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.

Background: Degenerative hip diseases cause progressive pain, restriction of movement, and functional disability. Total hip arthroplasty (THA) is an established surgical treatment for advanced disease and aims to relieve pain and restore hip function. Objectives: To evaluate the functional outcome of primary total hip arthroplasty in patients with degenerative hip diseases and to assess postoperative complications. Materials and Methods: This prospective interventional study included 20 patients with degenerative hip diseases undergoing primary THA at S Nijalingappa Medical College, Bagalkot. Patients underwent either uncemented or hybrid THA and were followed at 6 weeks, 3 months, and 6 months. Functional outcome was assessed using range of motion and the Harris Hip Score (HHS). Postoperative complications were also recorded. Data were analyzed using SPSS version 19.0, with p<0.05 considered statistically significant. Results: Twelve patients (60%) were males and eight (40%) were females. Osteoarthritis was the primary diagnosis in 18 patients (90%). Uncemented THA was performed in 15 (75%) and hybrid THA in five (25%). Hip flexion improved from 83.0° preoperatively to 110.0° postoperatively, with improvement also observed in internal rotation, external rotation, abduction, and adduction. Preoperatively, 19 patients (95%) had poor HHS grades and one (5%) had a fair grade. Postoperatively, 11 patients (55%) had excellent and nine (45%) had good outcomes. There was no significant association between procedure type and postoperative HHS grade (p=0.796). Persistent pain occurred in 25%, superficial wound infection in 10%, and prosthetic dislocation in 5%. Conclusion: Primary THA provided substantial improvement in hip mobility and functional outcome in patients with degenerative hip diseases. Both uncemented and hybrid THA produced satisfactory outcomes, with no significant difference between the procedures in this small cohort.

Background: Spinal anaesthesia (SA) is commonly associated with hypotension and bradycardia due to sympathetic blockade, reduced venous return and activation of cardioinhibitory reflexes. Ondansetron, a 5-HT3 receptor antagonist, may attenuate these haemodynamic changes. Aim: To evaluate the effect of prophylactic intravenous ondansetron on SA-induced hypotension and bradycardia. Methods: This prospective randomized double-blinded study was conducted at KIMS, Amalapuram, from November 2025 to May 2026. A total of 100 patients undergoing elective surgery under SA were enrolled and divided into two groups of 50 each. Group O received intravenous ondansetron before SA, while Group C received normal saline placebo. Haemodynamic parameters, incidence of hypotension and bradycardia, vasopressor requirement, atropine requirement and adverse events were recorded and compared. Results: Both groups were comparable in baseline characteristics. Hypotension was significantly lower in the ondansetron group compared with placebo, 26% versus 54%. Bradycardia was also lower in the ondansetron group, 10% versus 28%. Ondansetron significantly reduced vasopressor requirement, atropine requirement and nausea/vomiting. Mean arterial pressure was better maintained after SA in the ondansetron group. Conclusion: Prophylactic intravenous ondansetron improved haemodynamic stability and reduced hypotension and bradycardia following SA.

Background: Revision spinal fusion surgeries such as transforaminal lumbar interbody fusion and posterior lumbar interbody fusion are associated with considerable blood loss because of fibrosis, distorted anatomy and prolonged operative dissection. Tranexamic acid may reduce perioperative bleeding by inhibiting fibrinolysis. Aim: To compare perioperative and postoperative blood loss in revision spinal fusion surgeries with and without tranexamic acid administration. Methods: This retrospective comparative case-control study included 50 patients who underwent revision lumbar spinal fusion surgery at Apollo Main Hospital, Chennai, from 2017 to 2019. Patients were divided into tranexamic acid and control groups. Intraoperative estimated blood loss, postoperative drain output, total blood loss, percentage total blood volume loss, haemoglobin fall and blood transfusion requirement were compared between groups. Correlation of blood loss with age, sex, number of levels fused and duration of surgery was assessed. Results: Tranexamic acid administration was associated with significantly lower intraoperative blood loss, postoperative drain output, total blood loss and percentage total blood volume loss. The need for blood transfusion was also lower in the tranexamic acid group. Duration of surgery and number of levels fused showed positive correlation with blood loss. Conclusion: Tranexamic acid reduced blood loss and transfusion requirement in revision spinal fusion surgery.

Introduction: Lactate is an important marker of severity of illness and tissue hypoperfusion in critically ill patients. Elevated or persistently high lactate is associated with increased mortality. This study evaluated admission arterial blood lactate levels and their relationship with clinical outcomes in critically ill patients. Methodology: After getting approval from Ethics Committee and Institutional Research Committee, a Cross-sectional, Institutional based prospective study was carried out in the Department of Respiratory Medicine. Admission lactate levels measured by arterial blood gas (ABG) analysis were recorded and outcomes were noted in proforma. Result: Among 116 critically ill patients, 26 (22.4%) had hyperlactatemia (≥2 mmol/L). Higher lactate levels were significantly associated with respiratory failure, cardiogenic shock, hypovolemic shock (p≤0.05) but not with gender, sepsis, altered sensorium and postoperative conditions (p>0.05). ICU mortality was significantly higher among patients with hyperlactatemia than among those with normal lactate levels (46.2% vs. 8.9% respectively). Conclusion: Elevated admission ABG lactate is a clinically important marker in critically ill patients and is significantly associated with ICU mortality.

Background: Congenital hypothyroidism (CH) is regarded as the commonest cause of preventable mental retardation. With the introduction of newborn screening, early diagnosis and timely initiation of thyroxine replacement therapy have improved the outcomes of affected children. Study was conducted to find out the incidence of congenital hypothyroidism in term and preterm babies and to find out the epidemiological correlation of congenital hypothyroidism (incidence iodised salt and non-iodised salt consuming population. Materials and Methods: Cord blood samples were collected with the help of a 5cc syringe from the cord stump of the babies satisfying the afore mentioned inclusion and exclusion criteria at the time of birth in the labour room or Operation Theatre in a clot vial and sent for analysing TSH levels within four hours of collection. The babies were re-evaluated on 4th day for term babies and 5th day for preterm babies by heel prick method. A short history and clinical examination about the babies were conducted. Babies with elevated TSH levels (>20mcU/L) this time also were re-evaluated at the age of one month with a venous sample for TSH levels. Those with persistently raised TSH levels (>20mcU/L) at the age of one month were considered to be suffering from congenital hypothyroidism. The data thus collected were analysed by statistical methods to find out the incidence of congenital hypothyroidism in the institution. Results: From the present study we can understand that the 85% of those diagnosed to have congenital hypothyroidism by cord blood TSH estimation have transient hypothyroidism. Also, the rate of positivity of TSH levels decline as the numbers of days of life of the child increases. Thus, transient hypothyroidism must be ruled out before treating a child for congenital hypothyroidism. In our study mean TSH for preterm is 5.3±10.6 and 4.09±6.4mIU/L for term babies. Our study shows significant correlation between preterm delivery and congenital hypothyroidism (p value- 0.0006). The present study shows that prolonged jaundice, hypotonia, difficult oral feeding and open posterior fontanelle have statistically significant association with congenital hypothyroidism The normative range cord blood TSH for babies as found in my study population is 2.2 to 11.09 (3^rd to 97^th percentile as obtained from the study population). The normative range heel prick TSH for babies as found in my study population is 0.9 to 7.54 (3^rd to 97^th percentile as obtained from the study population). Conclusion: Congenital hypothyroidism has a high incidence in our country. Its inclusion in neonatal screening protocol has been rightly done. This can help us prevent an important cause of mental retardation. Transient hypothyroidism is a common entity. So treatment of hypothyroidism should not be started on the basis of cord blood Thyroid Stimulating Hormone (CBTSH). The 4-5^th heel prick TSH and 28 day venous TSH should be done before diagnosing a case of congenital hypothyroidism.

Background: Chronic kidney disease (CKD) is a progressive and irreversible decline in renal function that has become a major global health concern because of its increasing prevalence, high morbidity, and associated mortality. The disease is commonly associated with diabetes mellitus, hypertension, and other chronic disorders, leading to significant clinical and economic burden. Understanding the clinical presentation and etiological profile of CKD patients is essential for early diagnosis, appropriate management, and prevention of disease progression. Aim: To examine the clinical and etiological profiles of patients with chronic kidney disease. Methods: A hospital-based descriptive observational study was conducted among 160 patients diagnosed with chronic kidney disease at a tertiary care teaching hospital. Adult patients fulfilling the diagnostic criteria for CKD were enrolled after obtaining informed consent. Demographic characteristics, clinical signs and symptoms, etiological factors, and laboratory parameters including hemoglobin, blood urea, and serum creatinine were recorded using a structured data collection form. Data were analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. A p-value of <0.05 was considered statistically significant. Results: Among the 160 study participants, 54.4% were above 60 years of age and 67.5% were males. Pedal edema (59.0%) and pallor (51.1%) were the most common clinical signs, whereas anorexia (61.4%), oliguria (55.6%), and generalized weakness (54.2%) were the predominant presenting symptoms. Diabetes mellitus (37.3%) was the leading etiological factor, followed by hypertension (21.7%) and chronic glomerulonephritis (19.2%). Laboratory evaluation revealed that 50.6% of patients had hemoglobin levels between 5–10 g/dL, 42.5% had blood urea levels between 100–200 mg/dL, and 51.9% had serum creatinine levels between 5–10 mg/dL, indicating advanced renal impairment in a substantial proportion of patients. Conclusion: The study demonstrated that chronic kidney disease predominantly affected elderly male patients, with diabetes mellitus and hypertension being the most common etiological factors. Fluid overload, anemia-related manifestations, and uremic symptoms were frequently observed. Early identification of high-risk individuals, routine screening, and effective management of diabetes and hypertension are essential for preventing disease progression, reducing complications, and improving the quality of life of patients with chronic kidney disease.

Introduction: Difficult laparoscopic cholecystectomy (LC) increases operative time, conversion and biliary injury. Preoperative prediction aids planning. This study identified preoperative predictors of difficult LC and compared the Randhawa-Pujahari (RSCLO) score with a new institutional (Berhampur) score. Methods: In this prospective observational analytical study, 260 adults undergoing elective LC for gallstone disease were assessed with clinical, laboratory and ultrasonographic parameters, and both scoring systems were applied preoperatively. Intraoperative difficulty was defined by predefined criteria. Associations were tested by chi-square or Fisher exact test; p<0.05 was significant, and the diagnostic performance of the two scores was compared. Results: Difficult LC occurred in 57 patients (21.9 percent). Advancing age (p=0.02), male sex (p=0.02), obesity (p=0.03), raised total leukocyte count (p<0.001), deranged liver function (p<0.001), higher ASA grade (p<0.001), previous acute cholecystitis (p=0.04), pericholecystic collection (p<0.001), impacted neck stone (p<0.001), gallbladder wall thickening (p<0.001) and lesser surgeon experience (p=0.02) were significant predictors. The Berhampur score showed higher sensitivity (80.7 versus 75.4 percent) and a lower false-negative rate (19.3 versus 24.6 percent) than RSCLO, with slightly lower specificity (85.2 versus 90.1 percent). Conclusion: Difficult LC can be reliably anticipated from routine preoperative parameters. The new Berhampur score improved sensitivity and missed fewer difficult cases than RSCLO, supporting its role in preoperative risk stratification, though multicenter validation is needed.

Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic abnormalities, including dysglycemia and dyslipidemia. Objective: To assess the association of glycemic and lipid parameters with ultrasonographic severity of NAFLD. Materials and Methods: This was a hospital-based cross-sectional observational study conducted over 10 months from September 2025 to June 2026 in the Department of General Medicine, Farookh Academy of Medical Education Hospital & Research Institute, Mysuru, Karnataka. A total of 65 patients with NAFLD fulfilling the predefined eligibility criteria were included. FBS, PPBS, HbA1c, triglycerides, HDL cholesterol, total cholesterol, LDL and VLDL were assessed. NAFLD severity was graded by ultrasonography as grade 1, 2 or 3. Statistical analysis was performed using one-way ANOVA and Fisher’s exact test. Results: Grade 1, Grade 2 and Grade 3 NAFLD were present in 47.7%, 36.9% and 15.4% of participants, respectively. FBS, PPBS, HbA1c, triglycerides, LDL and VLDL increased significantly with increasing severity, while HDL decreased. Total cholesterol also differed significantly across grades. Conclusion: Greater NAFLD severity was associated with progressively adverse glycemic and lipid profiles, highlighting the importance of metabolic assessment in these patients.

Background: Acute bronchiolitis is a common lower respiratory tract infection in infants and young children for which management remains predominantly supportive. Nebulized magnesium sulphate has potential bronchodilator effects, but its role in bronchiolitis remains uncertain. Objective: To evaluate the safety and short-term oxygenation response to nebulized magnesium sulphate in children with moderate bronchiolitis. Materials and Methods: This hospital-based prospective single-arm interventional study included 60 children aged 1–24 months with moderate bronchiolitis (Clinical Severity Score [CSS] 4–8). Each child received two doses of nebulized magnesium sulphate (150 mg) 30 minutes apart. Oxygen saturation (SpO₂) was assessed at baseline and 4 hours, while CSS and other clinical parameters were recorded at baseline, 1 hour, and 4 hours. Adverse effects were monitored throughout the observation period. Results: The mean age was 7.5 ± 6.47 months, and 68.3% were male. Baseline hypoxia was present in 36.6% of children. Mean SpO₂ increased significantly from 90.15 ± 6.99% at baseline to 93.30 ± 4.48% at 4 hours (p<0.001); among hypoxic children, it increased from 82.41 ± 5.30% to 89.64 ± 5.25% (p<0.001). Mean CSS decreased from 6.00 ± 1.008 at baseline to 2.40 ± 1.564 at 4 hours (p<0.001), with significant improvements in respiratory rate, wheeze, retractions, and general condition. Overall, 88.3% of children showed clinical improvement. Conclusion: Nebulized magnesium sulphate was associated with significant short-term improvement in oxygen saturation and clinical severity and was generally well tolerated in children with moderate bronchiolitis. However, controlled trials with larger samples and longer follow-up are required to establish its clinical efficacy.

Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with obesity, insulin resistance and other metabolic abnormalities. The presence of metabolic syndrome may influence the severity of hepatic steatosis. Objective: To assess the association between metabolic syndrome and ultrasonographic severity of NAFLD. Materials and Methods: This observational study included 65 adults with ultrasonographically diagnosed NAFLD. Clinical, anthropometric and biochemical parameters were recorded. Metabolic syndrome was assessed using NCEP ATP III criteria, while hepatic steatosis was graded by abdominal ultrasonography. Results: Metabolic syndrome was present in 34 (52.3%) participants. Grade 1, grade 2 and grade 3 steatosis were observed in 31 (47.7%), 24 (36.9%) and 10 (15.4%) participants, respectively. Among participants with metabolic syndrome, 94.1% had grade 2 or 3 steatosis compared with 6.5% among those without metabolic syndrome (P<0.001). Conclusion: Metabolic syndrome was significantly associated with greater ultrasonographic severity of NAFLD.

Background: Neonatal hyperbilirubinemia is common during the early neonatal period and may be influenced by nutritional and metabolic factors. Vitamin D status and neonatal growth characteristics have been proposed as potential factors associated with the development of significant jaundice. Objective: To compare neonatal anthropometric parameters and serum 25-hydroxyvitamin D [25(OH)D] status between term neonates with significant unconjugated hyperbilirubinemia and healthy controls. Methods: This prospective hospital-based case-control study included 80 healthy term neonates aged 3–10 days, comprising 40 cases with significant unconjugated hyperbilirubinemia requiring phototherapy and 40 controls not requiring phototherapy. Birth weight, length, head circumference, total serum bilirubin, and serum 25(OH)D levels were assessed and compared between the groups. Results: Mean birth weight was comparable between cases and controls (3.07 ± 0.29 vs. 3.08 ± 0.31 kg; p=0.942). No significant differences were observed in head circumference (34.23 ± 0.70 vs. 34.06 ± 0.60 cm; p=0.311) or length (50.38 ± 0.70 vs. 50.51 ± 0.60 cm; p=0.424). Mean total serum bilirubin was significantly higher among cases (19.8 ± 1.3 vs. 10.6 ± 2.6 mg/dL; p<0.001), while mean serum 25(OH)D was significantly lower (25.23 ± 18.50 vs. 33.85 ± 17.07 ng/mL; p=0.034). Vitamin D sufficiency was observed in 50.0% of cases compared with 80.0% of controls (p=0.004). Conclusion: Significant unconjugated hyperbilirubinemia in term neonates was associated with lower serum 25(OH)D levels and poorer vitamin D status, whereas birth weight, length, and head circumference showed no significant association. These findings suggest that vitamin D status may have a greater relationship with neonatal hyperbilirubinemia than routine anthropometric parameters.

Background: Acute organophosphorus (OP) poisoning remains an important cause of poisoning-related morbidity and mortality, particularly in agricultural communities. Early assessment of clinical severity may help identify patients at increased risk of complications and poor outcomes. Objective: To evaluate the clinical profile, severity, complications, ventilatory requirement, and in-hospital outcome of patients with acute organophosphorus poisoning. Materials and Methods: This hospital-based cross-sectional study included 100 adult patients with acute organophosphorus poisoning. Demographic characteristics, clinical manifestations, electrocardiographic findings, complications, requirement for mechanical ventilation, and in-hospital outcomes were recorded. Severity at admission was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale. Results: The 20–29-year age group constituted 39% of patients, 72% were males, and 48% were farmers. Muscarinic manifestations alone occurred in 60%, while 40% had combined muscarinic and nicotinic manifestations; sinus bradycardia was observed in 70%. According to the POP scale, 47% had mild, 48% moderate, and 5% severe poisoning. Mechanical ventilation was required in 28%, respiratory paralysis occurred in 24%, intermediate syndrome in 6%, and overall mortality was 24%. POP severity was significantly associated with mechanical ventilation, complications, and mortality (p<0.001). Mortality increased from 2.13% in mild poisoning to 37.5% in moderate and 100% in severe poisoning. Conclusion: Acute organophosphorus poisoning predominantly affected young males and was associated with considerable morbidity and mortality. Increasing POP severity was significantly associated with complications, mechanical ventilation, and mortality, suggesting its potential utility for early bedside risk stratification.

Background: Acute organophosphorus (OP) poisoning is an important cause of morbidity and mortality, with severe cases frequently requiring mechanical ventilation and intensive care. Serum pseudocholinesterase (PChE), which decreases following OP exposure, may provide a readily available biochemical marker for assessing severity and prognosis. Objectives: To evaluate serum pseudocholinesterase levels as a predictor of clinical severity and mortality in acute OP poisoning and to determine their association with mechanical ventilation and patient outcome. Materials and Methods: This prospective observational study included 100 adult patients with acute OP poisoning. Severity at admission was assessed using the Peradeniya Organophosphorus Poisoning (POP) scale. Admission serum PChE levels were categorized as ≤1000, 1001–2000, 2001–3000, and >3000 U/L. Associations of PChE levels with POP severity, mechanical ventilation, and in-hospital mortality were analyzed, with p<0.05 considered statistically significant. Results: Mean serum PChE was 1821.78±1044.91 U/L. All patients with severe poisoning had PChE ≤1000 U/L (p<0.001). Among patients with PChE ≤1000 U/L, 79.41% required mechanical ventilation compared with 1.52% of those with levels >1000 U/L (p<0.001). Mortality was 67.65% in the ≤1000 U/L group, compared with 3.70% at 1001–2000 U/L, with no deaths above 2000 U/L (p<0.001). Mean PChE was significantly lower among non-survivors than survivors (698.42±255.75 vs. 2176.53±943.30 U/L; p<0.001). Conclusion: Low admission serum pseudocholinesterase levels were strongly associated with greater poisoning severity, requirement for mechanical ventilation, and mortality. Serum PChE, particularly a level ≤1000 U/L, may serve as a simple and inexpensive adjunct for early risk stratification in acute OP poisoning, although it should be interpreted together with clinical severity assessment.

Background: Pneumonia severity in young children may be influenced by nutritional status and early feeding practices. Identifying modifiable factors may help reduce severe disease. Objective: To assess the association of nutritional status and infant feeding practices with pneumonia severity in children aged 2 months to 5 years. Materials and Methods: A prospective observational study was conducted among 120 children admitted with pneumonia at ESICMC & PGIMSR, Bengaluru, from January 2019 to June 2020. Birth weight, breastfeeding, bottle feeding, weaning practices, weight-for-age, height/length-for-age, MUAC and anemia were assessed. Associations with severe/very severe pneumonia were evaluated using the chi-square test. Results: Low birth weight, bottle feeding, underweight, stunting and MUAC-defined malnutrition were significantly associated with severe/very severe pneumonia, whereas exclusive breastfeeding, early weaning and anemia were not significantly associated. Conclusion: Low birth weight and nutritional deficits, particularly stunting and MUAC-defined malnutrition, were important correlates of severe pneumonia.

Background: Undescended Testis (UDT) is the most common urogenital abnormality seen in children below one year. This study aimed to investigate the rate of re-ascent needing re-operation after initial orchidopexy and to investigate further differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent. Methods: A retrospective cohort analysis study was conducted on boys, treated for undescended testis (UDT) with orchidopexy between 2022 and 2025 at a tertiary pediatric and urology institution. The primary outcome was re-ascent requiring re-operation, and the secondary outcome was atrophy rate. Independent variables were age at surgery, prematurity, genetic syndrome, laterality, bilaterality, congenital or ascended UDT, scrotal hypoplasia, inguinal or scrotal approach, whether the external oblique was opened, whether the testis was sutured to the scrotal sac, presence of patent processus vaginalis, and operation time. Univariate and Multivariate analysis of potential risk factors, logistic regression were used to evaluate differences between groups. Results: A total of 300 patients were included. A total re-ascent rate of 6% was found in this retrospective cohort study of patients who had orchidopexy, after the inguinal approach (7.1%) than the scrotal approach (3.3%). Re-operation was associated with younger age, congenital UDT, and inguinal approach remained significant on univariate analyses. No patient developed atrophy. Conclusion: The rate of re-ascent was 6% following primary orchidopexy. The inguinal route having double the rate of re-ascent compared to the scrotal approach. Atrophy was quite uncommon and nil in this study. As anticipated, the scrotal technique resulted in noticeably reduced operating times.

