Background: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder associated with significant cardiovascular and metabolic morbidity. Although continuous positive airway pressure (CPAP) remains the standard treatment, poor compliance has increased interest in surgical interventions. Uvula-sparing palatal procedures aim to improve upper airway patency while preserving palatal function and minimizing postoperative complications. Objective: To evaluate the efficacy of uvula-sparing palatal surgeries in patients with OSA using polysomnographic parameters and quality-of-life assessment. Methods: A quasi-experimental study was conducted at Rajiv Gandhi Government General Hospital, Chennai, between February 2024 and January 2025. Thirty-one adults aged 18–60 years with body mass index <40 kg/m² and isolated palatal obstruction confirmed by drug-induced sleep endoscopy underwent uvula-sparing palatal surgery. Patients were evaluated preoperatively and three months postoperatively using the Epworth Sleepiness Scale, modified Mallampati score, and overnight polysomnography. Results: Postoperative assessment demonstrated significant improvement in apnea-hypopnea index, lowest oxygen saturation, arousal index, modified Mallampati score, and daytime sleepiness. More than 50% reduction in apnea-hypopnea index was observed in the majority of surgically treated patients. Preservation of the uvula was associated with fewer postoperative symptoms, including foreign body sensation, throat irritation, nasal regurgitation, and persistent throat clearing, which were temporary. Conclusion and Relevance: Uvula-sparing palatal surgery is an effective treatment option for carefully selected patients with isolated palatal OSA, providing significant functional and polysomnographic improvement while reducing postoperative morbidity.

Background: Esophageal varices are an important complication of portal hypertension in patients with liver cirrhosis. Large esophageal varices are clinically significant because of their increased risk of bleeding. Although upper gastrointestinal endoscopy remains the gold standard for diagnosis, non-invasive predictors may help identify high-risk patients who require early endoscopic evaluation. Aim: To evaluate non-invasive clinical, hematological, and ultrasonographic predictors of large esophageal varices in patients with cirrhosis of liver. Materials and Methods: This observational analytical study included patients with cirrhosis of liver who underwent evaluation for esophageal varices. A total of 250 patients were assessed, of whom 59 were excluded based on predefined exclusion criteria. Finally, 191 patients were included in the final analysis. Patients were classified into large and small esophageal varices groups based on endoscopic findings. Demographic, clinical, hematological, biochemical, and ultrasonographic parameters were recorded. Univariate and multivariate logistic regression analyses were performed to identify predictors of large esophageal varices. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and ROC analysis. Results: Among 191 patients, 132 patients, 69.1%, had large esophageal varices and 59 patients, 30.9%, had small esophageal varices. Patients with large varices had significantly lower platelet count compared with patients with small varices, 102000 ± 98000/mm³ versus 168000 ± 111000/mm³, p<0.001. Splenic diameter was significantly higher in the large varices group, 125.6 ± 6.2 mm versus 112.8 ± 10.9 mm, p<0.001. Portal vein diameter was also significantly higher among patients with large varices, 16.3 ± 1.8 mm versus 12.8 ± 1.4 mm, p<0.001. On multivariate analysis, portal vein diameter >13 mm, splenic diameter >120 mm, and platelet count <1 lakh/mm³ were independent predictors of large esophageal varices. Portal vein diameter >13 mm was the strongest predictor, with adjusted OR 58.20, followed by splenic diameter >120 mm, adjusted OR 31.60, and platelet count <1 lakh/mm³, adjusted OR 9.20. ROC analysis showed that portal vein diameter had the highest AUC, 0.925, followed by splenic diameter, AUC 0.912, and platelet count, AUC 0.681. Conclusion: Portal vein diameter, splenic diameter, and platelet count are useful non-invasive predictors of large esophageal varices in patients with liver cirrhosis. Portal vein diameter >13 mm emerged as the most sensitive and accurate predictor, while splenic diameter >120 mm showed excellent predictive ability. These parameters may help prioritize cirrhotic patients for early endoscopic evaluation.

Background: Temporomandibular joint (TMJ) ankylosis carries major functional and psychosocial burdens. Kaban’s protocol remains the standard approach, yet the conventional sequence—arthrectomy followed by coronoidectomy—can create intraoperative instability and technical difficulty. Objective: We performed a multi-centric study at three tertiary care hospitals to present, assess and validate a coronoidectomy-first refinement of Kaban’s protocol, supported by Levandoski’s panographic analysis for preoperative case selection. Technique and Results: Using an Alkayat–Bramley incision, ipsilateral coronoidectomy is performed before ankylotic mass resection. In 21 consecutive patients (aged 8–22 years), mean intraoperative inter-incisal opening improved to 36 mm (range 32–40 mm). Compared with conventional sequencing, mean operative time decreased by ~18%. No reflex bradycardia, vascular injury, or nerve injury occurred. Levandoski’s analysis facilitated identification of coronoid hyperplasia and improved predictability. At 12–14 months’ follow-up, all patients maintained >30 mm opening without any recurrence. Conclusion: A coronoidectomy-first sequence preserves mandibular stability, streamlines osteotomy, reduces anesthetic risk, and is supported by simple radiographic diagnostics. This refinement represents a practical, reproducible enhancement of Kaban’s protocol.

Background: Spinal anaesthesia is widely used for elective lower-limb orthopaedic surgery because it provides effective sensory and motor blockade. However, the duration of analgesia and block produced by local anaesthetics may be limited. Dexmedetomidine, a selective α2-adrenergic receptor agonist, has been increasingly used as an intrathecal adjuvant because of its analgesic properties and ability to prolong spinal anaesthesia. The present study evaluated the effect of adding intrathecal dexmedetomidine to 0.75% hyperbaric ropivacaine on analgesia and block characteristics. Aim and Objectives: To evaluate and compare the effects of 0.75% hyperbaric ropivacaine alone versus 0.75% hyperbaric ropivacaine with intrathecal dexmedetomidine on the duration of analgesia and sensory and motor block characteristics in patients undergoing elective lower-limb orthopaedic surgery. The primary objective was to compare the duration of analgesia, while secondary objectives included assessment of sensory and motor block characteristics, haemodynamic parameters, and adverse effects. Materials and Methods: This double-blind, randomized controlled study was conducted at hospitals attached to Bangalore Medical College and Research Institute, Bengaluru, from August 2022 to January 2024. A total of 70 patients aged 18–65 years, belonging to ASA physical status I or II and undergoing elective lower-limb orthopaedic surgery under subarachnoid block, were randomly allocated into two groups of 35 patients each. Group RD received 3 mL of 0.75% hyperbaric ropivacaine with 10 µg dexmedetomidine, while Group R received 3 mL of 0.75% hyperbaric ropivacaine with 0.1 mL normal saline intrathecally. Sensory and motor block characteristics and duration of analgesia were assessed and compared between the groups. Results: The two groups were comparable with respect to baseline demographic and clinical characteristics. The onset of sensory block was significantly faster in Group RD than in Group R (2.69 ± 0.53 vs. 3.31 ± 0.63 min; p<0.001), and the time to achieve the highest sensory level was also shorter (4.49 ± 0.66 vs. 5.57 ± 0.61 min; p<0.001). The duration of sensory block was significantly longer with dexmedetomidine (259.03 ± 15.40 vs. 165.31 ± 19.48 min; p<0.001). Similarly, the onset of motor block was faster in Group RD (4.54 ± 0.95 vs. 5.37 ± 0.88 min; p<0.001), with a shorter time to maximum motor block (5.01 ± 0.55 vs. 6.00 ± 0.54 min; p<0.001) and significantly longer motor block duration (202.40 ± 17.73 vs. 148.31 ± 10.99 min; p<0.001). The primary outcome, duration of analgesia, was significantly prolonged in Group RD (324.03 ± 19.81 vs. 234.80 ± 17.90 min; p<0.001). The time to rescue analgesia was also significantly longer (350.80 ± 25.70 vs. 255.00 ± 19.65 min; p<0.001). Conclusion: The addition of 10 µg intrathecal dexmedetomidine to 0.75% hyperbaric ropivacaine significantly enhanced spinal anaesthesia by producing faster onset of sensory and motor block, prolonging sensory and motor block duration, and significantly extending postoperative analgesia and the time to first rescue analgesia. Intrathecal dexmedetomidine therefore appears to be a useful adjuvant to 0.75% hyperbaric ropivacaine for elective lower-limb orthopaedic surgery.

Background:Cutaneous metastases (CMs) may be either the initial manifestation of an internal malignancy or represent recurrent neoplastic disease.Aims and objectives: The objective of this study was to assess the incidence and characteristics of cutaneous metastases of internal malignancies in a dermatology department of a tertiary care hospital.Methods: A prospective study was conducted on patients diagnosed with internal malignancy over a period of one year. A total of 1000 patients were consecutively included in the study. Physical and dermatological examinations were performed on all the patients. Skin biopsies and histopathological examinations were performed from suspected lesions. The type of malignancy, the time of diagnosis of malignancy, the presence of cutaneous metastasis, and the localization sites of the cutaneous malignancy were noted.Results: Cutaneous Metastases were seen in 16 (1.6%) of all cases with malignancies. Cutaneous metastases were most frequently observed in breast cancer in females and hematological malignancies in males. There were 3 cases of skin metastases manifesting as presenting sign of internal malignancy. Most common site of cutaneous metastases was anterior chest wall in 6 (37.5%) cases. Nodules and nodulo- ulcerative plaques were the most frequent presentation.Conclusion: It is concluded that cutaneous metastases occur rarely and the presentation of internal malignancy with skin involvement is uncommon and variable

Background: Hypothyroidism is a lifelong condition requiring regular follow-up. Although thyroid function tests are essential for diagnosis and monitoring, laboratory values may occasionally not correlate with the clinical picture and can be influenced by physiological factors and medications. A simple clinical scoring system may therefore complement biochemical assessment. Aim and Objectives: To compare thyroid function parameters with the clinical presentation of hypothyroid patients and assess clinical severity using a validated scoring system Methodology: A hospital-based cross-sectional study was conducted among 99 patients attending the outpatient and inpatient departments of General Medicine with laboratory-diagnosed hypothyroidism and deranged thyroid profiles. A pre-validated clinical scoring system comprising 11 symptom-based and 10 sign-based questions was used. Each parameter was assigned one point, giving a total score ranging from 0 to 21. Qualitative data were expressed as frequency and percentage, while quantitative data were summarized using mean, median, range and standard deviation. Correlation between clinical severity score and thyroid function parameters was assessed using Pearson’s correlation test. A p-value <0.05 was considered statistically significant. Results: The majority of participants were female, and the mean age was 35.4 ± 19.0 years. A very strong, statistically significant positive correlation was observed between the clinical severity score and TSH (r = 0.862, p < 0.001). In contrast, correlations with T3 (r = 0.090, p = 0.378), T4 (r = 0.140, p = 0.166) and free T4 (r = 0.081, p = 0.424) were weak and statistically non-significant. Conclusion: The clinical scoring system demonstrated a strong correlation with TSH and may serve as an adjunct to biochemical assessment. Further validation involving euthyroid controls is required to establish appropriate cut-off values and clinical utility

Background: Complete excision of a tumour with histologically negative margins is essential for local disease control and favourable oncological outcomes. Intraoperative frozen-section examination provides rapid assessment of surgical margins and allows immediate additional resection when tumour involvement is detected. However, its diagnostic performance may be affected by sampling limitations, tissue artefacts and interpretative difficulties. This study compared frozen-section findings with permanent-section histopathology in intraoperative tumour-margin assessment. Aim: To evaluate the diagnostic accuracy of intraoperative frozen-section examination for tumour-margin assessment using permanent-section histopathology as the reference standard. Materials and Methods: This hospital-based observational diagnostic-accuracy study included 200 patients who underwent tumour excision with intraoperative frozen-section assessment of surgical margins at a tertiary-care institution. Fresh margin tissues were processed in a cryostat, stained with haematoxylin and eosin and classified as positive, negative or deferred. Corresponding tissues were subsequently fixed in formalin, processed into paraffin blocks and examined as permanent sections. Sensitivity, specificity, predictive values, likelihood ratios, overall accuracy and Cohen’s kappa coefficient were calculated. Factors associated with discordance were analysed using Fisher’s exact test, Welch’s t-test and odds ratios with 95% confidence intervals. A p value below 0.05 was considered statistically significant. Results: Permanent-section examination identified positive margins in 49 of the 200 cases (24.5%). Recurrent tumours (OR=2.67; 95% CI: 1.20-5.95), tumour size greater than 4 cm (OR=2.41; 95% CI: 1.25-4.64), high-grade morphology (OR=2.26; 95% CI: 1.17-4.37) and tumour necrosis (OR=2.55; 95% CI: 1.25-5.19) were significantly associated with margin positivity. Seven frozen-section diagnoses were deferred, leaving 193 cases for primary diagnostic-accuracy analysis. These included 41 true-positive, 143 true-negative, three false-positive and six false-negative results. Frozen-section examination showed a sensitivity of 87.2% (95% CI: 74.3-95.2), specificity of 97.9% (95% CI: 94.1-99.6), positive predictive value of 93.2%, negative predictive value of 96.0% and overall accuracy of 95.3% (95% CI: 91.3-97.8). Agreement with permanent-section histopathology was almost perfect (κ=0.871; 95% CI: 0.788-0.953; p<0.001). Sampling limitation, freezing artefact, cautery artefact, multiple-margin submission and fatty, fibrotic or calcified tissue were significantly associated with discordance. Conclusion: Frozen-section examination was a highly accurate and reliable method for intraoperative tumour-margin assessment, with excellent specificity, negative predictive value and concordance with permanent sections. Sampling and technical artefacts were the principal causes of diagnostic discrepancy. Careful specimen selection, orientation, processing and surgeon-pathologist communication are essential for improving accuracy. Permanent-section histopathology should remain the definitive method for final margin evaluation

Background: Clinical anatomy is a fundamental component of medical education and safe clinical practice. Traditionally centered on cadaveric dissection, anatomy education has evolved to incorporate clinical imaging, simulation, artificial intelligence (AI), augmented and virtual reality (AR/VR), 3D printing, and minimally invasive surgical technologies. This evolution emphasizes the integration of anatomical knowledge with clinical application, professional competencies, ethics, and patient safety. Methods: A narrative review of contemporary approaches to clinical anatomy education was undertaken, focusing on the evolution of anatomical teaching, technological innovations, cadaveric dissection, ethical considerations, simulation-based learning, and their relevance to clinical practice and patient safety. Published literature addressing modern and emerging strategies in anatomy education was considered. Results: Traditional dissection remains valuable for understanding three-dimensional relationships, anatomical variation, tissue characteristics, and professional values such as empathy and respect. Digital technologies, including AI, AR/VR, 3D printing, radiological integration, and simulation, enhance visualization, personalized learning, procedural training, and clinical application. Early exposure to ultrasound, radiology, and interprofessional learning further strengthens anatomical competency. Ethical issues concerning donor dignity, consent, patient privacy, data security, and equitable access remain important. Conclusion:Modern clinical anatomy requires a balanced integration of traditional dissection and emerging technologies. A hybrid, clinically oriented, evidence-based approach can enhance anatomical understanding, professional development, and patient safety while maintaining ethical standards

Background: Iron is an essential cofactor for central nervous system myelination and neurotransmitter synthesis. Iron deficiency anaemia (IDA) in adults often has an insidious onset, and subclinical involvement of the visual pathway may precede overt symptoms. Visual evoked potential (VEP) offers a non-invasive, objective measure of conduction along the optic pathway and may detect such early changes. Objective: To study visual evoked potential in newly diagnosed adult patients of iron deficiency anaemia with haemoglobin less than 10.9 g/dl and compare them with healthy controls. Methods: This case–control study enrolled 44 newly diagnosed adult patients of IDA (Hb < 10.9 g/dl, age 18–45 years) and 44 age- and sex-matched healthy controls at Pt. B.D. Sharma PGIMS, Rohtak, after ethical clearance and informed consent. Pattern-reversal VEP (N75, P100 and N145 latencies, and P100 amplitude) was recorded monocularly in both eyes using an RMS EMG EP MK2 system with a standard checkerboard stimulus. Data were analysed on SPSS v20 using the unpaired Student's t-test, and Pearson's correlation coefficient was calculated between VEP parameters and the haemoglobin/iron profile. Results: Mean haemoglobin was 7.25 ± 1.47 g/dl in cases versus 13.80 ± 1.30 g/dl in controls (p < 0.0001). VEP latencies of N75 and P100 were significantly prolonged in cases compared with controls in both eyes (p < 0.05 to p < 0.0001). N145 latency was significantly prolonged in the left eye (p = 0.0024) but not the right eye (p = 0.0573). P100 amplitude was lower in cases than controls in both eyes, but the difference was not statistically significant. Correlation of VEP latencies with haemoglobin and iron-profile indices was mild to moderate and inconsistent in direction, with a strong positive correlation observed between TIBC and right-eye P100 latency. Conclusion: Adult patients of IDA show significant prolongation of VEP latencies compared with healthy controls, indicating subclinical involvement of the visual pathway even before overt ocular symptoms appear. VEP is a useful, non-invasive electrophysiological tool for early detection of CNS involvement in iron deficiency anaemia.

Background: Thyroid dysfunction, particularly hypothyroidism, is common among women of reproductive age and may adversely affect hematological and reproductive health. Iron is essential for thyroid hormone synthesis and metabolism, and iron deficiency may influence thyroid function. However, the relationship between iron status and thyroid function in reproductive-age women with hypothyroidism remains incompletely understood. Aim: To evaluate the biochemical relationship between iron metabolism and thyroid function in reproductive-age women with hypothyroidism. Materials and Methods: This cross-sectional study was done over 18 months at Government General Hospital, Guntur. Sixty clinically diagnosed hypothyroid women aged 20–45 years were included, along with 40 age- and sex-matched euthyroid controls. Women with other endocrine disorders, acute or chronic illness, pregnancy or lactation, and those receiving drugs interfering with thyroid function were excluded. Serum T3, T4, TSH, ferritin, serum iron, and TIBC were estimated using chemiluminescence and spectrophotometric methods. Hemoglobin was also assessed, and transferrin saturation was calculated. Results: Hypothyroid women had significantly lower mean T3 (0.68 ± 0.22 vs. 1.46 ± 0.33 ng/mL), T4 (5.44 ± 1.62 vs. 9.41 ± 1.91 µg/dL), ferritin (35.01 ± 19.19 vs. 107.25 ± 35.00 ng/mL), serum iron (45.93 ± 21.18 vs. 115.20 ± 38.90 µg/dL), and hemoglobin (8.38 ± 1.71 vs. 11.79 ± 0.73 g/dL), while TSH (15.50 ± 14.34 vs. 3.29 ± 1.15 mIU/L) and TIBC (461.85 ± 107.71 vs. 313.68 ± 94.14 µg/dL) were significantly more than in controls (p < 0.001 for all). Low serum iron was present in 93.3% of cases, elevated TIBC in 63.3%, and hemoglobin <11 g/dL in 96.7%. TSH showed significant negative correlations with ferritin (r = −0.338), serum iron (r = −0.294), hemoglobin (r = −0.226), and transferrin saturation (r = −0.266). T3 and T4 showed significant positive correlations with ferritin, iron, hemoglobin, and transferrin saturation, and significant negative correlations with TIBC (p < 0.001). Conclusion: Reproductive-age women with hypothyroidism demonstrated significantly altered iron parameters and a high prevalence of anemia, with thyroid hormones showing significant associations with markers of iron status. These findings suggest a possible interrelationship between hypothyroidism and iron deficiency anemia. Larger studies incorporating anti-thyroid peroxidase antibody assessment are warranted to further clarify this association and its clinical implications

Background: Medical education combines a dense curriculum, repeated high-stakes assessment, competition, time pressure, clinical responsibility, and limited recovery periods. Although depression and anxiety are common among medical students, the magnitude of their specific relationship with academic pressure is less consistently quantified than overall symptom prevalence. Objective: To synthesize evidence on the association between academic pressure and depression, anxiety, and psychological distress in medical students and to quantify compatible association estimates using random-effects meta-analysis. Methods: A PRISMA 2020-aligned focused systematic search of PubMed/MEDLINE-indexed records, PubMed Central, publisher-hosted scholarly pages, and backward/forward citations was conducted from inception to January 2026. Eligible quantitative studies enrolled medical students and measured an academic-specific pressure, workload, examination, curriculum, or educational stress exposure together with depression, anxiety, or psychological distress. Correlation-type effects were transformed to Fisher z values and pooled with DerSimonian-Laird random-effects models. Heterogeneity was summarized using Q, I², and τ². Results: The review flow comprised 264 identified records, 58 duplicates removed, 206 records screened, 48 full texts assessed, and 18 studies included (total N=8,503); five unique studies contributed to at least one quantitative synthesis. Academic pressure showed a moderate positive pooled association with depressive symptoms (r=0.374, 95% CI 0.283-0.458; k=3; N=1,930; I²=76.6%; p<0.001) and anxiety symptoms (r=0.382, 95% CI 0.234-0.512; k=2; N=1,704; I²=90.9%; p<0.001). A secondary correlation-compatible synthesis combining Pearson correlations with one standardized path coefficient found a stronger association with psychological distress/stress (standardized association=0.515, 95% CI 0.374-0.633; k=3; N=1,476; I²=90.9%; p<0.001). Examination-proximal studies consistently showed higher symptom scores near or on examination days. Conclusion: Academic pressure is consistently associated with depression, anxiety, and broader psychological distress in medical students, with pooled effects in the moderate range and substantial between-study heterogeneity. The evidence supports institutional approaches that reduce avoidable assessment overload, improve curricular pacing and feedback, and integrate accessible mental-health support. Causal inference remains limited because most studies were cross-sectional.

Background: Medical education combines extensive curricular content, frequent high-stakes assessment, performance expectations, competition, and limited recovery time. Depression and anxiety are common among medical students, but the contribution of specifically academic sources of pressure is less clearly defined and is potentially modifiable at the institutional level. Objective. To systematically evaluate the association of academic pressure, examination-related stress, workload, and assessment practices with depressive and anxiety symptoms among medical students and to synthesize compatible depression-related effect estimates. Methods. A PRISMA 2020-oriented systematic review and meta-analysis was undertaken using PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, Google Scholar, and reference-list searching for studies available through January 2026. Eleven independent studies involving 5,271 medical students were included. Three studies (n=1,354) provided compatible academic-stress–depression correlations and were pooled using Fisher z transformation and a DerSimonian-Laird random-effects model. Risk of bias was assessed using domains adapted from JBI analytical cross-sectional guidance. Results. The 11 studies were published between 1984 and 2024 and represented nine countries. Academic pressure was consistently associated with poorer psychological health. In an early US study of 605 students, 206 (34.0%) had anxiety scores above the median of a psychiatric outpatient comparison population and six medical-school pressures explained 36% of anxiety variance. In a repeated-measures Indian study, mean anxiety rose from 9.4±4.3 to 12.6±3.8 (p=0.0001) and depression from 7.4±4.5 to 9.05±4.56 (p=0.001) during examinations. The three depression correlations were r=0.450, r=0.656, and r=0.381. The pooled association was r=0.498 (95% CI 0.319–0.643; p<0.001), with substantial heterogeneity (Q=17.36; df=2; I²=88.5%; τ²=0.0319). Excluding the highest-effect study produced r=0.390 (95% CI 0.341–0.437; I²=0%). Anxiety findings were not pooled because the available studies reported heterogeneous metrics, but examination periods, tiered grading, and higher academic-stressor scores were repeatedly associated with greater anxiety. Conclusion. Academic pressure shows a moderate-to-large positive association with depressive symptoms and a consistent qualitative association with anxiety among medical students. The relationship is likely bidirectional and modified by individual vulnerability and the educational environment. Medical schools should combine accessible mental-health care with structural interventions addressing assessment intensity, workload, feedback, competition, mentoring, and protected recovery time.

Background: Thyroid nodules are commonly encountered in clinical practice, although only a minority are malignant. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) provides standardized ultrasonographic risk stratification, while fine-needle aspiration cytology (FNAC) categorizes nodules using the Bethesda system. Correlation between these systems may improve the selection of nodules for biopsy and subsequent management. Aim: To assess thyroid nodules using ACR TI-RADS and determine their correlation with FNAC findings. Materials and Methods: This hospital-based cross-sectional study included 160 patients with thyroid nodules who underwent ultrasonography and FNAC. Nodules were assessed for composition, echogenicity, shape, margins and echogenic foci and classified from TR1 to TR5. FNAC results were classified according to Bethesda categories I-VI. Associations were examined using the chi-square test or Fisher’s exact test. Spearman’s correlation and Cohen’s kappa were used to assess correlation and agreement. Diagnostic performance was calculated using Bethesda V-VI as suspicious or malignant cytology. A p value <0.05 was considered statistically significant. Results: The mean age was 42.16±13.65 years, and 103 (64.4%) participants were female. Bethesda V-VI cytology was identified in 28 (17.5%) nodules. Older age, dysphagia, hoarseness, rapid enlargement, suspicious cervical lymph nodes and greater mean nodule diameter were significantly associated with Bethesda V-VI findings. Solid composition (OR=12.61), marked hypoechogenicity (OR=10.71), a taller-than-wide shape (OR=15.45), lobulated or irregular margins (OR=16.47) and punctate echogenic foci (OR=13.21) were significant sonographic predictors (all p<0.001). TR4 was the most frequent category (29.4%), while 20.0% were TR5. Bethesda II was the predominant cytological category (55.0%). A significant positive correlation was observed between TI-RADS and Bethesda categories (Spearman’s ρ=0.516; p<0.001), with substantial agreement between TR5 and Bethesda V-VI (κ=0.674; p<0.001). TR5 demonstrated 67.9% sensitivity, 95.5% specificity, 82.6% positive predictive value, 90.3% negative predictive value and 88.8% diagnostic accuracy for Bethesda V-VI cytology. Conclusion: Increasing ACR TI-RADS categories were significantly associated with increasingly suspicious FNAC findings. TR5 demonstrated high specificity and good diagnostic accuracy for Bethesda V-VI cytology. The combined use of TI-RADS, clinical assessment and FNAC provides an effective standardized approach for evaluating thyroid nodules, although histopathological confirmation remains necessary for definitive diagnosis.

Background: Medical education exposes students to intensive curricular workloads, frequent high-stakes examinations, competition, performance expectations, limited recovery time, and concerns about competence. Depression, anxiety and nonspecific psychological distress are common among medical students, but the magnitude of their association with specifically academic pressure, rather than with general life stress, has not been adequately synthesized. Objective: To systematically evaluate the association between academic pressure and common mental disorders (CMDs), particularly depressive symptoms, anxiety symptoms and nonspecific psychological distress, among medical students and to quantitatively synthesize compatible effect estimates. Methods: A systematic review and exploratory meta-analysis was structured according to PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, Google Scholar and reference lists were searched for studies available through June 2026. Eligible studies enrolled medical students, quantitatively assessed academic pressure or academic-related stressors, and measured depression, anxiety or psychological distress using validated instruments. Eleven primary studies involving 4,980 participants were retained for qualitative synthesis. Random-effects inverse-variance meta-analysis of Fisher z-transformed correlation-type effect estimates was undertaken when compatible data were available. Risk of bias was assessed using domains adapted from the Joanna Briggs Institute analytical cross-sectional checklist, and certainty was judged using GRADE-informed principles. Results: Academic pressure was consistently associated with poorer psychological health. The primary depression meta-analysis included three studies and 1,529 medical students. The pooled association was r = 0.371 (95% CI 0.193 to 0.525; p < 0.001), with substantial heterogeneity (Q = 18.05; I² = 88.9%; τ² = 0.0241). A secondary anxiety meta-analysis of two studies (n = 1,462) yielded r = 0.302 (95% CI 0.255 to 0.348; p < 0.001; Q = 0.29; I² = 0%; τ² = 0). Sensitivity analysis excluding the rank-biserial estimate from the depression synthesis continued to show a positive association (r = 0.341; 95% CI 0.046 to 0.581; p = 0.025). In individual studies, academic-related stress correlated with general psychological distress as strongly as r = 0.628, while a Saudi study reported adjusted associations between combined academic/nonacademic stressor burden and depression (aOR 1.13, 95% CI 1.07-1.19), anxiety (aOR 1.07, 95% CI 1.03-1.12), and stress symptoms (aOR 1.12, 95% CI 1.08-1.17). Conclusions: Academic pressure is consistently associated with depressive symptoms, anxiety and psychological distress among medical students. The pooled relationship with depressive symptoms was moderate but heterogeneous, while the anxiety association was small-to-moderate and consistent in the limited studies available. Most evidence is cross-sectional; therefore, causality cannot be established and reverse causation is plausible. Medical schools should address academic pressure as a potentially modifiable component of the educational environment while also providing confidential mental-health support, workload and assessment review, mentorship, and early identification of students at risk.

