Objectives: The present study was to evaluate the effect of oral clonidine premedication on perioperative haemodynamic response and postoperative analgesic requirement in patients undergoing laparoscopic surgery at tertiary care hospital. Methods: Detailed preanaesthetic evaluation was carried out with history, general examination and systemic examination including airway assessment. Vital parameters including pulse rate, respiratory rate, blood pressure, oxygen saturation was noted. They were randomly assigned to two groups to receive either clonidine 3 ug /kg (group C) and placebo-vitamin C (group P) orally with sips of water 90 min before estimated time of induction of anaesthesia. Premedication given to all patients in each group with IV Midazolam 0.03 mg /kg, IV Fentanyl 2 mcg /kg, IV Ondansetron 0.05 – 0.15 mg/kg, IV Glycopyrolate 0.004 mg/kg if required (HR<45). Results: A total of 50 patients were enrolled. Dose
of Clonidine- 3mcg/kg of both group patients was not significant differenced (P=0.647). While, duration of surgery of both group patients (clonidine and non-clonidine group) was statistically significant differenced (p=0.016). Sedation score at one hour post operative (p<0.0001) and time of first analgesia requirement (Opioids/NSAIDS) (p<0.0001) of both group patients were highly significant differenced. Conclusion: Oral low dose clonidine premedication provides stable perioperative hemodynamic as revealed by less acute cardiovascular events that needed rescue drugs and protection against stress response triggered by pneumoperitoneum and intra and postoperative pain requirement are less requiring lesser rescue analgesia in patients undergoing laparoscopic surgery. Clonidine resulted in significantly lower pain scores, reduced rescue analgesic requirements. Hence, low dose oral clonidine 3mcg/kg can be prescribed as a routine premedication for all laparoscopic procedure.

Background: Ventilation recovery following exercise is a composite of metabolic, cardiovascular, autonomic and respiratory recovery. Comparisons of early respiratory recovery patterns following aerobic and resistance exercise in healthy adults have been limited. Method: This was a randomized crossover study in which 60 adults between 18 and 35 years of age performed 30 minutes of treadmill exercise at 70% heart-rate reserve and a resistance exercise that was matched in duration, comprising eight exercises for three sets at 70% of one-repetition maximum (1RM), separated by 72 hours. Respiratory rate, oxygen uptake, heart rate, peripheral oxygen saturation, and Borg dyspnea scores were obtained at rest, immediately post-exercise and after 15 minutes of seated recovery. The main outcome was the time to return to 10% of baseline respiratory rate. Results: Aerobic exercise had a higher immediate respiratory rate than resistance exercise (31.8 ± 4.3 vs 28.6 ± 4.1 breaths/min; p<0.001) but recovery was quicker. The mean difference in time to recovery for the respiratory rate after aerobic exercise versus resistance exercise was 2.8 minutes (95% CI 1.9–3.7; p<0.001). After 15 minutes, oxygen uptake was still elevated following resistance exercise (6.3 ± 1.2 vs 5.4 ± 1.0 mL/kg/min; p<0.001) but oxygen saturation was unchanged in both groups. One-minute heart-rate recovery was greater after aerobic exercise (29.4 ± 7.2 vs 22.1 ± 6.5 beats/min; p<0.001). Conclusions: Aerobic exercise resulted in a greater acute ventilatory response and quicker recovery of the respiratory and autonomic systems, while resistance exercise resulted in a higher post-exercise ventilatory response and faster recovery of oxygen consumption.

Background: For patients of carcinoma oesophagus post chemoradiation and those with tracheoesophageal fistula or those patients considered unfit for any modality of treatment owing to gross systemic impairment, self-expanding metallic stents offer a good modality of palliation for dysphagia. Historical data suggests that oesophageal stents have been used for palliation of malignant dysphagia in the past. But these were usually made from rigid plastic and they were associated with a wide host of complications. With the advent of self-expanding metal stents (SEMSs) in the early 1990s, the utility of plastic stents have gone down, as SEMS were associated with better palliation of dysphagia in greater than 85% of patients. This paper is a case series analysis of one year duration wherein we record the complication spectrum and rates of each complication associated with self-expanding metallic stents placed for palliative alleviation of dysphagia in patients of advanced or locally advanced carcinoma of oesophagus in a tertiary care cancer institute of north eastern part of India. The main objective of this study is to observe the complication spectrum and their rates post SEMS so that proper forewarning can be provided to the patient and patient party prior to the procedure for better compliance and transparency. It will also aid in the early vigilance towards the said complications for early detection and management. Patients and Methods: This retrospective study was conducted in Guwahati Medical College and Hospital, Assam. Herein data was collected from all oesophageal stentings done from 12/10/20 to 11/10/21. The patients were followed up for a minimum duration of 3 months. A total of 99 stentings were done as per records during the study period. 5 cases were excluded as the patients expired due to causes unrelated to the stenting. Of these 6 of the recorded cases were that of re-stenting. Thus, 88 patients were left in the study group. Conclusion: On reviewing the complication spectrum and the rates of each complication it was observed that most complications were minor and could me managed non operatively. Even though radiotherapy/brachytherapy do offer better long-term palliation from dysphagia, yet SEMS is also viable option for a selected group of patients who need urgent alleviation of dysphagia or those who are unable to tolerate the former owing to poor general performance status. The complications even though present were mostly minor which respond well to conservative management.

Background: Laryngoscopy and endotracheal intubation are associated with a transient sympathetic response resulting in tachycardia and hypertension, which may increase perioperative morbidity, particularly in patients with cardiovascular disease. Dexmedetomidine, a highly selective α₂-adrenergic agonist, effectively attenuates these haemodynamic responses; however, the optimal loading dose remains uncertain. Objective: To compare the efficacy of dexmedetomidine 0.5 μg/kg and 1 μg/kg in attenuating the haemodynamic response to laryngoscopy and endotracheal intubation during general anaesthesia. Materials and Methods: This prospective, randomized, double-blind, controlled study included 60 ASA physical status I–II patients aged 20–60 years undergoing elective surgery under general anaesthesia. Patients were randomly allocated into two groups of 30 each. Group A received intravenous dexmedetomidine 0.5 μg/kg, while Group B received dexmedetomidine 1 μg/kg infused over 10 minutes before induction. Anaesthesia was induced with propofol and maintained with oxygen, nitrous oxide, and isoflurane. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, during drug infusion, at induction, during laryngoscopy and intubation, and up to 10 minutes after intubation. Adverse events, including bradycardia and hypotension, were also recorded. Data were analysed using the independent Student’s t-test and Chi-square test, with p < 0.05 considered statistically significant. Results: Demographic characteristics were comparable between the groups (p > 0.05). Both doses significantly attenuated the haemodynamic response to laryngoscopy and intubation. However, Group B (1 μg/kg) demonstrated a greater reduction in HR, SBP, DBP, and MAP during and after intubation compared with Group A, with statistically significant differences at several time points (p < 0.05). Oxygen saturation remained comparable in both groups throughout the study. Bradycardia occurred more frequently in Group B, whereas no clinically significant hypotension requiring vasopressor therapy was observed in either group. Conclusion: Both dexmedetomidine doses effectively attenuated the haemodynamic response to laryngoscopy and tracheal intubation. Although 1 μg/kg provided superior haemodynamic control, the 0.5 μg/kg dose achieved satisfactory attenuation with fewer adverse effects, making it a safe and effective option for routine clinical practice.

Background: Enterococcus faecalis and Enterococcus faecium are important healthcare-associated pathogens with a high capacity to acquire antimicrobial-resistance and virulence determinants. High-level gentamicin resistance (HLGR) is clinically important because it eliminates aminoglycoside synergy with appropriate cell-wall-active agents. The bifunctional aminoglycoside-modifying enzyme gene aac(6′)-Ie-aph(2″)-Ia is a major molecular determinant of HLGR, while virulence-associated genes such as asa1, gelE, cylA, esp, and hyl may contribute to persistence and pathogenicity. To determine the prevalence of HLGR and to characterize the distribution of aac(6′)-Ie-aph(2″)-Ia and selected virulence-associated genes among clinical isolates of E. faecalis and E. faecium. Materials and Methods: This observational cross-sectional laboratory-based study was conducted at a tertiary-care hospital in Central India from January 2024 to December 2025. A total of 370 non-duplicate clinical Enterococcus isolates were included. HLGR was detected phenotypically using a 120-µg high-content gentamicin disk according to CLSI criteria. The 141 phenotypically HLGR isolates were subjected to conventional endpoint PCR for detection of aac(6′)-Ie-aph(2″)-Ia and the virulence-associated genes asa1, gelE, cylA, esp, and hyl. Species-wise differences were analyzed statistically, with p<0.05 considered significant. Results: Among 370 isolates, 276 (74.6%) were E. faecalis and 94 (25.4%) were E. faecium. HLGR was detected in 141 (38.1%) isolates and was significantly more frequent in E. faecium than E. faecalis (56.4% vs 31.9%; p<0.001). The aac(6′)-Ie-aph(2″)-Ia gene was detected in 132/141 (93.6%) HLGR isolates. Among virulence genes, esp was most frequent (62.4%), followed by gelE (57.4%), asa1 (52.5%), cylA (29.8%), and hyl (25.5%). asa1, gelE, and cylA were significantly more frequent in E. faecalis, whereas hyl was significantly more frequent in E. faecium. The species-wise distribution of esp and aac(6′)-Ie-aph(2″)-Ia was not statistically significant. Conclusion: HLGR was common among clinical enterococcal isolates, particularly E. faecium. The aac(6′)-Ie-aph(2″)-Ia gene was the predominant molecular determinant of HLGR in both species. Virulence-gene distribution showed clear species-specific differences, with asa1, gelE, and cylA predominating in E. faecalis and hyl being more frequent in E. faecium. These findings support the combined use of phenotypic HLGR screening and targeted molecular characterization for surveillance of clinically significant enterococci.

