Current Issue

Background: Hypertension is a leading non-communicable disease and a major contributor to cardiovascular morbidity and mortality globally. School teachers, as an occupational group, are uniquely exposed to high levels of psychological stress, sedentary work patterns, and inadequate health surveillance, rendering them particularly vulnerable. There is a paucity of data on the prevalence of hypertension and its associated sociodemographic determinants among school teachers in mid-sized urban centres like Prayagraj. The objective is to estimate the prevalence of hypertension and evaluate its association with sociodemographic variables among school teachers in urban Prayagraj. Materials and Methods: A community-based cross-sectional study was conducted among 320 school teachers (TGT and PGT) from government and private schools in urban Prayagraj, selected by multistage random sampling, over a 12-month period (February 2025–January 2026). Hypertension was diagnosed as SBP ≥140 mmHg and/or DBP ≥90 mmHg per JNC-7 criteria. Sociodemographic data were collected via semi-structured interview. Chi-square test and logistic regression were performed using SPSS version 20 (p<0.05 considered significant). Results: Of 320 participants (males 60.93%, mean age 40–49 years), 31.56% were hypertensive and 5.93% were prehypertensive. Hypertension was significantly associated with marital status (χ²=20.38, p=0.0004); divorced/widowed teachers had the highest prevalence (64.52%). On logistic regression, divorced/widowed marital status was the only independent sociodemographic predictor (AOR=1.242; 95% CI: 1.001–1.512; p=0.027). Age, school type, religion, socioeconomic status, and sole-earner status showed no statistically significant association. Conclusion: Nearly one-third of school teachers in urban Prayagraj have hypertension, with divorced/widowed marital status as the sole independent sociodemographic determinant. Regular occupational screening, targeted health education, and workplace wellness programs are urgently warranted for this group. Keywords: Hypertension, School teachers, Prevalence, Sociodemographic factors, Urban Prayagraj, Occupational health.

Background: Rapid expansion of digital technology has significantly transformed the way adolescents access information, communicate, and engage with their social environment. Adolescents represent one of the most active user groups of smartphones, utilizing them for communication, entertainment, academic purposes and information seeking. With potential benefits, excessive smartphone use has been associated with negative physical and psychological outcomes, including sleep disturbances, anxiety, depression, and reduced academic performance. Aim: To estimate the prevalence of smart phone usage and utilization of smartphone in seeking health related information among rural adolescent students. Materials and Methods: We adopted a cross-sectional study design with systematic random sampling technique to select 200 students aged in between 13 to 19 years. After obtaining written informed consent, we collected socio-demographic data, smartphone usage pattern and its purpose, source of health-related information was assessed using a self-directed questionnaire. Results: Out of 200 students enrolled, 151 (75.60%) of them had access to smartphones out of which 47% of them had their own smartphones and 14% of them were using smartphones for more than 3 hours per day. It was seen that YouTube and social media network such as Facebook/Instagram were the major source for health-related information students were using. Conclusion: Smartphone usage among rural students is widely increasing and source of health-related information varies widely. Matter of concern is that the source of health-related information accessed stands unscrutinised with questionable authenticity. Keywords: Smart phone, adolescents, health information, students.

Background: Biomedical waste poses direct risks to patient safety, healthcare workers, and the environment. While the Bio-Medical Waste Management Rules 2016 strengthened regulations in India, compliance gaps remain. Accreditation is promoted as a quality driver, yet evidence on its impact on waste management and environmental safety is limited. The aim is to assess how accreditation-driven quality assurance systems influence biomedical waste management practices, occupational safety, and regulatory compliance in a tertiary care hospital. The objective is to assess compliance with biomedical waste segregation practices at the point of waste generation and adherence to color coded BMW protocols. To assess staff training coverage and competency in biomedical waste management practice. To evaluate the effectiveness of internal audits and the implementation of corrective and preventive actions. Material and Methods: A hospital-based cross-sectional study was conducted over six months in a 500-bed accredited teaching hospital. We included 325 healthcare workers involved in waste handling. Compliance with segregation, color-coding, training, PPE use, waste generation, and regulatory standards was measured through direct observation, audits, and record review. Chi-square tests compared observed rates with 90% benchmark standards. Results: Among the 325 Healthcare workers, 319 (98.15%) Healthcare workers were covered in the training and 297 (91.38%) were covered in refresher training. Segregation compliance was observed in 313 (96.30%), color-coding in 308 (94.76%), and bin labelling in 304 (93.53%). PPE compliance was observed in 303 (93.23%) and Hepatitis-B vaccination in 310 (95.4%). Mean waste generation was 1.82 kg/bed/day. Collection within 24 hours occurred for 317 (97.5%) of waste and disposal within 48 hours for 100%. Needle-stick injuries were low at 2.1 per 100 workers/year with 100% investigation. SOP compliance was 95.2% and regulatory compliance 97.3%. All indicators significantly exceeded benchmark levels and were higher than previously reported studies. Conclusion: Accreditation-driven quality systems were associated with high compliance across biomedical waste management domains. Strong training, audit, and safety practices likely underpin these outcomes. The findings support integrating structured quality assurance into routine waste management to improve environmental safety and regulatory adherence. Keywords: Biomedical Waste Management, Medical Waste Disposal, Healthcare Waste Management, Hospital Accreditation, Quality Assurance, and Health Care.

Background: Liquid-Based Cytology (LBC) has increasingly been adopted in cervical cancer screening due to its improved sample adequacy and cleaner and more clear background compared to Conventional Smears (CS). Objectives: (1) To compare the adequacy of epithelial cell component in CS versus in LBC. (2) To evaluate the clarity of the background in CS versus LBC (3) To evaluate epithelial abnormalities detected on CS and LBC prepared from split cytobrush samples. Materials and Methods: A prospective study was conducted over one year at a teaching hospital, analysing 102 cervical cytobrush samples split for CS and LBC preparation. Five blinded pathologists reported each smear. Categorical variables were compared using Chi-square test; p < 0.05 was considered statistically significant. Results: Adequate cellularity was significantly higher in LBC (97%) than CS (85%) (p = 0.003). LBC produced significantly reduced inflammatory backgrounds (p < 0.0001), less haemorrhage, debris (scoring Likert scale). Percentage of cases with diagnostic architectural/morphological changes was found to be higher in LBC (96%) compared to CS (79%) (p = 0.0003). LBC yielded fewer unsatisfactory samples (2%) than CS (15%), and a higher proportion of NILM diagnoses (p = 0.0023). Conclusion: LBC is significantly superior to CS in terms of adequacy, background clarity, and detection of diagnostic morphological changes. Adoption of LBC can reduce unsatisfactory rates and improve diagnostic accuracy by reducing misinterpretation of artefactual changes in cervical cancer screening and in turn reducing the need for a repeat smears. Keywords: Liquid-based cytology, Conventional smear, Cervical cytology, Cytobrush, Diagnostic accuracy.

Background: One dangerous consequence of diabetes mellitus is diabetic foot ulcers (DFUs), which can lead to prolonged hospital admissions, infections, and even amputations. Topical insulin has emerged as a viable treatment for enhancing wound healing due to its angiogenic and proliferative properties. The aim is to evaluate the effectiveness of topical insulin dressings against conventional normal saline dressings in promoting wound healing in people with persistent diabetic ulcers. Materials and Methods: Fifty diabetic patients with chronic foot ulcers were enrolled at the Department of Surgery, Mahatma Gandhi Memorial Government Hospital, Trichy. Patients were randomly assigned to two equal groups: Group A received topical insulin dressings, while Group B received conventional normal saline dressings. Participants were followed for 21 days, with assessments on wound size reduction, granulation tissue formation, slough disappearance, and microbiological findings. Results: Significant improvements were observed in Group A in terms of earlier granulation tissue appearance, faster slough disappearance, and greater reduction in wound area by Day 21 (p < 0.05). The pus culture findings also showed a higher rate of sterile cultures in the insulin group, suggesting improved wound cleanliness. Conclusion: For diabetic foot ulcers, topical insulin dressing is a safe and efficient way to promote wound healing. It is advised that more multicentric studies be conducted to confirm these results. Keywords: Topical insulin, Diabetic foot ulcer, Wound healing, Granulation tissue, Normal saline dressing, Chronic wounds.

Background: The co-epidemic of Type 2 Diabetes Mellitus (T2DM) and pulmonary tuberculosis (PTB) constitutes a major public health challenge, particularly in low- and middle-income countries. Diabetes is recognised as a significant modifiable risk factor that adversely alters the clinical presentation, immune response, and treatment outcomes in PTB patients. The objective is to characterise the clinical and radiological profile of newly diagnosed PTB patients with T2DM, assess their glycaemic status at enrolment using fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c), and determine the impact of glycaemic control on treatment outcomes. Materials and Methods: A prospective, observational, hospital-based study conducted over 18 months at a tertiary care centre. Consecutive newly diagnosed PTB patients were enrolled and stratified into TB-DM (n=95) and TB-only (n=95) groups. Glycaemic status was assessed at baseline and at 2, 5, and 6 months. Primary outcomes included sputum conversion rates at 2 months, treatment success, failure, relapse, and mortality. Results: TB-DM patients exhibited higher symptom burden, lower BMI, and atypical radiological features including lower lobe involvement (58.9% vs 21.1%, p<0.001) and bilateral cavitary disease (44.2% vs 24.2%, p=0.006). Mean HbA1c at enrolment was 9.8 ± 2.1%. Sputum culture conversion at 2 months was significantly delayed in TB-DM (54.7% vs 78.9%, p<0.001). Poor glycaemic control (HbA1c ≥8%) was independently associated with treatment failure (OR 3.12, 95% CI 1.67–5.83), relapse (OR 2.94, 95% CI 1.41–6.13), and death (OR 2.17, 95% CI 1.03–4.57). Conclusion: T2DM significantly modifies the clinical and radiological phenotype of PTB and independently worsens treatment outcomes. Routine screening for diabetes in all newly diagnosed TB patients and integrated glycaemic management are essential for improving treatment success. Keywords: Pulmonary tuberculosis, Type 2 diabetes mellitus, HbA1c, glycaemic control, treatment outcomes, TB-DM comorbidity, sputum conversion.

Background: Despite advances in reperfusion and pharmacotherapy, patients with acute coronary syndrome (ACS) remain at substantial risk of recurrent major adverse cardiovascular events (MACE), and identifying readily available bedside predictors can refine risk stratification. The objective is to evaluate the clinical, laboratory, electrocardiographic, echocardiographic, and angiographic characteristics of patients with ACS and to identify independent predictors of MACE during 12 months of follow-up. Materials and Methods: In this single-centre, retrospective, observational cohort study, 412 consecutive patients admitted with ACS were analysed. MACE was defined as a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned revascularisation, and heart-failure hospitalisation. Univariable and multivariable logistic regression identified independent predictors; Kaplan-Meier analysis and the area under the ROC curve assessed the GRACE score. A P value below 0.05 was considered significant. Results: MACE occurred in 98 patients (23.8%). Independent predictors were advancing age (adjusted odds ratio [OR] 1.38 per decade), diabetes mellitus (OR 1.92), Killip class greater than one (OR 2.14), LVEF below 40% (OR 2.46), eGFR below 60 mL/min/1.73m² (OR 1.89), and a GRACE score above 140 (OR 2.27). The GRACE score discriminated MACE well (area under the curve 0.78). Conclusion: A small set of routinely recorded variables independently predicts 12-month MACE after ACS and can support pragmatic, resource-efficient risk stratification. Keywords: Acute Coronary Syndrome, Myocardial Infarction, Risk Factors, Prognosis, Heart Failure.

Background: Aim: Carbide gun-induced ocular trauma has emerged as a distinct and preventable pattern of thermochemical eye injury in India. The present review was prepared to synthesize the available evidence on epidemiology, mechanisms, clinical profile, management, outcomes, and prevention of carbide gun-related eye injuries, while comparing the present institutional dataset with the findings of the published studies. A secondary aim was to clarify whether our cases reflect the same trend described in recent Indian literature, namely unilateral severe injuries associated with direct inspection of a malfunctioning gun, limbal ischemia, corneal haze, epithelial defects, and persistent visual morbidity despite treatment. Materials and Methods: This systematic-style review was based on our center’s analysis, and compares it with a public health editorial on carbide gun-associated ocular injuries, one case-series report of five children and young adults from central India, one retrospective analysis of 28 eyes with calcium carbide-related thermochemical injury and one ophthalmic perspective article .The available studies were reviewed for patient demographics, setting of injury, mechanism, laterality, presenting visual acuity, ocular findings, acute management, surgical intervention, complications, and visual outcomes. Data from the spreadsheet were interpreted as an index institutional cohort and were compared descriptively with the supplied publications to identify shared patterns and important differences. Because the evidence base consisted mainly of case series, retrospective clinical data, and expert commentary, the review emphasizes qualitative synthesis and pragmatic clinical interpretation rather than pooled meta-analysis. Results: Across the attached literature, carbide gun injuries consistently affected predominantly young males and commonly occurred when the user peeped into a gun after delayed or failed ignition, leading to combined thermal and alkali damage from acetylene combustion and calcium hydroxide residue. The five-patient central India case series reported a mean age of 16.2 years, universal monocular involvement, and presenting vision ranging from 6/36 to no light perception. The larger retrospective series included 28 eyes of 23 patients with a mean age of 28.48 years; severe injuries carried significantly poorer presenting and final visual acuity, more limbal stem cell deficiency, and occasional phthisis bulbi. Our institutional spreadsheet similarly showed that most patients were male, many were from urban or semi-urban settings, and several had corneal haze, epithelial defects, limbal ischemia, retained particulate matter, or need for amniotic membrane grafting. Taken together, the evidence indicates that carbide gun trauma is not a trivial firecracker substitute but an evolving public health problem capable of causing long-term ocular surface failure and visual disability. Conclusion: The cumulative evidence supports classifying carbide gun-induced ocular trauma as an emerging, preventable cause of severe visual morbidity, particularly in resource-limited Indian settings where cheap devices, easy availability of calci

Background: Study of Electrocardiogram and Echocardiography parameters of post covid-19 patients. Materials and Methods: This was a Cross Sectional study carried out in Department of Cardiology. This study was conducted at the Department of Cardiology out-patient section in GGH, Ongole, Prakasam district, Andhra Pradesh, India. This study was approved by the Institutional Ethical Committee of the Rajiv Gandhi Institute of Medical and Sciences [RIMS], Ongole. This study was carried out for a period of 6 months. The total of 500 post Covid-19 patients. Both In and Out patients with >18 and <60 and who develop cardiovascular diseases in 6 months, 1 year, and 1 ½ - 2 years after corona virus exposure were included in this study who are infected with SARS-COV-2. Results: This study shows Predominance of Males over Females In our study 31-40 age group patients were commonly affected by Covid – 19. In this study we observed E.C.G and 2D ECHO parameters of Post Covid – 19 patients. Total 500 patients were evaluated. Among 302 people were found to be abnormal. The mean age of patients was 42.95±8.35 years. Tachycardia and Irregular Heart rhythm 88.56±23.0 were observed in our study. In current study we observed Short PR Interval, ST Segment Depression, Prolong R wave, Chamber Size, Sclerosis abnormalities were found. Patients who were affected with moderate- severe Covid-19 infection the presence of ST (or) T wave Inversion, Depression should be a concern for the occurrence of Cardiovascular disease in future. Patients with Severe Covid – 19 are at risk of Cardiac involvement in future. Periodic Cardiac assessment of these patients is essential. Conclusion: ECG and 2D ECHO Cardiography investigations are prerequisite in the evaluation of cardiovascular disease. Our Study have shown some significant findings from ECG and 2D ECHO Cardiogram hence our study concludes that ECG and 2D ECHO Cardiography must consider as a important diagnostic tools for evaluation of cardiovascular disease in Covid – 19 patientsegies. Keywords: COVID-19, ECG,2D ECHO Cardiography, ST Segment Depression, Prolong R wave.

Background: Acute Coronary Syndrome (ACS) in young adults is an emerging public health concern associated with significant morbidity and mortality. Traditional cardiovascular risk factors do not completely explain the occurrence and severity of coronary artery disease (CAD) in this population. Serum homocysteine has been identified as an independent risk factor for atherosclerosis and thrombotic cardiovascular events. The Gensini score is a validated angiographic scoring system used to quantify the severity of coronary artery disease. This study was undertaken to evaluate the correlation between serum homocysteine levels and Gensini score among young ACS patients admitted to a tertiary care hospital. The aim is to evaluate the correlation between serum homocysteine levels and the severity of coronary artery disease as assessed by the Gensini score in coronary angiography among young patients presenting with acute coronary syndrome. Materials and Methods: It was an observational cross-sectional correlation study. This study was conducted at the department of cardiology, In-patient section of tertiary care Government general hospital (GGH), Ongole, Prakasam dist, Andhra Pradesh. This study was submitted to the Institutional Ethics Committee (IEC), Government general hospital, ongole. Approval was obtained before initiation of the study. Written informed consents was obtained from all the participant’s.This study was carried out for a period of 6 months. Patients who are less than or equal to 45 years. Patients with confirmed diagnosis of acute coronary syndrome undergoing coronary angiography. Patient who accepted informed consent form. Results: The present study evaluated the relationship between serum homocysteine levels and the severity of coronary artery disease (CAD) among young patients diagnosed with acute coronary syndrome (ACS). The analysis of demographic, clinical, biochemical, and angiographic findings demonstrated several important observations regarding the role of homocysteine in cardiovascular disease among young individuals. The study also revealed a strong positive correlation analysis between serum homocysteine levels and the Gensini score, with a correlation coefficient of r = 0.79. This strong correlation indicates that higher homocysteine levels are closely associated with more severe coronary artery involvement as assessed by coronary angiography. These findings suggest that serum homocysteine may serve as a useful biochemical marker for assessing the severity of coronary artery disease in young patients with acute coronary syndrome. Conclusion: These results suggest that homocysteine may play an important role in the pathogenesis and progression of coronary artery disease. Serum homocysteine levels show a significant positive correlation with the Gensini score in young patients presenting with Acute Coronary Syndrome. Elevated homocysteine may serve as a useful biomarker for identifying patients at risk of severe coronary artery disease and may contribute to improved risk stratification and early intervention strategies. Keywords: Acute Coronary Syndrome, Coronary Artery Disease, Homocysteine, Gensini Score, Coron

Background: To study the relationship between lipoprotein(a) levels and severity of coronary artery disease in young patients with acute coronary syndrome at Tertiary Care Hospital. Materials and Methods: The present study was conducted as a cross-sectional observational study to evaluate the association between Lipoprotein(a) levels and the severity of coronary artery disease in young patients with acute coronary syndrome. The study was carried out in the Department of Cardiology, Government General Hospital (GGH), Ongole. The study protocol was submitted to the Institutional Ethics Committee (IEC), Government General Hospital, Ongole. Approval was obtained before initiation of the study. Written informed consent was obtained from all participants (English and Telugu formats). The study was conducted over a period of 6 months. Patients aged less than 45 years who were diagnosed with Acute Coronary Syndrome (ACS) and admitted to the cardiology department were included in the study. Results: The cross sectional study evaluated the relationship between Lipoprotein(a)[Lp(a)] levels and the severity of Coronary Artery Disease(CAD) in young patients presenting with Acute Coronary Syndrome(ACS). A total of 100 young ACS patients underwent clinical evaluation, measurement of Lp(a) levels, and coronary angiography. Disease severity was assessed using the SYNTAX score. Most patients were aged 36–40 years (33%), with a predominance of males (75%). Elevated Lp(a) levels (>30 mg/dL) were observed in 66% of patients, with a mean level of 52 mg/dL. Angiographic findings showed that single vessel disease was most common (58%), followed by double vessel disease (28%) and triple vessel disease (14%). The Left Anterior Descending (LAD) artery was the most frequently involved vessel. Based on SYNTAX scoring, 56% had low scores, 26% intermediate, and 18% high scores, with a mean score of 24. A significant positive correlation was found between Lp(a) levels and SYNTAX score (r = 0.68, p < 0.001), indicating increased CAD severity with higher Lp(a) levels. Conclusion: These findings suggest that elevated Lipoprotein(a) is an important independent risk factor for premature CAD and may serve as a useful biomarker for risk assessment in young ACS patients. Keywords: Acute coronary syndrome, CAD, Left Anterior Descending (LAD). Lipoprotein Lp(a), SYNTAX scoring.