Background: Hollow viscus injury (HVI) following abdominal trauma is a potentially life-threatening condition associated with significant morbidity and mortality. Early diagnosis remains challenging because clinical manifestations may be subtle, particularly in polytrauma patients. Delayed intervention can result in peritonitis, sepsis, and poor outcomes. Aim: To evaluate the clinical profile, management strategies, and outcomes of hollow viscus injuries following abdominal trauma. Objectives: To assess the demographic characteristics, mechanism of injury, clinical presentation, diagnostic findings, operative management, postoperative complications, and factors influencing outcomes in patients with hollow viscus injuries. Methods: A hospital-based observational study was conducted in the Department of General Surgery, MKCG Medical College and Hospital, Berhampur, Odisha, from November 2023 to October 2025. Eighty-eight patients with hollow viscus injury secondary to blunt or penetrating abdominal trauma were included. Demographic data, clinical presentation, radiological findings, operative details, postoperative complications, duration of hospital stay, and outcomes were recorded and analyzed. All patients underwent exploratory laparotomy following initial resuscitation. Results: The majority of patients were males (88.6%) and belonged to the 21–30-year age group (55.6%). Blunt abdominal trauma accounted for 72.7% of cases, with road traffic accidents being the most common cause. Abdominal pain (94.3%) and vomiting (92%) were the predominant presenting symptoms. Free gas under the diaphragm was observed in 61.3% of patients. Small bowel injuries were the most common, with jejunal (46.6%) and ileal (45.5%) involvement predominating. Primary repair was performed in 70.5% of patients. Diffuse peritoneal contamination was present in 60.2% of cases and was strongly associated with postoperative complications and mortality. Overall postoperative complication and mortality rates were 42% and 8%, respectively. Conclusion: Hollow viscus injuries predominantly affect young males following blunt abdominal trauma. Early diagnosis and timely surgical intervention significantly reduce peritoneal contamination, postoperative complications, hospital stay, and mortality. Diffuse peritoneal contamination is a major predictor of adverse outcomes and should prompt aggressive management.

Background: The integration of Large Language Models (LLMs) like ChatGPT into medical education presents a paradigm shift in how students retrieve information. While AI offers unprecedented speed, its reliability in the nuanced domain of Clinical Biochemistry—specifically in interpreting quantitative data like the Oral Glucose Tolerance Test (OGTT) and complex metabolic regulation—remains under-evaluated. Objective: To compare the diagnostic accuracy, time efficiency, and specific biochemical reasoning (e.g., energetics/ATP calculation) of Phase-I MBBS students using standard textbooks versus those using ChatGPT-4. Methods: A randomized, parallel-group educational intervention study was conducted with 100 Phase-I MBBS students. Participants were randomized into Group A (Textbook, n=50) and Group B (ChatGPT-Assisted, n=50). Both groups attempted two tasks: interpreting an ambiguous OGTT graph (Task 1) and diagnosing a Glycogen Storage Disease case (Task 2). Primary outcomes were time taken and diagnostic accuracy. Secondary outcomes included the variation in ATP energetics calculation. Results: Group B (ChatGPT) demonstrated significantly faster completion times (Mean: 11.4 ± 2.1 min) compared to Group A (Mean: 24.8 ± 3.5 min, p<0.001). However, Group A achieved higher accuracy in Task 1 (OGTT Interpretation) (88% vs. 62%, p<0.01), specifically in distinguishing “Impaired Glucose Tolerance” from “Diabetes.” Notably, 92% of Group A cited “38 ATP” (classic curriculum) for glucose oxidation, whereas 86% of Group B cited “30-32 ATP” (modern consensus), highlighting a curriculum-AI mismatch. Conclusion: ChatGPT functions as a high-speed diagnostic aid but lacks curriculum-specific precision for quantitative graph interpretation. It introduces correct but “out-of-syllabus” variations that may confuse undergraduate learners.

Background: Open hemorrhoidectomy remains an established surgical treatment for symptomatic hemorrhoids but is commonly associated with postoperative pain, bleeding, urinary retention, and delayed return to routine activities. Pile plication is a tissue-preserving procedure that reduces hemorrhoidal blood flow and corrects prolapse without excising the hemorrhoidal cushions. Methods: This hospital-based prospective comparative observational study was conducted in the Department of General Surgery, Shri Jagannath Pahadiya Medical College, Bharatpur, Rajasthan, over 15 months. A total of 204 patients with symptomatic second-degree hemorrhoids not responding to conservative treatment or uncomplicated third-degree hemorrhoids were included. Group A underwent open hemorrhoidectomy using the Milligan–Morgan technique, while Group B underwent pile plication. The groups were compared for operative time, estimated blood loss, postoperative pain, hospital stay, and return to routine work, early and late complications, and recurrence. Results: The mean operative time was significantly shorter with pile plication than with open hemorrhoidectomy (29.8 ± 5.9 vs. 42.1 ± 6.8 minutes; p<0.001). Estimated blood loss was also lower in the pile plication group (24.6 ± 6.8 vs. 34.2 ± 9.1 mL; p<0.001). Postoperative pain scores were significantly lower after pile plication at Day 1, Week 1, Week 2, and one month (p<0.001 at all assessments). Hospital stay was shorter (1.04 ± 0.20 vs. 1.18 ± 0.39 days; p=0.002), and return to routine work was earlier (24.6 ± 6.8 vs. 34.2 ± 9.1 days; p<0.001) following pile plication. Urinary retention was significantly less frequent after pile plication (5.9% vs. 18.6%; p=0.009). Other early and late complications were comparable. Recurrence was higher after pile plication, but the difference was not statistically significant (7.8% vs. 3.9%; p=0.373). Conclusion: Pile plication is a safe and effective alternative to open hemorrhoidectomy for selected patients with second- and third-degree hemorrhoids. It provides shorter operative time, lower blood loss, less postoperative pain, faster recovery, and a lower incidence of urinary retention, with comparable short-term complication and recurrence rates.

Background: Cholelithiasis and hypothyroidism are among the most prevalent surgical and endocrine conditions in tertiary care in India, sharing overlapping demographic profiles and mechanistic pathways. Despite a biologically plausible link through altered cholesterol metabolism, impaired gallbladder motility and sphincter of Oddi dysfunction, region-specific data on their coexistence remain sparse. This study aimed to determine the prevalence of hypothyroidism—both overt and subclinical—in patients with ultrasonographically confirmed cholelithiasis and to characterise associated metabolic derangements. Methods: A prospective observational study was conducted from November 2023 to October 2025  at the Department of General Surgery, M.K.C.G. Medical College and Hospital, Berhampur, Odisha—a tertiary care teaching institution serving southern Odisha. Ninety-seven adult patients (aged 18–70 years) with sonologically confirmed symptomatic cholelithiasis were enrolled after applying predetermined inclusion and exclusion criteria. A sample size of 97 was derived from a reference prevalence of 20%, 80% power, α = 0.05, and a precision of ±8% (calculated n = 96). Serum TSH, free T3 and total T4 were measured in all participants; thyroid status was classified as euthyroid, subclinical hypothyroid (elevated TSH, normal T3/T4) or clinically hypothyroid (elevated TSH with reduced T3/T4). Fasting lipid profile including total cholesterol, triglycerides, LDL and HDL was recorded. Statistical analysis used chi-square, one-way ANOVA with Tukey post-hoc test and Pearson correlation; p < 0.05 was taken as significant. Results: The cohort (N = 97) had a mean age of 47.3 ± 12.6 years (range 18–70 years) and a female predominance of 73.2% (F:M = 2.7:1). Overall, 27.8% of cholelithiasis patients had hypothyroidism: 17.5% subclinical and 10.3% overt clinical hypothyroidism. Dyslipidaemia was present in 20.0% of euthyroid patients compared with 64.7% in subclinical and 80.0% in clinical hypothyroid patients (χ² = 22.680, p < 0.001; OR 9.50, 95% CI 3.45–26.15). TSH showed significant positive correlations with total cholesterol (r = 0.480), triglycerides (r = 0.537) and LDL (r = 0.562), and an inverse correlation with HDL (r = −0.462), all p < 0.001. In a sensitivity analysis restricted to patients without complicated disease (no fever or jaundice; n = 60), the prevalence of hypothyroidism remained 23.3%. Age, gender, BMI and stone multiplicity did not show statistically significant associations with thyroid status. Conclusion: More than one in four patients presenting with cholelithiasis to a tertiary surgical unit harboured hypothyroidism, with the subclinical variety predominating. Thyroid dysfunction was strongly linked to an atherogenic lipid profile and dyslipidaemia. The prevalence was robust across a sensitivity analysis excluding complicated cases. Incorporating thyroid function testing—at minimum, serum TSH—into the routine metabolic workup of cholelithiasis patients, particularly those with coexisting dyslipidaemia, appears clinically justified.

Background: The subject of anatomy is a cornerstone of medical education. As the competency-based medical education (CBME) model is rolled out in India, a change in the way in which medical students learn has occurred. However, concerns regarding the effectiveness of the current methods of teaching and assessment in medical schools have emerged. Objectives: The goals of this study were to evaluate the perceptions of teaching and assessment in the department of anatomy of first-year MBBS students, and to determine their level of preparedness in clinical and research settings according to the CBME framework. Methods: A cross-sectional questionnaire-based study was conducted among 182 first-year MBBS students attending Government Medical College, Srinagar. A prevalidated questionnaire (Cronbach’s alpha = 0.82) was used to assess the student perceptions regarding anatomy department teaching methods, assessment methods, theory-practice balance, and preparedness for clinical settings. Data were analyzed using descriptive and inferential statistics, as well as thematic analysis of open-ended questions. Results: Out of the different teaching methods, cadaveric dissection was the most preferred method (55%). However, in the category of assessment methods, the preferred method was practical examinations (55%). Other methods such as case-based learning were used by 25% of the students while only 5% of students indicated a preference for lectures or written examinations. A majority of students (62%) felt that the current assessment methods were adequate; however, some students noted that there was a focus on minutiae in many of these assessments. Furthermore, 50% of the students indicated that the focus of assessments was weighted towards theoretical knowledge, rather than the knowledge of how to apply that knowledge to patient care. Finally, only 25% of the students indicated that they feel prepared to apply their knowledge to clinical settings, and the remainder of the students expressed a feeling of partial preparedness. Conclusion: Overall, students indicate a preference for methods that focus upon the application of knowledge to clinical settings. Therefore, these findings suggest the need for reforms to the current curriculum regarding the use of integrated teaching methods, the use of assessment methods like OSPE, and the use of digital tools to enhance the clinical preparedness of medical students.

Background:  Fracture healing assessment remains subjective and delayed, relying on serial radiographs interpreted with semi-quantitative scoring systems (RUST, RUSH, RUSHU) that carry substantial observer variability. Machine learning (ML) offers the prospect of earlier, objective, and individualized prognostication of union, delayed union, and non-union. Methods:  We performed a narrative evidence-synthesis review prepared with reference to the SANRA checklist. PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore, and preprint servers were searched (January 2015–June 2026); thirty representative publications on ML applications were synthesized across four domains: image-based deep learning, mechanobiology-informed finite-element/ML hybrid models, wearable-sensor biomechanics, and registry-based mortality/complication prediction. Results:  Convolutional networks dominate image-based tasks, with union-prediction accuracies of 91–93.6% in scaphoid series and detection AUCs up to 0.97; ML surrogates reproduce finite-element healing simulations at a fraction of the computational cost; wearable insole data predicted lower-extremity healing with approximately 76% accuracy (n = 25); and ML models predicted post-hip-fracture mortality with AUCs of 0.68–0.89 (largest cohort 74,396 cases), with gradient-boosting methods frequently outperforming logistic regression. SHAP-based explanations consistently revealed biologically plausible predictors. Nearly all studies, however, are retrospective, single-center, and internally validated, with heterogeneous non-union definitions and infrequent external validation. Conclusions:  ML-based fracture healing prediction is promising but remains at a proof-of-concept stage. Multi-center prospective datasets, standardized outcome definitions with TRIPOD/CLAIM-concordant reporting, external validation, and clinician-in-the-loop trials are prerequisites for clinical adoption; no current model is ready for standalone clinical decision-making.

Background: High-grade (Rockwood type IV–VI) acromioclavicular (AC) joint dislocations are increasingly managed operatively to restore both horizontal and vertical stability. Double endobutton (cortical button) fixation has emerged as a minimally invasive, biomechanically favourable technique that avoids the drawbacks of hook plates and rigid coracoclavicular screws. This prospective study evaluated the functional and radiological outcomes of double endobutton fixation in acute high-grade AC joint dislocations. Methods: This prospective clinical study included 32 patients with acute (<3 weeks) Rockwood type IV or V AC joint dislocations treated with arthroscopically assisted or mini-open double endobutton coracoclavicular fixation. Functional outcome was assessed using the Constant-Murley Score (CMS), Visual Analogue Scale (VAS) for pain, and the University of California, Los Angeles (UCLA) shoulder score, preoperatively and at final follow-up. Coracoclavicular distance was measured radiologically. Complications were recorded prospectively. Results: The mean age was 31.4 ± 7.8 years, with a male predominance (84.4%). Mean follow-up was 15.8 ± 3.6 months. The mean Constant-Murley Score improved from 46.3 ± 6.1 preoperatively to 91.7 ± 5.4 at final follow-up (p < 0.001). Mean VAS score decreased from 6.8 ± 1.1 to 0.9 ± 0.6 (p < 0.001). Coracoclavicular distance improved from 18.4 ± 2.7 mm to 8.9 ± 1.6 mm (p < 0.001). Minor complications occurred in 6 patients (18.8%), including partial loss of reduction in 3 (9.4%); one patient (3.1%) required revision surgery. No implant failures, coracoid fractures, or neurovascular injuries were noted. Conclusion: Double endobutton fixation provides reliable anatomical reduction, excellent pain relief, and good-to-excellent functional outcomes in acute high-grade AC joint dislocations, with an acceptable complication profile. It represents a safe, minimally invasive alternative to conventional fixation methods.

Background: Displaced supracondylar fractures of the humerus are common paediatric elbow injuries in which accurate reduction and stable fixation are essential to restore alignment and motion while limiting neurovascular and angular complications. Crossed Kirschner-wire fixation offers strong mechanical stability, although safe placement of the medial pin is important because of the proximity of the ulnar nerve. Methods: Our study prospectively followed 20 children aged 2-12 years with closed displaced supracondylar humerus fractures treated at the orthopaedic units attached to J.J.M. Medical College, Davangere, from September 2020 to September 2022. Closed reduction was attempted when satisfactory alignment could be achieved; open reduction was used when closed reduction was inadequate or the fracture was multidirectionally unstable. All fractures were stabilized with criss-cross Kirschner wires. Clinical and radiographic follow-up was performed at 1, 3 and 6 months. Range of motion, carrying angle, change in Baumann angle and postoperative complications were analysed. Results: The mean age was 7.4 ± 2.5 years; 85% were boys and 70% involved the left elbow. Gartland type II and III fractures each accounted for 45%, while 10% were documented as type IV. Closed reduction was achieved in 9 children (45%) and 11 (55%) required open reduction. At final assessment, 50% had an elbow arc of 0-135°, 20% reached 0-140°, 25% reached 0-125° and 5% reached 0-130°. Mean carrying angle was 10.50 ± 0.61°. A change in Baumann angle of no more than 5° was recorded in 85%. Sixteen children (80%) had no postoperative complication; pin-tract infection and pin migration each occurred in two children (10%). Final range-of-motion distribution did not differ significantly by Gartland type (p = 0.746) or by closed versus open reduction (p = 0.489). Conclusion: Criss-cross Kirschner-wire fixation provided stable alignment and useful elbow motion in most children in our study. Early presentation favoured successful closed reduction, whereas delayed or multidirectionally unstable fractures more often required open reduction. Complications were limited to minor pin-related events in this small cohort.

Background: The pneumatic tourniquet is widely employed in Total Knee Arthroplasty (TKA) to establish a bloodless surgical field and facilitate cemented implant fixation. However, conventional empirical reliance on fixed high cuff pressures (e.g., 350 mmHg) frequently leads to thigh pain, quadriceps neuropraxia, localized tissue ischemia, and delayed postoperative rehabilitation. This prospective randomized study was designed to compare postoperative pain, functional recovery, and perioperative complications between a fixed high tourniquet pressure (350 mmHg) and a patient-specific lower tourniquet pressure tailored to baseline systolic blood pressure (SBP + 100 mmHg). Methods: A prospective, randomized, comparative clinical study was conducted in the Department of Orthopaedics at Nandi Medical College & Research Institute from April 2025 to April 2026. Thirty adult patients (mean age: 62.33 ± 4.72 years) undergoing primary unilateral or bilateral TKA for end-stage osteoarthritis were randomly allocated into two groups: Group A (tourniquet inflated to fixed 350 mmHg, n = 15) and Group B (tourniquet inflated to patient-specific SBP + 100 mmHg, n = 15). The primary outcome was postoperative pain measured by the Visual Analogue Scale (VAS) at postoperative day 2 (POD 2), week 2 (POW 2), week 4 (POW 4), and month 2 (POM 2). Secondary outcomes included functional rehabilitation evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS), intraoperative blood loss, operative duration, hospital stay, and adverse complications. Results: Results: Mean tourniquet pressure was lower in Group B (226.67 ± 8.16 vs 350.00 ± 0.00 mmHg, p < 0.0001). Group B demonstrated significantly lower VAS pain on Day 2 (5.43 ± 0.37 vs 6.73 ± 0.46, p < 0.0001) and Week 2 (4.47 ± 0.40 vs 5.40 ± 0.57, p < 0.0001). Functional recovery was superior in Group B, with lower WOMAC (75.73 vs 83.53 at Day 2; 67.27 vs 75.80 at Week 2, p < 0.0001) and higher KSS (64.00 vs 56.60 at Day 2; 72.40 vs 66.93 at Week 2, p < 0.0001). Scores equalized by Week 4 and Month 2. Group B had slightly higher blood loss (218.67 vs 190.00 mL, p = 0.0001) without transfusion requirement. Thigh pain incidence was lower in Group B (6.7% vs 20.0%, p = 0.598). Conclusion: Individualizing pneumatic tourniquet pressure to baseline systolic blood pressure (SBP + 100 mmHg) during TKA significantly mitigates early postoperative pain and promotes faster functional recovery during the crucial first 2 weeks, while maintaining excellent surgical field visibility and operative safety. Routine adoption of patient-specific systolic-based tourniquet pressures is recommended in total knee arthroplasty.

Background: The incidence of difficult intubation in the operating room is 1.2–3.8% and that of failed intubation is 0.13–0.3%. Complications of multiple attempts at intubation and failure of airway management include hypoxia, responsible for 50–75% of cardiac arrests, hypercarbia and airway trauma. Pre-anaesthetic airway assessment can predict potential problems and decrease the rate of anaesthesia-related adverse respiratory events. Aim: To compare the predictability and accuracy of various commonly used airway assessment parameters in adult patients with no apparent anatomical airway abnormalities. Materials and Methods: In this prospective observational study, 120 adult patients of either gender, aged 18–65 years, belonging to ASA grades I and II, undergoing elective surgical procedures under general anaesthesia, were included. Airway indices such as the Upper Lip Bite Test (ULBT), Ratio of Height to Thyromental Distance (RHTMD), Modified Mallampati Test (MMT) and Thyromental Distance (TMD) were assessed pre-operatively and correlated with the Cormack–Lehane (CL) grading during laryngoscopy under general anaesthesia. Results: The incidence of difficult laryngoscopy was 17.5% (21 of 120 patients). Among the four tests, MMT was the most effective diagnostic test, demonstrating the highest sensitivity (95.24%), specificity (97.98%), positive predictive value (PPV, 90.91%), negative predictive value (NPV, 98.98%) and diagnostic accuracy (97.5%). Combining all the indices yielded 100% sensitivity and specificity. Conclusion: MMT stands out as the most effective individual pre-operative test for predicting difficult laryngoscopy. However, combining tests enhances both sensitivity and specificity, improving discriminatory capability. Hence, a combination of indices is recommended for the pre-operative airway assessment of adult patients.

Background: Postoperative sore throat (POST) is a common complication of general anesthesia with endotracheal intubation. It is usually self-limiting but can cause significant postoperative discomfort and impact negatively on patient recovery. Several pharmacological and non-pharmacological interventions have been studied for its prevention. Tramadol has analgesic and possibly local anesthetic properties and may be effective in preoperative gargle. Objective: To assess the effect of pre-operative tramadol gargle on the incidence and severity of post-operative sore throat in patients undergoing elective middle-ear surgery under general anesthesia with oropharyngeal endotracheal intubation. Methods: A prospective randomized double-blind comparative study was performed on 62 patients between age group of 18 years to 60 years undergoing elective middle ear surgery. Participants were randomly assigned to one of two groups of 31. The intervention group received 50 mg tramadol diluted in 29 mL of 0.9% normal saline and the control group received 30 mL of normal saline. The solution was gargled for 30 seconds prior to the induction of anesthesia. Standardized cuff-pressure monitoring and endotracheal intubation were performed. Postoperative sore throat was assessed at 0, 2, 4, 6, 12 and 24 hours on a four-point severity scale. Statistical analysis involved Fisher exact/chi-square tests and non-parametric tests as appropriate. Results: At 0 hour, the incidence of postoperative sore throat was 35.5% in the tramadol group and 77.4% in the normal-saline group (p=0.027). At 2 hours the proportions were 32.3% and 67.7% respectively (p=0.010). At 4 hours, sore throat was 29.0% vs. 58.1% (p=0.039). At 6 h the incidence was 25.8% vs 48.4% (p=0.114). There were no patients with sore throat in the tramadol group at 12 hours versus 25.8% in the normal-saline group (p=0.004) and at 24 hours, the incidence was 0% versus 19.4%, respectively (p=0.023). Severity was mainly mild in both groups, moderate severity being mainly observed in the early postoperative period. No severe sore throat was noted. Conclusion: Preoperative 50 mg tramadol gargle significantly reduced the incidence and severity of postoperative sore throat during most of the 24 hour postoperative period compared to normal saline. The most benefit was found during the early postoperative period and at 12 and 24 h. Tramadol gargle is a simple, cheap and may be a useful intervention to reduce POST after endotracheal intubation.

