Background: Proximal humerus fractures are a significant clinical challenge, particularly among elderly patients with osteoporotic bone. This study evaluates the clinical and functional outcomes of proximal humerus fractures treated with locking compression plates (LCPs) using the PHILOS system. Methods: A retrospective observational study of 54 patients with proximal humerus fractures treated with LCP fixation was conducted. Patients were followed up at 2, 6, 12, and 24 weeks postoperatively, and functional outcomes were assessed using the DASH score. Results: The study showed significant improvement in DASH scores over time, indicating substantial recovery of upper limb function. The mean DASH score improved from 68.5 at 2 weeks to 15.4 at 24 weeks. Complication rates were low, and outcomes were favorable with proper surgical technique and early rehabilitation. Conclusion: LCP fixation with PHILOS plates is a reliable and effective method for treating proximal humerus fractures, providing stable fixation and allowing for early mobilization. With careful patient selection and structured postoperative care, this approach can help restore function and improve quality of life after proximal humerus fractures.

Background: Academic stress and anxiety are increasingly recognized as critical challenges affecting adolescent well-being and academic performance. Cognitive Behavioral Therapy (CBT), a structured and evidence-based psychological intervention, has demonstrated considerable effectiveness in addressing these issues. This review examines the effectiveness of school-based CBT interventions designed to manage academic stress and anxiety among adolescents. Findings from randomized controlled trials and systematic reviews highlight that CBT not only reduces symptoms of stress, test anxiety, and burnout but also enhances self-efficacy, resilience, and academic engagement. Programs such as Study Without Stress, COPE, and DISCOVER demonstrate that both universal and targeted CBT interventions can be successfully implemented in school environments, providing accessible and cost-effective support. Evidence further underscores that delivery by trained mental health professionals yields stronger outcomes compared to teacher-led models, though teacher involvement remains valuable in resource-limited contexts. Peer support and group-based approaches enhance participation, normalize mental health conversations, and promote sustained benefits. Despite encouraging results, limitations include the lack of long-term follow-up, cultural adaptability concerns, and reliance on self-reported outcomes. Future directions should focus on longitudinal evaluations, culturally sensitive adaptations, hybrid digital delivery models, and exploration of peer-led approaches. Integrating CBT into school systems has the potential to create supportive educational environments that enhance both psychological resilience and academic performance in adolescents.

Background: This expanded study evaluates the anatomical relationship between the aortic bifurcation and the umbilicus in a cohort of 1000 adult patients, with an emphasis on its clinical implications for laparoscopic port placement. We analyzed demographic variables including age, sex, weight and BMI and evaluated the safety of Veress needle insertion and infraumbilical port placement. Results from the original study demonstrate that in the majority of patients, the aortic bifurcation lies below the umbilicus, supporting the relative safety and benefit of infraumbilical port access in laparoscopic procedures. The findings were particularly pronounced in female and obese patients.

Background: Breast cancer is the most common cancer among women and accounts for 12% of all new cancer cases globally. AIM: To study the reliability of pedicled latissimus dorsi flap in various indications, outcomes & complications associated in breast reconstruction. Methodology: In this observational study, 30 patients of breast reconstruction were studied over a duration of 12 months who underwent LD Flap coverage. All these patients were prospectively studied for LD Flap reconstruction under different clinical scenarios. Result: In our study, the majority of patients were over 60 years (40%), with most reconstructions performed as immediate procedures (80%). Seroma was the most common complication occurring in 13.33% of cases, followed by wound dehiscence seen in 3.33% cases. No flap necrosis or hematoma or shoulder restriction was reported, and overall complications were minor and manageable. These findings support the continued reliability and versatility of the pedicled latissimus dorsi myocutaneous flap in breast reconstruction. Conclusion: Pedicled LDMF is a simple, reliable and good versatile technique for breast reconstruction with minimal complications.

Background: Diabetes mellitus (DM) and thyroid dysfunction (TD) are two of the most common endocrine disorders encountered in clinical practice across all age groups and populations. AIM: Study of the Prevalence of thyroid dysfunction in patients with diabetes mellitus. Methodology: This observational cross-sectional study included 195 patients with type 1 or type 2 diabetes mellitus attending the outpatient diabetes clinic at Late Shrimati Indira Gandhi Memorial Government Medical College associated with Komaldev Hospital, Kanker, Chhattisgarh. Inclusion criteria were diabetes duration over 9 months for T2DM or over 1 year for T1DM, with specific diagnostic criteria applied to distinguish the two types. Result: This study showed that T1DM patients were generally younger with poorer glycemic control, while T2DM patients had higher obesity and hypertension prevalence. Subclinical hypothyroidism was the most common thyroid dysfunction across both groups, with anti-TPO positivity indicating notable autoimmune thyroid involvement. Overall, these findings stress the importance of long-term monitoring for metabolic, cardiovascular, and thyroid complications in diabetes. Conclusion: This study highlights the need for integrated, long-term screening and management of metabolic, cardiovascular, and thyroid dysfunctions in diabetes to reduce chronic complication

Background: Sickle cell disease (SCD) represents the most common hereditary hematologic disorder in the United States, affecting an estimated 100,000 Americans, primarily among African-American populations, and millions of individuals worldwide. Aim: Study of Hypogonadism in Patients with Sickle Cell Disease: Central or Peripheral? Methodology:  This observational study was conducted at the Late Shrimati Indira Gandhi Memorial Government Medical College associated with Komaldev Hospital, Kanker, Chhattisgarh. Eligible participants included adult male patients with sickle cell disease (SCD) who were not on testosterone therapy and had no acute illness within seven days prior to enrollment. Result: In this study, hypogonadism in SCD men was linked to older age, higher BMI, and low gonadotropin levels suggestive of secondary hypogonadism, with no significant difference in ferritin levels between groups. These findings are consistent with previous studies highlighting central hypogonadism as the predominant mechanism in sickle cell disease. Conclusion: This study found that 24% of men with SCD had hypogonadism, mainly of central origin, associated with higher age and BMI. Routine endocrine screening is recommended to detect and manage hypogonadism early in this population.

Background: Topical corticosteroids (TCS) are among the most commonly prescribed therapeutic agents in dermatology and have remained a cornerstone in the management of inflammatory skin disorders since the introduction of hydrocortisone (compound F) in 1952.AIM: To evaluate the misuse of topical corticosteroid on face  in patients attending tertiary care hospital. Methodology: The study was conducted in the outpatient clinic of Dermatology Government medical College Sri Ganganagar. Individuals of all ages and both sexes were recruited. Result: The study revealed that topical corticosteroid (TCS) misuse was most prevalent among adolescents and young adults, particularly in rural areas. Betamethasone valerate 0.1% (Class III) was the most commonly used formulation, mainly obtained through non-medical sources such as relatives and alternative medicine practitioners. The most frequent indications included acne and melasma, with acneiform eruption, pruritus, and photosensitivity being common side effects. Comparative studies also highlight similar patterns of inappropriate TCS use and associated dermatological complications. Conclusion: Topical corticosteroid misuse on the face is a growing concern in India, driven by over-the-counter access and lack of awareness. Many people use these creams inappropriately for cosmetic purposes, leading to harmful dermatological side effects. The problem is compounded by recommendations from non-medical sources and insufficient guidance from healthcare providers. Increasing cases of facial complications highlight the urgent need for intervention. Stronger regulations and widespread educational initiatives are essential to curb this misuse and protect public health.

Background: An anal fissure is a linear ulcer or tear in the anoderm, usually located just distal to the dentate line. It is a common and painful anorectal condition encountered in both surgical and obstetric practice, especially in postnatal women. Anal fissures may be primary (idiopathic), which are more prevalent, or secondary to underlying diseases like tuberculosis, Crohn’s disease, ulcerative colitis, AIDS, or malignancy. Aim: A Clinical Study to Evaluate the Outcome of Lord’s Anal Dilatation in the Treatment of Chronic Anal Fissure. Methodology: This prospective observational study was conducted in the Department of General Surgery at Government R.D.B.P. Jaipuria Hospital, which is affiliated with RUHS-CMS, Jaipur. The study population consisted of patients who were clinically diagnosed with chronic anal fissure and scheduled for surgical intervention using Lord’s Anal Dilatation. Result: Lord’s Anal Dilatation (LAD) proved to be a safe and effective treatment for chronic anal fissure in our study, with minimal complications and high patient tolerance. The most common complication was transient flatus incontinence (15%), with no cases of fecal incontinence or recurrence. Our findings support LAD as a reliable surgical option, with shorter hospital stays and outcomes comparable or better than existing literature. Conclusion: Lord’s Anal Dilatation is a safe, effective, and minimally invasive treatment for chronic anal fissure with low complication and recurrence rates.

Background: Anal fissure is defined as a linear ulcer or tear in the anoderm, most commonly occurring distal to the dentate line. It typically presents in the posterior midline of the anal canal due to anatomical and vascular predisposition. AIM: study to compare postoperative outcomes of lord’s anal dilatation and lateral anal sphincterotomy in chronic anal fissure. Methodology: This prospective observational study was conducted in the Department of General Surgery, Government R.D.B.P. Jaipuria Hospital, affiliated with RUHS-CMS, Jaipur. Result: Lateral anal sphincterotomy showed superior outcomes over Lord’s anal dilatation, with greater pain and constipation relief, no incontinence, and zero recurrence. Both procedures were safe, but LIS provided more consistent and sustained postoperative benefits. Conclusion: Lateral anal sphincterotomy is the superior surgical option for chronic anal fissure, offering better pain relief, lower recurrence, and fewer complications than Lord’s anal dilatation.

Background: An anal fissure is a common and distressing anorectal condition characterized by a longitudinal tear in the anoderm, typically extending distal to the dentate line. It presents most frequently with intense pain during defecation and is often accompanied by bright red rectal bleeding. Aim: A Clinical Study to Evaluate the Outcome of lateral internal sphincterotomy in the Treatment of Chronic Anal Fissure. Methodology: This prospective observational study was conducted over six months, from August 2023 to March 2024, in the Department of General Surgery at Government R.D.B.P. Jaipuria Hospital, Jaipur, affiliated with RUHS-CMS. The study aimed to evaluate the outcomes and safety profile of lateral internal sphinctertomy in patients with chronic anal fissure. Result: In our study of 60 patients with chronic anal fissure, CLIS was performed in 75% and OLIS in 25% of cases, with a high healing rate of 83.3% within 4 weeks. Local anesthesia was used most frequently (58.3%) and complications were minimal, with transient incontinence to flatus being the most common (8.3%). These findings support CLIS as a safe, effective, and well-tolerated procedure with favorable outcomes. Conclusion: Closed Lateral Internal Sphincterotomy is a safe, effective, and minimally invasive treatment for chronic anal fissure with excellent healing outcomes and minimal complications.

Background: Point-of-Care Ultrasound (POCUS) is an emerging bedside tool that enhances diagnostic speed and accuracy in pediatric emergency settings. This study aimed to evaluate the clinical utility, diagnostic accuracy, and impact of POCUS in children presenting with acute emergency conditions .Methods: A prospective observational study was conducted at Tx Children’s Hospitals, Hyderabad, over 20 months (June 2023 – February 2025). A total of 235 pediatric patients underwent POCUS based on clinical presentation. Applications included lung, abdominal, trauma-focused (FAST), cardiac/IVC, and cranial ultrasound. POCUS findings were compared to final imaging or discharge diagnoses. Diagnostic accuracy and clinical decision impact were assessed .Results: Lung ultrasound was the most common application (38.7%), followed by abdominal (29.3%) and trauma scans (15.7%). Sensitivity and specificity were highest for pneumonia (91.2% and 85.7%) and FAST scans (86.7% and 91.5%). Median time-to-diagnosis via POCUS was 14 minutes, significantly faster than conventional imaging (p < 0.001). POCUS altered clinical management in 62.5% of cases and showed substantial agreement with final diagnosis (kappa = 0.74). No adverse events were noted .Conclusion: POCUS is a rapid, accurate, and impactful diagnostic tool in pediatric emergencies. It enhances early decision-making and should be routinely integrated into pediatric emergency protocols, supported by structured training and quality monitoring.

Background: Enhanced Recovery after Surgery (ERAS) protocols emphasize standardized, patient-centered perioperative care aimed at reducing complications, shortening hospital stays, and improving functional recovery. Artificial intelligence (AI) technologies—such as closed-loop anesthesia delivery, machine learning (ML)–based pain prediction, and wearable-guided rehabilitation—are increasingly being integrated into ERAS pathways to optimize clinical outcomes. These tools promise greater precision in intraoperative management, improved postoperative pain control, and personalized recovery trajectories. Methods A systematic search of PubMed/MEDLINE, Embase and Scopus identified randomized controlled trials (RCTs), observational/cohort studies, and validated prediction model studies assessing AI-driven perioperative interventions. Risk of bias was evaluated using the Cochrane RoB 2, ROBINS-I, and PROBAST tools. Certainty of evidence was appraised using the GRADE approach. Results: Thirteen studies met inclusion criteria (6 RCTs, 4 prediction model evaluations, 3 observational or non-randomized studies). Key findings were as follows: •Closed-loop anesthesia (4 RCTs, n = 677) significantly increased time in target BIS/PSI range (mean difference [MD] +26.1%, 95% CI 22.3–29.9; high certainty). One trial reported higher propofol consumption in the closed-loop group. •ANI-guided opioid titration (1 RCT, n = 52) reduced cumulative remifentanil dosing (MD −0.027 µg/kg/min, 95% CI −0.045 to −0.009; moderate certainty) without compromising postoperative pain scores. •AI-based pain prediction (4 studies, AUROC 0.81–0.98) generally outperformed clinician assessment but lacked robust external validation and long-term outcome linkage (low certainty). •Wearable-guided rehabilitation (1 non-randomized clinical trial, n = 194) improved postoperative step counts (standardized mean difference [SMD] 0.67, 95% CI 0.34–1.00) and reduced dyspnea at early and late follow-up (low certainty).Conclusions AI-driven anesthesia systems enhance intraoperative precision and support opioid stewardship within ERAS protocols, while AI-enabled pain prediction models and wearable technologies show early promise for improving postoperative recovery. However, most evidence remains limited to small or single-center studies, with low-to-moderate certainty for many outcomes. High-quality, multicenter RCTs are required to determine long-term benefits, cost-effectiveness, and integration feasibility across diverse healthcare settings.