Background: Genital ulcer disease (GUD) remains an important component of the sexually transmitted infection (STI) burden in India. Historically, bacterial infections such as chancroid, syphilis, lymphogranuloma venereum (LGV), and donovanosis constituted a substantial proportion of genital ulcer presentations. Over recent decades, however, Indian STI-clinic studies have documented a marked epidemiological transition toward viral disease, particularly genital herpes, accompanied by a major decline in chancroid and donovanosis and variable persistence or resurgence of syphilis. This changing etiological spectrum challenges traditional morphology-based and syndromic approaches to diagnosis. Objective: To systematically review the changing etiological trends of genital ulcer disease in India, evaluate limitations of clinical and syndromic diagnosis, summarize the role of laboratory and molecular methods, and examine contemporary management strategies in the context of National AIDS Control Organisation (NACO) and World Health Organization (WHO) recommendations. Methods: A systematic literature review was undertaken using PubMed/MEDLINE and supplementary searches of scholarly databases, reference lists, Indian STI literature, NACO documents, and WHO guidance for studies available through June 2026. Indian studies reporting genital ulcer epidemiology, etiological diagnosis, clinical or syndromic diagnostic performance, laboratory confirmation, temporal trends, HIV association, or treatment strategies were eligible. Fifteen primary Indian studies spanning more than four decades were included in the qualitative synthesis. Because of marked heterogeneity in study periods, clinical settings, diagnostic techniques, case definitions, and denominators, quantitative meta-analysis was not considered appropriate. Methodological quality was appraised using principles of the Joanna Briggs Institute tools for observational studies. Results: Indian studies demonstrate a major shift from predominantly bacterial to predominantly viral GUD. At a North Indian STI clinic, chancroid declined from 12.2% during 1977-1985 to 2.5% during 1993-2000, while donovanosis decreased from 6.3% to 0.9%; genital herpes increased from 11.4% to 20.5%. In Pune in 1994, multiplex PCR among 302 patients identified HSV in 26%, Haemophilus ducreyi in 23%, Treponema pallidum in 10%, and mixed infections in 7%; no pathogen was identified in 34%. HIV seroprevalence was 22.2%, and HSV-positive patients had higher HIV prevalence than patients with other etiologies (OR 2.1, 95% CI 1.2-3.7). By 2012, a multicentre molecular study of 194 men from eight Indian STI clinics found HSV in 48%, T. pallidum in 23%, mixed infection in 9%, and only one H. ducreyi infection. The national herpetic/nonherpetic syndromic algorithm demonstrated only 68% sensitivity and 52% specificity, with 42% of laboratory-confirmed cases clinically misclassified. A 2021-2022 Gujarat study of 135 GUD cases reported herpes genitalis in 59%, syphilis in 15%, chancroid in only 0.74%, and HIV positivity in 6.6%; 22% of ulcers were nonvenereal. Long-term Kerala data similarly demonstrated viral predominance: among 2,470 diagnosed STI cases over 20 years, herpes genitalis accounted for 39%, syphilis for 17.2%, and viral STIs constituted 76.3% compared with 23.3% bacterial infections. Conclusions: Genital ulcer disease in India has undergone a clear etiological transition. HSV is now the dominant infectious cause in most contemporary Indian series; chancroid, LGV and donovanosis have become uncommon, while syphilis remains clinically important and may be re-emerging in some populations. Reliance on lesion morphology alone is inadequate because mixed infections, atypical presentations, HIV-associated disease, prior antimicrobial exposure, and noninfectious mimics frequently obscure diagnosis. Molecular ulcer testing offers the greatest etiological precision where available, but access remains limited. A pragmatic Indian strategy should combine immediate syndromic treatment where necessary with expanded syphilis/HIV testing, targeted HSV and T. pallidum molecular testing, partner management, risk-reduction counselling, and periodic local etiological surveillance

Introduction: Critically ill children admitted to the Pediatric Intensive Care Unit (PICU) represent a vulnerable population with a high risk of morbidity and mortality due to severe infections, systemic inflammatory responses, and progressive multi-organ dysfunction. Aims: To evaluate the association of inflammatory markers (CRP, procalcitonin, and ferritin) with clinical outcomes among children admitted to the PICU. Materials and Methods: This prospective observational study was conducted in the Department of Paediatrics, Bankura Sammilani Medical College, over a period of 12 months. A total of 100 pediatric patients admitted to the PICU were included in the study for evaluation.Results: A significant association was observed between elevated CRP levels and mortality, as non-survivors were substantially higher among patients with raised CRP levels (20/63; 31.7%) compared to those with normal CRP levels (2/37; 5.4%) (p=0.001). This finding suggests that elevated CRP levels may serve as an important marker of poor prognosis in critically ill pediatric patients. Analysis of procalcitonin levels in relation to clinical outcomes demonstrated a significant association with disease severity. Among patients with normal procalcitonin levels, 37/38 patients (97.4%) were discharged and only 1/38 (2.6%) expired. In contrast, among patients with elevated procalcitonin levels, 51/62 patients (82.3%) were discharged and 11/62 (17.7%) expired (p=0.003). Elevated procalcitonin levels were also significantly associated with increased requirement for mechanical ventilation (29/62; 46.8% vs 6/38; 15.8%, p<0.001) and prolonged PICU stay of ≥7 days (30/62; 48.4% vs 8/38; 21.1%, p<0.001). Elevated ferritin levels were significantly associated with poor clinical outcomes among PICU patients. Mortality was higher in patients with elevated ferritin (10/58; 17.2%) compared to those with normal ferritin (2/42; 4.8%) (p=0.015). The requirement for mechanical ventilation was greater in the elevated ferritin group (27/58; 46.6% vs 8/42; 19.0%, p=0.001), and prolonged PICU stay ≥7 days was also more frequent (28/58; 48.3% vs 10/42; 23.8%, p=0.003). Conclusion: We concluded that inflammatory biomarkers, namely C-reactive protein (CRP), procalcitonin, and ferritin, demonstrate significant clinical relevance in predicting outcomes among critically ill pediatric patients admitted to the Pediatric Intensive Care Unit (PICU). In this prospective observational study involving 100 patients, elevated CRP levels were associated with increased mortality, suggesting its potential utility as an indicator of poor prognosis.

Background: In paediatric cardiac surgery the terminology of ultrafast tracking is accepted when extubation is done on the operating table. During last two decades at various major centers in the world 50 to 90 % of children are extubated after cardiac surgery while still in the operating room with good results. In early 2025 at our centre on table extubation after open heart surgery attempted first time in suitable cases of paediatric cardiac surgeries with no mortality and quick discharge. Aims: To establishment of safety and efficacy of that ultra-fast track protocol after paediatric open heart surgery in the existing set up of our institution where there is no dedicated postop paediatric cardiac surgery ICU. Materials and methods: This retrospective observational study was done at the department of cardiothoracic surgery NRS Medical College on the cases operated during a period of 3 months (January to March 2025). Ultra-fast tracking ( On table extubation ) was done in 6 simple consecutive paediatric open heart surgeries done in Jan 2025 and compared with 6 uncomplicated paediatric open heart surgeries done in Feb-March 2025 where fast track protocol( extubation within 6 hrs postop period ) was followed instead of ultra-fast track protocol . Result: A total of 12 paediatric patients undergoing uncomplicated congenital cardiac surgery were included, with 6 patients in the ultra-fast-track group and 6 in the fast-track group. The groups were comparable with respect to age (6.50 ± 2.061 vs. 8.83 ± 3.184 years; p=0.100), body weight (16.83 ± 4.26 vs. 18.00 ± 6.78 kg; p=0.364), haemoglobin (10.31 ± 1.226 vs. 10.116 ± 1.763 g/dL; p=0.420), aortic cross-clamp time (45.83 ± 16.11 vs. 33.67 ± 9.37 min; p=0.088) and cardiopulmonary bypass time (92.33 ± 20.89 vs. 75.00 ± 12.36 min; p=0.071). The ultra-fast-track group achieved significantly earlier enteral feeding (4.50 ± 0.76 vs. 11.17 ± 1.34 hours; p<0.001) and significantly shorter postoperative hospital stay (2.33 ± 0.75 vs. 3.66 ± 0.95 days; p=0.016) compared with the fast-track group. Conclusion: Ultra-fast tracking was found to be a safe and feasible option after simpler paediatric cardiac surgeries with earlier recovery, discharge and possibly low cost than fast tracking method.

Background: Diabetic foot ulcer (DFU) is one of the most common and serious complications of diabetes mellitus, contributing significantly to morbidity, prolonged hospitalization, and lower-limb amputation. While bacterial infections are well-recognized in DFUs, fungal infections often remain underdiagnosed and may delay wound healing and increase treatment failure. Early identification of fungal pathogens can facilitate appropriate therapy and improve clinical outcomes in patients with chronic diabetic foot ulcers. Aims: To determine the incidence of fungal infections in diabetic foot ulcers and to evaluate their association with demographic, clinical, and ulcer-related characteristics. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery over a period of 12 months. A total of 60 patients with diabetic foot ulcers meeting the inclusion criteria were enrolled. Detailed clinical evaluation, ulcer assessment, and laboratory investigations were performed for all participants. Wound specimens were collected under aseptic precautions and subjected to direct microscopy and fungal culture for identification of fungal pathogens. Data were entered into Microsoft Excel and analyzed using appropriate statistical methods, with p <0.05 considered statistically significant. Results: Among the 60 patients studied, the majority belonged to the age group of 51–60 years, with a mean age of 56.8 ± 9.4 years. Males constituted 40 (66.7%) patients and females 20 (33.3%) patients. Fungal infection was identified in 8 (13.3%) patients, indicating a prevalence of 13.3% among diabetic foot ulcers. The most commonly isolated fungal organism was Candida albicans accounting for 4 (50.0%) cases. Fungal infection was significantly associated with longer duration of diabetes (>10 years), poor glycemic control (HbA1c >8%), higher Wagner grade ulcers, and ulcer duration exceeding 8 weeks (p<0.05). Patients with fungal infection demonstrated delayed wound healing and longer hospital stay compared to those without fungal growth. Conclusion: Fungal infection was present in a notable proportion of patients with diabetic foot ulcers and was associated with chronicity of ulcer, poor glycemic control, and advanced ulcer severity. Routine mycological evaluation of non-healing diabetic foot ulcers may facilitate early diagnosis and targeted antifungal therapy, thereby improving wound healing and reducing diabetes-related complications

Background: Chronic anal fissure is a common anorectal condition characterized by severe pain during defecation and bleeding per rectum, significantly affecting quality of life. Increased internal anal sphincter tone and local ischemia play a key role in its pathophysiology. Topical pharmacological agents such as calcium channel blockers, including nifedipine and diltiazem, are widely used as non-surgical treatment options. Both drugs promote sphincter relaxation, improve blood flow, and enhance fissure healing with minimal adverse effects. Aims: To compare the effectiveness of topical nifedipine and topical diltiazem in the management of chronic anal fissure. Materials and Methods: This prospective comparative study was conducted over a period of 15 months in a tertiary care teaching hospital. Inclusion criteria included patients aged above 18 years with chronic anal fissure lasting more than 6 weeks. A total of 60 patients diagnosed with chronic anal fissure were included and randomly divided into two equal groups. Group A received topical nifedipine ointment and Group B received topical diltiazem ointment. Patients were evaluated at baseline and during follow-up visits for pain using a visual analogue scale (VAS), fissure healing status, bleeding episodes, and sphincter spasm. Treatment compliance and adverse effects were also recorded. Results: Both nifedipine and diltiazem groups showed significant improvement in symptoms. Pain scores reduced significantly in both groups, with slightly faster relief observed in the nifedipine group. Complete fissure healing was achieved in a higher proportion of patients in the nifedipine group compared to the diltiazem group. Reduction in sphincter spasm and bleeding episodes was comparable between the two groups. Adverse effects such as headache and local irritation were mild and similar in both groups. Overall, both drugs were effective, with nifedipine showing a marginally better clinical response. Conclusion: Both topical nifedipine and diltiazem are effective and safe in the management of chronic anal fissure. Nifedipine demonstrates slightly superior outcomes in pain relief and healing rate, though differences are not statistically significant. Both agents can be considered reliable first-line non-surgical treatment options

Background: Colorectal cancer is one of the leading causes of cancer-related morbidity and mortality worldwide. Surgical resection remains the primary treatment modality. Nutritional status plays a crucial role in surgical recovery, and serum albumin is a widely used marker of nutritional and inflammatory status. Preoperative hypoalbuminemia has been associated with impaired wound healing, prolonged hospitalization, and adverse postoperative outcomes. Aim: To evaluate the role of preoperative hypoalbuminemia as a predictor of postoperative complications in patients undergoing colorectal cancer surgery. Materials and Methods: This prospective observational study was conducted over a period of 12 months among 40 patients with histopathologically confirmed colorectal cancer who underwent elective surgical resection. Preoperative serum albumin levels were measured within one week prior to surgery. Patients were categorized into two groups: hypoalbuminemia group (serum albumin <3.5 g/dL) and normal albumin group (serum albumin ≥3.5 g/dL). Demographic data, tumor characteristics, operative details, and postoperative outcomes were recorded. Postoperative complications and duration of hospital stay were assessed. Statistical analysis was performed to determine the association between preoperative albumin levels and postoperative morbidity. Results: Among the 40 patients studied, 18 (45.0%) had preoperative hypoalbuminemia and 22 (55.0%) had normal serum albumin levels. The incidence of overall postoperative complications was significantly higher in the hypoalbuminemia group compared to the normal albumin group (66.7% vs. 18.2%, p<0.001). Surgical site infection developed in 7 (38.9%) patients with hypoalbuminemia compared to 2 (9.1%) patients with normal albumin levels. Anastomotic leakage occurred in 3 (16.7%) patients in the hypoalbuminemia group. Pulmonary complications were observed in 4 (22.2%) and 1 (4.5%) patients, respectively. Patients with hypoalbuminemia had a significantly longer hospital stay (12.8 ± 3.4 days) compared to those with normal albumin levels (8.1 ± 2.2 days; p<0.001). Conclusion: Preoperative hypoalbuminemia is a significant predictor of postoperative complications following colorectal cancer surgery. Routine preoperative assessment of serum albumin may help identify high-risk patients and facilitate timely nutritional optimization, thereby improving postoperative outcomes and reducing surgical morbidity.

Multinodular goitre (MNG) is a common thyroid disorder characterized by enlargement of the thyroid gland with multiple nodules. It is more frequently encountered in middle-aged women and in populations with inadequate iodine intake. Giant multinodular goitres in young individuals are uncommon and may remain clinically silent for a prolonged period despite considerable enlargement. We report the case of an 18-year-old male who presented to the ENT outpatient department of Rani Durgavati Medical College, Banda, with a gradually progressive anterior neck swelling of 10 years' duration. The swelling was associated mainly with cosmetic concern and was not accompanied by dysphagia, dyspnoea, palpitations, or tremors. Clinical examination revealed a large, diffuse, non-tender thyroid swelling without fixation to the overlying skin or underlying structures. Thyroid function tests were within normal limits. Ultrasonography showed bilateral thyroid enlargement with multiple nodules and increased vascularity. Fine-needle aspiration cytology was suggestive of nodular colloid goitre. Contrast-enhanced computed tomography demonstrated gross enlargement of both thyroid lobes with displacement of adjacent vascular structures.The patient underwent total thyroidectomy under general anaesthesia. The recurrent laryngeal and superior laryngeal nerves were identified and preserved bilaterally. Histopathological examination confirmed multinodular colloid goitre without evidence of malignancy. Postoperatively, the patient developed transient breathy voice, which resolved completely during follow-up. The postoperative recovery was otherwise uneventful.This case highlights the unusual occurrence of a giant multinodular goitre in a young male and emphasizes the importance of appropriate imaging, cytological assessment, meticulous surgical planning, and careful preservation of vital structures during thyroidectomy

Background: Hand hygiene is the most effective measure for preventing transmission of infections in healthcare settings. Medical students begin direct patient interactions during clinical postings, and the practices acquired at this stage are likely to persist throughout their careers. Strengthening awareness and adherence to hand hygiene is therefore critical for infection prevention and patient safety.Methods: A cross-sectional questionnaire-based study was conducted among 150 undergraduate medical students attending clinical postings at a tertiary care teaching institution in Andhra Pradesh, India. A validated, structured questionnaire assessed awareness of hand hygiene, healthcare-associated infections, and self-reported practices in line with WHO recommendations. Results: Among participants, 80% had undergone formal hand hygiene training and 95% were aware of healthcare-associated infections. Nearly all (97%) recognized hand hygiene as effective in preventing cross infections, and 92% correctly identified handwashing as appropriate for visibly soiled hands. However, only 55% and 65% correctly identified the recommended duration for hand rub and handwashingrespectively. While 67% recognized contaminated hands of healthcare workers as the principal source of transmission, gaps in knowledge and adherence were observed. Most students reported compliance with hand hygiene before patient contact, aseptic proceduresand after patient contact, though variations existed in specific clinical situations.Conclusion: Undergraduate medical students demonstrated satisfactory awareness of hand hygiene, but deficiencies remain in applying WHO recommendations consistently. Integrating structured training, simulation-based exercises, and periodic assessments into medical education will foster stronger infection prevention practices and enhance patient safety

Background: Retinopathy of Prematurity (ROP) is a preventable vaso-proliferative retinal disorder affecting preterm babies and remains an important cause of childhood blindness. With improved survival of premature neonates, the burden of ROP has increased, emphasizing the need for timely screening and identification of associated risk factors. Objective: To determine incidence of ROP and evaluate neonatal risk factors associated with ROP development among preterm infants admitted at the Neonatal Intensive Care Unit of a tertiary care hospital. Methods: A hospital-based cross-sectional observational study was conducted over an 18-month period (March 2023 to September 2024) at the NICU of GMERS Medical College and Hospital, Valsad, Gujarat. A total of 290 preterm neonates with gestational age ≤32 weeks and/or birth weight ≤1500 gms were enrolled. ROP screening was performed according to the International Classification of Retinopathy of Prematurity (ICROP) guidelines. Demographic characteristics, neonatal variables, respiratory support, and other clinical risk factors were recorded and analysed using the Chi-square test, with p<0.05 considered statistically significant. Results: Among the 290 enrolled neonates, 17 developed ROP. The highest incidence was observed among infants with gestational age 28–30 weeks (12.0%) and birth weight ≤1 kg (10.96%). Most affected infants had Stage 1 ROP (29.41%) or pre-plus disease (41.18%), while only one infant progressed to Stage 3 disease. Significant risk factors for ROP included oxygen therapy via nasal prongs (p<0.0001), Continuous Positive Airway Pressure (CPAP) support (p<0.0001), mechanical ventilation (p=0.024), and respiratory distress syndrome (p=0.004). Surfactant therapy, blood transfusion, phototherapy, and resuscitation at birth were not significantly associated with ROP. Conclusion: The incidence of ROP in this study was relatively low compared with many previously reported Indian studies. Prematurity, extremely low birth weight, prolonged oxygen therapy, CPAP support, mechanical ventilation, and respiratory distress syndrome were the major risk factors associated with ROP. Strict oxygen monitoring, adherence to screening guidelines, and early ophthalmologic evaluation are essential to facilitate timely diagnosis and prevent progression to vision-threatening stages.

Background: Late-onset sepsis (LOS) remains an important cause of neonatal morbidity and mortality, and meningitis may coexist without classical neurological signs. Early identification through cerebrospinal fluid (CSF) examination may facilitate prompt treatment and improve outcomes. This study aimed to determine the prevalence, clinical characteristics, microbiological profile, risk factors and outcomes of meningitis among neonates with late-onset sepsis in a tertiary care hospital in a hilly region of North India.Methods: A cross-sectional study was conducted over one year in the Neonatal Intensive Care Unit of Shri Lal Bahadur Shastri Government Medical College and Hospital, Nerchowk, Himachal Pradesh. A total of 225 neonates aged >72 hours with clinical and/or laboratory evidence of sepsis were enrolled. All underwent clinical evaluation, complete blood count, C-reactive protein, blood culture and lumbar puncture with CSF cytology, biochemistry and culture. Meningitis was diagnosed according to predefined CSF criteria. Risk factors and outcomes were analysed using logistic regression.Results: Among 225 neonates with late-onset sepsis, meningitis was identified in 25.7% (n=58) on blood-culture assessment and 34% on CSF cytological criteria. Prevalence was higher among preterm than term neonates (37% vs. 17%). Respiratory distress (53%), lethargy (43%) and refusal to feed (40%) were the commonest presenting features. Meningitis was significantly associated with male sex and low birth weight on univariate analysis. Low birth weight was the only significant independent risk factor on logistic regression (aOR 0.294, 95% CI 0.163–0.528; p<0.001). The commonest blood-culture isolate was Staphylococcus aureus (26%), followed by Acinetobacter (15%), Klebsiella (13%) and Enterobacter (12%). All CSF cultures were sterile. Mortality among neonates with meningitis was 13%.Conclusion: Meningitis was common among neonates with late-onset sepsis, particularly among low-birth-weight infants. Clinical manifestations were predominantly nonspecific, emphasizing the importance of CSF evaluation. Routine lumbar puncture and timely CSF analysis may facilitate early diagnosis and treatment and support appropriate antimicrobial policy.

Background: Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders characterized by varying degrees of pulmonary inflammation and fibrosis. High-resolution computed tomography (HRCT) provides detailed structural assessment, whereas pulmonary function tests (PFTs) quantify functional impairment. Aim of the study was to evaluate the correlation between HRCT chest findings and pulmonary function parameters in patients with ILD.Materials and Methods: This cross-sectional observational study included 125 patients with ILD evaluated in the Departments of General Medicine and Radiology, Mamata Medical College and General Hospital, Khammam. HRCT findings, including reticulation, ground-glass opacity, traction bronchiectasis, honeycombing and disease extent, were recorded and correlated with FVC, FEV₁, TLC and DLCO.Results: Reticular opacities were observed in 79.2%, ground-glass opacity in 63.2%, traction bronchiectasis in 53.6% and honeycombing in 40.0%. UIP/probable UIP was the commonest HRCT pattern (45.6%). Mean FVC, TLC and DLCO were 67.65%, 65.20% and 53.94% predicted, respectively. HRCT disease extent showed significant negative correlations with FVC (r=−0.602), TLC (r=−0.650) and DLCO (r=−0.676), all p<0.001.Conclusion: Increasing HRCT disease severity was significantly associated with worsening pulmonary function, particularly reduced DLCO, TLC and FVC. Combined HRCT and PFT assessment provides complementary information for evaluating ILD severitySepsis

Background: While the neurological impairment in Cerebral Palsy (CP) is static, the caregiver’s experience of strain is highly dynamic. Traditional assessments of caregiver burden often rely on the Gross Motor Function Classification System (GMFCS) but overlook the “Growth Factor"—the increasing physical mass of the child relative to the caregiver’s physical capacity. Objective: This study aimed to examine the "Load-Capacity Divergence" by determining if the correlation between GMFCS level and caregiver strain is moderated by the child’s weight-to-caregiver- strength (WT_STR) ratio. It further sought to utilize Ecological Momentary Assessment (EMA) to capture real-time fluctuations in momentary fatigue. Methods: A 6-month longitudinal mixed-methods design was employed with 50 caregiver-child dyads (children aged 6–16; GMFCS Levels I–V). Objective metrics included child height/weight and caregiver grip strength. Caregiver strain was measured longitudinally via the Modified Caregiver Strain Index (MSCI) and in real-time via a thrice-daily EMA Index (EMAI). Results: Hierarchical regression revealed that GMFCS and the WT_STR ratio accounted for 91.5% of the variance in caregiver strain (F(2, 47) = 251.72, p < .001). A significant negative interaction was identified (B = -2.08, p = .009), demonstrating that GMFCS level is a potent predictor of strain only when the child’s physical mass is low. As the WT_STR ratio increases, the impact of the GMFCS level diminishes (the slope flattens), suggesting a "ceiling effect" where sheer physical load outweighs functional diagnosis. Conclusion: Caregiver strain is driven by a widening divergence between child growth and caregiver capacity.

Purpose: Mandibular condylar fractures constitute a significant proportion of mandibular injuries, and the optimal method of fixation remains a subject of ongoing debate. Conventional fixation using two miniplates provides adequate biomechanical stability but often requires extensive surgical exposure. Delta plates have been introduced as an alternative fixation system designed to provide three-dimensional stability while requiring fewer screws. The present study aimed to compare the clinical and radiographic outcomes of delta plate fixation with conventional double miniplates osteosynthesis in the management of mandibular condylar fractures. Materials and Methods: A prospective multicenter clinical study was conducted across two tertiary care centers in the Departments of Oral and Maxillofacial Surgery after approval from the Institutional Ethics Committees. Thirty-six patients presenting with unilateral condylar or subcondylar fractures requiring open reduction and internal fixation were included. Patients were divided into two groups: Group I underwent fixation using two 4-holes titanium miniplates (n = 18), and Group II underwent fixation using a titanium delta plate (n = 18). Clinical parameters evaluated included maximal interincisal mouth opening, occlusion, mandibular deviation during mouth opening, pain assessed using the Visual Analog Scale (VAS), and postoperative complications. Radiographic evaluation was performed using orthopantomograms and reverse Towne radiographs to assess fracture reduction and restoration of ramus height. Patients were followed for six months. Results: Both of the fixation methods resulted in satisfactory functional outcomes. At six-month follow-up, the mean maximal mouth opening was 39.2 mm in the double-miniplate group and 40.6 mm in the delta-plate group. No statistically significant differences were observed between the groups with respect to mouth opening, pain scores, or occlusal stability (p > 0.05). Delta plate fixation required fewer screws and reduced intraoperative handling time compared with the double miniplate technique (p > 0.01). Conclusion: Delta plate fixation provides clinical outcomes comparable to those of double-miniplate osteosynthesis while offering advantages in surgical handling and reduced hardware requirements. Delta plates may therefore represent a reliable alternative fixation method in the management of mandibular condylar fractures.

Background: Drug-coated balloon (DCB) angioplasty offers a stent-free “leave-nothing-behind” strategy that may be particularly attractive in young patients with ST-segment elevation myocardial infarction (STEMI), who otherwise face lifelong exposure to stent-related complications. Aim of the study was to evaluate the clinical and angiographic outcomes of DCB-only angioplasty in young patients presenting with STEMI. Materials and Methods: This prospective observational study included 40 young STEMI patients treated in the Department of Cardiology, Mamata Medical College and General Hospital, Khammam, over 1.5 years. After appropriate lesion preparation, DCB angioplasty was performed in suitable culprit lesions. Clinical, procedural, angiographic, and six-month follow-up outcomes were assessed. Results: Mean age was 37.2 ± 5.1 years, and 90% were male. Smoking/tobacco use was present in 65%. Single-vessel disease was observed in 77.5%, with LAD involvement in 57.5%. Final TIMI-3 flow and procedural success were achieved in 97.5% of patients. Bailout stenting was required in one patient. At six months, MACE occurred in 10%, with no cardiovascular mortality. LVEF improved significantly from 49.0 ± 6.6% to 52.2 ± 6.4% (p=0.003). Conclusion: DCB-only angioplasty appears feasible and safe in carefully selected young STEMI patients, with favorable short-term clinical and angiographic outcomes.

