Background: Caesarean section is one of the most frequently performed obstetric procedures, and electrosurgical devices such as monopolar cautery are increasingly used during abdominal entry to improve hemostasis and reduce operative time. Objective: To assess the effect on the newborn of using monopolar cautery during abdominal entry in elective cesarean sections compared with the conventional scalpel technique. Materials and Methods: This prospective randomized case–control study was conducted at a tertiary level medical college and hospital from Jan 25 to December 25, including 100 women undergoing elective lower segment cesarean section at term. Results: In this study of 100 patients (50 in each group), baseline characteristics were comparable between the cautery and no cautery groups. Mean maternal age was 29.9 ± 3.8 vs 30.2 ± 4.2 years, gestational age 38.27 ± 0.69 vs 38.37 ± 0.72 weeks, and birth weight 2.95 ±0.25 vs 2.93 ± 0.26 kg. Apgar scores improved similarly from 8.40 ± 0.25 vs 8.27 ± 0.26 at 1 minute to 9.33 ± 0.67 vs 9.40 ± 0.53 at 10 minutes. Cord pH (7.29 ± 0.07 vs 7.30 ± 0.05), lactate (2.6 ± 0.9 vs 2.4 ± 0.8 mmol/L), and glucose (76.8 ± 9.7 vs 78.3 ± 10.2 mg/dL) were comparable. Previous LSCS was the most common indication (64% vs 62%), and NICU admissions were low (6% vs 8%). Conclusion: The use of monopolar cautery during abdominal entry in elective cesarean sections does not adversely affect immediate neonatal outcomes. Monopolar cautery appears to be a safe and effective technique that can be used without compromising newborn well-being. Keywords: Cesarean section, monopolar cautery, electrocautery, neonatal outcomes, Apgar score, cord blood pH.

Background: Titanium Elastic Nailing System (TENS) has become a preferred minimally invasive method for stabilizing paediatric diaphyseal long bone fractures, offering balanced flexible fixation that preserves periosteal blood supply and allows early mobilization. This study assessed short-term functional and radiological outcomes, pain trajectory, malalignment, limb length discrepancy (LLD), and complications following TENS fixation in a tertiary care setting. Materials and Methods: A prospective cohort study was conducted over 12 months in the department of orthopaedics of a tertiary care hospital. Institutional ethics committee approved the study and informed and written consent was obtained from guardians of the cases. Children with simple, minimally displaced diaphyseal long bone fractures treated with TENS were included in this study on the basis of a predefined inclusion and exclusion criteria. Convenience sampling yielded 25 patients (sample size based on pilot proportion). Baseline demographics, injury mechanism, fracture pattern and final diagnosis were documented. Follow-up evaluations were performed postoperatively, at 1 month, and at 3 months. Functional outcomes were graded using Flynn et al TENS scoring system. Radiographs were assessed for alignment and union. Complications, pain, malalignment grades, and LLD were documented. SSPS 29.0 was used for statistical analysis and p value less than 0.05 was considered as statistically significant. Results: Mean age was 8.96±2.91 years; 68% were 5–10 years and 60% were male. Self-fall was the commonest mechanism (80%). Transverse fractures predominated (80%); femoral shaft fractures formed the largest diagnostic group. Malalignment <5° was maintained in 76% postoperatively and 80% at 3 months, with no significant change over follow-up (p=0.725). Pain decreased significantly to 0% at 3 months (p<0.0001). Minor complications occurred in 20% at 1 and 3 months (p=0.0139). Radiologically, 96% achieved union by 3 months. Malunion was reported in 1 (4%) patient. Mean LLD remained small (0.61–0.65 cm across intervals). Excellent functional outcomes were seen in 80% at 3 months. Conclusion: In selected paediatric diaphyseal long bone fractures, TENS provided reliable alignment control, rapid pain resolution, high union rates, minimal LLD, and predominantly excellent short-term functional outcomes with low minor complication rates. Keywords: Pediatrics long bone Fractures; Femur Fractures; Intramedullary Nailing; Treatment Outcome.

