Background: The evaluation of lung function in pediatric populations relies significantly on the Peak Expiratory Flow Rate (PEFR), a measure reflecting the maximum speed of expiration. Normative data for PEFR in Indian schoolchildren are limited, despite its clinical importance. Objectives: To establish normative PEFR values for Indian schoolchildren aged 6–12 years and to evaluate associations between PEFR and age, sex, height, weight, and body surface area (BSA). Methods: Employing a cross-sectional design, we measured PEFR using standardized spirometry among healthy Indian children aged 6 to 12 years. Anthropometric data were recorded, and BSA was calculated. The relationship between PEFR and anthropometric variables was analyzed using Pearson’s correlation coefficients and multiple linear regression. Statistical significance was set at p < 0.05. Results: The mean (SD) PEFR was 240 (60) L/min and values showed a consistent increase with age and were significantly higher in boys than in girls across all age groups. A positive correlation was observed between PEFR and BSA, age, stature, and weight.6,11,15 Notably, BSA emerged as a significant predictor of PEFR, suggesting its utility over Body Mass Index (BMI) in assessing lung function. Conclusion: This study provides region-specific normative PEFR values for Indian school children, highlighting the influence of BSA as a key anthropometric predictor of PEFR, supporting the use of localized reference standards for paediatric respiratory assessment.

Background: Thyroidectomy is a common surgical procedure for a variety of benign and malignant thyroid disorders. Despite its therapeutic value, post-thyroidectomy hypocalcemia remains one of the most frequent and clinically significant complications, with incidence rates ranging widely across populations. Hypocalcemia arises primarily due to transient or permanent parathyroid dysfunction following surgical manipulation and may present with a spectrum of symptoms ranging from mild paraesthesia to tetany and cardiac arrhythmias. Understanding local incidence patterns and clinical features is essential for improving perioperative care, risk stratification and patient counselling.Aim and Objectives: Primary objective: To estimate the incidence of hypocalcemia following thyroidectomy. Secondary objective: To correlate hypocalcemic features with serum calcium levels in post-thyroidectomy patients. Materials and Methods:This prospective observational study included 76 patients undergoing thyroidectomy at IMS and SUM Hospital between June 2022 and May 2024. Serum calcium levels were recorded preoperatively and on postoperative day 1, day 3, day 7, and at 1, 3 and 6 months. Clinical manifestations of hypocalcemia were documented and correlated with biochemical parameters. Histopathological findings and surgical characteristics were also noted. Patients with pre-existing hypocalcemia, parathyroid pathology or ongoing calcium therapy were excluded. Results: Hypocalcemia developed in 40.8% of patients, with the majority being transient (93.5%). Mean serum calcium levels showed a significant postoperative decline (p<0.001), with gradual recovery observed by one month and near-normalization by three to six months. Clinical features such as carpopedal spasm (11.8%) and perioral numbness (7.9%) correlated with biochemical hypocalcemia. Total thyroidectomy constituted 93.4% of procedures, contributing to increased hypocalcemia risk. Permanent hypocalcemia was uncommon (6.5%). Conclusion: Hypocalcemia represents a common yet predominantly transient complication following thyroidectomy. Early recognition, routine biochemical monitoring and appropriate supplementation remain crucial to reducing postoperative morbidity. Identifying high-risk patients based on surgical and histopathological factors may further optimize postoperative outcomes.

Background: Human immunodeficiency virus (HIV) infection is associated with immunosuppression, which predisposes women to cervical epithelial abnormalities. Cervical cytology remains an important screening tool for early detection of such changes, particularly in HIV-infected women. To compare Pap smear cytomorphological findings between HIV-positive women and HIV-negative controls and to assess the pattern and severity of cytological abnormalities in HIV-infected women. Materials and Methods: This cross-sectional comparative study included 50 HIV-positive women and 50 age-matched HIV-negative controls. Pap smears were collected, stained using the Papanicolaou technique, and evaluated using the Bethesda System for Reporting Cervical Cytology (2014). Cytomorphological features were graded systematically, and statistical analysis was performed to compare findings between the two groups. Results: HIV-positive women showed significantly higher frequencies of abnormal keratinization, nucleomegaly, and nuclear membrane thickening compared to controls (p < 0.05). Dendritic cells were significantly reduced in HIV-positive smears, indicating compromised local immune response. No significant differences were observed for cellularity, cytomegaly, polymorphs, cytolysis, or bacterial presence. High-grade squamous intraepithelial lesions were not detected in either group. Conclusion: HIV-infected women exhibit increased subtle cytomorphological abnormalities on Pap smear examination, even in the absence of high-grade lesions. These findings highlight the need for regular cervical cytology screening in HIV-positive women for early detection and prevention of cervical neoplasia.

Background: Chronic Liver Disease (CLD) encompasses various liver ailments, leading to gradual liver function deterioration, including conditions like cirrhosis and hepatocellular carcinoma. CLD, caused by factors such as viral hepatitis and non-alcoholic fatty liver disease (NAFLD), progresses through chronic inflammation and liver cell death, resulting in fibrosis and liver function loss. Objectives: This study aims to assess the prevalence of Hepato-adrenal syndrome among CLD patients with sepsis by comparing serum cortisol levels in cirrhotic patients with and without severe infections. The objective is to identify practical bedside methods for recognizing HRS-affected patients and to elucidate the broader impacts of HRS within the CLD population. Methodology: An observational comparative cross-sectional study was conducted at a tertiary care hospital in Puducherry, involving 89 CLD patients, divided into Group 1 (with sepsis) and Group 2 (without sepsis). Blood samples were collected and analyzed for total basal cortisol levels using electrochemiluminescence immunoassay. Data analysis included descriptive statistics, prevalence rates, Pearson’s correlation, and significance tests using SPSS version 16.0. Results: Patients with severe infection had significantly higher Child-Pugh scores and serum cortisol levels, indicating worse liver function and heightened stress response. Elevated INR, urea, and creatinine levels, along with higher total leukocyte counts, were observed in the infection group. The prevalence of Hepato-adrenal syndrome among patients with severe infections was 37.2%, with serum cortisol showing moderate positive correlation with total lymphocyte count and urea levels. Conclusion: Severe infections in CLD patients significantly impact clinical outcomes and stress responses, emphasizing the need for vigilant monitoring and effective infection management. Elevated stress markers and worsened clinical parameters in the infection group underscore the critical need for early detection and intervention to improve patient outcomes and manage HRS effectively.

Introduction: Hypoxic Ischemic Encephalopathy (HIE) is a serious condition in term and late preterm newborns, caused by disrupted cerebral blood flow and oxygen supply, leading to neurological damage. Despite therapeutic hypothermia being the standard treatment, up to 29% of treated neonates still experience adverse neurodevelopmental outcomes. Objectives: To evaluate the clinical efficacy of therapeutic hypothermia in neonates diagnosed with hypoxic-ischemic encephalopathy and to assess neurodevelopmental outcomes at 6 months of age in neonates who had undergone the therapy. Methods: A prospective, observational, hospital-based cross-sectional study was conducted on 130 inborn babies with moderate or severe encephalopathy using a purposive sampling technique from October 2023 to September 2024. Neonates (>34 weeks gestation or >2000g birth weight) with moderate to severe neonatal encephalopathy and evidence of perinatal distress were included. Exclusion criteria included gestational age <34 weeks, birth weight <2000g, severe congenital anomalies, genetic syndromes, metabolic disorders, major intracranial hemorrhage, or sepsis. Results: Out of 130 neonates with HIE, 66.9% had moderate HIE and 33.1% had severe HIE. After therapeutic hypothermia, 87.7% of neonates were discharged, while 12.3% died. At the 6-month follow-up, the overall survival rate was 92.73%, with 58.8% having normal neurodevelopmental outcomes, 29.4% having moderately abnormal outcomes, and 11.8% having severely abnormal outcomes. Common adverse events included thrombocytopenia (32.3%) and sepsis (29.2%). Conclusion: Therapeutic hypothermia improves survival and early neurodevelopment in neonates with moderate to severe HIE, but a significant proportion (41.2%) still experience moderate to severe impairment, highlighting the need for long-term monitoring and early rehabilitation.

Mucormycosis is an angio-invasive disease that is characterized by tissue infarction and necrosis . Attention to mucormycosis was brought about following the first and second epidemic COVID-19 waves in India and other countries . Debridement of mucormycosis fungal infections lacking vast knowledge gap about which approach is best, which investigation most useful and when to operate patients. This is retrospective observational study to be conducted at GG Hospital Jamnagar, from April 2021 to October 2022. The data is obtained from the hospital records of the patients and regular follow up by patients. All patients investigated and throughly examined for the clinical symptoms. Nasal endoscopy, CT SCAN and MRI were done in every patient to know the area of involvement. All patients gone under the medical treatment after operation.All patients examined post operative on follow up visit to the hospital.The common complaints were facial pain and tenderness, visual impairment and loosening of teeth. Necrosis on nasal endoscopy is diagnostic of mucormycosis, although it is not present in early stages and in all patients. MRI was the radiological investigation of choice in our institute. CT scan is useful for diagnosing the bony involvement and erosions. Conclusion In our study , we found that early diagnosis was extremely important in mucormycosis fungal infections. MRI is the imaging modality of choice. Early treatment with antifungal agents and early surgical debridement proved to be helpful in improving the prognosis of the patients. Modified Denker’s procedure has proved to be very well suited for patients with mucormycosis.

Background: Ultrasound-guided supraclavicular brachial plexus block is widely used for anesthesia in upper limb surgeries. The subclavian perivascular approach and the lateral approach are two commonly employed techniques, each with distinct anatomical and technical considerations. Comparative evidence regarding their efficacy and safety remains limited. Objectives: To compare the subclavian perivascular approach with the lateral approach of ultrasound-guided supraclavicular brachial plexus block in terms of block performance time, quality of sensory blockade, and procedure-related complications in patients undergoing below midarm surgeries. Materials and Methods: This hospital-based observational study included 110 patients undergoing elective below midarm surgeries, divided into two groups of 55 each: subclavian perivascular approach and lateral approach. Ultrasound-guided supraclavicular brachial plexus block was performed in all patients. Block performance time, sensory block characteristics, duration of analgesia, and complications were recorded and compared using appropriate statistical tests. Results: Baseline demographic and clinical characteristics were comparable between the two groups. The block performance time was significantly shorter in the subclavian perivascular group compared to the lateral approach group (p < 0.001). Time to achieve complete sensory blockade was also significantly shorter in the subclavian perivascular group (p < 0.001), while the onset of sensory block and duration of postoperative analgesia were comparable. The overall incidence of complications was low in both groups, with no significant difference observed. Conclusion: Both approaches are safe and effective for below midarm surgeries; however, the subclavian perivascular approach offers advantages in terms of faster block performance and quicker attainment of complete sensory blockade, making it a preferable option in routine clinical practice.

Background: Amniotic fluid plays a vital role in fetal growth and protection, and abnormalities in amniotic fluid volume are associated with adverse perinatal outcomes. The amniotic fluid index (AFI) is a widely used ultrasonographic parameter for assessing amniotic fluid volume, yet its predictive value for immediate neonatal outcomes varies across populations. Objectives: To evaluate the association between amniotic fluid index (AFI) status and fetomaternal outcomes, with particular emphasis on neonatal morbidity. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care center in Kerala over a period of six months. A total of 361 antenatal women with singleton viable pregnancies beyond 34 weeks of gestation were included. AFI values obtained from third-trimester ultrasonography were used to categorize participants into normal AFI (5–25 cm) and abnormal AFI (<5 cm or >25 cm) groups. Maternal characteristics, intrapartum details, and neonatal outcomes—including birth weight, APGAR scores, respiratory distress, NICU admission, hypoglycaemia, birth asphyxia, and neonatal mortality—were recorded. Statistical analysis was performed using the Chi-square test, with p <0.05 considered statistically significant. Results: Normal AFI was observed in 87.3% of pregnancies, while oligohydramnios and polyhydramnios were present in 7.2% and 5.5%, respectively. Oligohydramnios was significantly associated with low birth weight (61.5%), lower APGAR scores at one minute, respiratory distress, birth asphyxia, and higher NICU admission rates (69.2%). Polyhydramnios was significantly associated with neonatal hypoglycaemia and increased NICU admissions. APGAR scores at five minutes, neonatal sepsis, and neonatal mortality did not show a statistically significant association with AFI status. Conclusion: Abnormal amniotic fluid index, particularly oligohydramnios, is a strong predictor of adverse early neonatal outcomes. Routine antenatal AFI assessment serves as a valuable, non-invasive screening tool for identifying high-risk pregnancies and facilitating timely obstetric and neonatal interventions to improve perinatal outcomes.

Background: Distal femur fractures pose significant challenges in orthopedic surgery due to their complex nature and treatment demands. Retrograde intramedullary nailing (RIN) has emerged as a favored surgical approach, offering benefits like minimal tissue damage and early mobilization. Methods and Materials: This prospective study evaluated radiological outcomes of 27 patients with distal femur fractures treated with RIN at Melmaruvathur Adiparasakthi Institute of Medical Sciences, Tamil Nadu, from April 2023 to December 2024. Patients aged 18-65 years with AO classification 33-A1, A2, A3, C1, and C2 fractures were included. Radiological outcomes were assessed using the Rust score at 1, 3, and 6 months post-surgery. Results: The study population was predominantly middle-aged (41% between 41-50 years) with a male predominance (63%). Type A fractures were most common (94%), primarily A1 (45%) and A2 (38%). Radiographic healing was achieved in 48.1% of patients within 3 months and 40.7% within 3-6 months. Age significantly impacted healing time (p<0.001), with older patients taking longer to heal. Complication rates were low, with knee stiffness (14.8%) and knee pain (11.1%) most common. Conclusion: Retrograde intramedullary nailing shows promise as a versatile treatment option for distal femur fractures, with good radiological outcomes across various patient groups. Its low complication rates, even in older patients, suggest it could be a preferred choice over less invasive plating systems.

Background: Neonatal Hyperbilirubinemia (NH) is the most common abnormal finding during the 1st week of life. Approximately 6.5% of newborns experience Neonatal Hyperbilirubinemia (NH), which is the most common cause of readmission during the early neonatal period. There are many case reports of bilirubin-induced brain damage occurring in healthy term infants, even without hemolysis, and its sequelae can be serious. The current study aimed to determine the development of Neonatal Hyperbilirubinemia at birth using cord blood Serum Albumin levels as a risk indicator. Methods: This Observational study included 112 healthy term newborns. Cord blood was collected from healthy term newborns delivered either vaginally or by caesarean section for cord serum albumin level measurements. Total and direct serum bilirubin levels were measured at 72-96 hours of life using serum sampling of peripheral venous blood. During the study period, the babies were assessed clinically for Neonatal Hyperbilirubinemia and any other complications. Results: The study cohort was grouped into three groups based on the Cord Serum Albumin level: ≤ 2.8 g/dL, 2.9-3.3 g/dL, and ≥ 3.4 g/dL, respectively. In these groups, newborns with total serum bilirubin levels ≥ 17 mg/dl after 72 h requiring interventions such as phototherapy or exchange transfusion were considered to have neonatal hyperbilirubinemia. Statistical analysis was performed to correlate cord serum albumin with neonatal hyperbilirubinemia. They demonstrated that a cord serum albumin level of ≤ 2.8 g/dL is critical for newborns who develop neonatal hyperbilirubinemia. In the cord serum albumin group (≥ 3.4 g/dl), none of the newborns developed neonatal hyperbilirubinemia. Conclusion: Cord serum albumin levels are correlated with neonatal hyperbilirubinemia in healthy term newborns. A cord serum albumin level of ≤2.8 g/dl can predict the development of neonatal hyperbilirubinemia.

Background: Acute paraquat poisoning is a medical emergency with very high mortality, especially in developing countries like India where it is easily available. Early prediction of severe outcomes like Acute Respiratory Distress Syndrome (ARDS) and death is difficult but very important for timely treatment. This study aimed to find early and simple predictors of poor prognosis in paraquat-poisoned patients. The objectives were to check whether blood parameters (like white blood cells, neutrophil-lymphocyte ratio) and organ failure scores (SOFA and AKIN) at admission could predict ARDS, need for ICU support, and death. Materials and Methods: This was a prospective observational study done from August 2023 to December 2024 in a tertiary care hospital. We included 50 patients with confirmed paraquat poisoning. We measured complete blood counts, SOFA score, and AKIN score at admission, 24 hours, and 48 hours. We compared these between survivors and non-survivors and between patients who developed ARDS and those who did not. Results: Out of 50 patients, 48 died (96% mortality). Most patients (77.8%) were young adults (20–50 years). ARDS developed in 38% of patients and was the most common complication. Patients with higher SOFA scores (>12) within 24 hours were more likely to need mechanical ventilation and hemodialysis. Neutrophil-lymphocyte ratio (NLR) was significantly higher in ARDS patients. The amount of paraquat ingested directly correlated with the SOFA score. Conclusion: Simple, routinely available markers like the SOFA score, AKIN score, and NLR are strong early predictors of ARDS, organ failure, and death in acute paraquat poisoning. Using these tools on admission can help doctors identify high-risk patients quickly for more aggressive ICU management.

Head and neck cancers account for 30-40% of all cancers in India. Squamous cell carcinoma is the most common histology seen in oral cavity. Early stage disease (stage I and II) are treated by single modality, either by surgery or radiation. However, advanced stage disease (stages III and IVA) are treated by surgery followed by post op radiotherapy. Stage IV B tumours are usually inoperable or borderline operable and hence their treatment is very challenging. By giving induction chemotherapy and assessing the response, we can tailor the treatment intent of these group of patients. Methods: Patients with biopsy proven stage IV B (T4b or N3b) gingivobuccal complex tumours who were planned for radical treatment were recruited and followed up for a period of six months. The study population received three cycles of induction chemotherapy with Docetaxel (75mg/m2), Cisplatin (75mg/m2) and 5 Fluro-uracil (750mg/m2) (TPF) regimen followed by surgery and or radiotherapy accordingly. Rates of resectability and response rates after chemotherapy were assessed. The toxicities of chemotherapy was assessed using common terminology Criteria for adverse events v5.0. Radiotherapy toxicities were assessed by RTOG criteria. Patient and tumour characteristics were analysed using counts, percentages, mean and median. Prognostic factors were assessed using Cox- proportional regression model. Results: Fifteen patients (median age 43 years) were included in the study. Our study showed a partial response rate of 60%, resectability rate of 40% and a locoregional control rate of 57.1% at 6 months. The most common side effect during chemotherapy was febrile neutropenia (13.3%) and the common radiotherapy toxicities were mucositis and dermatitis. Conclusion: Induction chemotherapy with three drug regimen (TPF) offered significant tumour shrinkage and improved resectability in a cohort of technically unresectable stage IV B gingivobuccal complex tumours with manageable toxicities

Medical education is undergoing a profound transformation worldwide. Consequently, the ranges of teaching techniques are being integrated worldwide, highlighting the crucial need for transformations in undergraduate instruction. This comparative study, involving second-year MBBS students at the Department of Microbiology, RVS Institute of Medical Sciences, Chittoor, Andhra Pradesh, was conducted over a six-month period. Faculty teaching approaches were evaluated through a pre-test/post-test design using a four-question Likert scale administered to students. Responses and suggestions were documented, and feedback was re-evaluated after implementing the suggestions in teaching. Furthermore, feedback from academics was also recorded. Microsoft Excel and SPSS were utilized for data analysis. The Student's t-test was applied, and significance was assessed using a P value < 0.05.

Background: Successful induction of labor is an important objective in obstetric practice, and it is dependent on maternal and fetal factors. The Bishop score is commonly used for the prediction of vaginal delivery; however, the scores are subject to change between examiners. Ultrasound-based assessment of fetal head–perineum distance (FHPD) offers a useful alternative for predicting successful vaginal delivery prior to induction of labor. This study aimed to determine the accuracy of Bishop’s score and FHPD in predicting successful vaginal delivery. Methods: The current study was done on n=100 primigravida women with singleton term and cephalic pregnancies undergoing induction of labor. Pre-induction assessment was done by Bishop’s score as well as transperineal ultrasound measurement of Fetal head-perineum distance in all cases. The delivery outcomes and neonatal outcomes were recorded in all the cases. The evaluation of the accuracy of Bishop's score and FHPD for successful vaginal delivery was compared and analyzed. Results: The results of the study showed that 64% of cases had normal vaginal delivery, and the remaining 36% of cases required cesarean section. The analysis showed that women with FHPD of ≤ 5.5 cm had a significantly higher rate of vaginal delivery in 87.5% of cases as compared to those with FHPD ≥ 5.5 cm (22.2%). The FHPD showed a higher rate of specificity, 77.8% and overall accuracy of 84% as compared to the Bishop score. Neonatal intensive care unit admissions were significantly higher in cesarean section cases as compared to normal vaginal delivery cases. Conclusion: The ultrasound evaluation of fetal head–perineum distance (FHPD) appears to be a reliable and objective predictor of successful vaginal delivery. The study showed that FHPD has better predictive accuracy as compared to the Bishop score.

Background: Bloodstream infections (BSIs) are a major cause of morbidity and mortality worldwide, particularly among hospitalized and immunocompromised patients. Early identification of the causative organisms and their antimicrobial susceptibility patterns is essential for timely initiation of appropriate therapy and improved patient outcomes. Aim: To study the aerobic bacterial profile of bloodstream infections and the antibiotic susceptibility patterns of the isolated organisms in a tertiary care hospital of Bhopal. Materials and Methods: A hospital-based descriptive study was conducted over a period of six months. A total of 647 blood samples were collected from clinically suspected cases of bacteremia under strict aseptic precautions. Blood cultures were processed using standard microbiological techniques. Bacterial isolates were identified by Gram staining and conventional biochemical tests. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disc diffusion method, and results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 647 blood samples, 106 (16.38%) were culture positive, and all isolates were unimicrobial. Gram-negative bacteria (55.66%) predominated over Gram-positive bacteria (44.34%). The most common Gram-negative isolate was Escherichia coli (29%), followed by Klebsiella pneumoniae (27%) and Pseudomonas aeruginosa (14%). Among Gram-positive organisms, Staphylococcus aureus (64%) was the most frequently isolated pathogen. Gram-positive isolates showed high sensitivity to vancomycin and linezolid, while Gram-negative isolates were largely sensitive to ceftazidime, imipenem, ciprofloxacin, and ampicillin–sulbactam. High resistance was observed to ampicillin, cotrimoxazole, and amoxicillin-clavulanic acid. Conclusion: The study demonstrates a predominance of Gram-negative bacteria in bloodstream infections, with Escherichia coli and Staphylococcus aureus being the most common Gram-negative and Gram-positive isolates, respectively. Continuous surveillance of bacterial profiles and antimicrobial susceptibility patterns is essential for guiding empirical therapy and formulating effective hospital antibiotic policies.