Background: Medico-legal cases form an important component of emergency and trauma care. The medico-legal report has clinical and legal value, and incomplete documentation may affect investigation, judicial proceedings and patient rights. This study assessed the effect of integrating the speciality of Forensic Medicine on the quality of medico-legal documentation in an anonymised level 1 trauma centre. Materials and Methods: This before-and-after retrospective observational study was conducted at an anonymised level 1 trauma centre over a three-year period. The pre-integration period was from April 2022 to March 2023, and the post-integration period was from April 2023 to March 2025. A total of 3768 medico-legal case records were reviewed, comprising 840 cases in the pre-integration period and 2928 cases in the post-integration period. Demographic profile, nature of injury, dominant type of injury and predefined documentation errors were analysed using frequencies and percentages. Results: Males constituted 82.5% of medico-legal cases, while females constituted 17.5%. The commonest age group was 18–35 years, accounting for 64% of cases. Road traffic accidents were the most common cause of injury, accounting for 62.8% of cases, followed by falls at 12.6%. Blunt injury was the predominant type in 82.8% of cases. After the integration of the speciality of Forensic Medicine, the average monthly number of medico-legal cases increased from 70 cases/month in the pre-integration period to 122 cases/month in the post-integration period, representing a 1.75-fold increase. Missing date and time of examination decreased from 28.5% to 2.45%, improper documentation of mark of identification decreased from 65.7% to 14.75%, missing injury size decreased from 54.2% to 3.27%, missing injury site decreased from 38.5% to 2.45%, and missing age of injury decreased from 91.4% to 8.2%. Conclusion: Integration of the speciality of Forensic Medicine was associated with increased medico-legal case documentation and a reduction in major documentation errors. The findings suggest that structured involvement of Forensic Medicine may improve the completeness and quality of medico-legal documentation in tertiary trauma care settings. Keywords: Forensic Medicine; medico-legal case; medico-legal report; documentation errors; emergency department; trauma centre,

Background: Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumour that is most commonly found in the salivary glands but can also occur at extra-salivary locations. It can present clinically in many ways, leading to diagnostic difficulties despite the characteristic histopathological features. Case Presentation: This case series describes ACC of the nasal cavity, base of tongue, lung, and breast. The age of the patients ranged from 38 to 76 years. Clinical, radiological, histopathological and immunohistochemical data were analysed. All cases showed the typical tubular and cribriform patterns on histological examination, with pseudocystic areas containing hyaline basement membrane–like material. The nasal cavity lesion had invaded the perineurium, and the tongue lesion had invaded skeletal muscle. CD117 and p63 were consistently positive by immunohistochemistry. The pulmonary case was negative for Napsin A, confirming primary pulmonary ACC. The breast tumours were triple negative and showed the typical morphological characteristics of ACC. Conclusion: ACC is consistent in its histomorphological and immunohistochemical features across different anatomical locations. Its characteristic tubular and cribriform architecture is essential for accurate diagnosis, particularly at unusual sites, and is confirmed by CD117 and p63 immunostaining. Pathological examination and long-term follow-up are important because of the potential for local recurrence and delayed metastasis. Keywords: Adenoid cystic carcinoma; CD117; p63; immunohistochemistry; cribriform pattern.

Background: Proximal tibial plateau fractures are complex intra-articular injuries that affect the weight-bearing surface of the knee joint. These fractures commonly result from high-energy trauma in younger individuals and low-energy falls in elderly patients with osteoporosis. The management of tibial plateau fractures is challenging due to associated soft tissue injury, fracture comminution, and the need to restore joint congruity and stability. Hybrid external fixation has emerged as an effective treatment modality, particularly in fractures with severe soft tissue compromise, as it provides stable fixation while minimizing additional soft tissue damage. Aim of the study: This study aim is evaluate the function of hybrid external fixatorin treating high-energy tibia plateau fractures with minimal invasion and tissue damage. Objectives 1. To assess the performance of the Hybrid External Fixator in the treatment of tibial plateau fractures (Schatzker type V & VI). 2. To evaluate the functional outcome, soft tissue healing and fracture union and radiological outcome. 3. To evaluate the biomechanical and biological advantage of hybridexternal fixator. Materials and Methods: This a prospective study conducted from October 2019 to March 2021.Thirty patients with schatzker type-5 and type-6 with high energy tibial plateau fractures admitted in Narayana Medical College and Hospital,Nellore, were included in the study after their valid informed written consent. Approval of the Ethical Committee was obtained before the commencement of the study.Patients meeting the inclusion criteria were enrolled and followed up at regular intervals. Fractures were classified according to the Schatzker classification system. Clinical and radiological assessments were performed to evaluate fracture healing and alignment. Functional outcomes were assessed using the Rasmussen Functional Score and/or other validated knee scoring systems. Complications such as pin tract infection, malunion, nonunion, knee stiffness, and post-traumatic osteoarthritis were documented. Results: Hybrid external fixation provided satisfactory fracture stabilization and facilitated early mobilization in most patients. Fracture union was achieved in the majority of cases within an acceptable time frame. Functional assessment demonstrated good to excellent outcomes in a significant proportion of patients, with satisfactory knee range of motion and restoration of function. Complications were generally minor and manageable, with pin tract infection being the most commonly observed complication.. The difficulties are mainly related to sepsis, either superficial pin track infection or deep infection, preventable, treatable, and curable. We feel that the technique merits a place in the armamentarium for managing complex, high-energy tibial plateau fractures. Conclusion: Hybrid external fixation is an effective treatment option for proximal tibial plateau fractures, especially in cases associated with severe soft tissue injury. It provides stable fixation, promotes fracture healing, allows early knee mobilization, and yields favorable functional outcomes with a relatively low complication rate. Care

Background: Acute ischemic stroke is a major cause of mortality and long-term disability worldwide and accounts for the majority of cerebrovascular accidents. Early diagnosis and accurate characterization of ischemic lesions are essential for timely therapeutic intervention, prognostication, and prevention of neurological deterioration. Computed tomography (CT) and magnetic resonance imaging (MRI) are the principal imaging modalities used in the evaluation of ischemic stroke. While CT remains the first-line imaging technique because of its rapid availability and ability to exclude hemorrhage, MRI, particularly diffusion-weighted imaging (DWI), offers superior sensitivity in detecting acute ischemic changes. Correlation of lesion characteristics, vascular territory involvement, infarct severity, and infarct volume using these modalities can improve diagnostic accuracy and guide clinical decision-making. Aim: To evaluate the role of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in the assessment of ischemic stroke and to correlate lesion characteristics, vascular territory involvement, and infarct volume detected by the two imaging modalities. Objectives: To compare CT and MRI findings in ischemic stroke, assess lesion characteristics, determine vascular territory involvement, evaluate infarct severity using the Alberta Stroke Program Early CT Score (ASPECTS), measure infarct volume, correlate ASPECTS score with infarct volume, and determine the diagnostic value of combined CT and MRI evaluation. Materials and Methods: This hospital-based observational cross-sectional study included 132 consecutive patients with imaging-confirmed ischemic stroke who underwent both CT and MRI examinations. Lesion characteristics evaluated included side of involvement, lesion location, number of lesions, hemorrhagic transformation, contrast enhancement, gray-white matter differentiation loss on CT, and diffusion restriction on MRI. Vascular territory involvement was categorized as anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), vertebrobasilar, lacunar, or multiple territories. Infarct severity was assessed using ASPECTS, and infarct volume was measured by manual planimetric analysis and classified as small (<30 mL), moderate (30–70 mL), or large (>70 mL). Results: Left-sided infarcts were the most common (36.4%), followed by right-sided (32.6%) and bilateral lesions (31.1%). Cortical lesions accounted for 50.8% of cases, and single lesions were observed in 73.5% of patients. Haemorrhagic transformation and contrast enhancement were present in 36.4% and 46.2% of cases, respectively. Gray-white matter differentiation loss on CT was identified in 53.8% of patients, while diffusion restriction on MRI was detected in 66.7%. ACA territory infarction was the most frequent vascular distribution (22.0%), followed by MCA (19.7%) and PCA (18.9%) territories. Severe ASPECTS scores (0–4) were observed in 35.6% of patients, while small infarct volumes predominated (54.5%). A clear inverse relationship was noted between ASPECTS score and infarct volume. Conclusion: CT and MRI provide complementary

Background: Medical students frequently experience depression, anxiety, and stress due to academic demands, extensive study hours, and performance pressures. These mental health challenges impact both well-being and academic performance, underscoring the need for institutional support. Materials and Methods: A cross-sectional survey was conducted among 319 undergraduate medical students at Lala Lajpat Rai Memorial Government Medical College, Meerut, Uttar Pradesh during April-June 2025. Participants included MBBS students from all years who had spent over six months at the college and consented to participate. Students absent during assessment or with diagnosed psychiatric illness were excluded. Results: Depression, anxiety, and stress prevalence rates were 13.47%, 18.18%, and 9.71%, respectively. Significant associations were found between psychological disorders and factors including religion, parental living status, parental education and occupation, residence type, year of study, age, and socioeconomic status. Key contributing factors included academic pressure, adjustment difficulties, financial concerns, romantic relationships, and family conflicts. Conclusion: The prevalence of these psychological conditions among medical students necessitates urgent interventions and support systems within educational institutions. Prioritizing mental health awareness and providing appropriate resources can help students manage these challenges effectively, fostering a healthier learning environment that enhances both academic success and overall well-being. Keywords: Anxiety, Depression, DASS, Medical graduates, Stress.

Background: Squamous cell carcinoma (SCC) is a rare histological variant in anatomical sites with little or no squamous epithelium. Bladder SCC accounts for 2–5% of bladder cancers in non-endemic regions and is frequently associated with chronic irritation from vesical calculi. Gallbladder SCC constitutes 1–3% of biliary cancers and is characterised by aggressive behaviour and poor prognosis. Primary breast SCC constitutes less than 0.1% of breast carcinomas and typically exhibits a triple-negative phenotype with chemotherapy resistance. Case Presentation: Five cases are presented: a 50-year-old male with bladder SCC and calculi; a second bladder SCC associated with chronic irritation; a 46-year-old female with gallbladder SCC; and a 63-year-old and a 57-year-old woman with primary breast SCC showing squamous differentiation. Conclusion: When achievable, radical surgical resection provides the best prognosis, although five-year survival rates remain much lower than for conventional carcinomas at similar sites. Early histopathological diagnosis with immunohistochemical confirmation is essential. Multimodal strategies involving surgery, advanced pathology, and innovative therapies are required to improve overall patient outcomes. Keywords: Squamous cell carcinoma, rare malignancy, histopathology, immunohistochemistry, chronic inflammation.

Background: Bipolar Disorder (BD) is a chronic psychiatric illness characterized by recurrent episodes of mania and depression, resulting in significant psychosocial impairment. Attention-Deficit/Hyperactivity Disorder (ADHD), a common neurodevelopmental disorder of childhood, has been increasingly associated with Bipolar Disorder due to overlapping clinical features and shared neurobiological mechanisms. However, limited studies from India have explored the relationship between childhood ADHD symptoms and adult Bipolar Disorder. The aim is to evaluate the correlation between childhood ADHD symptoms and the occurrence of Bipolar Disorder in adulthood. Materials and Methods: This retrospective cohort-based observational study was conducted in the Department of Psychiatry at a tertiary care teaching hospital in Kolhapur over a period of 18 months. A total of 190 participants were included and divided into two groups: adults diagnosed with Bipolar Disorder (n=95) and age- and sex-matched controls without Bipolar Disorder (n=95). Childhood ADHD symptoms were assessed using validated tools such as the Wender Utah Rating Scale (WURS). Socio-demographic and clinical variables were recorded. Statistical analysis was performed using SPSS software. Chi-square test, independent t-test, and logistic regression analysis were applied, with p<0.05 considered statistically significant. Results: The Bipolar Disorder group demonstrated significantly higher WURS total scores (42.6 ± 11.8 vs 24.3 ± 8.7; p<0.001), inattention scores, hyperactivity scores, and impulsivity scores compared to controls. Positive ADHD screening was observed in 60.4% of Bipolar Disorder patients compared to 17.0% of controls (p<0.001). Bipolar Disorder patients with positive childhood ADHD symptoms showed earlier onset of illness, longer duration of illness, greater number of manic and depressive episodes, increased hospitalization, and higher substance use history. Logistic regression analysis identified positive childhood ADHD symptoms (OR=5.82, p<0.001), family history of psychiatric illness (OR=3.44, p=0.01), unemployment (OR=2.16, p=0.04), and higher WURS scores (OR=1.12, p=0.001) as significant predictors of Bipolar Disorder. Conclusion: The present study demonstrated a significant association between childhood ADHD symptoms and Bipolar Disorder in adulthood. Childhood ADHD symptoms were associated with earlier onset and more severe clinical course of Bipolar Disorder. Early identification and intervention for ADHD symptoms may help reduce future psychiatric morbidity and improve long-term outcomes in individuals at risk for Bipolar Disorder. Keywords: Bipolar Disorder; Attention-Deficit/Hyperactivity Disorder; Childhood ADHD; Wender Utah Rating Scale; Retrospective Cohort Study; Psychiatric Comorbidity; Adult Psychiatry; Neurodevelopmental Disorders.

Stress cardiomyopathy, also known as Takotsubo cardiomyopathy, is a transient form of acute heart failure characterized by reversible left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. It commonly mimics acute coronary syndrome with electrocardiographic changes and elevated cardiac biomarkers. We report the case of a 45-year-old female who presented with sudden onset slurring of speech and giddiness lasting for one hour, suggestive of a transient neurological event. Initially, the patient was hemodynamically stable and had no history of chest pain, addiction, or comorbid illness. During evaluation, she suddenly developed acute breathlessness with hypoxia and bilateral crepitations. Electrocardiography demonstrated T-wave inversions in leads I, II, aVL, and V4–V6. Cardiac biomarkers including high-sensitivity troponin-I and NT-proBNP were markedly elevated. Echocardiography revealed severe left ventricular systolic dysfunction with akinetic apical and mid segments and preserved basal contraction, suggestive of Takotsubo cardiomyopathy. Coronary angiography later showed normal coronary arteries, confirming the diagnosis. Neuroimaging demonstrated a lacunar non-hemorrhagic infarct in the right parietal lobe. The patient was managed conservatively with oxygen support, CPAP ventilation, intravenous diuretics, antiplatelet agents, and statins. Serial echocardiography showed gradual improvement in left ventricular function with normalization of ejection fraction from 29% to 55% within two weeks. This case highlights the association between acute neurological stress and Takotsubo cardiomyopathy. Early recognition is essential because the condition is reversible with prompt supportive therapy. Clinicians should maintain a high index of suspicion in patients presenting with acute neurological events followed by sudden cardiac dysfunction in the absence of coronary artery disease. Keywords: Stress Cardiomyopathy, Cardiology.

Antimicrobial resistance (AMR) is a serious global health concern, owing mostly to the rapid spread of resistant Gram-negative bacteria in hospital settings. This study investigated the antibiotic resistance patterns, molecular resistance mechanisms, and genetic variables of Gram-negative clinical isolates obtained from a tertiary care hospital in Tamil Nadu, India. A cross-sectional study was undertaken at the Government Theni Medical College and Hospital between November 2024 and April 2025. 171 bacterial isolates were collected from 219 clinical specimens, with 142 Gram-negative isolates chosen for further investigation. The Kirby-Bauer disk diffusion method was used to conduct phenotypic antimicrobial susceptibility testing in accordance with the Clinical and Laboratory Standards Institute guidelines. Carbapenemase-encoding genes like blaOXA-51 and blaOXA-23 were found using real-time polymerase chain reaction (RTPCR). GraphPad Prism software was used to evaluate the clinical, microbiological, and demographic data. Thirty-one percent of the 142 Gram-negative isolates exhibited treatment resistance. The most resistant strain was Klebsiella pneumoniae (47.7%), followed by Escherichia coli (18.2%) and Klebsiella oxytoca (25.0%). Meropenem resistance was observed in 38.2% of K. pneumoniae isolates, indicating a significant level of resistance to cephalosporins, fluoroquinolones, and aminoglycosides. According to molecular analysis, blaOXA-51 (67.3%) and blaOXA-23 (69.1%) genes were highly prevalent in K. pneumoniae, and they were also often found in E. coli and Pseudomonas aeruginosa. Differences in cycle threshold values indicated species-specific variations in gene expression. The results show a high prevalence of multidrug-resistant Gram-negative pathogens and highlight the necessity of ongoing molecular surveillance, improved antimicrobial stewardship, and focused infection control measures to stop the spread of AMR in healthcare settings with limited resources. Keywords: Antimicrobial resistance, Gram-negative bacteria, Klebsiella pneumoniae, Escherichia coli, Carbapenemase.

Background: Unstable intertrochanteric fractures of the femur are common injuries among elderly individuals and are associated with significant morbidity and functional impairment. Proximal Femoral Nailing (PFN) has emerged as an effective treatment option because of its biomechanical advantages and minimally invasive nature. The present study was conducted to evaluate the clinical and radiological outcomes of unstable intertrochanteric fractures managed with PFN. Materials and Methods: This prospective observational study included 50 patients with unstable intertrochanteric fractures classified as Boyd and Griffin Type III and Type IV fractures. All patients underwent fixation with Proximal Femoral Nail and were followed for a period of 12 months. Clinical and radiological evaluations were performed during follow-up visits. Functional outcomes were assessed using the Harris Hip Score. Results: The mean age of the patients was 68.8 years, and 66% of patients were older than 60 years. Females constituted 66% of the study population. Boyd and Griffin Type III fractures accounted for 64% of cases. The most common mechanism of injury was a simple fall, observed in 76% of patients. Functional outcome assessment revealed excellent results in 36% of patients, good results in 42%, fair results in 14%, and poor results in 8% of patients. Overall, 78% of patients achieved good to excellent functional outcomes following PFN fixation. Conclusion: Proximal Femoral Nailing is an effective and reliable treatment modality for unstable intertrochanteric fractures of the femur. The procedure provides stable fixation, facilitates early mobilization, and results in favorable functional outcomes in the majority of patients. PFN should be considered a preferred treatment option for unstable intertrochanteric fractures, particularly in the elderly population. Keywords: Intertrochanteric Fracture, Proximal Femoral Nail, Harris Hip Score, Functional Outcome

Background: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in India. The introduction of the BPaLM regimen comprising Bedaquiline, Pretomanid, Linezolid, Moxifloxacin has transformed the management of multidrug-resistant and rifampicin-resistant tuberculosis by providing a shorter, all-oral treatment option with improved outcomes. The Objective is to evaluate the clinical profile, adverse effects, and treatment outcomes among patients receiving the BPaLM regimen for drug-resistant tuberculosis at a tertiary care civil hospital ahmedabad hospital. Materials and Methods: A prospective observational study was conducted at the Department of Pulmonary Medicine and Drug-Resistant Tuberculosis Centre, B J Medical College and Civil Hospital, Ahmedabad, Gujarat, from January 2025 to December 2025. Fifty microbiologically confirmed DR-TB patients initiated on the BPaLM regimen were enrolled. Demographic characteristics, clinical profile, laboratory parameters, adverse drug reactions, sputum conversion rates, and treatment outcomes were recorded and analyzed. Results: The mean age of participants was 34.8 ± 11.6 years, with males constituting 64% of the study population. Pulmonary TB was observed in 90% of patients. Previous anti-tubercular treatment history was present in 78% of cases. Sputum culture conversion at 2 months occurred in 82% of patients. Treatment success was achieved in 88% of participants, while treatment failure and mortality were observed in 4% and 6% respectively. Peripheral neuropathy (22%) and anemia (18%) were the most common adverse events. Conclusion: The BPaLM regimen demonstrated high treatment success rates and rapid sputum conversion with manageable adverse effects among DR-TB patients. The findings support wider implementation of the regimen under the National Tuberculosis Elimination Programme (NTEP). Keywords: Drug-resistant tuberculosis, BPaLM regimen, Bedaquiline, Pretomanid, Linezolid, Treatment outcomes, India.

