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.

Background: Occurrence of hypotension during spinal anaesthesia for caesarean section is a common phenomenon. It is due to a decrease or variation in the haemodynamic pressure, resulting from sympathetic block. Hence, ephedrine plays a vital role as a vasoconstrictor. Hence, ephedrine is the most preferred drug. Method: Out of 90 (ninety), 45 were administered ephedrine, and 45 in the controlled group were administered the same quantity of normal saline during spinal anaesthesia. Haemodynamic and neonatal outcomes were noted and compared. Results: In comparison of systolic BP at the intervals of 1, 2, 3, and 15 minutes, there were significant p-values. In Apgar studies at the internal of 1 and 5 minutes, there was a significant O value. Moreover, the pH of umbilical cord blood also had a significant p-value. Conclusion: It is proved that IV infusion of ephedrine is more effective in preventing hypotension in parturients undergoing caesarean section without causing haemodynamic complications.

Introduction: Cervical lymphnodes is one of the commonest presentation of patients attending in ENT OPD. It is one of the commonest presentation of underlying pathologies of head and neck region which has large number of differential diagnosis like neoplasm (Hodgkin, non-Hodgkin, and metastatic secondaries from head and neck region including thyroid carcinoma, infection (specific and non-specific), immunodeficiency disorder. Aims and Objectives: (1) To study various pathological condition presenting with enlarged lymph nodes in neck. (2) To find out various modes of clinical presentation of lymph nodes enlargement. Materials and Methods: A Cross sectional study was conducted in rural based tertiary care hospital over a period of 18 months wherein a total of 200 patients presented with cervical lymphadenopathy were studied. Results: 90 males of the study population and 110 females of the study subjects had lymphadenopathy. Distribution of study population based non neoplastic and neoplastic cases. 142 study subjects had non-neoplastic cases and 58 had neoplastic cases. Distribution of study population based on histopathological diagnosis. 81 study subjects had Tuberculosis, 53 of the study subjects had reactive lymphadenitis, 34 study subjects had Secondaries, 24 had primary malignancy and 8 had chronic granuloma. Among male patients having cervical lymphadenopathy, 20 of the study subjects belonged to the age group of 0-14 years, 55 belonged to the age group of 15-60 years and 15 belonged to age group more than 60 years. And among female population having cervical lymphadenopathy, 30 study subjects belonged to the age group of 0-14 years, 65 belonged to the age group of 15-60 years and 15 belonged to age group more than 30 years. Distribution of study subjects according to their symptoms, 132 study subjects had swelling, 30 had pain, 56 had fever, 40 had cough, 28 had loss of appetite, 28 had loss of weight, 9 had difficulty in swallowing, 4 had change in voice. 12 study subjects had positive exposure of tuberculosis with tuberculosis lymphadenitis and 69 had negative exposure of tuberculosis with tuberculosis lymphadenitis shows among male study subjects non-specific inflammation was most common in <14 year age group and least in ≥60 years age group. Tubercular lymphandenitis was found maximum in age group of 14-59 years and minimum in age group <14 years. Secondary malignancies were most common in age group 14-49 years and least in <14 years age group. Primary malignancies were also visible most in age group 14-59 years and equal cases found in age group <14 years and ≥60 years. One case of chronic granuloma was visible among all the age groups. Among female study subjects equal number of cases of non-specific inflammation, tubercular lymphandenitis, secondary malignancies, primary malignancies and chronic granuloma found in age groups of 14-59 and ≥60 years and least number of all the cases was found in age group <14 years. It is found that level II site had maximum (35, 43.2%) tubercular cervical lymphadenitis case followed level III (30, 37.03%) and Level VI had not any number of cases of tubercular cervical lymphadenitis. In Reactive lymphadenitis level II had maximum number of cases (14, 26.4%) followed by level V (15, 28.3%) and level VI had no case. Lymphoma cases were maximum at level III sites (12, 50.0%) and again level VI had no case at all. Cases with secondaries malignancy were most common in level III (12, 35.3%) and level I had just only 1 case. Equal number of Chronic granuloma cases (2, 25%) were visible in level II, level III, level IV and level V respectively. Level I and level VI had no case of chronic granuloma. that primary malignancy cases were maximum among age group of 14-59 years of male study population and secondary malignancy cases were also maximum among the same age group of female study population. Conclusions: The findings of the present study may act as 1^st hand knowledge regarding age, sex distribution of lymph node diseases, their mode of presentation and predilection for involvement of different lymph node groups. It will help the care giver doctors especially at primary care level to think in a systematic way for detection/ referral to the respective cases early and thereby avoiding the diagnostic delay in cases like TB/ cancer of lymph nodes.

Background: Rapid recognition and risk stratification of sepsis remain challenging in the intensive care unit (ICU). C-reactive protein (CRP) is inexpensive and widely available but lacks specificity, whereas presepsin, a soluble CD14 subtype released during activation of innate immune pathways, has been proposed as an earlier and potentially more specific biomarker of bacterial sepsis. We compared the clinical utility of presepsin and CRP in the management of adults with sepsis admitted to a medical ICU. Methods: In this prospective observational model, 70 adult patients with clinically suspected sepsis admitted to the Medical ICU of Agartala Government Medical College were included. Presepsin and CRP were measured at ICU admission (0 hour), and their association with sepsis severity, microbiological confirmation, organ dysfunction and 07-day outcome was assessed. Receiver operating characteristic (ROC) analysis was used to compare discriminatory performance. The numerical findings in this draft are simulated and must be replaced with actual study data before publication. Results: Among the patients, 48 patients had sepsis and 22 had non-infectious systemic inflammation. Median presepsin and CRP concentrations were higher among patients with sepsis. Presepsin demonstrated an area under the ROC curve (AUC) of 0.86 for discrimination of sepsis compared with 0.74 for CRP. A presepsin threshold of 720 pg/mL yielded sensitivity of 83.3% and specificity of 77.3%, whereas a CRP threshold of 96 mg/L yielded sensitivity of 79.2% and specificity of 63.6%. Presepsin also showed stronger correlation with Sequential Organ Failure Assessment (SOFA) score. However, isolated baseline biomarker measurement showed only modest prognostic discrimination for 07-day mortality. Conclusion: In this study, presepsin demonstrated better diagnostic discrimination than CRP and may provide additional information regarding sepsis severity. Nevertheless, biomarkers should complement, rather than replace, clinical assessment, microbiological investigation and serial evaluation.

Background: Perforated appendicitis is associated with a high risk of postoperative wound infection and morbidity. The optimal surgical approach, laparoscopic versus open appendectomy, remains debated in complicated cases. Aim: To compare the incidence and severity of postoperative wound infections and overall outcomes between laparoscopic and open appendectomy in patients with perforated appendix. Materials and Methods: The present comparative study included 200 adult patients (18–60 years) with perforated appendicitis, divided equally into laparoscopic (n = 100) and open appendectomy (n = 100) groups. Demographic variables, co-morbidities, postoperative wound infections, complications, and hospital stay were analyzed. Regression and ROC curve analyses were performed to identify predictors of postoperative complications. Results: The incidence of wound infection was significantly lower in the laparoscopic group compared to the open group (10% vs 25%, p < 0.01). Moderate-to-severe wound infections and overall postoperative complications were more frequent following open appendectomy (44% vs 20%). The mean hospital stay was shorter in the laparoscopic group (4.5 ± 1.5 days) compared to the open group (6.5 ± 2.0 days). Multivariate regression identified open appendectomy as an independent predictor of postoperative complications. ROC analysis showed higher predictive accuracy of disease severity and hospital stay for complications in the open surgery group. Conclusion: Laparoscopic appendectomy significantly reduces wound infection rates, postoperative complications, and hospital stay in perforated appendicitis, supporting its use as the preferred surgical approach when expertise is available.

Background: Peritoneal adhesions are a common consequence of intra-abdominal surgery and may result in significant morbidity, including intestinal obstruction, chronic abdominal pain, infertility, prolonged operative time, and increased surgical difficulty during subsequent procedures. The Peritoneal Adhesion Index (PAI) provides a standardized method for objectively assessing the extent and severity of intra-abdominal adhesions. Aim: To assess the severity and distribution of peritoneal adhesions using the Peritoneal Adhesion Index and to evaluate their association with previous abdominal surgeries, surgical approach, operative difficulty, and postoperative outcomes. Materials and Methods: A prospective observational study was conducted among 50 patients aged 18–70 years undergoing abdominal surgery at Narayana Medical College and Hospital, Nellore, over an 18-month period. Patients with intra-abdominal adhesions identifiable during laparotomy or laparoscopy were assessed using the PAI. Demographic characteristics, previous surgical history, type of surgery, adhesion severity, operative parameters, postoperative complications, and duration of hospital stay were recorded. Patients were followed during hospitalization and at 1 and 3 months postoperatively. Statistical analysis was performed using SPSS, with p<0.05 considered statistically significant. Results: The study included 28 males (56%) and 22 females (44%), with a mean age of approximately 42.6 years. Open surgery was performed in 32 patients (64%), while 18 (36%) underwent laparoscopic surgery. Mild adhesions (PAI 0–5) were present in 42% of patients, moderate adhesions (PAI 6–10) in 34%, and severe adhesions (PAI >10) in 24%. Patients undergoing their first abdominal surgery had a lower mean PAI score (4.8 ± 2.1) compared with those with two or more previous surgeries (9.6 ± 3.4), demonstrating a strong association between repeated surgery and adhesion severity. Severe adhesions were more frequent following open surgery than laparoscopic surgery. Higher PAI scores were associated with prolonged operative duration, increased blood loss, postoperative complications, and longer hospital stay. Postoperative complications included bowel obstruction (18%), chronic abdominal pain (28%), and infertility among female patients (14%). Overall, 60% of patients recovered without complications, while 24% developed complications and 16% required intervention. Conclusion: Peritoneal adhesions are common among patients undergoing abdominal surgery, with greater adhesion severity observed in patients with previous abdominal operations and following open procedures. Increasing PAI scores were associated with greater operative difficulty and postoperative morbidity. The Peritoneal Adhesion Index provides a useful standardized approach for quantifying adhesion burden and may assist in surgical planning, risk stratification, and evaluation of postoperative outcomes. Strategies aimed at minimizing peritoneal trauma and promoting minimally invasive surgery may help reduce adhesion-related morbidity.

Background: Incisional hernia is a common long-term complication following abdominal surgery and is associated with pain, impaired quality of life, wound morbidity, and recurrence. Mesh reinforcement is widely accepted for repair, although the optimal mesh position remains debated. Onlay mesh placement is technically simpler, whereas retro-rectus mesh placement may provide better tissue integration and reduced wound-related complications. This study compared the surgical outcomes of retro-rectus and onlay mesh repair in patients with ventral and incisional hernias. Aim: To compare the effectiveness and surgical outcomes of open retro-rectus mesh repair with onlay mesh repair in patients undergoing ventral hernia repair. Materials and Methods: A prospective comparative hospital-based study was conducted in the Department of General Surgery, Narayana Medical College and Hospital, Nellore, from May 2024 to December 2025. Fifty adult patients with ventral hernias requiring surgical repair were included and alternatively allocated into two groups: onlay mesh repair (n=25) and retro-rectus mesh repair (n=25). Postoperative pain, wound complications, hospital stay, recovery, quality of life, cosmetic satisfaction, and recurrence were assessed. Patients were followed up on postoperative days 1 and 3, at discharge, and at 1, 3, and 6 months. A p-value <0.05 was considered statistically significant. Results: The mean operative time was significantly longer in the retro-rectus group than in the onlay group (80.6 ± 10.8 vs. 71.8 ± 11.9 minutes; p=0.006). Seroma occurred in 12% of retro-rectus repairs compared with 16% of onlay repairs, while deep surgical site infection occurred in 0% and 4%, respectively. Overall postoperative complications were lower with retro-rectus repair (16% vs. 24%), although the difference was not statistically significant (p=0.48). Postoperative day-1 pain was higher following retro-rectus repair (5.6 ± 1.0 vs. 4.7 ± 1.0; p=0.04), but pain scores became comparable subsequently. At six months, quality-of-life scores were significantly higher in the retro-rectus group (90.4 ± 5.9 vs. 86.8 ± 6.5; p=0.04), as were cosmetic satisfaction scores (3.9 ± 0.7 vs. 3.5 ± 0.8; p=0.03). Recurrence occurred in 1 patient (4%) in the onlay group and none in the retro-rectus group, without statistical significance (p=0.31). Conclusion: Retro-rectus mesh repair required a significantly longer operative time but demonstrated favourable postoperative outcomes, including fewer wound-related complications, better six-month quality of life, greater cosmetic satisfaction, and no recurrence during the six-month follow-up. Although the differences in complications and recurrence were not statistically significant, the overall findings support retro-rectus mesh placement as a preferable open technique for ventral and incisional hernia repair when adequate surgical expertise is available.

Background: Acute appendicitis is one of the most common surgical emergencies, but its diagnosis can be challenging because of variations in clinical presentation and overlap with other causes of right iliac fossa pain. Diagnostic scoring systems such as the Modified Alvarado and Tzanakis scores can assist in early risk stratification and surgical decision-making. Aim: To compare the diagnostic accuracy and clinical utility of the Tzanakis score and Modified Alvarado score in the diagnosis of acute appendicitis. Materials and Methods: This prospective hospital-based comparative study was conducted over 18 months from June 2024 to December 2025 in the Department of General Surgery, Narayana Medical College and Hospital, Nellore. A total of 100 patients with suspected acute appendicitis were included. All patients underwent detailed clinical evaluation, laboratory investigations, and ultrasonography. Both the Modified Alvarado and Tzanakis scores were calculated independently. Patients underwent appendectomy according to clinical assessment and institutional protocols. Histopathological examination of the excised appendix was considered the definitive diagnostic standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC) were compared. Results: The mean age of the study population was 44.14 ± 16.03 years, with females comprising 55% and males 45%. Right iliac fossa tenderness was the most frequent clinical finding (91%), followed by fever (64%) and vomiting (42%). Histopathology confirmed acute appendicitis in 78% of patients, while 22% had no evidence of acute appendicitis. A Tzanakis score >8 was observed in 76% of patients, while a Modified Alvarado score >7 was observed in 72%. Both scores showed significant association with histopathological diagnosis (p<0.001). The Tzanakis score demonstrated a sensitivity of 93.6%, specificity of 86.4%, PPV of 96.1%, NPV of 79.2%, and accuracy of 92%. The Modified Alvarado score demonstrated a sensitivity of 91%, specificity of 95.5%, PPV of 98.6%, NPV of 75%, and accuracy of 92%. ROC analysis showed an AUC of 0.90 for Tzanakis and 0.93 for Modified Alvarado, with both being statistically significant (p<0.001). Conclusion: Both the Tzanakis and Modified Alvarado scores demonstrated excellent diagnostic performance in patients with suspected acute appendicitis. The Tzanakis score showed slightly higher sensitivity, whereas the Modified Alvarado score demonstrated superior specificity and PPV. Both achieved an overall accuracy of 92%. Thus, either scoring system can be effectively used to support the diagnosis and surgical decision-making in acute appendicitis, with the choice depending on clinical requirements and availability of ultrasonography.

Background: Ventral and incisional hernias are common causes of postoperative morbidity and impaired quality of life. Open retro-rectus mesh repair is an established and durable technique; however, endoscopic total extraperitoneal (eTEP) repair allows placement of mesh in the retromuscular plane while potentially reducing abdominal wall trauma, postoperative pain, wound complications, and hospital stay. This study compared the operative, postoperative, and patient-centered outcomes of eTEP and open retro-rectus repair for ventral hernias. Aim: To compare the operative outcomes, efficacy, safety, postoperative recovery, complications, recurrence, and patient-centered outcomes of eTEP with open retro-rectus mesh repair in the management of ventral hernias. Materials and Methods: A prospective cohort study was conducted from July 2024 to June 2025 in the Department of General Surgery, Narayana Medical College and Hospital, Nellore. Fifty adult patients with clinically or radiologically confirmed ventral hernias were included and divided into eTEP (n=25) and open retro-rectus (n=25) groups. Operative duration, blood loss, drain requirement, postoperative pain, analgesic requirements, surgical-site complications, hospital stay, functional recovery, late complications, and hernia recurrence were assessed. Patients were followed up at 1 week, 1, 3, 6, and 12 months. Statistical significance was considered at p<0.05. Results: The mean operative time was significantly longer with eTEP than with open retro-rectus repair (118.6 ± 14.8 vs. 92.4 ± 12.6 minutes; p<0.001). However, eTEP was associated with significantly lower intraoperative blood loss (72.8 ± 18.4 vs. 148.6 ± 26.3 mL; p<0.001) and reduced drain requirement (24% vs. 68%; p=0.002). Postoperative pain was significantly lower in the eTEP group at 6, 24, 48, and 72 hours (all p<0.001). The duration of parenteral analgesia, total analgesic doses, and rescue analgesic requirement were also significantly lower with eTEP. Surgical-site infection occurred in 4% of eTEP patients compared with 24% following open repair (p=0.04). Hospital stay was significantly shorter with eTEP (3.2 ± 0.8 vs. 5.6 ± 1.1 days; p<0.001), with earlier ambulation, oral intake, and return to normal activities. Hernia recurrence was 4% with eTEP versus 16% with open repair (p=0.16). Overall surgical success was significantly higher in the eTEP group (88% vs. 56%; p=0.01). Conclusion: eTEP repair demonstrated favourable short-term outcomes compared with open retro-rectus repair, with significantly reduced blood loss, postoperative pain, analgesic requirements, surgical-site infection, hospital stay, and time to functional recovery, despite a longer operative duration. Although the difference in recurrence was not statistically significant, recurrence showed a favourable trend with eTEP. eTEP appears to be a safe and effective minimally invasive alternative to open retro-rectus repair in appropriately selected patients, particularly when performed by surgeons with adequate expertise in endoscopic retromuscular techniques.

Background: Ostomy formation is frequently performed as a lifesaving procedure in patients with intestinal obstruction, perforation, trauma, malignancy, and other gastrointestinal conditions. Although reversal restores intestinal continuity and improves quality of life, it is associated with significant postoperative morbidity. Identification of patient- and procedure-related factors associated with adverse outcomes is therefore important for optimizing the timing and safety of ostomy reversal. Aim: To evaluate the clinical outcomes, postoperative complications, and factors associated with adverse outcomes following colostomy and ileostomy reversal. Materials and Methods: A prospective and retrospective observational chart review was conducted in the Department of General Surgery, Narayana Medical College and Hospital, Nellore, over a 12-month period. Thirty-five patients aged ≥18 years who underwent colostomy or ileostomy reversal were included by convenient sampling. Demographic characteristics, comorbidities, indication and type of ostomy, duration of stoma, timing of reversal, operative findings, anastomotic technique, postoperative complications, hospital stay, readmission, and follow-up outcomes were analyzed. Statistical analysis was performed using descriptive statistics, Chi-square test, t-test, and multivariate logistic regression, with p<0.05 considered statistically significant. Results: The study included 22 males (62.9%) and 13 females (37.1%), with the majority aged 41–60 years (45.7%). Comorbidities were present in 60% of patients. Intestinal obstruction was the commonest indication for ostomy formation (40%), followed by perforation peritonitis (25.7%). Colostomy constituted 57.1% and ileostomy 42.9% of cases, while 74.3% were loop stomas. Delayed reversal (>3 months) was performed in 71.4% of patients. Dense adhesions were observed in 51.4%. The overall postoperative complication rate was 37.1%, with surgical site infection (20%) being the most common complication, followed by postoperative ileus (11.4%). Early reversal was significantly associated with postoperative complications (60% vs. 28%, p=0.036), as were dense adhesions (p=0.012) and presence of comorbidities (p=0.018). On multivariate analysis, dense adhesions (AOR 5.62, p=0.009), comorbidities (AOR 4.85, p=0.019), age >60 years (AOR 3.92, p=0.037), and early reversal (AOR 3.47, p=0.048) were independent predictors of postoperative complications. Colostomy reversal showed higher complication and readmission rates than ileostomy reversal, although differences were not statistically significant. Conclusion: Ostomy reversal is associated with considerable postoperative morbidity, with surgical site infection being the most frequent complication. Advanced age, comorbidities, early reversal, and dense intra-abdominal adhesions were significant predictors of adverse postoperative outcomes. Careful patient selection, optimization of comorbidities, appropriate timing of reversal, and meticulous management of adhesions may improve outcomes following ostomy closure.

Background: Lower limb cellulitis is a common bacterial infection of the skin and subcutaneous tissues and may range from localized inflammation to severe infection with deep tissue involvement, systemic toxicity, and limb-threatening complications. Diabetes mellitus, renal dysfunction, vascular insufficiency, and delayed presentation may contribute to increased severity and the need for surgical intervention. Aim: To assess the risk factors, etiopathogenesis, clinical presentation, severity, need for surgical management, recurrence, and outcomes of patients with lower limb cellulitis. Materials and Methods: This prospective cohort study was conducted over 18 months from June 2024 to November 2025 in the Department of General Surgery, Narayana Medical College and Hospital, Nellore. A total of 100 patients aged more than 25 years with clinically diagnosed lower limb cellulitis requiring hospital admission were included. Detailed history, clinical examination, laboratory investigations, Doppler studies, radiological evaluation, and microbiological investigations were performed as indicated. Disease severity was assessed using the Clinical Resource Efficiency Support Team (CREST) classification. Patients were managed conservatively or surgically depending on disease severity and clinical response. Outcomes assessed included healing, complications, recurrence, amputation, mortality, and duration of hospital stay. Results: The study population comprised 60% males and 40% females, with the highest proportion of patients in the 51–60-year age group (27%), followed by 71–80 years (26%). The right lower limb was involved in 54% of cases, the left in 45%, and bilateral involvement in 1%. According to CREST classification, 67% were Grade II, 30% Grade III, and 3% Grade IV. Diabetes mellitus was the most common comorbidity (54%), followed by chronic kidney disease (22%) and acute kidney injury (17%). Among Grade III patients, diabetes was present in 63% and chronic kidney disease in 33%. Osteomyelitic changes were observed in 9% of patients. Doppler abnormalities suggestive of arterial insufficiency were identified in several patients. Microbiological cultures showed no growth in 45%, while Escherichia coli and Klebsiella were each isolated in 6%. Surgical management included fasciotomy (32%), fasciotomy with wound debridement (47%), and wound debridement alone (20%). Overall, 68% achieved healing, while recurrence, amputation, and mortality occurred in a subset of patients. The mean duration of hospital stay was 7.23 ± 4.53 days. Infective counts significantly decreased following treatment (16.24 ± 7.51 before treatment versus 10.64 ± 6.57 after treatment; p<0.001). Conclusion: Lower limb cellulitis predominantly affects middle-aged and elderly individuals and is strongly associated with diabetes mellitus and renal dysfunction. Severe disease, vascular insufficiency, and deeper tissue involvement may necessitate surgical intervention. Early diagnosis, appropriate antimicrobial therapy, control of comorbidities, vascular assessment, and timely surgical management are essential to reduce complications, recurrence, and mortality and to improve overall patient outcomes.

Background: Social media use may affect sleep quality among young adults. This study assessed social media addiction, sleep quality and their association. Methods: A cross-sectional study was conducted among 350 participants. Social media addiction and sleep quality were assessed using the BSMAS and PSQI, respectively. Participants were categorised according to BSMAS scores and sleep quality. Associations were analysed using the chi-square test. Results: Overall, 24.9% met the criterion for social media addiction. Sleep quality was very good in 10.0%, fairly good in 16.9%, fairly bad in 39.7% and very bad in 33.4% of participants. Thus, 73.1% reported poor sleep quality. No significant association was observed between social media addiction and sleep quality (χ² = 3.043, p = 0.385). Conclusion: Poor sleep quality and social media addiction were common, but no significant association was identified. Further research should examine nighttime use, usage duration and psychological stress.

Background: Vaspin is an adipokine that may be involved in insulin resistance and metabolic regulation. However, its relationship with glycaemic control and lipid abnormalities in type 2 diabetes mellitus (T2DM) remains uncertain. Methods: This comparative cross-sectional study included 240 adults: 120 patients with T2DM and 120 age- and sex-matched healthy controls. Serum vaspin was measured using a sandwich enzyme-linked immunosorbent assay. Glycaemic and lipid parameters were estimated using standard laboratory methods. Between-group differences were assessed using the independent-samples t-test. Pearson’s correlation was used to examine the relationship of vaspin with glycaemic and lipid parameters. Results: Mean serum vaspin was significantly higher in patients with T2DM than in controls (1.49 ± 0.25 vs 0.59 ± 0.09 ng/mL; p<0.001). Patients with T2DM had significantly higher FBS, PPBS, HbA1c, total cholesterol, triglycerides, LDL and VLDL and lower HDL levels (all p<0.001). Serum vaspin showed a strong positive correlation with HbA1c (r=0.740, p<0.001), but not with FBS or PPBS. It correlated positively with total cholesterol, triglycerides, LDL and VLDL and negatively with HDL (all p<0.001). Conclusion: Serum vaspin was elevated in patients with T2DM and was associated with poor long-term glycaemic control and an adverse lipid profile. Further longitudinal studies are needed to determine its clinical value as a metabolic biomarker.

Background: Stress is common among undergraduate medical students and may adversely affect their academic performance, psychological well-being, and future professional competence. Objectives: This study aimed to determine the prevalence of stress, identify its associated factors, and explore coping strategies among MBBS students of Medical College, Kolkata. Material and Methods: An institution-based cross-sectional study was conducted among 424 MBBS students selected by simple random sampling from all four academic phases. Data were collected using a pretested, self-administered structured questionnaire incorporating items from the Depression, Anxiety and Stress Scale-42 (DASS-42). Descriptive statistics and Chi-square test were used for data analysis, with P≤0.05 considered statistically significant. Results: Overall, 41.98% of participants experienced stress, including 14.39% with mild, 12.74% moderate, 8.02% severe, and 6.84% extremely severe stress. Stress was significantly associated with female gender, rural residence, having at least one doctor parent, socioeconomic status, overeating, alcohol and cannabinoid use, perceived smartphone addiction, and attending late-night parties. Academic burden, lack of relaxation or recreational time, competitive college environment, postgraduate entrance examination concerns, and apprehension about future professional life were significant stressors. Common coping strategies included meditation, listening to motivational speeches, pursuing hobbies, spending time with friends or partners, taking short trips, entrepreneurship, long drives, and spending time amidst nature. Conclusion: Nearly two-fifths of undergraduate medical students experienced stress, with academic and behavioural factors showing significant associations. Institution-based mental health promotion programmes, adequate recreational opportunities, and supportive educational environments may help reduce stress and improve students’ psychological well-being.

Introduction: Ringer’s Lactate (RL) is commonly used to prevent hypotension during subarachnoid block (SAB). Hydroxyethyl Starch (HES), a synthetic colloid, provides greater volume expansion but may affect blood glucose levels. As perioperative hyperglycemia can worsen surgical outcomes, this study compared the effects of 6% HES and RL on intraoperative blood glucose and hemodynamic parameters in non-diabetic patients undergoing lower limb surgery under SAB. Materials and Methods: Ninety ASA I–II non-diabetic adults were randomly assigned to two groups: Group A received 6% HES 130/0.4 (n=45) and Group B received RL (n=45), administered as co-loading fluids at 20 mL/kg after SAB. Blood glucose levels and vital parameters (blood pressure, heart rate, and SpO₂) were recorded at baseline and at 15, 30, 45, 60, 120, and 150 minutes intraoperatively. Results: Blood glucose increased significantly from baseline in both groups. The RL group showed an earlier peak (~90 mg/dL at 45 min) with values returning to baseline by 150 minutes, whereas the HES group demonstrated a gradual rise, peaking at 60 minutes and remaining mildly elevated at 150 minutes. Intergroup differences were significant at several time points (p<0.05). Hemodynamic parameters showed no significant differences between groups (p>0.05). Conclusion: In non-diabetic patients undergoing SAB, 6% HES produces a more prolonged mild increase in blood glucose compared with RL, although both fluids maintain similar hemodynamic stability.

Background: Type 2 Diabetes Mellitus (T2DM) is a leading cause of morbidity and mortality worldwide. India bears one of the highest diabetes burdens globally. Gender-specific differences in clinical presentation, disease course, and management of T2DM remain underexplored, particularly in South Indian tertiary care populations. Objectives: To study gender differences in age, BMI, blood pressure, diabetes duration, glycaemic markers (HbA1c, FBS, PPBS), lipid profile, renal function, hepatic parameters, haematological indices, treatment modality, and compliance between male and female T2DM patients. Methods: A cross-sectional observational study of 516 patients (258 males, 258 females) with T2DM admitted to a tertiary care hospital. Universal screening was performed regardless of symptoms. Data were collected using a structured proforma covering demographics, anthropometric measurements, biochemical investigations, and treatment history. Chi-square test, Independent t-test, and binary multivariate logistic regression (adjusted for age, BMI, and DM duration) were used; exact p-values are reported throughout. Key Results: Universal clinical screening exposed a distinct cardiometabolic gender divergence: female patients presented with a significantly higher generalized obesity and hypertension burden, whereas male patients demonstrated a higher visceral adiposity profile (p=0.001), as characterized in Figure 1. Conclusion: Clinically relevant gender differences exist in the anthropometric profile, comorbidity burden, and certain biochemical parameters of T2DM patients. Targeted interventions addressing generalised obesity in females and central adiposity in males are essential. Both genders require urgent improvement in glycaemic management.

Background: Difficult laparoscopic cholecystectomy (LC) prolongs operative time, raises the risk of complications and the rate of conversion to open surgery. Prospective identification of preoperative predictors of difficult LC and conversion, and assessment of the discriminatory ability of a practical risk model. Methods: Two hundred and twenty adults who were scheduled for elective or early LC for gallstone disease were studied. Demographic, clinical, biochemical and ultrasonographic parameters were documented preoperatively. Operative difficulty was assessed on the Nassar scale with grades 3-5 considered difficult. Secondary outcome was conversion to open surgery. Multivariable logistic regression and receiver-operating-characteristic analysis were performed. Results: Difficult LC was seen in 67 patients (30.5%) and 14 procedures (6.4%) were converted to open surgery. Compared with easy cases, difficult cases had longer operative time (91.8 ± 27.4 vs 54.6 ± 16.9 min, p<0.001), higher blood loss (86 ± 57 vs 28 ± 22 mL, p<0.001), and longer postoperative stay (2.6 ± 1.3 vs 1.4 ± 0.7 days, p<0.001). Independent predictors of difficult LC were male sex (adjusted OR 2.35, 95% CI 1.14-4.84), previous hospitalization for acute cholecystitis (OR 2.81, 95% CI 1.33-5.93), gallbladder wall thickness >4 mm (OR 4.12, 95% CI 1.95-8.69), impacted neck stone (OR 3.56, 95% CI 1.58-8.03), and pericholecystic fluid (OR 3.22, 95% CI 1.21-8.56). The area under the ROC curve of the composite preoperative model was 0.86 (95% CI 0.81-0.91). Nassar grade 4-5, wall thickness >4 mm and impacted stone were all strongly associated with conversion. Conclusion: A limited number of easily obtained clinical and ultrasonographic parameters can be used to identify patients with a higher risk of difficult LC and conversion. Preoperative risk stratification can enhance case allocation, counseling, and preparation for bailout strategies.

Background: The increasing life expectancy of people living with HIV has made long-term metabolic complications an important area of clinical research. Antiretroviral therapy (ART) has substantially improved HIV-related outcomes, but metabolic abnormalities, including dysglycemia and insulin resistance, may occur during treatment. Objective: To evaluate changes in fasting and postprandial blood glucose among HIV-infected patients receiving HAART over a 24-month follow-up period. Methods: This observational follow-up study was conducted in the Department of Medicine, RIMS, Imphal. A total of 100 HIV-positive patients admitted to the medicine ward and receiving HAART were included. Patients were followed at baseline and at 6, 12, 18, and 24 months. Fasting and postprandial blood glucose were recorded, and adverse effects of HAART were documented. Statistical analysis was performed using SPSS version. The statistical test used and the method of handling repeated measurements require confirmation. Results: Among 100 patients, 34 (34%) were reported to have adverse effects related to HAART. Mean fasting blood glucose increased from 87.61 ± 11.18 mg/dL at baseline to 93.79 ± 10.21 mg/dL at 24 months. Mean postprandial blood glucose increased from 107.01 ± 23.82 mg/dL to 113.10 ± 23.69 mg/dL over the same period. The handwritten record reports statistically significant increases at several follow-up points; however, the exact p-values and statistical test require verification. Conclusion: This study suggests that blood glucose levels increased gradually during HAART follow-up. Regular metabolic monitoring may help identify patients who develop dysglycemia during treatment. Larger, prospective studies with appropriate adjustment for confounding factors are needed to clarify the relationship between ART and changes in blood glucose.

Background: In Type 2 Diabetes Mellitus, the progressive islets cell disorder has to be properly monitored & treated to avoid future complications. Monitoring is done mainly by a gold standard investigation namely HbA1c, which will reflect the average blood sugar for the past 2-3 months. Red blood cell, the highest count of all the cells in the body, functions to deliver oxygen mainly by hemoglobin present in it. Normal structure of red blood cell being discoid and biconcave, the red blood cell distribution width is considered as one of the blood indices which is calculated by standard deviation (SD) of mean corpuscular volume (MCV) divided by MCV multiplied by 100. Objectives: To determine the association between HbA1c and RDW in patients with T2DM. Methods: Type 2 DM patients attending the OPD were recruited. All demographic details, complete blood count with RDW and blood sugars were all tested along with HbA1c. Statistical analysis was carried out using Pearson correlation to assess the association between HbA1c and RDW. Results: Mean HbA1c is around 9.69 ± 2.2%, and the mean for RDW is around 13.45 ± 1.6%. Pearson correlation analysis demonstrated a strong positive correlation between HbA1c and RDW (p < 0.001). Patients who are having higher HbA1c levels prone to manifest higher RDW values, pointing to declining erythrocyte size variability with poorer glycemic control. Conclusion: RDW showed a positive correlation with HbA1c among patients with Type 2 Diabetes Mellitus. As RDW is a regular investigation in the list of complete blood count, it may serve as a latent marker locating patients who are under high risk of diabetic complications.

Background: Recovery after inguinal hernia surgery varies according to patient, surgical, occupational, and postoperative factors. Identifying determinants of delayed recovery may improve counselling and postoperative care. Objective: To assess factors affecting return to normal physical activity after elective inguinal hernia repair. Methods: This prospective observational study included 107 adults undergoing open, transabdominal preperitoneal (TAPP), or totally extraperitoneal (TEP) repair at Government Medical College, Siddipet. Demographic, clinical, occupational, operative, pain, and postoperative data were collected. Return time was assessed during follow-up. Group comparisons, correlation analysis, and multiple linear regression were performed, with p<0.05 considered statistically significant. Results: The mean time to resume normal physical activity was 11.04 ± 3.47 days; 94 patients (87.9%) returned within 14 days. Mean recovery time was longer after open repair (12.88 days) than after TAPP (9.16 days) or TEP (9.46 days; p<0.001). Heavy occupational work and postoperative complications were also associated with longer recovery (p<0.001). Postoperative pain correlated positively with return time (r=0.329, p<0.001). In adjusted analysis, postoperative pain, open repair, moderate or heavy work, postoperative complications, recurrent hernia, and bilateral hernia independently prolonged recovery. Age, body mass index, preoperative pain, and TAPP versus TEP were not significant predictors. Conclusion: Most patients resumed normal activity within two weeks. Laparoscopic repair, effective pain control, prevention of complications, and occupation-specific postoperative advice may facilitate earlier functional recovery.

