Background: Internal fixation is often necessary for high-energy injuries such as distal femur fractures. Significant perioperative blood loss is frequently experienced after these procedures, increasing the need for transfusions and the dangers involved. Although the antifibrinolytic drug tranexamic acid (TXA) has demonstrated effectiveness in lowering bleeding during a variety of orthopaedic procedures, nothing is known about how it affects distal femur fixation. Aim: To determine whether TXA is safe and effective in minimizing perioperative blood loss when internal fixation of distal femur fractures is performed. Methods: This six-month prospective cohort study was carried out at Baba Saheb Ambedkar Medical College & Hospital in New Delhi, where 30 adult patients undergoing internal fixation for distal femur fractures received intravenous TXA (15 mg/kg) 15–20 minutes prior to incision. Data were analysed using SPSS version 23.0, with p < 0.05 deemed significant. Intraoperative blood loss, postoperative drain output, haemoglobin changes, transfusion requirements, and complications were documented. Results: The mean intraoperative blood loss was 450.3 ± 78.2 mL, and the mean postoperative drain output was 120.6 ± 25.4 mL, yielding a total mean blood loss of 570.9 ± 84.6 mL (p < 0.001 vs historical controls). The mean haemoglobin drop was 1.2 ± 0.3 g/dL, and only 2 patients (6.7%) required transfusion (p = 0.04). No thromboembolic events occurred, and minor complications included mild swelling in 4 patients (13.3%) and one superficial wound infection. Conclusion: (TXA) supports its use as a safe adjunct in orthopaedic trauma surgery by considerably reducing perioperative blood loss and transfusion requirements in distal femur fracture fixation without raising the risk of serious complications. Recommendations: Routine use of (TXA) should be considered in internal fixation of distal femur fractures, with careful patient selection to avoid those at high thromboembolic risk. To validate these results and create uniform dose guidelines, larger randomized controlled trials are necessary.

Background: Guillain-Barré Syndrome (GBS) is an acute, immune-mediated neuropathy and a leading cause of acute flaccid paralysis globally. Its incidence varies across seasons and geographic regions, often influenced by preceding infections. Seasonal trends and electrophysiological patterns of GBS remain underreported in Eastern India, particularly in tertiary centers. Aim: To analyze the epidemiological trends, seasonal variation, and electrophysiological subtypes of GBS among patients admitted to a tertiary care center in Eastern India. Methods: A retrospective observational study was conducted at the Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, from June 2023 to April 2025. Medical records of 79 patients diagnosed with GBS were reviewed. Data on age, sex, seasonal occurrence, and electrophysiological subtypes were collected. Seasonal distribution was categorized into pre-monsoon, monsoon, post-monsoon, and winter. Statistical analysis was performed using SPSS version 23.0, with significance set at p<0.05. Results: Among 79 patients, the mean age was 42.7 ± 16.3 years, with a male predominance (65.8%). Most cases (40.5%) occurred during the monsoon season, followed by post-monsoon (24.1%). AIDP was the most common variant (54.4%), followed by AMAN (20.3%) and AMSAN (17.7%). A statistically significant association was found between seasonal occurrence and GBS incidence (p = 0.02), while no significant difference was observed between age or sex distribution across subtypes. Conclusion: The study identified a significant seasonal peak of GBS cases during the monsoon period, with AIDP as the predominant electrophysiological variant. These findings suggest a potential link between seasonal infections and GBS incidence. Recommendations: Enhanced surveillance and preparedness during high-incidence seasons are crucial. Early diagnosis, public health awareness, and region-specific studies can improve outcomes and resource planning.

Background: Hypertensive disorders associated with pregnancy, including superimposed preeclampsia, chronic hypertension, preeclampsia, and gestational hypertension, greatly lead to serious maternal and fetal complications, enduring health problems, and higher mortality rates worldwide. At the same time, it is recognized that a deficiency of vitamin D is a common issue, impacting 18% to 84% of people worldwide, shaped by factors such as geographical area, ethnicity, cultural clothing practices, and dietary habits. Methodology Patients meeting the inclusion and exclusion criteria selected for the study. A sample of serum vitamin D was collected upon admission at the Hospital. Maternal results such as anaemia, PPH, Length of Labour, Eclampsia, DIC, and Thromboembolism were noted. Neonatal outcomes such as low birth weight, neonatal tetany, hyperbilirubinemia, large fontanelle, enamel defects, congenital rickets, and infantile rickets were noted. Results the majority of cases with no chronic hypertension had adequate vitamin D levels, with 99 (97.06%) being adequate and 23 (95.83%) being inadequate. Most cases that did not receive supplements showed high rates of deficient (100%), insufficient (100%), and sufficient (89.22%) vitamin D levels. the study group shows no statistically significant connection between vitamin D levels and neonatal mortality. There is a notable correlation between vitamin D levels and the occurrence of LBW. The study discovered that a lack of vitamin D was associated with an increased risk of chronic hypertension. Conclusion Although keeping sufficient vitamin D levels is crucial for overall health, widespread screening and supplementation might not be required unless particular deficiencies are detected.

Background: Oral squamous cell carcinoma (OSCC) remains a significant public health challenge, particularly in India. Tumour budding, defined as isolated single cells or small clusters (<5 cells) at the invasive tumour front, has emerged as a histological marker of epithelial-mesenchymal transition (EMT) and tumour aggressiveness. This study evaluates the prognostic significance of tumour budding in OSCC and its association with clinicopathological parameters. Aim and Objectives: To assess the prognostic value of tumour budding at the invasive front in OSCC and determine its correlation with histopathological factors such as tumour grade, depth of invasion, lymph node metastasis, perineural invasion, and overall survival. Materials and Methods: This retrospective study included 80 histologically confirmed OSCC cases diagnosed between January 2019 and December 2023 at a tertiary care center in Tamil Nadu. Tumour budding was assessed in H&E-stained sections under high power (×20) using the ITBCC 2016 criteria. Cases were stratified into low (<5 buds) and high (≥5 buds) tumour budding categories. Clinical and pathological parameters were compared using Chi-square tests, and survival was analyzed using Kaplan–Meier curves and log-rank tests. Results: High tumour budding was significantly associated with poor differentiation (p < 0.01), depth of invasion >10 mm (p = 0.002), lymph node metastasis (p < 0.001), perineural invasion (p = 0.005), and lower overall survival (p = 0.003). Conclusion: Tumour budding at the invasive front is a reliable histological marker for predicting aggressive behaviour and poor prognosis in OSCC. It should be routinely incorporated in pathology reporting to aid in risk stratification and treatment planning.

Background: Osteoporosis is a disease of bone that leads to an increased risk of fracture. The, Singh index which describes trabecular patterns in the proximal femur, is accepted indicator of osteopenia and osteoporosis and may be used as a predictor for hip fractures. Present study was aimed to study porosity of bone and its relation to fractures around hip by using Singh index. Material and Methods: Present study was prospective, observational study, conducted in patients coming to the Orthopaedics OPD and casualty with a fractures around hip. The series of radiographs of normal hip are assessed by observer 1, twice with one month apart and observer 2 using Singh index for grading of osteoporosis. Results: In our study we had a series of 90 cases who had sustained fractures around hip.48 were women and 42 were male. There were 45 cases of fracture neck femur,39 cases of intertrochanteric fractures and 06 cases of subtrochanteric fractures. There was high relation of degree of osteoporosis with type of fractures (p value 0.00) around hip, but there was no relation with the gender of the patient. Over all inter- observer agreement was 0.56 (kappa value) and intra-observer agreement was 0.68 (kappa value). 95 % confidence interval in inter-observer agreement ranged from 0.584 and 0.795 with p value 0.00. Intraclass correlation coefficient in intra-observer agreement ranged from 0.726 and 0.872 with p value 0.00. There is moderate inter-observer agreement and a good intra-observer agreement. Agreement is good in severe osteoporosis than mild to moderate osteoporosis. Conclusion: Age of the patient have a relation to the degree of osteoporosis. Singh Index was found to be a reliable tool for grading of osteoporosis in a hip region.

Background: The Atlanta Classification is a standardized clinical framework introduced to define the severity and complications of acute pancreatitis (AP). Originally established in 1992 and revised in 2012, it helps clinicians categorize disease severity, assess prognosis, and guide treatment. [8] The present study aims to assess and compare the prognostic utility of the BISAP score and the Neutrophil-to-Lymphocyte Ratio (NLR) in predicting the severity of acute pancreatitis among patients presenting to the Emergency Department. Materials And Methods: This prospective observational study was conducted over one year (January 1, 2024 –December 31, 2024) in the Emergency Medicine Department, after getting institutional ethical clearanceKounis syndrome, Bee sting, Myocardial infarction. Results: This prospective study was conducted at Guwahati Medical College & Hospital, 82 patients aged 18–65 years were included for further analysis (figure 1). Demographics are tabulated in table 1, median age of 34.5 years and mean age of 37.1 ± 11.73 years. Males comprised 68.3% (n=56) and females 31.7% (n=26). According to the Revised Atlanta Classification, 48 patients (58.5%) had mild acute pancreatitis (MAP), and 34 (41.5%) had severe acute pancreatitis (SAP). Age and sex were not significantly associated with severity (p=0.227 and p=0.231 respectively). Conclusion: when BISAP scores are inconclusive. However, both scoring systems showed comparable performance in predicting complications

Background: Elderly individuals with COVID-19 are at increased risk of in-hospital mortality, and early risk stratification is essential for optimal management. This study aimed to develop and validate a simplified risk score using albumin and electrolyte parameters to predict in-hospital mortality in this population. Methods: A retrospective analysis was conducted on 325 elderly COVID-19 patients admitted to a tertiary care hospital. Demographic, clinical, and laboratory data were extracted, and logistic regression analysis was used to identify independent predictors of mortality. Based on the coefficients, a composite Albumin–Electrolyte Risk Score was developed and validated. Results: The overall in-hospital mortality rate was 22.8%. Lower serum albumin and higher clinical severity were independently associated with increased mortality (OR for albumin: 0.47, 95% CI: 0.30–0.72; OR for severity: 3.32, 95% CI: 1.87–5.90). The risk score demonstrated good discrimination (AUC = 0.757) and stratified patients into low- and moderate-risk categories with mortality rates of 12.8% and 39.7%, respectively. No patients in the sample fell into the high-risk category. Conclusion: The Albumin–Electrolyte Risk Score is a practical and easily applicable tool for predicting in-hospital mortality among elderly COVID-19 patients. External validation is recommended to confirm its utility and determine its performance across all risk strata.

Background: The etiology of retroperitoneal pseudocysts is not fully understood, but various potential pathological mechanisms have been hypothesized and grouped into urogenital, mesocolic, trachomatous, parasitic, traumatic, and lymphatic subtypes. According to the urogenital theory, these neoplasms are thought to arise from residual embryonic urogenital system tissues, involving both epithelial and mesothelial components.Diagnosis primarily relies on ultrasonography and computed tomography (CT) scans.

Background: Breast lesions cover a broad spectrum of both benign and malignant conditions, making histopathological analysis crucial for accurate diagnosis and effective treatment planning. By understanding the local patterns of these lesions, we can enhance early detection and ultimately improve patient outcomes. Objective: This study aims to examine the histopathological patterns of breast lesions diagnosed over a five-year span at a Laboratory. Methods: We conducted a retrospective review of 1,275 breast tissue specimens collected from January 2019 to December 2023. The specimens included both biopsies and surgical excisions, all analyzed using standard histopathological techniques. We looked at patient demographics, lesion types, laterality, and trends over the years using descriptive statistics. Results: Out of the 1,275 cases, 792 (62.1%) were benign, while 483 (37.9%) were malignant. The most common benign lesion was fibroadenoma, accounting for 28.4% of cases, primarily affecting women aged 21 to 40. Invasive ductal carcinoma (IDC) emerged as the most prevalent malignancy, representing 81.6% of malignant cases, with a notable increase in patients over 40. We observed a consistent rise in malignant diagnoses throughout the five-year period, likely attributed to improved screening and diagnostic services. Male breast lesions made up 3.3% of all cases, with a larger share being malignant. Conclusion: While benign lesions are more common than malignant ones, the increasing trend of breast cancer, especially IDC in older women, highlights the critical need for early histopathological evaluation. These findings emphasize the importance of strong screening programs and awareness initiatives, particularly aimed at high-risk age groups.

Background: Cognitive biases significantly shape decision-making in dentistry, influencing diagnostic accuracy, treatment planning, and patient interaction. While cognitive shortcuts can streamline judgments, unchecked biases may lead to systematic errors affecting patient outcomes and clinical efficiency. This review examines how common cognitive biases manifest in dental settings, offering strategies for mitigating their influence on both practitioners and patients. By integrating cognitive psychology principles into dental education and practice, clinicians can enhance their critical thinking, improve patient-centered communication, and minimize bias-driven errors. Clinical Relevance: Recognition and mitigation of cognitive biases in clinical settings is crucial as it can substantially empower dental students and clinicians to enhance diagnostic accuracy and thereby deliver improved patient care. Objective: To familiarise the clinician with the existing cognitive biases and the ways to avoid them in order to make better diagnostic decisions. Funding: No funding is required to complete the study. Conflict of interest: None of the author of the has declared any conflict of interest. I nformed consent: Not required as no images or personal information is used. Institutional review board approval : Obtained

Effective premedication in pediatric anesthesia is important in preventing preoperative anxiety, ensuring smooth induction, and improving perioperative outcomes. Of the many sedatives employed, dexmedetomidine, a potent α2-adrenergic agonist, and midazolam, an ultra-short-acting benzodiazepine, are employed in children due to their advantageous pharmacological profile. Their comparative efficacy and safety as premedication drugs, however, remain a subject of investigation.

Dexmedetomidine has arrived with its sedative, anxiolytic, and analgesic effects without resultant significant respiratory depression and is touted as a potentially preferable alternative to midazolam in children (Lang et al., 2020; Jen et al., 2024) [1,6]. A number of meta-analyses have demonstrated that dexmedetomidine can produce better results in sedation quality, parent-child separation, and less emergence agitation compared to midazolam (Pasin et al., 2015; Sun et al., 2014) [2,5]. In addition, a number of routes of administration—oral, intranasal, and intravenous—have been investigated, and evidence indicates intranasal and oral dexmedetomidine offer safe and effective sedation with an acceptable safety profile (Fu et al., 2023; Pereira et al., 2024) [4,7].

The combination of dexmedetomidine and midazolam has also been examined in recent systematic reviews, with suggested synergisms in certain contexts (Nie et al., 2024) [3]. Specific comparative analysis is required, however, for varying dosing, patient age ranges, and study endpoints [8].

This article attempts to critically review and compare the effectiveness and safety of midazolam and dexmedetomidine as pediatric anesthesia premedication from the most recent available evidence from meta-analyses and randomized trials to give a balanced perspective of their relative merits and demerits.

Background: Inhalational anesthetics, particularly halogenated ethers such as sevoflurane and desflurane, offer the benefits of rapid induction and recovery, making them ideal for outpatient surgeries. This study innovatively compares the postoperative respiratory impacts of isoflurane, sevoflurane, and desflurane, using spirometry to track changes in lung function, thereby contributing valuable insights into anesthesia's role in respiratory dynamics. Methods: This observational study was conducted at AIIMS Patna's General Surgery department, focusing on patients undergoing Laparoscopic Cholecystectomy from December 2020 to October 2021. 150 patients were divided into three groups to receive Isoflurane, Desflurane, or Sevoflurane. Preoperative and postoperative spirometry assessments were performed using the MIR SPIROLAB spirometer. The anesthesia induction followed a standard protocol, and recovery times were assessed with the Modified Aldrete score and other recovery parameters. Results: The change was statistically significant for only 3 values in the first hour, FEV1/FVC, F25-75, and PEF implying a substantial difference among the three groups in terms of these parameters. The recovery of the FEV1 (p =0.023) and F25-75 (p =0.01) values only showed a statistically significant difference at the 5th hour in our analysis. We found a statistically significant difference between the three inhalational agents between the time to eye-opening, time to follow commands, and time to get oriented to time, place, and person. Conclusion: The study conclusively demonstrates that inhalational agents Desflurane, Sevoflurane, and Isoflurane induce a measurable decline in pulmonary function post-laparoscopic cholecystectomy. Isoflurane showed the most significant FEV1, FVC, and FEV6 recovery by the fifth hour, while Desflurane led to the recovery of FEV1/FVC, F25-75, and PEF values.

Background: Syringocystadenoma papilliferum (SP) is a rare, benign hamartomatous adnexal neoplasm arising from apocrine or eccrine sweat glands. It often presents congenitally or around puberty and is predominantly localized to the scalp and face. Malignant transformation, though uncommon, has been reported. Case Presentation: We report the case of an 18-year-old male who presented with three swellings at the nape of the neck, present since birth, with sudden enlargement and pain in one lesion over the past month and a half. Clinical examination revealed firm, non-indurated nodules without lymphadenopathy. Ultrasonography initially suggested an infected sebaceous cyst. The patient underwent wide local excision under local anaesthesia. Histopathological analysis demonstrated characteristic features of SP, including cystically dilated invaginations connected to the epidermis and papillary projections lined by bilayered epithelium with decapitation secretion. Immunohistochemistry confirmed the diagnosis with positive CEA and EMA in luminal cells and SMA and p63 in abluminal cells. Postoperative recovery was uneventful with no recurrence at one-year follow-up. Conclusion: This case highlights an unusual presentation of multiple SP lesions at the nape of the neck, clinically mimicking an infected sebaceous cyst. Histopathology remains the gold standard for diagnosis. Early recognition and complete excision are essential to prevent recurrence and rule out malignant transformation.

Background: The objective of this study is to present the comprehensive experience of treating 132 consecutive EDCR in 127 patients of NLD obstruction without presacal disease and nasal pathology except anatomical variations and compare it with available literature. My all-encompassing experience gained by performing 132 endoscopic DCR on patients of NLD obstruction from the period of july 2020 to august 2022. All patients were operated using posterior sac technique and combination of mechanical and powered instruments. In AD EDCR was carried out after three days of conservative treatment. Associated anatomical factors were treated simultaneously. No complaint of epiphora visualization of ostium on NE and patency of sac on syringing at the end of one year is considered as success of procedure. In conclusion different factors were noted which help to improve the result of EDCR. In my series overall success rate is 93.4%.

Background: Functional recovery after total knee replacement (TKR) varies widely among patients. Preoperative quadriceps strength is a potentially modifiable factor that may influence postoperative outcomes, yet its predictive value remains incompletely defined. Materials and Methods: This prospective observational study was conducted at Government Medical College, Kothagudem from June 2024 to May 2025. A total of 120 patients undergoing primary unilateral TKR were enrolled. Preoperative isometric quadriceps strength was assessed using a dynamometer. Functional recovery was evaluated at 3 months using Knee Society Score (KSS), WOMAC function subscale, Timed Up and Go (TUG) test, and range of motion (ROM). Patients were stratified into tertiles based on strength, and statistical correlations were analyzed using Pearson's coefficient and ANOVA. Results: A significant correlation was observed between quadriceps strength and composite recovery score (r = 0.61, p < 0.001, 95% CI: 0.49–0.72). Patients in the highest strength tertile (>28 kg) demonstrated superior outcomes across all metrics: KSS (82.3 vs 69.4), WOMAC (74.0 vs 61.1), TUG (9.5s vs 11.2s), and ROM (123.2° vs 109.3°) compared to those in the lowest tertile (<22 kg), with all differences reaching statistical significance (p < 0.001). Conclusion: Preoperative quadriceps strength is a strong predictor of short-term functional recovery after TKR. Its assessment can aid in risk stratification and guide prehabilitation planning. Incorporating strength evaluation into preoperative assessment protocols may improve postoperative outcomes..

Background: Sarcopenia, first defined by Irwin Rosenberg in 1988 as an age-related decline in skeletal muscle mass and function, has since been further characterized by Baumgartner through the evaluation of appendicular lean mass adjusted for height. AIM: To evaluate the prevalence of sarcopenia in patients with type 2 diabetes mellitus (T2DM). Methodology: This cross-sectional study was conducted over a period of 18 months starting from April 2023, following the acceptance of Institutional Ethics Committee (IEC) approval. The research took place in the Department of General Medicine and the Department of Radiology at Mahatma Gandhi Medical College & Hospital, Jaipur. Result: The study found that diabetic patients exhibited significantly lower muscle strength, thickness, and higher fracture risk, along with increased BMI, waist circumference, and altered biochemical markers indicating poor glycemic control and inflammation. These findings emphasize the strong link between type 2 diabetes, sarcopenia, and metabolic dysfunction, highlighting the need for integrated management strategies. Conclusion: our study establishes a strong link between type 2 diabetes and sarcopenia, emphasizing the need for early screening and targeted management to improve patient outcomes.

Background: Thyroid dysfunction has been associated with cardiovascular disease. Subclinical hypothyroidism (SH), which is characterized by elevated thyroid stimulating hormone (TSH) levels and normal circulating free thyroid hormones is an independent risk factors for the pathogenesis of atherosclerosis and cardiovascular disease, affecting adversely the endothelial function. AIM: The aim of the study is to evaluate association between subclinical Hypothyroidism (SCH) and atherosclerosis as measured by CIMT. Methodology: A Cross Sectional Study conducted at Mahatma Gandhi Medical College & Hospital Jaipur Patients who are Diagnosed as Cases of Subclinical Hypothyroidism in Mahatma Gandhi Hospital on 130 patients who are divided into two groups-65 patients in Euthyroid group and 65 patients in Subclinical Hypothyroidism group. Result: Subclinical hypothyroidism was associated with significant dyslipidemia, elevated CRP, and increased CIMT, suggesting early atherosclerotic changes. However, conflicting findings in literature and the study's cross-sectional design limit causal inference. Conclusion: Subclinical hypothyroidism is associated with atherogenic dyslipidemia, elevated CRP, and increased CIMT, indicating a potential link to early atherosclerosis.

Background: Non-alcoholic fatty liver disease (NAFLD) is a leading global health concern, characterized by the accumulation of fat in the liver in individuals who consume little or no alcohol. Affecting approximately 25% of the global population, NAFLD is now the most common chronic liver condition in both developed and developing countries. AIM: To estimate the burden of NAFLD and identify patients at risk of progressive disease in Type 2 Diabetes Mellitus using non-invasive FibroScan-AST score. Methodology: This is a prospective observational hospital-based study conducted over 18 months at Mahatma Gandhi Medical College & Hospital, Jaipur, following IEC approval. The study will include patients admitted with type 2 diabetes mellitus and newly diagnosed cases during the study period. Result: In the present study, 75% of type 2 diabetes mellitus patients were found to have NAFLD, with significant associations observed between NAFLD and BMI, obesity, metabolic syndrome, dyslipidemia, liver enzyme derangements, and elevated FAST scores. Additionally, 15% of patients had intermediate FAST scores (0.35–0.67), indicating a risk for progressive liver disease requiring regular monitoring. Conclusion: The study concludes that the FAST score is an effective non-invasive tool for identifying type 2 diabetes patients at risk of progressive NAFLD, warranting routine screening and follow-up.

Background: Orthopaedic disorders such as osteoarthritis, back pain, postural issues, and osteoporosis are increasingly prevalent due to sedentary lifestyles, aging populations, and inadequate preventive practices. Physical activity is a proven, cost-effective strategy for maintaining musculoskeletal health. This study aimed to assess public awareness of the role of physical activity in preventing orthopaedic disorders among adults in Himachal Pradesh and explore socio-demographic factors influencing knowledge levels. Materials and Methods: A descriptive, cross-sectional survey was conducted among 400 adults (aged ≥18) from both urban and rural areas of Himachal Pradesh. A structured, bilingual (Hindi/English) Google Form questionnaire assessed socio-demographics, knowledge (20 MCQs), and self-reported practices related to physical activity and musculoskeletal health. Each correct answer was awarded one point (max score: 20). Knowledge was categorized as Very Good (17–20), Good (13–16), Fair (9–12), and Poor (0–8). Data were analyzed using Epi Info Version 7. Chi-square tests were used to assess associations between awareness and socio-demographic variables (p < 0.05 considered significant). Results: Overall, 30.5% of participants demonstrated Very Good awareness, 35.8% Good, 22.8% Fair, and 11.0% Poor. Awareness was highest regarding the benefits of physical activity for joint flexibility (72.0%), posture (71.3%), and osteoporosis prevention (68.5%). However, gaps were observed in knowledge about optimal frequency of exercise (62.8%), weight-bearing activities (65.8%), and rehabilitation practices (67.3%). Significant associations were found between awareness and age (p = 0.021), education level (p < 0.001), occupation (p = 0.033), and residence (p = 0.039), with urban, educated, and professionally active individuals scoring higher. Gender differences were not statistically significant (p = 0.198). Conclusion: While awareness of the preventive role of physical activity in orthopaedic health is growing in Himachal Pradesh, significant knowledge gaps persist—particularly among older, rural, and less-educated individuals. These disparities highlight the need for culturally sensitive, demographically targeted health education campaigns to promote sustainable, preventive musculoskeletal practices across all population groups. Addressing misconceptions and promoting accessible, age-appropriate physical activity can help reduce the long-term burden of orthopaedic disorders in the region.

Background: Low back pain (LBP) is a leading global cause of disability, increasingly prevalent in both urban and rural populations due to lifestyle, occupational, and ergonomic factors. Himachal Pradesh, with its physically demanding terrain and growing sedentary behaviors, presents a dual-risk environment. This research aimed to evaluate and compare awareness of LBP risk factors among urban and rural populations in Himachal Pradesh and to identify socio-demographic influences on awareness levels. Materials and Methods: A descriptive, cross-sectional study was conducted among 400 adult participants from diverse districts of Himachal Pradesh, using a structured, bilingual (English/Hindi) self-administered Google Form. The questionnaire covered socio-demographics, 20 knowledge-based multiple-choice questions on LBP risk factors, and awareness/practice items. Healthcare professionals were excluded. Knowledge scores were classified into Very Good (17–20), Good (13–16), Fair (9–12), and Poor (0–8). Data were analyzed using Epi Info Version 7, with chi-square tests applied to assess associations between knowledge scores and demographic variables (p < 0.05 considered significant). Results: A majority of participants demonstrated Very Good (31.5%) or Good (34.8%) knowledge of LBP risk factors, with 22.3% scoring Fair and 11.5% Poor. High awareness was recorded for common risk factors like poor posture (73.5%), prolonged sitting (74.0%), physical inactivity (75.5%), and improper lifting (74.5%). Awareness was lower for mental stress (62.0%), smoking (59.8%), and the overuse of imaging (58.0%). Significant associations were found between knowledge scores and age (p = 0.017), education level (p < 0.001), and residence (p = 0.041), with urban, more educated, and working-age individuals scoring higher. No significant difference was observed based on gender (p = 0.264). Conclusion: While public awareness of physical contributors to low back pain is generally strong in Himachal Pradesh, notable knowledge gaps remain—especially regarding psychosocial and lifestyle-related risk factors. Educational level, age, and urban-rural status significantly influence awareness, underscoring the need for inclusive, region-specific health education. Community outreach, ergonomic training, and integration of LBP prevention into primary care and school programs are recommended to mitigate the growing burden of LBP in both urban and rural settings.