Background: Cesarean section is a frequently performed obstetric procedure, and there is an increased risk of postoperative infectious complications including endometritis and surgical site infection. Prophylactic antibiotics should be administered in timely manner prior to skin incision, so as to reach a therapeutic level for the tissue during surgery. The anaesthetist's administration at induction of anaesthesia may lead to better compliance with recommended timing. The objective is to determine the effectiveness of prophylactic antibiotics administered by the anaesthetist at induction of anaesthesia in reducing post-cesarean endometritis and surgical site infections among obstetric patients. Materials and Methods: This comparative study was carried out in the Department of Obstetrics and Gynaecology of Hayatabad Medical Complex in Peshawar during a period of January-June 2024. There were 72 obstetric patients who had cesarean section. The patients were split into two equal groups. A total of 36 patients were assigned to Group A, who were given prophylactic antibiotics by the anaesthetist after induction of anaesthetic before skin incision, and 36 patients were assigned to Group B, who got antibiotics after cord clamping or later according to routine procedure. Patients were followed up for infectious complications such as endometritis, surgical site infection, postoperative fever, complications of the wounds, use of supplementary antibiotics and infectious morbidity. Appropriate statistical testing procedures were used to analyse data, and a p value of < 0.05 was considered significant. Results: The mean age of patients was 28.6 ± 5.1 years. Both groups were comparable regarding baseline demographic and obstetric characteristics. Post-cesarean endometritis was significantly lower in Group A compared with Group B, 2 (5.6%) versus 8 (22.2%), respectively. Surgical site infection was also lower in Group A, 3 (8.3%) versus 10 (27.8%) in Group B. Postoperative fever occurred in 4 (11.1%) patients in Group A and 11 (30.6%) patients in Group B. The need for additional antibiotics was reported in 5 (13.9%) patients in Group A compared with 13 (36.1%) patients in Group B. Overall infectious morbidity was 16.7% in Group A and 38.9% in Group B. Conclusion: Prophylactic antibiotics administered by the anaesthetist at induction of anaesthesia were effective in reducing post-cesarean endometritis, surgical site infection, postoperative fever, need for additional antibiotics, and overall infectious morbidity. Incorporating antibiotic administration into the anaesthesia induction checklist may improve timely prophylaxis and reduce preventable post-cesarean infections. Keywords: Cesarean section, prophylactic antibiotics, anaesthetist, induction of anaesthesia, endometritis, surgical site infection, obstetric patients.

Background: Recurrent dermatophytosis has emerged as a significant public health concern, particularly in tropical regions, with increasing chronicity and treatment failure. Beyond host and pharmacological factors, household overcrowding, shared personal items, humidity, and hygiene practices may contribute to reinfection and persistence. Understanding domestic and environmental determinants is essential for effective prevention strategies and long-term disease control in affected populations. Aims: To evaluate the association between household and environmental factors and recurrent dermatophytosis and to identify modifiable risk determinants contributing to recurrence. Materials and Methods: This hospital-based observational study was conducted over a period of 10 months and included 58 patients diagnosed with recurrent dermatophytosis attending the dermatology outpatient department. Detailed history was obtained using a structured questionnaire. Clinical examination was performed to document morphology and sites of involvement. Statistical analysis was carried out to determine associations between environmental factors and recurrence, with p < 0.05 considered statistically significant. Results: The majority of patients were aged 21–40 years (34; 58.6%), with a male predominance (36; 62.1%). Overcrowding was observed in 29 (50.0%) households, while 33 (56.9%) patients reported sharing towels or clothing with family members. A positive family history of dermatophytosis was present in 31 (53.4%) cases. Inadequate ventilation and high indoor humidity were noted in 27 (46.6%) households. Wearing tight synthetic clothing was reported by 35 (60.3%) patients, and irregular washing or sun-drying of clothes was observed in 24 (41.4%). Significant associations were found between recurrence and sharing of personal items (p = 0.021), positive family history (p = 0.017), and overcrowding (p = 0.034). Poor ventilation also demonstrated a statistically meaningful correlation (p = 0.042). Conclusion: Recurrent dermatophytosis is strongly influenced by modifiable household and environmental factors. Overcrowding, shared fomites, positive family history, and inadequate ventilation significantly contribute to reinfection and persistence. Addressing domestic hygiene practices alongside appropriate antifungal therapy is essential for reducing recurrence rates. Keywords: Environmental determinants, fomite transmission, fungal infections, household factors, overcrowding, Recurrent dermatophytosis.

Background: The superior thyroid artery is the first anterior branch of the external carotid artery and plays a major role in supplying the thyroid gland, larynx, and adjacent neck structures. Variations in its origin and branching pattern are common and possess significant surgical importance during thyroidectomy, neck dissections, vascular ligation, and interventional radiological procedures. Accurate anatomical knowledge of these variations helps prevent vascular injury, hemorrhage, and nerve damage during head and neck surgeries. Aims: To study the anatomical variations in the origin and branching pattern of the superior thyroid artery and to assess their clinical and surgical significance. Materials and Methods: This cadaveric observational study was conducted in the Department of Anatomy over a period of 12 months. A total of 45 adult human cadavers were included in the study. Detailed dissection of the carotid triangle and anterior neck region was performed bilaterally to identify the origin, course, branching pattern, and relations of the superior thyroid artery. Variations in arterial origin were documented. The branching pattern and relation of the artery to the external laryngeal nerve were also observed and analyzed. Data were entered and statistically analyzed using descriptive statistics and percentages. Results: Among the 45 cadavers studied, the superior thyroid artery originated from the external carotid artery in 31 (68.9%) specimens, from the carotid bifurcation in 9 (20.0%) specimens, and from the common carotid artery in 5 (11.1%) specimens. Classical branching pattern was observed in 34 (75.6%) specimens, while variations in branching were identified in 11 (24.4%) cases. Early branching near the arterial origin was noted in 6 (13.3%) specimens. Variations were slightly more common on the right side compared to the left side. The superior laryngeal branch arose independently in 8 (17.8%) specimens. Close relation between the superior thyroid artery and external laryngeal nerve was observed in 12 (26.7%) specimens, indicating potential risk of nerve injury during surgical procedures. Significant association was observed between anomalous origin and altered branching pattern (p < 0.05). Conclusion: The superior thyroid artery demonstrates considerable anatomical variation in its origin and branching pattern. Awareness of these variations is essential for surgeons, anatomists, and radiologists to minimize complications during thyroid and neck surgeries. Careful anatomical identification of the artery and its relation to surrounding neurovascular structures contributes to safer operative procedures and improved surgical outcomes. Keywords: Anatomy; Branching pattern; Cadaveric study; External carotid artery; Superior thyroid artery; Thyroid surgery.

Background: Trauma is a leading cause of mortality in low- and middle-income countries, and road traffic accidents account for a substantial share of trauma-related disability and death. In Kerala, India, no standardized pre-hospital emergency trauma care protocol exists, leaving initial response largely to untrained bystanders. The objective is to evaluate the effectiveness of a structured pre-hospital trauma care training program on the knowledge and practical skill of lay first responders in an accident-prone locality, and to assess knowledge retention over two months. Materials and Methods: Sixty volunteers — auto/taxi drivers, merchants, college students, and paramedical personnel — in Haripad, Alappuzha district, Kerala, were trained following American Heart Association guidelines, comprising lectures, hands-on practice, and simulation. Knowledge was assessed using a 15-item, 75-point questionnaire administered before training, immediately after training, and at two-month follow-up. Practical skill competence across six domains was assessed at follow-up. Paired Student’s t-test compared score changes, and McNemar’s test evaluated pass/fail conversion. Results: Mean knowledge scores rose from 25.7±12.2 pre-training to 57.7±9.4 post-training (t=–28.35, p<0.0001) and improved further to 63.7±7.7 at two-month follow-up (t=–10.06, p<0.0001). McNemar’s test confirmed a highly significant shift from failing to passing (χ²≈41, p<0.0001), with no participant regressing from pass to fail. At follow-up, bleeding control and fracture stabilization were the strongest skills (48/58, 82.8% each), while cervical spine stabilization was comparatively weaker (44/58, 75.9%). Conclusion: Structured pre-hospital trauma care training significantly and durably improves knowledge and practical skill among lay first responders, supporting community-based scaling of such programs to strengthen trauma response in resource-limited settings. Keywords: Pre-hospital care, first responders, road traffic accidents, trauma training, public health.

Background: Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi and is increasingly recognized as an important cause of pediatric hospitalization in endemic regions of India. The disease can lead to various complications involving multiple organ systems, including acute kidney injury (AKI), which contributes significantly to morbidity and mortality. Early identification of renal involvement is crucial for improving clinical outcomes. Objectives: To determine the incidence of acute kidney injury among children diagnosed with scrub typhus admitted to a tertiary care hospital in Vijayawada and to assess the clinical and laboratory characteristics associated with AKI. Materials and Methods: A hospital-based observational study was conducted among children aged Children aged 4 to 12 years admitted with confirmed scrub typhus at a tertiary care hospital in Vijayawada. During the period from August 2023-December 2024. Diagnosis was established by IgM ELISA or other standard serological methods. Demographic details, clinical manifestations, laboratory parameters, and outcomes were recorded. Acute kidney injury was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The incidence of AKI and its association with clinical variables were analyzed. Results: In the present study, 65 children diagnosed with scrub typhus were evaluated to determine the incidence and profile of Acute Kidney Injury (AKI). The highest proportion of children belonged to the 7–9 years age group (49.2%), with a slight male predominance (53.8%). AKI was documented in 13.8% of children. Interestingly, younger children (4–6 years) accounted for the highest proportion (44.4%) of AKI cases, although the association with age was not statistically significant (p=0.155). The occurrence of AKI was significantly higher in males (88.9% of AKI cases) compared to females, a finding that was statistically significant (p=0.023). The majority of AKI cases were classified as Stage 3 (77.8%) per KDIGO guidelines, reflecting severe renal impairment. Serum creatinine levels increased proportionately with the severity of AKI, with Stage 3 patients showing the highest mean levels (2.8 ± 0.0 mg/dL). Younger children (4–6 years) had the highest average serum creatinine levels among AKI cases. Urine output was significantly reduced in children with AKI (0.4 ± 0.10 ml/kg/hr) compared to those without AKI (1.26 ± 0.2 ml/kg/hr), with a highly significant p-value (<0.001).Complications such as encephalopathy (22.2%), ARDS (11.1%), and shock (11.1%) were notably more frequent among AKI patients. Moreover, a statistically significant association was observed between AKI and the development of Multi-Organ Dysfunction Syndrome (MODS), with 100% of MODS cases found among the AKI group (p=0.001). Dialysis was required in 44.4% of AKI patients, while none of the non-AKI patients required renal replacement therapy. Mortality was recorded only in the AKI group (11.1%), further emphasizing the clinical severity associated with renal involvement in scrub typhus. Conclusion: Acute kidney injury is a notable complication of pediatric scrub typhus and is associated wi

Background: Antithrombotic therapy remains a cornerstone of acute coronary syndrome (ACS) management. However, contemporary real-world data on the utilization of novel oral anticoagulants (NOACs) and antiplatelet agents in Indian patients with ACS remain limited. Objective: To evaluate the utilization patterns of oral anticoagulants and antiplatelet agents among patients with ACS undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in routine clinical practice. Materials and Methods: This multicentric retrospective cohort study reviewed medical records of 203 adult patients diagnosed with ACS across tertiary care centers in India. Demographic characteristics, cardiovascular risk factors, clinical presentation, laboratory parameters, revascularization procedures, and antithrombotic treatment patterns were collected using a standardized case report form. Descriptive statistics were used to summarize patient characteristics and treatment utilization patterns. Results: The mean age of the study population was 58.7 ± 10.9 years, and 59.6% of patients were male. Hypertension (75.9%) and type 2 diabetes mellitus (51.2%) were the most prevalent comorbidities. Chest pain was the most common presenting symptom. PCI was performed in 141 (69.5%) patients, while 62 (30.5%) underwent CABG. Apixaban was the most frequently prescribed oral anticoagulant, used in 187 (92.1%) patients, followed by dabigatran (5.4%), rivaroxaban (3.4%), and warfarin (1.5%). Ticagrelor was the predominant antiplatelet agent, prescribed in 157 (77.3%) patients, followed by aspirin (20.2%), clopidogrel (9.4%), and prasugrel (0.5%). Similar prescribing patterns were observed across PCI and CABG cohorts. Antihypertensive and lipid-lowering therapies were prescribed in 51.2% and 49.8% of patients, respectively. Conclusion: Among Indian patients with ACS, apixaban and ticagrelor were the most frequently prescribed oral anticoagulant and antiplatelet agents, respectively. The study highlights contemporary real-world antithrombotic prescribing practices and the increasing adoption of guideline-directed therapies in ACS management. Keywords: Acute coronary syndrome; oral anticoagulants; novel oral anticoagulants; apixaban; ticagrelor; antiplatelet therapy; PCI; CABG; real-world evidence.

Background: Men who have sex with men (MSM) carry a disproportionate burden of human papillomavirus (HPV)–related disease, including anogenital warts (AGW) and anal cancer, yet remain largely outside India’s cervical-cancer–centred, female-focused vaccination effort and continue to rely on a prevention model built around condom promotion. We examined the burden of AGW and the gap between condom awareness, condom practice, and HPV-vaccine awareness and uptake in this population. Materials and Methods: A hospital-based cross-sectional study was conducted among 72 self-reporting MSM attending the dermatology and venereology outpatient clinic of Government Medical College, Thiruvananthapuram, Kerala, India. Participants underwent clinical examination for AGW, serological and microbiological screening for other sexually transmitted infections (STIs), and a structured knowledge–attitude–practice assessment of barrier contraception and HPV vaccination. Categorical associations were tested using the chi-square test. Results: AGW were present in 11 of 72 participants (15.3%), and 61 (84.7%) had at least one STI, most commonly syphilis (73.6%) and HIV (33.3%); AGW frequently co-occurred with these infections. Although all participants (100%) were aware of condoms, only 9.7% used them consistently, while 90.3% reported both protected and unprotected encounters. Awareness of the HPV vaccine was low (18.1%), and none of the 72 participants reported prior vaccination. Better awareness was associated only with higher education and consistent condom use (p < 0.01). Conclusion: This population showed a substantial AGW and STI burden alongside near-absent HPV-specific primary prevention. Because condoms reduce but cannot eliminate HPV transmission—owing to skin-to-skin spread at uncovered sites and to slippage or breakage—HPV vaccination offers the complementary protection that barrier methods alone cannot. Embedding routine AGW screening, consistent-use condom counselling, and proactive, MSM-inclusive HPV vaccination into existing STI and HIV services represents a critical and currently missed opportunity. Keywords: Anogenital warts, HPV vaccination, Men who have sex with men, Barrier contraception, sexually transmitted infections.

Background: Pulmonary tuberculosis (PTB) remains a major public health problem, and delays in diagnosis and treatment contribute to ongoing transmission, advanced disease, and poor outcomes. This study aimed to evaluate the magnitude, determinants, and programmatic implications of diagnostic and treatment delays among newly diagnosed pulmonary tuberculosis patients. Delays in TB care are especially relevant in high-burden settings where patients often first seek care from informal providers, pharmacies, or multiple healthcare contacts before receiving definitive treatment. Materials and Methods: This manuscript is a hospital-based cross-sectional analytical study among newly diagnosed PTB patients. A structured interview schedule was used to document symptom onset, first healthcare contact, date of diagnosis, and date of treatment initiation. Delay was categorized as patient delay, diagnostic delay, treatment delay, and total delay according to standard TB care cascade definitions used in the literature and WHO-aligned frameworks. Descriptive statistics, chi-square testing, and multivariable logistic regression were used to identify factors associated with prolonged delays. Results: The study demonstrated substantial delays across the TB care pathway, with patient delay contributing the largest proportion of total delay, followed by diagnostic delay and then treatment delay, consistent with prior Indian and global evidence. Female sex, lower educational status, initial pharmacy or informal treatment, consultation with multiple providers, and private-sector diagnosis were associated with longer delays. Most patients experienced at least one avoidable barrier in the pathway to care, indicating that both community-level and system-level interventions are needed. Conclusion: Diagnostic and treatment delays in pulmonary tuberculosis remain common and multifactorial. The findings support strengthening early symptom recognition, referral pathways, frontline provider training, and rapid diagnostic access to reduce infectiousness and improve outcomes. Programmatic TB control should prioritize both patient-oriented awareness and health-system responsiveness to shorten the time from symptom onset to treatment initiation. Keywords: Pulmonary tuberculosis; diagnostic delay; treatment delay; patient delay; health system delay.

Background: Lumbar spine disorders may impair sexual function through pain, neurological compromise, and reduced quality of life. This study assessed changes in sexual function and intercourse-related back pain before treatment and at six months after conservative management, selective nerve root block, microdiscectomy with laminotomy, and transforaminal lumbar interbody fusion. Materials and Methods: This prospective observational study included one hundred sexually active adults aged 25 to 60 years with prolapsed intervertebral disc, spondylolisthesis, degenerative disc disease, or cauda equina syndrome. Participants underwent selective nerve root block (n = 20), transforaminal lumbar interbody fusion (n = 25), microdiscectomy with laminotomy (n = 30), or conservative management (n = 25). Outcomes included the International Index of Erectile Function-5 in male patients, the Female Sexual Function Index in female patients, back-pain visual analogue scale (0-10), intercourse-pain visual analogue scale (0-10), ejaculatory recovery (%), and satisfaction scores (0-10). Statistical analysis: paired t-test, ANOVA, chi-square, Pearson correlation; significance at p<0.05. Results: Interventional and surgical groups showed significant improvements in sexual function, pain scores, and satisfaction at six months, with the greatest gains in the microdiscectomy group. Conservative management showed minimal change. Ejaculatory recovery was highest after microdiscectomy. Conclusion: Lumbar spine interventions, particularly decompressive procedures, significantly improve sexual function and reduce intercourse-related back pain. Sexual health assessment should be incorporated into routine lumbar spine care. Keywords: Low Back Pain, Sexual Dysfunction, Physiological, Intervertebral Disc Displacement, Spondylolisthesis, Spinal Fusion.

Background: Antibiotic resistance is a global threat. Internship is crucial period where theoretical knowledge is applied in clinical practice, offering an opportunity to shape rational prescribing habits. Assessing the KAP of interns helps identify gaps and guide educational interventions to create awareness about antibiotic resistance & promote rational antibiotic use. Objective: To assess the knowledge, attitude and practice of interns about rational antibiotic use and antibiotic resistance. Materials and Methods: An observational questionnaire-based study was conducted among 200 interns at Andhra Medical College. First section included 10 knowledge-based questions, scoring out of 10 (0-3:poor, 4-7:moderate, 8-10:Good). Second section assessed attitude, using three-point Likert scale. Third section focused on current antibiotic use practices. Results: Total 200 interns participated, their average internship duration was 3-6 months. Mean knowledge score was 7.8. Moderate knowledge (score 4-7) was seen in 37% and good knowledge (score 8–10) in 63%. Responses to the attitude-based questions showed about 89% agreed that antibiotics should be prescribed only with clear clinical or microbiological evidence and 98% recognized irrational use contributes to antibiotic resistance. In practice-based questions, they are following rational use of antibiotics. Conclusion: Interns had good knowledge and a strongly positive attitude towards rational antibiotic use. Most of them were well aware that antibiotic resistance is a serious health issue. Inclusion in the internship training requires multi-modal approach with case-based scenarios, workshops and CME, along with active clinician involvement to promote rational use of antibiotics and thus control the growing problem of antibiotic resistance. Keywords: Antibiotic resistance, rational antibiotic use

Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by excessive secretion of parathyroid hormone leading to hypercalcemia and disturbances in calcium–phosphate metabolism. Although many cases are detected incidentally during routine biochemical screening, symptomatic disease with skeletal involvement continues to be encountered, particularly in regions where diagnosis is delayed. Classical skeletal manifestations include osteitis fibrosa cystica, decreased bone mineral density, and pathological fractures. However, rare skeletal presentations may mimic neoplastic or metastatic bone disease, posing diagnostic challenges. This case series highlights three patients with unusual skeletal manifestations of PHPT and discusses the diagnostic and therapeutic considerations associated with these presentations. The first case involved a 23-year-old male presenting with progressive swelling of the right jaw. Biochemical evaluation revealed severe hypercalcemia and markedly elevated parathyroid hormone levels. Imaging studies confirmed a right inferior parathyroid adenoma with a mandibular brown tumor. The second case described a 31-year-old female with severe bone pain and advanced osteoporosis due to PHPT. Following parathyroidectomy, she developed symptomatic hypocalcemia consistent with hungry bone syndrome, requiring intensive calcium and vitamin D supplementation. The third case involved a 49-year-old male presenting with bilateral lower limb weakness and vertebral compression fractures. Imaging revealed multiple osteolytic lesions mimicking metastatic malignancy; however, biochemical findings confirmed PHPT due to a parathyroid adenoma. These cases illustrate the diverse skeletal manifestations of PHPT and emphasize the importance of biochemical evaluation in patients presenting with unexplained bone lesions or hypercalcemia. Early recognition and appropriate imaging are essential for accurate diagnosis and surgical planning. Parathyroidectomy remains the definitive treatment and leads to significant clinical and biochemical improvement. Careful postoperative monitoring is crucial, particularly for complications such as hungry bone syndrome. This case series highlights the need for heightened clinical awareness to prevent diagnostic delay and reduce morbidity associated with advanced PHPT. Keywords: Primary hyperparathyroidism; Brown tumor; Hungry bone syndrome; Parathyroid adenoma; Vertebral compression fracture; CKD; Secondary hyperparathyroidism.

