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.

Background: Gallstone disease is a common gastrointestinal condition affecting a large proportion of adults worldwide. Although laparoscopic cholecystectomy is widely accepted as the standard treatment, open cholecystectomy remains essential in complicated cases. Identifying predictors of surgical difficulty and postoperative complications is therefore clinically important. The objective is to evaluate the association between preoperative neutrophil–lymphocyte ratio (NLR) and surgical outcomes in patients undergoing open cholecystectomy. Materials and Methods: A retrospective observational study was conducted in the Department of Anesthesia Kalyan Singh Government Medical College Bulandshahr, Uttar Pradesh, India from August 2024 to August 2025. Eighty patients undergoing open cholecystectomy were included. Patients were divided into two groups based on preoperative NLR values: NLR <3 and NLR ≥3. Operative time, difficult dissection, postoperative complications, and duration of hospital stay were recorded. Results: Patients with elevated NLR (≥3) had longer operative time (80 vs 55 minutes), higher incidence of difficult dissection (35% vs 10%), higher surgical site infection rates (18% vs 4%), and prolonged hospital stay (6 vs 3 days). Conclusion: Preoperative NLR is a simple and inexpensive biomarker that may help predict operative difficulty and postoperative complications in open cholecystectomy. Keywords: Neutrophil-lymphocyte ratio, gallstone disease, open cholecystectomy, inflammation, surgical outcomes.

Background: Cheiloscopy, the study of lip print patterns, has emerged as a useful adjunct in forensic identification due to the unique and relatively stable nature of lip groove patterns. Although several studies have evaluated the distribution of lip print patterns, limited research has focused on age-related variations in these patterns. The present study aimed to evaluate the distribution of lip print patterns across different age groups in a suburban population of Dakshina Kannada district. Materials and Methods: A cross-sectional study was conducted on 300 individuals aged 12–60 years residing in a suburban region of Dakshina Kannada district. The study population was categorized into three age groups: 12–20 years, 21–40 years, and 41–60 years. Lip prints were recorded using the cellophane tape method after applying lipstick and were analyzed using the Suzuki and Tsuchihashi classification. Data were analyzed using SPSS software, and the Chi-square test was used to assess the association between age groups and lip print patterns. Results: Among the five lip print patterns identified, Type I pattern was the most predominant (32.0%), followed by Type V (20.7%), Type IV (16.3%), Type II (15.7%), and Type III (15.3%). Age-wise analysis showed that Type I pattern was more common in the younger age group (44.8%), while Type III and Type V patterns were relatively more frequent in the older age group. However, statistical analysis showed no significant association between age group and lip print pattern distribution (χ² = 12.84, p = 0.118). Conclusion: The findings of this study indicate that lip print patterns remain largely stable across different age groups, supporting their potential use as a supplementary tool for personal identification in forensic investigations. Keywords: Cheiloscopy; Lip prints; Age-related variation; Suzuki and Tsuchihashi classification; Dakshina Kannada.

Background: Cheiloscopy, the study of lip print patterns, has been increasingly explored as an adjunct method for personal identification in forensic investigations. The characteristic grooves and fissures present on the vermilion border of the lips form distinct morphological patterns that may assist in identifying individuals. The present study aimed to evaluate the distribution of lip print patterns and assess the forensic utility of cheiloscopy in a population from Dakshina Kannada district. Materials and Methods: A population-based cross-sectional study was conducted on 300 individuals aged 12–60 years residing in suburban areas of Dakshina Kannada district. Lip prints were recorded using the cellophane tape method after applying lipstick and were analyzed according to the Suzuki and Tsuchihashi classification. Descriptive statistics were used to determine the frequency distribution of lip print patterns, and the Chi-square test was applied to assess the association between gender and lip print pattern distribution. Results: Among the five lip print patterns identified, Type I pattern was the most predominant (32.0%), followed by Type V (20.7%), Type IV (16.3%), Type II (15.7%), and Type III (15.3%). Gender-wise comparison showed that Type I pattern was the most common pattern in both males and females. However, statistical analysis revealed no significant association between gender and lip print pattern distribution (χ² = 5.236, p = 0.264). A majority of lip prints (79.3%) exhibited identifiable patterns (Type I–IV), indicating their potential usefulness for forensic identification. Conclusion: The findings of this study demonstrate that a large proportion of lip prints possess identifiable morphological patterns, supporting the use of cheiloscopy as a supplementary method for personal identification in forensic investigations. Keywords: Cheiloscopy; Forensic identification; Personal identification; Suzuki and Tsuchihashi classification; Dakshina Kannada.

Background: Proximal phalanx fractures are the most frequent hand fractures in children. Although most injuries are treated nonoperatively, outcomes vary according to fracture pattern, anatomical location, degree of displacement, and the presence of associated soft tissue injury. The objective is to evaluate the clinical profile, management patterns, and functional and radiological outcomes of proximal phalanx fractures in children aged 12 years or younger. Materials and Methods: This prospective study was conducted from January 2024 to January 2025 and included 24 children with proximal phalanx fractures. Data were collected on age, sex, mechanism of injury, fracture location and type, associated injuries, treatment modality, and follow-up outcomes. Pain was assessed using the Visual Analog Scale [VAS], functional outcome was evaluated by range of motion, and residual deformity was assessed on follow-up radiographs. Results: The study included 24 children, comprising 16 males and 8 females, with a mean age of 9 years. Sports-related trauma was the most common mechanism of injury, accounting for 58.3% of cases. The base of the proximal phalanx was the most frequently affected site [50.0%]. Conservative management with a volar slab was successful in 14 patients, whereas open reduction was required in 1 patient. At a mean follow-up of 9 months, 91.7% of patients were pain-free. Residual deformity was noted in 2 patients. Stiffness and restricted range of motion were primarily observed in children with associated soft tissue injury or extensor tendon involvement. Conclusion: Proximal phalanx fractures in children generally have favorable outcomes with conservative treatment. However, displaced fractures and injuries associated with soft tissue damage may require surgical intervention. Adherence to physiotherapy appears to play an important role in optimizing functional recovery. Keywords: children; proximal phalanx fracture; pediatric hand fractures; conservative management; functional outcome; range of motion; soft tissue injury.