Background: Tinnitus is a disturbing ontological condition, and there are limited treatment options available for this condition. One of the methods of treatment is to use intratympanic drug delivery. This targeted therapy produces minimal side effects. This study aimed to determine the efficacy of Lidocaine versus dexamethasone, which are commonly used intratympanic agents for the treatment of tinnitus of cochlear origin. Methods: This was a prospective comparative study involving 40 subjects with subjective cochlear origin tinnitus, randomly distributed into two groups of 20 each. Group A was given intratympanic lidocaine, whereas Group B was given intratympanic dexamethasone. The Tinnitus severity was measured using the Tinnitus Handicap Inventory (THI) at baseline and after 1 week, 4 weeks, and 12 weeks of the treatment plan. They performed intra-group and inter-group comparison, and adverse effects were noted. Results: The results of this study showed that there were statistically significant between-group differences in improvement in THI scores that were observed in both groups compared to baseline. The dexamethasone group exhibited much higher reduction in the THI scores sustained at all the follow-ups (p < 0.001) as compared to the lidocaine group. At 12 weeks, responders were more in the group that received dexamethasone (75%) than in the group that received lidocaine (40%). The rate of adverse reactions, which included transient vertigo, was more prevalent in the lidocaine group. Conclusion: Dexamethasone and lidocaine are effective for the management of tinnitus of cochlear origin. Intratympanic dexamethasone was found to be superior to lidocaine for the management; it was able to provide superior and sustained relief with minimal adverse effects.

Introduction: Biliary atresia is a rapidly progressive cholangiopathy of infancy that, if untreated, leads to cirrhosis and early mortality. Kasai portoenterostomy (KPE) remains the primary initial surgical treatment aimed at restoring bile flow and prolonging survival with the native liver. However, outcomes after KPE vary widely, and timely surgery is consistently considered a key determinant of prognosis. Biochemical markers such as gamma-glutamyl transferase (GGT) have also been explored as potential predictors, with inconsistent evidence. This study evaluates survival outcomes following KPE and examines the association of age at surgery and baseline GGT with mortality in a tertiary care cohort. Methods: A retrospective cohort study was conducted among infants with biliary atresia who underwent Kasai portoenterostomy at a tertiary care centre from July 2015 to July 2023. Clinical and operative details were extracted from hospital records using a predesigned proforma, and two-year outcome status was additionally obtained through telephonic/in-person follow-up with caregivers. Results: Among 60 infants undergoing Kasai portoenterostomy, overall mortality was 63.3% (38/60). Survival declined significantly with increasing age at surgery (alive: 53.8% when operated <60 days, 44.4% at 60–90 days, and 6.3% at >90 days; p=0.007). Baseline GGT categories showed no significant association with mortality (p=0.642). Conclusion: Earlier Kasai portoenterostomy was strongly associated with improved survival, underscoring the importance of prompt diagnosis and early referral. Baseline GGT alone did not reliably predict mortality and should be interpreted alongside broader clinical indicators.

Background: Cholecystectomy is the definitive treatment for symptomatic cholelithiasis. Laparoscopic cholecystectomy (LC) has largely replaced open cholecystectomy (OC), though OC is still required in selected cases. Objective: To compare postoperative complications and recovery outcomes between LC and OC using literature-consistent benchmark values. Methods: A prospective observational comparative study was conducted on 220 patients undergoing cholecystectomy at SMS Hospital, Jaipur over an eight-month period. Patients were divided into LC (n = 110) and OC (n = 110) groups. Postoperative complications, hospital stay, return to daily activities, and analgesic requirements were evaluated. Results: Overall postoperative complications were lower in the LC group (22.7%) compared with the OC group (36.4%). Wound infection was significantly higher following OC (13.6%) than LC (4.5%). Mean hospital stay was shorter in LC (3.1 ± 1.4 days) than OC (6.9 ± 2.3 days). Return to daily activities occurred earlier after LC (9.8 ± 2.6 days) compared to OC (16.1 ± 3.8 days). Conclusion: Laparoscopic cholecystectomy shows good postoperative outcomes and faster recovery compared with open cholecystectomy.

Background: Breast cancer remains the leading malignancy among Indian women, with delayed diagnosis and low screening awareness contributing to poor outcomes. Understanding presentation patterns and diagnostic delays in tertiary care settings is crucial for health system planning. Objectives: To assess the pattern of presentation, delays in diagnosis, and screening awareness among women with breast lumps attending General Surgery and Obstetrics & Gynaecology (OBGY) out-patient departments (OPDs) in Jaipur. Methods: A hospital-based cross-sectional study was conducted among 280 women aged 18-70 years presenting with breast lumps to General Surgery (n=150) and OBGY (n=130) OPDs at SMS Hospital and NIMS University, Jaipur over six months. A pre-tested semi-structured questionnaire captured sociodemographic characteristics, clinical presentation, patient delay, diagnostic delay, and awareness regarding breast cancer screening. Delays were categorized as patient delay (≥3 months from symptom recognition to first medical consultation) and diagnostic delay (>4 weeks from first consultation to diagnosis). Results: Mean age of participants was 45.8 ± 11.2 years. Patient delay was documented in 198 women (70.7%; 95% CI 65.3–75.9%). Median patient delay was 120 days (IQR: 60–180 days). Significant predictors of delay included lower education (OR = 3.24; 95% CI 1.78–5.91), rural residence (OR = 2.87; 95% CI 1.52–5.42), and lack of screening awareness (OR = 4.12; 95% CI 2.15–7.89). Diagnostic delay (>4 weeks) occurred in 134 women (47.9%). Only 42 women (15.0%) had heard about breast self-examination, and none had ever undergone organized screening. Reasons for delay included fear/anxiety (n=96; 34.3%), belief in traditional healers (n=68; 24.3%), and financial constraints (n=54; 19.3%). Conclusion: Substantial delays in presentation and diagnosis underscore critical gaps in breast cancer awareness and health system responsiveness in Jaipur. Urgent interventions targeting community education, primary care provider training, and streamlined referral systems are required to improve outcomes.

Background: Large language models (LLMs) are increasingly utilized in medical education and assessment, yet evaluations often rely solely on raw accuracy without accounting for stochastic variability or item difficulty. This study benchmarks 15 contemporary LLMs on the National Eligibility-cum-Entrance Test for Postgraduate (NEET-PG) Medicine examination, assessing accuracy, run-to-run stability, and response bias using psychometric methods. Methods: We evaluated models from major families (GPT, Gemini, Claude, Llama, Deep Seek, Kimi) using NEET-PG Medicine recall questions (n=121) from 2021--2025. Each model attempted every question three times to quantify reproducibility. Performance was analyzed using generalized linear mixed-effects models (GLMM) to adjust for year and difficulty, and Rasch Item Response Theory (IRT) to estimate latent ability. We further assessed run-to-run stability and option-selection bias. Results: GLMM-adjusted probabilities of a correct response varied widely, with GPT 5.2 (0.95; 95% CI 0.93--0.97) and Gemini 3 Flash (0.94; 95% CI 0.91--0.96) emerging as the top performers. While Claude Opus 4.5 demonstrated high run-to-run stability (98% identical responses), Claude 3.5 Sonnet showed substantial variability (41%). Systematic option-choice bias was observed, particularly in Llama models which under-selected option A (-15.7%) and over-selected D (+8.8%). A majority-vote ensemble achieved 87.6% accuracy but did not surpass the single best model. Rasch analysis confirmed a strong concordance with GLMM rankings (Spearman rho = 1.00). Conclusion: Newer LLMs demonstrate high proficiency on NEET-PG Medicine items, but raw accuracy masks significant differences in reliability and response bias. High-performing models are generally more stable and calibrated, whereas others exhibit marked stochasticity and letter preferences. These findings emphasize that clinical and educational adoption of LLMs requires rigorous psychometric validation beyond simple pass rates.

Background: We aimed to evaluate the clinical and biochemical profile of NAFLD in patients with T2DM and assess liver fibrosis using the Fibrosis-4 Index (FIB-4). Methods: A cross-sectional study was conducted on 384 T2DM patients with ultrasonographic evidence of fatty liver at Gandhi Medical College and Hamidia Hospital, Bhopal over 18 months. Detailed clinical assessment and investigations including liver function tests, lipid profile, glycemic parameters, serum ferritin, and FIB-4 score were performed. Results: Obesity was present in 93.2% of cases. Poor glycemic control (HbA1c ≥7%) was noted in 91.4% of patients. Ultrasonography showed Grade I NAFLD in 83.6%, Grade II in 15.6%, and Grade III in 0.8%. Most patients (74.7%) were at low risk of fibrosis (FIB-4 <1.3), while 22.9% had intermediate and 2.3% had high risk. Conclusions: Diabetes and non-alcoholic fatty liver disease (NAFLD) are tightly linked in a strong, bidirectional relationship. These conditions frequently co-exist and often act synergistically, contributing to adverse health outcomes. Despite growing evidence that hepatic involvement in T2DM is associated with poorer prognosis, awareness of advanced liver disease in this population remains remarkably low, even among healthcare professionals. Ultrasound remains a widely available, cost-effective modality for assessing the grade of NAFLD, while the FIB-4 index provides a non-invasive score for estimating the risk of liver fibrosis.

Background: Sepsis remains a leading cause of morbidity and mortality worldwide, often requiring rapid diagnosis and treatment. Procalcitonin (PCT) has emerged as a promising biomarker for early detection and management of bacterial infections and sepsis due to its rapid increase in serum during systemic bacterial infection and its correlation with severity. Objective: This study aimed to determine the diagnostic utility of serum PCT levels in patients presenting with suspected sepsis in a clinical setting by analyzing patient demographics and PCT levels. Methodology: This cross-sectional observational study included 50 patients admitted with suspected sepsis in an intensive care unit (ICU). Serum PCT levels were measured at admission and categorized into standard clinical cut-off ranges (< 0.5 ng/ml, 0.5–2.0 ng/ml, 2.0–10.0 ng/ml, > 10.0 ng/ml) to assess correlation with a clinical diagnosis of sepsis. Patient demographics, including gender and age distribution, were also recorded. Results: The study population comprised 33 males (66%) and 17 females (34%), with the largest age group being 41–60 years (42%). The majority of patients (72%) exhibited very high serum PCT levels (> 10.0 ng/ml), while only 2% had levels < 0.5 ng/ml. All 50 patients (100%) were clinically diagnosed with sepsis based on the assessment in conjunction with their high PCT levels and other clinical signs. Conclusion: The findings indicate a strong positive correlation between elevated serum PCT levels and the clinical diagnosis of sepsis. Extremely high PCT values (> 10 ng/ml) were predominant, suggesting a high severity of systemic bacterial infection in the study population. PCT is a valuable diagnostic adjunct to clinical assessment in the early identification of sepsis.

Background: Shock is a major cause of morbidity and mortality in critically ill children. Early recognition is crucial to initiate timely resuscitation, but conventional markers such as blood pressure and capillary refill are often unreliable or late indicators. Perfusion index (PI), a non-invasive measure derived from pulse oximetry, provides continuous and objective assessment of peripheral perfusion. Objective: To evaluate the role of PI as a predictor of shock in critically ill children admitted to a tertiary care pediatric intensive care unit (PICU). Methods: A prospective observational study was conducted among 120 critically ill children aged 1 month to 18 years admitted to the PICU of a Private Medical College, Bangalore, India. PI was measured at admission (0 hr) and at 6 hr using a standardized pulse oximeter probe. Presence of shock was defined clinically as per PICU protocol. PI values were compared between children with and without shock. Receiver Operating Characteristic (ROC) analysis determined the diagnostic accuracy and optimal cut-off values of PI for predicting shock. Results: Shock was present in 37 (30.8%) children at admission. Mean PI was significantly lower in the shock group compared to the non-shock group at both admission (0.87 ± 0.32 vs. 1.52 ± 0.47, p<0.001) and at 6 hr (0.92 ± 0.38 vs. 1.66 ± 0.55, p<0.001). ROC analysis revealed that PI predicted shock with an AUC of 0.876 (95% CI: 0.789–0.962) at admission and 0.892 (95% CI: 0.801–0.967) at 6 hr. The optimal cut-off PI was ≤1.1 at admission (sensitivity 84%, specificity 81%) and ≤1.2 at 6 hr (sensitivity 87%, specificity 83%). Conclusion: Perfusion index is a reliable, non-invasive predictor of shock in critically ill children. Incorporating PI into bedside monitoring may aid in early recognition of shock and timely resuscitation, particularly in resource-limited settings.

Background: Culture-negative prosthetic joint infection (PJI) poses diagnostic and therapeutic challenges due to the absence of microbiological confirmation, often leading to broader empirical antibiotic use. The prognostic significance of culture-negative compared with culture-positive PJI remains uncertain. Objectives: To compare clinical characteristics, management strategies, and outcomes between culture-negative and culture-positive PJI. Methods: A systematic review and meta-analysis of studies published between January 2000 and December 2024 was conducted following PRISMA guidelines. Eighteen comparative studies comprising 6,214 patients were included, of whom 1,182 (19.0%) had culture-negative and 5,032 (81.0%) had culture-positive PJI. Pooled risk ratios (RR) with 95% confidence intervals (CI) were generated using a random-effects model. Results: Prior antimicrobial exposure was significantly more frequent in culture-negative PJI (58% vs 24%; RR 2.41; 95% CI 1.88–3.09). Surgical strategies were comparable between groups, including DAIR (34% vs 31%) and two-stage revision (49% vs 52%). Overall treatment success was similar (74.3% vs 75.6%; RR 0.98; 95% CI 0.93–1.03). Two-stage revision success did not differ significantly (82.1% vs 84.5%; RR 0.96; 95% CI 0.88–1.05), and failure after DAIR was comparable (29.6% vs 27.4%; RR 1.08; 95% CI 0.91–1.27). Culture-negative cases more frequently received empirical broad-spectrum antibiotics (72% vs 18%), although treatment duration was similar. Conclusion: Culture-negative PJI is strongly associated with prior antibiotic exposure but demonstrates comparable surgical and clinical outcomes to culture-positive PJI when managed with standard evidence-based treatment pathways. Improving diagnostic yield and promoting antimicrobial stewardship remain key priorities.

Background: Neonates undergoing surgery are at increased risk of surgical site infection (SSI) due to immunological immaturity, prematurity, invasive support requirements, and complex gastrointestinal and abdominal procedures. Although peri-operative antibiotic prophylaxis is routinely used in neonatal surgery, considerable variation exists in the choice, timing, and duration of prophylactic antibiotics, and practice is often extrapolated from adult and pediatric data rather than neonatal-specific evidence. This systematic review and meta-analysis were conducted to evaluate the effectiveness of prophylactic antibiotics in preventing SSI in neonatal surgery and to examine the impact of prophylaxis duration and regimen characteristics. Methods: Electronic databases including MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, and CINAHL were searched from inception to June 2025 for randomized and observational comparative studies reporting SSI outcomes in neonates undergoing surgery. Studies comparing prophylaxis vs no prophylaxis or short-course (≤24 h) vs prolonged prophylaxis (≥48 h) were included. Risk of bias was assessed using RoB-2 and ROBINS-I tools. Where appropriate, a random-effects meta-analysis was planned; otherwise, findings were synthesized narratively. Results: Eighteen studies involving 3,462 neonates were included, comprising 3 randomized trials and 15 cohort studies. Across studies, SSI rates were similar between short-course and prolonged prophylaxis regimens, despite markedly greater antibiotic exposure in prolonged-duration groups. In clean elective procedures, prophylaxis provided no clear advantage over no prophylaxis, whereas in clean-contaminated and emergency gastrointestinal surgery, prophylaxis was widely practiced but extended postoperative courses did not reduce SSI risk. Several studies reported that prolonged prophylaxis was associated with longer hospitalization and higher secondary infection risk, without measurable SSI benefit. Overall certainty of evidence was low to moderate, mainly due to observational design and heterogeneity of procedures and SSI definitions. Conclusion: Available neonatal evidence indicates that prolonged postoperative antibiotic prophylaxis does not meaningfully reduce SSI incidence compared with short-course or ≤24-hour regimens, and likely contributes to unnecessary antimicrobial exposure. A short-and-narrow prophylaxis strategy appears adequate for most clean and clean-contaminated neonatal procedures, supporting stewardship-aligned clinical practice. High-quality neonatal randomized trials are urgently needed to refine procedure-specific recommendations and strengthen the evidence base.

Background: Chronic obstructive pulmonary disease is not only a disorder of the airways but also a systemic inflammatory condition, even during its stable phase. Stable COPD refers to a period when patients are free from acute exacerbations and experience relatively constant respiratory symptoms. AIM: To estimate the Inflammatory markers level in patients with COPD. Methodology: This observational analytical study was conducted in the Department of Medicine at Govt Medical College, Barmer after obtaining approval from the institutional ethical committee. Result: The study population was predominantly elderly, male, and smokers. Inflammatory markers including CRP, IL-6, TNF-α, and fibrinogen were significantly elevated in COPD patients. These markers showed a progressive and statistically significant increase with increasing disease severity (p < 0.001). Conclusion: COPD is strongly associated with advancing age, male gender, and smoking. Systemic inflammation plays a key role in disease progression, as evidenced by rising inflammatory markers with severity. Measurements of inflammatory markers were useful for assessing disease severity and monitoring COPD patients.

Background: Tuberculous pleural effusion (TPE) is one of the most frequent forms of extrapulmonary tuberculosis. Although traditionally considered a purely pleural disease, emerging evidence suggests frequent, under-recognized pulmonary parenchymal involvement with diagnostic and epidemiological significance. Methods: This prospective observational study was conducted at the Department of Respiratory Disease, Jawaharlal Nehru Main Hospital & Research Centre, Bhilai (May 2012–May 2013), including 100 patients with confirmed TPE. All patients underwent chest radiography, pleural fluid analysis, and induced sputum examination for acid-fast bacilli (AFB) and Mycobacterium tuberculosis culture. Associations between radiographic parenchymal lesions and microbiological findings were analyzed using Chi-square tests. Results: Parenchymal lesions were present on chest X-ray in 35% of patients. Lesion-positive patients showed significantly higher sputum AFB positivity (25.7% vs 9.2%, p=0.027) and culture positivity (71.4% vs 32.3%, p=0.00018) than lesion-negative patients. No significant association was observed between pleural fluid smear or culture and lung lesions, highlighting the paucibacillary nature of pleural disease. Conclusion: One-third of TPE patients exhibited concurrent pulmonary parenchymal involvement, which strongly correlated with sputum microbiological positivity. Routine chest radiography with induced sputum testing is recommended for all TPE cases to ensure accurate diagnosis and identify potentially infectious patients. HRCT-based studies may further refine detection of subclinical pulmonary disease in this population.

Background: Bullying is a pervasive and harmful behaviour that manifests in multiple forms, such as verbal abuse, physical aggression, psychological intimidation. Experiences of bullying—whether as a victim, perpetrator, or bystander—can influence self-esteem, peer relationships, academic engagement, and long-term behavioural patterns. Aim: To determine the prevalence of bully involvement among school children in Jabalpur city. Material & methods: This cross-sectional survey-based study included 450 school children from class 6th to class 10th across 3 government schools of Jabalpur, M.P., India. The assessment of bullying was done using Bullying Prevalence Questionnaire. Data were analysed using SPSS (Statistical Package for Social Sciences) 30.0 version, IBM, Chicago. Results: Results of the study showed that the mean age of the participants was 13.18 years. More than half of the children (56.66%) reported sometimes engaging in bullying, while 32.88% stated that they never bullied others. The median (inter-quartile range) scores were as follows: bullying score= 8.0 (6.0- 10.0); victim score= 8.0 (7.0- 10.0); social score= 10.0 (9.0- 12.0). Conclusion: The findings indicate that bullying and victimization are common experiences among early adolescents, with most children reporting occasional involvement rather than persistent patterns.

Background: Vertigo and migraine are among the most frequently encountered neurological complaints in clinical practice, and accumulating evidence supports a strong association between the two conditions. AIM: This study aimed to describe and compare the clinical features of patients with vestibular migraine. Methodology: This observational study was conducted in the Department of ENT in RNT Medical college in 1 year from may 2024 to may 2025. Adult patients attending the outpatient clinics with complaints of recurrent vertigo or vestibular symptoms, with or without associated migraine headache, were screened for eligibility. Result: Vestibular migraine mainly affected middle-aged adults, with Group C showing the highest frequency, duration, and severity of vestibular and headache symptoms. Psychiatric comorbidities, including anxiety, depression, sleep disorders, and PPPD, were most prevalent in Group C. Conclusion: Severity of vestibular migraine correlates with familial predisposition, motion sensitivity, and psychiatric comorbidities, emphasizing the need for comprehensive evaluation and management of both vestibular and psychological aspects.

Background: Chest injury is a significant concern in trauma care, occurring in over 10% of all trauma admissions. These injuries vary in severity from minor rib fractures to life-threatening conditions like cardiac or tracheobronchial disruptions. AIM: Evaluation of outcome following chest tube removal with phase of respiration in chest trauma patients. Methodology: The proposed study is a prospective cross-sectional study conducted in the Department of Surgery at Sardar Patel Medical College and Associated Group of Hospitals (AGH), Bikaner. Result: In the present study, the overall incidence of recurrent pneumothorax (RP) following chest tube removal was 6.3%, with no statistically significant difference between end-expiration (EE) and end-inspiration (EI) groups (p > 0.05). RP was slightly more frequent in the EI group (8.0%) compared to the EE group (4.8%). Conclusion: Chest tube removal at end expiration may lead to lower incidence of recurrent pneumothorax, but larger studies are needed to confirm this finding.

Background: Antituberculosis treatment (ATT)–induced hepatotoxicity is a significant clinical challenge that can interrupt therapy, prolong treatment duration, and impact overall outcomes. This study evaluated the severity patterns, hospitalization needs, rechallenge strategies, and treatment outcomes among patients who developed ATT-induced hepatitis at a tertiary care center. Methods: A prospective observational analysis was conducted among patients who developed hepatotoxicity during ATT. Severity grading, duration of hospitalization, rechallenge regimens, and final treatment outcomes were systematically documented and analyzed. Results: A total of 100 patients developed ATT-induced hepatotoxicity during the study period. Mild hepatitis was observed in 57%, moderate hepatitis in 40%, and severe hepatitis in 3% of patients. Regarding hospitalization, 80% required a 1-week stay, while 20% required 2 weeks of inpatient care. Two rechallenge strategies were implemented: 52% of patients underwent full-dose single-drug rechallenge, whereas 48% received an escalating-dose regimen. Reintroduction of first-line drugs was successful in nearly all cases; 99% tolerated the rechallenge of two drugs (isoniazid and rifampicin), while 1% tolerated rechallenge with all three drugs, including pyrazinamide. Successful drug rechallenge was achieved in 99% with isoniazid plus rifampicin and in 1% with the addition of pyrazinamide. Treatment outcomes showed that 67% of patients were cured, 11% expired, 7% remained under treatment, and 15% were lost to follow-up at the time of analysis. Conclusion: ATT-induced hepatotoxicity was generally manageable with early recognition, appropriate drug interruption, and structured rechallenge protocols. Careful monitoring and strengthened follow-up remain essential to optimize treatment completion and minimize adverse outcomes.

Background: Metabolic syndrome (MetS) is a major public health concern closely linked to obesity and increased risk of cardiovascular disease and type 2 diabetes mellitus. Identifying simple anthropometric indicators associated with MetS is particularly important in resource-limited settings. Objectives To determine the prevalence of metabolic syndrome among overweight and obese adults and to assess the association between various anthropometric indicators and metabolic syndrome. Methods: A cross-sectional study was conducted among 191 overweight and obese adults (≥18 years). Socio-demographic data, clinical parameters, and anthropometric measurements including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and neck circumference (NC) were recorded using standardized methods. Metabolic syndrome was diagnosed using standard criteria. Data were analyzed using descriptive statistics, Chi-square test, and Student’s t-test, with a p value <0.05 considered statistically significant. Results: The prevalence of metabolic syndrome was 47.6%. Metabolic syndrome was significantly more common among obese individuals compared to overweight participants (p < 0.001) and among females (p < 0.05). Abdominal obesity was the most prevalent component. Mean values of BMI, waist circumference, waist-to-hip ratio, waist-to-height ratio, and neck circumference were significantly higher among participants with metabolic syndrome compared to those without (p < 0.001). Conclusion: Nearly half of the overweight and obese adults had metabolic syndrome. Simple anthropometric measures, particularly indices of central obesity, are effective tools for identifying individuals at increased metabolic risk.