Background: Cirrhosis leads to portal hypertension and life-threatening complications like esophageal variceal bleeding. While endoscopy is the gold standard for diagnosis, its invasive nature and cost, necessitate reliable non-invasive predictors. Aim: To evaluate the Aspartate Aminotransferase to Platelet Ratio Index (APRI) score and Fibrosis-4 (FIB-4) as non-invasive predictors of esophageal varices in liver cirrhosis. Materials and Methods: This observational study at Narayana Medical College Hospital (January–July 2024) included 105 cirrhotic patients. APRI and FIB-4 scores were calculated and compared against endoscopic findings. Results: Esophageal varices were present in 65.7% of patients. An APRI cut-off of ≥ 0.9 demonstrated 74.5% sensitivity, 61.1% specificity, and a significant association with high-risk varices (p = 0.0005).Binary logistic regression analysis revealed that patients with an APRI score of ≥ 0.9 had nearly five times the odds of harbouring high-risk varices compared to patients with an APRI score < 0.9 (OR = 4.59; 95% CI: 2.00–10.58; p = 0.0003). A FIB-4 cut-off of ≥ 2.78 showed higher sensitivity (82.3%) but lower specificity (40.7%), with a significant association (p = 0.0174).Patients with a FIB-4 score ≥ 2.78 had more than five times the odds of having esophageal varices compared to patients with a score below the 2.78 threshold (Odds Ratio [OR] = 5.31; 95% Confidence Interval [CI], 2.15 – 13.10; p < 0.001). Conclusion: Both indices are valuable tools for risk stratification. APRI serves as a reliable positive predictor for identifying high-risk varices, while FIB-4’s high sensitivity makes it an effective primary screening tool to rule out severe disease in resource-limited settings Keywords: APRI, FIB-4, Esophageal varices, Non invasive predictor, Cirrhosis.

Background: Metformin is the most prescribed first-line medication for people with type 2 diabetes mellitus (T2DM). In addition to its blood sugar-lowering effect, metformin is known to be associated with weight stabilisation or even slight weight reduction. However, the amount and type of weight changes are highly variable with metformin. This study aims to determine the weight-reducing potential of the antihyperglycemic agent. Understanding other factors causing weight changes could help improve treatment plans and metabolic outcomes. Materials and Methods: This prospective observational cohort study was conducted on an outpatient basis. We used consecutive sampling during routine outpatient visits to enrol 300 adult patients with type 2 diabetes mellitus who had been on metformin for at least six months. We gathered demographic, clinical, and metabolic information of the participants at baseline. For three months, we conducted follow-ups and recorded their body weight. Data was analysed using paired t-tests and regression modelling to assess weight changes and identify variables that may contribute to weight loss. Results: The participants had an average age of 52.4 years, with a standard deviation of 9.3 years. The group was made up of 54% men and 46% women. At the beginning of the study, the average body mass index (BMI) was 28.3 kg/m², with a standard deviation of 4.2 kg/m². During the follow-up period, 42% of patients lost weight, 36% maintained their weight, and 22% gained weight. A higher baseline BMI and a shorter duration of diabetes were strongly correlated with weight loss with metformin medication. Age showed a substantial correlation with weight change, whereas gender did not. Conclusion: Metformin medication is linked to moderate weight loss in a significant number of individuals with type 2 diabetes. Baseline BMI and diabetes duration appear to be major predictors of weight change. This shows how vital it is to analyse each patient individually when managing diabetes. With appropriate lifestyle changes, we can postulate that the treatment results can be further optimised. Keywords: Metformin, Type 2 Diabetes Mellitus, Weight Change, Body Mass Index, Predictors, Glycemic Control.

Background: Total knee replacement (TKR) is associated with significant postoperative pain, which can delay rehabilitation and prolong hospital stay. Epidural analgesia using long-acting local anesthetics like levobupivacaine and ropivacaine is widely used for effective pain control. The aim is to compare the analgesic efficacy of epidural levobupivacaine (0.125%) and ropivacaine (0.2%) in patients undergoing TKR. Materials and Methods: This prospective, double-blind randomized study included 110 patients undergoing TKR, divided into two groups: Group L (levobupivacaine 0.125%, n=55) and Group R (ropivacaine 0.2%, n=55). Postoperative epidural infusion was administered, and patients were evaluated using Visual Analogue Scale (VAS) scores at rest and on movement at different time intervals. Hemodynamic parameters, sensory regression, motor blockade (Modified Bromage Scale), and adverse effects were also recorded. Results: Demographic parameters were comparable between groups. VAS scores at rest and during movement were similar at all time intervals (p>0.05). Group R demonstrated significantly lower pulse rate and systolic blood pressure at multiple time points (p<0.05), indicating better hemodynamic stability. Sensory regression to L1 was significantly prolonged in Group R (28.53 ± 13.463 hrs) compared to Group L (22.78 ± 11.263 hrs; p=0.018). Motor blockade and incidence of side effects were comparable in both groups. Conclusion: Both levobupivacaine and ropivacaine provide effective postoperative epidural analgesia following TKR. However, ropivacaine offers better hemodynamic stability and longer sensory blockade, making it a preferable choice. Keywords: Total knee replacement, Epidural analgesia, Ropivacaine, Levobupivacaine, Visual Analogue Scale, Postoperative pain.