Background: Malnutrition and impaired functional reserve are associated with increased morbidity following major hepatobiliary surgery. This study evaluated the impact of structured preoperative nutritional optimization on postoperative morbidity, resource utilization, and perioperative nutritional parameters. Methods: In this prospective interventional study (March 2022–February 2024), 100 patients scheduled for elective major hepatobiliary surgery at SMS Medical College, Jaipur, underwent standardized nutritional assessment (BMI, SGA, albumin, prealbumin, CRP, skeletal muscle index, handgrip strength, and NRS-2002 score). Patients received individualized optimization—oral diet, oral nutritional supplements, enteral or parenteral nutrition, and immunonutrition—targeting predefined biochemical and functional thresholds. Postoperative morbidity was classified using Clavien–Dindo criteria. Outcomes were compared between optimized and non-optimized patients, with multivariate logistic regression to identify independent predictors. Results: Nutritional optimization was achieved in 68 patients (68.0%) after a median of 12 days [IQR 8–16]. Optimized patients had lower rates of major morbidity (14.7% vs 46.9%, p = 0.001), surgical site infection (7.4% vs 31.3%, p = 0.004), pneumonia (4.4% vs 21.9%, p = 0.012), and acute kidney injury (2.9% vs 18.8%, p = 0.018). Median length of stay was reduced by 5 days (9 vs 14, p < 0.001), and ICU admissions were fewer (11.8% vs 37.5%, p = 0.005). Nutritional gains included increased albumin (+0.49 g/dL), prealbumin (+3.02 mg/dL), skeletal muscle index (+1.01 cm²/m²), and handgrip strength (+2.01 kg), with CRP reduction (−4.96 mg/L). In multivariate analysis, age was an independent predictor of major morbidity (aOR 1.09; 95% CI 1.03–1.16; p = 0.005), while optimization showed a protective but non-significant effect (aOR 0.50; 95% CI 0.15–1.63). Conclusion: Preoperative nutritional optimization is associated with significant reductions in postoperative morbidity and hospital resource utilization, with measurable improvements in nutritional and functional status. Benefits extend to patients without overt malnutrition, supporting its universal incorporation into perioperative care pathways.

Background: Malnutrition is a critical yet often under-recognized factor influencing postoperative outcomes in gastrointestinal (GI) surgery. Early assessment of nutritional status can aid in risk stratification and management of surgical patients. Objective: To evaluate the nutritional status of patients undergoing GI surgeries and determine its impact on postoperative outcomes and hospital stay. Methods: A prospective observational study was conducted on 100 patients undergoing various GI surgeries. Nutritional status was assessed using Subjective Global Assessment (SGA), body mass index (BMI), and serum albumin levels. Patients were categorized as well-nourished (SGA A), moderately malnourished (SGA B), or severely malnourished (SGA C). Postoperative complications and duration of hospital stay were recorded. Correlations between nutritional markers and outcomes were analyzed using appropriate statistical tests. Results: Of the 100 patients, 38% were well-nourished, 44% moderately malnourished, and 18% severely malnourished. The most common surgery was colorectal (32%), with a mean hospital stay of 9.3 ± 3.6 days. Postoperative complications were significantly higher in severely malnourished patients, including wound infections (27.8%), delayed healing (33.3%), anastomotic leak (16.7%), and mortality (11.1%) (p < 0.05). Serum albumin and BMI showed negative correlations with hospital stay (r = -0.48 and -0.34 respectively, p < 0.01), whereas SGA score showed a positive correlation (r = +0.52, p < 0.001). Conclusion: Poor nutritional status is significantly associated with adverse postoperative outcomes and prolonged hospitalization in GI surgical patients. Preoperative nutritional assessment should be an integral part of surgical care to improve outcomes.

Background: Knee osteoarthritis (OA) is a common degenerative joint disease leading to chronic pain and disability. Obesity is a known risk factor, but its direct association with radiographic severity and functional impairment remains an area of clinical interest. Objective: To evaluate the association between body mass index (BMI) and the severity of knee osteoarthritis in adults using radiographic grading and functional outcome scores. Methods: This cross-sectional observational study was conducted among 120 adults clinically and radiologically diagnosed with knee osteoarthritis. Participants were categorized based on BMI into normal (<25 kg/m²), overweight (25–29.9 kg/m²), and obese (≥30 kg/m²) groups. Radiographic severity was graded using the Kellgren-Lawrence (KL) system. Functional status was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were analyzed using descriptive statistics and Pearson’s correlation. Results: The mean age of participants was 58.4 ± 10.2 years; 65% were female. Obesity was prevalent in 43.3% of the sample. Radiographic severity showed a positive trend with BMI—48.1% of obese participants had severe OA (KL Grade 4), compared to only 8.3% in the normal BMI group. Mean WOMAC total scores were highest in the obese group (38.6 ± 7.9). BMI showed significant positive correlation with KL grade (r = +0.61, p < 0.001), WOMAC total score (r = +0.68, p < 0.001), and pain subscore (r = +0.59, p < 0.001). Conclusion: Higher BMI is significantly associated with increased radiographic severity and functional impairment in knee osteoarthritis. Targeted weight management may improve OA outcomes.

Background: Acute appendicitis is a common surgical emergency, traditionally managed by open appendectomy (OA). With advancements in minimally invasive techniques, laparoscopic appendectomy (LA) is increasingly preferred. This study compares the clinical outcomes of LA and OA to evaluate their relative efficacy and safety. Aims: To assess and compare intraoperative parameters and postoperative outcomes in patients undergoing laparoscopic versus open appendectomy for acute appendicitis. Methods: A prospective observational study was conducted on 100 patients diagnosed with acute appendicitis, who were allocated into two groups: Group A (n=50) underwent LA, and Group B (n=50) underwent OA. Operative time, blood loss, postoperative pain (VAS score), duration of hospital stay, return to normal activities, and complications were recorded. Statistical analysis was performed using SPSS version 25.0, with p < 0.05 considered significant. Results: The mean operative time was significantly longer in LA (62.8 ± 10.5 min) compared to OA (48.3 ± 9.6 min; p < 0.001). However, LA resulted in lower blood loss, reduced postoperative pain (VAS score at 24 hrs: 3.2 ± 0.8 vs. 5.1 ± 1.1; p < 0.001), shorter hospital stay (2.6 vs. 4.2 days; p < 0.001), and earlier return to activities (6.1 vs. 9.3 days; p < 0.001). Wound infection rates were also lower in the LA group (2% vs. 10%; p = 0.04). Conclusions: Laparoscopic appendectomy offers superior postoperative outcomes compared to open appendectomy and should be preferred in suitable cases, provided surgical expertise and equipment are available.

Background: Laryngoscopy and tracheal intubation often result in sympathetic stimulation leading to significant haemodynamic changes. Dexmedetomidine, an α2-adrenergic agonist, has shown potential in blunting these responses. This study compares two different doses of dexmedetomidine to assess their efficacy in attenuating haemodynamic responses during tracheal intubation. This study aims to contribute to the optimization of dexmedetomidine dosing strategies in general anesthesia, particularly in settings requiring blunting of laryngoscopy-induced sympathetic responses. Material and Methods: This randomized, double-blind study included 60 adult patients undergoing elective surgery under general anesthesia. Group A (n=30) received dexmedetomidine 0.5 μg/kg and Group B (n=30) received 1 μg/kg intravenously over 10 minutes before induction. Induction was with propofol 2 mg/kg and vecuronium 0.1 mg/kg. Intubation was performed 3 minutes after muscle relaxant administration. Haemodynamic parameters—heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)—were recorded at baseline, after drug infusion, immediately post-intubation, and at 1, 3, 5, and 10 minutes post-intubation. Results: Comparable Age between Group A (38.3 ± 8.2 years) and Group B (36.9 ± 7.5 years), p = 0.52. Distribution of Sex beteen Group A = 16 males, 14 females; Group B = 17 males, 13 females, p = 0.80. Whereas, Weight between Group A = 64.2 ± 6.1 kg; Group B = 63.5 ± 5.9 kg, p = 0.65. Group B (1 µg/kg) had a markedly lower rise in heart rate post-intubation. MAP, a key indicator of perfusion, increased significantly post-intubation in Group A. Group B maintained lower and more stable MAP, affirming that 1 µg/kg is the more effective dose for pressor response suppression. Conclusion: Dexmedetomidine 1 μg/kg is more effective than 0.5 μg/kg in blunting haemodynamic responses to tracheal intubation, with acceptable safety and sedation profile..

Background: Orthopedic surgical site infections (SSIs) are significant contributors to postoperative morbidity, prolonged hospital stays, and increased healthcare costs. The burden is particularly high in resource-limited settings where infrastructural constraints, limited infection control measures, and delayed presentation exacerbate the problem. This meta-analysis aimed to estimate the pooled prevalence of orthopedic SSIs and to evaluate the effectiveness of preventive interventions implemented in low- and middle-income countries (LMICs). Methods: A systematic search was conducted across PubMed, Embase, Scopus, and Cochrane Library databases for studies published between January 2000 and December 2024. Eligible studies reported either the prevalence of SSIs in orthopedic procedures or assessed preventive strategies such as preoperative antibiotic prophylaxis, intraoperative sterile practices, and postoperative wound care bundles. Data were extracted independently by two reviewers and synthesized using a random-effects model to estimate pooled prevalence rates and risk ratios for preventive measures. Heterogeneity was quantified using the I² statistic. Results: A total of 43 studies encompassing 28,500 orthopedic procedures were included. The pooled prevalence of SSIs was 12.3% (95% CI: 9.7–15.4%), substantially higher than reported rates in high-income settings. Gram-positive cocci, particularly Staphylococcus aureus, accounted for 56% of infections. Implementation of standardized infection prevention bundles reduced SSI risk significantly (RR 0.58, 95% CI: 0.44–0.75). Subgroup analyses revealed higher infection rates in trauma surgeries compared to elective procedures and in facilities lacking adequate sterilization infrastructure. Conclusion: Orthopedic SSIs remain a prevalent and preventable complication in resource-constrained environments. Adoption of evidence-based, low-cost infection control measures, including perioperative antibiotic prophylaxis, strict aseptic protocols, and community-level education, can markedly reduce infection rates. Strengthening health system capacity and prioritizing infection prevention should be integral to surgical care strategies in LMICs.

Background: This study aimed to compare the incidence and clinical implications of posterior capsular opacification (PCO) between hydrophobic and hydrophilic intraocular lenses (IOLs) over a two-year postoperative period. Methods: A total of 100 patients undergoing phacoemulsification cataract surgery at D.Y. Patil Medical College, Navi Mumbai, were enrolled between 2014 and 2016. Patients were randomly assigned to receive either a hydrophobic (n=50) or hydrophilic (n=50) IOL. PCO incidence, severity grading (0–3), Nd: YAG capsulotomy requirement, and time to event (months) were evaluated. Statistical analyses included chi-square tests, t-tests, and Mann–Whitney U tests where appropriate. Results: PCO incidence was significantly higher in the hydrophilic group (38.0%) than the hydrophobic group (10.0%) (χ² = 11.52, p = 0.0007). The severity distribution was skewed toward higher grades in the hydrophilic group (p = 0.002). Nd: YAG capsulotomy was required in 32.0% of hydrophilic patients versus 6.0% of hydrophobic patients (χ² = 10.71, p = 0.0011). Median time to PCO development or capsulotomy was shorter for hydrophilic IOLs (13.1 ± 3.7 months vs. 18.9 ± 4.3 months, p < 0.001). Conclusion: Hydrophobic IOLs are associated with significantly lower incidence and severity of PCO and reduced need for Nd: YAG capsulotomy compared to hydrophilic lenses. These findings support the preferential use of hydrophobic IOLs in cataract surgery to minimize postoperative complications.

Background: Accurate differentiation between primary tumors and metastatic lesions is essential for appropriate cancer diagnosis, staging, and treatment planning. While conventional histopathology provides initial morphological guidance, overlapping features between tumor types often necessitate the use of immunohistochemical (IHC) markers to determine the tissue of origin. Objective: To systematically review the diagnostic utility of immunohistochemical markers in distinguishing primary from metastatic tumors, with a focus on lung and colorectal carcinomas. Methods: A comprehensive literature search was conducted using PubMed, Scopus, Embase, and Web of Science to identify articles published between January 2000 and April 2024. Studies were included if they evaluated the diagnostic performance of IHC markers—including sensitivity, specificity, and overall accuracy—in differentiating primary tumors from metastatic lesions. Data extraction and quality assessment were independently performed by two reviewers using the QUADAS-2 tool. Results: Twelve studies involving over 3,800 tumor samples met the inclusion criteria. Frequently evaluated markers included TTF-1, CDX2, CK7, CK20, SATB2, Napsin A, and p40. TTF-1 and Napsin A demonstrated high specificity for lung adenocarcinomas, while CDX2 and SATB2 were consistently reliable for colorectal origin. The CK7/CK20 immunophenotypic profile, although helpful, showed limitations in specificity when used alone. Diagnostic accuracy improved significantly when markers were used in organ-specific combinations rather than in isolation. Conclusion: IHC markers play a pivotal role in distinguishing primary from metastatic tumors, particularly in poorly differentiated or ambiguous cases. The strategic use of multimarker panels tailored to clinical context enhances diagnostic precision. Standardized protocols and the integration of IHC with molecular tools such as next-generation sequencing may further refine tumor classification and support personalized treatment strategies.

Background: Minimally invasive coronary artery bypass grafting (MICS-CABG) has emerged as an alternative to conventional CABG, offering reduced surgical trauma and faster recovery. This study aimed to compare clinical outcomes and quality of life between MICS-CABG and conventional CABG in a real-world setting. Methods: A prospective comparative study was conducted at SMS Medical College from March 2022 to February 2024. A total of 130 patients undergoing elective CABG were included, with 65 receiving MICS-CABG and 65 conventional CABG. Primary outcomes included ICU and hospital stay, postoperative pain, complication rates, time to return to normal activity, and quality of life (SF-36) at 6 months. Statistical analysis was performed using independent t-tests and chi-square tests. Results: MICS-CABG patients had significantly shorter ICU stays (1.9 ± 0.6 vs. 3.0 ± 0.9 days, p < 0.001), hospital stays (5.9 ± 1.1 vs. 8.7 ± 1.5 days, p < 0.001), and lower pain scores (3.0 ± 1.0 vs. 5.7 ± 1.3, p < 0.001). Return to normal activity was significantly faster (28.2 ± 4.4 vs. 45.2 ± 6.3 days, p < 0.001). Postoperative infection rates were lower in the MICS group (4.6% vs. 23.1%, p = 0.005), with similar MACE rates (1.5% vs. 3.1%, p = 1.000). SF-36 scores were higher in the MICS group for both physical (78.1 ± 5.8 vs. 68.9 ± 7.7, p < 0.001) and mental health domains (79.7 ± 6.1 vs. 73.6 ± 5.8, p < 0.001). Conclusion: MICS-CABG is associated with superior early postoperative outcomes, faster functional recovery, and better quality of life compared to conventional CABG. These findings support the broader adoption of minimally invasive techniques in eligible patients.