Background: Delayed radiation complications, including osteoradionecrosis, radiation cystitis, proctitis, and soft tissue necrosis, significantly impair quality of life in cancer survivors. Hyperbaric oxygen therapy (HBOT) has emerged as a promising adjunctive treatment to enhance healing in irradiated tissues. However, consolidated evidence evaluating its efficacy across various late radiation sequelae remains limited. Methods: This systematic review was conducted at the Prana Hyperbaric Oxygen Therapy Centre, Mumbai, covering literature up to January 2025. Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Embase, Web of Science, and Cochrane Library was performed. Studies were included if they evaluated HBOT in adult patients with delayed radiation complications occurring ≥3 months post-radiotherapy. Data on study design, HBOT protocol, radiation injury type, clinical outcomes, and adverse events were extracted and qualitatively synthesized. Results: Out of 770 identified records, 34 studies met the inclusion criteria. HBOT was most commonly used for osteoradionecrosis, followed by radiation cystitis and proctitis. Pooled response rates ranged from 65% to 85%, with the highest efficacy observed in pelvic radiation complications. HBOT protocols typically involved 20–40 sessions at 2.0–2.5 ATA. Early initiation of therapy, particularly within 6 months of symptom onset, was associated with better outcomes. Adverse effects were minimal and primarily limited to ear barotrauma and transient fatigue. Conclusion: HBOT is a safe and effective adjunctive therapy for managing delayed radiation complications, particularly when initiated early. It enhances tissue healing, reduces symptoms, and lowers the need for surgical intervention. Standardized protocols and larger prospective studies—especially from low- and middle-income countries—are recommended to guide clinical implementation and policy development.

Background: Osteoporosis compromises bone quality, potentially impairing dental implant osseointegration. Titanium (Ti) implants are the clinical gold standard, but zirconia (ZrO₂) implants offer esthetic and biocompatibility advantages. However, their comparative performance in osteoporotic bone remains inadequately characterized. Objective: To compare osseointegration outcomes of Ti and ZrO₂ implants in osteoporotic patients over 12 months. Methods: A randomized controlled trial enrolled 60 osteoporotic patients (30 Ti, 30 ZrO₂). Implant stability quotient (ISQ), bone-implant contact (BIC), and survival rates were assessed at 3, 6, and 12 months. Key Findings: At 12 months, Ti implants exhibited significantly higher ISQ (75.2 ± 3.1 vs. 72.8 ± 4.2; p = 0.012) and BIC (58.3 ± 5.2% vs. 52.1 ± 6.1%; p = 0.003) than ZrO₂. Survival rates were comparable (Ti: 96.7%, ZrO₂: 90.0%; p = 0.308). ISQ increased over time in both groups (p < 0.001). Conclusion: Ti implants demonstrate superior osseointegration in osteoporotic patients, though ZrO₂ implants achieve clinically acceptable stability. Ti remains the preferred material, but ZrO₂ may be suitable for patients with metal hypersensitivity.

Background: Relaparotomy after cesarean delivery is a rare but critical complication that can significantly increase maternal morbidity and mortality. Understanding its causes and outcomes is essential for improving maternal care. Objective: To evaluate the indications, clinical profiles, surgical procedures, and outcomes of patients undergoing relaparotomy following cesarean section during the puerperal period. Methods: This prospective descriptive study was conducted over 12 months (November 2022 to October 2023) in the Department of Obstetrics and Gynaecology at North Bengal Medical College and Hospital. A total of 25 patients who underwent relaparotomy within six weeks of a cesarean section were included. Data on demographics, obstetric factors, comorbidities, surgical indications, procedures, and outcomes were collected and analyzed using SPSS v21.Results: The mean patient age was 28.8 years; 64% of cesarean deliveries were emergency procedures, and 56% were preterm. Common indications for cesarean included obstructed labor (40%) and non-progression of labor (20%). Intraperitoneal hemorrhage was the leading cause of relaparotomy (40%), followed by rectus sheath hematoma (16%) and burst abdomen (8%). The most frequent procedures performed were hysterectomy and hemoperitoneum evacuation (each 28%). Mortality was observed in 28% of cases, with sepsis, multi-organ failure, and DIC as leading causes. Conclusion: Relaparotomy after cesarean section is associated with high morbidity and mortality, primarily due to hemorrhagic and infectious complications. Prompt recognition, risk stratification, and aggressive perioperative care are crucial to improve outcomes.

Background: High-risk pregnancies contribute disproportionately to maternal and perinatal complications in low- and middle-income settings despite improving antenatal care coverage. Simple, scalable antenatal risk tools are needed to triage and guide care. This study evaluated the Modified Coopland’s Scoring System (MCSS) for antenatal risk stratification and its association with maternal and neonatal outcomes in a tertiary care hospital in Bhopal, India. Methods: A retrospective, case-record–based study was conducted in the Department of Obstetrics and Gynaecology, Mahaveer Medical College, Bhopal, reviewing 200 antenatal records from June 2022 to May 2024. Women aged 18–45 years with at least six antenatal visits were included. MCSS was applied in the third trimester to categorize risk as low (0–3), moderate (4–6), or high (>7). Maternal outcomes (mode of delivery, complications, postpartum hemorrhage, maternal mortality) and neonatal outcomes (preterm birth, low birth weight [LBW], NICU admission, 5-minute Apgar <7, perinatal mortality) were compared across risk groups using chi-square or Fisher’s exact tests. Results: Risk severity showed strong associations with demographic factors: higher age score and greater parity were enriched in the severe group (age score distribution p<0.0001; parity score p=0.003). Operative delivery increased with risk severity (52.3% mild vs 86.8% moderate vs 66.7% severe; p<0.0001). Postpartum hemorrhage was infrequent overall (2.5%) but higher in severe cases (11.1%; p=0.055). Neonatal outcomes deteriorated with increasing risk: LBW rose significantly across categories (25.5% mild, 39.5% moderate, 66.7% severe; p=0.012) and perinatal mortality increased markedly (2.0% mild, 7.9% moderate, 22.2% severe; p=0.009). Preterm birth (p=0.243), 5-minute Apgar <7 (p=0.317), and NICU admission (p=0.758) were more frequent in moderate/severe groups but did not reach statistical significance. Conclusion: MCSS effectively stratified antenatal risk and predicted a graded rise in adverse maternal and neonatal outcomes. Higher risk categories required more operative deliveries and showed a trend toward increased PPH, while LBW and perinatal mortality increased significantly with severity. Integrating MCSS into routine antenatal care can support targeted surveillance, intrapartum readiness (including hemorrhage prophylaxis), fetal growth monitoring, and neonatal preparedness. Future research should adjust for key confounders and evaluate structured, risk-based care pathways to mitigate LBW and perinatal loss.

Background: Pediatric septic shock remains a major cause of morbidity and mortality in intensive care units, particularly in low- and middle-income countries. Early identification of predictors of mortality is critical for timely intervention and improved outcomes. This study aimed to evaluate clinical and laboratory variables associated with mortality in pediatric septic shock. Methods: This prospective observational study was conducted at Tx Children’s Hospitals, Hyderabad, over 18 months (June 2023 to December 2024). A total of 200 pediatric patients aged 1 month to 18 years with septic shock were enrolled. Demographic, clinical, and laboratory parameters—including PELOD-2 score, serum lactate, and Vasoactive Inotropic Score (VIS)—were recorded. Patients were followed until discharge or death. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of mortality. Results: Out of 200 patients, 69 (34.5%) died. Non-survivors had significantly higher median serum lactate levels (4.9 mmol/L vs. 2.8 mmol/L), mean PELOD-2 scores (15.2 vs. 8.4), and higher VIS scores (>15 in 73.9% of non-survivors). The need for mechanical ventilation and prolonged capillary refill time were also associated with poor outcomes. On multivariate analysis, serum lactate >4 mmol/L (AOR 4.87), PELOD-2 score >12 (AOR 5.21), and requirement of mechanical ventilation (AOR 3.68) were identified as independent predictors of mortality. Conclusion: Serum lactate, PELOD-2 score, and mechanical ventilation requirement are strong, independent predictors of mortality in pediatric septic shock. Incorporating these markers into early assessment protocols can aid in timely triage, resource allocation, and escalation of care, potentially improving outcomes in critically ill children.

Background: Clavicle fractures are common injuries in adults, especially due to sport activities or road traffic accidents. Most lesions occur at the level of the middle-third presenting some degree of displacement often. Traditionally, non-surgical management was considered the first treatment option for the most clavicle fractures. Nowadays, various authors suggest early surgical fixation of displaced midshaft fractures. The aim of this study is to compare surgical versus non-surgical treatment and to evaluate the outcomes and the incidence of complications following to both treatment options. Material and methods: this prospective observational study done in department of orthopedics, Shri Rawatpura Sarkar Institute of Medical Sciences and Research, Atal Nagar Nawa Raipur, Chhattisgarh from January 2024- January 2025. 87 patients with 2 displaced clavicle fractures fragments were included in study, evaluating the clinical and functional outcomes and the complication rate with a follow-up average of 48 months. Results: The risk of nonunion resulted lower in the surgically treated patients. The Constant Score after 1 year was slightly better after the plate fixation (94,36 vs 91,36), while the DASH score resulted better in the conservatively treated patients (3,86 vs 4,63). The delay or revision surgery rates were similar for both groups and most of the complications were associated with the conservative treatment. Conclusions: According to our results, the plate fixation does not lead to better clinical and functional outcomes, instead it reduces the risk of non- union. We suggest to tailor the treatment patient-by-patient considering the functional demand, patient’s comorbidity and nonunion risk factor. (www.actabiomedica.it).

Background: Shoulder joint is an elegant anatomic structure. Its range of motion exceeds all other joints, yet under most circumstances it is stable. The shoulder joint relies upon a variety of structures for stability, including the osseous glenoid, the fibrous labrum, the joint capsule, the glenohumeral ligaments, and various muscles around the shoulder. Methods and materials- In this prospective study of USG and MRI evaluation of rotator cuff pathology; 50 patients. The source of data for the study is patients from the Department of orthopedics Shri Rawatpura Sarkar Institute of Medical Sciences and Research, Atal Nagar Nawa Raipur, Chhattisgarh from January 2024- January 2025. The study was a prospective study, in those patients who had been referred for USG, clinically suspicious of rotator cuff pathology selected according to the inclusion and exclusion criteria, and additional MRI of the shoulder joint was done following that. Findings of both MRI and USG were compared and evaluated. Results- The commonest pathology in rotator cuff tendons was tendinosis (68%), followed by partial tear (64%); and full thickness tears (12%). The most common rotator cuff tendon involved was the supraspinatus tendon (86%), followed by subscapularis (46%) and infraspinatus (14%). USG had almost 100% specificity & sensitivity in diagnosing complete tendon tears. 43 patients (86%) had joint effusion. Mild joint effusion was seen in 27 patients (54%), which was more common than moderate joint effusion, seen in 16 patients (32%). Peri-biceps tendon fluid was seen in 17 patients (34%), which was more common than subacromial-subdeltoid bursal effusion seen in 15patients (30%). Most common type of acromion was type I, seen in 37 patients (74%); followed by type II, seen in 11 patients (22%). 20 patients (40%) had Acromio-clavicular joint degenerative changes. USG had excellent specificity (88 to 100%), PPV (84 to 100%), better NPV (87 to 96%) and fair sensitivity (75 to 95%) as compared MRI for diagnosing rotator cuff pathologies. Conclusion- USG can be used as a first line screning investigation for a case of shoulder joint pain to rule out rotator cuff pathologies; however it was found poor in detecting partial tears. USG cannot completely replace MRI in evaluation of rotator cuff pathology as partial tear of rotator cuff, which was the most common rotator cuff pathology in our study, was not as effectively diagnosed on USG compared to MRI.

Background: The laryngeal mask airway (LMA) is gaining popularity in pediatric anesthesia due to its ease of insertion and minimal invasiveness. Nevertheless, its insertion requires optimal conditions, which include suppression of airway reflexes. Propofol is an agent that can be used but lacks analgesic properties and may cause cardiorespiratory depression in higher doses. Its combination with adjuvants such as fentanyl and midazolam can enhance insertion conditions and reduce complications. The current study aimed to compare the effectiveness of two fentanyl doses (1 µg/kg and 2 µg/kg) in combination with standard doses of propofol (2 mg/kg) and midazolam (0.05 mg/kg) for LMA insertion in children undergoing elective surgeries. Methods: This prospective randomized study compared the effectiveness of two fentanyl doses (1 µg/kg and 2 µg/kg) in combination with standard doses of propofol (2 mg/kg) and midazolam (0.05 mg/kg) for LMA insertion in children undergoing elective surgeries, which was done at our tertiary care hospital. Patients were divided into two groups: Group A (fentanyl 1 µg/kg) and Group B (fentanyl 2 µg/kg). Parameters assessed included first-attempt success rate, patient response to insertion, ease of insertion, and hemodynamic stability. Results: The important observations of this study show that group B showed superior outcomes, with a 93.3% first-attempt success rate compared to 76.6% in group A. Adverse incidents of responses, such as gagging and limb movements, were significantly lower in Group B (6.6%) compared to Group A (20%). Excellent insertion conditions were observed in 86.6% of group B patients versus 50% in Group A. Hemodynamic changes were mild and clinically insignificant in both groups. Conclusion: Fentanyl at 2 µg/kg combined with propofol and midazolam provides significantly better conditions for LMA insertion in children, with fewer adverse responses and stable hemodynamics. This regimen offers a safe and effective approach to pediatric airway management.

