; mean difference +3.61 hrs, 95% CI: 3.42–3.81, p<0.001) and motor block duration (Median 6.50 [6.50–7.00] hrs vs 3.50 [3.00–4.00] hrs; mean difference +3.13 hrs, 95% CI: 2.92–3.34, p<0.001) compared to Group I. Block onset was marginally but significantly delayed in Group II for both sensory (p<0.001) and motor block (p<0.001). Block success rate was higher in Group II (97.1% vs 88.6%), though this did not reach statistical significance (p=0.356). VAS scores at rescue analgesia were comparable between groups (p=0.567). Conclusions: The addition of fentanyl 50 mcg to ropivacaine 0.5% for supraclavicular brachial plexus block significantly prolongs both sensory and motor block duration, albeit with a slight delay in block onset. Fentanyl is a safe and effective adjuvant to ropivacaine for prolonging postoperative analgesia in patients undergoing upper limb surgery.

Background: Dry eye disease (DED) is a multifactorial ocular surface disorder increasingly recognized among young populations with high digital device exposure. Despite several regional studies, data from Maharashtra remain limited. Aim: To assess the prevalence of DED among medical students in northeast Maharashtra using the Ocular Surface Disease Index (OSDI) questionnaire and to evaluate its association with visual display terminal (VDT) use and refractive correction. Methods: A descriptive, cross‑sectional study was conducted among 250 medical students (aged 18–26 years) between January and April 2025. Data on screen exposure, spectacle and contact lens use, and ocular symptoms were collected via Google Form–based OSDI questionnaires. Dry eye was defined and graded according to OSDI scores. Statistical analysis was performed using the Chi‑square test, with significance set at P < 0.05. Results: The prevalence of DED was 60.8% (152/250), with 25.2% mild, 11.6% moderate, and 24.0% severe cases. Dry eye was slightly more common in males (56%) than females (44%) (P = 0.14). Among spectacle users (163/250), 54.0% reported dry eye, a statistically significant association (P < 0.0001). Contact lens use was not significantly associated with DED (47.8%, P = 0.53). Students with screen exposure >6 hours daily had a significantly higher prevalence of DED (73.6%, P < 0.001). Conclusion: The burden of DED among medical students in northeast Maharashtra is high, with prolonged screen exposure emerging as a major determinant. Preventive awareness and ergonomic interventions are warranted to mitigate the impact of digital device use on ocular health.

Background: Thyroglossal duct cyst (TGDC) is the most common congenital midline neck mass in children and young adults, arising from remnants of the thyroglossal tract. Primary malignancy arising within a thyroglossal duct cyst, most commonly papillary thyroid carcinoma, is an exceedingly rare occurrence with an estimated incidence of less than 1% of all TGDCs. The histomorphological spectrum of TGDCs remains undercharacterised in larger case series from the Indian subcontinent. Aim: To describe the clinicopathological and immunohistochemical features of thyroglossal duct cysts in a case series of 17 consecutive surgically excised specimens, with particular emphasis on the single case harbouring primary papillary carcinoma. Materials and Methods: All thyroglossal duct cyst specimens received at our department were retrospectively reviewed. Clinical data, gross and microscopic findings, and immunohistochemical results were analysed. Immunohistochemistry for Galectin-3, CK19, HBME-1, and TTF-1 was performed in cases with suspicious microscopic features. Results: The series comprised 17 cases (11 females, 6 males) with ages ranging from 19 to 63 years. The infrahyoid midline was the most common site (11/17). One case (5.9%) was found to harbour papillary carcinoma within the cyst wall. The malignant case demonstrated Galectin-3 and CK19 positivity, with focal HBME-1 and TTF-1 positivity. The remaining 16 cases showed benign histomorphology including squamous-lined cysts, ciliated columnar-lined cysts, thyroid follicles within the cyst wall, and varying degrees of chronic inflammation. Conclusion: Thorough sampling and careful histopathological evaluation of all thyroglossal duct cyst specimens is essential to detect incidental papillary carcinoma. Immunohistochemistry with Galectin-3, CK19, and HBME-1 serves as a valuable adjunct in confirming malignancy.

Introduction: Carcinoma cervix is a major health concern in developing countries. High dose rate (HDR) intracavitary brachytherapy (ICBT) following external beam radiotherapy (EBRT) is a crucial part of definitive treatment. The introduction of CT-based image-guided brachytherapy (IGBT) enables improved target coverage and sparing of organs at risk (OARs). Aim: To evaluate dosimetric parameters, acute toxicities and early clinical response in patients undergoing CT-based HDR brachytherapy using a cobalt-60 (Co-60) source. Materials and Methods: This prospective observational study included 20 patients with histologically confirmed carcinoma cervix (FIGO 2018 stages IIA–IIIB). All patients received EBRT (50 Gy in 25 fractions) with concurrent weekly cisplatin (40 mg/m²), followed by HDR brachytherapy (7 Gy × 3 weekly fractions). CT-based planning was performed according to American Brachytherapy Society guidelines. Dosimetric parameters including HR-CTV D₉₀ and OAR D_2cc doses were converted to EQD2. Acute toxicities were graded using CTCAE v5.0 and response was assessed clinically. Results: The mean HR-CTV D₉₀ EQD2 was 84.82 Gy. Mean D_2cc doses to bladder, rectum, and sigmoid were 72.93 Gy, 65.62 Gy and 62.06 Gy, respectively, all within recommended tolerance limits. Acute toxicities were predominantly Grade 1–2, with no Grade ≥3 events observed. Complete response was achieved in 90% of patients. Conclusion: CT-guided HDR brachytherapy using Cobalt-60 is an effective and practical treatment approach for carcinoma cervix. It provides promising results with adequate target coverage with acceptable OAR sparing and minimal acute toxicity.

Background: Postoperative delirium is a common and clinically important complication among elderly surgical patients. Anaesthetic technique may influence delirium risk through its effects on intraoperative physiology, postoperative pain, opioid requirement, and recovery profile. Aim and Objective: To evaluate the impact of regional anaesthesia on the incidence of postoperative delirium in elderly patients. Materials and Methods: This prospective comparative observational study was conducted at Gandhi Medical College, Bhopal, among 60 elderly patients aged 60 years and above undergoing elective surgical procedures between June 2025 and April 2026. Patients were divided into two groups according to anaesthetic technique: regional anaesthesia group (n=30) and general anaesthesia group (n=30). Postoperative delirium was assessed using the Confusion Assessment Method during the first 72 hours after surgery. Postoperative pain scores, rescue opioid requirement, and duration of hospital stay were also recorded. Results: The mean age of the study population was 68.4 ± 6.1 years. Postoperative delirium was observed in 11 patients (18.3%). The incidence was lower in the regional anaesthesia group compared with the general anaesthesia group [3 patients (10.0%) vs 8 patients (26.7%)], although this difference was not statistically significant (p=0.095). Regional anaesthesia was associated with significantly lower postoperative pain scores at 6 hours and 24 hours and reduced rescue opioid requirement [8 patients (26.7%) vs 17 patients (56.7%); p=0.018]. Advanced age, ASA III status, and postoperative opioid requirement were associated with a higher occurrence of delirium. Conclusion: Regional anaesthesia was associated with a lower observed incidence of postoperative delirium, better pain control, and reduced opioid requirement in elderly surgical patients. However, delirium risk appears multifactorial, and anaesthetic technique should be combined with comprehensive perioperative delirium-prevention strategies.

Background: Total knee arthroplasty is commonly associated with significant postoperative pain, which may delay early mobilisation and rehabilitation. The IPACK block is a motor-sparing regional anaesthesia technique that targets posterior knee pain and may improve analgesic outcomes when added to multimodal pain management. Aim and Objective: To evaluate the efficacy of IPACK block in multimodal postoperative pain management among patients undergoing total knee arthroplasty. Materials and Methods: This prospective comparative study was conducted at Gandhi Medical College, Bhopal, between June 2025 and April 2026. A total of 60 patients undergoing elective unilateral total knee arthroplasty were included and divided into two groups of 30 each. Group I received an ultrasound-guided IPACK block along with standard multimodal analgesia, while Group II received standard multimodal analgesia alone. Postoperative pain was assessed using VAS scores at rest and during movement. Rescue analgesic requirement, tramadol consumption, time to ambulation, knee flexion at 48 hours, length of hospital stay, and adverse events were recorded. Results: Postoperative VAS scores were significantly lower in the IPACK group compared with the control group at 6, 12, 24, and 48 hours. Mean time to first rescue analgesia was significantly longer in Group I than Group II (7.8 ± 2.3 hours vs 4.2 ± 1.6 hours; p < 0.001). Tramadol consumption during the first 24 hours was significantly lower in the IPACK group (82.5 ± 28.4 mg vs 132.7 ± 41.6 mg; p < 0.001). Patients receiving an IPACK block also achieved earlier assisted ambulation and better knee flexion at 48 hours. No major block-related complication was observed. Conclusion: IPACK block is a safe and effective adjunct to multimodal analgesia in total knee arthroplasty. It provides better early postoperative pain relief, reduces opioid requirement, and facilitates early functional recovery without significant motor weakness.

Rationale of study: Thyroid  disorder is highly prevalent in India. There are studies of thyroid hormone status and Albumin level in Malnutrition, Preecclampsia, Chronic kidney diseases in diabetes but few studies  related to thyroid hormone, its  metabolic function and renal haemodynamic of Albumin .So for better management of hypothyroid cases ,we focus on to find out correlation of serum FT4 ,serum TSH with serum Albumin serum  in our study. We choose Hypothyroid cases in age group 18-75 years. Objective of study: General: Relationship between F T4 and Albumin in Hypothyroid cases. Specific:  (1) To assess whether decrease in serumFT4 level ,also there is decrease in serum Albumin Level. (2) To assess whether serum TSH level correlate with serum  albumin. Method: Cross sectional and longitudinal clinical study of sample size 100 (case+Healthy subject) in age group of 18-75 years.Serum FT4 assessed by immunoassay. TSH assessed by chemiluminescence method, serum Albumin by Biochemical method. Statistical analysis done by SPSS. Result: Serum Albumin level are significantly altered in Hypothyroid cases compared with Healthy subjects(p=0.03). Conclusion: These finding suggest that hypothyroidism may affect Albumin homeostasis possibly through alteration in protein metabolism and renal haemodynamic of Albumin.

Background: Female genital tuberculosis (FGTB) is an important cause of infertility and menstrual disorders, but its diagnosis remains challenging because of its paucibacillary nature and nonspecific clinical presentation. Histopathology is commonly used for diagnosis but has limited sensitivity, while CBNAAT/Xpert MTB/RIF offers rapid molecular detection of Mycobacterium tuberculosis. This study compared the diagnostic performance of CBNAAT with histopathological examination of genital tissue in clinically suspected FGTB. Methods: A prospective observational study was conducted on 188 women with clinically suspected FGTB over a two-year period at a tertiary care hospital. Endometrial and other genital tissue specimens were subjected to both histopathological examination and CBNAAT testing, with histopathology considered the reference standard. Diagnostic indices including sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: The mean age of participants was 29.8 years, with primary infertility being the most common presentation (42.0%). Histopathology confirmed female genital tuberculosis in 4 (2.1%) patients. CBNAAT correctly identified 3 of the 4 histopathology-positive cases and yielded 2 false-positive results. Compared with histopathology, CBNAAT demonstrated a sensitivity of 75.0%, specificity of 98.9%, positive predictive value of 60.0%, and negative predictive value of 99.5%. Conclusion: CBNAAT demonstrated high specificity and excellent negative predictive value, supporting its role as a rapid adjunctive diagnostic tool for female genital tuberculosis. However, its moderate sensitivity indicates that it should be interpreted in conjunction with histopathological and clinical findings, and larger multicentric studies are needed to further validate its diagnostic performance.

Background: Human papillomavirus (HPV) infection is the necessary cause of cervical cancer, which remains a major public health burden in India, with 127,526 new cases and 79,906 deaths reported in 2022, accounting for approximately one quarter of global cervical cancer mortality. Prophylactic HPV vaccines are central to primary prevention strategies; with India recently integrating HPV vaccination into its Universal Immunisation Programme (UIP) using CERVAVAC®, the first indigenously developed quadrivalent HPV vaccine, a rigorous comparative evaluation of licensed vaccines with respect to effectiveness, duration of protection, and safety is urgently needed to guide Indian vaccination policy. Objectives: To comparatively evaluate approved HPV vaccines with respect to effectiveness, duration of protection, and safety. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library were searched from inception to October 2025. Randomised controlled trials (RCTs), long-term follow-up studies, and high-quality observational studies evaluating licensed bivalent, quadrivalent, and nonavalent HPV vaccines were eligible. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool and the Newcastle–Ottawa Scale (NOS). Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A narrative synthesis was performed due to clinical and methodological heterogeneity. Results: Forty-eight studies met the inclusion criteria. All licensed HPV vaccines demonstrated high efficacy against persistent HPV-16/18 infection and near-complete protection against vaccine-type–associated cervical intraepithelial neoplasia grade 2 or above (CIN2+) in HPV-naïve populations. Protection was sustained for at least 10–12 years with standard dosing schedules. Population-based studies confirmed real-world reductions in HPV prevalence, genital warts, and high-grade cervical lesions, with evidence of herd protection. Reduced-dose and single-dose schedules showed promising short- to medium-term effectiveness; however, certainty of evidence was low. All vaccines demonstrated a consistently favourable safety profile with no increased risk of serious adverse events. Conclusions: All approved HPV vaccines, including CERVAVAC®, are highly effective, provide durable protection, and have excellent safety profiles, supporting their use within India’s Universal Immunisation Programme. Differences between formulations are primarily attributable to breadth of HPV type coverage. Continued post-licensure surveillance of CERVAVAC® and long-term evaluation of reduced-dose and single-dose strategies are essential to inform evidence-based vaccination policy in India and other LMICs.

Introduction: Acute myocardial infarction (AMI) remains a major cause of morbidity and mortality worldwide despite advances in diagnostic and therapeutic strategies. Early identification of patients at increased risk of adverse outcomes is essential for effective risk stratification and optimal management. Serum uric acid, the final product of purine metabolism, has been implicated in oxidative stress, endothelial dysfunction, and inflammation, all of which contribute to cardiovascular injury. Several studies have suggested an association between elevated serum uric acid levels and poor clinical outcomes following AMI. However, its prognostic utility remains controversial across different populations. Therefore, the present study was undertaken to evaluate the prognostic significance of serum uric acid levels in patients presenting with acute ST-segment elevation myocardial infarction. Materials and Methods: This prospective observational cohort study was conducted in the Department of General Medicine at Ozone Hospitals, Hyderabad, India, between June 2023 and January 2024. A total of 100 consecutive patients diagnosed with acute ST-segment elevation myocardial infarction (STEMI) were enrolled. Demographic characteristics, cardiovascular risk factors, clinical findings, laboratory investigations, electrocardiographic parameters, and echocardiographic findings were recorded at admission. Serum uric acid levels were measured using the enzymatic uricase method. Hyperuricemia was defined as serum uric acid >7.0 mg/dL in men and >5.6 mg/dL in women. Patients with conditions or medications known to influence serum uric acid levels were excluded. All patients were monitored throughout hospitalization for clinical outcomes including mortality, heart failure, and arrhythmias. Clinical characteristics were compared between normal uric acid and hyperuricemia groups. Multivariate logistic regression analysis was performed to identify independent predictors of mortality after adjustment for potential confounding variables. Statistical significance was considered at p<0.05. Results: The study included 100 patients with STEMI, with a mean age of 55.0 ± 9.7 years; 75% were male. Hypertension, smoking, dyslipidemia, and diabetes mellitus were present in 38%, 45%, 32%, and 30% of patients, respectively. Anterior wall myocardial infarction (45%) was the most common presentation, followed by inferior wall myocardial infarction (41%). The mean serum uric acid level was 5.85 ± 1.85 mg/dL. Patients with hyperuricemia were significantly older and had higher serum creatinine levels than those with normal uric acid levels. Short-term mortality was significantly greater in the hyperuricemia group (19.4% vs. 6.4%, p=0.020). Non-survivors had significantly higher serum uric acid levels than survivors (6.71 ± 1.38 mg/dL vs. 4.45 ± 1.29 mg/dL, p<0.001). Multivariate logistic regression identified serum uric acid as an independent predictor of mortality (adjusted OR 6.76; 95% CI: 1.018–178.540; p=0.015). Conclusion: Elevated admission serum uric acid levels are significantly associated with adverse outcomes in patients with acute ST-segment elevation myocardial infarction. Serum uric acid serves as an independent predictor of mortality and may be a useful, inexpensive biomarker for early risk stratification in acute myocardial infarction.

Background: The mitral valve annulus (MVA) is a dynamic structure essential for normal cardiac function and a critical determinant in the pathogenesis of mitral valve disease. Its morphometry is of paramount importance for surgical repair, prosthetic valve selection, and interventional cardiology. While echocardiography provides functional in-vivo data, cadaveric studies offer direct anatomical insights. Limited studies exist correlating cadaveric and echocardiographic dimensions in the Indian population. Material and Methods: This cross-sectional observational study was conducted in a tertiary care teaching hospital of western Gujarat. Forty formalin-fixed adult cadaveric hearts without gross cardiac pathology were examined. The mitral annular anteroposterior diameter, transverse diameter, circumference, and area were measured using a digital Vernier caliper and flexible measuring tape. Age- and sex-matched echocardiographic data from 40 healthy individuals were retrospectively retrieved. Parameters were compared using independent sample t-tests, and Pearson’s correlation coefficient was calculated to assess the relationship between cadaveric and echocardiographic measurements. Results: Cadaveric measurements were consistently smaller than echocardiographic values. Mean anteroposterior and transverse diameters were 29.8 mm and 33.5 mm in cadavers, compared to 31.2 mm and 35.0 mm in vivo (p < 0.05). Similarly, annular circumference (96.4 mm vs 100.8 mm) and area (7.2 cm² vs 8.1 cm²) were significantly lower in cadavers. Correlation analysis demonstrated strong positive relationships between modalities (r = 0.65–0.74, p < 0.01). Leaflet dimensions showed no significant differences, while males consistently had larger annular parameters than females. Conclusion: Mitral annular dimensions in cadaveric hearts strongly correlate with echocardiographic data, though fixation-induced shrinkage leads to smaller values. These findings provide valuable region-specific anatomical references for surgical and interventional planning.

Background: In the digital age, excessive screen exposure from smartphones, computers, and televisions has become commonplace, particularly among young adults in urbanizing regions. Prolonged digital screen time is suspected to disrupt circadian rhythms through blue light emission, suppress melatonin production, and impair cognitive functions such as attention, memory, and reaction time. While global studies highlight these concerns, region-specific data from India, especially longitudinal observations in Gujarat’s population, remain limited. This one-year prospective study aimed to evaluate the effects of varying levels of daily digital screen exposure on sleep quality and cognitive performance among adults in western Gujarat. Material and Methods: This study was conducted at a tertiary care teaching hospital in western Gujarat over one year. A total of 250 healthy adults aged 18-45 years were recruited through convenient sampling from community and institutional settings and followed up at baseline, 6 months, and 12 months. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while cognitive performance was evaluated with standardized tests. Screen exposure time (SET) was self-reported via validated questionnaires and corroborated with device usage logs where possible. Ethical approval was obtained from the institutional ethics committee. Results: Participants with high screen exposure (>4 hours/day) exhibited significantly poorer sleep quality (mean PSQI 7.8 ± 2.1 vs. 4.2 ± 1.5 in low exposure group, p<0.001) and prolonged sleep latency. Cognitive assessments revealed slower reaction times (increased by ~25-30 ms), reduced attention scores, and lower memory performance in the high-exposure group. These differences persisted and slightly worsened over the one-year follow-up, with evening screen use showing stronger associations. Conclusion: The findings demonstrated a notable negative impact of prolonged digital screen exposure on both sleep architecture and cognitive efficiency in the western Gujarat population. Targeted interventions promoting screen hygiene are warranted to mitigate these effects in young adults.

Background: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit characterized by follicular hyperkeratinization, increased sebum production, bacterial colonization, and immune activation. Lipocalin-2 (LCN2), also known as neutrophil gelatinase-associated lipocalin (NGAL), has emerged as a potential inflammatory biomarker in various dermatological and metabolic disorders. Methods: This case-control study included 50 patients with acne vulgaris and 50 age- and gender-matched healthy controls. Acne severity was assessed using the Global Acne Grading System (GAGS). Serum Lipocalin-2 levels were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analyses included independent samples t-test, one-way ANOVA, and Pearson’s correlation coefficient. Results: Serum Lipocalin-2 levels were significantly higher in patients with acne vulgaris compared with healthy controls (278.4 ± 198.6 ng/mL vs. 95.8 ± 61.3 ng/mL; p<0.001). Among acne patients, 32.0% had mild, 36.0% moderate, 22.0% severe, and 10.0% very severe disease. Mean Lipocalin-2 levels increased progressively with disease severity, ranging from 156.8 ± 72.4 ng/mL in mild acne to 521.4 ± 134.2 ng/mL in very severe acne (p<0.001). A significant positive correlation was observed between GAGS scores and serum Lipocalin-2 levels (r=0.652, p<0.001). Conclusion: Serum Lipocalin-2 levels are significantly elevated in acne vulgaris and correlate positively with disease severity. Lipocalin-2 may serve as a useful biomarker for assessing inflammatory activity and severity in patients with acne vulgaris.

Background: Dissociative (conversion) disorder is often accompanied by psychosocial stress, recurrent somatic presentations and disturbance in day-to-day functioning. Coping style and perceived quality of life are therefore important clinical dimensions in these patients. Objective: To assess coping patterns and quality of life among patients diagnosed with dissociative (conversion) disorder using Brief COPE and WHOQOL-BREF. Methods: This cross-sectional study was conducted in the Department of Psychiatry, SMS Medical College and attached hospitals, Jaipur. One hundred and ten patients fulfilling ICD-10 diagnostic criteria for dissociative (conversion) disorder were enrolled. Socio-demographic and clinical details were recorded on a structured proforma. Coping was assessed with Brief COPE, and quality of life was assessed with WHOQOL-BREF. Data were summarized using frequencies, percentages, mean and standard deviation. Group comparisons and correlation analysis were performed as appropriate, and p < 0.05 was considered statistically significant. Results: Participants were predominantly female and most belonged to the young adult age group. Among coping domains, emotion-focused coping had the highest mean score (23.39 ± 3.88), followed by avoidant coping (21.89 ± 5.15) and problem-focused coping (17.41 ± 4.47). WHOQOL-BREF scores were lower across domains, with the psychological domain showing the lowest mean score (53.33 ± 8.39). Gender-wise differences in coping scores were not statistically significant. Avoidant coping did not show a significant correlation with psychological quality of life (r = 0.01, p = 0.905). Conclusion: Patients with dissociative (conversion) disorder showed greater use of emotion-focused and avoidant coping and reduced quality of life, particularly in the psychological domain. Incorporating coping assessment and psychosocial intervention into routine management may help improve patient-centred outcomes.

Extended-spectrum beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) producing gram-negative bacteria (GNB) are a major cause of treatment failure in hospital and community settings, making local surveillance essential for guiding empirical therapy. This six-month cross-sectional study was conducted in the Department of Microbiology, HIMSR, and associated HAHC Hospital, Jamia Hamdard, New Delhi, between October 2023 and March 2024. A total of 280 gram-negative isolates from clinical specimens (urine, pus, blood, stool, body fluids and others) of outpatients and inpatients were identified using VITEK 2. Isolates were screened for ESBL and MBL by VITEK and disk-diffusion, and screen-positive isolates were confirmed by the Double Disk Diffusion Test (ESBL) and the Imipenem-EDTA Combined Disk Synergy Test (MBL). A subset of ESBL-positive and ESBL-negative isolates was further characterized by PCR for blaSHV, blaTEM and blaCTX-M genes. E. coli and Klebsiella spp. predominated, mostly from urine (47.8%) and pus (30.7%) samples. Of 280 isolates, 120 (42.8%) were confirmed ESBL producers and 47 (16.7%) were confirmed MBL producers, with E. coli leading both groups. Carbapenems, amikacin and nitrofurantoin retained the highest activity against ESBL producers, while colistin (95.7% sensitive) was most active against MBL producers, most of which resisted carbapenems. On PCR, blaCTX-M (56%) was the commonest ESBL gene, followed by blaTEM (44%); blaSHV was undetected. The study demonstrates a substantial burden of ESBL and MBL-producing GNB in this tertiary-care setting and underscores the need for continued surveillance, antimicrobial stewardship, and judicious carbapenem and colistin use.

Background: Chronic kidney disease (CKD) is a common and serious complication of diabetes mellitus and a leading cause of end-stage renal disease worldwide. Adequate patient awareness is essential for early detection, prevention, and effective disease management. However, evidence regarding CKD awareness among diabetic patients remains inconsistent across different populations and healthcare settings. Methods: A systematic review and meta-analysis were conducted accordance with PRISMA 2020 guidelines. Electronic databases including PubMed, Google Scholar, and the Cochrane Library were systematically searched for observational studies assessing knowledge and awareness of CKD among patients with diabetes mellitus. Cross-sectional, cohort, and case-control studies published in English between 2016 and 2026 were included. The primary outcome was the pooled prevalence of CKD awareness. A random-effects model was used to calculate pooled estimates with 95% confidence intervals (CI). Results: A total of five cross-sectional studies involving 1,903 participants from India, Sri Lanka, Malaysia, and Saudi Arabia were included. The prevalence of adequate CKD awareness ranged from 21.36% to 75.1% across studies. Meta-analysis demonstrated a pooled CKD awareness prevalence of 39.6% (95% CI: 37.4%–41.8%), indicating that fewer than half of diabetic patients possessed adequate knowledge regarding CKD and its complications. Substantial heterogeneity was observed among studies (I² ≈ 90%). Educational status, socioeconomic factors, marital status, and the presence of diabetic complications were commonly associated with awareness levels. Conclusion: CKD awareness among patients with diabetes mellitus remains suboptimal, with less than half of patients demonstrating adequate knowledge. Strengthening patient education, routine kidney screening, and healthcare counseling programs may improve awareness and support early detection and prevention of CKD among high-risk diabetic populations.

Background: Infertility is clinically defined as the failure of a couple to conceive after one year of regular Intercourse without protection and 6 months of trying if the woman age is above 35years.Despite advanced technologies and diagnostic methods, Diagnosing and treating male infertility has become a great challenge for gynaecologists and andrologist as well. Method: 63 (sixty-three) infertile adults aged between 25 to 45 years were studied. Semen samples were collected in an plastic container by masturbation after the minimum abstinence period of 3 days. Semen parameters included appearance volume, PH, viscosity, liquefaction, motility and morphology were analysed microscopically. Results: 53 (84.1%) had primary infertility, 10 (15.8%) had secondary infertility, 6 (9.5%) were smokers, and 11 (17.4%) were alcoholics. In comparison of semen parameters between bacterial cultures, Group I and Group II participants studied the mean volume of semen, pH value, median sperm concentrations, and median progressive motility, which had a significant p-value (p < 0.001). The comparison of semen concentration, motility, and morphology between PCR Group I and Group II had a significant p-value (p < 0.001). Conclusion: Present morphological bacteriological studies will help the gynaecologist and andrologist to treat male infertility efficiently so that such patients can lead normal social life.

Background: Total Neoadjuvant Therapy (TNT) is increasingly adopted for locally advanced rectal cancer (LARC) to improve systemic control and treatment compliance. However, concerns remain regarding its impact on surgical outcomes, especially in resource-constrained settings. Objective: To prospectively compare surgical outcomes and pathological responses between TNT and standard Long-Course Chemoradiation (LCRT) in LARC patients at a tertiary centre in Eastern India. Design: Prospective cohort study. Setting: Department of Surgical Oncology, Acharya Harihar Post Graduate Institute of Cancer (AHPGIC), Eastern India. Patients: 80 patients with histologically confirmed LARC (cT3-4/any T + cN+), enrolled from December 2023 to December 2024. 36 received TNT and 44 underwent LCRT. Outcome Measures: Primary outcomes included major postoperative complications (Clavien-Dindo grade ≥III), operative time, Total Mesorectal Excision (TME) quality, R0 resection rate, circumferential resection margin positivity, and sphincter preservation rate. Secondary outcome: disease progression during neoadjuvant therapy. Results: Baseline characteristics were comparable between groups. TNT resulted in significantly longer operative time (215 vs. 190 min; p=0.002), higher breached TME rates (22.2% vs. 4.5%; p=0.04), and greater blood loss (325 vs. 270 ml; p=0.008). Major complications were similar (TNT 16.7% vs. LCRT 15.9%). R0 resection rates (88.8% vs. 90.9%; p=0.78), pCR rates (13.9% vs. 15.9%; p=0.82), and sphincter preservation (72.2% vs. 75%; p=0.78) were comparable. Disease progression to unresectable disease was low in both groups. Limitations: Single-centre study with a small sample size and short follow-up, lacking long-term oncologic outcomes. Conclusions: TNT and LCRT yield comparable oncological outcomes and complication rates. However, TNT is associated with increased surgical complexity. Careful patient selection and surgical expertise are essential when implementing TNT, particularly in resource-constrained settings.

Introduction: Trigonella foenum-graecum, commonly known as fenugreek, is used to enhance the flavor, color, and texture of food and for medicinal purposes in many traditional systems. Oxidative stress occurs due to an imbalance between the production and removal of free radicals. Anxiety is a mental condition characterized by excessive apprehensiveness about real or perceived threats, typically leading to avoidance behaviours and often to physical symptoms such as increased heart rate and muscle tension. Aim & Objectives: To evaluate the anti-anxiety and antioxidant activity of the ethanolic extract of fenugreek seed in Wistar rats. Materials& Methods: A total of 42 mice were taken & divided them in to 7 groups, six in each. Groups I, II, III, IV, and V were treated with normal saline (25ml/kg), Diazepam 1mg/kg, fenugreek 200mg/kg, fenugreek 400mg/kg, and diazepam 1 mg/kg + fenugreek 400mg/kg, respectively, for 7 days and studied for antianxiety effect. To study the antioxidant effect, along with groups I, III, and IV, 2 more groups were taken and designated as groups VI and VII. The formal one was given vitamin C alone, and the latter one was given fenugreek 400mg/kg + vitamin C. Results: The results revealed that EETFG at 200 mg/kg and 400mg/kg exhibited dose-dependent antianxiety and also antioxidant effect comparable to the standard drug diazepam (1 mg/kg) and vitamin C, respectively. A synergistic antianxiety and antioxidant effect was observed when EETFG was combined with diazepam and vitamin C, respectively. Conclusion: The study concludes that EETFG showed a significant antianxiety activity and antioxidant effect as it increased the duration of time spent in the open arm (Elevated plus maze method)and light chamber (Light-dark model) by mice and showed low serum MDA and high TAC level.

Background: Type 2 diabetes mellitus (T2DM) is a globally prevalent metabolic disorder with well-established links to cardiovascular morbidity and mortality. Glycated hemoglobin (HbA1c) serves as the gold-standard indicator of long-term glycemic control; however, the precise quantitative relationship between HbA1c levels and a composite panel of cardiovascular risk markers including inflammatory, lipidemic, and hemodynamic indices remains incompletely characterized in South Asian populations. Methods: In this prospective observational study conducted between March 2024 and February 2025 across two tertiary care hospital attached with medical college in Gujarat, India, we enrolled 350 adults aged 30–70 years with confirmed T2DM of at least two years duration. Participants were stratified by HbA1c: Group A (<7.0%), Group B (7.0–8.9%), and Group C (≥9.0%). Primary cardiovascular risk markers measured included high-sensitivity C-reactive protein (hsCRP), low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C), systolic and diastolic blood pressure, and estimated glomerular filtration rate (eGFR). Pearson correlation and multivariate linear regression analyses were employed. Results: HbA1c correlated significantly with hsCRP (r = 0.61, p < 0.001), LDL-C (r = 0.54, p < 0.001), systolic blood pressure (r = 0.47, p < 0.001), and triglycerides (r = 0.43, p < 0.001), while showing an inverse association with HDL-C (r = −0.39, p < 0.001) and eGFR (r = −0.33, p < 0.001). On multivariate regression, poor glycemic control (HbA1c ≥9%) was independently associated with elevated hsCRP (β = 0.48, 95% CI: 0.39–0.57) and LDL-C (β = 0.38, 95% CI: 0.29–0.47) after adjustment for age, sex, BMI, diabetes duration, and pharmacotherapy. Conclusions: Suboptimal glycemic control is independently and dose-dependently associated with an adverse cardiovascular risk profile in patients with T2DM. These findings underscore the critical importance of achieving and maintaining individualized HbA1c targets to attenuate multifactorial cardiovascular risk.

Background: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally and in India. Limited community-based data exist from central India regarding disease burden and utilization of services under national programs. Objectives: To assess the prevalence of NCDs, associated risk factors, and utilization of screening and treatment services under NPCDCS. Methods: A community-based cross-sectional study was conducted among 206 individuals aged ≥30 years in the urban field practice area of Bundelkhand Medical College, Sagar. Multistage random sampling was used. Data were collected using a semi-structured questionnaire. Analysis was performed using SPSS v26, and associations were tested using chi-square test. Results: The prevalence of any NCD was 59.6%, with multimorbidity in 23.3%. Hypertension (34.0%) and diabetes (26.7%) were the most common conditions. Major risk factors included obesity (36.9%), physical inactivity (31.1%), tobacco use (29.6%), and stress (27.2%). Tobacco use (p=0.013) and physical inactivity (p=0.019) were significantly associated with NCDs. Screening coverage was 62.1%, and 88.9% of referred individuals complied. Among NCD patients, 71.3% reported regular medication adherence. Conclusion: A high burden of NCDs and modifiable risk factors was observed. Although service utilization under NPCDCS is encouraging, gaps remain in continuity of care and medicine availability.

Background: Onychomycosis is a common fungal nail infection causing cosmetic and functional impairment, with increasing prevalence in India. Objective: To study the clinical and mycological profile of onychomycosis and associated risk factors in patients attending a dermatology OPD in South Rajasthan. Materials and Methods: A prospective observational study was conducted on 80 clinically suspected cases of onychomycosis for 1.5years. Clinical evaluation, risk factor assessment, 40% KOH microscopy, and fungal culture were performed. Results: Middle-aged males, particularly those aged 31–40 years, were most commonly affected. Farmers and housewives represented major occupational groups. DLSO was the predominant clinical type, with the right great toenail most frequently involved. KOH positivity was 75%, culture positivity 60%, and combined positivity 85%. Trichophyton mentagrophytes was the most common isolate, followed by T. rubrum and Candida species. Diabetes mellitus, family history, addiction, and associated dermatoses such as Tinea cruris and Tinea corporis were important risk factors. Conclusion: Onychomycosis predominantly affects middle-aged males and high-risk occupational groups in South Rajasthan. Combined KOH microscopy and fungal culture improve diagnostic accuracy, highlighting the importance of early diagnosis and targeted management.

Background: Cadaveric dissection remains one of the most effective ways to teach anatomy for anatomist worldwide in spite of the arrival of newer technologies. The study aims to evaluate the knowledge, attitude and willingness towards whole body donation among Indian population. Methods: A cross-sectional study was conducted by providing a semi structured questionnaire. The response was noted and analysed. Results: A total of 153 participants (mean age 38.9 ± 8.5 years) were included in the study, with 51.6% males and 41.2% females. Most respondents were graduates (46.4%), followed by postgraduates (31.4%), and 78.4% were aware of organ and body donation. However, 64.1% lacked knowledge of the legal aspects of body donation, 35.9% had no knowledge of cadaver sources, and 57.5% were unaware of existing body donation programs. The internet and social media were the main source of information (36.6%). More than half (54.9%) were uncertain (“Maybe”) about donating their bodies, while only 19.0% expressed willingness to donate. Although 58.2% reported that religious beliefs would not restrict body donation, 60.1% had never discussed the topic with their families, and 41.2% were unsure of family support. Nevertheless, 92.2% agreed that public awareness campaigns are necessary, 68.0% considered body donation very important for medical education and research, and 62.7% were willing to promote body donation. Conclusion: More awareness programme should be plan to increase the awareness amongst the general population.

Background: Oblique subcostal transverses abdominis plane block has been used for postoperative analgesia in patients undergoing Laparoscopic Cholecystectomy, but found not so effective. Our aim was to compare the efficacy of Erector spinae plane block with Oblique subcostal transverses abdominis plane block for postoperative analgesia. Materials and methods: This was a undertaken prospective randomized controlled study was done taking 60 adult patients admitted for laparoscopic cholecystectomy under anaesthesia who were arbitrarily split into 2 groups of 30 each. 30 patients were administered ultrasound guided erector spinae block and 30 were administered ultrasound guided OSTAP block. Intra-operative vitals and intra-operative analgesic requirement, post-operative NRS pain score was monitored. Results: It was noted that the analgesic requirement was comparatively less in ESP block (group1) than OSTAP block (group2) intraoperatively and postoperatively. The postoperative NRS scores at rest and on coughing were notably lower in the group 1 when compared to the group 2. Duration for 1^st rescue analgesia was increased in ESP block (group 1) which was remarkably significant. Rescue analgesia requirement was more in OSTAP block (group 2) in contrast to ESP block (group1). Conclusion: This study concludes that the total analgesic requirement in first 24 hours was comparatively lesser in ESP block group compared to OSTAP block group in patient undergoing LC. Also, time for first rescue analgesia was prolonged in ESP block group.

Background: Non-alcoholic fatty liver disease (NAFLD) is currently recognized as the hepatic manifestation of metabolic syndrome and is highly prevalent among patients with type 2 diabetes mellitus (T2DM). Besides progressive liver injury, NAFLD has emerged as an important predictor of cardiovascular morbidity and mortality. Increasing evidence suggests that NAFLD is associated with subclinical cardiac dysfunction, particularly left ventricular diastolic dysfunction (LVDD), even in the absence of overt cardiovascular disease. However, studies evaluating this association in the Indian population remain limited. Early identification of cardiac dysfunction among diabetic patients with NAFLD may facilitate timely intervention and reduce future cardiovascular complications. Objectives: Primary Objective: To evaluate the association between non-alcoholic fatty liver disease and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus. Secondary Objectives: (1) To determine the prevalence of left ventricular diastolic dysfunction among patients with type 2 diabetes mellitus having NAFLD. (2) To identify early echocardiographic abnormalities in diabetic patients with NAFLD. (3) To compare echocardiographic parameters between diabetic patients with and without NAFLD. (4) To assess the clinical significance of NAFLD as a predictor of subclinical cardiac dysfunction. Materials and Methods: A hospital-based case-control study was conducted in the Department of General Medicine, SMS Medical College and Hospital, Jaipur, Rajasthan, between January 2023 and June 2024. A total of 100 patients with type 2 diabetes mellitus were enrolled, comprising 50 patients with ultrasonographically diagnosed NAFLD (cases) and 50 diabetic patients without NAFLD (controls). Eligible participants underwent detailed clinical evaluation, laboratory investigations, abdominal ultrasonography, and comprehensive transthoracic echocardiography with tissue Doppler imaging for assessment of left ventricular systolic and diastolic function. Patients with ischemic heart disease, significant valvular heart disease, chronic liver disease of other etiologies, alcohol use, severe renal dysfunction, autoimmune diseases, or malignancy were excluded. Statistical analysis was performed using appropriate parametric and non-parametric tests. Continuous variables were expressed as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. Comparisons between groups were performed using the unpaired Student’s t-test and Chi-square test. Logistic regression analysis was used to evaluate independent predictors of diastolic dysfunction. A p-value <0.05 was considered statistically significant. Results: The mean age of study participants was 55.47 ± 8.62 years, with no statistically significant difference between the case and control groups. Baseline demographic characteristics including age, sex distribution, smoking status, hypertension, and statin use were comparable between both groups, minimizing confounding influences. Patients with NAFLD demonstrated a significantly higher prevalence of left ventricular diastolic dysfunction compared with diabetic patients without NAFLD. Tissue Doppler echocardiographic parameters indicative of impaired ventricular relaxation were significantly altered among patients with NAFLD despite preserved left ventricular systolic function. The findings suggest that NAFLD is independently associated with early myocardial dysfunction in patients with type 2 diabetes mellitus. Conclusion: Non-alcoholic fatty liver disease is strongly associated with subclinical left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus, independent of conventional cardiovascular risk factors. Routine screening for NAFLD and early echocardiographic assessment of cardiac function in diabetic patients may facilitate earlier diagnosis of diabetic cardiomyopathy and improve cardiovascular risk stratification. Early recognition and comprehensive management of NAFLD may contribute to reducing cardiovascular morbidity and improving long-term clinical outcomes in patients with type 2 diabetes mellitus.