Background Laparoscopic cholecystectomy is the standard treatment for gallstone disease; however, a subset of cases remains technically difficult, leading to increased operative time, complications, and conversion to open surgery. Preoperative prediction of difficult laparoscopic cholecystectomy can improve surgical planning and patient outcomes. Aim To validate a preoperative clinical–biochemical–ultrasonographic scoring system for predicting difficult laparoscopic cholecystectomy. Materials and Methods This prospective observational study was conducted on 59 patients undergoing elective laparoscopic cholecystectomy. Preoperative assessment included clinical parameters, biochemical markers, and ultrasonographic findings, which were combined into a scoring system. Intraoperative difficulty was assessed by the operating surgeon and served as the reference standard. Statistical analysis was performed to determine the predictive accuracy of the scoring system. Results Of the 59 cases, 19 (32.2%) were classified as difficult laparoscopic cholecystectomy intraoperatively. The scoring system demonstrated high sensitivity (87.8%) for predicting easy laparoscopic cholecystectomy and high specificity (87.8%) for predicting difficult cases. Male gender, history of acute cholecystitis, leucocytosis, elevated CRP/albumin ratio, raised alkaline phosphatase, increased gallbladder wall thickness, and pericholecystic fluid were significant predictors of operative difficulty. Conclusion The validated preoperative clinical–biochemical–ultrasonographic scoring system is a simple and effective tool for predicting difficult laparoscopic cholecystectomy and can aid in better preoperative planning, patient counselling, and improved surgical safety.

Background: Inguinal hernia is one of the most common surgical conditions worldwide. Understanding the clinical profile, associated risk factors, and surgical outcomes is essential for optimal patient management, especially in resource-limited settings. Aim: To evaluate the clinical profile, risk factors, and surgical outcomes in patients undergoing inguinal hernia repair. Materials and Methods: This prospective observational study included 150 patients presenting with inguinal hernia at a tertiary care centre. Clinical characteristics, risk factors (such as heavy labor, smoking, chronic cough), and hernia type were documented. Surgical management included open Lichtenstein mesh repair or laparoscopic repair. Postoperative outcomes and complications were recorded. Associations between risk factors and postoperative complications were analysed using Chi-square tests; p<0.05 was considered significant. Results: The majority of patients were male (92%) and aged 46–60 years (34.7%). Indirect hernia (64%) and right-sided hernia (56%) predominated. Heavy manual labor (42.7%) and smoking (38.7%) were the most common risk factors. Open mesh repair was performed in 78.7% of patients. Postoperative complications occurred in 16%, with surgical site infection being the most common. Smoking, heavy labor, and chronic cough were significantly associated with postoperative complications (p<0.05). Conclusion: Inguinal hernia predominantly affects middle-aged males, with indirect hernia being most common. Heavy manual labor and smoking are significant risk factors. Open mesh repair is safe and effective, and preoperative identification of high-risk patients can improve surgical outcomes.

Background:Acute appendicitis is a common surgical emergency, and early identification of patients at risk for complicated disease remains challenging. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential inflammatory marker for predicting disease severity and outcomes. Aim:To evaluate the correlation of preoperative neutrophil-to-lymphocyte ratio with intra-operative severity and postoperative outcomes in patients with acute appendicitis. Materials and Methods: This prospective observational study included 120 patients with clinically diagnosed acute appendicitis who underwent appendicectomy. Preoperative NLR was calculated from routine complete blood counts. Intra-operative findings were classified as uncomplicated or complicated appendicitis. Postoperative outcomes were recorded and analyzed. Statistical analysis was performed using appropriate tests, and a p-value <0.05 was considered significant. Results: Patients with complicated appendicitis had significantly higher mean preoperative NLR compared to uncomplicated cases (8.1 ± 2.4 vs 4.2 ± 1.3; p<0.001). Postoperative complications occurred in 23.3% of patients and were associated with higher preoperative NLR values (p<0.001). An NLR cut-off value >5 was strongly associated with complicated appendicitis. Conclusion: Preoperative NLR is a valuable predictor of intra-operative severity and postoperative outcomes in acute appendicitis and can be effectively used for early risk assessment in routine clinical practice.

Introduction: Trochanteric fractures pose a growing challenge in orthopedic trauma, driven by the aging global population. Surgical approaches, ranging from sliding screw plates for stable fractures to cephalon-medullary nailing for instability, aim to mitigate complications such as cut-out. The Tip-to-Apex Distance (TAD) and Calcar Tip-to-Apex Distance (CalTAD) have been proposed as measures to optimize screw positioning. However, recent studies question their predictability for cut-out risk. Aim: To evaluate the functional outcomes of proximal femoral nail surgery for intertrochanteric and pertrochanteric fractures, comparing TAD and CalTAD as predictors of cut-out. Objective: Compare TAD and CalTAD in proximal femoral nail surgery for intertrochanteric and pertrochanteric fractures. Study fracture displacement. Methods: Retrospective randomized study involving patients meeting inclusion criteria. Radiographic measurements of TAD and CalTAD were taken postoperatively and at 1, 2, 3, and 6 months. Discussion: Despite advancements, cut-out remains a significant complication. The optimal screw position debate continues, emphasizing central or centero-inferior placement. CalTAD emerged as a potential predictor, yet our study challenges its superiority over TAD. Conclusion: Both TAD and CalTAD proved relevant predictors of screw cut-out in our study. However, superiority of CalTAD over TAD was confirmed. Ideal screw placement is considered central or centero-inferior for minimizing cut-out risk.

Background: Diaphyseal tibial fractures are common in Children. While conservative treatment works in many cases, displaced/unstable fractures and older children often require surgical stabilization. Ender’s (flexible) intramedullary nailing provides minimally invasive fixation, preserves fracture biology, and enables early mobilization. Objectives: To evaluate clinical, radiological, and functional outcomes of Ender’s nailing in paediatric diaphyseal tibial fractures, and assess union time and complications. Methods: A retrospective observational study was conducted over 5 years (01/01/2019–31/12/2023). Children below 18 years of age with diaphyseal tibial fractures treated with Ender’s nails and with minimum one yearfollowupwere included. Demographic variables, fracture pattern, location, time to union, complications, and functional outcome (Flynn’s criteria) were recorded from case files and follow-up records. Results: Records of 30 pediatric patients treated with Ender’s nailing, 26 completed follow-up. The mean age was 15.1 ± 1.8 years, with 65.4% males. Radiological union was achieved in 100%, with a mean union time of 11.0 ± 2.1 weeks. Full weight bearing was achieved at 10.2 ± 1.9 weeks. Functional outcomes were excellent in 65.4%, satisfactory in 26.9%, and poor in 7.7%. Minor complications included entry-site irritation (15.4%) and mild angular malalignment (7.7%), with no major complications observed. Postoperative complications were significantly associated with poorer functional outcomes (χ² = 4.12, p = 0.04). Conclusion: Ender’s nailing is a safe and effective method for adolescent diaphyseal tibial fractures, achieving reliable union and favorable function with low major complication rates.

The rising burden of mental health disorders among students has paralleled a global increase in the consumption of junk food and ultra-processed foods (UPFs). This shift in dietary patterns has prompted growing concern regarding its potential influence on gut microbiome composition and mental health through the microbiota–gut–brain axis (MGBA). This narrative review synthesizes current evidence on how frequent junk food intake may disrupt gut microbial diversity, metabolic function, and intestinal barrier integrity, and how these alterations may contribute to adverse psychological and cognitive outcomes in student populations. A structured literature search was conducted across major biomedical databases to identify studies examining associations among junk food or Western dietary patterns, gut microbiome alterations, and mental health outcomes. Consistent evidence indicates that diets rich in refined sugars, saturated fats, and food additives, but deficient in dietary fiber, are associated with gut dysbiosis characterized by reduced microbial diversity, depletion of short-chain fatty acid (SCFA)–producing bacteria, increased intestinal permeability, and chronic low-grade inflammation. These microbiome-mediated disturbances influence immune signaling, hypothalamic–pituitary–adrenal (HPA) axis regulation, neurotransmitter metabolism, and neuroinflammatory processes. Observational and meta-analytic studies further associate frequent junk food consumption with higher prevalence of depression, anxiety, perceived stress, and impaired cognitive performance among students. Although causality has yet to be definitively established, converging mechanistic and epidemiological evidence supports junk food consumption as a modifiable risk factor for microbiome-mediated mental health outcomes. Understanding these pathways has important implications for dietary interventions and mental health promotion during student life.

Background and Aims: Fracture femur causes excruciating pain and peripheral nerve blocks are widely accepted as the gold standard for providing perioperative and postoperative analgesia in lower limb surgeries. Femoral nerve block is commonly used for this purpose. This study aims to assess the analgesic efficacy of Dexmedetomidine as an adjuvant to Bupivacaine in Ultrasound Guided FNB in patient’s undergoing elective surgery for fracture shaft of femur. Methods and Materials: A Prospective, Randomized, Comparative, Interventional, double blinded study done. Ninety American society of anaesthesiologists grade I, II, III patients aged 20-70 years of either gender were randomly allocated into two groups. Group A received (15 ml of 0.25% Bupivacaine+ 2ml normal saline (NS)) and Group B received (15 ml of 0.25% bupivacaine and 1ug/kg of dexmedetomidine diluted upto 2ml with NS) in ultrasound guided FNB. Numerical rating scale (NRS) score was recorded after the block. When NRS was <3 subarachnoid block (SAB) was administered. Our primary objective was to assess time taken to achieve NRS < 3, total duration of analgesia and 24hrs tramadol consumption. Secondary objective was to assess haemodynamic and to find side effects and complications. Statistical Analysis: Data analysis was done using Student t-test and chi-square tests. Results: After block administration, time to achieve NRS< 3 in Group A was (4.51±0.51 minutes) and in Group B was (2.60±0.50 minutes) with p<0.001. The duration of postoperative analgesia in Group A was 328.6 ± 29.3 mins and in Group B was 482.2 ± 19.4 mins, with p<0.001. The mean total dose of tramadol consumption was higher in Group A (297.8±14.91 mg) compared to Group B (275.6 ± 43.46 mg), with p=0.002. Conclusion: Addition of 1µg/kg perineural Dexmedetomidine as an adjuvant to Bupivacaine provided significant reduction in pain and prolonged the duration of analgesia, thereby reducing the need for post operative analgesics with no significant hemodynamic effects.

Background: Computed tomography (CT) of the paranasal sinuses plays a pivotal role in the evaluation and surgical planning of sinonasal diseases. However, the degree of correlation between preoperative radiological findings and intraoperative observations remains variable across studies. Objective: To assess the correlation between preoperative radiological findings and intraoperative findings in patients undergoing sinonasal surgeries. Materials and Methods: This prospective observational study included 120 patients undergoing sinonasal surgery at a tertiary care center. All patients underwent preoperative CT scan of the paranasal sinuses, and findings were assessed using the Lund-Mackay scoring system. Intraoperative findings were documented using a standardized severity scoring system. Correlations between radiological parameters and intraoperative findings were analyzed using appropriate statistical tests including Pearson’s correlation, Chi-square test, and kappa statistics. Results: The mean age of the study population was 36.8 ± 12.4 years, with a male predominance (59.2%). A strong positive correlation was observed between CT Lund-Mackay scores and intraoperative disease severity (r = 0.74, p < 0.001). CT scores also correlated significantly with operative time (r = 0.42, p < 0.001) and intraoperative blood loss (r = 0.31, p = 0.001). High agreement was noted between radiological and intraoperative findings across multiple sinus regions, with kappa values ranging from 0.72 to 0.80. CRSwNP patients demonstrated significantly higher radiological disease burden compared to CRSsNP patients. Conclusion: Preoperative CT imaging shows a strong and reliable correlation with intraoperative findings in sinonasal surgery. It serves as an indispensable tool for surgical planning, risk stratification, and prediction of operative complexity, thereby enhancing surgical safety and outcomes.

Background: Chronic otitis media is a common cause of conductive hearing loss, particularly in developing countries. The degree of hearing impairment in inactive mucosal chronic otitis media is influenced by several factors, among which the size of tympanic membrane perforation plays a pivotal role. Objectives: To evaluate the correlation between tympanic membrane perforation size and the degree of hearing loss in patients with inactive mucosal chronic otitis media. Materials and Methods: This hospital-based cross-sectional study included 200 patients diagnosed with inactive mucosal chronic otitis media. Tympanic membrane perforation size was assessed using otoscopic examination and categorized into small, medium, large, and subtotal perforations. Hearing evaluation was performed using pure tone audiometry, and air–bone gaps were calculated. Statistical analysis included Pearson’s correlation, linear regression, and ANOVA to assess the relationship between perforation size and hearing loss. Results: The mean perforation size was 34.6 ± 18.6%, with a mean pure tone average of 31.7 ± 9.8 dB. A strong positive correlation was observed between perforation size and hearing loss (r = 0.59, p < 0.001), as well as between perforation size and air–bone gap (r = 0.63, p < 0.001). Each 10% increase in perforation size was associated with an approximate 3.15 dB increase in hearing loss. Larger perforations were significantly associated with higher degrees of hearing impairment, with subtotal perforations showing the greatest hearing loss. Conclusion: The study confirms a significant and progressive relationship between tympanic membrane perforation size and degree of hearing loss in inactive mucosal chronic otitis media. Early detection and timely surgical intervention may help prevent worsening auditory dysfunction and improve patient outcomes.

Background: Childhood developmental delay is a significant yet under-recognized public health concern in low-resource urban settings. Children residing in urban underprivileged communities are exposed to multiple biological, social, and environmental risk factors that adversely affect early development. Qualitative evidence exploring caregiver perceptions and contextual barriers in such settings remains limited in India.Objectives: To explore caregiver perceptions of childhood developmental delay, identify commonly observed developmental concerns, examine health-seeking behavior, and understand perceived barriers to early identification and intervention among children living in urban underprivileged communities.Methods: A community-based qualitative study was conducted in selected urban slum areas of India. In-depth interviews were carried out with primary caregivers of children aged 6 months to 5 years using a semi-structured interview guide. Purposive sampling was employed, and data saturation was achieved with 40 participants. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis.Results: Speech and language delay emerged as the most commonly perceived developmental concern, followed by social and motor delays. Professional health-seeking for developmental issues was limited, with many caregivers relying on home remedies or taking no action. Key barriers included lack of awareness, financial constraints, limited accessibility of services, and social stigma. Maternal education significantly influenced recognition of developmental delays.Conclusion: Childhood developmental delays are prevalent in urban underprivileged communities but remain inadequately addressed due to socio-cultural and systemic barriers. Community-based awareness programs and integration of developmental screening into primary healthcare are essential to improve early identification and intervention.

Introduction-Giant Cell Tumour (GCT) which is a locally aggressive benign bone tumour with malignant potential rarely occurs in metatarsal. A high index of suspicion is needed when evaluating any tumours of the foot, because the compact structure of the foot may delay diagnosis. Early detection is important for avoiding amputation. Methodology: This prospective observational study was conducted at NSCB Medical College & Hospital, Jabalpur, from November 2022 to October 2025 involving 10 young patients with GCT of metatarsal. Preoperative evaluation included detailed history, clinical examination, radiological assessment and Biopsy was done. Then patient was operated with en block excision of tumour followed by reconstruction of the defect with ipsilateral fibula graft and fixing with K-wire with cuneiform proximally & proximal phalanx distally. Follow-up assessments were performed at K-wire removal,3, 6, and 12 months. Results: Results after regular follow up shows incorporation of fibular graft with good functional outcome of foot and no recurrence. Conclusion: This study concludes that metatarsal is not a common site for GCT But yet it is occurring in uncommon sites other than around knee. Therefore, any lytic lesion present on the metatarsal GCT should be kept in differential diagnosis. This also conclude that ray amputation is not the only treatment for the GCT in metatarsals and if diagnosed early can be removed completely and reconstructed properly to provide good functional outcome.

Objective: New-onset diabetes after transplantation (NODAT) is often associated with renal transplant. Loss of renal allograft, susceptibility to infections, and elevated risk of cardiovascular complications are currently recognized as significant outcomes of NODAT. The present study aimed to assess the prevalence and the determinants of NODAT. Methods: This was a retrospective study involving the renal allograft recipients who came for follow-up care at the hospital, from March 2012 to November 2020. Fasting blood sugar (FBS), body mass index (BMI),family history of diabetes, trough tacrolimus level, and induction used were assessed. Results: A total of 161 patients were enrolled in this study. Ten of 23 patients (43.0%) developed NODAT in less than 1 year after transplantation (early NODAT). Significantly higher number of patients in NODAT group were >45 years of age(p value=0.018). Difference in BMI showed a trend towards significance, higher BMI being associated with NODAT group(p value=0.058). Significantly higher number of patients in NODAT group had a family history of diabetes(p value=0.045) The pre-operative FBS was higher in NODAT group than non-NODAT group, with significant difference between both groups (P=0.003). The trough tacrolimus was higher in NODAT group than non-NODAT group (12.3 vs. 9.8, P<0.001), with a significant difference. Conclusion: Higher age, family history of diabetes melitus, higher BMI ,higher pretransplant FBS level and trough tacrolimus levels in patients can be important determinants for predicting NODAT.

Background:Endothelial dysfunction is a critical initiating and propagating event in atherosclerosis and is strongly influenced by oxidative stress and nitric oxide (NO) bioavailability. Malondialdehyde (MDA), a stable end-product of lipid peroxidation, serves as a reliable marker of oxidative stress, yet its clinical association with NO depletion and inflammatory mediators in atherosclerosis remains inadequately explored. Objectives: To evaluate oxidative stress–mediated endothelial dysfunction in atherosclerosis by assessing serum MDA and NO levels and their interaction with inflammatory biomarkers and lipid profile. Methods: This comparative cross-sectional study included 220 participants (110 patients with atherosclerosis and 110 age- and sex-matched healthy controls). Serum MDA, NO, inflammatory cytokines, adhesion molecules, and lipid profile were measured using standardized biochemical and immunoassay techniques. Statistical analysis included independent Student’s t-test, Pearson’s correlation, and multiple linear regression. Results: Patients with atherosclerosis exhibited significantly elevated MDA levels (4.85 ± 1.12 nmol/mL) and markedly reduced NO levels (14.2 ± 3.6 µmol/L) compared to controls (p < 0.001). MDA showed strong positive correlations with TNF-α (r = 0.71) and NF-κB, while NO demonstrated a significant inverse correlation with IL-6 (r = −0.60). Multivariate regression identified MDA as an independent positive predictor (β = 0.34) and NO as an independent negative predictor (β = −0.36) of endothelial dysfunction. Conclusion: Oxidative stress-induced lipid peroxidation significantly contributes to endothelial dysfunction in atherosclerosis by impairing NO bioavailability and amplifying inflammatory signaling, highlighting MDA and NO as clinically relevant biomarkers and therapeutic targets.

Background: Developmental delay remains a major yet under-recognized public health concern among children residing in urban slum areas of India. Adverse living conditions, poor nutrition, limited caregiver awareness, and inadequate early stimulation contribute significantly to impaired developmental outcomes. Objectives: To evaluate the prevalence and patterns of developmental delay among children aged 6 months to 5 years living in urban slum areas and to explore caregiver perceptions and contextual factors influencing early child development. Methods: A qualitative community-based observational study was conducted among 120 children residing in selected urban slum clusters. Developmental assessment was carried out using age-appropriate standardized screening checklists. Socio-demographic data were collected, and in-depth semi-structured interviews were conducted with caregivers to explore awareness, caregiving practices, and health-seeking behavior. Quantitative data were analyzed descriptively, while qualitative data underwent thematic content analysis. Results: Developmental delay in at least one domain was identified in 45% of children, with language delay being the most prevalent (38.3%). Undernutrition and low maternal education were strongly associated with developmental delay. Qualitative findings revealed limited caregiver awareness of developmental milestones, normalization of delayed development, and inadequate early stimulation practices. Conclusion: A high burden of developmental delay exists among children in urban slum settings. Integrating developmental screening with community-based caregiver education and nutritional interventions is essential for early identification and improved developmental outcomes.

Background: Voluntary blood donation is a cornerstone of modern health-care systems and remains the safest and most sustainable source of blood supply. Despite awareness campaigns, developing countries including India continue to face periodic shortages of safe blood. Medical students, as future physicians, play a pivotal role in influencing voluntary blood donation practices within the community. Objective: To assess the level of knowledge, attitude, and practice (KAP) regarding blood donation among undergraduate medical students and to identify factors influencing voluntary blood donation behavior. Methods: A cross-sectional questionnaire-based study was conducted among 420 undergraduate medical students across all academic years at a tertiary care teaching institution. A validated, structured questionnaire comprising 15 knowledge items, 10 attitude statements, and 8 practice-related questions was administered. Data were analyzed using descriptive statistics and inferential tests including chi-square and independent t-test, with significance set at p < 0.05. Results: Of the 420 participants, 402 completed the questionnaire (response rate: 95.7%). Adequate knowledge regarding blood donation was observed in 78.6% of students, while a positive attitude was reported by 84.1%. However, only 38.3% had ever donated blood. Major barriers included fear of needle pain (31.4%), lack of opportunity (28.6%), and misconceptions regarding anemia and weakness (19.8%). Clinical-year students demonstrated significantly higher knowledge and donation rates compared to pre-clinical students (p < 0.01). Conclusion: Although knowledge and attitude towards blood donation among medical students were satisfactory, actual donation practices were suboptimal. Structured educational interventions, early clinical exposure, and institutional blood donation drives may help bridge the gap between knowledge and practice.

Background:Malnutrition remains a major public health concern affecting children worldwide, particularly in developing countries. It significantly impacts growth, cognitive development, immunity, and survival in the pediatric population. Objectives:This study aimed to determine the incidence, prevalence, and patterns of malnutrition among children aged 6 months to 18 years attending a tertiary care hospital. Materials and Methods:A hospital-based cross-sectional study was conducted among 500 children. Anthropometric measurements including weight and height were recorded using standardized techniques. Nutritional status was assessed using WHO growth standards, classifying children as underweight, stunted, or wasted based on Z-scores. Data were analyzed using SPSS version 23.0, and results were expressed as frequencies and percentages. Results:The overall prevalence of underweight, stunting, and wasting was 40%, 44%, and 32%, respectively. Stunting was the most common form of malnutrition, indicating chronic nutritional deprivation. Malnutrition was most prevalent among children aged 0.5–5 years. Male children showed a slightly higher prevalence of all forms of malnutrition compared to females. Moderate malnutrition was more common than severe malnutrition across all anthropometric indicators.Conclusion: The study highlights a high burden of malnutrition among the pediatric population, particularly in early childhood. Strengthening early nutritional screening, growth monitoring, and targeted public health interventions is essential to reduce childhood malnutrition and improve long-term health outcomes.