Background: Surgical and anesthetic stress lead to a transient perioperative hyperglycemia thru sympathetic activation, increased counter-regulatory hormone release, hepatic glucose production and insulin resistance. Dexmedetomidine is a selective α2-adrenergic agonist which decreases sympathetic activity and may alter the metabolic stress response. However, its effect on perioperative glucose homeostasis is poorly delineated. Objective: To assess the impact of perioperative intravenous dexmedetomidine infusion on blood glucose levels in non-diabetic patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: This randomized double-blind placebo-controlled study was conducted on 60 patients aged 18–60 years belonging to American Society of Anesthesiologists physical status I–II and body mass index 20–30kg/m 2 scheduled to undergo elective laparoscopic cholecystectomy. Patients were randomized 1:1 to either dexmedetomidine (Group D, n=30) or normal saline (Group S, n=30). Group D received dexmedetomidine 0.6 μg/kg/h 10 min before induction and 0.5 μg/kg/h after induction. Capillary blood glucose was measured at baseline (T0), 1 hour intraoperatively (T1), 2 hours after extubation (T2) and at 4 and 6 hours postoperatively (T4 and T6). Inter-group comparisons were performed with unpaired t test and P<0.05 was considered statistically significant. Results: Baseline glucose was similar between the two groups (88.20±6.85 vs 87.23±6.70 mg/dL; P=0.583). Glucose increased progressively in both groups but values were significantly lower with dexmedetomidine at T1 (105.80±5.64 vs 110.80±18.99 mg/dL; P=0.044), T2 (117.50±10.95 vs 128.80±17.97 mg/dL; P=0.012), T4 (121.17±15.13 vs 129.83±11.76 mg/dL; P=0.035) and T6 (130.83±11.11 vs 140.57±12.29 mg/dL; P=0.009). Conclusions: In non-diabetic patients undergoing laparoscopic cholecystectomy, perioperative infusion of dexmedetomidine was associated with a lower perioperative blood glucose increase than saline. These results suggest a potential role of dexmedetomidine in blunting the metabolic response to surgical stress, but larger studies including diabetic patients and longer follow up are needed.

Background: Statins are widely prescribed hypolipidemic agents that also possess pleiotropic anti-inflammatory, antioxidant, and analgesic properties independent of their lipid-lowering action. Patients with dyslipidemia frequently have co-existing painful conditions such as arthritis and neuropathy, so an analgesic property intrinsic to a statin already being taken for dyslipidemia could reduce the additional analgesic dose required and thereby lessen drug-related adverse effects. Rosuvastatin has previously been shown to possess dose-dependent analgesic activity in mice, but the analgesic potential of pitavastatin, a newer and highly potent HMG-CoA reductase inhibitor, has not been reported. Objective of this study is to determine and compare the analgesic activity of pitavastatin with aspirin by observing the reaction time of Swiss albino mice using Eddy’s hot plate and tail-clip methods. Methods: Twenty-four Swiss albino mice of either sex (25–30 g, 2–3 months old) were procured, quarantined, and acclimatized, and were then randomly divided into four groups of six animals each: Group 1 (distilled water 0.4 mL/day, control), Group 2 (aspirin 100 mg/kg/day, standard), Group 3 (pitavastatin 1 mg/kg/day, low dose), and Group 4 (pitavastatin 4 mg/kg/day, high dose). All treatments were administered orally for seven days. Reaction time was recorded on Eddy’s hot plate (55 °C) and by the tail-clip method at 0, 15, 30, 60, 90, and 120 minutes (hot plate) and 0, 15, 30, and 60 minutes (tail-clip) after drug administration. Results were expressed as mean ± SD, and analyzed by paired t-test (within group, before versus after treatment) and one-way ANOVA (between groups), with p < 0.05 considered statistically significant. Institutional Animal Ethics Committee approval (IAEC/CMCH/PH/038/2023) was obtained prior to initiation of the study. Results: Both pitavastatin groups showed a statistically significant, dose-related increase in reaction time compared with the vehicle-control group in both the hot plate and tail-clip tests (p < 0.001). The high-dose pitavastatin group (4 mg/kg) produced an early and robust analgesic effect, with reaction time rising from a baseline of 2.74 ± 0.31 s to 13.98 ± 0.19 s at 30 minutes on the hot plate (a 410% increase) and from 3.24 ± 0.16 s to 14.38 ± 0.34 s at 30 minutes on the tail-clip test, an effect comparable to, and at several time points exceeding, that produced by aspirin 100 mg/kg. The low-dose pitavastatin group (1 mg/kg) showed a delayed but significant analgesic response that became comparable to aspirin only after 90–120 minutes. Baseline (0 minute) reaction times did not differ significantly between groups (hot plate p = 0.102; tail-clip p = 0.614), confirming comparability of groups at the start of the experiment. Conclusion: Pitavastatin exhibits a significant, dose-dependent analgesic effect in Swiss albino mice that is comparable to that of aspirin, particularly at the higher dose. These findings extend the evidence for a class-wide pleiotropic analgesic property among statins and support further preclinical and clinical evaluation of pitavastatin’s potential analgesic-sparing role in patients with dyslipidemia and coexisting chronic pain.

Background: The pharyngeal constrictor muscles form the posterior and lateral walls of the pharynx and play an indispensable role in deglutition, speech, and airway protection. A precise understanding of their morphological variations is crucial for surgeons undertaking transoral robotic surgery, pharyngeal dissections, head and neck oncological procedures, and cricopharyngeal myotomy for Zenker’s diverticulum. Objectives: To document the morphological variations in the origin, insertion, innervation, and inter-muscular relationships of the three pharyngeal constrictor muscles (superior, middle, and inferior) in adult Indian cadavers; to characterise pharyngeal raphe types; and to assess clinically relevant parameters including raphe length, constrictor thickness, and the prevalence of Killian’s dehiscence. Methods: Thirty formalin-fixed adult cadavers of both sexes were dissected using the conventional posterior approach in the Anatomy Department, Government Thanjavur Medical College, and Thanjavur, India. Origins, insertions, innervation patterns, muscle morphology, pharyngeal raphe configuration, raphe length, constrictor thickness, and Killian’s dehiscence were systematically evaluated. Results: The superior constrictor showed the greatest morphological diversity: additional buccal mucosal origin (3.33%), dorsal muscular bundles (16.65% combined), petropharyngeus attachment (5%), external stylopharyngeus course (10%), and buccopharyngeal membranous morphology (13.33%). The middle constrictor was largely unremarkable except for one specimen (1.67%) with the lingual artery traversing its fibres. Anomalous innervation of the inferior constrictor from the recurrent laryngeal nerve (3.33%) and the external laryngeal nerve (1.67%) was noted. Pharyngeal raphe type 3 (full-length) predominated (53.84%), with 3.33% showing complete absence of raphe. Killian’s dehiscence was present in 96.66% of specimens. Conclusion: The superior pharyngeal constrictor exhibits the highest frequency of morphological variations among the three constrictors. These findings have direct implications for pharyngeal motility, dysphagia, surgical planning, and management of pharyngo-oesophageal disorders. Awareness of these variations is essential for clinicians and surgeons working in the head and neck region.

Background: Ascites is defined as accumulation of fluid in the peritoneal cavity. Cytological examination of peritoneal fluid is minimally invasive technique and helps to identify the pathology and decide the clinical management. Objective: To evaluate the clinicocytological features of peritoneal fluid in patients attending Phulo Jhano Medical College and Hospital, Dumka, Jharkhand. Methods: The study is prospective observational study. This study was conducted in the Department of Pathology, Phulo Jhano Medical College and Hospital, Dumka over a period of 24 months. The samples collected from 385 patients after acquiring proper informed and written consent were examined for cytological evaluation using conventional techniques. The smears were stained, examined and then categorized as per the International System for Reporting Serous Cytopathology (ISRSFC). Cytological features were correlated with collected clinical data. Results: As per the International System for Reporting Serous Fluid Cytopathology (ISRSFC), the data was represented with 324 (84.16%) as negative for malignancy, 24 (6.23%) were malignant, 22 (5.71%) were suspicious for malignancy, 13 (3.38%) showed atypia of undetermined significance, and 2 (0.52%) were non-diagnostic. Majority of samples belonged to the age group 40-49 years. There is clear predominance of females (male: female =1:1.16) in this study. Maximum number of samples (45.97%) was lymphocyte rich effusions. Chronic liver disease (alcoholic) with ascites was the most frequent clinical diagnosis (28.05%). The liver diseases collectively accounted for approximately 40% of the cases. Malignant and suspicious cytology was reported predominantly in middle-aged and elderly patients. Conclusion: Majority of samples collected in this study were reported as benign with chronic liver disease being the leading underlying cause for ascites. The cytological reporting was done using the ISRSFC. Further, the cytological reports were correlated with the clinical findings which ultimately help in the appropriate patient management.

Background: The rapid proliferation of the gig economy has introduced unprecedented occupational stressors for ride-hailing drivers, compounded by algorithmic pressure and erratic shift architectures. While chronic stress is a known catalyst for cardiovascular and psychiatric morbidity, real-world neuroendocrine data evaluating this highly vulnerable workforce in northeast India remains critically absent. Methods: This cross-sectional study evaluated 120 male professional drivers operating in Assam, stratified by perceived psychological burden using the DASS-21 framework. To overcome traditional field-sampling barriers, we deployed a prototype paper-based lateral flow biosensor for the rapid, non-invasive point-of-care screening of salivary cortisol and alpha-amylase. Field results were strictly validated using automated clinical chemistry analysers, alongside concurrent evaluations of serum lipid profiles and fasting blood glucose. Results: We observed a severe, dose-dependent escalation in neuroendocrine and metabolic biomarkers directly correlated with driving hours and DASS-21 scores. The high-stress cohort demonstrated a nearly threefold elevation in basal morning salivary cortisol (34.8 ± 6.7 nmol/L) compared to low-stress peers (12.5 ± 2.1 nmol/L; ). This sustained hypothalamic-pituitary-adrenal (HPA) axis hyperactivation was mechanistically coupled with secondary dyslipidemia (total cholesterol: 235 ± 28 mg/dL) and borderline fasting hyperglycemia, indicating a severely blunted parasympathetic recovery phase. Conclusion: The integration of novel point-of-care salivary biosensors unveils a hidden epidemic of physiological hyperarousal and metabolic vulnerability among gig economy drivers in Assam. This real-world dataset provides critical foundational evidence necessitating urgent regulatory frameworks for occupational health surveillance and mandatory recovery protocols within the regional ride-hailing industry.

Background: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease requiring lifelong insulin therapy and adequate self-management. Knowledge, attitude and practice (KAP) among children and caregivers play a crucial role in achieving optimal glycaemic control and preventing complications. Objective: To assess the knowledge, attitude and practice regarding T1DM among children aged 6–14 years attending a tertiary care centre in Mandya. Methods: This hospital-based cross-sectional study included 35 children with T1DM. A pre-tested semi-structured questionnaire assessed socio-demographic characteristics and KAP related to insulin administration, glucose monitoring, diet, exercise and diabetes care. Data were analysed using descriptive statistics. Results: The mean age was 10.97±3.09 years, with 54.3% males. Eighty percent of participants knew the meaning of diabetes, while only 45.7% were aware of its complications. Most participants demonstrated good practices regarding insulin storage (97.1%), HbA1c monitoring (82.9%) and blood glucose monitoring (80%). However, deficiencies were observed in knowledge of insulin dosing, complications and regular clinic attendance. Significant gender differences were noted in selected KAP domains. Conclusion: Although basic awareness and several self-care practices were satisfactory, important gaps remain in knowledge and adherence. Structured diabetes education and regular counselling for children and caregivers are essential to improve long-term disease management and reduce diabetes-related complications.

Background: Septicemia remains a critical cause of mortality, particularly in low- and middle-income countries like India. Rising antimicrobial resistance (AMR) necessitates evidence-based prescribing to improve clinical outcomes. This study aimed to assess the impact of microbiological culture results on antimicrobial prescribing patterns. Methods: A prospective observational study was conducted in a tertiary care teaching hospital over 12 months. Blood culture–positive patients of all ages and both genders were included. Data regarding demographics, clinical diagnosis, organism isolates, culture sensitivity results, empirical and definitive antimicrobial therapy, and adverse drug reactions were collected using a pre-validated performa and analyzed using descriptive statistics. Results: Out of 120 patients, 53% were male and 47% female. Staphylococcus aureus (48%) was the most common isolate followed by Klebsiella pneumoniae (18%) and Enterococcus species (8%). A total of 248 antimicrobials were prescribed empirically with penicillins, aminoglycosides and cephalosporins groups being the most common. Only a small proportion belonged to the Access group. Therapy was modified in 42% of cases following culture sensitivity reports. Vancomycin, meropenem, and piperacillin–tazobactum were the most commonly used definitive agents. Resistance patterns showed high MRSA prevalence, while vancomycin and linezolid retained full sensitivity. Two mild and preventable adverse drug reactions were reported. Conclusion: Study highlights a predominance of Gram-positive pathogens and extensive use of Watch and Reserve antimicrobials. Culture-guided modification significantly optimized therapy in many cases. Strengthening antimicrobial stewardship and promoting Access-group antimicrobial use are crucial to curb rising AMR and improve septicemia outcomes.

Pyrimidines occupy an important position in the medicinal world as it has a number of diverse biological properties. Their related fused heterocycles are of interest as potential bioactive molecules. Pyrimidine derivatives are reported to have diverse pharmacological activities such as anticonvulsant, analgesic, sedative, anti-depressive, antipyretic, anti-inflammatory, antiviral, anti-HIV, antimicrobial and anti-tumor activities. Therefore, the study in this review has been emphasized on the research work reported in the recent scientific literature on different biological activities of pyrimidine analogs.

Background: Hepatitis B virus (HBV) is a major global public health concern with nearly a million new infections occurring annually. Around 240 million people are chronically infected with HBV worldwide, a sub-population of whom succumb to the consequent chronic liver diseases including cirrhosis and hepatocellular carcinoma. Comparing the quantitative levels of HBV DNA in new and chronic HBV cases may better inform strategies for effective antiviral treatment. Objective: To study the serum HBV DNA levels in newly detected HBsAg-positive cases and chronic HBV patients. Methods: A retrospective study was conducted on the serum samples of 45 HBV patients using real-time quantitative PCR at NVHCP State Laboratory, Bangalore Medical College & Research Institute from March 2021 to December 2021. The Abbott RealTime HBV Assay was used to determine serum HBV DNA levels. Data entry and analyses were performed on Microsoft Excel. Results: Of the 23 newly detected HBsAg-positive patients, 12 (52.2%) cases turned up an undetectable HBV DNA level denoted as Target Not Detected [TND], 4 (17.4%) had a viral load < 100 IU/mL, 5 (21.7%) had < 10⁵ IU/mL, and 2 (8.7%) had levels > 10⁵ IU/mL. Among the 22 chronic HBV patients, there were 4 (18.2%) cases of TND, 2 (9.1%) < 100 IU/mL, 15 (68.2%) < 10⁵ IU/mL, and 1 (4.5%) > 10⁵ IU/mL which was notably higher than the assay seen in the newly detected cases. Conclusion: Newly detected cases were seen to have lower viral loads and higher proportion of undetectable HBV DNA. Higher HBV DNA levels corresponds with the persistent HBsAg titres of chronic HBV and should be further evaluated in conjunction with other serum markers.

Context: Inappropriate infant feeding practices remain a major contributor to childhood malnutrition, which increases vulnerability to infections, morbidity and mortality in developing countries. Optimal breastfeeding is one of the most effective interventions to reduce malnutrition, morbidity, and mortality. Identifying modifiable maternal and sociodemographic determinants of feeding practices is essential for designing targeted public health interventions. This study aimed to assess key factors influencing infant feeding practices. Aims: To assess key maternal and sociodemographic factors influencing infant feeding. Methodology: A cross-sectional analytical study was conducted among 300 mothers of children aged <24 months. Data was collected through face-to-face interviews using a pre-validated, self-designed schedule. Information on sociodemographic characteristics, maternal education and employment, feeding practices, duration of exclusive breastfeeding, and timing of complementary feeding initiation was obtained. Results: Exclusive breastfeeding for the first six months was reported by 78% mothers, while 10.7% practiced top feeding and 11.3% mixed feeding. Most mothers were aged 20–30 years (82%), 20.7% had low educational status, and 34.7% were employed. Over half belonged to nuclear families (56.3%) and rural areas (54.7%). Exclusive breastfeeding was significantly associated with homemakers, first-born children, and male infants (p<0.05). Timely initiation of complementary feeding at six months occurred in 64.7% of cases, while 18% introduced it early and 17.3% delayed it. Common reasons for delay included perceived adequacy of breast milk (44.2%) and infant intolerance (40.4%). Conclusions: Strengthening breastfeeding-friendly workplace policies, expanding maternity protection, and promoting community-based education to address misconceptions can improve feeding practices and child health outcomes.

Background: Chronic abdominal pain is a challenging clinical problem, particularly when routine investigations fail to identify a definite cause. Diagnostic laparoscopy provides direct visualization of the abdominal cavity and may identify occult pathologies while allowing simultaneous therapeutic intervention. Aim: To assess the diagnostic and therapeutic efficacy of laparoscopy in the management of chronic abdominal pain. Materials and Methods: A prospective descriptive cross-sectional study was conducted among 30 consecutive patients aged 15–55 years presenting with chronic abdominal pain lasting more than 3 months at the Department of General Surgery, Government General Hospital, Kurnool, during 2022–2024. All patients underwent detailed clinical evaluation and appropriate investigations, followed by diagnostic laparoscopy. Intraoperative findings, therapeutic procedures, postoperative complications, and pain relief were assessed during 3 months of follow-up using the Verbal Rating Scale. Results: The mean age of patients was 33 years, with 17 (56.7%) males and 13 (43.3%) females. The mean duration of abdominal pain was 6 months. The right lower quadrant was the most common site of pain, accounting for 17 (56.6%) patients. Diagnostic laparoscopy identified thickened/inflamed appendix in 14 (46.6%) patients, adhesions in 6 (20%), abdominal tuberculosis in 5 (16.6%), enlarged mesenteric lymph nodes in 1 (3.3%), and neoplasia in 2 (6.6%). No abnormality was detected in 2 (6.6%) patients. Therapeutic procedures were performed in 20 (66%) patients, including laparoscopic appendicectomy and adhesiolysis. Most patients had an uncomplicated postoperative course; wound infection occurred in 2 (7%) patients. Complete or significant pain relief was reported in 36.7% of patients at 1 month and 93.3% at 3 months. Conclusion: Diagnostic laparoscopy is a safe and effective modality for evaluating chronic abdominal pain when conventional investigations fail to establish a definitive diagnosis. It can identify otherwise occult intra-abdominal pathology and permits simultaneous therapeutic intervention, with substantial improvement in pain and clinical outcomes during follow-up.

Objectives: The present study was to evaluate the biochemical changes and microbial profile of neonatal sepsis at tertiary care hospital. Methods: Blood culture sample included a single sample collected from a peripheral vein or artery under aseptic conditions. The local site was cleansed with 70% alcohol and povidone iodine (1%), followed by 70% alcohol again. Blood cultures were done in a brain heart infusion biphasic medium. Isolate was identified by their characteristic appearance on their respective media, Gram staining and confirmed by the pattern of biochemical reactions using the standard method. Biochemical data including urea, creatinine, total bilirubin, direct aminotransferase aminotransferase protein (CRP) were recorded. Results: A total of 546 newborns with clinical sepsis were included. Blood culture reports were positive in 102 cases (18.68%). Male-to-female ratio of 1.75:1. 78(76.47%) had early-onset sepsis and 24(23.53%) had late-onset sepsis. Gestational age of all 102 neonates was 34.56±5.12 weeks. 1 minute and 5 minutes APGAR score was 7.64±3.36 and 8.75±2.64 respectively. Mean urea of all neonates were 55.86±40.17 mg/dl. Mean CRP level was 8.32±9.16 mg/dL. Gram-negative bacilli and Gram-positive cocci were 66/102(64.71%), 36/102(35.29%) respectively. Highest sensitivity among Gram-negative isolates was to imipenem (96.83%), followed by amikacin (51.52%) and netilmicin (40.35%). Gram-positive isolates had the highest sensitivity of 94% to linezolid, 69.39% to tetracycline, 65.31% to piperacillin/ tazobactam, and 54.17% to ciprofloxacin. Conclusions: Klebsiella spp. and coagulase-negative staphylococci (CONS) are the most common organisms isolates in neonatal sepsis. Highest sensitivity among Gram-negative isolates was to imipenem followed by amikacin and netilmicin and gram-positive isolates are to linezolid followed by tetracycline, piperacillin/ tazobactam and ciprofloxacin. The gold standard for diagnostic sepsis is blood culture and the CRP is also particularly useful for monitoring the response to treatment and guiding antibiotic therapy. Hence, the elevated CRP concentrations is indicator of sepsis.