Background: Non-traumatic shoulder pain is a common musculoskeletal complaint causing significant disability and functional impairment. Accurate diagnosis is essential for appropriate management. Clinical examination is widely used as an initial assessment tool; however, its diagnostic accuracy may be limited by overlapping symptoms. High-resolution ultrasonography (HRUSG) has emerged as a valuable imaging modality for evaluating shoulder pathologies. The aim is to evaluate the role of high-resolution ultrasonography in the diagnosis of non-traumatic shoulder pain and to correlate ultrasonographic findings with clinical examination. Materials and Methods: A hospital-based observational study was conducted in the Department of Orthopaedics, M.L.B. Medical College, Jhansi, from November 2011 to November 2013. Seventy-five patients with unilateral non-traumatic shoulder pain underwent detailed clinical examination and HRUSG assessment. Clinical and ultrasonographic findings were compared to determine their diagnostic utility. Results: Clinical examination identified supraspinatus tendon lesions in 60 (80%) patients, biceps tendon pathology in 26 (35%), and acromioclavicular (AC) joint abnormalities in 18 (24%). HRUSG revealed subacromial bursitis in 48 (64%) patients, supraspinatus lesions in 40 (54%), impingement syndrome in 30 (40%), and AC joint abnormalities in 29 (38.7%). Clinical examination demonstrated higher sensitivity for supraspinatus lesions (80%), whereas HRUSG showed greater specificity for most shoulder pathologies, including 100% specificity for infraspinatus and subscapularis lesions. Conclusion: HRUSG is a valuable adjunct to clinical examination in patients with non-traumatic shoulder pain. While clinical examination remains a sensitive screening tool, HRUSG provides superior specificity and direct visualization of structural abnormalities, thereby improving diagnostic accuracy and diagnostic confidence. Keywords: Non-traumatic shoulder pain, High-resolution ultrasonography, Clinical examination, Rotator cuff lesions.

Background: Seizures are among the most common neurological emergencies in children and contribute significantly to paediatric hospital admissions. The etiological spectrum varies with age and geographic region, with febrile seizures being the most common cause in younger children. This study was conducted to evaluate the etiology, clinical profile, and short-term outcomes of seizures in children admitted to a tertiary care hospital. Aims and Objective is to study the etiology, clinical presentation, neurodiagnostic findings, and immediate outcomes of seizures in children. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at a tertiary care teaching hospital over 6 months. A total of 101 children presenting with seizures were included. Clinical details, laboratory investigations, neuroimaging, EEG findings, complications, and outcomes were recorded and analysed using descriptive statistics. Results: A total of 101 children with seizures were studied. Most belonged to the 1–5 years age group (45.5%) and were males (61.4%). Fever was present in 83.2% of cases. Generalized tonic–clonic seizures were the predominant seizure type (81.2%), while febrile seizures were the most common etiology (46.5%), followed by epilepsy disorders (10.9%) and CNS infections (10.0%). MRI brain was abnormal in 47.5% of the 59 children evaluated, with cerebral edema and hypoxic ischemic changes being the commonest findings. EEG abnormalities were observed in 33.7% of children. Most patients improved and were discharged without complications (83.2%). Developmental delay (6.9%) and aspiration pneumonia (5.0%) were the most frequent complications. Abnormal EEG findings were significantly associated with polytherapy (p = 0.006). Conclusion: Febrile seizures were the leading etiology, and generalized tonic–clonic seizures were the most common clinical presentation. Most children had favorable short-term outcomes with timely diagnosis and management. Early etiological evaluation, supported by EEG and neuroimaging, is crucial for optimizing outcomes and reducing seizure-related morbidity in children. Keywords: Seizures, Children, Febrile seizures, GTCS, EEG, Neuroimaging.

Background: Body image dissatisfaction (BID) and eating disorders (ED) are emerging public health concerns among adolescents. The present study was conducted to determine the prevalence of body image dissatisfaction and the risk of developing eating disorders among adolescents aged 11–18 years. Materials and Methods: A cross-sectional questionnaire-based study was conducted among 450 adolescents attending schools and junior colleges in Karimnagar, Telangana. Participants were selected through random sampling. Data were collected using a pre-structured questionnaire comprising demographic details, Stunkard’s Figure Rating Scale for assessment of body image dissatisfaction, and the Eating Attitudes Test-26 (EAT-26) for evaluating the risk of eating disorders. Results: The mean age of participants was 13.9±2.09 years, and mean BMI was 19.12±4.21 kg/m². BID was highly prevalent (79.77%), with 42.44% of participants expressing a desire to gain weight and 37.33% expressing a desire to lose weight; only 20.23% were satisfied with their body image. A total of 73 adolescents (16.22%) were identified as being at risk of developing ED based on EAT-26 scores ≥20, with a similar prevalence among boys (16.81%) and girls (15.59%). BID was observed across all BMI categories, including adolescents with normal BMI. Significant but weak correlations were found between BID and ED risk among adolescents wishing to lose weight (r= 0.105, p=0.025) and those wishing to gain weight (r=0.112, p=0.017). Socioeconomic status showed no significant association with ED risk (r=0.019, p=0.68). Conclusion: Body image dissatisfaction is highly prevalent among adolescents and is significantly associated with the risk of developing eating disorders. Early screening, awareness programs, and school-based interventions are essential to promote healthy body image and prevent disordered eating behaviours. Keywords: Adolescents; Body image dissatisfaction; Eating disorders; EAT-26; BMI; Risk factors; School health.

Background: Vaccination is a critical part of preventable health care. The tribal communities record lower antenatal care and immunization coverage. The study was aimed to assess the immunization coverage and to find the associated socio- demographic factors among the children in the age group 12-23 months in tribal settlements. Materials and Methods: This was a cross- sectional study conducted between July 2022 to June 2024 in the tribal settlements of Chamarajanagar among 210 children in the age group of 12 to 23 months. The samples were selected by WHO 30×7 cluster sampling method. The data was collected by using a standard validated questionnaire after obtaining the ethical clearance. Results: The fully immunized, partially immunized and un- immunized were 73.8%, 22.9% and 3.3% respectively. In bivariate analysis, the factors significantly associated with immunization coverage rate were mother’s age (p <0.005), father’s age (p<0.005), mother’s education (p=0.014) and father’s occupation (p=0.033). In multiple logistic regression analysis, there were no significant predictors of partial immunization or un- immunization status in children. Conclusion: The FIC rate was found to be low among the children in tribal settlements of Chamarajanagar district. The key determinants of immunization status included parental age and education, occupation, socio-economic status. Keywords: vaccine coverage, fully immunized, 12 to 23 months, tribal settlements, WHO 30x7 cluster sampling, COVID- 19.

Background: The study was aimed to generate evidence regarding clinical and etiological profile of patients with pancreatitis in a tertiary care center of Purba Bardhaman district, West Bengal. Materials and Methods: It was a facility based observational study with cross-sectional design. The study was done at in-patient department of General Medicine, Burdwan Medical College & Hospital, Purba Bardhaman district, West Bengal. The duration of study was 18 months – January 2023 to May 2024. Diagnosed patients of Pancreatitis, attending in-patient department of General Medicine in BMCH, during the period of data collection, were included in study population. Results: 17.5% study subjects had severe pancreatitis, 69.5% had moderate pancreatitis and 13% had mild pancreatitis. 59.5% study subjects were within 36-54 years age group; majority were male (73.3%); 7.7% were illiterate; 22.1% were home-maker; 49.6% belonged to middle class; 35.9% were suffering from pancreatitis for >2 years. 86.5%% study subjects presented with pain abdomen, 42.9% presented nausea, 36.5% with vomiting and 40.2% complained about yellow urine. 27.5% Study subjects presented bulky pancreas on USG (whole abdomen). Conclusion: In current study, larger number of patients were found to have moderate to severe pancreatitis. Idiopathic & alcoholic pancreatitis were most common forms. Periodic estimation of serum lipase, amylase, calcium, CRP are helpful to assess severity of pancreatitis. Keywords: Observational study, West Bengal, Etiological Profile.

Silicosis is a progressive and irreversible occupational lung disease caused by inhalation of respirable crystalline silica dust. Apart from pulmonary complications such as mycobacterial infection, obstructive airway disease, pulmonary fibrosis and lung cancer, silica exposure has been associated with immune dysregulation and autoimmune diseases. Silica-exposed individuals may develop autoantibodies, including antinuclear antibodies and anti-Scl-70 antibodies, which are also associated with systemic sclerosis (SSc). Erasmus syndrome refers to the development of SSc in the background of silica exposure or silicosis. We report a 47-year-old male flour mill worker with long-term unprotected dust exposure who presented with progressive dyspnea, persistent dry cough, skin darkening and tightening, joint pain, Raynaud phenomenon, sclerodactyly, dysphagia and strong anti-Scl-70 positivity. High-resolution computed tomography (HRCT) thorax showed bilateral pulmonary nodules, interstitial septal thickening and calcified mediastinal lymphadenopathy, supporting chronic silicosis. The clinico-radiological and serological findings were consistent with Erasmus syndrome. This case highlights the importance of detailed occupational history in male patients presenting with systemic sclerosis-like illness. Keywords: Erasmus syndrome; silicosis; systemic sclerosis; flour mill worker; occupational exposure.

Background: Ropivacaine is an amide local anesthetic with a long duration of action.[2] For analgesia dose, 0.1-0.2% is used. It is associated with superior safety profile compared to bupivacaine. Buprenorphine is a thebaine derivative and it is a mu receptor partial agonist and antagonist. It was introduced in 1976. It is most commonly used for orthopedic surgeries. Objective: to compare postoperative epidural analgesia in lower limb orthopaedic surgeries between two opioid adjuvants to the local anesthetic Ropivacaine – Buprenorphine and Fentanyl. Materials and Methods: This case control study was conducted on patients with lower limb fractures in Department of Anaesthesiology, Basaveshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Kalaburagi. Ethical committee clearance (IEC:-Reg no:ECR/899/Inst/2017) was taken. Study Duration of study was 18 months (01 August 2022 TO 31st January 2024) Results: This study included 60 patients, of which 30 patients in each group. In this study patient characteristics were comparable. The onset of analgesia was significantly faster (p<0.001) in Fentanyl Group (14.50+/-3.36 mins) as compared to Buprenorphine group (16.43+/- 3.44mins). While the duration of analgesia was 10.93 hourswith Buprenorphine as compared to 5.56 hours with Fentanyl and was statistically significant (p<0.001). Side effects such as nausea and vomiting, hypotension, pruritis, sedation was seen in 4, 2, nil, nil patients respectively in the Buprenorphine group and 2, 2, nil, nil patients respectively in the Fentanyl group. Conclusion: Buprenorphine and Fentanyl are both safe and effective epidural adjuvants to Ropivacaine. Because of its faster onset of action and fewer side effects, we concluded that Fentanyl is a preferable choice. However, the duration of analgesia is longer with Buprenorphine. Keywords: Epidural, Ropivacaine, Fentanyl, Buprenorphine, VAS score.

Background: Migraine involves neurovascular and autonomic dysfunction. Yoga may decrease CGRP levels and improve heart rate variability balance. The aim is to determine the Effect of yoga on Calcitonin Gene Related Peptide (CGRP) And LH/HF Ratio parameter of Heart Rate Variability (HRV) in migraine patients. Materials and Methods: This analytical observational study included 80 migraine patients divided into two groups two groups A. Yoga conventional care group B. conventional care group without Yoga at RMLIMS, Lucknow. Patients aged 18–50 years meeting ICHD-3 criteria were included. CGRP was measured by ELISA, and LF/HF ratio was assessed using software LABCHART PRO v8.1.8 with HRV module v2.0.3. Written informed consent was obtained from all participants. Results: Serum CGRP levels decreased significantly over 12 weeks in both groups, with a greater reduction observed in the yoga group. Baseline CGRP levels showed no significant difference between non-yoga and yoga groups. After 12 weeks, CGRP reduction was statisticaly significant higher in the yoga group, indicating enhanced improvement with yoga intervention. Intragroup analysis showed highly significant reductions in both groups, but the magnitude was greater with yoga practice. LF/HF ratio showed no baseline difference between groups. After 12 weeks, the yoga group demonstrated a statisticaly significant reduction in LF/HF ratio, while the non-yoga group showed no significant change, indicating improved autonomic balance associated with yoga practice. Conclusion: Yoga statisticalysignificant reduces CGRP levels and improves autonomic balance in migraine patients, supporting its role as a safe, effective adjunct therapy targeting neurochemical and autonomic mechanisms. Keywords: Migraine, Yoga therapy, Calcitonin Gene-Related Peptide (CGRP), Heart Rate Variability (HRV), LF/HF ratio.

Background: Intertrochanteric fractures are among the most common injuries encountered in the elderly population and are predominantly managed surgically. Treating unstable intertrochanteric fractures remains challenging, particularly in older patients. The optimal choice of implant for fixation continues to be debated. Implants are broadly classified into extra-medullary and intra-medullary types. The Dynamic Hip Screw (DHS), an extra-medullary device, has long been considered the gold standard; however, it is associated with higher complication rates in unstable fracture patterns. The Proximal Femoral Nail (PFN), a newer intra-medullary implant, has gained popularity in recent years. This study aims to evaluate the functional and radiological outcomes of unstable intertrochanteric femur fractures in patients aged over 50 years treated with PFN. Materials and Methods: This study was conducted in the Department of Orthopedics at Government Medical College/Government Teaching General Hospital, Eluru, Andhra Pradesh, India, from June 2023 to January 2025. A total of 33 patients aged above 50 years with unstable intertrochanteric fractures treated using Proximal Femoral Nail were included. Patients were followed up at regular intervals to assess fracture healing, functional outcomes, and any associated complications. Functional assessment was performed using the Harris Hip Score. Results: All patients achieved fracture union with a mean duration of 20 weeks. No complications were observed in 23 patients. Among the remaining cases, 3 patients experienced screw back-out, 3 developed varus malunion, and 4 reported anterior thigh pain. No cases of infection were noted. The mean Harris Hip Score at one year postoperatively was 83, indicating a good functional outcome. Conclusion: Management of unstable intertrochanteric fractures in elderly patients using Proximal Femoral Nail yields favorable functional and radiological outcomes, with a high rate of fracture union and an acceptable complication profile. These complications can be further minimized with proper surgical technique. Keywords: Unstable Intertrochanteric fracture, Proximal Femoral Nail, Harris hip score, Singh’s index, AO, elderly

Background: Aim: To determine the prevalence of overweight and obesity and identify the associated sociodemographic, dietary, behavioural, and lifestyle determinants among high school students in South Kerala. Materials and Methods: A school-based cross-sectional study was conducted among high school students in South Kerala. Information regarding sociodemographic characteristics, dietary habits, physical activity, sedentary behaviour, sleep pattern, family history, and lifestyle factors was collected using a structured questionnaire. Anthropometric measurements including height and weight were obtained using standardized procedures, and Body Mass Index (BMI) was calculated. Nutritional status was classified according to age- and sex-specific BMI criteria. Statistical analyses were performed to estimate the prevalence of overweight and obesity and evaluate their determinants. Results: The study estimated the prevalence of overweight and obesity among high school students and evaluated the influence of demographic, dietary, behavioural, physical activity, sedentary lifestyle, and familial factors. Unhealthy dietary practices, increased consumption of processed foods and sugar-sweetened beverages, prolonged screen time, inadequate physical activity, insufficient sleep, and positive family history were identified as important determinants associated with excess body weight. Conclusion: Overweight and obesity among adolescents represent an emerging public health challenge in South Kerala. Identification of modifiable risk factors provides an opportunity for early intervention through school-based health promotion, nutritional education, regular physical activity, and family-centred preventive strategies to reduce future non-communicable disease burden. Keywords: Adolescent obesity; Overweight; High school students; Body mass index; Dietary habits; Physical activity; Sedentary behaviour; Kerala; Cross-sectional study; Non-communicable diseases.

Background: Lumbar disc herniation (LDH) is a common cause of low back pain and lumbar radiculopathy, resulting in significant disability and reduced quality of life. Although conservative management remains the first-line treatment, many patients experience persistent symptoms requiring interventional pain management. Various minimally invasive procedures, including epidural steroid injections, selective nerve root blocks, pulsed radiofrequency, and image-guided interventions, have been increasingly utilized; however, their comparative effectiveness remains under investigation. The objective is to systematically evaluate the efficacy, safety, and clinical outcomes of interventional pain management techniques for lumbar disc herniation, with particular emphasis on anesthetic and corticosteroid injections. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Electronic databases including PubMed, MEDLINE, Embase, Scopus, Cochrane Library, and Google Scholar were searched for studies published between January 2010 and March 2026. Eligible studies included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses evaluating transforaminal epidural steroid injections (TFESI), interlaminar epidural steroid injections (ILESI), caudal epidural steroid injections (CESI), selective nerve root blocks (SNRB), pulsed radiofrequency (PRF), and image-guided interventions in adults with lumbar disc herniation. Fourteen studies met the inclusion criteria and were included in the qualitative synthesis. Results: TFESI demonstrated the strongest evidence for short- and medium-term pain relief and functional improvement in lumbar radiculopathy. ILESI and CESI were also effective, although generally less favorable than TFESI. Pulsed radiofrequency of the dorsal root ganglion showed significant and sustained reductions in pain and disability scores, particularly when combined with epidural steroid injections. Fluoroscopy-guided interventions remained the gold standard for procedural accuracy, while ultrasound-guided techniques offered comparable efficacy without radiation exposure. CT-guided procedures provided excellent anatomical precision in complex cases. Overall, interventional techniques were associated with meaningful improvements in pain, function, and quality of life with acceptable safety profiles. Conclusion: Interventional pain management techniques are effective minimally invasive treatment options for lumbar disc herniation. TFESI currently demonstrates the most robust evidence among epidural approaches, while PRF appears promising for longer-term symptom control. Further high-quality randomized controlled trials with extended follow-up are needed to establish optimal treatment algorithms and long-term outcomes. Keywords: Lumbar disc herniation, lumbar radiculopathy, epidural steroid injection, transforaminal epidural steroid injection, pulsed radiofrequency, selective nerve root block, interventional pain management, fluoroscopy-guided injection.

