AIM: The aim of the present study was to assess the role of USG and MRI in painful shoulder joint. Methods: The Descriptive correlational study was carried out in the Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. 50 cases were included in the study. Results: Out of the total participants, 15 are female, which constitutes 30% of the group, while 35 are male, making up 70% of the group. The data indicates that 34% of the participants are associated with the left side, while 66% are associated with the right side. The majority of respondents, comprising 88%, reported experiencing pain. A very small proportion, merely 2%, reported pain accompanied by swelling. Additionally, 10% of the sample cited trauma as the cause of their discomfort. Among those with lesions, the supraspinatus tendon was most frequently affected, with 12 subjects (24%) showing a full tear and 6 subjects (12%) a partial tear. The most common lesion was tendinosis of supraspinatus tendon observed in 20 patients (40%), followed by full thickness supraspinatus tear, observed in 13 subjects (26%), which was followed by supraspinatus partial-thickness tears (PT) in 10 subjects (20%). Conclusion: In our study, we concluded that most common cause for painful shoulder was rotator cuff disorders which included tendon tears i.e. partial and full thickness tears and tendinosis. Among the rotator cuff tendons most common tendon to be involved was Supraspinatus. USG showed comparable results to MRI in detection of full thickness tears of rotator cuff tendons however, MRI proved to be a better modality for detection of partial thickness tears and tendinosis of rotator cuff tendons. USG showed to have high sensitivity and specificity for full thickness tears and relatively less for detection of partial thickness tears. MRI proved to be superior and provided more accurate assessment of the extent and location of the rotator cuff tendon tears.

Background: Diabetic foot ulcers (DFUs) are a significant complication of diabetes mellitus and present a major healthcare burden in India. Negative Pressure Wound Therapy (NPWT) has emerged as an advanced wound management modality, but comparative clinical data against conventional dressings remain limited. Methods: This prospective, randomized comparative study evaluated 48 patients with Wagner Grade 2 or 3 diabetic foot ulcers over a 10-day period. Participants were randomized equally into two groups: one receiving NPWT and the other treated with povidone-iodine dressings. Wound parameters assessed included depth (Wagner grade), edge characteristics, infection severity, granulation tissue formation, exudate volume, and pain scores. Statistical significance was analyzed using Chi-square tests, repeated measures ANOVA, and appropriate association coefficients. Results: NPWT resulted in a greater reduction in wound depth, with Grade 3 ulcers decreasing from 54.2% to 8.3% by Day 10 (p = 0.002). Edge quality improved significantly (p = 0.000, CC = 0.472), and granulation tissue formation reached 95.8% by Day 10 (p = 0.000, CC = 0.573). Infection scores improved more markedly in the NPWT group (Cramer’s V = 0.349) than in controls (Cramer’s V = 0.285). Exudate management was superior with NPWT, reducing saturated wounds to 12.5% and leaking to 4.2% (p = 0.000, CC = 0.506). Pain scores in the NPWT group declined from 6.2 ± 0.84 to 1.83 ± 0.55, significantly lower than in the control group (p = 0.002). Conclusions: NPWT demonstrated statistically and clinically superior outcomes compared to conventional povidone-iodine dressings in managing diabetic foot ulcers over a 10-day period. It significantly enhanced wound healing, granulation, infection control, and patient comfort, supporting its use as a preferred modality in acute ulcer management.

Background: Incidental thyroid nodules (ITNs) are frequently identified on neck and chest computed tomography (CT) scans performed for non-thyroid indications. Their detection poses a clinical challenge in deciding appropriate follow-up and management, especially considering the potential risk of malignancy. Objectives: To assess the prevalence, radiological characteristics, and follow-up patterns of incidental thyroid nodules detected on neck and chest CT scans in a tertiary care hospital. Methods: This retrospective observational study included 100 patients who underwent neck or chest CT scans for unrelated clinical reasons. All images were reviewed to identify and characterize ITNs in terms of size, location, morphology, and follow-up recommendations. Data were extracted from radiology reports and patient medical records. Results: Incidental thyroid nodules were detected in 27 patients (27%). The mean age of patients with ITNs was 54.3 ± 12.6 years, with a female predominance (66.7%). Most nodules were <2 cm in size, and the majority were located in the right lobe. Morphologically, 59.3% were solid, 29.6% were mixed cystic-solid, and 11.1% were purely cystic. Follow-up imaging or FNAC was recommended in 74.1% of cases, but only 44.4% of patients underwent further evaluation. Among them, 16.7% of nodules were suspicious or malignant. Conclusion: ITNs are common findings on routine CT scans. Although a significant proportion may be benign, structured reporting and consistent follow-up are essential to identify malignant lesions early and guide appropriate management.

Background: Interstitial lung diseases (ILDs) represent a diverse group of chronic, progressive pulmonary disorders characterized by varying degrees of inflammation and fibrosis. Early diagnosis through clinical and radiological evaluation is essential for optimal management. Objectives: To assess the clinical presentation, risk factors, pulmonary function, and HRCT thorax findings in patients diagnosed with ILD at a tertiary care hospital. Methods: This observational cross-sectional study was conducted on 100 patients diagnosed with ILD over a one-year period. Detailed clinical history, physical examination, pulmonary function tests (PFT), six-minute walk test (6MWT), and high-resolution computed tomography (HRCT) were performed. Final diagnoses were based on clinical-radiological correlation and serological markers where indicated. Results: The mean age of the patients was 56.4 ± 12.8 years, with a female predominance (58%). Dyspnea (92%) and dry cough (76%) were the most common symptoms. Clubbing was observed in 28%, and basal crepitations in 83%. Risk factors included smoking (36%), organic dust exposure (24%), and occupational exposure (16%). PFT revealed a restrictive pattern in 81%, with reduced DLCO in 88%. Desaturation >4% on 6MWT was observed in 65%. HRCT findings included reticulations (86%), traction bronchiectasis (54%), and subpleural basal predominance (72%). The most common patterns were UIP (42%) and NSIP (28%). Final diagnoses included IPF (38%), CTD-ILD (20%), and hypersensitivity pneumonitis (15%). Conclusion: ILDs predominantly affect middle-aged adults with non-specific symptoms. HRCT patterns, combined with clinical evaluation, play a crucial role in early diagnosis and classification.

Background: Incisional hernia is a common postoperative complication following abdominal surgeries, particularly those performed via midline laparotomy. It can lead to significant morbidity, affect quality of life, and often necessitates further surgical intervention. Identifying the prevalence and associated risk factors is essential to guide preventive strategies. Objectives: To determine the prevalence of incisional hernias and to evaluate the associated demographic, clinical, and surgical risk factors among patients who underwent midline laparotomy. Materials and Methods: This observational cross-sectional study was conducted at the Department of General Surgery, Government Medical College and General Hospital, Suryapet, over a period of eight months from September 2023 to April 2024. A total of 100 patients who underwent midline laparotomy at least six months prior were enrolled. Relevant demographic, clinical, and surgical data were collected using a structured proforma. Physical examination and imaging, where necessary, were used to confirm incisional hernias. Data were analyzed using SPSS version 25, with p-values <0.05 considered statistically significant. Results: The prevalence of incisional hernia was found to be 18%. Significant risk factors associated with incisional hernia included higher age (p=0.003), BMI >25 kg/m² (p=0.009), diabetes mellitus (p=0.01), wound infection (p=0.002), emergency surgery (p=0.02), and prolonged operative duration (p=0.01). The majority of hernias occurred within one year of surgery and were infraumbilical in location. Conclusion: Incisional hernia remains a prevalent complication after midline laparotomy. Identifying modifiable risk factors such as glycemic control, nutritional optimization, and infection prevention may reduce its incidence.

Background: Postoperative complications following elective hernia repair can significantly impact recovery, prolong hospital stay, and increase healthcare costs. Identifying predictors of such complications is essential to improve perioperative care and outcomes. Objective: To evaluate the incidence and predictors of postoperative complications in patients undergoing elective hernia repair in tertiary care center. Methods: This observational study was conducted across three tertiary hospitals, enrolling 100 adult patients undergoing elective hernia repair. Demographic and clinical data were recorded. Postoperative complications were monitored for 30 days. Statistical analysis included univariate and multivariate logistic regression to identify significant predictors. Results: The mean age of patients was 52.6 ± 13.4 years, with 74% being male. Inguinal hernia was the most common type (61%). Postoperative complications occurred in 23 patients (23%), with surgical site infection (10%) being the most frequent, followed by urinary retention (6%), seroma (4%), and wound dehiscence (3%). Univariate analysis showed significant associations between complications and age >60 years (p=0.021), BMI >30 kg/m² (p=0.034), diabetes mellitus (p=0.016), smoking history (p=0.041), and ASA grade ≥ III (p=0.007). Multivariate analysis revealed diabetes mellitus (OR 3.21; 95% CI: 1.12–9.14; p=0.029) and ASA grade ≥ III (OR 4.17; 95% CI: 1.36–12.76; p=0.012) as independent predictors. Patients with complications had significantly longer hospital stays (p<0.001). No mortality was observed. Conclusion: Diabetes mellitus and high ASA physical status were independent predictors of postoperative complications. Early identification and optimization of these risk factors may improve surgical outcomes in elective hernia repair.

Background: Recurrent respiratory infections (RRIs) are a significant cause of morbidity among under-five children, particularly in low-resource settings. Identifying socio-environmental and nutritional determinants is vital for formulating effective public health strategies. Objectives: To determine the incidence of RRIs and assess associated risk factors among under-five children in a community-based setting. Methods: A cross-sectional observational study was conducted among 100 under-five children selected through systematic random sampling from a defined rural community. Data were collected using a structured questionnaire focusing on demographics, environmental exposures, immunization status, nutritional profile, and clinical history. RRIs were defined as ≥3 episodes of respiratory infection within a six-month period. Statistical analysis was performed using Chi-square test, and a p-value <0.05 was considered significant. Results: The incidence of RRIs was 39%. Male children constituted 58% of the total participants. Key determinants significantly associated with RRIs included low socioeconomic status (66.7%, p=0.01), maternal illiteracy (74.4%, p=0.005), overcrowding (61.5%, p=0.003), exposure to indoor air pollution (69.2%, p=0.01), and incomplete immunization (23.1%, p=0.02). Nutritional risk factors included undernutrition (53.8%, p<0.001) and non-exclusive breastfeeding (48.7%, p=0.01). Prematurity and low birth weight showed a non-significant association (20.5%, p=0.06). Conclusion: RRIs are prevalent among under-five children in the study setting and are significantly associated with modifiable sociodemographic and nutritional factors. Community-level interventions targeting these determinants could reduce the RRI burden in this vulnerable population.

Background: Cutaneous manifestations are often the first indicator of underlying systemic autoimmune disorders. Recognizing and correlating these with histopathological and immunological findings can facilitate early diagnosis and management. Objectives: To evaluate the spectrum of cutaneous manifestations in patients with systemic autoimmune disorders and correlate clinical features with histopathological and serological profiles. Methods: This cross-sectional observational study included 100 patients with confirmed systemic autoimmune diseases and cutaneous involvement attending the dermatology and rheumatology clinics at a tertiary care center. Detailed clinical evaluation, laboratory investigations, autoantibody profiling, and skin biopsies (where indicated) were performed. The data were tabulated and statistically analyzed. Results: Of the 100 patients, 78% were female with a mean age of 39.4 ± 12.7 years. The most common systemic autoimmune condition was systemic lupus erythematosus (44%), followed by systemic sclerosis (20%) and dermatomyositis (12%). Photosensitivity (35%) and malar rash (32%) were the most frequent cutaneous findings. Histopathological analysis (n=60) revealed interface dermatitis (43.3%) and basal cell vacuolization (30%) as predominant features. ANA positivity was seen in 90% of patients, with disease-specific autoantibodies (anti-dsDNA, anti-Ro/SSA, anti-Scl-70) correlating with respective clinical patterns. Conclusion: Cutaneous features in systemic autoimmune disorders show distinct clinical and pathological patterns. Timely recognition and biopsy evaluation of skin lesions, along with autoantibody profiling, play a vital role in early diagnosis and management.

Background: Renal artery stenosis (RAS) is a significant and potentially reversible cause of secondary hypertension. Early identification using non-invasive imaging modalities such as Doppler ultrasonography (USG) is critical for appropriate management. This study aimed to assess the prevalence, severity, and clinical correlations of RAS among hypertensive patients using Doppler USG. Methods: This observational cross-sectional study was conducted on 100 hypertensive patients who underwent renal Doppler USG to evaluate for RAS. Demographic data, duration of hypertension, and comorbid risk factors were recorded. Doppler parameters including peak systolic velocity (PSV), renal-aortic ratio (RAR), and waveform changes were assessed. A PSV >180 cm/s and/or RAR >3.5 were considered indicative of RAS. Results: The mean age of participants was 56.4 ± 10.8 years, with 58% being male. RAS was detected in 38% of patients, with unilateral involvement in 68.4% and bilateral in 31.6%. Of the RAS cases, 26.3% were mild, 39.5% moderate, and 34.2% severe. Significant associations were found between RAS and uncontrolled hypertension (SBP >160 mmHg; p < 0.01), diabetes mellitus (p = 0.03), and smoking history (p = 0.04). Doppler features such as elevated PSV and parvus-tardus waveform were consistent indicators of stenosis. Conclusion: Renal Doppler USG is a valuable screening tool in hypertensive patients, especially in those with high-risk profiles. Its non-invasive nature makes it ideal for early diagnosis and prevention of complications related to renovascular hypertension.

Background: Sexually transmitted infections (STIs) are a significant global health burden, often presenting as co-infections that complicate diagnosis and management. Chlamydia trachomatis and Treponema pallidum (the causative agent of syphilis) are among the most common bacterial STIs. Co-infections may enhance disease transmission and alter clinical outcomes. The objective of this study was to evaluate the prevalence and association of Chlamydia trachomatis infection with syphilis in patients attending the STD clinic of a tertiary care hospital. Material and Methods: This cross-sectional study was conducted over a period of 12 months and included 40 patients attending the STD clinic with symptoms suggestive of STIs. This study was conducted at department of Microbiology, Government Medical College, Nalgonda, Telangana, India from March 2024 to February 2025. Clinical data were collected using a structured proforma. Blood samples were tested for syphilis using VDRL and TPHA tests. Endocervical/urethral swabs and urine samples were obtained for the detection of Chlamydia trachomatis using nucleic acid amplification tests (NAAT). Data were analyzed to assess co-infection rates and demographic correlations. Results: Out of 40 patients, 18 (45%) were positive for syphilis and 12 (30%) tested positive for Chlamydia trachomatis infection. Co-infection with both pathogens was observed in 7 patients (17.5%). Co-infections were more common in males (71.4%) and in the 21–35 years age group. High-risk sexual behavior and lack of condom use were significantly associated with co-infection. The findings suggest a notable overlap between chlamydial and syphilitic infections, underlining the importance of routine screening for multiple STIs. Conclusion: The study demonstrates a significant association between chlamydial infection and syphilis among STI clinic attendees. Given the high rate of co-infection, simultaneous screening for both infections is recommended to improve early detection, treatment, and prevention of further transmission. Enhanced public health education and risk-reduction strategies are crucial in combating STI co-infections.

Background: Klebsiella species are notorious opportunistic pathogens causing various infections, particularly in hospital settings. The rising incidence of antimicrobial resistance among Klebsiella strains severely compromises treatment efficacy. This study aimed to investigate the drug resistance profile of Klebsiella species isolated from clinical samples in a tertiary care hospital, providing valuable insights into resistance trends and informing empirical therapy decisions. Materials and Methods: A total of 50 non-duplicate Klebsiella isolates were obtained from various clinical samples (urine, sputum, blood, wound swabs, and others). This study was conducted at department of Microbiology, Government Medical College, Nalgonda, Telangana, India from February 2024 to January 2025. Bacterial identification was carried out using standard microbiological techniques and confirmed by automated systems where applicable. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method, and results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Extended-spectrum beta-lactamase (ESBL) production was detected using the combined disc method. Results: Out of the 50 Klebsiella isolates, K. pneumoniae was the predominant species (86%), followed by K. oxytoca (14%). A high level of resistance was observed to commonly used antibiotics such as ampicillin (100%), cefotaxime (88%), and ceftazidime (84%). ESBL production was noted in 56% of the isolates. Carbapenem resistance was detected in 18% of the isolates, with meropenem showing reduced susceptibility. Colistin and tigecycline remained the most effective agents, with susceptibility rates of 98% and 92%, respectively. Conclusion: The study highlights a significant prevalence of multidrug resistance among Klebsiella species in the hospital setting, with a substantial proportion producing ESBLs and a notable emergence of carbapenem resistance. These findings underscore the need for continuous surveillance, strict infection control practices, and rational use of antibiotics to combat the threat of antimicrobial resistance.

Background: Plantar fasciitis is a common cause of heel pain, particularly among adults and athletes. It involves inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. Aim: To Analyse the functional outcome of various conservative treatment modalities in plantar fasciitis.  Methodology: It was a Prospective study; The study was conducted at Department of Orthopaedics. Data for the study will be taken from the patients coming to the outpatient block with heel pain for more than 2 months.  Results: The present study revealed that Plantar fasciitis is most common in the 31-40 years age group and equally common in both genders. Higher BMI is associated with increased incidence and severity of plantar fasciitis. Flat foot is associated with a higher incidence and severity of plantar fasciitis. Treatment Outcomes emphasized that Corticosteroids show the greatest improvement in functional outcomes, followed by laser therapy and conservative methods. Conclusion: This analysis supports the effectiveness of corticosteroids for improved functional outcomes in patients with plantar fasciitis. Further research with a larger sample size and additional treatment modalities is recommended to validate these findings.

Background: Chronic venous insufficiency (CVI), commonly presenting as varicose veins, is a prevalent vascular disorder with significant socioeconomic and health burdens. The Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification offers a standardized framework for assessment, yet its correlation with clinical outcomes requires further validation in prospective settings. Materials and Methods: This prospective observational study was conducted at a tertiary care center over 12 months. A total of 150 patients with primary varicose veins were enrolled. Patients were classified according to CEAP criteria and assessed using the Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ). Doppler ultrasonography confirmed anatomical involvement. Clinical outcomes including ulcer healing, symptom resolution, and recurrence were evaluated over a six-month follow-up. Statistical analysis was conducted using SPSS v26.0, employing chi-square tests and ANOVA where appropriate, with a p-value <0.05 considered significant. Results: Among 150 patients (M:F = 1.3:1), most presented in CEAP class C3 (38%) and C2 (27.3%). A significant association was found between CEAP class and symptom severity (mean VCSS: C2 = 5.4 ± 1.2, C3 = 7.1 ± 1.4, C6 = 11.3 ± 2.0; p < 0.001). Higher CEAP classes correlated with prolonged ulcer healing times and increased recurrence rates. AVVQ scores were highest in classes C5–C6. Conclusion: CEAP classification demonstrates a strong correlation with both subjective and objective clinical outcomes in patients with varicose veins. Its prospective validation supports its utility in clinical risk stratification and treatment planning.

Background: The objective of this study is to evaluate and contrast the concentrations of hepcidin and interleukin-6 in individuals with aggressive and chronic periodontitis prior to and following phase-I periodontal therapy. Method: Group I comprised 10 persons in a state of optimal health, Group II comprised ten patients diagnosed with chronic periodontitis, and Group III comprised ten patients diagnosed with aggressive periodontitis. The present investigation centred on these particular subjects. The assessed clinical symptoms were the plaque index, gingival bleeding index, pocket probing depth, and clinical attachment degree. The laboratory results encompassed examinations for hepcidin levels and serum IL-6 levels. The parameters were assessed at three specific time intervals: baseline, three months after phase I therapy, and baseline again for groups I, II, and III. Result: Individuals with aggressive and chronic periodontitis displayed elevated serum levels of IL-6 and Hepcidin compared to healthy individuals at the first stage. There was no statistically significant disparity in the initial levels of IL-6 and Hepcidin between persons with aggressive and chronic periodontitis. Following Phase I therapy, individuals with aggressive and chronic periodontitis observed a notable reduction in PI (Plaque Index), GBI (Gingival Bleeding Index), PPD (Probing Pocket Depth), CAL (Clinical Attachment Level), as well as blood concentrations of Hepcidin and IL-6, in comparison to their initial measurements.  Conclusion: Considering the limitations of the study, it can be concluded that patients with aggressive and chronic periodontitis had higher levels of hepcidin and IL-6 in their blood serum. This, in turn, increases the risk of long-term illness-related anaemia. Neither the baseline levels of IL-6 nor Hepcidin were significantly different between patients with aggressive and chronic periodontitis. Patients with severe and chronic periodontitis showed a decrease in levels of IL-6 and Hepcidin after undergoing phase I therapy. Future studies with larger sample sizes can assess the efficacy of phase I therapy in lowering blood levels of IL-6 and Hepcidin levels. Additionally, the relationship between the patient's periodontal health and serum Hepcidin levels can be explored.

Background: The purpose of this study was to evaluate the effects of splint therapy on the masseter and temporalis masticatory muscles in patients with temporomandibular joint dysfunction syndrome using a muscle force transducer. Method: This research involves a prospective examination of twenty patients. To rule out the chance that the illness was at an advanced stage, an MRI was performed. The patients were then given custom-made splints. Numerous parameters were evaluated in the study, including the prevalence of muscle activity, gender, pain levels, severity of the condition, third molar impact, parafunctional behaviours, and effectiveness of treatment. Result: According to the study, TMJ dysfunction was more common in women and was closely associated with parafunctional behaviours and impacted third molars. Both the pain score and muscle activity decreased in all of the individuals. Of the twenty people, nineteen had normal muscular activity values. Conclusion: It is clear that splints play a big part in helping people with TMJ dysfunction syndrome feel better. Rather than depending only on subjective assessments, the transducer can be used as a useful diagnostic tool to quantify muscle activity and precisely define how long splint therapy should last.

Background: Prosthetic replacement as a primary procedure eliminates osteonecrosis and non union as complications of femoral fractures and also allows immediate weight bearing to return elderly patients to activity and help avoid complications of recumbency and inactivity.2The decision to perform hemi arthroplasty using a unipolar or bipolar prosthesis remains controversial, with proponents on either side. So, in view of varied opinions we desire to compare the efficiency of these two prosthesis unipolar and bipolar prosthesis for the management of intra capsular fracture neck femur in elderly.  Methods: 52 patients above 60 years and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either AMP or bipolar HA. The patients were summoned at 6weeks, 12 weeks, 6 months and 1year. Functional outcome was assessed and compared with Harris hip score and radiological parameters.  Results: The two groups of patients with mean age of 70.4 in bipolar group and 69.1 in AMP group did not differ in their pre-injury characteristics (sex, fracture pattern, comorbidity, mode of injury and pre-injury ambulatory status) and perioperative parameters such as duration of operation, blood loss, hospital stay and mortality.  The mean Harris hip score in Bipolar and AMP group was 90.03 and 84.4, respectively (p=0.273), range of motion was 234.6 and 221.3 with Bipolar and AMP groups, respectively. Functional activities like use of public transport was better with bipolar group. Incidence of complications like Superficial infection, haematoma and acetabular erosion was encountered in AMP group.  Conclusion: The use of a bipolar end prosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur. Moreover the cost difference between AMP and Bipolar prosthesis is not much in our country

Background: Abdominal trauma is a major contributor to emergency surgical admissions worldwide, with blunt and penetrating mechanisms posing distinct clinical and surgical challenges. While blunt trauma is often associated with delayed diagnosis and concealed hemorrhage, penetrating injuries demand immediate intervention due to direct organ damage. This study aimed to compare surgical outcomes between blunt and penetrating abdominal trauma patients to guide operative decision-making and prognostication. Materials and Methods: This prospective observational study was conducted over a period of 12 months. All patients undergoing exploratory laparotomy for abdominal trauma were enrolled and classified into blunt or penetrating groups. Data were collected on demographics, intraoperative findings, postoperative complications, ICU stay, and mortality. Statistical analysis included Chi-square test, Student’s t-test, and logistic regression, with p<0.05 considered significant. Results: Out of 120 patients, 75 (62.5%) sustained blunt trauma and 45 (37.5%) had penetrating injuries. The mean age was 34.6±11.7 years, with male predominance (82.5%). Blunt trauma cases had higher incidence of solid organ injury (liver 36%, spleen 28%) and required splenectomy in 24% of cases. Penetrating trauma more frequently involved bowel injuries (jejunum 42%, ileum 31%) and required resection-anastomosis in 38% of cases. Postoperative complications such as wound infection (28% vs 16%, p=0.04) and ICU admission (34.7% vs 17.7%, p=0.03) were significantly higher in blunt trauma. Conclusion: Blunt abdominal trauma is associated with increased postoperative morbidity, ICU stay, and solid organ resections. Penetrating trauma more often necessitates bowel repair. Early identification and targeted surgical management improve outcomes.