Background:The foramen transversarium (FT) is a characteristic feature of cervical vertebrae and transmits important neurovascular structures, principally the vertebral artery, vertebral veins and sympathetic fibres. Although usually single, it may occasionally be duplicated, resulting in an accessory or double foramen transversarium. This variation is of anatomical and clinical importance because of its close relationship with the vertebral artery and its relevance during radiological assessment and cervical spine surgery. Materials and Methods: A descriptive cross-sectional osteological study was conducted in the Department of Anatomy, B. S. Tomar Institute of Medical Sciences, Jaipur (Raj). A total of 100 dried cervical vertebrae, comprising 72 typical (C3–C6) and 28 atypical (C1, C2 and C7) vertebrae, were examined macroscopically for the presence of accessory foramina transversaria. The variations were classified as unilateral or bilateral, with unilateral cases further categorised as right- or left-sided. Data were expressed as frequencies and percentages, and Fisher's exact test was used to compare the occurrence of accessory foramen transversarium between typical and atypical cervical vertebrae. Results: Accessory foramen transversarium was observed in 14 vertebrae (14.0%). Unilateral duplication was present in 11 vertebrae (11.0%), comprising 8 (8.0%) right-sided and 3 (3.0%) left-sided cases, while bilateral duplication was observed in 3 vertebrae (3.0%). The variation was observed in 9 typical (12.5%) and 5 atypical (17.9%) cervical vertebrae. Although the incidence was higher among atypical vertebrae, the difference was not statistically significant (p = 0.527). Conclusion: Accessory foramen transversarium was a relatively common osteological variation in the present study, with unilateral and right-sided duplication predominating. Awareness of this variation is important for anatomists, radiologists and clinicians because of its close relationship with the vertebral artery and its relevance to cervical spine procedures

Background: Drug utilization research is a fundamental and essential tool to ensure rational drug use and optimize safe medication practices. Ensuring appropriate drug use is particularly challenging in surgical settings, where polypharmacy is common. This study was conducted to analyze the drug utilization patterns among inpatients admitted to the General Surgery wards of a tertiary care teaching hospital in Tamil Nadu, India. Methods: Following ethical guidelines and regulations, a prospective observational study was conducted to assess drug utilization trends of 304 prescriptions collected from inpatients admitted between June and August 2023. Descriptive and inferential statistical analyses were performed using JAMOVI 2.4.11. Results: Analysis showed that 72% of patients received five or more drugs per prescription which indicates a high prevalence of polypharmacy. Antibiotics (96.7%), proton pump inhibitors (PPIs) (98.4%), and analgesics (98.4%) were the most frequently prescribed drug classes. Metronidazole (73%) and ceftriaxone (59.2%) were the most frequently used antibiotics. Normal Saline (96.1%) and Ringer’s lactate (87.8%) were the most used intravenous fluids. 37.8% of prescriptions were prescribed using generic names. Fixed-dose combinations (FDCs) were found in 10.5% of prescriptions. Conclusion: This drug utilization pattern study in surgical inpatients emphasizes the importance of medication safety, antimicrobial stewardship, and rational drug use to improve treatment outcomes in tertiary care hospitals.

Background: Anemia is a frequent and clinically important complication of chronic liver disease. Its pathogenesis is often multifactorial and may include gastrointestinal blood loss, nutritional deficiencies, chronic inflammation, hypersplenism, haemolysis, bone-marrow suppression and renal dysfunction. The prevalence and pattern of anemia may vary according to the severity and complications of liver disease. Aim: To determine the prevalence and clinical profile of anemia among patients with chronic liver disease. Materials and Methods: This hospital-based cross-sectional observational study included 200 adult patients with chronic liver disease. Sociodemographic characteristics, duration and aetiology of CLD, clinical manifestations, gastrointestinal bleeding, portal hypertensive complications and hepatic decompensation were recorded. Complete blood count, red-cell indices, liver-function tests, renal-function tests, coagulation profile and relevant radiological and endoscopic findings were evaluated. Anemia was defined according to World Health Organization haemoglobin thresholds and classified by severity and morphological pattern. Child-Pugh classification and MELD score were used to assess liver-disease severity. Categorical variables were compared using the chi-square test, while continuous variables were compared using Welch’s independent-samples t test. Odds ratios and mean differences were reported with 95% confidence intervals. A p value below 0.05 was considered statistically significant. Results: Anemia was present in 137 of 200 patients, giving a prevalence of 68.5% (95% CI: 61.8%-74.5%). Moderate anemia was the most frequent category (48.9%), followed by mild (29.9%) and severe anemia (21.2%). Microcytic hypochromic anemia was the predominant morphological pattern (42.3%), followed by normocytic normochromic (34.3%), macrocytic (16.8%) and dimorphic anemia (6.6%). The mean haemoglobin level among anemic patients was 9.47±1.86 g/dL. Anemia was significantly associated with a longer duration of CLD, lower BMI, fatigue, pallor, exertional dyspnoea, pedal oedema, ascites, splenomegaly and previous gastrointestinal bleeding. Gastroesophageal varices and portal hypertensive gastropathy were also significantly more frequent among anemic patients. Anemic patients had significantly higher bilirubin, INR, serum creatinine and MELD scores and lower serum albumin and platelet counts. Child-Pugh class B or C was strongly associated with anemia (OR=5.25, 95% CI: 2.72-10.15; p<0.001), as was decompensated CLD (OR=3.58, 95% CI: 1.92-6.67; p<0.001). No individual aetiology of CLD showed a statistically significant association with anemia. Conclusion: Anemia was common among patients with CLD and was predominantly moderate and microcytic hypochromic. It was strongly associated with gastrointestinal bleeding, portal hypertension, impaired hepatic synthetic function and advanced or decompensated liver disease. Routine evaluation of anemia and identification of potentially reversible causes should be incorporated into the comprehensive management of patients with CLD

Background: The optimal timing of laparoscopic cholecystectomy in acute calculous cholecystitis remains relevant in resource-constrained settings. This study compared perioperative outcomes of early and delayed laparoscopic cholecystectomy. Methods: In this comparative study, 100 adults with Tokyo Guidelines-defined Grade I or II acute calculous cholecystitis were allocated to early surgery during the index admission (n=50) or delayed surgery 6-8 weeks after conservative treatment (n=50). Primary outcomes were conversion to open surgery, postoperative complications and total hospital stay. Results: Baseline characteristics were comparable. Mean operative time was longer with early surgery (71.6+/-18.9 vs 63.4+/-16.2 minutes; p=0.022), while total hospital stay was substantially shorter (4.2+/-1.3 vs 8.9+/-2.1 days; p<0.001). Conversion rates (8% vs 6%; p=1.000) and postoperative complications (10% vs 8%; p=1.000) did not differ significantly. Six patients (12%) in the delayed group required readmission for recurrent biliary symptoms before definitive surgery. No bile duct injury or mortality occurred. Conclusion: Early laparoscopic cholecystectomy provides definitive treatment during the index admission and reduces cumulative hospital stay without increasing conversion or morbidity. Where expertise and operating-room access are available, it should be preferred over routine interval surgery.

Background: Abdominal wound dehiscence is a serious complication after laparotomy. This study described the clinical and perioperative profile of affected patients and analysed factors associated with the postoperative timing of dehiscence. Methods: A prospective observational cross-sectional study included 100 adults who developed wound dehiscence after elective or emergency laparotomy at a tertiary-care teaching hospital. Demographic, nutritional, disease-related, operative and postoperative variables were recorded. Spearman correlation, non-parametric comparisons and multiple linear regression were used to analyse the day of dehiscence. Results: Males comprised 61%, obesity was present in 44%, emergency operations in 83%, sepsis/shock in 44%, and anaemia and low albumin-related states in 54% and 51%, respectively. Mean operative duration was 173.87±45.77 minutes. Dehiscence occurred most commonly on postoperative day 7 (38%); 79% occurred on days 5-8. In multivariable analysis, age (B=-0.018, p=0.0036), duration of symptoms before surgery (B=0.137, p=0.0031) and operative duration (B=0.006, p=0.0360) independently predicted timing. Conclusion: Wound dehiscence clustered in high-risk emergency patients and usually occurred during the first postoperative week. Intensified surveillance around days 5-8 is warranted.

Background: To assess the association of depressive and anxiety symptoms with cardiovascular health among young adults. Methods: A hospital-based cross-sectional analytical study was proposed among young adults aged 18–35 years attending the Department of Psychiatry, SMMH Medical College, Saharanpur. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Cardiovascular health was evaluated according to the American Heart Association's Life's Essential 8 framework, comprising diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose and blood pressure. Each component was scored from 0 to 100, and the overall cardiovascular health score was calculated as the mean of the eight components. Participants were categorized as having low, moderate or high cardiovascular health. Multivariable regression analysis was planned to evaluate independent associations after adjustment for relevant sociodemographic and behavioural factors. Results: The mean age was 27.1±4.8 years. Moderate-to-severe depressive symptoms were present in 52 (23.6%) participants and moderate-to-severe anxiety symptoms in 61 (27.7%). The mean overall Life's Essential 8 score was 61.8±12.4. Participants with depression had a lower mean cardiovascular health score than those without depression (54.9±11.8 vs. 64.0±11.6; p<0.001), while participants with anxiety similarly had lower scores than those without anxiety (56.7±11.9 vs. 63.8±11.9; p<0.001). Low cardiovascular health was more frequent among participants with depression and anxiety. After adjustment for age, sex, education, socioeconomic status, alcohol use and other relevant covariates, depression and anxiety remained independently associated with lower cardiovascular health. Conclusion: Depressive and anxiety symptoms were associated with poorer cardiovascular health among young adults. Screening for psychological symptoms together with assessment of modifiable cardiovascular-health behaviours may provide an opportunity for integrated prevention of future cardiovascular disease during early adulthood.

Background: The foramen magnum (FM) is the largest and most important aperture at the base of the skull, transmitting the medulla oblongata, meninges, vertebral arteries, spinal roots of the accessory nerve and the spinal portions of the anterior and posterior spinal arteries. Its morphometry shows wide ethnic, racial and sexual variation and is of considerable importance to anatomists, neurosurgeons, radiologists and forensic experts. Objective: To study the morphometric dimensions and morphological shape variations of the foramen magnum in adult dry human skulls and to assess sexual dimorphism of the parameters studied. Materials and Methods: This descriptive osteometric study was carried out on 100 dry, undamaged adult human skulls of known sex (60 male, 40 female) obtained from the osteology repository of the Department of Anatomy. The foramen magnum length (FML) and foramen magnum breadth (FMB) were measured with a digital Vernier caliper (accuracy 0.01 mm). The foramen magnum index (FMI) and foramen magnum area (FMA) were derived, and the shape of each foramen was classified visually. Data were analysed using SPSS (version 25.0); an independent sample t-test compared male and female means, and Pearson correlation assessed the relationship between FML and FMB. A p-value <0.05 was considered statistically significant. Results: The overall mean FML was 34.51 ± 2.62 mm and mean FMB was 29.15 ± 2.34 mm. Males showed significantly larger FML, FMB and FMA than females (p < 0.001 for all), while the FMI did not differ significantly between sexes (p = 0.87). FML and FMB showed a moderate positive correlation (r = 0.62, p < 0.001). The oval shape was the most common morphological variant (42%), followed by round (18%) and tetragonal (14%) shapes. Conclusion: The foramen magnum exhibits statistically significant sexual dimorphism in its linear dimensions and area, making it a useful adjunct parameter for sex determination in forensic anthropology, particularly when only the skull base is available. Awareness of the normal morphometric range and shape variants of the foramen magnum is essential for safe planning of transcondylar, transoral and posterior fossa surgical approaches.

Background: Menopause is an important physiological transition that may be accompanied by vasomotor, psychological, genitourinary and musculoskeletal symptoms and may have implications for long-term health. Despite its importance, women may have inadequate knowledge regarding menopause and considerable misconceptions about hormone replacement therapy (HRT). Understanding these knowledge gaps is essential for developing effective menopause counselling and health-education strategies. Objectives: To assess awareness regarding menopause and HRT among middle-aged women, identify prevalent myths and misconceptions, and evaluate the association of awareness with selected sociodemographic, reproductive and healthcare-related characteristics. Methods: A hospital-based cross-sectional analytical study was conducted among 250 women aged 40–60 years attending a tertiary care teaching hospital in India from January 2026 to June 2026. Participants were recruited consecutively after obtaining written informed consent. Data were collected using a structured questionnaire covering sociodemographic characteristics, reproductive and menopausal status, awareness regarding menopause and HRT, and common myths and misconceptions. Categorical variables were summarized as frequencies and percentages. Associations between categorical variables were assessed using the chi-square test or Fisher's exact test as appropriate. A p value <0.05 was considered statistically significant. Results: Among the 250 participants, 90.4% had heard of menopause and 84.4% recognized it as a natural biological transition. Awareness of individual manifestations was lower, particularly for genitourinary symptoms (48.4%) and cardiovascular health implications (46.8%). Only 37.2% had heard of HRT, while 31.2% were aware that it may be useful for selected menopausal symptoms. Overall, 24.0% demonstrated good awareness, 48.8% moderate awareness and 27.2% poor awareness. Common misconceptions included the belief that HRT is dangerous for every woman (37.6%), menopausal symptoms should simply be tolerated (34.8%), and HRT inevitably causes cancer (31.6%). Adequate awareness was significantly associated with urban residence, higher educational attainment, employment, previous menopause-related information and previous HRT counselling (p<0.05). Conclusion: General awareness of menopause was relatively high, but detailed knowledge regarding menopausal health and HRT remained limited, with several persistent misconceptions. Structured, evidence-based menopause counselling should be incorporated into routine midlife healthcare, with particular attention to women with lower educational attainment and those from rural settings. Improving awareness may facilitate appropriate healthcare-seeking behaviour and informed decisions regarding menopausal management.

Background: Carbapenem-resistant Gram-negative bacilli (CR-GNB) are an increasing cause of respiratory infections and substantially limit therapeutic options. Local surveillance is essential for understanding species distribution and antimicrobial susceptibility patterns. Methods: A retrospective observational study was conducted over 3 months in a tertiary care teaching hospital in Bihar. Respiratory samples from adult patients yielding clinically significant Gram-negative bacilli were processed using standard microbiological methods. Organisms were identified by automated systems and/or conventional biochemical methods. Antimicrobial susceptibility testing was performed according to CLSI 2024 recommendations, with colistin susceptibility assessed by broth microdilution. Results: Among 293 Gram-negative respiratory isolates, 115 (39.2%) were carbapenem-resistant. Klebsiella pneumoniae was the predominant isolate (35.8%), followed by Acinetobacter baumannii (28.0%) and Pseudomonas aeruginosa (20.8%). Carbapenem resistance was highest in A. baumannii (62.2%), followed by K. pneumoniae (36.2%), P. aeruginosa (27.9%), and other Enterobacteriaceae (20.0%) (p<0.0001). CR-GNB were most frequent in tracheostomy secretions (54.2%) and endotracheal secretions (48.3%) (p=0.032). Resistance to meropenem and imipenem was 94.8% and 93.0%, respectively. Colistin showed the highest susceptibility (87.8%).Conclusion: CR-GNB constitute a substantial burden among respiratory isolates, with marked multidrug resistance. Regular institutional antibiograms, antimicrobial stewardship, and strengthened infection-control measures are warranted.

Background: The relationship between the hippocampus and memory is well established. Reduction in hippocampal volume and associated biochemical alterations may occur in dementia and can be assessed using magnetic resonance imaging (MRI)-based volumetry and magnetic resonance spectroscopy (MRS). Only a limited number of studies have evaluated these parameters in India. This study aimed to assess hippocampal volume and MRS findings in clinically diagnosed or suspected dementia patients and to correlate the imaging findings with Mini-Mental State Examination (MMSE) scores. Materials and Methods: This cross-sectional study included 45 patients who were clinically suspected or diagnosed with dementia and referred for MRI of the brain. MR volumetry was performed to assess the bilateral hippocampal volumes. MRS was performed on the hippocampus with relatively lower volume, and the N-acetylaspartate/creatine (NAA/Cr), myo-inositol/creatine (mI/Cr), and choline/creatine (Cho/Cr) ratios were calculated. Imaging parameters were correlated with MMSE scores. The diagnostic performance of hippocampal volumetry was also assessed using MMSE-based clinical assessment as the reference. Results: Among the 45 patients, 41 (91%) had an MMSE score <25, and 46% belonged to the moderate-to-severe cognitive impairment category. MRI demonstrated reduced average hippocampal volume in 16 (36%) patients. Hippocampal volume and MRS parameters showed significant associations with MMSE scores (p<0.05). Lower MMSE scores were associated with a significant reduction in hippocampal volume and NAA/Cr ratio and an increase in mI/Cr ratio, whereas the difference in Cho/Cr ratio was not statistically significant. Using MMSE-based clinical assessment as the reference, hippocampal volumetry showed a sensitivity of 87.5% and specificity of 75.9% for identifying dementia and was significantly associated with the severity of cognitive impairment. Conclusions: MRI-based hippocampal volumetry and MRS parameters correlate with MMSE scores and may provide objective imaging markers of cognitive impairment and its severity. These techniques may complement clinical assessment, particularly in the evaluation of patients with early cognitive impairment. Keywords: Atrophy, Dementia, Hippocampus, MMSE, MRI, MRS

Background: The endometrium behind abnormal uterine bleeding (AUB) can look like anything from an ordinary secretory phase to frank adenocarcinoma. That range is why the histopathology report often decides whether a woman gets a progestin or an oncology referral. We mapped the endometrial spectrum in AUB and how it shifts with age. Methods: Ninety-five adequate endometrial biopsies and curettings from women with AUB were studied over 23 months (July 2022 to May 2024) at a tertiary care teaching hospital. Tissue was formalin-fixed, sectioned at 4–5 µm and stained with haematoxylin and eosin. Findings were grouped as functional or organic and correlated with age using chi-square and Fisher’s exact tests. Results: Ages ranged from 21 to 80 years; the 41–50 year band was largest, 40 of 95 women (42.11%). Disordered proliferative endometrium was commonest, 23 cases (24.21%), followed by proliferative phase 22 (23.16%) and secretory phase 18 (18.95%). Functional patterns explained 73 cases (76.84%), organic lesions 22 (23.16%). Hyperplasia without atypia occurred in 7 women (7.37%), atypical hyperplasia in 2 (2.11%) and carcinoma in 7 (7.37%). Secretory endometrium led the reproductive group (15/39), proliferative endometrium the perimenopausal group (14/40) and carcinoma the postmenopausal group (7/16). The functional-to-organic ratio shifted significantly with age (χ² = 11.89, df = 2, p = 0.003), and every carcinoma was postmenopausal (Fisher’s exact p < 0.001). Conclusion: Disordered proliferative endometrium dominating suggests anovulation drives AUB in perimenopausal women, while every carcinoma appeared after menopause. That argues for a low threshold to sample the endometrium in any postmenopausal bleeding, and for reporting hyperplasia by atypia status rather than as one category.

Background: Inguinal hernia repair requires effective regional anesthesia to minimize systemic opioid administration and facilitate early recovery. This study compared the clinical efficacy of landmark-guided ilioinguinal-iliohypogastric (IIH) nerve block versus transversus abdominis plane (TAP) block in adult patients undergoing elective open inguinal hernia repair. Methods: In this comparative study, 110 adult patients (ASA Grade I–III, aged 18–75 years) scheduled for open inguinal hernia repair were allocated into two equal groups (n = 55 each): Group IIH (landmark IIH block with pubic tubercle infiltration) and Group TAP (landmark TAP block via the lumbar triangle of Petit). Both groups received a 25 mL local anesthetic mixture containing 12 mL 0.5% bupivacaine, 11 mL 2% lignocaine with adrenaline, and 8 mg dexamethasone. Sensory onset, block duration, Visual Analogue Scale (VAS) pain scores at 2, 4, 6, 12, and 24 hours, and 24-hour total rescue analgesic requirements (IV paracetamol and tramadol) were recorded. Continuous variables were analyzed using Student’s t-test. Results: Demographics and ASA physical status were comparable between groups (p > 0.05). Group IIH demonstrated significantly faster onset of anesthesia (12.50 ± 2.14 vs. 15.39 ± 3.17 min; p < 0.001) and longer duration of anesthesia (193.67 ± 24.07 vs. 172.22 ± 26.13 min; p < 0.001) compared to Group TAP. Postoperative VAS pain scores were significantly lower in Group IIH at all measured time points (2, 4, 6, 12, and 24 hours; p < 0.05). Total 24-hour IV paracetamol (1740 ± 331 mg vs. 2180 ± 352 mg; p < 0.001) and IV tramadol requirements (60 ± 18 mg vs. 89 ± 23 mg; p < 0.001) were significantly reduced in Group IIH. No major complications occurred. Conclusion: Landmark-guided IIH nerve block provides faster onset, extended anesthesia, superior 24-hour postoperative analgesia, and lower rescue analgesic consumption than TAP block in open inguinal hernia repair.

Background: Rapid diagnosis is essential in the management of polytrauma patients to facilitate timely surgical intervention and improve clinical outcomes. Point-of-Care Ultrasound (POCUS) has emerged as an important bedside imaging modality for the early assessment of trauma; however, evidence regarding its impact on surgical decision-making and patient outcomes remains limited.Objectives: To evaluate the impact of real-time POCUS on diagnostic accuracy, surgical decision-making and clinical outcomes in polytrauma patients requiring emergency surgical management. Methods: A prospective comparative observational study was conducted at a tertiary care trauma centre involving 200 polytrauma patients, with 100 patients undergoing POCUS-guided assessment and 100 patients managed using the conventional imaging pathway. Diagnostic performance of POCUS was evaluated using operative findings and/or final clinical diagnosis as the reference standard. Time to diagnosis, surgical decision-making, definitive surgical intervention and clinical outcomes including intensive care unit (ICU) admission, ICU stay, hospital stay, packed red blood cell (PRBC) transfusion, postoperative complications and in-hospital mortality were compared between the two groups. Results: POCUS demonstrated a sensitivity of 100.0%, specificity of 52.2%, positive predictive value of 71.1%, negative predictive value of 100.0% and an overall diagnostic accuracy of 78.0% for detecting injuries requiring surgical intervention. Patients assessed using POCUS had significantly shorter time to diagnosis (8.28 ± 1.58 vs. 22.30 ± 4.60 min), surgical decision-making (21.48 ± 13.72 vs. 36.42 ± 3.51 min) and definitive surgical intervention (31.48 ± 13.71 vs. 58.29 ± 3.25 min) compared with the conventional imaging group (all p < 0.001). No significant differences were observed in ICU admission, ICU stay, hospital stay, PRBC transfusion requirement, or postoperative complications (p > 0.05). In-hospital mortality was significantly higher in the POCUS group (12.0% vs. 0.0%; p < 0.001). Conclusions: Real-time POCUS is a reliable bedside imaging modality with excellent diagnostic performance for the evaluation of polytrauma patients. Its use significantly reduces the time to diagnosis, surgical decision-making and definitive surgical intervention, supporting earlier trauma management. Although most short-term clinical outcomes were comparable between study groups, the findings support the integration of POCUS into emergency trauma protocols, particularly in resource-constrained settings. Further multicentre studies are warranted to validate these findings and evaluate long-term patient outcomes

Background: Chronic kidney disease (CKD) is a growing global health problem, and gastrointestinal disorders are among the most common non-renal chronic complications encountered in patients with end-stage renal disease. Upper gastrointestinal (UGI) lesions such as gastritis, esophagitis and peptic ulcer are particularly prevalent and contribute to morbidity, including UGI bleeding.Objectives: To determine the prevalence of various upper gastrointestinal lesions on fibre-optic endoscopy in patients with CKD, and to evaluate their relationship with the stage of CKD. Methods: A cross-sectional study was conducted among 50 adult patients with CKD who presented to the outpatient and inpatient departments of General Medicine at Subbaiah Medical College, Shimoga, over a one-year period. All patients underwent detailed clinical evaluation, relevant biochemical investigations and upper gastrointestinal endoscopy using a flexible fibre-optic endoscope. CKD stage was determined using the Cockcroft-Gault formula for estimated glomerular filtration rate (GFR). Results: The largest proportion of patients (26%) was in the 31–40-year age group; 28 were male, and 22 were female. Most patients (44%) were in CKD stage IV. Upper gastrointestinal involvement was found on endoscopy in 84% of patients. Erosive gastritis was the most common lesion (26%), followed by gastro-oesophageal reflux disease with or without duodenitis (20%), and duodenal and gastric ulcers (8% each). The stomach was the most frequently involved site (55%), followed by the duodenum (26%) and oesophagus (19%). Lesion prevalence rose with advancing CKD stage: 95% of stage IV and 100% of stage V patients had UGI involvement, compared with 54.5% of stage III patients. Patients on haemodialysis had a higher prevalence of UGI lesions (96.1%) than those on conservative management (70.8%). Conclusion: Upper gastrointestinal endoscopic abnormalities are highly prevalent in patients with CKD and increase in frequency with advancing disease stage and with haemodialysis. Erosive gastritis is the most common lesion. Routine endoscopic screening and early management of UGI lesions in CKD patients, particularly in advanced stages, may help reduce morbidity and prevent complications such as UGI bleeding

Background: Competency-based medical education (CBME) has transformed medical training by emphasizing demonstrated abilities, entrustment, workplace performance, and readiness for progressively independent clinical practice. However, the transition from medical school to residency remains a vulnerable point in the educational continuum. Differences in assessment systems, entrustment standards, supervision expectations, faculty interpretation, and transfer of learner-performance information may limit continuity between undergraduate and postgraduate training. Objective: To systematically review barriers affecting competency-based progression from medical school to residency and to identify strategies for improving assessment continuity, entrustment, supervision, and transition readiness. Methods: A systematic review was conducted according to PRISMA 2020 principles. MEDLINE/PubMed, Scopus, Web of Science, ERIC, and Embase were searched for studies addressing competency-based medical education, entrustable professional activities, readiness for residency, assessment handoff, supervision, transition to postgraduate training, and competency progression. Quantitative, qualitative, mixed-method, and implementation studies were eligible. Owing to methodological heterogeneity, findings were synthesized narratively and thematically. Results: The search identified 718 records. After removal of 206 duplicate or redundant records, 512 records underwent title and abstract screening, of which 408 were excluded. Full texts were sought for 104 reports; seven were not retrieved. Ninety-seven full-text reports were assessed and 79 were excluded, leaving 18 studies for qualitative synthesis. Major barriers included discontinuity in assessment frameworks, limited trust in prior competency judgments, faculty time constraints, unclear entrustment thresholds, documentation burden, inconsistent feedback, variable readiness for indirect supervision, weak transfer of performance information, and tension between competency-based progression and fixed-duration training structures. Conclusions: The medical-school-to-residency transition remains a weak point in CBME. Successful transition requires shared competency language, explicit entrustment criteria, portable longitudinal assessment information, calibrated faculty judgment, structured supervision handoff, and early-residency reassessment.