Background: Sleep quality is defined as a multidimensional construct encompassing sleep duration, latency (the time taken to fall asleep), continuity, and subjective satisfaction. The prevalence of poor sleep quality among medical students is a global public health concern, with international literature reporting rates that significantly exceed those of the general population. Objectives: To access sleep quality among undergraduate medical students of Jhalawar using Pittsburgh Sleep Quality Index (PSQI). Methods: A cross-sectional analytical study was conducted among 690 undergraduate medical students of Jhalawar Medical College. Data was collected through pretested predesigned questionnaire consisting questions regarding sociodemographic and academic factors, personal habits and Pittsburg sleep quality index (PSQI). Responses were then compiled in Excel spreadsheet and analyzed using statistical software SPSS 23.0 trail version. Results: Study depicts 58.7% of the students reported good sleep, while 41.3% suffered from poor sleep quality. Poor sleep was most common among first-year students (51.28%).Students who had irregular attendance (63.51%), those admitted under the NRI quota (72.73), those who had bad relationships with their peers (64.81%), reported significantly higher rates of poor sleep. Regular intake of caffeinated drinks (54.4%) and abnormal eating habits particularly undereating (57.4%), also predicted poor sleep. Conversely, regular exercise was a major protective factor, with 65.2% of active students reporting good sleep. Conclusion: This study confirms that poor sleep quality is highly prevalent among undergraduate medical students affecting nearly half of the examined population. The primary drivers of sleep disruption are academic factors, physical inactivity along with abnormal eating habits, substance use and smartphone addiction.

Background: Burn scar contractures, particularly in the neck region, present significant anatomical challenges that complicate airway management during anesthesia. Case Report: A female patient with an anterior neck burn scar contracture resulting in restricted neck extension presented for elective laparoscopic sterilization. Due to the anticipated airway difficulties, Monitored Anesthesia Care (MAC) with titrated sedation was utilized to maintain spontaneous ventilation, leading to an uneventful procedure and recovery. Conclusion: With comprehensive preoperative planning, a multidisciplinary approach, and tailored anesthesia management, elective surgical procedures can be safely performed in patients with complex burn scar contractures.

Background: Nowadays among youth, especially in urban population, there is significant trend towards dieting and fitness, this study aims at finding the health effects and the attitude towards intermittent fasting among adults in urban population – Chennai. The study will help us know the effects of intermittent fasting as a lifestyle practice and their adherence to meals. Objective: There are two main objectives in this study: (1) To find out the health-related effects of intermittent fasting among adults in urban population – Chennai. (2) To study the attitude towards intermittent fasting among urban population – Chennai. Methods: A Cross sectional study was conducted among urban population Chennai which included individuals between 18- 35 yrs of age for a period of 100 days. Data was collected using a self semi-structured, standardized questionnaire assessing demographic characteristics, knowledge on intermittent fasting, various health effects like gastritis, mood disorders, sleep patterns. Data was analyzed using Jamovi software version 2.7.18. Descriptive statistics summarized 95% confidence interval. Chi square test was used. Results: The study was conducted among 18 to 35 yrs adult population through semi self-structured questionnaire, out of the 50 responses obtained (sample size 50), out of the 86 % of individuals who practiced intermittent fasting ,69.76 % of them did not skip any meal and there is no statistically significant association between intermittent fasting and gastritis , mood of an individual , quality of sleep , bowel habits such as constipation and diarrhea and drowsiness. However, there is a statistically significant association between skipping of meals and quality of sleep (p< 0.001). Conclusion: Intermittent fasting did not have any statistically significant effect on the health of individual such as gastritis, mood disturbances, quality of sleep, constipation or diarrhea and drowsiness. However, there is statistically significant association between skipping of meals and quality of sleep of an individual. And also, there is found to be an increased trend towards the practice of intermittent fasting in adults aged between 18 to 25 in urban population – Chennai.

Background: Ultrasound-guided infraclavicular brachial plexus block provides effective anaesthesia and postoperative analgesia for upper-limb surgery. Objective: To compare 0.5% ropivacaine with dexamethasone and 0.5% bupivacaine with dexamethasone in ultrasound-guided infraclavicular brachial plexus block. Methodology: This prospective randomized double-blind comparative study was conducted at Department of Anesthesiology, Khaja Bandenawaz University Faculty of Medical Sciences kalaburagi,India from December 2024 to April 2025and included 50 patients undergoing elective upper-limb surgery. Results: The mean sensory block onset was significantly faster in Group R than Group B, 11.2 ± 2.6 versus 13.1 ± 2.8 minutes (p=0.016). Sensory block duration was significantly longer in Group B, 812.7 ± 104.8 versus 738.4 ± 96.5 minutes (p=0.012), while motor block duration was 701.8 ± 95.7 versus 612.6 ± 88.3 minutes (p=0.001). Postoperative analgesia lasted longer with bupivacaine, 934.8 ± 126.4 versus 842.5 ± 118.6 minutes (p=0.010), and the first rescue analgesic was required later, 15.6 ± 2.1 versus 14.0 ± 2.0 hours (p=0.008). Total 24-hour rescue analgesic consumption was lower in Group B, 61.5 ± 28.4 versus 82.0 ± 32.6 mg (p=0.022). Successful surgical block was achieved in 24 (96.0%) patients in each group. Adverse events occurred in 4 (16.0%) patients in Group R and 6 (24.0%) in Group B, with no significant difference (p=0.725). Conclusion: Both combinations provided effective and safe infraclavicular brachial plexus block. Ropivacaine produced a faster sensory onset and earlier motor recovery, whereas bupivacaine provided longer sensory and motor blockade, prolonged postoperative analgesia, and lower rescue analgesic consumption.

Background: The normal volume of amniotic fluid is a reliable indicator of appropriate placental function and is crucial to the fetus’s healthy growth and development. One of the most crucial objectives of perinatal care is early diagnosis and intervention. The aim of this study is to evaluate perinatal outcome in low AFI patients as oligohydramnios canreflect fetal jeopardy. It can also guide an obstetrician whether further evaluation needed or not as well astiming of delivery. Methods: This study was conducted in the Sadar Hospital, Motihari, Bihar for over a period of one year i.e., from January 2025 to December 2025.In this period total 200 pregnant patients admitted in our hospital meeting the inclusion and exclusion criteria included inthis study. Among them 100 patients belong to group- A had low AFI (≤5) and group B comprises 100patients with normal AFI (>5). Assessment of perinatal outcome done by APGAR score at 1 and 5 minutes, birth weight, admission into SNCU, still birth & early neonatal death and mode of delivery. Results: This study found a significant difference between the two groups in terms of low birth weight, mode of delivery, and APGAR score at one minute. At one minute, 21% of Group-B neonates and 36% of Group-A neonates had low APGAR scores (<7), which improved after five minutes. According to an analysis of the birth weight data, 14% of newborns from Group B and 35% of newborns from Group A had low birth weights. Group A had a greater rate of Caesarean sections (84%) and Group B had a higher rate of vaginal deliveries (64%). There was no discernible difference between the two groups in terms of perinatal mortality, SNCU hospitalization, or APGAR score at five minutes. Conclusion: There is a statistically significant correlation between low amniotic fluid index (AFI≤5) and low birth weight, mode of delivery, and APGAR score at one minute.

Background: One common outcome of chronic kidney disease (CKD) is anemia. Darbepoetin and erythropoietin are the main medications used to treat it. This study compared the safety and effectiveness of darbepoetin against erythropoietin injection for the treatment of renal anemia in patients with chronic kidney disease. Methods: The study included patients of any gender with hemoglobin levels less than 12 g/dl who were diagnosed with anemia owing to chronic kidney disease (CKD), regardless of dialysis. The laboratory results of hemoglobin (Hb), red blood cells (RBCs), haematocrit (PCV), and adverse events were used to compare the safety and effectiveness of erythropoietin and darbepoetin. Results: Of the 216 patients who satisfied the inclusion criteria, 108 received erythropoietin treatment and 108 received darbepoetin treatment. In the group of patients receiving erythropoietin, the changes in Hb, RBCs, and PCV were 1.16, 0.49, and 3.76, respectively. Similarly, the group of patients using Darbepoetin showed changes in Hb, RBCs, and PCV of 1.19, 0.42, and 3.52, respectively. The variations in Hb, RBCs, and PCV between the two patient groups were 0.04, 0.07, and 0.24, respectively. 48 (44.44%) patients in the erythropoietin group had four adverse events (HTN, vomiting, headache, and joint pain), while 38 (35.19%) patients in the darbepoetin group reported one adverse event (HTN). Conclusion: For the treatment of anemia in CKD patients, erythropoietin and darbepoetin were found to be equally safe and efficacious.

Background: A stroke, also called a brain attack, happens when a blood vessel that supplies or drains blood to and from the brain is blocked, leaks, or both. This damages the brain, making it difficult to move, feel, speak, see, and sometimes even cause’s death. The purpose of this study is to compare the serum lipid levels of persons with ischemic versus hemorrhagic stroke and identify the risk variables. Methods: From September 2025 to February 2026, a comparative cross-sectional study was carried out at the Department of General Medicine, JLNMCH, Bhagalpur, and Bihar. A total of one hundred patients were recruited and split into two groups. Three milliliters of blood were extracted and forwarded to the institutional laboratory for a fasting lipid profile. An autoanalyzer was used to perform an enzymatic analysis of the blood samples. SPSS ver. 24 was used to analyze all of the collected data. Results: The mean total cholesterol (TC) was 227.20±16.47 mg/dl in ischemic stroke patients and 203.5±16.8 with a P=<0.001 in hemorrhagic stroke patients. With a value of p<0.001, the total mean HDL was determined to be 36.10±4.29. The mean LDL was 145.18±16.98 in ischemic stroke patients and 131.96±12.12 in hemorrhagic stroke patients (p-value<0.001). The mean TG was 203.18±57.74 mg/dl in ischemic stroke patients and 164.67±53.25 (p=0.001) in hemorrhagic stroke patients. Conclusion:  This study concluded that the mean TC, HDL, LDL, and TG of the patients was 215±20.42 mg/dl, 37.77±4.47 mg/dl, t 138.57±16.11 mg/dl, and 183.93±58.55 mg/dl respectively. This study further concluded that is substantial correlation exists between the serum lipid profile of adults and the type of stroke.

Background: In ENT practice, hoarseness of voice is one of the most common presenting complaints. To generate a regular voice, vocal cords must be able to accurately approximate one another, be the proper size and stiffness, and be able to vibrate consistently in reaction to the air column. The current study’s objective was to evaluate the causes and connections among the many factors that lead to hoarseness of voice. Methods: This study was carried out in the ENT department of ANMMCH in Gayaji, Bihar, between February and July of 2025. 144 patients who came to the ENT OPD with hoarseness of voice were included based on the inclusion and exclusion criteria. Each patient received an explanation of the study’s methodology and goal, and their informed consent was acquired. SPSS software 24.0 was used to gather and evaluate all patient demographic and clinical data. Results: The clinical study included 144 participants. Most of the patients were between the ages of 51 and 70, and most of them were men.  Benign causes outnumbered malignant ones. Of the patients, 25% were smokers. 33.3% of patients had VC polyps. Conclusion: Voice hoarseness can be caused by a variety of clinical problems. Even the slightest delays might have a significant impact on the patients’ stage. A thorough evaluation is required for each patient. A complete history, physical examination, and pertinent investigations may lead to an accurate and timely diagnosis of the underlying cause.

Background: Rhinitis is an inflammation of the nasal mucosa that typically manifests as sneezing, runny, or blocked noses. The frequency of allergic rhinitis is higher than that of non-allergic rhinitis. Treatment for SAR is primarily based on antihistamines. The antihistamines that are most frequently administered in our area are desloratadine, rupatadine, and ketotifen. In this study, the effectiveness and tolerability of rupatadine, ketotifen, and desloratadine in SAR were compared. Methods: From August 2025 to January 2026, a prospective, randomized, three-arm, open-label comparison trial of desloratadine, rupatadine, and ketotifen in SAR was carried out at the Department of ENT, ANMMCH, Gayaji, and Bihar. TNSS was used to gauge the patients’ quality of life and the severity of their SAR symptoms. At every visit, adverse effects were tracked during the clinical examination. Desloratadine (DES), rupatadine (RUP), and ketotifen (KET) were the three groups into which study participants were systematically randomized. Oral doses of desloratadine (10 mg OD), rupatadine (10 mg OD), and ketotifen (1 mg BD) were administered according to the designated group. Every drug was administered for four weeks. Every patient had a weekly follow-up during the four-week course of treatment. Change in the mean TNSS from baseline was the primary outcome measure. Individual nasal symptom scores, quality of life, and study medication tolerability were the supplementary outcome measures. Results: For this study, a total of 150 patients were enrolled and split into three groups. When it came to improving rhinorrhea, nasal congestion, TNSS, and AEC, DES and RUP were equally effective but considerably superior to KET (p=0.05). In terms of improving sneezing, nasal irritation, and quality of life, all medications were similarly beneficial, with no statistically significant intergroup difference. Because there were slightly fewer adverse events overall, RUP seemed to have greater tolerance. Conclusion: Compared to KET, DES and RUP are more efficient and act more quickly. There were only a few minor, self-limiting, brief side effects that didn’t require medical attention, and all of the research drugs were well tolerated.

Objective: To evaluate the efficacy and safety of 100% trichloroacetic acid (tca) in the management of plantar fissures. Methods: this prospective interventional pilot study included 20 patients aged above 15 years presenting with plantar fissures to the department of dermatology, Navodaya medical college hospital and research centre, Raichur, from June 2025 to February 2026. After cleaning the soles with sterile saline, 100% tca was applied to the fissure margins until fine white frosting was achieved. Superficial fissures were treated with a cotton swab, while deep fissures were treated using a pointed applicator. Applications were repeated at 3-week intervals for a maximum of four sittings or until complete resolution. All patients used a plain non-urea-based moisturizer twice daily. Physician-graded improvement, patient self-assessment, adverse effects and relapse at 10-week follow-up were recorded. Results: of 20 patients, 15 (75%) were female and 5 (25%) were male, with a mean age of 38.1 +/- 12.7 years. Twelve patients had superficial fissures and eight had deep fissures. Excellent improvement was achieved in 13 patients (65%), and marked-to-excellent improvement in 16 patients (80%). Excellent improvement was more frequent in superficial fissures than deep fissures (75.0% versus 50.0%), although the difference in overall response distribution was not statistically significant (p = 0.602). Transient exfoliation occurred in 5 patients (25%). No infection, dyspigmentation, scarring or relapse was observed during follow-up. Conclusion: TCA 100% is a simple, affordable and well-tolerated office-based treatment for plantar fissures, especially superficial fissures. Larger controlled studies with longer follow-up are required to confirm long-term efficacy and recurrence rates.

Background: Safe medication use during pregnancy is essential to prevent adverse maternal and fetal outcomes. However, knowledge, attitudes, and practices (KAP) among pregnant women significantly influence medication-related decisions, particularly in low- and middle-income settings. Objective: To assess the knowledge, attitude, and practices regarding safe medication use among pregnant women attending antenatal outpatient services. Methods: A questionnaire-based cross-sectional study was conducted among 95 pregnant women, age 18 years or more, attending antenatal OPD under department of Obstetrics & Gynaecology RNT Government Medical College Udaipur. Data were collected using a structured, interviewer-administered questionnaire assessing sociodemographic characteristics and KAP domains. Descriptive statistics were used for analysis. Results: The mean age of participants was 27.28 ± 5.45 years. While most women demonstrated positive attitudes toward safe medication use, including consulting healthcare professionals (89.5%) and avoiding unnecessary medications (84.2%) but there exists significant gap in knowledge & attitude as (57.9%) participants preferred natural remedies over prescription drug. Although 85.3% recognized the importance of medications during pregnancy, only 16.8% were aware of potential side effects, and 11.6% knew the critical teratogenic period. Misconceptions were prevalent, with 66.3% believing Complementary & Alternative medicines are always safe and 48.4% considering over-the-counter medications safe. Nearly all participants reported medication use, predominantly iron, calcium, and multivitamins. Despite favourable attitudes, knowledge deficiencies translated into potential risks in medication practices. Conclusion: A significant knowledge–practice gap exists among pregnant women regarding safe medication use. Clinical Implications: Integrating structured medication counselling into routine antenatal care can improve awareness, correct misconceptions, and promote safer, evidence-based medication practices.

Background: Total knee arthroplasty (TKA) is the standard surgical treatment for advanced knee osteoarthritis. However, effective postoperative pain management remains essential for early mobilization, functional recovery, and patient satisfaction. Intra-articular perioperative cocktail injection has emerged as an important component of multimodal analgesia, aiming to reduce postoperative pain while minimizing systemic opioid-related adverse effects. Aim: To evaluate the efficacy of intra-articular perioperative cocktail injection in patients undergoing total knee arthroplasty at the Department of Orthopaedic Surgery, Ramkrishna Care Hospital, Raipur, Chhattisgarh. Methodology: This prospective observational study was conducted over a period of 18 months and included 41 patients undergoing primary total knee arthroplasty. All eligible patients received standardized perioperative management, and demographic as well as clinical data were recorded. Postoperative pain was assessed using the Visual Analogue Scale (VAS) on postoperative days 1, 3, and 15, while functional recovery was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Postoperative complications, including surgical site infection and wound healing disturbances, were also documented. Statistical analysis was performed using SPSS version 26.0, and a p-value <0.05 was considered statistically significant. Results: Among the 41 patients, males constituted 56.1% and females 43.9%, with a mean age predominantly between 61 and 65 years. The mean VAS score decreased progressively from 4.29 ± 0.91 on postoperative day 1 to 3.07 ± 0.82 on postoperative day 3 and 1.93 ± 0.70 on postoperative day 15, indicating significant pain reduction. The mean WOMAC score improved significantly from 74.07 ± 7.51 preoperatively to 24.66 ± 6.01 postoperatively (p < 0.001). Superficial surgical site infection occurred in 26.8% of patients, while no deep infections were observed. Functional outcomes were comparable between patients receiving and not receiving the cocktail injection (p = 0.76). Conclusion: Intra-articular perioperative cocktail injection is a safe and effective adjunct to multimodal analgesia in total knee arthroplasty. It provides significant postoperative pain relief, facilitates functional recovery, and demonstrates an acceptable safety profile without increasing major postoperative complications. The technique may therefore be routinely incorporated into perioperative pain management protocols for patients undergoing total knee arthroplasty.

Background: Percutaneous nephrolithotomy (PCNL) is associated with substantial early postoperative pain and frequent opioid requirements that can delay recovery. Various analgesic techniques have been advocated as adjuncts to general anaesthesia in PCNL surgery. Regional anaesthesia plays a crucial role in enhancing patient care, improving the quality of treatment, and increasing patient satisfaction. The erector spinae plane block (ESPB) may offer opioid-sparing analgesia and improve quality of recovery, but its impact on patient-centred outcomes after PCNL remains insufficiently defined. Objective: To determine whether ESPB with 0.25% levobupivacaine, when added to general anaesthesia (GA), improves postoperative quality of recovery (QoR-15) compared with GA alone in adults undergoing elective PCNL. Methods: The study was conducted after receiving Institutional Ethics Committee approval and CTRI trial registration. Single-centre, prospective, randomized, parallel-group study was conducted at People’s College of Medical Science & Research Centre in India. Sixty adults (18–60 years, ASA I–II) scheduled for elective PCNL are randomized 1:1 to GA + ESPB (Group E) or GA only (Group C). ESPB is being performed after induction at the L1 level using 20 mL of 0.25% levobupivacaine. The primary outcome is QoR-15 on the day of discharge. Secondary outcomes include pain intensity at0 hr and every 4 hr to 24 hr, time to first rescue opioid, cumulative tramadol at 24 hr and 48 hr, postoperative nausea and vomiting, immediate postoperative haemodynamics, adverse events, and length of stay. Analyses were intention-to-treat (α=0.05). Results: All randomized patients completed the primary outcome. QoR-15 at discharge was higher with ESPB (124.8±10.7) than control (115.7±12.3); mean difference 9.1 (95% CI, 3.7–14.4; p=0.001), exceeding the 8-point MCID. ESPB reduced pain at PACU/0 hr (mean difference −1.6, 95% CI −2.3 to −0.9; p<0.001), 4 hr (−1.6; p<0.001), 8 hr (−1.4; p<0.001), and 12 hr (−1.1; p=0.002), with no significant difference at 24 hr. Time to first rescue opioid was longer (7.8 [5.2–10.1] vs 2.6 [1.3–4.1] hr; p<0.001), and cumulative tramadol use was lower at 24 hr (50 [0–100] vs 150 [100–200] mg; p<0.001) and 48 hr (100 [50–150] vs 250 [150–300] mg; p<0.001). PONV (13.3% vs 36.7%; p=0.02) and antiemetic use (20.0% vs 46.7%; p=0.01) were reduced with ESPB. Immediate postoperative haemodynamics were similar; no block-related complications occurred. Length of stay was modestly shorter (2.0 [2.0–3.0] vs 2.5 [2.0–4.0] days; p=0.03). Conclusion: ESPB added to GA improved patient-centred quality of recovery and provided opioid-sparing analgesia after PCNL, with a favourable safety profile. Adoption of ESPB within multimodal perioperative pathways for PCNL is supported; further multicentre work should refine results and evaluate comparative and economic outcomes.

Background: Acute lower respiratory tract infections (ALRTI) remain a leading cause of paediatric morbidity in India. While vaccines are known to be protective, the specific impact of immunization gaps on the clinical severity and healthcare burden of ALRTI requires localized evaluation. This study aimed to compare the clinical pattern, severity, and outcomes of ALRTI among fully immunized, partially immunized, and unimmunized children below 5 years of age. Methods: A hospital-based cross-sectional pilot study was conducted on 25 children aged 2 to 59 months admitted to the Paediatric Ward or ICU with ALRTI. Based on verified vaccination history, patients were categorized into fully immunized (n=14), partially immunized (n=7), and unimmunized (n=4) groups. Sociodemographic profiles, nutritional status, WHO severity classification (Classify as severe pneumonia if any general danger sign is present (unable to breastfeed/drink, lethargy/reduced consciousness, or convulsions); otherwise classify as pneumonia if there is fast breathing (≥50/min for 2–11 months, ≥40/min for 12–59 months) and/or chest indrawing, with no danger signs present.) and clinical outcomes were statistically analysed. Results: Immunization status was heavily dictated by socioeconomic status (SES); 100% of partially and unimmunized children belonged to lower/lower-middle SES strata, whereas 78.6% of fully immunized children came from upper/upper-middle classes (p<0.001). Unimmunized children universally suffered from acute malnutrition (100%) and had a significantly higher history of recurrent ALRTI episodes (mean 2.0 vs. 0.29, p=0.001). Clinically, vaccines significantly blunted disease severity: 85.7% of fully immunized children presented with mild-to-moderate pneumonia, whereas 71.4% of partially immunized and 50.0% of unimmunized children rapidly progressed to Severe Pneumonia (p=0.029). Consequently, vaccination gaps drove higher Intensive Care Unit (ICU) admissions (up to 50% vs. 14.3%) and prolonged hospital stays. Conclusion: Complete immunization significantly mitigates the severity of paediatric ALRTI and reduces the burden on critical care infrastructure. However, profound sociodemographic and nutritional disparities remain primary drivers of both vaccine hesitancy and severe respiratory morbidity. Targeted public health interventions focusing on routine immunization and early nutritional support are urgently needed for vulnerable paediatric populations.

Background & Aims: Unilateral spinal anaesthesia (USA) is known for its cardiovascular stability and used in high-risk patients for its safety profile. Ultrasound-guided combined sciatic femoral block (US CSFB) is an alternative to USA for lower limb surgeries. This prospective observational study, we compared cardiovascular morbidity of US CSFB and USA in high-risk patients undergoing lower limb surgeries. Methods: After institutional ethics committee approval 80 ASA III, IV patients were enrolled. 40 in USA and 40 in CSFB group and heart rate, blood pressure, changes in SpO₂ and electrocardiography, requirement of vasopressors, fluid management were monitored. Results: Hypotension incidence was 51% in USA group and 2.5% with CSFB group (P <0.001). USA group showed maximum percentage fall from baseline SBP at 20th minute (-14.78% with P 0.001) and CSFB group showed no significant fall and better hemodynamic stability. Conclusion: US CSFB provides better hemodynamic stability compared to USA in high risk patients undergoing lower limb surgeries.

Background: Spinal anaesthesia with hyperbaric bupivacaine is widely used for lower abdominal and lower limb surgeries; however, limited duration of postoperative analgesia remains a major concern. Intrathecal adjuvants such as fentanyl and dexmedetomidine are used to improve block characteristics and prolong analgesia. This study aimed to compare the efficacy and safety of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine for spinal anaesthesia. Methods: This randomized double-blind comparative study included 70 patients undergoing elective lower abdominal and lower limb surgeries under spinal anaesthesia. Patients were randomly allocated into two groups of 35 each. Group D received intrathecal dexmedetomidine with hyperbaric bupivacaine, whereas Group F received fentanyl with hyperbaric bupivacaine. Onset and duration of sensory and motor blockade, duration of postoperative analgesia, rescue analgesic requirement, haemodynamic changes, adverse effects, and patient satisfaction were assessed. Results: The duration of sensory blockade was significantly longer in the dexmedetomidine group compared with fentanyl (287.6 ± 32.4 min vs 221.8 ± 28.7 min; p<0.001). Similarly, motor blockade duration was significantly prolonged with dexmedetomidine (241.5 ± 29.6 min vs 184.3 ± 24.8 min; p<0.001). Duration of postoperative analgesia was significantly greater in Group D (392.4 ± 45.6 min vs 276.5 ± 38.9 min; p<0.001), with lower rescue analgesic requirement (1.2 ± 0.5 vs 2.1 ± 0.7 doses; p<0.001). Haemodynamic parameters were comparable between groups. Pruritus was observed more frequently with fentanyl, while sedation was slightly higher with dexmedetomidine. Patient satisfaction was significantly higher in the dexmedetomidine group.

Conclusion: Intrathecal dexmedetomidine provides superior prolongation of spinal block and postoperative analgesia compared with fentanyl when combined with bupivacaine. It offers effective analgesia with acceptable haemodynamic stability and fewer opioid-related adverse effects.

Background: Postoperative sore throat (POST), cough, and hoarseness of voice are common complications following endotracheal intubation under general anesthesia. Dexamethasone administered by different routes has been shown to reduce these airway-related complications. Objective: To compare the effectiveness of intracuff dexamethasone and dexamethasone gargles in reducing postoperative sore throat, cough, and hoarseness of voice. Materials and Methods: This prospective, randomized, double-blind clinical trial included 48 patients undergoing elective surgery under general anesthesia with oral endotracheal intubation. Patients were randomized into two groups (n=24 each): Group A received preoperative dexamethasone gargles (0.05%), while Group B received intracuff dexamethasone (0.1 mg/kg). Postoperative sore throat, cough, and hoarseness of voice were assessed at 1, 6, 12, and 24 hours after extubation using a four-point grading scale. Results: Baseline demographic characteristics were comparable between the groups. The incidence of postoperative sore throat was significantly lower in the dexamethasone gargles group than in the intracuff dexamethasone group (25.0% vs. 58.3%; p=0.03). The incidence of postoperative cough was identical in both groups (4.2% vs. 4.2%; p=1.000). Although the overall incidence of hoarseness of voice was comparable (37.5% vs. 45.8%; p=0.77), persistent hoarseness at 6 hours was significantly lower in the gargles group (p=0.0001). All symptoms were mild and resolved within 24 hours. Conclusion: Preoperative dexamethasone gargles were more effective than intracuff dexamethasone in reducing postoperative sore throat and facilitating earlier recovery from hoarseness, while both interventions showed similar efficacy in preventing postoperative cough.

Background: Transdermal buprenorphine may provide sustained postoperative analgesia with fewer adverse effects than oral tramadol. This study compared their safety, tolerability and analgesic efficacy following lower-limb surgery under spinal anaesthesia. Methods: Sixty ASA I–II patients were divided into two groups of 30. Group A received a transdermal buprenorphine patch 10 µg/hour, while Group B received oral tramadol 50 mg three times daily. Pain scores, rescue analgesic requirements, haemodynamic parameters and adverse effects were assessed for six postoperative days. Results: Baseline characteristics were comparable. VAS scores were significantly lower in Group A at all postoperative assessments. Rescue analgesia was required by 60.0% of Group A and 100.0% of Group B on Day 1, decreasing to 33.3% and remaining 100.0%, respectively, on Day 6. Adverse effects occurred in 13.3% of Group A and 40.0% of Group B (p=0.040). No respiratory depression or patch-site reaction occurred. Conclusion: Transdermal buprenorphine provided better analgesia, reduced rescue analgesic use and showed superior tolerability compared with oral tramadol.

Background: Laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation leading to tachycardia and hypertension, which may result in adverse cardiovascular events. Dexmedetomidine, a selective α2-adrenergic agonist, has been widely used to attenuate this stress response. Intranasal administration offers a non-invasive alternative with good bioavailability and patient compliance. Objective: To compare the efficacy of two different doses of intranasal dexmedetomidine (1 µg/kg and 0.75 µg/kg) administered via nasal atomizer in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation, and to evaluate sedation and postoperative outcomes. Methodology: A randomized comparative study was conducted among 72 adult patients (ASA I–II) undergoing elective surgery under general anaesthesia. Patients were divided into two groups: Group A received 1 µg/kg and Group B received 0.75 µg/kg intranasal dexmedetomidine 45 minutes prior to induction. Hemodynamic parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation were recorded at predefined intervals. Sedation was assessed using Ramsay Sedation Score, and postoperative nausea and vomiting (PONV) were evaluated in the post-anaesthesia care unit. Results: Both groups showed attenuation of hemodynamic response; however, Group A demonstrated better clinical stability with comparatively lower heart rate and blood pressure values during and after intubation. The differences between groups were not statistically significant (p > 0.05). Sedation levels were adequate and comparable in both groups without respiratory depression, as SpO₂ remained stable. The incidence of PONV was slightly higher in Group A in the early postoperative period but resolved within one hour.

Conclusion: Intranasal dexmedetomidine is an effective and safe premedication for attenuating the hemodynamic response to laryngoscopy and intubation. The higher dose (1 µg/kg) provides better clinical attenuation and hemodynamic stability without significant adverse effects, making it a suitable non-invasive alternative in anaesthetic practice.

Background: Preoperative fasting may result in varying degrees of intravascular volume depletion, which can contribute to hemodynamic instability following induction of anaesthesia. Bedside ultrasonographic assessment of the Inferior Vena Cava Collapsibility Index (IVCCI) has emerged as a simple, non-invasive method for evaluating volume status and predicting fluid responsiveness. Objectives: To assess the role of the Inferior Vena Cava Collapsibility Index in preoperative volume assessment among fasting patients undergoing elective surgery and to evaluate changes in IVCCI following intravenous fluid administration. Materials and Methods: This prospective observational study included 120 adult patients with American Society of Anesthesiologists (ASA) physical status I or II who had fasted for at least 8 hours before elective surgery. Baseline inferior vena cava (IVC) diameters during inspiration and expiration were measured using M-mode ultrasonography with a 3-MHz phased-array probe. IVCCI was calculated before and after administration of a 500 mL intravenous bolus of 0.9% normal saline over 20 minutes. Hemodynamic parameters and ultrasonographic measurements were compared using appropriate statistical tests, with p<0.05 considered statistically significant. Results: The mean baseline IVCCI was 46.2 ± 11.4%, which decreased significantly to 30.8 ± 8.6% following fluid administration (p<0.001). Both maximum and minimum IVC diameters increased significantly after the fluid bolus (p<0.001). Before fluid administration, 59.1% of patients had an IVCCI >40%, whereas this proportion decreased to 13.3% after volume expansion (p<0.001). Heart rate decreased significantly, while systolic, diastolic, and mean arterial pressures improved following fluid therapy. Oxygen saturation remained unchanged. Conclusion: Inferior Vena Cava Collapsibility Index is a rapid, safe, and non-invasive bedside tool for assessing preoperative intravascular volume status in fasting elective surgical patients. Significant reduction in IVCCI after crystalloid administration demonstrates its usefulness in identifying relative hypovolemia and monitoring response to fluid therapy. Incorporation of IVCCI into routine preoperative assessment may facilitate individualized perioperative fluid optimization and improve hemodynamic stability.

Background: Deviated nasal septum (DNS) with inferior turbinate hypertrophy is a common structural cause of chronic nasal obstruction. Although septoplasty is the standard surgical treatment for symptomatic DNS, the additional benefit of inferior turbinate reduction remains controversial. Objective- To compare the functional outcomes of septoplasty alone and septoplasty combined with inferior turbinate reduction. Methods: This prospective comparative observational study was conducted in the Department of Otorhinolaryngology and Head & Neck Surgery, Government Medical College, Churu, Rajasthan. Sixty patients aged 18–55 years with symptomatic DNS associated with inferior turbinate hypertrophy were enrolled and allocated into two groups of 30 patients each: Group A underwent septoplasty alone, while Group B underwent septoplasty with inferior turbinate reduction by submucosal resection and outfracture. Functional outcomes were assessed using the NOSE score preoperatively and at 2 weeks, 1 month, and 3 months postoperatively. Results: Baseline demographic and clinical characteristics were comparable between the groups. Both groups demonstrated significant postoperative improvement; however, the combined procedure group achieved significantly lower NOSE scores at 2 weeks, 1 month, and 3 months (p<0.05). At 3 months, the reduction in NOSE score from baseline was greater in the combined group (88.5%) than in the septoplasty-alone group (80.1%). A patent nasal airway was observed in 96.7% of patients undergoing combined surgery compared with 86.7% following septoplasty alone. Residual turbinate hypertrophy (3.3% vs. 16.7%) and persistent nasal obstruction (3.3% vs. 13.3%) were less frequent in the combined group. Conclusion: Both procedures effectively relieved nasal obstruction; however, septoplasty combined with inferior turbinate reduction provided superior functional outcomes, better endoscopic results, and fewer residual obstructive findings without increasing postoperative complications. Careful preoperative evaluation of inferior turbinate hypertrophy should be incorporated into surgical planning, and concomitant turbinate reduction may be considered in appropriately selected patients.

Background: Demographic transitions in middle-income nations have caused a significant increase in the absolute number of older adults. In urban settings, this shift often intersects with the breakdown of traditional family networks and growing social isolation, which can increase vulnerability to psychiatric conditions. This study evaluated the prevalence, socio-demographic predictors, and structural correlates of late-life depression and psychological distress within an urban geriatric population in Maharashtra, India. Methods: A community-based cross-sectional survey was conducted within an urban administrative zone of Maharashtra, featuring an eligible baseline population of 21,500 older adults. A representative sample of 2,040 consenting permanent residents aged 60 years or older was selected via systematic random sampling. Standardized, validated face-to-face interview instruments were used, including the 15-item Geriatric Depression Scale (GDS-15). Statistical analysis involved Pearson’s chi-square (χ2) tests and multivariable logistic regression models to compute adjusted odds ratios (OR) with 95% confidence intervals (CI). Results: The final sample consisted of 1,068 females (52.35%) and 972 males (47.65%). The overall prevalence of suggestive depressive symptomatology (GDS-15 score ≥5) was 49.26% (n=1,005). Bivariate analyses revealed a significant drop in subjective life satisfaction within the 70–79 age bracket (42.28%) and a high rate of activity discontinuation (95.57%). Multivariable regression models showed that severe perceived loneliness (OR = 4.12, 95% CI: [3.18, 5.34], p < 0.001), financial dependency (OR = 2.84, 95% CI: [2.12, 3.81], p < 0.001), and lack of age-adapted primary care services (OR = 2.35, 95% CI: [1.67, 3.31], p < 0.01) were independent predictors of depressive states. Conclusion: Late-life depression is a major public health challenge in urban settings, driven by a combination of social isolation, financial insecurity, and poorly adapted health systems. Primary healthcare frameworks must be restructured to integrate routine, community-based psychological screenings and age-friendly mental health interventions.

Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities including central obesity, hypertension, dyslipidemia, and impaired glucose metabolism that significantly increase the risk of cardiovascular disease and type 2 diabetes mellitus. Lifestyle factors such as physical inactivity, unhealthy dietary habits, tobacco use, alcohol consumption, inadequate sleep, and prolonged sedentary behavior contribute substantially to the development of MetS. This study aimed to evaluate the association between lifestyle factors and metabolic syndrome among adults. Methods: A hospital-based cross-sectional study was conducted among 200 adults aged 18 years and above. Data regarding socio-demographic characteristics, dietary habits, physical activity, smoking, alcohol intake, sleep duration, and sedentary behavior were collected using a structured questionnaire. Anthropometric measurements, blood pressure, fasting blood glucose, triglycerides, and HDL cholesterol were recorded. Metabolic syndrome was diagnosed according to the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Statistical analysis included Chi-square test, independent t-test, and multivariable logistic regression. Results: Of the 200 participants, 64 (32.0%) were diagnosed with metabolic syndrome. Physical inactivity, frequent fast-food consumption, smoking, inadequate sleep (<7 hours/day), and prolonged sedentary behavior (>8 hours/day) were significantly associated with metabolic syndrome (p<0.05). Logistic regression identified physical inactivity, obesity, and unhealthy dietary habits as independent predictors of metabolic syndrome. Conclusion: Lifestyle factors play a significant role in the development of metabolic syndrome. Promotion of healthy dietary practices, regular physical activity, adequate sleep, and smoking cessation may substantially reduce the burden of metabolic syndrome among adults.