Background: Childhood obesity and hypertension are emerging public health concerns worldwide. Rapid urbanization, sedentary lifestyles, unhealthy dietary habits, and increased screen time have contributed to a growing burden of overweight, obesity, and elevated blood pressure among school-aged children. Early identification of these risk factors is essential to prevent future cardiovascular morbidity and mortality. Previous Indian studies have demonstrated a significant association between obesity and elevated blood pressure among school children. The aim is to estimate the prevalence of obesity, overweight, prehypertension and hypertension among school children of age 10-16 years in Tirupati urban area. Materials and Methods: A cross-sectional observational study was conducted among school-going children aged 10–16 years in selected schools of Tirupati. Around 10 months for data collection (i.e., from September 2022 to June 2023). Another 2 months for data compilation and analysis and report writing (i.e., July to August 2023). Demographic details, anthropometric measurements including height and weight, and blood pressure recordings were obtained using standardized procedures. BMI was calculated and categorized according to age- and sex-specific reference standards. Blood pressure was classified as normotension, prehypertension, or hypertension based on pediatric blood pressure guidelines. Data were analyzed using appropriate statistical methods to determine prevalence and associations. Results: In the present study, prevalence of overweight, obesity, prehypertension and hypertension are 13.9%, 9.5%, 1.2% and 0.4% among apparently healthy school children aged 10-16 years of Tirupati urban. Overweight and obesity was more in students who have family history of obesity and this is statistically significant (p=0.001). In this study the prevalence of prehypertension and hypertension was significantly higher in overweight and obese compared to children with normal BMI indicating overweight and obesity as a risk factor for prehypertension and hypertension. Since adult hypertension starts early in life, if these trends continue further, cardiovascular morbidity & mortality will be enormous in future. Conclusion: The study highlights the growing burden of overweight, obesity, prehypertension, and hypertension among school-going children in the Tirupati area. Regular school-based screening programs, promotion of healthy dietary habits, increased physical activity, and lifestyle modification strategies are essential for early detection and prevention of future cardiovascular diseases. Early intervention during childhood can substantially reduce the risk of adult hypertension and other non-communicable diseases. Keywords: Obesity, Overweight, Prehypertension, Hypertension, Body Mass Index, School Children, Tirupati, Adolescents.

Background: Ultrasound-guided brachial plexus blocks are widely used for anaesthesia in upper limb surgeries. The supraclavicular approach is a well-established technique, while the costoclavicular approach is a newer infraclavicular variant with potentially improved block characteristics. This study aimed to compare the efficacy of ultrasound-guided costoclavicular brachial plexus block (CC-BPB) with supraclavicular brachial plexus block (SC-BPB). Materials and Methods: This prospective, randomized controlled study was conducted on 50 ASA I–II patients aged 18–65 years undergoing elective upper limb surgery. Patients were randomly allocated into two groups: Group C (CC-BPB) and Group S (SC-BPB), with 25 patients in each group. Both groups received 20 mL of local anaesthetic mixture (0.5% bupivacaine and 2% lignocaine with adrenaline in equal volumes). Primary outcome was onset of motor block. Secondary outcomes included onset of sensory block, time to complete block, block performance time, duration of block, duration of analgesia, block success rate, and complications. Results: The onset of sensory and motor blockade was significantly faster in the SC-BPB group compared to the CC-BPB group (2.12 ± 0.67 vs. 3.16 ± 0.85 min and 2.04 ± 1.21 vs. 4.40 ± 1.58 min; P < 0.001). However, CC-BPB achieved complete sensory and motor block earlier than SC-BPB (9.04 ± 2.30 vs. 12.60 ± 2.55 min and 11.84 ± 2.37 vs. 16.76 ± 3.44 min; P < 0.001). Block performance time was significantly shorter in CC-BPB (9.08 ± 2.86 vs. 11.28 ± 2.89 min; P = 0.006). Duration of analgesia was comparable between CC-BPB and SC-BPB groups (13.44 ± 1.42 vs. 13.60 ± 1.47 hours; P = 0.70). Block success rate was similar (84% vs. 80%), and no significant complications were observed in either group. Conclusion: Both ultrasound-guided costoclavicular and supraclavicular brachial plexus blocks are safe and effective techniques for upper limb surgery. SC-BPB provides faster initial onset of blockade, whereas CC-BPB offers quicker achievement of complete surgical anaesthesia and shorter procedural time. Postoperative analgesia and safety profiles are comparable between the two techniques. Keywords: Costoclavicular block, supraclavicular block, brachial plexus block, ultrasound-guided regional anaesthesia, upper limb surgery.

Background: Although many cases Chronic otitis media (COM) of the active mucosal type is often perpetuated by focal sepsis in the upper aerodigestive tract, Sinusitis is a known but under-evaluated contributor. This study aimed to determine the role of sinusitis in persistent ear discharge and to assess the improvement in middle ear mucosa after sinus disease clearance. The aim is to establish the role of sinusitis as a focal sepsis in patients with active mucosal type of chronic otitis media. Materials and Methods: This prospective study was conducted from January 2020 to September 2020 in the Department of Otorhinolaryngology, Thanjavur Medical College, Tamilnadu. Forty patients aged 18–45 years with active mucosal COM and chronic sinusitis were included. All underwent diagnostic nasal endoscopy (DNE) and CT paranasal sinuses. Functional endoscopic sinus surgery (FESS) with or without septal correction was performed. Preoperative and postoperative middle ear mucosal status was monitored at three months. Results: Among 40 patients, 19 (47.5%) were males and 21 (52.5%) females, most in the 26–35 years age group. On DNE, 12.5% had enlarged bulla and paradoxical middle turbinate. CT showed Grade I disease in 62.5%, Grade II in 20%, Grade III in 12.5%, and Grade IV in 5%. Preoperatively, 77.5% had moist edematous mucosa and 22.5% boggy polypoidal mucosa. Post-FESS, 35 (87.5%) patients showed improved middle ear mucosal status, while 5 (12.5%) had no improvement. Non-improvement was due to Eustachian tube hypofunction (n=1) or recurrence of sinus disease from surgical failure (n=4). Conclusion: Sinusitis is a major etiological factor in persistent ear discharge in active mucosal COM. Diagnostic nasal endoscopy is mandatory in all such patients. FESS effectively improves middle ear mucosal status and should be considered early. Keywords: Chronic otitis media active mucosal disease, Functional endoscopic sinus surgery, Septal correction, Enlarged middle turbinate & Chronic sinusitis.

Background: Endometriosis is a chronic gynecological disorder affecting approximately 10% of women of reproductive age and is a major cause of infertility. Delayed diagnosis remains a significant challenge due to the nonspecific nature of symptoms and limited awareness, potentially leading to disease progression and adverse reproductive outcomes. Aim: To evaluate the effect of diagnostic delay in endometriosis on reproductive outcomes among women attending gynecology and infertility clinics. Materials and Methods: This observational study was conducted in the Department of Obstetrics and Gynecology, Sree Venkateshwaraa Medical College and Research Institute, Redhills, Chennai, from March 2025 to February 2026. A total of 100 women aged 20–40 years with confirmed endometriosis were included. Data regarding age, age at symptom onset, age at diagnosis, diagnostic delay, stage of endometriosis, infertility status, IVF requirement, pregnancy outcomes, and live birth outcomes were collected from medical records. Statistical analysis was performed using SPSS version 26.0, with a p-value <0.05 considered statistically significant. Results: The mean age of participants was 31.8 ± 5.4 years. The mean age at symptom onset and diagnosis were 24.2 ± 4.6 years and 29.8 ± 5.1 years, respectively, resulting in a mean diagnostic delay of 5.6 ± 2.8 years. Infertility was observed in 62% of women, while 35% required IVF. Patients with diagnostic delays exceeding 7 years had significantly higher infertility rates (83.3%), greater IVF utilization (50.0%), lower pregnancy rates (40.0%), and reduced live birth rates (30.0%) compared to those diagnosed within 3 years (p<0.05). Conclusion: Prolonged diagnostic delay in endometriosis is associated with poorer reproductive outcomes. Early diagnosis and timely intervention may improve fertility potential and live birth rates. Keywords: Endometriosis, Diagnostic Delay, Infertility, IVF, Reproductive Outcomes, Live Birth.

Background: Femur is the longest and strongest bone in human body. Determination of sex is relatively easy if the entire skeleton is available for examination. In the absence of skull and pelvis, long bones either individually or in combination has been used for determining sex. Materials and Methods: In this study, total of 141 human femora (115 male, 26 female) of known sexes were taken from Anatomy Department, M. P. Shah Government Medical College, Jamnagar, Gujarat by using demarcating point method. In this study, we measured the sub trochanteric transverse diameter of the upper end of the shaft of femur, where it shows maximum lateral projection. When the lateral projection was not clear, this measurement was taken 5cm below the base of lesser trochanter, measured with sliding caliper. Results: The average Sub trochanteric transverse diameter of right male femur was 28.38 mm, average Sub trochanteric transverse diameter of right female femur was 26.33 mm, average Sub trochanteric transverse diameter of left male femur was 28.75 mm and average Sub trochanteric transverse diameter of left female femur was 27.71 mm. Demarcating Point for Sub trochanteric transverse diameter of right male femur was >34.02 mm and for right female femur was <20.76 mm, while for left male femur >39.97 mm and for left female femur <20.64 mm. Conclusion: Mean Sub trochanteric transverse diameter of male femur is more than the mean Sub trochanteric transverse diameter of female femur in the Gujarati population of present study. Findings of this study may be useful in medico legal cases for estimation of sex from available fragmentary femora. The study can also be useful to anatomist & physical anthropologist. Keywords: femur, sexual dimorphism, sub trochanteric transverse diameter of femur.

Background: Toddy, a naturally fermented alcoholic beverage obtained from the sap of palm trees, is widely consumed in rural parts of Telangana and other regions of South India. Its consumption is often influenced by cultural traditions, social practices, perceived health benefits, and other psychosocial factors. Frequent consumption may lead to alcohol-related health and psychiatric problems, making it an important public health concern. The aim is to identify and analyze the factors influencing toddy consumption among adults in a rural community of Telangana State. Materials and Methods: A community-based cross-sectional study was conducted in Yenkapally village, Moinabad Mandal, Ranga Reddy district, Telangana. Approval and permission were obtained from the concerned village authorities. A total of 100 adult participants were recruited after obtaining informed consent. Data were collected using a structured questionnaire that included socio-demographic details, the ICD-10 Diagnostic Criteria for Alcohol Dependence, the Severity of Alcohol Dependence Questionnaire (SADQ), and a checklist assessing perceived factors influencing toddy consumption. Results: The majority of participants were illiterate (84.4%). Decreased sleep was the most commonly reported factor influencing toddy consumption (92%), followed by physical fatigue (36%), low cost and easy availability (30%), psychosocial stress (20%), bereavement (20%), peer pressure (16%), and other substance abuse (16%). Factors such as physical fatigue, decreased sleep, peer pressure, psychosocial stress, and bereavement were more commonly reported among women aged 51–60 years. Peer pressure showed a statistically significant association with age (p<0.05) and duration of toddy consumption (p<0.05). Conclusion: The findings indicate that peer pressure is the predominant factor influencing toddy consumption among adults in this rural population. Cultural beliefs regarding health benefits, physical fatigue, and sleep disturbances also contribute substantially. These findings highlight the need for community-based awareness programs and targeted interventions addressing social influences and misconceptions related to toddy consumption. Keywords: Toddy Consumption, Rural Population, Telangana, Peer Pressure, Alcohol Use, Substance Dependence.

Background: Cyanotic congenital heart diseases (CCHDs) are complex structural defects typically diagnosed in early life due to overt clinical symptoms. However, late presentations, especially asymptomatic cases, are exceedingly rare. Objectives: To report an unusual case of an asymptomatic adult diagnosed incidentally with congenitally corrected transposition of the great arteries (CCTGA) and associated cardiac anomalies. Materials and Methods: A 19-year-old male was referred for evaluation after being declared unfit during routine blood donation. A detailed history, physical examination, chest radiograph, ECG, and transthoracic echocardiography were performed. Due to poor imaging windows, the patient was referred to a tertiary care center for advanced evaluation. Results: Echocardiography revealed dextrocardia, CCTGA, a large perimembranous ventricular septal defect (VSD), severe pulmonary stenosis, and severe tricuspid regurgitation, with preserved biventricular function. Despite these findings, the patient remained completely asymptomatic. He was referred for planned surgical correction. Conclusion: This case demonstrates that CCTGA with severe associated anomalies can remain clinically silent well into adulthood. Incidental diagnosis in an asymptomatic patient underscores the importance of routine screening and clinical vigilance. Early detection is crucial to prevent complications and guide timely intervention. Keywords: Cyanotic congenital heart disease; CCTGA; Dextrocardia; Asymptomatic presentation; Ventricular septal defect; Tricuspid regurgitation.

Background: Functional constipation is one of the most prevalent functional gastrointestinal disorders in pediatric populations, with a global prevalence ranging from 0.7% to 29%. Beyond its physical burden, functional constipation is increasingly recognized as a condition with significant psychosocial underpinnings. Despite the growing evidence on the role of behavioral and environmental factors, there is a paucity of observational data from the Indian subcontinent, particularly from Rajasthan, addressing the psychosocial determinants of this condition in children. Materials and Methods: This was a hospital-based observational study conducted in the Department of Paediatrics, Mahatma Gandhi Hospital, Jaipur, from April 2024 to November 2025. A total of 150 children aged 3-15 years who fulfilled the Rome IV criteria for functional constipation were enrolled. Detailed clinical history, bowel habit profile and a comprehensive psychosocial assessment were recorded using a pre-designed structured proforma and a self-designed questionnaire. Data were analyzed using SPSS version 28.0. Descriptive statistics, Chi-square test, Fisher exact test and Mann-Whitney U test were applied. A p-value of <0.05 was considered statistically significant. Results: The majority of children were in the 6-10 years age group (45.3%), with a mean age of 7.53 ± 3.10 years and a marginal male predominance (51.3%). Hard stools (Bristol Type 1: 42.7%) and reduced stool frequency were the dominant clinical features. Key psychosocial factors identified included school-related stress (28.7%), irregular meals (21.3%), high screen time (17.3%), low parent-child interaction (14.0%) and family conflict (10.7%). Statistically significant associations were observed between psychosocial domains and age (p=0.0015), stool frequency (p=0.0128), Bristol stool type (p=0.0084) and laxative use (p=0.0064). Conclusion: Functional constipation in children is a multifactorial condition with significant psychosocial involvement. Psychological factors were significantly associated with greater disease severity including harder stools and reduced bowel frequency, whereas behavioral/ social factors were associated with higher laxative use. A comprehensive, holistic management approach incorporating dietary modification, behavioral interventions, psychological support and parental education is essential. Keywords: Functional constipation, children, psychosocial factors, Rome IV criteria, school stress, screen time, bowel habits, pediatric gastroenterology.

Background: Menstruation reflects normal hypothalamic-pituitary-ovarian axis function in adolescents, and Body Mass Index (BMI) is a key indicator of nutritional status influencing reproductive health. Rural-urban differences in diet, socioeconomic status, and lifestyle can affect both BMI and menstrual health. Objectives: 1) To categorise BMI and compare impact of BMI on menstrual patterns and menstrual dysfunctions among rural and urban adolescent schoolgirls. 2) To estimate the prevalence of menstrual irregularities among them. 3) To predict the probability of menstrual irregularities based on multiple lifestyle factors in them. Materials and Methods: An observational cross-sectional analytical study was conducted among 277 adolescent schoolgirls (148 rural, 129 urban) aged 11-16 years in Srikakulam for about 3 months, using convenient sampling technique. Data on sociodemographic factors, anthropometry, lifestyle, and menstrual history were collected via questionnaire and analysed in Epi Info 7 using Chi-square test, t-test, and logistic regression. Results: Menstrual irregularity was significantly higher in rural girls (63.5%) than urban girls (22.4%), with residence as the strongest predictor (OR=0.036, p<0.001). Overweight BMI significantly increased odds of irregularity (OR=4.41, p=0.027). Mean BMI did not differ between groups (p=0.487) or between girls with/without irregularity (p=0.199). BMI was associated with school absenteeism due to pain (p=0.0075) and PCOS diagnosis (p=0.0027) in rural girls; maternal illiteracy was linked to irregularity (p=0.007). Lifestyle factors showed no independent association. Conclusion: Residence and overweight BMI are significant predictors of menstrual irregularity. School-based menstrual health education, nutritional support, and maternal awareness programmes are needed, especially in rural areas. Keywords: Adolescents, BMI, Menstrual irregularities, Rural-urban, PCOS.

Population aging and multi-morbidity among elderly diabetic patients lead to polypharmacy, increasing the risk of adverse drug events, non-adherence, and rising healthcare costs.Objectives: To assess the prevalence of polypharmacy and examine its associated demographic and clinical factors among elderly diabetic patients in Tamil Nadu. Methodology: A cross-sectional study was conducted in 2025 among 300 randomly selected type 2 diabetes mellitus patients aged ≥ 60 years across public and private facilities in Tamil Nadu. Data were collected via face-to-face interviews using pre-tested questionnaires and verified with medical records. Polypharmacy was defined as using five or more concurrent medications. Statistical analysis was performed using SPSS version 26.0. Results: The mean age of the participants was 65.3 ± 9.33 years, and 73.3% had co-morbidities. The prevalence of polypharmacy (>5 medications) was 47.0%. Polypharmacy was significantly associated with higher age (69.38 ± 4.6 vs. 63.9 ± 3.7 years; p=0.002), longer duration of diabetes (p=0.01), and presence of co-morbidities (p<0.001). Patients with polypharmacy experienced significantly higher adverse effects (65.2% vs. 45.3%; p=0.001), greater treatment non-adherence (64.5% vs. 47.2%; p=0.003), increased hospitalization rates (p<0.001), and higher monthly expenditure (p=0.004). Dizziness (28.0%) and gastritis (18.0%) were the most common side effects. Conclusion: Polypharmacy is highly prevalent among elderly diabetic patients in Tamil Nadu and is tightly linked to poor clinical and economic outcomes. Routine medication reviews, deprescribing strategies, and multi-disciplinary interventions are essential to optimize therapy. Keywords: Polypharmacy, diabetes, determinants.

Background: Diabetes mellitus increases healthcare costs and reduces patient productivity, leading to long term financial strain and poorer quality of life. Due to the paucity of data on the economic burden and quality of life among type 2 Diabetic patients in Kerala, this study was planned to assess the economic burden and quality of life of patients with type 2 Diabetes mellitus in a rural area of Malappuram district, Kerala. Materials and Methods: A community based cross-sectional study was done over a 14-month period among 306 chronic Type 2 DM patients. Malayalam version of WHO-BREF QOL questionnaire was used to assess quality of life. Economic burden was assumed when health expenditure equaled or exceeded 10% of total household expenditure. Results: The mean age of the study participants was 61.62 ±10.52 years. About three-fourth of the study population were having co-morbidities along with Diabetes mellitus. About 70% were having macro-vascular complications whereas only 37% were having micro-vascular complications. About 36% of the study participants were having economic burden. The economic burden was significantly associated with macro vascular and micro vascular complications, private source of treatment, oral hypoglycemic agents and emergency costs. More than half participants (52%) were having poor quality of life. Poor quality of life was significantly associated with economic burden. Conclusion: Comprehensive diabetes management strategies should go beyond clinical care and also address financial challenges, provide psychosocial support, and improve access to affordable treatment. Keywords: Diabetes mellitus, Economic burden, Kerala, Quality of life, Type 2 Diabetes mellitus.

Background: Acute appendicitis is among the most common pediatric surgical emergencies. Appendicoliths are calcified concretions that may obstruct the appendiceal lumen and predispose children to severe inflammation, perforation, and abscess formation. Their role in predicting disease severity in pediatric appendicitis remains clinically significant. The aim is to determine the clinical significance of appendicoliths in pediatric appendicitis, with particular emphasis on their prevalence, associated risk factors, and their relationship with appendiceal perforation. Materials and Methods: This retrospective observational study was conducted in the Department of Paediatric Surgery, Sri Venkateshwara Medical College, Tirupati. A total of 170 children below 12 years diagnosed with acute appendicitis were included. Clinical, laboratory, radiological, and intraoperative data were analyzed. Variables studied included appendicolith size, number, location, inflammatory markers, and operative findings. Statistical analysis was performed using R statistical software. Results: Appendicoliths were identified in a significant proportion of pediatric appendicitis cases and were associated with increased rates of perforation, abscess formation, elevated inflammatory markers, and prolonged duration of symptoms. Larger appendicoliths (≥5 mm) and appendicoliths located at the appendiceal base demonstrated higher association with perforation and severe disease. Conclusion: Appendicoliths are important predictors of complicated pediatric appendicitis. Early radiological detection and timely surgical intervention may reduce morbidity associated with perforation and abscess formation. Keywords: Pediatric appendicitis; Appendicolith; Fecalith; Perforated appendicitis; Complicated appendicitis; Appendicolith size; Ultrasound; Risk stratification; Acute abdomen; Pediatric surgery.

