Background: The relationship between surgical volume and oncologic outcomes in colorectal surgery has been widely debated. Several studies suggest that high-volume surgeons and centers achieve better oncological outcomes due to greater experience, improved technical skills, and adherence to standardized oncologic principles. However, data comparing outcomes between high- and low-volume surgical practices in colorectal cancer surgery remain limited in many regions1,2 . Methods: A retrospective cohort study was conducted including 42 patients who underwent elective colorectal cancer surgery between February 2025 and February 2026 at a tertiary care center. Patients were categorized into two groups based on surgeon case volume: high-volume surgeons (>20 colorectal resections/year) and low-volume surgeons (<20 resections/year). Demographic data, perioperative outcomes, and oncologic parameters including lymph node yield, margin status, postoperative complications, length of hospital stay, and short-term oncologic outcomes were analyzed. Results: Of the 42 patients, 24 (57.1%) were operated on by high-volume surgeons and 18 (42.9%) by low-volume surgeons. The mean lymph node yield was significantly higher in the high-volume group (18.6 ± 5.2 vs 13.2 ± 4.8 nodes). Negative circumferential resection margins were achieved in 95.8% of high-volume cases compared with 83.3% in the low-volume group. Postoperative complication rates were lower in the high-volume group (20.8% vs 33.3%). The mean hospital stay was also shorter in the high-volume group (6.2 ± 2.1 days vs 8.4 ± 2.7 days). Conclusion: High-volume surgical practice appears to be associated with improved oncologic parameters, better perioperative outcomes, and shorter hospital stay in colorectal cancer surgery. Concentrating colorectal cancer surgery in experienced hands may improve overall oncologic quality and patient outcomes.

Background: Type 2 diabetes mellitus (T2DM) is a common metabolic disorder associated with chronic hyperglycemia and multisystem complications. Emerging evidence indicates that diabetes may impair pulmonary function, resulting in restrictive ventilatory changes. Pulmonary function tests (PFTs) allow early detection of such subclinical involvement. This study aimed to assess pulmonary function in patients with T2DM and compare the findings with healthy controls. Methods: A cross-sectional study was conducted over 18 months at a tertiary care center, including 122 patients with T2DM and 122 age- and sex-matched healthy controls. Spirometry was performed according to ATS/ERS guidelines to assess FVC, FEV₁, FEV₁/FVC, PEFR, and FEF25-75%. Data were analyzed using SPSS, with p <0.05 considered statistically significant. Results: Abnormal pulmonary function was significantly more common in T2DM patients than controls (41.8% vs. 8.2%, p <0.001), predominantly showing a restrictive pattern. Mean values of FVC, FEV₁, PEFR, and FEF25-75% were significantly lower in cases (p <0.05), while the FEV₁/FVC ratio was comparable. Pulmonary function declined with increasing duration of diabetes, with significant reductions in FEV₁ and FEF25-75%. Conclusion: Pulmonary function is significantly compromised in patients with Type 2 Diabetes Mellitus, with restrictive ventilatory impairment being the most common abnormality. Routine pulmonary function assessment may help in early detection and improved management of diabetes-related pulmonary involvement.

BACKGROUND: Nutritional anemia in children is one of the major health problems in India as well as in many parts of the world, since anaemic children have reduced exercise tolerance, slow growth rate, impaired cognitive development and increased risk of complications associated with malnutrition and infection. This study highlights the spectrum of causes, clinical presentation and laboratory findings of nutritional anemia. METHODS: Seventy-Five (75) patients with a haematological diagnosis of nutritional anemia were studied for a period of two (02) years in the Department of Pathology in a Tertiary Care Centre. RESULTS: Among the Seventy-Five (75) cases studied, 33 were males and 42 were females. Most of the patients were in the age group of 11-15 years. The common presenting symptoms were gastrointestinal including vomiting, loose stools and pain abdomen followed by fever. Pallor was found in all the cases. The common signs included signs of dehydration, fever, nail changes including platynychia and koilonychia. Severe anemia was seen in majority of cases. Microcytic Hypochromic Anemia was the most common morphological type and Iron Deficiency Anemia was the most common etiological type of nutritional anemia. CONCLUSION: The present study concludes that detailed clinical findings, haematological investigations along with serum iron study and vitamin B12, folic acid assays and bone marrow examination (in relevant cases) is helpful to diagnose or rule out the causes of nutritional anemia in children and further planning of investigation and management.