Background: Acne vulgaris is a very common entity in terms of frequency and psychosocial importance in the population, and particularly it has severe psychosocial effects in adolescents and young adults. Since the emergence of increased antimicrobial resistance is reducing the efficacy of traditional treatments of topical clindamycin, the use of similar classes of drugs, like topical minocycline, is becoming a topic of interest. Methods: This was a comparative observational, single center, prospective study where 76 patients of 13 years and above age with clinically diagnosed acne vulgaris were randomly assigned to once nightly 4 percent Minocycline topical daily (n=38) or twice per day one percent clindamycin topical daily (n=38) within 12 weeks. The major outcomes were the percentage decrease in the number of lesions and change in severity rating (CASS). Secondary outcomes included adverse events, patient adherence and satisfaction scores. Results: The two groups were found to be similar in gender although the minocycline group was older. Eighty four point two percent of minocycline patients had clear/almost clear skin in the week 12 as compared to 57.9 percent in the clindamycin arm with greater decreases in the mean lesion counts. The minocycline patients had the lesser side effects - particularly dryness, burning and pruritus, and a more patient satisfaction visibly (39.5 percent and very satisfying versus 7.9 percent). Conclusion: Topical minocycline 4% gel was superior in its efficacy, better tolerability, and patient satisfaction in the 12 weeks management of acne compared to that of clindamycin 1% gel. These results should be replicated by bigger studies with follow-ups and be incorporated in clinical recommendations.

Background: Regional anesthesia is a preferred technique for various surgical procedures due to its safety, cost-effectiveness, and superior postoperative analgesia. The addition of adjuvants to local anesthetics in epidural anesthesia can enhance block quality, prolong analgesia, and provide sedation without significant respiratory depression. Dexmedetomidine and clonidine, both α2-adrenergic agonists, have shown promise as epidural adjuvants. Aim: To evaluate and compare the efficacy of epidural clonidine and dexmedetomidine as adjuvants to bupivacaine in providing postoperative analgesia in patients undergoing abdominal and vaginal hysterectomies. Materials and Methods: A randomized, comparative clinical study was conducted on 100 patients aged 44–65 years, classified as ASA grade I and II, scheduled for hysterectomy. Patients were randomly allocated into two groups of 50 each. Group A received 17 ml of 0.5% bupivacaine with clonidine (2 µg/kg), and Group B received 17 ml of 0.5% bupivacaine with dexmedetomidine (1.5 µg/kg) via epidural route. Parameters assessed included onset time of sensory and motor block, duration of analgesia, hemodynamic changes, sedation scores, and incidence of side effects. Results: Both groups were comparable in demographic and surgical characteristics (p > 0.05). The dexmedetomidine group showed a significantly faster onset of sensory and motor block (p < 0.001) and a longer duration of analgesia (p < 0.001) compared to the clonidine group. The time to two-segment regression, sensory regression to S1, and time to first epidural top-up were significantly prolonged with dexmedetomidine. Hemodynamic parameters and sedation scores were comparable, except for a lower heart rate at 120 minutes in the dexmedetomidine group (p < 0.05). The incidence of side effects was similar in both groups and not statistically significant. Conclusion: Dexmedetomidine, when used as an epidural adjuvant to bupivacaine, provides a faster onset of block and prolonged postoperative analgesia compared to clonidine, without an increased incidence of adverse effects. It can be considered a superior alternative for enhancing perioperative analgesia in hysterectomy patients.

Background: Functional endoscopic sinus surgery (FESS) is often associated with intraoperative bleeding, posing challenges for both surgeons and anesthesiologists. Achieving a clear, bloodless surgical field is crucial, and the principle of controlled hypotension can significantly aid in this goal. Methods: A hospital-based, randomized, comparative interventional study was conducted at Arundathi Institute of Medical Sciences, Hyderabad, Telangana, on 60 patients undergoing FESS. Patients were randomized to receive either clonidine (2 mcg/kg in 10 mL saline over 10 minutes before induction, followed by an infusion of 1 mcg/kg/hr during maintenance) or esmolol (1 mg/kg in 10 mL saline over 10 minutes before induction, followed by an infusion of 1 mg/kg/hr during maintenance). The primary outcomes assessed were intraoperative hemodynamic parameters and quality of the surgical field. Results: After induction, a significant difference was observed in mean heart rate and mean arterial pressure (MAP) between the two groups throughout the intraoperative period (p < 0.05). Both clonidine and esmolol groups successfully achieved the target MAP of 65–70 mmHg, resulting in improved surgical field visibility. Conclusion: Both clonidine and esmolol effectively provide hemodynamic stability and enhance surgical field quality during FESS. Additionally, clonidine offers the added benefit of postoperative sedation and analgesia, making it a valuable option in controlled hypotension protocols.

Background: Complex spine surgeries often require large doses of sedative and analgesic agents to ensure adequate intraoperative anesthesia and effective postoperative pain relief. However, the use of these high doses is associated with significant systemic side effects. Magnesium sulfate has emerged as a potential adjunct to reduce anesthetic requirements and improve postoperative pain outcomes. Methods: This double-blind clinical trial included 80 patients undergoing posterior spinal fusion surgery at Nova Institute of Medical Sciences and Research Centre, Hyderabad. Patients were randomly assigned to four groups of 20 each. Group M received magnesium sulfate at varying infusion rates: M1 (10 mg/kg/hr), M2 (15 mg/kg/hr), and M3 (20 mg/kg/hr). Group S received normal saline as a placebo. Due to the occurrence of severe hypotension and bradycardia in the M3 group, the infusion was discontinued, and this group was excluded from further analysis. The final analysis was conducted on 60 patients in the M1, M2, and S groups. Parameters evaluated included intraoperative fentanyl consumption, intraoperative blood loss, and postoperative pain scores. Results: The M2 group exhibited significantly lower intraoperative fentanyl requirements, reduced bleeding volume, and decreased postoperative pain scores compared to both the M1 and saline groups. These findings suggest superior analgesic efficacy and hemodynamic benefits at this dosing level. Conclusion: This study demonstrates that intraoperative administration of magnesium sulfate effectively reduces anesthetic and analgesic requirements and improves postoperative pain control in posterior spinal fusion surgeries. A dose of 15 mg/kg/hr was identified as optimal, offering enhanced analgesia and stable hemodynamic profiles. Doses ≥20 mg/kg/hr are not recommended due to the risk of profound hypotension and bradycardia.

Background: Anemia remains a major public health concern among adolescents, adversely impacting growth, cognitive development, and academic performance. Understanding its prevalence and associated factors among school-going adolescents is essential for effective interventions. Objective: To determine the prevalence of anemia and identify sociodemographic, nutritional, and clinical determinants among adolescents aged 10–19 years attending schools near FH Medical College and Hospital, Agra .Methodology: A prospective, cross-sectional observational study was conducted from May 2023 to December 2024. Using multistage random sampling, 700 adolescents (326 males, 374 females) from grades 6 to 12 were enrolled from three schools. Data collection included structured interviews, anthropometric measurements, clinical examination, and venous blood sampling. Hemoglobin levels and red cell indices were analyzed using an automated hematology analyzer. Anemia was defined and graded per WHO criteria. Statistical analyses were performed using SPSS v23.0, with significance set at p < 0.05. Results: The overall anemia prevalence was 40.15%. Among affected adolescents, 20.42% had mild anemia and 19.71% moderate anemia; no severe cases were detected. Peripheral smear examination identified hypochromic microcytic anemia in 23.42% of cases, indicating iron deficiency. A significant association was observed between anemia and lower socioeconomic status (p < 0.001). No statistically significant correlations were found with age or urban versus rural residence. Conclusion: Anemia is prevalent among school-going adolescents in Agra, primarily presenting as mild to moderate iron deficiency anemia. Socioeconomic status emerges as a significant determinant, emphasizing the need for targeted school-based nutritional and health interventions to mitigate anemia in this vulnerable group..

Background: Acute kidney injury (AKI) is a critical medical condition marked by a sudden decline in kidney function, often resulting from various medical issues, including cerebrovascular accidents (CVA). The development of AKI in patients with ischemic or hemorrhagic strokes has become increasingly acknowledged as a major factor affecting patient outcomes. Objectives:   1. To determine the incidence of acute kidney injury (AKI) in patients admitted with cerebrovascular accidents (stroke). 2. To assess changes in renal function parameters (serum creatinine, blood urea nitrogen, eGFR) in stroke patients over time. Material & Methods: Study Design: Longitudinal case series study.    Study area:  The study was conducted in Department of General Medicine, Teaching hospital AIMSR & District headquarters hospital, Chittoor. Study Period: November 2022- October 2023.      Study population: Patients admitted in medical ward at AIMSR & DHH, Chittoor with Cerebrovascular Accident (ischemic and hemorrhagic), diagnosis is based on clinical presentation and confirmation is made by computed tomography. Sample size: The study consisted of a total of 60 cases. Results: In the study, incidence of AKI was found in 11 individuals out of 60 CVA patients, which is 18%. Mean creatinine levels at admission were 1.23 ± 0.247 mg/dl, raising to 1.31 ± 0.27 mg/dl after 24 hours, 1.38 ± 0.34 mg/dl after 48 hours, and 1.43 ± 0.41 mg/dl by 72 hours and after 96 hours 1.42 ± 0.42 mg/dl. Creatinine levels at admission were 1.035 ± 0.20 mg/dl in hemorrhagic stroke patients and 1.332 ± 0.202 mg/dl in ischemic stroke patients (P <0.001). Conclusion: AKI occurs in 18% of stroke patients, with a higher incidence in ischemic stroke (20%) than hemorrhagic stroke (15%). Older age, especially over 60, increases AKI risk, particularly after ischemic stroke (P <0.001). Diabetes is significantly more common in ischemic stroke patients (80% vs. 40%, P <0.001).

Background: The incidence of seropositive (HIV) infection is increasing in Asia. It is often associated with a number of opportunistic infections and malignancies frequently involving the lymph nodes. In developing countries like India with a huge population and socioeconomic constraints, there is great need for a simple investigative technique for sero positive lymphadenopathy cases like Fine Needle Aspiration Cytology(FNAC).  This study investigated the fine needle aspiration cytology of lymph nodes in sero positive patients at P.D.U Medical College and Hospital, Rajkot, Gujarat.  Objective: To know various cytological patterns of lymph node lesions, to correlate with available clinicopathological parameters and segregation of HIV infected lymphadenopathy cases for further evaluation. Materials and Methods: The present study was carried out in the Cytopathology, Department of Pathology, P.D.U Medical College and Hospital, Rajkot, Gujarat over a period of 1 year and 4 months between January 2024 to April 2025. Smears were prepared using FNAC procedure, stained with Haematoxylin & eosin stain and Zeihl-Neelsen stain, examined under microscope. Results: A total of 60 cases of lymphadenopathy in sero positive patients study done. Among them maximum cases were detected in age group of 41-60 years(45%).Male were more commonly affected than females and most common cervical(50%) lymph nodes affected. Tuberculous lymphadenitis (33.33%) was found to be the most common lesion followed by chronic nonspecific lymphadenitis(18.33%) & Reactive lymphadenitis(21.67%). The overall rate of AFB positivity in tuberculous lymphadenitis was found to be 70%. The most common cytomorphological feature in tuberculous lymphadenitis was epithelioid granuloma with caseous necrosis (70%). Conclusion: Lymphadenopathy is one of the earliest manifestations of sero positive infection. Great advances have been made in the treatment of these patients. Sero positive related lymphadenopathy has definite patterns like florid reactive hyperplasia, folliculolysis, explosive follicular hyperplasia, advanced lymphocytic depletion. Though, FNAC cannot clearly demarcate all these lesions, it has definite identifiable reactive patterns and is useful in detecting specific infective aetiology.

Background: Orthopaedic surgeries are frequently associated with perioperative complications that may necessitate postoperative intensive care unit (ICU) admission. Identifying preoperative and intraoperative factors contributing to ICU requirement is essential for optimizing patient outcomes and resource allocation. Materials and Methods: This retrospective observational study was conducted in the Department of Anaesthesiology, Shree Krishna Hospital, Karamsad, from January 2021 to December 2023. The study included 46 patients who underwent orthopaedic surgery and were transferred to the ICU postoperatively. Patients with preoperative ICU admission were excluded. Data regarding demographics, comorbidities, addiction history, operative details, anaesthesia type, intraoperative complications, and ASA grading were collected and analyzed using Microsoft Excel and STATA 14.2. Results: Among 46 patients, 63% were aged over 60 years, and 52.2% were female. A BMI over 23 kg/m² was observed in 50% of patients. Common comorbidities included hypertension (69.6%), diabetes (28.3%), and COPD (17.4%). General anaesthesia was used in 47.8% of cases, and 71.7% of surgeries exceeded two hours. Intraoperative complications included hypotension (43.5%), hypoxia (41.3%), and blood loss >1 litre (50%). Most patients (91.3%) had an ASA grade of III or above. Conclusion: Postoperative ICU admission in orthopaedic surgical patients is strongly associated with advanced age, obesity, comorbidities, and intraoperative events such as hypotension, hypoxia, and major blood loss. Comprehensive preoperative evaluation, risk stratification, and vigilant intraoperative management are crucial in minimizing ICU admissions and improving surgical outcomes.

Introduction: Haemoglobinopathies are the most commonly occurring monogenic disorders of blood in Southeast Asia and Indian subcontinent. Screening of individuals at increased risk of being carriers for thalassemia, sickle cell anemia and other haemoglobinopathies, can identify couples with a 25% risk of having a pregnancy with a significant genetic disorder, for which prenatal diagnosis is possible. This study is done to know the prevalence of haemoglobinopathies and variant of haemoglobin using high performance liquid chromatography. Materials and Methods: 2 Millilitre(ml) of venous blood was collected in Ethylene Diaminetetra Acetic acid EDTA vials from the pregnant mothers who attended antenatal clinic, after informed consent in the Out Patient Department (OPD), PDU Medical College and hospital, Rajkot. The blood was subjected to complete haemogram, peripheral blood smear and High Performance Liquid Chromatography (HPLC) using Variant Haemoglobin Testing System (Bio-Rad Laboratories). Descriptive analysis was done and data is presented in numbers and percentages. Results: Total 400 cases were evaluated for the haemoglobinopathies in Department of Pathology, PDU Medical College and Hospital, Rajkot from April 2025 to June 2025, out of this 400 cases, 70(17.5%) cases were identified to be having haemoglobinopathies by HPLC. Out of these 70 cases, there were 36(9%) cases of Beta Thalassemia Trait, 25(6.25%) cases of Sickle Cell Heterozygous, 5(1.25%) cases of Sickle Cell Homozygous, and 4(1%) cases of HbD Heterozygous respectively. Conclusion: This study showed a high prevalence of haemoglobinopathies in antenatal mothers requiring an appropriate screening strategy for antenatal mothers. We also concluded that HPLC is a sensitive technique for studying haemoglobinopathies during pregnancy and may be utilized for screening.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) commonly result in acute respiratory failure. It poses a significant morbidity and mortality risk. Non-invasive ventilation (NIV) is an important first-line intervention in these cases. It also helps avoid endotracheal intubation, which can be associated with complications. The current study was done to evaluate the clinical efficacy and outcomes of NIV in patients admitted with AECOPD.  Methods: A prospective observational study was conducted on 50 patients with AECOPD who were admitted to the ICU. Initially, every patient was started on BiPAP. At baseline, 2 hours, 6 hours, and 24 hours clinics (respiratory rate, GCS, dyspnea score) and Arterial Blood Gas (ABG) values (pH, PaCO2, PaO2, HCO3-) were recorded. The outcomes to be measured were the rates of NIV success, days of ventilation, days of ICU/hospital stays, and death. Comparison between success and failure of NIV was conducted.  Results: A total of 50 cases were included in the study based on the inclusion and exclusion criteria. The results showed that out of 50 cases 42 (84%) cases showed successful outcomes with improvement in respiratory rate, arterial pH, and PaCO₂ within 2–4 hours after NIV application. N=8(16%) cases failed to improve following NIV and required invasive mechanical ventilation, primarily due to worsening acidosis and sensorium. NIV success was significantly associated with higher baseline pH and lower PaCO₂. Hospital stay and ICU duration were significantly shorter in the successful group compared to those requiring intubation. Conclusion:  The results of this study showed that NIV significantly improved clinical outcomes in most of the patients with AECOPD and reduces the need of invasive mechanical ventilation. However, it also requires recognition of early indicators of poor prognosis and timely escalation to invasive mechanical ventilation for improving survival.

Background: Early Life Stress (ELS), including adverse childhood experiences (ACEs) such as abuse, neglect, and trauma, significantly impacts the developing brain and psychological well-being across the lifespan. This paper explores how ELS alters neurobiological systems—particularly the hypothalamic-pituitary-adrenal (HPA) axis—leading to dysregulation of cortisol and structural changes in key brain regions like the hippocampus, amygdala, and prefrontal cortex. These alterations affect cognitive functions such as memory, attention, executive functioning, and emotional regulation. ELS has also been linked to increased vulnerability to anxiety disorders, especially in adolescence, with notable gender and socio-economic disparities. Females show higher prevalence of internalizing disorders, while children from low socio-economic backgrounds face heightened exposure to ACEs and more pronounced cognitive deficits. Neuroimaging and behavioral studies consistently show that early adversity disrupts cortical and subcortical development, impairing higher-order cognitive processes and predisposing individuals to chronic anxiety and other psychiatric conditions. Despite biological predispositions, cumulative adversity remains a modifiable risk factor. Understanding the mechanisms by which ELS influences cognitive and emotional development is critical for informing early interventions, public health strategies, and social policy aimed at reducing long-term psychological harm.

Background: Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide. Adiponectin, an adipocyte-derived plasma protein with anti-inflammatory, anti-atherogenic, and insulin-sensitizing properties, has been proposed as a potential biomarker in cardiovascular diseases. Aims: This study aims to assess the correlation between circulating adiponectin levels and the presence or severity of ischemic heart disease, contributing to the expanding knowledge on metabolic and inflammatory determinants of atherosclerosis. Methods: This cross-sectional observational study was conducted over one year in the Department of Biochemistry at BGS Medical College and Hospital, Bangalore, to evaluate the correlation between serum adiponectin levels and ischemic heart disease (IHD). A total of 100 participants were enrolled, including 50 confirmed IHD patients and 50 age- and sex-matched healthy controls without any clinical or laboratory evidence of IHD. Results: The study included 100 participants—50 ischemic heart disease (IHD) patients and 50 healthy controls. Both groups were comparable in age and gender. IHD patients had significantly higher BMI, systolic and diastolic blood pressure, fasting glucose, total cholesterol, LDL-C, and triglycerides, along with significantly lower HDL-C levels. Serum adiponectin levels were markedly reduced in IHD patients (3.6 ± 1.3 µg/mL) compared to controls (8.2 ± 1.7 µg/mL), with a strong inverse correlation observed between adiponectin and total cholesterol, LDL-C, and triglycerides, and a positive correlation with HDL-C. Logistic regression analysis identified low adiponectin as a strong independent risk factor for IHD (OR = 3.96, p < 0.001), alongside high LDL-C, low HDL-C, and elevated triglycerides. BMI showed a mild, non-significant association. Conclusion: The study concluded that low serum adiponectin levels are significantly associated with ischemic heart disease and serve as an independent risk factor. Adiponectin may thus hold potential as a biomarker for early detection and risk stratification in IHD patients.

Background: Enhanced Recovery after Surgery is a patient-centered, evidence-based, outcome-driven approach developed by a multidisciplinary team which creates strategies for a surgical specialty and facility culture with aim to preserve preoperative organ function, reduce the stress response after surgery, enhance their physiological functions, and promote faster recovery through tailored perioperative care strategies. Aim: To compare ERAS (enhanced recovery after surgery) protocols versus conventional surgical protocols in gynecological surgeries. Materials and Method: This randomized controlled trial was conducted in Department of Obstetrics and Gynecology on female patients more than 18 years of age undergoing gynecological surgeries including total abdominal hysterectomy, cystectomy, myomectomy, exploratory laparotomies. Patients were allocated to either ERAS or conventional care groups. Recovery was assessed postoperatively using the QoR-15 questionnaire, along with evaluation of post-operative complications. Result: The ERAS group reported significantly lower postoperative pain scores and required less intravenous fluid compared to the conventional group. Post-operative QOR-15 scores were also significantly higher in ERAS group, indicating a better quality of recovery. Additionally these patients experienced shorter hospital stays and reduced hospital costs compared to conventional care group. Conclusion: The adoption of ERAS protocols in gynecological surgeries represents a paradigm shift towards patient-centered care, resulting in improved recovery, reduced complications optimized resource utilization.

Background: Ovarian tumors encompass a wide range of neoplastic entities, varying from benign to malignant, with distinct histological and clinical characteristics. Early and accurate differentiation is critical but challenging due to nonspecific symptoms and overlapping radiological features. Objective: To evaluate the histopathological spectrum of ovarian tumors and assess their correlation with clinical presentation and sonological (ultrasound-based) findings, including O-RADS classification and CA-125 levels. Methods: A combined retrospective and prospective study was conducted on 50 female patients presenting with ovarian masses at MMIMSR, Mullana, from June 2022 to December 2024. Data included clinical symptoms, CA-125 levels, ultrasonography with O-RADS scoring, and histopathological diagnosis. Statistical correlation was assessed using sensitivity, specificity, and p-values (<0.05 considered significant). Results: Among 50 ovarian tumors, 64% were benign, 10% borderline, and 26% malignant. The most common benign lesion was serous cystadenoma (30%), and the most frequent malignant tumor was high-grade serous carcinoma (10%). Mean age was higher in malignant cases (43.69 ± 5.4 years). Nulliparity was more common among malignancies (38.5%). CA-125 was elevated (>35 IU/ml) in 76.9% of malignant cases. Ultrasound O-RADS 4–5 scores correlated significantly with malignancy (p < 0.01), with a specificity of 82.86% and sensitivity of 20%. Morphological features such as solid areas, papillary projections, and thick septa had higher predictive value for malignancy. Conclusion: Histopathology remains the gold standard for diagnosis of ovarian tumors. However, integration of clinical symptoms, O-RADS ultrasound scoring, and CA-125 levels enhances preoperative assessment. A multidisciplinary approach facilitates timely and appropriate intervention.

Background: Aizawl is the capital city of Mizoram which is a small state located in North-East India, The first recorded incidence of death in Mizoram due to substance abuse was in the 1980s when a young man aged 24 overdosed on heroin [1]. The prevalence of heroin and administration of drug through injection grew more and more after this incidence. In the present years the prevalence is very high, based on MSACS records alone, from IDU’s who are registered under their organisation within Aizawl, there are 6218 injecting drug users (MSACS, 2020)[2]. Thus it is very important to have studies on IDUs; their mental health status and social support in order to have an in-depth understanding of the problem at hand, the study main objective is to focus on the determination of mental health and social support status among drug users. Methods: Data on qualitative and quantitative studies were collected from de-addiction centres; drop in centres and home visits from March 2023 to February 2025. These include client’s demographics, mental health and social support status using questionnaires, case studies, FGDs and KIIs. An appropriate statistical analysis was performed. Results: From 700 data collected (2023–2025), 620 were quantitative and 80 qualitative. Among drug users, 49.35% had medium mental health, 46.77% low, and only 3.87% high. Social support from all sources was generally medium in availability, quality, and adequacy. Conclusions: The study highlights the strong link between drug use and mental health issues, with nearly half of the users having medium mental health status and a significant portion experiencing low mental health. While immediate family provides the most support, many users come from broken families, which correlates with addiction. Broader social support from NGOs, churches, and society remains limited due to persistent stigma, despite some harm reduction initiatives. Government support is minimal, with a need for better financial aid, well-equipped rehabilitation centers, and trained professionals to address the issue effectively.

Background: Otitis media with effusion (OME) is a common condition in children that often coexists with adenotonsillar hypertrophy. Children undergoing adenotonsillectomy frequently present with persistent OME, necessitating additional management. However, the optimal approach—whether surgical (tympanostomy tube insertion) or medical (decongestants, antihistamines, nasal steroids)—remains debatable. This study aims to compare the efficacy of surgical versus medical intervention for concurrent OME in children aged 5–15 years undergoing adenotonsillectomy. Materials and Methods: This prospective comparative study was conducted over 15 months at a tertiary care center. A total of 80 children aged between 5 and 15 years scheduled for adenotonsillectomy with coexisting OME were enrolled and randomized into two groups. Group A (n=40) underwent tympanostomy tube insertion along with adenotonsillectomy, while Group B (n=40) received postoperative medical management including antihistamines, nasal corticosteroids, and steam inhalation. Patients were followed up at 1, 3, and 6 months postoperatively using otoscopic examination, tympanometry, and pure tone audiometry. Results: At 3 months follow-up, 85% of patients in Group A showed complete resolution of middle ear effusion and normalization of hearing thresholds, compared to 60% in Group B. Tympanometric Type A curve was observed in 80% of Group A versus 55% in Group B. At 6 months, recurrence of effusion was seen in 10% of surgical cases and 25% of medically managed cases. The difference in improvement of hearing thresholds between the groups was statistically significant (p < 0.01). Conclusion: Surgical intervention with tympanostomy tube placement in conjunction with adenotonsillectomy offers superior resolution of OME and hearing improvement compared to medical therapy alone. Hence, surgical management should be considered in children with persistent OME undergoing adenotonsillectomya

Background: Dengue fever is a major public health concern in tropical and subtropical regions. The World Health Organization (WHO) classifies dengue into categories with and without warning signs, with the former indicating a higher risk of progression to severe disease. Aims: This study aims to compare the clinical profiles and short-term outcomes of dengue patients presenting with warning signs versus those without. Methods: This hospital-based, observational, prospective, comparative study was conducted over a period of one year in the Department of Medicine at Government Medical College and Hospital, Baramati, Pune, Maharashtra. The study aimed to evaluate the clinical profile and short-term outcomes of dengue patients with warning signs compared to those without. A total of 100 patients, admitted with a clinical and serological diagnosis of dengue fever, were screened and included based on predefined eligibility criteria. These patients were divided equally into two groups: Group A consisted of 50 patients presenting with warning signs, while Group B included 50 patients without warning signs. Results: In this study of 100 dengue patients (50 with warning signs, 50 without), those with warning signs were slightly older and more likely to present with abdominal pain (64%) and vomiting (60%)—both significantly higher than in those without warning signs. Headache and myalgia were comparable between groups. Lab findings showed that patients with warning signs had significantly lower platelet counts, higher hematocrit, lower WBCs, and elevated liver enzymes and bilirubin. These patients also had longer hospital stays and required more interventions such as IV fluids, platelet transfusions, and ICU care. Although recovery rates were high in both groups, complications—including shock, bleeding, pleural effusion, and hepatic dysfunction—were significantly more common in those with warning signs. Notably, lower platelet counts were strongly associated with increased complication rates. Conclusion: Patients with warning signs of dengue had more severe clinical presentations and laboratory abnormalities. They required more intensive management, including ICU care and transfusions. Complications such as shock, bleeding, and organ dysfunction were significantly more frequent in this group. Early identification of warning signs and timely intervention are crucial to improve outcomes.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition frequently aggravated by acute exacerbations. Smoking remains a well-established risk factor; however, non-smokers are also significantly affected due to other environmental and occupational exposures. This study aimed to compare the clinical profile and outcomes of acute exacerbation of COPD (AECOPD) in smokers versus non-smokers. Aims: This study compares the clinical features, severity, and outcomes of acute COPD exacerbations in smokers versus non-smokers, aiming to highlight how smoking status influences disease progression and guide more personalized management strategies. Methods: This hospital-based, prospective observational study was conducted in the Department of General Medicine and Pulmonary Medicine at Government Medical College and Hospital, Baramati, Pune, Maharashtra, to evaluate and compare the clinical profile and outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) among smokers and non-smokers. The study included a total of 100 patients admitted with a confirmed diagnosis of AECOPD. These patients were divided into two groups based on their smoking history: Group A comprised 50 patients with a history of smoking, while Group B included 50 patients with no history of smoking or significant exposure to second-hand smoke. Results: Laboratory and radiological assessments revealed some significant differences between smokers and non-smokers with COPD. The mean WBC count (11.2 ± 3.5 vs. 10.8 ± 3.3 ×10⁹/L; p = 0.48) and CRP levels (32.6 ± 12.8 vs. 29.4 ± 11.6 mg/L; p = 0.21) were comparable between the two groups. However, hyperinflation on chest X-ray was significantly more common among smokers (80%) than non-smokers (60%; p = 0.03). Arterial blood gas analysis showed that smokers had a significantly lower pH (7.34 ± 0.05 vs. 7.37 ± 0.04; p = 0.02) and higher pCO₂ levels (54.1 ± 7.2 vs. 48.9 ± 6.8 mmHg; p = 0.001), indicating greater respiratory acidosis in the smoker group. Conclusion: Laboratory and radiological assessments demonstrated important distinctions between smokers and non-smokers with COPD. While inflammatory markers such as WBC count and CRP levels did not differ significantly, hyperinflation on chest X-ray was notably more frequent in smokers, suggesting more advanced lung involvement. Arterial blood gas analysis further revealed that smokers exhibited greater respiratory acidosis, as evidenced by significantly lower pH levels and higher pCO₂ values. These findings indicate that smoking may contribute to more severe pulmonary dysfunction and impaired gas exchange in COPD patients.