Background: Diabetic neuropathy (DN) remains a highly disabling microvascular complication of diabetes mellitus. Chronic hyperglycemia prompts cellular damage through multiple metabolic routes, with oxidative stress serving as a primary driver of neuropathic structural degradation [1,2]. Concurrently, altered tissue remodelling and collagen degradation feature heavily in late-stage diabetic complications. Serum prolidase activity governs the final step of collagen degradation, yet its definitive role alongside systematic systemic oxidative stress parameters in DN remains poorly characterized [2,3]. This study evaluated the collective dynamics of serum prolidase activity, total oxidant status (TOS), total antioxidant status (TAS), and the oxidative stress index (OSI) in patients with diabetic neuropathy. Methods: A cross-sectional, comparative observational study was conducted involving 80 participants recruited from MGM Medical College, Indore, MP. The subjects were classified into three distinct cohorts: diabetic neuropathy cases (n=40), diabetic controls without neuropathy (n=40), and non-diabetic healthy controls (n=40). Serum prolidase activity, TAS, and TOS were spectrophotometrically determined using validated automated colorimetric assays [4,5], and the OSI was computed as the ratio of TOS to TAS. Glycemic indices and lipid profiles were correlated with these markers using Pearson’s data analysis via SPSS Version 19. Results: Serum TOS levels were markedly higher in DN patients (0.341 ± 0.187 μmol H2O2 Eq./L) compared to diabetic controls (0.258 ± 0.081 μmol H2O2 Eq./L) and non-diabetic controls (0.129 ± 0.041 μmol H2O2 Eq./L; p < 0.0001). The OSI similarly displayed a highly significant upward trend across the cohorts (1.301 ± 1.412 vs. 0.563 ± 0.311 vs. 0.402 ± 0.213; p < 0.0001). Serum prolidase activity was highest in the DN cohort (382.6 ± 138.5 U/L) compared to diabetic (368.4 ± 132.9 U/L) and healthy controls (361.2 ± 150.3 U/L), signaling active tissue remodeling. Prolidase activity demonstrated a significant negative correlation with HbA1c (r = -0.327, p = 0.039), high-density lipoprotein (HDL, r = 0.432, p = 0.004), and very low-density lipoprotein (VLDL, r = -0.315, p = 0.041). Conclusion: Accelerated systemic oxidative stress, represented by distinct elevations in TOS and OSI, combined with altered serum prolidase dynamics, highlights a combined pathophysiological framework of oxidative damage and aberrant collagen turnover in diabetic neuropathy. These parameters serve as potential biomarkers for microvascular deterioration in diabetic patients.

Introduction: Maternal vitamin D plays an important role in fetal growth and neonatal health. Its association with neonatal anthropometry and clinical outcome remains uncertain. This study evaluated maternal vitamin D status and its relationship with neonatal vitamin D level, anthropometric measurements, and neonatal outcome. Methods: This hospital-based prospective observational study included 90 pregnant women and their newborns delivered at a tertiary care hospital in Rajasthan between April 2021 and March 2022. Maternal and neonatal serum vitamin D levels were measured using chemiluminescence immunoassay. Maternal background characteristics, gestational age, birth weight, neonatal anthropometry, NICU admission, and neonatal outcome were recorded. Statistical analysis included Chi-square test, Pearson correlation, and receiver operating characteristic (ROC) analysis. Results: The mean maternal and neonatal vitamin D levels were 36.60 ± 13.96 ng/mL and 39.07 ± 13.70 ng/mL, respectively. Maternal vitamin D was sufficient in 74.44% of mothers, 85.56% of newborns had normal vitamin D levels. Maternal vitamin D status was not significantly associated with maternal background characteristics, gestational age, and birth weight, weight for gestational age, neonatal length, head circumference, NICU admission, or neonatal outcome (all p > 0.05). Very strong positive correlation was observed between maternal and neonatal vitamin D levels (r = 0.95, p < 0.001). Maternal vitamin D cut-off of >17.5 ng/mL predicted normal neonatal vitamin D status with 98.75% sensitivity, 100.00% specificity, and 98.89% diagnostic accuracy. Conclusion: Maternal vitamin D level was strongly associated with neonatal vitamin D level and accurately predicted neonatal vitamin D status. No significant association was found between maternal vitamin D status and neonatal anthropometry or short-term neonatal outcome in this study.

Background: Rational drug prescribing plays a crucial role in optimizing patient care outcomes. The World Health Organization (WHO) core prescribing indicators serve as standardized and reliable measures for evaluating key aspects of drug utilization patterns. The present study aimed to evaluate prescribing practices and the completeness of prescriptions using WHO-recommended core prescribing indicators. Materials and Methods: A prospective, descriptive, cross-sectional study was carried out among admitted patients in the Department of Obstetrics and Gynaecology at Adesh Medical College and Hospital, Kurukshetra, Haryana. The study was carried out over a period of 4 months. A total of 560 prescriptions were randomly selected and evaluated. Data were entered and analysed using Microsoft Excel while statistical analysis was carried out using SPSS software. Result: WHO core prescribing indicators analysis revealed that average number of drugs per prescription was 5. The drugs written by generic name were 21%. Out of total 2941 drugs, 18% drugs were antibiotics. Conclusion: The final observations emphasize the need for regular prescription audits, continuous medical education, and strict adherence to WHO prescribing guidelines to enhance prescription quality, minimize medication errors, and promote rational drug therapy in tertiary care settings.

Introduction: Social media platforms are increasingly being integrated into medical education due to their accessibility, flexibility, and ability to enhance learner engagement. In the post-COVID era, online learning tools have become popular among undergraduate medical students. Integrating social media with conventional teaching methods may improve student participation and facilitate competency-based medical education. Aim: To assess the impact of social media tools as an adjunct in teaching-learning methods among undergraduate medical students. Materials and Methods: This randomized controlled study was conducted among second-year undergraduate medical students at a Government Medical College from February 2024 to June 2024. A total of 102 students were randomized into two groups of 51 each. Educational materials related to Anaemia and Myocardial Infarction (MI) were shared through social media platforms (WhatsApp and Telegram) for one group, while conventional reference materials and notes were shared for the other group. A crossover design was followed. Pretests and post-tests were conducted for both topics. Data were analysed using SPSS version 23.0. Independent t-test was used to compare mean scores. Results: Among 102 participants, students receiving social media-assisted learning achieved significantly higher post-test scores and greater mean knowledge gain than those receiving conventional teaching (p < 0.001). Most students (89.9%) preferred online sharing of educational materials, and 98% reported improved understanding of classroom lectures. Conclusion: Social media platforms can serve as an effective adjunct to conventional teaching methods in undergraduate medical education by improving student engagement and academic performance.

The shifting status of SARS-CoV-2 from a pandemic emergency to an endemic respiratory threat has fundamentally altered global diagnostic requirements. This review article comprehensively examines the trajectory of COVID-19 testing protocols, contrasting the clinical efficacy and structural limitations of predominant diagnostic tools. Although quantitative real-time PCR (RT-qPCR) serves as the gold standard for analytical sensitivity, its utility is constrained by logistical delays, resource costs, and the post-infectious RNA retention paradox. In contrast, rapid antigen diagnostic tests (Ag-RDTs) facilitate decentralized screening but are hindered by viral-load dependencies and diminished accuracy in asymptomatic patients, requiring serial testing protocols. Furthermore, both modalities are vulnerable to sample degradation and variant-driven mutational escape. To navigate these limitations and differentiate overlapping clinical symptoms from co-circulating seasonal pathogens like Influenza A/B and RSV, this paper explores the vital evolution toward multiplex syndromic platforms alongside cutting-edge CRISPR and AI-driven screening techniques. Ultimately, consolidating integrated multiplex surveillance optimizes public health responses, enhances antimicrobial stewardship, and secures a scalable diagnostic network ready to confront future novel respiratory outbreaks.

Background: Dyslipidemia is a major modifiable risk factor for atherosclerotic cardiovascular disease and contributes substantially to global morbidity and mortality. It commonly coexists with hypertension and type 2 diabetes mellitus, thereby accelerating the development of cardiovascular complications. Statins remain the cornerstone of lipid-lowering therapy, with atorvastatin and rosuvastatin being among the most frequently prescribed agents. Although both drugs effectively reduce low-density lipoprotein cholesterol (LDL-C) and cardiovascular risk, comparative evidence from routine clinical practice in the Indian population remains limited. Aim: To comparatively evaluate the efficacy, safety, tolerability, and treatment compliance of rosuvastatin and atorvastatin monotherapy in patients with dyslipidemia, including those with associated hypertension and/or type 2 diabetes mellitus, managed at a tertiary care hospital according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Materials and Methods: A prospective observational comparative study was conducted in the Departments of Pharmacology and Medicine at Hamdard Institute of Medical Sciences and Research (HIMSR) and Hakeem Abdul Hameed Centenary Hospital (HAHC), Jamia Hamdard, New Delhi. A total of 300 eligible patients with dyslipidemia were enrolled, of whom 291 completed the study, while nine patients were lost to follow-up. Participants received either rosuvastatin or atorvastatin monotherapy according to the treating physician’s clinical judgment. Baseline demographic characteristics, cardiovascular risk factors, lipid profile parameters, fasting blood glucose, glycated haemoglobin (HbA1c), serum creatinine, blood urea, serum glutamic-pyruvic transaminase (SGPT), treatment compliance, and adverse drug reactions were assessed at baseline and during follow-up. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p < 0.05 considered statistically significant. Results: Among the 300 enrolled participants, 291 completed follow-up. Both rosuvastatin and atorvastatin produced significant improvements in serum lipid parameters during the study period. Rosuvastatin demonstrated greater reductions in total cholesterol and LDL cholesterol and achieved lipid targets in a higher proportion of patients, whereas atorvastatin showed comparable improvement in triglyceride levels. Both treatments were generally well tolerated, with adverse drug reactions being mild and consistent with the established safety profile of statins. Patient compliance remained satisfactory throughout the study. Conclusion: Rosuvastatin and atorvastatin are both effective and well-tolerated treatment options for dyslipidemia. Rosuvastatin demonstrated comparatively greater efficacy in improving LDL cholesterol and overall lipid control, while maintaining a favourable safety profile. These findings support the use of rosuvastatin as an effective therapeutic option for achieving recommended lipid targets in patients with dyslipidemia, particularly those with associated cardiovascular risk factors.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation and chronic airway inflammation. Although smoking remains the major risk factor, inflammatory biomarkers may play an important role in identifying disease severity and clinical phenotype. Serum immunoglobulin E (IgE), commonly associated with allergic and eosinophilic inflammation, may be linked with airway obstruction, bronchodilator response and severity of COPD. Aim: The aim of the study was to assess the association between serum IgE levels and disease severity in patients with COPD. Material and Methods: The present prospective observational study was conducted in the Department of Respiratory Medicine, People’s College of Medical Science and Research Centre and associated People’s Hospital, Bhopal, over a period of 24 months from February 2024 to January 2026. A total of 50 newly diagnosed COPD patients attending OPD and IPD services were enrolled after obtaining written informed consent. Patients were evaluated using detailed clinical history, sociodemographic profile, smoking status, chest X-ray, oxygen saturation, mMRC dyspnoea score, spirometry and GOLD staging. Blood investigations included complete blood count, absolute eosinophil count, serum IgE measured by fluoroenzyme immunoassay method and C-reactive protein. Data were analysed using MS Excel and IBM SPSS version 20. Results: Most patients belonged to the 60–69 years age group, 18 (36%), with male predominance, 38 (76%). Smoking was present in 41 (82%) patients. According to GOLD classification, 18 (36%) patients had moderate COPD, 17 (34%) had severe COPD, 9 (18%) had very severe COPD and 6 (12%) had mild COPD. Raised serum IgE was observed in 29 (58%) patients, while 21 (42%) had normal IgE levels. Mean pre-bronchodilator FEV1 was lower in the raised IgE group (49.2%) compared with the normal IgE group (63.63%). Serum IgE showed a strong negative correlation with FEV1 (r = −0.74, p < 0.001) and positive correlation with eosinophil count (r = 0.64, p < 0.001) and CRP (r = 0.51, p = 0.002). Conclusion: Raised serum IgE levels were associated with increased COPD severity, reduced lung function and inflammatory activity. Serum IgE may serve as a useful supportive biomarker for assessing disease severity and identifying inflammatory phenotype in COPD patients.

Background: Rheumatoid arthritis is a chronic systemic autoimmune disease that primarily affects the joints but may also involve extra-articular organs, especially the lungs. Pulmonary involvement in rheumatoid arthritis may remain asymptomatic in the early stage and can present with restrictive, obstructive, or mixed ventilatory defects. Spirometry and diffusing capacity of the lung for carbon monoxide (DLCO) are important pulmonary function tests for detecting respiratory impairment and assessing subclinical lung involvement. Aim: The aim of the study was to assess pulmonary manifestations and their correlation with DLCO and spirometry in patients with rheumatoid arthritis. Material and Methods: This single-centre, hospital-based, cross-sectional study was conducted in the Outpatient Department of Respiratory Medicine and Rheumatology Department at People’s Hospital, Bhopal. A total of 54 patients with clinically and/or serologically confirmed rheumatoid arthritis were included as per inclusion and exclusion criteria. After obtaining written informed consent, demographic details, clinical history, respiratory symptoms, and relevant examination findings were recorded. All participants underwent routine investigations, rheumatoid factor assessment, chest X-ray, spirometry, and DLCO testing. Disease activity was assessed using the Clinical Disease Activity Index and Simplified Disease Activity Index. Data were analysed to determine pulmonary manifestations and their correlation with spirometry and DLCO findings. Results: Among 54 participants, the majority were in the 41–50 years age group, 22 (40.7%), and females predominated, 41 (75.9%). Respiratory symptoms were absent in 28 (51.85%) patients, while dyspnea was the most common symptom, seen in 14 (25.67%). Chest X-ray was normal in 36 (66.67%) patients. Spirometry was abnormal in 26 (48.15%) patients, with restrictive pattern being the most common abnormality, 16 (29.63%). DLCO was reduced in 34 (62.96%) patients. Both spirometry and DLCO were abnormal in 22 (40.74%) cases, while isolated DLCO abnormality was seen in 12 (22.22%). Significant correlation was observed between pulmonary function abnormalities and disease activity assessed by CDAI and SDAI. Conclusion: Pulmonary involvement was common in rheumatoid arthritis patients, with interstitial lung disease being the most frequent manifestation. DLCO detected more abnormalities than spirometry and may help in early identification of subclinical pulmonary involvement.

Background: Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, resulting in organ dysfunction and high mortality. Early identification of disease severity is essential for timely management. Serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) are inexpensive and readily available biomarkers that may reflect the severity of organ dysfunction in patients with sepsis. Aim: To evaluate the association of serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) with the Sequential Organ Failure Assessment (SOFA) score in adult patients with sepsis. Methods: A hospital-based observational cross-sectional study was conducted in the Department of General Medicine at a tertiary care teaching hospital over one year. A total of 95 adult patients diagnosed with sepsis according to the Sepsis-3 criteria were enrolled using purposive sampling. Serum LDH, serum CRP, and SOFA score were assessed on admission (Day 0) and repeated on Day 3. Associations between biomarker levels and SOFA score were evaluated using the Chi-square test, while Pearson’s correlation coefficient was used to assess the strength of correlation. A p-value <0.05 was considered statistically significant. Results: The mean age of the participants was 56.05 ± 15.01 years, and 66.3% were female. The proportion of patients with SOFA scores of 0–6 increased from 63.2% on admission to 73.7% on Day 3. Elevated CRP (≥5 mg/L) was observed in 88.4% of patients on admission and 78.9% on Day 3, while elevated LDH (≥240 IU/L) was present in 87.4% and 81.1%, respectively. Significant associations were observed between CRP and SOFA score on admission (p=0.03) and Day 3 (p=0.02), as well as between LDH and SOFA score on admission (p=0.04) and Day 3 (p=0.03). Pearson correlation analysis demonstrated moderate positive correlations between SOFA score and CRP (Day 0: r=0.42; Day 3: r=0.39) and between SOFA score and LDH (Day 0: r=0.48; Day 3: r=0.44). LDH showed a slightly stronger correlation with SOFA score than CRP. Conclusion: Serum LDH and CRP were significantly associated with SOFA score in patients with sepsis, indicating their usefulness as adjunctive biomarkers of disease severity. LDH demonstrated a slightly stronger correlation with SOFA score than CRP, suggesting that it may better reflect organ dysfunction. The combined assessment of serum LDH, CRP, and SOFA score may facilitate early severity assessment and monitoring of patients with sepsis.

Background: Knee osteoarthritis (OA) is one of the most common degenerative joint disorders causing chronic pain, stiffness, and functional disability. While non-steroidal anti-inflammatory drugs (NSAIDs) such as Aceclofenac provide rapid symptomatic relief, they do not modify disease progression. Diacerein, an interleukin-1β inhibitor, has demonstrated disease-modifying potential with sustained symptomatic benefits. Objectives: To compare the clinical efficacy and safety of Diacerein and Aceclofenac in patients with knee osteoarthritis using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Methods: A total of 246 patients with radiologically confirmed Kellgren–Lawrence grade II or III knee OA were enrolled and allocated into two equal groups (n=123 each). Group A received Diacerein 50 mg twice daily, while Group B received Aceclofenac 100 mg twice daily for eight weeks. Patients were assessed at baseline and after 2, 4, 8, and 10 weeks using VAS and WOMAC scores. Results: Both treatments produced significant reductions in pain and improvement in functional status over the study period. Aceclofenac demonstrated a faster onset of action, with significantly lower VAS and WOMAC scores at 2, 4, and 8 weeks (p<0.05). However, at the 10-week follow-up after treatment discontinuation, the Diacerein group exhibited lower VAS scores, indicating a sustained carry-over effect. WOMAC scores also suggested prolonged functional improvement with Diacerein after cessation of therapy. Conclusion: Both Diacerein and Aceclofenac were effective and well tolerated in the management of knee osteoarthritis. Aceclofenac provided superior early symptomatic relief, whereas Diacerein demonstrated sustained post-treatment benefits, suggesting a disease-modifying carry-over effect.

Background: With the rising burden of non-communicable diseases (NCDs), ageing of population and certain chronic communicable diseases the need for palliative care has become immense. It has become increasingly important for a medical graduate to acquire knowledge, skills and confidence in providing palliative care. Understanding the current level of knowledge of medical students on palliative care would facilitate planning a need based curriculum and focused training on Palliative care. Methods An institution-based cross sectional study was conducted among 170 MBBS students and 55 foreign medical graduates (FMGs) externs of Shija Academy of Health Sciences (SAHS) by using convenience sampling technique from 10^th May-10^th June, 2023. A pre-designed, pre-tested, structured questionnaire developed from the training manual for doctors and nurses under National Programme for Palliative Care (NPPC), MoHFW was used for data collection. The data were entered in Microsoft Excel and analysed using SPSS-Version 25.Chi-square test was applied and P-value <0.05 was taken as statistically significant. Results: Out of the total 225 participants, 218 (96.9%) have heard of palliative care while only 7 (3.1%) participants have not heard of palliative care. More than half (52%) of the participants have adequate knowledge of palliative care while nearly half (48%) have inadequate knowledge. The level of knowledge of the students was found to have statistically significant association with the religion and position/semester of the participants. Conclusion: Although nearly half of the participants have adequate knowledge, a substantial proportion exhibited inadequate understanding of palliative care, indicating variability in competency levels. Inclusion of the subject as an integral part of MBBS curriculum and adequate training programs/continuing education may be provided to enhance the knowledge and skills of the students.

Background: Obesity is a growing public health concern in India. It has various risk factors ranging from genetics to lifestyle. Obesity increases risk of cardio-metabolic diseases, apart from it sleep related disorders can’t be ignored. Sleep disorders is one common risk factor as well as consequence of obesity with bidirectional relationship. Objectives: To screen obese adolescents for prevalence of sleep disorders using the BEARS screening tool. Methods: This is a prospective observational study where adolescents presenting to paediatric OPD at a tertiary care teaching hospital were screened for obesity. BMI >27^th adult equivalent as per IAP growth charts was considered obese. Adolescents with obesity were screened for sleep disorders using the BEARS tool after obtaining informed consent and results were analysed. Results: Total 260 obese adolescents were screened for sleep disorders. There were higher proportion of mid adolescents (48.84%), predominantly males (60%), nearly equal proportion from urban and rural residence. 206 adolescents had sleep affected in at least one of the 5 domains of BEARS screening tool. 54 (20.77%) had no sleep related complaints. Prevalence was higher in late adolescents, male subjects, urban population, and upper lower socioeconomic class. Conclusion: Adolescents with obesity do suffer from sleep disorders, attributable mainly to lifestyle. The BEARS screening tool is a simple, quick tool that can be practically applied in routine paediatrics OPD for early identification.

Background:  The term perimenopause encompasses the period of menopausal transition, during which the first endocrinological, biological, and clinical features of menopause begin to emerge, as well as the first year after menopause. Psychological and mental health problems like depression, anxiety, irritability and mood changes are prevalent during perimenopausal period apart from experiencing well recognized physical symptoms like hot flushes and night sweats. However, the awareness about mental health issues remains low in India. Hence our study was proposed to understand the extent of mental health burden in perimenopausal women. Methods: The study was a cross-sectional study conducted in a southwest Delhi area from May 2023 to October 2024. A total of 378 women were enrolled in the study using systemic random sampling technique. A validated Mini International Neuropsychiatric Interview (M.I.N.I) version 6.0.0 was administered as a diagnostic tool for the study. Result: Among the 378 study participants,129 of them were affected by one or more of the common psychiatric morbidities. The overall prevalence of the psychiatric morbidities was 34.1%, the commonest being suicidality followed by depression. The most commonly reported symptoms among participants diagnosed with depression was low mood with 98.2%. Conclusion: The present study highlights the substantial burden of mental health problems during perimenopause and the need to increase awareness among general public.

Background: Acacia nilotica has long been used in traditional medicine for wound management; however, evidence linking its antioxidant properties with angiogenesis remains limited. This study investigated the angiogenic potential of Acacia nilotica bark extract and explored its association with antioxidant activity. Methods: The bark extract was characterized using Fourier transform infrared spectroscopy (FTIR). Antioxidant activity was evaluated by the DPPH free radical scavenging assay at concentrations ranging from 10 to 150 µg/mL. Angiogenic activity was assessed using the chick chorioallantoic membrane (CAM) assay, and vascular parameters, including vessel area, total vessel length, and vascular junctions, were quantified using NIH AngioTool64 Version 0.6a. Results: FTIR analysis confirmed the presence of bioactive phytochemicals, including phenolic compounds, flavonoids, tannins, and polysaccharides. The extract exhibited concentration-dependent antioxidant activity, increasing from 33% at 10 µg/mL to 87% at 150 µg/mL, while ascorbic acid exhibited 100% antioxidant activity. CAM analysis demonstrated enhanced vascularization with increasing extract concentrations, reflected by greater vessel area, vascular junctions, and total vessel length. The highest angiogenic response was observed at 150 µg/mL. Conclusion: Acacia nilotica bark extract demonstrated significant antioxidant and pro-angiogenic activities, supporting its traditional use in wound healing. The findings suggest that its antioxidant-rich phytochemical composition may contribute to enhanced angiogenesis and tissue repair. Further mechanistic, preclinical, and clinical studies are warranted to establish its therapeutic potential.

Background: Non–ST-segment elevation myocardial infarction (NSTEMI) complicated by supraventricular tachycardia (SVT) presents unique diagnostic and therapeutic challenges. Advanced intracoronary imaging modalities—such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT)—enable precise lesion characterization, optimized stent deployment, and improved procedural outcomes in percutaneous coronary intervention (PCI). Case Summary: We report a case series of three male patients, presenting with NSTEMI and documented SVT. The first patient, with single-vessel disease involving a 95% concentric stenosis of the left anterior descending artery, underwent IVUS-guided PCI with drug-eluting stent implantation, achieving optimal TIMI III flow. The second patient, with complex triple-vessel disease and prior PCI to the right coronary artery, underwent staged OCT-guided PCI to the obtuse marginal branch (OM1) and drug-eluting balloon angioplasty to OM2, with confirmation of stent expansion and apposition on post-procedural OCT. Both had preserved left ventricular systolic function, uneventful recoveries, and were discharged in stable condition on optimal medical therapy. Conclusion: This case series underscores the value of IVUS and OCT in guiding PCI for NSTEMI complicated by SVT. Advanced imaging facilitates tailored revascularization strategies, ensures optimal device deployment, and supports favourable short-term outcomes, while coordinated arrhythmia management is essential for maintaining hemodynamic stability during intervention.

Background: Oral cavity lesions range from inflammatory and reactive conditions to cystic, benign, potentially malignant and frankly malignant neoplasms, and represent a major public health burden in India due to widespread tobacco and betel quid use. Objective: To describe the histopathological spectrum of oral cavity lesions and correlate lesion category with age, sex and anatomical site in a tertiary care setting. Methods: Cross‑sectional study of all oral cavity biopsies received in the Department of Pathology, Sardar Patel Medical College and associated hospitals, Bikaner, from 1 April 2025 to 28 February 2026. Clinical data (age, sex, and site) were abstracted from requisition forms and hospital records; tissues were processed by routine paraffin technique, stained with haematoxylin‑eosin, classified into broad histopathological categories, and analyzed using descriptive statistics and chi‑square tests. Results: A total of 360 oral cavity lesions were examined (mean age 48.42 years, range 7–86 years), with peak frequency in the 51–60 year age group (26.11%). Males comprised 71.94% (male: female ratio 2.56:1). Buccal mucosa (36.67%) and tongue (23.89%) were the most commonly involved sites. Malignant lesions predominated (64.45%), followed by inflammatory/reactive (18.89%), potentially malignant (8.61%), cystic (4.44%) and benign lesions (3.61%). Squamous cell carcinoma accounted for 92.67% of malignant lesions, most commonly moderately differentiated (66.51%). Age, sex and site showed highly significant associations with histopathological category (p<0.001 for all). Conclusion: There is a high burden of tobacco‑associated oral squamous cell carcinoma in this population, with predominance in middle‑aged and elderly males and preferential involvement of buccal mucosa and tongue. Early detection of potentially malignant lesions and strong habit‑cessation strategies are essential to reduce progression to invasive carcinoma.

Introduction: Ovarian carcinoma is a major gynaecological malignancy in India, frequently diagnosed at advanced stages requiring systemic chemotherapy. The combination of paclitaxel and carboplatin remains the standard first-line regimen and has significantly improved patient survival. However, paclitaxel is commonly associated with chemotherapy-induced peripheral neuropathy (CIPN), a dose-dependent adverse effect primarily affecting sensory nerves. This condition manifests as paraesthesia, numbness, burning pain, and impaired proprioception in a characteristic glove-and-stocking distribution. Despite its clinical importance, data regarding paclitaxel-induced peripheral neuropathy (PIPN) in South Indian populations remain limited. This study aims to describe the clinical presentation, associated risk factors, and management outcomes of PIPN in ovarian carcinoma patients treated at a tertiary care centre in South India. Case description: A case series was conducted in the Departments of Pharmacology and Medical Oncology at a tertiary care teaching hospital in South India. Five adult female patients with histologically confirmed epithelial ovarian carcinoma who developed peripheral neuropathy following paclitaxel-based chemotherapy were included. Patients received paclitaxel (175 mg/m²) and carboplatin (AUC 5-6) administered every 21 days for up to six cycles. Baseline neurological assessments were performed, and patients were monitored during each chemotherapy cycle for symptoms of neuropathy. Results: All five patients developed predominantly sensory neuropathy characterized by tingling, numbness, and paraesthesia involving distal extremities. Neuropathy typically appeared after multiple chemotherapy cycles, indicating a relationship with cumulative paclitaxel exposure. Clinical evaluation revealed a symmetrical glove-and-stocking distribution. Management included symptomatic treatment, close neurological monitoring, and chemotherapy dose modification when necessary. Conclusion: PIPN is a clinically significant complication of paclitaxel-carboplatin chemotherapy in ovarian carcinoma patients. Vigilant monitoring, timely recognition, and coordinated management are essential to prevent severe neurotoxicity and ensure uninterrupted cancer treatment.

Background: Adequate sleep is critical for medical students to optimize cognitive function, memory consolidation and emotional regulation. Medical students are vulnerable to sleep disturbances as they go through new environment, academic stress, long study hours, emotional challenges, and exhaustion. Poor sleep quality among the medical students can negatively impact their well-being and future professional competence. Methods: An Institution-based cross-sectional study was conducted among 342 undergraduate medical students of Shija Academy of Health Sciences, Manipur from 18^th March to 18^th April, 2025 using non-random convenience sampling technique. The study was conducted using predesigned, pre-tested, validated tools which are the Pittsburg quality of sleep index (PQSI) scale and Epworth Daytime Sleepiness Scale (EDSS). Data was analysed in SPSS Version 25.Descriptive statistics are expressed in mean, frequency and percentages. Chi-square test was applied to test the association of quality of sleep with selected variables of interest and p value <0.05 was taken as statistically significant. Results: The mean age of the study participants is 21.3 + 1.6 years. More than half (58.2%) of the medical students have poor sleep quality as per Pittsburgh Quality of Sleep Index (PQSI) score while extreme day time sleepiness was reported among 38.8% of the students as per Epworth Daytime Sleepiness Scale (EDSS).No Statistically significant association was found with the quality of sleep and age, semester, residence, use of electronic gadgets and consumption of alcohol, tobacco products, caffeine. Conclusion: More than half of the students have poor quality of sleep and a significant number of students also have day time sleepiness. Creating a positive environment and promoting good sleep hygiene among the medical students can help to achieve and maintain good quality of sleep.

Background: Ventilator-associated pneumonia is a nosocomial infection that occurs after 48 hours in patients receiving mechanical ventilation through endotracheal intubation. The risk of developing VAP increases with the duration of mechanical ventilation due to colonization by pathogenic microorganisms in the oral cavity and lower respiratory tract. A standardized oral care protocol significantly improved oral health status and decreased the risk of developing VAP. Methods: Out of a total of 56 articles between 2016 and 2026, a total of 19 articles were assessed. Out of these, 10 studies were included in the review. The population studied in the present review comprised patients admitted to intensive care receiving mechanical ventilation. The present study was carried out in accordance with the PRISMA guidelines. Results: A significant reduction in VAP incidence was observed in various studies with the use of 0.12%–0.2% chlorhexidine. Mechanical plaque removal also reduced the incidence of VAP. Chlorhexidine proved effective in reducing the total number of bacteria present in the mouth, including Staphylococcus aureus and Klebsiella pneumoniae. Conclusion: Integrating effective oral hygiene practices and adopting a multidisciplinary approach can significantly improve clinical outcomes for critically ill patients, thereby reducing the morbidity and mortality associated with VAP.

Background: Children younger than two years are physiologically distinct and unusually sensitive to intravenous anaesthetics. Although thiopentone remains widely used for induction in resource-limited settings, contemporary efficacy and safety data in this age band are scarce. We evaluated its efficacy and safety in this group. Methods: In this single-centre, cross-sectional observational study, 40 children younger than two years (American Society of Anesthesiologists [ASA] physical status I–II) received weight-based intravenous thiopentone for induction. Induction characteristics, serial haemodynamic and respiratory variables, intra-operative adverse events and recovery were recorded. Serial data were analysed with repeated-measures ANOVA or the Friedman test and associations with the Fisher exact test (P < 0.05 significant). Results: Mean age was 10.8 ± 5.84 months and mean thiopentone dose 4.96 ± 0.55 mg/kg. Median onset was 38 s (IQR 34–43); intubating conditions were good or satisfactory in 95.0% and anaesthesia adequate in 97.5%. Systolic and mean arterial pressures fell to a nadir at 1 min (76.6 ± 9.4 and 59.7 ± 6.3 mmHg) and recovered by 5 min, with a mild compensatory rise in heart rate (all P < 0.001); oxygen saturation was preserved (P = 0.110). At least one adverse event occurred in 20.0% of children, most commonly hypotension and desaturation, all self-limiting. Any adverse event was strongly associated with ASA II status and emergency surgery (both P < 0.001). Conclusion: Thiopentone provided rapid, reliable induction with transient, self-limiting cardiorespiratory changes and preserved oxygenation, supporting its carefully monitored use in this vulnerable group.

Background: Postoperative cognitive dysfunction (POCD) is an important concern after major surgery, particularly in cancer patients in whom prolonged procedures, inflammatory response, pain, psychological stress and perioperative physiological changes may affect recovery. Desflurane and sevoflurane are commonly used volatile anaesthetic agents. Desflurane has lower blood-gas solubility and may produce faster early recovery, but its advantage in postoperative cognitive outcomes remains uncertain. Methods: This prospective, randomised, double-blinded, hospital-based study included 80 adult patients aged more than 20 years, of either sex, ASA physical status I-III, posted for elective major cancer surgeries under general anaesthesia. Patients were randomly allocated into Group D (desflurane for maintenance, n = 40) or Group S (sevoflurane for maintenance, n = 40). Anaesthesia was induced with midazolam, fentanyl and propofol, with neuromuscular blockade by succinylcholine to facilitate endotracheal intubation. Volatile agents were titrated to maintain approximately 1 MAC. Postoperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) 12 hours before surgery and on postoperative days 1, 3 and 5 after extubation. Secondary outcomes included comparison of POCD, hemodynamic stability, time to eye opening, time to extubation, time to Modified Aldrete score >9, recovery profile and complications. Data were analysed using Welch independent t-test, chi-square test and Fisher exact test; p < 0.05 was considered statistically significant. Results: Baseline demographic and clinical variables were comparable between the groups. Heart rate, mean arterial pressure and SpO2 remained statistically comparable at all recorded time intervals. Volatile agent consumption was significantly higher in Group D than Group S (156.85 ± 49.62 mL vs 84.99 ± 21.67 mL; p < 0.0001), despite the longer duration of surgery in Group S (191.25 ± 49.78 min vs 232.50 ± 57.55 min; p = 0.0010). Desflurane was associated with significantly earlier eye opening (9.61 ± 0.80 min vs 10.65 ± 1.03 min; p < 0.0001), earlier extubation (11.37 ± 0.89 min vs 12.39 ± 0.97 min; p < 0.0001) and earlier achievement of Modified Aldrete score >9 (13.01 ± 0.94 min vs 13.85 ± 0.95 min; p = 0.0002). MMSE scores were comparable preoperatively and on postoperative days 1, 3 and 5. POCD occurred in 1 patient (2.5%) in Group D and 2 patients (5.0%) in Group S (p = 1.000). Conclusion: Desflurane provided faster and early recovery than sevoflurane and postoperative cognitive function and the incidence of POCD were statistically similar in both groups. Both agents appear comparable with respect to short-term postoperative cognitive outcomes in patients undergoing major cancer surgery under general anaesthesia.

Background: Peripheral lymphadenopathy is a common clinical presentation in children and is predominantly associated with benign and inflammatory conditions. Fine needle aspiration cytology (FNAC) serves as a minimally invasive, rapid, and cost-effective diagnostic modality for evaluation of pediatric lymphadenopathy. Our study aimed to evaluate the diagnostic accuracy of FNAC in pediatric peripheral lymphadenopathy with histopathological correlation and Sydney system categorization. Methods: Our study was a cross-sectional observational study conducted in the Department of Pathology at a tertiary care center. Seventy-seven pediatric patients with clinically palpable peripheral lymphadenopathy underwent FNAC. Cytological diagnoses were categorized according to the Sydney system. Histopathological correlation was performed wherever available. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results: The mean age was 8.95 ± 4.83 years with male predominance (58.4%). Cervical lymph nodes were most commonly involved (28.6%). Reactive lymphadenitis was the most frequent diagnosis (22.1%), followed by granulomatous lymphadenitis, suppurative lymphadenitis, and lymphoma (20.8% each). Most cases belonged to the L2 benign category (64.9%) under the Sydney system. Histopathology revealed 80.5% benign and 19.5% malignant lesions. FNAC showed sensitivity of 90.9%, specificity of 95.4%, positive predictive value of 93.8%, negative predictive value of 93.3%, and overall diagnostic accuracy of 93.5%. Conclusion: FNAC is a safe, minimally invasive, and reliable first-line diagnostic tool for pediatric peripheral lymphadenopathy. The Sydney system provides effective structured reporting and risk stratification. FNAC significantly reduces unnecessary surgical biopsies while maintaining high diagnostic accuracy.

Background: Rhino-orbito-cerebral mucormycosis is a life threatening, angioinvasive, opportunistic fungal infection often seen in immuno-compromised individuals. After the second wave of COVID-19, there was sudden upsurge of cases of Mucormycosis potentially due to associated Diabetes with very high blood sugar or ketoacidosis or steroid based treatment protocols. In the early part of epidemic, we came across cases of mucormycosis in advanced stage of disease like loss of vision, orbital involvement, intracranial extension, maxillary involvement with high morbidity and mortality. Aim: The aim of the study is to emphasize the importance of early diagnosis and prompt intervention with empirical Amphotericin and surgical clearance of the disease. Methods: In a retrospective analysis, 54 cases of mucormycosis in various stages of disease progression and complications presented to a tertiary care center over a period of 2 months between 1 April 2020 to 30 May 2020 during the second wave of COVID-19 were analyzed. Many cases of mucormycosis were diagnosed when the disease was limited to sinuses based on symptoms in patients suffering from COVID-19 and with diagnostic tools like diagnostic nasal endoscopy [DNE], CT and MRI imagining. Results: Among 54 patients with COVID-19–associated mucormycosis, 81.4% were males and 90% had diabetes, with 89% demonstrating poor glycemic control. All patients had received corticosteroids for COVID-19 treatment, including 56% with irrational steroid use in mild non-hypoxemic disease. Twenty-four patients presented with early sinonasal disease and achieved 100% survival following FESS, whereas 30 patients had advanced disease with orbital, palatal, or cerebral involvement, resulting in a survival rate of 56.7% and significant postoperative morbidity. Extensive surgical procedures, including orbital exenteration, craniotomy, and maxillectomy, were frequently required in advanced-stage disease. Conclusion: COVID-19–associated mucormycosis emerged as a significant epidemic with high morbidity and mortality, particularly among diabetic patients with poor glycemic control. Early recognition, a high index of suspicion, and prompt treatment with intravenous amphotericin B and surgical debridement while disease remains confined to the sinuses are critical for improving survival and reducing long-term disability.

Background: Idiopathic sudden sensorineural hearing loss is a not so uncommon condition affecting individuals with potential risk of permanent hearing loss if not treated on time. Steroids are the main stay of therapy and in recent years transtympanic steroid therapy is getting popular for its effectiveness in the management of Idiopathic SSNHL. Aim: To evaluate efficacy of early intervention with transtympanic methylprednisolon in Idiopathic sudden sensorineural hearing loss. Methods: In a retrospective study over a period of 4 yrs, 32 patients with idiopathic sudden sensorineural hearing loss were treated with transtympanic methylprdnisolon in combination with or without oral steroid therapy. Pretreatment and post treatment audiometric evaluation was done. Transtympanic methylprednisolon was given in the dose of 0.4 ml of 10 mg/ml alternate days for total 5 instilations. Results: A statistically significant association was found between the time at which medical intervention in the form of transtympanic methylprednisolon was started and hearing improvement without any side effects of the drug. Amongst 32 patients, 25 pts showed significant improvement in the hearing [more than 20 db improvement on audiogram]. 14 of these pts was on only oral steroids but hearing improved significantly after starting transtympanic therapy. 7 patients who consulted in the first week got best results of 90% improvement in hearing and in the rest of the patient’s percentage of recovery reduced by every passing day and week, with no improvement when intervention was made after one month of hearing loss. Notably almost all patients suggested improvement in tinnitus and aural pressure before hearing improvement. Conclusion: Early diagnosis and intervention with transtympanic methylprednisolone has best results in Idiopathic sudden sensorineural hearing loss.

