Background: This article explores how AWS services can be effectively leveraged to streamline clinical workflows, accelerate medical research, and enable equitable access to life-saving treatments globally.

Background: Primary open-angle glaucoma (POAG) leads to progressive retinal ganglion cell loss and structural changes detectable through optical coherence tomography (OCT). While peripapillary RNFL thinning is well established, macular thinning has gained attention as a potentially sensitive biomarker. Objectives: To compare macular thickness parameters in patients with POAG and healthy controls using spectral-domain OCT, and to evaluate their association with clinical glaucoma severity markers and diagnostic performance. Methods: This cross-sectional observational study included 100 participants (50 POAG patients and 50 age- and sex-matched healthy controls) from Dr. D.Y. Patil Medical College, Navi Mumbai, conducted over one year in 2015. Average and quadrant-specific macular thicknesses were recorded using SD-OCT. Correlations with vertical cup-to-disc ratio (CDR) and visual field mean deviation (MD) were assessed in the POAG group. Diagnostic performance of macular parameters was evaluated using ROC analysis. Results: The mean central subfield thickness (CST) was significantly lower in POAG patients (237.4 ± 11.2 µm) than in controls (252.8 ± 10.4 µm, p < 0.001). Similar thinning was noted in the inner (279.3 ± 12.7 µm vs. 295.4 ± 13.6 µm, p < 0.001) and outer macular rings (258.5 ± 11.4 µm vs. 268.6 ± 10.9 µm, p < 0.001). The inferior and superior quadrants showed the most pronounced loss (p < 0.001 for both). In the POAG group, CST negatively correlated with vertical CDR (ρ = -0.52, p < 0.001) and positively with MD (ρ = 0.47, p < 0.001). ROC analysis showed that CST (AUC = 0.84), inner ring average (AUC = 0.88), and inferior quadrant thickness (AUC = 0.91) had high diagnostic accuracy for POAG detection. Conclusion: Macular thickness parameters, especially inferior and inner ring measurements, are significantly reduced in POAG and show strong correlation with disease severity. These OCT-based markers may enhance early glaucoma detection and complement peripapillary RNFL analysis in clinical practice.

Background: Oxidative stress has been implicated in the pathogenesis of rheumatoid arthritis (RA), yet the comparative profiles of key oxidative biomarkers remain underexplored. Objective: This study aimed to evaluate and compare serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) in RA patients and age- and sex-matched healthy controls, and to explore their correlation with disease parameters. Methods: A cross-sectional observational study was conducted involving 48 RA patients and 50 healthy controls. Serum biomarker levels were measured using spectrophotometric methods. Statistical analyses included independent samples t-tests, correlation assessments, and ROC curve analysis. Results: RA patients showed significantly elevated MDA levels (4.93 ± 1.27 vs. 2.02 ± 0.87 nmol/mL, p < 0.001) and significantly decreased SOD, CAT, and GPx levels (all p < 0.001). MDA exhibited excellent diagnostic performance (AUC = 0.94), while other enzymes showed poor discrimination. Correlation between disease duration and oxidative markers was weak and non-significant. Conclusion: RA patients exhibit marked oxidative imbalance. MDA appears to be a promising biomarker for RA detection, with limited utility of antioxidant enzymes in this capacity.