Background: Pain, edema and trismus after mandibular third molar surgery greatly impacts patient comfort and recovery. Corticosteroids such as dexamethasone are widely used to reduce inflammation, a primary cause of pain, edema and trismus following mandibular third molar surgery. However, the ideal route of its administration is still up for debate. This study compares the efficacy of dexamethasone administered via submucosal (SM), intravenous (IV) and intramuscular (IM) routes in minimizing post-operative sequelae. Materials and Methods: A randomized controlled trial was conducted on 60 patients undergoing mandibular third molar surgery, divided equally into three groups (n=20 each). After injecting local anesthesia, 8 milligrams of dexamethasone was administered submucosally to Group I, intravenously to Group II and intramuscularly into the deltoid muscle to Group III. Post-operative pain (Visual Analogue Scale), facial edema (linear facial measurements) and maximum interincisal opening (MIO) were assessed post-operatively on the first, third and seventh day. Statistical analysis was performed using ANOVA and the post-hoc Tukey’s test (p < 0.05 considered significant). Results: On day 1, the mean VAS scores were lowest in the SM group (2.1±0.4) as compared to IV (2.8±0.6) and IM (3.2±0.5) groups (p=0.03). On day 3, the SM group again showed the lowest pain scores (1.5±0.3), when compared with IV group (2.0±0.4) and IM group (2.3±0.6) demonstrating significantly higher values (p=0.04). Facial edema was significantly lower in the SM group on day 1 (4.5 mm) and day 3 (3.0 mm) as compared to other groups (p<0.05). Reduction in MIO on day 3 was the least in SM group (5.1 mm) as compared to IV group (6.4 mm) and IM group (7.2 mm) (p=0.03). By day 7, all parameters improved across all groups, but the SM group showed the fastest recovery trajectory. Conclusion: Submucosal administration of dexamethasone resulted in better control of post-operative discomfort following mandibular third molar surgery as compared to intravenous and intramuscular routes. It demonstrated better outcomes in terms of pain, edema and trismus, with the added advantage of ease of administration.

Background: Non-neoplastic skin lesions are a wide array of benign, inflammatory, cys tic, vascular, and reactive processes. Non-neoplastic skin lesions often mimic neoplastic diseases clinically. The clinical overlap with neoplastic entities makes histopathological examination the gold standard for a definitive diagnosis. Objective: The present retrospective study aims to delineate the histopathological chara teristic spectrum, the demographic characteristics, and the anatomical site distribution met rics of non-neoplastic skin lesions in biopsies received at Government Medical College, Anantnag, a tertiary care referral center. Methods: This present study was carried out over a one year period, wherein 109 consec utive non-neoplastic skin biopsy specimens sampled from Government Medical College, Anantnag, were reviewed. The demographic and clinical data were exerted from the re spective medical records. Histopathological evaluations were performed on formalin-fixed, paraffin-embedded hematoxylin and Eosin (H &E) stained slides. The descriptive statistics and data analysis were performed using Python 3.9 and associated directories. Significance tests like χ2 test and Fischer’s tests were used.  Results: Patient ages ranged from 3 year old to 85 years with a mean age of 37.5 ± 18.0 years, and a male predominance (65 M : 44 F). Epidermal inclusion cysts (31%) were the most frequent lesions, followed by pilomatrixomas (11%) and keratinous cysts (8.0 %). Overall, the cystic lesions comprised 57% of the total cohort. We also documented a squamous cell carcinoma arising in an epidermal cyst (0.9%). Pediatric patients (<18years; n=7) showed a higher proportion of pilomatrixomas and keratinous cysts. The most common biopsy sites were the scalp (14%), chest (11%), and the neck (9%). Males were characterized by a significantly larger frequency of cystic lesions (75.4% vs. 51.3%, χ2 = 5.42, p = 0.02).  Conclusion: Non-neoplastic cutaneous lesions were most common in middle-aged males, with cystic lesions predominating. Epidermal inclusion cysts were the most frequent, and pilomatrixomas were more common in children. Scalp was the leading biopsy site. One rare case of malignant transformation was noted.

Background: Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection, especially in ICUs. AIM: Study of catheter associated urinary tract infections in ICU patients at a tertiary care centre. Methodology: This prospective observational study included 200 ICU patients catheterized during admission to Mahatma Gandhi Medical College and Hospital, Jaipur, from April 2023 to September 2024. Patients were enrolled via simple random sampling. Baseline urinalysis was done before catheterization to exclude existing UTIs. Result: The mean age was 45.7 ± 14.2 years, with a male-to-female ratio of 1.4:1. Common comorbidities included hypertension (48.5%), diabetes (39%), and CKD (15%). CAUTI incidence was 2% at 48 hours and 8.5% at day 7. Significant risk factors included advanced age, female sex (p<0.05 at day 7), CKD (p<0.001), diabetes, impaired mental status (p<0.001), non-ambulatory status (p<0.001), and elevated serum creatinine (p<0.001). Escherichia coli (33.5%) was the most common pathogen, followed by Enterococcus (19.5%) and Pseudomonas (17.5%). Conclusion: CAUTI prevention requires minimizing catheter use, managing risk factors, and ensuring strict adherence to infection control protocols.

Background: Cataracts are a leading cause of blindness worldwide and are notably prevalent among individuals with diabetes. Diabetes significantly increases the risk of cataract formation due to chronic hyperglycemia, which alters the metabolic and structural integrity of the lens. Studies show that approximately 20% of all cataract surgeries are performed on diabetic patients, emphasizing the strong association between the two conditions. Aim: To      assess     macular                thickness after phacoemulsification                by optical coherence tomography in diabetics and non-diabetics. Methodology: This study was designed as a prospective observational hospital-based study conducted in the Department of Ophthalmology at Mahatma Gandhi Medical College & Hospital, Jaipur. The research was initiated following formal approval from both the Institute’s Scientific Research Committee and the Institute’s Ethical Committee. The study spanned a period of 18 months, from April 2023 to September 2024. Result: Phacoemulsification cataract surgery can cause transient increases in central macular thickness, especially in diabetic patients, typically peaking around four weeks and resolving by twelve weeks. Diabetics are at higher risk for delayed cystoid macular edema, necessitating closer OCT monitoring and timely intervention. Overall, most postoperative macular thickening is temporary and related to mild surgical inflammation rather than lasting vision impairment. Conclusion: OCT is essential for monitoring macular changes after cataract surgery, especially in diabetic patients at higher risk for CME. Close follow-up and baseline measurements enable timely detection and management to prevent vision loss.

Background: Long-term corticosteroid therapy is commonly prescribed for chronic medical conditions such as autoimmune diseases, inflammatory disorders, and organ transplantation. While effective in managing these conditions, corticosteroids are associated with various ocular complications. Objective: This study aims to assess the prevalence and nature of visual changes in patients receiving long-term corticosteroid therapy. Methods: This is a cross-sectional observational study conducted and a total of 255 patients were included in the study. The sample size was calculated using a confidence level of 95% and a margin of error of 5%. Data were collected using a combination of medical record reviews and a systematically designed questionnaire. A detailed review of the patients’ medical records was conducted to gather information on their medical history, type of corticosteroid therapy, dosage, duration of treatment, and any previous ocular assessments. Results: A total of 55.7% of participants exhibited ocular complications. The most common condition was cataracts (34.9%), followed by glaucoma (20.4%) and central serous chorioretinopathy (11.0%). Cataracts were predominantly posterior subcapsular (62.9%). A significant association was found between higher corticosteroid doses (≥20 mg/day) and the development of cataracts and glaucoma (p = 0.002 and p = 0.004, respectively). Patients who had been on corticosteroid therapy for more than five years had a higher prevalence of cataracts and glaucoma (p = 0.03 and p = 0.02, respectively). Visual impairment was associated with reduced quality of life, with 67.4% of cataract patients and 42.3% of glaucoma patients reporting a best-corrected visual acuity of 20/40 or worse. Conclusions: Long-term corticosteroid therapy is significantly associated with a high prevalence of ocular complications, particularly cataracts, glaucoma, and central serous chorioretinopathy. The risk of developing these complications increases with higher doses and longer duration of therapy

Background: Computer Vision Syndrome (CVS) Has Emerged As A Growing Public Health Concern In The Digital Age, Particularly Among Students Who Are Increasingly Reliant On Screens For Academic And Recreational Purposes. Prolonged Exposure To Digital Devices Is Associated With A Range Of Ocular And Musculoskeletal Symptoms, Affecting Students’ Health And Academic Performance. Methodology: This Cross-Sectional Observational Study Was Conducted Among 268 College- Going Students (Medical And Engineering) At NIMS University, Jaipur. Participants With a daily screen time of more than three hours were included. Data were collected Through A Structured, Self-Administered Questionnaire Assessing Demographic Details, Screen Usage Habits, Ergonomic Practices, And CVS-Related Symptoms. Statistical Analysis Was Performed Using SPSS V23, Applying Chi-Square Tests And Logistic Regression With Significance Set At P < 0.05. Results: The Mean Age Of Participants Was 22.51 ± 2.206 Years With An Equal Distribution Of Medical And Engineering Students. CVS Symptoms Such As Headache, Dry Eyes, Blurred Vision, And Musculoskeletal Discomfort Were More Prevalent among Engineering Students. Notably, Only 35.1% Of Engineering Students Reported No Headaches Compared To 55.2% Of Medical Students. Eye Redness (54.5% Vs. 15.7%), Dry Eyes (60.4% Vs. 29.9%), And Poor Ergonomic Practices Were More Common In The Engineering Group. Awareness Of Preventive Measures Like The 20- 20-20 Rule Was Limited Across Both Groups. Conclusion: The Study Highlights A High Prevalence Of CVS Symptoms Among Students, Particularly Engineering Students, Linked To Prolonged Screen Time, Poor Posture, And Inadequate Awareness Of Visual Ergonomics. Targeted Preventive Strategies, Including Ergonomic Education And Promotion Of Screen Hygiene Practices, Are Essential To Reduce The Burden Of CVS In Academic Settings.

Background: Extrauterine Growth Restriction (EUGR) is a common concern among preterm newborns (PTNBs) and is associated with multiple risk factors and adverse outcomes. This study aimed to assess the prevalence of EUGR among PTNBs admitted to the Government Kilpauk Medical College and Hospital and explore its associations with various clinical factors. Methods: A descriptive cohort study including all PTNBs delivered at the hospital was conducted from December 2022 to June 2024. Informed consent was obtained from parents, and a standardized proforma was used to collect data on risk factors, including gestational age, Small for Gestational Age (SGA) status, the timing of achieving full enteral feeds, need for mechanical ventilation, major illnesses (meconium aspiration syndrome, intraventricular haemorrhage, necrotizing enterocolitis, respiratory distress syndrome, patent ductus arteriosus, persistent pulmonary hypertension, and sepsis), and hospital stay duration. Data analysis was performed using SPSS software, with categorical variables presented as proportions or percentages, and comparisons were made using the chi-square test. Results: Among the 270 PTNBs, 85 (31.5%) experienced EUGR. The associations between EUGR and gestational age (p < 0.0001), SGA status (p < 0.0001), timing of achieving full enteral feeds (p < 0.0001), need for mechanical ventilation (p < 0.0001), major illnesses (p < 0.0001), and duration of hospital stay (p < 0.0001) were statistically significant. EUGR prevalence was highest in PTNBs with gestational ages between 28-31 weeks (73.3%) and in those classified as SGA (88.4%). Delayed achievement of full enteral feeding (69.2% at 4-7 days) and need for mechanical ventilation (93.8%) were also strongly associated with EUGR. Major illnesses, such as Necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), and sepsis, were more common among PTNBs with EUGR, highlighting their potential contribution to growth restriction. A prolonged hospital stay (>14 days) was significantly associated with EUGR, emphasizing the impact of the clinical course on postnatal growth outcomes. Conclusion: This study underscores the high prevalence of EUGR among PTNBs, particularly in those with lower gestational age, SGA status, delayed enteral feeding, mechanical ventilation requirement, and major illnesses. Early identification and targeted interventions focusing on inimize l nutrition, respiratory support, and managing comorbidities are essential for mitigating EUGR and improving long-term outcomes for at-risk PTNBs. Collaborative efforts involving multidisciplinary teams are crucial for implementing effective strategies to promote optimal growth and development of this vulnerable population.

Background: As Population is growing, elderly acquire interest in smartphones to fulfil their daily needs. Smartphone offers an avenue for elderly to stay culturally and emotionally connected with others. With growing incorporation of smartphones into lives of elderly, this requires deeper understanding of its impact on overall health.  This Study aims to assess relation between social media and its effect on social gathering, loneliness and various other aspects among elderly staying in field practice area of tertiary care hospital. Methodology: After approval from institution ethics committee, a community based Cross-sectional Study was conducted with 400 participants aged 60 years or older. The data was collected by face to face interview using a questionnaire. The Collected data was entered using Microsoft Excel Software 2021 and it was cleaned and analysed using epi- info 7.2.2.1.6. The data was descriptively described and chi square test was applied. Results: The study showed that out of 400 participants, 354 (88.5%) were using mobile phones. Out of which, 296 (83.61%) were using mobile phones for >5 years. The primary use for majority i.e 173 (48.87%) was to make and receive calls. Among total participants, 251 (70.90%) were social media users, 25.49% felt lonely and 183 (72.90%) were socially interactive. Conclusions: This research examines relation of socio-demographic factors with usage of mobile phones. The usage of mobile phone was significantly associated with those who were young old, married, staying with family, belonging to lower socio-economic class. Frequently social media usage promotes social engagement among elderly and it was not significantly associated with loneliness.

Background: Malnutrition is a global burden and is the primary cause for most under five deaths in India. Despite the different nutrition programs enforced by the Government of Maharashtra, the under-nutrition scenario remains low. The aim of study is to assess the impact of nutritional advice and special mix in terms of improved nutrition status in malnourished children. Material and methods: The longitudinal, interventional study conducted from June 2022 to May 2023. The study included 240 under five children of three Anganwadi centers in Kolhapur. Post receiving informed written consent from the mothers, the underweight children were administered a nutrition mix to be consumed thrice a week providing 380 calories per 100 g. The difference in the nutritional status pre and post supplement administration and increase in weight were assessed by chi-square test and paired-t test, respectively. Results: Out of 240 children, with balanced gender distribution (male= 123; female= 117), malnutrition was observed in 60 children of varying grades. Gender was not associated with malnutrition (P=0.51). Post intervention, all grades of malnutrition improved by a grade concomitant with a significant weight increase (P=0.00001). Conclusion: The special nutrition mix was effective in improving the nutritional status of the under five children in this single region study.

Background: Indian construction industry is one of the largest industries in the world. It contributes to majority of fatal occupational injuries, but still there is ignorance about personal safety either by employees or employers of construction industries. Study planned to assess occupational hazards and usage of personal protective equipments among construction workers in urban area of Kolhapur. Material and Methods: A Cross-sectional study was conducted among consenting construction workers, who were present during data collection, between July-August 2023.Predesigned proforma were used to collect data pertaining to demographics, health related and health seeking behavior and working condition. Data analyzed using R software version 3.6.1. Association between variables was determined using Chi square test, with P<0.05. Results: Male predominance was seen (n=95). Most of the workers were in age group of 15-45 years (n=127). Workers suffered from mechanical & thermal injuries (n=20) and followed by mechanical injuries (n=15). Workers demonstrated unsafe behavior by not using personal protective equipments (n=141) and working when tired (n= 63). Most of the participants were themselves responsible for injuries (n=92). Workers not using protective equipments were more likely to be injured (OR= 4.7692, P=0.1371). Significant association was found between prone to injuries and age (P=0.035), sex (P=0.023), occupation (P=0.045) and education (P=0.007), respectively.  Conclusion: Non usage of personal protective wear by workers demonstrates their unsafe behaviors and in turn safety is compromised.

Aim: The aim of the present study was to assess the functional outcomes of arthroscopic reconstruction of Anterior Cruciate ligament using Peroneus longus tendon graft compared to hamstring tendon graft among patients presenting with ACL injury. Methods: The present study was conducted on the patients who presented to Department of Orthopaedics, Kanyakumari Government Medical College Hospital, Asaripallam with complaints of injury to knee with clinical and radiological evidence of ACL tear and requiring reconstruction surgery for management of the condition. Hence the final sample size of 20 (10 in each group) was included in the study. Results: More than half (60) of the study participants were in the age category between 17 and 25 years. Forty percentage of the patients were in age group of 26 to 42 years. The study population comprised of 95% males and 1% female. Most of the patients were students followed by manual labour. The mode of injury was RTA (50%) and sports injury (50%). 65% had left side injury. The most common arthroscopic findings were complete ACL tear (50%), Complete ACL tear with Bucket handle tear medial meniscus (10%), Complete Acl tear, chondromalacia along with Bucket handle tear medial meniscus (15%). Conclusion: In conclusion, there is no significant difference in functional outcome evaluation in terms of clinical testing and post-operative knee outcome scoring (IKDC score and Tegner-Lysholm score) on comparing Peroneus longus graft with Hamstring graft. Peroneus longus graft had a larger graft diameter, less post-op anterior knee and no documented ankle weakness. Peroneus longus graft can be considered a robust graft with functional outcomes comparable to the hamstring graft.

Background: Inguinal hernia repair is a common surgical procedure, with chronic groin pain (inguinodynia) being a significant postoperative complication. This study compares the incidence of inguinodynia between open (Lichtenstein) and laparoscopic hernia repair techniques. Aims: To evaluate and compare the incidence of chronic groin pain following open versus laparoscopic inguinal hernia repair. Materials and Method: A prospective cross-sectional study was conducted at Silchar Medical College and Hospital, involving 50 patients (25 open Lichtenstein repair, 25 laparoscopic repair). Pain severity was assessed using the Visual Analogue Scale (VAS) at postoperative intervals (1st day, 1st week, 3rd and 6th months). Statistical analysis was performed with significance at *p* < 0.05. Result: The incidence of inguinodynia was higher in the open repair group (24%) than in the laparoscopic group (22%). Pain scores were significantly lower in the laparoscopic group at all follow-ups (*p* < 0.05). Most cases were mild, with improvement over time. No significant differences were noted in age, gender, or operative duration between groups. Conclusion: Laparoscopic repair is associated with a lower incidence of chronic groin pain compared to open Lichtenstein repair. However, long-term studies are needed to validate these findings.

Background: External jugular vein (EJV) cannulation is a valuable alternative when peripheral venous access is challenging. This study evaluates the success rate, efficiency, and complication profile of EJV cannulation performed by junior clinicians in a high-acuity clinical setting. Methods:A prospective observational study was conducted on 100 adult patients requiring venous access in emergency or inpatient settings. EJV cannulation was performed by junior residents or interns using standard landmark techniques. Primary outcomes included overall and first-attempt success rates, cannulation time, and complication rates. Subgroup analyses evaluated operator level, cannula gauge, and side of access. Results: Successful cannulation was achieved in 79% of patients, with a first-attempt success rate of 62%. The mean cannulation time was 148 ± 35 seconds, and the mean number of attempts was 1.5. Success rates did not significantly differ by operator level, cannula size, or laterality (p > 0.05 for all). The overall complication rate was low (4%), including minor site swelling (3%) and malposition (1%). Mean cannula dwell time was 2.8 ± 1.1 days, with no delayed or infectious complications observed. Conclusion: EJV cannulation performed by junior clinicians demonstrates high procedural success and low complication rates, with consistent outcomes across operator experience and technique-related variables. The procedure appears safe for short-term use, supporting its inclusion in training programs and escalation algorithms for difficult access.

Background: Obstetric hysterectomy remains a life-saving yet drastic surgical intervention, often performed in the setting of life-threatening hemorrhage [1]. This case series examines the indications, intraoperative findings, and maternal outcomes associated with obstetric hysterectomy. Objective: To analyze the causes and outcomes of 10 consecutive cases of obstetric hysterectomy in a tertiary care center. Methods: A retrospective analysis of 10 cases of obstetric hysterectomy over a 12-month period was conducted. Patient demographics, indication for hysterectomy, operative findings, complications, and outcomes were reviewed. Results: The most common indications were morbidly adherent placenta (4 cases), uterine rupture (2 cases), traumatic PPH (2 cases), scar ectopic pregnancy (1 case), and atonic PPH (1 case). There was 1 maternal death due to traumatic PPH following vaginal delivery. Conclusion: Morbidly adherent placenta and uterine rupture remain leading causes of obstetric hysterectomy. Antenatal diagnosis and early surgical intervention are critical for improving maternal outcomes.

Background: Objective: To assess the changes in oral microbial flora in patients with carcinoma buccal mucosa (CBM) undergoing radiation therapy (RT), and evaluate the prevalence of opportunistic pathogens in relation to radiation dose and timing. Methods:•Study Design: Prospective observational cohort study. Setting: Single-center study conducted at JIET Medical College and Hospital, a tertiary care teaching hospital in Jodhpur, Rajasthan. Participants: A total of 111 adult patients diagnosed with histopathologically confirmed carcinoma of the buccal mucosa and scheduled for either intensity-modulated radiation therapy (IMRT) or image-guided radiation therapy (IGRT) between December 2024 and April 2025. Inclusion criteria included patients with ECOG performance status 0–2 and no ongoing antimicrobial therapy. Patients with previous head and neck radiation, recent antibiotic use, or systemic immunosuppression were excluded. Oral swabs were collected at three time points: before initiation of RT (baseline), at completion of RT, and three weeks post-RT. Microbial analysis was done using conventional culturing and identification techniques for bacterial and fungal species. Results: A significant shift in oral microbial composition was observed over the treatment course. Klebsiella pneumoniae prevalence increased from 25.5% (95% CI: 18.0–33.0%) pre-RT to 40.2% (95% CI: 31.6–48.8%) post-RT. Candida albicans increased from 45.6% (95% CI: 36.9–54.3%) to 70.3% (95% CI: 62.1–78.5%) post-RT.•Higher radiation doses (66 Gy) were significantly associated with increased colonization by Candida albicans (p < 0.01) and Staphylococcus aureus (p < 0.05).No statistically significant differences were noted between IMRT and IGRT in microbial shifts. Clinical symptoms of mucositis and secondary infection were more prevalent in patients with increased fungal load. Conclusions: Radiation therapy in CBM patients results in significant oral dysbiosis, with increased colonization by opportunistic pathogens, particularly Candida albicans and Klebsiella pneumoniae. This dysbiosis is more pronounced at higher radiation doses. The findings underscore the need for routine microbiological surveillance and timely prophylactic or therapeutic antimicrobial interventions to mitigate RT-induced complications. Clinical Trial Registration Number: Not applicable

Background: Pre-hospital delay, which refers to the delay between the onset of symptoms and presentation to the hospital, is one of the major factors in determining the treatment outcomes in acute ischaemic stroke. This study was aimed to identify the factors causing pre-hospital delay in patients with acute ischaemic stroke. Methodology: This cross-sectional descriptive study was done at a tertiary care centre in Northern India. A total of 120 patients with acute ischaemic stroke were included in the study. A pre-designed questionnaire was administered within 72 hours of hospital admission to every patient and associations were determined between pre-hospital delay (≥4.5 h) and the variables of interest. Results: The mean time to hospital presentation was 7.12 hours in females and 7.42 hours in males. Age group, educational status, residence in rural areas, distance >60 km from the tertiary care centre, lack of knowledge in the patients and bystanders about the symptoms of stroke, and mode of transport were the factors that emerged as significant predictors of pre-hospital delay on univariate analysis. A majority of patients who first visited their general practitioners or local hospitals, had significantly more pre-hospital delay than those who preented to the study hospital. Conclusions: Prevalence of pre hospital delay among acute stroke patients presenting to tertiary care hospitals in Northern India is very high. The causes of pre hospital delay should be further explored qualitatively. Efforts to reduce pre-hospital delay should include stroke awareness campaigns in rural areas and improving pre hospital transport systems for stroke patients.

Background: Distal tibial fractures involving the metaphysis or articular surface present a challenge due to complex biomechanics and soft tissue involvement. This study evaluates the clinical and functional outcomes of distal tibia fractures managed with locking plate osteosynthesis. Methods: A prospective interventional study was conducted on 30 adult patients with distal tibia fractures treated using open reduction and internal fixation with locking compression plates. Fractures were classified using the AO/OTA system. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for functional assessment. Follow-up included union time, complication rates, range of motion, and AOFAS-based final grading. Results: Majority of patients were males (80%), with road traffic accidents accounting for 77% of injuries. Most common fracture type was AO 43-A3. Union was achieved in 87% within 8–14 weeks; delayed union occurred in 13%. Surgical site infection (6.7%) and malunion (3.3%) were the main complications. Functional outcomes: Excellent in 30%, Good in 40%, Fair in 20%, Poor in 10%. Conclusion: Locking plate osteosynthesis for distal tibia fractures yields satisfactory union rates and functional recovery with acceptable complication profiles. Patient selection, precise surgical technique, and compliance with rehabilitation significantly impact outcomes.