Background: Gallstone pancreatitis is a leading cause of acute pancreatitis, marked by substantial morbidity and variable clinical outcomes. Identifying specific risk factors influencing disease severity can guide therapeutic decisions and prognostication. Materials and Methods: This prospective observational study was conducted over 12 months at a tertiary care center, enrolling 162 adult patients diagnosed with gallstone-induced acute pancreatitis. Patients were stratified into mild, moderately severe, and severe pancreatitis groups per the Revised Atlanta Classification. Baseline demographic, clinical, biochemical, and imaging data were collected. Key risk factors analyzed included age, BMI, comorbidities, leukocytosis, CRP, serum amylase, lipase, and imaging features. Outcomes assessed were ICU stay, necrosis, organ failure, and mortality. Chi-square and logistic regression analyses were performed. Results: Among 162 patients (mean age 46.2 ± 13.4 years; 57.4% female), 53.1% had mild, 30.2% moderately severe, and 16.7% severe disease. Age >60 years (OR 3.4; 95% CI: 1.6–7.1; p=0.002), BMI ≥30 (OR 2.8; p=0.008), elevated CRP >150 mg/L (OR 4.5; p<0.001), and CT-documented necrosis >30% (p<0.001) were significantly associated with severe pancreatitis. Overall mortality was 6.2%, exclusively in the severe group. ICU admission and multiorgan failure were independently associated with CRP >150 and necrosis. Conclusion: Older age, obesity, elevated inflammatory markers, and imaging-detected necrosis were significant predictors of adverse outcomes in gallstone pancreatitis. Early risk stratification using these parameters can optimize management and reduce complications.

Background: Gastroesophageal reflux disease (GERD) is a common pediatric gastrointestinal condition often presenting with regurgitation, feeding difficulties, and respiratory symptoms. Accurate and non-invasive diagnostic tools are essential to avoid unnecessary investigations. This study aimed to determine the prevalence of GERD in regurgitant children using milk scan scintigraphy and to evaluate the diagnostic utility of the Infant Gastroesophageal Reflux Questionnaire (IGERQ) score. Objectives: To assess the prevalence of GERD in regurgitant children aged 6 to 120 months, describe the clinical profile, and evaluate the sensitivity and specificity of the IGERQ score. Methods: A hospital-based cross-sectional study was conducted at the Department of Paediatrics, Niloufer Hospital, Hyderabad, from June 2020 to December 2021. Eighty-two children aged 6 months to 10 years presenting with regurgitation were enrolled based on predefined inclusion and exclusion criteria. Clinical features were documented, IGERQ scores were calculated, and all participants underwent milk scan scintigraphy. Results: The prevalence of GERD as per milk scan was 37.8%. Refusal to feed (21.95%), poor weight gain (19.51%), and recurrent LRTIs (7.31%) were common clinical features. Statistically significant associations were found between GERD and poor weight gain (p=0.02), refusal to feed (p=0.004), and recurrent pneumonia (p=0.01). The IGERQ score demonstrated high diagnostic accuracy with 94.12% sensitivity, 93.55% specificity, 96% PPV, and 90.63% NPV. Conclusion: GERD is prevalent among regurgitant infants and young children. Clinical symptoms, particularly feeding refusal and poor weight gain, are significantly associated with GERD. The IGERQ score is a highly sensitive and specific non-invasive tool that can effectively screen for GERD and minimize the need for invasive investigations.

Background: Vitamin D deficiency has been increasingly associated with various metabolic disorders, including Type 2 Diabetes Mellitus (T2DM). This study aimed to evaluate the correlation between serum vitamin D levels and glycemic control in patients with T2DM. Methods: A cross-sectional observational study was conducted among 100 patients with T2DM at a tertiary care hospital. Serum 25-hydroxyvitamin D and HbA1c levels were measured. Patients were classified based on vitamin D status into deficient (<20 ng/mL), insufficient (20–30 ng/mL), and sufficient (>30 ng/mL) groups. Glycemic control was categorized as good (HbA1c <7%) or poor (HbA1c ≥7%). Data were analyzed using descriptive statistics and correlation analysis. Results: Of the 100 participants, 54% were male and 46% were female, with a mean age of 56.8 ± 10.3 years. Vitamin D deficiency was observed in 62% of patients, insufficiency in 24%, and sufficiency in 14%. Poor glycemic control was present in 72% of the cohort. Among vitamin D-deficient individuals, 87.1% had poor glycemic control. Conversely, 71.4% of those with sufficient vitamin D levels had good glycemic control. The mean HbA1c was highest in the vitamin D-deficient group (8.3 ± 1.2%) and lowest in the sufficient group (6.9 ± 0.8%). A significant negative correlation was found between serum vitamin D levels and HbA1c values (r = –0.42, p < 0.001). Conclusion: Lower serum vitamin D levels are significantly associated with poor glycemic control in patients with T2DM. Routine screening and correction of vitamin D deficiency may contribute to better diabetes management.

Background: Metabolic Syndrome (MetS) is a cluster of interconnected risk factors including abdominal obesity, dyslipidemia, hypertension, and insulin resistance, which significantly increase the risk for cardiovascular disease and type 2 diabetes. This study aimed to estimate the prevalence and identify associated risk factors of MetS among adults attending a tertiary care hospital. Methods: A cross-sectional study was conducted among 100 adult outpatients at a tertiary care hospital. Data were collected on demographic variables, clinical parameters, and biochemical indices. MetS was diagnosed using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Statistical analyses included frequency distributions and multivariate logistic regression to identify independent risk factors. Results: The prevalence of MetS was found to be 41%. Abdominal obesity (52%) and elevated blood pressure (60%) were the most common components. The mean age of participants was 46.3 ± 11.2 years, with 58% males and 42% females. Females had a higher prevalence of MetS (45.2%) compared to males (37.9%). Logistic regression analysis identified age ≥45 years (OR: 2.6; p = 0.01), BMI ≥25 kg/m² (OR: 3.4; p = 0.002), and sedentary lifestyle (OR: 2.1; p = 0.04) as significant independent predictors of MetS. Conclusion: The study reveals a high burden of MetS among adults in the tertiary care setting. Screening for risk factors such as age, obesity, and physical inactivity is essential for early identification and intervention. Preventive strategies including lifestyle modifications are warranted.

Background: Lung diseases among chronic smokers often present late, by which time significant irreversible damage may have occurred. Conventional imaging may miss subtle structural abnormalities. High-resolution computed tomography (HRCT) offers greater sensitivity for early detection of pulmonary pathology, especially when applied using low-dose protocols. Materials and Methods: This cross-sectional study evaluated 120 symptomatic smokers aged ≥35 years with a smoking history of ≥10 pack-years. All participants underwent low-dose HRCT thorax. Imaging findings were classified into emphysema, bronchiectasis, interstitial lung disease (ILD), nodules, or normal. Clinical diagnosis, symptom duration, and pack-year data were collected. Statistical comparisons were made using appropriate tests (p < 0.05 significant). Results: HRCT identified emphysema in 40.8%, normal scans in 25.8%, bronchiectasis in 17.5%, ILD in 10%, and nodules in 5.8%. Diagnosis confirmation was highest in emphysema (87.8%) and bronchiectasis (90.5%). Patients with nodules had the longest symptom duration (mean 5.43 years), and ILD cases had the highest pack-year exposure (mean 22.25). Even patients with normal HRCT had substantial tobacco exposure (mean 20.13 pack-years), suggesting a latent disease phase. Conclusion: Low-dose HRCT is a valuable imaging modality in symptomatic smokers, enabling early detection of diverse lung pathologies. Strong correlations between radiological findings, symptom duration, and smoking burden support HRCT’s integration into standard diagnostic algorithms for high-risk patients. Routine use may facilitate earlier intervention and better outcomes.

Background: Magnetic resonance imaging (MRI) plays a pivotal role in identifying structural etiologies in pediatric seizures, enabling timely diagnosis and guiding management. This study aimed to evaluate the MRI spectrum, yield, and its concordance with clinical features in children presenting with seizures. Methods: A prospective observational study was conducted over 12 months at a tertiary care teaching hospital in South India. Pediatric patients aged 1 month to 18 years presenting with seizures were enrolled. MRI was performed using pediatric-specific epilepsy protocols, including T1, T2, FLAIR, DWI, SWI, and MR spectroscopy sequences where indicated. Clinical features, seizure type and duration, and EEG data were correlated with imaging findings. Results: A total of 60 patients were included. GTCS was the most prevalent seizure type (46.7%), while infantile spasms were confined to children <1 year. MRI yield was highest in infantile spasms (100%) and focal seizures (86.7%), and increased with seizure duration (from 60% to 81.8%). Structural abnormalities were the most common findings (30%), followed by hypoxic (16.7%) and infective (13.3%) etiologies. Normal MRIs were noted in 30% of cases. MRI concordance was strongest in children with developmental delay (88.2%) and neurocutaneous markers (75%). Lesions were most commonly localized to the frontal (29%) and temporal lobes (24%). Conclusion: MRI is an indispensable tool in pediatric seizure evaluation, particularly in cases of focal seizures, prolonged episodes, and neurodevelopmental impairment. A structured imaging protocol enhances detection, facilitating early diagnosis and intervention.

Background: Cerebral Venous Sinus Thrombosis (CVST) is a subtype of venous thromboembolism, which occurs in the dural venous sinuses. Common presenting features of CVST are symptoms of raised intracranial pressure, seizures, focal neurological deficits, and altered sensorium. Present case is a case of a young woman who developed CVST with no apparent risk factors for the same; and was found to have been taking oral contraceptive pills since 2 months for abnormal uterine bleeding (AUB). Present case illustrates vital lessons in the management of cerebral venous thrombosis (CVT) such as, maintaining a high index of suspicion is crucial for early diagnosis, rapid neuroimaging through magnetic resonance venography (MRV) or computed tomography venography (CTV), initiating immediate anticoagulation & consistent long-term monitoring including follow-up imaging and proactive risk factor management.

Background: Femur and tibial bone fractures are one of the common fractures seen in paediatric patients which accounts to 10-20 per 1 lakh children. Titanium elastic nail (TEN) is an alternative method for the treatment of long bone fractures in paediatric patients. TENS is surgeon’s choice than plaster application in the treatment of long bone fractures in children over 6 years of age. Treatment of long bone fractures in children has shifted more towards the operative owing to reduced immobilization, early recovery, short rehabilitation period, reduced incidence of joint stiffness. Elastic intramedullary nails are more advantageous with respect to above mentioned pros and also maintain a good alignment and rotation at the fracture site. TENS in long bone fractures in children is a safe and minimally invasive that helps to achieve stable reduction in long spiral fractures. The purpose of our study was to investigate the safety and efficacy of elastic stable intramedullary nailing in femur and tibial fractures in children. A few complications such as hardware prominence were present which was resolved with implant removal. Long-term studies with a comparison to casting techniques in paediatric long bone fractures are required. Methods: We included all the patient aged from 5-15 years of age with femoral and tibial diaphyseal fractures, admitted to Bapuji Hospital and Chigateri Government Hospital attached J.J.M. Medical college, Davanagere, treated with TENS for a period of December 2021 to January 2024. Peri operative morbidities, clinical and radiological outcome during follow up were prospectively analysed. Results: During the observed period of time, 50 patients (mean age 10.4 years (range: 5-15), male/female: 21/29) were treated. Most of them had RTA (n=21, 42%) followed by self-fall (n=19, 38%) followed by fall from height (n=10, 20%). Most of them had tibial fractures (n=33, 66%) followed by femur shaft fractures (n=17, 34%). The most prevalent post-surgical complication was pain (n=10, 20%) followed by infection (n=3, 6%). Patient was clinically and radiologically followed up in with majority of the patient had excellent result (n=40, 80%) followed by satisfactory (n=8, 16%). 2 of the patients had poor outcome. Conclusion: we are convinced that the TENS is more efficient method of surgical technique with a small complication rate but very successful and high healing rate in femur and tibial fractures among children.

Background: Inguinal hernia is a common pediatric surgical condition resulting from the persistence of the processus vaginalis. Early diagnosis and timely surgical intervention are critical in preventing complications such as incarceration and recurrence. Objectives: This study aimed to determine the incidence, demographic distribution, clinical presentation, and surgical outcomes of inguinal hernia in pediatric patients at a tertiary care center. Methods: A prospective observational study was conducted on 120 children aged 0–14 years diagnosed with inguinal hernia between January 2023 and June 2024. Data were collected on age, gender, laterality, clinical features, and operative outcomes. All patients underwent open herniotomy, and outcomes were assessed during postoperative follow-up. Results: The majority of patients were male (78.3%) with a male-to-female ratio of 3.6:1. The most affected age group was 1–5 years (46.7%). Right-sided hernia was most common (60%), followed by left-sided (30%) and bilateral (10%). Incarceration occurred in 11.7% of cases. Postoperative complications were minimal, with a 2.5% recurrence rate and 1.7% wound infection rate. Conclusion: Inguinal hernia in children is predominantly seen in young males and frequently affects the right side. Open herniotomy remains a safe and effective treatment with excellent outcomes and low complication rates.

Background: Recently, the Indian Academy of Cytologists (IAC) has published the guidelines for interpretation and reporting of serous effusions.  Aims:  The present study was carried out to assess the feasibility of applying the IAC reporting categories to effusions, determine the frequency, and provide an estimate of the risk of malignancy (ROM) for individual diagnostic categories. Materials and Methods: The present study was carried out in the Cytopathology Laboratory, Department of Pathology, P.D.U Medical College and Hospital, Rajkot, Gujarat   carried out over a period of 1 year between August 2023 to July 2024. All the cases referred to the department of Pathology from the Department of Surgery, Respiratory medicine, medicine, orthopedics for evaluation of fluid were included in the study. Clinical data and radiological assessment were done in all these cases. Direct smears and cytospin smears were prepared. Cerebrospinal fluid and urine samples were processed by cytospin method (at 2500 rpm for 5 minutes) and all other body fluids were centrifuged (2000 rpm for 10 minutes). The sediment separated from the above procedure was used in preparation of smears on 2 glass slides with frosted ends. One was air dried and stained with Papanicolaou’s stain, Giemsa stain. The other slide was immediately fixed in 95% alcohol and stained with Haematoxylin & Eosin Stain.

 Results: A total of 814 effusion samples were received from 785 patients. There were 414 (50.8%) males and 400 (49.2%) female. Majority were pleural (612, 75.1%), followed by peritoneal (123, 15.1%) and other fluid like (CSF, Urine) (79, 9.8 %) .The age ranged from 7 months to 92 years. There were 22 (2.7%) samples in category 1 (non diagnostic), 651(79.9 %) in category 2 (benign), 11 (1.3%) in category 3 (atypical), 36 (4.4%) in category 4 (suspicious for malignancy) and 94 (11.5 %) in category 5 (malignant).  Conclusions: The categorization of serous effusion cytology samples as per the IAC diagnostic categories and as per the reporting format developed by the IAC is feasible and the management recommendations are mostly appropriate.

Background: Favipiravir is a pyrazincar boxamide derivative that acts as an inhibitor of viral RNA-dependent RNA polymerase, causing chain termination and preventing RNA elongation. This study was undertaken to evaluate the efficacy of Favipiravir in COVID-19 patients.  Materials and Methods: This retrospective investigation was conducted over a period of one year in a tertiary care hospital. Data pertaining to adult patients diagnosed with mild to moderate COVID-19, and admitted to the hospital till August 2022, was gathered from the medical records department. Study comprised of two groups: (i) Favipiravir group comprised 100 COVID-19 positive patients who were administered Favipiravir, and (ii) non-Favipiravir group consisted of 100 COVID-19 positive patients who did not receive Favipiravir. Patients were evaluated with respect to time to clinical recovery, adverse events, and time to viral clearance.  Results: Significant improvements in COVID-19 symptoms such as fever, fatigue, sore throat, shortness of breath, and headache were observed with early initiation of Favipiravir. (p<0.05). Significantly higher incidence of adverse drugs events were observed in Favipiravir group as compared to non-Favipiravir group patients, which included altered liver function  test and rise in uric acid level (p<0.001). The mean time to viral clearance was significantly lower in Favipiravir group (p=0.0001). Conclusion: Favipiravir therapy was well tolerated by the patients, despite producing some mild unwanted effects such nausea, vomiting, diarrhoea, and slightly increased serum transaminases. No fatal adverse effects were reported.

Background: Purpose: To study the Comparison of difference from baseline in central macular thickness and appearance of intra-retinal cystoid spaces between diabetic and non-diabetic patients undergoing uncomplicated phacoemulsification.Study design: A Prospective observational non-interventional comparative study. Methods: In this study 64 eyes were assessed by optical coherence tomography preoperatively and postoperatively day 1, week 1, week 4 and 12 week after uncomplicated phacoemulsification with endocapsular foldable intraocular lens (IOL) implantation under peribulbar anesthesia.  The study included 32 eyes of non-diabetic patients (Group 1) and 32 eyes of diabetic patients (Group 2). The preoperative and post-operative changes in central macular(sub-field) thickness (CMT), macular cube volume thickness (MCV), average macular cube thickness (AMT) and development of cystoid macular edema on OCT of each group were noted and compared. Results: In group 1(non –diabetics) the preoperative mean central macular (sub-field) thickness (CMT) was 249.38 ± 19.64 µm and group 2 (non-diabetics) it was 257.66 ± 23.65 µm respectively. Post operatively central macular (sub-field) thickness [CMT] at 1 week in diabetic patients was significantly higher than in non-diabetic patients. Conclusion: This study has demonstrated that the increase in the macular thickness and macular edema is more prominent in diabetic eyes than non-diabetic eye at 1 week after surgery. The patients having more increased of central macular thickness and presence cystoid macular edema may need more aggressive treatment than other patient for example intravitreal steroids. OCT is noninvasive and has good reproducibility and thus helps in monitoring the anatomical changes of the retina in the postoperative period. Owing to its high sensitivity, OCT is suitable to demonstrate the postoperative subtle changes of the macular thickness and subclinical macular edema.

Purpose: To study the Comparison of difference from baseline in central macular thickness and appearance of intra-retinal cystoid spaces between diabetic and non-diabetic patients undergoing uncomplicated phacoemulsification. Study design: A Prospective observational non-interventional comparative study. Methods: In this study 64 eyes were assessed by optical coherence tomography preoperatively and postoperatively day 1, week 1, week 4 and 12 week after uncomplicated phacoemulsification with endocapsular foldable intraocular lens (IOL) implantation under peribulbar anesthesia.  The study included 32 eyes of non-diabetic patients (Group 1) and 32 eyes of diabetic patients (Group 2). The preoperative and post operative changes in central macular(sub-field) thickness (CMT), macular cube volume thickness (MCV), average macular cube thickness (AMT) and development of cystoid macular edema on OCT of each group were noted and compared. Results: In group 1(non –diabetics) the preoperative mean central macular (sub-field) thickness (CMT) was 249.38 ± 19.64 µm and group 2 (non-diabetics) it was 257.66 ± 23.65 µm respectively. Post operatively central macular (sub-field) thickness [CMT] at 1 week in diabetic patients was significantly higher than in non-diabetic patients. The percent change in central macular thickness at 1 week in group 1 (non –diabetics) and group 2 (diabetic)was 6% with mean 264.53± 30.29 and 13 % with mean 295.81± 80.53. The differences between each group were statistically significant at 1week. the preoperative mean macular cube thickness (MCV) in group 1 was 9.44. ± 0.38 mm3 and group 2 it was 9.67± 0.55 mm3. In our study the macular cube volume [CV] in group 1 and group 2, was 1.6% with mean 9.60±0.44 mm3 and 3% mean 9.94±0.81 mm3, the difference between two groups was statistically significant. In group 1 the preoperative mean average macular cube volume (AMT) was 267.94 ±12.70 and in group 2 it was 274.34±13.92. The difference between two groups was not statistically significant up to 12 weeks. In group 1 mean BCVA preoperatively was 0.40 ±0.16 and in group 2 it was 0.43± 0.14. In our study percentage change in the BCVA between group 1 and group 2 (estimated using LOGMAR visual acuity chart) at 1week and 4 week was statistically significant. However, this difference was no longer statistically significant at 12 weeks. At 1 week and 4 weeks % change in BCVA in group 1 was 91% with mean 0.03 ±0.09 and 93.98% with mean 0.02±0.10 and in group 2 it was 77.37% with mean 0.11±0.17 and 91.26% with mean 0.10±0.15 respectively. Conclusion: Diabetic patients are a challenge to the ophthalmologists as they are more likely to develop macular edema after cataract surgery than non-diabetic patients. It is the most important cause for uneventful visual outcome after surgery. Early detection of macular edema helps in prevention and treatment. Pre-operative OCT testing provides a baseline for post-operative comparison. This strategy helps the clinician in early detection of increase in macular thickness and cystoid macular edema. This study has demonstrated change in central macular thickness, change in macular cube thickness, change in average macular cube thickness, and appearance of cystoid macular edema in both non –diabetic and diabetic patients.  The incidence of substantial increase in macular thickness was associated with impaired visual acuity. This study has demonstrated that the increase in the macular thickness and macular edema is more prominent in diabetic eyes than non-diabetic eye at 1 week after surgery. The patients having more increased of central macular thickness and presence cystoid macular edema may need more aggressive treatment than other patient for example intravitreal steroids. OCT is noninvasive and has good reproducibility and thus helps in monitoring the anatomical changes of the retina in the postoperative period. Owing to its high sensitivity, OCT is suitable to demonstrate the postoperative subtle changes of the macular thickness and subclinical macular edema.

Background: Thyroid nodules are a common clinical finding, and accurate evaluation is essential to distinguish benign from malignant lesions. Fine-needle aspiration cytology (FNAC) is a standard diagnostic tool, but conventional FNAC has limitations, particularly in non-palpable or complex nodules. Ultrasound-guided FNAC (US-FNAC) has emerged as a promising alternative. Objective: To compare the diagnostic efficacy and smear quality of conventional FNAC versus ultrasound-guided FNAC in the evaluation of thyroid nodules. Methods: This retrospective cross-sectional study included 92 FNAC cases—53 conventional and 39 ultrasound-guided—collected over two years. Smear adequacy, blood contamination, and diagnostic yield were assessed and compared between the two groups using statistical analysis. Results: Smear adequacy was significantly higher in the US-FNAC group (97.44%) compared to conventional FNAC (83.01%) (p = 0.02). Bloody smears and inadequate cellularity were more common in conventional FNAC. Malignancies were identified in 8.6% of cases, with US-FNAC showing superior concordance with histopathology and no false-negative results, unlike conventional FNAC, which missed three malignant cases. Diagnostic accuracy, sensitivity, and negative predictive value were higher in the US-FNAC group. Conclusion: Ultrasound-guided FNAC significantly improves sample adequacy and diagnostic accuracy over conventional FNAC. It minimizes sampling errors and enhances detection of malignancies, making it the preferred method for evaluating thyroid nodules.