Dermatofibrosarcoma protuberans (DFSP) is a rare, low-to-intermediate grade fibroblastic neoplasm of dermal origin characterized by locally aggressive behavior and a high propensity for recurrence if inadequately excised. It accounts for less than 0.1% of all malignancies and approximately 1% of soft tissue sarcomas. Although metastasis is rare (<5%), the infiltrative growth pattern with tentacle-like projections into surrounding tissue necessitates meticulous surgical management. We report the case of a 36-year-old male who presented with a slowly progressive plaque over the left anterior chest wall for five years. The lesion was initially misdiagnosed as tinea incognito. Clinical examination revealed a well-defined infiltrative plaque measuring 10 × 8 cm with nodular components, confined to the dermis and subcutaneous tissue. Punch biopsy demonstrated spindle cell proliferation arranged in a storiform pattern. Immunohistochemistry showed strong CD34 positivity and S-100 negativity, confirming DFSP. Contrast-enhanced CT scan revealed tumor confinement to superficial planes without deep muscle or bony invasion. The patient underwent wide local excision (WLE) with adequate margins followed by split skin graft reconstruction. Histopathology confirmed tumor-free margins with a low Ki-67 index (6%). Postoperative recovery was uneventful, with excellent graft uptake and no recurrence to date. This case emphasizes the importance of early recognition, histopathological confirmation, immunohistochemistry, and adequate surgical margins in achieving optimal outcomes. Long-term surveillance remains essential due to the risk of late recurrence.

Background: Aim: To study the maternal and perinatal outcomes in singleton pregnancies with abnormal presentations. Materials and Methods: The study was designed as a single-center prospective observational investigation at the Government Maternity Hospital, Sultan Bazar, focusing on maternal and perinatal outcomes in singleton pregnancies with abnormal presentations. Spanning 24 months, the research included 150 antenatal women from 37 weeks gestation onward, confirmed by clinical and ultrasound examination. Exclusions were made for cases involving intrauterine death, congenital anomalies, and preterm births, using consecutive sampling of eligible participants. Data were collected using a semi- structured questionnaire, with thorough recordation of demographic and obstetric details, including gravidity, parity, and complications from previous pregnancies. Results: In the present study, the mode of delivery was predominantly through Lower Segment Caesarean Section (LSCS), which was necessary in 60% of the cases, reflecting the challenging nature of these pregnancies. Only 30% of the deliveries were normal vaginal births, indicating a tendency towards surgical intervention in complicated cases. Notably, age significantly influences the mode of delivery, with those under 20 years having a higher proportion of vaginal deliveries (55.6%) and LSCS least common (22.2%), a pattern that inversely correlates with increasing age, evident as LSCS dominates (84.3%) in those aged 30 years and above (P < 0.001). The AFI results highlight varying preferences for delivery mode based on fluid levels, with lower AFI favoring more balanced delivery methods and higher AFI leading predominantly to LSCS (92.2%) (P < 0.001). However, the type of labor, whether spontaneous or induced, shows no significant difference in delivery mode selection (P = 0.657), suggesting that other factors might have more substantial impacts on the decision-making process for the mode of delivery. Conclusion: The outcomes of this study reveal critical areas for potential improvement in perinatal care, particularly in the management of pregnancies complicated by abnormal presentations. The relatively high rates of NICU admissions illustrate the gravity of these cases and the imperative for enhanced prenatal monitoring and intervention strategies. The findings advocate for the development of refined guidelines that can assist healthcare providers in making informed decisions about the most suitable delivery methods, aiming to minimize complications and improve survival rates. Overall, this research contributes valuable insights into the impacts of delivery modes on maternal and perinatal health, serving as a basis for future studies and policy- making in obstetric care. Keywords: LSCS, Perinatal care, NICU, AFI, Vaginal Births.

Background: Type 2 diabetes mellitus is a common metabolic disorder characterized by high blood glucose levels. Adenosine Deaminase (ADA) is an enzyme which catalyses the irreversible deamination of adenosine to inosine. Adenosine is known to exert potent metabolic effects acting through its receptors. Increased levels of serum ADA has been shown in individuals with type 2 diabetes mellitus. The study aims to understand the relationship between serum ADA and blood glucose levels. The objective is to estimate the value of serum adenosine deaminase (ADA) in patients with uncomplicated cases of type 2 diabetes mellitus and non diabetics control group. To estimate the association between serum ADA values among cases and control based on blood sugars. Materials and Methods: The study was conducted at Gandhi Medical college, Secunderabad. It involved 50 cases of uncomplicated type 2 diabetes mellitus and 50 age and sex matched healthy controls. Blood and urine samples were collected after obtaining an informed written consent from cases and controls. Serum Adenosine Deaminase levels were estimated colourimetrically, based on the method described by Giusti and Galanti. Serum FBS, PPBS, HbA1c levels, blood urea, serum Creatinine, lipid profile and urinary sugar and proteins were also measured simultaneously using routine laboratory methods. Results: A clear-cut elevation of serum ADA was found in diabetic subjects as compared to controls. In addition a very large positive correlation was found between serum ADA and blood glucose levels. Conclusion: This study shows ADA level is significantly related to the glycemic status in type 2 diabetes mellitus. Altered serum ADA level is an indirect expression of the tissue adenosine levels. Adenosine through its multiple metabolic effects is involved in the pathophysiology of diabetes. The present study highlights the importance of this metabolite and the need for further studies. Keywords: Type 2 diabetes mellitus; Adenosine Deaminase; Adenosine.

Background: Smoking and excessive alcohol consumption are well-established risk factors for adverse postoperative outcomes, including wound complications, pulmonary infections, prolonged hospital stay, and increased morbidity and mortality. Evidence suggests that preoperative cessation of tobacco and alcohol significantly reduces surgical complications and improves recovery. Despite established clinical guidelines recommending cessation at least 4–8 weeks prior to elective surgery, patient awareness, adherence, and implementation of cessation practices remain inconsistent across healthcare settings. However, current evidence on awareness and real-world practices is fragmented. A comprehensive systematic review is therefore warranted. This systematic review aims to assess the level of awareness and the practices related to smoking and alcohol cessation prior to surgery among patients undergoing surgical procedures. Materials and Methods: This systematic review followed PRISMA guidelines and included English-language observational studies, randomized control trials, systematic review, meta-analysis, guidelines studies, focusing awareness and practices related to smoking and alcohol cessation prior to surgery and postoperative outcomes. Studies were included according to predefined inclusion criteria. Databases including PubMed/MEDLINE, Scopus, and Web of Science were searched using relevant keywords. Study selection and data extraction were performed, the risk of bias was assessed using appropriate design-specific tools, and findings were synthesized narratively. Results: Preoperative smoking and alcohol cessation reduces postoperative complications. Smoking cessation for at least 4 weeks before surgery significantly lowers pulmonary, wound, and overall complications, with greater benefits seen with longer cessation. Intensive cessation programs combining behavioral support and pharmacotherapy improve abstinence rates and may reduce postoperative morbidity. Combined smoking and alcohol use is associated with the highest risk of postoperative complications, readmission, and reoperation. Conclusion: Preoperative smoking and alcohol cessation interventions, particularly those lasting 4–8 weeks and involving behavioral and pharmacological support, improve abstinence rates and reduce postoperative complications, with greater benefits seen with longer cessation. However, further large-scale studies with standardized methods and long-term follow-up are needed to determine optimal intervention timing and long-term outcomes. Keywords: Smoking cessation, Alcohol cessation, Awareness and practices, surgery, Preoperative care, post operative outcomes.