Background: Low back pain (LBP) is a common complaint during pregnancy, often leading to impaired daily function and reduced quality of life. Despite its high prevalence, LBP is frequently underreported and undertreated in antenatal care. This study aimed to assess the prevalence and risk factors associated with pregnancy-related low back pain. Objectives: To determine the prevalence of low back pain among pregnant women and evaluate associated demographic and obstetric risk factors. Methods: A cross-sectional observational study was conducted among 100 pregnant women attending antenatal clinics at a tertiary care hospital. Data were collected through structured interviews, physical examination, and self-reported pain assessment using the Visual Analog Scale (VAS). Risk factors including BMI, parity, lifestyle habits, and history of back pain were evaluated. Descriptive statistics and Chi-square tests were used for analysis, with a p-value <0.05 considered statistically significant. Results: The prevalence of LBP among pregnant women was 62%. Higher rates were noted in the third trimester (81%) compared to the first (33.3%) and second (55%) trimesters. Significant risk factors included BMI >25 kg/m² (p=0.002), sedentary lifestyle (p=0.006), multigravidity (p=0.004), poor sleep quality (p=0.012), and history of pre-pregnancy back pain (p=0.001). Most women reported moderate pain intensity and noted interference with daily activities. Conclusion: Low back pain is highly prevalent during pregnancy, especially in later trimesters, and is influenced by modifiable risk factors. Routine screening and early interventions may help improve maternal comfort and function.

Background: Scaphoid fractures are the most common carpal bone injuries and often present diagnostic and therapeutic challenges due to complex vascular anatomy. Herbert screw fixation offers stable internal fixation, enabling early mobilization and promoting fracture union. Objectives: To assess the functional and radiological outcomes of scaphoid fractures managed with open or percutaneous Herbert screw fixation and to evaluate approach-specific results and complications. Methods: This prospective observational study was conducted over 18 months at Osmania General Hospital, Hyderabad. Twenty adult patients with displaced waist and proximal pole fractures were included. Fractures were classified using the Herbert classification and managed with Herbert screw fixation via volar or dorsal approaches, depending on fracture type. Functional outcome was evaluated using the Modified Mayo Wrist Score (MMWS), and radiographic union was assessed during follow-up. Results: The majority of patients were male (80%) and aged 25–34 years (60%). Herbert type B2 fractures were most common (60%). The volar approach was employed in 75% of cases, and the dorsal approach in 25%. Radiological union was achieved in all cases, with 65% of patients attaining excellent and 30% good functional outcomes. Minor complications such as wrist pain (20%) and stiffness (15%) were observed, all resolving with conservative management. Conclusion: Herbert screw fixation is a reliable and effective method for managing scaphoid fractures, ensuring high union rates and good functional recovery with minimal complications.

Introduction: Geriatric patients are particularly vulnerable to hemodynamic instability following spinal anaesthesia due to age-related physiological changes. This study aimed to evaluate the incidence, pattern, and management of hemodynamic changes during spinal anaesthesia in elderly patients undergoing lower limb surgery. Methods: A prospective observational study was conducted on 100 patients aged ≥65 years scheduled for elective lower limb surgeries under spinal anaesthesia. Hemodynamic parameters including systolic and diastolic blood pressure and heart rate were recorded at baseline and at 5, 10, 15, and 30 minutes post-spinal anaesthesia. The incidence of hypotension (≥20% drop in SBP), bradycardia (HR < 60 bpm), and use of vasopressors or anticholinergics was documented. Results: The mean age of the participants was 72.4 ± 5.8 years, with 62% being male. Hypotension occurred in 48% of patients, and bradycardia in 18%; 6% required atropine, and 28% required ephedrine. Maximum mean SBP and HR drops were 26.7 ± 7.9 mmHg and 14.1 ± 5.6 bpm, respectively. Hemodynamic values reached their lowest at 10 minutes and gradually returned toward baseline. Other observed complications included shivering (12%) and nausea/vomiting (9%). No patient required conversion to general anaesthesia. Conclusion: Spinal anaesthesia in the geriatric population is associated with a high incidence of hypotension and bradycardia, especially within the first 10 minutes post-induction. Close monitoring and timely pharmacological intervention are essential to ensure hemodynamic stability in this vulnerable group.

Background: Osteoarthritis (OA) of the knee is a progressive degenerative joint disorder frequently seen in the aging population. Conventional treatments often provide symptomatic relief without modifying disease progression. Platelet-rich plasma (PRP), an autologous biologic, has gained attention for its regenerative and anti-inflammatory properties. Objective: To evaluate the efficacy of intra-articular PRP injections in patients with mild to moderate knee OA. Materials and Methods: This prospective clinical study included 60 patients aged 40–70 years with Kellgren-Lawrence grade I–III knee OA. Each patient received three weekly intra-articular PRP injections. Pain and functional outcomes were assessed at baseline, 1 month, 3 months, and 6 months using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: Significant reductions were observed in mean VAS scores (from 7.3 to 3.4) and WOMAC scores (from 62.1 to 31.8) over 6 months (p < 0.001). Greater improvement was noted in KL grade I–II compared to grade III. Conclusion: PRP is a safe and effective modality for pain relief and functional improvement in early knee OA. It offers a promising biologic alternative for patients unresponsive to conservative therapies.

Background: Intertrochanteric fractures are among the most common injuries in the elderly, often resulting in significant morbidity and reduced quality of life. The Proximal Femoral Nail Antirotation (PFNA) system has been widely used to provide stable fixation and early mobilization. This study aimed to evaluate the functional outcomes of intertrochanteric fractures treated with PFNA in elderly patients. Methods: This prospective observational study included 100 elderly patients (aged ≥60 years) with intertrochanteric fractures treated with PFNA over a 12-month period. Patients were followed for six months postoperatively. Demographic data, fracture classification (AO/OTA), surgical details, complications, and Harris Hip Scores (HHS) at 3 and 6 months were recorded. Results: The mean age of the cohort was 74.6 ± 6.8 years, with 58% males. Low-energy falls accounted for 85% of injuries. Fracture classification included AO/OTA 31-A1 (46%), 31-A2 (38%), and 31-A3 (16%). The mean time to surgery was 3.4 ± 1.2 days. Superficial wound infections (5%), implant-related complications (3%), and DVT (2%) were noted. At 6 months, mean HHS improved to 85.3 ± 7.2, with 74% of patients showing good to excellent outcomes. Radiological union occurred in a mean of 14.2 weeks. Independent ambulation was regained by 92% of patients. Conclusion: PFNA offers favorable functional outcomes with minimal complications in elderly patients with intertrochanteric fractures. Early mobilization and stable fixation contribute significantly to improved postoperative recovery and quality of life.

Background: Tuberculosis (TB) continues to be a major public health burden in India, accounting for nearly one-fourth of global TB cases. Early and accurate diagnosis is essential to reduce transmission and improve outcomes. While sputum smear microscopy remains widely used, its sensitivity is limited. Molecular platforms such as GeneXpert have improved TB detection but are constrained by infrastructure requirements. TrueNat, a chip-based portable PCR platform, has emerged as a promising alternative for decentralized settings. Objective: To evaluate the diagnostic accuracy of the TrueNat MTB assay for detecting Mycobacterium tuberculosis in suspected pulmonary TB patients, using LJ culture as the gold standard. Methods: A cross-sectional study was conducted at a tertiary care hospital with 150 adult patients presenting with clinical suspicion of pulmonary TB. Sputum samples were tested using AFB microscopy, GeneXpert, TrueNat MTB, and LJ culture. Sensitivity, specificity, PPV, and NPV were calculated for TrueNat. Results: TrueNat showed a sensitivity of 91.3%, specificity of 95.2%, PPV of 93.5%, and NPV of 94.1% compared to culture. Its performance was comparable to GeneXpert and significantly superior to AFB smear microscopy (sensitivity 67.0%). No statistically significant difference was observed between GeneXpert and TrueNat (p > 0.05). Conclusion: TrueNat demonstrates excellent diagnostic performance for pulmonary TB and is suitable for peripheral settings due to its portability and minimal infrastructure requirements. Integration into the national TB diagnostic algorithm may enhance early case detection.

Background: Letrozole is a first-line ovulation induction agent in women with polycystic ovary syndrome (PCOS); however, a subset fails to respond, termed letrozole-resistant. This study evaluates the efficacy of adding dexamethasone to letrozole in inducing ovulation among these resistant cases. Methods: A retrospective observational study was conducted on 60 infertile women with PCOS who had failed to ovulate despite three cycles of letrozole at 7.5 mg/day. Patients were treated with letrozole (5 mg/day, days 2–6) and dexamethasone (0.5 mg/day, days 2–12). Follicular response was monitored via transvaginal sonography, and hCG was administered when dominant follicles reached ≥18 mm. Results: Ovulation occurred in 70% (n=42) of patients, with a clinical pregnancy rate of 30% (n=18). The mean endometrial thickness on the day of trigger was 8.4 ± 1.3 mm. Ovulatory patients had significantly lower BMI, LH/FSH ratios, and DHEAS levels than non-responders (p < 0.05). No significant adverse effects or cases of OHSS were noted. Conclusion: Letrozole combined with dexamethasone is a promising and safe second-line option for ovulation induction in letrozole-resistant PCOS. Further prospective studies are needed to validate these findings.

Background: Hollow viscous perforation is a serious condition requiring urgent surgery, and diabetes may worsen outcomes due to its effects on the body, such as impaired healing and immune function. This study looked at 60 patients, half with diabetes and half without, to see how diabetes affects recovery after surgery for this condition. Methods: The study followed 60 patients over 18 months at a hospital, with 30 having diabetes and 30 not. They collected data on patient details, symptoms, lab tests, surgery types, and recovery to compare the two groups.  Results: Diabetic patients were older on average (48 years vs. 38 years) and showed unique symptoms, like tense abdomen, not seen in non-diabetics. They had higher heart rates, lower oxygen levels, and worse blood sugar control. After surgery, diabetics needed more ICU time (67% vs. 40%), more antibiotics (73% vs. 40%), and had more complications (70% vs. 27%), with 17% dying compared to none in the non-diabetic group. Tests also showed more tuberculosis in diabetic patients. Conclusions: It appears diabetic patients face tougher recovery challenges, with higher risks of complications and death. This suggests doctors should be extra careful and provide more support after surgery for these patients.

Background: Type 1 Diabetes Mellitus (T1DM), or juvenile diabetes, is a chronic autoimmune condition increasingly affecting children. Early recognition of symptoms and risk factors is vital to prevent severe complications and improve outcomes. Objective: To evaluate caregiver awareness and identify risk indicators of juvenile diabetes among pediatric populations through a structured questionnaire survey. Methods: A cross-sectional study was conducted among 250 caregivers of children aged 5–16 years using a validated questionnaire covering demographics, symptom awareness, lifestyle patterns, and family history. Descriptive and inferential statistics, including Chi-square tests, were used to analyze the data. Results: Only 18.4% and 16.8% of respondents recognized polydipsia and polyuria, respectively, as symptoms of T1DM. A significant proportion (40%) had no awareness of any diabetic symptoms. Family history of diabetes was reported in 24.8% of cases. Awareness was significantly higher among graduates (p = 0.001) and those with family history (p = 0.03). High-sugar diets and sedentary lifestyle were prevalent among children. Conclusion: Caregiver awareness of juvenile diabetes remains inadequate, particularly among those with no family history or lower education levels. Structured awareness campaigns and school-based screening could facilitate early detection and better disease outcomes.

Background: The success of complete denture therapy relies on multiple factors, notably the materials used and the fabrication techniques employed. With emerging digital technologies, newer methods such as CAD/CAM milling and 3D printing offer potential improvements over conventional processing. This study aimed to evaluate and compare the material properties and clinical performance of complete dentures fabricated using three different techniques. Methods: A total of 45 maxillary and mandibular dentures were fabricated and categorized into three groups: Group A (conventional heat-cured PMMA), Group B (CAD/CAM milled), and Group C (3D printed). Surface hardness, flexural strength, and dimensional accuracy were tested in vitro. Additionally, 15 edentulous patients (5 per group) were rehabilitated, and clinical fit and patient satisfaction were assessed. Results: Group B (CAD/CAM) demonstrated the highest surface hardness (22.8 HV), flexural strength (95.6 MPa), and dimensional accuracy (58.3 µm RMS error), followed by Group C and Group A. Patient satisfaction scores were also highest for CAD/CAM dentures (mean score 4.8/5), with statistically significant differences among groups (p<0.05). Conclusion: CAD/CAM milled dentures outperformed conventional and 3D printed dentures in both material properties and clinical outcomes. Digital techniques offer promising alternatives for complete denture fabrication.

Background: Hepatic encephalopathy (HE) is a severe neuropsychiatric complication of chronic liver disease (CLD) caused by impaired detoxification and neurotoxin accumulation. Various factors like infections, GI bleeding, and electrolyte imbalances can trigger HE. This study aimed to analyze the clinical profile, identify precipitating factors, and assess their impact on patient outcomes. Methods: A hospital-based descriptive study was conducted on 440 patients with cirrhosis of the liver presenting with HE over 18 months. Clinical history, investigations, and treatment details were recorded. HE was graded using the West Haven criteria, and cirrhosis severity was assessed using the Child-Turcotte-Pugh score. Results: The median age of patients was 46.3 years, with a male predominance (88.8%). Alcoholism was the most common cause of cirrhosis (60%). The leading precipitating factors were constipation (45%), melena (32.9%), hematemesis (28%), hyponatremia (23.6%), and infections (17.5%). Disorientation (75.9%) and confusion (75.6%) were the most common symptoms, while asterixis (74%), pedal edema (62%), icterus (60%), ascites (60.6%), and pallor (59%) were the most common signs. The majority of patients were in Child-Pugh Class C (60%), with a higher mortality rate (91.03%). Most cases were classified as Grade III (30%) or IV (27.95%) HE. Patients with more than two precipitating factors had the highest mortality (62.5%). Conclusion: Hepatic encephalopathy in cirrhotic patients is frequently triggered by preventable factors such as upper GI bleeding, infections, electrolyte imbalances, and constipation. Health education, infection control, regular upper GI endoscopy, judicious use of diuretics and sedatives, and dietary modifications are essential for reducing HE incidence and mortality. Early recognition and management of precipitating factors can significantly improve patient outcomes.

Background: Pediatric head trauma is a common emergency with varying clinical outcomes. Computed tomography (CT) remains a crucial diagnostic tool for detecting intracranial injuries, but judicious use is essential to minimize radiation exposure. To assess the CT imaging characteristics of pediatric head trauma cases presenting to an emergency department and evaluate the association between clinical presentation, Glasgow Coma Scale (GCS) scores, and CT findings. Methods: An observational study was conducted on 50 pediatric patients (ages 1–15 years) presenting with head trauma at a tertiary care emergency department. Demographic details, mechanisms of injury, clinical presentations, GCS scores, and CT findings were recorded. Associations between GCS scores and CT abnormalities were analyzed descriptively. Results: The mean age of the patients was 7.8 ± 3.4 years, with a male predominance (62%). The most common injury mechanism was falls (52%), followed by road traffic accidents (28%). Loss of consciousness (38%) and scalp laceration/contusion (44%) were common clinical features. CT scans were normal in 58% of cases; abnormal findings included skull fractures (18%), subdural hematomas (10%), and epidural hematomas (6%). Abnormal CT findings were more prevalent in patients with lower GCS scores: 30% in mild (GCS 13–15), 83.3% in moderate (GCS 9–12), and 100% in severe cases (GCS ≤8). Neurosurgical intervention was required in 10% of patients, with a 2% mortality rate. Conclusions: A significant association exists between GCS scores and CT abnormalities in pediatric head trauma. CT imaging should be guided by clinical assessment to optimize patient care and minimize unnecessary radiation exposure.