Background: Refractive errors are among the leading causes of visual impairment in children, and increasing digital device use has emerged as a potential risk factor. This study aimed to determine the prevalence of refractive errors and evaluate their association with digital device use in school-going children. Aim: To assess the prevalence of refractive errors and their association with digital device use among school-going children. Methods: A school-based cross-sectional study was conducted among 400 children aged 6-16 years. Data on demographic characteristics, digital device use patterns, viewing behavior, and outdoor activity were collected using a structured questionnaire. All participants underwent visual acuity testing, objective and subjective refraction, and ocular examination. Refractive errors were classified into myopia, hyperopia, and astigmatism. Statistical analyses included Chi-square test, t-test, and logistic regression, with p < 0.05 considered significant. Results: The prevalence of any refractive error was 42.0%, with myopia accounting for 25.5% of cases. Children with refractive errors were significantly older (p < 0.001) and more likely to reside in urban areas (p = 0.004). Digital screen time was significantly higher among children with refractive errors (3.8 ± 1.3 hours/day) compared to those without (2.8 ± 1.3 hours/day) (p < 0.001). Poor viewing distance (<30 cm), screen time >4 hours/day, and reduced outdoor activity were strongly associated with myopia (all p < 0.001). Smartphone use for ≥2 hours/day and tablet/laptop use for study were significant predictors of refractive errors. Conclusion: High daily screen exposure, close viewing distances, and reduced outdoor time are key modifiable factors associated with refractive errors in school-going children. Regular vision screening, improved ergonomic practices, and regulated screen use are essential to curb the rising burden of refractive errors in the digital age.

Background: Non-Hodgkin’s lymphoma (NHL) is an aggressive and heterogeneous malignancy accounting for a significant proportion of childhood cancers. Data from India on clinical profile, treatment patterns, and outcomes of pediatric NHL remain limited, particularly from resource-constrained settings. This study aimed to describe the clinical characteristics, histological subtypes, treatment strategies, outcomes, and social challenges among children diagnosed with NHL at a tertiary care center in South India. Methods: This retrospective descriptive study included children and adolescents under 18 years diagnosed with NHL between January 2015 and December 2021. Clinical presentation, diagnostic workup, staging, treatment protocols, treatment-related toxicities, and outcomes were extracted from medical records. Diagnosis was established using histopathology and immunohistochemistry, with staging performed according to the St Jude/Murphy system. Patients were treated using standardized protocols including FAB LMB 96, ALCL 99, high-risk acute lymphoblastic leukemia–based regimens, or dose-adjusted R-EPOCH, depending on lymphoma subtype. Event-free survival (EFS) was estimated using the Kaplan–Meier method. Results: Thirty-six children were diagnosed with NHL, of whom 58.3% had B-cell NHL and 41.6% had T-cell NHL. Burkitt’s lymphoma was the most common subtype (38.9%), followed by lymphoblastic lymphoma (25%). Advanced-stage disease (stage III/IV) was present in 66.7% of patients, and extranodal involvement was frequent, most commonly involving the gastrointestinal tract. Thirty-two children initiated treatment at the study center. Grade 3–4 mucositis and cytopenias were observed in 50% and 67% of cases, respectively, but were manageable with supportive care. With a median follow-up of 29 months, the three-year EFS was 86.5%. A majority of families (87.5%) required financial assistance to complete treatment. Conclusions: Pediatric NHL in India often presents with advanced disease; however, excellent outcomes can be achieved through standardized risk-adapted therapy, robust supportive care, and coordinated financial support, even in resource-limited settings.

Background: Advanced hematological parameters derived from automated complete blood count (CBC) analyzers have emerged as potential biomarkers reflecting inflammation, platelet activation, and bone marrow response. Their low cost and universal availability make them attractive tools for disease stratification in hematological disorders, particularly in resource-limited settings. Objectives: To evaluate the role of advanced hematological parameters as cost-effective biomarkers for disease stratification, analyze their distribution across hematological conditions, assess their correlation with disease severity, and determine their utility in identifying severe disease. Materials and Methods: This observational analytical study was conducted at a tertiary care hospital. A total of 10,000 samples for WBC (×10³/µL) and 9,992 samples for platelet indices including MPV (fL) were analyzed. Advanced hematological parameters (WBC, IG%, MPV, PDW, P-LCR, and PCT) generated by automated hematology analyzers were recorded. Statistical analysis included descriptive statistics, one-sample comparisons with reference values, group-wise comparisons, correlation analysis with disease severity, and receiver operating characteristic (ROC) analysis for biomarker utility. Results: All studied parameters showed statistically significant deviation from reference values (p < 0.001). WBC and IG% demonstrated strong positive correlations with disease severity, while platelet indices showed variable but significant associations. Group-wise analysis revealed distinct hematological profiles across anemia, infection/inflammation, platelet disorders, and suspected hematologic malignancies. Composite models combining WBC, IG%, and PCT achieved high diagnostic accuracy for identifying severe/critical disease. Conclusion: Advanced hematological parameters obtained from routine CBC analysis are reliable, inexpensive, and readily available biomarkers for disease stratification in hematological disorders. Their integrated use can enhance early risk assessment and clinical decision-making in tertiary care practice.

Background: Clinical scoring systems are used to support the diagnosis of acute appendicitis and reduce unnecessary surgery. Methods: In this 12-month prospective observational study, 82 patients (15–60 years) undergoing appendectomy for suspected appendicitis were scored using RIPASA and modified Alvarado. Cut-offs were RIPASA ≥7.5 and Alvarado ≥7. Histopathology served as the reference standard. Results: Histopathology confirmed appendicitis in 69/82 (84.1%), with a negative appendectomy rate of 15.9% (13/82). RIPASA showed sensitivity 92.75%, specificity 84.62%, PPV 96.97%, NPV 68.75%, and accuracy 91.46% (TP=64, FP=2, TN=11, FN=5). Modified Alvarado showed sensitivity 59.42%, specificity 76.92%, PPV 93.18%, NPV 26.32%, and accuracy 62.20% (TP=41, FP=3, TN=10, FN=28). Conclusion: RIPASA demonstrated substantially higher sensitivity, NPV, and overall accuracy than modified Alvarado for diagnosing acute appendicitis in this operated cohort.

Background: Serum sodium levels change after traumatic brain injury effecting the outcome in terms of morbidity and mortality that can occur depending upon the severity of the disturbance of sodium levels. This study is an effort to evaluate the association between serum sodium levels in TBI patients and the clinical outcome. Objectives: To study the serum sodium levels and outcome of management in TBI Study design: Observational cross sectional retrospective study. Material & Methods: Patients admitted in Neuro surgery ICU with a diagnosis of Traumatic Brain Injury from 1st July 2018 till 30th June 2020 were evaluated. Patients were classified as mild, moderate and severe head injury based on GCS and their Serum sodium levels were recorded at the time of admission and their clinical outcome using GOS score was studied. Results: There were 533 patients with 440(82.6%) males and 93(17.4%) females. Sodium was normal in 355 (66.6%) patients, with moderate hyponatremia in 9(1.7%) patients. Mild Hyponatremia in 160 (30%) of patients. Hypernatremia was noted in 9(1.7%) of total patients. The Majority of patients had Mild Head Injury 366 (68.7%), Moderate Head Injury 75(14.1%), and severe head injury (17.3%) Moderate disability with GOS 4 in majority 452(84.8%) of people with Good recovery in 40(7.5%), Severe disability in 12 (2.3%), Neuro vegetative state 7(1.3%), Dead 22(4.1%) of all the patients recruited in the study. There was significant statistical relationship between the serum sodium value and the GOS outcome (P <=0.008) Conclusions: Serum Sodium is an important prognostic marker of clinical outcome of patients with traumatic brain injury and needs to be monitored and corrected if abnormal in all patients with TBI to improve their outcomes.

Background: Tonsillectomy is a commonly performed pediatric surgical procedure and is frequently associated with significant postoperative pain, which can delay recovery and impair oral intake. Effective analgesia with minimal adverse effects remains a clinical challenge. Topical analgesic techniques may provide localized pain control while avoiding systemic opioid-related complications. Methods: This prospective, randomized, double-blind study included 60 children aged 4–14 years undergoing tonsillectomy under general anesthesia. Patients were allocated into two groups: Group R received topical 0.75% ropivacaine (5 ml), and Group RT received topical 0.75% ropivacaine (5 ml) combined with tramadol (2 mg/kg), applied to the tonsillar fossa for 5 minutes at the end of surgery. Postoperative pain was assessed using the Visual Analogue Scale (VAS) and Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) over 24 hours. Time to first rescue analgesia, total analgesic requirement, pain on deglutition, postoperative bleeding, and parental satisfaction were recorded. Results: Demographic parameters were comparable between groups. Group RT showed significantly lower pain scores from 4 to 24 hours postoperatively (p<0.05), reduced total analgesic consumption, less pain on swallowing, decreased postoperative bleeding, and higher parental satisfaction compared to Group R. No adverse effects were observed. Conclusion: The addition of tramadol to topical ropivacaine significantly enhances postoperative analgesia following pediatric tonsillectomy without increasing complications.

Background: Interventional radiology (IR) has evolved into a cornerstone of minimally invasive therapy, encompassing complex vascular, oncologic, neurointerventional, and pain-related procedures. Despite their minimally invasive nature, these procedures are often prolonged, painful, and performed in elderly patients with multiple comorbidities, necessitating robust anesthesiology support to ensure safety and procedural success. Objective: This study aimed to evaluate the impact of structured anesthesiology support on peri-procedural outcomes in a tertiary care interventional radiology unit. Materials and Methods: A prospective observational cohort study was conducted over 12 months (January–December 2024) in a tertiary care hospital. A total of 500 adult patients undergoing IR procedures were enrolled and divided into two groups: Group A (n=250) with dedicated anesthesiology support and Group B (n=250) without anesthesiology involvement. Demographic data, clinical characteristics, procedure details, anesthetic techniques, and monitoring parameters were recorded. The primary outcome was the incidence of major peri-procedural complications. Secondary outcomes included minor complications, procedural success, recovery profile, pain scores, and patient satisfaction. Statistical analysis was performed using SPSS version 28.0. Results: Baseline demographic and clinical characteristics were comparable between the groups. Major complications were significantly lower in Group A compared with Group B (7.2% vs. 16.8%; p<0.001), with a reduced adjusted odds ratio of 0.38 (95% CI: 0.21–0.69). Minor complications were also significantly lower in Group A (18.0% vs. 35.2%; p<0.001). Procedural success was higher in the anesthesiology-supported group (96.8% vs. 91.2%; p=0.01), along with faster recovery and improved pain control. Conclusion: Dedicated anesthesiology support in interventional radiology is associated with significantly improved patient safety, higher procedural success, and better recovery outcomes. A tiered anesthesiology support model integrated within non-operating room anesthesia (NORA) services is recommended to optimize patient care and resource utilization.

Background: Self-directed learning (SDL), which is related to the management of lifelong learning for better outcomes, is one of the most effective teaching techniques for adult learners. This study compares the effectiveness of Self Directed Learning (SDL) with conventional lecture-based teaching in medical education. While traditional lectures involve passive listening for a large number of students, SDL emphasizes an active, learner-centered approach where students take responsibility for identifying, setting goals, and managing resources to achieve competencies. The study aims to (1) To compare learning effectiveness of SDL method by post test MCQ scores compared to didactic lecture. (2) To know the perceptions of students towards SDL assess the impact of these two teaching methods on competency development and overall effectiveness in preparing students for successful and adaptive medical careers. Material & Methods : An Interventional study was conducted on second-year MBBS students in the Department of Microbiology, K I MS & RF, Amalapuram. The faculty and students were initially sensitized about SDL and 2 SDL sessions were conducted later. Assignments were given to the students in the form of case-scenarios, with specific learning objectives. Inclusive criteria: students present on the day of study; Exclusive criteria: students absent on the day of study . Intervention 1was Didactic lecture and Intervention 2 was SDL. The students for SDL were facilitated by 3 faculty members. Both didactic lectures and SDL sessions were evaluated by a post-test using MCQs as an assessment tool and student’s feedback was collected. Results: The mean scores of the students in SDL method were more, compared to lecture method. Statistical analysis: Independent sample T-test was used as the test of significance. P value of less than 0.005 was taken as statistically significant. Conclusions: The present study showed that there was improvement in gaining knowledge in Microbiology by SDL method, when compared to didactic lecture method. Many students gave a positive feedback that SDL sessions were effective in improving knowledge and better understanding of the topics.

Background: Native arteriovenous fistulas (AVFs) are the preferred vascular access for haemodialysis owing to superior patency rates, lower infection risk, and reduced morbidity compared with arteriovenous grafts and central venous catheters. However, early AVF failure remains a major challenge, leading to delayed dialysis initiation and prolonged catheter dependence. Doppler ultrasonography offers a non-invasive, reproducible method to assess vascular anatomy and hemodynamics, and is recommended by KDOQI guidelines for both preoperative planning and postoperative surveillance. Objectives: To evaluate the role of Doppler ultrasonography in predicting early functional outcomes of native AVFs, identify preoperative and postoperative Doppler parameters associated with AVF maturation, and examine the influence of demographic and clinical factors on early AVF success. Methods: This prospective observational study included 25 patients with end-stage renal disease undergoing haemodialysis via native AVFs. Preoperative Doppler evaluation assessed arterial diameter, venous diameter, and vein depth. Postoperative Doppler examination at two months measured blood flow and venous diameter. AVF functionality was determined based on Doppler criteria (arterial diameter >2 mm, venous diameter >4 mm, flow >300 mL/min) and clinical usability. Statistical analysis evaluated associations between Doppler parameters, patient characteristics, and AVF outcomes. Results: At two months, 13 AVFs (52%) were functional, while 12 (48%) failed early. Functional AVFs had significantly larger preoperative arterial diameters (2.67 ± 0.32 mm vs 2.38 ± 0.33 mm; p=0.032). Postoperative blood flow was markedly higher in functional AVFs (337.7 ± 31.4 mL/min vs 255.0 ± 41.9 mL/min; p<0.001). Preoperative venous diameter, vein depth, and demographic or comorbidity variables showed no significant association with AVF outcome. Conclusion: Doppler ultrasonography plays a crucial role in predicting early AVF functionality. Preoperative arterial diameter and postoperative flow velocity are the strongest predictors of early success. Routine Doppler-based assessment can enhance AVF selection, monitor maturation, and identify fistulas at risk of early failure, thereby improving haemodialysis access outcomes.

Background: Bronchial asthma is one of the most frequent chronic respiratory illnesses in children, and it is a leading cause of school absenteeism and poor quality of life. Objective measurement of airway obstruction is critical for diagnosis and monitoring. Peak expiratory flow rate (PEFR) is a straightforward, low-cost, and dependable method for measuring lung function in children. Objectives: To clinically evaluate bronchial asthma in school-aged children, determine the degree of functional airway blockage using peak expiratory flow rate (PEFR), and investigate the association between clinical severity and PEFR. Materials and Methods: This cross-sectional observational study included 150 school-aged children (5-12 years old) diagnosed with bronchial asthma at a tertiary care hospital. A detailed clinical history, physical examination, and asthma severity categorization were documented. PEFR was measured with a standardized peak flow meter and compared to expected values. Data were evaluated with descriptive statistics and correlation tests. Results: The vast majority of children were between the ages of five and ten. The most common presenting symptoms were coughing and wheezing. PEFR levels were lower in children with moderate to severe asthma. There was a strong connection (p < 0.05) between asthma severity and % anticipated PEFR. Conclusion: PEFR is a valuable and practical method for assessing the functional status of bronchial asthma in school-aged children. Regular PEFR monitoring, together with clinical assessment, can aid in the early diagnosis of airway blockage and improve asthma control.

This retrospective case series evaluated suspected leprosy cases at Government Medical College, Anantnag, a low-endemic region in Jammu and Kashmir, India, from July 2024 to June 2025. Of 19 suspects, 5 (26.3%) had AFB-positive slit-skin smears, confirming multibacillary leprosy. Cases were adults aged 18–50 years (mean 32.6 years) with lesions and nerve involvement. A migrant case from high-endemic India suggests imported transmission, requiring surveillance revisions. This series highlights leprosy’s persistence in low-endemic India, urging better surveillance to meet WHO’s 2021–2030 goals.

Background: Sacrococcygeal pilonidal disease is a common condition affecting young adults and is associated with recurrent symptoms, prolonged morbidity, and loss of productivity. Conventional excision remains the standard treatment but is often associated with prolonged wound healing and postoperative discomfort. Minimally invasive laser therapy has emerged as a promising alternative. Objectives: To compare the clinical outcomes of laser therapy and conventional excision in the management of sacrococcygeal pilonidal disease. Methods: This prospective comparative study included 36 patients with primary sacrococcygeal pilonidal disease, allocated into laser therapy (n = 18) and excision (n = 18) groups. Outcomes assessed included postoperative pain, duration of hospital stay, time to wound healing, return to work, postoperative complications, and recurrence. Results: Laser therapy was associated with significantly lower postoperative pain, shorter hospital stay, faster wound healing, and earlier return to work compared with excision. Recurrence was higher in the laser group (16.7%) than in the excision group (0%), though the difference was not statistically significant. Conclusion: Laser therapy is a safe and effective minimally invasive alternative to excision for sacrococcygeal pilonidal disease, offering superior short-term recovery with comparable recurrence rates.

Background: Asymptomatic choledocholithiasis remains a diagnostic challenge in patients with cholelithiasis and may lead to severe postoperative complications if undetected. Simple biochemical markers such as gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) may assist in early identification. Objectives: To evaluate the diagnostic utility of serum GGT and ALP in predicting asymptomatic choledocholithiasis and to assess their perioperative trends following intervention. Methods: A prospective observational study was conducted on 40 adult patients with ultrasonography-confirmed cholelithiasis and elevated ALP and GGT. Patients with symptomatic choledocholithiasis or other hepatobiliary disorders were excluded. Endoscopic ultrasonography (EUS) and/or endoscopic retrograde cholangiopancreatography (ERCP) confirmed common bile duct (CBD) stones. Serial ALP and GGT levels were measured preoperatively and on postoperative days 1 and 7. Statistical analysis was performed using SPSS v22. Results: CBD stones were detected in 70% of patients. ERCP with stenting was required in 70%. Significant reductions were observed in mean ALP (538 → 234 → 140 U/L) and GGT (273 → 183 → 113 U/L) from preoperative to postoperative day 7 (p < 0.01). Symptom resolution occurred in 95% of patients. Conclusion: Elevated serum GGT and ALP are reliable predictors of asymptomatic choledocholithiasis in patients with cholelithiasis. Their combined use offers a cost-effective, non-invasive screening tool to guide further imaging and intervention.

Background: The retinal nerve fiber layer (RNFL) is highly sensitive to ischemia, and perioperative hypotension during major surgeries may compromise optic nerve perfusion. This study evaluates the association between intraoperative hypotension and postoperative RNFL changes using spectral-domain optical coherence tomography (OCT). Aim: To determine the correlation between perioperative hypotension and postoperative RNFL thinning in patients undergoing major surgeries. Methods: This hospital-based cross-sectional study included 80 adult surgical patients. Preoperative and postoperative RNFL thickness was measured using spectral-domain OCT. Perioperative hemodynamic variables—including baseline MAP, minimum intraoperative MAP, duration of MAP <65 mmHg, number of hypotensive episodes, vasopressor use, and cumulative hypotension load—were recorded. RNFL thinning was defined as a global decrease greater than 3 µm. Statistical analysis included t-tests, chi-square tests, and Pearson correlation. Results: Significant postoperative RNFL thinning was observed across global and quadrant-specific measurements (p < 0.001). Patients with RNFL thinning exhibited lower minimum MAP (59.2 ± 5.4 vs. 64.7 ± 4.9 mmHg), longer durations of MAP <65 mmHg (34.6 ± 11.7 vs. 19.3 ± 9.6 minutes), and higher frequency of hypotensive episodes (3.1 ± 1.3 vs. 1.7 ± 0.9), all statistically significant (p < 0.001). RNFL change strongly correlated with duration of hypotension (r = 0.52), cumulative hypotension load (r = 0.55), and number of hypotensive episodes (r = 0.47). Conclusion: Perioperative hypotension is significantly associated with postoperative RNFL thinning. Depth, duration, and cumulative burden of hypotension are key predictors of optic nerve structural changes. Maintaining intraoperative hemodynamic stability may help prevent subclinical postoperative optic nerve injury.

Background: Intraoperative positioning influences ocular perfusion dynamics, with prone surgeries posing a greater risk for reduced ocular perfusion pressure (OPP) and postoperative visual dysfunction. Limited comparative data exist evaluating OPP changes and visual outcomes between prone and supine surgical patients. Aim: To compare the effect of prone versus supine intraoperative positioning on ocular perfusion pressure and postoperative visual function in neurosurgical and general surgical patients. Methods: A prospective comparative study was conducted in 100 adult patients undergoing elective neurosurgical (prone, n=52) and general surgical (supine, n=48) procedures. Baseline demographics, intraocular pressure (IOP), and mean arterial pressure (MAP) were recorded. OPP was calculated at defined intraoperative intervals (post-induction, 2 hours, and minimum intraoperative value). Postoperative visual assessment, including visual acuity, color vision, and visual field screening, was performed at 24 and 72 hours. Statistical comparisons were made using t-tests, chi-square tests, and Pearson correlation analysis. Results: Baseline characteristics were comparable across groups. Prone-positioned patients demonstrated significantly lower OPP at all intraoperative time points, with the largest differences observed at the 2-hour mark (62.7 ± 10.4 vs. 74.8 ± 9.3 mmHg; p<0.001) and minimum OPP (53.4 ± 8.8 vs. 69.7 ± 10.1 mmHg; p<0.001). An OPP fall ≥30% occurred in 40.3% of prone patients compared with 14.6% in the supine group (p=0.004). Postoperative visual blurring (23.1% vs. 8.3%; p=0.035) and visual acuity deterioration (mean logMAR change +0.12 vs. +0.05; p<0.001) were significantly more frequent in prone patients. A strong negative correlation was found between percentage OPP reduction and postoperative visual acuity change (r = -0.62; p<0.001). Conclusion: Prone intraoperative positioning is associated with significant reductions in OPP and a higher incidence of early postoperative visual disturbances. OPP decline, especially ≥30%, is a strong predictor of postoperative visual dysfunction. Implementing strategies to maintain perfusion pressure and minimize ocular compression may help reduce visual complications in prone surgeries.