Background: Melasma is a chronic facial hyperpigmentation disorder commonly affecting women of reproductive age, driven by ultraviolet and visible light exposure, hormonal factors, and dermal changes, with frequent recurrence. Although hydroquinone-based triple combination therapy remains first-line treatment, lasers and intense pulsed light (IPL) are increasingly used. This systematic review evaluates the efficacy and safety of laser and light-based therapies for melasma. The objective is to determine the most effective and safest laser modalities, compare outcomes across technologies and protocols, and identify research gaps to inform future studies and guide evidence-based clinical decision-making in melasma management. Materials and Methods: This systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched using predefined keywords related to melasma and laser/light-based therapies. Randomized controlled trials and observational studies, review articles, meta-analysis were included. Two reviewers independently screened studies and extracted data. Owing to heterogeneity, results were synthesized qualitatively. Results: Laser and light-based therapies demonstrated variable efficacy in melasma management. Q-switched Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) showed temporary improvement but was associated with recurrence and pigmentary adverse effects. Fractional lasers and IPL provided moderate benefit, with combination IPL therapies enhancing outcomes. Picosecond lasers, particularly with diffractive lens arrays, showed superior efficacy, better patient satisfaction, and favorable safety profiles. Combination approaches improved long-term outcomes but increased the risk of mild adverse events. Conclusion: Picosecond lasers and combination-based strategies appear to offer the most promising balance of efficacy and safety. However, recurrence and procedure-related pigmentary changes remain concerns, highlighting the need for standardized protocols and larger controlled trials to optimize long-term melasma management. Keywords: Melasma, Laser therapy, Picosecond laser, Q-switched Nd:YAG, Fractional laser, Ablative laser, Non-ablative laser, Intense pulsed light (IPL), Combination therapy.

Background: Community-acquired pneumonia (CAP) is still one of the most prevalent reasons for kids to go to the hospital. The clinical manifestation of juvenile community-acquired pneumonia seems to be altering due to extensive immunization, enhanced nutrition, and shifting respiratory pathogen patterns. Classical symptoms like high fever and chest indrawing may not be as common now. Instead, more cases are being recorded with wheezing and viral-like symptoms. The objectives is to assess the present clinical symptomatology, severity indicators, and outcomes of community-acquired pneumonia in children admitted during a recent one-year timeframe. Materials and Methods: This retrospective observational study encompassed 100 children aged 1 month to 12 years, admitted with CAP from February 2025 to January 2026 at a tertiary care hospital. We looked at demographic information, symptoms, clinical indicators, oxygen saturation, laboratory results, radiographic findings, treatment, and outcomes. Results: Fever (93%) and cough (92%) were the most common symptoms that people had. 76% of the cases had tachypnea, although only twenty-four percent had chest indrawing. Wheezing was observed in 27% of children, suggesting an increasing wheeze-associated pneumonia phenotype. In 29% of cases, hypoxia (SpO₂ <92%) happened. 12% of patients had complicated pneumonia, and nine percent needed intensive care. Viral or unusual causes were suspected in over half of the cases based on clinical characteristics and lab results. Conclusion: The clinical manifestation of pediatric CAP is evolving towards diminished classical bacterial characteristics and an increased prevalence of wheeze-dominant and viral-like symptoms. These findings underscore the necessity to modify diagnostic and therapeutic strategies to align with current disease trends, thereby preventing overtreatment while facilitating the prompt recognition of severe cases. Keywords: Community-acquired pneumonia; pediatric population; clinical manifestations; wheezing; hypoxia; pediatric respiratory diseases.

Background: Various methods of femoral graft fixation are available, among which cortical loop fixation devices are most commonly used. This study aims to compare fixed loop and adjustable loop devices in terms of clinical outcomes. Materials and Methods: In this prospective randomized study, patients were divided into two groups based on the type of femoral fixation device used. Clinical outcomes were assessed at 6 months and 1 year using the International Knee Documentation Committee (IKDC) and Lysholm scores. Results: Both groups were comparable in terms of demographic characteristics and preoperative scores. Postoperatively, no statistically significant difference was observed between the two groups at 6 months or at 1 year. Conclusion: Arthroscopic ACL reconstruction yields comparable short-term clinical outcomes when either fixed loop or adjustable loop devices are used for femoral cortical fixation. Keywords: Fixed loop device, Adjustable loop device, Arthroscopic anterior cruciate ligament reconstruction.

Background: Blunt abdominal trauma frequently results in solid organ injury with hemoperitoneum. In hemodynamically stable patients, non-operative management has increasingly become the preferred approach. This study aimed to evaluate the outcomes of conservative management and assess the utility of the Clinical Abdominal Scoring System (CASS) in such cases. Materials and Methods: A retrospective observational study was conducted at a tertiary care centre in South Gujarat from 2024 to 2026. A total of 50 hemodynamically stable patients with radiologically confirmed solid organ injury and hemoperitoneum were included. Data regarding demographics, mode of injury, clinical presentation, vital parameters, organ involvement, and CASS were collected from medical records and analyzed using descriptive statistics. Results: Among the 50 patients, 86% were males. The most affected age group was 18–25 years (36%). Road traffic accidents were the leading cause (60%). Most patients (68%) presented within 2 hours of injury. Abdominal pain was present in all cases, while vomiting and loss of consciousness were noted in 18% and 12%, respectively. The majority had pulse rate <90/min (70%) and systolic blood pressure between 90–120 mmHg (80%). Liver was the most commonly injured organ (62%), followed by spleen (26%), kidney (8%), and combined injuries (4%). Most patients had CASS scores between 8–12 (56%), while 44% had scores <8. All patients were managed conservatively with no requirement for operative intervention. Conclusion: Conservative management is highly effective in hemodynamically stable patients with solid organ injury. CASS is a valuable tool for clinical assessment and management planning. Keywords: Blunt abdominal trauma, hemoperitoneum, conservative management, solid organ injury, clinical abdominal scoring system.

