Background: Snakebite envenoming is an acute, life-threatening and time-limited medical emergency that predominantly affects rural agricultural communities in tropical countries. The World Health Organization designated it a Category A neglected tropical disease in 2017. Its epidemiology varies markedly between regions according to the species present, occupational patterns and climate, so that data from one district cannot reliably be extrapolated to another. No clinical data on snakebite were available from the Koppal region of North Karnataka. Objectives: To describe the demographic, epidemiological and clinical profile of patients admitted with venomous snake bite, including age and sex distribution, occupation, socioeconomic status, anatomical site of bite, seasonal and diurnal pattern, interval between bite and hospital arrival, and the spectrum of envenomation syndromes. Materials and Methods: A hospital-based prospective observational study was conducted in the Department of General Medicine, Koppal Institute of Medical Sciences, Koppal, from 1 August 2022 to 30 May 2024. One hundred consecutive patients with a history of snake bite and one or more clinical manifestations of envenomation — fang marks, local swelling, haemorrhage, blister formation, vomiting, abdominal pain, regional lymphadenopathy or neurotoxicity — were enrolled after institutional ethics committee clearance and written informed consent. Patients with bites other than snake bite and non-poisonous snake bites were excluded. Demographic details, circumstances of the bite, primary measures taken and time of hospital arrival were recorded, followed by clinical examination and laboratory investigation including complete blood count, renal and liver function tests, coagulation profile, serum electrolytes, urine microscopy and the 20-minute whole blood clotting test. Data were analysed using SPSS version 21. Results: Mean age was 35.98 ± 13.55 years (median 34, range 16–65), with 55 patients (55%) aged between 21 and 40 years. Seventy patients (70%) were male. Farmers constituted the largest occupational group (41%), followed by students (32%) and housewives (26%); 70 patients (70%) belonged to the middle socioeconomic class. Bites involved the lower limb in 68 patients (68%) and the upper limb in 28 (28%), the right leg alone accounting for 32 (32%). Forty-six bites (46%) occurred during the monsoon and 40 (40%) in winter, with a fairly even diurnal spread. Mean interval between bite and hospital arrival was 4.17 ± 2.05 hours, and 91 patients (91%) presented within six hours. Fang marks were visible in 93 (93%) and local swelling in 76 (76%). Local envenomation alone was the commonest syndrome (52%), followed by haemotoxic (30%), neurotoxic (16%) and combined neurotoxic-haemotoxic envenomation (2%). Conclusion: Snake bite in this district affected predominantly young adult male agricultural workers, involved the lower limb in two-thirds of cases and clustered in the monsoon season. Encouragingly, nine in ten patients reached hospital within six hours. Local envenomation predominated over systemic syndromes. These findings support targeted prevention through protective footwear, lighting and community education during the monsoon months.

Background: Mental health resources in India are concentrated in large cities and urbanized states, leaving rural populations underserved. Village life has traditionally been assumed to protect against mental illness, yet research has consistently shown that rates of psychotic disorders in rural areas equal or exceed those in urban areas, while treatment gaps are far wider. Community-based prevalence data from rural southern Karnataka are scarce. Objectives: To estimate the prevalence of psychotic disorders in a rural community, to describe their diagnostic pattern, and to determine age- and sex-specific prevalence. Materials and Methods: A community-based cross-sectional door-to-door survey was carried out in rural Hoskote taluk, Bengaluru Rural district, from July 2020 to June 2021 through the Department of Psychiatry of a rural medical college. All consenting residents aged 18–65 years in the enumerated households were screened. Instruments comprised a semi-structured sociodemographic proforma, the Mini International Neuropsychiatric Interview, the Psychosis Screening Questionnaire of Bebbington and Nayani, and the Structured Clinical Interview for DSM-IV Axis I Disorders for diagnostic confirmation. Data were analysed in SPSS version 21.0 using the Chi-square test, with p < 0.05 taken as significant. Results: Of 958 individuals surveyed, 7 were diagnosed with a psychotic disorder, giving a point prevalence of 0.73%. Schizophrenia and delusional disorder accounted for 2 cases each (28.6% each), with one case each of brief psychotic disorder, substance-induced psychotic disorder and psychotic disorder due to a general medical condition (14.3% each). Prevalence declined across successive age bands, from 3.70% below 20 years to 1.08% at 20–30 years, 1.04% at 30–40 years and 0.42% at 40–50 years, with no cases beyond 50 years; this gradient was not statistically significant (p = 0.327). Prevalence was 0.70% in men and 0.77% in women (p = 0.89). The mean age of cases was 28.4 years against 39.3 years for the surveyed population. Conclusion: The prevalence of psychotic disorders in this rural community was 0.73%, higher than most national estimates for schizophrenia alone, with affective-spectrum and organic psychoses contributing substantially. Cases clustered in the second to fourth decades and were evenly distributed between the sexes. Community-level case finding is feasible and necessary if the rural treatment gap is to be reduced.

Background: Copper-T intrauterine contraceptive devices (IUCDs) are safe and effective; however, uterine perforation with extrauterine migration is a rare complication. Migration into the bowel is exceptionally uncommon. Case Presentation: A 42-year-old multiparous woman presented with lower abdominal pain and missing Copper-T strings. Ultrasonography failed to locate the IUCD, while computed tomography identified a migrated Copper-T adjacent to bowel loops. Diagnostic laparoscopy was converted to exploratory laparotomy because of dense adhesions. The device was found embedded in the transverse colon and was left in situ, as removal posed a greater surgical risk. Conclusion: Transverse colonic migration of a Copper-T is extremely rare. Missing IUCD strings require prompt imaging, and individualized surgical management is essential to prevent complications.

Background: Tibiotalocalcaneal (TTC) arthrodesis is an established salvage procedure for patients with end-stage ankle and hindfoot arthritis. Retrograde intramedullary nailing provides stable fixation, promotes fusion, and facilitates early weight bearing. Methods: This prospective study included 31 patients with end-stage ankle and hindfoot arthritis who underwent TTC arthrodesis using a retrograde intramedullary nail between 2020 and 2022. Patients were evaluated clinically and radiologically using serial ankle radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Time to fusion, time to full weight bearing, functional outcome, and postoperative complications were assessed during a 12-month follow-up. Results: The mean age of the study population was 38.58 ± 14.61 years, with males accounting for 80.6% of patients. The mean AOFAS score improved significantly from 24.87 ± 4.75 preoperatively to 79.00 ± 12.91 at 12 months (p<0.001). The mean time to fusion was 14.48 ± 3.36 weeks, and 51.6% of patients achieved full weight bearing by 3 months. Good-to-excellent functional outcomes were observed in 71.0% of patients. Infection occurred in 9.7% of patients, while non-union was observed in 3.2%. Conclusion: TTC arthrodesis using a retrograde intramedullary nail is a reliable and effective salvage procedure, providing satisfactory fusion, significant functional improvement, early restoration of weight bearing, and a low complication rate in patients with advanced ankle and hindfoot arthritis.

Background: Tibiotalocalcaneal (TTC) arthrodesis is a well-established salvage procedure for end-stage ankle and hindfoot arthritis. Retrograde intramedullary nailing offers stable fixation with favorable fusion and functional outcomes. Materials and Methods: This prospective study included 31 patients who underwent TTC arthrodesis between 2020 and 2022. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, while radiological union was evaluated on serial radiographs. Results: The mean age of the patients was 38.58 ± 14.61 years, and 80.6% were males. Radiological union was achieved in 29 patients (93.5%), with a mean fusion time of 14.48 ± 3.36 weeks. The mean AOFAS score improved significantly from 24.87 ± 4.75 preoperatively to 79.00 ± 12.91 at 12 months (p < 0.001). Overall, 71.0% of patients achieved good-to-excellent functional outcomes. Postoperative complications were minimal, with superficial infection in 9.7% and nonunion in 3.2% of patients. Conclusion: Retrograde intramedullary nailing for TTC arthrodesis provides a high fusion rate, significant functional improvement, and a low complication rate, making it an effective limb-salvage procedure for patients with end-stage ankle and hindfoot arthritis.

Background: Abnormal uterine bleeding (AUB) is a common gynaecological problem among adolescents and may result from ovulatory dysfunction, endocrine abnormalities, coagulation disorders, or structural lesions. It may lead to anaemia and interfere with the daily activities and quality of life of affected adolescents. Objectives: To describe the clinical and menstrual presentation of AUB among adolescent girls, classify its causes according to the FIGO PALM–COEIN system. Materials and Methods: This prospective, observational, hospital-based study included 200 adolescent girls aged 10–19 years presenting with AUB to the gynaecology outpatient department of J.K. Lone Mother and Child Hospital, Government Medical College, Kota, from June 2019 to May 2020. Participants were enrolled consecutively. Detailed menstrual, medical, sexual, and bleeding histories were obtained. Menstrual blood loss was assessed using the Pictorial Blood Loss Assessment Chart. Causes of AUB were classified according to the FIGO PALM–COEIN system. Results: The mean age of the participants was 15.08 ± 2.25 years, and the mean age at menarche was 12.07 ± 0.80 years. Heavy menstrual bleeding was the most common presenting complaint (45.0%), followed by irregular menstrual bleeding (20.0%). The mean haemoglobin level was 8.70 ± 1.25 g/dL; moderate anaemia was present in 67.5%, while severe anaemia was present in 8.0%. Ovulatory dysfunction was the most common PALM–COEIN category, accounting for 90.0% of cases. Among these, immaturity of the hypothalamic–pituitary–ovarian axis accounted for 47.2%, polycystic ovary syndrome for 39.4%, and thyroid dysfunction for 13.3%. Structural causes were uncommon. Tranexamic acid was administered to 58.0%, oral progesterone to 48.5%, and blood or blood-component transfusion was required in 9.5%. Conclusion: Ovulatory dysfunction was the predominant cause of adolescent AUB, and anaemia was common. Systematic evaluation using the PALM–COEIN classification and timely medical management are important for identifying the underlying cause and preventing complications.

Background: Early prediction of mortality among critically ill patients is essential for timely intervention and improved outcomes. Serum lactate and serum albumin are widely available biomarkers with established prognostic value in critical illness. Objectives: To evaluate the combined utility of serum lactate and serum albumin for predicting ICU mortality. Methods: This prospective observational study included 150 adult patients admitted to the intensive care unit of a tertiary care hospital. Serum lactate and serum albumin were measured within 24 hours of ICU admission. Patients were followed until ICU discharge or death. The predictive performance of individual biomarkers and their combined assessment was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Overall ICU mortality was 32.0%. Non-survivors had significantly higher serum lactate levels (5.1 ± 1.7 vs. 2.3 ± 0.8 mmol/L, p<0.001) and significantly lower serum albumin levels (2.6 ± 0.4 vs. 3.4 ± 0.5 g/dL, p<0.001) than survivors. The combined assessment of serum lactate and serum albumin demonstrated the highest predictive accuracy for ICU mortality with an AUC of 0.924, sensitivity of 91.7%, and specificity of 85.3%, outperforming either biomarker alone. Conclusion: The combined evaluation of serum lactate and serum albumin is a simple, inexpensive, and effective approach for early prediction of ICU mortality. Incorporating both biomarkers into routine ICU assessment may enhance early risk stratification and support prompt clinical decision-making.

Background: Early identification of patients with sepsis who are at increased risk of mortality is essential for prompt resuscitation and optimal critical care management. Lactate clearance and the Sequential Organ Failure Assessment (SOFA) score are widely used prognostic indicators, but their comparative performance remains an area of clinical interest. Objectives: To compare the prognostic utility of lactate clearance and SOFA score for early prediction of mortality in patients with sepsis. Methods: This prospective observational study included 160 adult patients with sepsis admitted to the intensive care unit of a tertiary care hospital. Serum lactate levels were measured at admission and after 6 hours to calculate lactate clearance. SOFA score was determined at admission. Patients were followed until ICU discharge or death. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of lactate clearance and SOFA score. Results: Overall ICU mortality was 32.5%. Survivors demonstrated significantly greater lactate clearance (39.8 ± 12.6% vs. 11.4 ± 8.2%; p<0.001), while non-survivors had significantly higher SOFA scores (12.4 ± 2.7 vs. 7.8 ± 2.3; p<0.001). Lactate clearance showed an AUC of 0.918 compared with 0.891 for SOFA score. The combined model demonstrated the highest predictive accuracy (AUC = 0.947), with sensitivity of 94.2% and specificity of 88.0%. Conclusion: Lactate clearance is a simple and effective prognostic marker with slightly better predictive performance than SOFA score for early mortality prediction in sepsis. The combined assessment of lactate clearance and SOFA score provides superior prognostic accuracy and may facilitate early identification of high-risk patients.

Background: Septic shock is associated with high mortality, making early identification of high-risk patients essential. Serum lactate and base deficit are readily available indicators of tissue hypoperfusion and metabolic derangement with potential prognostic value. Objectives: To evaluate the prognostic utility of admission serum lactate and base deficit in predicting ICU mortality among patients with septic shock. Methods: This prospective observational study included 150 adult patients diagnosed with septic shock and admitted to the intensive care unit of a tertiary care hospital. Admission serum lactate and arterial base deficit were measured within the first hour of ICU admission. Patients were followed until ICU discharge or death. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of both biomarkers. Results: Of the 150 patients, 54 (36.0%) died during ICU stay. Non-survivors had significantly higher serum lactate levels (5.7 ± 1.9 vs. 2.8 ± 1.1 mmol/L; p<0.001) and greater base deficit (-8.7 ± 3.1 vs. -3.4 ± 2.2 mmol/L; p<0.001) compared with survivors. Serum lactate demonstrated an AUC of 0.903, while base deficit showed an AUC of 0.874. The combined predictive model yielded the highest diagnostic accuracy (AUC 0.935), with sensitivity of 92.6% and specificity of 86.5%. Conclusion: Both admission serum lactate and base deficit are valuable prognostic biomarkers in septic shock. Their combined assessment provides superior prediction of ICU mortality compared with either parameter alone and may aid in early risk stratification and timely management of critically ill patients.

Background: Hypothermia is a frequent complication during aeromedical evacuation of critically ill patients because of low cabin temperatures, impaired thermoregulation, sedation, mechanical ventilation, and exposure during transport. Identification of an effective warming strategy is essential to improve patient safety during transfer. Methods: This prospective randomized study was conducted at Airforce Hospital Jorhat, Assam, from November 2016 to September 2019. Sixty mechanically ventilated critically ill patients undergoing aeromedical evacuation were randomly allocated into three groups (20 patients each). Group A received an electrically heated blanket combined with a woollen blanket, Group B received a reflective blanket with a woollen blanket, and Group C received an electrically heated blanket alone. Core temperature and physiological parameters were recorded every 15 minutes for 120 minutes. Data were analysed using one-way ANOVA with post hoc comparisons. Results: Baseline physiological characteristics were comparable among the three groups. Combined warming (Group A) maintained and progressively increased core temperature throughout transport, whereas Groups B and C demonstrated progressive reductions in temperature. Significant differences among the groups were observed from 30 minutes onward (p<0.001). Passive thermal insulation produced the greatest decline in core temperature, while active warming alone limited but did not completely prevent heat loss. The combined warming strategy showed significantly better thermal protection than both alternative methods. Conclusion: Combined use of an electrically heated blanket with a woollen blanket was superior to passive thermal insulation or active warming alone for maintaining normothermia during aeromedical evacuation. A multimodal warming strategy should be considered the preferred approach for critically ill patients undergoing prolonged air transport.

Background: Hip fractures in older adults are associated with considerable morbidity and mortality. Patients receiving antiplatelet therapy often experience delays in surgery because of concerns regarding perioperative bleeding, although the effect on overall outcomes remains uncertain. Methods: This hospital-based prospective comparative study included 120 patients aged over 50 years undergoing surgical treatment for proximal femur fractures between October 2023 and October 2024. Patients were divided into two equal groups based on pre-injury antiplatelet use (60 each). Baseline characteristics, perioperative variables, postoperative complications, functional outcomes, and mortality at 30 days and one year were compared using appropriate statistical tests. Results: Baseline demographic and clinical characteristics were comparable between the two groups. Patients receiving antiplatelet therapy had significantly greater delays to surgery (>48 hours) (68.3% vs. 26.7%, p=0.001) and longer hospital stay (12.37 ± 3.94 vs. 9.78 ± 4.11 days, p=0.001). Blood transfusion requirements, postoperative complications, Modified Harris Hip Scores, and 30-day readmission rates were similar in both groups. Intra-hospital mortality (5.0% vs. 1.7%), 30-day mortality (3.3% vs. 8.3%), and one-year mortality (21.7% in both groups) showed no statistically significant differences. Conclusion: Pre-injury antiplatelet therapy was associated with delayed surgery and prolonged hospitalization but did not significantly affect perioperative morbidity, functional recovery, or short- and long-term mortality. These findings support individualized perioperative management and suggest that unnecessary delays in hip fracture surgery solely because of antiplatelet therapy should be avoided.

Background: Knee osteoarthritis is traditionally assessed through clinical symptoms and plain radiography; however, increasing evidence indicates that low-grade inflammation contributes to cartilage degradation, synovial activation, subchondral bone remodeling, and pain progression. Biochemical inflammatory markers may therefore provide additional information regarding disease severity beyond conventional X-ray grading. Methods: This cross-sectional observational study evaluated 120 adults with clinically and radiographically diagnosed primary knee osteoarthritis. Patients were recruited from the orthopaedic outpatient department of a tertiary care teaching hospital over 12 months. Clinical severity was assessed using pain duration, visual analogue scale score, and Western Ontario and McMaster Universities Osteoarthritis Index score. Standing anteroposterior knee radiographs were graded according to the Kellgren–Lawrence classification. Serum C-reactive protein, erythrocyte sedimentation rate, interleukin-6, and tumour necrosis factor-alpha were measured using standardized laboratory methods. Correlations between biochemical markers, radiological grade, and clinical symptoms were assessed using Spearman’s correlation, one-way ANOVA or Kruskal–Wallis test, and multivariable ordinal regression. Results: The mean age of participants was 58.6 ± 8.9 years, and 68.3% were female. Kellgren–Lawrence grade II was observed in 35.0%, grade III in 43.3%, and grade IV in 21.7% of patients. Median C-reactive protein, erythrocyte sedimentation rate, interleukin-6, and tumour necrosis factor-alpha increased progressively with radiographic severity. Interleukin-6 demonstrated the strongest correlation with Kellgren–Lawrence grade, followed by C-reactive protein and erythrocyte sedimentation rate. Higher inflammatory marker levels were also associated with greater pain intensity and functional limitation. After adjustment for age, sex, body mass index, and symptom duration, interleukin-6 and C-reactive protein remained independently associated with advanced radiographic osteoarthritis. Conclusion: Biochemical inflammatory markers, particularly interleukin-6 and C-reactive protein, showed significant positive correlation with radiological severity and clinical symptoms in knee osteoarthritis. These findings support the concept that knee osteoarthritis is not purely mechanical but involves measurable systemic inflammatory activity.

Background: Chronic liver disease represents a major global health burden and is associated with significant morbidity and mortality. Disease progression from compensated liver disease to decompensated cirrhosis is often accompanied by metabolic disturbances, systemic inflammation, and impaired hepatic function. Several studies have suggested that elevated serum uric acid levels may correlate with nonalcoholic fatty liver disease, cirrhosis, and liver-related complications. However, the role of serum uric acid as a surrogate biomarker for determining disease severity in chronic liver disease remains insufficiently explored, particularly in hospital-based populations. The Child–Pugh classification remains widely used for assessing disease severity, but the addition of biochemical markers may improve clinical utility. Therefore, the present study aimed to assess serum uric acid levels in patients with chronic liver disease, analyze the association between serum uric acid levels and disease severity. Methods: The present study was conducted as a hospital-based observational cross-sectional study in the Department of General Medicine at GMERS Medical College and Hospital, Gotri, Vadodara. The study duration extended from January 2024 to December 2025. A total of 150 patients diagnosed with chronic liver disease were included consecutively after fulfilling predefined inclusion and exclusion criteria. Patients aged 18 years and above, clinically, biochemically, and radiologically diagnosed with chronic liver disease, and willing to provide informed consent were included. Patients with acute liver failure, acute-on-chronic liver failure, malignancy, pregnancy, or those receiving medications affecting uric acid metabolism were excluded from the study. Data collection was performed using a structured proforma. Sociodemographic variables including age, sex, residence, socioeconomic status, and educational level were recorded. Detailed clinical history including alcohol intake, smoking habits, and presenting symptoms was obtained. A thorough clinical examination was performed, including measurement of vital parameters and assessment of signs of chronic liver disease. Laboratory investigations included complete blood count, liver function tests, coagulation profile, and serum uric acid measurement using standard enzymatic colorimetric methods. The severity of chronic liver disease was graded using the Child–Pugh classification. Data were entered and analyzed using SPSS version 20. Continuous variables were expressed as mean ± standard deviation, while categorical variables were expressed as frequency and percentage. Comparative analysis between Child–Pugh classes was performed using one-way ANOVA and chi-square tests. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance of serum uric acid in predicting disease severity. A p-value less than 0.05 was considered statistically significant. Results: The mean age of the study population was 52.8 ± 10.4 years, with the majority of patients belonging to the 51–60-year age group (34.7%). Males constituted 68% of the study population, while females accounted for 32%. Alcohol consumption was reported in 46% of patients, while 36% were current smokers. The most common presenting feature was ascites (76%), followed by jaundice (58.7%), spider nevi (54.7%), pedal edema (49.3%), and hepatic encephalopathy (33.3%). Alcoholic liver disease was the most common etiology (46%), followed by NAFLD/NASH (27.3%), viral hepatitis (19.3%), and autoimmune causes (8.3%). The overall mean serum uric acid level was 5.75 ± 1.76 mg/dL. Ultrasonographic findings revealed nodular liver surface in 68% of patients, enlarged portal vein in 57.3%, and splenomegaly in 45.3%. Based on Child–Pugh classification, 32% of patients were categorized as Child A, 37.3% as Child B, and 30.7% as Child C. A significant association was observed between serum uric acid levels and Child–Pugh classification. Mean serum uric acid levels increased progressively from 4.18 ± 1.10 mg/dL in Child A to 5.86 ± 1.25 mg/dL in Child B and 7.12 ± 1.34 mg/dL in Child C (p < 0.001). Clinical severity indicators such as ascites, hepatic encephalopathy, and pedal edema showed significantly higher serum uric acid levels with increasing severity. Laboratory parameters including bilirubin, liver enzymes, and INR also worsened with higher Child–Pugh classes. Hyperuricemia was significantly more common in severe disease groups. Receiver operating characteristic analysis suggested potential cut-off values of serum uric acid for predicting disease severity. These findings indicated that serum uric acid levels were significantly associated with the severity of chronic liver disease. Conclusions: The present study demonstrated that serum uric acid levels were significantly associated with the severity of chronic liver disease. A progressive increase in serum uric acid levels was observed across Child–Pugh classes, indicating worsening hepatic dysfunction with increasing uric acid levels.