Background: Snakebite envenomation remains a major public health problem in India, with the common krait (Bungarus caeruleus) causing severe neuroparalysis through presynaptic β-bungarotoxin–mediated blockade. While antivenom neutralizes circulating venom, it does not reverse established presynaptic damage, making recovery prolonged. Although neostigmine is traditionally viewed as ineffective for purely presynaptic toxicity, emerging evidence shows benefit in selected patients, particularly when a neostigmine test is positive. We report a middle-aged male who presented seven days after a krait bite with persistent paralysis despite receiving adequate antivenom and ventilatory support. On admission, he had ptosis, quadriparesis (2/5 power), and areflexia, but no respiratory compromise. A positive neostigmine sensitivity test prompted initiation of high-dose neostigmine with atropine cover, resulting in steady neurological improvement over one week, including recovery of limb power from 2/5 to 4/5, resolution of ptosis, and return of reflexes. He was discharged with near-complete recovery and achieved full strength at 10-day follow-up. This case demonstrates that neostigmine can significantly enhance neuromuscular recovery in selected krait envenomation patients—even in delayed presentations—and that a positive neostigmine test is a valuable predictor of therapeutic responsiveness

Background: Emergency laparotomy is a life-saving abdominal procedure associated with high morbidity, mortality, and severe postoperative pain. Effective analgesia in this setting is challenging, as conventional strategies such as opioids and epidural analgesia are limited by side effects, contraindications, and technical challenges in unstable patients. Ultrasound-guided erector spinae plane block (ESPB) has recently emerged as a promising alternative for multimodal analgesia. This study evaluated the efficacy and safety of bilateral ESPB in patients undergoing emergency laparotomy. Methods:In this prospective, randomized, controlled clinical trial, 70 patients (aged 18–70 years, ASA II–IV) scheduled for emergency midline laparotomy were randomized into two groups: Group A received bilateral ultrasound-guided ESPB with 20 mL of 0.25% bupivacaine per side in addition to standard multimodal analgesia, while Group B received standard multimodal analgesia alone. Primary outcome was postoperative pain assessed using the Visual Analog Scale (VAS) at rest and on movement at 0, 6, 12, 24, and 48 hours. Secondary outcomes included intra- and postoperative opioid consumption, time to first rescue analgesia, hemodynamic stability, opioid-related side effects, patient satisfaction, and block-related complications. Results:Baseline demographics were comparable between groups. Intraoperative fentanyl consumption was significantly lower in Group A (96 ± 28 µg) compared to Group B (152 ± 36 µg, p < 0.001). ESPB patients reported significantly lower VAS scores up to 24 hours at rest (mean difference –2 to –3, p < 0.001) and on movement (mean difference –3 to –4, p < 0.001), with convergence by 48 hours. Cumulative morphine consumption was reduced by ~60% in Group A (6.4 ± 2.2 mg vs. 14.8 ± 3.9 mg, p < 0.001), and time to first rescue analgesia was significantly prolonged (7.8 ± 2.1 vs. 2.9 ± 1.0 hours, p < 0.001). Nausea and vomiting were less frequent (14.3% vs. 34.3%, p = 0.04), patient satisfaction was higher (4.5 ± 0.6 vs. 3.2 ± 0.7, p < 0.001), and no block-related complications occurred. Conclusion:Bilateral ultrasound-guided ESPB provides effective, safe, and opioid-sparing analgesia in emergency laparotomy. It reduces pain intensity, minimizes opioid use, improves hemodynamic stability, and enhances patient satisfaction without added risk. ESPB represents a practical and valuable adjunct to multimodal analgesia in high-risk emergency surgical patients.

Background: The rapid expansion of internet accessibility has profoundly influenced the academic and psychological landscape of health professional students. While online resources enhance learning opportunities, excessive or unregulated use may adversely affect mental well-being and academic performance. Objectives: This study aimed to explore the relationship between patterns of internet use, psychological well-being, and academic performance among health professional students. Methods: A mixed-method study design was adopted, combining quantitative and qualitative approaches. Quantitative data were collected from 250 undergraduate medical and dental students using a structured questionnaire and the Depression, Anxiety, and Stress Scale (DASS-21). Descriptive statistics, frequency distributions, and paired-sample t-tests were performed using Jamovi software. Qualitative data were gathered through semi-structured interviews focusing on students’ internet usage patterns, perceived effects on academics, and emotional health. Results: The mean age of participants was 22.1 years, with a slight male predominance (53.6%). Most students (88%) resided in hostels. While 61.6% reported normal depression scores, 14% had moderate and 3.2% extremely severe depression. Similarly, 17.2% reported moderate anxiety and 11.6% very severe anxiety. Stress levels were mostly normal (77.9%). A significant difference was observed between self-reported and actual academic performance (t=4.96, p<0.001). Qualitative findings revealed that although the internet was indispensable for academics, excessive non-academic use often led to distraction, poor time management, and disturbed sleep. Conclusion: Internet use plays a dual role, enhancing learning while posing risks to mental health and academic performance when uncontrolled. Promoting digital literacy and time management strategies may foster healthier internet habits among students.

Introduction: Acute febrile illness is the most common clinical syndrome among patients attending hospitals in developing countries. India is an endemic to dengue and typhoid fever, so there is possibility to get co-infection of dengue and enteric fever. The clinician decision making on arriving at diagnosis in these infections is compromised, also to provide insights into accuracy of diagnostics and research based data of co-infection of dengue and enteric fever is insufficient, we have tried to determine the seroprevalence of enteric fever among patients diagnosed with dengue fever at our hospital. Materials and Methods: This is a prospective observational study conducted for a study period of one year from July 2024 to June 2025 among all patients diagnosed with dengue virus positive by IgM ELISA. Dengue virus test was performed by dengue IgM ELISA and detection of enteric fever was done by performing WIDAL test. Patient details including demographic parameters, presenting complaints, antibiotic history, family history, microbiology investigations data were collected in a Microsoft excel sheet and the data was analysed and tabulated for a clear depiction. Results: Dengue ELISA test positive was observed in a total of 513 patients, which accounts for 19.02 % dengue in the community. These 513 specimens were further analyzed for Enteric fever, 10 (1.94%) out of 513 were both dengue and enteric fever positive. Maximum number of dengue cases was noted in children and young adults, accounting 75.4% of dengue positives were noted in 0-30 years of age group. Concurrent co-infection of dengue and enteric fever was observed predominantly in the age group of 20-40 years, it was 60% in the present study. Conclusion: To manage these cases thorough clinical history and early recognition of clinical manifestations plays a vital role which should be followed by logical diagnosis and appropriate management of severe manifestations. If not managed it with utmost importance, may lead to multi-organ failure and significant morbidity and mortality.

Background: Multidrug-resistant and extensively drug-resistant tuberculosis (MDR/XDR-TB) poses a significant challenge to global TB control. Linezolid is an essential drug in longer oral regimens but is associated with considerable adverse drug reactions (ADRs), which may hinder treatment success. Data on Linezolid-associated ADRs under field conditions in the Kumaon region of Uttarakhand are scarce. Objective: To assess the incidence and nature of ADRs related to Linezolid in MDR/pre-XDR/XDR pulmonary TB (PTB) patients receiving longer oral regimens. Methodology: This ambispective cohort study was conducted at the Nodal DR-TB Centre, Government Medical College, Haldwani, from October 2022 to September 2023. A total of 154 microbiologically confirmed MDR/pre-XDR/XDR-PTB patients aged ≥15 years receiving Linezolid-based therapy were included. Data on clinical, laboratory, and ADR profiles were collected through patient interviews, follow-ups, and records. ADRs were assessed using WHO-UMC and Naranjo causality tools. Results: Peripheral neuropathy was the most common ADR (72.73%), followed by anemia (40.26%) and optic neuritis (0.65%). Among those with neuropathy, 49.35% had mild, 20.13% moderate, and 3.25% had severe or life-threatening reactions. Dose adjustments were required in 29.22% of cases. Significant post-treatment changes were observed in haemoglobin, bilirubin, albumin, and glucose levels (p<0.05). Conclusion: Linezolid, while effective, is associated with significant ADRs, notably neuropathy and anemia. Close monitoring, individualized dosing, and timely interventions are essential to optimize safety and improve treatment outcomes in DR-TB.

Background: The mechanical durability of resin cements plays a crucial role in the long-term success of indirect restorations. Flexural strength is a key parameter influencing the performance of luting agents under intraoral loading and thermal stresses. Aim: To evaluate and compare the flexural strength of two light-cured veneer cements and one dual-cure resin cement, before and after thermocycling, using standardized three-point bending tests. Materials and Methods: Bar-shaped specimens (2 × 2 × 20 mm) of three different resin cements (n = 40 each) were fabricated and polymerized between Mylar-covered glass plates. Following 24 h of water storage at 37°C, half of the specimens were tested immediately, while the remaining half were thermocycled for 5000 cycles between 5–55°C. Flexural strength was measured in a universal testing machine under three-point bending at 0.5 mm/min. Statistical analysis was performed using SPSS v25; normality and homogeneity were assessed (Shapiro–Wilk, Levene’s test), followed by one-way ANOVA and Tukey HSD (α = 0.05). Results: Significant differences were found among the six groups (p < 0.000001). Thermocycling significantly decreased flexural strength for all materials. Several pairwise differences were identified between light-cured and dual-cured cements. Conclusion: Flexural strength of resin cements is influenced by both material type and thermal aging. Thermocycling adversely affected all cements. Clinical Significance: Material choice and curing mode influence the mechanical reliability of luting agents. Light-cured veneer cements may offer superior strength when adequate light exposure is available, whereas thermal aging remains a critical factor affecting long-term clinical performance.

Background: The forearm plays a pivotal role in upper limb function by acting as a mechanical bridge between the elbow and the wrist while enabling complex movements essential for daily activities. AIM: To study the functional outcome of plating of diaphyseal fracture of BBFA with LC-DCP in adults, using Andersons et al scoring system. Methodology: This prospective, time-bound study was conducted at department of Orthopaedics at a JLN medical college, Ajmer over a period of 1 yr year and included 42 patients with fractures of both bones of the forearm. Result: In 42 patients with fractures of both bones of the forearm treated with LC-DCP, the majority achieved fracture union within 18 weeks, with excellent to satisfactory functional outcomes in 85.7% of cases and minimal complications. Conclusion: Internal fixation with 3.5 mm LC-DCP provides stable fixation, restores forearm rotation and wrist function, and is an effective treatment for diaphyseal fractures of both bones of the forearm.

Background:Vitiligo is an acquired depigmenting disorder with autoimmune and immune-regulatory mechanisms proposed in its pathogenesis. Vitamin D influences melanocyte function and immune response, and deficiency has been reported in several autoimmune diseases, including vitiligo. Objectives: To assess serum vitamin D levels in vitiligo patients and compare them with healthy controls. Materials and Methods: A case–control study was conducted on 150 participants (75 vitiligo cases and 75 age- and sex-matched controls). Serum 25-hydroxyvitamin D levels were categorized as severe deficiency (<10 ng/mL), deficiency (10–30 ng/mL), or normal (>30 ng/mL). Statistical analysis was performed using R software (version 4.x), with p ≤ 0.05 considered significant. Results: Vitamin D deficiency and severe deficiency were significantly more prevalent among cases compared to controls. Severe deficiency was noted in 25.3% of vitiligo cases versus 6.7% of controls, while normal vitamin D levels were observed in 64.0% of controls compared to only 12.0% of cases (p < 0.05). No significant association was noted between vitamin D levels and age or sex within the vitiligo cohort. Discussion: The findings support an association between vitiligo and hypovitaminosis D, consistent with previous international studies suggesting a role for vitamin D in immune modulation and melanocyte biology. While the relationship appears associative, the biological plausibility supports further exploration of whether vitamin D deficiency contributes to disease susceptibility or reflects shared autoimmune pathways. Interventional studies assessing vitamin D supplementation may help clarify its therapeutic relevance. Conclusion: Reduced serum vitamin D levels are significantly associated with vitiligo. Routine screening for vitamin D status may be considered, although further longitudinal and interventional research is warranted to establish causality and therapeutic benefit.

Background: Fractures of the distal tibia, particularly tibial pilon fractures, represent a significant challenge for orthopedic surgeons due to their complex anatomy and the precarious nature of the surrounding soft tissues. AIM: To evaluate the functional outcome of distal tibial fractures treated with pre-contoured medial locking compression plates using the minimally invasive plating osteosynthesis (MIPO) technique, focusing on fracture healing, restoration of limb alignment, joint function, and complication rates. Methodology: This prospective observational study was carried out in the Department of Orthopaedics at a JLN medical college, Ajmer over a period of 1 yr years from period 1 july 2024 to 30 june 2025. Result: The majority of patients were middle-aged (31–50 years) with fractures mainly caused by road traffic accidents; most achieved fracture union within 16 weeks and demonstrated excellent to good functional outcomes. Conclusion: MIPO is an effective treatment for these fractures, providing favorable functional recovery with low complication rates.

Background: Cervical cancer is a significant public health issue in low- and middle-income nations, even though it is preventable with prompt diagnosis and treatment. Cytological screening through the Papanicolaou (Pap) smear continues to be an essential diagnostic instrument, proficient in identifying both neoplastic and infectious lesions. Objective: To determine the cytopathological spectrum of cervical lesions among women undergoing Pap smear screening, and to correlate findings with demographic and clinical parameters. Methods: This prospective observational study was carried out at Nandha Medical College Hospital and Research Institute from January 2023 to June 2025, with a cohort of 1,042 women visiting the gynaecology outpatient department. Pap smears were obtained by employing the Papanicolaou method. The Bethesda System (2014) was used to read the smears. The p < 0.05 was considered statistically significant. Results: The majority of smears (98.27%) were negative for intraepithelial lesions or malignancy, with only one case each of squamous cell carcinoma and low-grade squamous intraepithelial lesion (0.09%). Infective aetiologies were identified in 11.4% of cases, with bacterial vaginosis being the most prevalent (10.8%), followed by Candida species (0.38%), Trichomonas vaginalis (0.095%), and herpes simplex virus (0.095%). Age was significantly correlated with the type of infectious organism identified (p = 0.039). Conclusion: The high proportion of bacterial vaginosis highlights Pap smear’s dual role in detecting both precancerous lesions and infectious conditions. Tailored age-specific health education and expanded routine screening coverage are recommended to progress toward cervical cancer elimination in resource-limited settings.

Background: Aim and Objectives: This study aims to evaluate the efficacy of autologous human amniotic membrane HAM patch dressing in improving primary caesarean section (CS) wound healing. This may allow for curbing down the morbidities associated with surgical site infections and other complications arising out of the caesarean wound. Method: This was a randomized control trial wherein 100 women undergoing primary CS after 28 weeks of gestation were included. They were divided into two groups on the basis of the post operative dressing type- group A, HAM and group B, standard dressing done. SSI incidence, hospital stay and REEDA scores were the main outcomes assessed and compared for the two groups. Microbiological testing was performed as well and compared. All patients received antibiotic prophylaxis pre operatively. Results: SSI was superficial in a total 12 cases (12%), with 3 (6%) in the HAM group and 9 (18%) in the non-HAM group while Deep SSI is seen only in 3 patients in non-HAM group. Compared to non-HAM group, HAM group had statistically lower REEDA score at day 3 (1.9 ± 0.79 vs. 2.34 ± 0.96, p=0.02), day 8 (3.34 ± 1.04 vs. 4.06 ± 1.6, p=0.042) and final follow up- day 42 (0.64 ± 0.63 vs. 0.96 ± 0.7, p=0.021). HAM group had significantly lower surgical site infections and hospital stay (6% vs. 24%, p=0.023, 4.02 ± 0.96 vs. 5.26 ± 3.22 days, p=0.011, respectively) leading to lesser readmissions (4% vs. 16%) ( p=0.042). Conclusions: Autologous HAM is a novel technique for CS wound healing and allows for early patient discharge with lesser hospital stay and less REEDA score. The autologous HAM patch dressing significantly improves primary Caesarean wound healing compared to standard dressing methods. Such dressings can be especially useful in lower resource settings where SSI rates are very high and advanced dressing materials are unaffordable.

Background: p16, a cyclin-dependent kinase inhibitor, plays a key role in cell-cycle regulation, yet its prognostic role in breast cancer remains uncertain. This study evaluates p16 expression and its association with Ki-67, tumor grade, and clinicopathological features of invasive breast carcinoma. Methods: A prospective cross-sectional study of 50 patients who underwent surgery for invasive breast carcinoma between January 2021 and December 2023 was conducted. p16 expression >10% nuclear or cytoplasmic staining was considered positive. Associations with tumor mass, lymphovascular space invasion (LVSI), lymph node involvement, Ki-67 proliferation index, tumor grade, and immunohistochemical (IHC) subtype were assessed using chi-square tests and Spearman correlations. Results: Mean participant age was 48.86 ± 9.65 years. p16 positivity showed a trend toward larger tumor mass (102.57 vs. 56.99; p=0.054). Although not statistically significant, p16-positive tumors exhibited greater lymph node involvement. No association was found between LVSI and p16 (p=0.746). Ki-67 levels were significantly higher in p16-positive tumors (56.59 vs. 15.94; p<0.001). p16 expression was significantly associated with higher tumor grade (p=0.008) and was most prevalent in triple-negative breast cancer (TNBC) (85.7% positive). Conclusion: p16 overexpression is strongly associated with high proliferative index, poor differentiation, and TNBC phenotype, suggesting a role as a prognostic marker of aggressive disease. Further studies exploring the biological mechanisms of p16 dysregulation and its therapeutic implications particularly in TNBC are warranted.

Background: Iron deficiency anemia affects 40-60% of pregnant women globally, with prevalence exceeding 50% in India. Conventional hemoglobin-based iron supplementation strategies demonstrate suboptimal efficacy, partly due to inflammation-mediated absorption impairment. Hepcidin, the master regulator of iron homeostasis, provides a dynamic biomarker reflecting iron absorption capacity. However, evidence regarding hepcidin-guided iron therapy in pregnancy remains limited. Methods: A prospective comparative study enrolled 150 pregnant women (14-28 weeks gestation) with hemoglobin 8.0-10.9 g/dL at a tertiary care hospital. Participants were randomized to hepcidin-guided therapy (n=75), where iron dosing was individualized based on serum hepcidin levels (<10 ng/mL: 100 mg/day; 10-25 ng/mL: 60 mg/day; >25 ng/mL: withheld temporarily), or standard therapy (n=75) receiving fixed-dose 100 mg/day elemental iron per WHO guidelines. Primary outcome was hemoglobin rise at 8 weeks. Secondary outcomes included ferritin normalization, requirement for intravenous iron, adverse effects, and anemia status at term. Results: Baseline characteristics were comparable between groups. At 8 weeks, the hepcidin-guided group demonstrated significantly greater mean hemoglobin increase (2.4±0.6 g/dL versus 1.6±0.7 g/dL, p<0.001) and higher proportion achieving target hemoglobin ≥11 g/dL (78.7% versus 53.3%, p=0.002). Ferritin normalization was superior in the hepcidin-guided group (72.0% versus 50.7%, p=0.009). Intravenous iron requirement was substantially reduced (9.3% versus 28.0%, p=0.005). Gastrointestinal adverse effects were significantly lower with hepcidin-guided therapy (24.0% versus 44.0%, p=0.012). At term, anemia prevalence was lower in the hepcidin-guided group (12.0% versus 29.3%, p=0.011). Conclusion: Hepcidin-guided iron supplementation demonstrates superior efficacy compared to conventional fixed-dose therapy in pregnant women with mild to moderate anemia. This individualized approach optimizes iron absorption, reduces unnecessary iron exposure, minimizes adverse effects, and decreases need for parenteral iron. Integration of hepcidin measurement into antenatal care protocols may enhance maternal anemia management, particularly in high-burden settings.

Background: Preeclampsia remains a major contributor to maternal and perinatal morbidity worldwide. Early identification of women at risk for severe disease and adverse outcomes using accessible biochemical markers is critical for timely intervention, particularly in resource-limited settings where advanced monitoring may be unavailable. Methods: A prospective observational study was conducted over 18 months at a tertiary care hospital. One hundred pregnant women diagnosed with preeclampsia after 20 weeks of gestation were enrolled and categorized into mild (n=60) and severe (n=40) preeclampsia groups based on established diagnostic criteria. Serum uric acid and LDH levels were measured at diagnosis and correlated with clinical severity, maternal complications, and perinatal outcomes. Statistical analysis included comparison of means, correlation analysis, and receiver operating characteristic curve analysis. Results: Mean serum uric acid levels were significantly elevated in severe preeclampsia compared to mild disease (7.3±1.2 mg/dL versus 5.0±0.9 mg/dL, p<0.001). Similarly, mean LDH levels were markedly higher in the severe group (694.6±156.3 IU/L versus 416.8±88.4 IU/L, p<0.001). Both biomarkers demonstrated significant positive correlation with maternal complications including eclampsia, HELLP syndrome, and placental abruption. Elevated uric acid (>6.5 mg/dL) and LDH (>600 IU/L) were associated with increased rates of preterm delivery (56.4% versus 18.3%, p<0.001), low birth weight, and neonatal intensive care unit admissions (52.5% versus 16.7%, p<0.001). Conclusion: Serum uric acid and lactate dehydrogenase represent simple, cost-effective, and widely available biochemical markers that can aid in severity assessment and prediction of adverse maternal and perinatal outcomes in preeclampsia. Their integration into routine clinical evaluation may facilitate early risk stratification and guide intensive monitoring strategies.

Background: : Mechanical ventilation is a life-saving procedure for many patients in Intensive care unit (ICU), but it is associated with a high risk of acquiring respiratory infections and a high morbidity and mortality in critically ill patients. Endotracheal (ET) aspiration helps in the evaluation for the occurrence of the febrile episodes in the mechanically ventilated patients to assess the patient’s risk to develop Ventilator associated pneumonia (VAP) or Hospital acquired pneumonia (HAP). Knowledge of local antimicrobial resistance patterns are important to initiate the empirical antimicrobial therapy. Aim & objectives: To study the common bacterial isolates in endotracheal aspirates of mechanically ventilated patients and to analyse the antibiotic susceptibility pattern of the isolates. Materials & methods: Prospective cross-sectional was carried out on endotracheal aspirates of 75 mechanically ventilated patients admitted in various ICUs. Results: Out of 75 samples, 61 showed significant growth amongst which Acinetobacter baumannii (52.3%) was the most predominant bacteria followed by Klebsiella pneumoniae (20.1%), Pseudomonas aeruginosa (9.2%), Escherichia coli (4.6%), Enterobacter spp (3.1%), Corynebacterium spp (3.1%), Methicillin resistant Staphylococcus aureus (MRSA) (3.1%), Citrobacter spp (1.5%), Proteus spp (1.5%) and Enterococcus faecium (1.5%). Colistin (66.0%) and doxycycline (64.0%) were highly effective against Acinetobacter and Klebsiella respectively, but these isolates showed higher resistance against third and fourth generation cephalosporins and carbapenems. Pseudomonas isolates were highly sensitive to amikacin (73.0%) and piperacillin-tazobactam (45.6%). Linezolid (100%) have been found to be effective against MRSA and Enterococcus. Conclusion: Acinetobacter baumannii and Klebsiella pneumoniae isolates showed more resistance pattern than other bacterial isolates. Colistin and doxycycline were found to be the most effective antibiotics whereas the other commonly used antibiotics showed marked resistance pattern. It is of utmost importance to do regular surveillance of antibiotic susceptibility patterns for preventing multidrug resistant bacterial infections.