Background: Focal liver lesions (FLLs) are frequently detected on abdominal ultrasonography and include a wide spectrum of benign and malignant lesions. Although conventional B-mode ultrasonography and color Doppler provide valuable morphological and vascular information, characterization of some FLLs remains challenging because of overlapping imaging features. Shear-wave elastography (SWE) provides quantitative assessment of tissue stiffness and may provide additional information for lesion characterization. This study evaluated the role of SWE in the characterization of FLLs and its potential utility in differentiating benign from malignant lesions. Methods: This prospective observational study was conducted at Smt. N.H.L. Municipal Medical College and S.V.P. Hospital between August 2018 to April 2020. Fifty patients with focal liver lesions were included. The study population comprised 30 males and 20 females, aged 21–78 years. All patients underwent B-mode ultrasonography and color Doppler examination followed by SWE using a Mindray Resona 6 ultrasound system. Four stiffness measurements were obtained from different portions of each lesion, and two measurements were obtained from the adjacent hepatic parenchyma. Stiffness values were recorded in kilopascals (kPa). Final diagnosis was established by contrast-enhanced computed tomography and/or histopathological examination, as clinically indicated. Results: Among the 50 patients, 20 had benign and 30 had malignant focal liver lesions. Hemangioma was the most common benign lesion, whereas metastasis was the most common malignant lesion. The mean SWE values were 9.6 kPa for hepatic adenoma, 10.1 kPa for hemangioma, 10.5 kPa for regenerating nodules, and 15.3 kPa for focal nodular hyperplasia. Among malignant lesions, mean SWE values were 16.6 kPa for hepatocellular carcinoma (HCC), 21.5 kPa for metastases, and 52.3 kPa for intrahepatic cholangiocarcinoma. Overall, malignant lesions demonstrated a higher mean SWE value than benign lesions (25.0 vs. 11.1 kPa). In patients with cirrhosis, the mean SWE value was higher for HCC (16.6 kPa) than for regenerating nodules (10.5 kPa). Conclusion: SWE demonstrated higher tissue stiffness in malignant compared with benign focal liver lesions and may provide useful complementary information during lesion characterization. It also demonstrated a difference in mean stiffness between HCC and regenerating nodules in cirrhotic liver. However, overlap in stiffness values may occur among different lesion types, and measurements may be influenced by lesion composition, background liver disease, acquisition technique, and equipment. Therefore, SWE should be considered an adjunct to conventional ultrasonography and other appropriate imaging modalities rather than a standalone diagnostic technique.

Background: Type 2 Diabetes Mellitus (T2DM) management in Indian public healthcare involves subsidized care, yet patients face significant non-medical costs. Objective: To conduct a cost-effectiveness analysis (CEA) by calculating the Incremental Cost-Effectiveness Ratio (ICER) and Quality-Adjusted Life Years (QALYs) in a government setup. Methods: A prospective 90-day study was conducted with 133 patients at GMC Datia. Economic data included registration fees, transportation (₹300 total), and productivity loss (iMTA PCQ). Results: Direct medical costs were minimal (₹30 total for slips). The primary out-of-pocket expenditure (OOPE) was driven by transportation (51.7%) and indirect wage loss (43.1%). Clinical outcomes showed significant improvement in HbA1c and FPG. Conclusion: The government setup provides highly cost-effective care. While medical costs are covered, transportation remains the primary financial barrier for the patients.

Background: These factors along with long preoperative fast period may lead to thirst, relative intravascular depletion, metabolic stress, and exaggerated blood-pressure decrease upon induction of general anesthesia. Increased carbohydrate loading is known to be a part of the enhanced recovery program, but there is less of a clear association with early intraoperative hemodynamic stability. The aim of this study was to see if a pre-operative carbohydrate drink will decrease post induction hypotension and vasopressor use in adult elective laparoscopic abdominal surgery. Methods: A prospective randomized study, 126 non-diabetic adults with American Society of Anesthesiologists physical status I-II were randomly divided into two groups: carbohydrate group (CHO) and conventional fasting group (FAST). The CHO group was given a 12.5% maltodextrin drink the evening before surgery and 2 hours prior to induction, while the FAST group was given a normal overnight fasting. Standardisation of anaesthetic technique, ventilation, fluid and vasopressor rescue levels. The main outcome was the induction hypotension, which was defined as mean arterial pressure (MAP) <65 mmHg or the drop >20% from the baseline pressure in the first 15 minutes after induction. Results: Post-induction hypotension was seen in 11 patients (17.5%) in the CHO group and 23 (36.5%) in the FAST group (p=0.026). Lowest MAP was higher with carbohydrate loading (69.8 ± 8.7 vs. 64.2 ± 9.4 mmHg; p=0.001), and the maximal percentage fall in MAP was smaller (19.3 ± 8.1% vs. 26.8 ± 10.4%; p<0.001). Vasopressor therapy was necessary in 22.2% compared to 41.3% (p=0.035). Pre-induction Glucose was greater in CHO group and Postoperative was similar. The carbohydrate intake resulted in significantly reduced hunger and thirst scores. Regurgitation and/or pulmonary aspiration were not observed. Conclusion: Oral carbohydrate loading prior to surgery had a beneficial effect on early haemodynamic stability and reduced the amount of vasopressors used during standardized general anaesthetic in selected non-diabetic elective surgical patients.

Background: Peripheral nerve blocks are an essential component of multimodal analgesia for surgery of the upper extremity, but the technique used to localize the brachial plexus could affect the reliability of the block, procedural efficiency and postoperative pain relief. Objective: To evaluate ultrasound-guided block versus landmark-guided block for supraclavicular brachial plexus block in terms of postoperative analgesia, characteristics of the block, opioid usage and adverse events associated with the procedure. Method: This prospective, randomized, assessor-blinded study included 120 adults who were to receive elective upper-limb orthopedic surgery, and were randomly divided into an ultrasound-guided group (US, N=60) and a landmark-based nerve-stimulator guided group (LM, N=60). 20 mL of 0.375% ropivacaine was administered prior to standardized general anesthesia for each patient. The main outcome was total amount of IV morphine-equivalent doses in the first 24 hours after surgery. Secondary outcomes comprised time to first use of rescue analgesia, numerical rating scale (NRS) pain scores, success of the block, and time to onset and duration of sensory and motor blockade, number of needle passes and complications. Results: The 24-hour consumption of morphine equivalent doses was significantly lower (6.8 ± 3.4 mg) with ultrasound guidance when compared with landmark guidance (10.2 ± 4.5 mg; p<0.001). Time to first rescue analgesia was longer in the US group (612 ± 188 vs. 448 ± 176 min; p<0.001). Complete block success was 95.0% versus 81.7% (p=0.043), and performance time was shorter (5.9 ± 1.7 vs. 8.4 ± 2.2 min; p<0.001). The incidence of paresthesia during block placement was lower with ultrasound (5.0% vs. 20.0%, p=0.025). No pneumothorax, permanent neurological deficit or local anesthetic systemic toxicity was noted. Conclusion: Ultrasound-guided supraclavicular blockade led to better postoperative pain relief and opioid consumption as well as increased block efficiency compared to landmark-guided supraclavicular blockade. The results are supporting the use of ultrasound guidance when required, equipment and trained operators are available.