Background: Skin and soft tissue infections (SSTIs) are a major clinical burden, with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) increasingly implicated. These strains often combine resistance determinants with virulence factors such as Panton-Valentine leukocidin (PVL), complicating management. The aim is to investigate the clinical profile, microbiological spectrum, genotypic characteristics, and antibiotic resistance patterns of CA-SSTIs, with emphasis on CA-MRSA. Materials and Methods: A prospective cross-sectional study was conducted on 350 clinically diagnosed CA-SSTI cases over two years. Samples were processed for culture, phenotypic identification, antibiotic susceptibility testing, and PCR-based genotypic analysis. Results: The mean patient age was 37.9 years, with a slight male predominance (56%). Abscesses (46%) and cellulitis (34%) were the most common presentations. Culture positivity was 61%, with S. aureus as the predominant isolate (43%). MRSA accounted for 16% of cases. Genotypic analysis revealed mecA positivity in 86% and PVL gene presence in 79% of MRSA isolates. Antibiogram showed high resistance to ciprofloxacin (59%), gentamicin (59%), and erythromycin (53%), moderate resistance to clindamycin (33%) and tetracycline (34%), while all isolates remained sensitive to linezolid and vancomycin. Conclusion: CA-MRSA strains in this cohort demonstrated both multidrug resistance and high PVL prevalence, underscoring their dual threat of resistance and virulence. Linezolid and vancomycin remain reliable therapeutic options, while clindamycin may retain partial utility. Continuous molecular surveillance and antibiotic stewardship are essential to guide rational therapy and curb the spread of resistant, virulent clones. Keywords: Community-acquired SSTIs, MRSA.

Background: Chikungunya virus infection continues to pose a significant public health challenge in India, with recurrent outbreaks and marked seasonal variation. District-level laboratory surveillance is essential to understand local transmission dynamics and to guide targeted vector control measures. The objective is to describe the demographic, temporal and spatial distribution of laboratory-confirmed chikungunya cases in Gondia district, Maharashtra, during 2024–2025 and to compare the month-wise trend with dengue during the same period. Materials and Methods: This study was conducted at the Department of Microbiology, Government Medical College, Gondia, which serves as a sentinel centre for vector born disease surveillance. Serum samples received from clinically suspected chikungunya cases during January 2024 to December 2025 were tested for chikungunya IgM-capture ELISA. Data on age, sex, month of reporting and taluka of residence were analysed. Descriptive statistics were used to assess trends and distribution patterns. Results: A total of 6,507 samples were tested using IgM ELISA during the study period, of which 181 were laboratory confirmed for chikungunya virus infection, giving an overall positivity of 2.8%. The positivity rate was higher in 2024 as compared to 2025. Males constituted 52% of cases, while females accounted for 48%, indicating near equal sex distribution. The majority of infections were observed among adults, particularly in the 21-30-year age group followed by 31-40. Month-wise analysis demonstrated distinct seasonal peaks, with a major increase during the monsoon and post-monsoon period and a smaller rise during early months of the year. Spatial analysis revealed marked clustering of cases in Gondia taluka (98 cases, 54.1%), followed by Sadak Arjuni, Goregaon and Amgaon, while comparatively fewer cases were reported from peripheral talukas. Conclusion: The present laboratory-based surveillance highlights clear spatio-temporal clustering and predominance of chikungunya infection among the adult population in Gondia district, with transmission peaks corresponding to favourable vector breeding seasons. Concentration of cases in specific talukas underscores the need for focused vector control and strengthened surveillance at sub-district level. Continuous laboratory surveillance remains crucial for early detection of transmission trends and for guiding district-specific public health interventions. Keywords: Chikungunya, surveillance, seasonality, Maharashtra, dengue.

Background: Mastectomy is a commonly performed surgical procedure for the treatment of breast cancer. Although it is effective in controlling the disease, many patients experience postoperative complications such as post-mastectomy pain syndrome and phantom breast syndrome. These conditions may lead to persistent pain, discomfort, and psychological distress, thereby affecting the overall quality of life of patients. The aim is to determine the incidence of post-mastectomy pain and phantom breast syndrome in patients undergoing mastectomy for carcinoma breast. Materials and Methods: This observational study was conducted in the Department of General Surgery for a period of 2 years. A total of 100 patients who underwent mastectomy were included in the study. Patients above 35 years of age who underwent simple mastectomy or modified radical mastectomy were enrolled after obtaining informed consent. Patients were evaluated during follow-up visits approximately 8 to 12 weeks after surgery. A detailed clinical examination and a standardized questionnaire were used to assess the presence of postoperative pain and phantom breast symptoms. Data were entered in Microsoft Excel and analyzed using Epi Info and SPSS software. Results: Among the 100 patients studied, 67% underwent modified radical mastectomy and 33% underwent simple mastectomy. Post-mastectomy chest wall pain was observed in 21% of patients, while 11% experienced arm pain. Phantom breast pain was reported in 4% of patients, and phantom breast sensations were observed in 6% of patients. Most patients (66%) did not report any significant psychological impact following surgery. Conclusion: Post-mastectomy pain and phantom breast syndrome remain important postoperative complications, particularly following modified radical mastectomy. Early recognition, appropriate patient counseling, and improved surgical techniques may help reduce these complications and improve postoperative quality of life. Keywords: Breast cancer, Mastectomy, Post-mastectomy pain syndrome, Phantom breast pain, Phantom breast sensation.