Background: Chronic hyperglycemia contributes significantly to vascular and autonomic dysfunction in patients with long-standing type 2 diabetes mellitus (T2DM). Understanding these pathophysiological changes is critical for early risk identification and management. This study aimed to evaluate endothelial function and cardiovascular autonomic regulation in individuals with T2DM and to examine their associations with glycemic control. Methods: A cross-sectional observational study was conducted over 12 months at a tertiary care center in India. One hundred patients aged 40–65 years with T2DM duration ≥10 years and HbA1c ≥7.0% were enrolled. Flow-mediated dilation (FMD) was used to assess endothelial function, and a standardized battery of cardiovascular autonomic reflex tests was performed. Correlations between HbA1c and physiological parameters were analyzed using Pearson correlation and ANOVA. Results: The mean HbA1c was 8.3 ± 1.1%. FMD averaged 5.2 ± 1.5%, and autonomic dysfunction score was 2.1 ± 1.3. HbA1c negatively correlated with FMD (r = –0.49) and positively with autonomic dysfunction (r = 0.44). No statistically significant differences were observed across HbA1c tortillas by ANOVA (FMD: F = 0.24, p = 0.7835; Autonomic Score: F = 0.67, p = 0.5141), though moderate effect sizes were noted. Conclusion: Persistent hyperglycemia is moderately associated with impaired endothelial and autonomic function in patients with long-standing T2DM. Noninvasive testing may aid in early detection of multisystem dysfunction, supporting tighter glycemic control as a preventive strategy.

Background: The rising prevalence of type 2 diabetes in India, particularly in urbanizing regions, necessitates early identification of at-risk individuals. This study aimed to evaluate diabetes risk using the Indian Diabetes Risk Score (IDRS) among urban and semi-urban populations. Methods: A community-based, cross-sectional survey was conducted among 320 adults (≥18 years) from urban and semi-urban settings. Sociodemographic data, lifestyle behaviors, and anthropometric measurements were recorded. IDRS was used to categorize diabetes risk into low, moderate, or high. Statistical analysis included chi-square tests to assess associations between risk scores and variables such as age, central obesity, and family history. Results: High IDRS scores (≥60) were present in 39.7% of participants, with a significantly higher prevalence among urban residents (48.8%) compared to semi-urban (30.6%) (p=0.012). Central obesity, sedentary lifestyle, and family history of diabetes were significantly associated with high risk (p<0.05). Conclusion: Urban populations are at greater risk of developing type 2 diabetes. Community-level screening using IDRS is effective in identifying high-risk individuals. Public health interventions focusing on lifestyle modification and targeted education are urgently needed to prevent diabetes onset in these populations.

Background: Introduction: Urban noise pollution is a growing environmental concern with potential consequences on mental health. Although previous studies have highlighted its physiological effects, there is limited data on its psychiatric impact in densely populated Indian cities. To assess the association between environmental noise exposure and psychological distress, depression, anxiety, and sleep quality among urban residents in Hyderabad. Material and Methods: A cross-sectional study was conducted in 2023 at the Department of Psychiatry, Gandhi Medical College, Hyderabad, involving 1200 adult participants. Ambient noise levels were measured using a portable sound level meter and categorized as low (<55 dB), moderate (55–70 dB), and high (>70 dB). Psychological assessments included GHQ-28, PHQ-9, GAD-7, and PSQI. Statistical analyses included chi-square tests, Pearson’s correlation, and multiple logistic regression. Results: Among participants, 43% reported psychological distress (GHQ-28 ≥5), 33.5% had moderate to severe depression, 31% had moderate to severe anxiety, and 61.5% had poor sleep quality. Psychological distress was significantly higher in the high noise exposure group (59%) compared to moderate (41.8%) and low (29.8%) groups (χ² = 25.74, p < 0.001). High noise exposure was associated with increased odds of psychological distress (OR = 2.34, 95% CI: 1.65–3.30, p < 0.001), and poor sleep quality emerged as an independent predictor (OR = 2.81, 95% CI: 2.07–3.82, p < 0.001). PHQ-9 and GAD-7 scores were positively correlated with PSQI and GHQ-28 (p < 0.001). Conclusion: Urban noise exposure is significantly associated with psychological distress, depression, anxiety, and poor sleep quality. High noise levels and disturbed sleep were the strongest predictors of mental health issues. These findings highlight the need for public health interventions, noise regulation, and mental health support in urban settings.