Background: In order to minimise opioid-related side effects and promote early ambulation, mother comfort, and recovery after LSCS (Lower Segment Caesarean Section), effective postoperative pain management is crucial. An efficient localised analgesic method for postoperative pain management is ultrasound-guided TAP (Transversus Abdominis Plane) block. The addition of adjuvants such as dexmedetomidine or magnesium sulphate to bupivacaine may prolong analgesia and improve pain control. Methods: A comparative observational study was conducted in the Department of Anaesthesia, Government Medical College, Thrissur, Kerala, involving 70 women undergoing elective LSCS under spinal anaesthesia. Following surgery, patients received a bilateral ultrasound-guided TAP block with bupivacaine combined either with dexmedetomidine (n=35) or magnesium sulphate (n=35). Pain intensity was assessed using the VAS (Visual Analogue Scale) at 1, 2, 4, 6, 12, and 24 hours postoperatively. Duration of analgesia, haemodynamic parameters, sedation scores, postoperative nausea and vomiting, and other adverse effects were evaluated. Statistical analysis was performed using appropriate analytical methods. Results: In terms of ASA physical status and demographic traits, the two groups were similar. At 6, 12, and 24 hours after surgery, the dexmedetomidine group had significantly reduced VAS pain levels. The mean duration of analgesia was significantly longer with dexmedetomidine (11.79 ± 1.34 hours) than with magnesium sulphate (6.89 ± 1.21 hours). Heart rate and mean arterial pressure showed statistically significant differences at selected postoperative intervals; however, no intervention was required. Sedation scores were higher with dexmedetomidine at 6, 12, and 24 hours, while no significant differences in postoperative nausea, vomiting, or other adverse effects were observed between the groups. Conclusion: Both dexmedetomidine and magnesium sulphate are safe and effective adjuvants to bupivacaine for ultrasound-guided TAP block after LSCS. However, dexmedetomidine provides significantly longer postoperative analgesia, superior pain relief, and acceptable haemodynamic stability without increasing adverse effects, making it the preferred adjuvant for postoperative analgesia in LSCS patients.

Thyroid nodules are a common clinical entity, with benign lesions far outnumbering malignant ones, yet the primary challenge in clinical practice lies in reliably distinguishing benign from malignant nodules. The Thyroid Imaging Reporting and Data System (TIRADS) provides a standardized ultrasonographic risk stratification framework, while the Bethesda System for Reporting Thyroid Cytopathology offers a uniform cytological classification and malignancy risk estimate. This record-based cross-sectional study conducted in the Department of Pathology, S.P. Medical College, Bikaner, from March 2024 to February 2026, evaluated the correlation between TIRADS categories and Bethesda cytological categories in patients with thyroid nodules who underwent fine-needle aspiration cytology (FNAC). A total of 100 consecutive FNAC cases of thyroid lesions with prior radiological TIRADS scoring were included. Demographic data, ultrasonographic TIRADS category, Bethesda cytology category, and detailed cytological diagnosis were extracted from records and analyzed using standard descriptive statistics and Chi-square test. The majority of nodules were TIRADS 2 (63%) and Bethesda II (82%), indicating a predominance of radiologically and cytologically benign lesions. Malignancy (Bethesda V and VI) was present in 10% of cases overall, with malignancy rates of 75% and 100% in TIRADS 4 and TIRADS 5 categories respectively. A highly significant association was observed between TIRADS and Bethesda categories (χ² = 183.21, df = 16, p < 0.001), with complete concordance in TIRADS 1, 2, 4, and 5 categories and reduced concordance (70%) in TIRADS 3. The findings demonstrate that TIRADS is a reliable non-invasive tool for risk stratification of thyroid nodules and shows strong correlation with cytological outcomes, particularly at the extremes of risk. TIRADS 1 and 2 nodules can be managed conservatively in most cases, whereas TIRADS 4 and 5 nodules warrant aggressive diagnostic and therapeutic interventions. TIRADS 3 lesions remain a diagnostically heterogeneous group requiring close correlation with FNAC. A combined approach using both TIRADS and Bethesda systems optimizes diagnostic accuracy and supports rational, evidence-based management of thyroid nodules.

Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections and contribute substantially to antimicrobial use in community and hospital settings. Rising antimicrobial resistance, particularly among extended-spectrum beta-lactamase (ESBL)-producing uropathogens, has complicated empirical therapy and necessitates continuous local surveillance. Aims and Objectives: To determine the prevalence of culture-positive UTIs, identify bacterial uropathogens, evaluate antimicrobial susceptibility patterns, and assess ESBL production in a tertiary care hospital in Western Maharashtra. Materials and Methods: A retrospective laboratory-based study was conducted using urine culture and antimicrobial susceptibility records from January 2022 to January 2024. A total of 19,500 urine samples were analyzed. Demographic characteristics, bacterial isolates, antimicrobial susceptibility profiles, and ESBL production data were retrieved from laboratory records and analyzed using Microsoft Excel. Results: Significant bacteriuria was detected in 1,726 samples (8.85%). Most isolates were from hospital wards (52.9%), followed by outpatients (34.1%) and intensive care units (12.8%). Females constituted 51.3% of culture-positive cases. Escherichia coli (59.2%) was the predominant uropathogen, followed by Klebsiella spp. (21.0%). High resistance was observed to ampicillin, third-generation cephalosporins, and cotrimoxazole, whereas nitrofurantoin retained good activity against E. coli. ESBL production was detected in 59.6% of E. coli and 44.7% of Klebsiella spp. isolates. Conclusion: The high prevalence of ESBL-producing uropathogens and increasing antimicrobial resistance underscore the importance of regular local antibiogram surveillance to guide empirical therapy and strengthen antimicrobial stewardship programs.

Background: The skin changes among the elderly may be physiological or pathological. Physiological skin changes include Asteatotic dermatitis, Xerosis, seborrheic keratitis, dermatoheliosis (photoaging), degenerative changes such as wrinkling, Senile lentigines, Senile comedones, etc. Advancing age is also an independent risk for non-communicable diseases such as diabetes, cardiovascular diseases, hypertension, vascular insufficiency, etc. which may also have cutaneous manifestations leading to dermatoses associated with old age. Material & Methods: The present cross-sectional, prospective study was carried out at the Department of Dermatology, Pacific Institute of Medical Sciences, Umarda, Udaipur, Rajasthan, from 31 March 2021 to 30 September 2022. In this perspective, we enrolled all patients aged more than 60 years and above attending the outpatient clinic with newly onset skin diseases until a sample size of 300 was reached. Results: In the present study, the most common physiological skin change observed in our study population was skin wrinkling (67%), followed by Xerosis (63%).  Senile lentigines and comedones were documented in 12% of cases each. Cherry angioma was the least common physiological change in the skin, seen in 2% elderly population. Wrinkles as well as Senile comedones in significantly higher proportions of normotensive elderly individuals as compared to hypertensive individuals (p<0.05). Xerosis was documented in significantly higher proportions of diabetic elderly patients (p<0.05). Conclusion: We concluded from the present study that the Wrinkling and Xerosis are common physiological manifestations. Wrinkles as well as Senile comedones in significantly higher proportions of normotensive elderly individuals as compared to hypertensive individuals. Xerosis was documented in significantly higher proportions of diabetic elderly patients.

Background: Displaced intra-articular calcaneal fractures are complex injuries associated with subtalar joint incongruity, hindfoot deformity, pain, and long-term functional disability. Percutaneous screw fixation offers a minimally invasive alternative to open reduction, with the potential advantage of reduced soft-tissue complications. Methods: This prospective observational study included 25 patients with 28 displaced intra-articular calcaneal fractures treated by closed reduction and percutaneous fixation using 6.5 mm cannulated cancellous screws. Patients were evaluated clinically and radiologically. Fractures were classified using the Essex-Lopresti classification. Radiological outcome was assessed using Bohler’s angle, Gissane’s angle, calcaneal height, and calcaneal width. Functional outcome was assessed using the Maryland Foot Score. Results: The mean age was 32.4 years, with male predominance. Fall from height was the most common mode of injury. Tongue-type fractures were seen in 64.3% of fractures. Mean Bohler’s angle improved from 13.5° preoperatively to 24.5° postoperatively, while mean Gissane’s angle improved from 149.21° to 127.42°. Good-to-excellent functional outcome was achieved in 85.70% of fractures. Pain on weight bearing was the most common complication. Conclusion: Percutaneous fixation with 6.5 mm cannulated cancellous screws is an effective minimally invasive option for selected displaced intra-articular calcaneal fractures, providing satisfactory functional and radiological outcomes with acceptable complications.

Background: Healthcare professionals work in emotionally demanding environments requiring rapid decisions, empathy, teamwork, and effective communication. Emotional intelligence (EI) has emerged as an important determinant of professional competence, resilience, and quality patient care. Objective: To evaluate self-perceived emotional intelligence and functional emotional intelligence among healthcare professionals using a combination of self-report and performance-based assessment tools. Methods: A cross-sectional observational study was conducted among healthcare professionals working in teaching and private hospitals. A total of 48 participants were recruited through convenience purposive sampling. Emotional intelligence was assessed using the Brief Emotional Intelligence Scale (BEIS-10) and a Situational Judgment Test (SJT) consisting of ten healthcare-related scenarios. Descriptive statistics were used to summarize responses and compare self-perceived and functional emotional intelligence domains. Results: Participants demonstrated high levels of self-perceived emotional intelligence on the BEIS-10, with more than half selecting “Agree” or “Strongly Agree” for most items related to self-awareness, empathy, and emotional regulation. SJT responses indicated strong functional emotional intelligence, particularly in empathy (97.9%), accountability (97.9%), conflict management (87.5%), leadership under stress (91.7%), and supportive behavior toward colleagues (97.9%). Compared with BEIS scores, SJT responses displayed greater variability, suggesting a more realistic representation of emotional functioning under pressure. Conclusion: Healthcare professionals reported high emotional intelligence, particularly in empathy and social skills. However, performance-based assessments revealed modest differences between perceived and actual emotional responses in stressful situations. Combining self-report and situational assessments may provide a more comprehensive evaluation of emotional intelligence in healthcare settings.

Aim: This study aims to compare the effectiveness of medical and surgical management in achieving successful resolution of ectopic pregnancy. The study seeks to analyze the clinical implications of these findings to guide optimal management strategies for ectopic pregnancy. Method: This study is a retrospective observational study carried out at C.U.Shah Medical College and Shreemad Rajchandra Sarvamangal Hospital, Surendranagar, Gujarat, covered all women diagnosed with ectopic pregnancy who received either medical or surgical management at CUSMCH in last 5 years from January 2018 to December 2022. Results: Among 110 patients, 46 (41.8%) received medical management and 64 (58.2%) underwent surgical intervention. The success rate was 78.3% in the medical group and 96.9% in the surgical group (p = 0.01). Medical management failure requiring surgery occurred in 21.7% of cases. Complications were more frequent in the surgical group (12.5%), largely due to presentation with ruptured ectopic pregnancy and hemodynamic instability. Hospital stay was shorter in uncomplicated medically managed cases but required prolonged follow-up. Subsequent conception rates were comparable between groups (50% in medical vs. 44.4% in surgical). Discussion: Both medical and surgical management are effective for ectopic pregnancy when appropriately selected. Methotrexate is a suitable fertility-preserving option in stable, unruptured cases with reliable follow-up, whereas surgery remains the definitive and life-saving treatment in ruptured or unstable cases. Individualized, patient-centered decision-making is essential to optimize clinical and reproductive outcomes.

Background: Sarcopenia is increasingly recognised as a systemic complication of type 2 diabetes mellitus (T2DM) and chronic kidney disease. Its role as an early predictor of diabetic kidney disease progression remains insufficiently studied in Indian hospital settings. Methods: This prospective observational cohort study included 225 adults aged 40–75 years with T2DM at GSL Medical College. Baseline assessment included clinical characteristics, handgrip strength, calf circumference, five-times chair-stand test, walking speed, SARC-F score, HbA1c, serum creatinine, estimated glomerular filtration rate and urine albumin–creatinine ratio. Participants were classified according to sarcopenia status and followed for renal outcomes. Multivariable logistic regression was used to identify independent predictors of diabetic kidney disease progression. Results: Sarcopenia was present in 58 participants (25.8%). Diabetic kidney disease progression occurred in 43.1% of participants with sarcopenia and 16.8% without sarcopenia. Sarcopenia was associated with a 2.57-fold higher unadjusted risk of progression. After adjustment for age, sex, diabetes duration, HbA1c, hypertension, baseline eGFR and albuminuria, sarcopenia remained an independent predictor of renal deterioration (adjusted OR: 2.96; 95% CI: 1.48–5.92). Adding sarcopenia-related measurements improved the ROC area from 0.73 to 0.81. Conclusion: Sarcopenia independently predicted diabetic kidney disease progression and may serve as a practical early risk marker in adults with T2DM.

Background: Acute intestinal obstruction (AIO) is one of the most frequently encountered surgical emergencies, particularly in the developing world. Here delayed presentation, limited imaging access, and endemic infectious diseases shape a disease profile distinctly different from Western populations. Region-specific data are indispensable for guiding locally appropriate management. Objectives: To characterise the aetiological spectrum, clinical presentation, and diagnostic utility of imaging in AIO; to describe management strategies employed; and to identify preoperative predictors of postoperative morbidity at a tertiary care teaching hospital in southern Odisha. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery, M.K.C.G. Medical College and Hospital, Berhampur, from November 2023 to October 2025 (two years). Patients aged ≥13 years presenting with mechanical acute intestinal obstruction were enrolled consecutively (n = 114). Demographic data, clinical parameters, laboratory results, imaging findings, operative details, and postoperative outcomes were recorded on a structured proforma and analysed using SPSS® v20.0. A p-value <0.05 was considered statistically significant. Results: The cohort had a male predominance (male‑to‑female ratio 1.9:1); 61.4% were older than 45 years. Abdominal pain was the cardinal symptom (94.7%). Nearly 30% of patients arrived after 72 hours of symptom onset. Post-operative adhesions accounted for the largest share of cases (33.3%), followed by obstructed hernias (24.6%), abdominal tuberculosis (14.0%), malignancy (12.3%), and volvulus (9.6%). Small bowel obstruction predominated (70.2%). Plain radiography was diagnostic in 76.3% of patients, whereas contrast-enhanced CT abdomen achieved a diagnostic yield of 94.1% for identifying the site, cause, and complications of obstruction. Surgical intervention was required in 65.8% of patients. Surgical site infection was the most common postoperative complication (24.0%). Delayed presentation (>72 hours), presence of strangulation, and hypoalbuminaemia were significantly associated with postoperative morbidity (p < 0.05). The in-hospital mortality rate was 4.4%. Conclusion: Acute intestinal obstruction in southern Odisha follows a transitional aetiological pattern, with post-operative adhesions now predominating over obstructed hernias at the tertiary care level, while abdominal tuberculosis remains a significant regional contributor. Timely diagnosis, appropriate use of CT imaging, correction of nutritional deficits, and early surgical intervention are pivotal determinants of outcome. Strengthening referral pathways and community awareness could meaningfully reduce preventable morbidity and mortality in this population.

Background: Incisional hernia is one of the most frequent long-term complications following abdominal surgery and remains associated with considerable morbidity, prolonged hospitalization, impaired quality of life, and increased healthcare expenditure. Despite advances in abdominal wall closure techniques and mesh reinforcement strategies, incisional hernia continues to pose a significant surgical challenge. Data regarding clinical characteristics and outcomes of different repair techniques from Eastern India remain limited. Aim: To evaluate the clinical profile, operative management, and early postoperative outcomes of patients undergoing incisional hernia repair at a tertiary care teaching hospital. Methods: A prospective observational study was conducted in the Department of General Surgery, MKCG Medical College and Hospital, Berhampur, Odisha, from October 2023 to November 2025. A total of 134 patients were screened for eligibility. Twenty-five patients were excluded due to failure to meet eligibility criteria, while 39 were excluded because of incomplete records. Seventy patients were included in the final analysis. Demographic characteristics, comorbidities, previous surgical history, hernia characteristics, operative techniques, postoperative complications, duration of drainage, hospital stay, recurrence, and quality-of-life outcomes were evaluated. Statistical analysis was performed using SPSS version 26.0. Results: The mean age of patients was 46.2 ± 11.6 years. Females constituted 95.7% of the study population. Obesity and diabetes mellitus were present in 22.9% and 18.6% of patients, respectively. Lower-segment caesarean section was the commonest antecedent operation. According to the European Hernia Society classification, W2 defects constituted 90.0% of cases. ONLAY mesh repair was performed in 54.3% of patients, while laparoscopic intraperitoneal mesh placement and preperitoneal mesh repair accounted for 22.9% each. Seroma was the commonest postoperative complication (24.3%) and occurred predominantly following ONLAY repair. All patients completed 12 months of follow-up, and no recurrence was observed. Conclusion: Incisional hernia predominantly affects middle-aged women following lower abdominal and pelvic surgery. ONLAY repair remains the most frequently employed technique; however, it is associated with higher rates of seroma formation. Laparoscopic repair offers favourable short-term recovery outcomes. Appropriate patient selection and optimization of modifiable risk factors remain essential for improving surgical outcomes.

Objective: To identify the obstetric complications, antenatal characteristics, and immediate intrapartum exposure tracks that trigger early-onset neonatal sepsis (EONS) in a public tertiary healthcare hub. Methods: This prospective institutional observational study tracked mother–neonate pairs over an 18-month duration at government hospital of central India. Maternal demographics, antenatal clinic care logs, rupture of membrane timelines, and amniotic patterns were cataloged for cases where infants developed clinical or laboratory-confirmed systemic infection within 72 hours of life. Venous blood cultures were used to confirm specific bacterial flora. Results: A total of 170 mother–neonate pairs were included. Suboptimal antenatal care was a prominent risk marker, with 44.7% (n = 76) of mothers completing fewer than four routine antenatal visits. Prominent intrapartum risk factors driving transmission included prolonged rupture of membranes (≥18 hours) in 32.9% (n = 56), prolonged labor in 40.0% (n = 68), and meconium-stained amniotic fluid in 17.6% (n = 30). Neonatal vulnerability correlated strongly with low birth weight (70.0%; n = 119) and prematurity (47.1%; n = 80). Venous blood culture positivity was 20.6% (n = 35), with Staphylococcus aureus isolated as the predominant pathogen. Conclusions: Early systemic neonatal infection is directly linked to identifiable and manageable maternal indicators, notably unbooked status, maternal infections, and prolonged membrane rupture. Improving access to routine prenatal care and ensuring timely intrapartum antibiotic coverage for prolonged PROM are crucial steps to lower infant mortality.

Background: Intrathecal opioids are commonly added to hyperbaric bupivacaine to improve the quality and duration of spinal anaesthesia. Fentanyl is widely used for this purpose, whereas nalbuphine, a mixed opioid agonist-antagonist, may provide prolonged analgesia with a potentially favourable adverse-effect profile. This study compared the sensory and motor block characteristics produced by intrathecal hyperbaric bupivacaine combined with fentanyl or nalbuphine in patients undergoing lower limb surgery. Methods: This randomized prospective study was conducted in the Department of Anaesthesiology, Thumbay Hospital New Life, Hyderabad, over six months. Sixty patients aged 20–55 years with ASA physical status I or II scheduled for elective lower limb surgery under spinal anaesthesia were included. Patients were randomized into two groups of 30 each using a sealed-envelope technique. Group BUF received 3 mL of 0.5% hyperbaric bupivacaine (15 mg) with fentanyl 25 µg intrathecally, while Group BUN received 3 mL of 0.5% hyperbaric bupivacaine (15 mg) with nalbuphine 1 mg intrathecally. Sensory blockade was assessed by pinprick, while motor blockade was assessed using the modified Bromage scale. Results: The groups were comparable in baseline characteristics. The mean onset time of sensory blockade to T10 was 4.63±1.10 minutes in the BUF group and 5.40±1.38 minutes in the BUN group, with no statistically significant difference (p=0.21). The mean duration of sensory blockade was 156.83±10.70 minutes with BUF and 159.33±12.02 minutes with BUN (p=0.39). The maximum sensory level was also comparable between groups (p=0.843), with T6 being the most frequent level in both groups. In contrast, motor blockade developed significantly earlier with fentanyl. Mean onset of motor blockade was 6.65±0.92 minutes in BUF compared with 8.78±0.89 minutes in BUN (p<0.001). The duration of motor blockade was similar, at 168.83±9.71 minutes and 170.83±9.48 minutes, respectively (p=0.42). Conclusion: Addition of fentanyl or nalbuphine to hyperbaric bupivacaine produced comparable sensory block characteristics and duration of motor blockade. Fentanyl produced a significantly faster onset of motor blockade, whereas nalbuphine provided a similar overall block profile without prolonging motor recovery.

Background and Objectives: Prolongation of postoperative analgesia remains an important objective of spinal anaesthesia, particularly following lower limb surgery, where early mobilisation and effective pain control are essential for functional recovery. Fentanyl is a commonly used lipophilic opioid adjuvant, whereas nalbuphine, a mixed opioid agonist-antagonist with predominant κ-receptor agonist activity and μ-receptor antagonistic properties, has emerged as a potential alternative. Methods: A randomized prospective comparative study was conducted in 60 patients aged 20–55 years with American Society of Anesthesiologists (ASA) physical status I or II undergoing lower limb surgery under spinal anaesthesia. Patients were randomized into two equal groups of 30 each. Group BUF received 15 mg of 0.5% hyperbaric bupivacaine with fentanyl 25 µg intrathecally, whereas Group BUN received 15 mg of 0.5% hyperbaric bupivacaine with nalbuphine 1 mg intrathecally. The primary outcome was the interval from intrathecal drug administration to the first request for postoperative rescue analgesia. Results: The mean time to first rescue analgesia was significantly longer in Group BUN than in Group BUF (686.50±129.37 versus 379.50±54.11 minutes; p<0.001). The absolute between-group difference was 307 minutes, corresponding to approximately 5.1 additional hours of analgesia with nalbuphine. The derived 95% confidence interval for the mean difference was approximately 255.2–358.8 minutes. The standardized effect size was large (Cohen’s d≈3.10). Mean motor block duration was comparable between the groups, measuring 168.83±9.71 minutes in Group BUF and 170.83±9.48 minutes in Group BUN. Conclusion: Addition of 1 mg intrathecal nalbuphine to 15 mg hyperbaric bupivacaine produced a significantly longer duration of postoperative analgesia than 25 µg intrathecal fentanyl. The prolongation of analgesia occurred without meaningful prolongation of motor blockade, suggesting that nalbuphine may be an effective intrathecal adjuvant for extending postoperative pain relief following lower limb surgery.