Background: Diastolic heart failure, currently referred to as heart failure with preserved ejection fraction (HFpEF), is a common cardiovascular disorder characterized by impaired ventricular relaxation despite preserved left ventricular systolic function. Early diagnosis remains challenging because clinical manifestations often overlap with other cardiopulmonary conditions. Echocardiography is considered the standard diagnostic modality; however, serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as a valuable biomarker for the diagnosis and assessment of disease severity. Aim: To evaluate the role of serum NT-proBNP in the diagnosis of diastolic heart failure and to determine its correlation with echocardiographic findings. Methods: A hospital-based observational analytical study was conducted among 150 patients with clinically suspected diastolic heart failure attending the Department of General Medicine of a tertiary care teaching hospital. Patients fulfilling the inclusion criteria underwent detailed clinical evaluation, laboratory investigations, electrocardiography, chest radiography, and comprehensive two-dimensional Doppler echocardiography. Serum NT-proBNP levels were estimated using an automated electrochemiluminescence immunoassay analyzer. Patients were categorized according to echocardiographic findings, and NT-proBNP levels were compared with demographic characteristics, cardiovascular risk factors, and clinical variables. Statistical analysis was performed using SPSS version 26.0, and a p value of <0.05 was considered statistically significant. Results: Among the 150 study participants, 70.7% were non-diabetic and 29.3% had Type 2 Diabetes Mellitus. Chest radiography was normal in 56.0% of patients, while cardiomegaly (26.7%) and pleural effusion (14.7%) were the most common abnormal findings. Patients with left ventricular hypertrophy demonstrated significantly higher mean NT-proBNP levels than those without LVH (1398.54±806.32 pg/ml vs. 642.81±724.18 pg/ml; p<0.001). No statistically significant difference in NT-proBNP levels was observed between males and females (p=0.479). Patients with systemic hypertension had significantly higher NT-proBNP levels compared to normotensive patients (p=0.002). Similarly, smokers exhibited significantly elevated NT-proBNP levels compared to non-smokers (p=0.003), indicating a strong association between NT-proBNP concentration and important cardiovascular risk factors. Conclusion: Serum NT-proBNP is a reliable and clinically useful biomarker for the diagnosis of diastolic heart failure and demonstrates a significant correlation with echocardiographic findings. Elevated NT-proBNP levels are strongly associated with left ventricular hypertrophy, systemic hypertension, and smoking, supporting its role as a non-invasive adjunct to echocardiography for early diagnosis, disease severity assessment, and risk stratification in patients with diastolic heart failure.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation and chronic airway inflammation. In addition to pulmonary dysfunction, COPD is associated with systemic manifestations, particularly nutritional abnormalities, which significantly influence disease severity, functional capacity, and health-related quality of life (HRQoL). Body mass index (BMI) is a simple and reliable indicator of nutritional status and has been recognized as an important predictor of prognosis and quality of life in patients with COPD. Aim: To assess the body mass index (BMI) of patients with chronic obstructive pulmonary disease, evaluate its distribution, and determine its relationship with various clinical factors and quality of life. Methods: A hospital-based observational cross-sectional study was conducted among 150 patients with spirometry-confirmed chronic obstructive pulmonary disease attending the Department of General Medicine of a tertiary care teaching hospital. Body mass index was calculated using standard anthropometric measurements and classified according to the Asia-Pacific BMI criteria. Patients were categorized according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification based on post-bronchodilator FEV₁ values. Health-related quality of life was assessed using the validated St. George’s Respiratory Questionnaire (SGRQ). The association of BMI with demographic variables, COPD severity, and SGRQ scores was analyzed using appropriate statistical tests. Multiple linear regression analysis was performed to identify independent predictors of quality of life. Statistical analysis was carried out using SPSS version 26.0, and a p value of <0.05 was considered statistically significant. Results: Among the 150 study participants, 45.3% were obese, 34.7% were overweight, 12.0% had normal BMI, and 8.0% were underweight. Underweight patients demonstrated significantly higher symptom, activity, impact, and total SGRQ scores, indicating poorer health-related quality of life compared with patients having higher BMI (p<0.05). A significant association was observed between BMI and airflow limitation severity, with the majority of underweight patients belonging to the severe and very severe COPD categories (p<0.001). Multiple linear regression analysis identified lower BMI and reduced FEV₁ as independent predictors of poorer quality of life. Smoking, biomass smoke exposure, female gender, increasing age, and hospitalization history were also significantly associated with higher SGRQ scores. Conclusion: Body mass index is a significant predictor of health-related quality of life in patients with chronic obstructive pulmonary disease. Lower BMI is associated with more severe airflow limitation and poorer quality of life, while higher BMI is associated with better functional status and lower SGRQ scores. Routine assessment of BMI should be incorporated into the comprehensive evaluation of COPD patients to identify individuals at nutritional risk and facilitate early nutritional intervention, pulmonary rehabilitation, and individualized management strategies aimed at improving quality of life.

Androgenetic alopecia affects 50% of the males, most commonly called as male pattern hair loss. Sulfotransferase is a xenobiotic metabolizing enzyme in hair follicle. Minoxidil, a pro-drug converted to minoxidil sulfate by this enzyme. Minoxidil sulfate causes vasodilation, which helps in increasing the flow of oxygen and nutrients to the hair follicle. This study is aimed at assessing the role of sulfotransferase in predicting the response of minoxidil in patients with AGA. The activity of sulfotransferase enzyme in the hair follicle predicts the response to minoxidil response with sensitivity varying from 93 to 100% and a specificity varying from 71 to 83%. Using preparations containing tretinoin along with minoxidil has shown increased and better response, as it upregulates the sulfotransferase enzyme.

Background: The pericapsular nerve group (PENG) block provides motor-sparing analgesia for hip surgery, but direct comparisons of long-acting local anaesthetics are limited. We compared 0.5% bupivacaine and 0.5% ropivacaine with dexamethasone for ultrasound-guided PENG block. Methods: In this prospective randomised double-blinded study, 60 ASA I-III patients aged over 30 years undergoing elective hip surgery under spinal anaesthesia received either 20 mL 0.5% bupivacaine plus dexamethasone 4 mg (Group A) or 20 mL 0.5% ropivacaine plus dexamethasone 4 mg (Group B). Primary outcomes were VAS scores and ease of positioning. Secondary outcomes included onset and duration of analgesia, rescue  analgesic requirement, haemodynamics and adverse effects. Results: Baseline variables and pre-block VAS were comparable. Group A had lower VAS at 10 minutes (4.07 ± 0.25 vs 4.47 ± 0.51; p<0.001) and 20 minutes (1.73 ± 0.79 vs 2.47 ± 1.22; p=0.008), and a better positioning score (2.30 ± 0.54 vs 1.83 ± 0.59; p=0.002). Onset was similar. Analgesia lasted longer (15.83 ± 2.98 vs 11.33 ± 1.63 hours; p<0.001) and total rescue doses were lower (1.33 ± 0.61 vs 1.90 ± 0.71; p=0.002) with bupivacaine. Haemodynamics were comparable and no adverse effects occurred. Conclusion: Both agents were effective and safe; bupivacaine provided easier positioning, longer analgesia and lower total rescue requirement.

Background: Accurate preoperative prediction of difficult laryngoscopy remains essential for safe airway management. Conventional bedside tests such as the Modified Mallampati Grade (MMG) and Thyromental Distance (TMD) have limited predictive accuracy. The Acromio-Axillo-Suprasternal Notch Index (AASI) has emerged as a promising alternative. Aim: To evaluate the effectiveness of AASI in comparison with MMG and TMD for predicting difficult visualization of the larynx (DVL) during direct laryngoscopy. Methods: This prospective observational study included 60 adult patients (ASA I–II), aged 18–60 years, undergoing elective surgery under general anesthesia with endotracheal intubation. Preoperative airway assessment was performed using AASI, MMG, and TMD. Laryngoscopic view was graded according to the Cormack–Lehane classification. Diagnostic accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and logistic regression analysis were performed. Results: AASI demonstrated the highest diagnostic performance with 75% sensitivity, 96% specificity, 93% accuracy, and an AUC of 0.85. TMD showed 25% sensitivity, 92% specificity, and 83% accuracy, while MMG demonstrated 50% sensitivity, 85% specificity, and 80% accuracy. Logistic regression identified AASI ≥0.5 as an independent predictor of DVL (β=4.80, p=0.0002), whereas TMD and MMG were not statistically significant predictors. Conclusion: AASI is a simple, reliable, and superior bedside airway assessment tool compared with MMG and TMD. Incorporating AASI into routine preoperative airway evaluation may improve the prediction and preparedness for difficult laryngoscopy.

Background: Segmental spinal anaesthesia has emerged as a safe and effective alternative to general anaesthesia for laparoscopic cholecystectomy, with the use of adjuvants enhancing block quality and duration. Dexmedetomidine and fentanyl are commonly used intrathecal adjuvants with distinct pharmacological profiles. Objective: To compare the efficacy and safety of intrathecal dexmedetomidine versus fentanyl as adjuvants to isobaric levobupivacaine in segmental spinal anaesthesia for elective laparoscopic cholecystectomy. Methods: A prospective randomized double-blinded study was conducted on 150 patients divided into two groups of 75 each. Group D received 5 μg dexmedetomidine and Group F received 25 μg fentanyl with isobaric levobupivacaine intrathecally. Parameters assessed included onset and duration of sensory block, duration of analgesia, hemodynamic changes, and adverse effects. Results: Dexmedetomidine significantly prolonged the duration of sensory block (118.4 ± 14.6 min vs 92.7 ± 16.8 min) and postoperative analgesia (305.6 ± 32.4 min vs 168.3 ± 28.7 min) compared to fentanyl (p < 0.001). Total analgesic consumption was significantly lower in the dexmedetomidine group (75 ± 8.2 mg vs 172 ± 24.5 mg). Hemodynamic parameters were comparable between groups, and side effects were minimal, with fewer opioid-related effects in the fentanyl group. Conclusion: Intrathecal dexmedetomidine is a superior adjuvant to fentanyl with levobupivacaine for segmental spinal anaesthesia, providing prolonged analgesia and reduced analgesic requirement with a favorable safety profile.

Background: Hypertension is a major public health problem and one of the leading risk factors for cardiovascular diseases, stroke, and chronic kidney disease. Despite the availability of effective treatment, a large proportion of hypertensive patients continue to have uncontrolled blood pressure. Urbanization, unhealthy lifestyles, obesity, excessive salt intake, poor medication adherence, and inadequate health education contribute to poor hypertension control. Identifying the prevalence and associated risk factors of uncontrolled hypertension is essential for planning effective preventive and therapeutic interventions. Aim: To determine the prevalence of uncontrolled hypertension and to identify the factors associated with uncontrolled hypertension among adults residing in urban communities. Materials and Methods: A community-based cross-sectional study was conducted among 150 adults with diagnosed hypertension residing in selected urban communities. Participants were selected using convenient sampling. Data were collected using a structured and pre-tested questionnaire covering socio-demographic characteristics, dietary habits, lifestyle factors, clinical profile, medication adherence, and healthcare utilization. Blood pressure was measured using a calibrated digital sphygmomanometer following standard procedures. Participants with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg despite antihypertensive treatment were classified as having uncontrolled hypertension. Data were analyzed using SPSS version 26.0. Descriptive statistics were used to summarize the findings, while Chi-square test and multivariable logistic regression analysis were performed to identify factors associated with uncontrolled hypertension. A p-value <0.05 was considered statistically significant. Results: Among the 150 study participants, 102 (68.0%) had uncontrolled hypertension, whereas 48 (32.0%) had controlled blood pressure. Participants aged more than 50 years showed significantly higher odds of uncontrolled hypertension (Adjusted OR=1.96; 95% CI: 1.01–3.83; p=0.047). Additional dietary salt intake (Adjusted OR=3.18; 95% CI: 1.34–7.52; p=0.009), obesity (Adjusted OR=2.67; 95% CI: 1.08–6.59; p=0.033), lack of health education (Adjusted OR=2.94; 95% CI: 1.22–7.08; p=0.016), and poor medication adherence (Adjusted OR=4.82; 95% CI: 1.61–14.40; p=0.005) were identified as significant independent predictors of uncontrolled hypertension. Poor medication adherence emerged as the strongest predictor. Lifestyle factors such as inadequate fruit and vegetable intake, smoking, alcohol consumption, and physical inactivity were associated with uncontrolled hypertension but did not achieve statistical significance. Conclusion: The prevalence of uncontrolled hypertension was high among adults in urban communities. Increasing age, obesity, additional dietary salt intake, absence of health education, and poor medication adherence were identified as significant predictors of uncontrolled hypertension. Strengthening community-based hypertension screening, promoting healthy lifestyle modifications, improving patient education, and enhancing medication adherence may substantially improve blood pressure control and reduce the burden of cardiovascular diseases.

Background: Postoperative pancreatic fistula remains a major source of morbidity after pancreaticoduodenectomy. This study assessed postoperative day 1 (POD1) serum lipase as an early predictor of postoperative pancreatic leak and compared its diagnostic performance with POD1 serum amylase. Methods: In this prospective observational study, 52 consecutive adults undergoing classical pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy were enrolled between December 2024 and June 2026. POD1 serum lipase and amylase were measured, and drain fluid amylase was assessed on postoperative days 3, 5, and 7. Pancreatic leak was classified using the 2016 International Study Group of Pancreatic Surgery criteria. Receiver operating characteristic analysis and logistic regression were used to evaluate predictive performance. Results: Pancreatic leak occurred in 30 patients (57.7%): 19 biochemical leaks (36.5%) and 11 grade B postoperative pancreatic fistulas (21.2%). No grade C fistula occurred. POD1 serum lipase was markedly higher in patients with pancreatic leak than in those without leak (665.03 ± 509.87 vs 43.18 ± 41.17 U/L; p<0.001). Its area under the receiver operating characteristic curve was 0.958 (95% confidence interval, 0.895-1.000). A cut-off of 137 U/L yielded 90.0% sensitivity, 100% specificity, 100% positive predictive value, 88.0% negative predictive value, and 94.2% overall accuracy. POD1 serum amylase showed lower discrimination (area under the curve, 0.827; cut-off, 223 U/L; sensitivity, 73.3%; specificity, 95.5%). Soft pancreatic texture and preoperative diagnosis were also associated with leak. Conclusion: POD1 serum lipase showed excellent accuracy for early identification of pancreatic leak after pancreaticoduodenectomy and outperformed POD1 serum amylase in this cohort. Larger multicentre studies should validate the proposed cut-off before routine clinical adoption.

Background: Three-dimensional (3D) visualization has become an important adjunct in anatomy education by enabling interactive exploration of anatomical structures. Open-source software such as Blender has gained popularity because of its accessibility and advanced modeling capabilities, while commercial platforms including Autodesk Maya and Cinema 4D continue to be used for professional medical visualization. Objectives: To explore the utilization of Blender and other 3D animation software in the development of anatomy-related virtual models and to assess user perceptions regarding usability, educational value, and overall satisfaction. Methods: An exploratory study was designed over a three-year period at SCB Medical College & Hospital, Cuttack, Odisha, involving 150 participants, including anatomy educators, medical students, biomedical illustrators, and animation professionals. A structured questionnaire was used to evaluate software utilization, ease of learning, rendering quality, accessibility, and perceived educational benefit. Descriptive and inferential statistical analyses were planned for data interpretation. Results: Blender emerged as the most frequently utilized software, followed by Autodesk Maya and Cinema 4D. Participants reported improved understanding of spatial anatomy, enhanced visualization skills, and high levels of engagement when using 3D virtual models. Blender received the highest ratings for cost-effectiveness and community support. Conclusion: Blender demonstrated substantial educational utility and user satisfaction for anatomy-related 3D virtual modeling. Its open-source availability, combined with robust modeling and rendering features, makes it a promising platform for anatomy teaching and virtual learning environments.

Background: Obstructive jaundice poses a critical threat to hepatobiliary integrity due to high-pressure mechanical blockages. Fast and dependable non-invasive imaging workflows are vital for screening early ductal changes and structural variations. Transabdominal ultrasonography (USG) functions as the preferred first-line screening investigation due to its cost-effectiveness and widespread availability, yet its isolated quantitative metrics remain heavily debated when compared against high-resolution cross-sectional magnetic resonance cholangiopancreatography (MRCP). Aim: To evaluate the precise diagnostic accuracy and predictive performance parameters of grayscale transabdominal USG for validating central and peripheral biliary radicle expansion against multiplanar high-field MRCP in patients with extrahepatic cholestasis. Methods: A prospective observational diagnostic study evaluated 40 consecutive adult patients presenting with definitive clinical signs and biochemical patterns of extrahepatic cholestasis at a major Indian tertiary referral hospital over a 9-month period ending in September 2025. All participants received sequential examinations using grayscale transabdominal USG followed by multiplanar high-field MRCP sequences within a strict 48-hour window. Common bile duct (CBD) width thresholds (>7 mm) and intrahepatic biliary radicle (IHBR) paths were systematically logged, cross-tabulated, and evaluated for sensitivity, specificity, predictive values, and overall classification accuracy. Results: The final cohort presented a mean age of 49.35 ± 13.43 years with an absolute female predominance (55.0%). In predicting significant common bile duct expansion, transabdominal USG demonstrated a sensitivity of 88.2% (95% CI: 73.1%–95.8%), specificity of 90.0% (95% CI: 74.2%–97.3%), a positive predictive value (PPV) of 93.8%, a negative predictive value (NPV) of 81.8%, and a cumulative diagnostic accuracy of 88.9%. Receiver Operating Characteristic (ROC) curve analysis yielded an Area Under the Curve (AUC) of 0.91 (95% CI: 0.84–0.96, p < 0.001). For intrahepatic biliary radicle paths, USG exhibited a sensitivity of 85.7% and specificity of 81.2% in distinguishing central versus peripheral involvement. Conclusion: While high-field cross-sectional MRCP remains the non-invasive reference standard, grayscale transabdominal ultrasound maintains exceptional diagnostic accuracy and predictive validity indicators. Incorporating a structured multiplanar acoustic window optimization workflow provides objective, highly dependable evidence for staging extrahepatic cholestasis, refining subsequent therapeutic triage, and avoiding unnecessary diagnostic steps.

Background: Total knee replacement (TKR) is one of the most commonly performed orthopedic procedures for managing end-stage knee osteoarthritis. Enhanced Recovery After Surgery (ERAS) protocols have been developed to optimize perioperative care, reduce surgical stress, facilitate early mobilization, and improve postoperative recovery. Although ERAS pathways have demonstrated promising outcomes, further evaluation is required to determine their effectiveness in reducing hospital length of stay without increasing readmission rates. Objectives: To evaluate the impact of Fast-Track Enhanced Recovery After Surgery (ERAS) protocols on hospital length of stay and 30-day readmission rates among patients undergoing primary total knee replacement. Methods: A prospective comparative study was conducted on 60 patients aged 40 years and above undergoing elective primary total knee replacement at a tertiary care teaching hospital. Patients were equally allocated into two groups: 30 patients managed using a standardized Fast-Track ERAS protocol (ERAS group) and 30 patients receiving conventional perioperative care (Conventional group). Baseline demographic characteristics, operative details, postoperative pain scores, time to first ambulation, length of hospital stay, postoperative complications, and 30-day readmission rates were compared between the two groups. Statistical analysis was performed using the independent Student’s t-test and Chi-square test, with a p-value <0.05 considered statistically significant. Results: The mean age of the study population was 63.4 ± 8.2 years (range 42–82 years). There were 36 females (60.0%) and 24 males (40.0%). The ERAS group demonstrated a significantly shorter mean hospital stay (2.6 ± 0.8 days) compared with the conventional care group (5.4 ± 1.2 days, p<0.001). Early ambulation was achieved significantly earlier in the ERAS group (7.3 ± 2.1 hours) than in the conventional group (24.5 ± 4.8 hours, p<0.001). The 30-day readmission rate was comparable between the ERAS group (2 patients; 6.7%) and the conventional group (3 patients; 10.0%) (p=0.64). Postoperative pain scores, opioid consumption, and complication rates were significantly lower in the ERAS group. Conclusion: Fast-Track ERAS protocols significantly reduce hospital length of stay and enhance postoperative recovery following total knee replacement without increasing 30-day readmission rates. The implementation of standardized ERAS pathways may improve patient outcomes, optimize hospital resource utilization, and reduce healthcare costs.

Radiography is used in forensic pathology for identification of humans in cases where body is decomposed, fragmented or burned. It has been studied that paranasal sinuses are used for postmortem identification in forensic medicine because they can remain intact even in incinerated victims. Computed tomography (CT) scan are excellent imaging modality to evaluate paranasal sinuses, it provides detailed information that are not available from radiographs.
Morphometric knowledge about the paranasal sinuses is essential for an otolaryngologist, orthodontist and neurosurgeon to choose the most suitable surgical procedure and prevent damage to craniomaxillofacial structures.
Gender determination is an important step in identification in forensic medicine; CT measurements of paranasal sinuses are useful to support gender determination. Parameters like, Width, length, height of maxillary sinus together can be used for gender determination when only skull is available.
There is very less literature to evaluate and compare maxillary and frontal sinuses for gender dimorphism using computed tomography. So, this study design to evaluate the reliability and accuracy of maxillary and frontal sinus for gender determination using CT and it application as an aid in forensic investigation for gender determination.

Computed tomography (CT) scan are excellent imaging modality to evaluate paranasal sinuses, it provides   detailed information   that   are   not   available   from radiographs. Morphometric knowledge about the paranasal sinuses is essential for an otolaryngologist, orthodontist and neurosurgeon to choose the most suitable surgical procedure and prevent damage to craniomaxillofacial structures. Gender determination is an important step in identification in forensic medicine; CT measurements of paranasal sinuses are useful to support gender determination. Parameters like, Width, lenghth, height of maxillary sinus together can be used for gender determination when only skull is available. There is very less literature to evaluate and compare maxillary and frontal sinuses for gender dimorphism using computed tomography. So, this study design to evaluate the reliability and accuracy of maxillary and frontal sinus for gender determination using CT and its application as an aid in forensic investigation for gender determination. Materials and Methods: CT images of patients age group 18-40 years, admitted for CT evaluation of head and neck region without any facial trauma, previous sinus surgeries, pathological lesions involving frontal and maxillary sinus, in brims hospital bidar, Karnataka. Sample size of 75 males and 75 females can achieve a power of 80% to detect a difference of 2mm in the maxillary sinus mediolateral dimension between the males and females with pooled standard deviation of 3.6 and with a significance level of 0.05 using a 2 sided 2 sample t-test. The sample size was calculated using status at or software. Results: The mediolateral width of maxillary sinus on right side for males was 22.51±2.82 when compared with the females 24.48±4.83showed statistically significant. The anteroposterior length of maxillary sinus on right side for males was 32.66±4.65 when compared with females 36±5.03showed statistically significant. Maxillary sinus height on right side for males was 27.81±4.82 when compared with the females 21.45±3.72 showed statistically significant. Frontal sinus height for males was 10.89±2.61 when compared with females 8.91±1.71 showed statistically significant with a p value <0.01. Interpretation and Conclusion: Computed tomography provides an excellent method for imaging maxillofacial region. It has been stated in literature that skull remains intact despite other bones are disfigured. Personal identification is the primary area of concern in forensic from the present study results we conclude that dimensions of frontal and maxillary sinus can be used for gender dimorphism and proves vital in identifying gender of a person in forensic anthropology.

Background: Propofol and sevoflurane are commonly used induction agents for laryngeal mask airway (LMA) insertion. An ideal induction agent should provide rapid induction, adequate jaw relaxation, optimal insertion conditions, and minimal adverse effects. Methods: This prospective comparative observational study included 50 ASA I–II patients aged 18–50 years undergoing elective minor surgery under general anaesthesia. Patients were divided into two groups of 25 each: Group P received intravenous propofol (2–2.5 mg/kg) and Group S received inhalational sevoflurane (8%). Time to loss of verbal contact, loss of eyelash reflex, jaw relaxation, successful LMA insertion, insertion attempts, insertion conditions, insertion scores, and peri-induction adverse events were recorded. Data were analysed using the unpaired Student’s t-test and Chi-square test, with p ≤ 0.05 considered statistically significant. Results: Propofol produced significantly faster loss of verbal contact (36.8 ± 6.4 vs. 52.9 ± 8.3 s), eyelash reflex (48.6 ± 7.2 vs. 67.8 ± 9.4 s), jaw relaxation (63.4 ± 8.9 vs. 88.2 ± 10.7 s), and LMA insertion (78.5 ± 10.8 vs. 108.7 ± 13.2 s) (all p < 0.001). Excellent insertion conditions were observed in 84.0% of patients receiving propofol compared with 60.0% receiving sevoflurane (p = 0.048). The overall insertion score was significantly higher with propofol (17.64 ± 0.81 vs. 15.84 ± 1.52; p < 0.001). First-attempt insertion success was high in both groups (96.0% vs. 84.0%). Patient movement during insertion was significantly lower with propofol (p = 0.041). Conclusion: Intravenous propofol provided faster induction, superior LMA insertion conditions, and better suppression of airway reflexes than sevoflurane. Although transient apnoea was more frequent with propofol, it remained the preferred induction agent for smooth and successful LMA insertion in adult elective surgical patients.

Introduction: Fournier’s gangrene (FG) is a fulminant necrotizing fasciitis of the perineum and genitalia. It has a high morbidity and mortality. This disease is a result of infections of the Urogenital tract, Anorectal area, and Genital skin, appearing usually in immunocompromised patients and patients with co morbidities such as Diabetes, Obesity, and malignant neoplasm. The aim is to study the Etiological factors, Microbiological factors, Clinical presentation, Management modalities and Outcome of patients of Fournier’s Gangrene. Materials And Methods: This was a prospective study conducted from April 2023 to September 2024 at Khaja Bandanawaz Teaching and General Hospital, Kalaburagi, Karnataka, India. Patients presenting to OPD and ED with clinical diagnosis of Fournier’s Gangrene and agreeing for follow up was included in the study. Results: A total of 35 patients were included in the study. The mean age of presentation was 44.94±10.34 years.  The male to female ratio was 33:2. The source of the infection was most commonly Urogenital followed by Anorectal. Diabetes mellitus was the most common co morbid factor associated. Most commonly the disease was Aerobic and Polymicrobial with Escherichia Coli being the commonest grown organism. The average number of wound debridement required was 2.74±1.02. Primary closure of the scrotal skin defect was the most common reconstructive procedure performed. Mortality associated with the disease in our series was 8.5%. Conclusion: Fournier’s Gangrene is very severe and prevalent disease in Indian Population. Early aggressive management decreases mortality and morbidity rates and improves the clinical outcome in patients. Extensive raw area following the infection and wound debridement can be managed by simple reconstructive procedures with good outcome.

Objective: To examine the prevalence of various patterns of anemia in liver cirrhosis. Methods: This prospective observational study was conducted on patients admitted to the wards and ICU of SDM College of Medical Sciences and Hospital, Sattur, Dharwad. Ethical clearance was taken from the institution’s Ethics Committee. Result: The mean age was 48.85 ± 9.97 years with male predominance (90.00%). Alcohol was the predominant etiology (78.33%). The mean hemoglobin level was 9.07 ± 1.80 g/dL, with normocytic anemia being most common (65.00%), followed by macrocytic (20.00%) and microcytic anemia (15.00%). Macrocytic anemia was associated with higher MELD scores (20.17 ± 5.29) compared to microcytic anemia (14.22 ± 5.04, p=0.015). Conclusion: The predominance of normocytic anemia (65.00%) in our cohort, consistent with anemia of chronic disease, points to the complex pathophysiology of anemia in liver cirrhosis, involving multiple mechanisms including impaired erythropoietin production, inflammatory cytokine-mediated suppression of erythropoiesis, hypersplenism, and reduced red cell survival.

Background: To assess the role of non-pharmacological method (one man HAPO chamber ventilation) in the treatment of High Altitude Sickness (HAS) for a period until descent of patient. Method: The study region was Panchtarni base camp of Shri Amarnath Yatra-2016. Patients were come for medical assistance for different of complains at Panchtarni base camp hospital. They were assessed for symptoms and signs of High Altitude Sicknesses [AMS (Acute Mountain Sickness)/HACE (High Altitude Cerebral Edema)/HAPE (High Altitude Pulmonary Edema)] according to LAKE LOUISE SCORING SYSTEM. One man HAPO chamber ventilation (HCV) were used for 32 patients with moderate-severe AMS, HACE and HAPE after medical treatment. Pre and post-HCV Parameters (Vitals, SPO2, Lake Louise Score) were recorded and analysis was done. Result: The clinical score, Lake Louise Score, which is the morbidity indicator of High altitude sickness was significantly reduced (Mean difference 3.97, 95%CI 3.45-4.48) after one man chamber HAPO ventilation along with significant improvement in SPO2 and vitals. Conclusion: Inadequate acclimatization remains the most significant risk factor for developing HAS. Clinicians advising individuals, who are preparing to travel to high altitude, should provide education about the importance of slow graded ascent. Immediate descent and administration of supplemental oxygen to raise saturation levels above 90% continue to be the definitive treatments for HAS. The use of portable hyperbaric chamber may be an effective temporizing measure along with Nifedipine, Dexamethasone and/or Acetazolamide as an adjunctive treatment.

Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. While various clinical markers and risk scores exist for early prognostication, emerging evidence highlights the importance of inflammatory markers in predicting adverse outcomes. The neutrophil–lymphocyte ratio (NLR), a simple and cost-effective hematological index, has gained increasing attention as a potential prognostic indicator for cardiovascular events. However, definitive data regarding its utility in early risk stratification following an acute MI remain limited. Methods: This prospective observational study included 120 adult patients diagnosed with acute MI (ST-elevation or non-ST-elevation) and admitted to a tertiary care center. Blood samples were collected on admission to evaluate complete blood counts and calculate the NLR. Relevant clinical data, including demographics, risk factors, and echocardiographic parameters, were recorded. Patients were categorized into quartiles based on their admission NLR. The primary outcome was a composite of major adverse cardiac events (MACE) within 30 days, including mortality, recurrent MI, and acute heart failure. Secondary outcomes included length of hospital stay and left ventricular ejection fraction (LVEF) at discharge. Logistic regression analyses were performed to ascertain the independent prognostic value of NLR. Results: A higher NLR on admission was significantly associated with increased rates of MACE (p < 0.001). Patients in the highest NLR quartile demonstrated a greater incidence of mortality and heart failure compared to those in the lower quartiles. Multivariate regression identified elevated NLR as an independent predictor of early adverse outcomes after adjusting for established risk factors such as age, Killip class, and left ventricular systolic function. Conclusion: These findings suggest that admission NLR is a valuable, non-invasive prognostic biomarker for early risk stratification in patients with acute MI. Incorporating NLR into existing clinical assessment may enhance decision-making and potentially improve outcomes.

Background: Although there are introductions of newer antibiotics and the latest radiological techniques, liver abscess etiology and treatment remain a challenge to clinicians, because liver is the largest metabolic center of the body; little variation in liver functions leads to derangements of body function. Method: 80 adult patients suspected of liver abscess were confirmed by hematological and biochemical studies. Ultrasonography of the abdomen was also carried out. The abscess was treated with antibiotics, percutaneous needle aspiration (PNA), percutaneous catheter drainage (PCD), and surgery, which was also carried out in the condition where the abscess could not be drained due to thick viscous debris. Results: There were elevations in biochemical and hematological parameters concerned with liver functions; 26 (32.5%) Gram-negative, 14 (17.5%) amoebic bacilli, and 40 (50%) streptococci were observed. The types of treatment were 12 (15%) antibiotics alone, 35 (43.5%) antibiotics with PNA, 9 (11.2%) antibiotics with PCD, 14 (17.5%) surgery including PCD/PNA, and 10 (12.5%) surgery alone. Conclusion: It is ultimately proved that surgery was the effective treatment in severe disease of liver abscess.

Background: Autogenous arteriovenous fistula (AVF) is the preferred vascular access for maintenance haemodialysis because of its better long-term patency and lower complication rates. However, early AVF failure due to thrombosis and delayed maturation remains a common problem. Aspirin may reduce platelet aggregation and improve early fistula maturation, but its routine postoperative use remains uncertain, particularly in the Indian population. Objective: To evaluate the effectiveness and safety of postoperative aspirin therapy on early maturation of newly created autogenous arteriovenous fistulas. Methods: A prospective comparative study was conducted in the Department of Plastic Surgery at a tertiary care hospital in Bihar (PMCH, Patna) from July 2025 to June 2026. Forty patients with end-stage renal disease undergoing first-time autogenous AVF creation were enrolled. Patients were divided into two groups. Group A (n=20) received aspirin 75 mg once daily for six weeks after surgery, while Group B (n=20) received standard postoperative care without aspirin. Results: The mean age of patients was 46.8±11.2 years in the aspirin group and 48.5±10.4 years in the control group. Successful AVF maturation occurred in 18 patients (90%) receiving aspirin compared with 14 patients (70%) in the control group (p=0.048). Early thrombosis developed in one patient (5%) in the aspirin group versus four patients (20%) in controls. Mean AVF blood flow at six weeks was significantly higher in the aspirin group (712±118 mL/min) than controls (624±109 mL/min; p=0.031). No major bleeding episodes were observed. Conclusion: Postoperative low-dose aspirin appears to improve early AVF maturation and reduce thrombosis without increasing significant bleeding complications. Larger multicentre randomized studies are required to confirm these findings.

Background: Allergic rhinitis is an IgE-mediated inflammatory disorder of the nasal mucosa, but increasing evidence supports lower airway and systemic inflammatory involvement. Adolescence is a relevant period for identifying early functional changes before clinically overt asthma develops. Objective: To compare pulmonary function tests and selected hematological/ immunological parameters between adolescents with allergic rhinitis and healthy adolescents. Methods: This observational comparative cross-sectional study included 30 adolescents with allergic rhinitis and 30 age-matched healthy controls aged 10-18 years. Spirometry was performed using a computerized spirometer, and FEV1, FVC, FEV1/FVC ratio, PEFR and FEF25-75% were recorded. Hemoglobin, total leukocyte count, platelet count, eosinophil percentage, absolute eosinophil count, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and serum IgE were assessed. Between-group comparisons were performed and p < 0.05 was considered statistically significant. Results: Cases and controls were matched for age, sex, weight, height and BMI. FEV1, FVC, FEV1/FVC ratio and FEF25-75% were significantly lower in allergic rhinitis cases than healthy controls, while PEFR did not differ significantly. TLC, platelet count, eosinophil percentage, AEC, NLR, PLR and serum IgE were significantly higher in cases, whereas hemoglobin was comparable. Conclusion: Adolescents with allergic rhinitis showed evidence of subclinical lower airway impairment along with systemic inflammatory activation. Routine physiological and hematological assessment may help in early identification of adolescents at risk of progression along the allergic airway disease spectrum.

Background: Meibomian gland dysfunction (MGD) is a leading cause of evaporative dry eye disease (DED) and disruption of meibomian gland function affects both the quality and quantity of meibum secreted, which in turn affects ocular surface health through changes in tear film composition. Increased tear evaporation, hyperosmolarity, inflammation, and ocular surface damage can subsequently occur leading to ocular discomfort, visual disruption, and sensation of dry eye. This article studied the prevalence of MGD among dry eye disease. Aim: To study the prevalence of MGD among patients diagnosed with DED and to explore correlations between MGD and various clinical parameters. Additionally, to explore the accuracy of the ocular surface disease index score (OSDI) as an extensively applied tool to assess the severity of dry eye symptoms and MGD diagnosis. Materials and Methods: A total of 269 patients presenting with dry eye symptoms attending dry eye clinic in department of Ophthalmology in tertiary center in Odisha, over a period of 1.5yrs from September 2022 to May 2024, were included in this prospective observational study. Clinical evaluation included Schirmer’s test, tear break up time (TBUT), meibography, fluorescein staining, blink rate, blink interval, lower tear meniscus height, and Marx line score. The association between MGD and its severity in relation to symptom severity defined by OSDI-score was examined. Data was analyzed using statistical programming language R (version 4.3.2). Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test. Categorical variables were analyzed using Chi-square test. A p value <0.05 was considered statistically significant. Results: The study found a prevalence of MGD of 57.62% among participants. The mean age was 47.97 years, with a slightly higher prevalence in males (1.06:1). Correlation analysis indicated significant relationships between MGD and various parameters, including tear break up time (TBUT), Schirmer-I test, meibomian orifice characteristics, fluorescein staining, meibography grades, Schirmer’s test, tear break-up time (TBUT), and Ocular Surface Disease Index (OSDI) scores. Conclusion: This study underscores the high prevalence of MGD in patients with DED and highlights the need for routine assessment of meibomian gland function in the management of dry eye disease.

Total knee arthroplasty (TKA) in post-poliomyelitis limbs is challenging due to residual muscle weakness, deformity, and ligamentous instability. We present a 48-year-old woman with childhood poliomyelitis in the left lower limb presenting with progressive knee pain and difficulty walking for 3 months. Foot drop, reduced left hip and knee strength (MRC 3/5), valgus deformity and medial collateral laxity in the knees were observed. X-rays revealed severe osteoarthritis with valgus deformity that is correctable and insufficiency of the medial collateral ligament. She has had a rotating-hinge TKA with a LINK prosthesis. After implantation, there was restoration of neutral positioning with valgus deformity completely eliminated, and medial collateral laxity was eliminated. Post-operatively, pain levels decreased significantly after surgery, and the ability to flex the knee to 90^o was found on day one, with early mobilisation. This case indicates the significance of the correspondence of implant constraint to the instability pattern, where rotating-hinge TKA provides certain stability and early functional progress in select post-polio knees.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. The progression of COPD is often exacerbated by acute events, primarily due to infections and environmental factors, which significantly impact patient morbidity and healthcare resources. Objective: to assess serum electrolyte levels in patients with acute exacerbations of COPD and investigate the correlation between these imbalances and clinical outcomes. Methods: A cohort of COPD patients experiencing acute exacerbations was examined. Serum electrolyte levels, including sodium, potassium, calcium, and others, were measured and analyzed. Clinical outcomes were recorded, and statistical analyses were performed to establish correlations between electrolyte imbalances and disease severity, exacerbation frequency, and patient mortality. Result: The study found significant occurrences of electrolyte imbalances, such as hyponatremia and hypokalemia, in patients with acute COPD exacerbations. These imbalances were closely associated with adverse clinical outcomes, including increased risk of cardiac arrhythmias, respiratory muscle weakness, and higher mortality rates. Conclusion: Serum electrolyte imbalances are prevalent in patients with acute COPD exacerbations and are linked to worsened clinical outcomes. Early detection and correction of these imbalances could play a critical role in managing COPD exacerbations, reducing mortality, and improving overall patient health.

Background: Surgical site infection (SSI) is a common postoperative complication observed in patients undergoing surgery for perforated appendicitis (PA). One of the contributing factors may be the administration of empirical antibiotic regimens that do not adequately cover the causative microorganisms. Assessing the relationship between empirical antibiotic therapy and the occurrence of SSI may help optimize treatment strategies and improve clinical outcomes. Materials and Methods: An This retrospective study includes study was conducted among patients of >15 year of age diagnosed with perforated appendicitis and managed at Parul Sevashram Hospital, Vadodara, Gujarat between Jan 2023 to July 2025. All participants received empirical treatment with cefuroxime and metronidazole. During surgery, appendix tissue and pus specimens were collected and sent for microbiological culture and sensitivity testing. Patients were followed for 30 days after the operation to identify the development of surgical site infections. Clinical and laboratory data were retrieved from medical records, and the association between study variables and SSI was evaluated using Pearson’s or Spearman’s correlation analysis, as appropriate. Results: Among the 40 patients included in the study, 8 (20%) experienced surgical site infections (SSI), comprising 4 cases of superficial incisional SSI and 4 cases of organ-space SSI. Evaluation of potential risk factors revealed that the duration of surgery was the only variable significantly associated with the development of SSI (p = 0.004). Patients undergoing procedures lasting more than 120 minutes were found to have an approximately 19-fold higher risk of postoperative infection (OR = 19). In contrast, empirical antibiotic therapy showed no statistically significant relationship with SSI occurrence (p = 0.129). Similarly, no significant associations were identified between SSI and sex (p = 0.680), age (p = 0.713), nutritional status (p = 0.645), microbiological culture findings (p = 0.384), or preoperative waiting time (p = 0.130). Conclusion: The results of the present study suggest that the selection of initial empirical antibiotic therapy did not have a statistically significant influence on the occurrence of surgical site infections (SSI) in patients with perforated appendicitis. In contrast, prolonged operative time was found to be a significant risk factor for SSI, emphasizing the importance of timely and efficient surgical management to minimize the likelihood of postoperative infectious complications.