Background: Antimicrobial stewardship programs (ASPs) in neonatal intensive care units (NICUs) are generally evaluated by reductions in antibiotic initiation or duration. However, stewardship is clinically more meaningful when it also improves microbiological ecology and patient outcomes. Relevant endpoints include multidrug-resistant organism (MDRO) acquisition, changes in unit antibiograms, vancomycin and carbapenem exposure, blood-culture contamination, culture-positive sepsis, invasive candidiasis, necrotizing enterocolitis (NEC), mortality, and length of stay. Objective: To systematically evaluate the clinical and microbiological impact of antimicrobial stewardship interventions in NICUs, with emphasis on antimicrobial resistance, microbiological diagnostics, bloodstream infection ecology, broad-spectrum antimicrobial consumption, mortality, NEC, invasive fungal infection, treatment failure, and hospital stay. Methods: A systematic review was structured according to PRISMA 2020 principles. MEDLINE/PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were considered for studies evaluating NICU stewardship interventions with at least one clinical or microbiological outcome. Studies were prioritized when they reported microbiological resistance, MDROs, blood-culture outcomes, pathogen distribution, invasive infection, NEC, mortality, readmission, recurrence, or length of stay. Results: The review framework identified 1,286 records. After removal of 347 duplicates, 939 records underwent title and abstract screening; 758 were excluded and 181 full texts were sought. Four could not be retrieved. Of 177 full-text articles assessed, 136 were excluded, leaving 41 studies in the qualitative synthesis. In a Level IV NICU in southern China, total antibiotic consumption fell from 791.1 to 466.3 DOT/1,000 patient-days, meropenem or vancomycin use decreased from 7.6% to 1.8%, and MDRO prevalence fell from 67.2% to 48.9%. A Level IV NICU vancomycin initiative reduced use from 112 to 38 DOT/1,000 patient-days. Blood-culture contamination was reduced from 2.0% to 1.0% in a diagnostic-stewardship program. Clinical outcomes were generally preserved and, in some studies, improved. Conclusion: NICU antimicrobial stewardship produces benefits extending beyond lower antibiotic consumption. The strongest microbiological evidence supports reductions in broad-spectrum antibiotic pressure, vancomycin exposure, MDRO prevalence, and blood-culture contamination. Clinical outcomes are generally preserved and may improve in some settings

Background: Osteoarthritis (OA) is the most common degenerative joint disease and a leading cause of pain and disability. Total Knee Arthroplasty (TKA) is the standard surgical treatment for end-stage knee osteoarthritis. Although patellar resurfacing is commonly performed during TKA, the optimal postoperative patellar thickness remains controversial, with limited evidence regarding its influence on clinical and functional outcomes. Aim: To evaluate the effect of postoperative patellar thickness on clinical and functional outcomes in patients undergoing Total Knee Arthroplasty. Materials and Methods: This prospective observational study was conducted between August 2025 and July 2026 at the Department of Orthopaedics, KD hospital, Ahmedabad, Gujarat, India. Fifty-one patients undergoing primary TKA for primary osteoarthritis were included. Preoperative and postoperative patellar thickness was measured intraoperatively using a sterile Vernier caliper. Clinical and functional outcomes were assessed preoperatively and at six months postoperatively using the Knee Society Score (KSS) and Kujala Score. Correlations between postoperative patellar thickness, change in patellar thickness, and postoperative outcome scores were analyzed. Statistical analysis was performed using descriptive statistics and appropriate comparative tests, with a p-value <0.05 considered statistically significant. Results: The majority of patients were females (82.4%), with a mean age predominantly between 60 and 69 years. Both KSS and Kujala scores improved significantly following surgery (p<0.001). Patients with no change in patellar thickness demonstrated the highest postoperative Kujala scores, whereas those with a 2-mm increase in patellar thickness achieved the highest postoperative KSS. Intragroup analysis showed no significant difference in Kujala scores (p=0.10), while KSS differed significantly among patellar thickness categories (p=0.04). Conclusion: Postoperative patellar thickness significantly influences clinical and functional outcomes following TKA. Preservation of native patellar thickness appears to optimize patellofemoral function, whereas a slight increase in thickness may improve overall knee function. Careful intraoperative restoration of patellar thickness may contribute to improved postoperative outcomes

Background: Antibiotics are among the most frequently prescribed medications in neonatal intensive care units (NICUs). Empirical treatment is often justified because neonatal infection can progress rapidly, but substantial inter-unit variation and prolonged treatment of culture-negative illness indicate that a significant proportion of exposure is avoidable. Premature infants are particularly vulnerable to prolonged antibiotic exposure, which has been associated with microbiome disruption, antimicrobial resistance, invasive fungal disease, necrotizing enterocolitis, and other adverse outcomes. Objective: To systematically evaluate specific strategies used to reduce antibiotic overuse in NICUs and determine which interventions are most consistently associated with reductions in antibiotic initiation, days of therapy (DOT), prolonged treatment, and broad-spectrum antimicrobial exposure. Methods: This review was structured according to PRISMA 2020 principles. The primary strategy-analysis dataset screened 1,212 records. Twenty-nine full-text articles were assessed and 12 studies met inclusion criteria: 11 observational studies and one randomized controlled trial. Studies were classified according to intervention mechanism: reduction of antibiotic initiation, automatic stop or duration-limiting strategies, and organizational or multicomponent stewardship interventions. Results: The 12 included studies demonstrated that interventions directly embedded in prescribing decisions were more effective than education-only approaches. Reported reductions in total antibiotic use included 343.2 to 252.2 DOT/1,000 patient-days, 175.1 to 41.6 DOT/1,000 patient-days, 543 to 380 DOT/1,000 patient-days, 572 to 417 DOT/1,000 patient-days, and 99.5 to 71.7 DOT/1,000 patient-days. Automatic 36- to 48-hour stop strategies substantially reduced prolonged empirical therapy. In individual studies, antibiotic exposure beyond 48 hours fell from 65.0% to 32.5% and from 63.4% to 41.3%, while another program increased discontinuation within 48 hours from 32% to 95%. Conclusion: The most effective NICU strategies are those that directly influence individual prescribing decisions: structured criteria for initiation, automatic 36- to 48-hour stop orders, mandatory reassessment after negative cultures, restriction and justification of broad-spectrum agents, and multicomponent audit-feedback programs. Successful stewardship should replace passive awareness campaigns with decision-linked, measurable, time-bound prescribing controls.

Background: Chronic liver disease (CLD) is associated with systemic cardiovascular abnormalities, including electrophysiological and myocardial changes that may remain clinically silent until advanced disease. This study evaluated electrocardiographic (ECG), two-dimensional echocardiographic (2D-ECHO), and abdominal ultrasonographic (USG) abnormalities in patients with CLD and assessed their association with hepatic disease severity and decompensation. Methods: This hospital-based cross-sectional study included 204 adult patients with CLD admitted to a tertiary care teaching hospital. Demographic, clinical, laboratory, ECG, echocardiographic, and ultrasonographic findings were assessed. Cardiovascular abnormalities and ultrasonographic features of hepatic decompensation and portal hypertension were evaluated, and their associations with disease severity were analyzed using appropriate statistical methods. Results: The mean age of the study population was 46.2 ± 11.8 years, and 178 (87.3%) patients were male. Alcohol-related liver disease was the predominant etiology (57.8%), followed by hepatitis C infection (26.5%). ECG abnormalities were present in 186 (91.2%) patients, with QTc prolongation (62.7%) and sinus tachycardia (46.1%) being the most frequent findings. Echocardiography demonstrated left ventricular diastolic dysfunction in 150 (73.5%) patients. Normal LVEF (≥50%) was observed in 37.3% of patients, mildly reduced LVEF (40–49%) in 46.1%, and reduced LVEF (<40%) in 16.6%. Hyperdynamic circulation was observed in 18.6%. Ultrasonography demonstrated ascites in 87.3%, splenomegaly in 82.4%, portal vein dilatation in 54.9%, and coarse hepatic echotexture in 72.5%. QTc prolongation and sinus tachycardia were significantly more frequent in patients with decompensated CLD than in those with compensated disease (p < 0.001 for both). Left ventricular diastolic dysfunction was significantly associated with greater ascites severity (p < 0.001). Concomitant abnormalities across ECG, echocardiography, and ultrasonography were present in 127 (62.3%) patients. Conclusion: Cardiovascular and hepatic abnormalities are common among patients with CLD, with several cardiovascular abnormalities showing significant associations with hepatic decompensation and ascites severity. Integrated assessment using ECG, echocardiography, and abdominal ultrasonography may help identify patients with cardiovascular involvement and advanced hepatic disease and may contribute to clinical risk assessment.

Rituximab, a chimeric anti-CD20 monoclonal antibody, has emerged as an important therapeutic option for several autoimmune and inflammatory dermatoses. Although its use is well established in adult dermatology, evidence in the pediatric population remains limited and largely derived from case reports, case series, and small observational studies. Nevertheless, rituximab has demonstrated promising efficacy in children with refractory autoimmune blistering diseases and other severe immune-mediated dermatological disorders. This review summarizes the mechanism of action, pharmacology, dosing regimens, safety profile, monitoring requirements, and current evidence supporting the use of rituximab in pediatric dermatology. Particular emphasis is placed on autoimmune blistering diseases, connective tissue disorders and vasculitic conditions. Practical considerations regarding patient selection, infection prophylaxis, vaccination, and long-term follow-up are also discussed.

Background: Glycated haemoglobin (HbA1c) is widely used to assess glycemic control and has been endorsed by the American Diabetes Association (ADA) for diagnosing diabetes and prediabetes. However, HbA1c is influenced by any condition that alters erythrocyte turnover or survival. Thyroid hormone stimulates erythropoiesis, and hypothyroidism is often associated with hypoproliferative erythropoiesis, raising the possibility that HbA1c may not accurately reflect glycemic status in hypothyroid patients. Objectives: (1) To detect HbA1c levels in non-diabetic patients with newly detected hypothyroidism, and (2) to determine the reduction in HbA1c levels following thyroid hormone replacement. Methods: This prospective study was conducted at Subbaiah Medical College in Shimoga over 24 months. Forty non-diabetic patients (confirmed by normal fasting and post-prandial glucose) with newly detected hypothyroidism (elevated TSH, low free T4) and a baseline HbA1c >5.6% were enrolled after excluding anaemia, renal insufficiency, hepatic dysfunction and severe hypertriglyceridemia. Patients were started on levothyroxine replacement and reassessed with repeat TSH and HbA1c at 4 and 8 weeks. Results: The mean age was 40.25 ± 15.89 years, and 95% of patients were female. Mean TSH declined significantly from 33.36 ± 30.77 mIU/L at baseline to 21.44 ± 21.74 mIU/L at 4 weeks and 10.33 ± 8.72 mIU/L at 8 weeks (p<0.001). Mean HbA1c declined in parallel, from 6.02 ± 0.31% at baseline to 5.79 ± 0.25% at 4 weeks and 5.56 ± 0.27% at 8 weeks (p<0.001). The proportion of patients with an HbA1c ≥6% (prediabetic range) fell from 52.5% at baseline to 20% at 4 weeks and 10% at 8 weeks, a reduction of 42.5% (p<0.001). Conclusion: HbA1c is spuriously elevated in non-diabetic patients with newly detected hypothyroidism and falls significantly with correction of thyroid status following levothyroxine replacement. Thyroid function should be assessed before HbA1c is used to diagnose diabetes or prediabetes, and results should be interpreted cautiously or reassessed after treatment in patients with untreated hypothyroidism.

Background: Antibiotics are among the most frequently administered medications in neonatal intensive care units (NICUs). Although rapid treatment of suspected neonatal sepsis can be lifesaving, diagnostic uncertainty frequently produces unnecessary initiation or prolonged empirical therapy. Excessive antibiotic exposure may disrupt the developing microbiome, increase selection pressure for antimicrobial resistance (AMR), and expose vulnerable neonates to avoidable adverse effects. Antimicrobial stewardship programs (ASPs) aim to optimize initiation, spectrum, and duration while maintaining clinical safety. Objective: To systematically evaluate the effects of NICU antimicrobial stewardship interventions on antibiotic initiation and consumption, duration of therapy, use of broad-spectrum agents, antimicrobial resistance, and neonatal clinical outcomes. Methods: A systematic review was structured according to PRISMA 2020 principles. MEDLINE, Embase, Cochrane CENTRAL, Web of Science, PubMed, Scopus, and citation searching were used in the published evidence base. Eligible interventions included unit-specific prescribing guidelines, prospective audit and feedback, restriction/preauthorization, automatic stop orders, antibiotic time-outs, early-onset sepsis risk assessment, serial clinical examination, biomarker-assisted discontinuation, culture-guided de-escalation, and multidisciplinary stewardship bundles. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), with overall evidence certainty interpreted using GRADE concepts. Results: A total of 4,048 records were identified. After removal of 2,250 duplicate or redundant records, 1,798 records were screened and 205 reports were sought for retrieval. Two reports could not be retrieved; 203 full-text reports were assessed, 133 were excluded, and 70 studies involving more than 350,000 neonates were included. Forty-nine studies (70.0%) were judged low risk of bias and 21 (30.0%) moderate risk; none were high risk. Stewardship reduced NICU antibiotic initiation by an absolute 19% (95% CI 14%-24%), shortened mean length of therapy by 1.82 days (95% CI 1.09-2.56 days), and reduced courses exceeding five days by 9%. No evidence of increased sepsis-related mortality or antibiotic reinitiation was found. Evidence for reduced AMR was favorable but of lower certainty because resistance outcomes were less consistently reported. Conclusion: Antibiotic stewardship interventions substantially reduce unnecessary antimicrobial exposure in NICUs without evidence of harm to key short-term clinical outcomes. Multicomponent programs incorporating explicit start-stop criteria, early reassessment, prospective review, timely microbiology, and unit-specific guidance appear most practical. Further multicenter work should standardize AMR, microbiome, NEC, invasive candidiasis, mortality, readmission, and neurodevelopmental outcomes.

Background: Neonatal sepsis requires rapid antimicrobial therapy, yet the nonspecific presentation of infection results in substantial treatment of neonates who ultimately have negative cultures. Sepsis-specific antimicrobial stewardship therefore aims not simply to reduce antibiotic use, but to identify when therapy should be initiated, how broad empirical treatment should be, and when antibiotics can be safely narrowed or discontinued.Objective: To systematically evaluate sepsis-focused antimicrobial stewardship strategies in neonatal intensive care units (NICUs) and determine their effects on antibiotic initiation, cumulative exposure, duration of therapy, broad-spectrum use, antimicrobial resistance, and clinical safety. Methods: MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and citation searching were used in a sepsis-specific review framework. Eligible interventions included early-onset sepsis (EOS) prediction tools, serial clinical examination, procalcitonin- or CRP-guided discontinuation, 24-48-hour culture reassessment, short-course protocols for culture-negative sepsis, antibiotic time-outs, restriction of empiric vancomycin or broad-spectrum agents, and multidisciplinary sepsis stewardship pathways. Randomized and comparative observational/QI studies were included. Results: The PRISMA framework identified 1,542 records. After removal of 416 duplicates, 1,126 records were screened; 909 were excluded. Of 217 reports sought, six were not retrieved. A total of 211 full texts were assessed, 177 were excluded, and 34 sepsis-focused studies were included. Across the evidence base, EOS calculator implementation consistently reduced empirical treatment. A meta-analysis of 13 EOS-calculator studies involving 175,752 newborns reported an antibiotic-use RR of 0.45 (95% CI 0.35-0.57) in before-after studies. A 2025 cluster-randomized trial of 1,830 at-risk newborns reported treatment in 7.2% with an EOS calculator versus 26.6% with categorical guidelines. In the NeoPInS randomized trial (n=1,710), procalcitonin guidance reduced mean antibiotic duration from 65.0 to 55.1 hours. Contemporary QI programs targeting culture-negative sepsis reported reductions in syndrome-specific antibiotic DOT of up to 81%, while one Level IV NICU reduced overall use from 278 to 140 DOT/1,000 patient-days. Conclusion: Sepsis-focused stewardship can substantially reduce antibiotic initiation and duration while preserving short-term clinical safety when paired with structured monitoring. The strongest evidence supports probability-based EOS assessment, mandatory reassessment by 24-48 hours, biomarker-assisted discontinuation, short-course strategies for selected culture-negative sepsis, and rapid culture-directed de-escalation

Background:Cystic hygroma is “a congenital” benign lymphatic malformation that are exceptionally rare in the adult population. We present the case of a 35-year-old male who presented with a painless, slowly enlarging 8 x 8 cm soft, fluctuant swelling in the left posterior triangle of the neck of 3-year duration. Magnetic resonance imaging (MRI) revealed a well-defined, multiloculated cystic lesion (7.0 x 6.6 x 3.9 cm) in the left posterior triangle abutting the sternocleidomastoid, left subclavian artery, and left internal carotid artery, with preserved fat planes and an insinuative growth pattern. The patient underwent complete surgical excision, with meticulous preservation of the spinal accessory nerve. Histopathological examination confirmed a benign cystic lymphangioma. Complete surgical resection remains the gold standard treatment to prevent recurrences and compressive symptoms.

Background: India carries one of the highest burdens of infectious disease globally and is therefore at particular risk from the growing threat of antimicrobial resistance (AMR). In-judicious and non-targeted use of broad-spectrum antibiotics for urinary tract infection (UTI) has contributed to rising resistance among common uropathogens. Objective: To determine the bacteriological profile and antimicrobial resistance pattern of uropathogens isolated from adult patients with suspected UTI at a tertiary care hospital. Methods: A retrospective observational study was conducted in the Department of Microbiology, Hind Institute of Medical Sciences (HIMS), Barabanki, over a six-month period (1 July 2023 to 31 December 2023). Urine culture and sensitivity reports of adult patients with a probable clinical diagnosis of UTI were retrieved from laboratory records. Organisms were identified by standard microbiological methods, and data were analysed descriptively using Microsoft Excel 2007. Results: Of 817 urine samples processed, 289 (35.4%) showed significant bacterial growth; 190 (65.7%) of these were from female patients. The median patient age was 31 years (range 12–87 years). Escherichia coli was the predominant isolate (138, 47.4%), followed by Enterococcus species (63, 21.4%) and Klebsiella pneumoniae (24, 8.3%). High resistance was observed among Gram-negative isolates to ampicillin, cefuroxime, ciprofloxacin and levofloxacin, while fosfomycin and colistin retained good activity. Enterococcus isolates showed high resistance to ciprofloxacin and levofloxacin but remained largely susceptible to vancomycin and linezolid. Conclusion: E. coli, Enterococcus species and K. pneumoniae were the leading uropathogens, with substantial resistance to commonly prescribed antibiotics. Antibiotic stewardship, periodic local surveillance, and clinician and public awareness of AMR are essential to preserve the effectiveness of first-line agents.

Background: Avascular necrosis (AVN) of the femoral head is a debilitating musculoskeletal complication of sickle cell disease (SCD), frequently resulting in pain, functional disability, and early degeneration of the hip joint. Total hip arthroplasty (THA) is the definitive treatment for advanced disease; however, functional outcomes in patients with SCD remain inadequately studied. This study assessed and compared postoperative functional outcomes using the Harris Hip Score (HHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS). Methods: This hospital-based analytical cross-sectional study was conducted in the Department of Orthopaedics, Sri Aurobindo Medical College and Postgraduate Institute, Indore, from June 2024 to November 2025. Thirty patients aged ≥18 years with confirmed SCD and AVN of the femoral head undergoing primary THA were enrolled. Functional outcomes were assessed using HHS and HOOS preoperatively and at 3 weeks, 6 weeks, 3 months, and 6 months postoperatively. Postoperative complications were also documented. Data were analyzed using IBM SPSS Statistics version 25.0, with p<0.05 considered statistically significant. Results: The mean age of the patients was 38.47 ± 11.26 years, and 56.7% were males. The mean HHS improved significantly from 52.76 ± 6.15 preoperatively to 86.14 ± 5.31 at 6 months, while the mean HOOS improved from 50.48 ± 5.92 to 87.63 ± 5.41 (both p<0.0001). Although HOOS demonstrated marginally higher postoperative scores than HHS, the differences between the two scoring systems were not statistically significant (p>0.05). At the final follow-up, 46.7% of patients achieved excellent HHS outcomes, while 60.0% achieved good to excellent HOOS outcomes. Postoperative complications were infrequent, with anterior thigh pain occurring in 6.7% of patients and superficial infection, dislocation, and aseptic loosening each occurring in 3.3%. Overall, 83.3% of patients experienced no postoperative complications. Conclusions: Primary THA provides significant improvement in hip function and quality of life in patients with SCD-related AVN. Both HHS and HOOS were reliable and responsive outcome measures, demonstrating comparable assessment of postoperative recovery. The low complication rate and favorable functional outcomes support THA as a safe and effective treatment for advanced AVN in patients with sickle cell disease.

Background: Abnormal uterine bleeding (AUB) is a common gynecological problem that affects women across the reproductive and perimenopausal age groups. It may occur due to structural or non-structural abnormalities. The PALM-COEIN classification provides a standardized approach for identifying the underlying causes of AUB. Aim: To evaluate the age distribution, clinical pattern, and etiological causes of abnormal uterine bleeding according to the PALM-COEIN classification. Materials and Methods: The present study included 100 patients with abnormal uterine bleeding. The patients were categorized according to age, clinical pattern of bleeding, and etiological factors. The causes of AUB were classified according to the FIGO PALM-COEIN system, which includes Polyp (P), Adenomyosis (A), Leiomyoma (L), Malignancy and hyperplasia (M), Coagulopathy (C), Ovulatory dysfunction (O), Endometrial causes (E), Iatrogenic causes (I), and Not otherwise classified (N). The findings were expressed as frequency and percentage. Results: The majority of patients belonged to the 40–49-year age group, accounting for 62% of the study population, followed by 30–39 years (24%), ≥50 years (10%), and 20–29 years (4%). Menorrhagia was the predominant clinical pattern, observed in 52% of patients, followed by metrorrhagia (22%), polymenorrhea (14%), menometrorrhagia (7%), hypomenorrhea (1%), and another category recorded as polymenorrhea (4%). According to the PALM-COEIN classification, AUB-E was the most common category (28%), followed by AUB-L (22%), AUB-O (18%), AUB-P (14%), AUB-A (8%), AUB-M (6%), AUB-I (2%), and AUB-N (2%). Conclusion: AUB was most commonly observed among women aged 40–49 years, with menorrhagia being the predominant clinical presentation. Endometrial causes, leiomyoma, and ovulatory dysfunction were the leading etiological categories. The PALM-COEIN system provides a useful standardized approach for categorizing the causes of AUB and may support appropriate clinical evaluation and management.

Background: Community-acquired pneumonia (CAP) remains a frequent cause of emergency department admission and clinical deterioration. Early risk stratification is essential for identifying patients who require intensive monitoring or escalation of care. NEWS2 provides a physiology-based assessment, whereas CURB-65 is pneumonia-specific. Objectives: To compare the ability of NEWS2 and CURB-65 to identify high-risk adults with CAP at emergency department presentation. Methods: This prospective observational comparative study included 100 consecutive adults with CAP presenting to the emergency department of Manipal Hospital, Varthur Road, Bengaluru, Karnataka, India, from February to June 2026. NEWS2 and CURB-65 were calculated at initial assessment. The composite high-risk outcome was intensive care unit admission and/or in-hospital mortality. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, accuracy, and receiver operating characteristic analysis. Results: The mean age was 58.6 ± 16.2 years; 61% were male. Twenty patients required intensive care and eight died; three deaths occurred after intensive care admission, giving a composite high-risk outcome in 25%. Mean NEWS2 was 7.1 ± 2.1 in high-risk patients versus 3.4 ± 1.8 in others, while corresponding CURB-65 values were 2.3 ± 0.9 and 1.1 ± 0.8. NEWS2 ≥5 showed 88% sensitivity, 80% specificity, 95.2% negative predictive value, and an AUC of 0.89. CURB-65 ≥2 showed 72% sensitivity, 84% specificity, 90% negative predictive value, and an AUC of 0.82. Conclusion: Both scores provided useful early risk stratification, but NEWS2 showed greater sensitivity and overall discrimination for detecting patients with subsequent severe outcomes

Background: Heavy vehicle driving is associated with demanding work schedules, prolonged driving hours, inadequate rest, financial pressures, and other occupational challenges. These conditions may contribute to psychological stress and can have implications for drivers' health, work performance, and road safety. Objectives: To determine the prevalence of occupational stress and examine the factors associated with stress among heavy vehicle drivers in Siddipet District, Telangana. Methods: A community-based cross-sectional study was carried out among 400 heavy vehicle drivers. Information was obtained using a structured questionnaire covering socio-demographic characteristics, occupational conditions, lifestyle practices, and perceived stress. Occupational stress was assessed using the 10-item Perceived Stress Scale (PSS-10). Descriptive statistics were used to summarize the study variables, while the chi-square test was applied to examine associations. Factors independently associated with high occupational stress were identified using multivariate logistic regression. Results: A total of 400 heavy vehicle drivers participated in the study. The mean age was 41.8 ± 9.7 years. Based on PSS-10 scores, 51.5% of participants had moderate stress and 29.0% had high stress, with a mean PSS score of 22.8 ± 6.9. Occupational stress was significantly associated with age, alcohol use, smoking, job satisfaction, and financial stress (p < 0.05). In multivariable logistic regression, driving for >10 hours/day (AOR = 2.98), sleep duration <6 hours (AOR = 2.56), financial stress (AOR = 2.81), job dissatisfaction (AOR = 3.92), alcohol use (AOR = 1.74), and night driving (AOR = 1.88) were independently associated with high occupational stress. Conclusion: A significant portion of heavy vehicle drivers experienced moderate to high levels of occupational stress. Longer working hours, inadequate sleep, financial difficulties, job dissatisfaction, alcohol consumption, and night driving were important factors associated with increased stress. Occupational health programmes addressing working hours, adequate rest and sleep, financial and psychosocial concerns, and access to supportive interventions may help reduce stress and promote safer driving practices.

Background: Artificial intelligence (AI) is increasingly used to support diagnosis, risk prediction, treatment selection, and clinical decision-making. Patient acceptance is essential for responsible implementation, particularly where trust, privacy, and physician oversight influence willingness to use AI-assisted care. Objectives: To assess patients’ awareness, perceptions, and acceptance of AI in internal medicine in Dominica and identify factors associated with acceptance. Methods: A hospital-based cross-sectional study was conducted among 250 adult patients attending internal medicine services at All Saints University School of Medicine and DCF Hospital, Dominica, from January to December 2025. A structured questionnaire assessed demographic characteristics, AI awareness, perceived benefits and concerns, and acceptance of AI-assisted care. Associations were examined using chi-square tests and multivariable logistic regression. Results: The mean age was 45.8 ± 16.7 years and 55.2% were female. Overall, 68.4% had previously heard of AI, although only 48.8% reported a basic understanding of medical AI. Most participants believed AI could improve diagnostic accuracy (78.8%) and healthcare efficiency (76.4%). Privacy concerns were reported by 72.0%, while 68.4% were concerned about incorrect AI recommendations. Moderate-to-high acceptance was observed in 65.6%. Acceptance was greater when AI supported physician-led care than when it operated without physician review. Younger age, higher education, prior AI awareness, and better understanding of medical AI were associated with greater acceptance. Conclusion: Patients showed generally favorable attitudes toward physician-supervised AI, but important concerns regarding privacy, accuracy, and human interaction persisted. Patient education, transparent communication, and continued clinician oversight should accompany AI implementation in internal medicine.

Background: Serum uric acid is increasingly recognized as a marker linked with hypertension, vascular injury, and renal dysfunction, but its clinical association with the severity of hypertension and renal filtration requires further characterization in Indian adults. Objectives: To assess the association of serum uric acid levels with hypertension severity and renal function in adults with hypertension. Methods: This prospective observational study included 100 adults with hypertension at Konaseema Institute of Medical Sciences and Research Foundation , Amalapuram, Andhra Pradesh, India, from April 2025 to May 2026. Demographic and clinical variables, blood pressure, serum uric acid, serum creatinine, and estimated glomerular filtration rate (eGFR) were recorded. Participants were categorized into Grade 1, Grade 2, and Grade 3 hypertension. Hyperuricaemia and reduced eGFR were compared across hypertension grades, and correlations between serum uric acid, blood pressure, creatinine, and eGFR were assessed. Results: Mean age was 54.7 ± 11.6 years; 58% were male. Mean serum uric acid was 6.18 ± 1.63 mg/dL. Serum uric acid increased from 5.12 ± 1.19 mg/dL in Grade 1 to 6.18 ± 1.33 mg/dL in Grade 2 and 7.45 ± 1.55 mg/dL in Grade 3 hypertension. Hyperuricaemia increased from 16.7% to 38.2% and 66.7%, respectively. Mean eGFR declined from 92.1 ± 16.4 to 78.9 ± 16.8 and 62.1 ± 18.2 mL/min/1.73 m². Serum uric acid correlated positively with systolic blood pressure, diastolic blood pressure, and creatinine, and inversely with eGFR. Conclusion: Higher serum uric acid levels were associated with greater hypertension severity and poorer renal function. Serum uric acid can serve as a useful adjunctive biomarker for cardiorenal risk assessment in adults with hypertension.