Background: "Bio-medical waste" is any waste generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps. Majority of waste (75-90%) produced by the healthcare providers is non-risk or general and remaining (10-25%) of is regarded as hazardous for creating a variety of health problems (2). Among all health problems, there is a particular concern with HIV/AIDS, Hepatitis B and C, for which there is a strong evidence of transmission through healthcare waste. The purpose of BMW management- mainly to reduce waste generation, to ensure its efficient collection, handling, & safe disposal in such a way that it controls infection and improves safety for employees working in the system. Aims & Objectives: 1. To assess the awareness in hospital personnel regarding bio-medical waste and its management. 2. To know the existing practices of biomedical waste management in the health facilities. Methodology: The study was conducted by using pretested, semistructured proforma. The study included details of various socio- demographic variables, like age, gender, working experience, type of work, etc and other details regarding awareness and practices for bio medical waste handling and its management. Total 282 health care personnel participated in the present study. Result: Though overall knowledge of study participants was good and satisfactory but still they need good regular training to improve their current knowledge about BMW. Conclusion: 1. The practices of appropriate waste disposal can be affected by lack of proper and complete knowledge about biomedical waste management. 2. Hence regular and frequent trainings of the healthcare workers and checking rounds is must.

Background: Spinal cord tumors constitute a heterogenous group of neoplasms arising from various spinal compartments, including the spinal cord parenchyma, meninges, nerve roots, vessels or adjacent structures. Their anatomical location within the spinal cord renders them clinically significant due to potential for neural compression and resultant morbidity. MRI remains the imaging modality of choice, given its superior soft tissue resolution and multiplanar capabilities. Our study aimed to evaluate the imaging characteristics of spinal tumors encountered in our tertiary care centre. Methods:  A retrospective observational study was conducted, analyzing the MRI data from patients diagnosed with spinal tumors over a defined period. Inclusion criteria encompassed patients who underwent contrast enhanced MRI spine and were radiologically diagnosed. A total of 16 patients were included in the study.  Data was analyzed descriptively and results were compared with published imaging guidelines. Results:  Among the 16 patients (mean age: 52 years), the most prevalent tumor was metastatic disease (n=6,37.5%) involving the vertebral bodies in thoracic, lumbar spine. Nerve sheath and meningeal tumors, including schwannomas (n=2,18.75%) and meningiomas (n=2, 12.5%) demonstrated classical imaging appearances with uniform enhancement, dural tail sign and foraminal extension. Intramedullary tumors included ependymoma, astrocytoma. The ependymoma was located in the lumbar region showing central hyperintensity and peripheral T2 hypointense rim. The astrocytoma showed ill-defined margins, syrinx formation and patchy enhancement in the cervical spinal cord. The case of hemangioblastoma showed predominant flow voids, solid-cystic nature on MRI. Hematological neoplasms (multiple myeloma and acute myeloid leukemia) demonstrated infiltrative marrow changes and homogenous vertebral enhancement.  Conclusion: This retrospective study reinforces the crucial role of MRI in delineating the morphological features of spinal tumors, facilitating accurate localization and differential diagnosis. Metastatic tumors remain the most common spinal neoplasms with a predilection for the thoracolumbar spine. Comprehensive imaging evaluation enables effective clinical decision making, particularly in resource constrained centers.

Background: Anemia during pregnancy is a major public health concern worldwide, particularly in developing countries like India. It is associated with adverse maternal and fetal outcomes including maternal mortality, preterm delivery, low birth weight, and impaired cognitive development in children. Objective: To determine the prevalence of anemia among pregnant women attending the Antenatal Care (ANC) outpatient department at Shri M. P. Shah Govt. Medical College and G. G. Hospital, Jamnagar. Methods: A cross-sectional study was conducted over two months involving 100 pregnant women attending the ANC OPD. Data were collected via personal interviews, clinical examination, and hemoglobin estimation following WHO criteria. Results: The prevalence of anemia was found to be 62%. Most cases were mild to moderate anemia. Sociodemographic factors such as maternal age, parity, and socioeconomic status showed significant associations with anemia prevalence. Conclusion: Anemia remains highly prevalent among pregnant women in this region. Early detection and intervention through routine ANC visits are crucial to reduce adverse outcomes.

Background: Contraceptive awareness is essential for effective family planning, especially in developing countries like India where high fertility rates and unintended pregnancies remain prevalent. Antenatal care (ANC) visits present a strategic opportunity to educate women about contraception and promote postpartum family planning. Objective: To assess the level of awareness and intent to use contraception among pregnant women attending the antenatal OPD at a tertiary care teaching hospital in Jamnagar, Gujarat. Methods: A cross-sectional study was conducted over two months among 100 antenatal women using a structured, pre-validated questionnaire. Data were collected via face-to-face interviews and analyzed using descriptive statistics. Results: The majority of participants (84%) were aware of condoms, followed by oral contraceptive pills (76%) and sterilization (66%). However, awareness of injectable contraceptives (28%) and natural methods (33%) was relatively low. Healthcare professionals were the most common source of information (60%), while only 5% cited social media. A positive intent to use contraception postpartum was reported by 72% of respondents. Awareness was significantly higher among women with secondary or higher education. Conclusion: Although pregnant women were generally well-informed on contraception, there are still a lot of misconceptions about long-acting and natural methods. Awareness levels were significantly impacted by educational attainment and interactions with healthcare professionals. Informed contraceptive choices and improved maternal health outcomes might result from structured contraceptive counselling during ANC visits and the use of digital media for reproductive health promotion.

Background: Leprosy is an infectious disease that causes complex problems, particularly permanent disability due to late detection and inadequate treatment. Disability in leprosy brings stigma in the society; ultimately leading to stress among patients and affect their behaviours during the treatment period.   Objectives: To estimate the pattern of health seeking behaviour among leprosy patients and to determine the factors affecting their health seeking behaviour. Methods: This cross-sectional study was conducted among 115 leprosy patients attending leprosy clinic of Bhima Bhoi Medical College & Hospital (BBMCH), Balangir. Study participants were selected by convenient sampling method. After obtaining informed consent, participants were interviewed regarding their health seeking behaviour by using a pre-designed, pre-tested, semi-structured schedule.  Results: Among 115 study participants, 54.8% belongs to 21-40 yrs, 12.2% in 11-20 yrs and 10.4% were more than 60yrs. 68.7% were male, 19.1% illiterate and 45.2% were economically dependent on their family members. 87.8% were multi-bacillary and 12.2% of pauci-bacillary leprosy. 13.9% of participants had not been received immediate treatment after diagnosis; the reasons being, unaware and ignorance towards the treatment (5.2%), 1.7% migrated for work, 1.7% had transportation issues and 5.2% had initiated treatment from private clinics. 89.6% patients were regularly attending the health care facility for the treatment of the disease.  Conclusions: Proper knowledge and attitude towards the disease, adequate counselling to patients and IEC activities in the community are essential to improve the health seeking behaviour of leprosy patients and to fight against the stigma associated with the disease.

Background: Proteus species are important opportunistic pathogens increasingly exhibiting resistance to antibiotics, mainly due to Extended-Spectrum Beta-Lactamases (ESBLs). Early phenotypic detection of ESBL producers and understanding their antimicrobial resistance patterns are crucial for effective management. Methods: A total of 100 Proteus isolates from various clinical samples collected over 9 months at Tirunelveli Medical College were screened for ESBL production using 3rd generation cephalosporin disc diffusion tests. Confirmatory phenotypic tests included Combined Disc Test (CDT), Double Disc Synergy Test (DDST), and ESBL E-test. Antimicrobial susceptibility was assessed by disc diffusion method. Results: Among 100 isolates, 61% were resistant to ceftazidime and 60% to cefotaxime. ESBL production was confirmed by CDT in 47 isolates (77.4% of screen positives). DDST showed 80.8% sensitivity and 100% specificity compared to CDT, while the E-test showed 87.2% sensitivity but lower specificity (57.1%). The highest resistance was observed against cotrimoxazole (81%) and gentamicin (69%), while amikacin showed the least resistance (28%). Most isolates were P. mirabilis (63%) and predominantly recovered from pus samples (57%) and the surgery ward (44%). Conclusion: Phenotypic methods such as CDT and DDST remain effective for ESBL detection in Proteus species. Awareness of antimicrobial resistance patterns is vital for guiding appropriate therapy and infection control.

Background: Nail disorders comprise approximately 10% of all dermatological conditions. They can be presenting features before other signs of a systemic disease become clinically evident. Nail diseases are relatively uncommon in children; however, they play a significant role in identifying various systemic conditions, nutritional disorders and psychophysiological phenomenon in this age group. Ethnic, socio economic and environmental factors influence their incidence. Objectives: This study was done to identify the common nail disorders in children (i.e neonates, infants and children), their prevalence and to explore their association with systemic conditions, infectious conditions, nutritional status and local habits in this population. Methodology: All children less than 18 years of age visiting dermatology OPD were taken into study after taking prior informed consent from parent or guardian. Comprehensive nail assessment was done and the findings were recorded along with the recording of demographic data, history and examination of other skin lesions present currently, previous history of any diagnosed skin or systemic condition and drug history. Appropriate statistics were used to analyse the data. Results: Out of total 771 patients reported in the outpatient department 466(60.4%) were normal with no nail abnormalities. Out of 305(39.6%) patients with nail abnormalities, majority were leuconychia 146(18.9%), followed by onychorrhexis 92(11.9%),  onychoschizia 25 (3.2%), periungual wart 10 (1.3%) and onychophagia 7 (0.9%). Conclusion: Generally nail examination is not emphasized during routine clinical examination in the paediatric population, but it is an important finding that can give clues about the general health, nutritional status and habits of the child. Overall nails can serve as a window to systemic conditions in an individual level and a health indicator in the population level.

Background: Maxillary molars typically exhibit a three-rooted anatomy; however, anatomical variations such as the presence of a fourth root are rare and may complicate endodontic and surgical procedures if undetected. This study aimed to assess the incidence of four-rooted maxillary molars through gross morphological analysis of extracted teeth. Methods: A retrospective study was conducted using clinical records and archived extracted permanent maxillary molars collected at a tertiary dental center. Teeth were evaluated by three independent examiners using visual and tactile inspection. The number of roots was recorded and verified. Results:

Out of 180 maxillary molars examined, 165 (91.67%) had three roots, 14 (7.78%) had two roots, and only one tooth (0.56%) exhibited a four-root configuration. The four-rooted specimen was a maxillary second molar with two palatal and two buccal roots. All examiners showed perfect agreement (Cohen’s kappa = 1.00). Conclusion:

The incidence of four-rooted maxillary molars is extremely rare. Accurate detection through careful inspection is essential for clinical success. Enhanced awareness of such anatomical variations is critical to avoid missed canals and treatment failures.

Background: Heavy menstrual bleeding (HMB) is a common yet underdiagnosed condition in adolescents, often leading to anemia, reduced quality of life, and educational disruption. Objectives: To evaluate the incidence, causes, diagnostic profiles, and treatment responses in adolescent girls presenting with HMB. Methods: A cross-sectional observational study was conducted on 120 adolescent girls aged 10–19 years over 12 months. Clinical history, Pictorial Blood Assessment Chart (PBAC), hematologic and endocrine workups, and pelvic ultrasonography were utilized for assessment. Management included NSAIDs, tranexamic acid, hormonal therapy, and referral for hematological evaluation when required. Treatment outcomes were reassessed at 1 and 3 months using PBAC scores. Results: The mean age of participants was 15.2 years. PBAC >100 was seen in 78.3%. Anemia (Hb <12 g/dL) was found in 70.8%, thyroid dysfunction in 15.8%, and coagulation abnormalities in 12.5%. NSAIDs were the most common therapy (41.7%), followed by tranexamic acid (30.8%) and hormonal therapy (27.5%). At 3-month follow-up, 82.5% showed clinical improvement. Conclusion: HMB in adolescents is multifactorial and frequently associated with hematologic and endocrine disorders. Early recognition, objective assessment, and targeted therapy significantly improve outcomes and reduce morbidity.

Background: Severe acute malnutrition (SAM) is a major public health concern among children under five years of age, significantly contributing to childhood morbidity and mortality. This study aimed to assess the prevalence of infectious co-morbidities and micronutrient deficiencies among children diagnosed with SAM in Koraput district, Odisha. Methods: A descriptive, hospital-based observational study was conducted over one year at the Department of Paediatrics, SLN Medical College and Hospital, Koraput. Children aged 6–59 months diagnosed with SAM as per WHO criteria were enrolled. Clinical profiles, nutritional status, immunization coverage, and presence of infections and micronutrient deficiencies were evaluated using structured proformas and standard diagnostic methods. Results: A total of 240 children with SAM were included, with a mean age of 19.8 months. The majority (54.58%) were aged 13–24 months, and 62.08% were male. Only 10% were completely immunized. Most children (67.92%) belonged to the upper-lower socioeconomic class. Fever (74.58%), diarrhoea (44.17%), and cough (40.83%) were the most common presenting symptoms. Diarrhoea (42.08%) and acute respiratory infections (27.08%) were the leading co-morbidities. Anaemia was the most prevalent nutritional deficiency (85.83%), followed by vitamin B-complex deficiency (19.17%) and vitamin A deficiency (5.00%). Vitamin D insufficiency or deficiency was observed in 99% of assessed children. Conclusion: The study highlights a high burden of infectious co-morbidities and micronutrient deficiencies among children with SAM in Koraput. Strengthening early identification, nutritional rehabilitation, and integrated infection management is crucial to improving outcomes in this vulnerable population.

Background: Allergic Contact Dermatitis (ACD) is prevalent among agricultural workers due to repeated exposure to allergens without adequate protective measures. The hands are the most affected site, significantly impairing quality of life and productivity. Objective: To identify the clinical patterns and common allergens responsible for ACD of the hands among agricultural workers in Western Odisha through patch testing. Methods: A hospital-based, cross-sectional observational study was conducted over two years at VIMSAR, Burla, including 52 agricultural workers clinically diagnosed with hand ACD. Patients were subjected to detailed clinical evaluation and patch testing with the Indian Standard Series of Allergens. Results: Most patients were males (63.5%), aged 31–40 years. The dorsum of hands (63.5%) and fingers (53.8%) were the most affected sites. Patch test positivity was observed in 63% of patients. Parthenium was the most frequent sensitizer (40.3%), followed by Nickel sulphate (15.4%) and Cobalt sulphate (11.5%). Most reactions were graded as +1 (72.5%) on ICDRG scale. Conclusion: ACD of hands among agricultural workers is significantly associated with Parthenium and metallic compounds. Knowledge of prevalent allergens and preventive education is essential in management and occupational health policies.

Background: Benign Enlargement of Prostate (BEP) is one of the most common diseases that affect men beyond their middle age. These patients generally present with the lower urinary tract symptoms. As in majority of the patient’s symptoms are gradually progressive over the time, few patient presents with acute symptoms like urinary retention. In spite of technological advances and availability of recent techniques like Trans Urethral Nuclear Ablation (TUNA) & Holmium LASER evaporation of Prostate (HOLEP); Transurethral resection of Prostate (TURP) remains gold standard surgery for BEP. Outcome of these recent procedures are measured in comparison with TURP. Though majority patients report significant relief in the symptoms after TURP; however, some still remain unsatisfied. Methodology: The study was conducted in a community hospital of Mumbai.93 patients were included in the study. Presenting complaints were noted and IPSS score was calculated prior to the surgery. All patients were subjected to DRE (Digital Rectal Examination). Each patient was operated at a community hospital by a single surgeon using a Gyrus plasmakinetic unit with Karl Storz 3 chip video camera for every TURP. Post-operatively each patient was clinically followed up at one month, three months and five years. Results: Mean age of the included patients was 69.77 years. Average IPSS preoperatively was 18.01, at one-month post-op was 8.97, at three months post-op was 6.88 and at the end of 5 years post-op was 8.1. Observed complications were re-do TURP (8.57%), stricture formation (5.72%), incontinence (7.14%), bladder neck stenosis (7.14%) and ejaculatory disturbances (20.00%). Conclusion: TURP remains the gold standard procedure in the treatment of BEP and TURP operated patients remain benefited even at the end of 5 years after surgery. TURP benefits more to the patients in the group with predominant obstructive symptoms.

Background: Phacoemulsification is the standard technique for cataract surgery, aiming for rapid visual recovery with minimal complications. Surgically induced astigmatism (SIA) significantly impacts postoperative visual outcomes. The location of the corneal incision superior or temporal affects the degree and axis of astigmatism. Superior incisions are more influenced by eyelid pressure, potentially increasing SIA, whereas temporal incisions may offer more stable refractive results. This study compares visual outcomes and SIA between superior and temporal clear corneal incisions in phacoemulsification surgery. Methods: This prospective observational study was conducted on 100 patients with senile cataracts at a tertiary care center. Patients were randomly divided into two groups: Group A (n=50) underwent phacoemulsification with superior clear corneal incision, and Group B (n=50) with temporal clear corneal incision. Preoperative and postoperative evaluations included visual acuity, keratometry, and refraction. Surgically induced astigmatism was calculated postoperatively. Data were analyzed using appropriate statistical tests. Ethical clearance was obtained, and informed consent was taken from all participants. Results: The mean age was 60.01 ± 8.47 years in Group A and 58.2 ± 7.55 in Group B. Males predominated in both groups. Nuclear sclerosis was the most common cataract type. Postoperative BCVA of 6/6 was seen in 48% of Group A and 56% of Group B. Visual acuity outcomes favored temporal incisions. Postoperative astigmatism <0.50 D was achieved in 44% of Group B versus 14% of Group A. Mean postoperative astigmatism was 1.5 ± 0.76 D in Group A and 0.5 ± 0.30 D in Group B, indicating significantly better refractive outcomes with temporal clear corneal incisions (p < 0.05). Conclusion: This study demonstrates that temporal clear corneal incisions in phacoemulsification surgery provide better postoperative visual outcomes and significantly lower surgically induced astigmatism than superior incisions. A higher proportion of patients in the temporal group achieved the best corrected visual acuity of 6/6, along with more cases of minimal postoperative astigmatism (<0.50 D). The temporal approach is thus preferable for optimizing visual rehabilitation and reducing refractive error post-surgery, supporting its wider adoption in modern cataract surgery practices.

Introduction: Gallbladder disease, primarily caused by gallstones, affects 15% of Western populations and is more prevalent among women. Diagnosis involves clinical, biochemical, and imaging findings, with laparoscopic cholecystectomy being the standard treatment. Aims: This study evaluates acute cholecystitis clinical spectrum and severity, grading pathological and biochemical findings, and examining correlation between clinical, imaging, biochemical, and pathological markers. Materials and methods: This observational cross-sectional study was conducted over 18 months at the Department of General Surgery, Medical College and Hospital, Kolkata, with 60 indoor patients. Inclusion required a clinical and imaging diagnosis of acute cholecystitis and informed consent. Exclusions included age under 15, pregnancy, ASA class 3/4, and neurological/psychiatric conditions. Data were collected through history, clinical examination, imaging, VAS, weighing machine, and measuring tape. Results: Out of 60 patients, 31 (51.7%) had multiple stones with pericholecystic collection, making it the most common ultrasound finding. Other findings included single stone with pericholecystic collection in 10 patients (16.7%), and single stone with wall thickened and oedematous in 8 patients (13.3%). The distribution was statistically significant (P < 0.00001). Conclusion: Our study found that clinical signs, imaging, and biochemical markers like CRP, ESR, Hb, and liver enzymes significantly correlated with the severity of acute cholecystitis. Severe cases had longer pain duration, hospital stay, and marked lab changes. Female predominance and occupation were also significant, highlighting the value of these markers in grading and management.

Introduction: Gliomas, one of the most common types of brain tumors, are associated with significant morbidity and mortality. The prognosis and therapeutic strategies for glioma patients are largely determined by molecular and genetic factors, among which mutations in the isocitrate dehydrogenase (IDH1) gene have emerged as a critical biomarker. Aims: The aim of this study is to compare the detection of IDH1 mutations in gliomas using two diagnostic methods: Immunohistochemistry (IHC) with the IDH1 (H09) antibody and DNA sequencing. The study seeks to evaluate the concordance and diagnostic relevance of these methods in identifying IDH1 mutations across different glioma subtypes. Materials & Methods: The present study was a retrospective cross-sectional study. This Study was conducted from One year. Total 70 patients were included in this study. Result: Among the 70 cases analyzed, IDH1 (H09) IHC expression was positive in 48 (68.6%) and negative in 22 (31.4%). IDH1 positivity was most frequent in diffuse astrocytoma (DA II) with 14 cases (29.2%), followed by anaplastic astrocytoma (AA III) with 8 cases (16.7%) and oligodendroglioma grade III (OG III) with 7 cases (14.6%). In contrast, primary GBM showed the highest IDH1 negativity with 12 cases (54.5%). A statistically significant association was found between diagnosis and IDH1 expression (p = 0.0005), indicating diagnostic relevance. Conclusion: We concluded that, this study demonstrates that IDH1 (H09) immunohistochemistry (IHC) is a reliable method for detecting IDH1 mutations in gliomas, showing a strong correlation with DNA sequencing results. IDH1 positivity was most commonly observed in younger patients and specific glioma subtypes, such as diffuse and anaplastic astrocytomas.

Introduction: Preoperative anxiety in patients undergoing various surgical procedures is very common which creates greater stress related risk and dis-satisfaction results to altered neurological along with endocrinological problems followed by complications during surgery. Aims and Objective: To assess the anxiety level changes and awareness about various anesthetic techniques and surgical procedures and prevalence and contributing factors. Material and Methods: The present study was conducted in the Department of Anaesthesiology and Critical Care, World College of Medical Sciences & Research Hospital, Girawar, Jhajjar, Haryana (India) during 15th January 2025 to 15th March 2025. A total of 50 patients were enrolled in this study. Results: Out of 50 patients, male were outnumbered as compared to female i.e. 28(56%) were male and 22(44%) were female. Maximum number of patients were in the age range of 31-40 years i.e. 20(40%) i.e. in younger age group. In elderly age group, only 2(4%) patients observed. Maximum number of patients belonged to rural areas i.e.  37(74%). With regard to their socioeconomic status, majority of patients belonged to middle class i.e. 28(56%). In 36(72%) patients previous history of surgery was observed out of which 31(62%) underwent anaesthesia  during surgery for 1 or more surgeries and 5(10%) had not experienced anaesthesia. Maximum patients were found to be literature. In 38(76%) patients, elective surgery was performed. 22(44%) patients experienced anaesthesia related anxiety, 18(36%) had surgery related anxiety and 10(20%) demanded additional information. 34(68%) patients were aware about elective surgery and 16(32%) had knowledge about emergency surgery. Maximum number of patients underwent orthopaedics surgery, obstetrics and gynaecology surgery and general surgery i.e. 14(28%), 13(26%) and 12(24%), respectively. Only 2(4%) patients underwent ophthalmology surgery. Female had more anxiety level as compared to male i.e. 38% vs. 32%, respectively. Conclusion: We concluded that females and patients who underwent first-time surgery in their life had more anxiety as compared to male and patients already experienced surgery one or more, respectively.

Background: Intestinal anastomosis is one of the most commonly performed surgical procedures. Complications can occur at any time along the course of surgery and the postoperative course. This dissertation focuses on the factors that influence the healing process of intestinal primary repair and anastomosis, aiming to improve outcomes and reduce complications associated with these common surgeries. Methods: This study is prospective clinical study concerning all patients undergoing Intestinal Resection and Anastomosis and Primary Repair at Bundelkhand Medical college and Hospital, Sagar, Madhya Pradesh from February 2023 to February 2025. A total of 140 patients undergoing resection and anastomosis for different diseases were studied.  Result: In present study, 67.9% were male patients and 32.1% were female. 30.7% patients underwent anastomosis, routinely and 69.3% in emergency. In this study out of 140 total patients, 93.6% underwent end to end, 2.1% end to side and 4.3% side to side anastomosis. The risk factors for the outcome of bowel anastomosis were recorded including age, anaemia, hypo albuminemia and emergency surgery. The anastomotic leak rate was 4.3%, 11.5%, 9.3% and 14.3% respectively. The incidence of post op complications were - surgical site infections 33.3%, anastomotic disruption 17.9%, septicaemia 11.4%, acute renal failure 6.4%, respiratory complications 21.4% and abdominal wound dehiscence 20%. Conclusion: Anastomotic leak results in substantial mortality and the morbidity. Patient related factors and technical factors in post-operative management were implicated in occurrence of anastomotic leaks.