Background: Hypospadias is one of the most common congenital anomalies affecting the male external genitalia. Urethroplasty remains the definitive treatment; however, postoperative complications such as urethrocutaneous fistula (UCF), glans dehiscence (GD), and wound infection continue to present major clinical challenges. Regional analgesia techniques, particularly caudal and epidural blocks, are frequently used in pediatric urologic surgeries for perioperative pain management. Nevertheless, their influence on postoperative complications remains controversial. Aim:To evaluate the impact of central neuraxial regional analgesia (caudal/epidural block) on postoperative complications—specifically urethrocutaneous fistula and glans dehiscence in children undergoing primary urethroplasty for distal and mid-penile hypospadias. Materials and Methods: This retrospective cohort study was conducted over a 10-year period at a tertiary-care teaching hospital in India. A total of 112 children younger than 12 years who underwent primary urethroplasty for distal or mid-penile hypospadias were included. Patients were categorized into regional analgesia and no regional block groups. Demographic data, anesthetic details, surgical techniques, and postoperative complications were analyzed. Statistical analysis was performed using Chi-square test, Fisher’s exact test, and binary logistic regression were used for analysis, with p < 0.05 considered statistically significant. Results: Among the 112 children included, 77 received regional analgesia while 35 underwent surgery without regional block. Postoperative complications occurred in 25.5% of children receiving regional analgesia and 18.4% of those without block; however, the difference was not statistically significant (p = 0.38). UCF occurred in 14.3% of the regional block group and 8.6% of the no-block group, while GD occurred in 9.1% and 5.7%, respectively. Tubed urethroplasty demonstrated the highest complication rate and was identified as an independent predictor of postoperative complications (OR 3.18, 95% CI 1.12–8.94, p = 0.02). Regional analgesia was not an independent predictor of complications (OR 1.42, 95% CI 0.54–3.71, p = 0.46). Conclusion: Central neuraxial regional analgesia, including caudal and epidural blocks, did not significantly increase postoperative complications following primary urethroplasty in children. Surgical technique and severity of deformity appeared to have greater influence on postoperative outcomes than anesthetic technique. Regional analgesia may therefore continue to be safely used as part of multimodal perioperative pain management in pediatric hypospadias surgery. Keywords: Hypospadias, urethroplasty, caudal analgesia, epidural analgesia, regional block, urethrocutaneous fistula, glans dehiscence, pediatric urology.

Background: Colorectal carcinoma is one of the most frequent malignancies in the world. Recent Indian study shows that there is a significant increase in incidence of colonic carcinoma but the incidence of rectal carcinoma remains steady. Aim: The clinico-pathological study of colorectal carcinoma in a tertiary referral institute of India and to compare the above data with the data from the western world. Materials and Methods: The prospective observational study carried out in hospital in Eastern India. from July 2017 to October 2019. All patients who were diagnosed as a case of colorectal carcinoma were included in the study. Detailed history of the patients was recorded including chief complaints like pain in abdomen & per rectal bleed. On examination bleeding per rectum, mass per rectum and pallor, growth and types of surgery performed. Results: 40 patients were included in this study of which 11 were 41years. The mean age of this series was 50.90 ± 14.82 years. The M:F ratio of 2.75:1.25. 92.5% of patients clinically presented with altered bowel habits 72.5% of patients had pain in abdomen, 60% patients had per rectal bleeding followed by mass per rectum (52.5%) and lump in abdomen (30%) subsequently. Most common histological type, irrespective of age, was adenocarcinoma (93.8%). histopathological type, 47.5% cases showed a well differentiated type, 15% showed moderately differentiated type and 12% showed poorly differentiated types. Conclusion: However, the success rate of detecting early stage colorectal cancer is poor in our country as compared to western world. This is mainly because the symptomatology of colorectal cancer and benign colorectal diseases often overlap second, routine screening programs to detect early colorectal cancer are not followed religiously. However, early detection of colorectal malignancy and radical surgery well benefit the patients before they become grossly symptomatic. Keywords: colon, rectum, malignancy, srCEA.

Background: Percutaneous nephrolithotomy (PCNL) is the standard surgical procedure for large renal calculi but is frequently associated with significant postoperative pain. Ultrasound-guided erector spinae plane block (ESPB) has emerged as an effective regional analgesic technique. This study evaluated the efficacy of adding dexmedetomidine to levobupivacaine for ESPB in patients undergoing PCNL. Materials and Methods: This prospective, randomized comparative study included 60 patients (ASA I–II, 18–70 years) undergoing PCNL under general anaesthesia. Participants were randomized into two equal groups. Group A received ultrasound-guided ESPB with 19 mL of 0.25% levobupivacaine plus 1 mL normal saline, while Group B received 19 mL of 0.25% levobupivacaine with dexmedetomidine 20 μg. Postoperative pain was assessed using the Visual Analogue Scale (VAS) for 24 hours. Results: Baseline demographic and perioperative characteristics were comparable between the groups (p>0.05). The duration of postoperative analgesia was significantly longer in Group B than in Group A (1048.57 ± 255.09 vs. 397.77 ± 90.20 minutes; p<0.001). Total 24-hour tramadol consumption was significantly lower in Group B (113.33 ± 45.36 mg) compared with Group A (250.00 ± 49.13 mg; p<0.001). VAS scores were significantly lower in Group B at 6, 8, and 12 hours postoperatively (p<0.001), while scores were comparable during the early postoperative period and at 24 hours. Conclusion: The addition of dexmedetomidine (20 μg) to 0.25% levobupivacaine in ultrasound-guided ESPB significantly prolongs postoperative analgesia, reduces postoperative opioid requirement, and improves pain control following PCNL without compromising haemodynamic stability or increasing adverse effects. Keywords: Percutaneous nephrolithotomy, Erector spinae plane block, Dexmedetomidine Levobupivacaine, Postoperative analgesia, Regional anaesthesia.

Background: Patient positioning following spinal anaesthesia influences the intrathecal spread of hyperbaric local anaesthetics and may affect block characteristics, haemodynamic stability, and postoperative analgesia. Limited evidence exists regarding the effect of a precisely measured 10° Reverse Trendelenburg position following administration of 0.75% hyperbaric ropivacaine. The aim is to compare the effects of a 10° Reverse Trendelenburg position with the conventional supine position following subarachnoid block on sensory and motor block characteristics, haemodynamic parameters, and duration of analgesia in patients undergoing elective lower limb surgeries. Materials and Methods: This prospective, randomized comparative study included 60 ASA I–II patients aged 18–60 years undergoing elective lower limb surgeries under spinal anaesthesia. Patients were randomly allocated into two groups: Group T (10° Reverse Trendelenburg; n=30) and Group S (supine position; n=30). All patients received 2.5 mL of 0.75% hyperbaric ropivacaine intrathecally. Sensory and motor block characteristics, haemodynamic variables, oxygen saturation, and duration of analgesia were assessed. Statistical analysis was performed using the Independent Student's t-test, Mann–Whitney U test, and Chi-square test, with p<0.05 considered statistically significant. Results: Baseline demographic characteristics were comparable between the groups. Group T demonstrated a significantly lower maximum sensory block level (predominantly T10 vs. higher thoracic levels in Group S; p=0.04), prolonged two-segment regression time (98.60±18.55 vs. 84.93±14.22 min; p=0.002), longer motor block duration (112.33±21.44 vs. 89.67±12.77 min; p=0.002), and significantly prolonged postoperative analgesia (246.10±26.03 vs. 202.77±20.35 min; p<0.0001). Although the onset of sensory and motor blockade was slightly slower in Group T, patients maintained significantly higher systolic blood pressure and mean arterial pressure throughout most of the intraoperative period. Conclusion: A goniometrically measured 10° Reverse Trendelenburg position following spinal anaesthesia with 0.75% hyperbaric ropivacaine effectively restricts cephalad spread, prolongs sensory and motor blockade, extends postoperative analgesia, and improves haemodynamic stability without compromising oxygenation. Keywords: Spinal anaesthesia, Reverse Trendelenburg position, Hyperbaric ropivacaine, Subarachnoid block, Haemodynamic stability, Sensory block, Motor block, Postoperative analgesia, Lower limb surgery.

Background: Uterus is a vital reproductive organ. It is subjected to many benign and malignant diseases. Many treatment options are available, including medical, conservative and surgical modalities; however, hysterectomy remains one of the commonly performed gynecological surgical procedures¹. Despite the availability of various treatment options, such as medical management and conservative surgical techniques, hysterectomy continues to be an important gynecological surgical procedure². The indications for hysterectomy vary from benign to malignant conditions and include abnormal uterine bleeding, leiomyoma, adenomyosis, endometriosis, uterine prolapse, chronic pelvic pain, pelvic inflammatory disease and gynecological malignancies.³ Aim: To Study different Histopathological Lesions of Uterus in female sundergone Hysterectomy. Objectives: To study age wise incidence of uterine lesions in hysterectomy specimens and to analyze the patterns of lesions in hysterectomy specimens. Materials and Methods: All hysterectomy specimens received in the histopathology section were included. Relevant clinical history was noted from case records. Specimens were fixed in 10% neutral buffered formalin, grossed and representative sections were submitted. After routine processing and embedding, sections were stained with hematoxylin and eosin and examined microscopically Results: Total 363 hysterectomy specimens were examined by histopathological examination. Most common endometrial finding was secretory phase. In myometrium most common lesion was leiomyoma and in cervix most common finding is chronic non-specific cervicitis. Keywords: Hysterectomy, uterine lesions.

Background: Assertiveness and resilience are essential psychological attributes that enable nursing undergraduates to communicate effectively, adapt to challenging clinical situations, and provide safe, patient-centered care. Understanding the relationship between these attributes may help nursing educators develop interventions that enhance students' professional competence and emotional well-being. Aim: The present study aimed to explore the relationship between assertiveness and resilience among nursing undergraduates. Specifically, the study sought to examine the correlation between these two psychological attributes, determine the association between assertiveness and selected socio-demographic variables, and assess the association between resilience and selected socio-demographic variables. The findings are expected to provide evidence for developing educational strategies that enhance both professional competence and psychological well-being among future nurses. Materials and Methods: A quantitative cross-sectional correlational study was conducted among 192 undergraduate nursing students at the College of Nursing, AIIMS Patna, using a non-probability convenience sampling technique. Data were collected using a structured socio-demographic questionnaire, a standardized assertiveness scale, and a standardized resilience scale. Descriptive statistics, Pearson's correlation coefficient, and Chi-square test were used for data analysis. A p-value of <0.05 was considered statistically significant. Results: The mean assertiveness score was −3.09 ± 13.22, while the mean resilience score was 53.46 ± 25.00. Pearson's correlation analysis revealed a weak negative and statistically non-significant correlation between assertiveness and resilience (r = −0.09, p = 0.215). Assertiveness showed significant associations with parenting style (p = 0.002), 10th standard academic marks (p = 0.006), and present academic year (p = 0.007). Resilience was significantly associated with the medium of instruction in the 12th standard (p = 0.043) and formal training (p = 0.005). No significant associations were observed with most other socio-demographic variables. Conclusion: Assertiveness and resilience were not significantly correlated among nursing undergraduates. However, selected educational and environmental factors influenced each construct independently. Integrating assertiveness and resilience enhancement programmes into undergraduate nursing education may strengthen communication skills, psychological well-being, and professional preparedness. Keywords: Assertiveness, Correlational study, Cross-sectional study, Nursing, Nursing education, Resilience, Students, Stress, Undergraduates, Well-being.

Background: Enterococci have emerged as important nosocomial pathogens due to their intrinsic resistance and ability to acquire antimicrobial resistance genes. The emergence of Vancomycin Resistant Enterococci (VRE) is a major therapeutic challenge because of limited treatment options and potential transmission of resistance determinants. The aim is to determine the prevalence of Vancomycin Resistant Enterococci among clinical isolates and characterize resistance phenotypes and genotypes by phenotypic methods and PCR Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology, Chengalpattu Medical College, from March 2016 to February 2017. A total of 200 Enterococcus isolates recovered from urine, pus, blood, and body fluids were included. Species identification was performed using conventional biochemical methods. Antimicrobial susceptibility testing was performed by Kirby–Bauer disc diffusion method according to CLSI guidelines. Vancomycin resistance was screened by vancomycin screen agar and confirmed by vancomycin minimum inhibitory concentration (MIC) using broth microdilution method. Detection of vanA and vanB genes was performed by PCR. Results: Among 200 Enterococcus isolates, five (2.5%) were identified as VRE. Of these, three were E. faecium and two were E. faecalis. VRE isolates showed vancomycin MIC values ranging from 32–128 µg/ml. PCR analysis revealed vanA gene in three isolates and vanB gene in two isolates. All VRE isolates showed susceptibility to linezolid and tigecycline. Conclusion: The detection of VRE with transferable resistance genes emphasizes the need for routine screening, molecular confirmation, antimicrobial stewardship, and strict infection control practices to prevent dissemination of resistant Enterococcus strains. Keywords: Enterococcus, Vancomycin Resistant Enterococci, vanA, vanB, PCR, antimicrobial resistance.

Background: Cardiometabolic risk often begins with subtle biochemical abnormalities before the development of overt diabetes mellitus, hypertension or cardiovascular disease. Serum uric acid, triglyceride-glucose index and atherogenic index of plasma are inexpensive biochemical markers that reflect metabolic stress, insulin resistance and atherogenic dyslipidemia. Their combined assessment may help identify early biochemical cardiometabolic risk in routine laboratory practice. Aim: To evaluate the serum uric acid–triglyceride-glucose index–atherogenic index of plasma cluster as a low-cost biochemical signature of early cardiometabolic risk in Indian adults. Materials and Methods: This cross-sectional observational study was conducted at Government Medical College, Jangaon, Telangana, during 2024–2025. A total of 100 adult participants were included. Serum uric acid, fasting plasma glucose and lipid profile were estimated. Triglyceride-glucose index and atherogenic index of plasma were calculated using routine biochemical parameters. Participants were categorized into low, moderate and high biochemical cardiometabolic risk groups based on clustering of serum uric acid, TyG index and AIP. Correlation analysis and ROC curve analysis were performed to assess the association and diagnostic performance of individual markers and the combined cluster. Results: Among 100 participants, 34.0% were categorized as low risk, 38.0% as moderate risk and 28.0% as high biochemical cardiometabolic risk. Overall, 66.0% showed moderate to high biochemical risk. Raised TyG index was observed in 54.0%, raised AIP in 49.0%, hyperuricemia in 38.0%, raised triglycerides in 46.0%, low HDL cholesterol in 42.0% and impaired fasting glucose range in 31.0%. Serum uric acid, TyG index and AIP increased progressively across risk groups. TyG index showed significant positive correlation with fasting plasma glucose, triglycerides, AIP and serum uric acid. ROC analysis showed AUC values of 0.76 for serum uric acid, 0.84 for TyG index and 0.82 for AIP. The combined SUA–TyG–AIP cluster showed the highest diagnostic performance, with AUC 0.91, sensitivity 89.3% and specificity 83.3%. Conclusion: The serum uric acid–TyG index–AIP cluster may serve as a simple, affordable and practical biochemical signature for identifying early cardiometabolic risk among Indian adults. The combined cluster performed better than individual markers and may be useful for routine laboratory-based screening, although prospective validation is required. Keywords: Serum uric acid; triglyceride-glucose index; atherogenic index of plasma; cardiometabolic risk; insulin resistance; dyslipidemia.

Background: Immediate implant placement into fresh extraction sockets has become an established treatment option because it reduces treatment duration, preserves alveolar ridge dimensions, and improves patient comfort. However, achieving predictable osseointegration and minimizing peri-implant bone loss remain important clinical challenges. Platelet-rich fibrin (PRF) and demineralized freeze-dried bone allograft (DFDBA) have been widely investigated as regenerative adjuncts to promote peri-implant bone healing, enhance osseointegration, and improve implant stability. This study evaluated the clinical stability of immediate implants placed in fresh mandibular posterior extraction sockets using PRF combined with DFDBA. Materials and Methods: This prospective clinical study included 11 patients requiring extraction of mandibular posterior teeth followed by immediate implant placement. PRF was prepared from autologous venous blood and combined with DFDBA to fill the peri-implant gap before primary wound closure. Implant stability was assessed three months after surgery using reverse torque and percussion tests. Standardized intraoral periapical radiographs were obtained immediately after implant placement and at three and six months to evaluate vertical peri-implant bone changes. Bone loss measurements at different follow-up intervals were compared using Student's t-test. Results: Eleven immediate implants were placed, of which 10 achieved successful osseointegration, resulting in an implant survival rate of 90.9% after six months of follow-up. One implant failed before second-stage surgery because of severe traumatic extraction and poor oral hygiene. Mean vertical bone loss among successfully osseointegrated implants increased from 0.043 ± 0.096 mm immediately after implant placement to 0.260 ± 0.117 mm at three months and 0.367 ± 0.240 mm at six months. Two patients demonstrated radiographic bone gain during follow-up. A statistically significant increase in vertical bone loss was observed between the immediate postoperative period and the three-month follow-up (t=3.38), whereas no significant difference was observed between the three- and six-month evaluations (t=0.82), indicating stabilization of peri-implant bone levels after the initial healing phase. Conclusions: Immediate implant placement in fresh mandibular posterior extraction sockets using PRF combined with DFDBA demonstrated favorable short-term clinical outcomes, with a 90.9% implant survival rate and minimal peri-implant bone loss after six months. The greatest bone remodeling occurred during the first three months, followed by stabilization of peri-implant bone levels. Although these findings suggest that PRF combined with DFDBA may support successful osseointegration and peri-implant bone preservation, larger randomized controlled studies with longer follow-up are required to confirm the long-term effectiveness of this treatment approach. Keywords: Immediate dental implant; Platelet-rich fibrin; Demineralized freeze-dried bone allograft; Fresh extraction socket; Osseointegration; Implant stability; Vertical bone loss; Mandibular posterior teeth; Bone regeneration; Oral implantolo

Background: Pulmonary fungal infections are increasingly recognised as important mimickers of TB, often leading to misdiagnosis and inappropriate treatment. The clinical overlap between TB and fungal infections such as Aspergillus species complicates diagnosis, particularly in resource-limited settings. This study aims to evaluate the prevalence of pulmonary fungal infections among TB patients in Raichur District, Karnataka, thereby contributing to improved clinical management and public health interventions. Aim: To screen for pulmonary fungal infections among patients with pulmonary tuberculosis attending a tertiary care hospital in Raichur district, Karnataka. Objectives • To determine the prevalence of pulmonary fungal infections in patients diagnosed with pulmonary tuberculosis. • To identify the spectrum of fungal species associated with pulmonary infections in these patients. • To assess the clinical significance of fungal co-infections in the management and outcome of pulmonary tuberculosis Materials and Methods: Study Design: Hospital-based observational prospective study conducted in a tertiary care hospital in Raichur District, Karnataka. Duration: Typically 1–2 years, allowing seasonal variation in fungal prevalence to be captured. Ethical approval obtained from the institutional review board before initiation of the study. Sample Size: 210 patients. Results: Out of 210 individuals, 20 tested positive, giving an overall positivity rate of 18.2%. Among males, 14 out of 131 were positive, representing 10.6%. Among females, 6 out of 79 were positive, representing 7.6%. The data show a higher positivity rate in males compared to females, though both groups contribute to the overall total. Our study depicts that the dominant species is Candida albicans, representing more than one-third (35%) of the isolates. Aspergillus species collectively (flavus, fumigatus, niger) account for half of the isolates (50%), showing their strong presence in the sample. Penicillium species contribute 15%, making them the least frequent but still notable. Conclusion: This study in Raichur District reinforces the global call to action integrating fungal diagnostics into TB care pathways is essential to reduce misdiagnosis, optimize patient management and address the hidden burden of pulmonary fungal infections in TB populations. Keywords: Pulmonary fungal infections, Co-infections, Tertiary care hospital, Raichur district, Screening methods.