Introduction: Postoperative analgesia is essential following cesarean sections (LSCS) to improve maternal comfort and early recovery. Traditional opioid-based methods have notable side effects, making the Transversus Abdominis Plane (TAP) block a favorable alternative. This study compares 0.25% levobupivacaine and ropivacaine in TAP blocks for LSCS analgesia. Materials and Methods: In a prospective, randomized, double-blind trial, 60 patients undergoing LSCS were divided into two groups receiving TAP blocks with either 0.25% levobupivacaine or ropivacaine. Pain was assessed using a Visual Analog Scale (VAS) at multiple time points post-surgery, and the need for rescue analgesia was recorded. Results: VAS scores were significantly lower in the ropivacaine group at 6-, 8-, and 10-hours post-surgery (P < 0.05), and ropivacaine patients required fewer rescue analgesics. Both patient and surgeon satisfaction scores were higher in the ropivacaine group (P < 0.05). Discussion: Ropivacaine provided superior analgesia and longer pain relief, reducing the need for additional opioids. This aligns with previous findings on the efficacy of ropivacaine in TAP blocks. Conclusion: The TAP block with 0.25% ropivacaine offers effective, prolonged postoperative analgesia in LSCS, improving patient comfort and satisfaction while minimizing opioid use and associated side effects.

Background: Delirium is a frequent and serious complication among mechanically ventilated intensive care unit (ICU) patients, often associated with prolonged hospitalization and increased mortality. Sedation strategy may influence delirium incidence. This study compared the effects of dexmedetomidine and propofol on the incidence of delirium and clinical outcomes in mechanically ventilated ICU patients. Methods: A prospective, randomized, controlled trial was conducted among 100 ICU patients requiring mechanical ventilation. Participants were assigned to receive either dexmedetomidine (n = 50) or propofol (n = 50) for sedation. Delirium was assessed twice daily using the Confusion Assessment Method for the ICU (CAM-ICU). Other outcomes measured included duration of mechanical ventilation, ICU length of stay, mortality, and sedation-related adverse events (hypotension and bradycardia). Results: Delirium incidence was significantly lower in the dexmedetomidine group (22%) compared to the propofol group (40%) (p = 0.045). The mean duration of mechanical ventilation was also shorter with dexmedetomidine (4.2 ± 1.5 days) than with propofol (5.1 ± 1.8 days, p = 0.030). No significant differences were found in ICU length of stay (p = 0.210) or ICU mortality (p = 0.729). Bradycardia occurred more frequently in the dexmedetomidine group (20% vs. 8%, p = 0.082), while hypotension was slightly more common with propofol (18% vs. 12%, p = 0.402). Conclusion: Dexmedetomidine sedation was associated with a significantly lower incidence of delirium and shorter duration of mechanical ventilation compared to propofol, without increasing ICU mortality.a

Background: The timing of dental implant placement in the anterior maxilla significantly influences clinical and aesthetic outcomes. Immediate implant placement offers reduced treatment duration, while delayed placement is traditionally associated with predictable healing and stability. Aim: To compare the clinical, radiographic, and patient-centered outcomes of immediate versus delayed implant placement in the aesthetic zone through a prospective clinical study. Materials and Methods: A total of 40 patients requiring single-tooth replacement in the maxillary anterior region were randomly assigned into two groups: immediate implant placement (n=20) and delayed implant placement after 12 weeks of healing (n=20). Parameters assessed included marginal bone loss, Pink Esthetic Score (PES), and patient satisfaction scores over a 6-month follow-up. Results: Both groups showed minimal marginal bone loss at 6 months (0.56 ± 0.18 mm in immediate vs 0.48 ± 0.20 mm in delayed; p=0.12). PES and patient satisfaction scores were slightly higher in the immediate group, though not statistically significant (p>0.05). Implant survival rate was 100% in both groups. Conclusion: Immediate and delayed implant placements in the aesthetic zone provide comparable outcomes in terms of bone preservation, soft tissue aesthetics, and patient satisfaction. Proper case selection is crucial for clinical success.

Background: Childhood trauma has been extensively linked to various psychiatric disorders, including psychosis. However, less is known about this relationship in non-clinical adult populations, where subclinical symptoms may provide early indicators of vulnerability. Objectives: This study aims to explore the association between different types of childhood trauma and the presence and severity of psychotic symptoms in a non-clinical adult population. Methods: We conducted a cross-sectional study involving 140 adults from a non-clinical setting. Participants completed standardized questionnaires assessing their exposure to childhood trauma (physical, emotional, sexual abuse, and neglect) and current psychotic symptoms. Statistical analyses included t-tests, ANOVA, and Chi-square tests to compare means and proportions, with significance set at p<0.05. Results: Of the participants, 65.7% reported experiencing childhood trauma. The mean psychotic symptoms score was significantly higher in individuals with a history of trauma compared to those without (18.9 vs. 17.1, p<0.027). Emotional abuse was most strongly associated with psychotic symptoms (p<0.001), followed by neglect, physical, and sexual abuse.

Conclusion: Childhood trauma is significantly associated with higher psychotic symptoms scores in a non-clinical adult population. Emotional abuse appears to have the strongest correlation, emphasizing the need for targeted interventions to mitigate the long-term psychological effects of trauma.

Introduction: Burn injuries are a significant global health concern, requiring immediate and specialized care to minimize morbidity and mortality. Postgraduate medical trainees across multiple specialties, including General Surgery, Anesthesiology, Emergency Medicine, General Medicine, and Pediatrics, play a crucial role in managing burn cases. Objectives: This study aims to assess the knowledge, attitude, and practice (KAP) of postgraduate medical students regarding the treatment of burn injuries. Methods: A cross-sectional survey was conducted among postgraduate trainees in tertiary care hospitals. A validated questionnaire assessed their knowledge, attitudes, and practices related to burn management. Statistical analysis was performed to evaluate differences among specialties. Results: A total of 150 postgraduate students participated. Significant gaps in knowledge were observed, particularly in fluid resuscitation and wound care. Emergency medicine residents scored the highest in acute burn management, while pediatric residents exhibited lower confidence levels in treating burn injuries. Conclusion: There is a need for structured training programs to enhance postgraduate medical trainees' competencies in burn treatment. Focused educational interventions can improve patient outcomes.

Background-Neonatal jaundice is a prevalent condition affecting 60% of full-term and 80% of preterm infants globally, often leading to hospital readmissions. It typically manifests within the first few days after birth and can have severe consequences, including neurotoxicity and kernicterus, if not promptly identified and managed. This study aims to evaluate the impact of maternal risk factors on the incidence of neonatal jaundice at a tertiary care center in central India. Methods-This cross-sectional comparative study was conducted from January 2017 to June 2018 at the Department of Paediatrics, Index Medical College Hospital & Research Centre, Indore, (M.P). Data were collected from newborn medical records, including demographic and clinical information of both neonates and their mothers. The study included neonates up to 28 days old with jaundice, born both inborn and outborn, including those with low birth weight, ABO, and Rh incompatibility. Exclusion criteria were age over 28 days, lack of parental consent, and insufficient pregnancy or delivery information. Results-Out of 100 cases, 64% of mothers were aged 21-25 years, and 50% were first-time mothers. Hospital deliveries accounted for 88% of cases, with 67% of deliveries being via lower segment cesarean section (LSCS). Maternal factors contributing to neonatal jaundice included anemia (81%), fever (14%), hypothyroidism (6%), diabetes (4%), TORCH infections (5%), and Rh-negative status (11%). Among the neonates, 64% developed jaundice between 2-7 days old, with higher mean bilirubin levels observed in those older than 72 hours (19.92 mg/dl) compared to those younger (16.06 mg/dl). Conclusion-Neonatal jaundice is predominantly observed within the first week of life, particularly in newborns less than 7 days old. Maternal sociodemographic factors and illnesses significantly contribute to its incidence. Timely monitoring, effective management of maternal health conditions, and comprehensive prenatal care are essential to mitigate the risk and reduce the occurrence of neonatal jaundice.

Background: Dental implants are widely used for the rehabilitation of edentulous spaces, but prosthetic complications can affect their long-term success. Understanding the frequency and types of these complications is crucial for improving treatment outcomes. This study aims to evaluate the incidence and nature of prosthetic complications associated with dental implants. Materials and Methods: A retrospective analysis was conducted on 120 patients who received a total of 200 dental implants between 2018 and 2023. The types of prosthetic restorations included single crowns (50%), fixed partial dentures (30%), and implant-supported overdentures (20%). Prosthetic complications such as screw loosening, abutment fractures, veneer chipping, and prosthetic misfit were recorded. Data were analyzed using descriptive statistics and chi-square tests to determine significant associations. Results: Among the 200 implants, 35% experienced at least one prosthetic complication. The most common issue was screw loosening (40%), followed by ceramic veneer chipping (25%), abutment fractures (20%), and prosthetic misfit (15%). Fixed partial dentures exhibited the highest complication rate (45%), whereas single crowns had a lower incidence (30%). A significant correlation was found between complication rates and the type of prosthetic restoration (p < 0.05). Conclusion: Prosthetic complications remain a challenge in implant dentistry, with screw loosening and veneer chipping being the most prevalent issues. Regular follow-ups and meticulous treatment planning can help mitigate these complications, ensuring long-term prosthesis stability and patient satisfaction. Further studies are needed to evaluate the impact of different prosthetic designs and materials on complication rates.

Background: Decrease in amniotic fluid volume or Oligohydramnios has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Aims & Objective: (1) To study affects Oligohydramnios on fetal outcome in form of (a) Fetal distress (b) Growth retardation (c) NICU admission (2) To study APGAR scores of newborn babies in relation to Oligohydramnios (3) To study incidence of congenital malformation (4) To study early neonatal morbidity and mortality (5) To study maternal morbidity in form of operative delivery and induced labour. Material and Methods: Present study was done over a period from May 2024 to November 2024. 100 patients in third trimester of pregnancy with Oligohydramnios selected randomly after satisfying inclusion and exclusion criteria. A detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring AFI. Results: Mean maternal age-23.66 years. Incidence of oligohydramnios was more in primipara (52%) in our study. And operative morbidity was also more in primipara. Most common cause of Oligohydramnios is idiopathic (52%). Second commonest cause is PIH (25%). Operative morbidity is highest in PIH (60%). Operative morbidity was significantly higher in NST (non-stress test) non-reactive (3.12 ± 75=78.12%) group than NST reactive (26.47%) group. Most common reason to perform caesarean was fetal distress which was either due to cord compression or IUGR. 7% patients were found with fetoplacental insufficiency on Doppler study. Oligohydramnios was related to higher rate of growth retardation and NICU (neonatal intensive care unit) admission. Conclusion: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidity prevented and other side timely intervention can reduce perinatal morbidity and mortality.

Background & Method: The aim of the study is to determine the benefits and limitations of the presence of female birth companion on maternal and fetal outcomes, perception and experience of labouring women and health care workers. Perception & experience of patients & health care providers was assessed through questionnaires & data entered on pre structured proforma and then comparison was done with the control group. Result: 31.5% participants felt the birthing experience is excellent, 43% felt the birthing experience is good and 25.5% felt the birthing experience is not good with a birth companion. Without a birth companion 14% participants felt that the birthing experience is excellent, 37% felt the birthing experience is good and 49% felt that the birthing experience is not good.  The chi-square statistic is 13.3461 (p-value 0.003945). 7.5% of the babies of mothers with birth companion are referred to SNCU and 89% babies are motherside. 12% of the babies of mothers without birth companion are referred to SNCU and 85.5% babies are motherside. Conclusion: The results of our study showed a significant reduction of childbirth fear, anxiety and pain, enhanced childbirth self-efficacy, and increased birth companion social support in the intervention group compared with the control group. It is evident from the present study’s findings that adequate childbirth preparation in primigravid women is vital to simultaneously improve their psychosocial well-being and enhancing their ability to give birth. In the current study, birth companion support revealed a greater change in the intervention group than in the control group in terms of anxiety, pain and fear. These results were desirable, as primigravid women are generally more apprehensive about childbirth and need concrete social support before and after childbirth.

Background: Diffuse interstitial lung disease (ILD) is a heterogeneous group of pulmonary disorders with varied clinical, radiological, and histopathological presentations. This study aims to examine the demographic, clinical, radiological, and diagnostic characteristics of patients diagnosed with ILD. Methods: A total of 150 patients diagnosed with ILD were included in the study. Demographic data, clinical symptoms, and comorbidities were recorded. High-resolution CT (HRCT) thorax imaging was used to assess radiological abnormalities. The final diagnoses were based on clinical evaluation, imaging findings, and histopathological examination. Results: The study cohort consisted predominantly of males (59.3%) aged between 50-69 years. The most common clinical symptoms were exertional breathlessness and cough. Radiological findings on HRCT included ground glass opacities (52.5%), interlobular septal thickening (39.3%), and honeycombing (28.7%). A diffuse pattern of lung involvement was observed in the majority of patients. The most frequent ILD diagnosis was Idiopathic Pulmonary Fibrosis (IPF), followed by Non-IPF Idiopathic Interstitial Pneumonia and Nonspecific Interstitial Pneumonia. Conclusion: The study highlights the importance of careful clinical and radiological assessment in the diagnosis of ILD, which remains challenging due to the heterogeneity of the disease.

Background: Breast cancer is a multifactorial disease influenced by genetic, environmental, and hormonal factors. In recent years, it has become evident that vitamin D receptor (VDR) polymorphisms can play a key role in influencing breast cancer susceptibility. This report explores the relation between common VDR gene polymorphisms and the susceptibility to breast cancer in 150 women. Methods: A case-control study was conducted, which included 75 breast cancer patients and 75 age-matched healthy controls. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) genotyping of four common VDR polymorphisms-FokI, BsmI, ApaI, and TaqI-was used to assess associations between VDR polymorphisms and the risk of breast cancer using logistic regression models. Results: Significant associations between specific VDR polymorphisms and increased breast cancer risk were found. The FokI polymorphism, in particular, with the TT genotype, was significantly associated with increased susceptibility (p < 0.01), while the ApaI polymorphism, with the AA genotype, was related to decreased risk (p < 0.05). Additive effects on the modulation of risk were seen when genotypes were analyzed in combination. Conclusion: The present study clearly demonstrates the implication of VDR polymorphisms in breast cancer susceptibility, indicating their potential utility as genetic markers for risk stratification. Further research is needed to clarify the mechanisms by which these polymorphisms result in increased risks and their translation to clinical practice.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are chronic respiratory conditions that significantly impact patients' quality of life. Proper use of inhalational devices is crucial for effective management of these conditions. This study aimed to evaluate the knowledge, attitude, and practice (KAP) regarding the use of inhalational devices among asthma and COPD patients. A cross-sectional study was conducted involving 300 patients (150 asthma and 150 COPD) from a tertiary care hospital. Data were collected using a structured questionnaire and analyzed using descriptive and inferential statistics. The results revealed significant gaps in knowledge and practice, with only 40% of asthma patients and 35% of COPD patients demonstrating correct inhaler technique. Attitudes towards inhaler use were generally positive, but misconceptions and lack of adherence were prevalent. The study highlights the need for targeted educational interventions to improve inhaler use among these patient populations.