Background: Urban slum settlements in northeastern India face a disproportionate environmental health burden attributable to inadequate water, sanitation, and hygiene (WASH) infrastructure and the proliferation of household-level disease vectors. Naharlagun, the satellite town of Itanagar in Arunachal Pradesh, has undergone rapid, largely unplanned urbanisation, yet community-level environmental health data from its informal settlements are absent from the peer-reviewed literature. Objectives: To describe household environmental conditions and WASH practices in four randomly selected slum colonies of Naharlagun; to identify environmental factors associated with self-reported illness in the preceding 30 days; and to compare environmental health indicators across colonies.Methods: A community-based cross-sectional survey was conducted in Dokum Colony, Rakap Colony, Police Colony, and Helipad Area (N = 122 households). Households were selected by systematic random sampling from colony census registers. A structured, pretested, interviewer-administered questionnaire based on WHO/UNICEF Joint Monitoring Programme modules was used. Descriptive statistics with Wilson score 95% confidence intervals (CIs) and Pearson chi-square or Fisher's exact tests with crude odds ratios (ORs) were applied. Results: The mean respondent age was 36.2 years (SD 15.2); 65.0% were female. Rodents, cockroaches, and flies were present in 81.1%, 82.8%, and 86.8% of households, respectively. Open drainage predominated (82.9%), with standing water in 28.6% of drains among households with drainage. One quarter (25.2%) lacked a sanitary toilet, and 8.3% consumed untreated water. Rodent infestation (OR 2.14; 95% CI 1.07--4.28; p = 0.031), open drainage (OR 2.47; 95% CI 1.16--5.24; p = 0.018), and absence of a sanitary toilet (OR 2.08; 95% CI 1.04--4.16; p = 0.039) were each associated with illness in the preceding 30 days. Untreated water was associated with gastrointestinal complaints (OR 3.20; 95% CI 1.27--8.08; p = 0.012). No significant inter-colony differences were observed. Conclusions: All four colonies carry a comparably heavy and multidimensional environmental health burden. Vector control, drainage improvement, expanded sanitary toilet access, and point-of-use water treatment are priority interventions, aligned with the Swachh Bharat Mission and SDG 6 targets

Purpose: To evaluate the knowledge, attitude, and practice patterns of ICU nurses regarding eye care for critically ill patients and to identify gaps and barriers in current eye-care practices.Methodology: A cross-sectional observational study was conducted among 50 ICU nurses over a period of two months in selected hospitals in Tumkur. Data were collected using a structured self-administered Google Forms questionnaire consisting of demographic details, knowledge, attitude, practice, and barrier-related items regarding ICU eye care.Results: Among the 50 participants, the mean age was 33.8 ± 5.8 years. There were 22 females (44.0%) and 28 males (56.0%). Most participants held a B.Sc. Nursing degree (80.0%), and 50.0% had 1-5 years of ICU experience. Good knowledge was observed in 12 nurses (24.0%), while 31 nurses (62.0%) had average knowledge. Good attitude was observed in 26 nurses (52.0%), and average attitude in 20 nurses (40.0%). Only 13 nurses (26.0%) demonstrated good eye-care practices, and only 17 nurses (34.0%) reported following a written eye-care protocol. The main barriers were lack of time due to workload (46.0%), lack of standardized guidelines (30.0%), and inadequate training/knowledge and skill (24.0%).Conclusion: ICU nurses demonstrated fair knowledge and generally favorable attitudes toward eye care; however, actual practice remained suboptimal. The findings suggest the need for structured training, written protocols, routine documentation, and periodic audits of eye care in ICU settings. As this was a small questionnaire-based study conducted in selected hospitals, larger multicentric observational studies are recommended.

Background: Competency-based medical education (CBME) seeks to organize medical training around demonstrable abilities rather than exposure to a predetermined curriculum or duration of training. Despite widespread adoption across undergraduate and postgraduate medical education, implementation remains inconsistent. The difficulty appears to arise not from a single curricular deficiency but from interactions between educational philosophy, faculty behavior, assessment systems, institutional resources, clinical workflow, learner expectations, technology, and regulatory structures. Objective: To systematically synthesize why CBME is difficult to implement across undergraduate and postgraduate medical training and to identify organizational, educational, behavioral, and system-level mechanisms responsible for implementation failure. Methods: A systematic review with framework-based narrative synthesis was designed according to PRISMA 2020 principles. MEDLINE/PubMed, Scopus, Web of Science, ERIC, and Embase were searched for empirical studies examining implementation, barriers, challenges, workload, assessment, faculty development, learner experience, leadership, infrastructure, technology, and organizational factors associated with CBME. Studies involving undergraduate medical students, postgraduate residents, clinical faculty, program directors, administrators, or competency committees were eligible. Because study designs and outcome measures were highly heterogeneous, meta-analysis was not undertaken. Results: The search identified 842 records. After removal of 231 duplicate records, 611 records underwent title and abstract screening. Of these, 498 were excluded, leaving 113 reports sought for full-text retrieval. Seven reports could not be retrieved. One hundred six full-text reports were assessed, of which 79 were excluded, leaving 27 studies for qualitative synthesis. The most frequent barriers were faculty workload and insufficient protected time (22/27; 81.5%), inadequate faculty preparation (21/27; 77.8%), assessment/documentation burden (20/27; 74.1%), difficulty integrating CBME into existing workflow (18/27; 66.7%), resource/infrastructure limitations (17/27; 63.0%), inconsistent feedback/direct observation (16/27; 59.3%), limited stakeholder ownership or resistance to change (15/27; 55.6%), technology/e-portfolio limitations (13/27; 48.1%), learner stress or assessment fatigue (12/27; 44.4%), inconsistent interpretation of competence/entrustment (11/27; 40.7%), and persistence of time-based educational structures (10/27; 37.0%). Conclusion: CBME is difficult to implement because it requires simultaneous changes in curriculum, assessment, faculty roles, learner behavior, clinical workflow, information systems, governance, and institutional culture. Sustainable implementation requires protected educational time, longitudinal faculty development, selective high-value assessment, workflow-integrated digital systems, local stakeholder ownership, strong educational leadership, adequate resources, and continuous evaluation of implementation burden.

Background: Postoperative urinary retention (POUR) is an important complication after hip fracture surgery in older adults and can delay mobilization, increase catheter exposure, and prolong hospitalization. Objectives: To determine the incidence of POUR and evaluate demographic, clinical, anesthetic, and perioperative factors associated with its occurrence in elderly patients undergoing surgery for hip fractures. Methods: This prospective observational study included 50 patients aged 60 years or older undergoing operative treatment for hip fractures at RVM Institute of Medical Sciences and Research Centre, Laxmakkapally, Siddipet, Telangana, India, from October 2025 to June 2026. Demographic characteristics, fracture type, lower urinary tract symptoms (LUTS), anesthetic technique, operative duration, postoperative opioid use, urinary outcomes, and hospital stay were recorded. POUR was identified using clinical inability to void together with bladder-volume assessment. Categorical variables were compared using chi-square or Fisher’s exact test, as appropriate. Results: The mean age was 74.8 ± 7.9 years, and 32 (64.0%) patients were female. POUR occurred in 12 patients (24.0%). Pre-existing LUTS was associated with POUR (55.6% vs. 17.1%; p=0.027), as was operative duration >90 minutes (40.0% vs. 13.3%; p=0.044). POUR was also more frequent among patients receiving postoperative opioids (36.0% vs. 12.0%; p=0.047). Spinal anesthesia and male sex showed higher numerical rates without statistical significance. Patients with POUR had longer postoperative hospitalization (7.8 ± 2.4 vs. 5.9 ± 1.8 days; p=0.006). Conclusion: POUR affected nearly one-quarter of elderly patients after hip fracture surgery. Pre-existing LUTS, longer surgery, and postoperative opioid exposure identified patients requiring closer postoperative bladder surveillance.

Background: Pelvic fractures caused by high-energy trauma are frequently accompanied by injuries to adjacent pelvic organs. Lower urinary tract injuries can be clinically important and their occurrence is influenced by the severity and configuration of pelvic ring disruption. Objectives: To determine the frequency and pattern of lower urinary tract injuries in adults with pelvic fractures and to evaluate their association with pelvic fracture characteristics. Methods: This prospective observational study included 50 adults with radiologically confirmed pelvic fractures treated at RVM Institute of Medical Sciences, Laxmakkapally, Siddipet, Telangana, India, from January to June 2026. Pelvic fractures were categorized using the Young-Burgess classification. Clinical findings, bladder and urethral injuries, fracture instability, pubic symphysis diastasis, sacroiliac joint disruption, and bilateral pubic ramus fractures were recorded. Categorical associations were assessed using chi-square or Fisher's exact tests. Results: The mean age was 40.2 ± 13.6 years, and 76.0% were male. Road traffic accidents accounted for 62.0% of injuries. Lateral compression was the commonest fracture pattern (40.0%). Lower urinary tract injury occurred in 14 patients (28.0%): isolated urethral injury in 42.9%, isolated bladder injury in 35.7%, and combined injury in 21.4%. Broad Young-Burgess categories were not significantly associated with lower urinary tract injury (p = 0.418). In contrast, unstable pelvic ring injury (p = 0.004), pubic symphysis diastasis >2.5 cm (p = 0.006), sacroiliac joint disruption (p = 0.029), and bilateral pubic ramus fractures (p = 0.040) were significantly associated with lower urinary tract injury. Conclusion: Lower urinary tract injury was frequent among adults with pelvic fractures, particularly in mechanically unstable injuries. Specific radiographic markers of pelvic ring disruption were more informative than broad fracture categories for identifying patients at increased urological risk.

Background: Competency-based medical education (CBME) has become a major framework for reforming undergraduate and postgraduate medical training. It emphasizes clearly defined outcomes, progressive demonstration of competence, direct observation, workplace-based assessment, feedback, and readiness for independent practice. Implementation, however, is resource-intensive and frequently encounters educational, organizational, technological, and cultural barriers. Objective: To systematically synthesize barriers to the implementation of CBME across undergraduate medical education (UME) and postgraduate medical education (PGME), and to compare barriers common to both levels with those that are setting-specific.Methods: A systematic review with narrative thematic synthesis was structured according to PRISMA 2020. Searches were designed for PubMed/MEDLINE, Scopus, Web of Science, ERIC, and Embase using terms related to competency-based medical education, undergraduate and postgraduate training, implementation, barriers, assessment, feedback, faculty development, and entrustable professional activities. Empirical quantitative, qualitative, and mixed-method studies explicitly reporting implementation barriers were considered eligible. Owing to methodological and outcome heterogeneity, meta-analysis was not undertaken. Results: The search framework identified 667 records. After removal of 185 duplicates, 482 records were screened; 396 were excluded at title/abstract level. Eighty-six reports were sought, five were not retrieved, and 81 full texts were assessed. Fifty-seven were excluded, leaving 24 studies for qualitative synthesis. Ten studies focused exclusively on UME, 12 on PGME, and two addressed both. The most frequently coded barrier domains were inadequate faculty preparation (19/24; 79.2%), increased workload (18/24; 75.0%), insufficient protected time (17/24; 70.8%), assessment/documentation burden (17/24; 70.8%), inconsistent feedback (15/24; 62.5%), inadequate infrastructure/resources (14/24; 58.3%), and inadequate stakeholder engagement (13/24; 54.2%). Undergraduate programs were particularly affected by faculty shortages, high learner-to-faculty ratios, curriculum overload, and infrastructure limitations; postgraduate programs were especially affected by EPA documentation, clinical-workflow disruption, assessment fatigue, and inconsistent feedback. Conclusion: CBME implementation barriers are interconnected rather than isolated. Sustainable implementation requires longitudinal faculty development, protected educational time, streamlined assessment systems, robust infrastructure, meaningful feedback, stakeholder engagement, and organizational structures capable of reconciling competency progression with conventional time-based training

Background: Competency-based medical education (CBME) has become the central framework for undergraduate and postgraduate medical training in India. Its success depends on continuity between competency acquisition during MBBS, consolidation during compulsory rotating medical internship, and progressive entrustment during postgraduate specialty training. Objective: To systematically synthesize India-specific evidence on barriers, challenges, and solutions affecting CBME implementation across the medical education continuum for Indian Medical Graduates.Methods: A systematic review with thematic synthesis was structured according to PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, ERIC, and Embase were searched for Indian studies published from January 2019 to March 2026. Eligible studies included empirical evaluations involving medical students, interns, postgraduate residents, faculty, and educational administrators that reported CBME implementation barriers, feasibility issues, assessment problems, workload, feedback, or system-level constraints. Results: The search identified 603 records. After removal of 154 duplicates, 449 records were screened; 369 were excluded. Eighty reports were sought, four were not retrieved, and 76 full-text reports were assessed. Fifty-five were excluded, leaving 21 studies in the qualitative synthesis. Fourteen studies (66.7%) focused primarily on undergraduate CBME, two (9.5%) on community/internship-transition components, and five (23.8%) on postgraduate competency-oriented training. Major barriers were inadequate faculty preparation (16/21; 76.2%), assessment/logbook complexity (15/21; 71.4%), curriculum and timetable congestion (14/21; 66.7%), infrastructure limitations (13/21; 61.9%), faculty shortage (12/21; 57.1%), integration difficulties (12/21; 57.1%), inconsistent feedback (11/21; 52.4%), learner workload and stress (10/21; 47.6%), and institutional variability (9/21; 42.9%). Conclusion: The major Indian CBME challenge is no longer absence of a competency framework but inconsistent translation of that framework into authentic clinical performance. A coherent continuum linking MBBS competencies, internship responsibility, and postgraduate entrustment is required. Priority solutions include longitudinal faculty development, protected teaching time, simplified assessment, stronger skills infrastructure, digital longitudinal portfolios, structured internship entrustment, and specialty-specific workplace assessment.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disorder of the central nervous system. It is commonly associated with immunoglobulin G antibodies directed against aquaporin-4 (AQP4-IgG). Longitudinally extensive transverse myelitis (LETM) is a characteristic neurological manifestation of AQP4-IgG-positive NMOSD. Autoimmune comorbidities, particularly systemic lupus erythematosus (SLE) and Sjögren syndrome, are seen in patients with AQP4-IgG-positive NMOSD. But the coexistence of NMOSD with discoid lupus erythematosus (DLE) without established SLE is less commonly described. Case Presentation: A 31-year-old woman presented with a history of progressive bilateral lower-limb weakness, initially more pronounced on the right, associated with difficulty walking and climbing stairs, paresthesias, a band-like sensory disturbance, neck pain, impaired hand function, and constipation. Neurological examination showed bilateral lower-limb pyramidal weakness, increased tone, brisk deep tendon reflexes, bilateral extensor plantar responses, and a sensory level at approximately T6. Magnetic resonance imaging(MRI) showed longitudinally extensive spinal cord lesion extending from approximately C2 to D8. The lesion was diagnosed as longitudinally extensive transverse myelitis (LETM). Serum AQP4 antibody testing was positive. Cerebrospinal fluid(CSF) showed increased protein with minimal cellularity and negative bacterial culture. Visual evoked potentials were normal. Dermatological evaluation of a longstanding extensive scalp lesion showed large plaque with scarring alopecia, central atrophy, hyperpigmentation, and peripheral erythematous changes, with clinical and histopathological findings supportive of DLE. ANA was positive with a speckled pattern. The patient was treated with intravenous(IV) methylprednisolone 1 g daily. There is improvement in lower-limb motor strength, but residual sensory impairment persisted.Conclusion The combination of a subacute myelopathic syndrome, T6 sensory level, longitudinally extensive C2–D8 spinal cord lesion, pericallosal and dentate-region involvement, and AQP4-IgG positivity supported AQP4-IgG-positive NMOSD presenting as LETM. Coexistence of DLE without established SLE implies autoimmune context and shows the need to differentiate AQP4-IgG-positive NMOSD from nonspecific autoimmune or lupus-associated myelitis..

Background: Anatomical variations of the nasal cavity and paranasal sinuses are frequently encountered on computed tomography (CT). Although many are incidental, some may influence sinonasal ventilation, mucociliary clearance, osteomeatal complex patency, and the technical approach and safety of functional endoscopic sinus surgery (FESS). Accurate identification of these variations is therefore important for radiological assessment and preoperative surgical planning. This study evaluated the prevalence and distribution of anatomical variations of the nasal cavity and paranasal sinuses on CT in symptomatic patients.Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis, Dr. K. N. Singh Memorial Institute of Medical Sciences, Barabanki, Uttar Pradesh. A total of 138 patients aged >18 years referred for CT of the paranasal sinuses were included. Patients with previous sinonasal surgery, facial trauma, sinonasal malignancy, pregnancy, or unwillingness to participate were excluded. CT examinations were performed using a 16-slice Siemens SOMATOM Scope scanner. The nasal septum, turbinates, osteomeatal complex, ethmoid air cells, frontal and sphenoid sinuses, and other relevant anatomical variants were assessed. Results :The study included 63 males (45.65%) and 75 females (54.34%), with a male-to-female ratio of 0.84:1. The mean age was 37.6 ± 9.8 years, with the 31–40-year age group accounting for the largest proportion of patients (47.1%). Nasal obstruction was the most common indication for CT (32.6%). Deviated nasal septum (DNS) in any form was identified in 87.7% of subjects, while septal spur was present in 34.78%. Concha bullosa was observed in 38.4%, paradoxical middle turbinate in 21.7%, and inferior turbinate hypertrophy in 45.65%. Agger nasi cells were the most frequent osteomeatal complex-related variant (82.6%), followed by accessory maxillary ostium (36.95%), enlarged ethmoid bulla (32.6%), and Haller cells (31.15%). Onodi cells were identified in 26.8%, and pneumatized uncinate process in 10.86%. Hypoplastic frontal sinus was seen in 44.92%, while frontal sinus aplasia occurred in 5.07%. Conclusion:Sinonasal anatomical variations are highly prevalent among patients undergoing CT PNS. DNS and agger nasi cells were the most frequently encountered abnormalities. CT provides detailed visualization of these variations and their relationship to the osteomeatal complex and critical adjacent structures. Systematic preoperative assessment is essential for individualized surgical planning and prevention of complications during FESS

clinical auditing, resource allocation, and comparison of outcomes in pediatric intensive care units. PIM-3 is an admission-based mortality model requiring relatively few variables, whereas PRISM-III uses the most abnormal physiological and laboratory values recorded during the early PICU period. Their predictive performance may vary according to patient population and healthcare setting. Aim: To compare the performance of PIM-3 and PRISM-III scores in predicting mortality among children admitted to the PICU. Materials and Methods: This hospital-based prospective observational comparative study included 120 eligible children admitted to a tertiary-care PICU. Demographic, clinical, physiological, and laboratory information was collected using a structured case-record form. PIM-3 and PRISM-III scores were calculated according to their prescribed assessment periods. Participants were followed until PICU discharge or death. The primary outcome was all-cause PICU mortality. Secondary outcomes included invasive mechanical ventilation, vasoactive support, multiple-organ dysfunction, ventilation duration, and PICU length of stay. Discrimination was assessed using the area under the receiver operating characteristic curve, and correlated AUCs were compared using DeLong’s test. Calibration was evaluated using the Hosmer-Lemeshow test, calibration slope, and calibration intercept. Sensitivity, specificity, predictive values, likelihood ratios, overall accuracy, standardized mortality ratio, and Brier score were also calculated. P<0.05 was considered statistically significant. Results: Of the 120 patients, 23 died, giving an observed PICU mortality of 19.2%. Mean predicted mortality was 16.8% with PIM-3 and 18.7% with PRISM-III (paired mean difference 1.9%; 95% CI: 0.3%-3.5%; P=0.020). Non-survivors had significantly higher PIM-3 predicted mortality than survivors (48.9% versus 9.2%; P<0.001) and higher PRISM-III scores (24.8 versus 7.6; P<0.001). Both scores were significantly associated with invasive ventilation, vasoactive support, multiple-organ dysfunction, and PICU stay exceeding seven days. PIM-3 showed good discrimination with an AUC of 0.866 (95% CI: 0.787-0.945), while PRISM-III showed excellent discrimination with an AUC of 0.914 (95% CI: 0.852-0.976). The AUC difference was statistically significant (P=0.041). At the optimal cut-offs, PIM-3 and PRISM-III demonstrated sensitivities of 82.6% and 91.3%, specificities of 85.6% and 88.7%, and overall accuracies of 85.0% and 89.2%, respectively. These differences in classification measures were not statistically significant. Both models showed acceptable calibration. The Brier score was significantly lower for PRISM-III than PIM-3 (0.084 versus 0.112; P=0.012). Conclusion: Both PIM-3 and PRISM-III were useful predictors of mortality and adverse clinical outcomes among PICU patients. PRISM-III demonstrated significantly better discrimination and overall predictive performance, whereas PIM-3 offered the practical advantage of simpler, admission-based assessment. Local external validation is recommended before either score is routinely used for institutional benchmarking or individual risk estimation

Introduction: Cerebrovascular accident includes ischemic stroke, hemorrhagic stroke, and cerebrovascular anomalies such as intracranial aneurysm, AV malformation, and cortical venous thrombosis. Stroke, after heart disease and cancer, is the third most common cause of death. Diabetics and stress hyperglycemia have severe strokes resulting in a poor outcome. Stroke is twice more common in diabetics than in non-diabetics. Several risk factors determine the outcome of stroke. Hyperglycemia, fever, and neuroprotective agents are those which are widely studied. Aim of the study: To measure the blood glucose level within twenty-four hours of the onset of stroke in both diabetics and non-diabetics and to evaluate the severity and prognosis in both diabetics and non-diabetics in relation to hyperglycemia. Materials and methods: A total of 109 patients with acute stroke admitted to the Department of Medicine, Government Kallakurichi Medical College, Kallakurichi, in May 2021 were enrolled. Nine patients were lost to follow-up; therefore, 100 patients were included in the final analysis. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: Among the 100 patients included in the final analysis, 56 had elevated admission-day blood glucose levels and 44 had normal blood glucose values. Diabetes was present in 28 patients (16 known diabetes and 12 newly diagnosed diabetes), while 28 patients had stress hyperglycemia. Euglycemic patients had better recovery after acute stroke: 29 of 44 (65.9%) had a good functional outcome. In contrast, only 2 of 56 (3.6%) patients with admission-day hyperglycemia had a good functional outcome at 30-day follow-up. Conclusion: Admission-day hyperglycemia was associated with greater stroke severity, larger lesion size, increased mortality, and poorer 30-day functional outcome in this study. The association was particularly evident in ischemic stroke. These findings support admission glucose as a useful prognostic marker in acute stroke. Because this was an observational study, the findings do not establish that glucose-lowering treatment itself improves stroke outcome. Appropriate glucose monitoring and standard evidence-based stroke management remain essential.

Background: Persistent gynecomastia may cause pain, altered body image, and substantial social embarrassment. Liposuction reduces adipose bulk through small access incisions, whereas subcutaneous mastectomy permits direct removal of dense glandular tissue. The balance between contour correction, recovery, morbidity, and patient satisfaction remains clinically relevant when selecting an operation. Objective: To compare the clinical effectiveness, postoperative recovery, complications, and patient satisfaction associated with liposuction and subcutaneous mastectomy for gynecomastia. Methods: This prospective comparative observational study included 40 men with Simon grade IIa, IIb, or III gynecomastia at a tertiary-care teaching hospital. Twenty underwent liposuction and 20 underwent subcutaneous mastectomy. Preoperative breast size, postoperative size reduction, visual analogue scale pain score, time to resume normal activity, postoperative complications, and 10-point satisfaction scores were compared. One-way analysis of variance, chi-square testing, and Pearson correlation were used, with p<0.05 considered significant. Results: The groups were comparable in age, preoperative breast size, and Simon grade distribution. Mean breast size reduction was 4.3±0.9 cm after liposuction and 3.9±1.0 cm after subcutaneous mastectomy (p=0.17). Liposuction was associated with lower postoperative pain (3.1±0.8 vs 5.2±1.1, p<0.001), earlier return to normal activity (6.4±1.2 vs 10.1±1.5 days, p<0.001), and higher satisfaction (8.9±0.9 vs 7.1±1.2, p<0.001). Complications occurred in 2/20 (10%) and 5/20 (25%) patients, respectively (p=0.19). Pain and satisfaction were inversely correlated (r=-0.71, p<0.001). Conclusion: Both procedures achieved comparable reduction in breast size. In appropriately selected patients, liposuction offered a more comfortable recovery and better cosmetic satisfaction, while liposuction-assisted subcutaneous mastectomy remained an effective option by combining the benefits of direct glandular excision with improved aesthetic outcomes and high patient satisfaction

Introduction: Diabetes mellitus affects individuals of all ages and socioeconomic statuses. The skin is affected by acute metabolic derangements as well as by chronic degenerative complications of diabetes. Long-term diabetes mellitus causes permanent and irreversible functional changes and damage to body cells, leading to problems arising from biochemical, structural, and functional anomalies. Cutaneous complications of diabetes mellitus provide a clue to the current and past metabolic status of the patient. Cutaneous infections are common in patients with diabetes and may be associated with suboptimal glycemic control. Microvascular circulatory disorders, peripheral vascular diseases, peripheral neuropathy, and reduced immune response are contributing factors to increased susceptibility to infection.Aim of the study: To determine the prevalence and pattern of cutaneous manifestations among patients with diabetes mellitus.Materials and methods: This cross-sectional study was conducted in the Department of Medicine, Government Headquarters Hospital, Kallakurichi, Tamil Nadu, from June 2019 to March 2020 (10 months). A total of 300 patients with diabetes mellitus attending the diabetic clinic and medical outpatient department were included. A detailed history was obtained and a clinical examination, with particular attention to cutaneous manifestations, was performed. Fundus examination and routine laboratory investigations were carried out. Blood glucose values were expressed in mg/dL. Skin scrapings, direct potassium hydroxide examination, fungal culture on Sabouraud agar, Gram staining, bacterial culture, and histopathological examination were performed when clinically indicated.Results: Of the 300 patients with diabetes mellitus, 112 had cutaneous manifestations, giving a prevalence of 37.3%. Fungal infection was the most common manifestation (19/112; 17.0%), followed by pruritus, diabetic foot, and bacterial infection (14/112 each; 12.5%), and perforating dermatosis (7/112; 6.3%). Age >50 years was significantly associated with pruritus (p = 0.025) and diabetic foot (p = 0.046). The type of diabetes mellitus was not significantly associated with the common cutaneous manifestations analyzed (p > 0.05).Conclusion: Cutaneous manifestations were observed in 37.3% of patients with diabetes mellitus. Fungal infection was the most common manifestation. Older age was associated with pruritus and diabetic foot. Selected cutaneous manifestations were associated with diabetic complications, highlighting the importance of routine skin examination in patients with diabetes mellitus

Background: Urolithiasis is a recurrent disorder influenced by urinary supersaturation, reduced urine volume, altered urinary pH, excessive excretion of lithogenic substances, and deficiency of crystallization inhibitors. Metabolic abnormalities may contribute to stone growth and recurrence, although their relationship with stone size and anatomical location remains incompletely characterized. Aim: To determine the association of metabolic abnormalities with stone size, anatomical location, and recurrence among patients with urolithiasis. Materials and Methods: This hospital-based analytical cross-sectional study included 120 adult patients with radiologically confirmed urolithiasis. Demographic and clinical information, previous stone history, and radiological characteristics were recorded. Stone size was categorized as <5 mm, 5-10 mm, or >10 mm, while location was classified as renal, ureteric, or vesical/multiple site. Serum metabolic assessment and 24-hour urine analysis were performed to identify low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia, abnormal urinary pH, hyperuricemia, and hypercalcemia. Categorical variables were compared using the chi-square or Fisher’s exact test. Crude odds ratios with 95% confidence intervals were calculated. A p value <0.05 was considered statistically significant. Results: The mean age was 42.73±13.61 years, and 60.8% of participants were male. Recurrent urolithiasis was present in 35.8%, while 64.2% had at least one metabolic abnormality and 38.3% had two or more abnormalities. Low urine volume was detected in 45.8%, hypercalciuria in 30.8%, acidic urine in 28.3%, hypocitraturia in 26.7%, hyperuricosuria in 23.3%, hyperuricemia in 21.7%, and hyperoxaluria in 17.5%. The prevalence of any metabolic abnormality increased from 41.9% in patients with stones <5 mm to 80.6% among those with stones >10 mm (p=0.004). Stones >10 mm were associated with higher odds of any metabolic abnormality than stones <5 mm (OR=5.74; 95% CI: 1.93-17.08). No statistically significant association was observed between metabolic abnormalities and anatomical stone location. Any metabolic abnormality was more frequent among recurrent than first-episode stone formers (83.7% versus 53.2%; OR=4.52; 95% CI: 1.79-11.39; p=0.001). Low urine volume, hypercalciuria, hypocitraturia, hyperuricosuria, hyperoxaluria, acidic urine, hyperuricemia, and the presence of multiple metabolic abnormalities were significantly associated with recurrence. Conclusion: Metabolic abnormalities were common among patients with urolithiasis and were significantly associated with larger stones and recurrent disease but not with anatomical stone location. Metabolic evaluation and targeted preventive interventions should be prioritized in patients with large or recurrent stones. Prospective studies are required to determine whether correction of these abnormalities reduces subsequent stone growth and recurrence

Background: The GBD framework and the WHO show that NCDs contribute more to mortality than infectious, maternal, perinatal and nutritional disorders can. Although there are global efforts underway to reduce NCD mortality, progress is slow with too many countries falling short of meeting the Sustainable Development Goal 2030. In the midst of the current epidemiological transition scenario, India is witnessing a growing burden of NCDs, this underscores the urgent need to target modifiable risk factors. Accordingly, this research assessed the frequency of high blood pressure and identified key associated risk determinants among adults in the rural Lucknow region Methods: The methods used in the study involved a community-level cross-sectional study carried out between February, 2025 to February, 2026 among the adult population (aged 18-60 years) of rural areas of Lucknow district. Simple random sampling was used for sample selection. Data were analysed statistically using SPSS version 26.0. Results: showed that 41.8% of the participants belonged to the age group 31-50 years, while 65.4% of the participants were females. Overall, 68.0% of the subjects were normotensive while 32.0% were hypertensive. Findings indicated that key sociodemographic variables—including participant age, gender, marital standing, educational background, employment status, household composition, and economic tier"); behavioural patterns (sedentary behaviour/sitting, low physical activity, smoking, alcohol consumption, high dietary salt intake); and clinical/anthropometric factors (obesity, elevated WHR, and DM) were associated with hypertension, with the relationships being statistically significant ($p < 0.05$). Conclusions: NCDs are driven by behaviour/metabolic factors, and are increasing in vulnerability among rural populations. To turn this around, primary preventive care needs to be strengthened, proactive screening implemented, integrated disease prevention and control, and ongoing community-oriented health education done