Introduction: Acute Central Serous Chorioretinopathy (CSCR) is an important form of acquired maculopathy that usually presents as localised serous detachment of the neurosensory retina. Although, the disease is typically self limiting over a period of 2-3months, a percentage of patients ultimately develop chronic RPE changes. Eplerenone, a potential Mineralocorticoid Receptor (MR) antagonist, may play a role in regulating choroidal vascularity and modifying the disease in chronic CSCR. Aim: To assess the safety and functional outcome of oral eplerenone medication in acute CSCR. Materials and Methods: This was a randomised controlled trial that included 162 eyes of 162 patients with acute CSCR. Patients were divided into two groups– Group-A, which received oral Eplerenone, and Group-B, which received Placebo therapy. Each group comprised 81 eyes. Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CMT), and serum potassium (K+) levels were measured at baseline and monthly intervals for three consecutive months. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS). A p-value less than 0.05 was considered statistically significant. Results: The differences in CMT in Group-A and Group-B were 279±56.41μm and 207±68.88 μm (p<0.01) at the end of the first month and 361±33.56 μm and 278±46.27 μm at three months (p<0.01), respectively. The average BCVA improvement in Group-A and Group-B was 6.05 lines and 4.21 LogMAR lines, respectively, at the conclusion (p=0.002). Deterioration to chronicity was seen in 3.7% of the eyes in Group A and 17.3% of the eyes in Group B. The increase in Serum K+ at three months was 0.61±0.27 mg/dL in Group-A and 0.1±0.21 mg/dL in Group-B (p=0.03). Conclusion: Eplerenone is a safe and effective first-line treatment option for acute CSCR, leading to faster and higher resolution with protection from progression to chronicity.

Introduction: Transfusion-transmissible infections (TTIs) continue to pose a major challenge to blood safety, particularly in developing countries. Monitoring the pattern and burden of TTIs among blood donors is essential to ensure safe transfusion practices. Objectives: To assess the pattern and seroprevalence of transfusion-transmissible infections among replacement blood donors at a tertiary care centre in Western Uttar Pradesh. Materials and Methods: This retrospective, record-based study was conducted in the blood bank of a tertiary care hospital in Western Uttar Pradesh over a six-month period from July 2025 to December 2025. A total of 9300 replacement blood donors were screened for HIV, hepatitis B virus (HBsAg), hepatitis C virus (HCV), syphilis, and malaria using standard serological methods. Data were analysed using descriptive statistics. Results: Out of 9300 donors screened, 465 (5.0%) were found to be seroreactive for at least one transfusion-transmissible infection. Hepatitis B virus was the most common infection detected (2.19%), followed by hepatitis C virus (1.19%), HIV (1.16%), and syphilis (0.35%). No donor tested reactive for malaria. All seroreactive donors were male, with the majority belonging to the 18-30 year age group (60.4%). Conclusion: Hepatitis B virus remains the most prevalent transfusion-transmissible infection among replacement blood donors. Strengthening donor screening protocols, promoting voluntary blood donation, and improving hepatitis B vaccination coverage are crucial for enhancing blood safety.

Background: Subclinical hypothyroidism (SCH) frequently coexists with Type 2 Diabetes Mellitus (T2DM) and may influence metabolic control and complication risk, yet data on its prevalence and association with diabetic complications remain limited. Objective: To determine the prevalence of SCH in T2DM and compare its occurrence between uncomplicated and complicated cases. Materials and Methods: This hospital-based cross-sectional study enrolled 227 adult T2DM patients attending outpatient and inpatient services at a tertiary care teaching hospital in India between January 2022 and December 2023. Patients with Type 1 diabetes, chronic renal or liver disease, acute systemic illnesses, pregnancy, or medications affecting thyroid function were excluded. Demographic, clinical, and anthropometric data were recorded. Fasting blood samples were analyzed for glucose, HbA1c, lipid profile, liver and kidney function, and thyroid profile (TSH, free T3, free T4) using chemiluminescence immunoassay. SCH was defined as TSH > 5.0 µIU/mL with normal free T3 and T4. Results: SCH was observed in 11.0% and overt hypothyroidism in 3.5% of patients. SCH was most frequent in the 41–50 years age group (36%) and significantly higher in females (16.7% vs 4.7%, p = 0.0026). SCH patients had higher BMI (29.97 ± 4.85 vs 28.01 ± 4.12 kg/m², p = 0.029). No significant differences in HbA1c or TSH were noted between complicated and uncomplicated T2DM. Conclusion: SCH is common among middle-aged, female, and overweight T2DM patients, emphasizing the need for routine thyroid screening irrespective of glycemic control or complication status.