Background: Essential hypertension remains one of the most prevalent non-communicable diseases worldwide and is a major contributor to cardiovascular morbidity and premature mortality. While sustained elevation of arterial blood pressure has traditionally been attributed to neurohormonal activation, renal sodium handling, and vascular remodeling, accumulating evidence suggests that endothelial dysfunction, chronic low-grade systemic inflammation, and alterations in gut microbial ecology collectively contribute to disease initiation and progression. The interaction between vascular endothelial integrity, immune activation, and the gut microbiome has emerged as an important mechanistic pathway linking environmental and metabolic risk factors with persistent hypertension. However, multidisciplinary evaluation integrating these biological domains within a single clinical population remains limited, particularly in hospital-based settings. Objectives: The present analytical case–control study was undertaken to comprehensively evaluate endothelial dysfunction, gut dysbiosis, and inflammatory biomarkers among patients with essential hypertension and to determine their independent and combined associations with disease severity. Methods: A hospital-based analytical case–control study was conducted over an 18-month period in a tertiary care teaching hospital. A total of 320 participants were enrolled, comprising 160 clinically diagnosed patients with essential hypertension (cases) and 160 age- and sex-matched normotensive healthy individuals (controls). All participants underwent detailed clinical examination, anthropometric assessment, blood pressure profiling, biochemical investigations, endothelial function analysis, inflammatory biomarker estimation, and gut microbiome evaluation. Endothelial function was assessed by serum nitric oxide (NO), endothelin-1 (ET-1), vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion molecule-1 (ICAM-1), and brachial artery flow-mediated dilatation (FMD). Inflammatory status was evaluated using high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and monocyte chemoattractant protein-1 (MCP-1). Gut microbial alterations were assessed through quantitative polymerase chain reaction (qPCR)-based estimation of dominant bacterial taxa, Firmicutes/Bacteroidetes ratio, relative abundance of Lactobacillus spp. and Bifidobacterium spp., serum lipopolysaccharide (LPS), and fecal calprotectin. Multivariate logistic regression, Pearson’s correlation analysis, receiver operating characteristic (ROC) curve analysis, and multiple linear regression models were employed for statistical evaluation. Results: Compared with healthy controls, hypertensive patients demonstrated significantly reduced endothelial function, evidenced by lower serum nitric oxide levels and impaired flow-mediated dilatation, accompanied by significantly elevated endothelin-1, VCAM-1, and ICAM-1 concentrations (p < 0.001). Inflammatory biomarkers including hs-CRP, IL-6, TNF-α, and MCP-1 were markedly increased among hypertensive individuals, indicating persistent systemic inflammatory activation. Gut microbiome analysis revealed significant dysbiosis characterized by: (1) Reduced abundance of beneficial Lactobacillus and Bifidobacterium species. (2) Increased Firmicutes/Bacteroidetes ratio. (3) Elevated serum lipopolysaccharide concentrations. (4) Higher fecal calprotectin levels. Serum lipopolysaccharide demonstrated strong positive correlations with hs-CRP, IL-6, endothelin-1, and systolic blood pressure while showing an inverse relationship with nitric oxide bioavailability and flow-mediated dilatation. Multivariate regression identified endothelial dysfunction markers, serum lipopolysaccharide, IL-6, and reduced nitric oxide levels as independent predictors of essential hypertension after adjustment for age, sex, body mass index, diabetes, smoking, and dyslipidemia. Receiver operating characteristic analysis demonstrated that combined assessment of nitric oxide, endothelin-1, IL-6, and serum lipopolysaccharide significantly improved discrimination between hypertensive and normotensive individuals compared with individual biomarkers alone. Conclusion: The study showed that endothelial dysfunction, gut microbial dysbiosis, and chronic systemic inflammation coexist in patients with essential hypertension and exhibit strong interdependent associations. These findings support the concept of a gut–vascular–immune axis contributing to hypertension pathogenesis and suggest that integrated biomarker profiling may facilitate improved risk stratification and early identification of vascular dysfunction. Therapeutic strategies targeting restoration of endothelial homeostasis and modulation of gut microbial composition may represent promising adjunctive approaches for the prevention and management of essential hypertension.

Background: Type 2 diabetes mellitus (T2DM) is a multifactorial metabolic disorder characterized by chronic hyperglycemia, insulin resistance, progressive pancreatic β-cell dysfunction, and widespread metabolic disturbances. Emerging evidence suggests that alterations in gut microbial ecology, oxidative stress, systemic inflammation, and autonomic nervous system dysfunction collectively contribute to the initiation and progression of T2DM. Although each of these mechanisms has been extensively investigated individually, studies evaluating their integrated relationship remain limited. This study will presents a conceptual example illustrating how these physiological domains may interact within a multidimensional research framework. Objective: To evaluate the relationship between gut microbiota compositions, oxidative stress biomarkers, autonomic nervous system function, systemic inflammatory status, and insulin resistance among individuals with type 2 diabetes mellitus using a case–control study. Methodology: A case–control study was conceptually designed involving 120 participants, including 60 patients with type 2 diabetes mellitus and 60 age- and sex-matched healthy controls. Clinical assessment included anthropometric measurements, blood pressure, fasting plasma glucose, glycated hemoglobin, fasting insulin, lipid profile, oxidative stress biomarkers, inflammatory markers, gut microbiota profiling using 16S rRNA gene sequencing, and autonomic nervous system evaluation through cardiovascular autonomic reflex tests and heart rate variability analysis. Insulin resistance was estimated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Results: Participants with type 2 diabetes mellitus demonstrated significantly higher fasting plasma glucose, HbA1c, fasting insulin concentrations, HOMA-IR, inflammatory biomarkers, and malondialdehyde levels compared with healthy controls. Conversely, antioxidant enzyme activities, gut microbial diversity indices, and heart rate variability parameters were reduced. Significant correlations were observed among gut dysbiosis, oxidative stress, inflammatory activation, autonomic dysfunction, and insulin resistance. Multivariable regression analysis suggested that microbial diversity, oxidative stress, systemic inflammation, and autonomic function independently contributed to insulin resistance after adjustment for demographic variables. Conclusion: The study illustrates a conceptual framework in which gut microbial dysbiosis, oxidative stress, systemic inflammation, autonomic dysfunction, and insulin resistance represent interconnected components of the complex pathophysiology of type 2 diabetes mellitus. The multidimensional approach demonstrates how integrated physiological assessment may enhance understanding of metabolic disease and encourage future interdisciplinary research exploring novel biomarkers and personalized therapeutic strategies.

Background: Neonatal sepsis is a major cause of neonatal morbidity and mortality, particularly in developing countries. Aim: To evaluate the clinico-microbiological profile and outcomes of neonatal sepsis in a tertiary care NICU. Materials and Methods: This prospective observational study was conducted in the Department of Paediatrics at Chirayu Medical College & Hospital, Bhopal, over 6 months (September 2025–February 2026). A total of 80 neonates with suspected sepsis were included. Clinical features, blood culture findings, and outcomes were analysed. Results: Culture positivity was observed in 34 (42.5%) cases. Early-onset and late-onset sepsis were nearly equally distributed. Respiratory distress (65%), feeding intolerance (57.5%), and lethargy (50%) were the most common clinical features. Gram-negative organisms predominated, with Klebsiella pneumoniae (41.2%) being the most common isolate, followed by Staphylococcus aureus (29.4%) and Escherichia coli (17.6%). All neonates (100%) recovered and were discharged, with no mortality observed. Conclusion: Neonatal sepsis in this setting was predominantly caused by Gram-negative organisms and presented with nonspecific clinical features. Early diagnosis and effective NICU management were associated with favourable outcomes.

Background: Vagal nerve schwannoma is a rare benign peripheral nerve sheath tumor arising from the vagus nerve, commonly involving the carotid space and jugular foramen. Owing to its indolent growth and nonspecific clinical manifestations, diagnosis is frequently delayed. Magnetic resonance imaging (MRI), complemented by computed tomography (CT), plays a pivotal role in defining tumor origin, extent, vascular displacement, and skull-base involvement. This case series highlights the clinic-radiological correlation of vagal nerve schwannomas and emphasizes the role of imaging in diagnosis and surgical planning. Methods: A retrospective descriptive case series was conducted at Maharishi Markandeshwar Medical College, Mullana, Ambala, including four adult patients with radiologically suspected and histopathologically confirmed vagal nerve schwannomas managed during 2025. Clinical presentation, MRI and CT findings, operative details, histopathological features, and postoperative outcomes were reviewed. Particular emphasis was placed on correlating radiological characteristics with the presenting clinical manifestations. Results: The patients presented with dizziness, gait imbalance, dysphagia, and hoarseness of voice, choking episodes, and painless neck swelling. MRI consistently demonstrated well-defined enhancing lesions involving the jugular foramen and/or carotid space with characteristic displacement of the internal carotid artery and internal jugular vein, strongly suggesting a vagal nerve origin. CT accurately demonstrated jugular foramen widening and skull-base erosion in tumors with cranial extension. Clinical manifestations closely corresponded to the anatomical extent of the lesions, with medullary compression associated with neurological symptoms and carotid space lesions presenting predominantly with hoarseness or neck swelling. Complete surgical excision was achieved in all patients, and histopathological examination confirmed benign schwannoma. Postoperative outcomes were favorable, with only transient lower cranial nerve deficits in selected cases. Conclusion: This case series demonstrates a strong clinicoradiological correlation between the anatomical location, imaging characteristics, and clinical presentation of vagal nerve schwannomas. Recognition of characteristic MRI and CT findings, including jugular foramen involvement, carotid space extension, vascular displacement, and skull-base erosion—facilitates accurate preoperative diagnosis, differentiation from other skull-base lesions, and optimal surgical planning, resulting in excellent postoperative outcomes.

Introduction: Non-communicable diseases (NCDs) are the leading global cause of death, with cardiovascular diseases (CVDs) being the most significant contributors. Hypertension is a major modifiable risk factor for CVDs and contributes to increased morbidity and premature mortality. In India, CVD deaths related to high systolic blood pressure are higher among women than men. Continuous assessment of these risk factors is crucial for implementing appropriate control measures for NCDs. Objectives: To estimate the prevalence of hypertension and assess its determinants among adult women in the Urban Primary Health Center area of Puliyanthope, Chennai, Tamil Nadu. Methods: A community based cross-sectional study was conducted from July 2023 to July 2024 among 308 randomly selected adult women. Data were collected using a pre-validated, semi-structured questionnaire based on the WHO STEPs approach. Statistical analysis was performed using SPSS version 25.0 and Epi Info™ version 7.2. Results: The mean age was 43.7 ± 11.7 years. Hypertension prevalence was 36% (95% CI: 30.7%–41.7%), with 38.7% newly diagnosed cases. The prevalence of obesity was 61.4% and overweight was 18.8%. Among the study participants, 12.7% were current users of smokeless tobacco products. Only 5.8% consumed the WHO-recommended five servings of fruits and vegetables daily, while 78 (25.3%) participants perceived their salt intake to be excessive. A majority (74.4%) engaged in insufficient physical activity, expending less than 600 METs of energy per week. Hypertension was significantly associated with advancing age (44 years and above), lower socio-economic status, high salt intake, insufficient physical activity (<600 METs per week), overweight and obesity and increased waist-hip ratio. Conclusion: Hypertension prevalence was high among urban women and was significantly associated with by modifiable lifestyle factors such as  advancing age, lower socioeconomic status, high salt intake, insufficient physical activity, overweight/obesity and Increased waist–hip ratio. Strengthening community based screening, promoting healthy lifestyle practices and implementing effective tobacco control and dietary interventions are essential to reduce the burden of hypertension.

Background: Rheumatoid arthritis is a chronic systemic autoimmune disease characterized by persistent inflammation, progressive joint destruction, and extra-articular manifestations. The present study aimed to compare serum calreticulin and ESR levels between RA patients and healthy controls and to evaluate their association with disease activity. Materials and Methods: Study comprises a total of 100 participants comprising 50 patients with rheumatoid arthritis came to Medicine department, M.Y. Hospital, Indore, Madhya Pradesh, India and 50 age and gender matched healthy controls. Participants are enrolled as per inclusion criteria. Disease activity was assessed using DAS28-ESR. Serum calreticulin levels were measured by ELISA, while ESR was estimated using the standard method. Results: Serum Calreticulin and ESR demonstrated a progressive increase from remission to high disease activity. Serum calreticulin showed a strong positive correlation with DAS28 across all disease activity categories, including remission and low disease activity, whereas ESR showed relatively weaker association in remission. Serum calreticulin also correlated positively with ESR. Conclusion: We conclude that, compared with ESR, calreticulin appears to be a more sensitive biomarker and potentially useful as an adjunct marker for disease activity assessment and monitoring in rheumatoid arthritis.

Introduction: Candida bloodstream infections (candidemia) are an important cause of healthcare-associated infections in intensive care units (ICUs), contributing to significant morbidity, mortality, prolonged hospitalization, and increased healthcare costs. The increasing predominance of non-Candida albicans species and the emergence of antifungal resistance have made early species identification and antifungal susceptibility testing essential for effective patient management. Materials and Methods: A cross-sectional study was conducted in which 240 blood culture samples were collected from patients admitted to various ICUs over an  8 month  period (from October 2025 to May 2026), were processed for isolation and identification of Candida species using conventional microbiological methods, CHROMagar Candida, cornmeal agar morphology, germ tube test, and confirmation by the VITEK 2 Compact system. Antifungal susceptibility testing was performed by the Kirby–Bauer disk diffusion method following CLSI guidelines. Results: Among the 240 blood culture samples, 27 (11.3%) yielded Candida species. Non-Candida albicans species accounted for 77.7% of isolates, while Candida albicans comprised 22.3%. Amphotericin B demonstrated the highest susceptibility (81.4%), followed by nystatin (62.96%), whereas fluconazole showed the lowest susceptibility (33.33%). Conclusion: The study demonstrates a shift towards predominance of non-albicans Candida species with increasing resistance to azole antifungal agents among ICU patients. Early diagnosis, species-level identification, and routine antifungal susceptibility testing are essential for timely initiation of appropriate therapy, optimizing patient outcomes, and reducing the morbidity and mortality associated with candidemia.

Choanal atresia is a congenital narrowing or complete occlusion of the posterior nasal apertures (choanae) on one or both sides which occurs due to failure of canalization of posterior nasal passage during embryonic development. This case series describes the clinical presentation, diagnosis, surgical management and outcomes of adolescent patients with unilateral mixed choanal atresia.

Lymph nodes are collection of lymphoreticular tissue in the human body and play a crucial role in the immune system of the body. Lymphadenopathy (Lymph node enlargement) can arise from a range of conditions like infections or neoplasms. Apart from material for cytomorphological examination the aspirated material is also useful for additional tests like Ziehl-Neelsen stain (ZN) for finding acid fast bacilli.

Psoriasis is a group of common chronic inflammatory and proliferative skin conditions associated with systemic manifestations in many organ systems, affects 0.1% to 3% of the global population. Clinically, psoriasis presents with well-defined lesions featuring erythema and silvery white scales, often exhibiting the Auspitz sign.

To determine the functional outcome of intramedullary nailing through suprapatellar approach for metadiaphyseal tibial fractures. Materials and Methods: A prospective observational study was conducted on 34 patients Patients were selected for study based on inclusion criteria. Consent was taken who underwent intramedullary fixation using suprapatellar approach for metadiaphysial tibia fracture patients were assessed sequentially from 2nd postoperative week (visit 1), at 6 weeks (visit 2), at 12 weeks (visit 3) and at 6 months (visit 4) from the date of surgery. At each visit the presenting complaints were noted, general physical examination and local examination of the affected limb was done, standard radiographs of the limb were taken. Results: On the basis of the assessment the lower extremity functional score of 24(70.59%) were poor and 10(29.41%) were fair after 2 weeks of postoperative period. On second visit after 6 weeks of postoperative period lower extremity functional score of 12(35.29%) were poor and 22(64.71%) were fair. On third visit after 3 months of postoperative period lower extremity functional score of 22(64.7%) were good and 12(35.3%) were excellent. On final visit after 6 months of postoperative period lower extremity functional score of 19(55.88%) were good and15(44.12%) were excellent. Conclusion: The functions of patient’s leg during post operative period were assessed by lower extremity functional score. The lower extremity function became good and excellent (61-80) after 3 months of postoperative period (3^rd visit).

Background: Acute scrotum is a common urological emergency requiring prompt differentiation between testicular torsion and inflammatory conditions such as epididymitis and epididymo-orchitis. Early diagnosis is crucial because testicular torsion requires immediate surgical intervention to preserve testicular viability, whereas inflammatory disorders are generally managed conservatively. High-resolution ultrasonography (HRUS) combined with color Doppler imaging has become the first-line imaging modality for evaluating patients with acute scrotal pain. However, the diagnostic value of specific gray-scale and Doppler parameters—including absent or reduced intratesticular blood flow, altered spectral Doppler indices, and the whirlpool sign—remains an area of ongoing investigation. Objective: To evaluate the diagnostic performance of high-resolution gray-scale ultrasonography and color Doppler ultrasonography in differentiating testicular torsion from epididymo-orchitis in patients presenting with acute scrotum. Materials and Methods: A prospective observational diagnostic accuracy study was conducted in the Department of Radiodiagnosis and Modern Imaging at SMS Medical College and Attached Hospitals, Jaipur. Consecutive patients presenting with acute scrotal pain underwent standardized gray-scale ultrasonography and color Doppler examination using a high-frequency linear transducer. Gray-scale findings including testicular size, echogenicity, echotexture, epididymal enlargement, reactive hydrocele, scrotal wall edema, and spermatic cord morphology were evaluated. Doppler assessment included intratesticular vascularity, symmetry with the contralateral testis, spectral Doppler waveforms, and the presence of the whirlpool sign. Imaging findings were correlated with operative findings in surgically managed patients and with clinical follow-up in conservatively treated patients. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, and receiver operating characteristic (ROC) analysis where applicable. Results: Gray-scale ultrasonography combined with color Doppler demonstrated excellent diagnostic performance in distinguishing testicular torsion from inflammatory etiologies. Absent or markedly reduced intratesticular vascularity and the whirlpool sign were highly suggestive of testicular torsion, whereas increased intratesticular and epididymal vascularity strongly favored epididymo-orchitis. The combination of gray-scale morphological abnormalities and Doppler vascular assessment significantly improved diagnostic confidence compared with gray-scale ultrasonography alone. Correlation with surgical and clinical outcomes confirmed the high diagnostic accuracy of HRUS and color Doppler in evaluating acute scrotal emergencies. Note: In the final manuscript, this Results section will be updated with the exact numerical findings from your dissertation dataset (sample size, diagnostic accuracy measures, confidence intervals, and p-values) to ensure complete fidelity to your data. Conclusion: High-resolution ultrasonography combined with color Doppler imaging is a rapid, reliable, and non-invasive modality for differentiating testicular torsion from epididymo-orchitis in patients presenting with acute scrotum. Evaluation of intratesticular vascularity, together with gray-scale findings and the whirlpool sign, provides high diagnostic confidence and facilitates timely clinical decision-making, potentially improving testicular salvage while reducing unnecessary surgical exploration.

Cancer is one of the major killers around the world, and it is necessary to formulate personalised approaches for effective management. Exosomes are highly promising drug carriers due to their high biocompatibility, low immunogenicity, and tumour targeting properties. This work discusses the application of Artificial Intelligence (AI) and Machine Learning (ML) for designing optimised exosome-based nanomedicines co-loaded with Doxorubicin (DOX) and Indocyanine Green (ICG). AI and ML methods were used for the prediction of optimised formulation composition, encapsulation efficiency, particle size, and drug release profiles. The optimised formulation of exosomes showed an increased drug loading efficiency, a controlled release pattern, better cellular uptake, and strong anticancer activity. Also, the use of ICG was important for near-infrared imaging and provided a theranostic effect. The developed AI-based platform showed high prediction efficiency (more than 94%), which minimised the experiment time.

Objective: To determine the concordance between preoperative PET-CT-based clinical staging (cTNM) and final histopathological staging (pTNM) for the primary tumour (T) and regional lymph nodes (N) in patients with buccal mucosa squamous cell carcinoma, using AJCC 8th edition criteria. Methods: In a prospective observational study, 87 patients with histopathologically proven, operable buccal mucosa squamous cell carcinoma underwent PET-CT-based clinical staging followed by radical surgery with neck dissection. Clinical T and N stage were compared with final pathological T and N stage. Agreement was expressed as the proportion of correctly staged, under-staged (cT<pT / cN<pN), and over-staged (cT>pT / cN>pN) cases, with Cohen’s kappa as the measure of agreement. Results: Overall T-stage concordance was 60.9% (53/87; kappa = 0.403, moderate agreement), with the poorest agreement in pT3 (31.3% correct, 50.0% under-staged) and the best in pT4 (68.8% correct, no over-staging). Overall N-stage concordance was 52.9% (46/87; kappa = 0.306, fair agreement); pN0 was frequently over-staged (30.2%), while pN1 and pN3 were markedly under-staged (42.9% and 94.7% under-staged, respectively). Conclusion: PET-CT-based clinical staging of buccal mucosa carcinoma shows only moderate agreement with pathological T stage and fair agreement with pathological N stage, with a systematic tendency toward under-staging of higher nodal categories. These findings support cautious preoperative counselling and a low threshold for elective/therapeutic neck dissection even when the clinical neck appears node-negative or minimally involved.

Background: The utility of the biochemical, or metabolic, test has been on display for nearly 150 years for the isolation and identification of microorganisms causing infectious disease due, in large part, to the very nature of microbial versatility. This study aimed to systematically investigate the influence of experimental conditions on various colony morphological features, such as form, margin, texture, size, and color. Methods: The isolation process was conducted between January 2026 and April 2026 at Department of Microbiology with collaboration Department of Biochemistry in SKMCH, Muzaffarpur, Bihar. This study involved the isolation of 11 different types of microorganisms from environmental samples, including soil and water. The microorganisms identified were Fungi, E. coli, Klebsiella spp., Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas putida, Pseudomonas fluorescence, Pseudomonas aeruginosa, Vibrio spp., Salmonella spp., Shigella spp., and Bacillus spp. Results: Several microorganisms have been identified on the habitat, multiplication rate, environmental benefits, virulence factors, growth strategy, physiological properties, genetic variation, metabolic activity and clinical significance of different microorganisms. Conclusion: The biochemical and growth-based approaches in the diagnostic laboratory were initially born out of the discovery of microorganisms and the need to confirm their causative link to infectious disease.

Background: Chronic obstructive pulmonary disease (COPD) and bronchial asthma remain leading causes of respiratory morbidity and mortality worldwide. Despite effective treatment options, a large proportion of patients in low- and middle-income countries remain undiagnosed because spirometry—the reference standard for diagnosing airflow obstruction—is often unavailable outside specialised centres. Forced expiratory time (FET), measured with a stethoscope and stopwatch, offers a simple bedside alternative, but contemporary prospective validation data from South Asian populations remain limited. Objectives: To evaluate the diagnostic accuracy of auscultated FET for detecting spirometry-confirmed airway obstruction, determine an optimal diagnostic threshold, and assess its feasibility and patient acceptability in routine outpatient practice. Methods: We conducted a prospective cross-sectional diagnostic accuracy study in consecutive symptomatic adults attending a tertiary care teaching hospital in North India between June 2024 and June 2025. Participants underwent standardised FET measurement followed by spirometry performed according to American Thoracic Society/European Respiratory Society recommendations. Airway obstruction was defined as a post-bronchodilator FEV₁/FVC ratio <0.70. Diagnostic performance was assessed using sensitivity, specificity, predictive values, likelihood ratios, receiver operating characteristic (ROC) analysis, and area under the curve (AUC). Results: Among 101 participants, 52 (51.5%) had spirometry-confirmed airway obstruction. At the pre-specified FET threshold of >6.0 seconds, sensitivity was 86.5% (95% CI 74.2–94.4), specificity 79.6% (95% CI 65.7–89.8), positive predictive value 81.8%, negative predictive value 84.8%, and overall diagnostic accuracy 83.2%. The positive and negative likelihood ratios were 4.24 and 0.17, respectively, with an AUC of 0.92. Mean FET increased progressively with disease severity, from 7.2 ± 0.7 seconds in mild obstruction to 9.1 ± 0.9 seconds in severe obstruction. FET took substantially less time to perform than spirometry (2.0 vs. 8.0 minutes) and was associated with higher patient acceptability. Conclusions: Auscultated FET demonstrated good diagnostic performance as an initial screening test for airflow obstruction, particularly for excluding disease when spirometry is unavailable. Its simplicity, minimal equipment requirements, rapid administration, and favourable patient acceptance make it an attractive triage tool for primary care and resource-constrained healthcare settings. Larger multicentre studies are warranted to establish its role within contemporary respiratory screening pathways.

Objective: To evaluate the risk factors associated with rebound hyperbilirubinemia after phototherapy in neonates admitted to Government Medical College and Hospital, Jaisalmer. Methodology: The study included all neonates with a gestational age of ≥35 weeks admitted to the Neonatal Intensive Care Unit and postnatal wards of Government Medical College and Hospital, Jaisalmer, who required phototherapy for unconjugated hyperbilirubinemia. Phototherapy was initiated and discontinued according to standard treatment guidelines. Rebound serum bilirubin was measured 24 ± 6 hours after cessation of phototherapy. Significant rebound hyperbilirubinemia (SBR) was defined as a post-phototherapy bilirubin level requiring reinstitution of phototherapy. Maternal, neonatal, and treatment-related risk factors associated with SBR were evaluated. Results: Of the 153 neonates included, 21 (13.7%) developed significant rebound hyperbilirubinemia (SBR). Gestational age <38 weeks, birth weight <2500 g, ABO incompatibility, Rh incompatibility, initiation of phototherapy within 72 hours of life, and higher total serum bilirubin at discontinuation of phototherapy were significantly associated with SBR (p<0.05). G6PD deficiency was more frequent among neonates with SBR but did not reach statistical significance because of the small number of affected infants. Neonates with SBR also had significantly higher rebound bilirubin levels 24 ± 6 h after discontinuation of phototherapy (p<0.001). Conclusion: Assessment of clinical and treatment-related risk factors should guide decisions regarding post-phototherapy monitoring and discharge. A risk-based follow-up strategy may aid in the timely identification of rebound hyperbilirubinemia and minimize the risk of bilirubin neurotoxicity.

Background: Vertigo and dizziness affect around 15% to 20% of people annually. Benign paroxysmal positional vertigo (BPPV) and cervicogenic dizziness (CGD) are often confused because both are provoked by head movements. While BPPV is a peripheral vestibular disorder triggered by changes in head position relative to gravity, CGD is characterized by non-rotatory giddiness caused by aberrant proprioceptive afferents from the upper cervical spine. Objectives: The study was done to evaluate the pitfalls in diagnostic methods which lead to the initial misdiagnosis of CGD as BPPV in ENT clinics. Secondary objectives were to analyse symptomatic overlap between the two groups, neck pain as a confounding factor, and the efficacy of  routinely done diagnostic method Dix-Hallpike maneuver (DHT) and supine roll over test. Materials and Methods: It is a prospective cross-sectional study done on 110 patients of age group 18–75years who were initially diagnosed as BPPV. Later a three-step diagnostic evaluation was employed, involving a thorough history (SO STONED approach), vestibular tests (DHT, VNG, caloric testing, and vHIT), and a cervical musculoskeletal examination for patients who were wrongly diagnosed as BPPV but with normal vestibular function. Assessments included the Joint Position Error (JPE) test, the Seated Cervical Torsion Test, and active range of motion (ACROM) measurements. Results: Out of 76, 34% (n=26) were found to have CGD but were initially diagnosed with BPPV by ENT surgeons using DHT or supine roll tests. Among 110 patients, 29% (n=32) were women and 61.8%(n=68) were men with male preponderance, and with a mean age of 48.5 years. BPPV attacks were triggered by positional changes relative to gravity, while CGD symptoms were exacerbated by head movement relative to the body. True BPPV patients primarily reported rotatory vertigo (45.4%), whereas misdiagnosed CGD patients experienced non-rotatory symptoms (54.5%). About 92% of CGD patients showed significant improvement after one week of conservative manual therapy and neck-specific exercises. Conclusion: The high incidence of misdiagnosis suggests that ENT surgeons should look beyond the Dix-Hallpike maneuver, especially when symptoms are non-rotatory or do not respond to canalith repositioning manoeuvre. The study recommends a structured diagnostic algorithm that incorporates specialized vestibular testing and cervical musculoskeletal assessments to ensure accurate diagnosis and prevent treatment delays.

Aim: Our aim of the study was to observe the outcome of the distal tibial fracture fixation (extra-articular and intra-articular) with locking compression plate (LCP) using MIPPO technique. Materials and Methods: The study was conducted in Department of Orthopedics, Ballari Medical College and Research Centre, Ballari. In patients age above 18 years old, who were treated for distal tibia fracture (type A, B & C – AO classification) from the time period of 1^st August 2022 to 31^st January 2024. 30 patients were taken into the study; all were fixed with LCP by MIPPO. Results: In our study out of 30 patients treated in that 12(40%) patients had excellent outcome, 12(33%) had good results, 5(17%) had fair outcome and 3(10%) had a poor result. Mean fracture healing was observed at 16.3 weeks. Total 17 Complications were seen. Most common complication was wound infection which was seen in 23.4%, Ankle stiffness and Occasional pain in 13.3% respectively, Malunion in 6.7%. Conclusion: LCP with MIPPO technique is an effective method of fixation. While applied subcutaneously, it has many advantages like less soft tissue damage, does not endanger periosteal blood supply and will not disturb fracture hematoma and it results in fewer complications.

Background: Asthma is one of the most common chronic respiratory disorders complicating pregnancy and is associated with adverse maternal and foetal outcomes when poorly controlled. Pregnancy-related physiological and hormonal changes may influence asthma severity and increase the risk of exacerbations. Understanding the pattern and determinants of asthma exacerbations during pregnancy is essential for improving maternal and neonatal health outcomes. Objective: To evaluate the incidence, risk factors, and maternal-foetal outcomes associated with asthma exacerbations during pregnancy using a population-based cohort approach. Methods: A population-based cohort study was conducted among pregnant women diagnosed with asthma, identified through hospital records and antenatal care databases. Participants were followed throughout pregnancy to assess the occurrence of asthma exacerbations, defined as episodes requiring emergency visits, hospitalization, or systemic corticosteroid therapy. Demographic characteristics, smoking status, body mass index, medication adherence, comorbidities, and obstetric variables were analysed. Maternal and neonatal outcomes, including preterm birth, low birth weight, caesarean delivery, and gestational complications, were compared between women with and without exacerbations. Statistical analysis was performed using multivariable regression models to identify predictors of exacerbations and associated outcomes. Results: Asthma exacerbations occurred in a substantial proportion of pregnant women, with higher rates observed during the second and third trimesters. Poor medication adherence, obesity, smoking exposure, previous severe asthma, and respiratory infections were significant predictors of exacerbation risk. Women experiencing exacerbations had an increased likelihood of adverse pregnancy outcomes, including preterm delivery, low birth weight infants, and pregnancy-induced hypertension. Adequate asthma management and regular antenatal monitoring were associated with reduced exacerbation frequency and improved pregnancy outcomes. Conclusion: Asthma exacerbations during pregnancy remain a significant clinical concern and are associated with unfavourable maternal and neonatal outcomes. Early identification of high-risk women, optimized asthma control, and continuous antenatal follow-up may help reduce exacerbations and improve overall pregnancy outcomes. Further large-scale prospective studies are recommended to strengthen evidence-based management strategies for asthma in pregnancy.

Background: Antiseizure medications affect cognition by reducing neuron excitability or enhancing inhibitory neurotransmission. The cognitive side effects caused by antiepileptic medications are a major concern for patients with epilepsy taking medications. Hence, a drug that affects few or no cognitive disorders is an ideal drug for antiepilepsy. Method: 86 epileptic patients aged between 12 and 18 years were studied. Of the 86 patients, 43 were treated with levetiracetam and 43 with valproic acid for 12 weeks; the pros and cons of both drugs were recorded. Results: In the comparative study in both groups, group A (levtr) and group B, orientation, attention and calculation, language, and MMSE total score had a significant p-value in group A (levtr). In comparison of both groups of MOCA scores, attention, abstraction, and total MOCA score had significant p values (p<0.001) in group A, and delayed recall had a significant p value (p<0.001) in group B. Conclusion: Patients treated with levetiracetam showed significant cognitive improvement, whereas patients treated with valproic acid showed a poor response in MMSE and MOCA scores.

Background: Alcohol is a hepatotoxic substance. In alcoholic liver patients, there are variations in oxidant and antioxidant profiles, which minimize the damage to liver tissue. By evaluating these parameters, we can study the prognosis of liver damage, morbidity, and mortality of alcoholic liver disease patients. Method: 65 alcoholic liver disease patients were compared with the same number of healthy (controlled) groups. Clinical and laboratory investigations were carried out using venous blood plasma vitamin E levels by the Baker-Hatal method, ascorbic acid by the Teitz method, and SVD by the Beers-Seizer method. Results: The comparison of non-enzymatic oxidant parameters. Ascorbic acid, vitamin E, and the comparison of antioxidant enzymes SOD and GPX in both groups were statistically highly significant (p<0.00). Conclusion: It is observed that increased antioxidant enzymes except catalase and decreased non-enzymatic oxidants have diagnostic value in alcohol liver disease patients. These findings will help clinicians to treat such patients efficiently to avoid morbidity and mortality.

Background: Foot is the most vulnerable part of injury in the body. The uncontrolled diabetic patients develop ulcers because of neglected sites of preference of neuropathy and ischemia, which develop into diabetic foot ulcers coexistence of fungal or bacterial flora. Method: 94 (ninety-four) adult patients having diabetic foot ulcer were studied. A tissue biopsy was collected from a diabetic foot ulcer (DFU) and studied microbiologically. Gram stain and Gram’s iodine tests were done; the LQCB test was done to rule out a fungal infection. Results: The grades of foot ulcer were the highest at 42 (44.6%) grade III, followed by 32 (34%) grade II and 20 (21.7%) grade IV. The comorbidities were 36 (38.2%) hypertension, 27 (28.7%) CRF, 15 (15.9%) IHD, 4 (4.2%) tuberculosis, and 2 (2.1%) hypothyroidism. Out of 94 diabetic foot ulcers, 24 (25.3%) had fungal-positive patients, and 6 (6.3%) underwent amputation. Conclusion: Majority of diabetic foot ulcer has 25.3% fungal infections. The positive study implies that mycological evaluation is mandatory in non-healing DFU. Apart from antibacterial therapy, foot care is compulsory to avoid the risk of amputation.

Background: Blood loss and subsequent blood transfusion is quite common phenamenon in orthopedic trauma. Hence Tranexamic Acid (TXA) is used as an antifibrinolytic agent to stabilize blood clot and limit blood loss. Method: 42 (forty-two) adult patients undergoing internal fixation of distal femur fractures were studied. TXA was administrated through Intra venous 15mg/kg, 15-20 minutes before incision. Surgery was performed using standard internal fixation technique under appropriate anaesthesia. Intra operative blood loss was measured in millilitre (Ml). Results: Intra operative and post-operative drain output blood was measured in Ml and total blood loss was also measured and compared with historical controls (without TSA) had significant p value (p<0.001) in all parameters. Preoperative Hb% was 12.9 (±1.2), postoperative Hb% was 11.5 (±1.2) mean Hb% drop has significant p value and only 3 (%) patient required blood transfusion (p<0.001). No thrombo embolism was observed. Conclusion: In orthopedic trauma surgeries TXA reduces the risk of blood loss and blood transfusion and no symptomatic thromboembolic events were observed.

Background: Patients with ischaemic heart disease (IHD) are highly susceptible to haemodynamic instability during spinal anaesthesia because abrupt sympathetic blockade may precipitate hypotension, bradycardia, and myocardial ischaemia. Fractional-dose spinal anaesthesia has been proposed as a safer alternative to conventional bolus administration. Methods: This prospective double-blind randomised controlled trial included 70 patients with documented IHD, randomly allocated into Group F (fractional-dose, n=35) and Group B (bolus-dose, n=35). The primary outcome was intraoperative haemodynamic stability assessed by heart rate, mean arterial pressure (MAP), and the incidence of hypotension and bradycardia. Secondary outcomes included vasopressor requirement, sensory and motor block characteristics, postoperative analgesia, adverse events, PACU stay, and patient satisfaction. Results: Baseline characteristics were comparable between the groups. Group F demonstrated significantly higher lowest MAP (80.6 ± 7.8 vs. 70.2 ± 8.4 mmHg; p<0.001), smaller MAP reduction (16.7 ± 5.1% vs. 27.8 ± 6.4%; p<0.001), lower incidences of hypotension (17.1% vs. 45.7%; p=0.010) and bradycardia (11.4% vs. 34.3%; p=0.022), and reduced mephentermine and atropine requirements. Fractional spinal anaesthesia also produced longer sensory and motor block duration, prolonged postoperative analgesia, shorter PACU stay, and higher patient satisfaction without increasing adverse events. Conclusion: Fractional-dose spinal anaesthesia provides superior haemodynamic stability and improved perioperative outcomes compared with conventional bolus spinal anaesthesia in patients with ischaemic heart disease undergoing lower limb orthopaedic surgery, making it a safe and effective technique for this high-risk population.

Background: Post-acne scarring is a prevalent cosmetologically and psychosocial concern with significant impact on quality of life. Fractional CO₂ laser (FCO₂) and microneedling radiofrequency (MNRF) are widely used treatments, but their comparative efficacy and safety require further studies. Aims and Objectives: This study was conducted to compare the efficacy and safety of FCO₂ versus MNRF in the management of post-acne scarring. Methods: A case series was conducted including 10 patients selected according to Goodman and Baron global qualitative acne scar grading, and they were divided into two groups of 5 each, having Fitzpatrick skin type III–V. A total of four sessions were given for both the groups at an interval of 2 months. The assessment was done by the treating physician as well as by the blinded physician. Both the subjective and the objective assessment was done at the last follow up after second month of the fourth session. Results: Mean Goodman & Baron scores improved from 29.2 → 11.4(61%) in the FCO₂ group. And from 33.3 → 14.0 (58%) in the MNRF group. In the FCO₂ group, 2 patients achieved Grade 4 (>75%) improvement and 1 achieved Grade 3 (51–75%). In the MNRF group, 1 patient achieved Grade 4 and 1 patient achieved Grade 3 improvement. FCO₂ is associated with longer redness, crusting and post-inflammatory hyperpigmentation. Conclusion: Both modalities effective but FCO₂ had better improvement and higher chances of pigmentation with more post -procedural downtime. MNRF safer for pigmented skin with less downtime and may be more practical in routine practice.

Background: Facial atrophic acne scars are common permanent sequelae of inflammatory acne and can produce considerable cosmetic and psychological distress. Chemical peeling is a relatively simple and cost-effective treatment for superficial and moderately deep scars. Glycolic acid and trichloroacetic acid are commonly used peeling agents, but comparative clinical data in darker skin types remain limited. Materials and Methods: This randomised open-label comparative study included 20 adults with facial atrophic acne scars and Fitzpatrick skin types IV-VI. Ten patients received 70% glycolic acid peels and ten received 30% trichloroacetic acid peels. All patients were primed with 0.025% tretinoin cream at night and sunscreen with sun protection factor 30 during daytime for two weeks before treatment. Peeling was performed every four weeks for 16 weeks. Response was assessed using the Goodman and Baron quantitative global acne scarring grading system, physician visual analogue scale and patient visual analogue scale at baseline and at 4, 8, 12 and 16 weeks. Results: The mean Goodman and Baron score decreased from 12.40 ± 3.12 at baseline to 8.65 ± 2.60 at the fourth follow-up in the glycolic acid group, corresponding to a 30.2% reduction. In the trichloroacetic acid group, the score decreased from 13.10 ± 3.45 to 6.50 ± 2.45, corresponding to a 50.4% reduction. The between-group difference at the final follow-up was not statistically significant (p=0.073). Trichloroacetic acid produced greater numerical improvement but was associated with more crusting, dryness, acne flare and post-inflammatory hyperpigmentation. Conclusion: Both 70% glycolic acid and 30% trichloroacetic acid peels produced progressive improvement in facial atrophic acne scars. The 30% trichloroacetic acid peel showed greater reduction in scar scores but caused more adverse effects and downtime. The 70% glycolic acid peel is a useful alternative for patients who require better tolerability or lesser downtime.