Background: Premenstrual Dysphoric Disorder (PMDD) is a severe affective disorder affecting a subset of women during their reproductive years, often accompanied by psychiatric comorbidities. These comorbidities can significantly impair quality of life (QoL), yet their impact remains underexplored in Indian settings. To assess the prevalence of psychiatric comorbidities in women diagnosed with PMDD and to evaluate their impact on different domains of quality of life using the WHOQOL-BREF scale. Material and Methods: A cross-sectional study was conducted at the Department of Psychiatry, Gandhi Medical College, Hyderabad, Telangana, in 2023. A total of 200 women aged 18–45 years meeting DSM-5 criteria for PMDD were recruited. Psychiatric comorbidities were assessed using the Mini International Neuropsychiatric Interview (MINI). Quality of life was evaluated using WHOQOL-BREF. Statistical analyses included independent samples t-test, one-way ANOVA with Tukey’s post-hoc test, Pearson’s correlation, and multiple linear regression. Results: Psychiatric comorbidities were found in 60.5% of participants, with major depressive disorder (32%), generalized anxiety disorder (26%), and panic disorder (10.5%) being most common. WHOQOL-BREF scores were significantly lower in participants with psychiatric comorbidities across all domains (p < 0.001). One-way ANOVA revealed significantly lower psychological domain scores in participants with MDD and GAD compared to those without comorbidity. Pearson’s correlation showed a significant negative relationship between PMDD symptom severity and all QoL domains (r = -0.30 to -0.48; p < 0.001). Multiple regression analysis identified depression, anxiety, and symptom severity as significant negative predictors of psychological quality of life (p < 0.001), while age and BMI were not significant. Conclusion: Psychiatric comorbidities, especially depression and anxiety, are highly prevalent in women with PMDD and are strongly associated with lower quality of life. Comprehensive assessment and integrated management strategies addressing both PMDD and coexisting psychiatric conditions are essential to improve overall well-being.

Background: Neonatal hyperbilirubinemia or Neonatal jaundice is a common problem encountered in the newborn period. The biochemical analysis of blood for estimation of total serum bilirubin (TSB) involve invasive extraction of venous blood from premature neonates, making the frequent use of painful stimuli which is a significant issue marked in neonates over the past decade. Brain-Derived Neurotrophic Factor (BDNF) is a neurotrophic, immunotrophic, epitheliotrophic and metabotrophic factors, that shows its high expression in the central and peripheral nervous system, influencing the dopaminergic, serotonergic, glutamatergic, cholinergic and noradrenergic signaling pathways. BDNF performs the function of proliferation, differentiation, activity dependent plasticity and survival of neurons in CNS. Material and Methods: This study was a prospective and observational study was conducted in the Neonatal Intensive Care Unit (NICU) and postnatal ward and Department of Biochemistry at Index Medical College and Hospital over a period of 2 year. The study aimed to measure serum Brain-Derived Neurotrophic Factor (BDNF) levels in preterm and full-term neonates and assess its association with neonatal hyperbilirubinemia. Neonates admitted to the NICU or postnatal ward were enrolled based on the following inclusion and exclusion criteria. Results: The serum BDNF level is significantly lower in preterm neonates compared to full-term neonates. The p-value of 0.001 indicates strong statistical evidence that this difference is not due to chance. The total serum bilirubin level is significantly higher in preterm neonates compared to full-term neonates. The p-value of 0.001 indicates strong statistical evidence that this difference is not due to random chance, and the difference is highly significant. A significant proportion of preterm neonates (69.6%) were diagnosed with hyperbilirubinemia, which is more common in preterm infants due to their immature liver function and lower ability to process and excrete bilirubin effectively. Only 30.4% of preterm neonates did not experience hyperbilirubinemia, indicating that the majority of preterm infants in this cohort required some form of intervention, such as phototherapy. Conclusion: This study highlights a significant difference in serum BDNF and bilirubin levels between preterm and full-term neonates and establishes a negative correlation between bilirubin and BDNF.