Objectives: The present study was to compare the efficacy of SAB alone with the combination of SAB and intravenous infusion of dexmedetomidine in elective infra-umbilical surgeries. Methods: A total of 80 patients were undergone elective infra umbilical surgeries. All the cases were categorized into two groups. Group A- cases underwent subarachnoid block alone and Group B cases underwent subarachnoid block and intravenous infusion of injection Dexmedetomidine. A full anaesthetic checkup was done and patients accepted under ASA I & ASA II were enrolled. The onset of motor blockade was evaluated by using 4-Point modified Bromage score. Intra-operative requirement of sedatives was evaluated by Ramsay sedation score (RSS). Results: Patients were divided into two groups of 40 patients each. Higher proportion of patients were in the age group of 46 to 60 years (40% in subarachnoid block versus 42.5% in SAB with dexmedetomidine). Five (05) patients in subarachnoid block group had T10 as maximum level of sensory block as compared to two (02) patients in SAB with dexmedetomidine group. 12 patients in subarachnoid block group had T8 as maximum level of sensory block as compared to five (05) patients in SAB with dexmedetomidine group. 22 patients in SAB with dexmedetomidine group had T6 as maximum level of sensory block, 18 patients in subarachnoid block had maximum level of sensory block at T6. While 11 patients in SAB with dexmedetomidine group had T4 as maximum level of sensory block, 5 patients in subarachnoid block alone group had maximum level of sensory block at T4. It was not statistically significant differenced (p = 0.08). The mean Ramsay sedation score was higher in SAB with dexmedetomidine group as compared to subarachnoid group. It was statistically significant difference at all observed time intervals (p = 0.01). Conclusion: combination of SAB with dexmedetomidine resulted in significantly longer durations of sensory and motor blocks, providing an advantage in prolonging anaesthesia. No significant differences in intraoperative complications, vital signs, or adverse effects were observed between the clonidine and control group patients.

Background: Handgrip strength serves as an indicator of muscular fitness and health, while pulmonary function indicates respiratory efficiency. Evaluating the relationship between these factors may help identify early functional decline and support preventive health assessments. Objectives: A study evaluates the relationship between handgrip strength and pulmonary function in healthy young adults, assessing handgrip strength and spirometric parameters, determining correlations between muscle strength and lung function, and exploring handgrip strength as a simple screening marker. Methods: A cross-sectional study was conducted at teritary care centre, over a period of one year among healthy adults aged 18–30 years. After ethical approval and informed consent, demographic data, handgrip strength using dynamometer, and pulmonary function parameters using spirometry as per ATS/ERS guidelines were assessed. Results: Total of 60 healthy young adults, primarily aged 21–25 (43.33%), were studied, with a majority being male (88.33%). Most had normal BMI (50%), followed by overweight (28.33%), underweight (16.67%), and obese (5%). Participants reported no smoking, alcohol use, medical illnesses, or injuries. Mean handgrip strength was similar for both hands (27.92 ± 2.26 kg vs 27.39 ± 2.24 kg, p=0.202). Pulmonary function showed normal values: FVC (3.71 ± 0.59 L), FEV₁ (3.06 ± 0.59 L), PEFR (6.14 ± 2.15 L/sec), and FEV₁/FVC ratio (82.30 ±7.29%). Significant correlations were found between handgrip strength and FVC/FEV₁, while no associations existed with FEV₁/FVC or PEFR. Conclusion: Handgrip strength has a positive correlation with key pulmonary function parameters, particularly FVC and FEV₁, among healthy young adults. Handgrip assessment is a simple, inexpensive, and practical tool for evaluating physical fitness and respiratory health. Maintaining muscle strength may support better lung function.

Background: Neisseria gonorrhoeae remains one of the most common bacterial sexually transmitted pathogens worldwide and is a major cause of cervicitis, pelvic inflammatory disease, infertility, and adverse reproductive outcomes in women. Early diagnosis is often challenging because a substantial proportion of infected women remain asymptomatic, while conventional diagnostic methods demonstrate limited sensitivity. Nucleic acid amplification tests (NAATs) provide rapid and highly sensitive detection and may improve case identification in resource-limited settings. This study aimed to determine the prevalence of Neisseria gonorrhoeae infection among reproductive-age women using chip-based real-time PCR at a tertiary care hospital in Uttar Pradesh. Methods: A hospital-based cross-sectional study was conducted in the Department of Microbiology, Hind Institute of Medical Sciences, Barabanki, from 01 January 2025 to 31 January 2026. A total of 120 women aged 18–49 years attending the Obstetrics and Gynaecology outpatient department were enrolled after obtaining informed consent. Vaginal swabs were processed by wet mount microscopy, Gram staining, and culture, while endocervical swabs were analysed using the Truenat chip-based real-time PCR assay for molecular detection of Neisseria gonorrhoeae. Results: Molecular testing detected Neisseria gonorrhoeae in 10 of 120 participants, giving an overall prevalence of 8.3%. Conventional culture identified only 2 (1.7%) positive cases, demonstrating markedly lower detection than PCR. The highest positivity was observed among women aged 26–30 years, with age showing a statistically significant association with infection (p = 0.035). Most infected women were married, belonged to rural areas, and were from lower socioeconomic groups; however, these associations were not statistically significant. Conclusion: The study demonstrated that chip-based real-time PCR detected substantially more Neisseria gonorrhoeae infections than conventional diagnostic methods. Molecular screening can facilitate early diagnosis, prompt treatment, and improved control of gonococcal infection among reproductive-age women, particularly in settings where asymptomatic infection is common.

Introduction: Epididymo-orchitis is one of the most common urological conditions encountered in urology clinics in India. Despite advances in diagnostic modalities, many cases are still treated empirically without a confirmed causative agent. If not treated promptly, epididymo-orchitis may progress to testicular abscess, testicular infarction or septicaemia. Aim: To determine the aetiology of epididymo-orchitis in order to tailor treatment accordingly. Materials and Methods: This prospective cross-sectional study was conducted in the Department of Urology, Shri B. M. Patil Medical College, Hospital and Research Centre, Karnataka, from January 2016 to June 2017. Thirty-three patients aged above 10 years presenting with signs and symptoms suggestive of epididymo-orchitis were enrolled consecutively, evaluated by detailed clinical history, and subjected to relevant investigations. Patients with diabetes mellitus or a history of urological instrumentation were excluded. Results: The mean age of the 33 patients was 37.57 years. A causative organism was identified in 69.7% of cases. Gram-negative bacilli (Escherichia coli, Klebsiella and Pseudomonas species combined) were the most frequently identified group, accounting for 30.3% of cases, closely followed by Rickettsia as the single most common individual organism (21.2%). In the remaining 30.3% of cases, no causative organism could be identified. Conclusion: In a substantial proportion of cases of epididymo-orchitis, the aetiology remains obscure despite thorough investigation. Identifying the exact cause is essential to guide appropriate treatment; in the remaining idiopathic cases, testing for viral and fastidious organisms may be a useful direction for future study.

Background: Laser hemorrhoidoplasty (LHP) is a tissue preserving procedure for symptomatic hemorrhoidal disease that aims to minimize postoperative pain and promote functional recovery. The aim of this study was to prospectively assess pain trajectories, analgesic use, recovery milestones, early complications and factors related to delayed recovery after LHP. Methods: Ninety-six adults with symptomatic grade II-III hemorrhoids refractory to conservative therapy underwent standardized 1470-nm diode LHP and were followed for 90 days. The visual analogue scale (VAS) was used to assess pain at 6 hours, 24 hours, day 3 and day 7. Secondary outcomes were analgesic use, return to normal activity and work, complications, symptom resolution, and patient satisfaction. Results: Mean age was 44.7 ± 11.8 years and 60 (62.5%) participants were male. Mean VAS decreased from 3.1 ± 1.2 at 6 hours to 2.4 ± 1.0 at 24 hours, 1.5 ± 0.9 on day 3, and 0.6 ± 0.7 on day 7 (p<0.001). The mean time to normal daily activity was 3.2 ± 1.4 days and return to work was 5.6 ± 2.3 days. There was no anal stenosis or new fecal incontinence, and minor postoperative bleeding occurred in 4.2%, urinary retention in 3.1%, and thrombosed external hemorrhoid in 2.1%. 88.5% achieved full or almost full resolution of symptoms and 91.7% were satisfied or very satisfied at 90 days. On multivariable analysis, grade III disease (adjusted OR 2.72, 95% CI 1.08-6.85), 6-hour VAS ≥4 (OR 3.15, 95% CI 1.24-8.01), and total laser energy >1200 J (OR 2.46, 95% CI 1.01-5.98) independently predicted return to work after >7 days. Conclusion: LHP was correlated with moderate postoperative pain, which was rapidly decreasing, low early morbidity and early functional recovery. Early pain intensity and disease burden may help to identify patients who need more tailored postoperative care.

Cystic neck masses in adults are frequently presumed to be benign, most commonly attributed to abscesses, lymphatic malformations, or congenital cysts. However, malignant aetiologies, particularly metastatic papillary thyroid carcinoma (PTC) can occasionally masquerade as benign cystic lesions and delay diagnosis. We report the case of a 34-year-old male with an unusually large cystic neck mass, initially interpreted radiologically as benign, that was ultimately diagnosed as oncocytic variant PTC with tall-cell morphology and metastatic nodal involvement. Through this case, we highlight the diagnostic pitfalls of cystic neck lesions in adults, the prognostic implications of aggressive histologic variants of PTC, and the need for heightened suspicion in atypical cystic presentations. Awareness of this clinical pattern is crucial for early recognition and optimal multidisciplinary management.

Background: Static prognostic scores estimate severity at presentation but may not capture postoperative physiological recovery after emergency surgery for gastrointestinal perforation. This study evaluated dynamic lactate clearance and CRP–albumin ratio (CAR) response for early prediction of adverse outcomes. Methods: A prospective observational study included 120 adults undergoing emergency surgery for gastrointestinal perforation at KIMS, Amalapuram, from November 2025 to June 2026. MPI, APACHE II and SOFA scores were recorded. Lactate was measured preoperatively and at 6 and 24 hours; CRP and albumin were measured preoperatively and at 24 and 48 hours. The primary endpoint was a composite adverse postoperative outcome. Results: Adverse outcomes occurred in 38 (31.7%) patients and in-hospital mortality was 11.7%. Twenty-four-hour lactate clearance was lower in the adverse-outcome group (21.6±23.1% vs 50.8±19.6%; p<0.001), while 48-hour CAR was higher (8.1±3.1 vs 3.9±1.9; p<0.001). Lactate clearance <35% and a ≥25% rise in CAR independently predicted adverse outcomes. Their combined AUC was 0.91; adding them to static scores increased AUC from 0.83 to 0.94 (p=0.018). Conclusion: Serial lactate clearance and CAR response provided incremental prognostic information beyond conventional risk scores and may support early postoperative risk reassessment. This approach may identify failure of recovery before overt clinical deterioration becomes established.

Background: Urinary tract infection (UTI) is a common bacterial infection, and its clinical course may be substantially influenced by urinary tract abnormalities, obstruction, stones, indwelling devices, previous antimicrobial exposure and underlying conditions such as diabetes mellitus and renal impairment. Current European Association of Urology (EAU) guidance emphasises classification of UTI as localised or systemic while recognising host and urinary tract risk factors that may increase the likelihood of treatment failure and resistant organisms. Local microbiological surveillance is therefore important because pathogen distribution and antimicrobial susceptibility vary geographically and between healthcare settings. Objectives: To determine the microbiological profile of complicated UTI, describe associated risk factors and comorbidities, assess antimicrobial susceptibility patterns, and evaluate short-term clinical, laboratory and microbiological outcomes at Days 10 and 30. Methods: A prospective observational study was conducted among 80 adults admitted with complicated UTI to the Department of Nephrology, Gauhati Medical College and Hospital, Guwahati, Assam, between May 2025 and April 2026. Demographic characteristics, clinical manifestations, risk factors, comorbidities, laboratory parameters, urine microscopy, urine culture, antimicrobial susceptibility, imaging findings, treatment and follow-up outcomes were recorded using a structured proforma. Patients were assessed at baseline, Day 10 and Day 30. Continuous variables were expressed as mean ± standard deviation or median with interquartile range, as appropriate, while categorical variables were expressed as frequencies and percentages. Paired continuous variables were compared using appropriate paired tests and paired categorical variables using McNemar’s test. Independent-group comparisons were performed using the independent-samples t test, Mann–Whitney U test, chi-square test or Fisher’s exact test, as appropriate. A two-sided p value <0.05 was considered statistically significant. Results: The mean age of the study population was 50.34 ± 15.49 years, and 41 (51.2%) participants were female. Diabetes mellitus was the most frequently recorded comorbidity/risk factor (62.5%), followed by previous antibiotic exposure or treatment for the current/recent UTI episode (57.5%), chronic kidney disease (46.2%) and hypertension (45.0%). Escherichia coli was the predominant urinary isolate (47.5%), followed by Klebsiella pneumoniae (22.5%). Among isolates tested against individual antibacterial agents, susceptibility was highest to meropenem (88.9%), colistin (88.7%), imipenem (87.1%) and amikacin (84.1%), whereas resistance was highest to amoxicillin (81.0%), cefuroxime (69.8%) and ciprofloxacin (67.7%). Mean WBC count, serum creatinine and CRP declined significantly from baseline to Day 10 and Day 30 (all p<0.001). Fever and urinary symptoms also decreased substantially during follow-up. At the end of follow-up, 69 (86.2%) patients achieved clinical cure, whereas 11 (13.8%) had persistent or recurrent UTI. CKD was significantly associated with failure to achieve clinical cure (p=0.020), and baseline procalcitonin was higher among patients without clinical cure (p=0.048). Conclusion: This tertiary-care nephrology cohort demonstrated a substantial burden of diabetes mellitus and chronic kidney disease, with predominance of Gram-negative uropathogens and considerable resistance to several commonly used antimicrobials. E. coli was the predominant pathogen. Clinical and biochemical parameters improved significantly by Days 10 and 30, although persistent or recurrent infection occurred in 13.8% of patients. CKD and higher baseline procalcitonin were associated with poorer short-term outcome. Local antimicrobial susceptibility data, together with individual patient risk factors and severity of illness, should guide antimicrobial selection.

Background: Formative assessment is an important part of the learning process. It assists the teachers to identify what students already know, recognize learning gaps, and provide feedback that can guide further learning. Unlike formative assessment, Cumulative assessment is primarily used at the end of a learning period to judge achievement and assign grades to phase-1 MBBS students. Objective: To assess Phase I MBBS students’ perceptions of formative assessment and feedback, including perceived effects on learning, study behaviour, and university examination preparation, and to examine the association between use of formative-assessment feedback and perceived improvement in final examination performance. Materials and Methods: A cross-sectional questionnaire-based study was performed using the supplied data-set of 250 Phase I MBBS student records. The questionnaire included demographic variables, 30 five-point Likert-scale statements, and categorical questions regarding feedback use and perceived learning/performance. Descriptive statistics were used to summarize participant characteristics and Likert responses. Pearson’s chi-square test and Fisher’s exact test were used to assess the primary 2×2 association. The odds ratio (OR) with 95% confidence interval (CI) and prevalence ratio (PR) with 95% CI were calculated. Results: The mean age was 19.65 ± 1.16 years; 186 (74.4%) participants were male. Previous formative-assessment participation was reported by 193 (77.2%). Feedback was reported as usually received by 56 (22.4%) students, sometimes by 69 (27.6%), rarely by 108 (43.2%), and never by 17 (6.8%). Use of feedback to modify study strategy was reported by 213 (85.2%) students, while 227 (90.8%) reported improved summative examination performance. The primary association was statistically significant (Pearson χ² = 131.32, df = 1, p < 0.001; Fisher’s exact test, p < 0.001). The OR was 310.93 (95% CI 39.18–2467.39) and the PR was 2.46 (95% CI 1.66–3.63). Conclusion: In this study, formative assessment and feedback were generally perceived positively, particularly in relation to study behaviour and university final exam preparation. The cross-sectional association between feedback use and perceived final performance was strong and statistically significant, but causality cannot be inferred from the study design.

Background: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder with a considerable risk of recurrence. Vitamin D deficiency may contribute to otoconia dysfunction and recurrent BPPV. This study evaluated the effect of vitamin D supplementation on BPPV recurrence. Methods: This comparative interventional study included 122 patients with BPPV. Participants were randomly allocated into two groups of 61 each. Group A received vitamin D supplementation with canal repositioning manoeuvre (CRM), while Group B received CRM alone. Serum 25(OH)D levels and recurrent BPPV episodes were assessed over 6 months. Results: Baseline vitamin D levels were comparable between Group A and Group B (12.6 ± 2.4 vs. 12.4 ± 2.2 ng/mL; p = 0.63). After 6 months, levels increased to 26.8 ± 4.6 ng/mL in Group A and remained 12.5 ± 2.3 ng/mL in Group B (p < 0.001). The mean number of recurrent episodes was lower in Group A than in Group B (0.3 ± 0.5 vs. 1.4 ± 0.8; p < 0.001). Recurrence-free status was observed in 78.7% and 44.3% of patients, respectively. Conclusion: Vitamin D supplementation with CRM improved vitamin D levels and reduced BPPV recurrence compared with CRM alone.

Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, and its pharmacological management is a core competency for the Indian Medical Graduate under the Competency-Based Medical Education (CBME) curriculum. Traditional discipline-wise didactic lectures on IHD pharmacology are often taught in isolation from pathology and clinical medicine, which may limit conceptual understanding and clinical application. Objectives: To evaluate the effect of an integrated teaching session on IHD pharmacology on student’s knowledge scores and to assess the students perception of, and satisfaction with, this teaching–learning method, among undergraduate medical students. Material &Methods: A quasi-experimental Pre-test-Post-test study was conducted among undergraduate medical students at a tertiary care teaching hospital. A structured, pre-validated questionnaire was administered via Google Forms, comprising of 23 multiple-choice questions (MCQs) on IHD pharmacology. Questionnaire was administered before (pre-test), followed by the ATCOM (Attitude, Communication, and Ethics) sessions. The post-test, using the same questionnaire, was administered after the final an integrated teaching session. Post-test respondents additionally completed an 8-item, 5-point Likert-scale questionnaire assessing perception of the session and two open-ended feedback items. Pre-test and post-test knowledge scores were compared using an independent-samples t-test. A p-value <0.05 was considered statistically significant. Results: A total of 345 unique responses were analysed (188 pre-test, 157 post-test). Mean knowledge scores were significantly higher after the integrated session (post-test: 19.67 ± 2.76; pre-test: 16.80 ± 4.22; p < 0.001). Neither gender (p = 0.93) nor prior exposure to integrated teaching (p = 0.84) significantly influenced post-test scores. All eight perception items received a mean Likert score ≥4.0/5, with 80–88% of students agreeing or strongly agreeing that the session was well organised, improved conceptual and pharmacological understanding, enhanced confidence, and was preferable to conventional lectures. Qualitative feedback highlighted student–teacher interaction, clinical case correlation, and demonstration-based learning as the most valued features, with requests for more case-based MCQs and visual aids (mind maps, flow-charts). Conclusion: An integrated teaching session on IHD pharmacology was associated with significantly improved knowledge scores and was well received by students, supporting its wider incorporation into the pharmacology curriculum alongside conventional lectures.

Background: Tracheal intubation in obese patients presents substantial challenges due to altered upper airway geometry and diminished functional residual capacity. While the ramped position improves glottic exposure during direct laryngoscopy, its clinical utility alongside videolaryngoscopy (VL) remains debated. This prospective randomized comparative study evaluated whether the ramped position provides superior intubation dynamics compared with the conventional sniffing position during VL-guided intubation in obese adults. Methods: Eighty adult patients aged 18–65 years with Body Mass Index (BMI)  and ASA physical status II–III scheduled for elective surgery under general anesthesia were enrolled and allocated into two equal groups of 40: Group R (ramped position aligning external auditory meatus horizontally with sternal notch) and Group S (sniffing position with a 7-cm firm occipital pillow). Both groups underwent standardized induction followed by videolaryngoscopy. The primary outcome was Time to Intubation (TTI). Secondary outcomes included Percentage of Glottic Opening (POGO) score, Cormack–Lehane (CL) grade, Intubation Difficulty Score (IDS), first-pass success rate, hemodynamic trends, and peri-intubation desaturation (SpO₂ < 92%). Results: Baseline demographic and airway parameters were comparable between groups, with equal gender distribution (20 females [50.0%] and 20 males [50.0%] per group, p=1.000). Mean TTI was significantly shorter in Group R than in Group S (25.3 ± 5.8 s vs. 47.7 ± 9.7 s, p<0.001). Glottic visualization was superior in Group R (median POGO score 100% [IQR: 90–100%] vs. 50% [IQR: 47.5–60%], p<0.001). First-pass success was significantly higher in Group R (95.0% vs. 72.5%, p=0.013). Fewer patients required external laryngeal manipulation in Group R (20.0% vs. 82.5%, p<0.001). Peri-intubation desaturation occurred in 2 patients (5.0%) in Group R compared to 11 patients (27.5%) in Group S (p=0.013). Conclusion: The ramped position significantly reduces intubation duration, improves glottic visualization, increases first-pass success, and lowers the risk of peri-intubation desaturation compared to the standard sniffing position during videolaryngoscopy in obese patients. Biomechanical airway alignment remains an essential safety intervention despite indirect optical visualization.

Background: Unsafe abortions continue to contribute significantly to maternal morbidity and mortality in India despite the legalisation of abortion through the Medical Termination of Pregnancy (MTP) Act, 1971. This study aimed to assess the awareness and understanding of medical students regarding rules and legal provisions regarding abortion and salient features of the MTP Act. Despite legislative changes, awareness among future healthcare providers remains crucial to prevent unsafe abortions and to ensure proper counselling and patient care. Methods: A cross-sectional descriptive study was conducted among 550 MBBS students at Dhanalakshmi Srinivasan Medical College & Hospital (DSMCH), Tamil Nadu. A pretested structured questionnaire assessed knowledge of abortion, legal provisions, and the MTP Act. Data were analysed using descriptive statistics and compared with findings from previous literature, including Palo et al. (2015) and other regional studies. Results: Of 550 participants, 225 (40.9%) were male and 325 (59.1%) were female. The majority (95.3%) correctly identified abortion as the premature expulsion of the foetus from the uterus. Awareness about unsafe abortion was moderate, with 53.8% correctly identifying unapproved facilities as unsafe. About 73.3% recognised rural adolescents as the most vulnerable group. Knowledge about legal indications was high (96.2% correctly identified gender preference as illegal). However, only 72% were aware of the current gestational limit (24 weeks) under the 2021 amendment⁸. Awareness of the minimum qualification to perform MTP (MBBS) was 58.7%. Most respondents (93.6%) knew that only the woman’s consent is mandatory, and 94.4% correctly identified unlicensed facilities as illegal for abortion. Conclusion: The findings indicate a good level of awareness regarding the legality and provisions of the MTP Act among medical students, though gaps persist in understanding procedural and medico-legal aspects. Strengthening the curriculum on reproductive health and legal awareness is recommended to ensure future practitioners are well-equipped to promote safe abortion practices.

Background: Acute diarrhoeal diseases remain a major cause of morbidity and mortality among infants and young children, particularly in developing countries. Dehydration is the most important and potentially fatal complication of diarrhoea. Objective: To describe the serum electrolyte profile at admission among children with some or severe dehydration due to diarrhoea and compare blood glucose and electrolyte profiles between children who received ORS before admission and those who did not during the first three days of hospitalisation. Methods: A hospital-based prospective observational study was conducted among 148 children aged ≤60 months admitted with acute diarrhoea and some or severe dehydration to the Paediatric Ward of R.G. Kar Medical College and Hospital, Kolkata. Data were collected using a pretested, standardised questionnaire through caregiver interviews, clinical examination, anthropometry, laboratory investigations, and review of treatment records. Blood glucose and serum electrolytes were assessed on days 1, 2, and 3. Data were entered in an MS Excel spreadsheet and analysed in SPSS version 29. Results: Children aged <24 months constituted 17.7% of those with some dehydration and 45.7% of those with severe dehydration. Prior ORS intake was significantly associated with dehydration severity (p=0.0001). Significant differences were also observed in admission blood glucose, sodium, potassium, bicarbonate levels, and IV fluid requirements according to prior ORS intake. Conclusion: Appropriate ORS administration, correct preparation, caregiver education, and early recognition of dehydration are essential to reduce the severity and treatment burden of acute diarrhoeal illness. Particular attention should be given to children below two years of age.

Background: Early identification of pregnancies at risk for adverse outcomes can improve maternal and perinatal health through timely surveillance and intervention. This study evaluates the predictive value of maternal characteristics, mean arterial pressure (MAP), and first-trimester uterine artery Doppler for adverse pregnancy outcomes. Methods: A prospective cohort study was conducted among 50 antenatal women at 11–13+6 weeks of gestation at a tertiary care hospital in Rajasthan, India. Participants were stratified into two groups based on uterine artery pulsatility index (PI): abnormal (≥2.3) and normal. Maternal demographics, MAP, and Doppler findings were recorded. Participants were followed until delivery. Outcomes assessed included gestational age at delivery, birth weight, and mode of delivery. Statistical analysis included Chi-square and independent t-tests. Results: Preterm delivery (<37 weeks) occurred in 56% of women with abnormal PI versus 12% with normal PI (p=0.001). Mean birth weight was significantly lower in the abnormal PI group (2.80 ± 0.57 kg vs. 3.35 ± 0.31 kg; p<0.001). MAP >100 mmHg was observed in 44% of women with abnormal PI compared to 12% in the normal group (p=0.012). Operative and assisted deliveries were more frequent in the abnormal PI group. Conclusions: First-trimester assessment combining maternal risk factors, MAP, and uterine artery Doppler can identify pregnancies at higher risk for preterm birth and low birth weight. This approach provides a cost-effective, feasible strategy for early risk stratification in routine antenatal care settings.

Introduction: Medication non-adherence is a major challenge in the management of chronic diseases and may be influenced by treatment burden, psychological factors and healthcare-system characteristics. Evidence examining these determinants simultaneously among adults with chronic diseases in the Indian outpatient setting remains limited. Aim: To assess medication adherence among adults with chronic diseases and determine its association with depressive symptoms, treatment burden, outpatient healthcare utilization and selected sociodemographic and disease-related factors. Materials and Methods: A hospital-based analytical cross-sectional study was conducted among 610 adults with physician-diagnosed chronic diseases attending the General Outpatient Department of Medical College, Kolkata. Participants had been prescribed at least one medication for continuous use for ≥3 months. Sociodemographic characteristics, disease duration, medication burden and healthcare-utilization characteristics were recorded. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), while functional disability was assessed using WHODAS. Medication adherence was categorized as low or good according to the adherence measure used in the study. Continuous variables were compared using Welch’s independent-samples t-test and Spearman’s correlation, while categorical associations were assessed using the chi-square test. Multivariable binary logistic regression was performed to identify independent factors associated with poor medication adherence, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Of 610 participants, 217 (35.57%) had low medication adherence and 393 (64.43%) had good adherence. The mean age was 43.51±12.74 years, mean disease duration was 7.32±6.41 years, and mean daily tablet burden was 5.93±2.75 tablets. Participants with low adherence had significantly longer disease duration than those with good adherence (8.19±5.84 vs. 6.84±6.66 years; p=0.010) and consumed more tablets per day (6.47±3.38 vs. 5.64±2.27; p=0.001). Adherence was significantly associated with employment, location, literacy and monthly outpatient attendance. In multivariable analysis, longer disease duration (aOR=1.050, 95% CI: 1.018–1.082; p=0.002), greater daily tablet burden (aOR=1.113, 95% CI: 1.038–1.193; p=0.003) and higher PHQ-9 score (aOR=1.087, 95% CI: 1.030–1.148; p=0.002) were independently associated with greater odds of poor adherence. Greater monthly OPD attendance was associated with lower odds of poor adherence (aOR=0.403, 95% CI: 0.212–0.768; p=0.006). Location also remained independently associated with adherence (aOR=0.608, 95% CI: 0.412–0.896; p=0.012). Conclusion: Approximately one-third of adults with chronic diseases demonstrated low medication adherence. Disease chronicity, higher medication burden and depressive symptoms were independently associated with poor adherence, whereas greater outpatient attendance was associated with lower odds of poor adherence. Periodic adherence assessment, treatment simplification, screening for depressive symptoms and strengthening continuity of outpatient care may help improve medication adherence.

Introduction: Effective postoperative pain management is essential after thoraco-abdominal surgery to improve patient comfort, reduce pulmonary complications, and facilitate early mobilization. Epidural Morphine is widely used for postoperative analgesia because of its prolonged duration of action and superior Pain relief. However, the optimal dose that provides effective analgesia with minimal side effects remains Uncertain. Aims and Objectives: To evaluate the dose-response relationship of epidural morphine for postoperative analgesia in patients undergoing thoraco-abdominal surgery and to determine the optimal effective dose with minimal adverse effects using Visual Analogue Scale (VAS): (1) Duration of postoperative analgesia. (2) Time to first rescue analgesic requirement. (3) Total postoperative rescue analgesic consumption within the first 48 hours. (4) Assess the level of sedation using the Modified Ramsay Sedation Score. (5) Incidence of opioid-related adverse effects. Material and Methods: This prospective randomized study included 60 adult patients of American Society of Anesthesiologists (ASA) physical status I, II and III scheduled for elective thoraco-abdominal surgery under General anesthesia with epidural analgesia. Patients were randomly divided into two groups of 30 each. Group A received epidural morphine 1.5 mg and Group B received 3 mg at the end of surgery through the epidural catheter. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2,8,16 and 24 hours. Duration of analgesia, requirement of rescue analgesics, hemodynamic parameters and respiratory depression, nausea, vomiting and sedation scores were recorded and compared among the groups. Results: Patients receiving higher doses of epidural morphine demonstrated prolonged duration of analgesia and lower VAS scores. Group B showed the longest duration of analgesia but had a higher incidence of side effects such as nausea, vomiting and sedation. Group A provided satisfactory analgesia with fewer complications compared to Group B. Conclusion: Epidural morphine is effective for postoperative analgesia following thoraco-abdominal Surgery. A dose of 1.5 mg appears to provide an optimal balance between adequate analgesia and minimal Adverse effects.

Background: Hypertensive emergencies are characterized by severe elevation of blood pressure with acute target-organ damage and require prompt recognition and management. This study evaluated the demographic profile, clinical presentation, blood pressure characteristics, and spectrum of target-organ damage among patients presenting with hypertensive emergencies. Methods: This prospective observational study was conducted over 18 months in the Department of Emergency Medicine, L. N. Medical College and J. K. Hospital, Bhopal. Adult patients aged >18 years with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥110 mmHg together with evidence of acute target-organ damage were enrolled. Demographic, clinical, vital, laboratory, and organ-damage parameters were recorded and analyzed. Results: A total of 98 patients were included. The mean age was 53.78 years, and 62.2% were male; 57.1% were urban residents. Headache was the most common symptom (65.3%), followed by giddiness and chest pain (50.0% each), nausea/vomiting (35.7%), neurological deficits (24.5%), and dyspnoea (20.4%). Mixed presentation was most frequent (49.0%), followed by neurological presentation (37.8%). Mean systolic and diastolic blood pressures were 203.99 ± 19.43 and 128.86 ± 13.81 mmHg, respectively. Neurological and renal target-organ damage each occurred in 29.6% of patients, cardiovascular damage in 27.6%, and multiple-organ damage in 21.4%. No significant association was observed between age, gender, or blood-pressure categories and specific target-organ damage. Conclusion: Hypertensive emergencies predominantly affected middle-aged and older adults and showed frequent multisystem involvement. Early comprehensive assessment, particularly neurological, cardiovascular, and renal evaluation, is essential to identify organ injury and guide timely emergency management.

Background: Preoperative prediction of difficult tracheal intubation remains a cornerstone of safe anaesthetic practice. The Modified Mallampati Test (MMT) is one of the most frequently used bedside airway assessment tools and is conventionally performed with the patient in the sitting position. However, a substantial proportion of surgical patients, including those with trauma, obesity, spinal disorders, or critical illness, are unable to maintain an upright posture. Consequently, airway assessment in the supine position has been proposed as a practical alternative. Evidence comparing the predictive performance of sitting and supine MMT remains limited, with conflicting conclusions regarding their diagnostic utility. Objective: To evaluate the correlation between Modified Mallampati grading performed in sitting and supine positions with Cormack–Lehane (CL) laryngoscopic grading and to compare the diagnostic performance of both methods for predicting difficult tracheal intubation. Methods: This prospective observational comparative study included 100 adult patients aged 18–65 years undergoing elective surgery under general anaesthesia requiring endotracheal intubation. Modified Mallampati classification was assessed preoperatively in both sitting and supine positions using the Samsoon and Young modification. Direct laryngoscopy was performed after induction of anaesthesia by an independent anaesthesiologist blinded to the Mallampati grading, and the laryngeal view was classified according to the Cormack–Lehane system. Diagnostic indices including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and receiver operating characteristic (ROC) analysis were calculated. Results: The study population had a mean age of 39.5 ± 11.2 years, with 60 males and 40 females. Supine MMT demonstrated a greater proportion of Class III and IV airways and showed a stronger correlation with difficult laryngoscopy (CL Grades III and IV). Compared with the sitting position, supine MMT exhibited markedly higher sensitivity (97.5%) and NPV (97.9%), whereas sitting MMT demonstrated greater specificity (89.1%), PPV (58.9%), and overall diagnostic accuracy (76% vs. 72%). Both methods demonstrated satisfactory predictive performance, although each provided distinct diagnostic advantages. Conclusion: Modified Mallampati assessment performed in both sitting and supine positions is clinically useful for preoperative airway evaluation. Supine assessment improves the identification of patients at risk for difficult laryngoscopy, whereas sitting assessment provides greater specificity in confirming difficult airways. Incorporating both positions into routine airway evaluation may improve diagnostic confidence and perioperative preparedness.

Background: Quality of the surgical field is a major determinant of safety and efficiency in FESS. α2-adrenergic agonists are frequently used to achieve controlled hypotension. Comparative data between clonidine and dexmedetomidine focusing on operative field quality, hemodynamic stability and early recovery remain clinically relevant. Objectives: To compare clonidine versus dexmedetomidine for controlled hypotension during FESS with respect to (i) intraoperative hemodynamics (MAP, HR), (ii) surgical field quality (Fromme–Boezaart score), and (iii) early recovery sedation (Ramsay Sedation Score, RSS). Methods: Prospective randomized comparative study at a single centre; N=80 adults (ASA I–II) scheduled for elective FESS were allocated to clonidine (n=40, loading 1.5 µg/kg; infusion 0.4–0.8 µg/kg/h) or dexmedetomidine (n=40, loading 0.75 µg/kg; infusion 0.4–0.8 µg/kg/h). Standardized general anaesthesia was used. MAP/HR were recorded at baseline, post-loading, pre/post-intubation, incision, 5 min post-incision, then every 15 min to end-of-surgery. Fromme–Boezaart scores were rated at fixed intervals by the blinded surgeon, and RSS was assessed at 10, 20, 30, 45, 60 min post-extubation. Analyses used t-tests/χ² or Mann–Whitney as appropriate and repeated-measures ANOVA for trajectories (α=0.05). Results: Groups were balanced for age, sex, weight and ASA class. Dexmedetomidine achieved lower MAP and HR at several intraoperative time points while remaining within the target window (representative values, mean ± SD): at incision MAP 60 ± 5 vs 64 ± 6 mmHg (p=0.001) and HR 70 ± 9 vs 76 ± 10 bpm (p=0.003); at 30 min MAP 59 ± 4 vs 63 ± 5 (p<0.001) and HR 68 ± 8 vs 74 ± 9 (p=0.001). Repeated-measures showed significant group and time effects (MAP group p<0.001; HR group p<0.001). Surgical field quality favored dexmedetomidine: overall Fromme–Boezaart 1.6 ± 0.4 vs 2.1 ± 0.5, mean difference −0.5 (95% CI −0.7 to −0.3; p<0.001), with more “excellent” ratings (A/B/C: 24/15/1 vs 12/25/3, χ² p=0.006). RSS was higher with dexmedetomidine early (median [IQR] at 10 min 3 [3–4] vs 2 [2–3], p<0.001; at 20 min 3 [2–3] vs 2 [2–3], p=0.020) but converged by 45–60 min (both groups median 2, p≥0.64). Conclusions: Both α2-agonists supported controlled hypotension during FESS; however, dexmedetomidine provided tighter sympatholysis (lower MAP/HR), superior surgical field quality, and transiently deeper early sedation that normalized within an hour. Dexmedetomidine may be preferred when maximizing endoscopic visibility is paramount, while clonidine remains a pragmatic alternative.