Background: The rise of vegan nutraceuticals has revolutionized dietary supplementation, addressing challenges such as poor compliance, taste, and bioavailability associated with traditional delivery systems. This study evaluates the clinical efficacy and patient outcomes of two innovative delivery systems—opaque gummies and oral dissolving strips (ODS)—developed using liposomal encapsulation and nanodrop technology. Methods: A prospective, observational study was conducted over 12 months at a private hospital, involving 200 participants aged 18–65 years with nutritional deficiencies or specific health concerns. Participants were divided into two groups: Group A (opaque gummies) and Group B (ODS). Biochemical markers (e.g., Vitamin D, hemoglobin), patient-reported outcomes (e.g., taste satisfaction, ease of use), and compliance rates were assessed at baseline, 4, 8, and 12 weeks. Data were analyzed using paired t-tests and descriptive statistics. Results: Significant improvements were observed in serum Vitamin D levels (+18.5 ng/mL, p<0.001) and hemoglobin levels (+1.4 g/dL, p<0.001). Sleep quality scores improved by +3.2 points (p<0.001) in participants using melatonin gummies. Compliance rates were 92% for gummies and 97% for ODS. Patient satisfaction was high, with mean scores of 4.7/5 for gummies and 4.8/5 for ODS. No adverse events were reported. Conclusion: Vegan gummies and ODS demonstrated significant clinical efficacy, high patient satisfaction, and superior compliance, highlighting their potential to address nutritional deficiencies and enhance health outcomes. These delivery systems represent a major advancement in dietary supplementation.

Introduction: Acute generalized peritonitis from gastrointestinal hollow viscus perforation is a potentially life-threatening condition. It is a common surgical emergency in many general surgical units in the developing countries and it is often associated with high morbidity and mortality. Aims and Objectives: To evaluate the prognostic value of APACHE II scoring system in cases of perforation peritonitis and to examine its usefulness in stratifying the patients according to their surgical risk. Material and Methods: The study was conducted in the Department of General Surgery, Pt. B.D. Sharma PGIMS, Rohtak.  The study population included 100 of cases of perforation peritonitis who underwent surgery after fulfilling the inclusion criteria over a period of one year.  Results: In the present study, 85 patients were males and 15 were females. Age ranged from 18 years to 80 years with mean age of 37.04. 38.0% patients had enteric perforation, 30.0% patients had peptic perforation, 22.0% patients had tubercular perforation, 5.0% patients had perforation due to gangrenous bowel, 3.0% patients had appendicular perforation and 2.0% patients had colonic perforation. 62.0% patients had APACHE II score between 0 to 6, 30.0% patients had APACHE II score between 7 to 12, 8.0% patients had APACHE II score between 13 to 18 and mean of APACHE II score was 6.40. 90.0% patients were discharged and 10.0% patients expired. Among discharged patients 47 patients were discharged without any complication, 32 discharged patients had only local complication. Eleven patients were discharged after treating both local and systemic complications. Amongst expired patients, 4 patients expired within 72 hours while 6 patients expired after 72 hours.  Four patients who expired within 72 hours had delayed presentation. They presented after 72 hours of onset of their symptoms and all four of them having oliguria and uremia. In study 27.4% of the patients in the group APACHE II score 0 to 6  had complications, 86.7% patients in the group APACHE II score 7 to 12 had  complications and 100.0% of the patients in the group APACHE II score 13 to 18 had complication. Patients in group APACHE II score 0 to 6 did not require ICU admission, 16.7% of the patients in group APACHE II score 7 to 12 had ICU Admission, 87.5% of the patients in  group APACHE II score 13 to 18 had ICU Admission. Patients in the group APACHE II score 13 to 18 had the largest proportion of ICU Admission.   All patients in the group of APACHE II score 0 to 6 were discharged, 93.3% of the patients in the group of APACHE II score 7-12 were discharged while 6.7% of the patients were expired. All of the patients in the group of APACHE II score 13 to 18 expired. Conclusion: Study concluded that the APACHE II score can be used to predict the outcome of patients who presents with hollow viscus perforation. Patients with an APACHE II score of more than 14 have very high risk of mortality postoperatively and those who have a score of less than 10 are at risk of developing systemic complications

Aim: This literature review aims to explore the role of direct oral anticoagulants (DOACs) in the management of cancer-associated thrombosis (CAT), focusing on their efficacy, safety, and practical applications in clinical care. It seeks to summarize key clinical trial data, compare DOACs with traditional anticoagulation options, and discuss considerations for selecting optimal therapy in patients with cancer. Materials and methods: This study is a narrative review of the current literature on the role of direct oral anticoagulants (DOACs) in cancer-associated thrombosis. A comprehensive MEDLINE search was conducted using the PubMed database to identify relevant articles published up to 2024. Studies were included if they involved patients with cancer-associated thrombosis, evaluated the use of DOACs, and reported on outcomes related to efficacy or safety. Adult patients (≥18 years of age) with a primary cancer diagnosis (except skin cancer) during at least 1 inpatient or 2 outpatient visits within 6 months before the venous thromboembolism (VTE) developed were included. Articles were excluded if they were case reports, reviews, editorials, or focused on pediatric populations. The selection process involved screening titles and abstracts, followed by a full-text review to ensure eligibility. Data from eligible studies were extracted, including study design, population characteristics, type and dose of DOACs, comparator treatments, and outcomes such as thrombotic recurrence and bleeding events. The findings were synthesized qualitatively to identify patterns and trends in efficacy and safety outcomes. This review was limited to English-language articles available on PubMed, potentially excluding relevant research from other databases or languages. Results: Both treatment options, i.e., LMWHs and DOACs, are reliable solutions in VTE cancer-associated management and expand the spectrum of pharmaceutical choices in CAT patients. Apixaban, edoxaban, and rivaroxaban have demonstrated promising outcomes, with apixaban showing a particularly favorable safety profile in patients with gastrointestinal cancers. Conclusion: Data retrieved from the current literature, including RCTs and “real-world” studies, showed a favourable role of DOACs in CAT management, by highlighting their benefits and remarking upon the potential adverse outcomes.

Introduction Gall bladder is very common organ to be affected by many pathological diseases which include wide spectrum of the lesions from congenital ones to inflammatory or premalignant and malignant lesions and pre-neoplastic conditions like metaplasia and dysplasia, ultimately culminating into the neoplasia. Patients with cholelithiasis need proper surveillance as most of the carcinoma of gall bladder are found in association of the stones. As the most of the patients are asymptomatic, gall bladder carcinoma is often diagnosed late incidentally on histopathological examination accounting for the grave prognosis. Materials and Methods: This is a prospective study of 471 cholecystectomy specimens received in histopathology section of Department of Pathology over a period of 5 years from January 2016 to December 2020 at MGM Medical College and Hospital, Navi Mumbai. Clinical details of the patient including age and sex along with other relevant clinical findings were taken from the requisition forms received with the surgically resected cholecystectomy specimens. Results: The distribution of lesions in this study aligns with previously published literature, with non-neoplastic lesions being predominant. However, the proportion of xanthogranulomatous cholecystitis (11.1%) and carcinoma (3.9%) is slightly higher, likely due to increased awareness and detailed histopathological examination. Chronic cholecystitis is the most prevalent lesion, emphasizing the importance of early diagnosis and management to prevent complications. Neoplastic lesions, though less frequent, carry significant clinical implications, highlighting the need for vigilant screening in at-risk populations (older adults, metabolic syndrome).Histopathological examination remains crucial for differentiating between benign and malignant conditions, especially when radiological findings are inconclusive. Conclusions: The incidence of chronic calculus cholecystitis was found to be 57.76% with female preponderance and mostly in third decade. Malignancy of gall bladder is a rare condition. Routine histopathological examination of all cholecystectomy specimens is strongly recommended for the detection of various variants of chronic cholecystitis and also of incidental carcinoma of gall bladder which helps in their treatment and prognosis.

Cholelithiasis, or gallstone disease, is a common global health issue caused by the formation of calculi in the gallbladder. It presents a wide range of clinical manifestations, from asymptomatic cases to severe complications such as acute cholecystitis and gallstone pancreatitis. The present study aimed to evaluate the demographic characteristics, clinical presentation, and types of gallstones, surgical approaches, and post-surgical outcomes in patients undergoing cholecystectomy.

A total of 100 patients diagnosed with cholelithiasis were analyzed. Of these, 66% were female and 34% male, indicating a higher prevalence among females. Most patients (42%) were aged between 41–60 years, followed by 32% in the 20–40 years age group and 26% above 60 years. Pain was the most common symptom, reported by all patients (100%), while 69% experienced nausea or vomiting, 11% had fever, and 10% presented with jaundice.

Mixed stones were the most prevalent type, observed in 47% of patients, followed by pigment stones in 36% and cholesterol stones in 17%. Laparoscopic cholecystectomy was the preferred surgical method, performed in 62% of cases, while the remaining 38% underwent open cholecystectomy. Post-surgical outcomes were favorable, with 90% of patients experiencing no complications and only 10% reporting minor complications. Pain is the most frequent presenting symptom of cholelithiasis, with mixed stones being the predominant type. Laparoscopic cholecystectomy remains the preferred surgical approach due to its minimal invasiveness and favorable outcomes.

Introduction: Pseudomonas aeruginosa is a ubiquitous gram-negative bacterium capable of causing a wide array of infections, particularly in individuals with compromised immune systems. These infections range from superficial skin and soft tissue infections to severe conditions such as pneumonia, urinary tract infections, and bacteremia. The organism’s ability to adapt to diverse environments and its intrinsic resistance mechanisms make it a formidable pathogen in both community and healthcare settings. Multidrug-resistant (MDR) Pseudomonas aeruginosa poses a significant challenge in clinical settings due to its ability to resist antibiotics and form biofilms. This study investigates the antibiotic susceptibility and biofilm-forming potential of MDR P. aeruginosa strains isolated from clinical samples.  Materials and Methods: This is a prospective and observational study was conducted in the Department of Microbiology, Tertiary Care Teaching Center over a period of 1 year. Clinical isolates of P. aeruginosa were collected from various sources, including blood, urine, and respiratory samples, from a tertiary care hospital. Sample collection spanned six months, ensuring a diverse and representative set of isolates. All isolates were identified based on colony morphology, Gram staining, and biochemical tests, including oxidase and citrate utilization tests. The disk diffusion method was employed to determine susceptibility to antibiotics, including ceftazidime, ciprofloxacin, imipenem, and piperacillin-tazobactam, following Clinical and Laboratory Standards Institute (CLSI) guidelines. Zones of inhibition were measured and interpreted. In addition, the minimum inhibitory concentration (MIC) was determined for select isolates using the broth microdilution method to confirm resistance patterns. Results: The resistance rates of Pseudomonas aeruginosa isolates to key antibiotics. Ciprofloxacin exhibits the highest resistance (80%), followed by ceftazidime (70%), imipenem (60%), and piperacillin-tazobactam (50%). These results underline the significant challenge posed by MDR strains in clinical treatment, emphasizing the need for alternative therapeutic strategies. The isolates are categorized based on their biofilm-forming abilities. Strong biofilm-formers represent 40% of the isolates, followed by moderate formers at 35%, and weak/non-formers at 25%. This distribution demonstrates that a significant proportion of isolates have robust biofilm-forming capabilities, which likely contribute to their antibiotic resistance. Correlates biofilm-forming ability with resistance to ciprofloxacin, ceftazidime, and imipenem. Strong biofilm-formers have the highest resistance rates (e.g., 90% resistance to ciprofloxacin), while weak/non-formers exhibit the lowest resistance. This positive correlation indicates that biofilm formation significantly contributes to the resistance of P. aeruginosa isolates. Conclusion: MDR P. aeruginosa isolates demonstrate extensive antibiotic resistance and significant biofilm-forming potential. Addressing these challenges necessitates innovative therapeutic approaches and a deeper understanding of resistance mechanisms. Results indicated a high resistance to commonly used antibiotics, with a significant proportion of isolates demonstrating strong biofilm-forming ability. The findings underscore the critical need for novel therapeutic strategies to combat MDR P. aeruginosa infections.

Seasonal influenza is a major public health concern, disproportionately affecting children under five years of age. These demographic experiences significant morbidity and mortality due to immature immune systems and limited prior exposure to influenza viruses. Annually, seasonal influenza contributes to millions of respiratory infections, hospitalizations, and deaths worldwide, with the burden being most severe in low- and middle-income countries. Despite the availability of vaccines and antiviral treatments, suboptimal vaccination coverage, delayed diagnosis, and limited healthcare access continue to hinder efforts to reduce this burden. Clinical manifestations in young children are often nonspecific, complicating timely diagnosis and management. Severe complications, including pneumonia, neurological disorders, and sepsis, further contribute to mortality and strain on healthcare systems. Robust diagnostic tools and surveillance programs are crucial to understanding the disease burden and guiding prevention strategies. Vaccination remains the most effective preventive measure, while public health interventions and supportive care play vital roles in mitigating the impact. Addressing gaps in vaccine accessibility, treatment availability, and surveillance systems is essential for reducing the global burden of seasonal influenza in this vulnerable population. This review highlights current knowledge, challenges, and future directions for managing seasonal influenza in children under five.

Introduction Hypothyroidism is the insufficient production of thyroid hormone to satisfy the body's metabolic needs. Untreated hypothyroidism may lead to hypertension, lipid problems, infertility, cognitive impairment, and neuromuscular dysfunction. Hypothyroidism may arise due to insufficient thyroid stimulation from the hypothalamus or pituitary gland. Thyroid hormones (THs) have a crucial function in controlling energy metabolism. Additionally, it has a role in other processes related to the central nervous system (CNS), such as promoting survival, facilitating neuronal development, and regulating energy consumption. Materials and Methods This is a prospective study was conducted at Department of Biochemistry in the Ayaan Institute of Medical Sciences Teaching Hospital & Research Centre. A total of 60 blood samples were obtained from individuals aged (30 – 55) years who have hypothyroidism. Among them, 40 serum samples were taken from individuals with hypothyroidism, while 40 samples were collected from healthy individuals serving as the control group. The research focused on quantifying the concentration of tumor necrosis factor (TNF-a) using an examination kit developed by the Chinese business Sunlong, which utilizes the enzyme-linked immunosorbent assay (ELISA) technique. Results The study included 40 hypothyroid patients (24 females, 16 males) and 40 healthy controls (24 females, 16 males), with an average age of 45.5 ± 10.2 years in the hypothyroid group and 46.1 ± 9.8 years in the control group. The hypothyroid group showed significantly higher levels of TSH and significantly lower levels of T3 and T4 compared to the control group (p < 0.001). Hypothyroid patients had significantly higher levels of MDA (a marker of lipid peroxidation) and significantly lower TAC (a measure of antioxidant defense) compared to the healthy controls, suggesting increased oxidative stress in the hypothyroid group. The levels of TNF-α were significantly higher in the hypothyroid group compared to the control group, indicating an inflammatory response associated with hypothyroidism. A positive correlation was observed between MDA and TNF-α levels (r = 0.62, p < 0.01), suggesting that increased oxidative stress is associated with higher levels of inflammation in hypothyroidism. Conclusion The study of oxidative stress, thyroid profile, and TNF-α in hypothyroid patients provides valuable insights into the complex pathophysiology of the disorder. Oxidative stress and inflammation are intertwined processes that contribute to the metabolic and cardiovascular complications commonly observed in hypothyroid individuals.