Background: Menopause is defined retrospectively as the time of final menstrual period followed by 12 months of amenorrhea. Postmenopausal bleeding is bleeding from the reproductive system that occurs one year or more after menstrual periods have stopped. Bleeding from the genital tract occurring after the menopause is much more sinister than premenopausal bleeding. Hence postmenopausal bleeding should be thoroughly investigated. This is a cross sectional study for final histopathological diagnosis of postmenopausal bleeding females. Methods: The present study is conducted in the department of Obstetrics and Gynaecology at SAMC&PGI, Indore. Cross sectional study conducted with 30 eligible and consenting women with post-menopausal bleeding. All women presenting with h/o postmenopausal detailed history taken, clinical examination, USG pelvis with endometrial thickness done and endometrium sampling taken during hysteroscopy, or curettage or Pipelle biopsy Results: The mean age of presentation is 57.17±7.11. The most common histological diagnosis was endometrial atrophy (30%), followed by proliferative endometrium (26.6%). Notably, 16.6% (5/30) of cases were diagnosed with endometrial cancer (EC). 10% cases was of endometrial polyp, 3.3% each of simple hyperplasia and complex hyperplasia and 10% of atypical hyperplasia. Conclusion: The histopathological finding of endometrial Ca is about 16.6% cases of postmenopausal bleeding alarms for thorough examination of postmenopausal bleeding. The timely detection and prompt treatment of endometrial Ca increases survival and life expectancy of patient.

Background: Firearm-related injuries and deaths present a growing concern in India and globally. This study aimed to analyse the demographic profile, injury patterns, and manner of firearm deaths at a tertiary care hospital in North India. Methods: A retrospective review was conducted on firearm-related deaths from January 2016 to December 2017. Thirteen cases were identified among 1639 medico-legal autopsies. Data regarding demographic variables, cause and manner of death, type of weapon, and injury patterns were collected from inquest papers and postmortem reports. Results: Of the 13 victims, 92.3% were male. Suicide was the most common manner of death (61.53%), followed by homicide (30.76%) and accidental cases (7.69%). Rifled weapons were involved in 76.92% of cases. The head, chest, and abdomen were the most commonly affected anatomical sites. A majority of incidents occurred during early morning hours and in rural areas. Conclusion: The findings suggest a high burden of suicides and male predominance in firearm-related deaths. The study underscores the importance of targeted mental health interventions and stricter firearm regulations to reduce preventable deaths in the region.

Background: Surgical incisions are routinely made with scalpel or diathermy where diathermy is then further used for hemostasis and dissection of deeper tissues. Skin incision with diathermy is believed to cause burns, delayed healing and scarring. The modern electro surgical units that are capable of delivering pure sinusoidal current producing cleavage in tissue planes without creating damage to the surrounding tissues, thus reducing damage inflicted to tissues leading to minimal scar formation is an answer to these roadblocks.[1] The advantages are rapid hemostasis, faster dissection, and a reduced overall operative blood loss.[2] In an era of explosive aesthetic agents, electro-surgical instruments were used only selectively in surgery. However, the use of diathermy still has reservations in making skin incisions. The reluctance lies in the fear that electro surgical instruments create increased amounts of necrotic tissue within the wound which may increase the chances of wound infection leading to delayed wound healing and excessive scarring. Materials and Methods: The prospective randomized controlled study was carried out for a duration of one year from January 2024 to December 2024 in the department of General Surgery at Indira Gandhi Institute of Medical Sciences, Patna. The patients admitted for elective abdominal surgery were included in the study fulfilling the inclusion and exclusion criteria. A written informed consent was obtained from all the patients coupled with counselling about the merits and demerits of each method. Simple random sampling was used for allocation of the patients into Group ‘Scalpel’ and Group ‘Diathermy’. The patients along with the assessor was blinded. The operating surgeon was not blinded. Results: A total of 498 patients were included in the study those meeting the inclusion criteria. A total of 76 patients were excluded. After randomization, 211 patients were allocated to ‘Scalpel’ group and 211 patients were allocated to ‘Diathermy’ group. A total of 35 patients, 18 patients in ‘Scalpel’ group and 17 in ‘Diathermy’ group, were lost to follow-up. ‘Scalpel’ consisted of a total of 193 patients with 101 males and 92 females, mean age= 48.65 years with standard deviation of 16.85 years and range of 18 to 83 years. ‘Diathermy’ consisted of a total of 194 patients with 99 males and 95 females, mean age= 45.85 years with standard deviation of 15.15 years and range of 18 to 76 years. Conclusion: Skin incisions via did not exhibit a significant propensity to develop postoperative wound infections, contrary to prior hypotheses. Furthermore, the nociceptive response associated with these incisions was notably diminished during the immediate postoperative phase. Although electrosurgical incisions demonstrated a marked superiority over scalpel incisions with respect to reduced incision duration and minimized blood loss, it is imperative to consider the potential complications inherent to both methodologies in juxtaposition with their advantages prior to making an informed decision.

Background: Port site infections caused by atypical mycobacteria (ATM) are rare butare increasingly reported complications following laparoscopic surgery. These infections are often resistant to conventional antibiotic therapy and can result in prolonged morbidity which then undermines the benefit of laparoscopic surgery. As the infection has a protracted course, patients need to be identified early and managed properly for early resolution of the disease. Though medical management is effective in most patients but the treatment course is often prolonged and some patients still need a surgical port site excision after failed medical management. Few recent studies have shown that early port site infection followed by medical management offers effective and shorter alternative. Methods: we retrospectively studied the records of patients who were treated for port site infections in our hospital between1st March 2020 to 30 November February 2024. We divided our patients into two groups depending on the treatment they had received. Group A constitutes our early port-site excision group while Group B constitutes of patients treated with standard antibiotic regime (Clarithromycin and Ciprofloxacin). Variables like age, sex, type of index surgery, incubation period, size of port site infected and complications for each group were recorded and analysed. Results:  There was no significant difference in age, sex between the two groups. Females constituted majority of patients in both the groups. Laparoscopic cholecystectomy was the most commonly associated procedure in both the groups. The median incubation period from surgery to onset of symptoms was significantly longer in group B 40.5 days vs.32 days as seen in group A. 10 mmm port site showed higher involvement than 5 mm ports in both the groups. Group B significantly required a longer duration of antibiotic therapy 80 days in comparison of 43 days required in group A. Group B had a higher complication rate than group Aincluding 2 incisional hernias and 7 cases requiring delayed excision.

Background: Liver cirrhosis represents the final common pathway for chronic liver diseases, characterized by fibrosis, architectural distortion, and hepatic dysfunction. Pulmonary complications include hepatopulmonary syndrome, portopulmonary hypertension, hepatic hydrothorax, and altered pulmonary function, significantly impacting morbidity and mortality. This study evaluated the relationship between liver cirrhosis severity and pulmonary function parameters to establish patterns that might guide clinical management and prognostication. Methods: Sixty-five patients with liver cirrhosis were categorized according to Child-Pugh classification: Child A (n=6), Child B (n=21), and Child C (n=38). Demographic characteristics, clinical features, Child-Pugh and MELD scores, ultrasonographic findings, arterial blood gases, and pulmonary function tests were assessed. Pulmonary function parameters included FVC, FEV1, FEV1/FVC ratio, and FEF 25-75%, measured pre- and post-bronchodilator administration. Statistical analysis included ANOVA, chi-square test, and correlation analysis. Results: Significant differences in age across Child-Pugh groups (p=0.019). Child-Pugh and MELD scores showed expected significant differences (p<0.001). Ascite severity increased significantly with worsening liver function (p<0.001). Pulmonary function tests revealed substantial declines in FVC and FEV1 percentages with increasing disease severity (p<0.05), both pre- and post-bronchodilator. Restrictive ventilatory pattern predominated in Child C patients (94.7%) compared to Child A (33.3%) and Child B (47.6%) (p<0.001). Significant negative correlations were found between Child-Pugh score and pulmonary function parameters, while correlations with MELD score were weaker but still significant for FVC and FEV1.” Conclusion: Pulmonary function deteriorates progressively with increasing severity of liver cirrhosis, predominantly manifesting as a restrictive pattern in advanced disease. The significant negative correlations between liver disease severity scores and pulmonary function parameters suggest that pulmonary impairment parallels hepatic dysfunction. These findings highlight the importance of routine pulmonary function assessment in cirrhotic patients, particularly those with advanced disease, to identify abnormalities early and implement appropriate interventions.

Background: Intraoperative fluid management plays a crucial role in determining postoperative outcomes in patients undergoing major abdominal surgeries. Traditional fluid strategies may result in complications due to either fluid overload or hypovolemia. Goal-Directed Fluid Therapy (GDFT), which utilizes hemodynamic parameters to guide fluid administration, is gaining recognition for its potential to improve surgical outcomes. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital over 12 months. A total of 80 adult patients scheduled for elective major abdominal surgery were enrolled and divided into two groups based on intraoperative fluid management strategies: the GDFT group (n=40) received fluid therapy guided by dynamic parameters such as stroke volume variation (SVV) and cardiac output, while the conventional group (n=40) received fluid management based on standard practices. Data were collected on intraoperative fluid volume, hemodynamic stability, duration of surgery, postoperative complications (e.g., ileus, wound infection, pulmonary complications), length of ICU and hospital stay, and time to return of bowel function. Results: Patients in the GDFT group received a significantly lower volume of crystalloids (mean 2400 ± 300 ml) compared to the conventional group (mean 3100 ± 400 ml, p < 0.001). The incidence of postoperative complications was also lower in the GDFT group (20%) compared to the conventional group (45%, p = 0.02). Mean ICU stay was 1.8 ± 0.6 days in the GDFT group versus 3.1 ± 1.1 days in the conventional group (p < 0.05), and the total hospital stay was reduced by an average of 2.5 days. Return of bowel function occurred earlier in the GDFT group (median: 2 days) compared to the conventional group (median: 3.5 days, p = 0.01). Conclusion: The use of intraoperative Goal-Directed Fluid Therapy in major abdominal surgeries was associated with improved hemodynamic stability, fewer postoperative complications, and shorter ICU and hospital stays. Incorporating GDFT protocols in perioperative care may enhance recovery and reduce healthcare burden

Background: Surgical site infections (SSIs) are among the most common postoperative complications, significantly contributing to morbidity, prolonged hospitalization, and healthcare costs. The risk of SSIs is influenced by multiple factors, including the urgency of the surgery. This study aimed to compare the incidence of SSIs in patients undergoing emergency versus elective laparotomies at a tertiary care hospital. Materials and Methods: A hospital-based cross-sectional study was conducted over a 6-month period in the Department of General Surgery. A total of 120 patients who underwent laparotomy were included, with 60 patients each in the emergency and elective surgery groups. Data on demographic characteristics, comorbidities, type of surgery, intraoperative findings, and postoperative complications were collected. Surgical site infection was defined according to CDC guidelines. All patients were followed up for 30 days postoperatively. Statistical analysis was performed using the chi-square test for categorical variables and t-test for continuous variables, with a p-value <0.05 considered statistically significant. Results: Out of 120 patients, 42 (35%) developed surgical site infections. The infection rate was significantly higher in the emergency group (28/60; 46.7%) compared to the elective group (14/60; 23.3%) (p=0.004). The mean age of patients in the emergency group was 47.3 ± 14.2 years, while in the elective group it was 43.5 ± 12.8 years. Other risk factors significantly associated with increased SSI rates included diabetes mellitus (p=0.031), duration of surgery >2 hours (p=0.021), and contaminated or dirty wounds (p=0.002). Conclusion: The study highlights a significantly higher incidence of SSIs in emergency laparotomies compared to elective procedures. This difference may be attributed to limited preoperative optimization, increased contamination risk, and operative urgency. Stringent perioperative protocols, especially in emergency settings, are essential to reduce SSI rates and improve surgical outcomes.

Background: Abutment selection in implant-supported prostheses critically influences peri-implant tissue health and long-term success. This study compares the clinical outcomes of single-use versus multiple-use abutment protocols. Aim: To evaluate the efficacy of single abutment ("one abutment, one time") versus multiple abutment changes on marginal bone loss, soft tissue parameters, and patient satisfaction. Materials and Methods: A prospective randomized clinical study was conducted on 40 patients receiving single posterior implants. Group A (n=20) received a definitive abutment at second-stage surgery, while Group B (n=20) underwent multiple abutment changes during prosthetic phases. Marginal bone loss was assessed radiographically; probing depth, bleeding index, and VAS satisfaction scores were recorded over six months. Statistical analysis was performed using independent t-tests (p<0.05). Results: Group A showed significantly lower bone loss (0.81 ± 0.20 mm) compared to Group B (1.20 ± 0.25 mm, p<0.001). Probing depth and bleeding index were also lower in Group A (p<0.001). Patient satisfaction was significantly higher in the single abutment group (VAS: 8.92 ± 0.73 vs. 7.84 ± 0.70, p<0.001). Conclusion: Single abutment use enhances peri-implant bone preservation, soft tissue health, and patient satisfaction. Minimizing abutment disconnection should be considered to optimize implant success.

Background: Dyslipidemia is a common metabolic abnormality in type 2 diabetes mellitus (T2DM) and a major risk factor for cardiovascular disease (CVD). Anthropometric measurements such as Body Mass Index (BMI) and Waist Hip Ratio (WHR) are commonly used as indicators of metabolic syndrome and cardiovascular risk. However, their predictive value for dyslipidemia in South Indian urban type 2 diabetics remains unclear. Objectives: This study aimed to evaluate whether anthropometric indices like BMI and WHR can predict dyslipidemia in urban South Indian type 2 diabetic patients. Methods: A cross-sectional study was conducted involving 387 type 2 diabetics and 1500 non-diabetic controls aged 35-65 years from urban Chennai. Anthropometric measurements and fasting lipid profiles were obtained. Dyslipidemia was defined per ATP III criteria. Statistical analysis compared lipid abnormalities across BMI categories between diabetics and non-diabetics. Results: 42.63% of type 2 diabetics exhibited dyslipidemia regardless of BMI status, including those with ideal body weight. In contrast, only 2.2% of non-diabetics had dyslipidemia, which increased with higher BMI. The prevalence of dyslipidemia in diabetics remained high across all BMI categories, indicating poor correlation between anthropometric measures and dyslipidemia. Conclusion: Anthropometric measurements do not reliably predict dyslipidemia in urban South Indian type 2 diabetics. Diabetes itself is a key determinant of dyslipidemia, necessitating comprehensive metabolic management beyond anthropometric risk stratification to prevent cardiovascular morbidity.

Background: Preservative-free 2-chloroprocaine is considered as a promising alternative compared to bupivacaine and lidocaine because of its, short-acting nature and absence of transient neurologic symptoms in surgical patients. The present study thus designed to investigate the effectiveness of intrathecal 2-chloroprocaine vs. bupivacaine for spinal anaesthesia in patients undergoing lower limb and lower abdominal surgery of short duration.  Methods: The case-control study involved patients (N=66) aged 18-65 years with ASA physical status I and II scheduled to undergo lower limb and lower abdominal surgery of short duration (<60 min) under spinal anaesthesia. Patients recruited received either preservative free 1% 2-chloroprocaine 40 mg (4 ml; n=33; cases) or 0.5% hyperbaric bupivacaine 10 mg (2 ml; n=33; controls) without any adjuvant medication. The parameters such as highest level of sensory blockade, duration of sensory block, duration of motor block, time to ambulate and micturate were recorded. Hemodynamic parameters such as heart rate and blood pressure changes and side effects/complications like hypotension and bradycardia were also recorded. Results: The mean age, gender, weight, height, ASA status, and type of surgery were identical in both cases and controls. Cases showed highest level of sensory block at T6 level (87.9% vs. 54.5%; P=0.003), faster onset of sensory block (146 min vs. 329 min) and motor block (76 min vs. 124 min), and early ambulation (223 min vs. 262 min) and micturition (269 min vs. 339 min) (all P<0.001). Side effects noted were comparable between cases and controls (P=0.549)

Conclusion: Intrathecal 40 mg preservative-free 1% 2-chloroprocaine produces a ⁠faster surgical block (sensory and motor) and faster block resolution when compared with 10 mg 0.5% hyperbaric spinal bupivacaine. Therefore 2- chloroprocaine can be used successfully for lower abdomen and lower extremity surgeries of short duration where early ambulation and micturition is possible due to quicker block resolution which further facilitates early hospital discharge.

Background: Fissure-in-ano is one of the most common benign anorectal disorders often encountered in surgical outpatient department. The management of this disorder includes non-operative and operative treatments. Study aimed to compare operative management lord’s anal dilatation (LAD) and lateral internal sphincterotomy (LIS) in the management of chronic anal fissure.  Material and Methods: This study was based on analysis of 20 patients with chronic fissure-in-ano who underwent treatment in Narendra modi medical college and LG hospital, Ahmedabad. These patients were divided into two equal groups based on operative management given; 10 patients were treated by Lord’s anal dilatation and 10 patients were treated by lateral internal sphincterotomy.  Results: Male to female ratio was 1.85:1. Most common presenting complaint was pain seen in 95% patients. When visual analogue scale was used 75% was having moderate pain and 25% was having severe pain. The second most presenting complaint was of bleeding per rectum; it was found in 70% of the patients. Sentinel tag at 6 o’clock position was seen in the majority (85%) patients and 10% anterior and multiple in 5% cases on presentation.

Background: Aim: Step-wise surgical management of triple congenital malformations – Infantile hypertrophic pyloric stenosis, Y type Urethral duplication and Anorectal Malformation. Case: 25 days old neonate presented with projectile vomiting post feeds since birth. On physical examination the perineum revealed passage of urine and stool from a single perineal opening at the base of scrotum with bifid scrotum and atretic native urethra. Ultrasonography of abdomen revealed a thickened pylorus and bilateral multicystic kidney. Child was diagnosed as a case of IHPS with YUD with perineal fistula (ARM). The child underwent 4 stage surgical repair – 1st open Ramsteadt pyloromyotomy with sigmoid colostomy, 2nd: Anterior Sagittal Anorectoplasty (ASARP), 3rd single stage urethroplasty and scrotoplasty, 4th- sigmoid colostomy closure. No complications occurred during the course of management. Conclusion: This is a first case report of YUD with ARM presenting with IHPS in the available literature as per our knowledge. As the exact etiopathogenesis of the above 3 anomalies is not exactly known, it is difficult to comment on whether these anomalies have a common cause. We emphasize on thorough physical examination of any neonate/ infant to look for anomalies before the management strategy is decided for any case. There are no defined management protocols for repair of YUD and each case must be managed individually as per the anatomical configuration.

Background: The ancient holistic science has described the human body with Marma, nadi, chakra, prana. It also deals with more sukshma level, digging deeper in the constitution of body, Avyata, Mahat, Atma, Chitta, Ahankara and Tanmatras1.These Tanmatras are the subtle form of Mahabhuta (Panchmahabhutas) by which the body is formed. Each Chakra is also formed through Tanmatra. Each chakra is related with particular action. The Shad chakras in classical literature are Mooladhara, Swadhisthana, Manipura, Anahata, Visudhha and Agyna2.  The literary meaning of Chakra is wheel but in yogic sciences, Chakras are energy vortex through which prana flows. Chakras are located in spinal cord and brain. The physical manifestation of chakras is considered as plexus present in the body. For example, Anahata chakra which is present in the chest region is correlated with superficial and deep cardiac plexuses3.  Material and methods: 120 patients of diabetes mellitus were divided into 2 groups and studied for a period of 3 months These Chakras regulates the normal functioning of physical body through energy flow, when energy flow is blocked it causes various diseases, for e.g yoga performed on abdominal vicinity affects through Manipura chakra4. Thus Manipura chakra affects the abdominal organs physiology, pathology and produce physical effect. A leading metabolic disease, diabetes mellitus is caused due to improper functioning of pancreas comes in the vicinity of Manipur chakra. Results: Chakra healing procedures like Manipura chakra meditation helps to restore the prana, which is interrupted, due to negative and stressful condition. When the prana flow is continuous in chakras through nadis (Ida, pingla, Saraswati), it balances the sympathetic and parasympathetic activities of body. When the flow is obstructed may be due to negative psychological stress, it has a significant impact on Neuroendocrine, Cardio vascular, Immune and Central nervous system. Psychological distress has the significant association with Diabetes mellitus. Conclusion: Manipura chakra meditation aims at physical, mental and emotional well being and may have significant role in reduction of physiological and pathological symptoms of diabetes mellitus.

Background: Chronic Obstructive Pulmonary Disease (COPD) is frequently complicated by systemic comorbidities, including obesity and type 2 diabetes mellitus (T2DM), which may influence disease progression and risk of exacerbations. Objective: To evaluate the prevalence of obesity and diabetes among COPD patients and determine their correlation with the frequency of acute exacerbations. Methods: A cross-sectional study was conducted on 200 clinically stable COPD patients at a tertiary care center. Data collected included body mass index (BMI), diabetic status, spirometry findings, and number of exacerbations in the past year. Statistical analysis involved correlation and logistic regression modeling. Results: Obesity (BMI ≥30) was observed in 26% of patients, and T2DM in 38%. Obese and diabetic patients had significantly higher mean annual exacerbations (2.7 ± 1.1 and 2.5 ± 1.0, respectively) compared to non-obese and non-diabetic counterparts (p<0.001). Multivariate analysis identified obesity (OR 2.14) and diabetes (OR 1.88) as independent predictors of frequent exacerbations. Conclusion: Obesity and diabetes are highly prevalent in COPD and significantly increase the risk of exacerbations. Integrated management strategies targeting metabolic comorbidities may reduce COPD burden and improve patient outcomes.

Background: Hyperbilirubinemia is a common neonatal condition and a leading cause of morbidity, particularly in preterm infants. While phototherapy and exchange transfusion have reduced severe cases, the long-term neurodevelopmental impact of neonatal hyperbilirubinemia remains a concern. This study aimed to evaluate the neurodevelopmental outcomes of neonates with hyperbilirubinemia and to assess the correlation between the various outcomes including hearing abnormalities and developmental delay.  Materials and Methods: This hospital-based prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of Chacha Nehru Bal Chikitsalaya, Delhi. 60 neonates with hyperbilirubinemia requiring phototherapy or exchange transfusion were included. Detailed antenatal, perinatal, and postnatal histories were recorded. Bilirubin levels were assessed using the Jendrassik-Grof method. Neurodevelopmental assessment was performed using the Developmental Assessment Scales for Indian Infants (DASII) at admission, discharge, and at 3 and 6 months. Hearing assessment was conducted using otoacoustic emissions (OAE) and Brainstem Evoked Response Audiometry (BERA). Results: In our study, neonates with serum bilirubin levels >25 mg/dL had significantly lower motor (73.6 ± 25.0) and mental development quotients (77.5 ± 23.7) compared to those with lower bilirubin levels (p<0.001). Abnormal BERA findings were detected in 6.7% of neonates, with a raised threshold of wave V being the most common abnormality. Among neonates with neurodevelopmental abnormalities, 8.3% showed MRI changes, predominantly bilateral symmetric high signal areas in the globus pallidus on T2-weighted images. While 96.2% of neonates receiving phototherapy had normal neurological examinations, 57.1% of those requiring exchange transfusion exhibited neurodevelopmental impairments (p<0.05). Conclusion: Severe hyperbilirubinemia (>25 mg/dL) is associated with significant neurodevelopmental and auditory impairment, highlighting the need for early detection and intervention. This study underscores the importance of vigilant monitoring and timely management to prevent long-term complications.