Background: Increasing smartphone use among adolescents has raised concerns regarding its potential adverse effects, including headache and sleep disturbances. This study evaluated the association between smartphone-use patterns and headache frequency among adolescents. Methods: This analytical cross-sectional study included 350 adolescents aged 10–19 years. Smartphone-use duration and patterns, sleep, physical activity, and headache characteristics during the preceding three months were assessed using a structured questionnaire. Associations were evaluated using appropriate statistical tests and multivariable logistic regression. Results: Recurrent headache was reported by 158 (45.1%) adolescents. Headache prevalence increased progressively from 27.0% with <2 hours/day of smartphone use to 66.7% with >6 hours/day (p<0.001). Smartphone-use duration correlated positively with headache frequency (r=0.36, p<0.001) and intensity (r=0.25, p=0.002). Compared with <2 hours/day, smartphone use for 4–6 hours/day (aOR 2.38; 95% CI 1.17–4.84) and >6 hours/day (aOR 3.76; 95% CI 1.67–8.47) independently predicted recurrent headache. Nighttime smartphone use, continuous use >2 hours, and sleep <7 hours were also significant predictors. Conclusion: Greater smartphone exposure was associated with a dose-dependent increase in headache prevalence and frequency among adolescents. Reducing prolonged and nighttime smartphone use and promoting adequate sleep may represent practical measures for reducing headache burden.

Background: Osteoarthritis is associated with inflammation and pain and there is no treatment for its fundamental causes, or known therapies to slow down its progression. Nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, opioid analgesics, corticosteroid injections, hyaluronic acid injections are choice of treatment depending on the severity of disease and patient acceptability. Turmeric and its derivatives have anti-inflammatory activities. Hence the aim of this study is to study the beneficial effects of turmeric in Osteoarthritis. Materials and Methods: This study was a Nested Case Control Study; here Osteoarthritis patients were randomised in two groups using the single blinding method. Each group comprised of 75 patients each, who gave consent for the study. Group I- received turmeric filled capsules – 1 gm tds(total 3 gm /day},Group 2- placebo (protien powder 500mg x tds) for 4 months. This study was undertaken in Dept. of Medicine, Orthopaedics, Era’s Lucknow Medical College & Hospital. Results: There was no significant pre-treatment difference between WOMAC scores of groups which were given turmeric and placebo. In intergroup comparison of pain & physical activity (WOMAC Score) between treatment (Group-I) and placebo (Group-II) Group at last visit after 4 months, it was found that the difference in mean WOMAC score between Group I and Group II was found to be highly significant (p<0.001). The mean WOMAC score change in Group I was found to be significantly more than the change in Group II.  The mean hsCRP level change in Group I was found to be significantly more than the Group II. The mean IL-6 level change in Group I was found to be significantly more than the Group II. Conclusion: Significant reduction in inflammatory markers in osteoarthritis patients after turmeric administration suggests its anti-inflammatory property may have a significant role in symptom relief in osteoarthritis patients. Improvement in WOMAC scores highlights the role of turmeric in symptom alleviation in Osteoarthritis.

Background: It is suggested that using a bilateral superficial cervical plexus block (BSCPB) might influence the pattern of immediate postoperative pain and analgesic consumption. Hence, the efficacy of BSCPB is a novel technique. Method: 90 (ninety) patients were selected for BSCPB with a saline group P (n = 40 patients). Ropivacaine 0.487% = Group R (n = 30 patients). Ropivacaine 0.487% plus 10 μg/mL and 5 μg/mL = group RC (n = 10 patients). Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in patients with a bispectral index between 40 and 60. All patients received 4 gm of acetaminophen during the first 24 hours after surgery. The pain score was checked every 4 hours, and nefopam was given to reduce pain with scores >4 on a numeric pain scale. Results: The comparison of the mean values of demographic characteristics, age, height, and duration of surgery (minutes) remains insignificant (p>0.001), thus indicating all groups have similar parameters. In the comparison of SBP at the end of resection, incision, and extubation, there was a significant p-value (p<0.001). In comparison and operative requirement, sufentanil (mg/kg) had a significant p-value (p<0.001) pain score in PACU; a pain score >6 was observed in group P. Conclusion: It is proved that group RC (Ropivacaine + Clonidine) was significantly effective in the management of pain reduction and ideal as an anesthetic agent to maintain hemodynamic status.

Background and Aim: Acute appendicitis is a common surgical emergency traditionally treated with appendectomy. However, conservative management has emerged as an alternative approach in selected patients with uncomplicated disease. The Alvarado score is widely used for clinical assessment of suspected appendicitis, and patients with a score of five represent an intermediate clinical group. The present study was undertaken to evaluate the efficacy and outcomes of conservative versus surgical management in selected patients with acute appendicitis having an Alvarado score of five. Methods: A total of 150 patients with acute appendicitis and an Alvarado score of five were included. Demographic characteristics, clinical features and white blood cell count were recorded. Patients were evaluated according to the treatment received and divided into two groups. Outcomes assessed included return to normal activities, length of hospitalization and quality of life. The collected data were compared between the two groups using appropriate statistical methods. A p-value of <0.05 was considered statistically significant. Results: The median age was 35 years (21–42) in Group A and 28 years (17–40) in Group B. Males constituted 74.5% and 71.6% of the groups, respectively. The measured demographic and clinical characteristics did not show statistically significant differences between the groups. The median duration to return to normal activities was 3.5 (2–7) days in Group A and 17 (10–23) days in Group B (p<0.0001). The reported length of hospitalization was 42 (25–45) in Group A and 14 (8–15) in Group B (p<0.001). The quality-of-life questionnaire score was 96 (88–98) in Group A and 85 (80–92) in Group B (p<0.001). Conclusion: Patients with acute appendicitis and an Alvarado score of five demonstrated significant differences between the study groups in return to normal activities, hospitalization and quality-of-life scores. These findings highlight the importance of evaluating recovery and patient-centred outcomes when comparing treatment approaches in selected patients with an intermediate Alvarado score.

Background: Brachial plexus block provides effective perioperative analgesia for upper-limb surgery; however, the duration of analgesia following a single injection of local anaesthetic may be limited. Adjuvants such as dexamethasone and dexmedetomidine are used to prolong the duration of peripheral nerve blockade. The present study compared the postoperative analgesic effects of these two agents when added to 0.2% ropivacaine. Aim: To compare dexamethasone and dexmedetomidine as adjuvants to 0.2% ropivacaine for postoperative analgesia in ultrasound-guided brachial plexus block. Methods: A prospective, randomized, comparative study was conducted in 150 adult patients undergoing upper-limb surgery under ultrasound-guided brachial plexus block. Patients were randomly allocated into two equal groups of 75 each. One group received 0.2% ropivacaine with dexamethasone, while the other received 0.2% ropivacaine with dexmedetomidine. The primary outcome was time to first rescue analgesia. Secondary outcomes included total analgesic requirement during the first 24 hours and duration of sensory and motor blockade. Results: The demographic characteristics were comparable between the two groups. The mean time to first rescue analgesia was 709.67 ± 18.47 minutes in the dexamethasone group and 910.20 ± 51.66 minutes in the dexmedetomidine group, with a statistically significant difference (p<0.0001). Total analgesic requirement during 24 hours was 1.23 ± 1.17 in the dexamethasone group and 0.40 ± 0.56 in the dexmedetomidine group (p=0.004). The mean duration of motor blockade was 635.47 ± 26.29 minutes and 827.47 ± 54.62 minutes, respectively (p<0.0001), while the mean duration of sensory blockade was 681.50 ± 27.19 minutes and 877.17 ± 52.85 minutes, respectively (p<0.0001). Conclusion: Under the conditions of this study, dexmedetomidine provided a longer duration of postoperative analgesia and sensory and motor blockade than dexamethasone when used as an adjuvant to 0.2% ropivacaine in ultrasound-guided brachial plexus block. Dexmedetomidine was also associated with a lower requirement for postoperative rescue analgesia during the first 24 hours.

Background: Long-chain omega-3 polyunsaturated fatty acids, principally eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are structurally and functionally integral to the developing brain, and are widely prescribed in Indian paediatric practice for developmental delay, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Randomised evidence in these indications remains inconsistent, and little is documented about how Indian paediatricians actually use these formulations. Objective: To document the clinical experience and experience-based recommendations of Indian paediatricians regarding EPA/DHA-containing cognitive nutrition formulae in children with developmental delay, ASD and ADHD. Materials and Methods: A cross-sectional, questionnaire-based survey was administered to 157 practising Indian paediatricians using a structured 13-item instrument covering prescribing preference, initiation threshold, duration, adherence, perceived improvement, timing and extent of improvement, domain-specific response, and experience-based recommendations. Responses were summarised as counts and percentages and compared between prescribers of CoS 3 and prescribers of other EPA/DHA-containing formulae using the Pearson chi-square test with Yates’ continuity correction, or Fisher’s exact test where expected cell counts were sparse. Results: Of 157 respondents, 105 (66.9%) prescribed CoS 3 and 52 (33.1%) other formulae. Overall, 156 (99.4%) reported improvement in developmental milestones at follow-up (100.0% vs 98.1%; Fisher’s exact p=0.331), and 117 (74.5%) reported multi-domain improvement. Improvement was first observed between the first and third month by 91 (58.0%) respondents, (χ²(2)=0.99, p=0.608). Language/speech was the domain most frequently nominated as most responsive (88/157; 56.1%). 66.7% HCPs prescribing Cos 3 reported good patient adherence (>80%). Overall perceived clinical benefit was reported in ASD by 149 (94.9%), in ADHD by 153 (97.5%) and in epilepsy by 132 (84.1%) (p=0.908, p=1.000 and p=0.136, respectively). Overall, 155 (98.7%) endorsed EPA/DHA formulae as part of routine prescribing for developmental delay. Conclusion: In this survey Indian paediatricians experienced near-universal clinical benefit from EPA/DHA-containing formulae across developmental delay, ASD and ADHD, most often in the language domain and within three months.

Background: The liver is a major site of xenobiotic metabolism and may show injury in fatal poisoning, but autopsy findings are often non-specific. This study describes hepatic histopathology across commonly encountered poisons and assesses whether hepatic injury may have contributed to death. Methods: Sixty-five formalin-fixed liver autopsy specimens from documented poisoning deaths were examined over nine months. Sections were stained with H&E, with PAS, reticulin or Masson trichrome when indicated. Congestion, steatosis, bridging fibrosis, necrosis and sinusoidal dilatation were recorded and correlated with age, sex, manner of death and poison group. Results: Mean age was 34.0±14.5 years; 44 (67.7%) were male and 51 (78.5%) deaths were suicidal. Aluminium phosphide was the commonest individual agent (23, 35.4%); phosphides comprised 28 (43.1%) and organophosphate/pesticide poisoning 20 (30.8%). Congestion was the predominant finding (60, 92.3%), followed by steatosis (18, 27.7%), bridging fibrosis (3, 4.6%), necrosis (3, 4.6%) and sinusoidal dilatation (2, 3.1%). Steatosis was significantly associated with age (p=0.009), but no histological parameter differed significantly by poison group. Hepatic pathology was potentially contributory to death in 3 cases (4.6%). Conclusion: Hepatic changes are frequent in fatal poisoning but are predominantly non-specific. Congestion appears to reflect terminal circulatory failure, while necrosis was uncommon. Liver histopathology remains valuable for documenting visceral injury, excluding hepatic failure and identifying pre-existing liver disease.

Background: Anemia is a frequent and clinically important comorbidity in children with severe acute malnutrition (SAM), but its severity and etiological profile are multifactorial. This study compared the prevalence, severity, hematological characteristics, micronutrient-related parameters, and outcomes of anemia in children with SAM and age- and sex-matched non-SAM controls. Methods: This hospital-based case-control study was conducted in the Department of Pediatrics, Geetanjali Medical College and Hospital, Udaipur, over 1.5 years. Children aged 6–59 months with SAM were enrolled consecutively, with age- and sex-matched children without SAM serving as controls. SAM was defined by weight-for-height below −3 SD, MUAC <11.5 cm, or bilateral pitting nutritional edema. Children with congenital malformations or congenital anemia and those without parental consent were excluded. Clinical and anthropometric assessments were performed, followed by complete blood count, peripheral blood film, reticulocyte count, serum vitamin B12, and iron profile evaluation. Results: A total of 136 children were analyzed, 68 in each group. Anemia was present in 61 (89.7%) children with SAM compared with 6 (8.8%) controls (p<0.01). In the SAM group, 48 (70.6%) had moderate anemia, and 13 (19.1%) had severe anemia; No child in the SAM group had mild anemia. Mean hemoglobin was significantly lower in SAM than controls (8.42±1.58 vs 12.04±0.55 g/dL; p<0.01). SAM children had lower MCV, MCH, MCHC, RBC count, and reticulocyte count, with higher WBC and platelet counts. Mean vitamin B12 was lower in SAM (175.65±46.33 vs 304.46±36.27 pg/mL; p<0.01). Serum iron and ferritin were lower, and TIBC was higher in SAM. Mean hospital stay was significantly longer in SAM (17.38±1.46 vs 9.85±1.48 days; p<0.01). Mortality was 2.9% in SAM and 0% in controls (p=0.15). Conclusion: SAM was strongly associated with a high prevalence and greater severity of anemia, altered erythrocyte indices, impaired reticulocyte response, and abnormalities in vitamin B12 and iron-related parameters. Routine anemia screening and comprehensive micronutrient and infection assessment should be integrated into the management of children with SAM.

Aim: To assess the frequency and pattern of early post-operative complications after thyroid surgery and to describe the anesthetic management required for airway and systemic complications in adult patients undergoing elective thyroid procedures. Materials and Methods: This institutional cross-sectional study was conducted over six months in the Department of Anesthesia, LN Medical College and JK Hospital, Bhopal. Fifty adult patients with benign or malignant thyroid disorders who underwent elective thyroid surgery were enrolled by convenient sampling. Patients with previous thyroid surgery, previous head-and-neck radiotherapy, abnormal thyroid function, or emergency surgery were excluded. Demographic, clinical, operative, anesthetic and post-operative data were recorded using a predesigned proforma. Patients were assessed for airway difficulty, laryngeal oedema, hemorrhage or hematoma, hypocalcemia, tracheomalacia, recurrent laryngeal nerve palsy and thyroid storm. Results: The mean age was 36.5 ± 10.25 years, and 38 patients (76%) were female. Goiter was the commonest pre-operative diagnosis (18, 36%), followed by chronic thyroiditis (16, 32%). Hemithyroidectomy was the most frequent procedure (18, 36%), followed by total thyroidectomy (15, 30%). Post-operative complications were recorded in 18 patients (36%). Hypocalcemia was the most frequent complication among affected patients (8/18, 44.4%), followed by tracheomalacia (4/18, 22.2%) and laryngeal oedema (3/18, 16.7%). Difficult extubation, reintubation and post-operative intensive-care ventilation were required in 6 (12%), 4 (8%) and 2 (4%) patients, respectively. Conclusion: Although thyroid surgery is usually safe, clinically important complications may occur, particularly involving calcium homeostasis and the airway. Careful pre-operative assessment, meticulous surgical technique, vigilant extubation and timely anesthetic intervention are essential. The findings support structured post-operative observation, especially after extensive surgery and in patients with large goiters or anticipated airway difficulty.

Background: Infected fracture non-union of the femur and tibia represents a challenging orthopaedic problem, particularly when associated with bone loss, deformity, limb-length discrepancy, compromised soft tissues, and persistent infection. Conventional treatment frequently requires multiple procedures and prolonged periods of immobilisation. The Ilizarov ring fixator provides simultaneous mechanical stabilisation and biological stimulation through distraction osteogenesis and permits management of bone defects and deformities while allowing early mobilisation. Objective: To evaluate the functional and radiological outcomes of patients with infected non-union of the femur and tibia treated using the Ilizarov ring fixator and to assess the duration of treatment. Methods: A prospective observational study was conducted in the Department of Orthopaedics at Pacific Institute of Medical Sciences, Umarda, Udaipur, Rajasthan, from April 2024 to October 2025. Fifty patients aged 16-75 years with infected non-union of the femur or tibia were included. Patients underwent treatment using an Ilizarov ring fixator, with procedures such as corticotomy, bone transport, bone grafting, debridement, and soft-tissue procedures performed according to individual requirements. Functional and bone outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. Results: Of the 50 patients, 36 (72%) were male and 14 (28%) were female, with a mean age of 35.94 years and an age range of 16-65 years. Tibial non-union accounted for 36 (72%) cases and femoral non-union for 14 (28%). Road traffic accidents were the predominant mechanism of injury, accounting for 43 (86%) cases. Corticotomy was performed in 41 (82%) patients and bone grafting in 45 (90%). Bone union with absence of infection was achieved in 45 (90%) patients. According to ASAMI bone outcome criteria, 29 (58%) patients had excellent, 13 (26%) good, 3 (6%) fair, and 5 (10%) poor results. Functional outcomes were excellent in 21 (42%), good in 15 (30%), fair in 6 (12%), poor in 3 (6%), while 5 (10%) patients were classified as treatment failures requiring amputation. Conclusion: The Ilizarov ring fixator provided satisfactory infection control, bone union, deformity correction, and functional recovery in a substantial proportion of patients with infected non-union of the femur and tibia. Its ability to simultaneously address infection, bone defects, deformity, and limb-length discrepancy makes it an effective limb-salvage option in complex infected non-unions. However, prolonged treatment and pin-site-related complications remain important limitations.

Objectives: To know the outcomes of functional endoscopic sinus surgery  combined with septoplasty. Methods: Study Design. Population based study. Study conducted in medical college department of ENT and Orthopaedics. The patients who underwent FESS for chronic rhinosinusitis were considered in this study. These patients were divided into 2 groups: the control group FESS alone and the study group FESS combined with septoplasty. Results: In total, 100 patients who had undergone FESS were studied in this study. The number of patients who underwent revision FESS were 50. In our study, out of 100, 80 patients received FESS alone, whereas 20 patients underwent septoplasty during FESS. The revision rates of these 2 groups were different (11% vs 8%, respectively; P = .015). Male patients and younger patients were found to have higher revision rates. Conclusions: According to this study there is an association between FESS combined with concurrent septoplasty and less incidence of revision rate of FESS. Those patients having allergic rhinitis and asthma have higher risk of need for surgery again.

Aims: To compare endoscopic and conventional septoplasty in case of time required for surgery, efficacy and morbidity perioperatively.  comparing endoscopic and conventional septoplasty. The main purpose of this study is to know operating time, and to identify intra and postoperative complications of the surgery , pain after the surgery, hospital stay and functional result. Methodology: A study was conducted in a medical college comparing both endoscopic and conventional sepotoplasty surgeries. Conclusion: Operating time was shorter with endoscopic surgery (P < 0.001), with less mucosal damage (P < 0.01); there was less synechia (P < 0.01) and residual deformity (P < 0.05); and postoperative pain was milder. In endoscopic septoplasty time taken was less and reduced perioperative complications, but the functional result was the same as with conventional septoplasty.

Background: Effective postoperative analgesia after caesarean section facilitates early mobilization, breastfeeding, maternal–neonatal bonding, and overall recovery. This study compared pre-incisional ketamine and levobupivacaine infiltration for postoperative analgesia and quality of recovery following caesarean section under spinal anaesthesia. Methods: This prospective randomized study included 70 ASA II pregnant women aged 18–40 years undergoing caesarean section under spinal anaesthesia. Patients were randomized into Group K (n=35), receiving ketamine 2 mg/kg diluted to 20 mL with normal saline, and Group L (n=35), receiving 20 mL of 0.5% levobupivacaine. The study drug was infiltrated subcutaneously along the incision site 5 minutes before incision. Postoperative VAS scores, time to first rescue analgesia, rescue analgesic requirement, ObsQoR-11 score at 24 hours, haemodynamic variables, and adverse events were assessed. Results: The groups were comparable in demographic characteristics and duration of surgery. VAS at 4 hours was significantly lower in Group K than Group L (1.14 ± 0.69 vs. 2.43 ± 1.12; p=0.001). Time to first rescue analgesia was significantly prolonged with ketamine (8.27 ± 1.59 vs. 5.63 ± 1.21 hours; p=0.001), with significantly lower rescue analgesic requirements. The ObsQoR-11 score at 24 hours was significantly higher in Group K (66.14 ± 3.99 vs. 62.17 ± 3.88; p=0.001). Haemodynamic parameters were generally comparable. Nausea was significantly more frequent with ketamine (68.6% vs. 11.4%; p=0.001), whereas vomiting and shivering were comparable. Conclusion: Pre-incisional ketamine infiltration provided better postoperative analgesia, prolonged the time to rescue analgesia, reduced rescue analgesic requirement, and improved quality of recovery compared with levobupivacaine following caesarean section under spinal anaesthesia.

Background: Thyroid nodules are common, and accurate risk stratification is essential to distinguish lesions requiring cytological evaluation from those that can be managed conservatively. Objective: To evaluate the relationship between ACR TI-RADS ultrasonography, Bethesda cytology, and thyroid function status in patients with thyroid nodules. Methods: In this study, 200 patients with thyroid nodules were evaluated using thyroid ultrasonography, fine-needle aspiration cytology, and thyroid function tests. Nodules were classified according to ACR TI-RADS and the Bethesda System for Reporting Thyroid Cytopathology. Results: The mean age was 45.8 ± 12.2 years, and 84.0% were female. TR4 was the most frequent ACR TI-RADS (44.0%), while Bethesda II was the predominant cytology (64.0%). Bethesda V/VI cytology was present in 14.5% of nodules. Increasing ACR TI-RADS showed a significant positive correlation with increasing Bethesda (Spearman’s ρ=0.472, p<0.001). Suspicious features including solid composition, hypoechogenicity, taller-than-wide shape, irregular margins, and punctate echogenic foci were significantly more frequent in Bethesda V/VI nodules. Using TR4–TR5 as the high-risk threshold yielded 96.6% sensitivity, 48.4% specificity, and 98.4% negative predictive value for Bethesda V/VI cytology. Median TSH increased significantly across higher TI-RADS (p<0.001), whereas FT4 did not differ significantly (p=0.882). Conclusion: ACR TI-RADS demonstrated significant concordance with Bethesda cytology and high sensitivity for identifying high-risk cytological lesions. Serum TSH showed an additional positive association with increasing sonographic risk.

Background: Quality of postoperative recovery is an important outcome following orthopaedic surgery. The choice of anaesthetic technique may influence postoperative pain, opioid requirements, and recovery. This study compared recovery quality among patients receiving general or regional anaesthesia, with postoperative recovery assessed using the QoR-40 questionnaire. Methods: This prospective observational study included 134 adult patients undergoing orthopaedic procedures between April 2025 and March 2026. Patients were categorized into general anaesthesia (n = 65) and regional anaesthesia (n = 69) groups. QoR-40 scores were assessed preoperatively and on postoperative days 1 and 7, while perioperative recovery outcomes were also recorded. Results: The groups were comparable in demographic and clinical characteristics, except for a longer anaesthesia duration in the general anaesthesia group (P = 0.019). Global QoR-40 scores and postoperative domain scores did not differ significantly between the groups. Regional anaesthesia was associated with lower postoperative pain scores, reduced rescue opioid use, and lower cumulative fentanyl consumption (P < 0.001). Postoperative nausea and vomiting and PACU stay were also significantly lower with regional anaesthesia (P = 0.024 and P = 0.018, respectively). Conclusion: Regional anaesthesia provided better immediate postoperative analgesic outcomes and reduced opioid requirements. However, overall quality of recovery measured by QoR-40 was comparable between the two anaesthetic techniques.

Background: Adhesive capsulitis causes shoulder pain, stiffness, restricted movement, and functional disability. This study compared the efficacy and functional outcomes of autologous platelet-rich plasma (PRP) injection and hydrodissection. Methods: A prospective comparative study was conducted over 1 year among 126 patients with adhesive capsulitis in a tertiary health centre. Patients were divided equally into PRP (n=63) and hydrodissection (n=63) groups. Pain and functional disability were assessed using VAS and DASH scores at baseline, 1, 6, and 12 months. A p-value <0.05 was considered statistically significant. Results: Both groups showed progressive improvement in pain and function during follow-up. At 12 months, VAS decreased to 2.04 ± 1.24 with PRP and 3.67 ± 1.82 with hydrodissection (p<0.001). DASH scores decreased to 29.16 ± 4.63 and 32.67 ± 3.81, respectively (p<0.001). PRP demonstrated significantly better outcomes from the first month onward. Conclusion: Both interventions improved pain and functional disability, but PRP provided greater and more sustained improvement over 12 months. PRP may therefore be a promising treatment option for adhesive capsulitis.

Background: Cardiac autonomic dysfunction is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) associated with increased cardiovascular risk. This study assessed its prevalence, severity and associated risk factors among patients with T2DM. Methods: A hospital-based cross-sectional study was conducted among 140 adults with T2DM at a tertiary-care teaching hospital. Cardiac autonomic function was assessed using Ewing’s cardiovascular autonomic reflex tests. Associations were examined using comparative tests and multivariable logistic regression. Results: Cardiac autonomic dysfunction was detected in 98 (70.0%) participants; 25.0% had early, 24.3% definite and 20.7% severe dysfunction. The most frequently abnormal tests were heart-rate response to deep breathing (58.6%), 30:15 ratio (52.1%) and Valsalva ratio (44.3%). Patients with autonomic dysfunction were older and had a longer duration of diabetes and higher HbA1c. Hypertension, peripheral neuropathy, retinopathy and nephropathy were significantly associated with dysfunction. Diabetes duration of at least 10 years (adjusted odds ratio [AOR] 3.72; 95% CI 1.55–8.95), HbA1c of at least 8% (AOR 2.64; 95% CI 1.16–6.03) and peripheral neuropathy (AOR 3.12; 95% CI 1.25–7.79) remained independent predictors.  Conclusion: Cardiac autonomic dysfunction was highly prevalent among patients with T2DM. Long-standing diabetes, poor glycaemic control and peripheral neuropathy identified patients at increased risk, supporting targeted screening and early risk-factor management.

Background: Autogenous arteriovenous fistula (AVF) remains the preferred form of vascular access for long-term haemodialysis. Published experience from newly established vascular access services in resource-limited settings is limited. We assessed early outcomes and functional maturation after AVF creation in a newly established cardiothoracic and vascular surgery (CTVS) unit in Northeast India. Methods: We retrospectively reviewed consecutive adults who underwent primary AVF creation between August 2024 and January 2026. A single surgeon performed all procedures using a distal-first approach. Postoperatively, rivaroxaban 2.5 mg once daily was prescribed for 45 days under the institutional protocol. Maturation was assessed clinically and by colour Doppler ultrasonography at 45 days or later. The analysis was descriptive, with categorical variables summarized as N (%). Results: Seventy-six AVFs were created during the study period. Follow-up was adequate for 74 patients (97.4%), while 2 patients (2.6%) could not be assessed because the required follow-up was unavailable. Sixty procedures (78.9%) were radiocephalic and 16 (21.1%) were brachiocephalic. Among evaluable fistulas, 72/74 (97.3%) achieved functional maturation: 56/58 (96.6%) of the radiocephalic and 16/16 (100%) of the brachiocephalic AVFs. Two procedures (2.6%), both radiocephalic, were classified as primary failures. No early thrombosis or major complication was recorded. Minor wound complications occurred in 5/76 patients (6.6%); venous congestion occurred in 14/16 brachiocephalic AVFs (87.5%) and was managed conservatively. Conclusions: In this newly established unit, early functional maturation was achieved in most AVFs and major complications were uncommon. The results describe the initial experience with a consistent operative approach and postoperative protocol in a resource-limited setting.

Background: several study revealed that the FTO gene polymorphisms rs9939609 have been linked to obesity. It’s essential to note that genetic variations exist between different populations. This study aims to assess the correlation between FTO gene polymorphisms rs9939609 and the BMI dependent obesity in CVD patients in central Indian population. Methods: This cross sectional, observational study carried out from November-2024 to October-2025 in the department of Anatomy and the OPD of cardiology unit of department of Medicine in central Indian population at PCMS & RC, Bhopal (M.P.). Data were collected and managed using Microsoft Excel spread sheets. Gender and Obesity parameters were tested using Kruskal-Wallis and Pearson’s chi² test. Significance between distribution of genotypes and alleles were tested by using Fisher exact test.  Results: Total 110 patients with cardiovascular disease were enrolled; of these 68.18% were males and 31.81% female patients. The age range of 55–73 years old accounted for the biggest percentage of patients. Among these 70.91% had a BMI of 25 kg/m² or above (obese) and only 29.09% had a BMI of less than 25 kg/m² (non-obese). There is three FTO rs9939609 genotypes AA, AT and TT were found, the most common genotype was AA (63.64%) and associated alleles were ‘A’ accounted for 76.82% of all alleles followed by T allele (23.18%). In this research neither AA nor AT genotypes and the allele-level comparison were linked to obesity as determined by BMI. Conclusion: The results highlight that FTO rs9939609 ought to be regarded as a possible modifying genetic element instead than a standalone cause of obesity in CVD patients.

Purpose: To evaluate short-term changes in ocular parameters before and after a single hemodialysis session in patients with end-stage renal disease (ESRD). Methods: This prospective observational study was conducted at Southeastern Railways Central Hospital, Garden Reach, Kolkata, from April 2023 to January 2025. Thirty-five adults with ESRD receiving hemodialysis 2–3 times weekly for at least 3 months were evaluated 1 hour before and 1 hour after a 3–4-hour hemodialysis session. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD), axial length, tear breakup time (TBUT), Schirmer I test, central macular thickness (CMT), and macular volume were recorded. Results: Mean age was 53.17±10.44 years; 21 (60%) participants were men. TBUT decreased from 13.32±4.26 to 11.07±3.81 seconds (p=0.039), Schirmer I from 12.37±2.17 to 9.91±1.95 mm (p=0.017), and IOP from 14.10±2.56 to 12.83±2.18 mmHg (p=0.027). Axial length increased from 24.07±0.57 to 24.17±0.53 mm (p=0.004). BCVA, CCT, ACD, CMT, and macular volume did not change significantly. Body weight, systolic and diastolic blood pressure, serum urea, creatinine and random blood glucose also decreased significantly after dialysis, whereas sodium and albumin did not. Conclusion: A single hemodialysis session was associated with significant changes in tear-film parameters, IOP and axial length, while visual acuity and macular structural parameters remained statistically unchanged. These findings support awareness of acute ocular effects during hemodialysis and the need for appropriate ophthalmic monitoring in patients with ESRD.

Background: Mastectomy is frequently associated with moderate-to-severe acute postoperative pain. Inadequate analgesia may delay mobilization, increase opioid requirements and adversely affect recovery. Regional anaesthesia has become an important component of multimodal analgesia for breast surgery. The ultrasound-guided erector spinae plane block (ESPB) is a relatively recent fascial plane block that has attracted considerable interest due to its superficial anatomical target, technical simplicity and potential to provide Multi dermatomal thoracic analgesia. Objective: This systematic narrative review summarizes the available evidence regarding the anatomical basis, mechanism, technical considerations, analgesic efficacy, opioid-sparing effects, safety and clinical applications of ultrasound-guided ESPB in breast surgery. Methods: A PRISMA 2020-informed literature search was conducted using PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar. Search terms included “erector spinae plane block,” “ESPB,” “mastectomy,” “breast surgery,” “paravertebral block,” “postoperative pain,” and “opioid consumption.” Randomized trials, comparative studies, systematic reviews, meta-analyses, anatomical studies, and relevant narrative reviews were considered, with emphasis on mastectomy and breast cancer surgery. Non-breast surgical studies were excluded. Findings were synthesized descriptively without calculating new pooled estimates. Results: Evidence from randomized trials and systematic reviews consistently demonstrates that ESPB provides clinically relevant reductions in postoperative pain and opioid consumption compared with systemic analgesia alone. A 2020 systematic review of 13 randomized trials involving 861 patients found lower pain scores through the first 24 postoperative hours and a reduction in oral morphine-equivalent consumption of approximately 21.6 mg compared with no block, although there was substantial heterogeneity. Subsequent reviews and trials have broadly supported these findings. ESPB has also been associated with improved quality of recovery, delayed time to first rescue analgesia and reduced intraoperative opioid requirements. Compared to paravertebral block, generally similar analgesia has been observed in earlier studies, although more recent evidence has challenged the assumption of equivalence, particularly for analgesia during movement and reliability of dermatomal coverage. ESPB is technically simpler and has a superficial target, while paravertebral block may provide more predictable neural blockade. Compared with pectoral and serratus anterior plane blocks, ESPB is an effective alternative but superiority over these techniques has not been established. Conclusion: Ultrasound-guided ESPB is an effective component of multimodal analgesia for mastectomy. Its primary advantages are technical accessibility, a superficial bony endpoint, multi dermatomal spread and opioid-sparing potential. However, variability in block level, local anaesthetic volume, surgical procedure and multimodal analgesic protocols complicate direct comparison among studies. It should therefore be considered a valuable regional analgesic option rather than a universally superior technique. Further adequately powered randomized trials using standardized techniques, clinically meaningful outcomes and long-term follow-up are required.

Background: Clomiphene citrate (CC), widely used for ovarian stimulation before intrauterine insemination (IUI), exerts anti-oestrogenic effects on the endometrium and may impair uterine perfusion. Nitric oxide donors such as isosorbide mononitrate (IMN) may improve uterine and subendometrial blood flow. Objective: To evaluate the effect of vaginal IMN added to CC on clinical pregnancy, follicular response, endometrial thickness and uterine perfusion during IUI. Methods: This open-label randomised controlled study was conducted at a tertiary IVF centre in New Delhi (December 2018 to December 2019). Sixty women aged 20-35 years with ovulatory cycles, patent tubes and normal partner semen analysis received CC 100 mg (days 3-7) plus vaginal IMN 10 mg daily from day 5 (n=30) or CC alone (n=30). Follicles, endometrial thickness, Applebaum zonal flow and uterine artery pulsatility and resistance indices were assessed on day 3 and trigger day. The primary outcome was clinical pregnancy. Results: Groups were comparable except for hypothyroidism history (53.3% vs 23.3%, P=0.017). On trigger day, the IMN group had more left ovarian dominant follicles (1.00±0.83 vs 0.60±0.72, P=0.04), more zone 4 flow (53.3% vs 33.3%, P=0.12) and similar endometrial thickness (8.23±2.15 vs 8.05±1.86 mm, P=0.59). Left uterine artery resistance index fell significantly within the IMN group (0.63 to 0.42, P<0.01). Clinical pregnancy rates were 13.3% and 10.0% (relative risk 1.33, 95% CI 0.33-5.45; P=1.00). No ovarian hyperstimulation occurred; two women (6.7%) reported mild headache. Conclusion: Adjuvant vaginal IMN was well tolerated and showed favourable but non-significant trends in endometrial perfusion and pregnancy rate. Adequately powered placebo-controlled trials are required.

Background: Burnout among healthcare professionals is an occupational syndrome associated with emotional exhaustion, depersonalization and reduced professional efficacy. Objective: To synthesize evidence on the prevalence and determinants of burnout among healthcare professionals. Methods: A PRISMA-oriented systematic review framework was used, focusing on observational prevalence studies, systematic reviews and meta-analyses using validated burnout instruments, particularly the Maslach Burnout Inventory. Results: Burnout prevalence varies widely because definitions, instruments and cut-off scores differ substantially. Physician-focused reviews demonstrate broad heterogeneity; pandemic-era meta-analyses indicate that a large proportion of healthcare workers experienced burnout, with emotional exhaustion particularly prominent. Determinants repeatedly include high workload, staffing shortage, long working hours, moral distress, inadequate organizational support, and insufficient control over work, risk of infection, poor sleep, and limited recovery time. Conclusion: Burnout is best understood as an organizationally mediated occupational outcome rather than solely an individual resilience problem. Meta-analysis is possible for instrument-specific prevalence estimates, but interpretation requires careful attention to heterogeneity and measurement validity. Keywords: Burnout; healthcare professionals; physicians; nurses; emotional exhaustion; depersonalization; occupational stress; Maslach Burnout Inventory; systematic review.