Background: The growing effect of dengue infection on health and its mortality is an essential global issue. Therefore, it is of interest to study the current trends of dengue infection in India. Population explosion, poor waste management and drainage systems, migration, globalization, rapid urbanization, smart city work and diseases spread by the day-biting mosquito are the few reasons that dengue has made its place as one of the fastest emerging viral infections. In India case detection, case management, and integrated vector control are the main strategies for dengue prevention and control. Prevention of new incidence of dengue can be done by timely instituting the vector control measures. Materials and Methods: A retrospective study was conducted at a tertiary care centre for a period of 5 years. Samples from patients suggestive of dengue like illness were received at the department of Microbiology. The serum samples were tested for NS1 antigen detection, IgM and IgG antibody detection by Dengue Day1 test (immune chromatography method). Results & Conclusion: It was observed that Dengue cases start to rise in July and peaks in October and November and falls in December. The cases are seen more in monsoon and post monsoon season due to the favourable climate for the vector to breed and multiply. In the last 5 years it was also observed that the incidence of Dengue showed a decreasing trend after 2022. This may be due to the measures taken to control vector and promoting use of personal protection to get rid of mosquito bite. Keywords: dengue, seasonal variation, Immunochromatographic dengue test.

Artificial intelligence (AI), more specifically machine learning (ML) and deep learning (DL), is revolutionizing microbiology through the use of speeded-up microbial identification, antimicrobial resistance (AMR) prediction, drug discovery, and epidemiological surveillance. Culture-based assays, microscopy, and 16S rRNA sequencing are traditional techniques that are still necessary but hampered by time, scalability, and ability to differentiate closely related taxa. AI-based methods, such as convolutional neural networks (CNN), random forests, and transformer architectures, now facilitate high-throughput, fast analysis of genomic, proteomic, metabolomic, and imaging data, outperforming traditional diagnostics in sensitivity and reproducibility. In clinical microbiology, integration of AI with systems like MALDI-TOF MS and digital pathology platforms enables quicker pathogen identification, personalized therapy, and infection control. In addition to diagnostics, AI enables microbiome profiling, expediting the identification of new antimicrobials (e.g., Halicin, Abaucin), and optimizing vaccine design via epitope prediction and antigen prioritization. Predictive systems empowered by AI also improve outbreak detection, point-of-care testing, and sepsis treatment, with expanding uses in environmental microbiology and food safety. Despite this, issues remain with data quality, algorithmic bias, interpretability, regulation, and clinic adoption. Future directions highlight multi-omics integration, personalized medicine, laboratory automation, synthetic biology, and AI-powered global health surveillance. By and large, AI will complement microbiological research and practice to develop precision diagnosis, optimal therapeutics, and enhanced public health preparedness.

Background: Laparoscopic cholecystectomy is the standard operative approach for symptomatic gallbladder disease because it is associated with reduced pain, early mobilization, shorter hospitalization, and faster recovery. However, port-site infection remains an important postoperative complication that can prolong recovery and increase morbidity. The objective is to determine the incidence of port-site infection after laparoscopic cholecystectomy and identify the factors associated with its occurrence in a tertiary care setting. Materials and Methods: A prospective cohort study was carried out over a period of three years among 103 patients undergoing elective laparoscopic cholecystectomy. Demographic profile, body mass index, intraoperative events, and microbiological findings were recorded and analyzed. Results: Port-site infection developed in 14.6% of cases. Age, sex, and body mass index did not show a statistically significant association with infection. Intraoperative bile or gallstone spillage was significantly associated with port-site infection (p = 0.004). Escherichia coli and Staphylococcus aureus were the organisms most frequently isolated from infected sites. Conclusion: Intraoperative contamination, especially bile or gallstone spillage, appears to be the principal determinant of port-site infection after laparoscopic cholecystectomy. Careful surgical handling, prompt control of spillage, and strict aseptic precautions are essential to reduce postoperative infection. Keywords: Port-site infection, laparoscopic cholecystectomy, bile spillage, surgical site infection, prospective cohort.

Background: Iron deficiency anaemia (IDA) is the most common nutritional disorder during pregnancy and is associated with adverse maternal and fetal outcomes. Serum ferritin is considered the most reliable indicator of body iron stores and aids in the early diagnosis of iron deficiency before the development of severe anaemia. The present study aimed to determine the prevalence of iron deficiency anaemia and evaluate its relationship with serum ferritin concentration among women at term pregnancy. Materials and Methods: A hospital-based cross-sectional study was conducted among 200 pregnant women with singleton term pregnancies attending a tertiary care teaching hospital. Demographic and obstetric data were collected using a structured questionnaire. Haemoglobin concentration was estimated using an automated haematology analyser, while serum ferritin was also measured. Anaemia was defined according to the World Health Organization criteria, and serum ferritin levels <15 ng/mL were considered indicative of iron deficiency. Statistical analysis was performed using SPSS version. Results: Among the 200 participants, 47.0% were anaemic, including 44.0% with mild-to-moderate anaemia and 3.0% with severe anaemia. Low serum ferritin levels were observed in 11.0% of women, while 9.0% had iron deficiency anaemia. Booking status and educational level showed significant associations with both haemoglobin concentration and serum ferritin levels (p<0.05), whereas maternal age and parity were not significantly associated. A moderate positive correlation was observed between haemoglobin and serum ferritin concentrations (r = 0.46, p<0.001). Conclusion: Anaemia remains highly prevalent among women at term pregnancy, although only a proportion is attributable to iron deficiency. Serum ferritin estimation is a valuable adjunct to haemoglobin measurement for identifying depleted iron stores and facilitating early diagnosis of iron deficiency anaemia. Strengthening antenatal screening, nutritional counselling, and appropriate iron supplementation may improve maternal iron status and pregnancy outcomes. Keywords: Iron deficiency anaemia; Serum ferritin; Pregnancy; Haemoglobin; Maternal health; Antenatal care.

Background: The integration of Artificial Intelligence (AI) into public health marks a paradigm shift from reactive medical models to proactive, data-driven population health management. As global health systems face increasing pressure from emerging infectious diseases, chronic lifestyle conditions, and resource constraints, the ability to transform massive datasets into actionable intelligence has become a critical necessity. AI technologies, including machine learning and predictive analytics, offer unprecedented opportunities to enhance traditional epidemiological methods.This study aims to evaluate the transformative role of AI in public health decision-making. Materials and Methods: A comprehensive systematic review of current literature and case studies was conducted, focusing on AI applications in health informatics between 2019 and 2025. The methodology involved analyzing peer-reviewed journals, health policy reports, and pilot program results related to deep learning, natural language processing (NLP), and automated diagnostic tools in community health settings. Results: Findings indicate that AI significantly reduces response times during outbreaks through real-time geospatial tracking and early warning systems. Furthermore, predictive modeling has improved the accuracy of risk stratification for non-communicable diseases by 30%, allowing for early intervention. However, the results also highlight persistent challenges, including algorithmic bias, data privacy concerns, and the "digital divide" in low-resource environments that may exacerbate health inequities. Conclusion: AI is an indispensable catalyst in the transition from raw data to informed public health decisions. While it enhances the speed and accuracy of interventions, its ethical implementation requires robust governance frameworks. Future public health strategies must prioritize "human-in-the-loop" AI systems to ensure that data-driven insights are applied equitably and transparently. Keywords: Artificial Intelligence; Public Health; Predictive Analytics; Health Informatics; Data-Driven Decision Making; Disease Surveillance.

Background: The term "chronic obstructive pulmonary disease" (COPD) refers to a variety of lung conditions that are characterized by persistent, frequently progressive airflow obstruction caused by abnormalities of the airways (bronchitis, bronchiolitis), alveoli (emphysema), and/or respiratory symptoms (dyspnea, cough, sputum production, and/or exacerbations). A complete intervention, pulmonary rehabilitation consists of a full examination, followed by patient-tailored therapy, including education, exercise training, and behavior modification. Therefore, the purpose of this study was to evaluate how pulmonary rehabilitation programs affected the quality of life of COPD patients. Materials and Methods: Patients with a diagnosis of COPD who visited the outpatient department of the Sree Narayana Institute of Medical Sciences in Chalakka participated in this clinical trial. The study included patients who met the inclusion and exclusion criteria and agreed to provide informed permission. A clinical diagnosis of COPD was made using the patient's medical history, physical examination, and spirometry results. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 criteria, a subset of individuals were categorized into A, B, and E. Patients were assessed using St George’s respiratory questionnaire C, COPD Assessment Test, BODE index and pulmonary function test. Selected patients undergo a selected pulmonary rehabilitation program twice weekly for 8 weeks under supervision and were advised to do the same at home for at least 5 days a week. They were reassessed after 6 months using St George’s Respiratory Questionnaire C & COPD Assessment Test. The data was entered into Microsoft Excel and statistical analysis was done using SPSS Software. Results: There were no statistically significant differences in the pulmonary functions (FEV1 % predicted) and BODE index (p > 0.05). Rehabilitation resulted in significant improvements in both the SGRQ C score and CAT score 6 months after completion of 8 weeks (twice weekly) pulmonary rehabilitation programme under supervision. SGRQ C score and CAT score improved with a significance (p < 0.01). We conclude that rehabilitation resulted in improvements in health-related quality of life. Conclusion: Rehabilitation may be helpful in enhancing quality of life and may be one of the key elements of COPD care. Future studies should concentrate on determining which elements of pulmonary rehabilitation are crucial, as well as the optimal duration and setting for it, the level of supervision and training intensity needed, and the duration of therapy effects. Keywords: COPD, GOLD, Pulmonary rehabilitation, St. George’s questionnaire C, CAT score.

Background: Frozen shoulder is characterized by significant restriction of both active and passive movements with varying treatment options. It affects 2% to 5% of general population with increased incidence seen in diabetics up to 20%. The primary objective of the present study was to assess the clinical and functional outcome of primary frozen shoulder after saline hydraulic distension, intra-articular steroid injection and manipulation under general anaesthesia. The secondary objective was to determine the effect of diabetes on final outcomes. Materials and Methods: This prospective observational study was conducted on patients diagnosed with Reeves clinical stage II frozen shoulder who presented to Orthopaedic out-patient facility at a tertiary care hospital. The clinical and functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score and range of motion at pre-manipulation stage and at every follow up at 1 month, 3 months, 6 months and 1 year. Statistical analysis and evaluation was done with MS-Excel 2007 using Student paired ‘t’ test. Results: A total of 41 patients including 1 bilateral case were included in the present study with a Mean age of 57.44±8.46. The Mean ASES Pain score improved from 10.71±4.36 at pre manipulation stage to 37.02±2.93 at 1 month, 38.81±2.16 at 3 months, 40.51±2.51 at 6 months and 40.83±2.45 at 1 year follow up; while the ASES Functional score improved from 11.24±1.53 at pre manipulation stage to 35.21±1.70 at 1 month, 38.02±1.36 at 3 months, 39.94±1.11 at 6 months and 40.90±1.31 at 1 year which was statistically significant (p<0.001). Also, there was significant improvement in clinical and functional outcome in both diabetic and non-diabetic group of patients (p<0.001) while the difference in improvement compared between both the groups was not statistically significant (p>0.05). Conclusion: From the present study we conclude that frozen shoulder can be safely and effectively managed with hydraulic distension, intra-articular steroid injection and manipulation under GA with good clinical and functional recovery with or without presence of underlying diabetes. Keywords: Frozen Shoulder, Hydraulic Distension, Steroid, Manipulation, Diabetes.

Chronic liver disease (CLD) is associated with significant alterations in lipid metabolism due to impaired hepatic synthetic function, yet the clinical relevance of these changes remains incompletely understood. The present study aimed to evaluate the pattern of lipid profile abnormalities in patients with CLD and to assess their association with disease severity and clinical outcomes. A hospital-based cross-sectional observational study was conducted among 100 patients with chronic liver disease. Serum lipid parameters, including total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and non-HDL cholesterol, were analyzed. Disease severity was assessed using Child–Pugh classification and MELD-Na score. Statistical analyses included comparison of lipid parameters across severity groups using one-way ANOVA and correlation analysis using Pearson’s correlation coefficient, supported by scatter plot and heatmap visualization. Dyslipidemia was observed in 80% of patients with a progressive decline in lipid parameters noted with increasing disease severity. HDL and LDL cholesterol demonstrated the strongest inverse correlations with Child–Pugh score (r ≈ −0.51 and −0.52, respectively; p < 0.001) with similar negative associations observed with MELD-Na score. Significant differences in lipid levels across severity groups were confirmed by ANOVA with HDL and LDL showing the highest discriminatory power. Furthermore, lower lipid levels were associated with adverse clinical outcomes, including mortality, suggesting a link between impaired lipid metabolism and poor prognosis. In conclusion, lipid profile parameters, particularly HDL and LDL cholesterol, exhibit strong and consistent inverse relationships with disease severity and clinical outcomes in CLD, highlighting their potential role as simple, cost-effective adjunct biomarkers for disease assessment and prognostication. Keywords: Lipid profile, HDL cholesterol, LDL cholesterol, Child–Pugh score, MELD-Na, Dyslipidemia, Prognosis.

Background: Hypothyroidism is associated with disturbances in lipid metabolism and low-grade systemic inflammation, both of which may contribute to an increased risk of atherosclerotic cardiovascular disease. High-sensitivity C-reactive protein (hs-CRP) is a sensitive marker of systemic inflammation and cardiovascular risk. Evaluation of the relationship between hs-CRP and dyslipidemia among patients with overt and subclinical hypothyroidism may facilitate early identification of patients with an adverse cardiovascular risk profile. Aim: To assess the association of serum high-sensitivity C-reactive protein levels with dyslipidemia among patients with overt and subclinical hypothyroidism in comparison with euthyroid controls. Materials and Methods: This hospital-based comparative observational study included 160 participants comprising 80 patients with hypothyroidism and 80 euthyroid controls. The hypothyroid cases were further classified into overt hypothyroidism (n=40) and subclinical hypothyroidism (n=40). Demographic characteristics, anthropometric measurements, thyroid function tests, serum hs-CRP levels, and fasting lipid profile parameters were evaluated. The frequency and pattern of dyslipidemia were compared among the study groups. Correlations of serum hs-CRP with lipid profile parameters, thyroid function indices, and BMI were assessed using appropriate statistical tests. A p-value <0.05 was considered statistically significant. Results: Hypothyroid cases had significantly higher BMI, TSH, serum hs-CRP, total cholesterol, triglycerides, LDL-C, and VLDL-C and significantly lower FT4 and HDL-C levels compared with euthyroid controls (all p<0.001). Dyslipidemia was present in 72.5% of hypothyroid cases compared with 33.8% of controls (p<0.001). Serum hs-CRP showed a significant progressive increase from euthyroid controls (1.84 ± 1.12 mg/L) to subclinical hypothyroidism (3.76 ± 1.89 mg/L) and overt hypothyroidism (5.68 ± 2.41 mg/L) (p<0.001). The prevalence of dyslipidemia was highest in overt hypothyroidism (82.5%), followed by subclinical hypothyroidism (62.5%) and euthyroid controls (33.8%) (p<0.001). High LDL-C was the most frequent lipid abnormality, while combined dyslipidemia was significantly more common among overt hypothyroid patients. Serum hs-CRP showed significant positive correlations with total cholesterol (r=0.52), triglycerides (r=0.46), LDL-C (r=0.58), VLDL-C (r=0.44), TC/HDL-C ratio (r=0.61), LDL-C/HDL-C ratio (r=0.63), TSH (r=0.55), and BMI (r=0.29), whereas significant negative correlations were observed with HDL-C (r=-0.39), FT4 (r=-0.48), and FT3 (r=-0.31) (all p<0.001). Conclusion: Patients with overt and subclinical hypothyroidism had significantly elevated serum hs-CRP levels and a higher prevalence of dyslipidemia compared with euthyroid controls. The abnormalities were most pronounced among patients with overt hypothyroidism. The significant association of hs-CRP with atherogenic lipid parameters and thyroid function indices suggests that increasing systemic inflammation accompanies worsening dyslipidemia and biochemical severity of hypothyroidism. Combined assessment of hs-CRP, lipid profile, and thyroi

Background: Major Depressive Disorder (MDD) is associated with neurophysiological abnormalities involving brainstem auditory pathways. Brainstem Auditory Evoked Potentials (BAEPs) provide an objective assessment of auditory pathway conduction and brainstem function. The aim is to evaluate the neurophysiological correlates of depression severity in patients with Major Depressive Disorder using BAEP. Materials and Methods: This cross-sectional observational study included patients diagnosed with MDD. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D), and participants were categorised into mild, moderate, and severe groups. BAEP recordings were obtained under standard laboratory conditions. Absolute latencies of Waves I, III, and V and interpeak latencies (I–III, III–V, and I–V) were analysed bilaterally. Statistical analysis was performed using one-way ANOVA. Results: Among the 133 drug-naïve patients with Major Depressive Disorder, BAEP analysis demonstrated a significant association between depression severity and selected auditory brainstem conduction parameters. Absolute Wave V latency and Interpeak Wave I–V latency were significantly prolonged with increasing HAM-D severity in both the right (p = 0.037 and p = 0.036, respectively) and left ears (p = 0.039 and p = 0.038, respectively). No statistically significant differences were observed in Absolute Wave I, Absolute Wave III, Interpeak Wave I–III, or Interpeak Wave III–V latencies across the severity groups. Conclusion: Increasing severity of Major Depressive Disorder is associated with significant prolongation of Absolute Wave V and Interpeak Wave I–V latencies in both ears, while early BAEP components remain unaffected. These findings suggest selective impairment of central auditory brainstem conduction with increasing depression severity and indicate that Wave V and Interpeak Wave I–V latencies may serve as objective neurophysiological biomarkers for assessing disease severity in Major Depressive Disorder. Keywords: Major Depressive Disorder (MDD); Brainstem Auditory Evoked Potential (BAEP); Depression Severity; Hamilton Depression Rating Scale (HAM-D); Auditory Brainstem Response (ABR).

Background: Robotic-assisted pelvic surgeries require prolonged pneumoperitoneum and steep Trendelenburg positioning, which significantly alter pulmonary mechanics and cardiovascular physiology. Optimal ventilatory strategies are essential to minimize airway pressures, maintain lung compliance, and ensure hemodynamic stability. This study aimed to compare the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) on pulmonary and cardiovascular parameters in patients undergoing robotic-assisted pelvic procedures. Materials and Methods: This prospective comparative study included 88 adult patients scheduled for elective robotic-assisted pelvic surgeries. Participants were randomly allocated into two groups: PCV (n = 44) and VCV (n = 44). Standardized general anesthesia protocols were followed in both groups. Respiratory parameters including peak airway pressure, mean airway pressure, dynamic lung compliance, tidal volume, and minute ventilation were recorded during pneumoperitoneum. Hemodynamic variables such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation, and end-tidal carbon dioxide were recorded at predefined intraoperative time points. Ventilatory safety outcomes and postoperative respiratory complications were also assessed. Results: The PCV group demonstrated significantly lower peak and mean airway pressures and significantly higher dynamic lung compliance compared to the VCV group (p < 0.001). Hemodynamic stability was better preserved in the PCV group, with significantly higher systolic, diastolic, and mean arterial pressures (p < 0.05). Oxygenation and carbon dioxide elimination were comparable between both groups. The incidence of excessive airway pressures, hemodynamic instability, and need for ventilator adjustments was significantly lower in the PCV group. Postoperative respiratory complications were comparable between groups. Conclusion: Pressure-controlled ventilation provides superior pulmonary mechanics and improved intraoperative hemodynamic stability compared to volume-controlled ventilation during robotic-assisted pelvic surgeries. PCV can be considered a preferred ventilation strategy for such procedures to enhance intraoperative safety and optimize respiratory and cardiovascular outcomes. Keywords: Pressure-controlled ventilation. Robotic-assisted pelvic surgery. Pulmonary compliance.