Background: Vaccine hesitancy has emerged as a major public health concern, even in urban populations with better access to healthcare services. It is influenced by multiple sociodemographic and behavioral factors, affecting vaccine uptake and the success of immunization programs. This study aimed to assess the prevalence and determinants of vaccine hesitancy among adults in an urban population. Materials and Methods: A community-based cross-sectional study was conducted among 351 adults in the urban field practice area of a tertiary care center in Kalyani, West Bengal. Participants were selected using multistage sampling. Data were collected using a pretested semi-structured questionnaire. Vaccine hesitancy was assessed based on the WHO SAGE framework. Statistical analysis included descriptive statistics, Chi-square test, and logistic regression. Results: The prevalence of vaccine hesitancy was 28.8%. Higher hesitancy was observed among younger adults, males, individuals with lower education, and those from lower socioeconomic status. Fear of side effects (57.4%), social media misinformation (46.5%), and doubts about vaccine efficacy (40.6%) were the most common reasons. Multivariate analysis revealed that primary education (AOR = 2.48) and lower socioeconomic status (AOR = 2.31) were significant independent predictors of vaccine hesitancy. Conclusion: Vaccine hesitancy remains a significant challenge in urban populations, driven by educational, socioeconomic, and informational factors. Targeted health education, improved communication strategies, and efforts to counter misinformation are essential to enhance vaccine acceptance and strengthen immunization programs. Keywords: Vaccine hesitancy; Socioeconomic factors; Health education; Immunization.

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy, leading to significant maternal and fetal morbidity. Early detection and intervention can substantially reduce adverse outcomes. Uric acid, a final product of purine metabolism, has been associated with insulin resistance, endothelial dysfunction, and oxidative stress. The present study was undertaken to evaluate whether elevated first-trimester serum uric-acid levels could serve as an early biochemical marker for predicting GDM. Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, St. Peter’s Medical College, Hospital and Research Institute, Krishnagiri, over a period from March 2025 to February 2026. A total of 150 antenatal women with gestational age < 14 weeks were enrolled. Serum uric-acid levels and fasting blood sugar were estimated at recruitment. Women were later screened for GDM between 24–28 weeks using a 75-gram oral glucose-tolerance test (OGTT) according to IADPSG/DIPSI criteria. Statistical analysis was performed using SPSS (version __). ROC-curve analysis was used to determine the optimal uric-acid cut-off for predicting GDM. Results: The mean age of participants was 23.8 ± 2.4 years, and the mean BMI was 22.0 ± 2.2 kg/m². The incidence of GDM was 14 % (21 of 150). Women with serum uric acid > 3.6 mg/dL in the first trimester had a significantly higher risk of developing GDM (P < 0.01). ROC analysis showed an AUC = 0.90 (SE = 0.05) with 91 % sensitivity and 98 % specificity, indicating excellent predictive performance. Serum uric acid correlated positively with GDM (r = 0.42, P < 0.01) and was independent of BMI and parity. Conclusion: An elevated first-trimester serum uric-acid level (> 3.6 mg/dL) is a strong and independent predictor of subsequent GDM. Because uric-acid testing is inexpensive, simple, and widely available, it may be incorporated as an early screening tool in antenatal care to identify high-risk women well before routine glucose testing. Larger multicentric studies are recommended to validate its predictive accuracy and integrate it into early pregnancy screening protocols. Keywords: Gestational diabetes mellitus, uric acid, first trimester, insulin resistance, early prediction.

Background: Ductal carcinoma in situ (DCIS) frequently coexists with infiltrating duct carcinoma (IDC) of the breast and represents the non-invasive precursor component within the spectrum of breast carcinogenesis. Evaluating the histomorphological patterns of DCIS occurring alongside IDC provides important insights into tumor biology, aggressiveness, and potential prognostic implications. The aim is to study the histomorphological patterns of DCIS associated with IDC. Materials and Methods: Cross-sectional, descriptive study done in the department of Pathology, SVS Medical college, Mahbubnagar for duration of one-year ie from September 2024- september 2025. Results: DCIS was identified in the majority of IDC cases, with solid being the most common architectural pattern, followed by comedo and cribriform patterns. Mixed patterns were frequent, accounting for a substantial proportion of cases where more than one subtype of DCIS coexisted. High-grade DCIS showed a strong association with comedo necrosis and was more commonly present in tumors of higher histological grade. Cases with comedo or mixed architectural patterns demonstrated increased frequency of necrosis and a higher likelihood of lymphovascular invasion in the invasive component. No significant difference was observed in age distribution or tumor size in relation to DCIS subtype. Conclusion: DCIS accompanying IDC displays diverse architectural patterns, with solid and comedo types being most prevalent. High-grade nuclear features and comedo necrosis are more frequently associated with aggressive invasive carcinoma characteristics. Understanding the histomorphological spectrum of DCIS in association with IDC is essential, as it may provide prognostic information and help refine therapeutic decision-making. Keywords: Ductal carcinoma in situ (DCIS), Infiltrating duct carcinoma (IDC).

Background: The aim is to study dry eye in cases of unilateral pterygium. The objective is to study the incidence of dry eye among the patients of unilateral pterygium. To find the clinical correlation between dry eye and unilateral pterygium. Results: This study demonstrates a significant association between pterygium and dry eye disease, as evidenced by measurable impairments in tear film stability and production. Using objective clinical parameters—Tear Break-Up Time (TBUT), Tear Meniscus Height (TMH), and Schirmer’s Tests I and II—we found that patients with pterygium consistently exhibited reduced values across all indicators when compared to controls. Among these, TBUT showed the strongest correlation with both the presence and severity of pterygium, underscoring the progressive nature of tear film instability as pterygium advances in grade.While TMH and Schirmer’s test values were also significantly lower in pterygium patients, their association with pterygium severity was less pronounced, likely due to sample size limitations and variability in tear secretion patterns. Nevertheless, these findings align with existing literature suggesting that pterygium contributes to both aqueous tear deficiency and tear film instability—key factors in the pathogenesis of dry eye disease. Conclusion: The present study highlights the clinical importance of routine screening for dry eye symptoms in patients with pterygium, particularly in moderate to severe cases. Early identification and management of tear film dysfunctionmay alleviate symptoms, enhance visual quality, and potentially reduce postoperative recurrence following pterygium excision. Future studies with larger cohorts and standardized diagnostic criteria are recommended to further validate and refine the association between pterygium and dry eye disease. Keywords: Pterygium, Dry eye, TBUT, TMH, Schirmer’s test.

