Background: Insulin resistance arises from impaired signal flux through the insulin receptor–IRS-1–PI3K–Akt axis, driven substantially by inflammatory and stress-kinase-mediated inhibitory serine phosphorylation of insulin receptor substrate-1 (IRS-1). Peripheral blood mononuclear cells (PBMCs) express the full insulin-signalling machinery and offer a minimally invasive surrogate tissue for studying this cascade in humans. Objective: To characterize transcript and protein expression of key insulin-signalling molecules (IRS-1, PI3K, Akt, GLUT4), inflammatory/stress kinases (JNK, NF-κB), and negative regulators (SOCS3, PTP1B) in PBMCs of insulin-resistant subjects versus matched controls, to assess functional insulin responsiveness by ex vivo stimulation, and to identify independent molecular and clinical predictors of insulin resistance. Methods: In this case-control study, PBMCs were isolated by density-gradient centrifugation from 60 insulin-resistant subjects (HOMA-IR ≥2.5) and 60 matched controls. Gene expression was quantified by qRT-PCR and protein/phosphoprotein levels by Western blot; a subset of PBMCs underwent ex vivo insulin stimulation (100 nM, 15 min) to assess Akt (Ser473) phosphorylation response. Results: IRS-1, PI3K (p85α), and GLUT4 transcripts were significantly downregulated, and SOCS3, PTP1B, and TNF-α transcripts significantly upregulated, in insulin-resistant subjects (p<0.001 for all). Protein analysis confirmed reduced phosphorylation of IRS-1 (Tyr612) and Akt (Ser473), with increased phosphorylation of JNK and NF-κB p65 and increased PTP1B/SOCS3 protein (p<0.001 for all). The insulin-stimulated increment in p-Akt/Akt was markedly blunted in cases (1.6-fold) versus controls (2.6-fold; p<0.001). HOMA-IR correlated strongly with PBMC p-Akt/Akt (r=−0.71), SOCS3 mRNA (r=+0.64), and PTP1B protein (r=+0.68). Multivariable regression identified BMI, waist circumference, TNF-α, adiponectin, SOCS3 mRNA, and PTP1B protein as independent predictors of HOMA-IR (adjusted R²=0.55). Conclusion: Insulin-resistant subjects show a coordinated, multi-level derangement of the insulin-signalling cascade in PBMCs — encompassing transcriptional suppression of proximal effectors, upregulation of negative regulators, activation of inflammatory kinases, and blunted functional Akt responsiveness — that correlates strongly with whole-body insulin resistance, supporting PBMCs as a translational surrogate tissue for mechanistic biomarker development.

Background: Vermilion notching and inadequate vermilion height remain common aesthetic concerns following unilateral incomplete cleft lip repair. The Onizuka modification of the modified Millard technique utilizes a small triangular vermilion flap to augment the deficient medial vermilion and improve lip symmetry. Aim: To evaluate the effectiveness of the Onizuka modification of the modified Millard technique in preventing vermilion notching and improving cosmetic outcomes in patients with unilateral incomplete cleft lip. Methods: A prospective case–control study was conducted on 68 participants. Group A included 34 children with unilateral incomplete cleft lip who underwent repair using the modified Millard technique with Onizuka vermilion reconstruction. Group B consisted of 34 age-matched healthy controls without cleft lip. Postoperative outcomes were assessed after a minimum follow-up period of six months using standardized digital photography and anthropometric measurements obtained with Digimizer software. Vermilion symmetry, lip dimensions, cosmetic appearance, complications, and parental satisfaction were evaluated. Results: The mean age of patients was 4.56 ± 1.13 months. No significant differences were observed between cases and controls regarding postoperative vermilion and labial measurements (p > 0.05). Symmetrical and smooth vermilion borders were achieved in 97% of cases. Only one patient (2.9%) demonstrated vermilion border discontinuity, incorrect Cupid’s bow peak position, and muscle bulging. No scar contracture or major complications were reported. Parental satisfaction was high, with 94.2% of parents reporting happiness with the surgical outcome. Conclusion: The Onizuka modification of the modified Millard technique provides favorable aesthetic and functional outcomes in unilateral incomplete cleft lip repair. The technique effectively improves vermilion symmetry, minimizes secondary deformities, reduces the need for revision procedures, and achieves high parental satisfaction.