Background: Regenerative dentistry is a rapidly advancing field that aims to restore the form and function of oral tissues using biological approaches such as stem cell therapy, tissue engineering, and biomimetic materials. Unlike conventional treatments that merely repair or replace damaged structures, regenerative strategies attempt to reestablish native tissue architecture and functionality through cellular and molecular mechanisms. Dental stem cells (DSCs), including DPSCs, SHEDs, SCAPs, and PDLSCs, are central to this paradigm shift due to their multipotency, immunomodulatory properties, and accessibility. Methodology A narrative review approach was adopted to synthesize the current evidence on the applications of dental stem cells and associated biomaterials in regenerative dentistry. A comprehensive literature search was conducted across PubMed, Scopus, Science Direct, and Google Scholar using defined keywords and Boolean operators. Inclusion criteria focused on peer-reviewed studies involving human or animal models that explored the use of dental-derived stem cells and regenerative biomaterials. After duplicate removal and quality appraisal, 52 high-impact articles were selected for thematic analysis. Results: The review found that dental stem cells have demonstrated significant therapeutic potential in various dental specialties. In endodontics, DPSCs supported pulp-dentin regeneration with angiogenic and neurogenic integration. In periodontology, PDLSCs facilitated regeneration of cementum and ligament via biomimetic scaffolds. Alveolar ridge augmentation using MSC-loaded composite scaffolds showed promising bone regeneration. Exosome-based therapies emerged as an innovative cell-free alternative for pulp and temporomandibular joint regeneration. Biomaterials such as hydrogels, bioactive ceramics, and 3D bioprinted constructs played a crucial role in enhancing stem cell delivery and functionality. Conclusion: Dental stem cells, when paired with advanced biomaterials, offer a promising avenue for biological reconstruction of oral tissues. While several preclinical and early clinical trials have shown success, future efforts must focus on protocol standardization, long-term safety, and cost-effective translation into clinical practice. The integration of emerging technologies like exosome therapy and 3D bioprinting will likely define the next frontier in regenerative dental treatments..

Background: Allergic rhinitis (AR) is a common yet frequently underdiagnosed pediatric condition. Misconceptions about its treatment and social stigma further complicate management. Objective: To determine the prevalence, risk factors, clinical profile, and seasonal trends of allergic rhinitis in children attending pediatric and ENT outpatient departments at a tertiary care center. Methods: A cross-sectional study was conducted over six months (October 2024 to March 2025) among 9039 children aged 2–14 years attending the Pediatrics and ENT OPDs. AR was diagnosed using ARIA criteria. Demographic, environmental, and clinical data were collected using a structured checklist and analyzed using descriptive and comparative statistics. Results: AR was diagnosed in 486 children, with a prevalence of 5.38%. Mean age was 8.1 years; 63% were male. Urban residence (76%) and family history of atopy (60%) were common. Only 10.7% had been previously diagnosed, and none were on treatment. Seasonal symptoms were present in 71%. Moderate/severe nasal congestion occurred in 74%, and 48% had sleep disturbances. Mean QoL score was 5.1. Comorbid asthma was found in 21%. Misconceptions around therapy and stigma led to high treatment discontinuation. Cases peaked in November and February. Conclusion: Allergic rhinitis remains underrecognized and undertreated. Public awareness, provider training, and seasonal preparedness are essential to reduce morbidity

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. If not diagnosed and treated early, it often leads to nerve damage and disabilities. The World Health Organization (WHO) classifies leprosy-related disabilities into grades to assess severity. Despite the success of multi-drug therapy (MDT) in curing the disease, many patients still develop or retain disabilities. This study aims to evaluate the extent of WHO-graded disabilities in leprosy patients before and after completion of MDT, highlighting the need for improved disability prevention strategies. Methods: This prospective observational study was conducted on diagnosed leprosy patients attending a tertiary care center. WHO disability grading was assessed at the time of diagnosis and re-evaluated after completing multi-drug therapy (MDT). Detailed clinical examination, nerve assessment, and disability scoring were performed using WHO guidelines. Data on demographics, duration of symptoms, and delay in diagnosis were collected. Patients were monitored throughout the treatment to evaluate changes in disability status and the effectiveness of MDT in preventing or reducing disability progression. Results: Out of 53 enrolled patients, 3 were lost to follow-up; data from 50 cases were analyzed. Males constituted 70%, and the predominant age group was 20–29 years (34%). A significant 70% belonged to the upper-lower socioeconomic class. Multibacillary leprosy accounted for 88% of cases, and 90% had nerve involvement at diagnosis. Skin smear positivity was seen in 64%, while 48% of patients reported symptom duration >1 year. Erythema Nodosum Leprosum occurred in 18% at diagnosis and 20% during MDT. Grade 2 disability was seen in 48% pre-MDT, which reduced to 30% post-MDT, indicating some improvement but persistent disability. Conclusion: Our study highlights several important risk factors contributing to leprosy, including the number of peripheral nerves involved. The existence of lepra reactions at diagnosis or during treatment or delay in diagnosis and therapy initiation are major risk factors. Although, multidrug therapy (MDT) is very effective for treatment physical disabilities often persists post-treatment, therefore, there is a need to formulate new strategies to minimize the burden of disability.

Background: Benign Prostatic Hyperplasia (BPH) is a prevalent urological condition among aging men, often presenting with lower urinary tract symptoms (LUTS) that impair quality of life. Transurethral Resection of the Prostate (TURP) remains the standard surgical intervention for patients with moderate-to-severe LUTS refractory to medical management. This study evaluates the change in International Prostate Symptom Score (IPSS) before and after TURP. Methods: This prospective observational study was conducted at Dr. D. Y. Patil Medical College, Hospital & Research Institute, Kolhapur, from April 2023 to February 2025. A total of 63 male patients aged >50 years undergoing TURP for BPH were included. IPSS was recorded pre-operatively, and at 1 and 3 months post-operatively. Descriptive statistics and paired t-tests were applied. Complication rates were recorded and analyzed. Results: The mean pre-operative IPSS was 23.54 ± 7.26, with 79.37% of patients classified as severe. At 1 month post-TURP, the mean IPSS significantly reduced to 13.89 ± 4.60, and further decreased to 9.38 ± 4.69 at 3 months (p < 0.001). By 3 months, no patients remained in the severe category; 41.27% reported mild symptoms. Common pre-operative symptoms included incomplete emptying, intermittency, and urgency. Post-operative complications occurred in 34.92% of patients: urinary tract infection (15.87%), bleeding (12.70%), bladder spasms (9.52%), urinary retention (7.94%), and incontinence (3.17%). All complications were conservatively managed. Conclusions: TURP is a safe and effective surgical intervention for BPH, resulting in significant reduction of LUTS as measured by IPSS. Most patients achieve moderate-to-mild symptom levels by 3 months post-surgery. IPSS is a reliable tool for assessing TURP outcomes and patient-reported symptom improvement.

Background: Physiology of female body depends on many factors but menstrual cycle is one of the most important factors. The cyclical variation in hormonal levels can affect many bodily functions in female. Reaction time (Auditory and Visual Reaction Time) is a simple test to assess psychomotor function of a person. Present study was designed to see whether cyclical changes in normal menstrual cycle affects Auditory reaction time (ART) and Visual reaction time (VRT). Material and Methods- 81 young females with normal regular menstrual cycle were studied. ART and VRT were recorded on Day 1, Day 7, Day 14 and Day 21 of their menstrual cycle. Results were analysed by using ANOVA and Tukey HSD post hoc test. Results and Conclusion- Reaction Time vary significantly across a normal menstrual cycle. Both ART and VRT were fastest on day 21(190.74±23.226 msec and 209.01±27.231msec respectively) and slowest on day 14 (232.72±28.680 msec and 258±36.370 msec respectively).

Background: COVID-19 pandemic has had profound impact on the healthcare systems and medical education globally. Corona virus pandemic has seen the introduction of new teaching methods of delivering education to medical students. Therefore, the present study aimed to assess the student’s perceptions towards E-learning during the COVID -19. Materials and methods: This cross-sectional study was conducted in Department of Physiology, Dr. B.R. Ambedkar Medical College & Hospital, Bengaluru, Karnataka, India. This was a questionnaire-based study. The questions included general information of the student and related to advantages, disadvantages and other aspects of online teaching during COVID-19. This study included 358 undergraduate medical students belonging to 1st year, 2nd year, 3rd and final year MBBS during 2022. Among them, 1st year students were 94, 2nd year students were 92, 3rd year students were 85 and final year students were 87. Informed consent was obtained from all the study participants. Data was downloaded from google form in Microsoft excel and was used for analysis. Results: In this study, majority of the students were following/using text books 79 (84%), 80 (86%), 76 (89.4%) and 4th year 70 (80.4%), in 1st, 2nd, 3rd and 4th year respectively. In 3rd and 4th year, more than 75% of the students used power point with audio & video as source of study material. Even, online materials were also used: 1st year 15 (15.9%) 2nd year 50 (54.3%), 3rd year 59 (63.6%), 4th year 52 (59.7%) students. Majority of the students preferred link for additional teaching learning materials, online or live demonstrations, visual interface of the teacher, break between two consecutive lectures, option for questions/doubts during the lecture, interactive quiz during the lecture with mandatory responses, option for feedback about the class after the session, access platform for online classes in college/library and option for viewing the content later offline. In this study, majority of the students reported that academic progress during lockdown was average 158 (44.1%). Experience of online classes over regular classes reported to be average 167 (46.6%). Regarding improvement of practical knowledge, 123 (34.3%) students agree, strongly agree by 50 (13.9%). The benefits of online teaching reported to be cost-effectiveness of online education 245 (68.4%) and flexibility in the timing of classes 199 (55.5%). Majority of inconveniences/challenges faced by students in online classes were lack of internet connectivity 221 (61.7%), technical failure 209 (58.3%), lack of face-to-face interaction 199 (55.5%), distractions at home 155 (43.2%).  Conclusion: This study may conclude that COVID-19 pandemic has introduced new teaching methods for medical students. Majority of the students agreed that online learning has good impact on their education.

Background: Premenstrual syndrome (PMS) is a common yet often under-recognized condition among young women, influenced by lifestyle, psychological, and socio-demographic factors. Coping mechanisms may play a significant role in managing PMS symptoms. Aim: To study the severity of PMS and its association with coping strategies and socio-demographic variables among female medical students. Methodology: A cross-sectional study was conducted on four hundred  female participants using the Premenstrual Symptoms Screening Tool (PSST) and the Brief COPE inventory. Socio-demographic and lifestyle data were collected. Data was analysed using descriptive statistics, chi-square tests, and one-way ANOVA. Results: PMS was reported by 76.25% of participants, with 66% experiencing moderate and 10% severe symptoms. ANOVA revealed significant differences in all fourteen coping subscales across PMS severity groups, with both adaptive and maladaptive strategies being more frequent in severe PMS. Conclusion: The study highlights the high prevalence of PMS and the role of socio-demographic and lifestyle factors. Coping styles differ significantly with symptom severity, suggesting the need for targeted psycho educational support

Background: Aim: A Study of Etiology and Spectrum of Eye Injuries in Trauma Patients in a Tertiary Care Teaching Hospital Method: A prospective hospital based study was carried out in 560 trauma patients with ocular injuries were conducted at Department of Ophthalmology associated with Department of Pathology & Microbiology, KMC Medical College & Hospital from April 2024 to April 2025. Detailed history was taken regarding time, place and session of trauma, mode of injury and type and nature of traumatic agent. All the patients underwent complete ophthalmological evaluation to identify the type, extent and severity of injury and impact on ocular structures and vision. All the trauma patients with eye and orbital injuries were included in the study. Results: Out of 560 patients, males were most commonly affected. The mostly involved age group was between 21 to 30 years. Periorbital edema with ecchymosis was the most common ocular manifestation. Road traffic accidents were the most common etiology for the trauma followed by assault. Visual acuity at presentation was normal in most cases. Conclusion:  Trauma patients are at high risk for vision-threatening injuries. Early detection and management of eye injuries is essential to reduce the rate of complications and save the vision. Young males involved in RTAs represent a risk group.

Background: Chronic kidney disease (CKD) is a systemic condition with widespread microvascular involvement, including significant ocular manifestations. The anatomical and functional similarities between the renal and retinal microvasculature support the concept of a “renal-retinal axis.” However, ophthalmic changes are often underdiagnosed in CKD patients until irreversible visual impairment occurs. Aim: To evaluate the spectrum of ocular manifestations in patients with chronic kidney disease and to determine their association with different stages of the disease. Material and Methods: A cross-sectional observational study was conducted among 80 adult CKD patients at a tertiary care hospital. After clinical staging based on eGFR, all patients underwent detailed ophthalmological assessment, including visual acuity testing, slit-lamp examination, fundoscopy, and lens evaluation. The data were analyzed to correlate ocular findings with CKD stages and systemic parameters. Results: Ocular abnormalities were present in all stages of CKD, with severity increasing alongside disease progression. Visual impairment and blindness were more common in advanced stages, particularly Stage 4 and 5. Eyelid lesions such as sebaceous cysts and xanthelasma were seen in 10% of cases. Conjunctival changes, including pterygium and pinguecula, were observed in 12.5% of patients. Cataracts were highly prevalent (62.5%) and pseudophakia was noted in 37.5%. Fundoscopic abnormalities, suggestive of hypertensive or ischemic retinopathies, were present in 51.2% of cases. Conclusion: Ocular manifestations in CKD are frequent, varied, and progressive. As the disease advances, the risk of visual impairment significantly increases. Regular ophthalmic screening in CKD patients can facilitate early diagnosis, prevent irreversible vision loss, and may serve as an additional tool to monitor systemic microvascular damage.

Background: Coagulase negative staphylococcus is considered as the normal flora of human skin and mucous membrane which can also cause Blood stream infection. CoNS are often related to a variety of nosocomial illnesses, especially infections in the bloodstream and in prosthetics. Finding one positive blood culture for CoNS is hard to interpret clinically, and it is usually thought to be contamination unless at least two blood cultures show the same CoNS species. Our study will help in establishing the role of CoNS as true pathogen causing blood stream infection. Materials&Methods: The cross-sectional study was conducted in department of microbiology, TMMC & RC. A pair blood culture samples were collected from both the hands aseptically and loaded in BacT/Alert. Positive flag blood culture bottles were cultured and organism identification was done through gram staining and biochemical test.  AST was done by Automated system. Results: Out of 117 samples, 19 samples (16.23%) were isolated from both sites while the remaining CoNS were obtained from only a single site. Out of 19 Sample, 7 (36.84%) were male and 12 (63.15%) were female. The various species were isolated Staphylococcus haemolyticus 6 (31.57%), Staphylococcus hominis 5 (26.31%), Staphylococcus epidermidis 2 (10.52%), Staphylococcus warneri 2 (10.52%), Staphylococcus simulans 1 (5.26%), Staphylococcus xylosus 1 (5.26%), Staphylococcus capitis 1 (5.26%), Staphylococcus scuiri 1 (5.26%).Conclusion: The majority of Coagulase negative staphylococcus recovered from blood cultures was once thought to be contaminants, but as therapy modalities have changed more actual pathogenic CoNS have been isolated from blood cultures and CoNS species are also developing resistance to routinely used antibacterials.

Background: Certain bacteria produce enzymes known as extended-spectrum beta lactamases, which hydrolyse and render inactive a variety of beta-lactam antibiotics, such as cephalosporins, penicillin and monobactams. ESBL enzymes were identified as a major mechanism for the resistance to third-generation cephalosporins. The most prevalent pathogens that cause BSIs such as Escherichia coli, Klebsiella spp, Pseudomonas, Acinetobacter, etc. The purpose of this study was to identify ESBL producing organisms to avoid clinical failure in patients with such severe infections. Therefore, this investigation will provide insight into β-lactamase synthesis and organism-based antibiotic susceptibility patterns for efficient management and treatment plans. Materials & Methods: The observational study which was conducted in department of microbiology, TMMC&RC. Blood was collected in automated blood culture bottle (BacT/alert) aseptically. Positive flagged blood culture bottle was cultured on appropriate media and organism was identified by conventional methods.  Antibiotic sensitivity testing was done by manually. ESBL was identified in gram-negative isolates by using ceftazidime/ceftazidime clavulanic acid. Results: Out of total 93 samples of blood, 30 were ESBL producers and 63 were non ESBL. Out of 30 ESBL producers 20(66.67%) E. coli, 7(23.33%) K. pneumoniae and 3(10%) K. oxytoca was isolated. Most Sensitive drug for Gram negative bacteria was Polymyxin-B, Colistin and Tigecycline. Conclusion: Antibiotic resistance makes ESBL bloodstream infections extremely dangerous, hence proper treatment, infection prevention and antibiotic stewardship measures are essential.

Background: Chronic otitis media (COM), contribute significantly to morbidity, particularly hearing loss, if not managed appropriately. The causative organisms and their antibiotic resistance profiles vary geographically, shaped by local antimicrobial usage and socioeconomic status. Accurate identification of bacterial pathogens and their resistance patterns is crucial for optimizing treatment outcomes. Materials and Methods: This cross-sectional observational study was conducted over six months in a tertiary care hospital in North Maharashtra. A total of 144 patients with ear discharge were recruited based on inclusion criteria. Detailed clinical assessments were performed, and pus samples were collected using sterile techniques. These were cultured on MacConkey and blood agar, followed by bacterial identification using standard microbiological protocols. Antibiotic susceptibility was determined using the Kirby-Bauer disc diffusion method on Mueller-Hinton agar. Results the majority of participants were male (56.3%), with a mean age of 39.67 years. The most prevalent isolate was Pseudomonas aeruginosa (45.8%), followed by Staphylococcus aureus (18.8%). Other isolates included Proteus, Escherichia coli, and Enterobacter (each 2.1%), while 10.4% of samples showed no growth. Pseudomonas aeruginosa demonstrated resistance to several antibiotics but remained sensitive to piperacillin-tazobactam, imipenem, and meropenem. Staphylococcus aureus was sensitive to linezolid, methicillin, and gentamicin. Carbapenems and piperacillin-tazobactam were generally effective. A statistically significant association (P = 0.020) was observed between bacterial isolates and comorbidities such as diabetes, hypertension, and hyperthyroidism. Conclusion The study highlights the dominance of Pseudomonas aeruginosa and Staphylococcus aureus in COM patients, particularly those with comorbid conditions. Given the varying antibiotic resistance patterns, empirical treatment strategies must be guided by local susceptibility data to ensure optimal patient outcomes.

Background: Objectives: The study aimed to investigate the correlation between serum amylase levels and clinical outcomes in patients with acute organophosphate (OP) poisoning, assessing its utility as a marker for poisoning severity and prognostic outcomes .Materials and Methods: This prospective observational study was conducted at GMERS Medical College, Gandhinagar, from November 2020 to December 2021. A total of 83 patients with confirmed acute OP poisoning were included. Serum amylase levels were measured at three-time points: on admission, day 1, and day 3, alongside other clinical assessments such as pupil size, respiratory rate, and blood pressure. Statistical analysis was performed using Chi-square and ANOVA tests, with a p-value of less than 0.05 considered significant. Results: Of the 83 patients, 38.6% had serum amylase levels greater than 115 IU/L. Elevated serum amylase levels were significantly associated with dyspnea and cough (40.6% vs. 15.7%, p = 0.01) and pinpoint pupils (31.2% vs. 5.9%, p = 0.007). Patients with elevated amylase were more likely to require ventilatory support (56.3% vs. 7.8%, p = 0.001) and had a significantly higher mortality rate (37.5% vs. 3.9%, p = 0.000). The inverse relationship between serum cholinesterase and amylase levels further underscored the severity of poisoning in patients with raised amylase levels. Conclusion: Elevated serum amylase levels are strongly correlated with greater clinical severity, need for ventilatory support, and higher mortality in acute OP poisoning cases. Serum amylase can be a reliable prognostic marker for identifying high-risk patients, aiding early intervention and improving clinical outcomes.

Background: The organism Acinetobacter baumannii is a major contributor to hospital acquired infections because of certain characteristics that allow it to compromise the body’s protection. Acinetobacter baumannii is becoming more widely acknowledged as a dangerous illness due to its multidrug resistance and capacity to produce biofilms. Materials and Methods: An observational study was conducted in the bacteriology section of department of Microbiology, Teerthanker Mahaveer Hospital. Using standard methods isolates were identified and species were recognized. The Kirby Bauer disc diffusion test was used to conduct the antibiotic sensitivity test and Biofilm detection of Acinetobacter baumannii was performed using the Congo red agar method per CLSI guidelines 2023. Results: In this study, 97 ICU patients were included amongst which 49(50.51%) were males and 48(49.48%) females. Our findings demonstrated a strong correlation between improved biofilm development and MDR, among 97 Acinetobacter baumannii isolates, all were MDR for different drugs, and some were biofilm producers they were categorized into strong 27(27.83%), and negative 39(40.20%) biofilm formers. The biofilm formers showed the greatest resistance to Amikacin (72.22%) and Ampicillin/Sulbactam (80%). Conclusion: The result of this study significantly associated with multidrug resistant and increase biofilm production. This study’s findings suggest that biofilm serves as a means for bacteria to improve their chances of persistence, particularly in isolates with insufficient resistance. Furthermore, biofilms produced by isolates with high resistance levels may always offer the isolates a comparable degree of protection, given the fact that they are always weak.

Background: Dengue is a serious infectious disease transmitted by vectors and associated with dengue virus affecting populations globally. In humans dengue is spread in an urban environment by female Aedes aegypti mosquitoes, with humans susceptible to infection from all four serotypes: DENV1 to DENV4. In recent years, thrombocytopenia, leukopenia, lymphocytosis, elevation of hematocrit value and liver enzymes are common findings in dengue fever. So this inquiry looks at blood results and liver function in these patients to see if there is a link between blood problems and liver issues. Materials & Methods: An observational study was conducted for one year in the Virology section of the Department of Microbiology, Teerthanker Mahaveer Hospital. The sample size was 82. After obtaining informed consent, blood samples were collected and sent to the Virology, Hematology, and Biochemistry labs. Result: Out of 82 dengue-positive patients, NS1 antigen was detected in 61 (74.40%), IgM in 17 (20.89%), and IgG, IgM in 4 (4.72%). Most individuals 61 (74.40%) exhibited moderate to mild thrombocytopenia. Liver involvement in the form of elevated SGOT 13 (15.85%) and SGPT 10 (12.20%) participants, respectively. Conclusion: Platelet count and platelet indices play significant roles in predicting the severity of the outcome of dengue fever. Thrombocytopenia, elevated AST, and leukopenia may predict dengue diagnosis and its severity during an active infection. To improve dengue diagnosis and aid in appropriate patient care, these laboratory parameters can be used to complement less sensitive rapid tests with proper patient management.

Background: HIV/AIDS, also known as acquired immunodeficiency syndrome, is a serious medical issue in India. Opportunistic infections, such as intestinal parasitic infections brought on by intestinal parasites, can affect the quality of life for people with HIV/AIDS and produce asymptomatic to fatal diarrhea due to weakened immune systems. Intestinal parasite infestations in HIV-responsive patients were the focus of the study. In order to help clinicians choose the best care plans and minimize potential problems, this study aims to detect intestinal parasite infestations early. Materials and methods: The observational study was carried out in the Parasitology section of the Department of Microbiology at TMU Hospital, Moradabad, by collecting the stool sample from 70 HIV reactive patients. Modified Ziehl Neelsen staining was used to detect acid-fast parasites, and the stool wet mount method was used for regular stool microscopy. Results: Intestinal parasites were found in 19 out of 70 patients (27.14%). Among the opportunistic parasites, Isospora belli, Strongyloides stercoralis, and Entamoeba histolytica each accounted for 3 cases (15.78%), followed by Cryptosporidium spp. with 2 cases (10.52%) and Cyclospora spp. with 1 case (5.26%). Non-opportunistic parasites included Hookworm, Ascaris lumbricoides, and Hymenolepis nana with 2 cases each (10.52%), and Trichuris trichiura with 1 case (5.26%). Conclusion: Our study found higher S. stercoralis and I. belli infections in HIV-positive patients, highlighting the need for early screening of both HIV and intestinal parasites. Routine parasite checks and basic care remain important, even with free antiretroviral therapy, to help prevent HIV-related diarrheal infections.

Background: Non-alcoholic Fatty liver Disease (NAFLD) is an umbrella term which includes spectrum of liver disorders characterized by hepatic steatosis in absence of significant alcohol consumption.  Objective: to determine the prevalence of NAFLD in individuals with prediabetes in Rohilkhand region and analyse its association with other metabolic factors. Methods: This was a cross-sectional study conducted between June 2024 to December 2024 at Rohilkhand Medical College and Hospital, Bareilly, a tertiary care teaching hospital in Rohilkhand region of Uttar Pradesh.  Result: We have analysed 200 prediabetic patients from the Rohilkhand region in this study. Among them, 60% were male (n=120) and 40% were female (n=80). The mean age of the participants was 45 ± 10 years (range: 30-65 years). The mean BMI was 27.5 ± 3.2 kg/m², with 80 patients (40%) having BMI >27.5 kg/m², indicating overweight or obesity, a known risk factor for NAFLD. Out of 200 prediabetic patients, 78 (39%) were diagnosed with NAFLD, whereas 122 (61%) did not show signs of fatty liver. Prevalence of NAFLD among male was 41.7% (50 out of 120) while in female it was 35% (28 out of 80). The NAFLD prevalence among overweight patients (BMI > 27.5 kg/m²) was 60%, whereas in patients with BMI < 27.5 kg/m², it was 25%. Conclusion: Our study confirms that NAFLD is highly prevalent in prediabetes with strong associations between BMI, ALT, HbA1c, and NAFLD. These findings emphasize the need for early screening, lifestyle modifications, and tighter glycaemic control to prevent progression to NASH and Type 2 Diabetes Mellitus.

Background: Artificial Intelligence (AI) is rapidly revolutionizing medical education by introducing intelligent systems capable of enhancing the learning process, facilitating personalized instruction, and supporting clinical decision-making. This systematic review explores the integration of AI into medical education by analyzing 62 peer-reviewed studies published between 2010 and 2024. The review identifies key domains of AI application: simulation-based learning, adaptive tutoring systems, automated assessments, diagnostic training, and competency evaluation. Evidence indicates that AI-driven platforms significantly enhance student engagement, improve diagnostic accuracy, and promote individualized learning trajectories. Simulation tools powered by AI allow for risk-free, real-time procedural training, especially beneficial in surgical and emergency scenarios. Moreover, natural language processing and machine learning algorithms are being employed to assess clinical reasoning and communication skills, areas traditionally challenging to evaluate. Despite these advances, challenges such as data privacy, algorithmic bias, faculty readiness, and infrastructural limitations persist. The review calls for curriculum reforms, robust ethical guidelines, and interdisciplinary collaboration to ensure the responsible and equitable implementation of AI in medical training. As medical education moves toward a more technology-integrated future, AI offers promising solutions but demands careful consideration of ethical, pedagogical, and technical dimensions to truly enhance learning outcomes and healthcare delivery..