Background: Cartilage and temporalis fascia are commonly used grafts in Type-I tympanoplasty, but their relative anatomical and audiological performance in endoscopic surgery remains uncertain. Methods: This prospective, non-randomized comparative study included 143 patients undergoing endoscopic Type-I tympanoplasty: 75 received cartilage and 68 temporalis fascia grafts. The primary anatomical outcome was 6-month graft uptake, and the primary audiological outcome was change in air–bone gap (ABG). Pure-tone average (PTA), postoperative complications, and adjusted audiological outcomes were also analysed. Results: Six-month graft uptake was 87.1% with cartilage and 84.1% with temporalis fascia (p=0.620). Both groups showed significant improvement in PTA and ABG. Mean ABG closure was greater with cartilage (13.2 vs 10.3 dB; p<0.001), and cartilage remained associated with a lower postoperative ABG after adjustment (adjusted difference -2.52 dB, 95% CI -3.95 to -1.10). Tympanic membrane retraction occurred less often with cartilage (0% vs 6.3%, p=0.048). Conclusion: Both grafts achieved satisfactory anatomical outcomes, while cartilage provided greater audiological improvement and less postoperative retraction.

Background: Cardiovascular disease (CVD) is the leading cause of death in young and old patients due to myocardial infarction (MI). The risk factors and etiologies must be evaluated for definitive treatment. Method: 90 (Ninty) young and old patients with a confirmed diagnosis of MI were studied, and physical examination was as per Killip’s classification. ECG and angiography were tools to diagnose the condition of MI. Elevated lipid profile, CPKMB, Trop-T, and new modalities of imaging were also used. Results: The major group was 41-50, 26 (28.8%), followed by 22 (24.4%) in 36-40 years of age and 2 (2.20%), in 21-25 years of age. In clinical manifestation 78 (86.6%) had chest pain, followed by 44 (48.8%) perspiration, 14 (15.5%) palpitations, and 18 (20%) vomiting. In the signs, 38 (42.2%) had tachypnea, and 24 (26.6%) had hypertension, and 56 (62.2%) had the 1st classification of Killips. The rate of infarction was highest in 48 (53.3%) anterior septal, followed by 46 (51%) anterolateral. Elevation of ST wave in 80 (88.8%). Conclusion: The clinical study suggests risk factors of MI in adults and old age due to type-II DM, smoking, sedentary life (obesity), and hypertension, which have elevated ST waves, which is a bad prognosis, as it leads to premature mortality.

Background: Due to insidious onset and slow development of CKD lead to diabetic nephropathy (DN). The parameters to diagnose CKD and DN are microalbumin and GFR, these pathophysiological conditions. Hence, cystatin C, which is clearly excreted from the kidney in the circulatory system. Hence, cystatin C is an ideal method to diagnose CKD and DN. Method: Out of 60 type-2 DM patients, 30 were diagnosed with diabetic nephropathy, and 30 diabetics were without nephropathy. The parameters of both groups were compared with 30 healthy (controlled) groups, and significant results were noted. Results: Blood pressure, blood glucose, HbA1c, urea, Serum cr, microalbuminuria, and cystatin-C had significant p-values (p < 0.001). Conclusion: Serum cystatin-C has excellent diagnostic value in early diagnosis of CKD and diabetic nephropathy.

Background: Pale optic disc is due to damage to optic nerve. It could have many etiologies. Proper diagnose and treatments is very important because fundus signs that reflects loss or dysfunction of retinal neurons. Method: Every patients undergone biochemical investigations and neuro imaging studies. The patient were followed up for 6 (Six) months. Clinical examinations included visual acuity by using snellen’s charts, IOP measurement by NCT, refraction anterior sequent examination, slit-lamp biomicroscopy fundus. Photography by fundus camera colour vision by Inshihara’s chart, visual fields by Humphreys automated perimeter contrast sensitivity by Pelli Robson’s chart.    Results: Out of 48 cases 18(37.5%) had right eye, 15 (31.5%) left eye 15 (31.5%) both eyes were involved. Major history was 13 (27%) trauma (Head injury) followed by 6 (12.5%) optic neuritis and 5 (10.4%) SHT/DM. Radiological investigation had 4 (8.3%) fracture of frontal bone 3 (6.25%) parietal SOL, 3 (6.25%) fracture of optic canal MRI study had 10 (2.8%) demyelinating plaques. BCVA repon revealed 16 (33.3%) improved, 32 (66.6%) not improved. Conclusion: Pale optic disc has heterogeneous causes a proper diagnose of optic disc pallor will help the ophthalmologist to treat actual cause of disease, so that patients can lead a normal quality of life.

Background: Appendectomy remains a common emergency operation, yet postoperative morbidity continues to affect recovery, resource use, and unplanned readmission. Infectious and gastrointestinal complications remain particularly relevant after advanced disease. This study quantified the incidence and spectrum of 30-day post-appendectomy complications and examined clinical factors associated with adverse outcomes in an internally consistent simulated cohort. Methods: We conducted a retrospective study of 612 adults who had emergency appendectomy between December 2022 and December 2025. We modeled demographic, inflammatory, operative, and 30-day outcome variables in a manner that was contemporary. Complications were described descriptively and associations were analyzed with non-parametric or exact methods. The prespecified multivariable logistic regression model included age, diabetes mellitus, ASA class ≥III, C-reactive protein (CRP), complicated appendicitis, and laparoscopic approach. Results: At least 56 patients (9.2%) had at least one complication. In 18 patients (2.9%), in 15 patients (2.5%) abdominal abscess was found and 16 patients had postoperative ileus (2.6%). Complicated appendicitis was present in 149 patients (24.3%) and significantly greater morbidity than uncomplicated disease (28.2% vs. 3.0%, p<0.001). On average, patients with complications had a higher median CRP (93.6 vs. 47.4 mg/L), significantly more time under surgical control (86.2 vs. 61.9 minutes) and a longer postoperative period (5.0 vs. 1.8 days; all p<0.001). Further, complicated appendicitis (aOR 8.42, 95% CI 3.39-20.92), diabetes mellitus (aOR 2.89, 95% CI 1.39-6.01) and ASA class ≥III (aOR 2.23, 95% CI 1.05-4.74) also predicted morbidity independently. Laparoscopy is not independently associated with complications (aOR 0.99, p=0.975). Conclusion: Post-appendectomy morbidity in this simulated cohort was concentrated among patients with complicated disease, diabetes, and reduced physiological reserve. The findings illustrate how risk-adjusted analysis can distinguish disease- and host-related determinants from the apparent effects of operative approach.

Background: Chronic plantar fasciitis is one of the most common causes of heel pain and often results in significant pain and functional limitation. Although corticosteroid injection provides rapid pain relief, its effect is often short-lived and may be associated with recurrence and complications. Platelet-rich plasma (PRP), a regenerative biological treatment, has emerged as a promising alternative for promoting tissue healing and long-term symptom relief. Aims & Objectives: To compare the efficacy of platelet-rich plasma (PRP) injection with corticosteroid injection in patients with chronic plantar fasciitis at 1, 2, and 6 months following treatment. Materials and Methods: This prospective observational comparative study was conducted in the Department of Orthopaedics, Adesh Institute of Medical Sciences and Research (AIMSR), Bathinda. A total of 50 patients with chronic plantar fasciitis were included and divided into two groups: Group I received PRP injection, while Group II received corticosteroid injection. Patients were evaluated using the Visual Analog Scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score for functional outcome at baseline and at 1, 2, and 6 months after injection. Treatment-related complications were also recorded. Results: Both PRP and corticosteroid injections were effective in reducing pain and improving functional outcome. Corticosteroid injection demonstrated better early improvement, whereas PRP showed superior long-term reduction in VAS scores and higher AOFAS scores at 6 months. The PRP group also exhibited fewer treatment-related complications and a lower recurrence rate than the corticosteroid group. Conclusion: Both treatment modalities were effective for the management of chronic plantar fasciitis. However, PRP provided superior long-term pain relief, better functional recovery, and a more favorable safety profile compared with corticosteroid injection, making it a valuable treatment option for patients with chronic plantar fasciitis.

Background: Type 2 diabetes mellitus (T2DM) is associated with multiple cardiovascular complications, among which autonomic dysfunction and abnormal blood pressure variability (BPV) are important predictors of cardiovascular morbidity and mortality. Poor sleep quality is highly prevalent in individuals with T2DM and has been implicated in sympathetic over activity, impaired parasympathetic function, endothelial dysfunction, and altered circadian regulation of blood pressure. The interaction between sleep quality, autonomic dysfunction, and blood pressure variability may represent an important early mechanism contributing to cardiovascular risk in patients with T2DM. Objective: To evaluate the association of sleep quality with autonomic dysfunction and blood pressure variability in patients with type 2 diabetes mellitus. Materials and Methods: This cross-sectional observational study included 180 adults with T2DM aged 35–65 years. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Autonomic function was evaluated using Ewing’s cardiovascular autonomic function testsandheart rate variability (HRV) analysis. Blood pressure variability was assessed using 24-hour ambulatory blood pressure monitoring (ABPM). Correlations between PSQI score, autonomic function parameters, HRV indices, and blood pressure variability were analyzed using Pearson correlation and multivariable linear regression. Results: The mean age of participants was 52.8 ± 8.4 years, and the mean duration of diabetes was 7.6 ± 4.1 years. Poor sleep quality (PSQI >5) was observed in 68.3% of participants. Higher PSQI scores showed significant positive correlations with the autonomic dysfunction score (r = 0.48, p < 0.001) and 24-hour systolic blood pressure variability (r = 0.41, p < 0.001), and significant negative correlations with HRV indices including SDNN (r = −0.44, p < 0.001) and RMSSD (r = −0.39, p < 0.001). After adjustment for age, sex, body mass index, HbA1c, duration of diabetes, and antihypertensive therapy, PSQI score remained an independent predictor of autonomic dysfunction (β = 0.36, p < 0.001) and increased systolic blood pressure variability (β = 0.29, p = 0.001). Conclusion: Poor sleep quality was significantly associated with autonomic dysfunction and increased blood pressure variability in patients with type 2 diabetes mellitus. These findings suggest that sleep disturbance may contribute to sympathetic predominance, impaired cardiovascular autonomic regulation, and abnormal circadian blood pressure control, thereby increasing cardiovascular risk in individuals with T2DM.

Background: Serum uric acid (SUA) has emerged as a potential biomarker associated with endothelial dysfunction, impaired vascular reactivity, and elevated blood pressure even in otherwise healthy young adults. Experimental and epidemiological evidence suggests that uric acid may contribute to oxidative stress, reduced nitric oxide bioavailability, vascular smooth muscle proliferation, and activation of the renin-angiotensin system, thereby influencing vascular tone and blood pressure regulation. The relationship between SUA and early vascular changes in young adults remains clinically important because endothelial dysfunction often precedes overt hypertension and cardiovascular disease. Objective: To evaluate the correlation of serum uric acid with vascular reactivity and blood pressure among apparently healthy young adults aged 18–30 years. Materials and Methods: This cross-sectional observational study included 180 young adults (90 males and 90 females) aged 18–30 years. Serum uric acid was measured by the uricase-peroxidase method. Blood pressure was recorded according to standardized guidelines. Vascular reactivity was assessed using brachial artery flow-mediated dilation (FMD) measured by high-resolution ultrasonography after forearm occlusion. Correlations between SUA, FMD, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were analyzed using Pearson correlation and multivariable linear regression. Results: The mean age of participants was 22.4 ± 3.1 years. Mean SUA was 5.2 ± 1.1 mg/dL, mean SBP was 118.6 ± 9.8 mmHg, mean DBP was 74.2 ± 7.1 mmHg, and mean FMD was 9.8 ± 2.4%. Serum uric acid showed a significant negative correlation with FMD (r = −0.42, p < 0.001) and positive correlations with SBP (r = 0.36, p < 0.001) and DBP (r = 0.31, p < 0.001). After adjustment for age, sex, body mass index, fasting glucose, and lipid profile, SUA remained an independent predictor of impaired vascular reactivity (β = −0.34, p < 0.001) and higher systolic blood pressure (β = 0.27, p = 0.002). Conclusion: Higher serum uric acid levels were associated with reduced vascular reactivity and increased blood pressure in young adults. These findings support the hypothesis that elevated uric acid may serve as an early marker of endothelial dysfunction and subclinical cardiovascular risk in apparently healthy young individuals.

Background & Objectives: Chronic otitis media (COM) is a persistent inflammation of the middle ear cleft, serving as a primary cause of preventable hearing impairment in developing countries. Continuous surveillance of its bacteriological profile and antimicrobial resistance patterns is crucial for guiding effective empiric and targeted treatment. This study aimed to identify the aerobic bacterial isolates in patients presenting with COM and to evaluate their antibiotic susceptibility patterns in a tertiary care setting. Methods: A hospital-based cross-sectional study was conducted over an 18-month period (June 2023 to November 2024) at the Department of Otorhinolaryngology, Hassan Institute of Medical Sciences. A total of 100 patients with a history of middle ear discharge lasting >3 months were enrolled. Aural swabs were collected under strict aseptic precautions and processed for aerobic bacterial identification and standard antimicrobial susceptibility testing using the Kirby-Bauer disc diffusion method. Results: The mean age of the study population was 38.4 ± 14.26 years, with a slight male predominance (51% males, 49% females). Mucosal COM was present in 79% of subjects, while 21% had squamosal COM. Culture positivity yielded specific bacterial pathogens, with Staphylococcus aureus being the most prevalent isolate (34%), followed by Pseudomonas aeruginosa (16%), Klebsiella pneumoniae (13%), Proteus mirabilis (11%), Acinetobacter baumannii (8%), and Klebsiella aerogenes (7%). Culture negativity was observed in 6% of cases. Antimicrobial sensitivity testing revealed high susceptibility of S. aureus to Linezolid (20.4%), Clindamycin (12.8%), and Cotrimoxazole (12.8%), while displaying high resistance to Ciprofloxacin (15.4%) and Penicillin G (12.8%). Pseudomonas aeruginosa exhibited maximum sensitivity to Meropenem (15.9%), Piperacillin-tazobactam (13.6%), and Ceftazidime-clavulanic acid (13.6%), with notable resistance to Amikacin (12.9%). Acinetobacter baumannii displayed significant multidrug resistance, retaining maximum sensitivity to Piperacillin-tazobactam (13.5%). Conclusion: Staphylococcus aureus and Pseudomonas aeruginosa remain the primary causative pathogens in chronic otitis media. The emerging resistance against routinely used first-line antimicrobials underscores the critical necessity for regular microbiological monitoring and formulation of institution-specific antibiotic policies.

Objectives: Cataracts are symptomatic lens opacities that obstruct the passage of light onto the retina due to loss of transparency and cause a reduction in vision. The present systematic review and meta-analysis study was to evaluate the quality of life before and after cataract surgery. Methods & Results: A numerous article of national and international repute journals (data base: Pubmed, Scopus, Medline, Embase, etc) were reviewed. Factors Related to the Outcome of Cataract Surgery Monitoring cataract surgical outcomes can be observed in four categories: selection (selection of patients related to poor visual acuity due to preoperative comorbidities such as corneal opacity, glaucoma, and damage to the retina and optic nerve); surgery (surgery-related intraoperative and postoperative complications that affect visual acuity, including lens capsule rupture, iridodialysis, zonular dehiscence, presence of residual material, wound leakage, severe uveitis, and keratopathic striae); spectacles (eyeglass correction); and sequelae (post-operative complications such as posterior capsule opacification, retinal detachment, uveitis, and secondary glaucoma). Evaluation of surgical outcomes in each study was measured, including (1) visual acuity with or without the best correction; (2) measurement of refraction and deviation from the postoperative refractive target; (3) incidence of intraoperative or postoperative complications; and (4) return to the operating room for any secondary surgical intervention. Conclusions: Cataract surgery significantly improved the quality of life across all studies in developed and developing countries. Cataract surgery, a highly effective procedure for restoring vision, plays a crucial role in enhancing the quality of life for elderly individuals. Beyond the obvious visual benefits, this surgery significantly impacts mental health outcomes, including reductions in depression, anxiety, and cognitive decline. Improved vision leads to greater independence, increased social interaction, and overall enhanced psychological wellbeing. Despite these benefits, various barriers, such as socioeconomic factors and limited access to healthcare services, can hinder the positive outcomes of cataract surgery.

Background: Schizophrenia is a chronic and disabling psychiatric disorder that affects patients as well as family caregivers. Its long-term course, recurrent relapses and functional impairment can impose substantial emotional, social and financial demands on families. In India, where families commonly provide long-term care, systematic assessment of caregiver burden is clinically important. Aim: To assess the level of family burden among caregivers of patients with schizophrenia and to evaluate its association with socio-demographic and clinical variables. Methods: This cross-sectional observational study was conducted at Krishna Mohan Medical College and Hospital, Mathura, Uttar Pradesh, from November 2023 to May 2026. A total of 161 caregivers of patients diagnosed with schizophrenia according to ICD-10 criteria were included. Socio-demographic and clinical information was collected using a structured proforma. Caregiver burden was assessed using FBIS-24 and patient functioning using GAF. Data were analysed using IBM SPSS; chi-square tests and one-way analysis of variance were used as appropriate, with p<0.05 considered statistically significant. Results: Among 161 caregivers, 32.3% were aged 41–50 years and 64.0% were female. Parents constituted 46.0% and spouses 29.8% of caregivers. Low, moderate and high FBIS-24 burden were present in 25.5%, 45.3% and 29.2%, respectively. Significant associations were found with age, sex, educational status, duration of illness and relapse frequency. Mean GAF scores decreased from 68.4±7.6 in the low-burden group to 55.9±8.1 in the moderate-burden group and 42.7±6.9 in the high-burden group (p<0.001). Conclusion: Caregiver burden was substantial and was associated with demographic, illness-duration, relapse and functional factors. Early identification of high-risk caregivers and family-focused interventions are important components of comprehensive schizophrenia management.

Background: The liver synthesises most coagulation factors and natural anticoagulants, so chronic liver disease (CLD) disturbs haemostasis. This study assessed the coagulation profile in CLD and its correlation with severity of hepatic dysfunction. Methods: A hospital-based cross-sectional observational study was conducted at a tertiary care teaching hospital in Bhopal, central India, over 18 months. One hundred and eighty consecutive adults with CLD were enrolled. Prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count and liver function tests were measured. Severity was graded by Child–Pugh class and Model for End-stage Liver Disease (MELD) score. One-way analysis of variance with Tukey post hoc testing and Spearman rank correlation were applied. Results: Most participants were aged 31–45 years (37.8%) and male (71.1%); alcohol-related liver disease was the commonest aetiology (54.4%). Elevated INR was the most frequent abnormality (71.1%), followed by thrombocytopenia (60.0%), prolonged PT (57.8%) and prolonged aPTT (55.0%). All parameters worsened progressively across Child–Pugh classes, INR rising from 1.33 ± 0.29 in Class A to 2.56 ± 0.63 in Class C, and across MELD categories (p < 0.001 for all). INR correlated most strongly with MELD score (r = 0.62), followed by albumin (r = −0.59), PT (r = 0.57) and platelet count (r = −0.54); all p < 0.001. Conclusion: Coagulation abnormalities are highly prevalent in CLD and deteriorate predictably with worsening hepatic dysfunction. Routine PT, INR, aPTT and platelet count offer an inexpensive, widely available means of severity assessment and risk stratification.

Background: Spontaneous bacterial peritonitis (SBP) is a serious complication of decompensated liver disease with ascites. Indian data on SBP prevalence and clinical correlates remain limited. Objective: To determine SBP prevalence, microbiological profile, associated clinical parameters, and in-hospital mortality in patients with decompensated liver disease and ascites. Methods: This cross-sectional observational study enrolled 130 consecutive patients with confirmed liver cirrhosis and ascites at L.N. Medical College and J.K. Hospital, Bhopal. All patients underwent diagnostic paracentesis. SBP was diagnosed when ascitic fluid polymorphonuclear (PMN) cell count was ≥250 cells/mm³. Chi-squared and Fisher’s exact tests were used; p < 0.05 was considered significant. Results: The overall SBP prevalence was 13.8% (18/130), comprising culture-positive SBP (8.5%) and culture-negative neutrocytic ascites (5.4%). Mean age was 48.4 ± 12.0 years with male predominance (83.1%). Alcoholic cirrhosis was the commonest etiology (50.8%). Escherichia coli and Staphylococcus spp. were the most frequently isolated organisms (27.3% each). Altered sensorium was significantly associated with SBP (p = 0.036). In-hospital mortality was 16.2% overall, and higher among SBP patients (27.8% vs 14.3%; p = 0.170). Conclusion: SBP is a common complication in hospitalised patients with decompensated liver disease, with a prevalence of 13.8%. Altered sensorium is a significant clinical predictor. Routine diagnostic paracentesis is recommended in all cirrhotic patients admitted with ascites.

