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.