Background: Severe Acute Malnutrition (SAM) remains a major public health problem among under-five children in developing countries. Inappropriate child feeding practices play a crucial role in the development of malnutrition during early childhood. The aim is to identify and evaluate child feeding practices associated with Severe Acute Malnutrition among children under five years of age. Materials and Methods: This was a hospital-based case-control study conducted at the Nutritional Rehabilitation Centre of Pandit Deendayal Upadhyay Hospital, Pandeypur, Varanasi. The study was carried out over a period of 8 Months May 2025 to December 2025, at Pundit Deendayal Upadhyay Hospital, Varanasi. Results: Analysis of breastfeeding practices among the study participants revealed significant differences between cases and controls. Among the 50 cases with Severe Acute Malnutrition (SAM), only 20 (40%) children received early initiation of breastfeeding within one hour of birth, compared to 40 (80%) of the 50 controls (p<0.001), Exclusive breastfeeding for the first six months was observed in 18 (36%) cases and 35 (70%) controls (p<0.001), showing a significant protective effect of exclusive breastfeeding. Partial breastfeeding was more common among cases, reported in 25 (50%) children versus 12 (24%) controls (p=0.001). Children who were not breastfed at all included 7 (14%) cases and 3 (6%) controls, but this difference was not statistically significant (p=0.18). Conclusion: Suboptimal child feeding practices are major determinants of Severe Acute Malnutrition. Strengthening awareness and education regarding appropriate infant and young child feeding practices is essential to reduce the burden of malnutrition among under-five children. Keywords: Severe Acute Malnutrition, Under-five Children, Child Feeding Practices, Case-Control Study, Breastfeeding, Complementary Feeding, Dietary Diversity, Public Health.

Background: Ultrasound (USG)-guided interventions have revolutionized minimally invasive diagnostic and therapeutic procedures by enabling real-time visualization, improving accuracy, and reducing complication rates. USG guidance improves overall clinical results, diagnostic yield, and procedural safety as compared to blind procedures. The purpose of this study was to assess the complication profile, technical success, clinical range, and diagnostic sufficiency of USG-guided treatments carried out in a tertiary care hospital. Materials and Methods: This retrospective observational study was conducted in the Department of Radiology at MGM Medical College, Chhatrapati Sambhajinagar, Maharashtra, over a one-month period (01 July 2025 to 31 July 2025). Included were 122 patients who had different diagnostic and therapeutic treatments guided by USG. Hospital records were used to gather information on demographics, procedure type, technical success, diagnostic yield, and complications. Results were evaluated in terms of complication rates, diagnostic sample adequacy, and procedure success. Results: Among 122 patients, 55.7% were males and 44.3% were females, with an age range of 1–82 years. Pleural tapping was the most commonly performed procedure (32.8%), followed by thyroid FNAC (13.9%), breast biopsy (9.8%), and lymph node FNAC (9.0%). Technical success was achieved in 99.2% of cases, with a diagnostic yield of 95.1%. No complications were observed in 93.5% of patients. Minor complications occurred in 6.5% of cases, predominantly localized pain (62.5%) and minor bleeding (37.5%). No major complications or mortality were reported. Conclusion: High technical success, superior diagnostic reliability, and low complication rates are all demonstrated by USG-guided procedures. According to these results, they are safe, efficient, and considered standard practices in tertiary healthcare settings. Keywords: Ultrasound-guided interventions, Minimally invasive procedures, Diagnostic yield, Technical success rate, Complication profile.

Background: Neglected Achilles tendon ruptures, defined as untreated for over 3 weeks, lead to tendon retraction, muscle atrophy, and functional deficits like weak plantar flexion and gait instability. Surgical reconstruction via tendon transfers—flexor hallucis longus (FHL) or peroneus brevis (PB)—is standard when primary repair fails, but comparative outcomes remain underexplored. Materials and Methods: This prospective comparative study at a tertiary orthopedic department included 25 patients (13 FHL in Group A, 12 PB in Group B; aged 30-60 years) with chronic closed ruptures. FHL followed modified Wapner technique; PB used standard posterior/lateral harvest. Postoperatively, patients received equinus casting for 6 weeks, then progressive weight-bearing and physiotherapy. Outcomes at 6 months used Quigley scale, Leppilahti score, and AOFAS hindfoot-ankle score; complications were recorded. Results: Groups were balanced in age, sex, and injury-to-surgery time (3-5 weeks: 12 total; >5 weeks: 13 total). Group A excelled: Quigley excellent (6 vs 2), Leppilahti 91-100 (8 vs 2), AOFAS 91-100 (6 vs 2); all had good/excellent results vs 11/12 in B. Complications favored A: superficial infections (2 vs 4), no neurological issues (vs 3 in B); no reruptures. Conclusion: FHL transfer provides superior functional scores and fewer complications than PB for neglected Achilles ruptures, positioning it as the preferred option. Keywords: Achilles tendon rupture, flexor hallucis longus transfer, peroneus brevis transfer, tendon reconstruction, Quigley scale, AOFAS score.

Background: Heart failure (HF) is associated with high morbidity and mortality and is often accompanied by endocrine abnormalities, including thyroid dysfunction. Low T3 syndrome (LT3S), defined by reduced free triiodothyronine (FT3) with normal thyroid stimulating hormone (TSH) and free thyroxine (FT4), has been linked to adverse outcomes in HF. This study aimed to determine the prevalence of low T3 syndrome in patients with heart failure with reduced ejection fraction (HFrEF) and its association with clinical outcomes. Materials and Methods: This prospective observational study was conducted at Northern Railway Central Hospital, New Delhi over 18 months from July 2023 to December 2024. A total of 200 patients with HFrEF (LVEF <40%) were enrolled. Baseline clinical evaluation, thyroid function tests, and echocardiography were performed. Patients were categorized into low T3 syndrome and normal T3 groups and followed for six months to assess mortality, hospitalization, and major adverse cardiovascular events (MACE). Results: The mean age was 64.95 ± 12.99 years and 57.5% were males. Low T3 syndrome was observed in 40% of patients. Mortality at six months was significantly higher in the low T3 group compared to the normal T3 group (52.5% vs 16.67%, p<0.05). Hospitalization rates were also higher in the low T3 group (71.25% vs 49.17%, p<0.05). However, no significant association was found between low T3 syndrome and individual cardiovascular events. Conclusion: Low T3 syndrome is common in patients with HFrEF and is associated with increased mortality and hospitalization. Assessment of thyroid function may help identify high-risk patients. Keywords: Heart failure, Low T3 syndrome, HFrEF, Thyroid dysfunction, Mortality.