Background: Diabetes mellitus is an independent determinant of coronary artery disease severity, yet comparative angiographic data from central India remain limited. Objective: To compare the extent and severity of coronary artery disease between diabetic and non-diabetic patients undergoing coronary angiography. Methods: This observational cross-sectional study enrolled 226 consecutive patients with angiographically confirmed coronary artery disease at a tertiary care hospital in Bhopal over 18 months, allocated equally to diabetic and non-diabetic groups. Clinical, biochemical, electrocardiographic, echocardiographic and angiographic parameters were compared using the chi-square or Fisher’s exact test and the unpaired t test. Results: Diabetic patients were older (58.4 ± 9.2 versus 54.6 ± 10.8 years, p = 0.005) with higher body mass index, hypertension (67.3% versus 42.5%, p < 0.001) and dyslipidaemia (72.6% versus 51.3%, p = 0.001). Symptoms, electrocardiographic diagnosis and biomarker elevation did not differ. Triple vessel disease was far more frequent in diabetics (41.6% versus 16.8%; odds ratio 3.52, 95% confidence interval 1.90–6.54; p < 0.001), whereas single vessel disease predominated in non-diabetics (46.0% versus 24.8%, p < 0.001). Diabetics had more severe lesions (55.8% versus 36.3%, p = 0.003), greater lesion burden (2.8 ± 1.2 versus 1.9 ± 0.8, p < 0.001), more complex lesion morphology, and lower ejection fraction (44.6 ± 11.8% versus 48.4 ± 10.6%, p = 0.012). Conclusion: Diabetes was associated with substantially more extensive, severe and complex coronary artery disease despite a clinical presentation indistinguishable from that of non-diabetic patients, supporting early angiographic evaluation in this group.

Background: Sexual dysfunction is a highly prevalent yet under-recognized complication of diabetes mellitus that profoundly affects quality of life, psychological well-being, and interpersonal relationships. Systematic data from central India remain limited, particularly among younger diabetic men.

Objective: To determine the prevalence and severity of sexual dysfunction and erectile dysfunction in young-to-middle-aged diabetic men, evaluate comorbid depression, and identify associated clinical and demographic determinants.

Methods: This cross-sectional observational study enrolled 370 male diabetic patients aged 18–50 years at L.N. Medical College and J.K. Hospital, Bhopal, over 18 months. Patients were assessed using the Brief Sexual Function Inventory (BSFI), International Index of Erectile Function-5 (IIEF-5), and Hamilton Depression Rating Scale (HAM-D). Chi-square tests and Pearson correlation coefficients were employed.

Results: Mean age was 34.99 ± 9.36 years. Sexual dysfunction was present in 67.6% by BSFI and erectile dysfunction in 94.6% by IIEF-5. Depression affected 83.0%. Duration of diabetes (χ² = 15.20, p < 0.001), HbA1c (χ² = 16.69, p < 0.001), and depression (χ² = 63.96, p < 0.001) were significantly associated with sexual dysfunction; age was not (χ² = 4.82, p = 0.307). Depression was the strongest correlate (BSFI: r = −0.455, p < 0.001). Sexual dysfunction was more prevalent in uncontrolled diabetes (73.6% vs. 50.0%; χ² = 17.42, p < 0.001).

Conclusion: Sexual dysfunction is highly prevalent in young-to-middle-aged diabetic men, strongly associated with depression and poor glycaemic control. Routine screening should be integrated into standard diabetes care.

Background: Awake fiberoptic intubation (AFOI) requires effective topical anaesthesia, adequate sedation and preserved airway reflex suppression. Lignocaine nebulization alone is often insufficient, and adjuvants such as fentanyl and dexmedetomidine have been used to optimize intubating conditions. Comparative data between these two adjuvants during flexible fiberoptic awake nasal intubation (AFNI) under general anaesthesia remain limited.

Methods: In this prospective, randomized, double-blind study, 100 adult patients (ASA I–II) with a predicted difficult airway scheduled for elective ENT, maxillofacial, plastic, orthopaedic or spinal surgery under general anaesthesia were randomized to receive nebulization with either 4% lignocaine (4 mL) plus fentanyl 2 μg/kg (Group F, n = 50) or 4% lignocaine (4 mL) plus dexmedetomidine 1.5 μg/kg (Group D, n = 50), diluted with normal saline to 8 mL, over 20 minutes prior to AFNI. The primary outcome was the cough score during intubation; secondary outcomes included time to intubation, vocal cord position, post-intubation comfort score, Ramsay sedation score, haemodynamic parameters, post-surgery satisfaction score, and adverse effects.

Results: Baseline demographics were comparable between groups. A cough-free intubation occurred in 60% of Group D versus 34% of Group F (p = 0.033). Group D showed a shorter mean intubation time (3.58 ± 1.60 vs. 4.68 ± 1.80 min; p = 0.0017), more favourable vocal cord relaxation (62% vs. 36% fully relaxed; p = 0.029), better post-intubation comfort (64% vs. 32% cooperative; p = 0.007), higher post-surgery satisfaction (50% vs. 30% excellent; p = 0.043) and deeper Ramsay sedation scores (p = 0.038). Heart rate, systolic, diastolic and mean arterial pressures rose less during intubation in Group D, with significant differences between groups at 6, 8 and 10 minutes (p < 0.05). Oxygen saturation and adverse-effect rates were comparable between groups (p = 0.245).

Conclusion: Nebulized dexmedetomidine (1.5 μg/kg) as an adjuvant to lignocaine provided superior cough suppression, faster intubation, better patient comfort and satisfaction, deeper sedation, and greater haemodynamic stability than nebulized fentanyl (2 μg/kg), with a comparable safety profile, during flexible fiberoptic awake nasal intubation under general anaesthesia.

Objective: To determine the frequency of cervical cytological changes and evaluate associated socio-demographic, reproductive, and immunological risk factors among human immunodeficiency virus (HIV)-positive women attending a tertiary care Anti-Retroviral Therapy (ART) center in India.

Methods: A hospital-based cross-sectional study evaluated 206 sexually active HIV-infected women aged 20–70 years. Detailed demographic, gynecological, and reproductive histories were documented. Comprehensive clinical examinations and conventional Papanicolaou (Pap) smears were performed utilizing an Ayre spatula. Cytological classifications were executed following the standardized Bethesda System 2001. Findings were correlated against patient age, parity, coitarche age, sexual partnerships, absolute CD4 counts, and duration of ART.

Results: Normal cytological findings (Negative for Intraepithelial Lesion or Malignancy [NILM]) were reported in 51.0% (n=105) of participants, whereas 48.8% (n=101) presented abnormal cytological or inflammatory alterations. Cytological profiles demonstrated inflammation in 23.8% (n=49), reactive cellular changes in 13.1% (n=27), candidiasis or clue cells in 4.8% (n=10), atrophic changes in 5.8% (n=12), and probable malignancy (LSIL/HSIL/ASC-H) in 1.5% (n=3). Lower CD4 counts correlated inversely with immune preservation, as 49.0% of women with CD4 counts (<200 cells/µL) demonstrated severe cytological anomalies. Gynecological complaints were noted in 64.0% of the cohort, with vaginal discharge predominating at 54.8%.

Conclusion: HIV-positive women exhibit a high frequency of abnormal cervical cytology, compounded by severe immunosuppression. Direct integration of standardized, low-cost cytological screenings within existing ART networks is mandatory to foster early therapeutic intervention.

Background: Endoxifen is the principal active metabolite of tamoxifen and acts as a potent protein kinase C inhibitor. It has gained immense recognition in treatment for acute mania in bipolar disorder. Despite this growing use, its reproductive and endocrine safety in adolescent and reproductive age women remains terra incognita.

Methods: We conducted a retrospective review of five female patients, aged 15 to 28 years, already diagnosed with bipolar affective disorder, who developed menstrual or endocrine abnormalities while on endoxifen. For each case, we examined the clinical timeline, drug exposure history, laboratory reports, pelvic ultrasonography where clinically indicated, dechallenge outcomes and other attributable factors. Causality and severity were assessed using WHO-UMC scale, the Naranjo algorithm, modified Hartwig and Siegel scale and CTCAE (common terminology criteria for adverse events).

Results: The adverse events observed included secondary amenorrhoea, irregular menstrual cycles, hyperprolactinemia, hirsutism, hyperpigmentation and in one patient an ovarian cyst. Serum prolactin levels ranged from 13.07 to 53.4 ng/ml among cohort. Endoxifen was discontinued in every case, following which four patients showed clinical improvement within 6 weeks of discontinuation, while fifth demonstrated a gradual decline in prolactin levels during follow up over 4 months.

Causality assessment using WHO-UMC classified four cases as probable and one as possible. Naranjo scores ranging from 5 to 7.

Conclusion: The consistent temporal association between drug exposure and symptom onset, along with positive dechallenge, points to a possible reproductive endocrine safety signal with use of endoxifen. Clinicians should consider incorporating menstrual history and symptoms based endocrine evaluation in routine follow-up of patients on endoxifen therapy. Multicentre prospective studies are needed to determine the exact incidence and risk factors.

Background and Aims: Supraglottic airway devices (SADs) are increasingly used instead of endotracheal intubation for elective laparoscopic surgery, where a high oropharyngeal leak pressure (OLP) is needed to counter the raised intra-abdominal pressure of pneumoperitoneum. We compared the LMA BlockBuster® and Ambu® AuraGain™ with respect to OLP (primary outcome) and insertion characteristics, haemodynamic response and postoperative morbidity (secondary outcomes) in women undergoing elective diagnostic laparoscopic gynaecological surgery.

Methods: In this prospective, randomized, single-blind study, 80 women of American Society of Anesthesiologists (ASA) physical status I–II, aged 18–60 years, undergoing elective diagnostic laparoscopy under general anaesthesia were randomized by computer-generated random numbers to Group BB (LMA BlockBuster®, n = 40) or Group AA (Ambu® AuraGain™, n = 40). OLP, ease and time of insertion, number of attempts, manipulations required, haemodynamic parameters, and removal and postoperative complications were recorded. Continuous data were analysed using the independent-samples t-test and categorical data using the chi-square/Fisher’s exact test; p < 0.05 was considered significant.

Results: The groups were comparable for age, weight, ASA and Mallampati grade, and duration of surgery (p > 0.05). Mean OLP was significantly higher with the BlockBuster (30.55 ± 2.46 cm H₂O) than the AuraGain (26.41 ± 2.68 cm H₂O; p < 0.0001). Insertion was graded easy more often (62.5% vs. 45.0%; p = 0.043), was faster (17.77 ± 2.56 s vs. 20.05 ± 4.68 s; p = 0.008), required fewer attempts (95.0% vs. 72.5% first-attempt success; p = 0.006) and fewer manipulations (p = 0.022) with the BlockBuster. Haemodynamic parameters, SpO₂, removal characteristics and postoperative sore throat/dysphagia were comparable between groups (p > 0.05).

Conclusion: The LMA BlockBuster® provided a significantly higher oropharyngeal seal pressure and easier, faster, first-attempt insertion than the Ambu® AuraGain™, with comparable haemodynamic stability and postoperative morbidity, supporting its use for airway management during elective laparoscopic gynaecological surgery.

GBS was described by Landry in 1859, but the full extent of the disease and its characteristics were described by Guillain, Barré and Strohl in 1916. GBS is now the world’s most common cause of acute neuromuscular paralysis. GBS affects about 0.4-2.4/100,000 people annually with a bimodal incidence in early and late adulthood, however affecting young adults greater than the elderly. GBS also has a slightly greater male preponderance with a ratio of 1.25–1.5:1. GBS usually involves a prodromal event such as an upper respiratory infection, vaccination, surgery, or a gastrointestinal infection. It is thought that up to 88% of those affected by GBS have a prodromal infection. One to six weeks after the prodromal event, the patient will experience a sub-acute ascending peripheral weakness with decreased or absent deep tendon reflexes. Four subtypes are classified under the umbrella of GBS; these are acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor and sensory axonal neuropathy (AMSAN), and the Miller Fisher Syndrome (MFS). Treatment of GBS includes plasmapheresis or intravenous immunoglobulin (IVIg), as well as respiratory support when needed. Plasmapheresis and IVIG in GBS have been shown to be equal in efficacy; however, the ease of use of IVIG has made this the treatment of choice.

Background: Vector-borne diseases like dengue and chikungunya pose significant public health challenges in Pune. Despite their endemic nature, comprehensive data on their seroprevalence and clinical manifestations remain limited, particularly regarding co-infections. Objective: To investigate the seroprevalence and clinical profile of dengue, chikungunya, and their co – infections in tertiary care hospitals of Pune. Methods: We conducted a retrospective analysis of medical records from tertiary care hospitals across Pune between January 2022 and December 2024. Serological confirmation was done using ELISA for dengue NS1 antigen, IgM, and IgG antibodies, and chikungunya IgM antibodies. Clinical and laboratory parameters were analyzed using appropriate statistical methods. Results: Among 569 patients included in the study, dengue seroprevalence was 21.65%, chikungunya 13.71%, and co-infections 7.26%. Dengue patients predominantly presented with fever (98.61%), headache (86.22%), retro-orbital pain (72.1%), and thrombocytopenia (68.9%). Chikungunya cases typically manifested with high-grade fever (97.8%), severe arthralgia (94.2%), and characteristic rash (67.5%). Co-infected patients exhibited more severe clinical manifestations, with significantly higher rates of hemorrhagic complications (p<0.01) and prolonged hospitalization (mean 6.8 days vs. 4.2 days for mono-infections, p<0.001). Age >60 years, presence of comorbidities, and delayed presentation (>5 days) were identified as significant risk factors for severe disease. Conclusion: Our findings highlight the substantial burden of dengue and chikungunya in Pune, with co-infections presenting unique diagnostic and therapeutic challenges. The distinct clinical profiles identified can aid clinicians in early recognition and appropriate management. Enhanced surveillance, vector control measures, and public awareness campaigns are urgently needed to reduce the disease burden in this endemic region.

Introduction: Vulvovaginal candidiasis (VVC) is one of the most common infection which women experience at least once in their lifetime, caused by different species of Candida. Thus, this study determines the distribution of Candida species and its antifungal susceptibility pattern in a tertiary care hospital. Material and Methods: This is a cross sectional observational study done on the isolates of Candida obtained from the cases of Vulvovaginal candidiasis, from December 2022 to December 2023 and processed with standards using Germ tube test, CHROM agar, Corn meal agar and VITEK 2 Compact System. Results: A total of 436 swabs were received during the study period of which 160 were found to be culture positive for candida. Thus, the prevalence was 36.7% with highest prevalence in the age group of 25-34 years. Candida albicans was the commonest species isolated and resistance to fluconazole was found to be 26.7% and 14.7% susceptible dose dependent to fluconazole, among the strains of Candida albicans. Candida glabrata and Candida krusei are intrinsically resistant to fluconazole. Conclusion: Candida albicans was the most common species with highest prevalence of 75.6% followed by non albicans candida (24.4%). Among the NAC (24.4%), Candida tropicalis (10.6%) was the predominant species followed by Candida glabrata (8.7%). Emergence of fluconazole resistant Candida albicans and other Non albicans candida (NAC) can lead to treatment failure causing recurrent vulvovaginitis. Thus, speciation and its antifungal susceptibility testing can prevent the recurrence and resistance in future in cases of VVC.

Background: Nasotracheal intubation is essential in maxillofacial surgery but carries a high incidence of epistaxis, multiple attempts and an exaggerated pressor response, because the tube is advanced blindly through the nasopharynx. Guiding the tube with a finger placed behind the soft palate is a simple, equipment-free manoeuvre, but evidence for it rests largely on a single trial. Objectives: To compare the success rate, complications and haemodynamic response of finger-guided versus conventional nasotracheal intubation. Methods: Randomised comparative study of 70 adults (ASA I–II, aged 15–70 years) undergoing elective oral and maxillofacial surgery requiring nasotracheal intubation at S.M.S. Medical College and Attached Hospitals, Jaipur. Patients were allocated by sealed envelope to finger-guided intubation (Group A, n = 35) or conventional blind intubation (Group B, n = 35). The primary outcomes were first-attempt success and the incidence and severity of epistaxis (Sugiyama criteria) immediately and five minutes after intubation; secondary outcomes were heart rate, systolic and diastolic blood pressure, mean arterial pressure, oxygen saturation and time to intubation. Groups were compared using the independent-samples t-test and chi-square test. Results: The groups were comparable at baseline (all p > 0.05). Epistaxis occurred in 3/35 (8.6%) in Group A versus 24/35 (68.6%) in Group B immediately after intubation (relative risk 0.12, 95% CI 0.04–0.38; p < 0.001), and in 20.0% versus 94.3% at five minutes (p < 0.001). First-attempt success was 97.1% versus 74.3% (p = 0.017), and intubation was 13.4 seconds faster in Group A (p = 0.005). Heart rate, systolic blood pressure and mean arterial pressure were significantly lower in Group A during and after intubation (all p < 0.05). Conclusion: Finger-guided nasotracheal intubation reduced epistaxis significantly, improved first-attempt success, shortened intubation time and blunted the pressor response compared with the conventional blind technique. It requires no additional equipment or extra cost  and merits routine consideration in maxillofacial surgery.

Background: Orotracheal intubation is a fundamental procedure during general anaesthesia, and successful tube placement depends on both adequate glottic visualisation and effective handling of the endotracheal tube (ETT). The conventional pen-holding grip is the most widely taught method for holding the ETT during direct laryngoscopy; however, the between-the-fingers grip has been proposed as an alternative that may offer better real-time control of tube curvature and tip direction. Despite growing interest, limited randomised data exist comparing these two techniques in terms of intubation outcomes. Objective: To compare the between-the-fingers grip technique with the conventional pen-holding grip technique for holding an endotracheal tube during orotracheal intubation, with respect to intubation attempts, BURP (backward, upward, rightward pressure) requirement, intubation time, haemodynamic changes, and complications. Methods: This prospective, randomised, comparative study was conducted in the Department of Anaesthesiology, SMS Medical College and attached hospitals, Jaipur, after obtaining institutional ethical approval. Three hundred patients aged 18–60 years, ASA physical status I–II, scheduled for elective surgery under general anaesthesia, were randomly allocated to Group M (modified between-the-fingers grip, n = 150) or Group C (conventional pen-holding grip, n = 150) using sealed opaque envelopes. Primary outcomes included first-attempt intubation success rate, BURP requirement, and intubation time. Secondary outcomes included haemodynamic parameters and intubation-related complications. Results: Demographic and airway characteristics were comparable between the two groups. First-attempt intubation success was 99.3% in Group M and 97.3% in Group C (p = 0.176). BURP requirement was significantly lower in Group M than in Group C (0.7% vs. 6.7%; p = 0.014). Mean intubation time was significantly shorter in Group M (12.65 ± 4.23 vs. 14.62 ± 4.71 seconds; p = 0.0002). Heart rate and mean arterial pressure during tube insertion were comparable between the groups (p = 0.505 and p = 0.717, respectively). No major intubation-related complications were observed in either group. Conclusion: Both grip techniques achieved high first-attempt intubation success rates. However, the modified between-the-fingers grip significantly reduced the need for BURP assistance and shortened the intubation time without producing clinically meaningful haemodynamic differences. It may therefore be considered a useful and effective alternative to the conventional pen-holding grip for routine orotracheal intubation.

Background: Awake nasal fibre-optic intubation is the reference technique for the anticipated difficult airway in oral and maxillofacial surgery. The conventional scope-first approach is limited by soiling of the bronchoscope tip with secretions, which impairs glottic visualization and prolongs the procedure. In the modified tube-first (MTF) technique, the endotracheal tube is first positioned in the nasopharynx and the bronchoscope is then passed through it as a protective conduit. This study compared the MTF technique with the conventional technique. Methods: In this prospective, randomized, comparative trial, 94 adults (18–55 years, Mallampati grade ≥3) scheduled for elective oral and maxillofacial surgery were allocated to a conventional group (CG, n=47) or an MTF group (n=47). The primary outcomes were total intubation time, vocal-cord visualization (T1) and time to intubation (T2), while the secondary outcomes were ease of visualization and tube placement, number of attempts, need for rescue manoeuvres, patient reaction score, and complications. Results: The groups were comparable for age, sex and ASA status. Total intubation time was significantly shorter with MTF (104.49 ± 47.81 vs 125.72 ± 41.31 s; p=0.024). T1 was shorter with MTF but did not reach significance (73.06 ± 40.51 vs 86.57 ± 31.07 s; p=0.073, and T2 (31.43 ± 15.69 vs 39.15 ± 16.79 s; p=0.024). First-attempt success was higher with MTF (53.19% vs 23.40%; p=0.010). MTF required fewer bronchoscope reinsertions (46.81% vs 76.60%; p=0.006) and less oxygen insufflation through the bronchoscope (27.66% vs 55.32%; p=0.012). Patient reaction scores were better with MTF (3.09 ± 1.00 vs 3.55 ± 1.10; p=0.048). Epistaxis was less frequent with MTF (42.55% vs 61.70%) but not significantly (p=0.099). No laryngospasm, aspiration or airway injury occurred. Conclusion: The MTF technique is faster, achieves higher first-attempt success, requires fewer rescue manoeuvres and is better tolerated than the conventional technique, with comparable safety. It is a simple and reliable refinement of awake nasal fibre-optic intubation.

Background: The internal iliac artery (IIA) is the principal arterial supply to the pelvic organs, gluteal region, perineum, and medial thigh. Knowledge of its morphometry, especially its length, is essential for vascular surgeons, interventional radiologists, urologists, gynaecologists, and orthopaedic surgeons performing pelvic procedures. Variations in the length of the internal iliac artery may influence surgical exposure, catheterisation, embolisation, and ligation procedures. Aim: To determine the morphometric characteristics of the internal iliac artery with special emphasis on its length in adult human cadavers and to correlate the findings with their clinical significance. Materials and Methods: This descriptive cross-sectional cadaveric study was conducted on 60 internal iliac arteries (30 embalmed adult cadavers) in the Department of Anatomy. Following routine dissection, the common iliac artery and its bifurcation were exposed. The length of the internal iliac artery was measured from the point of origin at the common iliac artery bifurcation to its division into anterior and posterior divisions using a digital Vernier calliper. Measurements were recorded in Millimetres. Statistical analysis was performed using SPSS software. Results: The mean length on the right side was 11.34 ± 2.16 mm, while on the left side it was 11.68 ± 2.11mm. Statistically significant difference was observed between the two sides (p > 0.01). Conclusion: The present study demonstrated considerable variation in the length of the internal iliac artery. These findings provide valuable anatomical information for pelvic surgeries, vascular reconstruction, and endovascular interventions, thereby minimizing the risk of iatrogenic injury.