Background: Total knee arthroplasty (TKA) is a widely performed procedure for end-stage knee arthritis. Various surgical approaches have been described, with the subvastus and medial parapatellar approaches being among the most commonly used. The subvastus approach preserves the extensor mechanism and blood supply to the patella, potentially facilitating faster postoperative recovery. Objective: To retrospectively compare the clinical and functional outcomes of the subvastus and medial parapatellar approaches in patients undergoing primary TKA. Methods: A retrospective comparative study was conducted on patients who underwent primary TKA using either the subvastus or medial parapatellar approach. Demographic data, operative parameters, postoperative pain, range of motion, functional outcomes, and complications were reviewed and analyzed. Functional outcomes were assessed using standard knee scoring systems during follow-up. Results: Patients treated with the subvastus approach demonstrated improved early postoperative recovery, including better knee function and earlier restoration of quadriceps strength. Functional knee scores were higher in the subvastus group during the early postoperative period. However, long-term outcomes and complication rates were comparable between the two groups. Conclusion: The subvastus approach in TKA offers advantages in early postoperative rehabilitation and functional recovery while maintaining outcomes comparable to the medial parapatellar approach. It may be considered a safe and effective alternative for selected patients undergoing primary TKA.

Introduction: Neonatal sepsis is a major cause of morbidity and mortality in newborns [3]. Obtaining blood cultures before initiating antimicrobial therapy is a cornerstone of evidence-based management. In our NICU, inconsistent blood culture collection, variable staff competency, and deviations from guideline-based workflows prompted a clinical audit and quality improvement (QI) initiative. Methods: A retrospective pre-audit was conducted from August to November 2024, including 87 neonates with suspected sepsis. Data on blood culture collection, CRP timing, antibiotic initiation, documentation, and adherence to clinical indicators were analyzed. Multiple training sessions, process redesign, and NICE-based flowchart implementation were performed. A post-audit was conducted from December 2024 to March 2025, including 98 neonates. Results: In the pre-audit, only 12/87 neonates (13.7%) underwent blood culture collection before antibiotics. Contributing factors included lack of vials, untrained staff, unclear responsibilities, and delayed CRP reporting. After the QI intervention, compliance improved significantly to 63/98 neonates (64.3%). Staff knowledge, aseptic sampling technique, hand-hygiene compliance, and documentation improved on post-audit evaluation. Conclusion Major gaps were identified in pre-audit neonatal sepsis management. Structured training, improved logistics, and standardized workflow implementation resulted in substantial improvement in compliance. Continued re-audits and reinforcement are required to reach the target ≥90% compliance.

Background: Alcohol Dependence Syndrome (ADS) is a major public health concern in India and is strongly associated with Alcoholic Liver Disease (ALD). The severity of liver damage correlates with multiple factors including nutritional status, anthropometry, and biochemical parameters. Objective: To evaluate factors associated with liver disease in individuals with alcohol dependence, including nutritional intake, anthropometric indices, liver function tests (LFT), and severity of dependence. Methods: A cross-sectional study was conducted among 60 male patients diagnosed with ADS (ICD-10 criteria) in a tertiary care hospital. Data on sociodemographic profile, anthropometry (BMI, MAC, WHR), dietary intake (24-hour recall), LFT, ultrasound abdomen, and Severity of Alcohol Dependence Questionnaire (SADQ) were collected. Statistical analysis included descriptive statistics and inferential tests (Chi-square, Fisher’s exact test, Mann-Whitney U, Kruskal-Wallis). Results: Mean age was 41.53 ± 9.44 years. Nutritional deficiency was highly prevalent (energy 95%, protein 83.3%, fat 70%). Fatty liver was the most common ultrasound finding (68.3%). Majority had severe dependence (48.3%). No significant association was observed between anthropometric indices, nutritional intake, and severity of dependence with ALD. However, direct bilirubin (p=0.038) and alkaline phosphatase (p=0.020) showed significant association with ultrasound findings. Conclusion: Liver disease is highly prevalent among ADS patients. However, anthropometry, dietary intake, and dependence severity did not appear to have significant correlation . Direct bilirubin and ALP may serve as better indicators of liver damage. Larger studies are needed.