Introduction: Laparoscopic repair of ventral hernias has gained popularity due to advantages such as reduced blood loss, postoperative pain, and length of hospital stay. This study compares the outcomes of two laparoscopic techniques for ventral hernia repair: the Subcutaneous Onlay Laparoscopic Approach (SCOLA) and the Extended Totally Extraperitoneal Rives-Stoppa Approach (eTEP-RS). Materials and Methods: This prospective, cross-sectional, hospital-based observational study included 60 patients with ventral hernias, randomly allocated into two groups of 30 each, undergoing either SCOLA or eTEP-RS. Patients were followed at regular intervals, and outcomes including postoperative pain, complications, length of hospital stay, and time to return to normal activities were recorded. Results: There was no significant difference in age distribution between the two groups. Postoperative pain was comparable; however, the SCOLA group had higher rates of seroma formation (23.3% vs 3.3%, p=0.03), hematoma (6.7% vs 0%), and surgical site infection (6.7% vs 0%). The eTEP-RS group had a shorter mean hospital stay (2.37 vs 3.13 days, p=0.001) and faster return to normal activities (12.70 vs 14.00 days, p=0.014). Conclusion: Both techniques are effective for ventral hernia repair; however, eTEP-RS appears to offer advantages in terms of quicker recovery and potentially fewer complications. The choice between SCOLA and eTEP-RS should be based on individual patient characteristics, surgeon expertise, and specific clinical scenarios.

Intraventricular lipomas are rare, benign congenital malformations of the central nervous system, often discovered incidentally during imaging performed for unrelated neurological complaints. These lesions most frequently involve midline structures such as the pericallosal region, with lateral ventricular involvement being exceptionally uncommon. We report the case of a 52-year-old female who presented with a persistent left temporal headache. Her neurological examination was unremarkable. A “Non-Contrast Computed Tomography (NCCT) scan” of the brain revealed a well-defined, homogeneously hypodense lesion with fat attenuation located adjacent to the choroid plexus in the trigone region of the left lateral ventricle, consistent with an intraventricular lipoma. No mass effect, hydrocephalus, or other intracranial abnormalities were identified. Given the benign radiological features and absence of neurological deficits, conservative management with clinical observation was advised. This case highlights the importance of considering rare, incidental intracranial lesions during headache evaluation and emphasizes the role of neuroimaging in diagnosis and management.

Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis with high morbidity and mortality. Diagnosis and prognostication are challenging due to nonspecific clinical features and limited microbiological yield. Cerebrospinal fluid (CSF) analysis remains central to diagnosis, but its correlation with disease severity, radiological findings, and outcomes is not well established. Therefore, the aim of the study is to evaluate cerebrospinal fluid (CSF) findings in tuberculous meningitis (TBM) and correlate it with severity, radiological features, and outcome of TBM. Material and method: This cross-sectional study was conducted over 18 months in the Department of Medicine at a tertiary care hospital and included 73 patients aged >10 years diagnosed with tubercular meningitis. Detailed clinical evaluation, CSF analysis (cell count, differential, protein, glucose, ADA, microbiological tests), and neuroimaging (CT/MRI brain) were performed. Disease severity was classified using the Modified British Medical Research Council (BMRC) staging. CSF parameters were correlated with clinical severity, radiological characteristics, paradoxical reactions, and outcomes at 6 months. Statistical analysis was performed using SPSS version 21.0. Results: The mean patient age was 29.8 ± 14.6 years, with males comprising 57.5%. Most patients showed elevated CSF cell counts (93.1%), lymphocytic predominance (95.9%), increased protein (89%), low glucose (74%), and raised ADA levels (82.2%). CSF cell count, protein, and ADA levels increased significantly with advancing disease stage, while glucose levels declined (p < 0.001). Poor outcomes were independently associated with low CSF glucose, high CSF protein, elevated ADA, advanced BMRC stage, and radiological abnormalities, particularly hydrocephalus and infarcts. Conclusion: CSF biochemical abnormalities in TBM correlate strongly with clinical severity, radiological features, and patient outcomes. Integrating CSF analysis with neuroimaging can facilitate early prognostication and guide timely therapeutic interventions.

Introduction: Open lumbar spine fusion surgeries are associated with significant postoperative pain; Multimodal analgesia regimens are necessary to optimize pain control. The Erector Spinae Plane (ESP) is an emerging option for analgesia in spine surgeries; however, it’s efficacy compared with Local Wound Infiltration Of Local Anesthetic (LWIA) has not been extensively evaluated. Methods: This prospective, randomized study compared the analgesic efficacy of bilateral ultrasound-guided ESP block with LWIA in patients undergoing open lumbar fusion surgery under general anesthesia. After ethical approval and trial registration, 46 patients aged 18–75 years were randomized into two equal groups. Group A received bilateral ESP blocks using 15 ml of 0.375% ropivacaine per side. Group B received LWIA with 22.5 ml of 0.5% ropivacaine ensuring equivalent total doses of local anesthetic. Postoperative pain was assessed using static and dynamic verbal numeric rating scale (vNRS) scores over 24 hours by blinded assessors. Rescue analgesia was administered based on predefined pain thresholds. Quality of recovery (QoR-40) scores and postoperative nausea and vomiting (PONV) were evaluated as secondary outcomes. Results: The ESP group demonstrated significantly lower 24-hour analgesic consumption and pain scores compared with the LWIA group. Additionally, QoR-40 scores were higher in the ESP group, indicating improved recovery with no significant differences in PONV. Conclusion: Bilateral ultrasound-guided ESP block provides superior postoperative analgesia and enhances recovery compared with local wound infiltration in open lumbar fusion surgery. Larger studies may validate these findings and support incorporation of ESP block into postoperative analgesic protocols. CTRI/2021/06/034407 Registered on: 25/06/2021