Background: Spontaneous preterm labor is a major cause of neonatal morbidity and mortality. Maternal genital and urinary tract infections have been linked to inflammatory pathways involved in spontaneous preterm birth, but the role of individual microorganisms varies greatly among different populations. Characterization of the local clinical and microbiological spectrum may be useful in guiding appropriate diagnostic workup and management. Objective: To determine the clinical and microbiological profile of maternal genitourinary tract infections among women presenting with spontaneous preterm labour at a tertiary-care hospital. Materials and Methods: A hospital based prospective study was done among 100 women with singleton pregnancies presenting with spontaneous preterm labor between 28 and 36+6 weeks of gestation at S. Nijalingappa Medical College and HSK Hospital & Research Center, Bagalkot, Karnataka from August 2022 to February 2024. Clinical and obstetric characteristics were documented. Urine specimens and high vaginal swabs were cultured, examined microscopically and tested for antimicrobial susceptibility. Microorganisms were identified by standard microbiological methods and by VITEK-based identification. Participants were classified based on genital, urinary or combined genitourinary infection. Data were analysed by SPSS version 19.0. Chi-square test and Student’s t test were applied appropriately with p<0.05 considered statistically significant. Results: Among the 100 participants 49% were aged between 20–24 years and 63% of them were multigravida. Most women (67%) were between 34 and 37 weeks of gestation. The most common comorbidity noted in the study was hypothyroidism (35%). Genital infection was present in 55 %, urinary infection in 33 % and combined genitourinary infection in 12 %. Candida species was the most common isolate from vaginal specimens (33%) followed by Escherichia coli (15%) and Gardnerella vaginalis (9%). Candida species was isolated in 60% of women with genital infection. E. coli was the most common urinary pathogen (48.48%) and was also isolated in 75% of combined genitourinary infections. We found significant association between microorganism and maternal co-morbidities (p=0.045). Conclusion: Among the genitourinary infections, genital infection was found to be most common infection in women with spontaneous preterm labor. Candida species was the most common pathogen for genital isolates and E. coli was the predominant pathogen for urinary and combined genitourinary isolates. These results support the careful clinical assessment and appropriate microbiological evaluation of suspected maternal genitourinary infection. The study was a prospective observational study without a term-control group, so the findings describe the infection profile among women with spontaneous preterm labor and do not establish a causal relationship between infection and preterm birth.

Background: Hemodynamically significant patent ductus arteriosus (HsPDA) is a common cardiovascular condition in preterm neonates and is associated with considerable neonatal morbidity. Pharmacological closure using intravenous (IV) ibuprofen or IV paracetamol is widely practiced, although evidence regarding their comparative efficacy continues to evolve. Objective: To compare the efficacy of intravenous ibuprofen and intravenous paracetamol for pharmacological closure of hemodynamically significant patent ductus arteriosus in preterm neonates. Materials and Methods: This combined retrospective and prospective comparative study was conducted in a Level III NICU of a tertiary care hospital in Nashik over a period of 24 months. A total of 44 preterm neonates with birth weight below 1500 g and echocardiographically confirmed HsPDA requiring pharmacological treatment were included. Twenty-four neonates received IV paracetamol, while twenty received IV ibuprofen. Baseline characteristics, treatment parameters, duration of management, therapeutic response, and clinical outcomes were compared between the two groups using appropriate statistical tests. Results: Baseline neonatal and maternal characteristics were comparable between the groups. Infants treated with IV ibuprofen required significantly fewer treatment doses (4.3±1.3 vs. 25.2±11.4; p<0.001), shorter treatment duration (4.3±1.3 vs. 6.3±2.8 days; p=0.006), and fewer total days of PDA management (4.3±1.3 vs. 6.7±3.3 days; p=0.005). No statistically significant differences were observed in mortality, duration of hospital stay, oxygen requirement, or major neonatal morbidities between the treatment groups. Conclusion: Intravenous ibuprofen and intravenous paracetamol demonstrated comparable efficacy for the pharmacological management of hemodynamically significant patent ductus arteriosus in preterm neonates. Although intravenous ibuprofen achieved treatment with fewer doses and a shorter duration of therapy, short-term neonatal outcomes were similar between the two groups.

Background: Undernutrition is a common but often neglected complication of liver cirrhosis. It adversely affects the course of the disease, predisposes to complications, prolongs the duration of hospitalization and affects negatively on the survival. The available data on the prevalence and determinants of undernutrition in Indian patients with cirrhosis are scanty but clinically significant. The aim of the present study was to assess the prevalence of undernutrition in patients with liver cirrhosis by using different nutritional tools like clinical, anthropometric, functional and biochemical parameters. Methods: A cross sectional observational study was conducted among 120 adult patients diagnosed clinically and ultrasonographically for liver cirrhosis attending the Department of Medicine, Assam Medical College and Hospital, Dibrugarh. Nutritional status was assessed using a modified subjective global assessment (SGA) and anthropometric measurements such as body mass index (BMI), dry BMI, triceps skinfold thickness (TSF), waist circumference, waist-hip ratio, and handgrip strength (HGS). Biochemical parameters such as serum albumin, total cholesterol, total lymphocyte count, serum creatinine, hemoglobin, vitamin D, and vitamin B12 were also assessed. Severity of disease was evaluated by Child-Pugh classification. Descriptive and inferential tests were performed for the data analysis and p<0.05 was considered as statistically significant. Results: Patients with liver cirrhosis had a high prevalence of undernutrition. The prevalence differed based on the assessment tools, with functional and anthropometric methods detecting significantly more patients than BMI only. Nutritional indices including handgrip strength, triceps skinfold thickness, serum albumin, lymphocyte count and cholesterol were significantly less in patients with advanced Child–Pugh class. Patients with undernutrition were more likely to have clinical signs of micronutrient deficiency. The handgrip strength was one of the most sensitive indicators of nutritional impairment. Conclusion: Undernutrition is very common in patients with liver cirrhosis and it is strongly correlated with the disease severity. Routine nutritional screening with a combination of subjective, anthropometric, functional and biochemical methods should be incorporated into the standard f care for cirrhosis for early nutritional intervention and improved clinical outcomes.

Background: Community-acquired pneumonia (CAP) continues to be one of the most important infectious diseases worldwide and is associated with substantial morbidity, mortality, prolonged hospitalization and healthcare expenditure. Despite advances in antimicrobial therapy and critical care services, CAP remains a major challenge due to the heterogeneity of etiologic agents, increasing antimicrobial resistance, and variability in clinical presentation. There is paucity of data on clinical characteristics, radiological features and bacteriological profile of CAP from Northeast India and region-specific evidence is vital for improving the empirical treatment strategies. Objectives: To evaluate the clinical profile, radiological findings, bacteriological profile, risk factors and clinical outcomes in adult patients diagnosed with community acquired pneumonia in a tertiary care teaching hospital. Materials and Methodology: Methods: It was a prospective observational hospital based study done in Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam. Consecutive adult patients meeting the diagnostic criteria for community-acquired pneumonia, based on clinical features and chest radiography, were included during the study period. The demographic characteristics, clinical symptoms, physical examination findings, laboratory investigations, sputum Gram stain, bacterial culture, chest radiography and treatment outcomes were recorded on a structured proforma. Descriptive and inferential statistics were used to analyze the data. Continuous variables are presented as mean ± SD; categorical variables are expressed as frequencies and percentages. Statistical analyses were carried out using appropriate statistical tests and P<0.05 was considered statistically significant. Results: The study showed that community acquired pneumonia mainly affected the elderly and patients with underlying comorbid illnesses. Fever, productive cough, dyspnea, pleuritic chest pain and expectoration were the most common presenting complaints. Smoking and chronic obstructive pulmonary disease were the most common associated risk factors. The main radiological finding was lobar consolidation, with lower lobes being more often affected than upper lobes. Streptococcus pneumoniae remained the most common bacterial pathogen isolated but Gram-negative organisms such as Klebsiella pneumoniae and Pseudomonas aeruginosa were also identified, particularly in elderly patients and those with significant comorbidities. Multilobar involvement, severe hypoxemia, bacteremia and multiple comorbid conditions were associated with longer hospital stay and worse clinical outcomes. Conclusion: Pneumonia acquired in the community remains a major problem for public health in adults, especially in the elderly with pre-existing pulmonary disease and a history of smoking. Early chest radiography and microbiological assessment, along with a thorough clinical assessment, are essential for prompt diagnosis and appropriate empirical antimicrobial therapy. Knowledge of regional pathogen distribution may lead to evidence-based antibiotic choice and improve treatment outcome.

Background: Pregnancy-induced hypertension (PIH) is associated with systemic vascular changes that may involve the retina. Fundus examination can provide a non-invasive means of assessing the severity of hypertensive disease and its systemic vascular effects. This study evaluated the pattern of fundus changes in women with PIH and their association with hypertension severity and proteinuria. Material and Methods: This prospective observational study included 120 pregnant women with PIH beyond 28 weeks of gestation at Sir T. Hospital and Government Medical College, Bhavnagar. Participants underwent detailed ophthalmic examination, including dilated fundus evaluation. Hypertensive retinal changes were graded using the Keith-Wagener-Barker classification. Fundus findings were correlated with PIH severity, blood pressure, and proteinuria grade. Results: Grade 1 hypertensive retinopathy (HTNR) was the most common finding (35.8%), followed by Grade 2 (17.5%), Grade 3 (10.0%), and Grade 4 (6.7%); 26.7% had a normal fundus. Macular edema and retinal detachment occurred in 1.7% each. Fundus findings were significantly associated with PIH severity (χ²=34.716, p=0.0005) and proteinuria grade (χ²=43.227, p<0.0001). Grade 4 HTNR, macular edema, and retinal detachment occurred exclusively in women with eclampsia. Mean systolic blood pressure increased significantly across PIH severity categories for several fundus groups (p<0.0001). Conclusion: Fundus abnormalities were frequent in PIH and were significantly associated with disease severity and proteinuria, supporting the role of ophthalmic evaluation in identifying severe hypertensive disease.

Background: Intrathecal opioids are commonly used as adjuvants to local anaesthetics during spinal anaesthesia to improve intraoperative block quality and prolong postoperative analgesia. Fentanyl and pethidine possess differing pharmacological profiles that may influence onset, duration, and adverse-effect patterns. Objective: To compare intrathecal fentanyl and pethidine as adjuvants to bupivacaine in patients undergoing hip surgery with respect to onset and duration of sensory and motor block, postoperative analgesia, rescue analgesic requirement, and adverse effects. Materials and Methods: This prospective, randomized, double-blind study enrolled 66 patients undergoing hip surgery under spinal anaesthesia at the Department of Anaesthesiology, National Institute of Medical Sciences and Research Hospital, Jaipur. Patients were randomized in a 1:1 ratio into Group F (bupivacaine + fentanyl 25 µg, n = 33) and Group P (bupivacaine + pethidine 25 mg, n = 33). Block characteristics, Visual Analogue Scale (VAS) scores, time to first rescue analgesia, 24-hour analgesic consumption, and adverse effects were recorded and analysed. Results: Sensory block onset was significantly faster in Group F (2.86 ± 0.20 min) than Group P (3.86 ± 0.20 min; p<0.001), as was motor block onset (5.25 ± 0.29 vs 6.88 ± 0.25 min; p<0.001). Duration of analgesia was significantly longer in Group P (279.55 ± 11.13 min) than Group F (199.12 ± 10.29 min; p<0.001). VAS scores were significantly lower in Group F at 3 and 12 hours. Time to first rescue analgesia was comparable between groups (p=0.305). Adverse effects were numerically more frequent in Group P but did not reach statistical significance. Conclusion: Intrathecal fentanyl provides faster onset of block and superior early postoperative analgesia, while pethidine provides prolonged analgesia with lower early rescue requirement. Both agents demonstrated an acceptable safety profile.

Background: Ovarian cancer is one of the leading causes of gynecological cancer-related mortality due to late diagnosis. Serum CA-125 is widely used as a tumor marker for ovarian malignancy but lacks specificity, as it may be elevated in several non-ovarian malignancies and benign conditions. Carcinoembryonic antigen (CEA) is more frequently elevated in gastrointestinal and other non-ovarian malignancies. The ratio of CA-125 to CEA has been proposed as a useful diagnostic tool to differentiate ovarian from non-ovarian malignancies. Aim: To evaluate the diagnostic accuracy of the serum CA-125 to CEA ratio in differentiating ovarian malignancies from non-ovarian malignancies. Materials and Methods: This hospital-based cross-sectional study included patients with histopathologically confirmed malignancies. Serum CA-125 and CEA levels were measured using chemiluminescent immunoassay techniques. The CA-125/CEA ratio was calculated for each patient. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value and to assess diagnostic performance. Results: The CA-125/CEA ratio showed significantly higher values in ovarian malignancies compared to non-ovarian malignancies (p < 0.001). At an optimal cut-off value of >25, the ratio demonstrated good sensitivity and specificity for identifying ovarian malignancy. The area under the ROC curve indicated good diagnostic accuracy. Conclusion: The serum CA-125 to CEA ratio is a simple, cost-effective, and reliable diagnostic marker for differentiating ovarian malignancies from non-ovarian malignancies and may be used as an adjunct to routine diagnostic evaluation.

Background: Antimicrobial overuse and inappropriate prescribing are common in healthcare settings, although the prevalence varies between community pharmacies and Government hospitals. Few comparative studies have been conducted in India and hence needs further research. Objective: To compare antimicrobial use patterns, dispensing practices, and indicators of appropriate antibiotic use between a multidisciplinary teaching hospital and community pharmacies. Methods: This was a cross-sectional observational comparative study conducted over a six-month period. In a Government tertiary care teaching hospital, 846 prescriptions from twelve departments were assessed using WHO indicators for antimicrobial use. A total of 151 private pharmacies in urban and semi-urban areas were also surveyed to assess antimicrobial dispensing patterns and awareness on antimicrobial resistance (AMR). Results: In our hospital, 84.6% of hospitalizations required the use of antimicrobials, with an average of 1.6±0.5 antimicrobials per prescription and average treatment duration of 5.1±2.2 days. The most frequently used antimicrobials were ceftriaxone (40.4%), ceftriaxone-sulbactam (20%), and metronidazole (16.8%). Empirical treatment was predominant, with limited use of cultures and antibiotic susceptibility testing. In community pharmacies, 76.8% of antimicrobials were dispensed without a prescription, primarily for viral infections (colds, coughs, fever, and diarrhoea). Among those dispensing over-the-counter (OTC) medications, 84.1% were unaware of antimicrobial resistance (AMR). Azithromycin, amoxicillin-clavulanic acid, and the ofloxacin-ornidazole combination were the most frequently dispensed over-the-counter medications. Conclusion: The high use of antimicrobials in both cases is due to empirical prescribing in Government hospitals and over-the-counter dispensing in community pharmacies. The study highlights the need to strengthen antibiotic stewardship strategies through well-structured hospital guidelines, more frequent use of culture testing, strict adherence to guidelines, and time to time training of pharmacists in community pharmacies.

Background: ABO blood-group antigens have been investigated for their potential association with susceptibility to infectious diseases. However, the relationship between ABO blood group and seropositivity for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among blood donors remains uncertain. This study evaluated the association between ABO blood group and seropositivity for these transfusion-transmissible infections. Material and methods: A retrospective observational analytical study was conducted among 6,000 blood donors. Data regarding age, sex, ABO and Rh(D) blood groups, and screening results for HIV, HBV, and HCV were retrieved from blood-bank records. Associations between ABO blood group and infectious markers were assessed using the chi-square or Fisher’s exact test. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with blood group O as the reference category. Results: Among 6,000 donors, blood group B was predominant (35.0%), followed by A (30.0%), O (25.0%), and AB (10.0%). HIV, HBsAg, and anti-HCV seropositivity were observed in 12 (0.20%), 85 (1.42%), and 42 (0.70%) donors, respectively. No significant association was observed between ABO blood group and HIV seropositivity (P=0.963). Similarly, ABO group was not significantly associated with HBsAg positivity (P=0.437) or anti-HCV positivity (P=0.131). HBsAg positivity was highest in group O (1.73%), whereas anti-HCV positivity was also highest in group O (1.13%). Conclusion: ABO blood group was not significantly associated with HIV, HBV, or HCV seropositivity among the blood donors studied. Routine screening for transfusion-transmissible infections therefore remains essential irrespective of ABO blood group.

Background: Coagulopathy is a common and clinically significant complication of chronic liver disease (CLD), resulting from impaired hepatic synthesis of clotting factors. Fresh Frozen Plasma (FFP) is widely used to correct these abnormalities, yet its effectiveness in improving coagulation parameters and controlling clinical bleeding remains incompletely characterised in Indian tertiary settings. Aim: To evaluate the effect of FFP transfusion on Prothrombin Time (PT) and International Normalised Ratio (INR) in adult patients with CLD presenting with clinical bleeding diathesis, and to assess bleeding control outcomes in relation to disease severity. Methods: A single-centre, hospital-based, pre–post interventional study was conducted at Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH) (Former name) , but now presently known as Barpeta Medical College and Hospital (BMCH) (After name change of the College and Hospital) , Barpeta, Assam over 18 months. One hundred adult patients with diagnosed CLD, elevated PT and INR, and clinical bleeding diathesis were enrolled. PT and INR were measured before and after FFP transfusion using an automated coagulation analyser. Bleeding control was assessed clinically. Disease severity was graded by the Child–Pugh classification. Data were analysed using paired t-test and chi-square test; p<0.05 was considered significant. Results: Mean PT decreased significantly from 27.8±6.21 seconds pre-transfusion to 20.5±5.78 seconds post-transfusion (p<0.001), a mean percentage reduction of 26.5±11.3%. Mean INR declined from 3.77±1.33 to 3.0±1.31 (p=0.004), representing a 22.2±12.1% reduction. Bleeding was controlled in 84% of patients; 16% showed no improvement. The majority (76%) were classified as Child–Pugh Class C. Patients with more advanced disease required more FFP units and showed comparatively less consistent bleeding control, though the difference between Class B and Class C was not statistically significant (p=0.919). Conclusion: FFP transfusion produces statistically significant improvements in PT and INR in CLD patients with bleeding diathesis, and supports clinical haemostasis in most cases. However, the degree of benefit is influenced by underlying disease severity, and complete correction is rarely achieved in advanced disease. Routine monitoring of coagulation parameters and judicious use of FFP remain essential in this patient group.

Background: Perforation peritonitis is a major surgical emergency associated with polymicrobial infection, antimicrobial resistance, sepsis, postoperative morbidity, and mortality. Conventional culture may delay pathogen identification and antimicrobial susceptibility reporting, potentially prolonging inappropriate empirical therapy. Rapid whole genome sequencing (rWGS) offers earlier and broader microbial detection with resistance profiling. Objectives: To compare rWGS with conventional culture for detection of polymicrobial peritonitis, microbial profile, antimicrobial resistance, and to assess its utility in optimizing antibiotic therapy and clinical outcomes. Materials and Methods: This prospective observational study included 70 patients with perforation peritonitis undergoing surgery. Intra-abdominal fluid was divided for parallel rWGS and conventional culture. Pathogen detection, polymicrobial infection, resistance patterns, turnaround time, antibiotic modification, surgical site infection (SSI), ICU admission, and mortality were evaluated. Results: Conventional culture detected organisms in 58 patients (82.9%), whereas rWGS identified organisms in all 70 patients (100.0%). Polymicrobial infection was detected in 48.6% by culture and 68.6% by rWGS. Mean reporting time was significantly shorter with rWGS than culture (33.9 ± 6.0 vs 77.0 ± 12.1 hours; p<0.001). Antibiotic therapy was modified in 62.9% of patients following rWGS findings. SSI occurred in 48.6%, ICU admission in 65.7%, and mortality in 15.7%. Conclusion: rWGS provided superior pathogen detection, improved recognition of polymicrobial infection, and substantially faster reporting, thereby supporting earlier antimicrobial optimization in perforation peritonitis.

Background: Poisoning is a global health problem and has been considered as one of the common causes for attending emergency department of a hospital¹. Hospital-based data are useful for identifying commonly encountered poisons and developing appropriate preventive and emergency management strategies. The present study describes the demographic and epidemiological profile of poisoning cases presented to the emergency department of a private medical college in Manipur. Methods: A retrospective study was conducted between Jan 2024 – Dec2024 among patients presenting with poisoning to the Emergency Department of a Shija Academy of Health Sciences. A total of 69 poisoning cases were analyzed using descriptive statistics and expressed as frequency and percentage. Results: Among the 69 cases, 39 (56.5%) were males and 30 (43.5%) were females, giving a male-to-female ratio of 1.3:1. The largest age group was 31–40 years (15; 21.7%), followed. The majority of patients were Hindu (66; 95.6%). Suicidal poisoning was the predominant mode of poisoning, accounting for 52 cases (75.4%), followed by accidental poisoning in 17 cases (24.6%); Herbicide poisoning with paraquat was the most frequently identified type of poisoning (19; 27.5%), followed by organophosphorus insecticides (12; 17.4%). Most patients presented within six hours of poisoning (43; 62.3%). The commonest time of occurrence was afternoon (28; 40.6%). Regarding outcome, 46 patients (66.7%) were admitted, 17 (24.6%) were discharged and 6 (8.7%) left against medical advice. Fifty-four patients (78.3%) were brought by family/attendants, while 15 (21.7%) were referred from other hospitals. Conclusion: Suicidal poisoning constituted the majority of poisoning presentations in this study. Paraquat and organophosphorus compounds were the most frequently encountered toxic agents. The predominance of intentional self-poisoning, particularly with agricultural chemicals, highlights the need for early emergency management, mental health assessment and preventive strategies aimed at reducing access to highly hazardous pesticides. Strengthening poisoning surveillance and community-based prevention may help reduce the burden of poisoning in Manipur.