Introduction Urinary tract infections (UTIs) are a significant public health concern globally, affecting millions of individuals annually. They rank among the most common bacterial infections, especially in women, the elderly, and patients with underlying conditions. UTIs are primarily caused by uropathogenic microorganisms that invade the urinary tract, leading to clinical manifestations ranging from asymptomatic bacteriuria to severe pyelonephritis. The increasing prevalence of antimicrobial resistance (AMR) among uropathogens is a major challenge in clinical management. Resistance to first-line antibiotics, including fluoroquinolones and beta-lactams, has been reported worldwide, necessitating a reevaluation of empirical treatment protocols.  Material and Methods: This cross-sectional study was conducted over six months at a tertiary care hospital. A total of 90 patients with clinical symptoms of UTI were enrolled. Informed consent was obtained from all participants, and ethical approval was secured from the institutional ethics committee. Midstream urine samples were collected under sterile conditions from each participant. Samples were transported to the microbiology laboratory within two hours of collection. Results: Escherichia coli was the predominant pathogen (65%), followed by Klebsiella pneumoniae (15%), Proteus mirabilis (10%), and others (10%). High resistance rates to commonly used antibiotics such as ampicillin and ciprofloxacin were observed, while carbapenems and nitrofurantoin showed better efficacy. Our findings emphasize the importance of routine susceptibility testing to guide empirical treatment and combat antimicrobial resistance. The high prevalence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL) producing strains underscores the critical need for judicious antibiotic use. Routine screening for these resistance mechanisms should be integrated into diagnostic protocols. Conclusion:  This study highlights the microbiological profile and antimicrobial susceptibility patterns of uropathogens in a tertiary care setting. Routine surveillance of resistance patterns is critical for optimizing UTI management and curbing the AMR crisis.

Introduction: The word suicide breaks down into the Latin words sui and caedere, which together translate to “kill oneself. Approximately one million people die from suicide every year and 10‑20 times more attempt suicide. There were 2,30, 314 suicide deaths in India in 2016. There is drastic increase in Indian contribution to global suicide deaths from 25.3% in 1990 to 36.6% in 2016 among women, and from 18.7% to 24.3% among men. Suicide was the leading cause of death in India in 2016 for those aged 15–39 years; 71.2% of the suicide deaths among women and 57.7% among men were in this age group Southern India has a high rate of suicide and the average suicide rate for young women is as high as 148 per 100,000 and 78 per 100,000 in men. The quality of the information about suicide in India is quite limited. Methods: This is a cross-sectional descriptive study done on psychosocial factors and family dynamics of young adults who attempt suicide by methods other than burns. The study is done in Gandhi Medical College and Hospital located in Secunderabad, it is a multispeciality tertiary care teaching hospital, it provides services to patients from twin cities of Hyderabad and Secunderabad and other districts of Telangana. Results: There were 78 (52%) suicide attempters from urban background and 72(48%) from rural background.the ratio 1.08:1 with slight increase in urban population. There is no significant statistical difference between male and female distribution in rural and urban area. The increase in urban suicide could be due to increased stress, social isolation and migration of large number of population to cities. In this study 80% of suicide attempters were between 18-25 years of age ; 27% were between 26-30 years of age ;8% of suicide attempters were between 31-35 years of age . Mean age of presentation at 22.6 years (S,D+/-4,32) The higher represention in younger age group is statistically significant Conclusion Young adults were at increased risk of suicidal attempt with mean age of presentation at 22.6 years (S,D+/-4,32) Suicidal attempts were more common in age group 18-25 years. The higher represention in younger age group is statistically significant (chi-square statistic is 6.0491. The p-value is .04858.) There was slight increase in males and urban suicide attempters when compared to female and rural suicide attempters

Introduction: Tuberculosis (TB) and Diabetes Mellitus (DM) have a significant bidirectional relationship, with DM tripling the risk of developing active TB compared to non-diabetic individuals. AIM: This study aims to evaluate the clinical and radiological profiles of pulmonary TB and diabetes for improved diagnosis and management. Methodology: This comparative, observational study was conducted in the Department of Respiratory Medicine at Civil Hospital, Ganganagar, from July 2023 to November 2023. Result: This study found that TB with DM predominantly affected individuals in their 6th and 7th  decade (26%), exhibited higher lower zone chest X-ray involvement (85% vs. 40%, p = 0.0079), had more frequent infiltrations (52% vs. 32%) and cavitary lesions, and showed no significant differences in hematological parameters between TB with and without DM, aligning with findings from similar studies on clinical, radiological, and hematological presentations. Conclusion: This study highlights that DM significantly influences the clinical and radiological features of pulmonary TB, with cavitary lesions, and lower zone involvement being more common in TB with DM, emphasizing the need for mutual screening of TB and DM for early diagnosis and management to reduce morbidity and mortality.

Introduction: Lipid metabolism is intricately linked to prostate cancer pathogenesis. Alterations in lipid profiles, such as increased synthesis of cholesterol and fatty acids, are commonly observed in prostate cancer cells. These changes support membrane biogenesis, energy production, and the generation of signaling molecules essential for tumor growth and survival. Cytokines, small protein mediators of inflammation and immune responses, play a critical role in the tumor microenvironment of prostate cancer. Precancerous conditions such as PIN share several molecular and cellular features with prostate cancer, including alterations in metabolic and hormonal pathways. The transition from precancer to invasive prostate cancer involves complex interactions between genetic and environmental factors.  Material and Methods: This study is a cross-sectional analysis designed to evaluate the association of metabolic parameters, lipid and cytokine profiles, androgen levels, and insulin signaling with prostate cancer and its precursor lesions among Department of Biochemistry, Index Medical College.  The study recruited participants from urology outpatient clinics, including patients with confirmed prostate cancer, those with precancerous conditions such as prostatic intraepithelial neoplasia (PIN), and healthy controls. Venous blood samples will be collected from participants after an overnight fast. Serum and plasma will be separated by centrifugation and stored at −80°C until analysis. Prostate tissue samples will be obtained via biopsy or prostatectomy and preserved in formalin for histopathological evaluation. Results: Healthy Control group exhibits a concentration of triglyceride levels around 150–175 mg/dL, which falls within or close to the borderline-high range for triglycerides in clinical guidelines. Precancer and Prostate Cancer groups show a similar distribution pattern, with peaks slightly lower around 140–160 mg/dL. TNF-alpha levels are highest in the prostate cancer group (mean = 5.48 pg/mL) and lowest in the precancer group (mean = 4.99 pg/mL). Healthy controls have an intermediate mean TNF-alpha level (mean = 5.34 pg/mL). The lowest recorded TNF-alpha level is in the precancer group (1.36 pg/mL), while the highest level is in the prostate cancer group (8.79 pg/mL). TNF-alpha is a key pro-inflammatory cytokine. Elevated levels in the prostate cancer group suggest a potential role of systemic inflammation in cancer progression. Conclusion: This study emphasizes the importance of a multifaceted approach to prostate cancer prevention and treatment. By addressing the interconnected pathways of metabolic dysregulation, lipid imbalances, and systemic inflammation, it is possible to develop comprehensive strategies that not only mitigate cancer risk but also improve overall health outcomes. 

Background Neonatal septicaemia remains one of the leading causes of morbidity and mortality both among term and preterm infants. signs and symptoms of neonatal sepsis are nonspecific.[3] These include fever or hypothermia, respiratory distress including cyanosis and apnea, feeding difficulties, lethargy or irritability, hypotonia, seizures, bulging fontanel, poor perfusion, bleeding problems, abdominal distention, hepatomegaly, gauiac-positive stools, unexplained jaundice Neonatal sepsis is of two types: Early onset Sepsis (EOS): Early onset sepsis presents within first 72 hours of life Late onset Sepsis (LOS): Late onset sepsis usually presents after 72 hours of age. The source of infection is either nosocomial or community acquired and neonates usually present with septicemia, pneumonia or meningitis Material and Methods A prospective and observational study was carried out Ayaan institute of Medical Sciences. A total of 130 febrile subjects aged up to 28 days with clinical features such as Babies with birth asphyxia and congenital anomalies were excluded from the study Result:  The most common symptoms seen were lethargy and refusal of feeds in 61.66% and 55.9% respectively, followed by apnoea and respiratory distress in 34.17% and 21.67% respectively. Vancomycin and colistin showed 100% efficacy against Gram-positive isolates while amikacin, meropenem and linezolid was found to be most effective among Gram-negative isolates in both EOS and LOS. Conclusion: The clinical features of neonatal sepsis being non-specific, pose a great challenge for prompt diagnosis. Lethargy, refusal of feeds and apnoea were the most common clinical features in this study. Klebsiella was the predominant gram-negative organism and Staphylococcus aureus and CONS were the predominant gram-positive isolates from blood culture in EOS and LOS.

Introduction Psychological stress has great influence over physiological systems such as breathing functions. Young adults, who are regularly exposed to academic, social, and occupational related stressors, usually show variability in respiratory rates and patterns under stress. Understanding this association becomes very crucial so that stress-associated health risks can be addressed at a point where it becomes easy for development interventions to mitigate its effects. Methods A total of 100 healthy young and young adults aged 18-25 participated in cross-sectional studies. Each subject was exposed to stress conditions and controlled stress-inducing tasks, including simple mental arithmetic tests. Both baseline respiratory rates and their patterns were recorded using spirometry and by a wearable respiratory monitor. Continuous measurements were recorded, as well as recovery rates after stress treatment. Psychological stress levels were measured by approved scales, including the Perceived Stress Scale (PSS). Results Important changes in the respiratory rates, as much as a mean increase of about 20% were observed in the results. It also revealed unusual breathing patterns as manifestations of acute stress. The results have also established that hyperventilation and shallow breathing were the particular manifestations of stress among individuals with higher PSS scores. Further tests on more individuals showed a difference in recovery times; those reporting higher levels of stress took longer to return to the baseline. Differences in gender show higher respiratory variability under stress for females than males. Conclusion Changes in respiratory rate and patterns induced by psychological stress further necessitate the incorporation of methods for managing stress as a part of respiratory health. Findings emphasised the need for incorporating relaxation techniques such as diaphragmatic breathing and mindfulness in stress reduction programs among emerging adults. Further research should continue to determine longitudinal effects and possible therapeutic interventions.

Background Chronic Low Back Pain (CLBP) is one of the most common conditions that leads to serious functional disability. Conventional Physical Therapy (TPT), which involves stretching and strengthening exercises, has a limited long-term effectiveness. With the emergence of Core Stabilization Exercises (CSE), targeting deep core muscles to improve spinal stability, CSE may be a viable alternative for the management of CLBP. Objective: This study aimed to compare the effects of core stabilization exercise (CSE) versus a Traditional Physical Therapy (TPT) program in decreasing pain intensity, functional disability, and improving the quality of life of patients with CLBP for 12 weeks. Methods: This randomised controlled trial included 200 adults aged 25–55 years with CLBP. The participants were randomly assigned to the CSE (n=100) or TPT (n=100) groups. Pain intensity (Visual Analog Scale [VAS]), functional disability (Oswestry Disability Index [ODI] and Roland-Morris Disability Questionnaire [RMDQ]), quality of life (Short Form Health Survey [SF-36]), and lumbar mobility (Schober test) were evaluated at baseline and after 6 and 12 weeks. Results: The VAS (39.87% vs. 21.98%, p< 0.01), ODI (45% vs. 28%, p< 0.01), and RMDQ (39.75% vs. 24.57%, p<0.01) scores were significantly improved in the CSE group compared to those in the TPT group. There was a highly significant increase in quality of life (SF-36 physical health) and lumbar mobility compared with the control group (p<0.05). Serious adverse events were not observed. Conclusion: CSE is more effective than TPT for the treatment of CLBP, with significant effects on pain, functional capacity, and quality of life. These results suggest that CSE can be integrated into routine CLBP rehabilitation protocols

Introduction: Acute Kidney Injury (AKI), previously known as Acute Renal failure, is an abrupt decline in renal excretory function characterized by a reversible increase in the serum creatinine and nitrogenous waste products. Aim: To determine the Incidence of Acute Kidney Injury in idiopathic nephrotic syndrome children admitted to Paediatric department of a Tertiary care center. Methodology: This study was a prospective observational cross-sectional investigation aimed at assessing acute kidney injury (AKI) in hospitalized children with idiopathic nephrotic syndrome and those critically ill at the Department of Pediatrics, S.P. Medical College, Bikaner. The study was conducted over the course of one year, focusing on children aged 1 month to 14 years who were admitted to the department Result: The study found that the most common age group among the 75 patients was 5-8 years, with a mean age of 6.75±2.45 years. It highlighted significant differences between AKI and non-AKI patients in terms of blood urea, serum creatinine, albumin levels, and cholesterol, with statistical significance in each case (p<0.001 for blood urea and serum creatinine, p<0.05 for albumin, p<0.01 for cholesterol). Conclusion: Our study highlights that AKI is a prevalent complication in children with idiopathic nephrotic syndrome, emphasizing the need for vigilant monitoring and management, and suggests a large-scale multi-center study to further explore risk factors and long-term outcomes.

Introduction: Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) is associated with diffuse functional impairment of most endocrine organs resulted in diffuse endocrinopathies. As any chronic infection, like TB is also associated with hyperglycemia. Aim: To Study the association between Hemoglobin A1c Levels and Sputum Conversion Time by LED microscopy in patients of smear positive Pulmonary Tuberculosis. Methodology: This hospital-based prospective study was conducted in the Department of Respiratory Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, over six months (January 2024 to June 2024). Result: Our study found that diabetic patients with tuberculosis had higher bacterial grading, delayed sputum conversion, and atypical X-ray findings, with significant differences in HbA1c levels and TB lesion patterns compared to non-diabetic patients. Conclusion: Our study concludes that better glycemic control in tuberculosis patients with diabetes mellitus improves sputum conversion rates and bacillary load, emphasizing the importance of managing HbA1c levels for better outcomes.

Background: Metastatic cancer often leads to debilitating symptoms, including pain and compromised quality of life (QoL). Palliative radiotherapy (RT) serves as a critical intervention to alleviate symptoms and enhance QoL. Understanding patient-specific information needs, assessing pain, and evaluating QoL pre- and post-RT are essential for optimizing patient-centered care. Aim:  This study aims to assess the information needs, pain levels, and QoL of patients with metastatic cancer undergoing palliative RT and to evaluate the changes in QoL and pain scores before and after RT. Materials and Methods:  A prospective study was conducted from 2019 to 2020 at MNJ Institute of Oncology and Regional Cancer Centre, involving 50 patients with histologically confirmed metastatic cancers (age 18–75, ECOG performance score 1–3). Patients completed Cassileth’s Information Needs Questionnaire to assess information requirements, the Numeric Pain Scale for pain evaluation, and the EORTC QLQ-C30 questionnaire for QoL assessment before RT and one month after its completion. Statistical analysis was performed using SPSS version 22.0. Results:  The majority (88%) of patients expressed a strong need to know whether the illness was cancer, and 82% wanted to know the specific medical name of their illness. Pain scores significantly improved after RT (mean pain score pre-RT: 59.42; post-RT: 32.4; p=0.000). QoL assessment showed statistically significant improvements in Global Health Status (p=0.032), Physical Functioning (p=0.003), Role Functioning (p=0.002), Emotional Functioning (p=0.016), and Cognitive Functioning (p=0.008). Symptom scales showed significant improvement in fatigue (p=0.000), pain (p=0.000), dyspnea (p=0.034), appetite loss (p=0.047), diarrhea (p=0.009), and insomnia (p=0.018). Constipation worsened slightly, though not significantly (p=0.497). Conclusion:  Cancer patients consistently desired comprehensive information about their diagnosis and treatment options, regardless of age, education, socioeconomic status, or prognosis. Among those with metastatic cancers, palliative radiotherapy significantly improved quality of life, particularly by alleviating pain, the most common symptom.