Background: Fluorosis remains a significant public health concern in several regions of India where groundwater fluoride concentration exceeds permissible limits. To address this burden, the Government of India launched the National Programme for Prevention and Control of Fluorosis (NPPCF). Effective implementation of the programme is essential for reducing disease burden through surveillance, diagnosis, treatment, health education, and intersectoral coordination. However, evidence regarding district-level implementation remains limited. Objectives: To assess the implementation status of NPPCF in Kanker district, Chhattisgarh, and to identify barriers affecting programme performance. Materials and Methods: A mixed-methods cross-sectional study was conducted in Kanker district. Quantitative assessment included review of programme records, facility observations, and beneficiary data. Programme components were evaluated using a structured checklist covering human resources, training, diagnostics, IEC activities, logistics, reporting, and coordination. Qualitative data were collected through key informant interviews with programme officials and healthcare workers. Descriptive statistics were used for quantitative analysis, while thematic analysis was performed for qualitative findings. Results: The overall implementation score of NPPCF in Kanker district was 62.5%, indicating moderate implementation. Diagnostic services showed the highest performance (83.3%), whereas IEC activities and community awareness components scored lower. Dental fluorosis prevalence among screened individuals was 45.6%, while skeletal fluorosis prevalence was 0.7%. Major operational challenges included shortage of trained human resources, irregular monitoring, limited community participation, inadequate convergence with Public Health Engineering Department, and delayed reporting. Conclusion: NPPCF implementation in Kanker district was moderate with satisfactory diagnostic services but gaps in manpower, awareness generation, and coordination. Strengthening human resources, monitoring systems, intersectoral collaboration, and community-based IEC activities is essential for improving programme effectiveness.

Background and Aim:Spinal anaesthesia is one of the most widely used regional anaesthesia. But when a difficult lumbar puncture is encountered, multiple attempts can lead to patient discomfort and heightened anxiety and other complications. Anticipating such difficulty can enhance patient safety, procedural efficiency, and decision-making. This study aimed to assess the correlation between the grade of lumbar puncture and a five-variable bedside scoring system in adult patients scheduled for elective infra-umbilical surgeries.Methods: In this study, 157 ASA I–II patients aged 18–80 years were evaluated preoperatively using five parameters: age, abdominal circumference, spinal deformity (assessed via axial trunk rotation using a scoliometer), anatomical landmark visibility (graded using the Spinous Landmark Grading System)and patient position. Each variable was scored from 0 to 3, yielding a total bedside score ranging from 0 to 15. Spinal anaesthesia was performed by a blinded anaesthesiologist using a 25G Quincke needle. Lumbar puncture grade was classified as easy (1st attempt), moderate (2–4 attempts or ≥2 interspaces), or difficult (≥5 attempts or ≥3 interspaces). Correlation between bedside score and grade of lumbar puncture was analyzed using Spearman’s correlation.Results: Of the 157 patients, 102 (65%) had easy, 41 (26%) moderate, and 14 (9%) difficult lumbar punctures. A significant positive correlation was found between total bedside score and lumbar puncture grade (r = 0.71, p < 0.001). Among individual parameters, SLGS grade showed the strongest correlation with grade of lumbar puncture (r = 0.53), followed by patient position (r = 0.54), abdominal circumference (r = 0.51), age (r = 0.41), and spinal deformity (r = 0.39).Conclusion: The five-variable bedside scoring system shows a strong correlation with the grade of lumbar puncture. It is a practical, non-invasive tool for pre-procedural risk stratification, allowing anaesthesiologists to anticipate challenging cases and adopt appropriate strategies.

Background: Airway management in paediatric patients presents unique challenges due to anatomical and physiological differences, including a relatively larger tongue, cephalad larynx, and reduced functional residual capacity. Supraglottic airway devices (SGADs) have emerged as valuable tools not only for ventilation but also as conduits for tracheal intubation. Among these, AIR-Q Intubating Laryngeal Airway (ILA) and Ambu AuraGain are widely used in clinical practice. Objective: To compare the efficacy of AIR-Q ILA and Ambu AuraGain as conduits for blind tracheal intubation using microcuff endotracheal tubes in paediatric patients. Methods: This prospective randomized comparative study included 100 paediatric patients aged 1–18 years, categorized as ASA physical status I or II. Patients were randomly assigned into two groups: Group A (AIR-Q) and Group B (AuraGain), with 50 patients in each group. Primary outcomes included first-attempt intubation success rate, total intubation time, and number of attempts. Secondary outcomes included ease of device insertion and incidence of complications. Results: The AIR-Q group demonstrated a significantly higher first-attempt success rate (88%) compared to the AuraGain group (64%). Mean intubation time was significantly lower in the AIR-Q group (18.5 ± 6.2 seconds) compared to the AuraGain group (29.8 ± 9.4 seconds). The number of attempts required was fewer in the AIR-Q group. Complication rates were comparable between the two groups. Conclusion: AIR-Q ILA is superior to Ambu AuraGain as a conduit for blind tracheal intubation in paediatric patients, offering higher success rates and faster intubation.