Background: Thyroid eye disease is an autoimmune orbital disorder that may cause extraocular muscle inflammation, enlargement, and fibrosis, resulting in restrictive strabismus and diplopia. The clinical presentation and treatment response vary according to the stage of the disease. Objective: To describe the clinical characteristics, imaging findings, medical treatment, and surgical management of restrictive strabismus associated with thyroid eye disease. Methods: A retrospective descriptive study was conducted among 50 patients with thyroid eye disease-related restrictive strabismus. Clinical records were reviewed for demographic characteristics, disease phase, extraocular muscle involvement, imaging findings, treatment received, and clinical outcomes. Descriptive analysis was performed using frequencies and percentages. Results: The majority of patients belonged to the 50–59 years age group (50%). Chronic fibrotic disease was more common than acute inflammatory disease, accounting for 60% and 40% of patients, respectively. The inferior rectus muscle was the most frequently involved extraocular muscle (60%), followed by the medial rectus (16%), superior rectus (10%), multiple extraocular muscles (8%), and lateral rectus (6%). Imaging demonstrated extraocular muscle enlargement with fibrosis in 50% of patients, while fusiform enlargement with tendon sparing was observed in 40%. Intravenous corticosteroid therapy was administered to 40% of patients, whereas inferior rectus recession was performed in 50%. Supportive treatment, including prism correction, was provided to 10% of patients. Improvement in ocular motility and diplopia was observed following appropriate phase-specific treatment. Conclusion: Restrictive strabismus in thyroid eye disease is commonly associated with inferior rectus involvement and chronic fibrotic changes. Intravenous corticosteroids may be beneficial during the active inflammatory phase, while inferior rectus recession can improve ocular alignment and motility in stable fibrotic disease. Careful clinical assessment, imaging, and appropriate timing of treatment are essential for achieving satisfactory outcomes.

Background: Umbilical cord thickness reflects the amount of Wharton’s jelly and cord vascularity, and has been proposed as a simple, non-invasive antenatal marker of fetal well-being. Reduced cord thickness has been linked with intrauterine growth restriction and low birth weight (LBW), but its relationship with specific maternal risk factors and neonatal morbidity in LBW infants remains incompletely characterized in Indian settings. Objectives: To determine the correlation of umbilical cord diameter (UCD) with antenatal maternal risk factors, and to assess its association with clinical course and neonatal outcome in low birth weight infants. Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU) of the Department of Paediatrics, Geetanjali Medical College and Hospital, Udaipur, over 20 months (April 2024–December 2025). Low birth weight neonates (1250–2500 g, gestational age >32 weeks) were enrolled consecutively; neonates who died within 6 hours of life, had congenital malformations, were discharged against medical advice, or whose parents declined consent were excluded. Umbilical cord diameter was measured 2.5 cm from the neonatal end using a digital Vernier caliper in the horizontal, non-stretched position. Maternal antenatal risk factors and neonatal outcomes were recorded and correlated with UCD. Categorical variables were compared using the chi-square/Fisher’s exact test and continuous variables using the t-test; p<0.05 was considered significant. Receiver operating characteristic (ROC) curve analysis was used to derive an optimal UCD cut-off. Results: Of 140 neonates screened, 114 were included (mean birth weight 2329 ± 202 g; 55.3% term). ROC analysis identified a UCD cut-off of ≤11 mm as providing the best combination of sensitivity (90.9%) and specificity (73.9%) for predicting adverse outcome. Neonates with UCD ≤11 mm had significantly lower mean birth weight (2138.7 ± 271.8 g vs. 2386.3 ± 143.4 g, p<0.001) and lower gestational age (35.6 ± 1.5 vs. 37.3 ± 1.3 weeks, p<0.001) than those with UCD >11 mm. A thin cord (≤11 mm) was significantly associated with maternal pregnancy-induced hypertension (PIH) (p=0.021) and maternal hypothyroidism (p=0.042), but not with gestational diabetes mellitus or premature rupture of membranes. NICU admission was required in 45.5% of neonates with UCD ≤11 mm versus 2.9% with UCD >11 mm (p<0.001). Oxygen therapy (47.7% vs. 8.6%, p<0.001) and CPAP support (25.0% vs. 1.4%, p<0.001) were also significantly more frequent among neonates with a thin umbilical cord. Conclusion: A reduced umbilical cord diameter (≤11 mm) is significantly associated with maternal PIH and hypothyroidism, and with adverse neonatal outcomes including lower birth weight, lower gestational age, and greater need for NICU admission, oxygen, and CPAP support. Antenatal or immediate postnatal measurement of umbilical cord diameter is a simple, inexpensive, and reproducible tool that may help identify high-risk low birth weight infants who need closer surveillance and neonatal preparedness.

Fever of unknown origin (FUO) remains a major diagnostic challenge because its causes span infections, inflammatory disorders, malignancy and miscellaneous conditions. This case series describes five patients with diagnostically difficult febrile illnesses and highlights the clinical clues, targeted investigations, treatment and outcomes. We retrospectively reviewed five patients presenting with prolonged or otherwise unexplained fever admitted to Yashwantrao Chavan Memorial Hospital, Pimpri, Pune over a period of April 2024 to June 2025. Clinical assessment, laboratory testing, imaging and advanced diagnostic procedures were performed according to clinical suspicion. Final diagnoses included disseminated tuberculosis, scrub typhus without eschar, enteric fever with delayed culture positivity, adult-onset Still’s disease and culture-negative infective endocarditis. All patients improved with targeted treatment.

Background: Inadequate postoperative pain management in paediatric patients can lead to adverse physiological and psychological outcomes. Caudal epidural block is a widely accepted regional anaesthetic technique providing effective intraoperative and postoperative analgesia in infraumbilical surgeries. Adjuvants added to local anaesthetics prolong the duration and quality of caudal blockade. Aims: To compare the postoperative analgesic efficacy, sedation levels, hemodynamic stability, and rescue analgesic requirements of caudal dexmedetomidine versus caudal tramadol when added to 0.25% ropivacaine in paediatric patients undergoing infraumbilical surgeries. Settings and Design: A hospital-based, prospective, randomized, double-blind comparative study conducted at a tertiary care medical college hospital. Materials and Methods: Seventy paediatric patients aged 1–8 years of ASA physical status I and II scheduled for elective infraumbilical surgeries were randomly assigned into two groups of 35 each: Group RD (n=35) received caudal 0.25% ropivacaine (1 mL/kg) plus dexmedetomidine (2 μg/kg), and Group RT (n=35) received caudal 0.25% ropivacaine (1 mL/kg) plus preservative-free tramadol (2 mg/kg). Postoperative pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) score, and sedation was evaluated using the Ramsay Sedation Scale (RSS). Rescue analgesia (paracetamol suppository 15 mg/kg) was administered when the FLACC score reached ≥ 4. Statistical Analysis: Data were analyzed using R software and Microsoft Excel. Continuous variables were evaluated using Student’s t-test or Mann-Whitney U test depending on normality, and categorical data were analyzed using the Chi-square test. P < 0.05 was considered statistically significant. Results: Demographic profiles and surgical durations were comparable between the groups (P > 0.05). The mean duration of postoperative analgesia was significantly longer in Group RD (613.88 ± 39.28 min) compared to Group RT (462.55 ± 25.35 min; P < 0.0001). The mean total number of rescue analgesic doses required in 24 hours was significantly lower in Group RD (2.85 ± 0.36) compared to Group RT (3.28 ± 0.45; P < 0.0001). Postoperative Ramsay Sedation Scores were significantly higher in Group RD during the first postoperative hour (P < 0.05), representing mild, arousable sedation. Perioperative hemodynamics were stable in both groups without significant adverse effects. Conclusion: Caudal dexmedetomidine (2 μg/kg) added to 0.25% ropivacaine provides significantly longer duration of postoperative analgesia, superior pain control, lower rescue analgesic consumption, and favourable early postoperative sedation compared to caudal tramadol (2 mg/kg), with a comparable safety profile.

Pancytopenia is described as a decrease in all three blood cell lines (hemoglobin, leukocytes and platelets). Pancytopenia is a hematological manifestation of a wide spectrum of underlying pathologies, ranging from transient infections to malignancies. The following is a case series describing the clinical and etiological profile of various cases of pancytopenia and their respective treatment and outcomes. We retrospectively analyzed 6 adult cases of pancytopenia of varied etiologies presenting varied manifestations of an underlying pathology admitted to Yashwantrao Chavan Memorial Hospital, Pimpri, and Pune over a period of April 2024 to June 2025. Detailed clinical assessment, relevant laboratory tests and bone marrow studies wherever indicated were performed. Patients were followed up to assess outcomes.

Background: Acute glomerulonephritis (AGN) is a common cause of acute nephritic syndrome and acute kidney injury in children. Although most cases are self-limiting and post-infectious, a minority have a non-infectious or atypical cause and a more complicated course, and distinguishing between the two at presentation remains a practical clinical challenge. Objective: To describe the clinical, laboratory, and short-term outcome profile of children admitted with AGN at a tertiary-care centre in South India. Methods: This prospective observational study enrolled 60 children under 18 years with a clinical diagnosis of AGN, admitted to the paediatric ward of Cheluvamba Hospital, Mysuru, over two years. Clinical features, laboratory parameters, complications, treatment, and outcome at 1 and 3 months were recorded on a structured proforma. Results: Most children (35/60, 58.3%) were 11–15 years old, and 44 (73.3%) were male (male:female 2.7:1). Decreased urine output (53/60, 88.3%), oedema (40/60, 66.7%), and cola-coloured urine (32/60, 53.3%) were the commonest presenting complaints, and 59/60 (98.3%) were hypertensive at presentation. Nephritic-range proteinuria was seen in 42/60 (70%) and nephrotic-range proteinuria in 17/60 (28.3%). Antistreptolysin O (ASLO) was positive in 43/60 (71.7%) and serum C3 was low in 55/60 (91.7%). Thirty-six children (60%) developed at least one complication, most commonly acute kidney injury (18/60, 30%) and acute hypertensive encephalopathy (15/60, 25%); 19/60 (31.7%) required paediatric intensive care. By 3 months, 33/60 (55%) had achieved complete clinical and laboratory recovery. Conclusion: Most children with AGN in this cohort had a typical, post-infectious presentation and a favourable early course, but a substantial minority developed acute kidney injury or hypertensive encephalopathy requiring intensive care, and fewer than two-thirds had fully recovered by 3 months. Systematic follow-up to at least 3 months, with attention to persistent proteinuria, hypertension, or hypocomplementaemia, is warranted to identify children who need further evaluation for a non-infectious or atypical cause.