Introduction: Hysterectomy is the most common surgical procedure that is performed in females all over the world. It is performed for various clinical indications including neoplastic, non neoplastic and obstetric conditions when the conservative options fail. Cervix and fallopian tubes are also removed along with uterus and ovaries depending on the type of hysterectomy. All these specimens are routinely subjected for histopathological examination. However , pathological lesions in cervix and fallopian tubes are trivialized. Identification of such findings and their clinical correlation is essential for complete diagnosis and treatment. This work aims to identify the clinical indications ,  ultrasonographic findings, histopathological findings and their correlation in hysterectomy specimens. Materials and methods: Current study was conducted retrospectively in The Department Of Obstetrics and Gynaecology at Sree Narayana Institute of Medical Sciences, Chalakka, Ernakulam, Kerala in hysterectomy specimens from May 2025 to May 2024. Ethical approval was obtained from Institutional Ethical Committee. Data was collected from medical records and administrative data bases. The study excluded obstetric hysterectomy, diagnosed neoplastic cases and abnormal pap smear cytology. Results: Hysterectomies were commonly performed in the age group of 41-50 years(55.72 %) mainly via abdominal route (75.6 %). Most of the patients presented with AUB seen in 65 cases (49.6 %). Main ultrasonographic finding was fibroid uterus accounting for 61.1 % in 80 cases. Histopathological examinations revealed, in cervix, chronic cervicitis was found in 94 cases (71.8 %) and squamous metaplasia in 69 cases(52.7 %), 1 case of CIN 1 was identified. In fallopian tubes, paratubal cyst was present in 24 cases(18.3 %),also 1 case of serous cystadenoma and 1 serous cystadenofibroma was identified. Most common ovarian pathology was benign ovarian cystic lesions in 31 cases(23.7%). Leiomyoma was found in 88 cases (67.2 %) and adenomyosis in 55 cases(42 %). Atrophic endometrium was the common endometrial pathology seen in 41 cases(31.3 %),1 case of Endometrial Adenocarcinoma was also identified in the study.

Background: Sepsis is a medical emergency, occurring due to body’s systemic immunological response to infection[1]. It’s among the most common reasons for intensive care unit admissions[2] and top 10 leading causes of death worldwide[3]. Procalcitonin (PCT) is the marker of sepsis[4] and Ischemia modified albumin (IMA) is a novel biomarker, useful in detecting ischemic oxidative stress[5]. Aim and Objective: The purpose of the study was to estimate PCT and IMA levels in sepsis patients, before and after treatment and find the correlation between them. Method: In this observational follow up study, 60 sepsis patients with mean age of 59.8 ± 10.06 years were enrolled using purposive sampling method. Blood sample collection was done before and after the treatment. Result: The mean PCT before treatment was 40.37 ± 11.86 ng/ml and the difference between before and after treatment values was significantly high (p=0.000). The mean IMA was 1.44 ± 0.28 ABSU on admission and 0.05 ± 0.03 ABSU after treatment with a significant high difference (p=0.000). Also, a moderate positive correlation between PCT and IMA (r=0.485 p=0.000) was observed. Conclusion: It was concluded that in sepsis there is a concomitant existence of inflammation and ischemia. Since the values of IMA raised and declined with PCT, IMA may be considered to replace PCT as a cost effective marker in monitoring of sepsis. Moreover, IMA levels may help in recognizing early ischemic processes thereby, preventing serious complications in patients of sepsis.

Background: Severe mental illnesses (SMIs) significantly impact multiple aspects of life, including employment, relationships, and healthcare access. Individuals with SMIs are at heightened risk for physical comorbidities, such as obesity and smoking-related diseases, partly due to long-term antipsychotic use. These challenges contribute to a diminished quality of life and increased premature mortality. Assessing the unmet and met needs of individuals with SMIs is essential for improving outcomes. This study aims to evaluate the met and unmet needs of patients with SMIs using the CANSAS scale and identify areas requiring intervention. Materials and Methods: The study included 428 participants diagnosed with SMIs based on ICD-10 criteria, confirmed through MINI PLUS 5.0. Patients in remission were assessed using the PANSS, HDRS, YMRS, and YBOCS scales for specific diagnoses. Socio-demographic data were collected using Kuppuswamy's scale. Met and unmet needs were quantified using the CANSAS scale, and statistical analyses were performed using SPSS v19.0.Results: The most common diagnostic groups were affective disorders (53.4%) and schizophrenia (41.1%), with bipolar disorder as the predominant affective disorder (34.5%). Participants reported a mean of 8.20 ± 2.28 needs, with met needs averaging 5.35 ± 1.96 and unmet needs 2.85 ± 1.81. Psychological distress, welfare benefits, transportation, and intimate relationships were the most reported needs. Unmet needs were highest in welfare benefits and money. Conclusion: SMIs significantly hinder individuals from meeting basic needs, emphasizing the need for targeted interventions. Enhanced community mental health services, self-help groups, and government support can help address unmet needs and improve patient outcomes

Background: Open tibial fractures are among the most common long bone injuries encountered in orthopedic trauma, often resulting from high-energy mechanisms. The optimal fixation method—internal fixation (IF) or external fixation (EF) remains debated, particularly regarding functional outcomes, infection rates, and union time. Objectives: To prospectively compare internal fixation and external fixation in the management of open tibial fractures in terms of union rates, functional recovery, and complications. Methods: This prospective study was conducted in the Department of Orthopaedics, Pt. B.D. Sharma PGIMS, Rohtak, from May 2024 to April 2025. A total of 60 patients with Gustilo-Anderson type I–III open tibial fractures were randomly allocated into two equal groups: Group A underwent internal fixation, and Group B underwent external fixation. Patients were followed for 12 months, and outcomes assessed included fracture union time, functional score (Johner-Wruhs criteria), and complications. Data were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Results: The mean union time was significantly shorter in the internal fixation group (19.8 ± 2.5 weeks) compared to the external fixation group (23.6 ± 3.1 weeks, p < 0.001). Excellent to good functional outcomes were observed in 80% of IF cases and 66.7% of EF cases. Superficial infection occurred in 13.3% (IF) and 20% (EF) of patients, while deep infection was higher in the EF group (10% vs. 3.3%). Malunion rates were also higher in EF (13.3%) compared to IF (6.7%).Conclusion: Internal fixation provides faster union and better functional outcomes compared to external fixation in open tibial fractures, though EF remains a valuable option in severely contaminated wounds or unstable soft tissue conditions. A tailored approach considering fracture type, soft tissue status, and patient comorbidities is recommended for optimal results.

Background: Type 2 diabetes mellitus (T2DM) is among the most common forms of chronic metabolic disorders, accounting for about 90% of all people with diabetes. Carotid intima-media thickness (CIMT) is related to cardiovascular risk factors and diseases, and its measurement by means of ultrasound makes it possible to detect thickening in the initial phases of atherosclerosis. Methodology: It was an observational cross-sectional study. It included 120 patients according to inclusion criteria. The study was approved by institutional ethical committee and all participants signed informed consent forms before enrolment. It was an observational cross-sectional study. It included 120 patients according to inclusion criteria. The study was approved by institutional ethical committee and all participants signed informed consent forms before enrolment. patint were enrolled according to inclusion and exclusion criteria.  Result: Majority patients were within the 51-60 years age group (34.2%), followed by the 61-70 years (28.3%) and 41-50 years (15.8%) age groups. A significant proportion of patients (37.5%) had normal or near-normal right CIMT values (≤0.80 mm). However, a combined 55% of patients exhibited increased CIMT values, with 25% in the 0.81-1.00 mm range and 30% in the 1.01-1.20 mm range, suggesting subclinical atherosclerosis., more than half of the patients (64.2%) showed increased CIMT values, with 25.8% in the 0.81-1.00 mm range, 30.0% in the 1.01-1.20 mm range, and 8.3% with values exceeding 1.21 mm. Conclusion: We find that patients with poorly controlled type 2 diabetes (DM2) who have macrovascular disease show more severe vascular dysfunction, as indicated by non-invasive markers of subclinical atherosclerosis. Additionally, patients who have been diagnosed with diabetes for less than 5 years tend to have a significantly better vascular profile.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) has emerged as a major global health concern, closely linked to metabolic dysfunction and insulin resistance. The Triglyceride-Glucose (TyG) Index, a surrogate marker for insulin resistance, has gained attention as a potential predictor of NAFLD severity. Pharmacist-led education programs play a crucial role in managing metabolic disorders through patient counseling, lifestyle modifications, and medication adherence. This study aimed to evaluate the influence of pharmacist-led education on NAFLD while assessing metabolic risk using the TyG Index. Material and Methods: A cross-sectional study was conducted on 224 patients, with biochemical and metabolic parameters recorded. The TyG Index was calculated using fasting blood sugar (FBS) and triglyceride levels. Inclusion criteria comprised patients aged ≥18 years with available fasting blood sugar and triglyceride values and ultrasound-confirmed NAFLD classification. Exclusion criteria included patients with incomplete biochemical data, other liver diseases, or those on lipid-lowering or anti-diabetic medications. Results The TyG Index was successfully calculated for 142 patients, with a mean value of 9.02 ± 0.81. The only patient with NAFLD exhibited a significantly elevated TyG Index (11.21). A significant correlation was found between the TyG Index and triglycerides (r = 0.716, p < 0.001) and fasting blood sugar (r = 0.535, p < 0.001). ROC analysis revealed an Area Under the Curve (AUC) of 0.647, demonstrating strong discriminatory power in identifying individuals at metabolic risk. The optimal TyG Index cutoff was determined at 11.18 (sensitivity: 38.5%, specificity: 52.3%). The Kruskal-Wallis test findings highlight the TyG Index as a clinically relevant metabolic marker with a positive relationship with HDL-C. Conclusion: The Triglyceride-Glucose (TyG) Index demonstrates significant correlations with key metabolic markers, reinforcing its potential as a reliable indicator of metabolic risk. With a moderate predictive ability (AUC = 0.647) and an optimal cutoff of 11.18, the TyG Index may serve as a useful tool for early metabolic risk assessment. Further studies are warranted to validate its clinical applicability and refine its predictive accuracy.

Background: Anti-tubercular therapy (ATT)–induced hepatitis is a major adverse event that interrupts treatment and undermines tuberculosis (TB) control programs. Characterizing who gets it and how it presents can help clinicians intervene earlier. Objective: To evaluate the clinical, demographic and laboratory profile of patients presenting with ATT-induced hepatitis at a tertiary-care hospital. Methods: This was a prospective observational study conducted over a period 3 years at a tertiary care center. Adult TB patients receiving first-line ATT were screened for drug-induced hepatitis (DILI) using standard predefined criteria. We excluded patients with chronic liver disease (CLD), serological evidence of active viral hepatitis (Hepatitis A,B,C,E), and patients on concomitant hepatotoxic drugs. Data on clinical presentation, co-morbidities  and biochemical laboratory parameters were collected. Results: Of 103 screened patients with ATT innduced hepatitis, 98 patients met the inclusioncriteria and were analyzed. The mean age of patients was 44.9 ± 19.0 years; having a mean body mass index (BMI) of 22.07 ± 3.25; 55 (56.1%) were female patients; 78 (79.6%) belonged to rural areas. The most common symptoms at presentation were vomiting in 66 (67.3%), nausea in 60(61.2%), abdominal pain in 57(58.1%), anorexia in 49 (50.0%), jaundice in 28(28.5%) and encephalopathy in 15(18.3%) of patients. TB types included: pulmonary –23 (23.5%), pleural–18 (18.4%), TB meningitis –12 (12.2%), Pott’sdisease -11 (11.2%), intestinal – 11 (11.2) and other types 23 (23.4%). Conclusion: ATT-induced hepatitis is common in undernourished, middle-aged, rural-residing, female sex patients, with common presenting symptoms being gastrointestinal. Routine symptom evaluation and early liver function test (LFT) checks in these high-risk groups are warranted to diagnose the hepatotoxicity at the earliest.

Background: Breech presentation occurs in 3–4% of singleton term pregnancies and is a leading indication for cesarean delivery, which carries increased maternal morbidity and healthcare costs. External cephalic version (ECV) is a safe, underutilized procedure aimed at converting breech to cephalic presentation, thereby promoting vaginal birth and reducing cesarean rates. Objectives: To evaluate the success rate of ECV performed at 37 + 0 to 38 + 6 weeks’ gestation in singleton breech pregnancies, to compare outcomes between primigravida and multigravida women, and to document procedure related complications. Methodology: In this retrospective observational study at a tertiary care hospital in Mandya, 26 women with singleton breech presentations who underwent ECV between March 2024 and February 2025 were identified. Demographic and obstetric data, ECV outcomes, mode of delivery, and complications were extracted from institutional records. Descriptive statistics summarized success rates, delivery modes, and adverse events. Results: Of 26 ECV attempts, 19 (73.1%) resulted in successful version and subsequent vaginal delivery. Multigravida status was associated with higher success (63.1% of successful cases). Complications occurred in 23.1% of procedures, including premature rupture of membranes (11.6%), fetal distress (7.7%), and postpartum hemorrhage (3.8%). Six neonates (31.6%) required NICU admission, predominantly from primigravida vaginal births. Conclusion: ECV at term is an effective and safe intervention for breech presentation, particularly in multigravida women, and significantly increases vaginal delivery rates with low complication rates. Wider adoption of ECV could mitigate unnecessary cesarean deliveries.