Background of present study: Spinal anaesthesia is a widely accepted anaesthesia method of choice for caesarean delivery. However, there is some unwanted adverse effects like intraoperative nausea and vomiting (IONV) which causes both patient discomfort and increased risk of visceral injury. Therefore, IONV should be prevented or minimised using drugs like droperidol, metoclopramide, which in turn have their own demerits. Recently, it has been shown that low dose propofol and midazolam can reduce IONV more efficaciously. But there is scarcity of study comparing the efficacy between these two drugs.  Objective of research: This study will compare the efficacy between the subhypnotic doses of midazolam and propofol in preventing intraoperative nausea vomiting (IONV) during spinal anaesthesia in case of caesarean delivery and look for any advantages over another. Methodology: After obtaining institutional ethics committee approval this prospective, randomised, comparative study had been conducted in the Department of Anaesthesiology, North Bengal Medical College & Hospital over a span of one year. 110 parturients, aged 20-30yrs, ASA I &II, admitted for elective caesarean delivery had been included in the study after proper counselling and taking informed consent at the pre-anaesthetic checkup. Randomisation was done by computer generated code in sequentially numbered sealed envelope. Study variable included frequency of nausea, retching, vomiting, rescue antiemetic consumption, total requirement of phenylephrine to control hypotention and hemodynamic changes and post operative sedation score. Result: In our study, we have observed that the low incidence of nausea, retching, vomiting in both the groups. With respect to post operative sedation score, for group M 100% of patients showing Modified Ramsey Sedation Score 1 during immediate post operative period and for group P 98.18% of population shows sedation score 1. Regarding intraoperative hypotension and mean phenylephrine consumption, for group M the amount is 72.73 mcg and for group P is 120.91 mcg.  Conclusion: Subhypnotic doses of midazolam is as effective as subhypnotic doses of propofol  for the prevention of nausea and vomiting during and after caesarean section under spinal anaesthesia without causing any significant amount of sedation among the parturients post-operatively. Furthermore, as less severe haemodynamic changes are seen with midazolam, it seems that midazolam can be considered as a much better choice than propofol in reducing IONV in case of caesarean section under spinal anaesthesia.

Background: Urinary tract infections (UTIs) are among the most common infections affecting individuals with diabetes mellitus. Diabetic patients are at increased risk due to compromised immune function, poor glycemic control, and urinary stasis. These infections are often recurrent and complicated by antimicrobial resistance. Objectives: To determine the etiological agents of UTIs in diabetic patients and to evaluate the antimicrobial sensitivity patterns of the isolated uropathogens. Methods: This prospective, cross-sectional study was conducted over one year among diabetic patients presenting with clinical symptoms of UTI. Midstream urine samples were collected, cultured using standard microbiological techniques, and the isolates were identified using biochemical methods. Antibiotic susceptibility testing was performed by the Kirby-Bauer disk diffusion method and interpreted according to CLSI 2023 guidelines. Data were analyzed using SPSS Version 25. Results: Out of 320 diabetic patients evaluated, 196 (61.3%) had culture-positive UTIs. The most frequently isolated organism was Escherichia coli (48.5%), followed by Klebsiella pneumoniae (20.9%) and Enterococcus spp. (13.8%). High resistance was noted against ciprofloxacin (64.8%) and ampicillin (71.6%), while imipenem (89.2%), amikacin (82.1%), and nitrofurantoin (74.3%) showed the highest sensitivity among Gram-negative isolates. Linezolid (100%) and vancomycin (96.3%) were most effective against Gram-positive isolates. Conclusion: Diabetic patients are at high risk of developing UTIs caused predominantly by Gram-negative bacteria, especially multidrug-resistant E. coli. Rising antibiotic resistance underscores the need for culture-guided therapy and local antimicrobial surveillance to guide empirical treatment.

Background: There has been continuous advancement in healthcare with the goal of reducing morbidity, complications, and ensuring quicker recovery through surgical interventions. Laparoscopic or minimal access surgery has revolutionized this effort by allowing procedures through small skin incisions (ports) using trocars, telescopes, and specialized instruments. Aim: To determine the prevalence of port site complications in laparoscopic surgeries. Methodology: The present study was a hospital-based prospective study conducted in the Department of General Surgery at Mahatma Gandhi Medical College & Hospital (MGMC&H), Jaipur. The study was carried out over a period of 18 months, from September 2022 to March 2024. Result: In this study, laparoscopic cholecystectomy was the most commonly performed procedure (39%), followed by laparoscopic hernia repair (22%), and laparoscopic appendectomy (19%). The majority of patients (96%) had no post-operative complications, while 2% experienced infections, 1% had bleeding, and 1% developed hernia. These findings align with previous studies, confirming the safety and predominance of laparoscopic cholecystectomy in minimal access surgeries. Conclusion: Laparoscopic surgery, particularly laparoscopic cholecystectomy, is a safe and effective alternative to open procedures with minimal postoperative complications. This study reinforces its role as the preferred approach in modern surgical practice.

Background: Haemorrhoids is one of the commonest Ano-rectal diseases in patients attending surgery department. However, in Gujarat, India limited literature is available for determinants of this disease. Present study was conducted to know the prevalence and determinants of haemorrhoids among the patients who attended general surgery department of a tertiary care hospital. Methods: A hospital based cross sectional study was conducted in the outpatient department (OPD)of general surgery department of a tertiary care hospital of Mehsana district, Gujarat, India from July 2022 to December 2022. Out of 5261 patients, who attended OPD of surgery department, 441 patients were found to have haemorrhoids. Total 429 patients were included in this study as per prefixed inclusion and exclusion criteria by nonprobability sampling technique.  Results: Prevalence of haemorrhoids was 8.38% among the patients who attended OPD of general surgery department of a tertiary care centre. Various factors like age (54.90% in < 40 years of age), male gender (68.63%), low level education, occupation, low socio-economic status, having family history (31.37%), constipation (78.43%), low fibrous diet (64.70%) and more spicy diet (54.90%), inadequate water intake (43.13%), high BMI (17.64%) and sedentary lifestyle (21.57%) were present in patients with haemorrhoids. Forty nine percent patients had Grade I, 33.33% had Grade II and 17.65% had Grade III haemorrhoids. Conclusion: Haemorrhoids is a common disease observed in younger patients and in male gender. Some modifiable factors are commonly present in patients, i.e., constipation, inadequate intake of water and fibre, smoking, consumption of alcohol, high BMI and sedentary lifestyle.

Background: Anti-nuclear antibody (ANA) testing plays a pivotal role in the diagnosis of autoimmune connective tissue disorders (CTDs). Indirect immunofluorescence (IIF) using HEp-2 cells is considered the gold standard for ANA detection, while enzyme-linked immunosorbent assay (ELISA) offers a rapid, automated alternative. Comparative data on the diagnostic performance of these methods in regional cohorts remain limited. Objective: To evaluate the diagnostic accuracy of ELISA in comparison with IIF for the detection of ANA in patients clinically suspected of having CTDs. Methods: A cross-sectional study was conducted on 90 serum samples from CTD-suspected patients. Each sample was tested for ANA using both IIF (HEp-2 cell substrate) and ELISA (Calbiotech ANA IgG kit). IIF results were used as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of ELISA were calculated. Agreement between the two methods was assessed using Cohen’s kappa statistic. Results: ANA was detected in 65.6% of cases by IIF and in 57.8% by ELISA. ELISA showed a sensitivity of 81.4% and specificity of 87.1%, with a PPV of 92.3% and NPV of 71.0%. The overall diagnostic accuracy of ELISA was 84.4%. Concordance between the two methods was 87.8%, with a kappa value of 0.677, indicating substantial agreement. Discordant cases were primarily IIF-positive/ELISA-negative, often involving fluorescence patterns such as nucleolar and peripheral that are less likely to be detected by ELISA. Conclusion: ELISA demonstrates good specificity and agreement with IIF for ANA detection but may miss low-titer or rare pattern cases. While suitable for high-throughput screening, ELISA should be supplemented with IIF, especially in diagnostically challenging CTD cases. A tiered testing strategy incorporating both methods is recommended to enhance diagnostic accuracy.

Background: Self-medication—the use of drugs without professional medical consultation—has become an increasingly prevalent public health issue, particularly in developing regions like India. While some level of self-care is encouraged, inappropriate medication use can lead to adverse drug reactions, treatment delays, and the global threat of antimicrobial resistance. In Punjab, despite a relatively literate population, region-specific data on self-medication practices and awareness remain limited. Materials and Methods: A descriptive, cross-sectional study was conducted among 400 adult residents of Punjab using a structured, self-administered Google Form questionnaire, disseminated across social media platforms. The questionnaire assessed socio-demographic variables, knowledge regarding self-medication, and related practices. Each correct knowledge response was scored, and cumulative scores were categorized into four levels: Very Good (≥80%), Good (60–79%), Fair (41–59%), and Poor (<40%). Data were analyzed using SPSS version 26.0, with chi-square tests applied to assess associations (p < 0.05 considered significant). Results: Among 400 respondents, 72.5% reported self-medication in the past six months. Commonly used drugs included analgesics (67.5%) and antibiotics (42.0%). Primary reasons for self-medication were cost-saving (41.0%) and prior illness experience (38.0%). Knowledge assessment revealed that only 28.0% had Very Good knowledge, while 11.5% had Poor awareness. Statistically significant associations were observed between knowledge levels and age (p = 0.004), education (p < 0.001), and residence (p = 0.016). Similarly, self-medication practices were significantly linked to age (p = 0.008), education (p < 0.001), and urban residence (p = 0.006). Gender and occupation were not significantly associated with either knowledge or practice. Conclusion: The study underscores a high prevalence of self-medication in Punjab, driven by both behavioral and systemic factors. Although basic awareness exists, substantial knowledge gaps—especially regarding antibiotics and pharmacist roles—remain. Public health interventions focusing on health education, regulatory pharmacy oversight, and targeted awareness campaigns are essential to curb unsafe self-medication, particularly among urban and educated populations who are more likely to self-treat without medical advice.

Background: Blunt thyroid trauma is rare but life-threatening in patients with pre-existing thyroid disease, as gland fragility increases risk of rupture and haemorrhage, potentially causing airway compromise. This report discusses a post-fall thyroid haemorrhage with airway threat in a patient with prior thyroid swelling, highlighting management and outcomes Case Presentation- A 65-year-old male with chronic goitre sustained thyroid haemorrhage following a fall. After unsuccessful conservative treatment, surgical exploration was performed involving debridement of necrotic right thyroid tissue (histopathologically confirmed as syringocystadenoma papilliferum) and near total thyroidectomy. DISCUSSION- Blunt injury to the thyroid gland is rare, but carries more risk in nodular/goitrous glands due to vascular fragility; contrast CT or MRI guides management, as seen in our patient requiring surgery for hematoma-induced airway threat. Histopathology revealed unprecedented thyroid syringocystadenoma papilliferum (typically a sweat gland tumour) with hemorrhagic necrosis alongside nodular goitre, highlighting trauma risks in glandular pathologies. CONCLUSION- This report describes an uncommon case of isolated thyroid trauma with haemorrhage into a pre-existing tumour necessitating surgical intervention. Management should be guided by radiological findings, with treatment ranging from conservative approaches to emergency surgery depending on airway stability and pathological findings.

Background: A severe disease caused by microorganisms that results in an inflammatory response and manifests as fever, urgency, frequency, and dysuria is known as a urinary tract infection. Urinary tract instrumentation may cause UTIs linked to medical care. Multidrug-resistant strains of the bacteria that cause hospital-acquired CAUTIs sometimes require the administration of stronger antibiotics. Moreover, it is possible for these resistant strains to spread to additional patients. This research will assist in identifying the microbes that cause in order to fight drug resistance, the AST pattern for CAUTI will aid in the wise use of antibiotics in compliance with the antibiotic stewardship program. Materials and Methods: - It is an observational study. This study is conducted in TMU hospital, Moradabad. The bacteriology section of the department of microbiology received clinical samples that contained uropathogens. The sample size of the study is 126. Isolates were identified by standard methods. AST was done by automated VITEK-2 Compact System. Result: -Out of 126 patients, female were patients 65.88%, and males were 34.12%. Among 126 patients, CAUTI was mostly caused by Escherichia coli 24(19.04%), Escherichia coli (ESBL)13(10.31%), Klebsiella species 30(23.80%), followed by Enterococcus species 19(15.07%) Staphylococcus aureus 03 (5.55%), S. aureus (MRSA) 11(8.73%), CONS 09(7.14%), Acinetobacter Spp. 05(3.96%), Pseudomonas Spp. 5(3.96%), Citrobacter spp. 04(3.17%), and Proteus spp. 03(2.38%) respectively. Conclusion: - CAUTI among females having highest percentage than males. Escherichia coli and klebsiella species is the most common pathogens causing CAUTI among both the male and female.

Background: Chronic suppurative otitis media (CSOM) refers to persistent middle ear infections that continue for an extended period. India is considered a very prevalent country. It is the most prevalent cause of child hearing impairment in underdeveloped nations and primarily affects younger age groups. Meningitis, brain abscesses, facial nerve paralysis and lateral sinus thrombosis are among the complications. Common causative agents are Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Proteus species. Materials & Methods: This observational study was done in the ENT & Microbiology department at TMMC & RC, focusing on microbiological findings, and treatment outcomes. Data was collected from patient records, laboratory results, and direct observations. For the Gram stain and the culture and sensitivity tests, 2 swab (ear discharge) were taken. Using Kirby Bauer disk diffusion approach, a sensitivity profile was created. Result: Of the 100 samples, 84 had bacterial growth, microbial analysis of samples among the collected samples, P. aeruginosa was detected in forty-five cases, while S. aureus was present in twenty-nine. Additionally, Klebsiella species were found in five samples, E. coli in three, and Proteus species in two. The remaining sixteen samples showed no bacterial growth. Vancomycin, Linezolid, Clindamycin, Doxycycline and Teicoplanin showed sensitive pattern to gram-positive bacteria, while Polymyxin B, Colistin, Piperacillin Tazobactam, Cefepime, Ceftazidime, Ticarcillin clavulanate and Meropenem were found to be sensitive to gram-negative bacteria. Conclusion: The microbial species that were isolated were largely Pseudomonas aeruginosa (45%) along with Staphylococcus aureus (29%).

Background: Typhoid fever is a prevalent systemic infectious disease that continues to be a major cause of morbidity and mortality worldwide. Typhoid fever is caused by Salmonella typhi or Salmonella paratyphi serotypes A, B, and C. Enteric fever is typically diagnosed by Widal testing and blood culture. In order to diagnose typhoid fever, the current study compared the most widely used antibody detection test, the Widal test, with the quick antibody detection test, the Typhi dot. Materials and methods-: This observational comparative study was done on 139 patients for one year in Serological section of the Department of Microbiology, Teerthanker Mahaveer Hospital. All collected samples were tested for the Widal test and the Typhi Dot test. For the Widal test, for ‘O’antigen, a titer of 1:160 or more was considered as positive. For ‘H’ antigen a titre of 1:200 or more was considered as positive. Typhi Dot (IgM and IgG) test was done by the immune-chromatography-based rapid assay. Result-: Of 139 clinical samples, 51(36.69%) were from males, and 88 (63.30%) were from females. Out of 139 diagnosed cases of typhoid fever, 45(32.37%) patients were positive on the Widal test and 51(36.69%) were Typhi dot positive. Conclusion-: Traditionally Blood culture and Widal test are used to diagnose typhoid fever. Compared to the Widal test, the Typhi dot test is more specific, accurate and easy way of diagnosing typhoid fever with an additional advantage of separate determination of IgM and IgG antibody, aiding in identification of current infection and past exposure of infection.

Background: Very few Indian studies have looked into the psychological aspects of this chronic disfiguring disease. Thus the aim of my study is to assess the clinical severity, physical and psychological disability and to analyse their inter relationship in psoriasis patients. Methods: A total of 154 chronic plaque psoriasis patients attending the dermatology department in our hospital were enrolled in this study. Relevant history, clinical examination and necessary investigations along with PASI (psoriasis area severity index) were done for all the patients. Quality of life was measured using the DLQI. Results: Among the 154 patients, 102 (66.23%) were males whereas 52 (33.77%) were females. The mean DLQI was 3.58 for male patients (SD ± 3.07) and 2.96 for female patients (SD ± 2.69), the mean PASI was 6.91 (SD ± 5.98). Highly significant correlation was noted between the PASI score and the DLQI (r = 0.7683, P = <0.0001). In this study, 65.6% patients had mild psoriasis (PASI<7), 17.5% moderate severity (PASI 7-12) while 16.9% had severe type (PASI>12). Psoriasis had small effect on quality of life in 72.7% patients, no effect on 15.6% patients, moderate effect on 7.8% patients and very large effect on 3.3% patients. Symptom and feeling (99.4%) was the most commonly affected domain.  Conclusion: Patients with severe psoriasis have a reduction in quality of life and work productivity. Assessment of disease using both clinical and patient related QOL indices help in planning proper treatment outcome.

Background: Airway management in cancer patients poses unique challenges due to anatomical distortions and prior treatments. Identifying predictors of difficult airway in this population is essential for perioperative safety. Objectives: To determine the incidence, predictors, and intraoperative implications of difficult airway in adult cancer patients undergoing general anaesthesia. Methods: In this prospective observational study conducted at two tertiary cancer centres from June 2024 to May 2025, 60 adult cancer patients scheduled for elective surgery under general anaesthesia were evaluated. Preoperative assessments included airway metrics such as thyromental distance (TMD), Mallampati grade, neck mobility, and inter-incisor gap. Difficult mask ventilation and intubation were recorded. Logistic regression was used to identify associations between clinical predictors and difficult airway. Results: The incidence of difficult intubation was 23.3% (14/60), and difficult mask ventilation occurred in 26.7% (16/60). Video laryngoscopy was utilized in 58.3% of cases, either as a primary or rescue technique. Transient hypoxaemia (SpO₂ <90%) occurred in 15% of patients, though no unplanned tracheostomies or airway trauma were reported. On regression analysis, shorter thyromental distance (<6 cm) showed a trend toward increased risk of difficult intubation (OR 3.2; 95% CI: 0.85–12.3), while higher Mallampati grade (III–IV) showed a non-significant association with decreased odds (OR 0.49; 95% CI: 0.15–1.3). No single preoperative variable achieved statistical significance. Conclusion: Difficult airway remains prevalent in cancer patients, and conventional anatomical predictors alone have limited reliability. Integration of structured airway assessments, vigilant monitoring, and readiness to employ advanced tools like video laryngoscopy are vital for optimizing patient safety in oncologic anaesthesia.

Background: Chronic ankle instability (CAI) is a common consequence of repeated ankle sprains, leading to functional limitations and recurrent injuries. Alterations in foot arch height may influence lower limb biomechanics and contribute to ankle instability. This study aimed to investigate the correlation between foot arch height and the incidence of CAI. Methods: A cross-sectional observational study was conducted on 100 participants aged 18 years and above. Foot arch height was assessed using the Arch Height Index and categorized into low, normal, and high arch types. The presence of chronic ankle instability was evaluated using clinical history and standardized functional questionnaires. Data were analyzed using the chi-square test for association and logistic regression to calculate odds ratios. Results: Among the 100 participants, 52 were males and 48 were females, with a mean age of 27.3 ± 6.2 years. The distribution of foot arch types was: low arch (34%), normal arch (46%), and high arch (20%). The prevalence of CAI was significantly higher in individuals with low (52.9%) and high arches (55.0%) compared to those with normal arches (21.7%) (p = 0.0016). Logistic regression revealed significantly increased odds of CAI in participants with low arch (OR: 4.18, 95% CI: 1.56–11.17) and high arch (OR: 4.57, 95% CI: 1.48–14.12) compared to the normal arch group. Conclusion: There is a statistically significant correlation between abnormal foot arch height and chronic ankle instability. Assessment of arch type can help identify individuals at higher risk of CAI and guide preventive strategies.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition of the sinonasal mucosa, often requiring surgical intervention. The role of partial middle turbinate resection (PMTR) during functional endoscopic sinus surgery (FESS) in reducing recurrence rates is still debated. This prospective study evaluates the impact of PMTR on postoperative outcomes in patients with CRSwNP. Materials and Methods: This prospective study was conducted at BKL Walawalkar Medical College, Sawarde, District Ratnagiri, over a duration of 5 years. A total of 100 patients diagnosed with CRSwNP and undergoing FESS were enrolled. Patients were randomly assigned to two groups: Group A (n=50) underwent standard FESS without PMTR, while Group B (n=50) underwent FESS with PMTR. Patients were followed up postoperatively at 6 months, 1 year, 3 years, and 5 years. Recurrence was assessed based on endoscopic grading and symptom scores using the Lund-Kennedy and SNOT-22 scales. Results: At the end of 5 years, the recurrence rate was significantly lower in Group B (22%) compared to Group A (38%) (p<0.05). The mean SNOT-22 score in Group B improved from 56.3 ± 4.2 to 18.7 ± 2.8, while in Group A it improved from 55.7 ± 3.9 to 27.4 ± 3.2. Endoscopic evaluation showed better mucosal healing and reduced polyp regrowth in the PMTR group. No major complications related to turbinate resection were observed. Conclusion: Partial resection of the middle turbinate during FESS appears to reduce the long-term recurrence of nasal polyps in patients with CRSwNP. PMTR can be considered a safe and effective adjunct to standard surgical management, especially in recurrent or extensive disease cases.

Background: Aims : The present study was planned in patients with adenoids hypertrophy or tonsillitis or adenoid tonsillitis, to determine the clinical presentations of children undergoing adenoidectomy and tonsillectomy, to ascertain the symptomatic improvement in child after adenoidectomy and tonsillectomy, and to analyse the impact on quality of life of child and behavioral changes comparing pre-operative and post-operative symptoms using VAS (visual analogue scale) and OSD-6 (obstructive sleep disorders-6) survey score.  Materials and methods: The present study was carried out in Department of Otorhinolaryngology form 1st October 2021 to 31st July 2022 by Interventional Prospective study design with sample size 40. Adenoids and tonsils size were graded by clinical examination, and per-operative diagnostic nasal endoscopy. All the patients and their parents were asked to respond the subjective level of complains on VAS and OSD 6 Survey Score pre-operatively and 3 month after surgery. Correlation of preoperative and post operative scores were performed and statistically analysed. Results:  Maximum number of patients i.e. 22 out of 40 (55%) children were in the age group of 6-10 years. Male: female ratio was 2.63:1. Snoring, mouth breathing and nasal complains were present in all 40 (100%) children. and ear complaints were present in only 5 (12.5%) children. Grade III tonsillar hypertrophy was present in 20 (50%) children. Grade II adenoid hypertrophy was present in 17 (42.5%) children. Preoperative Mean VAS score 7.83+0.64 and post operative mean VAS score was 2.58+1.17. Preoperative Mean OSD-6 survey score 4.28+0.51 and post operative mean OSD-6 survey score was 0.67+0.18. Obtained results were statistically significant ( p< 0.0001). Conclusion: Adenotonsillectomy cause significant improvement in quality of life of children in terms of improvement in physical as well as mental state of health of child.

Background: The vertebral column plays a pivotal role in supporting body weight, protecting the spinal cord, and facilitating movement. Morphometric variations in vertebral body and disc dimensions may be influenced by age and gender, with clinical implications in orthopedics, anatomy, and forensic science. Objectives: To assess and compare the morphometric characteristics of the human vertebral column across different age groups and between genders. Materials and Methods: This observational study was conducted on 100 human vertebral column samples, including 60 males and 40 females aged 18–80 years. Morphometric parameters such as vertebral body height (L1–L5) and intervertebral disc height (L1–L5) were measured using digital calipers or radiographic analysis. Data were analyzed using descriptive statistics, independent t-tests, and Pearson correlation tests, with a p-value <0.05 considered statistically significant. Results: Male subjects exhibited significantly greater mean vertebral body heights at all lumbar levels compared to females (p < 0.01). For example, the mean vertebral height at L5 was 27.2 ± 1.9 mm in males versus 25.0 ± 1.7 mm in females. Similarly, intervertebral disc heights were higher in males, with significant differences at L1–L2, L2–L3, and L4–L5 (p < 0.05). A moderate negative correlation was observed between age and both vertebral body height (r = –0.48) and disc height (r = –0.42), indicating a decline in spinal dimensions with aging. Conclusion: Age and gender significantly influence vertebral morphometry, with important implications for spinal diagnostics, surgical planning, and anthropometric profiling.

Background: Urinary incontinence (UI), defined by the International Continence Society (ICS) as any involuntary leakage of urine, is a significant public health issue affecting women across all age groups, with higher prevalence among older women. AIM: Study of Urinary incontinence among women attending a tertiary care center. Methodology: The present cross-sectional study is conducted in the gynecology outpatient department of K. M. Medical college and Hospital, Mathura on women aged 38 years and older were recruited after providing informed consent, excluding those who were pregnant, postpartum within three months, or had recent gynecological surgery. Result: In this study, urinary incontinence was most common among women under 50 years, with normal or overweight BMI, and stress UI being the predominant type with mild leakage and minimal impact on quality of life. Comorbidities such as diabetes, chronic cough, constipation, recurrent UTIs, and prior prolapse surgery were significant contributors. Obstetric factors including lower parity, vaginal delivery, prolonged labor, and instrumental birth also showed strong associations with UI. Conclusion: In conclusion, this study demonstrates that urinary incontinence in women arises from multiple interrelated factors including age, BMI, comorbidities, and obstetric history. Stress incontinence with mild leakage predominated, most often affecting middle-aged and early elderly women. These findings support the need for targeted prevention, early screening, and tailored interventions to reduce UI burden.

Background: Pregnancy and childbirth are critical life events in a woman’s reproductive cycle, bringing about not only physical but also psychological and social transitions. While these experiences are usually associated with joy and fulfilment, they can also render women particularly vulnerable to mental health challenges. AIM: Study of Postpartum depression and risk factors in a tertiary care centre in Northern India. Methodology: A one-year cross-sectional study was conducted on 178 postpartum women attending the Obstetrics and Gynecology outpatient clinic 2–6 weeks after delivery. Result: In this study, 18% of women screened positive for moderate depressive symptoms on the EPDS, aligning with other regional and international findings. Factors significantly associated with postpartum depression included primigravida status, male child preference, adverse neonatal outcomes, pregnancy complications, and lack of family support. Additional contributors were domestic violence, spousal alcohol use, and stressful life events. These results underscore the importance of early screening and psychosocial support to reduce postpartum depression risk. Conclusion: Postpartum depression affects a significant proportion of women and is influenced by a combination of social, cultural, and obstetric risk factors. Early identification through validated screening tools and integrated psychosocial support is crucial for improving maternal mental health. Continued research across diverse settings is needed to strengthen prevention and intervention strategies.