Background: Aim: To compare the occurrence of incisional hernia in emergency and elective surgeries in Shadan Institute of Medical Sciences. Objective: 1) To compare the incidence of incisional hernia in emergency and elective surgeries. 2) To analyse the factors contributing for the development of Incisional hernia in the patients who have undergone elective and emergency surgeries in Shadan Institute of Medical sciences. Materials and Methods: It was a case-control study conducted at Department of General Surgery, Shadan institute of medical sciences, Peerancheru, Hyderabad. Patients admitted in surgical wards of Shadan institute of Medical Sciences with incisional hernia with primary surgery done within 5 years and those who have undergone emergency and elective surgeries 5 years back. Results: In the present study, incisional hernia is more common after emergency surgeries as compared to elective surgeries. The significance of age as a risk factor for Incisional Hernia cannot be determined in the present study. Further study with greater sample size of effected as well as controlled groups is required to establish a causal relation. Incisional hernia is more common in males as compared to females, but male sex is not a risk factor for development of incisional hernia. Post-operative wound infections, diabetes mellitus, smoking, BMI>25, COPD can be considered as risk factors in development of incisional hernia. Conclusion: The present study concluded that Incidence of incisional hernia can be decreased by following proper suturing techniques, using appropriate suture material, observing sterile methods preoperatively and by achieving optimum glycaemic control. Keywords: Incisional Hernia, BMI, COPD, Glycemic control, Smoking.

Background: Placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with abnormal placental invasion and rising caesarean section rates. Early diagnosis is essential for optimal management. This study evaluated the diagnostic performance of ultrasonography (USG) and magnetic resonance imaging (MRI) in post-caesarean pregnancies. Materials and Methods: A cross-sectional study was conducted over two years at RIMS, Imphal, including 84 pregnant women with prior caesarean section. All underwent USG, and MRI was performed in suspected cases. Histopathology was the gold standard. Data were analyzed using SPSS with chi-square test, t-test, and ROC analysis. Results: Most participants were aged 18–27 years (54%) with a mean age of 33.23 ± 5.91 years. Higher gravidity and multiple LSCS were significantly associated with PAS (p < 0.05). MRI showed higher sensitivity (65.3%) and specificity (77.3%) compared to USG (55.2% and 63.6%). ROC analysis indicated moderate diagnostic accuracy (MRI AUC = 0.614; USG AUC = 0.682). Conclusion: USG and MRI are effective for PAS diagnosis, with MRI showing better diagnostic performance. Multiparity and prior LSCS significantly increase PAS risk, highlighting the need for early detection and multidisciplinary management. Keywords: Placenta accreta spectrum, ultrasonography, MRI, caesarean section, multiparity, diagnostic accuracy.

Background: Spinal anesthesia is widely used for lower abdominal and lower extremity surgeries due to its rapid onset, reliable sensory and motor blockade, and favorable safety profile. Newer local anesthetics such as levobupivacaine and ropivacaine are increasingly preferred because of their lower cardiotoxicity and neurotoxicity compared to bupivacaine. The addition of opioids like fentanyl as an adjuvant enhances the quality and duration of spinal anesthesia. Aim: To determine and compare the characteristics of subarachnoid block induced by hyperbaric levobupivacaine 0.5% with fentanyl and hyperbaric ropivacaine 0.75% with fentanyl in patients undergoing lower abdominal and lower extremity surgeries. Materials and Methods: This comparative study included 80 patients who were randomly divided into two groups of 40 each. Group L received intrathecal hyperbaric levobupivacaine 0.5% with fentanyl, while Group R received hyperbaric ropivacaine 0.75% with fentanyl. The onset and level of sensory blockade, duration of sensory and motor blockade, motor block intensity using the Modified Bromage Scale, duration of analgesia, hemodynamic parameters, and adverse effects were recorded and analyzed. Results: The mean age of patients was comparable between the groups (p = 0.63). Group L demonstrated significantly longer duration of sensory blockade (187 ± 16 min vs 134 ± 13.1 min, p < 0.001), longer motor block duration (145 ± 15.6 min vs 109 ± 9.44 min, p < 0.001), and prolonged analgesia compared to Group R. The onset of sensory block was faster in Group R (8.55 ± 2.80 min) than in Group L (10.7 ± 3.57 min, p = 0.004). Hemodynamic parameters were largely comparable between groups. Conclusion: Both drug combinations provided effective spinal anesthesia; however, levobupivacaine with fentanyl produced longer sensory and motor blockade, while ropivacaine with fentanyl allowed earlier recovery, making it suitable for shorter procedures. Keywords: Spinal anesthesia, Levobupivacaine, Ropivacaine, Fentanyl, Sensory blockade, Motor blockade.

Background: Termination of pregnancy in the second trimester is associated with increased maternal risks. The MTP act, 1971 (amended in 2020) defines the ideal place and person who can conduct MTP. The safest, lowcost method of inducing MTP is preferred. This study was conducted to evaluate the efficacy and outcome of 2 medical methods of MTP , i.e., use of Foley’s bulb and misoprostol versus misoprostol with mifepristone. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology, St. Peter’s Medical College, Hospital and Research Institute, Krishnagiri, over 12 months period. A total of 150 patients in their second trimester eligible for MTP were included in this study. Patients were divided into 2 groups of 75 members each. Group A was induced with Foley’s bulb and misoprostol and Group B was induced with mifepristone and misoprostol. Results: most of the patients belonged to 20-30 years of age group. 86% of the study population was parous. Majority of the study patients were married and belonged to lower socioeconomic class. Most of the patients were in 17-20 weeks of gestational age. Request for MTP was the most common indication. The number of requirement of misoprostol doses was significantly decreasing with increase in the parity. The induction to abortion time interval was lower for Group B. patients of Group B had 100% success rate with minimal complications. Conclusion: Although Foley’s bulb with misoprostol is of low cost, but when compared to efficacy, it is inferior to mifepristone with misoprostol. Keywords: Abortion, second trimester, Foley’s, misoprostol, mifepristone.