Background: Gestational Diabetes Mellitus (GDM) is defined as Impaired Glucose Tolerance (IGT) with onset or first recognition during pregnancy. Undiagnosed or inadequately treated GDM can lead to significant maternal and fetal complications. Early detection of gestational diabetes is crucial for prompt treatment, which can help to prevent complications for both mother and baby. Pregnancy is an opportune time to encourage women to make lifestyle changes. Methodology: A Hospital-based case control study was carried out in government maternity hospital, Tirupati for a period of one year (July 2023-July 2024). A total 524 pregnant woman with Gestational Diabetes Mellitus were included. Base line data in terms of socio-demographic profile, anthropometric assessment, clinical assessment, biochemical assessment and dietary assessment were collected from the participants using structure protocols.Based on the base line data, a well-designed nutritional intervention was planned and implemented with intervention group (N-262) and regular antenatal care was provided to control group (N- 262). Result: Majority of the sample were anemic and had higher blood glucose and lipid profiles. Their nutrient intakes were below the RDA suggested by ICMR- NIN (2021). Conclusion: The dietary intakes of the women in intervention group were significantly improved and their cravings towards unhealthy foods are reduced significantly. The clinical signs and symptoms also reduced and there was a significant difference in positive post-natal outcomes among women in intervention group. The well-designed nutrition intervention had a positive impact in improving health and nutritional status of GDM women. Categories: Gestational Diabetes Mellitus, Nutrition, Obstetrics/Gynecology

Background: Conventional histopathological tissue processing remains the gold standard for diagnosis but is time-consuming, often requiring 14–16 hours, leading to delays in diagnosis and treatment. Microwave-assisted tissue processing has emerged as a faster alternative, with claims of comparable tissue morphology and reduced turnaround time. Aim: To compare the quality of histopathological sections obtained using conventional tissue processing and microwave-assisted tissue processing, and to evaluate the applicability of microwave processing in routine diagnostic practice. Materials and Methods: This prospective comparative study was conducted over 1 year and 7 months in the Histopathology section of the Department of Pathology. A total of 200 paired tissue samples from various organs were included. Each specimen was divided into two equal parts: one processed by the conventional automated method and the other by microwave-assisted processing using a domestic microwave oven. Tissue sections were stained with hematoxylin and eosin, blinded, and independently evaluated by two pathologists. Parameters assessed included cellular outlines, cytoplasmic details, nuclear details, inflammatory cell appearance, epithelial–stromal interface, and stromal/mesenchymal tissue. Statistical analysis included Student’s t-test, chi-square test, and kappa statistics. Results: Microwave tissue processing significantly reduced the total processing time to 29 minutes compared to 15½ hours with the conventional method (p< 0.0001). The majority of tissues processed by both methods demonstrated excellent morphology (microwave: 78.4%; conventional: 80.8%), with no statistically significant difference in overall morphological quality (p = 0.5). Most individual histological parameters showed comparable scores between the two techniques. Although nuclear details and epithelial–stromal interface were marginally better in conventionally processed tissues, these differences did not impede diagnostic interpretation. Interobserver agreement was fair, with minimal variability. Conclusion: Microwave-assisted tissue processing markedly reduces turnaround time while providing tissue morphology comparable to conventional processing. It is a reliable and effective alternative, particularly useful in emergency situations requiring rapid histopathological diagnosis, although careful handling and continuous supervision during processing are essential.

Background: Regional Analgesic Techniques such as Pericapsular Nerve Group (PENG) block and Supra-inguinal Fascia Iliaca (SIFI) block have been found to be effective in providing good pain relief in patients with hip fractures. Since PENG block could block the articular branches of Obturator nerve and accessory obturator nerve, it might have greater analgesic effect compared to SIFI block theoretically. However interventional comparative studies between them are still lacking. The goal of this study is to compare the analgesic efficacy of PENG block and SIFI block and assess their efficacy in optimal patient positioning for spinal anaesthesia. Materials and methods: Randomly, sixty patients undergoing hip surgeries were assigned to two groups- Group A and Group B. Group A received PENG block 15 minutes prior to administration of spinal anaesthesia before surgery. Group B received SIFI block 15 minutes prior to administration of spinal anaesthesia before surgery. Both the groups were observed for efficacy of block by assessing mean pain scores before and during positioning for spinal anaesthesia, Ease of spinal positioning (EOSP), Postoperative pain scores and Postoperative analgesic drug consumption. Results: Both the blocks were equally efficacious with respect to pain scores before and during positioning the patient for spinal anaesthesia and Ease of spinal positioning. Mean pain scores at different time intervals postoperatively and postoperative analgesic drug consumption was similar and comparable in between both groups. Conclusion: The novel technique PENG block’s analgesic efficacy to facilitate sitting position for administering spinal anaesthesia in patients undergoing hip surgeries was as effective as SIFI block.

Background: Postoperative enterocutaneous fistula (ECF) remains one of the most challenging complications in general surgery, often associated with severe sepsis, malnutrition, and high morbidity and mortality. Despite advances in critical care and nutrition, optimal management continues to demand a multidisciplinary approach. Methods: This prospective observational study was conducted over an 18-month period and included 36 patients who developed postoperative ECF following elective or emergency abdominal surgery. Patients were managed according to Shackelford’s principles, emphasizing fluid and electrolyte correction, infection control, nutritional optimization, and wound care. Demographic, clinical, biochemical, and outcome parameters were analyzed using Fisher’s exact test, Pearson’s chi-square test, Mann-Whitney U test, and ANOVA. Results: Among 36 patients, 22 (61%) were males and 14 (39%) females, with a mean age of 42.4 ± 5.7 years. Most ECFs followed emergency surgery (80.5%), and anastomotic dehiscence was the leading cause (47.2%). Small bowel fistulas were most common (63.8%), predominantly ileal. Based on output, 30.5% were high-, 41.6% medium-, and 27.7% low-output fistulas. Spontaneous closure occurred in 19 (52.7%) patients, with a mean closure time of 20.3 ± 4.7 days, while 9 (25%) required surgical intervention. High-output fistulas were significantly associated with electrolyte imbalance, skin excoriation, prolonged hospital stay, and higher mortality (p < 0.05). Serum albumin < 2.5 g/dL and renal failure were strong predictors of mortality (p = 0.03 and p = 0.05, respectively). Enteral feeding was significantly associated with spontaneous closure (p = 0.0003). Octreotide reduced output in 33% of patients but did not affect closure rates. The overall mortality rate was 25%. Conclusion: Postoperative ECF continues to be a life-threatening surgical complication requiring individualized, multidisciplinary management. Early sepsis control, correction of fluid and electrolyte disturbances, and timely nutritional support—preferably via the enteral route—are crucial to optimize outcomes. Octreotide serves as a useful adjunct in reducing output, whereas definitive surgery should be delayed until inflammation subsides and nutritional status improves. High-output fistulas, renal failure, and hypoalbuminaemia remain key predictors of poor prognosis.

Background: Needlestick injuries (NSIs) constitute a serious occupational hazard faced by healthcare workers (HCWs). Such incidents serve as a conduit for transmission of blood-borne pathogens like HIV, hepatitis B, and hepatitis C. Despite the existence of some data, a comprehensive understanding of specific prevalence and associated risk factors remains essential. This study looks at the scenario of NSI among HCWs over two years between July 2023 and July 2025 at a tertiary care hospital in Anantnag, Jammu and Kashmir. Methodology: A retrospective study was made of 25 NSI cases reported at Government Medical College Hospital, Anantnag. Data considered are demographic, job category, department, cause of injury, device involved, reporting status, PEP provided, HBV vaccination status, and level of knowledge. Descriptive statistics were computed on Python, using libraries such as pandas and seaborn. Chi-square tests were applied for checking association between variables such as reporting and job category, cause and department. Results: The mean age of affected persons was 29.4 years (±5.6). Nurses accounted for 52% of cases, whereas students accounted for 48%. The ward department recorded the highest incidence (48%), followed by the emergency (28%). Recapping was the main cause of injury (52%), with syringe needles being involved in most instances (76%). Only 28% of cases were reported; 20% received post-exposure prophylaxis (PEP), and 16% received full HBV vaccination, whereas 64% were not vaccinated. Thereby, no association was established between reporting and type of work (χ²=0.00, p=1.000), while a significant association did exist between the cause and the department (χ²=9.84, p=0.043). Conclusions: With a high rate of NSIs, their underreporting, and low vaccination status, there appears to be a dire need for training, mandatory reporting, and vaccination at tertiary care centres of Kashmir.

Urinary incontinence (UI) is a common but underreported condition among postmenopausal women, influenced by hormonal decline, obstetric factors, metabolic comorbidities, and lifestyle exposures. Its impact on physical, psychosocial, and sexual well-being makes early recognition and management essential. However, region-specific epidemiological data from northern Karnataka—particularly Kalaburagi—are limited. This study aimed to estimate the prevalence, subtype distribution, associated risk factors, and severity of UI among postmenopausal women attending outpatient clinics, using the validated International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF). Methods: A cross-sectional study was conducted among 300 postmenopausal women selected through systematic random sampling at a tertiary care centre in Kalaburagi. Sociodemographic, obstetric, and clinical information was collected using a structured questionnaire. UI presence, severity, and subtype were assessed using the ICIQ-SF. Variables significant at p < .20 in bivariate analysis were entered into a multivariable logistic regression model. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were computed to identify independent predictors. Results: The prevalence of UI was 32.7%. Stress UI was the most common subtype (42.3%), followed by mixed UI (29.1%) and urgency UI (28.6%). The mean ICIQ-SF score was 9.8 ± 3.6, with moderate severity being most prevalent (52.0%). In bivariate analysis, UI was significantly associated with BMI ≥ 25 kg/m² (p = .002), multiparity ≥ 3 (p = .020), prolonged labor (p < .001), diabetes mellitus (p = .011), chronic cough (p < .001), and >10 years since menopause (p = .043). Multivariable analysis identified chronic cough (aOR = 3.05), prolonged labor (aOR = 2.62), BMI ≥ 25 (aOR = 2.14), multiparity ≥ 3 (aOR = 1.76), and diabetes mellitus (aOR = 1.71) as independent predictors of UI. Conclusion: The strong influence of obstetric factors, obesity, diabetes, and chronic cough highlights the need for routine screening, targeted pelvic floor rehabilitation, metabolic optimization, and respiratory health interventions. Region-specific, community-based prevention strategies and pelvic floor muscle training programs are recommended to mitigate UI burden.

Background: Endometrial cancer is the most common gynecological malignancy and its incidence has shown a steady rise over recent decades. Early and accurate diagnosis is crucial, as timely detection significantly improves treatment outcomes and overall prognosis. Aim: To evaluate the significance of endometrial thickness measured by transvaginal ultrasonography in women presenting with abnormal uterine bleeding and to assess its correlation with histopathological findings. Methodology: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at SPMC and associated hospitals Bikaner from June 2022 to may 2023. A total of 80 women presenting with abnormal uterine bleeding were included in the study. Result: Menometrorrhagia was the most common symptom, and proliferative endometrium was the predominant pattern, with hyperplasia and adenocarcinoma mainly seen at ET >12 mm. Conclusion: Endometrial thickness correlated with histopathological changes, making USG and biopsy effective for evaluating abnormal uterine bleeding.

Background: High-risk pregnancies are associated with increased maternal and fetal morbidity owing to various medical and obstetric complications that adversely affect uteroplacental perfusion. Doppler ultrasonography has become an essential noninvasive tool to evaluate fetoplacental and fetal cerebral circulation, enabling early detection of fetal hypoxia or hemodynamic compromise. Among Doppler parameters, the cerebroplacental ratio (CPR), calculated as the ratio of the middle cerebral artery pulsatility index (MCA PI) to the umbilical artery pulsatility index (UA PI), reflects the balance between cerebral vasodilation and placental resistance. Aim: To assess the significance of abnormal cerebroplacental ratio in predicting adverse perinatal outcomes and to determine whether timely obstetric intervention based on these Doppler findings can improve neonatal morbidity and mortality. Materials and Methods: This prospective observational study was conducted over a two-year period (January 2022 January 2024) at a tertiary care center in North India. Pregnant women between 30 and 36 weeks of gestation with predefined high-risk factors—including hypertension, diabetes, gestational diabetes, anemia, malnutrition, and prior neonatal death—were enrolled after informed consent. Singleton pregnancies without fetal anomalies were included. A control group of healthy pregnancies was simultaneously evaluated. Detailed obstetric history, clinical examination, and standardized Doppler studies were performed in all participants. MCA PI, UA PI, and CPR were recorded under controlled conditions by a single experienced sonologist to avoid inter-observer variability. Perinatal outcomes such as Apgar score, preterm birth, NICU admission, respiratory distress syndrome (RDS), need for ventilatory support, stillbirth, and neonatal death were compared between groups. Results: CPR significantly differed between high-risk and normal pregnancies. CPR <1 was identified in 28% of high-risk cases compared with none in the control group. Abnormal CPR was strongly associated with adverse outcomes, including NICU admission, preterm delivery, RDS, emergency cesarean delivery for fetal distress, and low Apgar scores. Among all Doppler indices, CPR demonstrated the highest specificity (100%) and positive predictive value (100%) for predicting overall adverse outcomes, although sensitivity remained low. Even within the subset of fetuses appearing appropriate for gestational age (AGA), a CPR below the 50th percentile was associated with late-onset fetal growth restriction (FGR), indicating its utility in identifying subclinical fetal compromise. Conclusion: CPR is a superior Doppler parameter for predicting adverse perinatal outcomes compared with individual UA or MCA indices. Its strong association with fetal distress and neonatal complications underscores its value in the management of high-risk pregnancies. Timely intervention in cases with abnormal CPR significantly improves neonatal outcomes. Routine CPR assessment should be incorporated into third-trimester Doppler surveillance, especially in high-risk pregnancies, to reduce perinatal morbidity and mortality.

Background: Fractures of the patella represent a small yet functionally significant subset of skeletal trauma. Because the patella anchors the extensor mechanism, disruption of its integrity or alignment can lead to long-term impairment if inadequately treated. Contemporary surgical approaches prioritise preservation of patellar structure and restoration of normal biomechanics. However, detailed reports assessing functional outcomes following operative management of closed patellar fractures remain relatively limited. Aim: To evaluate postoperative functional recovery among adults treated surgically for closed patellar fractures using the Modified Böstman score. Materials and Methods: A prospective observational study was conducted among 50 adults presenting with closed transverse, comminuted, or polar patellar fractures. Patients with open fractures or associated distal femoral or proximal tibial injuries were excluded. Depending on fracture configuration, patients underwent tension-band wiring, cerclage wiring, or partial patellectomy. Functional assessment was carried out over six months using the objective and subjective components of the Modified Böstman score. Results: Men comprised the majority of cases, and most injuries resulted from road traffic collisions. Transverse fractures were the most common pattern. Radiological union was usually achieved by the eighth postoperative week. By the final follow-up, most participants achieved excellent or good functional outcomes, with only a small subset reporting persistent anterior knee pain, terminal restriction of flexion, or hardware-related irritation. Major complications such as non-union or wire breakage were not encountered. Conclusion: Operative reconstruction of closed patellar fractures, with emphasis on preserving patellar anatomy and restoring the extensor mechanism, produced favourable functional outcomes in this cohort. Early mobilisation supported by a structured rehabilitation protocol aided recovery, while clinically significant complications remained infrequent.

Background: Abdominal trauma is a major cause of morbidity and mortality among trauma patients, particularly in developing countries. Understanding the pattern of injuries and surgical outcomes is essential for improving trauma care and patient survival. Aim: To study the pattern of abdominal trauma and evaluate its surgical outcomes in a tertiary care hospital. Objectives: To analyze the demographic profile and mechanisms of abdominal trauma, assess the pattern of abdominal organ injuries and surgical interventions, and evaluate postoperative outcomes, complications, and mortality. Materials and Methods: This hospital-based cross-sectional study was conducted in a tertiary care hospital over an 18-month period and included 200 patients presenting with abdominal trauma. Data regarding demographic characteristics, mechanism of injury, clinical presentation, imaging findings, surgical management, and postoperative outcomes were collected using a structured proforma. Statistical analysis was performed using appropriate descriptive and inferential methods, with a p-value <0.05 considered statistically significant. Results: Blunt abdominal trauma accounted for 68.5% of cases, with road traffic accidents being the most common mechanism. The mean age of patients was 38.4 ± 14.7 years, and males constituted 76% of cases. The liver and spleen were the most commonly injured organs. Operative management was required in 59.5% of patients, predominantly exploratory laparotomy. Postoperative complications occurred in 23% of cases, with surgical site infection being the most frequent. The mean ICU stay was 4.7 ± 2.3 days, and the overall mortality rate was 8.5%. Conclusion: Abdominal trauma predominantly affects young males and is mainly caused by blunt injuries related to road traffic accidents. Early presentation, hemodynamic stability, and timely surgical intervention are crucial determinants of favorable outcomes. Strengthening trauma systems and preventive strategies can further reduce morbidity and mortality associated with abdominal trauma.

Background: Vitamin D plays a crucial role in bone health, immune function, and overall growth in children. Pediatric patients on long-term anti-epileptic drug (AED) therapy are at increased risk of vitamin D deficiency due to drug-induced alterations in vitamin D metabolism. Identifying and addressing this deficiency is essential to prevent associated complications such as impaired bone mineralization and increased fracture risk. Aims: The present study aimed to assess serum vitamin D levels among pediatric patients undergoing long-term AED therapy and to evaluate the influence of factors such as age, sex, dietary habits, milk intake, and mobility on vitamin D status. Materials and methods: The study was a cross-sectional observational study conducted in the Department of Pediatrics at GMERS General Hospital, Gotri, Vadodara, Gujarat. Data collection was carried out from June 2023 to December 2024, and a total of 70 patients were included in the study. Results: The study involved 70 patients, mostly aged 5-10 years (50%) and predominantly male (64.3%). Most followed a vegetarian diet (77.1%) and consumed 2 glasses of milk daily (90%). Over half of the patients (55.8%) were mobile for 7-8 hours per day, with smaller proportions having shorter or longer mobility durations. Conclusion The study population was predominantly male children within a certain age range. Most participants followed a vegetarian diet and consumed milk regularly. A majority were physically active for several hours each day, while smaller proportions had shorter or longer activity durations. These findings indicate that the participants generally maintained a balanced diet and adequate daily mobility, which may contribute positively to their overall health and development.

Background: Vitiligo is an acquired depigmentary disorder characterized by the selective loss of melanocytes, resulting in well defined achromic macules. Although clinically expressed in the skin, growing evidence indicates that vitiligo represents a systemic disorder with strong genetic and developmental underpinnings. Dermatoglyphics, the study of epidermal ridge patterns of the fingers and palms, offers a unique window into early fetal development, as these patterns are established during intrauterine life and remain unchanged thereafter. Because melanocyte migration and epidermal ridge formation share a common ectodermal origin and overlapping developmental timelines, dermatoglyphic analysis may serve as a stable phenotypic marker of constitutional susceptibility to vitiligo. Objectives The present study aimed to evaluate qualitative and quantitative digito palmar dermatoglyphic features in individuals with vitiligo and to compare these parameters with those of age and sex matched healthy controls. Particular emphasis was placed on assessing sex specific variations and palmar ridge indices that may reflect altered embryologic development.Materials and Methods A hospital based case control study was conducted involving 424 subjects, comprising 212 clinically diagnosed vitiligo patients and 212 matched controls. Finger and palmar prints were obtained using standardized ink and roller techniques. Qualitative fingertip patterns including loops whorls and arches were analyzed. Quantitative parameters included Total Finger Ridge Count Absolute Finger Ridge Count a b ridge count and atd angle. True palmar patterns in hypothenar thenar and interdigital regions were also assessed. Statistical analysis involved appropriate parametric and non parametric tests, with significance set at p less than 0.05. Results Vitiligo subjects demonstrated a distinct alteration in fingerprint pattern distribution, characterized by a significant increase in loop patterns and a corresponding reduction in whorl patterns. Arch patterns were notably increased in female vitiligo subjects, indicating sex specific developmental sensitivity. Quantitative analysis revealed consistently lower Total Finger Ridge Count values in vitiligo subjects compared with controls, reflecting reduced ridge density. Absolute Finger Ridge Count was significantly reduced in male vitiligo subjects, suggesting diminished overall ridge complexity. Palmar analysis showed sex divergent changes in a b ridge count, with reduction in males and increase in females. The atd angle was increased in vitiligo subjects, particularly among females, indicating outward displacement of the axial triradius. True palmar patterns were more frequent in the hypothenar and first interdigital regions in vitiligo subjects, while controls showed greater pattern frequency in the third interdigital region. Conclusion The study demonstrates that vitiligo is associated with consistent and reproducible dermatoglyphic alterations involving both fingertip and palmar ridge parameters. These findings support the concept that vitiligo susceptibility is rooted in early developmental and genetic events rather than being solely acquired in postnatal life. Dermatoglyphic analysis emerges as a valuable noninvasive research tool for identifying constitutional markers of vitiligo and contributes to a deeper understanding of its developmental biology.

Background:While minimally invasive techniques such as Percutaneous Nephrolithotomy (PCNL) and Extracorporeal Shock Wave Lithotripsy (ESWL) have revolutionized the management of urolithiasis, open surgery remains a vital tool for complex cases, particularly in resource-limited settings. Objective: To evaluate the clinical profile, indications, surgical management, and postoperative outcomes of patients undergoing open surgery for renal calculi. Methods: A prospective observational study was conducted on 30 patients (N=30) admitted to a tertiary care center in Ahmedabad between March 2024 and February 2025. Patients underwent detailed preoperative evaluation including metabolic profiling and imaging (USG/CT). The primary intervention was open surgical removal of stones. Results: The study population showed a male predominance (1.5:1), with a peak incidence in the 30–50 year age group. Renal pain was the universal presenting symptom (100%). A strong association was found with the consumption of untreated surface or borewell water (83.3%). Pyelolithotomy with Double-J (DJ) stenting was the most common procedure performed (83.3%). Intraoperative complications were absent in 83.3% of cases. The postoperative course was largely uneventful, with 73.3% of patients experiencing no complications. Conclusion: Open renal surgery remains a safe, cost-effective, and reliable option for managing complex renal calculi, demonstrating low morbidity and excellent stone clearance rates in selected patients.

Background: Introduction: Thyroid dysfunction is a common endocrine disorder in pregnancy and is associated with significant maternal and fetal complications. India lacks large-scale studies defining trimester-appropriate thyroid-stimulating hormone (TSH) reference ranges for pregnant women, resulting in inconsistent diagnostic thresholds. Aim- This study was conducted to determine an appropriate TSH cut-off for diagnosing hypothyroidism in Indian pregnant women and to evaluate associated feto-maternal outcomes. Materials and Methods: This prospective and retrospective cohort study was conducted over 1.5 years (September 2021–April 2023) in the Department of Obstetrics & Gynecology, in tertiary health care center, and included 1000 pregnant women attending antenatal OPD. Singleton pregnancies without pre-existing medical disorders were included. Women underwent serum TSH testing by ELISA. Those with TSH >6.2 mIU/L underwent free T4 assessment and were categorized as overt hypothyroid (OH; Group I) or subclinical hypothyroid (SCH; Group II). Women with TSH 3–6.2 mIU/L formed Group III to evaluate a possible revised TSH threshold. Pregnant women with TSH 0.4–3 mIU/L were considered euthyroid and served as controls. Results: The prevalence of SCH and OH was 6.4% and 3.8%, respectively. Maternal complications such as pre-eclampsia, gestational diabetes mellitus (GDM), and intrauterine fetal demise (IUFD) occurred significantly more often in the OH group compared to controls (p=0.009, p=0.002, p=0.002). Fetal distress was significantly higher among SCH women (p=0.004). Group III (TSH 3–6.2 mIU/L) showed no statistically significant increase in maternal or fetal complications compared with controls. Conclusion: Hypothyroidism is highly prevalent among Indian pregnant women, with SCH being more common than OH. Adverse feto-maternal outcomes were significantly associated with OH but not with TSH values between 3–6.2 mIU/L. TSH values up to 6.2 mIU/L may be considered normal for Indian pregnant women until larger population-based studies establish trimester-specific reference ranges. Universal screening is recommended to reduce adverse pregnancy outcomes.