Background: Chronic liver disease (CLD) represents a progressive spectrum of hepatic disorders that persist for months to years and frequently culminate in cirrhosis, portal hypertension, and multisystem complications. Among these, renal dysfunction is one of the most serious and prognostically significant complications, markedly increasing morbidity, mortality, length of hospital stay, and healthcare costs. Renal dysfunction in CLD encompasses a broad clinical spectrum ranging from potentially reversible acute renal failure to functional renal impairment such as hepatorenal syndrome and irreversible chronic kidney disease. Early identification of renal dysfunction in cirrhotic patients remains challenging because serum creatinine often underestimates renal impairment due to reduced muscle mass and altered hepatic creatine synthesis. Furthermore, renal dysfunction frequently develops in the setting of acute decompensation, making timely diagnosis and intervention difficult. Despite increasing recognition of its clinical importance, there is limited prospective data comprehensively evaluating predictors of renal dysfunction and associated outcomes across diverse etiologies of chronic liver disease, particularly in resource-limited tertiary-care settings. Methodology: This cross-sectional prospective observational study was conducted over a one-year period in the Medicine Ward and Medical Intensive Care Unit of a tertiary-care teaching hospital after approval from the institutional ethics committee. Total of 110 Adult patients aged more than eighteen years admitted with liver parenchymal disease complicated by renal dysfunction were consecutively screened and enrolled after obtaining written informed consent. Ascitic fluid analysis was performed where indicated, including total leukocyte count, albumin, protein, and serum–ascites albumin gradient. Disease severity was assessed using the Model for End-Stage Liver Disease score. Patients were categorized into acute renal failure, hepatorenal syndrome, or chronic kidney disease based on clinical, biochemical, and radiological criteria. All patients received standard treatment protocols and were followed until discharge or death. Statistical analysis was performed using appropriate parametric and non-parametric tests, with significance defined as a p-value less than 0.05. Results: total of 110 patients were included in the analysis, with a mean age of 48.6 years and a marked male predominance. Alcoholic liver disease emerged as the most common etiology. Ascites, jaundice, abdominal distension, pedal edema, and oliguria were the most frequently observed clinical manifestations, reflecting advanced hepatic decompensation. Acute renal failure was identified in 43.6% of patients, hepatorenal syndrome in 34.5%, and chronic kidney disease in 21.8%. Increasing age showed a significant association with more severe and chronic forms of renal dysfunction. Male gender predominated across all categories, particularly among patients with hepatorenal syndrome. Metabolic comorbidities such as diabetes mellitus, hypertension, obesity, and dyslipidemia were significantly associated with chronic kidney disease. Hepatorenal syndrome was strongly associated with severe ascites, oliguria, altered sensorium, prior episodes of ascites, previous acute kidney injury, and chronic alcohol consumption. Laboratory parameters differed significantly across renal dysfunction categories, with hepatorenal syndrome demonstrating higher serum bilirubin, INR, serum creatinine, blood urea, and MELD scores, along with lower serum sodium and albumin levels. Spontaneous bacterial peritonitis was significantly more frequent in patients with hepatorenal syndrome. Renal recovery was highest in acute renal failure, intermediate in chronic kidney disease, and lowest in hepatorenal syndrome. Requirement of dialysis and in-hospital mortality were significantly higher among patients with hepatorenal syndrome. Factors significantly associated with mortality included advanced age, presence of hepatorenal syndrome, acute kidney injury stage three, hepatic encephalopathy, hypotension, spontaneous bacterial peritonitis, severe hyponatremia, high MELD score, and requirement of renal replacement therapy. Conclusions: Renal dysfunction is a frequent and serious complication of chronic liver disease and is closely linked to the severity of hepatic dysfunction and systemic derangements. Acute renal failure represents the most common and potentially reversible form, whereas hepatorenal syndrome is associated with the poorest outcomes, including high dialysis requirement and mortality. Advanced age, metabolic comorbidities, recurrent hepatic decompensation, severe liver dysfunction, hyponatremia, infection, and circulatory failure are key predictors of renal impairment and death. The strong association between hepatorenal syndrome and adverse outcomes underscores the importance of early recognition, prompt treatment of precipitating factors, and aggressive supportive care. Regular monitoring of renal function trends, early detection of infections, careful management of volume status, and avoidance of nephrotoxic agents are essential in patients with chronic liver disease.

Background: Prevalence of meconium-stained liquor (MSL) is 12-16% of all the deliveries.1-3 .Detection of MSL is associated with abnormal fetal heart rate (FHR), so once the MSL is detected, continuous FHR monitoring is needed as is associated with abnormal foetal outcome. MSL is associated with both maternal and foetal risk factors. Maternal factors include hypertension, gestational diabetes mellitus, maternal chronic respiratory or cardiovascular diseases, post term pregnancy, pre- eclampsia and eclampsia. Foetal factors include oligohydramnios, foetal growth restriction and poor bio physical profile. AIM: To assess perinatal outcome and mode of delivery in MSL. Study Site: Department of Obstetrics and Gynecology, Sanjay Gandhi Memorial Hospital, Delhi. Study design is Hospital based case control study. Study duration was December 2019 to June 2021, and Study papulation was all pregnant women booked or unbooked who comes to labor room obstetrics and gynaecology department of Sanjay Gandhi memorial hospital, Delhi. Result: Caesarean section was commonly done in Cases group compared to Control group (49.6% vs. 26.4%) while spontaneous vaginal delivery was commonly done in Control group compared to Cases group (38.8% vs. 70.4%) 199 (79.6%) neonates in the Cases group were asymptomatic at birth compared to 232 (92.8%) neonates in the Control group. Incidence of meconium aspiration syndrome (2.8% vs. 0.8%), neonatal sepsis (2% vs. 1.2%), and Hypoxemic ischemic encephalopathy (1.2% vs. 0.8%) was comparable between the groups while the incidence of birth asphyxia was significantly higher in Cases Group compared to Control Group. Conclusion: Till such time that better strategies for management of meconium-stained neonates are outlined the best course would be careful intrapartum fetal heart rate monitoring and timely detection of fetal asphyxia. Meconium-stained amniotic fluid and the adverse neonatal outcome are associated with high-risk pregnancy like PIH and oligohydramnios, therefore, MSAF can be prevented with early screening, prompt recognition, quick and proper management. The presence of thick meconium needs close monitoring as it is associated with decreased APGAR score and increased NICU stay that’s why early and timely obstetrical intervention and appropriate neonatal care, to minimize meconium related complications and improve fetal outcome.

Introduction: Diabetic Retinopathy (DR) is a highly specific microvascular complication commonly seen in individuals with both type 1 and type 2 diabetes mellitus (DM), often leading to considerable visual impairment among adults globally. Various systemic factors play a role in the onset and progression of DR. Early detection and effective management of these risk factors during the initial stages of diabetes mellitus may help reduce the likelihood of DR development and limit its progression and severity. Aim: The aim of this study is to describe the correlation between Diabetic Retinopathy and Systemic Complications in Diabetes Mellitus in a tertiary care hospital in Bhopal. Materials and Methods: The study consists of 350 diabetic patients who visited the Ophthalmology Outpatient Department at Chirayu Medical College & Hospital Bhopal, between May 2023 till May 2025.  Each patient underwent a thorough clinical evaluation, along with relevant investigations, to identify the presence of systemic complications such as retinopathy, nephropathy, neuropathy, cardiovascular disease, cerebrovascular events, and diabetic foot. The study also examined the association between the duration of diabetes and both the stage of retinopathy and the occurrence of systemic complications. Results: A total of 350 diabetic patients with a mean age of 50.0 ± 15.0 years were included in the study and among them males were 211 (31.7%) and females were 99 (31.7%). A significant association was observed (p<0.001) between the duration of diabetes and the presence and severity of diabetic retinopathy. The overall prevalence of nephropathy, neuropathy, diabetic foot, CVS, CAD was 54.28 % and they were significantly more common in patients with DR as compared to those with no DR and complications increases with the severity of retinopathy. Conclusion: Patients with DM should be encouraged to optimise their control of the disease in order to prevent the development and progression of diabetic retinopathy. Of the systemic risk factors studied, a positive association was found between hypertension, CKD, CAD, CVA and diabetic retinopathy.

Background: Perforative peritonitis is one of the most common life-threatening surgical emergencies encountered in general surgical practice. It results from perforation of the gastrointestinal tract, leading to contamination of the peritoneal cavity, severe inflammatory response, sepsis, and multiorgan dysfunction if not treated promptly. Despite significant advances in diagnostic imaging, antimicrobial therapy, critical care, and surgical techniques, perforative peritonitis continues to be associated with considerable morbidity and mortality, particularly in developing countries where delayed presentation and limited healthcare access remain common. Understanding the demographic characteristics, etiological spectrum, operative findings, surgical management, and postoperative outcomes is essential for improving patient care and optimizing treatment strategies. Aim: To evaluate the demographic profile, etiological factors, anatomical sites of perforation, surgical management, postoperative complications, and clinical outcomes among patients with perforative peritonitis undergoing emergency laparotomy at a tertiary care teaching hospital. Materials and Methods: A retrospective observational study was conducted in the Department of General Surgery, Government Erode Medical College and Hospital, Tamil Nadu, India. Hospital records of 50 patients who underwent emergency surgery for perforative peritonitis during the study period were reviewed. Data regarding demographic characteristics, clinical presentation, operative findings, etiology, anatomical site of perforation, surgical procedures performed, postoperative complications, and clinical outcomes were collected using a structured data collection form. Descriptive statistics were used to summarize the data. Continuous variables were expressed as mean ± standard deviation where appropriate, while categorical variables were presented as frequencies and percentages. Statistical analysis was performed using SPSS version 26.0, and a p-value <0.05 was considered statistically significant. Results: A total of 50 patients were included in the study. The majority belonged to the 31–40-year age group (30%), followed by the 21–30-year age group (24%). Male patients constituted 56% of the study population. Peptic ulcer perforation was the most common etiology, accounting for 36% of cases, followed by traumatic perforation (24%), appendicular perforation (22%), tubercular perforation (10%), while iatrogenic perforation and enteric (typhoid) perforation each accounted for 4% of cases. The duodenum was the most frequently involved anatomical site (48%), followed by the ileum (20%), jejunum (20%), and appendix (12%). Primary repair was the most commonly performed surgical procedure (70%), whereas stoma formation was undertaken in 30% of patients. More than half of the patients (52%) developed one or more postoperative complications, with surgical site infection (24%) being the most common complication, followed by sepsis (16%), respiratory complications (14%), wound dehiscence (12%), and intra-abdominal abscess (10%). Conclusion: Perforative peritonitis remains a major surgical emergency associated with substantial postoperative morbidity. Middle-aged males constituted the majority of affected patients, and peptic ulcer disease was the leading cause of gastrointestinal perforation. Early diagnosis, aggressive resuscitation, timely surgical intervention, appropriate antimicrobial therapy, and meticulous postoperative care are essential for improving clinical outcomes and reducing postoperative complications.

Background: Phosphorus, together with calcium, forms the mineral basis of the skeleton and participates in energy transfer, membrane structure and acid–base buffering. Its serum concentration is regulated principally by parathyroid hormone and vitamin D acting on renal tubular reabsorption, processes upon which thyroid hormones exert a modulatory influence. Whereas hypocalcaemia in hypothyroidism is comparatively well documented, the behaviour of serum phosphorus remains contested, with published series variously reporting hyperphosphataemia, hypophosphataemia or no change at all. Objectives: To compare serum phosphorus concentrations between newly diagnosed overt hypothyroid patients and age- and sex-matched euthyroid individuals, to examine the correlation between serum thyroid-stimulating hormone and serum phosphorus, and to characterise the resulting shift in the calcium–phosphorus balance. Materials and Methods: A hospital-based comparative observational study was conducted in the Department of General Medicine, McGann Teaching District Hospital, Shivamogga Institute of Medical Sciences, Shivamogga, over 12 months. One hundred and sixty subjects aged above 18 years were enrolled after institutional ethics committee clearance and informed consent — 80 with newly diagnosed overt hypothyroidism and 80 age- and sex-matched euthyroid controls. Subjects with chronic kidney disease, hepatic disease, prior thyroid surgery or receiving mineral supplementation were excluded, since each independently disturbs phosphate handling. Two millilitres of venous blood was collected in a plain vacutainer, allowed to clot, centrifuged, and the serum stored at 4–8 °C until analysis. Serum free T3, free T4 and thyroid-stimulating hormone were estimated on a Cobas e411 analyser and serum calcium and phosphorus on a Cobas c311 analyser. The unpaired Student’s t-test and Pearson’s correlation coefficient were applied, with p<0.05 taken as significant. Results: The two groups were identically matched for sex, each containing 63 women and 17 men, with an overall mean age of 46.49 ± 12.87 years. Group allocation was confirmed biochemically, thyroid-stimulating hormone being 24.19 ± 13.70 versus 2.89 ± 1.30 µIU/mL and free T4 0.64 ± 0.20 versus 1.18 ± 0.19 ng/dL (both p<0.0001). Mean serum phosphorus was significantly higher in the hypothyroid group at 4.48 ± 0.42 mg/dL compared with 3.69 ± 0.60 mg/dL in controls — an absolute rise of 0.79 mg/dL, or 21.4% above the control mean (t = 9.12, p<0.0001), corresponding to a large effect size (Cohen’s d = 1.53). Thyroid-stimulating hormone correlated positively and significantly with serum phosphorus (r = 0.412, p<0.0001), accounting for approximately 17% of its variance. Because serum calcium simultaneously fell from 9.59 to 8.51 mg/dL, the calcium-to-phosphorus ratio derived from group means contracted markedly from 2.60 in euthyroid controls to 1.90 in hypothyroid patients. Conclusion: Newly diagnosed overt hypothyroidism was associated with significant hyperphosphataemia that varied in proportion to the degree of thyroid-stimulating hormone elevation. Combined with the concurrent fall in calcium, this produced a substantial contraction of the calcium-to-phosphorus ratio, indicating that the two minerals move in opposite directions and that neither should be interpreted in isolation.

Introduction: Up to 50% of individuals with chronic kidney disease who get long-term haemodialysis die from cardiovascular disease. In people with chronic kidney disease, left ventricular hypertrophy is a major predictor of cardiovascular outcomes. People with end-stage renal illness have a poor prognosis because left ventricular failure frequently precedes left ventricular hypertrophy1. One indicator of cardiovascular morbidity in patients with chronic renal disease receiving haemodialysis is left ventricular mass index². In research participants receiving haemodialysis, factors such anaemia, hypoalbuminemia, proteinuria, and decreased eGFR significantly predict LVH¹. In people with chronic renal disease, congestive heart failure and left ventricular dysfunction increase morbidity and death. Methods: Patients of both sexes with chronic kidney disease who are not receiving haemodialysis for Stages 2, 3, 4, and 5 and who are receiving maintenance haemodialysis for Stages 4 and 5 at the Department of General Medicine, Akash Institute of Medical Sciences and Research Center, Devanahalli, Bangalore Rural, will be the subject of a study. Patients with chronic renal disease who are willing to participate in the study will be found and subsequently recruited. Results: Concentric Hypertrophy is more prevalent in the dialysis group versus the non-dialysis group. IVSTd, PWTd, LVM, LVMI, eGFR and RWT are significant predictors of LVH in non-dialysis group and maintenance dialysis group. Conclusion: Echocardiographic parameters have prognostic significance in determining cardiovascular morbidity and mortality in CKD patients on haemodialysis.

Background: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal and perinatal morbidity and mortality worldwide. Thrombocytopenia is a common hematological complication associated with preeclampsia, eclampsia, and HELLP syndrome, reflecting disease severity and increasing the risk of adverse maternal and fetal outcomes. Early recognition and appropriate management are essential to improve pregnancy outcomes. Aim: To evaluate the maternal and fetal outcomes in pregnant women with hypertensive disorders complicated by thrombocytopenia. Materials and Methods: A prospective observational study was conducted over one year at Government Maternity Hospital, Tirupati, involving 100 third-trimester pregnant women with hypertensive disorders and thrombocytopenia. Women with immune thrombocytopenic purpura, chronic hypertension, viral fever, and idiopathic thrombocytopenia were excluded. Demographic characteristics, platelet counts, etiology, mode of delivery, maternal complications, neonatal outcomes, and blood product requirements were analyzed using MS Excel and Epi Info 7.2.4.0. Results: The mean maternal age was 26.92 ± 2.83 years, with 63% of women aged 25–29 years and 56% being primigravida. Non-severe preeclampsia was the commonest diagnosis (56%), followed by severe preeclampsia (24%), HELLP syndrome (11%), and eclampsia (9%). Most women (77%) had platelet counts between 1.0 and 1.5 lakh/µL. Caesarean section was performed in 58% of cases, while 35% had normal vaginal delivery. Blood transfusion was required in 19% of women. Maternal complications were infrequent, with postpartum hemorrhage (5%) being the most common; no maternal deaths were recorded. Among neonates, 70% had birth weights >2.5 kg and 67% were healthy at birth. However, NICU admission was required in 32%, preterm birth occurred in 17%, low birth weight in 21%, respiratory distress syndrome in 6%, early neonatal death in 5%, and intrauterine fetal death in 1%. Conclusion: Hypertensive disorders complicated by thrombocytopenia are associated with increased maternal and neonatal risks, particularly in severe preeclampsia and HELLP syndrome. Regular platelet monitoring, timely obstetric intervention, availability of blood products, and individualized management contribute to favorable maternal outcomes while reducing neonatal morbidity. Early diagnosis and multidisciplinary care remain essential for optimizing fetomaternal outcomes in these high-risk pregnancies.

Background: Chronic gastritis is a common inflammatory disorder of the stomach, with Helicobacter pylori being its principal etiological agent. The Updated Sydney System provides a standardized method for grading histopathological changes and assessing disease severity. Aim: To evaluate the histopathological spectrum of chronic gastritis using the Updated Sydney Scoring System and to correlate the findings with Helicobacter pylori infection. Materials and Methods: This hospital-based cross-sectional observational study included 160 gastric biopsy specimens diagnosed as chronic gastritis at a tertiary care centre in Bengaluru from January 2025 to June 2025. Gastric biopsy specimens were enrolled consecutively during the study period. Histopathological evaluation was performed using hematoxylin and eosin staining and Modified Giemsa stain where required. Chronic inflammation, neutrophilic activity, glandular atrophy, intestinal metaplasia, and H. pylori density were graded according to the Updated Sydney System. Statistical analysis was performed using SPSS version 26.0, with p<0.05 considered statistically significant. Results: The majority of patients were males (58.8%) and belonged to the 31–45-year age group. Moderate chronic inflammation was the most common histological finding (45.0%). Helicobacter pylori infection was detected in 63.8% of biopsy specimens. Glandular atrophy and intestinal metaplasia were observed in 41.3% and 20.0% of cases, respectively. A significant association was found between H. pylori positivity and increased histological activity (p=0.002). Conclusion: The Updated Sydney Scoring System is an effective tool for evaluating chronic gastritis and identifying premalignant gastric lesions. Helicobacter pylori infection showed a significant correlation with the severity of histopathological changes, emphasizing the importance of routine histological grading and detection of the organism for timely clinical management and prevention of gastric cancer.

Background: Lasers provide precise cutting, ablation, vaporization, and photocoagulation across otorhinolaryngology, but their clinical value varies by wavelength, tissue target, disease, comparator, and operator expertise. Objectives: To synthesize systematic-review evidence on the effectiveness, functional outcomes, and safety of therapeutic lasers in laryngology, rhinology, otology, and oropharyngeal or sleep surgery. Methods: PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library were searched from January 2000 to 15 July 2026 for systematic reviews and meta-analyses of therapeutic laser procedures in ENT. Eligible reviews evaluated CO2, potassium-titanyl-phosphate (KTP), diode, Nd: YAG, argon, Er:YAG, or related surgical lasers against conventional surgery, another energy modality, radiotherapy, or no active intervention. Selection and extraction followed a prespecified PICO framework and PRISMA 2020. Review quality was appraised with AMSTAR 2; reported primary-study risk-of-bias assessments were mapped to RoB 2 or Newcastle-Ottawa Scale domains. Because of substantial clinical overlap and heterogeneity, findings were synthesized narratively without re-pooling. Results: Eighteen systematic reviews were included. Laryngeal evidence was most developed. KTP treatment for recurrent respiratory papillomatosis showed fewer reported complications than CO2 laser, while transoral laser microsurgery achieved local control broadly comparable with radiotherapy for selected early glottic cancer. CO2 laser treatment of laryngeal leukoplakia was associated with pooled recurrence and malignant-transformation rates of approximately 15% and 3%, respectively. Inferior turbinate laser procedures improved nasal obstruction, but no technique was consistently superior. Laser photocoagulation reduced epistaxis severity in hereditary hemorrhagic telangiectasia, although recurrence remained common. In otology, laser and drill stapedotomy produced similar hearing outcomes; evidence for laser myringotomy and laser Eustachian tuboplasty was insufficient. Laser tonsil surgery reduced operative time and blood loss, but postoperative pain and hemorrhage advantages were inconsistent. Overall certainty ranged from low to moderate. Conclusion: Laser interventions are clinically valuable when wavelength and delivery are matched to tissue biology and procedural objectives, particularly in selected laryngeal disease. Routine superiority over established alternatives is not demonstrated across ENT, and standardized comparative trials with functional and long-term outcomes are required.

Background: Laparoscopic cholecystectomy is minimally invasive, but early postoperative shoulder pain (visceral, incisional, and referred) is common and often requires opioid use. Dexmedetomidine has sympatholytic, sedative and analgesic sparing properties without clinically significant respiratory depression. Dexmedetomidine is an alpha-2 adrenergic agonist that has been shown to decrease postoperative pain and the need for opioids in various surgical settings. The authors sought to determine if a single preoperative intravenous dose of dexmedetomidine would affect postoperative opioid use and pain scores after elective laparoscopic cholecystectomy. Method: The study design was a prospective, randomized, double-blind, placebo controlled trial of 80 adults with American Society of Anesthesiologists (ASA) physical status I–II who were randomly assigned to either receive dexmedetomidine 0.5 µg/kg (Group D, n=40) or volume-matched normal saline (Group C, n=40) over 10 minutes prior to general anesthesia induction. Standard anesthesia, multimodal analgesia during surgery and postoperative morphine PCA was used in all patients. The main outcome was total morphine use at 24 hours. Secondary outcomes were numerical rating scale pain scores, time to first analgesic demand, intraoperative use of fentanyl, postoperative nausea and vomiting, sedation, and hemodynamic adverse events. Results: The 24-hour morphine consumption was significantly lower in Group D compared to Group C (12.6±4.3 mg versus 19.8±5.6 mg; mean difference −7.2 mg, 95% CI −9.4 to −5.0; p<0.001). Resting pain scores were lower at 1, 2, 4 and 6 hours, and movement-evoked pain was lower at 12 hours. Time to first analgesic demand was prolonged (78.4±22.1 versus 34.6±15.7 minutes; p<0.001), and intraoperative fentanyl use was reduced (108±29 versus 154±36 µg; p<0.001). The incidence of postoperative nausea and vomiting was 15.0% and 35.0% respectively (p=0.039). Transient bradycardia occurred more often with dexmedetomidine, but was treated routinely. Conclusion: Clinically significant opioid sparing and better early pain control were achieved with pre-operative dexmedetomidine 0.5 µg/kg in laparoscopic cholecystectomy with no significant adverse effects.

Objective: Atopic dermatitis has a typical age-related distribution, and the skin lesions can vary depending on disease stage, ethnicity, as well as geographic location. The present study was to perform the systematic review and meta-analysis of various research articles to analyse the prevalence of atopic dermatitis. Methods: A search of MEDLINE (through PubMed), Embase, and Global Index Medicus databases was conducted. Search terms included ‘atopic dermatitis’ and ‘prevalence,’ with both controlled vocabulary (e.g., MeSH terms) and synonyms. Searches were restricted for studies published from 2012 onward, ensuring that the review is based on the most recent and up-to-date data, since the prevalence of AD may change over time due to changes in environmental or lifestyle factors. Results:  A total of 118 global studies were evaluated. 33(27.97%) studies were performed on infants to preschoolers. 46(38.98%) studies were on children and 39(33.05%) studies were on adolescents/adults. Highest number of studies included were Asia (50.85%) and Europe (22.03%). 55.93% studies included were from rural area and 44.07% from urban area.  65(55.08%) studies had male dominant. Most of the studies 70(59.32%) included were based on symptoms-based questionnaire. Overall prevalence of atopic dermatitis was 10.4%. Conclusions: Prevalence of atopic dermatitis is greater in infant to preschoolers. Prevalence of atopic dermatitis are higher in South America, central America, Africa, Europe and Asia as compared to others continent. Atopic Dermatitis is greatly seen in urban and male population as compared to rural and female population.

Background: Emotional intelligence (EI) is increasingly recognized as an essential competency for healthcare professionals, influencing communication, teamwork, empathy, leadership, stress management, and patient care. Higher emotional intelligence has been associated with improved clinical decision-making, reduced burnout, and enhanced professional relationships. Despite its importance, limited studies have evaluated EI among multidisciplinary healthcare professionals in Indian teaching institutions. Objectives: To assess the emotional intelligence of healthcare professionals using the Brief Emotional Intelligence Scale (BEIS-10) and explore demographic variations. Methods: A cross-sectional questionnaire-based study was conducted among 49 healthcare professionals from a teaching institution. Emotional intelligence was assessed using the validated Brief Emotional Intelligence Scale (BEIS-10). Descriptive statistics were used to summarize scores. Inferential analyses including independent t-test, one-way ANOVA, and correlation analyses were planned to evaluate demographic differences. Results: The overall mean BEIS-10 score was 8.70 ± 1.94 (median = 9; range = 1–10), indicating generally high emotional intelligence among participants. Most respondents demonstrated good awareness and regulation of emotions. Conclusion: Healthcare professionals demonstrated high levels of emotional intelligence. Strengthening EI through faculty development and professional training may further improve teamwork, communication, leadership, and patient-centered care.