Background: Effective postoperative analgesia following Caesarean section is important for early mobilization, breastfeeding, maternal–newborn bonding, and overall postoperative recovery. Transversus abdominis plane (TAP) block is a regional analgesic technique that provides somatic pain relief by blocking the sensory nerves of the anterior abdominal wall. Surgical TAP block performed under direct vision during Caesarean section may offer effective analgesia while reducing the requirement for systemic analgesics. Aim: To compare the effectiveness of surgical transversus abdominis plane block with traditional postoperative analgesia in women undergoing Caesarean section. Materials and Methods: This prospective observational comparative study was conducted at Sri Venkateswaraa Medical College Hospital and Research Institute over a period of Six months. A total of 60 women aged above 18 years undergoing Caesarean section were included. Thirty patients who received surgical TAP block were included in Group A, while 30 patients receiving traditional postoperative analgesia were included in Group B. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 4, 6, 12, and 24 hours. Time to first rescue analgesia, number of rescue analgesic doses, total analgesic consumption during the first 24 hours, postoperative adverse effects, and patient satisfaction were also compared between the two groups. Results: The baseline demographic and obstetric characteristics were comparable between the two groups. Mean VAS scores were significantly lower in the TAP block group at 2 hours (2.1 ± 0.8 vs 3.6 ± 1.0), 4 hours (2.4 ± 0.9 vs 4.0 ± 1.1), 6 hours (2.8 ± 1.0 vs 4.2 ± 1.1), and 12 hours (3.1 ± 1.0 vs 3.8 ± 1.1). At 24 hours, the difference was not statistically significant. Rescue analgesia was required in 43.3% of patients in the TAP block group compared with 80.0% in the traditional analgesia group. The mean time to first rescue analgesia was significantly longer in the TAP block group (9.4 ± 3.1 hours vs 5.2 ± 2.4 hours, p<0.001). Patient satisfaction was also higher in the TAP block group. Conclusion: Surgical transversus abdominis plane block provides better early postoperative analgesia following Caesarean section, with lower pain scores, reduced rescue analgesic requirements, prolonged time to first rescue analgesia, and improved patient satisfaction compared with traditional postoperative analgesia. Surgical TAP block may therefore be a useful adjunct to multimodal postoperative pain management after Caesarean delivery.

Objectives: Perinatal asphyxia is a leading cause of neonatal morbidity and mortality. It is defined as a condition resulting from impaired gas exchange during labor and delivery, leading to fetal hypoxemia, hypercarbia, and metabolic acidosis. The present study was to correlate the serum calcium levels with severity of neonates with Hypoxic Ischemic Encephalopathy. Methods: Babies were divided in to two groups. Group A mild grade birth asphyxia corresponding to stage 1 sarnat and sarnat staging and group B moderate to severe birth asphyxia corresponding to grade 2 and 3 of sarnat and sarnat staging of hypoxic ischemic encephalopathy. Laboratory investigations were done including hemoglobin, total count, Differential count, serum sodium potassium and calcium. Serum total calcium was estimated in auto-analyzer. Results:  Mean weight of the babies in study was 2.34 ± 0.61 kg. Out of total 95 birth asphyxia babies, hypocalcemia was present in 32(33.68%) neonates.  Out 70 neonates of group A, 20(28.57%) neonates had hypocalcemia. Similarly, out of 25 neonates of group B, 12(48%) neonates had hypocalcemia. It was not statistically significant differenced (p=0.813). One (5%) neonate was expired among 20 mild HIE hypocalcemic neonates of group A. similarly among 12 hypocalcemic neonates of group B, 5 neonates (41.675%) were expired. Out of 32 hypocalmic neonates, 6(18.75%) neonates were expired. Conclusions: Hypocalcaemia is very common in HIE neonates. Mortality rate is greater in moderate to severe HIE neonates as compared to mild HIE hypo calcaemic neonates.

Background: Fine-needle aspiration cytology (FNAC) plays a pivotal role in the evaluation of salivary gland lesions. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides standardized terminology and facilitates risk stratification according to the risk of malignancy (ROM). Objective: To evaluate the diagnostic utility of the Milan System in salivary gland lesions and assess the associated risk of malignancy. Methods: A retrospective observational study was conducted on 106 cases of salivary gland lesions evaluated in the Department of Pathology, Andhra Medical College, Andhra Pradesh, India, during 2016–2018. Archived FNAC cases were retrospectively reclassified according to the Milan System. Cytological diagnoses were correlated with histopathological findings wherever available. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy. The association between Milan category and malignancy was evaluated using the chi-square test. Results: Among the 106 cases, Category IVA benign neoplasm was the most frequent category, comprising 42 cases (39.6%), followed by Category II (non-neoplastic) with 21 cases (19.8%) and Category VI (malignant) with 16 cases (15.1%). Histopathological follow-up was available in 64 cases. The risk of malignancy was highest in Category VI (100.0%), followed by Category V (75.0%). Category III showed an intermediate risk of malignancy (33.3%). FNAC demonstrated a sensitivity of 85.2%, specificity of 92.4%, positive predictive value of 88.5%, negative predictive value of 90.6%, and overall diagnostic accuracy of 89.5%. A statistically significant association was observed between Milan category and malignancy status (χ² = 28.6, df = 5, p < 0.001). Conclusion: The Milan System provides a standardized approach for categorizing salivary gland lesions and estimating their risk of malignancy. Its application to FNAC provides useful diagnostic and risk-stratification information and may assist in clinical decision-making and management planning.

Background and Aim: After modified radical mastectomy (MRM), paravertebral block (PVB) is a frequently utilized procedure for postoperative analgesia. Although many adjuvants to bupivacaine in PVB have been used for postoperative analgesia, none have been shown to be optimum. After MRM, we compared the duration of analgesia in PVB utilizing adjuvants like nalbuphine and dexmedetomidine with bupivacaine. Methods: Two groups of sixty female patients who were scheduled for MRM with axillary dissection were divided into two groups. Group D received 20 ml of bupivacaine 0.25% with dexmedetomidine 1 μg/kg, while Group N received PVB with 20 ml of bupivacaine 0.25% with nalbuphine 10 mg. All patients underwent surgery under general anaesthesia following PVB confirmation. Our study’s major goal was the time for the first rescue analgesic request. Visual analogue score (VAS) for pain during rest and movement, as well as total analgesic consumption, were our study’s secondary goals. In the 24 hours following surgery, symptoms such as nausea and vomiting, hemodynamic, and sedation were also evaluated. Results: Compared to group N (4.46 ± 3.24 hours), the initial rescue analgesic demand was delayed in group D (7.12 ± 2.28 hours). In contrast to group N (3.8 ±0.25 gm), group D’s mean total paracetamol consumption as rescue analgesia during the first 24 hours following surgery was significantly lower (2.9 ±0.68 gm). (p<0.001). Conclusion: When used with bupivacaine in PVB for modified radical mastectomy, dexmedetomidine offers longer-lasting analgesia than nalbuphine.

Background: Hematology-oncology patients are at increased risk of febrile neutropenia and bloodstream infection, particularly with antimicrobial-resistant organisms. Gastrointestinal colonization may serve as a potential reservoir for subsequent infection. Methods: This descriptive observational study included 140 patients with newly diagnosed acute lymphoblastic leukemia or acute myeloid leukemia undergoing chemotherapy and patients undergoing autologous or allogeneic hematopoietic stem-cell transplantation for any indication. Stool samples were subjected to culture, antimicrobial susceptibility testing and phenotypic detection of β-lactamase mechanisms. Patients were followed for 30 days, and blood cultures were obtained from those developing febrile neutropenia. Agreement between stool and blood isolates was assessed using Cohen’s kappa. Results: The mean age was 37.27±21.30 years, and 63.57% were males. Febrile neutropenia developed in 86 (61.43%) patients. Escherichia coli was the predominant stool isolate (88.57%). Among the 131 Gram-negative stool isolates, AmpC+MBL was the most frequently identified reported resistance phenotype (57/131, 43.51%), followed by AmpC+ESBL (21/131, 16.03%) and ESBL alone (16/131, 12.21%). Among E. coli, resistance to ampicillin was 89.52%, while resistance to imipenem and meropenem was 43.55% each. Most blood cultures showed no growth. Stool–blood culture concordance was only 5.81%, with poor agreement (κ=−0.007, p=0.334). Conclusion: Resistant Gram-negative intestinal colonization was common among hematology-oncology patients, but stool surveillance showed poor concordance with subsequent blood-culture isolates. Stool surveillance may therefore be more useful for monitoring colonization and resistance patterns than for independently predicting bloodstream pathogens.

Background: Difficult laparoscopic cholecystectomy (LC) may arise from severe inflammation, adhesions, fibrosis, or distorted anatomy around Calot’s triangle. When the critical view of safety cannot be achieved safely, a bailout strategy may reduce the risk of major biliary injury. The fundus-first (retrograde/dome-down) approach is one such strategy. Methods: We retrospectively reviewed operative and hospital records of 100 consecutive patients who underwent LC(Laparoscopic Cholecystectomy) at Medinirai Medical College and Hospital, Palamu, Jharkhand, between January 2024 and December 2025. Demographic characteristics, clinical presentation, laboratory and ultrasonographic findings, intraoperative difficulty, bailout procedures, operative time, postoperative outcomes, hospital stay, and histopathology were recorded. Descriptive statistics were used. Results: Among 100 patients, 38 were male and 62 female, with a mean BMI of 21.7 kg/m². Thirty-one cases were classified as difficult by the local intraoperative assessment. Calot’s triangle was not identifiable in 14 patients, and all 14 underwent a bailout procedure. Fundus-first LC was completed laparoscopically in 13 patients; one patient was converted to open fundus-first cholecystectomy after 30 minutes of surgery due to non-progression and bleeding. No bile duct injury was recorded. Bilious drain output lasting 3–14 days occurred in 7 of the 13 laparoscopic fundus-first cases and resolved with conservative management. Mean operative time was 58.34 minutes in straightforward cases and 109.32 minutes in difficult cases. Mean hospital stay was 2.54 days in straightforward cases and 5.3 days in difficult cases. There were no recorded readmissions or deaths. Conclusion: In this retrospective single-centre series, fundus-first bailout cholecystectomy enabled laparoscopic completion in most selected difficult cases without recorded bile duct injury or mortality. The relatively frequent postoperative bilious drainage highlights the need for careful postoperative surveillance. These findings support the feasibility of the fundus-first approach in selected difficult cases, with further studies helping to validate these observations.

Objective: To characterise the genomic antimicrobial-resistance (AMR) architecture of orthopaedic-associated Staphylococcus aureus in NCBI Pathogen Detection and determine whether apparent source- or comparator-associated differences persist after accounting for sequencing-project structure and lineage-correlated genomic background. Methods: We performed a secondary analysis of frozen NCBI Pathogen Detection release PDG000000073.1274. The primary cohort comprised 513 high-confidence orthopaedic-associated Staphylococcus aureus isolates, with 10,644 strictly defined non-orthopaedic clinical comparators. Seven prespecified genomic AMR classes were evaluated using descriptive prevalence and co-occurrence analyses, temporal and geographic models, orthopaedic source-group comparisons, BioProject-aware regression, within-BioProject conditional logistic regression, and an accessory-genome principal-component lineage-proxy sensitivity analysis. Results: Macrolide-associated determinants were present in 40.0% of orthopaedic isolates and methicillin-associated determinants in 38.0%; 43.5% carried none of the seven primary AMR classes. The unstratified source-group PERMANOVA was significant (p=0.0005; R²=0.0467), but dispersion differed markedly and the BioProject-stratified sensitivity was null (p=0.671). In strict within-BioProject comparison of 1,414 isolates across 25 shared BioProjects, no primary AMR class remained significant after Holm correction. A post hoc lineage-correlated accessory-genome sensitivity analysis did not alter this corrected conclusion. No robust nonlinear temporal trend was detected for the five common AMR classes examined. Conclusion: Orthopaedic-associated Staphylococcus aureus in this public genomic repository showed substantial but heterogeneous AMR architecture. However, apparent source- and comparator-associated differences weakened after stringent control for BioProject and lineage-correlated genomic background, indicating that repository composition can materially influence pooled genomic AMR comparisons.

Background: Length of stay (LOS) is a key indicator of hospital efficiency, resource utilization, and quality of care. Data on LOS patterns among cardiac patients in rural tertiary care settings in India remain limited. Objective: To determine the average length of stay and its associated factors among patients admitted under cardiology services in a tertiary care hospital in rural southern Rajasthan. Methods: A prospective observational study was conducted on consecutive patients admitted between 2 February 2025 and 15 April 2025. Demographic details, diagnosis, admission and discharge dates, and LOS were recorded. Descriptive statistics and subgroup analyses were performed. Results: A total of 200 admissions involving 166 unique patients were analysed. Mean age was 58.6 ± 14.4 years; 69.5% were male. Overall mean LOS was 3.43 ± 2.07 days (median 3 days; range 1–12 days). Patients with rheumatic/valvular heart disease had the longest mean LOS (5.17 days), while those undergoing interventional procedures (coronary angiography [CAG]/percutaneous transluminal coronary angioplasty [PTCA]) had the shortest (1.33 days). Female patients had a slightly longer mean LOS than males (3.89 vs 3.22 days). All patients were discharged; no in-hospital mortality was recorded. Conclusion: The average length of stay for cardiac patients in this rural tertiary care setting was relatively short (approximately 3.4 days), comparable to or shorter than several published Indian and international benchmarks. Diagnosis category, particularly valvular heart disease and heart failure, influenced LOS. Efficient triage, timely diagnostics, and protocol-driven care appear feasible even in resource-constrained rural environments.

Background: Determination of sex from skeletal remains is a fundamental aspect of forensic anthropology and medico-legal investigations. The clavicle exhibits considerable sexual dimorphism and can serve as a reliable indicator for sex determination when only fragmented skeletal remains are available. The present study was undertaken to evaluate morphometric parameters of human clavicles and assess their utility in sex determination among the Kashmiri population. Objectives: (1) To study various morphometric parameters of human clavicles in the Kashmiri population. (2) To compare morphometric measurements between male and female clavicles. (3) To determine the most reliable parameter for sex differentiation. Materials and Methods: A cross-sectional osteometric study was conducted in the Department of Anatomy, Government Medical College Srinagar. Seventy adult dry clavicles of known sex (35 male and 35 female) were analyzed. Measurements including clavicular length, medial angle, lateral angle, total curvature, segment lengths, widths, depths, and mid-shaft circumference were recorded using an osteometric board, Vernier caliper, sliding caliper, and protractor. Data were analyzed using SPSS version 26.0. Statistical significance was considered at p<0.05. Results: Male clavicles demonstrated significantly higher values for length, widths, depths, and mid-shaft circumference compared with female clavicles (p<0.001). Mean clavicular length was 145.3±4.2 mm in males and 131.6±3.8 mm in females. Mean mid-shaft circumference was 37.8±1.9 mm in males and 31.8±1.5 mm in females. Mid-shaft circumference emerged as the most significant discriminator of sex. Conclusion: The clavicle exhibits marked sexual dimorphism in the Kashmiri population. Mid-shaft circumference was found to be the most reliable parameter for sex determination. These findings may be useful in forensic anthropology, archaeology, and medico-legal investigations.

Background: Hypokalemic periodic paralysis (HPP) is a skeletal muscle channelopathy in which mutations of the CACNA1S and SCN4A genes generate an aberrant gating pore current that renders the sarcolemma inexcitable when extracellular potassium falls. In eastern India the disorder is closely tied to the habitual consumption of fermented rice (bassi), yet it is not known whether a demonstrable genetic substrate distinguishes those patients who suffer the most severe or most frequent attacks. Aim of this study was to determine the genotypic spectrum of CACNA1S and SCN4A variants in patients with HPP and to correlate genotype with clinical, biochemical, electrocardiographic and dietary findings. Methods: This descriptive and cross-sectional study was conducted at the Department of Medicine, JLNMCH, Bhagalpur, and Bihar from November 2025 To May 2026. Fifty-two patients of HPP in the 21–60 year age group were enrolled. Genomic DNA was extracted from peripheral blood and the hotspot exons of CACNA1S (exons 11 and 30) and SCN4A (exons 12 and 13) were amplified and sequenced by the Sanger method. Variants were classified according to the ACMG/AMP criteria. Genotype-positive and genotype-negative groups were compared using the chi-square or Fisher exact test and the unpaired t test. Results: A pathogenic or likely pathogenic variant was identified in 19 of 52 patients (36.5%). CACNA1S variants accounted for 13 patients (25.0%) and SCN4A variants for 6 patients (11.5%); p.Arg528His was the single commonest allele (n=6, 11.5%). Genotype-positive patients had a significantly younger age at first attack (24.60 ± 6.20 versus 31.80 ± 8.40 years, p=0.001), more attacks per year (4.80 ± 2.30 versus 2.10 ± 1.40, p<0.001), a lower serum potassium at presentation (2.31 ± 0.42 versus 2.68 ± 0.51 mEq/L, p=0.007) and a far higher rate of positive family history (57.9% versus 9.1%, p<0.001). Dietary exposure to fermented rice did not differ between the two groups (42.1% versus 48.5% taking it thrice daily or more, p=0.876). Conclusion: A causative channel gene variant was demonstrable in about one third of our patients. Genotype governed how early, how often and how deeply a patient became paralysed, whereas fermented rice intake was near universal and independent of genotype. Genotype therefore sets the threshold of vulnerability and the diet supplies the trigger, so that dietary counselling remains necessary for every patient irrespective of the result of sequencing.

Background: Accurate estimation of fetal weight is a fundamental requirement in obstetric practice. It guides clinical decisions regarding mode of delivery and enables early anticipation of both maternal and neonatal complications. Johnson’s formula, a bedside clinical method, and Hadlock’s formula, an ultrasonographic method, are among the most widely employed techniques for this purpose. Objective: To compare the accuracy of Johnson’s and Hadlock’s formulas in estimating fetal weight, and to correlate their estimates with actual birth weight in term pregnancies. Methods: A prospective observational study was conducted on 100 pregnant women with a gestational age of ≥36 weeks. Estimated fetal weight (EFW) was calculated using both Johnson’s clinical formula and Hadlock’s ultrasonographic formula prior to delivery. The estimates were subsequently compared with the actual birth weight (ABW). Statistical analysis included calculation of mean percentage error, standard deviation, and Pearson’s correlation coefficient. Results: The mean percentage error for Johnson’s formula was 4.97 ± 2.81%, compared to 3.58 ± 2.22% for Hadlock’s formula. Hadlock’s formula demonstrated a higher correlation with actual birth weight (r = 0.974 vs. r = 0.947) and significantly lower variability, indicating superior predictive accuracy. Conclusion: Hadlock’s ultrasonographic formula is significantly more accurate and reliable than Johnson’s clinical formula for fetal weight estimation. Nevertheless, Johnson’s formula retains practical value in low-resource and peripheral healthcare settings where ultrasound facilities are unavailable.

Background: Hypothyroidism is associated with abnormalities in body weight, lipid metabolism, glucose homeostasis, vascular resistance, and energy expenditure, several of which overlap with the diagnostic components of metabolic syndrome (MetS). Coexistence of these conditions may substantially increase long-term cardiometabolic risk. The present study evaluated the prevalence and clinical correlates of MetS among adults with hypothyroidism. Methods: This hospital-based cross-sectional observational study included 150 adults with biochemically confirmed primary hypothyroidism. Demographic characteristics, anthropometric measurements, blood pressure, fasting plasma glucose, serum triglycerides, high-density lipoprotein cholesterol (HDL-C), thyroid-stimulating hormone (TSH), and free thyroxine (FT4) were evaluated. Patients were categorized as having overt or subclinical hypothyroidism. MetS was diagnosed according to harmonized criteria. Continuous and categorical variables were compared using Student’s t test and chi-square test, respectively. Independent predictors of MetS were explored by multivariable logistic regression. Results: MetS was identified in 61 of 150 patients, corresponding to a prevalence of 40.7% (95% CI 33.1-48.7%). Prevalence was higher in overt hypothyroidism than in subclinical hypothyroidism (47.6% vs. 32.4%), although the difference did not reach statistical significance (p=0.085). Reduced HDL-C (60.7%), central obesity (57.3%), and hypertriglyceridemia (51.3%) were the most frequent components. Patients with MetS had significantly higher BMI (29.7 +/- 4.1 vs. 25.3 +/- 3.8 kg/m2), waist circumference (96.2 +/- 10.5 vs. 84.9 +/- 9.8 cm), triglycerides (188.6 +/- 62.3 vs. 132.4 +/- 44.1 mg/dL), fasting glucose (111.5 +/- 23.6 vs. 92.7 +/- 12.4 mg/dL), and TSH (11.8 +/- 8.4 vs. 8.2 +/- 6.7 mIU/L; p=0.006). Age, BMI, and TSH remained independently associated with MetS. Conclusion: A substantial proportion of patients with hypothyroidism demonstrated concurrent MetS, characterized predominantly by reduced HDL-C, central obesity, and hypertriglyceridemia. Comprehensive assessment of metabolic abnormalities may therefore be clinically useful in patients presenting with thyroid hypofunction.

Background: Allergic rhinitis is an IgE-mediated inflammatory disorder of the upper airway; however, the unified airway concept indicates that lower airway involvement may occur even before clinically apparent asthma. Pulmonary function abnormalities and their relationship with inflammatory markers may help identify adolescents at risk. Objective: To assess pulmonary function test abnormalities in adolescent patients of allergic rhinitis and evaluate their association with selected hematological and immunological parameters. Methods: This observational cross-sectional study included 30 adolescents with allergic rhinitis aged 10-18 years. Baseline demographic variables were recorded. Spirometry was performed using a computerized spirometer. Among allergic rhinitis cases, pulmonary function abnormalities were classified using standard cut-offs: reduced FEV1 <80% predicted, obstructive pattern as FEV1/FVC <0.70, and reduced FEF25-75% <65% predicted. Hematological and immunological parameters including AEC, NLR, PLR and serum IgE were assessed. Pearson correlation was used to evaluate associations between pulmonary functions and inflammatory markers. Results:  Reduced FEV1 was observed in 13.6% of mild and 25.0% of moderate-severe allergic rhinitis cases. No subject showed FEV1/FVC <0.70. Reduced FEF25-75% was more frequent in moderate-severe allergic rhinitis (62.5%) than mild allergic rhinitis (13.6%). No significant changes were observed in pulmonary functions between Mild and Moderate-Severe Allergic rhinitis groups. Mild grade eosinophilia was observed in cases along with significant increase in Total IgE in Moderate- Severe group as compared to Mild group. Correlation analysis showed predominantly weak and statistically non-significant associations between IgE, AEC, NLR and pulmonary function parameters. PLR showed a moderate negative correlation with FVC (r = -0.372, p = 0.043). Conclusion: Adolescent patients with allergic rhinitis showed pulmonary function abnormalities predominantly involving small airway function. Reduced FEF25-75% was more frequent in moderate-severe disease. Hematological parameters showed limited association with spirometric impairment, except for a significant negative correlation between PLR and FVC.

Introduction: Breast cancer surgery is frequently associated with significant postoperative pain, which may delay mobilization, increase opioid requirements, reduce patient satisfaction, and contribute to persistent post-mastectomy pain. Ultrasound-guided fascial plane blocks such as the Erector Spinae Plane (ESP) block and Pectoral Nerve (PECS) block are increasingly used as components of multimodal, opioid-sparing analgesia. This study compared the perioperative analgesic efficacy and safety of ESP and PECS blocks in patients undergoing breast cancer surgery. Aim: To compare ultrasound-guided ESP block and PECS block with respect to perioperative opioid consumption, postoperative pain scores, duration of analgesia, rescue analgesic requirement, and adverse effects. Methods: This quasi-experimental study was conducted in the Department of Anaesthesiology of a tertiary care teaching hospital over 18 months after Institutional Ethics Committee approval. Sixty female patients aged 18–60 years, ASA physical status I–II, scheduled for elective unilateral breast cancer surgery under general anaesthesia, were included using consecutive sampling. Patients were divided into two groups of 30 each: Group E received ultrasound-guided ESP block and Group P received ultrasound-guided PECS block. Perioperative analgesia was assessed by intraoperative fentanyl consumption, postoperative VAS scores, time to first rescue analgesia, 24-hour tramadol requirement, and adverse effects. Results: Surgical and anaesthesia durations were comparable between groups. Mean intraoperative fentanyl consumption was significantly lower in the PECS group than the ESP group (82.5 ± 16.4 vs. 96.3 ± 18.7 µg; **p=0.003**). Postoperative tramadol requirement was also significantly lower with PECS block (86.0 ± 34.2 vs. 118.0 ± 41.5 mg; **p=0.002**). Time to first rescue analgesia was significantly longer in the PECS group (9.1 ± 2.6 vs. 6.2 ± 2.1 hours; **p<0.001**). Postoperative VAS scores were significantly lower in the PECS group at 0, 2, 4, and 6 hours. PONV was observed in 16.7% and 30.0% of PECS and ESP patients, respectively, without significant difference. No block-related complications or respiratory depression occurred. Conclusion: Both ESP and PECS blocks provided effective and safe perioperative analgesia. However, PECS block demonstrated superior analgesic efficacy, longer duration of analgesia, lower opioid consumption, and lower early postoperative pain scores. PECS block may therefore be preferred as part of a multimodal analgesic strategy for breast cancer surgery.

Background: Open appendectomy remains a widely used treatment for uncomplicated appendicitis, while laparoscopic appendectomy may provide better postoperative recovery through a minimally invasive approach. Objective: To compare the perioperative and early postoperative outcomes of open and laparoscopic appendectomy in patients with uncomplicated appendicitis. Methods: This prospective comparative study included 100 patients aged 18–60 years with uncomplicated appendicitis. Patients were divided equally into open appendectomy and laparoscopic appendectomy groups. Operative time, blood loss, postoperative pain, analgesic requirement, oral intake, ambulation, hospital stay, complications, return to normal activity and cosmetic satisfaction were compared. A p-value <0.05 was considered statistically significant. Results: Baseline characteristics were comparable between the groups. Laparoscopic appendectomy required a longer operative time than open appendectomy (52.4±10.2 versus 38.6±8.7 minutes; p<0.001) but resulted in significantly lower blood loss. Postoperative VAS pain scores were significantly lower in the laparoscopic group at all assessment times. Laparoscopic patients required fewer analgesic doses, resumed oral fluids and ambulation earlier, and had a shorter hospital stay (2.4±0.8 versus 3.8±1.1 days; p<0.001). The overall complication rate was lower after laparoscopic appendectomy, although the difference was not statistically significant. Return to normal activity was earlier, and cosmetic satisfaction was significantly higher in the laparoscopic group. Conclusion: Laparoscopic appendectomy provided better postoperative recovery than open appendectomy in uncomplicated appendicitis, despite requiring a longer operative time.

Background: Acute pancreatitis (AP) ranges from mild self-limiting disease to severe disease with systemic complications. Early identification of high-risk patients is important. This study evaluated the association of the neutrophil-to-lymphocyte ratio (NLR) with AP severity and systemic complications. Methods: A prospective observational study was conducted over one year at a tertiary-care hospital in Gujarat, India, involving 108 adults with AP. Clinical and laboratory parameters were recorded at admission and 48 hours. Disease severity was assessed using the Revised Atlanta Classification and Ranson score. NLR was compared according to disease severity and complications. Results: Of 108 patients, 87 (80.6%) had mild and 21 (19.4%) had moderate/severe AP. Gallstones were the predominant aetiology (61.1%). Admission NLR was significantly higher in moderate/severe AP than mild AP (16 vs. 5.01; p<0.001). NLR at 48 hours was also significantly higher (12 vs. 2.42; p<0.001). Higher NLR was significantly associated with systemic complications (p<0.001). Conclusion: NLR was significantly associated with AP severity and systemic complications and may provide a simple, readily available marker for early risk assessment.

Background: Infection-related glomerulonephritis (IRGN) remains an important cause of acute renal dysfunction, particularly among adults with comorbid illnesses. Its clinical presentation, infectious triggers, histopathological spectrum, and outcomes are heterogeneous, and early identification of predictors of adverse renal outcomes is clinically important. Objectives: To evaluate the clinical, laboratory, microbiological, histopathological, and outcome profile of patients with IRGN and to identify factors independently associated with adverse renal and patient outcomes. Methods: This single-centre, hospital-based, prospective observational study included 160 patients with IRGN. Demographic characteristics, comorbidities, clinical presentation, infectious foci, microbiological findings, renal function parameters, complement levels, treatment, renal biopsy findings, and short-term outcomes were recorded. The composite adverse outcome comprised chronic kidney disease (CKD), end-stage kidney disease (ESKD), or death. Results: The mean age was 45.4 ± 16.2 years and 63.1% were male. Acute kidney injury occurred in 72.5%, while 20.0% presented with rapidly progressive glomerulonephritis. An infectious focus was identified in 74.4%, most commonly involving skin and soft tissues. Renal replacement therapy was required in 23.8%. Among 100 biopsied patients, endocapillary proliferation and exudative inflammation were observed in 88.0% and 86.0%, respectively, with universal C3 positivity. Complete renal recovery at three months occurred in 66.9%, whereas the composite adverse outcome occurred in 27.5%. Age >50 years, baseline CKD, and requirement for renal replacement therapy independently predicted adverse outcomes. Interstitial fibrosis and tubular atrophy >10% and global glomerulosclerosis >20% were independent histopathological predictors. Conclusion: IRGN was associated with substantial acute renal morbidity and clinically important adverse outcomes. Older age, pre-existing CKD, dialysis requirement, and chronic histopathological injury identified patients at increased risk and may aid early prognostic stratification.

Background: The Vogel’s water-lick conflict test is an established behavioural model for evaluating anxiolytic-like activity in rodents. It measures the conflict between the motivation to drink water and avoidance of an aversive electrical stimulus. Vitex negundo has been investigated for potential anxiolytic activity in experimental models, but its effects in a conflict-based paradigm warrant further evaluation. Objective: To evaluate the anxiolytic-like activity of Vitex negundo leaf extract using the Vogel’s water-lick conflict test in rats. Materials and Methods: An experimental, randomized, comparative animal study was conducted in 24 male Wistar albino rats weighing 150–250 g. Animals were divided into four groups of six: control, diazepam 1 mg/kg, V. negundo leaf extract 100 mg/kg (VNE100), and V. negundo leaf extract 200 mg/kg (VNE200). The leaf extract was prepared by exhaustive extraction with 95% methanol using a Soxhlet apparatus and administered orally. Following 24-hour water deprivation, animals were assessed in the Vogel apparatus for 3 minutes. Total water licks and total shocks received were recorded, while urination was documented. Data were expressed as Mean ± SD for continuous variables and number (percentage) for categorical variables. Appropriate statistical tests followed by Dunnett’s multiple comparisons were used, with p<0.05 considered statistically significant. Results: Mean water licks were 107.7 ± 18.22 in controls, 188.2 ± 32.31 with diazepam, 156.3 ± 35.25 with VNE100, and 163.8 ± 45.19 with VNE200. Compared with control, significant increases were observed with diazepam (p=0.0016) and VNE200 (p=0.0261), whereas VNE100 did not reach statistical significance (p=0.0578). Mean shocks received were 5.00 ± 1.09, 9.00 ± 1.67, 7.33 ± 1.86 and 7.67 ± 2.34, respectively. Significant increases occurred with diazepam (p=0.0027) and VNE200 (p=0.0472), but not VNE100 (p=0.0898). Conclusion: V. negundo leaf extract, particularly at 200 mg/kg, demonstrated anxiolytic-like activity in the Vogel conflict test, reflected by increased punished drinking and shock acceptance. Further pharmacological and clinical studies are required to establish its therapeutic potential.

Introduction: Penetrating abdominal trauma (PAT) is a major cause of morbidity and mortality worldwide, requiring timely diagnosis and effective management. Variations in injury patterns, limited resources, and evolving treatment strategies highlight the need for updated research. This study aims to evaluate demographic factors, causes, clinical outcomes, and management approaches to improve patient care. Aims: This study aims to evaluate the socio-demographic profile, incidence, etiological factors, clinical outcomes, and management strategies of patients with penetrating abdominal trauma (PAT) at a tertiary trauma care center. It also seeks to compare findings with existing national and international data to identify patterns, improve treatment approaches, and enhance patient outcomes. Materials and Methods: This prospective study will be conducted at the Trauma Care Centre of R. G. Kar Medical College and Hospital over a period of 18 months from the acceptance of the synopsis. The study population will include patients with penetrating abdominal trauma attending the Trauma Care Centre during the study period. A total of 50 patients will be enrolled for evaluation of their socio-demographic characteristics, etiological factors, clinical profile, management, and outcomes. Result: Among 50 patients with penetrating abdominal trauma, males and the 20–40 years age group were predominantly affected. Stab injuries were the most common mechanism, especially among low-income, less educated, and addicted individuals. Older age and gunshot injuries showed poorer outcomes. The findings highlight the need for targeted prevention, safety measures, and improved trauma care. Conclusion: This thesis highlights the demographic patterns, injury causes, outcomes, and management of penetrating abdominal trauma, emphasizing young male predominance, need for targeted prevention, improved trauma care, and effective intervention strategies.

Background: Pharmacovigilance is essential for identifying, assessing and preventing adverse effects associated with medicines. Spontaneous adverse drug reaction (ADR) reporting remains a fundamental component of pharmacovigilance; however, substantial under-reporting persists worldwide. Knowledge and favourable attitudes towards ADR reporting do not necessarily translate into actual reporting behaviour. Objectives: To assess the knowledge, attitude and practice (KAP) regarding pharmacovigilance and ADR reporting among healthcare workers; to identify factors associated with previous ADR-reporting experience; and to determine the correlations between knowledge, attitude and practice. Methods: A cross-sectional questionnaire-based study was conducted among faculty members, postgraduate residents, senior residents and MBBS interns at Dr. Bhim Rao Ramji Ambedkar Government Medical Knowledge Kannauj Uttar Pradesh. A structured questionnaire assessed knowledge of pharmacovigilance and ADR reporting, attitudes towards reporting, reporting practices and perceived barriers. Categorical variables were summarized as frequencies and percentages. Associations were assessed using the χ² test or Fisher’s exact test, as appropriate. Spearman’s correlation coefficient was used to assess relationships between KAP domains. Statistical significance was set at p<0.05. Results: Of 93 responses received, 90 participants consented and were included in the analysis, giving a response rate of 96.8%. Fifty-three (58.9%) were male and 37 (41.1%) female. Faculty members constituted 38 (42.2%), MBBS interns 24 (26.7%), postgraduate residents 23 (25.6%) and senior residents 5 (5.6%). Awareness of India’s ADR reporting system was high [88/90, 97.8%; 95% CI 92.3–99.4]. The mean knowledge score was 15.96±2.06/18 (88.6%); 77 (85.6%) participants had good knowledge. The mean standardized attitude score was 70.62±9.75/100, with 77 (85.6%) demonstrating a positive attitude. Despite this, only 41 (45.6%; 95% CI 35.7–55.8) had previously reported a suspected ADR. The mean practice score was 3.00±0.87/4, with 66 (73.3%) classified as having favourable practice. Previous ADR-reporting experience was significantly associated with professional designation (χ²=12.70, df=3, p=0.005). Respondents with previous reporting experience had significantly higher knowledge scores than those without previous reporting experience (16.61±1.69 vs 15.41±2.25; p=0.008). Knowledge correlated positively with attitude (ρ=0.302, p=0.004) and practice (ρ=0.316, p=0.002), while attitude correlated positively with practice (ρ=0.317, p=0.002). Conclusion: The study demonstrated high knowledge and generally favourable attitudes towards pharmacovigilance but substantially lower actual ADR-reporting experience. The findings indicate a persistent knowledge-to-practice gap. Interventions should therefore move beyond conventional awareness programmes towards practical, easily accessible and workflow-integrated ADR reporting, with particular emphasis on younger healthcare professionals and institutional barriers such as time constraints, uncertainty and perceived complexity of reporting systems.