Background: Anaemia is a disorder characterized by a deficiency in the quantity of red blood cells or a reduced concentration of haemoglobin inside them. Accurate blood count findings and a probable diagnosis of anemia depend on the manual blood smear examination, RBC histogram, and red cell indices. Factors such as hemoglobin, hematocrit, mean corpuscular volume, red cell distribution width, mean corpuscular hemoglobin concentration, and mean corpuscular volume are used to classify anemia. Aim & Objectives: To compare and correlate diagnoses of anemia derived from peripheral smear examination with RBC indices and RBC histograms. Materials & Methods: A total of 200 patients with anemia were included in the study, with females having a hemoglobin level below 12 gm/dl and males having a level below 13 the same. Hemoglobin, total and differential counts, haematocrit values, RBC indices, and a histogram were all acquired with the Mindray BC 5300 automated analyzer. All patients had peripheral blood smear testing. The results of the RBC histogram and indices were compared to those of the peripheral smear for the purpose of diagnosis. Results: According to the results of the peripheral smear test, 16.5% of the cases were normocytic normochromic anemia, 16.5% were dimorphic anemia, 60% were microcytic hypochromic anemia, and 7% were macrocytic anemia. The histogram indicated a normal curve in 84.85% of cases of normocytic normochromic anemia on peripheral smears. Microcytic hypochromic anemia exhibited a left shift in 68.33% of cases, while macrocytic anemia exhibited a complete right shift in all cases. Variability was seen in dimorphic anemia, with a left shift in the histogram and a bimodal distribution throughout the majority of the curve. Conclusion: The many forms of anemia can only be diagnosed with the use of a red blood cell histogram, indices, and peripheral smear. To confirm a proper diagnosis of RBC abnormalities, histograms and RBC indices should be used in addition to peripheral smear testing.

Background: Inguinal hernias represent a common surgical problem, particularly in older males.1 While unilateral hernias are routinely repaired, the presence of contralateral bubonocele, a subtle pre-hernial defect, remains underrecognized and underexplored.3 This study evaluates the occurrence, risk factors and diagnostic challenges associated with contralateral bubonocele in patients undergoing elective inguinal hernia repair. Methodology: This hospital-based cross-sectional study was conducted at Vishesh Jupiter Hospital, Indore, between 2021 and 2024, involving 157 patients undergoing laparoscopic inguinal hernia repair. All patients underwent preoperative ultrasound screening followed by intraoperative exploration of the contralateral side. Data was collected using a structured proforma and analyzed using descriptive statistics, Chi-square and Z-tests. Results: Contralateral bubonocele was detected intraoperatively in 35.6% of cases, with preoperative ultrasonography identifying only 39.3% of these. Significant associations were found between contralateral bubonocele and risk factors such as benign prostatic hyperplasia (p=0.001), obesity (p=0.007), heavy lifting (p=0.018), constipation (p=0.035), and chronic cough (p=0.032). Direct hernias were the most common type (62.4%), and right-sided hernias predominated (57.3%). Older age groups (65-80 years) showed the highest prevalence of bubonocele. Conclusion: Routine intraoperative exploration of the contralateral side during laparoscopic hernia repair is essential, as preoperative ultrasonography alone is insufficient for detection. Risk stratification and targeted preventive measures could further reduce future hernia development, improving patient outcomes and minimizing the need for secondary surgeries.

Background: Serous tubal intraepithelial carcinoma (STIC) is the pre-invasive carcinoma of the fallopian tube and has been regarded as the precursor lesion for many high-grade pelvic serous carcinomas. Since it has been associated mostly with pelvic serous carcinomas, its incidence should be substantially lower in other gynaecological malignancies and benign gynaecological neoplasms as hypothesised in present study. Methods- Both side fallopian tubes of patients with various gynaecological neoplasms were collected and submitted for histopathological examination after grossing through Modified Sectioning and Extensively Examining the FIMbria (SEE-FIM) protocol. Further, all cases were subjected to immunohistochemistry for p53 and Ki-67 for confirming the presence of STIC. Results- The study included 104 benign gynaecological neoplasms and 72 gynecological malignancies. The presence of STIC was detected in 31%, 50% and 50% of cases of high-grade serous carcinoma of ovary, primary peritoneal carcinoma and primary tubal carcinoma, respectively. Among 29 high grade serous carcinomas (HGSC) of ovary, p53 signature, TILT and STIC were noted in 7 (24%), 5 (17.2%) and 9 (31%) cases respectively and no evidence of STIC in other gynaecological malignancies and benign gynaecological neoplasms. Conclusion- Routine examination of fimbrial end of fallopian tubes by SEE-FIM protocol should be done to detect the early lesions of pelvic serous carcinoma. In that respect, prophylactic salpingectomy during surgery for benign lesions must be incorporated to reduce the incidence, mortality and morbidity associated with pelvic serous carcinomas and help in future management.

Background: Ectopic pregnancy is a significant cause of maternal morbidity and mortality, especially in the first trimester. Early diagnosis and management are crucial to reduce adverse outcomes. This study aims to evaluate the demographic profile, parity, risk factors, clinical presentation and management of ectopic pregnancies managed at GGH, siddipet, over the past 2 years. Objective: To evaluate the demographic characteristics, clinical presentation, and management outcomes of patients diagnosed with ectopic pregnancy over a two-years period at GGH, Siddipet. Methodology This retrospective observational study included patients diagnosed with ectopic pregnancy from January 2023 to December 2024 at the Department of Obstetrics and Gynaecology, Government General Hospital, Siddipet. Data regarding age, parity, symptoms, site of ectopic implantation, diagnosis, and treatment modality were collected and analyzed using descriptive statistics. Results: A total of 27 cases were diagnosed as ectopic pregnancy and managed at GGH, Siddipet over a period of 2years (Jan 2023 to dec 2024). 37% of the patients were in 26–30-year age group and 33% in 20-25 years age group. Multiparity was observed in 59.3%. 22.2% of the patients had previous undergone tubectomy, 18.5% had previous history of ectopic, and 48.1% cases had previous LSCS. Abdominal pain was the most common symptom. 66.6% cases presented at 6-7 weeks of gestation. Ultrasound is the main diagnostic modality. Ruptured ectopic pregnancy was seen in 77.8% cases. The fallopian tube was the most common site, other less common sites being ovarian, cornual, cervical, scar ectopics. Majority of the cases were managed through laparotomy while 77.8% were managed with methotrexate. CONCLUSION: Ectopic pregnancy remains a critical cause of early pregnancy morbidity. High rate of rupture and reliance on laparotomy in a semi-urban tertiary care setting, reflects need for early diagnosis (routine early pregnancy ultrasound by 6weeks gestation), increased community awareness about the signs and symptoms of EP, strengthening of referral systems to reduce delayed presentation and complications, improved access to diagnostic modalities (TVS and beta-hCG) and intervention. The high proportion of cases with prior tubal surgeries and caesarean deliveries, highlights the importance of identifying high risk women early in gestation.

Background: The term “Talipes Equinovarus” is derived from Latin language, Talus means ankle, Pes means foot and equinus means horse like (plantar flexed) and varus means adducted and inverted. There are studies mentioning that the incidence of clubfoot is increasing, making it a challenge for us to treat it with more specific and accurate methods. Materials and Methods: A Prospective study of 60 cases of CTEV treated by Ponseti technique at Department of Orthopedics, J.J.M. Medical College, Davanagere were included in the study. Each patient was followed up regularly weekly during treatment and monthly after completion of treatment. The severity of foot deformities was graded as per Pirani’s scoring system before treatment, and at follow up and results were assessed. Results: Out of 60 patients, good results were obtained in 54 patients.6 patients developed recurrence of the deformity due to non-compliance with Dennis- Brown splint. Conclusion: The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot and decreases the need for extensive corrective surgery. There is high a level of parent satisfaction regarding the correction of deformity. Non-compliance with orthotics has been found to be the main factor causing failure of the technique.

Background: To investigate the clinical presentation, histopathological findings, and management outcomes of late opacification in posterior chamber intraocular lenses (PCIOLs), particularly hydrophilic types, following cataract surgery. Methods: A cross-sectional observational study was conducted involving three patients who presented with gradual, progressive diminution of vision years after uneventful cataract surgery with hydrophilic PCIOL implantation. Detailed slit lamp examinations, visual acuity assessments, and histopathological analyses of explanted lenses were performed. All cases underwent IOL exchange with secondary PCIOL implantation. Results: All three cases demonstrated significant visual impairment due to opacified PCIOLs, with histopathology revealing calcium deposits in two cases and proteinaceous deposits in one. Postoperative outcomes following IOL exchange were satisfactory, with improved best-corrected visual acuity (BCVA) in all patients. Conclusion: PCIOL opacification poses major threat to visual gains after cataract surgery. The only management for this is IOL exchange with secondary IOL implantation, which poses significant other intra and post-operative risks to patient.

Background: Diagnostic pathology services are foundational to early disease detection, monitoring, and management. However, public awareness and proper utilization of these services remain suboptimal, particularly in semi-urban and rural settings. This study aimed to assess the level of knowledge, awareness, and misconceptions regarding diagnostic pathology services among residents of Himachal Pradesh, India. Materials and Methods: A descriptive cross-sectional study was conducted using a structured, pre-validated questionnaire disseminated via Google Forms between Feb and March, 2025. A total of 400 participants aged 18 years and above from both rural and urban regions of Himachal Pradesh were included through convenience sampling. The questionnaire included socio-demographic details and 20 knowledge-based questions related to diagnostic tests, procedures, and common misconceptions. Data were analyzed using descriptive statistics, chi-square tests, and p-values to identify associations between knowledge levels and socio-demographic factors. Results: Of the 400 respondents, 54.5% were female, and 53.5% resided in rural areas. While 66.3% of participants scored in the "Good" to "Very Good" knowledge categories, significant knowledge gaps were noted, particularly regarding the accuracy of cancer markers, the reliability of self-diagnostic kits, and the necessity of NABL accreditation. Higher education levels and urban residency were strongly associated with better knowledge scores (p < 0.001 and p = 0.026, respectively). Participants aged 18–35 years demonstrated significantly higher awareness compared to older age groups. Conclusion: The study revealed a moderate overall awareness of diagnostic pathology services among the population, with notable disparities based on education, age, and location. Strengthening public education initiatives, ensuring accessibility of accurate information, and improving outreach in rural areas are essential to enhance informed utilization of diagnostic services, which can lead to earlier detection and better health outcomes.

Background: Pituitary gland morphology changes with age, sex, and ethnicity. It is imperative to establish normative Magnetic Resonance Imaging (MRI) based morphometric values of the pituitary gland in the Indian population to distinguish between physiological and pathological changes. The current study aimed to determine normative measurements of the pituitary gland (height, width, and shape) using mid-sagittal T1-weighted MRI and to measure their changes with age and sex. Methods: This retrospective study was conducted at a tertiary care hospital involving 300 subjects (175 males and 125 females) aged 11–80 years who underwent brain MRI for non-pituitary-related indications. Mid-sagittal T1-weighted images were analyzed for pituitary gland height, width, and shape. Statistical comparisons were made between age groups and genders. Statistical significance was set at p < 0.05.Results: The peak pituitary height was found in the age group of 21–30-years (6.6 ± 2.5 mm), and a significant decrease in height was observed after 50 years (mean: 5.6 ± 2.7 mm; p=0.05). The measurements of the width of the cohort showed that the width was relatively stable across age groups, with an overall mean of 10.3 ± 2.6 mm. Pituitary shape varied by sex, with convex shapes predominating in females (44%), while males had more flat and concave configurations. Conclusion: The present study established age- and sex-specific normative measurements of the pituitary gland in our cohort. The present study found that gland height is a reliable marker that is significantly influenced by age and sex. The pituitary gland size increases to a maximum during puberty. Width measurements remain constant across age and sex groups.

Background: Introduction and Objective: Proximal humerus fractures (PHFs) are common, with treatment choice depending on fracture complexity and patient factors. This study aimed to compare functional outcomes, using the Oxford Shoulder Score (OSS) and clinical outcomes, across four treatment modalities—open reduction and internal fixation (ORIF) with plating, closed reduction and internal fixation (CRIF) with K-wire, U-slab (non-operative), and CRIF with external fixation—and identify prognostic factors influencing outcomes. Materials and Methods: This retrospective study included 80 patients with PHFs, equally divided (n=20 each) among ORIF, CRIF with K-wire, U-slab, and CRIF with external fixation. Patients were assessed for demographics, Neer classification, comorbidities, surgical duration, complications, and OSS at 12–30 months. ANOVA, chi-square tests, and multivariate regression analyzed OSS, clinical outcomes, and prognostic factors (age, sex, fracture type, treatment timing, rehabilitation).Results: Non-operative and CRIF groups achieved significantly higher OSS (28–32 vs. 19.69–22.82 for ORIF, p=0.0001), with U-slab showing the most excellent outcomes (40%, p=0.871). ORIF had the lowest complication rate (90% complication-free, p=0.36) but longest surgical duration (71.05 ± 24.96 minutes, p<0.001). Age ≥50, Neer three-/four-part fractures, and comorbidities predicted poorer OSS (p<0.05), while early treatment and extended rehabilitation improved outcomes. Follow-up duration and sex were non-significant. Conclusion: Non-operative and CRIF methods offer superior functional outcomes for simpler PHFs, while ORIF suits displaced fractures despite poorer long-term OSS. Patient-specific factors guide treatment choice.