Background: Femoral shaft fractures are common high-energy injuries associated with significant morbidity, particularly in young adults. Antegrade intramedullary interlocking nailing has become the gold standard for their management due to its advantages of minimal soft tissue disruption, stable fixation, high union rates, and early mobilization. In addition to fracture union, functional recovery has emerged as a key outcome measure. This study aimed to evaluate the functional outcomes of femoral shaft fractures managed with antegrade intramedullary interlocking nailing in a tertiary care setting. Materials and Methods: A prospective observational study was conducted over 18 months at AIMS & RC Hospital, Rajasthan. A total of 56 adult patients (≥18 years) with fracture shaft of femur, including closed and Gustilo-Anderson type I and II fractures, were included. All patients underwent antegrade intramedullary interlocking nailing under spinal anaesthesia. Clinical and radiological evaluations were performed pre- and postoperatively, with regular follow-up. Fracture union was assessed radiologically, and functional outcomes were evaluated using the Thoresen et al. scoring system. Results: The mean age was 31.54 years, with the majority in the 18–30 years group (50%), and a male predominance (66.07%). Road traffic accidents accounted for 94.64% of cases. Type III fractures were most common (46.4%). Most patients had a hospital stay of 10–15 days (53.57%). Partial weight bearing was achieved within 12 weeks in 71.4% of patients, while 71.4% achieved full weight bearing between 13–16 weeks. Radiological union was most commonly observed between 17–20 weeks (39.2%), with an average union time of 20.27 weeks; delayed union occurred in 3.57% and no non-union was observed. Full knee range of motion was achieved in 69.6% of patients. Malunion was seen in 10.71% (valgus 7.14%, varus 3.57%) with no rotational deformities. Limb length discrepancy was absent in 92.8% of patients. Complications included superficial infection in 1 case and knee pain in 6 patients. Functional outcomes were excellent in 69.64%, good in 19.64%, and fair in 10.71% of patients, with no poor outcomes. Conclusion: Antegrade intramedullary interlocking nailing is an effective and reliable modality for the management of femoral shaft fractures, providing high union rates, satisfactory alignment, low complication rates, and favourable functional outcomes.

Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis, particularly in developing countries. Early and accurate diagnosis is essential for timely management and prevention of complications. This study evaluates the concordance between cytopathology using fine needle aspiration cytology (FNAC) and Gene Xpert MTB/RIF assay in diagnosing lymph node tuberculosis. Materials and Methods: A prospective study was conducted on 120 patients presenting with lymphadenopathy clinically suspected for tuberculosis. FNAC was performed, and aspirates were subjected to cytological examination and Gene Xpert testing. Cytological findings were categorized into granulomatous lymphadenitis with necrosis, without necrosis, suppurative lesions, and reactive lymphadenitis. Results: Out of 120 cases, cytopathology suggested tuberculosis in 85 cases (70.8%), while Gene Xpert detected Mycobacterium tuberculosis in 78 cases (65%). Concordance between FNAC and Gene Xpert was observed in 72 cases, yielding an overall agreement of 85%. Gene Xpert showed higher specificity in detecting Mycobacterium tuberculosis, particularly in necrotic and suppurative lesions. However, FNAC demonstrated higher sensitivity in identifying granulomatous inflammation even in Gene Xpert-negative cases. Conclusion: The combined use of cytopathology and Gene Xpert significantly improves diagnostic accuracy. While FNAC remains a rapid, cost-effective screening tool, Gene Xpert provides microbiological confirmation and detects rifampicin resistance. The dual diagnostic approach is therefore recommended for better clinical decision-making in lymph node tuberculosis.

Background: Tracheoesophageal fistula (TEF) is a rare congenital anomaly with significant morbidity and mortality, particularly in resource-limited settings. Prognosis is influenced by factors such as birth weight, associated anomalies, and postoperative complications. Objective: To evaluate the diagnosis, outcome, and prognosis of patients with tracheoesophageal fistula at a tertiary care centre. Methods: A retrospective and prospective study was conducted in the Department of General Surgery over five years (2020–2024). A total of 46 neonates diagnosed with TEF were included. Data on demographics, clinical presentation, associated anomalies, surgical management, and postoperative outcomes were analyzed. Statistical analysis was performed using SPSS version 25. Results: The mean age at presentation was 1.91 days, and mean birth weight was 2.04 kg. Type C TEF was the most common (93.5%). Associated anomalies included cyanotic congenital heart disease (23.9%) and spinal anomalies (28.3%). Postoperative ventilator support was required in 58.7% of cases. Overall mortality was 52.2%, with ventilator-associated pneumonia (21.7%) and sepsis (19.6%) being the leading causes of death. Survival was poorest in neonates weighing <1.5 kg and those with associated cardiac anomalies. Conclusion: Outcomes in TEF are strongly influenced by low birth weight, associated congenital anomalies, and postoperative infectious complications. Early diagnosis, multidisciplinary care, and improved neonatal intensive care support are essential to reduce mortality, particularly in high-risk groups.