Background: Urinary tract infection (UTI) is one of the most common bacterial infections encountered in clinical practice. The increasing prevalence of antimicrobial resistance (AMR) among uropathogens has significantly limited therapeutic options, emphasizing the need for continuous surveillance to guide empirical therapy. Aim: To compare the bacteriological profile and antimicrobial resistance patterns of uropathogens isolated from urine cultures during two study periods (January–March 2016 and January–March 2022) at a tertiary care teaching hospital. Materials and Methods: A retrospective comparative study was conducted on urine culture isolates conventionally during January–March 2016 and January–March 2022. Midstream clean-catch urine samples were processed by semi-quantitative culture on cysteine lactose electrolyte-deficient (CLED) agar. Significant bacteriuria (≥10⁵ CFU/mL) isolates were identified using Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method on Mueller–Hinton agar and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: A total of 1,421 urine culture isolates were analysed, comprising 445 isolates from 2016 and 976 isolates from 2022. Gram-negative bacilli predominated in both periods (86% in 2016 and 82% in 2022). Escherichia coli remained the most frequently isolated pathogen (44.5% in 2016 and 34.2% in 2022), followed by Klebsiella spp., Staphylococcus aureus, Pseudomonas aeruginosa, Proteus spp., Citrobacter spp., Enterobacter spp., and Acinetobacter spp. A significant increase in resistance was observed for ampicillin, amoxicillin–clavulanate, piperacillin–tazobactam, cephalosporins, fluoroquinolones, nitrofurantoin, aminoglycosides, and carbapenems between the two study periods (p < 0.05 for most agents). Resistance to carbapenems increased markedly, with imipenem resistance rising from 4.9% to 31.6% and meropenem resistance from 4.2% to 27.0%. Fosfomycin demonstrated excellent activity against tested isolates in 2022, while vancomycin retained 100% susceptibility among Gram-positive isolates. Conclusion: Escherichia coli continues to be the predominant pathogen. A substantial increase in antimicrobial resistance, particularly to carbapenems, cephalosporins, and fluoroquinolones, was observed. These findings highlight the urgent need for sustained antimicrobial resistance surveillance, timely revision of institutional antibiotic policies, and implementation of strict antimicrobial stewardship programmes to optimize empirical therapy and lessen the emergence of multidrug-resistant pathogens.

Background: Ventilator-associated pneumonia (VAP) is one of the most common and serious healthcare-associated infections (nosocomial) in intensive care units (ICUs). It develops in patients receiving mechanical ventilation for at least 48 hours and is associated with increased morbidity, mortality, prolonged hospital stays, greater duration of mechanical ventilation, and increased healthcare costs. Among the causative organisms, the ESKAPE pathogens—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species—are particularly important because of their ability to develop multidrug resistance and evade the effects of commonly used antimicrobials. Continuous surveillance of their prevalence and resistance patterns is essential to guide appropriate therapy and infection control measures. Aim: To determine the prevalence and antimicrobial resistance patterns of ESKAPE pathogens isolated from tracheal aspirates of patients with ventilator-associated pneumonia in a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in the Department of Emergency Microbiology at Lok Nayak Hospital between January 2025 to December 2025. Tracheal aspirate specimen obtained from patients who developed infections after 48 hours of hospitalization were processed using standard microbiological methods. Isolates were identified and antimicrobial susceptibility testing was performed using automated system (VITEK2, bioMérieux, France) method according to the latest CLSI guidelines.. Data were analyzed using descriptive and inferential statistics. Results: A total of 350 ESKAPE pathogen isolates were recovered. Klebsiella pneumoniae was the most common isolate, followed by Acinetobacter baumannii and Pseudomonas aeruginosa. Most infections occurred in intensive care unit patients. High resistance was observed to third-generation cephalosporins, fluoroquinolones, and carbapenems, while better susceptibility was noted to colistin, tigecycline, linezolid, and vancomycin, depending on the organism. More than half of the isolates were multidrug resistant. Conclusion: ESKAPE pathogens remain major contributors to HAIs (nosocomial) and exhibit high levels of antimicrobial resistance. Strengthening antimicrobial stewardship, routine surveillance, infection prevention practices, and rational antibiotic use is essential to curb the spread of multidrug-resistant organisms.

Background: Herpetic disciform keratitis is an immune-mediated manifestation of herpes simplex virus infection that may result in prolonged corneal inflammation, stromal scarring, and permanent visual impairment. Identification of factors associated with delayed clinical resolution is essential for improving patient outcomes. Objective: To evaluate the clinical predictors of delayed resolution in patients with herpetic disciform keratitis. Methods: This prospective observational cohort study included 130 patients with clinically diagnosed herpetic disciform keratitis. Baseline demographic characteristics, clinical findings, systemic comorbidities, and ophthalmic examination findings were recorded. All patients received standard antiviral therapy with topical corticosteroids under antiviral cover and were followed until complete clinical resolution. Delayed resolution was defined as persistence of active stromal inflammation beyond six weeks of treatment. Statistical analysis was performed using SPSS version 25.0. Results: Delayed clinical resolution occurred in 42 (32.3%) patients. Diabetes mellitus, previous episodes of herpetic keratitis, symptom duration greater than seven days before presentation, raised intraocular pressure, extensive stromal edema, and poor baseline visual acuity were significantly associated with delayed recovery (p<0.05). Multivariate logistic regression identified extensive stromal edema (OR 4.15), delayed presentation (OR 3.68), previous herpetic keratitis (OR 3.21), diabetes mellitus (OR 2.84), raised intraocular pressure (OR 2.76), and poor baseline visual acuity (OR 2.43) as independent predictors of delayed resolution. Patients with delayed recovery had significantly longer treatment duration, poorer final visual acuity, and higher rates of corneal scarring, persistent stromal haze, and recurrence. Conclusion: Delayed resolution in herpetic disciform keratitis is associated with several identifiable ocular and systemic factors. Early diagnosis, prompt treatment, and close monitoring of patients with these risk factors may reduce complications and improve visual outcomes.

Background: Evidence supporting thymosin alpha 1 as an adjunct in assisted reproduction is limited and is derived mainly from small, uncontrolled studies. This study described pregnancy outcomes and documented adverse events among women with implantation failure who received a short course of thymosin alpha 1 in routine clinical practice. Methods: This single-centre retrospective cohort study reviewed records of women older than 25 years with clinician-recorded implantation failure who received thymosin alpha 1 (Guficin Alfa) 3.2 mg on alternate days over 13 days. Demographic and infertility characteristics, previous embryo-transfer failures, the recorded binary pregnancy outcome, and treatment-related adverse events were summarized descriptively. Wilson 95% confidence intervals (CIs) were calculated for key proportions. Results: Thirty-nine women were included. Mean age was 33.10 ± 5.90 years, and the mean number of previous embryo-transfer failures was 2.03 ± 1.35. Ovarian factors were recorded in 14 (35.9%) women and pregnancy- or implantation-related factors in 12 (30.8%). A positive pregnancy outcome was documented in 37 of 39 women (94.9%; 95% CI, 83.1%-98.6%); the source dataset did not distinguish biochemical, clinical, ongoing pregnancy, or live birth. No treatment-related adverse event was documented in routine records. Conclusion: A high proportion of this treated cohort had a recorded positive pregnancy outcome. Because the study lacked an untreated comparator, used a non-standardized outcome, and did not control for prognostic or treatment-related confounding, the findings do not establish effectiveness. Prospective controlled studies using standardized recurrent implantation failure definitions and live-birth outcomes are required.

Background: Lumbar radiculopathy secondary to lumbar disc herniation (LDH) is a prevalent cause of debilitating back and leg pain. While epidural steroid injections (ESIs) are a mainstay of conservative management, consensus on the optimal delivery approach—parasagittal interlaminar, midline interlaminar, caudal, or transforaminal—remains limited due to conflicting direct comparative evidence. Objectives: To evaluate and rank the comparative effectiveness and safety of parasagittal interlaminar (PIL), midline interlaminar (MIL), caudal (CESI), and transforaminal (TFESI) epidural steroid injections in the management of lumbar radiculopathy secondary to LDH. Methods: This systematic review and network meta-analysis (NMA) was conducted in accordance with the PRISMA 2020 guidelines and the PRISMA extension statement for NMAs, and was registered prospectively in PROSPERO. We systematically searched major databases for randomized controlled trials (RCTs) comparing at least two ESI approaches or an ESI approach versus a control (saline or local anesthetic alone) in adult patients with LDH. Primary outcomes included pain relief (Visual Analog Scale/Numeric Rating Scale) and functional improvement (Oswestry Disability Index) at short-term (<3 months) and intermediate/long-term (≥6 months) follow-ups. Results: Fifteen randomized controlled trials meeting inclusion criteria were synthesized. Network estimates indicate that all ESI modalities are superior to control interventions in providing short-term pain relief. TFESI demonstrates the highest probability of being the most effective intervention for targeted radicular pain and functional restoration at short-term follow-up (SUCRA 88.4% for pain, 85.2% for function). The parasagittal interlaminar (PIL) approach ranks closely as the second most effective approach (SUCRA 76.1% for pain, 72.8% for function), significantly outperforming traditional midline interlaminar (MIL) injections. In long-term follow-up (≥6 months), while TFESI maintained a statistically significant advantage over MIL in pain reduction (SMD = −0.28, 95% CI: −0.51 to −0.05), the difference in long-term functional improvement between TFESI and MIL was no longer statistically significant (SMD = −0.22, 95% CI: −0.46 to 0.02). Complication rates vary by approach, with TFESI carrying an elevated risk of rare but severe vascular complications. Conclusions: All ESI approaches offer therapeutic benefit over conservative controls for managing lumbar radiculopathy. TFESI provides superior short-term symptom mitigation for unilateral radicular pain, while the parasagittal interlaminar (PIL) approach serves as a highly effective, safer alternative that achieves comparable ventral epidural spread without the risk of catastrophic radicular artery embolization. Traditional midline interlaminar (MIL) and caudal (CESI) approaches rank significantly lower and should not be considered first-line options for unilateral radicular symptoms.

Background: Disruptions in sleep are gaining momentum as an additional facet of extraocular and even generalized non-motor symptoms of MG. Difficulties with sleep adversely affect one’s daily performance and quality of life. We do not yet have a clear picture of how the disease severity based on MGFA classification corresponds with the use of subjective sleep assessment measures. Objective: To evaluate the correlation between MGFA clinical severity and subjective sleep scores measured by the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) in patients with myasthenia gravis. Methods: A hospital based cross-sectional observational study in 60 consecutively diagnosed myasthenia gravis was done in Department of Neurology of a tertiary care teaching hospital. Demographic and disease profile was noted out and severity of disease was graded on MGFA clinical classification. Patients completed their own subjective daytime sleepiness scale by using the Epworth sleepiness scale (ESS) and patient’s sleep quality was determined by Pittsburgh sleep quality index (PSQI). Spearman’s rank correlation coefficient was used to establish the association between MGFA severity and various sleep scores. Results: Age mean was 42.8±13.6 years, with 56.7% women. The distribution of patients MGFA classes was what comes next; 36.7% were in MGFA class II and 33.3% in MGFA class III. Poor sleep (PSQI >5) was seen in 71.7% of the patients and excessive daytime sleepiness (ESS≥10) was present in 41.7%. The mean score of PSQI and ESS was within the higher index is significant by constant increase with MGFA classes. Spearman correlation coefficient was significant positive correlation between MGFA severity and ESS score (r = 0.58 p<0.001) and an even more significant positive correlation between MGFA severity and PSQI scores (r = 0.71 p<0.001). Conclusion: Worsening MGFA severity strongly correlates with lower sleep quality and higher daytime sleepiness in myasthenia gravis patients. Subjectively measuring insomnia with PSQI and ESS is a straightforward and effective way to detect sleep problems in MG, mostly in those with generalized or more severe disease. Paying regular attention to sleep issues should be an integral part of a holistic patient-centred management for myasthenia gravis.

Background: Successful split-thickness skin graft (STSG) take is influenced by local wound conditions as well as the overall physiological status of the patient. Burn injury is associated with increased metabolic demand, protein loss, systemic inflammation and altered immune function, all of which may affect wound healing. The Prognostic Nutritional Index (PNI), calculated using serum albumin and peripheral lymphocyte count, provides a simple assessment of nutritional and immune status. This study aimed to evaluate the relationship between preoperative PNI and STSG take in burn patients. Materials and Methods: This prospective observational study included 40 adult patients with burn wounds undergoing STSG. Preoperative serum albumin and absolute lymphocyte count were recorded, and PNI was calculated for each patient. Graft take was assessed on postoperative day 14 and expressed as a percentage of the total grafted area. Correlation analysis was used to evaluate the relationship between PNI and graft take. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive ability of PNI for satisfactory graft take. Results: The mean preoperative PNI was 37.4 ± 6.1, while the mean graft take on postoperative day 14 was 86.8 ± 10.7%. A significant positive correlation was observed between PNI and percentage graft take (r=0.61, p<0.001). Twenty-seven (67.5%) patients achieved satisfactory graft take (≥85%). Their mean PNI was significantly higher than that of patients with graft take <85% (40.0 ± 4.6 vs. 32.1 ± 5.1; p<0.001). ROC analysis showed an area under the curve (AUC) of 0.86. A PNI cut-off of 36.5 showed a sensitivity of 81.5% and specificity of 76.9% for predicting satisfactory graft take. Conclusion: Higher preoperative PNI was associated with better STSG take in burn patients. PNI may be a simple and readily available marker for identifying patients at increased risk of suboptimal graft healing.

Objective: The present study was undertaken to compare the diagnostic performance of transvaginal sonography (TVS) and transabdominal sonography (TAS) for identifying the gestational sac during the early first trimester of pregnancy. Early and accurate confirmation of an intrauterine pregnancy is essential for appropriate clinical management and timely recognition of pregnancy-related complications. Methods: A prospective comparative study was conducted on 100 pregnant women aged 15–45 years who presented with a positive pregnancy test during the first trimester. Each participant underwent both transabdominal and transvaginal ultrasonographic examinations using standardized scanning protocols. The ability of each imaging modality to detect the gestational sac was compared, and statistical analysis was performed using the Pearson Chi-square test. Results: Transvaginal sonography demonstrated a significantly higher gestational sac detection rate than transabdominal sonography. Gestational sacs were identified in 80% of women examined by TVS compared with 30% by TAS. This difference was statistically significant (Pearson Chi-square = 32.727, P < 0.001). Although TAS provided valuable preliminary information, TVS offered superior image resolution and facilitated earlier visualization of intrauterine pregnancy. Nevertheless, TVS has practical limitations, including restricted assessment of structures beyond the pelvis and the requirement for appropriate patient counselling and operator expertise. Conclusion: Transvaginal sonography is a more sensitive and reliable imaging technique than transabdominal sonography for detecting gestational sacs during the early first trimester. Its enhanced diagnostic capability enables earlier confirmation of intrauterine pregnancy and supports prompt clinical decision-making, making it the preferred ultrasound modality for evaluating early pregnancy.

Background: Refractory status epilepticus is a neurological emergency frequently requiring intensive care and mechanical ventilation because of persistent seizures and impaired airway protection. Objectives: To identify the predictors of mechanical ventilation in patients with refractory status epilepticus admitted to the intensive care unit. Materials and Methods: This prospective observational study included 140 patients with refractory status epilepticus admitted to the ICU. Demographic, clinical, laboratory, and treatment-related variables were recorded. Patients were categorized into those requiring mechanical ventilation and those managed without ventilatory support. Multivariable logistic regression analysis was performed to identify independent predictors of mechanical ventilation. Results: Mechanical ventilation was required in 72 (51.4%) patients. Ventilated patients had significantly lower Glasgow Coma Scale scores, higher Status Epilepticus Severity Scores, prolonged seizure duration, elevated serum lactate levels, aspiration pneumonia, longer ICU stay, and higher in-hospital mortality (p<0.05). Multivariable analysis identified GCS ≤8 (OR 4.82), STESS ≥4 (OR 3.76), seizure duration >60 minutes (OR 3.21), aspiration pneumonia (OR 2.74), serum lactate >4 mmol/L (OR 2.58), and acute symptomatic etiology (OR 2.29) as independent predictors of mechanical ventilation. Conclusion: Low neurological status, prolonged seizures, severe disease, and systemic complications significantly predicted the need for mechanical ventilation in refractory status epilepticus. Early recognition of these factors may facilitate timely airway management and improve patient outcomes.

Background: Dengue produces a clinical spectrum ranging from an undifferentiated febrile illness to severe plasma leakage, haemorrhage and organ failure. Because specific antiviral therapy is unavailable, outcome depends almost entirely on early recognition of patients who are progressing towards severe disease. Bedside clinical features and routinely available serological and radiological findings therefore retain considerable triage value in resource-limited settings. Objectives: To describe the clinical profile of serologically confirmed adult dengue patients and to determine which clinical, serological and radiological features are associated with disease severity as defined by the World Health Organization (WHO) 2009 classification. Methods: A longitudinal, hospital-based study was conducted in the Department of General Medicine, McGann District Teaching Hospital, Shivamogga, Karnataka, between January 2021 and June 2022. All consecutive adults (>18 years) positive for dengue NS1 antigen or IgM by enzyme-linked immunosorbent assay (ELISA) were enrolled after written informed consent; patients with pre-existing hepatic disease, alcoholic hepatitis, hepatotoxic drug exposure or co-infections causing transaminase elevation were excluded. Participants were classified as dengue without warning signs, dengue with warning signs or severe dengue. Categorical variables were compared using the chi-square or Fisher’s exact test and continuous variables using one-way analysis of variance (ANOVA), with p<0.05 considered significant. Results: Of 130 patients, 75 (57.7%) were male and the mean age was 40.41 ± 15.95 years. Seventy-five (57.7%) had dengue without warning signs, 40 (30.8%) had dengue with warning signs and 15 (11.5%) had severe dengue. Fever was universal (100%), followed by headache (82.3%), myalgia (80.0%), arthralgia (68.5%), vomiting (45.4%), haemorrhagic manifestations (21.5%), rash (17.7%) and abdominal pain (14.6%). Longer duration of fever at presentation (p=0.003), headache (p=0.049), abdominal pain (p=0.037) and haemorrhagic manifestations (p=0.016) were significantly associated with severity. NS1 antigen positivity was highest in severe dengue (80.0%) and IgM positivity highest in dengue without warning signs (78.7%) (p=0.041 and p=0.022, respectively). Conclusion: Abdominal pain, haemorrhagic manifestations, prolonged fever, NS1 antigen positivity and abnormal chest and abdominal imaging identify adults at risk of severe dengue. These are inexpensive, widely available bedside markers and should prompt intensified monitoring in district hospital settings.

Background: Pregnancy is a physiological state in which drug therapy carries a dual obligation to treat the mother effectively while avoiding harm to the developing fetus. Antibiotics are among the most frequently prescribed drug classes in pregnancy, yet prescribing is often empirical, and both under-treatment of genuine infection and unnecessary exposure to broad-spectrum agents carry consequences. Periodic audit of antibiotic prescribing in antenatal care is therefore essential to rational drug use and antimicrobial stewardship. Objectives: To evaluate the pattern of antibiotic prescribing among pregnant women attending a tertiary care teaching hospital, to assess prescriptions against the WHO core prescribing indicators and the WHO classification, and to determine the fetal risk profile of the antibiotics prescribed. Methods: A cross-sectional study was conducted over 12 months in the Department of Obstetrics and Gynaecology of Vanivilas hospital, Bangalore medical college research institute (BMCRI) tertiary care teaching hospital after institutional ethics committee approval. Pregnant women of any gestational age attending the outpatient department or admitted to the antenatal ward were enrolled after written informed consent. Prescriptions were transcribed into a pre-designed proforma. Antibiotics were classified using the WHO core prescribing indicators, classification (Access, Watch, Reserve), and by the former US-FDA pregnancy risk categories. Results: Of 400 pregnant women, 248 (62.0%) received at least one antibiotic, accounting for 386 antibiotic prescriptions (mean 1.56 per exposed woman). The average number of drugs per prescription was 5.47, 68.9% of drugs were prescribed by generic name, and 79.4% were from the National List of Essential Medicines. Urinary tract infection (31.5%) and surgical/caesarean prophylaxis (25.0%) were the commonest indications. Beta-lactams were the most prescribed class (55.4%), led by amoxicillin–clavulanate (19.2%), and followed by nitrofurantoin (15.0%) and metronidazole (13.5%). By, 228 (59.1%) prescriptions were Access, 158 (40.9%) were Watch and none were Reserve. By the former USFDA categories, 92.7% were category B, 1.6% category C and 5.7% category D. A culture and sensitivity report was available before initiation in only 96 (38.7%) exposed women. Antibiotic exposure was significantly higher among inpatients than outpatients (88.1% vs 43.1%, p < 0.001). Conclusions: Antibiotic prescribing in this antenatal population was broadly consistent with fetal safety, with a strong predominance of beta-lactams and category B agents. However, the proportion of Access-group antibiotics fell marginally short of the WHO 60% target, fixed-dose combinations and third-generation cephalosporins were used liberally, culture-guided prescribing was infrequent, and a small but avoidable proportion of category C and D agents was prescribed. Strengthening culture-based de-escalation, restricting empirical Watch-group use and embedding antenatal prescribing within the hospital antimicrobial stewardship programme are the priority interventions.

Background: The rising incidence of type 1 diabetes mellitus (T1DM) in Indian children has made the prevention of long-term microvascular complications a priority. Persistent microalbuminuria is the earliest clinically detectable marker of diabetic kidney disease and an independent predictor of cardiovascular risk. Data on microalbuminuria in Indian children with T1DM remain limited. Objective: To determine the occurrence of persistent microalbuminuria and to identify the clinical and biochemical factors associated with it in children with T1DM. Methods: A prospective observational study was conducted over 18 months at a tertiary paediatric hospital in Bengaluru, India. Seventy-two children aged 1–18 years with T1DM of more than two years’ duration were enrolled after informed consent and assent. Demographic data, disease duration, history of diabetic ketoacidosis (DKA), insulin regimen, anthropometry and blood pressure were recorded. The urinary albumin–creatinine ratio (ACR) was measured on three early-morning midstream specimens collected over 3–6 months; microalbuminuria was defined as an ACR of 30–300 µg/mg and was considered persistent when present in at least two of three specimens. HbA1c, blood urea and serum creatinine were measured, and the estimated glomerular filtration rate (eGFR) was derived using the Schwartz formula. Data were analysed with the chi-square test and ANOVA; p < 0.05 was considered significant. Results: Of 72 children (mean age 12 ± 3.7 years), 40 (55.6%) were aged 12–18 years and 43 (59.7%) were female (male: female 1:1.48). Disease duration was 2–5 years in 48 (66.7%). A family history of diabetes was present in 20 (27.8%). Poor glycaemic control (HbA1c > 9%) was documented in 51 (70.8%). Persistent microalbuminuria was detected in 6 children (8.3%), of whom 5 (83.3%) were aged 12–18 years and 5 (83.3%) were female; 3 (50%) had disease duration of 5–10 years and 2 (33.3%) had duration of only 2–5 years. All 6 microalbuminuric children (100%) had poor glycaemic control. Mean HbA1c across three visits was significantly higher in microalbuminuric than normoalbuminuric children (12.8 ± 2.7% vs 9.7 ± 2.0%; p < 0.001). Mean eGFR was higher in the microalbuminuric group (131.8 ± 2.8 vs 124.0 ± 2.3 mL/min/1.73 m²; p = 0.47), while urea and creatinine were comparable. Blood pressure, BMI, sex, disease duration and family history did not differ significantly between groups. Transient microalbuminuria was observed in a further 3 children (4.2%). Conclusion: Persistent microalbuminuria affected 8.3% of children with T1DM and occurred even in those with less than five years of disease. Poor glycaemic control (HbA1c > 9%) was the only significant risk factor identified, and glomerular hyperfiltration accompanied early albuminuria. Screening for microalbuminuria should therefore begin close to the time of diagnosis rather than being deferred to an arbitrary duration threshold, so that intensification of glycaemic control can be instituted while renal injury is still reversible.

Background: Surgical site infection (SSI) is one of the most common postoperative complications following abdominal surgery and is associated with increased morbidity, prolonged hospitalization, higher treatment costs, and poorer clinical outcomes. The risk of SSI varies according to patient characteristics and operative factors, particularly between elective and emergency procedures. Objective: To identify the predictors of postoperative surgical site infection following elective and emergency abdominal surgeries and to evaluate their impact on postoperative outcomes. Materials and Methods: A prospective observational study was conducted on 180 patients undergoing abdominal surgery at the Department of General Surgery, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Tamil Nadu, India, over a period of 18 months. Demographic, clinical, and operative variables were recorded, and patients were followed for 30 days to detect SSI. Statistical analysis was performed using SPSS version 26.0. Results: SSI occurred in 32 (17.8%) patients and was significantly more common after emergency surgeries. Diabetes mellitus, obesity, contaminated wounds, prolonged operative duration, higher ASA grade, and delayed prophylactic antibiotic administration were significant predictors. Patients with SSI had longer postoperative hospital stays and increased wound-related complications. Conclusion: Emergency surgery and several modifiable perioperative factors significantly increase the risk of SSI. Early identification and optimization of these predictors may reduce postoperative infections and improve patient outcomes.