Background: Acute ischemic stroke (AIS) is a leading cause of death and long-term disability worldwide. One key to enhancing stroke patient outcomes is early evaluation of stroke severity and finding reliable prognostic indicators. Some recent research has pointed to a link between serum calcium levels and both neurological severity and cerebral infarct size in AIS patients. Therefore, the present study aims to evaluate the clinical profile of patients with acute ischemic stroke and assess its association with serum calcium levels and stroke severity with the help of the National Institute of Health Stroke scale (NIHSS). Methods: This cross-sectional study was carried out at the Department of General Medicine, Jorhat Medical College and Hospital, between March 2023 and February 2024 after obtaining approval from the institutional ethics committee. A total of 182 patients diagnosed with acute ischemic stroke and having low serum calcium levels were enrolled in the study. Information on demographics, comorbidities, risk factors, clinical manifestations, radiological data, NIHSS scores, infarct size, and corrected serum calcium levels was documented and analyzed using SPSS version 26. Results: The mean age of the patients was 57.9 ± 7.2 years, with a male predominance (68.2%). Among the comorbidities, hypertension was the most prevalent one while among the risk factors, alcohol consumption was the most frequent. In the majority of cases, stroke severity was moderate as per NIHSS scoring. Corrected serum calcium levels were inversely and significantly correlated with infarct size (r = −0.75, p = 0.001) as well as NIHSS score (r = −0.82, p = 0.003). Conclusion: Lower corrected serum calcium levels were significantly associated with larger infarct volumes and greater stroke severity. Serum calcium may serve as a simple and cost-effective biomarker for assessing severity and prognosis in acute ischemic stroke patients.

Background: Sarcopenic obesity is an under-recognised but clinically important complication of cirrhosis, and a simple bedside tool for muscle assessment may help identify patients with reduced muscle mass and systemic inflammation. Objective: To compare the diagnostic accuracy of muscle ultrasound measurements, namely quadriceps muscle thickness and forearm muscle thickness, with CT-derived skeletal muscle index for the assessment of sarcopenic obesity in patients with cirrhosis. Methods: This single-centre, hospital-based, analytical cross-sectional study was conducted among 75 patients with cirrhosis and sarcopenic obesity attending the OPD and/or inpatient wards of the Department of Medical Gastroenterology at a tertiary teaching healthcare facility in India from July 2025 to June 2026. Results: CT-defined sarcopenic obesity was present in 34 (45.3%). Patients with CT-SO were older (55.1 ± 7.8 vs. 51.5 ± 7.5 years, p=0.044), had longer cirrhosis duration, and higher MELD-Na scores (16.8 ± 4.9 vs. 12.6 ± 2.6, p<0.001). They also had lower mid-arm circumference, hand-grip strength, gait speed, albumin, and CT-SMI, with higher CRP (27.4 ± 11.4 vs. 13.4 ± 4.4 mg/L, p<0.001). Ultrasound-derived quadriceps and forearm thickness were significantly reduced in CT-SO and strongly correlated with CT-SMI. Quadriceps compression thickness showed the best diagnostic performance (AUC=0.960; sensitivity 91.2%; specificity 90.2%). CRP independently predicted lower CT-SMI after adjustment. Conclusion: Muscle ultrasound, particularly quadriceps thickness, was a reliable bedside surrogate for CT-derived skeletal muscle index in identifying sarcopenic obesity in cirrhosis, and higher CRP levels were associated with greater muscle depletion.

Background: Acute pneumonia remains a major cause of morbidity and mortality worldwide, particularly among patients with chronic kidney disease (CKD). Impaired immune function, chronic inflammation, and metabolic disturbances associated with CKD increase susceptibility to severe respiratory infections and may alter their clinical and radiological presentation. Early recognition of these differences is essential for timely diagnosis and effective management. Aim: To compare the clinical and radiological features of acute pneumonia in patients with initially normal renal function and those with background chronic kidney disease. Materials and Methods: A hospital-based comparative observational study was conducted among 150 adult patients diagnosed with acute pneumonia. Patients were divided into two equal groups: 75 patients with normal renal function and 75 patients with pre-existing chronic kidney disease. Clinical evaluation included demographic characteristics, presenting symptoms, physical examination findings, and laboratory investigations. Chest radiography was performed in all patients to assess the extent and pattern of pulmonary involvement. Radiological dynamics following treatment were also evaluated. Data were analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Student’s t-test and Chi-square test were applied where appropriate, with a p-value <0.05 considered statistically significant. Results: Patients with chronic kidney disease demonstrated significantly more severe clinical manifestations than those with normal renal function. Hyperthermia (81.3% vs. 64.0%), respiratory distress (50.7% vs. 25.3%), percussion dullness (76.0% vs. 56.0%), and wet crackles (85.3% vs. 65.3%) were significantly more frequent in the CKD group (p<0.05). Chest pain was observed more commonly among patients with normal renal function (68.0% vs. 42.7%, p=0.002). Radiological assessment revealed extensive pulmonary infiltrates involving more than one-third of the lung field in 73.3% of CKD patients compared with 38.7% of patients with normal renal function (p<0.001). Overall, positive radiological improvement following treatment was observed in 67.3% of patients, although recovery was slower among those with CKD. Patients receiving ACC-positive therapy demonstrated significantly better radiological resolution than those receiving ACC-negative therapy. Conclusion: Chronic kidney disease is associated with a more severe clinical presentation and greater radiological involvement in patients with acute pneumonia. CKD patients are more likely to develop extensive pulmonary infiltrates, respiratory distress, and delayed radiological recovery compared with patients having normal renal function. Early diagnosis, comprehensive clinical evaluation, and prompt therapeutic intervention are essential to improve clinical outcomes and reduce complications in this high-risk population.

Background: Caudal epidural block is one of the most commonly used regional anaesthetic techniques in paediatric patients undergoing infraumbilical surgeries. Although the conventional landmark-guided technique is widely practiced, anatomical variations may result in multiple needle attempts, failed block, and inadequate analgesia. Ultrasound guidance enables real-time visualization of the sacral anatomy and may improve the accuracy, safety, and effectiveness of caudal block. Aim: To compare the traditionally used landmark-guided technique of caudal block with the ultrasound-guided technique in terms of intraoperative analgesia, haemodynamic parameters, time required to perform the block, and the requirement for rescue analgesia in paediatric patients. Materials and Methods: This prospective, randomized comparative study was conducted on 150 paediatric patients aged 1–12 years, belonging to ASA physical status I and II, undergoing elective infraumbilical surgeries under general anaesthesia. Patients were randomly allocated into two groups of 75 each. Group C received conventional landmark-guided caudal block, whereas Group U received ultrasound-guided caudal block. The primary outcome measures included intraoperative analgesia, haemodynamic parameters, time required to perform the block, and the requirement for rescue analgesia. Data were analysed using the independent Student’s t-test and Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The demographic characteristics of both groups were comparable. The mean time required to perform the caudal block was significantly lower in the ultrasound-guided group (3.72 ± 0.64 minutes) than in the conventional group (4.85 ± 0.88 minutes) (p<0.001). Adequate intraoperative analgesia was achieved in 97.3% of patients in Group U compared with 86.7% in Group C (p=0.027). Rescue analgesia was required in only 4.0% of patients in the ultrasound-guided group compared with 16.0% in the conventional group (p=0.014). First-attempt block success was significantly higher in Group U (97.3%) than in Group C (81.3%) (p=0.002). Intraoperative heart rate and mean arterial pressure remained more stable in the ultrasound-guided group. Procedure-related complications were fewer with ultrasound guidance, although the difference was not statistically significant. Conclusion: Ultrasound-guided caudal block is superior to the conventional landmark-guided technique in paediatric patients undergoing infraumbilical surgeries. It provides better intraoperative analgesia, improved haemodynamic stability, shorter block performance time, higher first-attempt success, and reduced requirement for rescue analgesia. Ultrasound guidance should be considered the preferred technique whenever the necessary equipment and expertise are available.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and is associated with an increased risk of progressive liver fibrosis. This study evaluated the association of MASLD with obesity and glycaemic control in patients with T2DM. Methods: This hospital-based cross-sectional study included 100 adults with T2DM and ultrasonographic evidence of MASLD. Clinical, anthropometric, and biochemical data were collected. Hepatic steatosis was assessed by ultrasonography, while liver fibrosis was evaluated using shear wave elastography, the MASLD Fibrosis Score, Fibrosis-4 (FIB-4) index, and the Body Mass Index, AST/ALT Ratio, and Diabetes (BARD) score. Results: The mean age was predominantly within 18–40 and 51–60 years, with females comprising 59.0% of participants. The mean BMI and HbA1c were 32.2 ± 2.87 kg/m² and 8.12 ± 1.65%, respectively. Mild steatosis (57.0%) was the most common ultrasonographic finding, while significant (44.0%) and advanced fibrosis (38.0%) predominated on elastography. Most participants were classified as high risk by the MASLD Fibrosis Score (60.0%) and BARD score (97.0%). No significant association was observed between steatosis severity and BMI (p=0.086), HbA1c (p=0.931), or liver stiffness (p=0.767). Conclusion: MASLD was common among patients with T2DM and was frequently accompanied by obesity, poor glycaemic control, and significant liver fibrosis. Routine non-invasive fibrosis assessment may facilitate early identification of high-risk individuals and improve clinical management.

Background: Intracerebral hemorrhage (ICH) is a devastating subtype of stroke with a 30-day mortality close to 50%. Incidence is disproportionately high in South and East Asian populations. Despite advances in stroke care, no intervention of proven benefit exists for ICH. This study was undertaken to delineate the clinical profile, imaging characteristics, and short-term outcomes of ICH patients at a tertiary emergency department in South India. Methods: A prospective observational study was conducted at Kurnool Medical College / Government General Hospital, Kurnool from May 2025 to January 2026. One hundred patients (>18 years) with CT-confirmed ICH were enrolled. GCS score, ICH score, hematoma volume (ABC/2 method), intraventricular extension (IVE), midline shift, and mean arterial pressure (MAP) were documented. Primary endpoint was in-hospital outcome (death or discharge alive). Results: Mean age was 58.37 ± 12.26 years; males predominated (M:F = 1.85:1). Hypertension was the leading risk factor (68%). Putaminal hemorrhage was most common (54%). Limb weakness occurred in 83% of patients. GCS ≤ 6 was associated with 100% mortality (p < 0.001). Hematoma volume > 60 ml, ICH score ≥ 4, IVE (mortality 64.2% vs 13.8%), midline shift > 5 mm (mortality 66.6% vs 15.7%), and MAP > 130 mmHg (mortality 55.5% vs 21.9%; p = 0.004) were significantly associated with death. Infratentorial hemorrhage carried the highest mortality (cerebellar 100%, brainstem 77.7%). Surgical vs medical management did not differ significantly (p = 0.182). Overall in-hospital mortality was 28%. Conclusion: ICH predominantly affected hypertensive middle-aged males. Low GCS, high ICH score, large hematoma, IVE, midline shift > 5 mm, and elevated MAP at admission were key mortality predictors. Aggressive blood pressure control and early risk stratification using validated tools are essential in the emergency setting.

Background: Perimenopause is the transitional phase preceding menopause and extending up to one year after the final menstrual period. Anxiety is one of the common psychological problems experienced during this period, along with other symptoms such as mood changes and irritability, in addition to vasomotor symptoms like hot flushes and night sweats. Despite its impact on women’s well-being and quality of life, anxiety often remains under-recognized and undertreated in India. Therefore, the present study was undertaken to estimate the prevalence of anxiety disorders and examine the factors associated with anxiety disorders among perimenopausal women. Method: The study was a cross-sectional study conducted in a rural community of Delhi from May 2023 to October 2024. A total of 378 women were enrolled in the study using systemic random sampling technique. A well validated Mini International Neuropsychiatric Interview (M.I.N.I) version 6.0.0 was administered as a diagnostic tool for the study. Result: Generalised anxiety disorder (GAD) was present in 11.11% of perimenopausal women in the study. The prevalence of other anxiety related disorders namely panic disorder, agoraphobia, and social phobia among the study participants was 4.23%, 2.38%, and 2.38%, respectively. GAD was significantly associated with higher parity, not living with children despite having children, and past history of psychiatric morbidity. Homemakers were significantly more affected by panic disorder and agoraphobia. Conclusion: The present study highlights the substantial burden of anxiety during perimenopause and the need to increase awareness among general public and women who are at higher risk of anxiety disorders.

Purpose: To estimate the prevalence of age-related macular degeneration (AMD) and describe associated demographic and systemic characteristics among individuals aged 50 years and above attending a tertiary care ophthalmology centre. Methods: A hospital-based cross-sectional study was conducted in the Department of Ophthalmology, Government General Hospital, Kakinada, from May 2023 to October 2024. Consecutive patients aged ≥50 years attending the ophthalmology outpatient department and meeting the eligibility criteria were screened for AMD. All participants underwent detailed ocular examination. Demographic information, lifestyle factors, systemic comorbidities, and ocular history were recorded using a structured questionnaire. AMD was classified according to the Age-Related Eye Disease Study (AREDS) classification system. Descriptive statistics were used to summarize patient characteristics and AMD subtypes. Results: A total of 4,500 individuals aged 50 years and above were screened during the study period. AMD was identified in 100 participants, yielding a prevalence of 2.2%. The mean age of AMD patients was 68.7 years. Among AMD cases, 77% had dry AMD and 23% had wet AMD. Females constituted 66% of AMD cases. Hypertension was present in 75% of AMD patients, diabetes mellitus in 83%, smoking history in 87%, and alcohol consumption in 63%. The prevalence of AMD increased with advancing age. Visual impairment was present in the majority of affected individuals, with 69% having best-corrected visual acuity between 6/18 and 6/60. Conclusions: AMD was detected in 2.2% of screened individuals aged 50 years and above attending a tertiary care ophthalmology center. Increasing age was associated with a higher occurrence of AMD. Smoking, hypertension, diabetes mellitus, and alcohol consumption were commonly observed among AMD patients. Further population-based studies with multivariable analyses are required to establish independent risk factors and determine the true community burden of AMD.

Background: Double-J (DJ) ureteral stent–related symptoms significantly reduce patients’ quality of life after endourological procedures. Common symptoms include hematuria, urinary urgency, frequency, dysuria, flank pain, and irritative lower urinary tract symptoms. Although ureteral stents are essential for maintaining urinary drainage and promoting postoperative recovery, these adverse effects often require pharmacological management. α-Adrenergic blockers and antimuscarinic agents, particularly tamsulosin and solifenacin, are commonly prescribed because they are effective, convenient once-daily therapies, and relatively inexpensive. Therefore, comparing their efficacy in alleviating DJ stent-related symptoms is clinically important. Objectives: To comparatively evaluate the therapeutic efficacy of tamsulosin and solifenacin in ameliorating symptoms associated with indwelling Double-J ureteral stents. Methodology: This quasi-experimental study includes total of 50 patients who received ureteral stents after ureteroscopic lithotripsy were included and purposively allocated into two treatment groups. Group A comprised 25 patients who received tamsulosin, while Group B included 25 patients treated with solifenacin. Participant selection was performed according to predefined inclusion and exclusion criteria using a purposive sampling technique. Results: The mean age of participants was 40.08 ± 7.798 years in Group A and 37.84 ± 10.063 years in Group B. Male patients predominated in both treatment groups. Assessment performed on the third postoperative day (T1) demonstrated no statistically significant intergroup differences in total International Prostate Symptom Score (IPSS), irrigative IPSS subscore, Quality of Life (QOL) score, or Visual Analogue Scale (VAS) pain score (P > 0.05). However, subsequent evaluation revealed a statistically significant improvement in the tamsulosin group compared with the solifenacin group. The mean total IPSS, irrigative IPSS subscore, and QOL score were 5.28, 3.15, and 2.50, respectively, in Group A, compared with 6.40, 4.10, and 2.90 in Group B (P < 0.05). Furthermore, the severity of stent-related flank pain was significantly lower among patients receiving tamsulosin than among those treated with solifenacin (mean VAS score: 2.45 vs. 2.64; P < 0.05). Conclusion: The present investigation was undertaken to compare the clinical effectiveness of tamsulosin and solifenacin in mitigating symptoms associated with indwelling DJ ureteral stents. The findings indicate that tamsulosin provides superior symptomatic relief compared with solifenacin, thereby representing a more effective pharmacological option for the management of DJ stent-related symptoms.

Introduction: Malnutrition is the most widespread condition affecting the health of children [1]. As recent data shows higher malnutrition in children of urban area and little work has been done in this regard hence this study aims to estimate the magnitude and explore the socio-economic determinants of malnutrition among under-five children of field practicing area of UHTC. This would help in better understanding of the issue and future planning. Methods: This Community based, cross-sectional, observational study was done at Sushilpura area from July 2021 to October 2022. Total 360 children under five year of age were assessed for malnutrition and factors associated. Results: There were 46.7% male and 53.3% female. Majorities (83.9%) were Hindus and were nuclear families (68.3%). Only 6.4 percent families were higher socioeconomic status while only 7.2% households were lowest socioeconomic status. Around one fourth subjects were from ST/SC categories. The prevalence of under nutrition was 56.4%. Overall stunting was about 35.3% with 4.2% of severe stunting; moreover about 21.1% had wasting with 5.6% of severe wasting. Sex, religion, caste, family size, socio economic status, livestock in house, ventilation of house, overcrowding were significant factors associated with malnutrition. Conclusion: Under-nutrition is high among children of Sushilpura, an urban dwelling of Jaipur city. One third was stunted and every fifth child was wasted too. Low socioeconomic status, less educated parents, poor sanitation, female sex, birth order, lack of exclusive breast feeding, nuclear family.

Background: Pregnancy-related body mass index (BMI) is essential for identifying health hazards. Excessive weight increase during pregnancy and/or high pre-pregnancy BMI have detrimental effects on pregnancy outcomes, endangering the health of both the mother and the neonates and increasing the burden of chronic disease. The aim of the study is to the maternal and neonatal outcomes in patients of different BMI groups (classified into four groups as per WHO in 1993) in singleton pregnancies in primigravidae under 30 years age. Methods: The present hospital based prospective cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, PMCH, Patna, Bihar from June 2024 to May 2025. A total 200 patients in primigravida below 30 years with singleton pregnancy who made their first antenatal visit in PMCH in first trimester and delivered at PMCH were included in this study. Results: This study was conducted on 200 patients to understand the relationship between maternal characteristics, clinical parameters, and neonatal outcomes. The majority of participants were young adults, with a mean age of 25.27 years, and most were in the 21–29 years age group. Anthropometric measurements showed that most patients had an average height around 162 cm and a mean weight of approximately 59.7 kg, indicating a relatively uniform physical profile within the study population. Body mass index (BMI) distribution revealed that half of the patients had a normal BMI, while the remaining were either underweight or overweight. Among pregnant women, gestational weight gain was generally within recommended limits, with a mean of 11.73 kg. Most deliveries occurred at term (39–40 weeks), indicating good obstetric care. Vaginal delivery was the most common mode (60%), although a considerable number (40%) underwent cesarean section, mainly due to conditions such as cephalopelvic disproportion and fetal distress. Maternal complications were seen in half of the cases, with prolonged labor being the most frequent, followed by anemia and preterm labor. Neonatal outcomes were generally favorable. The mean birth weight was 2.96 kg, which falls within the normal range. APGAR scores improved from 1 minute to 5 minutes, indicating good neonatal adaptation after birth. Most neonates (70%) did not require NICU admission and had no complications, although 30% experienced issues such as birth asphyxia, respiratory distress, or birth injury. Conclusion: Pregnancy outcomes are significantly impacted by both underweight and obesity in developing countries like India. The formation of a healthy population and the physiological course of pregnancy and childbirth depend on each pregnant woman gaining the ideal amount of weight, which also helps to lower maternal and newborn mortality and morbidity.

Background: Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, In spite of improvement in maternal and neonatal care, PIH and its sequel are a dreaded complication of pregnancy. If prediction becomes possible, prevention will follow naturally. Aim of this is to evaluate “whether maternal serum beta hCG and lipid profile levels in early and late second trimester are correlated with subsequent development of PIH/Preeclampsia and its time of onset. Methods: This prospective observational study was conducted at Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar from March 2024 to February 2026. Total 200 antenatal patients between 14-28 weeks (as determined by LMP or Dating USG scan) with singleton pregnancy were included in this study. Blood samples were collected twice, once at 14–18 weeks and second at 24–28 weeks for Beta hCG and lipid profile. Results: The present study analyzed various maternal characteristics and biochemical parameters to understand their association with pregnancy-induced hypertension (PIH). The age-wise distribution of participants showed that most women were in the 25–29 years group (41%), followed by 30–34 years (30.5%) and 20–24 years (28.5%), suggesting higher engagement from slightly older young adults. Interestingly, when looking specifically at PIH cases, younger women aged 20–24 years were more affected (45%), followed by 25–29 years (28.33%) and 30–34 years (26.67%). This indicates that early adulthood, particularly the first pregnancies, may carry a higher risk for developing PIH, likely due to physiological and immunological adaptations during a first pregnancy. Lipid profiles also differed markedly between groups. In both early and late second trimesters, PIH patients had higher total cholesterol, triglycerides, LDL, and VLDL, and lower HDL compared to non-PIH women. For instance, early second-trimester triglycerides averaged 197.70 mg/dl in PIH versus 140.58mg/dl in non-PIH participants, while HDL was reduced to 41.41 mg/dl in PIH from 52.83 mg/dl in non-PIH. These differences persisted and became more pronounced in the late second trimester. Importantly, low HDL and high triglycerides were observed more often in PIH patients, with 65–80% showing reduced HDL and 70–75% having elevated triglycerides. This pattern was also consistent when analyzed according to onset week, with earlier onset PIH associated with higher triglycerides and lower HDL, suggesting that dyslipidemia plays a role in the development and severity of the condition. β-hCG levels were measured in study participants. The study showed that in early & late 2^nd trimester, the mean β-hCG levels were significantly higher in PIH groups as compared to the non-PIH group, with a statistically significant p-value of <0.001. Conclusion: One of the main causes of maternal morbidity and death during pregnancy is hypertensive disorders. It is still difficult to find the optimum illness predictor, whose use might considerably change the related morbidity and death. Serum beta-hCG and lipid profile can be used to predict PIH, the tests with accepted level of sensitivity and sensitivity. If this test is made available to women who have PIH risk factors, it would be beneficial.

Background: Noise-induced hearing loss (NIHL) is one of the leading preventable causes of permanent hearing impairment worldwide. Long-term exposure to occupational and environmental noise damages the sensory hair cells of the inner ear, resulting in irreversible hearing loss. Industrialization, mechanization of agriculture, and increasing environmental noise have raised the risk of NIHL, particularly in rural and semi-urban populations. However, limited data are available from North Bihar regarding the prevalence of NIHL and its associated risk factors. Aim and Objectives: The study aimed to determine the prevalence of noise-induced hearing loss among adults in North Bihar. The objectives were to estimate the prevalence of NIHL using pure tone audiometry, assess occupational noise exposure, evaluate the association between occupational noise exposure and NIHL, and identify demographic and clinical risk factors associated with hearing loss. Methodology: A hospital-based cross-sectional observational study was conducted over 12 months in the Department of Otorhinolaryngology of a tertiary care hospital in North Bihar. A total of 100 adults aged 18 years and above were included in the analysis. Socio-demographic details, occupational history, noise exposure, use of hearing protection devices, smoking, alcohol consumption, hypertension, and ototoxic drug use were recorded using a structured questionnaire. All participants underwent ENT examination and pure tone audiometry. Data were analyzed using SPSS version 26.0, and associations were assessed using the Chi-square test, with p <0.05 considered statistically significant. Results: The prevalence of NIHL was 26%, with mild hearing loss being the most common type (46.2%). Bilateral hearing loss was observed in 61.5% of affected participants. Occupational noise exposure was reported by 45% of participants, and only 33.3% of exposed workers used hearing protection devices. A highly significant association was found between occupational noise exposure and NIHL (p = 0.0002). Smoking (p = 0.018), alcohol consumption (p = 0.031), history of ototoxic drug use (p = 0.041), and hypertension (p = 0.027) were also significantly associated with NIHL. Conclusion: Noise-induced hearing loss is a common occupational health problem among adults in North Bihar. Occupational noise exposure is the major contributing factor, while smoking, alcohol use, hypertension, and ototoxic drug use further increase the risk. Strengthening workplace noise control measures, promoting regular hearing screening, encouraging consistent use of hearing protection devices, and improving public awareness are essential for preventing NIHL and reducing its long-term health burden.

Background & Objectives: Hypertensive disorders of pregnancy (HDP) remain a major cause of maternal and fetal morbidity and mortality worldwide. While physiological hyperlipidemia occurs in normal pregnancy under hormonal regulation, defective lipid adaptation can induce oxidative stress and endothelial damage. This study was designed to evaluate serum lipid profile parameters in cases of HDP (gestational hypertension, preeclampsia, and eclampsia) in comparison to normal healthy pregnant controls. Materials & Methods: A prospective case-control study was conducted comprising 200 pregnant women with gestation >20 weeks. The study population was divided into two groups: 100 cases diagnosed with HDP (45 Gestational Hypertension, 50 Preeclampsia, 5 Eclampsia) and 100 age-matched normotensive pregnant controls. Fasting blood samples (12-hour fast) were evaluated for Total Cholesterol (TC), High-Density Lipoprotein (HDL), Low-Density Lipoprotein (LDL), Very Low-Density Lipoprotein (VLDL), and Triglycerides (TG). Statistical analysis was carried out using Student’s t-test, One-Way ANOVA, and Pearson/Kendall correlation coefficients. Results: The mean serum Total Cholesterol (TC) was significantly elevated in the HDP group compared to controls (237.32 ± 60.73 mg/dL vs. 215.20 ± 43.99 mg/dL, p < 0.05). Serum HDL was significantly reduced in cases compared to controls (49.42 ± 10.76 mg/dL vs. 53.99 ± 18.47 mg/dL, p = 0.034). The HDL/TC ratio was significantly lower in the hypertensive group (0.22 ± 0.07 vs. 0.26 ± 0.10, p = 0.002). A positive correlation was observed between blood pressure (SBP & DBP) and lipid parameters (TC & TG), whereas HDL exhibited a negative correlation with blood pressure. No significant correlation was observed between lipid parameters and the degree of proteinuria. Conclusion: Dyslipidemia characterized by elevated Total Cholesterol and decreased HDL levels plays an essential role in mediating endothelial dysfunction in HDP. Serum lipid profiling during pregnancy may serve as a valuable biochemical tool for early detection and assessment of disease severity in hypertensive pregnancy.

Background and Objectives: Preeclampsia remains a primary cause of maternal morbidity, mortality, perinatal mortality, and preterm delivery worldwide. It is a multisystem vasospastic disorder whose exact etiology is not fully elucidated. Electrolytes like calcium and magnesium contribute significantly to the functioning of vascular smooth muscles and vasomotor tone regulations. This study aimed to measure and compare total serum calcium and serum magnesium levels between preeclamptic pregnancies and normotensive pregnancies in their third trimester, and to correlate these levels with disease severity and perinatal outcomes. Materials and Methods: A prospective, comparative hospital-based study was carried out. Venous serum samples of 100 preeclamptic women (cases) and 100 normotensive pregnant women (controls) in their third trimester (≥28 weeks) were evaluated. Serum levels of calcium and magnesium were determined via a colorimetric analyzer. Frequencies, standard deviation, Chi-square test, and Student’s t-test were utilized to evaluate statistical significance. Results: Both total serum calcium and serum magnesium levels were significantly lower in preeclamptic mothers compared to normotensive mothers, with p-values of 0.042 and <0.00001, respectively. A significant negative correlation was verified between the serum concentrations of these minerals and both systolic and diastolic blood pressure. Worsened hypocalcemia and hypomagnesemia highly correlated with adverse perinatal outcomes, including low birth weight (p=0.00011), increased rates of intrauterine fetal death (p=0.01), reduced Apgar scores (p=0.03841), and increased NICU admissions (p=0.029). Conclusion: Preeclamptic mothers manifest significantly reduced total serum calcium and magnesium levels compared to normotensive cohorts. These reductions heavily correlate with the clinical severity of hypertension and adverse maternal-neonatal outcomes, highlighting their potential role in monitoring and surveillance strategies.

Background and Objectives: Pre-eclampsia complicates 5–7% of pregnancies worldwide and remains a major cause of maternal and perinatal morbidity and mortality. Serum uric acid (UA) elevation is one of the earliest detectable laboratory alterations in pre-eclampsia. This study aims to evaluate and compare serum UA levels in normotensive and pre-eclamptic pregnant women, assessing its utility as a biomarker for early detection of severity and its correlation with perinatal outcomes. Methodology: A prospective comparative hospital-based study was conducted involving 200 pregnant women (≥20 weeks of gestation, aged 18–35 years), divided equally into 100 pre-eclamptic cases and 100 normotensive controls. Serum UA levels were measured using the automated uricase-peroxidase method. Maternal and perinatal outcomes were tracked until the 7th postpartum day. Results: The mean serum UA level was significantly higher in the pre-eclamptic group (5.78 ± 1.1 mg/dL) compared to the control group (4.1 ± 0.6 mg/dL, p = 0.001). Elevated UA levels (>5 mg/dL) were found in 54% of pre-eclamptic mothers compared to only 20% of normotensive controls. Higher serum UA significantly correlated with severe maternal complications (6.86 ± 1.43 mg/dL vs. 4.61 ± 1.00 mg/dL, p = 0.005) and adverse fetal outcomes, particularly intrauterine fetal demise (7.4 ± 2.04 mg/dL). Conclusion: Elevated serum uric acid is a reliable and inexpensive predictor of pre-eclampsia severity, maternal complications, and poor perinatal outcomes. Weekly or thrice-weekly monitoring provides critical prognostic insights for optimal clinical intervention.

Background: Pain after laparoscopic cholecystectomy arises from trocar wounds, peritoneal irritation, diaphragmatic stimulation, and visceral manipulation. Port-site infiltration is simple and is recommended as a basic procedure-specific intervention, whereas ultrasound-guided subcostal transversus abdominis plane (TAP) block may provide wider somatic coverage but requires additional expertise. Objective: To compare the analgesic efficacy and safety of bilateral ultrasound-guided subcostal TAP block with local port-site infiltration when the total bupivacaine dose and background multimodal analgesia are standardised. Methods: This study describes a prospective, randomised, assessor-blinded, parallel-group study of 100 adults undergoing elective four-port laparoscopic cholecystectomy. Participants received either bilateral subcostal TAP block using 15 mL of 0.25% bupivacaine per side or full-thickness infiltration of the four port sites using 30 mL of 0.25% bupivacaine in total. The primary outcome was cumulative rescue tramadol during the first 24 postoperative hours. Secondary outcomes were pain scores at rest and with movement, time to first rescue analgesic, postoperative nausea or vomiting, shoulder-tip pain, satisfaction, and adverse events. Results: In our study we found out, mean 24-hour tramadol consumption was 84.0 ± 71.7 mg after TAP block and 137.0 ± 80.1 mg after infiltration (mean difference -53 mg, 95% CI -83 to -23; p = 0.001; Cohen d = -0.70). Time to first rescue analgesic was longer after TAP block (408.3 ± 208.1 versus 233.1 ± 188.6 minutes; mean difference 175 minutes, 95% CI 96 to 254; p < 0.001). Rest and movement pain scores were lower through six hours, but group differences narrowed by 12 hours and were absent at 24 hours. Postoperative nausea or vomiting occurred in 22% and 32% of participants, respectively (risk ratio 0.69, 95% CI 0.36 to 1.33). No serious local-anaesthetic-related event occurred. Conclusion: Within this study, ultrasound-guided subcostal TAP block produced an early opioid-sparing advantage over port-site infiltration despite an equal bupivacaine dose.

Introduction: Migraine is a headache disorder caused by release of pain-producing inflammatory substances around cranial nerves and blood vessels. Moderate-severe headache occurs, associated with nausea and vomiting (WHO), which leads to impaired quality of life. In this study, Flunarizine and Sodium Valproate were prescribed to assess the effect of migraine on disability and quality of life of participants. Methods: Patients aged 18 years and above suffering from headache were selected after taking proper consent. Physiological parameters like Height, Body weight, Blood Pressure, Pulse rate and baseline investigations like Complete Blood Count, Kidney Function Test, Liver Function Test were safety parameters performed as screening procedures.  Patients were also assessed by efficacy parameters like Migraine frequency, Migraine duration, Migraine Disability Assessment Scale (MIDAS) and Migraine Specific Quality of Life (MSQ) Questionnaire, version 2.1. Patients were divided into two groups, each with 60 patients, and administered tablet Flunarizine and tablet Sodium valproate once daily.  Patients were followed up at 3- and 6-months interval with all efficacy and safety parameters. Results: Regarding demographic profile we noted that most patients were females and were within age range of 20-40 years. Both drugs decreased migraine frequency, migraine duration and MIDAS score and increased MSQL score significantly after 6 months as compared to baseline. Flunarizine was slightly safer than valproate. Conclusion: Both study drugs were very much effective in migraine prophylaxis in terms of efficacy and safety. While considering adverse events, prescribing flunarizine may be safer than valproate, though this finding has to be confirmed by more research.

Background: Ultrasound-guided axillary brachial plexus block is an effective regional anaesthetic technique for forearm surgeries. The addition of adjuvants to local anaesthetics improves block characteristics and prolongs postoperative analgesia. Dexmedetomidine and dexamethasone are commonly used adjuvants; however, evidence comparing their efficacy in axillary brachial plexus block remains limited. Methods: This prospective, randomized, double-blind comparative study included 100 ASA I–II patients aged 18–60 years undergoing elective forearm fracture surgeries. Patients were randomly allocated into two groups. Group A received 30 mL of 0.5% levobupivacaine with dexmedetomidine (1 µg/kg), while Group B received 30 mL of 0.5% levobupivacaine with dexamethasone (0.1 mg/kg). Sensory and motor block characteristics, duration of postoperative analgesia, haemodynamic parameters, and adverse effects were evaluated. Results: Dexmedetomidine produced a significantly faster onset of sensory block (8.34 ± 1.24 vs. 9.55 ± 1.30 min; p=0.016) and motor block (12.50 ± 1.45 vs. 14.00 ± 1.62 min; p<0.001). Sensory block duration (850 ± 124 vs. 730 ± 130 min), motor block duration (690 ± 124 vs. 620 ± 108 min), and time to first rescue analgesia (22.75 ± 2.47 vs. 17.50 ± 2.20 h) were significantly longer in the dexmedetomidine group (p<0.001). Mild bradycardia, hypotension, and sedation occurred more frequently with dexmedetomidine but were clinically manageable. Conclusion: Both dexmedetomidine and dexamethasone were effective adjuvants to levobupivacaine for ultrasound-guided axillary brachial plexus block. However, dexmedetomidine provided superior block characteristics and prolonged postoperative analgesia with acceptable haemodynamic safety, making it the preferred adjuvant for forearm fracture surgeries.

Background: Hypertensive disorders of pregnancy, particularly severe pre-eclampsia and eclampsia, are major causes of maternal and perinatal morbidity and mortality. These conditions can result in multi-organ dysfunction, HELLP syndrome, renal failure, and placental abruption. Fetal complications include prematurity, low birth weight, and intrauterine growth restriction. Early diagnosis, close monitoring, and timely obstetric intervention are essential to improve maternal and neonatal outcomes. Aim: To study the maternal and fetal outcomes in cases of severe pre-eclampsia and eclampsia and to identify factors associated with adverse maternal outcomes. Methods: This hospital-based cross-sectional observational study included 65 pregnant women with severe pre-eclampsia or eclampsia after 20 weeks of gestation. Sociodemographic, clinical, laboratory, maternal, and perinatal data were collected using a structured proforma. Statistical analysis was performed using descriptive statistics and the chi-square test to assess associations with maternal and fetal outcomes. Results: Among 65 patients, 48 (73.8%) had severe pre-eclampsia and 17 (26.2%) had eclampsia. Maternal complications occurred in 24 (36.9%), with ICU admission in 14 (21.5%) and maternal mortality in 2 (3.1%). Preterm delivery occurred in 31 (47.7%), low birth weight in 36 (55.4%), and NICU admission in 23 (35.4%). Severe hypertension, thrombocytopenia, multiple severe features, and inadequate antenatal care significantly increased maternal morbidity. Conclusion: Severe pre-eclampsia and eclampsia are associated with significant maternal and perinatal morbidity. Early detection, regular antenatal monitoring, and timely obstetric intervention are essential to reduce adverse maternal and fetal outcomes.

Background: Chronic non-healing ulcers are defined as wounds that fail to progress through the normal stages of healing despite adequate treatment. They are commonly associated with diabetes mellitus, peripheral vascular disease, venous insufficiency, neuropathy, and trauma. These ulcers significantly impair quality of life due to prolonged treatment, recurrent infections, pain, reduced mobility, and risk of limb loss. Aim: To compare the efficacy of platelet-rich plasma (PRP) dressing with conventional dressing in chronic non-healing leg ulcers. Method: This prospective randomized controlled study was conducted in the Department of General Surgery, Pacific Institute of Medical Sciences, Udaipur (April 2024–September 2025). Fifty patients were randomized into two groups: conventional dressing (n=25) and PRP dressing (n=25). Both groups received standard antibiotics. PRP was prepared from autologous blood using a two-step centrifugation technique and applied twice weekly, while the control group received saline dressings. Wound healing was assessed by reduction in ulcer size, granulation, and epithelialization at serial intervals. Results: Both groups were comparable at baseline (p>0.05). The PRP group showed significantly greater reduction in ulcer size from Day 7 onwards (p<0.001), faster granulation, earlier epithelialization, and higher sterile culture rates (p=0.01). Healing rates were significantly faster in the PRP group (p<0.0001). Mean healing time was shorter with PRP (30.6±0.02 vs 50.1±0.04 days). Complete healing was achieved in 52% versus 16% in controls. Conclusion: PRP dressing is a safe and effective treatment for chronic non-healing leg ulcers, providing faster healing, improved granulation, earlier epithelialization, better infection control, fewer complications, and superior overall outcomes than conventional dressing.