Background: Leprosy remains an important public health concern in endemic regions despite the availability of multidrug therapy. Slit-skin smear (SSS) examination is an established laboratory method for confirming the diagnosis, estimating bacillary load, and supporting disease classification. Understanding the clinic-bacteriological profile of leprosy patients is essential for strengthening disease surveillance and early case detection. Objective: To evaluate the demographic profile, clinical characteristics, bacteriological index (BI) grading, and temporal trends among slit-skin smear-positive leprosy cases in a tertiary care centre. Methods: A retrospective observational study was conducted using records of clinically suspected leprosy patients who underwent slit-skin smear examination from January 2020 to February 2025 at the Supervisory Urban Leprosy Unit, Nagpur, Maharashtra. Demographic details, clinical features, clinical spectrum, bacterial index (BI) grading, and year-wise distribution were extracted from laboratory records and analysed using descriptive statistics at a tertiary care teaching hospital in Nagpur. Results: Among 389 clinically suspected cases, 167 (42.93%) were slit-skin smear-positive. Rural cases constituted 245 (62.98%) of the suspected cases, with a smear positivity of 42.86%, while urban cases showed a positivity of 43.06%. The highest number of smear-positive cases occurred in the 35–44-year age group. Hypopigmented patches (30%) were the most frequently documented clinical presentation, followed by numbness (27%) and nerve involvement (18%). Grade 2 disability was documented in 82 cases, with claw hand being the predominant disability (39.0%). On Ridley–Jopling classification, lepromatous leprosy was the predominant category (40.7%), followed by borderline lepromatous (26.9%) and mid-borderline disease (20.3%). A high bacteriological index of 5+ or 6+ was observed in 72 (43.1%) smear-positive cases. Year-wise analysis demonstrated an overall increase in the number of smear-positive cases during the study period. Conclusion: The findings indicate a persistent burden of multibacillary leprosy with significant disability and high bacillary loads. Strengthening early case detection, timely treatment, and disability prevention measures is essential to reduce transmission and improve patient outcomes.

Background: Dengue fever presents an escalating public health crisis globally, necessitating robust entomological surveillance protocols to track its primary vectors, Aedes aegypti and Aedes albopictus. Traditional Stegomyia indices viz, House Index (HI), Container Index (CI), and Breteau Index (BI) serve as the foundational indicators for evaluating ecological receptivity and epidemic potential. This study evaluates the seasonal spatial colonization dynamics of Aedes larvae within a high density urban environment to establish actionable vector control thresholds. Methods: A prospective, 12 month cross sectional entomological survey was conducted across 12,450 residential and commercial properties. Standardized visual inspections of 45,680 domestic, peri-domestic, and commercial water holding structures were systematically executed. Larval specimens were extracted via standard dipping methods and subjected to definitive morphological species identification. Monthly distributions of HI, CI, and BI were mapped against macroclimatic parameters. Results: A total of 18,420 Aedes larvae were recovered, with A. aegypti accounting for 84.5% and A. albopictus for 15.5%. Pronounced temporal variations were observed, culminating in a critical post-monsoon surge where indices reached their maxima (HI: 12.6%, CI: 10.9%, BI: 34.5), vastly exceeding standard public health alert thresholds ( HI > 5%; BI > 20). Old; and discarded automobile tyres and open plastic storage drums demonstrated the highest breeding productivity, serving as primary ecological reservoirs. Conclusion: Aedes larval indices exhibit strict seasonal coupling with monsoon precipitation patterns and human water storage adaptations. While immature surveillance metrics pose operational constraints regarding cryptic breeding and adult production, they remain vital for mapping micro epidemiological vulnerability. Vector management must transition to proactive source reduction and localized targeted chemical interventions 4 to 6 weeks before historical seasonal transitions to prevent urban dengue outbreaks.. Old; and discarded automobile tyres and open plastic storage drums demonstrated the highest breeding productivity, serving as primary ecological reservoirs.

Background: Dengue is a major mosquito-borne viral illness with clinical manifestations ranging from uncomplicated febrile disease to severe dengue with plasma leakage, haemorrhage, and organ dysfunction. Ultrasonography (USG), being rapid, non-invasive, accessible, and radiation-free, can demonstrate early features of plasma leakage and visceral involvement, potentially assisting assessment of disease severity. Aims & Objectives: To evaluate the spectrum of ultrasonographic findings in patients with dengue and determine their correlation with clinical dengue infection severity. Material & Methods: This cross-sectional study was conducted in the Department of Radio-diagnosis, Basaveshwara Medical College and Hospital, Chitradurga, from October 2022 to September 2023. Hospitalized dengue patients referred from General Medicine were selected by simple random sampling and underwent ultrasonographic assessment for relevant abdominal and thoracic abnormalities. Statistical analysis was performed using Microsoft Excel and SPSS, with data presented in percentages. Results: Among the participants, 54.3% had dengue with warning signs, 30.0% dengue without warning signs, and 15.7% severe dengue. Among severe dengue cases, perinephric fluid was observed in 45.5%, pleural effusion in 18.2%, and splenomegaly and pericholecystic fluid in 9.1% each. Among patients with warning signs, gallbladder wall thickening occurred in 31.6%, hepatomegaly in 28.9%, ascites in 15.8%, pleural effusion in 13.2%, and splenomegaly in 10.5%. Conclusion: USG provides valuable supportive evidence of dengue severity. Gallbladder wall thickening emerged as the most sensitive finding, while pleural effusion was the most specific, supporting ultrasonography as a useful adjunct for timely severity assessment.

Background: Neck masses comprise a heterogeneous group of inflammatory, congenital, benign, and malignant lesions, often presenting diagnostic challenges because of complex cervical anatomy. Multidetector computed tomography (MDCT) enables rapid volumetric acquisition, high spatial resolution, multiplanar reconstruction, and accurate assessment of lesion extent. This study evaluated MDCT characteristics of neck masses with cytological correlation. Aims & Objectives: To assess the role of MDCT in detecting, characterizing, and diagnosing neck masses; correlate imaging findings with cytology; determine diagnostic accuracy; and differentiate benign from malignant lesions. Material & Methods: This hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis, Basaveshwara Medical College and Hospital, Chitradurga, from August 2022 to March 2024. Eligible patients presenting with neck masses were recruited through universal sampling and evaluated using MDCT, with cytological correlation wherever applicable. Statistical analysis was performed using Microsoft Excel and SPSS, with data presented in percentages. Results: Visceral space was the commonest site (40%), followed by parapharyngeal space (18%). Heterogeneous density predominated (66%). Abscess was the commonest benign lesion (14%), followed by lymph-node mass (12%) and lymphangioma (10%). Among malignant lesions, carcinoma was most frequent (14%), followed by malignant lymph-node mass (8%) and laryngeal carcinoma (6%). MDCT demonstrated 95.2% sensitivity, 100% specificity, and 100% positive predictive value for predicting neck masses. Conclusion: MDCT provides valuable characterization of neck masses and facilitates differentiation of benign and malignant lesions through assessment of enhancement, necrosis, invasion, calcification, and fat content. Its high diagnostic performance, combined with cytological correlation, supports accurate diagnosis, evaluation of disease extent, biopsy guidance, and appropriate therapeutic planning.

Background: Postpartum haemorrhage remains an important cause of maternal morbidity and mortality, particularly after caesarean delivery. Effective prophylactic uterotonics are therefore essential. Carbetocin, a long-acting oxytocin analogue, may provide sustained uterine contraction and reduce the need for additional interventions. Its prolonged action may offer clinical advantages over conventional oxytocin during the immediate postoperative period. Aims & Objectives: To compare the haemodynamic effects of carbetocin and oxytocin and assess their efficacy in preventing postpartum haemorrhage following caesarean section. Material & Methods: This randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology, Basaveshwara Medical College and Hospital, Chitradurga, from August 2022 to March 2024. A total of 240 women beyond 37 weeks undergoing caesarean section were allocated equally: 120 received intramuscular carbetocin and 120 received intravenous oxytocin infusion. Haemodynamic parameters, uterine tone, additional uterotonic requirement, perioperative haemoglobin and blood transfusion were evaluated. Statistical analysis was performed using Microsoft Excel and SPSS, with data presented in percentages. Results: Second-line uterotonics were required in 45.0% of the oxytocin group but in none receiving carbetocin. At 24 hours, very good uterine tone was observed in 42.5% with carbetocin versus 32.5% with oxytocin. Mean postoperative haemoglobin was 10.9 g/dL and 8.9 g/dL, respectively, with a statistically significant difference. Blood transfusion was required in 5.0% of oxytocin recipients and none receiving carbetocin. Conclusion: Carbetocin demonstrated favourable efficacy in maintaining uterine tone, limiting haemoglobin decline, reducing additional uterotonic use and minimizing transfusion requirements after caesarean delivery.

Background: Surgical site infections (SSIs) remain important postoperative complications following elective gynecological surgery, increasing morbidity, hospital stay, treatment burden, and healthcare expenditure. Prevention care bundles integrate evidence-based perioperative measures and may provide a practical strategy for minimizing infection risk. Aims & Objectives: To assess SSI rates following implementation of a prevention care bundle during the perioperative period and compare SSI rates before and after bundle implementation. Material & Methods: This observational study included 300 patients undergoing elective gynecological surgery at Vani Vilas Hospital, BMCRI, and Bengaluru. SSI occurrence after implementation of the prevention care bundle was evaluated and compared with baseline pre-implementation data. Age, education, comorbidities, body mass index, hemoglobin, incision type, blood transfusion, and microbiological findings were assessed. Statistical analysis was performed using Microsoft Excel and SPSS, with data presented in percentages. Results: SSI incidence was significantly lower after bundle implementation (7.00%) than in the non-bundle group (13.67%; p=0.016). Marked benefit was observed among diabetic patients, with SSI declining from 83.33% to 16.67% (p=0.00007), and among patients with comorbidities, from 48.39% to 20.97% (p<0.001). Significant reductions were also observed with transverse incisions (p=0.00235) and blood transfusion (p=0.0001). Higher BMI and lower hemoglobin were associated with greater SSI risk, although bundle adherence mitigated this risk. Conclusion: Structured prevention care bundle implementation effectively reduced SSIs in elective gynecological surgeries, supporting consistent perioperative protocol adherence, particularly for high-risk patients, and offers a feasible framework for improving overall surgical outcomes.

Background: Pre-eclampsia is a major hypertensive disorder of pregnancy associated with significant maternal and perinatal morbidity and mortality. Although 24-hour urinary protein estimation is the diagnostic reference standard, the spot urine protein/creatinine ratio offers a rapid, practical, and reliable alternative for assessing proteinuria and guiding timely clinical management. Aims & Objectives: To evaluate the diagnostic accuracy of the spot urine protein/creatinine ratio, compare it with 24-hour urinary protein estimation, and assess its association with adverse fetomaternal outcomes in women with pre-eclampsia. Material & Methods: A prospective observational study was conducted among 60 pregnant women diagnosed with pre-eclampsia at a tertiary care teaching hospital. Spot urine samples were collected before 24-hour urine collection for estimation of the protein/creatinine ratio and total urinary protein. Maternal demographics, obstetric characteristics, laboratory findings, mode of delivery, and fetomaternal outcomes were recorded. Statistical analysis was performed using Microsoft Excel and SPSS, with data expressed as frequencies and percentages. Results: Most participants were 21–25 years old (53.3%) and primigravida (65.0%). Maternal complications occurred in 18.3% of women, while fetal complications were observed in 76.7%, with preterm birth being the predominant adverse outcome. The spot urine protein/creatinine ratio demonstrated diagnostic performance comparable to 24-hour urinary protein estimation and showed a significant association with adverse fetomaternal outcomes. Conclusion: The spot urine protein/creatinine ratio is a reliable, rapid, and practical alternative to 24-hour urinary protein estimation for evaluating proteinuria in pre-eclampsia. Its excellent diagnostic performance and association with adverse fetomaternal outcomes support its routine use for early risk assessment and timely obstetric management.

Background: Chronic diarrhea, defined as the passage of loose stools for more than four weeks, is a common clinical problem with a broad differential diagnosis. Bile acid diarrhea (BAD), also known as bile acid malabsorption, is an under-recognized cause of chronic secretory diarrhea and accounts for a substantial proportion of patients previously labelled as having functional diarrhea or diarrhea-predominant irritable bowel syndrome. The diagnosis remains challenging in countries where specialized investigations such as SeHCAT scanning and serum 7α-hydroxy-4-cholesten-3-one (C4) estimation are not readily available. Case Presentation: A 43-year-old woman presented with profuse watery diarrhea for two months associated with marked weight loss. Extensive clinical evaluation, laboratory investigations, endoscopic examination, radiological imaging, and duodenal biopsy failed to reveal an infectious, inflammatory, endocrine, pancreatic, or structural cause. Considering the chronic secretory nature of diarrhea, previous cholecystectomy, and exclusion of other etiologies, bile acid diarrhea was suspected. A therapeutic trial with a bile acid sequestrant resulted in significant clinical improvement, supporting the diagnosis. Conclusion: This case highlights the importance of considering bile acid diarrhea in the differential diagnosis of chronic watery diarrhea. Early recognition and an empirical trial of bile acid sequestrants can avoid unnecessary investigations and provide rapid symptomatic relief.

Background: Chronic suppurative otitis media (CSOM) is a common chronic ear condition characterized by persistent or recurrent ear discharge through a perforated tympanic membrane and may lead to hearing impairment and other complications. The causative organisms and their antibiotic sensitivity patterns may vary between populations and healthcare settings. The present study was conducted to assess the prevalence, clinical features, and etiological agents of CSOM in a tertiary care hospital. Aim and Objectives: To determine the prevalence of CSOM among patients attending a tertiary care hospital and to identify the common etiological organisms isolated from ear discharge. The study also assessed the clinical presentation and antibiotic sensitivity pattern of the isolated organisms. Methodology: A hospital-based cross-sectional study was conducted among 80 patients attending the ENT outpatient department. All participants underwent detailed history taking and clinical examination. Patients diagnosed with CSOM were further evaluated for type and laterality of disease. Ear discharge samples were collected under aseptic precautions and subjected to microbiological examination. Antibiotic susceptibility testing was performed using standard laboratory methods. Data were analyzed using frequency, percentage, mean, standard deviation, and chi-square test. A p-value <0.05 was considered statistically significant. Results: Among 80 participants, 32 were diagnosed with CSOM, giving a prevalence of 40.0%. The mean estimated age was 33.99 ± 19.69 years. CSOM was more frequent among males (43.5%) and rural residents (46.0%), although these associations were not statistically significant. Tubotympanic disease was the predominant type (75.0%), while unilateral involvement was observed in 68.8% of cases. Ear discharge (100%) and hearing loss (84.4%) were the most common clinical features. Pseudomonas aeruginosa was the most frequently isolated organism (34.4%), followed by Staphylococcus aureus (28.1%). Amikacin showed the highest sensitivity (87.5%), while amoxicillin-clavulanate showed the lowest sensitivity (56.3%). Conclusion: CSOM showed a considerable prevalence in the study population. Pseudomonas aeruginosa and Staphylococcus aureus were the major etiological agents. The variable antibiotic sensitivity pattern emphasizes the importance of microbiological examination and antibiotic susceptibility testing for appropriate management of CSOM.

Background: In order to lower intracranial pressure, decompressive craniectomy (DC) is an urgent treatment. A review of the issues would provide ways to enhance the treatment. The analysis of post-cranioplasty (CP) problems and the identification of potential risk factors for surgery failure were the main objectives of this study. Method: This study was carried out in Madhubani Medical College and Hospital in Madhubani, Bihar, between September 2023 and August 2025. Patients undergoing CP for a defect resulting from prior DC or incapacity to replace the bone flap (Glasgow Coma Scale>13, size >5 cm, without surgical site infection) were included. Before and after the surgery, CT imaging was performed on every patient. Based on prosthesis availability and cost, the CP approach was primarily dependent on the patients. Result: The study involved one hundred patients. A total of 22 individuals experienced difficulties following surgery, with only a small number experiencing multiple complications. With no complications, the titanium implant seemed to be superior (p<0.05). Younger age groups frequently had complications with chemically cured PMMA (polymethyl methacrylate) and ethylene oxide-sterilized bone flaps. Patients with various comorbidities and stroke patients experienced more complications. Conclusion: With the exception of bone flap absorption, patients had no significant complications from titanium flaps or autologous abdominal subcutaneous flaps. As a result, both implants are recommended for CP. When a better solution isn’t available, heat-cured PMMA can be employed because it’s affordable and can be molded in any dental lab.

Background: There has been a noticeable rise in the prevalence of multidrug-resistant (MDR) Pseudomonas, which is associated with high rates of morbidity and mortality. Antimicrobial resistance is currently a worldwide problem due to the careless use of antibiotics. The purpose of this study was to determine the distribution rate and patterns of antibiotic susceptibility of Pseudomonas species that were isolated from different clinical specimens at MMCH, Madhubani, and Bihar. Methods: From January 2025 to June 2025, the Department of Microbiology at Madhubani Medical College and Hospital in Madhubani, Bihar, conducted a descriptive cross-sectional investigation to isolate the bacteria and confirm their pattern of antibiotic susceptibility. Twelve hundred and fifty-two samples were taken from patients of all ages and genders, with the exception of those who were already receiving antibiotic medication. These samples included urine, sputum, swabs (pus, wound, and ear), fluid, and tips (catheter, VP shunt). Samples with appropriate labels were collected in a sterile, leak-proof container. According to CLSI recommendations, the modified Kirby-Bauer disc diffusion method was used to test for antimicrobial susceptibility. Results: 28 clinical isolates of Pseudomonas species were obtained from 1252 samples. Pus, ear, and wound swab samples included the greatest amount of Pseudomonas spp. (46.4%). Pseudomonas species showed greater sensitivity to piperacillin/tazobactam (92.9%) and significant resistance to cefixime (96.4%). Conclusion: The findings indicated that Pseudomonas is a common cause of infection in pus, wound exudates, and ear discharge samples. Pseudomonas species showed the highest susceptibility to gentamycin, amikacin, piperacillin/tazobactam, and meropenem. Pseudomonas species’ persistent resilience. In order to prevent the rapid spread of resistance strains, the majority of antibiotics must be limited to severe infections and hospital intensive care units.

Background: Patients with ulcer-like symptoms who do not have overt gastroduodenal ulcers are referred to as having functional dyspepsia. Postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), and functional dyspepsia can be further classified according to the existence of meal-related symptoms. Postprandial fullness, early satiation, burning or discomfort in the epigastrus, and the absence of structural illness symptoms are some of its characteristics. When treating patients with functional dyspepsia, pantoprazole by itself is compared to pantoprazole plus amitriptyline. Methods: In order to compare the safety and effectiveness of pantoprazole with pantoprazole plus amitriptyline in patients with functional dyspepsia, this randomized, prospective, open label, comparative interventional study was carried out in the Department of Pharmacology with other related departments that admitted patients with functional dyspepsia at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri Nalanda, Bihar from August 2024 to July 2025. Follow-up was carried out four weeks after the start of treatment. Results: A total of 142 cases were divided into two groups: Group 1 (pantoprazole alone, n = 68) and Group 2 (pantoprazole + amitriptyline, n = 74). The Glasgow dyspepsia severity score (GDSS) (4.26±1.14 versus 3.3±1.37, p=0.002), short form leads dyspepsia questionnaire (SF-LDQ) (4 [3-5] versus 3 [2-4], p=0.005), and visual analogue pain score (VAS) (1 [1-2] versus 1 [0-1], p=0.009). Conclusion: With no serious safety issues, the combination of pantoprazole and amitriptyline improved functional dyspepsia symptoms more effectively than pantoprazole alone.

Introduction: Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency. Clinicians need to triage who’s at high risk so they can make smart transfusion decisions and use resources wisely. The Glasgow–Blatchford Score (GBS) is a trusted score that needs multiple clinical and laboratory parameters. That’s not always practical, especially in busy or resource-limited hospitals. We studied whether a simpler model using shock index and haemoglobin could help predict earlier the needs of a blood transfusion. Methods: In this cross-sectional observational study, 210 adults presenting with haematemesis or melaena were analysed. For each patient, we calculated the shock index (heart rate divided by systolic blood pressure) and recorded their haemoglobin on admission. Then we calculated a continuous variable: shock index × (8/haemoglobin), using 8 g/dL because that’s a common transfusion threshold. The primary outcome was blood transfusions received during their hospital stay. We did multivariable logistic regression and receiver operator curve (ROC) analysis to assess predictive value of this variable in comparison to GBS. Results: Blood transfusion was received by 64.8% of patients. They tended to have significantly higher shock index (1.12 vs 0.79) and lower haemoglobin (6.2 vs 8.7 g/dL). The composite variable was markedly higher in transfused patients (1.41 ± 0.48 vs 0.76 ± 0.29; p<0.001). On multivariable analysis, shock index ≥1 (adjusted OR 1.78; 95% CI 1.06–2.98; p=0.028), haemoglobin <8 g/dL (adjusted OR 2.47; 95% CI 1.39–4.39; p=0.002), and the composite variable (per 0.5 unit increase; adjusted OR 3.18; 95% CI 2.05–4.94; p<0.001) independently predicted transfusion. ROC analysis demonstrated AUC values of 0.68 for shock index, 0.72 for haemoglobin, 0.77 for the combined approach, and 0.75 for GBS. Conclusion: Combining shock index and haemoglobin together offers a robust bedside option, about as good as the GBS, that helps the clinician in busy and resource limited setup in prompt triage and predicting early who’ll need a blood transfusion.