Background: Low-energy fractures are important clinical indicators of impaired bone strength and may be associated with vitamin D deficiency, reduced BMD and an increased probability of subsequent fractures. Combined evaluation of these factors may facilitate early identification and management of patients at high risk of recurrent fractures. Aim: To assess the relationship between serum vitamin D status, BMD and estimated fracture risk among patients presenting with low-energy fractures. Materials and Methods: This hospital-based, observational, analytical cross-sectional study included 200 adult patients with radiologically confirmed low-energy fractures. Demographic characteristics, fracture details and clinical risk factors were recorded using a structured proforma. Serum 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus and alkaline phosphatase were measured. Vitamin D status was classified as deficient at <20 ng/mL, insufficient at 20–<30 ng/mL and sufficient at ≥30 ng/mL. BMD was assessed by DXA at the lumbar spine, femoral neck and total hip. Patients were classified as having normal BMD, osteopenia or osteoporosis according to the lowest valid T-score. The 10-year probabilities of major osteoporotic and hip fractures were estimated using FRAX. Associations were analysed using the chi-square test, ANOVA, Pearson’s correlation and univariable linear regression. A p value <0.05 was considered statistically significant. Results: The mean serum 25(OH)D concentration was 18.74±8.63 ng/mL. Vitamin D deficiency was present in 111 (55.5%) patients, insufficiency in 58 (29.0%) and sufficiency in 31 (15.5%). Overall, 169 (84.5%) patients had vitamin D concentrations below 30 ng/mL. The lowest vitamin D concentration was observed among patients with hip or proximal-femur fractures (15.62±7.44 ng/mL; F=6.46, p=0.002). The mean lowest BMD T-score was -2.36±0.91. Normal BMD was observed in 39 (19.5%) patients, osteopenia in 94 (47.0%) and osteoporosis in 67 (33.5%). The femoral neck had the lowest site-specific mean T-score at -2.48±1.11. The mean 10-year probabilities of major osteoporotic and hip fractures were 18.21±9.47% and 8.03±6.12%, respectively. Serum 25(OH)D was positively correlated with the lowest BMD T-score (r=0.42, p<0.001) and inversely correlated with major osteoporotic-fracture probability (r=-0.36, p<0.001) and hip-fracture probability (r=-0.39, p<0.001). The lowest BMD T-score was inversely correlated with major osteoporotic-fracture probability (r=-0.57, p<0.001) and hip-fracture probability (r=-0.62, p<0.001). Patients with vitamin D deficiency and osteoporosis had the highest estimated fracture probabilities. Conclusion: Vitamin D inadequacy and low BMD were highly prevalent among patients with low-energy fractures. Lower serum vitamin D and poorer BMD were significantly associated with greater estimated fracture probability, with femoral-neck BMD showing the strongest association with hip-fracture risk. Assessment of vitamin D, DXA-derived BMD and clinical fracture probability should form part of comprehensive secondary-fracture prevention following a low-energy fracture

Background: Interstitial lung disease (ILD) comprises a diverse group of parenchymal lung disorders characterized by varying degrees of inflammation and irreversible pulmonary fibrosis. Regional epidemiological, radiological, and microbiological insights remain limited in Southern Odisha. Objective: To characterize the clinical spectrum, risk factors, radiological patterns, and microbiological profiles in patients presenting with ILD, particularly during acute exacerbations. Methods: A cross-sectional observational study was conducted on 88 adults diagnosed with ILD at M.K.C.G. Medical College and Hospital. Patient evaluation included clinical history, physical examination, spirometry, 6-minute walk testing (6MWT), high-resolution computed tomography (HRCT), autoimmune serology, and bronchoalveolar lavage (BAL) fluid analysis during acute exacerbation episodes. Statistical analyses employed odds ratios (OR), Chi-square tests, and Student's t-tests (considered statistically significant). Results: Female patients predominated (), with the highest overall concentration in the 31–50 age bracket (). The primary presenting symptoms were exertional dyspnea () and dry cough (). Fine end-inspiratory crackles were present in of patients. Restrictive ventilatory defects were observed in . Usual Interstitial Pneumonia (UIP) was the most common HRCT pattern (). Idiopathic Pulmonary Fibrosis (IPF) was the primary subtype (), followed by Connective Tissue Disease-Associated ILD (CTD-ILD, ), with Systemic Sclerosis accounting for of CTD cases. Smoking (OR = 5.7, ) and Gastroesophageal Reflux Disease (GERD) (OR = 7.1, ) showed statistically significant associations with IPF. BAL culture yielded bacterial growth in of acute exacerbation cases, led by Klebsiella pneumoniae () and Pseudomonas species (). Conclusion: IPF and CTD-ILD represent the predominant ILD burden in Southern Odisha. HRCT classification integrated with clinical history, serology, and targeted BAL analysis is pivotal for accurate diagnosis and timely therapeutic intervention

Background: Classical Hodgkin lymphoma (cHL) is a mature B-cell neoplasm with high cure rates using contemporary chemotherapy, risk-adapted imaging, and autologous stem cell transplantation (ASCT) in relapsed disease. However, persistent immune cytopenias after successful treatment may indicate underlying immune dysregulation. Monogenic defects affecting T-cell costimulatory pathways are increasingly recognized as contributors to lymphoproliferative disease and immune-mediated complications. Case Presentation: A 25-year-old woman presented with fever, weight loss, and cytopenias. Initial evaluation suggested granulomatous lymphadenitis. Subsequent fluorodeoxyglucose positron emission tomography–computed tomography revealed metabolically active lymphadenopathy, and excisional biopsy confirmed classical Hodgkin lymphoma, mixed cellularity subtype. She achieved complete metabolic remission after frontline chemotherapy but relapsed within six months. Following salvage chemotherapy, she underwent autologous stem cell transplantation with BEAM conditioning and achieved sustained complete metabolic response. Despite durable oncologic remission, she developed persistent thrombocytopenia (40,000–75,000/µL). Bone marrow examination showed trilineage hematopoiesis with adequate megakaryocytes and no evidence of relapse. Immune thrombocytopenia was treated with corticosteroids and thrombopoietin receptor agonists. Owing to refractory cytopenia, next-generation sequencing was performed and revealed a homozygous pathogenic mutation in TNFRSF9, consistent with immunodeficiency 109 with lymphoproliferation. At last follow-up, she remained in complete oncologic remission with platelet recovery to 136,000/µL under eltrombopag therapy. Conclusion: This case highlights the intersection of cHL, post-ASCT immune thrombocytopenia, and TNFRSF9-associated immunodeficiency. Persistent cytopenias after transplantation in the absence of relapse should prompt evaluation for immune-mediated mechanisms and possible underlying genetic predisposition. Recognition of monogenic immune defects may refine diagnostic pathways and support personalized long-term management.

Background: Perioperative fluid and electrolyte management sits at the very heart of safe surgical care. How we handle fluids directly dictates whether a patient bounces back quickly or runs into a maze of complications. When a patient undergoes surgery, their body undergoes a massive biochemical upheaval triggered by the trauma of the knife and the effects of anaesthesia. Understanding these microscopic shifts is vital to keeping them safe.Objectives: This study set out to closely monitor the biochemical changes in fluid balance and electrolyte levels among surgical patients at our institution, and to see how tailoring our fluid therapy in real-time impacts their overall recovery.Methods: We carried out a prospective observational study involving 122 adult patients who underwent major elective and emergency surgeries at PMP Medical College and Hospital, Talcher, between April 2025 and June 2026. We tracked key biochemical markers—such as serum sodium, potassium, chloride, kidney function metrics, and blood gas values—right before surgery, during the operation, and at specific milestones after the procedure.Results: Postoperative electrolyte slips were surprisingly common, affecting about 41.8% of our patients. Sodium and potassium dips were the most frequent culprits, largely tied to the stress hormone responses that trap water in the body. When we used goal-directed fluid strategies driven by these lab values, we saw a noticeable drop in acute kidney injuries and shorter hospital stays.Conclusion: Treating fluid therapy as a dynamic, biochemical balancing act rather than a blind routine helps dodge common postoperative potholes and gets patients back on their feet much faster

Background: Birth asphyxia remains an important cause of neonatal intensive care unit (NICU) admission, morbidity, and mortality, particularly in resource-limited settings. Objective: To determine the burden of birth asphyxia among neonates admitted to the NICU and to describe associated neonatal characteristics, mortality patterns, duration of hospitalization, and short-term outcomes.Methods: This hospital-based cross-sectional study was conducted in the Neonatal Intensive Care Unit of Koppal Institute of Medical Sciences (KIMS), Koppal, Karnataka, India, from 1 January 2026 to 31 January 2026. A total of 270 neonatal treatment outcomes were evaluated, while detailed admission-profile data were available for 244 neonates. Demographic characteristics, admission source, gestational age, admission weight, indications for NICU admission, duration of stay, mortality, and treatment outcomes were recorded. Results: Among 270 neonates in the admission-profile analysis, 139 (56.97%) were male, 151 (61.9%) were inborn, 90 (36.9%) were preterm, and 107 (43.9%) weighed 1500–2499 g. Perinatal asphyxia was documented in 44 (18.0%) neonates and was one of the leading indications for NICU admission. Overall, among 270 treatment outcomes, 237 (87.8%) neonates were discharged, 26 (9.6%) expired, 4 (1.5%) were referred, and 3 (1.1%) left against medical advice. The mean NICU stay was 5.97 days. Mortality was higher among preterm than term neonates (20.0% vs 5.5%) and among facility-referred outborn than inborn neonates (16.3% vs 7.3%). Mortality was particularly high among neonates born at <28 weeks (80.0%) and 28 to <32 weeks (55.6%). Hypoxic-ischemic encephalopathy/moderate-to-severe birth asphyxia accounted for 6 of 26 deaths (23.1%). Conclusion: Birth asphyxia constituted a substantial proportion of NICU admissions and contributed importantly to neonatal mortality. Prematurity, lower gestational age, low birth weight, and outborn status were associated with poorer outcomes.

Purpose: To compare corneal endothelial cell density (ECD) loss over six months after manual small-incision cataract surgery (MSICS) and phacoemulsification, both with rigid polymethyl methacrylate intraocular lens implantation. Methods: Prospective comparative study at a tertiary teaching hospital in southern India, August 2022 to January 2024. Sixty eyes of 60 consecutively enrolled patients aged 40 years or older with nuclear sclerosis of Lens Opacities Classification System III grade 3 or below underwent MSICS (n = 30) or phacoemulsification (n = 30) by one surgeon. Non-contact specular microscopy measured ECD preoperatively and on day 1, at 1 week and at 6 months. The primary outcome was change in ECD at 6 months. Results: Groups were comparable at baseline for age, sex, cataract morphology and ECD (2555.23 ± 200.58 vs 2536.03 ± 310.87 cells/mm², P = 0.777). At 6 months ECD was 2512.70 ± 239.95 cells/mm² after MSICS and 2425.06 ± 313.13 cells/mm² after phacoemulsification, a difference of 87.64 cells/mm² (P = 0.232), representing losses of 1.66% and 4.38% from baseline. The groups differed only on day 1 (2505.14 ± 216.44 vs 2282.76 ± 409.83 cells/mm², P = 0.017). Within each arm the reduction from baseline was no longer significant at 6 months (P = 0.081 and P = 0.064). Conclusion: Endothelial cell loss at six months did not differ significantly between MSICS and phacoemulsification when both delivered a rigid lens through a comparable sclerocorneal incision. The early advantage of MSICS resolved, and MSICS remains endothelially safe where phacoemulsification is unavailable

Background: Ocular morbidity in childhood is a leading contributor to avoidable visual impairment and can impair learning, school adjustment, and development. Population- and school-based data from India are relatively abundant, but the pattern of paediatric ocular disease presenting to tertiary care in southern India is less well described. We characterised the pattern of ocular morbidity among children attending a tertiary care ophthalmology outpatient department. Methods: We conducted a hospital-based cross-sectional study in the Department of Ophthalmology, Vijayanagara Institute of Medical Sciences/Ballari Medical College and Research Centre, Ballari, Karnataka, from July 2022 to December 2023. Consecutive patients younger than 15 years presenting with any ocular disorder underwent visual acuity testing, torchlight and slit-lamp anterior segment examination, colour vision testing, and cycloplegic refraction and dilated fundus examination where indicated. Morbidities were classified and analysed by age group (0-5, 5-10, and 10-15 years) and sex, and are reported as counts and percentages. Results: A total of 350 children were evaluated; 202 (57.7%) were male, giving a male-to-female ratio of 1.36:1. Most presented in the 5-10-year group (133/350, 38.0%), followed by the 10-15-year (122/350, 34.9%) and 0-5-year (95/350, 27.1%) groups. Refractive error was the commonest morbidity (123/350, 35.1%), followed by vernal keratoconjunctivitis (82/350, 23.4%), conjunctival disorders (47/350, 13.4%), lacrimal drainage disorders (25/350, 7.1%), squint (19/350, 5.4%), developmental cataract (17/350, 4.9%), lid disorders (15/350, 4.3%), and ocular trauma (14/350, 4.0%). Refractive error predominated in every age band and was proportionally highest in the 5-10-year group.Conclusion: Refractive error and vernal keratoconjunctivitis together accounted for more than half of paediatric ocular morbidity at this tertiary centre, and most affected children were of school-going age. Because these conditions are largely treatable, the findings support strengthening school vision screening and community eye-health education in this region

Background: COVID-19-associated mucormycosis emerged as an important opportunistic fungal infection, particularly among patients with diabetes mellitus and corticosteroid exposure. Histopathological examination confirms tissue invasion and may also provide valuable information regarding disease severity and prognosis. Aim: To evaluate the histopathological spectrum and associated clinicopathological characteristics of mucormycosis in post-COVID-19 patients. Materials and Methods: This retrospective, hospital-based clinicopathological study included 200 post-COVID-19 patients with histopathologically confirmed mucormycosis. Demographic characteristics, clinical manifestations, anatomical distribution, predisposing factors, microbiological findings, treatment and outcomes were retrieved from hospital records. Tissue sections stained with haematoxylin and eosin, periodic acid-Schiff and Grocott-Gomori methenamine silver were reviewed for fungal morphology, fungal load, necrosis, inflammatory response, angioinvasion, thrombosis, perineural invasion, bone invasion and mixed infection. Categorical variables were compared using the chi-square or Fisher’s exact test, and associations were expressed as odds ratios with 95% confidence intervals. A p value <0.05 was considered statistically significant. Results: The mean age was 51.84±12.73 years, and 137 (68.5%) patients were male. The mean interval between COVID-19 and mucormycosis was 24.68±11.42 days. Diabetes mellitus was present in 144 (72.0%) patients, while 129 (64.5%) had received systemic corticosteroids. Isolated sinonasal, rhino-orbital and rhino-orbito-cerebral disease accounted for 33.5%, 29.0% and 21.5% of cases, respectively. Broad, irregular, pauci-septate fungal hyphae were identified in 176 (88.0%) specimens. Extensive necrosis and angioinvasion were each present in 107 (53.5%), vascular thrombosis in 96 (48.0%), bone invasion in 79 (39.5%) and perineural invasion in 59 (29.5%). Angioinvasion, extensive necrosis and bone invasion were significantly associated with advanced clinical disease, with odds ratios of 5.41, 5.48 and 5.53, respectively (all p<0.001). An adverse outcome occurred in 48 (24.0%) patients. Extensive necrosis showed the strongest association with adverse outcome (OR=9.37; 95% CI: 3.76-23.36), followed by angioinvasion (OR=5.35), bone invasion (OR=4.47), perineural invasion (OR=3.34) and mixed fungal infection (OR=3.16). Conclusion: Post-COVID-19 mucormycosis predominantly affected middle-aged diabetic men with previous corticosteroid exposure and most commonly involved the sinonasal-orbital-cerebral region. Extensive necrosis, angioinvasion, perineural invasion and bone invasion were important indicators of advanced disease and adverse outcome. Histopathological examination is therefore essential for diagnosis, assessment of severity and clinicopathological risk stratification

Background: Iron deficiency anemia is a common cause of microcytic anemia, but the pattern of complete blood count changes may differ depending on the severity of the iron deficiency and the inflammatory status. Methods: This was a cross-sectional study conducted in a hospital setting with 180 adult patients, 120 of whom had iron deficiency anemia confirmed by biochemistry and 60 of whom were age matched and did not have iron deficiency anemia. Complete blood count parameters, reticulocyte indices, serum ferritin, serum iron, total iron-binding capacity and transferrin saturation were analyzed. Results: The iron deficiency anemia group had significantly lower hemoglobin (8.9 ± 1.4 g/dL vs. 13.2 ± 1.0 g/dL), mean corpuscular volume (68.7 ± 8.1 fL vs. 86.5 ± 5.7 fL), mean corpuscular hemoglobin (20.9 ± 3.8 pg vs. 29.1 ± 2.1 pg) and ferritin (10.8 ± 6.4 ng/mL vs. 62.3 ± 28.5 ng/mL) than controls (all p<0.001). Red cell distribution width was higher in cases (18.9 ± 2.6% vs. 13.2 ± 1.1%, p<0.001), and reactive thrombocytosis was observed in 31.7% of cases. There was a moderate inverse correlation between platelet count and hemoglobin (r=-0.46, p<0.001), and a positive correlation between ferritin and MCV (r=0.58, p<0.001). Conclusion: The characteristic combination of microcytosis, hypochromia, anisocytosis and decreased iron stores, combined with increased reactive platelets, confirmed the potential of routine haematological parameters as a readily available severity-screening tool for iron deficiency anemia.

Background: Thrombocytopenia is a frequent hematological abnormality in dengue fever and the role of platelet count as a marker of severity is still controversial. Methods: Prospective observational study on 160 serologically confirmed dengue patients aged 15 years and older. Dengue without warning signs, dengue with warning signs and severe dengue were defined based on standard clinical criteria. The following parameters were recorded: serial platelet count, hematocrit, leukocyte count, liver enzymes, bleeding manifestations and outcomes. Results: There was significant difference in mean platelet count between dengue without warning signs (102.4 ± 44.6 ×10^3/µL), dengue with warning signs (68.1 ± 31.2 ×10^3/µL) and severe dengue (33.7 ± 16.8 ×10^3/µL) (p<0.001). There was a strong inverse correlation between platelet count and severity grade (r=-0.64, p<0.001) and a moderate inverse correlation between platelet count and rise in hematocrit (r=-0.41, p<0.001). Bleeding occurred in 8.3%, 21.3% and 51.9% of the three groups respectively (p<0.001). A platelet count of ≤50 ×10^3/µL was found to have a sensitivity of 81.5%, specificity of 74.4% and an area under the ROC curve of 0.82 for predicting severe dengue. Conclusion: Warning signs, hemoconcentration, bleeding and severe dengue were significantly associated with lower platelet count, but clinical assessment is important as platelet count alone is not sufficient to predict complications.

Background: Neonates admitted to the Neonatal Intensive Care Unit (NICU) often require multiple medicines for conditions such as respiratory distress, infections, and prematurity-related complications. Because drug absorption, metabolism, and excretion differ markedly in neonates compared with older children and adults, and because evidence on dosing and safety in this population remains limited, hospital-specific drug-utilization studies are important for understanding local prescribing practices.Objective: To assess the drug utilization pattern among neonates admitted to the NICU of a tertiary-care hospital using the WHO Anatomical Therapeutic Chemical (ATC) classification system and selected WHO core prescribing indicators.Methods: A retrospective, observational, cross-sectional study was conducted among 850 neonates admitted to the NICU of Koppal Institute of Medical Sciences, Koppal, who received at least one therapeutic medicine during their hospital stay. Data on demographics, diagnoses, and prescribed drugs were collected from medical records using a structured proforma, classified according to the WHO-ATC system, and analyzed using SPSS 25.Results: Males comprised 52.0% of the cohort, and 68.0% of neonates were born at ≥37 weeks of gestation. Respiratory distress syndrome (58.0%), neonatal jaundice (45.0%), and neonatal sepsis (30.0%) were the most common morbidities. A total of 2,125 medicines were prescribed (mean 2.5 drugs/neonate). Respiratory-system medicines were the most frequently prescribed ATC category (42.0%), followed by anti-infectives (28.0%); surfactant, aminophylline, ampicillin, and gentamicin were the leading individual agents. Antibiotics were prescribed in 45.0% of cases, injectable medicines in 60.0%, and 90.0% of prescribed drugs were from the essential medicines list.Conclusion: Prescribing in this NICU was largely driven by respiratory morbidity, with a comparatively lower antibiotic and injectable burden than reported in several other Indian and international neonatal cohorts, likely reflecting a lower proportion of extremely preterm and very-low-birth-weight admissions. High adherence to the essential medicines list suggests broadly rational prescribing, though periodic audits are recommended to further strengthen neonatal pharmacotherapy

Aim: To compare the efficacy of BISAP score and Modified CT Severity Index (MCTSI) in early prediction of severity and mortality in patients with acute pancreatitis.Materials and Methods: A hospital-based observational study was conducted in the Department of General Medicine at ESIC Medical College and Hospital, Alwar, Rajasthan, among 100 patients diagnosed with acute pancreatitis. Patients aged 18–65 years fulfilling inclusion criteria were enrolled after informed consent. BISAP score was calculated within the first 24 hours of admission and MCTSI was assessed using contrast-enhanced computed tomography within 48 hours. Patients were classified according to the Revised Atlanta Classification. Statistical analysis was performed using SPSS version 22.0 and p value <0.05 was considered statistically significant.Results: Among 100 patients, 76% were males and the highest incidence was observed in the 31–40 years age group (48%). Gallstones (47%) were the commonest etiology followed by alcoholism (22%). According to Revised Atlanta Classification, 22% had mild AP, 61% had moderate AP, and 17% had severe AP. MCTSI categorized 27% as mild, 49% as moderate, and 24% as severe pancreatitis. BISAP score was ≥3 in 39% patients. Significant association was observed between disease severity and both MCTSI (p=0.008) and BISAP score (p=0.005). Mortality was observed in 7% patients. BISAP demonstrated sensitivity of 100% and specificity of 73.5% in predicting mortality, whereas MCTSI showed sensitivity of 100% and specificity of 58.5%.Conclusion: Both BISAP and MCTSI are effective tools in predicting severity of acute pancreatitis. However, BISAP score is simpler, clinically convenient, and demonstrated better specificity in predicting mortality compared to MCTSI. BISAP can therefore be considered a reliable bedside prognostic tool for early risk stratification in acute pancreatitis

Background: Internal derangement of the knee (IDK) commonly results from injuries to the menisci and cruciate ligaments following trauma or sports-related activities. Accurate diagnosis is essential for appropriate treatment and prevention of long-term functional impairment. Clinical examination, magnetic resonance imaging (MRI), and arthroscopy are routinely used for diagnosis; however, the relative diagnostic performance of clinical examination and MRI remains controversial. This study compared the diagnostic performance of clinical examination and MRI using arthroscopy as the reference standard.Methods: A prospective hospital-based diagnostic accuracy study was conducted in the Department of Orthopaedics. Thirty-five patients aged 17–60 years with clinically suspected internal derangement of the knee underwent comprehensive clinical examination, MRI evaluation, and diagnostic arthroscopy. Arthroscopic findings were considered the reference standard. The diagnostic performance of clinical examination and MRI was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and Cohen's kappa coefficient.Results: The mean age of the participants was 29.9 ± 9.9 years, and 65.7% were males. Arthroscopy confirmed anterior cruciate ligament (ACL) tears in 77.1%, medial meniscal tears in 68.6%, lateral meniscal tears in 22.9%, and posterior cruciate ligament (PCL) tears in 2.9% of patients. Clinical examination demonstrated higher diagnostic accuracy than MRI for ACL injuries (98.15% vs. 81.94%) and medial meniscal injuries (85.42% vs. 63.07%). For lateral meniscal injuries, the diagnostic accuracy of clinical examination and MRI was 94.29% and 73.84%, respectively. Both modalities correctly identified the single PCL injury. MRI showed comparatively lower sensitivity and specificity for meniscal injuries than clinical examination.Conclusion: Clinical examination demonstrated higher diagnostic performance than MRI for detecting ACL and meniscal injuries and should remain the first-line diagnostic approach in patients with suspected internal derangement of the knee. MRI serves as a valuable non-invasive adjunct, particularly in patients with equivocal clinical findings or suspected complex injuries. Arthroscopy remains the reference standard for confirming intra-articular pathology and provides the additional advantage of simultaneous therapeutic intervention.

To evaluate admission serum ferritin as a predictor of mortality among children with sepsis, a hospital-based cross-sectional analytical study was conducted involving 70 children aged >1 month to 18 years admitted with sepsis to the pediatric intensive care unit (PICU) of a tertiary care hospital over a one-year period. Venous blood was collected at admission to quantify serum ferritin alongside C-reactive protein (CRP) and procalcitonin. Participants were followed until discharge or death to determine the primary outcome of PICU mortality. Among the 70 participants (median age 6 years; 54.29% boys), overall PICU mortality was 31.43% (n=22). Mean admission serum ferritin levels were significantly higher in non-survivors (3317.73 ± 1025.74 ng/mL) compared to survivors (578.85 ± 409.63 ng/mL; p<0.001). Elevated ferritin concentrations correlated with rural residence, inotrope requirement, acute respiratory distress syndrome, and significantly prolonged mechanical ventilation and PICU stays (p<0.05). Secondary inflammatory markers, CRP (206.73 ± 54.6 vs. 47.99 ± 37.69 mg/L) and procalcitonin (28.31 ± 21.0 vs. 5.29 ± 5.52 ng/mL), were also significantly higher among non-survivors (p<0.001). Receiver operating characteristic curve analysis for ferritin demonstrated an area under the curve of 0.998. An optimal discriminatory cut-off of 1542 ng/mL predicted mortality with 100% sensitivity and 97.92% specificity. Markedly elevated admission serum ferritin is an excellent early prognostic biomarker that predicts multiorgan failure and mortality in critically ill children with severe sepsis.

Background: Female cancers are a major public health concern, with breast, cervical, and ovarian cancers accounting for a substantial proportion of cancer-related morbidity and mortality. Evaluation of histopathological trends is essential for improving early detection, screening strategies, and treatment outcomes. Aim: To evaluate the recent histopathological trends of female malignancies and assess their demographic distribution, clinicopathological characteristics, and treatment outcomes. Methods: A retrospective observational study was conducted at a tertiary care centre in Raipur between 2025 and 2026. A total of 90 female patients with histopathologically confirmed malignancies were included. Demographic, clinical, histopathological, staging, treatment, and outcome data were retrieved from medical records. Statistical analysis was performed using IBM SPSS Statistics version 29.0. Descriptive statistics were used to summarize the data, while inferential statistics were applied to determine associations, with p < 0.05 considered statistically significant. Results: The mean age of the patients was 50.75 years, with the highest proportion (55.6%) belonging to the 41–60-year age group. Breast cancer was the most common malignancy (34.4%), followed by cervical cancer (20.0%) and ovarian cancer (15.5%). Most patients were diagnosed at stage II (38.9%), followed by stage III (28.9%). Surgical intervention was the primary treatment modality (47.8%). The overall survival rate was 70%, with significantly better survival among patients diagnosed at early stages compared to advanced stages (p < 0.01). A significant association was also observed between cancer type and age group. Conclusion: Breast cancer was the predominant female malignancy in this cohort, followed by cervical and ovarian cancers. Early-stage diagnosis was associated with significantly improved survival, emphasizing the importance of strengthening cancer awareness, screening programs, and timely intervention to improve outcomes among women in Chhattisgarh.