Introduction: Head injury patients are at risk of secondary brain injury due to hemodynamic instability during intubation. This study evaluates the effect of intratracheal dexmedetomidine combined with 4% lignocaine on hemodynamic changes during intubation in head injury patients. Materials and Methods: A randomized controlled trial was conducted on 60 head injury patients requiring intubation. Patients were divided into two groups: Group A received intratracheal dexmedetomidine (1 µg/kg) + 4% lignocaine (2 mg/kg), and Group B received normal saline as placebo. Hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate-pressure product) were recorded at baseline, during intubation, and post-intubation. Results: Group A demonstrated significantly attenuated hemodynamic responses compared to Group B (p < 0.05). Heart rate and blood pressure remained stable in Group A, while Group B showed significant increases during intubation. Conclusion: Intratracheal dexmedetomidine combined with 4% lignocaine effectively attenuates hemodynamic changes during intubation in head injury patients, reducing the risk of secondary brain injury.

Introduction Femoral shaft fractures are among the most common long bone fractures in pediatric patients, constituting approximately 1.6% of all pediatric fractures. These fractures result from high-energy trauma, such as road traffic accidents (RTAs) and falls from height, making them a significant concern in pediatric orthopedic trauma. The management of femoral shaft fractures varies according to patient age, fracture pattern, and associated injuries, necessitating a tailored approach for optimal outcomes.  Materials and Methods A prospective study was conducted over a period of 1 year in the Department of Orthopedics, Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre. Patients aged 5–16 years diagnosed with closed femoral shaft fractures and treated with TENS were included. This study evaluates the functional outcome of femoral shaft fractures in pediatric patients treated with TENS, focusing on healing time, complications, weight-bearing status, and overall functional recovery. A prospective study was conducted on pediatric patients aged 5–16 years with closed femoral shaft fractures treated using TENS.  Results The most common fracture type in this dataset is transverse (25 cases), followed by oblique (15 cases) and comminuted (10 cases). This distribution suggests that the majority of fractures in this dataset are relatively stable (transverse and oblique), with a smaller proportion being more complex (comminuted). The fracture heals on average in 8.2 weeks, but full functional recovery (full weight-bearing) takes longer, at 10 weeks. Patients can begin partial weight-bearing at 6 weeks, which is an important milestone in the rehabilitation process. The most common complication in this dataset is nail prominence (6%), followed by limb length discrepancy (4%) and infection (2%). The majority of patients (40 out of 50, or 80%) achieved an excellent outcome. A smaller proportion (8 out of 50, or 16%) had a satisfactory outcome. Only a few patients (2 out of 50, or 4%) had a poor outcome.

Introduction: Postmenopausal bleeding is the most common reason for office hysteroscopy in postmenopausal women. While transvaginal ultrasonography (TV-US) systematic screening is not recommended for postmenopausal women, it is often performed and leads to the diagnosis of asymptomatic intra-uterine abnormalities, most often polyps. While dilatation and curettage is no longer recommended TV-US is often performed as a first measure of endometrial thickness.  Material and Methods This is a retrospective study involving case records of  women undergone outpatient hysteroscopy and endometrial biopsy between July 2022 and June 2023 in the Department of Obstetrics and Gynaecology at the Ayaan Institute of Medical Sciences, Teaching Hospital & Research Centre. The patients were all postmenopausal and asymptomatic. None of them had positive personal history of cancer of the genital tract. None took hormone replacement therapy. Results In the bleeding group, 40% had a bulky uterus compared to 15% in the non-bleeding group, which was statistically significant (p = 0.05). The difference in endometrial thickness (ET on TVS) was also significant (p = 0.029). At diagnosis, the bleeding group had a larger uterus but a thinner endometrium compared to asymptomatic women. Hysterectomy was performed for one case of complex hyperplasia with atypia and two cases of simple hyperplasia with atypia. Operative hysteroscopy was done in 24 (60%) PMB cases and 15 (75%) asymptomatic postmenopausal women with increased endometrial thickness due to benign polyps. Conclusion Hysteroscopy plays a crucial role in evaluating postmenopausal women, especially those with PMB, as it provides superior diagnostic accuracy compared to endometrial curettage. Given its high sensitivity and specificity, hysteroscopy should be the first-line investigation for postmenopausal bleeding.