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Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease, but carbon dioxide pneumoperitoneum may cause transient alterations in liver function tests (LFTs). This study evaluated the pattern and clinical significance of these biochemical changes in relation to pneumoperitoneum duration. Methods: A prospective observational study was conducted on 170 patients undergoing elective laparoscopic cholecystectomy with normal preoperative liver function. Patients were divided into two groups based on pneumoperitoneum duration: ≤60 minutes (n=110) and >60 minutes (n=60). Serial measurements of serum ALT, AST, ALP, and total bilirubin were obtained preoperatively and on postoperative days 1, 3, and 7. Data were analyzed using t-tests, with p < 0.05 considered significant. Results: Both groups demonstrated significant transient elevations in all measured liver enzymes and total bilirubin on postoperative day 1, with greater increases observed in the >60 min group (ALT: 46.4 ± 12.6 vs. 38.5 ± 13.1 U/L; AST: 40.7 ± 17.0 vs. 27.9 ± 15.7 U/L; ALP: 162.7 ± 26.5 vs. 147.3 ± 23.0 U/L; total bilirubin: 1.98 ± 0.60 vs. 1.28 ± 0.16 mg/dL; all p < 0.001). Enzyme levels declined by postoperative day 3 and normalized by day 7 in both groups. No patient developed clinical hepatic dysfunction or postoperative complications. Conclusions: Laparoscopic cholecystectomy is associated with statistically significant but clinically transient elevations in liver enzymes and bilirubin, particularly with longer pneumoperitoneum duration. These changes resolve within one week and are not associated with adverse clinical outcomes in patients with normal baseline liver function.

Background: Sickle cell disease (SCD) is a genetic disorder resulting from the presence of a mutated form of hemoglobin, hemoglobin S (HBS).  Diagnosis is an important aspect of the management of the disease. In this present study, the efficacy of the solubility test as a screening method was assessed and High-performance liquid chromatography (HPLC) in the diagnosis of Sickle cell disorders. Material and Methods: A total of 2500 patients were screened. All the positive samples with solubility test were further analysed on high-performance liquid chromatography (HPLC) ‘BIO-RAD’ analyser for the confirmation along with distinction of Sickle cell trait (heterozygous) and sickle cell disease (homozygous) and Heterozygous sickle cell and beta-thalassemia. Results: Out of all 2500 patients screened, 251 samples were found to be positive with the solubility test. A total of 157 samples were diagnosed as Sickle cell Trait, 10 for sickle cell disease (homozygous) and 02 samples were diagnosed as Sickle cell beta-thalassemia (heterozygous) with HPLC. Conclusion: Solubility test is very effective with 95.4% sensitivity. Specificity calibrated was on average 96.4%, with the predictive value of positive test 67.3% and a predictive value of negative test 99.6%. The most commonly used method now in Gujarat is HPLC although the solubility test can be used as a preliminary screening.

Background: The optimal surgical technique for primary inguinal hernia repair remains debated, particularly concerning the use of synthetic mesh versus tissue-based approaches. This study compared the clinical efficacy, safety, cost-effectiveness, and long-term outcomes of Desarda’s no-mesh tissue repair with the standard Lichtenstein mesh repair. Methods: In this prospective, randomised, comparative study, 152 adult patients with primary, reducible inguinal or inguino-scrotal hernia were enrolled at a tertiary care centre in India and randomised to undergo either Desarda repair (n=76) or Lichtenstein mesh repair (n=76). Perioperative, short-term, economic, and long-term outcomes were recorded, including operative time, postoperative pain (VAS, day 1), ambulation time, wound complications, hospital stay, total cost, recurrence, and chronic pain at 3, 6, and 12 months. Statistical analysis was performed using t-tests, Mann–Whitney U, Fisher’s exact test, and Kaplan–Meier analysis. Results: The mean operative time was significantly longer for Desarda (55.7 ± 12.1 min) than for Lichtenstein (50.6 ± 12.5 min; p < 0.001). Postoperative pain scores on day 1 were significantly lower in the Desarda group (3.8 ± 1.2 vs. 4.6 ± 1.3; p = 0.0002), and ambulation occurred earlier (10.8 ± 3.7 hr vs. 13.2 ± 3.9 hr; p < 0.001). Wound infection and induration rates were low and not significantly different between groups. Hospital stay was modestly but significantly shorter in the Desarda group (3.1 ± 0.8 vs. 3.4 ± 0.8 days; p = 0.01). The total cost was substantially lower for Desarda (₹5,750 ± 780) than Lichtenstein (₹8,320 ± 1,350; p < 0.001). Recurrence rates at 12 months were low and comparable (3% vs. 4%, p = 1.00). Chronic pain or discomfort was infrequent in both groups. Conclusion: Desarda’s no-mesh repair is a safe and effective alternative to Lichtenstein mesh repair for primary inguinal hernia, offering advantages of reduced postoperative pain, earlier ambulation, shorter hospital stay, and lower cost, without increasing recurrence or complication rates. Both techniques remain viable options for surgical management, with individualisation based on patient preference and resource availability.

Background: Serum uric acid (SUA) has been increasingly recognized not only as a marker of metabolic disturbances but also as a potential contributor to cardiovascular disease. Hypertension, being a major cardiovascular risk factor, has shown frequent association with elevated SUA levels. This study aimed to assess the relationship between SUA levels and cardiovascular risk markers in hypertensive patients. Methods: This hospital-based cross-sectional study was conducted over one year at the Department of Biochemistry, FH Medical College, Agra, India. A total of 200 hypertensive patients aged 30–70 years were enrolled. Clinical data including blood pressure, BMI, and history of smoking or alcohol use were collected. Fasting blood samples were analyzed for SUA, lipid profile, and fasting blood glucose. Patients were categorized based on SUA levels into elevated and normal groups, and correlations with cardiovascular risk parameters were evaluated. Results: The mean SUA level was 6.8 ± 1.4 mg/dL. Elevated SUA levels (>7.0 mg/dL in males, >6.0 mg/dL in females) were found in 62% of participants. Those with elevated SUA had significantly higher levels of total cholesterol (218.5 ± 34.1 mg/dL), LDL cholesterol (148.6 ± 28.4 mg/dL), triglycerides (178.4 ± 41.5 mg/dL), and lower HDL cholesterol (39.8 ± 7.2 mg/dL) compared to those with normal SUA levels (p < 0.05). Serum uric acid showed a significant positive correlation with systolic blood pressure (r = 0.41), LDL cholesterol (r = 0.36), and triglycerides (r = 0.29), and a negative correlation with HDL cholesterol (r = –0.27).Conclusion: Elevated serum uric acid levels are common in hypertensive patients and show significant associations with several cardiovascular risk factors. SUA may serve as a useful biomarker in cardiovascular risk assessment among hypertensive individuals.

Background: Gallstone disease is a common gastrointestinal condition affecting 10–20% of adults in developed countries and around 4% in India, contributing significantly to illness and sometimes even death.1 Understanding its prevalence and risk factors—such as older age, female gender Although imaging studies like MRCP are highly specific, they may not always be available or cost-effective in resource-limited settings. This highlights the importance of reliable, accessible biochemical markers to assist in early detection. Materials And Methods: Data collection was followed by statistical analysis using SPSS version 22.0. Results were expressed as mean ± standard deviation, and the diagnostic accuracy of GGT and ALP was evaluated using Receiver Operating Characteristic (ROC) curve analysis. Comparisons between markers were assessed using the Z-test, and a p-value of less than 0.05 was considered statistically significant. Results: The present study was conducted at General surgery department and Gastroenterology department in the Fortis hospital, Noida, Uttar Pradesh for a duration of 2 years (August 2020 to August 2022). 100 patients with symptoms of Choledocholithiasis were taken for this study. Females (62%) were comparatively more as compared to males (38%) in this study.Conclusion: In conclusion abnormally elevated serum GGT level may be a potentially useful marker for the early prediction of choledocholithiasis secondary to cholelithiasis. When the serum GGT level reaches the cutoff value

Background: Lateral epicondylitis (LE), a common overuse tendinopathy of the elbow, results in pain and functional limitation, particularly during resisted wrist extension. Corticosteroid injections have long been used to alleviate symptoms, yet their effects may be short-lived. Recent interest in regenerative therapies such as hypertonic dextrose prolotherapy has led to investigations into their efficacy in promoting sustained pain relief. This study compares the pain trajectory between hypertonic dextrose and corticosteroid injections using the PRTEE (Patient-Rated Tennis Elbow Evaluation) Pain Subscale. Materials and Methods: A prospective, randomized, comparative study was conducted on 60 patients clinically diagnosed with LE. Participants were randomly allocated into two equal groups: Group A received hypertonic dextrose (25%) injections, and Group B received corticosteroid (methylprednisolone acetate) injections. Pain related to functional activity was assessed using the PRTEE Pain Subscale at baseline, 1 week, 6 weeks, and 3 months post-intervention. Statistical analyses included paired and unpaired t-tests for intra- and intergroup comparisons, respectively. Results: Both groups exhibited significant pain reduction from baseline at all follow-up intervals (p < 0.001). However, intergroup analysis revealed that Group A (dextrose) achieved greater pain relief at 1 week (mean difference = 2.83, p = 0.029), 6 weeks (mean difference = 2.93, p = 0.007), and 3 months (mean difference = 4.23, p < 0.001) compared to Group B. The mean PRTEE Pain score in Group A declined from 34.16 ± 4.41 at baseline to 10.43 ± 3.56 at 3 months, versus a decline from 36.10 ± 4.17 to 15.26 ± 4.18 in Group B. Conclusion: While both injection modalities offer clinically meaningful pain reduction, hypertonic dextrose demonstrated a more gradual, sustained, and statistically superior improvement in PRTEE Pain Subscale scores over corticosteroids. These findings support the use of dextrose prolotherapy as a favorable long-term treatment strategy in the management of lateral epicondylitis.

Background: The management of foot and leg injuries remains complex and multifaceted. Mechanism of injury often predisposes these wounds to contamination, with high rates of infection. Flap choice should be made to minimize donor-site morbidity and to maximize lower extremity function. When choosing a flap for transfer, considerations must be made regarding flap size, vascular pedicle length and diameter, and the ultimate desired functional and aesthetic outcome. This study aims to analyze the clinical outcomes of various treatment modalities available for managing leg and foot injuries at a tertiary care center. Methods: This prospective observational study was done in the Department of Plastic and Reconstructive Surgery, Gandhi Medical College and Hospital, Secunderabad, Telangana. Patients of either sex and all age groups with injuries of leg and foot were included in the study.  Bony injuries were identified and assessed with standard X-rays and computed tomography (CT) scans at the time of presentation and were managed by the Orthopedician. Once the patient was hemodynamically stable, the limb was examined for the extent of soft tissue and bony loss. Various flaps were used based on the anatomical location of the defect. Results: A total of 100 cases were managed during the duration of this study. The commonly affected age group is young males aged 21 – 30 years contributing to 91% of all cases. The severity of the injury was 4-6 based on MESS scores in 67% of the cases. Flap cover alone was the most common procedure (68%), followed by tendon/nerve repairs and skin grafts. A total of 78 flaps were used; most were fasciocutaneous (82%), pedicled (97.4%), and sourced from the ipsilateral limb (89.7%). Foot and ankle regions were the most frequently reconstructed sites (32%), mainly using fasciocutaneous flaps. Postoperative complications were low, with 90% of cases having no adverse outcomes. At 6 months, 77% of patients achieved LEFS scores above 60, with 53% showing good final functional outcomes. Conclusion: This study highlights that lower limb trauma predominantly affects young males, with road traffic accidents being the primary cause. Flap reconstruction, particularly pedicled fasciocutaneous flaps from the ipsilateral limb, proved effective in managing complex leg and foot injuries. Complication rates were low, and functional outcomes were favorable, with most patients achieving good recovery by six months. Early orthopedic intervention and tailored flap selection significantly improve both aesthetic and functional outcomes in lower extremity reconstruction, ensuring optimal patient recovery and limb salvage.

Background: We present a case series that examines the complex relationship between ovarian and colonic pathologies. The case series highlights the diagnostic challenges and therapeutic approaches. The four cases presented in this study are cases of ovarian masses associated with colonic involvement, each with a distinct clinical presentation and management strategy. These cases underscore the difficulty in differentiating primary ovarian tumours from metastatic lesions originating in the colon due to overlapping clinical and radiological features. Diagnostic modalities, including advanced imaging (CT, MRI), tumour markers (CA-125, CEA), colonoscopy, and histopathological assessment with immunohistochemistry, are crucial for accurate diagnosis and treatment. The cases demonstrate varied scenarios, including carcinoma of the cecum with bilateral Krukenberg tumour, high-grade serous carcinoma of the ovary metastasizing to the colon, mucinous cystadenoma of the ovary with adenocarcinoma of the ascending colon, and perforated sigmoid colon mimicking an ovarian mass. Surgical management required a multidisciplinary approach involving gynaecologic and gastrointestinal oncologists, emphasizing thorough intraoperative exploration and complete cytoreduction. The series emphasizes the importance of meticulous preoperative planning, comprehensive intraoperative evaluation, and accurate histopathological characterization for optimal outcomes. Vigilance and a multidisciplinary approach are essential to improve diagnostic precision and therapeutic success in managing these complex cases. The recognition of potential correlations between ovarian and colonic masses is critical, as their concurrent presence can significantly influence diagnostic procedures, surgical planning, and overall management strategies.