Introduction: Postoperative pain, including referred shoulder pain, remains a common concern following laparoscopic cholecystectomy. The 5% lidocaine patch may provide local analgesia with minimal systemic effects. This study evaluated the efficacy and safety of a 5% lidocaine patch for postoperative pain management in patients undergoing laparoscopic cholecystectomy. Materials and Methods: This hospital-based, single-blinded, randomized controlled study was conducted at a tertiary care hospital in Jaipur from March 2024 to August 2025. Eighty patients aged 18–65 years, with American Society of Anesthesiologists physical status I or II, undergoing elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated into two groups of 40 each. In the patch group, a 5% lidocaine patch was applied over the left shoulder before surgery, while the control group received dressing tape at the same site. Postoperative pain was assessed using the Visual Analogue Scale (VAS) for 24 hours. Time to first rescue analgesia, total analgesic consumption, incidence of shoulder pain, haemodynamic parameters, and adverse effects were recorded. Results: Baseline demographic, clinical, operative, and anaesthetic characteristics were comparable between the groups. VAS scores were significantly lower in the patch group from 1 to 24 hours postoperatively. The mean time to first rescue analgesia was longer in the patch group than in the control group (148 ± 41 versus 92 ± 34 minutes; p<0.001). Total analgesic consumption was also lower in the patch group (96 ± 32 versus 134 ± 38 mg; p<0.001). Postoperative shoulder pain occurred in 35.0% of patients in the patch group compared with 67.5% in the control group (p=0.006). Haemodynamic parameters remained stable, and the frequency of nausea, vomiting, and skin irritation did not differ significantly between the groups. Conclusion: The 5% lidocaine patch improved postoperative pain control following laparoscopic cholecystectomy. It reduced pain scores, analgesic consumption, and postoperative shoulder pain while delaying the need for rescue analgesia, without a significant increase in adverse effects. It may be used as a simple and safe adjunct to multimodal postoperative analgesia.

Background: Breast carcinoma is the most common cancer among women worldwide and one of the leading causes of cancer-related mortality. Modified radical mastectomy (MRM) still continues to be one of the most common surgical procedures performed for operable breast cancer especially in the developing countries where patients present with locally advanced disease. Knowing the clinicopathological features and postoperative outcomes of these patients would improve the surgical care and long-term prognosis. Objective: To assess clinicopathological profile and surgical outcomes in carcinoma breast patients undergoing modified radical mastectomy. Materials and Methods: The present hospital based cross sectional study consisted of 80 patients of histopathologically confirmed breast carcinoma who underwent modified radical mastectomy in a period of 12 months. Demographic data, clinical presentation, tumor characteristics, histopathological findings, lymph node status, receptor status, postoperative complications, duration of hospital stay and early surgical results were recorded in a structured proforma. Statistical analysis was conducted using SPSS version 26. Continuous variables were expressed as mean ± standard deviation, categorical variables as frequencies and percentages. A p-value < 0.05 was considered statistically significant. Results: The patients’ mean age was 52.6±11.4 years. The largest share (56.3%) fell to the age group 41–60 years. The study population was composed of 98.8% female patients. The commonest presenting complaint was painless breast lump (91.3 per cent). The most common site of the tumor was upper outer quadrant (58.8%). 87.5% of cases were invasive ductal carcinoma. Stage II disease was present in 47.5% of patients followed by stage III disease (35.0%). An axillary lymph node metastasis was detected in 61.3 % of the patients. The estrogen receptor was positive in 65.0% of patients, the progesterone receptor in 57.5%, and HER2 in 26.3% . The most frequent postoperative complication was seroma formation (15.0%), followed by surgical site infection (8.8%). Mean postoperative hospital stay was 7.4±2.1 days. Overall surgical results were good in 90.0% of patients. Conclusion: Modified radical mastectomy is a safe and effective surgical procedure for carcinoma breast with an acceptable postoperative morbidity. Early diagnosis, timely operation and multidisciplinary comprehensive management are crucial for better clinical outcomes.

Background: Chronic plantar fasciitis is one of the main causes of chronic heel pain in younger aged populations with an active lifestyle. Although primary management of plantar fasciitis remains conservative, a subset of patients not responding to the same require invasive methods for effective management. Ultrasound-guided steroid injections offer real-time drug delivery allowing precision as well as confirmation of drug delivery at the site of diseased tissue. This, hence, offers a superior therapeutic outcome and alleviates the risk of heel pad atrophy as is possible with routine palpation-guided blind injections. Methodology: A hospital based prospective observational study was conducted to assess the effectiveness of Triamcinolone Acetonide injection in chronic plantar fasciitis when given under ultrasound scan. A total of fifty consecutive patients aged 20 to 60 years who failed to respond to conservative management were included in the study. The patients received a 50:50 drug mixture of Triamcinolone Acetonide injection (20mg) and 2% Xylocaine 2ml under ultrasound scan. Each patient was followed-up at Week 2 and Week 6 post-injection wherein the effectiveness of treatment was assessed in terms of symptomatic pain relief and resolution of plantar fascia thickness. Results: The mean score on Visual Analogue scale of patients at the time of entry to the study was 71.54 mm and the mean plantar fascia thickness as measured on ultrasound was 5.33 mm. After six-weeks of injection, the mean Visual Analogue Score had reduced to 33.83 mm and corresponding mean plantar fascia thickness had reduced to 3.60 mm. The average percentage reduction in mean visual Analogue Score was 52.69%. Conclusion: The ultrasound-guided single-shot steroid injection is an effective modality of treatment in chronic plantar fasciitis. The ultrasound not only offers real-time scans for precise drug delivery, thus alleviating the risks of plantar fascia rupture or heel pad atrophy, but also acts as a reliable tool for objective confirmation of clinical resolution.

Background: Split-thickness skin grafting (STSG) is one of the most commonly performed reconstructive procedures for the management of traumatic wounds, burns, chronic ulcers, and post-excisional soft tissue defects. Despite its widespread use, graft failure due to hematoma, seroma, infection, or inadequate vascularization remains an important clinical challenge. Platelet-rich plasma (PRP), an autologous concentrate of platelets containing multiple growth factors, has emerged as a promising biological adjunct to improve graft adherence and wound healing. Recent studies suggest PRP may improve graft healing and reduce complications, although further clinical evidence is needed. Objectives: To evaluate the effectiveness of topical PRP in improving split-thickness skin graft survival and reducing graft-related complications. Materials and Methods: A prospective observational study was conducted in the Department of Plastic Surgery of a tertiary care teaching hospital, PMCH, Patna. Fifty consecutive patients requiring split-thickness skin grafting were included. Autologous PRP was prepared using a standardized double-spin centrifugation technique and applied over the recipient wound bed immediately before graft placement. Patients were followed for four weeks. Primary outcome was percentage graft uptake. Secondary outcomes included postoperative infection, hematoma, seroma, graft loss, duration of wound healing, and hospital stay. Results: The mean age of the patients was 41.8 ± 13.2 years. The mean graft uptake at postoperative Day 14 was 95.2 ± 5.4%, with complete graft uptake (>95%) achieved in 42 (84%) patients. At Day 28 follow-up, satisfactory graft survival was maintained, with no additional graft loss or late graft failure observed. Partial graft loss occurred in 6 (12%) patients, while complete graft failure was observed in 2 (4%). Infection developed in 8%, hematoma in 6%, and seroma in 4% of patients. No PRP-related adverse events were recorded. Conclusion: Topical PRP appears to be a safe and effective adjunct in split-thickness skin grafting. It promotes excellent graft uptake, accelerates wound healing, and reduces graft-related complications. Larger controlled studies are required to validate these findings and establish standardized protocols for PRP use.

Objective: To Study Incidence and Clinical Presentations of Surgical Site Infection Following Cesarean Section. Methods: A prospective hospital-based clinical study was conducted among all pregnant woman admitted to the labor room with either elective or emergency caesarean section in OBG department at SSIMS & RC Davangere, during period of March 2021 to March 2023. Result: Overall prevalence of surgical site infection was 13.5%. Prevalence of surgical site infection among conventional and study groups were 18.4% and 8.6% respectively which is statistically significant (p=0.001) Conclusion: After implementing the care bundle in our study, the prevalence of study group was 8.6% when compared to the convention group, which reported 18.4%. Majority of the study participants had superficial surgical site infection (n=30, 73.2%).

Background: Spinal and epidural anaesthesia are widely used for elective lower segment caesarean section (LSCS). While spinal anaesthesia offers rapid onset and reliable blockade, it may produce greater maternal haemodynamic changes than epidural anaesthesia. Aim: To compare maternal haemodynamic changes following spinal versus epidural anaesthesia for elective LSCS. Methods: This prospective randomized comparative study included 120 pregnant women undergoing elective LSCS. Participants were allocated into two groups: Group S (spinal anaesthesia, n=60) and Group E (epidural anaesthesia, n=60). Maternal heart rate, blood pressure, incidence of hypotension, bradycardia, vasopressor requirement, maternal complications, neonatal APGAR scores, and maternal satisfaction were evaluated. Results: Spinal anaesthesia produced a significantly faster onset of surgical anaesthesia (5.2 ± 0.9 vs. 14.8 ± 2.6 minutes; p<0.001). The spinal group demonstrated a significantly greater fall in mean arterial pressure (25.9 ± 6.4% vs. 16.8 ± 5.3%; p<0.001) and higher incidences of hypotension (38.3% vs. 15.0%; p=0.004), bradycardia (16.7% vs. 5.0%; p=0.038), and vasopressor requirement (35.0% vs. 13.3%; p=0.006). Neonatal APGAR scores at one and five minutes, maternal satisfaction, and overall surgical outcomes were comparable between the two groups. Conclusion: Spinal anaesthesia provides rapid and reliable surgical anaesthesia but is associated with greater maternal haemodynamic instability. Epidural anaesthesia offers better cardiovascular stability with equivalent neonatal outcomes and maternal satisfaction, making both techniques suitable options for elective LSCS when supported by careful monitoring and appropriate haemodynamic management.

Background: Major surgery under general anaesthesia is associated with significant physiological stress, and early identification of patients at risk of postoperative complications remains a clinical challenge. Perioperative lactate clearance has emerged as a promising biomarker of tissue perfusion and metabolic recovery. Aim: To evaluate perioperative lactate clearance as a predictor of postoperative outcomes following major surgery under general anaesthesia. Methods: This prospective observational study included 120 adult patients undergoing elective major surgery under general anaesthesia. Arterial lactate levels were measured preoperatively, at the end of surgery, and at 6 and 24 hours postoperatively. Lactate clearance was calculated, and patients were categorized into adequate (≥20%) and poor (<20%) lactate clearance groups. Postoperative complications, ICU admission, duration of mechanical ventilation, hospital stay, and mortality were compared. Results: Seventy-eight patients (65%) achieved adequate lactate clearance, whereas forty-two (35%) had poor clearance. Patients with poor lactate clearance demonstrated significantly higher postoperative lactate concentrations, greater intraoperative blood loss, and longer operative duration (p<0.05). They also experienced significantly higher rates of ICU admission (61.9% vs. 15.4%), prolonged mechanical ventilation (35.7% vs. 6.4%), acute kidney injury (28.6% vs. 5.1%), sepsis (23.8% vs. 3.8%), prolonged hospital stay (13.6 ± 4.2 vs. 8.4 ± 2.3 days), and mortality (16.7% vs. 2.6%) compared with patients demonstrating adequate lactate clearance (all p<0.05). Conclusion: Perioperative lactate clearance is a reliable predictor of postoperative morbidity and mortality following major surgery under general anaesthesia. Poor lactate clearance identifies patients at increased risk for adverse outcomes and may facilitate early postoperative intervention, improved perioperative management, and enhanced patient prognosis.

Background: Adjuvants are added to local anesthetics in peripheral nerve blocks to improve block quality and prolong postoperative analgesia. Dexmedetomidine and butorphanol have both been used as adjuvants, but comparative evidence remains limited. Methods: This prospective comparative observational study included 60 patients aged 18–60 years undergoing upper-limb surgery under ultrasound-guided supraclavicular brachial plexus block. Patients were divided into two groups of 30 each. Group D received dexmedetomidine 1 µg/kg with 30 mL of 0.5% ropivacaine, whereas Group B received butorphanol 30 µg/kg with the same volume and concentration of ropivacaine. Onset and duration of sensory and motor blockade, time to first rescue analgesia, hemodynamic parameters, respiratory variables, sedation, and adverse effects were compared. Results: The onset of sensory block was significantly faster in Group D than in Group B (4.90 ± 0.94 versus 10.82 ± 0.98 minutes; p<0.001). Motor block onset was also faster with dexmedetomidine (9.88 ± 1.02 versus 15.26 ± 1.47 minutes; p<0.001). Sensory block duration, motor block duration, and time to first rescue analgesia were significantly longer in Group D. Hemodynamic parameters, oxygen saturation, and respiratory rate remained comparable between groups. Sedation scores were higher with dexmedetomidine, although sedation remained mild. Conclusion: Dexmedetomidine was superior to butorphanol as an adjuvant to ropivacaine by providing faster block onset, prolonged sensory and motor blockade, and longer postoperative analgesia without clinically significant hemodynamic or respiratory adverse effects.

Background: Obesity leads to metabolic and cardiac diseases. There have been studies which have reported association between obesity and sudden cardiac deaths. Aim: To study the comparison of heart rate variability between obese and young adult males. Material and Methods: A case control study was conducted in N=50 obese young adult males of 18–30 years and N=50 age‑matched healthy adult males. The power spectral analysis of HRV was done to detect early the autonomic imbalance in obese adults. HRV was performed using HRV software Lab Chart. The absolute values of low frequency (LF) and high frequency (HF) (in ms²), LF and HF units (in nu) and LF/HF ratio were calculated as mean ± standard deviation and statistically analyzed using student unpaired t test. Results: HF in normalized units was significantly decrease in obese young adults group as to compared to age‑matched control group and was statistically significant (p<0.001). LF (nu) and LF/HF ratio were increase in obese group as compared to control group and was found statistically significant. A negative correlation between HF and body mass index in obese individuals was reported and positive correlation between LF and LF/HF ratio was found statistically significant. Conclusion: Obese young adults reported decrease in parasympathetic activity and increase in sympathetic activity hence autonomic imbalance was reported.

Introduction: In the first two years of life, Infant and young child feeding (IYCF) practices are fundamental for growth, development, and survival. Risk of malnutrition, infections, and childhood mortality reduces if appropriate breastfeeding and complementary feeding are practised. Despite many efforts, suboptimal IYCF practices is very common in many rural communities due to inadequate knowledge, cultural beliefs, and socioeconomic factors. This study aimed to assess IYCF practices among rural mothers of children aged below 24 months attending a tertiary care hospital in Udaipur, Rajasthan, India. Methods: A hospital-based descriptive observational analytical study was conducted in the Department of Pediatrics, Pacific Institute of Medical Sciences, Udaipur, and Rajasthan. A total of 350 mother–child pairs were included using purposive sampling. Data were collected using a predesigned, pretested, semi-structured questionnaire. Associations between sociodemographic factors and IYCF practices were analyzed using the Chi-square test or Fisher’s exact test, (p<0.05 considered statistically significant). Results: The mean maternal age was 24.88±1.92 years, and 56.0% mothers were aged 20–24 years. Exclusive breastfeeding was present in 62.3% children, colostrum feeding in 95.7%, prelacteal feeding in 41.7%, timely initiation of breastfeeding in 85.1%, and complementary feeding at six to eight months in 67.4% of children. Maternal age, education, occupation, socioeconomic status, and child sex were significantly associated with IYCF practices. Conclusion: This study shows that many infant and young child feeding (IYCF) practices, like timely initiation of breastfeeding, colostrum feeding, continued breastfeeding, and complementary feeding, were satisfactory among rural mothers; but important gaps present in some areas like maternal knowledge, exclusive breastfeeding, avoidance of prelacteal feeding, and timely complementary feeding.

Background: Nephrotic syndrome is one of the most common chronic renal disorders in children and is frequently associated with relapses. During relapse, children are highly susceptible to infections, particularly bacterial infections, which significantly contribute to morbidity and hospitalization. Early identification of bacterial infection is essential for prompt management. Serum Procalcitonin (PCT) has emerged as a promising biomarker for the early detection of bacterial infections. Objective: To evaluate the role of serum procalcitonin as a marker of bacterial infection in relapse cases of nephrotic syndrome among children admitted to a Tertiary Care Hospital in Hyderabad, Telangana. Methods: This study was conducted among children diagnosed with relapse of nephrotic syndrome admitted to a tertiary care hospital in Hyderabad. Clinical evaluation and laboratory investigations, including serum procalcitonin levels, complete blood count, C-reactive protein, and relevant cultures, were performed. Serum PCT levels were compared between children with clinically and microbiologically confirmed bacterial infections and those without evidence of bacterial infection. Results: Serum procalcitonin levels were significantly elevated in children with confirmed bacterial infections compared to those without infection. Higher PCT levels correlated with positive culture findings and increased inflammatory markers. The sensitivity and specificity of serum procalcitonin in detecting bacterial infection were found to be clinically significant. Conclusion: Serum procalcitonin is a reliable and early biomarker for detecting bacterial infection in relapse cases of nephrotic syndrome among children. Its use may help in early diagnosis, appropriate antibiotic initiation, and reduction of unnecessary antibiotic exposure in non-bacterial cases. Further large-scale studies are recommended to validate these findings.

Background: Connective tissue diseases (CTDs), particularly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), are systemic autoimmune disorders associated with significant cardiovascular morbidity and mortality. Cardiac involvement in CTDs may remain asymptomatic during the early stages, leading to delayed diagnosis and increased risk of adverse cardiovascular outcomes. Early detection through appropriate screening modalities is therefore essential for improving patient prognosis. Aim: To assess the prevalence and pattern of cardiac involvement in patients with established connective tissue diseases, specifically rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), attending the outpatient Department of General Medicine at Tertiary Care Hospital, Telangana. Objectives: To determine the prevalence of cardiac involvement among patients with RA and SLE; to evaluate the spectrum of cardiovascular manifestations in established CTDs; to document cardiac abnormalities using chest radiography, electrocardiography (ECG), and echocardiography; and to highlight the importance of early cardiovascular screening in CTD patients. Methods: This observational study included patients with established diagnoses of rheumatoid arthritis and systemic lupus erythematosus attending the outpatient department. All patients underwent detailed clinical evaluation and cardiovascular assessment using chest radiography, ECG, and echocardiography to identify cardiac involvement. Results: Cardiac manifestations identified among CTD patients included pericardial involvement, valvular abnormalities, conduction disturbances, myocardial dysfunction, and pulmonary hypertension. Echocardiography proved to be a valuable non-invasive tool for detecting both symptomatic and subclinical cardiac abnormalities. Cardiovascular involvement was observed more frequently in patients with longer disease duration and increased disease activity. Conclusion: Cardiac involvement is a common yet often underrecognized complication in patients with connective tissue diseases. Routine cardiovascular evaluation using ECG and echocardiography can facilitate early detection and timely management of cardiac complications, thereby reducing morbidity and improving overall clinical outcomes in CTD patients.

Background: Emergency exploratory laparotomy is a life-saving procedure performed under urgent conditions. The choice of abdominal wall closure technique significantly affects postoperative outcomes, including wound healing, infection, and dehiscence. While continuous suturing is faster and commonly used, interrupted (X-pattern) suturing may provide better strength and resistance to complications. Evidence comparing these techniques, particularly with non-absorbable sutures in emergency settings, remains limited. Aims: This study compares the efficacy and outcomes of continuous versus X-interrupted mass closure using non-absorbable sutures in patients undergoing emergency exploratory laparotomy. Methodology: A total of 100 patients undergoing emergency midline laparotomy were randomly divided into two groups: Group A (Interrupted X-mass closure) and Group B (Continuous mass closure), with 50 patients each. Parameters assessed included operative times, wound healing duration, postoperative pain scores, infection rates, and complications. Results: Both groups were comparable in age, gender, and surgical indications. Closure time was significantly shorter in Group B, whereas Group A showed significantly faster wound healing (p<0.001). Postoperative wound infection, pain scores, and complications (suture sinus, gaping, dehiscence) were significantly higher in the continuous closure group (p<0.05). Conclusion: While continuous suturing reduces closure time, X-interrupted suturing results in superior wound healing and fewer postoperative complications, making it a safer and more effective technique for abdominal wall closure in emergency laparotomies.

Background: Greying of hair is a regular feature of chronological aging that occurs in all regions and races. This study aims at finding any association between vitamin D deficiency levels as well as its clinical profile in premature graying of hair (PGH). Materials & Methods: A detailed history was taken, including age of onset of graying, family history, lifestyle habits, and any medical history. Each participant then underwent a complete clinical examination. Blood samples were collected to measure their serum Vitamin D levels. All the collected information was studied to find out if low Vitamin D could be a reason for early white hair. Results: In the study group of 74 individuals with premature graying, 45 participants (60.8%) were found to have Vitamin D deficiency, showing that more than half of them had low levels. In contrast, among the 74 people in the control group, only 21 individuals (28.3%) showed low Vitamin D levels. This means that Vitamin D deficiency was more than twice as common in patients with premature canities compared to those without graying. Conclusion: The study findings show that Vitamin D deficiency was much more common in individuals with premature graying compared to those without. This significant association suggests that low Vitamin D levels may play an important role in the early loss of hair pigment. Timely correction of low Vitamin D levels may help in reducing progression and potentially preventing premature graying.

Aim: Total abdominal hysterectomy (TAH) is the most common surgery performed in women which can results in remarkable postoperative pain. The aim of the present study was to compare the effectiveness of ultrasound-Guided quadratus lumborum block (QLB) with the transversus abdominis plane (TAP) block for postoperative pain in total abdominal hysterectomy. Methods: This study was done in 70 patients posted for abdominal hysterectomy who were divided into two groups of 35 each. QLB was given bilaterally in group Q with 40 ml of 0.375% ropivacaine and TAP block was given in group T with 40 ml of 0.375% ropivacaine. Time required for first analgesic demand was primary aim. Secondary aim was total rescue analgesia (paracetamol) required in 24 hrs, pain scores, nausea, vomiting, sedation and any other complications. Results: The time required for first analgesic demand was5.4± 1.7hrs in T group and 10.2± 1.1hrs in group Q which was statistically significant. The total paracetamol consumption in 24 hours was1.8± 0.4 gm in group Q and 3.2± 0.7gmin group T, difference being significant. Conclusion: In patients undergoing abdominal hysterectomy quadratus lumborum block may be preferred over TAP block for post-operative analgesia. It not only improves the visual analogue scale (VAS) score but also decreases the rescue analgesic consumption without any complications.

Background: Routine cystoscopic ureteral stent removal is commonly performed after uncomplicated urological procedures. However, the necessity of antibiotic prophylaxis during stent removal remains controversial, particularly in low-risk patients, because unnecessary antibiotic exposure may contribute to antimicrobial resistance and adverse effects. Aim: To evaluate whether routine antibiotic prophylaxis was necessary for preventing post-procedural urinary tract infection (UTI) following uncomplicated cystoscopic ureteral stent removal. Materials and Methods: This prospective comparative clinical study included 100 adult patients undergoing routine outpatient cystoscopic ureteral stent removal following uncomplicated urological procedures, predominantly ureteroscopy and treatment of urinary calculi. Patients were divided into two equal groups: Group A (n=50) received antibiotic prophylaxis, while Group B (n=50) underwent stent removal without antibiotic prophylaxis. Patients with active UTI, significant immunosuppression, renal transplantation, urinary diversion, long-term stenting, or complex urological conditions were excluded. Baseline clinical characteristics, pre-procedural urine findings, post-procedural urinary symptoms, and infectious complications were assessed. Patients were followed for 30 days after stent removal. Results: The mean age of the study population was 46.2 ± 13.0 years, and 62% were male. The two groups were comparable regarding demographic characteristics, diabetes mellitus, previous UTI, indication for stenting, preceding urological procedure, and duration of stent indwelling (P>0.05). Ureteric calculi were the most common indication for stent placement (69%), and ureteroscopy was the most frequent preceding procedure (73%). Post-procedural urinary symptoms were comparable between the groups. Symptomatic UTI occurred in 2 patients (4%) in the antibiotic group and 1 patient (2%) in the no-antibiotic group (P=0.56). Culture-confirmed UTI showed a similar distribution, with 2 cases (4%) in the antibiotic group and 1 case (2%) in the no-antibiotic group (P=0.56). No patient developed febrile UTI, pyelonephritis, urosepsis, or required hospital admission. Escherichia coli was the most frequently isolated organism (66.7%), followed by Klebsiella pneumoniae (33.3%). Conclusion: Routine antibiotic prophylaxis did not significantly reduce the incidence of symptomatic or culture-confirmed UTI following uncomplicated cystoscopic ureteral stent removal in this low-risk study population. An antibiotic-sparing approach may therefore be appropriate for carefully selected patients without active urinary infection or major risk factors. However, larger multicentre prospective studies are required to establish definitive risk-based recommendations for antibiotic prophylaxis.

Background: Oral squamous cell carcinoma (OSCC) is the most common oral malignancy and is associated with a high risk of recurrence despite definitive treatment. Identification of clinicopathological predictors of recurrence may facilitate risk stratification and improve postoperative management. This study evaluated the clinicopathological predictors associated with recurrence in patients with OSCC. Methods: This retrospective observational study included 27 surgically treated OSCC patients managed at an oncosurgery hospital in Buldhana, Maharashtra, between June 2023 and May 2026. Clinical, histopathological and follow-up data were retrieved from hospital records. Fisher’s exact test was used to evaluate the association between clinicopathological variables and recurrence, with p<0.05 considered statistically significant. Results: The mean age of patients was 51.70 ± 13.03 years, with a male predominance (74.1%). Buccal mucosa was the most common tumour site (44.4%), and ulcer was the commonest presenting complaint (85.2%). Recurrence occurred in 6 (22.2%) patients, of whom 5 (83.3%) developed local recurrence. Significant histopathological predictors of recurrence included depth of invasion >10 mm (p=0.010), poor tumour differentiation (p=0.018), lymphovascular invasion (p=0.004), perineural invasion (p=0.017), nodal involvement (p=0.011), and distant metastasis (p=0.011). The mean time to recurrence was 14.83 ± 11.5 months. Conclusion: Histopathological parameters were stronger predictors of recurrence than demographic or clinical characteristics. Careful assessment of these factors may help identify high-risk patients requiring adjuvant treatment and closer postoperative surveillance.

Background: Maternal near miss (MNM) refers to a woman who nearly died but survived a life-threatening complication occurring during pregnancy, childbirth, or within 42 days following termination of pregnancy. Maternal near-miss assessment provides valuable information regarding the quality of obstetric care and helps identify factors contributing to severe maternal morbidity. Evaluation of these cases may help improve the timely recognition and management of life-threatening obstetric complications. Aim and Objective: To evaluate the clinical profile, causes, management, and outcomes of maternal near-miss cases at Sanjay Gandhi Memorial Hospital, Mangolpuri, Delhi, India. Method: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Sanjay Gandhi Memorial Hospital, Mangolpuri, Delhi, India. Data were collected retrospectively from hospital records for a period of two years, from January 2018 to January 2020. Women who developed life-threatening obstetric complications during pregnancy, childbirth, or within 42 days following termination of pregnancy and fulfilled the specified maternal near-miss criteria were included. Results: During the 24-month study period, 4,066 deliveries were recorded, of which 72 women were identified as maternal near-miss cases. The prevalence of maternal near miss was 1.78%, corresponding to approximately 18 maternal near-miss cases per 1,000 deliveries. Haemorrhage (39%) and hypertensive disorders of pregnancy (30%) were the leading causes. Conclusion: Haemorrhage and hypertensive disorders of pregnancy were the leading causes of maternal near-miss events, followed by sepsis and severe anaemia.

Background: Genu varum deformity in adults is commonly associated with medial compartment osteoarthritis, abnormal mechanical axis, chronic pain, and progressive functional limitation. High tibial osteotomy (HTO) remains an established joint-preserving procedure for active adults with isolated medial compartment disease. Medial open wedge high tibial osteotomy has gained widespread acceptance because of its ability to achieve accurate deformity correction while preserving bone stock and avoiding fibular osteotomy. Stable fixation combined with structural bone grafting facilitates osteotomy healing and maintenance of correction. Careful patient selection, meticulous surgical planning, and appropriate fixation are essential for successful clinical and radiological outcomes. Aim: To evaluate the clinical, radiological, and functional outcomes of medial open wedge high tibial osteotomy stabilized with lateral plate fixation and bone grafting using the lateral surgical approach in adults with genu varum deformity. Materials and Methods: A prospective observational study was conducted in the Department of Orthopaedics, RNT Medical College and Hospital, Udaipur, Rajasthan, India, from March 2024 to January 2026. Thirty-seven adult patients with symptomatic genu varum deformity undergoing medial open wedge high tibial osteotomy with lateral plate fixation and bone grafting were included. Clinical assessment included Visual Analogue Scale (VAS), Knee Society Score (KSS), range of motion, and radiological evaluation of the mechanical axis, medial proximal tibial angle (MPTA), and tibiofemoral angle. Patients were followed for one year after surgery. Statistical analysis was performed using IBM SPSS Statistics version 26.0. Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequency and percentage. Paired Student’s t-test and repeated-measures ANOVA were used where appropriate. A p-value <0.05 was considered statistically significant. Results: Among 37 patients, the mean age was 42.8 ± 8.9 years, and 59.5% were females. Significant improvement was observed in functional outcome following surgery. Mean VAS score improved from 7.4 ± 1.2 preoperatively to 2.1 ± 0.9 at final follow-up (p<0.001). Mean Knee Society Score improved from 54.8 ± 9.6 to 86.9 ± 7.3 (p<0.001). Radiological correction demonstrated significant improvement in tibiofemoral alignment and MPTA. Osteotomy union was achieved in 94.6% of patients within six months. Postoperative complications were minimal and managed successfully. Conclusion: Medial open wedge high tibial osteotomy with lateral plate fixation and bone grafting is an effective joint-preserving procedure for adult genu varum deformity. The technique provides reliable deformity correction, satisfactory functional improvement, predictable osteotomy healing, and acceptable complication rates when appropriate patient selection and surgical technique are employed.

Background: The incidence of cardiovascular morbidity and mortality in people with end stage renal disease (ESRD) on dialysis is higher than in the general population. The US Renal Data System estimates the prevalence of cardiovascular disease in ESRD patients on hemodialysis (HD) a 70.6% and that in peritoneal dialysis patients 57.8%. Furthermore, arrhythmia / cardiac arrest is the only cause of death in 40% of dialysis patients. There is little evidence to support the effectiveness of traditional risk factor modification approaches, drug use or lifestyle changes in this population. Furthermore, coronary artery revascularization in patients with documented coronary artery disease did not alter arrhythmia mortality rates. Therefore, optimal strategies for the diagnosis, prevention and management of cardiovascular disease need to be modified in patients with ESRD. Method: Sixty one patients with end stage renal disease on maintenance hemodialysis attending OPD / IPD or dialysis centre were studied using random sampling method. We conveniently took 61 patients who are adequately dialysed (KT/V urea > 1.2 for last 4 weeks) out of total 165 patients. Their demographic profile, clinical (cardiac symptoms) and biochemical profile (NT-proBNP) was recorded. Assessment with 2D echocardiography was done to find cardiac structural or functional abnormality. Results: All patients had significantly raised NT-proBNP level with mean NT-proBNP level of 15912.1 ± 13078.3 pg/ml. Prevalence of LV systolic dysfunction was 13.11%; out of them 3.28%, 4.9% and 4.9% patients had mild, moderate and severe systolic dysfunction respectively. Prevalence of LV hypertrophy (100%) and Diastolic dysfunction (98.36%) was very high. Significant correlation found between NT proBNP level and echocardiographic parameters. No significant correlation found between interdialytic weight gain (IDWG) and DD (P = 0.174), IDWG and dyspnea NYHA grade (P = 0.929) or IDWG and NT-proBNP level (P value = 0.39). Over 1 year of study period, 7 patients were hospitalized due to heart failure and 2 patients were died due to other causes with mean NT-proBNP level 25472.85 pg/ml and 30506 pg/ml respectively. Conclusions: NT-proBNP is not a reliable marker for heart failure in end stage renal disease patients. However, if we increase it cut off to more than 11500 pg/ml that is 20 times more than present value, it may have diagnostic value. It can also have prognostic significance as high value is associated with increased risk of heart failure and mortality.

Background: The kidney is a vital organ that is frequently involved in both pre-existing chronic disease and acute terminal events identified at medicolegal autopsy. Routine hematoxylin and eosin (H&E) staining, while useful, often fails to highlight subtle changes in glomerular and tubular basement membranes. The Periodic Acid-Schiff (PAS) stain, by selectively staining carbohydrate-rich structures, provides superior contrast for evaluating renal microanatomy, making it indispensable in forensic renal pathology. Aims and Objectives: To elucidate and characterise histopathological changes in kidney tissue using the PAS technique in medicolegal cases, and to investigate and document proliferative changes in glomeruli, basement membrane, and Bowman’s capsule while correlating histopathological findings with medicolegal aspects of renal disease. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Rajendra Institute of Medical Sciences (RIMS), Ranchi over 18 months (July 2024–2026). A total of 110 consecutive medicolegal autopsy kidney specimens were processed using standard tissue preparation protocols and stained with the PAS technique. Glomerular and tubular changes were graded using the Arzec and Blanchette grading system. Statistical analysis was performed using SPSS v.22; chi-square test was applied, and p < 0.05 was considered significant. Results: The predominant age group was 31–40 years (30.0%) with a strong male preponderance (74.55%). Cardiorespiratory failure was the most common certified cause of death (65.45%). Diabetes mellitus (21.82%) and hypertension (15.45%) were the leading comorbidities. On PAS staining, moderate-to-severe GBM thickening was present in 45.0% of cases, mesangial expansion in 56.36%, and Bowman’s capsule thickening in 44.55%. Tubular atrophy was noted in 57.27%, severe tubular damage in 35.0%, and interstitial fibrosis in 50.0%. Chronic pyelonephritis (26.36%), glomerulosclerosis (16.36%), and chronic glomerulonephritis (14.55%) were the most common final diagnoses. No statistically significant association was found between PAS-detected changes and cause of death. Conclusion: Significant renal histological changes are common in medicolegal autopsy cases, many of which remain undetected during life. PAS staining is a reliable, cost-effective tool for detecting chronic basement membrane disease, tubular injury, and incidental lesions in forensic settings. Systematic histopathological examination of renal tissue should be considered routine in medicolegal autopsies.

Background: Elastic fibres are essential for maintaining the structural integrity, elasticity, and recoil of the trachea and main bronchi. Although age-related degeneration of elastin has been described in several connective tissues, quantitative information regarding age-associated changes in the central conducting airways remains limited. This study aimed to evaluate histomorphometric alterations in elastic fibres of the human trachea and main bronchi across different age groups. Methods: A descriptive cross-sectional histomorphometric study was conducted on tissues obtained from 63 human cadavers. Tracheal and main bronchial specimens were processed using routine histological techniques and stained with Verhoeff–Van Gieson stain for elastic fibre visualization. Elastic fibre density, fibre thickness, fragmentation index, and degeneration score were quantified using digital image analysis and compared across six age groups. Regional differences between the trachea and bronchi were evaluated, while Pearson’s correlation was used to determine the association between age and morphometric parameters. Results: The mean age of the study population was 49.8 ± 17.2 years, with males constituting 66.7% of the specimens. Elastic fibre density declined significantly from 33.8 ± 2.5% in the 20–29-year group to 20.9 ± 2.0% in individuals aged ≥70 years (F = 58.72, p<0.001), while fibre thickness decreased from 2.81 ± 0.19 µm to 1.71 ± 0.14 µm (F = 67.14, p<0.001). Conversely, fragmentation index and degeneration score increased significantly with age (both p<0.001). Qualitative histological examination demonstrated progressive fragmentation, fibre waviness, loss of parallel orientation, and elastic fibre clumping in older age groups. No significant differences were observed between the trachea and main bronchi or between the right and left main bronchi (all p>0.05). Age showed strong negative correlations with elastic fibre density (r = −0.857) and fibre thickness (r = −0.881), and strong positive correlations with fragmentation index (r = 0.912) and degeneration score (r = 0.894) (all p<0.001). Conclusion: Advancing age is associated with significant deterioration of elastic fibres within the human trachea and main bronchi, characterized by reduced fibre density and thickness together with increased fragmentation and structural degeneration. These findings provide quantitative baseline evidence of normal tracheobronchial ageing and improve understanding of extracellular matrix remodelling in the central airways, thereby serving as a valuable reference for future anatomical and respiratory research.

Background: ROP is a vasoproliferative disease of retina that affects premature infants. In India, the guidelines given by the National neonatology forum were followed for ROP screening previously. In February 2013, RBSK was launched under the National Health Mission, which focussed on improving the quality of life of children from the time of birth to 18 years through timely screening for various defects, including eye and vision related problems. Aim: To evaluate the incidence of Retinopathy of Prematurity (ROP) and analyse the risk factors in premature infants based on National Health Mission-Rashtriya Bal Swasthya Karyakram (NHM-RBSK) guidelines. Methodology: The present study was a cross sectional study based on NHM-RBSK guidelines for ROP screening in a tertiary care hospital. All included babies were subjected to indirect ophthalmoscopy and the presence or absence of ROP was noted. Prior to that a detailed history from the parents and case records was collected regarding various pre, intra and postnatal risk factors. The data was analyzed statistically using appropriate tests. Results: The incidence of ROP was found to be 14.7%. Gestational age(GA) < 27 weeks, Birth weight (BW) <1700 grams, Oxygen therapy for > 5 days and multiple gestation were statistically significant risk factors on univariate analysis and multiple gestation and PDA were the significant risk factors on multiple logistic regression analysis.

Background: Early recognition of severe acute pancreatitis remains difficult because organ failure may evolve after an initially nondiagnostic presentation. The neutrophil-to-lymphocyte ratio (NLR), derived from a routine differential leukocyte count, integrates innate inflammatory activation and stress-associated lymphopenia. This study evaluated admission NLR as an early predictor of acute pancreatitis severity and adverse hospital outcomes. Methods: A prospective observational study included 180 consecutive adults admitted within 24 hours of symptom onset to a tertiary-care hospital. Acute pancreatitis and disease severity were classified according to the revised Atlanta criteria. Admission NLR was calculated from absolute neutrophil and lymphocyte counts. Bedside Index for Severity in Acute Pancreatitis (BISAP), Acute Physiology and Chronic Health Evaluation II (APACHE II), 48-hour C-reactive protein (CRP), and modified computed tomography severity index were recorded. Receiver-operating-characteristic analysis and multivariable logistic regression were used to evaluate the prediction of severe acute pancreatitis. Results: Of 180 patients, 108 (60.0%) had mild, 48 (26.7%) had moderately severe, and 24 (13.3%) had severe acute pancreatitis. Median admission NLR increased progressively from 5.2 in mild disease to 6.5 in moderately severe disease and 10.7 in severe pancreatitis (p<0.001). NLR predicted severe disease with an area under the receiver-operating-characteristic curve of 0.853 (95% confidence interval [CI]: 0.769–0.920). A cutoff of 6.7 provided 95.8% sensitivity and 66.0% specificity. Severe pancreatitis occurred in 30.1% of patients with NLR ≥6.7 compared with 1.9% of those below this threshold (p<0.001). Mortality was 11.0% and 0%, respectively. After adjustment for age, BISAP, and blood urea nitrogen, every one-unit increase in NLR remained independently associated with severe pancreatitis (adjusted odds ratio [OR]: 1.40; 95% CI: 1.15–1.72; p<0.001). Conclusion: Admission NLR provided rapid, inexpensive, and clinically meaningful early risk stratification in acute pancreatitis. Although it did not replace multiparametric assessment or 48-hour CRP, an NLR ≥6.7 identified a high-risk subgroup requiring intensified monitoring and early organ-support planning.

