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.