Background: Intestinal tuberculosis (ITB) is a significant clinical entity in endemic regions, often presenting with non-specific abdominal symptoms and requiring surgical intervention in complicated cases. Accurate diagnosis remains a challenge due to overlapping features with other gastrointestinal pathologies, particularly Crohn’s disease. Material and Methods: This retrospective observational study was conducted over a three-year period at a tertiary care center and included 53 patients who underwent surgery for suspected ITB. Clinical presentation, operative findings, and histopathological examination (HPE) results were analyzed to assess diagnostic correlation and outcomes. Results: Among 53 patients, the mean age was 36.8 ± 12.4 years, with a male predominance (58.5%). The most common clinical presentation was abdominal pain (84.9%), followed by weight loss (71.7%) and fever (54.7%). Intraoperative findings revealed ileocecal involvement in 66.0% of cases, mesenteric lymphadenopathy in 58.5%, and multiple strictures in 39.6% of patients. Histopathological analysis showed caseating granulomas in 73.6% of specimens, lymphocytic infiltration in 64.1%, and Langhans-type giant cells in 41.5%; acid-fast bacilli were identified in 32.1% of cases. Postoperative complications included wound infection in 17.0% and anastomotic leak in 5.7%; one patient (1.9%) succumbed postoperatively. Conclusion: Surgical intervention remains a vital component in the management of complicated or diagnostically uncertain cases of ITB. Histopathological evaluation continues to be the cornerstone for definitive diagnosis, especially in settings with limited access to advanced diagnostic modalities. High clinical suspicion and timely surgical management significantly improve patient outcomes in endemic areas.

Background: Coronary artery disease (CAD) is a major public health concern worldwide, and genetic factors play a significant role in its development. The fat mass and obesity-associated (FTO) gene has been linked to obesity and CAD in various populations. Objective: This study aimed to investigate the association between FTO gene polymorphism (rs9939609) and CAD in a North Indian population. Methods: A total of 140 CAD patients were enrolled in this cross-sectional observational study, and their FTO gene polymorphism was analyzed using polymerase chain reaction and agarose gel electrophoresis. Results: The study found a significant association between FTO gene polymorphism and CAD, particularly in males. Genotype Distribution: The AA genotype was more prevalent among males (73.7%) and associated with right coronary dominance (100%). Lipid Profiles: The AA genotype was linked to higher levels of total cholesterol (218.74 ± 7.14 mg/dL), LDL (137.53 ± 5.65 mg/dL), and VLDL (135.79 ± 3.66 mg/dL). Atherogenic Index: A significant difference was found in the atherogenic index of plasma among the different genotypes. Conclusion: These findings suggest that FTO gene polymorphism may play a role in the development of CAD in the North Indian population. Further studies are needed to confirm these results and explore the potential implications for disease prevention and treatment.

Background: Myocardial ischemia and infarction are caused by the narrowing of the interior width of the coronary arteries, which is the complex condition known as coronary artery disease (CAD).  Methodology: The diameter of the coronary artery were measured in 140 patients including both genders on CT angiogram. The diameter of proximal left main (LM), the left anterior descending (LAD), left circumflex (LCx), and the right coronary artery (RCA) were measured. Results: Significant variations in the mean diameters of the LM, LAD, LCX, and RCA arteries across the three groups (A-A, A-T, and T-T). The results indicate that the mean diameter of all four coronary arteries is significantly larger in the T-T group compared to the A-T group, which is significantly larger than the A-A group. Conclusion: Transluminal diameter has an significantly on the development of CAD, as this study shows. Reduction transluminal diameter is associated to a higher incidence of CAD, highlighting its significance in the recognition and management of CAD. These findings have consequences for creating individualized treatment plans and enhancing patient outcomes.

Background: This systematic review evaluates the efficacy of acetic acid in achieving a dry mastoid cavity and reducing granulation tissue following modified radical mastoidectomy, based on cumulative data from studies totalling over 60 patients. Methods: A literature search was conducted across peer-reviewed indexed journals for studies assessing postoperative use of acetic acid in patients who underwent modified radical mastoidectomy. Data were pooled from studies with a total sample size exceeding 60 patients, focusing on cavity dryness outcomes, granulation tissue, and complications. Results: Acetic acid, commonly used in concentrations ranging from 4% to 12.5%, consistently accelerated cavity dryness and reduced granulation tissue compared to less frequent or non-acetic acid protocols. In studies with rigorous follow-up, up to 24% of patients achieved a dry cavity at 3 months postoperative, though results varied depending on acetic acid concentration and frequency of application. Comparatively, more frequent instillation (e.g., three times daily) resulted in earlier achievement of dry cavities. Side effects were minimal and mostly limited to mild irritation. Conclusion: Regular postoperative instillation of acetic acid is an effective, safe, and economical intervention to achieve an early dry cavity in patients post-modified radical mastoidectomy. Protocols utilizing 4% acetic acid thrice daily showed superior outcomes versus infrequent or lower-concentration applications.

Background: Knee osteoarthritis is a leading cause of disability among India’s elderly population, especially in rural and hilly states like Himachal Pradesh where access to orthopedic care is limited and terrain-related joint stress is high. Knee Replacement Surgery (KRS) offers significant symptomatic relief and functional improvement for patients with advanced joint degeneration, yet cultural beliefs, misinformation, and low health literacy continue to influence the decision-making of older adults. Despite the rising prevalence of knee-related morbidity, awareness and acceptance of KRS and its non-surgical alternatives remain underexplored in this demographic. Materials and Methods: A descriptive, cross-sectional study was conducted over a three-month period in 2025 using a structured Google Form questionnaire targeting residents aged 60 years and above in Himachal Pradesh. A total of 400 participants were enrolled through convenience sampling via online platforms and caregiver networks. The questionnaire, available in English and Hindi, assessed socio-demographic details, awareness and misconceptions regarding KRS and conservative treatments, and attitudinal beliefs. Knowledge scores were categorized into four levels (Very Good, Good, Fair, Poor). Associations between knowledge and socio-demographic factors were analyzed using Chi-square tests, with a significance threshold of p < 0.05. Results: Most respondents (69.0%) correctly identified pain relief and mobility improvement as the main goal of KRS, and over 70% were aware of physiotherapy and exercise as viable non-surgical alternatives. However, only 63.3% understood the true longevity of knee implants, and just 61.3% were aware of government schemes covering surgical costs. Knowledge classification revealed 29.0% of participants had "Very Good" scores, 36.8% "Good," 22.3% "Fair," and 12.0% "Poor." Statistically significant associations were found between knowledge scores and age (p = 0.024), education (p < 0.001), and residence (p = 0.031), while gender showed no significant correlation (p = 0.287). Conclusion: While awareness of knee replacement surgery and its alternatives is generally moderate to high among the elderly in Himachal Pradesh, substantial knowledge disparities persist, particularly among the oldest, least educated, and rural subgroups. These findings underscore the urgent need for targeted, culturally sensitive educational interventions to address myths, improve orthopedic literacy, and support informed decision-making in aging populations.

Background: Lateral epicondylitis (LE), commonly referred to as tennis elbow, is a degenerative tendinopathy that causes significant functional impairment and pain. Although corticosteroid injections are widely used for rapid symptom relief, their long-term efficacy remains questionable. Hypertonic dextrose prolotherapy has recently gained attention as a regenerative treatment option, yet direct comparative data with corticosteroids using validated pain metrics remain limited. Materials and Methods: A prospective, randomized clinical trial was conducted involving 60 patients diagnosed with LE. Participants were randomized into two equal groups: Group A received intralesional injections of 25% hypertonic dextrose with lignocaine; Group B received 40 mg/mL triamcinolone acetonide with lignocaine. Injections were administered at the most tender point near the lateral epicondyle using a 20-gauge needle. Pain intensity was measured using the Visual Analog Scale (VAS) at baseline, 1 week, 6 weeks, and 3 months post-injection. Statistical analysis was performed using SPSS v26, with a significance level set at p < 0.05. Results: Both groups showed statistically significant reductions in VAS scores over time (p < 0.001). However, Group A (Dextrose) demonstrated significantly greater pain reduction compared to Group B (Steroid) at both 6 weeks (mean difference = 0.80, p = 0.002) and 3 months (mean difference = 0.73, p = 0.002). The mean VAS in Group A decreased from 8.46 ± 1.07 at baseline to 1.30 ± 0.74 at 3 months, while in Group B it declined from 7.50 ± 0.97 to 2.20 ± 0.88. Conclusion: While both corticosteroid and dextrose injections are effective in reducing pain in patients with lateral epicondylitis, hypertonic dextrose provides significantly superior and sustained analgesic benefits. These findings support the use of dextrose prolotherapy as a regenerative, long-term treatment strategy for chronic LE.

Background: Fine needle aspiration cytology (FNAC) has long been a crucial tool for the early detection and diagnosis of breast lesions. Given the inherent complexity of these lesions, a standardized approach to cytological interpretation is essential for consistent and accurate results. The Yokohama classification, introduced in 2016, addresses this need by categorizing breast cytology findings into five distinct groups. Objectives -1. To categorize breast fine needle aspiration cytology (FNAC) lesions according to the 2016 Yokohama classification system. 2. To assess the diagnostic accuracy of the Yokohama classification by correlating cytological diagnoses with subsequent histopathological findings. Material and Method- This retrospective study spanned for one year and was conducted within the Department of Pathology. We retrieved cytology slides to classify them according to the Yokohama system. Wherever available, histopathological correlation was performed. Statistical analysis of diagnostic accuracy was conducted using SPSS software. Results- Of the 251 lesions categorized using the Yokohama system, 72.90% were classified as C2 (benign), 10.75% as C3 (atypical), and 16.33% as C5 (malignant). Notably, no cases fell into the C1 (inadequate) or C4 (suspicious of malignancy) categories. Eighty-one of these cases had corresponding histopathological results, comprising 72 benign and 9 malignant cases. The analysis revealed a sensitivity of 100%, specificity of 90.27%, positive predictive value of 56.25%, negative predictive value of 100%, and an overall diagnostic accuracy of 91.35%. Conclusion-The observed diagnostic accuracy of 91.3% strongly suggests that implementing the Yokohama classification significantly advances breast cytology by offering a systematic and standardized approach to FNAC reporting. Adopting this system in routine practice represents a key step towards enhancing the clarity and reliability of breast cytology, ultimately leading to improved patient management.

Background: Acute Coronary Syndrome (ACS) and Chronic Obstructive Pulmonary Disease (COPD) are both prevalent and life-threatening conditions, often co-existing in patients due to common risk factors. Their coexistence not only complicates diagnosis and treatment but may also influence clinical outcomes. Understanding the pattern of risk factors in this subgroup is crucial for preventive and therapeutic strategies. Aims: To evaluate and compare the distribution of major cardiovascular risk factors among ACS patients with and without COPD.Materials and Methods: It was a descriptive, observational, cross-sectional study this study was conducted 8 months, from 1st March 2023 to 31st August  2024 at Department of Cardiology at Nilratan Sircar Medical College and Hospital, located at 138, A.J.C. Bose Road, Kolkata 700014.100 Patients were included in this study Results: Tobacco use was significantly more prevalent among ACS patients with COPD (96%) compared to those without (90%), although not statistically significant (p=0.2396). Hypertension, diabetes, psychological stress, dyslipidemia, family history, and substance use showed no significant differences between the two groups (p>0.05 for all). Despite similar prevalence rates, patients with COPD tended to exhibit higher rates for some risk factors, particularly tobacco use and psychological stress. Conclusion: ACS patients with COPD demonstrate a higher burden of modifiable risk factors, especially tobacco use and psychological stress. Targeted screening and lifestyle interventions in this high-risk subgroup could improve cardiovascular outcomes.

Background: Acute abdominal pain is a common yet diagnostically challenging presentation in the pediatric population, with a wide spectrum of potential causes ranging from benign conditions to surgical emergencies. Accurate and timely diagnosis is crucial to minimize morbidity and guide appropriate intervention. Ultrasonography (USG) has emerged as a frontline imaging modality owing to its safety, availability, and diagnostic capability. Objectives: To evaluate the diagnostic performance of ultrasonography in detecting interventional and surgical causes of acute abdominal pain in children aged 1 to 18 years, and to correlate USG findings with final operative and histopathological diagnoses Materials and Methods: This prospective observational study was conducted in the Department of Radiodiagnosis, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, over a period of two years. A total of 75 pediatric patients presenting with acute abdominal pain underwent abdominal USG. Findings were compared with operative and histopathological results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for each major condition. Results: USG demonstrated high sensitivity and specificity for acute appendicitis (87.2% and 90%, respectively), intestinal obstruction (85% and 88%), cholelithiasis (86% and 85%), and mesenteric lymphadenitis (84% and 82.3%). A strong correlation was found between USG and final diagnoses (p < 0.001), with an overall USG diagnostic accuracy ranging from 80.6% to 88%. Statistically significant associations were also noted between clinical and ultrasonographic diagnoses (p = 0.002).Conclusion: Ultrasonography is an effective, accurate, and non-invasive diagnostic tool for evaluating pediatric acute abdomen. Its high diagnostic performance supports its role as the primary imaging modality in emergency pediatric settings, aiding in prompt clinical decision-making and reducing unnecessary interventions.