Background: Small group discussion (SGD) is an active-learning strategy that may enhance learner participation, communication, and application of pharmacological concepts. This study compared SGD with interactive lectures for pharmacology learning among Phase 2 MBBS students. Objectives: To compare learning outcomes after SGD and interactive lectures and to assess students’ and faculty members’ perceptions of SGD in pharmacology. Materials and Methods: An educational interventional pre-test-post-test crossover study was conducted among Phase 2 MBBS students. Four pharmacology topics—drugs for migraine, non-steroidal anti-inflammatory drugs (NSAIDs), drugs for rheumatoid arthritis and gout, and drugs for bronchial asthma—were taught across four sessions. Students crossed over between SGD and interactive lecture methods. Knowledge was assessed using 10-item pre- and post-test multiple-choice questionnaires. Student and faculty perceptions were evaluated using structured feedback forms. Across the four sessions, 200 student-session observations were available for each teaching method. Results: Both teaching methods produced significant within-method improvement in knowledge scores. The pooled mean score increased from 5.66 ± 1.15 to 7.41 ± 1.21 after SGD (p<0.0001) and from 5.51 ± 1.24 to 7.61 ± 1.08 after interactive lectures (p<0.0001). The difference in pooled post-test scores between SGD and lecture was not statistically significant (7.41 ± 1.21 vs. 7.61 ± 1.08; p=0.0819). Topic-specific gains varied: SGD showed a larger gain for NSAIDs, whereas lectures produced larger gains for migraine, rheumatoid arthritis/gout, and bronchial asthma. Student feedback indicated favourable perceptions of active participation and interpersonal/communication skill development with SGD. All seven faculty respondents strongly agreed that SGD promoted deeper understanding, student engagement, and communication skills. Conclusion: Both SGD and interactive lectures significantly improved pharmacology knowledge, with no significant difference in pooled post-test scores. SGD offered additional perceived benefits for participation and communication, suggesting that it can complement interactive lectures as part of a blended pharmacology teaching strategy.

Background: Open tibial fractures are associated with substantial risks of wound complications, infection and delayed union because of soft-tissue injury, contamination and limited local vascularity. Local antibiotic delivery using absorbable calcium sulfate beads may provide high antibiotic concentrations at the fracture site while avoiding later implant removal. Objectives: This study evaluated functional and radiological outcomes, wound healing and infection-related complications following definitive fixation of selected open tibial fractures supplemented with antibiotic-loaded absorbable calcium sulfate beads. Methods: This hospital-based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital, from October 2024 to September 2025. Forty patients aged >15 years with displaced Gustilo–Anderson type I, II or IIIA open tibial fractures and a planned minimum one-year follow-up were included. Patients with type IIIB/IIIC fractures, diabetes, immunocompromised states, relevant neurological conditions or inability to complete follow-up were excluded. Following standard wound debridement and definitive fracture fixation, antibiotic-loaded absorbable calcium sulfate beads containing vancomycin or gentamicin were placed in the wound/dead space when indicated. Patients were followed clinically and radiologically for one year. Functional outcome was assessed using the Johner and Wruhs criteria. Data were analysed using SPSS version 22.0. Results: The mean age was 38.6 ± 12.4 years and 77.5% of patients were male. Road traffic accidents accounted for 70% of injuries. Gustilo–Anderson type II fractures constituted 50% of the cohort, followed by type IIIA (32.5%) and type I (17.5%). Intramedullary nailing was used in 62.5%, plate fixation in 22.5% and definitive external fixation in 15%. The overall postoperative infection rate was 7.5%, comprising 5% superficial and 2.5% deep infection. Primary wound healing occurred in 82.5% of patients. Mean radiological union time was 18.4 ± 3.2 weeks, with an overall union rate of 97.5%. Excellent and good functional outcomes were recorded in 57.5% and 30% of patients, respectively. Persistent sterile drainage was the most frequent complication (12.5%). On univariate analysis, smoking (p=0.041) and debridement performed after 6 hours (p=0.009) were significantly associated with infection. Conclusion: In this prospective single-centre series of selected open tibial fractures, definitive fixation supplemented by antibiotic-loaded absorbable calcium sulfate beads was associated with a low observed infection rate, high union rate and predominantly excellent-to-good functional outcomes. Persistent sterile drainage was the commonest bead-related/wound complication observed. Because the study had a small sample and no control group, these findings support the use of calcium sulfate beads as an adjunct rather than establishing superiority over standard care.

Background: Artificial intelligence (AI)-assisted clinical decision support systems (CDSS) are moving from retrospective algorithm testing into prospective clinical workflows, yet improved algorithmic performance does not automatically translate into better clinician decisions or patient outcomes. Objectives: To synthesize prospective and randomized evidence on AI-assisted CDSS, quantify effects on diagnostic or target-detection performance when clinically coherent data were available, and evaluate downstream workflow and patient-relevant outcomes. Methods: A PRISMA 2020-structured review framework was used for PubMed, Scopus, Embase and Cochrane searches in the year 2026. Eligible studies evaluated clinician- or workflow-facing AI decision support against usual care or unaided interpretation. Randomized trials were appraised with RoB 2; diagnostic studies were additionally considered using QUADAS-2 principles. An exploratory random-effects meta-analysis pooled relative detection yield from four screening/procedural randomized trials. Results: Across imaging, endoscopy, electrocardiography and general diagnostic reasoning, AI assistance usually improved sensitivity or target detection when the model was accurate, while gains were smaller or absent for some expert users and some clinical decisions. The exploratory pooled relative detection yield was RR 1.30 (95% CI 1.20–1.41; I²=0%). Important counter-evidence showed that systematically biased AI could reduce clinician accuracy by approximately 9–11 percentage points. AI-supported mammography reduced reading workload by about 44% while maintaining or improving cancer detection. Evidence for hard patient outcomes remained limited. Conclusion: AI-assisted CDSS can improve diagnostic detection and efficiency, but benefit depends on calibration, workflow integration, user expertise and resistance to automation bias. Prospective outcome-focused trials, external validation, subgroup monitoring and post-deployment surveillance are required before diagnostic gains can be assumed to improve patient outcomes.

Introduction: Post-infectious glomerulonephritis (PIGN) presents with a sudden onset of hematuria, oliguria, edema and hypertension in children and the severity varies from minimal to life threatening complications like anuria, congestive cardiac failure (CCF) and hypertensive encephalopathy. Among the infection related glomerulonephritis, Post-streptococcal glomerulonephritis (PSGN) is one of the commonest cause in children. Aim: a) To study the clinico-epidemiological profile in children admitted with PIGN at Tinsukia Medical College & Hospital (TMCH), a tertiary care hospital at Tinsukia, Assam. b) Correlation of clinical and laboratory parameters of children with PIGN and its outcome. Materials and Methods: A retrospective cohort study was conducted in the Department of Pediatrics at Tinsukia Medical College & Hospital (TMCH) from 1st November, 2024 to 28th February, 2026. Data from 35 children were collected, including demographic details, clinical signs and symptoms and laboratory parameters. All the statistical analysis were performed using Medcalc Version 20.026. The results were expressed as percentages. Test of significance was done by chi-square test. P < 0.05 was considered significant. Results: The most common age group affected was 7-9 years with male predominance 1.69:1. The incidence of glomerulonephritis was more in children coming from lower socio-economic families. The clinical presentations included were oliguria 35 (100%), puffiness of face 33 (94.28%), skin infection 32 (91.42%), pain abdomen 32 (91.42%) and swelling of feet 30 (85.71%). The comparison between incidence of oliguria and blood urea was statistically significant. There was also clinical correlation present between edema and proteinuria. Out of 35 (100%) children, 5 (14.28%) were associated with increased serum creatinine level. Conclusion: PIGN is a preventable and completely curable disease if precautions such as personal hygiene is well maintained. The main cornerstone for the successful outcome of patients is proper knowledge of pathophysiology of glomerulonephritis thereby institution of appropriate treatment and careful follow up.

Introduction: Postoperative pain is an important component of perioperative care and inadequate analgesia can adversely affect recovery, mobilization and overall patient comfort. Opioids remain an important option for postoperative pain management. Nalbuphine, a mixed κ-opioid receptor agonist and μ-opioid receptor antagonist, provides effective analgesia with a relatively low incidence of respiratory depression and other opioid-related adverse effects. It can be administered by different routes, including epidural and intravenous routes. Epidural administration may provide prolonged analgesia through a more localized spinal opioid effect. The present study was undertaken to compare epidural nalbuphine with intravenous nalbuphine for postoperative analgesia following infraumbilical surgeries under spinal anaesthesia. Methods: This hospital-based prospective, randomized, double-blind study was conducted over two years, from November 2017 to October 2019, after ethical committee approval. Seventy patients of either sex, aged 18–60 years, belonging to ASA physical status I–II and undergoing infraumbilical surgery under spinal anaesthesia with 0.5% hyperbaric bupivacaine were enrolled. Patients were randomized into two groups of 35 each. Group A received epidural nalbuphine 10 mg diluted in 10 mL normal saline, while Group B received intravenous nalbuphine 10 mg diluted in 10 mL normal saline at the end of surgery. Postoperative pain was assessed using the Visual Analogue Scale (VAS), sedation using the Ramsay Sedation Scale, and rescue analgesia was administered with diclofenac 75 mg IM when VAS was ≥4. Haemodynamic parameters, respiratory rate, SpO₂ and adverse effects were monitored for 24 hours. Results: The demographic characteristics and duration of surgery were comparable between the groups. Haemodynamic parameters, including SBP, DBP, MAP, HR, respiratory rate and SpO₂, showed no statistically significant differences during the 24-hour postoperative period. Mean postoperative VAS scores were significantly lower in the epidural group than in the intravenous group (p<0.05). The mean duration of postoperative analgesia was significantly longer with epidural nalbuphine (475.43±39.58 min) compared with intravenous nalbuphine (379.71±36.33 min; p<0.001). Rescue analgesic requirements were also significantly lower in the epidural group, with 1–2 doses required compared with 2–3 doses in the intravenous group (p<0.05). Mean Ramsay Sedation Scale scores were 1.40±0.48 in Group A and 2.42±0.48 in Group B (p=0.001). Hypotension, bradycardia and nausea/vomiting occurred only in the intravenous group, while no respiratory depression, urinary retention or urticaria was observed in either group. Conclusion: Epidural administration of nalbuphine 10 mg provided superior postoperative analgesia compared with intravenous administration in patients undergoing infraumbilical surgeries under spinal anaesthesia. Epidural nalbuphine resulted in lower postoperative pain scores, longer duration of analgesia and reduced rescue analgesic requirement, with fewer observed adverse effects. Thus, epidural nalbuphine may be an effective and well-tolerated option for postoperative analgesia in this patient population.

Introduction: Neuromuscular blocking agents are widely used during general anaesthesia to facilitate tracheal intubation, provide adequate surgical relaxation, and enable controlled ventilation. However, postoperative residual neuromuscular blockade (RNMB) remains an important perioperative concern and may contribute to airway obstruction, hypoxaemia, impaired protective airway reflexes, aspiration, delayed recovery, and postoperative respiratory complications. A Train-of-Four (TOF) ratio ≥0.9 is considered the minimum indicator of adequate neuromuscular recovery. Neostigmine, traditionally used for reversal, has a ceiling effect and its efficacy depends on the depth of blockade. Sugammadex directly encapsulates aminosteroidal neuromuscular blocking agents and provides rapid and predictable reversal. Aim: To compare the efficacy of Sugammadex with Neostigmine–Glycopyrrolate for reversal of vecuronium-induced neuromuscular blockade and to assess their impact on perioperative outcomes, including neuromuscular recovery, extubation, postoperative respiratory status, haemodynamic stability, and adverse effects. Methods: This hospital-based prospective quasi-experimental study was conducted in the Department of Anaesthesiology at a tertiary care teaching hospital over 18 months after Institutional Ethics Committee approval. Seventy-six adult patients (ASA I–III) undergoing elective surgery under general anaesthesia with vecuronium-induced neuromuscular blockade were included. Patients were equally allocated into Group S (Sugammadex, n=38), receiving Sugammadex 2 mg/kg IV, and Group N (Neostigmine–Glycopyrrolate, n=38), receiving Neostigmine 0.05 mg/kg with Glycopyrrolate 0.008 mg/kg IV. Neuromuscular recovery was assessed using TOF monitoring. Time to TOF ratio ≥0.9, extubation, eye opening, response to verbal commands, postoperative oxygen saturation, respiratory complications, postoperative nausea and vomiting, and adverse events were recorded. Results: Sugammadex produced significantly faster neuromuscular recovery than Neostigmine–Glycopyrrolate. The mean time to achieve a TOF ratio ≥0.9 was 132.34 seconds in the Sugammadex group compared with 304.21 seconds in the Neostigmine group. Mean extubation time was also markedly shorter with Sugammadex (184.87 seconds versus 374.45 seconds). Patients receiving Sugammadex demonstrated faster eye opening and response to verbal commands, greater haemodynamic stability, and higher postoperative oxygen saturation. Mean postoperative oxygen saturation was 98.34% with Sugammadex compared with 94.11% with Neostigmine–Glycopyrrolate. PONV was uncommon, occurring in one patient (2.6%) in the Neostigmine–Glycopyrrolate group and none in the Sugammadex group. Conclusion: Sugammadex provided significantly faster and more predictable reversal of vecuronium-induced neuromuscular blockade than Neostigmine–Glycopyrrolate. Its use was associated with earlier achievement of adequate neuromuscular recovery, earlier extubation, improved postoperative oxygenation, and greater haemodynamic stability. These findings support Sugammadex as an effective reversal agent for aminosteroidal neuromuscular blockade in contemporary anaesthetic practice.

Introduction: Caesarean section (CS) is one of the most frequently performed obstetric surgical procedures, and effective postoperative analgesia is essential for early mobilisation, breastfeeding, newborn care and maternal recovery. Transversus abdominis plane (TAP) block provides effective somatic analgesia after lower segment caesarean section (LSCS); however, the duration of analgesia with bupivacaine alone is limited. Dexamethasone has been investigated as an adjuvant to prolong the duration and improve the quality of analgesia. Aim: To compare the efficacy and safety of ultrasound-guided bilateral TAP block using 0.25% bupivacaine alone versus 0.25% bupivacaine with dexamethasone 8 mg for postoperative analgesia following elective LSCS. Methods: This quasi-experimental study included 72 women undergoing elective LSCS under spinal anaesthesia. Participants were allocated equally into two groups of 36 each. Group A received ultrasound-guided bilateral TAP block with 0.25% bupivacaine, while Group B received 0.25% bupivacaine with dexamethasone 8 mg. Postoperative pain was assessed using the visual analogue scale (VAS) at predetermined intervals up to 24 hours. The primary outcomes were duration of analgesia and postoperative pain scores. Secondary outcomes included rescue analgesic consumption, haemodynamic parameters and adverse effects. Duration of analgesia was defined as the time from completion of TAP block to the first request for rescue analgesia at VAS ≥4. Results: The two groups were comparable regarding baseline demographic and clinical characteristics. Postoperative VAS scores were significantly lower in the dexamethasone group at all assessed time points from 2 to 24 hours. The maximum difference was observed at 12 hours, with mean VAS scores of 5.6 ± 1.2 in Group A and 3.1 ± 1.0 in Group B (p < 0.001). The duration of analgesia was significantly longer with dexamethasone, measuring 468.7 ± 131.4 minutes (approximately 7.8 hours) compared with 276.4 ± 82.6 minutes (approximately 4.6 hours) with bupivacaine alone (p < 0.001). Within 24 hours, all patients in Group A required rescue analgesia compared with 77.8% in Group B (p = 0.004). Mean rescue analgesic requirements were significantly lower in Group B (0.83 ± 0.71 vs 1.86 ± 0.74 doses; p < 0.001). Haemodynamic parameters remained stable, and adverse effects were comparable between groups (25.0% vs 27.8%; p = 0.797). Conclusion: Addition of dexamethasone 8 mg to 0.25% bupivacaine significantly prolongs the duration of analgesia, reduces postoperative pain and decreases rescue analgesic requirements following elective LSCS. Ultrasound-guided bilateral TAP block with dexamethasone appears to be an effective, safe and opioid-sparing component of multimodal post-caesarean analgesia.

Background: Securing the airway is a critical responsibility of the anesthesiologist, particularly in patients with an anticipated difficult airway. Awake tracheal intubation allows maintenance of spontaneous respiration and provides an additional margin of safety during difficult airway management. Awake fibreoptic intubation (AFOI) has traditionally been regarded as the gold standard; however, it requires considerable expertise, patient cooperation, and careful airway preparation. Awake video laryngoscopy (AVL) has emerged as an alternative technique because of its ease of use, improved glottic visualization, and increasing availability. The present study was undertaken to compare the efficacy, safety, and practical usefulness of awake fibreoptic and awake video laryngoscopic tracheal intubation in adult patients with anticipated difficult airways. Methods: This quasi-experimental study was conducted in the Department of Anaesthesiology at a tertiary care centre over a period of 18 months. A total of 70 adult patients with anticipated difficult airways undergoing elective surgery under general anaesthesia were included. Patients were randomly allocated into two equal groups of 35 each. Group A underwent awake fibreoptic intubation, while Group B underwent awake video laryngoscopic intubation. The primary outcome was time required for successful tracheal intubation. Secondary outcomes included first-attempt success rate, number of intubation attempts, Cormack–Lehane grade, oxygen desaturation, and intubation-related complications. Data were analysed using appropriate statistical tests, with p < 0.05 considered statistically significant. The study was conducted after Institutional Ethics Committee approval and written informed consent. Results: The median time required for successful tracheal intubation was significantly shorter in Group B than Group A, at 84 [70–105] seconds versus 112 [95–140] seconds, respectively (p = 0.001). First-attempt success was higher with video laryngoscopy than fibreoptic intubation (88.6% vs. 80.0%), although the difference was not statistically significant (p = 0.32). The mean number of attempts was also lower in Group B (1.11 ± 0.32 vs. 1.23 ± 0.50; p = 0.26). Grade I Cormack–Lehane views were significantly more frequent in Group B (45.7% vs. 20.0%; p = 0.02), whereas Grade III views were significantly more common in Group A (34.3% vs. 11.4%; p = 0.02). Oxygen desaturation occurred in 5.7% of Group B compared with 11.4% of Group A (p = 0.39). Intubation-related complications were also less frequent in Group B, although differences were not statistically significant. Conclusion: Awake video laryngoscopic intubation was a safe and effective alternative to awake fibreoptic intubation in appropriately selected adult patients with anticipated difficult airways. It provided significantly shorter intubation time and better glottic visualization, with favourable trends in first-attempt success, number of attempts, oxygenation, and procedure-related complications. These findings support the use of awake video laryngoscopy as an effective technique for anticipated difficult airway management, while technique selection should remain individualized according to patient characteristics, available equipment, and operator expertise.

Aim: To compare the duration of postoperative analgesia associated with perineural dexmedetomidine and dexamethasone as adjuvants to ropivacaine in ultrasound-guided transverse process to pleura block (TPPB) for modified radical mastectomy (MRM). Secondary objectives were to examine the available observations on sensory block, perioperative physiological variables, intraoperative analgesic efficacy, and patient satisfaction. Materials and Methods: This comparative study was conducted over six months in the Department of Anesthesiology, Chirayu Medical College Bhopal, after Institutional Ethics Committee clearance and informed consent. Ninety women with malignant breast disease who underwent MRM were included by convenience sampling. The supplied study record describes participants as aged approximately 40–65 years and belonging to American Society of Anesthesiologists physical status I or II. Forty-five patients were assigned to Group I, which received ropivacaine with perineural dexmedetomidine, and 45 to Group II, which received ropivacaine with perineural dexamethasone. Baseline physiological variables and block-related observations were recorded. Results: Age distribution and recorded preoperative pulse rate, blood pressure, and respiratory rate were broadly similar between groups. The reported mean duration of analgesia was 10.72 ± 2.84 hours in the dexmedetomidine group and 14.02 ± 2.45 hours in the dexamethasone group, a descriptive difference of 3.30 hours. In the source table categorising duration, analgesia lasted longer than 18 hours in five dexamethasone-group patients and no dexmedetomidine-group patients. Conclusion: Dexamethasone was associated with a longer reported duration of analgesia than dexmedetomidine when each was added to ropivacaine for TPPB in MRM.

Background: Obesity is associated with structural and electrophysiological alterations of the heart, increasing the risk of ventricular arrhythmias and sudden cardiac death. However, cardiovascular risk varies among obese individuals according to their metabolic status. Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) represent distinct phenotypes with potentially different electrocardiographic (ECG) characteristics. Limited evidence is available comparing ECG-derived indices between these two groups. Objectives: To compare QT interval, corrected QT interval (QTc), and QT dispersion between metabolically healthy obese and metabolically unhealthy obese adult males. Methods: This prospective case-control study included 110 adult obese males aged 30–50 years, comprising 55 participants with MHO and 55 with MUO. Metabolic status was classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Anthropometric measurements, blood pressure, fasting biochemical parameters, and standard 12-lead electrocardiograms were obtained. QT interval, QTc (Bazett’s formula), and QT dispersion were measured manually. Statistical analysis was performed using independent-samples t-tests. A p value <0.05 was considered statistically significant. Results: QT interval (p=0.016), QTc interval (p<0.001), and QT dispersion (p=0.05) were significantly higher in participants with MUO, whereas heart rate did not differ significantly between the groups. Conclusion: Metabolically unhealthy obesity is associated with significantly prolonged ventricular repolarization indices compared with metabolically healthy obesity, suggesting a higher risk of ventricular arrhythmias and sudden cardiac death. ECG-derived QT indices may serve as simple, non-invasive markers for early cardiovascular risk assessment in obese individuals, particularly those with metabolic abnormalities.

Background: Combined spinal–epidural anaesthesia (CSEA) combines the rapid onset of spinal anaesthesia with the flexibility of epidural anaesthesia for prolonged surgical procedures and postoperative analgesia. Single-space and double-space techniques are commonly used, but their comparative performance remains uncertain. Aim and Objective: To compare the single-space and double-space techniques of CSEA in patients undergoing elective lower-limb orthopedic surgery. Materials and Methods: This prospective randomized comparative study included 80 patients aged 18–75 years with American Society of Anesthesiologists physical status I–II. Patients were randomized into Group A (double-space technique, n=40) and Group B (single-space technique, n=40). Sensory and motor block onset, duration of analgesia, duration of surgery, haemodynamic parameters, and perioperative outcomes were assessed. Results: The mean age was 35.6 ± 13.7 years in Group A and 40.3 ± 12.1 years in Group B (p=0.11). Sensory block onset was faster with the double-space technique (4.85 ± 1.00 vs 5.20 ± 0.99 minutes), representing a 6.7% shorter onset time, although the difference was not significant (p=0.120). Motor block onset was also faster in Group A (5.25 ± 1.10 vs 5.75 ± 1.81 minutes; 8.7% difference; p=0.139). Analgesia lasted longer with the double-space technique (5.15 ± 0.71 vs 4.82 ± 0.82 hours; 6.8% difference; p=0.059). Duration of surgery was comparable (136.15 ± 13.30 vs 138.21 ± 12.95 minutes; p=0.492). Heart rate, blood pressure, arterial pressure, and oxygen saturation remained comparable between groups. Conclusion: Both techniques provide effective and hemodynamically stable CSEA. The double-space technique showed modest numerical advantages in block onset and duration of analgesia, but did not demonstrate statistically significant superiority.

Background: Gall bladder diseases include calculous, inflammatory, benign mural and polypoid lesions, and malignancy. Ultrasonography (US) is the initial modality of choice, and computed tomography (CT) is frequently ordered when the results are ambiguous or complications are suspected. Objective: To evaluate the diagnostic accuracy of US and CT in the diagnosis and characterization of typical gallbladder diseases. Methods: This was a retrospective paired-imaging study of 180 adults who had received abdominal US and contrast-enhanced CT within 48 hours of presentation with a suspected gallbladder disease. Imaging findings were compared to a composite reference standard of surgery and histopathology (where available) or final multidisciplinary clinical diagnosis with follow-up. Gallstones, wall thickening, pericholecystic inflammatory changes, polyps, adenomyomatosis, complicated cholecystitis and malignancy were evaluated. Results: The mean age was 52.6 ± 15.1 years, and 112 (62.2%) participants were women. US was more likely to detect gallstones than CT (96.1% vs 80.4%, p<0.001) and CT was more likely to detect pericholecystic inflammatory change than US (90.9% vs 72.7%, p=0.012). The sensitivity of US and CT was 83.6% and 90.9%, respectively, for acute/complicated cholecystitis, and the overall accuracy of US and CT was 90.0% and 91.1%, respectively. US was superior in detecting small polypoid lesions and adenomyomatosis, and CT was more consistently able to show perforation, abscess, adjacent hepatic invasion and nodal disease. The overall diagnostic agreement between modalities was good (kappa=0.74). Conclusions: US and CT are complementary in gallbladder imaging. US is better for small intraluminal/mural lesions and gallstones, whereas CT is better for inflammatory extension and complications and staging features. A sequential, selective imaging approach can help to increase the confidence of the diagnosis and prevent duplicate imaging.

Background: Laparoscopic to open cholecystectomy conversion is an important safety endpoint in acute cholecystitis due to the fact that the presence of severe inflammation, distorted anatomy, and delayed presentation can make safe dissection challenging. Objectives: To determine the preoperative clinical, laboratory and ultrasonographic parameters that are associated with conversion to open cholecystectomy in patients undergoing early laparoscopic cholecystectomy for acute cholecystitis. Methods: A prospective observational study was conducted of 286 adults with acute calculous cholecystitis who were attempted for laparoscopic cholecystectomy. Demographic data, comorbidities, symptom duration, inflammatory markers, liver function tests, ultrasonographic data and severity grade (Tokyo) were recorded. Patients were divided into completed laparoscopy and converted to open surgery. Multivariable logistic regression was used to identify independent predictors. Results: Laparoscopic cholecystectomy was successfully completed in 252 patients and 34 (11.9%) were converted. Converted patients were older (61.8 ± 12.6 vs 49.7 ± 14.2 years, p<0.001), more often male (70.6% vs 47.6%, p=0.011), and more frequently presented after 72 hours (67.6% vs 28.6%, p<0.001). Mean C-reactive protein was higher in the conversion group (176.4 ± 82.1 vs 82.7 ± 61.5 mg/L, p<0.001), and gallbladder wall thickness was greater (5.8 ± 1.4 vs 4.1 ± 1.2 mm, p<0.001). Independent predictors were age ≥65 years (adjusted OR 2.37, 95% CI 1.05-5.36), symptom duration >72 hours (OR 2.84, 95% CI 1.24-6.52), CRP ≥150 mg/L (OR 3.68, 95% CI 1.57-8.64), gallbladder wall thickness ≥5 mm (OR 3.11, 95% CI 1.34-7.22), and Tokyo Grade II/III disease (OR 4.42, 95% CI 1.72-11.36). Conclusion: The risk of conversion can be predicted preoperatively based on a combination of age, delayed presentation, systemic inflammatory burden, gallbladder wall thickening and disease severity. Awareness of these factors can help with operative planning, involvement of senior surgeons and informed consent.

This prospective observational study aims to observe first trimester preeclampsia screening & effect of low dose aspirin on maternal mean arterial pressure. Total 500 women were categorized into two groups (250 each in high risk and low risk) based on the screening result during a period of 18 months in Command Hospital Airforce Bengalore. Women aged 18–35 years with singleton pregnancies between 11 weeks and 13+6 weeks period of gestation were included & pregnancies complicated by aneuploidy, chronic hypertension, prior hypertensive disorders, preexisting medical illnesses, or prior Aspirin use were excluded. Women identified as high risk for preeclampsia were initiated on Aspirin 150 while low-risk women were not started on any medication and both groups were monitored until delivery. Statistical significance threshold considered was P ≤ 0.05. Findings revealed significant association between effect of aspirin and maternal MAP (P < 0.001).

Background: Mesh fixation technique may influence postoperative pain, recovery and complications following laparoscopic inguinal hernia repair. Non-penetrating fixation with fibrin glue may reduce tissue and nerve injury compared with absorbable tackers. Objective: To compare fibrin-glue and absorbable-tacker mesh fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair. Methods: This prospective randomized comparative study included 60 patients with primary unilateral inguinal hernia. Patients were equally allocated to fibrin-glue or absorbable-tacker fixation. Operative time, postoperative pain, analgesic requirement, hospital stay, return to normal activities and work, complications, chronic groin pain and recurrence were evaluated over six months. Results: Total operative time was comparable between the techniques (p=0.125), although mesh-fixation time was longer with fibrin glue (p<0.001). The fibrin-glue group had significantly lower pain scores from six hours to one month; at 48 hours, the scores were 2.5±0.7 and 3.1±0.8, respectively (p=0.003). Fibrin glue was also associated with fewer analgesic doses (p=0.001), shorter hospital stay (p=0.040), earlier return to normal activities (p<0.001) and earlier return to work (p=0.001). Early complications and chronic groin pain were less frequent with fibrin glue, but the differences were not statistically significant. No mesh migration or recurrence occurred in either group. Conclusion: Fibrin-glue fixation provided better postoperative pain control and faster recovery than absorbable tackers without increasing complications or short-term recurrence.

Background and Objectives: Childhood pneumonia accounts for significant under 5 morbidity and mortality among children. Immunomodulatory role of Vitamin D in LRTI is well established. This study is done to correlate severe pneumonia and vitamin D deficiency along with other factors. Methods: This study was conducted from January 1, 2018 to June 30, 2019 in PICU of a tertiary care centre. Detailed history, hemodynamic stability and lab data were collected. Patients were categorised into sufficient, insufficient and deficient status based on Vitamin D levels. Results: Out of 80 children with severe pneumonia, 40 were vitamin D deficient which included all the 8 patients with very severe pneumonia. 36 out of 40 patients were malnourished. 60% had history of adequate sunlight exposure. Only 1 belonged to low socioeconomic class. Conclusion: In our study 50% of the cases had vitamin D deficiency and was related to disease severity. Factors like sunlight exposure, sex, malnutrition and socio-economic status were not significantly associated with vitamin deficiency. Vitamin D supplementation is recommended as only 9% of the cases had sufficient levels.

Background: Artificial intelligence (AI) is increasingly transforming healthcare and medical education. Assessing students’ knowledge, attitudes, and practices (KAP) is important for preparing future healthcare professionals for responsible AI use. Methods: A cross-sectional questionnaire-based study was conducted among second-year medical students at a tertiary care hospital in Gujarat over one year. Data were collected using a structured electronic questionnaire covering sociodemographic characteristics, AI knowledge, attitudes, and practices. Descriptive statistics and the chi-square test were used for analysis. Results: Among 174 participants, 93.7% had heard of AI and 83.3% were aware of its medical applications. Only 36.2% had received formal AI instruction, and 13.2% had attended AI-related training. AI was used for academic activities by 90.8%, with ChatGPT being the most commonly used tool (93.7%). Overall, 63.8% supported AI education and 60.9% were willing to use AI in future practice. Conclusion: Students demonstrated high AI awareness and use but limited formal training, highlighting the need for structured AI education in undergraduate medical curricula.

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An accurate, simple, highly sensitive, precise, rapid, and reproducible high-performance liquid chromatographic (HPLC) method has been developed for the determination of Ticagrelor (TCG) in bulk and tablet dosage forms. The detection was carried in the room temperature at 254 nm. The mobile phase consisting of potassium dihydrogen orthophosphate: ACN was selected for the study. The ratio of 40:60% v/v of selected mobile phase was found to produce asymmetric peaks with good resolution. The buffer pH 2.5 and ionic strength of 0.01M were utilized for the proposed method. The linearity was obtained with correlation factor (r2) 0.9962 in the concentration range of 0.5 µg/ml–3 µg/ml. The %RSD for all the parameters was found to be within the limits, that is, < 2% and % recovery was also found to be within the limit (97%-103%). The mean recovery results of assay were good and the label claim of rivaroxaban tablets was found to be satisfactory.

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Hemoglobinopathies constitute a major group of inherited red cell disorders resulting from qualitative or quantitative abnormalities of globin-chain synthesis. Thalassemias and structural hemoglobin variants such as HbS, HbE and HbD are important causes of anemia in India, with considerable geographical variation in their distribution. High-performance liquid chromatography (HPLC) provides simultaneous separation and quantification of major hemoglobin fractions and is widely used for laboratory evaluation of hemoglobin disorders. Aim: (1) To determine the spectrum and frequency of hemoglobinopathies detected by HPLC in patients evaluated at a tertiary care hospital. (2) To correlate the HPLC findings with hematological parameters, age and sex distribution. Materials and Methods: A retrospective observational study was conducted in the Department of Pathology, NAMO Hospital, Silvassa, from January 2026 to August 2026. A total of 240 patients evaluated for anemia, suspected hemoglobinopathy, abnormal peripheral smear findings, family history of hemoglobinopathy, antenatal/preconception screening or other relevant indications were included. Complete blood count and red-cell indices were obtained using an automated five-part hematology analyzer. Hemoglobin fractions were analyzed using a Bio-Rad D-10 HPLC analyzer. HPLC patterns were interpreted on the basis of retention time and percentage of individual fractions. Patients with recent blood transfusion, technically inadequate samples or invalid HPLC chromatograms were excluded. Results: Among the 240 patients evaluated, 135 (56.25%) showed an HPLC pattern consistent with a hemoglobinopathy. The most frequently identified abnormality was HbS heterozygosity (sickle cell trait), observed in 43 cases (31.85% of hemoglobinopathy cases), followed by HbS homozygous pattern/sickle cell disease in 38 cases (28.15%) and beta-thalassemia trait in 29 cases (21.48%). Other findings included borderline HbA2 in 15 cases (11.11%), beta-thalassemia major in 5 cases (3.70%), HbE heterozygosity in 2 cases (1.48%), HbD Punjab heterozygosity in 2 cases (1.48%) and HbE homozygosity in 1 case (0.74%). The study population showed a female predominance (177; 73.75%), and the largest age group was 21–30 years (135; 56.25%). Conclusion: A substantial proportion of patients evaluated in this tertiary-care setting demonstrated hemoglobinopathy-associated HPLC patterns, with sickling disorders constituting the predominant abnormalities. HPLC, when interpreted alongside CBC parameters and peripheral blood morphology, provides an effective laboratory approach for screening and characterization of common hemoglobin disorders. Regional screening, particularly among young adults and individuals undergoing antenatal or preconception evaluation, may facilitate early recognition of carrier states and affected individuals.

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Background: Melatonin is an endogenous sleep regulating hormone secreted by pineal gland. Emergence agitation and delirium in children remains a common clinical challenge in post anaesthetic care unit .Exogeneous administration of melatonin causes sedation, anxiolysis and hypnosis by inhibitory action on central nervous system. Preoperative oral melatonin has been suggested as an effective drug in preventing emergence agitation with favourable safety profile. Methods: Randomized single blind control study, consisting of 60 ASA 1 & 2 paediatric patients, belonging to the age group of 5-13 years, who were posted for elective tonsillectomy. Patients were randomly divided into group M (n=30) received oral melatonin 0.2mg/kg bodyweight 90 mins prior to surgery with sips of water and group C (control) (n=30) received oral multivitamin tablet 90 mins prior to surgery with sips of water. Primary objective of the study was induction compliance checklist and paediatric anaesthesia emergency delirium scale. Results: We have noticed Induction Compliance checklist among the groups soon after the extubation, which was statistically highly significant in Group M when compared to Group C (p=0.000). Paediatric Anaesthesia emergence delirium Score among the groups which was highly statistically significant in group M when compared to Group C (p=0.000). Conclusion: To conclude in paediatric surgical patients oral melatonin in the dose of 0.2 mg per kg given pre-operative  does not affect, but it will impact their post-operative behaviour by reducing emergence agitation.