Background: The disease process of Alzheimer’s disease (AD) is now understood as a process, requiring a syndromic definition, and disease-modifying treatments are starting to be introduced to the clinic in the context of AD with amyloid pathology. Predictive fluid markers, which are able to forecast progression instead of just diagnose, are thus needed for patient selection and monitoring. Objective: To compile evidence relating to blood- and cerebrospinal fluid (CSF)-based markers as predictors for conversion from cognitively normal to mild cognitive impairment (MCI) and MCI to dementia, and to help pinpoint those with the best and most consistent predictive performance. Methods: A systematic review, meta-analysis and large longitudinal cohort study search, performed based on PRISMA 2020 principles, resulted in a structured synthesis of these studies identified from the PubMed/MEDLINE, Embase, Scopus, Web of Science and Cochrane Library databases. The QUADAS-2 domains were used to appraise the diagnostic studies, while the QUIPS domain was used to appraise the prognostic studies. The most robust available meta-analysis available was used to obtain pooled odds ratios (OR), hazard ratios (HR), areas under the receiver operating characteristic curve (AUC), sensitivity and specificity and heterogeneity (I²). Results: Amyloid positivity alone increased pooled OR for MCI to dementia (5.18; 95% CI 3.93–6.81), with a combined tau positivity and amyloid positivity increasing the pooled OR for MCI to dementia further to 11.60 (7.96–16.91). The plasma p-tau217 was the most effective single biomarker, with a pooled diagnostic sensitivity of 88.1% (86.7–89.5) and specificity of 88.7% (87.4–89.9) across 113 studies (29,625 individuals), as well as a pooled prognostic AUC of 0.85 (0.75–0.91) for MCI-to-dementia conversion, which surpassed that of plasma p-tau181 (AUC 0.73, 0.68–0.78). Plasma p-tau217 had a HR of 1.57 (1.43–1.72) in cognitively unimpaired individuals and was statistically similar (HR 1.61 [1.48–1.76]; p=0.322) to tau PET. Other CSF factors, such as NF-L (c=0.947) and GFAP (c=0.925) were complementary but less informative; and CSF ratios (p-tau/Aβ42, c=0.960) provided similarly high diagnostic concordance with amyloid PET. Conclusion: Considering the convenience of the measurement, and that plasma p-tau217 levels currently are more informative and reproducible than CSF or imaging, this is currently the strongest and most consistent evidence available for predicting early progression to AD. Immediate priorities to aid clinical translation are assay standardisation, validation in cognitively unimpaired and primary-care populations, and its integration with brief cognitive measures.

Background: Adverse drug reactions (ADRs) remain an important cause of patient morbidity and may compromise treatment outcomes, particularly in dermatology where prolonged therapy and multiple medications are frequently prescribed. Objective: To evaluate the pattern of adverse drug reactions associated with medications prescribed in a dermatology outpatient department and to assess their causality and severity. Materials and Methods: A hospital-based prospective observational study was conducted over 18 months among 406 patients attending the dermatology outpatient department of a tertiary care teaching hospital. Suspected ADRs were documented using a structured case record form and assessed using the WHO-UMC causality scale and Hartwig severity scale. Results: Out of 406 patients included in the study, 26 (6.4%) experienced documented adverse drug reactions. Doxycycline was the most frequently implicated medication, followed by Adapalene and Luliconazole. According to the WHO–UMC causality assessment, 12 (46.2%) ADRs were classified as probable/likely and 12 (46.2%) as possible, while all ADRs were graded as mild (Level 1) on the Modified Hartwig Severity Assessment Scale. A higher frequency of ADRs was observed among patients receiving polypharmacy; however, the association was not statistically significant. Conclusion: Active pharmacovigilance in dermatology practice facilitates early detection of ADRs and promotes safer and more rational prescribing practices.

Background: Chronic rhinosinusitis (CRS) is a persistent inflammatory disorder of the sinonasal mucosa. Although Functional Endoscopic Sinus Surgery (FESS) effectively improves symptoms in medically refractory cases, postoperative recurrence remains a significant clinical concern. Aim/Objectives: To identify the risk factors associated with recurrence after Functional Endoscopic Sinus Surgery in patients with chronic rhinosinusitis. Materials and Methods: A prospective observational study was conducted in the Department of ENT at Sri Chamundeshwari Medical College Hospital and Research Institute over one year. Fifty adult patients with CRS undergoing FESS were enrolled and followed postoperatively. Demographic, clinical, radiological, and laboratory parameters were analyzed to determine factors associated with disease recurrence. Results: Recurrence occurred in 14 (28.0%) patients. Nasal polyps, allergic rhinitis, bronchial asthma, smoking, peripheral eosinophilia, and a high Lund–Mackay CT score were significantly associated with recurrence (p<0.05). Multivariate analysis identified a high Lund–Mackay score and nasal polyps as the strongest independent predictors. Conclusion: Disease severity and inflammatory comorbidities are major determinants of recurrence after FESS. Careful preoperative risk assessment and individualized postoperative follow-up may improve long-term outcomes and reduce recurrence.

Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive impairment, cholinergic dysfunction, and oxidative stress. Glaucine, an aporphine alkaloid isolated from Pennisetum purpureum, has previously demonstrated promising acetylcholinesterase (AChE) binding affinity through molecular docking studies, warranting further pharmacological investigation. Objective: The present study aimed to evaluate the neuroprotective and anti-Alzheimer’s potential of glaucine against scopolamine-induced cognitive impairment in rats through behavioural, biochemical, and histopathological assessments. Methods: In vitro antioxidant activity was determined using the DPPH radical scavenging assay, while AChE inhibitory activity was evaluated using Ellman’s method. Acute oral toxicity was assessed according to OECD 423/425 guidelines. Alzheimer’s disease was induced in Wistar rats using scopolamine (2 mg/kg, i.p.). Glaucine (1 and 2.5 mg/kg, p.o.) and galantamine (2.5 mg/kg) were administered, and cognitive performance was evaluated using the Elevated Plus Maze and Rectangular Maze tests. Brain homogenates were analysed for AChE, superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) levels. Histopathological examination of brain tissues was also performed. Results: Glaucine exhibited moderate in vitro antioxidant activity (DPPH IC₅₀ >320 µg/mL) and significant AChE inhibitory activity (IC₅₀ = 77.51 µg/mL). In vivo, glaucine significantly improved learning and memory in behavioural models, reduced brain AChE activity, restored SOD and CAT levels, and markedly decreased MDA concentration in a dose-dependent manner. Histopathological studies demonstrated preservation of neuronal architecture and reduced neurodegenerative changes, particularly at 2.5 mg/kg, with effects comparable to galantamine. Conclusion: Glaucine exerts significant neuroprotective effects against scopolamine-induced Alzheimer’s-like neurodegeneration through dual mechanisms involving cholinesterase inhibition and attenuation of oxidative stress. These findings suggest that glaucine is a promising multitarget natural therapeutic candidate for the management of Alzheimer’s disease.

Background: Undescended testis (cryptorchidism) is one of the most common congenital anomalies of the male genitourinary tract. Although early diagnosis and surgical correction are recommended during infancy, many patients in developing countries continue to present during adolescence and young adulthood, increasing the risk of infertility, testicular malignancy, and other complications. This study evaluated the clinical presentation, management, and surgical outcomes of undescended testes in adolescents and young adults. Methods: A hospital-based observational study was conducted among 150 adolescent and young adult males diagnosed with undescended testes at a tertiary care teaching hospital. Demographic characteristics, clinical presentation, anatomical location of the undescended testis, reasons for delayed presentation, associated anomalies, surgical approach, and postoperative complications were recorded using a structured proforma. Data were analyzed using SPSS version 26.0. Categorical variables were expressed as frequencies and percentages, and a p-value of <0.05 was considered statistically significant. Results: Among the 150 patients, 48.0% belonged to the 15–19 years age group. The majority had secondary education (62.67%). The canalicular location was the most common site of undescended testis (60.0%), followed by the superficial inguinal ring (23.33%). Poverty (32.67%), shame (22.0%), and lack of awareness (20.0%) were the leading causes of delayed presentation. The transinguinal approach was used in 81.33% of patients. Postoperative complications occurred in 20.0% of cases, with scrotal hematoma (73.33%) being the most common complication among affected patients. Associated congenital anomalies were observed in 12.0% of participants, with umbilical hernia (61.11%) being the most frequent anomaly. Conclusion: Delayed presentation of undescended testes remains common among adolescents and young adults, primarily because of socioeconomic and awareness-related factors. The canalicular testis was the most frequent anatomical location, and the transinguinal approach was the predominant surgical procedure with satisfactory outcomes. Early diagnosis, timely referral, and prompt surgical management are essential to preserve fertility potential, reduce postoperative morbidity, and minimize the long-term risk of testicular malignancy.

Background: Acute cholecystitis is one of the most common surgical emergencies worldwide, with cholecystectomy serving as the definitive treatment. Laparoscopic cholecystectomy has largely replaced open cholecystectomy because of its minimally invasive nature and favorable postoperative outcomes. However, open cholecystectomy remains an important option in patients with complicated gallbladder disease or difficult surgical anatomy. The present study was undertaken to compare laparoscopic cholecystectomy and open cholecystectomy in patients with cholecystitis. Methods: A hospital-based comparative observational study was conducted among 150 patients diagnosed with cholecystitis at a tertiary care teaching hospital. Patients were divided into two groups based on the surgical procedure performed: 75 patients underwent laparoscopic cholecystectomy and 75 underwent open cholecystectomy. Demographic characteristics, clinical findings, operative details, postoperative complications, duration of hospital stay, and surgical outcomes were recorded using a structured proforma. Data were analyzed using SPSS version 26.0, and a p-value <0.05 was considered statistically significant. Results: Among the 150 study participants, 61.33% were males and 38.67% were females. The majority of patients (72.00%) belonged to rural areas. Laparoscopic cholecystectomy demonstrated favorable perioperative outcomes, including reduced postoperative pain, shorter hospital stay, faster recovery, and earlier return to routine activities compared with open cholecystectomy. Open cholecystectomy was performed mainly in patients with complicated gallbladder disease, severe inflammation, or difficult intraoperative anatomy. Overall, both procedures were safe and effective, with acceptable postoperative outcomes when appropriate patient selection and surgical expertise were ensured. Conclusion: Laparoscopic cholecystectomy remains the preferred surgical treatment for uncomplicated cholecystitis because of its minimal invasiveness, quicker postoperative recovery, and shorter hospitalization. Open cholecystectomy continues to play a vital role in managing complicated cases and should be considered whenever laparoscopic surgery is contraindicated or conversion is required. Appropriate patient selection, timely surgical intervention, and adherence to established surgical guidelines are essential for achieving optimal clinical outcomes.

Background: Cytological examination of serous effusions is a simple, minimally invasive, and cost‑effective diagnostic modality that aids in distinguishing benign from malignant conditions and in identifying infectious and inflammatory etiologies. Tuberculosis and malignancy remain leading causes of pleural and peritoneal effusions in low‑ and middle‑income, tuberculosis‑endemic settings. Objectives: To study and evaluate the current trends in cytological evaluation of serous effusions for various pathological conditions in a tertiary health care hospital, and to analyse their frequency in relation to diagnosis. Methods: A prospective observational diagnostic test evaluation study was conducted in the Department of Pathology of a tertiary care teaching hospital over 18 months (March 2023–August 2024). A total of 150 pleural and peritoneal fluid samples fulfilling inclusion criteria were processed by both conventional smear and cytospin techniques and stained with Haematoxylin and Eosin and Giemsa. Demographic, clinical, fluid gross characteristics and cytological findings were recorded, and associations with final clinical diagnosis were analysed using chi‑square tests. Results: Of 150 effusions, 134 (89.3%) were pleural and 16 (10.7%) peritoneal. Most patients were 20–40 years (40.7%) and male (76%). Clear, pale‑yellow fluids predominated (80.7% clear; 63.3% pale yellow). Overall, 92.0% were negative for malignancy, 6.7% positive, and 1.3% suspicious. Tuberculosis was the commonest diagnosis (39.3%), followed by bacterial pneumonia (20.0%) and viral pneumonia (13.3%); malignancy accounted for 8.0% of cases. Atypical cells were seen exclusively in malignant effusions and showed perfect specificity for malignancy; high cellularity and age >60 years were also independent predictors of malignancy. Significant associations were noted between clinical diagnosis and type of fluid, fluid appearance, predominant cell type, and cytological category (p<0.05).  Conclusion: In this tuberculosis‑endemic setting, lymphocyte‑predominant pleural effusions were strongly associated with tuberculous etiology, whereas neutrophil‑rich effusions correlated with acute bacterial infections and empyema. The presence of atypical cells and high cellularity were robust predictors of malignancy.

Background: Various changes in body composition significantly notable during menopause transition. These changes may contribute to mood disturbances and depressive symptoms. Exploring this association can aid in early detection and preventive care. Objectives: The aim was to correlate the body fat percentage and body mass index with depression in post-menopausal women. Materials and Methods: Fifty postmenopausal women of age 45 to 60 years and fifty premenopausal women of age 35 to 45 years were selected for the study. Body composition parameters recorded by using bioelectrical impedance analysis.  Depression is assessd by Hamilton Rating Scale (HAM-D). Results: In postmenopausal women, body fat percentage and HAMD score was found to be positively correlated to the significant extent. (p= 0.013). Correlation between body mass index and HAM –D score was not positively correlated in postmenopausal women. (p=0.275). Conclusion: The findings of our study suggest that change in body composition is associated with psychological problems in women. Early screening of body composition and mental health status may help in timely intervention and improve quality of life in this population.

Background: Anterior cruciate ligament (ACL) injury is one of the most common ligamentous injuries of the knee, particularly among young and physically active individuals. Although arthroscopic ACL reconstruction is considered the gold standard for restoring knee stability, the optimal timing of surgical intervention remains controversial. Delaying surgery may increase the risk of secondary meniscal injuries due to recurrent instability, whereas very early reconstruction has historically been associated with postoperative arthrofibrosis and knee stiffness. Recent advances in rehabilitation protocols have challenged this concept, emphasizing early restoration of knee motion before surgery. This study aimed to compare early and delayed arthroscopic ACL reconstruction regarding meniscal injury rates, postoperative stiffness, and functional outcomes. Objectives: To compare the effect of early (≤3 weeks) versus delayed (>6 weeks) arthroscopic ACL reconstruction on meniscal injury rates, postoperative stiffness, and functional outcomes. Materials and Methods: A retrospective comparative study was conducted among 100 patients diagnosed with acute ACL rupture who underwent arthroscopic ACL reconstruction. Fifty patients underwent surgery within three weeks of injury (early group), while fifty underwent surgery after six weeks (delayed group). Patient demographics, meniscal injuries identified during arthroscopy, postoperative knee stiffness, and functional outcomes using the International Knee Documentation Committee (IKDC), Lysholm Knee Score, and Tegner Activity Scale were evaluated during follow-up. Statistical analysis was performed using appropriate parametric and non-parametric tests with p<0.05 considered statistically significant. Results: The delayed reconstruction group demonstrated a significantly higher incidence of meniscal injuries compared with the early intervention group. Medial meniscal tears were more frequent among delayed cases. The incidence of postoperative knee stiffness was comparable between the two groups following standardized rehabilitation. Functional outcome scores showed significant improvement in both groups, with superior knee stability and patient-reported outcomes observed in the early intervention group. Conclusion: Early arthroscopic ACL reconstruction performed within three weeks of injury appears to reduce secondary meniscal injuries without increasing postoperative stiffness when combined with appropriate rehabilitation. Early intervention may therefore provide better preservation of intra-articular structures and improved functional recovery.

Contraceptive use plays a vital role in improving maternal and reproductive health outcomes, particularly in rural communities. This study aims to assess the knowledge, attitudes, and practices regarding contraceptive use among the rural population. A hospital-based cross-sectional descriptive study is planned among married men and women aged 18–45 years residing in rural areas. A minimum sample size of 384 participants will be enrolled using convenience sampling. Data will be collected using a pre-tested semi-structured questionnaire covering demographic characteristics, knowledge, attitudes, and contraceptive practices. Trained interviewers will administer the questionnaire in the local language after obtaining informed consent. Descriptive statistics and appropriate inferential tests, including Chi-square and logistic regression, will be used for data analysis. The study is expected to identify knowledge gaps, misconceptions, and socio-cultural barriers influencing contraceptive acceptance and utilization. The findings will help strengthen family planning services, improve counselling strategies, and promote male participation in reproductive health decisions. The study is expected to contribute to evidence-based interventions aimed at increasing contraceptive awareness and improving reproductive health outcomes in rural populations.

Today, fine needle aspiration has become a definitive prerequisite prior to operative procedures in many cases, soft tissue tumors or otherwise, as it gives the surgeon and insight as to what they are dealing with and so surgery can be planned accordingly. Fine needle aspiration is a diagnostic procedure used for examination of a superficial or deep seated mass (guided radio logically), by sampling a minute amount of the tissue representative of the mass and examining it microscopically after smear preparation & proper staining. The aspirate can be examined for individual cells (cytology/FNAC) or histologically by sampling a greater amount of tissue (biopsy/FNAB).

Today, fine needle aspiration has become a definitive prerequisite prior to operative procedures in many cases, soft tissue tumors or otherwise, as it gives the surgeon and insight as to what they are dealing with and so surgery can be planned accordingly.
Fine needle aspiration is a diagnostic procedure used for examination of a superficial or deep seated mass (guided radio logically), by sampling a minute amount of the tissue representative of the mass and examining it microscopically after smear preparation & proper staining. The aspirate can be examined for individual cells (cytology/FNAC) or histologically by sampling a greater amount of tissue (biopsy/FNAB).

Background: Breathing exercises like pranayama improves autonomic function. Effect on sympathetic or parasympathetic activity has been observed. Hence, here the effect of breathing exercises on sympathetic and parasympathetic activity was studied in young subjects between 18-30 years age group. Bhramari Pranayama and Shambhavi Mudra improve autonomic function individually. However very few studies regarding their combined short-term effect in young adults is there. Hence this study has been planned. Aim & Objective: To assess the pre- and post-intervention effects of one week combined practice of Bhramari pranayama and Shambhavi mudra on HRV, blood pressure and perceived stress level in young adults by using the pulse based HRV monitoring device, sphygmomanometer and perceived stress scale. Methods: One-week combined practice of Bhramari pranayama and Shambhavi mudra a pre–post interventional study was performed on N=36 apparently healthy adults. Autonomic function tests were performed before and after the Bhramari pranayama and Shambhavi mudra. Statistical analysis was done using SPSS v26. Results: The increased parasympathetic activity and decreased sympathetic activity were observed by the improved HRV parameters. Significant reduction in perceived stress scores was observed. Decrease in resting heart rate and blood pressure was observed. Conclusion: One-week combined practice of Bhramari Pranayama and Shambhavi Mudra significantly improves autonomic modulation.

Introduction: The mandibular foramen an important anatomical landmark for inferior alveolar nerve anaesthetic block which is a widely practiced technique in dentistry and maxillofacial surgery. Considering the pivotal clinical importance, accurate location of the mandibular foramen is essential, therefore the present study was conducted to determine the precise position and variations of the mandibular foramen from various anatomical landmarks. Aims & Objectives:  To determine the morphometric parameters of mandibular foramen in 60 dry adult mandibles. Methods and Materials: A cross-sectional study was conducted on 30 dry adult mandibles of unknown sex and age in the Department of Anatomy, Churachandpur Medical College, Manipur from November 2024 to May 2025. Distances were measured from (1) Anterior border of ramus to Mandibular Foramen (AB-MF) (2) Posterior border of ramus to Mandibular foramen (PB-MF) (3) Mandibular notch to Mandibular Foramen (MF-MN) and (4) Mandibular base to Mandibular Foramen (MF-MB). Descriptive statistics of data obtained was analysed using SPSS software. Results: A total of 60 mandibular foramens (30- right; 30-Left) was studied. The mean distance of 1) Anterior border of the ramus to mandibular foramen is 16.8±1.82 mm (Left side) and 16.67±1.74 mm (Right side) 2) Posterior border of the ramus to mandibular foramen is 11.11±1.20 mm (Left side) and 11.08±1.06 mm (Right side) 3) Mandibular notch to mandibular foramen is 22.14±2.61 mm (Left side) and 21.71±2.76 mm (Right side) 4) Mandibular base to mandibular foramen is 22.44±2.16 mm (Left side) and 21.86±2.14 mm (Right side). Conclusion: Determining the location of the mandibular foramen for successful inferior alveolar neurovascular block is essential for performing various dental surgeries and reducing failure rate.

Background: Bilirubin is a metabolic by-product of the breakdown of hemoglobin degradation which itself must be metabolized for appropriate excretion. High levels of bilirubin are associated with decreased risk of coronary heart disease (CHD) and cardiovascular disease (CVD). Objectives: To study the correlation between serum bilirubin level and Risk factor of cardiac disease in patients admitted in hospital. Methodology: This study includes 100 Male Indian subjects between 35 to 60 years of age who visited medicine OPD of our institute. Biochemical test like Lipid profile, Serum bilirubin and blood sugar(Fasting & Post Prandial) were measured on a fully automated analyzer along with quality control sera. Obtained Results were analyzed statistically to calculate p value and to see the difference of significance. Results: HDL level between OPD and IPD (31.92 ± 4.25 mg/dl and 49.92 ± 7.23 mg/dl ) subjects respectively. In the same manner this table also showed a higher level of FBS 122.23±4.2 mg/dl and PP2BS 132.23±8.0 mg/dl in OPD subjects as compared to IPD patients but the difference among them was not significant. It was represented that the OPD subjects were more prone to risk of CVD because the level of S. cholesterol was 220.92 ± 40.21 as compared to 209.45 ± 29.90 in IPD subjects.(p value:<0.001 significant).While comparing the level of serum LDL it was 164.64±15.29 and 134.83±10.39 in Control and case Group Respectively.(p <0.001). The Level of Total bilirubin was 0.84±0.41 mg/dl in control group and 4.42±3.1 in case Group and difference among them was highly significant. Conclusions: The present study demonstrated a significant negative association between baseline bilirubin concentrations and the occurrence of CHD as well as CVD-related death. These findings indicate that serum bilirubin is a valuable parameter for evaluating an individual’s cardiovascular disease risk.

Background: Vitamin B12 remains a major public health challenge in India. It contributes to anemia, impaired growth, neurodevelopmental delay, and increased susceptibility to infections. This study aimed to estimate vitamin B12 levels among children with severe acute malnutrition and determine their association with socio-demographic and anthropometric factors. Methods: A hospital-based observational study was conducted over 10 months (March 2024–December 2024) among 107 children aged 6–60 months admitted with SAM to the Malnutrition Treatment Centre (MNTC), J.L.N. Medical College and Hospital, Ajmer. Serum vitamin B12 levels were measured using the electrochemiluminescence (ECL) method on the COBAS e411 analyzer. Vitamin B12 levels <100 pg/mL were considered deficient, 100–200 pg/mL borderline, and >200 pg/mL sufficient. Statistical analysis was performed using SPSS version 23.0, with p<0.05 considered statistically significant. Results: Among the 107 children, 54 (50.5%) were males and 53 (49.5%) were females. The majority (45.8%) were aged 37–60 months, 82% belonged to low or middle socioeconomic status, 32.7% were exclusively breastfed and 55.1% were completely immunized. Overall, 75 (70.1%) children had vitamin B12 levels <200 pg/mL. Vitamin B12 deficiency was significantly associated with female gender (81.1% vs. 59.3% in males; p=0.0135), lower socioeconomic status (88.9%; p<0.0001), lack of exclusive breastfeeding (86.1%; p<0.0001), and incomplete immunization (p=0.0062). No significant association was observed with age (p=0.1025). Head circumference <-3 SD (78.5% vs. 46.4%; p=0.0014) as well as weight-for-height <-3 SD (82.9% vs. 28.0%; p<0.0001) showed significant associations with vitamin B12 deficiency. Conclusion: Vitamin B12 deficiency is highly prevalent among children with severe acute malnutrition. Female gender, low socioeconomic status, non-exclusive breastfeeding, incomplete immunization and severe anthropometric deficits were significantly associated with lower vitamin B12 levels. Routine screening and timely correction of vitamin B12 deficiency should be considered as an integral component to improve growth and developmental outcomes.

Background: There is qualitative monitoring of the effectiveness of rituximab therapy in autoimmune diseases by measuring IgG, IgM and IgA. Due to limited resources, measurement of B cell count is difficult. Thus, the study will provide a comparison between the quantitative and qualitative monitoring which may help to prevent immunosuppression due to excessive treatment with rituximab. Materials and Methods: Patients with autoimmune diseases admitted in Rheumatology department of IPGMER and SSKM Hospital, Kolkata, receiving Rituximab (RTx) therapy were included as study population (n=48). The B cell count was performed in the Flow Cytometer of the Institute’s ‘Multidisciplinary Research Unit’ and the serum IgG, IgM and IgA was measured in the Dept. of Rheumatology of peripheral venous blood drawn from antecubital vein. Level of immunoglobulins (IgG, IgA, and IgM) were measured in the Department of Rheumatology by nephelometry and B cell count (CD19% & CD20%) was done by flow cytometry in the Department of Pharmacology. Results: An overwhelming majority of patients who had either normal or depleted %CD19 had normal levels of serum IgG. This result reinforces the fact that mature long-lived antibody-secreting plasma cells are apparently not depleted by RTX. Conclusion: The purpose of our study was to compare CD19% and CD20% with serum Ig levels in patients receiving Rituximab in order to assess whether clinicians can use serum Ig levels as predictors for long term immunosuppression, thereby allowing more tailored monitoring of such patients especially when receiving long-term treatment with RTX. An overwhelming majority of patients who had either normal or depleted %CD19 had normal levels of serum IgG. This result reinforces the fact that mature long-lived antibody-secreting plasma cells are apparently not depleted by RTX.