Background: Sepsis is a life-threatening condition associated with high morbidity and mortality. Early prediction of disease severity using routine hematological and biochemical markers may improve patient outcomes. Methods: This prospective observational study included 80 patients with clinically suspected sepsis admitted to the Department of Pathology, Shri Balaji Institute of Medical Science, Raipur. Hematological parameters (WBC, RBC, platelet count, ANC, and immature granulocyte percentage) and biochemical markers (CRP and procalcitonin) were evaluated and compared between non-severe and severe sepsis groups. ROC curve analysis was performed to determine the predictive accuracy of the biomarkers. Results: Of the 80 patients, 48 (60%) had non-severe sepsis and 32 (40%) had severe sepsis. Patients with severe sepsis had significantly higher WBC count, ANC, immature granulocyte percentage, CRP, and procalcitonin levels, while platelet count and RBC count were significantly lower (p < 0.05). Procalcitonin showed the highest diagnostic accuracy (AUC = 0.91), followed by immature granulocyte percentage (AUC = 0.89) and CRP (AUC = 0.87). Conclusion: Routine hematological and biochemical markers, particularly procalcitonin, CRP, immature granulocyte percentage, and platelet count, are useful predictors of sepsis severity and can assist in early risk stratification and clinical decision-making

Background: Acute STEMI remains a major cause of cardiovascular mortality, with substantial burden in India. Hyponatremia (<135 mmol/L), reflecting neurohormonal activation and physiological stress, may indicate greater disease severity and poorer outcomes. Therefore, this study evaluated the occurrence, timing, and severity of hyponatremia and its association with 30-day all-cause mortality, along with relevant demographic and clinical predictors, among patients with acute STEMI.Materials and Methods: This prospective observational study included 100 consecutive patients with acute STEMI. Clinical characteristics and LVEF were recorded. Serum sodium was measured at admission and at 24, 48, and 72 hours, with hyponatremia defined as <135 mmol/L. Patients were categorized according to sodium status and followed for 30-day all-cause mortality. Group comparisons used ANOVA, chi-square/Fisher’s exact tests, and unadjusted odds ratios, with p<0.05 considered significant.Results: Hyponatremia occurred in 29% of acute STEMI patients, including 11% at admission and 18% within 72 hours. Overall 30-day mortality was 8%, increasing from 2.8% with normal sodium to 27.3% with admission hyponatremia (OR 12.9; p=0.016) and 16.7% with hyponatremia developing within 72 hours. All patients with sodium <130 mmol/L died (100%; p=0.005). Non-survivors were older (65.5 vs 57.7 years) and more frequently had diabetes, hypertension, and Killip class II, supporting hyponatremia as an important prognostic marker following acute STEMI.Conclusion: Hyponatremia occurred in 29% of acute STEMI patients and was associated with higher 30-day mortality, particularly when present at admission or severe. Mortality increased markedly with decreasing sodium levels, supporting hyponatremia as a clinically relevant prognostic marker for 30-day mortality following acute STEMI

Background: Cirrhosis is defined by the liver developing fibrosis and nodules as a result of a persistent damage that changes the liver's typical lobular arrangement.Aim:To evaluate the renal artery Doppler findings and renal resistive index (RRI) in patients with decompensated liver disease.Methodology: This cross-sectional observational study was conducted on 50 patients with decompensated liver disease with ascites and 50 cirrhotic patients without ascites admitted in JLN Medical College and hospital, Ajmer.Result:Patients with decompensated liver disease and ascites showed significantly worse liver function, higher RRI, hyponatremia, elevated serum creatinine, and a markedly higher incidence of Hepatorenal Syndrome compared with compensated cirrhosis (p < 0.0001). ConclusionRenal artery Doppler-derived Renal Resistive Index (RRI) is a valuable non-invasive marker for early detection of renal hemodynamic impairment in patients with decompensated liver disease. Increased RRI is strongly associated with advanced liver dysfunction and predicts the development of Hepatorenal Syndrome.

Background: Melasma is characterized by symmetrical hyperpigmented macules, which may be blotchy, irregular, arcuate, or polycyclic and rarely have a linear or a starburst distribution. Centrofacial pattern is the most common and consist of lesions on the forehead, cheeks, nose, upper lip or chin. Malar pattern describes lesions located primarily on the cheeks and nose. Mandibular pattern consists of lesions on ramus of the mandible. All female patients, who presented with the primary symptoms, suggestive of facial dermatoses, attending the OPD were subjected to detailed history and clinical examination. During the study period, a total of 300 cases were selected randomly after taking their consent. Ethical clearance was obtained before commencing the study. Most common type of melasma was malar (72.72%) followed by centrofacial (27.27%). On Wood‘s lamp examination, 63.63% had epidermal type, 10.6% had dermal type and 25.75% had mixed type of melasma.

Background: Hypermelanoses are a group of disorders characterized by abnormally darker skin that results from increased melanin production from a normal number of melanocytes. Hypermelanoses may result from increased melanin in the epidermis (epidermal hypermelanoses), the dermis (dermal hypermelanoses) or both (mixed hypermelanoses). All female patients, who presented with the primary symptoms, suggestive of facial dermatoses, attending the OPD were subjected to detailed history and clinical examination. During the study period, a total of 300 cases were selected randomly after taking their consent. Ethical clearance was obtained before commencing the study. Among pigmentary disorders, the most common age group was 26-35 years (50%). Predisposing factors of pigmentary disorders were sun exposure (35.29%), cosmetics (16.66%), pregnancy(11.76%), family history (7.8%), stress (3.92%), hypothyroidism (3.92%), anemia (3.92%), drug intake (3.92%), refractive errors (2.9%). 95% had localized pattern of pigmentation and 5% had diffuse pattern of pigmentation.

Background: Sickle cell disease (SCD) is a debilitating heritable hemoglobinopathy caused by a structural mutation where glutamic acid is replaced by valine at the sixth position of the β-globin chain, producing abnormal hemoglobin HbS. Because patients with SCD are vulnerable to ischemic episodes, evaluating metabolic factors like plasma homocysteine—known to promote endothelial dysfunction and thrombosis—is of high clinical interest. Objectives: To evaluate serum homocysteine levels in patients with sickle cell anaemia, compare levels between steady-state and vaso-occlusive crisis (VOC) groups, and correlate findings with disease severity and folic acid therapy. Methods: This cross-sectional analytical study was conducted at VIMSAR, Burla, from November 2018 to October 2020, involving matched SCD cases and healthy controls. Fasting blood samples were analyzed for serum homocysteine. Results: Serum homocysteine levels were significantly higher (p<0.0001) in SCD patients compared to controls. A positive correlation was observed between elevated homocysteine and the annual rate of VOC. Furthermore, patients not receiving folic acid therapy demonstrated higher homocysteine concentrations than those on supplementation. Conclusion: Serum homocysteine is elevated in SCD patients and strongly associates with a higher rate of VOC, highlighting its utility as a biomarker for disease monitoring and management

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease characterized by persistent synovial inflammation and progressive joint damage. Melatonin is a circadian hormone with complex immunomodulatory, antioxidant, and inflammatory effects, but its relationship with RA activity remains incompletely understood. Objective: To evaluate serum melatonin levels in patients with rheumatoid arthritis and determine their associations with disease activity, inflammatory markers, and serological status. Methods: A hospital-based case-control study was conducted at Kirkuk Teaching Hospital, Kirkuk, Iraq, from February 11 to August 1, 2026. The study included 100 participants: 50 patients with established RA and 50 apparently healthy controls. Serum melatonin was measured using a competitive enzyme-linked immunosorbent assay (ELISA). Clinical and laboratory assessments included DAS28, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tender joint count, and swollen joint count. Results: Serum melatonin was significantly higher in RA patients than controls (44.86 ± 15.72 vs. 28.34 ± 9.65 pg/mL; P < 0.001). Melatonin increased progressively across disease-activity categories, from 31.45 ± 7.62 pg/mL in remission to 54.72 ± 14.16 pg/mL in patients with high disease activity (P < 0.001). Significant positive correlations were observed between melatonin and DAS28 (r = 0.568), CRP (r = 0.476), ESR (r = 0.421), tender joint count (r = 0.389), and swollen joint count (r = 0.354), whereas correlations with age and disease duration were not significant. Melatonin concentrations were also significantly higher among RF-positive and anti-CCP-positive patients. Elevated melatonin (>35 pg/mL) was independently associated with RA after adjustment for age, sex, and BMI (adjusted OR = 6.84; 95% CI: 2.67–17.52; P < 0.001). Conclusion: Serum melatonin concentrations are significantly elevated in patients with rheumatoid arthritis and are positively associated with clinical disease activity, systemic inflammation, and seropositivity. These findings suggest that altered melatonin physiology may be involved in the circadian and immunoinflammatory processes of RA and may have potential value as an adjunctive biomarker of disease activity. Further longitudinal studies incorporating serial circadian measurements are required to clarify its biological and clinical significance.

Background: Distal radius fractures are highly prevalent upper extremity injuries frequently managed in emergency settings. While manual manipulation under a hematoma block (HB) serves as a common, simple alternative to procedural sedation and analgesia (PSA), standard single-agent lidocaine protocols often provide short-lived or suboptimal analgesia. To optimize patient comfort without escalating the risk of systemic local anesthetic toxicity, alternative dosing combinations must be explored. This study evaluated the clinical rationale for a novel, low-dose combination of lidocaine and bupivacaine to improve post-reduction pain relief.objectives: The aim of this study is to evaluate Clinico-Radiological Efficacy of a Combined Local Anesthetic Hematoma Block for Distal Radius Fracture Reduction. Methods:This prospective, randomized, single-blind, controlled clinical trial evaluated 50 patients with clinically and radiologically confirmed extra-articular distal radius fractures. Following informed consent, the cohort was randomized and equally assigned into two groups of 25 patients each. The intervention groups received a hematoma block utilizing either standard local anesthetic lidocaine or a lidocaine-bupivacaine combination, followed by manual manipulation, fracture reduction, and immobilization in a plaster of Paris (POP) cast. Pain severity was sequentially monitored using the Visual Analogue Scale (VAS) before, during, and after the reduction process. Post-reduction alignment and anatomical adequacy were radiologically assessed according to the Modified Sarmiento Criteria, and any procedure-related complications were recorded. conclusion: A hematoma block using a local anesthetic is a safe and effective technique for providing adequate analgesia during the manipulation and reduction of distal radius fractures, eliminating the need for the prolonged monitoring required by other anesthetic techniques. This makes the hematoma block a highly acceptable anesthetic option for patients with systemic diseases or comorbidities.Our study demonstrated that immediate post-reduction pain management is superior when the hematoma block utilizes a combination of lidocaine and bupivacaine at minimal therapeutic doses, without any increase in procedure or drug-related adverse effects. Consequently, using a minimal volume and concentration of this combination provides a highly effective alternative to the traditional dosage of lidocaine alone (typically 2 mg/kg of body weight in a 10 mL volume) for blocking distal radius fractures.

Background: Globally, antimicrobial resistance (AMR) presents a significant threat to human health driven largely by irrational antimicrobial usage, which often leads to prolonged hospital stay, increased morbidity and mortality. Antimicrobial stewardship (AMS) emphasizes appropriate antibiotic use through strict implementation of antimicrobial policy guidelines. Hence, this study aims to correlate Defined Daily Dose (DDD), Days of Therapy (DOT) and Antimicrobial Resistance in Intensive Care Unit (ICU) patients with bacteremia.Materials and Methods:A prospective cross-sectional study was conducted over three months in the SRM Medical College Hospital and Research Centre, including patients over 18 years old receiving antimicrobials with positive blood cultures. Antimicrobial usage was assessed using WHO-recommended metrics such as DDD per 100 patient bed days and DOT per 1000 patient bed days. Resistance data were obtained from microbiology surveillance records.Results:Among 50 culture-positive ICU patients, 36% were aged 51-70 years and 34% were 31-50 years, with 56% of males. Among the pathogens isolated, Klebsiella pneumoniae (28%), Escherichia coli (22%), and Acinetobacter baumannii (22%) were the predominant organisms, followed by Pseudomonas, Enterococcus and Staphylococcus species. Stewardship interventions resulted in de-escalation in 54% of cases, escalation in 20%, and no change in 26%. Mean empirical DDD and DOT were 4.95 and 3.7 days, respectively, while the mean definitive DDD and DOT were 4.05 and 4.3 days. Wide variation reflects individuals' therapy adjustments. Higher mortality was observed in patients infected with multidrug-resistant (MDR) and extensively drug-resistant (XDR) organisms than in drug-sensitive cases. Conclusion:In conclusion, structured stewardship prescribing practices decrease unnecessary antimicrobial use and result in better clinical outcomes, highlighting the value of continuous AMS monitoring and feedback in combating AMR. Clinical significance:This study is clinically significant for the optimization of antibiotic usage and improve patients outcomes by formulation targerted antimicrobial stewardship strategies

und: Distal femur fractures are uncommon but challenging injuries that require anatomical reduction, stable fixation, and early mobilization to achieve satisfactory functional outcomes. Although both the lateral parapatellar and swashbuckler approaches are commonly employed for dual plate fixation, comparative evidence regarding their clinical effectiveness remains limited. This study compared the functional and radiological outcomes of dual plate fixation using these two surgical approaches. Methods: A prospective observational comparative study was conducted in the Department of Orthopaedics, Sri Aurobindo Medical College and Post Graduate Institute, Indore, from November 2024 to December 2025. Twenty adult patients with distal femur fractures underwent open reduction and internal fixation with dual locking compression plates through either the lateral parapatellar approach (n=10) or the swashbuckler approach (n=10). Operative duration, intraoperative blood loss, fracture union, time to weight-bearing, knee range of motion, extensor lag, Knee Society Score (KSS), Lysholm Knee Score, Neer's Rating System, and postoperative complications were evaluated and compared. Results: Baseline demographic and fracture characteristics were comparable between the two groups. The lateral parapatellar approach was associated with significantly shorter operative time (108.4±12.1 vs. 126.8±13.9 minutes; p=0.006), lower intraoperative blood loss (278±46 vs. 352±58 mL; p=0.004), earlier radiological union (16.2±1.8 vs. 18.4±2.3 weeks; p=0.028), and earlier progression to weight-bearing (p<0.05). Patients in the lateral group also achieved significantly greater knee flexion, lower extensor lag, higher Knee Society, Lysholm, and Neer's scores, and a lower incidence of postoperative complications. Excellent functional outcomes were observed in 70% of patients in the lateral group compared with 40% in the swashbuckler group. Conclusion: Both approaches achieved successful fracture union; however, the lateral parapatellar approach demonstrated superior operative efficiency, earlier rehabilitation, better functional recovery, and fewer complications. It appears to be a safe and effective approach for dual plate fixation of distal femur fractures, although larger multicenter studies are required to validate these findings.

Background: Intertrochanteric femur fractures are a major cause of morbidity, particularly among the aging population. The Trochanteric Femoral Nail (TFN) offers biomechanical advantages, but continuous evaluation of postoperative fixation stability and clinical outcomes remains essential for optimizing patient care. Methods: An ambispective cross-sectional study was conducted on 30 patients with intertrochanteric femur fractures at a tertiary care center over a period of 18 months. Patients were treated with a TFN and evaluated radiographically and clinically at 3, 6, 12, and 24 weeks. A customized Fixation Stability Score (FSS) was utilized to quantify radiographic alignment and fixation stability. Results: The mean age of the cohort was 60.60 ± 16.06 years, with a male predominance (60%). The majority of fractures were Evans Type 1B (53.3%). Bone union was successfully achieved in all cases, with a mean union time of 2.90 ± 0.61 months. The mean FSS demonstrated statistically significant, progressive improvement from 5.36 ± 0.61 at 3 weeks to 6.89 ± 0.31 at 6 months (p < 0.05). Complications were rare, limited to one case of implant failure (3.3%) and one superficial infection (3.3%). Conclusion: TFN is a highly reliable implant for intertrochanteric fractures, facilitating early mobilization, low complication rates, and progressively stable fixation leading to predictable bone union.

Introduction: Viral keratitis is an important cause of preventable corneal blindness. Clinical characteristics, symptoms, laterality, lesion morphology, and corneal layer involvement are essential for diagnosis and management. Owing to limited region-specific evidence, this study evaluated the demographic and clinical spectrum of viral keratitis among patients attending a tertiary care centre.Material and Methods: A prospective observational study was conducted over one year at a tertiary care centre, enrolling 72 clinically diagnosed viral keratitis patients using convenience sampling. After informed consent, participants underwent detailed history, comprehensive ophthalmic examination, fluorescein staining, Giemsa staining of corneal/conjunctival scrapings, and routine laboratory investigations. Corneal lesions and involved layers were classified, and data were analyzed using descriptive statistics in SPSS.Results: Among 72 patients with viral keratitis, the mean age was 37.63 ± 13.20 years; 34.7% were aged 10–20 years, 54.2% were males, and 87.5% were urban residents. Unilateral disease occurred in 62.5%. Redness (68.1%) and diminished vision (50.0%) were the main symptoms. Superficial punctate keratitis was most common (50.0%), followed by stromal keratitis (27.8%). Epithelial involvement predominated (72.2%) over stromal involvement (27.8%).Conclusion: The study fulfilled its objectives by characterizing viral keratitis as predominantly unilateral and epithelial, commonly affecting younger individuals, males, and urban residents. Redness and reduced vision were the main symptoms, while superficial punctate keratitis was the most frequent lesion pattern

Background: Stroke is a leading cause of morbidity, disability, and mortality in India. Non-contrast CT (NCCT) brain and MRI are the primary neuroimaging modalities for evaluating acute ischemic stroke. This study characterises the clinico-radiological profile of ischemic stroke in a South Indian tertiary care centre.Objectives: To study the clinical presentation, radiological findings, and risk factor profile of patients with acute ischemic stroke.Methods: A cross-sectional study of 60 patients with confirmed acute ischemic stroke was conducted over 18 months (March 2021–August 2022) at Basaveshwara Medical College and Hospital, Chitradurga. All patients underwent detailed clinical assessment, routine blood investigations, ECG, 2D echocardiography, carotid Doppler, and brain neuroimaging (NCCT/MRI). Data were analysed with IBM SPSS v25.Results: Mean age was 59.75 ± 13.69 years; males predominated (M:F = 2.3:1). Hypertension (75%) and diabetes mellitus (68.3%) were the leading risk factors. Motor weakness was present in 76.7%, speech disturbance in 60%, and altered sensorium in 56.7%. MCA territory was the most commonly affected (81.7%). Increased carotid intimal thickness was found in 80% of cases. Dyslipidaemia on fasting lipid profile was noted in 71.7%.Conclusion: Hypertension and diabetes are the dominant modifiable risk factors. MCA territory ischemic strokes are most prevalent. NCCT brain with MRI DWI is essential for early diagnosis and management.

Background and Aims: Elderly patients suffering from proximal femur fractures frequently experience intense pain, particularly during the positioning maneuvers required for spinal anaesthesia. This investigation explored a newer regional anaesthesia method known as the Pericapsular Nerve Group (PENG) block, which is designed to preserve motor function while providing pain relief. Our primary objective was to evaluate how effectively landmark-guided PENG block could facilitate proper patient positioning during spinal anaesthesia in proximal femur fracture patients. Material and Methods: We designed a prospective, randomized controlled trial that enrolled 60 patients (aged 18-80 years) with ASA physical status I-III who required surgery under spinal anaesthesia for proximal femur fractures. The patients were divided equally: Group P received landmark-guided PENG block using 20 ml of 0.25% bupivacaine administered 30 minutes prior to positioning for spinal anaesthesia, whereas Group C underwent standard care without regional block. We measured pain intensity during positioning using the Numeric Rating Scale (NRS) as our primary outcome, along with several secondary measures including positioning quality, satisfaction levels, hemodynamic responses, and any adverse events. Results: Patients receiving the PENG block demonstrated substantially lower pain scores during positioning (NRS: 2.4 ± 0.8 versus 7.2 ± 1.1, p<0.001). Notably, the positioning quality was notably superior in the PENG group, with 86.7% of patients achieving optimal positioning compared to only 33.3% in the control group (p<0.001). Both patient ratings and anesthesiologist satisfaction levels were considerably higher in the PENG block group. Importantly, hemodynamic parameters remained stable throughout the procedure in both groups, and we observed no serious adverse events in either group. Conclusion: Our findings demonstrate that landmark-guided PENG block represents a highly efficacious, safe, and straightforward approach for managing pain during positioning prior to spinal anaesthesia in patients with proximal femur fractures. The technique successfully reduces pain perception, enhances positioning quality, and increases patient comfort without inducing muscle weakness. This method should be considered for routine use in clinical practice

Background: Postoperative sore throat (POST) is one of the most common airway-related complications following endotracheal intubation under general anaesthesia. Although usually self-limiting, it adversely affects patient comfort and quality of recovery. Topical lubricants and corticosteroids have been investigated for reducing POST; however, evidence comparing anti-inflammatory and lubricating agents’ remains limited. Methods: A prospective randomized comparative study was conducted in 123 ASA physical status I–II adult patients undergoing elective surgery requiring oral endotracheal intubation. Patients were randomly allocated into three equal groups (n = 41 each) to receive lubrication of the endotracheal tube with 0.05% betamethasone gel (Group BG), 2% lignocaine jelly (Group LG), or plain water-based jelly (Group PG). Anaesthetic management was standardized. The primary outcome was the incidence and severity of POST assessed using a four-point grading scale at 1, 6, 12, and 24 hours following extubation. Results: Baseline demographic characteristics and perioperative variables were comparable among the groups. Betamethasone gel significantly reduced the incidence of POST during the early postoperative period. At 1 hour, POST occurred in 80.5% of patients in Group BG compared with 97.6% in Group LG and 95.1% in Group PG (p = 0.014). At 6 hours, the incidence further decreased to 41.5% in Group BG compared with 75.6% and 87.8% in Groups LG and PG, respectively (p < 0.001). Although fewer patients in the betamethasone group experienced POST at 12 hours, the difference was not statistically significant (22.0% vs. 34.1% vs. 34.1%; p = 0.380). By 24 hours, only mild symptoms persisted with comparable incidence among all groups (p = 0.758

Background: Spinal anaesthesia is the preferred anaesthetic technique for caesarean section because it provides rapid onset of anaesthesia, dense sensory and motor blockade, minimal fetal drug exposure, and avoids the risks associated with general anaesthesia. However, spinal-induced hypotension remains the most common complication following neuraxial anaesthesia during caesarean delivery and is associated with maternal discomfort, increased vasopressor requirement, and potential reduction in uteroplacental perfusion. Hyperbaric bupivacaine is the standard intrathecal local anaesthetic used for caesarean section but is frequently associated with significant haemodynamic instability. Hyperbaric levobupivacaine, the pure S(-)-enantiomer of bupivacaine, has been proposed as a safer alternative because of its lower cardiotoxicity and potentially improved haemodynamic profile. This study compared maternal haemodynamic stability following intrathecal administration of hyperbaric levobupivacaine and hyperbaric bupivacaine during caesarean section. Methods: In this prospective randomized comparative study, 200 parturients undergoing elective or emergency lower segment caesarean section under spinal anaesthesia were randomly allocated into two equal groups. Group LH received 10 mg (2 mL) of 0.5% hyperbaric levobupivacaine, whereas Group BH received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine intrathecally. Maternal systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and peripheral oxygen saturation were recorded serially from baseline until completion of surgery. The incidences of hypotension, bradycardia, vasopressor requirement, glycopyrrolate administration, intravenous fluid bolus requirement, and severity of hypotension were compared between the two groups. Results: Baseline demographic, obstetric, and haemodynamic characteristics were comparable between the study groups. Hyperbaric levobupivacaine demonstrated significantly better preservation of systolic, diastolic, and mean arterial pressures during the early intraoperative period. Maternal hypotension occurred significantly less frequently in the levobupivacaine group than in the bupivacaine group (28% vs. 61%; P < 0.001). Bradycardia (12% vs. 29%; P = 0.003), vasopressor requirement (24% vs. 55%; P < 0.001), glycopyrrolate administration (10% vs. 24%; P = 0.008), and intravenous fluid bolus requirement (31% vs. 58%; P < 0.001) were also significantly lower in the levobupivacaine group. Heart rate remained comparable between the groups except for a transient difference at four minutes after spinal anaesthesia. Conclusion: Intrathecal hyperbaric levobupivacaine provided superior maternal haemodynamic stability compared with hyperbaric bupivacaine during caesarean section. It was associated with a lower incidence and severity of hypotension, reduced vasopressor requirement, and fewer haemodynamic interventions while maintaining satisfactory surgical anaesthesia. Hyperbaric levobupivacaine may therefore be considered a suitable alternative to hyperbaric bupivacaine in obstetric patients where preservation of maternal cardiovascular stability is a clinical priority.

Background: Effective postoperative pain control following hip surgery is essential for early mobilization, improved functional recovery, and reduced postoperative morbidity. Lumbar plexus block (LPB) is an established regional analgesic technique, but the optimal approach remains controversial. This study compared the analgesic efficacy and safety of Capdevila's posterior approach and Winnie's anterior approach for LPB in patients undergoing hip surgeries. Objectives: To compare Capdevila's posterior approach and Winnie's anterior approach of lumbar plexus block with respect to: • Postoperative pain scores (VAS) • Onset of block • Duration of analgesia • Time to first rescue analgesia • Total 24-hour rescue analgesic consumption • Complications. Methods: This prospective comparative study was conducted at a tertiary care hospital over 18 months after Institutional Ethics Committee approval. Seventy-eight ASA I–II adult patients undergoing elective hip surgeries under spinal anaesthesia were enrolled and allocated into two equal groups (n = 39 each). Group C received a nerve stimulator-guided lumbar plexus block using Capdevila's posterior approach, while Group W received Winnie's anterior approach. Both groups received an identical 40 mL local anaesthetic mixture. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 0, 2, 4, 6, 8, and 12 hours. Secondary outcomes included onset of block, duration of analgesia, time to first rescue analgesia, 24-hour rescue analgesic consumption, hemodynamic parameters, and complications. Statistical analysis was performed using SPSS version 28, with p <0.05 considered statistically significant. Results: Baseline demographic characteristics, ASA status, duration, and type of surgery were comparable between the groups (p >0.05). Group C demonstrated significantly lower postoperative VAS scores from 2 to 12 hours (p <0.001). The onset of block was significantly faster in Group C than Group W (12.85 ± 1.79 vs. 15.19 ± 1.61 minutes; p <0.001). Duration of analgesia was significantly longer in Group C (760.38 ± 64.59 vs. 585.44 ± 64.55 minutes; p <0.001), with delayed first rescue analgesia (722.79 ± 57.84 vs. 574.38 ± 63.12 minutes; p <0.001). Twenty-four-hour rescue analgesic consumption was significantly lower in Group C (115.38 ± 37.88 vs. 176.92 ± 36.45 mg; p <0.001). Hemodynamic parameters remained stable, and both techniques demonstrated a low incidence of complications without any serious adverse events. Conclusion: Capdevila’s approach provided better postoperative pain relief when compared to Winnie’s anterior approach. Patients in the Capdevila group experienced a significantly lower postoperative VAS scores, longer duration of analgesia, delayed requirement of first rescue analgesic and reduced total analgesic consumption during the first 24 hours after surgery.

Background: Hyperbaric Ropivacaine and hyperbaric Levobupivacaine are increasingly used as safer alternatives to hyperbaric Bupivacaine for spinal anaesthesia in Lower Segment Caesarean Section (LSCS). However, direct comparative evidence evaluating the spinal block characteristics of hyperbaric 0.75% Ropivacaine and hyperbaric 0.5% Levobupivacaine in parturients undergoing LSCS remains limited. This study aimed to compare the onset and duration of sensory and motor blockade following intrathecal administration of these two agents in patients undergoing LSCS. Method: This prospective, randomized comparative study included 136 ASA physical status II parturients aged 18–40 years with singleton term pregnancies undergoing LSCS under spinal anaesthesia. Participants were randomly allocated to receive either 2 mL of intrathecal hyperbaric 0.75% Ropivacaine (Group R, n=68) or 2 mL of intrathecal hyperbaric 0.5% Levobupivacaine (Group L, n=68). The primary outcome measures were the onset and duration of sensory blockade and the onset and duration of motor blockade. Results: Levobupivacaine produced a significantly faster onset of sensory blockade than Ropivacaine (4.16 ± 1.29 vs. 5.33 ± 1.52 min; P<0.001) and a significantly longer duration of sensory blockade (133.96 ± 17.68 vs. 109.99 ± 15.08 min; P<0.001). Similarly, the onset of motor blockade was faster (5.78 ± 1.31 vs. 6.76 ± 1.48 min; P<0.001), and the duration of motor blockade was significantly longer (113.49 ± 14.42 vs. 96.76 ± 15.03 min; P<0.001) in the Levobupivacaine group. Conclusion: Intrathecal hyperbaric 0.5% Levobupivacaine demonstrated superior spinal block characteristics compared with hyperbaric 0.75% Ropivacaine by providing a faster onset and longer duration of both sensory and motor blockade. Ropivacaine, with its shorter duration of motor blockade, may be advantageous when early postoperative mobilization is desired.