Background: Sepsis remains a leading cause of preventable mortality worldwide, particularly in resource-limited settings where delayed recognition and inconsistent adherence to evidence-based guidelines are common. The Surviving Sepsis Campaign recommends implementation of the Hour-1 Sepsis Bundle to improve outcomes. However, compliance remains suboptimal in many tertiary-care hospitals. Objective: To evaluate compliance with the Hour-1 Sepsis Bundle in suspected sepsis patients and to assess the impact of a simple Rapid Response Card intervention on improving bundle adherence. Materials and Methods: This prospective interventional study was conducted over two months (October–December 2025) in the Department of General Medicine and ICUs of a tertiary-care teaching hospital in Visakhapatnam. Ninety-two adult patients with newly diagnosed sepsis (46 pre-intervention and 46 post-intervention) were included. Baseline compliance with individual Hour-1 bundle components—blood cultures, intravenous (IV) antibiotics, IV fluids, and vasopressors (when indicated)—was recorded. Serum lactate measurement was excluded due to non-availability. During the intervention phase, a bedside Sepsis Rapid Response Card was introduced to prompt timely action. Compliance rates and patient outcomes were compared using the Chi-square test, with p < 0.05 considered statistically significant. Results: IV antibiotic compliance improved significantly from 34.8% pre-intervention to 84.8% post-intervention (χ²=21.88, p<0.001). Complete Hour-1 bundle compliance increased from 13% to 32.6% (χ²=3.95, p=0.047). Blood culture collection improved from 15.2% to 30.4%, and IV fluid administration increased from 63% to 73.9%, though these changes were not statistically significant. Mortality decreased from 21.7% in the pre-intervention group to 13% post-intervention, representing a clinically meaningful reduction. Discharge rates increased from 71.7% to 82.6%. Conclusion: Implementation of a low-cost bedside Rapid Response Card significantly improved compliance with key components of the Hour-1 Sepsis Bundle, particularly timely IV antibiotic administration and overall bundle completion. Although full compliance remains suboptimal, structured, simple quality-improvement interventions can enhance early sepsis management and potentially improve clinical outcomes in resource-constrained settings. Keywords: Sepsis, Hour-1 bundle, Rapid response intervention, Antibiotic compliance, Quality improvement, Tertiary care hospital.

Background: Coronary artery disease (CAD) remains one of the leading causes of morbidity and mortality worldwide. In patients with severe or advanced disease, coronary artery bypass grafting (CABG) is an established surgical procedure that helps restore adequate blood flow to the heart. Understanding the demographic characteristics and cardiovascular risk factor profile of patients undergoing CABG is important for improving clinical management and long-term outcomes. The objective is to evaluate the demographic profile, clinical parameters, and major cardiovascular risk factors among patients undergoing coronary artery bypass grafting. Materials and Methods: This observational descriptive study included 200 patients who underwent CABG at a tertiary care center. Data on demographic variables, clinical parameters, and comorbid conditions such as hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and heart failure were collected. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequency and percentage. Chi-square test, independent sample t-test and Pearson correlation were applied where appropriate, with a p-value <0.05 considered statistically significant. Results: The mean age of patients was 61.8 ± 10.7 years, and males constituted the majority of the study population (78%). Hypertension was the most common risk factor (55%), followed by diabetes mellitus (33.5%), hypercholesterolemia (24%), hypertriglyceridemia (21%), heart failure (18%), and chronic kidney disease (13.5%). A significant positive correlation was observed between age and systolic blood pressure (r = 0.28, p = 0.002) as well as between age and blood glucose levels (r = 0.21, p = 0.01). Conclusion: Patients undergoing CABG were predominantly older males with a high burden of cardiovascular risk factors, particularly hypertension and diabetes. Early identification and effective management of these modifiable risk factors may help reduce disease progression and improve clinical outcomes. Keywords: Coronary artery disease, Coronary artery bypass grafting, Cardiovascular risk factors, Hypertension, Diabetes mellitus, Dyslipidemia.

Background: Differentiating Alcoholic Steatohepatitis (ASH) from Non-Alcoholic Steatohepatitis (NASH) is challenging. This study evaluates the diagnostic utility of MRI, focusing on perivascular branching heterogeneity, in distinguishing ASH from NASH. Materials and Methods: This retrospective cohort study included 90 MRI exams from 60 NASH and 30 ASH patients, with both MRI and liver biopsy performed within 13 months. MRI findings were independently scored by two radiologists, and interclass correlation coefficients (ICC) and receiver operating characteristic (ROC) analysis were used to assess diagnostic accuracy. Results: The mean age of NASH and ASH patients was 60.5 ± 9.38 and 54.1 ± 11.48 years, respectively (p=0.012). Perivascular branching heterogeneity was observed in 63% of ASH patients and 30% of NASH patients (Reader 1). The ICC was 0.69 (0.46–0.82), and ROC analysis showed an area under the curve (AUC) of 0.69 for Reader 1 and 0.72 for Reader 2. The positive predictive value (PPV) for perivascular branching was 65% (Reader 1) and 67% (Reader 2). Conclusion: MRI, particularly perivascular branching heterogeneity, can aid in differentiating ASH from NASH. However, the moderate diagnostic accuracy suggests it should be used alongside clinical and biochemical data for more reliable diagnosis. Further studies with larger cohorts and advanced imaging are needed. Keywords: Steatohepatitis, Alcoholic Liver Disease, Non-Alcoholic Steatohepatitis (NASH), Liver Cirrhosis, Biochemical Profile, Clinical Profile.

Background: Dengue Fever is a rapidly spreading vector-borne illness in tropical and subtropical regions. Plasma leakage due to increased vascular permeability is a key feature of severe dengue and may lead to complications such as pleural effusion, ascites, and shock. Early identification of plasma leakage is essential for timely clinical management. Ultrasonography of the chest and abdomen has emerged as a useful non-invasive modality for detecting early radiological evidence of plasma leakage. The objective is to evaluate the radiological and laboratory correlation of plasma leakage in dengue infection using chest and abdominal ultrasonography. Materials and Methods: This hospital-based observational study included 100 patients with serologically confirmed dengue infection. Demographic details, clinical findings, and laboratory parameters such as platelet count and hematocrit levels were recorded. All patients underwent thoracoabdominal ultrasonography to detect radiological signs of plasma leakage, including pleural effusion, ascites, gallbladder wall thickening, and pericardial effusion. The ultrasonographic findings were correlated with laboratory parameters. Statistical analysis was performed using appropriate tests, and a p-value <0.05 was considered statistically significant. Results: The mean age of the patients was 34.6 ± 11.2 years, with a male predominance (58% males). Ultrasonographic findings suggestive of plasma leakage were observed in 54% of patients. The most common findings were gallbladder wall thickening (38%), followed by ascites (32%) and pleural effusion (28%). Patients with ultrasonographic evidence of plasma leakage had significantly lower platelet counts (58,300 ± 18,200 cells/mm³) and higher hematocrit levels (44.2 ± 4.9%) compared to those without plasma leakage (p < 0.001). Conclusion: Chest and abdominal ultrasonography is a valuable, non-invasive tool for the early detection of plasma leakage in dengue infection. When combined with laboratory parameters, it can help identify patients at risk of severe disease and support timely clinical management. Keywords: Dengue fever, Plasma leakage, Ultrasonography, Pleural effusion, Hematocrit.