Background: Mechanical ventilation is a lifesaving intervention for critically ill pediatric patients but is also associated with high morbidity and mortality. Identifying modifiable risk factors is essential to improve outcomes. Aim: To identify risk factors associated with mortality among mechanically ventilated children admitted to a tertiary care Pediatric Intensive Care Unit. Methods: This prospective observational study was conducted on 300 children aged 1 month to 12 years who underwent mechanical ventilation in the PICU over 11 months. Data on demographics, clinical parameters, and complications were collected. Statistical analysis included t-tests, chi-square tests, and logistic regression, with a significance threshold of p < 0.05. Results: The mortality rate among ventilated children was 38.0%. Demographic and general clinical parameters such as age, sex, PRISM score, duration of hospital and PICU stay did not show significant association with mortality. However, certain complications, including ventilator-associated pneumonia (15.3%, p = 0.028), nosocomial sepsis (19.7%, p = 0.004), and urinary tract infection (14.3%, p = 0.023) were significantly associated with increased mortality risk. Conclusion: Nosocomial infections, especially VAP and sepsis, are key predictors of mortality in ventilated children. Focused infection control practices and early management of complications are crucial to reducing mortality in this vulnerable population.

Background: The placenta forms the most important link between the developing fetus and mother. The normal situation of the placenta is vital for appropriate growth and development of the fetus. Once there is a change in placental location or architecture, the outcome of pregnancy (maternal and fetal) is altered. The placenta is usually situated in the upper uterine segment usually near the fundus on the posterior wall of the uterus and less frequently located on the anterior wall. Sometimes for other causes or reasons, the placental position may alter; lying wholly or partially in the lower uterine segment resulting in placenta previa (or praevia). The incidence is approximately 4 to 5 per 1000 pregnancies (3'4).Aims: To determine the risk factors and fetomaternal outcomes of placenta previa among pregnant women. Materials and method: The present study was a Prospective, Observational institutional based study. This study was conducted at Dept. of Obstetrics & Gynaecology in NRS Medical College & hospital. 133 patients were included in this study. Result: In our study, 31 (23.0%) patients were Primi Gravida and 102 (76.7%) patients were Multi Gravida. The value of z is 7.158. The value of p is < .00001. The result is significant at p < .05. In our study, 46 (34.6%) patients had h/o Previous Abortion. The value of z is 5.0277. The value of p is < .00001. The result is significant at p < .05. In our study, 88 (66.2%) patients had Previous H/O C-Section. The value of z is 5.273. The value of p is < .00001.Conclusion: Placenta previa, whether found fortuitously by ultrasound or with the clinical emergency of maternal hemorrhage carries significant maternal and fetal risk. Accurate diagnosis, judicious expectant management with blood transfusion as required and timely delivery can lead to the most favourable outcome. The current study suggested there is association between advancing maternal age, gravidity parity previous abortion and cesarean sections as increased risk factors for placenta previa. Anticipation of the clinical complications like PPH and conservative management may avoid serious consequences.

Background: Caesarean section (CS) performed in the second stage of labor has been associated with greater maternal and neonatal risks compared to CS in the first stage. With rising rates of second stage CS in modern obstetric practice, it is crucial to evaluate and compare the outcomes to guide clinical decisions and improve perinatal care. Aims: This study aims to compare fetomaternal outcomes of caesarean sections performed in the first versus second stage of labour by examining the rising incidence of second-stage caesareans, evaluating related maternal and neonatal risks, and reviewing current evidence to suggest best practices and highlight the need for further research into predictive models and strategies to enhance surgical safety and long-term outcomes. Materials & methods: This observational prospective analytical study was conducted over 18 months (February 2020–July 2021) in the Department of Obstetrics and Gynaecology at R.G. Kar Medical College and Hospital, Kolkata. It included 90 antenatal mothers in labour who underwent caesarean section—45 in the first stage of labour (Group A) and 45 in the second stage (Group B)—according to the study’s inclusion criteria. The hospital, a tertiary care centre, performs about 5000 emergency caesarean sections annually. Result: The study compared maternal and neonatal outcomes of caesarean sections performed in the first stage of labour (Group-A) versus the second stage (Group-B). Baseline characteristics—such as age, parity, religion, gestational age, and birth weight—were similar between groups with no significant differences. However, indications for caesarean differed: fetal distress and non-progress of labour were more common in Group-A, while deep transverse arrest and cephalopelvic disproportion were more frequent in Group-B (P=1.121). Intraoperative complications—including haemorrhage >1000 ml, uterine incision extension, and bladder injury—were significantly higher in Group-B. Postoperative complications like wound infection and prolonged hospital stay were also more common in Group-B. Regarding neonatal outcomes, adverse events such as APGAR <7 at 5 minutes, higher NICU admission rates, and longer NICU stay were significantly more frequent in Group-B. Conclusion: In conclusion, the study demonstrated that while baseline maternal and neonatal characteristics were comparable between caesarean sections performed in the first and second stages of labour, the outcomes varied notably. Caesarean sections in the second stage were associated with significantly higher rates of intraoperative complications such as excessive haemorrhage, uterine incision extensions, and bladder injuries. Postoperative complications, including wound infection, wound dehiscence, and prolonged hospital stay, were also more frequent in this group. Moreover, neonatal outcomes were less favourable in the second stage group, with a greater proportion of babies exhibiting lower APGAR scores at five minutes, increased need for NICU admission, and longer NICU stays, underscoring the elevated risks associated with second stage caesarean sections

Background: Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice.  Aim: To carry out retrospective evaluation of effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair. Methods: Data from patients who underwent open inguinal hernia repair under Spinal Anesthesia between 2022 and 2024 were obtained. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications.

Results: Four hundred patients were included in both groups. Lateral and direct hernias occurred in 61.5 % and 40.5 %. According to EHS, 31.5 %, 22.3 % and 46.2 % were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities. Conclusion:1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort.

Background: Pregnancy induced hypertensive (PIH) disorders are a significant cause of adverse maternal and fetal outcomes, especially in developing countries like India.  Aim: Objective of this study to evaluate the maternal and fetal outcomes of PIH patients in a tertiary care Indian hospital. Materials & Methods:  This cross sectional observational enrolled eighty pregnant women with PIH was studied. The data regarding demographic variables, obstetric history, clinical details & examinations, investigations, fetal and maternal outcomes data recorded and documented. Results: Overall incidences of LSCS were 31.3% among PIH women. The common maternal outcomes were Placental abruption (11.3%), postpartum hemorrhage (10%), Posterior reversible encephalopathy syndrome (8.7%), pulmonary oedema (7.5%), maternal mortality (3.7%), HELLP syndrome (2.5%), ARF (1.3%), DIC (1.3%) and ARDS (1.3%), whereas common fetal outcomes are preterm delivery (40%), LBW (38.7%), NICU admission (32.5%), neonatal sepsis (10%), meconium aspiration syndrome (7.5%), IUGR (7.5%), Transient tachypnoea of new-born (5%), still birth/IUFD (1.3%) and neonatal death were 6.3%.  Conclusions: Pregnancy-related hypertensive disorders are common and adversely impact maternal and fetal outcomes. Efforts should be made at both the community and hospital levels to increase awareness regarding PIH and reduce its associated morbidity and mortality.

Background: Vitiligo vulgaris is a disease of acquired nature, of chronic state caused by the fact that depigmented patches appear on the skin with macules. It is a psychosocially important mind issue that touches on 0.5-2 percent of the world population. The pathomechanism is not understood, although an autoimmune hypothesis is popular. Recent researches have proposed the possible involvement of vitamin D deficiency in development and further course of vitiligo as it has a main role in melanogenesis process and immune response. The relationship between the amount of serum vitamin D3 and vitiligo is however, irregular. Methods: The study is observational, cross-sectional in nature and carried out in Amaltas Hospital, Dewas in 18 months. In the study there were two groups Group A (patients with vitiligo vulgaris) and Group B (healthy control patients matched by age and sex). Vitamin D3 serum levels were determined in a chemiluminescent immunoassay. Demographic, clinical and comorbidity data were also measured and examined. The level of statistical significance was p < 0.05. Results: The sample size comprised 90 people, 45 of whom were enrolled in each group. Vitamin D3 was significantly lower in the vitiligo group (21.3 +/- 9.4 ng/mL) than that of the control group (35.4 +/- 6.3mg /ml, p < 0.001). Moreover, 75.5 percent of vitiligo patients used to have low levels of vitamin D, and 17.8 percent were deficient. Vitiligo group: The vitiligo group had a moderate to severe level of depigmentation according to the score received on VASI (13.7 + 7.1). Conclusion: The literature shows a strong relationship between low vitamin D3 serum levels and vitiligo vulgaris making us assume that vitamin D3 deficiency could be a causative factor in the pathogenesis of the disease. More studies should be conducted to determine the possible benefits of vitamin D3 supplement in treating vitiligo and the associated comorbidities.

Background: Introduction: Anaemia remains one of the most prevalent and persistent public health challenges in developing countries, disproportionately affecting women, particularly during pregnancy. According to estimates by the World Health Organization (WHO), approximately 50% of women in developing nations are anaemic. AIM: Study of effect of maternal hb on birth weight and apgar score of baby. Methodology: The present cross-sectional observational study was conducted from feb. 2024 to feb 2025 at the Departments of Obstetrics & Gynaecology, American institute of Medical Sciences, Udaipur. Term neonates and their mothers in the first stage of labour were included, with a calculated minimum sample size of 90. Result: Our study revealed a high prevalence of maternal anemia (59%), with moderate to severe anemia seen in 41% of cases. Anemia was more common in younger mothers and associated with higher rates of preterm delivery. Neonates born to anemic mothers had significantly lower birth weights and Apgar scores. These outcomes underscore the adverse effects of maternal anemia on neonatal health. Early detection and management of anemia during pregnancy is vital to reduce neonatal morbidity and mortality. Conclusion: Maternal anemia is significantly associated with adverse neonatal outcomes, including low birth weight, preterm delivery, and reduced Apgar scores. These findings underscore the urgent need for targeted interventions to prevent and manage anemia during pregnancy.

Background: Menstrual health is fundamental to adolescent well being, educational engagement, and gender equity. Despite policy attention, schoolgirls in many low  and middle income settings continue to lack accurate information, hygienic menstrual materials, and supportive school environments. Evidence from rigorously evaluated, curriculum linked interventions in government schools remains limited. Materials and Methods: We conducted a cluster controlled, quasi experimental study across eight government secondary schools (grades 6–10) in rural catchment areas served by the Department of Community Medicine, Kamineni Academy of Medical Sciences and Research Centre. Four schools received a multifaceted health education package (interactive sessions, peer champions, audiovisual modules, teacher training, and low cost pad distribution support); four comparison schools continued routine curricula. Menstruating students aged 10–17 years who had attained menarche were enrolled (N=384; Intervention=192; Control=192). Baseline (pre intervention) and 6 month post intervention surveys captured knowledge (0–20 scale), attitudes (0–50 scale), practices, school absence, and a composite “adequate MHM” indicator (hygienic absorbent, ≥3 changes/day, privacy, safe disposal). Analyses used cluster adjusted tests and difference in differences estimates. Results: Follow up response was 96.1% (Intervention n=184; Control n=185). Mean knowledge improved from 6.2±2.8 to 15.4±2.5 in the intervention arm versus 6.0±2.9 to 8.2±3.1 in controls (Diff in Diff +7.4; p<0.001). Adequate MHM rose from 23.4% to 71.2% in the intervention arm and from 22.9% to 30.3% in controls (Risk Ratio 2.35; 95% CI 1.82–3.02; p<0.001). Menstrual related school absence (≥1 day/last period) fell from 45.8% to 18.5% in the intervention arm versus 43.8% to 41.1% in controls (p<0.001 between arms at endline). Conclusion: A low cost, school integrated health education package substantially improved menstrual knowledge, hygienic practices, and school participation. Scaling participatory, teacher supported models could accelerate progress toward adolescent health and education goals.

Background: Anemia remains a major public health concern among adolescent girls, particularly in rural India where dietary inadequacies and poor menstrual hygiene contribute to the burden. This study aimed to estimate the prevalence of anemia and identify its key determinants among adolescent girls in a rural setting.  Materials and Methods: A community-based cross-sectional study was conducted between June 2024 and May 2025 in the rural field practice area of Kamineni Academy of Medical Sciences and Research Centre. A total of 165 adolescent girls aged 10–19 years were selected using systematic random sampling. Hemoglobin levels were measured using HemoCue, and anemia was classified per WHO criteria. Data on dietary intake, menstruation, and hygiene practices were collected using a pretested questionnaire. Statistical analysis included chi-square tests and logistic regression. Results: The prevalence of anemia was 60%, with moderate anemia being the most common (27.3%). Significant associations were found with low intake of green leafy vegetables (p = 0.009), fewer than three meals per day (p = 0.037), and irregular menstruation (p = 0.015). Logistic regression revealed that inadequate leafy vegetable intake (AOR = 2.9, p = 0.004), meal frequency <3/day (AOR = 2.1, p = 0.026), and irregular menstruation (AOR = 2.7, p = 0.007) were independent predictors. Conclusion: Anemia among rural adolescent girls is highly prevalent and strongly associated with modifiable dietary and menstrual health factors. Community-driven interventions targeting these determinants are critical to reducing anemia burden and improving adolescent health outcomes.