Pulmonary Alveolar Microlithiasis (PAM) is an uncommon inherited lung disorder characterized by the accumulation of calcium phosphate microliths within the intra-alveolar spaces, despite the absence of any known abnormalities in calcium metabolism. This condition is associated with mutations in the SLC34A2 gene, which encodes the type IIb sodium-dependent phosphate transporter. These mutations impair the ability of alveolar type 2 epithelial cells to remove phosphate ions from the alveolar space, leading to the development of microliths in the extracellular fluid. A hallmark feature of PAM is a disconnect between clinical symptoms and radiological findings—imaging typically reveals distinct patterns that closely align with pathological changes. Diagnosis is often made based on characteristic radiologic features and the detection of microliths in samples from bronchoalveolar lavage (BAL) or even sputum. In many cases, a lung biopsy or transbronchial biopsy confirms the diagnosis. At present, there are no approved medical or gene-based treatments, though lung transplantation remains a potential option. Here we describe five interesting cases of PAM, suspected on incidental Chest X-Ray findings and proved from BAL samples and corelated with familial screening with Chest X-Rays.

Background: Postmenopause is an estrogen deficient state associated with increased incidence of insulin resistance(IR). Yoga has been described as having beneficial effect on IR in many studies and populations. The aim of our research was to study the effect of 3 month long Yoga practice on IR in early postmenopausal women. Methods: A prospective longitudinal study of 67 women within five years of menopause between 45 and 60 years of age attending the menopause clinic of a tertiary care hospital fulfilling inclusion and exclusion criteria and consenting were enrolled for study. Yoga group participants received intervention of Integrated Yoga module comprising asanas, pranayama, savasana, and OM chanting in addition to routine gynaecological management for 12 weeks. IR of 37 cases (Yoga group) and 30 controls (non Yoga group) was measured using HOMA-IR method pre and postintervention. Statistical Analysis was done by GraphPad Prism Version 5 software. Values are a mean and standard error of mean. Statistical significance was set up at P < 0.05. Result: A definite increase was observed in S. Fasting Insulin and HOMA-IR in Yoga group but it failed to achieve statistical significance. In the Non-Yoga group, S. Fasting Insulin levels (p=0.0066) and HOMA-IR measurements (p=0.0212) showed significant rise after 3 months. Conclusion: Three month long Yoga practice attenuated increase in insulin resistance in early postmenopausal women and has the potential to prevent early onset of IR and prevent further development of type 2 diabetes mellitus in our population if instated early in menopause.

Background: Tympanic membrane perforation (TMP) is a common otologic condition and an important cause of conductive hearing loss. The degree of hearing impairment depends on several anatomical factors, including perforation size, site, malleolar involvement, and mastoid pneumatization. Understanding these relationships is essential for improving clinical assessment and treatment planning. Objective: To evaluate the correlation between TMP characteristics and the degree and frequency pattern of conductive hearing loss in patients with unilateral dry perforations. Methods: This prospective observational study included 100 patients aged 18–50 years with unilateral dry TMP attending the ENT department of a tertiary care hospital between March 2021 and September 2023. Patients with active infection, bilateral perforations, prior ear surgery, tympanosclerosis, ossicular pathology, or sensorineural hearing loss were excluded. Perforation size and location were assessed microscopically, and mastoid pneumatization was evaluated radiologically. Hearing status was measured using pure tone audiometry (PTA) and tuning fork tests. Data were analyzed using SPSS version 25 with a significance threshold of p < 0.05. Results: Most patients were aged 31–50 years (65%), with equal gender distribution. The anteroinferior quadrant was the most common perforation site (78%). Chronic otitis media accounted for 86% of cases. Moderate-to-severe hearing loss was more prevalent in ears with larger perforations, posterior quadrants, malleolar involvement, and sclerosed mastoids. PTA demonstrated greater loss at lower frequencies, consistent with the classical inverted “V” pattern. Conclusion: Perforation size, location, malleolar involvement, and mastoid pneumatization significantly influence conductive hearing loss in TMP. Larger and posterior perforations are associated with greater hearing impairment. These findings may help clinicians predict hearing outcomes and tailor surgical decision-making.