Introduction: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. The choice of surgical technique remains a topic of debate, with Modified Bassini's repair and Lichtenstein's repair being two widely used methods. This study aims to compare the outcomes of these two techniques in terms of postoperative complications, recurrence rates, and patient satisfaction Materials and Methods: A prospective randomized study was conducted on 200 patients with indirect inguinal hernia. Patients were divided into two groups: Group A (Modified Bassini's repair) and Group B (Lichtenstein's repair). Inclusion criteria included adult patients with primary unilateral indirect inguinal hernia, while exclusion criteria included recurrent hernias, complicated hernias, and patients with comorbidities. Data were collected on operative time, postoperative pain, complications, recurrence rates, and patient satisfaction. Results: The mean operative time was shorter in Group A (45 minutes) compared to Group B (55 minutes). Postoperative pain was significantly lower in Group B (p < 0.05). Complication rates were comparable, but recurrence rates were higher in Group A (5%) compared to Group B (1%). Patient satisfaction was higher in Group B (90%) than in Group A (75%). Conclusion: Lichtenstein's repair offers better outcomes in terms of postoperative pain, recurrence rates, and patient satisfaction compared to Modified Bassini's repair. However, Modified Bassini's repair may still be a viable option in resource-limited settings.

Introduction The global increase in the prevalence of obesity has led to an increased need for measurement tools for research, management and treatment of the obese person. The physical size limitations imposed by obesity, variations in body composition from that of normal weight, and a complex psychopathology all pose tremendous challenges to the assessment of an obese person. The field of obesity research would benefit from having more uniform methods of assessment which would enable researchers for clinical and community-based studies, evaluation teams to assess intervention programs, and health professionals for counseling individuals.  Material and Methods: This is Prospective, Randomized and Observational study was conducted in the Department of Physiology, Index Medical College. The data collection tool was a validated tool, the investigator has obtained permission from the author to use the tool. Physical examination, checking height and weight and interpreting it as BMI, Waist circumference, blood pressure, heart rate and body fat composition was assessed. Nutritional measuring cups were used to find the volume of food taken by the adolescent from 6 am to 6 am of the previous day. All food items consumed by the adolescents were assessed for calorie, protein and fat, they were calculated and tabulated. Results: The mean age of both groups is very close (14.2 years for the intervention group and 14.1 years for the control group), indicating that the two groups are similar in age on average. A standard deviation of 1.5 or 1.6 suggests that, for both groups, the ages are fairly close to the mean, with most individuals' ages falling within 1.5 to 1.6 years of the average. The prevalence of obesity is 30% in the intervention group and 32% in the control group. Obesity prevalence at baseline is comparable between the two groups, confirming that both groups started with similar health profiles. 20% of adolescents in the intervention group and 35% in the control group reported inadequate physical activity at baseline. Total 45% of children in the intervention group and 48% in the control group had correct perceptions of obesity at baseline. Conclusion: This study’s findings highlight that individual interventions are not likely to be sufficient in addressing the adolescent obesity epidemic without changes within the family and community. Change in social norms and environment, similar to what has been done with tobacco use, must be part of the solution in addressing overweight and obesity in adolescents.