Background: Emergency laparotomy is a life-saving procedure performed for critical conditions such as bowel obstruction or ischemia. Surgeons must choose between stoma placement and primary anastomosis, both of which have unique risks and outcomes. This study aims to compare these procedures based on their respective postoperative complications to guide decision-making. Methods: This retrospective cohort study analyzed 50 patients who underwent emergency laparotomy, categorized into two groups: stoma placement and primary anastomosis. Patient demographics, surgical outcomes, and postoperative complications were analyzed using statistical methods. Results: Stoma placement resulted in fewer immediate postoperative complications, such as infection (8%) compared to primary anastomosis (32%). The stoma group, however, faced a prolonged treatment period due to the need for stoma closure surgeries. Anastomotic leakage occurred in 16% of the resection and anastomosis group. Conclusions: Stoma placement is recommended for unstable patients or those with compromised bowel viability, while resection with anastomosis may be preferable for stable patients. A tailored approach is essential to optimize surgical outcomes.

Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus and a major cause of vision loss. Identifying clinical and biochemical factors associated with its severity is critical for early diagnosis, risk stratification, and timely intervention. Aim of the study was to evaluate the association between the severity of diabetic retinopathy and various clinical, systemic, and biochemical risk factors among patients attending a tertiary care center. Material and Methods: A hospital-based cross-sectional study was conducted on 50 patients diagnosed with diabetic retinopathy at the Department of Ophthalmology, Mamata Medical College, Khammam. Patients underwent detailed ophthalmic evaluation including BCVA, intraocular pressure, slit-lamp biomicroscopy, and fundus examination under mydriasis using direct and indirect ophthalmoscopy and a +90D lens. DR was graded based on ETDRS classification. Systemic investigations included fasting and postprandial blood sugar, HbA1c, serum creatinine, lipid profile, and urine albumin. The association between DR severity and various risk factors was assessed using Chi-square test for categorical variables and Pearson’s correlation coefficient for continuous variables. Results: The mean age was 56.8 ± 9.4 years, with a male predominance (60%). A significant association was observed between DR severity and duration of diabetes (p = 0.002), HbA1c (p = 0.005), hypertension (p = 0.023), and nephropathy (p = 0.004). Pearson’s correlation showed a moderate positive relationship between DR severity and duration of diabetes (r = 0.62), HbA1c (r = 0.59), and serum creatinine (r = 0.47). Macular edema was observed in 28% of eyes, and proliferative DR in 22%. Conclusion: Severity of diabetic retinopathy was significantly associated with longer diabetes duration, poor glycemic control, hypertension, and nephropathy. Early identification and control of these modifiable risk factors may help reduce vision-threatening complications. Periodic ophthalmic screening should be an integral part of diabetes management in tertiary care settings.

Background: A thyroid adenoma is a benign (non-cancerous) tumor of the thyroid gland. Thyroid adenoma can be classified into active or inactive depending on the amount of thyroid hormone produce. hereas a Colloid goitre, also known as nontoxic goitre, simple goitre, or adenomatous nodular goiter, is a benign, non-cancerous enlargement of the thyroid gland. It is characterized by the accumulationof colloid material within the thyroid tissue, often forming nodules. Thyroid adenomas and colloid goitres can occur simultaneously in the same patient and the presence of both conditions may lead to a more complex clinical picture, requiring careful evaluation and management. So, here we report a case of anterior midline neck swelling having a rare diagnosis patient having co-existing thyroid adenoma and colloid goitre.

Background: The treatment of complete crico-pharyngo-esophageal strictures resulting from corrosive injuries poses a considerable surgical challenge due to the intricate anatomy, scar tissue development, limited mobility, and the necessity for a strong and functional reconstruction. Corrosive ingestion causes extensive harm, leading to severe fibrosis, strictures, and impaired swallowing function. This paper discusses the application of colonic interposition as a definitive reconstructive approach in two patients with high esophageal strictures affecting the cricopharynx due to corrosive ingestion. The technique involves using a vascularized segment of the colon, which is mobilized through a subcutaneous path and connected proximally to the pharynx and distally to the pyloro-duodenal junction. Methods: The authors performed colonic interposition technique on 2 patients who presented with high oesophageal stricture involving the cricopharynx, post corrosive ingestion. For the first 2 months, patients were managed conservatively with feeding jejunostomy. Following which a definitive procedure was done.  In the procedure the colonic conduit which was supplied by the ascending branch of left colic artery; was anastomosed proximally to the pharynx and distally to the pyloro-duodenal junction. Results: In both cases, intraoperative blood flow from the ascending branch of left colic artery to the proximal ascending colon was adequate. Endoscopy confirmed that the conduit remained viable and functioning post operatively in both patients. Conclusion: In conclusion the colonic conduit is a viable option of cricopharyngoesophageal strictures. The left colic artery, along with its splenic flexure collaterals, provides sufficient blood flow to the proximal ascending colon following ligation of the middle and right colic arteries.

Background: Umbilical hernia repair is associated with significant postoperative pain, which can affect early recovery and prolong hospital stay. Regional anesthesia techniques such as the Transversus Abdominis Plane (TAP) block and Rectus Sheath (RS) block have shown promise in managing postoperative pain. This study aims to compare the effectiveness of TAP block versus RS block in reducing postoperative pain following elective umbilical hernia surgery. Materials and Methods: This prospective randomized study was conducted on 60 patients undergoing elective umbilical hernia repair under general anesthesia. Patients were divided into two groups: Group A (n=30) received ultrasound-guided TAP block, and Group B (n=30) received RS block after induction of anesthesia. Pain was assessed using the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours postoperatively. Total analgesic consumption within the first 24 hours and time to first rescue analgesia were also recorded. Results: VAS scores were significantly lower in Group A (TAP block) at 4 and 8 hours postoperatively compared to Group B. The mean VAS score at 4 hours was 3.2 ± 0.9 in Group A versus 4.6 ± 1.1 in Group B (p<0.05). The total 24-hour analgesic requirement was also less in the TAP group (110 ± 25 mg tramadol) than in the RS group (150 ± 30 mg tramadol) (p<0.05). Time to first rescue analgesia was longer in Group A (7.8 ± 1.2 hours) compared to Group B (5.4 ± 1.4 hours). Conclusion: TAP block provides superior postoperative analgesia compared to RS block in patients undergoing umbilical hernia repair. It significantly reduces pain scores, delays the requirement for rescue analgesia, and lowers overall analgesic consumption.

Background: Se Neonatal sepsis accounts for 30–50% of neonatal deaths, in developing nations. Prompt identification and management are crucial to improving outcomes. This study aimed to evaluate the diagnostic potential of red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) in neonatal sepsis and examine their correlation with CRP levels. Materials and Methods: This study was carried out in the neonatal intensive care unit (NICU) of a tertiary care hospital for a period of one and half years. Study involved 80 neonates presenting with clinical signs of sepsis, positive sepsis screening, or known risk factors for infection, who were enrolled as the case group. An equal number of age- and gender-matched neonates without signs of infection, negative screening, and no high-risk history served as controls. Blood samples were collected prior to the initiation of antibiotic therapy to measure complete blood count (CBC) parameters, including RDW, NLR, and CRP. Results: The mean birth weight in neonates with sepsis was significantly lower than those in control group. Sepsis was significantly associated with risk factors such as meconium-stained amniotic fluid, premature rupture of membranes (PROM), prematurity, low birth weight, and maternal parity. RDW and NLR were significantly elevated in septic neonates, with NLR showing the highest diagnostic efficiency. Conclusion: RDW and NLR can be a valuable and accessible marker for the early diagnosis of neonatal sepsis.psis.

Background: The turnaround time is vital to optimal functioning of an operation theatre of any multispecialty hospital which also impacts its revenue generation. The aim of this study was primarily to identify and address the causes leading to delay in start of planned surgical cases, cancellation of cases and to analyse the OT turnaround time. The objective was to draw necessary conclusions and recommendations to improve the OT turnaround and utilization time thus increasing the efficiency. Methods: A prospective observational study was conducted in the Orthopaedic operation theatre (OT) complex in a 1000 bedded tertiary care teaching hospital in January and February 2021. The OT in-time, OT turnaround time and number of cancelled cases with reasons for cancellation was assessed for all surgical cases as per inclusion and exclusion criteria. Results: Out of 79 cases which fulfilled the inclusion criteria, 32 (41%) of cases were delayed in shifting to the OT of which teaching activity was the most common cause. The average OT turnaround time was 80±30 minutes with minimum time taken being 40 minutes and maximum time 140 minutes. Out of the total 154 routine scheduled cases, 26 cases were cancelled or rescheduled the most common reason of which was the patient being unfit on the day of surgery (38%). Conclusion: Proper planning and prior scheduling of surgical cases is of prime importance in optimal functioning of any OT complex. Most of the causes of delay in start of scheduled cases, increased OT turnaround time and cancellations are avoidable and requires multidisciplinary contributions. Accordingly recommendations for optimal OT utiization have been suggested in the present study.

Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increase the risk of cardiovascular diseases, diabetes, and renal disorders. Its association with urolithiasis (kidney stones) is increasingly recognized due to shared metabolic and biochemical disturbances. Aim was to study the association between metabolic syndrome, biochemical and urinary parameters contributing to urolithiasis, and to compare treatment outcomes in patients with and without MetS. Materials and Methods: An observational study was conducted on 210 patients diagnosed with urolithiasis over 24 months (September 2022 – August 2024) at a tertiary care institute in Khammam. Patients were evaluated clinically and relevant anthropometric, biochemical, and urinary parameters were recorded. MetS was diagnosed based on ATP-III criteria. Data were analyzed using SPSS v21, and appropriate statistical tests were applied. Results: Out of 210 patients, 47 (22.4%) had MetS. The prevalence of MetS increased with age (p < 0.001) but showed no significant association with gender (p = 0.607). Patients with MetS had significantly higher BMI, waist circumference, blood pressure, triglycerides, fasting blood sugar, and serum uric acid, along with lower HDL levels (all p < 0.01). Urinary findings showed higher uric acid and oxalate levels and reduced citrate levels in MetS patients. Treatment outcomes revealed a higher complication rate (23% vs. 10%, p = 0.01), increased need for additional procedures (30% vs. 15%, p = 0.02), and longer hospital stay (3.8 vs. 2.5 days, p = 0.001) in the MetS group. Stone-free rates were not significantly different. Conclusion: Metabolic syndrome is significantly associated with altered biochemical and urinary parameters that promote stone formation and negatively influence treatment outcomes in urolithiasis. Early identification and comprehensive management of MetS may improve clinical outcomes and reduce recurrence in stone formers.

Background: Diabetic patients are at increased risk for urinary tract infections (UTIs) due to compromised immunity, glycosuria, and neurogenic bladder dysfunction. The rising incidence of multidrug-resistant (MDR) uropathogens further complicates treatment in this vulnerable population, particularly in resource-limited settings like Central India. Objectives: To identify the etiological agents of UTIs in diabetic patients, evaluate their antimicrobial susceptibility patterns, and assess the burden of multidrug resistance across three tertiary care hospitals in Central India. Methods: A prospective multicentric study was conducted over one year across three tertiary hospitals. Midstream or catheter-collected urine samples were obtained from diabetic patients presenting with symptoms of UTI. Samples were cultured using standard microbiological techniques, and isolates were identified using conventional biochemical methods. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method as per CLSI 2023 guidelines. Data were analyzed using SPSS version 25. Results: Of 1,250 diabetic patients screened, 364 (29.1%) had culture-positive UTIs. The majority were females (60.4%) and aged >60 years. Escherichia coli was the most common uropathogen (48.9%), followed by Klebsiella pneumoniae (21.7%), Enterococcus spp. (12.1%), and Pseudomonas aeruginosa (7.1%). High resistance was observed to fluoroquinolones and co-trimoxazole, while nitrofurantoin, fosfomycin, amikacin, and carbapenems showed higher efficacy. Multidrug resistance was detected in 38.7% of isolates, with the highest MDR prevalence in K. pneumoniae (47.8%). Conclusion: The study underscores the high prevalence of UTIs and MDR organisms in diabetic patients. E. coli remains the predominant pathogen, but an increasing trend of resistant non-E. coli Gram-negative bacteria demands attention. Routine urine culture and region-specific antibiograms are essential for guiding empirical therapy. Antimicrobial stewardship and strict glycemic control are imperative to prevent recurrent infections and resistance proliferation.

Background: this study was planned to explore perceptions, attitudes and practices toward research among post graduate students and the factors or problems encountered during protocol writing. This study aimed to audit the submitted protocols for identifying the gaps. Materials And Methods: A checklist for audit of thesis protocol that was designed by subject experts was used for audit of the thesis protocols After taking approval from Institutional ethical committee and proper informed consent from students the pretested questionnaire was then given anonymously to all the students meeting inclusion criteria. Results: Out of 143 participants, 96.5% (138) of the participants had knowledge of approvals which are mandatory for research, each of 83.2% (119) of the participants had knowledge of type of study that uses only the information recorded in the past, 81.1% (116) of the participants have knowledge of double blinding in clinical trial Majority, 87.4 % (125) participants chose a prospective study for their thesis 77.6% (111) had never done any research during graduation. Majority of patients 75 (52.4%) became aware of research project by information from teachers followed by seniors Conclusion: Results of this study bring forward the problems encountered by the students in writing thesis protocols and identifies the mistakes in their protocols.

Inferior pole fractures of the patella (IPFP) pose a significant surgical challenge due to the small size and comminution of the distal fragments, as well as disruption of the extensor mechanism. There is currently no consensus in the literature on the optimal surgical approach for managing these injuries. We report the case of a young male presenting with chronic knee pain and difficulty walking, secondary to a neglected avulsion fracture of the inferior pole of the patella. The patient was managed successfully using transosseous Ethibond sutures combined with ipsilateral semitendinosus autograft augmentation to restore extensor mechanism integrity. This report highlights the clinical, radiological, and functional outcomes of this technique, suggesting it as a viable option in managing chronic IPFP cases.

Background: Major Depressive Disorder (MDD) is increasingly associated with biochemical mechanisms such as oxidative stress, which may contribute to neuronal damage and disease progression. This study aimed to evaluate oxidative stress markers in patients with MDD .Methods: A cross-sectional, pathology-based study was conducted on 60 patients with clinically diagnosed MDD over one year. Serum levels of malondialdehyde (MDA), nitric oxide (NO), and total antioxidant capacity (TAC) were measured using spectrophotometric methods. Statistical analysis was performed to assess the relationship between oxidative stress and depression severity. Results: Mean MDA and NO levels were significantly elevated (3.92 ± 0.84 nmol/mL and 52.4 ± 9.1 µmol/L respectively), while TAC was reduced (0.92 ± 0.26 mmol/L). These changes were more pronounced with increasing severity of depression (p < 0.05). A majority of patients (75–80%) had abnormal oxidative parameters. Conclusion: The study confirms that oxidative stress is significantly altered in MDD and worsens with clinical severity. Oxidative biomarkers may serve as valuable adjuncts in assessing and managing depression, supporting a more integrated biological understanding of the disorder..

Background: Corneal ulcer is a common and potentially blinding ocular emergency, especially in developing countries. Early identification of causative organisms and risk factors is essential for prompt and effective treatment. This study aimed to evaluate the clinical features, risk factors, microbiological spectrum, treatment, and outcomes of patients presenting with corneal ulcers in a tertiary care hospital. Material and Methods: A prospective observational study was conducted at the Department of Ophthalmology, Mamata Medical College, Khammam, over a period of 18 months. A total of 75 patients with clinical features of corneal ulcers were included. All patients underwent detailed ocular examination including visual acuity assessment and slit-lamp biomicroscopy. Corneal scrapings were subjected to Gram stain; KOH wet mount, Giemsa stain, and culture on blood agar, chocolate agar, Sabouraud dextrose agar (SDA), and brain heart infusion broth. Empirical therapy was initiated and modified based on microbiological results. Patients were followed to assess clinical outcomes and visual recovery. Results: The mean age was 43.2 ± 17.6 years, with a male predominance (61.3%). Trauma was the most common predisposing factor (56%), particularly with vegetative matter (36%). Culture positivity was seen in 62.7% of cases; 34.7% were bacterial and 28% were fungal. The most common bacterial isolate was Streptococcus pneumoniae (13.3%), and the most frequent fungal isolate was Fusarium species (12%). Empirical therapy was modified in 70.2% of culture-positive cases. Healing was achieved in 76% of patients; however, only 28% achieved visual acuity ≥6/18 at final follow-up. Complications such as corneal thinning (24%) and perforation (6.7%) were observed. Conclusion: Corneal ulcers remain a major cause of visual morbidity, particularly in rural and agricultural communities. Trauma is the leading risk factor, and fungal pathogens are commonly implicated. Prompt diagnosis and appropriate microbiological workup are essential for targeted therapy. Delayed presentation continues to adversely affect visual outcomes. Public awareness and early referral can significantly reduce the burden of corneal blindness.

Background: Cervical cancer remains a major public health burden, particularly in low- and middle-income countries. While Conventional Pap Smear (CPS) has long been the mainstay of cytological screening, Liquid-Based Cytology (LBC) offers potential advantages in terms of sample adequacy and diagnostic accuracy. This study aimed to compare the performance of LBC and CPS in detecting cervical epithelial abnormalities. Methods: This cross-sectional study was conducted at the Department of Pathology, Burdwan Medical College, over six months, involving 100 women aged 21–65 years undergoing cervical screening. Each participant provided samples for both CPS and LBC. Smears were evaluated using the 2014 Bethesda System. Parameters analyzed included sample adequacy, detection of epithelial abnormalities (ASC-US, LSIL, HSIL), smear quality, and diagnostic concordance. Statistical analysis was performed using McNemar’s test, Cohen’s kappa, and appropriate descriptive tests. Results: LBC showed significantly higher sample adequacy (97%) compared to CPS (85%) (p = 0.004). Detection of epithelial abnormalities was also higher with LBC: ASC-US (11% vs. 7%) and LSIL (9% vs. 6%), although not statistically significant. HSIL detection was identical (3%) in both methods. Smear quality was superior in LBC, with more clean backgrounds (93% vs. 62%) and fewer inflammatory or haemorrhagic samples (p < 0.001). Diagnostic concordance was substantial, with a kappa value of 0.72 overall and perfect agreement for HSIL. Conclusion: LBC demonstrated clear advantages over CPS in terms of adequacy, smear clarity, and early lesion detection, supporting its implementation as a frontline screening method. However, larger studies with histopathological follow-up and economic analysis are needed to validate its widespread adoption in resource-limited settings.

Background: Type 1 diabetes is an autoimmune disorder affecting millions of people worldwide. Once diagnosed, patients require lifelong insulin treatment and can experience numerous disease-associated complications. It is known that young people with diabetes appear to have a greater incidence of depression, anxiety, psychological distress, and eating disorders compared to their peers without disease. Hence it is very important to study the quality of life of diabetic children and factors affecting it. Methods: Those who were diagnosed with type 1 diabetes for more than 1 year and aged more than 8 years were given validated proforma of QOLID (Quality Of Life instrument in Indian Diabetes) questionnaire in their own language and asked to provide details accordingly. Scoring was given according to the answers given by them. All reports were compiled finally to draw a conclusion regarding quality-of-life Results: Total of 96 children with type 1 DM were studied among which 36 children had score below 8 (37.5%). Mean score of all children was 8.1. Most of the children were Kannada speaking children (74%) followed by Telugu (12%) Tamil (5%), Hindi (2%). Least age of diagnosis of Type 1 DM was 1 year and maximum age was 14 years. .It was also noted that 24(25%) children were from upper class,38 children(39.5%) were from middle , 34 children (35.4%) from lower socio economical class according modified kuppuswamy classification. 58 children (60%) had HbA1c value below 8 and 38 children (39.6%) had HbA1c value above 8. Among various parameters of QOLID most affected was general health (mean of 7.11) followed by treatment satisfaction (mean of 7.9) and least affected was physical endurance (mean of 8.8) followed by Role limitation (mean of 8.2). Socio economic status (p value of 0.02) and HbA1c values (p value of <0.001) were found to be statistically significant parameters. Age at the diagnosis (p value 0.212), sex (p value 0.868), and occupation of parents (p value 0.652) were found not statistically significant. Among the various factors affecting the quality-of-life HbA1c affects the most. Conclusion: To conclude, 37.5 % of our children with T1DM had impaired Quality of life (QoL). Most of our patients had impaired QoL in domains of general health (71%), followed by treatment satisfaction (79%) and financial worries (51%).

Socioeconomic status and HbA1c were most essential determinants, Assessment of QoL should be done periodically in such children so that if any significant impairment is identified, early interventions could be initiated and thus improve the overall outcome of the disease

Background: About 50 million people around the world have cognitive impairment (CI), which is a major global public health issue. People who have chronic kidney disease (CKD) are more likely to develop cognitive impairment (CI), which can lower their quality of life, make it harder to take their medications, raise their risk of death, and make them use more healthcare resources. The goal of this study is to find out how common cognitive damage is among older people with chronic kidney disease and other health problems that are linked to this condition. Material and Method: A study was done in a hospital to look at cognitive impairment and how bad it is at different stages of chronic kidney disease (CKD) and to find out what factors affect this impairment. A cross-sectional study was done on 64 people who met the conditions and had Stage III to V chronic kidney disease. Tests such as the Mini- Mental condition Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were utilised in order to evaluate the cognitive condition of the individuals. Based on their estimated glomerular filtration rate (eGFR), the patients were put into four groups. The study got ethical approval from the right research ethics committee, and all the people who took part gave their informed permission. SPSS version 27.0 was used for the statistical study. Result: There was a statistically significant positive correlation between the MMSE and MoCA scores and haemoglobin, serum corrected calcium, and eGFR (P < 0.01). There was a statistically significant negative correlation between the scores and blood urea, serum uric acid, serum creatinine, serum potassium, serum phosphate, serum potassium, and the stage of CKD (P < 0.01). Conclusion: Our study shows that there is a strong link between older people who have chronic kidney disease and those who have trouble thinking and remembering things. It also emphasises the higher likelihood of comorbidities in these people. People with CKD and other conditions that are often found together may have much better cognitive function and general quality of life in the future if they are quickly diagnosed, followed up on, and treated

Background: Vitamin D deficiency is a major public health concern, particularly among children in developing countries. It is associated with impaired growth and development, as it plays a crucial role in bone health, immune function, and overall well-being. The present study aims to investigate the serum vitamin D levels and their association with growth parameters (height, weight, and head circumference) in children under 5 years of age in Saharanpur, Uttar Pradesh, India.  Methods: A prospective observational study was conducted at Ul-Hind Maulana Mahmood Hasan (SMMH) Government Medical College, Saharanpur, from September 2024 to February 2025. A total of 200 children aged 6 months to 5 years were included. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured, and growth parameters (height, weight, and head circumference) were recorded. Statistical analysis was performed to examine the correlation between vitamin D levels and growth parameters. Results: The results revealed that 70% of the children had either deficient or insufficient levels of vitamin D. A significant positive correlation was found between serum vitamin D levels and growth parameters, with children having sufficient vitamin D levels showing better growth outcomes. Children with vitamin D deficiency had lower height, weight, and head circumference compared to those with sufficient levels. Risk factors for vitamin D deficiency included exclusive breastfeeding, limited sunlight exposure, and lower socioeconomic status. Conclusion: This study highlights the high prevalence of vitamin D deficiency in children under 5 years of age in Saharanpur, Uttar Pradesh. Vitamin D deficiency was significantly associated with impaired growth, underscoring the need for targeted interventions, such as supplementation and public awareness campaigns, to address this issue in the region.

Background: Traditional autopsy remains the gold standard for determining the cause of death, yet its declining acceptance due to cultural, emotional, and logistical concerns has prompted the exploration of non-invasive alternatives. CT virtual autopsy (virtopsy) offers a promising solution by utilizing advanced imaging to examine the body without dissection. This study evaluates the diagnostic utility of CT virtual autopsy and its concordance with traditional autopsy findings in a tertiary care setting.  Methods: A retrospective, record-based study was conducted over 12 months (January–December 2024) at a tertiary care hospital in Mandya. Fifteen cases that underwent CT virtual autopsy followed by traditional autopsy were included. CT scans were performed using a 160-slice uCT 780 scanner, and findings were compared with gross, histopathological, and toxicological results from conventional autopsy. Concordance was defined as agreement in the cause of death or major findings between both modalities.  Results: Out of 15 cases, 7 (46.7%) showed concordance between CT and traditional autopsy. High concordance was observed in trauma-related and septic deaths, where CT effectively identified skull fractures, hemorrhages, and emphysematous changes. Low concordance was noted in asphyxial deaths and poisonings, where CT failed to detect soft tissue injuries and toxicological evidence. CT demonstrated high sensitivity for trauma-related findings (~90–100%) but limited sensitivity (<30%) for asphyxial and toxicological causes.  Conclusion: CT virtual autopsy is a valuable adjunct to traditional autopsy, particularly in trauma and infectious cases. Its non-invasive nature enhances cultural acceptability and preserves anatomical integrity. However, it cannot replace conventional autopsy in cases requiring soft tissue, histological, or toxicological evaluation. Integrating CT virtual autopsy into routine forensic practice in resource-limited settings like Mandya could modernize postmortem diagnostics, provided adequate infrastructure and interdisciplinary collaboration are established.

Background: Refractory anemia in children often reflects underlying malabsorptive or mucosal pathologies. Duodenal biopsy remains the gold standard for diagnosing small intestinal abnormalities. This study aims to determine the prevalence and spectrum of duodenal biopsy abnormalities in children with refractory anemia. Methods: A cross-sectional study was conducted on 120 children aged 1–16 years with refractory anemia at a tertiary care hospital. Clinical evaluation, laboratory investigations, and upper gastrointestinal endoscopy with duodenal biopsy were performed. Histopathological findings were classified using the Marsh criteria. Data were analyzed for correlations between clinical parameters and biopsy results. Results: Duodenal biopsy abnormalities were present in 68.3% of children, with villous atrophy (40.8%) being the most common lesion. Nutritional deficiencies and infectious enteropathies accounted for 29.2% and 9.2% of cases, respectively. Children with abnormal biopsies had significantly longer anemia duration and lower serum ferritin and vitamin B12 levels (p < 0.001). Chronic diarrhea was more frequent in this group (p = 0.05).  Conclusion: A significant proportion of children with refractory anemia harbor duodenal mucosal abnormalities, predominantly celiac disease and nutritional deficiencies. Early biopsy evaluation facilitates precise diagnosis and management, improving patient outcomes.