Background: Scrub typhus, caused by Orientiatsutsugamushi, presents with diverse clinical manifestations. This study aimed to identify distinct predictors for mortality versus prolonged hospitalization and develop simplified risk stratification tools in Southern Assam, India. Methods: We conducted a prospective study of 80 hospitalized adults with confirmed scrub typhus. Severe outcomes were defined as mortality and prolonged hospitalization (>7 days). Multivariate logistic regression was used to develop separate predictive models for each outcome. Results: The mortality rate was 7.5% while 33.8% required prolonged hospitalization. Multi-organ dysfunction affected 41.3% of patients, predominantly hepatic (73.8%) and renal (38.8%) systems. Independent predictors of mortality included sepsis (OR = 40.85), elevated creatinine (OR = 17.12), altered sensorium (OR = 16.61), and leukocytosis (OR = 14.44), with mortality increasing dramatically with involvement of ≥3 organ systems. Prolonged hospitalization was predicted by a distinct profile: sepsis (OR = 7.03), altered sensorium (OR = 5.16), elevated bilirubin (OR = 4.76), leukocytosis (OR = 3.94), and elevated creatinine (OR = 2.89). Novel risk scores derived from these models showed excellent discrimination (AUC = 0.924 for mortality, AUC = 0.911 for prolonged hospitalization) and strong internal validation. Conclusion: This study demonstrates that different pathophysiological mechanisms drive mortality versus prolonged hospitalization in scrub typhus. The simplified risk scores enable rapid identification of high-risk patients requiring intensive intervention and facilitate resource allocation decisions in endemic regions. Implementation of these tools could improve triage accuracy, guide management intensity, and potentially reduce both mortality and healthcare resource utilization.

Background: Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine disorder among women of reproductive age group, characterized by hyperandrogenism, menstrual irregularities and various metabolic dysfunction. Understanding of these biochemical variations in women with PCOS and without PCOS is pivotal for development of targeted and effective therapeutic strategies. Aim & Objective: This study aims to compare the biochemical profile with emphasis on hormonal parameters of women with PCOS and those without PCOS.  Methods: A cross-sectional observational study was conducted over a duration of eight months in Department of Obstetrics and Gynaecology (Zanana Hospital), J.L.N Medical College and Attached Group of Hospitals. Atotal of 120 women between ages of 18–40 years were divided into two groups: 60 with PCOS (diagnosed per Rotterdam Criteria) and 60 without PCOS. Datawerecollected on day 3–7 of the menstrual cycle. Parametersassessed were hormonal levels (FSH, LH, Testosterone, and Prolactin) Results: The study undertaken revealed that women with PCOS exhibited significantly higher LH (11.83 ± 7.1 IU/mL vs. 7.34 ± 2.23 IU/mL, p < 0.0001), Testosterone (1.24 ± 0.6 ng/mL vs. 0.51 ± 0.31 ng/mL, p < 0.0001), LH/FSH ratio (1.88 ± 0.35 vs. 1.26 ± 0.11, p < 0.0001) Conclusion: Women with PCOS demonstrate distinct biochemical alterations, which particularly include hormonal imbalances. These findings emphasize the need for comprehensive monitoring in PCOS patients to mitigate associated risks and plan therapeutic interventions accordingly

Background: In this regard, a “Collaborative framework for care and control of tuberculosis and diabetes” has been outlined most recently by WHO and the International Union against Tuberculosis and Lung Diseases. Materials and Method: The study conducted in Sambhram Institute of medical sciences and Research, KGF, Karnataka a tertiary care hospital. The study was approved by Institutional Ethical clearance (IEC no:-SIMSAR/Ethics/Proc.No.36/2022).  Results: A total of 761 patients with tuberculosis symptoms were retrospectively analysed in this study. Among 761 patients 128 (16.82%) patients are known Diabetic and 633 (83.18%) patients were non-diabetic. Diabetic and Non-diabetic group patient’s sputum samples were processed prospectively for MTB detection and Rifampicin susceptibility by Gene-Xpert MTB/Rif assay. Conclusion: Individuals with diabetes have a 3.6 times higher likelihood of acquiring tuberculosis (TB) infection compared to those without diabetes. The precise mechanisms responsible for this increased susceptibility to TB remain relatively unclear and require further investigation.

Background: The primary objective of this study was to investigate the diagnostic efficacy and longitudinal clinical utility of high-resolution sonography in the comprehensive assessment, therapeutic guidance, and post-treatment monitoring of congenital talipes equinovarus in infants. Methodology: This prospective, observational study was conducted over a two-year period. A total of 52 children age of 0-18 months were consecutively enrolled and subjected to comprehensive clinical examination, followed by high-resolution sonographic evaluation utilizing a 7–12 MHz linear transducer. Standardized imaging protocols focused on the assessment of tarsal bone alignment, navicular displacement, Achilles tendon morphology, and subtalar joint congruity. Only idiopathic, untreated cases with complete clinical and imaging data were included in the final analysis. Results: Of the 52 study subjects (Children age 0-18 months) screened, 10 were confirmed to have idiopathic clubfoot based on an integrated clinical and ultrasonographic assessment. Bilateral deformities were identified in 50% of cases, while the remaining presented with unilateral involvement. Sonographic evaluation consistently revealed medial displacement of the navicular and pathological widening of the talo-navicular angle in all cases (100%). Additional findings included Achilles tendon hypertrophy in 90% of cases, reduced subtalar congruency in 80%, and restricted dynamic mobility of tarsal bones in 80%. Following conservative management using the Ponseti method, post-treatment sonographic measurements demonstrated statistically significant improvements. The mean talo-navicular angle was reduced from 48.2° ± 5.4° to 27.5° ± 4.1°, and the calcaneal inclination angle increased from 10.3° ± 2.1° to 18.6° ± 2.5° (p < 0.001 for both). Achilles tendon thickness decreased notably from 3.9 ± 0.7 mm to 2.2 ± 0.4 mm. Anatomical correction and functional normalization were achieved in 90% of cases, with post-treatment ultrasound confirming structural realignment in all patients. Conclusion: Ultrasonography proved to be an invaluable diagnostic and monitoring tool in the management of CTEV, offering high sensitivity in detecting both osseous and soft tissue abnormalities. The modality’s ability to provide real-time, radiation-free visualization facilitated early diagnosis, guided therapeutic interventions, and enabled the detection of subtle anatomical changes predictive of relapse. These findings underscore the integral role of sonographic imaging in optimizing clinical outcomes and reinforcing precision-based care in the early management of congenital clubfoot.

Background: Urticaria is a diverse skin condition characterized by raised, red patches of erythema, accompanied by itching and swelling. The lesions usually emerge and disappear on their own, without leaving any scars. Objective: To evaluate the quality of life in patients of Chronic Urticaria. Methods: This cross-sectional study was conducted among all patients of chronic urticaria coming in the OPD in Department of Dermatology, Venereology and Leprosy, Rohilkhand Medical College, Bareilly, Uttar Pradesh. Duration of study was one year from August 2023 - July 2024. Result: Majority of our patients were females and constitute (64.7%) of the cases, the average patient age was 35.6 years and the common age group was 21- 40 year. In this study of 300 cases, (20.0%) of them were housewives, (71%) were married and (60%) the level of education was low. Stress has been reported as an important aggravating factor (80%) and drugs like aspirin, paracetamol and ibuprofen (20%) have also been implicated. Conclusion: Symptoms and feelings are the most affected part assessed in our patients followed by work and school and no statistically significant correlation was found between QOL scores and disease duration, associated angioedema or disease severity.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common comorbidity among elderly patients undergoing total hip or knee arthroplasty. While COPD is known to increase perioperative risks, its influence on postoperative functional recovery is not clearly understood. Aim of the study was to evaluate the functional outcomes in COPD patients undergoing hip or knee arthroplasty and assess the relationship between baseline pulmonary function and postoperative recovery. Material and Methods: This prospective observational study included 50 COPD patients undergoing elective total hip or knee arthroplasty at the Departments of Pulmonary Medicine and Orthopaedics. Baseline assessments included spirometry (FEV₁%, FVC, FEV₁/FVC), mMRC dyspnea scale, COPD Assessment Test (CAT), 6-Minute Walk Test (6MWT), and Barthel Index. Postoperative outcomes were assessed at discharge, 6 weeks, and 3 months, including pulmonary complications, hospital stay, time to mobilization, and repeated functional assessments. Statistical analysis included Kruskal-Wallis tests for group comparisons and Pearson’s correlation for continuous variables. Results: The mean FEV₁% predicted was 51.6 ± 10.9%. Functional measures (6MWT and Barthel Index) improved significantly over the 3-month period. No statistically significant differences in functional recovery were found between different COPD severity groups. Pearson’s correlation showed weak and non-significant associations between FEV₁% and 6MWT distance (r = –0.03, p = 0.8223), FEV₁% and Barthel Index (r = 0.08, p = 0.5670), and CAT score with hospital stay (r = 0.11, p = 0.4407). Conclusion: COPD patients undergoing joint arthroplasty show meaningful functional improvement postoperatively, independent of baseline pulmonary function severity. COPD status alone may not be a limiting factor for rehabilitation if managed appropriately. Comprehensive perioperative planning and tailored rehabilitation remain essential for optimal recovery.

Background: Chronic Obstructive Pulmonary Disease (COPD) is increasingly recognized as a systemic illness with significant comorbidities, including osteoporosis. The association between declining pulmonary function, corticosteroid use, and fracture risk remains underexplored in the Indian population. Aim of the study was to assess bone mineral density (BMD) and 10-year fracture risk in COPD patients, and to examine associations between osteoporosis, pulmonary function, corticosteroid use, and other clinical parameters. Material and Methods: A cross-sectional study was conducted among 75 COPD patients in the Departments of Pulmonary Medicine and Orthopedics at a tertiary care hospital. BMD was measured using DEXA at the lumbar spine and femoral neck. Fracture risk was calculated using the FRAX (India) tool. Spirometry assessed COPD severity, and functional status was evaluated using the mMRC dyspnea scale. Chi-square tests and Pearson correlations were used to examine associations. Multiple linear regression was performed to identify predictors of fracture risk. Results: Osteoporosis was observed in 38.6% of patients, and osteopenia in 42.7%. The mean 10-year FRAX risk was 16.4% for major osteoporotic fractures and 4.8% for hip fractures. Significant positive correlations were found between age and fracture risk (r = 0.758), steroid duration and FRAX score (r = 0.843), and negative correlations between FEV1% and BMD (r = 0.893). Regression analysis showed that age, BMI, FEV1%, steroid use, and mMRC grade were significant predictors of fracture risk (adjusted R² = 0.76). Conclusion: There is a high prevalence of osteoporosis and elevated fracture risk among COPD patients, especially those with severe airflow limitation and prolonged corticosteroid use. Routine BMD assessment and fracture risk evaluation should be integrated into the comprehensive management of COPD.

Background:  Combined endo-periodontal lesions present a significant therapeutic challenge due to the involvement of both pulp and periodontal tissues. Advanced platelet-rich fibrin (A-PRF), owing to its regenerative properties, and guided tissue regeneration (GTR), using barrier membranes, are modern strategies aimed at enhancing healing and improving clinical outcomes. This study aimed to evaluate and compare the effectiveness of A-PRF and GTR in the clinical management of primary endodontic lesions with secondary periodontal involvement.  Materials and Methods:  A randomized clinical trial was conducted on 30 patients diagnosed with combined endo-perio lesions in single-rooted teeth. Patients were randomly divided into two groups: Group A (n=15): Received endodontic therapy followed by placement of A-PRF in the periodontal defect. Group B (n=15): Received endodontic therapy followed by GTR using a resorbable collagen membrane. Clinical parameters such as probing depth (PD), clinical attachment level (CAL), and radiographic bone fill were assessed at baseline and at 6 months post-treatment. Data were analyzed using SPSS version 25.0, and significance was set at p<0.05.  Results:  At 6 months, both groups demonstrated significant improvements in clinical parameters. Group A showed a mean PD reduction of 4.1 ± 0.7 mm, CAL gain of 3.6 ± 0.5 mm, and radiographic bone fill of 68.2 ± 5.3%. Group B showed a PD reduction of 3.4 ± 0.6 mm, CAL gain of 2.9 ± 0.4 mm, and bone fill of 56.7 ± 4.9%. The differences were statistically significant in favor of Group A (p<0.05).  Conclusion:  A-PRF demonstrated superior clinical and radiographic outcomes compared to GTR in the management of combined endo-perio lesions. Its autologous origin, cost-effectiveness, and growth factor release make it a promising regenerative approach for such lesions.

Background: Intussusception is the most common cause of acute intestinal obstruction in infants and young children. It involves the telescoping of one intestinal segment into another, potentially leading to ischemia and necrosis if untreated. This study aimed to evaluate the clinical profile, types, and management of intussusception in children less than five years of age at a tertiary care center in Northeast India. Materials and Methods: A retrospective descriptive study was conducted at Assam Medical College and Hospital between December 2021 and November 2024. Data from 51 pediatric patients diagnosed with intussusception based on radiological and surgical findings were analyzed.  Results: The median age of presentation was 14 months, with a male predominance (74.5%). The most common clinical features were vomiting (80.4%) and abdominal pain (72.55%). Ileo-colic intussusception was the predominant type (80.4%). Pneumatic reduction was successful in 49.02% of cases, while 50.98% required surgical intervention. Timely diagnosis using ultrasound significantly aided in reducing the need for extensive surgery and improving outcomes. Conclusion: Early diagnosis and intervention are vital in managing pediatric intussusception effectively. Non-surgical reduction techniques are successful in many cases; however, delayed presentation often necessitates surgical management. Strengthening pediatric diagnostic facilities can further reduce complications and mortality associated with intussusception.

Background: Aim: This study aims to explore the relationship between clinical assessment, ultrasound (USG), and Doppler studies in diagnosing Fetal Growth Restriction (FGR) among pregnant women. FGR is a significant cause of perinatal morbidity and mortality, and the study aims to assess the diagnostic accuracy of these methods to improve antenatal care, particularly in underserved areas. Material and Methods: This prospective study was conducted at Dr Rajendra Gode Medical College and Hospital, Amravati, from January 2024 to June 2024. The study included 125 women with singleton pregnancies, gestational age of 24 weeks or more, and a longitudinal lie and clinical assessment of intrauterine growth restriction of fetus. Around 25 patients were lost to follow up. So, the study was carried out for 100 patients. Participants underwent clinical assessments, ultrasound for fetal measurements, and Doppler studies to assess blood flow and placental function. Data were analyzed using SPSS software, and sensitivity, specificity, and predictive values were calculated for both diagnostic methods. Results: Of the 100 participants, 41 were confirmed to have FGR at birth, while 59 were not. Ultrasound findings suggested FGR in 35 cases, and Doppler changes were present in 54 cases. Significant correlations were observed between clinical findings, USG, and Doppler studies, with Doppler studies showing the highest diagnostic accuracy (90.2% sensitivity, 95.1% specificity). The p-values for the correlation between USG findings and Doppler changes were <0.001, indicating statistically significant associations. Conclusion: Doppler studies demonstrated the highest diagnostic accuracy for FGR detection, with ultrasound serving as a valuable complementary tool. Combining clinical, ultrasound, and Doppler assessments offers the most accurate method for diagnosing FGR, crucial for improving neonatal outcomes and reducing perinatal mortality in resource-constrained settings.

Background: Quality control (QC) in hematology is crucial for ensuring the accuracy and reliability of test results, which are integral for patient diagnosis and management. Traditionally, commercial control materials are used, but they may not fully represent the variability encountered in patient samples. Objective: This study aims to evaluate the effectiveness of using patient samples as an alternative to commercial controls for quality control in hematology analyzers. Methods: A comparative analysis was conducted involving 200 patient samples alongside commercial controls. The study assessed several parameters including calibration accuracy, error rates, analyzer downtime, sample rejection rates, and maintenance frequency. Statistical tests such as t-tests were used to determine the significance of differences between the use of patient samples and commercial controls. Results: The use of patient samples resulted in higher calibration accuracy (96% vs. 90%, p=0.02) and lower error rates (4% vs. 10%, p=0.01). Furthermore, analyzer downtime and sample rejection rates were significantly reduced when patient samples were used (8% vs. 15%, p=0.04 and 2% vs. 9%, p<0.001, respectively). Maintenance frequency also decreased (18% vs. 30%, p=0.005). Conclusion: The findings suggest that patient samples can serve as a viable and potentially superior alternative to commercial controls for quality control in hematology analyzers. They offer a more realistic assessment of analyzer performance, leading to improvements in test reliability and operational efficiency.

Background: Fractures of the humeral shaft represent a significant challenge in orthopedic trauma due to their complex anatomical and biomechanical characteristics. Two widely accepted surgical interventions—Dynamic Compression Plating (DCP) and Intramedullary Nailing (IMN)—are commonly utilized, each with distinct benefits and drawbacks. Aim: To compare the clinical outcomes, union rates, complication profiles, and functional recovery of patients aged 50 to 80 years undergoing surgical management of humeral diaphyseal fractures using either DCP or IMN. Methods: This prospective observational study was conducted at a tertiary care centre and included 50 patients aged 50–80 years who were treated for diaphyseal fractures of the humerus, with 25 receiving DCP and 25 undergoing IMN. Patients were followed up for a period of 6 months postoperatively, and data were collected on union times, functional scores (Constant-Murley and DASH), and complications. Results: Union rates were 92% for DCP and 88% for IMN. The average time to union was shorter in the IMN group (14.8 weeks) compared to the DCP group (16.1 weeks). Functional outcomes were marginally better in the DCP group at 6 months, with a higher mean Constant-Murley score. Complications such as shoulder impingement were more common in the IMN group, whereas wound-related complications were slightly higher in the DCP group. Conclusion: Both techniques are effective, but the choice should be individualized based on fracture pattern, soft tissue condition, and surgeon expertise. DCP may offer better functional results, while IMN provides shorter operative time and lesser soft tissue disruption.

Background: Chest pain is a common cause of presentation to emergency departments (EDs), with acute coronary syndrome (ACS) being one of the most critical conditions to rule out. While ACS can be difficult to diagnose based on initial evaluations, the role of electrocardiography (ECG) and cardiac biomarkers remains essential in identifying at-risk patients.  Objectives: The primary objective of this study was to assess the incidence of ACS among patients presenting with chest pain and normal initial ECG. Secondary objectives included evaluating the diagnostic value of cardiac biomarkers, non-invasive imaging, and clinical scoring systems for risk stratification and safe discharge planning. Materials and Methods: This was a cross-sectional, hospital-based follow-up observational study conducted at Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala. A total of 160 patients aged 30 years or older, presenting with acute chest pain and a normal ECG, were enrolled. Patients were assessed using cardiac biomarkers (troponin-I), echocardiography, and repeated ECGs. The HEART score was used for risk stratification. Data analysis was performed using SPSS version 20.0. Results: Of the 160 patients, 26 (16.3%) were diagnosed with ACS, including 9 cases of non-ST-elevation ACS (NSTEACS) and 17 cases of unstable angina. Risk factors such as smoking, hypertension, diabetes, and dyslipidemia were prevalent in the study population. Echocardiography revealed regional wall motion abnormalities (RWMA) in 5 patients, mitral regurgitation in 4 patients, and systolic dysfunction in 3 patients. Conclusion: This study highlights the importance of using a combination of ECG, cardiac biomarkers, echocardiography, and clinical scoring systems in the diagnosis and management of chest pain patients with normal initial ECG. The HEART score was particularly effective in identifying patients at intermediate and high risk for ACS, guiding appropriate management strategies.

Background: Objectives: To compare the efficacy, safety, and patient satisfaction of fractional carbon dioxide (CO₂) laser versus microneedling in treating atrophic facial acne scars. Materials and Methods: A prospective comparative study was conducted on 50 patients aged 18–35 years with Goodman and Baron Grade 2 or 3 atrophic acne scars and Fitzpatrick skin types III to V. Patients were randomized into two groups (n=25 each): Group A received four monthly sessions of fractional CO₂ laser, while Group B underwent microneedling with a 1.5 mm dermaroller. Outcomes were assessed two months post-treatment using the Goodman and Baron Qualitative Scar Grading System and Visual Analogue Scale (VAS) for satisfaction, and documentation of adverse effects, including pain, pigmentation, and downtime. Results: Both groups showed significant scar improvement. One-grade improvement was seen in 84% (CO₂ laser) and 72% (microneedling) patients. Two-grade improvement was more frequent with CO₂ laser (16% vs. 12%) but not statistically significant. Mean VAS satisfaction scores were similar (7.8 vs. 7.5). Post-inflammatory hyperpigmentation (20% vs. 4%), downtime >3 days (40% vs 16%), and mean pain score (5.6 vs 4.1) were significantly higher in the CO₂ laser group. Conclusion: Both treatments are effective for atrophic acne scars. CO₂ laser offers superior improvement, while microneedling is safer, better tolerated, and more suitable for darker skin types.

Background: The aim of this study is to evaluate different platelet function disorders in patients with bleeding history referred to CIIHO Hospital, Nagpur by Light transmission aggregometery (LTA) using a panel of agonists. Results obtained by LTA were confirmed by experienced Hematopathologist with clinical and laboratory correlation. Material & Methods: The PFT was performed on patients by light transmission aggregometry on Chronolog 492D platelet aggregometer using platelet rich plasma. The panel of agonists included ADP (5μm/l and 2.5 μm/l), collagen (2μg/ml) and ristocetin (1.25 mg/ml). Results: Total 153 cases were studied in 8 years, out of which platelet function abnormality was found in 32.02% (49/153) cases and 1.3 (2/153) were with defective aggregation. Remaining were normal studies. Diagnosed cases included Glanzmann Thromboasthenia(GT)-13, vonWillebrand Disease(VWD)-4, Bernard Soulier’syndrome(BSS)-1, storage pool disorder(SPD)-17, defect with drug aspirin -14. Conclusion: Platelet function disorders represent the significant fraction of all bleeding diathesis. This article will help to make awareness amongst clinicians that suspected platelet function disorders should be promptly investigated to come to conclusion.

Background: Blunt cerebrovascular injury (BCVI) refers to a spectrum of uncommon but potentially catastrophic injuries to the intracranial and extracranial carotid and vertebral due to blunt trauma. While the reported incidence appears to be rising as diagnostic modalities advances, these injuries are often diagnosed only after patients have developed acute neurologic deficits. Improving awareness of blunt cerebrovascular injuries and using computed tomography angiography to pre-screen patients at high risk is recommended by current guidelines to prevent the occurrence of ischemic stroke or transient ischemic attack complications. This case emphasizes the need for increased apprehension of a potentially debilitating and disastrous disease process. A high index of speculation is thus required among emergency medicine physicians for early diagnosis and treatment of trauma patients with BCVI.

Introduction: Splanchnic vein thrombosis (SVT) is a significant yet frequently underrecognized vascular complication that can arise in patients with acute pancreatitis (AP). SVT, which involves thrombosis of veins in the splanchnic circulation, can exacerbate the clinical course of AP and negatively impact patient prognosis. Despite its potential implications, the incidence, clinical manifestations, and underlying mechanisms linking SVT to AP remain poorly understood. This study aims to evaluate the incidence, patterns, and clinical associations of SVT in patients with AP, with the goal of improving early recognition, management, and outcomes in this at-risk population. Materials and Methods: A cross-sectional study was carried out at Victoria Hospital, BMCRI, Bengaluru, from June 2023 to June 2024. 426 patients diagnosed with AP as per the Revised Atlanta Criteria were evaluated. All underwent contrast-enhanced CT (CECT) of the abdomen to assess for SVT. Data on demographics, severity of AP, and etiology were collected and analyzed. Results: Out of 426 patients with acute pancreatitis, 43 patients (10.1%) developed SVT. Among them, Splenic Vein Thrombosis (34 cases; 79.1%) was most common, followed by Portal Vein Thrombosis (18 cases; 41.8%) and Superior Mesenteric Vein Thrombosis (17 cases; 39.5%), with some patients showing multi-vessel involvement. SVT occurred more frequently in cases of moderately severe and severe pancreatitis. Alcohol was the leading etiological factor among SVT patients. Most cases were managed conservatively, with selective use of anticoagulation. No mortality was directly attributed to SVT. Conclusion: SVT is a relatively common complication in acute pancreatitis, particularly in more severe cases and those with alcohol-related etiology. Early imaging and risk stratification are essential for timely diagnosis and effective management. Further prospective studies are needed to establish standardized protocols.