Background The erector spinae plane (ESP) block has emerged as an effective regional anesthesia technique, offering pain relief in various surgical procedures. This study aimed to evaluate the impact of ESP block on the quality of recovery in patients undergoing lumbar spine decompression surgery, comparing outcomes between addicts and non-addicts. Materials and Methods This prospective comparative study was conducted on 120 patients undergoing lumbar spine decompression surgery. The participants were divided into two groups: addicts (n=60) and non-addicts (n=60). All patients received general anesthesia and half of each group received an ultrasound-guided ESP block preoperatively using 20 mL of 0.375% bupivacaine. The quality of recovery was assessed using the Quality of Recovery-15 (QoR-15) scale at 24 and 48 hours postoperatively. Pain scores were measured using the Visual Analog Scale (VAS), and opioid consumption was recorded during the first 48 hours. Results Patients who received the ESP block reported significantly higher QoR-15 scores at 24 hours (ESP block: addicts 110 ± 5, non-addicts 120 ± 4; no block: addicts 95 ± 6, non-addicts 105 ± 5) and 48 hours (ESP block: addicts 115 ± 4, non-addicts 125 ± 3; no block: addicts 100 ± 5, non-addicts 110 ± 4). The VAS scores were significantly lower in the ESP block groups (ESP block: addicts 3 ± 0.5, non-addicts 2 ± 0.4; no block: addicts 5 ± 0.6, non-addicts 4 ± 0.5). Opioid consumption was reduced in ESP block recipients compared to those who did not receive the block. Conclusion The ESP block significantly improves the quality of recovery, reduces pain scores, and decreases opioid requirements in patients undergoing lumbar spine decompression surgery. The benefits are evident in both addicts and non-addicts, though non-addicts demonstrated slightly better outcomes overall. Incorporating the ESP block into perioperative pain management protocols could enhance recovery and reduce opioid dependency risks

Background - Spigelian hernia is an uncommon and often underdiagnosed type of ventral abdominal hernia that occurs through a defect in the Spigelian fascia, located between the rectus abdominis muscle and the semilunar line. Due to its location and sometimes absence of a visible bulge, Spigelian hernia can be challenging to diagnose, leading to delayed or missed diagnoses. This can result in serious complications such as incarceration or strangulation, making timely intervention crucial. Method - A retrospective case study of 12 patients diagnosed with Spigelian hernia who underwent surgical repair at our institution between January 2020 and Feburary 2024 in southern Rajasthan. An online search for Spigelian hernia repairs, component separation surgery and radiological modalities in assistance to early diagnosis of spigelian hernia was carried out and a comprehensive literature review was done to devise an ideal approach to spigelian hernia.  Conclusion - There is a paucity of literature on Spigelian hernia due to its rarity, and existing studies often lack large sample sizes or robust statistical analysis. This study aims to fill this gap by providing a detailed case series of 12 cases, coupled with a comprehensive literature review. Additionally, this study supports the use of the open onlay mesh repair technique as an effective surgical option, while emphasising the need for accurate preoperative imaging to guide diagnosis and management.

Background: This study aimed to determine the prevalence of mask-associated dry eye (MADE) among doctors during the COVID-19 pandemic. Objectives: To evaluate the prevalence and symptoms of dry eye among doctors, assess its association with mask usage and duration of wear, and examine whether mask-wearing exacerbates existing dry eye symptoms. Methods: This cross-sectional descriptive study was conducted in the Department of Ophthalmology at a multispecialty hospital after receiving ethical committee approval. The study was carried out from February 2021 to July 2021, coinciding with the peak of COVID-19 cases in India. All doctors working in the hospital were included. The study utilized the OSDI (Ocular Surface Disease Index) questionnaire to score and quantify dry eye symptoms. Participants were grouped based on gender, age, duration of mask usage, and prior history of dry eye disease (DED).  Results: Responses from 136 doctors were analyzed. MADE was identified in 49 doctors (36%). Of these, 20 doctors (14.7%) scored more than 13 on the OSDI questionnaire, indicating dry eye symptoms. Reversal of dry eye symptoms was observed in 8 participants (5.9%), including 5 individuals (3.7%) with a history of DED. Among participants with DED, 13 (9.6%) reported worsening symptoms associated with mask usage. Subjectively, 39% of respondents reported a worsening of dry eye symptoms with mask use, while 53.7% reported no difference. Conclusion: The OSDI questionnaire revealed a prevalence of MADE of 36%. While a significant proportion reported worsening symptoms associated with mask use, over half of the participants perceived no difference. These findings highlight the need for increased awareness and potential strategies to address MADE, particularly in healthcare professionals during prolonged mask usage.

The integration of artificial intelligence (AI), specifically machine learning (ML) and deep learning (DL), has revolutionized radiology, enhancing diagnostic accuracy, workflow efficiency, and predictive capabilities. This bibliographic analysis explores recent trends in AI applications within radiology, focusing on ML and DL technologies in medical imaging from 2019 to 2023. A systematic review of 41 articles was conducted, examining AI’s impact on diagnostic tasks, radiomics, educational initiatives, and radiologists’ attitudes toward AI. Results indicate that convolutional neural networks (CNNs) and radiomics play significant roles in advancing diagnostic support, particularly in oncology, where they assist in tumor subtyping and treatment response assessment. However, technical and ethical challenges—such as data privacy, generalizability of models, and regulatory constraints—limit AI’s widespread adoption. Educational initiatives, including AI-specific curricula, are critical for equipping radiologists with AI competencies, addressing the knowledge gap between AI developers and practitioners. Radiologists exhibit a cautiously optimistic attitude toward AI, recognizing its supportive potential but expressing concerns over job security and reliance on technology. Future directions emphasize the need for hybrid AI models that combine DL with traditional radiological expertise, greater transparency in AI models, interdisciplinary collaboration, and policy development to address regulatory and ethical issues. This analysis provides valuable insights into how AI is shaping the future of radiology, suggesting that a balanced approach can ensure AI remains an invaluable tool within clinical practice.

Introduction: The HDP-Gestosis score is an innovative risk assessment tool designed to predict the likelihood of pre-eclampsia in pregnant women. Individuals scoring three or more on this scale are categorized as "at risk," enabling early identification of potential complications. Objective: To assess the diagnostic performance of the HDP-Gestosis score in predicting pre-eclampsia by evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) & overall diagnostic accuracy. Methods: This prospective study, conducted from June 2022 to June 2024, involved 210 pregnant women enrolled from the Obstetrics & Gynecology Department. Participants were evaluated for pre-eclampsia onset after 20 weeks of gestation. The Gestosis score was calculated for each participant, with a cutoff score of ≥3 used to classify individuals as at risk. Statistical analyses were performed to determine the tool's predictive performance. Results: The study population had a mean age of 27.36 ± 4.60 years. The HDP-Gestosis score demonstrated a sensitivity of 76.3%, specificity of 77.2%, PPV of 81.1%, NPV of 71.7%, & an overall diagnostic accuracy of 76.7% in predicting pre-eclampsia. Conclusion: The HDP-Gestosis score proves to be a practical & effective tool for the early identification of pre-eclampsia, particularly in outpatient settings with limited resources. Its simplicity & applicability make it an ideal choice for use in areas with minimal healthcare infrastructure or specialized training. 

Introduction: Retinoblastoma, the most common intraocular malignancy in children, contributes significantly to paediatric cancer burden, particularly in developing countries. In India, delayed diagnosis and limited access to specialized care result in advanced-stage presentations and suboptimal outcomes. This study analyses the demographic, clinical, and treatment profiles of retinoblastoma patients over a 15-year period at a regional cancer centre in Northwest India. Aim: The aim was to evaluate demographic data, clinical presentations, diagnostic pathways, and treatment outcomes. Methods: A retrospective analysis of 95 retinoblastoma cases (2010–2024) was conducted. Data included demographic details, clinical presentation, diagnostic timelines, treatment modalities, and outcomes. Patients were staged using the International Retinoblastoma Staging System (IRSS) and treated according to resource availability, including enucleation, chemotherapy, radiotherapy, and, in select cases, advanced focal therapies. Statistical analysis focused on remission, relapse, and mortality rates. Results: Of the 95 cases, 84.2% were unilateral, with a median diagnosis age of 3 years for unilateral and 2 years for bilateral cases. Leukocoria (78.9%) was the most common symptom, with a median diagnostic delay of 9.1 months. Stage I disease was predominant (45.3%), but 19% presented with metastatic (Stage IV) disease. Enucleation was performed in 47.4% of cases, and chemotherapy showed the highest remission rate (83.8%). Overall remission was 78.9%, with relapse and mortality rates of 12.6% and 8.4%, respectively. Advanced-stage disease was associated with poorer outcomes. Conclusion: This study underscores the challenges of retinoblastoma management in resource-constrained settings, including delayed diagnosis and limited access to advanced treatments. Public awareness campaigns, improved referral systems, and investments in healthcare infrastructure are critical for earlier detection and better outcomes. Comprehensive follow-up care addressing cosmetic and psychosocial impacts is essential to improve survivors' quality of life.

Introduction: Lower respiratory tract infection (LRTI) is a short-term illness lasting 21 days or less, characterized primarily by cough and at least one other symptom such as fever, breathlessness, sputum production, or chest discomfort. AIM: Clinical and Microbiological Profile of Patients with Pneumonia Admitted to the ICU of a Tertiary Care Hospital in Southern Rajasthan. Methodology: This study was conducted in the Medical and Respiratory ICUs of SPMC Bikaner, from January 2016 to October 2017, following approval by the Institutional Ethical Committee. Result: The study provides insights into gender distribution, symptoms, hospital infections, radiographic patterns, and antibiotic resistance, emphasizing targeted diagnosis, treatment, and infection control strategies. Conclusion: Effective pneumonia management requires a locally developed antibiogram, bacteriological diagnosis, and susceptibility testing to combat the global challenge of antibiotic resistance

Introduction: A febrile seizure is a seizure occurring in children aged six months to five years with fever, without intracranial infection, metabolic disturbance, or a history of afebrile seizures. AIM: To compare serum magnesium levels between patients of febrile convulsions and febrile children without convulsions. Methodology: This case-control study was conducted in the Department of Pediatrics in collaboration with the Department of Pathology at sardar patel medical college bikaner, from April 2023 to March 2024. Result: The study found significantly lower serum magnesium levels in febrile seizure cases (mean: 1.75±0.48 mg/dL) compared to controls (mean: 2.04±0.26 mg/dL), with S. magnesium <1.5 mg/dL being 42% sensitive and 100% specific for febrile seizures. Higher TLC in cases and eosinophil levels in controls were also observed. Conclusion: Magnesium deficiency is significantly associated with febrile seizures, but its limited sensitivity and complex pathophysiology warrant further investigation. 

Introduction: Malaria remains a major global health issue, causing around 200 million infections and over 500 thousand deaths annually, with the highest mortality in sub-Saharan Africa, while also significantly affecting rural regions in Asia and South America. AIM: To identify and evaluate patients of malaria by clinical, hematological and by biochemical parameters. Methodology: This hospital-based comparative cross-sectional study was conducted over 15 months in the Department of Medicine at S.P. Medical College and P.B.M. Hospital, Bikaner. A total of 54 participants, with 27 cases in each group, were included using a random sampling method. Result: Our study found that malaria affects all age groups, predominantly in rural areas, with clinical findings including hepatosplenomegaly, anaemia, normal or low TLC, thrombocytopenia, mild renal impairment, and elevated liver enzymes, consistent with previous research. Conclusion: In conclusion, malaria affects all age groups, primarily in rural areas, with clinical features of hepatosplenomegaly, anaemia, thrombocytopenia, mild renal impairment, and elevated liver enzymes, highlighting the need for early detection and comprehensive evaluation

Introduction: Malaria is the most important human parasitic disease. AIM: To identify and investigate the adult patients infected with Plasmodium vivax and Plasmodium falciparum using clinical, biochemical parameters, and oxidative stress pathway. Methodology: This hospital-based comparative cross-sectional study was conducted over a duration of 15 months at the Department of Medicine, S.P. Medical College and P.B.M Hospital, Bikaner. Result: The study found P. vivax to be the predominant malaria type, with fever as the most common symptom. Oxidative stress markers SOD-1, CP, and HBB were upregulated, while PRDX2 was downregulated, indicating their significant roles in malaria pathogenesis. Conclusion: The study concluded that oxidative stress markers, with SOD-1, CP, and HBB upregulated and PRDX2 downregulated, play key roles in malaria pathogenesis and related organ dysfunction.

Background Hip arthroplasty in unstable trochanteric fractures helps in quick recovery with little risk of mechanical failure, avoids the risk associated with internal fixation, and enables patients to maintain a good level of function immediately after surgery. The current study aimed to evaluate the clinical and functional outcomes of cemented bipolar prostheses for unstable intertrochanteric fractures in the elderly. Methods: Twenty-four patients with unstable intertrochanteric fractures according to the Association Osteosynthesis Classification were treated with hemiarthroplasty (cemented bipolar prosthesis) and trochanter reconstruction. The mean age of the patients was 75 years. We evaluated postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to the pre-injury activity level, and radiological signs of healing and loosening or migration of the implant. The follow-up period was 2–4 years (mean 2 years). Results: Mobilization and full weight bearing were started within 1 week of surgery. In this study, the dislocation rate is zero. Deep infection and implant loosening were not observed in any of the cases. The mean Harris hip score improved progressively with follow-up time. The mean score was 48.50 on the third day. The final mean Harris hip score at the last follow-up was 82.60. Limb length discrepancy was observed in six patients and average shortening was 1.0 cm (range: 0.5–1.6 cm). Conclusion: Hip arthroplasty is a valuable treatment option in mobile and psychologically stable elderly patients with unstable intertrochanteric fractures.

Introduction: Fever is an elevated body temperature triggered by the hypothalamus to support immune function, with normal axillary temperature in children ranging from 36.0°C to 37.7°C, and any values above this considered abnormalfebrile convulsion are most common seizures seenin 6months to 5years of age. AIM: The aim of the present study was to establish serummagnesium levels in children with febrile convulsions. Methodology: The study was conducted in collaboration between the Department of Pediatrics and the Department of Pathology at sardar patel medical college bikaner, as a case-control study from April 2023 to March 2024. Result: This study found significantly lower serum magnesium levels in children with febrile seizures compared to controls, with a 42% sensitivity and 100% specificity for identifying febrile seizures. Additionally, a novel association was found between lower serum magnesium levels and seizure complexity, warranting further investigation into magnesium's role in febrile seizures. Conclusion: The study concludes that serum magnesium levels are significantly lower in children with febrile convulsions, with a high prevalence of magnesium deficiency (42%) suggesting a possible link to febrile seizures and seizure complexity.