Background: Brainstem evoked response audiometry (BERA) is usually reported and interpreted per ear, but whether the two ears respond symmetrically — and whether that symmetry differs between children with type 1 diabetes mellitus (T1DM) and healthy children — is rarely examined explicitly, despite its relevance to how asymmetric findings should be interpreted in clinical practice. Objective: To compare right-ear and left-ear BERA absolute and inter-peak latencies within the same children, separately in a T1DM group and a non-diabetic control group, to determine whether interaural asymmetry differs between the two. Methods: In a case-control study of 60 children and adolescents with T1DM and 60 non-diabetic controls at a tertiary-care hospital in South India, BERA absolute latencies (waves I–V) and inter-peak latencies (I–III, III–V, I–V) were recorded for both ears in every participant. Right- and left-ear values were compared within each group using the paired t-test. Results: In the T1DM group, absolute latencies of waves II, III, IV and V differed significantly between the right and left ear (p<0.05 for each, most strongly for wave V, p<0.001), while none of the three inter-peak latencies differed significantly between ears. In the control group, the pattern was different: absolute latencies of waves IV and V, and inter-peak latencies I–V and III–V, differed significantly between ears (p<0.001 for each), while earlier waves (I, II, III) and inter-peak latency I–III did not. Conclusion: Both children with T1DM and healthy controls showed statistically detectable right–left asymmetry in BERA parameters, but the pattern differed between groups: diabetic children showed asymmetry concentrated in absolute peak latencies without inter-peak asymmetry, while controls showed asymmetry in later waves and inter-peak intervals. All differences were small in absolute terms and are unlikely to be clinically meaningful in isolation, but they indicate that interaural comparison in paediatric BERA should be interpreted against group-specific expectations rather than assumed symmetry, and that isolated interaural differences should not, by themselves, be over-interpreted as pathological in either group.

Background: Neonatal sepsis is a leading cause of neonatal death worldwide, and blood culture, its reference standard, takes 48–72 hours to yield a result. Nucleated red blood cells (NRBCs), released from the marrow in response to hypoxic or inflammatory stress, have been proposed as a rapid, inexpensive adjunct for identifying sepsis and anticipating its course. Objective: To measure NRBC counts in term neonates with suspected sepsis and to assess their diagnostic accuracy for sepsis and their association with neonatal outcome. Methods: In this prospective observational study, 73 term neonates admitted to the neonatal intensive care unit (NICU) of Cheluvamba Hospital, Mysuru, with risk factors or clinical features of sepsis were enrolled over 12 months (September 2021–September 2022) by purposive sampling. A sepsis screen, blood culture, and peripheral-smear NRBC count (per 100 white blood cells) were obtained on day 1 of admission, with a repeat NRBC count on day 3. Neonates were classified as proven sepsis (positive blood culture), probable/clinical sepsis (positive screen, negative culture), or no sepsis. An NRBC count greater than 10/100 WBC was considered elevated. Results: Sepsis was diagnosed in 52 of 73 neonates (71.2%). Mean NRBC counts were significantly higher in the sepsis group than the no-sepsis group on day 1 (10.96±5.56 vs 3.95±2.13; p<0.001) and day 3 (12.58±8.02 vs 1.05±2.18; p<0.001). At the >10/100 WBC cut-off, NRBC had a sensitivity of 51.9%, specificity of 94.6%, positive predictive value of 87.8%, and negative predictive value of 45.6% for sepsis. Twenty-two neonates (30.1% overall; 42.3% of the sepsis group) died, all of whom belonged to the sepsis group. Mean NRBC counts were significantly higher in neonates who died than in those discharged, on both day 1 (12.68±5.99 vs 7.33±4.92; p<0.001) and day 3 (16.77±7.31 vs 6.02±7.02; p<0.001). Conclusion: NRBC count is significantly and consistently elevated in term neonates with sepsis and rises further in those who die. Although its sensitivity for diagnosing sepsis is modest, its high specificity and its association with mortality support its use as a low-cost, rapidly available prognostic adjunct in resource-limited NICUs, best interpreted alongside conventional sepsis-screen parameters rather than as a stand-alone diagnostic test.

Background: Musculoskeletal disorders (MSDs) are among the leading causes of pain, disability, and reduced quality of life worldwide. Although rescue oral analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for pain management, their prolonged use is associated with adverse effects on gastrointestinal, cardiovascular, and renal systems. Topical herbal formulations are the choice for delivering localized analgesic and anti-inflammatory effects.  Body Massage Oil is formulated using Ayurvedic medicinal oils and botanicals traditionally indicated and also well researched for pain relief and inflammation. Objective: To evaluate the efficacy, safety, and tolerability of Body Massage Oil in reducing musculoskeletal pain and improving functional outcomes compared with a placebo oil. Methods: This was a prospective, randomized, single-blind, placebo-controlled clinical trial involving 60 participants with mild-to-moderate musculoskeletal pain. Participants were randomized equally to receive either placebo oil (n=30) or Body Massage Oil (n=30). Study medication was applied and well massaged twice daily over the affected area for 15 consecutive days. Clinical assessments were performed at baseline, Day 8, and Day 15. Primary outcome measures included changes in pain severity, pain intensity assessed using the Visual Analogue Scale (VAS), and functional improvement. Secondary outcomes included changes in PEG (Pain, Enjoyment of life, and General activity) score, sleep quality, local tolerability, pigmentation changes (if present), and adverse events. Within-group analyses were performed using paired statistical testing. Results: Both placebo and investigational product groups demonstrated statistically significant improvements from baseline. In the placebo group, pain severity, pain intensity, and PEG scores showed significant reductions at the end of the study (paired p<0.05). The Body Massage Oil demonstrated greater numerical reductions across all assessed parameters, with highly significant within-group improvements in pain severity (p=0.0000145), pain intensity (p=0.00015), and PEG score (p=0.000025). No major safety concerns or treatment-related serious adverse events were reported in the available study data. The statistical dataset provided descriptive analyses and within-group comparisons; however, between-group statistical comparisons were not available. Conclusion: Body Massage Oil demonstrated clinically meaningful improvements in musculoskeletal pain and functional status over the 15-day treatment period and was well tolerated. The findings support the potential utility of this Ayurvedic topical formulation as a complementary approach for the management of acute and chronic musculoskeletal pain.

Background: Dexmedetomidine is a highly selective alpha-2 adrenergic agonist that has sedative, sympatholytic, and analgesic-sparing properties that may decrease perioperative opioid exposure. Hypothesis: Intraoperative dexmedetomidine will decrease acute postoperative pain and 24-hour opioid use in adult patients under general anesthesia. Method: A prospective, randomized, double-blind, placebo-controlled trial model was used, with 100 adults (18–65 years) with American Society of Anesthesiologists physical status I–II who were scheduled for elective laparoscopic abdominal surgery assigned to dexmedetomidine (n=50) or saline control (n=50). The dexmedetomidine group was given 0.5 µg/kg over 10 minutes prior to induction and then 0.4 µg/kg/h until 20 minutes before the end of surgery. General anesthesia and patient-controlled analgesia with postoperative morphine were used in a standard manner. The main outcome was cumulative morphine equivalent dose at 24 hours. Secondary outcomes were numerical rating scale (NRS) pain scores, requirement for fentanyl during surgery, time to first rescue analgesia, postoperative nausea and vomiting (PONV), sedation, and hemodynamic adverse events. Results: The mean 24-hour consumption of morphine was significantly lower with dexmedetomidine (17.6±6.8 mg) than with placebo (25.9±8.1 mg; p<0.001). Resting NRS pain scores were reduced at 1, 6, 12 and 24 hours, and time to first rescue analgesia was increased (189±74 vs 112±56 minutes; p<0.001). PONV occurred in 12% versus 32% of patients (p=0.028). There was a numerical increase in Bradycardia with dexmedetomidine (16% vs 4%; p=0.092) but no significant increase in hypotension. Conclusions: Intraoperative dexmedetomidine was found to be clinically relevant in providing opioid-sparing analgesia and better early postoperative pain management, and had a manageable hemodynamic profile when adequate monitoring was employed.