Background: Ischemic stroke is a major public health concern globally, with a disproportionately high burden in developing countries like India. It accounts for significant morbidity, mortality, and socioeconomic loss, with modifiable risk factors playing a crucial role in its occurrence and outcome. Methods: This prospective, observational study included 100 consecutive adult patients with radiologically confirmed ischemic stroke admitted to a tertiary care hospital in Navi Mumbai over 18 months. Baseline demographic, clinical, and risk factor data were collected. Stroke severity was assessed using the NIHSS at admission, and patients were followed for clinical outcomes (discharge or death). Data were analyzed using IBM SPSS Statistics, with chi-square tests applied to assess associations. Results: The mean age was 60.08 ± 12.95 years; 71% were male. Most patients were in the 51–70 year age group. Hypertension (54%), smoking (35%), diabetes (29%), and alcohol consumption (32%) were the most prevalent risk factors. Motor deficits (95%), speech involvement (76%), and cranial nerve palsies (74%) were the most common clinical features. Most strokes were of moderate severity (mean NIHSS 10.3). Mortality was 30%, with higher NIHSS scores, altered sensorium, cranial nerve involvement, and cerebellar signs significantly associated with death (p < 0.05), whereas traditional risk factors were not. Conclusion: The study underscores the predominance of modifiable risk factors among ischemic stroke patients and highlights the importance of early neurological assessment. Outcomes are more closely linked to severity and clinical features at presentation than to baseline vascular risk factors. These findings emphasize the need for targeted preventive strategies and timely intervention in stroke care.

Background: Sepsis remains a critical cause of morbidity and mortality globally, with delayed diagnosis and risk stratification contributing to poor outcomes. Serum lactate, a marker of tissue hypoxia, has emerged as a valuable prognostic biomarker in sepsis, with rising and persistently elevated levels correlating with increased mortality. While lactate is integrated into international guidelines, Indian data validating its utility in sepsis prognostication remains limited. Objectives: To assess the prognostic value of serum lactate levels measured at admission and 72 hours in predicting in-hospital mortality among sepsis patients and to correlate these values with APACHE II scores for risk stratification. Methods: This prospective observational study was conducted over 12 months at the Department of General Medicine, GMERS Medical College and General Hospital, Himmatnagar. A total of 87 adult patients with sepsis, diagnosed per Sepsis-3 criteria and admitted to the ICU, were enrolled. Serum lactate levels were measured at admission and 72 hours, and APACHE II scores were calculated on admission. Patients were followed until discharge or in-hospital death. Statistical analysis was performed using SPSS version 20, with p < 0.05 considered significant. Results: The mean age of patients was 50.9 ± 16.3 years, with a mortality rate of 47.1%. Non-survivors had significantly higher APACHE II scores (21.7 vs. 19.0, p = 0.013) and elevated lactate levels at admission (6.4 ± 4.0 vs. 3.5 ± 1.6 mmol/L, p < 0.001) and at 72 hours (6.1 ± 4.5 vs. 3.0 ± 1.6 mmol/L, p < 0.001). A lactate threshold of ≥4 mmol/L showed strong prognostic significance, with mortality peaking at 70.3% in this group (p = 0.007). ROC analysis revealed that lactate at 72 hours had the highest predictive accuracy (AUC = 0.745) compared to admission lactate and APACHE II. Combining lactate with APACHE II did not improve prognostic performance. Conclusion: Serial serum lactate measurements, especially persistent elevation at 72 hours, are reliable and independent predictors of mortality in sepsis. Compared to APACHE II, lactate levels demonstrated superior prognostic performance, supporting their inclusion in early risk assessment and guiding clinical decisions in resource-limited settings.

Background: Acute appendicitis is among the most common causes of emergency abdominal surgeries worldwide. Despite advancements in diagnostic modalities, the condition often poses clinical challenges due to its variable presentation and risk of negative appendectomies. This study aimed to evaluate the clinical presentation, diagnostic approaches, and outcomes of acute appendicitis at a tertiary care center in northern India. Methods: A prospective observational study was conducted involving 200 adult patients (≥18 years) who underwent appendectomy for suspected acute appendicitis. Clinical assessments, abdominal ultrasound, intraoperative findings, and post-operative outcomes were recorded and analyzed. Ultrasound findings were categorized as definite, probable, or normal based on predefined criteria. Associations between symptom duration, disease severity, and complications were statistically assessed. Results: The majority of patients (63.9%) were male, with a mean age of 27.6 ± 8.6 years. Half of the cases were aged 18–25 years. Abdominal ultrasound identified definite appendicitis in 145 patients, correlating well with intraoperative findings. Patients presenting after ≥48 hours had a significantly higher rate of complicated appendicitis (43.2%). The overall post-operative complication rate was 4.5%, with superficial surgical site infections being most common. Conclusion: Acute appendicitis predominantly affects young males and is most effectively managed with early diagnosis and intervention. Delayed presentation increases the risk of complications. Abdominal ultrasound serves as a useful adjunct in diagnosis, and a low rate of postoperative complications highlights the effectiveness of prompt surgical treatment.

Background:Anemia of Chronic Disease (ACD) is the second most common form of anemia after Iron Deficiency Anemia (IDA), often complicating chronic infections, inflammatory disorders, and malignancies. Differentiating between ACD and IDA is critical for appropriate management, especially in patients with hemoglobin levels below 10 g/dL. Methods: A cross-sectional study was conducted at R.D. Gardi Medical College and Civil Hospital, Mandsaur, involving 100 patients aged 30–45 years with hemoglobin <10 g/dL. Clinical history, physical examinations, and laboratory investigations—including serum ferritin, CRP, liver and renal function tests—were used to differentiate between IDA and ACD. Descriptive statistics were used for analysis. Results: Among the participants, 87% were aged 30–45 years and 80% were female. ACD was more prevalent (58%) than IDA (42%). Within ACD cases, chronic infections accounted for 40%, cancer for 28%, autoimmune diseases for 10%, chronic kidney disease for 7%, and other chronic conditions for 15%. Conclusion: ACD was the predominant anemia type in this cohort, highlighting the significant burden of chronic diseases in the population. The findings call for improved diagnostic protocols and targeted interventions, especially among women and individuals in the productive age group.

Introduction:  Organophosphate (OP) compounds are extensively used as pesticides, particularly in agricultural regions, and are a significant cause of worldwide poisoning. The toxicity primarily results from inhibiting acetylcholinesterase enzyme, causing the accumulation of acetylcholine at synapses and manifesting as a characteristic cholinergic toxidrome. While plasma cholinesterase levels have been traditionally used to confirm exposure and assess severity, their correlation with clinical outcomes is not always consistent. This study aimed to “correlate serum potassium and plasma cholinesterase levels with the clinical severity of acute organophosphate poisoning. Methods: This prospective study was conducted at Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, from May 2023 to December 2024. A total of 83 patients with acute organophosphate poisoning were included. A detailed clinical assessment, including Glasgow Coma Scale (GCS) scoring and pupillary examination, was performed upon admission. Serum potassium and plasma cholinesterase levels were measured at admission and after 24 hours. Patients were classified as having severe or non-severe poisoning based on clinical parameters and requirements for mechanical ventilation. Statistical analysis assessed the correlation between biochemical markers and poisoning severity. Results: Patients with severe poisoning initially had significantly lower serum potassium levels at 24 hours compared to non-severe cases. Similarly, plasma cholinesterase levels were substantially lower initially and at 24 hours in severe cases. A significant positive correlation was observed between serum potassium and acetylcholinesterase levels in severe (r=0.675, p=0.001) and non-severe (r=0.582, p=0.003) poisoning cases.  Conclusion: Serum potassium levels significantly correlate with the severity of acute organophosphate poisoning, comparable to the established marker plasma cholinesterase.” Combining these biochemical parameters with clinical indicators like GCS scores and pupillary changes provides a comprehensive approach to severity assessment.

Background: According to the World Health Organization, RTAs are projected to become the third leading cause of death by 2020, with low and middle-income countries bearing the brunt of this burden. Aim of the study: To study the otorhinolaryngological manifestations of Road traffic accident patients, by revealing the patterns of injury and their correlation with head trauma severity. Material & methods: This cross-sectional study was conducted among 147 patients involved in road traffic accidents with Otorhinolaryngological injuries who visited the hospital during the study period of 18 months. A detailed history and clinical examination were conducted, and findings were recorded in a proforma. The collected data were analysed to establish correlations between the severity of injuries and GCS scores. Data was entered into Microsoft Excel version 17 and analysed utilizing Statistical Package for Social Sciences (SPSS). The quantitative data, if required was analysed using independent student’s t test, p<0.05 was be considered as level of statistically significant. Results: Self-falls from vehicles were the most common cause of road traffic accidents for both females (63.77%) and males (69.23%). The most common fracture was maxillary, accounting for 68.7% (101 cases), followed by zygomatic fractures at 23.8% (35 cases). Le-Fort fractures were also common, with type 1 at 41.5% (61 cases), type 2 at 22.4% (33 cases), and type 3 at 4.8% (7 cases). The mean eye response score was 3.51 with a standard deviation of 0.51. The motor response had a mean of 5.47 and a standard deviation of 0.51. The GCS Score in Moderate (9-12) had 56 cases, having Prevalence of 38.1%. Conclusion: The present study highlights the epidemiological and clinical characteristics of road traffic accident (RTA) cases, emphasizing the high prevalence among young males and the significant burden of facial and skeletal injuries. These findings underscore the substantial burden of facial and skeletal injuries in RTA patients, particularly among young males, and emphasize the need for preventive measures, early diagnosis, and timely intervention to reduce morbidity and improve patient outcomes.

Background: Hair loss is a prevalent dermatological concern, mainly associated with androgenetic alopecia (AGA). Platelet-rich plasma (PRP) and microneedling have emerged as promising minimally invasive therapies. However, limited data exists regarding their combined efficacy in enhancing hair regrowth outcomes. Objective: This study aimed to evaluate the synergistic effects of PRP and microneedling in hair regrowth compared to PRP alone and Microneedling alone, focusing on hair density improvement, follicular regeneration, and patient satisfaction. Methods: A randomized controlled study was conducted at two tertiary care centres in North India over a period of one year. A total of 60 participants with androgenetic alopecia (AGA) were allocated into three groups: PRP + Microneedling (n=40), PRP Alone (n=30), and Microneedling Alone (n=30). Baseline and post-treatment assessments included hair density measurements (Trichoscopy), follicular thickness evaluation, and patient satisfaction surveys (GAIS scoring). Data were analysed using paired t-tests, ANOVA, and regression models. Results: PRP + Microneedling demonstrated the highest hair density increase (+22.1 ± 4.5 hairs/cm², p < 0.001), significantly outperforming PRP Alone (+13.6 ± 3.9) and Microneedling Alone (+10.9 ± 4.1). Terminal-to-vellus hair ratio (T/V ratio) showed greater improvement in PRP + Microneedling (+1.1 ± 0.4, p < 0.001). Patient satisfaction was highest in the combination group, with 78% reporting significant hair regrowth (GAIS Score 4–5). Adverse events were mild and self-limiting, with no severe complications. Conclusion: PRP + Microneedling is a highly effective, safe, and well-tolerated treatment modality for hair regrowth, demonstrating superior improvements in hair density, follicular health, and patient satisfaction compared to monotherapy. This study supports the integration of PRP + Microneedling as a first-line, non-surgical intervention for hair restoration.

Background: Tuberculous arthritis and osteomyelitis are chronic forms of extrapulmonary tuberculosis that can lead to significant joint destruction and disability if not diagnosed early. Accurate diagnosis relies on the integration of radiological imaging and histopathological confirmation, especially in resource-limited settings. Aim of the study was to evaluate and correlate radiological and histopathological findings in patients with tuberculous arthritis and osteomyelitis and to assess the diagnostic value of radiological severity grading with histological features and AFB positivity. Materials and Methods: A retrospective study was conducted on 100 patients diagnosed with tuberculous arthritis and osteomyelitis at the Departments of Pathology and Radiology. All cases had plain radiographs and CT imaging, along with biopsy-confirmed histopathological findings. Radiological features were documented and categorized as mild, moderate, or severe based on erosion, cortical destruction, and abscess formation. Histological slides were examined for caseating granulomas, Langhans giant cells, and necrosis. Ziehl-Neelsen staining was done for AFB detection. Correlation between imaging severity, histopathological features, and AFB positivity was analyzed. Results: Periarticular osteopenia (24%), marginal erosions (31%), and joint space narrowing (28%) were the most common radiographic features. Histopathological analysis revealed caseating granulomas in 82% and Langhans giant cells in 73% of cases. AFB positivity was observed in 51% of cases. Radiological findings showed a sensitivity of 74.7% and specificity of 76.9% in comparison with histopathological diagnosis. Severe radiological cases were associated with higher AFB positivity (40%) and more frequent caseating granulomas (83.3%). However, no significant association was found between granuloma type and AFB positivity (p=0.98). Conclusion: This study underscores the importance of combined radiological and histopathological evaluation for accurate diagnosis of tuberculous arthritis and osteomyelitis. Radiological grading correlates with disease severity but is insufficient alone for definitive diagnosis. Histopathology remains the gold standard, while AFB detection provides additional microbiological confirmation.

Background: Interstitial lung diseases (ILDs) are a heterogeneous group of pulmonary disorders that require precise diagnosis due to significant differences in management and prognosis. Radiological and histopathological evaluations play a central role, but diagnostic variability remains high without a multidisciplinary approach. Aim of the present study was to assess the diagnostic concordance between radiological and histopathological patterns in ILD and evaluate the impact of multidisciplinary discussion (MDD) in refining final diagnoses. Material and Methods: A retrospective study was conducted on 75 patients suspected of ILD at the Departments of Radiology and Pathology. High-resolution CT (HRCT) findings were classified into UIP, NSIP, OP, HP, or unclassifiable patterns. Histopathological evaluation was done via surgical or cryobiopsy, with standard staining protocols. Multidisciplinary team discussions included pulmonologists, radiologists, and pathologists. Diagnostic concordance was measured using Cohen’s Kappa (κ), and diagnostic performance metrics such as sensitivity, specificity, PPV, and NPV were calculated for radiological diagnosis using histopathology as the gold standard. Results: The most common radiological pattern was UIP (37.3%), followed by NSIP (24%). Histopathology confirmed UIP in 34.7% and NSIP in 26.7%. The overall agreement between radiological and pathological diagnoses was moderate (κ = 0.50). Multidisciplinary discussion resulted in a change of diagnosis in 18.6% of cases, particularly reducing the proportion of unclassifiable patterns. Post-MDD agreement improved significantly. Radiological diagnosis of UIP showed high sensitivity (92.3%) and NPV (95.7%). Similar trends were observed for NSIP and OP, while HP and unclassifiable patterns had lower PPV. Conclusion: Moderate agreement exists between radiological and histopathological ILD diagnoses. Multidisciplinary discussion significantly improves diagnostic precision, justifying its role as the preferred approach for accurate ILD classification. Integration of clinical, radiological, and pathological data remains essential in reducing misdiagnosis and optimizing treatment decisions.

Background: Effective postoperative pain management is vital in orthopaedic practice to enhance recovery, minimize complications, and improve patient satisfaction. While opioids have traditionally been used, concerns over side effects and addiction have prompted a shift toward non-opioid and multimodal analgesic approaches. Aim was to compare the effectiveness, safety, and patient satisfaction between opioid-based and non-opioid-based pain management strategies in patients undergoing orthopaedic surgeries. Materials and Methods: A prospective observational study was conducted in the Department of Orthopaedics in collaboration with the Department of Pharmacology. A total of 75 adult patients undergoing elective orthopaedic procedures were included. Patients were categorized into two groups: Group A received opioid-based analgesia, while Group B received non-opioid multimodal analgesia. Pain scores using the Visual Analog Scale (VAS) at 6, 12, 24, and 48 hours post-surgery, opioid consumption, time to first analgesic request, incidence of adverse effects, patient satisfaction, and hospital stay duration were assessed. Statistical analyses included t-tests, repeated measures ANOVA, and correlation analysis. Results: VAS scores at rest and on movement were significantly lower in the non-opioid group at 24 and 48 hours (p < 0.05). Total opioid consumption was significantly lower in Group B (12.3 ± 4.2 mg vs. 45.6 ± 10.5 mg, p < 0.001). Time to first analgesic request was longer in the non-opioid group, and adverse effects such as nausea, vomiting, sedation, and constipation were significantly less frequent. Patient satisfaction scores were higher in Group B at discharge (8.5 ± 1.1 vs. 7.8 ± 1.2, p = 0.0001). The average hospital stay was also shorter in Group B (4.8 ± 1.0 vs. 5.6 ± 1.2 days, p < 0.001). Repeated measures ANOVA confirmed significant pain reduction over time in both groups (p < 0.0001). Conclusion: Non-opioid multimodal analgesia is an effective and safer alternative to opioid-based regimens for postoperative pain management in orthopaedic patients. It offers better pain control, fewer adverse effects, higher patient satisfaction, and reduced hospital stay. These findings support the adoption of opioid-sparing strategies in routine orthopaedic care.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint inflammation and systemic manifestations. Although non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac sodium are standard treatments, their adverse effects, particularly gastrointestinal toxicity, limit long-term use. Omeprazole, primarily used as a proton pump inhibitor, has been shown to exhibit anti-inflammatory effects in various preclinical models. Aim of the study was to evaluate the anti-arthritic activity of Omeprazole at different doses in comparison with Diclofenac sodium in a rat model of Complete Freund’s Adjuvant (CFA)-induced arthritis. Materials and Methods: The study was conducted on 30 Wistar albino rats (150–250 g), divided into five groups (n=6 each). Arthritis was induced by intra-plantar injection of 0.1 ml CFA in the left hind paw. Treatment was given for 21 days as follows: Group I (control – distilled water), Group II (diclofenac sodium 10 mg/kg), Groups III-V (omeprazole 10, 20, and 30 mg/kg, respectively). Paw edema was measured using a digital plethysmometer on days 0, 7, 14, and 21. Hematological and serological parameters (Hb, WBC, RBC, SRF, and CRP) were assessed, and arthritis severity was evaluated by arthritis score and pain index. Results: Omeprazole reduced paw edema in a dose-dependent manner, with the 30 mg/kg group showing 54% inhibition by day 21, comparable to 60% in the diclofenac group. Hematological improvements, including increased Hb and RBC and reduced WBC levels, were noted at higher doses. Serological markers (SRF and CRP) significantly decreased in the 30 mg/kg Omeprazole group. Arthritis scores were also markedly reduced at higher Omeprazole doses. Conclusion: Omeprazole exhibited significant anti-arthritic activity in CFA-induced arthritis in rats, particularly at 30 mg/kg. These effects may be attributed to its anti-inflammatory and immunomodulatory properties. Omeprazole may represent a potential alternative or adjunct in arthritis management, especially where NSAID use is contraindicated.

Background: Vitiligo is a chronic depigmenting disorder affecting the skin and mucosal surfaces. This study aims to assess the clinicodemographic characteristics of vitiligo patients and their association with endocrine disorders such as diabetes mellitus, thyroid dysfunction, and Addison's disease. Methods: A hospital-based cross-sectional Results: observational study was conducted on 100 patients at M.K.C.G Medical College and Hospital. Patients underwent detailed history-taking, clinical examination, and laboratory investigations, including thyroid function tests, fasting and postprandial blood glucose levels, and serum cortisol estimation. Statistical analysis was performed using SPSS version 21. Conclusion: The findings suggest significant associations between vitiligo and endocrine disorders, particularly hypothyroidism. These results emphasize the need for endocrinological screening in vitiligo patients for early diagnosis and management.

Background: Association between MetS and skin disorders such as psoriasis, hidradenitis suppurativa, acanthosis nigricans, chronic infections, and stasis dermatitis remains an interesting area of research. This study aims to evaluate the relationship between metabolic dysregulation and dermatological disease severity and, impact of long-term metabolic control on decreasing dermatological disease burden. Methods: This prospective observational study was conducted in two tertiary care centres in North India, involving 100 obese patients, 50 each with and without metabolic syndrome. Baseline metabolic parameters (HbA1c, HOMA-IR, triglycerides, CRP, IL-6, TNF-α) were correlated with severity scores in psoriasis, hidradenitis suppurative and acanthosis nigricans. A subset of participants underwent metabolic interventions, including weight loss and glycaemic control, and dermatological outcomes were assessed at 6, 12, and 24 months. Results: Severity in psoriasis (PASI), hidradenitis suppurativa (HSSI), and acanthosis nigricans (AN severity) were significantly more in individuals with MetS. HbA1c strongly correlated with PASI scores, while HOMA-IR was an independent predictor of AN severity. Chronic infections (bacterial and fungal) were more frequent and severe in MetS patients. Longitudinal analysis showed significant reductions in PASI and HSSI scores over 24 months in patients with improved metabolic control. Similarly, CRP, IL-6, and TNF-α significantly decreased post-weight loss intervention, correlating with improvements in dermatological outcomes. Conclusion: This study reiterates the need for integrated dermatological and metabolic management, where metabolic interventions such as weight loss, glycaemic control, and lipid regulation can serve as effective adjunct therapies for various dermatoses, since MetS significantly exacerbates the severity of inflammatory and proliferative skin conditions.

Background: Hand washing is a crucial practice in preventing healthcare-associated infections, particularly among medical students who are future healthcare providers. This study aims to assess the orientation and adherence to hand washing practices among medical students at Shri Narayan Medical Institute and Hospital, Saharsa, Bihar. Materials and Methods: An observational cross-sectional study was conducted from July 2023 to March 2024. A total of 252 medical students participated in the study, comprising 136 boys and 116 girls. Data were collected through a structured questionnaire assessing knowledge, attitude, and practices (KAP) regarding hand washing. The data were analyzed using descriptive statistics and chi-square tests to determine the association between demographic factors and hand washing practices. Results: The study revealed that 78% of the students had good knowledge of hand washing, but only 62% adhered to proper hand washing practices consistently. Boys showed a slightly higher adherence rate (64%) compared to girls (59%). The most common reason for non-compliance was a lack of time, reported by 45% of the students. A significant association was found between knowledge levels and adherence to hand washing practices (p < 0.05). Conclusion: While the majority of medical students at Shri Narayan Medical Institute and Hospital are knowledgeable about hand washing, a gap exists between knowledge and practice. Interventions targeting behavioral change and emphasizing the importance of hand hygiene are needed to improve adherence rates.

Background: Peripheral nerve blocks, particularly supraclavicular brachial plexus block, provide effective anesthesia and analgesia for upper limb surgeries. Various adjuvants have been used with local anesthetic combinations to enhance block characteristics. This study compared dexmedetomidine versus dexamethasone as adjuvants to lignocaine with adrenaline and bupivacaine combination in ultrasound-guided supraclavicular block for forearm surgeries. Methods: In this prospective comparative study, 72 patients scheduled for forearm surgeries under supraclavicular block were randomly allocated into two groups of 36 each. Group A received 12.5ml of 2% lignocaine with adrenaline (1:200,000) + 12.5ml of 0.5% bupivacaine with dexmedetomidine (1µg/kg), while Group B received 12.5ml of 2% lignocaine with adrenaline (1:200,000) + 12.5ml of 0.5% bupivacaine with dexamethasone (4mg). Block characteristics (onset and duration of sensory and motor block), duration of analgesia, postoperative pain scores, analgesic consumption, hemodynamic parameters, and adverse effects were compared between the groups. Results: The onset of sensory block (8.72±1.86 vs 11.44±2.08 minutes) and motor block (12.14±2.22 vs 15.36±2.48 minutes) was significantly faster in the dexmedetomidine group compared to the dexamethasone group (p<0.001). Duration of sensory block (13.68±1.92 vs 11.86±1.74 hours), motor block (11.94±1.68 vs 10.26±1.52 hours), and analgesia (16.42±2.18 vs 14.28±1.96 hours) were significantly longer in the dexmedetomidine group (p<0.001). Total analgesic consumption was significantly lower in the dexmedetomidine group (82.64±24.86 vs 112.38±30.42 mg, p<0.001). The dexmedetomidine group had significantly lower heart rates and blood pressure values during the intraoperative period. Adverse effects, particularly bradycardia (11.11% vs 0%), were more common in the dexmedetomidine group (p=0.024). Conclusion: Both dexmedetomidine and dexamethasone are effective adjuvants to lignocaine with adrenaline and bupivacaine combination in supraclavicular block for forearm surgeries. Dexmedetomidine provides faster onset, longer duration of block and analgesia, and reduced analgesic requirements compared to dexamethasone, albeit with a higher incidence of hemodynamic adverse effects, particularly bradycardia.