Background: Menopause, a physiological event marking the end of monthly cycles, is associated with hormonal changes that may impact lung function. Decline in 17β-estradiol levels during menopause has been linked to increased systemic and pulmonary inflammation, potentially influencing respiratory parameters such as Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV₁), and Peak Expiratory Flow Rate (PEFR). However, literature exploring the relationship between menopausal status and pulmonary function remains limited.  Objectives: To assess and compare FVC, FEV₁, and PEFR among premenopausal and postmenopausal women in Southern Tamil Nadu.  Methods: A cross-sectional study was conducted on 90 healthy female participants, comprising 45 premenopausal (Group 1) and 45 postmenopausal (Group 2) women, recruited based on strict inclusion and exclusion criteria. Pulmonary function was evaluated using the Spiro Excel computer-based digital spirometer. Institutional ethical clearance and informed consent were obtained prior to data collection.  Results: Preliminary findings indicate a significant reduction in mean FVC, FEV₁, and PEFR values in postmenopausal women compared to premenopausal counterparts (p < 0.05). The observed decline suggests a potential influence of hormonal changes on respiratory mechanics during menopause.  Conclusion: Menopause appears to be associated with decreased pulmonary function parameters, possibly due to hormonal alterations and increased inflammatory markers. These findings emphasize the need for further research to explore the role of hormonal status in respiratory health and to develop strategies for early detection and management of pulmonary changes in postmenopausal women..

Background: Nephrotic syndrome in children is a common glomerular disease with variable clinical course and outcomes, influenced by underlying histopathological patterns. Renal biopsy plays a crucial role in identifying these patterns, guiding therapy, and predicting prognosis. Objectives: To evaluate the histopathological spectrum of renal biopsies in children with nephrotic syndrome and correlate these findings with clinical characteristics, steroid response, and treatment outcomes. Methods: This cross-sectional study included 200 pediatric patients (aged 1–18 years) diagnosed with nephrotic syndrome who underwent renal biopsy at a tertiary care hospital. Baseline demographic and clinical data were recorded. Histopathological patterns were classified and correlated with steroid responsiveness, laboratory parameters, and clinical outcomes using appropriate statistical methods.  Results: Minimal Change Disease was the most frequent lesion (52.5%), followed by Focal Segmental Glomerulosclerosis (23%) and other patterns such as mesangial proliferative GN, membranous nephropathy, and others. MCD was significantly associated with steroid sensitivity and favorable outcomes, while FSGS and non-MCD lesions were linked with steroid resistance, higher relapse rates, and increased risk of progression to chronic kidney disease. Statistically significant associations were observed between histopathological findings, clinical parameters, and treatment outcomes (p < 0.05).  Conclusion: Renal biopsy reveals a diverse histopathological spectrum in pediatric nephrotic syndrome, with significant implications for treatment and prognosis. Accurate diagnosis through biopsy enables individualized management, especially in cases of steroid resistance, ultimately aiming to improve long-term renal outcomes in children..

Background: The eyelid is a complex anatomical structure prone to various pathological lesions ranging from benign inflammatory conditions to aggressive malignancies. Accurate histopathological diagnosis is critical for effective management and prognosis.  Aim: To study the histopathological spectrum of various neoplastic and non-neoplastic eyelid lesions and correlate findings with clinical parameters.  Materials and Methods: This cross-sectional observational study was conducted on 200 patients presenting with eyelid lesions at a tertiary care center over a 5-year period. Clinical data were collected and histopathological examination performed on biopsy specimens using routine Hematoxylin and Eosin staining. Lesions were categorized into malignant, benign, inflammatory, and cystic types. Statistical analysis was performed to assess the correlation of histopathological diagnosis with clinical variables such as age, sex, and lesion location.  Results: Among 49 cases, malignant lesions accounted for 48.5%, with sebaceous carcinoma as the most common malignancy (35%). Benign lesions constituted 17%, inflammatory 23%, and cystic lesions 11%. Malignant lesions were significantly associated with older age (mean 47.2 years vs 41.1 years in benign/inflammatory, p=0.02). Females constituted 60% of cases. Upper eyelid involvement was slightly more frequent (53%) than lower eyelid (47%). No significant difference was found in lesion laterality.  Conclusion: Malignant eyelid tumors, particularly sebaceous carcinoma, form a substantial proportion of eyelid lesions in this population, with a predilection for older patients and females. Histopathological evaluation remains the gold standard for diagnosis and plays a crucial role in guiding appropriate clinical management.

Background: Epidural anesthesia is widely employed for lower abdominal surgeries due to its ability to provide effective anesthesia and postoperative analgesia with better hemodynamic control than spinal anesthesia. Bupivacaine is a potent local anesthetic but is associated with higher cardiotoxicity. Ropivacaine, a newer S (-) enantiomer, offers similar efficacy with potentially reduced systemic toxicity. The current study aimed to evaluate the clinical efficacy and safety of 0.75% Ropivacaine with 0.5% Bupivacaine for epidural anesthesia in patients undergoing elective lower abdominal surgeries. Methods: A prospective, randomized study was conducted on 60 ASA I–II patients aged 18–60 years undergoing elective lower abdominal surgeries under epidural anesthesia. Patients were divided into two groups: Group R received 20 mL of 0.75% Ropivacaine, and Group B received 20 mL of 0.5% Bupivacaine. The onset and duration of sensory and motor blockade, duration of analgesia, hemodynamic changes, and adverse events were recorded and analyzed. Results: The onset of sensory blockade in the Ropivacaine group was (2.26 ± 0.91 min) and motor block (6.69 ± 0.98 min) was significantly slower as compared to Bupivacaine (1.86 ± 0.65 min and 6.10 ± 0.94 min respectively) group. However, Bupivacaine produced a longer sensory and motor blockade, whereas Ropivacaine provided a significantly longer duration of analgesia (p < 0.001). Hemodynamic parameters remained comparable. The total incidence of adverse effects was significantly lower in the Ropivacaine group (p = 0.036). Conclusion: We conclude that 0.75% Ropivacaine, when administered via the epidural route, provides adequate anesthesia for lower abdominal surgeries. 0.75% Ropivacaine had a short duration of motor block and prolonged duration of analgesia compared with 0.5% bupivacaine. The onset of sensory and motor blocks, hemodynamic changes, and side effect profile of Ropivacaine was not significantly different from that of bupivacaine..

Background: Postoperative pain control is a crucial component of hip surgeries. This ensures faster recovery and reduced opioid use postoperatively. The current study aimed to evaluate the efficacy of supra-inguinal fascia iliaca block (SIFIB) versus infra-inguinal fascia iliaca block (IIFIB) for postoperative analgesia following hip surgeries.  Methods: A prospective comparative study was conducted on 100 patients undergoing hip surgery, randomized into two groups: SIFIB (n=50) and IIFIB (n=50). Postoperative pain was assessed using the Visual Analogue Scale (VAS) at rest and during movement, along with time to first rescue analgesia.  Results: Both groups had comparable baseline characteristics. VAS scores at rest and on movement were significantly lower in the SIFIB group between 12–36 hours postoperatively (p<0.001), indicating superior mid-phase analgesia. The mean time to first rescue analgesia was significantly longer in the SIFIB group (13.1 ± 1.27 hours) compared to the IIFIB group (9.3 ± 1.30 hours) (p<0.001). Early pain control (0–6 hours) was similar in both groups, with no significant differences observed. Conclusion: SIFIB offers superior intermediate postoperative pain control and delayed rescue analgesia compared to IIFIB, making it a more effective technique for analgesia following hip surgery.

Background: Accurate and accessible diagnostic tools are essential for evaluating palpable breast lumps in outpatient settings. This study compares the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) and Trucut biopsy, with histopathological correlation. It also assesses the precision of tumor localization during FNAC. Materials and Methods: A prospective study was conducted on 50 patients with palpable breast lumps. All underwent FNAC followed by Trucut biopsy and histopathological examination. FNAC adequacy and diagnostic accuracy were evaluated, and repeat aspirations were performed in inadequate samples before Trucut. Results: FNAC showed 82% accuracy for both benign and malignant lesions, with 18% false positives and false negatives. Trucut biopsy demonstrated higher accuracy (92% benign, 90% malignant), with false-positive and false-negative rates of 8% and 10%, respectively. FNAC had a sensitivity, specificity, PPV, and NPV of 82%, while Trucut biopsy showed 90%, 92%, 91.8%, and 90.2%, respectively. Needle tip localization accuracy in FNAC was 96%. Conclusion: Trucut biopsy offers superior diagnostic accuracy and can guide definitive treatment when results are conclusive. FNAC accuracy can be improved with repeat aspiration in inadequate cases. Both methods are valuable, but Trucut biopsy, when performed skillfully, closely aligns with final histopathological findings.

Garre’s osteomyelitis, also known as chronic sclerosing osteomyelitis or proliferative periostitis, is a rare form of chronic non-suppurative osteomyelitis characterized by periosteal bone formation in response to persistent low-grade irritation or infection. It most commonly affects children and adolescents, with the mandible being the most frequently involved site. Case Presentation: We report the case of a 14-year-old male who presented with progressive left cheek swelling and facial asymmetry. Clinical examination revealed a bony hard, non-tender swelling in the mandibular region. The initial episode was associated with dental caries of the first deciduous molar, which was followed by painful eruption of the permanent tooth. Radiographic imaging revealed the classic "onion-skin" periosteal reaction. Over the past three years, the patient had nearly ten recurrent episodes and was evaluated across multiple departments without definitive resolution. Contrast-enhanced CT (CECT) of the head and neck confirmed features consistent with Garre’s osteomyelitis, and laboratory investigations were within normal limits. Treatment involved extraction of the offending tooth, gingival curettage, and antibiotic therapy, following which the patient showed significant improvement. He is currently maintained on NSAIDs (Naproxen) and regular follow-up. Conclusion: This case underscores the importance of early recognition of Garre’s osteomyelitis in pediatric patients with mandibular swelling. Timely dental intervention and infection control can prevent recurrent episodes and unnecessary systemic evaluations.

Background: Acute symptomatic seizures (ASS) are provoked seizures occurring in response to acute brain or systemic insults. They form a significant proportion of first-time seizure presentations and vary in etiology and outcome. This study aimed to evaluate the clinical and demographic characteristics of patients with ASS and identify factors associated with their hospital outcomes. Material and Methods: This was a prospective observational study conducted at the Department of General Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, over a period of 12 months. A total of 75 adult patients presenting with acute symptomatic seizures were enrolled. Detailed history, clinical examination, biochemical tests, neuroimaging, CSF analysis (where indicated), and EEG (in selected cases) were performed. Outcomes such as seizure recurrence, duration of hospital stay, neurological status at discharge, and mortality were assessed. Results: The mean age of the study population was 48.6 ± 16.4 years, with males comprising 58.7% of cases. The most common etiologies were ischemic stroke (37.3%), metabolic disturbances (24%), and CNS infections (16%). Neuroimaging was abnormal in 70.7% of patients. Electrolyte disturbances, particularly hyponatremia (36%), were frequently noted. Seizure recurrence during admission occurred in 14.7% of patients. At discharge, 77.3% had full recovery, 16% had persistent neurological deficits, and mortality was 6.7%. Poor outcomes were associated with stroke, severe metabolic derangements, and delayed presentation .Conclusion: Acute symptomatic seizures are predominantly observed in middle-aged males and are most commonly triggered by stroke or metabolic abnormalities. Early recognition and treatment of the underlying cause result in favorable outcomes in most patients. Identification of risk factors can help guide prognosis and improve management strategies..

Background: The PIPAS score and qSOFA score are the pre-operative parameters that are easy to perform and assessed bedside to predict the prognosis of perforation peritonitis patients in pre-operative phase. The ability of these tools as a mortality indicator is yet to be assessed and compared in our setting.  Method: The major objective of this study was to ascertain whether the PIPAS severity score is more accurate than the qSOFA at foretelling unfavourable outcomes in patients with perforated peritonitis. Pre-operatively both scores were measured for each patient. All patients were monitored peri-operatively until their release from our center, or for a maximum of 30 days (if the duration of the hospital stay was very long). Result: Among the two scores, total PIPAS severity score was good predictor of mortality at >3 cut-off point having area under curve of 0.748 for correctly predicting mortality. Total qSOFA score had sensitivity of 77.27%, and total PIPAS severity score had sensitivity of 50.00%. Conclusion: In present research, the patients’ mortality rate was high with perforation peritonitis. The PIPAS severity score instrument demonstrated a greater ability to predict in-patient mortality on comparison to qSOFA score. The PIPAS score of two or more cut-off values have high specificity compared to qSOFA criteria while latter has high sensitivity.

Background:  In patients of ASD, pulmonary hypertension can be due to increased pulmonary blood flow or due to obliterative changes in pulmonary vasculature. Pulmonary vascular resistance(PVR) is markedly raised in obliterative vasculopathy and helps in differentiating the two condtions.It has important clinical implication as surgical or device closure is contraindicated in patients with high PVR.Right heart catheterisation is the best method for determining PVR.Doppler echocardiography derived PVR has been shown to correlate with PVR determined by RHC.We aimed to compare PVR by Transthoracic echocardiography and cardiac catheterisation in patients of Ostium secundum ASD. Methods: This retrospective observational study was conducted in 25 patients of Ostium secundum ASD. Patients underwent echocardiography and PVRecho was determined using Abbas formula. All the patients underwent RHC and PVRcath was determined. Results: Majority of patients were female gender (72%).Mean age of study population was 36 ± 11 years. PVRecho was 2.6±0.78 WU, PVRcath was found to be 2.7±0.74 WU.There was good correlation between the two(r = 0.6203, p: 0.0009).Bland-Atman analysis showed good agreement between the two with small bias. ROC analysis of PVRecho showed an area under the curve (AUC) of 0.9048 (p < 0.0001). The optimal cut-off echocardiographic PVR to determine high PVR was 2.16 WU, sensitivity 94%, and specificity 71.5%.Conclusions: We conclude that PVRecho is reliable in predicting high PVR in uncorrected ostium secundum ASD. PVR measured by echocardiography according to Abbas formula is well correlated with PVRcath. By using a PVRecho cutoff of 2.16 WU, patients with high PVR can be determined in whom RHC is indicated. However, PVR determination by echocardiography should not be considered as a substitute for RHC.

Background: The COVID-19 pandemic disrupted healthcare systems globally, including mental health services and electroconvulsive therapy (ECT). Key challenges included infection risk, resource constraints, and redeployment of anesthesiologists to critical care units. Materials and Methods: This retrospective study was conducted at the Institute of Psychiatry and Human Behaviour (IPHB), Goa, a tertiary mental health facility offering ECT thrice weekly. All patients who received ECT between 2018 and 2022 were included—71 in the pre-COVID period (22 March 2018 – 21 March 2020) and 55 in the post-COVID period (22 March 2020 – 21 March 2022). Data were collected from the ECT register. The study compared patient profiles, treatment delays, and outcomes across the two periods. Ethical clearance was obtained. Results: Post-pandemic, the mean age of patients receiving ECT decreased. Fewer parents consented during the pandemic, with siblings and spouses often stepping in. Both the number of patients and total ECT sessions declined. Initiation of ECT was delayed, but discharges were faster. All patients were administered glycopyrrolate and propofol; thiopentone and atropine were avoided. Conclusion: Despite the pandemic, IPHB sustained ECT services by adhering to safety protocols. Though fewer in number, procedures were conducted safely without any major complications or COVID-related fatalities. Strict preventive measures, including PPE use and regular PCR testing, contributed to minimal infection rates, demonstrating that essential services like ECT can continue effectively during health crises.

Background: Optimal potassium replacement strategies in critically ill patients remain debated. This study compares clinical outcomes between aggressive and conservative potassium replacement approaches in ICU settings. Methods: A prospective observational study was conducted at Sukh Sagar Medical College and Hospital, Jabalpur, enrolling 113 critically ill patients with hypokalemia. Patients were divided into aggressive (n=57) and conservative (n=56) replacement groups. Primary outcomes included time to normokalaemia, arrhythmia, cardiac arrest, and 28-day mortality. Secondary outcomes were ICU length of stay and incidence of hyperkalemia. Results: Aggressive replacement significantly reduced time to normokalaemia (8.0 ± 3.0 vs. 16.2 ± 3.3 hours; p < 0.0001) and ICU stay (5.1 ± 1.7 vs. 6.8 ± 1.6 days; p < 0.0001). No significant differences were observed in arrhythmia (p = 0.253), cardiac arrest (p = 0.717), hyperkalemia (p = 0.441), or 28-day mortality (p = 0.106). Conclusion: Aggressive potassium replacement in critically ill patients was associated with faster biochemical correction and shorter ICU stay without increasing adverse events. This approach may enhance ICU efficiency when applied under appropriate monitoring protocols.

Background:  Gestational diabetes mellitus (GDM) is a rising concern in maternal healthcare, often accompanied by comorbidities that can complicate pregnancy outcomes. This study aimed to investigate maternal and neonatal outcomes associated with GDM and assess the impact of glycemic control in a resource-limited clinical setting.  Methods:  This prospective observational study was Conducted in Pandit Deen Dayal Upadhayay Goverment Hospital, Varanasi over six months, from August 2024 to January 2025. included 162 pregnant women diagnosed with GDM using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Comorbid conditions, lipid profiles, and glycemic status were documented. Glycemic control was achieved through dietary modifications and insulin therapy when required. Age- and parity-matched women with normal glucose tolerance were used as controls. All participants were followed through delivery, and maternal and neonatal complications were recorded.  Results:  The mean maternal age was 29.4 years, and the average BMI was 29.6 kg/m². Comorbidities included gestational hypertension (21%), chronic hypertension (5.5%), and hypothyroidism (28%). Insulin therapy was initiated in 72% of the women, with optimal glycemic control achieved in 66%. Cesarean section was performed in 49% of the cases, and 31% experienced antenatal or intrapartum complications. Neonatal outcomes included macrosomia in 3.1%, NICU admissions in 18%, and neonatal death in 1.2%. Infants born to mothers with good glycemic control had fewer complications and lower NICU admissions. Conclusion:  GDM significantly increases the risk of maternal and neonatal complications, particularly in women with comorbidities such as hypertension and hypothyroidism. However, appropriate glycemic control, especially with insulin when indicated, can lead to improved perinatal outcomes even in low-resource settings.

Background: Tribal communities often face socio-cultural barriers in accessing reproductive healthcare services, particularly modern contraceptive methods. Understanding the knowledge, attitudes, and practices (KAP) regarding contraception among women in these communities is critical for developing effective family planning interventions. This study was undertaken to assess the KAP regarding contraceptive methods among reproductive-age women in a tribal community in a Sambalpur district present in western part of Odisha. The findings aim to inform targeted interventions to increase awareness and acceptance of contraception in similar underprivileged populations.  Materials and Methods:           A cross-sectional and descriptive study conducted among 785 women aged 15–49 years in a tribal-dominated blocks of Sambalpur district November 2022 to December 2023. The region comprises primarily rural and remote areas with limited access to healthcare services. The study focused on assessing the knowledge, attitude, and practices (KAP) related to contraceptive methods among women of reproductive age residing in tribal communities. A structured questionnaire assessed their knowledge, attitudes, and contraceptive practices. Data were analyzed using descriptive and inferential statistics. Results:Out of 785 women interviewed, the majority (44%) were aged 25–35 years, with 68.9% being unemployed and 93.2% belonging to lower socio-economic status. Awareness about contraceptive methods was reported by 86% of participants. Among those aware (n=675), the most commonly known methods were oral pills (68%) and condoms (66%). However, only 61.1% had ever used contraception and just 23.8% were current users, with condoms (53.6%) and oral pills (31.1%) being the most used. Fear of side effects (51.4%) and partner opposition (20.6%) were major reasons for non-use. Statistically significant associations were found between knowledge/practice and factors such as age, education, occupation, religion, marital status, and number of children (p < 0.05). Conclusion:Though awareness is relatively high, the gap between knowledge and practice remains due to cultural, educational, and accessibility challenges. Tailored health education and community engagement are essential to improve uptake.

Background: Critically ill obstetric patients often require intensive care management due to life-threatening complications such as haemorrhage, hypertensive crises, and sepsis. Limited prospective data are available from resource-constrained tertiary centres in India. Objectives: To evaluate the clinical indications, interventions, outcomes, and predictors of mortality among obstetric patients admitted to a tertiary care Critical Care Unit (CCU). Methods: This prospective observational study included 32 obstetric patients admitted to the CCU over a 12-month period. Data were collected on demographics, admission indications, interventions received, duration of stay, and maternal outcomes. Statistical analysis included χ² tests and odds ratio estimation to evaluate mortality predictors. Results: The maternal mortality rate was 56.3% (18/32). The most common indications for CCU admission were haemorrhage (34.4%) and refractory seizures (21.9%). Blood transfusion was required in 53.1% of patients; all non-survivors had received transfusion (p = 0.008). Mean CCU stay was 4.0 ± 2.42 days. Referral delay >24 hours, presence of sepsis, need for mechanical ventilation, and requirement of >2 critical interventions were significantly associated with mortality, with odds ratios ranging from 3.2 to 6.0 (p < 0.05 for all). Conclusions: Haemorrhage and hypertensive disorders are the leading drivers of obstetric CCU admissions. Early referral and aggressive management are critical to improving outcomes. Referral delay, sepsis, and multiorgan intervention needs are strong predictors of mortality in this population.

Background- Anemia is a prevalent medical condition that often complicates pregnancy. In a population-based survey 2016 held in India, 50% of women were anemic. As a part of global strategy to prevent anemia, it has been put forward by WHO that all pregnant women be given 60mg of elemental iron with 400microgram of folic acid everyday prophylactically. However, many undesirable side effects causing poor compliance to iron has been observed by pregnant females due to daily intake of iron. Objective- Impact of Continuous versus Intermittent oral iron therapy on blood indices and fetomaternal outcome. Method- A Randomized control study (simple randomization) was done in Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital AMU Aligarh during August 2022 – June2024. Two hundred and twenty pregnant women with gestational age between 12- 16 weeks coming to antenatal clinic after taking informed consent were included in the study and divided in two equal groups. Group 1- Sixty mg of elemental iron daily was given to pregnant women till delivery. Group 2 – Sixty mg of elemental iron on day 1and 4 twice a day was given to pregnant women till delivery.  Blood indices on starting of iron supplementation at 12-16 weeks and after 20 weeks of iron supplementation during antenatal period were noted. Fetomaternal outcome of the two groups was also noted. Result- Both the groups were similar with respect to age, gravidity, literacy and other sociodemographic parameters. There was a significant increase in the haemoglobin post iron supplementation in both the groups (p<0.001). It was noted that no significant difference in haemoglobin and blood indices was present when the two groups were compared (p>0.05). Moreover, both the groups were found to be comparable in fetomaternal outcome. However, there were significantly more gastrointestinal side effects in continuous group as compared to intermittent group (p=0.006). Conclusion- The study showed during antenatal period intermittent iron therapy was equivalent to continuous iron therapy with less gastrointestinal side effects.

Introduction: The intestine plays a crucial role in nutrient absorption and overall health. Intestinal anastomosis is a common surgical procedure to restore intestinal continuity after removing a diseased portion. Aim: To study the factors that affecting the outcome of intestinal resection and anastomosis and predispose to anastomotic leak and the measures by which these complications can be minimized and managed. Methods: 100 patients of bowel primary resection and anastomosis, either emergency or elective, involving bowel anastomosis, with a minimum age of 12 years in various surgical units at Jawaharlal Nehru Medical College & Attached group of Hospitals, Ajmer from January 2023 to June 2024. Results: The mean age of the patients was 46.13±18.3 years. 59 males (59%) and 41 females (41%). 49 patients (49%) had abdominal pain. Alter bowel habit was observed in 5 (5%) patients. Conclusion: Additionally, emergency surgery and poor nutritional status were found to worsen outcomes. Conversely, total parenteral nutrition (TPN) was shown to benefit patient outcomes by preventing malnutrition.

Autoimmune disorders represent a broad spectrum of diseases. Among them, Sjögren’s syndrome is traditionally known for its classic presentation of sicca symptoms, yet atypical manifestations may precede these hallmark features. We present the case of a 30-year-old unmarried female who initially presented with abnormal uterine bleeding persisting over 28 days, accompanied by a non-blanchable, non-palpable purpuric rash on both lower limbs. Notably, there was no prior history of similar complaints, systemic illnesses, or relevant family history. Initial evaluation revealed significant thrombocytopenia (15,000/μL), anaemia (Hb 7.8 g/dL), and isolated prolonged activated partial thromboplastin time (aPTT: 72.6 sec) with normal prothrombin time, raising suspicion for an acquired bleeding diathesis. Coagulation studies revealed elevated D-dimer (754 ng/mL), normal fibrinogen levels and Mixing Study that failed to correct the prolonged aPTT, indicating presence of an inhibitor. Lupus anticoagulant was also detected, with negative anticardiolipin and beta-2 glycoprotein antibodies, creating a rare and paradoxical dual-coagulopathy profile—both haemorrhagic (due to thrombocytopenia) and prothrombotic (Lupus Anticoagulant). Given the autoimmune serology profile—positive ANA (2+), anti-Ro/SSA and anti-La/SSB antibodies (2+)—Sjögren’s syndrome was suspected despite the absence of sicca symptoms. Ophthalmologic assessment revealed a reduced Schirmer’s test and tear break-up time, confirming aqueous-deficient dry eye, thus substantiating the diagnosis of Sjögren’s syndrome with hematologic dominance. The final diagnosis was Sjögren’s syndrome with secondary immune thrombocytopenic purpura and positive Lupus Anticoagulant. The patient was treated with intravenous methylprednisolone followed by oral prednisolone and hydroxychloroquine. Significant clinical improvement was observed with resolution of bleeding, however, aPTT was still prolonged. This case underscores the necessity of considering autoimmune aetiologies in atypical bleeding presentations and highlights the diagnostic challenge i.e. prothrombotic state due to lupus anticoagulant.

Introduction: Acute myocardial infarction (AMI), commonly known as a heart attack, continues to be a leading global cause of morbidity and mortality.  AIM: Study of relationship of Serum Uric acid in Acute Myocardial Infarction.  Methodology: This hospital-based observational case-control study focused on evaluating the role of serum uric acid in acute myocardial infarction (AMI). Conducted over 18 months from April 2023 to September 2024 at the Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur.  Result: The study found significantly elevated serum uric acid levels in MI patients (64.4%) compared to non-MI controls (17.5%) (p < 0.0001), linking it to myocardial infarction risk. Uric acid showed moderate, significant correlations with Troponin-I and CK-MB, indicating its association with myocardial injury. Its weaker correlations with hs-CRP and LDH suggest a limited role in general inflammation or non-specific tissue damage.  Conclusion: This study concludes that serum uric acid levels are significantly higher in AMI patients and moderately correlate with cardiac injury markers like Troponin-I and CK-MB. These findings suggest its potential as an adjunctive biomarker in myocardial infarction. Further research is warranted to confirm its clinical value in cardiovascular risk assessment.

Introduction: Anaemia, a condition marked by low red blood cell count or haemoglobin concentration, impairs oxygen delivery to tissues and is a major public health issue in India. AIM: Study of association of HbA1C with iron deficiency anaemia. Methodology: This hospital-based observational descriptive study with a cross-sectional design was conducted in the Department of General Medicine, Mahatma Gandhi Medical College & Hospital, from March 2023 to August 2024. Result: In this study, HbA1c showed a strong and statistically significant inverse correlation with anemia-related parameters, while FBS and PPBS showed non-significant negative correlations. Females, being more anemic, had significantly higher HbA1c despite similar FBS and PPBS levels, highlighting the influence of anemia on HbA1c interpretation. Conclusion: This study highlights that anemia, particularly in females, can falsely elevate HbA1c levels, potentially leading to misdiagnosis of diabetes. Therefore, hemoglobin levels should be assessed alongside HbA1c when screening anemic individuals for diabetes.