Background: After colloid goiter, chronic lymphocytic thyroiditis, an autoimmune thyroid condition, is the second most frequent thyroid condition identified by FNAC. For the diagnosis of various thyroid lesions, FNAC is a dependable and effective technique. Women are more likely than men to have chronic lymphocytic thyroiditis, which is typically associated with hypothyroidism, euthyroidism, or occasionally hyperthyroidism. Hashimoto’s thyroiditis occurs 30–60 times per 100,000 people annually, with an incidence rate of 1-4%. The cytomorphological characteristics of FNAC can be used to classify autoimmune thyroiditis. Aim of this study to compare FNAC cytological findings with TFT in Chronic lymphocytic thyroiditis. Methods: From June 2025 to May 2026, 220 patients with thyroid swellings were seen for FNAC testing, TFT and anti-TPO antibody serology, and ultrasound. Additionally, aspiration or non-aspiration methods were used for fine needle aspiration cytology. Using an auto analyzer based on the chemiluminescence method, TFT and anti-TPO antibodies were tested. Results: 86 of the 220 cases of midline neck edema that were reported to our department had autoimmune thyroiditis. The male to female ratio was 1:3, and the age group most affected by lymphocytic thyroiditis was 21–30 years old. Few patients had nodular swelling, while the majority had diffuse swelling. TSH was raised in 56 cases (40.81%) and anti-TPO antibody was elevated in 38 cases (26.2%), according to the criteria employed by Bhatia et al. to grade the lymphocytic thyroiditis. Cytology, clinical diagnosis, and radiographic evidence all supported the diagnosis of autoimmune thyroiditis in these individuals. 16 (62.50%) had Grade 2 lymphoid infiltrate, whereas 53.33% (32/60) had Grade 3 lymphoid infiltrate. 10 cases (11.63%) had grade 1 lymphoid infiltration. Of the 86 cases, 56 (65.12%) have hypothyroidism, 14 (16.28%) have hyperthyroidism, and 16 (18.60%) have euthyroidism. Of these 86 individuals, 14 had a single nodule and 52 had diffuse thyroid enlargement on ultrasonography. Conclusion: When combined with ultrasonography results of diffuse thyroid gland enlargement, grade 3 lymphocytic infiltration statistically correlates with anti-TPO and TSH. Hurthle cell change, large cells, anisonucleosus, and granulomas do not statistically correlate with lymphocytic thyroiditis because these conditions are mainly associated with Grade 1 and Grade 2. Despite the availability of various diagnostic modalities for the diagnosis of thyroid abnormalities, we conclude from this study that FNAC is still the gold standard approach. FNAC Smear grading is based on TSH and antithyroid antibody (anti-TPO antibody) positive, as well as lymphocytic infiltration of the thyroid follicles. These results are strongly linked to Chronic Lymphocytic Thyroiditis.

Background: One of the most life-threatening types of stroke is spontaneous intracerebral hemorrhage (SICH), which has a 30–40% death rate. In patients with supratentorial capsuloganglionic bleeding who received a decompressive craniectomy (DC) at our facility, we sought to assess the impact of craniotomy size and decompression volume on surgical outcome, complications, mortality, and morbidity. Methods: The study was conducted prospectively at MMCH, Madhubani, Bihar between April 2024 and March 2026. The study included all patients with capsuloganglionic bleeding who underwent DC and hematoma evacuation. Results: During the study period, 55 patients at our hospital had DC for SICH. The bone flap’s mean anteroposterior (AP) diameter was 12.42 cm. In our study, a greater AP diameter was linked to a higher incidence of hydrocephalus, but the volume of decompression had no effect on mortality or morbidity. Midline shift (MLS) was less reduced after a smaller craniectomy with an AP diameter of less than 12 cm. Mortality was significantly impacted by persistent postoperative MLS, and the magnitude of the craniectomy affected its decrease (p=–0.037). Conclusion: In terms of MLS reduction, DC with an AP diameter of 12 to 13 cm yields the best results. A larger DC volume need careful monitoring since it increases the risk of hydrocephalus.

Background: One significant risk factor for the onset of atherosclerotic cardiovascular disease (ASCVD) is dyslipidemia. HMG CoA reductase inhibitors, or statins, are thought to be the best lipid-lowering medications. This study evaluated the safety and efficacy of daily versus alternate-day rosuvastatin dosage schedules in patients with dyslipidemia. Methods: This prospective, randomized, open-label study was conducted for a period of 3 months (from January 2026 to March 2026) at Department of Pharmacology with collaboration of Department of Medicine, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, and Bihar. A total of 180 participants who were randomly assigned to three groups—A (rosuvastatin 10 mg daily), B (rosuvastatin 10 mg on alternate days), and C (rosuvastatin 20 mg on alternate days)—completed the study. The participants were patients of either sex who were diagnosed with dyslipidemia and were between the ages of 18 and 65. Results: In every group, rosuvastain significantly decreased triglycerides, total cholesterol, and low density lipoprotein cholesterol (p<0.001). The rise in high density lipoprotein cholesterol was not statistically significant (p>0.05). There was no statistically significant difference between the groups. Compared to groups B and C, group A reported somewhat more adverse events. Conclusion: In patients who had dyslipidemia, alternate-day rosuvastatin medication demonstrated efficacy that was statistically comparable to daily dosage therapy. Additionally, it showed fewer adverse effects, indicating that it might be a practical method of controlling dyslipidemia, offering a more affordable and possibly safer substitute for daily administration.

Background: Globally, respiratory tract infections are a major cause of both mortality and morbidity. Geographically and across time, the most common bacterial agents and their patterns of antibiotic resistance vary. The sensitivity and specificity of diagnostic methods for lung infections have been enhanced by bronchoalveolar lavage. Since the use of empirical therapy with conventional drugs has become more difficult due to the evolution of antibiotic resistance in frequently isolated pathogens, the current study aims to identify bacterial isolates and their sensitivity pattern. Methods: Over a period of nine months, from July 2025 to March 2026, BAL fluid samples from patients with respiratory infections having bronchoscopy at MMCH, Madhubani, Bihar, were collected under aseptic settings and processed in accordance with normal practice. According to CLSI recommendations, the Kirby-Bauer disc diffusion method was used to test the antimicrobial susceptibility. Results: 104 (38.5%) of the 270 samples were positive for growth. Six of these were fungal isolates and 98 were bacterial isolates. The age group of 51–60 years old had the highest isolation rate, followed by 61–70 years old. The most frequently isolated species were GNB, with Klebsiella pneumoniae accounting for 60% of the total, followed by Pseudomonas (30%) and E. coli (8%). Allcephalosporin resistance and amikacin sensitivity were seen, followed by piperacillin-tazobactam and various aminoglycosides. Conclusion: When diagnosing respiratory infections, BAL has increased both sensitivity and specificity. Antibiotic resistance and the evolving pattern of bacterial infections are responsible for an updated antibiogram, monitoring of bacterial isolates, and other susceptibility.

Background: Hepatic steatosis was frequently associated with obesity, diabetes mellitus, dyslipidaemia and other metabolic abnormalities. This study assessed the frequency of ultrasonographically detected hepatic steatosis and evaluated its association with metabolic risk factors. Material and Methods: A hospital-based analytical cross-sectional study was conducted among 220 adults aged 18–70 years. Participants underwent clinical, anthropometric and biochemical assessment followed by abdominal ultrasonography. Hepatic steatosis was graded as Grade 0 to Grade 3 according to sonographic features. Associations between steatosis and metabolic risk factors were assessed using appropriate statistical tests and multivariable logistic regression. Results: Hepatic steatosis was detected in 126 (57.3%) participants, including Grade 1 in 65 (29.5%), Grade 2 in 45 (20.5%) and Grade 3 in 16 (7.3%). Compared with participants without steatosis, those with steatosis had significantly higher BMI, waist circumference, fasting glucose, HbA1c, triglycerides, LDL-cholesterol, ALT and AST levels and lower HDL-cholesterol (all P≤0.006). BMI ≥23 kg/m², central obesity and diabetes mellitus were more frequent among participants with steatosis (83.3%, 78.6% and 44.4%, respectively) than those without steatosis (59.6%, 46.8% and 17.0%, respectively). Increasing metabolic risk-factor burden was significantly associated with steatosis (P<0.001). BMI ≥23 kg/m², central obesity, diabetes mellitus, hypertriglyceridaemia and low HDL-cholesterol remained independently associated with steatosis. Conclusion: Ultrasonographically detected hepatic steatosis was common and was significantly associated with adverse metabolic characteristics. Early identification and management of modifiable metabolic risk factors may help reduce the associated hepatic and metabolic burden.