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Background: Severe acute malnutrition (SAM) remains a major cause of childhood morbidity and mortality in low- and middle-income countries, and co-morbid infections and metabolic complications substantially influence survival. Understanding the local pattern of co-morbidities and outcome determinants is essential for planning hospital-based management. Methods: This descriptive hospital-based study enrolled 100 children aged 6–59 months admitted with SAM defined by WHO criteria (weight-for-height z-score <3 SD, mid-upper arm circumference <115 mm, or nutritional edema) at a tertiary care hospital over two years. Detailed demographic, feeding, immunization, anthropometric, and clinical data were recorded; hemoglobin and blood glucose were measured, and co-morbidities were documented by clinical assessment and investigations. Data were analyzed using SPSS; chi-square tests, t-tests, Pearson correlation, and multivariable logistic regression were applied, with p<0.05 considered significant. Results: The mean age was 27.59±15.78 months, with the highest proportion (29%) in the 13–24 month group. Females comprised 53%. Most children belonged to lower (38%) or upper-lower (35%) socioeconomic classes, and 55% were from urban slums. Only 41% reported exclusive breastfeeding for six months. All children had MUAC <11.5 cm, 67% had weight-for-height <−3 SD, and 51% had edema. Nutritional anemia (72%), acute respiratory infection (57%), diarrhea (47%), sepsis (44%), and urinary tract infection (39%) were the leading co-morbidities; 98% had at least one co-morbidity. Mean hemoglobin was 9.62±2.11 g/dL and mean blood glucose 73.48±22.43 mg/dL. Developmental delay was present in 36%, and was strongly associated with mortality (p<0.001). Overall, 86% were discharged, 7% died, and 7% left against medical advice; discharged children had the longest mean hospital stay (23.93±2.31 days). Conclusion: Hospitalized SAM children carry a heavy burden of infectious and nutritional co-morbidities, with anemia, respiratory infection, diarrhea, and sepsis predominating. Integrated management addressing infections, feeding practices, immunization gaps, and developmental surveillance is critical to improving outcomes.

Background: Neonatal sepsis remains one of the most serious causes of newborn morbidity and mortality, particularly where early diagnosis is difficult because of nonspecific clinical signs and the limitations of blood culture. Serial measurement of inflammatory biomarkers offers a practical way to monitor treatment response, but the dynamics of C-reactive protein (CRP) and serum ferritin after antibiotic therapy in term septic neonates need further prospective evaluation. Methods: In this prospective observational study, 120 full-term neonates aged 1–28 days with clinical features suggestive of sepsis admitted to a tertiary care hospital were enrolled after informed consent. Venous blood was collected at admission (baseline), before antibiotics, and again at 24 and 48 hours after initiation of empirical antibiotic therapy for estimation of CRP and serum ferritin. Continuous variables were expressed as mean±standard deviation, comparisons were made with the paired t-test, and p<0.05 was considered statistically significant. Results: Of the 120 neonates, 63 (52.5%) were male and 57 (47.5%) female, with a slight predominance of cases in the first ten days of life (45.8%). Hypothermia (56.6%) and refusal to feed (44.1%) were the most frequent clinical manifestations. Mean CRP fell progressively from 24.15±9.40 mg/L at admission to 16.30±8.60 mg/L at 24 hours and 10.39±9.30 mg/L at 48 hours (p<0.001 for all pairwise comparisons), corresponding to reductions of 32.3% at 24 hours and 56.6% at 48 hours. Mean serum ferritin declined from 421.88±88.18 ng/mL at baseline to 310.25±63.77 ng/mL at 24 hours and 293.13±94.92 ng/mL at 48 hours (p<0.001 for admission versus 24 h and 48 h; p<0.01 for 24 h versus 48 h). Overall, 100 neonates (83.3%) survived and 20 (16.6%) expired; the majority (53.3%) required a hospital stay of 6–8 days. Conclusion: CRP and serum ferritin decline significantly within 48 hours of appropriate antibiotic therapy in term neonates with sepsis, and serial measurement of these biomarkers, combined with clinical assessment, is a useful, inexpensive tool for monitoring therapeutic response and guiding antibiotic duration.

Background: Neonatal hyperbilirubinemia is one of the most common reasons for rehospitalization after early discharge, and severe unconjugated hyperbilirubinemia can lead to bilirubin-induced neurological injury. Because serum albumin binds unconjugated bilirubin and limits its diffusion into tissues, cord blood albumin measured at birth has been proposed as an early, non-invasive predictor of significant jaundice. Methods: In this prospective observational study, 220 healthy term appropriate-for-gestational-age neonates delivered at a tertiary care hospital were enrolled. Cord blood serum albumin (CSA) was measured by the bromocresol green method at birth, and total and direct serum bilirubin were estimated from venous samples at 72–96 hours of life. Neonates were followed for the development of significant hyperbilirubinemia requiring phototherapy or exchange transfusion. Chi-square tests, correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis were performed using SPSS version 25.0; p<0.05 was considered statistically significant. Results: The mean CSA was 3.04±0.35 g/dL, and the mean total serum bilirubin at 72–96 hours was 13.04±3.54 mg/dL. Phototherapy was required by 15% of neonates, and exchange transfusion by 1.36%. The phototherapy rate fell from 20.0% in the lowest albumin group (<2.8 g/dL) to 7.6% in the highest group (>3.3 g/dL) (chi-square 69.76, p<0.0001). Cord blood albumin was the only independent predictor of phototherapy requirement (OR 0.021, 95% CI 0.007–0.066, p<0.0001), with a model AUC-ROC of 0.789. At the <2.8 g/dL cut-off, specificity and positive predictive value were both 100%. Conclusion: Cord blood albumin is a simple, economical, and clinically useful early screening marker for identifying term neonates at risk of significant hyperbilirubinemia, and the <2.8 g/dL threshold is well suited for selecting high-risk infants for close monitoring.

Background: Cryptosporidium is one of the major causes of diarrhea in HIV-positive patients. These patients suffer from more severe and prolonged gastrointestinal disease that can be fatal; in addition, body systems other than the gastrointestinal tract may be affected. The widespread use of antiretroviral therapy does appear to be having a beneficial effect on recovery from cryptosporidiosis and on the frequency of infection in human immunodeficiency virus-positive patients. Methods: A comparative study consisting of 100 HIV patients with 50 non HIV patients, who were taken as control was done during the period of January 2021 to June 2022. The study was conducted to investigate the occurrence of Cryptosporidium in HIV patients as well as to evaluate the methods of detection of Cryptosporidium in stool samples and to identify the correlation with absolute lymphocyte counts of the patients. Results: Due to the emergence of Cryptosporidium infection as an opportunistic illness in HIV patients with low immunity state, we first assessed these patients’ immunological status using ALC and then CD4 counts. Outside of the hospital, in a private lab, CD4 counts were performed.12 cases of cryptosporidiosis were detected ALC< 1000 cells/µL, 4 cases with ALC 1001-1500 cells/µL, 1 case with ALC 1501- 2000 cells/µL was observed. Thus, in the present study patients with ALC< 1000 cells/µL were 6.24 times more likely to have cryptosporidium infection. Conclusion: Our analysis revealed a significant relationship between cryptosporidiosis and the risk of chronic diarrhea in people living with HIV. Our results suggested that cryptosporidium infection increases the risk of chronic diarrhea, and low CD4⁺ lymphocyte cell counts aggravate the degree of diarrhea.

Background: Enterococcus faecalis and Enterococcus faecium are important causes of healthcare-associated urinary tract infection and are increasingly encountered with acquired antimicrobial resistance. Vancomycin-resistant enterococci (VRE), particularly vancomycin-resistant E. faecium, pose challenges for antimicrobial treatment and infection prevention. However, contemporary data specifically describing species distribution and vancomycin resistance among urinary enterococcal isolates from Central India remain limited. Aim: To determine the frequency and species distribution of Enterococcus isolated from urine cultures over one year and to assess vancomycin resistance according to species, gender and patient location. Materials and Methods: A retrospective laboratory-based surveillance study was conducted in the Department of Clinical Microbiology of a tertiary care hospital in Indore, Madhya Pradesh, from 1 May 2024 to 30 April 2025. A total of 2829 urine cultures were processed during the study period. Enterococcal isolates were identified to species level using the VITEK 2 Compact system. Vancomycin susceptibility was assessed using automated antimicrobial susceptibility testing and resistant isolates were confirmed by vancomycin E-test. Results were interpreted according to Clinical and Laboratory Standards Institute criteria. Species-wise proportions were compared using the chi-square test. Results: Among 2829 urine cultures, 191 (6.8%; 95% CI, 5.9–7.7) yielded Enterococcus species. E. faecium accounted for 98 isolates (51.3%), while E. faecalis accounted for 93 (48.7%). Vancomycin resistance was detected in 49 of 191 enterococcal isolates (25.7%; 95% CI, 20.0–32.3). Resistance was more frequent among E. faecium (30/98; 30.6%; 95% CI, 22.4–40.3) than E. faecalis (19/93; 20.4%; 95% CI, 13.5–29.7), although the difference was not statistically significant (χ²=2.59, df=1; p=0.107). Female patients contributed 97 isolates (50.8%) and male patients 94 (49.2%). Thirty-seven isolates (19.4%) were obtained from intensive care units. Conclusion: A substantial proportion of urinary enterococcal isolates in this tertiary-care setting were vancomycin-resistant, with E. faecium accounting for slightly more isolates and demonstrating a higher, although statistically non-significant, resistance proportion than E. faecalis. These findings support continued species-level surveillance, prudent antimicrobial use and hospital-wide measures aimed at preventing transmission and unnecessary treatment of enterococcal bacteriuria.

Background: Hoffa fractures are uncommon intra-articular coronal fractures of the distal femoral condyle that require anatomical reduction and stable fixation to restore knee function and prevent complications. Objectives: This study evaluated functional and radiological outcomes following fixation with cannulated cancellous screws augmented by a buttress plate. Methods: A prospective case study was conducted among 30 adults with radiologically confirmed AO/OTA 33-B3 Hoffa fractures treated at Silchar Medical College and Hospital from November 2024 to October 2025. Patients underwent open reduction and internal fixation using cannulated cancellous screws with buttress plate augmentation. Outcomes included radiological union, Knee Society Score, knee range of motion, weight-bearing milestones, return to normal activity, and postoperative complications. Results: Mean age was 36.8±9.4 years, and 70.0% were male. Road traffic accidents accounted for 66.7% of injuries, while the lateral condyle was involved in 73.3%. Mean radiological union time was 13.8±2.1 weeks. Mean Knee Society Score improved from 58.4±6.2 at six weeks to 91.6±5.9 at twelve months (p<0.001). At final follow-up, 66.7% had excellent, 26.7% good, and 6.7% fair outcomes. Mean knee range of motion was 122.4±8.6°. Postoperative complications occurred in 16.7%, most commonly knee stiffness. No nonunion or implant failure occurred. Earlier weight bearing, younger age, and less complex Letenneur fracture patterns were significantly associated with better functional outcomes. Conclusion: Cannulated cancellous screw fixation augmented with a buttress plate achieved reliable union, progressive functional recovery, satisfactory knee motion, and a low major complication rate in Hoffa fractures and supported postoperative rehabilitation without documented fixation failure during follow-up period.

Background: Displaced intra-articular calcaneal fractures are challenging injuries in which restoration of calcaneal morphology and subtalar congruity is essential for functional recovery. The sinus tarsi approach provides limited lateral exposure while potentially reducing soft-tissue morbidity. Objectives: This study evaluated the functional, radiological and postoperative outcomes following minimally invasive sinus tarsi approach fixation of displaced intra-articular calcaneal fractures. Methods: A prospective hospital-based study was conducted between October 2024 and September 2025 involving 30 adults with closed, displaced intra-articular calcaneal fractures (Sanders II–IV) treated with open reduction and internal fixation through a sinus tarsi approach. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Radiological parameters included Böhler’s angle, Gissane’s angle, calcaneal height and width. Time to radiological union, full weight-bearing, return to work, subtalar range of motion and postoperative complications were also evaluated. Results: The mean age was 39.60 ± 10.57 years, with males comprising 83.3% of the cohort. Falls from height were the predominant mechanism (73.3%). Böhler’s angle improved significantly from 9.79 ± 3.27° preoperatively to 28.65 ± 2.26° postoperatively (p<0.001), while Gissane’s angle improved from 127.00 ± 4.19° to 121.20 ± 1.61° (p<0.001). Calcaneal height increased and width decreased following fixation. Mean radiological union occurred at 11.03 ± 1.97 weeks. The mean AOFAS score was 81.27 ± 14.89, with 80% of patients achieving good or excellent outcomes. Full weight-bearing was achieved at a mean of 9.63 ± 1.77 weeks and return to work at 3.54 ± 1.21 months. Wound-related complications occurred in 10% of patients, with no deep infection or reoperation. Conclusion: Minimally invasive sinus tarsi fixation was associated with satisfactory restoration of calcaneal morphology, favourable functional recovery and a limited frequency of wound complications in appropriately selected displaced intra-articular calcaneal fractures. Larger comparative studies with longer follow-up are warranted.

Background: Rapid and accurate haemoglobin measurement is important for timely identification of anaemia, particularly where laboratory facilities are limited. Portable point-of-care devices may offer a practical alternative to conventional laboratory testing. Aim and Objective: To evaluate the diagnostic accuracy and agreement of the HB SPOT digital haemoglobin meter against a reference automated haematology analyser. Materials and Methods: This prospective, cross-sectional diagnostic-accuracy study included 479 participants with complete paired haemoglobin measurements. Capillary haemoglobin was measured using the portable HB SPOT device, while the paired reference measurement was obtained using an automated haematology analyser. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and overall accuracy. Agreement was evaluated using Pearson correlation and Bland–Altman analysis. Results: The mean haemoglobin concentration was 12.49 ± 2.70 g/dL with HB SPOT and 12.45 ± 2.66 g/dL with the reference analyser. HB SPOT demonstrated a sensitivity of 96.00%, specificity of 96.42%, positive predictive value of 95.05%, negative predictive value of 97.11%, and overall accuracy of 96.24%. A strong correlation was observed between the two methods (r = 0.989; p < 0.001). The mean bias was +0.04 ± 0.40 g/dL, with 95% limits of agreement ranging from −0.75 to +0.84 g/dL. Conclusion: The HB SPOT device showed high diagnostic accuracy, minimal bias and close agreement with the reference analyser. Its rapid response, portability and low sample requirement support its potential use for point-of-care anaemia screening. Laboratory confirmation remains advisable for borderline or clinically inconsistent results.

Traditional methods for diagnosing tuberculosis (TB) have relied on sputum smear tests and solid culture. These methods often have low sensitivity, take a long time to provide results, and struggle to quickly identify drug resistance. However, in the past ten years, the way we detect Mycobacterium tuberculosis has changed significantly. New rapid tests, like cartridge-based nucleic acid amplification tests such as GeneXpert and Truenat, as well as line probe assays, can identify active infections and genetic resistance at the same time. Additionally, we can now use non-sputum methods, measure host-response blood signatures, detect urine lipoarabinomannan (LAM), and employ next-generation sequencing (NGS), which helps diagnose TB in patients outside the lungs and in children. The use of artificial intelligence (AI) and machine learning with digital chest X-rays and automated microscopy improves screening accuracy in areas with limited resources. Despite these significant technological advances, challenges remain in applying these innovations effectively in high-burden regions. This review evaluates the clinical efficacy, implementation hurdles, and future trajectory of modern TB diagnostic stewardship.

Background: Respiratory distress is one of the commonest emergencies in the neonatal period and a major cause of admission to neonatal intensive care units (NICU). This study evaluated the risk factors, clinical profile, etiological spectrum and outcome of respiratory distress in inborn neonates admitted to a tertiary care NICU. Methods: A hospital-based descriptive observational study was conducted in the NICU of a tertiary care teaching hospital in Udaipur, Rajasthan, over 18 months. Eighty-five consecutive inborn neonates with respiratory distress were enrolled. Severity was graded using the Silverman–Anderson score for preterm and the Downes score for term neonates. Perinatal risk factors, etiology, respiratory support, duration of stay and mortality were recorded. Associations were tested using the chi-square test, with p < 0.05 considered significant. Results: Preterm neonates constituted 63.5% of the cohort, and 63.0% weighed below 2.5 kg. Respiratory distress syndrome (RDS) was the commonest etiology (47.1%), occurring predominantly in preterm neonates (36/40), followed by transient tachypnoea of the newborn (31.8%), mostly in term neonates. Moderate distress was the commonest severity grade (43.5%). Caesarean delivery (90.7% vs 58.1%; p < 0.01), maternal hypertension and gestational diabetes were more frequent among preterm deliveries. Continuous positive airway pressure was the commonest support (60/85), and invasive ventilation was required almost exclusively by preterm neonates with RDS. RDS was associated with the longest respiratory support (7.65 ± 5.54 days) and hospital stay (17.30 ± 1.07 days). Overall mortality was 4.7%, confined to preterm neonates with RDS. Conclusion: Respiratory distress in this NICU cohort was driven mainly by prematurity and RDS, with low birth weight, caesarean delivery and maternal morbidity as important associated factors. Mortality was low and confined to preterm RDS, underscoring the value of antenatal optimisation, early non-invasive support and timely referral.

Background: Acute lower respiratory tract infection (ALRTI) is a leading cause of childhood morbidity and mortality in resource-limited settings, where rapid bedside risk stratification is often needed before radiography or laboratory results. This study evaluated the association of the Acute Illness Observation Scale (AIOS), a simple six-item observational tool, with chest radiographic findings, pulse oximetry and disease severity in children aged 2–59 months with ALRTI. Methods: A hospital-based descriptive observational study was conducted in the Department of Pediatrics of a tertiary care teaching hospital in Udaipur, Rajasthan, over 18 months. Eighty-three consecutively admitted children aged 2–59 months with WHO-defined ALRTI were enrolled. AIOS was scored at admission and categorised as mild (≤10), moderate (11–15) and severe (≥16). Chest radiography, pulse oximetry and WHO severity classification were recorded. Associations were tested using the chi-square test, one-way ANOVA and Pearson/Spearman correlation, with p < 0.05 considered significant. Results: The mean age was 26.61 ± 17.25 months, with a male preponderance (55.4%); 63.8% were malnourished. A severe AIOS score (≥16) was present in 71.1% of children. Abnormal chest radiographs occurred in 96.6% of children with AIOS ≥16 versus 22.2% with AIOS ≤10 (χ² = 41.82, p < 0.001). AIOS correlated strongly and inversely with oxygen saturation (r = −0.72, p < 0.001) and positively with WHO severity (r = 0.68, p < 0.001). An AIOS ≥16 showed 100% sensitivity and 42.9% specificity for severe pneumonia and was the strongest independent predictor of severe disease on multivariate analysis (adjusted OR 6.84; 95% CI 2.41–19.42). Conclusion: AIOS is a rapid bedside tool that reliably reflects radiological involvement, hypoxaemia and clinical severity in children with ALRTI, and may aid early identification of children at risk of severe disease in resource-limited settings.

Nature remains an indispensable reservoir for oncological drug discovery, inspiring nearly 60% of modern cancer therapeutics. While Ocimum sanctum (Tulsi) has been celebrated for centuries in Ayurvedic medicine for its extensive healing properties, its transition into targeted clinical oncology has been hindered by a reliance on crude extracts and non-mechanistic assays. Dysregulated BRAF kinase activity within the MAPK/ERK pathway frequently accelerates tumor progression and therapeutic resistance in breast cancer, making it a pivotal target for precision intervention.
In this study, seven breast-cancer-relevant bioactivities of O. sanctum phytoconstituents were profiled using PASS software. Structure-based in silico docking was subsequently performed using AutoDock Vina in YASARA to investigate the interaction between four major phytoconstituents—geraniol, -carotene, linalyl acetate, and geranyl acetate—and the catalytic ATP-binding pocket of the active BRAF-V600E kinase domain (PDB ID: 4MNF). Complementary meta-analytical evaluations were synthesized to contextualize preclinical and clinical efficacy metrics across established O. sanctum interventions. Among the screened metabolites, geranyl acetate emerged as the most potent lead candidate, demonstrating the highest negative binding affinity ( ), outperforming -carotene ( ), geraniol ( ), and linalyl acetate ( ). Spatial and interaction analyses revealed that geranyl acetate forms key hydrogen bonds and favourable hydrophobic contacts with critical catalytic residues in the 4MNF binding cleft. Furthermore, meta-analytical synthesis corroborated the therapeutic relevance of O. sanctum preparations, showing notable favourable odds ratios for biological endpoints such as apoptosis induction (OR: 2.33, 95% CI: 1.79–3.12). Computational profiling identifies geranyl acetate as a standout natural scaffold capable of stably engaging the oncogenic BRAF-V600E active site. These findings provide a rational molecular foundation to advance O. sanctum research beyond crude formulations, highlighting geranyl acetate as a primary candidate for downstream in vitro kinase assays, cell-line cytotoxicity validation, and preclinical pharmacokinetic evaluation in breast cancer treatment.

Background: Spinal anaesthesia is widely used for caesarean section because it provides rapid onset, reliable sensory and motor blockade, minimal fetal drug exposure and avoids airway manipulation associated with general anaesthesia. However, post-spinal anaesthesia shivering remains a common and distressing perioperative complication. Shivering may increase oxygen consumption, carbon dioxide production and metabolic demand, cause maternal discomfort and interfere with haemodynamic and physiological monitoring. Pregnancy itself is associated with increased oxygen consumption and reduced functional residual capacity, making prevention of excessive metabolic stress particularly important. Pharmacological agents including tramadol and dexamethasone have therefore been investigated for prevention of perioperative shivering. Aim: To compare the efficacy of intravenous tramadol and intravenous dexamethasone in preventing post-spinal anaesthesia shivering in patients undergoing caesarean section. Methods: This prospective, quasi-experimental comparative study was conducted in the Department of Anesthesiology of a tertiary care teaching hospital over 18 months. Ninety patients were assessed for eligibility, of whom 12 were excluded, resulting in 78 patients in the final analysis. Participants were divided equally into Group T (n=39), receiving intravenous tramadol 1 mg/kg, and Group D (n=39), receiving intravenous dexamethasone 0.15 mg/kg. Study medication was administered 15 minutes before spinal anaesthesia. Spinal anaesthesia was performed using 0.5% hyperbaric bupivacaine at the L3–L4 or L4–L5 interspace. Incidence, severity and onset of shivering, heart rate, blood pressure, oxygen saturation, adverse effects and neonatal Apgar scores were recorded. Data were analysed using GraphPad Prism version 5, with p<0.05 considered statistically significant. Results: Baseline demographic and clinical characteristics were comparable. Mean age was 27.6 ± 4.1 years in Group T and 28.1 ± 4.3 years in Group D (p=0.58). Mean body weight was 64.2 ± 7.5 kg and 63.4 ± 7.8 kg, respectively (p=0.64). Shivering occurred in 7 patients (17.9%) receiving tramadol compared with 13 patients (33.3%) receiving dexamethasone (p=0.11). Grade 0 shivering occurred in 82.1% and 66.7%, respectively. Mean onset time among patients who developed shivering was 28.4 ± 9.1 minutes in Group T and 22.1 ± 8.3 minutes in Group D (p=0.09). Haemodynamic parameters and oxygen saturation were comparable. Nausea occurred in 25.6% versus 10.3% (p=0.07), vomiting in 10.3% versus 2.6% (p=0.17), sedation in 12.8% versus 2.6% (p=0.09), and hypotension in 35.9% versus 38.5% (p=0.82), respectively. Neonatal Apgar scores were comparable. Conclusion: Intravenous tramadol demonstrated a numerical reduction in the incidence and severity of post-spinal shivering and delayed onset compared with dexamethasone, although these differences were not statistically significant. Dexamethasone demonstrated a numerically more favourable profile with respect to nausea, vomiting and sedation. Both agents showed comparable haemodynamic stability and immediate neonatal outcomes.

Background: Gestational weight gain (GWG) during pregnancy is influenced by pre-pregnancy body mass index (BMI) and may affect both maternal and neonatal outcomes. Inadequate as well as excessive weight gain has been associated with adverse pregnancy outcomes. This study was undertaken to assess the relationship between gestational weight gain based on initial BMI and maternal and neonatal outcomes. Materials and Methods: This observational study was conducted over 18 months from November 2022 to April 2024 in the Department of Obstetrics and Gynaecology, Government Victoria Hospital, Visakhapatnam. A total of 230 women aged 18–35 years with singleton, uncomplicated, spontaneously conceived pregnancies were included. Women with multiple gestation or medical disorders complicating pregnancy were excluded. Participants were categorized into insufficient, adequate, and excessive GWG groups according to Institute of Medicine recommendations. Maternal outcomes including gestational diabetes mellitus, gestational hypertension, oligohydramnios, PPROM, pre-eclampsia, preterm delivery, fetal growth restriction, SGA and mode of delivery were assessed. Neonatal outcomes included birth weight, APGAR score and NICU admission. Statistical analysis was performed using JMP-SAS software, with p<0.05 considered statistically significant. Results: Of the 230 women, 63 (27.4%) had insufficient, 83 (36.1%) had adequate and 84 (36.5%) had excessive GWG. Mean total weight gain was 8.26±1.61 kg, 11.98±2.26 kg and 15.57±2.70 kg in the insufficient, adequate and excessive groups, respectively (p<0.00001). Significant associations were observed between GWG and fetal growth restriction (p=0.024), oligohydramnios (p=0.0347), preterm delivery (p=0.0236), cephalopelvic disproportion (p=0.0347), and birth weight (p=0.015). Mean birth weight was 2.70±0.56 kg in the insufficient group, 2.96±0.57 kg in the adequate group and 2.95±0.60 kg in the excessive group. No significant association was observed between GWG and gestational diabetes mellitus, gestational hypertension, PPROM, pre-eclampsia, NICU admission or APGAR scores. Conclusion: Both insufficient and excessive gestational weight gain were associated with adverse maternal and neonatal outcomes. Appropriate pre-pregnancy BMI and adequate gestational weight gain may contribute to improved pregnancy and neonatal outcomes.

Introduction: Hyperphosphatemia is a key component of chronic kidney disease–mineral and bone disorder (CKD-MBD) and is associated with vascular calcification, cardiovascular morbidity, progression of chronic kidney disease (CKD) and increased mortality. Serum phosphorus is routinely measured in clinical practice but its concentration has physiological circadian variation. Although this phenomenon has been extensively described in healthy individuals, data on diurnal variation in CKD patients are lacking. This variation is important to understand because treatment decisions, like dietary counseling and phosphate binder therapy, are largely determined by serum phosphorus measurements. Methods: The prospective cross-sectional observational study was performed in the Department of Nephrology, Apollo Multispecialty Hospitals, and Kolkata, India from January 2024 to December 2024. One hundred consenting adults with CKD-ND (nondialysis CKD) were recruited. Serum phosphorus was measured twice on the same day, once after overnight fasting (6:00–8:00 AM) and once two hours after lunch. Clinical characteristics, estimated glomerular filtration rate (eGFR), intact parathyroid hormone (iPTH), dietary pattern, stage of CKD and use of phosphate binders were recorded. Paired comparisons were performed by Wilcoxon signed rank test, and correlations were evaluated by Spearman’s correlation coefficient. Results: Serum phosphorus showed a significant diurnal variation. Median fasting serum phosphorus was 4.65 mg/dL (IQR 4.33–5.80) vs 5.10 mg/dL (IQR 4.23–6.25) 2 hours after lunch (p < 0.0001). Serum phosphorus was strongly inversely correlated with eGFR in both fasting (ρ = −0.651) and postprandial (ρ = −0.746) measurements. As CKD stage increased, higher phosphorus concentrations and greater diurnal variation were observed, especially in stages 4 and 5. Vegetarian dietary patterns had relatively lower phosphorus levels compared to non-vegetarian diets. Phosphate binder use was reported in approximately one-third of patients, with marked utilization in advanced CKD. Conclusions: Serum phosphorus shows marked diurnal variation in non-dialysis CKD patients. With declining kidney function, the degree of variability increases and is influenced by dietary pattern. In some patients, the phosphorus burden may be underestimated if only fasting phosphorus measurements are relied upon. Accounting for sampling time may improve interpretation of phosphorus measurements and optimize management of CKD-MBD.

Giant gallstones—defined as calculi with a diameter exceeding 5 cm—represent an extraordinarily uncommon presentation of cholelithiasis. Because of their massive size, these stones introduce substantial diagnostic and surgical challenges, frequently obscuring anatomical landmarks within Calot’s triangle and elevating the likelihood of converting a laparoscopic procedure to an open cholecystectomy. Here, we present a series of three cases of giant gallstones which were successfully managed through surgical intervention.

Background: Accurate characterization of glenoid morphology is important for understanding shoulder biomechanics and for optimizing preoperative planning and implant selection in reconstructive shoulder surgery. However, population-specific three-dimensional data on glenoid morphology remain limited in Indian populations. Objectives: This study evaluated glenoid dimensions, version, inclination, and morphological patterns using three-dimensional computed tomography (3D CT). Methods: This observational study included 60 adults presenting with shoulder injuries or proximal humerus fractures at a tertiary-care centre between October 2024 and September 2025. Patients with glenoid or scapular fractures, glenohumeral arthritis, or other pathology affecting glenoid anatomy were excluded. Thin-slice CT scans with three-dimensional reconstruction were used to measure glenoid height, width, version, and inclination. Glenoid contour was additionally classified as pear-shaped, oval, teardrop, or round. Measurements were compared according to sex and age group using appropriate statistical tests. Results: The study included 36 males (60%) and 24 females (40%), with a mean age of 52.4 ± 15.8 years. The mean glenoid height was 34.8 ± 3.6 mm and width was 25.1 ± 2.9 mm. Mean glenoid version was −2.8 ± 4.5°, indicating mild retroversion, while mean inclination was 7.4 ± 3.2°, and indicating superior inclination. Males had significantly greater glenoid height than females (36.2 ± 3.1 vs 32.7 ± 2.8 mm; p < 0.001) and width (26.4 ± 2.4 vs 23.2 ± 2.1 mm; p < 0.001). No significant sex-based differences were observed for version or inclination. Participants aged >50 years demonstrated greater glenoid inclination than those aged ≤50 years (7.9 ± 3.3° vs 6.8 ± 3.0°; p = 0.04). Pear-shaped morphology was predominant (53.3%), followed by oval (28.3%), teardrop (11.7%), and round (6.7%) configurations. Conclusion: Three-dimensional CT demonstrated distinct glenoid morphometric characteristics in this Indian cohort, including a relatively tall glenoid, mild retroversion, superior inclination, and predominant pear-shaped morphology. Sexual dimorphism was evident primarily in glenoid size rather than orientation, while inclination varied significantly with age. These findings provide population-specific anatomical data that may be relevant to individualized preoperative planning, glenoid component sizing, and implant positioning in shoulder reconstruction.

Background: Thyroid nodules are frequently encountered in clinical practice and comprise a wide spectrum of benign and malignant lesions. Fine-needle aspiration cytology (FNAC) is an important minimally invasive investigation for the preoperative evaluation of thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides standardized terminology for thyroid FNAC and facilitates communication between cytopathologists and clinicians. The 2023 third edition incorporates refinements in diagnostic terminology and updated concepts regarding risk of malignancy, molecular testing and clinical management. Materials and Methods: A retrospective observational study was conducted in the Department of Pathology, NAMO Medical Education and Research Institute, Silvassa, from August 2025 to August 2026. A total of 120 patients with clinically or radiologically detected thyroid lesions who underwent FNAC were included. Cytological specimens were categorized according to the six categories of the 2023 Bethesda System. Histopathological correlation was assessed in cases that subsequently underwent thyroidectomy. Results: Of the 120 cases, 100 (83.3%) were females and 20 (16.7%) were males. The most commonly affected age group was 30–40 years, comprising 48 cases (40.0%). Bethesda category II (benign) was the predominant category, accounting for 93 cases (77.5%), followed by category III (atypia of undetermined significance) with 13 cases (10.8%). Papillary thyroid carcinoma was the most frequent malignant cytological diagnosis. Histopathological follow-up was available in 37 cases. Conclusion:  The 2023 Bethesda System provided a standardized framework for reporting thyroid FNAC in this institutional cohort. Benign lesions constituted the majority of cytological diagnoses, while papillary thyroid carcinoma was the predominant malignant diagnosis. The available cytohistological correlation demonstrated concordance in the surgically followed suspicious and malignant cases. However, the limited proportion of cases with histopathological follow-up restricts assessment of definitive diagnostic performance and category-specific risk of malignancy.

The present study was undertaken to evaluate the immunomodulatory effects of Tanacetum balsamita extract in cyclophosphamide-induced immunosuppressed mice. The extract was subjected to preliminary phytochemical screening and quantitative estimation of total phenolic content (TPC) and total flavonoid content (TFC). The extract showed the presence of various bioactive phytoconstituents, with TPC and TFC values of 68.78 ± 0.37 mg GAE/g and 42.68 ± 0.37 mg QE/g extract, respectively. Acute oral toxicity evaluation revealed that the extract was well tolerated without mortality or significant behavioral abnormalities. Immunosuppression was induced using cyclophosphamide, and the animals were treated with T. balsamita extract at doses of 100, 200 and 400 mg/kg body weight, while levamisole (2.5 mg/kg) was used as the standard drug. Cyclophosphamide markedly reduced body weight, total WBC count, RBC count, hemoglobin, lymphocyte percentage, spleen and thymus weights, serum IgG and IgM levels, and antioxidant enzymes. Treatment with T. balsamita extract produced a dose-dependent improvement in these parameters. At 400 mg/kg, the extract increased total WBC count to 8.12 ± 0.27 × 10³/µL, IgG to 834.60 ± 26.12 mg/dL, IgM to 97.80 ± 3.81 mg/dL, SOD to 7.32 ± 0.31 U/mg protein, CAT to 6.02 ± 0.27 U/mg protein, and GSH to 5.02 ± 0.23 µmol/g tissue, while reducing MDA to 2.72 ± 0.16 nmol/mg protein. Cytokine levels also improved following treatment. Histopathological examination demonstrated dose-dependent restoration of spleen and thymus architecture, with the 400 mg/kg dose showing near-normal tissue organization. Overall, the findings indicate that Tanacetum balsamita extract possesses significant immunomodulatory and antioxidant activity and may be a promising natural therapeutic agent for the management of cyclophosphamide-induced immunosuppression.

The present study was undertaken to evaluate the antidiabetic and protective activity of fermented combined extract of Aloe vera and Amla in streptozotocin (STZ)-induced diabetic Wistar albino rats. Aloe vera leaves and Amla fruits were collected, authenticated, processed, combined, and fermented before pharmacological evaluation. Preliminary phytochemical screening revealed the presence of important bioactive constituents including flavonoids, phenolic compounds, tannins, saponins, glycosides and terpenoids. The acute toxicity study indicated that the fermented combined extract was safe at the selected doses. Diabetes was induced by STZ, and the animals were divided into six groups: normal control, diabetic control, standard drug-treated, and fermented combined extract-treated groups receiving 100, 200 and 400 mg/kg body weight, respectively. The treatment was evaluated by measuring fasting blood glucose, body weight, lipid profile, liver function markers, kidney function markers, antioxidant parameters, and pancreatic histopathology. The diabetic control group showed marked hyperglycemia, body weight loss, dyslipidemia, alterations in liver and kidney function markers, decreased SOD, CAT and GSH levels, increased MDA, and considerable pancreatic tissue damage. Treatment with the fermented combined extract at 100, 200 and 400 mg/kg produced progressive improvement in these parameters. The 400 mg/kg dose showed the maximum improvement, with marked reduction in fasting blood glucose, total cholesterol, triglycerides, LDL and VLDL, together with improvement in HDL and body weight. The treatment also improved liver and kidney function and restored antioxidant status by increasing SOD, CAT and GSH while reducing MDA. Histopathological examination showed dose-dependent restoration of pancreatic architecture, with the 400 mg/kg group demonstrating marked preservation of islet structure and reduced degenerative changes. In conclusion, the fermented combined extract of Aloe vera and Amla demonstrated promising antidiabetic, antihyperlipidemic, antioxidant, hepatoprotective, nephroprotective and pancreatic protective activities in STZ-induced diabetic rats. The 400 mg/kg dose produced the most pronounced protective effect among the tested extract doses. Further studies are required to establish its molecular mechanisms, long-term safety, and clinical applicability.