Background: Ovarian carcinoma is a gynaecologic malignancy with a high rate of recurrence, often involving metastatic spread to various anatomical sites. Identifying the patterns of metastasis in relapsed ovarian cancer is critical for appropriate management and treatment planning. Materials and Methods: The study was a prospective cross-sectional study was conducted on 50 ovarian carcinoma patients were referred for imaging between June 2018 and May 2019 in the Department of Radiodiagnosis at Basavatarakam Indo-American Cancer Hospital (BIACH), Banjara Hills, Hyderabad. All patients underwent MDCT scanning with intravenous and oral contrast to assess metastatic disease. The imaging findings were recorded, and the patterns of metastasis were statistically analysed. Comparisons were made with existing literature to determine similarities or variations in metastatic involvement. Statistical analysis was carried out using the Mann-Whitney U test, and results were represented using histograms. Data were entered and analysed using Microsoft Excel on a Windows XP platform. Results: In this study, MDCT successfully identified various sites of recurrence, which were classified into usual and unusual sites. The usual sites included pelvic deposits or local recurrence in 40% of patients, abdominal lymph node involvement in 42%, pelvic lymph nodes in 40%, distant lymph nodes in 18%, peritoneal and omental deposits in 54%, serosal deposits in 50%, and ascites in 40%. Unusual metastatic sites included the liver (18%), spleen (4%), brain (6%), bone (2%), lungs (8%), muscles (8%), parietal wall of the abdomen or chest (10%), adrenal glands (8%), ureters (10%), urinary bladder (10%), vaginal vault (6%), and pleural effusion (12%). Overall, 30% of patients showed metastases only at usual sites, 8% at only unusual sites, and 62% had involvement of both usual and unusual metastatic locations. Conclusion: The findings indicate that patients undergoing extensive therapy are more likely to experience widespread recurrence. MDCT was found to be an effective imaging modality for evaluating metastatic patterns in relapsed ovarian carcinoma and remains the investigation of choice for comprehensive disease assessment.

Background: Proper patient education on antiepileptic drug (AED) side effects is crucial for informed decision-making, treatment compliance, and enhanced health outcomes. The National Institute for Health and Care Excellence (NICE) guideline CG137 advises that all patients prescribed AEDs are provided with complete information regarding possible adverse effects. This audit examined current practice concerning patient education and measured the effect of targeted interventions. Methods: A two-cycle clinical audit was carried out in a tertiary care hospital. The first cycle consisted of a retrospective examination of medical records and patient surveys to measure recall and documentation of AED side effect education. Interventions such as training staff, preparing educational materials, and standardized procedures were done between cycles. The second cycle had the same methodology to measure changes. Further analyses explored the effect of lifestyle influences and methods of education delivery on patient outcomes. Results: The first cycle saw documentation at 60% average and recall of all patients under 35%. The satisfaction ratings were fair, and most patients had no memory of side effect education. After interventions, documentation rose to greater than 80%, recall was improved across all ages, and satisfaction ratings increased substantially. Face-to-face consultations were the most effective educational method. Active patients demonstrated improved recall and reduced readmission. Conclusion: Organized educational interventions, standardized documentation, and follow-up greatly improve patient comprehension of AED side effects. Adding personalized and multimodal education has the ability to enhance adherence and decrease adverse outcomes.

Background

Uterine fibroids, also known as leiomyomas, are the most common benign tumors affecting women of reproductive age worldwide. Globally, it is estimated that up to 70–80% of women may develop fibroids by the age of 50. In India, the prevalence is increasing due to rising awareness and improved diagnostic access, although many cases still remain undiagnosed. The burden on the healthcare system is substantial, particularly due to complications like anemia, infertility, and the need for surgical interventions. Aims and Objectives: To study the demographic distribution, clinical presentation, types and degeneration of fibroids, and treatment modalities in women diagnosed with uterine fibroids in a clinical setting. Materials and Methods: This observational study was conducted on 50 female patients diagnosed with uterine fibroids. Data on age, parity, clinical symptoms, fibroid types, degeneration, and management were collected. Inclusion and exclusion criteria were applied, and findings were analyzed using descriptive statistics. Results: Most patients were aged 41–60 years (58%) and multiparous (72%). Abnormal uterine bleeding (AUB) was the predominant symptom (72%). Intramural fibroids were the most common type (72%), and degeneration was noted in 42% of cases. Surgical management was the main treatment approach (60%). Conclusion: Fibroids predominantly affect perimenopausal women and commonly present with AUB. Intramural fibroids are the most frequent type. A considerable number of cases show degeneration. Surgical intervention remains the mainstay of treatment. Early detection and individualized management are essential for optimal patient outcomes.

Background: Coronary artery disease (CAD) remains the leading cause of cardiovascular mortality globally. Atherosclerosis, the fundamental pathological process in CAD, affects not only the coronary arteries but also peripheral vessels such as the carotid arteries. Carotid intima-media thickness (CIMT), measurable by non-invasive ultrasonography, has emerged as a potential surrogate marker for systemic atherosclerosis and cardiovascular risk. Objective: To evaluate the association between CIMT and angiographically confirmed CAD and explore its relationship with traditional cardiovascular risk factors. Methods: This hospital-based case-control study included 100 participants (50 CAD cases, 50 age- and sex-matched controls) at a tertiary care hospital in Navi Mumbai. CIMT was measured using high-resolution B-mode ultrasonography. Clinical and biochemical parameters, including lipid profile, blood pressure, and blood sugar, were also recorded. Statistical analysis was performed using SPSS v26.0. Results: Mean CIMT was significantly higher in CAD cases (1.29 ± 0.58 mm) compared to controls (0.70 ± 0.13 mm; p < 0.001). CIMT increased progressively with the severity of coronary involvement and was significantly elevated in diabetics, hypertensives, and smokers. Moderate positive correlations were found between CIMT and total cholesterol (r = 0.44) and LDL (r = 0.24). No significant difference in CIMT was observed with gender or age. Conclusion: CIMT is significantly associated with both the presence and severity of CAD, as well as with key modifiable risk factors. These findings support its role as a non-invasive, cost-effective tool for early detection and risk stratification in CAD.

Background: Female genital tuberculosis (FGTB), a form of extrapulmonary tuberculosis (EPTB), is a silent yet significant cause of infertility in reproductive-age women, particularly in low-resource settings. Due to its nonspecific symptoms and paucibacillary nature, diagnosing FGTB remains a clinical challenge. This study aimed to evaluate the prevalence of genital tract involvement among women with documented extragenital TB and to compare the diagnostic performance of histopathology and CBNAAT in detecting such involvement. Materials and Methods: A prospective observational study was conducted over 24 months at Government Maternity Hospital and Government Chest & TB Hospital, Hanamkonda. One hundred women aged 20–45 years with a history of extragenital TB were enrolled. Endometrial tissue was collected using dilation and curettage and analyzed by histopathological examination (HPE) and Cartridge-Based Nucleic Acid Amplification Test (CBNAAT). Data were statistically analyzed using SPSS Version 24, with significance set at p < 0.05. Results: The mean age of participants was 27.35 ± 2.16 years, with the majority in the 26–30 year age group. Genital tract TB was detected in 12% of subjects. CBNAAT showed greater diagnostic sensitivity (44.3%) compared to HPE (8.2%), with respective specificities of 80.4% and 100%. Most patients had poor socioeconomic status, resided in overcrowded kutcha houses, and had a positive family or contact history of TB (83%). Conclusion: FGTB remains an under-recognized contributor to female infertility in extragenital TB patients. Rapid molecular diagnostics like CBNAAT offer better sensitivity and facilitate early detection, enabling timely intervention. Integrating such tools at the primary care level is vital to reduce diagnostic delays and improve reproductive outcomes in high TB-burden regions.

Background: Intra-abdominal hypertension (IAH) is an increasingly recognized complication in critically ill surgical patients, especially those undergoing emergency abdominal surgeries. Elevated intra-abdominal pressure (IAP) can compromise splanchnic perfusion and impair tissue healing, thereby predisposing to surgical site infections (SSIs), fascial dehiscence, and other post-operative morbidities (Kirkpatrick et al., 2013). Methods: This prospective observational study was conducted over 12 months at Victoria Hospital, Bangalore, involving 43 adult patients (aged 18–60 years) who underwent emergency laparotomy for perforating or blunt abdominal trauma. IAP was measured pre-operatively and post-operatively using the standard Foley catheter manometry technique. Wound healing was assessed using CDC criteria on post-operative days 3, 5, 7, and 9, and outcomes were followed up for 30 days. The primary outcome was the incidence of SSI and fascial dehiscence, stratified by IAH grades based on WSACS definitions. Results (anticipated): Preliminary analysis suggests that patients with IAH (IAP ≥12 mmHg) had significantly higher odds of developing SSIs and fascial dehiscence compared to those with normal IAP (Dugar et al., 2024). Additionally, Grade 2 and above IAH correlated with longer hospital stay and higher rates of peritonitis and post-operative fever. Conclusion: IAH is a strong, independent predictor of post-operative wound complications in trauma patients undergoing emergency laparotomy. Routine IAP monitoring using bladder manometry is a cost-effective, low-risk strategy that enables early risk stratification and early implementation of targeted interventions, potentially reducing the incidence of wound-related morbidity and improving overall surgical outcomes in this high-risk population.

Background: Venous thromboembolism (VTE) is a significant healthcare burden, with a higher risk among critically sick patients and those undergoing major surgeries [1]. Risk assessment models like WELL’s and PADUA scores help identify individuals at high risk of developing DVT. However, it's important to note that WELL has higher NPV (Negative Predictive Value) VTE risk, while PADUA aims to identify high-risk individuals who benefit from pharmacological thromboprophylaxis or mechanical measures. Aims and Objective: To measure and compare the accuracy of the PADUA score and WELL score in the prediction of the post-operative VTE in surgical patients. Materials and Methods: The study design was cross-sectional and analytical, focusing on predicting Deep Vein Thrombosis (DVT) in surgical patients. The sample size, calculated using nMaster software, with 160 subjects included. Patients were aged over 18 years, willing to give informed consent, and undergoing major surgery. IBM SPSS Statistics was used to do the statistical analysis of the recorded data. Results: The study involved 160 patients undergoing major surgery at the Department of General Surgery at hospitals attached to BMCRI between August 2022 and January 2024. Most of the study participants were males, with a mean age of 56.78. The pre-operative WELL and PADUA score showed significant positive correlations with DVT incidence and duration of hospital stay. Conclusion: The study showed that the WELL and PADUA risk assessment models, both are effective in predicting post-operative DVT in surgical patients. The study found that WELL has higher sensitivity (76.2%) and specificity (69.1%), indicating its effectiveness in identifying high-risk patients and facilitating targeted thromboprophylaxis.

Background: Among the complications encountered during spinal anesthesia, a reduction in blood pressure is the most frequently observed, particularly in individuals with a pre-existing diagnosis of hypertension. Although chronic administration of antihypertensive therapy may mitigate this response, the perioperative management of agents targeting the renin-angiotensin-aldosterone pathway remains contentious.This investigation was conducted to evaluate intraoperative variations in hemodynamic parameters—specifically blood pressure and pulse rate—among patients maintained on angiotensin receptor blockers (ARBs) undergoing procedures under spinal anesthesia, in comparison to normotensive individuals. Materials and Methods: A total of 100 subjects were enrolled, comprising 50 normotensive participants (Group N) and 50 individuals with controlled hypertension who continued ARB therapy on the day of surgery (Group H). Baseline hemodynamic values were documented, followed by serial measurements of blood pressure and heart rate at specified time intervals following administration of spinal anesthesia. The principal outcomes assessed included alterations in mean arterial pressure and heart rate.  Results: A statistically significant elevation in the incidence of intraoperative hypotension and a notable decline in systolic blood pressure were observed in Group H. Heart rate variations did not reach statistical significance. Changes in diastolic pressure were also not significant. While the use of vasoactive agents was more frequent in the hypertensive cohort, the difference was not statistically significant. Conclusion: Patients with hypertension who continue ARB therapy on the day of surgery exhibit a higher propensity for developing hypotension during spinal anesthesia; however, this can be effectively managed with appropriate pharmacological interventions.

Background: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for renal stones. But wide array of complications due to larger tract size has lead to development of improved techniques like mini PCNL and RIRS (Retrograde intrarenal surgery). Aim: The aim of this study is to evaluate the complications and outcomes of RIRS and Mini-PCNL in the management of <2 cm renal stones in a tertiary care hospital. Methods: This is a single-center, prospective study on patients diagnosed with renal calculi between April 2018 and March 2020. A total of 50 patients were included and divided into two groups –Group I: 25 patients who underwent RIRS and Group II: 25 patients who underwent Mini-PCNL. Data were collected to compare the operative data, postoperative complications, duration of hospital stay, stone-free rate, and auxiliary procedure rate associated with RIRS and Mini PCNL for the treatment of <2 cm renal calculi. Results: The mean stone size, mean duration of surgery, site of stone impactions, Pre operative and Post operative hemoglobin levels were statistically similar in mini PCNL and RIRS group (p>0.05). The Visual Analog Scale (VAS) score and mean hospital stay was higher for Mini PCNL patients as compared to RIRS (p<0.05), while post operative complication were higher in RIRS. Stone clearance rate was more (96%) in Mini PCNL as compared to RIRS (84%). Conclusions: Mini PCNL had higher stone free rate and less post operative complications, while RIRS had shorter hospital stay and less post operative pain. Both techniques are safe and effective in managing renal stones less than 2 cm size

Background: Effective postoperative pain management is essential for patient recovery and quality of care. Analgesics, especially opioids and non-opioids, are commonly used in clinical practice, yet their efficacy and patterns of use require continual assessment. Objective: This study aimed to evaluate the analgesic regimens employed and their effectiveness in pain control among 100 postoperative patients, analyzing Numeric Rating Scale (NRS) scores over 48 hours. Methods: A prospective observational study was conducted involving 100 patients undergoing elective and emergency surgeries. Data on demographics, type of surgery, analgesics administered, and NRS scores at 6, 12, 24, and 48 hours postoperatively were collected and analyzed. Results: Tramadol and paracetamol were universally used, with 90% of patients receiving additional non-opioids. Mean NRS scores showed a significant decline from 7.91 at 6 hours to 5.08 at 48 hours, indicating effective pain management over time. Conclusion: Opioid and non-opioid analgesic combinations were effective in reducing postoperative pain. Further studies are recommended to explore multimodal pain management strategies tailored to surgical types and patient profiles.

Background: Poisoning is a major public health issue, contributing to significant morbidity and mortality worldwide. It occurs due to the ingestion, inhalation, or absorption of toxic substances, either accidentally or intentionally. In India, organophosphorus compounds, pharmaceutical drugs, and household chemicals are the most common toxic agents. The World Health Organization (WHO) estimates that unintentional poisoning leads to nearly 200,000 deaths annually, with the highest burden in low- and middle-income countries. This study aims to assess the clinical profile, management, and outcomes of patients with acute poisoning in a tertiary care hospital. Methodology: A hospital-based observational study was conducted, including all patients diagnosed with acute poisoning. Data collection involved history-taking, clinical examination, and laboratory investigations. The study analyzed demographics, poisoning intent (accidental or suicidal), clinical presentation, time to hospital arrival, treatment received, and patient outcomes. Management approaches such as gastric lavage, antidote use, and ICU admission were evaluated. Mortality, hospital stay duration, and complications were the primary outcome measures. Results: Organophosphorus poisoning was the most common, followed by pharmaceutical drug overdose and household chemicals. Poisoning was predominantly suicidal, with young adults being the most affected. Delayed hospital arrival increased mortality and complications. ICU admission, ventilatory support, and antidote therapy were associated with poorer outcomes. Conclusion: This study highlights the high burden of poisoning, with organophosphorus compounds being the leading cause. Early medical intervention and improved critical care facilities are essential to reduce poisoning-related morbidity and mortality. Strengthening preventive strategies and public awareness is crucial.

Background: Asymptomatic bacteriuria (ASB) in pregnancy, defined as the presence of ≥10⁵ colony-forming units (CFU)/mL of bacteria in urine without clinical symptoms, is associated with adverse maternal and neonatal outcomes if untreated. Given the regional variability in prevalence, this study aimed to estimate the prevalence of ASB and associated risk factors among pregnant women attending antenatal care at a tertiary hospital in Navi Mumbai. Methods: This descriptive cross-sectional study included 200 pregnant women, selected through consecutive sampling. Midstream clean-catch urine samples were collected, cultured, and subjected to antimicrobial sensitivity testing. Demographic details, clinical characteristics, and obstetric outcomes were recorded. Statistical analysis was performed using IBM SPSS version 26.0. Results: The prevalence of ASB was found to be 11%. Higher prevalence was observed in women aged 23–27 years (12.9%), primigravidae (11.3%), and those in the third trimester (11.8%). ASB was associated with elevated urine albumin (50% in 3+), increased pus cells, anemia (13.7%), and maternal complications such as premature rupture of membranes (25%) and puerperal fever (18%). Escherichia coli (50%) and Klebsiella species (23%) were the most common isolates. Highest antibiotic sensitivity was observed for Piperacillin + Tazobactam (95.5%) and Amikacin (90.9%). Post-treatment follow-up showed microbiological clearance in 90.9% of cases. Neonatal outcomes included low birth weight (9.1%), NICU admissions (13.6%), and normal neonatorum in 59.1% of cases. Conclusion: ASB is a significant concern in pregnancy with implications for maternal and neonatal health. Routine screening and targeted antibiotic therapy based on culture sensitivity are recommended to improve pregnancy outcomes.

Background: Medial malleolar fractures are commonly encountered injuries of the ankle joint, which, due to their intra-articular nature and role in weight-bearing, require precise anatomical reduction and stable internal fixation to prevent complications such as malunion, arthritis, and long-term functional disability. Objective: To compare the functional outcomes of open reduction and internal fixation (ORIF) using tension band wiring (TBW) versus screw fixation in patients with medial malleolar fractures. Methods: This prospective study was conducted at Mahatma Gandhi Memorial Hospital, Warangal, over a period of two years. A total of 30 patients aged 18–70 years with isolated medial malleolar or bimalleolar fractures were included. They were randomly divided into two groups of 15 patients each—one managed with TBW and the other with cancellous screw fixation. Functional outcomes were assessed using the Baird and Jackson scoring system. Patients were followed for an average of 18 months postoperatively. Results: All fractures achieved union without any cases of nonunion. The mean time to union was 12 weeks for both groups. TBW resulted in superior functional outcomes with 93.3% of cases achieving excellent to good results compared to 79.9% in the screw fixation group (p = 0.04). TBW also demonstrated statistically significant improvements in range of motion (p = 0.048) and ability to return to work (p = 0.04). Postoperative complications, including superficial infections, were comparable and managed conservatively. Conclusion: Both tension band wiring and screw fixation are effective in the management of medial malleolar fractures. However, TBW offers superior functional outcomes and biomechanical advantages, particularly in cases involving small or osteoporotic fragments. It is therefore a favorable option in the surgical management of medial malleolar fractures.

Introduction: Obstruction of the bowel is a commonly encountered problem in gastrointestinal surgery all over the world. Aim: To determine the clinical presentation, identify the etiologies, and evaluate the management and outcomes of acute bowel obstruction. Methodology: The study was undertaken following approval from the institutional ethical committee, and informed consent was obtained from all participating patients. Data were collected from patients admitted to the Department of Surgery at RNT Medical College and its attached MBGH Hospital, Udaipur, who presented with a clinical diagnosis of intestinal obstruction. Result: The study found that the most common causes of intestinal obstruction were adhesions (36.7%), hernia (16.7%), and malignancy (16.7%), with the majority of patients (55 out of 60) undergoing surgery, primarily adhesiolysis and resection. The mortality rate was 8.3%, which is lower than many previous studies, reflecting improvements in surgical techniques, early diagnosis, and supportive care. Our study highlights a shift in etiology, with adhesions becoming the leading cause, and suggest improved outcomes due to advancements in treatment. Conclusion: Intestinal obstruction remains a critical surgical emergency, requiring timely diagnosis and early intervention to prevent complications such as peritonitis, sepsis, and multi-organ failure.

Background: The morphology of the proximal femur plays a crucial role in maintaining erect bipedal posture and has significant implications in orthopedic surgery and prosthetic design. This study aimed to evaluate the morphometric parameters of the hip joint in the adult population of Western Rajasthan using digital radiographs. Methods: A prospective observational study was conducted using 206 anteroposterior pelvic radiographs (412 hip joints) of healthy adults aged 20–80 years, including 138 males and 68 females. anatomical parameters such as neck-shaft angle (NSA), vertical offset (VO), and horizontal offset (HO). Results: The mean NSA was 127.74° (±3.93) in males and 125.88° (±4.72) in females. The average HO was 34.48 mm (±6.52) in males and 32.91 mm (±7.02) in females, while VO measured 39.22 mm (±5.91) and 36.42 mm (±6.25), respectively. All parameters followed a normal distribution. Conclusion: This study highlights notable anatomical differences between Indian and Western populations, particularly in the femoral neck-shaft angle and offset values. These findings support the need for race-specific hip implant designs and provide essential normative data for preoperative planning and prosthesis development in the Indian subcontinent.

Aims: Comparison of ultrasound guided adenexal mass alcazar score with histopathological examination report and Evaluation of adenexal mass as benign and malignant based on Alcazar score.  Materials and methods: This study was conducted for a period of one year in 100 patients with adnexal mass were included in the study based on purposive sampling technique. a detailed history was taken and complete examination done in all registered patients were subjected to transabdominal sonography. The sonographic parameters of the scoring system included thick papillary projections and solid areas. Various parameters and scoring system as proposed by Alcazar et al. The gold standard for diagnosis was histopathological examination of specimen obtained from laparotomy and or cytology of acitic fluid.  Results: The scoring system by Alcazar gave better results because of the use of Colo Doppler measurements. The use of color Doppler decreased the false negative results. Presence of central vascularization (P=0.000) and high velocity/low resistance (P=0.000) were most consistently associated with malignancy. Addition of color Doppler increases the specificity and diagnostic performance of Alcazar scoring system. The false positive results in the scoring system by Alcazar et al were because of benign lesions like ovarian cystadenofibroma and ovarian fibroma, which were frequently encountered as unilocular cysts with solid areas and central flow. Ultrasonographic and color Doppler technique is highly operator dependent leading to high interobserver variation, also the flow within the tumor varies greatly. So the whole mass should be adequately scanned by only an expert sonologist.  Conclusions: Alcazar scoring system is useful in differentiating benign from malignant ovarian masses. It is simple, easy to memorize and it is reproducible. Alcazar scoring system was found to be more sensitive and specific than other available scoring systems

Introduction: Most adult patients seek orthodontic treatment primarily for aesthetic reasons, and one condition that affects the aesthetics is the midline diastema. Active therapy is readily accessible to patients who find that the diastema is awful. Not all diastemas yet can be handled in the same way or at the same time. It is necessary to accurately assess the diastema's degree and cause. Numerous causes of midline diastema have also been documented, including variations in tooth size, abnormal and strongly positioned labial frenum attachments, habits, tooth loss, and some midline disorders like mesiodens, among others.  Case report: The current case study illustrates how the M-spring appliance was used to treat a case with Angle's Class I malocclusion with midline diastema, leading to full closure in just four months. Frenectomy was done to address the incorrect labial frenal attachment, succeeded by placement of M-spring orthodontic device. By tilting the crowns of the central incisors mesially, "M" shaped device which has certain activation points, gives controlled movement of teeth and, as a result, accomplishes this site closure quickly.  Conclusion: It was concluded that M-spring appliance was designed to improve and guarantee functional occlusion while simultaneously addressing aesthetic concerns and aids in shortening the treatment time.