Background: Pleural effusion is a common clinical finding that requires timely and accurate diagnosis. Conventional chest radiography may have limited sensitivity, particularly for small effusions. This study compared the diagnostic performance of chest X-ray and bedside ultrasound in detecting pleural effusion. Material and Methods: A prospective comparative diagnostic-accuracy study was conducted among 150 adults with clinical suspicion of pleural effusion. All participants underwent conventional chest radiography and bedside thoracic ultrasonography. Findings were compared with a reference standard based on computed tomography and/or final clinical-radiological assessment. Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, and diagnostic accuracy were calculated. Paired diagnostic results were compared using the McNemar test. Results: Pleural effusion was confirmed in 80 (53.3%) patients. Bedside ultrasound correctly identified 76 cases, compared with 48 cases detected by chest radiography. Ultrasound demonstrated higher sensitivity (95.0% vs. 60.0%), specificity (98.6% vs. 90.0%), positive predictive value (98.7% vs. 87.3%), negative predictive value (94.5% vs. 66.3%), and overall diagnostic accuracy (96.7% vs. 74.0%). Ultrasound produced fewer false-negative results than chest radiography (4 vs. 32). Paired analysis demonstrated a statistically significant difference between the modalities (χ²=19.24, p<0.001). Conclusion: Bedside ultrasound demonstrated substantially superior diagnostic performance compared with chest radiography for detecting pleural effusion. Its high sensitivity and accuracy support its use as a rapid and accessible first-line imaging modality in patients with suspected pleural effusion.

Background: Adipose tissue is an active endocrine organ that secretes adipokines involved in glucose metabolism, lipid homeostasis, inflammation and vascular function. Leptin generally exhibits pro-inflammatory and potentially pro-atherogenic effects, whereas adiponectin exerts insulin-sensitizing, anti-inflammatory and vasculoprotective actions. An imbalance between these adipokines may therefore contribute to coronary artery disease (CAD) and associated metabolic abnormalities. Material and Methods: This hospital-based case-control study included 200 adults, comprising 100 angiographically confirmed CAD patients and 100 apparently healthy controls. Anthropometric measurements, blood pressure and conventional biochemical parameters were recorded. Serum leptin and adiponectin were estimated using enzyme-linked immunosorbent assays, and the leptin/adiponectin ratio (LAR) was calculated. CAD severity was assessed using the Gensini score. Associations between adipokines, metabolic risk factors and CAD severity were evaluated using correlation and multivariable regression analyses. Results: CAD patients demonstrated higher body mass index, waist circumference, fasting glucose, triglycerides, LDL-C and hs-CRP and lower HDL-C than controls. Mean leptin concentration was higher in CAD patients (18.6±8.4 ng/mL) than controls (11.2±5.7 ng/mL), whereas adiponectin was lower (5.7±2.4 vs 8.9±3.1 μg/mL; both p<0.001). LAR was substantially higher among CAD patients (3.42±2.18 vs 1.35±0.91; p<0.001). LAR showed positive correlations with BMI, waist circumference, fasting glucose, triglycerides, HOMA-IR and Gensini score and an inverse correlation with HDL-C. Conclusion: Leptin–adiponectin imbalance was significantly associated with CAD and adverse metabolic characteristics. LAR may provide a useful integrated marker of cardiometabolic dysfunction, although prospective studies are required to establish its independent predictive value.

Background: Coronary artery disease (CAD) is a multifactorial disorder involving dyslipidaemia, insulin resistance, endothelial dysfunction and chronic inflammation. Adiponectin and leptin are adipose-tissue-derived hormones with contrasting metabolic and vascular effects, whereas high-sensitivity C-reactive protein (hs-CRP) is an established marker of low-grade systemic inflammation. Alterations in these biomarkers may be associated with the development and severity of coronary atherosclerosis. This study evaluated the association of serum adiponectin, leptin and hs-CRP with angiographic severity of CAD. Material and Methods: This hospital-based observational study included 200 adults undergoing coronary angiographic evaluation, comprising 150 patients with angiographically confirmed CAD and 50 controls without significant coronary stenosis. Anthropometric, clinical and biochemical parameters were recorded. Serum adiponectin, leptin and hs-CRP were estimated using standardised laboratory methods. CAD severity was quantified using the Gensini scoring system. Correlations between biomarkers, metabolic risk factors and Gensini score were assessed, followed by multivariable regression analysis. Results: Compared with controls, CAD patients had significantly higher BMI, waist circumference, fasting glucose, triglycerides, LDL-C and hs-CRP and lower HDL-C and adiponectin (p<0.001). Serum leptin was also significantly higher in CAD patients (21.4±9.6 vs 11.5±5.8 ng/mL, p<0.001). With increasing CAD severity, leptin and hs-CRP progressively increased, whereas adiponectin decreased (p<0.001). Leptin (r=0.42), hs-CRP (r=0.39) and adiponectin (r=−0.36) were significantly correlated with Gensini score. Conclusion: Increased leptin and hs-CRP and reduced adiponectin were significantly associated with greater angiographic severity of CAD and adverse metabolic characteristics. These biomarkers may reflect interacting metabolic and inflammatory pathways involved in coronary atherosclerosis.

Background: Typhoid fever remains an important infectious disease among children, particularly in settings with inadequate access to safe drinking water, sanitation and hygiene. Socioeconomic and environmental conditions may play an important role in the transmission of Salmonella Typhi. The present study was conducted to assess socioeconomic and environmental factors associated with pediatric typhoid fever in a tertiary care hospital. Methods: A hospital-based observational study was conducted in the Department of Paediatrics of a tertiary care teaching hospital over a period of 12 months. A total of 100 children aged 1–18 years diagnosed with typhoid fever were included. Sociodemographic, socioeconomic, water and sanitation characteristics, hygiene practices, food-related exposures, clinical findings and laboratory results were recorded using a structured proforma. Data were analyzed using appropriate statistical tests, with p<0.05 considered statistically significant. Results: Among the 100 children, 56% were male and 44% were female. The largest proportion belonged to the 6–10-year age group (32%), and 63% were from rural areas. Lower and lower-middle socioeconomic groups accounted for 80% of participants. Half of the households (50%) reported no regular drinking-water purification. Inadequate sanitation was reported in 32%, while irregular handwashing before meals was reported in 39%. Consumption of food from outside the home and street-vended food was reported in 57% and 46% of children, respectively. Laboratory confirmation was available in 62% of cases. Lack of regular water purification (p=0.015), inadequate sanitation (p=0.027) and irregular handwashing (p=0.044) were significantly associated with laboratory-confirmed typhoid fever. Conclusion: The study highlights the important role of modifiable environmental and hygiene-related factors in pediatric typhoid fever. Strengthening safe drinking-water practices, household sanitation, hand hygiene and food safety, together with appropriate vaccination and health education, may help reduce the burden of typhoid fever among children.

Background: Typhoid fever is a systemic bacterial infection that commonly affects children and may be associated with hematological abnormalities and hepatosplenomegaly. The presence of organomegaly may reflect systemic involvement and could be associated with greater hematological derangement. This study was undertaken to evaluate the association between hepatosplenomegaly and hematological abnormalities in children with typhoid fever. Methods: A hospital-based observational study was conducted in the Department of Paediatrics of a tertiary care teaching hospital over a period of one year.  A total of 100 children aged 1–18 years diagnosed with typhoid fever were included. Clinical examination was performed to assess hepatomegaly and splenomegaly. Hematological parameters including hemoglobin, total leukocyte count, differential leukocyte count, platelet count and red cell indices were evaluated. The association between hepatosplenomegaly and hematological abnormalities was analyzed using appropriate statistical tests, with p<0.05 considered statistically significant. Results: Among the 100 children, 28 (28%) had hepatosplenomegaly, while 18 (18%) had isolated hepatomegaly and 12 (12%) had isolated splenomegaly. Anemia was observed in 46% of children, thrombocytopenia in 34%, leukopenia in 31%, neutropenia in 19% and leukocytosis in 12%. Children with hepatosplenomegaly had a significantly higher frequency of anemia (71.4% vs. 36.1%, p=0.004), leukopenia (53.6% vs. 22.2%, p=0.006) and thrombocytopenia (53.6% vs. 26.4%, p=0.012) compared with those without hepatosplenomegaly. Mean hemoglobin, total leukocyte count and platelet count were also significantly lower in children with hepatosplenomegaly. Conclusion: Hepatosplenomegaly was significantly associated with anemia, leukopenia and thrombocytopenia in children with typhoid fever. Its presence may serve as a useful clinical indicator of increased hematological involvement and may warrant closer hematological monitoring.