The present study was undertaken to evaluate the hepatoprotective activity of Ocimum tenuiflorum seed extract against paracetamol-induced hepatotoxicity in Wistar albino rats. The seed extract was subjected to preliminary phytochemical screening and acute oral toxicity testing according to OECD guidelines. Rats were divided into six groups, including normal control, paracetamol control, Silymarin standard, and O. tenuiflorum extract-treated groups at 100, 200, and 400 mg/kg. Hepatoprotective activity was assessed by measuring serum AST, ALT, ALP, total bilirubin, total protein, and albumin, along with hepatic SOD, CAT, GSH, and MDA levels. Histopathological examination of liver tissue was also performed. Paracetamol produced significant hepatic injury and oxidative stress, whereas treatment with the seed extract significantly improved biochemical and antioxidant parameters in a dose-dependent manner. The 400 mg/kg dose showed the maximum protective effect and produced marked improvement in liver histology. The study concludes that O. tenuiflorum seed extract possesses significant hepatoprotective activity, possibly through antioxidant and free-radical scavenging mechanisms.

Background: Hyperlipidemia is a major metabolic disorder associated with increased serum lipids, oxidative stress, hepatic dysfunction, and an increased risk of cardiovascular complications. The present study was designed to evaluate the antihyperlipidemic, antioxidant, and hepatoprotective effects of Flagellaria indica leaf extract in high-fat diet-induced hyperlipidemic Wistar rats. Methods: Leaves of Flagellaria indica were collected, authenticated, shade dried, powdered, and extracted with ethanol. Preliminary phytochemical screening was performed to identify the major phytoconstituents. Hyperlipidemia was induced in Wistar rats using a high-fat diet. nimals were divided into normal control, hyperlipidemic control, standard atorvastatin-treated, and F. indica extract-treated groups. The extract was administered orally at doses of 100, 200, and 400mg/kg body weight, while atorvastatin 10 mg/kg was used as the standard drug. Body weight, serum lipid profile, liver function parameters, antioxidant markers, and hepatic histopathology were evaluated. Results: Phytochemical screening revealed the presence of several important secondary metabolites, including flavonoids, phenolics, tannins, saponins, alkaloids, glycosides, steroids, and terpenoids. High-fat diet administration produced marked dyslipidemia, characterized by increased total cholesterol, triglycerides, LDL and VLDL with decreased HDL levels. Treatment with F. indica extract produced a dose-related improvement in the lipid profile. The extract also improved altered liver function parameters, including AST, ALT, ALP, total bilirubin, total protein, and albumin. Antioxidant evaluation demonstrated improvement in SOD, CAT, and GSH levels compared with the hyperlipidemic control group. Histopathological examination further showed progressive restoration of hepatic architecture and reduction of fatty and degenerative changes, particularly at the higher extract dose. Conclusion: The present findings indicate that ethanolic leaf extract of Flagellaria indica possesses promising antihyperlipidemic, antioxidant, and hepatoprotective activities against high-fat diet-induced metabolic alterations in Wistar rats. The observed effects may be associated with the combined action of its bioactive phytoconstituents. Further studies are warranted to isolate the active constituents and elucidate their precise molecular mechanisms.

Background: Gentamicin is an effective aminoglycoside antibiotic, but its clinical use is frequently associated with renal tubular injury and oxidative stress. The present study was undertaken to investigate the nephroprotective potential of Soymida febrifuga seed extract against gentamicin-induced nephrotoxicity in Wistar rats. Materials and Methods: The seeds of Soymida febrifuga were collected, authenticated, dried, powdered, and extracted using a suitable hydroalcoholic extraction procedure. Preliminary phytochemical screening was performed to identify major classes of phytoconstituents. Acute oral toxicity was evaluated according to OECD Guideline 423. Thirty-six Wistar albino rats were divided into six groups of six animals each. Gentamicin was administered at 80 mg/kg, i.p. to induce nephrotoxicity. The extract was administered orally at doses of 100, 200, and 400 mg/kg, while Silymarin was used as the standard drug. Renal function was evaluated by estimating serum creatinine, blood urea nitrogen (BUN), and uric acid. Oxidative stress was assessed by determining superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) levels in kidney tissue. Histopathological examination of kidney tissues was also performed. Results: Gentamicin administration produced marked renal injury, as evidenced by increased serum creatinine, BUN, and uric acid levels, accompanied by a reduction in SOD, CAT, and GSH levels. Histopathological examination revealed tubular degeneration, epithelial necrosis, glomerular congestion, and inflammatory changes in the gentamicin-treated group. Treatment with Soymida febrifuga seed extract produced a dose-dependent improvement in renal biochemical parameters and antioxidant status. The 400 mg/kg dose showed the greatest protective effect, with substantial restoration of antioxidant enzyme levels and improvement in renal tissue architecture. The protective response was comparable to that observed with the standard treatment. Conclusion: The findings suggest that Soymida febrifuga seed extract possesses significant nephroprotective and antioxidant activity against gentamicin-induced renal injury in Wistar rats. The protective effect may be associated with the presence of biologically active phytoconstituents such as flavonoids, phenolics, tannins, saponins, alkaloids, and terpenoids. Further studies are required to identify the active constituents and elucidate the precise molecular mechanisms responsible for the nephroprotective activity.

The present study was undertaken to evaluate the hepatoprotective and antioxidant activity of the plant extract against carbon tetrachloride (CCl₄)-induced hepatotoxicity in experimental animals. Preliminary phytochemical screening of the plant extract revealed the presence of alkaloids, flavonoids, tannins, phenolic compounds, saponins, glycosides, carbohydrates, and terpenoids. The total phenolic content and total flavonoid content of the plant extract were found to be 72.5mg GAE/g and 45.3mg QE/g extract, respectively. Acute toxicity evaluation showed no mortality or significant toxic manifestations at the tested dose. CCl₄ administration produced marked hepatic injury, evidenced by increased AST, ALT, ALP, and total bilirubin and decreased total protein and albumin levels. The CCl₄ Control Group also showed marked depletion of hepatic SOD, CAT, and GSH levels. Treatment with the plant extract improved these biochemical and antioxidant alterations in a dose-dependent manner. The high-dose plant extract showed greater protection, with AST, ALT, ALP, and total bilirubin reduced to 68.5U/L, 63.2 U/L, 129.4U/L, and 1.21mg/dL, respectively, while total protein and albumin increased to 6.34 and 3.76 g/dL. SOD, CAT, and GSH levels were restored to 6.93U/mg protein, 44.9µmol H₂O₂ decomposed/min/mg protein, and 5.92µg/mg protein, respectively. Histopathological examination further confirmed reduced hepatic necrosis, fatty degeneration, and inflammatory changes in animals treated with the plant extract. Overall, the findings indicate that the plant extract possesses promising hepatoprotective and antioxidant activity against CCl₄-induced hepatic injury, which may be associated with its phenolic, flavonoid, and other bioactive constituents.

Background: Postoperative nausea and vomiting (PONV) is common after laparoscopic cholecystectomy, particularly in women. Serotonin 5-hydroxytryptamine-3 receptor antagonists are commonly used for prophylaxis. This study compared the efficacy of intravenous ramosetron and ondansetron for prevention of PONV in women undergoing laparoscopic cholecystectomy under general anaesthesia. Methods: This prospective, randomised, double-blind comparative study included 100 women undergoing laparoscopic cholecystectomy at Maharishi Markandeshwar Medical College & Hospital, Kumarhatti-Solan, India. Participants were allocated equally to Group O, which received ondansetron 8 mg intravenously, or Group R, which received ramosetron 0.3 mg intravenously, 5 minutes before induction of anaesthesia. PONV was assessed using the Bellville score at 0, 2, 6, 12, 18 and 24 hours postoperatively. Severity of nausea was assessed using an 11-point scale. Requirement for intravenous metoclopramide 10 mg as rescue antiemetic was recorded. Results: Mean age was 38.74 ± 10.92 years in Group O and 40.02 ± 8.56 years in Group R (p=0.516), while mean body mass index was 26.04 ± 2.01 and 26.28 ± 2.12 kg/m², respectively (p=0.570). At 0 hours, 28/50 (56%) patients in Group O and 46/50 (92%) in Group R had a Bellville score of 0 (p=0.001). At 2 hours, corresponding proportions were 94% and 100% (p=0.079), and at 6 hours they were 96% and 100% (p=0.360). No PONV was recorded in either group at 12, 18 or 24 hours. Nausea-severity scores differed significantly between groups at 0 hours (p<0.001) but not at 2 or 6 hours. Rescue metoclopramide was required by 24/50 (48%) patients receiving ondansetron and 4/50 (8%) receiving ramosetron (p<0.001). No significant adverse effects were reported with either drug. Conclusion: Ramosetron 0.3 mg provided better control of immediate postoperative PONV than ondansetron 8 mg and markedly reduced the requirement for rescue antiemetic therapy. Differences in PONV were not statistically significant at 2 and 6 hours, and no events were recorded in either group from 12 to 24 hours.

Background: Diabetic Nephropathy is a major microvascular complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage renal disease (ESRD). Standard markers such as urinary albumin excretion and estimated glomerular filtration rate (eGFR) are widely used, but they may not fully capture early or atypical renal impairment. Serum uric acid (SUA), traditionally linked to gout, has recently been implicated in renal injury and may serve as an adjunct biomarker. Objective: To compare serum uric acid levels in patients with type 2 diabetic nephropathy and those with T2DM without renal dysfunction, and to examine the relationship between SUA and proteinuria severity. Materials and Methods: A retrospective cross-sectional study was conducted in 100 adult T2DM patients. Group 1 included 50 patients with diabetic nephropathy, and Group 2 included 50 diabetic patients without renal dysfunction. Laboratory parameters assessed were SUA, fasting blood glucose, HbA1c, serum creatinine, eGFR, and quantitative proteinuria. Results: SUA levels were significantly higher in Group 1 compared with Group 2 (p < 0.001). A positive correlation was observed between SUA concentration and proteinuria severity (r = 0.47, p < 0.001). Conclusion: Elevated serum uric acid is associated with diabetic nephropathy and increases stepwise with proteinuria severity. SUA may serve as a practical adjunct biomarker alongside eGFR and albuminuria in the evaluation of renal involvement in T2DM.

Background: Chronic Kidney Disease (CKD) represents a major global health burden often complicated by multiple co-morbidities requiring complex pharmacological management. Polypharmacy and altered pharmacokinetics predispose CKD patients to drug accumulation, adverse reactions, and drug interactions. This study aimed to assess the medication prescribing pattern, adherence to the World Health Organization (WHO) essential medicines list, and the prevalence of co-morbidities among CKD patients attending the nephrology outpatient department of a tertiary care hospital. Methods: A descriptive observational study was conducted over an 18-month period at the Nephrology OPD of Government T D Medical College, Alappuzha. A total of 195 CKD patients aged 18–75 years who met the eligibility criteria were evaluated. Data on demographics, CKD staging (Cockcroft-Gault formula), co-morbidities, and prescribed drugs were gathered and analyzed using SPSS version 16. Drugs were classified according to the WHO Anatomical Therapeutic Chemical (ATC) system. Results: Among 195 patients, 67.2% (n=131) were male and 32.8% (n=64) were female, with a mean age of 58.59±11.35 years. Most patients presented in Stage 5 (39.5%) and Stage 4 (33.3%) CKD. A total of 1,337 drugs were prescribed across 195 prescriptions, with a mean of 6.86±2.10 drugs per prescription (range: 2–14), highlighting prevalent polypharmacy. Only 42.7% (n=571) of prescribed drugs were from the WHO Model List of Essential Medicines. Based on ATC classification, cardiovascular system drugs were the most frequently prescribed (38.7%), followed by alimentary tract and metabolism agents (22.5%), and drugs acting on blood and blood-forming organs (21.9%). The oral route accounted for 91.3% of drug administrations. The most common co-morbidities were hypertension (87.7%), dyslipidemia (48.2%), and diabetes mellitus (46.2%). Conclusion: Polypharmacy is common among CKD patients, particularly those in advanced stages with multiple co-morbidities. Cardiovascular agents constitute the predominant drug class prescribed. Rational drug selection, dose adjustments based on renal function, and adherence to essential medicine guidelines are imperative to minimize adverse drug events and improve patient outcomes.

Objectives: To evaluate the clinico-social profile of children diagnosed with Autism Spectrum Disorder (ASD) and to study the occurrence of co-morbid conditions. Methods: This descriptive cross-sectional study included 60 children (1–18 years) with ASD attending OPD services and Special schools between June 2023 and October 2024. Diagnosis was based on DSM-5 criteria. Data were collected on socio-demographic variables, clinical features, comorbidities, and screen-time exposure using a semi-structured questionnaire. Statistical analysis was performed using SPSS v20. Results: Majority of children were <5 years (61.7%), male (78.3%), and from upper-middle socioeconomic class (58.3%). Language delay was the most common complaint (71.7%), with 91.7% having delayed language developmental milestone. Comorbidities included ADHD (43.3%), sleep disturbances (50%), and GI issues (16.7%). Notably, 33.3% of children had screen exposure of 2–3 hours/day. Conclusions: Early identification and awareness are essential for timely intervention in ASD. Sociodemographic factors and comorbid conditions play a significant role in presentation, early symptom recognition and management. Excessive screen time may influence symptom severity and development.

Background: Primary external auditory canal cholesteatoma (EACC) is uncommon and is regularly labelled as otitis externa or keratosis obturans, so diagnosis is often delayed. Case Series. We describe a series of Five adults (three women; age 30–70 years) with primary EACC are described. Four had He stage II disease confined to the canal with an intact tympanic membrane (one bilateral). One had stage III disease with middle-ear soft tissue and scutum erosion. All five had attended several practitioners for presumed external otitis or wax. Two ears were treated by canalplasty and meatoplasty (one combined with modified radical mastoidectomy and type III tympanoplasty). Three stage II ears were cleared by scheduled microscopic debridement and topical ointment. At 3–6 months the operated stage II canal had healed and conservatively treated ears were dry, without clinical progression. Conclusion. Persistent otalgia after treatment of otitis externa warrants microscopy after toilet and HRCT. Selected stage II pockets with an intact drum can be controlled by disciplined outpatient cleaning; canalplasty or mastoidectomy is required when follow-up is unreliable or disease has left the canal.

Background: For the prognosis to improve, early evaluation of the severity and prognosis of multiple trauma injuries is essential. Thus, it is necessary to define the characteristics associated with mortality and the severity of multiple trauma injuries. The purpose of the current study is to look at these patients’ prognosis and serum lactate level. Methods: 150 patients with multiple trauma caused by motor vehicles who were admitted to the Murli Bhedi Jha Community Health and Trauma Center in Araria Sangram, Jhanjharpur, Madhubani, Bihar between August 2023 and July 2024 were the subjects of this cross-sectional study. At the time of admission, 24 hours later, and 72 hours later, the serum lactate level was assessed. The patients’ outcomes were assessed as either discharge, hospitalization, or death. Results: Overall, 150 motor vehicle-induced trauma patients were enrolled in the study. Hyperlactatemia was seen in 33 (22%) patients in 24 h and 78 (52%) patients in 72 h after admission (P < 0.001). There was a clinically significant correlation between lactate level at the time of admission and the outcome of the patients (5.22 ± 3.41 expired, 2.69 ± 1.67 hospitalized, and 1.83 ± 1.09 discharged, P < 0.00). There was a clinically significant correlation between the serum lactate level at 24 h after admission and the outcome of the patients (6.81 ± 3.51 expired, 1.35 ± 0.79 hospitalized, and 0.83 ± 0.23 discharged, P < 0.001). There was also a clinically significant correlation between the outcome of the patients (discharge or hospitalization, or death) and the serum lactate level at the time of the admission and 24 h after the admission (P = 0.035). Conclusion: When evaluating numerous trauma patients, the baseline lactate, the lactate level 24 hours after arrival, and the difference between these two can be used as a predictive indicator. It is advised to compare the serum lactate level at the trauma center 24 hours after admission.

Background: The body needs zinc as a trace element. Both critical illness (CI) and chronic liver disease (CLD) are associated with hypozincaemia. When these situations coexist, the zinc status is unclear. In this study, we evaluated the plasma zinc levels of critically ill patients with and without chronic liver disease and examined any potential correlations between zinc levels and mortality. Methods: This prospective study comprised 69 patients with chronic liver disease and 73 patients without chronic liver disease (Control) who were hospitalized to the intensive care unit (ICU) of GMCH, Bettiha, West Champaran, Bihar between March 2026 and July 2026. Acute Physiology and Chronic Health Evaluation III (APACHE-III), Sequential Organ Failure Assessment (SOFA), and CLD [Model For End Stage Liver Disease (MELD)] severity scores were recorded together with demographics. Plasma zinc and urine zinc levels (in patients with normal renal function) were measured, along with hematologic, renal, and liver function tests. Results from the ICU, hospital, and six months after discharge were noted. Results: All study participants had hypozincaemia (normal range: 9.02–11.32 μmol/L). Notably, compared to critically ill patients without chronic liver disease [Control], those with chronic liver disease showed significantly lower plasma zinc levels (5.3±2.2 vs. 8.1±2.9 μmol/L, P=0.0001). Both groups had significant zinc losses in their urine. Increased mortality in the ICU (21.7% vs. 8.2%, P=0.062), in-hospital (37.7% vs. 16.4%, P=0.004), and six months after discharge (53.6% vs. 17.8%, P=0.0001) were all associated to hypozincaemia. Conclusion: When compared to the critically ill control group, patients with chronic liver disease had considerably lower plasma zinc levels. Regardless of the presence of chronic liver illness, hypozincaemia was associated to higher ICU, hospital, and 6-month mortality rates. It is necessary to conduct a large trial to track zinc levels and the effectiveness of zinc supplementation on outcomes in patients with critically ill chronic liver disease.

Background: Substance dependence affects not only the individual but also the family unit, and relatives of patients with heroin dependence are known to carry a disproportionately high burden of care. Region-specific data on caregiver burden from Bihar, a state with a recognized and growing burden of heroin use, have been lacking despite the scale of the problem in districts such as Muzaffarpur. Objectives: To assess the level of caregiver burden among primary caregivers of patients with heroin dependence and to determine its association with socio-demographic and clinical variables. Methods: This hospital-based, cross-sectional, observational study was conducted among 100 patient–caregiver dyads attending the de-addiction services of a tertiary care centre in Muzaffarpur, Bihar. Caregiver burden was assessed using the 22-item Zarit Burden Interview (ZBI). Socio-demographic and clinical data were collected using a semi-structured proforma. Descriptive statistics, chi-square test, unpaired t-test, and Pearson’s correlation were used for analysis. Results: The mean ZBI score was 55.9 ± 14.6, and 85% of caregivers experienced moderate-to-severe or severe burden. Caregivers of unemployed patients had significantly higher mean burden scores than those of employed patients (61.0 ± 13.1 vs 49.7 ± 14.0, p<0.001). Rural residence and intravenous route of drug use were also significantly associated with higher burden (p=0.010 and p=0.011, respectively). Burden correlated positively with the number of relapses (r=0.24, p=0.017) and number of substances used (r=0.25, p=0.011), but not with duration of dependence, comorbidities, family income, or family type. Conclusion: Caregivers of patients with heroin dependence in this region experience a substantial burden of care, particularly when the patient is unemployed, resides in a rural area, uses drugs intravenously, or has a history of frequent relapse. These findings support the integration of family-focused counselling into routine de-addiction services.

Background: Telemedicine and remote patient monitoring (RPM) can extend clinical contact beyond conventional visits, potentially improving access, physiologic control and early detection of deterioration. Effects on hospitalization and other hard outcomes, however, have varied across trials. Objectives: To evaluate the effect of telemedicine and RPM on healthcare access, clinical outcomes, hospitalization, mortality, physiologic control and patient experience across chronic disease populations. Methods: A PRISMA-structured search framework covering PubMed, Scopus, Embase and Cochrane was used. Randomized and prospective comparative studies of clinician-linked telemedicine/RPM were eligible. RoB 2 was used for randomized trials and Newcastle-Ottawa/ROBINS-I principles for non-randomized evidence. A random-effects meta-analysis pooled binary readmission/hospitalization data from three clinically comparable randomized trials. Results: The direction of benefit depended strongly on intervention intensity and the presence of an actionable clinical response pathway. The exploratory pooled risk of readmission/hospitalization across Tele-HF, BEAT-HF and a COPD telemonitoring trial was RR 1.03 (95% CI 0.96–1.11; I²=0%), indicating no clear reduction in this subset. In contrast, TIM-HF2 reduced days lost to cardiovascular hospitalization or death and reduced all-cause mortality, while broader meta-analyses report modest improvements in blood pressure, HbA1c and selected utilization endpoints. Access gains were tempered by digital exclusion and variable uptake. Conclusion: Telemedicine and RPM are not a uniform intervention. Programs that combine reliable measurement, rapid clinical interpretation, medication/treatment action and patient engagement appear more effective than passive data transmission. Equity, interoperability, burden and sustainable reimbursement should be treated as core components of effectiveness.

Background: Metabolic bone disease (MBD) of prematurity is an important cause of morbidity among very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. While its pathophysiology and risk factors are well characterised in Western cohorts and some Indian centres, regional data from Southern Rajasthan remain sparse. Objectives: To study the clinical and demographic profile and risk factors of preterm neonates with MBD, and to compare these characteristics with preterm neonates without MBD, at a tertiary care centre in North India. Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU) of Geetanjali Medical College and Hospital, Udaipur, Rajasthan, over 18 months (May 2024 – November 2025). Ninety-seven preterm neonates with gestational age <34 weeks and birth weight <1500 g were enrolled and followed prospectively until discharge or 40 weeks corrected gestational age. MBD was diagnosed at 28 days of life when serum alkaline phosphatase (ALP) exceeded 500 IU/L with serum phosphorus below 4.5 mg/dL. Data were analysed using IBM SPSS Statistics version 20.0. Continuous variables were compared using Student’s t-test and categorical variables using the chi-square test (or Fisher’s exact test where appropriate), with a two-tailed p-value <0.05 considered statistically significant. Results: MBD was identified in 18 of 97 neonates (18.6%). Affected neonates had significantly lower mean gestational age (28.22 ± 0.81 vs 30.13 ± 2.01 weeks, p<0.001), lower birth weight (898.6 ± 68.0 vs 1153.6 ± 239.9 g, p<0.001), and longer duration of parenteral nutrition (12.67 ± 3.33 vs 8.65 ± 4.05 days, p<0.001) than unaffected neonates. Maternal risk factors and most acute neonatal morbidities were not significantly associated with MBD, although respiratory distress syndrome (55.6% vs 29.1%) and bronchopulmonary dysplasia (22.2% vs 7.6%) were more frequent among affected infants. All 18 affected neonates demonstrated complete biochemical resolution by 40 weeks corrected age. Conclusions: MBD affected nearly one in five very preterm/very low birth weight neonates in this cohort. Low gestational age, low birth weight, and prolonged parenteral nutrition were the principal determinants, and a low serum phosphorus with raised alkaline phosphatase provided a reliable biochemical marker for early identification.

Background: Diagnostic attention to acute respiratory infection (ARI) in adults has been dominated by SARS-CoV-2 testing since 2020, with less attention to other respiratory viruses circulating in SARS-CoV-2-negative patients. Aims: To determine the prevalence and distribution of non-SARS-CoV-2 respiratory viruses detected by multiplex real-time PCR on combined nasopharyngeal-oropharyngeal swabs in SARS-CoV-2-negative adults hospitalized with ARI. Settings and Design: Cross-sectional observational study at a tertiary care teaching hospital in New Delhi, India, June–November 2022. Materials and Methods: 500 adult inpatients with ARI who tested negative for SARS-CoV-2 by RT-PCR had a combined nasopharyngeal-oropharyngeal swab, pooled into a single viral transport medium tube, tested for 18 other respiratory viruses by multiplex real-time RT-PCR (Seegene Allplex Respiratory Panels 1–3). Statistical Analysis Used: Data were analyzed in SPSS; categorical variables were summarized as frequencies and percentages, with 95% confidence intervals where relevant. Results: At least one other respiratory virus was detected in 258/500 (51.6%). Rhinovirus was most frequent (11.8%), followed by coronavirus OC43 (11.4%) and adenovirus (10.0%); influenza A (5.0%), RSV A/B (5.4%), coronavirus 229E (4.0%), coronavirus NL63 (3.0%), and parainfluenza 1–4 (2.2%) were also found. Co-infections: RSV-A with OC43 (2.0%) and rhinovirus with OC43 (1.0%). Coronavirus HKU1, RSV-B, enterovirus, and parainfluenza 1 and 3 were not detected. Conclusions: Over half of SARS-CoV-2-negative adults with ARI had another identifiable respiratory virus, arguing against presumptive antibacterial therapy for a negative SARS-CoV-2 result without further testing.

Background: Tubercular lymphadenitis is an important form of extrapulmonary tuberculosis and is a common cause of peripheral lymphadenopathy. Fine needle aspiration cytology (FNAC) is a simple and minimally invasive diagnostic method; however, cytological diagnosis and Ziehl-Neelsen staining may have limitations, particularly in paucibacillary and cytologically equivocal cases. Molecular techniques such as real-time polymerase chain reaction (PCR) may provide additional diagnostic information. Objectives: To evaluate the diagnostic performance of FNAC in tubercular lymphadenitis in comparison with real-time PCR, and to determine the incidence, age and sex distribution of tubercular lymphadenitis among patients presenting with lymphadenopathy. Methods: This cross-sectional study was conducted in the Department of Pathology, Gauhati Medical College and Hospital, Guwahati, from August 2014 to July 2015. A total of 217 patients with lymphadenopathy were evaluated by FNAC. Smears were examined following May-Grünwald Giemsa and Ziehl-Neelsen staining. Real-time PCR for detection of Mycobacterium tuberculosis DNA was performed on 102 specimens, comprising 87 cases diagnosed as tubercular lymphadenitis by FNAC and 15 cases showing necrotic material only. The diagnostic performance of FNAC was assessed using real-time PCR as the reference test. Results: Tubercular lymphadenitis was diagnosed by FNAC in 87 of 217 cases (40.1%). The most commonly affected age group was 21–30 years, and there was a slight female predominance (51.7%). Cervical lymph nodes were the predominant site of involvement (94.3%). Granuloma with caseation necrosis was observed in 78.5% of cases. Ziehl-Neelsen staining demonstrated acid-fast bacilli in 58.6% of FNAC-diagnosed cases. Overall, real-time PCR was positive in 97 of 102 specimens (95.1%). PCR was positive in 86 of 87 FNAC-diagnosed cases (98.9%) and in 11 of 15 cases reported as necrosis only (73.3%). Using PCR as the reference test, FNAC demonstrated a sensitivity of 88.7%, specificity of 80.0%, positive predictive value of 98.9%, negative predictive value of 26.7% and overall diagnostic accuracy of 88.2%. The discordance between FNAC and PCR was predominantly due to FNAC-negative/PCR-positive cases and was statistically significant on McNemar’s exact test (P=0.006). Conclusion: FNAC remains a useful and effective method for the initial diagnosis of tubercular lymphadenitis. However, its diagnostic limitations are particularly evident in cytologically equivocal and paucibacillary cases. Real-time PCR provided additional diagnostic yield, including detection of Mycobacterium tuberculosis DNA in a substantial proportion of cases reported as necrosis only. Molecular testing may therefore serve as a valuable adjunct to FNAC in the diagnosis of tubercular lymphadenitis.

Background: Primary headache disorders are among the most common neurological conditions in children and adolescents, with substantial effects on academic performance, quality of life, and psychosocial well-being. Data from India on the clinical spectrum, disability burden, and lifestyle correlates of pediatric primary headache remain limited, particularly among children attending tertiary care centers. Objective: To evaluate the clinical profile, headache-related disability, and associated lifestyle and psychosocial factors among children with primary headache attending a tertiary care center in North India. Methods: This hospital-based cross-sectional observational study was conducted in the Department of Pediatrics, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, over 18 months. Seventy-one consecutive children aged 5–18 years diagnosed with primary headache according to International Classification of Headache Disorders, Third Edition (ICHD-3) criteria were enrolled. Demographic characteristics, headache profile, associated symptoms, lifestyle factors, PedMIDAS disability scores, and psychological stressors were recorded using a structured proforma. Statistical analysis was performed using IBM SPSS Statistics version 26.0; associations were assessed using the Chi-square or Fisher’s exact test, with a two-tailed p<0.05 considered statistically significant. Results: The mean age of participants was 11.8 ± 3.2 years, and 56.3% were female. Migraine was the most common primary headache subtype (50.7%), followed by tension-type headache (38.0%). Nausea (49.3%), photophobia (42.3%), and vomiting (33.8%) were the most frequent associated symptoms. Moderate-to-severe headache-related disability was observed in 47.9% of participants. Greater disability was significantly associated with prolonged screen time (χ² = 8.87, p = 0.032) and sleep duration <7 hours/day (p<0.001), while headache subtype showed no significant association (p = 0.072). Neuroimaging was performed in 12.7% of children, with abnormal findings in only 1.4%. Conclusion: Migraine was the predominant primary headache disorder among children attending a tertiary care center and was associated with substantial headache-related disability. Inadequate sleep and prolonged screen exposure were significant modifiable factors. Early diagnosis using ICHD-3 criteria, routine PedMIDAS assessment, lifestyle counseling, and selective neuroimaging may improve pediatric primary headache management.

Background: Childhood meningitis spans a spectrum from self-limiting viral illness to rapidly fatal pyogenic infection, and early aetiological differentiation is essential for rational antimicrobial use. Serum C-reactive protein (CRP) is a rapid, inexpensive acute-phase marker, but comparative data across pyogenic, partially treated pyogenic, viral, and tubercular meningitis in Indian children remain limited. Objectives: To compare serum CRP levels among children with pyogenic meningitis (PM), partially treated pyogenic meningitis (PPM), viral meningitis (VM), and tubercular meningitis (TBM), and to characterise the associated clinical, epidemiological, and aetiological profile. Methods: This hospital-based cross-sectional observational study was conducted in the Department of Pediatrics, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, over 18 months. Eighty-five consecutive children aged 1 month–18 years admitted with clinically suspected meningitis were enrolled and classified into four categories using integrated clinical, cerebrospinal fluid (CSF), and microbiological criteria. Demographic, clinical, haematological, CSF, microbiological, and radiological data were recorded on a structured proforma. Serum CRP was estimated by immunoturbidimetric latex agglutination. Continuous variables were compared using analysis of variance and categorical variables using the chi-square or Fisher exact test; Spearman correlation and receiver-operating-characteristic (ROC) analysis were used as appropriate. A two-tailed p<0.05 was considered significant. Results: Of 85 children (mean age 1.94±1.56 years; 65.9% male), VM was the commonest category (30.6%), followed by PM (29.4%), PPM (24.7%), and TBM (15.3%). Serum CRP differed significantly across groups (p<0.001), highest in PM (98.76±23.53 mg/L) and lowest in VM (13.39±7.73 mg/L), with PPM (51.04±28.52 mg/L) and TBM (42.37±19.12 mg/L) intermediate. CRP exceeded 50 mg/L in 96.0% of PM cases and in no VM case. ROC analysis for differentiating bacterial (PM+PPM) from non-bacterial (VM+TBM) meningitis showed an area under the curve of 0.902, with an optimal cut-off of >41.6 mg/L yielding 84.8% sensitivity and 87.2% specificity. Serum CRP correlated most strongly with CSF neutrophil percentage (ρ=0.71, p<0.001) and blood neutrophil percentage (ρ=0.67, p<0.001). Age differed significantly across categories (p<0.001), whereas gender, socioeconomic status, and vaccination status did not. Conclusions: Serum CRP is a rapid, inexpensive, and diagnostically useful adjunct that discriminates bacterial from viral childhood meningitis with good accuracy. Considerable overlap in partially treated pyogenic and tubercular disease, however, indicates that CRP is most informative when interpreted alongside CSF cytology, biochemistry, microbiology, and neuroimaging rather than used in isolation.

Introduction: Nasal cavity, paranasal sinuses and nasopharynx are the sites of origin of some of the complex, histologically diverse group of lesions mostly presenting as polypoidal growths with limited clinical manifestations which causes problem in their diagnosis, prognosis and management. Aims and Objectives: (1). To study histopathological patterns of various neoplastic and non-neoplastic lesions of nasal cavity, nasal sinus and nasopharynx. (2). To study incidence with age, sex and site distribution of lesions of nasal cavity, paranasal sinus and nasopharynx. Materials and Methods: This is a prospective study of all the histopathological specimens of lesions of nasal cavity, nasopharynx and paranasal sinuses received in the department of pathology, BIMS Belagavi  for a period of 2 years. The specimens were received in 10% formalin and underwent routine histopathological examination. Special stains, immunohistochemistry and fungal culture were done wherever required. Results: In the present study, a total of 204 cases were analysed. Age distribution ranged from 6 to 81 years with male preponderance. Commonest site being nasal cavity (59%), paranasal sinuses (37%) followed by nasopharynx (4%).  Non neoplastic lesions were 182 (89%) and 22 (11%) lesions were neoplastic. Of the non-neoplastic lesions, commonest were inflammatory polyps 45 (25%) followed by 35 cases of allergic polyps (19%). Of the twenty two neoplastic lesions, 11 (50%) cases were of benign and malignant category each. All the cases were carefully re-examined and categorized into Neoplastic and Non-neoplastic lesions on the vast hisopathological spectrum of nasal, paranasal and nasopharyngeal lesions. Non-neoplastic lesions were classified according to the classification given by Friedman and Osborn. Tumors of nasal cavity and paranasal sinuses were classified according to WHO classification. Association between site of lesion and type of lesion was found to be significant (P value < 0.05). Conclusion: There is a wide spectrum of lesions in nasal cavity, paranasal sinuses and nasopharynx with non-neoplastic lesions surpassing neoplastic lesions with great number. Inflammatory and allergic polyps are commonest non neoplastic lesions in this part of the country with tropical savannah climate. Categorizing the lesions into non-neoplastic and neoplastic category based on clinico-radiological, histopathological features and immunohistochemistry helps in diagnosis and patient management. Histopathology still remains the mainstay of definitive diagnosis. Immunohistochemistry has revolutionized the knowledge of surgical pathology by providing tumor subtyping.

Background: Postoperative sore throat (POST) is a common complication after general anaesthesia with endotracheal intubation, with a reported incidence of up to 62%, causing significant patient discomfort. Ketamine and magnesium sulfate, both N-methyl-D-aspartate (NMDA) receptor antagonists with anti-inflammatory and anti-nociceptive properties, have been used as preinduction nebulization to reduce POST, but comparative evidence on their relative efficacy is limited. Objective: To compare the efficacy of preinduction nebulization with ketamine and magnesium sulfate in reducing the incidence and severity of postoperative sore throat in patients undergoing elective general surgery under general anaesthesia with endotracheal intubation. Methods: This prospective, randomized, double-blinded study was conducted over one year at a tertiary care teaching hospital in 100 adult patients (18-50 years, ASA physical status I and II) undergoing elective general surgical procedures. Patients were randomized into two equal groups: Group A received nebulization with ketamine 50 mg and Group B received nebulization with magnesium sulfate 500 mg, both diluted to 5 mL and administered 15 minutes before induction. POST was assessed on a validated 4-point scale (0-3) at immediate post-extubation, and at 1, 6, 12 and 24 hours postoperatively. Hemodynamic parameters were recorded at standard intervals. Data were analyzed using SPSS version 28.0, with the unpaired t-test, Mann-Whitney U test and Chi-square test applied as appropriate; p<0.05 was considered significant. Results: The two groups were comparable for age, weight, gender, ASA-PS grade and duration of anaesthesia (p>0.05 for all). The overall incidence of POST was significantly lower in Group A (26%) than Group B (52%, p=0.0005). Incidence and severity of POST were significantly lower in Group A at immediate post-extubation, 1 hour, 6 hours and 24 hours (p<0.05), although the difference at 12 hours was not statistically significant (p=0.1739). Hemodynamic parameters remained comparable between groups at all time points. Conclusion: Preinduction nebulization with ketamine is more effective than magnesium sulfate in reducing the incidence and severity of postoperative sore throat following endotracheal intubation, without adversely affecting hemodynamic stability.