Background: Hypertension in pregnancy is one of the most common medical conditions encountered during gestation, with significant implications for both maternal and fetal health. Nifedipine has the advantage of being cost effective, rapid onset of action, long duration of action and can be administered orally, however it is known to cause sudden maternal hypotension and fetal distress caused by placental hypoperfusion, palpitation and transient neuromuscular weakness when used concomitant with magnesium sulphate. Intravenous Labetalol is considered to control severe hypertension in pregnancy. Its advantages include little placental transfer, less palpitation and less maternal tachycardia. Methods: The present study was prospective, randomized comparative clinical trial conducted on 140 patients in the department of Obstetrics & Gynaecology over a period of 1 year following approval from institutional ethical committee. A thorough history was elicited from the patients regarding age, parity, socio economic status, history suggestive of imminent symptoms. Their past history regarding bronchial asthma, cardiac diseases, prior drug intake for hypertension and other medical disorders were also obtained. The pregnant women were randomized with computer generated numbers into two groups to receive either oral nifedipine or intermittent intravenous labetalol injections. Enrolled patients will be randomized to receive either oral nifedipine or intravenous labetalol. Results: Our study reports showed that, baseline diastolic blood pressure did not vary significantly in the groups. The mean of the baseline diastolic blood pressure were 109 mm Hg and 112 mm Hg in the groups A and B, respectively. 55.8% and 50% in groups A and B had diastolic blood pressure more than 110 mm Hg. In present study on comparison of time taken to control BP between two groups, i.e. to achieve BP 150/100mm of Hg. The mean time required were 51.50 ± 11.85 mins in the Labetalol groups and 48.0 ± 6.25 minutes in the Nifedipine group. This comparision showed no difference in the two groups with a ‘P’ value of 0.358. Similarly on comparison of no. of doses of drugs required to control BP between two groups it was observed that most of the patients were controlled by two doses of each drug. Mean number of doses required to Achieve Target Bp in IV labetalol group 2.08 and in nifedipine group was 2.02. Conclusions: Ultimately, both medications can be valuable in the management of hypertensive disorders in pregnancy, and the choice between them should be guided by the severity of the condition, the need for rapid blood pressure control, and the clinical setting. For severe and rapidly progressing hypertensive emergencies, intravenous labetalol remains the gold standard. However, nifedipine can be an effective alternative for less acute cases or in settings where oral administration is more practical.

Background: Gallbladder function plays a crucial role in the management and outcomes of patients with common bile duct (CBD) stones. Common bile duct stones are a significant cause of morbidity, often resulting in complications like cholangitis, pancreatitis, and biliary colic. While endoscopic and surgical interventions have advanced, predicting the occurrence of complications remains challenging. The gallbladder plays a pivotal role in bile storage and secretion, and its dysfunction may exacerbate biliary pathology. However, its predictive value for subsequent biliary complications remains unclear. This study aims to assess the relationship between gallbladder function and the incidence of biliary complications in CBD stone patients. Methods: We conducted a retrospective analysis of 80 patients diagnosed with CBD stones. Gallbladder function was evaluated using preoperative imaging and laboratory tests, and patients were followed up for biliary complications over a 12-month period. Gallbladder function was evaluated using hepatobiliary scintigraphy (HIDA scan) to assess the ejection fraction (EF). An EF below 35% was considered indicative of gallbladder dysfunction. Other imaging modalities, such as ultrasound and magnetic resonance cholangiopancreatography (MRCP), were used to confirm the diagnosis of CBD stones. Results: The study included 80 patients with a mean age of 60 ± 8.2 years. Of the cohort, 55% were male, and 45% were female. The majority of patients presented with symptoms of biliary colic (68%), followed by jaundice (45%), and fever (25%). The notable proportion of patients (40%) had impaired gallbladder function (EF < 35%), indicating that gallbladder dysfunction is common in this patient population. The even distribution across higher EF ranges (35–70%) reflects a broad spectrum of gallbladder performance among patients without severe dysfunction. Patients with EF < 35% had a significantly higher incidence of biliary complications (40.6%) compared to those with EF ≥ 35% (10.4%). Cholangitis was the most common complication, occurring in 31.3% of patients with EF < 35%, compared to only 6.3% in patients with normal EF. Similarly, pancreatitis was more prevalent in the impaired EF group (15.6% vs. 4.2%), further emphasizing the role of gallbladder dysfunction in increasing complication risks. Conclusion: Impaired gallbladder function can predict biliary complications in patients with CBD stones. Preoperative assessment of gallbladder function may help guide treatment decisions and improve patient outcomes