Background: Typhoid fever remains an important cause of morbidity among children, and a proportion of patients experience prolonged illness and delayed clinical recovery despite appropriate treatment. Identification of predictors of delayed recovery may facilitate early recognition and appropriate management of high-risk children. Objective: To identify clinical, laboratory, demographic, microbiological, and treatment-related predictors of delayed clinical recovery in children with typhoid fever. Materials and Methods: A hospital-based observational study was conducted in the Department of Paediatrics at a tertiary care teaching hospital over a period of 1 year. A total of 100 children aged ≤18 years diagnosed with typhoid fever were included. Demographic, clinical, laboratory, microbiological, and treatment-related data were collected using a structured proforma. Patients were categorised into early and delayed clinical recovery groups. Factors associated with delayed recovery were evaluated using univariate analysis, followed by multivariable logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and a p-value <0.05 was considered statistically significant. Results: Of the 100 children, 68 (68.0%) achieved early recovery, while 32 (32.0%) had delayed recovery. Delayed recovery was significantly associated with fever >7 days before presentation, high-grade fever, hepatomegaly, splenomegaly, dehydration, elevated AST and ALT, and antibiotic modification. On multivariable logistic regression, fever >7 days before presentation (adjusted OR 3.02; 95% CI: 1.18–7.73; p=0.020), dehydration (adjusted OR 2.91; 95% CI: 1.01–8.38; p=0.048), elevated ALT (adjusted OR 2.76; 95% CI: 1.04–7.34; p=0.042), and antibiotic modification (adjusted OR 2.89; 95% CI: 1.02–8.18; p=0.046) were identified as independent predictors of delayed clinical recovery. Conclusion: Delayed clinical recovery occurred in nearly one-third of children with typhoid fever. Prolonged fever before presentation, dehydration, elevated ALT, and antibiotic modification were independent predictors of delayed recovery. Early identification of these factors may help in risk stratification, closer monitoring, and timely management of pediatric typhoid fever.

Background: Increasing evidence suggests that immune dysregulation and chronic low grade inflammation contribute to the pathophysiology of schizophrenia. Interleukin-6 (IL-6) and C-reactive protein (CRP) are key inflammatory biomarkers that may reflect disease activity and clinical severity. Aim: To compare serum IL-6 and CRP levels between patients with schizophrenia and healthy controls and to evaluate their association with disease severity. Methods: This hospital based comparative cross-sectional study included 50 patients with schizophrenia and 50 age and gender matched healthy controls. Schizophrenia severity was assessed using the Positive and Negative Syndrome Scale (PANSS). Serum IL-6 concentrations were measured using enzyme linked immunosorbent assay (ELISA), while CRP levels were estimated by an immunoturbidimetric method. Statistical analysis was performed using Jamovi. Results: Patients with schizophrenia demonstrated significantly higher serum IL-6 and CRP levels than healthy controls (both p<0.001). Both biomarkers increased progressively with disease severity. Serum IL-6 showed a significant positive correlation with CRP (r=0.577, p<0.001), indicating coordinated inflammatory activation in schizophrenia. Conclusion: Elevated serum IL-6 and CRP levels and their association with increasing disease severity support the role of systemic inflammation in schizophrenia. These biomarkers may serve as useful indicators of inflammatory activity and disease severity, although longitudinal studies are required to establish their prognostic and clinical utility.

Introduction: Although spinal anaesthesia is a very common technique in anaesthetic care, it involves many complications, with post-dural puncture headache (PDPH) being one of the most common. Atraumatic pencil-point spinal needles are associated with a lower incidence of PDPH than cutting needles. Methods: The hospital-based, observational comparative study included 144 patients, aged 18 to 60 years, of either sex, undergoing lower limb orthopaedic surgeries under spinal anaesthesia. Patients were assigned into two equal groups (n=72 each), who were consecutively sampled. 25 G Quincke needles in Group Q and 25 G Whitacre needles in Group W were used for administration of drug into the CSF. We evaluated the incidence and severity of PDPH, post-spinal backache, PDPH based on gender, PDPH based on any pre-existing headache before lumbar puncture, and perioperative side effects. Results: Demographic and haemodynamic parameters were similar in both groups (p>0.05). PDPH was seen in 13.89% of the Quincke group and 4.17% of the Whitacre group, demonstrating a statistically significant decrease with Whitacre needles (p=0.0419). Incidence of PDPH was higher among the female patients and individuals with any pre-existing headache before lumbar puncture (p<0.05). The incidence of post-spinal backache and perioperative side effects, such as nausea, vomiting, hypotension, and bradycardia, was higher in the Quincke group, however, these differences were not statistically significant (p>0.05). Conclusion: Although the use of both spinal needle designs provides comparable haemodynamic stability and procedural success rate, the 25 G Whitacre pencil-point spinal needle significantly lowers the incidence of post-dural puncture headache compared to the 25 G Quincke needle. Hence, the routine use of Whitacre needles for spinal anaesthesia in lower limb orthopaedic surgeries could be considered as a better choice.

Background: Femoral nerve block is an effective component of multimodal postoperative analgesia following knee surgery. Bupivacaine and ropivacaine are commonly used long-acting local anaesthetics, although differences in their sensory and motor block characteristics may influence their clinical utility. Aim: To compare 0.25% bupivacaine and 0.25% ropivacaine in ultrasound-guided single-shot femoral nerve block for postoperative analgesia following elective knee surgery. Methods: This prospective, randomized, comparative study included 90 patients with ASA physical status I–II, aged 18–60 years, undergoing elective knee surgery. Patients were randomly allocated to Group A (n=45), receiving 30 mL of 0.25% bupivacaine, or Group B (n=45), receiving 30 mL of 0.25% ropivacaine. Postoperative VAS scores, sensory and motor blockade, haemodynamic parameters, rescue analgesic requirement, time to first rescue analgesia, and adverse effects were assessed over 24 hours. Results: Baseline characteristics were comparable between the groups. VAS scores were similar at most assessment intervals; however, the VAS score at 20 hours was significantly lower with ropivacaine (median 2 vs 3; p=0.039). Sensory scores were significantly higher in the ropivacaine group at 4 and 8 hours (p=0.001 each), whereas motor scores remained comparable throughout the study. Rescue analgesia was required in 35.6% of the bupivacaine group and 37.8% of the ropivacaine group (p=0.999). Mean time to first rescue analgesia was 1110.0 ± 275.4 and 1030.6 ± 278.4 minutes, respectively (p=0.417). Adverse effects occurred in five patients (11.1%) receiving bupivacaine compared with none receiving ropivacaine (p=0.056). Conclusion: Both 0.25% bupivacaine and 0.25% ropivacaine provided effective postoperative analgesia following ultrasound-guided single-shot femoral nerve block for knee surgery. Ropivacaine demonstrated greater sensory blockade at selected early time points and lower pain scores at 20 hours, while overall rescue analgesic requirement and duration of analgesia were comparable.

Background & Aim: Many clinical investigations have demonstrated that clonidine extends sensory motor blockade when utilized as an adjunct to ropivacaine, albeit with certain limitations. Our aim was to assess the impact of clonidine and dexmedetomidine on ropivacaine for supraclavicular brachial plexus blockade. Methods: In a prospective randomized double-blind study, ultrasound-guided supraclavicular brachial plexus blockade was conducted in 100 patients employing clonidine and dexmedetomidine alongside ropivacaine. Group C received 1 μg/kg of clonidine (1 ml) along with 30 ml of ropivacaine (0.5%), while Group D was administered 1 μg/kg of dexmedetomidine (1 ml) along with the same volume of ropivacaine. Sensory and motor block was evaluated every 5 minutes for the first 30 minutes and subsequently at 15-minute intervals. Results: The average sensory onset time for group D was 2.35 ± 1.8 minutes, while for group C it was 3.94 ± 1.68 minutes, demonstrating statistical significance. Patients in group D had a mean motor onset time of 4.14 ± 1.75 minutes, whereas those in group C demonstrated a mean motor onset time of 7.62 ± 1.39 minutes, with the disparity being statistically significant. The average length of sensory block in group D was 602.34 ± 55.6 minutes, while in group C it was 492.34 ± 65.18 minutes, a statistically significant difference. Patients in group D experienced an average motor block duration of 474.25 ± 54.6 minutes, while those in group C had a mean duration of 375.63 ± 61.9 minutes, a difference that was statistically significant. Conclusion: Dexmedetomidine when added to ropivacaine increases the duration of motor and sensory block in brachial plexus blockade compared to clonidine.

Background: Noncommunicable diseases (NCDs) require continuous treatment and monitoring, resulting in repeated healthcare utilization and sustained household expenditure. Objective- To assess healthcare utilization, out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and their associated factors among patients with NCDs in a rural population. Methods: A community-based cross-sectional analytical study was conducted among 600 adults with at least one physician-diagnosed NCD in the field-practice area of a Rural Health Training Centre in Bundi, Rajasthan. Six villages were selected through simple random sampling, followed by systematic household sampling. Data were collected using a pretested, interviewer-administered questionnaire. Outpatient utilization and expenditure were assessed for the preceding three months, while hospitalization was assessed for the preceding 12 months. CHE was defined as annualized NCD-related OOPE exceeding 10% of annual household income. Results: Outpatient healthcare was utilized by 505 (84.2%) participants, and 103 (17.2%) reported hospitalization. Private facilities were used by 276 (46.0%) participants, while 208 (34.7%) used government facilities. The median net OOPE was ₹1,510 (IQR: ₹648–₹3,171). Medicines constituted the largest expenditure component. Private-facility users incurred significantly higher median OOPE than government-facility users (₹2,572 versus ₹1,323; p<0.001). Expenditure was also significantly higher among participants with multimorbidity and NCD-related complications. Complications were associated with greater healthcare utilization (p=0.026). CHE was experienced by 75 (12.5%) households. OOPE did not differ significantly according to insurance or socioeconomic status. Conclusion: NCD care involved frequent outpatient utilization and household expenditure. Medicines, private-facility use, multimorbidity, and complications contributed substantially to the financial burden. Strengthening public primary care and extending financial protection to outpatient medicines and investigations may reduce NCD-related OOPE and CHE.