Background: Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic disease associated with insulin resistance and hyperglycemia. Elevated serum uric acid (SUA) levels have been implicated in the pathophysiology of T2DM, but the relationship between SUA and glycemic control remains underexplored. Objective: This study aimed to investigate the correlation between SUA levels and key glycemic control markers—fasting blood sugar (FBS), HbA1c, and postprandial blood glucose (PPBG)—in T2DM patients. Methods: A total of 150 T2DM patients were enrolled in this cross-sectional study. Demographic data, SUA levels, FBS, HbA1c, and PPBG were measured. Pearson's correlation coefficient was used to assess the relationship between SUA and glycemic markers, and regression analysis was performed to quantify the strength of associations. Results: SUA levels showed weak positive correlations with FBS (r = 0.021), HbA1c (r = 0.0599), and PPBG (r = -0.1621). Regression analysis revealed that higher SUA levels were associated with higher FBS and HbA1c, suggesting SUA may be a potential biomarker for poor glycemic control. Conclusion: Elevated SUA levels are weakly associated with poor glycemic control in T2DM patients. Although the relationship is modest, SUA could serve as a useful adjunct to monitor glycemic control. Further longitudinal studies are necessary to determine causality and explore therapeutic interventions targeting SUA.

Background: The nose and paranasal sinuses exhibit a wide spectrum of anatomical variations, which are most effectively identified through computed tomography (CT) imaging and diagnostic nasal endoscopy (DNE). This cross-sectional study aimed to investigate the prevalence of anatomical variations in individuals diagnosed with chronic rhinosinusitis (CRS) and to examine the association between these variations and CRS. Materials and Methods: The study included 145 patients who were diagnosed with CRS based on the TASK FORCE criteria for diagnosis of CRS. Each participant underwent both DNE and CT imaging for evaluation.  Results: The findings revealed that a deviated nasal septum and concha bullosa were the most significant anatomical variations associated with CRS. There was a statistically significant correlation between CRS and the presence of a deviated nasal septum and concha bullosa. Conclusion: Anatomical variations critically impact the development and severity of sinus involvement in chronic rhinosinusitis. DNE and CT imaging are essential for endoscopic surgeons during FESS, facilitating sinus physiology restoration, reducing complications, and improving anatomical visualization for precise CRS management.  

Introduction: Epilepsy is the disorder of the brain characterized by a predisposition to develop seizures. Aim: The aim is to evaluate serum calcium and 25-hydroxyvitamin D3 levels in pediatric patients (ages 1–14) before and after 6 months of antiepileptic drug therapy. Methodology: This study was conducted in the Department of Pediatrics at S. P. Medical College and PBM Hospital, Bikaner, with institutional ethical committee approval. The study period spanned one year, from January 2023 to December 2023. Result: Our study found that triple therapy was associated with the highest rates of hypocalcemia and vitamin D deficiency, with significant differences in calcium levels between therapy groups, while vitamin D levels remained statistically similar across treatments after 6 months. Conclusion: Our study shows that as the number of drugs increased, mean calcium and vit D levels were decreased. 

Introduction: Iron deficiency is ‘perhaps           the most frequent nutritional deficiency in the world. Aim: To evaluate the proportions of children with moderate to severe iron deficiency anemia associated with celiac disease. Methods: This was a prospective observational study on 60 cases(group A) and 60 healthy controls (group B) aged up to 14 yrs by Simple random sampling over a period of one year in a tertiary care hospital. Moderate-to-severe anemia was diagnosed according to the WHO criteria. Serum IgA tTG antibody levels measured using indirect solid-phase enzyme immunosorbent assay (ELISA) kits. Esophagogastrodudenoscopy is only to be done in patients diagnosed with celiac disease. Four biopsies were taken from the first/second part of duodenum for histopathological examination. Results: Mean age in group A was 9.25 ± 3.26 yr, whereas 9.14 ± 3.4 yr in group B. 12% cases in group A were positive for IgA TTG, whereas 1.33% in group B were IgA TTG positive (p<0.0001*). Among IgATTG positive cases 66.67% in group A had subtotal villous atrophy, 27.77% had partial villous atrophy whereas in group B, 50% had partial or subtotal villous atrophy (p<0.05). Mean serum ferritin level were 10.2 ± 4.6 ng/ml and 58.4 ± 20.96 ng/ml in group A and group B respectively. (p<0.05). Mean transferrin saturation were 17.65 ± 1.65 % and 39.5 ± 10.5 % in group A and group B respectively. (p<0.05). Conclusion: Anemic children, especially those presenting with severe anemia have significantly higher likelihood of having Celiac disease. Physicians treating children with severe anemia may consider screening them for celiac disease. We recommend for community-based studies to confirm these findings.

Introduction: Aspirated foreign bodies in the airway are the major present challenges for the paediatricians. AIM: The study aims to evaluate the clinical profile of foreign body inhalation in children aged 1-14 years, assess the efficacy of HRCT for diagnosing tracheobronchial foreign bodies. Methodology: This prospective study, conducted at the Department of Pediatrics, S. P. Medical College and PBM Hospital, Bikaner, over one year (April 2022 to December 2023), employed convenience sampling to recruit 50 pediatric patients suspected of foreign body (FB) inhalation based on clinical history and persistent chest infections. Result: In our study, foreign body aspiration was most prevalent in children aged 1-3 years (40%), with a high incidence of cough (92%) and difficulty in breathing (80%). HRCT sensitivity was 88% and specificity was 87.5%, while bronchoscopy had a positive predictive value of 97%. Most foreign bodies were located in the right main bronchus (52.38%), with supari being the most common foreign object (61.90%). Complications were rare, and 94% of patients were discharged within 7 days. Conclusion: Accidental inhalation of foreign bodies in children remains a significant concern, with early recognition and referral to specialized centers being crucial, while non-contrast chest CT proves to be a reliable diagnostic tool.

Introduction: Postpartum hemorrhage (PPH), defined as blood loss more than 500 ml in normal vaginal delivery and > 1000 ml blood loss in cesarean delivery. AIM: The aim of this study is to determine if induction of labor leads to increased blood loss or postpartum hemorrhage (PPH) compared to spontaneous onset of labor. Methodology: This study was conducted in the labor room of the Department of Obstetrics and Gynaecology at Sardar Patel Medical College and A.G. Hospital, Bikaner, from February 2023 to May 2024. Result: In our study, induced labor showed higher blood loss during a 6-10 hour labor duration compared to spontaneous labor, with a statistically significant difference (p<0.05). However, neonatal outcomes such as birth weight and APGAR scores were similar between the two groups, with no significant differences observed. Conclusion: Induced labor is associated with higher blood loss, particularly with longer induction-to-delivery intervals, and accurate blood loss estimation using quantitative methods is essential to reduce maternal morbidity and mortality.

Introduction: Thyroid-related ophthalmopathy is an inflammatory auto-immune process with frequent extra thyroidal manifestations. Symptoms and signs of dysthyroid optic neuropathy leads to alteration of visual parameters, relative afferent pupillary defect and visual field defects. Venous obstruction is proved to be a contributing factor leading to proptosis, periorbital swelling, and chemosis. Aim-we evaluated the effect of early thyroid ophthalmopathy on visual parameters - visual acuity, intra-ocular pressure, color vision, contrast sensitivity and correlated with ocular blood flow. Method- We conducted a prospective, comparative study of total 30 patients who visited in the thyroid eye disease clinic in the oculoplastics and orbit unit, department of ophthalmology, sp medical college associated group of hospital between, June 2022 to May 2023. Patients with exposure keratopathy and optic neuropathy were excluded. Thyroid eye disease was considered to be present if eyelid retraction occurred together with objective evidence of thyroid dysfunction or exophthalmus or optic nerve dysfunction or extra ocular muscle involvement. If eyelid retraction was absent, then thyroid eye disease was diagnosed when exophthalmoses, optic nerve involvement, or restrictive extra ocular myopathy coexisted with thyroid dysfunction. Results- Patients were divided into 3 groups on the basis of the clinical activity score (CAS) of Mourits. Group A included 13 patients with CAS value ‘‘zero’’, group B included 10 patients with CAS value 1 to 2; group C included 7 patients with CAS value 3 or greater. Ocular blood flow as well as visual parameters was found not to be affected in group A and B. Ocular blood flow in group C was slightly affected without statistically significance. Conclusion- In early thyroid disease, visual parameters were not affected significantly except contrast sensitivity. Ocular blood flow shows little change with clinical activity score more than 2. Contrast sensitivity function may decline with increasing CAS score subsequently associated with increased ocular blood flow with increasing resistance in ocular veins. Furthermore studies required to authenticate this correlation.

Introduction: Leiomyoma or fibroid uterus is a benign tumor primarily made up of unicellular smooth muscle cells with variable levels of fibrous connective tissue. They are linked to substantial morbidity, which causes financial hardship for the patient and manifests as abnormal uterine bleeding, anaemia, pelvic pain, miscarriage and subfertility. We aim to evaluate the association of low vitamin D levels with occurrence of uterine fibroids and to study its role as a risk factor for development of fibroids. Methodology: This was cross-sectional observational study. It was conducted on 100 female patients aged (18 to 45 years) presenting to the OPD of department of Obstetrics and Gynecology at SPMC, Bikaner for a period of one year. 50 patients with at least one fibroid lesion with a mean volume of ≥ 2cm³ were taken as cases. The rest 50 patients who had normal uterine morphology on ultrasonography were approached to participate as controls. All women were subjected to ultrasound examination of uterus followed by serum vitamin D₃ levels. Result: The mean value of vitamin D levels in cases was 13.61±5.67 ng/ml and in controls it was 19.69±9.42 ng/ml with p value <0.05. Thus, it was statistically significantly lower in cases of fibroid uterus as compared to controls. Secondary incidental outcomes were found between vitamin D₃ level and BMI as fibroids occur statistically significantly more often in patient having of BMI ≥25 kg/m². A statistically significant difference was also found between low levels of serum vitamin D and location and number of fibroids but none with volume of fibroid. Conclusion: Serum vitamin D₃ level inversely correlated with the burden of leiomyoma and possibly its deficiency is a causative factor for the occurrence of uterine fibroid in the reproductive age group women

Human immunodeficiency virus type-1 (HIV) is a global health problem. One-third of HIV-infected individuals are co-infected with Mycobacterium tuberculosis, a leading cause of death among people living with HIV AIM: Determination of serum 25-hydroxyvitamin D level in HIV patients with active tuberculosis Methods In this observation study, we included a total of 60 subjects, consecutive 30 cases of HIV with tuberculosis and 30 cases of HIV without tuberculosis subjects who attended our outpatient clinic as well as those admitted in the department of General Medicine at SMS Medical College and attached group of Hospitals were enrolled into the study at our Institute. A detailed history was taken from the selected subjects about age, sex, residential address, economic status, occupation, any drug history, bleeding disorder and febrile. Results: In our study, there were similar gender distributions and TLD regimen usage between groups A and B. Group A had higher mean Vitamin D levels compared to Group B. Significant differences were found in mean CRP levels between both groups, while SGOT, SGPT, and S. Bilirubin showed no significant differences. We observed correlations between CRP and Vitamin D, ESR and Vitamin D, as well as BMI and Vitamin D in both groups, with varying strengths and significances Conclusion The findings of our study diverge from the commonly accepted link between serum vitamin D levels and pulmonary tuberculosis (PTB). However, they align with several other studies indicating a potential association between elevated serum 25(OH) D concentrations and PTB risk.

HIV-infected individuals often co-infected with Mycobacterium tuberculosis. The susceptibility and progression of TB are influence6+d by host immune response, environmental, and genetic factors, or their interactions. AIM: Association of vitamin D level with disease severity (as detected By CD4 cell count.) Methods This observational study recruited 60 subjects, divided into two groups: 30 HIV patients with tuberculosis (Group A) and 30 HIV patients without tuberculosis (Group B). Subjects were selected from the outpatient clinic and inpatients at SMS Medical College and its affiliated hospitals. Results: In our study, 66% of patients in Group A (HIV with TB) were at WHO stage 3, and 24% at stage 4. In Group B (HIV without TB), 70% were at stage 3, and 26% at stage 4 (p > 0.05). We observed an inverse correlation between Vitamin D and CD4 levels, with an r-value of -0.01 in Group A and -0.23 in Group B (p > 0.05). Similarly, for Vitamin D and WHO staging, the r-values were 0.17 for Group A and -0.1 for Group B, with no significant difference in either group (p > 0.05).  Conclusion There’s evidence suggesting a correlation between serum vitamin D levels and pulmonary tuberculosis (PTB). However, the overall variation in this correlation might be influenced by genetic factors. Studies have shown that genetic variations can impact both vitamin D metabolism and susceptibility to tuberculosis.

Background Treatment for orbital dermoid cysts has undergone a shift towards non surgical management after the introduction of sclerotherapy. Aim: To evaluate the role of foam sclerotherapy for the treatment of the large orbital dermoids. Methods: A prospective case series of 14 patients of large orbital dermoid was conducted in the Oculoplastics and Orbit Unit, Department of Ophthalmology, King George’s Medical University, Lucknow, between August 2018 and July 2019. Patients with history of associated trauma or spontaneous inflammation were excluded. 3% STS (Sodium Tetradecyl sulphate ) in amount equivalent to 10% of cyst aspirate was injected into the dermoid after making foam using Tessari's method. Data recorded included cyst location and size, pre and post intervention contrast enhanced CT scan data of the cyst size, volume, density. Patients were followed up at day 1, then biweekly for one month, monthly for two visits, and at six months. Cosmetic acceptability, assessed by patient at 6 months after procedure, was graded as good, fair and poor. Results: Mean age of the patients was 15.04+5.18 years. Majority of dermoid cysts were superficial (71.4%). The mean cyst volume was 12.4 ml. The mean aspirate volume was 6.03 ml. and cyst density ranged from -20 to 190 Hounsfield Unit. At 4 weeks, nine patients showed complete resolution. Five patients with residual lesion underwent repeat injection following which two resolved. Three unresolved patients needed surgical excision. Reported cosmetic outcome was good in 72.72% and fair in 27.27% patients. Conclusion Foam sclero-therapy is a minimally invasive, day-care therapeutic option providing good cosmetic outcome for management of large dermoid cyst.  