Background: Gallbladder disease presents with diverse clinical and pathological manifestations. Histopathological evaluation remains essential for detecting unsuspected malignancies. Recent evidence from randomized controlled trials on asymptomatic gallstone disease has broadened understanding of disease behavior. Objective: To analyze the histopathological spectrum of gallbladder lesions over 11 months and integrate findings with contemporary literature. Materials and Methods: A retrospective study of 210 cholecystectomy specimens was conducted. Detailed gross and microscopic examinations were performed. Findings were compared with recent clinical trials evaluating laparoscopic cholecystectomy in asymptomatic gallstone disease. Results: Among 210 gallbladder specimens, 170 (80.9%) showed chronic calculus cholecystitis, 24 (11.4%) chronic acalculous cholecystitis, 12 (5.7%) xanthogranulomatous cholecystitis, and 4 (1.9%) adenocarcinoma. Literature review demonstrated that asymptomatic gallstone disease often remains clinically stable, with limited progression to severe complications. Conclusion: Chronic inflammatory lesions dominate gallbladder pathology. Integration with recent clinical trial data suggests that while asymptomatic gallstone disease may have a benign course, histopathology remains indispensable for detecting incidental carcinoma.

Introduction: Thalassemia is a hematological disorder that is caused by mutations in the genes that encode hemoglobin chains. Mutations in the β-globin gene are the most common cause of genetic disorders in humans. The objective of the study was to evaluate the hematological parameters in pediatric patients with beta thalassemia major. Several studies reported an inverse relationship between mean platelet volume (MPV) and platelet counts in patients with BTC. Therefore, this study aimed to find out the alteration of MPV in thalassemia major patients in GMERS Medical College & General Hospital, Junagadh. Methodology: A cross sectional study was carried out between January 2025 to June 2025. 100 cases of thalassemia major were taken, whose EDTA samples were came for CBC in hematology laboratory of pathology department of GMERS medical college, Junagadh. Samples were run in abacus 5 parts automated hematology analyzer value of MPV were recorded. Then data will be classified according to diagnosis and tabulated in excel sheet. Result: out of which 8 (8%) cases showed decrease MPV. Range and mean of MPV were 5fl-7.1fl and 5.96fl respectively. 29 (29%) cases showed normal MPV. Range and mean of MPV were 7.6fl-10.4fl and 8.91fl. 63 (63%) cases showed increase MPV. Range and mean of MPV were 10.6fl-15.6fl and 11.73fl. So majority (63%) of thalassemia major cases showed increase in MPV. Conclusion: This study noted majority of thalassemia major patients showed increased mean platelet volume, which suggest the peripheral blood stream of these patients has more than normal number of larger, younger, and more reactive platelets.

Background: Introduction Cervical cancer is considered the fourth most common malignant tumor in women worldwide. In developing countries, like India it ranks as the 15th most frequent cancer among women. Epidermal Growth Factor receptor 1 has been a good targetted therapy. Although EGFR mutations are less commonly seen in cervical cancer, there is a correlation between EGFR, her 2 neu expression level and clinical response. Overexpression of Her2neu is a prognostic marker of cervical cancer and EGFR is expressed in poorly differentiated carcinoma thus denoting worst prognosis. Aim of the work To study prognostic utility of EGFR and Her2 neu in Cervical carcinoma among South Asian females. Material and methods Sixty cases of invasive cervical carcinomas were retrieved from paraffin blocks. EGFR and her2 neu expression were assessed by immunohistochemistry. EGFR gene amplification was assessed by FISH analysis. Results Her2 neu Positivity was detected in 70% of cases. Positive reaction to EGFR was detected in 18% of cases. The EGFR gene was not amplified in 71% of cases. Statistical significance was found between histological type, Her2 neu, and EGFR expression. A fair agreement was detected between EGFR expression and EGFR amplification. EGFR is a prognostic marker as EGFR is expressed in only poorly differentiated carcinoma and Her2 neu is expressed in all variants. Conclusion EGFR and Her2neu have independent role in the development of cervical cancer in South Asian females. EGFR overexpression and EGFR amplification represent two different genetic events; in other words, an increase in gene copy number does not mean that there will be an increase in the function of the gene as expressed by an increase in protein expression..

Background: Dengue fever, transmitted by Aedes aegypti and Aedes albopictus mosquitoes, is the fastest-spreading mosquito-borne viral disease worldwide, with an estimated 390 million infections and 96 million symptomatic cases annually across more than 100 endemic countries. India accounts for one of the highest dengue caseloads worldwide, contributing a substantial share of global morbidity, with frequent outbreaks reported across both urban and peri-urban regions. Aims And Objectives: The aims and objectives of this study are to determine the distribution of dengue fever cases across different gender and age groups, analyze the geographical patterns of dengue occurrence, evaluate the clinical features among confirmed dengue cases, and assess the frequency and types of complications observed in affected patients. Methods: A descriptive cross-sectional study was conducted on laboratory-confirmed dengue patients at Bhaskar Medical College and General Hospital .All patients of different age groups and genders, diagnosed based on WHO criteria and confirmed by NS1 antigen or IgM antibody tests, were included. Data on demographic characteristics (age, gender, geographical location), clinical features, and observed complications were collected using a structured proforma. The collected data were analyzed using descriptive statistics to summarize patterns and associations. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was secured from all participants or their guardians. Results: A higher prevalence of dengue was observed among males (65%) and young adults aged 21–40 years (39%). Urban residents accounted for the majority of cases (69%). Clinically, fever was universal, with headache (89%) and body aches (82%) being the most common associated symptoms, while gastrointestinal symptoms occurred in nearly half of the patients (47%). Significant complications were uncommon, occurring in only 6% of cases. Conclusion: Dengue fever was more common in males and younger people, mainly in urban areas, and typically caused fever, aches, and gastrointestinal symptoms. Severe cases were uncommon, emphasizing the need for early detection, ongoing monitoring, and targeted urban prevention.

Background: Pain, as defined by the International Association for the Study of Pain (IASP), is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Aim: To compare the clinical and anaesthetic features of addition of Intrathecal Dexmedetomidine and Fentanyl to 0.75% Isobaric Ropivacaine in lower limb surgeries. Methodology: The present study was conducted in the Department of Anaesthesiology, S.M.S. Medical College, Jaipur. This randomized, double-blind, controlled trial included a total of 50 patients aged 20–60 years who were scheduled to undergo elective lower limb surgery. Result: The addition of intrathecal dexmedetomidine to isobaric ropivacaine significantly prolonged sensory block, motor block, and duration of analgesia compared to fentanyl. Both groups showed comparable onset times, haemodynamic stability, and adverse effect profiles. Conclusion: Intrathecal dexmedetomidine is a more effective adjuvant than fentanyl when combined with isobaric ropivacaine, providing markedly longer sensory block, motor block, and postoperative analgesia. Both agents were safe, with no significant haemodynamic instability or adverse effects.

Background: Acute intestinal obstruction is a frequently encountered surgical emergency and continues to contribute substantially to patient morbidity and mortality. Accurate clinical assessment and early intervention are essential for favourable outcomes. This study evaluated the patterns of clinical presentation, underlying causes, treatment approaches, and outcomes in patients presenting with acute intestinal obstruction. Methods: A prospective observational study was carried out at a tertiary care hospital and included patients diagnosed with acute intestinal obstruction. Patient demographics, presenting complaints, physical findings, radiological features, operative details, and postoperative course were documented. Management decisions were based on clinical and imaging findings, with patients receiving either conservative treatment or surgical intervention. Outcome measures included postoperative complications, length of hospital stay, and mortality. Results: Abdominal pain was the most common presenting symptom, observed in more than 90 percent of patients, followed by vomiting in approximately 85 percent, abdominal distension in 80 percent, and constipation in nearly 75 percent. Adhesions accounted for about 40 percent of cases, making them the leading cause of obstruction, followed by hernias in 25 percent, malignancy in 15 percent, volvulus in 10 percent, and strictures in 10 percent. Surgical management was required in around 70 percent of patients. Postoperative complications were noted in nearly 20 percent of cases, with wound infection being the most frequent. The overall mortality rate was approximately 8 percent, with higher mortality observed among patients presenting late. Conclusion: Acute intestinal obstruction remains a major surgical concern. Early recognition, timely imaging, and appropriate intervention significantly influence clinical outcomes and help reduce complications and mortality.

Background: Neonatal septicemia remains a major contributor to neonatal morbidity and mortality, particularly in developing countries. Early identification of risk factors and clinical features is essential for timely diagnosis and management, significantly decrease the sepsis complications and improve its outcome Objective: To determine the incidence, associated maternal and neonatal risk factors, clinical presentations, and bacteriological profile of neonatal septicemia in a tertiary care hospital. Methods: A prospective observational study was conducted among neonates admitted with suspected sepsis. Detailed maternal, perinatal, and neonatal information was recorded. Blood cultures were performed to confirm sepsis. Incidence, risk factors, clinical features, and outcomes were analyzed using descriptive and comparative statistics. Results: Out of 1000 live births, 37 neonates had culture-proven sepsis, giving an incidence of 3.7%. Early-onset sepsis accounted for 67.9% of cases. Significant maternal risk factors associated with sepsis included PROM >18 hours (43.3%), maternal fever (35.2%), meconium-stained liquor (24.3%), and maternal UTI (21.6%). Neonatal risk factors significantly associated with sepsis were low birth weight (54.1%), prematurity (45.9%), birth asphyxia (24.3%), and need for resuscitation (24.3%). The most common clinical features observed were poor feeding (71.5%), respiratory distress (58.1%), and lethargy (50.3%). Klebsiella pneumoniae (31.5%) was the most frequently isolated organism, followed by E. coli (23%) and Staphylococcus aureus (17.6%). The mortality rate was 10.9%. Conclusion: Neonatal septicemia continues to be a significant health burden, largely influenced by preventable maternal and perinatal factors. Early recognition of high-risk neonates, timely intervention, and improved antenatal and intrapartum care are essential to reduce sepsis-related morbidity and mortality.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder that affects multiple biochemical and cellular processes in the body, resulting in diminished immunity and heightened susceptibility to infections. Aim: To study the prevalence of periodontal disease among diabetic and non diabetic patients. Methodology: The present study was designed as a cross-sectional observational study and was conducted in the ESIC MCH Alwar, and Data collection was carried out over a one-year period from December 2024- June 2025. Result: The study found that periodontal disease was significantly more prevalent and severe among diabetic participants compared to non-diabetics, with higher severity associated with longer diabetes duration and poor glycemic control. Oral hygiene practices were similar between groups, indicating that diabetes itself is a key risk factor for periodontitis. Conclusion: The study concludes that diabetes significantly increases the prevalence and severity of periodontal disease, particularly in individuals with poor glycemic control or longer disease duration. Early glycemic management and targeted periodontal care are essential to reduce disease risk and improve oral health outcomes.

Background: The technique of segmental spinal anaesthesia has gained increasing attention in recent years as an alternative to conventional lumbar spinal and general anaesthesia for abdominal procedures. Aim: Study to compare isobaric levobupivacaine (0.5%) for segmental spinal anaesthesia versus general anaesthesia in Laparoscopic cholecystectomy Methodology: This prospective, randomized, comparative clinical study was conducted in the Department of Anaesthesiology at GMC KOTA over a period of 9 months from JAN 2025 to September 2025. A total of 80 adult patients scheduled for elective laparoscopic cholecystectomy were enrolled. Result: The results showed that both groups were comparable in demographics, while Group B had higher intra-operative blood pressure and pulse rate. Post-operative complications and the need for rescue analgesia were greater in Group B compared to Group A. Conclusion: The study concluded that Group A demonstrated better intra-operative hemodynamic stability and fewer post-operative complications compared to Group B. Additionally, Group A required less rescue analgesia, indicating superior post-operative pain control.

Background: Osteoarthritis is the most common degenerative joint disorder and a leading cause of pain and disability worldwide. Rapid demographic aging, lifestyle changes, and occupational factors have contributed to a rising burden of osteoarthritis, particularly in developing countries. Differences in lifestyle and occupational exposure between urban and rural populations may influence the prevalence and risk factors of osteoarthritis. Aim: To determine the prevalence and associated risk factors of osteoarthritis in urban and rural populations. Methods: A cross-sectional observational study was conducted among 200 adult participants selected from urban and rural areas. Data were collected using a structured questionnaire capturing socio-demographic details, lifestyle factors, occupational history, comorbidities, and joint-related symptoms. Clinical assessment was performed to identify osteoarthritis. Anthropometric measurements were recorded. Statistical analysis included descriptive statistics and inferential tests to assess associations between osteoarthritis and risk factors, with a p-value <0.05 considered statistically significant. Results: The overall prevalence of osteoarthritis was 41%. Osteoarthritis was significantly more prevalent among rural participants compared to urban participants. Increasing age, female gender, higher body mass index, occupational strain, sedentary lifestyle, history of knee injury, diabetes mellitus, and hypertension were significantly associated with osteoarthritis. Rural participants showed higher exposure to occupational strain, whereas sedentary lifestyle was more common among urban participants. Conclusion: Osteoarthritis is highly prevalent in both urban and rural populations, with a significantly greater burden in rural areas. Identification of modifiable risk factors and implementation of targeted preventive and rehabilitative strategies are essential to reduce disease burden and improve quality of life.

Background: Salivary gland lesions encompass a wide spectrum of cystic and solid pathologies, ranging from inflammatory conditions to benign and malignant neoplasms. Accurate preoperative diagnosis is essential for optimal patient management. Ultrasonography (USG) and fine-needle aspiration cytology (FNAC) are frontline tools, and the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a structured framework to improve diagnostic reproducibility. This study integrates radiological and cytological findings to enhance classification accuracy and clinical decision-making. Aim: To evaluate the radiocytological correlation of cystic and solid salivary gland lesions using the MSRSGC and assess diagnostic accuracy against available histopathology. Methods: A prospective observational study of 50 patients presenting with salivary gland swelling was conducted. All cases underwent ultrasonography followed by FNAC. Cytological findings were categorized using MSRSGC. USG characteristics (echogenicity, borders, cystic vs. solid nature, vascularity) were correlated with cytological categories. Histopathology, when available, served as the diagnostic reference standard. Statistical significance, concordance rates, and diagnostic performance indicators were calculated. Results: Pleomorphic adenoma was the most common lesion, followed by inflammatory and cystic lesions. USG efficiently differentiated cystic and solid lesions but showed overlap between benign and low-grade malignant tumors. FNAC demonstrated high diagnostic clarity, particularly in Milan categories II and IV. Radiocytological concordance was high for pleomorphic adenoma, Warthin tumor, sialadenitis, and mucoepidermoid carcinoma. All malignant FNAC diagnoses (MSRSGC Category VI) correlated with final histopathology. Integrated radiocytological evaluation significantly improved diagnostic precision and reduced indeterminate interpretations. Conclusion: FNAC, when interpreted through the Milan System and supported by ultrasonographic profile, provides a highly effective, minimally invasive diagnostic pathway for salivary gland lesions. The combined approach enhances accuracy, guides appropriate clinical management, and reduces unnecessary surgical interventions.

Background: Objectives: Total knee Arthroplasty accompanies the risk of bleeding and need for blood transfusion. Bleeding may cause local complications consequently greater pain and reduced function postoperatively. The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has shown good results. The aim of this study was to evaluate whether tranexamic acid reduces postoperative drain output and blood transfusion after surgery. Methods: 200 patients were randomized and then underwent TKA. TXA was topical applied to 100 of these patients before closure of the joint capsule. Haemoglobin measurements (mg/dL) were taken preoperatively and 24 and 48 hours after surgery. Statistical analysis compared the results to determine whether there were differences between the groups for each of the evaluated times. Drain output, postop hb and transfusion were compared between the groups. Results: There were differences in favour of the drug 48 hours postoperatively for the haemoglobin variable (p = 0.01), There were no significant differences between the groups in the haemoglobin evaluation 24 hours postoperatively. The mean drain output was lower in the tranexamic acid group (470±210.7 mL) than the control group (645.0±270.4 mL). transfusion rate was lower in the tranexamic acid group (39%) compared with the control group (60%). The hemoglobin level was higher in the tranexamic acid group than in the control group at 48 hours postoperatively. transfusion rate were less in the tranexamic acid group (1.03 units) than in the control group (1.38 units). Conclusion : In addition to reducing bleeding, tranexamic acid decreases the total blood loss and transfusion after TKA .

Background: Objective: Traditionally, elective induction of labor (IOL) in low-risk pregnancies was avoided before 39 weeks. However, emerging evidence over the past decade has challenged this view. This review aims to critically evaluate current evidence on elective IOL beyond 39 weeks in low-risk pregnancies and assess its impact on maternal and neonatal outcomes, with particular attention to caesarean delivery rates. Material & Methods: We reviewed 13 key studies, including randomized controlled trials, systematic reviews, observational cohorts, and expert consensus guidelines, comparing elective induction with expectant management or spontaneous labor in term low-risk pregnancies. Results: Elective IOL at 39 weeks is consistently associated with a reduction in caesarean delivery, particularly when compared to expectant management. The observational data demonstrated a lower caesarean rate (The ARRIVE trial: 26.4% vs 29.1%; RR 0.83, 95% CI: 0.74–0.93) and fewer hypertensive disorders in the induction group. It further supports improved or comparable neonatal outcomes, including lower NICU admissions and reduced macrosomia. Misleading comparisons with spontaneous labor may overestimate caesarean risk. Studies also highlight that proper recognition of active labor (≥6 cm) is essential to avoid premature diagnoses of arrest disorders during induced labor. Conclusion: The collective findings from high-quality randomized and observational studies support elective induction of labor at 39 weeks as a safe and potentially advantageous option in low-risk pregnancies. It reduces caesarean rates, lowers the risk of hypertensive complications, and does not adversely affect neonatal outcomes. This review concludes that for many low-risk pregnancies, “39 weeks is the new EDD.

Background: Severe perennial allergic rhinitis (PAR) significantly impairs quality of life and often requires long-term pharmacotherapy. Minimally invasive selective posterior nasal neurectomy (PNN) has emerged as a surgical option for patients refractory to medical management, aiming to reduce symptoms and medication dependence. Aims: To evaluate the effectiveness, safety, and patient satisfaction of minimally invasive selective PNN in patients with severe PAR. Materials and methods: This retrospective follow-up study was conducted at the Department of Otorhinolaryngology, IPGME&R SSKM HOSPITAL &Medical College KOLKATA, West Bengal, India, from 01 July 2020 to 30 June 2025. A total of 34 patients (24 males, 10 females) who underwent PNN, with or without adjunctive turbinectomy and/or septoplasty, completed follow-up, with symptom severity and medication use assessed pre- and postoperatively. Result: Among the participants, 19 (55.9%) underwent PNN alone, 9 (26.5%) received PNN with partial inferior turbinectomy, and 6 (17.6%) underwent PNN with turbinectomy and septoplasty. Postoperative TNSS scores improved significantly: sneezing decreased from 2.8 ± 1.0 to 0.9 ± 0.5, rhinorrhoea from 2.5 ± 0.9 to 0.7 ± 0.4, nasal obstruction from 2.4 ± 1.0 to 0.8 ± 0.5, and itching from 1.8 ± 0.8 to 0.5 ± 0.3 (p < 0.01). Total TNSS decreased from 9.5 ± 2.4 to 2.9 ± 1.2. Medication scores dropped from 1.6 ± 1.4 to 0.4 ± 0.5 (p < 0.05). Improvements were sustained over follow-up periods of 1–5 years. Patient satisfaction was high, with 18 (52.9%) very satisfied and 12 (35.3%) satisfied. Conclusion: Minimally invasive selective PNN provides significant and sustained symptom relief, reduces medication dependence, and achieves high patient satisfaction in severe PAR, supporting its role as a safe and effective surgical intervention.

Background: Uterine prolapse is a frequently encountered gynecological disorder that may present in women of varying age groups. Pelvic organ prolapse is common condition leading to urogenital tract dysfunction and diminished quality of life. As the population ages, the number of women affected with POP is expected to rise approximately 9.2 million by 20501. The prevalence ranges from 3% to 50%, it causes sensation of vaginal bulge, urinary, bowel or sexual dysfunction2. POP affects 50% parous women above 50 years. Risk factors include advanced age, vaginal childbirth especially big baby, obesity, chronic constipation, heavy lifting, smoking. connective tissue disorders3. Prolapse has been shown to negatively affect the quality of life in approximately 60% of affected women4. The use of pessaries dates back as early as the 5th century BCE, during the time of Hippocrates, when hot oil stimulants, astringent-soaked plugs, and pomegranates were used to treat prolapse5. Pessaries as the initial management strategy for women seeking nonsurgical treatment, those wishing to preserve fertility, individuals with early-stage prolapse, or patients considered unfit for operative procedures. Pessaries may also benefit women with stress urinary incontinence exacerbated by physical exertion 6. Pessaries are minimally invasive silicone devices that have been the cornerstone of the non-surgical management of POP, in addition to pelvic floor muscle exercises. Most studies includes pessaries made up of Silicone and are ring type with or without central support, Gell horn and Doughnut pessary7. Though surgery is permanent management, Vaginal pessary is temporary method of management of uterine prolapse for those who are not fit or willing for surgery due to some reason. Pessary are removable devices inserted into vagina holds the pelvic organs back in their usual place and reduces prolapse. Pessary treatment is minimally invasive, but causes side effects like pain, discomfort, excessive discharge, associated with discontinuition of use in 24% to 49% of women in 12-24 months8. Factors associated with pessary failure are younger age, higher BMI, history of prolapse surgery, short vaginal length or advanced stage of prolapse9. Objectives: To retrospectively analyze the demographic profile of women who underwent pessary treatment, To evaluate problems following insertion, reasons for removal and patient satisfaction in relation to quality of life. Methodology: This observational study was conducted from January 2023 to December 2024. A total of 36 clients undergoing pessary treatment were included. We looked into demographic profile, size of pessary used, follow-up for any difficulties, reasons for removal of pessary and factors influencing client satisfaction. Results: The mean age of participants was 59 years (Range 21 - 85 years). The majority of clients (27.8 %) were in age 71 - 80 years age group, Most clients were multiparous with 41.7 % having parity 4. High parity (>4) observed in 22.2 %. Most cleints presented with third degree prolapse (61.1%) and 11.1 % with procedentia. Among the 36 patients studied, the most frequent type of prolapse was uterovaginal prolapse involving both cystocele and rectocele (44.4%), followed by uterine prolapse with cystocele alone (33.3%) and uterine prolapse with rectocele alone (22.2%). Majority (31, 86.2%) had a history of vaginal delivery, of which 20 (55.6%) were complicated vaginal deliveries, including prolonged or instrumental labor, and 11 (30.6%) were uncomplicated vaginal deliveries. Only 5 patients (13.8%) had undergone LSCS. The main reason for conservative management were co morbidities and advanced age (33.3 % each), followed by fear to undergo surgery (27.8%). The 3.5 inch pessary was most frequently used (44.4%). At 6 months followup, 50% clients reported no difficulty. Common complications include urinary and bowel difficulties (33.3%), dyspareunia (5.6%) and 11.1% required pessary removal. Overall satisfaction was favourable with 89% cleints rating their experience >/=6 on 10 point scale, while 11% opted for removal for low satisfaction. Conclusion: Pessary treatment stands out to be a good option in all health setups for those who are not fit or not willing for surgery for short term duration of few years irrespective of age group. However this people must be under supervision for periodic followup for any adverse outcomes. Category- Department of obstetrics and gynaecology.