Background: Awareness about hearing loss in children is important in general population for early detection and timely intervention. Multiple studies have been conducted to assess shortfall in subjects seeking appropriate treatment promptly. One such study has been conducted in a tertiary care centre in Mumbai, India. Materials and Methods: This study investigated the awareness of hearing loss in children in general population through a self-administered questionnaire survey. A total of 855 participants visiting a tertiary care center in Mumbai, India were included in this study. Results: About half of the participants (54.2%) were found to be aware of screening tests for hearing loss in a child at birth, while slightly more (60.9%) were aware of surgical options in case the child is detected with hearing loss. 48.6% had the knowledge of schemes and concessions offered by government to hearing impaired children, and 22.5% participants reported ever having the chance to attend an event that entails details of such government schemes. Conclusion: Despite facilities that are available, accessible and affordable, there exists a lack of knowledge among general population on hearing loss in children and treatment options. Responses from the current study should raise concerns about the dire need to educate and sensitize the public in general. Early identification of hearing loss in children is paramount for successful implementation of early hearing intervention and favourable prognosis.

Background: Pharmacogenomics (PGx) uses genetic information to explain differences in patient responses to medicines and to support appropriate drug selection and dosing. Objective: To review recent advances in pharmacogenomic technologies and examine their relevance to the development and clinical use of personalized medicine. Methods: A systematic review was undertaken using predefined eligibility criteria. Literature addressing pharmacogenomic technologies, genomic discovery, clinical applications, and implementation was identified and evaluated. Information was extracted on study characteristics, technologies, applications, major findings, and clinical relevance. Findings were synthesized descriptively and thematically in accordance with PRISMA 2020 reporting principles. Results: The literature demonstrates a progression from individual SNP-based studies and genome-wide association studies (GWAS) toward next-generation sequencing (NGS), regulatory genomics, pharmacometabonomics, bioinformatics, and emerging computational approaches. These methods have expanded the investigation of genetic contributors to drug efficacy, toxicity, and pharmacokinetic variability. Translation into clinical practice, however, remains constrained by challenges in evidence interpretation, population diversity, cost and reimbursement, clinical decision support, clinician education, and equitable access to testing. Conclusion: Pharmacogenomics is increasingly capable of informing individualized treatment, but advances in technology alone will not guarantee clinical uptake. Meaningful implementation depends on reliable genomic evidence, integration with clinical information, clear interpretation, effective decision support, and healthcare systems capable of supporting testing and follow-up.

Introduction: Allergic rhinitis (AR) is a globally prevalent IgE mediated inflammatory disorder of the nasal mucosal membranes. Symptoms of nasal congestion, rhinorrhoea, sneezing, nasal and ocular itching affect quality of life. Intranasal corticosteroids are first-line therapy for allergic rhinitis with mometasone furoate and fluticasone propionate nasal spray. Methods: A double-blind randomized control trial was conducted from February 2021 to July 2022, on 130 children aged 6 to 18 years at the department of Paediatrics Geetanjali medical college and hospital, Udaipur. Patients were randomized into two groups, Group A received Mometasone Furoate (MF) nasal spray, and Group B received Fluticasone furoate (FF) nasal spray for 4 weeks. Total Nasal Symptom Score (TNSS) and Total Non-nasal symptoms score (TNNS) were filled at baseline and at follow up. Data was analysed and statistically evaluated. Results: Statistically significant difference found at 4 weeks p<0.001 in the mean value of TNSS for FF group. Mean value of TNNS at baseline was 14.10, at 1 week was 4.07 and at 4 week was 0.67 which was found statistically significant. Nasal stuffiness, nasal itching and sneezing found at 1 week p = 0.001- and 4-week p = 0.001 was statistically significant in FF group. Discussion: Fluticasone demonstrated a better control of nasal and ocular symptoms. Both the agents showed comparable effectiveness, though Fluticasone trended towards better Sneezing and nasal itching control due to localized anti-inflammatory action.

Background: Hospitalized patients often suffer from urinary fungal infections. With the increasing burden of patients with fungal infections, our study aims at determining susceptibility of Candida species in urinary isolates along with treatment outcome. Methods: A retrospective observational study was conducted spanning from January 2022 to December 2023. A total of 41 Candida isolates were studied from urine samples of cancer patients. Relevant information was obtained using the hospital electronic medical record system. Findings: Amongst the 41 patients, study population ranged from 10 months to 79 years of age. Female preponderance was seen (56.1%). Candida tropicalis (34.1%) was the most frequently isolated Candida species, followed by Trichosporon asahii (17%) & C. albicans (17%). Fluconazole (46.3%) was most commonly used antifungal agent. Candida albicans isolates were susceptible to all the antifungals under study. Candida tropicalis exhibited susceptibility to most drugs, though Posaconazole and Itraconazole showed highest frequencies of resistance at 10 and 5, respectively. Interpretation: Since candiduria is an important cause of morbidity in neutropenic patients, accurate identification of Candida species can be useful for the appropriate selection of antifungal agents.

Introduction: Renal papillary necrosis complicating acute pyelonephritis is seen with increasing frequency in poorly controlled type 2 diabetes. Sloughed papillae obstruct the collecting system and sustain infection. Emergency decompression with a double-J stent is standard practice, but there is no agreement on when the necrotic tissue should be cleared endoscopically. We compared clearance at 2 to 3 months with clearance at 9 to 12 months. Methods: Prospective, non-randomised comparative study conducted at Department of Urology, Sri Siddhartha Medical College, Sri Siddhartha Academy of Higher Education, Tumkur between April 2022 and April 2025. Sixty adults with radiologically confirmed non-calculous acute pyelonephritis with papillary necrosis and hydroureteronephrosis underwent emergency 6 Fr/24 cm silicone double-J stenting, followed by two weeks of intravenous and two weeks of oral culture-directed antibiotics. Allocation to early clearance at 2 to 3 months (Group A) or delayed clearance at 9 to 12 months (Group B) followed the protocol of the admitting consultant unit, determined by the day of admission roster. The primary outcome was complete clearance of necrosed papillae in a single session. Secondary outcomes were operative time, re-stenting, peri-operative sepsis, stent burden, and chronic pyelonephritis on dimercaptosuccinic acid scintigraphy performed at least six months after clearance. Chronic pyelonephritis was modelled by multivariable logistic regression adjusting for baseline chronic kidney disease, glycated haemoglobin and age. Results: Fifty-three of 60 patients completed follow-up (28 in Group A, 25 in Group B). Mean age was 54.0 (SD 10.6) years, 47 patients (88.7%) were female, 45 (84.9%) had type 2 diabetes and mean glycated haemoglobin was 9.1% (SD 1.9). Complete single-session clearance was achieved in 20 of 28 (71.4%) in Group A and 23 of 25 (92.0%) in Group B (p = 0.081). Mean operative time was 127.7 (SD 28.5) minutes against 75.8 (SD 20.9) minutes (p < 0.001). Peri-operative sepsis occurred in 5 patients (17.9%) and 1 patient (4.0%) respectively (p = 0.196). Median stent dwell was 80 days against 322 days (p < 0.001). Chronic pyelonephritis was identified in 6 of 28 (21.4%) in Group A and 17 of 25 (68.0%) in Group B (p < 0.001), and delayed clearance remained independently associated with it after adjustment (adjusted odds ratio 8.13, 95% CI 1.97 to 33.56, p = 0.004). Mean estimated glomerular filtration rate fell by 1.0 (SD 6.1) mL/min/1.73 m2 in Group A and by 7.5 (SD 7.0) in Group B (p < 0.001). Conclusions: Delaying clearance to 9 to 12 months makes the endoscopic procedure easier, faster and safer in the short term, but is independently associated with renal cortical scarring and accelerated loss of filtration. The two strategies compared here are the extremes of a spectrum, and the balance of harms suggests the optimal window lies between them. An adequately powered randomised trial comparing intermediate timing against these two anchors is the logical next step.

Background: Alcohol dependence is frequently associated with significant psychiatric co-morbidities which may increase the risk of suicidal ideation. Suicide is currently the fourth most common cause of death worldwide. Aim: To find out the relationship between suicidal ideation and explore the risk factors for suicide among alcohol dependent subjects. Materials and Methods: A total of 100 male patients diagnosed with alcohol dependence syndrome as per DSM V were included for the study. M.I.N.I version 6.00 used for assessing psychiatric comorbidity and Beck’s suicidal ideation scale was used to measure the suicidal ideation. Results: Among the study subjects mean score on Beck’s suicidal ideation was found to be 7.55 with a SD of ±7, psychotic disorders were found to be 40 % followed by generalized anxiety disorders – 18% followed by major depressive disorder-2%. Conclusion: suicidal ideation is highly prevalent among alcohol dependent individuals particularly those with co-existing psychiatric disorders.