Background: Regular exercise has been shown to have a neuroprotective impact on cognitive function over the long term, lowering the risk of dementia and delaying its onset. We conducted a study to determine the correlation between physical inactivity during midlife and occurrence of dementia in later life. Materials and Methods: A Sample of 47 clinically diagnosed dementia patients according to ICD -11 /DSM -5 and 47 age, sex and locality matched controls were chosen for the study. Basic socio-demographic details and Questions regarding the physical activity they did during their midlife in different domains like work, travel and recreational activities were collected. A validated questionnaire- GPAQ questionnaire was used to collect data about physical activity. The data collected was entered in excel and analyzed with IBM SPSS software version 21. Results: The mean age of the participants was 67.57 ± 7.27 with the minimum age being 54 and the maximum age being 85. About 46.8% of the respondents were males. The amount of physical activity by controls was significantly higher as compared to the cases as measured categorized by work, recreational, travel and total METs. Those who were doing low physical activity and are in the high risk group have more risk of getting dementia [OR = 24.5 (7.87-76.27)]. The risk increases after adjusting for age, gender, education, occupation, presence of diabetes and presence of hypertension. [aOR = 31.5 (13.2 – 54.1)]. Conclusion: Physical inactivity during midlife is a significant predictor for the onset of dementia in later life.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that affect patients’ social, emotional, and physical well-being. In most Western countries, the prevalence of RA is approximately 0.5– 1%, affecting more females than males, the prevalence of RA in India is approximately 0.75% and increasing trend has been noticed. Aims and Objectives: This observational cross-sectional study was designed to study the adherence to therapy in Rheumatoid arthritis patients in Indian adult population in orthopaedic outpatient department in a tertiary care teaching hospital. Materials and Methods: This study was conducted over the span of 1 year ,where 100 patients were enrolled in study following the inclusion and exclusion criteria after taking informed consent. Adherence to therapy was assessed by Morisky Green and Levine scale. This is a validated scale designed to estimate the risk of medication non adherence. Results: In our study, evaluation of adherence to therapy was done on the basis of patient’s response to 4-item Morisky Green and Levine scale. Among 100 patients, 44% forgot to take their medicine, 28% were careless at times about taking their medicine, 33% respondents sometimes stopped taking medicine when feeling better, and 23% respondents sometimes stopped taking medicine when feeling worse. Our study results showed that majority of the patients had moderate adherence to prescribed therapy i.e., 47%, followed by low adherence in 31% patients and high adherence in 22% patients. The difference in low, medium and high adherence groups in comparison to, age and education was statistically significant (p0.05) and in comparison, to gender and occupation was statistically not significant (p>0.05). Conclusions: In High adherence group – most of the patients were in the age range of 61-75 years, females, with secondary education status, with no present family history of RA, with RA factor positive.

Background: Peripheral vascular disease (PVD) is a common macrovascular complication of diabetes mellitus and hypertension and shows a strong correlation with coronary artery disease and cerebrovascular disease. This study aimed to detect PVD in patients with myocardial infarction (MI) using the ankle brachial index (ABI) and arterial Doppler of the lower limbs, and to correlate clinical and biochemical variables with PVD and coronary artery disease. Methods: One hundred randomly selected patients with myocardial infarction admitted to Subbaiah medical college, were included. ABI and arterial Doppler study of the lower limbs were performed in all patients to detect PVD. Results: PVD was detected by Doppler study in 33% of patients and by ABI (<0.9) in 32% of patients. The occurrence of PVD showed a direct relationship with increasing age, hypertension, diabetes mellitus and smoking. Most patients belonged to the 56–65 year age group (45%), with a male predominance (74%). Non-ST elevation MI (NSTEMI) was the commonest presentation (48%), followed by unstable angina (34%) and ST elevation MI (18%). Conclusion: The occurrence of PVD in myocardial infarction by Doppler study was 33% in and around Shimoga. Patients with MI and concomitant PVD are likely to carry higher morbidity than those without PVD. Advanced age increases the risk of PVD, and PVD is significantly associated with hypertension, smoking and diabetes mellitus. ABI is a simple, inexpensive and reliable screening tool and should be considered for routine use in patients with myocardial infarction.

Background: Measles remains one of the most contagious vaccine-preventable diseases and continues to cause outbreaks in areas with suboptimal immunization coverage. Despite intensified immunization strategies in India, localized outbreaks still occur in vulnerable rural communities. This study investigated a measles outbreak in Kanjia village, Sagar district, Madhya Pradesh, to assess epidemiological characteristics, clinical profile, and immunization gaps. Methods: A community-based cross-sectional outbreak investigation was conducted in November 2024 using a house-to-house survey in Kanjia village. A total of 1,678 residents from 556 households were surveyed by a multidisciplinary team. Data were collected using a pretested structured questionnaire covering demographic characteristics, symptoms, vaccination status, treatment-seeking behavior, and complications. Cases were identified according to standard measles case definitions. Descriptive epidemiological analysis was performed. Results: A total of 204 measles cases were identified, yielding an overall attack rate of 12.2%. Children aged 1–6 years accounted for 75.5% of all cases, followed by infants aged <1 year (18.6%). Males constituted 59.3% of cases. Common symptoms included rash (98%), fever (93%), and cough (41%). Pneumonia was reported in 22.5% of patients, and one death occurred (0.4%). Among children aged 0–6 years, only 32% had received two doses of measles vaccine, while 16% were unvaccinated and 49% had unknown vaccination status. Conclusion: The outbreak highlights persistent immunity gaps in rural populations despite national measles elimination efforts. Strengthening routine immunization, improving documentation, enhancing community awareness, and timely outbreak surveillance are essential to prevent recurrence.

Background: Sore throat is very common after endotracheal intubation (ETI) under general anaesthetic (GA). Ketamine and dexmedetomidine have anti-inflammatory and analgesic properties and have been shown to decrease airway irritation when nebulized. The present study examined the effect of nebulized ketamine versus nebulized dexmedetomidine on the prevention of POST. Objectives: To compare the efficacy of nebulized ketamine and dexmedetomidine to decrease the incidence and severity of POST, reduce postop sore throat hoarseness and treatment related adverse effects. Materials and Methods: The study was conducted at Datta Meghe Medical College and Wanadongri in Nagpur, this study is a prospective randomized controlled trial conducted during this period (January 2023 to December 2024). 100 patients undergoing general anaesthesia with endotracheally intubation were randomly divided into 2 groups (50 patients in both groups). Then, either ketamine may be nebulized or dexmedetomidine may be nebulized prior to induction. A validated grading scale was used to evaluate POST at 2, 6, 12 and 24 hours after surgery. Other effects included cough, hoarseness, haemodynamic changes and adverse effect. Results: In the ketamine group, 24-hour MPS results were seen for 4 (8%) patients, and for 2 (4%) in the dexmedetomidine group. At 6 hours, the incidence was 22% and 12%, respectively (P = 0.041). The percentage of patients with a postoperative cough was not significantly different between the two groups: 24% (ketamine) versus 14% (dexmedetomidine) (P = 0.201); with hoarseness not significantly different: 18% (ketamine) versus 10% (dexmedetomidine) (P = 0.249). There were no major adverse effects found in either group. Conclusions: Nebulized dexmedetomidine resulted in better reduction in the incidence and severity of the postoperative sore throat than nebulized ketamine. Both interventions were tolerated well and could potentially be beneficial in reducing post-operative airway related complications following general anaesthesia.

Introduction: Thyroid nodules are common endocrine disorders. Although most lesions are benign, early identification of malignancy remains critical. Accurate preoperative diagnosis of thyroid nodules is essential for appropriate surgical decision-making. Ultrasound-guided FNAC is widely used because it is minimally invasive, economical, and highly informative. The present cross sectional study was evaluated the correlation between preoperative FNAC and postoperative histopathological examination (HPE). Methods: A Cross sectional study was conducted in the Department of General Surgery, at Tertiary Care Hospital, in rural area over 6 months. 90 adult patients with thyroid swelling who underwent ultrasound-guided FNAC followed by surgery were included. Statistical measures including sensitivity, specificity, PPV, NPV, and accuracy were calculated. Results: Age group 41–50 years constituted the largest subgroup (30%). Females accounted for 85.5%. Solitary thyroid nodules were present in 70%. Benign ultrasound features were seen in 77.8%. Benign cytology was observed in 75.5%, while malignant cytology in 24.4% on FNAC. However, histopathology confirmed 81.1% lesions are benign and 18.8% lesions are malignant. FNAC demonstrated sensitivity of 94.12%, specificity of 91.78%, PPV of 72.73%, NPV of 98.53%, and an overall diagnostic accuracy of 92.22%. Correlation between FNAC and HPE was statistically significant (p < 0.00001). Conclusion: Ultrasound-guided FNAC is a reliable and cost-effective diagnostic tool for thyroid nodules and correlates well with postoperative histopathology. And its Strong cytohistological correlation supports its routine use in surgical practice.

Hormones are chemical messengers that are released directly into the circulation and distributed to organs and tissues throughout the body to carry out their activities.” They have a wide range of effects on biological functions and processes. Food metabolism, Sexual function, Reproductive development and health, cognitive function and mood, body temperature, and thirst are all factors to consider of development and growth. The two main female sex hormones are oestrogen and progesterone. The three primary estrogens found in the human body are estradiol, estrone, and estriol. During puberty, these substances interact to guarantee fertility and encourage the development of suitable female sex characteristics Hormone assessed in the first, second or third trimester as well as hormone pregnancies are associated, according to our observational study.

Objective: The present study was undertaken to compare the diagnostic performance of transvaginal sonography (TVS) and transabdominal sonography (TAS) for identifying the gestational sac during the early first trimester of pregnancy. Early and accurate confirmation of an intrauterine pregnancy is essential for appropriate clinical management and timely recognition of pregnancy-related complications. Methods: A prospective comparative study was conducted on 100 pregnant women aged 15–45 years who presented with a positive pregnancy test during the first trimester. Each participant underwent both transabdominal and transvaginal ultrasonographic examinations using standardized scanning protocols. The ability of each imaging modality to detect the gestational sac was compared, and statistical analysis was performed using the Pearson Chi-square test. Results: Transvaginal sonography demonstrated a significantly higher gestational sac detection rate than transabdominal sonography. Gestational sacs were identified in 80% of women examined by TVS compared with 30% by TAS. This difference was statistically significant (Pearson Chi-square = 32.727, P < 0.001). Although TAS provided valuable preliminary information, TVS offered superior image resolution and facilitated earlier visualization of intrauterine pregnancy. Nevertheless, TVS has practical limitations, including restricted assessment of structures beyond the pelvis and the requirement for appropriate patient counselling and operator expertise. Conclusion: Transvaginal sonography is a more sensitive and reliable imaging technique than transabdominal sonography for detecting gestational sacs during the early first trimester. Its enhanced diagnostic capability enables earlier confirmation of intrauterine pregnancy and supports prompt clinical decision-making, making it the preferred ultrasound modality for evaluating early pregnancy.

Background: Refractory status epilepticus is a neurological emergency frequently requiring intensive care and mechanical ventilation because of persistent seizures and impaired airway protection. Objectives: To identify the predictors of mechanical ventilation in patients with refractory status epilepticus admitted to the intensive care unit. Materials and Methods: This prospective observational study included 140 patients with refractory status epilepticus admitted to the ICU. Demographic, clinical, laboratory, and treatment-related variables were recorded. Patients were categorized into those requiring mechanical ventilation and those managed without ventilatory support. Multivariable logistic regression analysis was performed to identify independent predictors of mechanical ventilation. Results: Mechanical ventilation was required in 72 (51.4%) patients. Ventilated patients had significantly lower Glasgow Coma Scale scores, higher Status Epilepticus Severity Scores, prolonged seizure duration, elevated serum lactate levels, aspiration pneumonia, longer ICU stay, and higher in-hospital mortality (p<0.05). Multivariable analysis identified GCS ≤8 (OR 4.82), STESS ≥4 (OR 3.76), seizure duration >60 minutes (OR 3.21), aspiration pneumonia (OR 2.74), serum lactate >4 mmol/L (OR 2.58), and acute symptomatic etiology (OR 2.29) as independent predictors of mechanical ventilation. Conclusion: Low neurological status, prolonged seizures, severe disease, and systemic complications significantly predicted the need for mechanical ventilation in refractory status epilepticus. Early recognition of these factors may facilitate timely airway management and improve patient outcomes.

Background: Cystic change in the thyroid is common and is generally regarded as a favourable finding, yet a proportion of cystic thyroid nodules harbour malignancy, most often papillary thyroid carcinoma. Cyst fluid dilutes the cellular yield of fine needle aspiration cytology (FNAC) and is a recognised source of both false negative and false positive diagnoses. Aims: To describe the cytomorphological spectrum of cystic thyroid lesions, estimate the frequency of malignancy in cystic thyroid nodules, and analyse discordant cyto-histopathological diagnoses. Materials and Methods: Thirty-seven cystic thyroid lesions were identified among 90 palpable cystic head and neck lesions aspirated over two years (June 2018 to May 2020) in a prospective study at the Department of Pathology, J.J.M. Medical College, Davangere. Aspirations were performed with a 23-gauge needle; smears were stained with H&E, Papanicolaou and Giemsa stains and reported using the Bethesda System. Histopathological correlation was performed wherever thyroidectomy specimens were received. Results: Thyroid cysts were the commonest cystic lesion of the neck (41.1%). Of the 37 cases, 31 (83.8%) were colloid goitre with cystic degeneration (Bethesda II), four (10.8%) were papillary thyroid carcinoma with cystic change (Bethesda VI) and two (5.4%) were follicular neoplasm with cystic change (Bethesda IV/V), giving a malignancy frequency of 16.2%. Benign cystic goitre showed a female preponderance and right-lobe predominance. Histopathological correlation was available in 22 colloid goitre cases (concordant in 20), in three of four papillary carcinomas (all concordant), and in one follicular neoplasm, which proved to be nodular colloid goitre. One cytologically benign goitre was reclassified as colloid goitre with micropapillary carcinoma on histopathology. Conclusion: FNAC reliably characterises cystic thyroid nodules, but sampling error in paucicellular cyst fluid may cause false negative diagnoses, and reactive atypia of cyst-lining cells may cause overdiagnosis. Careful attention to nuclear features, the background, re-aspiration of residual nodules and clinico-radiological correlation are essential.

Diabetes mellitus is a multi-system disease with multiple complications. Dyslipidemia is one of the, most important event which plays major role in these complications. There is usually high triglycerides level in most diabetic dyslipidemia. Hence ideal management of diabetes should include management of dyslipidemia & hence increased levels of triglycerides and the. This study is carried out to evaluate the effect of Sitagliptin and combination of sitagliptin and metformin on triglyceride level in diabetic rats. Type-2 diabetes was induced in Albino Wister Rats by using high fat-low Streptozotocin method. Rats were fed with coconut oil and vanaspathi ghee for 6 weeks followed by a low dose Streptozotocin. Rats were treated with Sitagliptin, Metformin and combination of Metformin and Sitagliptin for 21 days. Triglyceride levels were analysed after induction of diabetes and after completion of treatment. Results: Groups treated with Sitagliptin and combination of Sitagliptin and Metformin showed significant reduction in triglyceride level. Conclusion: It can be concluded that Sitagliptin and combination of Sitagliptin and Metformin reduces the triglyceride level in diabetic Albino Wister rats.

Background: Pharmacovigilance plays a crucial role in detecting, assessing, understanding, and preventing adverse drug reactions and other medicine-related problems. Under-reporting of ADRs remains an important limitation of pharmacovigilance systems and may be related to inadequate knowledge, awareness, and reporting practices among healthcare professionals. Postgraduate doctors are particularly important because of their extensive involvement in prescribing, monitoring treatment, and direct patient care. The study protocol therefore proposed assessment of postgraduate students’ knowledge, attitude, and practice regarding pharmacovigilance before and after a structured sensitization programme. Aim: To enhance the detection, reporting, and prevention of adverse drug reactions in patients among postgraduate students. Objectives: To assess the knowledge, attitude, and practice of postgraduate students regarding pharmacovigilance and ADR reporting, and to assess changes in these parameters following a structured pharmacovigilance educational intervention. Materials and Methods: A longitudinal questionnaire-based educational intervention study was conducted among 60 postgraduate students at Subbaiah Institute of Medical Sciences, Shivamogga, over a period of one year. Universal sampling was adopted. A semi-structured questionnaire was administered as a pre-test to assess baseline knowledge, attitude, and practice regarding pharmacovigilance. A structured pharmacovigilance sensitization session was subsequently conducted, and the same participants were reassessed using the questionnaire after one year. The original protocol specifies a longitudinal design, universal sampling, pre- and post-intervention assessment, and appropriate descriptive and inferential statistical analysis. Results: A total of 60 postgraduate students were included. The mean knowledge score increased from 5.42 ± 1.61 to 8.47 ± 1.13, attitude score from 6.68 ± 1.44 to 8.55 ± 1.06, and practice score from 4.18 ± 1.52 to 7.35 ± 1.39 following intervention (p<0.001 for all). The overall KAP score increased significantly from 16.28 ± 3.21 to 24.37 ± 2.62 (p<0.001). Awareness of PvPI increased from 45.0% to 91.7%, while knowledge regarding where ADRs should be reported increased from 40.0% to 88.3%. Willingness to report ADRs increased from 65.0% to 93.3%. Actual ADR reporting increased from 18.3% to 65.0%, and knowledge regarding completion of an ADR reporting form increased from 28.3% to 86.7%. Significant improvements were therefore observed across knowledge, attitude, and practice domains. Conclusion: Structured pharmacovigilance education significantly improved the knowledge, attitude, and ADR-reporting practices of postgraduate students. Incorporating regular pharmacovigilance sensitization, practical ADR-reporting exercises, and periodic reinforcement into postgraduate medical education may improve spontaneous ADR reporting and contribute to better medication safety and patient care.

Background: The thoracic duct is the principal collecting vessel of the lymphatic system. Injury during oesophageal, thoracic, cervical or spinal surgery is a recognised cause of chylothorax and chylous fistula. Although classical descriptions portray a single continuous conduit terminating at the left venous angle, the frequency and topography of morphological variants—and whether these are congenital or acquired—remain incompletely defined. Methods: Twenty-four human cadavers (12 adults aged 50–80 years; 12 fetuses at 35–40 weeks’ gestation) were studied. Specimens were sequentially perfused with pigmented acrylic latex—first through the internal marginal vein, then through the thoracic duct via the interazygous–aortic recess, and finally through the posterior tibial artery—with intermediate hardening of latex at the left venous angle to prevent mixing of media. Specimens were fixed in 5% formalin, cleared in hydrogen peroxide, dissected and photographed. Frequencies of plexiform segments, cisterna chyli, duplication and terminal pattern were recorded. Proportions are reported with 95% Wilson score confidence intervals. Results: Plexiform (plexus-shaped) segments and derivative pathways of the thoracic duct were present in 80% of adult specimens (approximately 9–10/12; 95% CI 46.8–95.3% across bracketing counts) and in none of the fetal specimens (0/12; 95% CI 0–24.3%). A cisterna chyli, presenting as an ampullary dilatation at the origin of the duct, was present in 100% of fetuses (12/12; 95% CI 75.7–100%) but in only one adult (1/12, 8.3%; 95% CI 1.5–35.4%), in whom the dilatation lay at the level of the left lumbar lymphatic trunk rather than at the classical confluence. No complete duplication of the duct was observed in either group; partial duplication was confined to the cervical segment in a minority of adults. Termination at the left venous angle (angle of Pirogoff), either directly or through interposed lymph nodes, occurred in 100% of specimens in both groups (24/24; 95% CI 86.2–100%). Conclusions: The site of termination of the thoracic duct is anatomically stable; the morphology of the pre-terminal duct is not. The near-complete dissociation between adult and fetal patterns—plexuses in adults only, a cisterna chyli in fetuses almost exclusively—is most consistent with postnatal remodelling of the duct rather than with congenital variation alone. The resulting collateral capacity provides a plausible anatomical explanation for the clinical observation that some patients tolerate thoracic duct ligation without developing chylous effusion. Larger series with quantitative morphometry and correlation with in-vivo imaging are warranted.

Background: Diffusing capacity for carbon monoxide (DLco) of lung, is a important index of gas exchange as it provides physiological severity which is distinct from spirometry. DLCO is not routinely included for COPD assessment. dlco itself is an important prognostic marker for assessment of disease severity, treatment response, clinical follow up. Objective: To study diffusion capacity of lung for carbon monoxide in patients with COPD and to assess severity of these diseases. Methods: This hospital-based cross-sectional study included 33 treatment-naive adults with COPD from March 2025 to February 2026.After a thorough history, general examination and systemic examination subjects were evaluated by Blood test, CXR, HRCT, spirometry, DLCO and 6MWT. Results: Among 33 COPD patients, 27 were diagnosed as emphysema and 6 chronic bronchitis cases. males were 25(75.7%) 8 (24.2%) were females.79% smokers while 6% non-smokers, and 15% were former smokers. Mean pack years was 36.39 ± 7.7. The predominant symptom was cough and SOB observed in 100%, 60.4% had wheeze, 42.4% had chest pain, and 72.7% had fever. Mean DLCO level for 20-30 pack yrs group was 72.88 ± 25.17, while for 30-40 pack yrs was 56.07 ± 15.77 and for 40-50 pack yrs was 45.00 ± 7.27.9% had mild, 42% had moderate, 18% had normal and 30% had severe DLCO. 6% mild obstruction, while 58% moderate and 33% severe obstruction. 1(3%) patient has normal spirometry. Mean FEV1/FVC was 53.52 ± 6.71, mean FEV1(%) was 55.42 ± 11.56, while mean FVC was 74.15 ± 8.61. Mean DLCO for mild division was 85.71 ± 29.12 while for moderate division was 58.50 ± 15.28 and for severe mean DLCO was 41.13 ± 12.02. One COPD patient with normal spirometry has DLCO value of 56. Conclusion: D_LCO can be indicated in morbidity assessment, a low D_LCO is seen in cases with increased symptomatology and low exercise capacity. DLCO below 40% predicted may qualify a patient for total disability and as an indication to assess if the patient needs oxygen therapy. DLCO integration into the clinical workup provides a more comprehensive assessment in patients with COPD and will help plan strategies for disease management.

Background: Early identification of patients expected to stay in the ICU for at least 24 hours after admission, followed by their monitoring for clinical deterioration are important strategies to reduce mortality. Scoring systems derived and validated for predicting clinical deterioration and mortality include qSOFA, NEWS2 and SOFA. While most studies compared the scores at the time of admission, a comparison of the sequential scores is more useful. Objective: This is a prospective observational study that aimed to compare qSOFA, NEWS2 and SOFA scores in critical care setting. The primary outcome was in-hospital mortality and the study also looked at a number of secondary outcomes. The primary end-point was predicted using serially collected scores recorded within the first 48 hours of patient’s ICU admission. Methods: The study was conducted in a 20 bedded ICU of a tertiary care hospital over a period of one year i.e. from August 2025 to July 2026. All the patients aged 18 years or above who were expected to stay in the ICU for 24 hours or more and were either conscious or unconscious were included in the study. The qSOFA, NEWS2 and SOFA scores were calculated at the time of admission to the ICU, 24 hours later and 48 hours later. The primary end point was in-hospital mortality. Other end points studied were ICU mortality, need for invasive mechanical ventilation, need for vasopressors, prolonged stay in the ICU and length of hospital stay. Area under the receiver operating characteristic curve (AUC-ROC) was used to compare the prognostic performance of the three scoring systems. Results: The study included 240 patients with a mean age of 57.8 ± 16.9 years among which 142 (59.2%) were men. The in-hospital mortality rate was 24.2% (58/240 patients). All scores at all three time points were significantly higher in deceased patients. The AUC for admission qSOFA, NEWS2 and SOFA were 0.68, 0.74 and 0.79, respectively. The AUC for 48 hr qSOFA, NEWS2 and SOFA were 0.75, 0.82 and 0.89, respectively. Increase in SOFA score within the first 48 hours of ICU admission was an independent predictor of in-hospital mortality. The 48 hr SOFA score was the best score to predict in-hospital mortality. Conclusion: Trend in scores of the three scoring systems to predict patient’s outcome improved with sequential assessment. The best scoring system to predict in-hospital mortality was 48h SOFA score, while the best scoring system to predict patient’s outcome with balance between good prognostic value and ease of calculation at the bedside was NEWS2 score. Importantly, trend in single values of scoring systems was far more important than single admission value of scoring system.