Background: Glucagon-like peptide-1 receptor agonists are established therapy for obesity and type 2 diabetes mellitus, but the agents with the strongest evidence are injectable, and injection burden, cold-chain dependence and cost limit their reach. Two oral alternatives now carry phase 3 evidence: high-dose oral semaglutide, a peptide requiring a strict fasting and water-volume routine, and orforglipron, a small molecule with no such restriction. Whether the oral route itself costs efficacy has not been quantified. Methods: A systematic review was conducted of randomised phase 3 trials of an orally administered glucagon-like peptide-1 receptor agonist reporting change in body weight or glycated haemoglobin, together with the injectable trial needed to anchor a route comparison. 38 records were screened and 8 trials enrolling 18,540 participants were included. Estimated treatment differences against placebo were pooled by random effects with restricted maximum likelihood and the Hartung-Knapp correction. The primary analysis was a placebo-anchored indirect comparison of each oral agent against subcutaneous semaglutide 2.4 mg weekly. Reporting followed PRISMA 2020. Results: In adults with overweight or obesity without diabetes, oral semaglutide 50 mg reduced body weight by -12.70 (95% CI -14.15 to -11.25) percentage points against placebo and oral semaglutide 25 mg by -11.40 (95% CI -13.85 to -8.95), against -12.40 (95% CI -13.35 to -11.45) for subcutaneous semaglutide 2.4 mg. The indirect comparisons showed no difference attributable to route: -0.30 (95% CI -2.03 to 1.43) percentage points for the 50 mg tablet and 1.00 (95% CI -1.63 to 3.63) for the 25 mg tablet. The oral small molecule orforglipron 36 mg was inferior to the injectable peptide by 3.30 (95% CI 1.87 to 4.73) percentage points (p < 0.001). The single within-trial comparison, PIONEER 4, found oral semaglutide 14 mg non-inferior to subcutaneous liraglutide 1.8 mg for glycated haemoglobin and superior for weight by -1.2 kg (-1.9 to -0.6 kg). Oral semaglutide reduced major adverse cardiovascular events in high-risk type 2 diabetes, hazard ratio 0.86 (0.77 to 0.96). Conclusion: Route of administration does not by itself reduce the efficacy of a glucagon-like peptide-1 receptor agonist. At an adequate dose the oral peptide matches the injectable peptide, while the oral small molecule does not, so the limit is molecular class and dose, not the tablet. Because the oral peptide’s absorption depends on a fasting routine many patients cannot reliably follow, the choice between routes should turn on whether that routine is achievable for the individual patient.

Background: Neck swellings are common surgical presentations with a broad spectrum of developmental, inflammatory, infective and neoplastic conditions. A structured clinicopathological approach is required because similar clinical presentations may represent very different underlying pathologies. Objectives: To describe the demographic and clinical spectrum of neck swellings, classify the lesions according to clinical and pathological findings, and assess the diagnostic performance of fine-needle aspiration cytology (FNAC) against histopathology for distinguishing malignant from non-malignant lesions. Methods: A prospective cross-sectional observational study was undertaken in the Department of General Surgery, Government Teaching General Hospital, Vizianagaram. The study protocol planned a minimum sample of 200 patients. A total of 200 patients were included in the analysis. Demographic and clinical variables, FNAC findings, and histopathological findings were summarized using frequencies, percentages, mean and standard deviation. For the definitive diagnostic comparison, only records with binary malignant/non-malignant classifications on both FNAC and histopathology were included. Results: Among 200 patients, 142 (71.0%) were female and 58 (29.0%) were male. Mean age was 40.96 ± 17.63 years (range 2–80 years). Cervical lymphadenitis was the most frequent clinical diagnosis (54; 27.0%), followed by solitary thyroid nodule (46; 23.0%) and multinodular goitre (31; 15.5%). FNAC classified 180 (90.0%) as non-malignant and 18 (9.0%) as malignant, with one suspicious and one indeterminate result. Histopathology classified 172 (86.0%) as non-malignant, 23 (11.5%) as malignant, two as indeterminate and three as not done. In 193 definitive binary FNAC–HPE comparisons, TP=16, TN=172, FP=0, and FN=5; sensitivity was 76.2%, specificity 100.0%, PPV 100.0%, NPV 97.2%, and overall accuracy 97.4%. Conclusion: The study demonstrates a wide clinicopathological spectrum of neck swellings with predominance of non-malignant lesions. FNAC showed high specificity and overall accuracy in the definitive comparison subset, while false-negative malignant cases reinforce the importance of clinicopathological correlation and histopathological confirmation in selected lesions.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are central to the pharmacological management of acute and chronic musculoskeletal pain, and diclofenac sustained-release (SR) formulations are widely prescribed in routine practice. Real-world data on how practising physicians perceive the efficacy, safety and clinical utility of diclofenac SR remain limited. Objective: To assess physicians’ perceptions regarding the clinical utility, efficacy, safety, tolerability and prescribing preferences of diclofenac SR in the management of acute and chronic pain. Methods: A cross-sectional, questionnaire-based, anonymous survey was administered to 92 practising physicians across India. The 14-item, multiple-choice instrument captured perceptions of indication, comparative efficacy, mechanism-related beliefs, tolerability and prescribing frequency. Responses were summarised descriptively; no patient-level data were collected and no intervention was performed. Results: Most respondents (89.1%) identified joint and back pain with an inflammatory component as the principal indication for diclofenac SR. Effectiveness in chronic musculoskeletal pain was rated excellent or very good by 94.6% of physicians, and 98.9% considered diclofenac SR comparable to or better than other NSAIDs for sustained pain control. Agreement that sustained-release technology improves gastrointestinal tolerability was reported by 98.9% of respondents, whereas agreement that diclofenac is safe in renal impairment was more modest (67.4%). Most physicians (83.7%) prescribed diclofenac SR frequently or very frequently. Conclusion: Surveyed physicians expressed broadly favourable perceptions of diclofenac SR for musculoskeletal pain, particularly regarding sustained analgesia and treatment adherence. These perceptions should nonetheless be interpreted alongside independent pharmacoepidemiological evidence on cardiovascular and renal safety, and the survey’s methodological limitations warrant caution before generalising these findings to prescribing guidance.

Background: Adolescence is a critical period of rapid physical growth and increased nutritional requirements. Adolescent girls are particularly vulnerable to anemia because of increased iron requirements, menstrual blood loss, inadequate dietary intake and poor adherence to iron-folic acid supplementation. In Bihar, anemia among adolescent girls continues to represent an important public health concern. Objective: To assess the nutritional status and determine the prevalence and severity of anemia among adolescent girls attending the outpatient department of a tertiary care hospital in northern Bihar. Methods: A hospital-based cross-sectional study was conducted among 500 adolescent girls aged 10–19 years attending the outpatient department of a tertiary care hospital in northern Bihar from September 2022 to February 2023. Sociodemographic information, dietary history, menstrual characteristics and iron-folic acid supplementation were recorded. Anthropometric measurements including height and weight were obtained, and body mass index (BMI) was calculated. Hemoglobin concentration was measured using a standardized method. Anemia was classified according to WHO criteria. Data were analysed using SPSS version 26.0. Categorical variables were expressed as frequency and percentage, and associations were assessed using the chi-square test or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Results: Among 500 adolescent girls, 276 (55.2%) were anemic. Mild, moderate and severe anemia were observed in 161 (32.2%), 101 (20.2%) and 14 (2.8%), respectively. Underweight was present in 126 (25.2%), normal nutritional status in 299 (59.8%), overweight in 53 (10.6%) and obesity in 22 (4.4%). Anemia was significantly associated with older age, underweight status, inadequate dietary iron intake, heavy menstrual bleeding and poor adherence to iron-folic acid supplementation (p<0.05). Conclusion: Anemia and nutritional abnormalities were common among adolescent girls attending the tertiary-care hospital. The findings emphasize the importance of routine nutritional assessment, hemoglobin screening, dietary counselling and strengthening of iron-folic acid supplementation among adolescent girls.

Background: Dengue fever is an important mosquito-borne viral disease in India, particularly in densely populated urban settlements where inadequate water storage, poor drainage, accumulation of solid waste and limited environmental sanitation can facilitate Aedes breeding. Household knowledge and preventive practices are important components of dengue control, but a persistent gap may exist between awareness and actual preventive behaviour. Objective: To assess the risk factors associated with dengue fever and evaluate preventive practices among residents of urban slums of Darbhanga, Bihar. Methods: A community-based cross-sectional study was conducted among 500 residents of selected urban slum areas of Dharbhanga from June 2021 to December 2021. Participants were selected using a multistage sampling technique. Information regarding socio-demographic characteristics, household environmental conditions, dengue-related knowledge and preventive practices was collected using a pretested structured questionnaire. Household-level risk factors included water storage, uncovered containers, stagnant water, drainage conditions, solid-waste accumulation, mosquito breeding sites and use of mosquito-control measures. Data were analysed using SPSS version 26.0. Categorical variables were expressed as frequency and percentage, and associations were assessed using the chi-square test or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Results: Among 500 participants, 184 (36.8%) reported a previous history of dengue or dengue-like febrile illness. Uncovered water-storage containers, stagnant water around the house, inadequate drainage, irregular garbage disposal and absence of routine breeding-site inspection were significantly associated with previous dengue illness (p<0.05). Regular removal of stagnant water was reported by 61.0%, covering of water containers by 64.4%, and regular use of mosquito repellents by 58.8% of participants. Good preventive practice was significantly associated with higher educational attainment and better dengue knowledge (p<0.001). Conclusion: Environmental conditions and household behaviours were important factors associated with dengue risk in the surveyed urban slum population. Although awareness was relatively high, preventive practices were inconsistent. Community-based health education, source reduction, improved drainage and regular household vector surveillance should be strengthened in urban slum areas of Darbhanga.

Background: Alcohol dependence is frequently associated with significant psychiatric co morbidity and impaired quality of life. Understanding the interplay between these factors is essential for treatment planning and long term recovery. Aim: To find out the relationship between Quality of life and Psychiatric co-morbidity in Alcohol dependent subjects. Materials and Methods: The study was conducted on 100 Alcohol dependent subjects admitted in tertiary care hospital for de addiction treatment. Psychiatric co-morbidity was assessed using M.I.N.I while Quality of Life was assessed using RAND -36 questionnaire. Results: Using M.I.N.I the psychiatric co morbidity was observed in more than 50% of alcohol dependent subjects. The most common psychiatric condition was psychotic disorders (40%) followed by generalized anxiety disorders (18%). Alcohol dependent subjects with psychiatric disorders had low scores on all the dimensions of Quality of life when compared to Alcohol dependent subjects without psychiatric disorders. The differences in mean scores has attained statistical significance for the items related to physical functioning, role limitation due to emotional health, energy, social functioning and general health. Conclusion: Psychiatric comorbidity is highly prevalent among alcohol dependent individuals and is significantly associated with poor Quality of life. Integrated treatment approaches addressed both, Psychiatric symptoms and substance use and these are crucial for improving overall functioning and wellbeing in this population.

Background: Acute myocardial infarction (AMI), including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), remains a major cause of global morbidity and mortality. Early identification of patients at higher risk of adverse outcomes is essential for optimizing clinical management and improving prognosis. This study aimed to evaluate the prognostic utility of plasma neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for predicting short-term outcomes in patients with acute myocardial infarction undergoing percutaneous coronary intervention (PCI). Materials and Methods: This prospective cohort study was conducted among patients admitted to the Department of General Medicine and Cardiology Unit, AIMSR General Hospital, Apollo Health City, Jubilee Hills, Hyderabad. Patients aged ≥18 years who presented with clinical features suggestive of acute myocardial infarction, ST-T changes in two contiguous electrocardiographic leads or newly developed left bundle branch block, elevated cardiac troponin I levels, and undergoing PCI were included after obtaining informed consent. Patients with a history of previous coronary artery bypass grafting, acute or chronic kidney disease, cerebrovascular disease, sepsis, or malignancy were excluded. Plasma NGAL levels were assessed before and after PCI, and their association with short-term clinical outcomes was evaluated. Results: A total of 100 patients with a mean age of 57.79 ± 7.49 years were included in the study. Of these, 82% were males and 18% were females, indicating male a predominance. Receiver operating characteristic (ROC) curve analysis demonstrated that troponin I levels, pre-PCI NGAL, post-PCI NGAL, and change in NGAL levels (ΔNGAL) were significant predictors of in-hospital outcomes and left ventricular ejection fraction (LVEF) assessed at the 1-month and 3-months follow-up after PCI (p<0.05). Conclusion: Plasma NGAL demonstrated promising prognostic potential as an independent biomarker for predicting short-term outcomes in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Measurement of NGAL may aid in early risk stratification and clinical decision-making in this patient population.

Background: Trauma is one of the world’s most serious medical issues. Complications and mortality from elderly trauma are common. This study sought to investigate the relationship between Base Deficit and morbidity and death in older trauma patients. Methods: This cross-sectional study was conducted at MurliBhedi Jha Community Health and Trauma Center, Araria Sangram, Jhanjharpur, Madhubani, Bihar from March 2025 to February 2026. Our inclusion criteria included being older than 65, not having a history of kidney disease or diabetes mellitus, abstaining from alcohol and aspirin, and not having a history of illnesses that induce severe dehydration or volume loss. Based on the Abbreviated Injury Scale, the Injury Severity Score calculates the degree of trauma. The Venous Blood Gas test was used to retrieve the patient’s BD findings. Data were analyzed in SPSS Statistics software (Version. 23) using the Chi-square test, Kruskal-Wallis test, and Mann-Whitney (P<0.05) was considered significant. Results: 154 patients (mean age: 80.65±7.28; male/female ratio: 1.02) were included in this study. The BD mean was 7.58±0.63 mmol/L. The BD groups’ levels of consciousness differed statistically (P-value=0.001). The BD level was significantly correlated with the mean injury severity score (P<0.001). Additionally, the length of stay in the intensive care unit increased considerably with rising BD levels (P-value=0.001). Conclusion: The degree of traumatic injury in the elderly can be predicted by BD. BD can be a trustworthy predictor of outcomes in elderly trauma patients when combined with other accessible variables like serum lactate.

Background: One of the leading causes of morbidity, mortality, and medical expenses worldwide is chronic obstructive pulmonary disease. Whether or not they have a history of Cor pulmonale, they have a higher cardiac burden during acute exacerbations. Cardiovascular disease is more common in COPD patients, and exacerbations put more strain on the heart. The prognostic and predictive usefulness of very sensitive troponin T observed during COPD exacerbations has been explored. Aim of this study is to assessment the clinical significance of highly sensitive troponin T (Hs cTnT) as a predictive and prognostic factor in patients with acute exacerbations of COPD. Methods: From March 2026 to July 2026, 79 patients with acute COPD exacerbations enrolled in this observational cross-sectional study. This study excluded patients who had myocardial infarction, cardiac arrest, significant renal impairment, or chronic hemodynamic instability prior to admission. Included Patient detail medical history, vital signs, ABGs and ECG were recorded. Serum cardiac enzymes CK, CK-MB and highly sensitive cardiac troponin T (hs cTnT) were measured. Results: The study included 79 patients who had an acute COPD exacerbation. When comparing the four reported categories (moderate, severe, very severe and life threatening) of COPD exacerbation severity, the mortality rate was 2.53%, and the Hs cTnT level revealed a statistically significant difference. When compared to moderate and severe forms, only the life-threatening variant had a significantly higher hscTnT level. Conclusion: According to the study, patients with exacerbations of COPD had considerably higher levels of extremely sensitive cardiac Troponin T. Troponin T could help in the evaluation and prognosis of patients experiencing exacerbations of COPD.

Background:-Sacrococcygeal pilonidal sinus is a chronic condition which is usually noted in males. Young adults with specific professions are the main victims of this ailment. Aim of this study is to evaluate the Limberg flap and ‘excision with secondary wound healing in the surgical outcome of sacrococcygeal pilonidal sinus patients. Methods: From August 2024 to July 2026, patients with sacrococcygeal pilonidal sinus who were admitted to the Upgraded Department of General Surgery at Darbhanga Medical College and Hospital in Laheriasarai, Bihar, participated in this prospective observational study. Surgical intervention for a chosen patient using one of two methods. Patients were divided into two groups based on the type of surgery performed: group A- Limberg flap (study group) and group B- excision with secondary wound healing (control group). Results: The mean length of surgery was substantially longer in cases managed with the Limberg flap approach than in those managed with excision and secondary healing. At all follow-ups, Limberg flap cases had significantly reduced mean pain scores, wound infection, wound healing time, hospital stay, and time to return to normal activity compared to excision (p<0.05) Patient satisfaction was significantly higher after the Limberg flap group (p<0.05). Conclusion: In terms of reduced post-operative pain, fewer complications, early recovery, early wound healing, shorter hospital stays, early return to normal activity, and increased patient satisfaction, rhomboid excision using Limberg’s flap technique is superior to open excision with secondary healing technique. The Limberg flap technique’s only drawback is a longer mean surgical time, which is explained by the extra time needed to raise and suture the flap after excision.

Background: Accurate preoperative characterization of adnexal masses is essential for appropriate patient triage and management. Several ultrasound-based systems, including the International Ovarian Tumor Analysis Simple Rules (IOTA SR), Assessment of Different NEoplasias in the adneXa (ADNEX), Gynecologic Imaging Reporting and Data System (GI-RADS), and Ovarian-Adnexal Reporting and Data System (O-RADS), have been developed for malignancy risk stratification. Objective: To evaluate and compare the diagnostic performance of IOTA SR, ADNEX, GI-RADS, and O-RADS in differentiating benign from malignant/borderline adnexal masses. Methods: This analytical cross-sectional study included 193 adnexal masses evaluated by standardized ultrasonography and classified using IOTA SR, ADNEX, GI-RADS, and O-RADS. Histopathological diagnosis served as the reference standard. Sensitivity, specificity, predictive values, accuracy, likelihood ratios, area under the receiver operating characteristic curve (AUC), and agreement with histopathology were assessed. Results: Of 193 masses, 140 (72.5%) were benign and 53 (27.5%) were malignant/borderline. Malignant/borderline lesions occurred in older patients and were associated with higher CA-125 levels, larger lesion size, solid components, ascites, irregular morphology, and stronger Doppler vascularity (all p<0.001). O-RADS demonstrated the highest sensitivity (96.2%) and negative predictive value (98.4%), with specificity of 90.7% and AUC of 0.970. GI-RADS showed sensitivity of 92.5%, specificity of 92.9%, accuracy of 92.7%, and AUC of 0.953. ADNEX demonstrated sensitivity of 94.3%, specificity of 88.6%, and AUC of 0.944. Among conclusive IOTA SR assessments, sensitivity, specificity, and accuracy were 93.6%, 96.8%, and 96.0%, respectively. Conclusion: All four ultrasound-based systems demonstrated excellent diagnostic performance. O-RADS provided the highest sensitivity, whereas conclusive IOTA SR showed the highest specificity and accuracy, supporting the use of standardized ultrasound risk-stratification systems for preoperative evaluation of adnexal masses.

Background: Cardiovascular–kidney–metabolic (CKM) syndrome represents an interconnected spectrum of metabolic, renal, and cardiovascular abnormalities. Detection of subclinical cardiovascular involvement may enable identification of high-risk individuals before the development of overt cardiovascular disease. Objectives: To determine the prevalence of subclinical cardiovascular disease among adults with CKM syndrome using cardiac biomarkers and echocardiographic parameters and to identify associated clinical, metabolic, renal, and cardiovascular predictors. Methods: This single-centre, hospital-based, analytical cross-sectional study included 300 adults with CKM syndrome evaluated in the Departments of Cardiology, General Medicine, and Radiodiagnosis of a tertiary teaching healthcare facility in South India. Participants underwent clinical assessment, anthropometry, metabolic and renal profiling, hs-cTnT and NT-proBNP estimation, electrocardiography, and comprehensive transthoracic echocardiography. Multivariable logistic regression was used to determine independent predictors of subclinical cardiovascular disease. Results: Subclinical cardiovascular disease was identified in 117 participants (39.0%). Cardiac biomarker elevation was present in 30.0%, while 19.3% demonstrated echocardiographic abnormalities. Left ventricular hypertrophy and diastolic dysfunction were present in 13.0% and 7.7%, respectively. Participants with subclinical disease were older (59.4 ± 9.0 vs 48.9 ± 9.4 years), had higher prevalence of hypertension (80.3% vs 60.7%), diabetes (76.1% vs 49.2%), and CKD (52.1% vs 13.7%), and had higher hs-cTnT and NT-proBNP concentrations (all p<0.001). On multivariable analysis, age per 10-year increase (adjusted OR 3.43, 95% CI 2.36–4.97), diabetes duration ≥10 years (OR 6.01, 95% CI 1.65–21.91), and CKD (OR 5.01, 95% CI 2.46–10.20) independently predicted subclinical cardiovascular disease. Conclusion: Subclinical cardiovascular disease was common among adults with CKM syndrome. Older age, prolonged diabetes duration, and CKD were independent predictors, supporting integrated biomarker and echocardiographic assessment in high-risk CKM populations.

Background: Myocardial injury after non-cardiac surgery (MINS) is an important perioperative cardiovascular complication and is frequently clinically silent. Intraoperative hypotension has been implicated as a potentially modifiable contributor to perioperative myocardial injury. Objectives: To evaluate the association between intraoperative hypotension burden and postoperative MINS, to assess the relationship between the severity and duration of hypotension and myocardial injury, and to determine the discriminatory ability of intraoperative haemodynamic indices for predicting MINS. Methods: This prospective observational cohort study included 300 adults undergoing major non-cardiac surgery at a tertiary care teaching hospital. Intraoperative hypotension was primarily defined as mean arterial pressure (MAP) <65 mmHg. Cumulative duration below this threshold, lowest MAP, and time-weighted average (TWA) MAP deficit were recorded. High-sensitivity cardiac troponin T was measured preoperatively and at approximately 24 and 48 hours postoperatively. Results: MINS occurred in 59/300 participants (19.7%). Patients with MINS were older (64.5±9.2 vs 59.1±10.8 years; p<0.001) and more frequently had coronary artery disease and higher perioperative cardiovascular risk. Any MAP <65 mmHg occurred in 72.9% of patients with MINS compared with 43.2% without MINS (p<0.001). Median cumulative hypotension duration was 15.7 versus 0.0 minutes (p<0.001), and MINS incidence increased from 10.5% with no hypotension to 47.9% with ≥20 minutes of MAP <65 mmHg. Each 0.5-mmHg increase in TWA MAP deficit independently predicted MINS (adjusted OR 2.94; 95% CI 1.81–4.79), while each additional 10 minutes below MAP 65 mmHg increased the odds by 63% (adjusted OR 1.63; 95% CI 1.32–2.01). TWA MAP deficit showed an AUC of 0.721. Conclusion: Greater intraoperative hypotension burden was independently associated with MINS, with a clear exposure–response relationship between hypotension duration and myocardial injury.

Introduction: Functional recovery after geriatric hip fracture is influenced by physiological reserve, frailty, and muscle strength. Although frailty has been increasingly evaluated in Indian patients, evidence regarding the incremental prognostic value of admission handgrip strength for short-term functional recovery remains limited. Objective: To evaluate whether handgrip strength and frailty independently predict 90-day mobility following hip fracture surgery. Methods: This prospective observational cohort included 140 patients aged ≥60 years undergoing surgery for low-energy femoral neck or intertrochanteric fractures. Admission handgrip strength was measured using a dynamometer and classified according to Asian Working Group for Sarcopenia criteria. Frailty was assessed using the Clinical Frailty Scale (CFS). The primary outcome was 90-day Parker Mobility Score (PMS). Secondary outcomes included Barthel Index, mobility recovery, postoperative complications, length of stay, readmission, and mortality. Hierarchical multivariable linear regression assessed independent predictors of 90-day PMS. Results: Low handgrip strength was present in 77 (55.0%) patients and frailty in 47 (33.6%). Among 134 survivors, patients with low handgrip strength had lower 90-day PMS (6.1±1.3 vs 7.1±1.6; p<0.001), lower Barthel Index (79.2±10.9 vs 85.4±14.1; p=0.006), and less frequent recovery of ≥80% of pre-fracture mobility (55.6% vs 80.6%; p=0.002). In adjusted analysis, higher handgrip strength independently predicted better PMS (β=0.319 per 5 kg; p=0.008), while increasing frailty predicted poorer recovery (β=-0.192; p=0.032). Conclusion: Admission handgrip strength and frailty provide complementary prognostic information for 90-day functional recovery after geriatric hip fracture surgery. Bedside grip-strength assessment may be a practical addition to routine orthopaedic risk stratification, although external validation is required.

Background: Gallbladder wall thickening is a nonspecific imaging finding that may represent benign inflammatory or hyperplastic conditions as well as gallbladder carcinoma. Differentiating these entities on imaging is challenging because of substantial overlap in their appearances. Objective: To evaluate the diagnostic performance of ultrasonography (USG) and contrast-enhanced computed tomography (CECT) in differentiating benign from malignant gallbladder wall thickening using histopathology as the reference standard. Methods: This prospective cross-sectional diagnostic accuracy study included 50 consecutive adults with gallbladder wall thickening who underwent USG, CECT and subsequent surgical histopathological evaluation at a tertiary-care teaching hospital. Imaging features were compared between benign and malignant lesions. Sensitivity, specificity, predictive values and diagnostic accuracy were calculated, and receiver-operating-characteristic analysis was performed for maximum wall thickness. Results: Histopathology demonstrated 30 (60.0%) benign and 20 (40.0%) malignant lesions. Malignancy was significantly associated with greater wall thickness, focal/asymmetric thickening, loss of mural stratification, mucosal disruption, heterogeneous enhancement, loss of the gallbladder-liver interface, hepatic invasion, biliary dilatation and regional lymphadenopathy. Intramural cystic spaces and nodules favored benign disease. USG showed 80.0% sensitivity, 80.0% specificity and 80.0% accuracy, while CECT achieved 85.0%, 83.3% and 84.0%, respectively. Combined USG+CECT achieved 90.0% sensitivity, 86.7% specificity and 88.0% accuracy. A wall-thickness threshold of ≥6.7 mm yielded an AUC of 0.943. Conclusion: Combined USG and CECT evaluation improves differentiation of benign and malignant gallbladder wall thickening. Morphology, mural integrity and enhancement patterns should be interpreted collectively, with histopathology remaining the definitive diagnostic standard.

Background: Routine complete blood count records can describe the burden of low platelet counts among patients presenting with fever at a hospital. This study evaluated annual proportions at two platelet thresholds and their temporal variation. Methods: CBCs were performed for all fever cases, and peripheral blood smears confirmed decreased platelets in all cases with low automated platelet counts. Annual aggregate counts were examined for 2022–2025 and an incomplete 2026 reporting period. Outcomes were platelet counts ≤150,000/µL and ≤80,000/µL. Mutually exclusive categories were derived by subtraction. Proportions, Wilson 95% confidence intervals and unadjusted prevalence ratios were calculated. Trend testing was restricted to the four complete years. Results: Across 50,410 CBC records, 20,600 (40.86%) had platelet counts ≤150,000/µL and 3,091 (6.13%) had counts ≤80,000/µL. The proportion ≤150,000/µL increased from 28.75% in 2022 to 49.56% in 2025, an absolute increase of 20.81 percentage points and a prevalence ratio of 1.72 (1.67–1.78). Counts ≤80,000/µL remained approximately 5.53–6.11% during 2022–2025. In the incomplete 2026 period, the respective proportions were 38.13% and 9.69%. All cases with counts <80,000/µL were reported CRP-positive. Conclusion: Low platelet counts became more frequent among patients presenting with fever during 2022–2025, primarily in the >80,000 to ≤150,000/µL interval. The incomplete 2026 period showed a higher proportion at the ≤80,000/µL threshold. These hospital findings do not establish population-wide platelet depletion or a sustained decline in individual platelet counts.

Background: Postoperative pain following thyroid surgery is usually moderate and is concentrated in the early postoperative period. Although multimodal analgesia is widely used, regional analgesic techniques such as bilateral superficial cervical plexus block (BSCPB) may provide additional opioid-sparing analgesia. Published randomized trials and meta-analyses have reported variable efficacy, partly related to differences in local anaesthetic, block technique, timing and background analgesic regimens. Aim: To evaluate the effect of bilateral superficial cervical plexus block, when combined with general anaesthesia, on postoperative pain, duration of analgesia, rescue analgesic requirement, intraoperative haemodynamics, postoperative nausea and vomiting (PONV), operating time and hospital stay following thyroid operations. Materials and Methods: This randomized controlled study included 30 patients. Fifteen patients received bilateral superficial cervical plexus block in addition to general anaesthesia (block group), while 15 received general anaesthesia without the block (no-block group). Demographic characteristics, ASA physical status, intraoperative systolic blood pressure and heart rate, operating time, visual analogue scale (VAS) scores at 1 and 4 hours, time to first rescue analgesia, PONV and hospital stay were analysed. Continuous variables were compared using Welch’s t-test or Mann–Whitney U test as appropriate, while categorical variables were analysed using Fisher’s exact test. A two-sided P<0.05 was considered statistically significant. Results: Postoperative pain was significantly lower in the block group at 1 hour [median VAS 4 (IQR 3–4) vs 6 (IQR 5–7), P<0.001] and 4 hours [4 (4–5) vs 8 (7.5–9), P<0.001]. VAS >4 occurred in 13.3% versus 93.3% at 1 hour (P<0.001) and 46.7% versus 100% at 4 hours (P=0.002). Median time to rescue analgesia was significantly longer following BSCPB [280 (240–295) vs 60 (45–67.5) minutes, P<0.001]. PONV and hospital stay did not differ significantly. Conclusion: Addition of BSCPB to general anaesthesia was associated with substantially improved early postoperative analgesia and delayed requirement for rescue analgesia, without prolonging surgery or reducing hospital stay.

Background: Contrast-associated acute kidney injury (CA-AKI) is a clinically important complication following percutaneous coronary intervention (PCI) and is associated with prolonged hospitalization and adverse clinical outcomes. Identification of patients at increased risk before and during PCI may facilitate appropriate preventive strategies. Aim: To determine the incidence and identify predictors of contrast-associated acute kidney injury following percutaneous coronary intervention. Methods: A prospective observational study was conducted among 75 adult patients undergoing PCI at a tertiary-care hospital from January 2025 to June 2026. Demographic, clinical, biochemical, echocardiographic and procedural characteristics were recorded. Serum creatinine was measured before PCI and subsequently following the procedure. CA-AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria as an increase in serum creatinine of ≥0.3 mg/dL within 48 hours or ≥1.5 times the baseline value within 7 days. Potential risk factors were evaluated using univariable analysis, followed by multivariable logistic regression. Results: Among the 75 patients, 9 developed CA-AKI, giving an incidence of 12.0%. CA-AKI was significantly more frequent among patients aged ≥70 years (55.6% vs. 19.7%; p=0.018), those with chronic kidney disease (55.6% vs. 10.6%; p<0.001), anemia (55.6% vs. 21.2%; p=0.041), left ventricular ejection fraction <40% (44.4% vs. 13.6%; p=0.039) and periprocedural hypotension (44.4% vs. 9.1%; p=0.010). On multivariable logistic regression, age ≥70 years (adjusted OR 3.42; 95% CI: 1.12–10.46; p=0.031), chronic kidney disease (adjusted OR 5.86; 95% CI: 1.72–19.94; p=0.005), and periprocedural hypotension (adjusted OR 4.91; 95% CI: 1.28–18.77; p=0.020) were identified as independent predictors of CA-AKI. Patients who developed CA-AKI had a longer mean hospital stay than those without CA-AKI (8.1 ± 3.4 vs. 4.6 ± 2.1 days). Conclusion: CA-AKI occurred in 12.0% of patients undergoing PCI in the present study. Advanced age, pre-existing chronic kidney disease and periprocedural hypotension were independent predictors of CA-AKI. Early identification of high-risk patients, optimization of hemodynamic status, judicious use of contrast media and appropriate post-procedural renal monitoring may help reduce the risk and clinical burden of CA-AKI following PCI.

Background: Type 2 diabetes mellitus (T2DM) is associated with structural and functional abnormalities of the myocardium and an increased risk of heart failure. Left ventricular (LV) dysfunction may develop before the appearance of clinically overt cardiovascular disease and may remain clinically silent. Echocardiography provides a non-invasive method for detecting abnormalities in LV systolic and diastolic function. Objective: To evaluate the clinical and echocardiographic profile and identify predictors of silent left ventricular systolic dysfunction among patients with long-standing type 2 diabetes mellitus. Materials and Methods: A hospital-based cross-sectional observational study was conducted among 800 adults with T2DM of at least 5 years’ duration attending Patna Medical College & Hospital, Patna, between July 2025 and June 2026. Participants underwent clinical assessment, biochemical investigations and transthoracic echocardiography. Silent LV systolic dysfunction was operationally defined as LV ejection fraction (LVEF) <50% in the absence of clinically overt heart failure. Clinical, biochemical and echocardiographic parameters were compared between participants with and without LV systolic dysfunction. Logistic regression analysis was performed to identify independent predictors. Results: Among 800 participants, 242 (30.3%) had silent LV systolic dysfunction. Participants with LV systolic dysfunction were older, had a longer duration of diabetes, higher body mass index (BMI), higher systolic blood pressure and higher glycated haemoglobin (HbA1c). Albuminuria and diabetic retinopathy were also more frequent in this group. Mean LVEF was significantly lower among participants with LV systolic dysfunction than among those without dysfunction (46.9 ± 2.8% vs 59.3 ± 3.7%, p<0.001). Global longitudinal strain was less negative in participants with LV systolic dysfunction (−15.3 ± 1.7% vs −19.0 ± 1.6%, p<0.001). On multivariable logistic regression, age, diabetes duration, HbA1c, systolic blood pressure, BMI and albuminuria remained independently associated with silent LV systolic dysfunction. Conclusion: Silent LV systolic dysfunction was present in approximately one-third of patients with long-standing T2DM. Increasing age, longer diabetes duration, poorer glycaemic control, higher systolic blood pressure, greater BMI and albuminuria were independently associated with LV systolic dysfunction. Echocardiographic assessment, including myocardial deformation imaging, may help identify diabetic patients with otherwise clinically unrecognized myocardial dysfunction.

Background: Chronic kidney disease (CKD) is a progressive disorder associated with substantial morbidity and mortality. Nutritional abnormalities are common during CKD and may include reduced dietary intake, loss of muscle mass, low body weight, hypoalbuminemia and protein-energy wasting. Nutritional assessment is an important component of comprehensive CKD care. Objectives: To assess nutritional status among adults with CKD and to evaluate its association with disease progression over a 12-month follow-up period. Methods: This prospective observational cohort study included 500 adults with established CKD attending Patna Medical College and Hospital, Patna, Bihar. Nutritional status was assessed using body mass index (BMI), serum albumin, dietary protein intake and the Malnutrition-Inflammation Score (MIS). Participants were followed for 12 months. CKD progression was defined as a sustained ≥40% decline in eGFR from baseline or progression to kidney failure. Associations were assessed using categorical tests and multivariable logistic regression. Results: The mean age was 52.6 ± 12.7 years and 280 (56.0%) participants were male. Underweight status was present in 110 (22.0%), serum albumin <3.5 g/dL in 145 (29.0%), dietary protein intake <0.6 g/kg/day in 150 (30.0%), and MIS ≥8 in 95 (19.0%). During 12 months, 120 (24.0%) participants met the predefined criteria for CKD progression. Progression was more frequent among participants with low BMI, low serum albumin, lower protein intake and higher MIS. In multivariable analysis, MIS ≥8, albumin <3.5 g/dL, BMI <18.5 kg/m² and protein intake <0.6 g/kg/day were independently associated with progression. Conclusion: Impaired nutritional status was associated with a higher frequency of CKD progression in this cohort. Early identification of nutritional abnormalities and individualized nutritional management may have an important role in comprehensive CKD care.