Background: Acute kidney injury (AKI) is a frequent complication of acute illness and is associated with prolonged hospitalization, kidney replacement therapy, chronic kidney disease, and death. Its clinical spectrum varies according to patient characteristics, healthcare setting, regional disease patterns, and access to timely nephrological care. This study evaluated the clinical profile, etiological distribution, severity, treatment requirements, renal recovery, and predictors of in-hospital mortality among adults with AKI admitted to a tertiary care hospital. Methods: A prospective observational study was conducted over 18 months in the medicine department of a tertiary care hospital. Consecutive adults fulfilling Kidney Disease: Improving Global Outcomes criteria for AKI were included. Demographic characteristics, comorbidities, precipitating factors, laboratory parameters, urine output, maximum AKI stage, organ-support requirements, kidney replacement therapy, and outcomes were recorded. Outcomes were categorized as complete renal recovery, partial recovery, dialysis dependence, or in-hospital death. Multivariable logistic regression identified independent predictors of mortality. Results: A total of 180 patients were evaluated; the mean age was 56.3 ± 14.7 years, and 102 (56.7%) were men. Community-acquired AKI accounted for 60.6% of cases. Sepsis was the leading etiology (35.6%), followed by hypovolemia (21.7%), nephrotoxic exposure (17.2%), and urinary obstruction (13.9%). KDIGO stages 1, 2, and 3 were observed in 31.1%, 27.2%, and 41.7% of patients, respectively. Oliguria occurred in 37.8%, while 23.9% required kidney replacement therapy. Complete recovery occurred in 43.3%, partial recovery in 30.6%, dialysis dependence in 4.4%, and death in 21.7%. Mortality increased from 8.9% in stage 1 to 36.0% in stage 3. Older age, sepsis-associated AKI, KDIGO stage 3, and mechanical ventilation independently predicted mortality. Conclusion: AKI in a tertiary care setting was predominantly associated with sepsis, hypovolemia, and nephrotoxic exposure. Severe AKI, respiratory failure, and sepsis identified a subgroup at particularly high risk of death. Early recognition, hemodynamic optimization, nephrotoxin stewardship, and coordinated critical-care and nephrology management may improve renal recovery and survival.

Background: The tumor is not just malignant proliferating cancerous cells, but it has many other accompanying cells such as fibroblasts, macrophages, mast cells and NK cells that together form a complex tumor microenvironment (TME). These tumor cells along with TME form self-governing and self-sufficient biological structure. Objective: to quantify the eosinophil infiltration in dysplastic and malignant lesions that is squamous cell carcinoma of oral cavity and its variation in various grades of dysplasia and squamous cell carcinoma of oral cavity. Methods: This prospective cross-sectional study was done on tissue sections of clinically suspected and histologically proven cases of dysplastic and malignant lesions of oral cavity. The tissue studied were received in Histopathology section of the Department of Pathology, BLDE (Deemed to be university) Shri B M Patil Medical College Hospital & Research Centre, Vijayapura. Duration of study wasc 1^st December, 2019 – 31^st July, 2021. Result: Mean age was 45.5 yrs. Male: female ratio of 1.96: 1 with 53 male cases and 27 female cases were noted in present study. A non-significant increase (p>0.05) was observed in the eosinophil count in squamous cell carcinoma when compared to epithelial dysplasia. Amongst the 32 cases of Epithelial dysplasia, increase in eosinophil count was observed in mild dysplasia with high standard deviation when compared to moderate and severe dysplasia. This increase eosinophil count was not statistically significant. (p>0.05). In 48 cases of squamous cell carcinomas studied, increased eosinophil count in well differentiated squamous cell carcinoma was found to be non- significant (p>0.05) when compared to moderately and poorly differentiated squamous cell carcinoma. Conclusion: Eosinophil count was higher in SCC as compared to epithelial dysplasia. Thus multicentric, extensive studies with large sample size may help to consider role of eosinophils as a novel target for therapeutic agent.

Background: Chronic maxillary sinusitis (CMS) is a multifactorial inflammatory disorder with significant quality-of-life burden affecting 146/1000 population in India. Aim: To evaluate prevalence of etiological factors causing CMS in Eastern Indian population. Methods: Cross-sectional observational study conducted at ENT OPD, RIMS, Ranchi over one year (n=127, age >17 years, symptoms >12 weeks). Consecutive sampling applied. Clinical history, SNOT-22, anterior/posterior rhinoscopy, diagnostic nasal endoscopy (Lund-Kennedy score), X-ray PNS and CT PNS (256-slice) were recorded. Bacteriology and socioeconomic assessment (Kuppuswamy) done. Analysis in Jamovi v2.6.19. Results: Mean age 32.1±13.7 years, peak 21-30 years (41.7%), male predominance 61.4% (p=0.013). Nasal blockage (88.98%) and anterior discharge (81.89%) were commonest symptoms. Mean SNOT-22 23.5±19.9; 59.1% mild disease. Deviated nasal septum (41.7%) was commonest anatomical variation; 66.9% had multiple variations (p=0.027 association with severity). Allergy (56.7%), odontogenic causes (33.9%), environmental exposure (25.2%) and lower socioeconomic status (37.3% lower class) were major contributors. Conclusion: CMS is multifactorial with anatomical, allergic, odontogenic and socioeconomic interplay requiring multidisciplinary evaluation and early intervention.

Background: The Universal Immunization Programme (UIP) is one of India’s largest public health initiatives aimed at reducing childhood morbidity and mortality caused by vaccine-preventable diseases (VPDs). Although there have been significant gains in coverage, VPDs remain because people have not been vaccinated, or they have been postponed, and there are healthcare access gaps. Materials and Methods: An observational cross-sectional study was conducted at the Department of Pediatrics in Lord Buddha Koshi Medical College and Hospital during September 2025 to February 2026 with 98 pediatric patients. A structured proforma was used to gather data on demographic parameters, immunization status, vaccination records, history of vaccine-preventable disease and hospitalization. Data was analyzed statistically in SPSS version 26.0, and descriptive analysis, chi-square test, Fisher’s exact test, and odds ratio were used. A p-value <0.05 was regarded as statistically significant. Results: Of the 98 children, 69.4% were fully immunized, 22.4% partially immunized and 8.2% were unimmunized. Vaccine-preventable diseases occurred 32.7% of participants; pneumonia and measles were the most prevalent diseases. A significant association was observed between incomplete vaccination and the presence of VPDs (p<0.001). Partially immunized and unimmunized children were more likely to be hospitalized and admitted to intensive care. Conclusion: The introduction of the UIP was shown to be effective in decreasing the incidence of vaccine-preventable diseases and hospitalizations in children. Optimizing childhood immunization coverage requires the reinforcement of routine immunisation services, encouraging full vaccination, and increasing community awareness.

Background: Overweight and obesity are rising sharply among young adults and are increasingly linked to impaired respiratory mechanics. Whether a modestly elevated body mass index (BMI) measurably reduces lung function in apparently healthy young Indians remains insufficiently explored, particularly in this region. Aim: To record and compare pulmonary function test (PFT) parameters — forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio and peak expiratory flow rate (PEFR) — between normal-weight and overweight medical students, and to evaluate the effect of increased BMI on lung function. Materials and Methods: In this cross-sectional comparative study, 120 healthy medical students aged 18–30 years were recruited by simple random sampling: 60 normal-weight (BMI 18.5–24.99 kg/m²) and 60 overweight (BMI 25.0–29.99 kg/m²). Anthropometry was recorded and spirometry was performed in the standing position with a calibrated SPIROLAB spirometer; the best of three acceptable manoeuvres was analysed. Inter-group comparisons used the independent two-tailed Student t-test (SPSS 15.0); p < 0.05 was considered significant. Results: FVC (2.93±0.46 vs 2.71±0.39 L; p = 0.006), FEV1 (2.50±0.63 vs 2.31±0.24 L; p = 0.033) and PEFR (409.29±65.41 vs 337.04±85.09 L/min; p < 0.001) were all significantly lower in overweight students, whereas the FEV1/FVC ratio was significantly higher (84.88±14.10 vs 90.94±7.84%; p = 0.004). On age stratification, the FVC difference was significant above 20 years (p = 0.003) and the PEFR difference was significant in both age strata (p = 0.022 and p < 0.001). Conclusion: Even a moderate increase in BMI is associated with significant reductions in FVC, FEV1 and PEFR, together with an elevated FEV1/FVC ratio indicative of an early restrictive ventilatory pattern. Weight management in young adults may help preserve pulmonary health and reduce future respiratory morbidity.

Background: Helicobacter pylori (H. pylori) is a major cause of various gastrointestinal disorders, including gastritis, peptic ulcer disease, and gastric cancer. It is particularly prevalent in populations with poor sanitation and hygiene. Rapid and accurate diagnosis of H. pylori infection is crucial for effective treatment and prevention of complications. Aim and Objectives: To determine the prevalence of H. pylori infection among dyspeptic patients using the Rapid Urease Test (RUT). To analyze the association between H. pylori infection and endoscopic as well as histopathological findings. To assess the impact of demographic and lifestyle factors on H. pylori infection. Materials and Methods: A hospital-based observational study was conducted at Basaveshwara Medical College and Hospital, Chitradurga, from May 2023 to October 2024. A total of 50 patients with dyspeptic symptoms underwent upper gastrointestinal endoscopy. Biopsy specimens were collected and tested for H. pylori using the Rapid Urease Test and histopathological examination. Relevant clinical, demographic, and lifestyle data were recorded. Statistical analysis was performed using appropriate tests to assess correlations. Results: The prevalence of H. pylori infection was 50% based on RUT and histopathological confirmation. Epigastric pain (86%) was the most common symptom. Gastritis (84%) was the predominant endoscopic finding, followed by GERD (54%) and gastric erosion (50%). There was a significant correlation between RUT and histopathology results (p < 0.001), confirming the diagnostic accuracy of RUT. No significant association was found between H. pylori infection and specific endoscopic findings (p > 0.05). Conclusion: The study highlights a high prevalence of H. pylori infection (50%) among dyspeptic patients. Routine screening using RUT and histopathology can aid in early detection and treatment. Lifestyle factors such as smoking and alcohol consumption may contribute to disease progression. Further large-scale studies are recommended to explore non-H. pylori causes of dyspepsia and improve treatment strategies.

Background: Congenital hypothyroidism (CH) is regarded as the commonest cause of preventable mental retardation. With the introduction of newborn screening, early diagnosis and timely initiation of thyroxine replacement therapy have improved the outcomes of affected children. Study was conducted to find out the incidence of congenital hypothyroidism in term and preterm babies and to find out the epidemiological correlation of congenital hypothyroidism (incidence iodised salt and non-iodised salt consuming population. Materials and Methods: Cord blood samples were collected with the help of a 5cc syringe from the cord stump of the babies satisfying the afore mentioned inclusion and exclusion criteria at the time of birth in the labour room or Operation Theatre in a clot vial and sent for analysing TSH levels within four hours of collection. The babies were re-evaluated on 4th day for term babies and 5th day for preterm babies by heel prick method. A short history and clinical examination about the babies were conducted. Babies with elevated TSH levels (>20mcU/L) this time also were re-evaluated at the age of one month with a venous sample for TSH levels. Those with persistently raised TSH levels (>20mcU/L) at the age of one month were considered to be suffering from congenital hypothyroidism. The data thus collected were analysed by statistical methods to find out the incidence of congenital hypothyroidism in the institution. Results: rom the present study, we can see that of the 1640 babies 27.5% were from Kolkata, 14.2% from Murshidabad, 12.6% from Malda, 8.5% from North 24 parganas, 0.2% from Bankura, 2.7% from Birbhum,1.9% from Burdwan, 5.3% from Nadia, 4.8% from Paschim Midnapore,3.9% from Purba Midnapore, 5.9% from Howrah, 5.4% from Hoogly, 6.4%from South 24 parganas and 0.3% from Purulia. The study shows that 79.4% of the mothers had no complications, 15.2% had anaemia, 2.01%had hypertension, 1.58% had hypothyroidism, 0.9% had antepartum haemorrhage, 0.6% had gestational diabetes, 0.1% had fibroid uterus and increased maternal age respectively. In our study no mother was found to take antithyroid drug. Conclusion: Congenital hypothyroidism has a high incidence in our country. Its inclusion in neonatal screening protocol has been rightly done. This can help us prevent an important cause of mental retardation. Transient hypothyroidism is a common entity. So treatment of hypothyroidism should not be started on the basis of Cord blood Thyroid Stimulating Hormone (CBTSH).

Background: Appropriate infant and young child feeding (IYCF) practices during the first two years of life are fundamental for ensuring optimal growth, neurodevelopment, and long-term health. Although evidence-based recommendations on breastfeeding and complementary feeding are widely disseminated, gaps often persist between maternal knowledge and actual feeding practices. Understanding these gaps is essential for designing effective educational and public health interventions. Objectives: To evaluate maternal knowledge, attitudes, and practices regarding infant and young child feeding among mothers of children aged 6–24 months attending a tertiary care teaching hospital and to identify the disparity between knowledge and actual feeding practices. Materials and Methods: A hospital-based cross-sectional study was conducted among 200 mothers of children aged 6–24 months attending the Immunization Clinic and Pediatric Outpatient Department of Sri Chamundeshwari Medical College Hospital and Research Institute (SCMCH&RI), Channapatna, Karnataka, between November 2022 and April 2024. Participants were recruited using predefined eligibility criteria after obtaining informed consent. Data were collected using a pretested semi-structured questionnaire based on World Health Organization (WHO) recommendations for infant and young child feeding practices. The questionnaire assessed maternal knowledge, attitudes, and feeding practices. Data were entered into Microsoft Excel and analysed using SPSS version 20. Descriptive statistics were expressed as frequencies and percentages. Associations between variables were evaluated using the Chi-square test and Student’s t-test, with a p-value <0.05 considered statistically significant. Results: Among the 200 participating mothers, 95% correctly identified the importance of colostrum, 90% knew the recommended time for initiation of breastfeeding, and 85% were aware of the recommended duration of exclusive breastfeeding and the appropriate age for introducing complementary feeding. Despite satisfactory knowledge, recommended practices were considerably lower. Only 55% initiated breastfeeding within one hour of birth, while 61.5% breastfed their infants at least eight times during the first month. Although 85% of mothers knew complementary feeding should begin at six months, only 24% initiated complementary feeding at the recommended age, whereas 70% introduced complementary foods before six months and 6% delayed introduction beyond six months. Homemade foods, particularly rice gruel (47.5%) and ragi preparations (35%), were the most commonly used first complementary foods. Institutional delivery was significantly associated with timely initiation of breastfeeding and appropriate feeding practices (p<0.0001). Conclusion: The study demonstrates that maternal knowledge and attitudes towards infant and young child feeding were generally satisfactory; however, adherence to recommended feeding practices remained suboptimal. The substantial gap between knowledge and practice highlights the need for structured counselling during antenatal and postnatal care, continuous community-based nutrition education, and active involvement of family caregivers to improve compliance with WHO-recommended infant feeding practices.

Background: Thyroid peroxidase antibodies (TPOAb) are markers of thyroid autoimmunity associated with adverse pregnancy outcomes. Objective: To determine the prevalence of TPOAb positivity and its association with recurrent pregnancy loss (RPL), maternal, and perinatal outcomes. Methods: This prospective observational study included 100 pregnant women with gestational age ≤20 weeks. Thyroid function tests and anti-TPO antibody levels were assessed, and participants were followed until delivery. Maternal and perinatal outcomes were recorded and analyzed. Results: TPOAb positivity was observed in 32% of participants. TPOAb-positive women had significantly higher TSH levels (p<0.001) and a higher prevalence of RPL (56.3% vs. 17.6%, p<0.001). Significant associations were observed with gestational hypertension (p=0.042), preeclampsia (p=0.037), preterm labour (p=0.047), low birth weight (p=0.021), and NICU admission (p=0.048). Logistic regression identified TPOAb positivity (OR=3.46, p=0.006) and subclinical hypothyroidism (OR=2.63, p=0.033) as independent predictors of RPL. Conclusion: TPOAb positivity is common in pregnancy and is significantly associated with recurrent pregnancy loss and adverse maternal and perinatal outcomes. Early screening may help identify high-risk pregnancies and improve outcomes.

Background: Chronic non-healing ulcers are a major clinical problem associated with prolonged morbidity, especially in patients with diabetes and vascular disorders. Conventional treatment often shows delayed healing. Autologous platelet-rich plasma (PRP), rich in growth factors, has emerged as a promising modality to enhance wound healing. Aim: To evaluate the role of autologous platelet-rich plasma in the treatment of chronic ulcers. Materials and Methods: This prospective observational study was conducted on 30 cases with chronic ulcers at a tertiary care center from April 2024 to October 2025. Cases aged >18 years with ulcer duration >4 weeks were included. PRP was prepared by double-spin centrifugation and applied weekly for up to 6 weeks. Cases were followed on days 1, 7, 15, 30, and 45. Outcome measures included ulcer size reduction, granulation tissue formation, pain score (VAS), wound discharge, and number of dressings. Results: Most cases belonged to 31–50 years age group 14(46.7%) with male predominance 21(70.0%). Diabetic ulcers were most common 14(46.7%) and foot was the commonest site 16(53.3%). Mean ulcer size reduced significantly from 9.8 ± 2.4 cm² to 1.8 ± 1.2 cm² (p <0.001). Granulation tissue increased from 6(20.0%) to 29(96.7%). Pain score reduced from 7.2 ± 1.1 to 1.3 ± 0.6. Majority of cases 18(60.0%) showed healing within 30 days. Complete healing was observed in 20(66.7%) cases with overall success rate of 96.7%. Conclusion: Autologous PRP was found to be a safe, effective, and cost-efficient treatment modality for chronic ulcers, leading to faster wound healing, reduced pain, and improved clinical outcomes.

Background: Pulmonary tuberculosis (PTB) is associated with systemic inflammation and coagulation activation, leading to elevated D-dimer levels. This study evaluated the correlation between plasma D-dimer levels and the extent of lung involvement in PTB patients. Methods: A cross-sectional study was conducted among 100 newly diagnosed, microbiologically confirmed PTB patients. Lung involvement was assessed using chest radiographs, and plasma D-dimer levels were measured by immunoturbidimetric assay. Data were analyzed using Pearson’s correlation and one-way ANOVA. Results: The mean D-dimer level was 1638.8 ± 804.1 ng/mL. Moderate lung involvement was observed in 60% of patients. Plasma D-dimer levels increased significantly with greater radiological severity (p<0.001) and showed a significant positive correlation with the extent of lung involvement (r=0.62, p<0.001). Conclusion: Plasma D-dimer levels were significantly associated with the extent of pulmonary involvement in PTB, suggesting that D-dimer may serve as a simple biomarker for assessing disease severity.

Background: Burst abdomen, also referred to as postoperative wound dehiscence, is one of the most serious complications following emergency exploratory laparotomy. It is associated with prolonged hospital stay, increased morbidity, repeated surgical intervention, and higher healthcare costs. Several patient-related and metabolic factors influence wound healing. Serum lactate reflects tissue hypoperfusion and systemic stress, whereas serum cholesterol plays an important role in cell membrane synthesis, collagen formation, and tissue repair. The combined predictive value of these readily available biochemical markers has not been extensively evaluated in emergency abdominal surgery. Objectives: To evaluate the association of preoperative serum lactate and serum cholesterol levels with the occurrence of wound dehiscence among patients undergoing emergency exploratory laparotomy. Methods: A prospective observational analytical study was conducted among 220 adult patients undergoing emergency exploratory laparotomy at Rajendra Institute of Medical Sciences (RIMS), Ranchi, over a period of twelve months. Preoperative serum lactate and fasting serum cholesterol levels were measured before surgery. Patients were followed until discharge for the occurrence of postoperative wound dehiscence. Statistical analysis included descriptive statistics, Student’s t-test, Chi-square test, multivariable logistic regression, receiver operating characteristic (ROC) curve analysis, and calculation of diagnostic indices. Results: Among the cohort, wound dehiscence developed in 29 patients (13.2%). Patients who developed wound dehiscence demonstrated significantly higher serum lactate levels and significantly lower serum cholesterol levels compared with those without wound complications (p<0.001). Multivariable logistic regression identified elevated serum lactate, hypocholesterolaemia, hypoalbuminaemia, and faecal peritonitis as independent predictors of wound dehiscence. The combined biochemical model demonstrated superior predictive performance compared with either marker alone. Conclusion: The findings suggest that preoperative serum lactate and serum cholesterol may serve as inexpensive and useful predictors of postoperative wound dehiscence following emergency exploratory laparotomy. Their combined assessment may facilitate early risk stratification and perioperative optimisation.

Background: Premenstrual disorders (PMDs), including Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), are common conditions affecting women of reproductive age. These disorders are characterized by physical, emotional, behavioral, and psychological symptoms occurring during the luteal phase of the menstrual cycle and may significantly impair academic performance, social interactions, and quality of life. Objectives: To determine the prevalence and severity of premenstrual symptoms and to assess knowledge regarding Premenstrual Disorder among female medical students. Methods: A cross-sectional study was conducted among 235 female medical students at GMERS Medical College and Hospital, Junagadh. Data were collected using a structured questionnaire that included demographic and menstrual characteristics, a Premenstrual Symptoms Screening Tool (PSST) for assessment of symptom severity, and a knowledge questionnaire regarding PMD. Data were analyzed using SPSS software version 26.0. Descriptive statistics were used to summarize the findings. Results: The majority of participants were aged 20 years (29.8%), belonged to nuclear families (71.5%), and attained menarche between 13–17 years of age (96.6%). Regular menstrual cycles were reported by 82.1% of participants, while dysmenorrhea was present in 58.7%. Mild-to-moderate premenstrual symptoms were highly prevalent. Anger/irritability was reported as mild by 47.2% and moderate by 35.3% of participants. Fatigue/lack of energy was reported as moderate by 37.4%, while decreased mood/hopelessness was reported as mild by 45.5% and moderate by 34.9%. Severe symptoms were relatively uncommon. Knowledge assessment revealed that 52.3% of participants had average knowledge, 40.9% had good knowledge, and 6.8% had poor knowledge regarding PMD. Conclusion: Premenstrual symptoms and dysmenorrhea were highly prevalent among female medical students, with emotional and physical symptoms being the most commonly reported manifestations. Although the majority demonstrated average to good knowledge regarding PMD, enhanced awareness, early screening, and supportive interventions are necessary to improve menstrual health and quality of life.

Background: Surface ablation laser procedures are widely used for refractive correction; however, they induce significant stromal wound healing responses, particularly affecting corneal keratocytes. Understanding these morphological and quantitative changes is essential for optimizing surgical outcomes and minimizing complications. Methods: This prospective observational study included 52 patients undergoing surface ablation procedures, including Photorefractive Keratectomy, Laser-Assisted Subepithelial Keratomileusis, and Epithelial Laser In Situ Keratomileusis. Keratocyte density and morphology were assessed preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively using In Vivo Confocal Microscopy. Statistical analysis included repeated measures ANOVA, Chi-square test, and Spearman correlation. Results: A significant reduction in anterior stromal keratocyte density (~29.6%) was observed at 1 week (p < 0.001), followed by gradual recovery by 6 months. Qualitative changes, including increased reflectivity (86.5%) and activated keratocytes (75.0%), declined significantly over time (p < 0.001). Keratocyte loss correlated negatively with ablation depth (r = −0.62, p < 0.001). PRK showed greater cellular loss compared to epithelial-preserving procedures (p = 0.041). Corneal haze was significantly associated with keratocyte activation (p = 0.018). Visual outcomes were favorable, with significant improvement in uncorrected visual acuity (p < 0.001). Conclusion: Surface ablation procedures induce dynamic, depth-dependent keratocyte changes predominantly in the anterior stroma. These alterations are influenced by surgical technique and contribute to postoperative haze, though visual outcomes remain excellent. Understanding these responses may help refine surgical strategies and improve patient outcomes.

Background: Epilepsy is a chronic neurological disorder requiring long-term pharmacological treatment. Appropriate selection of antiepileptic drugs (AEDs) is essential for achieving seizure control while minimizing adverse effects. Drug utilization studies help evaluate prescribing patterns and optimize patient care. Objectives: To study the pharmacotherapy of epilepsy and quality of life among adult patients attending a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted among 110 adult epilepsy patients receiving treatment at a tertiary care hospital. Data regarding demographic characteristics, seizure type, antiepileptic medications prescribed, treatment patterns, and adverse drug reactions were collected and analyzed using descriptive statistics. Results: The mean age was 36.4±11 years, with a male preponderance (55.5%). Polytherapy (73.6%) was more common than monotherapy (26.4%); levetiracetam was the most frequently prescribed AED overall (63.6%). Impaired QOL (QOLIE-10 score >25) was present in 85% of patients, most marked in the social, memory, and work domains. Mean QOLIE-10 scores did not differ significantly by seizure type (generalized 30±2.5 vs partial 29.9±3.6; P=0.951), seizure frequency score band (P=0.665), or therapy type (monotherapy 29.9±4.3 vs. polytherapy 30.1±2.8; P=0.721). Conclusion: Levetiracetam was the most commonly prescribed AED. Impaired quality of life was highly prevalent in this population and was not explained by seizure type, seizure frequency, or the number of AEDs used. This suggests QOL impairment in epilepsy is driven substantially by factors outside routine clinical and prescribing variables, and supports incorporating structured QOL screening into standard epilepsy follow-up regardless of apparent seizure control.

Background: 60% companies got Licensing for Ayurveda & upgraded to GMP. Caffeine is the most widely consumed psychoactive substance worldwide, and habitual intake has been linked to modest improvements in reaction time in several population-based studies, while its relationship with sleep quality and short-term memory remains less consistent. Few studies have examined caffeine and cognitive performance while formally adjusting for sleep quality. Objectives: To determine the association between habitual caffeine consumption and reaction time, and to evaluate whether sleep quality (Pittsburgh Sleep Quality Index, PSQI) modifies or explains this relationship, alongside short-term memory outcomes. Methods: In this cross-sectional analytical study, 220 healthy adults aged 18-45 years were assessed using a validated caffeine-intake questionnaire, the PSQI, computerized visual and auditory simple reaction time tasks, and the Digit Span Test for short-term memory. Associations were examined using one-way ANOVA, independent-samples t-tests, Pearson correlation, and multiple linear regression adjusted for age, sex, BMI, smoking, and physical activity. Results: Mean visual and auditory reaction times were fastest in moderate caffeine consumers (100-300 mg/day) compared with low and high consumers (ANOVA, p < 0.001 for both), but caffeine intake as a continuous variable was not linearly correlated with reaction time (r ≈ 0.03-0.08, p > 0.05) or memory. PSQI global score was significantly correlated with visual reaction time (r = 0.459), auditory reaction time (r = 0.328), and memory (r = -0.460, all p < 0.001). Poor sleepers (PSQI > 5) had significantly slower reaction times and lower memory scores than good sleepers (p < 0.01 for all comparisons). In multivariable regression, PSQI remained an independent predictor of both reaction time measures and memory score after adjustment (p < 0.001), whereas habitual caffeine intake did not (p > 0.05). Conclusion: Habitual sleep quality was a stronger and more consistent independent predictor of reaction time and short-term memory than habitual caffeine intake in this sample. A non-linear, dose-dependent association between caffeine and reaction time was observed at the group level, consistent with an inverted-U pattern, but this did not translate into an independent linear effect once sleep quality and other confounders were accounted for.

Background: Complete childhood immunization is essential for preventing vaccine-preventable morbidity and mortality. Despite improvements in vaccination services, incomplete immunization persists in rural communities. This study assessed full immunization coverage and its determinants among children under five years in rural Agra, Uttar Pradesh. Material and Methods: A community-based cross-sectional study was conducted during 2022–2023 among 300 children aged 12–59 months. Immunization status was determined using immunization cards and caregiver information. Sociodemographic, maternal, child-related, and health-service factors were assessed. Chi-square tests and multivariable logistic regression were used to identify determinants of full immunization. Results: Of 300 children, 218 (72.7%) were fully immunized, 68 (22.7%) were partially immunized, and 14 (4.7%) were unimmunized. Full immunization was significantly associated with maternal education, lower birth order, socioeconomic status, antenatal care, immunization-card availability, maternal knowledge, and regular ASHA/ANM contact. Adequate maternal knowledge was the strongest independent predictor (AOR 3.42; 95% CI: 1.79–6.54), followed by immunization-card availability (AOR 2.68; 95% CI: 1.35–5.32) and regular ASHA/ANM contact (AOR 2.57; 95% CI: 1.33–4.96). Lack of awareness regarding subsequent doses was the most common reason for incomplete immunization. Conclusion: Approximately three-fourths of children were fully immunized. Maternal awareness, education, antenatal care, maintenance of immunization records, and regular contact with frontline health workers were important determinants of full immunization.

Objectives: The present study was to evaluate the prevalence of low birth weight babies and their association with various maternal risk factors at tertiary care hospital. Methods: A detail assessment of neonates were performed. A detail assessment of mother health during pregnancy and sociodemographic profile were recorded from hospital records. All the babies were weighed within one hour after birth and birth weight was measured to the nearest 10 grams using a baby weighing scale. All the data about maternal exposure to different risk factors were recorded using a prescribed preformed questionnaire. Results: 100 neonates were included. The prevalence of low-birth-weight neonates was 27%. The mean birth weight of the population was 2.65kilograms. 54% were male babies. Illiterate mothers (p=0.0173), pregnancy induced hypertension (p=0.0020), multigravida (p=0.0418), oligohydramnios (p=0.0039) and mothers who gained less than 6kgs during pregnancy (p<0.0013) are the major significant maternal risk factors associated with low-birth-weight babies. Conclusions: Low birth weight newborns is associated with various maternal risk factors such as illiteracy, rural residence, PIH, irregular antenatal checkup, oligohydramnios, and weight gain less than 6 kg during pregnancy. Hence, the identification of factors involved in the repetition of LBW is an attempt to understand the causal links that increase the chance of some women to be more susceptible to give birth to an LBW child. A longitudinal study should be done from the period prior to conception through pregnancy to after deliver. To allow for a close follow-up of the subjects and evaluate the factors contributing to low birth weight in a cause-effect model for development of specific interventions. Awareness of the importance of education might help drive investment in education and improvements in education and educational policy.

Background: Recurrent anterior shoulder instability is a common orthopedic condition, particularly among young, active individuals, and is often associated with significant glenoid bone loss. Soft-tissue stabilization procedures have high recurrence rates in patients with substantial osseous defects. The Latarjet procedure restores shoulder stability through coracoid transfer and has become an effective surgical option for managing recurrent anterior shoulder instability. This study aimed to evaluate the functional outcome, recurrence, and complications following the open Latarjet procedure. Methods: A prospective observational study was conducted in the Department of Orthopaedics, AJ Institute of Medical Sciences and Research Centre, Mangalore, between October 2019 and September 2021. Nineteen patients with recurrent anterior shoulder instability who fulfilled the inclusion criteria underwent the open Latarjet procedure. Patients were evaluated clinically and radiologically and followed up at 1–3, 4–9, 10–15, and 16–20 weeks. Functional outcome was assessed using the Rowe Shoulder Score and VAS (Visual Analogue Scale), along with assessment of pain relief, range of motion, shoulder stability, return to daily activities, complications, and recurrence. Statistical analysis was performed using SPSS 23.0 with a paired t-test, considering p<0.05 as statistically significant. Results: The mean age of patients was 28 years, with males constituting 89.5% of the study population and right shoulder involvement in 68.4%. Significant improvement was observed in functional outcomes, with the mean Rowe score increasing from 35.26 preoperatively to 85.26 postoperatively, while the mean VAS score decreased from 5.63 to 0.47. Abduction and external rotation improved progressively during follow-up. Excellent outcomes were achieved in 52.6% of patients, good outcomes in 36.8%, and fair outcomes in 10.5%. No patient experienced recurrent dislocation, and only one patient developed a superficial wound infection that resolved with antibiotics. Conclusion: The open Latarjet procedure is a safe and dependable surgical option for recurrent anterior shoulder instability with significant glenoid bone loss. It provides excellent pain relief, restores shoulder stability, improves functional outcome and range of motion, facilitates early return to daily activities, and demonstrates a very low recurrence rate when combined with appropriate postoperative rehabilitation.

Background: Postoperative septic arthritis following anterior cruciate ligament reconstruction (ACLR) is a rare but catastrophic complication, with historical incidence rates ranging from 0.14% to 1.8%. Contamination of the graft during preparation is a primary modifiable risk factor. This study evaluates whether presoaking hamstring autografts in vancomycin, alongside standard intravenous (IV) antibiotics, reduces deep knee infections without increasing the incidence of arthrofibrosis or graft failure. Methods: This prospective, single-arm interventional study was conducted from August 2017 to January 2020. Seventy-five consecutive patients (powered to estimate a 1.5% infection rate with ±3% precision) with unilateral ACL tears underwent arthroscopic reconstruction. Autografts were soaked in 5 mg/mL vancomycin solution for 15 minutes prior to implantation. All patients received standard preoperative IV antibiotics. Follow-ups occurred at 3 weeks, 9 weeks, and 12 months. Primary outcomes included deep infection rates (defined by positive culture or elevated synovial WCC/CRP); secondary outcomes included graft failure, arthrofibrosis, and functional scores (Lysholm and IKDC). Statistical significance was set at p < 0.05. Results: The cohort (n=75) had a mean age of 28.1 ± 7.1 years and was predominantly male (85.3%). Deep knee infection occurred in one patient (1.3%, 95% CI: 0.07% – 7.2%). Graft failure and arthrofibrosis were observed exclusively in this same infected patient (1.3% each). Functional outcomes improved significantly: Lysholm scores rose from 46.7 ± 3.8 preoperatively to 90.0 ± 5.5 at 12 months (p < 0.001), while IKDC scores improved from 36.9 ± 3.1 to 92.9 ± 5.9 (p < 0.001). Conclusion: Adjunctive vancomycin presoaking of autografts reduces the post-ACLR deep infection rate to approximately 1.3%, which is below the historical baseline of 2% for IV antibiotics alone. This technique is safe, cost-effective, and does not elevate the risk of arthrofibrosis or graft failure. We advocate for its routine adoption, though larger randomized trials are warranted to confirm non-inferiority.

Aim: Diabetic cardiomyopathy (DCM) represents a distinct cardiovascular complication characterized by myocardial dysfunction independent of coronary artery disease and hypertension. This retrospective study aimed to evaluate the efficacy of anti-fibrotic therapy on left ventricular (LV) strain patterns in patients with type 2 diabetes mellitus and early-stage diabetic cardiomyopathy. The primary objective was to assess changes in global longitudinal strain (GLS) following 6 months of anti-fibrotic treatment, with secondary endpoints including evaluation of diastolic function parameters, left ventricular mass index, and correlation with glycemic control markers. Materials and Methods: This single-center retrospective observational study included 180 patients with type 2 diabetes mellitus diagnosed with early-stage diabetic cardiomyopathy between January 2026 and June 2026. Patients were divided into two groups: Group A (n=90) received standard diabetes care plus anti-fibrotic therapy (spironolactone 25-50 mg daily), while Group B (n=90) received standard diabetes care alone. All patients underwent comprehensive transthoracic echocardiography with speckle-tracking echocardiography at baseline and 6-month follow-up. Primary outcome measure was change in LV-GLS from baseline to 6 months. Secondary outcomes included changes in E/e’ ratio, left ventricular mass index (LVMI), left atrial volume index (LAVI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Results: At 6 month follow-up, Group A demonstrated significant improvement in LV-GLS compared to Group B (−18.2% ± 2.1% vs. −16.1% ± 2.4%; p<0.001). The mean change in GLS from baseline was +2.3% ± 1.1% in Group A versus +0.4% ± 0.9% in Group B (p<0.001). Group A showed significant reductions in E/e’ ratio (8.9 ± 2.1 vs. 10.7 ± 2.5; p<0.001), LVMI (98.4 ± 12.3 g/m² vs. 104.7 ± 14.1 g/m²; p=0.002), and NT-proBNP levels (142.3 ± 45.6 pg/mL vs. 178.9 ± 52.3 pg/mL; p<0.001). No significant differences were observed in left ventricular ejection fraction between groups. Subgroup analysis revealed greater GLS improvement in patients with baseline HbA1c <7.5% and treatment duration <5 years. Conclusion: Anti-fibrotic therapy with spironolactone in addition to standard diabetes care significantly improves left ventricular global longitudinal strain and diastolic function parameters in patients with early-stage diabetic cardiomyopathy. These findings suggest that early intervention with anti-fibrotic agents may attenuate myocardial fibrosis progression and preserve cardiac function in diabetic patients. LV-GLS serves as a sensitive marker for detecting subclinical cardiac improvement following anti-fibrotic treatment. Larger prospective randomized controlled trials are warranted to confirm these findings and establish optimal timing and duration of anti-fibrotic therapy in diabetic cardiomyopathy.

Background: Labour pain is a major physical and emotional experience of childbirth. Lavender aromatherapy has been investigated as a non-pharmacological intervention, including inhalation and massage, but the evidence is heterogeneous. Objective: To systematically evaluate the available evidence on the effectiveness of lavender aromatherapy, particularly lavender aromatherapy massage, for reducing labour pain and/or labour duration in women undergoing labour. Methods: A systematic-review framework based on PRISMA 2020 is proposed. Eligible studies should include pregnant women in labour, lavender aromatherapy delivered by massage and/or inhalation, and a comparator such as usual care, placebo, massage without lavender, or another non-pharmacological intervention. Primary outcomes are labour pain intensity and labour duration; secondary outcomes include maternal anxiety/satisfaction and maternal or neonatal adverse outcomes. The current draft incorporates evidence identified from PubMed and publicly accessible scientific sources, but the final database search and screening counts remain to be completed. Results: Existing randomized evidence supports a possible reduction in labour pain with lavender aromatherapy. A randomized trial of 120 primiparous women found reduced pain with lavender inhalation but no significant difference in active-phase or second-stage duration. A randomized trial specifically evaluating lavender aromatherapy massage reported lower pain and shorter first- and second-stage duration. A later randomized trial comparing lavender inhalation, lavender massage and control groups also evaluated pain across phases of the first stage. However, the literature is heterogeneous in intervention route, comparator, outcome measurement and methodological quality. Conclusion: Lavender aromatherapy, particularly when incorporated into massage, appears promising as an adjunctive non-pharmacological approach to labour pain management. Current evidence is insufficient to justify replacing established analgesic options. A rigorously conducted systematic review with transparent database searching and risk-of-bias assessment is required before definitive conclusions are made.

Introduction: Labor pain produces significant deleterious effect on mother and the fetus. It Increases the maternal mean arterial pressure due to stress induced release of catecholamines that cause concomitant decrease in uterine blood flow and subsequent fetal adverse effects. Materials and Methods: This study done at Dept of Anaesthesiology the Study was conducted on 30 parturient in Gravida I and II and American Society of Anaesthesiologist classification I. Results: The height distribution of the parturients in this study ranges between 145 and 160 cms. 13 patients were in the range of 145 to 150 cm and 14 patient had range of 151 to 155 cm and 3 patient were in the range of 156 cm to 160 cm. Conclusion: This study proves that the combination of 0.0625% bupivacaine and sufentanil 1 micro gram/ml of local anesthetic is effective in relieving labor pain. The motor blockade is very minimal which makes the parturient ambulant.

Anxiety and fear of operation, injections, physicians, operation theater environment, and parental separation are all traumatizing experiences in young children resulting in postoperative maladaptive behavioral changes. Premedication should yield a patient who is calm, free of anxiety and pain, sedated, but easily arousable and fully co-operative. The concept of premedication was introduced in early 1900s.The administration of drugs before the induction and maintenance of anaesthesia is reffered to as Preanaesthetic medication. The term premedication was first used in the 1920s.

Inhalational volatile anaesthetics remain the most widely used drugs for maintenance of general anesthesia because of their predictable intraoperative and recovery characteristics. Management of intraoperative haemodynamic stability and early recovery is the most important part of a standardized balanced technique. Rapid induction and recovery may lead to faster operating room turnover times, shorter recovery room stays, and earlier discharges to home. Over the last 15 years, there has been an explosive growth in the trend to provide cost-effective care in the practice of medicine.