Introduction: The increasing rate of preterm caesarean sections has become a significant concern due to its impact on maternal and neonatal outcomes. Preterm births, defined as delivery before 37 completed weeks of gestation, are associated with increased neonatal morbidity and mortality. The present study aimed to audit preterm caesarean sections at a tertiary care centre in Western Gujarat to evaluate clinical indications, maternal and neonatal outcomes, and identify opportunities for improving obstetric management. Materials and Methods: A retrospective observational audit was conducted in the Department of Obstetrics and Gynecology at a tertiary care teaching hospital in Western Gujarat. A total of 120 women who underwent preterm caesarean section between 28 and 36+6 weeks of gestation were included. Data were collected retrospectively from hospital medical records, labour room registers, operation theatre records, and NICU registers. Maternal demographic characteristics, obstetric profile, indications for surgery, and maternal and neonatal outcomes were analyzed using descriptive statistics and Robson Ten Group Classification System wherever applicable. Results: The majority of women belonged to the age group of 20–29 years (71.7%), were nulliparous (61.7%), and from rural areas (68.3%). Cephalic presentation was observed in 86.7% of cases, while singleton pregnancies accounted for 90.0%. Major indications for preterm caesarean section included antepartum hemorrhage (13.3%), fetal distress (12.5%), severe maternal conditions (11.7%), and previous caesarean section with refusal for trial of labor after caesarean (10.0%). Maternal outcomes were favorable, with 94.2% discharged successfully and only 13.3% requiring OBICU admission. Neonatal outcomes showed NICU admission in 85.0% of cases, respiratory support requirement in 11.7%, and live births in 95.0% of neonates. Conclusion: Preterm caesarean sections were predominantly associated with fetal distress, antepartum hemorrhage, and previous caesarean section. Periodic auditing and evidence-based obstetric decision-making are essential to optimize maternal and neonatal outcomes while minimizing unnecessary preterm caesarean sections.

Introduction: Giant cell tumor of the tendon sheath (GCTTS) is a benign soft-tissue tumor of the hand. Despite its non-malignant nature, recurrence remains a concern. Complete excision of the lesion, including any satellite nodules, is important in reducing the risk of recurrence. The use of a magnifying loupe may facilitate meticulous dissection and complete removal of the lesion. Aim: To evaluate the surgical management and clinical outcomes of giant cell tumor of the tendon sheath of the hand. Materials and Methods: This was an observational case series conducted in the Department of Plastic and Reconstructive Surgery, PMCH, Patna, over an 18-month period (2024–2025). A total of 10 patients with GCTTS were surgically treated after preoperative confirmation by fine-needle aspiration cytology (FNAC). Meticulous dissection and tumor excision were performed with the aid of a magnifying loupe. Patients were subsequently contacted for follow-up and clinical assessment. Results: A total of 10 patients, comprising six females and four males, with a mean age of 29.5 years (range, 22–53 years), underwent excision of GCTTS of the hand. The lesions were located over the thumb (n = 3), index finger (n = 3), ring finger (n = 1), middle finger (n = 1), and hand (n = 2). The lesions were classified according to the Al-Qattan classification. A mass involving the phalanx, particularly the thumb and index finger, was a common presentation. Postoperative complications included infection (n = 1), skin necrosis (n = 1), neurovascular injury (n = 1), and stiffness (n = 3). Recurrence was observed in one patient (10%). Conclusion: Successful management of GCTTS requires adequate surgical exposure, meticulous dissection, and complete excision of the tumor, including satellite lesions. Preoperative FNAC may assist in diagnosis and surgical planning, while loupe-assisted dissection may facilitate careful identification and removal of the lesion. Regular postoperative follow-up is important for early detection of recurrence.

Background: The scalp, a crucial protective barrier for intracranial structures, undergoes intricate reconstruction procedures, demanding detailed anatomical knowledge.  Vascular considerations, orchestrated by branches from carotid arteries, sustain scalp health. The multifaceted nature of scalp defects, driven by diverse causes, underscores reconstruction complexity. Aim and Objective: To evaluate the surgical reconstruction of scalp defects and the associated clinical outcomes. Material and Method: This was an observational case series conducted over a 2-year period (2025–2026). The study evaluated the use of local flaps, Matriderm, and free flaps for scalp defect reconstruction, with the reconstructive technique selected according to the characteristics of the defect. A total of 18 patients underwent scalp reconstruction, with trauma being the most common etiology (50%). The study details flap nourishment, defect location descriptions, and surgical planning, meticulously assessing intrinsic and extrinsic factors. Result: 18 patients underwent successful scalp reconstruction, primarily for traumatic (50%) . There was a male predominance (72.2%, and interventions varied across regions, with the parietal area being the most common (44%). Conclusions: For the majority of scalp defects in this series, local flaps with or without skin grafting provided satisfactory coverage. The choice of reconstructive technique should be individualized according to the size, location, depth, wound-bed condition, and availability of local tissue.

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disorder with substantial extra-articular involvement, of which pulmonary manifestations are an important cause of morbidity. Pulmonary abnormalities may occur in the absence of respiratory symptoms and can include interstitial, obstructive, restrictive, or mixed patterns. Pulmonary function tests, particularly spirometry and measurement of diffusing capacity for carbon monoxide (DLCO), may facilitate the detection of early pulmonary involvement. Objective: To evaluate pulmonary manifestations in patients with rheumatoid arthritis and assess their association with spirometric parameters, DLCO, and disease activity. Materials and Methods: A hospital-based cross-sectional study was conducted among 60 patients with clinically and/or serologically confirmed RA attending the Departments of Respiratory Medicine and Rheumatology at People’s Hospital, Bhopal. Following informed consent, demographic characteristics, clinical history, respiratory symptoms, and examination findings were recorded. Participants underwent routine laboratory investigations, rheumatoid factor assessment, chest radiography, spirometry, and DLCO measurement. Disease activity was assessed using the Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI). Pulmonary function abnormalities were analysed in relation to clinical characteristics and disease activity. Results: The study included 60 patients with rheumatoid arthritis, of whom 46 (76.7%) were women. The largest proportion of participants belonged to the 41–50-year age group [24 (40.0%)]. More than half of the patients [31 (51.7%)] were asymptomatic, while dyspnoea was the most frequently reported respiratory symptom [16 (26.7%)]. Chest radiography was normal in 40 (66.7%) patients. Abnormal spirometric findings were observed in 29 (48.3%) patients, with a restrictive ventilatory pattern being the most common abnormality [18 (30.0%)]. Reduced DLCO was detected in 38 (63.3%) patients. Both spirometry and DLCO were abnormal in 24 (40.0%) patients, whereas isolated DLCO impairment was observed in 14 (23.3%). Pulmonary manifestations were identified in 32 (53.3%) patients, with interstitial lung disease being the most frequent [17 (28.3%)]. Pulmonary function abnormalities showed significant associations with disease activity assessed using CDAI and SDAI. Conclusion: Pulmonary involvement was common among patients with RA, including those without respiratory symptoms. Reduced DLCO was more frequently observed than spirometric abnormalities, suggesting that DLCO may provide additional sensitivity for detecting early or subclinical pulmonary involvement. Incorporating DLCO along with spirometry into the pulmonary evaluation of patients with RA may facilitate earlier recognition of respiratory abnormalities and enable timely clinical assessment and management.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive respiratory disorder characterized by persistent airflow limitation and chronic airway inflammation. Although tobacco smoking is a major risk factor, distinct inflammatory pathways may contribute to differences in disease severity and clinical phenotype. Serum immunoglobulin E (IgE), a marker associated with type 2 and allergic inflammation, may have a potential association with airway obstruction and inflammatory activity in COPD. Aim: To evaluate the association between serum IgE levels and disease severity in patients with COPD. Material and Methods: This prospective observational study was conducted in the Department of Respiratory Medicine, People’s College of Medical Science and Research Centre and associated People’s Hospital, Bhopal, over 24 months from February 2024 to January 2026. Fifty newly diagnosed patients with COPD attending the outpatient and inpatient services were enrolled after obtaining written informed consent. Participants underwent detailed clinical assessment, including sociodemographic and smoking history, chest radiography, oxygen saturation, modified Medical Research Council (mMRC) dyspnoea assessment, spirometry, and Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging. Laboratory investigations included complete blood count, absolute eosinophil count, serum IgE measured by fluoroenzyme immunoassay, and C-reactive protein (CRP). Statistical analysis was performed using Microsoft Excel and IBM SPSS Statistics version 20. Results: The majority of participants belonged to the 60–69-year age group [18 (36%)], with a predominance of males [38 (76%)]. Smoking history was present in 41 (82%) patients. According to GOLD classification, 18 (36%) patients had moderate COPD, followed by severe COPD in 17 (34%), very severe COPD in 9 (18%), and mild COPD in 6 (12%). Serum IgE was elevated in 29 (58%) patients and within the normal range in 21 (42%). Mean pre-bronchodilator FEV₁ was lower among patients with elevated IgE than among those with normal IgE (49.2% vs. 63.63% predicted). Serum IgE demonstrated a strong inverse correlation with FEV₁ (r = −0.74, p < 0.001) and positive correlations with absolute eosinophil count (r = 0.64, p < 0.001) and CRP (r = 0.51, p = 0.002). Conclusion: Elevated serum IgE was associated with greater airflow limitation and increased inflammatory activity among patients with COPD. Serum IgE may provide supportive information for identifying patients with an inflammatory phenotype and greater disease burden; however, its clinical utility as an independent marker of COPD severity requires validation in larger prospective studies.

Background: Acute exacerbations of COPD (AECOPD) trigger systemic inflammation and coagulation activation. D-dimer, a fibrin degradation product, may serve as a biomarker of disease severity. This study evaluated the association of serum D-dimer levels with disease severity and hospital stay in AECOPD. Methods: This prospective observational study was conducted at the Department of Respiratory Medicine, People’s College of Medical Sciences & Research Centre, Bhopal, over two years (2023–2026). Fifty AECOPD patients were enrolled. Patients on anticoagulants or with DVT, PE, DIC, CAD, stroke, hematological disorders, autoimmune diseases, and pregnant women were excluded. D-dimer was measured by latex-enhanced immunoturbidimetry (≥500 ng/mL = elevated). Severity was classified as mild, moderate, or severe. Chi-square test was used for associations (p≤0.05 significant). Results: Mean age was 64.61±9.27 years; 76% were male; 58% were current smokers. Elevated D-dimer was found in 42% of patients. Among those with elevated D-dimer, 24% had severe disease vs. 18% with normal D-dimer (χ²=3.511, p=0.172). Patients with elevated D-dimer showed no statistically significant association with hospital stay (χ²=3.195, p=0.362). All 50 patients (100%) were discharged alive. Conclusion: D-dimer was elevated in 42% of AECOPD patients but was not significantly associated with disease severity (p=0.172) or hospital stay (p=0.362) in this cohort. D-dimer should be interpreted within the broader clinical context.

Background: Congenital anomalies are the leading cause of infant mortality. In 40%–60% of cases of malformations, the cause of congenital anomaly is unknown. Genetic factors such as chromosomal abnormalities and mutant genes account for approximately 15% of cases. Chromosomal abnormalities, which may be numerical or structural, are important causes of birth defects Deficiencies in diagnostic capabilities and lack of reliability of medical records and health statistics underestimate the birth prevalence of congenital anomalies in the developing world. The most common serious congenital disorders are congenital heart diseases, neural tube defects, and down syndrome. Objective: To determine the chromosomal abnormalities (structural and numerical) in congenital anomalies of suspected genetic causes, by Karyotyping. Methods: A total of 35 cases of congenital anomalies with suspected genetic abnormalities were studied. Peripheral blood from these cases was collected and fifteen–twenty metaphase spread was examined under trinocular research microscope. Results: In our study, 12 babies had abnormal karyotyping (34.3%) and 23 had normal karyotyping (65.7%). In the study 68.6% had consanguineous marriage and 31.4% had non-consanguineous marriage. Parental consanguinity was significantly associated with an increased risk of congenital anomalies. In the study 57.1% of them were males and 42.9% were females. Among Females, 20% had abnormal karyotyping and among males, 53.3% had abnormal karyotyping. There was significant association between Gender and karyotyping. Abnormal karyotyping was common among males with congenital anomalies. Conclusion: Anomalies were most likely to be in the genitourinary system. Maternal history of parental consanguinity was significantly associated with an increased risk of congenital anomalies. There was significant association between Gender and karyotyping. Abnormal karyotyping was common among males with congenital anomalies. Regular antenatal visits and prenatal diagnosis are recommended for prevention, early intervention and even planned termination, when needed.

Introduction: High-risk pregnancies contributes for significant proportion of maternal and perinatal morbidity and mortality. Early identification of risk factors during antenatal care is essential for preventing adverse feto maternal outcome. The objective of the study was to estimate the prevalence of high risk pregnancy and to classify it into low, moderate and high risk pregnancy among the women in the tertiary care hospital. Methods: A prospective analytical study was conducted in the Department of Obs & Gynae at T.S. Misra Medical College, Lucknow, from January 2025 to December 2025. A total 550 antenatal women were evaluated using the Dutta and Das cumulative antenatal risk scoring system and were categorized as low risk (0–2), moderate risk (3–5), and high risk (≥6). Feto maternal outcomes were analyzed. Results: among 550 participants, 22.7% were low risk, 49.7% moderate risk, and 27.5% high risk. High-risk pregnancies showed significantly higher rates of preterm delivery, operative delivery, NICU admission, and low birth weight. Strong statistical association was found between the associated medical disorder like PIH, Anemia, Thrombocytopenia, IHCP, Multiple pregnancy along with the risk category. Strong statistical associations were also observed between risk category and feto maternal outcomes (p < 0.001). Conclusion: Dutta and Das risk scoring was found to be an effective tool for predicting adverse fetomaternal outcomes in low resource settings. Routine implementation of structured risk scoring assessment during antenatal care can identify high risk pregnancy at earliest, optimize referral, and improve the feto maternal outcomes.

Introduction: Diabetes mellitus (DM) is a metabolic condition characterized by insufficient insulin production or diminished insulin effectiveness, leading to disruptions in carbohydrate, fat, and protein metabolism. Aim: This study aims to evaluate the positive impact of vitamin C on glycemic control and oxidative stress. Materials & Methods: A total of 120 patients with DM were enrolled, and 5 ml of venous blood was drawn from each participant for the assessment of baseline glycemic levels (HbA1c, FBS, and PPBS) and oxidative stress markers (MDA and TAC). The participants were divided into two groups: Group A received Metformin 1000mg + Voglibose 0.2mg/day for 3 months, while Group B received Metformin 1000mg + Voglibose 0.2mg/day + vitamin C 1000mg/day for the same duration. Following the initiation of the study, blood glucose and oxidative stress parameters were measured and compared to baseline values. Results: Both groups showed significant decreases in mean HbA1c, FBS, and PPBS after 3 months of treatment (p<0.05). However, only Group B showed a significant increase in TAC levels and a decrease in MDA levels, unlike Group A. Conclusion: While both groups achieved good glycemic control, only the patients receiving vitamin C alongside antidiabetic medications demonstrated improved oxidative stress management. These findings suggest that the addition of vitamin C to antidiabetic therapy may help mitigate oxidative stress and its related complications.

Background: Pediatric shock is a life-threatening condition characterized by inadequate tissue perfusion leading to organ dysfunction and high mortality. It remains a major cause of death in critically ill children, especially in developing countries where delayed recognition and referral are common.  Objective: To assess the proportion of shock, its clinico-etiological factors and outcome in children. Methods: This hospital-based observational study was conducted in a Pediatric Intensive Care Unit and included 72 children with shock. Among them, 62 presented with shock at admission and 10 developed shock during hospitalization. Result: The mean age was 6.98 ± 4.563 years with slight male predominance. The overall mortality rate was 95.8%. Septic shock was the most common type (83.3%), with severe pneumonia and encephalitis as leading causes. Clinical features such as hypotension, prolonged capillary refill time, altered sensorium, oliguria, and hypoxemia were strongly associated with mortality. Conclusion: Pediatric shock, particularly septic shock, has very high mortality due to late presentation and severe disease.

Background: Type 2 diabetes mellitus (T2DM) and thyroid dysfunction frequently coexist and may share metabolic mechanisms involving insulin resistance, adiposity, and altered thyroid hormone activity. Poor glycemic control and obesity have been associated with a greater frequency of thyroid abnormalities in patients with T2DM. Aim: To evaluate the association of glycemic control and body mass index (BMI) with thyroid dysfunction in patients with newly diagnosed T2DM. Materials and Methods: This cross-sectional observational study included 100 patients with newly diagnosed T2DM at, Farookh Academy of Medical Education Hospital & Research Institute, Mysuru, from May 2025 to May 2026. BMI was categorized as normal, overweight, or obese. Glycemic control was assessed using glycated hemoglobin (HbA1c), and thyroid status was determined by serum thyroid-stimulating hormone (TSH), T3, and T4 levels. Associations were assessed using the chi-square test, and correlation analysis was performed between HbA1c and TSH. A p-value <0.05 was considered statistically significant. Results: Thyroid dysfunction was significantly associated with BMI (χ²=25.481, p=0.001). Obesity was observed in 62.5% of patients with subclinical hypothyroidism and 77.8% with overt hypothyroidism compared with 26.8% of euthyroid patients. Poor glycemic control was also significantly associated with thyroid status (χ²=16.913, p=0.002); HbA1c ≥7% was present in 68.8% of patients with subclinical hypothyroidism and 77.8% with overt hypothyroidism compared with 26.8% of euthyroid patients. Mean HbA1c was higher in subclinical hypothyroidism (8.72±1.61%) and overt hypothyroidism (8.32±1.41%) than in euthyroid patients (7.27±1.17%). HbA1c showed a significant positive correlation with serum TSH (r=0.356, p<0.001). Conclusion: Higher BMI and poor glycemic control were significantly associated with thyroid dysfunction in newly diagnosed T2DM, particularly with subclinical and overt hypothyroidism. The positive correlation between HbA1c and TSH further suggests an interrelationship between glycemic status and thyroid function. Thyroid function assessment may therefore be particularly useful in newly diagnosed T2DM patients with obesity or inadequate glycemic control.

Background: Colorectal Carcinoma is one of the primary gastrointestinal malignancies where histopathological grading and staging are crucial elements in prognosis and treatment planning. This is a retrospective observational study of clinicopathological profile, histological grade and pathological stage of colorectal carcinoma diagnosed at tertiary care centre. Records of 164 patients with biopsy or resection-confirmed colorectal carcinoma from January 2020 to December 2023 were reviewed. The age, sex, presenting symptoms, gross morphology, histological type, grade, lymphovascular invasion, perineural invasion, nodal status and TNM stage were documented. Results: The mean age was 55.8 +/- 13.9 years, and 58.5% were male. Rectum was the commonest site (38.4%) followed by sigmoid colon (24.4%). Conventional adenocarcinoma (81.7 %), mucinous adenocarcinoma (13.4 %) and signet-ring cell carcinoma (3.0 %) were identified. The majority of the tumors were moderately differentiated (61.0%). 118 resection specimens, most (48.3%) were pT3, and nodal metastasis, lymphovascular invasion, and perineural invasion were seen in 56, 38.1%, and 28.8%, respectively. Poor differentiation, positivity of lymphovascular invasion, positivity of perineural invasion and positivity of nodes were significantly associated with advanced stage (stage III/IV) (p<0.001). Conclusion: The present study highlights the significance of a structured histopathological reporting of CRC, especially grade, depth of invasion, adverse morphological features, and nodal yield.

Background: Abnormal uterine bleeding is a frequent clinical presentation in gynecology and endometrial sampling is crucial for the diagnosis of functional, benign, pre-cancerous, and cancerous lesions. Patients and Methods: This is a retrospective observation study to analyze the histopathological spectrum of endometrial lesions in the patients who have presented with AUB. Over three years 420 endometrial biopsy/curettage specimens were reviewed for age, bleeding pattern, menopausal status, endometrial thickness and histopathological diagnosis. Results: The mean age was 43.6 +/- 9.8 years, and the largest group was 41-50 years (44.0%). The most common presentation was heavy menstrual bleeding (47.6%) followed by intermenstrual bleeding (18.1%) and postmenopausal bleeding (15.2%). A normal functional pattern was observed in 222 cases (52.9%) of which 31.4% showed a proliferative pattern. The organic lesions were endometrial hyperplasia without atypia (14.3%), endometrial polyp (8.8%), chronic endometritis (5.7%), atypical hyperplasia/endometrial intraepithelial neoplasia (3.1%) and endometrial carcinoma (3.8%). Increased incidence of pre-malignant and malignant lesions were seen in women of age >50 years and in women with post-menopausal bleeding (p<0.001). Hyperplasia or carcinoma was related to endometrial thickness >=12 mm (p=0.002). Recommendations: This study highlights the importance of histopathological investigation in cases of abnormal uterine bleeding particularly in older women in the perimenopause and post-menopause.

Introduction: Obese patients undergoing general anesthesia are at an increased risk of postoperative respiratory complications due to altered respiratory physiology and residual neuromuscular blockade. Rocuronium is commonly used to facilitate muscle relaxation during lower abdominal surgeries, necessitating effective reversal at the end of the procedure. Neostigmine has traditionally been used for this purpose but is associated with delayed recovery and cholinergic adverse effects. Sugammadex, a selective relaxant-binding agent, has emerged as a rapid and effective alternative for reversing rocuronium-induced neuromuscular blockade. This study compared the efficacy and safety of sugammadex and neostigmine in obese patients undergoing lower abdominal surgeries. Materials and Methods: A prospective, randomized, comparative study was conducted among 100 obese patients (BMI ≥30 kg/m²) aged 18–65 years undergoing elective lower abdominal surgeries under general anesthesia. Participants were randomly allocated into two groups of 50 each. Group S received intravenous sugammadex (2 mg/kg), while Group N received intravenous neostigmine (50 µg/kg) with glycopyrrolate (10 µg/kg) for reversal of moderate rocuronium-induced neuromuscular blockade. The primary outcome was time to achieve a train-of-four (TOF) ratio ≥0.9. Secondary outcomes included extubation time, recovery profile, postoperative complications, hemodynamic parameters, and patient and surgeon satisfaction. Results: Baseline demographic and intraoperative characteristics were comparable between the groups. Sugammadex achieved significantly faster recovery to TOF ratio ≥0.9 (2.6 ± 0.8 vs. 10.4 ± 2.3 minutes; p<0.001), earlier extubation (5.2 ± 1.3 vs. 12.1 ± 2.8 minutes; p<0.001), shorter PACU stay (42.8 ± 8.6 vs. 58.6 ± 10.4 minutes; p<0.001), and higher Modified Aldrete scores at PACU admission (p<0.001). Residual neuromuscular blockade, bradycardia, and excessive salivation occurred significantly less frequently in the sugammadex group. Furthermore, successful reversal within five minutes (92.0% vs. 8.0%) and both patient and surgeon satisfaction scores were significantly higher with sugammadex (all p<0.001). Conclusion: Sugammadex demonstrated superior efficacy and safety compared with neostigmine for reversal of rocuronium-induced neuromuscular blockade in obese patients undergoing lower abdominal surgeries. It provided faster and more predictable neuromuscular recovery, reduced postoperative complications, shortened recovery time, and improved patient and surgeon satisfaction, supporting its preferential use in obese patients undergoing general anesthesia.

Introduction: Ultrasound-guided supraclavicular brachial plexus block is widely used for upper limb orthopedic surgeries because it provides effective intraoperative anesthesia and prolonged postoperative analgesia. Various adjuvants have been combined with ropivacaine to improve block characteristics and extend analgesic duration. Nalbuphine and dexamethasone are among the most commonly investigated adjuvants; however, evidence comparing their relative efficacy remains limited. This study compared nalbuphine and dexamethasone as adjuvants to ropivacaine for ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: This prospective, randomized comparative study included 100 ASA physical status I–II patients aged 18–65 years undergoing elective upper limb orthopedic surgery. Patients were randomly allocated into two equal groups (n=50 each). Group N received 30 mL of 0.5% ropivacaine with nalbuphine, while Group D received 30 mL of 0.5% ropivacaine with dexamethasone. Primary outcomes included onset and duration of sensory and motor blockade and duration of postoperative analgesia. Secondary outcomes comprised postoperative Visual Analog Scale (VAS) scores, rescue analgesic requirement, hemodynamic parameters, Ramsay sedation scores, and adverse effects. Statistical analysis was performed using SPSS version 26.0, with p<0.05 considered statistically significant. Results: Baseline demographic and surgical characteristics were comparable between the groups (p>0.05). Nalbuphine produced a significantly faster onset of sensory and motor blockade (p<0.05). Dexamethasone significantly prolonged sensory block (760.48±82.37 vs. 598.64±74.91 minutes), motor block (650.12±74.65 vs. 505.38±66.82 minutes), and postoperative analgesia (912.68±96.24 vs. 683.54±81.36 minutes) (all p<0.001). Patients receiving dexamethasone demonstrated significantly lower postoperative VAS scores after four hours, delayed first rescue analgesia, reduced 24-hour analgesic consumption, and fewer rescue analgesic requirements (all p<0.01). Hemodynamic parameters remained stable, and adverse effects were infrequent and comparable in both groups. Conclusion: Both nalbuphine and dexamethasone were safe and effective adjuvants to ropivacaine for ultrasound-guided supraclavicular brachial plexus block. Nalbuphine provided a faster onset of blockade, whereas dexamethasone offered significantly prolonged block duration, superior postoperative analgesia, reduced analgesic consumption, and an excellent safety profile, making it the preferred adjuvant for prolonged postoperative pain control.