Background: Maxillofacial fractures represent a significant burden in trauma care, influencing patient outcomes and healthcare resource utilization. This retrospective analysis aims to comprehensively examine the patterns and trends of maxillofacial fractures presenting at a prominent tertiary trauma center in Kerala over 10 years.  Methodology: Data encompassing a decade of cases from casualty records of patients with maxillofacial fractures from 2010 to 2020 were utilized for the study. The study focused on demographic characteristics (gender), fracture characteristics (type), associated injury, etiological factors, and temporal trends. Results: Key findings indicate a diverse distribution of maxillofacial fractures, with mandibular fractures being most prevalent. Demographically, a higher incidence was noted among males. Etiologically, motor vehicle accidents under the influence of alcohol were the most common. Conclusion: The overall trend from 2010 to 2020 across various categories indicates significant fluctuations, a general decline in maxillofacial injuries towards the end of the decade, and a pronounced impact of the COVID-19 pandemic in 2020. This retrospective analysis not only fills gaps in regional trauma literature but also serves as a foundation for targeted interventions aimed at reducing the incidence and severity of maxillofacial injuries in Kerala.

Background: Pulmonary edema is a critical clinical condition with two major etiologies: cardiogenic pulmonary edema (CPE), caused by elevated hydrostatic pressure, and non-cardiogenic pulmonary edema (NCPE), resulting from increased capillary permeability. Differentiation between the two is essential for guiding appropriate treatment. This study evaluates the diagnostic value of clinical parameters, chest X-ray, high-resolution computed tomography (HRCT), and lung ultrasound (LUS) in distinguishing CPE from NCPE. To compare clinical, biochemical, and radiological findings in patients with CPE and NCPE, and to determine the diagnostic accuracy of specific imaging and laboratory parameters. Material and Methods: A prospective observational study was conducted on 50 patients with radiologically confirmed pulmonary edema at the Departments of Medicine and Radiology, Mamata Medical College, Khammam. Patients were classified into CPE and NCPE groups based on clinical, echocardiographic, and biomarker data. All underwent chest X-ray, HRCT, and lung ultrasound. Data were analyzed using independent t-tests, Fisher’s exact test, and ROC curve analysis to assess statistical and diagnostic significance. Results: BNP levels were significantly higher in the CPE group (751.75 ± 152.78 pg/mL) compared to NCPE (140.28 ± 36.46 pg/mL), with an AUC of 1.0 and an optimal cut-off of 498.8 pg/mL. Chest X-ray showed cardiomegaly (88% vs. 4%) and Kerley B lines (84% vs. 28%) significantly more in CPE. HRCT revealed interlobular septal thickening (80%) and central opacities predominantly in CPE, while NCPE showed peripheral ground-glass opacities (88%). LUS findings showed diffuse B-lines in 84% of CPE and focal B-lines in 72% of NCPE. Most categorical imaging features showed p < 0.01. Conclusion: BNP is a reliable biomarker for differentiating CPE from NCPE. Chest X-ray and HRCT remain important diagnostic tools, while LUS offers rapid bedside evaluation with high diagnostic value. A combined clinical and radiological approach improves diagnostic accuracy and guides timely management.

Background: Excessive screen time has emerged as a growing public health concern, particularly among school-aged children. Prolonged exposure to digital screens has been linked to adverse behavioral and psychological outcomes. This study aims to assess the association between screen time addiction and behavioral problems among children aged 6–12 years. Materials and Methods: A cross-sectional survey was conducted among 400 children attending urban schools in Surat-India. Parents completed a structured questionnaire consisting of the Screen Time Addiction Scale (STAS) and the Strengths and Difficulties Questionnaire (SDQ) to evaluate screen dependency and behavioral issues respectively. Demographic data and average daily screen time were also recorded. Statistical analysis was performed using SPSS version 26.0, with significance set at p<0.05. Results: Among the participants, 62.5% were identified with moderate to high screen time addiction (STAS score ≥25). The mean daily screen exposure was 4.1 ± 1.3 hours. Behavioral difficulties, especially hyperactivity (mean SDQ score 6.2 ± 1.5) and peer problems (mean score 5.4 ± 1.3), were significantly higher in children with screen addiction compared to those with lower exposure (p<0.01). A positive correlation (r = 0.56, p<0.001) was found between STAS and total SDQ scores. Conclusion: The study highlights a significant association between increased screen time and behavioral challenges among school-aged children. Interventions targeting screen time regulation, along with behavioral counseling, may play a pivotal role in mitigating these effects.

Background: Vocal fold paralysis (VFP) is a fairly common entity encountered by otorhinolaryngologists & is usually an indicator of an underlying pathology. It can be a manifestation of numerous diseases that may arise from thorax, head & neck, or systemic disease. The current study was designed to identify the thoracic causes of VFP in the Indian population with the help of chest imaging. Material & Methods: This was an observational, cross-sectional study in a tertiary care institute in Uttarakhand. 147 cases were included in the present study. All study participants underwent Chest radiography and CECT chest.  Results: Out of 147 patients, 116 had a grossly normal Chest radiography. The most common pattern seen on chest radiography was heterogenous opacities (n=16, 10.9%) followed by homogenous opacity (n=9, 6.1%), cavitation (n=4, 2.7%), hyperinflation (n=1), and hilar prominence (n=1). The most common thoracic cause for vocal cord paralysis was malignant neoplasm (25 cases) followed by Tuberculosis, including fibrosis (15 cases). Conclusion: Our study had some differences from previous done studies such as Tuberculosis was one of the major causes of VFP in our study possibly due to increased prevalence of Tuberculosis in our country. Among malignant neoplasm, malignant lymph nodes were a major cause for VFP in our study. Malignant neoplasm and both active and past infection of Tuberculosis need to be considered in every case of VFP

Background: Caregivers of ventilator-dependent patients face significant psychological challenges due to the intensive nature of caregiving and the emotional toll of witnessing critical illness. This study investigated the prevalence and dimensions of psychological burden among caregivers of ventilator-dependent patients in a tertiary care hospital, focusing on stress and caregiving load to identify gaps in support systems and inform the design of targeted, evidence-based interventions. Methods: A cross-sectional study was conducted at Santhiram Medical College, Andhra Pradesh, between February and June 2023. A structured questionnaire collected socio-demographic data from caregivers who provided informed consent. Psychological strain was evaluated using the Perceived Stress Scale (PSS), while the caregiving burden was assessed via the Burden Assessment Scale (BAS). Statistical analysis was performed using SPSS version 26.0, with categorical data expressed as percentages and associations analysed using Chi-square tests. Results: Among 174 caregivers, most were male (84.5%) and aged 30–49 years. Moderate stress levels were reported by 71.8% of caregivers, while 27.6% experienced high stress. Minimal burden was reported by 89.1% of caregivers, with only 4.6% experiencing moderate burden. Demographic factors such as education, income, occupation, and residence significantly influenced caregiving burden scores, while gender showed no significant association with perceived stress or burden levels. Conclusion: The study demonstrated that caregivers of ventilator-dependent patients experience considerable psychological stress, particularly those with lower socioeconomic status. These findings underscore the need for targeted support interventions to alleviate caregiver burden and enhance overall well-being in tertiary care settings.

Background: Acute appendicitis remains one of the most common abdominal emergencies, with diagnosis often challenging in clinical practice. While various diagnostic scoring systems exist, the RIPASA scoring system, developed specifically for Asian populations, has demonstrated high sensitivity in diagnosing acute appendicitis. This study aims to validate the RIPASA scoring system in diagnosing acute appendicitis at a tertiary care center. Methods: A prospective observational study was conducted on 162 patients presenting with right iliac fossa pain at Yenepoya Medical College Hospital between August 2022 and July 2024. Patients were assessed using the RIPASA scoring system, which consists of 14 clinical parameters, and were then treated with appendicectomy. Histopathological findings were used as the gold standard for diagnosis. The diagnostic performance of the RIPASA score was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. ROC curve analysis was also performed. Results: The RIPASA score demonstrated high sensitivity (88.46%) and PPV (93%) for diagnosing acute appendicitis, with moderate specificity (66.7%) and NPV (53%). The overall diagnostic accuracy was 80.5%. The optimal cutoff score of ≥7.5 was found to be effective in identifying patients with acute appendicitis. ROC curve analysis showed an area under the curve (AUC) of 0.88, indicating good diagnostic performance. Conclusion: The RIPASA scoring system is a reliable and sensitive tool for diagnosing acute appendicitis, especially in settings with limited access to imaging. While its specificity is moderate, the high sensitivity and PPV make it a valuable diagnostic aid in clinical practice. Further studies are required to refine its diagnostic accuracy and combine it with imaging modalities.

Background: Superficial Parotidectomy historically performed without magnification, there has been a progressive shift toward the use of microsurgical techniques, improving visualization and reducing nerve injury.3 Facial nerve dysfunction can profoundly impact the patient’s quality of life. Thus, accurate identification and meticulous dissection of the facial nerve trunk and its branches are critical for favourable outcomes. This case series explores current advancements in parotid surgery with an emphasis on facial nerve preservation and highlights the role of microsurgery in enhancing outcomes. Additionally, the approach has educational value in surgical training.

Duodenal perforation is a rare but potentially life-threatening condition with a mortality rate ranging from 8% to 25% in published literature. Perforations of the third part of the duodenum (D3) are particularly uncommon, presenting unique diagnostic and management challenges. While most duodenal perforations result from peptic ulcer disease, trauma, or iatrogenic causes, they typically manifest as acute peritonitis requiring prompt surgical intervention. A 92-year-old male presented to the emergency department with diffuse abdominal pain and distension persisting for five days. Clinical examination revealed the patient to be in septic shock. Abdominal computed tomography (CT) demonstrated minimal loculated free fluid in the abdomen and pelvis suggestive of ascites, diffuse mesenteric and omental fat stranding, and a 3.8 mm defect in the anterior wall of the third part of the duodenum with adjacent free air foci, confirming perforation. Additional tiny air foci were noted in the right lumbar omentum, consistent with pneumoperitoneum. This case highlights the critical importance of early suspicion and prompt investigation in cases of duodenal perforation, especially when involving the less common third segment. Delayed presentation, as in this elderly patient arriving five days after symptom onset, significantly increases morbidity and mortality risks. Management of such cases requires a multidisciplinary approach, with treatment strategies tailored to the patient's clinical status, perforation size, and degree of contamination. This rare case provides valuable insights into the diagnostic approach and management considerations for D3 perforations in elderly patients presenting with advanced complications.

Background: Hypoalbuminemia, a condition characterized by low serum albumin levels, is commonly observed in critically ill patients. It is associated with poor prognosis, including increased mortality, prolonged ICU stays, and a higher incidence of complications like infections and venous thromboembolism (VTE). This study explores the clinical implications of serum albumin in critical care and evaluates the potential benefits of albumin infusion therapy. Methods: A prospective cohort study was conducted on 150 adult patients admitted to the ICU or diagnosed with nephrotic syndrome. Patients were classified into two groups: low albumin group (serum albumin < 3.5 g/dL) and normal albumin group (serum albumin ≥ 3.5 g/dL). Data were collected on demographics, clinical outcomes (mortality, ICU stay, complications), and albumin infusion therapy. Statistical analyses were performed using chi-square tests, t-tests, and Cox proportional hazards models. Results: The low albumin group showed significantly higher mortality (32% vs. 18%, p = 0.03), longer ICU stays (10 days vs. 6 days, p = 0.01), and a higher incidence of infections (27% vs. 15%, p = 0.02). In nephrotic syndrome patients, the low albumin group had a 10% VTE incidence compared to 2% in the normal albumin group (p = 0.04). Albumin infusion improved clinical outcomes, with 31% of patients in the low albumin group showing significant improvement. Conclusion: Low serum albumin levels are associated with poor outcomes in critically ill patients. Albumin infusion therapy offers potential therapeutic benefits and should be considered in the management of hypoalbuminemic patients in critical care settings.

Background: Nutritional anemia affects 58.5% of children under five in India, with infants and toddlers being particularly vulnerable. Factors like poverty, malnutrition, poor dietary practices, and infections contribute to the condition. Despite efforts, the prevalence remains high. Recent research suggests novel biomarkers could improve diagnosis and management. Aims: The study aims to assess homocysteine levels in moderate to severe nutritional anemia cases aged 3 months to 2 years and calculate the prevalence of hyper homocysteinemia. Materials and methods: The present study was an observational and cross-sectional study. This Study was conducted from 12 months, March 2024 to February 2025 at Department of Pediatrics, GMERS Medical College & Hospital, Gotri, Vadodara Study population 100.  Result: The majority of participants were aged 7–12 months (51%) and from urban areas (69%), with 53% females. Mean serum B12 was 269.9 ± 101.6 pg/mL, ferritin 16.4 ± 5.7 mcg/mL, and homocysteine 61.6 ± 38.5 μmol/L. B12 levels were lower in macrocytic hypochromic anemia (158 ± 56.1 pg/mL) vs. microcytic normochromic (298.6 ± 88.9 pg/mL, p<0.001), while homocysteine was higher (98.2 ± 33.4 vs. 53.9 ± 35.7 μmol/L, p<0.001). Ferritin levels showed no significant difference between groups. Conclusion: The study found a strong link between homocysteine levels and anemia type in children aged three months to two years with moderate to severe nutritional anemia. It suggested that vitamin B12 deficiency and hyperhomocysteinemia are linked. The findings emphasize the need for routine screening for these deficiencies.

Background: Iron Deficiency Anemia (IDA) is a global health concern, particularly affecting adolescent girls due to increased nutritional needs during growth and menstruation. This study focuses on IDA prevalence in Anantnag, Jammu and Kashmir, highlighting dietary patterns and socioeconomic influences. Understanding these factors is essential for targeted interventions to improve health outcomes. Objectives: To find out the prevalence of IDA among adolescent girls, to assess the dietary patens of adolescent girls and to know the role of socio-economic status in IDA. Methods: A cross-sectional study was carried out to evaluate the prevalence of anemia and its associated factors. Information was gathered through structured questionnaires and hemoglobin levels were measured using Sahli’s method. Collected data included demographic details, symptoms, dietary practices, and knowledge related to anemia. The analysis involved descriptive statistics and inferential methods such as the chi-square test, t-test, and Mann-Whitney U test. Statistical significance was determined at a p-value of less than 0.05. Ethical clearance was obtained, and informed consent was secured from all participants. Results: Participants with anemia had significantly lower height, weight, BMI, and socioeconomic status compared to those without anemia. Symptoms such as breathlessness, sleepiness, lack of concentration, and hypothermia were significantly more common in the anemia group. Dietary habits showed less frequent non-vegetarian food consumption in participants with anemia, but green leafy vegetable and nut/fruit intake were similar between groups. Knowledge about anemia, including its causes, symptoms, and treatments, was comparable across groups, with no significant differences observed. Conclusion: Anemia continues to be widespread and is significantly affected by physical, socioeconomic, and dietary factors. Although participants possess adequate knowledge, this has not led to better health outcomes, underscoring the need for comprehensive strategies that address nutrition, reduce inequalities, and enhance access to healthcare.

Background: Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening medical emergency with varied etiology. Early diagnosis, risk stratification, and intervention are critical to reducing morbidity and mortality. Objectives: To identify the etiology, assess risk severity using validated scores, and evaluate clinical outcomes in patients with UGIB admitted to a tertiary care hospital in Eastern India. Methods: This was a descriptive observational study conducted over 12 months, including 100 adult patients with hematemesis and/or melena. All patients underwent upper GI endoscopy and were assessed using the Glasgow-Blatchford Score (GBS) and Rockall Score. Data on demographics, risk factors, endoscopic findings, hospital stay, and outcomes were analyzed using SPSS v20, with p < 0.05 considered statistically significant. Results: The majority of patients were male (79%) and aged 35–49 years. Peptic ulcer disease was the most common etiology (48%), followed by esophageal varices and portal hypertensive lesions (30%). Most patients had GBS ≥6 (89%) and Rockall scores of 3–7 (81%). The average hospital stay increased with lesion severity (p < 0.001). Clinical outcomes were favourable: 94% discharged, 6% referred, and no deaths. Conclusion: Peptic ulcer disease and variceal bleeding were the predominant causes of UGIB. Early endoscopic evaluation and application of risk scores such as GBS and Rockall were effective in predicting severity and guiding management. Outcomes were excellent with timely and appropriate care.

Background: Pediatric eye diseases significantly impact development, education, and quality of life, with early-onset conditions risking irreversible blindness if undetected. The global epidemiology varies, with infections and malnutrition leading causes in developing nations and retinal disorders more common in developed regions; however, refractive errors remain the primary cause worldwide. Despite WHO initiatives prioritizing refractive errors and childhood cataracts, Indian studies often focus on isolated conditions, lacking comprehensive data. Thus, the objective of our study was to establish a complete profile of pediatric ocular morbidities to aid in early diagnosis, targeted interventions, and effective child eye care planning. Methods: A prospective observational study was conducted over 12 months at Sri Chamundeshwari Medical College Hospital & Research Institute, Channapatna, involving 200 pediatric patients (0–18 years) attending the ophthalmology outpatient department. Detailed histories and comprehensive ocular examinations, including visual acuity assessment, cycloplegic refraction, anterior and posterior segment evaluations, intraocular pressure measurement, and squint assessment, were performed. Management included glasses, medical, or surgical treatment, with a six-month follow-up. Results: In our study of 200 pediatric subjects, the majority were aged 7–12 years (42%) and male (58.5%). Good visual acuity (6/6 to 6/18) was noted in 74% of better eyes, while 21.5% could not be assessed by Snellen chart. Refractive errors were the most common ocular disorder (26%), followed by conjunctival disorders (17%) and adnexal diseases (13%). Amblyopia was predominantly isometropic (50%), mainly caused by refractive errors (71.4%). Medical management (29.5%) and glasses (26%) were primary treatments, while surgery was needed in 11.5%. Surgical outcomes were favorable, with 78.3% achieving good results after six months. Conclusion: Our study comprehensively profiled pediatric ocular morbidity, revealing refractive errors as the leading cause, predominantly affecting school-aged males. Most children had good visual acuity, and early interventions, mainly medical or optical, yielded favorable outcomes. Surgical management was effective where needed. These findings highlight the need for early screening and timely treatment to reduce preventable childhood visual impairment.

Background:  Most intertrochanteric fracture occurs in elderly people (above 60 yrs.) with reported mortality rates ranging from 15 to 30% .Unstable intertrochanteric fracture in osteoporotic bone are difficult to treat. Failure Rates of fracture with internal fixation are found high mainly with cephalomedullary screw cut out especially in osteoporotic bone. Aim: The aim of the study is to assess the efficacy of cemented bipolar hemiarthroplasty in the management of comminuted intertrochanteric fracture through transtrochanteric approach in elderly patient with osteoporosis. Materials and method: 25 patients (above 60yrs) of age with unstable intertrochanteric fracture who underwent bipolar hemiarthroplasty were retrospectively evaluated. Transtrochanteric approach was used in all patients, Greater trochanter encirclage was done in all patients. Harris hip score is used for clinical evaluation. Minimum follow up years 1 year. Results: In our study 25 cases were taken, which had a mean age 67.2 years. The mean Harris hip score at one year was 81.25 . At one year follow-up Excellent results were obtained in 5(20%) cases Good in 13(52%) cases , fair in 5 (20%) cases, poor in 2 (8%). Mean hospital stay was 16.64 days. There was one case of superficial infection and one case of periprosthetic fracture which were managed with wound Debridement and antibiotics and ORIF with plating (fracture fixation) respectively. Three cases of shortening and managed with shoe Raise. Conclusion: Osteosynthesis with Dynamic hip screw fixtions or intramedullary fixation are the most commonly performed operations for intertrochanteric fracture of hip. These fractures are better treated with Cemented bipolar hemiarthroplasty through a trans-trochanteric approach that gives good results in a majority of elderly patients with unstable intertrochanteric fracture. Cemented hemiarthroplasty provides stable and mobile hip, it has advantage of an early ambulation as compared to the internal fixation. Also, the patient's rehabilitation is easy and fast.

Background:  Acne vulgaris is a common dermatological condition in adolescents, often influenced by hormonal, genetic, dietary, and environmental factors. Emerging evidence suggests that vitamin D, a fat-soluble secosteroid hormone with immunomodulatory and anti-inflammatory properties, may play a role in acne pathogenesis. This study aims to assess the correlation between serum vitamin D levels and the clinical severity of acne vulgaris in adolescents. Materials and Methods: A cross-sectional study was conducted among 120 adolescents aged 13–19 years diagnosed with acne vulgaris. Participants were categorized into three groups based on the Global Acne Grading System (GAGS): mild (n=40), moderate (n=40), and severe (n=40). Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using a chemiluminescent immunoassay. Statistical analysis was performed using ANOVA and Pearson’s correlation to determine the relationship between vitamin D levels and acne severity, with p<0.05 considered statistically significant. Results: The mean serum vitamin D levels in the mild, moderate, and severe acne groups were 28.7 ± 5.4 ng/mL, 21.3 ± 4.9 ng/mL, and 14.6 ± 3.7 ng/mL respectively. A statistically significant inverse correlation was observed between serum vitamin D levels and acne severity (r = -0.72, p < 0.001). Vitamin D deficiency (<20 ng/mL) was more prevalent in the severe acne group (82.5%) compared to the moderate (60%) and mild (25%) groups. Conclusion: A significant inverse correlation was found between serum vitamin D levels and the severity of acne vulgaris in adolescents. These findings suggest that vitamin D insufficiency or deficiency may be associated with increased acne severity, indicating the potential role of vitamin D supplementation in acne management

Background:  Midshaft clavicle fractures are among the most common injuries of the shoulder girdle. While both plate fixation and intramedullary nailing are standard surgical approaches, their comparative functional outcomes remain under continuous evaluation. This study aims to assess and compare the functional recovery, complication rates, and union times between these two techniques.  Materials and Methods:  A prospective cohort study was conducted on 60 patients aged between 18 and 60 years with displaced midshaft clavicle fractures. Patients were divided into two groups: Group A (n=30) underwent open reduction and internal fixation (ORIF) with plating, while Group B (n=30) received intramedullary nailing. Functional outcomes were assessed using the Constant-Murley Shoulder Score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score at 6 weeks, 3 months, and 6 months. Radiological union and postoperative complications were also evaluated.  Results:  At 6 months, Group A showed a mean Constant score of 91.4 ± 5.2, while Group B recorded a mean score of 88.1 ± 6.7 (p = 0.045). The DASH score was lower in Group A (8.3 ± 2.4) compared to Group B (10.6 ± 3.1) (p = 0.038), indicating slightly better functional recovery with plate fixation. The average union time was 11.2 weeks in Group A and 10.7 weeks in Group B (p = 0.22). Complication rates were 13.3% in Group A (minor infections, hardware irritation) and 10% in Group B (nail migration, skin irritation).  Conclusion:  Both plate fixation and intramedullary nailing provide satisfactory functional outcomes in treating midshaft clavicle fractures. However, plate fixation demonstrated marginally superior shoulder function and fewer subjective disabilities in the mid-term follow-up, with comparable union times and complication rates.