Background Children account for 1-5% of diagnosed COVID-19 cases however, many infected asymptomatic children may go undiagnosed without population screening.Even though the severity of disease in children is mild to moderate, the risk of long-term effects on respiratory health especially in children with comorbidities cannot be ruled out. Aims: To evaluate respiratory problems and pulmonary function test abnormalities in children after COVID-19 infection. Methods: The study had 86 individuals, 52 of whom were male and 34 of whom were female, with ages ranging from 6 to 18 years. The respiratory issues that each child's parents experienced both during and after their COVID-19 illness and recovery were enquired about. The American Thoracic Society (ATS) spirometry guidelines were adhered to, and computerized spirometry devices (RMS Helios 702 spirometer) were utilized for the investigation.Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC, Peak expiratory flow rate (PEF), and forced expiratory flow between 25% and 75% expired volume (FEF25-75) were the spirometry variables that were measured. The 6-MWT was carried out in compliance with ATS recommendations, and the outcomes were documented and compared to expected normal values. Results: post covid respiratory problems were present in up to 67.3% of symptomatic and 25.8% of asymptomatic children which includes respiratory symptoms in 52.3%, abnormal chest x-ray findings in 16.3%, abnormalities in 6-MWT results in 29.1% cases Conclusion To conclude thatcovid-19 illness is generally less severe in majority of children still it was associated with significant post covid respiratory problems and pulmonary function abnormalities in our study. Therefore, all cases of covid-19 illness should undergo long term follow up by regular clinical examination, 6-MWT and pulmonary function test for early detection of post covid respiratory morbidities.

Background This is an observational study for evaluation of use of distractors in contractures in digits of hand at distal interphalangeal joints and proximal inter phalangeal joints. Release of contractures involves different methods like excision of contracture band followed by coverage of raw area with split skin graft, full thickness graft and local flaps. In cases where excision of fibrous tissue alone does not give full release of contracture. In such cases to achieve complete or near complete release, distractors are used. Aim: Evaluation of utilization of distractors in flexion contracture of interphalangeal joints of hand. Methods: We have observed 20 patients with contracture of digits of hands due to burn or trauma. After soft tissue release, distractors were applied using micro motor drill, K-wire and appropriate size of distractors. Post operatively, after 5 day, gradual distraction was started. Observation done in terms of release in contracture, pain, duration of treatment and infection. Results: In our observational study of 20 patient,in 18 patients distractions was applied for the duration of 3-6 weeks   And in 2 patients it was required to remove due to infection Conclusion in our observation study, data suggest that the use of distractors can useful in cases where complete soft tissue release cannot be possible due to chronicity of the contracture. It is useful in both burn as well as post traumatic contracture.

We report a case of a 40-year-old female from Pakistan, who was referred to our clinic due to a prolonged activated partial thromboplastin time (APTT) detected during routine preoperative laboratory testing. The patient's past history included two cesarean sections with no notable bleeding episodes. A subsequent investigation revealed Factor XI deficiency, a rare coagulation disorder. The case highlights the importance of thorough preoperative screening and the need for careful interpretation of laboratory findings to guide management decisions in patients with coagulation abnormalities.

MOGAD (Myelin oligodendrocyte glycoprotein associated disease) is a rare demyelinating disorder which may present as optic neuritis, transverse myelitis, cortical encephalomyelitis or acute demyelinating encephalomyelitis (ADEM), of these the most common presentation is optic neuritis in adults and ADEM in children. This is a case report of a pediatric patient who presented with Atypical Optic neuritis (AON) and some features of ADEM and who subsequently tested positive for MOG antibodies. The patient regained normal vision after successful treatment.

Introduction: Dengue fever, which exhibits a higher prevalence in Asia, stands as a significantly overlooked vector-borne disease. This ailment manifests with a diverse spectrum of symptoms, extending from the typical presentation of fever to more unconventional and atypical manifestations. The sim of this study was to examine the clinical profile and identify the atypical presentations of dengue fever cases. Methodology: This retrospective observational study incorporated 1423 cases clinically suspected of dengue, documented from 2015 to 2023. Serum samples were collected from these cases, and confirmation was achieved through NS1 antigen, IgM, and IgG antibody detection using ELISA. A comprehensive history was obtained, and a meticulous clinical examination was conducted for all confirmed positive cases. Haematological parameters were recorded and compared as part of the analysis. Results: In this study, 1423 cases underwent screening for dengue, with 804 cases testing positive. The peak incidence occurred in the year 2021. Among the positive cases, the majority were males, constituting 59.95%. The predominant clinical manifestation observed was fever, prevalent in 93.53% of the cases. Notably, 177 cases exhibited atypical clinical features, with Hepatomegaly being the most frequently observed. Haematological analysis of dengue-positive cases revealed that Thrombocytopenia was prevalent, affecting 65.17% of the cases. Conclusion: In the midst of ongoing epidemics, it is imperative to promptly investigate the clinical profile and atypical manifestations in individuals suspected of dengue. This proactive approach is crucial for early identification, enabling timely treatment of severe forms of the disease

Youth nutrition plays a pivotal role in determining immediate health and lifelong well-being. However, the rapid rise of processed and ultra-processed food consumption among children and adolescents has introduced significant public health challenges. These foods, rich in refined sugars, unhealthy fats, sodium, and artificial additives, are often deficient in essential nutrients such as fiber, vitamins, and minerals. Their consumption is strongly linked to a spectrum of adverse health outcomes, including obesity, metabolic syndrome, cardiovascular diseases, cognitive impairments, and behavioral disorders. This systematic review explores the socio-environmental factors driving the consumption of processed foods among youth and evaluates their long-term physiological and psychological impacts. It also discusses evidence-based intervention strategies, including policy reforms, educational initiatives, and industry-led innovations, to mitigate the negative effects of processed foods. The findings emphasize the urgency of integrated, multi-sectoral efforts to combat the growing epidemic of poor dietary habits among children and adolescents.

Background Vaginal birth and cesarean section (CS) are the primary delivery modes, each with distinct short- and long-term maternal health outcomes. Understanding these differences aids in informed delivery planning. Objective To evaluate and compare the short- and long-term maternal health outcomes of vaginal births versus cesarean sections among patients at Barasat Government Medical College. Methods: A prospective cohort study was conducted on 100 patients (vaginal birth: n=60; CS: n=40) between January 2023 and December 2024. Short-term outcomes assessed included recovery time, infection rates, and postpartum pain, while long-term outcomes included pelvic floor disorders, complications in subsequent pregnancies, and chronic pain. Data analysis was performed using chi-square and t-tests (p<0.05). Results: Recovery within five days was achieved by 75% of vaginal birth patients compared to 30% of CS patients (p<0.01). Infection rates were 10% in vaginal births and 25% in CS cases, including surgical site infections (20% in CS). Severe postpartum pain was reported in 15% of vaginal births versus 40% of CS patients. Perineal trauma occurred in 18% of vaginal births, while 5% of CS cases had abdominal wound dehiscence.Long-term, pelvic floor disorders were higher in vaginal births (12%) compared to CS (5%). Subsequent pregnancy complications occurred in 32% of CS patients, including uterine rupture (12%) and placenta accreta (15%), compared to 5% in vaginal births. Chronic pelvic pain was reported in 20% of CS patients versus 8% in vaginal births Conclusion: Vaginal birth promotes faster recovery and fewer surgical risks, while CS poses significant long-term reproductive risks. Individualized care decisions are essential for optimizing maternal health.

Background: Maxillofacial reconstruction often requires bone grafting to restore form and function following trauma, congenital defects, or tumor resection. The choice of graft material—autogenous bone, alloplastic materials, allogeneic bone, or xenogeneic bone—significantly impacts clinical outcomes. This systematic review and network meta-analysis aimed to compare the efficacy and safety of these different grafting materials in maxillofacial reconstruction. Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, MEDLINE, and Embase to identify relevant randomized controlled trials (RCTs). Studies were selected based on predefined inclusion criteria, including human subjects undergoing maxillofacial reconstruction with various bone graft materials. Data were extracted from the included studies, and a network meta-analysis was performed to compare the clinical outcomes, including success rates, complication rates, functional recovery, and aesthetic outcomes. Results: The review included 10 RCTs involving 496 patients. Autogenous bone grafting demonstrated the highest overall success rate and was considered the gold standard due to its osteogenic, osteoinductive, and osteoconductive properties. However, it was associated with donor site morbidity. Alloplastic materials showed satisfactory outcomes but had a higher rate of material-related complications. Allogeneic and xenogeneic bone grafts were less effective than autogenous grafts, with lower success rates and higher complication rates. Conclusion: Autogenous bone grafts remain the preferred choice for maxillofacial reconstruction due to their superior biological properties and clinical outcomes. However, alloplastic, allogeneic, and xenogeneic materials can be viable alternatives in specific clinical contexts, particularly where autogenous grafts are contraindicated or donor site morbidity is a concern.

        Background: Ventral hernias are defined as defects in the abdominal wall fascia that are neither inguinal nor hiatal. AIM: To compare surgical outcomes of TAPP and IPOM PLUS in small and mid-sized ventral hernia cases.     

    Methods: The study population comprised patients diagnosed with ventral hernias at SMS Medical College and Hospital in Jaipur, utilising both clinical and radiological assessments.

        Results: Our study revealed significant differences between the IPOM Plus and Ventral TAPP groups, with the IPOM group being younger and reporting higher pain levels postoperatively, particularly on Days 1, 30, and 90 (p < 0.001), while the TAPP group had shorter hospital stays (2.22 days vs. 2.8 days, p < 0.001) and longer operative times (76.70 minutes vs. 67.09 minutes, p = 0.003).

         Conclusion: In conclusion, while the Ventral TAPP technique for hernia repair is more time-consuming, it provides significant benefits in pain management, shorter hospital stays, and improved recovery outcomes compared to the IPOM Plus approach.

Background: Common bile duct stones occur in 5% of asymptomatic and 10-20% of symptomatic gallstone patients, necessitating treatment to prevent complications like obstructive jaundice and pancreatitis. AIM: To study safety and clinical efficacy of: Biliary Stent and T-tube Biliary drainage in patients of choledocholithiasis

        Methods: study is a hospital-based prospective comparative study designed as a randomised control trial, conducted at SMS Medical College and Hospital in Jaipur.

        Results: In our study, the biliary stent group had significantly shorter surgery durations, hospital stays, and intraoperative blood loss, along with lower postoperative complications and pain scores compared to the T-Tube group.

         Conclusion: Biliary stenting is a safe and effective with lesser rate of surgical site wound infections.

Background: Gallbladder-related diseases are among the most common reasons for elective and emergency surgeries. AIM: To Predict the intraoperative and postoperative complications in patients undergoing laparoscopic cholecystectomy using The Ten Point Scoring System

        Methods: This study is a hospital-based cross-sectional observational study conducted in the Department of General Surgery at SMS Medical College and Hospital, Jaipur, from November 2022 to May 2024.

        Results: Operative mortality for cholecystectomy is under 1%, but complications occur in 10–15% of cases, notably bile duct injuries and cystic duct leaks, which can be minimized by following the ten-point scoring system. In difficult cases, Laparoscopic cholecystectomy is more challenging and should be performed by experienced surgeons to reduce complications and conversion rates using ten-point scoring system.

         Conclusion: Laparoscopic cholecystectomy is safe and effective, with negligible morbidity and no conversions to open cholecystectomy, by following ten-point scoring system

Background: Perforation peritonitis is a common emergency in general surgical practice. AIM: To compare the efficacy of Jabalpur prognostic scoring system with Mannheims peritonitis index in evaluating prognosis in patients with perforation peritonitis.

        Methods: The study was a hospital-based comparative observational design conducted at the Department of General Surgery, SMS Medical College, Jaipur. Spanning from April 2023 to April 2024

        Results: In the study, the JPS score effectively categorised patients with perforation peritonitis, showing significant mortality differences across categories, with a high area under the ROC curve (0.977) indicating strong predictive ability. The MPS score also demonstrated good predictive capability (0.917), but JPS was slightly superior and more user-friendly, relying on easily obtainable clinical parameters without requiring intraoperative data.

         Conclusion: The study concludes that both JPS and MPI effectively predict morbidity and mortality in patients with peritonitis. JPS demonstrates slightly higher accuracy and greater ease of use in resource-limited settings.

Background: Acute appendicitis is a common inflammatory condition of the appendix, often caused by obstruction from fecoliths or foreign bodies, leading to bacterial overgrowth and potential necrosis. AIM: To evaluate the diagnostic efficacy of Total leukocyte count and C-Reactive Protein in radiologically diagnosed acute appendicitis.

        Methods: This observational study is designed as a hospital-based prospective investigation involving patients admitted to the Department of General Surgery at SMS Hospital, Jaipur, with symptoms suggestive of acute appendicitis

        Results: In our study of 77 patients, the mean age was 30.59 years, with a predominance of males (57) and common symptoms including migratory pain (81.81%), anorexia (72.72%), and elevated CRP levels (71.42%), showing a sensitivity of 91.07% and specificity of 80.95% for diagnosing acute appendicitis. These findings highlight CRP's effectiveness as a diagnostic tool, particularly when correlated with histopathological examination, though its predictive values may be limited when used alone.

         Conclusion: TLC and CRP tests are recommended for patients with suspected acute appendicitis to reduce the incidence of negative appendectomies.

Background: This study investigates the prevalence and long-term health consequences of Vitamin D deficiency in pediatric populations, focusing on its impact on bone health, immune function, and susceptibility to chronic diseases in adulthood.

        Methods: A cross-sectional study was conducted with 300 pediatric participants aged 5-15 years. Vitamin D levels were measured via serum tests, while Bone Mineral Density (BMD), immune markers (CRP, WBC), and early chronic disease indicators (BMI, blood glucose) were assessed. Statistical analyses included t-tests and Pearson correlations to examine relationships between Vitamin D levels and health markers.

        Results: Vitamin D-deficient children exhibited significantly lower BMD, elevated immune markers, and higher BMI, suggesting early health risks. Longitudinal analysis showed that adults deficient in Vitamin D during childhood had a 65% incidence of bone disorders and 40% chronic disease prevalence, compared to 30% and 18%, respectively, among those with sufficient levels.

         Conclusion: Pediatric Vitamin D deficiency is associated with adverse health outcomes in adulthood, emphasizing the importance of early intervention. Strategies to improve Vitamin D levels in children may reduce the risk of bone disorders, immune dysfunction, and chronic diseases later in life.

Background: The incidence of preterm births has been rising steadily, and although full-term newborns face relatively lower risks, neonates born between 34- and 36-weeks’ gestation exhibit significantly higher rates of morbidity and mortality. Consequently, these infants, classified as "late preterms," warrant special attention and monitoring to mitigate health risks. Proper infrastructure, basic monitoring, and timely support can often stabilize this vulnerable group. Objective: This study aims to assess the morbidity and mortality profiles of term and near-term neonates admitted to a Neonatal Intensive Care Unit (NICU).

        Methods: The study included 426 neonates, both inborn and outborn, divided into two groups based on gestational age: 343 term and 83 near-term infants. Both groups were evaluated for various morbidities and mortality.

        Results: Neonatal mortality was slightly higher in near-term infants (1.20%) compared to term infants (0.58%), though this difference was not statistically significant (Fisher’s exact test, p=0.4826). Morbidity, however, showed significant differences in certain risk factors. Near-term infants had a higher incidence of respiratory distress (69.87%) compared to term infants (47.52%), with a p-value of <0.0001, and were more frequently diagnosed with sepsis (37.34% in near-term vs. 5.24% in term infants, p=0.0001). Additionally, hypoglycemia was more common among term infants (5.83%) but remained statistically significant with a p-value of 0.005. No significant differences were found in other risk factors, including congenital malformations, hypocalcemia, cardiovascular complications, and shock, nor were there significant differences in comorbidities at discharge.

         Conclusion: Near-term neonates face a higher risk of neonatal morbidity and mortality compared to term neonates, with morbidity inversely related to gestational age. Intensive monitoring and supportive care are essential for preterm infants to improve health outcomes.