Introduction: Cervical lymph node status is the single most important prognostic determinant in oral squamous cell carcinoma (OSCC). Elective neck dissection results in overtreatment in a substantial proportion of clinically node-negative patients, whereas sentinel lymph node biopsy (SLNB) using low-cost methylene blue dye offers a feasible, minimally invasive alternative for nodal staging. We prospectively evaluated the diagnostic accuracy of methylene blue dye-only SLNB against formal neck dissection as the reference standard. Methods: This prospective diagnostic accuracy study enrolled 70 consecutive patients with early oral cavity squamous cell carcinoma (T1–T2, cN0) at a tertiary care centre between March 2023 and September 2024. Methylene blue dye (1 mL) was injected peritumorally 15 minutes before incision as the index test; blue-stained nodes were harvested as sentinel lymph nodes (SLNs) and examined by haematoxylin and eosin staining. All patients subsequently underwent at least a supraomohyoid neck dissection, which served as the reference standard applied uniformly regardless of SLNB result. The primary endpoint was the SLN identification rate; secondary endpoints were sensitivity, specificity, PPV, NPV, false-negative rate, and diagnostic accuracy. Reporting follows the STARD 2015 guideline. Results: SLNs were identified in 62 of 70 patients (identification rate 88.6%). In total, 131 SLNs were retrieved, with a mean of 2.1 nodes per patient among the 62 successfully mapped cases (1.9 across all 70 patients). SLN positivity was seen in 12 patients; pathological upstaging from cN0 to pN+ occurred in 20 patients (28.6%). Patient-level sensitivity, specificity, PPV, and NPV were 60%, 100%, 100%, and 86.2%, respectively. Overall diagnostic accuracy was 88.6% with a false-negative rate of 40%. The identification failure rate was 11.4% (95% CI: 6.5–22.5%). Conclusion: Methylene blue dye-only SLNB is technically feasible and highly specific (100%) for nodal staging in early cN0 OSCC, but its 40% false-negative rate precludes standalone use as a decision tool to safely omit neck dissection. Dual-tracer techniques and serial sectioning with immunohistochemistry are recommended to reduce the false-negative burden.

Background: Electrolyte imbalance is a common and potentially life-threatening condition in critically ill patients. Rapid assessment of electrolytes is essential for timely clinical decision-making. ABG analyzers are increasingly used as POCT devices due to their short turnaround time; however, concerns remain regarding their comparability with conventional electrolyte analyzers. This study aimed to compare electrolyte measurements obtained from an ABG analyzer and an electrolyte analyzer using the same heparinized whole blood samples. Methods: A total of 100 arterial blood samples were collected from adult patients admitted to the emergency department and ICU. Samples were collected in lithium-heparinized ABG syringes and analyzed immediately using a Radiometer ABL 90 FLEX ABG analyzer and a Roche 9180 electrolyte analyzer, both based on direct ISE technology. Data were collected and analyzed with the help of Microsoft Excel. Results: The study included 100 participants with a mean age of 53.6 years; 59% were males and 41% were females. The mean sodium concentration measured by the ABG analyzer was significantly higher than that measured by the electrolyte analyzer (133.56 ± 8.91 mmol/L vs. 129.72 ± 8.44 mmol/L; mean difference 3.84 mmol/L, p = 0.002). The maximum observed difference for sodium was 8 mmol/L. Potassium levels showed excellent agreement between the two analyzers (4.13 ± 1.12 mmol/L vs. 4.14 ± 1.16 mmol/L; mean difference 0.01 mmol/L, p = 0.951). Similarly, chloride levels were comparable (96.87 ± 10.38 mmol/L vs. 96.58 ± 8.19 mmol/L; mean difference 0.24 mmol/L, p = 0.827). Most observed differences were within the acceptable limits recommended by the CLIA. Conclusion: Potassium and chloride measurements obtained from the ABG analyzer and electrolyte analyzer demonstrated excellent agreement and can be used interchangeably in clinical practice. Although sodium measurements showed a statistically significant difference, the variation was clinically acceptable in most cases. Therefore, ABG analyzers can serve as reliable point-of-care instruments for rapid electrolyte assessment in emergency and critical care settings. The use of dried heparin syringes may further improve analytical accuracy.

Background: Preterm neonates are highly vulnerable to respiratory, infectious, metabolic, and neurological complications and contribute substantially to neonatal intensive care unit (NICU) morbidity and mortality, particularly at lower gestational ages and birth weights. Objective: To evaluate the clinical profile, indications for admission, mortality patterns, and short-term outcomes of neonates admitted to the NICU, with particular emphasis on prematurity and related risk factors. Methods: This hospital-based cross-sectional observational study was conducted in the NICU of Koppal Institute of Medical Sciences (KIMS), Koppal, Karnataka, India, from 1 December 2025 to 31st December 2025. A total of 218 neonates were included. Results: Of the 218 neonates, 135 (61.93%) were male and 147 (67.4%) were inborn. Preterm neonates accounted for 69 (31.7%) admissions, while 146 (67.0%) were full term. Respiratory distress was the most frequent specified indication for admission, occurring in 42 (19.3%) neonates, followed by perinatal asphyxia in 38 (17.4%) and low birth weight <1800 g in 28 (12.8%). Overall mortality was 34 (15.6%). Mortality was substantially higher among preterm than term neonates, 29.0% versus 8.9%. Mortality reached 66.7% among neonates born at <28 weeks and 76.5% among those born at 28 to <32 weeks. Similarly, mortality was 75.0% among neonates weighing <1000 g and 63.6% among those weighing 1000–1499g. Conclusion: Prematurity, lower gestational age, and low birth weight were strongly associated with adverse neonatal outcomes. Respiratory distress, birth asphyxia, and low birth weight were major causes of NICU admission, while HIE, respiratory distress syndrome, extremely low birth weight, and sepsis were the principal contributors to mortality.

Background: Status epilepticus is a life-threatening pediatric neurological emergency associated with significant mortality and long-term neurological disability. Early prediction of outcome is essential for appropriate management. The Encephalitis, Non-convulsive status epilepticus, Diazepam resistance, Imaging, and Tracheal intubation (END-IT) score is a simple clinical tool designed to predict functional outcomes in patients with status epilepticus. Aim: To evaluate the role of the END-IT score in predicting mortality, neurological morbidity, and duration of hospital stay among children with clinical status epilepticus. Materials and Methods: This prospective observational study included 100 children aged 1 month to 18 years admitted with clinical status epilepticus to the Emergency Department and Pediatric Intensive Care Unit of Indira Gandhi Institute of Child Health, Bengaluru. END-IT scores were calculated at admission and modified after neuroimaging when required. Neurological outcomes were assessed using the Pediatric Overall Performance Category (POPC) score at discharge and three months after discharge. Statistical analysis was performed using SPSS version 25.0, and correlations were evaluated using Pearson’s correlation coefficient. Results: Most patients were infants (36%), and 61% were males. The majority reached the hospital more than two hours after seizure onset. The most common END-IT score was 0 (29%). Hospital stay increased significantly with increasing END-IT score (r=0.547, p<0.001). Significant positive correlations were observed between END-IT score and neurological outcome at discharge (r=0.729, p<0.001) and at three months (r=0.653, p<0.001). Eighty-four percent of children were discharged, 11% died, and 5% were discharged against medical advice. Conclusion: The END-IT score demonstrated excellent prognostic value in predicting mortality, neurological outcome, and duration of hospital stay among children with status epilepticus. Its routine use at admission may facilitate early risk stratification, timely management, efficient resource utilization, and improved counselling of caregivers.

Background: Vitamin D has important immunomodulatory functions and may influence the clinical course of sepsis. The relationship between serum vitamin D levels at admission and outcomes in pediatric sepsis remains incompletely understood. Objective: To determine the association between serum vitamin D status at admission and clinical outcomes in children with sepsis admitted to a tertiary-level Pediatric Intensive Care Unit. Methods: This prospective observational study included 154 children aged 1 month to 18 years admitted with sepsis over an 18-month period. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured within 24 hours of admission and patients were categorized as vitamin D sufficient (≥20 ng/mL), insufficient (12–20 ng/mL), or deficient (<12 ng/mL). Outcomes assessed included duration of hospital stay, duration for normalization of C-reactive protein (CRP), and in-hospital mortality. Statistical analysis was performed using SPSS version 23.0 with one-way ANOVA, logistic regression, and ROC curve analysis. Results: Of the 154 children, 66 (42.9%) had sufficient vitamin D levels, 50 (32.5%) had insufficient levels, and 38 (24.7%) had vitamin D deficiency. Vitamin D-deficient children had significantly longer hospital stay (25.3 ± 29.8 days), delayed CRP normalization (9.4 ± 4.0 days), and higher mortality (55.3%) compared with children with sufficient vitamin D levels (p<0.05). Logistic regression demonstrated significant associations between lower vitamin D levels and prolonged hospitalization and delayed CRP normalization, whereas the association with mortality was not statistically significant after adjustment. ROC analysis identified a vitamin D cut-off value of 9.55 ng/mL for predicting mortality with 81.5% sensitivity (AUC=0.57, p=0.03). Conclusion: Low serum vitamin D levels at admission are associated with prolonged hospitalization and delayed inflammatory recovery in children with sepsis. Serum vitamin D estimation may be a useful adjunctive prognostic marker for early risk assessment in critically ill pediatric patients.

Background: High tibial osteotomy and unicompartmental knee arthroplasty are established surgical options for medial compartment knee osteoarthritis. The present study compared their functional and clinical outcomes. Methods: This prospective comparative study included 100 patients with medial compartment osteoarthritis, divided equally into HTO (n=50) and UKA (n=50) groups. Patients were evaluated using the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS), range of motion (ROM), and postoperative complications over 12 months. Results: Both groups demonstrated significant postoperative improvement. At 12 months, KSS was 86.4 ± 6.8 following HTO and 89.7 ± 6.1 following UKA (p=0.012), while WOMAC scores were 16.9 ± 5.8 and 14.3 ± 5.1, respectively (p=0.019). VAS pain scores were significantly lower following UKA (1.4 ± 0.6 vs 1.7 ± 0.7; p=0.023). HTO demonstrated greater final ROM (126.2° ± 7.8° vs 122.4° ± 7.5°; p=0.015). Overall complication rates were comparable between HTO and UKA (14% vs 12%; p=0.766). Conclusion: Both HTO and UKA are effective for medial compartment knee osteoarthritis. UKA provides better early functional recovery and pain relief, while HTO may offer greater postoperative range of motion. Selection of the procedure should be individualized according to patient characteristics and functional requirements.

Background: Robotic-assisted total knee arthroplasty (TKA) has been introduced to improve surgical precision, component positioning, and limb alignment. This study compared the functional and radiological outcomes of robotic-assisted and conventional TKA. Methods: This prospective comparative study included 140 patients undergoing primary TKA, with 70 patients each in the robotic-assisted and conventional groups. Functional outcomes were assessed using the Knee Society Score (KSS), WOMAC score, Visual Analogue Scale (VAS), and range of motion. Radiological assessment included hip–knee–ankle angle, mechanical-axis deviation, and component alignment. Patients were followed for 12 months. Results: Both groups showed substantial postoperative improvement. Robotic-assisted TKA demonstrated significantly better KSS and WOMAC scores at 3 and 6 months; however, differences at 12 months were not statistically significant. Mechanical-axis alignment within ±3° of neutral was achieved in 94.3% of robotic-assisted and 81.4% of conventional TKAs (p=0.020). Mechanical-axis outliers occurred in 5.7% and 18.6%, respectively (p=0.020). Femoral and tibial component alignment deviations were significantly lower with robotic assistance (p<0.001). Operative time was longer in the robotic group (105.6 ± 15.8 vs 88.4 ± 14.2 minutes; p<0.001), while complication rates were comparable. Conclusion: Robotic-assisted TKA provided superior radiological accuracy and fewer alignment outliers, with modest advantages in early functional recovery. However, both techniques produced comparable functional outcomes at 12 months. Longer-term studies are required to determine whether improved robotic precision translates into superior implant survival and sustained clinical benefit.

Background: Rotator cuff tears are a frequent cause of shoulder pain and functional limitation. Ultrasonography and magnetic resonance imaging are commonly used for their diagnosis. This study compared the diagnostic performance of USG and MRI in patients with suspected rotator cuff tears. Methods: This prospective comparative diagnostic study included 130 patients who underwent both high-resolution USG and MRI of the affected shoulder. Rotator cuff abnormalities were classified as no tear, partial-thickness tear, or full-thickness tear. Arthroscopic findings were available in 80 patients and were used as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and agreement were assessed. Results: Rotator cuff tears were detected in 73.1% of patients by USG and 76.2% by MRI. Overall agreement between USG and MRI was 91.5% (κ=0.87, p<0.001). For any rotator cuff tear, USG demonstrated sensitivity, specificity, and accuracy of 92.5%, 84.6%, and 91.3%, respectively, compared with 96.9%, 92.3%, and 96.3% for MRI. For full-thickness tears, diagnostic accuracy was 95.0% for USG and 97.5% for MRI. MRI showed greater sensitivity for partial-thickness tears (90.9% vs 81.8%). Conclusion: USG and MRI demonstrated high diagnostic performance for rotator cuff tears. USG is a reliable initial imaging modality, particularly for full-thickness tears, whereas MRI provides greater accuracy for partial-thickness tears and more detailed characterization for surgical planning.

Background: Periprosthetic femoral fractures following total hip arthroplasty are challenging injuries requiring treatment according to fracture location, femoral stem stability, and available bone stock. This study evaluated functional and radiological outcomes following their surgical management. Methods: This prospective observational study included 80 patients with periprosthetic femoral fractures following THA. Fractures were classified according to the Vancouver classification and treated using open reduction and internal fixation or revision arthroplasty as appropriate. Patients were followed for a minimum of 12 months. Outcomes included fracture union, time to union, implant stability, Harris Hip Score, ambulatory status, complications, and reoperation. Results: Vancouver B2 fractures were most common (37.5%), followed by B1 (30.0%), C (17.5%), and B3 (15.0%). Overall fracture union was achieved in 93.8% of patients, with a mean union time of 18.2 ± 4.2 weeks. The union rates for B1, B2, B3, and C fractures were 95.8%, 93.3%, 83.3%, and 100%, respectively. The mean Harris Hip Score at 12 months was 81.7 ± 9.8, and 76.3% achieved excellent or good functional outcomes. Nonunion occurred in 6.3%, implant failure in 3.8%, and reoperation in 10.0% of patients. Conclusion: Appropriate surgical management based on Vancouver fracture type, stem stability, and bone stock resulted in high union rates and satisfactory functional recovery. B3 fractures demonstrated comparatively less favorable outcomes because of their greater reconstructive complexity.

Background: Residual deformity and recurrence remain important concerns following treatment of idiopathic clubfoot. This study compared residual deformity, recurrence, and functional outcomes following Ponseti treatment and posteromedial release. Methods: This comparative observational study included 100 patients with idiopathic clubfoot, comprising 50 treated using the Ponseti method and 50 by posteromedial release. Patients were evaluated for residual and recurrent deformity, ankle range of motion, pain, gait, footwear difficulty, functional outcome, satisfaction, and requirement for additional intervention. Results: Residual deformity was significantly less frequent in the Ponseti group than in the posteromedial release group (16.0% vs 36.0%; p=0.023). Recurrence occurred in 18.0% and 38.0%, respectively (p=0.025). Mean ankle dorsiflexion was significantly greater following Ponseti treatment (15.8° vs 8.6°; p<0.001). Pain, abnormal gait, footwear difficulty, and ankle stiffness were significantly more frequent following posteromedial release. Excellent or good functional outcomes were achieved in 90.0% of the Ponseti group compared with 74.0% of the posteromedial release group (p=0.037). Additional surgical procedures were required in 12.0% and 30.0%, respectively (p=0.027). Conclusion: Ponseti treatment was associated with lower residual deformity and recurrence, greater ankle mobility, and better functional outcomes than posteromedial release. Long-term surveillance remains important because recurrence may occur following either treatment.

Background: University students experience high levels of stress, anxiety and depressive symptoms, and physical activity is a plausible low-cost strategy for prevention and symptom reduction. Objective: To synthesize evidence on the impact of physical activity and exercise interventions on mental health outcomes among university students. Methods: A PRISMA-oriented systematic review framework was applied to systematic reviews, meta-analyses, randomized trials and observational studies evaluating physical activity exposure or intervention in university students. Results: Evidence supports an inverse association between physical activity and depressive symptoms and suggests that structured exercise interventions reduce anxiety, depression and stress. Recent meta-analyses in university students show beneficial pooled effects, but heterogeneity is substantial because interventions vary by modality, supervision, duration, intensity and baseline symptom severity. The most consistent benefits are reported for moderate-intensity aerobic exercise, yoga, mind-body exercise, group-based exercise and multimodal programs. Conclusion: Physical activity is a clinically practical adjunct for student mental health promotion, but it should complement rather than replace psychological or psychiatric care for moderate to severe symptoms. Keywords: Physical activity; exercise; university students; mental health; depression; anxiety; stress; wellbeing; systematic review; meta-analysis.

Background: CAP continues to be a leading cause of hospitalisation and mortality and the microbial composition and susceptibility to antimicrobials are highly variable across geographical regions and local antibiotic pressure. Objective: To describe the clinical characteristics, microbiological spectrum and antimicrobial susceptibility patterns of adults admitted to hospital with CAP and to explore the association between these and severity of illness. Methods: This was a prospective observational study of 180 adults with clinical and radiographic CAP in a tertiary-care teaching hospital. Demographic data, symptoms, comorbidities, CURB-65 severity, laboratory and radiographic data, microbiological data, antimicrobial susceptibility, treatment course and outcomes were documented. Selected antigen and molecular tests were added to conventional cultures. Results: The mean age was 56.8 ± 17.1 years and 112 (62.2%) participants were male. Common comorbidities included hypertension (39.4%), diabetes mellitus (34.4%) and chronic obstructive pulmonary disease (26.7%). In 104 (57.8%) patients, a microbiological etiology was found. A total of 92 isolates were obtained from 88 patients, with Klebsiella pneumoniae (26.1% of isolates) and Streptococcus pneumoniae (23.9%) being the most common, followed by Haemophilus influenzae (14.1%) and Pseudomonas aeruginosa (10.9%). Extended-spectrum beta-lactamase production was found in 45.8% of K. pneumoniae and 95.5% of S. pneumoniae isolates, while only 68.2% of S. pneumoniae isolates were susceptible to azithromycin. MDROs were found in 27 (15.0%) patients, and were more common in severe CAP than non-severe CAP (36.7% vs 10.7%, p=0.001). Severe CAP was also associated with longer hospitalization (10.8 ± 4.7 vs 6.1 ± 2.8 days, p<0.001), greater ICU admission (60.0% vs 4.0%, p<0.001), and higher in-hospital mortality (26.7% vs 2.0%, p<0.001). Conclusions: CAP in hospitalized adults had a mixed spectrum of pneumococcal and Gram-negative bacteria, and clinically important resistance was seen, particularly with K. pneumoniae. Empiric therapy depends on local microbiological surveillance and susceptibility.

Background: Hepatic cholesterol synthesis, lipoprotein clearance and turnover of triglycerides are regulated by thyroid hormones and mild thyroid dysfunction might be a contributing factor to atherogenic dyslipidemia. To evaluate the relationship between thyroid function tests and lipid profile in adult patients of a tertiary care hospital. Materials and Methods: This was a cross-sectional study of 210 adults who were subjected to thyroid function test and fasting lipid estimation in a hospital setting. The participants were divided into three groups: euthyroid (n=139), subclinical hypothyroid (n=48), and overt hypothyroid (n=23), according to their serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4). The serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were compared among thyroid categories. Correlation and multivariable linear regression analyses were performed. Results: Mean age was 43.6±12.4 years and 61.0% were women. The mean TSH level was 181.2±30.1 mg/dL in euthyroid subjects, 208.6±34.8 mg/dL in subclinical hypothyroidism and 235.7±44.6 mg/dL in overt hypothyroidism (p<0.001). Corresponding LDL-C values were 108.4±27.7, 132.5±29.6, and 155.9±38.3 mg/dL (p<0.001). TSH correlated positively with TC (r=0.41), LDL-C (r=0.46), and TG (r=0.30), and negatively with HDL-C (r=-0.24) (all p≤0.001). TSH was still independently associated with LDL-C (standardized β=0.34, p<0.001) after adjustment for age, sex and BMI. Dyslipidemia was present in 43.2%, 70.8%, and 87.0% of the three groups, respectively (p<0.001). Conclusions: As biochemical severity of hypothyroidism increased, lipid parameters worsened, especially LDL-C, suggesting that thyroid status evaluation may be clinically helpful in adults with unexplained or refractory dyslipidemia.

Background: Neonatal sepsis is a major cause of neonatal morbidity and mortality, particularly in developing countries, where delayed diagnosis contributes significantly to adverse outcomes. Clinical manifestations are often subtle and nonspecific, making early diagnosis challenging. Although blood culture remains the gold standard for diagnosis, its delayed turnaround time and low sensitivity limit its utility in emergency settings. The Hematological Scoring System (HSS) proposed by Rodwell et al. provides a rapid, economical, and bedside diagnostic approach for early detection of neonatal sepsis. Objective: The present study was conducted to evaluate the significance of HSS in the early diagnosis of neonatal sepsis and to compare hematological parameters with blood culture findings. Material and Methods: This cross-sectional study was conducted in the Department of Pathology, Shyam Shah Medical College, Rewa, over a period of 12 months. A total of 115 neonates clinically suspected of sepsis were included. Blood samples were collected under aseptic precautions for complete blood count, peripheral smear examination, and blood culture. Hematological parameters assessed included Total Leukocyte Count (TLC), Absolute Neutrophil Count (ANC), Immature-to-Total neutrophil ratio (I:T ratio), degenerative changes in neutrophils, platelet count, nucleated red blood cells (NRBCs), and Mean Platelet Volume (MPV). Hematological scoring was interpreted as: score ≤2 – sepsis unlikely, score 3–4 – probable sepsis, and score ≥5 – sepsis very likely. Results: Previous studies reviewed in the present work demonstrated high diagnostic utility of HSS. Baruwal S et al. reported sensitivity, specificity, and diagnostic accuracy of 90.48%, 96.83%, and 95.91%, respectively, using a modified HSS cutoff score ≥4. Degenerative changes in neutrophils showed the highest sensitivity (95.23%), while NRBCs demonstrated an accuracy of 91.15%. Elsayed MS et al. reported sensitivity and specificity of 96% and 90%, respectively, for HSS in neonatal sepsis. Elevated I:T ratio (>0.12), thrombocytopenia, neutropenia, increased MPV (>9.5 fL), and presence of toxic granules or Döhle bodies were among the most significant hematological abnormalities associated with culture-positive neonatal sepsis. Conclusion: The Hematological Scoring System is a rapid, reliable, and cost-effective screening tool for early diagnosis of neonatal sepsis. Incorporation of additional parameters such as NRBCs and MPV further improves diagnostic accuracy and aids timely initiation of therapy, especially in resource-limited settings.

Background: The term “Stress” as used in biology refers to any change in the environment that changes or threatens to change an existing optimal steady state. IT professionals are exposed to higher professional stress. Pharmacological treatments for stress carry risk of dependence and adverse effects. Limited studies have been done on Sudarshan Kriya yoga for improving stress levels in IT professionals; hence this study is performed to evaluate the effect of yoga on stress in healthy young adults. Objective: To evaluate the effect of Sudarshan Kriya yoga on stress scores in IT Professionals. Materials and Methods: Study is an interventional study performed on 60 healthy young IT professionals aged 21-30 years; study was conducted from Bangalore Medical College and Research Institute from December 2018- December 2020. Subjects practiced Sudarshan Kriyaat the yoga centre, the yoga was performed for 30 minutes daily on an empty stomach or 4 hours after food for a period of 12 weeks. A professional life stress scale was administered to assess stress level. Data were expressed as mean ± SD.  A paired t-test was used for data analysis. P-value < 0.001 was considered significant. Results: After 12 weeks of  Sudarshan Kriya yoga practice, the professional life stress score decreased significantly from 20.58±4.49  to  15.30±2.8  (p<0.001) indicating improved stress tolerance. Conclusion: 12 weeks of Sudarshan Kriya yoga practice significantly reduced stress levels in young IT professionals. Yoga may be recommended as a safe, non-pharmacological intervention for occupational stress issues in young adults.

Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, forming a complex cardiorenal syndrome associated with increased morbidity, mortality, and healthcare utilization. Iron deficiency, affecting nearly half of patients with chronic HF and an even greater proportion of those with concomitant CKD, has emerged as an independent determinant of reduced functional capacity, impaired quality of life, recurrent hospitalization, and adverse cardiovascular outcomes. The pathophysiology of iron deficiency in this population extends beyond nutritional depletion and is characterized by chronic inflammation, elevated hepcidin concentrations, impaired intestinal iron absorption, reduced iron mobilization, and altered erythropoiesis. Consequently, conventional oral iron therapy often demonstrates limited efficacy, whereas intravenous iron formulations have shown promising clinical benefits. This systematic review synthesizes current evidence regarding the efficacy, safety, and clinical outcomes of iron supplementation in patients with HF and CKD. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and Google Scholar identified studies evaluating iron supplementation in adult patients with concomitant HF and CKD. Randomized controlled trials, observational studies, systematic reviews, and meta-analyses reporting cardiovascular, renal, hematological, functional, or quality-of-life outcomes were included. The available evidence consistently demonstrates that intravenous iron, particularly ferric carboxymaltose and ferric derisomaltose, improves exercise tolerance, New York Heart Association functional class, six-minute walk distance, health-related quality of life, and iron indices while reducing HF-related hospitalizations. Oral iron supplementation showed limited therapeutic benefit because of impaired gastrointestinal absorption and inflammation-mediated iron sequestration. Although improvements in all-cause mortality remain inconclusive, contemporary evidence supports intravenous iron as an important adjunctive therapy in appropriately selected patients with HF and CKD. Current international guidelines increasingly recommend routine screening for iron deficiency and individualized iron replacement strategies in patients with chronic HF. Future large-scale studies with longer follow-up are needed to determine optimal treatment protocols, evaluate long-term renal outcomes, compare intravenous iron formulations directly, and identify patient subgroups most likely to benefit from therapy.

Background: Laryngoscopy and endotracheal intubation cause sympathetic stimulation resulting in tachycardia and hypertension. Dexmedetomidine and fentanyl are commonly used to attenuate these responses. Methods: This prospective randomized comparative study included 100 ASA I–II patients undergoing elective surgery under general anesthesia. Patients were divided into Group D (n=50), receiving dexmedetomidine 1 µg/kg, and Group F (n=50), receiving fentanyl 2 µg/kg. Heart rate and mean arterial pressure were recorded at baseline and at predefined intervals before and after intubation. Results: Immediately after intubation, mean heart rate was significantly lower in Group D than Group F (82.4 ± 8.2 vs. 94.7 ± 9.1 beats/min; p<0.001). Mean arterial pressure was also significantly lower (98.4 ± 7.7 vs. 110.8 ± 9.2 mmHg; p<0.001). Tachycardia and hypertension occurred significantly less frequently with dexmedetomidine. Bradycardia and hypotension were slightly more frequent with dexmedetomidine but did not differ significantly between groups. Conclusion: Dexmedetomidine was more effective than fentanyl in attenuating the heart rate and blood pressure responses to laryngoscopy and endotracheal intubation, with acceptable hemodynamic safety.

Background: The thumb is essential for opposition, precision pinch, grasp and fine manipulation. Its importance has also been appreciated in ancient Indian literature; in the Mahabharata, Guru Dronacharya asked Eklavya to offer his right thumb as guru dakshina, reflecting the long-recognised importance of the thumb in skilled hand function. Thumb-tip injuries can therefore result in significant functional impairment because loss of pulp tissue affects both mechanical stability and tactile sensibility. Reconstruction should provide durable soft-tissue coverage while preserving thumb length, mobility, sensation and appearance. The Moberg advancement flap is a useful local reconstructive option for selected distal thumb defects because it provides sensate tissue from the thumb itself and avoids a distant donor site. Aim: To evaluate the functional and sensory outcomes following Moberg flap reconstruction in patients with traumatic thumb-tip injuries. Methods: A prospective observational study was conducted from April 2024 to March 2026. Forty patients with traumatic thumb-tip defects suitable for Moberg flap reconstruction were included. Demographic and injury characteristics were recorded. All patients underwent Moberg advancement flap reconstruction. Postoperative assessment included flap survival, static two-point discrimination, thumb interphalangeal joint range of motion, grip strength, pinch strength, QuickDASH score, postoperative complications and patient satisfaction. Patients were followed clinically at scheduled postoperative visits. Data were analysed using descriptive statistical methods and appropriate comparative tests where applicable. Results: Forty patients were included, with a mean age of 37.8 ± 12.4 years. There were 34 males and 6 females. The right thumb was involved in 25 patients and the left thumb in 15. Crush injury was the most frequent mechanism, followed by injuries sustained during sickle use. The mean defect size was 1.6 ± 0.4 cm. Primary coverage without additional bony shortening was achieved in 33 patients, while 7 required limited bony shortening. Complete flap survival was achieved in 39 patients (97.5%), while partial marginal necrosis occurred in 1 patient (2.5%). No complete flap loss was observed. At final follow-up, mean static two-point discrimination was 6.2 ± 1.3 mm. Normal or near-normal protective sensibility was achieved in 31 patients (77.5%). The mean interphalangeal joint flexion was 53.5 ± 8.6°, with a mean extension deficit of 3.1 ± 4.2°. Mean grip strength was 31.8 ± 6.7 kg and mean pinch strength was 6.8 ± 1.5 kg. The mean QuickDASH score was 12.8 ± 8.7. Cold intolerance was reported by 9 patients (22.5%), while hypersensitivity was observed in 5 patients (12.5%). Overall, 24 patients (60.0%) reported being satisfied or very satisfied with the reconstruction. Conclusion: Moberg flap reconstruction provided reliable soft-tissue coverage with high flap survival and satisfactory sensory and functional recovery in patients with selected thumb-tip injuries. The ability to provide sensate tissue while preserving thumb length and avoiding a distant donor site makes the Moberg flap a useful reconstructive option for appropriately selected distal thumb defects.

Background: Subclinical hypothyroidism (SH) in neonates is increasingly identified via expanded newborn screening programs; however, its natural trajectory and precise clinical significance remain under active investigation. Early detection is critical because persistent hyperthyrotropinemia can adversely affect neurodevelopmental outcomes if left unmanaged. Objective: To evaluate the prevalence of neonatal subclinical hypothyroidism, determine the proportion of neonates exhibiting persistent thyroid-stimulating hormone (TSH) elevation requiring levothyroxine therapy, and analyze potential associations between maternal thyroid disorders and neonatal SH. Methods: A prospective observational investigation was conducted in the postnatal care unit of a major tertiary care teaching hospital over a four-month period (June to September 2025). Inborn neonates meeting inclusion criteria with informed parental consent were enrolled. Venous blood samples were collected after 72 hours of life and analyzed for TSH using chemiluminescence immunoassay (CLIA). Infants with TSH concentrations between 6–20 mIU/L underwent systematic follow-up and repeat testing at 14 days of life. Comprehensive maternal and neonatal clinical variables were recorded and analyzed. Results: Among 218 eligible neonates screened, 58 (26.6%) were diagnosed with subclinical hypothyroidism, while 160 (73.4%) demonstrated normal thyroid function profiles. Upon serial follow-up, 22 out of 58 neonates (37.9%) exhibited persistently elevated TSH levels, 32 (55.2%) showed complete biochemical normalization, and 4 (6.9%) were lost to follow-up. Seven neonates ultimately met criteria and were initiated on levothyroxine replacement therapy. Among evaluated maternal comorbidities, maternal hypothyroidism demonstrated a statistically significant association with neonatal SH (χ² = 5.16, p = 0.02). Conclusion: Neonatal subclinical hypothyroidism is notably prevalent and frequently persists in a substantial subset of infants, necessitating structured therapeutic intervention. Serial biochemical surveillance is indispensable, particularly among neonates born to hypothyroid mothers.

Background: Renal artery stenosis (RAS) is a significant cause of secondary hypertension and progressive renal impairment. Non-invasive screening modalities are essential for early detection, particularly in patients with contraindications to contrast agents. Objective: To compare the diagnostic performance of Doppler ultrasonography (USG) and non-contrast MR angiography (NC-MRA) for detecting RAS, using digital subtraction angiography (DSA) as the gold standard. Methods: This prospective observational study included 60 patients (32 males, 28 females; mean age 43.40±15.74 years) with clinical suspicion of renovascular hypertension. All patients underwent Doppler USG, NC-MRA on a 3.0 Tesla system, and DSA. Significant stenosis was defined as ≥60% luminal narrowing. Sensitivity, specificity, predictive values, accuracy, and Cohen’s Kappa were calculated. Results: DSA confirmed significant stenosis in 73.3% of right and 48.3% of left renal arteries. For the right renal artery, Doppler USG showed sensitivity of 62.50%, specificity of 83.33%, and accuracy of 66.67% (κ=0.305, fair), while NC-MRA demonstrated superior sensitivity (83.33%), accuracy (80.00%), and moderate agreement (κ=0.444). For the left renal artery, both modalities performed excellently with sensitivity of 82.76%, specificity of 100%, accuracy of 91.67%, and κ=0.832 (excellent). At patient level, NC-MRA showed higher sensitivity (81.48% vs 74.07%) and accuracy (76.67% vs 70.00%). Conclusion: NC-MRA provides more consistent diagnostic performance across both renal arteries, particularly for right-sided disease where Doppler USG has limited sensitivity. Doppler USG remains valuable for left renal artery evaluation and as a first-line screening tool in resource-limited settings.

Background: Cleft lip and palate surgeries require optimal anaesthetic management to ensure adequate surgical conditions, hemodynamic stability, and rapid postoperative recovery. While fentanyl and sevoflurane are widely used for paediatric anaesthesia, the role of atracurium as an adjunct for muscle relaxation remains a subject of interest. Aim: To compare the efficacy and safety of fentanyl–sevoflurane anaesthesia with fentanyl–sevoflurane–atracurium anaesthesia in patients undergoing cleft lip and palate surgeries. Material and methods: This prospective comparative study included patients undergoing elective cleft lip and palate repair under general anaesthesia. Patients were allocated into 2 groups: Group FS received fentanyl and sevoflurane, while Group FSA received fentanyl, sevoflurane, and atracurium. Hemodynamic parameters, intubation conditions, surgical field quality, recovery characteristics, post extubation NBM time, and postoperative complications were evaluated. Results: Group FS demonstrated significantly better extubation time, recovery score, post extubation NBM time compared with Group FSA. Hemodynamic parameters remained comparable between groups. Intubation conditions and surgical field quality were comparable. No major perioperative complications were observed in either group. Conclusion: The addition of atracurium to fentanyl–sevoflurane anaesthesia provides superior operating conditions and airway management during cleft lip and palate surgery, although recovery and extubation time may be slightly prolonged. Both techniques were safe and effective.

Background: Diabetic foot ulcers cause infection, delayed healing, prolonged hospitalization, limb loss, and treatment expenditure. Topical ozone gas therapy and vacuum-assisted closure (VAC) are adjunctive modalities, but comparative evidence remains limited. Objectives: To compare ozone therapy and VAC for wound healing, granulation tissue formation, hospital stay, safety, healing outcome, and treatment cost. Materials and Methods: This randomized controlled trial included 30 adults with type 1 or type 2 diabetes mellitus and Wagner grade 2, grade 3, or post-debridement grade 4 ulcers. Participants were randomly allocated to ozone therapy or VAC, with 15 patients in each group. All received debridement, glycaemic control, infection management, and care. Continuous variables were analysed using the independent-samples t-test, with Welch’s correction where required, and categorical variables using the chi-square test. Results: Mean wound-area reduction was greater with ozone than VAC (0.83 ± 0.18 versus 0.33 ± 0.13 cm²), with percentage reductions of 17.36 ± 6.16% and 6.45 ± 3.56%, respectively (both p<0.001). Healthy granulation occurred in 66.7% versus 40.0% (p=0.143). Hospital stay was shorter with ozone (7.00 ± 0.85 versus 11.8 ± 2.62 days; p<0.001). Bleeding and skin irritation were less frequent with ozone. Complete healing occurred in 40.0% of VAC-treated patients and none receiving ozone (p=0.006). Total cost was ₹7,140 ± 755 with ozone and ₹16,000 ± 0 with VAC (p<0.001). Conclusion: Ozone therapy achieved greater wound reduction, fewer adverse effects, shorter hospitalization, and lower cost, whereas VAC produced a higher complete-healing rate.

Background: Oral squamous cell carcinoma is frequently diagnosed at an advanced stage, creating a need for reliable, non-invasive biomarkers capable of identifying malignant transformation and reflecting disease severity. Salivary interleukin-8 (IL-8) and lactate dehydrogenase (LDH) may indicate tumour-associated inflammation, cellular injury, and metabolic activity. Objectives: To compare salivary IL-8 and LDH levels among healthy individuals, patients with oral potentially malignant disorders (OPMD), and patients with oral squamous cell carcinoma (OSCC); evaluate their diagnostic accuracy; and assess their correlation with TNM stage. Materials and Methods: This prospective observational analytical study included 75 participants divided equally into healthy, OPMD, and OSCC groups. Sociodemographic, clinical, habit-related, and histopathological data were recorded. Standardized saliva samples were analysed for IL-8 and LDH using enzyme-linked immunosorbent assay. Statistical analysis included Chi-square test, Welch’s one-way ANOVA, receiver operating characteristic curve analysis, and Spearman correlation. Results: Mean salivary IL-8 levels increased from 15.4 ± 4.38 pg/mL in healthy participants to 52.1 ± 14.86 pg/mL in OPMD and 161.1 ± 42.06 pg/mL in OSCC. Corresponding LDH levels were 200 ± 25.6, 304 ± 56.8, and 519 ± 88.2 U/L, respectively (p<0.001). The combination of biomarkers showed 94% sensitivity, 90% specificity and AUC of 0.94. IL-8 and LDH were highly correlated with TNM stage (ρ=0.72 and ρ=0.75; p<0.001). Conclusion: Salivary IL-8 and LDH are promising non-invasive adjunctive biomarkers for detection of oral malignancy, for differentiating OPMD from OSCC and for monitoring disease progression.

Background: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. Oxidative stress and inflammation are central to its pathogenesis, and serum ferritin—an acute-phase iron-storage protein—may reflect these processes. This study estimated serum ferritin in preeclamptic women and compared it with normotensive pregnant women. Methods: An analytical cross-sectional study was conducted over one year (September 2023–September 2024) in the Department of Biochemistry in collaboration with the Department of Obstetrics & Gynaecology, Government General Hospital, Kurnool. Using stratified random sampling, 120 pregnant women (>20 weeks gestation, 19–35 years) were enrolled—60 preeclamptic cases and 60 normotensive controls. Serum ferritin was measured by a solid-phase, two-site immunoenzymatic assay. Groups were compared using the independent samples t-test; correlation with blood pressure was assessed by Pearson’s coefficient. Results: Mean serum ferritin was markedly higher in preeclamptic women (107.0 ± 51.7 ng/mL) than in controls (17.9 ± 12.4 ng/mL); the difference was highly significant (t = −12.9, df = 118, p < 0.001). Elevated ferritin was seen in 12.4% of cases and in none of the controls, while 48.3% of controls had low ferritin versus only 3.33% of cases. Serum ferritin correlated positively with systolic blood pressure (r = 0.758, p < 0.001). Conclusion: Serum ferritin is significantly elevated in preeclampsia and correlates with blood pressure severity, supporting its potential role as an inflammatory/oxidative-stress biomarker for risk stratification. Population-specific cut-offs and larger prospective studies are warranted.

Background: Adjuvant intrathecal opioids improve the quality and duration of subarachnoid block. Ropivacaine, a pure S-enantiomer amide local anaesthetic, is proposed to provide comparable analgesia with reduced motor blockade relative to bupivacaine, a property of value in lower abdominal and lower limb surgery where early mobilisation is desirable. Aim: To compare the sensory and motor block characteristics, duration of postoperative analgesia, haemodynamic stability and adverse-effect profile of intrathecal 0.5% isobaric ropivacaine with fentanyl versus 0.5% hyperbaric bupivacaine with fentanyl. Methods: In this prospective, randomised, single-blind comparative trial, 60 ASA I–II patients undergoing elective lower abdominal and lower limb surgery were allocated to Group B (bupivacaine 0.5% + fentanyl 25 µg, n = 30) or Group R (ropivacaine 0.5% + fentanyl 25 µg, n = 30). Onset and duration of sensory and motor block, duration of analgesia, haemodynamic parameters and adverse events were recorded and analysed using the independent-samples t-test and Chi-square test (p < 0.05 significant). Results: Sensory and motor block onset were significantly faster in Group B (p < 0.001). Group B produced a longer duration of sensory block (198 ± 22 vs 176 ± 20 min), motor block (212 ± 25 vs 168 ± 22 min) and analgesia (268 ± 30 vs 244 ± 28 min). Group R showed greater haemodynamic stability with fewer episodes of hypotension and bradycardia. The groups were demographically comparable. Conclusion: Ropivacaine with fentanyl provides effective surgical anaesthesia with shorter motor blockade, faster motor recovery and greater haemodynamic stability, making it a favourable alternative to bupivacaine with fentanyl, particularly where early ambulation is advantageous.

Introduction: India is greying, it is ageing and with it, so are the people. Skin diseases being visually unpleasant not only affect the physical but also, mental health of the patients. Indian literature in this background is limited therefore, this study is being conducted to identify common cutaneous dermatoses in this age group and assess the effect they have on quality of life. Objective: The aim of this study is to discover the most prevalent geriatric dermatoses, its pattern and frequency, various clinicodemographic factors and the effect these cutaneous dermatoses have on the quality of life. Methods: 240 patients aged 65 years and above presenting to the Dermatology OPD from 1st January 2021 to 30th June 2022 were recruited. Details were collected regarding various clinicodemographic factors, their primary dermatological complaint and co-morbidities. Then a self-assessing Dermatology Life Quality Index (DLQI) was administered to evaluate the effect of these cutaneous dermatoses on the patient’s quality of life. Results: Out of 240 patients, males (55%) predominated in our study. 81.66% of patients were retired, 69.58% were married, 22.5% were educated and 63.75% lived in urban settings. Infections were the commonest dermatoses (26.66%) and 57.91% reported a small effect on their quality of life. Conclusion: Cutaneous dermatoses can have a significant impact on the quality of life of the geriatric population. These conditions are not only physically discomforting but emotionally distracting too as well. Health policies must be created and put into place to address the needs and worries of this community.

Background: Different types of videolaryngoscopes may result in different performance and success of tracheal intubation. This study investigates the intubation performance of nonchanneled Kingvision vs non channeled Hugemed videolaryngoscope. Aims: To compare the time to successful intubation of nonchanneled King vision vs non channeled Hugemed videolaryngoscopes. Materials and Methods: Sixty subjects aged 18-60 years, American Society of Anesthesiologists (ASA) class I and II undergoing elective surgeries under general anaesthesia were randomly assigned into two groups of 30 each. Following standard premedication and induction, the patients were intubated using nonchanneled Kingvision or non-channeled Hugemed videolagyngoscope by skilled anesthesiologists familiar with the videolaryngoscopic intubation technique. The intubation time, visualization of the glottis, percentage of glottic opening (POGO) scoring was determined. The degree of difficulty of intubation using a five point Likert scale and the number of intubation attempts were assessed. Statistical analysis was performed using appropriate tests with p value < 0.05 considered significant. Results: Intubation time was significantly shorter with Hugemed 20.5 ± 7 vs Kingvision 32.7 ± 7.6s (p<0.001). The time from laryngoscope insertion to glottis recognition with the Kingvision was 6.5 ± 1.6s as compared to Hugemed with 15.7 ± 6.7s (p<0.001). The ease of intubation grading, glottis view grading, number of intubation attempts were comparable between the groups. Conclusion: The time for tracheal intubation was shorter with non-channeled Hugemed Videolaryngoscope compared to non-channeled Kingvision videolaryngoscope whereas Glottic recognition time was shorter with Kingvision videolaryngoscope. POGO score, Likert scale and intubation parameters were comparable between the two devices.

Background: Safe drinking water is essential in healthcare facilities because contaminated water may contribute to water-borne infections and healthcare-associated infections. Microbiological surveillance of hospital drinking water sources helps identify faecal contamination and guides corrective measures. Aim: To assess the bacteriological quality of drinking water in a tertiary care hospital of North India. Materials and Methods: This hospital-based bacteriological survey was conducted from 1 January 2024 to 31 December 2024. A total of 324 drinking water samples were collected from nine drinking water sites. Samples were collected aseptically in sterile screw-capped bottles, transported immediately to the microbiology laboratory and tested for presumptive coliform count by the multiple tube culture method using MacConkey purple broth with single-strength and double-strength media. The tubes were incubated at 37°C for 48 hours. Tubes showing colour change were further processed for organism identification as per standard microbiological protocol. Water quality was categorised using the most probable number table. Results: Out of 324 drinking water samples, 249 (76.9%) were categorised as excellent, 15 (4.6%) as satisfactory, 27 (8.3%) as intermediate and 33 (10.2%) as unsatisfactory. Escherichia coli was the most common organism isolated, detected in 48 (14.8%) samples, followed by Pseudomonas species in 21 (6.5%) samples and Klebsiella species in 6 (1.9%) samples.. The maximum reported most probable number was 161. Conclusion: Most drinking water samples were categorised as excellent; however, the detection of intermediate and unsatisfactory samples, along with isolation of E. coli, Pseudomonas species and Klebsiella species, indicates the need for periodic microbiological surveillance of hospital drinking water. Regular monitoring, timely corrective measures and maintenance of water-distribution systems are necessary to reduce the risk of water-borne healthcare-associated infections.

Background: Anaemia remains a major nutritional problem among women of reproductive age in India. This study assessed the prevalence of anaemia and its dietary, socioeconomic, and reproductive determinants among women attending a tertiary care hospital in Jodhpur, Rajasthan. Methods: A hospital-based cross-sectional study was conducted during 2024–2025 among 400 women aged 15–49 years. Haemoglobin concentration, anthropometric measurements, dietary practices, socioeconomic characteristics, and reproductive factors were assessed. Associations with anaemia were evaluated using appropriate statistical tests and multivariable logistic regression. Results: The overall prevalence of anaemia was 56.0%, comprising 22.8% mild, 29.5% moderate, and 3.8% severe anaemia. Anaemia was significantly associated with lower education, lower socioeconomic status, underweight, higher parity, heavy menstrual bleeding, inadequate dietary diversity, low consumption of iron-rich foods, and tea/coffee consumption near meals. Heavy menstrual bleeding was the strongest independent predictor (AOR 2.64; 95% CI: 1.52–4.58), followed by inadequate dietary diversity (AOR 2.21; 95% CI: 1.39–3.51) and underweight status (AOR 2.18; 95% CI: 1.31–3.63). Regular iron-folic acid supplementation showed a protective association (AOR 0.52; 95% CI: 0.32–0.84). Conclusion: Anaemia affected more than half of the women studied and was associated with modifiable nutritional, socioeconomic, and reproductive factors. Dietary improvement, iron-folic acid supplementation, nutritional education, and identification of chronic blood loss may help reduce the burden.

Background: Acute pancreatitis (AP) is usually self-limiting, but approximately 25% of patients develop a severe form associated with mortality of up to 50%. The neutrophil-lymphocyte ratio (NLR), a simple and inexpensive measure of the systemic inflammatory response, may help identify patients at risk of severe disease earlier and more reliably than the total white cell count. Objectives: To evaluate the usefulness of the NLR in predicting outcome in patients with acute pancreatitis, and to determine optimal NLR cut-off values for distinguishing mild (MAP) from severe acute pancreatitis (SAP) at admission, 24 hours, and 48 hours. Methods: This prospective observational study was conducted in the Departments of General Medicine and General Surgery, Subbaiah Medical College, Shimoga, between November 2023 and June 2025, and included 50 consecutive in patients with acute pancreatitis. Patients were classified as MAP or SAP using the APACHE II score. Neutrophil and lymphocyte counts, and the NLR, were recorded at baseline, 24 hours, and 48 hours. Receiver operating characteristic (ROC) curve analysis was used to determine optimal NLR cut-offs and diagnostic performance at each time point. Results: Of 50 patients, 31 (62%) had MAP and 19 (38%) had SAP. Alcohol was the commonest aetiology (52%), followed by gallstones (24%). The mean NLR was higher in the SAP group than the MAP group at every time point, and the between-group difference was statistically significant at 48 hours (SAP 4.21 ± 1.11 vs MAP 3.00 ± 0.96, p < 0.001). An NLR cut-off of 3.45 at 48 hours predicted severe disease with a sensitivity of 68.4% and specificity of 71.0% (AUROC 0.80, 95% CI 0.69–0.92, p < 0.001) — performance that was superior to the NLR at baseline (cut-off 7.65) or 24 hours (cut-off 5.62, AUROC 0.53, 95% CI 0.37–0.70, not significant). Total leucocyte count, haematocrit, serum calcium, SGOT, GGT, amylase, lipase, and random blood sugar also differed significantly between MAP and SAP (p < 0.05). Conclusion: The NLR, particularly when measured at 48 hours, is a simple, inexpensive, and readily available marker that can help identify patients with acute pancreatitis who are likely to follow a severe clinical course, supporting its use alongside established prognostic scoring systems.