Introduction: Various adjuvants have been explored to improve anaesthesia by accelerating onset and prolonging analgesia, including epinephrine, midazolam, neostigmine, hyaluronidase, ketamine, and bicarbonate. However, their effectiveness is often limited by side effects. More promising results have been seen with opioids like fentanyl and alpha-2 adrenergic agonists like clonidine, which enhance sensory block depth and duration while reducing local anaesthetic doses, minimizing systemic toxicity. Aimed to observe the effect of adding either fentanyl or clonidine to bupivacaine and lignocaine combination for supra clavicular brachial plexus block in patients undergoing elective upper limb surgery. Methodology: The study was conducted in the Department of Anesthesiology, S.M.S Medical College, Jaipur. This randomized double-blind controlled study included 135 Patients (age 20-50 years) undergoing elective surgery of upper limb after taking written informed consent as per inclusion & exclusion criteria. Study design- A Prospective, Randomized, Double Blind Hospital based Controlled study. Results: Sensory block onset was fastest in the clonidine group (2.87±0.786 min), followed by fentanyl (3.69±1.104 min) and control (4.44±1.235 min) (p < 0.001). Motor block onset was fastest with fentanyl (3.87±1.079 min), compared to clonidine (4.82±1.787 min) and control (4.78±1.428 min). Clonidine significantly prolonged sensory block duration (466.20±97.028 min), followed by fentanyl (340.11±53.369 min) and control (222.56±50.222 min).Motor block duration was longer with clonidine (402.22±82.031 min) and fentanyl (338.78±52.550 min) than control (208.67±40.261 min) (p < 0.001).Analgesia duration was significantly longer in clonidine (619.33±72.344 min) and fentanyl groups (455.44±75.301 min) than control (256.78±41.288 min) (p < 0.001).Pain scores were lowest in the clonidine group.No significant intraoperative or postoperative adverse effects were observed in any group. Conclusion: Adding fentanyl (50 mcg) and clonidine (75 mcg) to the local anaesthetic for supraclavicular brachial plexus block effectively prolongs anaesthesia and analgesia, ensuring postoperative comfort without significant side effects.

Background: Appendicitis refers to the inflammation of the appendix. It is predominantly observed in younger demographics. 40percent of cases occur between the ages of 10 & 29yrs. Objective: To assess the efficacy of Ultrasound of Abdomen and Pelvis in diagnosing acute appendicitis. Methods: The Prospective comparative observational study includes patients who underwent surgery for acute appendicitis (AA) after presenting to the General Surgery Department of the SDM College of Medical Sciences and Hospital in Sattur, Dharwad. Duration of study was between October 2022 to October 2023. Ethical clearance was obtained from SDM Instituitional Ethic Committee.  Result: Forty patients were female and forty-five were male, indicating a preponderance of male (Male: Female = 1.1:1). With a standard deviation of 11.87 years, the patient's mean age was 30.86 years. In the current study out of 85 subjects, 70(82.4%) were found to have features of acute appendicitis on the USG abdomen and pelvis. Of these, 67 (78.8%) has AA on Histopathological report. The sensitivity of USG is 91.78%, and its specificity is 75.0% with a diagnostic accuracy of 89.41% Conclusion: The sensitivity of USG is 91.78%, and its specificity is 75.0% with a diagnostic accuracy of 89.41%

Background: The partograph is an important tool for monitoring labor and preventing complications. However, the traditional modified WHO partograph has some limitations concerning manual input, time cost, and inconsistent documentation. This study represents a comparative assessment of the paperless (digital) partograph and the modified WHO partograph in the management of labor. Methods: This prospective study included 200 low-risk parturients in active labor. The patients were equally divided into two groups. The first group was monitored using a tablet-based paperless partograph, and the second group was monitored using a modified WHO paper-based partograph. Labor outcomes, neonatal outcomes, documentation efficiency, and user satisfaction were assessed between the two groups using appropriate statistical analyses.  Results: Baseline maternal characteristics were comparable between the groups. The paperless partograph group showed a significantly shorter duration of active labor (5.2 ± 1.4 vs. 6.8 ± 1.9 hours, p<0.001), higher rate of spontaneous vaginal delivery (78% vs. 65%, p=0.04), and lower cesarean section rate (14% vs. 23%, p=0.03). Neonates in the paperless group had significantly higher Apgar scores and fewer admissions to the NICU. Documentation completeness (98.7% vs. 85.2%), time efficiency, and alert recognition were significantly better in the digital group. User satisfaction scores were consistently higher with the paperless system across all measured parameters. Conclusion: The paperless partograph demonstrated better performance than the modified WHO partograph in labor monitoring, with better clinical outcomes, documentation quality, and user satisfaction. When applied to labor wards (especially those with large workflows or limited resources), it may substantially increase the strength of intrapartum care and maternal and neonatal outcomes.

Background: Acute Coronary Syndrome (ACS) is a major contributor to global cardiovascular morbidity and mortality. While Troponin I is the gold standard for diagnosing myocardial injury, its limitations in early detection and accessibility in resource-limited settings necessitate evaluation of adjunct biomarkers. Platelet Distribution Width (PDW), a marker of platelet activation, may offer diagnostic value in ACS. Objective: To assess the diagnostic sensitivity of PDW in identifying ACS and compare its performance with Troponin I levels. Methods: This cross-sectional observational study included 152 patients presenting with chest pain at a tertiary care hospital. Based on the Troponin I result, patients were categorized as having ACS or not having ACS. PDW and Troponin I levels were measured at 0 and 6 hours. Statistical analysis included correlation, group comparisons, and ROC curve analysis. Results: Of the 152 participants, 74.3% were diagnosed with ACS. PDW was significantly higher in the ACS group (16.94 ± 0.52 fl) than in non-ACS (16.24 ± 0.57 fl, p < 0.0001). Troponin I levels were also significantly elevated at both time points. PDW showed a weak positive correlation with Troponin I at 0 hours (r = 0.209, p = 0.0099). ROC analysis demonstrated good discriminatory power with AUCs of 0.743 and 0.797 at 0 and 6 hours, respectively. Sensitivity ranged from 94.6% to 97.2%, with moderate specificity (45%–52.2%). Conclusion: PDW is significantly elevated in ACS and demonstrates high sensitivity as an adjunct diagnostic marker. It may be valuable in early ACS assessment, especially where Troponin I testing is limited.

Background: Laryngeal tuberculosis is a rare form of extrapulmonary tuberculosis affecting the larynx, often misdiagnosed due to symptoms mimicking laryngeal cancer. It presents with hoarseness, dysphagia, and cough. Diagnosis involves laryngoscopy, biopsy, and microbiological testing. Early recognition and appropriate antitubercular therapy are essential for effective management and prevention of complications. Unilateral tubercular lung destruction is a rare but serious manifestation of pulmonary tuberculosis, characterized by extensive, often irreversible damage confined to one lung. This condition typically arises from chronic, untreated, or drug-resistant tuberculosis, leading to progressive cavitation, fibrosis, bronchiectasis, and eventual collapse of the affected lung. Clinically, patients may present with chronic cough, dyspnea, hemoptysis, weight loss, and signs of respiratory insufficiency. Radiological features include mediastinal shift, hyperinflation of the contralateral lung, volume loss, and extensive parenchymal distortion. Diagnostic confirmation relies on imaging modalities, sputum testing, bronchoscopy, and histopathology. Treatment involves standard anti-tubercular therapy (ATT), but outcomes are often suboptimal in cases with advanced destruction. Surgical intervention, such as pneumonectomy, may be required for symptom control or in cases complicated by massive hemoptysis or recurrent infections. The coexistence of laryngeal granuloma and UTLD reflects advanced disease and necessitates prompt diagnosis, antitubercular therapy, and sometimes surgical intervention for effective management and improved outcomes.

Background: Anterior cruciate ligament (ACL) injuries are common in physically active individuals and often require surgical reconstruction for restoring joint stability and function. Although semitendinosus tendon autografts are widely used in ACL reconstruction, the peroneus longus tendon (PLT) is gaining popularity due to its biomechanical properties and potential for reduced donor site morbidity. This study aims to compare the functional outcomes and postoperative complications associated with semitendinosus and peroneus longus tendon autografts in arthroscopic ACL reconstruction. Methods: This prospective comparative study was conducted at Saraswati Medical College and Hospital, Unnao, from February 2024 to February 2025. A total of 60 patients with ACL tears were randomly allocated into two groups: Group ST (semitendinosus tendon graft, n=30) and Group PLT (peroneus longus tendon graft, n=30). All patients underwent arthroscopic ACL reconstruction and were assessed postoperatively at regular intervals for up to 12 months using the Lysholm Knee Score, IKDC grading, and Lachman test. Postoperative complications were also recorded. Results: Both groups demonstrated excellent to good outcomes postoperatively. In Group ST, 60% had excellent and 40% had good Lysholm scores, with a mean score of 90.6 ± 3.18. Group PLT had 73.33% excellent and 26.67% good scores, with a mean of 92.2 ± 2.65 (p = 0.439). IKDC grading showed Grade A in 66.67% (ST) and 73.33% (PLT) (p = 0.690). Negative Lachman test results were observed in 66.67% of ST and 73.33% of PLT patients. Complications were slightly higher in the ST group, notably anterior knee pain (26.7%) and quadriceps hypotrophy (20%), whereas PLT showed lower rates (13.3% each). Conclusion: Both semitendinosus and peroneus longus tendon autografts are effective for ACL reconstruction with comparable functional outcomes. However, the peroneus longus graft demonstrated slightly better clinical performance and fewer complications, indicating it as a favorable alternative in ACL surgery, especially in settings requiring lower donor site morbidity and improved cosmetic outcomes..

Background: Pre-eclampsia, an obstetrician’s perennial nemesis and a formidable harbinger of both maternal and perinatal morbidity, continues to plague the gestational course in an alarmingly high proportion within low-resource settings. Its protean clinical manifestations and capricious trajectory render it a formidable challenge in antenatal care, particularly in regions where healthcare infrastructure remains strained. Aims And Objectives: This prospective longitudinal inquiry was meticulously devised to ascertain and juxtapose the antihypertensive efficacy of orally administered Labetalol, a mixed α/β-adrenergic antagonist, against Nifedipine, a dihydropyridine calcium channel inhibitor, in the therapeutic stewardship of pre-eclampsia. The study endeavoured to compare not only hemodynamic control but also maternal tolerability and perinatal outcomes across these pharmacological strata. Materials And Methodology: The investigation incorporated 100 eligible gravidae diagnosed with pre-eclampsia, who were systematically allocated into two pharmacotherapeutic cohorts by randomisation—Labetalol (n=50) and Nifedipine (n=50). The respective antihypertensive regimens were administered as per established protocols, with vigilant monitoring of blood pressure indices, maternal side effects, and neonatal outcomes including Apgar scores and birth weight. Results: The results illuminate that Labetalol demonstrates superior efficacy in reducing systolic and diastolic blood pressures as well as mean arterial pressure (MAP), albeit at the expense of requiring higher cumulative dosing compared to Nifedipine. While neonatal outcomes, encompassing Apgar scores and birth weight, remained statistically comparable between the cohorts, the maternal side effect profile conspicuously favored Labetalol, with fewer adverse events noted. Conclusion: These findings, emanating from an Indian tertiary care context hitherto underexplored in rigorous pharmacotherapeutic research, provide pivotal insights for the optimization of obstetric management protocols. They underscore the clinical superiority and tolerability of Labetalol in the antihypertensive stewardship of pre-eclampsia, particularly within resource-constrained healthcare milieus where therapeutic precision is often necessitated amidst infrastructural limitations.

Background: Studies suggest a strong link between hypogonadism (low testosterone levels in men) and non-alcoholic fatty liver disease (NAFLD), with a higher prevalence of NAFLD observed in hypogonadal men. This association may be due to the influence of testosterone on hepatic lipid metabolism and the development of insulin resistance, a key factor in NAFLD.  The main aim of this study was to assess the correlation between NAFLD patients having liver stiffness measured by Fibroscan and testosterone level in male population.  Methods: This was an institute based Cross Sectional Study, done at General Medicine OPD, Department of General Medicine, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, from January 2018 to March 2019. Total 139 patients with NAFLD and fulfilled the inclusion criteria were included in this study data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS (version 20.0; SPSS Inc., Chicago, IL, USA).  Result: The maximum value for age was 51, minimum value 30 and mean was 36.31. Maximum value of Body Mass Index (BMI) Was 29.9, minimum value 19.7 and mean was 24.06. There is no difference between mean ages, BMI, urea, creatinine, serum fasting blood sugar (FBS), serum post prandial and blood sugar (PPBS) between the hypogonal and normal NAFLD patients. There is significant relation in between fibroscan of liver and serum total testosterone level among hypogonadal and eugonadal NAFLD patients (p value= 0.001).  Conclusion: This study revealed that there is a significant relationship between non alcoholic fatty liver disease patients having liver stiffness which is measured by transient elastography (fibroscan of liver) and hypogonadism which is measured by serum testosterone level.

Background: Restoring anterior teeth with subgingival fractures poses functional and aesthetic challenges. Surgical extrusion offers a conservative approach by repositioning the tooth coronally to allow proper restoration without compromising periodontal health. Case Summary: A 34-year-old female presented with a complicated crown-root fracture of the maxillary left canine. The fracture line extended below the gingival margin, rendering conventional restorative techniques insufficient. Surgical extrusion was performed under local anaesthesia, and the tooth was repositioned approximately 2mm coronally. A semi-rigid splint was applied for stabilization, followed by root canal therapy and final restoration with a metal ceramic crown. Clinical Outcome: At 12-month follow-up, the tooth remained asymptomatic, with healthy periodontal support and no signs of resorption or mobility. Conclusion: Surgical extrusion is a predictable and minimally invasive option for managing subgingival fractures in the aesthetic zone, preserving both tooth structure and function.

Background: Rotator cuff tears are a common cause of shoulder dysfunction, and surgical repair is the standard treatment for full-thickness tears. Open and arthroscopic repairs are widely performed, but comparative data on functional outcomes remain variable. Aim: To compare the functional outcomes of patients undergoing open versus arthroscopic rotator cuff repair. Methods: This prospective comparative study included 50 patients with full-thickness rotator cuff tears, equally divided between open (n=25) and arthroscopic (n=25) repair groups. Baseline demographic and clinical data were collected. Functional outcomes were assessed at 12 months using Constant-Murley, UCLA, and ASES scores, along with range of motion, pain levels, strength, complications, and patient satisfaction. Statistical analyses included t-tests and chi-square tests with significance at p < 0.05. Results: At 12 months, the arthroscopic repair group showed significantly higher Constant-Murley (83.7 ± 9.2 vs. 78.4 ± 10.5, p=0.04) and UCLA Shoulder scores (30.2 ± 3.7 vs. 27.8 ± 4.1, p=0.03) compared to the open repair group. The arthroscopic group demonstrated trends toward improved ASES scores, range of motion, and reduced pain, though these differences were not statistically significant. Complication rates, including re-tear confirmed by MRI, were comparable between groups. Patient satisfaction was higher in the arthroscopic group (88% vs. 80%), but without statistical significance. Conclusion: Arthroscopic rotator cuff repair yields superior functional outcomes, reduced pain, and higher patient satisfaction compared to open repair, supporting its preferred use when feasible.

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that affects multiple organ systems and often leads to progressive organ damage. Thyroid dysfunction, particularly hypothyroidism, is commonly observed in SLE patients, but the relationship between thyroid abnormalities and disease severity remains unclear. This study aims to investigate the correlation between thyroid function and disease activity in SLE patients. Methods: A prospective observational study was conducted on 52 newly diagnosed SLE patients attending the Rheumatology OPD at M.Y.H. Hospital, Indore, over six months. Participants were assessed for thyroid function (T3, T4, TSH), and disease activity was measured using the SLE Disease Activity Index (SLEDAI) score. Data on patient demographics, clinical symptoms, and disease severity were collected and analyzed. Follow-up evaluations were performed at 3 and 6 months. Results: The study population had a predominance of females (94.2%) with a mean age of 27.4 years. Most patients (76.9%) had euthyroid status, while 7.7% had subclinical hypothyroidism, and 15.4% had overt hypothyroidism. Disease severity distribution showed 38.5% with mild disease, 34.6% with moderate severity, and 26.9% with severe disease. A significant correlation was found between hypothyroidism and increased disease severity, with a higher percentage of hypothyroid patients classified as severe (6 out of 8). Conclusion: The study indicates that thyroid dysfunction, particularly hypothyroidism, is associated with increased disease severity in SLE patients. Regular thyroid screening should be incorporated into the management of SLE to identify thyroid abnormalities and potentially improve disease outcomes. Further studies are required to establish the causal relationship and explore the role of thyroid hormone replacement in managing SLE.

Background: Nosocomial infections, or health care–associated infections (HAIs), are infections acquired during medical care that were not present or incubating at admission. Typically developing 48 to 72 hours post-admission, HAIs pose a major challenge globally, impacting patient safety, prolonging hospital stays, increasing healthcare costs, and contributing to significant morbidity and mortality. The prevalence of HAIs varies widely worldwide, with higher rates in developing countries due to resource limitations and inadequate infection control measures. This study aims to evaluate the prevalence of HAIs in a tertiary care center, identify commonly affected systems and pathogens, and assess associated risk factors to guide effective infection control policies. Materials and Methods: A cross-sectional study was conducted over 18 months at F.H. Medical College and Hospital, Agra, including 300 patients suspected of nosocomial infections. Samples were collected from post-operative wards, ICUs, and catheterized patients. Microbiological identification and antimicrobial susceptibility testing were performed following standard protocols. Data on patient demographics, clinical history, and infection sources were recorded and analyzed statistically using SPSS v25.0. Results: The study population ranged from 2 to 80 years, with a mean age of 41.14 ± 17.72 years, and a near-equal gender distribution (49% males, 51% females). A majority (90%) resided in rural areas and belonged to lower socioeconomic classes (91.3%). Most patients (67%) had hospital stays of 8–10 days. Common medical histories included chronic obstructive pulmonary disease (7%) and diabetic ketoacidosis (6.3%), while 65% had surgical histories, predominantly lower segment cesarean sections (21%). Post-operative patients constituted the largest infection source (57.3%), followed by ICU patients (35%). Blood and urine samples accounted for the majority of specimens collected (41% and 37.7%, respectively). Culture positivity was low (3.3%), with Gram-negative isolates predominating. Conclusion: Nosocomial infections remain a significant concern, particularly in resource-limited settings where prolonged hospital stays and invasive procedures increase infection risk. The predominance of post-operative and ICU-related infections underscores the need for rigorous adherence to infection control protocols, regular surveillance, and targeted antimicrobial stewardship. Strengthening hospital infection prevention strategies based on local epidemiology can substantially improve patient outcomes and reduce healthcare burden.

Background: Anemia is a frequent comorbidity in chronic heart failure (CHF) and is linked to adverse outcomes. While global data highlight its impact, regional evidence—especially from South Indian institutions remains limited. To estimate the prevalence and severity of anemia in patients with chronic heart failure and to analyze its association with clinical parameters such as New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), and common comorbidities. Material and Methods: A cross-sectional, observational study was conducted over six months at Shri Sathya Sai Medical College and Research Institute, Chennai. Fifty adult CHF patients were enrolled based on clinical and echocardiographic criteria. Data on demographics, comorbidities, laboratory values, NYHA class, and LVEF were collected. Anemia was defined per WHO criteria. Statistical analysis included descriptive statistics, Kruskal-Wallis test, correlation, and chi-square tests. Results: The mean age of participants was 57.74 ± 9.38 years; 56% were male. Anemia was present in over half the patients, with a mean hemoglobin of 11.25 ± 1.08 g/dL. The prevalence of diabetes and hypertension was 44% and 46%, respectively. Most patients were in NYHA Class II or III. LVEF showed that 52% had HFrEF, 38% had HFmrEF, and 10% had HFpEF. A statistically significant association was found between anemia and LVEF category (p = 0.0073), but not with NYHA class or comorbidities. A modest positive correlation between hemoglobin and LVEF was observed (Spearman’s r = 0.288, p = 0.0427). Conclusions: Anemia is prevalent in CHF patients, particularly those with reduced ejection fraction. While not significantly linked to NYHA class or comorbidities, its association with lower LVEF underscores the need for routine anemia screening and targeted management in CHF care, especially in resource-limited Indian settings.

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder associated with increased cardiovascular risk and a prothrombotic state. Platelet hyperactivity plays a pivotal role in the pathogenesis of diabetic vascular complications. Platelet indices such as Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet Large Cell Ratio (P-LCR) can serve as early, cost-effective markers of platelet activation and vascular risk in diabetic patients. Aim and Objectives: To assess and compare platelet indices in patients with controlled (HbA1c <7%) and uncontrolled (HbA1c >7%) type 2 diabetes mellitus, and correlate these indices with glycemic parameters and clinical features. Methods: A cross-sectional, observational study was conducted on 150 type 2 diabetic patients attending OPD and IPD at Dr. D.Y. Patil Hospital, Nerul, Navi Mumbai. Patients were classified into two groups based on HbA1c levels. Platelet indices, glycemic parameters (HbA1c, FBG, PPG), blood pressure, clinical history, ECG, and fundoscopic findings were evaluated. Statistical analyses were performed to compare the two groups. Results: Out of 150 participants, 54 (36%) had controlled diabetes and 96 (64%) had uncontrolled diabetes. The uncontrolled group showed significantly higher values of platelet indices: MPV (9.85±0.97 mm³ vs. 9.44±1.01 mm³), PDW (21.11±2.95 mm³ vs. 19.04±3.38 mm³), PCT (0.42±0.09% vs. 0.39±0.08%), and P-LCR (54.54±6.87% vs. 51.69±9.13%) with p-values <0.05 for all. Fasting and postprandial blood glucose levels were also significantly higher in the uncontrolled group. A longer duration of diabetes was associated with higher platelet activation markers. Conclusion: There exists a significant correlation between poor glycemic control and elevated platelet indices in type 2 diabetic patients. These indices may serve as valuable, economical markers for identifying patients at increased risk for thrombotic complications and warranting closer clinical monitoring.

Background: Isolated male epispadias is a rare congenital malformation in which the urethral opening is situated on the dorsal side of the phallus with deficiency of dorsal penile skin. In isolated female epispadias, there is a depressed mons, a bifid clitoris, and labia minora. The urethra is lying above vagina, short and widely open dorsally, communicating with an open bladder neck. The surgical correction primarily focuses on achieving a good cosmetic appearance and functional outcomes, including improved micturition and sexual function.  Aim: This study, conducted on patients with isolated epispadias, aimed to evaluate the incidence, postoperative complications, cosmetic appearance, continence, upper urinary tract changes, and the requirement for redo or additional surgery.  Methods: This study was a retrospective and prospective analysis of patients with isolated epispadias who underwent Modified Cantwell-Ransley repair with or without bladder neck repair and with or without osteotomy from October 2017 to February 2019, spanning a period of 2.5 years. The patients were followed for a period of 1 month to 2.5 years. Results: A total of 22 patients with epispadias underwent surgery. Out of them, seven patients were enrolled as prospective cases, while 15 patients were enrolled retrospectively by reviewing records. There were 19 male and three female isolated epispadias. Sixteen patients were fresh primary patients, while five patients were redo patients. One patient required a second-stage BNR who had previously undergone surgery for epispadias. Bladder neck repair was done in 17 patients, while osteotomy was done in 7 patients. The postoperative complication was suture line infection in 2 patients, fistula in 5 patients, bad scar in 2 patients, and stone formation in 1 patient. Seven patients (31%) have dry intervals of more than 2 hours labeled as continent. Another 7 (31%) patients had a dry interval of 1.5 hours. Two patients had continuous dribbling.  Conclusion: Isolated epispadias is a rare congenital anomaly that requires surgical correction. A good cosmetic appearance can be achieved with good surgical technique. Long-term follow-up is necessary for evaluation of continent status, upper urinary tract changes, and psychological condition.

Background: Oligohydramnios is a condition in which the amount of amniotic fluid is reduced to < 200 ml at term. Its incidence is about 4% of all pregnancies. The volume of amniotic fluid varies according to gestational maturity. It measures about 20 ml at 10 weeks, 400 ml at 20 weeks, 750 ml at 28 weeks, and peaks to about 800ml-1.0L at 36 weeks. Fetal complications include intrauterine growth restriction, pulmonary hypoplasia, respiratory distress syndrome, postmaturity syndrome, fetal malpresentation, umbilical cord compression, skeletal deformities, contracture bands, meconium aspiration, increased perinatal mortality, low APGAR scores, hypoxic ischemic encephalopathy and increased operative deliveries. By the second and third trimester, amniotic fluid is produced primarily by fetal urine, and is reabsorbed through fetal swallowing, fetal lung and directly by placenta. Amniotic fluid is affected by the status of maternal hydration and status of maternal osmolality. Materials and Methods: A prospective observational study was conducted in 100 pregnant women with isolated oligohydramnios in Siddhartha medical college, Vijayawada from Jan 2024 to Dec 2024.The inclusion criteria are primigravidas, singleton pregnancy with vertex presentation, Gestational age from 30 weeks to 40 weeks term pregnancies, maternal age from 18-35 years, non-anomalous fetus, initial AFI between 6-8 and with intact membranes. Multiple pregnancies, Congenital fetal anomalies, PROM and PPROM, IUD, postdated pregnancies, medical disorders unrelated to pregnancy GDM, preeclampsia, cardiac disease, thyroid disorders, all high-risk pregnancies and obstetric indication for immediate termination were excluded from study.  Results: Improvement in AFI in isolated oligohydramnios depends on the gestational age at the time of oral hydration and the time available till delivery. There is improvement of AFI in younger age groups than elderly age groups. Increase in AFI is more in early gestational age than term pregnancies. The outcome is Normal vaginal delivery in 80% of cases. LSCS was the outcome in 5% of cases. There is a significant increase in APGAR scores at birth.  Conclusion: Maternal oral hydration therapy is simple, safe, noninvasive and non expensive method to improve amniotic fluid volume and decrease in operative interferences in oligohydramnios but requires continuous therapy for long term to improve the perinatal outcome

Molars with involvement of the furcation have lower prognosis for retention than single-rooted teeth. Mandibular molars being the keystone for occlusion as well as the most commonly extracted tooth due to caries and periodontal disease, conservative treatment modalities such as hemisection is an efficacious alternative to save it. Hemisection is the sectioning of teeth and removal of the damaged root along with its associated crown, thereby preserving the healthy root. The key element to ensuring the long-term success of the procedure is proper case selection. This case report outlines hemisection of a mandibular molar with root caries, followed by its prosthetic rehabilitation.