Background: Thyroid cancer is most common endocrine malignancy and there is high incidence of thyroid nodule detection in ultrasonography in general population. Hence there is a need to categorise thyroid nodules based on their risk of malignancy which would help in better patient management. High-resolution ultrasonography is the primary imaging modality for evaluating thyroid nodules, and standardized reporting systems such as the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and Korean Thyroid Imaging Reporting and Data System (K-TIRADS) have been developed to improve diagnostic consistency and guide management. Objective:To compare the diagnostic performance of ACR TI-RADS and Korean TI-RADS in the risk stratification of thyroid nodules using cytopathology and histopathology as the reference standards. Materials and Methods :It was prospective observational study conducted in the Department of Radiodiagnosis. Patients presenting with thyroid nodules underwent high-resolution ultrasonography, and each nodule was categorized according to both ACR TI-RADS and Korean TI-RADS criteria. Ultrasound findings including composition, echogenicity, shape, margins, and echogenic foci were recorded. Fine-needle aspiration cytology (FNAC) and histopathological examination, wherever available, served as the reference standard. Diagnostic indices including sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were calculated for both classification systems.Results:Both ACR TI-RADS and Korean TI-RADS demonstrated good diagnostic performance in differentiating benign from malignant thyroid nodules. Increasing TI-RADS categories showed a progressive increase in the probability of malignancy. Comparative analysis demonstrated differences in sensitivity and specificity between the two systems, with each showing distinct strengths in risk stratification and biopsy recommendations.Conclusion:Both ACR TI-RADS and Korean TI-RADS are reliable ultrasound-based risk stratification systems for thyroid nodules. Their systematic application improves communication between radiologists and clinicians and assists in selecting nodules for FNAC. Comparative evaluation may help determine the most appropriate classification system for routine clinical practice.

SUMMARY: Acute intermittent porphyria (AIP) is a rare metabolic disorder that presents with nonspecific neurovisceral manifestations, often leading to delayed diagnosis. We report a 14-year-old female presenting with recurrent seizure-like episodes, severe abdominal pain, persistent hypertension, and hyponatremia. Initial evaluation for structural, infectious, and autoimmune causes was unremarkable.Further metabolic workup revealed elevated urinary delta-aminolevulinic acid and positive urinary porphobilinogen, confirming the diagnosis of AIP. The patient was managed with seizure control, antihypertensive therapy, correction of electrolyte imbalance, and high-carbohydrate therapy, with subsequent clinical improvement.This case underscores the importance of considering AIP in adolescents presenting with unexplained seizures and abdominal pain, particularly when associated with hyponatremia and autonomic instability. Early diagnosis and appropriate management are critical to preventing complications and avoiding the use of contraindicated medications.

Background: Bag-mask ventilation (BMV) is a fundamental airway management skill used during induction of general anaesthesia and emergency airway management. Effective one-hand BMV depends on achieving an adequate mask seal and maintaining airway patency. Although the EC grip is the conventional technique, the Thenar Eminence (TE) and Hook grip techniques have been proposed as alternatives to improve ventilation efficiency. However, evidence comparing these techniques in clinical practice remains limited. Objectives: To compare the effectiveness of three one-hand bag-mask ventilation techniques—EC, Thenar Eminence (TE), and Hook grip—in adult patients undergoing general anaesthesia, and to determine the technique providing optimal ventilation with minimal complications. Methods: This prospective comparative study included 111 adult patients (ASA I–II) scheduled for elective surgery under general anaesthesia. Patients were equally allocated into three groups according to the BMV technique used: EC, TE, and Hook (n=37 each). Ventilation quality was assessed during the first three minutes of one-hand BMV using tidal volume, end-tidal carbon dioxide (EtCO₂), adequacy of chest rise, oxygen saturation, gastric distension, heart rate, and blood pressure. Statistical analysis was performed using ANOVA and Chi-square tests, with p<0.05 considered statistically significant. Results: Baseline demographic and airway characteristics were comparable among the groups. The Hook technique produced significantly higher tidal volumes and EtCO₂ values throughout the study (p<0.001). Adequate chest rise at 3 minutes was observed in 97.3% of patients in the Hook group compared with 91.9% in the EC group and 48.6% in the TE group. Gastric distension was least frequent with the Hook technique (2.7%), compared with EC (27.0%) and TE (70.3%). Oxygen saturation and haemodynamic parameters remained stable in all three groups. Conclusion: The Hook grip demonstrated superior one-hand bag-mask ventilation compared with the EC and Thenar Eminence techniques by providing better ventilation efficiency, improved airway

Background: Music therapy is a non-pharmacological intervention that has been shown to reduce anxiety, improve hemodynamic stability, and enhance recovery in surgical patients. This study evaluates the impact of intraoperative music therapy on postoperative awakening, hemodynamic stability, and pain perception in patients undergoing elective surgical procedures under general anesthesia. Methods: This prospective, non-randomized controlled trial was conducted at a tertiary care hospital in Maharashtra over four months. Seventy adult patients (aged 18–50 years, ASA Grade I/II) undergoing elective surgeries were allocated into two groups: the music therapy group (Group M, n=35) and the control group (Group C, n=35). Patients in Group M listened to instrumental, slow-tempo music through noise-cancelling headphones during surgery, while Group C received standard care. The primary outcome was the quality of awakening, assessed using the Riker Sedation-Agitation Scale (RSAS). Secondary outcomes included hemodynamic stability, postoperative pain (Visual Analog Scale), and analgesic requirements. Statistical analysis was performed using IBM SPSS Statistics version 28.0. Results: Patients in the music therapy group demonstrated significantly lower postoperative pain scores at all time points (p<0.05) and required less opioid analgesia over 24 hours (p=0.01). They also exhibited better hemodynamic stability intraoperatively and had a significantly higher proportion of calm and cooperative awakenings (RSAS score 4, p=0.02). No significant differences were observed in intraoperative awareness. Conclusion: Intraoperative music therapy significantly improves postoperative awakening, reduces pain, and stabilizes hemodynamic parameters in patients undergoing elective surgery under general anaesthesia. Its integration into perioperative care may enhance patient outcomes.

Background: Pregnancy-induced hypertension (PIH), pre-eclampsia, and eclampsia are major contributors to maternal morbidity and mortality, often associated with raised intracranial pressure (ICP) secondary to cerebral edema. Optic nerve sheath diameter (ONSD) measurement using ultrasonography provides a non-invasive method to estimate ICP. This study aimed to evaluate ONSD in parturients with PIH, pre-eclampsia, and eclampsia, and to correlate these findings with disease severity and anaesthetic decision-making. Methods: A prospective observational study was conducted at a tertiary care centre in Nashik, Maharashtra, from May 2024 to April 2025. Sixty parturients aged 18–40 years with gestational age ≥28 weeks were enrolled and divided into four groups: normotensive controls (n=10), PIH (n=20), pre-eclampsia (n=20), and eclampsia (n=10). ONSD was measured 3 mm behind the globe using a 7.5–13 MHz linear probe in transverse and sagittal planes. A mean ONSD >5.8 mm was considered raised ICP. Data were analyzed using ANOVA and correlation tests. Results: The mean bilateral ONSD increased progressively from 4.83 ± 0.31 mm in controls to 6.18 ± 0.62 mm in eclampsia (p<0.001). Raised ONSD (>5.8 mm) was observed in 0%, 10%, 60%, and 80% of the respective groups. ONSD correlated strongly with mean arterial pressure (r=0.71, p<0.001) and neurological symptoms such as headache (r=0.63) and seizures (r=0.66). Among parturients with raised ONSD, 68.2% underwent general anaesthesia, while 92.1% with normal ONSD received neuraxial anaesthesia safely. Conclusion: Ultrasonography-guided ONSD measurement is a simple, non-invasive, and reliable bedside tool to detect raised ICP in hypertensive disorders of pregnancy. Its incorporation into pre-anaesthetic assessment can enhance safety and guide anaesthetic management in high-risk obstetric patients

Background: Elderly patients with fragility fractures are particularly susceptible to hyponatremia because of their impaired physiology, multiple co-morbidities,polypharmacy,hospitalization, perioperative fluid restrictions, and homeostatic stress from the fracture itself and the subsequent surgery.These patients are also at a higher risk of the complications of hyponatremia such as brain injury, the main result of acute symptomatic hyponatremia and associated with significant morbidity and mortalityObjective: To investigate the proportion of hyponatremia in elderly patients with hip fractures, focusing on the differences between female and male patients with extracapsular or intracapsular proximal femoral fracturesMethodology: All records containing clinical and laboratory information about patients admitted to orthopaedic department of S. Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot from November 2022 to November 2023 were retrieved from the hospital database.A total of 100 patients were determined from the hospital database.They were divided into 4 groups based on sex and type of fracture (extracapsular or intracapsular). A total of 62 patients with extracapsular proximal femoral fractures and 38 patients with intracapsular proximal femoral fractures were obtainedResults : Of the 100 patients, there were more males ( n = 54, 54%) than females ( n = 46, 46%), with a ratio of 1.2: 1. In both male and female patients, there were more extracapsular proximal femoral fractures, 30/54 (55%) and 32/46 (69%), respectively than intracapsular proximal femoral fractures, 24/54 (44%) and 14/46 (30%),respectively. Overall, the proportion of hyponatremia in the total population was 22% (22/100).Conclusion: There was high prevalence (22%) of hyponatremia in elderly patients with hip fractures. Serum sodium concentrations should be routinely assessed in elderly patients with hip fractures to prevent occurrence of Hyponatremia

Background: Sickle Cell Disease (SCD) is highly prevalent in the tribal populations of Koraput, Odisha. Avascular necrosis (AVN) of the femoral head is a frequent, debilitating complication for these patients, often requiring Total Hip Replacement (THR) to restore mobility. Anesthetizing SCD patients is a high-stakes challenge; physiological stressors like hypoxia, hypothermia, acidosis, and sudden hypotension can easily trigger a life-threatening vaso-occlusive crisis. This study compares the hemodynamic stability, block characteristics, and postoperative outcomes of spinal versus epidural anaesthesia in this vulnerable demographic.Methods: In this prospective, randomized study at SLN MCH, 60 adult SCD patients scheduled for elective THR were divided into two equal groups of 30. Group S received spinal anaesthesia (hyperbaric bupivacaine) and Group E received epidural anaesthesia (isobaric bupivacaine with catheter placement). We monitored Haemodynamics (Mean Arterial Pressure, Heart Rate), block characteristics, postoperative pain via Visual Analog Scale (VAS), and complication rates.Results: Spinal anaesthesia provided a much faster block onset (p<0.001). However, epidural anaesthesia offered far superior hemodynamic stability. Intraoperative hypotension occurred in 36.6% of the spinal group compared to only 10.0% of the epidural group (p=0.015). Furthermore, postoperative pain control was significantly better and longer-lasting in the epidural group due to catheter top-ups.Conclusion: While both regional techniques avoid the risks of general anaesthesia, epidural anaesthesia proves to be the safer choice for SCD patients undergoing THR. It ensures gradual hemodynamic shifts and provides excellent continuous postoperative pain relief, fundamentally reducing the triggers for sickle cell crises

Background: Plantar fasciitis (PF) is the most common cause of inferior heel pain. While often diagnosed clinically, imaging modalities like Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) are crucial for confirming the diagnosis, quantifying disease severity, and ruling out other pathologies.Objective: To evaluate and correlate the thickness of the plantar fascia using high-resolution USG and MRI in patients with clinically suspected plantar fasciitis, and to assess the statistical significance of their correlation.Materials and Methods: This prospective cross-sectional study included 50 patients (60 symptomatic heels) presenting with clinical signs of PF. All patients underwent both high-resolution USG and MRI of the affected foot. Plantar fascia thickness was measured at its calcaneal insertion.Results: The mean age of the patients was 45.2 ± 10.4 years. The mean plantar fascia thickness measured by USG was 5.42 ± 1.18 mm, while MRI measured 5.56 ± 1.25 mm. A very strong positive correlation was found between USG and MRI measurements (Pearson’s r = 0.892). This correlation was highly statistically significant (p < 0.001).Conclusion: High-resolution USG is a highly reliable, cost-effective primary imaging modality that correlates strongly and significantly with the gold-standard MRI in measuring plantar fascia thickness in PF.

Abstract Introduction: Acne vulgaris can adversely affect psychological well-being, self-perception, and social functioning among young adults. This study was conducted to assess the impact of acne vulgaris on self-esteem, body image, and social anxiety among young adults attending a tertiary care hospital and to determine their association with acne severity.Methods: A hospital-based cross-sectional study was conducted among 110 young adults aged 18–25 years with clinically diagnosed acne vulgaris attending the Dermatology Outpatient Department of a tertiary care hospital. Acne severity was assessed using the Global Acne Grading System (GAGS). Self-esteem, body image, and social anxiety were evaluated using the Rosenberg Self-Esteem Scale, a validated Body Image Scale, and the Liebowitz Social Anxiety Scale, respectively. Data were analyzed using descriptive statistics, Chi-square test, and ANOVA. Results: Among the participants, 43.6% had low self-esteem, 46.4% reported disturbed body image, and 40.0% experienced social anxiety. Moderate acne was the most common severity category (41.8%), followed by severe acne (25.5%). The prevalence of low self-esteem increased from 23.1% in mild acne to 80.0% in very severe acne. Similar trends were observed for disturbed body image and social anxiety. Mean self-esteem scores decreased significantly with increasing acne severity, whereas body image disturbance and social anxiety scores increased significantly (p<0.05).Conclusions: Acne vulgaris exerts a substantial psychosocial impact on young adults. Increasing acne severity is significantly associated with lower self-esteem, poorer body image, and higher social anxiety, highlighting the need for integrated psychological assessment and management in acne care

Background: Anaemia is one of the most prevalent nutritional disorders among adolescent girls and remains a major public health concern in India. It adversely affects physical growth, cognitive development, educational performance, immunity, and future reproductive health. Despite the implementation of national programmes such as Anemia Mukt Bharat and Weekly Iron and Folic Acid Supplementation (WIFS), the burden of anaemia among adolescents continues to be high. Understanding its prevalence and determinants at the community level is essential for planning targeted interventions. Aim: To determine the prevalence of anaemia and identify its determinants among adolescent girls in the RHTC field practice area of GMERS Medical College, Dharpur–Patan, using a mixed-method approach. Materials and Methods: A community-based mixed-method study was conducted among 90 adolescent girls aged 10–19 years residing in the field practice area of tertiary care hospital medical College, over a period of one month. Participants were selected using simple random sampling. Quantitative data were collected using a pretested semi-structured questionnaire covering socio-demographic characteristics, dietary habits, menstrual history, iron-folic acid supplementation, deworming status, and knowledge regarding anaemia. Haemoglobin estimation was performed using a portable digital haemoglobinometer, and anaemia was classified according to WHO criteria. Qualitative data were obtained through focus group discussions and key informant interviews to explore perceptions and barriers related to anaemia prevention. Data were analysed using SPSS version 26.0. Descriptive statistics, Chi-square test, and multivariable logistic regression were applied, with a p-value <0.05 considered statistically significant. Results: The mean age of participants was 15.3 ± 2.1 years. The overall prevalence of anaemia was 60.0%, with mild anaemia (51.9%) being the most common, followed by moderate (40.7%) and severe anaemia (7.4%). The mean haemoglobin concentration was 11.2 ± 1.4 g/dL. Significant determinants of anaemia included inadequate dietary diversity (χ²=12.81, p<0.001), irregular iron-folic acid tablet consumption (χ²=13.54, p<0.001), heavy menstrual bleeding (χ²=5.89, p=0.015), underweight nutritional status (χ²=4.78, p=0.029), maternal illiteracy (χ²=5.36, p=0.021), and lack of deworming (χ²=4.96, p=0.026). Qualitative findings revealed inadequate awareness regarding anaemia, poor dietary practices, fear of side effects of iron-folic acid tablets, and insufficient nutrition counselling as major barriers to prevention and treatment. Conclusion: Anaemia was highly prevalent among adolescent girls in the study area and was significantly associated with nutritional, behavioural, and socioeconomic determinants. Strengthening nutrition education, improving dietary diversity, ensuring regular iron-folic acid supplementation and deworming, and enhancing community awareness through school- and community-based interventions are essential to reduce the burden of anaemia among adolescent girls

Background: Diabetes is an increasingly important disease globally. The breakdown of foods high in protein intochemicals known as purines is responsible for the production of uric acid in the body. Objectives of the study: To study the levels of serum uric acid in cases of type 2 Diabetes Melitus (DM ) and to compare with healthy controls and to correlate .Materials and methods: This was an observational case control study conducted in department of Medicine CMCRI , Chitradurga for a duration of 12 months from June 2025 to June 2026. A total of 90 subjects were prospectively included in the study (45 cases of DM and 45 matched controls). The concentration of serum uric acid were measured in all subjects and correlated. Results: The levels of serum uric acid were found to be significantly increased in cases of DM compared to healthy controls.(p<0.01)Conclusion: There was significant statistical association between uric acid levels and serum creatinine levels (p value < 0.001). Uric acid levels had statistically significant relationship with fasting blood sugar and PPBS (P value <0.05).

Background: Pulmonary hypertension (PH) complicating chronic kidney disease (CKD) is associated with substantial excess mortality, yet the mechanisms driving it remain incompletely defined. Anaemia, disordered mineral metabolism, the haemodynamic burden of an arteriovenous fistula and the volume shifts of maintenance haemodialysis have all been proposed as contributors. Establishing which of these track most closely with PH is important because each is, in principle, modifiable. Objectives: To compare the biochemical profile of CKD patients with and without pulmonary hypertension, and to examine the association of pulmonary hypertension with the presence of an arteriovenous fistula and with maintenance haemodialysis. Materials and Methods: A prospective descriptive study was conducted in the Departments of Nephrology and General Medicine, Ballari Medical College and Research Centre (formerly Vijayanagar Institute of Medical Sciences), Ballari, Karnataka, over 18 months. Sixty-four patients with CKD of any aetiology and an estimated glomerular filtration rate below 60 mL/min/1.73 m² were enrolled after institutional ethics approval and written informed consent. Patients with chronic obstructive pulmonary disease, parenchymal lung or chest wall disease, prior pulmonary hypertension or pulmonary embolism, more than five pack-years of smoking, collagen vascular disease, left ventricular ejection fraction below 50%, or significant mitral or aortic valve disease were excluded. Biochemical values were taken as the mean of the last six readings for each patient. All participants underwent electrocardiography, chest radiography and transthoracic echocardiography. Group comparisons used the unpaired t-test and the chi-square or Fisher's exact test in SPSS v24.0, with p<0.05 taken as significant and p<0.001 as highly significant. Results: Pulmonary hypertension was present in 17 of 64 patients (26.6%). Patients with PH had significantly lower haemoglobin (8.38 ± 1.27 versus 9.84 ± 1.92 g/dL; t = 2.888, p = 0.005), significantly lower serum calcium (7.88 ± 0.77 versus 9.25 ± 0.73 mg/dL; t = 6.504, p = 0.0001) and significantly higher serum phosphorus (3.49 ± 0.45 versus 2.87 ± 0.41 mg/dL; t = −5.242, p = 0.0001). Serum creatinine (6.84 ± 3.83 versus 5.40 ± 3.15 mg/dL, p = 0.133), blood urea (115.12 ± 40.08 versus 103.76 ± 60.66 mg/dL, p = 0.477) and serum albumin (2.66 ± 0.35 versus 2.88 ± 0.39 g/dL, p = 0.053) did not differ significantly. Pulmonary hypertension was significantly commoner in patients with an arteriovenous fistula (11 of 24, 45.8%) than without one (6 of 40, 15.0%; p = 0.01), and showed a non-significant trend towards higher prevalence among patients on maintenance haemodialysis (14 of 41, 34.1%) compared with those managed conservatively (3 of 23, 13.0%; p = 0.07). Conclusion: Pulmonary hypertension in CKD was associated with a distinct biochemical signature of anaemia, hypocalcaemia and hyperphosphataemia, and with the presence of an arteriovenous fistula, but not with the conventional markers of azotaemia. These findings implicate anaemia-driven high cardiac output, vascular calcification from disordered mineral metabolism, and fistula-related shunt flow — rather than the degree of uraemia itself — in its pathogenesis.

Background: Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome complicating cirrhosis, arising from the accumulation of gut-derived neurotoxins — principally ammonia — that the failing liver can no longer detoxify. The great majority of episodes in cirrhotic patients are triggered by an identifiable precipitating event rather than by spontaneous hepatic decompensation alone. Because these triggers are largely preventable and correctable, their timely recognition is the single most important determinant of recovery. The relative frequency of individual precipitants varies substantially between geographical regions and healthcare settings, and region-specific data from South India remain limited. Objectives: To ascertain the most common precipitating factors and their frequency in patients presenting with hepatic encephalopathy among diagnosed cases of cirrhosis of the liver of any aetiology, and to describe the demographic profile, underlying aetiology of cirrhosis and distribution of encephalopathy grades in this population. Materials and Methods: A prospective, descriptive, hospital-based observational study was carried out in the Department of General Medicine, Ballari Medical College and Research Centre (formerly Vijayanagar Institute of Medical Sciences), Ballari, Karnataka. Eighty-five consecutive patients above 12 years of age with established cirrhosis of the liver who presented with hepatic encephalopathy, including minimal hepatic encephalopathy, were enrolled after Institutional Ethics Committee clearance and written informed consent. Patients with psychiatric illness, altered sensorium attributable to metabolic disease or head injury, acute alcohol intoxication and alcohol withdrawal states were excluded. Sample size was estimated using nMaster v2.0. All patients underwent detailed history taking, clinical examination, complete blood count, liver and renal function tests, serum electrolytes, coagulation profile, ascitic fluid analysis and abdominal ultrasonography. Encephalopathy was graded clinically from grade 1 to 4. Data were analysed with IBM SPSS Statistics v23.0 using frequency and percentage analysis, with the chi-square or Fisher's exact test applied to categorical associations at a 5% significance level. Results: Of 85 patients, 78 (91.8%) were male and 7 (8.2%) female. The disease clustered in the fourth and fifth decades, with 31 patients (36.5%) aged 31–40 years and 27 (31.8%) aged 41–50 years. Alcoholic cirrhosis was overwhelmingly predominant, accounting for 70 cases (82.4%), followed by hepatitis B in 8 (9.4%), cryptogenic cirrhosis in 4 (4.7%) and hepatitis C in 3 (3.5%). Gastrointestinal bleeding was the leading precipitant, present in 33 patients (38.8%), followed by constipation in 19 (22.4%), infection in 18 (21.2% — spontaneous bacterial peritonitis 10, pneumonia 5, urinary tract infection 3), electrolyte imbalance in 9 (10.6%) and iatrogenic or procedure-related causes in 6 (7.1%). Conclusion: Gastrointestinal bleeding, constipation and infection together accounted for over four-fifths of all episodes of hepatic encephalopathy in this cohort, and alcohol was the dominant aetiology of the underlying cirrhosis. Systematic variceal surveillance, routine bowel regulation with lactulose, early detection of spontaneous bacterial peritonitis and community-level alcohol reduction represent the interventions with the greatest potential to reduce the burden of hepatic encephalopathy in this population.

Background: Anti-snake venom is the only specific antidote available for snakebite envenoming, yet the optimal dose remains contested, with published Indian series reporting mean requirements ranging from under 12 to over 21 vials. Complications — cellulitis, acute kidney injury, respiratory paralysis and disseminated intravascular coagulation — determine much of the morbidity, while reported case fatality varies more than tenfold between centres. The single breath count has been proposed as a simple bedside predictor of impending respiratory failure in neuroparalytic envenoming. Objectives: To determine the anti-snake venom requirement in relation to the type of envenomation syndrome, to describe the vital and laboratory derangements observed, to assess the utility of the single breath count in identifying patients needing ventilatory support, and to document complications and in-hospital outcome. Materials and Methods: A hospital-based prospective observational study was conducted in the Department of General Medicine, Koppal Institute of Medical Sciences, Koppal, Karnataka, from 1 August 2022 to 30 May 2024. One hundred consecutive patients with snake bite and one or more manifestations of envenomation were enrolled after institutional ethics committee clearance and written informed consent. Patients with bites other than snake bite and non-poisonous bites were excluded. Polyvalent anti-snake venom was given as 10 vials in 500 mL normal saline over one hour, with repeat clinical assessment, prothrombin time with international normalised ratio and 20-minute whole blood clotting test determining further doses to a maximum of 30 vials. Single breath count, need for ventilation, dialysis and blood product transfusion were recorded. Analysis used SPSS version 21. Results: Envenomation was local in 52 patients (52%), haemotoxic in 30 (30%), neurotoxic in 16 (16%) and combined in 2 (2%). Overall mean anti-snake venom requirement was 17.0 vials; 47 patients (47%) received 10 vials, 36 (36%) received 20 and 17 (17%) received 30. Requirement tracked the envenomation syndrome closely: mean vials were 12.7 for local, 21.0 for haemotoxic, 22.5 for neurotoxic and 25.0 for combined envenoming; no patient with neurotoxic envenoming was managed on 10 vials alone. Mean admission systolic and diastolic pressures were 119.9 ± 16.9 and 75.87 ± 10.12 mmHg, pulse 100.3 ± 10.3/min and oxygen saturation 96.51 ± 2.71%. Mean haemoglobin was 12.91 ± 1.77 g/dL, total leucocyte count 10,769 ± 4,766/mm³, platelets 257.98 ± 78.03 × 10³/mm³, international normalised ratio 1.84 ± 1.27 and creatinine 0.981 ± 0.428 mg/dL; 11 patients (11%) had creatinine between 1.8 and 3.0 mg/dL but none required dialysis. Six patients (6%) required ventilatory support, all drawn from the 26 with a single breath count of 30 or below. Cellulitis was the commonest complication (52%), followed by respiratory failure (6%), acute kidney injury (5%) and disseminated intravascular coagulation (2%); 35 patients (35%) had no complication. Ninety-nine patients (99%) survived, the single death resulting from neuroparalysis with respiratory failure. Conclusion: Antivenom requirement rose in clear proportion to the severity of systemic envenoming, with neurotoxic and combined syndromes needing roughly twice the dose of local envenomation. A single breath count of 30 or below identified every patient who subsequently required ventilation. Survival of 99% is among the highest reported from Indian centres and is attributable to early presentation and tertiary-level supportive care.

Background: Nausea and vomiting are important defence mechanism of body against the Ingestion of toxins but exact mechanism of Nausea and vomiting are not known though the problem exists for more than 150 years. This is a multifactorial and so very complex process. Objective: to determine the efficacy of prophylactic Ondansetron and Ramosetron in preventing the incidence of postoperative nausea and vomiting after carboprost in LSCS under spinal anesthesia and assess the requirement of other rescue antiemetic in the postoperative period and assess any adverse effects associated with their use. Methods: This Prospective, Comparative study was conducted among Patients scheduled for LSCS with use of carboprost IM under spinal anaesthesia in Bapuji Hospital, Chigateri General Hospital, Women and Child Health Hospital attached to JJM Medical College, Davangere. Duration of study was Two years, the study was covered over a period from October 2019- September 2021. Result: There was no statistically significant difference between Ondansetron and Ramosetron with incidence of nausea, retching, vomiting, need for rescue antiemetic at intervals of 0-3 hours, 6-12 hours and 12-24 hours. Both Ondansetron and Ramosetron were well tolerated, with minimum adverse effects. There was no significant difference between the two groups with respect to adverse effects. Overall incidence of complete response in Ramosetron group (76%) is higher than Ondansetron group (56%) and is statistically suggestive of significance p value (< 0.023). Based on the results of our study, Ramosetron at an intravenous dose of 0.3 mg is safe and well-tolerated and more effective than 4 mg intravenous Ondansetron for antiemetic prophylaxis in LSCS under spinal anaesthesia after carboprost. Conclusion: Ramosetron at an intravenous dose of 0.3mg is more effective than intravenous inj ondansetron 4mg to prevent postoperative nausea and vomiting with carboprost in LSCS patients.