Background: Epistaxis is one of the most common emergencies encountered in otorhinolaryngology practice.[1] Although most cases are self-limiting, some may become severe and life-threatening. Etiology varies with age, environmental factors, and systemic comorbidities. Identifying the underlying cause is essential for proper management and prevention of recurrence. Objectives: Primary objective is to identify the cause of epistaxis in different age groups among patients attending the ENT Department. The secondary objective is to identify the most commonly affected age group, and effective management of epistaxis on the basis of etiology. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Otorhinolaryngology at Sree Uthradom Thirunal Academy of Medical Sciences, Thiruvananthapuram, from March 2023 to October 2024. A total of 162 patients presenting with epistaxis were included. Detailed clinical history, ENT examination, nasal endoscopy, laboratory investigations were done in all patients. Radiological evaluation were performed when indicated. Data were analyzed using Jamovi software version 2.6.23. Results: Among 162 patients, 90 (55.6%) were males and 72 (44.4%) were females. The most commonly affected age group was 1–15 years (38.3%). Trauma was the leading etiological factor (33.95%), followed by acute on chronic adenoiditis (19.75%), hypertension (13.58%), septal spur (9.88%), acute sinusitis (8.64%), rhinosporidiosis (4.94%), acute on chronic rhinosinusitis (4.32%), tumors (1.85%), idiopathic causes (1.85%), granulomatous disease (0.62%), and internal carotid artery aneurysm (0.62%). Conservative treatment was effective in 64% of patients, while 36% required surgical intervention. Conclusion: Epistaxis is a common ENT emergency with varying etiological patterns across different age groups. Trauma and inflammatory conditions predominate in children and young adults, whereas hypertension is more common among older patients. Appropriate evaluation and early etiological identification help in effective management and reduction of morbidity. Keywords: Epistaxis; Etiology; Trauma; Hypertension; Nasal bleeding; Management.

Background: Laparoscopic operations are prevalent owing to their minimum invasiveness, expedited recovery, and less postoperative discomfort. Nonetheless, the closure of port sites is essential to avert wound problems, including infection, dehiscence, seroma development, and unsatisfactory esthetic outcomes. Traditionally, sutures are utilized for skin closure, providing secure approximation but necessitating more operating time and technical proficiency. Skin adhesives represent a contemporary option, offering expedited closure, less risk of needle-stick injuries, and potentially enhanced aesthetic results. Aims: This study evaluates the comparative efficacy, safety, and patient satisfaction of laparoscopic port site closure using sutures versus skin adhesives. Materials and Methods: A prospective, comparative study was conducted over 10 months involving 60 patients undergoing elective laparoscopic procedures. Patients were randomized into two groups: Group A (n=30) received conventional skin closure using absorbable sutures, and Group B (n=30) received closure with skin adhesives. Inclusion criteria comprised adult patients undergoing laparoscopic procedures requiring 5–12 mm ports. Postoperative outcomes were assessed for wound infection, dehiscence, hematoma, seroma, closure time, and cosmetic appearance using standardized scoring at days 3, 7, and 30. Patient satisfaction regarding scar appearance was also recorded. Results: The mean port site closure duration was markedly reduced in the skin adhesive group (2.5 ± 0.4 minutes) relative to the suture cohort (6.8 ± 0.7 minutes, p<0.001). The adhesive group exhibited somewhat fewer wound complications, reporting 1 case of mild infection and 1 hematoma, compared to 2 infections and 2 hematomas in the suture group; nevertheless, these differences lacked statistical significance. The cosmetic results, evaluated with the validated Patient and Observer Scar Assessment Scale (POSAS), indicated significantly higher scores in the adhesive group after 30 days (mean 8.2 ± 1.1) compared to the suture group (mean 10.5 ± 1.5, p=0.02). Patient satisfaction reflected these results, demonstrating greater acceptability of adhesive closure. Conclusion: Skin adhesives provide a safe, effective, and cosmetically superior alternative to sutures. While sutures remain reliable, adhesives offer practical advantages, especially in day-care laparoscopic procedures or patients prioritizing cosmetic outcomes. Keywords: Adhesives, Laparoscopic surgery, Port site closure, Sutures, Wound complications.

Background: Chronic lower limb ulcers provide a substantial clinical challenge owing to protracted healing, elevated recurrence rates, and socioeconomic impact. Topical treatments are essential for facilitating wound healing and preventing infection. Povidone-iodine, a standard antiseptic, provides extensive antibacterial protection, whereas topical phenytoin, typically an anticonvulsant, has demonstrated potential in promoting wound healing by enhancing fibroblast proliferation and collagen synthesis. Aims: The study aims to evaluate and compare the efficacy of topical phenytoin and povidone-iodine dressings in patients with lower limb ulcers. Materials and Methods: A prospective comparative study was conducted over 9 months on 60 patients with lower limb ulcers admitted to the Department of General Surgery. Patients were randomly assigned into two groups of 30 each. Group A received topical phenytoin dressings once daily. Group B received povidone-iodine dressings once daily. Baseline wound dimensions, discharge, pain score, and granulation tissue appearance were recorded on day 0, and reassessed weekly for up to 6 weeks or until complete healing. Exclusion criteria included malignant ulcers, osteomyelitis, immunocompromised states, and uncontrolled diabetes. Data were statistically analyzed using Student’s t-test and Chi-square test, with p < 0.05 considered significant. Results: The mean percentage reduction in ulcer area after 4 weeks was substantially greater in the phenytoin group (78.4%) than in the povidone-iodine group (59.2%) (p < 0.01). By the second week, 80% of patients in Group A exhibited early formation of healthy granulation tissue, compared to 50% in Group B. Topical phenytoin had higher efficacy in pain relief and discharge control. No notable detrimental effects were observed in either cohort. The average length of complete healing was 24 days in the phenytoin group compared to 33 days in the povidone-iodine group. Conclusion: Topical phenytoin dressing markedly accelerates healing, improves granulation tissue development, and diminishes pain and exudate in lower limb ulcers compared to povidone-iodine dressing. Integrating it with conventional wound treatment regimens can enhance outcomes and decrease hospital duration. Keywords: Chronic ulcers, Granulation tissue, Povidone-iodine, Topical phenytoin, Wound healing.

Background: Inguinal hernia is one of the most common surgical conditions encountered worldwide and accounts for a significant proportion of general surgical procedures. Various operative techniques have been developed for hernia repair, among which darning repair and mesh hernioplasty are commonly practiced. Selection of an appropriate surgical technique is important to reduce postoperative complications, recurrence, pain, and duration of hospital stay while ensuring effective reinforcement of the posterior wall of the inguinal canal. Aims: To compare the surgical outcomes of darning repair and mesh hernioplasty in patients undergoing inguinal hernia repair. Materials and Methods: This prospective comparative study was conducted in the Department of General Surgery over a duration of 15 months. A total of 54 patients diagnosed with uncomplicated inguinal hernia were included in the study and divided into two groups of 27 patients each. Group D underwent darning repair, while Group M underwent mesh hernioplasty. Detailed clinical history, type of hernia, operative duration, postoperative pain score, complications, duration of hospital stay, were recorded. Postoperative pain was assessed using Visual Analog Scale (VAS). Patients were followed periodically after surgery to evaluate recovery and recurrence. Statistical analysis was performed using SPSS software version 25, and a p-value less than 0.05 was considered statistically significant. Results: Mean operative duration was significantly shorter in the darning group compared to the mesh hernioplasty group (48.6 ± 6.4 minutes vs 62.3 ± 7.1 minutes, p <0.001). Postoperative pain scores were lower in the mesh hernioplasty group during follow-up. Postoperative complications such as seroma formation and wound infection were slightly higher in the darning group, although the difference was not statistically significant. Mean duration of hospital stay was 4.2 ± 1.1 days in the darning group and 3.6 ± 0.9 days in the mesh group. Recurrence was observed in 3 (11.1%) patients in the darning group and 1 (3.7%) patient in the mesh hernioplasty group during follow-up. Conclusion: Mesh hernioplasty demonstrated better postoperative outcomes with lower pain scores, shorter hospital stay, and lower recurrence rates compared to darning repair. However, darning repair required shorter operative duration and may still be useful in selected patients. Mesh hernioplasty remains an effective and reliable technique for inguinal hernia repair. Keywords: Darning repair, Hernia recurrence, Inguinal hernia, Mesh hernioplasty, Postoperative complications, Visual Analog Scale.

Background: The National Medical Commission (NMC) introduced the Foundation Course under the Competency-Based Medical Education (CBME) curriculum to facilitate the transition of students into medical education by promoting academic preparedness, professionalism, communication skills, and psychological well-being. Regular evaluation of students' perceptions is essential to assess its effectiveness and identify areas for improvement. The objective is to assess first-year MBBS students' perceptions regarding the Foundation Course, evaluate its impact on academic preparedness, communication skills, professionalism, and stress management, and identify areas for further improvement. Materials and Methods: A cross-sectional questionnaire-based study was conducted among 200 first-year MBBS students who had completed the Foundation Course at a tertiary care teaching institution. Universal sampling was employed. Students completed a validated 33-item questionnaire using a five-point Likert scale covering orientation to the medical profession, academic preparedness, communication skills, professionalism and ethics, basic clinical skills, stress management, teaching-learning methods, and overall satisfaction. Descriptive statistics were used to summarize the findings, and internal consistency was assessed using Cronbach's alpha. Results: The response rate was 95.2%. The overall satisfaction score was 4.31 ± 0.54. Orientation to the medical profession received the highest mean score (4.45 ± 0.52), followed by professionalism and ethics (4.39 ± 0.57) and basic clinical skills (4.34 ± 0.59). More than 90% of students agreed that the Foundation Course improved their understanding of the MBBS curriculum (93.0%), enhanced professionalism and ethical awareness (92.0%), and that Basic Life Support training was beneficial (93.0%). Overall, 91.5% considered the Foundation Course beneficial and 94.0% recommended its continuation for future batches. The questionnaire demonstrated excellent reliability (Cronbach's alpha = 0.91). Qualitative feedback indicated a preference for greater emphasis on simulation-based teaching, early clinical exposure, small-group discussions, and hands-on skill training. Conclusion: The Foundation Course was highly appreciated by first-year MBBS students and effectively supported their transition into medical education by improving academic preparedness, professional development, communication skills, and confidence. Incorporating more interactive, skill-based, and early clinical learning experiences may further enhance the effectiveness of the programme and strengthen the implementation of Competency-Based Medical Education. Keywords: - Foundation Course, Competency-Based Medical Education (CBME), First-Year MBBS Students, Medical Education; Student.

Background: Empyema thoracis remains a significant cause of morbidity, with varied clinical manifestations and low microbiological yield due to prior antibiotic exposure. This study aims to evaluate the clinical and bacteriological profile of patients with empyema admitted to a tertiary care centre. Materials and Methods: A hospital-based observational study was conducted in the Department of Pulmonary Medicine, Gauhati Medical College & Hospital, Assam, from May 2019 to April 2020. Seventy-five patients above 15 years of age, diagnosed with empyema based on clinical, radiological, and pleural fluid criteria, were included. Detailed clinical evaluation, blood investigations, and pleural fluid analysis—including biochemistry, Gram stain, and culture were performed. Data were analysed using descriptive statistics. Results: Of the 75 patients, 76% were males with a mean age of 44±16.7 years. The most common symptoms were cough (88%), dyspnoea (74.7%), fever (64%), and chest pain (49.3%). Comorbidities were present in 41.3%, predominantly diabetes mellitus (21.4%) and COPD (10.7%). Pleural fluid analysis showed frank pus in 80%, glucose ≤40 mg/dl in 86.7%, LDH >1000 IU/L in 78.7%, and ADA ≥40 U/L in 85.3%. Culture positivity was observed in 58.7% of cases. Gram-negative organisms predominated (65.7%), with Klebsiella pneumoniae (25%) being the most common isolate, followed by Pseudomonas aeruginosa (18.2%) and Staphylococcus aureus (15.9%). Mycobacterium tuberculosis was identified in 13.6% of patients. Prior antibiotic use did not significantly affect culture positivity. Conclusion: Empyema thoracis continues to be a significant clinical challenge, particularly in resource-limited settings. Empyema thoracis in this study occurred predominantly in males and commonly, and pleural fluid findings showed typical presented with cough and dyspnoea. Diabetes was the leading comorbidity markers of complicated infection. Gram-negative bacteria—especially Klebsiella pneumoniae—were the most frequent isolates. These findings highlight the need for early diagnosis, pathogen-directed antimicrobial therapy, and prompt drainage to reduce morbidity and improve outcomes in empyema thoracis. Keywords: Empyema thoracis, thoracocentesis, bacteriological profile, antibiotic use.

Background: A prevalent metabolic disease, diabetes mellitus is linked to a number of microvascular and neuropathic consequences. Particularly vulnerable to microangiopathic alterations that could cause hearing loss is the cochlea. Asymptomatic diabetic patients may have subclinical auditory impairment since hearing loss frequently goes undetected in its early stages. The present study aimed to evaluate the prevalence and pattern of hearing loss among asymptomatic patients with Type 2 Diabetes Mellitus and compare the audiological profile with non-diabetic controls. In addition, the study sought to establish a link between hearing impairment and age, duration of diabetes, glycaemic control (HbA1c), and serum creatinine levels. Materials and Methods: Our study was conducted in the Department of Otorhinolaryngology at Sri Lalithambigai Medical College and Hospital. The study included Type 2 Diabetic adults in the age group 20-60 years with no subjective hearing complaints and an age- and sex-matched group of healthy non-diabetic controls. Demographic details, duration of diabetes, HbA1c values, and serum creatinine levels were recorded using a structured proforma. Otoscopic examination and Pure tone audiometry was done to all participants in a sound-treated environment. Hearing thresholds were analysed and compared between the two groups. Statistical analysis was performed using SPSS, with a p-value of <0.05 considered statistically significant. Results: The mean PTA was higher among diabetic patients (32.18 dB) compared to controls (20.38 dB). Hearing loss was observed in 72% of diabetic patients and 16% of controls (p < 0.001). Sensorineural hearing loss was the most common type of hearing impairment among diabetic patients. Mild hearing loss was the predominant severity category. PTA demonstrated significant positive correlations with age, duration of diabetes, HbA1c levels, and serum creatinine levels (p < 0.001). HbA1c showed the strongest association with hearing threshold elevation. Conclusion: Hearing loss is significantly prevalent among asymptomatic patients with Type 2 Diabetes Mellitus than among non-diabetic controls. Poor glycemic control, longer duration of diabetes, increasing age, and higher serum creatinine levels are associated with worsening hearing thresholds. Routine audiological screening may facilitate early detection of subclinical hearing impairment in diabetic patients. Keywords: Diabetes Mellitus; Hearing Loss; Sensorineural Hearing Loss; Pure Tone Audiometry; HbA1c; Asymptomatic Diabetic Patients.

Background: Problematic internet use (PIU) represents a growing behavioral challenge for youth, threatening both academic outcomes and psychological well-being. Due to substantial academic demands and routine internet reliance, medical students face heightened vulnerability to this issue. This study aimed to evaluate the prevalence and predictors of PIU among undergraduate medical students, determine the frequency of psychological distress, and analyze the relationship between these two conditions. Materials and Methods: A descriptive, cross-sectional investigation spanning two months involved 409 undergraduate medical students at a private institution in North Andhra Pradesh. Participants with a minimum of six months of internet experience were selected via probability proportional to size sampling combined with simple random sampling. The Problematic and Risky Internet Use Screening Scale (PRIUSS) measured PIU, while the 12-item General Health Questionnaire (GHQ-12) evaluated mental distress. Data analysis utilized descriptive statistics, chi-square tests, and multivariable binary logistic regression. P < 0.05 was considered as statistically significant. Results: Over half (50.9%) of the surveyed students met the criteria for PIU (PRIUSS score ≥ 25). Bivariate analyses linked PIU with academic year, residential status, age of initial internet exposure, multi-device usage, daily screen time, and monthly internet expenditure. Multivariable regression confirmed that academic year, daily time online, monthly expenses on internet services, and utilizing the internet for casual leisure ("time pass") were independent predictors. Alarmingly, 91% of the cohort suffered from psychological distress (GHQ-12 score ≥ 12), including 96.6% of those with PIU, revealing a significant statistical correlation between PIU and psychological distress. Conclusion: PIU and mental health distress are exceptionally widespread among undergraduate medical students in this region, with a robust link between problematic browsing habits and psychological issues. Establishing proactive screening, digital literacy initiatives, and accessible mental health support frameworks within medical schools is essential to address PIU and foster better student well-being. Keywords: Problematic Internet Use, Medical Training, Psychological Distress, PRIUSS, GHQ-12.

Background: Distal femur fractures are complex injuries requiring stable fixation to achieve early mobilization and satisfactory functional recovery. This study evaluated the functional and radiological outcomes of pre-contoured distal femoral locking compression plate (DF-LCP) fixation. Materials and Methods: A prospective observational study was conducted on 40 adult patients with distal femur fractures treated with DF-LCP between January 2020 and January 2022. Functional outcomes were assessed using the Oxford Knee Score (OKS) and Neer Functional Score (NFS), while radiological union and postoperative complications were evaluated during serial follow-up. Results: Mean OKS improved significantly from 9.15 ± 3.17 preoperatively to 40.10 ± 4.54 at 20 weeks, and mean NFS increased from 10.88 ± 5.81 to 83.15 ± 11.94 (both p < 0.001). Radiological union occurred at a mean of 20.58 ± 4.52 weeks, with 45% of fractures uniting between 15–19 weeks. At final follow-up, 65% achieved satisfactory OKS and 62.5% had excellent NFS. Most patients (82.5%) experienced no postoperative complications, and earlier fracture union was significantly associated with superior functional outcomes (p < 0.001). Conclusion: Pre-contoured DF-LCP provides reliable fixation for distal femur fractures, resulting in excellent functional recovery, satisfactory radiological union, and a low complication rate, supporting its effectiveness as a preferred treatment option. Keywords: Distal femur fracture; Distal femoral locking compression plate (DF-LCP); Locking compression plate (LCP); Functional outcome.

Background: Iron Deficiency leading to severe stages of Iron Deficiency Anemia in young women interferes with Cognitive function. Iron deficiency, being the Worldwide most common Nutritional deficiency has an unfavourable impact on the human brain. The objective is to evaluate and compare the Mathematical Test score of Anemic Iron deficient and Non anemic iron deficient study group with the Non anemic Non-iron deficient control group in order to rule out the impact of Iron deficiency on cognition in the present study. Materials and Methods: This case control study was conducted at Hospital. Informed written consent was taken from the participants. Results: On scholastic assessment the difference in the Mathematical score was highly significant between the Non anemic Non-iron deficient control (Group 1) &Anemic Iron deficient(Group 2), and also between Non anemic Non-iron deficient control (Group 1) & Non anemic iron deficient (Group 3), in all the subsets S1,S2,S3,S4,S5,TOTAL SCORES. Conclusion: Neurocognitive insufficiency of iron in young women influences the cognitive functions of the study participants in terms of reduction in mathematical score, reduction in test scores on various domains of cognition like Logical memory,Immediate Recall,Digit forward,Digit backward were noticed. Keywords: Hemoglobin and Serrum Ferritin levels, Mathematical score.

Background: Pioneer MBBS students enrolled in newly established medical colleges encounter unique academic, psychosocial and infrastructural challenges while simultaneously shaping in the institutional culture. This study assessed changes in experiences, perceptions and adaptation among the first MBBS batch during their first academic year. Materials and Methods: A questionnaire-based longitudinal observational study was conducted among the pioneer MBBS batch of Kalyan Singh Government Medical College during the academic year 2024–2025. A structured and validated questionnaire comprising closed- and open-ended items was administered at two time points, at entry into the MBBS course and after completion of the first academic year. All consenting students were included. Data were analysed using Microsoft Excel and Epi Info software. Results: A total of 100 students participated. The mean age was 20.8 years, 55% were male and 45% were female. Most students belonged to urban backgrounds (64%) had studied under the CBSE curriculum (77%) and had English as the medium of instruction (96%). Teaching and faculty support received the highest satisfaction score (3.91/5) whereas exposure and learning scored the lowest (2.87/5). Student life (2.98/5) and infrastructure (3.25/5) emerged as areas requiring improvement. Conclusion: Although pioneer MBBS students demonstrated substantial adaptation and satisfaction with teaching and mentorship, improvements in clinical exposure, infrastructure and student support systems are required to ensure a balanced educational experience in newly established medical colleges. Keywords: Medical Students, Pioneer Batch, New Medical College, Medico Reflection, Uncertainty to Adaptation.