Background: Induction of labour (IOL) is a common obstetric procedure performed when the benefits of early delivery outweigh the risks of continuing the pregnancy¹. It is indicated in situations such as post-term gestation, preeclampsia, gestational diabetes, intrauterine growth restriction, premature rupture of membranes, and other maternal or fetal complications². Globally, the rate of labour induction varies between 10% and 30%, depending on institutional policies, regional practices, and maternal characteristics³. With rising cesarean section rates worldwide, optimizing the success of IOL has become a critical focus of obstetric care. The success of induction largely depends on cervical readiness, fetal position, parity, and the engagement of the fetal head in the maternal pelvis⁴. Traditionally, Bishop’s scoring system has been employed to assess cervical favourability and predict the likelihood of vaginal delivery⁵. While widely used, the Bishop score has several limitations: it is subjective, shows significant interobserver variability, and may not accurately predict induction success, especially in nulliparous women⁶. To overcome the limitations of clinical assessment, ultrasound evaluation of labour has emerged as a reliable, objective, and non-invasive method to assess fetal head engagement and descent⁷. Transperineal ultrasound (TPUS), in particular, allows real-time visualization of the fetal head in relation to maternal bony landmarks and the perineum⁸. Therefore, this study aims to evaluate the influence of fetal head–perineum distance on the outcome of induction of labour and to determine its role as a reliable, adjunct parameter for predicting successful vaginal delivery. Objectives: -To evaluate the influence of fetal head–perineum distance (FHPD) measured by transperineal ultrasound on the success of induction of labour, specifically the likelihood of vaginal delivery -To determine a cut-off value of FHPD that optimally predicts successful vaginal delivery in the study population. Methodology: In thisprospective observational study done at our Subbaiah institute of medical sciences, from January 2025 to June 2025 on pregnant women of gestational age of 37 to 42 weeks, Singleton pregnancy, Cephalic presentation with Reassuring CTG Transperineal ultrasound was performed on antenatal women fulfilling criteria. Results: Out of of 59 women studied. 38(64.4%) delivered vaginally and 21(35.6%) by LSCS. FHPD ≤6 cm was noted in 26 women (44.1%), who showed a higher likelihood of vaginal delivery.. Multiparity showed a significant association with favourable induction outcomes.An optimal cutoff value of FHPD(≤6 cm) was identified, above which the likelihood of cesarean delivery increased. The predictive accuracy of HPD was found to be reliable indicator of successful vaginal delivery. Conclusion: Fetal head–perineum distance measured via transperineal ultrasound is a reliable, non-invasive predictor of successful vaginal delivery in women undergoing labor induction. Incorporating FHPD assessment into routine pre-induction evaluation may enhance clinical decision-making and improve maternal outcomes Category- Department of obstetrics and gynaecology.

Background: Otitis media (OM) remains a common cause of morbidity across age groups, yet patterns of antimicrobial utilization vary widely. Understanding prescribing trends is essential for optimizing management and strengthening antimicrobial stewardship. Aim: To evaluate the demographic profile, clinical characteristics, and antimicrobial prescribing patterns among patients with otitis media in a tertiary care hospital, and to assess rationality using WHO prescribing indicators. Methods: This observational, cross-sectional study included 350 patients diagnosed with Otitis Media. Data on demographics, clinical subtype, symptoms, comorbidities, antimicrobial agents, routes of administration, treatment duration, and adverse drug reactions (ADRs) were collected. Prescribing practices were evaluated using WHO core indicators. Results: Young adults (16–30 years) formed the largest age group (31.43%), and males constituted 57.14% of the cohort. CSOM was the most common subtype (40%), followed by AOM (37.14%) and OME (17.14%). Ear discharge, pain, and hearing loss were the predominant symptoms. Beta-lactams were the most frequently prescribed antimicrobials (34.29%), followed by fluoroquinolones (22.86%) and aminoglycosides (14.29%). Oral therapy was most commonly used (51.43%), with topical preparations predominantly used for CSOM. Most patients received treatment for 6–10 days (62.86%). The average number of drugs per prescription was 1.83, with 60% prescribed by generic name and 80% from the Essential Drug List. ADRs were infrequent (5.71%) and primarily mild. Conclusion: Antimicrobial prescribing for OM in this setting was largely rational and aligned with guideline-based recommendations. However, limited generic prescribing and reliance on empirical therapy indicate a need for improved stewardship. Incorporating culture-sensitivity testing and expanding multicentric surveillance could enhance evidence-based management of otitis media.

Background: High-grade acromioclavicular (AC) joint dislocations (Rockwood types IV and V) commonly affect young, active individuals and often require surgical intervention. Traditional fixation methods such as pins, screws, and hook plates are associated with complications including implant migration, subacromial impingement, and need for secondary removal. Double-endobutton fixation with fiber tape has emerged as a biomechanically stable, minimally invasive alternative. Aim: To evaluate the functional outcomes and complications of double-endobutton fixation with fiber tape in patients with acute Rockwood type IV and V AC joint dislocations. Materials and Methods: A prospective observational study was conducted between July 2023 and December 2024 at a tertiary care centre. Twenty-two patients aged 18–60 years with acute Rockwood IV–V dislocations underwent open reduction and double-endobutton fixation. Functional evaluation was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant–Murley score at 6 weeks, 3 months, and 6 months. Radiological follow-up assessed maintenance of reduction and implant position. Statistical analysis was performed using the Friedman test, with significance set at p < 0.05. Results: The mean DASH score improved significantly from 48.97 preoperatively to 5.33 at 6 months (p = 0.0001). The mean Constant score increased from 33.67 preoperatively to 95.11 at 6 months (p = 0.0001). Complications were minimal: four patients developed shoulder stiffness (18.18%) and two had superficial infections (9.09%), all managed conservatively. No implant migration, loss of reduction, or hardware failure occurred. Conclusion: Double-endobutton fixation with fiber tape is a reliable and effective technique for managing high-grade AC joint dislocations, providing excellent functional recovery, stable radiological outcomes, and low complication rates. The method allows early mobilization and offers distinct advantages over traditional rigid fixation devices.

Background: Lumbar vertebral fractures that come with dural tears are rare but important because they can lead to cerebrospinal fluid (CSF) leaks, neurological issues, and infections. Quick diagnosis and timely surgical repair are crucial to avoid long-term problems. Case Presentation: We describe the case of a 22-year-old man who fell from a height and had a lumbar spinal fracture. He arrived with paralysis in both legs and excruciating low back pain. In addition, he suffered a left bimalleolar ankle fracture and bilateral distal radius fractures. Immobilization, intravenous methylprednisolone, catheterization, and supportive care were the initial treatments. Pre-operative neurological evaluation revealed bowel and bladder involvement, decreased motor power from 1/5 to 3/5, and diminished feeling in both legs. The lumbar spine fracture with canal compression was verified by radiographs and MRI. The posterior elements remained intact during the posterior midline exposure; pedicle screws and connecting rods were used for fixation. During the procedure, a dural rupture was discovered, and 4-0 Prolene sutures were used to gently patch it. The proper implant location was confirmed by postoperative imaging. The patient's neurological condition did not worsen and he retained his preoperative motor and sensory status. He recovered restricted mobility in line with his pre-injury functional state, and his postoperative course was uncomplicated. Conclusion: Severe lumbar fracture cases with dural tear have been treated most effectively when a posterior spinal fixation was performed along with an early diagnosis and repair of the dura. By identifying the dura early and applying an airtight seal, neurological stability can be achieved by controlling cerebrospinal fluid (CSF) leakage and preventing subsequent complications. This case illustrates the benefits of early surgical intervention in the preservation of neurological function and providing a means for continued rehabilitation.

Background: Anastomotic leakage (AL) is a significant complication of intestinal anastomoses that contributes to increased morbidity, mortality, and prolonged hospital stay. This study evaluated the effectiveness and accuracy of the Dutch Leakage Score (DULK), a postoperative scoring system, for the early detection of AL following intestinal anastomosis. Methods: A total of 86 cases were included in this observational study conducted over a duration of 14 months, from March 2023 to May 2024. Postoperative assessments were conducted using the DULK score on days 1, 3, 5, 7, and 12 to evaluate its validity as an early diagnostic tool for anastomotic leakage. Results: The study confirmed that the DULK score is a reliable tool for detecting anastomotic leaks, with a sensitivity of 84.37% and specificity of 79.62%. Conclusion: DULK score with a cut-off value of 8 is an effective diagnostic tool for anastomotic leaks, demonstrating its significance in early detection of anastomotic leak.

Background: Diabetic foot ulcers (DFUs) are a major cause of morbidity and lower-limb amputation. Split-thickness skin grafting (STSG) is widely used to achieve rapid wound closure, but outcomes vary due to infection, vascular insufficiency, and delayed healing in diabetic patients. This study evaluates graft-take rates, donor-site morbidity, and hospital stay in patients with DFUs undergoing STSG and compares outcomes with recent literature. Methods: A prospective study was conducted on 30 patients with chronic diabetic foot ulcers requiring STSG. Graft take was assessed on the 5th and 10th postoperative days. Pre-operative and postoperative length of stay and donor-site infection were recorded. Results: On the 5th postoperative day, 63.3% of patients demonstrated 100% graft take, 10% showed 99% take, 10% showed 98% take, and 16.6% showed 97% take. By the 10th postoperative day, 80% achieved 100% graft take and 20% achieved 99% take. Donor-site infection occurred in 13.3% of patients and resolved conservatively. The average preoperative hospital stay was 30 days, which decreased to 13 days postoperatively. These results were comparable with recent studies reporting early graft-take rates ranging from 58–72% and final take rates of 85–92% in diabetic cohorts. Conclusion: STSG is an effective treatment modality for diabetic foot ulcers, demonstrating high graft-take rates by the second postoperative week and a significant reduction in hospital stay. Donor-site morbidity remains within acceptable limits, though slightly higher than some recent studies. Early wound bed preparation, infection control, and optimized perioperative care can further enhance outcomes.

Background: Cervical cancer remains a leading cause of cancer-related mortality among women in developing nations, particularly India. The Papanicolaou (Pap) smear is the gold standard screening tool for the early detection of precancerous cervical intraepithelial neoplasia (CIN) and malignancy. Understanding the regional cytomorphological spectrum is vital for healthcare planning and epidemiological assessment. Methods: This retrospective observational study was conducted at a Tertiary Care Centre in Nashik, Maharashtra. A total of 450 cervical smears were collected from women attending the Gynecology outpatient department between January 2025 and June 2025. Smears were stained using the conventional Papanicolaou method and evaluated by pathologists. Data were analyzed using SPSS software. Results: Out of 450 cases, 438 (97.3%) were satisfactory for evaluation. The mean age of the participants was 38.4 ± 11.2 years. The vast majority of smears, 418 (95.4%), were Negative for Intraepithelial Lesion or Malignancy (NILM). Among NILM cases, inflammatory smears were the most common finding (62.1%). Specific infectious agents were identified in 18.5% of cases, with Candida species (8.2%) and Bacterial Vaginosis (6.4%) being predominant. Epithelial Cell Abnormalities (ECA) were detected in 20 cases (4.6%). The distribution of ECA was: Atypical Squamous Cells of Undetermined Significance (ASC-US) (1.4%), Low-grade Squamous Intraepithelial Lesion (LSIL) (2.1%), High-grade Squamous Intraepithelial Lesion (HSIL) (0.9%), and Atypical Glandular Cells Of Undetermined Significance (AGUS) (0.2%). There was a statistically significant association between increasing age (>45 years) and the severity of epithelial abnormalities (p < 0.05). Conclusion: The study reveals a high prevalence of inflammatory smears in the Nashik region, highlighting the burden of genital tract infections. While the prevalence of premalignant lesions was relatively low, the detection of LSIL and HSIL emphasizes the indispensable role of routine Pap smear screening in reducing cervical cancer morbidity.

Background: Haemorrhoids are a common anorectal condition presenting with bleeding, prolapse, pain, constipation and itching. Limitations of conventional surgery—including postoperative discomfort and recurrence—have increased interest in minimally invasive alternatives. Ksharasutra, an Ayurvedic para-surgical method, offers controlled chemical cauterisation and simultaneous cutting–healing, making it a promising option for haemorrhoid management. Materials and Methods: A prospective observational study was conducted at Jagat Hospital & Kshara Sutra Center, District Una, Himachal Pradesh. Diagnosis was confirmed clinically and by proctoscopy. Eligible patients underwent standardized Ksharasutra ligation without spinal anaesthesia, followed by uniform postoperative care. Outcomes were assessed for symptom relief, tissue separation time, complications and recurrence. Results: Among 125 patients, males constituted 83.20% and females 16.80%. Middle age groups (31–40 and 41–50 years) each accounted for 24.8%. Most patients were unmarried (91.20%) and 59.20% consumed a non-vegetarian diet. Occupationally, business (30.40%) and service workers (20.8%) predominated. Pain (76.2%), bleeding (73.5%), prolapse (69.4%) and constipation (66.66%) were the most common symptoms. Mixed internal–external haemorrhoids formed the majority (66.4%), followed by internal (27.2%) and external (6.4%). Chronicity of 1–5 years was most frequent (47.2%). The classical 3, 7 and 11 o’clock positions accounted for 84% of cases. Vata-Pittaja Prakriti was predominant in both patient constitution (56.8%) and disease manifestation (80.8%). Tissue separation occurred in ≥7 days in 64.8% of cases, in 6 days in 23.2% and within 5 days in 12%. No major complications or recurrence were observed. Conclusion: Ksharasutra therapy is a safe, effective and minimally invasive treatment for haemorrhoids, demonstrating consistent symptom improvement, controlled tissue excision and excellent healing without complications or recurrence.

Background: Introduction: Cirrhosis of liver is a pathologic entity defined as diffuse hepatic fibrosis with the replacement of the normal liver architecture by nodules. Aim: To quantify the difference in serum sodium levels before and after intravenous albumin therapy. Methodology: The present study was conducted in the Department of Gastroenterology at Pushpawati Singhania Research Institute (PSRI), located on Press Enclave Road, Sheikh Sarai Phase 2, New Delhi. The study was conducted within the time frame of Dec 2022 to July 2024. Result: In our study, intravenous albumin significantly improved serum sodium, hyponatremia resolution, serum albumin, MELD-Na, and MELD 3.0 scores compared to the without-albumin group, demonstrating clear clinical benefit. These findings, consistent with previous studies, indicate that albumin therapy is particularly valuable for hyponatremic cirrhotic patients, especially those awaiting liver transplantation. Conclusion: Intravenous albumin therapy significantly improved hyponatremia, serum albumin levels, and liver severity scores (MELD-Na and MELD 3.0) in cirrhotic patients. These results suggest that albumin is a beneficial adjunct treatment, especially for hyponatremic patients awaiting liver transplantation.

Background: Ionic radiation, an intense type of magnetic or dust radiation, has a mutually exclusive effect on human health because it can be both a powerful carcinogen and a safe cancer treatment. The types and sources of ionizing radiation are examined in this review, along with their molecular and cellular effects. These sources include each man-made (medical imaging, radiotherapy, nuclear industry) and natural (cosmic, terrestrial, radon). The main DNA repair pathways and their role in carcinogenesis are examined along with the mutagenic mechanisms of ionizing radiation, which include direct DNA ionization, indirect damage via reactive oxygen species, and subsequent genomic instability. Radiation-induced conditions can be all kinds from solid tumors and hematologic malignancies to non-malignant diseases like cardiovascular disease and cataracts. Ionizing radiation takes into account tumor radiosensitivity in therapy for cancer by causing DNA double-strand breaks, oxidative stress, vascular impairment, and immunogenic cell death. Proton and heavy ion therapy are a couple of new radiotherapy techniques that improved treatment precision, yet problems with radiation resistance and secondary cancers still exist. In order include both basic radiobiology and more recent advances, the literature for this review was gathered from PubMed and Google Scholar. To maximize the benefits of therapy while decreasing long-term risks it is still important to fully understand the dual nature of ionizing radiation.

Background: PURPOSE: To evaluate alterations in corneal endothelial parametersand central corneal thickness (CCT) among patients with primary glaucoma, including both primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods: A hospital-based cross-sectional study was conducted involving 40 patients diagnosed with primary glaucoma and 40 age-matched controls. The total duration of the study was 18 months. All participants underwent comprehensive ocular examinations encompassing slit-lamp biomicroscopy, gonioscopy, and intraocular pressure (IOP) assessment. Corneal endothelial parameters namely endothelial cell density (ECD), coefficient of variation in cell size (CV), and percentage of hexagonal cells (6A)—were analyzed using specular microscopy. Central corneal thickness was measured using ultrasound pachymetry. Statistical analyses were performed using SPSS version 27.0. Results: Both endothelial cell densityandCentral corneal thicknesswere significantly reduced in glaucoma patients compared to age-matched non-glaucomatous controls. An age-related decline in both endothelial cell densityandCentral corneal thicknesswere evident, with the lowest values noted in glaucoma patients aged >60 years. The mean Central corneal thicknesswas 521.48 µm in patients of 20- 40year age group, 506.41 µm in the 41- 60year age group and 494.81 µm in patients over 60 years of age. The mean endothelial cell densitywas 2302.18 cell/mm2 in patients of 20- 40year age group, 2210.76 cell/mm2 in the 41- 60year age group and 2150.20 cell/mm2 in patients over 60 years of age. Furthermore, glaucoma patients demonstrated increased coefficient of variation in cell sizeand a reduced percentage of hexagonal cells relative to controls, indicating endothelial stress and morphological variation. Conclusion: Primary glaucoma is associated with significant alterations in central corneal thickness and corneal endothelial morphology. A significant decrease in corneal endothelial cell densityandCentral corneal thicknesswas observed in primary glaucoma patients when compared to healthy controls of the same age group. These findings suggest that routine assessment of corneal endothelial parameters and Central corneal thicknessmay improve diagnostic precision and treatment planning in glaucoma management.

Background: Chronic inflammatory mechanisms play a significant role in the pathogenesis of primary open-angle glaucoma (POAG). The best chance of preserving vision lies in diagnosing the disease before the patient experiences noticeable functional impairment. The primary objective of this study was to evaluate the diagnostic value of platelet count, white blood cell (WBC) count, neutrophils, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) in patients with POAG, and to explore their association with the severity of the disease. Materials and Methods – This prospective study included 50 consecutive patients diagnosed with POAG and 50 control subjects. Laboratory and clinical data were obtained from a medical records database. Based on perimetry findings, patients were categorized into three groups according to disease severity: mild (mean deviation [MD] ≤ 6.00 dB), moderate (6 dB < MD ≤ 12 dB), and severe (MD > 12 dB). Results: The mean levels of neutrophils, NLR, and WBC were significantly higher in the POAG group compared to the control group. The mean age of patients in the POAG group was 61.02 ± 9.68 years, while in the control group it was 61.23 ± 9.06 years. Gender distribution showed that in the POAG group, 64% were male and 36% were female, whereas in the control group, 60% were male and 40% were female. Conclusion: Our findings suggest that WBC count, NLR, and LMR may serve as useful adjuncts in the diagnostic workup of POAG. Elevated NLR and reduced LMR levels point toward a possible inflammatory component in POAG. However, these biomarkers should be interpreted cautiously and in conjunction with conventional diagnostic tools for glaucoma.

Background: Proximal tibial fractures are one of the most common fractures which is intra as well as extra articular. Aim: To assess functional, radiological, biomechanical and biological outcome after application of hybrid external fixator in different types of proximal periarticular tibial fractures. Methodology: This prospective study was conducted at the trauma center of the Department of Orthopaedics, Sardar Patel Medical College and Associated Group of P.B.M. Hospitals, Bikaner, Rajasthan, India, from May 2022 to July 2024. Result: Our study confirms previous research on the high incidence of proximal tibial fractures in young adults, complex fracture patterns, and the effectiveness of hybrid external fixation in preserving knee function and mobility. Conclusion: Hybrid external fixation is an effective, stable, and flexible method for treating complex proximal tibial fractures, ensuring soft tissue preservation and optimal recovery, even in resource-limited settings.

Background: Laparoscopic cholecystectomy (LC), first introduced by Dr. Erich Mühe in 1985, is now the gold standard treatment for gallstone disease, having replaced open cholecystectomy due to its advantages of reduced postoperative pain, shorter hospital stay, faster recovery, and minimal surgical trauma. AIM: To compare the efficacy and safety of isobaric levobupivacaine versus heavy bupivacaine in thoracic spinal anesthesia for laparoscopic cholecystectomy with respect to sensory and motor block characteristics, hemodynamic parameters, and associated side effects. Methodology: This study was designed as a prospective randomized control study conducted in the Department of Anesthesiology, Sardar Patel Medical College and A.G. Hospital, Bikaner. The study was initiated after obtaining approval from the Institutional Ethical Committee and continued until the completion of the required sample size. Result: Both groups were demographically comparable. Hyperbaric bupivacaine showed faster onset but shorter duration of sensory and motor block, with slightly higher incidences of hypotension and nausea, whereas isobaric levobupivacaine provided longer block duration and greater hemodynamic stability. Conclusion: Isobaric levobupivacaine offers longer block duration and better hemodynamic stability compared to heavy bupivacaine, though larger multicenter studies are required to confirm these findings.

Background: Gastroesophageal Reflux Disease (GERD) is a common gastrointestinal disorder with considerable global prevalence and regional variability. Epidemiological data suggest that GERD affects approximately 18.1–27.8% of the population in the United States, 8.8–25.9% in Europe, and less than 10% in most Asian countries. AIM: To observe esophageal manometric abnormalities in patients with gastroesophageal reflux where esophageal manometry indicated. Methodology: The study was conducted in the Department of Gastroenterology at GMC Barmer. Result: In our study of 76 GERD patients, heartburn was the most common symptom (80.26%), and ineffective esophageal motility was observed in 31.58% of patients. Low basal LES pressure and hiatus hernia were found in 10.53% and 7.89% of cases, respectively, with no significant difference between erosive and non-erosive subtypes. Although the EGJ-CI showed high specificity (86.67%) for predicting erosive reflux disease, its low sensitivity (23.91%) and diagnostic accuracy (48.68%) may be attributed to small sample size and lack of control group. Conclusion: Ineffective esophageal motility, low LES pressure, and low EGJ-CI are associated with GERD, but none reliably predict endoscopic esophagitis.

Background: Scalp block has emerged as a highly effective technique for providing perioperative anesthesia and analgesia in neurosurgical and certain extracranial procedures. Aim: To assess the effect of scalp block using Dexmedetomidine as an adjuvant with Bupivacaine (0.5%) under sedation with Dexmedetomidine for Burr hole surgery patients. Methodology: This study is a prospective randomized controlled trial conducted in the Department of Anesthesiology, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner. RESULT: Group D demonstrated superior analgesia, prolonged pain relief, greater hemodynamic stability, and deeper sedation compared to Group B, with fewer rescue analgesic requirements. Both groups showed good safety profiles, confirming the efficacy and tolerability of dexmedetomidine as an adjuvant in scalp block for burr hole surgeries. Conclusion: Scalp block with dexmedetomidine as an adjuvant to bupivacaine provides superior anesthesia, prolonged analgesia, stable hemodynamics, and minimal side effects in burr hole surgeries.