Background: Tobacco use is the leading global cause of preventable death. There is estimation that three quarters of these deaths will be in low and middle income countries. Very few studies were available on the tobacco habit of transport staff from India. Aims and Objectives: prevalence of oral mucosal lesions associated with habit of using tobacco and areca nut in motor vehicle drivers in NTR district. Materials and Methods A total of 100 subjects with consumption of Areca nut or Tobacco in any form will be enrolled in the study. A self structured, pre-tested questionnaire was used for data collection and it was followed by clinical examination for any tobacco and areca nut associated oral mucosal lesions. Results:  Among the subjects the duration of consumption of tobacco was seen 1-10 years in 57% individuals and 11-20 years frequency in 25% of the individuals. More than 30 years frequency was seen in 9% individuals.. Only 34% of the subjects never attempted to quit tobacco consuming habit. The prevalence of oral and mucosal lesions were seen in 44% of the subjects. Discussion: As a single habit chewing was more popular compared to smoking followed by alcohol. This may be due to acceptability in the society. Amongst the chewers gutka was more popular followed by khaini. Conclusion: Areca nut and Tobacco use in different forms is one of the prime factors responsible for potentially malignant disorders and cancerous lesions. Lack of awareness regarding harmful effects is a major reason

Background: This cross-sectional study compares the clinical profile and management of migraine in young (20-50 years) versus older patients (51 years and above). Data from 240 patients were analysed, revealing that younger patients experience more frequent, longer, and more intense migraine attacks, along with higher prevalence of associated symptoms like nausea and photophobia. Older patients, however, have more comorbidities such as hypertension and diabetes, complicating migraine management. Treatment patterns also vary, with younger patients favouring acute medications and older patients using preventive treatments. The study highlights the importance of considering age-related differences in migraine management to optimize treatment strategies. Future research should focus on longitudinal studies, diverse populations, lifestyle influences, and genetic mechanisms to further understand and improve age-specific therapeutic strategies

Background: Introduction: The primary goal in modern obstetrics is to deliver a healthy baby to a healthy mother with minimal complications. Birth weight plays a pivotal role in determining neonatal outcomes and survival. AIM: To compare the fetal weight estimated by Johnson’s formula, Dare’s formula, and the Hadlock ultrasound formula in term pregnancies. Methodology: This prospective comparative observational study was conducted in the Department of Obstetrics and Gynaecology at American institute of Medical Sciences, Udaipur over a period of 1 year. The study population consisted of pregnant women with singleton term pregnancies (≥37 weeks gestation) who were admitted for delivery. Result: In this study, the Hadlock formula showed the closest estimation to actual birth weight with the least mean error (+30 ± 110 g), while Johnson’s formula had the highest discrepancy (–120 ± 150 g). Ultrasonography-based methods demonstrated superior accuracy over clinical formulas, consistent with other studies. Combining ultrasound with clinical assessment supports safer obstetric care and improves perinatal outcomes. Conclusion: Accurate fetal weight estimation is essential for safe obstetric care. In this study, the Hadlock formula proved most reliable, confirming the superiority of ultrasound-based methods over clinical estimates. Integrating sonographic and clinical parameters can further improve fetal weight prediction and perinatal outcomes.

Background: Pediatric seizures exhibit distinct age-related patterns that necessitate optimized diagnostic approaches, particularly in resource-limited settings. Methods: This retrospective analysis included 62 children (aged 0–18 years) with epilepsy at a tertiary care center between January and May 2025. Clinical profiles, EEG findings (30-minute awake/sleep recordings), and MRI results were evaluated. Results: Generalized seizures were significantly more common in infants under 1 year of age (45.5% vs. 11.1% with partial seizures; OR = 6.67, p = 0.008) and showed stronger correlations with abnormal EEG findings (88.6% vs. 50.0%; OR = 7.22, p = 0.001). Generalized seizures were also significantly associated with a positive family history (p = 0.02), abnormal birth history (p = 0.01), and the presence of neurocutaneous markers (p < 0.05). MRI abnormalities were comparable between the generalized and partial seizure groups (68.2% vs. 77.8%, p = 0.44). Conclusion: EEG demonstrates a superior diagnostic yield in cases of generalized seizures, especially in infants, supporting its use as a first-line investigation in Indian clinical settings. These findings highlight the diagnostic value of combining demographic factors with neurophysiological and imaging tools in the evaluation of pediatric seizures

Background: Rhinosporidiosis is a chronic granulomatous condition caused by Rhinosporidium seeberi. Although intraocular involvement is rare, it poses an essential clinical dilemma in endemic areas because of its potential associated morbidity. Knowledge of its epidemiology and clinical presentation is necessary for its diagnosis and early treatment. Methods: This was a descriptive case series of six months' duration in a tertiary care hospital. Ten patients with ocular rhinosporidiosis were included. Prime importance was given to a detailed clinical history with special reference to exposure, if any, from the environment. Surgical excision of the lesions was performed in all patients with diathermy of the base. Diagnosis was based on histopathologic tests in all cases. Patients were followed up postoperatively for recurrence and vision. Results: Our study cohort consisted predominantly of boys younger than 15 (9 out of 10 cases). All patients had a history of exposure to stagnant polluted water sources. The inferior tarsal conjunctiva was most commonly involved. Most importantly, no patient had any diminution of visual acuity throughout treatment. There was one patient who had a recurrence after follow-up. Conclusion: Based on these experiences, ocular rhinosporidiosis is a rare condition that needs to be considered in the differential diagnosis, especially if we see young adult males with a history of contact with stagnant water, living or visiting endemic areas. Obtaining an early diagnosis and achieving a complete surgical removal are key to keeping it from returning. Reducing the incidence of rhinosporidiosis requires robust public health efforts beyond clinical care, including providing safe water sources and community education on risk prevention.

Background: Cholelithiasis is rarely diagnosed in infants and neonates. However, the increasing use of ultrasonography has led to more frequent identification of asymptomatic and symptomatic gallstones in the pediatric population. We report the case of a 7-month-old male infant with hemoglobin E trait who presented with recurrent vomiting and was diagnosed with gallstones. After initial conservative management, he underwent elective cholecystectomy at 11 months of age, with a favorable outcome. This case emphasizes the importance of considering gallstone disease even in very young children, particularly those with hemolytic disorders.

Background: Breast abscess is common in developing countries. The traditional treatment was incision and drainage of the abscess. Recently more emphasis is on ultrasound guided percutaneous aspiration of breast abscesses. Needle aspiration with ultrasound guidance is an effective treatment for breast abscess irrespective of abscess volume and size and is a less invasive and more conservative approach. Methods: This prospective study was conducted from December 2012 to May 2014. All patients were given Amoxicillin- Clavunate antibiotic. Ultrasound guided aspiration of the abscess was done under local anaesthesia and pus was sent for culture sensitivity. Patients were followed up after 48 hours, one week, two weeks and one month and were evaluated for symptoms and signs. Antibiotics were changed according to culture sensitivity. Results: Among 36 patients, 66.67% patients had complete resolution of symptoms after one aspiration only, 19.44% patients needed 2 aspirations and 2.78% had undergone 4 aspirations for complete resolution. Four (11.11%) patients underwent incision and drainage of abscess. The success rate by needle aspiration was 88.89% which was comparable to other studies. Conclusions: Ultrasound guided percutaneous aspiration is a feasible, safe, well-tolerated, and successful method as primary and definitive treatment for breast abscesses.

Background: Perforative peritonitis remains a significant surgical emergency worldwide, with etiology and outcomes varying by geographic region. Timely diagnosis and intervention are crucial to reduce morbidity and mortality. Methods: A prospective observational study was conducted over 18 months at a tertiary care centre, including 115 patients with clinical and radiological features of peritonitis who underwent emergency surgery. Demographic data, clinical presentation, comorbidities, site and cause of perforation, operative management, complications, and outcomes were recorded and analyzed. Results: The study population had a mean age of 44.6 years (SD 12.03), with the highest incidence in the 41–50 year age group (32.2%). Males predominated (70%). Comorbidities were present in 65% of patients, with diabetes and hypertension each noted in 14%. The most common presenting symptom was abdominal pain (100%), followed by abdominal distension/constipation (73%), vomiting (42.6%), and fever (33%). The most frequent site of perforation was the appendix (26.1%), followed by duodenum (23.4%), ileum (20.9%), and stomach (17.3%). Surgical management included primary closure or modified Graham’s omentoplasty (each 34%), open appendectomy (26%), resection and anastomosis (5.2%), and stoma formation in select cases. Nearly half (47%) required postoperative ICU care. The in-hospital mortality rate was 5.2%. Most patients (60%) had a hospital stay of 10–15 days. Conclusions: Appendicular and duodenal perforations are the most common causes of perforative peritonitis in this rural South Indian cohort. Prompt surgical intervention results in acceptable morbidity and mortality, but outcomes are adversely affected by comorbidities and the need for intensive care. Early recognition and management remain essential to improving prognosis.

Background: About 5–10% of pregnancies are complicated by hypertensive disorders. It is among the leading causes of morbidity and mortality among mothers and newborns. Pre-eclampsia, chronic hypertension, gestational hypertension, and pre-eclampsia with chronic hypertension are some of these various disorders. A considerable amount of prenatal morbidity and mortality is caused by these conditions. Methodology: Following a thorough history and clinical evaluation, all patients had venous blood drawn between weeks 14 and 20 of pregnancy in order to test and analyze their lipid profiles. All subjects were fasted for at least eight hours before their samples were taken. The sample was centrifuged for five minutes at 4000 rpm to separate the serum after the clot retracts, and it was then stored at 4°C until analysis. Enzymatic spectrophotometry was used to estimate the lipid profile. Results: There is significantly higher number of patients with elevated total cholesterol in the hypertensive group compared to the normotensive group. An inverse relationship between HDL and hypertension in the second trimester is seen. As the levels of HDL decreases there are more chances of finding hypertension in those patients. A directly proportional relationship between LDL and hypertension in the second trimester is seen. We can come to the inference that as the levels of LDL increases there are more chances of finding hypertension in those patients. A directly proportional relationship between triglyceride levels and hypertension in the second trimester is seen. We can come to the inference that as the levels of triglycerides increases there are more chances of finding hypertension in those patients. A directly proportional relationship between VLDL levels and hypertension in the second trimester is seen. We can come to the inference that as the levels of VLDL increases there are more chances of finding hypertension in those patients. The average BMI of the hypertensive group was found to be 26.2 and that of the normotensive group was 23.4. A significant increase in BMI is evident in the hypertensive group. Conclusion: In the context of clinical practice, lipid profiles can be an effective screening tool for early identification of pregnant women at risk of hypertension before the symptoms and consequences of pre-eclampsia and eclampsia materialize, thereby improving the prognosis for the mother and fetus.

Background: A family history of type 2 diabetes mellitus (T2DM) is a well-established non-modifiable risk factor that predisposes individuals to metabolic dysfunction, even in the absence of overt clinical symptoms. Cardiopulmonary fitness (CPF), measured via VO₂ max, is a crucial predictor of metabolic health and cardiovascular outcomes. However, it remains unclear whether healthy individuals with a familial predisposition to T2DM exhibit reduced CPF compared to those without such a history.Materials and Methods: This cross-sectional study included 120 healthy adults aged 20–40 years, categorized into two groups: those with a first-degree relative with T2DM (FH+) and those without (FH−). Subjects underwent anthropometric assessment, fasting glucose analysis, and cardiopulmonary exercise testing (CPET) to determine VO₂ max. Inclusion criteria encompassed BMI between 18.5 and 24.9 kg/m², nonsmoking status, and absence of chronic illness or medication use. Data were analyzed using SPSS v25. Results: Mean VO₂ max was significantly lower in the FH+ group (36.2 ± 5.8 mL/kg/min) compared to the FH− group (41.7 ± 6.3 mL/kg/min, p < 0.01). Furthermore, FH+ individuals demonstrated slightly higher fasting glucose and lower exercise tolerance, although both values remained within normal ranges. Six comparative tables illustrate group differences, including age, BMI, waist circumference, fasting glucose, VO₂ max, and exercise duration. Conclusion: Healthy individuals with a family history of T2DM exhibit lower cardiopulmonary fitness despite normal glycemic status and anthropometric indices. Early preventive strategies emphasizing aerobic capacity enhancement may be warranted for this at-risk population.

Background: Cholangiocarcinomas (CCA) are the tumors originating from the biliary tract. These tumors generally present with obstructive jaundice, leading to delay in diagnosis of the underlying cancer. Patients usually keep taking treatments for their jaundice and thereby they present to the oncologists quite late in their disease’s natural history. This malignancy constitutes a sizeable proportion of the morbidity and mortality among total cancer population. This study therefore aims to study the basic demographics of this disease to provide further insights into planning preventive and treatment strategies for such patients. Method- A retrospective analysis of database of all patients of biliary tract malignancy registered in our centre between 2018 and 2023 was conducted and the data so obtained was tabulated. Results- A total of 336 patients were included in the study. Patients with localized, locally advanced and metastatic disease were 9%, 19%, 72% respectively. Out of the total cases, males were 42.26% and females were 57.74% of the total cases. The age group most commonly affected was 51–60-year age group which accounted for 29.17% of total cases followed by 41–50-year age group which accounted for 23.8% of total case load. Bhopal district accounted for 19.34% of all cases while the districts with second highest number of case load were Satna and sehore districts which accounted for 7.73% of total case load each. Conclusion - Most cases of cholangiocarcinoma’s present in metastatic condition to the tertiary care hospital. Females are affected more commonly compared to males and most affected age group is 51-60 years. In Madhya Pradesh, the district most commonly affected is Bhopal.  Information education and communication strategies should be planned accordingly so that the cases can be picked up in early stages so that curative approach can be offered to the patients. Also, epidemiological studies to identify the causative factors shall be planned in the most affected areas to mitigate the etiological factor.